Transcript The Role of the Physical Therapist in the Healthcare Team

THE ROLE OF THE PHYSICAL
THERAPIST IN THE HEALTHCARE TEAM
Eric L. Lippincott, PT, ATC
Associate Professor
Health Science Department
Lock Haven University
Objectives
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Define and describe the role of the physical therapist in the
healthcare team
Describe role of the PT within the continuum of care
Identify patients within various primary care settings that may
benefit from physical therapy services
Identify specific therapies, and services provided by Physical
Therapists
Differentiate between various PT Modalities, including
indications, contraindications, and their application
A bit about PTs
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Current degree is DPT (clinical doctorate)
National exam with state licensure and CE
requirements
Practice settings
Hospital
LTC
Outpatient
Schools
Home Health
Universities
Work Settings
Rehab Hospitals
Advanced Certifications (residency, fellowship,
certifications)
Role of PTs in the “Team”
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Providers who examine and treat individuals who
have a limitation in function
PT vs OT
Trained in four major body systems
 Musculoskeletal
 Neuromuscular
 Cardiovascular
/ Pulmonary
 Integumentary
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Referral vs Direct Access
PTs and the Continuum of Care
Typical progression is from in-patient to out-patient to
community-based facility
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Emergency Room
ICU/CCU
Acute Care Facility
Sub-Acute / Step Down
Rehabilitation Hospital /
Center
SNF / LTC
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Home Health
Hospice
Outpatient Rehab
Outpatient Ortho
School System
Athletic Facility
Industry
Physical Therapy Treatments
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Thermal Agents
Manual Therapy Techniques
Electrical Agents
Ultrasound/Phonophoresis
Laser Therapy
Therapeutic Exercise
ACTIVE vs PASSIVE TREATMENT
EDUCATION & PREVENTION
Thermal Agents
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Options
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Cold Modalities
Ice Bags, Reusable Cold Packs
 Ice Massage
 Ice Immersion
 Cryostretch?
 Cryokinetics
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Heat Modalities
Moist Heat Packs
 Paraffin
 Diathermy – deep heat
 Ultrasound – deep heat - more to come later
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Whirlpool
Thermal Agents – Cold Modalities
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Temp between 32˚ and 65˚ F
Local Effects
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Vasoconstriction
Decreased cellular metabolism
Decreased production of
cellular waste
Reduction in inflammation
Decreased pain and muscle
spasm
Ideal treatment is typically 15
min
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Indications
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Acute injury, pain, edema or
inflammation
Muscle Spasm
Contraindications
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Cardiac or respiratory
concerns
Cold allergy
Decreased sensation
Thermal Agents – Heat Modalities
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Superficial Agents - 104˚ 113˚ F
Local Effects
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Vasodilation
Increased cell metabolism
Increased delivery of
leukocytes
Increased elasticity of tissue
Decreased spasm
Ideal treatment is typically
15-20 min
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Indications
Subacute or chronic
inflammation and pain
 Muscle spasm
 Decreased ROM
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Contraindications
Acute injuries
 Impaired circulation
 Poor thermal regulation
 Neoplasm
 Decreased sensation
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Hot vs Cold
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Does the area feel warm to touch?
Is the area tender?
Does swelling increase with activity?
Does pain limit joint motion?
Is the patient in acute stage?
Manual Therapy Techniques
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Massage
 Treatment
result depends on
technique
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Myofascial Techniques
Mobilization (including
manipulation)
 Stretch
peri-articular structures
 Manipulation depends on state
practice act
Electrical Agents
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Examples
 Electrical
stimulation
 Iontophoresis
Electrical Stimulation
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Effects:
 Pain
reduction (sensory level)
 Edema reduction
 Motor stimulation – atrophy and denervation
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Contraindications
 Cancer
 Pacemakers
 Over
the carotid sinus and spinal cord
So what about these???
Iontophoresis
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Using electrical current to
facilitate transmission of
medication ions through the
skin
Typical medications include
analgesics and antiinflammatories
(dexamethasone and
lidocaine are most
common)
Not strongly supported in
the literature
Ultrasound
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Ultrasound – sound waves
produced by crystal in the sound
head
Can have both thermal and nonthermal effects
Thermal effects are deeper than
traditional thermal modalities
Contraindications
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Metal implants
Undiagnosed fracture
Cancer
Acute inflammation/infection
Over epiphyseal plates and the
spinal cord
Phonophoresis
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Using sound waves to facilitate the transmission of
medications through the skin
Examples: hydrocortisone, dexamethasone,
lidocaine
Not strongly supported in the literature
Laser Therapy (LLLT)
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Relatively new to the marketplace and only FDAapproved for certain diagnoses
Effects are similar to ultrasound
Outcomes are pending
Mechanical Devices
Intermittent Compression (Jobst)
Biofeedback
Continuous Passive Motion (CPM)
Traction
Therapeutic Exercise
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ROM – AROM / AAROM / PROM
 Muscle
tightness, decrease in joint mobility, postural
problems
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Strengthening
Balance / Neuromuscular Control
HEP
Have you seen these kids?
Specific Therapies and Services
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Discuss basic therapy for each of the following:
Acute musculoskeletal injury
 Fracture Care
 Post operative care
 Integumentary Issues
 CNS Rehab
 Arthritis/Connective Tissue Disease Rehab
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Acute Injury Rehab
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Follows tissue healing guidelines
 Inflammatory
Stage
 PRICE
 Immobilize
 Modalities
 Fibroblastic
Stage
 Restore
ROM
 Begin strengthening and balance
 Remodeling
 Advanced
Stage
strengthening and functional training
Fracture Care Rehab
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ROM limitations, atrophy, and deconditioning are
the major concerns
Restore ROM once fracture is stable
Strengthen as tol (WBing increases bone density)
Associated joints
Cross Train
Post-Op Care
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Hospital-Based Therapy
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Assistive Device / DME
Gait Initiation / Training
Education (ie hip
precautions)
Begin strengthening
Out-Patient / Home-Based
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ROM followed by
strengthening
Specific protocol dictated
by operative procedure
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Amputations
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Desensitization treatment
Prevent contractures
Prosthetic fitting &
prescription
Gait training & strengthening
Treatment of Integumentary Issues
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Burns
 Typical
wound care – debridement, packing, and
dressing
 Prevention of contractures
 Pressure to prevent keloids
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Skin Lesions – treatment depends on type
 Debridement
 Packing,
Dressing, and Casting
 Education
CNS Rehab (CVA, TBI, SCI)
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Deficits depend upon location of
injury
Carefully directed, structured
repetitive practice
Acute treatment focuses on
initiating movement
Progress to promoting
independence (ADLs, DME, etc)
Safety, thought initiation, emotional
disturbances
Usually a team approach to rehab
Arthritis Treatment
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Decrease joint stiffness
 ROM
exercises
 Thermal modalities
 HEP & Education
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Strengthen as tol (surrounding musculature)
What about Athletic Trainers?
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Education falls under six
domains
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Prevention
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Professional Responsibility
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Clinical Evaluation and Diagnosis
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Organization & Administration
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Immediate Care
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Credential varies by state
Education includes modalities
and rehabilitation
Current PA practice act includes
treatment of physically active
Treatment, Rehab, &
Reconditioning
Questions and Thank You