ABC IN PHYSIOTHERAPY

By khalid alzoubi Ahmad alkhshini Sakar Physiotherapist at Faruk Medical City ( FMC ).

The Role of a Physical Therapist

Physical therapists (PTs) : are health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives.

Physical therapists : provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a physical therapist practices.

Physical therapy (PT) in Intensive care unit (ICU)Goals of PT treatment in ICU

improve / maintain cardiopulmonary function promoting mucociliary clearance , sputum expectoration , alveolar expansion.

maximize musculoskeletal function physical performance joint movement , muscle strength , ADL , ambulation.

Con…

¤ Improve / Maintain Normal or Baseline Ventilation andOxygenation. a) Clearance of Airways b) Improve Chest Expansion c) Improve Breath Sound d) Improve Cough Effectiveness e) Improve Breathing Pattern¤ Improve / Maintain Musculoskeletal System within Functional Limit. a) Improve ROM b) Improve Muscle Strength and Endurance c) Prevent Joint Deformities and Contractures¤ Improve Circulatory System Function a) Prevent DVT b) Prevent Swelling¤ Improve / Maintain Neurological System and Cognitive Status within Functional Limits.¤ Improve / Maintain Level of Functional Status within Patient's Tolerance.

Airway clearance techniques:

Postural drainage positionPercussionVibrationFET(Forced Expiration Technique)ACBT(Active Cycle of Breathing Technique)

Con…

Secretion removal techniques:

Coughing suctionhuffing

Breathing exercises (BE)

Muscles of ventilation consist of diaphragmatic muscle and intercostal muscle, act as “pump muscles” to move bony thorax, causing Intrathoracic pressure changes that, in turn, produce airflow into the lungs.

- Muscles of the larynx and pharynx act as “valves” that help regulate airflow and maintain airway patency.

Disk Removal

Definition:Diskectomy (also called discectomy) is the removal of an intervertebral disk, the flexible plate that

connects any two adjacent vertebrae in the spine. Intervertebral disks act as shock absorbers, protecting the brain and spinal cord from the impact produced by the body's movements.

Diskectomy - Avoid Sitting, avoid long car rides x 2 weeks - No bending, twisting or lifting over 10 pounds Laminectomy - May sit, bend and twist without limitations - Lift as pain permitsFusion - Sit in chair for all meals - Sit at 30+ minute intervals throughout the day - Bending, twisting, lifting as pain permits - TENS / Ice to assist with pain relief

Con…

Patients usually leave the hospital on the fourth or fifth day after surgery. They must:

1. Avoid sitting for more than 15–20 minutes.

2. Use a reclined chair.

3. Avoid bending at the waist, twisting, or lifting heavy objects.

Con…

4. Begin gentle walking (indoors or outdoors), and gradually increase exercise . Exercise should be continued for the next four weeks.

5. Begin stationary biking or gentle swimming after two weeks.

6. Sleep on a firm mattress.

7. Slow down if they experience more than minor pain in the back or leg.

8. Refrain from sitting in one place for an extended period of time (e.g., long car ride).

9. Patients should be able to resume normal activities in four to six weeks.

TOTAL KNEE REPLACEMENT (T.K.R.)

Goals:

1. demonstrate safe and independent transfers from bed and various surfaces. 2. demonstrate safe and independent ambulation with appropriate assistant device. 3. negotiate steps safely with wide based quad cane (WBQC) or crutches. 4. demonstrate fair to good static and dynamic balance with appropriate assistant device. 5. attain full extension (0°) and 100° flexion of the involved knee. 6. demonstrate home exercise program (HEP) accurately.

Day of Surgery:

• CPM 0-100° started in Recovery Room for minimum of 4 hours. • Ice for 20 minutes every 1-2 hours. • A towel roll should be placed under the ankle when the CPM is not in use.

Con…

Ankle Pumps

Quadriceps SettingHip and knee bending

Supine Hip Abduction

Knee Extension Stretch

Con…

Straight Leg Raises

Side lying Hip Abduction

Knee straightening

Con…Active Knee Bending

Prone Knee Bending

Hip Extension

Passive Knee Bending

Passive knee extension Passive knee extension

Total Hip Replacement

Education on restrictions and precautions, information sheets provided to resident

Do not cross your legs at the knees Do not twist your body at the waist Do not turn operative foot inward Do not flex your hip greater than 90° Do not bend at the waist Minimize lifting to no more than 20 pounds in the first three

months and 40 pounds thereafter Keep pillows between legs when sleeping Sit only 30-45 minutes at a time May ride in a car, stopping every 30 minutes to get out and

stretch for 5 – 10 minutes May sleep on operative side two weeks after surgery with a pillow

between your legs

Con…

Restrictions:Posterior ApproachNo flexion greater than 90 degrees, no internal rotation or adduction

beyond neutral.

Lateral ApproachAs above, including no external rotation past neutral and no active

abduction exercises for 6 weeks post THA (Functional abduction for ambulation and transfers in/out of bed is allowed).

Greater Trochanter DetachedPassive abduction only, unless otherwise ordered by the surgeon,

Con…

Activities of Daily Living: Do's and Don'ts DO NOT move your operated hip toward your chest (flexion) any more than a right angle. This

is 90 degrees.

DO NOT sit on chairs without arms.

DO grasp chair arms to help you rise safely to standing position. Place extra pillow(s) or cushion(s) in your chair so that you do not bend your hip more than 90 degrees.

Con… DO NOT get up like this. Keep your involved leg in front while getting up.

DO use a chair with arms. Place your operated leg in front and your uninvolved leg well under. DO NOT sit low on toilet or chair.

DO get up from toilet as directed by your therapist. Use the elevated toilet seat if we have given you one.

Con… DO NOT pull blankets up like this

DO use a long-handled reacher to pull up sheets or blankets or as directed by therapist. DO NOT bend way over.

DO NOT turn your knee cap inward when sitting, standing, or lying down.

Con…

DO NOT try to put on your own shoes or stockings in the usual way. By doing this improperly you could bend or cross your operated leg too far.

DO these activities as directed by your therapist. DO NOT cross your operated leg across the midline of your body (in toward your other leg).

DO NOT lie without pillow between legs.

DO keep a pillow between your legs when you roll onto your "good" side. This is to keep your operated leg from crossing the midline.

Reference:

Source: Guide to Physical Therapist Practice, 2nd Edition (2003)

Source: Copied from Physio-Therapy

sours: Institute for Orthopedics and Sports Medicine 210 East 64th Street, 4th Floor, New York, NY 10065

The End…