Roles and Characteristics of Physical Therapists

7/31/2019 Roles and Characteristics of Physical Therapists

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Reference : Introduction to PT by Michael Pagliarulo


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Many activities and some no longerparticipate in clinical practice

DIRECT PATIENT CARESTANDARDS OF PRACTICEStatements of conditions and performances thatare essential for the provision of high qualityprofessional service to society , and provide afoundation for assessment of PT practice.


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I. Ethical / Legal considerationsII. Administration of the Physical Therapy

ServiceIII. Patient/Client ManagementIV. EducationV. ResearchVI. Community Responsibility


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PRIMARY CARE BHC , family, communitymembers

SECONDARY CARE- referral basis afterindividual received primary careTERTIARY CARE- SpecialistsALL THREE LEVELSDIRECT ACCESS VS PRACTICE WITHOUTREFERRAL


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TEAM APPROACHPREVENTION AND HEALTH PROMOTION

SCREENING

PREVENTIONCONSULTANTS ERGONOMICS and FUNCTIONAL

CAPACITY EVALUATIONERGONOMICS the relationship between the worker,the workers task and the work environment. Work conditioning program and work hardeningprogram.- return the individual to work.


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1. EXAMINATION is the process of gatheringinformation about the past and current

status of the patient/client.HISTORY patient, caregivers, other healthprofessionals, medical recordsSYSTEMS REVIEW consider need of otherspecialists.TESTS and MEASURES


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Aerobic Capacity and EnduranceAbility to use the bodys oxygen uptake and

delivery systemAnthropometric CharacteristicsBody measurements and fat composition

Arousal, Attention and CognitionDegree of responsiveness and awareness

Assistive and Adaptive devicesEquipment to aid in performing tasks


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CIRCULATION Analysis of blood and lymph movements to determine

adequacy of cardiovascular pump , oxygen delivery andlymphatic drainage.

CRANIAL AND PERIPHERNAL NERVE INTEGRITY-sensory and motor nerve functionENVIRONMENTAL, HOME AND WORK BARRIERS

Analysis of physical restrictionsERGONOMIC S AND BODY MECHANICS

analysis of work tasks and postural adjustment toperform tasks.


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GAIT LOCOMOTION AND BALANCEINTEGUMENTARY INTEGRITYJOINT INTEGRITY AND MOBILITY joint

structure and impact on passive movementMOTOR FUNCTION control of voluntarymovementMUSCLE PERFORMANCE strength, power andenduranceNEUROMOTOR DEVELOPMENT and SENSORYINTEGRATION evolution of movement skillsand integration of information from theenvironment.


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ORTHOTIC, PROTECTIVE AND SUPPORTIVEDEVICESPAIN intensity, quality and frequencyPOSTURE body alignment and positioningPROSTHETIC REQUIREMENTSRANGE OF MOTION

REFLEX INTEGRITYSELF CARE AND HOME MANAGEMENTSENSORY INTEGRITYCNS and PNS,proprioception and kinesthesia


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VENTILATION AND RESPIRATION AND GASEXCHANGE in relation to ADL and EXERCISE.

WORK, COMMUNITY AND LEISUREINTEGRATION OR REINTEGRATION if patient can assume a role in community orwork.


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2. EVALUATION clinical judgment based on thedata gathered through tests andmeasurements and other examinationsources.- may involve consultation with others.

3. DIAGNOSIS in accordance with a policy adoptedby the House of Delegates of APTA whichrecognizes the professional and autonomous judgment of the PT and stipulates theresponsibility for referral to other practitionerswhen warranted.


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4. PROGNOSIS- prediction of the level of improvement and time necessary to reach

that level.Plan of Care, STG, LTG, outcomes,interventions and discharge criteria.

5. INTERVENTION


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WRITTENNarrative forms

Standardized formsSOAP

Computer technology

NON VERBAL


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HOME INSTRUCTIONS LOCALLYTAKE INTO CONSIDERATION THE

LEARNING ABILITIESDOS AND DONTS


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HIGH TOUCH manual techniquesHIGH TECH equipmentsRe-examinations or re-evaluations

1. THERAPEUTIC EXERCISE passive, active,resistive

2. FUNCTIONAL TRAINING in self care and

home management ADL3. FUNCTIONAL TRAINING in work,community and leisure integration orreintegration.


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MANUAL THERAPY TECHNIQUESPRESCRIPTION, APPLICATION, ANDFABRICATION OF DEVICES ANDEQUIPMENTAIRWAY CLEARANCE TECHNIQUESINTEGUMENTARY REPAIR AND

PROTECTIVE TECHNIQUESELECTROTHERAPEUTIC MODALITIESPHYSICAL AGENTS AND MECHANICALMODALITIES.


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DISCHARGE when thegoals and outcomeshave been achieved as

based on the PTs judgmentBoth should be planned,documented and

followed-up.

DISCONTINUATION-1. When the patient/client

decides to terminate

services2. The individual is no

longer able to continuebecause of medical or

financial reasons.3. PT believes that further

intervention will notbenefit the individual.


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PATIENT CENTERED CONSULTATIONCLIENT CENTERED CONSULTATION

EDUCATION to lay persons, family,patients, educational institutionsCRITICAL INQUIRYADMINISTRATION promotion ladderinvolves more administrative responsibilitiesat the expense of patient care activities.


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PT PERSPECTIVES


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Practice of medicine requires team effort.One member of the team cannot do wellwithout the others. It is a wrong perceptionthat a physiatrist can handle everythingregarding patient care. Below are teammodels we may observe in our healthcare

practice. Each model has its own advantagesand disadvantages


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HEALTH CARE TEAM

Group of health care professionals fromdifferent disciplines who share commonvalues and objectives.Ex. Rehabilitation team


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Refers to the traditional model The physician attends to the patients needs.

When the services of another discipline areneeded, the doctor consults the professionalbut the former will give specific instructions orgeneral requests on what is to be done. Any new problem or recommendation mustalways be consulted to the attendingphysician.


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Advantage : There is a clear chain of responsibility, which is importantmedico legally. Disadvantage : Coordination of theother health workers, the physician, andthe patient may be limited and

compromised.


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Efforts of the team are parallel and disciplineoriented.Team members need only to know the skill related

to their disciplineEach discipline provides each own unique activityThis model however is still physician-controlled.Under the physician are the rest of the team

members, including the patient.Patient and family is part of the team


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Advantage: provides means for multipleprofessionals who require frequent interactions

to meet and coordinate efforts on consistentbasis.Disadvantage: no lateral communicationPyramid type modelDuring team meeting, communication is onlyvertical.


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Team members from various disciplines work intandem toward a common goal.

Group effort, synergistic thus the team

produces/accomplishes more than the sum of anindividualized effort.

Expected norm is group decision making andgroup responsibility for developing for developing

optimal care planning.Requires a team conference after the individualevaluation by each discipline.


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Members communicate , collaborate andconsolidate knowledge from which thetreatment goals and plan are made andevaluated.Lateral communication becomes present.

Requires intra-team communication to besuccessful.Results in a coordinated non fragmented, cost-effective rehabilitation program


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Fosters mutual authority.Whenever a certain decision is to bemade, all of the members of the teamshould have been consulted.In addition, the responsibility of deciding does not only fall on the

physician, but to the whole team.


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more collaborative; health workers fromother disciplines do not merely become aphysicians follower but are also able topractice their own clinical skills in devisingmanagements for the patientMatrix organization model

Comparable to the rehabilitation teammodel.


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requires high level of competence from otherteam membersRequires training in team building and the teamprocess.The physician may be uncomfortable with theteam decision making process because of medicolegal responsibility.Management may be delayed when conflict existsince they must always be resolved by the team.


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Cross treatment between disciplinesDeveloped largely out of educational models, justified based on the inadequate number of rehabilitation professionalsExample is the cross training of teachers andaides in providing community services.


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This trained health workers are readilyavailable to the patients

Will work well in certain settings such as inthe community based rehabilitationprograms of remote areas of our country.


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Assurance of competent care is still doubtfulMaybe limited by state licensure and

qualifications requirement.


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PRODUCTIVE AND STIMULATINGGOAL ORIENTED AND THE GROUP

REMAINS FOCUSED ON THE TASKTHROUGH-OUT THE MEETINGINVOLVES CREATIVITY, PROBLEM SOLVINGAND INTERACTION.


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PT PERSPECTIVESANNA MARGARITA FERMINA GUICO, PTRP


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The goal of the physical medicine andrehabilitation treatment (PM&R) team is towork together with the patient and familyto help a person with an injury or disabilityreach maximum potential.


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REHABILITATION TEAM


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The team is usually directed by aphysiatrist, with other specialistsplaying important roles in thetreatment and education process.Team members involved depend onmany factors, including patient need,facility resources, and insurancecoverage for services.


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The patientand family areconsidered

the mostimportantmembers of

therehabilitationteam.


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A physician who evaluates and treats rehabilitationpatients.The physiatrist is usually the team leader and is

responsible for coordinating patient care services withother team members.A physiatrist focuses on restoring function to people withdisabilities.


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A nurse who specializesin rehabilitative careand assists the patientin achieving maximum

independence,especially in regards tomedical care,prevention of complications, andpatient and familyeducation.

A professional


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A professionalcounselor who acts asa liaison for the

patient, family, andrehabilitationtreatment team.The social worker helpsprovide support, andcoordinate dischargeplanning and referrals,

and may also helpcoordinate care withinsurance companies.


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A therapist who helpsrestore function for

patients withproblems related tomovement, musclestrength, exercise,and joint function.


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A therapist whohelps restore

function for patientswith problemsrelated to activitiesof daily living (ADLs)including work,school, family, andcommunity andleisure activities.


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A therapist whohelps restorefunction forpatients withproblems related

to cognitive,communication,or swallowing

issues.

A physician or


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A physician orcounselor whoconductscognitive(thinking andlearning)assessments of the patient andhelps the

patient andfamily adjust tothe disability.


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A healthcareprofessionalwho specializesin theevaluation andtreatment of hearing andhearing loss.


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A nutritionist whoevaluates andprovides for thedietary needs of eachpatient based on thepatient's medicalneeds, eating abilities,and food preferences.


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A counselor whoassists people

with disabilitiesto plan careersand find and keepsatisfying jobs.


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A healthcareprofessionalwho makesbraces orsplints used tostrengthen orstabilize a partof the body.


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A healthcareprofessionalwho makes

and fitsartificial bodyparts, such as

an artificialleg or arm.


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A rehabilitation case manager helpsplan, organize, coordinate, and monitorservices and resources for the patient.


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A therapist whohelps treat andrestore functionfor patients withairway andbreathingproblems.


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A spiritualcounselor whohelps patients andfamilies duringcrisis periods andhelps serve as aliaison between the

hospital and thehome church orplace of worship.


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Most rehabilitation teams hold weekly, biweekly, ormonthly meetings, depending on the setting.Topics covered at team meetings include such items as thefollowing:

the patient's plan of carethe patient's progressshort- and long-term goalslength of staypatient and family education needsdischarge planning


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Team meetings help withcommunication and planning amongteam members and the patient andfamily.

Reports of team meetings are oftenshared with insurance companies andcase managers to assist in discharge

planning, use of resources, andcontinuation of care.


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PT PERSPECTIVESANNA MARGARITA FERMINA GUICO, PTRP


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The anatomical position is theuniversal starting position fordescribing movements, with theexception of horizontal flexion,which occurs when the arm moves

forwards from an already abductedposition.

If h ld h h


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If the movement would not cross throughthe plane, it is said to occur within it.

For example, if you turn your head to theright, the head moves in the horizontalplane (it is rotational moves that take

place in the horizontal plane).If you lift your leg straight up, themovement occurs in the sagittal plane. If you lift your leg to the side, the movementoccurs in the frontal plane.


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Movement AND DefinitionFlexion-Narrowing joint angle in sagittal plane(bending elbow).

Extension -Increasing joint angle in sagittal plane(straightening elbows).Hyperextension -Increasing angle more than in

natural position, eg bending backwards


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Abduction -Lifting a body part away frombody midline (in frontal plane).Adduction -Returning a body part tobody midline (in frontal plane)Rotation -Turning a body part on axis(horizontal plane) (not rotation all theway round - see circumduction).

L t l fl i B di b d id


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Lateral flexion- Bending body sideways(frontal plane)

Lateral extension- Returning body toanatomical positionElevation -Lifting a body part (shouldershrugs)Depression -Lowering a body part (droppingthe jaw)Protraction -Moving a body part outwards

Retraction -Bringing a body part back


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Horizontal Flexion (starts from abductedposition)- Moving arm forwards in horizontal

planeHorizontal Extension (starts from abductedposition)- Returning arm to the abducted

position.


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Dorsal Flexion/dorsiflexion- Bendingankle so that the toes are raised Plantar Flexion- Hyperextending ankle joint so toes point downwardsCircumduction -Range of movementsthat create a complete circle (as opposedto a rotation of less than 360 degrees.)


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b d f d ff


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Bones can be separated into five different bone types :Long bones - these are the bonesconnected with large movement. They arelong and cylindrincal with growth heads -epiphyses (singular epiphysis -pronounced epi-physis) at either end. Theepiphysis is covered by articular cartilage.


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The outer layer of the bone is hard, and iscalled "compact bone".The inside of the bone is spongy, called"cancellous bone".

Examples of long bones include thefemur (thigh bone), the humerus (upperbone in the arm) and the phalanges

(fingers and toes).


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Sh t b th b l t


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Short bones - these bones are almostcube shaped and associated with

smaller, more complex movements.Examples of complex bones include thecarpals (small bones in the base of thehand) and tarsals (in the feet).Flat bones - these bones protect theinternal organs and include the skull(cranium), ribs, scapula (shoulder blade),sternum (breast bone) and the pelvicgirdle.


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Irregular bones these bones are


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Irregular bones - these bones areirregular in shape and include the

vertebrae and some facial bones.Sesamoid bones - these are smallbones held within tendons andinclude the patella (knee cap).Cartilage separates the femur andthe patella, and acts as a shockabsorber.


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When the foetus in the womb initially starts todevelop it has no bone, only cartilage.At 6-7 weeks, the ossification process starts.When the baby is born, it has over 300 bones, butas the baby grows up, many bones fuse togetherand a fully grown adult has just 206 bones.When ossification occurs, cartilage is replaced with

bone by laying down calcium. This process isknown as calcification


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During the growth phase the bone


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During the growth phase, the bonegrows from the growth plates

(epiphyseal plates) which are situated atthe end of the bone, just before theepiphysis.At the end of growth, between the agesof about 16 - 21, these epiphyseal platesturn to bone.


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T f ll i l d i b h


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Two types of cell involved in bone growthare osteoblasts and osteoclasts .Osteoblasts lay down new bone, whilstosteoclasts clear away the old bone.Growth occurs when the cells in thecartilage divide and push the oldercartilage cells down towards the bone.The diaphysis ossifies first, followed by theepiphyses.


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Sufficient calciumSufficient phosphorusVitamins, especially vitamin D which is involved inthe absorption of calciumThe correct hormone balance, specifically:

Growth hormone from the pituitary glandCalcitonin from the thyroid gland. Calcitonin metabolisescalcium and phosphorus.

Parathormone - from the parathyroid gland - almost worksin opposition to calcitonin to balance it out.The sex hormones, testosterone and oestrogen.


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Women start to lose calcium from theirbones at around the age of 40, and in menat around the age of 60, perhaps eventuallyleading to brittle bone disease -osteoporosis .Other causes of osteoporosis includeprolonged treatment with cortisonesteroids, anorexia nervosa and an

inadequate diet, especially duringpregnancy and breast feeding.

However it is possible to increase bone density


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However, it is possible to increase bone densityby performing weight bearing exercise,

taking calcium supplements (where the dietdoes not contain sufficient calcium) and,in women, oestrogen replacement therapy.

Protein formation in bone decreases with age,which can make bones more liable to fracture.


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DRAW THE SCAPULA AND LABEL


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Roles and Characteristics of Physical Therapists