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The Role of the Physical Therapist in the Healthcare Team. Eric L. Lippincott, PT, ATC Associate Professor Health Science Department Lock Haven University. Objectives. Define and describe the role of the physical therapist in the healthcare team - PowerPoint PPT Presentation
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THE ROLE OF THE PHYSICAL THERAPIST IN THE HEALTHCARE TEAM
Eric L. Lippincott, PT, ATC
Associate ProfessorHealth Science Department
Lock Haven University
Objectives 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 Current degree is DPT (clinical
doctorate) National exam with state licensure and
CE requirements Practice settingsHospital LTC Outpatient
Schools Universities Rehab HospitalsHome Health Work Settings
Advanced Certifications (residency, fellowship, certifications)
Role of PTs in the “Team” 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
Referral vs Direct Access
PTs and the Continuum of Care
Emergency Room ICU/CCU Acute Care Facility Sub-Acute / Step Down Rehabilitation
Hospital / Center SNF / LTC
Home Health Hospice Outpatient Rehab Outpatient Ortho School System Athletic Facility Industry
Typical progression is from in-patient to out-patient to community-based facility
Physical Therapy Treatments Thermal Agents Manual Therapy
Techniques Electrical Agents Ultrasound/Phonophoresis Laser Therapy Therapeutic Exercise ACTIVE vs PASSIVE
TREATMENT EDUCATION &
PREVENTION
Thermal Agents Options
Cold Modalities Ice Bags, Reusable Cold Packs Ice Massage Ice Immersion Cryostretch? Cryokinetics
Heat Modalities Moist Heat Packs Paraffin Diathermy – deep heat Ultrasound – deep heat - more to come later
Whirlpool
Thermal Agents – Cold Modalities
Temp between 32˚ and 65˚ F
Local Effects Vasoconstriction Decreased cellular
metabolism Decreased production of
cellular waste Reduction in inflammation Decreased pain and muscle
spasm Ideal treatment is typically
15 min
Indications Acute injury, pain,
edema or inflammation
Muscle Spasm Contraindications
Cardiac or respiratory concerns
Cold allergy Decreased sensation
Thermal Agents – Heat Modalities Superficial Agents -
104˚ - 113˚ F Local Effects
Vasodilation Increased cell
metabolism Increased delivery of
leukocytes Increased elasticity of
tissue Decreased spasm
Ideal treatment is typically 15-20 min
Indications Subacute or chronic
inflammation and pain Muscle spasm Decreased ROM
Contraindications Acute injuries Impaired circulation Poor thermal
regulation Neoplasm Decreased sensation
Hot vs Cold 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 Massage
Treatment result depends on technique
Myofascial Techniques Mobilization (including
manipulation) Stretch peri-articular
structures Manipulation depends
on state practice act
Electrical Agents Examples
Electrical stimulation Iontophoresis
Electrical Stimulation Effects:
Pain reduction (sensory level) Edema reduction Motor stimulation – atrophy and
denervation Contraindications
Cancer Pacemakers Over the carotid sinus and spinal cord
So what about these???
Iontophoresis Using electrical current to
facilitate transmission of medication ions through the skin
Typical medications include analgesics and anti-inflammatories (dexamethasone and lidocaine are most common)
Not strongly supported in the literature
Ultrasound Ultrasound – sound waves
produced by crystal in the sound head
Can have both thermal and non-thermal effects
Thermal effects are deeper than traditional thermal modalities
Contraindications Metal implants Undiagnosed fracture Cancer Acute inflammation/infection Over epiphyseal plates and the
spinal cord
Phonophoresis 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) Relatively new to the marketplace and
only FDA-approved for certain diagnoses Effects are similar to ultrasound Outcomes are pending
Mechanical Devices
Intermittent Compression (Jobst)Continuous Passive Motion (CPM)
BiofeedbackTraction
Therapeutic Exercise ROM – AROM / AAROM / PROM
Muscle tightness, decrease in joint mobility, postural problems
Strengthening Balance / Neuromuscular Control HEP
Have you seen these kids?
Specific Therapies and Services 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
Acute Injury Rehab Follows tissue healing guidelines
Inflammatory Stage PRICE Immobilize Modalities
Fibroblastic Stage Restore ROM Begin strengthening and balance
Remodeling Stage Advanced strengthening and functional training
Fracture Care Rehab 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 Hospital-Based
Therapy Assistive Device / DME Gait Initiation /
Training Education (ie hip
precautions) Begin strengthening
Out-Patient / Home-Based ROM followed by
strengthening Specific protocol
dictated by operative procedure
Amputations Desensitization
treatment Prevent contractures Prosthetic fitting &
prescription Gait training &
strengthening
Treatment of Integumentary Issues Burns
Typical wound care – debridement, packing, and dressing
Prevention of contractures Pressure to prevent keloids
Skin Lesions – treatment depends on type Debridement Packing, Dressing, and Casting Education
CNS Rehab (CVA, TBI, SCI) 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 Decrease joint stiffness
ROM exercises Thermal modalities HEP & Education
Strengthen as tol (surrounding musculature)
What about Athletic Trainers? Education falls under six
domains
Credential varies by state Education includes
modalities and rehabilitation
Current PA practice act includes treatment of physically active
Prevention Professional Responsibility Clinical Evaluation and Diagnosis
Organization & Administration
Immediate Care Treatment, Rehab, & Reconditioning
Questions and Thank You