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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. Define and describe the role of the physical therapist in the healthcare team

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The Role of the Physical Therapist in the Healthcare Team

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  1. The Role of the Physical Therapist in the Healthcare Team Eric L. Lippincott, PT, ATC Associate Professor Health Science Department Lock Haven University

  2. 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

  3. A bit about PTs • Current degree is DPT (clinical doctorate) • National exam with state licensure and CE requirements • Practice settings • Advanced Certifications (residency, fellowship, certifications)

  4. 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

  5. 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

  6. Physical Therapy Treatments • Thermal Agents • Manual Therapy Techniques • Electrical Agents • Ultrasound/Phonophoresis • Laser Therapy • Therapeutic Exercise • ACTIVE vs PASSIVE TREATMENT • EDUCATION & PREVENTION

  7. 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

  8. 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

  9. 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

  10. 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?

  11. Manual Therapy Techniques • Massage • Treatment result depends on technique • Myofascial Techniques • Mobilization (including manipulation) • Stretch peri-articular structures • Manipulation depends on state practice act

  12. Electrical Agents • Examples • Electrical stimulation • Iontophoresis

  13. Electrical Stimulation • Effects: • Pain reduction (sensory level) • Edema reduction • Motor stimulation – atrophy and denervation • Contraindications • Cancer • Pacemakers • Over the carotid sinus and spinal cord

  14. So what about these???

  15. 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

  16. 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

  17. Phonophoresis • Using sound waves to facilitate the transmission of medications through the skin • Examples: hydrocortisone, dexamethasone, lidocaine • Not strongly supported in the literature

  18. Laser Therapy (LLLT) • Relatively new to the marketplace and only FDA-approved for certain diagnoses • Effects are similar to ultrasound • Outcomes are pending

  19. Mechanical Devices Intermittent Compression (Jobst) Continuous Passive Motion (CPM) Traction Biofeedback

  20. Therapeutic Exercise • ROM – AROM / AAROM / PROM • Muscle tightness, decrease in joint mobility, postural problems • Strengthening • Balance / Neuromuscular Control • HEP

  21. Have you seen these kids?

  22. 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

  23. 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

  24. 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

  25. 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 Post-Op Care

  26. 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

  27. 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 CNS Rehab (CVA, TBI, SCI)

  28. Arthritis Treatment • Decrease joint stiffness • ROM exercises • Thermal modalities • HEP & Education • Strengthen as tol (surrounding musculature)

  29. 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

  30. Questions and Thank You

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