Lesson 2 - PT Practice PDF

lOMoARcPSD|28201721 Lesson 2 - PT Practice Foundations in Rehabilitation Science (The University of Western Ontario) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university...

lOMoARcPSD|28201721 Lesson 2 - PT Practice Foundations in Rehabilitation Science (The University of Western Ontario) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 Lesson 2 - PT Practice Practice Settings: Child-development centres Community health centres Government/health planning agencies Health clubs/Fitness centres Hospices Hospitals Individual homes/home care Insurance companies Nursing Homes/long term care facilities Occupational health centres Outpatient/ambulatory care clinics Physiotherapy clinics/practices/private offices Prisons and public settings for health promotion Rehabilitation Centers Research facilities Seniors centers/residences Schools/universities/colleges Sporting events/field settings Sports medicine clinics Worksites/companies Private Practice in PT: Outpatient clinic is the most common private practice setting Individuals visit a physical therapist in a clinic or other health care facilities for their health needs Private practice is primarily to address: ○ Musculoskeletal (orthopedic) and neuromuscular injuries or impairments Home Health in PT: Physiotherapy is provided in the patient's place of residence Patient populations that can be served by this setting include: ○ Older Adults ○ Pediatric patients with developmental disabilities and other conditions ○ Individuals needing rehabilitation due to long-term illness Home health is provided in: ○ Patient's residence ○ Caregiver's home ○ Nursing facility ○ Residential facility ○ Hospice Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 Acute Care Physiotherapy: This is a branch of secondary health care where a patient receives: ○ Active but short-term treatment ○ For severe injury or episode of illness ○ For an urgent medical condition ○ During recovery from surgery This also includes: ○ Inpatient Physical Therapy ○ Assessments and treatments when in hospital ○ Has strict protocols and standards of practice and safety Wide range of patients including: ○ Cardiac conditions ○ Oncology ○ ICU ○ MSK – functional mobility ○ Neurology Functional mobility focuses on: ○ Bed mobility (as in rolling in bed, lying to sitting and the like) ○ Transfers (from bed to wheelchair/commode etc) ○ Ambulation (walking training) Rehab Setting in PT: In this setting, physical therapy is provided to individuals: ○ Admitted to a facility or rehabilitation unit ○ The goal is to provide intense therapy to improve the person's ability to care for himself or herself (typically 3 hours or more per day) Licensing & Registration: Registering as a Licensed PT: Any regulated health professional should register with a regulatory body Entry to practice requirements for Physiotherapy: ○ Physiotherapy degree from an accredited university ○ Completion of Physiotherapy Competency Exam (PCE) after completing the degree ○ Register with College of Physiotherapists in the respective provinces (CPO in Ontario) Ongoing competency (required for practice as Physiotherapist): ○ College requirements for quality management Onsite audits (conducted by College on a random basis) Jurisprudence exams (once in 5 years) PISA (Professional issues self-assessment – annually) Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 Step 1: PT University Degree: Universities in Canada that provide Physiotherapy degrees: 1. Dalhousie University 2. McGill University 3. McMaster University 4. Queen’s University 5. University of Alberta 6. UBC 7. Universite Laval 8. University of Manitoba 9. Université de Montreal 10. University of Ottawa 11. University of Saskatchewan 12. Université de Sherbrooke 13. University of Toronto 14. Western University 15. Université du Québec à Chicoutimi Step 2: Physiotherapy Competency Exam: Step 3: Registration with College College of Physiotherapists of Ontario (CPO) - regulates physiotherapists in Ontario The College is governed by a Council Council is made up of physiotherapists elected by: ○ Peers ○ Members of the public appointed by the Ontario government ○ Academic representatives from Ontario universities Mission Statement: To protect and serve the public interest by: Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 ○ Promoting collaboration and accountability for self-regulation of PTs ○ Enabling continuous improvement to ensure that PTs provide competent and ethical services Registration with CPO is MANDATORY to practice in Ontario This is the summary of steps to practice as a PT: 1. Complete university degree 2. Complete licensing exam (PCE) 3. Register with College 4. Ongoing quality management Common Physiotherapy Interventions: Therapeutic Modalities: A modality is a way or mode in which a procedure is done Therapeutic modalities are those that enhance treatment goals or outcomes Physical modalities are physical agents that produce a specific therapeutic response The use of a physical modality is dictated by (among other factors): ○ Nature of the condition that is being treated ○ Stage of the condition ○ Goal of the treatment Why do we use Modalities? 1. Pain Management: Pain is the most common reason people seek medical attention Chronic pain affects approximately 25% of the Canadian adult population, rising to 50% in the older adults Ongoing pain affects the physical, emotional, and psychosocial well-being of individuals and their families Society sufferers with loss in work productivity, in disability support, and in health care $ The economic loss in Canada due to chronic pain is in the range of 5-6 billion dollars/year Pain management focuses on: ○ Education-acceptance ○ Pacing ○ Relaxation strategies Pain Management is aided by: ○ Physiotherapy (PTs are experts not only in treating pain but also in treating its source) ○ Pain-relieving medications ○ Nerve blocks, trigger points injections Pain Management - Gate Control Theory of Pain: First proposed in 1965 by Ronald Melzack and Patrick Wall, the theory offers a physiological explanation for the previously observed effect of psychology on pain perception Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 Asserts that non-painful input closes the nerve "gates" to painful input, preventing pain sensation from travelling to the central nervous system Describes how non-painful sensations can override and reduce painful sensations A painful, nociceptive stimulus stimulates primary afferent fibres and travels to the brain via transmission cells Increasing activity of the transmission cells results in increased perceived pain Conversely, decreasing the activity of transmission cells reduces perceived pain In the gate control theory, a closed "gate" describes when input to transmission cells is blocked, therefore reducing the sensation of pain An open “gate” describes when input to transmission cells is permitted, therefore allowing the sensation of pain 2. Tissue Healing: Depending on the stage of tissue healing, the response to treatment interventions differs When applied and treated at different stages, various modalities have various effects and affect tissue healing in different ways Physiotherapy focuses on applying appropriate modalities during various stages of tissue healing to bring out the efficient response to regain movement and function Stages in Tissue Healing: Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 3. Tissue Function: Depending on the tissue that is being treated, modalities help in teaching and regaining properties of tissues For example, the properties of muscle tissues are contractility, excitability, extensibility and elasticity. When treated appropriately, a physical modality will help in the re-education of these properties in the muscle tissue and thereby help in regaining muscle function Therapeutic Modalities: Physical modalities include: ○ Thermal ○ Electrical ○ Manual ○ Exercise ○ Education Thermal Modalities: Type of Agent Modalities Conductive heating agent Hot packs, paraffin wax, cryotherapy (ice) Heating by radiation Infrared therapy (not widely used in Canada now) Physiological Effects of Heat and Cold: Response Heat Cold Hemodynamic Effect Increase blood flow Decrease in blood flow Increase chemical mediators (15 min) initially, then increase in blood flow Metabolic Effect Increase in metabolic rate Decrease metabolic rate Alters tissue extensibility Neuromuscular Effect Increase nerve conduction Decrease nerve velocity (2m/s for 1-degree conduction velocity (up celsius) to 15 min) Increase pain threshold via gate Increase pain control via control gate control Inhibits muscle contraction Facilitates muscle Used in chronic conditions contraction when inflammation has Used in acute subsided conditions when active inflammation is present Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 Electrical Modalities - Electrotherapy: Assists in pain reduction and promotes a natural healing response Have short-term benefits that can assist with the earlier introduction of other techniques such as exercises and manual therapy ○ Decreases pain to permit movement Allows one to continue moving and functioning as comfortably as possible until the cause is fixed Ultrasound Therapy: Creating high-frequency sound waves (which are not audible) in the range of 1 to 3 MHz (megahertz) from electric current and using it for therapeutic purposes Promotes tissue healing by stimulating/enhancing normal events at each stage ○ It doesn’t directly reduce pain itself but rather triggers a series of events that will result in pain reduction Increases efficiency of healing TENS: Transcutaneous electrical nerve stimulation Low-frequency currents (1 to 1000Hz) Pain modulation through gate control theory or endorphin release IFC: Interferential therapy/current Involves the use of “medium frequency” current (1000 to 10000Hz) to bring about the effect of a low-frequency current in the tissues NMES: Neuromuscular Electrical Stimulation Sends low-frequency electrical impulses to nerves Causes muscles to contract Used to “re-train” or “re-educate” a muscle to function and to build strength after surgery or period of disuse Manual Therapy: Hands-on therapy A standard approach for MSK, Neuro, cardiorespiratory PT practice Manipulation and mobilization: ○ Moving joints & soft tissues through their physiological ROM ○ Involves joints (bones, capsules), ligaments, tendons, muscles, skin, fascia, scars, etc. Treatment effects: ○ Modulates pain ○ Improves ROM ○ Facilitates function Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 Therapeutic Exercises: Systematic and planned performance of body movements or exercises The focus of therapeutic exercises is on regaining flexibility, strength, balance, stability and endurance Goals: ○ To improve and restore physical function ○ To prevent loss of function ○ To enhance a patient’s functional capabilities ○ To prevent and decrease impairment and disability ○ To improve overall health status, fitness and sense of well-being Types of Therapeutic Exercises: Classified according to the aim and purpose: Range of motion (ROM) exercises - aim to maintain and increase range of motion ○ PROM (passive ROM) done by a PT ○ AROM (active ROM) done by the patient ○ AAROM (active-assisted ROM) done by the patient with help from a PT Muscle performance exercises to increase muscle strength, power and endurance - resisted and endurance exercises Neuromuscular control exercises (postural and stabilization) Balance and coordination exercises Area-specific exercises as breathing exercises and circulatory exercises Relaxation exercises Patient Education: Most forgotten as an intervention technique Providing the skills and knowledge to patients for them to maintain treatment individually One of the PT goals is for patients to be self-sufficient following intervention Mandatory to PT practice PTs are teachers too!!! Outcome Measures: What are Outcome Measures? Tool to determine the baseline function of a patient at the beginning of treatment Once treatment has commenced, the same instrument can be used to determine progress and treatment efficacy Types: ○ Questionnaires - require that either a therapist interviews a patient or the patient independently completes the questionnaire (patient-reported outcome - PRO) ○ Performance-based measures: requires the patient to perform a set of movements or tasks to determine functional abilities Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 Pain: Visual Analog Scale (VAS) Numerical Pain Rating Scale (NPRS) Limb Function: Lower Extremity Functional Scale (LEFS) Upper Extremity Functional Scale (UEFS) Functional Activities/Change: The Patient-Specific Functional Scale Neck Pain: Neck Disability Index Back Pain: Roland Morris Questionnaire (RMQ) Balance and Gait: Tinetti Balance Assessment Tool Charting of PT Services: Informed Consent: Permission granted in the knowledge of the possible consequences Given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits Must be obtained for both assessment and treatment Process of Informed Consent: 1. Introduce self 2. Introduce activity (assessment or treatment) 3. Need of the activity 4. Benefits and risk 5. Alternatives 6. Questions and consent Assessment - SOAP Notes: Subjective - What the patient says about the problem/intervention Objective - PT’s objective observations ○ Palpation ○ Auscultation (with a stethoscope) ○ ROM ○ Muscle strength Downloaded by Ehsha Vig ([email protected])  lOMoARcPSD|28201721 ○ Outcome measures ○ Functional assessment Analysis/Assessment - PT’s analysis of the various components of the assessment ○ Potentially the most important legal note ○ This documents the PT’s professional opinion ○ This should be supported by subjective and objective assessment ○ Should explain the reasoning behind the decisions taken ○ Should clarify and support the analytical thinking ○ Progress towards the stated goals should be indicated Set short and long-term goals Plan - Outlines the plan for future treatment sessions ○ The treatment plan should include FITT: Frequency of treatment sessions Intensity of exercises Time and repetition of exercises Type of treatment When to Chart? Every assessment and treatment session When there is a clinical change If done by PTA (Physiotherapy assistant), PT has to check and sign How to Chart? Full assessment and professional analysis must appear in the chart ○ Name, designation, signature Each entry in the chart needs to be clearly attributable and legible Informed consent for assessment and treatment should be documented every session Chart content should be within the scope of PT practice Downloaded by Ehsha Vig ([email protected])