Introduction to Physical Therapy PDF

**INTRODUCTION TO PHYSICAL THERAPY PROFESSION** Physical Therapy is a health profession whose primary purpose is the promotion of optimal health & functions. This purpose is accomplished through the application of scientific principles through the processes of examination, evaluation, diagnosis, pr...

**INTRODUCTION TO PHYSICAL THERAPY PROFESSION** Physical Therapy is a health profession whose primary purpose is the promotion of optimal health & functions. This purpose is accomplished through the application of scientific principles through the processes of examination, evaluation, diagnosis, prognosis, and intervention to prevent or remediate impairments, functional limitations, and disabilities as related to movement and health. Physical Therapy encompasses areas of specialized competence and includes the development of new principles and applications to meet existing and emerging health needs. Other professional activities that serve the purpose of physical therapy are research, education, consultation, and administration. -- APTA, 2009 Physical therapy is providing services to people to develop, maintain and restore maximum movement and functional ability throughout the lifespan. Physical therapy is concerned with identifying and maximizing movement potential within the spheres of promotion, prevention, treatment and rehabilitation. This is also the service provided only by, or under the direction or supervision of a physical therapist. The clinical practice of physical therapy includes assessment, diagnosis, planning, intervention and re- evaluation. Patients are individuals who have disorders that require interventions to improve their function. Client is the term used to refer to an individual who seeks the services of a PT to maintain health or a business that hires a PT for consultation. **Historical Development** Massage was used by the Chinese in 3000 BC, described by Hippocrates in 460 BC, modified by the Romans, and accepted as a scientific procedure in the early 1800s. Researches has found that the application of cold, heat, water, exercise, massage and sunlight was often used to stop physical illness even during the prehistoric time. Cong fu was described by a Taoist priest before 100BC which is a type of exercise that relieves pain and other symptoms. It consists of body positioning and breathing exercises. Hippocrates who is considered as the father of medicine, recognizes the value of muscle strengthening using exercise. He was the first physician in his time to recommend therapeutic exercise to his patient because he understood the effects of muscle, ligament, and bone atrophy due to inactivity. This was in ancient Greece around 400BC. Furthermore, He also was the first to use electrical stimulation using torpedo-fish poultices for head ache. Hydrotherapy was practiced by the Greeks and Romans through the use of baths and river worship. The Greek Philosopher Aristotle recommended rubbing oil and water as a remedy for tiredness. The development of electrotherapy began in the 1600s with the introduction of electricity and electrical devices. Europe and America from the 1500s to the 1900s Around 1400s in Europe, therapeutic exercise was introduced in schools as part of physical education classes. During the 1500, the first book on exercise entitled Llibro del Exercicio was printed in Spain which was authored by Christobal Mendez. In the United States, massage, hydrotherapy and exercises were first introduced around the year 1700. Back to Europe in 1723, Nicolas Andry was considered the grandfather of orthopedic and was the first scientist to relate the movement created by exercise to the musculoskeletal system. He believed that exercises can cure many infirmities of the body. In 1813 Per Henrik Ling, who is known as the "father of Swedish gymnastics founded the royal Central Institute of Gymnastics for massage, manipulation and exercise. In 1920, injured workers received active, voluntary joint-motion and muscle exercises which were to be provided by a "reconstruction aide" Per Henrik Ling a combination of a school teacher and a professional nurse). In 1860 electrical stimulation was introduced in the United States. In the beginning of 1950, in England, Herman Kabat introduced neurological exercised called Proprioceptive Facilitation. Then in 1945 Thomas Delorme introduced Progressive Resistance exercise which is still used today. In 1960 swiss ball exercise was developed in Switzerland, was introduced in the united states in 1970. Reconstruction aide Fi: 'Reconstruction Aide' treating the amputated soldier Arlington Magazine In 1851, the term "Physiotherapy" first appeared in its German form "Physiotherapie" in an article written by Dr. Lorenz Gleich, a military physician from Bavaria. In an English article published in Montreal Medical Journal in the year 1894, Dr. Edward Playter used the word "Physiotherapy." With time, the word "Physiotherapie" changed to "Physiotherapy" and then to "Physical therapy." In the United States, Physical Therapy started during the reconstruction era (between 1914 and 1919). The creation was centered to the poliomyelitis pandemic and the negative effects of world war I and II. Marguerite Sanderson who was appointed as the first supervisor of reconstruction aides in 1917 and Mary Mcmillan were the first physical therapists during the reconstruction era. However, according to Pagliarulo, Mary McMillan was credited as the first physical therapist in the United States. The American Women's Physical Therapeutic Association was created in January 15, 1921 electing Mary McMillan as the president. The organization was established to maintain high standards and provide a mechanism for sharing information. In 1922, the name of the organization was changed to American Physiotherapy Association. Then in 1946, the APA changed its name to American Physical Therapy Association. In 1947, the length of the PT school curriculum increased from 9 months to 12 months. Then in the 1950, a 4 year bachelor's degree was offered and licensure examination was implemented in 1959 in most states in America. In the Philippines the Philippine Physical Therapy Association was founded on December 8, 1964 by the first BSPT graduates from the University of the Philippines School of Allied Medical Professions. (UP SAMP), the first academic institution to offer a Bachelor's Degree in Physical Therapy in the Philippines. The Association was incorporated on December 26, 1964. One of the early fruits of labor of the Association was the enactment of the Republic Act 5680 (Philippine Physical and Occupational Therapy Law) on January 21, 1969. The PPTA was accredited by the Professional Regulation Commission as a National organization for physical therapists on May 31, 1978 (with accreditation number 29). The PPTA acquired membership in the World Confederation for Physical Therapy on May 24, 1967 and became founding member of the Asian Confederation for Physical Therapy. **PHYSICAL THERAPY AND THE CONSULTATION PROCESS** Consultation is defined by Oxford dictionary as a meeting with an expert or professional, such as a medical doctor, in order to seek advice. Physical therapist can provide consultation by practicing the patient/client management model which eventually leads to patient rehabilitation. Rehabilitation is from the Latin word "habil" which means able, hence in its simplest definition, it means "to make able again". According to De Lisa,et.al "Rehabilitation is defined as the development of a person to the fullest physical, psychological, social, vocational, avocational, and educational potential consistent with his or her physiological or anatomical impairment and environmental limitation. It should be comprehensive and should include prevention and early recognition, as well as outpatient, inpatient, and extended care programs." A rehabilitation team is a group of health care professionals, including the patient working together towards a common goal of a holistic and comprehensive approach of formulating and implementing a care plan from the initial assessment, discharge and return to the community or prior level of function with or without modifications. Though, the rehabilitation team is composed of different professionals, they understand each other because of the use of documentation. **Scope of practice** According to the American Physical Therapy Association, the scope of practice for physical therapists has three components: first is the professional scope of practice which is grounded on the profession's unique body of knowledge, supported by educational preparation, based on a body of evidence, and linked to an existing or emerging practice frameworks. Second is the jurisdictional (i.e. legal) scope of practice which is established by a state\'s practice governing the specific physical therapist' license, and the rules adopted pursuant to that act. Third is personal scope of practice which consists of activities for which an individual physical therapist is educated and trained, and that he or she is competent to perform. Roles and Characteristics of Physical Therapist Physical therapy is providing services to people to develop, maintain and restore maximum movement and functional ability throughout the lifespan. Physical therapy is concerned with identifying and maximizing movement potential within the spheres of promotion, prevention, treatment and rehabilitation. This is the service provided only by, or under the direction or supervision of a physical therapist. The clinical practice of physical therapy includes assessment, diagnosis, planning, intervention and re-evaluation. Physical Therapist (PT) is a person who is the holder of a registered and valid professional license legally qualified to practice physical therapy. A physical therapist holds a degree of Bachelor of Science in Physical Therapy from an accredited school. Physical Therapist Role in Disease prevention Physical therapist can provide services that prevent or limit dysfunctions because of their wide-ranging education from knowledge of anatomy and physiology and medical conditions that affects the normal functioning of the body. These services can be provided by a physical therapist through the different level of care as follows: A. Primary Prevention \- Stopping the process that leads to the development of the disease, illness and other pathologic health condition. B. Secondary prevention \- Early detection of disease, illnesses and other pathologic health condition, through regular health screening. C. Tertiary prevention \- Providing ways to limit the degree of disability while improving functions in patients / clients with chronic and or irreversible disease. Examination. This is the first component of the patient/client management model, which is the process of gathering information about the past and current status of the patient/client. It begins with a history to describe the past and current nature of the condition or health status of the patient/client. A systems review is then conducted to obtain general information about the anatomic and physiologic status of the musculoskeletal, neuromuscular, cardiovascular/pulmonary, and integumentary systems, as well as the cognitive abilities of the patient and client. This review provides information to determine if referral to other health professionals is necessary. In the final component of the examination, tests and measures, the therapist selects and performs specific procedures to quantify the physical and functional status of the patient/client. A list of these tests and measures as presented in the Guide appears in Table 2-1, these activities involve observation, manual techniques, simple and complex equipment, and environmental analysis.  Other members of the rehabilitation team A rehabilitation physician's overall responsibility for the patient and team coordination is diagnosing underlying pathology and impairments, medical and functional assessment, setting up treatment and rehabilitation plan, including prescription of pharmacological and nonpharmacological treatments. A rehabilitation nurse is responsible for day-to-day care and management of the patient and has a unique view-point, as they are present all the time (for inpatients). They often have particular expertise in continence management, tissue viability, positioning, and providing educational and emotional support for patients and families; they provide support for patients to practice their newly rehabilitated skills, outside of therapy sessions. An occupational therapist assesses the effect of impairments on activities of daily living, not only in the home, but also for leisure activities and return to work, providing expertise on strategies and environmental adaptations to facilitate patients' activities and participation. The aim is to maximize performance in ADLs and return to function. Physiotherapist responsible for the assessment of movement and posture, address improvement in gross motor skills and mobility through exercise and training, including wheelchair training. Speech and language therapists are responsible for the assessment and treatment of communication and swallowing disorders. This includes the impact of cognitive impairment on the ability to communicate or learn, followed by training of vocalization or testing and implementing of alternative communication options or devices. A clinical psychologist may make a detailed assessment of cognitive, emotional, and behavioral problems, including the development of strategies for the patient and the family to manage these problems. This may include time-limited psychotherapeutic interventions with patients and their families, as well as strategies to manage challenging behaviors, risk, and cognitive deficits. They may also undertake assessments of mental capacity in those patients with cognitive sequelae. A social worker aims to improve community reintegration and social support. She/ he is involved in finding appropriate discharge destinations for those with significant changes from pre-admission, and identifying resources available after discharge to support patients and family. Social workers can often be a link to community teams, equipment or long-term care facilities. They can provide counselling and advice on claiming benefits. Prosthetist, orthotist and rehabilitation engineer are professionals that may contribute specific expertise in providing aids and technologies, such as splints, prosthetics and environmental controls to enhance functioning. A dietitian assesses and promotes adequate nutrition and educates the patient and family regarding diet. Other professionals, according to the setting of a service and the size of the parent organization, other specialists may be required (e.g., other medical doctors, such as neurologist, orthopedic surgeon, pediatrician or psychiatrist, sports and recreation therapist, vocational counsellor). As many services assume more acute roles, the place of respiratory therapists becomes integral in suctioning, positioning and postural drainage in respiratory insufficiency. There is some evidence that larger teams become less flexible, and behaviors are more likely to regress to uni-professional-based patterns. **SCREENING, REFERRAL AND DELEGATION PROCESS** **Direct access** In other countries, the practice of physical therapy can be direct access. Thus, a physical therapist can treat the patient without a referral coming from a physician. Unfortunately, direct access is not practiced here in the Philippines. Thus, a patient should consult a physician and be referred to a licensed physical therapist before the treatment begins. **Physical Therapy screening** Physical therapy is the service provided only by, or under the direction or supervision of a physical therapist. The clinical practice of physical therapy includes assessment, diagnosis, planning, intervention and re-evaluation (Code of ethics for PPTA, article 1, section 1). These are few of our responsibilities as physical therapists. Before we proceed with the assessment, we should start with screening which is a method for detecting disease or body dysfunction before an individual would normally seek medical care. Medical screening tests are usually administered to individuals who do not have current symptoms, but who may be at high risk for certain adverse health outcomes. Thus, the screening process needs our knowledge in anatomy and physiology; as physical therapists we must serve the patient's interest with the greatest solicitude, giving always his/her best knowledge and skills (article 2 section 3). According to Goodman and Snyder, there are 3 key factors that create a need for screening, namely: side effects of medication, comorbidities and visceral pain mechanism. Medications, either over the counter or prescribed mostly have some side effects especially if they are taken in for prolonged period of time. Thus, it is very important for a physical therapist to ask the patient regarding medications that they are taking in during the interview process. An example for this are anti-cholesterol medications which cause muscle aches, tenderness, or weakness (myalgia) (Di Stasi, MacLeod, Winters, Binder- Macleod, 2010). The primary complaint of patients is pain which is related to tenderness and muscle aches. Comorbidities pertains to another medical condition that the patient might be suffering and a physical therapist is not concentrating with, this can contribute to morbidity and worse to mortality. It is the physical therapist's responsibility to refer the patient to a specialist. Lastly, is visceral pain, some clients with a systemic or viscerogenic origin of NMS symptoms get better with physical therapy intervention. This might be attributed to placebo effect. However, if the symptoms get worse or the patient's condition is not improving despite PT interventions, this can be a sign that the condition of the patient is not really musculoskeletal and proper referral is warranted. Example for this is pain in the Iow back which might be referred by the kidney like in the case of urolithiasis. Thus, screening is very important. When performing screening, a PT should be vigilant with the yellow flag which means cautionary or the warning signs and the red flag which requires immediate attention and perhaps a referral to a specialist. A few examples are: personal or family history of cancer, recent (last 6 weeks) infection, recurrent colds or flu with a cyclical pattern, recent history of trauma such as motor vehicle accident or fall or minor trauma in older adults with osteopenia/osteoporosis, symptoms that are unrelieved by physical therapy interventions, pain unrelieved by rest or change in position, significant weight loss or weight gain without effort ( more that 10% of the patient's body weight within 10 to 21 days. If the physical therapist believe that the results of the screening is beyond the scope of his expertise, the individual shall be informed and assisted in finding a qualified person to provide necessary services (Code of ethics PPTA, Article 4, section 6). Vital signs assessment is the most inexpensive procedure that we can do to screen our patient from other illnesses. Thus, we physical therapists should assess the vital signs of our patient/ client before a physical therapist treats her patient because this will serve as our basis, during the treatment to know how the patient responds to the treatment, and to know if the patient is to be permitted to leave the care of a physical therapist after the treatment. These are just some reasons why we have to assess the vital signs of the patient. Aside from vital signs or cardinal signs, observations, and reported associated signs and symptoms are among the best screening tools available to the therapist. Vital signs include the pulse rate or heart rate, blood pressure, core body temperature, respiration and the fifth vital sign is pain**.** **Temperature** is the balance between the heat produced by the body and the heat lost from the body. 2 types of temperature are core and surface body temperature. Core pertains to the temperature of the deep tissues of the body while the other pertains to the temperature of the skin, subcutaneous tissue and fat. Normal body temperature is not a specific number but a range of values that depends on factors such as the time of day, age, medical status, medication use, activity level, or presence of infection. Oral body temperature ranges from 36° to 37.5° C (96.8° to 99.5° F), with an average of 37° C (98.6° F). Hypothermic core temperature is defined as less than 35° C (95° F). The body heat is primarily produced by metabolism and the heat-regulating center is found in the hypothalamus. There is process involved in heat loss like radiation which is transfer of body heat to a cooler solid object without any contact to the body surface (ex. person near a huge block of ice). The next one is conduction; this is the transfer of heat from the body surface to a cooler solid object with the presence of body contact. Convection is dispersion of heat from the body surface to cooler surrounding air and evaporation which is a heat loss through wet surface/skin (ex. Tepid sponge bath akaTSB). There are alterations in body temperature such as pyrexia (Hyperthermia, fever) which is a temperature above the normal range and hyperpyrexia is a very high fever (41°C/ 105.8F). On the other hand, hypothermia is a subnormal body temperature Methods of temperature taking can be the choice for a physical therapist. Oral is the most accessible & convenient method; just place the thermometer under the tongue towards the side and wait for 2-3 minutes. Do not forget to wash the oral thermometer. Before using, wash from the bulb to the stem and after use, wash from stem to bulb. There are contraindications using this method such as oral lesions or surgery, dyspnea, cough, nausea, vomiting, presence of oro-nasal devices, seizure, very young children, unconscious, restless, disoriented, and confused patient. Rectal method is the most accurate measurement. Assist the client to assume lateral position, lubricate the thermometer and insert 0.5 -- 1.5 in (1.5- 4cm) - instruct the client to take a deep breath during insertion to relax the sphincter then wait for 2-4 mins Normal -- 99.5°F; 37.5°C. Axillary is the safest, non-invasive method. Pat dry the thermometer and place in axilla then place arm tightly across the chest to keep thermometer in place; the skin surface let it stand for 10 mins and for infants 5 mins. The next vital sign is **pulse rate** which is a wave of blood created by contraction of the left ventricle of the heart. Thus, this assesses the heart rate and heart rhythm. This is regulated by the autonomic nervous system. Terminologies are used to describe pulse such as tachycardia- this is pulse rate above 100 bpm while bradycardia is less than 60 bpm. Rhythm is a pattern and interval of beats; dysrhythmia/ arrhythmia is irregular heart rate. Volume (Amplitude) is the strength of pulse. A normal pulse can be felt with moderate pressure **Respiration** which is the act of breathing. There are types of breathing like costal (thoracic) which is a movement of the chest and diaphragmatic (abdominal) movement of the abdomen. The normal rate is 12 to 20/min for adult. Observe rate, excursion, effort, and pattern. Note any use of accessory muscles and whether breathing is silent or noisy. Watch for puffed cheeks, pursed lips, nasal flaring, or asymmetrical chest expansion. Changes in the rate, depth, effort, or pattern of a client\'s respirations can be early signs of neurologic, pulmonary, or cardiovascular impairment. Rhythm is regularity of exhalations and inhalations. Eupnea is a normal respiration, quiet, rhythmic and effortless while tachypnea is a rapid respiration marked by quick, shallow breaths while bradypnea is a slow breathing. Furthermore, hyperventilation is prolonged and deep breaths, carbon dioxide is excessively exhaled while hypoventilation is a slow, shallow respiration carbon dioxide is excessively retained. Dyspnea is used to describe a difficult and labored breathing and orthopnea is the ability to breath in upright position. **Blood pressure** is a measure of the pressure exerted by the blood as it pulsates through the arteries. Systolic pressure is a pressure of blood as a result of contraction of the ventricles which is the 1st sound heard on a stethoscope while diastolic pressure is exerted by the blood against the blood vessels as the ventricle relaxes or fills, this is the last sound heard. Pulse Pressure is the difference between systolic and diastolic pressure. A difference of more than 40mmHg is abnormal and should be reported. A widened pulse pressure often results from stiffening of the aorta secondary to atherosclerosis. **Physician referral** Medical consultation or referral is required when there is no apparent movement dysfunction, causative factors, or syndrome can be identified and/or the findings are not consistent with the NMS dysfunction. Once the therapist recognizes red flag histories, risk factors, signs and symptoms, and/o r a clinical presentation that does not fit the expected picture for NM S dysfunction, then this information must be communicated effectively to the appropriate referral source. Communication with the physician is a key component in the referral process. The hallmark of professionalism in any health care practitioner is the ability to understand the limits of his or her professional knowledge. **Documentation** This refers to any entry into the patient/ client record that serves as communications between the other healthcare professionals taking care the patient. Thus, communication in the health care system is heavy on written documentation or in this age- secured electronic documentation. Medical doctors, nurses, Physical Therapist, Occupational Therapist, Speech Therapist have standardized forms of documentation. Purposes for documentation include communication with other professionals, clinical decision making, creation of legal record of PT management of patients, this may also be a source for quality assurance, discharge and future placement tool, decision for payment services, data for research outcomes, and also for legal purpose. 5 types of documentation usually used are: 1\. initial examination/evaluation- is required at the beginning of the treatment. 2\. daily notes also known as visit notes, session notes, or treatment notes which is done every after treatment. 3\. progress notes which are written based on a reexamination of a patient/client and this provides an update to a patient/client\'s functional status and response to intervention. 4\. discharge notes which is written at the conclusion of the treatment. If the goal of the PT for the patient or the goal of the patient is not achieved and the patient wishes to stop the treatment then discontinuation notes is made. One of the most recognized written communications is medical documentation. In Physical Therapy the Subjective, Objective, Assessment, and Plan notes (SOAP) which is a problem oriented medical record (POMR) is popularly used. It is considered to be a highly structured documentation format developed by D. Lawrence Weed in 1960's at the University of Vermont. Subjective includes patient\'s subjective response to interventions including any adverse reactions and patient\'s report of changes in participation or activity limitations. Objective pertains to status update which includes any objective, measurable changes in patient\'s status with regard to activity limitations or impairments, in addition to that, outline interventions that were preformed that include communication and/or education with health care providers, patient, family, or significant others. A PT should include frequency, duration, and intensity, if appropriate, as well as any equipment provided. The assessment part indicates the progress being made toward patient\'s goals, including adherence to patient-related instructions. Furthermore, a PT should discuss factors that modify frequency or intensity of intervention and progression toward anticipated goals. The last part which is the Plan should contain a specific intervention plan for upcoming sessions in addition, report the patient activity between sessions examples are home program, other interventions/tests). Other formats are Narrative Format and Functional Outcome Formats. "Skill in documentation is the hallmark of a professional approach to physical therapy and is one characteristic that distinguishes a professional from a technician" --Quinn & Gordon. **BASIC PATIENT HANDLING** **A. Personal Protective Equipment** These are "specialized clothing or equipment, worn by an employee for protection against infectious materials. As defined by the Occupational Safety and Health Administration, or OSHA'. PPE is used to prevent contact with the infectious agent, or body fluid that may contain the infectious agent, by creating a barrier between the worker and the infectious material. There are three key things in selecting PPE namely: The type of anticipated exposure such as touch, splashes or sprays, or large volumes of blood or body fluids that might penetrate the clothing, the durability and appropriateness of the PPE for the task. This will affect, for example, whether a gown or apron is selected for PPE, or, if a gown is selected, whether it needs to be fluid resistant, fluid proof, or neither and the fit will be the third. Gloves are the most common type of PPE used in healthcare settings. This protects the hands from being in contact against infectious material. Gloves can be used in patient care, environmental services, etc. It is also made up of vinyl, latex, nitrile, other and can also be sterile or nonsterile. Furthermore, gloves can be used as one or a pair and can be for single use or reusable. Gowns or aprons protect the skin and/or clothing, Gowns should fully cover the torso, fit comfortably over the body, and have long sleeves that fit snuggly at the wrist. Masks and respirators protect the mouth and nose, goggles protect the eyes. Masks should fully cover the nose and mouth and prevent fluid penetration. Masks should fit snuggly over the nose and mouth. The respirator, has been designed to also protect the respiratory tract from airborne transmission of infectious agents. Goggles provide barrier protection for the eyes; personal prescription lenses do not provide optimal eye protection and should not be used as a substitute for goggles. Goggles should fit snuggly over and around the eyes or personal prescription lenses. Goggles with antifog features will help maintain clarity of vision. The face shield should cover the forehead, extend below the chin, and wrap around the side of the face in short, the face shields protect the entire face. When skin protection, in addition to mouth, nose, and eye protection, is needed or desired, for example, when irrigating a wound or suctioning copious secretions, a face shield can be used as a substitute to wearing a mask or goggles. A Personal protective equipment is to be worn in a specific order. The gown should be donned first. The mask or respirator should be put on next and properly adjusted to fit; remember to fit check the respirator. The goggles or face shield should be donned next and the gloves are donned last. Kindly open and watch this site for proper wearing of PPE. https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html To take off the PPE, gear more than one doffing method may be acceptable. One example of doffing is to remove gloves by ensuring that glove removal does not cause additional contamination of hands. Followed by the gown by untying all ties and reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable approach. Dispose in trash receptacle. Healthcare personnel may now exit patient room and perform hand hygiene. After washing the hands remove face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch the front of face shield or goggles. Remove and discard respirator (or facemask if used instead of respirator). Respirator can be removed through the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator. Facemask can be removed; carefully untie (or unhook from the ears) and pull away from face without touching the front. Do not touch the front of the respirator or facemask. Perform hand hygiene after removing the respirator/facemask and before putting it on again if your workplace is practicing reuse. Orientation is very important before we start treating our patient/client. Thus, we start by introducing ourselves and our profession, verify client information and interview client on relevant information regarding the topic. If the information is correct then you are sure that he/she is your patient/client. Perform evaluation activities, inform patient about treatment plan and risks. Encouraging patient to ask questions regarding his condition is very important, and lastly ask patients consent if he is declining the treatment or will continue the treatment. Document and let patient sign the consent. Furthermore, safety must be considered in patient care activities such as the following: perform handwashing before and after treatment, maintain sufficient space during treatment and do not perform transfers and ambulation in areas where view is obstructed or congested. In addition to that, routinely evaluate the equipment and they should be position in a stable, secure and accessible location, keep floor clear of electrical cords, litter, rugs, water and dirt because this can predispose the patient to fall. Also do not leave the patient unattended thus, you should obtain equipment and supplies needed before treatment. Qualified personnel should provide patient care. **B. Proper Body Mechanics** Body mechanics is the use of one\`s body to produce motion that is safe, energy conserving, and anatomically and physiologically efficient and maintains body balance and control. Center of gravity (COG) and the base of support (BOS) are 2 actions required to use for proper body mechanics. Furthermore, the application of PBM is very important for caregivers because this conserve energy, reduces stress and strain to muscles, joints, ligaments, promotes effective, efficient and safe movements. This also promotes and maintain proper body control and balance, promote effective cardiopulmonary function. Aside from that, there are also principles of body mechanics such as: Visualize and plan for the activity. When lifting, caregiver should position himself close to the object so that short lever arm is used. Maintaining vertical gravity line with the base to maintain stability and balance is very important. In addition, to improve control you should position your COG close to the objects COG. When ready to perform the activity, tighten your core muscles and use the largest and strongest muscles of your arms, legs, and trunk to lift, push, pull, or carry. Avoid twisting your body when you lift. When possible, pushing, pulling, rolling, or sliding the object is better rather than lifting it, and lastly take your time and lift smoothly avoiding jerking motions. Posture This is an alignment of the body parts whether upright, sitting, or recumbent. It is described by the position of the joints and body segments. There should be balance between muscles crossing the joints. **C. Draping Technique** This is the manner of arranging the covering in order to expose the part being examined, treated or cleaned. Health workers properly drape their patients to provide modesty, protect patients skin and clothing from being damaged or soiled, provide access and exposure to area treated while protecting other areas and maintain temperature. **D. Patient positioning** is placing the patient safely, comfortably, and effectively in preparation for a procedure or for positioning. Rationale for positioning includes prevention contractures, provide comfort, provide support and stability, provide access to areas to be treated, provide sufficient functions of organ system and provide positional change. Horizontal recumbent / supine position is described as patient is laying on his back with pillow under the head and under the knees. The pressure points on this position are the occiput, scapula, olecranon, thoracic vertebrae, sacrum and coccyx with the calcaneus. The prone position is lying on the belly with pillow under the head, abdominal area and under the ankle. Sidelying or lateral recumbent, pillows are located on the head, chest level and between the legs. The upper leg bended and is a little bit forward. Fowlers position is head of the bed elevated 45 degrees. Trendelenburg is placing the patient head down while the feet are elevated. This is a variant of the supine position. In utilizing the common positions, there are common muscles that are susceptible to contractures, the hip and knee flexors, ankle plantar flexors, shoulder extensors, adductors and internal rotators, and the hip external rotators. The prone position will lead to ankle plantar flexor, shoulder extensors, adductors and internal rotators, external rotators contracture while side lying leads to hip and knee flexors, hip adductors and internal rotators contracture. Furthermore, maintaining sitting for prolonged period of time will lead to hip and knee flexor, hip adductor and internal rotator contracture together with shoulder adductors, extensors and internal rotator. **Introduction to Medical Language** **The four-word parts** Medical terms are built from four-word parts these are the prefix, word root, suffix, and combining vowel. When a word root is combined with a combining vowel, the word part is referred to as a combining form. 1\. Word Root The word root contains the important meaning of the word. It is the core part of the word. Each medical term contains at least one word root. Some medical terms words contain more than one word root. Examples: In the following medical term: a\. chondr/oma (chondr -- meaning "cartilage" -- is the word root) b\. oste/itis (oste- meaning "bone"- is the word root) c\. hepat/itis (hepat- meaning "liver"- is the wort root) 2\. Prefixes Prefixes are located at the beginning of a medical term. The prefix alters the meaning of the medical term. Not all medical terms have prefixes. Many prefixes that you find in medical terms are common to English language prefixes. Examples; In the following medical term: a\. brady/cardia ("brady" is the prefix) b\. tachy/cardia ("tachy"is the prefix) Common prefixes used: PREFIX MEANING PREFIX MEANING a- without, lack of ab- away from abdomi(n)- abdomen acr(o)- pertaining to an extremity ad- to, toward aden(o)- pertaining to a gland an- without, lack of ana- up, back, again angio- vessel ante- before, forward anti- against, opposed to arteri(o)- artery arthro- pertaining to a joint auto- self bi- two bi(o)- pertaining to life blast(o)- germ or cell blephar(o)- pertaining to an eyelid brady- slow calc- stone; also heel cardi(o)- pertaining to the heart cephal(o)- pertaining to the head cerebr(o)- pertaining to the cerebrum, a part of the brain cervic(o)- pertaining to the neck or the uterine cervix chole- pertaining to bile chondr(o)- pertaining to cartilage circum- around, about contra- against, opposite cost(o)- pertaining to a rib cyan(o)- blue cyst(o)- pertaining to the bladder or any fl uid-containing sac cyt(o)- pertaining to a cell de- down from dermat(o)- pertaining to the skin di- twice, double dia- through, completely dys- diffi cult, painful, abnormal ect(o)- out from electro- pertaining to electricity end(o)- within enter(o)- pertaining to the intestines epi- upon, on erythr(o)- pertaining to anything red or to erythrocytes (red blood cells) eu- easy, good, normal ex(o)- outside extra- outside, in addition gastr(o)- pertaining to the stomach glyc(o)- sugar gynec(o)- pertaining to females or the female reproductive organs hemat(o)- pertaining to blood hemi- half hem(o)- pertaining to blood hydr(o)- water hyper- over, excessive hypo- under, defi cient hyster(o)- pertaining to the uterus infra- below hepat(o)- pertaining to the liver heter- other, different hom- same or inter- between intra- within iso- equal latero- side leuk(o)- pertaining to anything white or to leukocytes (white blood cells) lith(o)- pertaining to a stone macro- large mal- bad or abnormal medi- middle mega- large melan- black mening(o)- pertaining to a membrane, particularly the meninges micro- small mono- one myel(o)- pertaining to the spinal cord, the bone marrow, or myelin my(o)- pertaining to muscle nas(o)- pertaining to the nose ne(o)- new nephr(o)- pertaining to the kidney neur(o)- pertaining to a nerve or the nervous system noct- night olig(o)- little, defi cient oophor(o)- pertaining to the ovary ophthalm(o)- pertaining to the eye orchid(o)- pertaining to the testicles orchi(o)- pertaining to the testicles oro- pertaining to the mouth ortho- straight or normal oste(o)- pertaining to bone ot(o)- pertaining to the ear para- by the side path(o): disease per- through peri- around phag(o)- pertaining to eating, ingesting, or engulfi ng pharyng(o)- pertaining to the throat, or pharynx phleb(o)- pertaining to a vein pneum(o)- pertaining to respiration, the lungs, or air pro- before, in front of proct(o)- pertaining to the rectum pseud(o)- false psych(o)- pertaining to the mind pulm(o)- pertaining to the lung pur- pertaining to pus pyel(o)- pertaining to the kidney or pelvis py(o)- pertaining to pus quadr(i)- four quar- four quat- four retr(o)- backward or behind rhin(o)- pertaining to the nose salping(o)- pertaining to a tube scler(o)- hard; also means pertaining to the sclera semi- half or partial sub- under, moderately super- above, excessive, or more than normal supra- above tachy- fast therm- pertaining to temperature thorac(o)- pertaining to the chest trans- across tri- three uni-one vas(o)- vessel 3\. Suffixes Suffixes are word parts that are located at the end of words. Suffixes can alter the meaning of medical terms. Examples: In the following medical term: a\. chondr/oma (oma -- meaning "tumor" -- is the suffix) b\. oste/itis (itis- meaning "inflammation"- is the suffix) SUFFIXES MEANING SUFFIXES MEANING -algia pertaining to pain -asthen(o) weakness -blast immature cell -cele pertaining to a tumor or swelling -centesis pertaining to a procedure in which an organ or body cavity is punctured, often to drain excess fluid or obtain a sample for analysis -cyte cell -ectomy surgical removal of -emia pertaining to the presence of a substance in the blood -genic causing -gram record -graph a record or the instrument used to create the record -itis inflammation -lysis decline, disintegration, or destruction -megaly enlargement of -ology science of -oma tumor -osis pertaining to a disease process (see also - sis) -ostomy surgical creation of an opening, or hole -otomy surgical incision -pathy disease or a system for treating disease -phagia pertaining to eating or swallowing -phasia pertaining to speech -phobia pertaining to an irrational fear -plasty plastic surgery -plegia paralysis -pnea pertaining to breathing -ptosis drooping -rrhage abnormal or excessive fl ow or discharge -rrhagia abnormal or excessive fl ow or discharge -rrhaphy suture of; repair of -rrhea fl ow or discharge -scope instrument for examination -scopy examination with an instrument -sis a process, action, or condition -taxis order, arrangement of -trophic pertaining to nutrition -uria pertaining to a substance in the urine or the condition so indicated 4\. Combining Vowel This is a word part -- most often an o -- that helps pronunciation. The combining vowel is placed to connect two-word roots or to connect a word root and a suffix. Do NOT place a combining vowel to connect a prefix and a word root. Not all medical terms will have combining vowels. Table 1.1 Combining Vowel Guidelines a\. When connecting a word root and a suffix, a combining vowel is used if the suffix DOES NOT begin with a vowel. Example arthr/o/pathy b\. When connecting two-word roots, a combining vowel is usually used even if vowels are present at the junction oste/o/arthr/itis c\. When connecting a prefix and a word root, a combining vowel is NOT USED sub/hepat/ic