Introduction to Physical Therapy 1 - History of Physical Therapy PDF

INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Prof: 1917-1918 (WWI) BEGINNINGS OF PHYSICAL THERAPY ○ Therapy was performed wid...

INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Prof: 1917-1918 (WWI) BEGINNINGS OF PHYSICAL THERAPY ○ Therapy was performed widely ○ Rehabilitation Therapy Ancient Times 3 principal divisions of physical treatments: CHINESE (3000 B.C.) - Electrotherapy - use of electrical currents to manage ○ Employed rubbing as a therapeutic measure neuromuscular problems THALES OF MILETUS (641 B.C.) - Hydrobalneology - treating diseases through bath ○ Discovered the magnetic properties of - Massage and exercise amber HECTOR (460 B.C.) PT in England ○ Hydrotherapy was practiced through baths - PT evolved into Physical Medicine and rivers worships in Greece - Guy’s Hospital (London) HIPPOCRATES (460 B.C.) - 1st hospital PT department (electrotherapy) ○ Wrote about the therapeutic effects of under Dr. Golding Bird rubbing DR GILBERT CHOLCHESTER (1600) ○ Laid down the foundation of modern scientific electrotherapy LUIGI GALVANI (1791) ○ Discovered DC (galvanic current) MICHAEL FARADAY (1831) ○ Discovered AC (faradic current) D’Arsonal (1890) ○ High frequency currents DR KELLOGG ○ Used incandescent lights for radiant heating FINSEN ○ Demonstrated the value of UV Physical Therapy Practice in the United States Evolved around two major historical events: 19th Century 1. Poliomyelitis epidemics of the 1800s through 1950s 2. Effects of the ravages of several wars 1812 - PETER HENRY LING ○ Swedish founder of curative gymnastics American Reconstruction Aides in Physiotherapy ○ First described the scientific basis of rubbing Surgeon General, Merritte W. Ireland, MD ○ RCIG (Royal Central Institute of Gymnastics) - ○ Division of Orthopedic Surgery headed by massage, manipulation and exercise Elliott Brackett, MD. called for the 1887 establishment of hospitals for the ○ PTs were given official registration by reconstruction of soldiers with disabilities Sweden’s National Board of Health and ○ Division of Physical Reconstruction Welfare influenced by Frank B. Granger, MD and 1894 Joel Goldthwait, MD by planning the training ○ Chartered Society of Physiotherapy\ program for these reconstruction aides. 4 nurses in Great Britain Physical therapist - assist the 1913 physicians and were to provide ○ University of Otago, New Zealand exercise programs, hydrotherapy 1914 and other modalities, and massage ○ Reed College Portland, Oregon INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Occupational therapist - were to Elizabeth Kenny provide the training in the vocational Impact on treatment of those with paralytic skills of the day needed for return to poliomyelitis a gainful environment. ○ Massage of the involved body parts ○ Exercises for the limbs Marguerite Sanderson ○ Wrapping of the affected extremities with ○ Worked with Goldthwait hot, moist compresses to reduce muscle ○ Director of the Reconstruction Aide Program spasms and the resultant pain in 1917 ○ “Muscle reeducation” technique in which she ○ Her task was to prepare and mobilize these taught her patients to exercise specific new reconstruction aide workers for muscles overseas duty Stressed the importance of psychotherapy ○ Established a training program for ○ Insisted children had to be “willed to move reconstruction aides at Walter Reed General paralyzed limbs” Hospital 1946 - Hill Burton Act 11 Mary McMillan ○ A nation-wide hospital-building program ○ Headed the Walter Reed program leading to an increase in hospital-based 1921 - elected the first President of practice for physical therapists the AWPTA (American Women’s 1955 - Founded Self-Employed Section of APTA Physical Therapeutic Association) ○ Expansion of private practice 1922 - changed name to the Late 1950s to 1960s American Physiotherapy Association ○ Increasing numbers of states saw the (APA) enactment of state licensure laws for 1944 - American Physical Therapy physical therapist Association (APTA) ○ Pennsylvania - 1913 ○ Published “Massage and Therapeutic ○ New York - 1926 Exercise”, the first textbook written by a physiotherapist (1921) Margaret Rood ○ Set up a medical and surgical unit in UST ○ Developed techniques of icing and brushing during WWII and practiced her profession and her use of patterns and stability and attending to the sick and injured which could mobility have been the first services rendered by a Margaret Knott and Dorothy PT in the Philippines ○ Proprioceptive Neuromuscular Facilitation (PNF) Rehabilitation Physicians Signe Brunnstrom Changed their designation in 1920 from ○ Charted new avenues for assessment and “physiotherapists” to “physical therapy physicians”. treatment of individuals with cerebrovascular Operated at the level of technicians and only under accidents the physician’s direction in treating war wounded ○ First to delineate the stages of stroke soldiers and civilians recovery 1937 - achieved recognition as a medical specialty Berta Bobath and Dr. Karl Bobath and began to call themselves “physiatrists”. ○ Developed their reflex inhibiting postures for the management of children with cerebral palsy INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira 1960s and 1970s San Juan de Dios Hospital ○ Physical therapist practice expanded more ○ 1st Hospital Physical Therapy Department and more into the management of was established orthopedic and cardiopulmonary disorders Veterans’ Memorial Medical Center and V. Luna 1970s - 1980s General Hospital ○ The professions witnessed an increasing ○ Were the pioneers in the field of PT in the movement from hospital-based practice to Philippines private practice 1981 and 1982 1948 ○ APTA House of Delegates adopted the ○ Mandaluyong General Hospital -> National policy that physical therapist practice, Orthopedic Hospital (NOH) -> Phil independent of physician referral was ethical Orthopedic Center (POC): as long as it was legal in the state Pioneers in establishing PT education in the Philippines ➔ At long last the domination of the physical therapist 1949 by the physician faced elimination ○ Dr. Henry Kessler ➔ This action led to increasing numbers of states Consultation in Rehabilitation and legislatively receiving the right to practice without the Orthopedic Surgery to the United referral requirement States Armed Forces Trained allied medical professionals 1990 in rehabilitation ○ Passage of Americans with Disabilities Act ○ Training programs were given by the US ○ Physical therapists as consultants Army Physicians, American Red Cross 2001 nurses, and other foreign consultants in ○ Vast revision of the Guide to Physical Physical and Occupational Therapy Therapist Practice was published ○ Crash courses were given for PT technicians Direct Access to physical therapist services involving 1956 examination/evaluation or intervention or both ○ UN sent a team led by Dr. Henry Kessler to evaluate the status of rehabilitation in the Philippines Physical Therapy Practice in the Philippines ○ Dr. Kessler recommended the establishment of a school for the training of physical and 1908 - 1909 occupational therapists ○ Establishment of section of 1959 electrotherapeutics at the UST Faculty of ○ The 1st proposal for the organization of a Medicine and Surgery formal physical therapy education was Dr. Benito Valdes - 1st Director created by Dr. Benjamin Tamesis (Chief of Dr. Eulalio Martinez - Asst. DIrector the NOH) Dr. Ignacio Valdes - Professor of 1962 Therapeutics and Electrotherapy ○ First 20 students in PT were admitted at the 1916 NOH under Dr. Tamesis ○ Physiotherapy and Radiography was UP was the first university in Asia to included in the curriculum of the UST Faculty offer a degree in Physical Therapy of Medicine and Surgery and Occupational Therapy (17 PTs Dr. Paulino Garcia - 1st Section Chief and 2 OTs) INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Dec 8, 1964 1997 ○ Foundation of the Philippine Physical ○ A new set of Board of Examiners was Therapy Association (PPTA) created ○ Jose Inoturan - founder and 1st president 1999 - 2000 ○ Michael Gabilo, MHPEd (cand), PTRP - ○ Judicial hearings have started on the current president changes to RA 5680 ○ UST Alumni who became president of PPTA Congress: House Bill 3430 (OT) Victor L. Wu Congress: House Bill 6831 (PT) Jocelyn F. Agcaoili Senate: Bill No. 552 Cheryl R. Peralta 2017 June 21, 1969 ○ CHED Memorandum Order 55 - New ○ RA 5680 (Philippine Physical and Policies, Standards and Guidelines of BSPT Occupational Therapy Law) program in response to K-12 ○ This act created a Board of Examiners for PTs 2019 and OTs ○ Move to revise the PT Bill June 1973 ○ 1st licensure examinations in PT WHAT IS PHYSICAL THERAPY? 1974 (IPT - Pagliarulo) Physical Therapy or Physiotherapy (PT) ○ UST - Institute of Physical Therapy opened Acc.: Intro to PT, Pagliarulo (book) Dr. Tyrone Reyes, MD: 1st DIrector - Is a health care profession Dr. Ricardo Agbayani, MD: 1st Dean - Primary purpose is the promotion of optimal health Dr. Consuelo Suarez, MD: 1st alumna and functional ability of the IPT to be elected Dean - Through the application of scientific principles to the 1986 processes of examination, evaluation, diagnosis, ○ APPTOTS (Association of the Philippine prognosis, and intervention. Physical Therapy and Occupational Therapy - To prevent or remediate impairments, functional Schools) was established limitations, and disabilities related to movement Dr. Ofelia Reyes - 1st President - Carried out by Physical Therapists (Physiotherapists) Dr. Romeo Abiog - current acting and Physical Therapist Assistants (Physical president Rehabilitation Therapists) ○ Original member schools: UST, UP, Cebu - Encompasses areas of specialized competence and Doctor’s College, Perpetual Help College includes the development of new principles and Laguna, EAC, Virgen Milagrosa Educational applications to meet existing and emerging health Institute needs 1987 - 1988 - And other activities such as research, education, ○ DECS order No. 91 converting the BSPT consultation, and administration curriculum from 4 years to 5 years 1993 Acc.: WCPT ○ Philippines through the PPTA became a - Provides services to individuals and populations member of the World Confederation of - To develop, maintain, & restore maximum movement Physical Therapy (WCPT) & functional ability throughout the lifespan ○ Jocelyn F. Agcaoili, MSPT, RPT - Treasurer of - Provides services in circumstances where the Asia Western Pacific Region of the WCPT movement and function are threatened by (1994 - 1999) ageing, injury, disease, or environmental 1996 factors ○ Revision of the RA 5680 was passed to the - Functional movement is central to what it Senate and House of Reps through Sen Raul means to be healthy Roco and Congressman Mike Defensor INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira - Concerned with identifying and maximizing quality of Who are Physical Therapists? life and movement potential Physical Therapists are graduates of an accredited program - Within the spheres of promotion, prevention, with a bachelor’s degree or an advanced degree (Master’s or treatment/intervention, habilitation, and rehabilitation. Doctorate) following extensive educational and clinical - This encompasses physical, psychological, training emotional, and social well being - Involves the interaction between physical therapist, Duties and Responsibilities of a PT patients/clients, other health professionals, families, Undertake a comprehensive care givers, and communities examination/assessment/evaluation of the - In a process where movement potential is assessed patient/client or needs of a client group and goals are agreed upon Formulate a diagnosis, prognosis, and a plan - Using knowledge and skills unique to physical Provide consultation within their expertise therapists And determine when patients/clients need to be referred to another healthcare professional Acc.: APTA Implement a physical therapist intervention/treatment - Is health profession program - Whose primary purpose is the promotion of optimal Determine the outcomes of any health and function through the application of interventions/treatments scientific principles Make recommendations for self management - To prevent, identify, assess, correct, or alleviate acute Provide patient and family education or prolonged movement dysfunction Delegates portions of the treatment to support - It encompasses areas of specialized competence personnel and supervises them (PTA’s, PT aides, PT - And includes the development of new principles & technician) applications to more effectively meet existing and emerging health needs Where do they Practice? Community based rehabilitation programs Acc.: RA 5680 Community settings - Physical Therapy is the art and science of treatment ○ Primary health care centers, individual - By means of therapeutic exercise, heat, cold, light, homes, and field settings water, manual manipulation, electricity, and other Education and research centers physical agents Fitness clubs, health clubs, gymnasia, and spas Hospices Acc.: PPTA Hospitals - Physical Therapy is an allied medical profession Nursing homes - Which develops, coordinates, and utilizes selected Occupational health centers knowledge and skill Out-patient clinics - In planning, organizing, directing, and evaluating the Physical therapist private offices, practices, and programs for the care of individuals whose ability to clinics function is impaired or threatened by disease or Prisons injury Public settings (e.g. shopping malls) for health promotion The Physical Therapy Profession Rehabilitation centers - Is committed to providing quality and competent Residential homes services to people Schools, including pre-schools and special schools - To develop, maintain, and restore maximum Senior citizen centers movement and functional ability through their Sports centers/clubs lifespan Workplaces/companies INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Patients vs Clients - Maintain health (thereby preventing further Patients - individuals who are sick or injured, they are the deterioration and future illness) recipients of physical therapy care and direct intervention - Create appropriate environmental adaptations to enhance independent function Clients - individuals who are not necessarily sick or injured but who can benefit from a physical therapist’s consultation, 3 Types of Prevention professional advice or prevention services Primary Prevention: preventing disease in a susceptible or potentially susceptible population through general health Scope of Practice promotion Direct patient/client care Public health strategies Secondary Prevention: decreasing the duration of illness, Advocating for patients/clients and for health severity of disease and sequelae through early diagnosis and Supervising and delegating to others prompt intervention Leading Managing Tertiary Prevention: limiting the degree of disability and Teaching promoting rehabilitation and restoration of function in patients Research with chronic and irreversible diseases Developing and implementing health policy, locally, - e.g. back to school programs; workplace redesign; nationally and internationally endurance exercise programs/fitness Interact and practice in collaboration with a variety of professionals including physicians, dentists, nurses, The Rehabilitation Team educators, social workers, OTs and SPs REHABILITATION Provide prevention and wellness services, including - It is the development of a person to the fullest screening and health promotion physical, psychological, social, vocational, and Direct and supervise PT services, including support educational potential consistent with his or her personnel physiologic or anatomic impairment and environmental limitations Roles in Different Practice Settings Members of the Rehabilitation Team Role in Primary Care PHYSICIAN / PHYSIATRIST - PTs are the immediate care-givers and provide the Head of the team initial examination Pilot of the combined medical and rehabilitation - E.g. acute musculoskeletal conditions program Role in Secondary Care PHYSICAL THERAPIST - Patients are treated initially by another health care practitioner and are then referred to PTs for OCCUPATIONAL THERAPIST secondary care Focuses more on functional activities Role in Tertiary Care - Highly specialized, complex, and technology based PROSTHETIST / ORTHOTIST settings Involved in the evaluation, design, and fabrication of - E.g. heart and lung transplant services, burn units, prostheses and orthoses SCI, and TBI REHABILITATION NURSE Role in Prevention and Wellness Specializes in direct personal care of physically - Minimize impairments, functional limitations and impaired patients disabilities related to congenital and acquired conditions INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira SPEECH AND LANGUAGE PATHOLOGIST ICF AND THE PT PROCESS Evaluates and treats patients with aphasia, dysarthria, apraxia, communication and other speech and CONCEPTUAL MODELS OF DISABILITY language impairments PSYCHOLOGIST Helps the patient prepare psychologically for full participation in rehabilitation SOCIAL WORKER Interacts with the patient, family, and rehabilitation team for a better outlook with regards to the condition and the rehabilitation process VOCATIONAL COUNSELOR Helps the patient attain realistic vocational goals CHILD LIFE SPECIALIST Helps to minimize the interruption, disruption of - Disability is always an interaction between features of normal life experiences caused by hospitalization or the person and features of the overall context in which the person lives (social phenomenon) illness in children THE NAGI MODEL OF DISABILITY KINESIOTHERAPIST Helps the patient reach the goal of becoming independent, self-sustaining person Overlaps with the PT, OT, and recreation therapist CERTIFIED THERAPEUTIC RECREATION THERAPIST Uses recreational activities for purposive intervention in some physical, social, or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient THE WHO MODEL OF DISABILITY HORTICULTURAL THERAPIST Advocates the raising of flowers, vegetables, and other plants as having therapeutic value in building or rebuilding confidence and self-esteem Why is there a need for ICF? MUSIC THERAPIST For health planning and management purposes Use of music as a therapeutic intervention through Determine the overall health of populations, the performance with instruments, voice, and body prevalence and incidence of non-fatal health movements outcomes, and to measure health care needs and the performance and effectiveness of health care DANCE THERAPIST (Movement Therapist) systems Use of rhythmic body movement as a medium for “Health language” physical and psychological change “Policy tools for decision makers” INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira What is ICF? Three Levels of Human Functioning INTERNATIONAL CLASSIFICATION OF FUNCTIONING, Impairments DISABILITY AND HEALTH ○ “How is the person’s body affected?” Disablement model of the World Health Organization ○ Problems in body function or structure such (WHO) as their framework for health and disability as a significant deviation or loss Standard language and framework for the BODY STRUCTURES - are description of health and health-related states. anatomical parts of the body such as “All healthcare professionals can understand” organs, limbs, and their components The conceptual basis for the definition, BODY FUNCTIONS - are measurement, and policy formulations for health and physiological functions of body disability systems (including psychological It is the universal classification of disability and health functions) for use in health and health-related sectors ○ Examples Muscle weakness Pain Limitation of motion Decreased cardiovascular endurance Gait deviations Poor standing balance Activity Limitations ○ “How does the problem affect the person’s life?” ○ Are difficulties an individual may have in Health Condition executing activities Refers to the disease, disorders, or injuries of the ACTIVITIES - execution of a task or person action by an individual Ex. ankle sprain, low back pain, cervical strain, ○ Can include limitations in the performance of transtibial amputation cognitive and learning skills, communication skills, functional mobility skills and basic Contextual Factors activities of daily living (BADLs) Environmental ○ Examples ○ Social attitudes, architectural characteristics, Mod difficulty in bed mobility legal and social structures, as well as climate, Min +1 assist in bed to chair transfer terrain and other factors in which people live Inability to walk on level surfaces and conduct their lives (selfcare, grooming, toileting, Personal locomotion) ○ Gender, age, coping styles, social Participation Restriction background, education, profession, past and ○ Problems in involvement in life situations and current experience, overall behavior pattern, social interactions including home character and other factors that influence management, work ( job/school/play) and how disability is experienced by the community/leisure individual PARTICIPATION - involvement in a life situation ○ A disadvantage for an individual resulting from an impairment or a disability that limits INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira or prevents the fulfillment of a role that is Underlying Principles of ICF normal Universality ○ Instrumental Activities of Daily Living(IADLs) Applicable to all people irrespective of health ○ Examples condition Inability to perform roles as a ○ “Not only applies to disabled” businessman Difficulty performing housewife Parity duties There should not be, explicitly, or implicitly, a Inability to play golf distinction between different health conditions as ‘mental’ and ‘physical’ that affect the structure of content of a classification of functioning and disability ○ “Not differentiated by cause” Neutrality Domain names should be worded in neutral language so that the classification can express both positive and negative aspects of each aspect of functioning and disability Environmental Factors Essential aspect of the scientific understanding of the phenomena included under the umbrella terms ‘functioning and disability’ Qualifiers Record the presence and severity of a problem in functioning at the body, person and societal levels ○ PERFORMING QUALIFIERS - describes what an individual does in his or her current environment Extent of difficulty in performing tasks which can range from mild to moderate to severe to complete ○ CAPACITY QUALIFIERS - describes an individual’s ability to execute a task or an action indicating the highest probable level The Physical Therapy Process of functioning Can range from the assistance of a device or another person or environmental modification INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Examination Intervention - Involves identifying and defining the patient’s - Purposeful interaction of the physical therapist with problem(s) and the resources available to determine the patient/client and, when appropriate, other appropriate intervention individuals involved in the care of the patient/client, using various physical therapy procedures and techniques to produce changes in the condition Outcomes/Re-examination - Involves continuous re-examination of the patient and a determination of the efficacy of treatment - Results of patient/client management, which include Evaluation the impact of physical therapy interventions - Identifies and prioritizes the patient’s impairments, activity limitations, and participation restrictions and develops a problem list VITAL SIGNS - Impairments, activity limitations, and participation AKA Cardinal Signs restrictions must be analyzed to identify causal Indicators of body’s physiological status relationships Response of the body to physical activity, environmental conditions, and emotional stressors Diagnosis Identified among the tests and measures used to characterize or quantify circulatory and pulmonary - Identify the impact of a condition on function at the status and reflects the function of internal organs level of the system (especially the movement system) “Variations reflect changes in the internal and at the level of the whole person environment of the body” - Elaboration of the medical diagnosis to identify altered physical status focusing on functional Provides clinical judgements for consequences physical therapists to: - Assign a diagnostic label and classify patient findings within a specific practice pattern (classifies patient) - Determine the prognosis and plan of care including identification of anticipated goals and expected outcomes and selection of specific interventions - Evaluate patient progress through re-examination at periodic intervals during an episode of care - Evaluate the effectiveness of selected interventions Prognosis in achieving anticipated goals and expected - Predicted optimal level of improvement in function outcomes and amount of time needed to reach that level - Determine if a referral to another practitioner is warranted INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira DECREASED BODY TEMPERATURE: (feels cold) Vital sign measurements yield the most useful information when performed and recorded at periodic intervals over time as opposed to a single measurement taken at a given point in Effector Organs: time. Vascular Temperature ○ vasoconstriction of cutaneous blood vessels Represents a balance between the heat produced or ○ Smaller diameter = less blood flow acquired and the amount lost by the body. Metabolic ○ Homoiothermic – warm blooded ○ Secretion of norepinephrine, epinephrine, ○ Poikilothermic – cold blooded and thyroxine Body temperatures ○ Increased metabolic activity = more heat ○ Normal – 37 degrees Celsius (normothermic) ○ Happens over a long period of time exposed ○ Hypothermia (cold) to cold environments (days) ○ Hyperthermia (hot) Skeletal muscles Celsius to Fahrenheit ○ Shivering reflex initiated by the post (F = [9/5 x C] + 32 hypothalamus ○ Increased muscle tone + Increased Fahrenheit to Celsius contractions = generate heat C = [F-32] x 5/9 Cutis anserina/piloerection ○ “Hair standing on end” Thermoregulatory System ○ Goosebumps Maintains a relatively constant body temperature for normal cellular and vital organ function. INCREASED BODY TEMPERATURE: (feels hot) Three components: ○ Receptors – thermoreceptors (sensory) Peripheral –skin (free nerve endings) (Afferent) Central – abdominal organs, nervous system, hypothalamus ○ Regulatory center – hypothalamus (coordinator for heal loss or conservation) Internal thermostat of the body (37 C + 1) ○ Effector organs Effector Organs: Blood vessels Vascular Metabolic glands ○ Vasodilation of cutaneous blood vessels Skeletal muscles ○ Increased diameter = increase blood flow Sweat glands Sweat glands Hairs on skin ○ Heat loss via evaporation INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Factors Influencing Body Temperature TIME OF DAY ○ Circadian rhythm – 24 hr cycle of normal variation in body temp Lowest temp between 4-6am Highest temp between 4-8pm Influenced by digestive processes and level of skeletal muscle activity AGE ○ Infants and young children > adult > elderly ○ Higher -> lower temps Abnormalities in Body Temperature EMOTIONS/STRESS ○ Due to SNS stimulation Increased body temp - assists the body in fighting disease or Releases epinephrine and infection (sign not a disease) norepinephrine Pyrexia : “fever”, brought about by pyrogens from Increase metabolic rate = increase toxic bacteria or from degenerating body tissues body temperature ○ Prodromal Phase - period prior to onset of fever with non-specific symptoms EXERCISE ○ Phase 1: Onset – period of gradual or ○ Body temp increases is proportional to the sudden rise until the max temp is reached relative intensity of the workload with chills, shivering and paleness of skin ○ Vigorous exercise can increase metabolic ○ Phase 2: Course – point of the highest rate by 20-25x elevation of fever (remains relatively stable) MENSTRUAL CYCLE with warm and flushed skin, no shivering ○ Increased progesterone levels during ○ Phase 3: Defervescence– period during ovulation which the fever subsides where cutaneous PREGNANCY vasodilation occurs and sweating ○ Increased metabolic activity Hyperpyrexia/ hyperthermia – unusually high fever EXTERNAL ENVIRONMENT (>41ºC) (or “(+) febrile to touch”) ○ conditions influence the body’s ability to maintain constant temperatures Decreased body temp MEASUREMENT SITE Hypothermia ○ Rectal and tympanic sites > oral> axillary ○ Below 34.4ºC – the thermoregulatory center INGESTION OF WARM OR COLD FOODS becomes seriously impaired ○ Affects oral temp reading ○ Below 29.4ºC – completely lost thermoregulatory function Temperature Examination s/sx: decreased HR and RR, cold and pale skin, cyanosis, decreased cutaneous sensation, depressed - Glass Mercury mental and muscular responses, drowsiness, coma, - Automated death - Oral - Tympanic Infrared - Temporal Artery - Disposable Single-use - Oral - Skin Surface INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Abnormal Pulses CORRIGAN’S (WATER-HAMMER) PULSE Pulse PULSUS ALTERNANS Wave of blood in the artery created by the PULSUS BIGEMINUS contraction of the left ventricle during a cardiac cycle PULSUS BISFERIENS ○ Peripheral pulses - radial, carotid, and PULSUS PARADOXUS popliteal ○ Apical pulse – apex of the heart Pressure changes in the large arteries during the cardiac cycle are reflected in the relatively smooth Factors Influencing Heart Rate and rounded appearance of the normal arterial AGE waveform ○ Fetal > newborn > adult SEX ○ Men < Women EMOTION/STRESS ○ Due to activity of the SNS, pain EXERCISE ○ Increased oxygen demand of skeletal Pulse Parameters muscles RATE ○ Chronotropic competence – linear ○ Number of pulsations or frequency per relationship between HR and intensity of minute workload Bradycardia ○ HRmax = 220 – age Tachycardia ○ Karvonen’s formula: THR = [(HRmax– HRrest) Palpitations x % intensity] + Hrrest RHYTHM ○ Inbar formula: (Hrmax = 205.8 – [0.685 x ○ Pattern of pulsations and the intervals age]) between them Regular Arrythmia/Dysrhythmia – premature, late or missed QUALITY ○ Amount of force created by the ejected blood volume against the arterial wall during each ventricular contraction Full or strong Weak or thread Bounding INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira MEDICATIONS Monitoring Pulse ○ Beta-blockers –decreases resting HR and HR AUTOMATED MONITORING response to exercise ○ Heart Rate Monitors (HRM) Use RPE to monitor exercise DOPPLER ULTRASOUND intensity ○ Examine pulses that are extremely weak or SYSTEMIC OR LOCAL HEAT faint or that are obliterated by even slight ○ Fever, application of thermal modalities pressure or when arterial flow is severely compromised Pulse Examination PULSE OXIMETRY Peripheral: ○ Measures arterial blood oxygenation updated with each pulse wave (SpO2) ○ SaO2– 96-100% Hypoxemia Hypoxia Anoxia Respiration Movement of air into and out of the lungs to supply the body with oxygen for metabolic activity and to Apical or Central: remove carbon dioxide Most accurate and is monitored through auscultation ○ External respiration – exchange of oxygen Used for weak heartbeats that are imperceptible and carbon dioxide between the lungs and peripherally and other sites are inaccessible or environment difficult to locate or palpate ○ Internal respiration – exchange of oxygen Used to monitor the effects of cardiac medications and carbon dioxide between the circulating designed to alter HR and rhythm blood and body tissues. PULSE RATE EXAMINATION: PALPATION ○ Use index and third finger or the first three fingers of the hand ○ NEVER USE the thumb Respiration Zones Conductive Zone – continuous air movement in and ○ Use light pressure to locate and firm out of the lungs pressure to monitor ○ Trachea AUSCULTATION ○ Bronchi APICAL-RADIAL PULSE ○ Terminal bronchioles ○ Pulse deficit – difference between the rate of the apical and radial pulses Respiratory Zone – gas exchange happens ○ Respiratory bronchioles ○ Alveolar ducts ○ Alveoli (alveolar sacs) INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira INSPIRATION ENVIRONMENT - Contraction of the diaphragm and intercostal muscles ○ Exposure to pollutants – gas and particle EXPIRATION emissions, asbestos, chemical waste - A passive process products, coal dust, high ozone - Recoil of the lungs brought by the inherent elastic concentration, sulfur dioxide, carbon property of the lungs monoxide ○ High altitude Regulatory Mechanism EMOTION/STRESS Involves the neural and chemical controls of the body ○ Stimulation of the SNS and is closely integrated with the cardiovascular PHARMACOLOGICAL AGENTS system ○ CNS depressants - narcotics, barbiturates, Three components: diazepam, muscle relaxants, antidepressants ○ Receptors – Chemoreceptors ○ Bronchodilators – albuterol, bitolterol Central – located in the pons and medulla Parameters of Respiration Peripheral – located in the arch of RATE the aorta and bifurcation of the ○ Number of breaths per minute counted in 30 carotid arteries seconds x 2 ○ Regulating Center – bilateral pons and DEPTH medulla ○ Amount of air exchanged with each breath ○ Effector Organs – respiratory muscles ○ Deep or shallow RHYTHM ○ Regularity of inspiration and expiration ○ Regular or irregular SOUND ○ Deviations from normal, quiet and effortless breathing ○ Adventitious sounds Wheeze – whistling sound due to air passing through a narrowed airway more prominent in expiration Stridor – high pitched crowing HERING-BREUER REFLEX occurs with upper airway obstruction ○ Pulmonary stretch receptors of the lungs due to narrowing of glottis or trachea inhibit further inspiration and increase Crackle/rales – rattling or bubbling duration of expiration sound due to secretions in the air passages Factors Influencing Respiration Sigh – deep inspiration followed by AGE prolonged audible expiration ○ Newborn > adulthood Stertor– snoring sound due to BODY SIZE AND STATURE partial obstruction of the upper ○ Women >Men airway ○ Stout or obese > tall and thin EXERCISE ○ Increased oxygen demand and carbon dioxide production BODY POSITION ○ Supine position INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Patterns of Respiration Blood Pressure Force the blood exerts against a vessel wall EUPNEA ○ SYSTOLIC - highest pressure exerted by the ○ Normal breathing pattern blood against the arterial walls (ventricular HYPERVENTILATION contraction) ○ Abnormally fast rate and depth ○ DIASTOLIC - lowest pressure (ventricular HYPOVENTILATION relaxation) ○ Reduction in the rate and depth ○ PULSE PRESSURE – difference of the DYSPNEA systolic and diastolic pressures ○ Difficult or labored breathing with increased effort to breath; ○ COSTAL/THORACIC - accessory muscles are active (SCM, pectorals, scalenes and subclavius) ORTHOPNEA ○ Dyspnea while lying down TACHYPNEA ○ Abnormally fast RR due to respiratory insufficiency and fever BRADYPNEA Function of the following element ○ Abnormally slow RR due to impairment of the ○ CARDIAC OUTPUT (CO) – amount of blood respiratory center (increased ICP, drugs, flow metabolic disorder) ○ PERIPHERAL RESISTANCE (R) – APNEA impediment to blood flow inside the vessel ○ Absence of respiration and is transient that the heart must overcome CHEYNE-STOKES Other factors ○ Period of apnea followed by gradually ○ Diameter of the vessel wall increasing depth and frequency ○ Elasticity of the vessel wall BIOT’S ○ Blood volume ○ Irregular ○ Blood viscosity respiration with variable Blood Pressure Regulation depth alternating with periods of apnea KUSSMAUL’S ○ Regular but abnormally deep respiration with increased rate Respiration Rate Examination Pt should be unaware Ideally, chest must be exposed Patient’s forearm across the chest INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira VALSALVA MANEUVER ○ Force exhalation with a closed glottis, nose and mouth ○ Increased intrathoracic pressure with accompanying collapse of the chest wall veins → decreased venous return → decreased BP ORTHOSTATIC HYPOTENSION ○ Sudden drop in BP upon movement to upright position is initiated due to pooling of the blood in the LE veins ○ Decreased Venous return and CO → cerebral hypoperfusion → lightheadedness, dizziness, syncope ○ Period of inactivity, exercise, antihypertensive drugs, vasodilators, aging, Valsalva, hypovolemia ARM POSITION ○ Position: sitting with arm horizontally supported positioned at heart level Factors Influencing Blood Pressure BLOOD VOLUME – amount of blood circulating in the body ○ Blood loss – hemorrhage, diarrhea, dehydration ○ Excess fluid – CHF, bladder distention ARTERIAL DIAMETER AND ELASTICITY ○ Vasodilation ○ Vasoconstriction CARDIAC OUTPUT AGE EXERCISE ○ Increases cardiac output ○ Termination of exercise: drop of SBP by >10mmHg INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira Blood Pressure Measurement DIRECT ○ Use of a thin catheter inserted in to an artery INDIRECT ○ Use of a sphygmomanometer and stethoscope BP cuff Manometer Stethoscope KOROTKOFF’S SOUNDS – low frequency sounds ○ PHASE I – clear, faint, rhythmic tapping sound which gradually increases Systolic Pressure – period when blood initially flows through the artery and is the highest pressure in the system during ventricular contraction AUSCULTATORY GAP – temporary disappearance of sound normally heard over the brachial artery and may cover a range of as much as 40mmHg. ○ PHASE II – murmur or swishing sound as artery widens ○ PHASE III – crisp, more intense and louder due to flowing unobstructive blood ○ PHASE IV – distinct with abrupt muffling with soft blowing quality ○ PHASE V – last sound heard Diastolic Pressure INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira INTRODUCTION TO PHYSICAL THERAPY 1 - HISTORY OF PHYSICAL THERAPY By: Almira