Session 1 Lab Guide (Student) PDF

SESSION 1: Lab Guide ==================== ### Learning Goal: Think Like A PT #### Course Goal \#1: Develop a **therapeutic alliance** with patients, clients, and caretakers #### Course Goal \#2: Apply effective **decision-making guidelines** in planning and implementing therapeutic interventions...

SESSION 1: Lab Guide ==================== ### Learning Goal: Think Like A PT #### Course Goal \#1: Develop a **therapeutic alliance** with patients, clients, and caretakers #### Course Goal \#2: Apply effective **decision-making guidelines** in planning and implementing therapeutic interventions ### Learning Goal: Safely and Effectively Utilize Foundational Intervention Strategies When Working with Non-Complex Patients #### Course Goal \#4: **Maintain cleanliness** in the clinical environment #### Course Goal \#5: Use principles of **biomechanics** to inform decision-making in movement and injury prevention Part 1: Decision-Making Guides ============================== Decision Making Guides - ### Progressing Toward Independence - ### AMAP/ANAP (As Much As Possible; As Normally As Possible) - ### Person- Task- Environment - ### CCDD (Control Centrally; Direct Distally) - ### Biomechanics - ### Stability-Mobility Continuum - ### Focus on the Objective (maintain clarity of purpose; Begin with the End in Mind!) Applying The Decision-Making Guides To Practice ----------------------------------------------- 1. You are working at home with a patient with an ankle fracture 2 days ago. The pt is NWB and casted with B axillary crutches. The pt is fearful and does not feel steady on crutches. The pt lives in a 2-story home with the bedrooms upstairs with a significant other who works outside the home during the day. The pt's typical roles include managing the home, including cleaning, laundry, and cooking, etc. - Considering Dynamic Systems Theory, what options do you have to optimize your patient's independence at home? 2. A PT is working with a patient to help him get out of his wheelchair. What can be improved based on this image? 3. After 10 minutes sitting in her wheelchair a pt starts to lean toward to the side. How can CCDD be used to assist the pt? 4. Review the flow chart for standing up and consider the following scenarios: a. A pt is NWB on the R LE b. A pt with significant balance deficits that stiffens up and lean backwards into the chair the chair when trying unsuccessfully to stand up. 5. Name That Decision Making Guide: a. If the goal is independence engage the patient. [ ] b. When possible normal movement patterns are more efficient. [ ] c. As the pelvis goes, so does the body! [ ] d. Where the eyes go, the head will follow; where the head goes the body will follow! [ ] e. If you lead the movement with a distal component of the body, the rest of the body will follow! [ ] 6. Place these in order of most stable to least stable Summary and Review ------------------ The ultimate goal of physical therapy is to help a patient achieve their ultimate function and their goals. As physical therapists we have tools in our toolbox to help our patient's achieve their goals. Diagram Description automatically generated - Movement progresses from simple to complex, dependence to independence, and stable to mobile - Engage your patient in the movement activity - Balance mobility with stability - Begin with the End in mind; focus on your patient's goals Part 2: Therapeutic Alliance ============================ Keys for Communication: ----------------------- - Utilize person-first language or, when appropriate, identity-first language - Always start with complete introductions then obtain permission and consent to treat - Implement appropriate and efficient instructions prior to tasks and short concise verbal cues during skills - Utilize "teach back" to gauge understanding and foster patient buy-in The Intro: ---------- - This is the start of a therapeutic alliance with your patients. These elements can be in any order but all must be included. - Hello, \[PATIENT'S FULL NAME\]. - Can you please confirm your date of birth for me? - My name is \[YOUR FULL NAME\], I prefer to be addressed \[INSERT YOUR PRONOUNS AND HOW YOU WANT THE PATIENT TO ADDRESS YOU\]. - I am a student physical therapist from The George Washington University. - How would you like me to address you? - I am here to help you \[PROVIDE A SHORT SYNOPSIS OF THE PLAN OF CARE ie. learn how to use your crutches today.\] Is that okay with you? - Before we get started, do you have any questions? This doesn't always need to be in the is order but it must be the patient's full name, address yourself as a student, make sure your clarify how they prefer to be addressed, and state what the plan is for the day, and ask if they have a question Part 3: Infection Control ========================= Handwashing ----------- REVIEW PPE & PRECAUTIONS ------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Isolation Type** **Common Clinical Syndromes** **Room** **Mask** **Gown** **Gloves** **Transport** -------------------- ------------------------------- ---------------------------- ---------------------- ------------------------------------------ ------------------------------------------ ---------------------------------- Contact MRSA Private No Yes Yes Minimize; cover infected areas Droplet Mumps, flu Private Yes, if respiratory\ Yes, if respiratory spray is anticipated Yes, if respiratory spray is anticipated Mask patient spray is anticipated Airborne Measles, tuberculosis Private, negative air flow Yes (N95) No No Mask patient Airborne + Contact Chickenpox Private, negative air flow Yes (N95) Yes Yes Mask patient; cover open lesions --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Apply Your Knowledge To Patient Care ------------------------------------ What precautions are appropriate for the following patients: 1. A PTA cuts their finger on a plinth. 2. A patient has chicken pox but the caregivers need to know how to transfer them in and out of the car post-operatively. 3. A patient has tuberculosis but the PT goal is to work on ambulation endurance in the hospital setting. 4. A PT is sniffling and sneezing and may be coming down with a cold. Donning and Doffing PPE ----------------------- ### Order of Donning: 1. Hand hygiene 2. Gown 3. Face mask/respirator 4. Goggles/Shield 5. Gloves ### Order of Doffing: 1. Gloves 2. Goggles/Shield 3. Gown 4. Mask/Respirator 5. Hand hygiene +-----------------+-----------------+-----------------+-----------------+ | **Transmission | **PPE Needed** | **Location to | **Location to | | Mode** | | Don** | Doff** | +=================+=================+=================+=================+ | Contact (direct | Gloves | Before entering | Before leaving | | and indirect) | | room | room | | | Gown | | | | | | Before entering | Before leaving | | | | room | room | +-----------------+-----------------+-----------------+-----------------+ | Droplet | Face mask | Before entering | Before leaving | | | | room | room | | | Gloves/gown | | | | | | Before entering | Before leaving | | | | room | room | +-----------------+-----------------+-----------------+-----------------+ | Airborne | Face mask or | Before entering | **After leaving | | | respirator | room | room** | +-----------------+-----------------+-----------------+-----------------+ Part 4: Body Mechanics ====================== PTs are at risk. Research shows **30-60%** of PT's experience Work-Related Musculoskeletal Disorders (WMSDs) at some time in their career. - Low back injury (most common) followed by neck, upper back, and thumb injuries - Risk factors include **patient transfers, patient repositioning, bent or twisted postures, joint mobilization, soft tissue work**. - **Increased prevalence** in the younger therapist, within **first 5 years of practice** - Majority responded to injury by continuing to work with discomfort, others **changed specialty areas of practice or left the profession**, some sought treatment. Center of Mass (CoM) -------------------- In what direction does the CoM shift in the following situations? - One foot standing on RLE? - Squatting to lift a toy off the floor? - Reaching overhead for a box? - Cast on the RLE? - Cast on the LUE? - RLE trans-tibial amputation (TTA)? Applying Body Mechanics To Patient Care ---------------------------------------  1. In the picture to the left, how do the following impact the stability/mobility of the therapist and, therefore, the safety of the patient? - BoS? - CoM? - LOG? - Patient's CoM? - Distance between caregiver and patient? 2. Why should patients use a cane in the hand opposite the injured leg? 3. Why do therapists bend their hips and knees when working with patients? See the hint below... 10 Rules of Good Body Mechanics ------------------------------- 1. Keep load **close** to the body (Once lifted, the object is part of your body) 2. Maintain proper **base of support (anterior-posterior as well as lateral)** 3. Stabilize your **core** 4. Keep hips and knees slightly **flexed** 5. **Lift with your legs** (power muscles: quadriceps, hamstrings, gluteals and abdominals) 6. Exhale upon exertion; **do not Valsalva (exhale!)** 7. **Push** rather than pull (generally!) 8. **Avoid twisting** motions 9. Maintain **neutral** spinal curve 10. **BE SMART - BE SAFE NOT SORRY - GET HELP !!** Key Points to Remember for Patient Mobility ------------------------------------------- - Begin with the end in mind! - Plan before you being moving: mentally survey what you are about to move - Prepare the area - Think about your feet (don't let them cross) - Have assistance ready if needed - Use clear, concise verbal instructions and cues Types of Lifts -------------- +-----------------------------------+-----------------------------------+ | Deep Squat | lifting-pic.jpg | | | | | - Traditional model of lifting | | | objects below waist level | | | using squatting position | | | | | | - Hips below level of knees, | | | feet straddle object | | | | | | - Maintain neutral spinal | | | curves (hip hinge) | | | | | | - Bring it close to your body | | | | | | - Use legs to lift along with | | | isometric muscle contraction | | | of the core | | +===================================+===================================+ | Half Kneel Lift |  | | Useful for bulky or awkward items | | | on the floor | | | | | | - Kneel on one knee, lift | | | object (may place on knee), | | | move object close to body and | | | stand. | | | | | | - Allows you to get the item | | | closer to you before lifting | | | then push down through the | | | forward leg and rise to | | | standing | | | | | | - Spine remains upright, look | | | forward | | +-----------------------------------+-----------------------------------+ | Single Leg Stance Lift (aka | golfer\'s lift.jpg | | Golfer's Lift) | | | | | | Good for picking up light weight | | | objects | | | | | | - Hip flexes and UE reaces | | | closer to the ground while | | | lifting the opposite leg | | | reducing the strain on the | | | lower back | | | | | | - Keep back neutral | | | | | | - May maintain a slight knee | | | bend | | +-----------------------------------+-----------------------------------+ | Push vs. Pull | | | | | | - When possible push rather | | | than pull an object | | | | | | - Pushing allows for a greater | | | BOS and lower CoM, allows for | | | larger muscles to do the work | | | and the forward lead allows | | | for the force to be directed | | | toward the desired motion | | | | | | - Avoid twisting | | +-----------------------------------+-----------------------------------+ Summary Questions ================= #### Decision-Making Guides, Therapeutic Alliance, Infection Control, & Body Mechanics 1. What will you do before any patient interaction? 2. What are the critical component of an introduction with a patient? Clean to clean 3. If your patient is sitting in a wheelchair leaning to the side what are some of your options to help them sit upright? Wide base of support, lower COM, brings LOG straight down through that wide base of support 4. What does AMAP/ANAP mean? 5. When assisting a patient with rolling where are the key points of control to focus on? 6. How does the stage of loss or injury impact how a patient may present? 7. When educating a patient on an intervention what are some effective techniques? 8. Change these phrases to be person-first: He is wheelchair bound; The stroke in room 312; my shoulder is coming in next. 9. Describe to a group of kids coming into the hospital what they should do if they need to cough? 10. What is the order of donning and doffing gloves, gown, and face mask? 11. When seeing a patient with contact precautions, what type of PPE would you don and when and where would you don and doff? 12. When seeing a patient with airborne precautions, what type of PPE would you don and when and where would you don and doff? 13. If you need to enter the room of a patient with droplet precautions to ask a question, what type of PPE do you need? 14. What does an N95 mask mean? 15. Name one major rule to follow when donning and doffing PPE? 16. If your patient develops an infection after playing with a toy a visitor brought to the hospital, what kind of transmission is that considered? 17. Which lifting technique is best for bulky or unwieldy equipment? 18. What is the best technique to use when lifting and moving objects from one surface to another of equal height (grocery cart to car trunk)? 19. What lifting technique would you teach a patient who wants to lift a light object from the floor but has either hip or knee problems? 20. If you have the choice to pull or push an object across the floor, which would you do and why? 21. For maximum stability what should you do with your BOS, LOG, and COM 22. What are some of the CARDINAL RULES of Good Body Mechanics? 23. Which lift would you use for: a. A small child that is fast asleep on the floor and you need to pick them up and put in bed b. A heavy carton of paraffin for the paraffin machine c. A large plastic bag of small extraneous supplies for the office weighing 12-15lbs d. Your patient has a total hip arthroplasty (THA)(cannot bend his right hip \>90^0^) and dropped a tee shirt when getting dressed e. Your patient is a 45 y.o. 5'0", 98 pounds with weakness in BUE and BLE and you need to move from bed to gurney f. Your patient is a 45 y.o. 6'2" who is obese who is unable to follow your commands and has weakness in BUE and BLE and you need to move from bed to gurney