PTH 105 Introduction to Physical Therapy History PDF

VA BEACH CAMPUS PTH 105 -- [Unit 1 Lecture] -- [HO\#2] -- [PM&R and] [History of Physical Therapy] ================================================================================================================================== **Learner Objectives**: B1 Define physical medicine and rehabilitat...

VA BEACH CAMPUS PTH 105 -- [Unit 1 Lecture] -- [HO\#2] -- [PM&R and] [History of Physical Therapy] ================================================================================================================================== **Learner Objectives**: B1 Define physical medicine and rehabilitation. B2. Define physical therapy. B3. Describe the history and philosophy of rehabilitation in the U.S. and its role in health care. B4. Describe the history of the development of P.T. in the U.S, development of the APTA, and priorities of the profession from the 1920\'s through present. B5. Discuss the functions of the APTA and its subgroups. B6. Describe the different types of physical therapy practice settings. B7. Identify the primary goals, outcome measures, and interventions used in physical therapy. B8. Describe common diagnoses seen in physical therapy. B9. Identify specialty areas within physical therapy. B10. Identify members of the rehab team and describe their roles in rehab. B11. Differentiate the roles and responsibilities of the PT, PTA, and non-licensed personnel. **[Physical Medicine]** - the use of rehabilitation specialties including PT, OT, ST (SLP) and recreational therapy to return physically diseased or injured patients to their maximum potential. Physical Medicine and Rehabilitation (PM & R) Team -------------------------------------------------- - Physician (often a physiatrist -- doctor of physical medicine and rehabilitation, works with neurological patients and those with chronic pain) -- oversees medical needs in rehab - PT, PTA - OT, COTA -- involved in treating BADLs (eating, bathing, dressing), IADLs (driving, working, running a household) and cognitive impairments - SLP -- speech language pathologist -- speaking, swallowing, cognitive impairments - RT -- recreational therapist -- resume hobbies (avocation) - Nursing staff - Dietician - Psychologist - LCSW -- licensed clinical social worker -- coordinates with family/patient; DC planning - Patient and family -- **patient is the most important team member**; must help with goal setting Differences between a PT and a PTA ---------------------------------- "What matters is not the letters that come after your name, but what you can do." Nancy Watts, PT, FAPTA ### Physical Therapist - Entry-level doctorate (DPT) -- this is 3 years post BS degree - Initial Evaluation (establishes POC), establishes all STGs/LTGs, D/C summary - Documentation and communication of POC - More complex treatment (according to APTA -- this is not the same as the law) - Joint mobs (peripheral -- grade 3, 4, 5; spinal -- grade 1-5) - **THIS IS THE ROOT OF CONTROVERSY ABOUT PTAs (GRADE 1/2)**. By law you are allowed to perform all joint mobs if you and supervising PT are confident with your ability. During your entry level education as PTA, we can only require competence in Grade 1/2. - Selective sharps debridement of wounds & dry needling (use of scalpel or scissors to cut along a long of demarcation separating viable and necrotic tissue and does not require prior softening of tissues by means such as hydrotherapy). ### ### Physical Therapist Assistant - Associate in Applied Science degree -- 2 years - VA law states -- "assists PT in selected components of PT intervention to include treatment, measurement, data collection but **[not]** evaluation" - Treatment interventions that have been selected by PT, usually but not limited to: - Therapeutic exercise, neuromuscular re-education, therapeutic activities, gait training, modalities, manual therapy including **peripheral** **joint mobilization (grade 1 and 2 considered entry level as of 2013),** patient education. - Assessment techniques including but not limited to: MMT and goniometry - Documentation - Daily SOAP (progress) notes, progress notes to MD, re-assessments, assists PT in the process of discharging patients (**some clinics more strict on what PTAs are allowed to do regardless of the law**) - Can modify an intervention in accordance with changes in the patient's status within the established treatment plan - Must consult PT if desire a change in treatment plan ### Physical Therapy Aide A non-licensed worker who provides PT directed support to the PT and PTA. Can perform tasks that do not require clinical decision making (PT) or clinical problem solving (PT and PTA). The PT or PTA must make the determination as to which tasks are appropriately directed to the aide. **[Physical Therapy Goals, Outcomes Measures, and Interventions]** **[Primary Goals of PT Intervention:]** 1. Improve function -- Examples: - Independent gait without AD; - Able to sit for 2 hours without pain; - Able to reach into overhead cupboard; - Able to don/doff pants safely; - Increase LEFS to greater than or equal to 70/80 to allow patient to safely negotiate stairs; - Increase DGI to greater than or equal to 22/24 to show decreased fall risk 2. Decrease pain -- Example: - Decrease pain to no greater than 2/10 during 8 hour work day to allow RTW 3. Increase strength -- Example: - Increase LE strength to 4/5 or greater to allow patient to walk safely over outdoor terrain and minimize fall risk 4. Increase ROM -- Example: - Increase (R) shoulder ER to 0-90 to allow patient to don/doff clothing independently 5. Decrease edema -- Example: - Decrease edema in (L) ankle by at least 1 cm to allow patient to wear normal shoes **[Common Outcomes Measures used to assess Functional Status]** [Patient self-report questionnaires:] - OSW (Oswestry Disability Index) -- used for low back pain - NDI (Neck Disability Index) - Quick DASH (Disabilities of the Arm, Shoulder, and Hand) - LEFS (Lower Extremity Functional Scale) - SPADI (Shoulder Pain and Disability Index) - FOTO (Focus On Therapeutic Outcomes) -- This will be in Unit \#3 [Balance assessments:] - BBS (Berg Balance Scale) - DGI (Dynamic Gait Index) - FGA (Functional Gait assessment) - TUG (Timed Up and Go) -- TUG motor and TUG cognitive - 10 meter walk test - Five times sit to stand test You will find copies of the most of the above outcome's measures in your Canvas Unit 1 Module. These are FYI. You will begin using these during clinical rotations in the spring. The self-report questionnaires are used for musculoskeletal issues in OP clinics that do not use FOTO. We will cover the balance assessments in Neuro in great detail, but you will use the 10-meter walk test in Unit 4 and the five times sit-to-stand test in Timeless Living. You can additionally go to Mission Gait.org and view their video resource library to see several of these performed. **[Physical Therapy Interventions]** 1. [Superficial heat]: (HP, paraffin, infrared) to decrease pain/mm spasm and promote healing 2. [Deep heat]: (US, diathermy) to decrease pain/mm spasm and promote healing 3. [Cryotherapy]: (cold pack, ice massage) to decrease pain, mm spasm, and inflammation 4. [Hydrotherapy]: (WP) to promote healing, decrease pain, mm spasm, and edema 5. [Ultraviolet:] (UV) to promote healing of open wounds and other skin conditions 6. [Compression therapy:] (intermittent compression pump (ICP) and compression garments- Jobst) to decrease edema 7\. [Manual and mechanical traction]: pelvic and cervical (static and intermittent) 8\. [Electrical stimulation:] a. [Neuromuscular electrical stimulation:] (NMES) to reeducate weak muscles b. [High Volt Pulsatile Current:] (HVPC) to decrease pain, mm spasm, edema and promote healing of open wounds c\. [Interferential current:] (IFC) to decrease pain and mm spasm d. d\. [Transcutaneous electrical nerve stimulation:] (TENS) to decrease pain 9\. [Biofeedback]: to decrease pain/mm spasm, increase motor control, and promote relaxation 10**. [Manual therapy]**: - [Massage (STM)]: to decrease pain, muscle spasm, and edema, to promote relaxation - [Joint mobilization]: moving joint surfaces (passive) on one another to increase P/AROM - [Muscle Energy Techniques:] (MET) using muscles and their attachment points to move bones that are out of alignment -- ex. pelvic correction - [Myofascial Release:] (MFR) gentle prolonged manual release of fascia (surrounds muscles, blood vessels, nerves, organs) - [Craniosacral therapy:] (CST) gentle prolonged manual release of dura (covering over brain and spinal cord) - [Passive ROM (PROM):] moving joints passively following surgical procedures or when active movement is contraindicated - [Instrument Assisted Soft Tissue Mobilization (IASTM):] - [Graston]: use of tools to break up scar tissue and tightness (easier on hands; deeper). - [Cupping]: use of clear cups with suction to bring blood into an area for healing. 11. **[Therapeutic exercise]**: to increase flexibility and strength, muscle reeducation, decrease tone, improve circulation, increase core stability (**includes stretching and strengthening exercises**) 12. **[Therapeutic activity]**: transfers, bed mobility, lifting techniques, throwing 13. [**Neuromuscular re-education**:] balance, muscle facilitation and re-education (often Neuro patients) 14. **[Gait training:]** ambulation with assistive devices; working on kinetics/kinematics of walking (ex. Facilitating heel strike, increased knee flexion during stance, increased hip extension during stance) 15. [Functional training:] (gait, transfer, BADLs, IADLs, bed mobility) -- not billable as a group -- each activity is billed in the highlighted groupings; these common activities are grouped as sometimes functional training especially in home health, SNF, and acute rehab settings 16. [Cardiopulmonary rehabilitation:] chest PT, cardiac rehab, breathing 17. [Prosthetic training:] using artificial limbs 18. [Aquatic therapy:] exercise in the water to reduce compressive forces in patients with arthritis 19. [Job site analysis/ergonomic assessment:] is the workplace safe? 20. [Consultation:] act as consultants for industries to prevent work injuries 21. [Group therapy:] for back patients, arthritis patients, chronic pain patients, etc. 22. [Education:] teaching in a PT/PTA program [ ] 23. [Hippotherapy:] using horses to reduce or increase tone as needed -- mostly for children 24. [Animal Facilitated Therapy:] using dolphins to treat those with cognitive/physical impairments The following information through page 7 will be primarily self-study using assignments as a study guide: **[History of Physical Therapy:]** - Physical Therapy (PT) began \~ 400 BC in Europe. - Greeks and Romans used heat such as hot wax treatments and exercise in spas, Roman spas used hydrotherapy for exercise (Roman baths) - Russians used ice for fever and gout (build up of uric acid, usually big toe, hand, or foot) - Electrotherapy began with electric fish and eels. 1^st^ book on electrotherapy written \~1600. **[Three events responsible for development of PT in US:]** 1. Increase in the number of disabled due to industrialization, polio epidemics, WWI, and WWII. 2. Increase in religious beliefs that man is worthy 3. More economic opportunities for the disabled -- more sedentary jobs available vs. manual labor jobs - Polio epidemics occurred in 1894, 1914, 1916, 1944 (1944 was worst epidemic) - The Division of Special Hospitals and Physical Reconstruction (DSH&PR) was developed in 1917 to work with the increasing number of disabled. - DSH&PR's purpose was to train reconstruction aides (the first physical therapists). - 1^st^ Reconstruction Aide/Physical Therapist in the US was Mary McMillan. - Additional programs for reconstruction aides (RAs) were developed and were 4-month intense programs for individuals with nursing or physical education backgrounds. Coursework included anatomy/physiology, hydrotherapy, electrotherapy, mechanotherapy, and massage. **[First National Organization: ]** - Was developed in 1921 in New York City - Mary McMillan was the president of the organization - Known as the American Women's Physical Therapeutic Association (AWPTA) - Name was changed in 1922 to the American Physiotherapy Association (APA) - In 1923, 2 men were admitted into the APA **[Five purposes for the AWPTA: ]** 1. To establish and maintain a professional and scientific standard for those engaged in the profession of physical therapeutics. 2. To increase efficiency in members by encouraging advanced study. 3. To disseminate information by distribution of medical literature. 4. To make available efficiently trained women to the medical profession. 5. To sustain social fellowship upon grounds of mutual interest. **[Early priorities of the Association:]** 1. 1920-30s - Worked on increasing membership in the organization, members were required to work under the direction of a physician. - 1^st^ physical therapy publication - Physiotherapy Review - **1^st^ PT program began in 1928** - Started educational requirements for PT programs - accreditation process began as a joint effort between the APA and the American Medical Association (AMA) 2\. 1940s - WWII increased the demand for PTs - 1944 -- worst polio epidemic in the history of the US - Scholarships became available to recruit people into PT - APA changed its name to the American Physical Therapy Association (APTA) in 1947 3\. 1950s - Licensure for PTs - Streamlining of education 4\. 1960s - Licensure required in all 50 states - **1^st^ PTA program was started -- 1967** - Dissatisfaction with the AMA standards in the accreditation process 5\. 1970s - In 1976, the APTA became the official accrediting agency for PT programs - Direct Access became an issue to increase professional autonomy 6\. 1980-90s - Increased PT education to a post BS degree, now received a masters degree in PT (MPT) - Continued fight for direct access - Certification of specialists -- CHT (certified hand therapist), OCS (orthopedic certified specialist), GCS (geriatric), NCS (neurologic) and PCS (pediatric) - Improved standards for PT/PTA programs through accreditation - Increased recognition of PTAs through establishment of the affiliate assembly of the APTA 7\. 2000s - Reimbursement issues -- Medicare; Affordable Care Act - **Direct access** -- **VA became 34^th^ state to achieve this on 7/1/01** - Doctorate required for entry level PT degree by 2020 (DPT) - Evidence-based practice -- Clinical Practice Guidelines (apta.org) - BS for entry level PTA degree - Outcomes (FOTO) -- data collected on all patients -- this is national, so all clinics are compared to see who is getting patients better with fewest number of visits - With COVID-19 -- Telehealth visits (began March 2020) - Concierge Physical Therapy services **[Physical Therapy Practice Settings with Common Diagnoses per Setting:]** Patients generally progress through various settings as their condition stabilizes: they generally begin in acute care, progress to subacute rehab (or SNF), then home health, and finally outpatient. Not all patients require all settings. Some come directly to outpatient depending on the severity of their condition. 1. **Hospitals (critical care, intensive care, acute care, and subacute care - subacute rehab facilities in this area include: ex. Riverside Rehab, Sentara Norfolk General, Sheltering Arms (Richmond) )** a. Acute neurologic conditions (CVA, SCI, MS, ALS, TBI) b. Acute fractures c. Burn patients d. Open wounds e. Cardiac patients (s/p MI) f. Respiratory patients (bronchitis, emphysema, asthma, COPD, CA) g. Post-surgical patients (s/p TKA, THA, meniscectomy, rotator cuff repair) h. Patients with musculoskeletal pain (acute stage often seen as inpatient vs. chronic stage often seen as outpatient) i. Amputees (TFA, TTA) j. Miscellaneous medical conditions -- dehydration, DM **2.** **Skilled nursing and extended care facilities** a\. Hip and femur fractures b. CVA and other neurological patients c. Pressure ulcers and other open wounds d. Cardiac patients e. Respiratory patients f. Musculoskeletal pain (esp. arthritis) g. Generalized weakness due to illness, periods of bed rest, dehydration h. Amputees i. Miscellaneous medical conditions **3. Outpatient clinics (private practice or hospital based)** a. Primarily orthopedic conditions (fractures, post- surgical, neck, back, shoulder, knee etc) b. Neurological conditions (CVA, MS, head injury, SCI, etc) -- fall risk patients c. Open wounds d. Amputees e. Work hardening, industrial rehab, back programs, pool therapy 4. **Home health (primarily geriatric patients)** a. CVA and other neurological patients -- fall risk b. Orthopedic patients (hip fx, s/p THA, TKA, etc) c. Open wounds d. Cardiac and respiratory patients e. Generalized weakness due to illness, surgery, dehydration, etc f. Amputees g. Miscellaneous medical conditions **5.** **Schools and playgrounds (early intervention = birth to 3 yo), preschool, primary and secondary)** a. Cerebral palsy (CP) b. Muscular Dystrophy (MD) c. Myelodysplasia (Spina Bifida) d. Head injury and other trauma patients e. Juvenile idiopathic arthritis (JIA) --formerly juvenile rheumatoid arthritis (JRA) f. Other genetic and acquired neuromuscular and musculoskeletal conditions 6. **Residential facilities for special disabilities** (mental health and cognitive impairment facilities) 7. **Athletic teams** (professional, semi-professional, college, and public schools) -- PGA/LPGA 8. **Veterans Administration facilities** (comprehensive facilities which include acute care and long term care) 9. **Private industry** (large corporations/factories may have PTs on staff to treat employees injured on the job to reduce time away from work) 11\. **Wellness and Fitness Centers** 12. **Emergency Rooms** 13. **Hospice --** end of life care (patients with terminal illnesses) 14. **Education and research centers** 15. **Community health and wellness** -- Timeless Living Fall Prevention program 16. **Telehealth** 17. **Concierge services**