Reference : Introduction to PT by Michael Pagliarulo

Many activities and some no longer participate in clinical practice DIRECT PATIENT CARE STANDARDS OF PRACTICE
Statements of conditions and performances that

are essential for the provision of high quality professional service to society , and provide a foundation for assessment of PT practice.

I.
II.

III.
IV. V.

VI.

Ethical / Legal considerations Administration of the Physical Therapy Service Patient/Client Management Education Research Community Responsibility

PRIMARY CARE BHC , family, community members SECONDARY CARE- referral basis after individual received primary care TERTIARY CARE- Specialists ALL THREE LEVELS DIRECT ACCESS VS PRACTICE WITHOUT REFERRAL

TEAM APPROACH PREVENTION AND HEALTH PROMOTION

SCREENING PREVENTION

CONSULTANTS ERGONOMICS and FUNCTIONAL CAPACITY EVALUATION ERGONOMICS the relationship between the worker, the workers task and the work environment. Work conditioning program and work hardening program.- return the individual to work.

1.

EXAMINATION is the process of gathering information about the past and current status of the patient/client.
HISTORY patient, caregivers, other health

professionals, medical records SYSTEMS REVIEW consider need of other specialists. TESTS and MEASURES

Aerobic Capacity and Endurance

Ability to use the bodys oxygen uptake and

delivery system

Anthropometric Characteristics
Body measurements and fat composition

Arousal, Attention and Cognition

Degree of responsiveness and awareness

Assistive and Adaptive devices

Equipment to aid in performing tasks

 CIRCULATION Analysis of blood and lymph movements to determine adequacy of cardiovascular pump , oxygen delivery and lymphatic drainage. CRANIAL AND PERIPHERNAL NERVE INTEGRITY-

sensory and motor nerve function ENVIRONMENTAL, HOME AND WORK BARRIERS
Analysis of physical restrictions

ERGONOMIC S AND BODY MECHANICS analysis of work tasks and postural adjustment to perform tasks.

GAIT LOCOMOTION AND BALANCE INTEGUMENTARY INTEGRITY JOINT INTEGRITY AND MOBILITY joint structure and impact on passive movement MOTOR FUNCTION control of voluntary movement MUSCLE PERFORMANCE strength, power and endurance NEUROMOTOR DEVELOPMENT and SENSORY INTEGRATION evolution of movement skills and integration of information from the environment.

ORTHOTIC, PROTECTIVE AND SUPPORTIVE DEVICES PAIN intensity, quality and frequency POSTURE body alignment and positioning PROSTHETIC REQUIREMENTS RANGE OF MOTION REFLEX INTEGRITY SELF CARE AND HOME MANAGEMENT SENSORY INTEGRITY CNS and PNS, proprioception and kinesthesia

VENTILATION AND RESPIRATION AND GAS EXCHANGE in relation to ADL and EXERCISE. WORK, COMMUNITY AND LEISURE INTEGRATION OR REINTEGRATION if patient can assume a role in community or work.

2. EVALUATION clinical judgment based on the data gathered through tests and measurements and other examination sources.- may involve consultation with others. 3. DIAGNOSIS in accordance with a policy adopted by the House of Delegates of APTA which recognizes the professional and autonomous judgment of the PT and stipulates the responsibility for referral to other practitioners when warranted.

4. PROGNOSIS- prediction of the level of improvement and time necessary to reach that level. Plan of Care, STG, LTG, outcomes, interventions and discharge criteria. 5. INTERVENTION

WRITTEN
Narrative forms Standardized forms

SOAP

Computer technology NON VERBAL

HOME INSTRUCTIONS LOCALLY TAKE INTO CONSIDERATION THE LEARNING ABILITIES DOS AND DONTS

HIGH TOUCH manual techniques HIGH TECH equipments Re-examinations or re-evaluations 1. THERAPEUTIC EXERCISE passive, active, resistive 2. FUNCTIONAL TRAINING in self care and home management ADL 3. FUNCTIONAL TRAINING in work, community and leisure integration or reintegration.

MANUAL THERAPY TECHNIQUES PRESCRIPTION, APPLICATION, AND FABRICATION OF DEVICES AND EQUIPMENT AIRWAY CLEARANCE TECHNIQUES INTEGUMENTARY REPAIR AND PROTECTIVE TECHNIQUES ELECTROTHERAPEUTIC MODALITIES PHYSICAL AGENTS AND MECHANICAL MODALITIES.

DISCHARGE when the goals and outcomes have been achieved as based on the PTs judgment Both should be planned, documented and followed-up.

1.

2.

3.

DISCONTINUATIONWhen the patient/client decides to terminate services The individual is no longer able to continue because of medical or financial reasons. PT believes that further intervention will not benefit the individual.

PATIENT CENTERED CONSULTATION CLIENT CENTERED CONSULTATION EDUCATION to lay persons, family, patients, educational institutions CRITICAL INQUIRY ADMINISTRATION promotion ladder involves more administrative responsibilities at the expense of patient care activities.

PT PERSPECTIVES

Practice of medicine requires team effort. One member of the team cannot do well without the others. It is a wrong perception that a physiatrist can handle everything regarding patient care. Below are team models we may observe in our healthcare practice. Each model has its own advantages and disadvantages

HEALTH CARE TEAM

Group of health care professionals from different disciplines who share common values and objectives. Ex. Rehabilitation team

Refers to the traditional model The physician attends to the patients needs. When the services of another discipline are needed, the doctor consults the professional but the former will give specific instructions or general requests on what is to be done. Any new problem or recommendation must always be consulted to the attending physician.

Advantage: There is a clear chain of responsibility, which is important medico legally. Disadvantage: Coordination of the other health workers, the physician, and the patient may be limited and compromised.

Efforts of the team are parallel and discipline oriented. Team members need only to know the skill related to their discipline Each discipline provides each own unique activity This model however is still physician-controlled. Under the physician are the rest of the team members, including the patient. Patient and family is part of the team

Advantage: provides means for multiple professionals who require frequent interactions to meet and coordinate efforts on consistent basis. Disadvantage: no lateral communication Pyramid type model During team meeting, communication is only vertical.

Team members from various disciplines work in tandem toward a common goal. Group effort, synergistic thus the team produces/accomplishes more than the sum of an individualized effort.

Expected norm is group decision making and group responsibility for developing for developing optimal care planning. Requires a team conference after the individual evaluation by each discipline.

Members communicate , collaborate and consolidate knowledge from which the treatment goals and plan are made and evaluated. Lateral communication becomes present. Requires intra-team communication to be successful. Results in a coordinated non fragmented, costeffective rehabilitation program

Fosters mutual authority. Whenever a certain decision is to be made, all of the members of the team should have been consulted. In addition, the responsibility of deciding does not only fall on the physician, but to the whole team.

more collaborative; health workers from other disciplines do not merely become a physicians follower but are also able to practice their own clinical skills in devising managements for the patient Matrix organization model Comparable to the rehabilitation team model.

requires high level of competence from other team members Requires training in team building and the team process. The physician may be uncomfortable with the team decision making process because of medicolegal responsibility. Management may be delayed when conflict exist since they must always be resolved by the team.

Cross treatment between disciplines Developed largely out of educational models, justified based on the inadequate number of rehabilitation professionals Example is the cross training of teachers and aides in providing community services.

This trained health workers are readily available to the patients Will work well in certain settings such as in the community based rehabilitation programs of remote areas of our country.

Assurance of competent care is still doubtful Maybe limited by state licensure and qualifications requirement.

PRODUCTIVE AND STIMULATING GOAL ORIENTED AND THE GROUP REMAINS FOCUSED ON THE TASK THROUGH-OUT THE MEETING INVOLVES CREATIVITY, PROBLEM SOLVING AND INTERACTION.

PT PERSPECTIVES ANNA MARGARITA FERMINA GUICO, PTRP

The goal of the physical medicine and rehabilitation treatment (PM&R) team is to work together with the patient and family to help a person with an injury or disability reach maximum potential.

REHABILITATION TEAM

The team is usually directed by a physiatrist, with other specialists playing important roles in the treatment and education process. Team members involved depend on many factors, including patient need, facility resources, and insurance coverage for services.

The patient and family are considered the most important members of the rehabilitation team.

A physician who evaluates and treats rehabilitation patients. The physiatrist is usually the team leader and is responsible for coordinating patient care services with other team members. A physiatrist focuses on restoring function to people with disabilities.

A nurse who specializes in rehabilitative care and assists the patient in achieving maximum independence, especially in regards to medical care, prevention of complications, and patient and family education.

A professional counselor who acts as a liaison for the patient, family, and rehabilitation treatment team. The social worker helps provide support, and coordinate discharge planning and referrals, and may also help coordinate care with insurance companies.

A therapist who helps restore function for patients with problems related to movement, muscle strength, exercise, and joint function.

A therapist who helps restore function for patients with problems related to activities of daily living (ADLs) including work, school, family, and community and leisure activities.

A therapist who helps restore function for patients with problems related to cognitive, communication, or swallowing issues.

A physician or counselor who conducts cognitive (thinking and learning) assessments of the patient and helps the patient and family adjust to the disability.

A healthcare professional who specializes in the evaluation and treatment of hearing and hearing loss.

A nutritionist who evaluates and provides for the dietary needs of each patient based on the patient's medical needs, eating abilities, and food preferences.

A counselor who assists people with disabilities to plan careers and find and keep satisfying jobs.

A healthcare professional who makes braces or splints used to strengthen or stabilize a part of the body.

A healthcare professional who makes and fits artificial body parts, such as an artificial leg or arm.

A rehabilitation case manager helps plan, organize, coordinate, and monitor services and resources for the patient.

A therapist who helps treat and restore function for patients with airway and breathing problems.

A spiritual counselor who helps patients and families during crisis periods and helps serve as a liaison between the hospital and the home church or place of worship.

Most rehabilitation teams hold weekly, biweekly, or monthly meetings, depending on the setting. Topics covered at team meetings include such items as the following: the patient's plan of care the patient's progress short- and long-term goals length of stay patient and family education needs discharge planning

Team meetings help with communication and planning among team members and the patient and family. Reports of team meetings are often shared with insurance companies and case managers to assist in discharge planning, use of resources, and continuation of care.

PT PERSPECTIVES ANNA MARGARITA FERMINA GUICO, PTRP

 The anatomical position is the

universal starting position for describing movements, with the exception of horizontal flexion, which occurs when the arm moves forwards from an already abducted position.

If the movement would not cross through the plane, it is said to occur within it. For example, if you turn your head to the right, the head moves in the horizontal plane (it is rotational moves that take place in the horizontal plane). If you lift your leg straight up, the movement occurs in the sagittal plane. If you lift your leg to the side, the movement occurs in the frontal plane.

Movement AND Definition Flexion-Narrowing joint angle in sagittal plane (bending elbow). Extension-Increasing joint angle in sagittal plane (straightening elbows). Hyperextension-Increasing angle more than in natural position, eg bending backwards

Abduction-Lifting a body part away from body midline (in frontal plane). Adduction-Returning a body part to body midline (in frontal plane) Rotation-Turning a body part on axis (horizontal plane) (not rotation all the way round - see circumduction).

Lateral flexion- Bending body sideways (frontal plane) Lateral extension- Returning body to anatomical position Elevation -Lifting a body part (shoulder shrugs) Depression-Lowering a body part (dropping the jaw) Protraction-Moving a body part outwards Retraction-Bringing a body part back

Horizontal Flexion (starts from abducted position)- Moving arm forwards in horizontal plane Horizontal Extension (starts from abducted position)- Returning arm to the abducted position.

Dorsal Flexion/dorsiflexion- Bending ankle so that the toes are raised Plantar Flexion- Hyperextending ankle joint so toes point downwards Circumduction-Range of movements that create a complete circle (as opposed to a rotation of less than 360 degrees.)

Bones can be separated into five different bone types: Long bones - these are the bones connected with large movement. They are long and cylindrincal with growth heads epiphyses (singular epiphysis pronounced epi-physis) at either end. The epiphysis is covered by articular cartilage.

The outer layer of the bone is hard, and is called "compact bone". The inside of the bone is spongy, called "cancellous bone". Examples of long bones include the femur (thigh bone), the humerus (upper bone in the arm) and the phalanges (fingers and toes).

Short bones - these bones are almost cube shaped and associated with smaller, more complex movements. Examples of complex bones include the carpals (small bones in the base of the hand) and tarsals (in the feet). Flat bones - these bones protect the internal organs and include the skull (cranium), ribs, scapula (shoulder blade), sternum (breast bone) and the pelvic girdle.

 Irregular bones - these bones are

irregular in shape and include the vertebrae and some facial bones. Sesamoid bones - these are small bones held within tendons and include the patella (knee cap). Cartilage separates the femur and the patella, and acts as a shock absorber.

When the foetus in the womb initially starts to develop it has no bone, only cartilage. At 6-7 weeks, the ossification process starts. When the baby is born, it has over 300 bones, but as the baby grows up, many bones fuse together and a fully grown adult has just 206 bones. When ossification occurs, cartilage is replaced with bone by laying down calcium. This process is known as calcification

During the growth phase, the bone grows from the growth plates (epiphyseal plates) which are situated at the end of the bone, just before the epiphysis. At the end of growth, between the ages of about 16 - 21, these epiphyseal plates turn to bone.

Two types of cell involved in bone growth are osteoblasts and osteoclasts. Osteoblasts lay down new bone, whilst osteoclasts clear away the old bone. Growth occurs when the cells in the cartilage divide and push the older cartilage cells down towards the bone. The diaphysis ossifies first, followed by the epiphyses.

Sufficient calcium Sufficient phosphorus Vitamins, especially vitamin D which is involved in the absorption of calcium The correct hormone balance, specifically:

Growth hormone from the pituitary gland
Calcitonin from the thyroid gland. Calcitonin metabolises

calcium and phosphorus. Parathormone - from the parathyroid gland - almost works in opposition to calcitonin to balance it out. The sex hormones, testosterone and oestrogen.

Women start to lose calcium from their bones at around the age of 40, and in men at around the age of 60, perhaps eventually leading to brittle bone disease osteoporosis. Other causes of osteoporosis include prolonged treatment with cortisone steroids, anorexia nervosa and an inadequate diet, especially during pregnancy and breast feeding.

However, it is possible to increase bone density by performing weight bearing exercise, taking calcium supplements (where the diet does not contain sufficient calcium) and, in women, oestrogen replacement therapy.
Protein formation in bone decreases with age, which can make bones more liable to fracture.

DRAW THE SCAPULA AND LABEL