2. © 2009 The McGraw-Hill Companies, Inc. All rights reserved PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson Assisting with Cold and Heat Therapy and Ambulation

3. 42-2 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Learning Outcomes 42.1 Explain how medical assistants might assist with some forms of physical therapy. 42.2 Describe ways to test joint mobility, muscle strength, gait, and posture. 42.3 Discuss the benefits of cold and heat therapies. 42.4 List contraindications to cold and heat therapies. 42.5 Identify various cold and heat therapies.

4. 42-3 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Learning Outcomes (cont.) 42.6 Demonstrate how to perform cold and heat therapies. 42.7 Describe hydrotherapy methods. 42.8 Identify several methods of exercise therapy. 42.9 Compare different methods of traction. 42.10 Demonstrate how to teach a patient to use a cane, a walker, crutches, and a wheelchair.

5. 42-4 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Introduction  Medical assistant Common duties  Apply cold and heat therapy  Assist patients with ambulation  You may also Teach basic exercises Demonstrate how to use a wheelchair Demonstrate the use of cane, walker, and crutches Discuss therapies with the patient

6. 42-5 © 2009 The McGraw-Hill Companies, Inc. All rights reserved General Principles of Physical Therapy  Physical therapy is a medical specialty that treats Musculoskeletal disorders Nervous disorders Cardiopulmonary disorders

7. 42-6 © 2009 The McGraw-Hill Companies, Inc. All rights reserved General Principles of Physical Therapy (cont.)  Assisting the therapeutic team Members  Physicians  Nurses  Medical assistants  Other specialists Coordinate patient schedule Make referrals Explain treatment approach Documentation Reinforce instructions Answer patient questions You must have a working knowledge of therapy techniques.

8. 42-7 © 2009 The McGraw-Hill Companies, Inc. All rights reserved  Specialized therapies Art Music Dance Writing Crafts Aquatic Horticultural Equestrian General Principles of Physical Therapy (cont.)

9. 42-8 © 2009 The McGraw-Hill Companies, Inc. All rights reserved  Joint mobility testing Range of motion – degree to which a joint is able to move Goniometer Degree of movement compared to a standard measure  Muscle strength testing Determines the amount of force the patient can exert with a group of muscles Compare each side of body General Principles of Physical Therapy: Patient Assessment

10. 42-9 © 2009 The McGraw-Hill Companies, Inc. All rights reserved  Gait testing The way a person walks (gait and swing) Includes  Length of stride  Balance  Coordination  Direction of knees and feet  Posture Body position and alignment Checks spinal curves Symmetry of alignment  Shoulders  Knees  Hips General Principles of Physical Therapy: Patient Assessment (cont.)

11. 42-10 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge Match description with assessment type: ___ How a person walksA. Joint mobility ___ Range of motionB. Muscle strength ___ Body position and alignmentC. Posture ___ Force exerted with a group of musclesD. Gait ___ Goniometer ___ Check spinal curves ___ Length of stride C D C B A A D Good Job! ANSWER:

12. 42-11 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Cryotherapy and Thermotherapy  Cryotherapy Applying cold for therapeutic reasons Types  Wet or dry  Chemical or natural  Thermotherapy Applying heat for therapeutic reasons Types  Dry  Moist

13. 42-12 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Cryotherapy and Thermotherapy (cont.)  Generally promote healing  Side effect – damage to underlying nerves and tissues  Monitor patient closely  Factors affecting the use of these treatments Age Treatment location Circulation or sensation impairment Temperature tolerance

14. 42-13 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Cryotherapy and Thermotherapy (cont.)  Principles of cryotherapy Constricts blood vessels Physiologic responses to cold  Prevents swelling  Controls bleeding  Reduces inflammation  Anesthetic effect for pain  Reduces pus formation  Lowers body temperature

15. 42-14 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Cryotherapy and Thermotherapy (cont.)  Administering cryotherapy Dry cold applications  Ice bags and collars  Chemical ice packs Wet cold applications  Cold compresses  Ice massage

16. 42-15 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Cryotherapy and Thermotherapy (cont.)  Principles of thermotherapy Dilates blood vessels Physiologic responses to heat  Relieves pain and congestion  Reduces muscle spasms  Muscle relaxation  Reduces inflammation  Reduces swelling

17. 42-16 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Cryotherapy and Thermotherapy (cont.)  Administering thermotherapy Dry heat therapies  Chemical hot packs  Heating pad  Hot-water bottle  Heat lamp  Fluidotherapy

18. 42-17 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Cryotherapy and Thermotherapy (cont.) Moist heat applications  Hot soak  Hot compress  Hot pack  Paraffin bath Diathermy – high- frequency wave achieves deep heat penetration  Ultrasound  Shortwave  Microwave

19. 42-18 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge What is the main difference in the effect of cryotherapy and thermotherapy that results in the physiologic response of each? ANSWER: Cryotherapy causes blood vessels to constrict, resulting in its physiologic effects, while thermotherapy causes blood vessels to dilate.

20. 42-19 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Hydrotherapy  Use of water to treat physical problems  Whirlpools Water is agitated by jets of air under pressure Generates hydromassage  Relaxes muscles  Increases circulation Also used to clean and debride wounds, ulcers, and burns

21. 42-20 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Hydrotherapy (cont.)  Contrast baths 2 baths, one hot and one cold Patient moves quickly from one to the other Purpose  Induces relaxation  Improves circulation  Greater mobility  Underwater exercises Warm swimming pool Buoyancy takes pressure off joints Purpose  Promotes relaxation  Increases circulation

22. 42-21 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge What are the main effects of hydrotherapy? ANSWER: Hydrotherapy relaxes muscles, increases circulation, and improves flexibility and mobility.

23. 42-22 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Exercise Therapy  Preventive and therapeutic benefits Flexibility Mobility Muscle tone Strength  Primary treatment for fractures, arthritis, and some respiratory diseases Minimizes symptoms Slows disease progression

24. 42-23 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Exercise Therapy (cont.)  Exercise Improves muscle tone and strength Maintains ROM Prevents or corrects physical deformities Promotes neuromuscular coordination Improves circulation Relieves stress Lowers cholesterol levels Aids in resumption of normal daily activities

25. 42-24 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Exercise Therapy: Medical Assistant’s Role  Provide patient information Types of exercise programs Treatment plan  Provide support and encouragement  Assist with ROM exercises  Teach the patient and family about ROM exercises.

26. 42-25 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Exercise Therapy: Type of Exercise  Choice based on patient’s physical condition  Active mobility Self-directed exercises Increase muscle strength and function  Passive mobility Therapist or machine moves the patient’s body part Retain ROM and improve circulation  Aided mobility Self-directed with assistance of a device such as exercise machine Retain or improve ROM

27. 42-26 © 2009 The McGraw-Hill Companies, Inc. All rights reserved  Active resistance Works against resistance Increases muscle strength  Isometric Patient relaxes and then contracts muscles while in a fixed position Maintains muscle strength if immobilized  ROM exercises Move each joint through its full range of motions Improves flexibility and mobility Improves circulation and muscle function Exercise Therapy: Type of Exercise (cont.)

28. 42-27 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Exercise Therapy: Electrical Stimulation  Delivers a controlled amounts of low-voltage electric current to motor and sensory nerves Stimulates muscle Prevents atrophy Helps in healing injured joints Retrains a patient to use injured muscles

29. 42-28 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge Match description with type of exercise: ___ Self-directed; exercise machineA. Isometric ___ Self-directed; no assistanceB. Aided mobility ___ Low-voltage current; stimulates C. Active resistance nerves / muscles ___ Relax and contract muscles fromD. Electrical fixed position stimulation ___ Exercise against counter-pressureE. Active mobility ___ Move joint through full rangeF. ROM D E F C A YIPPEE! B ANSWER:

30. 42-29 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Traction  The pulling or stretching of the musculoskeletal system Used to treat fractured bones and dislocation, arthritic, or other diseased joints  Uses Create and maintain bone alignment Reduce and prevent joint stiffening Correct deformities Reduce and relieve muscle spasms

31. 42-30 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Traction (cont.)  Manual Stretching muscles and separating joints by gently pulling on them Improves motion and decreases stiffening Uses  Muscle spasms  Stiffness  Arthritis  Static Weight traction using harness and weights Used to relieve muscle spasms

32. 42-31 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Traction (cont.)  Skeletal Long-term / heavy weights Pins, wires, or tongs surgically placed Pulleys and weights provide continuous traction  Mechanical Device intermittently pulls and relaxes Promotes relaxation

33. 42-32 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge True or False: ___ Static traction uses a harness and weights to induce muscle spasms. ___ Manual traction stretches muscles and separates joints by gently pulling on them. ___ Skeletal traction uses pulleys and weights to provide continuous traction. ___ Mechanical traction maintains constant tension on the extremity. F T T F alternately pulls and relaxes relieve ANSWER: F A N T A S T I C !

34. 42-33 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Mobility Aids  Devices to improve patients’ ability to ambulate or move about  Mobility aid chosen depends on Patient’s disability Muscle coordination Strength Age

35. 42-34 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Mobility Aids: Canes  Standard Patient who needs only small amount of support  Tripod (3 legs) and quad-base (4 legs) Create wide base of support More stable than standard canes  Must be adjusted to correct height for patient

36. 42-35 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Mobility Aids: Walkers  Used by older patients with Difficulty walking unassisted Balance problems  Provides a sense of stability  Types – Table 42-2  Adjust to proper height for patient

37. 42-36 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Mobility Aids: Crutches  Transfers weight to the arms  Types Axillary  Ground to axilla  Short-term use Lofstrand, or Canadian  Ground to forearm  Long-term use

38. 42-37 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Mobility Aids: Crutches (cont.)  Complications may arise if not measured properly Pressure on nerves in axilla Strain on back, imbalance  Measuring for crutches Should be 2 to 3 finger-widths between supports and axilla 30º flexion at elbow

39. 42-38 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Mobility Aids: Crutches (cont.)  Crutch gaits Four-point – slow gait for a patient who can bear weight on both legs Three-point – used when patient cannot bear weight on one leg Two-point – used when patient can have some weight on both legs; must have good muscle coordination and balance Swing gait – used when patient has severe disabilities

40. 42-39 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Mobility Aids: Wheelchairs  Type of chair chosen Depends on patient’s disability Length of time wheelchair needed  Always ensure patient safety during transfers  Use appropriate lifting techniques

41. 42-40 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Apply Your Knowledge When would a walker be an appropriate mobility device for use by your patient? ANSWER: Walkers are used by older patients who are too weak to walk unassisted or who have balance problems. Hip-Hip- Hurray!

42. 42-41 © 2009 The McGraw-Hill Companies, Inc. All rights reserved Referral to a Physical Therapist  Referrals to preferred therapists Provide physician’s order Provide patient information  Therapists Independent practitioners Hospital or clinic Home health

43. 42-42 © 2009 The McGraw-Hill Companies, Inc. All rights reserved In Summary  Physical therapy Medical specialty – musculoskeletal and neurological disorders Therapeutic effects through  Physical and mechanical processes  Patient education  Rehabilitation programs  Therapy chosen depends on patient needs  Medical assistant Assist with therapies Provide patient education

44. 42-43 © 2009 The McGraw-Hill Companies, Inc. All rights reserved End of Chapter Disability is a matter of perception. If you can do just one thing well, you're needed by someone. ~ Martina Navratilova