1. THE ROLE OF THE PHYSICAL THERAPIST IN THE HEALTHCARE TEAM Eric L. Lippincott, PT, ATC Associate Professor Health Science Department Lock Haven University

2. Objectives  Define and describe the role of the physical therapist in the healthcare team  Describe role of the PT within the continuum of care  Identify patients within various primary care settings that may benefit from physical therapy services  Identify specific therapies, and services provided by Physical Therapists  Differentiate between various PT Modalities, including indications, contraindications, and their application

3. A bit about PTs  Current degree is DPT (clinical doctorate)  National exam with state licensure and CE requirements  Practice settings HospitalLTCOutpatient SchoolsUniversitiesRehab Hospitals Home HealthWork Settings  Advanced Certifications (residency, fellowship, certifications)

4. Role of PTs in the “Team”  Providers who examine and treat individuals who have a limitation in function  PT vs OT  Trained in four major body systems  Musculoskeletal  Neuromuscular  Cardiovascular / Pulmonary  Integumentary  Referral vs Direct Access

5. PTs and the Continuum of Care  Emergency Room  ICU/CCU  Acute Care Facility  Sub-Acute / Step Down  Rehabilitation Hospital / Center  SNF / LTC  Home Health  Hospice  Outpatient Rehab  Outpatient Ortho  School System  Athletic Facility  Industry Typical progression is from in-patient to out-patient to community-based facility

6. Physical Therapy Treatments  Thermal Agents  Manual Therapy Techniques  Electrical Agents  Ultrasound/Phonophoresis  Laser Therapy  Therapeutic Exercise  ACTIVE vs PASSIVE TREATMENT  EDUCATION & PREVENTION

7. Thermal Agents  Options  Cold Modalities Ice Bags, Reusable Cold Packs Ice Massage Ice Immersion Cryostretch? Cryokinetics  Heat Modalities Moist Heat Packs Paraffin Diathermy – deep heat Ultrasound – deep heat - more to come later  Whirlpool

8. Thermal Agents – Cold Modalities  Temp between 32˚ and 65˚ F  Local Effects  Vasoconstriction  Decreased cellular metabolism  Decreased production of cellular waste  Reduction in inflammation  Decreased pain and muscle spasm  Ideal treatment is typically 15 min  Indications  Acute injury, pain, edema or inflammation  Muscle Spasm  Contraindications  Cardiac or respiratory concerns  Cold allergy  Decreased sensation

9. Thermal Agents – Heat Modalities  Superficial Agents - 104˚ - 113˚ F  Local Effects  Vasodilation  Increased cell metabolism  Increased delivery of leukocytes  Increased elasticity of tissue  Decreased spasm  Ideal treatment is typically 15-20 min  Indications  Subacute or chronic inflammation and pain  Muscle spasm  Decreased ROM  Contraindications  Acute injuries  Impaired circulation  Poor thermal regulation  Neoplasm  Decreased sensation

10. Hot vs Cold  Does the area feel warm to touch?  Is the area tender?  Does swelling increase with activity?  Does pain limit joint motion?  Is the patient in acute stage?

11. Manual Therapy Techniques  Massage  Treatment result depends on technique  Myofascial Techniques  Mobilization (including manipulation)  Stretch peri-articular structures  Manipulation depends on state practice act

12. Electrical Agents  Examples  Electrical stimulation  Iontophoresis

13. Electrical Stimulation  Effects:  Pain reduction (sensory level)  Edema reduction  Motor stimulation – atrophy and denervation  Contraindications  Cancer  Pacemakers  Over the carotid sinus and spinal cord

14. So what about these???

15. Iontophoresis  Using electrical current to facilitate transmission of medication ions through the skin  Typical medications include analgesics and anti- inflammatories (dexamethasone and lidocaine are most common)  Not strongly supported in the literature

16. Ultrasound  Ultrasound – sound waves produced by crystal in the sound head  Can have both thermal and non- thermal effects  Thermal effects are deeper than traditional thermal modalities  Contraindications  Metal implants  Undiagnosed fracture  Cancer  Acute inflammation/infection  Over epiphyseal plates and the spinal cord

17. Phonophoresis  Using sound waves to facilitate the transmission of medications through the skin  Examples: hydrocortisone, dexamethasone, lidocaine  Not strongly supported in the literature

18. Laser Therapy (LLLT)  Relatively new to the marketplace and only FDA- approved for certain diagnoses  Effects are similar to ultrasound  Outcomes are pending

19. Mechanical Devices Intermittent Compression (Jobst) Continuous Passive Motion (CPM) Biofeedback Traction

20. Therapeutic Exercise  ROM – AROM / AAROM / PROM  Muscle tightness, decrease in joint mobility, postural problems  Strengthening  Balance / Neuromuscular Control  HEP

21. Have you seen these kids?

22. Specific Therapies and Services  Discuss basic therapy for each of the following:  Acute musculoskeletal injury  Fracture Care  Post operative care  Integumentary Issues  CNS Rehab  Arthritis/Connective Tissue Disease Rehab

23. Acute Injury Rehab  Follows tissue healing guidelines  Inflammatory Stage PRICE Immobilize Modalities  Fibroblastic Stage Restore ROM Begin strengthening and balance  Remodeling Stage Advanced strengthening and functional training

24. Fracture Care Rehab  ROM limitations, atrophy, and deconditioning are the major concerns  Restore ROM once fracture is stable  Strengthen as tol (WBing increases bone density)  Associated joints  Cross Train

25. Post-Op Care  Hospital-Based Therapy  Assistive Device / DME  Gait Initiation / Training  Education (ie hip precautions)  Begin strengthening  Out-Patient / Home-Based  ROM followed by strengthening  Specific protocol dictated by operative procedure  Amputations  Desensitization treatment  Prevent contractures  Prosthetic fitting & prescription  Gait training & strengthening

26. Treatment of Integumentary Issues  Burns  Typical wound care – debridement, packing, and dressing  Prevention of contractures  Pressure to prevent keloids  Skin Lesions – treatment depends on type  Debridement  Packing, Dressing, and Casting  Education

27. CNS Rehab (CVA, TBI, SCI)  Deficits depend upon location of injury  Carefully directed, structured repetitive practice  Acute treatment focuses on initiating movement  Progress to promoting independence (ADLs, DME, etc)  Safety, thought initiation, emotional disturbances  Usually a team approach to rehab

28. Arthritis Treatment  Decrease joint stiffness  ROM exercises  Thermal modalities  HEP & Education  Strengthen as tol (surrounding musculature)

29. What about Athletic Trainers?  Education falls under six domains  Credential varies by state  Education includes modalities and rehabilitation  Current PA practice act includes treatment of physically active  Prevention  Professional Responsibility  Clinical Evaluation and Diagnosis  Organization & Administration  Immediate Care  Treatment, Rehab, & Reconditioning

30. Questions and Thank You