2. CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42 Assisting with Cold and Heat Therapy and Ambulation

3. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-2 Learning Outcomes 42.1Explain how medical assistants might assist with some forms of physical therapy. 42.2Describe ways to test joint mobility, muscle strength, gait, and posture. 42.3Discuss the benefits of cold and heat therapies. 42.4List contraindications to cold and heat therapies. 42.5Identify various cold and heat therapies.

4. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-3 Learning Outcomes (cont.) 42.6 Demonstrate how to perform cold and heat therapies. 42.7Describe hydrotherapy methods. 42.8Identify several methods of exercise therapy. 42.9Compare different methods of traction. 42.10Demonstrate how to teach a patient to use a cane, a walker, crutches, and a wheelchair.

5. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-4 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-5 General Principles of Physical Therapy Physical therapy is a medical specialty that treats –Musculoskeletal disorders –Nervous disorders –Cardiopulmonary disorders

7. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-6 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-7 General Principles of Physical Therapy (cont.) Specialized therapies –Art –Music –Dance –Writing –Crafts –Aquatic –Horticultural –Equestrian

9. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-8 Patient Assessment Joint mobility testing –Range of motion (ROM) – 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

10. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-9 Patient Assessment (cont.) 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

11. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-10 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-11 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-12 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 –Treatment location –Circulation or sensation impairment –Temperature tolerance –Age

14. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-13 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-14 Administering Cryotherapy Dry cold applications –Ice bags and collars –Chemical ice packs Wet cold applications –Cold compresses –Ice massage

16. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-15 Principles of Thermotherapy Dilates blood vessels Physiologic responses to heat –Relieves pain and congestion –Reduces muscle spasms –Muscle relaxation –Reduces inflammation –Reduces swelling

17. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-16 Administering Thermotherapy Dry heat therapies –Chemical hot packs –Heating pad –Hot-water bottle –Heat lamp –Fluidotherapy

18. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-17 Administering 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-18 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-19 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-20 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-21 Apply Your Knowledge What are the main effects of hydrotherapy? ANSWER: Hydrotherapy relaxes muscles, increases circulation, and improves flexibility and mobility.

23. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-22 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-23 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-24 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-25 Types 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-26 Types of Exercise (cont.) 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

28. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-27 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-28 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-29 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-30 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-31 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-32 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-33 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-34 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-35 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-36 Crutches Transfers weight to the arms Types –Axillary Ground to axilla Short-term use –Lofstrand, or Canadian Ground to forearm Long-term use

38. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-37 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-38 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-39 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-40 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-41 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. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-42 In Summary 42.1 A medical assistant may be asked to apply cold and heat; teach basic exercises; demonstrate how to use a cane, walker, and crutches; demonstrate how to use a wheelchair; and discuss with the patient specific therapies for use at home. 42.2Various physical tests are performed on patients, including joint mobility testing, muscle strength testing, gait, and posture testing. 42.3Cold and heat therapy promote healing and increase patient comfort.

44. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-43 In Summary (cont.) 42.4Contraindications to cold and heat therapies include circulation problems, pain, and hemorrhage. 42.5There are various types of cold and heat therapies. These include dry and wet, cold, and heat applications. 42.6The general steps to applying cold and heat therapies include checking the physician’s order, positioning and draping the patient, applying the pack, and monitoring the patient. 42.7Various types of hydrotherapy used to treat physical problems include whirlpools, contrast baths, and underwater exercises.

45. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-44 In Summary (cont.) 42.8There are several methods of exercise therapy, including active mobility, passive mobility, aided mobility, and active resistance. 42.9The different methods of traction used to treat physical problems include manual, static, skeletal, and mechanical. 42.10There are various mobility aids, including canes, walkers, crutches, and wheelchairs. Specific instructions for each of these aids must be followed to reduce the possibility of patient injury during their use.

46. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42-45 End of Chapter 42 Disability is a matter of perception. If you can do just one thing well, you're needed by someone. ~ Martina Navratilova