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THE ROLE OF THE PHYSICAL THERAPIST IN THE HEALTHCARE TEAM Eric L. Lippincott, PT, ATC Associate Professor Health Science Department Lock Haven University 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 A bit about PTs Current degree is DPT (clinical doctorate) National exam with state licensure and CE requirements Practice settings Hospital LTC Outpatient Schools Home Health Universities Work Settings Rehab Hospitals Advanced Certifications (residency, fellowship, certifications) 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 PTs and the Continuum of Care Typical progression is from in-patient to out-patient to community-based facility 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 Physical Therapy Treatments Thermal Agents Manual Therapy Techniques Electrical Agents Ultrasound/Phonophoresis Laser Therapy Therapeutic Exercise ACTIVE vs PASSIVE TREATMENT EDUCATION & PREVENTION 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 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 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 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? Manual Therapy Techniques Massage Treatment result depends on technique Myofascial Techniques Mobilization (including manipulation) Stretch peri-articular structures Manipulation depends on state practice act Electrical Agents Examples Electrical stimulation Iontophoresis Electrical Stimulation Effects: Pain reduction (sensory level) Edema reduction Motor stimulation – atrophy and denervation Contraindications Cancer Pacemakers Over the carotid sinus and spinal cord So what about these??? Iontophoresis Using electrical current to facilitate transmission of medication ions through the skin Typical medications include analgesics and antiinflammatories (dexamethasone and lidocaine are most common) Not strongly supported in the literature Ultrasound Ultrasound – sound waves produced by crystal in the sound head Can have both thermal and nonthermal 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 Phonophoresis Using sound waves to facilitate the transmission of medications through the skin Examples: hydrocortisone, dexamethasone, lidocaine Not strongly supported in the literature Laser Therapy (LLLT) Relatively new to the marketplace and only FDAapproved for certain diagnoses Effects are similar to ultrasound Outcomes are pending Mechanical Devices Intermittent Compression (Jobst) Biofeedback Continuous Passive Motion (CPM) Traction Therapeutic Exercise ROM – AROM / AAROM / PROM Muscle tightness, decrease in joint mobility, postural problems Strengthening Balance / Neuromuscular Control HEP Have you seen these kids? 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 Acute Injury Rehab Follows tissue healing guidelines Inflammatory Stage PRICE Immobilize Modalities Fibroblastic Stage Restore ROM Begin strengthening and balance Remodeling Advanced Stage strengthening and functional training 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 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 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 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 Arthritis Treatment Decrease joint stiffness ROM exercises Thermal modalities HEP & Education Strengthen as tol (surrounding musculature) What about Athletic Trainers? Education falls under six domains Prevention Professional Responsibility Clinical Evaluation and Diagnosis Organization & Administration Immediate Care Credential varies by state Education includes modalities and rehabilitation Current PA practice act includes treatment of physically active Treatment, Rehab, & Reconditioning Questions and Thank You
