Bài giảng Clinical procedures - Chapter 11: Assisting with Cold and Heat Therapy and Ambulation

11Assisting with Cold and Heat Therapy and Ambulation11-*Learning Outcomes11.1 Explain how medical assistants might assist with some forms of physical therapy.11.2 Describe ways to test joint mobility, muscle strength, gait, and posture.11.3 Discuss the benefits of cold and heat therapies.11.4 List contraindications to cold and heat therapies.11.5 Identify various cold and heat therapies.11-*Learning Outcomes (cont.)11.6 Demonstrate how to perform cold and heat therapies.11.7 Describe hydrotherapy methods.11.8 Identify several methods of exercise therapy.11.9 Compare different methods of traction.11.10 Demonstrate how to teach a patient to use a cane, a walker, crutches, and a wheelchair. 11-*Introduction Medical assistantCommon dutiesApply cold and heat therapy Assist patients with ambulationYou may also Teach basic exercisesDemonstrate how to use a wheelchairDemonstrate the use of cane, walker, and crutchesDiscuss therapies with the patient11-*General Principles of Physical TherapyPhysical therapy is a medical specialty that treatsMusculoskeletal disordersNervous disordersCardiopulmonary disorders11-*General Principles of Physical Therapy (cont.) Assisting the therapeutic teamMembers PhysiciansNursesMedical assistantsOther specialistsCoordinate patient scheduleMake referralsExplain treatment approachDocumentationReinforce instructionsAnswer patient questions You must have a working knowledge of therapy techniques.11-*General Principles of Physical Therapy (cont.) Specialized therapiesArtMusicDanceWritingCraftsAquaticHorticulturalEquestrian11-*Patient Assessment Joint mobility testingRange of motion (ROM) – degree to which a joint is able to moveGoniometerDegree of movement compared to a standard measureMuscle strength testing Determines the amount of force the patient can exert with a group of musclesCompare each side of body11-*Patient Assessment (cont.) Gait testing The way a person walks (gait and swing)IncludesLength of strideBalance CoordinationDirection of knees and feetPosture Body position and alignmentChecks spinal curvesSymmetry of alignmentShouldersKneesHips 11-*Apply Your KnowledgeMatch description with assessment type:___ How a person walks A. Joint mobility___ Range of motion B. Muscle strength___ Body position and alignment C. Posture___ Force exerted with a group of muscles D. Gait___ Goniometer___ Check spinal curves___ Length of strideCDCBAADGood Job!ANSWER:11-*Cryotherapy and Thermotherapy CryotherapyApplying cold for therapeutic reasonsTypes Wet or dryChemical or naturalThermotherapy Applying heat for therapeutic reasonsTypes DryMoist 11-*Cryotherapy and Thermotherapy (cont.)Generally promote healingSide effect – damage to underlying nerves and tissuesMonitor patient closelyFactors affecting the use of these treatmentsTreatment locationCirculation or sensation impairmentTemperature toleranceAge11-*Principles of CryotherapyConstricts blood vesselsPhysiologic responses to coldPrevents swelling Controls bleedingReduces inflammationAnesthetic effect for painReduces pus formation Lowers body temperature11-*Administering CryotherapyDry cold applicationsIce bags and collarsChemical ice packsWet cold applicationsCold compressesIce massage11-*Principles of ThermotherapyDilates blood vessels Physiologic responses to heatRelieves pain and congestionReduces muscle spasmsMuscle relaxationReduces inflammationReduces swelling11-*Administering ThermotherapyDry heat therapiesChemical hot packsHeating pad Hot-water bottleHeat lampFluidotherapy11-*Administering Thermotherapy (cont.)Moist heat applicationsHot soakHot compressHot packParaffin bathDiathermy – high-frequency wave achieves deep heat penetrationUltrasound ShortwaveMicrowave11-*Apply Your KnowledgeWhat 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.Correct!11-*HydrotherapyUse of water to treat physical problemsWhirlpoolsWater is agitated by jets of air under pressureGenerates hydromassageRelaxes muscles Increases circulationAlso used to clean and debride wounds, ulcers, and burns11-*Hydrotherapy (cont.)Contrast baths2 baths, one hot and one coldPatient moves quickly from one to the otherPurposeInduces relaxationImproves circulationGreater mobilityUnderwater exercisesWarm swimming poolBuoyancy takes pressure off jointsPurposePromotes relaxation Increases circulation11-*Apply Your KnowledgeWhat are the main effects of hydrotherapy?ANSWER: Hydrotherapy relaxes muscles, increases circulation, and improves flexibility and mobility. Super!11-*Exercise TherapyPreventive and therapeutic benefitsFlexibilityMobilityMuscle toneStrength Primary treatment for fractures, arthritis, and some respiratory diseasesMinimizes symptomsSlows disease progression11-*Exercise Therapy (cont.)ExerciseImproves muscle tone and strengthMaintains ROMPrevents or corrects physical deformitiesPromotes neuromuscular coordinationImproves circulationRelieves stressLowers cholesterol levelsAids in resumption of normal daily activities 11-*Medical Assistant’s RoleProvide patient informationTypes of exercise programs Treatment planProvide support and encouragementAssist with ROM exercisesTeach the patient and family about ROM exercises.11-*Types of ExerciseChoice based on patient’s physical conditionActive mobility Self-directed exercises Increase muscle strength and functionPassive mobility Therapist or machine moves the patient’s body partRetain ROM and improve circulationAided mobility Self-directed with assistance of a device such as exercise machineRetain or improve ROM11-*Types of Exercise (cont.)Active resistance Works against resistanceIncreases muscle strengthIsometricPatient relaxes and then contracts muscles while in a fixed positionMaintains muscle strength if immobilizedROM exercisesMove each joint through its full range of motionsImproves flexibility and mobilityImproves circulation and muscle function11-*Electrical StimulationDelivers a controlled amounts of low-voltage electric current to motor and sensory nerves Stimulates musclePrevents atrophy Helps in healing injured jointsRetrains a patient to use injured muscles11-*Apply Your KnowledgeMatch description with type of exercise:___ Self-directed; exercise machine A. Isometric___ Self-directed; no assistance B. Aided mobility___ Low-voltage current; stimulates C. Active resistance nerves/muscles___ Relax and contract muscles from D. Electrical  fixed position stimulation___ Exercise against counter-pressure E. Active mobility___ Move joint through full range F. ROMDEFCAYIPPEE!BANSWER:11-*TractionThe pulling or stretching of the musculoskeletal system Used to treat fractured bones and dislocation, arthritic, or other diseased jointsUsesCreate and maintain bone alignmentReduce and prevent joint stiffeningCorrect deformitiesReduce and relieve muscle spasms11-*Traction (cont.)ManualStretching muscles and separating joints by gently pulling on themImproves motion and decreases stiffeningUses Muscle spasmsStiffnessArthritis StaticWeight traction using harness and weightsUsed to relieve muscle spasms11-*Traction (cont.)Skeletal Long-term/heavy weightsPins, wires, or tongs surgically placedPulleys and weights provide continuous tractionMechanical Device intermittently pulls and relaxesPromotes relaxation11-*Apply Your KnowledgeTrue 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.FTTFalternately pulls and relaxesrelieveANSWER:FANTASTIC!11-*Mobility AidsDevices to improve patients’ ability to ambulate or move aboutMobility aid chosen depends onPatient’s disabilityMuscle coordinationStrength Age 11-*CanesStandardPatient who needs only small amount of supportTripod (3 legs) and quad-base (4 legs)Create wide base of supportMore stable than standard canesMust be adjusted to correct height for patient11-*WalkersUsed by older patients withDifficulty walking unassistedBalance problems Provides a sense of stabilityTypes – Table 11-2Adjust to proper height for patient11-*CrutchesTransfers weight to the armsTypes Axillary Ground to axillaShort-term useLofstrand, or CanadianGround to forearmLong-term use11-*Crutches (cont.)Complications may arise if not measured properlyPressure on nerves in axillaStrain on back, imbalanceMeasuring for crutchesShould be 2 to 3 finger-widths between supports and axilla30º flexion at elbow11-*Crutches (cont.)Crutch gaitsFour-point – slow gait for a patient who can bear weight on both legsThree-point – used when patient cannot bear weight on one legTwo-point – used when patient can have some weight on both legs; must have good muscle coordination and balanceSwing gait – used when patient has severe disabilities 11-*WheelchairsType of chair chosen Depends on patient’s disability Length of time wheelchair neededAlways ensure patient safety during transfersUse appropriate lifting techniques11-*Apply Your KnowledgeWhen 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!11-*Referral to a Physical TherapistReferrals to preferred therapistsProvide physician’s orderProvide patient informationTherapists Independent practitionersHospital or clinicHome health 11-*In Summary11.1 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. 11.2 Various physical tests are performed on patients, including joint mobility testing, muscle strength testing, gait, and posture testing.11.3 Cold and heat therapy promote healing and increase patient comfort. 11-*In Summary (cont.)11.4 Contraindications to cold and heat therapies include circulation problems, pain, and hemorrhage.11.5 There are various types of cold and heat therapies. These include dry and wet, cold, and heat applications.11.6 The 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.11.7 Various types of hydrotherapy used to treat physical problems include whirlpools, contrast baths, and underwater exercises.11-*In Summary (cont.)11.8 There are several methods of exercise therapy, including active mobility, passive mobility, aided mobility, and active resistance.11.9 The different methods of traction used to treat physical problems include manual, static, skeletal, and mechanical.11.10 There 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.11-*End of Chapter 11Disability is a matter of perception. If you can do just one thing well, you're needed by someone.~ Martina Navratilova