DHO UNIT 21PHYSICAL THERAPY

J.J.Nelson RN,CMA

Objectives

• Demonstrate each skill with > 90% accuracy.• Evaluate the need for the modalities.• Explain safety protocol for each skill.• Define each ROM movement

21:1 Range of Motion

Range of Motion exercises are done to maintain the health of the

musculoskeletal system.

They are done to prevent the problems caused by lack of

movement

Problems caused by lack of movement:

• Contractures- tightening and shortening of a muscle.• Muscles atrophy and become weak while joints

become stiff and difficult to move.• Circulation of blood is affected possibly resulting in

blood clots and decubitus ulcers.• Bones become brittle and fractures may occur due to

mineral loss• Additional Problems: poor appetite, constipation,

urinary infections, and respiratory problems.

Three Types of ROM exercises

• 1. Active– Active Assistive

• 2. Passive

• 3. Resistive

Active ROM

Performed by patients who are able to move each joint

WITHOUT assistance

Passive ROM

Performed by another person who moves each joint for a patient because they are

not able to do it themselves

Resistive ROM

Usually performed by a therapist

The exercises are performed against resistance provided by the therapist

Cont…….

• Various movements are used when performing Range of Motion exercises.

• The healthcare worker should be aware of the terms associated with these movements.

• (refer to Table 21-3 in DHO Book)

A few things to remember

• Movements should be slow, smooth, and gentle

• A joint should never be forced beyond its ROM

• Support the part above and below the part being exercised

• The patient should be encouraged to assist as much as possible• Use correct body mechanics!!

Hip Rotation

In conclusion:

Being in the healthcare industry, everyone may run into teaching or using range of motion. It

is very important for the well-being of patients that have limited movement during

their care. Therefore, it is important for you to know how to do Range of Motion.

GAIT BELT, CRUTCHES, CANES AND WALKER

21:2

• Falls• Fractures• Hip or knee replacements• CVA• Ambulating residents

• Ambulatory aids e.g. crutches, a cane, a walker and gait belt may be used for all of these patients.

CONSIDERATIONS

• Walk on the patient’s weak side, slightly behind the patient.

• Use correct body mechanics even when the patient may be falling.

• Support patient against wall or table to start

• Patient’s shoes must be safe• If a patient falls; follow protocol

including completing an incident report.

• Types of crutches: axillary, Lofstrand, Platform (photos on page 809)

• Positioned 4-6” in front and 4-6” on the side of foot.• Allow a two inch gap between the pad of the crutch

and the armpit. Rest weight on hand grips NOT axillary pads

• Elbows flexed at 25-30° angles• Gaits vary depending on the patient’s ability to bear weight on one or both legs.

Brachial Plexus & crutches

• Four point gait- used when both feet can bear weight. This is the slowest . –Start with RIGHT crutch using opposite foot.

• Two point gait- next level after four point, (also for bearing weight on both feet) this is faster and also closer to the natural rhythm of walking-Start with RIGHT foot and LEFT crutch.

• Three point gait-used when only one leg can bear weight.- Move both crutches AND affected foot, followed then by the unaffected foot meeting at the same point as the crutches-not past.

Four Point Gait for crutches

For patients able to bear weight on both legs.

Two Point Gait for crutches

A faster gait for patients able to bear weight on both legs

Three Point Gait for crutches

Used for patients able to bear weight on only one leg.

• Swing to gait- Crutches are moved first, both feet are swung to the same point as the crutches.

• Swing through gait- Crutches are moved followed by both feet beyond the point at which the crutches are.

• Used for one or both legs • Used when patient has mastered the earlier

gaits.

• Various types of canes are available. (Please note photos on page 811)

• Use on unaffected side• Place cane 6-10” from the

unaffected foot.• Cane handle should be at level

with top of femur.• Elbow flexed at 25-30° angles• Three Point or Two Point gait• Encourage small steps

Canes and stairs…notice leg outlined in red is the affected leg.

• “GOOD GUYS GO UP”

“BAD GUYS GO DOWN”

• Used for balance• Handle level with top of femurs• Elbows flexed at 25-30° angle• Rubber tips on ends to prevent slipping• Lift (not scoot) walker and place it in front of

body making the back legs even with the front of toes.

• Patient then walks into the walker.

• A fitted belt positioned around patient waist. • Healthcare workers hold onto the belt

(underhand grip) to support patient.• Not too tight (leave two fingers space under

belt)• Check that breast are not caught in belt• Buckle is placed slightly off center.

• As a health care professional you will have patients who need to be taught how to use various types of walking devices.

• Make sure they comprehend, so they are safe using the ambulatory device.

21:3 HEAT AND COLD PACKS

• Doctor’s order required• Heat used for vasodilation.• Cold applications result in

vasoconstriction.• Can you think of times

heat/cold applications will be ordered?

• Moist is more penetrating

Cold Pack

• May be disposable• May be ice bag or collar to fill (half full) with

ice.• Always cover • Follow physicians order for length of time to

be applied• Check frequently and note skin condition

Check skin with heat/cold applications

• What condition of skin will cause you to DC a heat treatment?

• What condition of skin will cause you to DC a heat treatment? What is “mottled”?

Dry Heat

• Hot water bag is filled with 110o -120o

• Fill 1/3-1/2 full• Cover Bag• Position ON area. Do not let patient lie

on the pack• Check skin regularly

Moist Compresses• Moist is more penetrating• May be hot or cold• Protect linen by using a towel or plastic barrier• May be a hydrocollator. (HWP) Take care not to burn self in pulling pads out of unit.

Aquamatic Pad• Note photo DHO page 827• This piece of electrical equipment heats water

and circulates it through a pad.• Obvious safety considerations:

Place unit on secure table Assure correct temperature setting Do not have cap too tightDo not let tube fall to floor (avoid someone tripping on it)Check patient’s skin at regular intervals

SITZ Bath• May be tub, portable or

chair.• Frequently ordered

postpartum or post hemorhoidectomy

• Caution-watch patient for vertigo or weakness and DC treatment immediately

SITZ CHAIR/ BATH

REVIEW TERMS

• Contractures• Atrophy• Active/Passive/Resistive• Mottled• Vertigo• Incident Report• Brachial Plexus

• Vasodialation• Vasoconstriction