Chapter 22
Physical Therapy Skills
© 2009 Delmar, Cengage Learning
Career Highlight
• Physical Therapist Assistants( PTAs) are
valuable members of the health care team
• Education requirements: Associate’s Degree
• Licensure in most states: must pass test after
graduation from accredited program and pass
in order to practice
• Duties performed: ROM exercises, heat/cold
treatments, ambulating clients w/ assistive
devices
• Work under direction of a Physical Therapist
© 2009 Delmar, Cengage Learning
22:1 Performing Range-of-Motion
(ROM) Exercises
• Purposes of ROM= maintain health of
musculoskeletal system
• Problems caused by lack of movement
and activity
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Contracture of muscles
Muscle and joint function
Circulatory impairment
Mineral loss
Other problems
(continues)
© 2009 Delmar, Cengage Learning
22:1 Performing Range-of-Motion
(ROM) Exercises
(continued)
• Types of ROM
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Active ROM
Active assistive ROM
Passive ROM
Resistive ROM
(continues)
© 2009 Delmar, Cengage Learning
Performing Range-of-Motion
(ROM) Exercises
Proper terms for movement of each joint; see Fig. 22-3 in text
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Abduction
Adduction
Flexion
Extension
Hyperextension
Rotation
Circumduction
Pronation
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Supination
Opposition
Inversion
Inversion
Eversion
Dorsiflexion
Plantar flexion
Radial deviation
Ulnar deviation
© 2009 Delmar, Cengage Learning
© 2009 Delmar, Cengage Learning
Performing Range-of-Motion
(ROM) Exercises
Principles to observe while performing ROM
*movements should be slow, smooth, and gentle to prevent
injury
*provide support above and below joint being exercised
*never force joint beyond it’s ROM
*do not exercise to point of pain or extreme fatigue
*if c/o pain, is SOB, profusely diaphoretic, or pale/dizzystop-report to supervisor
*encourage patient to assist if able
*perform each exercise 3-5 times or as ordered
*provide privacy
*use good body mechanics
© 2009 Delmar, Cengage Learning
22:2 Transfer (Gait) Belts, Crutches,
Canes, or Walkers
• Patients may require aids, or assistive
devices, for ambulation
• Type used depends on injury and
patient’s condition
• Certain points must be observed when a
patient uses crutches, canes, a walker,
or a transfer belt
• Remain alert at all times while
(continues)
ambulating
© 2009 Delmar, Cengage Learning
Transfer (Gait) Belts, Crutches,
Canes, or Walkers
• Transfer (Gait) Belt
• Basic principles for ambulating a patient
with a transfer belt
– Proper size
– Use underhand grasp
– Grasp on back during ambulation(walk behind to
side)
– Grasp on sides when assisting to stand/sit
– Apply over clothing
© 2009 Delmar, Cengage Learning
© 2009 Delmar, Cengage Learning
• Crutches—artificial supports
– Types: Axillary Crutches, Forearm/Loftstand Crutches,
Platform Crutches
– Fitting Crutches:
• Wear shoes
• Position crutches 4-6inches in front of foot; 4-6 inches to side of
foot
• Length (axillary crutches) 2 inches below armpit
• Length (forearm crutches) 25-30 degree bend in each elbow
– Crutch-Walking Gaits:
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2 Point Gait
3 Point Gait
4 Point Gait
Swing-to Gait
Swing-through Gait
© 2009 Delmar, Cengage Learning
© 2009 Delmar, Cengage Learning
• Cane—provides balance and support
– Types:
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Standard
Tripod
Quad
Walkcane/Hemiwalker
– Basic Principles:
• Hold cane with unaffected “good” side
– Fitting:
• Tip of cane positioned 6-8 inches from side of “good” foot
• Cane handle should be level top of femur
• Patients elbow should flex 25-30 degrees
– Gaits:
• 2 Point Gait
• 3 Point Gait
© 2009 Delmar, Cengage Learning
© 2009 Delmar, Cengage Learning
• Walker—has four legs
– Types:
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Folding
Rolling
Platform
With and without brakes
– Fitting:
• Handles should be level with top of femur
• Elbows flexed 25-30 degrees
– Gaits:
• “walk into” : lift walker and position in front with back legs of
walker level with toes; then walk into
– Basic Principles/Precautions:
• Do not slide a walker
• Avoid using as a transfer device
© 2009 Delmar, Cengage Learning
Summary
• Always check ambulation aids before
using
• Make sure aid is properly fitted to patient
• Use gait taught by therapist
• Be alert to patient safety at all times
© 2009 Delmar, Cengage Learning
Heat/Cold Applications
• Cryotherapy—use of cold for treatment
• Applied to the skin
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Pain relief
Reduce swelling
Control bleeding
Reduce body temp.
• Moist Cold: compresses, packs, soaks;
more penetrating than dry
• Dry Cold: ice bags/collars, hypothermia
(continues)
blankets
© 2009 Delmar, Cengage Learning
Heat/Cold Applications
• Thermotherapy—use of heat for
treatment
• Applied to the skin
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Pain relief
Increase drainage and stimulate healing
Fight infection and increase circulation
Muscle spasm relief
Increase muscle mobility
(continues)
© 2009 Delmar, Cengage Learning
• Moist Heat: sitz bath, hot soaks,
compresses, paraffin wax treatments
• Dry Heat: warm-water bags, heating pads,
heat lamps (never exceed 120F)
• Effect of heat and cold applications on
blood vessels
– heat: dilate- increases blood flow, stimulates healing
– cold: constrict- decreases blood flow, pain, swelling
• Doctor’s order is required for a heat or
cold application
© 2009 Delmar, Cengage Learning
)
Administering Heat/Cold
Applications
(continued)
• Checkpoints while application in place
• Alertness required
• Safety precautions:
– infants/children burn more easily
– Watches, rings, metal conducts heat/cold better
– Place barrier between skin and heat/cold
application
• Standard precautions
(continues)
© 2009 Delmar, Cengage Learning
Administering Heat/Cold
Applications: Basic Principles
• ice bag / ice collar
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Fill with ice (half ) and water
If ice cubes; rinse with water to remove sharp corners
Check for leaks
Expel air from bag
Place barrier between skin and ice bag
Remove after 15-20 minutes
(continues)
© 2009 Delmar, Cengage Learning
Administering Heat/Cold
Applications: Basic Principles
• warm-water bag
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Fill with warm water 1/3-1/2 full
Check bag for leaks
Expel air
Use water 110-120 degrees F
Use thermometer
place barrier between skin and warm water bag
Remove after 15-20 minutes
© 2009 Delmar, Cengage Learning
Administering Heat/Cold
Applications: Basic Principles
• aquathermia pad
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Place unit on solid, flat table surface
Fill with distilled water to “fill” line
Screw cap then loosen
Set desired temp with key: 95-105 degrees F
Remove key
Check for leaks
Cover pad with barrier
Ensure tubing is not below level of bed
Remove after 15-20 minutes
© 2009 Delmar, Cengage Learning
Administering Heat/Cold
Applications: Basic Principles
• moist compress
– Protect sheets/clothing from becoming wet
– Fill basin with water water/ice OR warm water (100105 degrees F)
– Wring excess water out before placing on patient
– Wrap with a bath towel over plastic sheet
– Remove after 15-20 minutes
© 2009 Delmar, Cengage Learning
Administering Heat/Cold
Applications: Basic Principles
• sitz bath
– Cover legs and shoulders
– Privacy
– Use correct water temp
© 2009 Delmar, Cengage Learning
Summary
• Doctor’s order required for all heat or
cold applications
• Follow correct procedures to prevent
injury to patient
• Check patient and condition of skin
frequently
© 2009 Delmar, Cengage Learning