CHAPTER
54
Physical Therapy
and Rehabilitation
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54-2
Learning Outcomes
54.1 Discuss the general principles of physical
therapy.
54.2 Relate various cold and heat therapies to
their benefits and contraindications.
54.3 Recall hydrotherapy methods.
54.4 Name several methods of exercise therapy.
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54-3
Learning Outcomes
54.5 Describe the types of massage used in
rehabilitation therapy.
54.6 Compare different methods of traction.
54.7 Carry out the procedure for teaching a
patient to use a cane, a walker, crutches,
and a wheelchair.
54.8 Model the steps you should take when
referring a patient to a physical therapist.
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54-4
Introduction
• Medical assistant
– Apply cold and heat
– Assist with ambulation
– Teach basic exercises
– Demonstrate how to use a cane, walker,
crutches, or wheelchair
– Discuss with the patient specific therapies for
home use
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54-5
General Principles of Physical Therapy
• Physical therapy
– Medical specialty treating
• Musculoskeletal disorders
• Nervous disorders
• Cardiopulmonary disorders
– Treatments
– Patient benefits
– Disorders
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54-6
Assisting Within a Therapeutic Team
• Therapeutic team members
• Medical assistant
– Coordinate the patient’s schedule
– Make referrals
– Document treatments and findings
– Reinforce instructions for the patient
– Answer the patient’s questions
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54-7
Assisting with 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
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54-8
Assisting with Patient Assessment (cont.)
• Muscle strength testing
– Determines the amount of force exerted
exert with a group of muscles
– Compare each side of body
• Gait testing –
assessment of how
a patient walks
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54-9
Assisting with Patient Assessment (cont.)
• Posture testing
– Body position and alignment
– Checks spinal curves
– Symmetry of alignment
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54-10
Apply Your Knowledge
Match description with assessment type:
ANSWER:
___
D How a person walks
A. Joint mobility
___
A Range of motion
B. Muscle strength
___
C Body position and alignment
C. Posture
B Force exerted with a group of muscles D. Gait
___
___
A Goniometer
___
C Check spinal curves
___
D Length of stride
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54-11
Cryotherapy and Thermotherapy
• Cryotherapy
• Thermotherapy
– Applying cold for
therapeutic
reasons
– Applying heat for
therapeutic
reasons
– Types
– Types
• Wet or dry
• Dry
• Chemical or natural
• Moist
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54-12
Cryotherapy and Thermotherapy (cont.)
• Factors affecting use
– Therapy's purpose
– Location and condition of affected area
– Patient’s age and general health
• Monitor patient for signs of tissue damage
• Be aware of
contraindications
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54-13
Cryotherapy and Thermotherapy (cont.)
• Treatment location
• Circulation or sensation impairment
• Temperature tolerance
• Elderly’s sensitivity to cold and heat
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54-14
Principles of Cryotherapy
• Constricts blood vessels
• Physiologic responses to cold
– Prevents swelling
– Anesthetic effect
– Controls bleeding
– Reduces pus
formation
– Reduces
inflammation
– Lowers body
temperature
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54-15
Administering Cryotherapy
• Dry cold applications
– Ice bags and collars
– Chemical ice packs
• Wet cold applications
– Cold compresses
– Ice massage
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54-16
Principles of Thermotherapy
• Dilates blood vessels – erythema
• Physiologic responses to heat
– Relieves pain and congestion
– Reduces muscle spasms
– Relaxes muscles
– Reduces inflammation and
swelling
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54-17
Administering Thermotherapy
• Dry heat therapies
– Chemical hot
packs
– Heating pad
– Hot-water bottle
– Heat lamp
– Fluidotherapy
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54-18
Administering Thermotherapy (cont.)
• Moist heat applications
– Hot soak
– Paraffin bath
– Hot compress
– Alternating hot
and cold packs
– Hot pack
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54-19
Administering Thermotherapy (cont.)
• Diathermy
– High-frequency wave achieves deep heat
penetration
– Types
• Ultrasound
• Shortwave
• Microwave
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54-20
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.
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54-21
Hydrotherapy
• Use of water to treat physical
problems
• Whirlpools
– Water is agitated by jets of air under pressure
– Generates hydromassage
• Relaxes muscles
• Increases circulation
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54-22
Hydrotherapy (cont.)
• Contrast baths
– 2 baths, one hot
and one cold
– Affected area is
quickly moved
from one to the
other
• Underwater
exercises
– Warm swimming
pool
– Buoyancy takes
pressure off joints
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54-23
Apply Your Knowledge
What are the main effects of hydrotherapy?
ANSWER: Hydrotherapy relaxes muscles,
increases circulation, and improves
flexibility and mobility.
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54-24
Exercise Therapy
• Preventive and therapeutic benefits
– Flexibility
– Mobility
– Muscle tone
– Strength
• Primary treatment for some
disorders and sports injuries
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54-25
Exercise Therapy (cont.)
• Exercise benefits include
– Improve muscle tone and strength
– Regain or maintain ROM
– Promotes neuromuscular coordination
– Helps patients to resume normal activities of
daily living
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54-26
Role of the Medical Assistant
• Information resource
• Source of support and encouragement
• Assist with ROM
• Patient instructions
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54-27
Types of Exercise
• Choice based on patient’s physical
condition
• Active mobility
– Self-directed exercises
– Increase muscle strength
and function
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54-28
Types of Exercise
• Passive mobility
– Therapist or machine moves
the patient’s body part
– Retain ROM and improve
circulation
• Aided mobility
– Self-directed with using a device
– Retain or improve ROM
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54-29
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
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54-30
Types of Exercise (cont.)
• ROM exercises
– Moving each joint through its full range of
motions
– Improves flexibility and mobility
– Types
• Active
• Passive
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54-31
Electrical Stimulation
• Delivery of controlled amounts of lowvoltage electric
– Stimulates muscles
– Prevents atrophy
– Helps in healing injured joints
– Retrains a patient to use injured muscles
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54-32
YIPPEE!
Apply Your Knowledge
Match description with type of exercise:
ANSWER:
B Self-directed; exercise machine
___
A. Isometric
E Self-directed; no assistance
___
B. Aided mobility
___
D Low-voltage current; stimulates
nerves/muscles
C. Active resistance
___
A Relax and contract muscles from
fixed position
D. Electrical
stimulation
___
C Exercise against counter-pressure
E. Active mobility
F Move joint through full range
___
F. ROM
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54-33
Massage
• Benefits
– Relaxation and counters effects of stress
–  heart rate and blood pressure
–  pain due to tight muscles
– Improves concentration
– Promotes restful sleep
– Relaxes the mind
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54-34
Massage (cont.)
• Swedish Massage
– Stimulates circulation
and lymph flow
– Five basic strokes
• Neuromuscular massage
– Targets specific muscles
– Releases tension
– Relieves pain and pressure on nerves
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54-35
Apply Your Knowledge
What is the difference between Swedish massage
and neuromuscular massage?
ANSWER: Swedish massage stimulates circulation
and lymph flow with five basic strokes that manipulate
the body’s soft tissues.
Neuromuscular massage is applied to specific
muscles and helps release tension and knots, relieve
pain and release pressure on nerves, and increase
blood flow.
AAH Yes!
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54-36
Traction
• The pulling or stretching of the
musculoskeletal system
• Uses
– Create and maintain bone alignment
– Reduce and prevent joint stiffening
– Correct deformities
– Reduce and relieve muscle spasms
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54-37
Traction (cont.)
• Manual
– Gentle pull on muscles and joints
– Improves motion and decreases stiffening
• Static
– Harness and weights
– Used to relieve muscle spasms
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54-38
Traction (cont.)
• Skeletal – performed for injuries requiring
long traction time and heavy weights
• Mechanical – device that intermittently
pulls and relaxes
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54-39
Apply Your Knowledge
ANSWER:
True or False:
F Static traction uses a harness and weights to induce
___
relieve
muscle spasms.
T Manual traction stretches muscles and separates joints by
___
gently pulling on them.
T Skeletal traction uses pulleys and weights to provide
___
continuous traction.
F Mechanical traction maintains constant tension on the
___
extremity.
alternately pulls and relaxes
F
A
N
T
A
S
T
I
C
!
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54-40
Mobility Aids
• Devices to improve patients’ ability to
ambulate or move about
• Mobility aid chosen depends on
– Patient’s disability
– Muscle coordination
– Strength
– Age
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54-41
Canes
• Standard – provide small amount of
support
• Tripod and quad-base
• Correct height
– Elbow bent 20-25 degrees
– Should not lean on cane
for support
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54-42
Walkers
• Used by patients who
– Cannot walk unassisted
– Have balance problems
• Provides a sense of
stability
• Adjust to proper height
for patient
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54-43
Crutches
• Transfers weight to the arms
• Types
– Axillary
• Ground to axilla
• Short-term use
– Lofstrand, or Canadian
• Ground to forearm
• Long-term use
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54-44
Crutches (cont.)
• Measure to fit
– Too long
• Crutch palsy
• Back pain
– Too short
• Back pain
• Imbalance
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54-45
Crutches (cont.)
• Crutch gaits
– Tripod or standing position
– Determine proper gait
– Slow or fast gaits
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54-46
Crutches (cont.)
• Four-point gait
– Slow gait
– Bear weight on both legs
– Stable and save
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54-47
Crutches (cont.)
• Three-point
– Cannot bear weight
on one leg
– Must have good
muscle coordination
and arm strength
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54-48
Crutches (cont.)
• Two-point
• Swing gait
Swing-to
Swing-through
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54-49
Wheelchairs
• Type of chair
– Depends on patient’s disability
– Length of time wheelchair needed
• Always ensure patient safety during
transfers
• Use appropriate lifting techniques
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54-50
Referral to a Physical Therapist
• Referrals
– Provide physician’s order
– Provide patient
information
• Therapists
– Independent practitioners
– Hospital or clinic
– Home health
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54-51
Apply Your Knowledge
1. When would a walker be an appropriate mobility
device for use by your patient?
ANSWER: Walkers are usually used by patients who
are too weak to walk unassisted or who have balance
problems.
Hurray!
2. What is the role of the medical assistant related
to referrals for physical therapy
ANSWER: The medical assistant may be asked to
contact the therapist directly or to give the patient a
written order and information about contacting the
therapist. The referral must also be documented in
the patient’schart
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54-52
In Summary
54.1 Physical therapy is a medical specialty
for the treatment of musculoskeletal,
nervous, and cardiopulmonary disorders
using a variety of treatments, including
cold, heat, water, exercise, massage,
and traction.
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54-53
In Summary
54.2 There are various types of cold and
heat therapies, including dry and wet
cold and heat applications.
Cold and heat therapy promote healing
and increase patient comfort.
Contraindications to cold and heat
therapies include circulation problems,
pain, and hemorrhage
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54-54
In Summary (cont.)
54.3 Various types of hydrotherapy used to
treat physical problems include
whirlpools, contrast baths, and
underwater exercises.
54.4 There are several methods of exercise
therapy, including active mobility,
passive mobility, aided mobility, and
active resistance.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
54-55
In Summary (cont.)
54.5 The two major types of massage used in
rehabilitation therapy are Swedish and
neuromuscular.
Swedish massage uses 5 basic strokes to
manipulate soft tissues.
Neuromuscular massage is applied to
specific muscles and helps release tension
and knots, relieve pain and release pressure
on nerves, and increase blood flow.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
54-56
In Summary (cont.)
54.6 The different methods of traction used
to treat physical problems include
manual, static, skeletal, and mechanical
54.7 The various mobility aids include
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.
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54-57
In Summary (cont.)
54.8 You may be asked to contact the
specialist directly or to give the patient
a written order and information about
contacting the specialist.
Keep a file with information about the
therapists your office uses, noting the
forms and information each therapist
requires
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54-58
End of Chapter 54
Disability is a
matter of
perception. If you
can do just one
thing well, you're
needed by
someone.
~ Martina Navratilova
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.