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7/31/2019 Edited Notes

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PHILIPPINE REHABILITATION INSTITUTE FOUNDATION, INC

COLLEGE OF PHYSICAL THERAPY

1 Prepared By: Floriza P. de Leon, PTRP

CONCEPT OF REHABILITATION

Derived from latin word habil which means to make able again Origin in civil or canon law of middle ages

o Restoration of a baron or knight to his former right ranko Privilege after such had been lost or forfeitedo Re-establishment of ones good name

With the coming of age of modern social thinking and practiceo Restoration of a person to his former or mental capacity

Child with congenital defects habilitate rather than rehabilitate In light with its objectives making a person aware of his potential and providing him with the

means to attain that potential

US National Council on Rehabilitation (1942) restoration of the handicapped to the fullestphysical, mental, social, vocational and economic usefulness of which they are capable

Dr. Leonard Mayo: rehabilitation is a philosophy, first; second, an objective, and third, it is amethod

Marco Polo described watchmen who are unable to work due to lameness are placed in one ofthe hospitalswhen he is cured, he is obliged to work at some trade

For FilipinosChristianity and Democracy Christian teachings of brotherhoods, of charity, ofworth, and the basic democratic rights and freedoms, formed the roots of our growing concern

for the medical, social, and economic welfare of our fellow countrymen

Rehabilitation of today more than merely the palliative or curative treatment for injury orillness

Patient patient-centered; patient-oriented; most active participant Rehabilitation must start early for once the disability starts, each passing time results in a

greater fixation of the disability, and reduces the opportunity of a patient for the maximumrestoration to physical, mental, social and economic status


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THE CHALLENGE OF REHABILITATION

Attention to the need of not only adding years to life but also of adding life to years.Changing Pattern of Sickness and Health

Previously, acute and contagious diseases prevailed, at present time chronic illness, industrialinjuries and accidents, degenerative, and neuromusculoskeletal disorders consist a large part of

the patient population

Previously, majority of cases died or recovered fully; now large segment of the population has toadapt to a life of chronic disability and to adjust to a long term functional loss

Kerr L. White (Professor of Medical Care and Hospitals at John Hopkins University) withoutdistracting from the importance of classifying the dead, we should recognize that society is

increasing by concerned with problems of living, the quality of life, and the burden of disability,

distress and dependency.

Dimensions of the Need for Rehabilitation

1973, UN survey found more than 300 million persons in the world to be physically or mentallyhandicapped and in need of rehabilitation to become productive members of their own

communities

Growing due to population growth, wars, greater longevity and ever increasing numbers ofindustrial, traffic and other accidents

Need for rehabilitation is expected to rise further in the future; for, as the world populationcontinues to grow older, the incidence of chronic illness with its resultant physical disability will

continue to increase correspondingly.

Economic Impact of Rehabilitation

Bernard M. Baruch the investment in rehabilitation is an investment in the greatest and mostvaluable of our possessions, the conservation of human resources

Dr. Howard Rusk Health, including the rehabilitation of the handicapped, is fundamental tothe prime democratic concept of equal opportunity for all.

Good health is fundamental to economic self-sufficiencyDr. Charles Mayo poverty makespeople sicksickness makes people poor.

In a study of the Programs of Rehabilitation for the Disabled in Thirty Seven countries (includingthe Philippines) prepared by the Committee on Government Operations of the U.S. Senate, one

of the conclusions was that from the social and economic point of view, the burden ofdependency the necessity of carrying so large an unproductive segment of the population

has contributed in no small part to a countrys poverty and relative backwardness. Moreover,

the sheer waste of productive capacity is, in this day and age, a matter of grave concern. That

waste is being recognized by a number of underdeveloped countries which are attempting to

lift themselves

Studies of the Bureau of Vocational Rehabilitation in the United States have shown that medianannual earnings were more than 2 times greater after completing programs of vocational


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rehabilitation. Indeed within four years, rehabilitated workers have repaid the government in

taxes an amount even more than the total cost of their rehabilitation

4 valid reasons why economic factors in rehabilitation process are of great importance:o Efficient manpower utilizationo Economic gains in restoring workers to earning powero Tax savings made by the removal from public assistanceo Reduction of the cost of disability

Rehabilitation Medicine Comes of Age

In medicine rehabilitation medicine is in the forefront of this fight against disability anddependency

In rehabilitation medicine branch of medicine concerned with the comprehensivemanagement of patients with impairment and disability arising from neuromuscular,

musculoskeletal, cardiovascular, and pulmonary disorders, and with the psychological, social

and vocational disruptions concomitant with them

This specialty also called Physical medicine and rehabilitation involved the use of physicalagents in the management of disease

Physiatrist specialist in the field Rehabilitation medicine entails the restoration of the handicapped individual to the fullest

physical, mental, social and economic usefulness of which he is capable

Involves cooperative efforts of various medical specialists and allied health professionals Practice of rehabilitation for any physician it ends only when the individual is retrained to live

as independently as possible back into society; team approach

Rehabilitation as a Social Science

Medicine is clearly coming of age as a social science in the service of society Total care concept Whole man approach Wrong to taken an impersonal approach

Rehabilitation Team

Physiatrist assisted by internal medicine, pediatrics, orthopedics, and neurosurgery, neurology,cardiologist, pulmonary specialist, psychiatrist and plastic surgery

Physical therapist Occupational therapist Rehabilitation nurses Social workers Vocational counselors Clinical psychologists Speech therapists


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PHYSICAL THERAPY

Integral part of the patient care Profession concerned with the restoration of function and the prevention of disability following

disease, injury, or loss of a body part

Goal: help the patient reach his maximum potential and to assume his due place in societywhile learning to live with in the limits of his capabilities.

APTA (American Physical Therapy Association): is a profession which develops, coordinates andutilizes selected knowledge and skill in planning, organizing and directing programs for the care

of individuals whose ability to function is impaired or threatened by disease or injury

Evaluationo Performing and interpreting tests to assist in differential diagnosis, and to determine the

degree of impairment of relevant aspects

o Provides the basis for the selection of appropriate therapeutic procedures and theappraisal of the results of the treatment

Therapeutic procedureso Exercise for increasing strength, endurance, coordination, and ROMo Stimuli to facilitate motor activity and learning, instruction in ADL, use of assistive

devices, and the application of physical agents to relieve pain or alter the physiological

status

Knowledgeo Human growth and developmento Human anatomy and physiologyo Neuroanatomyo Neurophysiologyo Biomechanics of motiono Manifestation of disease and traumao Normal and abnormal psychological response to injury and disabilityo Ethics

Activitieso Direct patient careo Consultationo Supervisiono Teachingo Administrationo Researcho Community service

Nature of the Practice of Physical Therapy

1. The evaluation and management of patients who have physical disabilities is an integral aspectof medical care. The physical therapist actively participates in this vital aspect of patient care.

2. Disability can often be prevented or reduced through appropriate physical therapy measures


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3. The goals of management include improvements not only in the physical, but also social,psychological, and vocational functioning with or without change in the basic process. Such

goals must also be a proper physical therapy concern

4. The physical therapist practices as part of a large and varied team personnel which include thephysician and other professional and assistive health specialists as well as members of the lay

community

5. Family and community resources are often essential to the success of the physical therapyprocess, and the physical therapist must include them in his therapeutic efforts.

6. The responsibilities of the practicing physical therapist are varied. Within the framework of asingle job, even the recent graduate is often called upon to serve not only as a provider of

service, but also as administrator, supervisor, teacher, program planner, and consultant

7. Physical therapy services are provided in a wide variety of settings and through varied patternsof service organizations. The growing number of physical therapists who provide services

through out-of-hospital community based programs, and is extended care facilities of particular

interest

8. Individual variations in patient response create an element of uncertainty in many phases oftreatment planning. This is reflected in the diversity of procedures currently in use for the

treatment of most clinical problems seen by the physical therapist. At the same time, the high

cost of health care makes it imperative that the most effective an efficient means of treatment

be used. It is therefore important that the selection of treatment goals and methods are made

through a process which is imaginative, thorough and based on scientific principles. It is equally

important that planning include specific measures to assess the actual effectiveness of

treatment

5 General Types of PT Positions

1. Staff/supervisory position direct service to patient2. Administrators of programs in educational institutions, clinical departments or health agencies3. Consultants to health care agencies, schools, sports organization4. Teachers in clinical and academic setting5. Researchers in research institutions investigating problems related to physical therapy practice

Patients Treated by Physical Therapist

- Hemiplegia, arthritis, paraplegia and quadriplegia, amputation and other less severe disorder- Impairments from pulmonary and vascular diseases as well as acute and chronic conditions- Concerned with patients of all ages

Impairment, Disability and Handicap


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Impairment any loss or abnormality of psychological, physiological, or anatomical structure or function

Disability any restriction or lack resulting from an impairment of ability to perform an activity in the

manner or within the range considered normal for a human being

Handicap a disadvantage for a given individual resulting from an impairment or a disability that limits

or prevents the fulfillment of a role that is normal for that individual.


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VITAL SIGNS

- Patients vital signs are important because they are indicators of general health or physiologicstatus

- The determination of a patients sense or level of pain is frequently included with themeasurement of vital signs

- It is important to know the normal values and determine the normal and abnormal changes thatmay occur as a result of illness, trauma, exercise, or physical condition

- It is particularly important to establish baseline values for the following types of patients:o Elderly patients (that is, older than 65 y/o)o Very young patients (younger than 2 years)o Debilitated patientso The patients who have performed limited aerobic activities for several weeks or monthso Patients with a previous current history of cardiovascular problemso Patients recovering from recent trauma or those with a condition or disease that affects

the cardiopulmonary system (such as SCI, cerebrovascular injury, hypertension, PVD,

COPD) or those recovering from recent major surgery

Factors Affecting Vital Signs

Time of day Age Environmental temperature Infection Physical activity Emotional status Site of measurement Menstrual cycle Oral cavity

Body Temperature

- Is an indication of the intensity or degree of heat within the body.- Represents a balance between the heat that is produced in the body and the heat that is lost- In humans, body temperature remains relatively constant regardless of the environmental

temperature. However, there are some exceptions, as when someone is exposed to extremes

of heat or cold or when other factors such as humidity and physical exertion are involved

- Normal Value: 96.8-99.3 F (36-37.3 C)- The average temperature of 98.6 F (37 C) is the most generally accepted single value

Factors Affecting Body Temperature

Time of day Age Environmental temperature Infection Physical activity


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Emotional status Site of measurement Menstrual cycle Oral cavity temperature

Assessment of Body Temperature

- Sites used to assess a persons body temperature are the oral cavity, rectum, axilla, ear canal,and occasionally the inguinal fold

- Most common and a convenient location to measure a persons temperature is the oral cavity,but the most accurate measurement of the body temperature is obtained from the rectal cavity

- Rectal or ear canal measurement can be used for infants or young (that is, preschool) childrenwho are unable to maintain the thermometer under the tongue or to safely hold it between the

lips and for unconscious patients or patients who are unable to maintained the thermometer in

the mouth ( patient who are intubated)

- Axillary or inguinal folds are the least desirable sites because the measurement will not beaccurate because air currents may reduce the accuracy of the measurement.

- Equipment available to measure body temperature includes the clinical glass thermometer orthe oral electronic thermometer with a probe, both of which are reusable; the chemical

thermometer, which is disposed after one use; or the ear canal electronic thermometer

Pulse

It is an indirect measure of the contraction of the left ventricle of the heart and indicates therate at which the heart is beating.

It is the movement of blood in an artery, which can be palpated at various sites of the body ormeasured through auscultation over the apex of the heart with the use of a stethoscope

Measured in beats per minute (bpm)

(N) resting pulse rate 60-100 bpm (adults)- 100-130 bpm (newborn)

- 80-120 bpm (1-7 years old)

Apical pulse used when the peripheral sites are inaccessible or the pulse is difficult to palpateat those sites.

Pulse is often subjectively described according to its rate, rhythm, and volume.o strong and regular indicates even beats with a good force to each beato weak and regular indicates even beats with a poor force to each beato irregular indicates that both strong and weak beats occur during the period of

measurement

o "thready indicates a weak force to each beat and irregular beatso tachycardia indicates a rapid heart rate (greater than 100 bpm)o bradycardia indicates a slow heart rate (less than 60 bpm)

Factors Affecting Pulse

Age Gender Environmental temperature


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Infection Physical activity Emotional status Medications Cardiopulmonary disease Physical conditioning

Pulse Measurement Sites

Temporal: anterior and adjacent to the ear Carotid: inferior to the angle of the mandible and anterior to the SCM mm Brachial: medial to the biceps in the antecubital fossa or on the medial aspect of the midshaft of

the humerus

Radial: at the wrist on the volar forearm medial to the stylus process of the radius Femoral: at the femoral triangle slightly lateral and anterior to the inguinal crease Popliteal: in the midline of the posterior knee crease between the tendons of the hamstring

mm Dorsal pedal: along the midline or slightly medial on the dorsum of the foot. Posterior tibial: on the medial aspect of the foot inferior to the medial mallelus

Abnormal Responses Exhibited by the Pulse

Pulse rate slowly increases during active exercises Pulse rate does not increase during active exercise Pulse rate continues to increase or decreases as the intensity of exercise or activity plateaus Pulse rate slowly declines as the intensity of the exercise or activity declines and terminates Pulse rate does not decline as the intensity of the exercise or activity declines Pulse rate declines during the exercise before the intensity of the exercise or activity declines Increased pulse rate or the amount of the increase exceeds the level expected to occur during

the exercise period

Rhythm of the pulse becomes irregular during or after the exercise or activity (such asdysrhythmia, arrhythmia, or ectopic beats occur)

Blood Pressure

- Systemic arterial BP is a physiologic variable that reflects the effects of cardiac output,peripheral vascular resistance, other hemodynamic factors

- Sphygmomanometer measures BP and is an indirect measurement of the pressure inside anartery caused by blood flow through the artery

- Systolic pressure is the BP at the time of contraction of the left ventricle (systole), and thediastolic pressure is the BP at the time of the rest period of the heart (diastole)

- Accepted normal BP ranges in adults are systolic, 120-130 millimeters of mercury (mm Hg); andthe diastolic, 80-85 mm Hg

- Hypotension systolic pressure that is consistently below 100 mm HgAssessment of Blood Pressure


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- Most common site used to measure BP is the brachial artery- Occasionally, the femoral artery is used, particularly in patients with known or suspected lower

extremity vascular diseases

- A stethoscope, sphygmomanometer, chairs, an object to support the patients upper extremity,alcohol wipes, and recording materials are necessary to measure and record the patients BP

- Cuff must be the proper size to obtain an accurate measurement- The width of the bladder should be 40% of the circumference of the midpoint of the limb

o Average sized adult 3-6 inches (13 cm) wideo Infant 1-1 inches (3 cm) wideo Large adult 6-8 inches (17 cm)o Thigh 8-9 inches (20 cm)

- Length of the bladder is also important and should be approximately twice the width of thebladder, or 80% of the arm circumference

- 1-2 mins before the measurement are retaken- Measuring blood pressure by auscultation or by palpation

Korotkoffs Sounds

Phase Description

I First faint, clear tapping sounds are detected & gradually increase in the intensity. These sounds are the initial

indication of systolic pressure in an adult, accdg to the American Heart Assoc.

II The sounds heart have a murmur or swishing quality to them

III Sounds become crisp and louder than those previously heard

IV There is distinct and abrupt muffling of the sounds until a soft, blowing quality is heard. The phase is the initial

indication of the diastolic pressure and is the best indicator of diastolic pressure in adults

V Sounds essentially disappear totally; the phase is also referred to as the second diastolic pressure phase


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Factors Affecting Blood Pressure

Age Physical activity Emotional status Medications Size and condition of arteries Arm position Muscle contraction Blood volume Cardiac output Site of measurement

Abnormal Responses Exhibited by BP

Systolic pressure rapidly increases during active exercise Systolic pressure does not increase during active exercise Systolic pressure continues to increase or decrease as the intensity of the exercise or activity

plateaus

Systolic rapidly declines as the intensity of the exercise or activity declines and terminates Systolic pressure does not decline as the intensity of the exercise or activity declines Systolic pressure declines significantly below its resting level at the termination of exercise or

activity

Systolic pressure declines during exercise before the intensity of the exercise declines Systolic pressure rate or the amount of systolic pressure increase is excessive during the

exercise or activity period

Diastolic pressure increase more than 10-15 mm Hg during the exercise or activity periodRespiratory Rate

Physical components of respiration produce an inflow (inspiration) and outflow (expiration) ofair between the environment and the lungs

Accepted normal range for respirationo 12-18 rpm (cpm) for adultso 30-50 rpm for infants

Assessment of Respiration

Measurement of the rate, rhythm, depth, and character of respiration is performed byobservation or tactilely.

rate refers to the number of breaths per minute rhythm refers to the regularity of the pattern depth refers to the amount of air exchanged with each respiration character refers to deviations from normal, resting, or quiet respirations Upper chest breather the thorax elevates and expands during inspiration and the abdomen

remains relatively motionless


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Abdominal breathers exhibits expansion of the abdomen and the thoracic remains relativelymotionless

Factors Affecting Respiration

Age Physical activity Emotional status Air quality Attitude disease

Abnormal Responses Exhibited by respiration rate

Respiration rate slowly increases during exercise or activity Respiration rate does not increase during exercise or activity Respiration rate increases as the intensity of the exercise or activity plateaus Respiration rate slowly declines as the intensity of the exercise or activity declines and

terminates

Respiration rate does not decline as the intensity of the exercise or activity decline Respiration rate declines during exercise or activity before the intensity of the exercise declines Increase in the rate or the amount of increase in the pxs respiration rate is excessive during the

exercise period

Rhythm of the respiration pattern becomes irregular during or after exercise or activityPain

- Initial assessment of pain should be based on a detailed history and include an assessment ofpain, its characteristics and intensity, a physical examination, a psychosocial assessment, and a

diagnostic evaluation ofsigns and symptoms associated with the patients cause of pain

Pain Descriptions and Related Structure

Type of Pain Structure

Cramping, dull, aching Muscle

Sharp, shooting Nerve root

Sharp, bright, lightninglike Nerve

Burning, pressurelike, stinging, aching Sympathetic nerve

Deep, nagging, dull Bone

Sharp, severe, intolerable Fracture


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Throbbing, diffuse vasculature

Assessment of Pain

In the initial assessment of pain, the clinician should document Pain onset Pattern of pain Exact location of pain Results of a pain questionnaire, if available Whether the pain radiates or spreads to other parts of the body Description of the pain; that is, when is it best and worst, constant or intermittent, what

activities make the pain better and worse, time of day pain is better or worse

What work or social activity is affected by the pain


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CHARTING

Definition: Charting is the recording done on the patients chart

Purposes:

1. To provide information as to the treatment and care given to the patient for the purpose ofserving as guide for his care

2. To furnish data which may help in planning and evaluating the patients treatment3. To provide information which can serve as reference material for medical research as well as

evidence in legal matters

4. To serve as resource material for assessing community health needsGuidelines in Charting:

1. Be concise, specific, informative and legible when recording on the patients chart2. In reporting your entries, be accurate and exact3. Describe accurately all your observations, and in doing so, use appropriate medical terms4. Be sure that your entries must reflect the patients condition, including unusual symptoms or

changes in his condition

5. Enter all notations in a chronological order. Write down all observations, treatments and otherdata as they are accomplished

6. Write your notations in long hand or in print, using blue, black, blue-black or red ink (as specifiedby the policies of the department)

7. Use only standard or universally accepted abbreviations8. Place your notations in the especially prescribed form under the appropriate column9. Affix your signature (full name with your middle initial) at the end of the recorded notation you

made immediately after the last sentence.

10. In case of error in chartinga. Do not eraseb. Draw a line, in red ink, across the word or words, or if the error involves a bigger area,

across the page from the upper left-hand corner to the lower right hand corner,

covering the necessary space

c. On the line just drawn, write in the word error followed by your signatured. An error in charting does not require recopying the entire pagee. Consult the physical therapy clinical instructor or staff physical therapist before

recopying a page on which an error has been made. If it is copied, the original page

must be signed and filed at the back of the chart

11.Fill out all headings of each page properly12.Arrange the different pages of forms that make up the chart according to the prescribed

sequence of the department13. In case of hospital accident, charting should include

a. Patients condition before the incident or accidentb. Time accident occurredc. What exactly happened, why and how it happenedd. If an injury is noted, state the part of the body involved and describe the damage or

injury

e. Time the physician was notified about the incident


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f. Time the patient was examinedg. Name of the doctor who examined the patienth. Finding of the physician s examinationi. Medication or treatment givenj. Filling of an accident report

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