the role of the physical therapist in the healthcare team

THE ROLE OF THE PHYSICAL THERAPIST IN THE HEALTHCARE TEAM

Eric L. Lippincott, PT, ATC

Associate ProfessorHealth Science Department

Lock Haven University

Objectives Define and describe the role of the physical

therapist in the healthcare team Describe role of the PT within the continuum of

care Identify patients within various primary care

settings that may benefit from physical therapy services

Identify specific therapies, and services provided by Physical Therapists

Differentiate between various PT Modalities, including indications, contraindications, and their application

A bit about PTs Current degree is DPT (clinical

doctorate) National exam with state licensure and

CE requirements Practice settingsHospital LTC Outpatient

Schools Universities Rehab HospitalsHome Health Work Settings

Advanced Certifications (residency, fellowship, certifications)

Role of PTs in the “Team” Providers who examine and treat

individuals who have a limitation in function

PT vs OT Trained in four major body systems

Musculoskeletal Neuromuscular Cardiovascular / Pulmonary Integumentary

Referral vs Direct Access

PTs and the Continuum of Care

Emergency Room ICU/CCU Acute Care Facility Sub-Acute / Step Down Rehabilitation

Hospital / Center SNF / LTC

Home Health Hospice Outpatient Rehab Outpatient Ortho School System Athletic Facility Industry

Typical progression is from in-patient to out-patient to community-based facility

Physical Therapy Treatments Thermal Agents Manual Therapy

Techniques Electrical Agents Ultrasound/Phonophoresis Laser Therapy Therapeutic Exercise ACTIVE vs PASSIVE

TREATMENT EDUCATION &

PREVENTION

Thermal Agents Options

Cold Modalities Ice Bags, Reusable Cold Packs Ice Massage Ice Immersion Cryostretch? Cryokinetics

Heat Modalities Moist Heat Packs Paraffin Diathermy – deep heat Ultrasound – deep heat - more to come later

Whirlpool

Thermal Agents – Cold Modalities

Temp between 32˚ and 65˚ F

Local Effects Vasoconstriction Decreased cellular

metabolism Decreased production of

cellular waste Reduction in inflammation Decreased pain and muscle

spasm Ideal treatment is typically

15 min

Indications Acute injury, pain,

edema or inflammation

Muscle Spasm Contraindications

Cardiac or respiratory concerns

Cold allergy Decreased sensation

Thermal Agents – Heat Modalities Superficial Agents -

104˚ - 113˚ F Local Effects

Vasodilation Increased cell

metabolism Increased delivery of

leukocytes Increased elasticity of

tissue Decreased spasm

Ideal treatment is typically 15-20 min

Indications Subacute or chronic

inflammation and pain Muscle spasm Decreased ROM

Contraindications Acute injuries Impaired circulation Poor thermal

regulation Neoplasm Decreased sensation

Hot vs Cold Does the area feel warm to touch? Is the area tender? Does swelling increase with activity? Does pain limit joint motion? Is the patient in acute stage?

Manual Therapy Techniques Massage

Treatment result depends on technique

Myofascial Techniques Mobilization (including

manipulation) Stretch peri-articular

structures Manipulation depends

on state practice act

Electrical Agents Examples

Electrical stimulation Iontophoresis

Electrical Stimulation Effects:

Pain reduction (sensory level) Edema reduction Motor stimulation – atrophy and

denervation Contraindications

Cancer Pacemakers Over the carotid sinus and spinal cord

So what about these???

Iontophoresis Using electrical current to

facilitate transmission of medication ions through the skin

Typical medications include analgesics and anti-inflammatories (dexamethasone and lidocaine are most common)

Not strongly supported in the literature

Ultrasound Ultrasound – sound waves

produced by crystal in the sound head

Can have both thermal and non-thermal effects

Thermal effects are deeper than traditional thermal modalities

Contraindications Metal implants Undiagnosed fracture Cancer Acute inflammation/infection Over epiphyseal plates and the

spinal cord

Phonophoresis Using sound waves to facilitate the

transmission of medications through the skin

Examples: hydrocortisone, dexamethasone, lidocaine

Not strongly supported in the literature

Laser Therapy (LLLT) Relatively new to the marketplace and

only FDA-approved for certain diagnoses Effects are similar to ultrasound Outcomes are pending

Mechanical Devices

Intermittent Compression (Jobst)Continuous Passive Motion (CPM)

BiofeedbackTraction

Therapeutic Exercise ROM – AROM / AAROM / PROM

Muscle tightness, decrease in joint mobility, postural problems

Strengthening Balance / Neuromuscular Control HEP

Have you seen these kids?

Specific Therapies and Services Discuss basic therapy for each of the

following: Acute musculoskeletal injury Fracture Care Post operative care Integumentary Issues CNS Rehab Arthritis/Connective Tissue Disease Rehab

Acute Injury Rehab Follows tissue healing guidelines

Inflammatory Stage PRICE Immobilize Modalities

Fibroblastic Stage Restore ROM Begin strengthening and balance

Remodeling Stage Advanced strengthening and functional training

Fracture Care Rehab ROM limitations, atrophy, and

deconditioning are the major concerns Restore ROM once fracture is stable Strengthen as tol (WBing increases bone

density) Associated joints Cross Train

Post-Op Care Hospital-Based

Therapy Assistive Device / DME Gait Initiation /

Training Education (ie hip

precautions) Begin strengthening

Out-Patient / Home-Based ROM followed by

strengthening Specific protocol

dictated by operative procedure

Amputations Desensitization

treatment Prevent contractures Prosthetic fitting &

prescription Gait training &

strengthening

Treatment of Integumentary Issues Burns

Typical wound care – debridement, packing, and dressing

Prevention of contractures Pressure to prevent keloids

Skin Lesions – treatment depends on type Debridement Packing, Dressing, and Casting Education

CNS Rehab (CVA, TBI, SCI) Deficits depend upon

location of injury Carefully directed,

structured repetitive practice

Acute treatment focuses on initiating movement

Progress to promoting independence (ADLs, DME, etc)

Safety, thought initiation, emotional disturbances

Usually a team approach to rehab

Arthritis Treatment Decrease joint stiffness

ROM exercises Thermal modalities HEP & Education

Strengthen as tol (surrounding musculature)

What about Athletic Trainers? Education falls under six

domains

Credential varies by state Education includes

modalities and rehabilitation

Current PA practice act includes treatment of physically active

Prevention Professional Responsibility Clinical Evaluation and Diagnosis

Organization & Administration

Immediate Care Treatment, Rehab, & Reconditioning

Questions and Thank You