CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42 Assisting with Cold and Heat Therapy and Ambulation

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

42Assisting with Cold and Heat Therapy and Ambulation


42-2

Learning Outcomes42.1 Explain how medical assistants might assist with

some forms of physical therapy.

42.2 Describe ways to test joint mobility, muscle strength, gait, and posture.

42.3 Discuss the benefits of cold and heat therapies.

42.4 List contraindications to cold and heat therapies.

42.5 Identify various cold and heat therapies.


42-3

Learning Outcomes (cont.)

42.6 Demonstrate how to perform cold and heat therapies.

42.7 Describe hydrotherapy methods.

42.8 Identify several methods of exercise therapy.

42.9 Compare different methods of traction.

42.10 Demonstrate how to teach a patient to use a cane, a walker, crutches, and a wheelchair.


42-4

Introduction

• Medical assistant– Common duties

• Apply cold and heat therapy

• Assist patients with ambulation

• You may also – Teach basic

exercises– Demonstrate how

to use a wheelchair– Demonstrate the

use of cane, walker, and crutches

– Discuss therapies with the patient


42-5

General Principles of Physical Therapy

• Physical therapy is a medical specialty that treats– Musculoskeletal

disorders– Nervous disorders– Cardiopulmonary

disorders


42-6

General Principles of Physical Therapy (cont.)

• Assisting the therapeutic team– Members

• Physicians• Nurses• Medical assistants• Other specialists

– Coordinate patient schedule

– Make referrals– Explain treatment

approach– Documentation– Reinforce instructions– Answer patient

questions

You must have a working knowledge of

therapy techniques.


42-7

General Principles of Physical Therapy (cont.)

• Specialized therapies– Art– Music– Dance– Writing

– Crafts– Aquatic– Horticultural– Equestrian


42-8

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 measure

• Muscle strength testing – Determines the amount of force the patient can

exert with a group of muscles– Compare each side of body


42-9

Patient Assessment (cont.)

• Gait testing – The way a person

walks (gait and swing)

– Includes• Length of stride• Balance • Coordination• Direction of

knees and feet

• Posture – Body position and

alignment– Checks spinal

curves– Symmetry of

alignment• Shoulders• Knees• Hips


42-10

Apply Your Knowledge

Match description with assessment type:

___ How a person walks A. Joint mobility

___ Range of motion B. Muscle strength

___ Body position and alignment C. Posture

___ Force exerted with a group of muscles D. Gait

___ Goniometer

___ Check spinal curves

___ Length of stride

C

D

C

B

A

A

DGood Job!

ANSWER:


42-11

Cryotherapy and Thermotherapy

• Cryotherapy– Applying cold for

therapeutic reasons

– Types • Wet or dry

• Chemical or natural

• Thermotherapy – Applying heat for

therapeutic reasons

– Types • Dry

• Moist


42-12

Cryotherapy and Thermotherapy (cont.)

• Generally promote healing

• Side effect – damage to underlying nerves and tissues

• Monitor patient closely

• Factors affecting the use of these treatments

– Treatment location

– Circulation or sensation impairment

– Temperature tolerance

– Age


42-13

Principles of Cryotherapy

• Constricts blood vessels

• Physiologic responses to cold

– Prevents swelling

– Controls bleeding

– Reduces

inflammation

– Anesthetic effect for pain

– Reduces pus formation

– Lowers body

temperature


42-14

Administering Cryotherapy

• Dry cold applications– Ice bags and collars

– Chemical ice packs

• Wet cold applications– Cold compresses

– Ice massage


42-15

Principles of Thermotherapy

• Dilates blood vessels

• Physiologic responses to heat– Relieves pain and congestion– Reduces muscle spasms– Muscle relaxation– Reduces inflammation– Reduces swelling


42-16

Administering Thermotherapy

• Dry heat therapies– Chemical hot packs– Heating pad

– Hot-water bottle– Heat lamp– Fluidotherapy


42-17

Administering Thermotherapy (cont.)

– Moist heat applications• Hot soak• Hot compress• Hot pack• Paraffin bath

– Diathermy – high-frequency wave achieves deep heat penetration

• Ultrasound • Shortwave• Microwave


42-18


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.


42-19

Hydrotherapy

• Use of water to treat physical

problems

• Whirlpools– Water is agitated by jets of air

under pressure– Generates hydromassage

• Relaxes muscles • Increases circulation

– Also used to clean and debride wounds, ulcers, and burns


42-20

Hydrotherapy (cont.)

• Contrast baths– 2 baths, one hot

and one cold– Patient moves

quickly from one to the other

– Purpose• Induces relaxation• Improves circulation• Greater mobility

• Underwater exercises– Warm swimming

pool– Buoyancy takes

pressure off joints– Purpose

• Promotes relaxation • Increases

circulation


42-21


What are the main effects of hydrotherapy?

ANSWER: Hydrotherapy relaxes muscles, increases circulation, and improves flexibility and mobility.


42-22

Exercise Therapy

• Preventive and therapeutic benefits– Flexibility– Mobility– Muscle tone– Strength

• Primary treatment for fractures, arthritis, and some respiratory diseases– Minimizes symptoms– Slows disease progression


42-23

Exercise Therapy (cont.)

• Exercise– Improves muscle tone

and strength

– Maintains ROM

– Prevents or corrects physical deformities

– Promotes neuromuscular coordination

– Improves circulation

– Relieves stress

– Lowers cholesterol levels

– Aids in resumption of normal daily activities


42-24

Medical Assistant’s Role

• Provide patient information– Types of exercise

programs – Treatment plan

• Provide support and encouragement

Assist with ROM exercises

Teach the patient and family about ROM exercises.


42-25

Types of Exercise

• Choice based on patient’s physical condition

• Active mobility – Self-directed exercises – Increase muscle strength

and function

• Passive mobility – Therapist or machine

moves the patient’s body part

– Retain ROM and improve circulation

• Aided mobility – Self-directed with

assistance of a device such as exercise machine

– Retain or improve ROM


42-26

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

• ROM exercises– Move each joint

through its full range of motions

– Improves flexibility and mobility

– Improves circulation and muscle function


42-27

Electrical Stimulation

• Delivers a controlled amounts of low-voltage electric current to motor and sensory nerves

– Stimulates muscle

– Prevents atrophy

– Helps in healing injured joints

– Retrains a patient to use injured muscles


42-28


Match description with type of exercise:

___ Self-directed; exercise machine A. Isometric

___ Self-directed; no assistance B. Aided mobility

___ Low-voltage current; stimulates C. Active resistance nerves/muscles

___ Relax and contract muscles from D. Electrical fixed position stimulation

___ Exercise against counter-pressure E. Active mobility

___ Move joint through full range F. ROM

D

E

F

C

A

YIPPEE!

B

ANSWER:


42-29

Traction

• The pulling or stretching of the musculoskeletal system – Used to treat fractured bones and dislocation,

arthritic, or other diseased joints

• Uses– Create and maintain bone alignment– Reduce and prevent joint stiffening– Correct deformities– Reduce and relieve muscle spasms


42-30

Traction (cont.)

• Manual– Stretching muscles

and separating joints by gently pulling on them

– Improves motion and decreases stiffening

– Uses • Muscle spasms• Stiffness• Arthritis

• Static– Weight traction using

harness and weights– Used to relieve muscle

spasms


42-31

Traction (cont.)

• Skeletal – Long-term/heavy

weights– Pins, wires, or tongs

surgically placed– Pulleys and weights

provide continuous traction

• Mechanical – Device intermittently

pulls and relaxes– Promotes relaxation


42-32


True or False:___ Static traction uses a harness and weights to induce muscle spasms.

___ Manual traction stretches muscles and separates joints by gently pulling on them.

___ Skeletal traction uses pulleys and weights to provide continuous traction.

___ Mechanical traction maintains constant tension on the extremity.

F

T

T

F

alternately pulls and relaxes

relieve

ANSWER: FANTASTIC

!


42-33

Mobility Aids

• Devices to improve patients’ ability to ambulate or move about

• Mobility aid chosen depends on– Patient’s disability– Muscle coordination– Strength – Age


42-34

Canes

• Standard– Patient who needs only small amount of

support

• Tripod (3 legs) and quad-base (4 legs)– Create wide base of support– More stable than

standard canes

• Must be adjusted to correct height for patient


42-35

Walkers

• Used by older patients with– Difficulty walking unassisted– Balance problems

• Provides a sense of stability

• Types – Table 42-2

• Adjust to proper height for patient


42-36

Crutches

• Transfers weight to the arms

• Types – Axillary

• Ground to axilla• Short-term use

– Lofstrand, or Canadian

• Ground to forearm• Long-term use


42-37

Crutches (cont.)

• Complications may arise if not measured properly– Pressure on nerves in

axilla– Strain on back, imbalance

• Measuring for crutches– Should be 2 to 3 finger-

widths between supports and axilla

– 30º flexion at elbow


42-38

Crutches (cont.)

• Crutch gaits– Four-point – slow gait for a patient who can

bear weight on both legs

– Three-point – used when patient cannot bear weight on one leg

– Two-point – used when patient can have some weight on both legs; must have good muscle coordination and balance

– Swing gait – used when patient has severe disabilities


42-39

Wheelchairs

• Type of chair chosen – Depends on patient’s disability

– Length of time wheelchair needed

• Always ensure patient safety during transfers

• Use appropriate lifting techniques


42-40


When would a walker be an appropriate mobility device for use by your patient?

ANSWER: Walkers are used by older patients who are too weak to walk unassisted or who have balance problems.

Hip-Hip- Hurray!


42-41

Referral to a Physical Therapist

• Referrals to preferred therapists– Provide physician’s order– Provide patient

information

• Therapists – Independent practitioners– Hospital or clinic– Home health


42-42

In Summary

42.1 A medical assistant may be asked to apply cold and heat; teach basic exercises; demonstrate how to use a cane, walker, and crutches; demonstrate how to use a wheelchair; and discuss with the patient specific therapies for use at home.

42.2 Various physical tests are performed on patients, including joint mobility testing, muscle strength testing, gait, and posture testing.

42.3 Cold and heat therapy promote healing and increase patient comfort.


42-43

In Summary (cont.)

42.4 Contraindications to cold and heat therapies include circulation problems, pain, and hemorrhage.

42.5 There are various types of cold and heat therapies. These include dry and wet, cold, and heat applications.

42.6 The general steps to applying cold and heat therapies include checking the physician’s order, positioning and draping the patient, applying the pack, and monitoring the patient.

42.7 Various types of hydrotherapy used to treat physical problems include whirlpools, contrast baths, and underwater exercises.


42-44

In Summary (cont.)

42.8 There are several methods of exercise therapy, including active mobility, passive mobility, aided mobility, and active resistance.

42.9 The different methods of traction used to treat physical problems include manual, static, skeletal, and mechanical.

42.10 There are various mobility aids, including 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.


42-45

End of Chapter 42

Disability is a matter of perception. If you

can do just one thing well, you're needed

by someone.~ Martina Navratilova

Documents

CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42 Assisting with Cold and Heat Therapy and Ambulation