School of Health SciencesRobert Gordon University

AberdeenUnited Kingdom

Anne Wallace and Dawn Mitchell

Occupational Therapy and Physiotherapy Education at RGU

• 4 year BSc Hons Degree Courses• Practice Placements and volunteer patients• Inter-professional working on the courses• Thorough assessment, problem solving and

clinical reasoning. • 2 year MSc Pre-reg Physiotherapy

Plan for Today

• Physiotherapy Practice in rehabilitation – Anne Wallace

• Principles and practice of Occupational therapy – Dawn Mitchell

• The team and Case study – working together

Physiotherapy Practice in Rehabilitation and Team working

Anne WallaceSubject Lead Physiotherapy

RGU Aberdeen a.wallace@rgu.ac.uk

Physiotherapy

Physiotherapy- a definition

• Physiotherapy uses physical methods to affect recovery and rehabilitation of individuals which may involve reducing pain, increasing function and improving quality of life.

Physiotherapy Scope of PracticeIn the UK • Independent practitioners • First line referrals• Work in extended scope roles e.g. Prescribing,

ventilation, bronchoscopy, injecting• Consultant physiotherapists

Where do Physiotherapists work?

• Hospital including ICU and women's health• Out patient clinics• Mental health• Learning disabilities and Paediatrics• Sport and leisure• Industry• Schools

3 main areas of clinical focus

•Cardio respiratory,• Musculo-skeletal • Neurological.These can be separate or combined.Elderly patients often require all the

physiotherapist skills.

Benefits of exercise and activity • Bone density• Cardio-vascular • Respiratory• Mental health and cognitive ability• Cancer – colon and breast• Diabetes• Falls prevention (Warburton et al 2006)

Physiotherapy Principles• Accurate assessment • Diagnosis or identification of problems• Setting goals• Modification of treatment depending on

response using anatomical, physiological measurement and patient response.

• Evaluation and accurate recording

Physiotherapy for cardiac problems

• Physiotherapy can be used medical and surgical cardiac conditions.

Once medically stable it is important that they exercise in a controlled manner and keep mobilising and exercising for years to come to reduce the risk of further cardiac events, improve function and quality of life.

When exercising other existing pathologies must be considered

Phases of cardiac rehabilitation

• ONCE STABLE• Phase I – patient encouraged to mobilise on

the ward and increase function prior to going home

• Phase II – patient given instructions to increase walking tolerance at home. Visit or phone call.

• Phase III – patient returns to the hospital for cardiac rehabilitation classes

Phase III

• Patient is tested using Shuttle walk test and Q of L questionnaire-15 min warm up-30min CV exercise-10 min cool down -Education classesExercise is monitored using RPE scale and HR and

progressively increased6-12 week programme x 2 per week

Perceived Exertion scale

COPD and chest conditions

• On admission patient may require chest physiotherapy to position, improve breathing, remove sputum and mobilise.

• Pulmonary rehabilitation classes can also be given.

• Education on prevention of recurring problems

Spiral of Inactivity

Inactivity

Breathlessness and Fear

Inactivity

Rehabilitation of Neurological patients• Stroke, Parkinson’s disease, Multiple sclerosis,

TBI, MND and many more• Early mobilisation essential• Maximising Function through muscle

activation, Task specific practice, Tone management Balance rehabilitation, Walking/transfer aids preventing secondary complications and prescribing orthotics

Musculoskeletal- outpatients

- Back and neck problems and joint problems,- -arthritis - Sports injury- A variety of specialised techniques including

mobilisation and manipulation- Electrical techniques to reduce pain - -Exercise and education

Musculoskeletal- inpatients

• Amputees, hip and Knee replacements• Mobility problems• FallsExercise and rehabilitation including walking

practice provision of walking aids and orthotics.

Wheel chair and prosthetic assessment

Advances in Physiotherapy

• Physiotherapy like all health care professions has to respond to the challenges of a constantly changing health care keeping the population well as well as treating the patient that is ill.

Team• Working as a team has been proven to be of

benefit to give the patient the best outcome• A team is more than it component members

working separately• The team can be as big or as small as the

patient requires• The team needs a leader and agreed goals

Types of Team

• Multidisciplinary– Team approach but each discipline works towards

own goals• Interdisciplinary/Interprofessional– Team approach where all professions work

towards shared goals• WHOSE GOALS?

Issues in teams

Communication

Time pressures

Differences in Professional Cultures• Negative professional stereotypes• Trust and respect• Joint training / team building• Different professional philosophies or ideologies

Cameron and Lart (2003)

Case Study

• Mrs Bell 76 years old• Early Parkinson's Disease on medication• Lives with husband• Found fallen in the bathroom

Falls – cause and effect

Reduced Occupational Performance in Activities of Daily living

Team

Patient

Occupational therapists

Doctors

Physiotherapist

Nurses

PharmacistSpeech Therapist

Optometrist

Family

Other

Patient Goals

Early Goal -to get to and use the bathroom independently- to get dressedMedium term Goal- to go home and resume her role as housewife-Long term Goal-Return to activities in the community-Role as grandparent, wife, church group member

Early Stage Goals

GoalEarly stage

Doctor / pharmacist

Nurse Occupational Therapist

Physiotherapist

-to get to and use the bathroom independently

-to get dressed

-Managing medication to manage symptoms-- ensure medically stable and for to mobilise

- Caring and promoting independence

-Independent transfers- Safe washing technique

-- dressing practice and managing clothes

-Promote mobility, muscle strengthening and walking aid

-- sitting balance

Early mobility

Medium term GoalsGoalMedium stage

Nurses Occupational Therapist

Physiotherapist

- to go home and resume her role as housewife

--to help mobilise the patient and encourage her to gain confidence and promote independence-Confidence building-Liaison with carers / MDT

-Home visit to identify risks /barriers to performance -Environmental adaptation / Equipment provision-Meal preparation practice / teaching safe techniques-Confidence building-Liaison with carers / MDT

Progress independent mobilityStair practicePractice getting up from floor-Continued balance /strengthening exercises-Confidence building-Liaison with carers / MDT

Home Visit

Longer Term Goals

GoalLate stage

Occupational Therapist

Physiotherapist

-Return to activities in the community-Role as grandparent, wife, church group member

•Outdoor mobility / public transport practice•Visit to community facilities •Adaptation / skills enablement to participate in roles

Outdoor mobility / strengthening exercisePacingExercise class

Mobility

Continued Rehabilitation in the Community

References

http://www.nhs.uk/Livewell/fitness/Documents/older-adults-65-years.pdfBHF Technical Report :Physical Activity Guidelines in the UK: Review and Recommendations May 2010

Scottish Health Survey 2012 http://www.scotland.gov.uk/Resource/0043/00434590.pdf

CAMERON, A. and LART, R., 2003. Factors Promoting and Obstacles Hindering Joint Working: A Systematic Review of the Research Evidence. Journal of Integrated Care, 11(2); pp 9-17.

Darren E.R. Warburton, Crystal Whitney Nicol, Shannon S.D. Bredin (2006) Health benefits of physical activity: the evidence CMAJ • March 14, 2006 • 174(6) | 801-809

Langlos F et al (2012) Benefits of Physical Exercise on Cognition and Quality of Life in frail olderAdults. J Gerontol Psycohol Set Soc Sci (2013) 68 (3) 400-404

Thank you for listening.Any questions?