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Sunday, February 13, 2011

The Modalities of Physical Therapy

Rehab Room
Physical therapy is the treatment of neurological, musculoskeletal, circulatory, and skin disorders using various physical therapy modalities. The goal of physical therapy intervention is for patients to regain maximum potential and to have a productive life with or without the presence of disability.

Physical therapists may use a number of different modalities for your problem(s) or condition for a variety of reasons, including:
  • Reduction of pain
  • Increasing range of motion
  • Decreasing swelling
  • Increasing the rate of healing
  • Stabilizing areas needing support

“Four basic modalities are employed in physical therapy, each applied where and when it will do the most good. Not all of the modalities are used in every case.

 

Cold therapy

Cold therapy or cryotherapy is an effective means of reducing inflammation following an accident or injury. Cold therapy is applied in the form of ice packs, sometimes combined with massage, cold water bath of the injured area, and other methods. The reduced temperature will quell the firing of the nerve-muscle units and reduce muscle spasms, and that along with the anesthetic effect of the cold temperature will ease pain. Also, the cold reduces blood flow into the injury and reduces any bleeding that may be present and reduces oxygen demands of the injured tissue, thus preserving the muscle cells. An ice pack often is applied with a compression wrap to reduce swelling, and with elevation of the injured extremity above heart level for maximal reduction in swelling.

 

Heat therapy

Heat or thermotherapy may be employed only after the active swelling of the injury has abated, 24-48 hours following the injury. Heat is conveyed into the injured area by the use of moist heat packs, hot paraffin, hot air or hot water as in a whirlpool bath, by infrared lamp, and by conversion. Conversion is the development of heat brought about by the passage of sound waves or electric current through tissue. Diathermy is an example of electrical waves directed into tissue and converted into heat. Ultrasound, very high-frequency sound waves, bring about the vibration of the tissues, which increases the temperature within them. A form of application of sound waves called phonophoresis consists of application of a medication to the injured area followed by ultrasound to drive the medication deep into the tissues.
Heat increases blood flow to an area, so should not be used when internal bleeding accompanies an injury. However, like cryotherapy, heat reduces muscle spasms by increasing the blood flow to an area, which helps to wash out metabolic waste products and increase the amount of oxygen reaching the tissues.

 

Electrical stimulation

Application of electrical stimulation can restore muscle tone by stimulating muscles to contract rhythmically. This method is used often when an injured person has been confined to bed for a long period of time. Over time, muscles will atrophy and the patient will require long, arduous periods of exercise once he is mobile. The use of electrical stimulation can prevent muscle atrophy and reduce the necessary physical therapy regimen required later. Electricity is also used to drive molecules of medication through the skin into the tissues. This is called iontophoresis. A special machine called a TENS machine (transcutaneous electrical nerve stimulation) beams electric current through the skin (transcutaneously) into the injured area specifically to stop pain. Why TENS has this ability to assuage pain remains open to question, but it is thought that it prevents pain perception by the sensory nerves in the injured area. That is, the nerves that normally would detect pain and carry the impulse to the spinal cord do not sense pain. The electrical signal from the TENS machine can be adjusted for frequency and strength to achieve its effect without patient discomfort. All electrical stimulation is delivered by placing pads on or around the injured area to conduct the electrical current.

 

Mechanical manipulation

The use of massage, manipulation of the injured limb, traction, and weight lifting are part of the mechanical form of physical therapy. Massage is the rubbing, tapping, or kneading of an injured area to increase blood circulation and relieve pain. Manipulation consists of putting an injured joint through its movements from one extreme to the other. This is designed to restore full range of motion to the joint and eliminate pain from movement. Traction is the application of weight to stretch muscles or to help increase the space between vertebrae and relieve nerve compression. Manipulation may be carried out by a trained technician or by using a machine especially constructed to exercise the injured joint. Resistance can be altered in the machine to make joint extension or flexing more difficult, thus helping to build the muscles that control the joint movement.


Many forms of physical therapy can be carried out at home, but the exercises must first be carefully explained by a trained therapist. Incorrect application of a physical therapy modality can be as harmful as any traumatic injury. Most modalities are applied two or three times daily over a period of time to help restore movement, flexibility, or strength to an injured area.

Through the use of tests, evaluations, exercises, treatments with modalities, screening programs, as well as educational information, physical therapists:
  • increase, restore or maintain range of motion, physical strength, flexibility, coordination, balance and endurance
  • recommend adaptations to make the home accessible and safe
  • teach positioning, transfers, and walking skills to promote maximum function and independence within an individual's capability
  • increase overall fitness through exercise programs
  • prevent further decline in functional abilities through education, energy conservation techniques, joint protection, and use of assistive devices to promote independence
  • improve sensation, joint proprioception and reduce pain

 

Common Conditions

A vast number of conditions are treated effectively with physical therapy intervention. Examples of specific diseases and conditions that may be improved with physical therapy include:
  • arthritis
  • sports/orthopedic injuries
  • joint replacements
  • cerebral vascular accident (stroke)
  • coordination and balance disorders
  • Alzheimer disease


To ensure the best treatment outcome for the patient, the physiatrist and the physical therapist must ensure that the correct physical therapy modalities are prescribed.

Many researches supported that treatment outcome differ from patient to patient depending upon the severity and extent of the disability, methods used, and also the level of cooperation of the patient to rehabilitation.

Monday, February 7, 2011

The Power of Physiotherapy Exercises - Why Are They So Beneficial?

Health care providers referred to as physical therapists or physiotherapists are qualified in giving assessments and treatments on different conditions. They are more focused in providing relief and wellness through a more physical approach such as manual therapy, acupuncture and physiotherapy exercises.

Physiotherapists or "PT's" are highly trained professionals who can identify weaknesses or imbalances in the body. Physical therapists can help in targeting specific areas in the body where weakness or pain is felt and then prescribe the suitable treatment plan. Physiotherapy exercises are methods that can truly help relieve and soothe stress, as well as help the body function without pain and limitation.

How Exercise Helps the Body

When you incur an injury, the pain felt should serve as a guide to where the sensitive areas are located. Physiotherapists stress that there are two major types of pain: first is the pain due to stiffness and the second is pain due to damage. Pain due to stiffness may be quite bearable when you are doing exercise, and may be relieved gradually once you finish an exercise. The pain basically means that your muscles are a bit out of sync, and need to be eased back into working condition. Pain due to damage can be unbearable, which is an obvious indicator that your muscles are damaged, and are not ready for any exercise yet.

Once your physiotherapist determines the extent and cause of your pain, he or she will ask you to perform an array of physiotherapy exercises. There are practically hundreds of PT exercises for different injuries, from injuries to the neck, lower back, shoulders, spinal cord, legs, and feet. Your Physiotherapy clinician may also specify additional personalized stretching exercises for you. Stretching, as you should know, is important for maintaining proper range of motion of the joins, and also promotes flexibility of muscles.

For example, if you have tight muscles or stiff joints, performing normal activities like climbing the stairs or reaching for items above the cupboard may be tough to do. With proper stretching exercises, the normal body functions can either be preserved or enhanced. Scar tissue is formed and soft tissue becomes contracted as a result of an injury or a surgery. It's important that you regularly perform physical therapist-assisted stretching exercises, to ensure that the scar formation does not impair your movements.

How Prescription Exercises Help to Improve Muscle Strength

Prescription physiotherapy exercises are generally employed to specifically target muscle deficiencies, and also to help rehabilitate patients after an injury or after undergoing surgery. Therapeutic or prescription exercises are often used to improve the patient's strength, function and mobility, as well as to significantly lessen pain and swelling in the affected part of the body. Family doctors and PT practitioners often prescribe simple and easy home-based physiotherapy exercises, and also provide their patients with handouts and easy-to-understand instructional manuals or guides. Many agree that supervised physiotherapy exercises are more effective than home-based exercises, especially in patients who have osteoarthritis of the knee, low back injury and intermittent claudification. Still, physiotherapy exercises performed at home have their own advantages as well, more so for the post-operative recovery of anterior cruciate ligament.

Exercise is truly vital for the treatment and management of a wide array of chronic health conditions and injuries. Supervised physical therapy exercise programs consist of individualized prescription exercises that are specifically designed by trained physiotherapists, and are done in conjunction with the patient's condition and fitness level. Physical therapists are specialists in movement impairments, and are effective in developing or designing therapeutic exercise programs and modalities which suit a patient's specific needs.

One past study by a group of physicians from The Netherlands concluded that supervised physiotherapy exercises also result in less pain and improved function for tested patients, both in short term and long term durations.
Resources on Physiotherapy Exercises and other Information
A number of helpful physiotherapy resources are available online, to give you more helpful information on new and improved modalities for easing pain and improving strength and mobility. The American Family Physician's website offers relevant information related to physiotherapy exercises. Another authority site when it comes to information and resources about any specific therapy program, such as physiotherapy exercises, is the Canadian Physiotherapy Association.

Discover the benefits of physiotherapy exercises - for a healthy lifestyle, safe weight loss and effective injury rehab - you are sure to be on the path to wellness. Learn more about Exercise Prescription with the help of the PT Health Team. Get in touch with one of the competent health professionals today. 

Book your free consultation with PT Health now!

Image Credit: sciencephoto.com

Sunday, January 30, 2011

Nursing vs PT



Part of the constant battle between nurses and therapists.

Saturday, January 29, 2011

Benefits of Home Physical Therapy

There are many settings that physical therapists practice their craft.  Schools, hospitals, private outpatient clinics, nursing homes, and private homes are some of these settings.  The most common setting for a patient that is unable to commute to an outpatient clinic or for patients that are homebound is home care physical therapy.  New trend in physical therapy such as the clinic is brought to the patient is now a common practice. Some models are being used. One model is that some physical therapists have a mobile clinic in the form of an RV.  Equipments such as treatment tables, exercise equipments and the typical modalities you would find in a PT outpatient clinic can be found in the RV. A second model which is cheaper would be a physical therapist coming to the patient’s home with a portable treatment table and other hand-held physical therapy modalities such as ultrasound machine, ES, TENS, walking aids and more.

What are the benefits of treating patients in their homes?

  • Patients will not miss any treatment sessions thereby improving compliance.
  • Evaluation of patients by physical therapist in their REAL natural environment.
  • More time efficient since patients don’t have to travel to the clinic
  • Patient’s privacy with their family
  • Elimination of disruptions such as other clients/patients being treated, etc.
  • Physical therapist can have a quality time with the patient as it is a one on one treatment session.
  • Allows effective treatment sessions and reduces the risk of injury
  • Your whole family is present to support you throughout the treatment session
  • Can eliminate complications of driving or riding a car or a public vehicle and the hassle of going to an outpatient physical therapy clinic after a surgery.

Why is home physical therapy right for you?

You must consider some few questions if the home physical therapy is right for you. 

Are you comfortable with a stranger in your home? 

The first few minutes in a therapy session is the adjustment period.  After the physical therapist has introduced him and the treatment approach, you may now be comfortable with him since you are divulging personal information regarding your medical history.

Can you concentrate without any distractions in your home?

Just enough space for the therapy session is required by the physical therapist.  They just need to set up the treatment table and may require an outlet for modalities.  Therapists are trained to be creative in such a way to take advantage of a small area to achieve the required room for exercise.  In addition, most equipments and modalities required for therapy is light and portable.  Thus requires just a little space.

In my experience, patients prefer home therapy because it is more comfortable, more convenient, and promote patient compliance.  They can also take advantage of not going to travel anymore.  It is typical for the patients who undergo home physical therapy to have their therapy sessions scheduled in the morning before going to work or late in the evening after office or working hours.

What about insurance coverage?

Your insurance coverage is dependent on your physical therapist.  Some therapists are connected with Medicare and other commercial plans while others are out of network. It is important to communicate with the therapist prior to the first visit to find out how your treatment sessions will be covered.

Not all patients are candidates for home therapy program.  Physiatrists and physical therapists may advice outpatient care.  However, if you are enjoying your home therapy program you can ask your physiatrist and physical therapist so that they can provide adjustments in your treatment program.

Sunday, December 26, 2010

Recovery from Mild Hemiparetic Stroke

There are many risk factors for stroke to occur. Such are smoking, alcohol drinking, sedentary lifestyle, obesity, hypertension, family history of stroke, old age, heart disease, diabetes and many more. Individuals that have these risk factors must consider that anytime stroke may happen.

Some individuals may develop mild, moderate to severe stroke depending upon the severity of damaged portion of the brain. The brain is a delicate organ that is responsible for most of body functions; particularly motor and sensory functions.

Mild form of stroke occurs when a small portion of the brain is devoid of blood supply for a significant period of time and thereby created an irreversible damage to the brain cells. Partially damaged brain cells may recover over time called “spontaneous recovery”. Affectation of the right side of the brain will result to a left-sided stroke and affectation of the left side of the brain will result to a right-sided stroke. This is due to the crossing over of sensory and motor nerves before it enters into the spinal cord.

What are the Symptoms of Stroke?
  • Sudden paralysis of a leg, arm or one side of the face
  • Sudden trouble speaking or understanding speech
  • Sudden vision problems, such as blurred or double vision
  • Sudden loss of coordination or problems with balance
  • A severe, sudden headache without apparent cause
  • Sudden numbness, weakness or dizziness
Call 911 or go to the hospital right away upon noticing these symptoms.

What are the Goals of Stroke Rehabilitation?
·          
  • Prevention of re-stroke - Avoiding the risk factors such as cigarette smoking, alcohol drinking, sedentary lifestyle, obesity and blood pressure monitoring are just some of the preventions of re-stroke.
  • Prevention of complications – includes contracture, pressure sores, physical deformity, respiratory complications and more. 
  • Recovery from stroke by attaining the highest functional level – Active participation to the rehabilitation program is necessary to attain the highest functional level of recovery.
What are the Physical Therapy Interventions of Stroke? 

1. Patient education 
2. Proper bed mobility and transfer techniques 
3. Functional rehabilitation – including fine motor movement technique 
4. Home exercise program – Done regularly
  • Range of Motion Exercises – active (done by the patient) and passive (done by the therapist)
  • Peripheral neuromuscular facilitation
  • Stretching of tight musculature and tissues
  • Walking
  • Bicycle ergometer
  • Treadmill
      5. Physical Therapy modalities – eg. electrical stimulation 
6. Activities of daily living modifications
7. Family support

It would take six months, one year or even more years to attain full recovery post stroke or at least minimal residual deficit post stroke. Recovery from mild hemiparetic stroke is different from individual to individual. However, fast recovery post stroke can be attained when rehabilitation intervention is done meticulously.

Image Credit: reporter.leeds.ac.uk