PHYSICAL THERAPY

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PHYSICAL THERAPY By Dr. Jay Shahed
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Definition

• Physical therapy is the therapeutic exercises
  that involves the scientific use of physical
  measures, devices,and body movements to restore
  normal function to injured tissues.

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• Heat Therapy

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Physiological effect of heat Application

• Heat Procedures
• Local vasodilatation
• Increases circulation
• Speeds up inflammatory process
• Promote local drainage from abscess
• Relaxes and relieve muscles pain
• Repairs tissue cells
• Relieve tissue congestion (nasal)
• Reduce swelling (edema)
• Improve the repair time of a sprained joint

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The Effect of Heat Depends on

• The type of heat used
• The length of time the heat is applied
• The general condition of patient
• The size of the area needed treatment

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Important point of views about prolonged heat
application

• Lower skin resistance to injury.
• Increase patient's tolerance to heat
• Patient may be burned without knowing it.
• Infants and elderly are susceptible to burns.

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Conditions to Avoid in Treating with Heat

• Acute inflammation during first 24 hours
• promotes swelling and decrease repair
• Severe circulatory problems
• Blockage, Bleeding.
• Lack of sensation in a body part
• Paralysis
• Never apply heat to abdominal cramps
• Prolongs bleeding
• Pregnancy or menstruation
• Promotes uteral contraction and menstrual flow

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• Encapsulated pus
• May rupture
• Newly burned areas
• Has weak circulation that will delay repair
• Scar tissues
• Has no circulation leads to burn)
• Malignant tumors
• Promotes spread
• Erythema
• possible clot)
• Metal materials
• Pace makers, IUD, prostheses to avoid burns

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Moist Heat (Hydrotherapy)

• Normal temperature
• 110 F 44 C
• Normal time
• 20 minutes
• After 1 hour will cause vasoconstriction.
• Penetrates skins better than day heat

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Types of moist heat

• Soaks
• Immersed part gradually into medicated or plain
  water for
• Time and Temp
• 15-20 minutes 110 F.
• M/F used on extremities.
• Treatment for open wound
• After Episiotomy

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• Whirlpool
• Tank that provides gentle massage.
• Used for exercises or cleansing wounds.
• Paraffin Bath
• Paraffin (wax) and mineral oil
• Temp 127 F
• Body part dipped into a thick coat and Left for
  30 minutes then peeled off
• Used for the treatment of chronic joint diseases

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• Hot Moist Compresses
• Moist gauze or towels
• Applied to small areas like hands
• Ask patient to remove jewelry
• Silicon gel hot packs
• Commercially prepared hot moist leather
• Preserved in hot water

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Dry Heat

• Superficial penetration
• (10mm deep)

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Types

• Heating Pads (20 minutes)
• Controlled pads with a thermostat
• Safe to use
• Keep on low or medium temperature.
• Never use near moisture
• Will cause boiling.
• Infrared Radiation Lamps (20-45 min)
• Heart producing electric bulb
• Shallow heat penetration
• (3-5 mm) (1-2 inches)
• Skin should be cleansed before use

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• Ultraviolet Radiation
• Sun lamps (cold quartz lamp)
• Distance
• 36 inches from patient
• Time of exposure
• Seconds to minutes
• More penetrating than infrared
• Capable to kill bacteria
• Used in treatment of acne ,psoriasis and
  ulceration
• Physician should prescribe exact time
• Can easily burn

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• UV is considered carcinogen if their use is
  prolonged.
• Sulfa increases the sensitivity of skin to UV
  rays.
• Cover genitalia if exposed.
• Must wear UV filtered glasses
• Most intensity exposure is at 90 angle

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• Hot Water Bottles
• Make sure that the bottle is not very before
• Application. Not more than 125 F.
• Disposable Chemical Hot Packs
• Commercially prepared activated as needed

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Diathermy

• Deep Penetration

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• Short-wave diathermy
• Radio waves energy transmitted through two plates
  on body.
• Indicated for inflammatory processes
• Acute, Subacute, Chronic.
• Relieve pain within 36-48 hours.
• Usually prescribed 3 times a week for 6 weeks.
• (20-30 min)

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• Microwave Diathermy
• Radar Waves
• Higher frequency and shorter wave length than
  radio waves
• One electrode is placed on body part
• Never use over moist areas or near implanted
  objects

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• Ultrasound diathermy
• Sound waves
• concentrated into a narrow beam and transmitted
  through a medium in the form of vibrations At a
  rate of 100 to 12,000 hertz (cycles/seconds)
• A transducer creates the frequency
• High frequency sound waves only travel through a
  coupling agent (water or gel)

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• It penetrates best through body tissues that have
  a high water content, such as muscles (TX.
  0.5-1.0 watts/cm)
• Can cause damage to tissue that has low
  concentration of water such as bone.
• Arthritis, is treated at higher frequencies
  1.5-2.5 watts/cm
• Treatment is usually up to 15 minutes.

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• Cold Therapy
• (Cryotherapy)

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Physical effects

• Vasoconstriction
• (reduce blood flow)
• Causes contraction of involuntary muscles
• Numbing of sensory nerves endings
• Used to control bleeding
• Used to slow down inflammatory reactions
• Used to stop swelling
• Does not reverse swelling only heat does

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• Slows down the activity of living cells
• Controls infection
• Treat burns
• Reduces fever
• Temperatures recommended
• Tepid 80 - 93 F
• cool 65 - 80
• Cold 55 F - 65 F
• Very cold below 55 F.

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Types

• Cold Compresses
• Applied to small areas such as face and head
• Change every 3 minutes
• (for 20 minutes)
• Check for redness or swelling
• Stop if there is pain

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• Ice Bags
• Applied for 30-60 minutes or until pain is
  generated
• Applied to the head to treat headaches, fever,
  delirium
• And minor head injuries
• To the abdomen and pelvis to slow down
  inflammation
• To the eyes to control swelling and inflammation
• To control post surgical bleeding

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• Cold Packs (chemical)
• Plastic flat bags containing chemicals or liquids
• Good for 30-60 minutes

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Therapeutic Exercises
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• To correct disabilities
• Restore motility and coordination
• Restore strength
• Relaxation
• Relieve tension or pain
• Often is combined with heat hydrotherapy

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• Joint Mobility
• Types
• Active Body movement voluntarily initiated and
  controlled by patient.
• Bicycles, free weights.
• Passive Body movement initiated by therapist or
  machine not by patient.

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• Range of motions exercises (ROM)
• Exercises are especially designed exercises that
  move each joint of the body through it's full
  range of motion
• Done usually after an injury to a joint
• 3 x week for 6 weeks
• Done either actively or passively
• Should be done slowly and gently and monitored by
  the physical therapist
• Could harm patient if done incorrectly.

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• Aided Exercises
• The patient is helped by the therapist to move
  muscles that are too weak to move on their own
  strength.
• Active Resistance exercises
• The patient voluntarily applies pressure or
  movement of the past, and another individual
  applies resistance to the motion.

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Traction
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• Traction is the process of pulling as applied to
  the Musculoskeletal system
• Dislocated joint, fractured bones, disease
  peripheral joints (arthritic joints).
• Usage
• Maintain proper position
• Correct or prevent a deformity
• Decrease or overcome muscle spasm
• Lessen or prevent contractures
• Achieve relief of compression at vertebral joints.

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Methods and Devices

• Static Traction
• Using weights with a pulley
• Elastic Traction
• Elastic appliances
• Mechanical Traction
• Set amount of tension for a set amount of time
• Manual Traction
• Applied by therapists
• Skin Traction
• With pads attached to weights
• Skeletal Traction
• Surgically applied pins and wires installed to
  bones

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• Massages
• Aids circulation
• Relax muscles and relieves spasm
• Reduces pain
• Help restore motion and function to the affected
  part
• Decrease swelling
• Reduce edema

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• Types
• Effleurage
• Superficial stroking movement (child birth)
• Friction
• Deep stroking or rubbing (back rub)
• Petrissage
• Rolling type
• Tapotement
• Rapid repeated light percussion with the side of
  the hand
• (karate chop)

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Electromuscle Stimulation (Tens-Pac)

• Low voltage machine that creates electric current
  to stimulate the motor and sensory nerves
  supplying the muscles.
• The waves act like the body's own nerves, causing
• The muscles to contract and relax ( denervation
  of muscle ).
• Parts
• Small moistened electrodes with tap water
  strapped into body
• Usage
• To revitalize a muscle or prevent atrophy of
  normal muscle.

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• Crutches

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How to use the crutches

• Head and back straight
• Tips should be placed 2 inches in front and 6
  inches away from and parallel to toes.
• Adjust crutches so that 2-3 fingers below armpit
• Bend the elbow about 30 degrees when holding the
  handgrip
• The hand and the arm should hold all the bodies
  weight with each stride not by Axilla.

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Types of Gait(See diagram)

• Two-point Gait
• Weight bearing
• Simultaneously same side foot and crutch
  together.
• Non weight-bearing
• Put both crutches ahead of you and swing forward
  through the crutches with one foot.
• Used if leg has a
• ( Cast ).

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• Three-point Gait
• Partial weight - bearing gait
• This is used when one leg is stronger than the
  other.
• Put your crutches forward and then shuffle your
  body with the weaker leg first through the
  crutches.
• (One weak leg).

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• Four-Point Gait
• (Both legs weights-bearing)
• Left Crutch, left foot then right crutch, right
  foot.
• ( Bilateral weak legs but able to move them
  barley.

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• Swing-to Gait
• Put both crutches forward then swing the legs up
  to the crutches site.
• (Bilateral weak legs)

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• Swing-Through Gait
• Put the crutches forward and swing the legs
  through and past them.
• (Paraplegics)

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Wheel Chairs
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Tips on Using a Wheelchair

• Lock the chair before seating the patient.
• Fold back the foot rests
• Place your unaffected foot flat on the floor,
  just slightly under the seat.
• Place your hands through the Axilla on to the
  scapulas of the patient
• Into an upright position, using your thigh
  muscles along with your arm and shoulder muscles,
  ask the patient to try to stand up and maneuver
  him or her into the chair.
• Use your legs and belly to push the wheelchair,
  dont use your back.

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Walkers
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• Types
• Stationary walker
• Doesn't move.
• Rolling walker
• Has wheels.
• Tips
• Used on patients that need help walking or
  standing
• Must be below the waist line

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OCCUPATIONAL THERAPY

• The use of purposeful activity with individuals
  who are limited by physical injury or illness.
• Process of maximizing independence
• prevent disabilities
• Learning how to use artificial parts
• (Prosthesis) in amputations