Interventions Exam 1

Biopsychosocial construct

Categories of intervention

• education

• respiratory

• adaptive assistance

• biophysical

• functional training

• integumentary repair and protection

• manual therapy

• motor function and movement training

• therapeutic exercise

Evidence informed practice

What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy?

• PT interpersonal and communication skills

• PT practical skills

• individualized patient centered care

• organizational and environmental factors

Managing conflict

use active listening skills, incorporate clear and calm communication, take time to think and avoid emotional response

Main goal of proper positioning

support, stabilize, and provide proper alignment of the axial and appendicular skeletal segments in a position that promotes the efficient function of the body systems

when is short term positioning used

specific exercise, therapy, able to change positions when treatment is complete

when is long term positioning used

when they must remain in one position for a long time, mobility limitations

contracture

a permanent shortening producing deformity or distortion

bony prominences associated with supine positioning

• occipital tuberosity

• spine and inferior angle of scapula

• spinous processes of the vertebrae

• posterior iliac crest

• sacrum

• posterior calcaneus

bony prominences associated with side-lying position

• lateral ribs

• lateral ear

• lateral acromion process

• epicondyles of humorous and femur

• condyles of femur

• malleolus

bony prominences associated with prone postion

• forehead

• ear

• acromion

• humerus head

• sternum

• ASIS

• patella

• tibial crest

• dorsum of foot

bony prominences associated with sitting position

• ischial tuberosity

• posterior area of the thigh

• sacrum

• spinous process of the vertebrae

• medial epicondyle of humerus

Contracture sites for supine position

• shoulder internal rotators, extensors, adductors

• hip and knee flexors

• hip external rotators

• ankle plantarflexors

contracture sites for prone position

• neck rotators

• shoulder internal and external rotators, extensors and adductors

• ankle plantarflexors

contracture sites for side-lying and sitting positions

• shoulder adductors and internal rotators

• hip adductors, internal rotators

• hip and knee flexors

body mechanics

allows maximal efficiency of the musculoskeletal system without causing undue fatigue

neutral position

anatomical midpoint between end ranges of joint motion

What are the 3 C

keep the curves, keep it close, and compensate

care of the extremities

neutral anatomical positioning of joints, avoid prolonged postures or repetitive motions, utilize adaptive equipment when needed, avoid working at end ROM, exercise and take breaks frequently

components of bed mobility

hooklying and bridging, supine scooting, rolling, supine to and from sit

types of rolling over

flexion strategy, extension strategy, log rolling strategy

ways to go from supine to/from sit

synchronous, through sidelying, log rolling, through long sitting, dependent

Dependent

requires full assistance, the patient is unable to help

max assistance

PT is able to help slightly (25-49%)

moderate assistance

pt is able to do part of the task without help but requires help with at least half (50-74%)

minimal assistance

pt is able to do the majority of the work (75-99%)

Contact guard

you only need to hold onto the gait belt during the task, otherwise the patient is able to complete without help

Stand by assist

only stand next to the patient while they complete the task, likely provide cues

supervision

pt requires someone within arms reach as a precaution; low probability of pt having a problem requiring assistance

independent

patient is able to independently complete task without supervision, would be safe for going home alone

modified independence

no assistance is needed however the patient requires used of equipment, takes increased time, requires maximal vocal cues, or completes the task in a modified way

different types of canes

standard single end cane, quad cane, bariatric, hurry cane

Who would use a single end cane

• mild balance problems

• slight LE weakness

• unilateral LE pain

positives of single endpoint canes

• can be stored and transported more easily than crutches or a walker

• more functional on stairs and in narrow confined areas

• inexpensive

• different designs

• adjustable (maybe)

limiting factors of single end point canes

• provides very limited support because of its small BOS

• cannot be used with WB restrictions

who would benefit from quad canes

• unilateral LE pain

• slight LE weakness

• mild balance problems

• slightly more than SEC

positives of Quad cane

• can be stored and transported easier then a walker

• more stable during ambulation than a SEC

• can stand up on its own

• relatively inexpensive

• adjustable

limiting factors of a quad cane

• may not fit on a standard stair unless turned sideways

• slightly more cumbersome than a SEC

• cannot be used with WB restrictions

how to fit axillary crutches

• elbow angle 20-25 degrees

• pad=2 inches below armpit

• hand grip at wrist crease

who would use axillary crutches

• NWB

• weakness

• requires ROM and upper body strength

• need trunk support

contraindications to axillary crutches

• shoulder strength

• bilateral LE weakness

• trunk weakness

axillary crutches positives

• provides moderate degree of stability and balance improvement

• permits wide range of gait patterns and ambulation speeds

• can be used in individuals with weightbearing precautions/restrictions

• easily adjustable for proper fit

• easily stored and transported

• can be used on stairs

• relatively inexpensive

limiting factor for axillary crutches

• more challenging

• less stable

• requires balance

• may lead to axillary injuries

contraindications for loftstrand crutches

trunk weakness

who uses loftstrand crutches

• weakness in LE

• need to reduce WB in LE

• mild balance impairment

• good trunk stability

• good UE strength and coordination

• someone who needs them for a longer period of time

advantages of loftstrand crutches

• less cumbersome

• more maneuverable

• provide more stability than SEC or quad cane

• eliminate danger of axillary damage

• more functional in small areas

• can use hands

• shorter, sleeker, lighter

disadvantages of loftstrand crutches

• less lateral support

• can be difficult to remove

• requires functional standing balance and upper body strength

benefits of parallel bars

• most stable

• limits ambulation distance, location

• safe starting point for patients with significant functional impairments

types of walkers

hemiwalker, 2WW, 4WW, platform walkers

limiting factors of a hemi walker

• unsafe to use on stairs

• cumbersome

• cannot be used with weightbearing restrictions

positives for hemi walkers

• more stable than SEC or quad cane

• only requires use of unilateral UE/LE

• can stand up on its own, adjustable

who would use a hemiwalker

• unilateral LE weakness

• mild to moderate balance problems

• commonly after a CVA resulting in hemiparesis

positives of wheeled walkers

• stability for upright standing through AD

• may have seat for patient to rest

• can have complete offloading with 2WW

limiting factors for wheeled walkers

• must be able to navigate break systems

• does have wheels

• does allow some instability

• taller the walker the tippier it is

• transportation

contraindications for a wheeled walker

• UE offloading as you need bilateral UE strength to navigate standard 2WW or 4WW

who would use a wheeled walker

• requiring moderate to max stability in standing or offloading capabilities

• moderate balance impairments

• acute LE injury or amputations

platform walker uses (0WW)

• beneficial for individuals unable to grasp with hands or weightbearing through fingers

• encourages upright posture and more stable trunk position

what gait pattern is NWB with a 2WW

3 point

what gait pattern is pwb with a 2ww

modified 3 point

how to prevent falles

• remove small rugs and mats

• avoid waxed or wet floors

• use secure stair handrails

• remove clutter and loose objects (36 inches wide)

benefits of a gait belt

• increases safety for you and your patient

• prevents falls

• decreases risk

• reduces risk of liability

therapist guarding technique

• physical therapist stands posteriolateral to pt weaker side

• maintain a wide BOS

• moves lead LE with device

• one hand on gait belt

• other hand near shoulder of patient

AD training instructional sequence

• verbal instructions

• ask if there is questions

• provide manual contacts and verbal cuing

• feedback to patient and review as needed