Rehabilitation Medicine Notes

Rehabilitation Medicine

  • Clinical management of disability-related problems.
  • Objective: Maximize physical, socio-economic, and physiological functioning.
  • Integral part of total medical care.
  • Achieved through coordinated work of various health disciplines:
    • Medicine
    • Psychology
    • Social Work
    • Physical Therapy
    • Occupational Therapy
    • Speech and Hearing
    • Nursing
    • Vocational Evaluation
    • Dietetics
    • Special Education

Scope of Rehabilitation Medicine

  • Concerned with comprehensive management of patients with impairment and disability.
  • Arising from neuromuscular, musculoskeletal, cardiovascular, and pulmonary disorders.
  • Addresses psychological, social, and vocational disruption.
  • Also referred to as "Physical Medicine and Rehabilitation".
  • Involves the use of physical agents in disease management.

Increased Need for Rehabilitation

  • Improvement of Medical Care
    • Increased life expectancy leads to more people at risk of degenerative and chronic diseases.
  • Decreased Mortality Rate
    • More individuals surviving but often with extensive disabilities or chronic illnesses.
  • Increased industrial and vehicular accidents.
  • Increased communicable diseases resulting in residual physical impairment (e.g., Poliomyelitis, Meningitis).

Physiatrist

  • Legally qualified and licensed physician specializing in rehabilitation medicine.
  • Principles:
    • Evaluation and management of patients with physical disabilities is an integral aspect of medical care.
    • Disability can be prevented or reduced through appropriate medical management.
    • Restoration/maintenance of functional abilities demands a team approach.
    • Goals: Improvements in physical, social, psychological, and vocational functioning.

Physical Therapy Profession

  • Definition
    • Art and science of treatment using therapeutic exercises, heat, cold, light, water, manual manipulation, electricity, and other physical agents (PPTA).
    • Dynamic profession with a theoretical and scientific base.
    • Widespread clinical applications for restoration, maintenance, and promotion of optimal physical function.

Physical Therapist

  • Legally qualified and licensed to practice physical therapy under RA 5680 (PPTA/PRC).
  • Healthcare professionals who diagnose and treat individuals of all ages with medical problems or health-related conditions that limit their ability to move and perform functional activities.
  • Provide care in various settings: hospitals, private practice, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes.
  • Licensure examination is required (APTA).
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote optimal physical function, wellness, fitness, and quality of life related to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities resulting from diseases, disorders, conditions, or injuries.
  • As clinicians, physical therapists engage in an examination process that includes:
    • Taking the patient/client history.
    • Conducting a system review.
    • Performing tests and measures to identify potential and existing problems.

Importance of Physical Therapy

  • Drugs & surgery help patients live longer.
  • Physical therapy makes the person become functional.
    • Home education program.
    • Adaptive devices.

Aims of Physical Therapy

  • Relieve Pain
    • TENS (Transcutaneous Electrical Nerve Stimulation):
      • Blocks pain.
      • Gate Control Theory.
    • Soft Tissue Mobilization.
    • Hot and Cold Compress.
  • Improve Circulation
    • Soft tissue mobilization.
  • Restore Motion
    • Range of Motion Exercises.
    • Coordination.
    • Peripheral Joint Mobilization.
  • Strengthen Muscles
    • Progressive Resistive Exercise.
  • Correct Deformities
  • Speedy Recovery
    • Physical therapy restores physical and economic independence.

Anatomy of Movement

  • Skeletal System
    • Bones
    • Joints
  • Soft Tissue System
    • Stabilizes bones and joints and allows them to move.
    • Ligaments and tendons.
    • Muscles and fascia.
  • Neurological System
    • Brain and spinal cord.
    • Cranial and peripheral nerves.

Physical Therapy Job Description

  • Job Title: Physical Therapist (PT)
  • Job Summary: A professionally trained person who utilizes physical agents such as heat, cold, water, electricity, sound and therapeutic exercises to treat physical disorders in its various stages upon referral of a physician.
  • Functions:
    • Understands the philosophy and standards of the hospital and its rehabilitation medicine services.
    • Assumes responsibility for all treatments made.
    • Tests the patient and discovers their abilities, limitations and potentials for rehabilitation.
    • Trains the patient and his family in the use and care of rehabilitation equipment for the home exercises.
    • Supervises and trains the PT technician and other auxiliary personnel.
    • Assists in keeping a safe and therapeutic environment as well as custody of all equipment used.
    • Assists in teaching students on methods and objectives of physical and other member of the health care professions.
    • Prepares and keeps records of physical therapy treatments made at the department.
    • Prepares a monthly report.
    • Keeps the department head informed of all reportable items.
    • Performs related tasks, including participation in the department research project.
  • Qualifications:
    • Must be a graduate of a course leading to the degree of Bachelor of Science in Physical Therapy.
    • Must have passed the Licensure Examination for Physical Therapist.
    • Must be aware of the relative value and limitations of each piece of equipment and skilled in the use of Physical Therapy modalities.
    • Must be able to apply the knowledge of anatomy and physiology in treating patients.
    • Must be tactful and diplomatic in dealing with people.
    • To establish diagnosis, prognoses, and plans of care, physical therapists perform evaluations, synthesizing the examination data and determining whether the problems to be addressed are within the scope of physical therapist practice.
    • Based on their judgements about diagnoses and prognoses and based on patient/client goals, physical therapists:
      • Provide interventions
      • Conduct re-examination
      • Modify interventions as necessary to achieve anticipated goals and expected outcomes
      • Develop and implement discharge plan

Physical Therapy Core Values

  • Accountability
    • Active acceptance of the responsibility for the diverse roles, obligations, and actions of the physical therapist including self-regulation and other behaviors that positively influence patient/client outcomes, the profession and the health needs of society.
  • Altruism
    • The primary regard for or devotion to the interest of patients/clients, thus assuming the fiduciary responsibility of placing the needs of the patient/client ahead of the physical therapist’s self interest.
  • Compassion vs Caring
    • Compassion: The desire to identify with or sense something of another’s experience; a precursor of caring.
    • Caring: The concern, empathy, and consideration for the needs and values of others.
  • Excellence
    • Physical therapy practice that consistently uses current knowledge and theory while understanding personal limits; integrates judgement and the patient/client perspective, embraces advancement, challenges mediocrity, and work toward development of new knowledge.
  • Integrity
    • Steadfast adherence to high ethical principle or professional standards; truthfulness, fairness, doing what you say you will do, and “speaking forth” about why you do what you do.

Code of Ethics

  • General Responsibilities
    • The need for PT is universal. The service of the physical therapist, is therefore unrestricted by considerations of nationality, race, creed, color, politics or social status.
    • Each PT shall act as representative of the whole profession and as such, conduct himself with honor and integrity.
    • A PT must serve the patient’s interested with the greatest solicitude, giving always his best skills and knowledge.
    • A PT must safeguard the legitimate interest, reputation and dignity of his colleagues.
  • Duties Toward the Patient
    • A PT must attend to his patients faithfully and conscientiously, securing for them all the benefits that depend upon his professional skill and care.
    • A PT should keep secret all confidential matters pertaining to the patient, except in the interest of justice, public health, or public safety.
    • A PT should regularly evaluate the patient’s condition. Any unusual changes in the patient must be reported to the physician-in-charge.
  • Duties to Other Physical Therapist
    • A PT must work harmoniously with his or her colleagues and be willing to share knowledge and experience.
    • A PT must observe utmost caution, tack and prudence regarding the professional conduct of other physical therapists. He should not say or do anything that might lessen that patient’s confidence in his colleagues.
    • A PT must not take charge of, nor advise a patient under the care of another therapist, unless in a case if emergency, or until the attending PT has endorsed the case to him, unless the physician-in-charge has referred the patient to him.
    • Irreconcilable difference of opinion or conflicts among PT must be referred to competent authorities for arbitration, selected by the Board of Directors of the PPTA.
  • Duties to the Public
    • A PT should cooperate with the proper authorities in the promotion of health in the community. He must inform the public about diseases, their dangers, cures and preventions.
    • A PT must render services unselfishly to the indigent, in accordance with the prescriptions/or written order/or written referral of a registered and licensed physician.
  • Duties Toward Allied Professionals
    • A PT must cooperate with, and safeguard the interests, reputation and dignity of other allied health professionals.
    • A PT must should not involve himself in the promotion or sale of any medical device apparatus or drugs.
    • A PT must be imbued with a spirit of loyalty, mutual confidence, respect and faith in allied professionals joining them in cheerful cooperation and self-sacrifices for the common good.
    • A PT must make due acknowledgment of assistance received from his associates.
    • Professional criticism of associates should be made only for the welfare of the patient and service and only in a formal accusation before the proper authority to try the case on its merits.
    • A PT must report to the proper authorities any knowledge of unethical practices being carried on by any member of any profession and be willing to testify in an investigation of such charges if requested.
    • A PT must not criticize the qualifications of any competitor in order to gain preference in employment.
  • Duties to the Physician
    • A PT must give the treatment only upon the prescription/or consultation/or referral of a duly registered physician.
    • A PT must give all necessary information concerning the case to the physician-in charge, during the progress of the treatment.
  • Duties to the Profession
    • A PT does not base his practice on any exclusive dogma or sectarian system. He should strive to broaden his cultural outlook and deepen his professional interest. He should pursue studies to improve his efficiency and enhance the prestige of the profession.

Rehabilitation Team

  • Rehabilitation Program
    • Specially designed for each individual depending on the injury, disorder, or illness.
    • A multidisciplinary approach for care and service is the basis of rehabilitation treatment.
  • Physiatrist/Rehabilitation Doctor
    • A healthcare provider who evaluates and treats rehabilitation patients.
    • The team leader.
    • Responsible for coordinating patient care services with other team members.
    • Focuses in restoring function to people with disabilities.
  • Physical Therapist
    • Develop treatment programs to help you improve mobility through exercise and training.
    • Helps restore function for patients with problem related to movement, muscle strength, exercise, and joint function.
  • Occupational Therapist
    • Help you develop the skills needed for the ADLs.
    • Helps restore function for patients with problems related to ADLs including school, work, family, community and leisure activities.
  • Recreational Therapist
    • Assess your leisure needs and interests and develop treatments to help you return to as satisfying lifestyle.
    • Who coordinates therapeutic recreation programs to help promote social skills and leisure activities.
  • Rehabilitation Psychologist
    • Provide psychological testing and individualized and family counseling.
    • A healthcare provider or counselor who conducts cognitive assessments of the patient.
    • Helps the patient and family to adjust to the disability.
  • Rehabilitation Nurse
    • Encourage you can help you practice your skills learned in therapy sessions.
    • Who specializes in rehabilitative care and assists the patient in achieving maximum independence.
    • Focus is on medical care, prevention of complications, and patient and family education.
  • Speech-Language Pathologist
    • Work to improve speech and language, conversation skills and thinking skills necessary for communication.
    • Help restore function for patients with problems related to cognitive, communication, or swallowing issues.
  • Registered Dietician
    • Advice you about healthy diet choices and special dietary needs.
    • A nutritionist who evaluates and provides for the dietary needs of each patient.
    • Based on the patient’s medical needs, eating abilities, and food preferences.
  • Respiratory Therapist
    • Help people with breathing disorders, including training use of ventilators.
    • Treat and restore function for patients with airway and breathing problem.
  • Orthotist
    • A healthcare professional who makes braces or splints used to strengthen or stabilize a part of the body.
  • Prosthetist
    • A healthcare professional who makes and fits artificial body parts, such as an artificial leg or arm.
  • Audiologist
    • A healthcare professional who specializes in the evaluation and treatment of hearing and hearing loss.
  • Medical Social Worker
    • Provide emotional support, identify economic resources and community agencies and help you make arrangement to leave the hospital and find follow-up care.
    • A professional counselor who acts as a liaison for the patient, family and rehabilitation team. The social worker helps provide support and coordinate discharge planning and referrals. He or she also help coordinate care with insurance companies.
  • Vocational Care Coordinator
    • Help you develop a plan to return to work in your community.
    • A counselor who assists people with disabilities to plan careers and fin and keep satisfying jobs.
  • Chaplains
    • Support the spiritual, religious and emotional needs of you and your family.

Rehabilitation Team Meeting

  • Most rehabilitation teams hold weekly, biweekly, or monthly meetings depending on the setting.
  • Topics covered at team meetings:
    • The patient’s POC
    • Patient’s progress
    • STG and LTG
    • Length of stay
    • Patient and family education needs
    • Discharge planning
  • Help with communication and planning among team members and the patient and family. Assist in discharge planning, use of resources, and continuation of care.