Management Options in Physiotherapy

Recap: SOAP

• Subjective, Objective, Assessment, and Plan (SOAP)
• Overlaps in assessment and treatment.
• Treatment indicates what's going on for the patient.
• Observe patient response to instructions and adjustments.
• Baseline and follow-up:
  • Questions about how they're doing.
  • Sample of objective assessment (e.g., knee flexion).
  • Treatment around the knee.
  • Re-assessment to gauge improvement.
• Focus on 'Plan' (treatment).

ICF Framework

• Framework to approach treatment.
• Health condition.
• Body structure and functions (e.g., massage, stretching).
• Activity participation.
• Environmental factors:
  • Home environment changes.
  • Work environment alterations.
• Personal factors:
  • Address co-existing conditions (e.g., anxiety, depression).
  • Refer to other health professionals for comprehensive management (relaxation exercises).

Management Decision Approaches

• Clinical reasoning skills.
  • Information from subjective and objective assessments.
  • Identify causes of symptoms/difficulties.
• Evidence-based practice:
  • Best research evidence.
  • Patient preferences and past experiences.
  • Clinical experience.
  • Context of work.
• Patient-centered care:
  • Patient's wants and expectations.
  • Important activities they want to resume.
  • Targets activity and participation in ICF framework.
• Goal setting:
  • Realistic goals fitting SMART criteria.
  • Example: returning to a sport in a specific time frame.
• Discharge planning:
  • Hospital/rehab setting: post-stay arrangements (home, aged care).
  • Community setting: goals achieved before ending physio.
  • Involvement of other health professionals.
• Professional practice:
  • Consider who else needs to be involved currently and after physiotherapy.

Common Elements Across Areas of Physiotherapy

Cardiorespiratory

• Breathing exercises:
  • Deep breathing and breath-holding.
  • Targeted exercises using devices.
• Positive Expiratory Pressure (PEP) devices:
  • Create back pressure.
  • Open up lung areas, move secretions.
  • Analogy: blowing bubbles in a drink with a straw.
  • More complex devices with vibration for discretion.
  • Engaging kids with detergent or dye for fun.
• Positioning:
  • Sitting out of bed to improve lung function.
  • Postural drainage (e.g., for cystic fibrosis).
  • Positions to drain secretions from specific lung areas.
• Mobilizing:
  • Getting patients moving, walking.
  • Aerobic exercise (exercise bike, treadmill).
  • Varies based on condition severity: from a few steps post-surgery to more intense exercise.
• Functional activities:
  • Focusing on activities important to the patient.
• Education:
  • Informed consent conversation.
  • Broad education about the condition.
  • Risk factors and prevention.
  • Understanding the condition and treatment.
  • Prognosis (recovery, plateau, progression).
• Coping mechanisms:
  • Stress reduction strategies, relaxation exercises.
  • Managing symptoms like chronic cough or shortness of breath.
  • Addressing heightened sensitivity (e.g., chronic cough).
• Self-management:
  • Breathing exercises, positioning, walking at home.
  • Ensuring safety for home practice.
• Referral:
  • Occupational therapy (OT) for functional activities, grief management.
  • Psychologists for stress reduction.
  • Nursing services, cardiorespiratory doctor, community services.
  • Rehab or exercise classes for community and education.

Neurological

• Exercise:
  • Strength, endurance, and control of affected muscles.
  • Building strength in other areas for compensation (e.g., upper limbs for spinal cord injury).
  • Strength: lifting something heavy once.
  • Endurance: repeated actions.
  • Aerobic fitness.
• Range of motion:
  • Muscle length, stretches, and positioning.
• Proprioception:
  • Understanding joint position in space.
  • Exercises to reposition joints.
• Desensitization and Sensitization:
  • Rubbing numb areas to re-engage nervous system.
  • Light touch for pain desensitization in a safe environment.
  • Treating dizziness or vertigo.
• Nerve stimulation:
  • Electrotherapy to engage nerves.
• Biofeedback:
  • Sensors to monitor muscle engagement.
  • Training movement.
• Mobilization and aerobic fitness:
  • Walking.
• Transfers:
  • Bed to chair, commode.
• Prescribing gait aids and equipment:
  • Frames, walking sticks.
• Functional activities:
  • Tying activities to patient goals.
  • Practicing in relevant environments (e.g., gravel, grass).
• Falls prevention:
  • Retraining balance.
  • Practicing how to safely fall and get up, use of parallel bars
• Education, coping mechanisms, self-management, and referral.

Musculoskeletal

• Exercise (similar to neurological).
• Joint mobilizations:
  • Passive mobilization (e.g., pushing on the spine).
• Massage:
  • Manual therapy and self-massage techniques.
• Electrophysical agents:
  • Hot and cold therapies.
  • Nerve stimulation for pain management.
  • Ultrasound and laser for healing.
• Biofeedback:
  • Muscle sensor feedback regarding muscle engagement.
  • Diagnostic ultrasound to assess core muscle engagement.
• Mobilization.
• Prescribing gait aids.
• Functional activities (patient-focused).
• Falls prevention and management.
• Taping or bracing:
  • Injury prevention and support during activity.
• Education, coping mechanisms, self-management, and referral.
• Self-management: exercise, self-massage.
• Pain management education:
  • Understanding symptoms vs. injury severity.
    Stress reduction for pain management.

Pelvic Health

• Pelvic floor exercises:
  • Engaging muscles to prevent bladder/bowel leakage.
  • Relaxing muscles for control.
• Exercises with devices:
  • Vaginal weights.
• Biofeedback:
  • Internal ultrasound for visual feedback.
• Incontinence pads:
  • Short-term use to build confidence during recovery.
• Education:
  • Condition overview and causes.
  • Pelvic floor function.
  • Incontinence pad selection.
  • Drinking behavior and awareness of sensation.
• Coping mechanisms:
  • Managing heightened sensations.
• Self-management:
  • Exercises and education about drinking.
• Referrals:
  • Surgical repair.

Pediatrics

• Fun activities:
  • Songs, games, competitions, play, and dance.
  • Animal imitation for specific movements (e.g., frog jumps, flamingo stands).
• Specific approaches like stretches and positioning.
• Casting:
  • Corrective casting for tight calves and toe-walking.
• Braces:
  • Hip dysplasia braces.
• Prescribing gait aids and equipment (neurological conditions).
• Education, coping mechanisms, self-management, and referrals (targeting parents).
• Parental involvement is critical for consistent care.

Aged Care

• Fun activities (competition, play, dance).
• Intergenerational programs.
• Functional activities for safety at home.
• Meaningful activities (gardening, lawn bowls, board games).
• Touch is important (massage for calming and pain reduction).
• Education, coping mechanisms, self-management, and referral.
• Family involvement in self-management.
• Referrals to social workers, psychologists, gerontologists, OTs.
• Focus on improving quality of life and engaging patients in unexpected activities.

Key Points

• Core components: exercise/movement, functional activities, education, coping mechanisms, self-management, referral.
• Targeted therapies for specific groups.
• Consider the individual patient and adapt treatments accordingly, combining approaches from different areas as needed.