Week 6 physio 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.