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Published on : Aug 02, 2021 | Views : 4406 | Downloads : 7

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ROLE OF PHYSIOTHERAPY IN IPD Dr. Mohabbat Ali
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What is physiotherapy ? Physiotherapy, is a physical medicine and rehabilitation specialty that, by using mechanical force and movements, remediates impairments and promotes mobility, function, and quality of life through examination, diagnosis, prognosis, and physical intervention. It is performed by physical therapists
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PHYSICAL THERAPY Physical therapy is the use of physical methods and agents in the treatment of the disease, impairment, disability and handicap
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Goal of Physiotherapy Determine the patient’s functional loss Estimate functional potential Implement a plan to progress from measured loss to full potential To improve quality of life To listen ‘actively and positively’ with an awareness of priorities as determined by the patient Achieve the best possible quality of life for patients and their families Availability as a resource for patient and families
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AIM of physiotherapy Prevent muscle shortening & joint contractures Influence pain control Educate in all aspects of physical function Education and participation of the carer Treat the patient with dignity – allowing them to “live until they die” Build a relationship of confidence and trust
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AIM of Physiotherapy Assess and optimise the patient’s level of physical function Take into consideration the interplay between the physical, psychological, social and vocational aspects of function Understand the patients underlying emotional, pathological and psychological condition, Focus is the physical and functional consequences of the disease and/or its treatment, on the patient.
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AIM of Physiotherapy Restore the patient’s sense of self Facilitate and optimise the patient's ability to function with safety and independence in the face of diminishing resources. Maintain optimum respiratory & circulatory function Listen to patient Set realistic goals with the patient
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STAGES OF PHYSIOTHERAPY Preventive Restorative Supportive Palliative
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Preventive Aims at restricting or inhibiting the development of disability in the course of the disease or treatment before disability occurs Education for patient and families commencing immediately after diagnosis Mobility and exercise programs. Availability of therapist as a resource for patients and families
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Restorative Rehabilitation is the objective when no or little residual disability is anticipated for some time and patients are expected to return to normal living styles Encouragement, education and treatment in achieving physical, work and lifestyle goals Specific treatments as required (
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Supportive Enhance independent functioning when residual cancer is present and progressive disability is probable Encouragement, education and treatment in achieving physical, work and lifestyle goals Availability of therapist as a resource )
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Palliative Primarily directed at promoting maximum comfort Maintaining the highest level of function possible in the face of disease progression and impending death
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Patients who need Physiotherapy in IPD
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Which patients groups benefit from physiotherapy ? Cardiac patients Orthopaedic patients Amputees General surgical Neurological Elderly Learning disabilities Psychiatric Palliative care Respiratory Paediatric Rheumatology Musculo-skeletal Occupational Spinal injuries Obstetrics Gynaecological Burns and plastics
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ROLE OF PT IN ICU
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Goals of PT in ICU Improve / maintain normal or baseline ventilation and oxygenation Improve / maintain musculoskeletal system within functional limit Improve range of motion Improve muscle strength and endurance Prevent joint deformities and contractures
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Goals-contd... Improve circulatory system function Improve / maintain neurological system and cognitive status within the functional limits. Improve / maintain level of functional status within patient tolerance
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Exercise plays a critical role in recovery and wellness during and after cancer. Exercise in cancer
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Benefits of Exercise Reduces your risk of heart disease, high blood pressure, osteoporosis, diabetes and obesity Keeps joints, tendons and ligaments flexible Reduces some of the effects of aging Contributes to your mental well-being and helps treat depression Helps relieve stress and anxiety Increases your energy and endurance Helps you sleep better Helps you maintain a normal weight by increasing your metabolism
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Benefits of Exercise Specific to Breast Cancer Decreased Risk of Recurrence Decreased Fatigue / Anemia Decreased Severity of Nausea Maintenance of Bone Mineral Density Improved Body Composition Increased Quality of Life Reduction of Lymphedema Prevention of Lymphedema
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Benefits of the chest physiotherapy in IPD To prevent hospital acquired pneumonia. It takes out the secretions, clear the chest and improves breathing without medication. Increases levels of oxygen in the blood. Promotes expansion of the lungs. Strengthen respiratory muscles. Makes the chest area better visible through an X- ray.
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Indication of CPT Prophylactic - Pre-operative high risk surgical patient - Post-operative patient who is unable to mobilize secretions - Neurological patient who is unable to cough effectively - Patient receiving mechanical ventilation who has a tendency to retain secretions - Patients with pulmonary disease, who needs to improve bronchial hygiene
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Indication of CPT
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Patient at risk of nosocomial infections There are patient, therapy and environment related risk factors for the development of nosocomial infection. Age more than 70 years Shock Major trauma Acute renal failure Coma Prior antibiotics Mechanical ventilation Drugs affecting the immune system (steroids, chemotherapy) Indwelling catheters Prolonged ICU stay (>3 days).
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Immuno-compromised patients Immunocompromised people, like people undergoing treatment for cancer, leukemia, lymphoma, HIV, and patients on immunosuppressive drugs are at an increased risk of developing chest infection, decrease mobility , swelling, joint pain. Others who are at a higher risk include patients who have had a transplant, or are under a lot of stress.
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Geriartric patients Muscles weakness Low immunity Low bone density Cardiopulmonary weakness Poor Balancing Risk of fall These all increased during hospital stay
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Indications for geriatric PT referral Recent fall or history of falls Deficits in strength or range of motion Loss of mobility or ambulation requiring an assistive device Musculoskeletal pain Difficulty with transfers Orthotic or prosthetic needs Open wound Neurological disorder Balance deficits Decreased endurance for ADLs Bed bound status Need for adaptive equipment to enhance safety and function
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Palliative patients physiotherapy Flexibility Understanding both emotionally and physically – clarity - agreeing with other sources Information Education Encouragement Respect for their choices
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General or local anesthesia and physiotherapy Surgery and general anesthesia have direct effects on the respiratory system depending on the organ/system involved and modality of delivery, potentially leading to postoperative pulmonary complications that increase hospital morbidity, prolong hospital stay and add to health-care costs. Postoperative complications have been reported to be as high as 30% for thoracotomy and lung resection in patients with chronic obstructive pulmonary disease. Most of the complications are due to respiratory muscle dysfunction and surgery-related changes in chest wall mechanics. In general, preoperative optimisation of medical therapy combined with physiotherapy and early extubation and mobilisation may improve clinical outcomes in high-risk surgeries, including upper abdominal and thoracic surgery in patients with severe emphysema.
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Anesthetic effects on Pulmonary functions The primary function of the lungs is to provide an adequate gas exchange for maintaining normal oxygen content in blood and eliminate carbon dioxide. This is achieved by optimizing lung volumes to meet higher metabolic demand during the Peri-Operative period. General anesthesia (GA) causes respiratory impairment and both oxygenation and elimination of carbon dioxide are affected. The factors affecting pulmonary function include loss of consciousness, mode of ventilation (spontaneous or mechanical), posture of patient, actions of anaesthetic agents and drugs, used during anesthesia on respiratory smooth muscles and secretions.
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Cont….. Effect on upper airway GA causes relaxation of jaw and pharyngeal muscles and leads to posterior displacement of tongue. Loss of cough reflex along with increased secretions results in airway obstruction, laryngospasm and bronchospasm. Patients with hyper-reactive airways are more prone to complications. Tracheal intubation protects airway but increases the dead space, and delivery of dry gases may affect pulmonary function, especially in younger patients.
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Kidney disease and physiotherapy Kidney diseases are associated with an increased risk of functional impairment, independent of age, gender, and co-morbidities. Clinicians should counsel patients with CKD including frail elder people to increase physical activity levels and target that regular physical activity including aerobic or endurance exercises training benefits health
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Physiotherapy in Gyn.&obs. During the whole period of pregnancy women’s body undergoes various physical and physiological changes. Due to the change during and after pregnancy common problems faced by the women’s are low back pain, stress urinary incontinence, pelvic pain. Physiotherapy can help in this through postural reeducation, strengthening of pelvic floor muscles and through some modalities
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Suggested sequence of exercise. General rhythmic activities to warm-up. Gentle selective stretching Aerobic activities for CVS conditioning UL &LL strengthening ex. Abdominal ex Pelvic floor ex. Relaxation /cool down activities Educational information [if any] & postpartum ex. Education.
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Selected exercise techniques Postural exercise. Abdominal exercise Stabilization exercise Pelvic motion training & strengthening. Modified UL & LL strengthening. Perineum &adductor flexibility. Relaxation &breathing exercise
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Physiotherapy in the PICU
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PMs and stretching Splinting Muscle strengthening Movement reeducation Improve ex tolerance Clear secretions Reexpand collapsed lobes Improve V/Q matching Weaning Developmental stimulation Positioning Thoracic mobility Prevent deformities Rehabilitation Respiratory Physiotherapy
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PHYSIOTHERAPY IN CARDIOLOGY
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Aims of Cardiac Rehabilitation To restore him to self reliance in daily active life. To restore him to formal work activities To prepare him for another full time employment compatible with his working capacities.
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Phase–I of Cardiac Rehabilitation This begins when the patient is admitted to the hospital and ends on discharge, which is usually 7 to 10 days. Aim To prevent accumulation of secretion in the lungs. To prevent Deep Vein Thrombosis. To prevent bed sores. To teach and encourage relaxation. To train postural awareness strengthening trunk and leg muscles
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Day 1 to 2 Humidification, Vibration, Postural drainage and Breathing exercise. Passive exercises –ankle/toe exercises–Active movements limited to 5 repetitions. Positioning of the patient to prevent bed sores. Activities allowed are bed side commode, self feeding, partial self care and mostly bed rest and supported sitting.
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Day 3 to 4 Continue all of above, number of repetitions can be increased to 10. SLR (straight leg raising) can be started– repeat 5 times. Sitting in a chair 5–10 minutes. Partial self–care, taking bath in sitting, position by sitting on a high stool. Isometric activities can be started. SLR repetition can be increased to 10. Walking 5–10 minutes. Sitting and self feeding in a chair
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Post–operative Period of Amputation Preprosthetic stage: The patient’s bed should have a firm mattress and be adjustable in height with a rope ladder of monkey pole and a cradle. Postoperatively the patient requires regular and adequate analgesics to combat pain which may arise from the wound site or the phantom of a limb. Uncontrolled pain may limit the rehabilitation program
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Aim of treatment To prevent post–operative complications. To prevent deformities. To control stump edema. To maintain strength of whole body and increase strength of muscles controlling the stump. To maintain general mobility. To improve balance and transfers. To re–educate walking. To restore functional independence. To treat phantom pain.
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Physiotherapy in Surgical Conditions Preoperative care Physiotherapy for Post–Operative Care Prevention of chest complications Prevention of thrombosis Prevention of pressure sores Prevention of muscle wasting and joint immobility Education of positioning ,posture & gait training.
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Physiotherapy in Burns Respiratory Care Prevention of Contractures and Deformities Positioning Head and Neck Lower limbs Splinting (Splints may be static or dynamic)
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Cont.……. Exercises Muscles strength Flexibility Regaining maximum function Out-patient physiotherapy Graft PT if grafted
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Mobility is Medicine Health Benefits of Physical Activity Improves blood sugar homeostasis Enhances cardiovascular function Enhances endothelial function Decreases chronic inflammation Regulates hormone levels Preserves musculoskeletal and neuromuscular integrity Decreases depression and improves cognition
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Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial Participants 626 men and women aged 38 to 99 years (average 80 years) were recruited from consecutive admissions to subacute hospital wards Intervention Falls risk alert card with information brochure, exercise programme, education programme, and hip protectors. Main outcome measures Incidence rate of falls, injuries related to falls, and proportion of participants who experienced one or more falls during their stay in hospital.
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EFFECT OF PHYSIOTHERAPY ON PULMONARY FUNCTION: A Laboratory Study Abstract 33 patients with acute exacerbations of chronic bronchitis were studied within 4 days of admission to hospital. Physiotherapy produced an acute rise in lung volume and conductance, without altering specific conductance. There was no consistent change in arterial-blood gases.
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Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients Conclusions We conclude that the presence of the chest physiotherapist in the intensive care unit contributes to the early recovery of the patient, reducing length of stay on mechanical ventilation and hospitalization as well as the incidence of respiratory infection and mortality. Key message Chest physical therapy care given in a 24 h basis can reduce mechanical ventilation and hospitalization length of stay as well as the incidence of respiratory infections and mortality.
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Prehospital education: effectiveness with total hip replacement surgery patients bstract In-hospital education can reduce anxiety, improve coping and shorten hospital stays of surgical patients. However, hospitals are containing costs by shortening pre- and postoperative stays and reducing the time available for in-hospital teaching. This study evaluated prehospital education for total hip replacement (THR) surgery. Half of the patients waiting for admission for THR surgery were randomly selected to receive a THR education booklet in the mail 4–6 weeks before their scheduled THR surgery. Compared to the No-Booklet patients, patients who had received the booklet were less anxious at the time of hospital admission and at discharge, were more likely to have practised physiotherapy exercises prior to hospitalization, and required significantly less occupational therapy and physiotherapy while in hospital. There were no group differences for length of hospital stay.
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Early exercise in critically ill patients enhances short-term functional recovery CONCLUSIONS In conclusion, this adequately powered, randomized controlled trial showed that an individually tailored exercise training protocol can be initiated during the acute ICU stay in critically ill patients. When instituted early in ICU survivors with prolonged ICU stay, exercise training may enhance recovery of functional exercise capacity, self-perceived functional status, and quadriceps force at discharge from hospital.
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Post stroke Depression and Its Role in Rehabilitation of Inpatients
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