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Physical medicine

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The branch of medicine that uses physical devices or agents therapeutically for the diagnosis, treatment, management, and prevention of diseases. It is also called physiatry.

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Rehabilitation

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Restoration of those functions that have been affected by a patient's injuries or disease.

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Sports medicine

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The branch of medicine that specializes in the prevention and treatment of injuries caused by athletic participation. More than one million people are treated for sports injuries each year in the United States. Most sports injuries involve muscle strains, sprains, and tears.

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Physiatrist

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A physician specializing in physical medicine and rehabilitation.

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Fitness

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Overall good physical condition, including cardiovascular strength, muscular strength, and flexibility.

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Range of motion (ROM)

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The degree to which a joint is able to move, measured in degrees with a protractor-like device called a goniometer.

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Flexion

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The bending movement allowed by certain joints of the skeleton, such as the elbow, that decreases the angle between the two adjoining bones.

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Extension

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The straightening movement allowed by certain joints of the skeleton, such as the knee, that increases the angle between the two adjoining bones.

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Hyperextension

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The position of maximum extension, or the extension of a body part beyond its normal limits.

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Reduction

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The correction of a fracture, dislocation, or hernia.

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Lordosis (swayback)

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Exaggerated anterior curvature of the lumbar spine.

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Kyphosis

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Abnormally increased convex curvature of the thoracic spine. It is also colloquially called hunchback or humpback.

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Scoliosis

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Lateral deviation in the normal vertical curve of the spine.

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Osteoporosis

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A reduction in the mass of bone per unit of volume that interferes with the mechanical support function of bone, causing bone fractures in situations that would not normally damage the skeleton.

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Luxation

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Complete dislocation of the bone from the joint.

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Subluxation

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Incomplete dislocation of the bone from the joint.

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Tendonitis

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Inflammation of tendons. Tendonitis is one of the most common causes of acute pain in the shoulder.

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Quadriplegia

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Paralysis of all four extremities of the body and the trunk. This disorder is usually caused by spinal cord injury, especially in the area of the fifth to the seventh cervical vertebrae. Automobile accidents and sporting mishaps are common causes.

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Paraplegia

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Paralysis of the lower portion of the body, usually caused by spinal cord injury or disease. Paraplegia commonly results from automobile and motorcycle accidents, sporting accidents, falls, and gunshot wounds.

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Hemiplegia

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Paralysis of one side of the body. The three types of hemiplegia are cerebral, facial, and spastic.

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Hemiparesis

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Muscular weakness of one half of the body.

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Cerebral palsy

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Nonprogressive paralysis due to defects in or trauma to the brain, especially at birth. Spastic cerebral palsy is characterized by hyperactive reflexes, rapid muscle contraction, muscle weakness, and underdevelopment of the limbs. Mental retardation, seizure disorders, and impaired speech are also common with this condition.

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Gait

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A style of walking. A normal gait consists of two phases: stance and swing. Generally, a physician or physical therapist assesses a patient's gait. The patient is asked to walk away, turn around, and walk back.

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Goniometry

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The measurement of joint mobility. Goniometric tests are noninvasive.

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Goniometer

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A device used to measure the degree of joint movement.

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Using a goniometer

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The medical assistant may be asked to assist with or perform goniometry. Have the patient move each body part in a specified manner, and position the goniometer to measure degrees of movement.

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Muscle testing

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Consists of ROM tests (with a goniometer), strength tests, and task skill tests.

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Muscle strength testing

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Determines the amount of muscle force. This test is usually done from head to foot, usually in combination with ROM testing. The patient is asked to resist pressure that the physician or medical assistant applies to each muscle or group of muscles.

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Posture testing

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The physician looks at the patient's spinal curve from the sides, back, and front; notes the symmetry of alignment of the shoulders, knees, and hips; assesses alignment and degree of straightness as the patient bends at the waist; and assesses knee position by having the patient stand with both feet together.

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Electromyography (EMG)

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A process of electrically recording muscle action potentials. The patient may receive sedation before this test because the electric current can be painful. Abnormal EMG test results can indicate a congenital or an acquired disease condition of the muscles.

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Physical therapy

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The treatment of disorders with physical agents and methods such as massage, manipulation, therapeutic exercise, cold, heat, hydrotherapy, and electrical stimulation. Physical therapy includes rehabilitative treatment to restore function after an illness or an injury. It is also called physiotherapy.

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Physical therapist

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An allied health professional who has completed at least a 4-year baccalaureate training program in physical therapy and has received state licensure. He or she deals primarily with movement dysfunction and works with body parts that have been injured by accident, amputation, or disease.

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Thermotherapy

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The treatment of disease by the application of heat. Thermotherapy is used to relieve pain, to relax spasms of muscles, to relieve localized swelling, to increase tissue metabolism and repair, and to increase drainage from an infected area. A temperature of 116°F (47°C) or above can cause burning. Thermotherapy should not be used longer than 30 minutes.

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Types of heat therapy

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The main types are dry heat, moist heat, and diathermy.

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Dry heat therapy

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Includes the use of heating pads, hot-water bottles, chemical hot packs, heat lamps, and fluidotherapy.

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Heating pad

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The physician should specify the heating pad temperature and the length of time the pad should be applied. Cover the pad with a pillowcase or towel, make sure that the cord is not frayed, make sure that the patient's skin is dry, plug the cord into an outlet, and turn on the pad. The patient should not lie on top of a heating pad.

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Hot-water bottle

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Water temperature should not exceed 125°F for adults and 115°F for children and elderly patients. Fill the bottle halfway, and expel the air. Cover the bottle with a cloth or pillowcase before applying.

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Chemical hot pack

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A disposable, flexible pack of chemicals that becomes hot when activated (kneaded or slapped). After activating the pack, cover it with a cloth and place it on the patient's skin in the area being treated.

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Heat lamp

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Uses an infrared or ultraviolet bulb. Place the lamp 2 to 4 feet from the area being treated. Treatment usually lasts 20 to 30 minutes.

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Infrared therapy

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Treatment by exposure to various wavelengths of infrared radiation. Infrared treatment is performed to relieve pain and to stimulate blood circulation.

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Ultraviolet therapy

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Used in the treatment of rickets and certain skin conditions such as psoriasis. This therapy is also useful in the control of infectious airborne bacteria and viruses. Ultraviolet ray lamp treatments must be carefully controlled because they can cause severe sunburn and even second- or third-degree burns. The time and the distance of the lamp from the patient must be controlled. Treatment is prescribed by the second, for example, 10 or 20 seconds of exposure.

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Fluidotherapy

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A relatively new technique in which the patient places the hand or foot in a container of glass beads that are heated and agitated with hot air.

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Moist heat therapy

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There are several types of moist heat applications, including hot soaks, hot compresses, hot packs, and paraffin baths.

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Hot soak

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Usually used on arms or legs. The patient places the body part being treated in a container of plain or medicated water heated to not more than 110°F. A hot soak should last about 15 minutes.

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Hot compress

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Soak the gauze or cloth in hot water, wring it out, and apply it to the area being treated. Either place a hot-water bottle on top of it or frequently rewarm the compress in hot water.

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Hot pack

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Moist, hot pack is covered with a towel and placed over the area being treated.

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Paraffin bath

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Utilizes a receptacle of heated wax and mineral oil to reduce pain, muscle spasms, and stiffness in patients with arthritis. A thick coat of wax remains on the area for about 30 minutes and then is peeled off.

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Diathermy

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The production of heat in body tissues for therapeutic purposes by high-frequency currents that are insufficiently intense to destroy tissues. Diathermy is useful in treating muscular disorders, tendonitis, arthritis, and bursitis. Diathermy cannot be used in patients with metal implants, such as hip replacements, because of the electrical field it creates and the consequent danger of burns.There are three basic methods of diathermy: ultrasound, microwave, and shortwave.

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Ultrasound

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Projects high-frequency sound waves that are converted to heat in muscle tissue. The most common type of diathermy, it is administered by rubbing a gel-covered transducer over the skin in circular patterns. It is used to treat sprains, strains, and other acute ailments. Ultrasound treatments should not be used in areas where bones are near the skin's surface.

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Microwave

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Electromagnetic radiation that is converted into heat in tissues. It should not be used on patients with pacemakers, in combination with wet dressings, or near metal implants.

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Shortwave

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Provides heat deep in the body by means of radio waves that travel between two condenser plates. It is used to treat chronic arthritis, bursitis, sinusitis, and other conditions.

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Administering thermotherapy

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Place the thermotherapy device on the affected body part. Ask the patient how the device feels. Leave the device in place for as long as ordered by the physician. Check the skin for color, feeling, and pain periodically, and have the physician examine any area that becomes excessively red, blistered, or painful.

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Cryotherapy: Treatment using dry cold or wet cold applications to

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•Prevent swelling by limiting fluid accumulation in body tissue•Control bleeding by constricting blood vessels•Reduce inflammation by slowing blood and fluid movement•Provide an anesthetic effect by reducing inflammation•Reduce pus formation by inhibiting microorganisms•Lower body temperature

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Dry cold applications

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Ice bags (or ice collars) and chemical ice packs.

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Ice bag or ice collar

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Place ice chips or small ice cubes in the device, filling it two-thirds full; compress the container to expel air; dry the container; and cover it with a towel to absorb moisture.

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Chemical ice pack

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A flat plastic bag containing semifluid chemicals. Most chemical ice packs remain cold for 30 to 60 minutes; some are disposable, and some are reusable. Check the pack for leaks, and shake or squeeze it to activate the chemicals. Cover the pack with a towel.

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Wet cold applications

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Cold compresses and ice massage.

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Cold compress

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Place large ice cubes and a small amount of water in a basin. Place a washcloth or gauze square in the basin to moisten it, wring it out, and apply it to the area being treated.

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Ice massage

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Wrap an ice cube in a plastic bag, or freeze water in a paper cup, then use the device to massage the area.

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Administering cryotherapy

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Place the cryotherapy device on the affected body part. Ask the patient how the device feels. Leave the device in place for as long as ordered by the physician. Check the skin for color, feeling, and pain periodically, and have the physician examine any area that becomes excessively pale or blue, numb, or painful. After treatment, check for reduced swelling, redness, and pain.

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Hydrotherapy

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The use of water in the treatment of various disorders. Hydrotherapy may include continuous tub baths, wet sheet packs, or shower sprays.

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Whirlpool

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A tank in which water is agitated by jets of air under pressure, used to relax muscles and to increase circulation.

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Contrast bath

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Two baths, one filled with hot water and the other with cold water. The patient quickly moves the affected body part from one to the other. It is used to induce relaxation, stimulate circulation, and improve mobility.

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Underwater exercises

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Generally performed in a warm swimming pool by patients with joint injuries, burns, and arthritis.

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Exercise therapy

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A technique for helping patients prevent deformities, regain body movement, improve muscle strength, stimulate circulation, retain neuromuscular coordination, and resume normal daily activities. Therapeutic exercises are ordered by the physician after complete evaluation of the physical problem.

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Medical assistant's role in exercise therapy

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To provide information for the patient and family, to provide support and encouragement, to assist with ROM exercises, and to teach the patient how to perform them at home.

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Active mobility exercises

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Self-directed exercises a patient performs without assistance to increase muscle strength and function. They may require such equipment as a stationary bicycle or treadmill.

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Passive mobility exercises

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Used for patients with neuromuscular disabilities or weaknesses. The physical therapist or a machine moves the body part.

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Aided mobility exercises

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Self-directed exercises performed with the help of such devices as exercise machines or therapy pools.

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Active resistance exercises

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The patient works against resistance, which is provided by a therapist or by an exercise machine, to increase muscle strength.

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ROM exercises

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Exercises that slowly move each joint through its full range of motion. They may be active (performed by the patient without assistance) or passive (performed with the help of another person or a machine). Typical ROM exercises are shoulder abduction, back rotation, hip flexion, and toe abduction.

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Electrical stimulation

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The delivery of controlled amounts of low-voltage electric current to motor and sensory nerves to stimulate muscles. It is used to help retrain a patient to use injured muscles.

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Massage

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The application of pressure with the hands on the soft tissue of the body through stroking, rubbing, kneading, or tapping, in order to increase circulation, improve muscle tone, and relax the patient. It is one of the oldest known methods for promoting healing. The most common sites for massage are the back, knees, elbows, and heels. Stroking is the most common massage modality used in the medical office.

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Immobilization

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The restriction of movement of a body part in order to promote healing. Devices such as splints and slings are prescribed by the physician and used by the physical therapist to immobilize damaged tissues and bones.

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Manipulation

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The application of rapid thrusting motions in order to stabilize, stretch, or reposition a joint.

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Traction

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The process of pulling or stretching a part of the body. It is applied by a physical therapist to create proper bone alignment, reduce joint stiffening and abnormal muscle shortening, correct deformities, relieve compression of vertebral joints, and reduce or relieve muscle spasms.

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Cane

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A sturdy wooden or aluminum shaft or walking stick, used to give support and greater mobility to a person who is ambulatory but needs some assistance.

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Standard cane

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A cane with a single leg, used by someone who needs only a small amount of support in walking.

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Tripod and quad-base canes

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Canes with bases having three and four legs, respectively, that provide greater support and stability.

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Cane height

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When the patient is holding the cane and standing up straight, the cane should be level with the top of the patient's femur, and the elbow should be bent at a 30-degree angle.

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Teaching a patient to use a cane

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The medical assistant may be asked to teach a patient how to use a cane.

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Crutch

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A metal or wooden staff used to aid a person in walking. It is important that the person be taught how to use the crutch(es) safely and how to achieve a stable and acceptable gait.

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Types of crutches

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The two basic kinds of crutches are axillary crutches (which reach from the ground almost to the armpit) and forearm crutches (which reach from the ground to the forearm and are also called Lofstrand or Canadian crutches).

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Measuring a patient for crutches

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Crutches must be measured to fit the patient. Crutches that are too long or too short can cause muscle weakness, back strain, or imbalance. When the patient is standing erect, with feet slightly apart, and the crutch tips are positioned 2 inches in front of the feet and 4 to 6 inches to the side of each foot, there should be 2 to 3 finger-widths between the axillary supports and the armpits and the handgrips should be positioned to create a 30-degree flexion at the elbows.

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Crutch gaits

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Begin with the standing or tripod position, in which the patient places the crutch tips 4 to 6 inches in front of the feet and 4 to 6 inches away from the side of each foot. Patients should use a slow gait in crowded areas or when feeling tired.

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Four-point gait

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A slow gait used by persons who can bear weight on both legs. The patient should begin in the tripod position, then move the right crutch forward, move the left foot forward to the level of the left crutch, move the left crutch forward, and move the right foot forward to the level of the right crutch.

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Three-point gait

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Used by persons who can bear full weight on one leg and no weight on the other. It requires good muscle coordination and arm strength. The patient begins in the tripod position, moves both crutches and the affected leg forward, then balances weight on both crutches and moves the unaffected leg forward.

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Two-point gait

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A faster gait used by persons who can bear some weight on both feet and have good muscle coordination and balance. The patient begins in the tripod position, then moves the left crutch and right foot forward at the same time, followed by the right crutch and left foot.

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Swing-to gait

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A modified three-point gait often used by persons with physical disabilities. The patient begins in the tripod position and then moves both crutches forward at the same time. The patient then lifts the body and swings it to the crutches.

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Swing-through gait

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Also often used by persons with physical disabilities. It is like the swing-to gait, but the patient swings the body past the crutches.

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Walker

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An extremely light, movable apparatus, about waist high, made of metal tubing (usually aluminum), used to aid a patient in walking. There are two types: standard (with four widely placed legs ending in rubber tips) and rolling (with wheels).

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Walker height

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The top of the walker should be just below the patient's waist or at the same height as the top of the hip bone, so that when the patient holds the handgrip, the elbow is bent at a 30-degree angle.

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Using a walker

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Although a physical therapist usually trains patients in the use of walkers, medical assistants may be asked to do it or to reinforce the information.

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Wheelchair

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A mobile chair equipped with large wheels and brakes. If long-term use of the chair is expected, a physical therapist may prescribe particular features, such as seat size and height, left- or right-hand propulsion, brake type, armrest height, footrest style (e.g., fixed, swing-away, elevating), and special seat pads.

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Using a wheelchair

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To get into the wheelchair, the patient should lock the chair and fold back the footplates, then back into the chair, supporting himself or herself on the armrests while lowering the body into the chair.

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Transferring a patient from a wheelchair to a table

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Make sure that the wheelchair is in the locked position and that the patient is sitting at the front of the wheelchair seat. Face the patient, spread your feet apart, and bend slightly at the knees. Have the patient hold on to your shoulders, and place your arms around the patient under the arms. At the count of "3," lift and pivot the patient to bring the back of his or her knees against the table. Gently lower the patient into a sitting or supine position.

CH 22 Physical Therapy – Flashcards

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