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  1. 1. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 1 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS SPEC. BY: Abdulrehman S. Mulla DATE: 03/25/2009 REVISION HISTORY REV. DESCRIPHYSICAL CN No. BY DATE THERAPYION 01 Initial Release PHYSICAL THERAPY0005 ASM 03/28/2009 Medicine: It’s a noble profession, It serves humanity 1
  2. 2. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 2 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. TABLE OF CONTENTS PAGE 1.0 GERIATRIC PHYSICAL THERAPY: ................................................................................................................................................................ 5 RESISTANCE EXERCISE...........................................................................................................................................................7 2.0 PHYSICAL THERAPY FOR ARTHRITIS: ........................................................................................................................................................ 9 1.1 SIGNS AND SYMPHYSICAL THERAPYOMS OF ARTHRITIS:...................................................................................................... 9 1.1.1 WHAT IS TO BE DONE WHEN YOU SUSPECT SYMPTOMS OF ARTHRITIS: ........................................................... 9 1.2 PHYSICAL THERAPY AND EXERCISE:....................................................................................................................................... 10 1.2.1 TYPES OF EXERCISE: ................................................................................................................................................. 10 A. STRENGTHENING EXERCISES: ..........................................................................................................................11 B. ENDURANCE OR AEROBIC EXERCISES: ...........................................................................................................11 1.2.2 OTHER THERAPIES: .................................................................................................................................................... 11 A. HEAT THERAPY:....................................................................................................................................................11 B. COLD THERAPY: ...................................................................................................................................................12 C. WATER THERAPY(Aquatic Therapy): ...................................................................................................................12 I. SHALLOW END: .............................................................................................................................................13 II. DEEP END: ....................................................................................................................................................13 D. Beneficiaries of the Aquatic Physical Therapy:.......................................................................................................14 E. MASSAGE: .............................................................................................................................................................15 I. KNEE & ANKLE PAIN MASSAGE: .................................................................................................................16 II. WRIST, PALM, BACK OF THE PALM & FINGERS MASSAGE: ...................................................................16 III. FOOT MASSAGE: ..........................................................................................................................................16 F. TENS (TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION): .................................................................17 1.3 BRACING: ...................................................................................................................................................................................... 18 1.4 ADVANCED NON-INVASIVE TREATMENT FOR ARTHRITIS PAIN............................................................................................ 19 1.4.1 INDICATIONS: ............................................................................................................................................................... 19 1.4.2 MUSCLE STIMULATION: .............................................................................................................................................. 19 2.0 PHYSICAL THERAPY FOR OSTEOPOROSIS TREATMENT: ..................................................................................................................... 20 2.1 OSTEOPOROSIS: ......................................................................................................................................................................... 20 2.1.1 OSTEOPOROSIS TREATMENT: ADVANTAGES OF PHYSICAL THERAPY:............................................................. 20 2.2 OSTEOPOROSIS TREATMENT: .................................................................................................................................................. 21 2.2.1 PHYSICAL THERAPY REHAB AFTER A FRACTURE: ................................................................................................ 21 2.2.2 EMOTIONAL REHAB:.................................................................................................................................................... 23 2.2.3 PHYSICAL THERAPY REHAB BEFORE A FRACTURE: ............................................................................................. 23 3.0 PHYSICAL THERAPY FOR CANCER: .......................................................................................................................................................... 24 3.1 MULTIPLE MYELOMA:.................................................................................................................................................................. 24 3.2 BONE MARROW TRANSPLANT/PER IPHERAL BLOOD STEM CELL TRANSPLANT: ............................................................. 25 3.3 LONG-TERM FOLLOW-UP PATIENTS......................................................................................................................................... 25 3.4 BREAST CANCER:........................................................................................................................................................................ 26 3.4.1 FOR LYMPHEDEMA TREATMENT, PT’s OFFER THE FOLLOWING SERVICES: ..................................................... 27 3.5 MELANOMA:.................................................................................................................................................................................. 30 3.6 FOR LYMPHEDEMA TREATMENT, PT’s OFFER THE FOLLOWING SERVICES: ..................................................................... 32 3.7 HEAD AND NECK CANCER:......................................................................................................................................................... 32 3.8 PROSTATE CANCER:................................................................................................................................................................... 33 3.9 LUNG CANCER: ............................................................................................................................................................................ 34 3.9.1 LUNG CANCER PHYSIOTHERAPY: ............................................................................................................................ 35 3.10 SARCOMA: .................................................................................................................................................................................... 36 3.10.1 FOR LYMPHEDEMA TREATMENT, PT’s OFFER THE FOLLOWING SERVICES: ..................................................... 36 4.0 ALZHEIMER'S DISEASE: .............................................................................................................................................................................. 37 4.1 RISK FACTORS:............................................................................................................................................................................ 38 4.1.1 KNOWN RISK FACTORS:............................................................................................................................................. 38 4.1.2 POTENTIAL CONTRIBUTING FACTORS:.................................................................................................................... 39 4.1.3 HEREDITY AND ALZHEIMER'S DISEASE: .................................................................................................................. 40 4.2 PHYSICAL THERAPY FOR ALZHEIMER'S DISEASE:................................................................................................................. 40 4.2.1 BEGINNER: ................................................................................................................................................................... 41 4.2.2 INTERMEDIATE: ........................................................................................................................................................... 41 4.2.3 CORE STRENGTHENING:............................................................................................................................................ 41 4.2.4 WALL SLIDES: AN EFFECTIVE QUAD STRENGTHENING EXERCISE ..................................................................... 41 A. HOW TO DO A WALL SLIDE .................................................................................................................................41 4.2.5 ABDOMINAL MUSCLES................................................................................................................................................ 42 4.2.6 STRETCHING EXERCISES: ......................................................................................................................................... 42 5.0 PHYSICAL THERAPY FOR HIP AND JOINT REPLACEMENT: ................................................................................................................... 43 5.1 WHAT IS HIP REPLACEMENT: .................................................................................................................................................... 43 Medicine: It’s a noble profession, It serves humanity 2
  3. 3. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 3 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 5.1.1 THE quot;NORMALquot; HIP: ..................................................................................................................................................... 44 5.1.2 WHEN IS A HIP REPLACEMENT NEEDED? ............................................................................................................... 44 A. OSTEOARTHRITIS:................................................................................................................................................44 B. RHEUMATOID ARTHRITIS: ...................................................................................................................................45 C. TRAUMATIC ARTHRITIS: ......................................................................................................................................45 D. AVASCULAR NECROSIS: .....................................................................................................................................46 E. OTHER REASONS: ................................................................................................................................................46 5.2 PHYSICAL THERAPY AFTER HIP REPLACEMENT:................................................................................................................... 47 5.2.1 HEEL SLIDES: ............................................................................................................................................................... 47 5.2.2 STRAIGHT LEG RAISES:.............................................................................................................................................. 47 5.2.3 GLUTEAL SETS: ........................................................................................................................................................... 48 A. ANKLE PUMPS:......................................................................................................................................................48 B. QUAD SETS: ..........................................................................................................................................................48 C. GLUTEAL SQUEEZES: ..........................................................................................................................................48 D. Heel Slides: .............................................................................................................................................................48 E. SHORT ARC QUADS: ............................................................................................................................................48 F. HIP ABDUCTION: ..................................................................................................................................................48 G. LONG ARC QUADS:...............................................................................................................................................48 5.2.4 STANDING EXERCISES: .............................................................................................................................................. 49 A. STANDING KNEE RAISES: ...................................................................................................................................49 B. STANDING HIP ABDUCTION: ...............................................................................................................................49 C. STANDING HIP ABDUCTION: ...............................................................................................................................49 D. STANDING HIP EXTENSIONS: .............................................................................................................................49 E. WALKING AND EARLY ACTIVITY: ........................................................................................................................49 F. WALKING WITH WALKER, FULL WEIGHT BEARING: ........................................................................................49 G. WALKING WITH CANE OR CRUTCH:...................................................................................................................49 H. STAIR CLIMBING AND DESCENDING: ................................................................................................................50 I. ADVANCED EXERCISES AND ACTIVITIES: ........................................................................................................50 5.2.5 ELASTIC TUBE EXERCISES ........................................................................................................................................ 50 A. RESISTIVE HIP FLEXION: .....................................................................................................................................50 B. RESISTIVE HIP ABDUCTION: ...............................................................................................................................50 C. RESISTIVE HIP EXTENSIONS: .............................................................................................................................50 D. EXERCYCLING: .....................................................................................................................................................50 E. WALKING:...............................................................................................................................................................50 6.0 BALANCE DISORDERS: ............................................................................................................................................................................... 51 6.1 HOW DOES THE BALANCE SYSTEM WORK? ........................................................................................................................... 51 6.2 WHAT ARE THE SYMPTOMS OF A BALANCE DISORDER? ..................................................................................................... 53 6.3 WHAT CAUSES A BALANCE DISORDER?.................................................................................................................................. 53 6.4 WHAT ARE SOME TYPES OF BALANCE DISORDERS?............................................................................................................ 54 6.5 HOW ARE BALANCE DISORDERS DIAGNOSED? ..................................................................................................................... 55 6.6 HOW ARE BALANCE DISORDERS TREATED? .......................................................................................................................... 56 6.7 HOW CAN THE PATIENT HELP THE DOCTOR MAKE A DIAGNOSIS?..................................................................................... 56 6.8 HOW ARE BALANCE DISORDERS TREATED? .......................................................................................................................... 56 6.8.1 OFFICE TREATMENT OF BPPV: ................................................................................................................................. 56 A. THE EPLEY AND SEMONT MANEUVERS: ..........................................................................................................56 B. INSTRUCTIONS FOR PATIENTS AFTER OFFICE TREATMENTS (Epley or Semont manoeuvres)...................57 C. WHAT IF THE MANEUVERS DON'T WORK? .......................................................................................................58 D. HOME TREATMENT OF BPPV:.............................................................................................................................58 E. HOME EPLEY MANEUVER: ..................................................................................................................................59 6.9 AYURVEDA MEDICINE FOR BPPV:............................................................................................................................................. 60 6.9.1 BALANCE IS THE KEY:................................................................................................................................................. 60 6.9.2 PRAKRITI AND VIKRITI: ............................................................................................................................................... 60 6.9.3 THE BEEJ-BHOOMI THEORY: ..................................................................................................................................... 61 6.9.4 THE SCIENCE OF HERB COMBINING AND PROCESSING....................................................................................... 61 6.9.5 SCIENTIFIC SCRUTINY OF AYURVEDA: .................................................................................................................... 61 6.9.6 CUMULATIVE BENEFITS OF AYURVEDA:.................................................................................................................. 62 7.0 PHYSICAL THERAPY FOR INCONTINENCE:.............................................................................................................................................. 63 7.1 NORMAL URINATION: .................................................................................................................................................................. 63 7.2 THE PROCESS OF URINATION:.................................................................................................................................................. 64 7.3 FOUR TYPES OF INCONTINENCE: ............................................................................................................................................. 65 7.3.1 STRESS INCONTINENCE: ........................................................................................................................................... 65 7.3.2 URGE INCONTINENCE: ............................................................................................................................................... 65 Medicine: It’s a noble profession, It serves humanity 3
  4. 4. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 4 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 7.3.3 OVERFLOW INCONTINENCE: ..................................................................................................................................... 65 7.3.4 FUNCTIONAL INCONTINENCE:................................................................................................................................... 65 7.4 PHYSICAL THERAPY FOR INCONTINENCE:.............................................................................................................................. 65 7.4.1 KEGEL OR PELVIC FLOOR MUSCLE EXERCISES FOR MEN: ................................................................................. 65 A. WHAT IS THE PELVIC FLOOR?............................................................................................................................65 B. HOW DO YOU EXERCISE THESE MUSCLES? ...................................................................................................66 C. HOW DO I FIND THE RIGHT MUSCLES?.............................................................................................................66 D. HOW DO I DO THESE EXERCISES? ....................................................................................................................66 E. WHERE WILL I DO THE EXERCISES? .................................................................................................................66 F. ARE THERE ANY PRECAUTIONS? ......................................................................................................................66 7.4.2 KEGEL OR PELVIC FLOOR MUSCLE EXERCISES FOR WOMEN: ........................................................................... 67 A. WHAT IS THE PELVIC FLOOR?............................................................................................................................67 B. THE PELVIC FLOOR MUSCLES: ..........................................................................................................................67 C. FACTORS CONTRIBUTING TO PELVIC FLOOR MUSCLE WEAKNESS:...........................................................67 E. HOW DO YOU STRENGTHEN MY PELVIC FLOOR MUSCLES? ........................................................................67 F. STARTING YOUR PELVIC FLOOR MUSCLE TRAINING PROGRAM: ................................................................68 8.0 HOW TO MAKE YOUR PARENTS FEEL HAPPY IN THEIR OLD AGE:....................................................................................................... 69 Medicine: It’s a noble profession, It serves humanity 4
  5. 5. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 5 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 1.0 GERIATRIC PHYSICAL THERAPY: From the Greek quot;geronquot; meaning quot;old manquot; + quot;iatreiaquot; meaning quot;the treatment of disease.quot;. Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging, but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to:  Arthritis  Osteoporosis  Cancer  Alzheimer’s disease  Hip and joint replacement  Balance disorders  Incontinence and more. The goals of an exercise program for individuals with the above ailments are to: 1) Preserve or restore range of motion and flexibility around affected joints, 2) Increase muscle strength and endurance, and 3) Increase aerobic conditioning to improve mood and decrease health risks associated with a sedentary lifestyle. The exercise program can be organized around the Exercise Pyramid for Patients with the above ailments, as pictured below. Medicine: It’s a noble profession, It serves humanity 5
  6. 6. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 6 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Geriatric physical therapy helps those affected by such problems in developing a specialized program to help restore mobility, reduce pain, increase fitness levels and more. Many older adults develop functional decline and impaired walking while in the hospital. Preventing and treating hospital-related deconditioning is, therefore, of great importance. Nevertheless, most hospital exercise protocols are untested and poorly described. Although the exact cause of hospital-related deconditioning is uncertain and the optimal type and intensity of exercise needed to prevent deconditioning is yet to be determined, many studies show that loss of muscle mass and deteriorating muscle strength occurs after several days of bed rest. Moreover, many older adults have impaired muscle strength prior to admission to the hospital. Given low baseline levels of muscle strength at the time of hospital admission, any further deterioration of strength due to bed rest may quickly cause dependency in walking and other functions. Accordingly, it appears logical to use an exercise program that specifically builds strength, such as high intensity resistance training (HIRT), to prevent hospital-related deconditioning. The crucial principle of this technique is to provide sufficient resistance to achieve muscle fatigue within 8 to 12 repetitions of an exercise. Although the safety and efficacy of HIRT has been demonstrated with both nursing home residents and healthy older adults, the ability to use HIRT in the acute care setting is unknown. Firstly, the acuity of illness might limit the use of resistance exercise. Secondly, it is uncertain whether hospitalized older adults can exercise at a level that would have a significant effect on muscle strength and function. Finally, many studies of HIRT use costly machines that both determine the necessary resistance for each exercise and place the body in a mechanically effective position. This type of exercise equipment is not available in most hospitals, and it is unclear whether the integrity of a resistance exercise program can be maintained without it. Importantly, for frail older adults in hospital, any strengthening exercise program needs to provide enough resistance to train muscles while maintaining safe, correct posture and positioning. Sets of resistance exercises that can be performed in hospital have been derived. The objectives of the exercise program are to:  Allow the patient to exercise from bed, for ease of administration,  Provide enough resistance so that muscle fatigue occurs before 10 repetitions,  Strengthen the major muscle groups of the lower extremities,  Utilize safe,  Effective procedures and postures, and  Standardize and describe the exercise program so that it can be precisely reproduced. Patients must exercise 3 times per Week, assisted by the physiotherapist, with a rest day between sessions. The resistance exercise program targeted the lower extremities, including the gluteal muscles, quadriceps, hamstrings, hip flexors, hip adductors/abductors, and plantar/dorsiflexors. Principles of postural alignment and correct exercise technique were stressed. Exhalation must be coordinated with the exertion phase of the exercise. Each exercise was repeated 10 times, after which the patient can repeat the set to a maximum of three sets. Patients must exercise until discharge from the hospital unit, or for a maximum of 4 Weeks. A physiotherapist must supervise all exercise sessions. Recognizing the importance of being able to accurately incorporate any therapeutic intervention into medical practice, PT’s have detailed the exercise protocol in Table 1. HIRT techniques were adapted so that exercise could be performed in bed and without the typical equipment used in many studies of HIRT, such as Cybex or Universal machines. The exercises incorporated principles of overload and specificity, consistent with the American College of Sports Medicine guidelines for strength training. The resistance for single leg knee extension, was based on the one-repetition maximum (1RM), calculated using 1 pound increments. The 1RM is the maximum amount of Weight an exerciser can lift while maintaining correct posture. Once exercising, single leg knee extension was performed using a Weight equal to 60% to 80% of the 1RM. For the remaining strengthening exercises, resistance was achieved using Weights, Therabands (rubber tubing) or springs, selecting a Weight or length of tubing or spring that would achieve muscle fatigue within 10 repetitions. Exercises Were progressed during the study. For each subject, the physiotherapist measured the length of Theraband™ Medicine: It’s a noble profession, It serves humanity 6
  7. 7. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 7 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. required to cause muscle fatigue within 10 repetitions. If muscle fatigue failed to occur as the study proceeded, the theraband or spring length was shortened. Similarly, if the designated Weight for the 1RM did not cause muscle fatigue within 10 repetitions, the amount of Weight was increased. TABLE 1: RESISTANCE EXERCISE EXERCISE GOAL TECHNIQUE 1. Place the legs over a half-barrel (facilitates proper positioning). 2. Place a Weight on the ankle ~70% of the 1RM. 3. On exhalation, while keeping the upper leg on the barrel, To strengthen the quadriceps muscle extend the knee of 1 leg to a fully lengthened position. while maintaining proper alignment of the Single leg extension (Figure 1a) knee hip, and ankle. 4. LoWer the leg on the inhale. 1. Wrap a sling in a figure 8 around the foot and ankle, so that a small ring is positioned at the heel (Figure 1b). 2. Attach one end of a spring to this ring. 3. Attach the other end of the spring to the bed in line with the median sagittal plane of the leg and at a distance that will achieve muscle fatigue after 10 repetitions. 4. Lie in a supine position with the working leg flexed at a 110° angle and the resting leg extended. 5. Exhale, activate the gluteal and hamstring muscles, then move the foot as close to the buttock as possible. Heel drag (Figure 1c) To strengthen the hamstring muscles. 6. Afterwards, on the inhale, return to the starting position. 1. Lie supine with legs over the barrel and the pelvis in a neutral position with a 4-inch piece of dense foam between the knees. 2. To activate the adductor muscles of the thigh, squeeze the foam, then simultaneously extend both legs on the exhale. To strengthen the adductor muscles of the thigh and the muscles of the pelvic 3. Return to the starting position on the inhale. Bilateral leg extension (Figure 1d) floor. 1. Wear a shoe or a boot with a rigid bottom. 2. Choose a length of theraband™ that will fatigue the plantarflexor muscles after 10 repetitions. Place the middle of the theraband™ around the sole of the shoe and hold the two free ends of the theraband. 3. Plantarflex the foot on the exhale. To strengthen the muscles used for Plantar flexion (Figure 1e) plantar flexion. 4. Return to starting position on the inhale. 1. Attach a nylon circular band to one end of a spring. 2. Loop the band around the top of the foot then attach the other end of the spring to the bottom of the bed at a distance that provides enough tension to fatigue the muscle To strengthen the muscles used for 3. Dorsiflex the foot on the exhale and return to the starting Dorsiflexion (Figure 1f) dorsiflexion. position on the inhale. Side lying diamond (Figure 1g) To strengthen the gluteal muscles, the 1. Lie on the side, making sure that the shoulders, trunk and Medicine: It’s a noble profession, It serves humanity 7
  8. 8. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 8 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. abductor muscles of the thigh, and the pelvis are perpendicular to the bed, with the hips and knees lateral rotators of the hip. flexed at a 45-degree angle and the heels together. Place a Weight over the distal thigh, if necessary, to achieve the appropriate resistance. 2. While exhaling, press the heels together to engage the gluteal muscles, then open the top leg to make a diamond shape. 3. On the inhale, return the leg to the starting position. Medicine: It’s a noble profession, It serves humanity 8
  9. 9. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 9 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 2.0 PHYSICAL THERAPY FOR ARTHRITIS: 1.1 SIGNS AND SYMPHYSICAL THERAPYOMS OF ARTHRITIS: If you feel pain and stiffness in your body or have trouble moving around, you might have arthritis. Most kinds of arthritis cause pain and swelling in your joints. Joints are places where two bones meet, such as your elbow or knee. Over time, a swollen joint can become severely damaged. Some kinds of arthritis can also cause problems in your organs, such as your eyes or skin. One type of arthritis, osteoarthritis, is often related to aging or to an injury. Other types occur when your immune system, which normally protects your body from infection, attacks your body's own tissues. Rheumatoid arthritis is the most common form of this kind of arthritis. Juvenile rheumatoid arthritis is a form of the disease that happens in children. 1.1.1 WHAT IS TO BE DONE WHEN YOU SUSPECT SYMPTOMS OF ARTHRITIS: The first step you need to take if you suspect you may have arthritis is to visit a qualified medical practitioner. Usually this will involve referral to a hospital where X ray and blood tests will be performed. Sometimes there will be a specialist on site who will be able to administer more advanced forms of tests and give advice on the spot. Once a diagnosis has been made, there are various treatments that can be applied. The most obvious and crude, of these treatments is the simple pain-killing drug, such as aspirin or paracetamol. Aspirin is preferred in many cases as it has anti-inflammatory properties. Many of these basic painkillers are available without prescription. Physical Therapy, so it vitally important to inform your physician if you intend to take these on top of any prescribed medicine. Medicine: It’s a noble profession, It serves humanity 9
  10. 10. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 10 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 1.2 PHYSICAL THERAPY AND EXERCISE: In addition to medications, many people with arthritis can find relief from physical therapy and exercise. Physical therapy is a treatment method that focuses on pain relief, healing, restoring function and movement, improving body mechanics, as Well as overall fitness and Wellness. Your doctor will prescribe physical therapy as part of your treatment plan and will refer you to a physical therapist. Physical therapists are rehabilitation professionals trained in the variety of exercises and treatment Physical Therapy that are appropriate for arthritis sufferers. Your therapist will work closely with your doctor and you to develop an exercise regimen specifically for you. Exercising can help arthritis sufferers in many ways. Exercise reduces joint pain and stiffness and increases flexibility, muscle strength and endurance. It also helps with Weight reduction, which is important since extra Weight can place too much pressure on joints. 1.2.1 TYPES OF EXERCISE: Generally there are 3 types of exercises that are appropriate for people with arthritis: Range-of-motion exercises. These exercises should be done daily to help maintain normal joint movement, relieve stiffness and increase flexibility. Range-of-motion exercises for the spine may include bending forward, back and to each side. Medicine: It’s a noble profession, It serves humanity 10
  11. 11. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 11 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. A. STRENGTHENING EXERCISES: These exercises can also be done every day (unless you have severe pain) to help increase muscle strength. Strong muscles help support and protect joints affected by arthritis. Your therapist will instruct you on proper ways to lift and flex during these exercises. Follow table 1 exercises for strengthening. B. ENDURANCE OR AEROBIC EXERCISES: These exercises can be done three times a Week for 20-30 minutes. They improve cardiovascular fitness, help control Weight and improve overall function. Examples include walking and bike riding. Pict:4 1.2.2 OTHER THERAPIES: In addition to therapeutic exercise, your therapist may use other treatments such as: A. HEAT THERAPY: Warm towels or heat packs are placed on the spine to relieve pain by increasing blood flow and relaxing tissues. Which types of heat therapy are effective for arthritis pain? You can choose from the following popular types of heat therapy:  Disposable heat patches or belts available at most drugstores  Heated swimming pool  Hot packs (you can buy some -- such as Bed Buddy -- that can be warmed in a microwave)  Moist heating pad  Therapeutic mixture of paraffin and mineral oil  Warm bath  Warm shower  Warm whirlpool or hot tub  Warm, moist towel or cloth  You may also sit on a stool that has rubber tips for safety while letting the warm shower hit the affected area. The constant heat flowing on the arthritic joint or pain site helps to keep pain minimal and allows for easier movement. Many people with arthritis find good relief from pain and stiffness with hot baths or spas. The moist heat increases muscle relaxation, boosts blood supply to the site of pain, and relieves rigidity and spasms in the muscles. But avoid hot tubs or spas if you have diabetes, high blood pressure, or cardiovascular disease, or if you are pregnant. Medicine: It’s a noble profession, It serves humanity 11
  12. 12. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 12 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Pict:5 B. COLD THERAPY: Ice packs or ice massage applied to painful areas of the spine to reduce sWelling and pain. Pict:6 C. WATER THERAPY(Aquatic Therapy): Exercising in a large pool to reduce pressure on the spine. The heat and movement of whirlpools may also provide pain relief. Water has been used for thousands of years as a medium for exercise and healing. Aquatic (or Water) Therapy when provided by a licensed physical therapist may be considered an entity of physical therapy. Water provides a safe and supportive environment in which individuals can perform movements that would be painful or impossible if attempted Physical Therapy on land. The unique properties of the aquatic environment enable one to begin to exercise more quickly after an injury, or earlier in the rehabilitation process if limited in Weight-bearing or by pain, as Well as being used for relief of pain itself. Medicine: It’s a noble profession, It serves humanity 12
  13. 13. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 13 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. I. SHALLOW END: Weight bearing load in your joints is only 50% when submerged in water to waist level. In the shallow end people thus have better tolerance for walking activities, balance retraining and lower extremity strengthening exercises compared to on land. In addition, PT’s can use the viscosity and turbulence of water to get people in a position where their balance is challenged. Also note that the increased hydrostatic pressure around the body helps to reduce or control swelling in the joints and to relieve pain. Assisted flotation is also possible in the shallow end and can be used for relaxation or exercise techniques. II. DEEP END: When performing deep-water exercises PT’s use a specialized flotation belt that suspends you in the water. When you are submerged in water to shoulder Physical Therapy, 90 % of your body Weight is removed due to the buoyancy of water. This quot;unloadingquot; provides decompression and reduced shearing of the spine and other joints allowing for greater ease of movement with less pain. In addition, the core muscles are activated and strengthened when you are asked to balance the centre of buoyancy over the center of gravity by staying vertical (vertical stability exercises). It is a unique challenge to be still in the water versus moving in the water (swimming)! Improved body awareness, postural control and restoration of functional movement patterns are skills a person gains while activating these core stabilizing muscles, and they translate Well to land-based stability programs, such as those given for home programs or those done using a quot;Swiss ballquot;. An added benefit is that aquatic therapy involves use of the entire body, not just the injured part, thereby enhancing overall fitness. Deep water conditioning activities can be utilized to improve or maintain cardiovascular health with less strain on joints, either for general health or for returning to a specific sport. For example, a high school athlete with a knee sprain can work out in the aquatic environment to maintain his or her level of fitness while the injury heals and therapy progresses, until they are ready to return to the field. Pict:7 Pict:8 Medicine: It’s a noble profession, It serves humanity 13
  14. 14. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 14 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Other beneficial properties of water therapy include: Hydrostatic pressure - helps decrease sWelling and improve venous blood flow back to the heart. Pict:9 Viscosity - can be utilized to either assist, support or resist movement. Performing exercises against the resistance of the water is a great way to strengthen muscles and build bone mass without stressing the joints. FUN - Exercises performed in the pool are usually a fun and social experience that make it easy to continue even when formal treatment is complete. D. Beneficiaries of the Aquatic Physical Therapy: Anyone with: Osteoarthritis Rheumatoid Arthritis Joint Replacement Surgery Arthroscopic Surgery Low Back Pain Fibromyalgia Parkinson's Disease Tendonitis Multiple Sclerosis Idiopathic Joint Pain Balance Disorders Scoliosis Stroke Sprains and Strains TBI/SCI Medicine: It’s a noble profession, It serves humanity 14
  15. 15. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 15 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. E. MASSAGE: Can help increase flexibility and circulation. Be sure to find a trained professional who is experienced in treating people with arthritis. Medicine: It’s a noble profession, It serves humanity 15
  16. 16. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 16 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. I. KNEE & ANKLE PAIN MASSAGE: Arthritis causes a lot of painful knee problems. There are some things you can do for yourself that can make a big difference. 1. The first step with any inflammation is to cool it down with ice. In the case of a sports injury ice for 10-15 minutes on and off is a great first step. I don't recommend ice for arthritis. 2. Next comes warmth from massage or a heating pad. Actually both is best. First warm up the knee for a few minutes and then massage the oil you have bought into the knee using circular friction movements. Massaging in this fashion suits the shape of the knee. You can do it for yourself or if you are lucky ask a friend. Professional massage is best. 3. The massaging of the knee will not cause pain. Make sure it is oiled enough not to irritate the skin. Work all around the knee for at least 15 minutes. Now try to walk and see how you feel. You can do this as often as you want. It speeds up recovery. In the sports stadiums the work on the injured football, basketball, hockey and baseball players on and off all day which is why they get better so quickly. II. WRIST, PALM, BACK OF THE PALM & FINGERS MASSAGE: 1. Use one hand to flex the wrist of your other hand. Work your thumb into your wrist joint, then up the outside of your hand and up each finger. Repeat on the other side. 2. Using your thumb, press firmly on your palm. Work your way across the inside of your hand. Repeat on the other side. 3. Run your thumb down the back of your hand from your wrist to your knuckles, pressing in between the bones of your hand. Repeat on the other side. 4. Gentle pull each finger and massage each joint of your fingers and thumb, both from the side of the joint and on top of each joint. Repeat on the other side. III. FOOT MASSAGE: 1. Start by soaking your feet in warm water for 5 to 10 minutes. You may add scented oil if desired. This will help clean and warm the feet and provide aromatherapy if scented oil was added to the water. Dry your feet with a warm toWel. 2. Lay or sit back and start to relax. The feet and legs should be supported by a surface (massage table, sofa or bed) or by the person giving the foot massage. Massage one foot at a time. Keep the other foot wrapped in a towel to keep the foot warm. 3. You may use oil or lotion for the foot massage. Run warm water over your hands to warm them before beginning the foot massage. Rub the oil or lotion over the entire foot to above the ankle. 4. You want to warm up the foot by doing some basic stretches. Gently stretch the foot up and down and around in circles. One hand should be cupping and supporting the heel and one hand should be moving the foot at the ankle joint. 5. Place the foot back down onto the supporting surface. Now squeeze the foot with both hands starting at the toes and work your way up to above the ankles and back down. One hand should be grasping the inside of the foot and one hand the outside of the foot. 6. Instead of squeezing, you are now going to use both hands and twist the foot in opposite directions starting at the toes and working up to the ankles and back down. One hand should be on the inside of the foot and one hand on the outside of the foot. Medicine: It’s a noble profession, It serves humanity 16
  17. 17. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 17 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 7. The foot should be warmed up and now it is time to do strokes. Use the fingers of both hands to do strokes on the top of the foot and use your thumbs to do strokes on the bottom of the foot. Again, start at the toes and work up to the ankles and back down. Try to find the grooves between the bones and tendons of your feet and apply the strokes in those areas. Don't forget the areas around the anklebones. 8. Next, turn your focus toward the toes. Find the areas where the bases of your toes bend (metatarsalphalangeal joints), with your fingers on top of the foot and your thumb on the bottom, make circular motions at these areas for toes 1 through 5. 9. Starting with toe number five (little toe), use your index and middle finger on top of the toe and your thumb on the bottom and start at the base of the toe and massage to the tip of the toe then make a circle with the toe. Follow that by gently pulling on the toe, you may hear the toe pop. Do this for all five toes, ending with the big toe. 10. Continue with the toes by running your four fingers of one hand into the four interspaces of the toes. You can start from the top of the foot or the bottom. Do several gentle back and forth movements. Finish the toes by using your index finger on top and your thumb on the bottom and gently massaging the toe interspaces, then stroke the interspaces by pulling your index finger and thumb towards you. 11. Now, you should focus on the bottom of the foot. Start with your thumbs and make circular motions, then do strokes both up and down and side to side. For a little more pressure, you can use your knuckles and knead the bottom of the foot. 12. Finish the foot massage by doing light strokes with your fingers on top of the foot and your thumbs on the bottom of the foot and starting at the toes and working up above the ankles. F. TENS (TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION): This is a technique that directs small pulses of electricity to specific nerves. The aim is to reduce the sensitivity of nerve endings in the spinal cord, thereby closing the pain quot;gates.quot; Although TENS is not effective in all arthritis sufferers, some people find it to be a practical means of pain control. The procedure, which produces a tingling sensation at the site of the electrical pads, has few side effects. (Some people have reported allergic reactions to the jelly used to apply the pads.) TENS instruction usually is provided by a physiotherapist, who can explain how to position the pads, select the correct electrical frequency and pulse strength, and time how long the treatment should last. Many people continue their exercise programs even after their prescribed physical therapy is finished. Your therapist will instruct you on the proper ways to do your exercises at home and give you tips on how to continue your treatment on your own. Medicine: It’s a noble profession, It serves humanity 17
  18. 18. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 18 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 1.3 BRACING: Another area of treatment for arthritis pain involves the use of braces or quot;assistive devicesquot; to help support your back and/or relieve pain. Spinal bracing can help control back pain by limiting motion and relieving pressure on the vertebrae. Your doctor will let you know if bracing is an Physical Therapy for you. In addition, devices such as canes, splints or walkers may also help you get around easier and with less pain. Orthotics, Lumbar (LoWer Back) Braces, Cervical (Neck) Braces, Wrist Braces, Ankle Braces, Knee Braces, Pict:13 Medicine: It’s a noble profession, It serves humanity 18
  19. 19. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 19 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 1.4 ADVANCED NON-INVASIVE TREATMENT FOR ARTHRITIS PAIN. The answer to pain from osteoarthritis is here; Horizontal Therapy. Patented technology that relieves over 80% of your patients with pain from osteoarthritis. This safe, effective, and easy to use modality is available to your practice now with no out-of-pocket expense. Being non-invasive and having no negative side effects when used correctly this revolutionary treatment enables you to expand and retain your patient base. 1.4.1 INDICATIONS:  Pain Management  For adjunctive use in post traumatic pain syndromes  For management and symptomatic relief of chronic (long term) pain  As an adjunctive treatment in the management of post surgical pain problems 1.4.2 MUSCLE STIMULATION:  Relaxation of muscle spasms  Prevention or retardation of tissue atrophy  Increasing blood circulation  Muscle re-education  Immediate post surgical stimulation of calf muscles to prevent phlebothrombosis  Maintaining or increasing range of motion  Stimulate peripheral nerves for the purpose of providing pain relief  Stimulate motor nerves for the purpose of muscle rehabilitation EMS devices should only be used under medical supervision for adjunctive treatment of medical diseases and conditions. Medicine: It’s a noble profession, It serves humanity 19
  20. 20. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 20 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 2.0 PHYSICAL THERAPY FOR OSTEOPOROSIS TREATMENT: 2.1 OSTEOPOROSIS: Is a condition characterized by progressive loss of bone density, thinning of bone tissue and increased vulnerability to fractures. Osteoporosis may result from disease, dietary or hormonal deficiency or advanced age. Regular exercise and vitamin and mineral supplements can reduce and even reverse loss of bone density. Both the diagnosis of osteoporosis and a bone fracture can have a paralyzing effect: You might find that you are scared to engage in activities that could potentially cause a new fracture or injury. Fortunately, following a rehabilitation treatment plan outlined and supervised by a physical therapist can not only getting you back on your feet, but also help you feel confident about doing so. 2.1.1 OSTEOPOROSIS TREATMENT: ADVANTAGES OF PHYSICAL THERAPY: “If a person is afraid of falling or they are afraid of having another fracture, that’s a specific time when they need to get to a physical therapist (physical therapy) because a physical therapy can help divide the world into very safe activity and activity that is more likely to cause a fracture”. “Physical therapists can help provide people to be maximally active in a safe way. And that is what will prevent future fractures.” While many patients receive most of their osteoporosis management information from their family doctor, not all doctors are aware of the role that physical therapists can play in rehabilitation and management of osteoporosis symptoms Physical Therapy. Patients may have to ask directly about some of the services they need as part of their rehabilitation. Medicine: It’s a noble profession, It serves humanity 20
  21. 21. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 21 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 2.2 OSTEOPOROSIS TREATMENT: 2.2.1 PHYSICAL THERAPY REHAB AFTER A FRACTURE:  For many people, their first experience with osteoporosis comes by way of a fracture to the spine, hip, wrist, or ankle from an impact that would not have caused injury in earlier years. Even rolling over in bed can cause vertebral (spinal) fractures for some people,.  At this point, rehabilitation focuses on pain management immediately after the fracture, and then on returning to an active lifestyle as the fracture heals.  “For both wrist and hip fractures there is a lot of evidence that people don’t return to full function unless they go to physical therapy after the sub acute phase (about six Weeks after injury)”. Medicine: It’s a noble profession, It serves humanity 21
  22. 22. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 22 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Studies show six months of progressive resistance exercises done three times a Week and supervised by a physical therapist provide the best outcomes for patients with hip fractures. Meeting with a physical therapy once a Week and then doing recommended exercises in a fitness facility as an alternative. Supervision by a trained physical therapist helps to prevent additional fractures, so be especially cautious when exercising on your own. A physical therapist can also help you to find the best fitting assistive device, such as a cane or walker to use during your healing period. “After a fracture, you might not need to use one for a long time, but a cane or walker can keep up your fitness during recovery and also reduce pain”. Pict:16 Activities of daily living can be very difficult to manage alone after this disabling injury. The patient often needs assistance walking and managing stairs. Studies show that patients who are able to return home after a hip fracture have better results than those who go to a skilled nursing facility or nursing home. And there are fewer deaths among patients who receive home care physical therapy after a hip fracture. The current status of home care physical therapy includes active range of motion exercises and functional training activities. These training activities include moving in bed (rolling over, sitting up), getting in and out of bed, and tub or shower transfers. Balance and safety training are also included. Some therapists add stretching and resistance training. Balance training, some, but not all, therapists included breathing exercises, and aerobic conditioning. The next step is to identify treatments that lead to the best results or outcomes for home physical therapy after hip fracture. Some studies already show that exercise with resistance is needed. With this added feature of the treatment program, mobility disabilities may be decreased. Specific exercises and the intensity, frequency, and duration of the chosen exercises remain to be determined. Medicine: It’s a noble profession, It serves humanity 22
  23. 23. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 23 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 2.2.2 EMOTIONAL REHAB: Another element of rehabilitation is managing the emotional impact of fractures and breaks. Therapists, social workers, and osteoporosis support groups can help you cope with the fear and grief that accompany osteoporosis-related life changes and loss of independence. 2.2.3 PHYSICAL THERAPY REHAB BEFORE A FRACTURE: Injury prevention is a part of rehabilitation, and ideally people with osteoporosis should work with a physical therapist before they experience an injury, says Shipp. If your doctor has diagnosed you with osteoporosis, you should start making the changes that will prevent an injury now. Such changes include:  Learning how to lift items without using your back  Learning how to move without twisting your spine  Implementing fall prevention strategies at home, work, and on the go  Identifying exercises that can keep you safely active  Asking for help with tasks that require lifting heavy items or climbing  Preventing fractures before they happen is obviously best. But if you do suffer a fracture, healing properly and getting advice on how to prevent another one are going to be even more important, and that’s where a physical therapist can be your best ally. Pict:18 Medicine: It’s a noble profession, It serves humanity 23
  24. 24. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 24 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 3.0 PHYSICAL THERAPY FOR CANCER: Common patient types referred for physical therapy:  Leukemia/Lymphoma Patients may be Weak from abnormal blood counts and/or from cancer treatments. The following services are offered:  Strength training – gently according to SCCA blood value guidelines  Cardiovascular and stretching education  Safety and fatigue management Pict:19 3.1 MULTIPLE MYELOMA: Patients often have disease spread to multiple bones upon diagnosis. Careful, tailored exercise is important to help maintain function, quality of life and to gently enhance the non-cancerous portions of the bone. The following services are offered:  Strength training – gently strengthening the muscles surrounding the bones help provide increased bone strength and stability to decrease the risk of falls, fractures or pain.  Cardiovascular and stretching training  Spinal bracing to assist proper healing and pain relief  Safety management  Pain management Medicine: It’s a noble profession, It serves humanity 24
  25. 25. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 25 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 3.2 BONE MARROW TRANSPLANT/PER IPHERAL BLOOD STEM CELL TRANSPLANT: Pediatric and adult patients should exercise as much as possible prior to the transplant in order to maximize function and strength. Exercise before, throughout and after the transplant is critical to decrease the possibility of complications such as severe muscle atrophy, infections, falls and depression. The following services are offered:  Strength training – gently according to SCCA blood value guidelines  Cardiovascular and stretching training  Safety and fatigue management Pict:21 3.3 LONG-TERM FOLLOW-UP PATIENTS Patients with chronic Graft Versus Host Disease (GVHD) often return to the SCCA for continued management of symptoms and medications. The following services are offered:  Range of motion stretching exercise  Strength training  Cardiovascular exercise education  Fatigue management Pict:22 Medicine: It’s a noble profession, It serves humanity 25
  26. 26. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 26 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 3.4 BREAST CANCER: All patients who have had a mastectomy and/or axillary lymph node dissection are automatically referred to a physical or occupational therapist specializing in breast cancer. Patients who have had a lumpectomy may also have rehabilitation needs. PT’s offer the following services: Pict:23  Radiation precaution education  Overall shoulder stretching, strengthening, and cardiovascular conditioning programs  Lymphedema risk reduction education  Baseline arm girth measurements  Assessment for Axillary Web Syndrome (cording)  Scar tissue work Medicine: It’s a noble profession, It serves humanity 26
  27. 27. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:005 Revision: 01 Page: 27 of 74 PHYSICAL THERAPY MANAGEMENT OF GERIATRIC AND AGED CONDITIONS NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 3.4.1 FOR LYMPHEDEMA TREATMENT, PT’s OFFER THE FOLLOWING SERVICES: 1. Management with compression bandaging Pict:25 2. Manual lymph drainage Pict:26 3. Lymphedema exercises Pict:27 Medicine: It’s a noble profession, It serves humanity 27

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