Role of Physiotherapy in Hospital - Dr Rohit Bhaskar

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ROLE OF PHYSIOTHERAPY
IN HOSPITAL
©2020 Rohit Bhaskar PT
Whatsapp - +919026742838
https://www.pt-pedia.com/

What is physiotherapy ?
• Physiotherapy, is a physical medicine and
rehabilitation specialty that, by using mechanical
force and movements, remediates impairments
and promotes mobility, function, and quality of life
through examination, diagnosis, prognosis, and
physical intervention.
• It is performed by physical therapists

PHYSICAL THERAPY
Physical therapy is the use of physical
methods and agents in the treatment of the
disease, impairment, disability and
handicap

Goal of Physiotherapy
• Determine the patient’s functional loss
• Estimate functional potential
• Implement a plan to progress from measured loss to full
potential
• To improve quality of life
• To listen ‘actively and positively’ with an awareness of
priorities as determined by the patient
• Achieve the best possible quality of life for patients and
their families
• Availability as a resource for patient and families

AIM of physiotherapy
• Prevent muscle shortening & joint contractures
• Influence pain control
• Educate in all aspects of physical function
• Education and participation ofthe carer
• Treat the patient with dignity – allowing them to
“live until they die”
• Build a relationship of confidence and trust

AIM of Physiotherapy
• Assess and optimise the patient’s level of
physical function
• Take into consideration the interplay
between the physical, psychological, social
and vocational aspects of function
• Understand the patients underlying emotional,
pathological and psychological condition,
• Focus is the physical and functional
consequences of the disease
and/or its treatment, on the patient.

AIM of Physiotherapy
• Restore the patient’s sense of self
• Facilitate and optimise the patient's ability to
function with safety and independence in the face
of diminishing resources.
• Maintain optimum respiratory & circulatory function
• Listen to patient
• Set realistic goals with the patient

STAGES OF PHYSIOTHERAPY
• Preventive
• Restorative
• Supportive
• Palliative

Preventive
• Aims at restricting or inhibiting the
development of disability in the course ofthe
disease or treatment before disability occurs
• Education for patient and families
commencing immediately after diagnosis
• Mobility and exercise programs.
• Availability of therapist as a resource for
patients and families

Restorative
• Rehabilitation is the objective when no or little
residual disability is anticipated for some time and
patients are expected to return to normal living
styles
• Encouragement, education and treatment in
achieving physical, work and lifestyle goals
• Specific treatments as required

Supportive
• Enhance independent functioning
when residual cancer is present and
progressive disability is probable
• Encouragement, education and
treatment in achieving physical, work
and lifestyle goals
• Availability of therapist as a resource

Palliative
• Primarily directed at promoting maximum
comfort
• Maintaining the highest level of function
possible in the face of disease
progression and impending death

Which patients groups benefit from
physiotherapy ?
• Cardiac patients
• Orthopaedic
patients
• Amputees
• General surgical
• Neurological
• Elderly
• Learning
disabilities
• Psychiatric
• Palliative care
• Respiratory
• Paediatric
• Rheumatology
• Musculo-skeletal
• Occupational
• Spinal injuries
• Obstetrics
• Gynaecological
• Burns and plastics

ROLE OF PT IN
ICU

Goals of PT in ICU
1. Improve / maintain normal or baseline
ventilation and oxygenation
2. Improve / maintain musculoskeletal system
within functional limit
- Improve range of motion
- Improve muscle strength and endurance
- Prevent joint deformities and contractures

Goals contd...
3.Improve circulatory system function
4.Improve / maintain neurological system and
cognitive status within the functional limits.
5.Improve / maintain level of functional
status within patient tolerance

Exercise plays a critical
role in recovery and
wellness during and
after cancer.
Exercise in cancer

Benefits of Exercise
 Reduces your risk of heart disease, high blood
pressure, osteoporosis, diabetes and obesity
 Keeps joints, tendons and ligaments flexible
 Reduces some of the effects of aging
 Contributes to your mental well-being and helps treat
depression
 Helps relieve stress and anxiety
 Increases your energy and endurance
 Helps you sleep better
 Helps you maintain a normal weight by increasing your
metabolism

Benefits of Exercise Specific
to Breast Cancer
•Decreased Risk of Recurrence
•Decreased Fatigue / Anemia
•Decreased Severity of Nausea
•Maintenance of Bone Mineral Density
•Improved Body Composition
•Increased Quality of Life
•Reduction of Lymphedema
•Prevention of Lymphedema

Benefits of the chest physiotherapy in IPD
• To prevent hospital acquired pneumonia.
• It takes out the secretions, clear the chest and
improves breathing without medication.
• Increases levels of oxygen in the blood.
• Promotes expansion of the lungs.
• Strengthen respiratory muscles.
• Makes the chest area better visible through an
X- ray.

Indication of CPT
• Prophylactic
• Pre-operative high risk surgical patient
• Post-operative patient who is unable to
mobilize secretions
• Neurological patient who is unable to cough
effectively
• Patient receiving mechanical ventilation
who has a tendency to retain secretions
• Patients with pulmonary disease, who needs to
improve bronchial hygiene

Patient at risk of nosocomial infections
• There are patient, therapy and environment related risk factors for the
development of nosocomial infection.
• Age more than 70 years
• Shock
• Major trauma
• Acute renal failure
• Coma
• Prior antibiotics
• Mechanical ventilation
• Drugs affecting the immune system (steroids, chemotherapy)
• Indwelling catheters
• Prolonged ICU stay (>3 days).

Immuno-compromised patients
Immunocompromised people, like people
undergoing treatment for cancer, leukemia,
lymphoma, HIV, and patients on
immunosuppressive drugs are at an increased
risk of developing chest infection, decrease
mobility , swelling, joint pain. Others who are at
a higher risk include patients who have had a
transplant, or are under a lot of stress.

• Muscles weakness
• Low immunity
• Low bone density
• Cardiopulmonary weakness
• Poor Balancing
• Risk of fall
• These all increased during hospital stay
Geriartric patients

Kidney disease and physiotherapy
Kidney diseases are associated with an increased
risk of functional impairment, independent
ofage, gender, and co-morbidities. Clinicians should
counsel patients with CKD including
frail elder people to increase physical activity levels
and target that regular physical activity
including aerobic or endurance exercises training
benefits health

Physiotherapy in Gyn.&obs.
During the whole period of pregnancy
women’s body undergoes various physical and
physiological changes. Due to the change
during and after pregnancy common problems
faced by the women’s are low back pain, stress
urinary incontinence, pelvic pain.
Physiotherapy can help in this through postural
reeducation, strengthening of pelvic floor
muscles and through some modalities

Suggested sequence of exercise.
• General rhythmic activities to warm-up.
• Gentle selective stretching
• Aerobic activities for CVS conditioning
• UL &LL strengthening ex.
• Abdominal ex
• Pelvic floor ex.
• Relaxation /cool down activities
• Educational information [if any] &
postpartum ex. Education.

Selected exercise techniques
• Postural exercise.
• Abdominal exercise
• Stabilization exercise
• Pelvic motion training & strengthening.
• Modified UL & LL strengthening.
• Perineum &adductor flexibility.
• Relaxation &breathing exercise

Physiotherapy in the PICU

PMs and stretching
Splinting
Muscle strengthening
Movement reeducation
Improve ex tolerance
Clear secretions
Reexpand
collapsed lobes
Improve V/Q
matching
Weaning
Developmental
stimulation
Positioning
Thoracic mobility
Prevent
deformities
Rehabilitation
Respiratory
Physiotherapy

PHYSIOTHERAPY IN
CARDIOLOGY

Aims of Cardiac Rehabilitation
• To restore him to self reliance in
daily active life.
• To restore him to formal work
activities
• To prepare him for another full
time employment compatible
with his working capacities.

Phase–I of Cardiac Rehabilitation
This begins when the patient is admitted to the
hospital and ends on discharge, which is usually 7
to 10 days.
Aim
•To prevent accumulation of secretion in the lungs.
•To prevent Deep Vein Thrombosis.
•To prevent bed sores.
•To teach and encourage relaxation.
•To train postural awareness strengthening trunk and
leg muscles

Day 1 to 2
• Humidification, Vibration, Postural drainage
and Breathing exercise.
• Passive exercises –ankle/toe exercises–Active
movements limited to 5 repetitions. Positioning
of the patient to prevent bed sores.
• Activities allowed are bed side commode,
self feeding, partial self care and mostly bed
rest and supported sitting.

Day 3 to 4
• Continue all of above, number of repetitions can be
increased to 10.
• SLR (straight leg raising) can be started– repeat 5 times.
• Sitting in a chair 5–10 minutes.
• Partial self–care, taking bath in sitting, position by sitting
on a high stool.
• Isometric activities can be started.
• SLR repetition can be increased to 10.
• Walking 5–10 minutes.
• Sitting and self feeding in a chair

Physiotherapy in Surgical Conditions
1.Preoperative care
2.Physiotherapy for Post–Operative Care
• Prevention of chest complications
• Prevention of thrombosis
• Prevention of pressure sores
• Prevention of muscle wasting and joint
immobility
• Education of positioning ,posture & gait
training.

Physiotherapy in Burns
• Respiratory Care
• Prevention of Contractures and Deformities
• Positioning
• Head and Neck
• Lower limbs
• Splinting (Splints may be static or dynamic)

Cont...
• Exercises
• Muscles strength
• Flexibility
• Regaining maximum function
• Out-patient physiotherapy
• Graft PT if grafted

THANK YOU

Role of Physiotherapy in Hospital - Dr Rohit Bhaskar

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