Guide To Physical Therapist Practice Revised 2nd Edition Pdf Download

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... Accordingly, a higher level of clinical decision-making is required of physical therapists in order to determine the appropriate management of patients who present in a direct-access setting. The importance of higher-level clinical decision-making is also supported in the 'Guide to Physical Therapist Practice' [3], which discusses physical therapists' responsibility to determine appropriateness for potential referral to another healthcare provider based on examination findings. The referral patterns of physical therapists to other healthcare providers for various medical conditions, including low back pain (LBP)-related disorders, have been examined in several studies [4][5][6][7][8]. ...

Background There is a lack of consensus for optimal management of patients with foot drop due to acute lumbar disc herniation (LDH) with lumbar radiculopathy (LR), which is a clinical scenario that may be encountered by physical therapists. Consequently, it is important to explore physical therapists' referral practice patterns for surgical consult. Currently, physical therapist referral patterns for surgical consult in this patient population are unknown. Objectives To describe physical therapist referral patterns for immediate neurosurgical consult in patients with foot drop due to suspected acute LDH with LR. Design Cross-sectional descriptive research design using an electronic, internet-based survey that utilized two clinical vignettes. Method An electronic survey was developed by an expert peer review panel. Survey participants were licensed physical therapists in the United States and members of the Orthopedic Section of the American Physical Therapy Association. Results Of the individuals receiving the survey invitation, 2172 completed the survey. Depending on the severity of foot drop, 34–61% were likely to refer for immediate neurosurgical consult. Presence of imaging to confirm suspected clinical diagnosis slightly affected the likelihood of referral (4–12% increase) for immediate neurosurgical consult. Conclusion In patients with foot drop due to suspected acute LDH with LR, this study found that physical therapist referral patterns for immediate neurosurgical consult varied and are likely influenced by the severity of weakness and availability of MRI findings. Further research regarding the optimal management of this patient population and potential reasons for variation in practice is warranted.

... The tasks performed are designed according to the recovery plan and imply repetitions where the therapist needs to evaluate the exercise both qualitatively and quantitatively. This process is usually intensive, time consuming, dependent on the expertise of the therapist, and implies the collaboration of the patient who is usually asked to perform the therapy multiple times at home with no supervision [1] [5]. ...

We present new solutions based on Virtual Reality technologies for improving the delivery of physical therapy and rehabilitation. Three main aspects are addressed: 1) the ability to allow therapists to cre-ate new exercises and therapy programs intuitively by direct demon-stration, 2) automatic therapy delivery and monitoring with the use of an autonomous virtual tutor that can monitor and quantitatively assess the motions performed by the patient, and 3) networked col-laborative remote therapy sessions via connected applications dis-playing the motions of both the therapist and the patient. We also provide 3D assessment tools for monitoring changes in the range of motion, and for allowing the visualization of a number of properties during or after the execution of exercises. The pre-sented system has been implemented for a low-cost hardware solu-tion based on Kinect and for a high-end immersive virtual reality facility.

... Among the nonoperative treatment approaches that are recommended in a rehabilitation program for PFPS are the therapeutic modalities.3,4,10,15,16,20,27 In addition, the American Physical Therapy Association's Guide for Physical Therapist Practice2 recommends the use of therapeutic modalities for a variety of musculoskeletal conditions, including PFPS. ...

• David Allen Lake
• Nancy H Wofford

Patellofemoral pain syndrome (PFPS) is a common orthopaedic condition for which operative and nonoperative treatments have been used. Therapeutic modalities have been recommended for the treatment of patients with PFPS-including cold, ultrasound, phonophoresis, iontophoresis, neuromuscular electrical stimulation, electrical stimulation for pain control, electromyographic biofeedback, and laser. To determine the effectiveness of therapeutic modalities for the treatment of patients with PFPS. In May and August 2010, Medline was searched using the following databases: PubMed, CINAHL, Web of Science Citation Index, Science Direct, ProQuest Nursing & Allied Health, and Your Journals@OVID. Selected studies were randomized controlled trials that used a therapeutic modality to treat patients with PFPS. The review included articles with all outcome measures relevant for the PFPS patient: knee extension and flexion strength (isokinetic and isometric), patellofemoral pain assessment during activities of daily life, functional tests (eg, squats), Kujala patellofemoral score, and electromyographic recording from knee flexors and extensors and quadriceps femoris cross-sectional areas. Authors conducted independent quality appraisals of studies using the PEDro Scale and a system designed for analysis of studies on interventions for patellofemoral pain. TWELVE STUDIES MET CRITERIA: 1 on the effects of cold and ultrasound together, ice alone, iontophoresis, and phonophoresis; 3, neuromuscular electrical stimulation; 4, electromyographic biofeedback; 3, electrical stimulation for control of pain; and 1, laser. Most studies were of low to moderate quality. Some reported that therapeutic modalities, when combined with other treatments, may be of some benefit for pain management or other symptoms. There was no consistent evidence of any beneficial effect when a therapeutic modality was used alone. Studies did not consistently provide added benefit to conventional physical therapy in the treatment of PFPS. None of the therapeutic modalities reviewed has sound scientific justification for the treatment of PFPS when used alone.

Background and purpose: The APTA recently established a vision for physical therapists to transform society by optimizing movement to promote health and wellness, mitigate impairments, and prevent disability. An important element of this vision entails the integration of the movement system into the profession, and necessitates the development of movement system diagnoses by physical therapists. At this point in time, the profession as a whole has not agreed upon diagnostic classifications or guidelines to assist in developing movement system diagnoses that will consistently capture an individual's movement problems. We propose that, going forward, diagnostic classifications of movement system problems need to be developed, tested, and validated. The Academy of Neurologic Physical Therapy's Movement System Task Force was convened to address these issues with respect to management of movement system problems in patients with neurologic conditions. The purpose of this article is to report on the work and recommendations of the Task Force. Summary of key findings: The Task Force identified 4 essential elements necessary to develop and implement movement system diagnoses for patients with primarily neurologic involvement from existing movement system classifications. The Task Force considered the potential impact of using movement system diagnoses on clinical practice, education and, research. Recommendations were developed and provided recommendations for potential next steps to broaden this discussion and foster the development of movement system diagnostic classifications. Recommendations for clinical practice: The Task Force proposes that diagnostic classifications of movement system problems need to be developed, tested, and validated with the long-range goal to reach consensus on and adoption of a movement system diagnostic framework for clients with neurologic injury or disease states.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A198).

Ultrasound (US) waves have shown promising therapeutic outcomes for different wounds. High penetration into the wound bed, highly steering and focusable and not approved harmful effects are the main advantages of US treatment for wounds. In addition to antimicrobial effects, triggering wound-healing physiological mechanisms are among the mechanisms of action of US in wound healing. Despite of rigorous evidence on the therapeutic efficiency of US in different and particularly chronic wounds, no definite dose-response existed on the clinical trials applications of this technique. However, there is a consensus on the spatial average temporal average dosage in the range of 0.5 W/cm2 to 3 W/cm2 with significant therapeutic outcomes and minimum adverse effects. Further in vitro and clinical trials are needed to shed light on the exact mechanisms of action and dose-response of US techniques for different wounds.

Background: Physiotherapy has a very important role in the maintenance of the integumentary system integrity. There is very few evidence in humans. Nevertheless, there are some studies about tissue regeneration using low-level laser therapy (LLLT). Aim: To analyze the effectiveness of LLLT on scar tissue. Methods: Seventeen volunteers were stratified by age of their scars, and then randomly assigned to an experimental group (EG) - n = 9 - and a placebo group (PG) - n = 8. Fifteen sessions were conducted to both the groups thrice a week. However, in the PG, the laser device was switched off. Scars' thickness, length, width, macroscopic aspect, pain threshold, pain perception, and itching were measured. Results: After 5 weeks, there were no statistically significant differences in any variable between both the groups. However, analyzing independently each group, EG showed a significant improvement in macroscopic aspect (p = 0.003) using LLLT. Taking into account the scars' age, LLLT showed a tendency to decrease older scars' thickness in EG. Conclusion: The intervention with LLLT appears to have a positive effect on the macroscopic scars' appearance, and on old scars' thickness, in the studied sample. However, it cannot be said for sure that LLLT has influence on scar tissue.

• Eilish Byrne
• Suzann Campbell

ABSTRACT This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert therapists, with supporting evidence cited. Assessment in the NICU begins with a thorough review of the health care record. Assessment proceeds by using the least invasive methods of gathering the behavioral, developmental, physiologic, and musculoskeletal information needed to implement a physical therapy plan of care. As the neonate matures and can better tolerate handling, assessment methods include lengthier standardized tests with the psychometric properties needed for informing diagnosis and intervention planning. Standardized tests and measures for screening, diagnosis, and developmental assessment are appraised and special considerations for assessment of neonates in the NICU are discussed.

• Vanessa Maziero Barbosa

ABSTRACT Medical and technological advances in neonatology have prompted the initiation and expansion of developmentally supportive services for newborns and have incorporated rehabilitation professionals into the neonatal intensive care unit (NICU) multidisciplinary team. Availability of therapists specialized in the care of neonates, the roles of rehabilitation professionals, and models of service delivery vary from hospital to hospital based on philosophy, resources, and other considerations. To provide quality care for infants and families, cohesive team dynamics are required including professional competence, mutual respect, accountability, effective communication, and collaboration. This article highlights the contribution of each member of the NICU team. The dynamics of team collaboration are presented with the goal of improving outcomes of infants and families.

The purpose of this case report is to describe attempts to prevent skin-related adverse events from occurring and protect the skin once breakdown occurred in a person with chronic stroke during locomotor training. There is scant literature in how to address skin during locomotor training with the Lokomat®, particularly when a patient presents with sensory deficits and frail skin. The patient was a 75-year-old male survivor of stroke who participated in the Lokomat® group of a randomized clinical pilot study comparing locomotor training with the Lokomat® and conventional means. He had diminished sensation to light touch and proprioception on his left leg with skin on both lower legs presenting as thin, flaky, and virtually hairless. Although much effort was put towards prevention of skin breakdown, he developed numerous skin-related adverse events during his training. However, his skin healed completely with reduced training intensity and initiation of "pre-wrapping" his lower legs with Akton® viscoelastic polymer sheets and elastic bandages. Significant improvements were noted in his Functional Improvement Measure™ locomotion score and Stroke Impact Scale domains of strength, participation/role function, and total recovery, though not in his 10-m walk test velocity or 6-min walk test. The Akton® sheets and team approach between study team, patient, and his wife allowed simultaneous safe continuation of locomotor training with the Lokomat® and healing of his skin breakdown.

• Deepak Sebastian

Radicular pain in the upper extremity can have a cervical origin terminating at the cervicothoracic junction (C8, T1). Review of the literature suggests cutaneous representations of T2 nerve root to the axilla, posteromedial arm, and lateral forearm, suggesting yet another source of upper extremity radicular pain. A 53-year-old female experienced insidious right upper thoracic pain radiating into the right axilla, upper arm, and lateral forearm (10/10 numerical pain rating scale (NPRS)) of 1-week duration. Medical referral suggested cervical radiculopathy, however, cervical spine examination was unremarkable. She presented with mechanical dysfunction of C8, T1; T1, T2; and T2, T3 vertebral segments with restricted cervical extension. Firm compression over the right lateral aspect of the second and third thoracic vertebrae reproduced her symptoms markedly. There was a predominance of right axillary pain. Cervical extension reproduced local upper thoracic pain. Nine treatment visits for a period of 3 weeks addressed mechanical dysfunction at the cervicothoracic junction and upper thoracic region, comprising manual therapy, corrective exercise, and pain modalities. Reduction of local tenderness, and radiating axillary and right arm pain was observed (2/10 NPRS), with improved cervical extension. The second thoracic intercostal nerve and the adjoining intercostobrachial nerve, medial antebrachial cutaneous nerve, and the posterior brachial cutaneous branch of the radial nerve are speculated to be potential symptom mediators. They have a representation to the axilla, medial and posterior arm, and lateral forearm - a representation supporting the speculation of upper extremity radicular symptoms following mechanical dysfunction of the upper thoracic vertebrae.

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