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WHY, WHO, WHAT AND HOW
Why?
Immobilized extremities quickly lose their functional abilities
through disuse of muscle, bone and joints. The muscle mass
decreases and strength decreases. Without weight-bearing stresses,
bone loses mineral content and becomes more vulnerable to fracture.
Joint motion is necessary for nutrition of the articular cartilage;
if joints are immobilized for long periods, fibrous tissue
bridges will begin to develop across the joint surfaces.
The goal of physical therapy is to prevent these changes and
to keep the musculoskeletal system functional while waiting
for the injured bone, muscle or ligaments to heal. Other organ
systems also clearly benefit from early functional return:
maintaining normal mobility helps to prevent venous thrombosis
and pressure sores and enhances pulmonary function.
Who should provide this care?
All care providers should be familiar with the concepts and
basic techniques of physical therapy. If a trained physical
therapist is available, that person should direct the therapy,
but often there will be a need for other providers to participate.
If there is no therapist available, other care givers should
assume the responsibility. These might include:
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Physical
therapy aide |
| :: |
Nurse |
| :: |
Physician |
| :: |
Medical
assistant |
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Patient’s
family. |
The
patient and family members should be taught how to perform
the necessary functions and be provided with clear written
instructions. Ultimately, it is the motivation of the patient
that will determine the outcome.
What materials are necessary?
Expensive equipment is not essential. Most materials can be
gathered locally or be made by a carpenter from available supplies.
Basic equipment includes:
| :: |
Overhead
bed frame: needed on some beds, especially if using traction |
| :: |
Crutches
and walkers: a ready supply is required |
| :: |
Foam,
inner tube or other padding: for use with patients in
traction to prevent pressure sores |
| :: |
Weights:
free weights for extremity strengthening. |
How
should therapy be performed?
Techniques vary with the injury and with the ability of the
patient to perform certain tasks. Begin a range of motion and
strengthening on the affected extremity as the injury permits.
This will change as healing progresses, and is described for
specific injuries in Unit 18: Orthopaedic Trauma. Begin motion
and strengthening of uninjured extremities as soon as possible.
Techniques
Techniques are classified as:
| :: |
Active:
the patient moves the extremity with or without resistance |
| :: |
Active
assisted: the patient moves the joint with help from
the therapist |
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Passive:
the therapist alone moves the joint. |
Active
and active assisted therapy are preferable in most cases.
Isometric exercise
Isometric exercise involves muscle contraction without joint
motion and is useful across injured joints to keep the muscles
functioning.
Motion with gravity
Motion with gravity allows the extremity to be dependent,
unweighting the joint and allowing motion with little stress
on the bone. It works well for shoulder injuries (see pages
18–2 to
18–3).
Assisted walking
| :: |
With
a cane, crutches, walker or stick |
| :: |
The
amount of weight placed on the extremity is classified
as:
| • |
Non-weight
bearing: the extremity is held off the ground |
| • |
Touch
down: the weight of the limb only is rested on
the ground, causing less force across the hip area
than non-weight bearing |
| • |
Partial
weight bearing: placing part of the body weight
on the limb, part on an assistive device and varying
the proportions of weight as the injury heals |
| • |
Full
weight bearing: the assistive device is used for
balance and in case of emergency. |
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Physical therapy keeps the musculoskeletal
system functional while the injured bone, muscle or ligament
heals
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Restoring
movement early in the healing process helps to prevent
venous thrombosis and pressure sores and enhances pulmonary
function.
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