THE IMPORTANCE OF TEAM WORK In many cases therapeutic treatment cannot succeed without the cooperation of nursing staff.

For example, it is futile for an elderly or handicapped patient to attend the physiotherapy department several times a day for exercise sessions or to begin to learn to walk if for the remainder of the day he / she is simply left in bed, or worse still, left to sit in a chair. Constant cooperation between the physiotherapist and the nurse is required so that physiotherapy tretment is supported by purposeful activity in the ward. In addition there are patients whose physiotherapy must be timed to fit in with nursing treatment, as for example in patients suffering from spinal cord injuries and often for the chest as well, then physiotherapy is carried out when the patient is turned. Other patients requiring close cooperation between nurses and physiotherapists are those with chest injuries or with thoracotomy or tracheostomy, especially those requiring special chest manipulations to loosen secretions which are then removed by suction. Children require special consideration and their treatment must often be timed not only to fit in with nursing programmes but with their education too. Explanation of words and phrases Staff a group of people, employees, working together (eg. Hospital staff) Succeed get desired results, finish something as wished, have success Futile incapable of having results, useless Remainder of the day the rest of the day Require to need, demandm order In addition to as well as, besides Fit in suitable, corresponding Spine backbone Cord rope, string Spinal cord inner soft part of the backbone Limb extremity, a leg or an arm Injury damage or harm on the bidy, a wound Loosen to undo, set free, relieve (as sputum by coughing or so) Match the following words with the definitions bellow : purposeful, session, handicapped, treatment, futile, limb, cooperation 1) 2) 3) 4) 5) 6) 7) management in application of medicines or surgery etc. TREATMENT A working together, assistance of another person or organization COOPERATION A period of time during which people meet for a special activity SESSION Having an aim, having a special meaning PURPOSEFUL Physically and mental disabled HANDICAPPED Part of a member of a body, as a leg, arm, or a wing in birds LIMB Useless, not successful FUTILE

Answer the following questions 1) 2) 3) 4) 5) 6) 7) How should physiotherapeutic treatment be organized? Why is team work necessary? Name four types of exercises. In which cases are they used? In which exercises may mechanical devices be applied? Name some devices. Why do children require special consideration? What should be removed by suction? Name all the members of the team cooperating in the rehabilitation of a physiotherapy patient. 8) Name at least three cases which may probably require physiotherapeutic treatment. 9) Explain the purpose of physiotherapy. 10) What kind of measurements that are essential in physiotherapy may include documentation 11) Name types of physiotherapy treatments / interventions POSSIBLE ANSWERS: 1) Physiotherapeutic treatment should be organized with the cooperation of nursing staff. 2) Team work is necessary so that physiotherapy tretment is supported by purposeful activity in the ward. 5) children require special consideration because their treatment must often be timed not only to fit in with nursing programmes but with their education too. 6) Secretions should be removed by suction.

3) The type of physiotherapy exercises:

There are three types of ROM exercises: passive, active assistive, and active range of motion exercises. Passive range of motion exercise (PROME) In PROME, the physiotherapist will move your limb along the joint range. This is often performed on patients who are unable to move their limb. Active-assistive range of motion exercise (AAROME) This range of motion exercise is done on clients who are able to move their limb but needs assistance from the physiotherapist to complete the joint range. Sometimes, pain may limit the patients ability to actively complete the motion. The physiotherapist may assist the patient to complete the movement or just beyond the point of pain. The pain should not persist or worsen when motion is stopped. In this type of ROM exercise, there is minimal assistance from the physiotherapist. Active range of motion exercise (AROME) The client performs the movement without physical assistance from the therapist. The physiotherapist may still verbally instruct the client on the proper execution of the exercise. Strengthening exercises Strengthening exercises are usually done on weakened muscles. It may also be done as part of the clients general conditioning exercise program. Having normal muscle strength help prevent future injury. When muscles are not moved for a while because of an injury or immobilization (cast or brace), the muscles tend to get weak. Often, progressive strengthening exercises are included in your rehabilitation program. Your physiotherapist may let you perform the exercises with resistance bands and progress to weights as your strength improves. General conditioning exercises General conditioning exercises involve a combination of exercises including range of motion, strengthening, and walking exercises to help maintain or improve your - Cardiopulmonary fitness; - Muscle and joint flexibility; and - Muscle strength. Balance exercises Balance exercises may be a part of your rehabilitation program if you have problems with your balance. Strengthening your major muscles are important parts of a balance rehab program. Depending on your specific needs and level of fitness, your physiotherapist may start from where you are most stable. For example, if you can sit without support, your therapist may suggest that you do balance exercises using parallel bars. Once you are able to do the exercises easily, you may start doing them without parallel bars.

4) A physical therapist, also known as physiotherapist, may give therapy manually as well as by using either mechanical or electrical equipment to aid in therapy and support the recovery process of his patients. The physiotherapy equipment works on reducing the pain besides healing and joints and muscles. Certain equipment also makes the patient comfortable during the visit to the physiotherapist. While physiotherapy chair, couch, bed and table are some of the common physiotherapy equipment, a cushioned flat bench with head support that is also cushioned and adjustable sections ranging from two to seven in number, is also used. The purpose of these sections is that they are adjustable and the patient can lie down on the stomach or on the back, as required. It can also be folded into various degrees to serve as a chair or an exercise table. This equipment lets the physiotherapist make the patient comfortable during examination and diagnosis. The same equipment is also used during exercises that have to be performed by the patient and during massage therapy. Weights to exercise hands and legs, exercise balls, and elastic bands are also a part of physiotherapy equipment. A large ball filled with air and attached to a small stool set on rollers with back support id used for exercises that require support. It enables to contain strain that would otherwise be felt on the spine and back. Physiotherapy equipment, such as Transcutaneous Electrical Nerve Stimulation, also called TENS is used to decrease acute and chronic pain. TENS provides short-term relief for pain without having to resort to medication, narcotics, or injections. This machine generates tiny electrical impulses that are sent to the nerves. These electrical pulses block the pain signals from reaching the brain. It is believed that they increase the quantity of endorphins generated by the brain. Portable models of this equipment are available in the form of handheld devices that are battery operated. Equipment used to conduct ultrasound and electrotherapy is also important to the physiotherapist. A round handheld wand or probe is used in ultrasound. This device is connected to the patient's body by putting it on the skin with an ultrasound gel. This probe then transmits ultrasonic waves through the skin. This equipment is very useful in delivering medication below the skin, without involving injections. The same equipment can also be useful in generating tissue heat for pain alleviation and muscle relaxation as well as for tissue relaxation by producing a pulse without heat. Ultrasound wands can be attached with a large electronic device further connected to a cart for convenient handling.

7) All the members of the team cooperating in the rehabilitation of a physiotherapy patient
The Case Manager serves as the primary contact for the patient and family. His or her role on the team is to direct the patient's rehabilitation and coordinate with everyone involved in the patient's care. The case manager also provides ongoing communication with the patient, family, attending and consulting physicians, referral sources and insurance companies. In addition, he or she helps patients and families access needed services, and prepare for identify available resources for the return home. Physiatrists are the main medical doctor on the rehabilitation team. A physiatrist is either an M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine) with a specialty in physical medicine and rehabilitation. The physiatrist assesses patients at admission to rehabilitation and directs the patient's medical care, monitoring the course of rehabilitation to help the patient attain optimal function. Your physiatrist stays in contact with your other physicians to address special issues and keep them updated on your rehabilitation progress. The physiatrist makes contact with all patients daily and meets with families as needed during the rehabilitation stay. Nurses and nursing assistants provide the patient with 24-hour-a-day nursing care. Our nurses have specialized training in rehabilitation and provide the patient's daily medical care, support and education. They encourage patients to use techniques learned in therapy. Unlike in other nursing units, rehabilitation nurses encourage patients to do as much of their own care as functionally possible, since the goal is to teach independence and challenge each patient to achieve their maximum potential. Neuropsychologists are clinical psychologists who specialize in studying brain behavior relationships. Neuropsychologists have extensive training in the anatomy, physiology, and pathology of the nervous system. Their role on the rehabilitation treatment team is to address psychological needs and concerns, helping patients and families adjust to changes in their life. They offer assessment, treatment, and consultation and education. Physical Therapists and Physical Therapy Assistants provide assessments, treatment and therapy programs to help patients gain greater mobility, muscle strength and performance, and joint motion and balance. They also work with patients to improve their ability to perform daily activities. Treatment often includes walking, transfers (moving from bed to chair, for example), balance, therapeutic exercise, and cardiovascular endurance training. They recommend and provide training on any assistive devices to improve mobility, such as crutches, canes, walkers, wheelchairs and artificial limbs or braces. Occupational Therapists and Occupational Therapy Assistants work with patients to regain, develop, and build skills that are important for independent functioning, health, well-being and security. Treatment focuses on helping individuals regain greater independence with activities for daily living, often referred to as ADLs. These may include eating, dressing, and personal care. Your occupational therapists may use a variety of activities and tools to improve your strength, movements and motor skills. They will provide training on adaptive techniques or devices as needed, such as one-handed techniques, reachers, dressing aids or environmental modifications. They also will help simulate your home environment or real life situations as part of your therapy. Speech Therapists (also referred to as Speech-Language Pathologists) evaluate speech and language, memory, problem-solving, hearing and swallowing skills in order to develop a treatment plan for improving problems related to a patient's injury or illness. Treatment may focus on expressive language (talking, naming, writing), receptive language (understanding and reading), swallowing, and/or diet recommendations, SSM Rehabilitation Hospital's holistic team approach includes Pastoral Care. Members of the Pastoral Care staff can help patients and families address their hopes and fears in facing recovery and the hard work of rehabilitation, as well as the unique spiritual and emotional needs in reaching their goals. They can help patients and families discover value amidst the personal and physical changes from their injury or illness. Pastoral Care chaplains are available to visit, listen, comfort, and address any spiritual needs, whatever the denomination or preference. They can also help in contact a patient's faith communities or church, and encourage ministers of all faiths to visit at any time during the patient's stay. Dietitians supervise methods of feeding and caloric needs, and monitor feeding tolerance to assure patients receive adequate nutrition.

8) cases which may probably require physiotherapeutic treatment Sprains (e.g. ankle and knee sprain) Muscle strains (e.g. pulled hamstrings) Fractures and dislocations Arthritis (e.g. osteoarthritis and rheumatoid arthritis) Back and neck injuries Multiple sclerosis (MS) Parkinson's disease (PD) Stroke Pediatric conditions (e.g. cerepral palsy, spina bifida) Work-related injuries Sports injuries

9) Physiotherapys purpose is to help the patient regain their range of motion after their body has been injured. Physiotherapy works slowly but is quite effective. For older patients regular sessions of physiotherapy can mean the difference between living independently and relying on assistance. Physiotherapy can be quite effective in improving the quality of life of the elderly giving them more freedom and more ability to conduct their daily lives. 10) Measurements that are essential in your physiotherapy documentation may include: Blood pressure (BP), heart rate (HR), pulse rate (PR) and temperature (To) Joint range of motion Manual muscle tests (MMT) / Testing for baseline muscle strength Other relevant measurements specific for your client's problem. For example, stump measurement for a patient who have had an amputation.

11) types of physiotherapy treatments / interventions Cold Therapy or Cryotherapy Cold therapy is effective in minimizing pain and swelling, especially in acute (immediate) injuries. It may also be used just after deep kneading massage (DKM). Examples of cold therapy are ice pack application and ice massage. Heat Therapy Applying heat can help improve your blood flow especially at the site of injury, thus, speeding up healing. In addition, it can help soften tight tissues and relieves pain. There are several heating modalities and devices available including Hot packs Paraffin wax bath Infrared heat Ultrasound (US) Diathermy

Electrical Stimulation Electrical stimulation is used to prevent muscle atrophy (wasting) in people with paralysis and assist in gaining some degree of muscle strength, such as after a knee surgery. In electrical stimulation, electrodes are placed on the surface of the skin, which can cause muscles to shorten. TENS TENS, or transcutaneous electrical nerve stimulation, is a type of electrical stimulation. It is a small battery-powered device that sends low current through the electrodes place on the skin surface. A TENS device does not cause the muscles to contract, but rather helps temporarily relieve pain. Range of Motion (ROM) Exercises Range of motion exercises are often prescribed to increase or maintain flexibility of your joints and to reduce stiffness. There several types of range of motion exercises often prescribed including the following Passive Range of Motion (PROM) Exercises Active Assistive Range of Motion(AAROM) Exercises Active Range of Motion (AROM) Exercices

Strengthening Exercises Certain conditions can make your muscles to become weak. Strengthening exercises is an important part of physiotherapy rehabilitation to prepare you for your return to your original performance level or highest possible function. Soft Tissue Mobilization Soft tissue mobilization or therapeutic massage may be a part of your physiotherapy treatment to relax your tight muscles, relieve pain and reduce swelling. The following are other physiotherapy treatments. More information will be provided in future topics. Joint Mobilization Gait (Walking) Training / Assistive Device Training Postural Training Ergonomic training Balance Exercises Traction Taping Bandaging Fitting of Orthosis

Another important aspect of physiotherapy rehabilitation is patient / family education. You will learn so much from your physiotherapist about your particular condition, what you can do at home to manage your symptoms, precautions to observe, and repeat injury prevention.