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Duttons Introductory Skills and Procedures For The Physical Therapist Assistant 1St Edition Mark Dutton Full Chapter
Duttons Introductory Skills and Procedures For The Physical Therapist Assistant 1St Edition Mark Dutton Full Chapter
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DUTTON'S
INTRODUCTORY SKILLS and
PROCEDURES for the
PHYSICAL THERAPIST
ASSISTANT
Me
Graw
Hill MARK DUTTON
OUTSTANDING PEDAGOGY
INCLUDES:
400 Color Illustrations
FREE Videos
Evidence-informed practice
and clinical decision-making
Patient positioning and draping
The core concepts of bed
mobility, gait, and transfers
Range of motion and
strength testing
Vital signs assesment
DUTTON'S
INTRODUCTORY SKILLS and
PROCEDURES for the
PHYSICAL THERAPIST
ASSISTANT
Graw
Hill
L
NOTICE
Medicine is an ever-changing science. As new research and clinical
experience broaden our knowledge, changes in treatment and drug therapy
are required. The authors and the publisher of this work have checked
with sources believed to be reliable in their efforts to provide information
that is complete and generally in accord with the standards accepted at the
time of publication. However, in view of the possibility of human error or
changes in medical sciences, neither the authors nor the publisher nor any
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accurate or complete, and they disclaim all responsibility for any errors
or omissions or for the results obtained from use of the information
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DUTTON'S INTRODUCTORY SKILLS
AND PROCEDURES FORTHE
PHYSICAL THERAPIST ASSISTANT
Mark Dutton, PT
ISBN: 978-1-26-426718-7
MHID: 1-26-426718-5
The material in this eBook also appears in the print version of this title:
ISBN: 978-1-26-426717-0, MHID: 1-26-426717-7.
All trademarks are trademarks of their respective owners. Rather than put a
trademark symbol after every occurrence of a trademarked name, we use
names in an editorial fashion only, and to the benefit of the trademark owner,
with no intention of infringement of the trademark. Where such designations
appear in this book, they have been printed with initial caps.
TERMS OF USE
Acknowledgments
Introduction
1. The Physical Therapy Profession
2. Healthcare Regulations
3. Evidence-Informed Practice and Clinical Decision-Making
4. Clinical Documentation
5. Preparation for Patient Care
6. Monitoring Vital Signs
7. Bed Mobility, Patient Positioning, and Draping
8. Mobility
9. Manual Muscle Testing
10. Patient Transfers and Mobility
11. Gait Training
12. Putting It All Together
Any work, however enjoyable, takes time away from family members and
friends. I would thus like to take this opportunity to thank the following:
CHAPTER OBJECTIVES
OVERVIEW
CLINICAL PEARL
The Guide, together with the Standards of Ethical Conduct of the Physical
Therapist Assistant, another document provided by the APTA, outlines the
PTA’s role (Appendix A). The Guide1 describes six elements of the physical
therapy patient/client management (Figure 1-1). The only one of the six
elements that may be delegated to a qualified PTA is the intervention—the
purposeful and skilled interaction of the PTA using various physical therapy
methods and techniques to produce changes in the condition consistent with
the diagnosis and prognosis.1 The PTA cannot evaluate, reevaluate, or
discharge a patient. However, the PTA can perform most tests and measures
related to the intervention in a continuous data collection process. Thus, the
PTA reviews the initial documentation, including the plan of care (POC),
notes which interventions to use during the first and ensuing treatment
sessions, and effectively arranges those interventions within each session
while using suitable tests and measures to measure the patient’s progress
toward the goals while monitoring any patient response to the interventions
used. Some of this data is then documented according to facility policy
and/or provided orally to the supervising PT.
FIGURE 1-1 The six elements of physical therapy patient/client
management. (Reproduced with permission from Dutton M: Introduction to
Physical Therapy and Patient Skills, 2nd ed. New York, NY: McGraw Hill;
2014.)
HISTORICAL PERSPECTIVE
Descriptions of the early years of the United States’ physical therapy
profession began at the beginning of the twentieth century. Much of the
impetus behind the profession during these times resulted from the high
incidence of acute anterior poliomyelitis, referred to as infantile paralysis,
which occurred in 1916 (Figure 1-2) in areas of Louisiana, Boston, and New
York.2 Rehabilitation medicine became involved with polio first when
orthopedic surgeons adopted what they referred to as aftercare rehabilitation
programs for the children and adults affected. The best known of these
programs, led by Robert Lovett, a professor of orthopedic surgery at
Harvard, and Wilhelmine Wright, a PT, was a statewide program that came
to be known as the Vermont Plan. Wilhelmine Wright developed the training
technique of ambulation with crutches for patients with paraplegia or
paralysis caused by polio. She also introduced manual muscle testing
concepts in physical therapy, which appeared in a book called Muscle
Function.
FIGURE 1-2 Early treatment approach to poliomyelitis.
Dr. Lovett discovered that muscle training exercises were the most
important early therapeutic measures for polio treatment and organized teams
of workers, including physicians, nurses, and other nonphysician personnel,
to provide interventions. The nonphysician personnel included three
individuals—Wilhelmine Wright, Janet Merrill, and Alice Lou Plastridge—
who received special training in massage, muscle training, and corrective
exercises from Dr. Lovett.
The United States entered World War I by declaring war on Germany in
1917, and the Army recognized the need to rehabilitate soldiers injured in the
war.3 This caused a change in focus on using multiple and combined methods
to restore physical function in the military forces and the civilian workforce
under the umbrella term physical reconstruction. Physical reconstruction
was defined as the “maximum mental and physical restoration of the
individuals achieved by the use of medicine and surgery, supplemented by
physical therapy, occupational therapy or curative workshop activities,
education, recreation, and vocational training.” Many of the exercises used
were based on Pehr Henrik Ling’s Swedish exercise/gymnastics and Dr.
Jonas Gustaf Wilhelm Zander’s exercise machines (Figure 1-3) (see Box 1-
1). These exercise-based approaches and their subsequent outcomes began to
change the belief that disability was irreversible.
CLINICAL PEARL
Physical therapy practice in the United States evolved around two major
historical events: the poliomyelitis epidemics of the 1800s through the
1950s and the effects of several wars, including World War I,
World War II, and the Korean conflict.
Historically, physical therapy emerged as a profession within the
medical model, not as an alternative to medical care.4
Box 1-1
CLINICAL PEARL
CLINICAL PEARL
CLINICAL PEARL
After World War II, many patients who had sustained brain injuries sought
the services of physical therapists. Signe Brunnström, a Swedish physical
therapist, documented new approaches for assessing and treating
individuals with cerebrovascular accidents (CVAs) and, after observing
thousands of patients, delineated stroke recovery stages.10 Also, during this
time, Berta Bobath and Dr. Karl Bobath began to develop their reflex-
inhibiting postures for the management of children with cerebral palsy,
which utilized specialized handling techniques to decrease tone and
stiffness, increase muscle control against gravity, and help stabilize muscle
activity.11
The physical therapist’s role progressed further in the 1950s from that of a
technician to a professional practitioner.7
The outbreak of the Korean War in 1950 involved the United States in yet
another war effort.7 It is during this period that Margaret Rood, a physical
and occupational therapist, broke new ground in the treatment of individuals
with central nervous system (CNS) disorders.12
The 1950s were a pivotal time for the physical therapy profession to gain
independence, autonomy, and professionalism. For example, during the late
1950s and into the 1960s, increasing numbers of states enacted state
licensure laws for physical therapists, and in 1954, a seven-hour
professional competency exam was developed by the APTA in conjunction
with the Professional Examination Service of the American Public Health
Association.7 By 1959, 45 states and the territory of Hawaii had physical
therapy practice acts in place.5
CLINICAL PEARL
CLINICAL PEARL
The earlier efforts to gain state licensure clearly influenced the Medicare
program in 1967 and 1968, as most states had licensure laws by this time,
which regulated the practice of physical therapy. Amendments to the Social
Security Act (SSA) in 1967 added a definition of “outpatient physical
therapy services,” resulting in the Social Security organization recognizing
physical therapy services as a healthcare provider for reimbursement. This
amendment also resulted in dramatic changes to the practice of physical
therapy for patients with neuromuscular disorders. Influenced by the earlier
work of Margaret Rood, Margaret Knott, Dorothy Voss, and Signe
Brunnström, Berta and Karl Bobath developed techniques for adults with a
cerebrovascular accident (stroke), cerebral palsy, and other disorders of the
central nervous system.9 Since that time, the physical therapy profession has
continued to expand its treatment areas, which has led to the need for
specializations.
CLINICAL PEARL
In the late 1960s and early 1970s, open-heart surgery became possible,
and the physical therapy profession expanded the cardiovascular/pulmonary
area of its practice with increasing chest physical therapy programs for pre-
and postoperative patients. There was an expansion of joint replacements in
the orthopedic practice arena, resulting in the emergence of new avenues for
orthopedic physical therapy practice by introducing new options for patients
with severe joint restrictions to live more independent and pain-free lives.
During this time, technological advances provided new testing
methodologies and options to improve patient function, which allowed the
profession opportunities to develop more objective outcome measures, new
intervention strategies, and an increase in the types of diseases and
conditions that physical therapy could positively influence. In 1970, PTAs
were granted temporary membership into the APTA. PTAs were admitted as
affiliate members in 1973, and, since 1992, PTAs have been able to hold
offices (except for president) on the state and national levels of the APTA.
CLINICAL PEARL
The APTA HOD adopted the Physical Therapist Assistant (PTA) Policy,
and affiliate membership was granted to PTAs in 1973.
The APTA HOD adopted its first Standards for Services and Practice in
1975.
The first Combined Sections Meeting was held in Washington, DC, in
1976.
The PT Fund became the Foundation for Physical Therapy in 1979. The
Foundation promotes and provides financial support for clinically
focused research to improve physical therapy’s practice and cost-
effectiveness.
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rocks, mates,” says I, trying to speak stern, though, Lord love yer, I
felt for all the world as if I was agoin’ to choke.
We left two men to do sentry-go, and set to work to overhaul them
rocks and all the ground and underwood which was near ’em; but not
a blessed sign of anything could we find except the marks of feet,
and in places these were plentiful enough, but ’tis a most tremenjous
difficult thing to track any one in a forest where there’s always a lot of
dead leaves and such like muck about.
Well, I’d be afraid, and that’s the truth, to say how many hours we
spent over that there hopeless job of searching for our lost
shipmates. We scoured the forest in all directions, made our way into
the valley to look for the enemy’s camp, but found nothing but a
burned-out fire; and overhauled the surrounding cliffs—and there
was a pretty few of ’em, mind you—in hopes of lighting upon some of
the blooming caves we’d heard so much talk about. It just was talk,
and nothing else—that I’ll take my affidavy to. Where were those
swabs o’ mutineers and the confounded Creole niggers that we’d
been sent after? and where was their hidden cargo? Shiver my
timbers, if I wouldn’t have slugged the lot of ’em if I could have got
the chance. I don’t like fallin’ out with people as a rule, specially
strangers; but when it comes to their kidnappin’ your own shipmates,
and p’raps cutting their throats, or giving ’em foul play of some sort
or another, why then my monkey gits up, I can tell you, and I’d think
it child’s play to corpse the lot of ’em if they came within reach of my
cutlass.
When the sun began to go down, I knew well enough that we must
knock off and make tracks for the camping-ground that Mr.
Thompson had spoken of. The alarm must be given as quickly as
possible, so that the whole force might turn-to and join in the search;
but then a fresh difficulty came to the fore, for we’d lost our guide,
and hadn’t the remotest idea of the bearings of this here bivouac.
However, I don’t want to make a long yarn out of this part of the
business, so I’ll only tell you that we made a sternboard, so to speak,
and found our way back with uncommon difficulty to the rough cart-
track we had quitted early in the afternoon. Here, of course, we got
on the spoor of the brigade, and had no difficulty in tracking ’em to
their camping-ground. ’Twas a weary march, and we were footsore
and a bit done up when we got there, which was after dark; and we
ran a narrow shave of being shot down by our own sentries.
Well, naterally there was a tremenjous sensation amongst all
hands when they heard our terrible story. The gunnery lootenant was
almost beside himself, and vowed vengeance on them dastardly
rebels when he caught them. He wanted to set off at once, but on
coming to think it over calmly, he saw that ’twas wellnigh impossible
till the morning. In the first place, every mother’s son was tired out by
the long stretch they’d had in full marching order; and, secondly, it
was that dark—there being no moon—that it would have been
wellnigh impossible to find our way through the forest, to say nothing
of the chances it would give them thundering swabs of mutineers
and niggers to go for us under cover of the darkness. They couldn’t
have drubbed us, of course, but through their sarpentine cunning
they might have harassed us like old winky.
The orders was passed round therefore to start in the morning, at
the first break of dawn.
Through the adventures what follered it seemed to me as I ought
to make some alterations in this here gimcrack of a log; but when I
consults the gunnery orficer—“You just leave it as it is, Jim
Beddoes,” says he; “’tis more interestin’,” he says. Well, ’tis a new
thing to me that anything I should have written, being no scholard,
should be interestin’; but, there, I’ve had my say. The yarn is spun,
such as it is, and I can only say in conclusion, and with many
apologies for takin’ of the liberty, “My dooty to you, and wishing you
all good-luck.”
CHAPTER XII.
TAKEN PRISONER.