Shifting the Borders of PHYSIOTHERAPIST in ACCIDENT & EMERGENCY DEPARTMENTS

INTRODUCTION:
As a Medical practioner, how many of us know the Emergency ambulance number to call ? Probably 95% would not know.
Accidents can occur at any times and any places usually at Odd times and at Places where a doctor would not be expected to be.
Injuries are a common cause of Death, Most of the Deaths due to injuries may be unavoidable, but prompt care saves life.1
Early skilled care can reduce the extend & duration of damage and return the patient into his community in earlier period.2
Emergency medical service is a life saving service, it is a chain of human & Physical resources, brought together to provide total patient care. 3, 4
Emergency triage is a process of sorting or classifying patients according to the need for Emergency treatment & potential for further injury. Triage comes from French. 5.
The health care industry is becoming more complex, there are considerable personal shortages in many of the professional disciplines.
Physiotherapists are responsible for providing quality services and care for patients. Still they can provide more services if they extend their area.
This article focuses role of physiotherapist in Accident & Emergency situations through Available literatures. The available literatures for the Role of Physiotherapist practioners in Emergency department are severely limited.
There are Major Benefits for employing Physiotherapist practioner in Emergency Department. 6, 7.
Ø Enhance the ability of department
Ø Reduce the Waiting time for patients.
Ø Reduce Hospital admissions
Ø Treatment applied on the site of injury
Ø Help to manage the increasing load
Ø Being a part of flexible & responsive work force
Ø Giving timely & Quality care
Ø Improving access to most appropriate emergency practioner.

The Major Disadvantage for not applying physiotherapist in Accident & Emergency situations are. 6
Ø Lack of Communication Skills
Ø Deficient in Hands on approach on First Aid.
Ø Insufficient knowledge in Emergency Code/ Colour.
Ø Not knowing to apply POP
Ø Poor Knowledge on Monitors.

Physiotherapist can reduce the number of admission in hospital. A study on COPD patients’ states that Exercises delivered in the Community will reduce the number of hospital admission and ease the burden on waiting list. 8
Physiotherapist work successful in all areas in U.K, Physiotherapy Triage was successfully trialed in the Emergency department of Royal Melbourne Hospital in 2004, where a Physiotherapist found vital in reducing waiting time and total treatment time for emergency patients with Musculoskeletal injuries.
Jibuike et al., conducted a study on “ Acute Knee screening service” shows that Physiotherapist can reduce number of patients in Trauma & Accident & Emergency clinics.
Jibuike et al., also found that Physiotherapy practioners could diagnose knee conditions better than Accident & Emergency Senior house officers. 9
The Role of the Accident and Emergency extend scope of Physiotherapy practioners with the ability to treat patients autonomously can be challenging for both the practioners & other health care providers whose professional boundaries have been crossed. 10
Conclusion:
There are clear advantages in having Accident & Emergency extend scope Physiotherapy practioner in emergency departments particularly for patients with Musculoskeletal injuries.
Physiotherapy practioner are already providing a valuable resources for the A& E team members and their role fits in with the ‘See and Treat’ and minor injury streaming systems that the department of Health. 12
Suitably trained and Qualified physiotherapy practioner can lead Accident & Emergency soft tissue injury review clinics, thereby freeing up senior doctors for other duties. 11

Bibliography:
1) John Norman (1978) “Management of injured patients” Mc Milan journal limited, USA.
2) Easton. K (1970) “The general practioner and the rescue services” community health. Bristol.
3) Herbert J. Proctor MD( 1979) “Management of Acute trauma” Year Book Medical publishers, USA.
4) Gene Weatherall. (1983) “Instructors guide for emergency care” Prentice—Hall Publishing, Mary land.
5) Jean H Roger.(1989) “Emergency Nursing—A Practical guide” William & Willikins, USA.
6) Bethel J (2005) “The role of the Physiotherapist practioner in Emergency departments: A critical appraisal, Emergency Nurse.
7) Department of Health (2003). “Work force matters: A guide to role redesign in emergency care. The stationary Offices, London.
8) Kathleen Philip (2006), “Physiotherapy can reduce Hospital admission” Australian journal of Physiotherapy.
9) Jibuike et al (2003). “Management of soft tissue knee injuries in an Accident & Emergency department.
10) Mike smith ( 2004). “Collaborative working” Emergency nurse.
11) Boyce S ( 2003) “ The Physiotherapist practioner: Extending the role of the physiotherapist. Emergency medicine journal.

Author: B. Arun., MPT, CMPT,

Efficacy of sensorimotor training in the rehabilitation of improving function and Proprioception of patient with Osteoarthrosis of Knee

The knee joint is commonly involved area which gets degeneration. The treatment requires great skill and perfection to bring the patient into the track of work.

Osteoarthrosis causes much musculoskeletal pain and disability. Patients suffer prolonged pain and disability some of the patients suffer with deformity of joint.

Apart form this many patient suffer with Q’ceps weakness, Proprioception deficit and postural instability.

Strengthening of Q’ceps muscle and the training to the joint improves patients Proprioception and postural stability.

QPER and DAPRE techniques commonly prescribed to improve the function and Proprioception.

ERGONOMIC ANALYSIS FOR PADDY WORKERS

• Musculoskeletal disorder is very common in all occupations.
• Surprisingly Agricultural workers are also having problems due to Poor positions & Awkward postures.

Agriculture is the very physical occupation where muscular aches & pain are often considered to be “Part of Job”

Susan.G.2003

Repetitive forces at the same muscle, tendon or region result in Trauma, injury & inflammation lead to Cumulative trauma disorders or Repetitive Stress Injury.

James 2006

Field crop production workers are at high risk for work related muscular disorders

Murphy 2003

Heavy physical work, repeated lifting & Twisting activity causes Low back Pain in workers. Marras et al., 1993

Repeated force to joints and soft tissues results in Pain. Musculoskeletal disorders affect the work force & Production.

Blondell et al.,1977.

“To forget how to dig the earth & to tend the soil is to forget ourselves.”

Mahatma Gandhi.

SUBCALCANEAL HEEL PAIN

SUBCALCANEAL HEEL PAIN

Pain in the plantar pad of heel in a common condition and has been reported in patients aged from 18 to 80.

It is a summation of series of micro trauma to the plantar fascia caused by a strain of the attachment of plantar fascia to the calcaneum.

AETIOLOGY:

Excessive Pronation of subtalar joint

Repeated stress over the fascia.

Pes cavus highly arched foot.

Occupational stress like prolonged standing and walking.

High heel shoes.

Obesity

Length and stride during running

Wearing shoes without sufficient

CLINICAL FEATURE:

• Sharp or acute pain over the heel.
• Pain is most severe when the athlete first puts weight on the foot.
• Pain occurs in the heel when no person getting out of the bed in the morning.
• Pain diminishes during activity.
• Pain increase when the activity stops.
• Tenderness over the calcaneal end of the Aponeurosis seen over the anterior medial tuberosity of the calcaneum.

INVESTIGATION

X-Ray

May reveal the presence of calcaneal spur.

MANAGEMENT:

Medical Management

Cortisone injection

Aspirin pills

Soluble steroid injection

Physiotherapy Management

Acute phase

Pulsed ultrasound

Electrical stimulation

Faradic foot bath.

Rehabilitation phase

• Continuous ultrasound
• Ionoto / phonopheresis
• Cryotherapy

Stretching

• T.A. Stretching
• Foot mobilization
• plantar fascia stretch
• intrinsic foot muscle strengthening

Foot Support

• Custom foot Orthosis

Home program

• Avoid prolonged standing
• Advice about suitable standing foot wear.
• Exercise for intrinsic foot muscle should be taught to the patient.
• Contrast bath
• Rest splits should be administered if necessary.

Exercise

• Pricking a golf ball and up your toes.

Lay a towel on the floor and scrunch it up with your toes

RECTUS ABDOMINIS DIASTASIS

RECTUS ABDOMINIS DIASTASIS

Rectus abdominis diastasis is a conventional term used to define the split between the two rectus abdominis muscles (Polden and Mantle 1990). However, as the two Recti muscles are attached in the middle by the linea Alba, the widening actually occurs as a result of stretching and thinning of the linea alba. It commonly occurs in childbearing women, third trimester. (Boissonnault and Blaschak 1988). It can persist in 30-60% of women during the post partum period at different sites along the linea alba. (Boissonnault and Blaschak 1988; Bursch 19987).

This can vary between a small vertical gap 2-3cm wide and 12-15cm long to a space measuring 12-20cm in width and extending nearly the whole length of the recti muscles.

Investigation

Checking for Diastasis recti should be done in the,

Beginning of second trimester and continue throughout the rest of pregnancy.

Post partum phase.

Patient Position

Supine Hook lying.

Procedure

Chin should be tucked

Arm extended to knees

Patient should raise her head, shoulders until the scapulae clear the Surface

Therapist check for Central budge in abdomen and with fingers placed Cephalo Caudally, measure the amount of seperation between the Rectus abdominis Muscles 2 inches above, below, al the level of umbilicus.

Common treatment given for diastasis recti includes Binder, Exercise and Rest. Binder helps to hold the abdomen tight and maintain the muscle length properly. Abdominal exercises helps to strengthen the abdominals and helps in maintain the posture

Patellar tendinitis

Patellar tendinitis or Jumper’s knee is a over use or repetitive trauma to the extensor mechanism of the knee, which commonly results from jumping or running sports such as ‘Basket ball’ and ‘Volley ball’.
The prevalence of Jumpers knee is 40-50% among elite volleyball and basketball players. Ferrati A, Panpandrea P -1990 ,Lion O, Holen K J -1996.
They are present with anterior knee pain and intermittent swelling.
The tenderness is localizes to the patellar tendon, primarily at its origin on the ‘Inferior pole of patella’ and the tenderness is appreciated with the knee in extension.
This often recurrent condition can severely limit or even an athletic career and recovery from each episode can be prolonged. Cook J L, Khan K M-1997.
Recent investigations have shown that squat performed on a 25 degree decline board ‘target knee extensor mechanism more specifically than the ‘Standard squat ‘ and it has been suggested that this may be relevant in the management of patellar tendinopathy Purdam C R -2004 , Cook J -2003.
The progressive eccentric strengthening forming the corner stone of most rehabilitation programmes. The treatment includes Ultrasound and Transfriction Massage.
Therapeutic ultrasound is one of the most common treatments used in the management of soft tissue lesions like tendon, ligament, and bursa.
Ultrasound induces thermal and non thermal physical effects in tissues. The thermal effects are increased blood flow, reduction in muscle spasm, increased extensibility of collagen fibers and an inflammatory response at the temperature level of 40-45 degree for 5 minutes.