Physiotherapy and PROCEDURE: Shortwave diathermy-pulsed

 Procedure Of Short Wave Diathermy

DEFINITION/DESCRIPTION:

The application of a high frequency oscillating field to the tissues via either a capacitor field method or an inductothermy method.

Application will be by pulsed electromagnetic energy.

Any heating effects are dissipated during the long intervals when the output is pulsed.

Frequency range:     27.12MHz +/- 160 KHz - most common range

Power range:            Pulsed mode     -acute          0-3 watts

                                                          -sub acute     2-5 watts

                                                          -chronic        5-40 watts

Application time:     maximum 20 minutes

CONTRAINDICATIONS:

-           implanted cardiac pacemakers

-           advanced cardiovascular disease

-           metal in the tissues

-           the pregnant uterus

-           the testes

-           local areas of impaired peripheral circulation

-           hemorrhaging tissue, or liable to do so

-           scar tissue

-           area previously treated with radiotherapy

-           malignant tumors / neoplasm

-           acute febrile illness

-           deep venous thrombosis

-           impaired thermal sensation

-           subjects with reduced level of consciousness or impaired understanding

-           some acute skin conditions e.g. eczema, dermatitis

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           burns

INFECTION CONTROL:

-           appropriate hand hygiene

-           appropriate hygiene of plinth, pillows, all surfaces in direct contact with subject

Physiotherapy and PROCEDURE: The use of Walking Aids – The use of mobility aids – axillary and elbow crutches; walking frames; rollators; walking sticks; PPAM aid; parallel bars; wheelchairs

Procedure of using walking aids

DEFINITION/DESCRIPTION:

The education of non-weight bearing and partial weight bearing gait using a variety of supporting aids; the education of the use of walking aids on stairs and uneven surfaces; +/- footwear; use of wheelchair

CONTRAINDICATIONS:

-           unsafe equipment/environment

-           inability of subject to understand instructions

-           inappropriate subject presentation

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           inappropriate choice of mobility aid

-           inappropriate choice of gait pattern

-           loss of balance/co-ordination of maneuver

INFECTION CONTROL:

-           maintenance of surface cleanliness of mobility aids e.g. hand grips, wheelchair seating

Physiotherapy and PROCEDURE: Traction- manual and mechanical

Procedure of Traction Manual and mechanical

DEFINITION/DESCRIPTION:

The application of a longitudinal force resulting in separation of joint surfaces that may be sustained, continuous, intermittent or rhythmic; vertical, horizontal or angled.

Cervical spine starting weight 2-3kg up to 5kg

                        absolute maximum for cervical spine 10kg

Lumbar spine starting weight 13kg up to maximum of 20kg

CONTRAINDICATIONS:

-           pain associated with disturbances of reflex activity, muscle power or sensation due to nerve root compression

-           disturbances of bladder or bowel function

-           perinea anesthesia

-           compression of neurological structures

-           arterial compression

-           vertigo

-           hyper mobility syndromes involving spine and sacroiliac joints

-           trauma e.g. fractures, dislocations & spondylolysis

-           infections

-           inflammatory disease e.g. rheumatoid arthritis

-           metabolic bone disease e.g. osteoporosis

-           tumors

-           developmental anomalies

HAZARDS/COMPLICATIONS.PRECAUTIONS:

-           strength & safety of pull must be assessed by palpation between interspinous processes and assessment of the passive physiological intervertebral movements (PPIVMS)

-           progression by increasing weight or time

-           increased pain or complete cessation of pain

-           visual disturbances

INFECTION CONTROL:

-           appropriate hand hygiene

-           appropriate protection of halter/belts if used

manual

mechanical

Physiotherapy and PROCEDURE: The application of cold therapy

 Procedure aplication Cold treatment

DEFINITION/DESCRIPTION:

The therapeutic use of local body cooling to transfer heat energy away from the tissues, thereby lowering local tissue temperature and provoking a thermoregulatory response.

Application may be by: local immersion

                                                                cold packs

                                                                ice towels

                                                                ice massage

Application is restricted to a maximum of 9% of body area at any one time and a minimum temperature of 4° Centigrade and ceases when hyperemia is visible.

CONTRAINDICATIONS:

-           cold sensitivity – vasospasm, cold urticaria, cryoglobinaemia

-           coronary thrombosis

-           angina

-           hypertension or labile blood pressure

-           sensory deficiency

-           emotional and psychological factors

-           hypersensitive areas

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           excessive local cold – tissue injury

-           pathological conditions which predispose to cold injury, e.g. lower motor neuron lesions, Reynard’s disease

INFECTION CONTROL:

-           appropriate hygiene/cleanliness of ice towels

-           appropriate skin care of subject

Physiotherapy and PROCEDURE: The application of therapeutic convection and Conduction heating

Procedure of application Heat Therapy

DEFINITION/DESCRIPTION:

Application may be made by:     heated packs

                                                    electric heating pads

                                                    infra red radiation

The application of heat directly to the surface of the skin, allowing transference of heat by convection, conduction and radiation, to give raises it heating of superficial body tissues. Skin temperature should not rise above 40 degree centigrade.

CONTRAINDICATIONS:

-           impaired cutaneous thermal sensation

-           defective arterial cutaneous circulation

-           labile blood pressure

-           poor skin condition-open wounds, rashes, skin infections, acute dermatitis, eczema

-           skin hypersensitivity

-           recently healed tissues, skin grafts

-           recent radiotherapy to skin area

-           skin tumours

-           chemical irritants e.g. application of skin creams etc.

-           acute febrile illness

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           burn

-           shock

-           excessive rise in skin temperature

INFECTION CONTROL:

-           appropriate hygiene of all subject contact apparatus

-           appropriate skin care of subject

Physiotherapy and PROCEDURE: Therapeutic electrical stimulation

Procedure for elctrical stimulation

DEFINITION/DESCRIPTION:

Application may be by:     carbon-rubber electrodes

                                           +/- suction

                                           continuous or intermittent

The application of alternating currents of frequencies up to 4000Hz. Application may be to promote tissue healing and / or pain relief and may be used to initiate muscle contraction. Maximum dosage for the initiation of muscle contraction must be comfortable for the patient and not produce fatigue. Application is usually for a period of 15-20 minutes.

CONTRAINDICATIONS:

-           likelihood of muscle damage

-           likelihood of thrombus/hemorrhage

-           cardiac arrhythmia

-           eczema/open wounds

-           malignant tumours/neoplasma

-           active TB

-           impaired sensation to pinprick

HAZARDS/COMPLICATION/PRECAUTIONS:

-           skin damage/irritation

-           electric shock

INFECTION CONTROL:

-           appropriate hygiene of equipment in contact with the subject

-           appropriate hygiene of plinth etc.

-           all washable equipment to be cleansed after use

Physiotherapy and PROCEDURE: The application of therapeutic ultrasound

Procedure Ultrasound therapy

DEFINITION/DESCRIPTION:

Application may be by:     direct contact

                                           water bath

                                           solid, sterile gel as a medium

                                           continuous or pulsed output

The application of local ultrasonic transmission to the tissues, such that ultrasound is absorbed and a local thermal effect may result. Thermal effects are reduced through lowering intensity of the pulsing of the output.

Dosage:     frequency     1 & 3 MHz

                  intensity       maximal 2 W/cm²   

                  time             maximal 5 minutes per size of transducer head

CONTRAINDICATIONS:

-           rapidly dividing tissue

-           infection

-           vascular problems

-           recent radiotherapy to the area

-           specialized tissue e.g. eyes, testes

-           loss of skin sensation

-           fractures metal implants in the treatment area

HAZARDS/COMPLICATION/PRECAUTION:

-           burn

-           tissue destruction

INFECTION CONTROL:

-           appropriate hygiene of apparatus in subject contact

-           appropriate subject skin care and cleanliness

-           hygiene associated with application and removal of  medium