Physiotherapy and PROCEDURE: Manual techniques for the removal of bronchial secretions: percussion

Procedure : Chest Percussion

DEFINITION/DESCRIPTION:

The application of the minimal effective mechanical force to the thorax delivered using a cupped hand, using either single handed (slow) percussion (60 beats per minute) or double handed percussion, throughout the respiratory cycle, but with maximum effect during full inspiration followed by an inspiratory hold.

CONTRAINDICATIONS:

-           prolonged history of use of steroids

-           metabolic bone disease e.g. osteoporosis, rib metastases

-           predisposition to paroxysms of coughing

-           presence of wheeze

-           predisposition to bronchial hypersensitivity

-           subject intolerance

-           thoracic burns

-           thoracic burns

-           application directly over site of rib fractures

-           frank haemoptysis

-           low platelet count

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           a rigid & non-compliant thorax

-           increased bronchial constriction

-           precipitated paroxysm of coughing

-           breathlessness

-           pulmonary carcinoma (unless specifically indicated)

INFECTION CONTROL:

-           management of expectorated products

-           hand hygiene

-           appropriate disposal of clinical waste

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Physiotherapy and PROCEDURE: Manual techniques for the removal of bronchial secretions: vibrations and shaking

Procedure : Manual Vibration and Shaking

DEFINITION/DESCRIPTION:

The application to the thorax of a rhythmical compression force in the direction of airflow. Movement occurs throughout the expiratory phase of respiration. The minimum effective compression force is applied, normally for a period of 3-5 respirations, interspersed with adequate periods of breathing control.

Vibrations are a smaller grade of the same movement carried out is a similar way.

CONTRAINDICATIONS:

-           prolonged history of use of steroids

-           metabolic bone disease e.g. osteoporosis, rib metastases

-           predisposition to paroxysms of coughing

-           presence of wheeze

-           predisposition to bronchial hypersensitivity

-           subject intolerance

-           thoracic burns

-           application directly over rib fractures

-           frank haemoptysis

-           low platelet count

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           a rigid & non-compliant thorax

-           increased bronchial constriction

-           precipitated paroxysm of coughing

-           breathlessness

-           pulmonary carcinoma (unless specifically indicated)

INFECTION CONTROL:

-           management of expectorated products

-           hand hygiene

-           appropriate disposal of clinical waste

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Physiotherapy and PROCEDURE: The application of therapeutic strapping / tapping

Procedure : Tapping /Straping

DEFINITION/DESCRIPTION:

The application of taping to support and/or restrain movement of a specific joint(s) or soft tissue structure(s).

CONTRAINDICATIONS:

-           subject intolerance

-           poor skin condition

-           skin hypersensitivity /  allergy

-           circulatory insufficiency

-           excessive oedema

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           inappropriate choice of technique

-           ineffective taping

-           other musculoskeletal injury

-           skin hypersensitivity

-           inappropriate choice of tape

INFECTION CONTROL:

-           appropriate skin care of subject

-           single subject application of tapping and skin protection materials

-           appropriate disposal of clinical waste

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Physiotherapy and PROCEDURE: Analysis of posture and positioning

 Procedure : Posture Analysis

  

DEFINITION/DESCRIPTION:

The detailed anatomical evaluation of the posture of an individual subject, performed through observation and objective measurement, including video and photography. The positioning and evaluation of an individual subject in sitting, supine and side lying, with the use of cushions and wedges.

By necessity, in the circumstances of observational assessment and handling when physical contact may occur, the subject will be required to wear only underwear and no footwear.

CONTRAINDICATIONS:

-           inappropriate subject presentation

Prior to undertaking a manual handling task the assessment of risk associated with the task must be undertaken by consideration of:

-           task factors

-           individual factors – the skills, competency and physical ability of handler (physical abilities will include consideration of health status, gender, pregnancy, age disability and anthropometric status)

-           load factors

-           environmental factors

Risk should be reduced so far as it is reasonably practicable – if sufficient reduction of risk is not possible the manual handling activity should be avoid.

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           every effort must be made to protect the subject from unwanted exposure

-           inadequate assessment or management of risk as identified above.

INFECTIONS CONTROL:

-           appropriate hand hygiene

-           appropriate cleanliness of equipment before & after use

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Physiotherapy and PROCEDURE: Analysis and re-education of gait

Procedure : Gait Analysis
DEFINITION/DESCRIPTION:

The detailed anatomical and biomechanical evaluation of the gait of an individual subject, performed through observation and objective measurement. This may involved the use of foot paint (which is suitable for use be children) as volunteers use different gait patterns and speeds leaving footprints on a paper walkway. By necessity, in the circumstances of observational assessment the subject may be requires to wear only minimal clothing, i.e. underwear, +/- footwear.

CONTRAINDICATIONS:

-           inappropriate subject presentation

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           inappropriate selection of subjective

-           ineffective supervision of subjective during activity

-           unsafe / inappropriate choice of environment

INFECTION CONTROL:

-           hygiene of environment especially floor or other standing surfaces and equipment e.g. force plate.

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Physiotherapy and PROCEDURE: Manual Therapy – manipulation techniques

 Procedure : Manipulation

DEFINITION/DESCRIPTION:

Manipulation may be specifically defined as a high velocity technique performed at speed outside the models control

Grades of Movement:

Grade I       is a small amplitude movement in resistance free range

Grade II      is a large amplitude movement in resistance free range

Grade III     is a large amplitude movement into resistance

Grade IV     is a small amplitude movement into resistance

Grade V     small amplitude high velocity thrust technique into resistance

CONTRAINDICATIONS:

-           clinical features of cord compression

-           clinical features of cauda equine compression e.g. disturbances of bladder or bowel function, perineal anesthesia

-           clinical features associated with disturbances of reflexes, muscle power or sensation due to nerve root compression

-           hypermobility syndromes involving spine

-           fixed spinal deformities

-           spinal surgery

-           trauma e.g. fractures, open wounds, dislocations, spondylolysis and spondylolisthesis

-           congenital anomalies

-           infections

-           inflammatory arthropathies

-           metabolic bone disease and endocrine disorders

-           tumors

-           vascular disorders

-           some medications e.g. anti-coagulants, steroids

-           pregnancy

-           patients judged to be unsuitable for manipulation

HAZARDS/COMPLICATIONS/PERCAUTIONS:

-           development and/or exacerbation of symptoms including protective muscle spasm or guarding during attempts to position model would contra-indicate continuation of the technique

INFECTION CONTROL:

-           appropriate hand hygiene

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

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Physiotherapy and PROCEDURE: Manual Therapy – mobilization techniques

Procedure - Manual Therapy

DEFINITION/DESCRIPTION:

These techniques are described in general terms and may be used for assessment or treatment of any neuromusculoskeletal tissue in the body

Mobilization is a passive movement performed in such a manner that it is at all times within the ability of the model to prevent the movement. There are 2 type of passive mobilization performed for the purpose of relieving pain and restoring pain free functional movements;

1. passive accessory movements are those movements which a subject cannot perform themselves
2. passive physiological movements are those movements which a subject could perform themselves

Grades of Movement:

Grade I      a small amplitude movement in resistance free range

Grade II     a large amplitude movement in resistance free range

Grade III    a large amplitude movement into resistance

Grade IV    a small amplitude movement into resistance

CONTRAINDICATIONS:

-           clinical features of cauda equine compression e.g. disturbance of bladder or bowel function, perinea anesthesia

-           clinical features of cord compression

-           vascular disorders

-           vertigo

-           hyper mobility syndromes

-           infections

-           active inflammatory arthropathies

-           metabolic bone disease and endocrine disorders

-           tumors

-           congenital anomalies

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           development and/or exacerbation of symptoms including protective muscle spasm or guarding during attempts to position model would contra-indicate continuation of the technique

INFECTION CONTROLS:

-           appropriate hand hygiene

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

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Physiotherapy and PROCEDURE: Massage

Procedure : Massage

DEFINITION/DESCRIPTION:

Massage is a general term indicating the application of methodical pressure e.g. triggers points, friction or kneading to the body.

CONTRAINDICATION:

-           compression of neurological structures

-           trauma e.g. fractures, open wounds, dislocations & spondylolysis

-           infections

-           tumors

-           fragile/sensitive skin

HAZARDS/COMPLICATIONS/PRECAUTIONS:

-           inappropriate skin response

-           subject intolerance

INFECTION CONTROL:

-           appropriate hand hygiene

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

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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

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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

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