Physiotherapy Management in Respiratory Care - Research Proposal Example

 Physiotherapy Management in Respiratory Care INTRODUCTION Physiotherapy is defined as a therapy that makes use of physical agents in order to treat injury and to maintain the functions of the body. Amongst the myriad types of cases that physiotherapists deal with, one common type are victims of road traffic accidents (RTA). Physiotherapy attempts to treat people who have been injured during RTA and to bring make their motor function to normal, or as near to normal as it can. The essence of the practice is clinical reasoning along with informed analysis. Physiotherapy relies on sciences to expand, put into action, analyze and review the evidence that forms the basis of, and gives knowledge about, its management. Physiotherapy uses physical approaches to promote health after reviewing the past medical history of the patient and other fluctuations in the health condition of the patient; hence it follows that physiotherapy is not just telling the individual to perform certain exercises. On the other hand, successful and effective physiotherapy management plan is devised after reviewing the physical status of the patient in detail, and taking into account health factors that can complicate the delivery and practice of the exercises. The Charted Society of Physiotherapy (2010) highlights the elements of physiotherapy practice: physiotherapy practice and delivery is shaped by reflective behavior and systematic clinical reasoning, both contributing to and buttressing a problem-solving approach to patient-centered care. PHYSIOTHERAPY MANAGEMENT Simon, O’Reilley, Proctor and Buckmaster (2007) suggest physiotherapy for nerve entrapments in accidents. The foremost thing that the physiotherapist needs to tell the patient is to assure her that whiplash injuries are not usually malignant or spread to other parts of the body. The physiotherapist should tell the patient that her injuries are not untreatable and that he or she will try his or her level best to alleviate the symptoms of the patient and to provide pain relief. The patient should be encouraged to carry out her normal activities, even though it may be painful in the start; however, she needs to be reassured that the pain does not indicate more damage to the tissues and the exercises will actually help her to regain health quickly. Moreover, studies have shown that such patients should not use soft collars, since that would cause immobilization and hamper recovery. She also needs to be ensured that physiotherapy is a good option for her as recent studies demonstrate that physiotherapy is more effective than GP care on the increasing the movement of the cervical part of the spine at short-term follow up (Tidy, 2009). Physiotherapy needs to be started right after the injury. Since there are psychological repercussions of the incident, as well as the treatment due to not going to absence from office and staying away from family, the patient may have low morale and feel reluctant to participate in physiotherapy exercises. Hence the physiotherapy should be focused on providing the patient emotional support and psychological counseling along with exercises to retain full function. Patients need to be highly motivated in order to gain benefit from the exercises (Pryor & Prasad, 2002). Prioritizing the Patient’s Presenting Problems In my opinion, the numbness that is spreading down the length of the patient’s spine requires immediate attention. The rest of the complaints are minor and can be dealt with over the period of time. However, numbness can be indicative of spinal damage or perforations of the intervertebral discs, and if the condition remains untreated, it can cause irreversible damage. Moreover, numbness can be a cause of great concern for the patient since other symptoms are not that severe and are commonly encountered in daily life. Hence, the short term goal for physiotherapy should aim to achieve mobilization of the spine and to relief the patient of any distress it is causing her. Physiotherapy for Spine In spinal management, physiotherapy aims to provide the patient with a structured relevant process. This encompasses an accurate assessment of the patient, clinical reasoning, data processing and diagnosis (). Such a process would help the physiotherapist to draft a treatment program for the patient that is tailored according to the requirements of the patient. For the patient to regain all normal functions of the spine, all parts and aspects of spinal components, such as soft tissue and muscular, must be able to perform their individual functions and to work together with each other to enable the spine to function normally as a whole. Since the patient complains of numbness down the length of her spine, a MRI or CT scan can be done to determine the structures that have been injured. If the injury is in the lumbar region, the patient’s ability to breathe would not be affected. However, an injury in the cervical and thoracic region, it may compromise the patient’s ability to breathe and reduce arm power. Therefore the patient can be asked to perform respiratory exercises. These may include asking the patient to take deep breaths and to teach her how to expand her lungs fully. The patient can be asked to cough to expectorate (). It is useless to deal with the respiration of the person without paying attention to the person as a whole; thus, respiratory physiotherapy aims to not only provide pain relief but also to educate the patient (Hough, 2001). Physiotherapy Interventions Clarke, Jones and O’Malley (2010) suggest that physiotherapy interventions for damage to the spinal cord should be based on four levels. The first include manual techniques. These are the techniques that are performed by the physiotherapist. These aim to improve the range of movements of the joints. Adjustments and joint manipulations can be done to release protective spasm. Mulligan’s techniques and joint gliding techniques can be employed to regain the normal biomechanics of the joints. It should be remembered that the patient’s history of steroid can be a cause of impaired healing (Porter, 2008); so the physiotherapist needs to be patient and not rush the treatment. The second aspect of interventions involves passive techniques. This requires the use of electrotherapy and ice or heat. Electrical equipment, ultrasound, laser and interferential can be made use of to restrict inflammatory changes going on in the spine. These measures will also help to improve muscle spasm and to promote the health of the patient. The usage of ice or heat can be instrumental in mitigating inflammation in the regions of the spine and in decreasing muscle spasm. The third aspect of physiotherapy interventions involves exercise interventions. Rehabilitation can focus on enhancing the flexibility and the stability of the muscle. Various exercises can be utilized for this intention. However, the exercises that need to be performed should be light and gentle, mainly because the patient’s social history is not indicative of strenuous work. Therefore her body would not be accustomed to perform intensive exercises. The patient also has asthma, and cardiovascular training can be given in line with the patient’s medical history. The patient can not perform strenuous exercises due to her history of asthma. However, an intervention that could be of benefit for both asthma and spinal mobilization includes massage. Studies have shown that symptoms like wheezing and breathlessness can be relieved through physiotherapy. For people with asthma, a Cochrane systematic review has found out that physical training can enhance cardiopulmonary fitness (Chaitow & Pizzorno, 2008). A factor to consider when asking the patient to exercise is to ensure that the patient is hydrated. Dehydration occurs faster in patients with asthma and may elicit an asthmatic attack. The last aspect of the interventions that the physiotherapist needs to offer to the patient is education. Education is discussed in detail in the yellow flags indicator. The interventions need to be aided by sympathy and compassion from the doctor. The patient needs to be encouraged and emotional support should be provided. Yellow Flags Analysis The physiotherapist needs to assess the psychological profile of the patient. Indicators such as a negative attitude towards pain being deleterious to health, low levels of activity, preference of passive treatment over active, feeling depressed and not participating in social activities and low morale need to be dealt with along with the physical therapy (Tidy, 2009). This is important in order to achieve the maximum effects of the treatment. Patients who actively participate in the exercises and activities that the physiotherapist prescribes show faster recovery than those who are not that active. The management plan should thus include education regarding the false beliefs of the patient. The management plan should aim to increase the awareness of the patient and to ascertain that the patient understands the importance and effects of the exercises that she does. CONCLUSION Physiotherapy aims to alleviate the condition of the patient and to provide relief from discomfort and pain. The physiotherapy interventions suggested above are short-term and would help the patient return back to her normal routine soon. However, the physiotherapist should be aware of the fact that the patient is going through a lot emotionally and hence needs to be patient and empathic towards her. The faith of the patient in her recovery needs to be consistently built upon by encouragement by the physiotherapist. Only then can the therapy be maximally effective. Appendix CASE STUDY 46 year old women reports to the Accident and Emergency department of the hospital. She was in a stationary car when the car was hit from behind. Her main concern was her baby son, and she had him checked at the hospital. The patient was asymptomatic at that time and did not carry out any diagnostic tests. She was well oriented in space and time and only presented to be anxious. She was recommended pain killers if she experienced pain and rest. After some time has elapsed the patient presents in the clinic. She is presenting with severe “numbing” pain along the length of her spine and across her shoulders, sharp pain on inspiration with soreness across her chest, some tingling in her right foot. She is holding her head and neck stiffly and is reluctant to move as afraid of “breaking something”. The patient is depressed and her response to the therapy is not positive. The patient is a mother of a 14 month old boy. She is a housewife and assists her husband, who runs his own print business, in his work. Her past medical history is marked by multiple attacks of asthma. She was diagnosed with asthma in her early childhood and was often admitted to the hospital in her teenage for severe acute attacks necessitating systemic corticosteroids. She uses inhaled bronchodilators/steroids regularly now to control the asthma. Her first pregnancy was prior to her menopause and was normal. She also had anorexia nervosa during her adolescence. FACTORS THAT NEED TO BE ADDRESSED IN PHYSIOTHERAPY MANAGEMENT PLAN Physiotherapy can prove to be very beneficial for victims of non-fault car accidents. Such accidents often cause soft tissue injuries to the neck, shoulders and back. When the person is driving, his head and neck are against the seat. If the car is hit from the rear, the impact will make the body move forward. The sudden jerk when the car is hit and the subsequent propulsive movement of the body forward can be the cause of many soft tissue injuries through out the body. A whip lash is defined as the injuries that the neck sustains after hyperextension of the head in the forward or backward direction or sideways. Whip lash symptoms may not develop immediately. In accidents where no bones are broken and there is no external bleeding and bruises, soft tissue injury can go unnoticed since the patient might appear to be asymptomatic. In the event of such an impact, the following typical symptoms explain the symptoms of the aforementioned patient and define the goals of the physiotherapy management plan: Neck pain: occurring in 62% to 98% of the people, and starts two hours up to two days after the accident (Anon., 2009). Neck pain is the consequence of tightened muscles as a reflex to muscle tears or increased movement of joints due to ligament damage. The tightening of the muscles is a spontaneous response of the body to support the head and to restrict unnecessary movement. The patient is holding her neck and head stiffly; physiotherapy will be aimed to provide relief to the tightness she feels due to the strain in the muscles. Shoulder pain: patients describe it as radiating from the base of the neck to the shoulder blade and may be due to tensed muscles. Muscle tears: patients describe muscle tears as burning pain of tingling. The tingling in the patient’s right foot is suggestive of a muscle tear. Numbing in the spine: the force with which the body is jolted forward can cause damage to the intervertebral discs. This can result in the perforation of the discs. Spasm in the vertebral column can be a cause of lower back pain. The nerves can be stretched, irritated or choked (Langlitz, 2009). Damage to the chest cavity: internal organs of the chest cavity can also sustain injury during a road traffic accident. A likely cause for the soreness in chest and painful inspiration that the patient feels is due to misalignments in the mid thoracic area. Anxiety and depression: psychological symptoms of whiplash injuries. An analysis of the clinical yellow flags would be useful. It needs to be noted that the patient’s usage of systemic steroids is a risk factor for severe injury (Tidy, 2009). Therefore an analysis of the red flag conditions needs to be made. Moreover, since the patient complains of numbness spreading down the length of her spine it is safe to assume that the thoracic as well as the cervical regions of the spine have been injured. Moreover the patient has a history of asthma and anorexia nervosa and before suggesting treatment for the patient, these factors need to be taken into account. The patient’s social history indicates low to medium activities and so the physical therapy can not incorporate strenuous exercises. REFERENCE LIST Anon., 2009. What is whip lash? [Online] Available from: http://www.themedicalquestions.com/illness/what-is-whip-lash.html [Accessed 10 July 2010]. Chaitow, L. & Pizzorno, J., 2008. Naturopathic Physical Medicine: Theory and Practice for Manual Therapists and Naturopaths. Elsevier Health Sciences. Charted Society of Physiotherapy, 2010. What physiotherapists do. [Online] Available from: http://www.csp.org.uk/director/public/whatphysiotherapistsdo.cfm [Accessed 10 July 2010]. Clarke, A., Jones, A. & O’Malley, M., 2010. ABC of Spinal Disorders. Oxford: John Wiley and Sons. Hough, A., 2001. Physiotherapy in respiratory care: an evidence-based approach to respiratory and cardiac management. 3rd ed. Nelson Thornes. Langlitz, G., 2009. Chiropractic Care: Symptoms of Whiplash. [Online] (Updated 12 January 2010) Available from: http://www.spineuniverse.com/conditions/whiplash/chiropractic-care-symptoms-whiplash [Accessed 10 July 2010]. Pryor, J. A. & Prasad, S. A., 2002. Physiotherapy for respiratory and cardiac problems: adults and paediatrics. 3rd ed. Elsevier Health Sciences. Porter, S. B., 2008. Tidy’s Physiotherapy. 14th ed. Philadelphia (PA): Elsevier Health Sciences. Simon, C., O’Reilley, K., Proctor, R. & Buckmaster, J., 2007. Emergencies in Primary Care. Oxford University Press. Tidy, C., 2009. Whiplash and Cervical Spine Injury. [Online] (Updated 24 November 2009) Available from: http://www.patient.co.uk/doctor/Whiplash-and-Cervical-Spine-Injury.htm [Accessed 10 July 2010]. Read More