Assisting in physical therapy & rehabilitation

Physical medicine and rehabilitation (PM&R) is also called physiatry or rehabilitation medicine. PM&R uses therapies and physical agents (e.g., heat, electricity, and light) to diagnose, prevent, and treat disorders. This area of medicine is focused on improving and restoring a patient’s ability and quality of life when the person has physical impairments. Such disabilities include conditions that impact the nervous, muscular, and skeletal systems. The goals of PM&R are to do the following:

• Help the patient become as independent as possible with activities of daily living (e.g., grooming, walking, eating)
• Improve the person’s quality of life (e.g., reduce pain, increase a person’s ability to do activities)
• A physiatrist is a physician who specializes in physical medicine and rehabilitation. A physiatrist diagnoses and prescribes treatments and therapies for the patient. As the patient undergoes rehabilitation, the physiatrist manages the patient’s medical conditions. A physiatrist works closely with several therapies:
• Physical therapy (PT) focuses on improving a person’s movement, strength, and mobility through the use of stretches, exercises, and other physical activities. A physical therapist works with patients to help them learn to walk with assistive devices, such as walkers and canes.
• Occupational therapy (OT) focuses on improving a person’s ability to perform activities of daily living, such as bathing, grooming, toileting, and eating. OT is focused on a patient’s fine and gross motor skills.
• Speech therapy is involved with the diagnosis and treatment of patients with swallowing and communication (speech and language) difficulties.

Often medical assistants are hired to assist physiatrists with patient care. Medical assistants in other areas of ambulatory care also work with patients who have conditions that affect movement and mobility. Coaching patients on how to use a sling, cold therapy, or assistive devices, such as crutches, is common in urgent care, orthopedics, and primary care settings. This chapter addresses the medical assistant’s role in assisting with the examination and treatments of conditions related to rehabilitation.

Assisting with the examination

When a patient arrives for an examination, the medical assistant obtains the patient’s vital signs and medical history. Allergies and medication lists are updated. The following sections describe the medical assistant’s role in preparing the patient for the examination and assisting the patient during the examination.

Preparing for the examination

When the medical assistant gathers a medical history on patients with a musculoskeletal concern, it is important to ask about the symptoms, the pain level, and the effect on the patient’s life. When discussing the symptoms, the medical assistant should obtain information about the onset and what reduces or increases the symptoms. The medical assistant can ask the patient to rate the pain using a 0 to 10 scale. Zero is no pain, and 10 is the worst pain ever. Another pain assessment tool is the Wong-Baker FACES Pain Rating Scale. The medical assistant should explain the scale to patients, and then patients can state how they feel. This scale works well for children. The healthcare facility may also require a functional assessment to be done, which gathers information on the patient’s mobility and ability to do activities of daily living (ADLs) (e.g., toileting, bathing, grooming, and eating).

Assisting Patients

When you work with a patient who has an injury, assist the patient into a comfortable position and offer a pillow or folded blanket to support the extremity. For recent injuries, if ordered by the provider, apply a cold application to the injured area. (This procedure will be discussed later in the chapter.)

Patients may have limited mobility because of pain. The medical assistant may need to help patients change into the examination gown. Explain clearly what is happening and what the patient can expect.

Assisting with diagnostic procedures

The medical assistant helps with diagnostic procedures by scheduling and preparing patients for procedures. If tests require restrictions of food or fluids, the medical assistant should address the following points with the patient after talking with the provider:

• Can the patient have water prior to the test?
• Which medications should the patient take prior to the test, or when can the patient resume the current medications?

The medical assistant may need to screen the patient for specific allergies, medications, and so on prior to scheduling the procedure. For some procedures, a signed consent form is required. Patients should be notified of what they will experience during the procedure and any follow-up care required after the test.

Range-of-motion measurement

Often orthopedic injuries severely affect the normal range of motion (ROM) of a joint. The range of motion is the normal movement allowed by the joint. Testing the ROM of specific joints is an objective measure of both the seriousness of an injury and the recovery progress. The joint may be evaluated with active and passive ROM. To determine the active ROM of a joint, the patient is asked to move the joint as far as possible. To evaluate passive ROM, the provider moves the joint as far as possible.

A goniometer is the most common tool used to measure the ROM of a joint. Goniometers have calibration markings to indicate the measurement. A goniometer has two arms that are fixed together with a hinge joint at one end. Each of the arms is lined up with a bone on each side of the joint being tested. The degrees of motion are indicated on a scale on the hinged center of the non digital instrument or on the digital display of the digital goniometer. All ROMs are measured in degrees. Usually, pain, tenderness, or crepitation is also noted during the procedure.

Muscle strength evaluation

During the ROM evaluation, the provider also assesses each muscle group for strength. Normal muscle strength allows for complete voluntary ROM despite resistance. This resistance can be gravity, as when rising from a sitting to a standing position, or physical, as in pulling, pushing, or lifting an object. Muscle strength is bilaterally equal in normal conditions.

Hand grip strength can be measured with a dynamometer. Digital and nondigital dynamometers are available. A dynamometer provides an objective measurement of hand grip strength. The patient holds the dynamometer in the hand being tested. Typically, the arm is at the side of the patient with the elbow bent at 90 degrees. Various arm and hand positions may be used for different assessments. If a dynamometer is not available, a blood pressure cuff can be used. Follow these steps to assess the hand strength:

1. Roll up an aneroid blood pressure cuff, and have the patient hold it in one hand.
2. Inflate the cuff to 20 mm Hg of pressure, and lock the valve.
3. Ask the patient to squeeze the cuff as tightly as possible.
4. Note the increase in pressure on the dial (a normal grip registers above 150 mm Hg).
5. Record the hand tested and the results of the test.
6. Repeat on the other hand.

Assisting with immobilization treatments

There is a wide range of immobilization treatments used for patients with musculoskeletal conditions and rehabilitation. The following sections describe devices that provide varying degrees of immobilization to the affected extremity. The medical assistant needs to be familiar with how to apply the devices and the required coaching for patients.