Physical therapists

Lifestyle modifications should be started early and continued throughout treatment because they may improve ADL, gait, balance, and mental health. The most common interventions include maintaining good nutrition, physical condition, and social interactions. Patients should avoid medications that block central dopamine, as they may worsen PD.1,18 A multidisciplinary approach using the expertise of nutritionists, speech therapists, physical therapists, occupational therapists, and social workers may optimize care but may not be covered by insurance. Patients should maintain regular visits with their optometrist or ophthalmologist and their dentist. The dentist should be informed that the patient has PD, as PD medications that decrease saliva flow may increase the risk of dental caries. 

Stress lifestyle modifications for rehabilitation and prevention. Recommend strength training, range-of-motion exercises, and a warm-up period before exercise. In repetitive-motion injury, recommend methods to correct biomechanical abnormalities and vary work tasks as applicable. Refer to a physical therapist or sports trainer as needed. 

LPT Licensed Physical Therapist NSR Normal sinus rhythm... 

W. E. Prentice, Therapeutic Modalitiesfor Physical Therapists, McGraw-Hill, New York, 2002. 

It is therefore clear that consumers need to be educated about the use of such medications and reminded that OTC products can produce substantial benefits and adverse effects. All health care providers, including physical therapists and occupational therapists, need to be in a position to help educate and counsel their patients about the benefits and drawbacks of such medications. While therapists should not directly prescribe or administer OTC products, therapists can provide information about the proper use and potential benefits of these medications. 

Physical therapists may encounter the use of local anesthetics in several patient situations because of their various clinical applications. For example, therapists may be directly involved in the topical or transdermal administration of local anesthetics. As discussed earlier, repeated topical application of local anesthetics may help produce long-term improvements in motor function in patients with skeletal muscle hypertonicity, so therapists may want to consider incorporating topical anesthetics into the treatment of certain patients with CNS dysfunction. Therapists may also administer local anesthetics transdermally, using the techniques of iontophoresis and phonophoresis. Agents such as lido-caine can be administered through this method for the treatment of acute inflammation in bursitis, tendinitis, and so on. 

Brief History. R.D. is a 35-year-old man who developed pain in his right shoulder after spending the weekend chopping firewood. He was examined by a physical therapist and evaluated as having supraspinatus tendinitis. Apparently, this tendinitis recurred intermittently, usually after extensive use of the right shoulder. During past episodes, the tendinitis was resistant to treatment and usually took several months to resolve. 

Rheumatoid arthritis and osteoarthritis represent the two primary pathologic conditions that affect the joints and periarticular structures. Although the causes underlying these conditions are quite different from one another, both conditions can cause severe pain and deformity in various joints in the body. Likewise, pharmacologic management plays an important role in the treatment of each disorder. Because physical therapists and other rehabilitation specialists often work with patients who have rheumatoid arthritis or osteoarthritis, an understanding of the types of drugs used to treat these diseases is important. 

Brief History. M.R. is a 48-year-old man with a history of coronary artery disease and cardiac rhythm disturbances. Specifically, he has experienced episodes of paroxysmal supraventricular tachycardia, with his heart rate often exceeding 180 beats per minute. He has been treated for several years with the nonspecific beta blocker propranolol (Inderal). Oral propranolol (60 mg/d) has successfully diminished his episodes of tachycardia. In an effort to improve his myocardial function and overall cardiovascular fitness, M.R. recently enrolled as an outpatient in a cardiac rehabilitation program. Under the supervision of a physical therapist, he attended cardiac training sessions three times each week. A typical session consisted of warm-up calisthenics, bicycle ergometry, and cool-down stretching activities. Each session lasted approximately 45 minutes. 

Decision/Solution. In addition to the neuromuscular facilitation activities, the physical therapist initiated a program of chest physical therapy including postural drainage and deep-breathing exercises. The physical therapist coordinated these activities with the respiratory therapist so that the patient first received a treatment of the mucolytic agent. Also, the physical therapist had the patient self-administer a dose of the inhaled beta-2 bronchodilator approximately 1 hour prior to the chest therapy session, thus allowing the bronchodilator to produce maximal airway dilation and permit optimal clearance of bronchial secretions. 

This chapter first discusses the physiologic role of the male hormones and the pharmacologic use of natural and synthetic androgens. The physiologic and pharmacologic characteristics of the female hormones are then addressed. As these discussions indicate, there are several aspects of male and female hormones that should concern physical therapists and occupational therapists. Rehabilitation patients may use these agents for approved purposes, for example, female hormones as contraceptives. These agents may also be... 

Therapists may also play an important role in educating patients about the dangers of androgen abuse. When dealing with an athletic population, physical therapists may serve as a source of information about anabolic steroids. Therapists should advise athletes about the potential side effects, such as liver, cardiovascular, and reproductive abnormalities. Therapists can also monitor blood pressure in athletes who appear to be using androgenic steroids. This interaction may help prevent a hypertensive crisis, as well as illustrate to the athlete the harmful effects of these drugs. 

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