Physiotherapy

Miller, L.R. and Mellor, F. (2002) Longitudinal changes in extended roles in radiography. Radiography, 8, 223-34. 

Prescriptions/TheNonMedicalPrescribingProgramme/index.htm http //www.dh.gov.uk/ en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH. 4110032 Department of Health, Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/Podiatrists, Physiotherapists and Radiographers within the NHS in England A Guide for Implementation 2005 

A physiotherapy perspective of non-medical prescribing is discussed here. 

In 2003, qualified registered physiotherapists were included in the list of professionals who are able to supply medicinal products under PGDs. A typical example of PGD use is in accident and emergency analgesia, when a physiotherapist would be allowed to supply 

The information that must be included in a PGD for a physiotherapist follows the same general rules that are listed in the podiatric example given earlier in this chapter. Specific examples of drugs that might be included in a physiotherapy PGD are triamcinolone acetonide lOmg/ml and methylprednisolone acetate 40 mg/lidocaine hydrochloride 10 mg/ml, which are administered by intra- or extra-articular injection. Both of these drugs are used for the treatment of inflammatory conditions such as soft tissue injuries and isolated joint inflammation (see Chapter 7). 

Mobilization Postures Passive and active limb exercises CRT 

Chest physiotherapy MH Percusssion/vibration Manually or mechanically assisted cough suctioning 

Muscle retraining Respiratory muscle training Peripheral muscle training NMES 

Abbreviations. TDP, therapist-driven protocols CRT, continuous rotational therapy  

manual hyperinflation NMES, neuromuscular electrical stimulation. 

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The traditional form of chest physiotherapy (CPT) is known as percussion and postural drainage. Areas of the patient s chest, sides, and back are rapidly clapped by hand in different patient positions, followed by cough or forced expiration to... 

Women often experience pelvic and back pain during pregnancy. Systematic review suggests that water aerobics, pillows that support the abdomen, physiotherapy, and acupuncture... 

The supportive care of the patient with pneumonia includes the use of humidified oxygen for hypoxemia, fluid resuscitation, administration of bronchodilators when bronchospasm is present, and chest physiotherapy with postural drainage if there is evidence of retained secretions. 

Medicine Ultrasonic imaging (2 -10 MHz) is used, particularly in obstetrics, for observing the foetus and for guiding subcutaneous surgical implements. In physiotherapy lower frequencies (20-50 kHz) are used in the treatment of muscle strains, dissolution of blood clots and cancer treatment. 

Note that the doses used in RA (7.5 to 15 mg/week) are somewhat lower than those used in psoriasis and that larger doses could lead to toxicity. Rest and physiotherapy as indicated should be continued. 

Medical non-pharmaceutical therapy of soft tissue rheumatism includes general and local rest, often physiotherapy, occupational therapy, and early mobilization. The pharmaceutical therapy of soft tissue rheumatism comprises analgesics and NSAIDs, the latter when inflammatory components are present. 

Most nonspecific LBP settles within 2 weeks. Almost 90% of patients are relieved from pain within 6 months. Only 1-2% of patients eventually require surgery. Of the patients with LBP in combination with sciatica due to a herniated disc 70-93% is relieved of symptoms between 2 and 8 weeks without surgery. Before the pain settles, analgesics, minimum rest, appropriate physiotherapy, and early mobilization are required. Recurrence of LBP can be effectively prevented by endurance exercises. 

Some general principles for the treatment of Seronegative Spondylarthritis can be summarized as follows. Mild cases of SpA are controlled with physiotherapy and NSAIDs, paying attention to GI, renal, cardiovascular, hypertensive and hepatic risk... 

ReA refractory to NSAIDs, DMARDs and physiotherapy can be treated with SBC-5-IMNs. When also refractory to SBC-5-IMNs then add on infliximab at week 0-2-6 combined with IVT - - PA. Corticosteroids and dilating eye drops are used to suppress ocular inflammation to prevent scaring and alleviate pain. When required to prevent blindness, corticosteroids are injected into the eye. 

Dodd ME, Prasad SA. Physiotherapy management of cystic fibrosis. Chron Respir Dis. 2005 2 139-149. 

Alter short-term therapy (some weeks), in CF patients with mild to moderate stable pulmonary disease, inhalation of rhDNase in combination with other CF therapies (eg., bronchodilators, pancreatic enzymes, chest physiotherapy) improves the lung function [64.70-72], The rhDNase therapy is also associated with significant improvements in general well-being, cough frequency, and congestion [71,72],... 

Mrs KR should be advised to try and lose weight. She may wish to discuss the possibility of physiotherapy treatment with her GP. Patients should be encouraged to exercise gently and that exercise should include local muscle stretching and general aerobic exercise. The use of heat and cold therapy may help, as may ultrasound. Some patients may find a TENS (transcutaneous electrical nerve stimulation) machine is helpful. 

Arthritis Research Campaign (2008) Physiotherapy and arthritis an information sheet. Available at http //www.arc.org.uk/about arth/infosheets/6256/6256.htm [Accessed on 2 July 2008],... 

The patient may benefit from physiotherapy and she should enquire at her local surgery or hospital. The Arthritis Research Campaign also publishes support information. 

Many patients can recover at least part of their lost muscular activity following a stroke as the undamaged neurones can be induced to make new connections and take over some of the lost functions of the damaged area. Physiotherapy will be required to promote any improvement in muscle control and activity. 

Pneumonia is a common complication in elderly patients confined to bed. Chest infection is particularly common after stroke because of impairment in swallow and cough reflex, poor respiratory movement and pulmonary embolism. The risks can be reduced by good nursing and chest physiotherapy. A pharyngeal airway may be required, particularly in drowsy patients or after a brainstem stroke, and ventilation may be considered in certain patients. 

Spasticity, muscle contractures, painful shoulder and other joints of a paralyzed limb, malalignment or subluxation of the shoulder, falls and fractures can all potentially be avoided by good nursing and physiotherapy. Osteoporosis in a paralyzed Umb presumably increases the risk of fractures but may be unavoidable (Sato et al. 1998). 

A randomised controlled trial. Australian Journal of Physiotherapy 50 219-224 Bowen A, Lincoln NB, Dewey ME (2002). Spatial neglect is rehabilitation effective Stroke 33 2728-2729... 

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