Physiotherapist's: October 2011

Thursday, October 13, 2011

Physical Therapy Abbreviations

P-Z
P
_
p – after

P – poor (used in muscle testing)

P: - plan

P.A. – physician’s assistant

PA – posterior/anterior

para – paraplegia

pc – after meals

PCL – posterior cruciate ligament

PE – pulmonary embolus

PEEP – positive end expiratory pressure

per – by/through

PF – plantar flexion

p.o. – by mouth (per orem)

PERRLA – pupils equal, round, reactive to light and accommodation

P.H. – past history

p.m. – afternoon

PMH – past medical history

PNF – proprioceptive neuromuscular facilitation

PNI – peripheral nerve injury

POMR – problem-oriented medical record

pos. - positive

poss – possible

post. – posterior

post-op – after surgery

PRE – progressive resistive exercise

pre-op – before operation

Prep. – preparation

prn – whenever necessary

PROM – passive range of motion

PROME – passive range of motion exercise

PSIS – posterior superior iliac spine

PT – physical therapy/ therapist

PT – prothrombin time

Pt. or pt. – patient

PTA – prior to admission

PTA – physical therapist assistant

PTB – patellar tendon bearing

PVD – peripheral vascular disease

PWB – partial weight bearing

Q

q – every

qd – everyday

qh – ever hour

qid – four times a day

qn – every night

R

® - right

RA – rheumatoid arthritis

RBBB – right bundle branch block

R.D. – registered dietitian

Rehab – rehabilitation

reps. – repetitions

resp – respiratory, respirationRICE - rest, ice, compression, elevation
Z
RN – registered nurse

R/O or r/o – rule out

ROM – range of motion

ROME – range of motion exercises

ROS – review of systems

rot. – rotation

RR – respiratory rate

RROM – resistive range of motion

R.T. – respiratory therapist/therapy

Rx – prescription; therapy; intervention plan; treatment

S

_
s – without

SACH – solid ankle cushion heel

SBA – standby assist

SCI – spinal cord injury

SC jt. – sternoclavicular joint

SED – suberythemal dose

sig – directions for use; use as follows; let it be labeled

SI jt. – sacroiliac joint

SLE – systemic lupus erythematosus

SLP – speech-language pathologist

SLR – straight leg raise

SNF – skilled nursing facility

SOAP – subjective, objective, assessment, plan

SOB – shortness of breath

S/P – status post

S/Sx – signs and symptoms

stat. – immediately or at once

STG – short term goal

sup. – superior

Sx – symptoms

T

tab – tablet

TB – tuberculosis

TBI – traumatic brain injury

TENS or TNS – transcutaneous electrical nerve stimulator/ stimulation

THA – total hip arthroplasty

THR – total hip replacement

TIA – transient ischemic attack

tid – three times daily

TIW – three times per week

TKA – total knee arthroplasty

TKR – total knee replacement

TMJ – temporomandibular joint

TNR – tonic neck reflex

t.o. – telephone order

TPR – temperature, pulse and respiration

TTWB – toe touch weight bearing

TV – tidal volume

Tx – treatment

tx – traction

U

UA – urine analysis

UE – upper extremity

UMN – upper motor neuron

UMNL – upper motor neuron lesion

URI – upper respiratory infection

US - ultrasound

UTI – urinary tract infection

UV ultraviolet

V

VC – vital capacity

VC – verbal cues

VD – venereal disease

VO or v.o. – verbal orders

Vol. – volumev.s. – vital signs

W

w/c – wheel chair

W/cm2 – watts per centimeter square

WBC – white blood cell

WFL – within functional limits

wk. – week

WNL – within normal limits

wt. – weight

X

x – number of times performed (e.g. x3, x8, etc.)

Y

y/o or y.o. – years old

yr. – year

Physical Therapy Abbreviations

I-O

I&O – intake and output

IADL – instrumental activities of daily living

ICU – intensive care unit

IDDM – insulin dependent diabetes mellitus

IE – initial evaluation

IFC – interferential current

IM – intramuscular

imp. – impression

indep – independent

inf. – inferior

inv. - inversion

IR or int. rot. – internal rotation

IRDS – infant respiratory distress syndrome

IS – incentive spirometer, incentive spirometry

IV – intravenous

K

KAFO – knee ankle foot orthosis

kcal – kilocalories

KJ – knee jerk

KUB – kidney, ureter, bladder

L

L within a circle – left

Lat – lateral

LBBB – left bundle branch block

LBP – low back pain

LE – lower extremity

LOC – loss of consciousness, level of consciousness

LMN – lower motor neuron

LMNL – lower motor neuron lesion

LOS – length of stay

LP – lumbar puncture

LLQ – left lower quadrant

LQ – lower quadrant

LTG – long term goal

LUQ – left upper quadrant

M

MAP – mean arterial pressure

max. – maximal

MD – medical doctor, doctor of medicine

MED – minimal erythemal dose

Meds. – medications

MI – myocardial infarction

min – minimal

min. – minute

mm. - muscle

MMT – manual muscle test, manual muscle testing

mod. – moderate

MP – metacarpophalangeal

MRSA – methicilin resistant staphylococcus virus

MS – multiple sclerosis

MVA – motor vehicle accident

N

NDT – neurodevelopmental treatment

neg. – negative

NG or ng – nasogastric

N.H. – nursing home

NIDDM – non-insulin dependent diabetes mellitus

nn. – nerve

noc – night, at night

NPO or npo – nothing by mouth

NSR – normal sinus rhythm

NWB – non-weight bearing

O

O: - objective

OA – osteoarthritis

OB – obstetrics

OBS – organic brain syndrome

od – once daily

OOB – out of bed

O.P. – outpatient

O.R. – operating room

ORIF – open reduction, internal fixation

OT – occupational therapist/therapy

OTR – registered occupational therapist

Physical Therapy Abbreviations

A-H

A

@ – at

ā – before

A: – assessment

AAA – abdominal aortic aneurysm

AAROM – active assistive range of motion

Abd. or abd. – abduction

ABG – arterial blood gas

ABI – acquired brain injury

ac – before meals

AC – acromioclavicular

ACL – anterior cruciate ligament

ACTH – adrenocorticotropic hormone

Add. or add. – adduction

ADL’s or ADL – activities of daily living

ad lib – at discretion

adm – admission/admitted

AE – above elbow

afib – atrial fibrillation

AFO – ankle foot orthosis

AIDS – acquired immune deficiency syndrome

AIIS – anterior inferior iliac spine

AJ – ankle jerk

AK – above knee

AKA – above knee amputee, above knee amputation

ALS – amyotrophic lateral sclerosis

a.m. – morning

AMA – against medical advice

amb – ambulate, ambulates, ambulated, ambulatory, ambulation

ANS – autonomic nervous system

Ant. – anterior

AP – anterior-posterior

approx. – approximately (also "~" symbol can be used)

ARDS – adult respiratory distress syndrome

ARF – acute renal failure

AROM – active range of motion

ASA – aspirin

ASAP or asap – as soon as possible

ASCVD – arteriosclerotic cardiovascular disease

ASHD – arteriosclerotic heart disease

ASIS – anterior superior iliac spine

Assist. – assistive, assistance

A-V – arteriovenous

AVM – arteriovenous malformation

B

B/S – bedside

BE – below elbow

bed mob. – bed mobility
BID or bid – twice a day

bilat – bilateral (a B enclosed within a circle may also be used)

BK – below knee

BKA – below knee amputee, below knee amputation

BM – bowel movement

BOS – base of support

BP – blood pressure

bpm – beats per minute

BR – bedrest

BRP – bathroom privileges

BS – breath sounds/bowel sounds

BLE – both lower extremities

BUE – both upper extremities

BUN – blood urea nitrogen

C
_
c - with

C&S – culture and sensitivity

c/o – complains of

CA – cancer, carcinoma

CABG – coronary artery bypass graft

CAD – coronary artery disease

CAT – computerized axial tomography

CBC – complete blood count

C/C – chief complaint

cc. – cubic centimeter

cerv. - cervical

CF – cystic fibrosis

CHF – congestive heart failure

CHI – closed head injury

CKD – chronic kidney disease

cm. – centimeter

CMV – cytomegalovirus

CNS – central nervous system

CO – cardiac output

CO2 – carbon dioxide

Cont. or cont. – continue

COPD – chronic obstructive pulmonary disease

COTA – certified occupational therapist assistant

CP – cerebral palsy

CPAP – continuous positive airway pressure

CPR – cardiopulmonary resuscitation

CRF – chronic renal failure

CSF – cerebrospinal fluid

CV – cardiovascular

CVD – cardiovascular disease

CWI – crutch walking instructions

CXR – chest x-ray

Cysto – cystoscopic examination
D

D/C – discontinue, discontinued, discharge, discharged

dept. – department

DF - dorsiflexion

DIP – distal interphalangeal

DJD – degenerative joint disease

DM – diabetes mellitus

DNR – do not resuscitate

DO – doctor of osteopathy

DOB – date of birth

DOE – dyspnea on exertion

DTR – deep tendon reflex

DVT – deep vein thrombosis

Dx – diagnosis

E

ECF – extended care facility (In Physiology – extracellular fluid)

ECG/EKG – electrocardiogram, electrocardiograph

ED – emergency department

EEG – electroencephalogram, electroencephalograph

EENT – ear, eyes, nose, throat

EMG – electromyogram, electromyography, electromyography

ER or Ext. rot. – external rotation

E.R. – emergency room

eval. – evaluation

Ex. – exercise

ext. – extension

F

FBS – fasting blood sugar

FEV – forced expiratory volume

FH – family history

flex. – flexionFRC – functional residual capacity

FUO – fever unknown origin

FVC – forced vital capacity

FWB – full weight bearing

Fx., fx – fracture

G

GB – gall bladder

GCS – Glasgow coma scale

GI – gastrointestinal

GIT – gastrointestinal tract

GSW – gunshot wound

GYN – gynecology

H

H/A - headache

H&H, H/H – hematocrit and hemoglobin

Hct – hematocrit

HEENT – head, ear, eyes, nose, throat

Hemi. – hemiplegia, hemiparesis

HEP – home exercise program

Hgb – hemoglobin

HIV – human immunodeficiency virus

HKAFO – hip knee ankle foot orthosis

HNP – herniated nucleus pulposus

h/o – history of

HOB – head of bed

HR – heart rate

hr. - hour

hs – at bedtime

HTN or Htn – hypertension

Hx – history

Saturday, October 8, 2011

Physiotherapy Evaluation and Examination

Physiotherapy evaluation and examination is a very important process in physiotherapy practice. You become a detective of some sort. It becomes a skill that is sharpened as you see more people requiring physiotherapy evaluation and treatments.

Don't forget to introduce yourself first

Before getting any data from your client, you should always introduce yourself and make him or her comfortable talking to you. If possible, the area should be clear of distractions such as an open door where people are seen passing all the time. In addition, sitting in front of your client without any barrier (a table perhaps) between you and your client may be even better. This could probably make the person more comfortable talking to you.

History of Present Illness

In the history of present illness, or HPI, you will be asking questions that are related to the specific problem of your client. This may include asking:

What made you come here?
What did you feel? Please describe to me (Location/Intensity/Duration). What other symptoms did you feel? Please describe them.
What was your activity at the time your symptoms occurred? / What were you doing when your symptoms occurred?
What makes your symptoms worse? What makes it better?
What did you do about your symptoms? (Medications/Consultations and treatments provided including relevant lab works and results if available)
What other concerns do you have?

If your client's symptoms had been present in the past, ask why he or she decided to have a consultation today.

You might also want to make use of the mnemonics OLD CARTS, which stands for Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing and Severity. But, as you become skilled in clinical questioning (with client rapport of course!), questions that your supposed to ask will come in naturally.

Your Clinical Eye

Sometimes, you will know what your client's problem is as he or she enters the evaluation room before the actual evaluation and examination. This is your clinical eye working.

For example, your client is walking with exaggerated right hip and knee bending, lifting the foot to clear it off the ground while walking. Having your clinical eye working, you might expect that he has weakness or paralysis of his ankle dorsiflexors (muscles in front of the leg). Since you know that that may be the case with your client, you can now prepare your questions in your mind.

Past Medical History (PMHx)

Ask about previous medical conditions or other treatments that they are having for another health problem.

Family Medical History

Some conditions are inherited. Sometimes, health problems, such as heart disease or diabetes runs in their family, putting them at risk for the condition, as well.

Tests and Measurements

By doing physiotherapy tests and measurements during the initial encounter / initial evaluation, you will establish a baseline data, which will become your basis for possible change in your physiotherapy treatment plan.

Measurements that are essential in your physiotherapy documentation may include:

Blood pressure (BP), heart rate (HR), pulse rate (PR) and temperature (T^o)
Joint range of motion
Manual muscle tests (MMT) / Testing for baseline muscle strength
Other relevant measurements specific for your client's problem. For example, stump measurement for a patient who have had an amputation.

You may also need to perform orthopedic special tests to determine the actual structure affected. For example, the Lachman test, which can be used to test for anterior cruciate ligament injury or the McMurray test for meniscus injuries.

Setting Client / Patient Goals

Setting goals for physiotherapy rehabilitation should involve the person (your client). The goals should be realistic and achievable according to person's condition and problems. By making your client actively participating in setting goals, he or she will feel more comfortable and may be more motivated in achieving those goals, thus, resulting in better outcomes.

Plan of Treatment

Again, in formulating physiotherapy treatment plan, your client should always be involved. Besides, he or she is the most important person in the rehabilitation team. The treatment options to be followed should address the problems that you gathered from your examination and the goals set with your client.Your client should feel that you are putting great importance on what he or she thinks.

Always remember that rehabilitation is a collaboration between you and your client and the rest of the rehab team. Without motivation and active participation of the person (your client), the set goals may be hard to achieve.

Parts of the Physiotherapy SOAP Notes

Physiotherapy (PT) SOAP notes writing is an important part of physiotherapy practice. Following proper PT recording of every patient or client encounter should be practiced to avoid confusion or delays in reimbursements.

The physiotherapy SOAP notes, sometimes called daily notes or progress notes, is the documentation done for every patient physiotherapy visit following the comprehensive PT initial evaluation (IE). The daily SOAP notes will indicate whether a particular plan of care is benefiting the client or not or treatments need to be modified.
Every physiotherapy SOAP notes should include basic information such as the client's full name and identification number is included if applicable. The full name of the physiotherapist, proper designation, such as PT, DPT or MPT and signature should be included as well. The date of treatment or encountered should always be included.

Subjective

The subjective part of the SOAP note is where you write what your client has to say about his or her current condition. For example, "I can now bend my back to put on my socks and shoes following my treatment session yesterday."

It is better if the patient's subjective statement is more specific. For example, "The pain on my back has moved down to 3/10 from that of yesterday before my treatment."

Objective

The "objective" part includes all the measurements that you've obtained from your client. This include the vital signs (e.g. BP-blood pressure, T^o-temperature, HR-heart rate, and RR- respiratory rate), manual muscle testing measurements, joint range of motion measurements, etc.

The specific physiotherapy treatments are also included in the objective part of your SOAP note. The treatments provided should be specific enough so as another PT can provide treatment if the treating physiotherapist is out for the day. The treatment should include the specific weight, repetitions, intensity and duration whenever applicable.

Examples

Knee extension, full ROM, 10 reps, 3 sets with 5 lbs. ankle weight
HMP on bilateral lumbar area x 20 minutes

Assessment/Analysis

This is where the physiotherapist impression regarding patient's current situation since his or her last visit. This may also include the physiotherapist's perspective on whether a particular treatment will be continued or modified according to client's needs.

Example: "The patient tolerated the treatments well but patient needs frequent verbal cues from the physiotherapist to complete knee exercises at full range."

Plan

In the SOAP plan part, the physiotherapist writes the plans for the client's next physiotherapy visit. This may include the objectives, treatments, progression parameters, and precautions.

Tendonitis – Where Does Tendonitis Commonly Occur?

Tendonitis means that your tendon – a strong band of connective tissue connecting your muscle to your bone – is inflamed. Tendonitis can cause pain, swelling, and difficulty moving. This condition is also called tendinitis.

There are different types of tendonitis depending on the specific type of tendon affected.

Tendons Commonly Affected with Tendonitis

There are several places in your body where tendonitis can occur. The following are some of the major tendons in the body where tendon injury can happen:

Rotator cuff and biceps tendons in your shoulder ( Shoulder Tendonitis)
Forearm tendons near your elbow and wrist (e.g. Elbow Tendonitis, Wrist Tendonitis)
Tendons near or attached in your hip
Quadriceps tendon in front of your thigh, just above your kneecap
Patellar tendon, just below your kneecap
Hamstring tendons at the back of your thigh, near your knee joint
Achilles tendon, which is the largest tendon in your body, located at the back of your leg near your ankle joint (Achilles Tendonitis)

Often, tendonitis occurs as a result of overuse of the tendon or overstretching from a forceful or sudden movement.

Tendonitis – All About Tendonitis

Tendonitis occurs when any of your tendons becomes irritated and inflamed. A tendon is a strong band of tissue connecting your muscle to your bone. Tendonitis often results from overstretching or overuse/repetitive movements. Tendinitis is the other term for tendonitis.

What causes tendonitis?

Tendonitis can happen when your tendon is overstretched causing small or large tears in the tendon. In some cases, the tendon can be fully torn. The condition can be acute or chronic. Acute tendonitis can be due to a forceful movement, such as in pitching in baseball, sprinting, or sudden jumping in basketball or volleyball.

Chronic tendonitis is caused by repetitive movements putting stress on the tendon. Some sports at risk for the condition may include baseball, basketball, swimming, football, sprinting, long-jumping, heavy weight-lifters, and certain racket sports.

Repetitive activities at work can put a person at risk for developing tendonitis, as well. This may include carpenters, typists, and gardeners.

What are the symptoms of tendonitis?

The symptoms that you experience depend on what tendon is involved. However, the most common symptoms of tendonitis are pain, swelling, and difficulty moving. You may also experience bruising, a bluish discoloration of the skin overlying the injured area. Other symptoms may include tenderness, hearing a pop at the time of injury, and warmth or redness.

Treatments

What you can do

Immediately following your injury, you should

Rest and avoid certain movements that aggravate your symptoms
Apply ice on the injured area
Elevate your injured limb above the level of your heart

Taking anti-inflammatory medication may help relieve your pain and swelling.

Other Treatments

You may need other treatments for your tendonitis including

Ultrasound
Physiotherapy
Use of supportive brace or strap
Use of assistive device
Steroid injection

Your doctor may recommend surgery for a severe case of tendonitis only if your condition is not relieved with conservative means.

Physiotherapy for Tendonitis

Physiotherapy can help you manage your tendonitis symptoms and other associated problems. Tendonitis, sometimes called tendinitis, is an irritation or inflammation of any of the tendons in your body. Your tendons are strong bands of connective tissue that attach your muscles to your bones. Tendonitis can be caused by repetitive use or overstretching of the tendon causing it to become irritated and inflamed.
Physiotherapy for Tendonitis

Physiotherapy ultimately aims to improve your quality of life. The physiotherapy rehabilitation goals for tendonitis are

To relieve your symptoms
Maintain or improve your muscle strength
Maintain your overall fitness
Promote injury prevention
Safely return you to your original activities or sports

The kind of physiotherapy treatment that you will receive will depend on the specific type of tendonitis that you have; your symptoms and other related problems; whether you have had surgery or not; and your overall rehabilitation goals.

Physiotherapy Treatment Options for Tendonitis

Your physiotherapist may employ a combination of any of the following

Immobilization if necessary (e.g. splinting, bandaging, taping)
Cold therapy or cryotherapy (e.g. ice pack, ice massage)
Heat pack
Electrical stimulation / Iontophoresis
Ultrasound / Phonophoresis
Massage
Joint mobilization techniques
Physiotherapy exercises

Gentle range of motion (ROM) exercises
Flexibility / Stretching exercises
General conditioning exercises
Progressive strengthening exercises

Suggest brace if necessary
Recommend walking aid if needed
Gait/Walking/Assistive device training (for lower limb injury)
Ergonomic training
Patient education

Regarding the patient’s specific condition (type of tendonitis)
Precautions to observe
Suggest activity or work modification
Self-care of symptoms
Wound self-care / post-operative care (after surgery)
Injury prevention

Suggest work or sport-specific rehabilitation program

The physiotherapy treatment options mentioned above are general treatment interventions and should not be considered as treatment guideline for tendonitis. Only your personal physiotherapist can help you determine the appropriate treatment intervention best for your specific problems and goals. Your physiotherapist will gladly discuss with you about your specific plan of care.

Tuesday, October 4, 2011

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