Physical Therapy Goals Research Articles

How controlled stress affects healing tissues

Restoration of a patient's full range of motion, strength, and function are the primary goals of occupational and physical therapy. Immobilization of normal connective tissue leads to biochemical, biomechanical, and physiologic changes within a week. These changes are magnified in the presence of trauma or edema, and they may create permanent damage if not addressed swiftly and properly. This is best accomplished by applying specific types of stress to the involved and associated structures at optimal intervals during the rehabilitation process. Load must be applied at adequate intensity and duration to successfully affect the viscous property of connective tissue. This is necessary to effect permanent elongation of the restricted tissues. Early controlled motion is vital to prevent the negative changes associated with immobilization and to maintain normal viscoelasticity and homeostasis of connective tissue. Hand therapists must have a thorough understanding of the changes associated with injured structures. Only then can they provide optimal stress delivery to facilitate restoration of function.

A survey of physical therapy goals and interventions for patients with back and knee pain.

The physical therapy management of patients with pain often lacks a theoretical or conceptual basis. The purpose of this study was to compare treatments of patients with back and knee pain with a treatment framework (conceptual model) that we developed. This framework emphasizes physiological recovery, or reduction of impairments (eg, reduction of swelling), followed by emphasis on the reduction of disabilities. Expectations were derived concerning treatment goals and interventions in the course of treatment. Patients with back pain (n = 1,085) and patients with knee trauma (n = 416) were treated by 83 Dutch physical therapists. Survey data were gathered on impairments and disabilities and on treatment goals and interventions. For both groups of patients, two out of a maximum of eight treatment goals were directed at alleviating impairments in accordance with the framework. Goals directed toward the alleviation of disabilities did not show a similar relationship to the framework. For two treatment goals, the course of treatment was in accordance with the framework for both groups of patients. The framework is only partially reflected in Dutch physical therapist practice. The use of such a framework, however, may be a helpful tool in gaining more insight into physical therapy in daily practice.

Treating arthritis with locally applied heat or cold

The scientific for the treatment of arthritis with locally applied heat or cold is reviewed. Experimental studies in vitro, in animals, in healthy subjects, and in patients are considered. Results of investigations of the effects of locally applied heat or cold on the deeper tissues of joints and on joint temperature in patients are not consistent. In general, locally applied heat increases and locally applied cold decreases the temperature of the skin, superficial and deeper tissues, and joint cavity. Most studies dealing with the effects of heat and cold on pain, joint stiffness, grip strength, and joint function in inflamed joints report beneficial effects. In vitro studies show that higher temperatures increase the breakdown of articular cartilage and tissues that contain collagen. Therefore, one goal of physical therapy should be to decrease intraarticular temperature in actively inflamed arthritic joints.

The Reciprocation-Gait Orthosis for Children with Myelodysplasia

The reciprocation-gait orthosis (RGO) and its use by children with myelodysplasia are described. The review of the literature includes the ambulatory status attainable by children with different lesion levels, gait, and energy expenditure when the RGO is used by children who have spina bifida. An overview of orthopedic factors, criteria for fitting the RGO, training programs, and physical therapy treatment and goals are presented. Disadvantages of the RGO are also discussed.