Importance of Physical Therapy

A local advertisment simply says it all, "Mahal ang magkasakit." (Getting sick is expensive). This is especially true for those who got hit by devastating or debilitating conditions such as strokes or similar conditions that affect the physical strength of a patient. Lets try to enumerate the would be expenses: Hospitalization, medicines, laboratory and imaging/diagnostice procedures, and profesional fees for physicians

Now comes the second part of the expenses, upon discharge of a patient and brought home its time to deal with the refitting of the residence to the present needs of the patient. Then one will include continuation of medicine, needed diagnostic test for monitoring and scheduled checkups with their physician.

Now why am I trying to enumerate all of these and yet the title is importance of Physical Therapy. Well simply stating it, a patient who is brought home and has lost the ability to be independent in activities of daily living (walking, dressing, eating, walking, bathing, working etc), needs assistance and caregiving. Which in order to achieve independence partial or complete, needs to undergo physical therapy. Now the other concern is, did physical therapy start while in the hospital or just an afterthought upon dischage?

Unfortunately, this is something that is not sometimes discussed to the patient/relatives and if by any chance discussed, may be considered as a miscellaneous expense and not a required expense. What am I pointing out? If a patient is asked to buy medicines and/or undergo physical therapy, what will the patient/relative do? The patient/relatives may opt to have both but oftentimes will opt to have the medicine and forego the physical therapy. The would be possible reasoning is, "Pwede naman yan pag lumabas na ng hospital" (That can be done already once the patient is discharged).

Again unfortunately, it may be initially less expensive if physical therapy is not done during confinement but how is it in the long run? An article done by Ruth M. Kleinpell, Kathcy Fletcher and Bonnie Jennings in Patient Safety and Quality: An Evidence-Based Handbook for Nurses pointed out the ff:

1. I quote " A dissonance exists between the hospital environment and therapeutic goal for the hospitalized elderly." (This means the goal is to make them medically stable but not functionally recovered upon discharge)
2. By Day 2 deconditioning and functional decline was evident on elderly individuals.
3. Elderly patients who was assessed during confinement showed that from day 2 to discharge, 67% showed no improvement and 10 percent showed further decline.

It then just shows that if an individual further declines in functional status that means, EXTRA care/assistance. Which is equivalent to a caregiver or nurse stay at home. If the patient is fully dependent you might need 2 caregivers in 1 duty shift. Or even to the point that the relative/love one would stop or not work in order to take care of the patient. That is lost productivity not only for the patient but also for the relative taking care of him/her.

And study shows that a deconditioned muscle (due to disuse or non use), needs 2 to 3 times the duration to be strengthened back to its original condition as compared to its deconditioning. So for example, the lower limbs lost its strength for 2 weeks of bedrest/immobility, it will need 4 to 6 weeks before it regains its former strength. And that is for young individuals, what more for elderly or those who became debilitated?

The Evidence Based Review of Stroke Rehabilitation (ESBSR), states that there is strong evidence that greater intensities of physiotherapy and occupational therapy resulted in improved functional outcomes after stroke. This then points to the fact that in the long run, which is the usual duration for those who have a stroke will benefit on early intervention to minimize potential prolonged bedridden and immobilization complications management. These complications, such as bedsores, pulmonary conditions, lower limb edema, joint stiffening, fully dependent on all activities, depression etc, may then prove more costly than having early intervention.

Table 1 shows the effect of prolonged bed rest. (click Table to enlarge)
*Source/Table were it was taken from is noted at end of article.

Conclusion: Patients who had debilitating conditions that affect their functional status during confinement should be assessed properly if early physical therapy intervention is needed or not. Talk to your attending physician so that the recommended Physical Medicine and Rehabilitation specialist can discuss and provide the benefits and consequences or early physical/occupational therapy. Know your options so that you can decide on what would be more beneficial for the patient as well as for the love ones.


* Ruth M. Kleinpell, Kathcy Fletcher and Bonnie Jennings in Patient Safety and Quality: An Evidence-Based Handbook for Nurses
Next article would be the difference between neurological and functional recovery.

Falls in the elderly: Exercises done at home

Your patients or love ones who have been not so  active at home will succumb sooner or later to the what we call deconditioning. Due to their condition such as poor balance or affected by other ailments, they become confined in bed, or wheelchair or chair. Definitely such situations will leave their upper and lower limbs weaker. As the saying goes, "Use it or lose it."

So here are some simple exercises that you can ask your patient or love one to do at home. We will start with some exercises for the upper limbs done during sitting.

1. Forward Arm lift
While the patient is sitted. Make the patient do an arms forward position. Then let the patient lift the arms alternately beyond the head level or as high as they can go. Just make sure the patient breathes in and out while doing the exercise. Do not make them hold their breath.

Do this without or with weights being held on the hand depending on the patients capability.


2. Backward pull exercise

Again patient in an arms forward position and then let the person imagine as if pulling a stick backward. This can be done with or without weights or even holding a stick. Remind the person to just breath in on starting position and breath out during pull position. Do not make them hold their breath.

Arms forward starting position

Backward pull position

3. Shoulder shrugs

Let the person keep the arms and hands on the side (with or without weights) and then let the person shrug the shoulders. Breath in during starting position and breath out on shrug position.

Shoulder shrug starting position

Shoulder Shrug up position

Reasons of doing this?

1. To keep the upper limb in good condition or at the least not deteriorate its strength.
2. Keep the joints moving and not become stiff
3. Strengthen the muscles that help the person stand during pull up to stand as well as keep the tone of the upper back muscles.
4. Prevent stooping forward during sitting.

How many times to be done?

Depending on the condition of the patient, you can start at 10 counts per exercise and progress accordingly.
It is advised to do it 3 times a day, morning, afternoon and early evening.

Extra Tip:

The simpliest weight you can use are just plastic water bottles. A 250ml water bottle is equivalent to 1/4th kg. (100ml water is equivalent to 100gms) So no need to buy gym weights.

The next set will be standing exercises.

Special Thanks to Mr. Jayson Javier, PTRP. Upon this blog post, he is  a PT faculty instructor in The College of Physical Therapy of San Juan De Dios Educational Foundation, Incorporated, Pasay City.