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PTA Blog Talk

Chairs, Stairs and Ramps

Published November 4, 2008 4:44 PM by Jason Marketti

"Watch my hands and legs!" I yelled to the HOH, 781.2 patient. I demonstrated the sequencing of getting up and down from a chair.

I took him to the stairs after that, again demonstrating with verbal cues for the patient to do as I do. The ramp was next. A quick demonstration and away he went, going up and down the grade like a pro.

Chairs, stairs and ramps have become a staple in my therapy routine. Not only do I find it functional for most patients, but all three challenge a person's balance and mobility all the while strengthening the legs and arms.

I try to ensure all the patients I see can at least get up and down safely from a chair, go up three to four stairs with a rail and ascend and descend a ramp without losing their balance.

The PTs don't always write goals for these and sometimes I am questioned about why I am doing it when there is no goal for it. The simple reason is that it works and I get results. Sometimes my treatment techniques are unrehearsed and unorthodox.

I remember I put Bag Balm on a patient because the PT and myself knew it worked. It was not in the protocol that I helped develop but was very effective. We could not tell the DOR or the administrator because they would not understand and they would want the MSDS and a whole lot of documentation to "prove" it worked.

Just like we know ice decreases edema and swelling, and after a TKA treatment the patient should probably apply ice to their knee. But we don't have an order for it. Like I told another PTA, "Why don't you call the surgeon out of surgery and ask him if it is okay to apply ice to a knee?"

What do you think the surgeon is going to say? This is an example where direct access is beneficial. It is also an example where goals and POCs should be written broadly enough for us to do our jobs without much interference and interruptions in a patient's progress.

Another example is the usage of groups. If a PT doesn't write it, we can't do it (or so I am told). If I see a benefit for a patient, should I ignore it because it was not written?

"Oh, I am sorry Mrs. Smith, I can't walk you today because the PT didn't write a goal for that and it is not in your plan of care."  Yes, this occurred. The PT did not write a gait goal and questioned why I was walking them. I will discuss more of that later.

4 comments

PTAs work under supervision of a PT.  If you are unable to speak with your PT then it is the patient's loss.  Your PT should be available for you and your patients should any treatmnet changes come up.  It is unfortunate for the patient that you can not act autonomously from your PT but that is the regulation.  It is your PTs job to be on top of things and to communicate with the attending physician.  It can be frustrating, yes, but lack of coordination of care is a liability.  

Melinda , PT - PT February 3, 2009 11:38 AM
Los Angeles CA

     I'm not really sure as to whether or not I'm even supposed to be posting a comment,asking any questions,or even making any statements...in that I think this blog is supposed to be re-

served for physical therapists' ;and if so,excuse me all over the place please.

     I(and I'm assuming there are many,many more)that are very ignorant when it comes to what we've "heard"works,as far as

home remedies and the likes;but actually what I've got here just

might be a serious mistake on MY part !!!My girlfriend(we think),

has M.E.R.S.A.She has been tested at this somewhat free clinic

for the real destitute twice.What with having her nose swabbed

alone is truly astronomical(cost wise)...let alone all other things.

So what do I do?Sue says"I think the reason I keep itching down

there(to where it bleeds,is just because of extra dry skin"Yester-

day(1/4/09),I say"why not put some Bag Balm down there?"And

yes,down there I'm referring to her outter vaginal lips.

    Please,what do You think ?

    We can't afford any high faluttin doctors or treatment!!!

    Not looking for any violin concerto here...just some honesty

and sound advise.

    Thank You Most Kindly,

                                                                            Patrick

Patrick, construction(laborer) - laborer January 4, 2009 11:56 AM
Grand Rapids MI

Christie,

Bag Balm works.  Ask any farmer who has milked cows for a living.  And, what if I asked you to prove ice works or how about that mysterious blue gell gunk that lots of PT places use, what if a patient tells their doc that the PT used a mysterious blue cold pack and they were allergic to it?  Where is the MSDS for ice?

We in therapy use modalities that work and have a history of being proven to work.  Ultrasound has been debunked as a useless modality, however, PT's continue to use it and MD's continue to prescribe it.  I have been to clinics that do not use any modalities and get the same results as clinics that rely on them.  

If we find a way to treat patients that work then we need to explore it.

Karen December 5, 2008 7:47 PM

Jason,

I think some of your treatment techniques of chairs, stairs and ramps would still fall under a reasonable plan of care if that plan included gait, strength and/or balance training.  Whether a ramp or stair goal was written, climbing stairs addresses both strength and balance.  Sometimes we don't write goals for those because they are not in a patient's immediate environment and sometimes there are more pertinent goals to be addressed first.  

As far as using "bag balm" because it "works", I am not sure in what context you are referring, but I'd review some literature before you make that claim to your supervisors. Furthermore, I think you are walking a fine edge...what should happen if a patient had an allergic reaction to bag balm?  What if the patient complained to the nurse that the "therapist" put some "strange salve on me?"  and it later comes out that this was an unauthorized application and non-approved substance.  It could go as far as saying that you were trying to assess and treat a skin condition and violated hospital safety policy.  There goes your job and probably your PTA license.  

In the end, think the real issue here is your communication with your co-workers.  Having read some of your previous posts, it's obvious your PTs are not always receptive to communication.  I would hope that if my PTAs had any question as to whether a not a gait goal should be written or whether using chair, stairs and ramps is appropriate, I am confident they would approach me.  

Writing goals and treatment plan broadly can give you a lot of freedom, but I've found with some PTAs that they really need that focused direction.  Being a certified McKenzie therapist, I've had some PTAs treat my extension responders by going in and starting pelvic tilts with stabilization exercises simply because I checked "theraputic exercise" as part of the treatment.  Obviously, these patients come back feeling worse by the next time I see them.  I've had some contract PTAs neglect to do ROM on someone who had a TKA. In either case, it requires me to either write very specific treatment plans or communicate directly with the PTA.  

Christie , Physical Therapist November 6, 2008 8:27 AM
Streamwood IL

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    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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