General Info
ACUTE CARE PHYSICAL THERAPY
Article written by Sharon Gorman, PT
General information
This area of PT focuses on the physical therapy needs of the acutely ill person. While changes in healthcare have led to an increase in the diversity of settings in which acute care physical therapy is practiced, mainly hospitals, skilled nursing units, sub-acute rehabilitation centers, home care, and acute rehabilitation centers have PT’s who would refer to themselves as "acute care physical therapists". This type of physical therapy is unique because many times the patient is acutely ill with an active disease process while also having a concomitant decrease in physical function. Acute care physical therapists need to have a broad knowledge of pathophysiology and how disease processes can further limit the functional mobility of a person.
An acute care physical therapist is often the first physical therapist a patient and/or family has contact with once a disease process has started to effect a person’s strength, mobility, flexibility, or endurance. Acute care physical therapists work closely with the patient’s medical team (nursing, physician, social worker, case manager, etc.) to ensure that a patient is discharged appropriately. This may include recommendations for continued rehabilitation after discharge, at home or in a different type of medical facility such as a skilled nursing unit or rehabilitation unit. Additionally, an acute care physical therapist may recommend appropriate medical equipment or assistive devices, such as a walker, crutches, grab bars in the bathroom, or a cane.
	Acute care physical therapists also have a broad knowledge of the various surgeries performed on persons, along with the specific precautions or contraindications to movement or exercise that accompany these procedures. A good background in laboratory tests and normal laboratory values is also needed to ensure the physical therapy interventions help and do not harm the patient. Lastly, the acute care physical therapist also must know about all of the various modern monitoring devices and lines that a patient may be connected to while receiving therapy. This may include cardiac monitors, a variety of intravenous lines, intracrainial monitoring, and ventilators.
To access an acute care physical therapist, one needs to get a prescription or referral from their physician. Since most persons needing acute care physical therapists’ are in a medical facility (hospital, skilled nursing unit, rehab unit), the facility has a coordinated system to take this doctor’s order and contact the physical therapist directly. The therapist then will usually come to the patient and conduct the initial evaluation to determine if physical therapy is indicated and what interventions may benefit the patient. Acute care physical therapists, like all physical therapists, actively involve the patient and/or family/caregivers in the process of formulating goals and interventions in the physical therapy plan of care.
Diagnosis
	Any acutely ill person with a change in physical function and/or health status resulting from injury, illness, or other cause may be appropriate for acute care physical therapy intervention. In the acute care setting, diagnosis is not so important in determining whether a person would benefit from acute care physical therapy. The main determination resides in whether the person has, in the recent past, experienced a change from their normal physical function because of a disease, illness or other health problem. For example, a person who just broke his/her ankle may need acute care physical therapy before discharge from the hospital to learn how to use crutches, protect the ankle until the bone is healed, and prevent complications such as swelling, pain, and weakness while the ankle heals. However, a person with pneumonia may need acute care physical therapy to ensure that they can continue to live at home alone safely, move throughout their home/community once discharged from the skilled nursing facility, get any medical equipment such as a cane or home oxygen that they may need to function independently and safely, and arrange for continued physical therapy at home if needed. Basically, acute care physical therapists are normally accustomed to seeing all sorts of diagnoses from neurological, cardiac, orthopedic, and pulmonary diagnoses.
Intervention
A normal treatment is always individualized to reach the patient’s/families goals. Normal physical therapy interventions that may be used include therapeutic exercise, functional training (how to transfer from bed to chair, move in bed, sit to stand, etc.), gait training (how to walk safely, efficiently, and independently), prescription/application of equipment or assistive devices (orthotics, prosthetics, walking aids, splints, etc.), airway clearance techniques and/or breathing exercises, and wound management. Hydrotherapy, in the form of whirlpools or pulsed lavage of wounds, is also common. Specialized devices, such as tilt tables or standing frames which are used to assist very deconditioned or weak persons achieve a standing position, are also common.
Acute care physical therapy tends to emphasize working on the skills or mobility tasks that a patient has difficulty with or cannot do without help from another person. For some patients, the acute care physical therapy intervention focuses on training the family members or caregivers in safe ways to manage the patient’s physical limitations. This can include stretching or range of motion exercises, positioning in bed and/or seated, transfer training, and gait training. Typically, patients are seen for treatment at the bedside, in a therapy gym, or even in their own home. Simulation of the home setting is an important part of acute care physical therapy because safe return to the home or prior living arrangement is normally a goal for the patient. Often, the acute care physical therapist works closely with other rehabilitation professionals such as speech therapists, occupational therapists, and respiratory therapists.
	State of the art acute care physical therapy encompasses creative planning and thinking to be able to enable the therapist to work with the patient, no matter how ill or how complex their medical condition. Intensive care or cardiac care units now routinely see physical therapists conducting interventions when only years ago these patients were not seen for days or weeks because of their medical condition. Prolonged bedrest, or "staying in bed until I feel like getting up", is no longer considered appropriate for patients. Patients routinely receive physical therapy in the morning the day after surgery, especially for orthopedic surgeries, is considered the norm. Additionally, patients often are discharged from the hospital as soon as they are considered medically stable. This means many persons need to go to a rehabilitation hospital or skilled nursing facility to complete their course of physical therapy. For some orthopedic surgeries, this means that a discharge to another facility for continued physical therapy can happen as soon as the third day after surgery.
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