Physiotherapy Manual of Operations

ANANT INSTITUTE OF MEDICAL SCIENCES, PHYSIOTHERAPY DEPARTMENT
MANUAL OF OPERATION, DATE 20/10/2017
Department of physiotherapy
MANUAL OF OPERATIONS
PHYSIOTHERAPY DEPARTMENT
[Type the document subtitle]
0 Manual of Operations
MANUAL OF OPERATIONS
PHYSIOTHERAPY DEPARTMENT
Service Name : Physiotherapy Department

Date Created : 15-01-2008
Chief Medical Superintendent
Approved By :
Name :
Signature :
Physiotherapist
Reviewed By :
Name :
Signature :
Director
Issued By :
Name :
Signature :
Physiotherapist
Responsibility of Updating :
Name :
Signature :
Page of contents
SN Particulars
1. Purpose
2. Scope
3. Definitions and Abbreviations
4. Inpatient Work Process
5. Outpatient Work Process
6. Treatment Modalities
Interferential Therapy
Ultrasound Therapy
Paraffin Wax Bath
Moist Heat Therapy
Short Wave Diathermy
Infra Red
Traction
Electric Stimulation
Continuous Passive Motion
Exercise Therapy
Pulmonary Function Test
7. Departmental Policy
8. Patient Safety
9. Maintenance of Patients Confidentiality
10. Maintenance of Equipment
Purpose: The purpose of the Physiotherapy Department is to provide an expert physiotherapy service,
with systematic methods of assessing musculo-skeletal, cardio-vascular, etc disorders of function
including pain and those of a psychosomatic origin and dealing with or preventing these problems by
natural methods based essentially on movement, manual therapy and physical agencies.
Scope: Include staff and patients involved in the process.
Definitions and Abbreviations:
1. Postural Drainage Positioning the patient according to the anatomy of the bronchial tree in order to
use gravity to assist drainage of secretions.
2. Gait Training Gait training begins by teaching transfers to the bed, mat and wheel chair, then
improving standing balance on the affected limb. The patient is taught the most optimal gait pattern in
and out of the parallel bars, and on stairs, ramps, and curbs. Orthosis (braces) and other assistive devices
are used to correct gait deviations, and may decrease energy expenditure during gait. Harnesses to
provide partial body weight support may accelerate early ambulation.
3.Vertigo Vertigo, or dizziness, is a symptom, not a disease. The term vertigo refers to the sensation of
spinning or whirling that occurs as a result of a disturbance in balance (equilibrium). It also may be used
to describe feelings of dizziness, faintness, and unsteadiness vertigo usually occurs as a result of a
disorder in the vestibular system (i.e., structures of the inner ear, the vestibular nerve, brainstem, and
cerebellum). The vestibular system is responsible for integrating sensory stimuli and movement and for
objects in visual focus as the body moves.
4. Abbreviations
ABBREVIATIONS FULL FORM
IFT Interferential therapy
UST Ultrasound therapy
SWD Shortwave diathermy
CVT Cervical traction
LBT Lumbar traction
WXT Wax therapy
MOT Moist therapy
LAS Laser therapy
CPM Continuous passive movement
PD Postural drainage
GAT Gait training
PSN Post natal exercise
MBZ Mobilization exercise
CPT Chest physiotherapy
SPN Spinal exercise
PVF Pelvic floor exercise
PFT Pulmonary function test
ROM Range of motion
MMT Muscle power
D. Inpatient Work Process:
Patient in ward
Doctor refers patient

for physiotherapy
treatment
Nurse informs physiotherapist

& send request form to
physiotherapy dept
Assessment and
evaluation of the
patient
Physiotherapy
treatment starts
Entry Made in Patients

BST
Order entry
E. Out patient work process:
e
Consultant refers to
Physiotherapy department
Patient with reference

enters the physiotherapy
department
Patient assessment and

evaluation done
Plan of treatment and

treatment starts
Appointment given
Entry made in
Patients case
sheet
Patient leaves the

department
F. Treatment modalities
Interferential Therapy:
Procedure: It is a method of producing Low frequency current selectively at any tissue depth without
the problem of skin resistance
Preparation of patients:
i. Position the patient comfortably with the area to be treated adequately
supported, exposed and relaxed.
ii. Inspect the part of any cuts, abrasions, excessive swelling, warmth or any skin
condition.
iii. Inform the patient about the treatment and sensation to be experienced a mild
pricking sensation but pleasant.
Treatment:
i. Explain the procedure to the patient
ii. Apply the electrodes firmly on the patients complaint area
iii. Make sure sponges are adequately damped
iv. Position the electrodes so that the red and black leads are diagonally across
v. Turn on the equipment, select the programme, frequency, and increase the
intensity up to the patient tolerance
vi. Duration of the Treatment between 10 15 minutes, based on level
Acute
Sub acute
Chronic
a. Precautions:
i. Patient should not feel the heat, burning sensation, discomfort, or pinching
sensation beneath the electrode
ii. Do not apply electrodes over mucous membranes
iii. Patient should remove all kind of jewels before treatment.
b. Infection control:
i. Cleaning the electrode pads with water before and after the treatment.
ii. Electrode pads must be cleaned with alcohol swabs in infectious patients
2.Ultrasound Therapy:
Procedure:
Ultrasound is high frequency sound waves that produce temperature elevation to the deeper structures
with out causing excessive heating of the superficial layers through the use of coupling agents
a. Preparation of the Patient:
i. Position the patient comfortably with the area to be treated adequately supported,
exposed and relaxed.
ii. Inspect the part for any cuts, abrasions, excessive swelling, warmth or any skin
condition
iii. Inform the patient about the treatment and sensation to be experienced a mild heat
b. Treatment:
i. Explain the procedure
ii. Apply generous amount of coupling agent. Spread the gel evenly over the transducer
iii. Slowly increase the intensity apply the transducer to the skin and move continuously
in small circular motions
iv. Duration of the Treatment is between 10 15 minutes, based on levels
Acute
Sub acute
Chronic
c. Precautions:
i. Keep the transducer head moving continuously on the skin or burning may occur
through over heating of tissues
ii. Do not hold the transducer head in the air or break treatment contact, this could
damage the transducer head crystals
iii. Do not treat near the heart
iv. Not to be used during pregnancy
v. Patients with the Pace maker should not be in the treatment area/ undergo treatment.
d. Infection control:
i. Clean the transducer head with tissue paper after every use
ii. Transducer head must be cleaned with the alcohol swabs in infectious patients
3.Paraffin Wax Bath :
Procedure:
Paraffin wax bath is utilization of paraffin wax at a temperature 40- 44 degree Celsius. The application
of hot wax through dipping with the lint cloth and apply to patients extremities .This wax has low
thermal conductivity, so that the heat will stay in the tissues for a longer period.
a. Preparation of the patient:
i. Position the patient comfortably with the area to be treated adequately supported,
exposed and relaxed.
ii. The part to be treated must be cleaned and free form cuts, rashes or infections
b. Treatment:
i. Explain the procedure
ii. Therapist should wear gloves
iii. Dip the lint clothe in the wax bath, clear the excess wax on the cloth and wrap it
around the area to be treated
iv. Duration of the treatment 20 30minutes
c. Precautions:
i. Patient should be cautioned not to change position during treatment
ii. Paraffin can easily fall to the floor during treatment making the floor
slippery
iii. Paraffin wax is flammable.
i. Change the lint cloth once a week
ii. Wax bath to be cleaned with the spirit when the wax is replaced with new (once in
four months)
iii. Lint cloth has to be discarded if used in infectious patient
4. Moist Heat Therapy:

Procedure:
Silicon hot packs are conductive type of superficial moist heat. The temperature has to be maintained
between 70 100 degrees Celsius
i. Drape the patient, expose the area to be treated, place the patient in comfortable
position
b. Treatment:
ii. Place the towel between the patients skin or treatment area and the hot packs
iii. Wrap additional towels depending on patients tolerance to heat
iv. Duration of the treatment is 20 30 minutes
c. Precautions:
i. Extra towel must be utilized, so heat is not transferred too quickly and results in
burn.
5. Short Wave Diathermy:
Procedure:
1. High frequency current produced deep heat with in body tissues for therapeutic purposes.
Produces heat below the skin surfaces through conversion heat transmission.
i. Drape the patient, expose the area to be treated, place the patient in comfortable
position.
iii. Inform the patient about the treatment and sensation to be experienced a Deep heat
b. Treatment:
ii. Place one layer of the towel over the treatment area.
iii. Position the treatment area midway between two electrodes
iv. Allow the machine to warm up first two minutes
v. Increase the intensity until the patient feels a soothing sensation
vi. Give the patient the call bell in case the heat is more.
vii. Duration of the treatment 15 30 minutes
c. Precautions:
i. Patients with the Pace maker should not be in the treatment area
ii. Patient should not move during treatment or touch cable or the machine
iii. Due to electromagnetic radiation all watch, jewellery and hearing aids should be
removed
i. Change the towel used for disc and pads everyday
6. Traction:
Procedure:
1. Mechanical traction applies a distraction force to the spine to attempt to separate vertebral
bodies and elongate spinal structures.
i. Check the weight of the patient
ii. Patient is positioned supine on the table with belt underneath
iii. Inform the patient about the treatment and pull to be experienced
b. Treatment:
ii. Set the tension according to the patients body weight
iii. See that the belt around the patient is secured
iv. Adjust the traction machine height for correct pull alignment
v. Have an emergency shut off device available to the patient
vi. Duration of the treatment is 15 20 minutes
c. Precautions:
i. Do not move during the treatment
ii. Use the emergency shut off device if needed
iii. Traction not advised during osteoporosis, pregnancy, bone tumors, spinal infection and
fractures
d. Infection control
i. Wrap a tissue paper on the cervical head halter for every treatment.
7. Electric Stimulation:
Procedure:
Electrical stimulation is the use of electricity to stimulate nerves and muscles. It is used to accomplished
a variety of therapeutic purposes, such as effect on de innervated muscles, innervated muscle and
decreased spasm
i. The part to be treated must be cleaned and free form cuts, rashes or infections
ii. Inform the patient about the treatment and sensation to be experienced mild
pricking sensation
b. Treatment:
ii. Place the dispersive electrode on an antagonistic muscle surface and active electrode
over area being treated
iii. Set the intensity based on the muscle contraction
iv. Duration of the treatment 10 20 minutes
c. Precautions:
i. Use correct type of current for de innervated and innervated muscles
ii. Equipment should be over mackintosh sheet
iii. Make sure the intensity knob to be turned to zero prior to turning on the machine
i. Use new cotton padding for every treatment.
8. Continuous Passive motion :

Procedure:
The passive movement of lower extremities through a predetermined range of motion by the use of a
mechanical device.
i. The part to be treated must be covered with a dressing to maintain sterile conditions
ii. Inform the patient about the treatment and movement in the knee within pain free
range.
b. Treatment:
ii. Adjust the unit under the patient with the anatomical joint aligning with the
mechanical hinge joint on the machine.
iii. Place joint in the machine and secure safety straps
iv. Set the beginning and end range of motion degrees on the machine.
v. Turn the unit on and monitor for security of treatment area, joint placement, and
patient complaints
vi. Provide the patient with an emergency shut off switch in case of any discomfort
c. Precautions:
i. For safety of the patient, be sure to remove all linen and clothing away from roller
tracks
ii. Make sure the setting knob to be turned to zero prior to turning on the machine
i. Clean the equipment with spirit once a week
9. Exercise Therapy :
Procedure:
Exercise is physical activity in order to improve ones health. Physicians, and physical therapist, have
found that exercise plays an important role in the maintenance of brain, nerve and muscle function in the
human body. Therapeutic exercises have been designed to enhance a variety of aspects of physical
fitness in patients suffering from diseases and dysfunctions. New research suggests that exercise may
delay mental deterioration with age and disease.
a. Goals of Exercise therapy
i. To improve blood circulation
ii. To improve co-ordination
iii. Maintain balance
iv. To increase muscle power
v. Joint mobility
vi. To improve flexibility
vii. To strengthen the muscles
viii. To increase respiratory capacity
b. Preparation of the patient:
i. Positioning the patient
ii. Explanation and demonstration of the exercise
c. Various types of exercise are
i. Active exercise
ii. Active Assistive exercise
iii. Resistive exercise
iv. Passive exercise
v. Mobilization
vi. Independence in mobility
vii. Spinal exercise
viii. Respiratory exercise
ix. Strengthening exercise
x. Co-ordination exercise
xi. Vertigo exercise
xii. Mat exercise
xiii. Postural drainage
xiv.Massage
xv. Chest manipulation
xvi. Diabetic exercise
xvii. Antenatal exercise
xviii. Post natal exercise
xix. Pre operative exercise
xx. Post operative exercise
xxi. Pelvic floor exercise
xxii. Ambulation exercise
10.Pulmonary Function Test:
Pulmonary function test is performed to assess the functional states of the lungs. It measures how well
the lungs take in and exhale air and how efficiently they transfer oxygen into the blood.
a. Procedure:
In a pulmonary function test or spirometry test, a person breathes into mouthpiece that is
connected to an instrument called a spiro meter. The spiro meter records the amount and
the rate of air that is breathed in and out over a specified time. Some of the test
measurements are obtained by normal, quiet breathing and other tests require forced
inhalation or exhalation after a deep breath.It is designed to measure changes in volume
and can only measure lung volume compartments that exchange gas with the atmosphere.
Spiro meters with electronic signal outputs also measure flow (volume per unit of time). A
device is usually always attached to the spiro meter which measures the movement of gas
in and out of the chest and is referred to as a spiro graph. Sometimes the spiro graph is
replaced by a printer. The resulting tracing is called a spiro gram. Many computerized
systems have complex Spiro graphs or printouts that show the predicted values next to the
observed values (the values actually measured). The unit will have in memory all of the
prediction tables for males and females across all age groups.
b. Precautions:
i. Do not eat a heavy meal before the test
ii. Do not smoke for 4 6 hours prior to the test
iii. Do not exercise strenuously prior to the test
iv. If you have dentures, wear them during the test to help you to form a tight
seal around a mouth piece of the spiro meter.
c. Infection control:
i. Turbine pneumotach as to be cleaned once a week with cidex solution
ii. Mouth piece has to be discarded after each use
G. Departmental Policy :
1.Qualifications of physiotherapists:
All Physiotherapists should have completed bachelors Degree in physiotherapy.
2. Initial Assessment of patient:
An initial assessment of every patient will be entered by a physiotherapist in the patients case sheet, for
inpatient initial assessment must be recorded in the patients bed side ticket.
a. Initial assessment will include information gathered by the physiotherapist as follows:

1. Past medical, surgical history, present history and forms of treatment
2. Doctor provided primary and secondary diagnosis, with onset
3. Patients current clinical condition
4. Pain assessment
5. Muscle power
6. Range of motion
7. Functional limitations
8. Problems of dysfunction
9. Activities of daily living (ADL)
10. Splints used or anticipated
11. Treatment plan
b. All assessment and evaluation must be performed by the physiotherapist. Patients
progress is entered in patients case sheet/Bed side Ticket as applicable and will
exhibit overall response to the initial treatment plan.
3. Discharge Plan :
Patient will be discharged from the department according to the assessment of the patients level of
functioning and treatment goal. Through assessments and evaluations of patient progress, discharge
plans will be formulated. An assessment of the patients home programme will be made upon initial
assessment to allow for formulation of early plans for discharge.
a. The Discharge plan includes:
i. Total length of time in active physiotherapy care.
ii. Comparison of all objective data (range of motion, strength, special testing) to
initial findings
iii. Comparison of patient complaints.
iv. Treatment provided to the patient during the course of treatment.
v. Physiotherapy care.
vi. Patients current clinical condition and status as discharged from active
physiotherapy care
vii. Plans for discharge will be formulated in a collaborative manner with the patient.
viii. Communication with the consultant about the patients condition
ix. Arrangement of all necessary medical aids for the patient prior to discharge
x. The patient will be discharged when the above mentioned criteria have been met.
xi. If the inpatient have to continue physiotherapy after discharge will be mentioned
in the discharge summary by the consultant.
4. Safety Measures :
Department Precautions:
1. The physiotherapist is responsible for maintaining safety standards, developing safety
rules, supervising and training staff in departmental standards.
2. The physiotherapist is responsible for informing facility in case of any safety hazard.
3. All physiotherapy employees shall report defective equipment, unsafe conditions and
acts, or safety hazards to the head of the department.
4. Safety measures include:
a. Keeping electrical cords clear of passageways. Avoid using electrical extension cords.
b. Proper storage of all equipment and supplies. Do not store heavy items on top shelves.
Scissors, knives, pins, razor blades and other sharp instruments must be safely stored and
used.
c. Turning off all electric machines with heat producing elements when not in use.
d. Notification to facilities department immediately of improper illumination and
ventilation.
e. Arrangement of furniture and equipment must be arranged to allow passage and access to
exits at all times.
f. Giving information regarding minor spills, such as water to cleaning team by the
employee who discovers the spill immediately.
g. Reporting faulty equipment to the clerk incharge for equipment maintenance or vendor as
per policy.
h. Obey warning signs.
i. Usage of appropriate personal protective equipment.
j. Safety precautions such as closing file drawers and cabinet doors when not in use. Open
only one drawer at a time. Even distribution of material to prevent the file cabinet from
being unbalanced and tipping over
k. Frequently inspect cords, plugs, switches, sockets and outlets for damage. Report any
defects such as frayed cords, broken plugs, etc. immediately.
5. Not leaving equipment standing in traffic lanes. Return equipment to its proper location
when not in use.
6. Do not obstruct fire equipment. Know location of fire fighting equipment and how to use
it. Know evacuation routes and what to do in case of fire.
H. Patient Safety:
1. Patients safety is at all times given highest priority. No action should be undertaken
which would knowingly be harmful or potentially harmful to patient
2. All patients shall receive the utmost care and attention from the physiotherapy staffs. All
patients shall be assured of their privacy and dignity while on their treatment.
3. Explanation of the procedure and hand out is to be given before the treatment
4. No In patients will be shifted to the physiotherapy department for treatment with out an
accompanying hospital staff.
5. Patients will be lifted correctly. Get help when needed. Use mechanical aids when
necessary.
6. Be sure that disc and pads are wrapped with towels to prevent accidental burns to the
patient.
7. Obtain the necessary assistance to safely aid the patient in ambulating and exercise
therapy.
8. Do not leave elderly, pediatric or confused patients unattended on therapy tables or in
therapeutic wax bath.
9. When transporting a patient to the treatment area by wheelchair, take the following safety
precautions.
a. Lock the wheel brakes or otherwise secure the vehicle in place before moving
patient to/from transport.
b. Prevent the patient from falling by using safety belts or side rails.
c. Position yourself at the patients head, push slowly, steadily.
I. Maintenance of patients confidentiality:
1. In the course of performing work responsibilities all information with regard to patient, their
family, their physician and / or the hospital will be kept confidential.
2. Physiotherapist are cautioned by the administration of the hospital not to discuss any such
information with others,
3. Causal comment with fellow co-workers in the hallways, lobby or other place may be
overheard and violate the trust others have placed in physiotherapist.
J. Maintenance of Equipment:
The following aspects of equipment maintenance are to be ensured :
a. Periodic servicing: Service to be conducted by Qualified company Service personals
b. Proper technical care to be taken during the maintenance.
Periodic Servicing:
a. Periodic servicing must be done as instructed by the respective instruments manual or
by the company person. Mention in the equipment history card the date of equipment
commissioned and break down during warranty period.
b. Equipment not working must be tagged OUT OF ORDER
c. Any work carried out by the instrument / equipments technician or engineer should be
recorded in Instrument History card as follows:
i. Time spent for servicing.
ii. Description of service being carried out
iii. Status of equipment after servicing
iv. Name of the technician / engineer attended
Logging complaint during Breakdown
a. First switch off the equipment.
b. Inform the clerk incharge of equipment maintenance and higher authorities.
c. Raise the work order.
d. The company person is called .
e. Log complaint to company service department.
f. Display out of order board near the machine.
g. Log the incident in the History card with time.
h. Once the engineer has diagnosed the problem inform authorities.
Reporting Format (Monthly) to be forwarded to the Chief Medical Superintendent :
Physiotherapy - Enter Departmental

month here statistics
Enter daily statistics
-------------------
DATE 1 2 3 4 5 6 7 8 9- - 31 total
OP pts
IFT 0
ULTRASOUND 0
WAX 0
TRACTION 0
MOIST THERAPY 0
COLD THERAPY 0
CPM 0
SHORT WAVE 0
ELECTRICAL
STIMULATION 0
EXERCISES 0
sub total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IP pts
CHEST PHYSIO 0
ORTHO EXERCISES 0
NEURO EXERCISES 0
US 0
SWD 0
TRACTION 0
IFT 0
CPM 0
COLD THERAPY 0
EXERCISES 0
sub total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total patients 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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ANANT INSTITUTE OF MEDICAL SCIENCES, PHYSIOTHERAPY DEPARTMENT

MANUAL OF OPERATION, DATE 20/10/2017

Service Name : Physiotherapy Department

Chief Medical Superintendent

Scope: Include staff and patients involved in the process.

Definitions and Abbreviations:

D. Inpatient Work Process:

Doctor refers patient

Nurse informs physiotherapist

Entry Made in Patients

E. Out patient work process:

Patient with reference

Patient assessment and

Plan of treatment and

Patient leaves the

4. Moist Heat Therapy:

8. Continuous Passive motion :

a. Initial assessment will include information gathered by the physiotherapist as follows:

I. Maintenance of patients confidentiality:

Physiotherapy - Enter Departmental

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