Conditions Requiring Inpatient Physical Therapy

Physical therapists are key members of the cardiac rehabilitation treatment team. Patients who have had cardiac surgery or who have suffered a heart attack will be seen by a physical therapist for a comprehensive evaluation and cardiac rehabilitation. They will assess their patient's vital signs during activity and set parameters for exercise and walking while recuperating in the hospital.

Prior to being discharged from the hospital, the physical therapist will develop a personalized exercise program outlining the recommended level of activity for when patients return home. Patients who have had cardiac surgery also have the opportunity to attend a patient education group several times a week, which gives patients an opportunity to ask questions about their activity levels and recovery.

Intensive Care Unit

Physical therapists primarily serve in a consultative role in the Intensive Care Units (ICUs). All physical therapists assigned to the ICU have an advanced level of skill and knowledge in order to treat this critically ill patient population. They are available to conduct comprehensive initial assessments and monitor and reassess a patient's progress as appropriate. Often, they will assist the nursing staff with getting a patient out of bed for the first time. The therapist educates nurses and families to properly position and/or exercise critically ill patients while they are required to be in bed. They also work closely with the treatment team to help patients manage their airway secretions and breathe independently by performing chest physical therapy, if indicated.

Neonatal Intensive Care Unit

A physical therapist is available to provide consultation to infants and their parents in the Neonatal Intensive Care Unit (NICU). She is available to conduct developmental assessments and to recommend strategies to both nursing staff and to parents that will encourage normal infant development. This physical therapist works closely with an occupational therapist as part of the rehabilitation consult team.

Most patients who upon discharge require a greater level of assistance with their mobility than before their hospitalization can benefit from physical therapy. Patients admitted to BIDMC's general medicine units may be referred to physical therapy if they are having difficulty getting out of bed, walking, climbing stairs, losing their balance and/or are weak from prolonged bedrest. Physical therapists may perform home safety assessments in preparation for a patient's return to home. Physicians also refer patients for chest physical therapy who are unable to manage airway secretions independently or who complain of difficulty breathing with activity.

Many patients following surgery have difficulty moving due to painful incisions or weakness from prolonged bedrest. Patients may require a brief course of physical therapy if they are having difficulty getting around after surgery. This often consists of teaching patients easier ways to move that are less painful and/or using a cane or a walker until their pain is better, and they are stronger. Some post-surgical patients have trouble coughing due to painful incisions. These patients may require chest physical therapy to aid them in clearing airway secretions so they can breathe easier.

Physical therapists evaluate and treat patients who have problems with coordination, motor function, balance or endurance because of a neurological illness or injury. Patients who are admitted with head or spinal cord injuries are often extremely limited in their ability to move. The goal of therapy is to maximize function to allow the patient to be transferred to an appropriate rehabilitation center for further physical therapy. Some patients, upon discharge, are able to return home and receive physical therapy there or as an outpatient at a private facility.

Some expectant mothers have to be placed on bed rest prior during their pregnancy, which can result in weak muscles. Physical therapists instruct these patients in an exercise program that they can perform while they are restricted to bed to help maintain muscle strength.

On occasion, mothers who have given birth have leg weakness or pelvic pain from the delivery which can necessitate the need for a walker or crutches. In this case, a physical therapist provides instruction on these assistive devices and prescribes muscle strengthening exercises.

Bone Marrow Transplants

Patients who have had bone marrow transplants are often hospitalized for several weeks in BIDMC's dedicated inpatient transplant unit. Physical therapists are available on a consultative basis to perform a comprehensive evaluation and establish a care plan to minimize the effects of the extended hospitalization. Physical therapists prescribe exercise and conditioning programs to keep patients strong, modifying these programs according to the patient's performance and medical condition. Physical Therapy Cooperative Program students are available to assist patients with their exercise programs.

Lymphedema

Patients with lymphedema experience the build up of fluid in their arms, legs or other parts of their body during their hospitalization. Physical therapy, including manual techniques, therapeutic exercises and the application compression bandages, helps to reduce the edema or swelling caused by the fluid. Therapists also teach patients and their families bandaging techniques, exercises and skin care. Some patients may require the use of additional equipment to control their edema.

Cancer

Patients who have cancer can present with many different medical conditions that often result in muscle weakness, decreased endurance, loss of balance and an inability to get out of bed and walk. Patients experiencing these difficulties are referred to physical therapy for a comprehensive evaluation and to develop a plan for addressing these issues.

Joint Replacement and Reconstruction Rehabilitation

A physical therapist consults with a patient recovering from an orthopedic surgery. Physical therapists are key members of the orthopedic treatment team for patients undergoing joint replacement and/or joint reconstruction rehabilitation. Following surgery, therapists work with patients to teach them range-of-motion exercises, strengthening exercises and functional training, including walking training. Patients are given instruction on caring for their new joints, and prior to being discharged, are taught exercises to be done at home as part of a follow-up therapy program.

Spinal Surgery

Patients are often referred for physical therapy following spinal surgery, particularly back surgery. The physical therapist's primary role is to teach patients the proper way to get in and out of bed and to move while walking in order to protect the spine. Some patients have pain or weakness after surgery and need to be instructed in the use of a cane or a walker. Patients who are required to wear a brace are taught, along with family members, how to put it on and take it off by the physical therapist.

Sports Medicine

Various orthopedic knee or shoulder surgeries, such as ACL reconstructions, trilliat procedures, acromioplasties or rotator cuff repairs, sometimes require an overnight hospital stay. These patients typically receive one physical therapy visit before they are discharged home. The therapist teaches patients exercises to keep their joint flexible and strong and, if needed, provide instruction on using crutches. The physical therapist may also recommend continued therapy in an outpatient setting.

Patients who are recovering from transplant surgery or preparing for surgery are often in the hospital for an extended period of time. Physical therapists are available on a consultative basis to perform a comprehensive evaluation and establish a plan of care to minimize the effects of the extended hospitalization. Physical therapists prescribe exercise and conditioning programs to keep patients strong, modifying these programs according to the patient's performance and medical condition. Physical Therapy Cooperative Program students are available to assist patients with their exercise programs. Patients on the transplant floor can attend exercise groups 2-3 times a week.

Beth Israel Deaconess Medical Center is a Level I Trauma Center. Patients on the trauma service may have sustained numerous injuries to multiple parts of their bodies, including orthopedic and neurological injuries that require an inpatient rehabilitation stay. Most patients sustaining multiple trauma are referred to physical therapy for a comprehensive assessment. Typically physical therapists help these patients with getting in and out of bed and walking, exercising weak or damaged limbs, and assisting in clearing airway secretions. Physical therapists work closely with the entire medical team to optimize care and return patients to home as soon as possible.

Patients recovering from vascular surgery often have difficulty walking and require the skill of a physical therapist to teach them how to use crutches, a walker or a cane. They may also have stiff joints requiring a physical therapist to teach them stretching exercises. For patients with amputations, physical therapy teaches how to prepare for the use of a prosthesis or artificial limb.