Role of the PTA

Review PT Evaluation

Understand how the reason for the PT referral medical history and contributing factors influence the focus of the PT intervention plan and goals. Specific elements in these conditions include

• Review of clinical and lab tests and medications

• Hypoglycemia = 70 or < mg/dL blood glucose
• Normal blood glucose range: 70-110 mg/dL
• Hyperglycemia = blood glucose levels >200 mg/dL
• Insulin use
• Cardiac and blood pressure medications

• Review of body systems

• Cardiovascular/pulmonary: VS, SpO2, pain, VS response with activity, cough strength, breath sounds
• Integumentary: skin checks, particularly in WB areas, check surgical/wound dressings, IV sites, swelling
• Endocrine: related hormone function and therapies
• Musculoskeletal: ROM, MMT, levels of assistance
• Neuromuscular: sensory testing (light touch, sharp/ dull, vibration), proprioception
• Communication, Cognition, Language, Learning Style

Assess prior use of assistive devices, such as adaptive footwear, braces, device for gait

Tests and Measurements

Selected tests and measures will be driven by clinical need and are based on the goals and plan of care. Due to the intricate involvement of the endocrine system on blood glucose and homeostatic regulation, care must be taken to

• Assess readiness for movement
• Monitor response to movement
• Careful observation and listening are key driving factors that inform intensity and modifications to movement
• Predict personnel, equipment, and physiological monitoring equipment needed to progress and perform movement safely

Cardiac, pulmonary, neuromuscular and integument conditions are systems that may influence optimal movement. Considerations for test include

• Angina equivalents (monitor and request feedback regarding sxs of nausea, vomiting, dizziness, SOB) due to unreliable autonomic nervous system.
• Check skin before and after treatment, especially in friction/WB areas for signs of poor circulation/ erythema
• Ask patients about blood sugar control patterns, when they last took their blood sugar measurement; what was the value; when/what did they last eat?
• Screen for unreported falls: cardinal signs for inflammation
• Closely monitor intensity so interventions do not result in over-fatigue and loss of function

 

Exercise and Insulin

• Exercise produces an insulin-like effect in that blood sugars are mobilized and utilized quickly in response to an increased demand for energy/ fuel

• Persons with DM are more at risk for hypoglycemia with exercise

• Persons with DM may choose to temporarily stop insulin infusion prior to exercise or may be encouraged to eat a small snack before exercise

 

 

 

Education, Education, Education

Simple messages for type 2 diabetes control: advise consulting with attending physician and or nutritionist

1. Lose excess body fat: best way to curve the disruption of insulin producing cells in the pancreas and to assist in more normal insult production.
1. Be mindful of the socioeconomic and developmental factors that influence excessive body weight. Many children are born overweight due to in utero over exposure to high glucose from mom's diet. Many diabetics live in higher crime, low income neighborhoods where unhealthy food in convenience markets are highly affordable and accessible.
2. Choose your fats: more fish and plant based oils/olive oil with less meat and dairy.
3. Feed those gut microbes: recommend diets in high in fiber and raw vegetables and fruits.
4. Avoid high corn syrup, fruit juice and processed foods that contain preservatives
5. Inspect skin and engage in prevention activities to protect feet, including appropriate footwear
6. Discuss smoking cessation if patient is a smoker, provide resources on dangers of smoking to all body systems, not just cardiovascular. Make appropriate referrals and follow up if patient wants to quit

 

 

Communication, Coordination, Documentation

• Document most recent blood sugar levels if available; query patient on knowledge of lab levels and relative perceived exertion during activities outside of therapy;
• Document subjective and objective information which may indicate poor patient compliance with blood sugar regulation/DM management
• Coordinate vendor consults for adaptive and assistive equipment, such as bracing, seating, and devices to help with energy conservation and mobility.
• Document type and level of family support
• Document patient and family education and the outcome of that education
• Recognize changes indicating a decline in medical status and/or medical emergency; communicate changes with appropriate medical personnel using relevant medical terminology
• Request referral/recommend medical or community-based psychosocial support for adjustment to disability

 

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