Medical criteria for active physical therapy. Physician guidelines for patient participation in a program of...

Medical guidelines are presented by which the physician may evaluate a patient for participation in a program of active physical therapy (A.P.T.). A.P.T. system modalities are introduced and defined as: a) isokinetic leg trainer, b) stationary bicycle ergometer, c) outdoor exercise bicycle, and d) Functional Electrical Stimulation (F.E.S.)--Orthosis for ambulation. The physiological responses to these F.E.S. exercise modalities are reviewed. Initial and interim patient evaluations are discussed. The initial patient evaluation includes a history, physical examination, lab tests, and a report summary, all of which culminate in an F.E.S. exercise prescription. The interim patient evaluation is performed for continuation-termination purposes as well as to progress the patient through the various F.E.S. exercise modalities. Specific F.E.S. exercise progression criteria are summarized. The medical criteria are presented with respect to both patient participation in the F.E.S. exercise program and patient monitoring during the exercise itself. Specific medical criteria for patient participation in A.P.T. are organized around eight functional categories: a) level of neurological injury, b) muscular system, c) skeletal system, subdivided into bone criteria and joint criteria, d) cardiovascular system, e) respiratory system, f) urogenital system, g) cutaneous system, and h) psychological system. The medical criteria for patient monitoring during F.E.S. exercise are discussed with respect to: a) cardiovascular monitoring, b) objective patient monitoring, and c) F.E.S. exercise system monitoring. The article concludes with a discussion of informed consent when applied to an emerging treatment modality.