Clinical decision making

Question 1

the outcomes of clinical reasoning are ?

Answer 1

clinical decisions

Question 2

what is clinical reasoning?

Answer 2

the synthesis of information based on evidence
includes patient, caregivers, and care team

Question 3

what are the three pillars of evidence based practice?

Answer 3

best available evidence
clinical expertise
patient or client values

Question 4

what are systematically developed statements to guide clinicians in using best available clinical evidence in patient’s care?

Answer 4

CPGs

Question 5

CPGs bridge the gap between ______ and ________

Answer 5

evidence and recommendation

Question 6

conceptual framework:
- provides _____
- ______ and ______ data
- influences _______
- guides _______

Answer 6

structure
gathers and organizes
decisions
care

Question 7

conceptual framework is a tool for ______
example?

Answer 7

organization or model used for decision making
ex: ICF model, Schenkman model

Question 8

true or false. integrated framework for CDM focuses on patient centered care and hypothesis-oriented algorithm for clinicians

Answer 8

true

Question 9

Why do we use hypothesis in the clinic and in CDM?

Answer 9

helps to determine the relationship between functional limitations and underlying impairment

Question 10

clarifying the causes of functional movement problems requires the clinician to?

Answer 10

1. generate hypothesis (or multiple)
2. determine tests and expected outcomes
3. perform the tests
4. continue generating and testing hypotheses to refine an understanding of the cause

Question 11

hypothesis-oriented approach of schenkman model is similar to what other model? what step?

Answer 11

hedman model
step 4: treat the problem
(form hypothesis, implement interventions, evaluate outcomes, repeat)

Question 12

when do you start forming hypotheses for your patient?

Answer 12

chart review
patient interview

Question 13

what type of screen would you perform for
- MSK
- neuromuscular
- cardiovascular/pulm:
- cognitive ability

Answer 13

• motor screen
• sensory screen
• vital signs
• cognitive screen

Question 14

motor control is governed by what three factors?

Answer 14

task
environment
individual

Question 15

Hedman model step 2:

Answer 15

analyze the task. where in the movement continuum does the problem occur?

Question 16

what are contextual factors of the ICF model that help to interpret clinical information? (5)

Answer 16

environmental factors
personal factors
body functions and structure
activity
participation

Question 17

what is the difference between a PT diagnosis and medical diagnosis?

Answer 17

PT: includes level of impairment, activity limitation, participation restrictions

med: identification of disease, disorder or condition

Question 18

what is a prognosis?

Answer 18

predicted optimal level of improvement in function and amount of time needed to reach
helps determine where they can d/c to

Question 19

list some aspects of motor learning

Answer 19

goal
learning variables
dosing of treatments
practice schedules
altering the environment
feedback education
compensation vs restoration
progressions vs regression

Question 20

what are the three stages of learning in order to help with deciding when to progress or regress your patient? describe them

Answer 20

1. cognitive
   - closed environ., massed practice, constant cues & immediate feedback
2. associative
   - open vs closed, high variability, fading cues, delayed feedback
3. autonomous
   - open, random, bandwidth for safety

Question 21

how do short term goals differ from long term goals?

Answer 21

short term: should be progressible toward similar long term goal

long term: relates to discharge goals

Question 22

what is the ABCDE model goals should be written as in physical therapy?

Answer 22

actor
behavior
condition
degree
expected time

Question 23

is the following an example of a short or long term goal for a patient in inpatient rehab:

patient will perform sit to stand in order to transfer out of bed on level surface similar to home independently in 2 weeks

Answer 23

short term goal

Question 24

what categories of the ICF model does short term goals fall into?

Answer 24

patient’s body function and activity disabilities

Question 25

what categories of the ICF model does long term goals fall into?

Answer 25

patient’s participation disabilities

Question 26

true or false. only one discipline of the care team decides on the discharge plan for a patient

Answer 26

false - everyone on the team

Question 27

what is PTs role in DC planning?

Answer 27

mobility and safety

Question 28

if the patient is discharged before outcomes are reached, reasons for discontinuation of services must be _____ ________

Answer 28

carefully documented

Question 29

what are discharge options from acute care setting?

Answer 29

home (with HHPT or support system)
sub acute rehab
inpatient rehab

Question 30

what is the flow of the schenkman model?

Answer 30

interview history
systems review
exam
diagnosis/prognosis
plan of care interventions
outcome

Question 31

when is a neuro screen conducted?

Answer 31

during systems review

Question 32

a neurological screen is a _______ assessment of neurologic aspects of the ______ ______ for patients with suspected neurologic involvement

Answer 32

gross/broad
physical examination

Question 33

what are you screening for in a neuro screen of someone with a suspected neurological impairment?

Answer 33

sensation
muscle tone, strength
functional movement
coordination
DTRs (clonus)
UMN signs (babinski, hoffman)

Question 34

why do we perform a neurological screen?
- screen for _____ _____ and for _____
- differential _______
- establish ______
- observe for ______

Answer 34

red flags and referral
diagnosis
baseline
changes

Question 35

a screen is ______ to rule ____/rule______
an exam is further ______ into a specific _____

Answer 35

quick, in, out
investigation, system

Question 36

in your screen, you find that your patient experiences sensory changes in their LEs. what is your next step?

Answer 36

go into more testing of light touch, pin prick and determine exact location

Question 37

should you perform a neuro screen on a patient with no neurologic diagnosis?

Answer 37

no

Question 38

when should you complete a neuro screen?

Answer 38

if the patient’s S&S or history guide you to dig deeper by choosing portions or all of the exam

Question 39

flow of a neuro screen:
_____ review
observations & _____ status
systems review
–> ROM/_____/DTR/______
______ nerve screen
functional ______ screen

Answer 39

chart
mental
strength/sensation
cranial
mobility