Clinical Decision-Making Models and Measurement: Exam 1 Flashcards
(52 cards)
1
Q
Model of Disablement:
ICIDH I Model
A
Disease causes
Impairment causes
Disability causes
Handicap
2
Q
Models of Disablement:
The Nagi Model
A
Looks @
patho
impairment
functional limit
disability
2ndary impairment
2ndary patho
3
Q
Current WHO Model:
ICF
A
Health Condition/Disease
Body Functions/Structures Activity Participation
Contextual Factors
Personal Factors Environmental Factors
4
Q
Modifiers to the Disablement Models
3
A
- Pos. or Neg
- Ext. to the indiv.
- Indiv. factors
5
Q
Modifiers to the disablement model that are external to the individual
A
Healthcare services
6
Q
Individual factors that are Modifiers to the Disablement model
A
Lifestyle/health behaviors
Psychosocial attributes
ability to adapt to limitations and accept disability
7
Q
Conceptual frameworks that are from the perspective of what the individual IS ABLE TO DO rather than what the individual IS UNABLE TO DO
A
Enablement Models
8
Q
Drawbacks of Enablement Models
A
- Does NOT help from dx problem
- WE follow what pts cannot do
9
Q
Model of PT Practice
From the Guide
A
- Exam:
- Hx
- Systems Review
- Tests & Measures
- Eval, PT Dx, Prognosis
- Intervention
10
Q
EXAMINATION:
3 components
A
- Hx
- Systems Review
- Tests & Measures
11
Q
As far as Hx goes…
A
- Interview Pt, family, caregiver
- chart review
- should be used to develop a holistic picture of the pt and how he/she is affeced by the patho.
12
Q
Exam:
Interview and Hx
A
- generates pt-ID’d problems
- MAY reveal NON-pt-ID’d problems
-
Informs LATER stages of the exam.
- ”At the end, I’m going to tell you what I found and what I think”
13
Q
Exam:
Systems Review
A
- CV and Pulm
- heart
- Integumentary
- risk for wounds, sores
- MSK
- Flex
- strength
- jts
- mm’s
- NMSK
- prev. Hx
- dermo/myo/reflexes
- Communication, Affect, Cognition, Learning Style
- interaction
- memory
- problem-solving
14
Q
Exam: Tests & Measures
Reliability
A
- Whether the test will be the SAME when doing it again
- OR if 2 PT’s use it on same pt will it give the pt the same result
15
Q
Exam: Tests & Measures
Validity
A
Does the test measure what I WANT it to measure?
16
Q
Exam: Tests an Measures
Function
A
- Can they do activity
17
Q
Exam: Tests an Measures
Observation
A
- HOW they do it
- Mvmt quality
*NOTE: if you cannot measure it, then DESCRIBE it
18
Q
Exam: Tests an Measures
Problem Solving
A
- Find tools that get to the pts problems
19
Q
Examination: Tests and Measures
What is some documentation for pts w/ neuro. patho?
A
- Guide to PT practice
- Standardized
- Descriptive (Qualitative)
20
Q
Exam: Tests and Measures
Slide 1
A
- aerobic capacity/endurance
- anthropometric characteristics
- limb length
- BMI
- arousal, attention, cognition
- assistive/adaptive devices
- community and work integration or reintegration
21
Q
Exam: Tests an Measures
Slide 2
A
- CN integrity
- environmental, home and work barriers
- ergonomics and body mechanics
- gait, loco, balance
- integumentary integrity
22
Q
Exam: Tests an Measures
Slide 3
A
- jt integrity/mobility
- motor function
- mm perform.
- Neuromotor dev. and sensory integration
- orthotic, protective and supportive devices
- pain
- posture
23
Q
Exam: Tests an Measures
Slide 4
A
- prosthetic req’s
- ROM
- reflex integ.
- self-care/home mgmt
- sensory integrity
- ventilation, resp, circulation
24
Q
What do the CPGs or Clinical Practice Guidelines tell us?
A
Enough evidence that we can tell you this is how you should do it ***
25
Eval/Dx/Prognosis
Includes these things: 5
* probs w/ **body structure/function**
* **Activity limits**
* **Dx patterns**
* ****defined syndrome?
* clinical impression
* **synopsis of what we THINK is going on**
* Prognosis
* where do you think they'll be able to get?
* ult. lvl of function?
26
Eval, Dx, Prognosis
## Footnote
**Should result in these 3 things**
* thoughtful analysis all info collected thru exam
* dev. of prioritized list
* pt-ID'd probs
* NON-pt ID'd probs
* One or more **appropriate, measurable, achievable goals**
* ****FOR EACH PROBLEM!!!
27
PLAN OF CARE
2 Parts:
* **Anticipated** goals
* **Expected** outcomes
28
Interventions include 3 categories:
* Team coord./communication/doc.
* Pt/client-related instruction
* Ther-Ex
29
What are some ex's of **Direct Interventions?**
* **Functional training**
* ****self care
* home mgmt
* Manual therapy tech's
* devices + equip.
* airway clearance tech's
* wound mgmt
* electrotherapeutic modal's
* phys. agents
30
Criteria for **Discharge**
* Probs w/ body structure/function---\> **anticipated goals**
* activity limits---\> **expected outcomes**
basically.... using our POC to ADDRESS these
31
Outcomes AFTER interventions
* Act. limits and Part. restrictions
* pt satisfaction
* \*\***Secondary prevention**
* ****preventing FUTURE problem
32
Hypothesis-Oriented Clinical Practice
explain the **Hypothesis**
proposal to **explain the cause** of a pt's problem
Exam (hypothesis)---\> intervention---\> re-exam
TEST your hypothesis!!!
33
What must the **Clinician do** in regards to the **Hypothesis?**
**3 things**
* Gen. **multiple** hypotheses
* Select/perform tests to **rule out one or more hypotheses**
* Cont. process **until cause is understood**
**Exam (hyp.) ---\> intervention---\> re-exam**
**See Ex. attached--- Mr. Hay**
34
In regards to Theories of Motor Control
## Footnote
**Exam and tx are based on \_\_\_\_\_\_\_\_**
Assumptions
\*\*they must be **dynamic** to reflect changes in scientific theory
35
What theories of Motor control are currently being used?
* Motor Learning Theory
* Ecological Model
36
2 helpful uses of Differential Dx
1. separates accurate vs. inaccurate dx
2. helps us narrow things down
37
What is the MAIN purpose of **Screening?**
* Narrows the **focus of the examination**
38
When **Screening** is combined w/ **Hx**
## Footnote
**it does 4 things:**
* localizes source of patho.
* areas to focus on for **in-depth eval.**
* what **tests/measures** must be carried out
* **Saves Time!!!**
39
**Screening** det's a patient's gross _______ and \_\_\_\_\_\_\_\_
Gross **cababilities and limitations**
40
The Screen det's pts gross capabilities and limits to decide 2 things in regards to **Tx**
* IF pt is able to **proceed w/ tx**
* ****can they follow instructions?
* **HOW to proceed** w/ subsequent tx
41
The Screen ID's
4 things:
* ID's
* exist. med cond's
* s/s suggesting **deterioration/new prob**
* acute OR life-threatening neuro. manifests./probs
* s/s suggestive of **occult disease**
* ****not obvious or hidden dis.
42
How do we ID health risk factors?
Chart review
Questionnaire
43
Chart review/Questionnaire answers direct therapist HOW
```
# * consider impact of complaints
* **Choose exam and tx tech's**
```
44
Components of a Screen
* mental status
* pt hx
* vitals !!!
* myo/dermo tests
* UQS/LQS
* mm tone
* reflex tests
* **Patho. reflexes**
* coord.
* posture
* CN tests
45
w/ **Symptom Investigation**
MUST consider: 3 things
* **Loc**. sx's
* Pattern of **change**
* **Hx** of onset/symptoms
46
W/ Symptom investigation....
The PT must interpret the **pt's description of:**
* symptoms
* act/participation limits
* exam findings
Interpret them in a way to point you in the right direction!!!
47
W/ symptom investigation....
there should be a **link b/w these:**
* problems w/ **body structure/function** AND **act/participation limits**
48
Use this to help w/ **location of sx's**
Body diagram
\***also get a 24hr report!!!**
49
W/ diff. dx's
the goal is NOT to formulate medical dx---not in PT scope
instead what is the Goal?
ID PT Dx
* **recognize s/s**
* **communicate** findings to physician
* **Create a PT DX \*\*\*\*\*\*\*\*\*\*\*\*\***
50
Body Systems
CV
Pulm
GI
Endocrine
Urogenital
Integumentary
Psychological
NS
51
Decision to Treat
Consider....
* Scope of practice
* **Do findings warrant communication w/ PCP**
* **Clinical Decision:**
* ****Treat
* Treat + Refer
* Refer
52
