HOP-FA Flashcards
(43 cards)
1
Q
Definition of HOP-FA
A
clinical framework designed to guide students and novice clinicians through the clinical reasoning process in pediatric physical therapy practice
2
Q
what does HOP-FA stand for?
A
Hypothesis-Oriented Pediatric Focused Algorithm
3
Q
What really is the HOP-FA and what does it do?
A
- A systematic, step-wise guide to the patient/client management process
- Assists physical therapist students in developing pediatric clinical reasoning skills
- Promotes a child-and family-centered approach to pediatric physical therapist practice
4
Q
is the HOP-FA intended to provide specific guidelines for pediatric physical therapy practice?
A
nope
5
Q
is the HOP-FA built upon a specific therapeutic examination or intervention philosophy?
A
nope
6
Q
Definition of Cerebral Palsy:
A
- Disorder of the development of movement and posture causing activity limitation
- Attributed to non-progressive disturbances that occurred in the developing brain
- Motor disturbances
- Disturbances in sensation, perception, cognition, communication, behavior, epilepsy
- Secondary musculoskeletal problems
7
Q
Antenatal Pathophysiology of CP
A
- Prematurity and low birth weight
- intrauterine infections
- multiple gestation
- pregnancy complications
8
Q
Perinatal Pathophysiology of CP
A
- birth asphyxia
- complicated labor and delivery
9
Q
Postnatal Pathophysiology of CP
A
- Non-accidental injury
- Head trauma
- Meningitis/ Encephalitis
- Cardiopulmonary arrest
10
Q
Periventricular Leukomalacia
A
- Ischemic necrosis to periventricular white matter
- Causes bilateral cystic lesions (myelin doesn’t form)
- distal > proximal
11
Q
Periventricular Hemorrhagic Infarction
A
- Hemorrhage into germinal matrix and ventricles
- Unilateral
- Caused by an increase in cerebral blood pressure
12
Q
pathophysiology - preterm infant
A
*Periventricular leukomalacia (PVL)
*Periventricular hemorrhagic infarction
*Affects ascending/descending axons
*Topographic and size relationship
13
Q
Pathophysiology - Term Infant
A
*Infarction in parasagittal watershed area, MCA stroke
*Basal ganglia & thalamic injury
14
Q
Term Infant- Infarction in parasagittal watershed area, MCA stroke
A
Cortical and deep gray matter lesion
15
Q
Basal ganglia & thalamic injury
A
- Athetosis, chorea
- Seizures and cognitive impairments
- Hemiplegia > Diplegia
16
Q
Classification of CP - Movement Disorder
A
- Hypertonia –spasticity, dystonia, rigidity
- Hyperkinetic –athetosis, chorea, dystonia, myoclonus, tics, tremor
- Negative –ataxia, weakness, decreased selective motor control
17
Q
Classification of CP- Anatomic Distribution
A
- Hemiplegia
- Diplegia
- Triplegia
- Quadriplegia –involvement of head and neck
18
Q
GMFCS - Level I
A
- Walks without limitation
19
Q
GMFCS - Level II
A
- Walks with Limitations
- Climb stairs holding onto a railing
- difficulty walking long distances or uneven terrain
- May walk with physical assistance, a hand-held mobility device or wheelchair over long distances
- Minimal ability to perform gross motor skills such as running and jumping
20
Q
GMFCS - Level III
A
- Walks using a hand-held mobility device in most indoor settings
- May climb stairs holding onto a railing with supervision or assistance
- Wheeled mobility when traveling long distances and may self-propel for shorter distances
21
Q
GMFCS - Level IV
A
- Self-Mobility with Limitations; may use powered mobility
- May walk short distances at home with physical assistance or use powered mobility or a body support walker when positioned
- At school, in community, or outdoors, children are transported in a manual wheelchair or powered mobility
22
Q
GMFCS - Level V
A
- Transported in a manual wheelchair in all settings
- Children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements
23
Q
Twelve Steps of the HOP-FA
A
- Initial Hypothesis
- Initial Data Collection
- Problem Statement
- Hypothesize Goals
- Examination Planning
- Examination
- Evaluation
- Diagnosis and Prognosis
- General Intervention Planning
- Intervention Session Planning
- Reflection
- Formal Re-examination
24
Q
Initial Hypothesis - 1a
A
- Question: What is the child’s
chronological age? - Build a mental image of the child at this
age…. - Gross Motor Function
- Social
- Educational
- Family Activities
25
Initial Hypothesis - 1b
* Question: What are the primary and
secondary impairments associated with
the child’s medical diagnosis?
Assists with:
* Foundational aspects of examination
* Building a mental image of the child
26
Initial Data Collection
* Review of records (Medical, Educational)
* Interview with family
* Observe the child during the interview
process
* What is the lived reality and environment of the child and family?
* Why are the child/family seeking PT?
* What are their desired goals/outcomes
from PT?
27
what is the information collected during initial data collection for?
This information assists the PT to further
develop an initial impression of the child’s
functional capabilities/status
28
Measures to assist with goal setting
* Canadian Occupational Performance Measure (COPM)
* Perceived Efficacy and Goal Setting System
29
Problem statement
*Statement that specifically describes why the child/family are seeking PT
*The foundation of family-centered care --> Ensures that the child’s and family’s goals and expected outcomes are well understood and delineated prior to examination
30
Problem statement to fill in:
“The family/child are seeking physical therapy to be able to...”
31
Hypothesize goals
*Propose short and long-term functional goals that will direct the examination process
*Ensure that these goals are consistent with the child’s/family’s desired outcomes --> Encourages family involvement in the examination process
32
What is important to note when hypothesizing goals
These goals might not be the definitive goals established for the plan of care --> These initial goals are tools to help prioritize the tests and measures used in the examination
33
tests and measures identified based on:
* The PT’s mental image of the child
* The problem statement
* The hypothesized goals
* The information gathered through the initial data collection process
* The PT’s knowledge of available tests and measures
34
what is extremely important during examination planning?
ICF
35
examination
*Administer tests and measures
*You will find that measures of Activity and Participation are not routinely employed in clinical settings --> Good for tracking progression over time, measuring effectiveness of interventions
36
measures of examination should be:
* Valid
* Reliable
* Feasible
* Able to detect clinically-relevant changes
37
Evaluation
*Synthesis of examination findings
*Facilitates the inclusion of contextual factors during the synthesis of
examination findings
38
Questions to consider during evaluation?
* What are this child’s specific strengths?
* What are the physical therapy problem areas (impairments, functional limitations, and activity or participation restrictions), and how do
these problem areas impact this child’s function?
* In what ways do the identified physical therapy problem areas restrict the child’s ability to fully participate in activities that are
appropriate for the child’s age?
* Do any of the identified physical therapy problem areas have the potential to lead to the development of further problem areas? Can
these future problems be prevented? How?
* Are there any changes coming up for this child and family in the next year? How might these anticipated changes affect the child and
the family?
* What is the child’s anticipated level of function in 1 year? 5 years? What needs to be done now to maximize the child’s future independence and function?
39
diagnosis and prognosis
*Identify the primary 1-2 physical therapy problem areas that are most limiting the child’s functional activity level (Prioritize problem areas and Assist in focusing the physical therapy plan of care)
*Helps drive intervention strategies
*Are additional referrals necessary?
*Refine mental image of child based on examination/evaluation
40
general intervention planning
*Physical therapy interventions based on plan of care (Coordination, Communication, Documentation)
*Procedural interventions
*Patient/client and family-centered instruction (Home program)
41
Intervention Session Planning
* Base interventions for individual sessions on a specific functional goal
* Specific activities (Preparation, Motor, Links to the next session)
* Consider: Motivational factors, Play, Feedback mechanisms, How to increase/decrease level of difficulty
42
Reflection - Continue monitoring:
* Was the intervention successful?
* Are we progressing toward the short-and long-term goals?
43
formal re-examination
*Re-administration of examination tests and measures to modify/redirect
interventions
