Intro, ICF, Client Management

Question 1

Multidisciplinary Care:

Guide to Physical Therapist Practice:

Purpose?

Answer 1

1. Describes physical therapist practice
2. Describes settings in which PTs/PTAs practice and the role of physical therapists in:

• Primary, secondary, and tertiary care
• Prevention
• Promotion of health, wellness, fitness

3. Standardizes terminology
4. Delineates the clinical decision-making process that occurs as part of patient/client management
5. Reviews interventions that are part of PT practice
6. Describes how outcome measures are used

Question 2

Multidisciplinary Care

Acute Care General Guidelines for Treatment Goals?

Answer 2

• Prevent/minimize adverse effects of immobility/inactivity
• Prevent contractures
• Improve general conditioning, bed mobility, respiration
• Prevent pressure ulcers
• Return patient to pre-hospitalization level of function if possible or maximize to promote to post-acute rehab

Question 3

Multidisciplinary Care

Special Considerations for Acute Care?

Answer 3

• Monitor vital signs and activity tolerance closely
• Use anti-embolism stockings, compression devices to prevent DVT/PE
• Utilize equipment to encourage mobility if patient is too weak to get OOB
• Supplement PT session with “homework”
• Isolation Precautions/Infectious disease status
• Monitor tubes/lines/drains/catheters
• Safety strategies/call light/ fall risk assessment

Question 4

Multidisciplinary Care

ICF = ?

should be ‘ICFDH’

Answer 4

International Classification of Functioning, Disability and Health (ICF Model)

• ICF provides a unified, standard language and framework for data collection in practice and research
• ICF language describes how people function in their daily lives rather than focus on their disease-specific diagnosis

Question 5

Multidisciplinary Care

Inability or restricted ability to perform actions, tasks, and activities related to required self-care, home management, work, school, play, community, and leisure roles = ?

Answer 5

Disability:

• Inability or restricted ability to perform actions, tasks, and activities related to required self-care, home management, work, school, play, community, and leisure roles
• Occurs when cannot overcome functional limitations to perform “normal” roles
• Depends on capacities of individual and expectations imposed on individual in immediate social environment

Question 6

Multidisciplinary Care

3 components that describes how a medical (health) condition/pathology effects a peron’s ability to function and how the condition causes disability?

Answer 6

(1A) Body Structures: Anatomical Parts of the Body.

(1B) Body Functions: Physiological / Psychological function of the Body Systems.

(2) Activities: Execution of a task or action by an individual.

(3) Participation: Involvement in a life situation.

Question 7

Multidisciplinary Care

What is a Health Condition?

Answer 7

• Pathology, disorder, disease, injury, trauma or congenital anomaly
• Usually diagnosed by a physician
• Primarily identified at the cellular level
• The door that opens the episode of care

Examples: Spinal injury, Diabetes, Blindness, CVA, Arthritis

Question 8

Multidisciplinary Care

• Physical Therapy Diagnosis?
• Catergorized by?

Answer 8

• Takes the medical (health) condition/pathology and puts it in the framework of the ICF to define how it effects the person’s function and how the condition causes disability.

Categorized by:

• Impairments of body structure or function
• Activity limitations
• Participation restrictions

Question 9

Multidisciplinary Care

Examples:

Impairments of Body Structure
vs.
Impairments of Body Function

Answer 9

Question 10

Multidisciplinary Care

• Carrying an object
• Problem Solving
• Bathing and Dressing
• Communicating
• Rolling over in bed
• Transferring to chair
• Walking
• Climbing stairs

Are examples of ?

Answer 10

Activities: Execution of a task or action by an individual

Question 11

Multidisciplinary Care

• Difficulty ascending stairs
• Unable to lift gallon of milk
• Inability to count money
• Requires assistance to put on shoes

Are examples of ?

Answer 11

Activity Limitations: Difficulties an individual may have in performing actions, tasks, and “usual activities”.

Measured at the level of the PERSON

Question 12

Multidisciplinary Care

• Cashing a check/using an ATM
• Mowing the grass
• Caring for a child
• Working
• Attending a concert

Examples of?

Answer 12

Participation: Involvement in a life situation

Question 13

Multidisciplinary Care

• Inability to maintain a job
• Inability to care for child
• Inability to drive to grocery store to get food for family

Are examples of?

Answer 13

Participation Restrictions: Problems an individual may experience in involvement in life situations.

Question 14

Multidisciplinary Care

Contextual Factors include?

Answer 14

• Personal Factors: Background of person’s life
• Environmental Factors: Make up the physical, social, and attitudinal environment in which people conduct their lives

Question 15

Multidisciplinary Care

• Age
• Gender
• Coping styles
• Education
• Past and current experience

Are examples of?

Answer 15

Personal Factors: Background of person’s life

Question 16

Multidisciplinary Care

• Products and technology
• Natural environment and human-made environment
• Support and relationships
• Attitudes of others
• Services, systems, policies

Are examples of?

Answer 16

Environmental Factors: Make up the physical, social, and attitudinal environment in which people conduct their lives.

Question 17

Multidisciplinary Care

Disorder, disease, injury, trauma, aging, congenital anomaly = ?

International Classification of Functioning, Disability and Health (ICF)

Answer 17

Health Condition: disorder, disease, injury, trauma, aging, congenital anomaly

Question 18

Multidisciplinary Care

Problems in body function or structure such as significant deviation or loss = ?

International Classification of Functioning, Disability and Health (ICF)

Answer 18

Impairments of Body Functions and Structures: problems in body function or structure such as significant deviation or loss

Question 19

Multidisciplinary Care

Execution of a task or action by an individual = ?

International Classification of Functioning, Disability and Health (ICF)

Answer 19

Activity Limitation: execution of a task or action by an individual

Question 20

Multidisciplinary Care

Problems an individual may experience in involvement in life situations = ?

International Classification of Functioning, Disability and Health (ICF)

Answer 20

Participation restriction: problems an individual may experience in involvement in life situations.

Question 21

Multidisciplinary Care

Components of the Patient/Client management model?

Answer 21

Question 22

Multidisciplinary Care

Describe this component of the Patient/Client management model.

Answer 22

• Examination: Comprehensive screening & specific testing process leading to diagnostic classification and/or referral to another practitioner.
• Required prior to intervention

Three components:

1. History

• Medical/surgical/medication/social history
• Symptom Investigation
• Review of Systems

2. Systems Review
3. Tests and measures

Question 23

Multidisciplinary Care

Examination - History?

Patient/Client management model

Answer 23

• Systematic gathering of data from past + present related to why patient is seeking PT
• Obtained through review of medical record, interview, and other sources (ie teachers, case managers, caregivers, family)
• Provides initial information used to create hypothesis = Helps to decide further in-depth analysis during tests + measures

Question 24

Multidisciplinary Care

Examination - Review of systems includes?

Patient/Client management model

Answer 24

Question 25

# Multidisciplinary Care Examination – Physical Therapy **Systems Review** ## Footnote Patient/Client management model

Answer 25

**HANDS-ON** examination of the anatomical and physiological status of these systems: * **Cardiovascular/Pulmonary**: Heart rate, respiratory rate, blood pressure, oxygenation and edema * **Integumentary**: Skin color, texture and integrity (wounds, scars etc.) * **Musculoskeletal**: Gross symmetry of the body, gross range of motion, gross strength, posture, height, and weight * **Neuromuscular**: Gross cognition, coordination, balance, gait, locomotion, transfers, and motor function * Also includes a brief examination of: Communication ability, affect, cognition, language, orientation, emotional/behavioral responses and learning style of the individual

Question 26

# Multidisciplinary Care Examination – Tests and Measures ## Footnote Patient/Client management model

Answer 26

A process of gathering data to: 1. Rule in or out presence of and links between * Impairments in body function + structure * Activity limitations * Participation restrictions 2. Help establish a diagnosis, prognosis and treatment plan 3. Help determine what interventions to use Physical therapists must select appropriate tests/measures for each patient individually Selection is based on: * Psychometric properties of the measurements * Reliability, validity, responsiveness in detecting minimal, meaningful change * Clinical utility of tests and measures * Appropriateness of using self-report or performance based measures

Question 27

# Multidisciplinary Care Describe this component of the Patient/Client management model. ## Footnote Patient/Client management model

Answer 27

**Diagnosis** The objective of the PT diagnostic process is: * To identify the discrepancies between the patient’s level of function what is desired (patient goal) * To determine the capacity of the patient to achieve that level * Medical physicians typically diagnose conditions using labels that identify disease, disorder or condition at the level of the cell, tissue, organ, or system * Physical Therapists use labels that identify the impact of a condition on function at the level of the system (especially the movement system) and at the level of the whole person

Question 28

# Multidisciplinary Care Describe this component of the Patient/Client management model. ## Footnote Patient/Client management model

Answer 28

The process of “**PUTTING IT ALL TOGETHER**”, requires the physical therapist to: * Integrate the test/measure data with information collected during the history * **Develop a statement of why the patient needs physical therapy and how we can help** (Does the patient need referral to other healthcare service?) * Determine a physical therapy diagnosis * Develop a **problem list** * Determine a prognosis, including goals for physical therapy management * Develop a **plan of care**

Question 29

# Multidisciplinary Care Describe this component of the Patient/Client management model. ## Footnote Patient/Client management model

Answer 29

A prediction of: * Optimal level of improvement in function * Patient’s potential to reach best improvement based on capabilities, goals, motivation, resources * “The patient has good potential to return to home independently due to motivation, minimal balance impairment, family support” A Listing of: * Goals established in collaboration with patient * Short term incremental goals * Long term goals to be achieved by the predicted end of the episode of care and relate to patient’s highest level of functioning **The plan of care** consists of statements of specific interventions to be used and proposed duration and frequency of the interventions that are required to reach the goals and outcomes. * Established in collaboration with patient Includes anticipated discharge plans **Example**: “The patient will participate in resistive strength training for B LEs 3 times/week for 3 weeks”

Question 30

# Multidisciplinary Care Problem List = ? ## Footnote Patient/Client management model

Answer 30

A summary of the patient’s: * Impairments of body structure and function * Activity limitations * Participation Restrictions Example: * Impaired B hip strength * Impaired bed mobility * Impaired transfer ability * Cognitive/memory deficits preventing ability to live independently

Question 31

# Multidisciplinary Care Describe this component of the Patient/Client management model. ## Footnote Patient/Client management model

Answer 31

**Intervention**: * Purposeful interaction using various PT procedures and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis * Communication, coordination, documentation * Patient-related instruction Categories of Physical Therapy Intervention: * Patient or client instruction * Assistive technology * Airway clearance techniques * Biophysical Agents * Functional training in self-care and domestic, work, community, social and civic life * Integumentary repair and protection techniques * Manual therapy techniques * Motor function training * Therapeutic exercise

Question 32

# Multidisciplinary Care Describe this component of the Patient/Client management model. ## Footnote Patient/Client management model

Answer 32

**Outcomes**: As the patient reaches the end of the episode of care, the PT uses evidence-based tools to measure the impact or results of the PT interventions related to: * Disease/disorder/condition * Impairments in body structure and function * Activity Limitations * Participation restrictions * Risk reduction/prevention * Health/wellness/fitness * Societal resources * Patient/client satisfaction