Chapter 5 Exam Eval POC Intervention Flashcards
Examination
1-process of obtaining medical &functional, history, systems review, and performing specific tests & measures
2•Performed by PT and can be assisted by PTA
Examination & Evaluation
First step before treatment
Evaluation
1-process by which the PT makes clinical judgements based on data gathered during the examination
•Only performed by PT
PT diagnosis (Dx)
a label encompassing a cluster of signs & sx associated with a disorder or syndrome
Plan of care (POC)
the individualized PT treatment plan developed by the PT, includes:
1•Interventions/treatment
2•The PT Exam should be holistic (not just the chief complaint of the patient).
Prognosis
expected outcome, likelihood of improvement
•Expected outcomes/goals
Examination is completed by doing which of the following steps
1•Reviewing a patient’s hospital chart and records
2•Interviewing patient
3•Assessing the patient directly.
What does the Examination Include?
1•Medical Diagnosis (dx)
2•Precautions
3•Chief complaint (CC), including description of condition
4•History of Present Illness (HPI): including symptoms (sx) with description of location, severity, frequency and nature, and what makes it better/worse
5•Onset of problem, including mechanism of injury, sequence & progression of sx, prior treatments (tx) & results, and associated disability
6•Past medical history (PMH): prior episodes/tx, disorders, general health status, medications, past tests (x-rays, etc), surgeries
7•Personal Information- age, gender, occupation, home situation (stairs, w/c accessible, family support, etc)
8•Patient lifestyle: occupation, assistance from family
Pain Description???
-part of pt. history (Hx) 1•Pain ratings should be taken prior to and after treatments 2•Location 3•Radiation 4•Intensity 5•Duration 6•Onset 7•Frequency 8•Aggravating or Relieving factors
Sensory Exam?
- superficial, deep, and combined 1•pain 2•Temperature 3•light touch 4•pressure
Visual Analog Scale (VAS)
-10 cm long unmarked line, pt. places a mark on the line between no pain and worst pain possible, and then the line is measured for pain rating
Numerical Rating System (NRS)
Uses range of numbers (usually 1-10), 0=no pain, 10 worst
tactile localization
determining where you are being touched
two-point discrimination
whether being touched with 1 or 2 points
barognosis
difference in weights
stereognosis
determining what an object is by feeling it
graphesthesia
Determining the shape of something drawn on skin
recognition of texture
Cranial Nerve Integrity
•Testing nerves in head/neck (brain injuries)
Vital Signs
1•Heart Rate (HR)
2•Respiration Rate (RR)
3•Blood Pressure (BP)
Anthropometrics
- Length, girth, volume of body parts
* Includes leg length difference, body weight, Body Mass Index (BMI)
Mentation, Hearing, & Vision
1•Attention: patient’s awareness of their environment
2•Orientation: awareness of time, person, & place
3•Mentation/Cognition: thinking skills, short & long-term memory
4•Vision & Hearing
Range of Motion (ROM)
amount of movement in a joint
•Measured with a goniometer
Manual Muscle Testing (MMT)
measuring strength
•Normal-5, Good-4, Fair-3, Poor-2, Trace-1, None-0
Muscle Tone
-resistance to stretch
1•Hypertonia- increased tone, spasticity or rigidity
2•Hypotonia- decreased to no tone (flaccidity)
3•Dystonia- abnormal tone
4•Postural Analysis
5•Balance and Control
Function
1•Mobility- walking/gait/ambulation, bed mobility, transfers
2•ADLs- dressing, meal preparation, shower, brushing teeth, shopping, etc
Gait Examination
Observation and Analysis of Gait Cycle
Outcome Measures
1•Standardized tests that measure function and tasks
-Examples:
1•Oswestry Low Back Disability questionnaire
2•Dash- Disability of the Arm, Shoulder, and Hand
3•Barthel Index – basic home functions
4•Berg Balance Test
Orthopedic Examination
1•Utilizes measurements & special tests that examine musculoskeletal components (bones, muscles, and joints)
2•Common diagnoses: Total Hip/Knee Replacement, ACL reconstruction, Shoulder Rotator Cuff repair, Ankle and back muscle strain, tendonitis, shin splints
Neurologic Examination
1•Similar to the Orthopedic exam, but for neurologic conditions
2•Psychosocial aspects of rehab important
3•Adaptation and adjustment to disability by patient/family
4•Effects of impairments, functional limitations, and disability
5•Reintegration in family, work, social life
6•Common diagnoses: Stroke/CVA, Traumatic Brain Injury (TBI), Spinal Cord Injury (SCI), Multiple Sclerosis (MS), Parkinsons
Cardiopulmonary Examination
Monitoring of vital signs- Pulse, BP, RR, O2 Sat
Common cardiac diagnoses
Congestive Heart Failure (CHF) and Coronary Heart Disease (CHD), Myocardial Infarction (MI)
Common pulmonary diagnoses
Chronic Obstructive Pulmonary Disease (COPD) and Asthma
Primary cardiac sx
1-angina/chest pain 2-dyspnea (abnormal breathing) 3-shortness of breath (SOB) 4-fatigue 5- palpitations (heart rhythm abnormalities) 6-dizziness 7-edema (CHF)
Other Cardiovascular sx
Diaphoresis/sweating, Decreased pulses with Peripheral Vascular Disease (PVD), Cyanotic skin (bluish) with PVD, cold skin, skin changes (shiny & loss of hair) with PVD or arterial insufficiency,
Pulses
radial (wrist), femoral (groin), popliteal (knee), pedal (foot)
Pulmonary Exam
Similar to cardiac exam, but adding listening to breath sounds (crackles, wheezes), special pulmonary tests
Pediatric Examination
1•Involves in-depth knowledge of child development, developmental progression, pathophysiologies, and Screening assessments:
2•examples include APGAR for newborns at 1 & 3 minutes, Denver Developmental screen, Bayley Scales of Infant Development, Peabody Developmental scales
3•Exams also include skeletal growth, Range of Motion (ROM) & posture
Reflexes
1- sucking, flexor withdrawal, crossed extension, plantar grasp, symmetrical tonic neck reflex (STNR), asymmetric tonic neck reflex (ATNR)
2-These reflexes only last for a short time and that time period is known, so that is a way to tell if the baby is developing along appropriate timelines.
Developmental Milestones
- activities that a child can perform normally starting in a specific time period (like walking at 1 year)
Geriatric Examinations
1•Requires understanding of aging
2•Focuses on function and independence
3•Be aware of cultural preferences
4•Plan of Care (POC) developed with patient and caregiver
5•Exam should include:
1•Patient/caregiver interview
2•Pain Assessment
3•Physical Assessment dependent upon pathology
4•Psychosocial assessment including depression and dementia exams
5•Functional exam
6•Home/Environmental Assessment
Environmental Examination/Home Assessment
•Checks the home for safe amounts of lighting, accessible bathrooms, clutter, etc
Integumentary (Skin) Examination
•PT assess for... 1- rashes 2-dry skin 3-edema 4-changes in skincolor/temperature/texture 5-sensory integrity 6- pain 7- soreness
Assess wounds
1•Drainage amount, color, odor 2•Periwound tissue 3•Tunneling, undermining 4•Wound size, depth, width, color: red=good (granulation tissue) 5•Dressing needs
Assess burns
1•Thickness of tissue damage:
2•Surface Area- Rule of Nines
3•Head-9%, arm-9%, back-18%, trunk front-18%, leg-18%
Developing a Plan of Care (POC)
1.Complete Exam/Eval
2.Develop problem list
3.Define treatment goals
4.Define interventions to address problems/meet goals
1•PTA follows POC and cannot change it, but may discuss with PT to have it changed.
2•POC leaves many decisions to be decided by the PTA how to best and safely follow the POC and address goals.
3•PTA’s can modify their treatments WITHIN the POC
Therapeutic Exercise (Ther-Ex)
•Ex that uses muscle contractions, movement, posture & activity to improve function, flexibility, strength, endurance, cardiovascular fitness, coordination, speed and relaxation
Home Exercise Program (HEP)
-ex that pt. can complete on their own
Exercise Parameters
1•Frequency- how often
2•Duration- how long
3•Repetitions- how many in a group
4•Sets- how many groups of the exercise
5•Intensity- how hard/fast/challenging it is
6•Mode or type of activity- what type of exercise
Range of Motion (ROM)
- exercises that move a joint through its area of movement
•Can include PROM, AAROM, AROM
Passive (PROM)
- limb moved by PT/PTA or machine (continuous passive range of motion- CPM)
1•When pt cannot move their own joint 2•When AROM is prohibited 3•Following paralysis, coma 4•Maintain mobility/elasticity of tissue 5•Increase movement of synovial fluid for nutrition 6•Assist circulation 7•Prevent contracture 8•Decrease pain 9•Help healing
Active (AROM)
- movement performed by the patient 1•All the reasons for PROM and… 2•Increase strength 3•Bone and soft tissue integrity 4•Coordination/motor skills 5•Prevent DVTs 6•Increase circulation 7•Prepare for functional activites
•Active Assisted (AAROM)
1•When the patient needs help with the movement,
2•Help given by PT/PTA, wand/cane, pulleys
Isometric
-Muscles contract, but no movement
1•Good for when joint movement is contraindicated because of pain, inflammation or surgery
2•Example: Quad sets, Glute sets
Isotonic
- muscles contract with movement at joint
1•Concentric- contract & shorten
2•Ex: bicep curl (up)
Eccentric
- contract & lengthen, resist movement
•Ex: bicep curl (down)
Isokinetic
- Ex at same speed
1•Force is maximal throughout
2•Uses specialized machines
3•Cybex, Kincom, Biodex
Flexibility Exercises
1•Manual passive stretching- external force used to stretch
2•Self Stretching
Patient Education
1•About mobility, ADLs, HEP, etc
Physical Agents and Modalities
- use energy to get effect. Includes 1•Thermotherapy (heat)/Cryotherapy (cold) 2•Hydrotherapy (water tanks) 3•Electrotherapy 4•Mechanical Traction 5•Dry Needling
Modalities are used to
1•decrease inflammation
2•increase healing rate
3•decrease pain modify tone or scar tissue
4•increase connective tissue extensibility
Manual Therapy
hands-on therapeutic techniques
1•primarily in orthopedic settings, but sometimes in others
2•Massage, Myofascial Release
3•Instrument Assisted Soft Tissue Mobilization (IASTM)
4•Manual Traction
Spinal Mobilization and Manipulation
APTA recommends only PTs perform these techniques
Proprioceptive Neuromuscular Flexibility (PNF)
using neuro techniques to get a better stretch
Gait Training
-teaching patients the proper gait patterns and techniques to enable them to walk
•Just walking is NOT gait training, needs skilled assistance
Weight-bearing
-weight a patient is permitted on feet 1•Non-weight bearing (NWB) 2•Partial weight bearing (PWB) 3•Weight bearing as tolerated (WBAT) 4•Full weight bearing (FWB)
Cardiac Rehab
- for patients with MI, unstable angina, heart transplants
Multidisciplinary team
physician, PT/PTA, nurse, OT/COTA, SW, Nutritionist, Exercise Physiologist
•Phases of Cardiac Rehab
- Phase I: occurs in hospital, includes pt. education, bed mobility skills, gentle exercises, basic ADLs, transfers, gait
- Phase II: in outpatient settings, includes self-monitoring of vital signs, ADLs, stationary bike, exercise
- Phase III: after discharge (D/C) from outpatient program, but continues in community based program, involves fitness/activities
Pulmonary Physical Therapy
-Secretion removal tech.
1•Postural Drainage (chest PT)
2•Percussion techniques
Orthotics & Prosthetics
•use of braces and artificial limbs
Motor Control and Motor Learning
•Variety of neurologic techniques in using the central nervous system to control specific movements or perform tasks
Neurodevelopmental Treatment (NDT)
Bobath
Proprioceptive Neuromuscular Facilitation (PNF)
Knott, Voss
Sensory Stimulation Techniques
Rood
Movement Therapy in Hemiplegia
Brunnstrom
Geriatric
1•Depends on the disease process
2•Need to understand aging process & pathology
3•Promote max function
4•May have multiple diagnoses
Pediatric
1•Depends on pathology
2•Can utilize neuro treatments of sensory stimulation, strengthening exercises through therapeutic play, functional activities, assistive devices such as standers/walkers, manual & power wheelchairs
Integumentary
1•Wound care, dressings, debridement (sharp-PT only, autolytic-self, mechanical- wet to dry dressing removal or whirlpool, maggot)
2•Pt. education
3•Modalities: light therapy, ultrasound (US), aquatic therapy, whirlpool, pulsed lavage, heat, compression therapy
