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NeuroPT 1 > Clinical Decision-Making Models and Measurement: Exam 1 > Flashcards

Clinical Decision-Making Models and Measurement: Exam 1 Flashcards

1
Q

Model of Disablement:

ICIDH I Model

A

Disease causes

Impairment causes

Disability causes

Handicap

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2
Q

Models of Disablement:

The Nagi Model

A

Looks @

patho

impairment

functional limit

disability

2ndary impairment

2ndary patho

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3
Q

Current WHO Model:

ICF

A

Health Condition/Disease

Body Functions/Structures Activity Participation

Contextual Factors

Personal Factors Environmental Factors

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4
Q

Modifiers to the Disablement Models

3

A
  1. Pos. or Neg
  2. Ext. to the indiv.
  3. Indiv. factors
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5
Q

Modifiers to the disablement model that are external to the individual

A

Healthcare services

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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

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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 ​

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8
Q

Drawbacks of Enablement Models

A
  • Does NOT help from dx problem
    • WE follow what pts cannot do
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9
Q

Model of PT Practice

From the Guide

A
  • Exam:
    • Hx
    • Systems Review
    • Tests & Measures
  • Eval, PT Dx, Prognosis
  • Intervention
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10
Q

EXAMINATION:

3 components

A
  1. Hx
  2. Systems Review
  3. Tests & Measures
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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.

​

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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”
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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
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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
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15
Q

Exam: Tests & Measures

Validity

A

Does the test measure what I WANT it to measure?

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16
Q

Exam: Tests an Measures

Function

A
  • Can they do activity
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17
Q

Exam: Tests an Measures

Observation

A
  • HOW they do it
  • Mvmt quality

*NOTE: if you cannot measure it, then DESCRIBE it

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18
Q

Exam: Tests an Measures

Problem Solving

A
  • Find tools that get to the pts problems
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19
Q

Examination: Tests and Measures

What is some documentation for pts w/ neuro. patho?

A
  • Guide to PT practice
  • Standardized
  • Descriptive (Qualitative)
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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
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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
Q

Eval/Dx/Prognosis

Includes these things: 5

A
  • 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
Q

Eval, Dx, Prognosis

Should result in these 3 things

A
  • 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
Q

PLAN OF CARE

2 Parts:

A
  • Anticipated goals
  • Expected outcomes
28
Q

Interventions include 3 categories:

A
  • Team coord./communication/doc.
  • Pt/client-related instruction
  • Ther-Ex
29
Q

What are some ex’s of Direct Interventions?

A
  • Functional training
    • ​self care
    • home mgmt
  • Manual therapy tech’s
  • devices + equip.
  • airway clearance tech’s
  • wound mgmt
  • electrotherapeutic modal’s
  • phys. agents
30
Q

Criteria for Discharge

A
  • Probs w/ body structure/function—> anticipated goals
  • activity limits—> expected outcomes

basically…. using our POC to ADDRESS these

31
Q

Outcomes AFTER interventions

A
  • Act. limits and Part. restrictions
  • pt satisfaction
  • **Secondary prevention
    • ​preventing FUTURE problem
32
Q

Hypothesis-Oriented Clinical Practice

explain the Hypothesis

A

proposal to explain the cause of a pt’s problem

Exam (hypothesis)—> intervention—> re-exam

TEST your hypothesis!!!

33
Q

What must the Clinician do in regards to the Hypothesis?

3 things

A
  • 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
Q

In regards to Theories of Motor Control

Exam and tx are based on ________

A

Assumptions

**they must be dynamic to reflect changes in scientific theory

35
Q

What theories of Motor control are currently being used?

A
  • Motor Learning Theory
  • Ecological Model
36
Q

2 helpful uses of Differential Dx

A
  1. separates accurate vs. inaccurate dx
  2. helps us narrow things down
37
Q

What is the MAIN purpose of Screening?

A
  • Narrows the focus of the examination
38
Q

When Screening is combined w/ Hx

it does 4 things:

A
  • localizes source of patho.
  • areas to focus on for in-depth eval.
  • what tests/measures must be carried out
  • Saves Time!!!
39
Q

Screening det’s a patient’s gross _______ and ________

A

Gross cababilities and limitations

40
Q

The Screen det’s pts gross capabilities and limits to decide 2 things in regards to Tx

A
  • IF pt is able to proceed w/ tx
    • ​can they follow instructions?
  • HOW to proceed w/ subsequent tx
41
Q

The Screen ID’s

4 things:

A
  • 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
Q

How do we ID health risk factors?

A

Chart review

Questionnaire

43
Q

Chart review/Questionnaire answers direct therapist HOW

A 
# * consider impact of complaints
* **Choose exam and tx tech's**
44
Q

Components of a Screen

A
  • mental status
  • pt hx
  • vitals !!!
  • myo/dermo tests
    • UQS/LQS
  • mm tone
  • reflex tests
  • Patho. reflexes
  • coord.
  • posture
  • CN tests
45
Q

w/ Symptom Investigation

MUST consider: 3 things

A
  • Loc. sx’s
  • Pattern of change
  • Hx of onset/symptoms
46
Q

W/ Symptom investigation….

The PT must interpret the pt’s description of:

A
  • symptoms
  • act/participation limits
  • exam findings

Interpret them in a way to point you in the right direction!!!

47
Q

W/ symptom investigation….

there should be a link b/w these:

A
  • problems w/ body structure/function AND act/participation limits
48
Q

Use this to help w/ location of sx’s

A

Body diagram

*also get a 24hr report!!!

49
Q

W/ diff. dx’s

the goal is NOT to formulate medical dx—not in PT scope

instead what is the Goal?

A

ID PT Dx

  • recognize s/s
  • communicate findings to physician
  • Create a PT DX *************
50
Q

Body Systems

A

CV

Pulm

GI

Endocrine

Urogenital

Integumentary

Psychological

NS

51
Q

Decision to Treat

Consider….

A
  • Scope of practice
  • Do findings warrant communication w/ PCP
  • Clinical Decision:
    • ​Treat
    • Treat + Refer
    • Refer
52
Q
A

NeuroPT 1 (7 decks)

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