Clinical Decision-Making Models and Measurement: Exam 1 Flashcards
Model of Disablement:
ICIDH I Model
Disease causes
Impairment causes
Disability causes
Handicap
Models of Disablement:
The Nagi Model
Looks @
patho
impairment
functional limit
disability
2ndary impairment
2ndary patho
Current WHO Model:
ICF
Health Condition/Disease
Body Functions/Structures Activity Participation
Contextual Factors
Personal Factors Environmental Factors
Modifiers to the Disablement Models
3
- Pos. or Neg
- Ext. to the indiv.
- Indiv. factors
Modifiers to the disablement model that are external to the individual
Healthcare services
Individual factors that are Modifiers to the Disablement model
Lifestyle/health behaviors
Psychosocial attributes
ability to adapt to limitations and accept disability
Conceptual frameworks that are from the perspective of what the individual IS ABLE TO DO rather than what the individual IS UNABLE TO DO
Enablement Models
Drawbacks of Enablement Models
- Does NOT help from dx problem
- WE follow what pts cannot do
Model of PT Practice
From the Guide
- Exam:
- Hx
- Systems Review
- Tests & Measures
- Eval, PT Dx, Prognosis
- Intervention
EXAMINATION:
3 components
- Hx
- Systems Review
- Tests & Measures
As far as Hx goes…
- 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.
Exam:
Interview and Hx
- 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”
Exam:
Systems Review
- 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
Exam: Tests & Measures
Reliability
- 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
Exam: Tests & Measures
Validity
Does the test measure what I WANT it to measure?
Exam: Tests an Measures
Function
- Can they do activity
Exam: Tests an Measures
Observation
- HOW they do it
- Mvmt quality
*NOTE: if you cannot measure it, then DESCRIBE it
Exam: Tests an Measures
Problem Solving
- Find tools that get to the pts problems
Examination: Tests and Measures
What is some documentation for pts w/ neuro. patho?
- Guide to PT practice
- Standardized
- Descriptive (Qualitative)
Exam: Tests and Measures
Slide 1
- aerobic capacity/endurance
- anthropometric characteristics
- limb length
- BMI
- arousal, attention, cognition
- assistive/adaptive devices
- community and work integration or reintegration
Exam: Tests an Measures
Slide 2
- CN integrity
- environmental, home and work barriers
- ergonomics and body mechanics
- gait, loco, balance
- integumentary integrity
Exam: Tests an Measures
Slide 3
- jt integrity/mobility
- motor function
- mm perform.
- Neuromotor dev. and sensory integration
- orthotic, protective and supportive devices
- pain
- posture
Exam: Tests an Measures
Slide 4
- prosthetic req’s
- ROM
- reflex integ.
- self-care/home mgmt
- sensory integrity
- ventilation, resp, circulation
What do the CPGs or Clinical Practice Guidelines tell us?
Enough evidence that we can tell you this is how you should do it ***
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?
Eval, Dx, Prognosis
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!!!
PLAN OF CARE
2 Parts:
- Anticipated goals
- Expected outcomes
Interventions include 3 categories:
- Team coord./communication/doc.
- Pt/client-related instruction
- Ther-Ex
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
Criteria for Discharge
- Probs w/ body structure/function—> anticipated goals
- activity limits—> expected outcomes
basically…. using our POC to ADDRESS these
Outcomes AFTER interventions
- Act. limits and Part. restrictions
- pt satisfaction
- **Secondary prevention
- preventing FUTURE problem
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!!!
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
In regards to Theories of Motor Control
Exam and tx are based on ________
Assumptions
**they must be dynamic to reflect changes in scientific theory
What theories of Motor control are currently being used?
- Motor Learning Theory
- Ecological Model
2 helpful uses of Differential Dx
- separates accurate vs. inaccurate dx
- helps us narrow things down
What is the MAIN purpose of Screening?
- Narrows the focus of the examination
When Screening is combined w/ Hx
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!!!
Screening det’s a patient’s gross _______ and ________
Gross cababilities and limitations
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
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.
How do we ID health risk factors?
Chart review
Questionnaire
Chart review/Questionnaire answers direct therapist HOW
# * consider impact of complaints * **Choose exam and tx tech's**
Components of a Screen
- mental status
- pt hx
- vitals !!!
- myo/dermo tests
- UQS/LQS
- mm tone
- reflex tests
- Patho. reflexes
- coord.
- posture
- CN tests
w/ Symptom Investigation
MUST consider: 3 things
- Loc. sx’s
- Pattern of change
- Hx of onset/symptoms
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!!!
W/ symptom investigation….
there should be a link b/w these:
- problems w/ body structure/function AND act/participation limits
Use this to help w/ location of sx’s
Body diagram
*also get a 24hr report!!!
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 *************
Body Systems
CV
Pulm
GI
Endocrine
Urogenital
Integumentary
Psychological
NS
Decision to Treat
Consider….
- Scope of practice
- Do findings warrant communication w/ PCP
-
Clinical Decision:
- Treat
- Treat + Refer
- Refer
