Conceptual frame work for Neurologic Physical THerapy Clinical Practice Flashcards
Introduction
- Conceptual framework is a logical structure that helps organize clinical practices into a cohesive and comprehensive plan
- It provides context in which information is gathered and interpreted
- It provides guidelines for clinical intervention
Four key concepts or elements that contribute to a comprehensive conceptual framework for clinical practice
models of practice
models of disablement
HOAC
Theory of motor control
Models of practice
Process used to gather information design an intervention program is similar for all patients
APTA model of practice
Examination
- -History
- -systems review
- -tests and measurements
- evaluations
- diagnosis
- prognosis and plan of care
- intervention
Diagnosis
both the process and the end result of evaluating information obtained from the examination, which the physical therapist then organizes into defined clusters, syndromes, or categories to help determine the most appropriate intervention strategies
Prognosis
determination of the level of optimal improvement that maight be attained tr
Intervention
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Outcomes
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Examination
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Evaluation
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Examination
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Evaluation
dynamic proves in which the PT makes clinical judgments based on data gathered during the examination
Diagnosis
- both the process and the end result of evaluating information obtained from the examination
- Which the PT then organized into defined clusters, syndromes, or categories to help determine the most appropriate treatment strategies.
Neurologic Physical Therapy Diagnosis
- movement pattern coordination deficit
- force production deficit
- sensory detection deficit
- sensory selection and weighting deficit
- perceptual deficit (pushers)
- fractionated movement deficit (can’t isolate movements)
- hypermetria (all big movements) cerebellar
- hypokinesia (small movements–Parkinson’s)
The essential components of diagnosis
organizing relevant information into defined clusters, syndromes or categories to help determine the most appropriate treatment strategies.
Prognosis
determining the level of optimal improvement that might be attained through intervention
- as well as, the amount of time required to reach that level
- prognostic statements are important
- Goals also explicitly represents the prognosis that the PT has determined
Essential Components of a well-written functional goal
Actor Behavior Condition Degree Expected Time
Writing Goals
- in addition to being well written, goals should address 3 outcome levels:
- -disability (LEFS)
- -function (walk 300 feet w/I 2 min Independent on uneven surface in two weeks.)
- -Impairment (mostly ST) ( increase ROM-connect it with the function)
Goals
goals should apply to the episode of care under your direction: write goals for your setting
ACUTE care with estimated 5 day LOS example
-NO STG
-LTG to be achieved by D/C from hospital
-Recommendations: continue with HHPT 2X/week for 4 weeks to achieve modified independence in all transfer and safe, modified independent gait including stair climbing.
Components of PT intervention
- coordination, communication and documentation
- patient/client-related instruction
- procedural interventions
Models of Disablement
framework for structuring the effects of disease on the individual
describe the path from disease to disability
WHO international classification functioning, disability, and health
- body function and structure
- activities
- participation
- contextual factors: environmental factors and personal factors
Environmental Factors?modifiers
external influences on functioning and disability; facilitating or hindering impact of features of the physical, social, and attitudinal world; barriers
Personal Factors/modifiers:
internal influences on functioning and disability; impact of attributes
Posture, Balance, and Gait: Functional Activity or Underlying Impairments
controlled by multiple systems;
Posture and Balance problems are not easily defined as solely functions activity or body structure/function impairments
Hypothesis-Oriented Clinical Practice
- generate alternative hypothesis about potential causes
- determine crucial tests and expected outcomes to rule out one or more hypothesis
- Carry out tests
- continue the process of generating and testing hypothesis, refining understanding of the causes of the problem.
Evidence-Based Clinical Practice
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Theories of Motor Control
theories of motor control lead to development of clinical practices
Applying
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Task-Oriented Approach to Examination
- quantification of functional abilities
- description of the strategies used to accomplish functional skills
- quantification of underlying sensory, motor, ad cognitive impairments that constrain functional movement
Examination at the Functional Level
- performance-based versus self-reported functional measures
- -some agencies may not accept self-report
- Task-specific tests and measures
- Age-specific tests and measures
- diagnosis-specific tests and measures
- measuring disability–function in a social and physical context.
