Continuation Of Timeline Flashcards
In what year was the APTA formed?
In 1941
World War II was important in the development of what?
Prosthetics
When was the competency exam developed? How many members in APTA were there?
1951 Over 4,000 members
When was the increased movement toward private practice and other settings?
In the 1960’s and 1970’s
When were the APTA sections developed?
1975
When did PT become mainstream in public schools?
1977
When did joint replacements become more common, increasing the need for PT?
1980’s
When was the American Disability Act?
1990
“Guide to Physical Therapy Practice” developed?
2001
Today’s focus in PT?
Evidence based and direct access
How many practicing PT’s? How many APTA members?
215,000 practicing PT’s 95,000 APTA members
How many PT programs were there in 1950’s? How many programs today?
-39 programs in 1950’s -Today 250
When first baccalaureate programs?
1980
Transitional DPT when and where start?
1992 at USC
Entry level DPT when and where start?
1993 at Creighton
4 Elements in PT Practice
- Evaluation/Examination
- Formulation of Clinical Judgements and Treatment Plan
- Provide interventions
- Re-evaluation and outcome measures (FIM= Functional Independent Measure)
Evaluation/Examination
- -Chart review
- -PT interview
- -Recent Medical course
- -Medications
- -Cognitive status
- -Function prior to admission
- -home situation/environment
- -PT’s goals
Evaluation/Examination cont
- -Vital signs
- -Pain assessment
- -Skin inspection
- -Sensation
- -Posture
- -ROM (AROM & PROM)
- -Strength/motor control
- -Tone
- -Balance
- -Functional Tests
Evaluation of Pain (PQRSTQ)
- -Provoke (triggers vs. relief)
- -Quality (dull, sharp, shock-like, burning)
- -Radiates -Severity (pain scale)
- -Time (history, periods of exacerbation, constant)
- -Questionnaire (Oswestry scale etc.)
Functional Evaluation (one of the most important part of evaluation)
ADLs - activities of daily living
- Bed mobility
- Transfers
- Sit to stand
- Ambulation
- WC mobility
- Standard functional tests
Functional Tests
- • TUG (The Up and Go)- time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. should be less than 10 secs
- • 10 meter walk test- looks at elapsed time it takes to walk 10 meters
- • Functional ambulation profile (GAITRite®)- mat looks at step length, velocity, symmetry…
- • 6 minute walk test- walk for 6 min. look at distance & calculate velocity
- • 3 minute walk test- abbreviated one
- • Functional reach test- standing & reaching out
- • Berg balance test- test for balance to see if risk for falls
Cinical Implications Related to Gait Velocity
- Correlational to general health status, functional capabilities
- Individual confidence in balance
- Need for rehabilitation / “red flag”
- Provide criteria for discharge
- Contribute to outcome measures
- Relation to quality of gait
Fomulation of Treatment Plan
- -Results of evaluation (based on)
- -Problem lists (patients major problems)
- -Goals writing (short term & long term)
- -Modifications / progressions
- -Priorities
- -Referrals (if you feel patient needs a specialist)
Provide Interventions
- -Functional Training
- Therapeutic Exercise
- -Stretching
- -Positioning (in bed, wheelchair)
- -Manual Therapy
- -Orthotic/prosthetic training
- -Balance activities
- -Patient education
- -Specialized interventions (kinesio tape, dry needling, manual lymph. draining)
Re-evaluation/ outcome measures
-
FIM scores (Functional Independent Measure)-
- assess all functional stuff, walking with what amount of supervision
- numerical scale
- at admission & at discharge
-
Functional re-evaluation
- Ex. needed max assistance, now need minimal, instead of numerical
-
Changes in pain
- Changes in ROM
- Passive and active
- Changes in muscle strength / motor control
- Changes in balance
-
Standardized tests
- Ex. TUG before and after
Vital Signs
- Establish baseline
- Medical stability
- will determine how to monitor their treatment
- Response to treatment
- HR, BP, Pulse oximetry (SpO2 (saturation of peripheral oxygen)), RR
Heart Rate
- -60-100 bpm (bradycardia less, tachycardia more)
- -Rhythm
- -Amplitude (strong or weak)
- -Resting (3-5 min) after coming in
- -During or immediately after activity
- -Max HR (220-age)
- -Target HR (50 to 85% of max HR)
- Ex. patient is 80 & is ordered to not exceed 75% of max HR
- 220-80= 140
- 140 • 0.75= 105
- so wouldn’t want to have Pt exceed 105 HR
- Ex. patient is 80 & is ordered to not exceed 75% of max HR
Places to Take Heart Rate
- Radial
- Carotid
- Brachial
- Dorsalis Pedis
Normative Values of HR in diff. ages
- 120 - 160 bpm for neonates (1 to 28 days) *
- 100 - 120 bpm for infants (1 to 12 months) *
- 80 - 120 bpm for 3 to 4 yr. old
- 75 - 115 bpm for 5 to 6 yr. old
- 70 - 110 bpm for 7 to 9 yr. old
- 60 - 100 bpm for adults (>10 yr. old)
** Brachial pulses used in neonates and infants
Factors influencing HR
- -Medications
- -Environment
- -Activity
- Anxiety/ SNS
- -Fitness Level
- Age
Blood Pressure in Adults
Systole / Diastole
- Normal = 100-119/ 70-79
- Prehypertension = 120-139/ 80-89
- Stage 1 HTN = 140-159/ 90-99
- Stage 2 HTN = _>_160/ _>_100
Avg. Pediatric BP
- Neonate (1- 28 days) = 60/ 35
- Toddler = 100/ 55
- 5 yo = 105/ 70
- 10 yo = 115/ 75
Red Flags with Exercise
- Systolic > 200
- Diastolic > 100
- Drop in diastolic of >10
Signs and Symptoms of hypertension
- Severe headache
- Chest pain / difficulty breathing
- Pounding chest, neck and ears
- Confusion / Fatigue
- Blood in urine
Signs and Symptoms of Hypotension
- Light headedness
- Blurry vision
- Fatigue / weakness
- Sleepiness
- Syncope (fainting)
Factors to Consider with BP
- Anxiety / pain
- Tobacco use
- Position change / activity
- Alcohol consumption
- Exposure to heat/cold
- Valsalva (holding breath)
Taking BP
- -Left arm desirable
- -Sphygmomanometer
- -Arm diameter = 80-100% cuff length
- -Approx 1 inch above cubital fossa
- -Palpate brachial artery and align bladder
- -Arm at heart level
- -Don’t round off
- know BP before assessment ?
Additional Considerations for Taking BP
- -Slow deflation
- -Test stethoscope
- -Angle ear pieces forward
- -At least 1 min before retrying
- -“White coat” HTN (nervousness about Dr. office)
Respiration Rates
Breaths/min
- 12- 20 = adult
- 15- 30 = 1- 8 yo
- 25- 50 = 1- 12 months
- 40- 60 = 1- 28 days
- OTHER FACTORS -
- Rhythm
- Ease
- Talk (can they talk comfortably during activity)
- Accessory muscle activity
Pulse Oximetry
- Saturation of oxygen to hemoglobin
- NORMAL: 94-100% SpO2
- < 92% considered hypoxemia = RED FLAG
Pulse Oximetry Limitations
- Weak or irregular pulse
- may not get true value
- Hypotension
- Cold fingers
- lots of vasoconstriction in vessels, may not get reliable SPO2 reading
- With inflated blood pressure cuff
- affects blow flow to finger
- Hand movement / tremors (ear lobe option)
- Excessive environmental light
- Dark nail polish
- Always Relate to patient presentation (look for other signs)
- Accessory muscle use
- Rapid shallow breaths / rapid HR
- Inability to talk
- Carbon monoxide / smoking
- PAOD (Periphery Arterial Occlusive Disease a type of PVD)
- Correlate with other indicators
Causes for Low SpO2
- -COPD (Chronic Obstructive Pulmonary Disease)
- -Asthma
- -Pneumonia
- -Pulmonary fibrosis or edema
- pressure impeades lungs ability to expand
- -Heart failure
- -Sleep apnea
- -Pneumothorax
- -Narcotics / anesthetics
Scale that Relies of Pt feedback rating level of exertion used in addition to vital signs
•Borg’s Rate of Perceived Exertion (RPE) Scale
Body Mechanics
- -Keep neutral spine
- -Use large muscle groups
- -Keeps objects close to COG (center of gravity) and BOS (base of support)
- -Pivot on feet instead of twisting at trunk
- -Use assistive devices
Functional Training Terminology (Stages of Help)
-
-Independent (I)
- Pt can do activity w/o compensation (no need walker, cane…)
- -Mod I - independent with adaptive device
- -DS - distant supervision
- Pt can do activity PT can be in same space
- -CS - Close supervision
- need be in ready position w/o hands on
- -CG - contact guard
- Hands on Pt, usually on involved side
- -Min A - Patient >75%
- Pt does 75% or greater of activity
- -Mod A - Patient between 50-75%
- Pt does 50- 75 of work
- -Max A - Patient <50%
- Pt less than 50%
- if Pt can give some sort of assistance
- -Dependent - 0%
- not able to do anything
Weight Bearing Terminology
- -NWB - non-weight bearing
- -TTWB - Toe touch weight bearing - no appreciate weight through foot, like having sponge under foot
- -PWB - partial weight bearing= 50%
- 50% legs, 50% arms
- should have bilateral support cause when walking transfer of weight
- -WBAT - weight bearing as tolerated
- -FWB - Full weight bearing
Assistive Ambulatory Devices
- -SW - Standard Walker
- -RW - Rolling Walker
- -PRW - Platform rolling walker
- For when can’t weight-bear through hands
- RA, wrist fx, multiple fx
- For when can’t weight-bear through hands
- -Axillary Crutches (AC)
- -Loftstrand Crutches - forearm cuff
- -HW - Hemiwalker - one side with major support
- used for stroke Pts
- -WBQC - Wide-based quad cane
- More acute angle faces out
- -NBQC - Narrow-based quad cane, can be used for stairs
- -SC - Straight cane
- Knee walker
- Pediatric Walker
- Rollator walker
Assistive Device Height
- Walker/Cane = Greater trochanter
- Walker/Axillary crutches = Styloid process (elbow flexed 20 degrees)
- Axillary crutches = 2-3 fingers below axilla
