HOP-FA Flashcards
Definition of HOP-FA
clinical framework designed to guide students and novice clinicians through the clinical reasoning process in pediatric physical therapy practice
what does HOP-FA stand for?
Hypothesis-Oriented Pediatric Focused Algorithm
What really is the HOP-FA and what does it do?
- A systematic, step-wise guide to the patient/client management process
- Assists physical therapist students in developing pediatric clinical reasoning skills
- Promotes a child-and family-centered approach to pediatric physical therapist practice
is the HOP-FA intended to provide specific guidelines for pediatric physical therapy practice?
nope
is the HOP-FA built upon a specific therapeutic examination or intervention philosophy?
nope
Definition of Cerebral Palsy:
- Disorder of the development of movement and posture causing activity limitation
- Attributed to non-progressive disturbances that occurred in the developing brain
- Motor disturbances
- Disturbances in sensation, perception, cognition, communication, behavior, epilepsy
- Secondary musculoskeletal problems
Antenatal Pathophysiology of CP
- Prematurity and low birth weight
- intrauterine infections
- multiple gestation
- pregnancy complications
Perinatal Pathophysiology of CP
- birth asphyxia
- complicated labor and delivery
Postnatal Pathophysiology of CP
- Non-accidental injury
- Head trauma
- Meningitis/ Encephalitis
- Cardiopulmonary arrest
Periventricular Leukomalacia
- Ischemic necrosis to periventricular white matter
- Causes bilateral cystic lesions (myelin doesn’t form)
- distal > proximal
Periventricular Hemorrhagic Infarction
- Hemorrhage into germinal matrix and ventricles
- Unilateral
- Caused by an increase in cerebral blood pressure
pathophysiology - preterm infant
*Periventricular leukomalacia (PVL)
*Periventricular hemorrhagic infarction
*Affects ascending/descending axons
*Topographic and size relationship
Pathophysiology - Term Infant
*Infarction in parasagittal watershed area, MCA stroke
*Basal ganglia & thalamic injury
Term Infant- Infarction in parasagittal watershed area, MCA stroke
Cortical and deep gray matter lesion
Basal ganglia & thalamic injury
- Athetosis, chorea
- Seizures and cognitive impairments
- Hemiplegia > Diplegia
Classification of CP - Movement Disorder
- Hypertonia –spasticity, dystonia, rigidity
- Hyperkinetic –athetosis, chorea, dystonia, myoclonus, tics, tremor
- Negative –ataxia, weakness, decreased selective motor control
Classification of CP- Anatomic Distribution
- Hemiplegia
- Diplegia
- Triplegia
- Quadriplegia –involvement of head and neck
GMFCS - Level I
- Walks without limitation
GMFCS - Level II
- Walks with Limitations
- Climb stairs holding onto a railing
- difficulty walking long distances or uneven terrain
- May walk with physical assistance, a hand-held mobility device or wheelchair over long distances
- Minimal ability to perform gross motor skills such as running and jumping
GMFCS - Level III
- Walks using a hand-held mobility device in most indoor settings
- May climb stairs holding onto a railing with supervision or assistance
- Wheeled mobility when traveling long distances and may self-propel for shorter distances
GMFCS - Level IV
- Self-Mobility with Limitations; may use powered mobility
- May walk short distances at home with physical assistance or use powered mobility or a body support walker when positioned
- At school, in community, or outdoors, children are transported in a manual wheelchair or powered mobility
GMFCS - Level V
- Transported in a manual wheelchair in all settings
- Children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements
Twelve Steps of the HOP-FA
- Initial Hypothesis
- Initial Data Collection
- Problem Statement
- Hypothesize Goals
- Examination Planning
- Examination
- Evaluation
- Diagnosis and Prognosis
- General Intervention Planning
- Intervention Session Planning
- Reflection
- Formal Re-examination
Initial Hypothesis - 1a
- Question: What is the child’s
chronological age? - Build a mental image of the child at this
age…. - Gross Motor Function
- Social
- Educational
- Family Activities
Initial Hypothesis - 1b
- Question: What are the primary and
secondary impairments associated with
the child’s medical diagnosis?
Assists with:
* Foundational aspects of examination
* Building a mental image of the child
Initial Data Collection
- Review of records (Medical, Educational)
- Interview with family
- Observe the child during the interview
process - What is the lived reality and environment of the child and family?
- Why are the child/family seeking PT?
- What are their desired goals/outcomes
from PT?
what is the information collected during initial data collection for?
This information assists the PT to further
develop an initial impression of the child’s
functional capabilities/status
Measures to assist with goal setting
- Canadian Occupational Performance Measure (COPM)
- Perceived Efficacy and Goal Setting System
Problem statement
*Statement that specifically describes why the child/family are seeking PT
*The foundation of family-centered care –> Ensures that the child’s and family’s goals and expected outcomes are well understood and delineated prior to examination
Problem statement to fill in:
“The family/child are seeking physical therapy to be able to…”
Hypothesize goals
*Propose short and long-term functional goals that will direct the examination process
*Ensure that these goals are consistent with the child’s/family’s desired outcomes –> Encourages family involvement in the examination process
What is important to note when hypothesizing goals
These goals might not be the definitive goals established for the plan of care –> These initial goals are tools to help prioritize the tests and measures used in the examination
tests and measures identified based on:
- The PT’s mental image of the child
- The problem statement
- The hypothesized goals
- The information gathered through the initial data collection process
- The PT’s knowledge of available tests and measures
what is extremely important during examination planning?
ICF
examination
*Administer tests and measures
*You will find that measures of Activity and Participation are not routinely employed in clinical settings –> Good for tracking progression over time, measuring effectiveness of interventions
measures of examination should be:
- Valid
- Reliable
- Feasible
- Able to detect clinically-relevant changes
Evaluation
*Synthesis of examination findings
*Facilitates the inclusion of contextual factors during the synthesis of
examination findings
Questions to consider during evaluation?
- What are this child’s specific strengths?
- What are the physical therapy problem areas (impairments, functional limitations, and activity or participation restrictions), and how do
these problem areas impact this child’s function? - In what ways do the identified physical therapy problem areas restrict the child’s ability to fully participate in activities that are
appropriate for the child’s age? - Do any of the identified physical therapy problem areas have the potential to lead to the development of further problem areas? Can
these future problems be prevented? How? - Are there any changes coming up for this child and family in the next year? How might these anticipated changes affect the child and
the family? - What is the child’s anticipated level of function in 1 year? 5 years? What needs to be done now to maximize the child’s future independence and function?
diagnosis and prognosis
*Identify the primary 1-2 physical therapy problem areas that are most limiting the child’s functional activity level (Prioritize problem areas and Assist in focusing the physical therapy plan of care)
*Helps drive intervention strategies
*Are additional referrals necessary?
*Refine mental image of child based on examination/evaluation
general intervention planning
*Physical therapy interventions based on plan of care (Coordination, Communication, Documentation)
*Procedural interventions
*Patient/client and family-centered instruction (Home program)
Intervention Session Planning
- Base interventions for individual sessions on a specific functional goal
- Specific activities (Preparation, Motor, Links to the next session)
- Consider: Motivational factors, Play, Feedback mechanisms, How to increase/decrease level of difficulty
Reflection - Continue monitoring:
- Was the intervention successful?
- Are we progressing toward the short-and long-term goals?
formal re-examination
*Re-administration of examination tests and measures to modify/redirect
interventions
