ICF Model, Movement System, Pt Management Model Flashcards
what level do expert clinicians function at
metacognitive level
what are the stages of the patient management model
examination
evaluation
diagnosis
prognosis
intervention
outcomes
what are the 5 categories of the ICF Model
body functions/structures
activities
participation
environmental factors
personal factors
ICF: aerobic capacity/endurance, assistive technology, balance, circulation, cranial and peripheral N integrity, gait, integumentary integrity, joint, mental functions, mobility, muscle performance, pain, posture, ROM, reflex integrity, sensory integrity, skeletal integrity, ventilation and respiration
body functions and structures
ICF: community, social, civil life, education life, self care and domestic life, work life
participation
ICF: products and technology, natural environment and human made changes to environment, support and relationships, attitudes, services/systems/policies
environmental factors
ICF: age, gender, race, educational levels, copying styles, economic status, support
personal factors
what is PT specific and is how we frame decision making and PT dx for functional impairment with movement
movement system
original movement system model
endocrine
nervous
cardiovascular
pulmonary
integumentary
MSK
new 4-item movement system
motion
force
motor control
energy
describe motion in movement system
- passive movement
- Related to the length of tissues, mechanical cx’s, tissue tension (hyper/hypo/normal)
- Assessed via PROM, accessory motion, special testing
- Interventions depend on nature of problem: need for stretching shortened structures, reducing neural tension/hypertonicity
describe force in movement system
- producing movement
- Ability of contractile and noncontractile tissues to produce movement and provide stability around joints
- Assessed via MMT, isokinetic testing, dynamometry
- Interventions specific to impairment (strengthening)
describe energy in movement system
- ability to perform repeated movements
- Integrated function of CV, pulmonary, endocrine, and NM systems
- Assessed via CV testing (6 MWT, 2 MWT, BCTT), RPE, time
- Addressed via aerobic training
describe motor control in movement system
- planning, executing and adaption of goal directed movement
- Receive and process task-specific input (visual, vestibular, somatosensory); select, plan and execute movement to accomplish goal
- Relies on intact sensory motor pathways, perception, cognition (feedforward/feedback)
- Assessed via observation of task analysis, coordination, precision, movement quality, coordination, balance/gait, sensory testing
- Addressed via task-oriented practice
CASSS
control
amount
speed
symmetry
symptoms
what is the flow of a neuro exam
- attention, arousal, attention, orientation, mental status
- vital
- sensory assessment
- CN testing
- motor assessment
- coordination/balance/vestibular
- posture
- mobility (gait, WC)
- function - bed mobility, level/unlevel surfaces, ADLs/IADLs
general outcome measures
berg-balance scale
6 MWT
dynamic gait index
functional independence measure
barthel index
functional gait assessment
10 MWT
disease specific outcome measures
fugl-meyer assessment of physical performance (stroke)
stroke rehabilitation assession of mvmt
MS quality of life
Spinal cord independence measure
red flags
- Loss of consciousness or change in arousal status
- Extreme confusion not consistent with premorbid status
- Status epilepticus - seizures > 5 minutes
- Signs of acute infection accompanied by nuchal rigidity or intense localized back pain (Neck resists passive flexion)
- Rapid, unexplainable onset of neurologic signs and sx
- Signs of spinal instability
- Non-responsive autonomic dysreflexia
- HA that is severe, sudden, unusual (Thunderclap HA)
signs of concern for referral or report out
- Saddle anesthesia, bowel/bladder changes not previously diagnosed
- Progressive neurologic changes in non-degenerative disorder
- New presentation of involuntary motor responses or tremor
- Changes in automic status
- Progressive bulbar changes
- HA that worsens over time
- Significant change in personality/behavior
- Detectable vertebral A insufficiency
- Constitutional s/s associated with systemic illness
- 5 D’s and 3 N’s (diplopia, dysarthria, dysphagia, drop attacks, dizzy, nausea, nystagmus, numbness)
what are the 3 main types of interventions
restorative
compensatory
preventative
restorative interventions
directed toward remediating or improving impairments and activity limitations
- recovery of/optimization of function
compensatory interventions
optimizing function using residual ability
- adaptation of tasks, use of AD, environmental adaptations
preventative interventions
identification of risks, prevent sequelae, pt education to live well despite ongoing disease
- wellness
what is re-examination
Continuous process used to assess progress toward anticipated goals and outcomes as per POC
Determine obstacles toward progress based on prognosis
Revise POC as indicated
PT needs to be INVOLVED
what does Medicare require to charge for re-evaluation
MUST have significant CHANGE in status (ie. hospitalization)
Cannot charge every 2 weeks/30 days without above
describe discharge planning
Initiated at the start of the episode of care (Day 1)
Plan for pt/caregiver/family education, plan for follow-up care or referral to another level of service, home exercise instruction, evaluation/modification of home environment, pt’s status/prognosis at time of conclusion of episode of care
