Interventions - Shoulder Flashcards
Acute phase - irritability
High
Subacute phase - irritability
Moderate
Return to function phase - irritability
Low
Phase 1 =
acute
post op
Stability/ROM
Phase 2 =
subacute
ROM/early strengthening
Biggest area for PT
Phase 3 =
Return to function
Strength and function
Acute - characteristics
High pain (7/10) Consistent night or rest pain Pain before end range AROM less than PROM High disability
Subacute - characteristics
Moderate pain (4-6/10) Intermittent night or rest pain Pain at end range AROM about equal to PROM Moderate disability
Return to Function - Characteristics
Low pain (0-3/10) Absent night or rest pain Minimal pain with overpressure AROM = PROM Low disability
Acute phase/Phase 1 = PT
Minimize physical stress Activity modification Physical agents Medication Pain relief manual therapy Low physical stress Pt education Monitor impairments
Subacute phase/Phase 2 = PT
Mild to mod physical stress
Address impairments
Controlled physical stress via progressive manual therapy, mild stretching, motor control exercises
Basic level functional activity restoration
Return to function phase/Phase 3 = PT
Mod to high physical stress Address impairments Stretch Resisted exercise More aggressive manual therapy High demand functional activity restoration
Define controlled physical stress
You are not using it in painful ways
You are minimizing the physical stress
Expanded classification system is designed to
match rehab interventions to patient subgroups and stages to facilitate more effective care
Pathoanatomic system of diagnosis - rehab
Good for surgical decision making but nor for guiding rehab
Classification systems primarily aim to
guide treatment decision making and inform prognosis
Article proposes what
A staged approach to classification that includes screening, pathoanatomic dx, and rehab classification - also matches interventions
The rehab classification is used to
guide intensity and specific focus of rehab
Both pathoanatomic dx and rehab classification are determined from the
history and physical exam
likely to be derived in parallel
Level 1 =
Screening
Taking hx and performing basic exam to gain idea of problem - red and yellow flags
Potential red flags for shoulder
Tumor Infection Fracture or dislocation Neurologic lesion Visceral pathology
Level 2 -
Pathoanatomic dx
Made based on identifying presumed tissue pathology that is generating the symptoms
First step in level 2
Determine that the symptoms are attributable to shoulder rather than referred from elsewhere
Level 2 - one of the primary intervention decisions
surgery or nonsurgery
Level 3 -
Rehab classification/tissue irritability and impairments
Level 3 - rehab categories are based on
the stage of tissue irritability to guide the intensity of the tx
Pathoanatomical Dx vs. Rehab classification - what do they identify
Patho - identifies primary tissue pathology
Rehab - identifies level of irritability and key impairments
Patho Dx vs. Rehab classification - over course of care
Patho - remains stable across episode of care
Rehab - changes over episode of care
Patho Dx vs. Rehab classification - Guides what
Patho - guides a general treatment strategy
Rehab - guides specific rehab intervention
Patho Dx vs. Rehab class - prognosis
Patho - informs prognosis
Rehab - may inform prognosis
