Intro and Phases of Intervention Flashcards
Psychomotor Skill Learning - 5 Stages
- Stage 1: Acquiring knowledge of what should be done, to what purposes, in what sequence, and by what means. (Why is it important?)
- Stage 2: Executing the actions in a step-by-step manner, for each of the steps of the operation.
- Stage 3: Transfer of control from the eyes to other senses or to kinesthetic control through muscular coordination.
- Stage 4: Automatization of the skill. This stage is characterized by reduction of the need for conscious attention and “thinking through” of the actions.
- Stage 5: Generalization of the skills to a continually greater range of application situations. This last stage applies to the productive/strategy/planning end of our skills continuum.
Components to the Examination/Evaluation
Component 1
- Component 1: Medical Screening
– Subjective and Objective red flags and yellow flag assessment - Component 2: Differentiation of impairments, activity and participation restrictions associated with health condition - ID patterns of symptoms
- Component 3: Diagnosis of severity, irritability, stage and stability of condition
- Component 4: Match intervention strategies based on findings
Primary Impairments of Physical Function
Component 2
- Cognition and altered beliefs/attitudes/emotions
– Fear avoidance beliefs/kinesiophobia
– Understanding of condition - Mobility/flexibility Deficits
– Joint mobility
– Soft tissue mobility/flexibility
– Neural mobility - Motor function Deficits
– Neuromuscular control/coordination/Balance/Proprioception
– Muscle strength
– Muscle endurance
Fear now and anxiety in the future is the most common cognition belief
SINSS
Component 3
Severity: Intensity of symptom (0-10, How does the symptom affect life/ADL)
Irritability: Clinician’sassessment of ability to aggravate and ease symptoms (“real time”)
Nature of Symptoms: Nociceptive, Peripheral, Central Sensitization
Stage: Acute, sub-acute, chronic
Stability: Symptom progression over time
Intervention strategies based on findings
Component 4
- Match up appropriate intervention with appropriate impairment
- THEN: ASSESS HOW THE PATIENT RESPONDS TO THE TREATMENT. ASTERISK SIGN (Motion, Strength, Patients perception and motion)
- Impairment based Intervention Approach. As the status of the patient changes, the treatment is modified.
- Patient and PT values are very important
What does an impairment distribution include?
- Cognition/Beliefs
- Motor control
- Mobility (Soft tissue, joint mob)
Phases of intervention: Progression depends on -
- Experience
- Sound clinical reasoning skills
- Assessment of how patient responds to the intervention (ex: pain level, motion, etc…)
- Ability of clinician to educate the patient (ex: minimize anxiety/fear of movement)
- Positive or negative contextual factors (ex: patient motivation and compliance)
Phase 1 =
High irritability/max protectionTends to be more ACUTE
Phase 1 Presentation:
- High severity of pain
- High tissue irritability (symptoms easily provoked, intensity in which it comes on, how long it takes for symptoms to resolve)
- High level of activities and participation restrictions
- Empty and painful end feels or high muscle tone
- Poor motor control
- May have associated elevated anxiety/Fear Avoidance Beliefs (FAB)
Phase 1 Goals
- REDUCE ANXIETY/FAB (Do this first)
- EDUCATION on pain/condition (The more patients understand, the less patients fear movement)
- Minimize levels of stress/load to tissues
- Protect tissue and promote healing
- Maintain motion within acceptable range (Goal is NOT to restore but to maintain)
- Prevent muscle atrophy
- Movement strategies to decrease pain (breathing)
Phase 1 Interventions: Cognition/Beliefs
- Education on current condition, prognosis, etc.
- Neuroscience education about pain.
- Minimize patient anxiety/fear of movement (if indicated)
- Education on positioning and/or posture
- Create a therapeutic alliance with patient
Phase 1 Interventions: Mobility
- PROM > AAROM > AROM (pain free)
- Gentle joint and/or soft tissue mobilizations
Phase 1 Intervention: Motor Function
- MOVEMENT REEDUCATION – Modify movement patterns
- Motor coordination/control exercises (mm activation/ recruitment)
- Submax Isometrics to minimize atrophy
- Maintain proximal/distal function
In Phase 1 interventions, are modalities needed?
As needed basis
Phase 2
Moderate irritability/moderate protection
Phase 2 Presentation:
- Less severe pain
- Moderate tissue irritability
- More tolerant to activity
- Moderate level of activities and participation restrictions
- Pain AT end feel joint motion. Tenderness with muscle palpation
- Strength (force production) deficits
- Varying levels of fear and anxiety
Phase 2 Goals:
- Continued education and strategies to reduce fear and anxiety
- Restore/improve motion, strength, balance and function
- Enhance ideal movement patterns and force production (strength)
- Progress to performing more advanced ADL’s
- Continued strategies to decrease pain
Goal is to get back to functional activities
Phase 2 Interventions: Cognition
- Continued education
- Posture and body mechanics during functional activities (“functional retraining”)
Phase 2 Interventions: Mobility
- AROM (minimal pain)
- More vigorous PROM into restricted motion
- Joint and/or soft tissue mobilizations
- Manual and self stretching of restricted tissue
Phase 2 Intervention: Motor Function
- Proximal stabilization/recruitment (core stabilization)
- Strengthening of deep stabilizers of the region
- Isotonic strengthening (OKC and CKC)
Phase 2 Intervention: Balance
As Needed
Phase 3
Low irritability/minimal protection. Tends to be more CHRONIC
Enhancing function in the activity they want to get back too.
Phase 3 Presentation
- Lower levels of pain but may be more chronic
- Minimal tissue irritability
- Symptoms not as easily provoked
- Pain with overpressure into end feel. Mild to moderate tenderness of tissue
- Endurance deficits
- Varying levels of fear and anxiety
Phase 3 Goals
- Enhance neuromuscular control during “high level activities” (based on pt’s goals)
- Enhance endurance, dynamic stability, power, speed, etc.
- Restore activities and participation (“Graded exercise/exposure”)
- Improve CV conditioning
Phase 3 Interventions: Cognition
- Continued education
- Graded exposure to minimize fear anxiety in chronic cases
Phase 3 Intervention: Mobility
- More vigorous joint and/or soft tissue mobilizations (end range overpressure)
- Manual and self-stretching
Phase 3 Intervention: Motor Function
- Functional strengthening
- Higher level isotonics
- Exercise to enhance endurance
- OKC and CKC Rhythmic Stabilization
- Continued core stabilization
Phase 3: Balance
As needed
