Intro, ICF, Client Management Flashcards
Multidisciplinary Care:
Guide to Physical Therapist Practice:
Purpose?
- Describes physical therapist practice
- Describes settings in which PTs/PTAs practice and the role of physical therapists in:
- Primary, secondary, and tertiary care
- Prevention
- Promotion of health, wellness, fitness
- Standardizes terminology
- Delineates the clinical decision-making process that occurs as part of patient/client management
- Reviews interventions that are part of PT practice
- Describes how outcome measures are used
Multidisciplinary Care
Acute Care General Guidelines for Treatment Goals?
- Prevent/minimize adverse effects of immobility/inactivity
- Prevent contractures
- Improve general conditioning, bed mobility, respiration
- Prevent pressure ulcers
- Return patient to pre-hospitalization level of function if possible or maximize to promote to post-acute rehab
Multidisciplinary Care
Special Considerations for Acute Care?
- Monitor vital signs and activity tolerance closely
- Use anti-embolism stockings, compression devices to prevent DVT/PE
- Utilize equipment to encourage mobility if patient is too weak to get OOB
- Supplement PT session with “homework”
- Isolation Precautions/Infectious disease status
- Monitor tubes/lines/drains/catheters
- Safety strategies/call light/ fall risk assessment
Multidisciplinary Care
ICF = ?
should be ‘ICFDH’
International Classification of Functioning, Disability and Health (ICF Model)
- ICF provides a unified, standard language and framework for data collection in practice and research
- ICF language describes how people function in their daily lives rather than focus on their disease-specific diagnosis
Multidisciplinary Care
Inability or restricted ability to perform actions, tasks, and activities related to required self-care, home management, work, school, play, community, and leisure roles = ?
Disability:
- Inability or restricted ability to perform actions, tasks, and activities related to required self-care, home management, work, school, play, community, and leisure roles
- Occurs when cannot overcome functional limitations to perform “normal” roles
- Depends on capacities of individual and expectations imposed on individual in immediate social environment
Multidisciplinary Care
3 components that describes how a medical (health) condition/pathology effects a peron’s ability to function and how the condition causes disability?
(1A) Body Structures: Anatomical Parts of the Body.
(1B) Body Functions: Physiological / Psychological function of the Body Systems.
(2) Activities: Execution of a task or action by an individual.
(3) Participation: Involvement in a life situation.
Multidisciplinary Care
What is a Health Condition?
- Pathology, disorder, disease, injury, trauma or congenital anomaly
- Usually diagnosed by a physician
- Primarily identified at the cellular level
- The door that opens the episode of care
Examples: Spinal injury, Diabetes, Blindness, CVA, Arthritis
Multidisciplinary Care
- Physical Therapy Diagnosis?
- Catergorized by?
- Takes the medical (health) condition/pathology and puts it in the framework of the ICF to define how it effects the person’s function and how the condition causes disability.
Categorized by:
- Impairments of body structure or function
- Activity limitations
- Participation restrictions
Multidisciplinary Care
Examples:
Impairments of Body Structure
vs.
Impairments of Body Function
Multidisciplinary Care
- Carrying an object
- Problem Solving
- Bathing and Dressing
- Communicating
- Rolling over in bed
- Transferring to chair
- Walking
- Climbing stairs
Are examples of ?
Activities: Execution of a task or action by an individual
Multidisciplinary Care
- Difficulty ascending stairs
- Unable to lift gallon of milk
- Inability to count money
- Requires assistance to put on shoes
Are examples of ?
Activity Limitations: Difficulties an individual may have in performing actions, tasks, and “usual activities”.
Measured at the level of the PERSON
Multidisciplinary Care
- Cashing a check/using an ATM
- Mowing the grass
- Caring for a child
- Working
- Attending a concert
Examples of?
Participation: Involvement in a life situation
Multidisciplinary Care
- Inability to maintain a job
- Inability to care for child
- Inability to drive to grocery store to get food for family
Are examples of?
Participation Restrictions: Problems an individual may experience in involvement in life situations.
Multidisciplinary Care
Contextual Factors include?
- Personal Factors: Background of person’s life
- Environmental Factors: Make up the physical, social, and attitudinal environment in which people conduct their lives
Multidisciplinary Care
- Age
- Gender
- Coping styles
- Education
- Past and current experience
Are examples of?
Personal Factors: Background of person’s life
Multidisciplinary Care
- Products and technology
- Natural environment and human-made environment
- Support and relationships
- Attitudes of others
- Services, systems, policies
Are examples of?
Environmental Factors: Make up the physical, social, and attitudinal environment in which people conduct their lives.
Multidisciplinary Care
Disorder, disease, injury, trauma, aging, congenital anomaly = ?
International Classification of Functioning, Disability and Health (ICF)
Health Condition: disorder, disease, injury, trauma, aging, congenital anomaly
Multidisciplinary Care
Problems in body function or structure such as significant deviation or loss = ?
International Classification of Functioning, Disability and Health (ICF)
Impairments of Body Functions and Structures: problems in body function or structure such as significant deviation or loss
Multidisciplinary Care
Execution of a task or action by an individual = ?
International Classification of Functioning, Disability and Health (ICF)
Activity Limitation: execution of a task or action by an individual
Multidisciplinary Care
Problems an individual may experience in involvement in life situations = ?
International Classification of Functioning, Disability and Health (ICF)
Participation restriction: problems an individual may experience in involvement in life situations.
Multidisciplinary Care
Components of the Patient/Client management model?
Multidisciplinary Care
Describe this component of the Patient/Client management model.
- Examination: Comprehensive screening & specific testing process leading to diagnostic classification and/or referral to another practitioner.
- Required prior to intervention
Three components:
- History
- Medical/surgical/medication/social history
- Symptom Investigation
- Review of Systems
- Systems Review
- Tests and measures
Multidisciplinary Care
Examination - History?
Patient/Client management model
- Systematic gathering of data from past + present related to why patient is seeking PT
- Obtained through review of medical record, interview, and other sources (ie teachers, case managers, caregivers, family)
- Provides initial information used to create hypothesis = Helps to decide further in-depth analysis during tests + measures
Multidisciplinary Care
Examination - Review of systems includes?
Patient/Client management model
Multidisciplinary Care
Examination – Physical Therapy Systems Review
Patient/Client management model
HANDS-ON examination of the anatomical and physiological status of these systems:
- Cardiovascular/Pulmonary: Heart rate, respiratory rate, blood pressure, oxygenation and edema
- Integumentary: Skin color, texture and integrity (wounds, scars etc.)
- Musculoskeletal: Gross symmetry of the body, gross range of motion, gross strength, posture, height, and weight
- Neuromuscular: Gross cognition, coordination, balance, gait, locomotion, transfers, and motor function
- Also includes a brief examination of: Communication ability, affect, cognition, language, orientation, emotional/behavioral responses and learning style of the individual
Multidisciplinary Care
Examination – Tests and Measures
Patient/Client management model
A process of gathering data to:
- Rule in or out presence of and links between
- Impairments in body function + structure
- Activity limitations
- Participation restrictions
- Help establish a diagnosis, prognosis and treatment plan
- Help determine what interventions to use
Physical therapists must select appropriate tests/measures for each patient individually
Selection is based on:
- Psychometric properties of the measurements
- Reliability, validity, responsiveness in detecting minimal, meaningful change
- Clinical utility of tests and measures
- Appropriateness of using self-report or performance based measures
Multidisciplinary Care
Describe this component of the Patient/Client management model.
Patient/Client management model
Diagnosis The objective of the PT diagnostic process is:
- To identify the discrepancies between the patient’s level of function what is desired (patient goal)
- To determine the capacity of the patient to achieve that level
- Medical physicians typically diagnose conditions using labels that identify disease, disorder or condition at the level of the cell, tissue, organ, or system
- Physical Therapists use labels that identify the impact of a condition on function at the level of the system (especially the movement system) and at the level of the whole person
Multidisciplinary Care
Describe this component of the Patient/Client management model.
Patient/Client management model
The process of “PUTTING IT ALL TOGETHER”, requires the physical therapist to:
- Integrate the test/measure data with information collected during the history
- Develop a statement of why the patient needs physical therapy and how we can help (Does the patient need referral to other healthcare service?)
- Determine a physical therapy diagnosis
- Develop a problem list
- Determine a prognosis, including goals for physical therapy management
- Develop a plan of care
Multidisciplinary Care
Describe this component of the Patient/Client management model.
Patient/Client management model
A prediction of:
- Optimal level of improvement in function
- Patient’s potential to reach best improvement based on capabilities, goals, motivation, resources
- “The patient has good potential to return to home independently due to motivation, minimal balance impairment, family support”
A Listing of:
- Goals established in collaboration with patient
- Short term incremental goals
- Long term goals to be achieved by the predicted end of the episode of care and relate to patient’s highest level of functioning
The plan of care consists of statements of specific interventions to be used and proposed duration and frequency of the interventions that are required to reach the goals and outcomes.
- Established in collaboration with patient
Includes anticipated discharge plans
Example: “The patient will participate in resistive strength training for B LEs 3 times/week for 3 weeks”
Multidisciplinary Care
Problem List = ?
Patient/Client management model
A summary of the patient’s:
- Impairments of body structure and function
- Activity limitations
- Participation Restrictions
Example:
- Impaired B hip strength
- Impaired bed mobility
- Impaired transfer ability
- Cognitive/memory deficits preventing ability to live independently
Multidisciplinary Care
Describe this component of the Patient/Client management model.
Patient/Client management model
Intervention:
- Purposeful interaction using various PT procedures and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis
- Communication, coordination, documentation
- Patient-related instruction
Categories of Physical Therapy Intervention:
- Patient or client instruction
- Assistive technology
- Airway clearance techniques
- Biophysical Agents
- Functional training in self-care and domestic, work, community, social and civic life
- Integumentary repair and protection techniques
- Manual therapy techniques
- Motor function training
- Therapeutic exercise
Multidisciplinary Care
Describe this component of the Patient/Client management model.
Patient/Client management model
Outcomes:
As the patient reaches the end of the episode of care, the PT uses evidence-based tools to measure the impact or results of the PT interventions related to:
- Disease/disorder/condition
- Impairments in body structure and function
- Activity Limitations
- Participation restrictions
- Risk reduction/prevention
- Health/wellness/fitness
- Societal resources
- Patient/client satisfaction
