L3 Plan of Care Flashcards
principle #1–inductive and deductive reasoning
PT Prognosis
Inductive: creating a theory of the pt’s prognosis and use this to develop a PT POC
Deductive: you use continually, to test your theory and make adjustments to the patients POC based on pt response
Four Principles of Neurologic Rehab
- Effective neuro rehab involves a continuous cycle of deductive and inductive reasoning
- The goal of neuro rehab is functional competence
- Functional competence is promoted by basing rehab strategies on embedded models of motor behavior and neuro rehab
- Functional Competence requires motor learning and self-efficacy
Principle #2–Functional Independence
- Recovery
- Compensatory
- Maintenance
How do you know your pts prognosis?
-CPR
-Injury/Disease characteristics and natural hx
-Capacity for neural recovery
-Pt drive and engagement
-caregiver support
-pt resources
What should the plan of care include?
Goals
Interventions
Treatment frequency and duration
Restorative POC
- Goals should target improvement in function and selected outcome measures
- Intervention should optimize recovery
Compensatory POC
- Goals should target increased independence, with compensatory strategies or use of medical equipment
- Interventions involve training in compensatory strategies and use of equipment, addressing impairments that would stop them using equipment
Maintenance POC
- Goals target maintaining function and impairments
- Interventions involve training in home to maintain function and ensure no further worsening of body structure impairments
DME
Durable medical equipment
Principle #3–Embedded ICF Model
PT should select a task that is important to the patient at the activity/participation
Make sure to address body structure/function impairments
Principles of Neuroplasticity
- Use it or lose it
- Use it and improve it
- Specificity
- Repetition matters
- Intensity matters
- Time matters
- Salience Matters
- Age Matters
- Transference
- Interference
Aerobic Exercise and Neuro
-Aerobic exercise can increase the capacity for motor learning and for neuroplastic changes
-helps with stroke, SCI, parkinson’s, MS
-Brain-derived neurotrophic factor helps with motor learning and neuroplasticity is released with aerobic exercise
Principle #4–OPTIMAL Theory
Optimizing
Performance
Through
Intrinsic
Motivation (and)
Attention (for)
Learning
Enhanced Expectancies
-Individual ‘s expectation of performance is based on experiences
-Positive or negative past experiences can impact their performance
Self-Efficacy
an individual’s situation-specific confidence or prospective sense that he or she will be able to affect the actions that bring about task outcomes
important to promote in patients
Positive Feedback
-emphasize successful performance, while ignoring less successful attempts benefits learning
-feedback after good trials increases competence and self-efficacy
Social-comparative feedback
positive feedback about comparison to normative information has positive effects on motor learning
Self-modeling
watching edited video feedback of learners best performance demonstrated enhanced learning, intrinsic motivation, and satistfaction with performance
Perceived task difficulty
providing a cue, prior to practicing a novel balance task, improves learning and self-efficacy
Conception of ability
view of ability as reflecting a fixed capacity versus being amenable to change with practice can affect motivation to practice, performance, and learning. Focusing on change is better!
Extrinsic rewards
expectation of an external reward have been shown to improve motor performance and learning
not super practical for clinics
Autonomy
allowing individuals to exercise control over the environment improves intrinsic motivation and motor skill learning
Patients should be given choices in regard to practice conditions, the extent of practice. Language should focus on autonomy!
External vs Internal Focus of attention
External focus have an enhancing impact on performance and learning
Benefits of External Focus of Attention
- Effectiveness in motor control
- Efficiency in energy consumption
- Enhanced movement/speed/endurance
- Enhanced coordination and kinematics
- Promotes automaticity
Goal Action Coupling
Motor learning is associated with structural changes in neuroanatomy and functional connections across brain regions
practice under optimal motivational and attentional focus conditions helps with the development of more effective neural connections in support of better performance and more efficient learning
Key Points of Optimal learning
-Provide feedback at the request of the learner
-highlight good aspects of performance
-provide feedback focused n the goal
-Extrinsic rewards
-success will promote self-efficacy
-patient is an active participant
How do you recognize if an activity is too easy or too hard?
Patient perception of exertion
Therapist observation
-More errors than desirable
-Can’t complete task
-Can only do activity once
-Activity causes pain or other distress
Intervention Progression
-Single joint movements should be mastered before multijoint
-Stability should be mastered before mobility
-Part to whole task training is not always appropriate
-Tasks are not always more difficult, just different
