Lecture 1 - Introduction to Assessment Flashcards
International Classification of Functioning (ICF) Model
Health
State of complete physical, mental, and social well-being
Health Condition (ICF)
Disease, disorder, or injury
Body Functions (ICF)
Physiological functions of body systems
Body Structures (ICF)
Anatomical parts of the body eg. organs, limbs
Impairments
Problems an individual may have in body function or structure
Changes in body function defines the
magnitude of the impairment
Changes in body structures defines the
magnitude of impairment, nature of change, and localization (could see on observation or X-Ray)
Eg. a person comes in for physiotherapy with a sore hip but upon observation of the X-Rays you notice there is a fracture, what would happen?
The patient would have to stop seeing physiotherapy and instead go see a doctor for casting or surgery
Activity
Functioning at the level of the person (Everybody has to do every day)
List Basic Activities of Daily Living (BADLs)
Toileting, walking, dressing, eating,t alking, learning
Activity Limitations
Difficulty an individual may have in executing tasks or actions
Participation
Persons individual involvement in life situations/social interactions within the context of their environment (Specific activities to your preference)
Participation Restrictions
Problems an individual experiences in personal life situations/social interactions
Instrumental Activities of Daily Living (IADLs)
House/school work, play/leisure, parenting, driving (not required life activities)
Performance
What an individual does in their current environment eg. use of assistive devices to walk
Performance Qualifiers
Extent of participation restriction in performing tasks eg. had stroke and cant dab a bingo marker to play bingo
Capacity
Individuals ability to execute a task or action
Capacity Qualifiers
Extent of activity limitation eg. individual had stroke and needs cane to walk around house
Contextual Factors
Entire background of individuals life and living situations
Contextual factors are made up of:
1.Environmental Factors
2. Personal Factors
Examples of Environmental Factors
- Cultural/social norms
-Physical/built environment
-Political Factors
Products/Technology
-Transportation
Examples of Personal Factors
-Age
-Gender
-Co-morbidities
-Sociocultural Background
- Education/profession
-Past experience
-Personality/character/coping style
Barriers
Factors in individuals environment that limit functioning and create disability eg. having diabetes may cause longer healing times for fractured hip
Facilitators
Factors in individuals environments that improve functioning and remove disability eg. supportive friend or spouse to drive individual with broken hip around for socialization
Steps of patient management
1) Examination of patient
2) evaluation of data and identification of problems
3) Diagnosis and prognosis
4) Plan of care
5) Intervention
6) Reexamination and evaluation of treatment outcomes
Steps to identify relevant information to develop problem lists, goals, and expectations/prognosis
1) Use information gathered from ICF model (impairments, limitations, restrictions, barriers/facilitators)
2) Use patient centered care to adapt to clients wishes
List 3 modes of information gathering and the order you should gather them in to prevent repetition with client
- Chart Review
- Consultation
- Client Interview
Step 1: Examination
Identify patients impairments, limitations and restrictions in participation and resources to determine appropriate intervention
What 4 components make up the examination
- Patient History
- Systemic Review
- Tests and Measures
- Task Analysis
History is obtained by
Medical chart review and patient interview
Systemic Review is obtained by
Scanning the patients body systems to determine areas of intact function and dysfunction
6 Types of body systems used in scanning (systemic review)
- Muscoloskeletal: range of motion and strength
- Neuromuscular: Coordinated movements (eg. balance) and motor function
- Cardiovascular/Pulmonary: Assessment of heart/respiratory rate and blood pressure
- Communication Ability: Produce and understand language, feelings
- Integumentary: Skin integrity
- Cognitive Ability: Assessment of consciousness
Systemic review helps with what 4 things:
- Confirm need for further more detailed examination
- Rule out specific system involvement
- Determine if referral to other health professional is needed
- Identify specific area of body from symptoms
15 items that would be found in a chart
- Demographic information (eg. age, gender)
- HPI (History of Presenting Illness
- Physician Report (treatment plans)
- Surgery
- Additional illnesses (eg. diabetes)
- Medications (important to determine if symptoms caused by medication or ailment)
- Dietary/Fluid Restrictions (Dont give water to individual who cant have fluids)
- Imaging Results (CT scan, Xray)
- Lab Values (eg. hematocrit, pulmonary stress test, etc)
- Vital signs (eg. heart rate, resp rate, blood pressure)
- Nursing assessment (eg. medical status, pain level, discharge plans,etc)
- Patient Self Report Outcome Measures
- Occupational Therapy Assessment
- Speech Language Pathology Assessment
- Psychology assessment
REVIEW PG. 9 of Physical Rehab Textbook
SAMPLE INTERVIEW QUESTIONS
When looking at a chart what are 3 things to consider
- Define acronyms unfamiliar with
- Create a problem list and prioritize afterwards
- Learn roles and responsibilities to identify issues related only to PT
3 steps to create a prioritized problem list
- List problems from chart reviews, consultations and interviews
- Categorize problems based on ICF model (impairment, limitation, restriction, modifiable/nonmodifiable contextual factor)
- Identify whether problem is within scope of PT practice
Where can you find physiotherapy scope of practice
Googling The Physiotherapy Act
Where can you find role clarifications
Googling national competencies for other healthcare professionals
4 reasons why its important to make a prioritization list
- Determine assessment/intervention needs
- Determines if need for referral to another healthcare provider
- Determines prognosis expectations
- Supports goal setting and communication with client
Example: Run through the ICF model for an individual with hip arthritis that wants to play pickle ball
Importance of Goals and Outcomes
Goals should be measurable and set by the individual and provider and should include conditions that need to change to achieve goals, behaviour/activity to reach goals and the time it will take to reach the goal to give expected outcomes (improvement after rehab)
