Lecture 3 Flashcards
Shared Decision Making
Allowing the patient to have an opinion in their care while using the best available evidence and practices.
Benefits to SDM
enhances patients’ experiences
improves outcomes
Stages of SDM
preparing for collab
exchanging info about options
implementing plan
Preparing for Collab
Options exist! Patient is the participant.
The needs of the patient cannot be met without them participating
Barriers to collaboration
power imbalances
patient believes input is not wanted
time demands
patient’s lack of confidence in health info
Exchange Information
Both PT and pt share goals for the treatment
patient is the expert of their body & values
PT is the expert about medical practices
Includes patient education. Prevention, safety, options, meaning.
Affirm and Implement Decision
Summarize and confirm understanding
Can the patient repeat/teach me about what we have discussed?
Empathy
more effective than reassurance, humor, or counseling.
Verbal and nonverbal. helps to build rapport
What does patient education do?
empowers the patient
establishes a partnership
Keys to compliance
self-efficacy
meaningful
ease of implementation
Domains of learning
cognitive
affective
psychomotor
Cognitive
knowledge and development of intellectual skills
Affective
manner in which we deal with things emotionally, our attitude
Psychomotor
physical movement, coordination, motor-skills
What can improve motor learning?
Patient choosing which exercise to do next (choosing the order). Causes active involvement. Possibly a release of dopamine with choices.
Ensuring proper performance
after patient education
have the patient perform exercises under your supervision
have pt take notes, photos, videos
involve caregivers or friends
use mirrors
Considerations for at home program
Stage of healing
Symptoms
Time & willingness
Equipment
Early Stage of Healing
Appts are frequent
exercise program changes frequently
Intermediate to Late stages of healing
symptoms and function change more slowly
Symptoms
important to recognize what exercises or activities will cause more tissue irritability or symptoms to flare up
Motor control
neural, physical, and behavioral aspects of human movement
Movement
interaction of 3 elements, none exist without the other
learner
task
environment
Motor performance
execution of a movement task. Does NOT mean that a pt has learned a skill just because they can complete a task
What is required to transition from performance of a task to learning?
passage of time
repeatable under different conditions
happens in clinic and outside clinic
Motor learning
acquisition or modification of movement
retention of a skill
ultimate goal of physical therapy
occurs when movement is done without thought, or effort
Motor learning is accomplished through…
repetition
modeling
dual tasks
feedback/cues
novel/meaningful
random/blocked practice
Novel/meaningful
exercise can be new/challenging = novel
exercise can connect to goals = meaningful
Random vs blocked practice
random: variability to task. better outcomes
blocked: repeat same task over and over. Faster learning
Modeling
expert (PT or PTA)
non-expert (someone with similar injury)
Feedback
sensory info that is received and processed by learner during/after performing a motor skill
Knowledge of performance
feedback received during the performance of a task. understanding how the skill was performed. Parts of the task.
Knowledge of Results
immediate, post-task feedback about the outcome of motor task. How successfully a skill was performed. Entirety of task.
Intrinsic feedback
sensory systems. relate to body parts and how they move. Within the body and mind of the patient
Extrinsic feedback
gives info about the performance of task. Things that the PT says to the pt. Promote greater skill acquisition vs internal
Focusing on self vs goal
Focusing on the goal increases motor performance and learning
Types of cues
Tactile
Visual
Auditory
Verbal
Haptic
