Topic 5 - Treatment Planning Flashcards
_______ patient care comes from the ability to make sound clinical judgements, solve problems that are important to patient ____________ and apply knowledge of the interrelationships between pathology impairment, __________ limitations and the level of disability throughout each phase of treatment.
Quality
Presentation
Functional
How many phases are involved in the clinical decision making process?
4
The clinical ________ ______ process is used to create effective interventions that use massage techniques to create specialized clinical outcomes.
Decision Making
T/F - The clinical decision making process is intended to be used in a linear, sequential manner.
False - The clinical decision making process is NOT intended to be used in a linear, sequential manner.
We want to get away from a ____________ treatment for specific conditions and look at the individual’s related impairments that we find through our __________.
Standardized
Assessment
The impairments that are found in the evaluation will help shape our ________ and goals of treatment. This will also guide the choice of appropriate massage __________ we use to treat the impairments.
Outcomes
Techniques
An approach to practice that is continuing to evolve as understanding and expertise increases. Clinical practices should be based on “________.”
Evidence Informed Practice
“Evidence”
Not all areas of clinical practice are well _______. It is clinical _________ that ties them all together to inform practice decisions.
Studied
Expertise
Clinical expertise takes the form of knowledge of each of the domains in the EIP model, but also in the ______ required to pull them into the equation when decisions about practice in individual situations or in more ______ recommendations are being deliberated.
Skills
Global
What are the 4 pillars of evidence informed research?
1) Research
2) Therapist Expertise
3) Client-Centered
4) Context
The _________ of evidence can help when searching for best available research evidence. It is viewed as a ladder of increasing filtering and processing.
Hierarchy
When looking at the hierarchy of evidence, the _______ levels include resources where evidence is the most rigorously processed and filtered in reliable ways, with the most specific being the ________ _______ systems.
Highest
Decision Support
__________ reviews and ____-________ can be very useful, as they have done some of the review of evidence for you and can point you to the original sources.
Systematic
Meta-Analyses
A variable that is measured in order to gauge a patient’s progress towards a specific outcome.
Outcome Measure
A systematic treatment approach in which a therapist provides interventions with the goal of achieving specific outcomes that are tailored to specific identified patient unique presentation, presenting issues and preferences.
Outcome Based Massage
The systematic set of therapeutic techniques selected by the clinician to achieve identified outcomes or wellness goals.
Plan of Care (aka. Treatment Plan)
Results of a single intervention and/or results of multiple interventions in a plan of care (aka. treatment plan).
Outcome
Primary concern is not the client’s impairments.
Wellness Interventions
Aim is to reduce the impairments associated with medical conditions.
Treatment of Impairments
A restriction of the individual’s ability to execute a task or action in an ideal situation.
Functional Limitations
The process by which therapists analyze client information and formulate/progress therapeutic regimens for their clients.
Clinical Decision Making
T/F - Therapists using clinical decision making perform several steps of the process concurrently.
True
T/F - Therapists only cycle through the steps of the clinical decision making process once.
False - Therapists only cycle through the SAME steps of the clinical decision making process SEVERAL TIMES.
Cycling through the same steps of the clinical decision making process several times allows the therapist to ______ on their information and refine their __________.
Expand
Hypotheses
A model of the present human function, health and disability as an interaction between the individual, the disease process and the environment in which the individual lives.
International Classification of Functioning, Disability & Health
Some ____ assessment tools for various impairments include:
- Pressure algometers
- Pain Catastrophizing Scale
- Neurogenic tests (e.g. reflexes, neural tension tests, sensation)
- Numeric Rating Scale
- Verbal Categorical Rating Scale
- Visual Analog Scale
- Face Picture Scale
- Neuropathic Pain Scale
- Body Diagrams
- The McGill Pain Questionnaire
Pain
Measures tissue sensitivity to pressure.
Pressure Algometer
Tests the interplay between pain and psychological reaction to pain.
Pain Catastrophizing Scale
What are the 4 phases in clinical decision making?
1) Evaluative
2) Treatment Planning
3) Treatment
4) Discharge
A phase in clinical decision making where information is gathered through your evaluation so you can formulate then confirm a clinical hypothesis (aka. clinical impression) about the patient’s clinical problems or wellness goals.
Evaluative Phase
During intake/health history, goals of gathering __________ information:
- To identify & understand the nature of the person’s complaint
- To generate a preliminary hypothesis
- To identify any health concerns & predisposing factors that may introduce modifications
- To help prioritize complaints if there is more than one
- To identify how the patient’s ADLs are being affected
- To identify what the patient’s goals are for the treatment
- To identify if massage can help them achieve those goals
Subjective
Some ___________ of soft tissue dysfunction given in a patient’s health history include:
- Mentions long standing musculoskeletal condition
- History of prolonged/reoccurring infection
- Changes in pain from local to diffuse
- History of chronic pain
- Anxiety, stress & depression
- History of injury/surgery
- Gradual onset of discomfort with an alteration in posture
- Relief through soft tissue work/massage
- Emotional trauma
- Complaints of muscles feeling stiff/hard
- Complaints of altered sensation
- Bony malalignment (e.g. scoliosis)
Indications
Conduct ________ examination to identify, confirm or rule out impairments and pathologies. The following can help you to confirm a clinical hypothesis:
- Observations
- Postural analysis
- Gait analysis
- Palpation
- Neurological & special tests
Objective
Skilled _________ is an art and a required component of many examination techniques. It is the ____________ skill for the execution of all massage techniques. It is also used to help assess and reassess the impairments throughout the treatment.
Palpation
Prerequisite
Some impairments that can be evaluated through _________ and compared bilaterally include:
- Contour & bulk
- Abnormal connective tissue density
- Abnormal levels of resting muscle tension
- Abnormal neuromuscular tone
- Impaired extensibility of contractile & non-contractile tissues
- Impaired integrity of contractile & non-contractile tissues
- Decreased ribcage mobility
- Fascial restrictions
- Muscle spasm
- Scarring
- Swelling (e.g. edema, effusion, lymphedema)
- Temperature
- Trigger points
- Adhesions
- Texture & consistency
Palpation
At the __________ phase, you want to be able to:
- Confirm/refute your clinical hypothesis
- Summarize clinical findings by distinguishing between the patient’s areas of function & dysfunction
Evaluative
A phase in clinical decision making where our identified impairments are taken and used to identify functional limitations as the criterion for creating outcomes and then to select appropriate techniques to achieve them.
Treatment Planning Phase
Some types of patient ___________ we treat with massage include:
- Musculoskeletal
- Neurological
- Functional
- Psychoneuroimmunologic
- Wellness intervention
Impairments
Some examples of _______________ impairments include:
- Adhesions/scarring
- Impaired connective tissue integrity
- Impaired joint integrity
- impaired joint mobility
- Impaired muscle integrity
- Abnormal muscle resting tension & muscle spasm
- Trigger points
- Postural malalignment
- Decreased endurance
- Adaptive shortening
- Limited ROM/restricted joint capsule
- Restricted connective tissue
- Decreased muscle length
- Impaired circulation
- Mechanical instability
- General deconditioning/muscle weakness
- Rigidity
- Paralysis
- Atrophy
- Swelling (e.g. edema, joint effusion)
Musculoskeletal
Some examples of __________ limitations include:
- Inability to sit for 10 minutes
- Can’t climb stairs
- Pain with reaching overhead
- Can’t drive for more than 15 minutes without pain
Functional
Some examples of ______________________ impairments include:
- Stress
- Depression
- Altered body image
- Immune suppression
- Altered patterns of sleep
Psychoneuroimmunologic
Some examples of issues that patients come in with relating to ________ include:
- Prevention of injury
- Improved body awareness
- Enhanced mental focus
- Enhanced ability to deal with stress
- Self-nurturing
Wellness
A list of all the impairments and wellness goals gathered from your assessment in the evaluative phase to help guide treatment planning.
General Clinical Problems List
In the treatment planning phase, we want to identify the clinical problems that will respond to direct application of _______ and those that will not. The other impairments may be ________ appropriate.
Massage
Referral
In the treatment planning phase, we want to identify relevant __________ outcomes in collaboration with the patient and these are used as a ________ for setting goals.
Functional
Baseline
In the treatment planning phase, we want to identify the _________ impairments and wellness goals, as well as list all relevant outcomes. These are used as a baseline for setting impairment related _____.
Treatable
Goals
Examples of a ______ effect include:
- Decreasing muscle tone
- Eliminating a trigger point
- Reducing an adhesion
Direct
Examples of a _________ effect include:
- Decreasing anxiety
- Increasing ability to sleep
- Increasing ROM due to eliminating trigger points
Secondary
T/F - It is possible that our massage techniques may have no effect on an impairment.
True
When creating treatment goals, choose goals within your _____ of ________ that are of ongoing importance to the patient. This can ______ over the course of the treatment.
Scope of Practice
Change
Some things to consider when creating treatment _____ include:
- Consider the client’s _____
- Severity of impairments
- Potential to cause secondary impairments
- Decide whether to treat sequentially/simultaneously within each intervention & within the episode of care as a whole
- Injury & healing times
- Results of assessment
Goals
T/F - We don’t want to eliminate or decrease certain impairments before moving on to treat other impairments.
False - We DO want to eliminate or decrease certain impairments before moving on to treat other impairments.
Under most circumstances we treat in the following order:
1) ____________ (e.g. pain & swelling)
2) Mobility
3) ROM
4) ________
5) Proprioception
6) Return to ________
Inflammation
Strength
Function
A key point to consider in the treatment planning phase is what is causing the ____ or dysfunction. Our goal is to reduce or _________ it and we must pick appropriate tools to achieve that goal.
Pain
Eliminate
____ can be caused by:
- Mechanical stresses (e.g. stretch/compression of nociceptors)
- Somatic ____ (e.g. inflammation, chemical irritants/noxious stimuli, edema/swelling)
- Neuropathic ____ (e.g. referral, TrPs, nerve generated, visceral)
- Chronic/persistent ____
- Psychological ____
Pain
Pain that is caused by increased or prolonged by mental, emotional or behavioural factors.
Psychological Pain
Can be present due to inflammation (e.g. sprained ankle) or due to another pathology (e.g. kidney, heart) working on the assumption that we can treat it.
Swelling
T/F - Chronic swelling will always cause pain.
False - Chronic swelling DOES NOT always cause pain.
Tools to achieve the goal of decreasing/removing ________ include:
- Patient positioning (e.g. elevation)
- Diaphragmatic breathing
- Cold hydrotherapy
- Lymphatic drainage techniques
- Superficial fluid techniques
- ROM (e.g. pain free passive relaxed)
- Joint mobilization (grades 1 & 2)
- Self-care (e.g. PIER, PR ROM)
Swelling
_____ of ______ can be reduced due to inflammation/swelling, fascial restrictions, hypertonic/short muscles, trigger points, joint restrictions, spasm and willingness to move.
Range of Motion
If there is inflammation present, we need to ________ ROM and eliminate inflammation.
Maintain
Tools to achieve the goal of ___________ ROM include:
- Pain free passive relaxed ROM
- Gentle swedish techniques
Maintaining
If there is no inflammation present, our goal is to _______ and _________ ROM unless it is contraindicated by something (e.g. instability, prosthesis, muscle imbalances).
Improve
Normalize
Tools to achieve the goal of ___________ ROM include:
- Myofascial techniques (e.g. frictions)
- Swedish techniques (to lengthen tissue)
-Trigger point therapy
- Joint mobilizations
- ROM (e.g. stretching, PIR)
Normalizing
T/F - Lengthen before strengthening, except when it comes to joint instability.
True
________ can be decreased due to disuse, trigger points, soft tissue restrictions or injury. _____________ is needed when there is a muscle imbalance (this is often a cause of injury/re-injury). This demonstrated and the patient works on it as self-care.
Strength
Strengthening
Tools to achieve the goal of maintaining/normalizing ________ include:
- Self-care exercises (e.g. isometric, isotonic, eccentric, ________/endurance, balance)
- Proprioception training
- Tapotement to increase systemic/sensory arousal
Strength
With CNS disorders, __________ may normalize neuromuscular tone and balance agonist/antagonist functions.
Tapotement
T/F - It is not within our scope of practice to return a patient to pre-injury status.
False - It is WELL within our scope of practice to return a patient to pre-injury status.
The therapist needs to specify and document the treatment _________ within the patient’s written plan of care, including:
- Duration of the episode of care (e.g. 60 min)
- Frequency (e.g # of times per week)
- Length of plan (e.g. 6 weeks)
Parameters
The therapist will base the desired ________ and the ____ needed to achieve them on several factors:
- Patient’s current/prior level of function
- Severity, complexity, stability & acuity of patient’s condition
- Patient’s discharge destination
- Patient’s home, work, social & personal goals
- Overall health status & treatment tolerance
- Literature on prognosis of someone with that condition
- Therapist’s judgement from clinical experience of what patient has the potential to achieve
Outcomes
Time
A _____-____ outcome provides us with a useful benchmark as to the effectiveness of treatment and will allow you to make necessary changes.
Short-Term
____-____ goals are associated with the functional outcomes.
Long-Term
It is important to address patient ________, even if there is a lack of change. You can perform informal patient ____________ anytime during the interventions.
Progress
Examinations
T/F - Your treatment plan will likely include other health care providers, therapeutic exercise and other self-care. This will have no effect in the frequency and duration of the plan.
False - Your treatment plan will likely include other health care providers, therapeutic exercise and other self-care. This MAY ALTER the frequency and duration of the plan.
Some clinical ______________ for treatment include:
- Mobility issues (e.g. hypermobility/hypomobility)
- Pain
- Movement control
- Person’s sense of well-being
Considerations
_________ can tell us:
- State of tissue integrity
- Structures involved
- Predictable impairments
- Expected course of healing/disease
- Inherent considerations & modifications
Pathology
A phase in clinical decision making where we deliver treatment outlined in the plan of care, conduct client re-examination and modify treatment.
Treatment Phase
A phase in clinical decision making that occurs by the time the patient is close to achieving their functional outcomes (90%). The therapist should have initiated referrals, identified other needs (e.g. exercise equipment) and finalized the content of home care.
Discharge Phase
There can be a _____________ component to discharge.
Psychological
