Week 1 - Clinical Foundations Flashcards
What is health?
Ability to function in society
What are 4 states that contribute to health?
Biological, Psychological, Sociological, Spiritual
Must incorporate all into approach!
Why is the disablement model of management of health care flawed?
Believes in a linear relationship between Pathology to Disability. Not true! Many baseball players have a labral tears and so no disability!
Fails to Realize three things:
- Person’s individual reaction to his/her own condition/situation (Patient’s education and personal beliefs of what they can and cannot do)
-How other’s react to o define the person’s condition/situation (Tell patient to shrug injury off vs overprotective over scrape.
-Person’s environment/society may present with barriers or provide ways to overcome barriers (Ex: Not having elevators when in a wheelchair)
Enablement Model (ICF MODEL)
ICF: International Classification of Function
Change in focus & wording from one of “disablement” (What you can’t do) to “enablement” (What you can do with your condition)
Patient Centered Care Focus
Contextual Factors Included
Outcomes and prognosis can be effected by multiple reasons: Psychological, Sociological, Economical, etc.
What is Patient Centered Care?
Focus is now on the patient and their beliefs and their environment as well as the condition.
What are Contextual Factors?
Understand patient beliefs/values/needs and other factors affecting function.
Ex: Coaches, Parents, Peers, Enjoyment
What are some questions you can ask to find out more about a patients contextual factors?
Do you enjoy your sport?
What part of the season are you in?
What is your playing time like?
Do you have a history of this injury?
Do you like your coach?
Is there a negative or positive parental support?
Were parents with the child when you asked the questions?
What are the 3 Levels of Functioning in the ICF MODEL?
Body Functions (Impairments) - “Tissue Level” (Joint mobility, Flexibility)
Activities (Activity Limit) - ADL
Participation (Participation constrictions) - Work may not have stairs, patient can’t ascend stairs yet, therefore cannot work.
What are the 2 Contextual Factors in the ICF MODEL?
Personal Factors (Coach Pressure)
Environmental Factors (Don’t have access to prescription)
What are the two physiologies of Health Care?
Biomedical “Healing”: Pathology exists. Cause/Effect Relationship
Biopsychosocial & Spiritual - Healing & Adaptation: Identifies functional activities and participation and people’s abilities to achieve these. Role of health care is to empower patient to manage their condition.
What does ADL mean?
Activities of Daily Living
Why is pain complicated to treat?
Physical, Emotional, Psychological and Social Factors
We are not able to treat all pain conditions BUT we help patients learn to accommodate their lives.
Example of treatments we don’t know how to treat: Pain, Fibromyalgia, Autism
ICF MODEL COVID EXAMPLE
COVID
Body Function
Shortness of breath, body aches, etc.
Functional Limitations
Cardiovascular Fitness, Exercise
Participation Restrictions
Can’t go anywhere
Contextual Factor
Don’t want to quarantine, don’t get tested
No pill available to reduce effect of virus
What are the five steps in the patient client model?
- Examination and Evaluation
- Diagnosis
- Goals and Prognosis
- Intervention
- Outcomes
What do you during an examination/evaluation?
- Exclude serious pathologies (red flags)
- Identify nature of the symptoms
- If in pain, consider pain mechanisms
- Determine influence of contextual factors
- Understand influence of psychosocial factors
- ID the most appropriate course of treatment
Is PT appropriate for this individual?
Yes
-Treat
-Treat and refer
No
-Refer back to HCP
-No treatment. Possibly refer back to HCP nonurgently
Parts of Examination
Medical screening/systems review
Inspection of body’s systems to determine presence or absence of health condition
Data Collection (Chart review, subjective data, objective review)
What is Medical Screening?
Screen for medical/health conditions that may require medical attention
Involves a system review: Cardiopulomary, Musculoskeletal, etc
DO NOT NEED TO DIAGNOSE PATHOLOGIES
What is Differential Diagnosis
Diagnose impairments and limitations (mobility vs strength deficits)
May differentialy diagnose a medical pathology
-Ex: ACL tear vs Meniscus tear
Diagnosis
Assessment of findings in an examination
Fluid and ongoing process through interaction with patient
Medical diagnosis
Medical condition/Pathology
PT Diagnosis
Descriptive summary of findings from your exam relevant to function and body structure. Also known as Impairment-based diagnosis
Develop a problem list taking into consideration the components of the ICF Model
Problem list should be prioritized.
Diagnosis considerations
Pathoanatomic diagnosis
Biomedical model
ID base on presumed cause
Reliant on knowing the pathology involved
Technology can give us a proof positive that diagnosis exists
Impairment-Based Diagnosis
Classified by a cluster of signs and symptoms
May also diagnose by syndromes
Do not always know pathology
No proof positive
Diagnosis consideration examples
Pathoanatomic DX: (Diagnosis may not guide intervention)
Rotator Cuff Tendinitis
Shoulder Bursitis
Impairment based DX: (Lists what you will address in intervention)
Shoulder pain associated with neuromotor control deficits of the scapulo-thoracic joint and diminished endurance of the rotator cuff muscles
Goals and Prognosis
Need to be made with patient
Must consider contextual factors (Positive or Negative Influence)
Types of goals:
Functional goals: Participation restricitons, ability to regain activity/role in society. (ascend stairs)
Body function goals: Restore body stucture and function. (ROM)
Prognosis
What is your expected outcome of the patient?
What is the patient’s potential?
Intervention
Treatment plan: developed in collaboration with patient (Patient Centered!)
Must consider positive and negative contextual factors
3 Parts:
Coordination/Communication
Other Health Care
Patient and family members instruction and education
Procedural interventions
Informed Consent – patient agrees to the treatment plan
Continual assessment of effectiveness of intervention
If not, why?
Outcomes
What is the impact of the PT intervention in :
Participation restrictions
“Health Related Quality of Life” Questionairres
Activity restrictions
Body Functions/Systems
