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74 Cards in this Set

  • Front
  • Back
Disablement Models (classified in guide to PT practice)
a. Provides basis for patient/client management
b. Describes results of disease, injury at level of the person and at level of society
c. Different models try to define interrelationships between:
i.Disease
ii. Impairments
iii. Functional limitations
iv. Disabilities
v. Handicaps
vi. Effects of environment
d. A way to classify people and look at them as a PT
Disablement Models
a. Nagi Scheme
b. International Classification of Functioning, Disability and Health (ICF)
i. Was previously “International Classification of Impairments, Disabilities, and Handicaps”
Nagi Model
Nagi Model
a. Active Pathology: interruption or interference with normal processes, and efforts of the organism to regain normal state
i. Ex: Diabetes, coronary artery disease, etc.
b. Impairment: anatomical, physiological, mental, or emotional abnormalities or loss
i. What it does to the body – anatomically, physiologically, emotionally
c. Functional Limitation: limitation in the performance at the level of the whole organism or person
i. How it effects function and the ability to move
d. Disability: limitation in performance of socially defined roles and tasks within a socio-cultural and physical environment
i. How your injury, disease or illness affects you in society
Nagi Model
Nagi Model
a. Describes process of disablement
b. Focuses on impairments not functioning
Pathology/Pathophysiology
a. Primarily identified at cellular level
b. Usually physician’s diagnosis
Impairments
a. Abnormality in structure or function:
i. Result from underlying changes in the normal state
ii. Contribute to illness
b. Indicated by signs/symptoms
c. Examples:
i. Abnormal muscle strength
ii. Abnormal range of motion
iii. Abnormal gait
iv. Usually measured by noninvasive procedures
Functional Limitations
a. Result of the inability to perform the actions, tasks and activities that constitute the “usual activities” for an individual
i. Examples
1. Getting out of bed
2. Reaching a dish on an overhead shelf
3. Measured at the level of the person
b. Movement that you need to do to move the body about
Disability
a. Inability or restricted ability to perform actions, tasks, and activities related to required self-care, home management, work, school, play, community, and leisure roles
b. Occurs when cannot overcome functional limitations to perform “normal” roles
c. Depends on capacities of individual and expectations imposed on individual in immediate social environment
i. Ex: Inability to bathe self
d. How is this affecting you in socity?
ICF
a. World Health Organization (WHO)
b. Universal classification
c. Describes health and function in neutral language
d. Classifies functioning and disability associated with health conditions
i. Functioning: non-problematic or neutral aspects of health
ii. Disability: impairments, activity limitations or participation restrictions

1. Health condition = how do you function?
Health Condition (same as diagnosis on disease model)
a. Similar to pathology
b. Disorder, disease, injury, trauma or congenital anomaly
c. Examples:
i. Spinal injury
ii. Diabetes
Body Functions (Nagi – Impairment) = SOMETHING ISN’T WORKING RIGHT
a. Physiological functions of body systems (including psychological functions)
b. Examples:
i. Hearing
ii. Seeing
iii. Orientation
iv. Muscle power
v. Mobility of a joint
vi. Sensing pain
c. Includes all physical, physiological, psychological factors that impact a person’s body in the orientation process
i. Ex: Issue with body function = something that doesn’t work right in the body = poor shoulder ROM = loss of sensation in the feet
Body Structures = SOMETHING IS MISSING
a. Anatomical parts of the body such as organs, limbs and their components
b. Examples:
i. Brain
ii. Peripheral nerves
iii. Cardiovascular system
iv. Pelvis
c. Something is missing – amputation
Impairments
a. Problems in body function or structure such as significant deviation or loss
b. Examples:
i. Loss of shoulder ROM = Function
ii. Amputation of leg below the knee = Structure
c. Activities
i. Execution of a task or action by an individual
ii. Examples:
1. Walking
2. Carrying an object
3. Problem Solving
4. Bathing and Dressing
5. Communicating
Activity Limitations
a. Difficulties an individual may have in executing activities
b. Examples:
i. Difficulty ascending stairs
ii. Unable to lift gallon of milk
iii. Inability to count money
iv. Requires assistance to put on shoes
Participation
a. Involvement in a life situation
b. Examples:
i. Working
ii. Attending a concert
iii. Cashing a check/using an ATM
iv. Mowing the grass
Participation Restrictions
a. Problems an individual may experience in involvement in life situations
b. Examples:
i. Inability to maintain a job
ii. Inability to care for child
iii. Inability to drive to grocery store
c. How issues of structure and function can impair/limit participation
i. Brain injury = short memory = can’t keep a job
ii. Spinal cord injury = can’t lift child without severe pain
Capacity (EQUALS POTENTIAL) and Performance
a. Capacity
i. Inherent or intrinsic features of the person themselves
ii. Without assistance
iii. Judged relative to that normally expected of the person, or the person’s capacity prior to their health condition

b. Performance
i. Actual performance in the person’s actual situation or surroundings
23. Environmental Factors
a. Make up the physical, social, and attitudinal environment in which people conduct their lives
i. Examples:
1. Products and technology
2. Natural environment and human-made environment
3. Support and relationships
4. Attitudes
5. Services, systems, policies
Personal Factors
a. Background of person’s life
b. Examples:
i. Age – ability to heal, declining endurance, muscle power, heart rate, etc.
ii. Gender – relate between genders
iii. Coping styles – premorbid psychological profile
iv. Education – ability to interpret the world around you
v. Past and current experience
Nagi versus ICF
Nagi versus ICF
Nagi versus ICF
Case Study Example 1


26. Mrs. Sunshine
a. 33 years old – ?
b. CVA 2008 – ?
c. Right UE weakness – ?
d. Berg Balance Score 35/56 – ?
e. Mother of two - ?
f. Enjoys canning food – ?
a. Personal factor
b. health condition
c. Impairment of body function
d. Impairment of body function
e. Participation
f. Activity
ICF Model Example
ICF Model Example
ICF Model Example
Scope of PT Practice
a. Provide services to patients who have impairments, functional limitations, disabilities, or changes in physical function and health status
b. Interact, practice in collaboration with variety of professionals
c. Address risk factors and behaviors that may impede optimal functioning
d. Provide prevention & promote health, wellness, fitness
e. Consult, educate, engage in critical inquiry, administrate
f. Direct, supervise PT service, including support personnel
Physical Therapist Roles
a. Primary Care – prevention = proactive care officers, ER
b. Secondary Care – reactionary = already diagnosed and referred to PT
c. Tertiary Care – Specialty environment – specialist

d. Prevention and Promotion of Health, Wellness, and Fitness
Primary Care
“Provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing within the context of family and community.”
Secondary Care
a. Patients are initially treated by another practitioner and then referred to PTs for secondary care
i. Acute care
ii. Rehabilitation hospitals
iii. Outpatient clinics
iv. Home health
v. School systems
Tertiary Care (in environment – not referred)
a. Specialized and/or consultative care
b. Provided in highly specialized, complex settings or in response to other health care practitioner’s requests
i. Heart and lung transplant services
ii. Burn units
c. Patients with spinal cord injury or brain injury
Other Professional Roles of the PT
a. Consultation
b. Education
c. Critical Inquiry
d. Administration
e. Professional Organization
Five Elements of Patient/Client Management
a. Examination
b. Evaluation
c. Diagnosis
d. Prognosis (Including the Plan of Care)
e. Intervention
Examination
1.
2.
3.
1. History
2. Systems Review
3. Tests and Measures
Examination - History
a. Systematic gathering of data from past + present related to why patient is seeking PT
b. Obtained through review of record, interview, and other sources (ie teachers, case managers)
c. Provides initial information used to create hypothesis
d. Leads to help decide further in-depth analysis during tests + measures
Examination - Systems Review
a. Limited examination of
i. Anatomical and physiological status of the cardiovascular/pulmonary, integumentary, musculoskeletal and neuromuscular systems
ii. Communication ability, affect, cognition, language, psycho-emotional status + learning style of patient
iii. Review of “red flags” + screening data
Examination - Tests and Measures
a. Aerobic capacity/endurance
b. Antropometric characteristics
c. Arousal, attention, cognition
d. Assistive, adaptive devices
e. Circulation
f. Cranial, peripheral nerve integrity
g. Environmental, home, work barriers
h. Ergonomics, body mechanics
i. Gait, locomotion, balance
j. Integumentary integrity
k. Sensory integrity
l. Ventilation, respiration/gas exchange
Examination - Tests and Measures
a. Joint integrity, mobility
b. Motor function
c. Muscle performance (strength)
d. Neuromotor development, sensory integration
e. Orthotic, protective, supportive devices
f. Pain
g. Posture
h. Prosthetic requirements
i. Range of motion
j. Reflex integrity
k. Self-care, home management
l. Work, community, leisure integration
Evaluation
a. Clinical judgments
b. Synthesis all findings from history, systems review, test and measures to establish the diagnosis, prognosis, and plan of care
c. Reflects
i. Chronicity or severity of current problem
ii. Possibility of multisite or multisystem involvement
iii. Presence of pre-existing systemic conditions or diseases
iv. Stability of the condition
Diagnosis – What it is
a. Both the process and classification/ description of findings related to the patient
b. Defined clusters, syndromes, or categories to help determine the prognosis, plan of care and most appropriate intervention strategies
Prognosis and Plan of Care – What we’re going to do about it
a. Prognosis: Determination of the predicted optimal level of improvement in function and the time needed to reach that level

b. Plan of Care: Statements that specify the anticipated goals and the expected outcomes, predicted level of optimal improvement, specific interventions to be used, and proposed duration and frequency of the interventions
i. Established in collaboration with patient
ii. Includes anticipated discharge plans
Intervention
1.
2.
3.
4.
1. The plan
2. Coordination, Communication and Documentation
3. Patient related instruction
4. Procedural interventions
Intervention - The plan
a. Purposeful interaction using various PT procedures and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis
i. Includes
ii. Coordination, communication, documentation
iii. Patient-related instruction
iv. Procedural interventionsa. Purposeful interaction using various PT procedures and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis
i. Includes
ii. Coordination, communication, documentation
iii. Patient-related instruction
iv. Procedural interventions
Intervention - Coordination, Communication and Documentation
a. Intended to ensure patients receive appropriate, comprehensive, efficient, effective quality of care from admission to discharge
b. Coordination: all parties involved working together
c. Communication: exchange of information
d. Documentation: entry into patient record
Intervention - Patient-Related Instruction
Process of informing, educating, training patients, families, significant others, caregivers to promote and optimize PT services
Intervention - Procedural Interventions
a. Therapeutic exercise
b. Functional training in self-care + home management
c. Functional training in work, community, recreational activities
d. Manual therapy techniques
e. Prescription, application, fabrication of devices/equipment
f. Airway clearance techniques
g. Skin repair and protection techniques
h. Modalities
Reexamination
a. Process of performing selected tests and measure after the initial examination to evaluate progress and modify or redirect interventions
b. Indications for reexamination
i. New clinical findings
ii. Failure to respond to PT interventions
42. Termination of PT Services (discharge)
i. Process of ending PT services that have been provided during a single episode of care
ii. Anticipated goals and expected outcomes have been achieved
iii. Termination of PT Services
1. When patient has achieved their goals, the outcome has been met
Discontinuation: process of ending PT services that have been provided during a single episode of care when
a. Patient, caregiver, guardian declines to continue
b. Unable to continue progress toward anticipated goals/expected outcomes due to
i. Medical or psychosocial complications
ii. Financial resources have been expended
c. PT determines patient will no longer benefit from services
Practice Patterns
1. Diagnostic categories based on the patient/client’s leading impairment, functional limitation or disability

2. Boundaries that PTs may work within to design and implement plans of care for patients/clients, based on PT diagnosis
Goals of Practice Patterns
a. Identify breadth PT practice (to help make care better)
b. Help improve quality of care
c. Increase efficiency
d. Reduce unwarranted variation in services
e. Increase positive outcomes
f. Enhance patient satisfaction
g. Promote proper utilization of health care services
h. Diminish economic burden through prevention & promotion of health, wellness, fitness initiatives
Four Categories of Practice Patterns

1.
2.
3.
4.
1. Musculoskeletal = 4
2. Neuromuscular = 5
3. Cardiovascular = 6
4. Integumentary = 7
Which practice pattern?
Which practice pattern?
Musculoskeletal = 4
Which practice pattern?
Which practice pattern?
Cardiovasuclar = 6
Which practice pattern?
Which practice pattern?
Musculoskeletal = 4
Which practice pattern?
Which practice pattern?
Integumentary
Which practice pattern?
Which practice pattern?
Neuromuscular
Musculoskeletal = 4

Key Areas
A: Primary Prevention/Risk Reduction ...
B: Impaired Posture
C: Impaired Muscle Performance
D: Impaired Joint Mobility, Motor Function, Muscle Performance, & Range of Motion Associated With Connective Tissue Dysfunction
E: With Localized Inflammation
F: With Spinal Disorders
G: With Fracture
H: With Joint Arthroplasty
I: With Bony or Soft Tissue Surgery
J: With Amputation
Neuromuscular = 5

Key areas
A: Primary Prevention/Risk Reduction ...
B: Impaired Neuromotor Development
C: Congenital Origin or Acquired in Infancy or Childhood
D: Acquired in Adolescence or Adulthood
E: Impaired Motor Function & Sensory Integrity Associated with Progressive Disorders of the Central Nervous System
F: Associated with Peripheral Nerve Injury
G: Associated with Acute or Chronic Polyneuopathies
H: Associated with Nonprogressive Disorders of the Spinal Cord
I: Associated with Coma, Near Coma, or Vegetative State
Cardiovascular/Pulmonary = 6

Key areas
A: Primary Prevention/Risk Reduction ...
B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning
C: Assoc. w/ Airway Clearance Dysfunction
D: Assoc w/ Cardiovascular Pump Dysfunction or Failure
E: Assoc w/ Ventilatory Pump Dysfunction or Failure
F: Assoc w/ Respiratory Failure
G: Assoc. w/ Respiratory Failure in the Neonate
H: Assoc. w/ Lymphatic System Disorders
Integumentary = 7

Key areas
A: Primary Prevention/Risk Reduction for Integumentary Disorders
B: Superficial Skin Involvement
C: Partial-Thickness Skin Involvement and Scar Formation
D: Full-Thickness Skin Involvement and Scar Formation
Contents of each pattern = ?

(hint: five elements of client/patient management)
1. Examination
2. Evaluation
3. Diagnosis
4. Prognosis
5. Intervention (including plan)
Additional to client/patient management
1. Re-evaluation
2. Global outcome
3. f. Criteria for Termination of PT Services
Contents of each pattern
a. Patient/Client Diagnostic Classification
i. Criteria
1. Inclusion
2. Exclusion
3. Multiple-pattern classification
Examples of Examination
1. Muscle strength: Right quadriceps + hamstrings are normal
2. Heart rate
3. Surgical history
4. Transfers: bed to/from chair with minimal assistance
5. ROM of shoulder 140 degrees
6. Blood pressure 143/78
7. Reflexes: left achilles not elicited, right normal
8. Medications
9. Patient reports left knee pain that has gradually worsened over time
Examples of Evaluation
1. After completing the med history, the patient has impaired balance and motor function that limits ability to complete household functions
2. Patient requires assistance for transfer, gait and activities of daily living due to pain and edema
3. Problem list: impaired joint mobility, pain, impaired coordination; functional limitations - limitations in leisue activities and self-care
Examples of Diagnosis
1. abnormality of gait
2. lumbar extension and rotation syndrome
Examples of Prognosis
1. Good
2. Goals: Balance will be in normal limits in unsupported sitting and standing in 1 week
3. Plan: Recommended PT 2x/wk for 5 weeks
4. The patient requires skilled PT to address limitations of UB strength to improve ability to reach cupboards
5. Goal: 2 weeks, patient will walk 60 feet w/o assistance or loss of balance
6. Fair due to patient's co-morbidities of diabetes and Alzheimers
Examples of Intervention
1. Patient completed therapeutic exercise of upper extremities in sitting with 3# weights
2. Ultrasound was completed on the left forearm for 5 mins., 1 mHz, 1.3 W/cm2
3. Patient completed transfer training to increase patient independence with getting out of a chair
ICF
1. International Classification of Functioning, Health and Disability
2. Focuses on Function
Function = ?
Refers to all body functions, activities and participation
Disability
Activity limitations
3 ways ICF can be used?
1. Assessment of the individual
2. Individual treatment planning
3. Evaluation of treatment and other interventions
ICF
1. Institutional level
2. Social level
1. Institutional level
a. educational training
b. resource planning
c. quality improvement

2. Social
a. needs assessment
b. eligibility criteria
c. social policy development
3 examples of environmental factors that influence how disability is experienced by the individual
1. social attitudes
2. architectural characteristics
3. legal and social structures
Name 3 examples of personal factors that influence how disability is experienced by the individual
1. gender
2. age
3. coping styles
Name 2 broad categories of interventions for activity limitations
1. difficulty ascending stairs
2. unable to lift a gallon of milk
Name two broad categories of interventions for participation restrictions
1 Inability to maintain job
2. Inability to care for child