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74 Cards in this Set
- Front
- Back
Disablement Models (classified in guide to PT practice)
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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 |
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Disablement Models
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a. Nagi Scheme
b. International Classification of Functioning, Disability and Health (ICF) i. Was previously “International Classification of Impairments, Disabilities, and Handicaps” |
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Nagi Model
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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 |
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Nagi Model
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a. Describes process of disablement
b. Focuses on impairments not functioning |
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Pathology/Pathophysiology
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a. Primarily identified at cellular level
b. Usually physician’s diagnosis |
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Impairments
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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 |
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Functional Limitations
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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 |
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Disability
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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? |
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ICF
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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? |
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Health Condition (same as diagnosis on disease model)
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a. Similar to pathology
b. Disorder, disease, injury, trauma or congenital anomaly c. Examples: i. Spinal injury ii. Diabetes |
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Body Functions (Nagi – Impairment) = SOMETHING ISN’T WORKING RIGHT
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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 |
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Body Structures = SOMETHING IS MISSING
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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 |
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Impairments
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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 |
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Activity Limitations
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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 |
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Participation
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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 |
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Participation Restrictions
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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 |
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Capacity (EQUALS POTENTIAL) and Performance
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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 |
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23. Environmental Factors
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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 |
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Personal Factors
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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 |
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Nagi versus ICF
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Nagi versus ICF
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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 |
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ICF Model Example
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ICF Model Example
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Scope of PT Practice
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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 |
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Physical Therapist Roles
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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 |
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Primary Care
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“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.”
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Secondary Care
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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 |
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Tertiary Care (in environment – not referred)
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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 |
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Other Professional Roles of the PT
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a. Consultation
b. Education c. Critical Inquiry d. Administration e. Professional Organization |
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Five Elements of Patient/Client Management
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a. Examination
b. Evaluation c. Diagnosis d. Prognosis (Including the Plan of Care) e. Intervention |
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Examination
1. 2. 3. |
1. History
2. Systems Review 3. Tests and Measures |
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Examination - History
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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 |
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Examination - Systems Review
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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 |
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Examination - Tests and Measures
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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 |
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Examination - Tests and Measures
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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 |
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Evaluation
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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 |
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Diagnosis – What it is
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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 |
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Prognosis and Plan of Care – What we’re going to do about it
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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 |
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Intervention
1. 2. 3. 4. |
1. The plan
2. Coordination, Communication and Documentation 3. Patient related instruction 4. Procedural interventions |
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Intervention - The plan
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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 |
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Intervention - Coordination, Communication and Documentation
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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 |
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Intervention - Patient-Related Instruction
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Process of informing, educating, training patients, families, significant others, caregivers to promote and optimize PT services
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Intervention - Procedural Interventions
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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 |
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Reexamination
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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 |
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42. Termination of PT Services (discharge)
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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 |
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Discontinuation: process of ending PT services that have been provided during a single episode of care when
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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 |
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Practice Patterns
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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 |
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Goals of Practice Patterns
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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 |
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Four Categories of Practice Patterns
1. 2. 3. 4. |
1. Musculoskeletal = 4
2. Neuromuscular = 5 3. Cardiovascular = 6 4. Integumentary = 7 |
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Which practice pattern?
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Musculoskeletal = 4
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Which practice pattern?
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Cardiovasuclar = 6
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Which practice pattern?
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Musculoskeletal = 4
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Which practice pattern?
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Integumentary
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Which practice pattern?
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Neuromuscular
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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 |
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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 |
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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 |
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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 |
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Contents of each pattern = ?
(hint: five elements of client/patient management) |
1. Examination
2. Evaluation 3. Diagnosis 4. Prognosis 5. Intervention (including plan) |
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Additional to client/patient management
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1. Re-evaluation
2. Global outcome 3. f. Criteria for Termination of PT Services |
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Contents of each pattern
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a. Patient/Client Diagnostic Classification
i. Criteria 1. Inclusion 2. Exclusion 3. Multiple-pattern classification |
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Examples of Examination
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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 |
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Examples of Evaluation
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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 |
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Examples of Diagnosis
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1. abnormality of gait
2. lumbar extension and rotation syndrome |
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Examples of Prognosis
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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 |
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Examples of Intervention
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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 |
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ICF
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1. International Classification of Functioning, Health and Disability
2. Focuses on Function |
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Function = ?
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Refers to all body functions, activities and participation
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Disability
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Activity limitations
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3 ways ICF can be used?
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1. Assessment of the individual
2. Individual treatment planning 3. Evaluation of treatment and other interventions |
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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 |
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3 examples of environmental factors that influence how disability is experienced by the individual
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1. social attitudes
2. architectural characteristics 3. legal and social structures |
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Name 3 examples of personal factors that influence how disability is experienced by the individual
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1. gender
2. age 3. coping styles |
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Name 2 broad categories of interventions for activity limitations
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1. difficulty ascending stairs
2. unable to lift a gallon of milk |
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Name two broad categories of interventions for participation restrictions
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1 Inability to maintain job
2. Inability to care for child |