Lecture 2 (part 2)

kms013's version from 2016-01-31 04:05


Question Answer
What is evaluation?encompasses the entire interaction with the pt, during which the clinican is trying to understand clearly the pts problem, both from the pt (hx) and clincians (examination) perspective
What is examination?refers to the procedures the clinician uses to observe, test, measure, etc. specific phyiscal fx
dx in PT is only a matter of apply....anatomy
The Guide definition: A cluster of s/s, syndromes, or categories which includes: Evaluating, organizing, INTERPRETING!
Medical Dxcomparison of sx of similar diseases and medical diagnostics (lab, imaging etc) so that a correct assessment is made = PATHOLOGY
PT dxcomparison of neuro and MS s/s to ID mvmt dysfx
limitation of medical/surgical dx in PT....tells you what you can't do...doesn't tell you what TO do
What does medical dx treat? How?pathology; restoring anotomy and eliminating p! (due to abnormal anatomy)
what does PT dx treat? How?mvment dysfx; addressing impairments (i.e. what is causing the mvmt dysfx) like p!, swelling, posture/habits, mobility (hypo/hyper), Stability/weakness, NM/motor control, balance, deconditioning/endurance; return to fx ASAP
what is a differential dx?process of listing 2 or more dx w similar sx that might be causing the pts complaint
_____ before ______Horses before zebras (think about the common problems first)--- differential dx
Why differential dx?medical problems (systemic disease) can mimick MS problems
for diff dx, you want to ID MS pathology and treat specifically, but you also want to investigate and recognize what kinds of problems?problems beyond the expertise of a PT and rule these out to make sure you aren't missing anything (DIRECT ACCESS)
How do you know the diff if its MS or a red flag?if you can recreate their sx with our tests, its most likely MS problem. If we can't recreate it or if we ID it as Red flag criteria, it may not be a MS problem
Start with _____ problems at the top of the list (diff dx)common (horses, NOT zebras)..NOTE: have to have evidence/reason for the problem included in the diff dix list
what do you do to rule in/out diff dx?objective tests and measures
what are the 4 keys to the diagnostic process?SOAP, hypothesis generating and testing, Heuristic search, pattern-recognition
HOACHypothesis Oriented Algorithm for Clinicans
Expert clinicans generate _____ early and ______ as they go alonghypothesis, modify (expert clinicans do less examination)
General steps to the HOAC evaluation process1. generate working hypothesis about the problem(s) by correlating and interpreting findings of hx/examination to determine PT Dx (or consult/refer if cannot generate a hypothesis) 2. Plan re-eval methods (dates, re-evals), 3. Plan tx strategy based on hypo 4. Plan tactics to implement strategy (tx plan specifics), 5. implement tactics (perform tx) and document 6. Re-assess and readvise tx strategy PRN, 7. Discharge if/when goals are met
HOAC evaluationg process (flow chart)working hypothesis & diff dx (hx/subj), --->rule in/out diff dix (physical examination) -->PT dx/mvmt dysfx ---> treatment ---> reassessment
Everything starts with inital collection of data. Your first view of pt is....Chart review, Referral (script), Intake form/Eval paperwork, Interview (Subjective-- pt hx)
Establishing goals for the patient should tie back toMeasurable, functional, temporal component (hardest part)
Most patients will rank the importance of their desired outcomes along a continuum. (Regain self care activities, return to work, performing leisure activities.
CP: ____ should end with patients resuming all the activities that they have deemed to be important.Pt centered tx. (This is why goals have to be realistic.)
Why do we do a physical exam?Collect more data, once we know what the patient can't do (activity/functional limitations) we need to figure out why they can't (impairment). > Physical exam
If no hypothesis can be generated...Refer to other practitioner (not PT issue or red flags), or consult with other practitioner (partial PT issue, lack of expertise.)
Once we have collected data, are the goals viable? If yes, get to gettin; if no, modify (not held to initial opinion.)
Why do we have to plan re-evals/reassessment? Methodology, dates
Plan ___ based on diagnosis.Treatment strategy (consult if necessary) ---> example: decreased back pain by increasing stability (treatment classification based on S&S based on clinical practice guidelines, clinical experience, clinical judgment/reasoning
Treatment strategy must consider....the dimension of rehab.
What are dimensions of rehab?What conditions are responsible for the movement dysfunction, and are they reversible. If reversible what would be the most appropriate means of intervening therapeutically so as to affect these conditions, and if the conditions at fault appear irreversible, what can be done to optimize residual function.
Plan tacticsspecifics of your treatment strategy (based on rehab dimension.) Example: decrease back pain by increasing stability (specific tactics ---> bracing, taping, manual therapy, HEP)
Implement tacticsEvidence guided help, clinical practice guidelines, clinical prediction rules (CPR ---> changing the way we practice, if patients fit this picture do this specific treatment as a minimum), experience.
Continued reassessment: if pt is improving, continue to progress treatment plan toward improving function: single joints ---> ____ Low volume --->Movement patterns, increased volume
Three outcomes of continued reassessment:Pt improving, pt not improving --> status quo/getting worse, pt improved ---> goals met (discharge, must have HEP/lifestyle change for permanent fix)
Continually observe, evaluate, and think critically (four keys).Continually test your PT diagnosis, compare current measurements to baseline (IE), continually critique your chosen interventions and ask yourself, "Is this the best thing for my patient at this time." Always consider the progression of treatment and continue to challenge the patient, ultimately preparing the patient for return to activities.
Just because a persons problem is not fixable....does not mean the problem cannot be alleviated or improved through a therapist's intervention (we're in the improving/increasing function business.)

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