ITEM 7. The Physical Therapy Process.pptx

UNIT 7: THE PHYSICAL THERAPY PROCESS Foundations of Physiotherapy D. Pedro Vega Moreu Sports and Invasive Physiotherapy Specialist [email protected] The physical therapy proces Personal + Filiation Data History Taking Physical Examination Evaluation Functional Status EVALUATE CHANGES REA...

UNIT 7: THE PHYSICAL THERAPY PROCESS Foundations of Physiotherapy D. Pedro Vega Moreu Sports and Invasive Physiotherapy Specialist [email protected] The physical therapy proces Personal + Filiation Data History Taking Physical Examination Evaluation Functional Status EVALUATE CHANGES REASSESMENT Physical Therapy Diagnosis Treatmen t Plan Treatmen t Objectives 2 3 The Physical Therapy process • Dynamic Purpose: achievement of objectives • Process for achieving an efficient and individualized physiotherapy program The Physic al Therap y proces s Is based on clinical reasoning: “The thinking and decision-making processes that are used in clinical practice” “A process in which the therapist, interacting with the patient and others (such as family members), helps and create health management strategies based on clinical data, patient choices, professional judgment and scientifical knowledge” 4 Clinical reasoning: Hypothetico-deductive model + SC IENT IFIC + EM PYRI C + CO M SENS MON E-INT UITIV E + LO GICA L CLINICAL REASONING 5 COGNITION Cognition is the set of all mental abilities and processes related to knowledge: - Attention - Memory & working memory - Judgement & evaluation - Reasoning & "computation“ - Problem solving & decision making - Comprehension & production of language, etc. 6 Metacognition literally means cognition about cognition, or more informally, thinking about thinking. METACOGNITION Metacognition as knowledge about cognition and control of cognition. For example, a person is engaging in metacognition if he notices that he is having more trouble learning A than B 7 Filiation + Personal Data 8 Filiation and Personal Data 8 – – – – – – – – – Name and surname Age and Gender Nationality DNI-NIF (ID) Address - Telephone Health insurance Occupation Civil status Religion ATTENTION: Organic Law 03/2018, of December 5, Protection of Personal Data (PPDL). Law 41/2002, of November 14, basic regulatory of the autonomy of the patient and of rights and obligations in matters of information and clinical documentation. CONFIDENTIALITY AND LEGAL PROPERTY DOCUMENT + INFORMED CONSENT 10 History taking Anamnesis 8 History taking • Sources of information: • Patient • Family • Previous medical record • Other (O.T., psychologist, nurse...) • Subjective data 9 SPECIAL CASES KIDS Neurological impairments Physcological communication impairments 13 ANAMNESIS • • Reason for coming Temporalization • • • • • • • • • • Medical diagnosis Previous treatments Pharmacology Image Probes Family/genetic Antecedents Accidents/Trauma Surgeries Visceral Patologies Nearby structure problems • • • • • • • Physical activity type / level Hours seated Hours stand up Carrying objects Hours and quality of sleep Nutritional habits Toxical Habits Anxiety/stress levels 14 PAIN 15 16 Subjective data. Symptoms • Pain: “An unpleasant sensory and emotional experience associated with current or potential tissue damage, or described in terms of such “Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. ” 17 •BEGINNING AND DEVELOPMENT •INTENSITY •TYPE •AREA •INCREASE •DECREASE •TEMPORAL DISTRIBUTION 18 19 Chronic VS Acute 13 OTHER SYMPTOMS • STRENGHT • MOVEMENT – QUALITY AND QUANTITY • PARESTHESIA • FATIGUE • MOTOR CONTROL • SENSIBILITY • … 21 Physical Examination 22 Objective data: physical examination • 1. Functioning and disability. • 2. Visual: observation – Posture, gait… • 3. Manual: – Surface palpation and movilization… • 4. Instrumental: – Range of movement, strenght, balance… 23 Functioning and Disability Questionnaires 24 25 VISUAL 26 VISUAL 27 VISUAL 28 Gait cycle VISUAL •ABNORMAL GAIT CYCLES: •1. Hemiplegic •2. Parkinsonian gait •3. Cerebellar or Ataxic •4. Cerebral Palsy •5. Peripheral sensitive nerves affection (proprioception) Stomping. •6. Peripheral motor nerves affection (equine gait) •5. Miopathy •6. Antalgic 29 Manual examination • Palpation –Detect altered tissue texture/temperature. –Assess symmetry of structures. –Detect tender structures / reproduction of patient´s pain. –Assess the evolution of all the previous aspects. • Tissue mobilization: to check the mechanical properties of soft tissue. Extensibility, elasticity, thickness, mobility… • Joint mobilization: Osteokinematic / Arthrokinematic. 19 MANUAL Palpatory Anatomy 31 MANUAL Tissue and Joints Mobilization 32 Daniels Scale • 0 = No muscle response. • 1 = The muscle performs a visible or palpable contraction although no evidence of movement. • 2 = The muscle performs all movement without gravity and without resistance. • 3 = The muscle performs all movement against gravity and without resistance . • 4 = Movement is possible in all its amplitude, against the action of gravity and against moderate manual resistance. • 5 = The muscle supports a maximum manual resistance and movement is possible in all its amplitude, against gravity. 33 MANUAL Orthopedic Tests 34 MANUAL VASCULAR, NEUROLOGICAL… TESTS 35 Instrumental examination 20 21 22 Ultrasound imaging https://www.youtube.com/watch?v=tYXXUufufGM 39 Algometer 40 2 3 The patient is the main source of relevant information Complete and detailed collection of data when possible Objective and subjective data complement each other Physical therapy diagnosis “The professional opinion of a therapist about the health status of a patient taking into consideration the underlying pathological process and based on referral data, data from history, data from physical examination and additional medical and psychosocial data” Heerkens YF 42 CIF Structure • Body Functions (b) • Body Structure (s) Description of Impairments Description of disability • Activity & Participation (d) • Environmental Factors (e) Description of Handicap Description of Barriers and facilitators 43 44 45 46 47 Physical therapy diagnosis Cause Manifestations Problem IDEAL: FOCUS ON THE CAUSE 26 Formulation of treatment plan 27 Formulation of treatment plan • Organized, individualized objectives-oriented • State priorities (1st acts daily living…) • Goals: short-term / longterm • Choose techniques and methods 26 Short Term Term 72h. Day 4-15 Long Day 16 - 60 51 Physical Therapy Treatment 30 Physical Therapy Treatment • Applicatio n of the treatment 53 Reevaluatio n 32 ¿EFFECTIVE TREATMENT? YES END? NO -REVIEW EACH STAGE -FIND THE ERROR -MODIFY THE PLAN 33 34 57