OUR LADY OF FATIMA UNIVERSITY

College of Physical Therapy

A N T I P O L O C AM PU S

EVALUATION AND EXAMINATION IN PHYSICAL

THERAPY (EEPT211)

ELEMENTS OF PHYSICAL
THERAPY PROCESS
Ira Alyssa C. Lastimosa, PTRP
LEARNING OBJECTIVES – 2 WEEK
ND

At the end of the session, students must be

able to:
• Apply each element of Physical Therapy
Process in assessing & evaluating a
hypothetical case
TOPIC OUTLINE
•Physical Therapy Practice
•Physical Therapy Process
•Patient/Client Management
PHYSICAL THERAPY PRACTICE
• Physical therapists are health care professionals
who help patients/clients maintain, restore, and
improve movement, activity, and functioning, thereby
enabling optimal performance and enhancing health,
well-being, and quality of life.
• Their services prevent, minimize, or eliminate
impairments of body functions and structures,
activity limitations, and participation restrictions
PHYSICAL THERAPY PROCESS
• Provides a framework for practice
• Provides a common language and
framework for clinical instruction
• Implements a common approach to
measuring outcomes for documenting
effectiveness
• Develops research hypotheses
• Educates external community and
payers
PT Practice: Patient/Client Management (APTA,2001)
PT Practice: Patient/Client Management (APTA,2001)
PT Practice: Patient/Client Management (APTA,2016)
PATIENT/CLIENT MANAGEMENT MODEL
The management model is applied for purposes
of rehabilitation, habilitation, the maintenance of
health or function, the prevention of functional
decline, and, in healthy persons, and the
enhancement of performance.
 PATIENT VS CLIENT
PATIENT CLIENT

is a person or animal is a customer, a buyer

who receives treatment or receiver of goods or
services
from a doctor or other
medically educated
person
I. EXAMINATION
• Initial Examination is a comprehensive
screening and specific testing process leading to
diagnostic classification and/or, as appropriate,
to a referral to another practitioner
• Involves identifying and defining the patient’s
problem(s) and the resources available to
determine appropriate intervention.
I. EXAMINATION
• Components:
a. Patient/client history
b. Systems review
c. Tests and measures
a. PATIENT/CLIENT HISTORY
• Symptom investigation
• Past medical history
• Current health status
• Social history
• Identification of patient expectations and
desired outcomes
a. PATIENT/CLIENT HISTORY
• INTERVIEW - is an important tool used to obtain
information and gain understanding directly from the
patient
• general health, past and present medical
conditions/complications, and treatment
• current problems, primary complaint (reason for
seeking physical therapy), and anticipated
goals/expected outcomes
• patient’s social and physical environment, vocation,
recreational interests, health habits (e.g., smoking
history, alcohol use), exercise likes and dislikes, and
frequency and intensity of regular activity.
b. SYSTEM REVIEW
• General health of patient
• Identification of possible health problems
requiring consultation and/or referral to other
providers
• Physiologic status of musculoskeletal,
neuromuscular, cardiopulmonary, and
integumentary conditions
• May include ability to communicate, affect,
cognition, language, and learning style
WHY DO WE NEED SYSTEM REVIEW?
• Confirm the need for further or more detailed
examination
• Rule out or differentiate specific system
involvement
• Determine if referral to another health care
professional is warranted (triage)
• Focus the search of the origin of symptoms to a
specific location or body part
CONSULTATION
• Is appropriate if the needs of
the patient/client are
outside the scope of the
expertise of the therapist
assigned to the case
SCREENING EXAMINATION
• May involve observation, chart review, oral
history, and/or a brief examination
• For healthy population, pediatric, geriatric,
athletes, working adults
c. TEST AND MEASURES
• Including a screening of the musculoskeletal,
neuromuscular, cardiovascular/pulmonary, and
integumentary systems
• During the examination, assessment is defined
as the measurement or quantification of a
variable or placement of a value on a behavior
CATEGORIES Barriers
• Aerobic Capacity/Endurance • Ergonomics and Body
• Anthropometric Mechanics
Characteristics • Gait, Locomotion, and
• Arousal, Attention, and Balance
Cognition • Integumentary Integrity
• Assistive and Adaptive • Joint Integrity and Mobility
Devices • Motor Function (Motor
• Circulation (Arterial, Venous, Control and Motor Learning)
Lymphatic) • Muscle Performance
• Cranial and Peripheral Nerve (Including Strength, Power,
Integrity and Endurance)
• Environmental, Home, and
Work (Job/School/Play)
• Neuromotor Development Activities of Daily Living
and Sensory Integration and Instrumental
• Orthotic, Protective, and Activities of Daily Living)
Supportive Devices • Sensory Integrity
• Pain • Ventilation and
• Posture Respiration/Gas
Exchange
• Prosthetic Requirements
• Work (Job/School/Play),
• Range of Motion Community, and Leisure
(Including Muscle Length)
• Integration or
• Reflex Integrity Reintegration (Including
• Self-Care and Home Instrumental
Management (Including • Activities of Daily Living)
WHY DO WE NEED TO CONDUCT THESE?
• To make the diagnosis
• To determine the needs of the patient/client
• To know whether the patient/client would
benefit from physical therapy
• For selection of interventions
• For development of the plan of care
• For progression of the patient/client
II. EVALUATION
• A synthesis of all of the data and findings gathered
from the examination
• Collaborative decision-making with the patient/client
• Process leads to documentation of impairments,
functional limitations, and disabilities
• Guides the physical therapist to a diagnosis and
prognosis for each patient/client
DO PTs DIAGNOSE?

- APTA, 2011
III. DIAGNOSIS
• A label encompassing a cluster of signs related to
impairments of the four systems of the body
(musculoskeletal, neuromuscular, cardiopulmonary,
and integumentary).
• Indicates level of impairment, activity limitation and
participation restriction determined by the PT.
• May be indicated by selecting one or more preferred
practice patterns from the Guide to Physical Therapist
Practice
MEDICAL DX VS PT DX
MEDICAL DX PT DX
• refers to the identification • to “identify the impact of a
of a disease, disorder, or condition on function at
condition (pathology/ the level of the system
pathophysiology) by (especially the movement
evaluating the presenting system) and at the level of
signs, symptoms, history, the whole person”
laboratory test results,
and procedures
EXAMPLE
• Medical diagnosis: Cerebrovascular accident
(CVA)
• Physical therapy diagnosis: Impaired motor
function and sensory integrity associated with
non-progressive disorders of the central
nervous system—acquired in adolescence or
adulthood
EXAMPLE
• Medical diagnosis: Spinal cord injury (SCI)
• Physical therapy diagnosis: Impaired motor
function, peripheral nerve integrity, and sensory
integrity associated with non-progressive
disorders of the spinal cord
PATTERNS
1. Musculoskeletal Patterns
2. Neuromuscular Patterns
3. Cardiovascular/Pulmonary Patterns
4. Integumentary Patterns
MUSCULOSKELETAL PATTERNS
• A. Primary Prevention/ Risk Reduction for Skeletal
Demineralization
• B. Impaired Posture
• C. Impaired Muscle Performance
• D. Impaired Joint Mobility, Motor Function, Muscle
Performance, & ROM Associated with CTD
• E. Impaired Joint Mobility, Motor Function, Muscle
Performance, & ROM Associated with Localized
Inflammation
• F. Impaired Joint Mobility, Motor Function, Muscle
Performance, ROM & Reflex Integrity Associated with
Spinal Disorders
MUSCULOSKELETAL PATTERNS
• G. Impaired Joint Mobility, Motor Function, Muscle
Performance, & ROM Associated with Fracture
• H. Impaired Joint Mobility, Motor Function, Muscle
Performance, & ROM Associated with Joint
Arthroplasty
• I. Impaired Joint Mobility, Motor Function, Muscle
Performance, & ROM Associated with Bony or Soft
Tissue Surgery
• J. Impaired Joint Mobility, Motor Function, Muscle
Performance, ROM, Gait, Locomotion, & Balance
Associated with Amputation
NEUROMUSCULAR PATTERNS
• A. Primary Prevention/Risk Reduction for Loss of
Balance & Falling
• B. Impaired Neuromotor Development
• C. Impaired Motor Function & Sensory Integrity
Associated with Non-progressive Disorders of the
CNS –Congenital Origin or Acquired in Infancy or
Childhood
• D. Impaired Motor Function & Sensory Integrity
Associated with Non-progressive Disorders of the
CNS-Acquired in Adolescence or Adulthood
NEUROMUSCULAR PATTERNS
• E. Impaired Motor Function & Sensory Integrity
Associated with Progressive Disorders of the CNS
• F. Impaired Peripheral Nerve Integrity & Muscle
Performance Associated with PNI
• G. Impaired Motor Function & Sensory Integrity
Associated with Acute or Chronic Polyneuropathies
• H. Impaired Motor Function, Peripheral Nerve Integrity
& Sensory Integrity Associated with Non-progressive
Disorders of the SC
• I. Impaired Arousal, ROM, & Motor Control Associated
with Coma, Near Coma, or Vegetative State
CARDIOVASCULAR/PULMONARY PATTERNS
• A. Primary Prevention/ Risk Reduction for CV/P
Disorders
• B. Impaired Aerobic Capacity/ Endurance
Associated with Deconditioning
• C. Impaired Ventilation, Respiration/ Gas
Exchange & Aerobic Capacity/ Endurance
Associated with Airway Clearance Dysfunction
• D. Impaired Aerobic Capacity/ Endurance
Associated with Cardiovascular Pump
Dysfunction or Failure
CARDIOVASCULAR/PULMONARY PATTERNS
• E. Impaired Ventilation, Respiration/Gas
Exchange Associated with Ventilatory Pump
Dysfunction or Failure
• F. Impaired Ventilation, Respiration/Gas
Exchange Associated with Respiratory Failure
• G. Impaired Ventilation, Respiration/Gas
Exchange & Aerobic Capacity/Endurance
Associated with Respiratory Failure in the
Neonate
CARDIOVASCULAR/PULMONARY PATTERNS
• H. Impaired Circulation & Anthropometric
Dimensions Associated with Lymphatic System
Disorders
• I. Impaired Aerobic Capacity, Muscle Performance,
Integumentary Integrity and Mobility Associated with
Peripheral Venous Disorders
• J. Impaired Aerobic Capacity, Muscle Performance,
Blood Flow In the Legs, Integumentary Integrity and
Mobility Associated with Peripheral Arterial Disorder
INTEGUMENTARY PATTERNS
• A. Primary Prevention/ Risk Reduction for
Integumentary Disorders
• B. Impaired Integumentary Integrity Associated with
Superficial Skin Involvement
• C. Impaired Integumentary Integrity Associated with
Partial-Thickness Skin Involvement & Scar Formation
• D. Impaired Integumentary Integrity Associated with
Full-Thickness Skin Involvement & Scar Formation
• E. Impaired Integumentary Integrity Associated with
Skin Involvement Extending Into Fascia, Muscle, or
Bone & Scar Formation
IV. PROGNOSIS
• “The predicted optimal level of improvement in
function and amount of time needed to reach
that level.”
• Conveys the physical therapist’s professional
judgment for the patient’s/client’s predicted level
of improvement that might be attained through
intervention and the amount of time required to
reach that level.
PLAN OF CARE (POC)
• Outlines anticipated patient management
• Producing meaningful changes at the
personal/social level by reducing activity
limitations and participation restrictions
PLAN OF CARE
ESSENTIAL COMPONENTS:
1. Anticipated goals and expected outcomes
2. The predicted level of optimal improvement
3. The specific interventions to be used, including
type, duration, and frequency
4. Criteria for discharge
 1. GOALS AND EXPECTED OUTCOMES
•An important first step in the development
of the POC
V. INTERVENTION
• Purposeful interaction with the patient/client.
• Consistent with the diagnosis and prognosis.
• Decisions about interventions are contingent upon
the regular and timely monitoring of patient/client
response.
• Progression are made toward achieving the
anticipated goals and expected outcomes.
Physical therapist interventions
include, but are not limited to:
• Therapeutic exercise • Prescription, application, and,
as appropriate, fabrication of
• Training in self-care
devices and equipment
• Home management
• Airway clearance
• Work (job/school/play) • Integumentary repair and
• Community integration and protection technique
reintegration • Electrotherapeutic modalities
• Manual therapy (including • Physical agents
mobilization/ manipulation) • Mechanical modalities
V. INTERVENTION
Three (3) components of Intervention:
a. Direct/Procedural Intervention
b. Patient Related Instructions
c. Coordination, Communication, &
Documentation
a. DIRECT/PROCEDURAL INTERVENTION
•Is used to determine core interventions,
including therapeutic exercise and
functional training.
•Restorative VS Compensatory VS
Preventive
a. DIRECT/PROCEDURAL INTERVENTION
• Restorative interventions - directed toward
remediating or improving the patient’s status in
terms of impairments, activity limitations,
participation restrictions, and recovery of function.
• Compensatory interventions - are directed toward
promoting optimal function using residual abilities.
• Preventative interventions - are directed toward
minimizing potential problems (e.g., anticipated
indirect impairments, activity limitations, and
participation restrictions) and maintaining health
b. PATIENT RELATED INSTRUCTIONS
• Is providing education on current condition,
resources, plan of care, and future transitions.
c. COORDINATION, COMMUNICATION,
AND DOCUMENTATION
• Means providing services to ensure comprehensive
and cost-effective care and efficient integration to
home and community
DOCUMENTATION
• Is any entry into the patient/client health
record—such as consultation reports, initial
examination reports, progress notes, flow
sheets, checklists, reexamination reports, or
summations of care—that identifies the care or
service provided and the patient/client
response to that care or service.
APPROPRIATE DOCUMENTATION OF PHYSICAL
THERAPY SERVICES IS CRUCIAL BECAUSE IT:
1. Serves as a record of
patient/client care, including a
report of patient/client status,
physical therapist management,
and outcome of physical therapy
intervention; serves as a tool for
the planning and provision of
services; and serves as a
communication vehicle among
providers.
APPROPRIATE DOCUMENTATION OF PHYSICAL
THERAPY SERVICES IS CRUCIAL BECAUSE IT:
2. Informs others about
physical therapists’
abilities and unique body
of knowledge and about
the services provided by
physical therapists and
physical therapist
assistants.
APPROPRIATE DOCUMENTATION OF PHYSICAL
THERAPY SERVICES IS CRUCIAL BECAUSE IT:
3. May be used to
demonstrate compliance
with federal, state, payer,
and local regulations
APPROPRIATE DOCUMENTATION OF PHYSICAL
THERAPY SERVICES IS CRUCIAL BECAUSE IT:
4. Provides an historical
account of patient/client
encounters that can be
used as evidence in
potential legal situations.
APPROPRIATE DOCUMENTATION OF PHYSICAL
THERAPY SERVICES IS CRUCIAL BECAUSE IT:
5. May be used to
demonstrate appropriate
service utilization and
reimbursement for many
third-party payers.
APPROPRIATE DOCUMENTATION OF PHYSICAL
THERAPY SERVICES IS CRUCIAL BECAUSE IT:
6. May be used for policy
or research purposes,
including outcomes
analysis.
DISCHARGE PLANNING
• Initiated early in the rehabilitation process
during the data collection phase and intensifies
as goals and expected outcomes
• Initiated if the patient refuses further treatment
or becomes medically or psychologically
unstable
• Include the discharge prognosis (Excellent,
Good, Fair, Poor)
OUTCOME
• Outcomes may include minimization of
functional limitations and disability, optimization
of health status, prevention of disability, and
optimization of patient/client satisfaction.
References
• APTA (2001), Guide to Physical Therapy
• O’Sullivan, S., Schmidtz, T. & Fulk, G. (2014).
Physical Rehabilitation. 6th Ed. F.A. Davis
Company, Philadelphia, Pennsylvania