Clinical Reasoning & Decision Making

what is a multidimensional, non-linear cognitive process w/ 3 key parts?

clinical reasoning

what are the 3 key parts of clinical reasoning?

synthesis, collaboration, integration

clinical reasoning utilizes integration of information, task, and the

environment in which they need to do it

in terms of the ICF model, what is an execution of a task (must do)?

activities

in terms of the ICF model contextual factors; what is the physical, social, & attitudinal ‘area’ of a person?

environmental factors

pt/client mgmt starts w/ exam where clinician needs to identify the impairments, activity limitations, participation restrictions, and as well as

resources available to determine most appropriate intervention

the three main parts of the exam is

history, systems review, tests and measures

exam history taking has 2 components

medical record and interviews

interviewing during exam history taking helps to develop

rapport, trust, & open communication

what is a strategy to get more information from the pt’s caregiver?

do you mind if I clarify a couple of things with….

what are important questions to ask during history taking?

AD use, bathroom use/adaptation, home support, PLOF, falls, transportation, hospitalization/prior care

(does anyone live with you?), (did you have help before?), (have you noticed any changes in your thinking/communication skills?), (have you noticed any changes in your vision?), (what’s hard for you right now?)

A systems review following the interview from an eval should include

orientation awareness, CN testing, motor function, sensory function, reflexes, emotional status, communication, cardiorespiratory status, general physical function, skin integrity

the two strategies involved for tests and measures of the examination are Impairments → Functional performance or Functional performance → Impairments. Impairments must be done first in which setting?

inpatient setting

after going thru the exam continue on with evaluation which is the

decision making piece, formulates future steps (assessment)

Pt/Client Mgmt: Diagnosis - Collect, evaluate & categorize data according to a classification scheme. Typically includes

level of impairment, activity limitation, & participation restrictions

What is a predicted optimal level of improvement in function & amount of time needed to reach that level?

Generally very complicated in individual w/ neurologic dysfunction. Knowledge of recovery patterns is helpful. Important to determine “rehab potential”

prognosis

what are the 4 main components of the plan of care?

Goals & expected outcomes

Prognosis

Interventions (education)

Anticipated discharge plans

in terms of outcomes, after every session you must think

What is better?

What is not getting better?

What needs to be changed?