WK5: Clinical Specialities & Settings

What are Basic Activities of Daily Living (BADLs)?

BADLs (or ADLs) are essential self-care tasks required for basic daily functioning and hygiene, including bathing, dressing, eating, grooming, and toileting.

What is the main focus of the Physical Therapy Classification and Payment System (PTCPS)?

It shifts payment toward rewarding quality of care rather than quantity of care, while promoting the clinical judgment of the Physical Therapist (PT) and ensuring proper coverage for medically necessary services.

What are the primary treatment focus areas in Home Health physical therapy?

Treatment focuses on bed mobility, transfers, gait training (walking), establishing a Home Exercise Program (HEP), and evaluating the home for environmental safety.

Who are the primary stakeholders involved in healthcare delivery, and who is at the center?

The Patient is at the center. Surrounding the patient are Doctors, Nurses, Social Workers, the Rehabilitation Team, Caregivers, and Spiritual Leaders. Diagram showing the patient at the center surrounded by doctors, nurses, social workers, rehab team, caregivers, and spiritual leader

What is the International Classification of Functioning, Disability and Health (ICF)?

The ICF is a bio-psycho-social classification model created by the WHO (and endorsed by the APTA) that uses positive "enablement" terms to describe health, body functions, daily tasks, and social participation. Diagram of the ICF bio-psycho-social model linking health condition, body structure, activities, participation, and contextual factors

How did the older ICIDH model define a Disability?

A Disability was defined as any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal.

How did the older ICIDH model define a Handicap?

A Handicap was defined as a social disadvantage resulting from an impairment or disability that limits or prevents the fulfillment of a normal role (based on age, sex, and social/cultural factors).

What are Personal Factors in the ICF model?

Internal background traits unique to an individual that affect how disability is experienced:

• Age

• Gender

• Coping styles

• Education level

• Profession

• Past experiences

What is the first priority area of the Affordable Care Act (ACA)?

To make affordable health insurance available to more people, primarily through subsidies and health insurance marketplaces.

What are Contextual Factors in the ICF framework?

Contextual Factors represent the complete background of an individual's life and living environment. They are divided into Environmental Factors and Personal Factors.

What is Pediatric physical therapy?

A specialty focused on treating patients under age 18, requiring in-depth knowledge of child development, pediatric pathologies, and youth exercise guidelines.

What defines a Sub-Acute Rehab (Inpatient Rehab) setting?

Sub-Acute Rehab provides intensive, multidisciplinary rehabilitation in an inpatient facility for patients medically stable enough to leave acute hospital care but needing intensive therapy before going home.

What is Orthopedic physical therapy?

A specialty focused on evaluating and treating injuries, surgeries, or disorders of the musculoskeletal system (bones, joints, muscles, ligaments, and tendons).

What is an Activity Limitation in the ICF framework?

An Activity Limitation is a difficulty an individual experiences when trying to execute everyday tasks or functional movements.

What conditions are commonly treated in Women's Health physical therapy?

Pelvic floor dysfunction, chronic pelvic pain, urinary incontinence, and musculoskeletal issues related to pregnancy and postpartum recovery.

What is Patient-Centered Care?

Patient actively participates in planning, decision-making, and evaluating outcomes when establishing their Plan of Care (POC).

What are Social Determinants of Health (SDOH)?

Social Determinants of Health (SDOH) are the non-medical conditions and environmental surroundings where people are born, live, learn, work, and age that directly shape their health risks and overall health outcomes. Diagram showing various social determinants of health across different living domains

In the ICF model, what is an Impairment?

An Impairment is a problem, loss, or significant deviation in body function or anatomical structure (e.g., joint stiffness, muscle weakness, or paralysis).

What is the main focus of Sports physical therapy?

Rehabilitating athletic injuries and designing sport-specific exercise programs to safely return athletes to high-level athletic performance.

How does the ICF model classify a 20-year-old male with a spinal cord injury who has leg paralysis, cannot use snowy public buses, and cannot attend college sports games?

• Health Condition: Spinal cord injury

• Body Function/Structure Impairment: Muscle paralysis & inability to walk

• Activity Limitation: Inability to use public transit independently

• Environmental Trait: Snow & unaccessible wheelchair transport

• Participation Restriction: Inability to attend college sporting events ICF model example applying spinal cord injury to activity limitations, environmental traits, personal traits, and participation restrictions

What is a Skilled Nursing Facility (SNF)?

A SNF is a medical facility that provides 24-hour nursing care and rehabilitation services for patients who need skilled medical monitoring and recovery support.

What requirement must a patient meet to receive Home Health physical therapy?

The patient must be considered "homebound," meaning insurance requires that they are physically unable to leave home without physical assistance or major effort.

In the ICF model, how is Participation defined?

An individual's involvement in real-life situations and societal roles, including home management, employment, and community activities.

What are Instrumental Activities of Daily Living (IADLs)?

IADLs are complex life-management activities required to live independently in a community, such as house cleaning, preparing meals, shopping, and managing finances.

What is Geriatric physical therapy?

A subspecialty focused on older adults, addressing:

• age-related bodily changes

• fall prevention

• balance deficits

• chronic degenerative movement conditions

In ICF terminology, what is a Performance Qualifier?

A Performance Qualifier describes what an individual actually does in their current real-world environment, including any assistive devices (e.g., walker) or human assistance they routinely use.

What is a Participation Restriction in the ICF framework?

A Participation Restriction is any problem an individual experiences that limits their involvement in life situations, social roles, or community engagement.

What is the International Classification of Impairments, Disabilities, and Handicaps (ICIDH)?

The ICIDH is an older classification model created by the WHO in 1980 that categorizes disease consequences into three stages: Impairment, Disability, and Handicap. It is used to help develop Physical Therapy Diagnoses.

What are Environmental Factors in the ICF model?

Environmental Factors are external physical, social, and attitudinal surroundings in which people live—such as building accessibility, weather, public transportation, social attitudes, and family support.

In school-based physical therapy (ages 3-21), what plan guides a student's therapy goals?

An Individualized Education Program (IEP), created collaboratively by the PT, teachers, and school team to improve the student's function within the classroom and school environment.

Which social and personal factors fall under Social Determinants of Health (SDOH)?

1. Social support networks

2. Experience of discrimination (including healthcare discrimination)

3. Loneliness

4. Stress levels

5. Language/English proficiency

6. Spiritual or religious attendance.

What federal legislation guarantees special education and physical therapy services in schools?

The Individuals with Disabilities Education Act (IDEA) of 2004, which ensures children with disabilities receive a free appropriate public education tailored to their needs.

What is the Affordable Care Act (ACA), and when was it enacted?

• AKA “Obamacare” or PPACA; a comprehensive healthcare reform law designed to expand insurance access, lower medical costs, and improve healthcare delivery

• Enacted in March 2010

What defines an Acute Care physical therapy setting?

A hospital setting, providing short-term physical therapy to individuals admitted for urgent medical conditions, surgeries, or acute illnesses

In the ICF model, how is an Activity defined?

An Activity is the execution of a specific task or action by an individual (e.g., standing up from a chair or walking 50 feet).

During patient intervention, what data collection responsibility does a Physical Therapist Assistant (PTA) have?

The PTA must collect data on the patient's current condition (e.g., chart review, vitals, pain level, observation) and compare it against the safety parameters established by the PT.

Which 4 environmental factors fall under Social Determinants of Health (SDOH)?

1. Neighborhood safety

2. Neighborhood environment (like access to parks and public transit)

3. Housing stability

4. Food security (access to nutritious food)

Where do physical therapists work within government settings?

They care for active military personnel and military veterans through federal agency employment in the Department of Defense (DoD) and the Veterans Health Administration (VHA).

How does the ICF model differ from the older ICIDH model in its core approach?

ICIDH uses linear "disablement" terms focused on deficit and social disadvantage (Handicap), whereas ICF uses an integrative "enablement" perspective that considers human function, environmental barriers, and personal strengths.

How did the older ICIDH model define an Impairment?

An Impairment was defined as any loss or abnormality of a psychological, physiological, or anatomical structure or function.

What is Oncologic physical therapy?

A subspecialty serving individuals diagnosed with cancer or undergoing cancer treatment, focusing on fatigue management, mobility restoration, and lymphedema therapy.

What new system did the APTA develop in collaboration with the AMA to reform physical therapy billing?

The Physical Therapy Classification and Payment System (PTCPS).

How does the World Health Organization (WHO) define health?

Health is defined as a state of complete physical, mental, and social well-being—not merely the absence of disease or illness (infirmity).

What is the goal of physical therapy in Industrial or Occupational settings?

To help injured employees safely return to work, enhance workplace safety, optimize ergonomics, and improve worker productivity.

In clinical decision-making, what must a Physical Therapist Assistant (PTA) review before treating a patient?

The PTA must read and review the Physical Therapy examination, evaluation, and Plan of Care (POC) established by the supervising Physical Therapist (PT).

What are the main types of Outpatient Physical Therapy facilities?

Private practices (PT-owned), hospital-based outpatient clinics, corporate-owned chains (e.g., Select Medical, NovaCare, ATI), and Physician-Owned Physical Therapy Practices (POPTs).

What action should a Physical Therapist Assistant (PTA) take if a patient experiences safety concerns or fails to make expected progress?

The PTA must immediately stop or interrupt the intervention, ensure patient safety, and communicate with the supervising PT for clarification or plan adjustments.

What are Functional Mobility Skills (FMS)?

Functional Mobility Skills are fundamental physical movements required to navigate one's body, such as transfers (e.g., bed to chair), walking (gait), and carrying objects.

In the ICF model, what is a Health Condition?

A Health Condition is an umbrella term for a disease, disorder, injury, or trauma. It can also include states such as aging, stress, congenital anomalies, or genetic predispositions.

What is the third priority area of the Affordable Care Act (ACA)?

To support innovative medical delivery methods designed to lower overall healthcare costs while improving patient care quality.

What conditions are treated in Neurologic physical therapy?

Conditions affecting the brain, spinal cord, or peripheral nerves (stroke, traumatic brain injury (TBI), spinal cord injury (SCI), and nerve disorders)

In ICF terminology, what is a Capacity Qualifier?

A Capacity Qualifier describes an individual's highest probable level of physical functioning to execute a task in a standardized environment without external assistance.

How is the ICF framework utilized in physical therapy practice guidelines?

The APTA uses the ICF framework to structure the Guide to Physical Therapist Practice, helping clinicians evaluate function, set goals, and manage patient care systematically.

What is the second priority area of the Affordable Care Act (ACA)?

To expand the Medicare program, helping older adults and individuals with specific qualifying health conditions receive broader medical coverage.

In the ICF model, what is the difference between Body Functions and Body Structures?

Body Functions are physiological or psychological operations of body systems (e.g., heart rate, muscle strength), while Body Structures are structural anatomical parts like organs, bones, and limbs.

What upper extremity areas are treated by a Hand Therapy specialist?

Injuries and post-surgical rehabilitation of the elbow, wrist, and hand.

Why is Neurologic physical therapy often physically intensive for the clinician?

Patients frequently require hands-on physical support for transfers, gait re-training, posture control, and balance exercises.