Clinical decision making and conceptional framework

clinical reasoning

multidimensional process that involves a wide range of cog skills used to process info, reach decisions, and determine actions

clinical decisions

outcomes of clinical reasoning process; forms basis of pt-client management process

prac model, dis/enablement model, hypothesis-oriented clinical prac, theories of motor control, evidence-based prac

5 key elements that contribute to a comprehensive conceptual framework for clinical prac: ___ (guide to PT prac; pt/client management), ___ (ICF), ___, ___, ___ (outcome measures)

task-oriented approach

based on contemporary theories of motor control/learning

task-oriented approach

advocates the exam/treat of pts at several lvls w/ emphasis on pt's funcal performance of very specific tasks

task-oriented approach

exam looks at funcal performance, strats used, impairments (RoM, MMT)

pt/client management

exam, eval, dx, px, intervention, outcomes

pt/client management

ongoing iterative process that begins w/ 1^st interaction w/ indi

pt/client management

PT initiates process by gathering info prior to 1^st meeting w/ pt and continues thru/o episode of care

develop PoC, accountability, provide direct services

goals for pt/client management

guide to PT prac

used to help form documentation

ICF

provides a biopsychosocial view of hlth status from a biological, personal, social perspective

activity limitation

ex: unable to stand from low seated position/walk long distance

env factors

ex: set-up of home, hobbies

direct impairment

impairment that affects body func/structure

direct impairment

ex: stroke directly cause contralat weakness

indirect impairment

2^ndary conditions resulting from primary injury/disease

indirect impairment

ex: knee injury RoM loss causes pt to become sedentary and get weaker

composite impairment

having multi underlying causes that can result from in/direct impairments or from multi systems

composite impairment

ex: deficits in balance, postural control, and coordination (involves moskel/neurom systems)

hypothesis-oriented clinical prac

ex: w/ stroke, use pt's dx to begin to hypothesize what impairments will likely exhibit

hypothesis-oriented clinical prac

systematic way to guide the testing of assumptions causing movement system dxs

clinical prac

theories of motor control have led to the development of ___

theories of motor control

how a PT exams/treats a pt is based on underlying assumptions about the cause of movement dysfunc or movement system disorder

assumption

thot processes about why/how our intervention work

theory of motor control

drives contemporary prac in alignment w/ use of task-oriented approach

outcome measure

assist in dx/px, track performance/hlth status change

outcome measures

unlike measurement tools (posture, MMT), ___ have research evidence that provide psychometric properties for specific pt pops

outcome measures

more specific use of evidence w/in exam process

evidence-based clinical prac guidelines

systematically-developed statements that assist PT/pt decisions about appropriate hlthcare for specific clinical circumstances

task-oriented approach

contemporary motor control theory that drives our clinical prac

integrated framework

demonstrates the steps in clinical decision-making process

integrated framework

pt-centered; integrates both the enablement and disablement perspective

integrated framework

incorporates a variety of conceptual models and analyses at various points in pt management process

Hypothesis-Oriented Algorithm For Clinicians (HOAC)

ex of an integrated framework

funcal performance, strats, impairments

task oriented approach 1^st looks at ___, then at ___ (how func is being performed), then at the ___

4 STEP

summer institute for clinicians/educators/researchers to explore new theory/research evidence related to movement science and to translate it into PT prac for all indis w/ neuro disorders

4 STEP

explore PT roles in preventing disabling conditions; eval ways to classify movement disorders; summarize critical periods for emergence of neuroplasticity and strats for maxing experience-dep plasticity; analyze/apply emerging measures/interventions to optimize participation

participation, prediction, plasticity, prevention

4 P’s of 4 STEP

participation

involvement of ppl in all areas of life or the funcing of a person as a member of society

participation restriction

probs an indi experience w/ involvement in life situations

participation

less emphasis in rehab research

barriers (participation)

what pt experiences are meaningful, pt/fam preferences, considerations for pt outcome reporting

prediction

.___ of optimal response to intervention choice is fundamental to effective prac

prediction

tests and measures in classification (who/when)

prediction

being w/ meaningful movement system dx and measurements

prediction

relates to primary prevention

primary prevention

classification of movement disorders/strats to link classification w/ predicted outcomes

prediction

Ex: standardized outcome measures like GMFCS, berg balance scale, TUG

plasticity

capacity of cerebral neurons and neural circuits to change (structurally and funcally) in response to experience

plasticity

Brain/SC ___ is critical for sensory func maturation during development, behavior adaptions to env, and for CNS repair due to injury/disease

plasticity

id exposure to enriched envs (cog, sensory, motor interventions)

prevention

actions taken to prevent onset of disease/disability, to stop its progress, and to minimize its consequences

primary prevention

acting before dx/disability happens (ex: helmet)

secondary prevention

screening; using procedures to detect/treat preclinical pathological changes for control of progression to a disability

secondary prevention

ex: screening premature infants; Rxing graded aerobic exercise for stroke-risk indis w/ hypertension

tertiary prevention

act to minimize impact of movement disorders on indis' activity/participation and impact on quality of life (main focus of PT prac)