KNPE 355

Before beginning a clinical skills task

• Introduce yourself

• Hand hygiene

• Confirm the client’s first and last name, and ask how they would like you to address them (preferred name)

• Provide an overview of the session/rationale and obtain client’s permission

SOAP Notes

• Subjective

• Objective

• Analysis/Assessment

• Plan

Analysis statement - components

1. client profile/summary

   • D.O.B., age, gender, pronouns, significant presentation

2. present condition/diagnosis

   • Current medical diagnosis or working differential diagnoses or physical

     diagnosis or potential differential diagnoses and/or present condition

3. any risks

   • acuity/chronicity/stability, any risks – including clinician primary concerns,

     precautions, contraindications or patient primary concerns/goals.

4. prognosis and rationale

   • what is/are the possible etiology(ies) of the diagnosis(es) and/or impairments (the ‘why?’), and what possible ramifications there may be for interventions &/or for the future

   • Prognosis do they have support, do they express high or low levels of self-

     efficacy and/or motivation?)

5. potential for kinesiology or referral to other services

   • the likelihood that a RKIN has something to offer and that the client is likely to, or not to, benefit from KIN.

   • If a referral to other services is warranted (e.g., med, PT, OT, dietician etc.)

Problem list

• A list of problems that are amenable to kinesiology (within the scope of practice)

• Forms the basis of your treatment plan (next step)

• Problems can be function, impairments, activity or participation limitations

• Problems can be actual or potential (at risk for)

• Relate to the underlying cause or treatable issue

Goal setting

• Made in collaboration with the client

Based on:

• Client’s stated goals and the problem list

• Prognosis, which is based on:

  • Nature, acuity/chronicity of illness/injury

  • Prior and current level of function

  • Social supports, living environment, apparent motivation

• Must be client-driven/person-centered

• Should be SMART

  • Specific

  • Measurable

  • Action-oriented

  • Realistic

  • Time-bound

Short-term goals

Steps or milestones along the way to achieving long-term goals (outcomes)

• Short-term goals typically address:

  • Function

  • Impairments

  • Education

Can have one or more for each long-term goal

Long-term goals

• Outcomes

• Often linked to resolving the problem list and returning to performing a meaningful activity/role and/or optimizing health and well-being

• Should be prioritized by importance

Plan

A concise statement of the overall intervention plan and follow-up proposal for next session

Body Composition

• Body composition refers to the components that make up the body

  • Body weight and relative amounts of muscle, fat, bone and other vital tissues

  • Often limited to fat and lean body mass (fat-free mass) and expressed as relative (percentage) and absolute (kilograms)

• Body composition is frequently used as an outcome measure to determine the effectiveness of community-based obesity prevention strategies

Body Composition Standards

• Currently, universally accepted norms for body composition do not exist.

• A consensus opinion for an exact percent body fat value associated with optimal health risk has yet to be defined.

• However, based on skinfold percentile reference values, the “good” category for body fat values across a wide age spectrum are:

  • 12%– 23% for males

  • 17%–26% for females

Why do we measure body composition?

• Risk of metabolic diseases

• Obesity is related to health risks

• Maximize performance/health

• Research outcome

Body composition models

Two-component models

• Anthropometry (circumference measures)

• Skinfold thickness

• Bioelectrical impedance analysis

• Underwater weighing

• Plethysmography (Bod Pod)

• Ultrasound

Three-component models

• Dual-energy x-ray absorptiometry (DEXA, DXA)

• Magnetic resonance imaging (MRI)

• Computed tomography (CT)

Body composition - Valid/Reliable

• A body composition technique is considered valid if it measures what it says it measures (relative body fat).

• A body composition technique is considered reliable if the results are reproducible.

Dual-energy x-ray absorptiometry (DEXA, DXA)

• Considered the gold-standard

• A 3-component model which provides an estimate of bone, fat, and lean tissue densities

• Expensive equipment that is usually found in research and clinical settings

• Full-body x-ray is used to evaluate various tissue densities

Underwater weighing (UWW)

• Also called hydrostatic weighing or hydrodensitometry

• Considered one of the most valid methods of estimating relative body fat

• Densitometry - fat and lean tissues have different densities

  • Water density ~ 1 g • ml^-1

  • Fat density < 1 g • ml^-1 or approx. 0.9 g • ml^-1

  • Lean tissue density = 1.1 g • ml^-1

  • 2-component model

Air-Displacement Plethysmography

• Commercial name: BOD POD

• Densitometry technique

• Displacement of air in a sealed compartment