Introduction to Physical Therapy for Neuromuscular Conditions
PTA 103 Intro to Clinical Practice 2

Instructional Use Statement

The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution or commercial purposes. It is not intended to serve as medical advice or treatment.

Contact howardc@lanecc.edu for permissions

PT Examination

Key elements of a physical therapy examination includes

• Mental status screening
• consciousness, attention, orientation, and general cognition (e.g., memory, information processing)
• Communication
• includes speech and language disorders
• Motor control
• volitional versus involuntary movements, isolated or synergistic
• Motor learning
• ability sustain motor performance over time, interpret motor feedback, transfer skills to different environments
• Postural control, balance and coordination
• Coordination
• muscle activity during voluntary movement
• muscle groups working together to perform a task (timing, accuracy, sequence) = synergy
• level of skill and efficiency
• start, control and stop according to activity/environment demand
• Gait and Locomotion
• Neuromuscular tone
• Range of Motion and Flexibility
• Integument integrity
• skin observations, pressure areas
• Pain
• Sensation and Sensory Integration
• deep tendon reflexes (DTRs)
• pathological reflex testing
• proprioception
• kinesthesia
• sensory discrimination (sharp & dull, hot & cold, vibration, light touch & pressure, right & left discrimination)
• Cranial nerve integrity
• Peripheral nerve conduction / electromyography (EMG)
• Manual Muscle Testing
• Functional Task and Mobility Analysis
• Protective and Support Equipment
• Standardized Outcome Measures
• Functional Independence Measure (FIM)
• Performance Oriented Assessment of Mobility (Tinetti)
• Functional Reach Test
• Timed Get Up and Go Test
• Timed Walking Test
• Berg Balance Scale
• Barthel Index
• Aerobic Capacity and Endurance

PT Examination

The Guide to Physical Therapy Practice frames seven, impairment-based patterns that are consistent with patients and clients encountered in the physical therapy service. The language in practice patterns reflects the commitment to documenting and tracking how a person functions within their disease versus focusing on the disease.

Physical Therapy practice patterns connect affected body structures and functions with outcomes in the examination process. The result is a clear application of the International Classification of Functioning, Disability, and Health (ICF) which aids in evidence-based treatment planning. Within practice patterns, the physical therapist evaluates how body systems and conditions and the associated impairments impact function and disability within the patient's individual circumstance.

The table below outlines how physical therapy approaches establishing a PT diagnosis. A PT prognosis will factor in specific patient situations and circumstances (such as comorbidities, support systems, etc., work/home activities) in order to set treatment goals, frequency and duration.

Summary of Patient-Client Management for Patients and Clients with Neuromuscular Conditions

• PT examination
• Review of history, reason for referral, review of systems, tests and measures, special tests, review of diagnostic studies (outcomes of imaging, lab results)
• PT Evaluation
• Intepret examination findings and apply clinical reasoning
• Considers personal and contextual factors
• Differentially diagnose and make appropriate referrals as needed for coordinating care
• PT Diagnosis
• Select practice pattern(s) that reflect a neuromuscular pattern within the scope of practice
• PT Prognosis
• Generate goals and expected outcomes; includes a plan of care (interventions, frequency, duration) to achieve goals
• Interventions
• Skilled services selected to progress patient toward goals
• Performed by the PT or the PTA as directed by the supervising PT
• Examples include
• therapeutic exercise (ROM, strengthening, stabilization, postural exercises, endurance training)
• modalities
• therapeutic activities (functional training, family training, transfer training)
• gait and locomotion
• orthotics, prosthetics, and equipment / assistive technology
• balance and coordination training
• positioning for pain relief and pain management
• skin care and protection
• Outcomes
• PTAs perform repeat tests and measures as directed by the physical therapsit to make comparisons to evaluation or reassessment findings
• PTAs assess patient response to treatment within the plan of care and report findings to the physical therapist
• PTs interpret treatment outcomes during reassessment, when revising the plan of care, or determining discharge readiness

 

Neuromuscular Practice Patterns in Physical Therapy

Role of the PTA

• Prepare for safe and effective interventions by thoroughly reviewing the PT Examination findings, associated progress reports, and the plan of care
• Recognize declines in function or abnormal responses to interventions and report findings to the supervising PT
• Perform interventions within the POC to achieve stated goals
• Monitor and report physiologic responses to interventions
• Communicate barriers, questions, and concerns to the supervising physical therapist
• Complete and repeat tests and measures as indicated to monitor patient response and progress
• Educate patients and family members in use of positioning, equipment, assistive devices, energy conservation, home and community safety (including fall prevention)
• Include age-appropriate and instructional strategies consistent with the patient's developmental and cognitive status
• Coordinate with the interprofessional health care team to optimize safety and recovery