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
|
Practice Pattern |
Practice Pattern Description |
Example Diagnoses |
|
Pattern A
|
Impaired Motor Function and Sensory Integrity Associated With Congenital or Acquired Disorders of the Central Nervous System in Infancy, Childhood, and Adolescence
|
Cerebral Palsy (CP) Spina Bifida Myelomeningocele Spastic Hemiplegia Spastic Diplegia Epilepsy Autism Spectrum Disorders Fetal Alcohol Syndrome |
|
Pattern B
|
Impaired Motor Function and Sensory Integrity Associated With Acquired Nonprogressive Disorders of the Central Nervous System in Adulthood
|
Traumatic Brain Injury (TBI) Cerebral Vascular Accident (CVA) Transient Ischemic Attack (TIA) Burns |
|
Pattern C
|
Impaired Motor Function and Sensory Integrity Associated With Progressive Disorders of the Central Nervous System in Adulthood
|
Multiple Sclerosis (MS) Amyotrophic Lateral Sclerosis (ALS) Parkinson's Disease (PD) Myasthenia Gravis Huntington's Disease Alzheimer's Disease |
|
Pattern D
|
Impaired Motor Function and Sensory Integrity Associated With Peripheral Nerve Injury
|
Ischemic compression stretch inflammation chemotoxicity |
|
Pattern E
|
Impaired Motor Function and Sensory Integrity Associated With Acute or Chronic Polyneuropathies
|
Guillain-Barré Syndrome (GBS) Autoimmune diseases Diabetic Neuropathy Alcoholism Nutritional Deficits (e.g, B12) Infection (Herpes, Polio) |
|
Pattern F
|
Impaired Motor Function and Sensory Integrity Associated With Nonprogressive Disorders of the Spinal Cord
|
Spinal Cord Injury (SCI) Degenerative Joint/Disc Disease in Spine |
|
Pattern G
|
Impaired Arousal, Range of Motion, Sensory Integrity, and Motor Control Associated With Coma, Near Coma, or Vegetative State
|
Minimally Responsive State Anoxic Brain Injury Toxicity or Metabolic Dysfunction |
