Module 2 GQ's

• Evaluation

  Organization, synthesis, & interpretation of the data
• Plan of care

  Based on synthesis of the information including the patient's goals & expectations, task performance, & patient's resources and impairments, and the medical diagnosis & prognosis for the condition
• Factors identified and prioritized in the evaluation

  • The most important problems for the patient
  • Evaluation from both enablement & disablement perspectives
  • Summary of the movement problem
• Evaluation process

  1. Develops diagnostic & prognosis

  2. Develops realistic goals

  3. Selects outcome measures to assess progress & intervention effectiveness

  4. Determines overall approach to intervention
• Questions the summary of the patient's movement problem answers

  • In what environmental contexts does the patient have difficulty performing the task or tasks?
  • What other issues related to the environmental context such as chair height, BOS, lighting, & compliance of the support surfaces should be considered?
  • How does the movement problem manifest itself with regard to the temporal sequence of movements that make up the task
  • Which key underlying impairments or determinants likely affect specific or multiple stages within the temporal sequence of task performance?
  • Does the patient have difficulty coordinating synergistic groups of muscles and under what conditions?
• Diagnosis made by a physical therapist

  • Describes the patient's movement problems that are causing the patient's activity limitations & participation restrictions
  • Focuses on the patient's movement problems and enables PT to properly & effectively manage disorders of the movement system
• Diagnostic labels for the management of patients with neurologic conditions

  • Identified at the level of body structure/function impairments & describe their casual relationship with patient's activity limitations & participation restrictions
• Motor control deficits in patients with motor cortex pathology

  • Weakness (inability to produce normal levels of force)
  • Paresis (mild or partial loss of muscle activity)
  • Abnormal muscle tone or spasticity
  • Loss of selective motor activation
  • Abnormal synergies
  • Coactivation of additional muscles during functional movements
• Motor control deficits in patients with cerebellar pathology

  • Hypotonia
  • Ataxia
  • Action or intention tremor
  • Impaired error correction impacting motor learning
• Motor control deficits in patients with basal ganglia pathology

  • Akinesia
  • Hypokinesia
  • Micrographia
  • Bradykinesia
  • Rigidity
  • Resting tremor
  • Hyperkinesia
  • Dystonia
• Motor control deficits in patients with somatosensory pathology

  Reduces ability to detect & perceive information coming in from somatosensory inputs & affects ability to integrate somatosensory inputs with other sensory modalities from multiple parts of the body
• Motor control deficits in patients with visual system pathology

  Can impact motor control because vision provides information on the position & movement of objects in space & position & movement of our own bodies
• Motor control deficits in patients with vestibular system pathology

  Problems related to gaze stabilization, posture & balance, vertigo or dizziness
• Motor control deficits in patients with pathology in the higher-order association cortices

  Causes right hemisphere spatial & nonspatial deficits
• Secondary impairments that can occur in patients with nervous system lesions due to immobility resulting from primary impairments

  • Contractures
  • Decreased ROM
  • Further muscle weakness
  • Deconditioning
• Movement dysfunctions that postural control impairments can result in

  Impaired stability which results in loss of functional independence, reduced or restricted participation in activities of daily living, reduced confidence in the ability to perform activities of daily living safely, increased risk for falls
• Functional consequences of steady state postural control deficits

  Inability to maintain a stable sitting or standing position
• Specific steady state postural control impairments

  • Impairments in relationship of body segments to one another
  • Position of body with reference to surroundings, gravity & BOS, functional stability limits & postural sway
• What happens to steady state postural control when postural alignment is abnormal

  Movement strategies used in controlling posture & how muscle are recruited & coordinated for recovery of stability are affected
• How sensory deficits can lead to impairments in steady state balance

  • Disruption in the ability to adapt sensory inputs to changes in task & environmental demands
  • Disruptions in development of accurate internal models & perceptions of the body
  • Sensory organization & integration dysfunction
  • Sensory selection problems
• Functional consequences of reactive balance deficits

  Ability to recover stability following unexpected perturbations
• Specific reactive balance impairments

  • Impairments in coordination of postural muscle synergies of both in – place & change – in – support strategies
• Specific in-place strategy impairments

  • Sequencing problems
  • Coactivation
  • Delayed onset of postural responses
  • Problems modifying postural strategies in response to changing tasks & environmental demands
  • Impaired central set (ability to change the pattern of postural muscle activity quickly)
• Specific change in support strategy impairments

  Disruption in the organization & timing of automatic stepping or reach for support strategies to recover from unexcepted perturbation
• Causes of deficits in anticipatory postural control

  Loss of anticipatory processes that activate postural adjustments in advance of potentially destabilizing voluntary movement
• How sensory problems affect anticipatory postural control

  Loss of somatosensory inputs resulting in profound changes in motor adaptation & earlier activation of anticipatory adjustments
• How perceptual deficits and impairments in attentional capacity can impact postural control

  • Perceptual deficits: Impairments in perceptions of verticality
  • Attentional capacity: Impaired from neurologic pathology impacting postural control under dual-task conditions
• Other types of impairments in cognition that can impact postural control

  • Decreased balance confidence
  • Falls self-efficacy
• How paresis or weakness affects gait

  Affects ability to generate forces to move the body forward which affects the progression requirement of gait & unrestrained motions resulting in lack of control
• How spasticity affects gait

  • Inappropriate activation of a muscle at points during the gait cycle when it is being rapidly lengthened
  • Alters mechanical properties of a muscle, producing increased stiffness which affect the freedom of body segments to move rapidly with regard to one another
  • Limits the transfer of momentum during gait
• How impairments in selective motor control affect gait

  Abnormal coupling of muscles leading to abnormal synergies that manifest during gait as total extension or flexion patterns
• How coordination impairments affect gait

  • Increased activation of muscles
  • Abnormal phasing of multijoint movement leading to poor intersegmental coordination
  • Coactivation of agonist & antagonist muscles
• What types of postural control deficits can result in impaired adaptation of gait

  Response to changes in terrain occurs with reactive balance deficits
• How somatosensory deficits affect gait

  Gait ataxia
• How visual deficits affect gait

  Contribute to anticipatory postural control deficits & impairments to the ability to make adaptations during gait
• How vestibular deficits affect gait

  Gait ataxia
• How perceptual impairments affect gait

  Body image deficits leading to alignment problems, inappropriate foot placement, difficulty controlling the center of mass
• Prognosis made by a physical therapist

  The predicted optimal level of functional improvement that can be expected & the amount of time required for the patient to reach that level
• Purposes of prognosis in the physical therapist management of patients with neurologic conditions

  • Provide the patient & PT with information about the patient's likely recovery from the neurological lesion
  • Likely response to intervention
  • Likely duration of treatment
  • To inform shared decision-making
• How a physical therapist establishes or formulates a prognosis

  Begins with diagnostic process to identify discrepancies that exist between level of function that is desired by person, current capabilities & the capacity of the person to achieve that level