PHYSICAL THERAPY PRACTICE o Know the step-by-step procedures which

are universally accepted

 Physical therapists are health care
 Patient/client
professionals who help patients /clients
o The main priority is the goal set by the
maintain restore, and improve movement
pt./client
activity and functioning, thereby enabling
o Beliefs can influence the decisions of pt.
optimal performance and enhancing health,
when it comes to treatments
well - being, and quality of life.
 Physical, Psychosocial, Educational, cultural
 Their services prevent minimize or
and overall factors
eliminate impairments of body functions
 Time
and structures, activity limitations, and
o Time that the pt. can a lot for the
participation restrictions
treatment
PT DECISION MAKING  Level of financial/social support
o Considered when setting goals and the
 PTs can co-manage or refer with different
number of treatment sessions the PT can
health care professionals if the disease we
give to the pt.
are treating are not in our scope
o The money needed to sustain the
CLINICAL REASONING treatment is considered

- multidimensional process that involves a International classification of functioning,

wide range of cognitive skills physical disability, and health (WHO)
therapists use to process information, reach
 Provides important framework for better
decisions, and determine actions.
understanding and categorizing health
- Also called clinical decision making
conditions and pt.’s problem
Factors that Influence Decision Making  It defines complex interaction among the
health condition, impairment, activity
 Clinician’s goal
limitation of the pt., participation, and
o PTs should align the treatment of the pt.
restrictions and other contextual factors
to the goal of clinician  Health condition
o If the PT wants to modify or add
o Umbrella term for the disease or disorder
something in the treatments, they should
or the injury
consult with the clinician first
o Universal
 Knowledge based and expertise
 Impairments
o Knowledge and expertise to a particular
o Problems in body function and structure
treatment or assessment influences
such as significant deviation or LOM
clinical reasoning of the PT
 Activity
 Psychosocial skills
o Difficulties of an individual to execute ADL
o PT needs to be more understanding to
both instrumental and basic ADLs
the condition of the pt.
 Participation
o They should have open-communication
o Participation of individual’s involvement
w/ the pt. & other members of the rehab
in life situations or social perspective of
team
functioning
 Problem-solving strategies
o Example: what is the role of the pt. in the
o PTs should be trained in regards to
community
problem solving
 Environmental factors
 Procedural skills
 o Gives background to the pt.
o To see if there is precipitating factors in
the pt.’s environment
o External factors that influence the pt.
 Personal factors
o Gives background to the pt.
o Specific factor in one’s life
o Considers overall behavior of the pt.
PHYSICAL THERAPY PROCESS – provides a
framework for practice.
PATIENT /CLIENT MANAGEMENT MODEL
- The management model is applied for
purposes of rehabilitation, habilitation, the
maintenance of health or function, the
prevention of functional decline, and, in
healthy persons and the enhancement of
performance.
- The plan of care that the PT selects must be SYSTEM REVIEW
appropriate towards the pt.’s goal
- The treatment is holistically, but the priority
is the pt.’s goal
 PATIENT – is a person or animal who
receives treatment from a doctor or other
medically educated person
 CLIENT – is a customer, a buyer or receiver
of goods or services
EXAMINATION
- involves identifying and defining the
patient's problem (s) and the resources
available to determine appropriate
intervention.
- Begins w/ pt.’s referral, initial entry, or
direct access
It consists of four components:
 Patient history
 Systems review
 Tests and measures
 Task analysis
PATIENT HISTORY
o Medical Record
 Contains previous management done to
the pt., previous medications, lab
results, diagnostic procedures, other
notes form the medical team and
history of the disease the disorder
o Interview
 Obtain the history directly from the pt.
or relatives of the pt. if the pt. is
unconscious or if you can’t
communicate w/ them
 Ask pertinent details, and the pt.’s goals
 This is where the PT can establish
rapport and mutual trust w/ pt.
 Open communication is needed to have
good and enhanced motivation of the
pt.
- Allows PT to quickly scan the patient's body
systems and determine the areas of intact
function and dysfunction
- Musculoskeletal
 Assessment of gross symmetry
 Gross range of motion
 Gross strength
 Height
 Weight
- Neuromuscular - assessment of gross
coordinated movement and motor function.
- Cardiovascular /Pulmonary
 Assessment of heart rate
 Respiratory rate
 Blood pressure
 Edema
- Integumentary
 Assessment of skin integrity
 Pliability (texture)
 Presence of scar formation
 Skin color
- Communication ability, affect and language
 Assessment of the ability to produce
and understand speech
 Communicate thoughts and feeling

- Cognitive ability
 Assessment of consciousness
 Orientation
 Expected emotional /behavioral responses,
and
RANGE OF MOTION TESTING
 Learning preferences.
WHY DO WE NEED SYSTEM REVIEW?
 Confirm the need for further or more
detailed examination
 Rule out or differentiate specific system
involvement
 Determine if referral to another health care
professional is warranted triage)
 Focus the search of the origin of symptoms
to a specific location or body part
CONSULTATION
- appropriate if the needs of the patient /
client are outside the scope of the expertise
of the therapist assigned to the case
SCREENING EXAMINATION
- May involve observation, chart review, oral
history, and /or a brief examination
- For healthy population, pediatric, geriatric,
athletes, working adults
TEST AND MEASURES
- Including a screening of the
musculoskeletal, neuromuscular,
cardiovascular / pulmonary and
integumentary systems
- During the examination assessment is
defined as the measurement or
quantification of a variable or
placement of a value on a behavior
TEST AND MEASURE – used to provide objective
data to accurately determine the degree of specific
function and dysfunction.
 Range of Motion Testing
 Manual Muscle Testing
 Functional Testing
 Special Test
 Anthropometric Measurement
 Neurologic Assessment
 Postural Assessment
 Galt Assessment, etc.
o Arch of motion in degrees between the
beginning and the end of a motion
- GONIOMETRY
- Gonia (angle) | metron (measure)
- Refers to measurement of angles
created at human joints by the bones of
the body
 Active ROM
 arc of motion attained by a subject during
unassisted voluntary joint motion
 Assessing the contractile unit
o No external force involved
o Voluntary motion of the pt.
o Provides the examiner of the info. If
the pt. is willing to move the body
part and how far the pt. can move a
specific jt.
o Gives the examiner the idea of the
coordination of the body parts,
muscle strength, and the jt. ROM
o If pain occurs here, the pt. can have
a problem in the contracting and
stretching unit or tissues
 Passive ROM
 arc of motion attained by an examiner
without assistance from the subject
 Assessing the non- contractile unit
o The pt. is relaxed and there is no
active participation on moving the
body parts
o Slightly greater than the AROM, as
each jt. Has a special amount of
motion that is not under voluntary
control
o Tests the integrity of the jt., jt.
Surfaces, capsules, and ligaments
o Pain in the end range of PROM can
involve muscles
  End-feel
o Characteristic feel that may be detected by
the examiner who is performing the passive
o Feeling experienced by the examiner and a
barrier for further motion
Hypomobility
 Capsular patterns
o Restrictions in here do not involve a fixed
number of degrees for each motion
o A fixed proportion of a motion relative to
another motion
o The sequence of the limitation of a joint
must be followed
 Example: in the glenohumeral jt., the
sequence is ERABIR (external
rotation, abduction, internal
rotation), the external rotation will
be the one that will experience a
greater loss of motion that the two,
then followed by abduction and then
internal rotation
 Noncapsular patterns
o Involves one or two motion of a jt. in
contrast to capsular pattern that involves
all motions
o Example: there is an adhesion in a jt.
Capsule, the particular part that has
adhesion experiences restriction
o The particular muscles involved for the
motion also experiences restriction
o Not all are involved
Muscle Length Testing
- the greatest extensibility of a muscle
tendon unit
- One joint muscle cross and therefore
influence the motion of only one joint
- Two -joint muscles cross and influence
the motion of two joints
- Multi -joint muscles cross and influence
multiple joints
ACTIVE vs PASSIVE INSUFFICIENCY
Active Insufficiency
The mm is at its SHORTENED position
wherein the contraction is minimal
 Example:
o Biceps muscle: fully shoulder flexion(biceps
is shortened and fully contracted),
combined with shoulder extension = you
will no longer produce additional or
another contraction = the movement is
actively insufficient
Passive Insufficiency
The mm is at its ELONGATED position so
that further shortening of opposite mm is
prevented
 Example:
o Biceps: fully extension of the elbow + full
extension of the shoulder, the opposing
muscles such as triceps muscle can’t
shorten
POSITIONING – refers to the positions of the body
recommended for obtaining both goniometric and
muscle length measurements
 Important in goniometry and muscle length
because it places the jt. in 0 starting position,
which is neutral, in measuring ROM
 When you deviate from the normal
positioning of testing, the reliability of the
result is low
STABILIZATION – the testing position for ROM
helps to stabilize the individual's body and proximal
joint segment so that a motion can be isolated to
the joint being examined
 Prevents any additional or excessive
movement to the patient for them to
compensate the motion

Goniometer
 Instrument most common used
measurement of ROM in clinical settings
 Body
o By 5 measurements
o Can be a half circle (180º) and a full circle
(360º)
 Arm
o Stationary
 Structural part of the body of the
goniometer and can’t be moved
independently from the body
 On the proximal side of the part being
measured
o Moving
 On the distal side of the part being
measured
 Attached to the center of the body
 Permits the arms to move freely in the
body, within the plane of motion
 Sizes
o The measurement is wrong if the wrong
size is used to measure a certain area
o Long arm
 Used for measuring extremities
 Alignment
o Refers to the alignment of the arms of the
goniometer w/ the proximal and distal
segments of the individual jt.
o Proximal arm
 Aligned to the proximal segment of the
jt.
o Distal arm (moving arm)
 Aligned to the distal segment of the jt.
Manual muscle testing
 Records muscle strength as numerical or
ordinal score ranging from 0-5
 Tests the manual strength of the muscle
 Tests muscle groups that perform the same
motion or action
Break test
in
 Common way to test MMT
 Done when the pt. can do a motion against
gravity
 Gives resistance to the patient when doing an
action
o Resistance
 Concentric force that is applied by the
examiner to act as opposition to the
contracting muscle group
Make test
 Gives resistance to the pt. while the pt. is
doing AROM
Active resistance test
 From 0 to the last degree of motion of s jt. the
examiner will give resistance
Application of resistance
 End range application
o single jointed muscle
 Mid-range application
o two jointed muscle (ex.: hamstrings)
 grade 5 – longer lever for stronger resistance
 grade 4 – shorter lever
 application of resistance should be gradual or
progression so the pt. is aware that they
should give maximal force while doing the
motion
grade 0,1,2
 eliminate force of gravity when testing this as
the muscles are weak
 the test should be done horizontal to the
direction of the gravity
 done in a smooth flat surface to reduce
friction during motion that can cause
deviation with the result
  friction force must be minimal (PT can use  PTs need to consider everything in regards to
power board to minimize friction) assessment to the pt.’s condition as it can
affect the prognosis the pt., like comorbidities
of the pt.

grade 4,5

 adds resistance additional to the pull of

Plan of care
gravity
o the resistance application should be  List of management the PT will give to the pt.
perpendicular to the line of gravity  Includes pt.’s education, exercise program,
and specific management that will be given to
stabilization is important in testing to eliminate
the pt.
muscle substitution or other movements the pt.
can do to improve ROM
Special test

 PT can’t diagnose a condition with just one

special test, it is used to confirm and
differentiate conditions from one to another
 provocative special test
o provoking symptoms in order to look for a
positive sign that the pt. has that specific
condition
o example: Spurling test
 test used to check if there is irritation
of the nerve roots
 reliving special test
o tests used when symptoms are present and
for it to be considered positive the
symptoms should be gone(?)
 Special diagnostic test
o Phalen’s test
 Good strong evidence
o Reverse Phalen’s test
 Minimal evidence
o Ulnomeniscotriquetral dorsal glide test
 Strong evidences
Evaluation

 Done after observation and assessment

Prognosis