Table of Contents

 

 

 

PART I

SAFETY IN THE CLINICAL ENVIRONMENT

1

SECTION 1-1

PHYSICAL THERAPIST AND PHYSICAL THERAPIST ASSISTANT RELATIONSHIP

4

 

The Collaborative Path Between the PT and the PTA

5

 

PTA Duties (As per the American Physical Therapy Association—APTA)

6

 

PTAs Clinical Considerations During Interventions

6

SECTION 1-2

PATIENT COMMUNICATION

7

 

General Recommendations for Verbal Communication

8

 

Methods of Effective Patient Communication

8

 

Informed Consent

9

 

Methods of Effective Listening

9

SECTION 1-3

PATIENT EDUCATION

11

 

The PTA’s Responsibilities During Patient Education

12

 

Patient Education for Patients (Clients) Who have Difficulty Reading

12

 

Patient (Client) Education for Older Adults

13

 

Patient Education for Patients (Clients) Who have Visual Impairments

13

 

Patient Education for Patients (Clients) Who have Hearing Impairments

14

 

Patient Education for Patients (Clients) Who cannot Speak English

14

 

Basic Requirements for the Home Exercise Program (HEP)

15

SECTION 1-4

PATIENT CONFIDENTIALITY

16

 

Situations When Patient’s Written Authorization for Release of Medical Information is Required

17

SECTION 1-5

CULTURAL COMPETENCE

18

 

General Methods to Increase Cultural Competence

19

 

Guidelines to Cultural Competence

19

 

Religious Beliefs and Health Concepts

20

 

Intervention Strategies Considering Cultural Diversity

23

SECTION 1-6

INFECTION CONTROL

27

 

Centers for Disease Control (CDC) Recommended Standard Precautions

28

 

CDC Guidelines for Airborne, Droplet, and Contact Transmission Based Precautions

29

 

Occupational Safety and Health Administration’s Universal Precautions Recommendations

30

 

Asepsis Methods

30

 

Types of Nosocomial Infections

31

 

Infectious Diseases

32

SECTION 1-7

DOMESTIC VIOLENCE

35

 

How to Recognize Forms of Domestic Abuse

36

 

Difficulties Identifying/Helping Victims of Domestic Violence

36

 

Methods to Overcome Difficulties Identifying/Helping Victims of Domestic Violence

37

 

Signs Indicating a Victim of Domestic Abuse

37

 

Domestic Abuse Signs that Need Screening

38

 

Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO’s) Guidelines and Goals for Identifying Victims of Domestic Violence

38

SECTION 1-8

PATIENT SAFETY DURING INTERVENTIONS

40

 

Vital Signs Normatives

41

 

Patient’s Emergency Situations

42

 

General Signs and Symptoms to Discontinue Physical Therapy Interventions

43

 

Signs and Symptoms of Hyperglycemia: High Blood Sugar of More Than 200 mg/dL

43

 

Signs and Symptoms of Hypoglycemia: Low Blood Sugar of Less Than 50 mg/dL

44

 

Intervention Precautions for Patients with Diabetes

44

 

Signs and Symptoms of Electrolyte Disturbances: Hyperkalemia (High Potassium Level in Blood)

45

 

Signs and Symptoms of Electrolyte Disturbances: Hypokalemia (Low Potassium Level in Blood)

45

 

Signs and Symptoms of Electrolyte Disturbances: Hypernatremia (High Sodium Level in Blood)

46

 

Signs and Symptoms of Electrolyte Disturbances: Hyponatremia (Low Sodium Level in Blood)

46

 

Signs and Symptoms of Electrolyte Disturbances: Hypercalcemia (High Calcium Level in Blood)

47

 

Signs and Symptoms of Electrolyte Disturbances: Hypocalcemia (Low Calcium Level in Blood)

47

 

Signs and Symptoms of Respiratory Acidosis: CO2 Retention and Impaired Alveolar Ventilation

48

 

Signs and Symptoms of Respiratory Alkalosis: Low CO2 and Alveolar Hyperventilation

48

 

Signs and Symptoms of Overhydration: Excess of Body Fluid

49

 

Signs and Symptoms of Dehydration: Extreme Decrease of Body Fluid

50

 

Medications and Patient’s Adverse Reactions in the Clinic

51

 

Contraindications and Precautions of Physical Agents/Modalities

51

 

Acute Care Safety

59

PART II

CLINICAL DOCUMENTATION

61

SECTION 2-1

DOCUMENTATION GUIDELINES

63

 

General Documentation Guidelines

64

 

American Physical Therapy Association’s (APTA’s) Documentation Guidelines

64

 

APTA’s Documentation Guidelines on Domestic Violence

65

SECTION 2-2

DOCUMENTATION ELEMENTS

66

 

Initial Examination and Evaluation Elements

67

 

Patient’s History Elements

68

 

Progress Report Elements

68

 

Discontinuation of Physical Therapy Report Elements

69

 

Possible Indications for Patient’s Discontinuation of Physical Therapy

69

SECTION 2-3

DAILY/WEEKLY SOAP NOTE ELEMENTS

70

 

Subjective Data

71

 

Strategies for Writing Subjective Data

71

 

Objective Data

71

 

Objective Data Guidelines

72

 

Examples of Impairments and Related Functional Limitations

73

 

Strategies for Writing Objective Data

73

 

Assessment Data

74

 

Strategies for Writing Assessment Data

74

 

Plan Data

74

 

Strategies for Writing Plan Data

75

 

Documentation Tips

75

 

Telephone Referral Documentation

75

 

Health Insurance Portability and Accountability Act (HIPAA) and Documentation

76

SECTION 2-4

ABBREVIATIONS AND SYMBOLS USED THE MOST IN PHYSICAL THERAPY

78

 

Abbreviations

79

 

Symbols

82

PART III

MUSCULOSKELETAL INTERVENTIONS

85

SECTION 3-1

MUSCULOSKELETAL DATA COLLECTION

88

 

Goniometry—joint Measurements: Body Position, Goniometer Alignment, and Normal Range of Motion Degrees (Per AAOS)

89

 

Cervical and Thoracolumbar Range of Motion Normatives (Per AAOS)

102

 

Manual Muscle Testing—Grading System of Hislop and Montgomery

102

 

Upper Extremity Manual Muscle Testing

103

 

Finger and Thumb Manual Muscle Testing

119

 

Lower Extremity Manual Muscle Testing

121

 

Big Toe and other Toes Manual Muscle Testing

133

 

Myotomes Testing

133

 

Deep Tendon Reflexes and Grades

134

 

Orthopedic Special Tests: Shoulder, Elbow, Wrist, and Hand

135

 

Orthopedic Special Tests: Hip, Knee, and Ankle

138

 

Common Injuries of Brachial Plexus

141

 

Common Muscle Substitutions

143

SECTION 3-2

BASIC CLINICAL IMPAIRMENTS AND FUNCTIONAL LIMITATIONS OF COMMON MUSCULOSKELETAL CONDITIONS

144

 

Clinical Impairments and Functional Limitations of Arthritic Disorders

145

 

Clinical Impairments and Functional Limitations of other Musculoskeletal Conditions

147

SECTION 3-3

TYPES OF MUSCULOSKELETAL INTERVENTIONS

148

 

Therapeutic Exercises

149

 

Relaxation Exercises

156

 

PNF Exercises—Diagonal Patterns

157

 

Closed Kinetic Chain Exercises to Increase Weight- bearing Control and Stability

162

 

Patient Education Topics for Lumbar Spine

163

 

Abdominal Strengthening Exercises

164

 

Exercise Topics for the Obstetric Patient

165

 

Physical Agents and Modalities: Indications and Applications

167

 

Therapeutic Massage Application

182

 

Orthotics

182

 

Orthotic Interventions

186

 

Transtibial (Below Knee) Prostheses

187

 

Transfemoral (Above Knee) Prostheses

188

 

Prosthetics: Levels of Amputation

190

 

Prosthetics: Pressure Tolerant and Pressure Sensitive Areas

190

 

Prosthetic Interventions

191

 

Phases of Gait Cycles

193

 

Muscle Activation Patterns

193

 

Common Gait Deviations: Stance Phase

194

 

Common Gait Deviations: Swing Phase

194

 

Gait Training Points

195

 

Wheelchair Measurements

196

 

Wheelchair’s Postural Support System

197

 

Wheelchair Training

201

SECTION 3-4

MUSCULOSKELETAL INTERVENTION PATTERNS

203

 

APTA’s Guide to Physical Therapist Practice—APTA’s Musculoskeletal Intervention Patterns

204

 

Arthritic Disorders and Intervention Patterns

207

 

Bursitis and Intervention Patterns

209

 

Strains, Sprains, Dislocations, and Fractures and Intervention Patterns

211

 

Thoracic Outlet Syndrome, Adhesive Capsulitis, Lower - Back Disorders, Plantar Fasciitis, and Arthroplasties and Intervention Patterns

215

SECTION 3-5

PHASES OF TISSUE HEALING AND CLINICAL INTERVENTIONS

220

 

Tissue Healing and Interventions

221

SECTION 3-6

BONES

222

 

Human Skeleton

223

 

Carpal Bones

224

 

Tarsal Bones

224

SECTION 3-7

MUSCLES: FUNCTION, NERVE, ORIGIN, INSERTION, AND PALPATION

225

 

Pelvis and Hip Muscles

227

 

Knee Muscles

227

 

Ankle/Foot Muscles

227

 

Shoulder Muscles

227

 

Rotator Cuff Muscles

227

 

Elbow and Forearm Muscles

227

 

Wrist, Hand, and Finger Muscles

227

 

Neck, Trunk, and Back Muscles

227

 

Thenar and Hypothenar Muscles

254

PART IV

NEUROLOGIC INTERVENTIONS

257

SECTION 4-1

NEUROLOGIC DATA COLLECTION

260

 

Patient’s Arousal Levels

261

 

Memory and Amnesia Terms

261

 

Ranches Los Amigos Levels of Cognitive Functioning

262

 

Terms of Cognitive-Perceptual Deficits

263

 

Speech and Communication Functions and Impairments

264

 

Sensory Function—Sensory Receptors

264

 

Sensory Function—Dermatomes

266

 

Motor Function—Tonal Abnormalities

266

 

Motor Function—Myotatic Reflexes (Stretch Reflexes)

267

 

Motor Function—Grading Scale for Muscle Stretch Reflex

268

 

Motor Function—Babinski’s Reflex

268

 

Motor Function—Cranial Nerves Functions and Impairments

268

 

Motor Function—Cerebellar Dysfunction Characteristics

270

 

Motor Function—Basal Ganglia Dysfunction Characteristics

271

 

Motor Function—Characteristics of Upper Motor Neuron and Lower Motor Neuron Lesions

272

 

Motor Function—Coordination Tests and Scoring

273

 

Motor Function—Balance Tests and Scoring

273

 

Functional Balance Test—Berg Balance Scale

274

 

Functional Balance Test—Timed Get up and Go Test and Normatives

277

 

Motor Deficits of the Cerebral Vascular Accident: Abnormal Synergy Patterns

278

 

Brunnstrom’s Spasticity Patterns

279

 

Motor Deficits of the Cerebral Vascular Accident: Brunnstrom’s Stages of Recovery

279

 

Cerebral Vascular Accident—Gait Deficits

280

 

Traumatic Spinal Cord Injury Functional Capabilities and Assistance

280

 

Mechanisms of Injury for the Traumatic Spinal Coed Injury

283

 

Spinal Cord Injury Syndromes

283

 

Classification of Spinal Cord Injury

284

 

Multiple Sclerosis Categories

288

SECTION 4-2

CLINICAL IMPAIRMENTS AND FUNCTIONAL LIMITATIONS OF NEUROLOGIC CONDITIONS

289

 

Clinical Impairments and Functional Limitations of Cerebral Vascular Accidents

290

 

Clinical Impairments and Functional Limitations of Parkinson’s Disease

292

 

Clinical Impairments and Functional Limitations of Multiple Sclerosis

293

 

Clinical Impairments and Functional Limitations of Traumatic Brain Injury

293

 

Clinical Impairments and Functional Limitations of Traumatic Spinal Cord Injury

294

 

Clinical Impairments and Functional Limitations of Guillain-Barré Syndrome (Polyneuritis)

296

 

Clinical Impairments and Functional Limitations of Amyotrophic Lateral Sclerosis

297

SECTION 4-3

TYPES OF NEUROLOGIC INTERVENTIONS

298

 

Motor Function Interventions—Postural Strategies to Regain Balance

299

 

Motor Function Interventions—Developmental Motor Skills (Essential Functional Skills)

299

 

Motor Function Interventions—Restore Movement and Functional Mobility (Using Developmental Sequence Postures)

300

 

Motor Function Interventions—Basic Motor Learning Strategies

301

 

Neurologic Facilitation Techniques

302

 

PNF Diagonal Patterns

304

 

Neurologic Inhibition Techniques

304

 

Locomotion Training

306

 

Constraint-Induced Movement Therapy as a Form of Functional Training

307

SECTION 4-4

NEUROLOGIC INTERVENTION PATTERNS

309

 

APTA’s Guide to Physical Therapist Practice—APTA’s Neuromuscular Intervention Patterns

310

 

Intervention Patterns for Cerebral Vascular Accident

313

 

Intervention Patterns for Parkinson’s Disease

318

 

Intervention Patterns for Multiple Sclerosis

320

 

Intervention Patterns for Traumatic Brain Injury

323

 

Intervention Patterns for Spinal Cord Injury

325

 

Intervention Patterns for Guillain-Barré Syndrome

327

 

Intervention Patterns for Amyotrophic Lateral Sclerosis

328

SECTION 4-5

REVIEW OF NERVOUS SYSTEM ANATOMY AND PHYSIOLOGY

329

 

Parts of the Brain and Functions

330

 

Cerebral Hemispheres and Functions

332

 

Spinal Cord

336

 

Ascending (Sensory) Tracts

338

 

Descending (Motor) Tracts

339

 

Autonomic Nervous System

339

 

Brain Meninges and Ventricles

340

 

The Role of Cerebrospinal Fluid (CSF)

341

 

Brain Blood Supply

342

 

Muscle Sensory Receptors and Functions

342

PART V

CARDIOPULMONARV INTERVENTIONS

345

SECTION 5-1

CARDIOPULMONARV DATA COLLECTION

348

 

Vital Signs and Normatives

349

 

Abnormal Breathing Patterns

351

 

Blood Values and Normatives

351

 

Heart and Lung Sounds

353

 

Sputum Analysis

354

 

Cardiopulmonary Signs and Symptoms

355

 

Electrocardiogram (EKG or ECG)

356

 

Cardiac Cycle

356

 

Cardiac Terminology and Norma lives

359

 

Pulmonary Terminology and Normatives

359

 

Contraindications to Exercise Tolerance Tests

361

 

Termination Criteria to Exercise Tolerance Test

361

 

Medical Cardiac Tests and Procedures; Left Heart Cardiac Catheterization, Echocardiogram, Coronary Artery Bypass Graft Surgery, Percutaneous Transluminal Coronary Angioplasty

362

SECTION 5-2

IMPAIRMENTS OF CARDIOPULMONARY CONDITIONS

364

 

Coronary Artery Disease Impairments

365

 

Congestive Heart Failure Impairments

366

 

Chronic Obstructive Pulmonary Diseases (COPDs) Impairments

366

 

Chronic Restrictive Lung Diseases Impairments

368

SECTION 5-3

PATIENT SAFETY DURING CARDIOPULMONARY INTERVENTIONS

370

 

Basic Cardiac Life Support for Adults

371

 

Effects of Medications in Cardiac Rehab

373

 

Common Bronchodilators Used in the Pulmonary Rehab

374

 

Signs/Symptoms to Discontinue Cardiac Interventions

375

 

Signs and Symptoms to Change or Discontinue Interventions in Pulmonary Rehab

375

 

Postural Drainage Possible Complications and Safety Interventions during Pulmonary Rehab

376

 

Oxygen Safety

377

 

Cardiac Safety Rehab Guidelines after Medical Cardiac Procedures

378

 

Orthostatic Hypotension in Cardiopulmonary Rehab

379

SECTION 5-4

TYPES OF CARDIOPULMONARY INTERVENTIONS

380

 

Target Heart Rate

381

 

Patient Education: Rating of Perceived Exertion

381

 

Metabolic Equivalents and Activities

382

 

Patient Education Topics for Cardiac Disease

384

 

Phases of Cardiac Rehabilitation after Myocardial Infarction

385

 

Prevention Interventions for Coronary Artery Disease

386

 

Pulmonary Interventions: Terms Related to Postural Drainage

386

 

Postural Drainage Positions: Indications, Contraindications, and Precautions

387

 

Percussion and Shaking Techniques: Indications, Precautions, and Contraindications

389

 

Other Interventions for Pulmonary Rehab

390

 

Examples of Pulmonary Exercises

393

SECTION 5-5

CARDIOPULMONARY INTERVENTION PATTERNS

394

 

APTA’s Guide to Physical Therapist Practice—APTA’s Cardiopulmonary Intervention Patterns

395

 

Coronary Artery Disease Intervention Patterns

398

 

Congestive Heart Failure Intervention Patterns

400

 

Chronic Obstructive Pulmonary Disease (COPD) Intervention Patterns

401

 

Intervention Patterns: Chronic Restrictive Lung Diseases, Atelectasis, and Pulmonary Edema

402

SECTION 5-6

REVIEW OF CARDIOPULMONARY SYSTEM ANATOMY AND PHYSIOLOGY

404

 

Overview of the Heart

405

 

Arteries of the Body

408

 

Overview of the Coronary Circulation (Hemodynamics)

410

 

Blood Supply to the Heart

411

 

Overview of the Electrical Conduction of the Heart

412

 

The Autonomic Nervous System Influences on the Heart

413

 

Overview of the Pulmonary Anatomy, Including the Respiratory Muscles

414

PART V

INTEGUMENTARY INTERVENTIONS

419

SECTION 6-1

INTEGUMENTARY DATA COLLECTION

421

 

Burn Classification

422

 

Burn Wound Zones

423

 

Rule of Nines and Lund-Browder Burn Classifications

424

 

Complications of Burn Injury

426

 

Bum Healing

426

 

Normal Physiology of Wound Healing

427

 

Pressure Ulcer Staging

428

 

Wound Characteristics

430

 

Wound Closure

430

 

Signs of Potential Wound Infection

431

 

Factors Contributing to Abnormal Wound Healing

432

 

Arterial/Venous Insufficiency and Ulcers

432

 

Neuropathic Ulcers (Caused by Diabetes)

433

 

Classification of Edema

434

 

Grading of Arterial Pulses

435

 

Terms Related to Integumentary Lesions

435

 

Other Integumentary Signs and Symptoms

436

SECTION 6-2

CLINICAL IMPAIRMENTS AND FUNCTIONAL LIMITATIONS OF INTEGUMENTARY CONDITIONS

438

 

Clinical Impairments and Functional Limitations in Wounds/Bums and Ulcerations

439

 

Integumentary Conditions and Impairments (Not Related to Wounds, Bums, and Ulcerations)

439

SECTION 6-3

TYPES OF INTEGUMENTARY INTERVENTIONS

442

 

Bum Rehabilitation Interventions

443

 

Elements to Effect Wound Healing

444

 

Integumentary Patient Education

445

 

Patient Education for Skin Care

446

 

Patient Education for Foot Care

446

 

Wound Cleansing Methods

447

 

Wound Debridement Methods

448

 

Types of Wound Dressings

450

 

Patient’s Safety Precautions during Wound Interventions

453

 

Pressure Ulcers and Interventions

453

 

Other Integumentary Interventions for Lymphedema, Edema, and Wounds

455

 

Immnunocompromised Patients and Infection Control

457

SECTION 6-4

INTEGUMENTARY INTERVENTION PATTERNS

458

 

APTA’s Guide to Physical Therapist Practice—APTA’s Integumentary Intervention Patterns

459

 

Other Integumentary Intervention Patterns (Not Related to Wounds, Burns, and Ulcerations)

461

SECTION 6-5

WOUND DOCUMENTATION

463

 

Wound Documentation Elements

464

SECTION 6-6

REVIEW OF INTEGUMENTARY SYSTEM ANATOMY

465

 

Skin Anatomy

466

 

Sensory Receptors Location in the Skin to Identify Depth of the Bum

467

PART VI

GERIATRIC INTERVENTIONS

471

SECTION 7-1

GERIATRIC DATA COLLECTION

473

 

Theories of Aging

474

 

Sleep Patterns m Older Persons

476

 

Factors Contributing to Malnutrition (Protein Deficiency) in Older Persons

477

 

Risk Factors for Hypothermia in Older Persons

477

SECTION 7-2

AGE-RELATED IMPAIRMENTS AND FUNCTIONAL LIMITATIONS AND SUGGESTIONS FOR INTERVENTIONS

479

 

Muscular Impairments and Functional Limitations and Suggestions for Interventions

480

 

Skeletal Impairments and Functional Limitations and Suggestions for Interventions

481

 

Neurologic Impairments and Functional Limitations and Suggestions for Interventions

482

 

Sensory Visual Impairments and Functional Limitations and Suggestions for Interventions

484

 

Sensory Hearing Impairments and Functional Limitations and Suggestions for Interventions

485

 

Vestibular and Balance Sensory Impairments and Functional Limitations and Suggestions for Interventions

487

 

Somatosensory Balance Impairments and Functional Limitations and Suggestions for Interventions

488

 

Taste and Smell Impairments and Functional Limitations and Suggestions for Interventions

489

 

Cognitive Impairments and Functional Limitations and Suggestions for Interventions

490

 

Cardiopulmonary System Impairments and Functional Limitations and Suggestions for Interventions

491

 

Integumentary, Gastrointestinal, and Renal Impairments

493

 

Bladder Impairments and Interventions (for Incontinence)

494

SECTION 7-3

GERIATRIC DISORDERS/DISEASES AND INTERVENTION PATTERNS

495

 

Osteoporosis and Intervention Goals

496

 

Common Geriatric Fractures and Interventions

497

 

Degenerative Joint Disease and Interventions

499

 

Stroke and Parkinson’s Disease and Interventions

499

 

Cognitive Disorders and Intervention Goals

501

 

Cardiopulmonary Disorders/Diseases and Intervention Goals

504

 

Integumentary Conditions/Diseases and Intervention Goals for Pressure Ulcers

506

 

Diabetes Mellitus and Intervention Goals

507

 

Immobility and Intervention Goals

508

 

Falls and Intervention Goals

509

SECTION 7-4

REIMBURSEMENT OVERVIEW

512

 

Medicare Reimbursement

513

PART VIII

PEDIATRIC INTERVENTIONS

515

SECTION 8-1

PEDIATRIC DATA COLLECTION

517

 

Pediatric Screening Tests

518

 

Infant Reflexes and Possible Effects If Reflexes Persist

521

 

Impairments and Functional Limitations of Tonic Reflexes when the Reflexes Persist

524

 

Other Reflexes and Postural Reactions

524

 

Reflexes and Developmental Reactions of Childhood

526

 

Pediatric Development of Gross and Fine Motor Skills

527

 

Common Surgical Procedures for the Hip in Children

535

 

Juvenile Rheumatoid Arthritic Medications and Possible Side Effects

536

 

Scoliosis Classifications

536

 

Common Surgical Procedures for Scoliosis

537

 

Types of Developmental Dysplasia of the Hip in Infancy

538

 

Spina Bifida Classification and Functional Skill Levels

539

 

Classifications of Cerebral Palsy

539

 

Common Causes of Cerebral Palsy

541

 

Genetic Disorders

545

 

Osteogenesis Imperfecta

547

 

Slipped Capital Femoral Epiphysis

549

SECTION 8-2

PEDIATRIC INTERVENTIONS

550

 

Screening for Scoliosis

551

 

Pediatric Mobility Interventions

551

 

Pediatric Orthotic Interventions

553

 

Other Types of Pediatric Physical Therapy Interventions

555

 

Pediatric Wheelchair Positioning Components

556

SECTION 8-3

PEDIATRIC DISORDERS/DISEASES AND INTERVENTION PATTERNS

558

 

Pediatric Spondyloarthropathies and Intervention Patterns

559

 

Pediatric Orthopedic Disorders/Diseases and Intervention Patterns

560

 

Other Pediatric Disorders/Diseases and Intervention Patterns

564

APPENDIX A

BERG BALANCE SCALE

569

APPENDIX B

PATIENT EDUCATION: BORG SCALE OF RATING OF PERCEIVED EXERTION

574

APPENDIX C

SKIN CARE FOR LYMPHEDEMA

576

APPENDIX D

PATIENT EDUCATION FOR SKIN CARE (FOR DIABETES)

578

APPENDIX E

PATIENT EDUCATION FOR FOOT CARE (FOR DIABETES)

580

 

Index

583