Module 2 - Week 1 Objectives

Glia

"Glue" -Supporting cells -Astrocytes -Oligodendrocytes -Microglia

Home Health

-Role: Maximize function (or maintain/slow decline) with a goal of progressing to outpatient PT -Referrals: Could come from any type of MD/PA/NP overseeing the pt's care -Duration of Care: 1 week to months -Care Planning/Goal Setting: Weekly team conferences to optimize care/plan for discharge -Short term goals - 1 week -Long term goals - discharge

Inpatient Rehabilitation Facility (IRF)

-Role: Maximize function and attain the highest level of independent possible with the #1 goal of discharging to home (+/- caregiver support); working as a TEAM -Referrals: In-house MD (neurologist or physiatrist) -Duration of Care: 1-8 weeks -Care Planning/Goal Setting: Weekly team conferences to optimize care/plan for discharge -Short term goals - 1 week -Long term goals - discharge

Acute Care Hospital

-Role: Maximize function prevent complications of bedrest -Referrals: In-house MD -Duration of Care: 1 day to several weeks (on avg) -Care Planning/Goal Setting: Work social worker to coordinate location of "discharge" and need for equipment and f/u; One set of goals that are set for time of discharge

Early Intervention (Pediatrics)

-Role: Support families in promoting their child's development, learning, and participation in family and community life -Referrals: Source is dependent upon direct access. In MO, must come from MD or other approved practitioner. Otherwise can be family, daycare, etc. -Duration of Care: Typically until 3rd birthday. Can discontinue services if goals are met, but not recommended. -Care Plan/Goals: Reviewed every 6 months. LTGs: 6 months. STGs: varies, dependent on frequency. Focus: Activity and participation -Types of Patients: Infants/toddlers with ALs that affect participation. Not infants who only have impairments that don't interfere participation -Attributes of a Successful PT: Loves babies & adults. Good handling skills. Doesn't mind getting on the floor and dirty. Creative. Willing to drive. Interested in home health.

School-Based (Pediatrics)

-Role: Support student's IEP. Assist students in accessing school environments and benefiting from their educational program -Referrals: Teacher, parent/guardian, other concerned party, must also have an MD referral if not in a direct access state -Duration of Care: School year. Reevaluated yearly, sometimes at semester. Can go until 21 -Care Plan/Goals: Team meets every 6 months to review PLOF and IEP. LTGs: School year. STGs: Monthly. Focus: Activity and participation -Types of Patients: Children with ALs that affect participation in educational environment. Not children who have impairments that are managed in outpatient physical therapy. -Attributes of a Successful PT: Loves kids. Patient with communication. Doesn't mind getting on the floor and dirty. Creative. Wants summers off.

Control

-Smoothness, coordination, stability, sequencing, timing, initiation -Normal -Limited control

Inhibition of Growth Hormone

-Somatostatin -Somatomedins (IGF-1 by negative feedback) -Increased free fatty acids in the blood -Administration of Exogenous GH -Obesity -Senescence (aging)

PTs Role in Tertiary Care

-Specialized Unit -Example: Burn Unit, etc.

Symmetry

-Speed, amount, or control of movement is similar on the right and left -Symmetrical or Asymmetrical

List healthcare settings in which physical therapists practice.

-The Emergency Department (ER) -Acute Care Hospital -Inpatient Rehabilitation Facility (IRF) -Home Health -Skilled Nursing Facility (SNF) -Outpatient Therapy - Tremendous Variability -Pediatrics (Early Intervention, School-Based, Outpatient, Inpatient, Home Health, pool, playground, etc.)

Describe the main functions of the major CNS regions.

-The central nervous system CNS is responsible for integrating sensory information and responding accordingly. It consists of two main components: The spinal cord serves as a conduit for signals between the brain and the rest of the body. It also controls simple musculoskeletal reflexes without input from the brain. -The central nervous system has been thoroughly studied by anatomists and physiologists, but it still holds many secrets; it controls our thoughts, movements, emotions, and desires. It also controls our breathing, heart rate, the release of some hormones, body temperature, and much more.

Describe how movement and psychosocial factors influence the pain condition.

Biopsychosocial Model: -Importance of understanding the complex biological psycho-social nature of pain -The model helps us understand why 2 people with the same diagnosis may have very different outcomes. -Variation in person's psychology and social environment help to explain differences -Apply concepts of the ICF model **Look at picture of graph on google doc**

The Emergency Department (ED)

-Role: Highly skilled at diagnosis and coordination; triage -Referrals: In-house MD/PA/RN -Duration of Care: <24 hours -Care Planning/Goal Setting: Work with ED staff members to coordinate location of "discharge" and need for equipment and f/u (follow-up)

Skilled Nursing Facility (SNF)

-Role: Maximize function (or maintain/slow decline) with a goal of discharge to home -Referrals: Could come from any type of MD's who staff the SNF -Duration of Care: 1 week to months -Care Planning/Goal Setting: Care conferences to optimize care/plan for discharge -Short term goals - 1 week -Long term goals - discharge

Nociceptive Pain

-"...arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors" (injury, inflammation, or mechanical irritant) -Examples: injured hamstrings muscle or infection in the kidney

Nociplastic Pain

-"...arises from altered nociception despite no clear evidence of actual or threatened tissue damage..." -sensitization is under this umbrella (Chimenti 2018) -Increased responsiveness of nociceptive neurons to their normal input or subthreshold inputs elicit a response

Neuropathic Pain

-"...arises from lesion or disease of the somatosensory nervous system." -Example: sciatica (involvement of the nervous system)

Primary Prevention

-"The ameliorate of specific risk factors in susceptible population" (i.e. obesity) -Primary prevention (aimed at avoiding a negative health condition) -Examples: washing hands, eating fruits and vegetables, exercise, sleep, body mechanics education -Does not have the problem yet, prevent it from happening

Movement System Diagnosis

-A term that refers to a condition or syndrome of the movement system. -Physical therapists make movement system diagnosis but there is no ownership of diagnosis by the profession. (PT Diagnosis - do not like the term, a diagnosis made by the physical therapist for a movement, we do not own them) -The diagnosis made by a physical therapist must be based on an examination that is within the scope of our practice.

Tertiary Prevention

-Actions taken to limit disability and improve length and quality of life among individuals who are symptomatic (eg, rehabilitation for individuals with lower limb amputation secondary to diabetic peripheral neuropathy) -Improve their quality of life, help with their management of their disease -Walking stick for someone with osteoporosis to continue walking, phone with reading screen for someone who is hearing impaired

Amount

-Can you complete the task at hand (or with forward bend, can you touch your toes, etc.) -Amplitude, excursion, ROM required to complete the activity. -Normal, limited or excessive -If an activity requires movement at multiple joints, describe the amount of the task that can be completed -Could use % or walking distance

Describe components and inter-relationships of the iron triangle of healthcare

-Cost Containment: can't pay everyone everything they want to all the time (contain cost to make the whole system doable) -Quality: want high quality care for the people -Access: want everyone to have the ability to see doctors and specialists that they need to see -Very hard to achieve all of these things at once. (a push-pull relationship, do too much of one thing and greatly affect other things) -Look at PowerPoint slides for more details on these things

Understand the importance of performing a systematic examination.

-Learn about the patient's history and review of systems, movement system review, and test and measures to best diagnosis (use the patient/client management model) to learn more about what they need help with and how you can help them reach their appropriate outcomes/goals

Name factors that have shaped the delivery of the U.S. healthcare system

-Cultural Beliefs, Values -We want this and we want it know -Don't have to wait -Advances in Technology -We like our technology and want it now (MRI, CT, etc.), however there is a cost to that) -Economic Constraints -Make decisions on healthcare based on how much it costs, if you can afford it or not -Social Changes -Immigration status - provide healthcare to them or not? -Shift towards urbanization - no hospitals in rural areas - healthcare more difficult in rural areas -Political Opportunism -Things and policies related to politics -Make change in healthcare is very difficult and complicated to due with the U.S. politics

Secondary Prevention

-Early detection of disease during a detectable, asymptomatic period through clinical and population-based screening. -Examples: blood pressure levels - unaware of having hypertension, tell them that they have hypertension but don't have any symptoms, provide education for it, increase activity level, lower salt intake, diet, etc -Example: scoliosis - forward bending to see if you have scoliosis in children, and provide education to parents, and forward information to doctor

What is Evidence-Based Practice?

-Forms a diagnostic and therapeutic alliance which optimizes outcomes and quality of life Determining "Best Research Evidence" requires critical appraisal of the evidence. -Determine quality and judge how much confidence to place in the author's conclusions -Understand the population in a study to determine whether the results apply to your patients or clients -The strength of the evidence is related to methods used to obtain it.

Stimulation of Growth Factor

-GHRH -Ghrelin (also orexigenic: hunger hormone) -Sleep -Fasting, acute hypoglycemia -High protein meal -Exercise -Estrogen and Androgens -Physiological Stress (i.e., trauma, surgery, infection, fever)

Define key terms used in the International Classification of Functioning, Disability and Health (ICF) model.

-Health condition is the first ICF term. -Body structures are anatomical parts of the body such as organs, limbs, and their components -Body functions which are physiological functions of body systems, including psychological functions -Activity is the execution of a task or action by an individual. When lacking, is referred to as an ACTIVITY LIMITATION -Participation is the involvement in a life situation. When lacking, is called a PARTICIPATION RESTRICTION -Environment is a contextual factor that includes the physical, social, attitudinal environment in which people live and conduct their lives. -Personal factors are recognized in the model, but they are not classified in the ICF. Such factors influence how disability is experienced by an individual. ICF Terms: -Problems with the body structures and functions are called IMPAIRMENTS. -DISABILITY refers to decrements in impairments, activity limitations or participation restrictions

Discuss the effects of Growth Hormone and IGF-1 on bodily functions to include regulation growth and development and metabolism.

-Human growth hormone (hGH) plays a pivotal role in postnatal growth and development. Growth hormone helps to maintain lean body mass and bone density in adults. During fasting situation, growth hormone helps to raise blood glucose and stimulates lipolysis and fat utilization. -Many of the effects of growth hormone are indirect and are stimulated by the Liver secretion of Somatomedins are known as insulin-like growth factors (IGF). (The most common Somatomedin is Somatomedin C is called IGF-1). Many other tissues also secret tissue IGFs in response to GH stimulation. Metabolic Effects: Increase protein synthesis (synergistic action with Insulin) Increased amino acid transport into cells Stimulation of transcription and translation Inhibit protein catabolism Mobilization of fatty acids and utilization of fatty acids Stimulates release of fatty acids from adipose cells therefore see an increase in plasma FFA and ketoacids Increase oxidation of fatty acids by the body's cells Effect of Carbohydrate (CHO) metabolism is to decrease utilization of glucose, therefore elevate blood glucose; an effect often called "anti-insulin effect". GH is a diabetogenic hormone because it increases insulin resistance, especially in situations of in high GH concentrations. Decreased glucose uptake into muscles and adipocytes Simtulates glucose production by the liver (gluconeogenesis) Growth Promoting Effects: -The growth promoting effects of hGH requires normal insulin levels and adequate diet of CHO & protein. -GH-IGF stimulates linear growth in bone by stimulating all aspects of chondrocyte function. -Increase amino acid uptake -Increase protein synthesis -Increased collagen -Increased chorndroitin sulfate -Increase cell size and number -Total bone mass and mineral content of bone are increased by GH -GH-IGF is a potent stimulator of osteoblastic activity -Hypertrophy and hyperplasia of visceral organ -Increased growth of heart, lung, liver, pancreas, GI tract, adrenal glands, etc. -GH sensitizes the gonads to LH and FSH during puberty

Learners will differentiate basic study designs in experimental versus observational sciences.

-If experimental > observational, why do observation studies at all? -First, you don't always need experiments to establish cause or have strong testable theories (e.g., geology, astronomy) -Second, observational studies have history made major advancements in population health and epidemiology (Florence Nightingale and germ theory, John Snow and cholera, the list is long) -There is more weight put on experimental trials. However, we also know that observational studies are very valuable and "control" can be achieved (at least partially) in non-experimental settings. -No one single study can have the answer for a topic. Most studies have studies that find complete different finding from each other. **Look at picture on google doc**

Categories in the Review of Systems

-Integumentary, musculoskeletal/neurological, rheumatologic, cardiovascular, pulmonary, psychologic, gastrointestinal, hepatic/biliary, hematologic, genitourinary, gynecologic, endocrine, cancer, immunologic

Peripheral Nervous System

-It includes somatic and autonomic divisions. -Use the terms ganglia and nerves when describing PNS structures.

Diagnosis

-It is a label encompassing a cluster of signs and symptoms commonly associated with a disorder or syndrome or category of impairment, functional limitation, or disability. It is the decision reached as a result of the diagnosis process, which is the evaluation of information obtained from the patient/client examination. -The purpose of the diagnosis is to guide the physical therapist in determining the most appropriate intervention strategy for each patient/client. In the event the diagnostic process does not yield an identifiable cluster, disorder, syndrome, or category, intervention may be directed toward the alleviation of symptoms and remediation of impairment, functional limitation, or disability.

Critical Appraisal

-It is not the same as doing research. -First, you will learn to understand and assess the scientific credibility of individual studies and then groups of studies

Reliability

-It is the extent to which a measurement is consistent across time, raters, contexts. -I.e., are our measurements consistent? -Reliability is necessary precondition for validity -Arm degree angle (example)

Discuss evidence regarding administration of growth hormone to promote muscle hypertrophy and function.

-Look at case studies on the One Notes -First case: resistance exercise improved muscle strength and anabolism, but the improvement were not enhanced when exercise was combined with daily GH administration. -Second case: In the young men studied, resistance exercise with or without GH resulted in similar increments in muscle size, strength, and muscle protein synthesis, indicating that 1) the larger increase in FFM with GH treatment was probably due to an increase in lean tissue other than skeletal muscle and 2) resistance training supplemented with GH did not further enhance muscle anabolism and function. -Third case: In this study, GH with or without sex seriods in healthy, aged women and men increased LBM (lean body mass) and decreased fat mass. Sex steriod + GH increased muscle strength marginally and O2 max in men, but women had no significant change in strength or cardiovascular endurance. Because adverse effects were frequent (importantly, diabetes and glucose intolerance), GH interventions in the elderly should be confined to controlled studies.

Classify a person's health using the language of the ICF model.

-Look at powerpoint for the person's health in the ICF Model Example from the PowerPoint: -Health Condition: Stroke -Body Structure & Functions: Quadriceps Muscle & Weak -Activity: Gait -Participation: Work -Environmental Factors: Urban Environment -Personal Factors: 72, Male ***Look at the slide in the google doc for more information***

Tests and Measures Categories

-Mental Status/Cognition, Posture/Alignment, Movement, Cardiorespiratory Function, Range of Motion, Muscle Performance, Muscle Length, Coordination, Muscle Tone, Reflexes, Sensation, Tissue Integrity, Vision, Vestibular Function, Endurance/fatigue, Equipment needs

Classification of Data

-Nominal -Ordinal -Interval -Ratio

PTs Role in Primary Care

-PT principal provider (main provider) -PTs are part of the primary care team (interprofessional experts will be helpful, working as a team)

Identify red flag symptoms and clusters of signs and symptoms that suggest involvement of a physiological system.

-Page 7-8 from the Differential Diagnosis for Physical Therapists -Symptoms in last 6 months that may suggest problems requiring referral to another health care practitioner -Risk Factors: age, gender, race/ethnicity, BMI, substance abuse, tobacco use, exposure to radiation, sedentary lifestyle, domestic violence, occupation, hysterectomy -Review of System -Stroke is a big one here (any numbness or tingling over one side and not the other) **Look at pictures of table on google doc**

6 Key Points Provided with the Definition of Pain

-Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors -Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons. -Through their life experiences, individuals learn the concept of pain. -A person's report of an experience as pain should be respected. -Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being. -Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or nonhuman animal experiences pain.

Describe how diagnosis relates to the following models; patient client management, kinesiopathologic, pathokinesilogic, and the ICF.

-Pathokinesiology Model: Pathology results in movement impairments -Kinesiopathology Model: Impairment in movement lead to pathology -ICF: Diagnosis through the different parts of the ICF (look at the PowerPoint) -Patient Client Management: Diagnosis - What is the label for these movement impairments?; Use the 6 essential parts to this management model to discover a diagnosis, especially the examination and evaluation to determine the diagnosis for the patient

Secondary Care

-Patients with musculoskeletal, neuromuscular, cardiovascular/pulmonary, or integumentary conditions may be treated initially by another practitioner and then referred to physical therapists for secondary care. -Provided in a wide range of settings -Where you envision yourself the most Examples: Secondary Care in Various Settings: -Provider, Educator, Supervisor, Critical inquiry -Acute care in hospital (knee replacement, in-patient and then out-patient after surgery) -Rehabilitation Center -Skilled Nursing Home -Outpatient clinic -Home -School Systems -PT receives a referral for evaluation and treatment of a 65 year old who had a total knee replacement. Any setting above except the school system.

Primary Care

-Provision of integrated, accessible health care services -Addresses a large majority of personal health care needs -Involves a sustained partnership with patients -Practice takes place within the context of family and community Examples of Primary Cases in Various Settings: -Acute problem in neuromusculoskeletal system: -Examination, diagnosis, and intervention -Prevents delay of care - more efficient -Examples of settings: workplace, military (direct access, order imaging), etc. -Chronic health conditions: -PT coordinates care to prevent loss of function -Examples of settings: Schools, YMCA, nursing homes, skilled nursing facilities

Ordinal

-Quantitative differences, but no fixed intervals -Values are ordered, but differences aren't meaningful -Preferences, contest placing, years of education -1st - 2nd (not equal) 2nd - 3rd -Mathematical notion of greater-than (>, =) -Additional meaningful statisitics -Median, quantiles -Range, interquartile range

Choose PT relevant example of different data types.

-Record Review (retrospective) -Interview -Questionnaires -Observation -Manual Assessment -Use of equipment/technology -Video, photo, EMG, scale, goniometer 11-point scale: -Interval Data 6-minute walk test (distance) -Ratio (true zero point) Fear Avoidance Beliefs Questionnaire -Ordinal Data (no true zero, in order, no numeral value for one question, could be interval with average score of all questions due to being able to get a mean) Nominal: -2 intervals -Pain (1) -No Pain (0) -Or categories with no order Ratio: -Time on activity measured in seconds (e.g., 3651 sec) Interval Data: -Time of day measured in hours and minutes (e.g., 1:15 pm for 13:15) Ordinal Data: -Time of day as qualitative phase (e.g., morning, midday, and night) -Geological times (one time coming before another)

Outpatient Therapy - Tremendous Variability

-Role: Address home/work/recreational activities (and health promotion/prevention) -Referrals: Could come from any type of qualified referring provider -Duration of Care: 1 day to months -Care Planning/Goal Setting: No formal care planning meetings; can make coordination of care challenging; -Short term goals = 1 month -Long term goals = discharge

Describe desirable characteristics of a test or measure.

-They are objective tests or more specific tests to determine a diagnosis, prognosis, and plan of care. -Tests and measures are the means of gathering reliable and valid cellular-level to person-level information about the individual's capacity for, and performance during, movement-related functioning. Characteristics of a good measuring tool: -Consider Pyschometric Properties: -Reliable -Valid -Responsiveness -Sensitive to change and individual differences -Psychometric properties are characteristics of tests and other measurements of human characteristics that identify and describe attribute of an instrument, such as its reliability or appropriateness for use in a particular circumstance. -Make sure it measures change

PTs Role in Secondary Care

-Typically referred from doctor -How most physical therapy runs - treated by someone else and then come to physical therapy -No direct access

Patient Values

-Unique preferences, concerns, and expectations each patient brings to a clinical encounter -Must be integrated into clinical decisions if they are to serve the patient -Example: Cowboy boots, very important to patient, do not take them off of her, adjust to the situation

Clinical Expertise

-Use of clinical skills and past experience -Rapidly identify each patient's unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations

Describe the process used when performing the examination.

-Use the patient/client management model to go through the examination process: look at their history and review of systems, movement system review, and test and measures. Look at previous questions and PowerPoint for examples and more details on this. -Be sure to look at everyone going on in the patient to see if they are good for physical therapy and how you can help -Use previous history in file to help learn more about the patient even before they go in. -Establish good rapport with your patient - allow them to feel comfortable and safe

Movement System Review

-Vital Signs (resting pulse, BP, RR, Temp) -Mental status (alert, oriented, able to follow commands) -Appearance (general and specific) -Posture/Alignment (gross assessment) -Movement (movements, tasks, activities)

5 Steps of Evidence-Based Practice

1. Convert the need for evidence into answerable questions. 2. Track down the best evidence 3. Critically appraise the evidence (may go back and check the question, first three steps repeat over time) 4. Integrate the appraisal with clinical expertise and patient values 5. Evaluate our effectiveness and efficiency -Determine a question/direction for future research

History - Main Categories

1. Reason for seeking PT 2. Personal Information 3. Living Environment 4. Abbreviated Review of Systems 5. Medical/Surgical History 6. Current Medications 7. Current Health Behaviors 8. Self-report Measures 9. Safety and Well-Being 10. Goals -Framework does not typically provide a script. -Not an exhaustive list, just a sample

Define 3 pain classifications identified by the International Association for the Study of Pain (IASP): nociceptive pain, neuropathic pain, and nociplastic pain and recognize the type of pain in case examples.

3 IASP Pain Classifications: -Nociceptive Pain -Neuropathic Pain -Nociplastic Pain -A person may have 1, 2, or all 3 types.

In reference to measures, define the terms standardized, non-standardized, and self-report or performance based.

A standardized test is a test or questionnaire that is administered and scored in a consistent, or "standard", manner. Not all standard test are norm referenced. -Example: the Berg Balance Scale is a standard test of balance A non-standardized test is one that allow for assessment of an individual's abilities or performances, but doesn't allow for a fair comparison of one student to another. -Examples: visual appraisal of alignment or palpation - you will be given rules to make these assessments more objective but simply observing alignment or feeling a structure is not standardized. Performed-Based: -6 Minute Walk Test -Patient doing activity and takes measure, taken by the physical therapist Self-Report Measure: -Pain Scale -Pain intensity is according to the patient, can be different for everyone

Understand a patient's capacity versus performance in a specific environment.

Activity Qualifiers: -Capacity is the level at which a person has the potential to do in a standard environment without personal assistance or equipment. Indicates the highest probable level of performance at a given moment. Typically assessed in a standardized environment. -Performance is the level at which a person actually performs in the person's current environment ("involvement in a life situation" or "the lived experience"). This environment can include assistive devices or personal assistance if available. These can be captured via self-report or direct performance. Capacity and performance are not always equal. -Capacity < Performance -The person's environment has enabled him/her to perform better than what data would predict -Capacity > Performance -Some aspects of the environment is a BARRIER to performance.

The nervous system has two major subdivision:

Central and peripheral

Understand the role of data obtained from the medical record, history, examination, and a review of systems in patient screening when screening a patient/client for physical therapy management.

Decide what to do: -Diagnosis/Classification and Intervene -Refer out -Both Purpose of Screening: -ID medical emergencies (emergent signs or symptoms) -ID signs and symptoms of medical condition (red flags, pg 7-8) -Look for pattern that suggest a viscerogenic or systemic origin of pain or symptoms

Decide on an appropriate action based on the results of the screening process; immediately refer out; diagnose and treat the physical therapy problem(s) and refer out for non-physical therapy problem(s); or diagnose and treat the physical therapy problem and do not refer out.

Decision to REFER OUT: -Concerns alerting you to NonPT problems: -Pain is vague, general or throbbing -Weakness is general -Signs and symptoms are symmetrical -Signs and symptoms involve multiple joints -Constitutional signs and symptoms -Pain behavior is nonmechanical -Other: trauma, fever, clustering Factors to Consider: -Is there a PT problem, or a nonPT problem or both -If both, are the problems related? -Is the nonPT problem controlled? -If nonPT is uncontrolled, -is control needed before treatment Example: -PT only: Neck Pain/Cervical Rotation Syndrome -PT and nonPT unrelated: Neck pain and Cervical Rotation Syndrome and uncontrolled HBP (high blood pressure) Another Example: -PT and nonPT related: 12 year old male long jumper in track with knee pain at insertion of patellar tendon on tibial tuberosity -NonPT only: Pain in multiple joints, fever

Communicate in an effective manner by using empathy, verbal and nonverbal skills, language understood by patients and motivational interviewing skills.

Do in lab - look at notes in PowerPoint Elements for Meeting Expectations: Community during History and Review of System: 1. Introduces self (including pronouns) and determines patient's preferred name and pronouns. 2. Listens actively 3. Expresses empathy as appropriate 4. Non-verbal communication appropriate (eye contact, appropriate proximity to patient, projects confidence, lack of fidgeting) 5. Avoids medical jargon and offers clear/understandable explanations as appropriate 6. Demonstrates cultural competence through respecting background beliefs and individuality 7. Effective closure of discussion (summarizes key findings, asks if person has any questions)

Define the 6 essential elements of patient/client management

Examination: -History, systems review, tests and measures Evaluation: -Clinical Judgements -How do you interpret these findings? -Lumbar spine is extended and rotated -Hamstrings are short and stiff -Lumbar -Not a test and measure, clinical reasoning -What you do in your brain to evaluate the information that you just got/evaluation of data Diagnosis: -What is the label for these movement impairments? -Lumbar Extension Rotation Prognosis: -Expected outcome; optimal level of improvement in function -Time frame -Moderators (+/-) -Not always gets completely better or recovery, intervention what do you think they can be able to do over time -Rating: good, fair, poor, etc. Intervention: -Instruction -Education and training for Patient/client, caregivers, families -Direct - Procedures (Directed by the diagnosis) -Therapeutic exercise, functional training, manual therapy, and others -Must determine type and intensity -Coordination, Communication, Documentation: -Administrative and supportive processes for quality of care -Coordination of all parties involved with patients/client -Communication (exchange of information), -Documentation (entry into patient/client record) -Includes re-examination & modification of intervention Outcomes: -Results of the implementation of the plan of care -Use standard measures whenever possible to objectively document outcomes of PT intervention. **Look at powerpoint for example for more specific details on these steps.** May need to refer them out if needed.

Understand the types of diagnoses made by a physical therapist.

Example of Diagnosis: Pathoanatomy: -Rotator cuff tear -Basal cell cancer -Cerebrovascular accident -Pain Name: -Parkinson's Disease -Diabetes -Lou Gehrig's Disease Movement: -Scapular Depression - scapula is setting too low -Hip Adduction with Medial Rotation -Movement Pattern Coordination Deficit - common for people who have had cerebrovascular accidents -**What the physical therapist diagnosis**

Ratio

Fixed intervals and a true zero point that indicates the absence of a quality -Zero is meaningful -Physical properties. -Weight, time, etc. -Ratios between scores make sense -Twice as heavy, twice as long -Mathematical notion of division (/, -, >, =) -No notable new statistics

Intervals

Fixed intervals, but no true zero point. -Differences between scores are meaningful -Today is 4 degrees warmer than yesterday -Ratio of scores can be misleading -20C (293 K) is not twice as hot as 10C (183 K) -Also consider IQ tests, time of day -No real zero point -Mathematical notion of subtraction (-, >, =) -Additional meaningful statistics -Mean -Variance, standard deviation

Identify the tasks comprising the movement portion of the movement system review.

From example in PowerPoint: Movement Portion of MS Review: -Head Movement (up/down, rotate, sidebend) -Hand and Arm Use (readching, grasping, manipulating) -Maintaining and Changing Body Position -Rolling -Lying to sit to lying -Sit to stand to sit -Forward bending* -Squatting -Single leg standing to single leg squat* *WashU DPT added objectives Mobility: -Crawling/walking/running/wheelchair -Step up and step down -Hop or jump* *WashU DPT added objectives **Look at notes in OneNote for more information on this**

Microglia

Garbage trucks of the CNS, clearing debris following damage

Identify 5 milestones in the evolution of health insurance and how milestones have affected healthcare delivery

Health Insurance System (1800's-1930's): -1800 to 1900: Insurance was purchased by similar to car insurance. In 1847, the Massachusetts Health Insurance Co. of Boston was the first insurer to issue "sickness insurance" -1900 to 1920: In 1913, the International Ladies Garment Workers began the first union-provided medical services. The National Convention of Insurance Commissioners drafted the first model for regulation of the health insurance industry. -1920s (1929): The blueprint for health insurance was established with a hospital insurance plan for school teachers at the Baylor University Hospital in Texas Health Insurance System (1930's-1960's): -1930s: Discussions regarding the development of a national health insurance program. AMA opposed the move; With the Depression and WW I, the funding was not available. In 1935, President Roosevelt signed the Social Security Act (SSA), which created "old age insurance" -1940s to 1950s: The War Labor Board froze wages, forcing employers to offer health insurance to attract potential employees. In 1947, the Blue Cross Commission was established to create a national doctors network. By 1950, 57% of the population had hospital insurance. -1965: President Johnson signed Medicare and Medicaid programs into law Health Insurance System (1970's-1980's): -1970s to 1980s: President Nixon signed the HMO Act (predecessor of managed care) -In 1982, Medicare proposed paying for hospice or end-of-life care. In 1982, diagnosis related groups (DRGs) and prospective payment guidelines were developed to control insurance reimbursement costs. -In 1985, the Consolidated Omnibus Budget Reconciliation Act (COBRA) required employers to offer partially subsidized health coverage to terminated employees. Health Insurance System (1990's-2000): -1990 to 2000: President Clinton's Health Security Act proposed a universal healthcare coverage plan, which was never passed. -In 1993, the Family Medical Leave Act (FMLA) was enacted, which allowed employees up to 12 weeks of unpaid leave because of family illness. -In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was enacted, making it easier to carry health insurance when changing employment. -In 1997, the Balanced Budget Act (BBA) was enacted to control growth of Medicare spending. It also established the State Children's Health Insurance Program (SCHIP) (Medicaid for children) Health Insurance System (2000-2015): -2003: The Medicare Prescription Drug, Improvement, and Modernization Act was passed, which created Medicare Part D, prescription plans for the elderly. -2010: The ACA was signed into law, making it illegal for insurance companies to rescind insurance on their sick beneficiaries. Consumers can also appeal denials by the insurance companies. Insurance companies are unable to impose lifetime limits on essential benefits. -2013: Individual can buy qualified health benefits plans from the Health Insurance Marketplaces. If an employer does not offer insurance, consumer can purchase it from the federal Health Insurance Marketplace. -2015: CMS began to reduce payments to hospitals if Medicare pts re-admitted within 30 days

Describe the purpose of the three main components of an examination: history and review of systems, movement system review, and tests and measures.

History: -Establish rapport -Visual appraisal -Gather data to determine a working movement system diagnosis or identify problems that need to be referred out -Gain an understanding of the person as a whole -Find out information about a person's past and present health status, particularly related to the reason for seeking physical therapy -Obtained through your interview and a review of the medical record Review of Systems: -Review of systems: a checklist; each body system is included with a list of symptoms or signs that might suggest involvement of that system. -The full review of systems is most useful as a resource for questioning after you have completed your full examination. -If you are suspicious of involvement in a particular system or presence of a condition such as cancer, you can find the category on the handout and ask about the items listed Movement System Review: -Vital Signs (resting pulse, BP, RR, Temp) -Mental status (alert, oriented, able to follow commands) -Appearance (general and specific) -Posture/Alignment (gross assessment) -Movement (movements, tasks, activities) Tests and Measurements: -Objective tests or more specific tests to determine a diagnosis, prognosis, and plan of care -Specific clinical tests and measurements used for confirming a diagnosis and identifying contributing factor -Exam as a whole helps you determine the diagnosis, prognosis, and plan of care

Understand the use of information about pain behavior in screening and determining the appropriateness of physical therapy management.

History: Reason for Seeking PT: -Pain is a primary complaint with most musculoskeletal problems but also present in many other conditions. Definition of Pain (Traditional) -Old definition: An unpleasant sensory experience associated with tissue damage -Term used to describe the behavior of pain -Mechanical vs. Non-mechanical Mechanical Pain: -Caused by stress to nociceptors -Process is NOT primarily inflammatory -Intermittent, but if constant varies in intensity -Relieved with rest -Modified by position or movement -PTs can help with this! Appropriate for our management Nonmechanical Pain: -Primary cause is systemic, inflammatory (chemical) or neoplastic -Not relieved by rest -Not modified by position or movement -More constant, intensity does not vary -PTs can't really help with this! Not appropriate for our management Pain: Involves both ascending and descending pathways of the nervous system. Emotional; not always tissue damage; recognition of pain (may not be able to communicate it to you verbally; look for nonverbals) Mechanisms-based Classification: -Classify pain according to the underlying neurophysiological mechanism for the generation or maintenance of pain. -Concepts of mechanical and nonmechanical are still relevant.

Somatomedins

IGF-I (insulin-like growth factors)

Problems with the body structures and function are called

Impairments

Nominal

It can be labeled, qualitative differences. -Values are just labels -Sex: (male, female) -Color: (red, green, blue....) -No structure or relationships between values -Essentially non-numeric -Can use number for "coding" but just as placeholders -Red = 1; green = 2; blue = 3 -Only mathematical notion is equality (=) -Two scores are equal or they're not -Few meaningful statistics -Frequencies: Number of scores of a given value -Mode: Value with greatest frequency

Sulcus

It is a cleft on the cerebrum.

Critical Inquiry

It is a process of applying the principle of scientific methods to: -read and interpret professional literature (primarily for us as first year) -participate in, plan, and conduct research -evaluate outcome data (primarily for us as first year) -assess new concepts and technologies

Gyrus

It is a ridge on the cerebrum.

Validity

It is the extent to which a concept, conclusion or measurement corresponds accurately to the real world. -I.e., does your data reflect the quality you intended to measure? -Validity is not an absolute property of a tool, however, it depends on context.

Disability

It refers to decrements in impairments, activity limitations, or participation restrictions.

Provide examples of settings and roles and in primary, secondary, and tertiary prevention.

Levels of Prevention: -Primary -Secondary -Tertiary Settings: -Health fair (screening role) -Health club -Schools -Community based agencies -Also in settings already mentioned such as hospitals, rehabilitation centers, and outpatient clinics The Case of Osteoarthritis: -Primary (avoiding it) -Secondary (reducing its impact with early detection) -Tertiary (dealing with it) -Look at details of this on powerpoint notes

Astrocytes

Maintaining appropriate chemical environment to permit electrical signaling in the neuron.

Oligodendrocytes

Make myelin in CNS, serves as insulation for neurons

Learners will describe levels of evidence in medicine, including case studies, cohort studies, and randomized (controlled) trials.

Observation + Intervention + Follow-Up + Control + Randomizing + Blinding Example in PowerPoint: -Observation: Watch people over time to see natural progression with low back pain, create a study by watching them -Intervention: People come to you for the study for intervention, but it is not until pain is really bad (even when it gets really bad, people tend to get where it feels better and vice versa) -Follow-Up: Assessment throughout the year to see if it was a transitory change or permanent change (try to see bias) -Control: Have a group that did do it versus a group that did (the control) -Randomization: Put people randomly in groups to avoid bias and make sure it is balanced in each group -Blinding: Allow the participant and potentially the assessors or therapist not to know who is in what group to prevent bias -The more steps you take in this equation above, the further up you will go on the level of evidence pyramid. **Look at picture on google doc**

Describe the purpose of measuring patient outcomes.

Outcomes: Definition from the Guide: -The end result of patient/client management, which includes the impact of PT intervention. -What outcomes should be tracked to document change? -These outcomes help you know when goals have been achieved and patient is ready for discharge or end the episode of care. -Select only those measures as outcomes that are relevant to your patient case

Orexins

Peptides that regulate food intake, wakefulness, energy expenditure

Reflect on the reliability and validity (e.g., identifying potential sources of bias) for self-report and performance-based measures.

Performed-Based: -6 Minute Walk Test -Patient doing activity and takes measure, taken by the physical therapist Self-Report Measure: -Pain Scale -Pain intensity is according to the patient, can be different for everyone Reliability: the extent to which repeated measurements agree with one another (stability, consistency, reproducibility). You have like heard of intra (tester)- and inter-rater reliability (multiple testers) or test/retest (instrument). Validity: the degree to which a measurement captures what it is intended to measure (many forms). -Validity: face, content, construct, concurrent, predictive (does test measure what you are going after)

Utilize directional terminology to describe the relative positions of the structures

References on cuts for internal anatomy: -Axial (transverse, horizontal) - parallel to rostral/caudal axis of brain (top & bottom) -Sagittal - divides hemispheres (right & left) -Mid- or para- (near midline or not) -Coronal (frontal) - plane of face (front & back) -Spinal cord: transverse & longitudinal **Look at picture on google doc**

Systematic Review

Solution for limited time: "Systematic Review" -Summary of the literature -Cochrane Database for Intervention studies -Appraisal of systematic review - not all of them are done with credibility though - make sure to look them through carefully

Provide examples of settings and roles of physical therapy in primary, secondary, and tertiary care.

Settings for Physical Therapy: -Hospital -Rehabilitation Center -Skilled Nursing Home -Outpatient clinic -Home -Workplace -School -Sports (field, gym, training facility) -Community-based agency (YMCA) -Health Fair (Any role in any of these settings) Types of Care Primary Care Secondary Care Tertiary Care Prevention and Health Promotion

Briefly discuss how the secretion of growth hormone varies across the lifespan and within the sleep-wake cycle.

Sleep-Wake Cycle: -GH secretion varies within the 24-hour sleep-week cycle -Increased secretion with slow-wave sleep (deep, stage 3 non-rapid eye movement sleep) Life Span: -Plasma levels of IGF-1 are greatest in children and peak during puberty. -IGF-1 levels decline with aging.

Clinical Practice Guidelines

Solution for limited time: "Clinical Practice Guidelines" -A systematically developed statement designed to assist clinician and patient decisions about appropriate health care for specific clinical circumstances. -Need critical appraisal - relay on the team, no biases, group of experts, who are the authors, where do they come from, their background

Distinguish the roles of the physical therapist as direct care provider, educator, consultant, administrator or supervisor, and professional who engages in critical inquiry.

Supervisor or Administrator: -Care provider -Education for patients/other professionals/caretakers/families/students -Administrator or manager - supervisor role -Supervise physical therapy assistants -Consultant - not providing care but guidance for care -Engaged in critical inquiry Role in Prevention and Health Promotion: -Range from helping individuals with chronic conditions engage in physical activity programs to advising elite athletes on sports performance enhancement

Tertiary Care

Tertiary Care: -Care provided by a PT in a complex, highly specialized, and technology based setting -Care provided in response to request for consultation or specialized services -Example: burn unit, etc.

Neurons and Glia

They are the building blocks of the nervous system.

Neurons

They are the cells that do the signaling. They are specialized structures for receiving and sending information. They connect with each other at synapses. The form circuits to process and relay specific kinds of information. -Cell body -Axon -Dendrites

Speed

Time to complete task -Slow -Normal -Fast

CNS

Use gray and white matter when describing CNS structures: -Gray matter is organized in clusters called nuclei or in layers called cortex. -White matter is organized in tracts -These are the major components of the CNS. -Cerebrum (cerebral cortex) -Diencephalon (thalamus, hypothalamus) -Brain stem -Midbrain -Pons -Cerebellum -Medulla -Spinal Cord