What Types of Tests and Measures Do Physical Therapists Use?Introduction Test and measures are the means of gathering information about the patient/client. Depending on the data generated during the history and systems review, the physical therapist may use one or more tests and measures, in whole or in part: * To help identify and characterize signs and symptoms of pathology/pathophysiology, impairments, functional limitations, and disabilities * To establish the diagnosis and the prognosis, to select interventions, and to document changes in patient/client status * To indicate achievement of the outcomes that are the end points of care and thereby ensure timely and appropriate discharge. Physical therapists may perform more than one test or obtain more than one measurement at a time. Physical therapists individualize the selection of tests and measures based on the history they take and systems review they perform, rather than basing their selection on a previously determined medical diagnosis. When examining a patient/client with impairments, functional limitations, or disabilities resulting from brain injury, for instance, the physical therapist may decide to perform part or all of several tests and measures, based on the signs and symptoms of that particular patient. What Is Measurement? Obtaining measurements is an everyday part of physical therapist practice. APTA's Standards for Tests and Measurements in Physical Therapy Practice[1] state that a measurement is the "numeral assigned to an object, event, or person or the class (category) to which an object, event, or person is assigned according to rules." Physical therapists obtain many different types of measurements. Assessing the magnitude of a patient's report of pain, quantifying muscle performance or range of motion, describing the various characteristics of a patient's gait pattern, categorizing the assistance that a patient requires to dress--all of these are measurements. The physical therapist collects data through many different methods, such as interviewing; observation; questionnaires; palpation; auscultation auscultation /aus·cul·ta·tion/ (aws?kul-ta´shun) listening for sounds within the body, chiefly to ascertain the condition of the thoracic or abdominal viscera and to detect pregnancy; it may be performed with the unaided ear (direct or immediate a.) or with a stethoscope (mediate a.) .; conducting performance based assessments; electrophysiological testing; taking photographs and making other videographic recordings; recording data using scales, indexes, and inventories; obtaining data through the use of technology-assisted devices; administering patient/client self-assessment tests; and reviewing patient/client diaries and logs. Physical therapists use tests and measures to obtain measurements, which they then interpret to identify: * Signs and symptoms of pathology/pathophysiology (disease, disorder, or condition), such as joint tenderness, pain, elevated blood pressure with activity, numbness and tingling, and edema * Impairments, such as aerobic capacity; anthropometric characteristics; arousal, attention, and cognition; circulation; cranial and peripheral nerve integrity; ergonomics and body mechanics; gait, locomotion, and balance; integumentary integrity; joint integrity and mobility; motor function; muscle performance; neuromotor development and sensory integration; posture; range of motion; reflex integrity; sensory integrity; and ventilation and respiration/gas exchange * Functional limitations, such as work (job/school/ play), community, and leisure integration or reintegration (including instrumental activities of daily living), ergonomics and body mechanics, and self-care and home management (including activities of daily living and instrumental activities of daily living) * Disabilities, such as inability to engage in community, leisure, social, and work roles * Device and equipment need and use, such as assistive and adaptive devices; orthotic, protective, and supportive devices; and prosthetic devices * Barriers, such as environmental, home, and work (job/school/play) barriers In the evaluation process, the physical therapist synthesizes the examination data to establish the diagnosis and prognosis (including the plan of care). The data gathered through the use of tests and measures during initial examination provide information used for determining anticipated goals and expected outcomes. These data may indicate initial abilities in performing actions, tasks, and activities; establish criteria for placement decisions; and identify level of safety in performing a particular task or risk of injury with continued performance with or without devices and equipment. Reexamination at regular intervals during an episode of care enables the physical therapist to measure and document changes in patient/client status and the progress that the patient/client is making toward the anticipated goals and expected outcomes. Whenever possible, physical therapists should use measurements whose reliability and validity have been documented in the peer-reviewed literature. Reliable and valid measurements enable physical therapists to gauge the certainty of their examination data and the appropriate scope of inferences that may be drawn from those data. Reliability and validity are properties of a measurement, not the test or measure that is used to obtain the measurement. A measurement is reliable only under certain conditions and for certain types of patients/clients and is valid only for a particular purpose. Reliability and validity have not yet been reported for every measurement used by physical therapists. Use of measurements without established reliability and validity may be appropriate, however, especially when there are no alternatives-and provided that the physical therapist is aware that those measurements may be prone to error and that, therefore, decisions made using those measurements may be less certain. Reliability of Measurements Assessing a measurement's reliability is an attempt to identify sources of error.[2(p73-74)] A measurement is said to be reliable when it is consistent time after time, with as little variation as possible. Because all measurements have some error, however, the clinician must determine whether a measurement is useful or whether there is so much error that the measurement is rendered useless for a particular purpose. Two major types of reliability--test-retest and intratester/intertester--help determine how much error exists in a measurement. Test-retest reliability is the consistency of repeated measurements that are separated in time when there is no change in what is being measured; test-retest reliability indicates the stability of a measurement. Intrarater reliability indicates the degree to which measurements that are obtained by the same physical therapist at different times will be consistent. Interrater reliability indicates the degree to which measurements obtained by multiple therapists will be consistent.[1] Interrater reliability is especially important-if different physical therapists obtain different measurements when measuring the same phenomenon, the usefulness of the measurements is limited. There are two other forms of reliability: parallel-form reliability, which relates to measurements that are obtained by using different versions of the same test or measure, and internal consistency, or homogeneity, which relates to measurements that are obtained by using tests or measures with multiple items or parts, where each part is supposed to measure one, and only one, concept.[1] Validity of Measurements Validity is the "degree to which a useful (meaningful) interpretation can be inferred from a measurement."[1] There are many forms of validity, including face validity, content validity, construct validity, concurrent validity, and predictive validity. Face validity exists when the measurement seems to reflect what is supposed to be measured-but it does not depend on evidence. Goniometric measurements, for instance, have face validity as measurements of joint position. Content validity establishes the degree to which a measurement reflects the domain of interest. For example, an instrument that is used to assess joint pain might generate data only regarding pain on motion, not pain at rest or factors that aggravate or alleviate pain. Construct validity is a theoretical form of validity that is established on the basis of evidence that a measurement represents the underlying concept of what is to be measured.[1] For example, the overall concept of "motor function" is the construct that underlies any particular test or measure of motor function. There are no direct tests of construct validity. Theoretical evidence of construct validity is often provided by demonstrating convergence if tests or measures believed to represent the same construct are highly related. For example, a test of motor function, based on a particular concept of what "motor function" means, should correlate highly with other tests or measures based on similar conceptions of "motor function" or on concepts that are closely related to "motor function," such as "dexterity" and "coordination." Evidence of construct validity is also found when there is a low association, or divergence, between a test or measure of one particular construct and other tests or measures reflecting distinctly different, or even unrelated, constructs. For example, there should be a low association between a test or measure of "motor function" and tests and measures that are based on the concepts of "aerobic conditioning" or "range of motion." Concurrent validity exists when "an inferred interpretation is justified by comparing a measurement with supporting evidence that was obtained at approximately the same time as the measurement being validated."[1] The developers of a new balance test might compare the measurements obtained using the new test to those obtained using an established balance test involving one legged stance. The comparative method of establishing concurrent validity is particularly relevant for self-assessment instruments. Predictive validity exists when "an inferred interpretation is justified by comparing a measurement with supporting evidence that is obtained at a later point in time" and "examines the justification of using a measurement to say something about future events or conditions."[1] The predictive validity of a measurement of functional capacity might be established by verifying whether the measurement indicates the likelihood of return to work. Knowing the predictive validity of a measurement may facilitate the identification of achievable outcomes and increase the efficiency of discharge planning. Predictive validity also may provide the physical therapist with several kinds of information about the value of selecting particular tests or measures for the examination. The sensitivity of a measurement indicates the proportion of individuals with a positive finding who already have or will have a particular characteristic or outcome.[1,3,4] In other words, sensitivity is the positive predictive validity of the measurement. In contrast, the specificity of a measurement indicates the proportion of people who have a negative finding on a test or measure who truly do not or will not have a particular characteristic or outcome.[1,3,4] Thus, specificity is the negative predictive validity of the test or measure. Clinical Utility In addition to reliability and validity of the measurements obtained with a given test or measure, a physical therapist considers the clinical utility of the test or measure for a particular purpose. Physical therapists should consider the precision of the data yielded by a test or measure and whether it will meet the needs of the situation. Some measurements are only gross measurements. Gross measurements may be useful for a population screen but may not be useful for identifying a small change in patient/client status after intervention. The measurements used by the physical therapist should always be sensitive enough to detect the degree of change expected as a result of intervention. The physical therapist also should consider the time involved in administering a test or measure, the cost of administering it, and such patient/client factors as tolerance of testing positions and suitability of the test or measure to a particular population. Guide Categories for Tests and Measures This chapter contains 24 categories of tests and measures (Figure) that the physical therapist may decide to use during an examination. Tests and measures are listed in alphabetical order. In Part Two, each preferred practice pattern contains a list of tests and measures that are used in the examination of patients/clients who are classified in the diagnostic group for that pattern. Part Three of the Guide, available on CD-ROM, provides available information on tests and measures used by physical therapists, including the reliability and validity of measurements that are obtained using those tests and measures. Physical therapists may decide to use other tests and measures that are not described in the Guide, following the principles stated in the Standards for, Tests and Measurements in Physical Therapy Practice.[1] Figure Guide Categories for Tests and Measures Aerobic Capacity/Endurance Anthropometric Characteristics Arousal, Attention, and Cognition Assistive and Adaptive Devices Circulation (Arterial, Venous, Lymphatic) Cranial and Peripheral Nerve Integrity Environmental, Home, and Work (Job/School/Play) Barriers Ergonomics and Body Mechanics Gait, Locomotion, and Balance Integumentary Integrity Joint Integrity and Mobility Motor Function (Motor Control and Motor Learning) Muscle Performance (Including Strength, Power, and Endurance) Neuromotor Development and Sensory Integration Orthotic, Protective, and Supportive Devices Pain Posture Prosthetic Requirements Range of Motion (Including Muscle Length) Reflex Integrity Self-Care and Home Management (Including Activities of Daily Living and Instrumental Activities of Daily Living) Sensory Integrity Ventilation and Respiration/Gas Exchange Work (Job/School/Play), Community, and Leisure Integrity or Reintegration (Including Instrumental Activities of Daily Living) * General definition and purpose of the test and measure. A definition and purpose of the test and measure is provided. All tests and measures produce information used to identify the possible or actual causes of difficulties during performance of essential everyday activities, work tasks, and leisure pursuits. Selection of tests and measures depends on the findings of the history and systems review. The examination findings may indicate, for instance, that tests should be conducted while the patient/client performs specific activities. In all cases, the purpose of tests and measures is to ensure the gathering of information that will lead to evaluation, diagnosis, prognosis, and selection of appropriate interventions. * Clinical indications. Examples of clinical indications that are identified during the history and systems review are provided to indicate the use of tests and measures. Special requirements may prompt the physical therapist to perform tests and measures. All tests and measures are appropriate in the presence of: - impairment, functional limitation, disability, developmental delay, injury, or suspected or identified pathology that prevents or alters performance of daily activities, including self-care, home management, work (job/school/play), community, and leisure actions, tasks, or activities - requirements of employment that specify minimum capacity for performance - identified risk factors - need to initiate programs that promote health, wellness, or fitness * Tests and measures (methods and techniques). Examples of specific tests and measures are provided. * Tools used for gathering data. A listing of tools used for collecting data is provided. * Data generated. Types of data that may be generated from the tests and measures are listed. Other information that may be required for the examination includes findings of other professionals; results of diagnostic imaging, clinical laboratory, and electrophysiological studies; federal, state, and local work surveillance and safety reports and announcements; and the reported observations of family members, significant others, caregivers, and other interested people. Physical therapists are the only professionals who provide physical therapy. Physical therapist assistants--under the direction and supervision of the physical therapist-are the only paraprofessionals who assist in the provision of physical therapy interventions. APTA recommends that federal and state government agencies and other third-party payers require physical therapy to be provided only by a physical therapist or under the direction and supervision of a physical therapist. Examination, evaluation, diagnosis, and prognosis should be represented and reimbursed as physical therapy only when performed by a physical therapist. Intervention should be represented and reimbursed as physical therapy only when performed by a physical therapist or by a physical therapist assistant under the direction and supervision of a physical therapist. Note: The terms "physical therapy" and "physiotherapy," and the terms "physical therapist" and "physiotherapist," are synonymous. References [1] American Physical Therapy Association. Standards for Tests and Measurements in Physical Therapy Practice. Phys Ther. 1991;71:589-622. [2] Rothstein JM, Echternach JL. Primer on Measurement: An Introductory Guide to Measurement Issues. Alexandria, Va: American Physical Therapy Association; 1993. [3] Jaeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and how will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994;271:703-707. [4] Sackett DL, Straus SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. New York, NY: Churchill Livingstone Inc; 2000. Tests and Measures Aerobic Capacity/Endurance Aerobic capacity/endurance is the ability to perform work or participate in activity over time using the body's oxygen uptake, delivery, and energy release mechanisms. During activity, the physical therapist uses tests and measures ranging from simple measurements to complex calculations to determine the appropriateness of patient/client responses to increased oxygen demand. Responses that are monitored both at rest and during and after activity may indicate the degree of severity of the impairment, functional limitation, or disability. Results of tests and measures of aerobic capacity/endurance are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of aerobic capacity/endurance. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, cerebral vascular accident, coronary artery disease, peripheral vascular disease) - endocrine/metabolic (eg, osteoporosis) multiple systems (eg,AIDS, trauma) - musculoskeletal (eg, arthritis) - neuromuscular (eg, cerebral palsy, Parkinson disease) - pulmonary (eg, emphysema, pulmonary fibrosis) * Impairments in the following categories: - circulation (eg, abnormal heart rate, rhythm, blood pressure) - muscle performance (eg, generalized muscle weakness, decreased muscle endurance) - posture (eg, abnormal body alignment) - range of motion (eg, asymmetrical chest wall motion, thorax tightness) - ventilation and respiration/gas exchange (eg, abnormal respiratory pattern, rate, rhythm) * Functional limitations in the ability to perform actions, tasks, and activities in the following categories: - self-care (eg, inability to perform shower or overhead activities because of shortness of breath) - home management (eg, inability to vacuum or make the bed because of chest discomfort) - work (job/school/play) (eg, inability to keep up with peers during recess, inability as a parent to carry a child up the stairs because of increasing sense of fatigue, inability to perform overhead lifting tasks because of shortness of breath) - community/leisure (eg, inability to walk to religious activities because of shortness of breath, difficulty with gardening because of chest discomfort) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired aerobic capacity: - family history of cardiovascular or pulmonary disease - obesity - sedentary lifestyle - smoking history * Health, wellness, and fitness needs: - fitness, including physical performance (eg, submaximal oxygen uptake for age and sex, submaximal running efficiency for sprint) - health and wellness (eg, incomplete understanding of role of aerobic capacity/endurance during activities) Tests and Measures Tests and measures may include those that characterize or quantify: * Aerobic capacity during functional activities (eg, activities of daily living [ADL] scales, indexes, instrumental activities of daily living [IADL] scales, observations) * Aerobic capacity during standardized exercise test protocols (eg, ergometry, step tests, time/distance walk/run tests, treadmill tests, wheelchair tests) * Cardiovascular signs and symptoms in response to increased oxygen demand with exercise or activity, including pressures and flow; heart rate, rhythm, and sounds; and superficial vascular responses (eg, angina, claudication, dyspnea, and exertion scales; electrocardiography; observations; palpation; sphygmomanometry) * Pulmonary signs and symptoms in response to increased oxygen demand with exercise or activity, including breath and voice sounds; cyanosis; gas exchange; respiratory pattern, rate, and rhythm; and ventilatory flow, force, and volume (eg, auscultation, dyspnea and exertion scales, gas analyses, observations, oximetry, palpation, pulmonary function tests) Tools Used for Gathering Data Tools for gathering data may include: * Devices for gas analysis * Electrocardiographs * Ergometers * Force meters * Indexes * Measured walkways * Nomograms * Observations * Palpation * Pulse oximeters * Scales * Sphygmomanometers * Spirometers * Steps * Stethoscopes * Stop watches * Treadmills Data Generated Data are used in providing documentation and may include: * Cardiovascular and pulmonary signs, symptoms, and responses per unit of work * Gas volume, concentration, and flow per unit of work * Heart rate, rhythm, and sounds per unit of work * Oxygen uptake during functional activity * Oxygen uptake, time and distance walked or bicycled, and maximum aerobic performance * Peripheral vascular responses per unit of work * Respiratory rate, rhythm, pattern, and breath sounds per unit of work Anthropometric Characteristics Anthropometric characteristics are those traits that describe body dimensions, such as height, weight, girth, and body fat composition. The physical therapist uses tests and measures to quantify these traits. Results of tests and measures of anthropometric characteristics are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for tests and measures are predicated on the history and systems review findings (egg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of anthropometric characteristics. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, ascites chyliform ascites , chylous ascites the presence of chyle in the peritoneal cavity owing to anomalies, injuries, or obstruction of the thoracic duct. as·ci·tes (  -s, lymphedema) genitourinary (eg,
pregnancy) multiple systems (eg,AIDS, cancer)- musculoskeletal (eg, amputation, muscular dystrophy) - neuromuscular (eg, prematurity, spinal cord injury) - pulmonary (eg, cystic fibrosis) * Impairments in the following categories: - circulation (eg, abnormal blood pressure, abnormal fluid distribution) - muscle performance (eg, generalized muscle weakness) - neuromotor development (eg, abnormal growth rate) - range of motion (eg, abnormal fluid distribution) - ventilation and respiration (eg, abnormal rate and rhythm) * Functional limitations in the ability to perform actions, tasks, or fixed activities in the following categories: - self-care (eg, inability to dress and reach because of abnormal fat or fluid distribution) - home management (eg, inability to get down on knees to clean floor because of weight abnormality) - work (job/school/play) (eg, inability to assume parenting role because of impaired fluid distribution from pregnancy, inability to gain access to classroom environment because of delayed growth, inability to perform filing tasks because of decreased range of motion and muscle weakness) - community/leisure (eg,inability to fish because of generalized muscle weakness, inability to participate in amateur sports because of edema, inability to participate in social activities because of perceived body image as a result of impaired fluid distribution) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired anthropometric characteristics: - anorexia - obesity * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inefficient sprinting because of excess body fat, limited endurance for long-distance hiking because of inappropriate body composition) - health and wellness (eg, incomplete understanding of the relationship between nutrition and body composition) Tests and Measures Tests and measures may include those that characterize or quantify: * Body composition (eg, body mass index, impedance measurement, skinfold thickness measurement) * Body dimensions (eg, body mass index, girth measurement, length measurement) * Edema (eg, girth measurement, palpation, scales, volume measurement) Tools Used for Gathering Data Fools for gathering data may include: * Body mass index * Calipers * Cameras and photographs * Impedance devices * Nomograms * Palpation * Rulers * Scales * Tape measures * Volumometers * Weight scales Data Generated Data are used in providing documentation and may include: * Height and weight * Presence and severity of abnormal body fluid distribution Arousal, Attention, and Cognition Arousal is a state of responsiveness to stimulation or action or of physiological readiness for activity. Attention is the selective awareness of the environment or selective responsiveness to stimuli. Cognition is the act or process of knowing, including both awareness and judgment. The physical therapist uses tests and measures to characterize the patient's/client's responsiveness. Results of tests and measures of arousal, attention, and cognition are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of arousal, attention, and cognition. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, malignant hypertension, cerebral vascular accident) - multiple systems (eg, Down syndrome) - neuromuscular (eg, hydrocephalus, traumatic brain injury) - pulmonary (eg, end-stage chronic obstructive pulmonary disease) * Impairments in the following categories: - arousal (eg, lack of response to stimulation) - circulation (eg, abnormal blood pressure in shock) - cognition (eg, inability to follow instructions) - motor function (eg, inability to plan and carry out movement) - ventilation and respiration (eg, hypoventilation, somnolence) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to perform bathroom transfers because of lack of safety awareness) - home management (eg, decreased environmental mobility in the home because of lack of safety awareness) - work (job/school/play) (eg, inability to perform bricklaying because of inability to recall steps of task, inability to play at age-appropriate level because of lack of internal desire to move) - community/leisure (eg, inability to participate as volunteer at child's school because of inattention, inability to participate in routine exercise program because of lack of interest) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired arousal, attention, and cognition - inability to manage stress - lack of motivation - poor attitude * Health, wellness, and fitness needs: - fitness, including physical performance (eg, impaired judgment during workout, ineffective attention and recall for complete training regimen) - health and wellness (eg, incomplete understanding of the role of attention to safety during activities) Tests and Measures Tests and measures may include those that characterize or quantify: * Arousal and attention (eg, adaptability tests, arousal and awareness scales, indexes, profiles, questionnaires) * Cognition, including ability to process commands (eg, developmental inventories, indexes, interviews, mental state scales, observations, questionnaires, safety checklists) * Communication (eg, functional communication profiles, interviews, inventories, observations, questionnaires) * Consciousness, including agitation and coma (eg, scales) * Motivation (eg, adaptive behavior scales) * Orientation to time, person, place, and situation (eg, attention tests, learning profiles, mental state scales) * Recall, including memory and retention (eg, assessment scales, interviews, questionnaires) Tools Use for Data Collection Tools for gathering data may include: * Adaptability tests * Attention tests * Indexes * Interviews * Inventories * Observations * Profiles * Questionnaires * Safety checklists * Scales * Screening tests Data Generated Data are used in providing documentation and may include: * Descriptions of short-term and long-term memory * Presence and severity of: - cognitive impairment - coma - communication deficits depression or impaired motivation impaired consciousness * Quantifications or characterization of: - ability to attend to task or to - participate - ability to recognize time, person, place, and situation Assistive and Adaptive Devices Assistive and adaptive devices are implements and equipment used to aid patients/clients in performing tasks or movements. Assistive devices include crutches, canes, walkers, wheelchairs, power devices, long-handled reachers, percussors, static and dynamic splints, and vibrators. Adaptive devices include raised toilet seats, seating systems, and environmental controls. The physical therapist uses tests and measures to determine whether a patient/client might benefit from such a device or, when such a device already is in use, to assess how well the patient/client performs with it. Results of tests and measures of assistive and adaptive devices are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which indudes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of assistive and adaptive devices. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, cerebral vascular accident, coronary artery disease) - endocrine/metabolic (eg, diabetes) - integumentary (eg, surgical wound, vascular ulcer) - multiple systems (eg, sarcoidosis, trauma) - musculoskeletal (eg, arthritis, sprain, strain) - neuromuscular (eg, cerebral palsy, spina bifida, spinal cord injury) - pulmonary (eg, amyotrophic lateral sclerosis, respiratory failure) * Impairments in the following categories: - aerobic capacity (eg, decreased endurance) - gait, locomotion, and balance (eg, frequent falls) - motor function (eg, inability to sit) - muscle performance (eg, weakness) - range of motion (eg, pain on reaching) * Functional limitations in the ability to perform actions, tasks, or activities in following categories: - self-care (eg, inability to dress because of difficulty with sitting) - home management (eg, inability to remove items from closet shelf because of limited range of motion) - work (job/school/play) (eg, difficulty with keyboarding because of pain, inability to attend school because of lack of endurance, inability to get to work because of distance that must be traveled to work site) - community/leisure (eg, inability to walk on uneven surfaces because of altered balance) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factor for improper use or lack of use of assistive and adaptive devices - inactivity * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inability to participate in wheelchair sports, poor wheelchair tolerance because of inadequate fit) - health and wellness (eg, in adequate knowledge of how to regularly assess devices) Tests and Measures Tests and measures may include those that characterize or quantify: * Assistive or adaptive devices and equipment use during functional activities (eg, activities of daily living [ADL], functional scales, instrumental activities of daily living [IADL] scales, interviews, observations) * Components, alignment, fit, and ability to care for the assistive or adaptive devices and equipment (eg, interviews, logs, observations, pressure-sensing maps, reports) * Remediation of impairments, functional limitations, or disabilities with use of assistive or adaptive devices and equipment (eg, activity status indexes, ADL scales, aerobic capacity tests, functional performance inventories, health assessment questionnaires, IADL scales, pain scales, play scales, videographic assessments) * Safety during use of assistive or adaptive devices and equipment (eg, diaries, fall scales, interviews, logs, observations, reports) Tools Used for Gathering Data Tools for gathering data may include: * Activity status indexes * Aerobic capacity tests * Diaries * Functional performance inventories * Health assessment questionnaires * Interviews * Logs * Observations * Pressure-sensing devices * Reports * Scales * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Descriptions of: - alignment and fit of devices and equipment - ability to use and care for devices and equipment - components of assistive and adaptive devices and equipment level of safety with devices and equipment - practicality of devices and equipment - remediation of impairment, functional limitation, or disability with devices and equipment * Quantifications of: - movement patterns with or without devices and equipment - physiological and functional effect and benefit of devices and equipment Circulation (Arterial, Venous, Lymphatic) Circulation is the movement of blood through organs and tissues to deliver oxygen and to remove carbon dioxide and the passive movement (drainage) of lymph through channels, organs, and tissues for removal of cellular byproducts and inflammatory wastes. The physical therapist uses the results of circulation tests and measures to determine whether the patient/client has adequate cardiovascular pump, circulation, oxygen delivery, and lymphatic drainage systems to meet the body's demands at rest and with activity. Results of tests and measures of circulation (arterial, venous, lymphatic) are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records).The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of circulation (arterial, venous, lymphatic). Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, atherosclerosis, coronary artery bypass graft, lymphedema) - endocrine/metabolic (eg, diabetes, reflex sympathetic dystrophy) - genitourinary (eg, renal failure) - integumentary (eg, cellulitis, lymphadenitis) - multiple systems (eg, cancer, trauma) - musculoskeletal (eg, fracture) - neuromuscular (eg, multiple sclerosis, spinal cord injury) * Impairments in the following categories: - aerobic capacity (eg, shortness of breath) - circulation (eg, swollen feet) - gait, locomotion, and balance (eg, dizziness on rising from sitting to standing position) - muscle performance (eg, palpitations on stair climb) - ventilation and respiration (eg, shortness of breath at night) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, difficulty with eating because of indigestion) - home management (eg, inability to mow lawn because of leg cramps) - work (job/school/play) (eg, difficulty with loading cargo because of shortness of breath, inability to support family financially because of shortness of breath with manual labor) - community/leisure (eg, inability to play tennis because of chest and shoulder pain, inability to walk to the senior center because of leg pain) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired circulation: - obesity - positive family history of cardiovascular disease - sedentary lifestyle - smoking history * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inadequate circulation for cross-country skiing, inadequate protection of extremities during extended activities in cold weather ) - health and wellness (eg, incomplete understanding of importance of motion to circulation) Tests and Measures Tests and measures may include those that characterize or quantify: * Cardiovascular signs, including heart rate, rhythm, and sounds; pressures and flow; and superficial vascular responses (eg, auscultation, claudication scales, electrocardiography, girth measurement, observations, palpation, sphygmomanometry, thermography) * Cardiovascular symptoms (eg, angina, claudication, dyspnea, and perceived exertion scales) * Physiological responses to position change, including autonomic responses, central and peripheral pressures, heart rate and rhythm, respiratory rate and rhythm, ventilatory pattern (eg, auscultation, electrocardiography, observations, palpation, sphygmomanometry) Tools Used for Gathering Data Tools for gathering data may include: * Doppler ultrasonographs * Electrocardiographs * Observations * Palpation * Scales * Sphygmomanometers * Stethoscopes * Tape measures * Thermographs * Tilt tables Data Generated Data are used in providing documentation and may include: * Characterizations of: - central pressure and volume - intracranial pressure responses - physiological responses to position change * Descriptions of: - peripheral arterial circulation - peripheral lymphatic circulation - peripheral venous circulation - skin color - nail changes * Presence of bruits * Presence and severity of: - abnormal heart sounds - abnormal heart rate or rhythm at rest - cardiovascular signs and symptoms - edema * Quantifications of cardiovascular pump demand * Vital signs at rest Cranial and Peripheral Nerve Integrity Cranial nerve integrity is the intactness of the twelve pairs of nerves connected with the brain, including their somatic, visceral, and afferent and efferent components. Peripheral nerve integrity is the intactness of the spinal nerves, including their afferent and efferent components. The physical therapist uses tests and measures to assess the cranial and peripheral nerves. Results of tests and measures of cranial and peripheral nerve integrity are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of cranial and peripheral nerve integrity. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, cerebral vascular accident) - endocrine/metabolic (eg, Meniere disease, viral encephalitis) - integumentary disease/disorder (eg, neuropathic ulcer) - multiple systems (eg, Guillain-Barre syndrome) - neuromuscular (eg, Erb palsy, labyrinthitis) - pulmonary (eg, amyotrophic lateral sclerosis) * Impairments in the following categories: - cranial nerve and peripheral nerve integrity (eg, numb and tingling fingers) - gait, locomotion, and balance (eg, staggering gait) - motor function (eg, numbness of foot leading to falls) - muscle performance (eg, weakness of upper extremity) - ventilation (eg, decreased expansion and excursion) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, difficulty with eating because of swallowing difficulties) - home management (eg, decreased environmental mobility in the home because of unsteadiness) - work (job/school/play) (eg, inability to perform activities as a stuntperson because of difficulty with coordination, inability to perform electrical wiring and circuitry because of numbness of fingers) - community/leisure (eg, inability to play cards because of proprioceptive deficit, inability to sing in choir because of inadequate phonation control) * Disability-that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context-in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired cranial and peripheral nerve integrity. - habitual suboptimal posture - increased risk for falls * Health, wellness, and fitness needs.' - fitness, including physical performance (eg, inadequate hand control in school child, limited neuromuscular control of jumping) - health and wellness (eg, incomplete comprehension of value of sensation in gross motor activities) Tests and Measures Tests and measures may include those that characterize or quantify: * Electrophysiological integrity (eg, electroneuromyography) * Motor distribution of the cranial nerves (eg, dynamometry, muscle tests, observations) * Motor distribution of the peripheral nerves (eg, dynamometry, muscle tests, observations, thoracic outlet tests) * Response to neural provocation (eg, tension tests, vertebral artery compression tests) * Response to stimuli, including auditory, gustatory, olfactory, pharyngeal, vestibular, and visual (eg, observations, provocation tests) * Sensory distribution of the cranial nerves (eg, discrimination tests; tactile tests, including coarse and light touch, cold and heat, pain, pressure, and vibration) * Sensory distribution of the peripheral nerves (eg, discrimination tests; tactile tests, including coarse and light touch, cold and heat, pain, pressure, and vibration; thoracic outlet tests) Tools Used for Gathering Data Tools for gathering data may include: * Dynamometers * Electroneuromyographs * Muscle tests * Observations * Palpation * Provocation tests * Scales * Sensory tests Data Generated Data are used in providing documentation and may include: * Descriptions and quantification of: - sensory responses to provocation of cranial and peripheral nerves - vestibular responses * Descriptions of ability to swallow * Presence or absence of gag reflex * Quantifications of electrophysiological response to stimulation * Response to neural provocation Environmental, Home, and Work (Job/School/Play) Barriers Environmental, home, and work (job/school/play) barriers are the physical impediments that keep patients/clients from functioning optimally in their surroundings. The physical therapist uses the results of tests and measures to identify any of a variety of possible impediments, including safety hazards (eg, throw rugs, slippery surfaces), access problems (eg, narrow doors, thresholds, high steps, absence of power doors or elevators), and home or office design barriers (eg, excessive distances to negotiate, multistory environments, sinks, bathrooms,counters, placement of controls or switches). The physical therapist also uses the results to suggest modifications to the environment(eg, grab bars in the shower, ramps, raised toilet seats, increased lighting) that will allow the patient/client to improve functioning in the home, workplace, and other settings. Results of tests and measures of environmental, home, and work (job/school/play) barriers are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of environmental, home, and work (job/school/play) barriers. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, congestive heart failure) - multiple systems (eg, trauma) - musculoskeletal (eg, amputation, joint replacement, muscular dystrophy) - neuromuscular (eg, cerebral palsy, multiple sclerosis, traumatic brain injury) - pulmonary (eg, chronic obstructive pulmonary disease) * Impairments in the following categories. - circulation (eg, calf cramps with walking) - gait, locomotion, and balance (eg, ataxic a·tac·tic ( -t k t k)adj. gait)- muscle performance (eg, decreased muscle strength and endurance) - ventilation (eg, increased respiratory rate) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to get into bathtub because of decreased muscle strength) - home management (eg, inability to climb stairs to bathroom because of decreased muscle endurance) - work (job/school/play) (eg, inability as a student to gain wheelchair access to science station in school because of station height, inability to enter building because no ramp is available) - community/leisure (eg, inability to join friends on sailboat because of dock instability, inability to walk on beach because of ataxic gait) * Disability-that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context-in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for environmental, home, and work barriers. - decreased accessibility to home, work (job/school/play), community, and leisure environments - increased risk for falls - lack of emergency evacuation plan * Health, wellness, and fitness needs.' - fitness, including physical performance (eg, inability to negotiate uneven terrains, limited ability to gain access to outdoor trails) - health and wellness (eg, incomplete understanding of how to assess terrains for more efficient functioning) Tests and Measures Tests and measures may include those that characterize or quantify: * Current and potential barriers (eg, checklists, interviews, observations, questionnaires) * Physical space and environment (eg, compliance standards, observations, photographic assessments, questionnaires, structural specifications, technology-assisted assessments, videographic assessments) Tools Used for Gathering Data Tools for gathering data include: * Cameras and photographs * Checklists * Interviews * Observations * Questionnaires * Structural specifications * Technology-assisted analysis systems * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Descriptions of: - barriers - environment * Documentation and description of compliance with regulatory standards * Observations of environment * Quantifications of physical space Ergonomics and Body Mechanics Ergonomics is the relationship among the worker; the work that is done; the actions, tasks, or activities inherent in that work (job/school/play); and the environment in which the work (job/school/play) is performed. Ergonomics uses scientific and engineering principles to improve safety, efficiency, and quality of movement involved in work (job/school/play). Body mechanics are the interrelationships of the muscles and joints as they maintain or adjust posture in response to forces placed on or generated by the body. The physical therapist uses these tests and measures in examining both the worker and the work (job/school/play) environment and in determining the potential for trauma or repetitive stress injuries from inappropriate workplace design. These tests and measures may be conducted after a work injury or as a preventive step. The physical therapist may conduct tests and measures as part of work hardening or work conditioning programs and may use the results of tests and measures to develop such programs. Results of tests and measures of ergonomics and body mechanics are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of ergonomics and body mechanics. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, coronary artery disease) - endocrine/metabolic (eg, pregnancy) - multiple systems (eg, deconditioning) - musculoskeletal (eg, repetitive strain injury, scoliosis, spinal stenosis) - neuromuscular (eg, paroxysmal positional vertigo, spina bifida) - pulmonary (eg, ventilatory pump disorders) * Impairments in the following categories: - aerobic capacity (eg, decreased endurance and shortness of breath) - circulation (eg, abnormal heart rate and rhythm) - gait, locomotion, and balance (eg, dizziness) - muscle performance (eg, decreased power) - range of motion (eg, decreased range of motion) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories. - home management (eg, inability to lift laundry basket because of decreased range of motion) - community/leisure (eg, inability to bowl because of decreased muscle power, inability to deliver meals-onwheels because of poor sitting tolerance) - self-care (eg, inability to tie shoes because of dizziness) - work (job/school/play) (eg, inability to carry school back pack because of pain, inability to rotate trunk at assembly line because of pain) * Disablity--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context-in the following categories: - self-care - home management - work (job/school/play) - community/leisure Risk factors for inefficient ergonomics and impaired body mechanics: - habitual suboptimal posture - hazardous work environment - lack of safety awareness in all environments - risk-prone behaviors (eg, lack of use of safety gear, performance of tasks requiring repetitive motion) * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inability to perform all workplace tasks, use of inappropriate body mechanics for pushing) - health and wellness (incomplete understanding of importance of correct body mechanics during work tasks) Tests and Measures Tests and measures may include those that characterize or quantify: Ergonomics * Dexterity and coordination during work (job/school/play) (eg, hand function tests, impairment rating scales, manipulative ability tests) * Functional capacity and performance during work actions, tasks, or activities (eg, accelerometry, dynamometry, electroneuromyography, endurance tests,force platform tests, goniometry, interviews, observations, photographic assessments, physical capacity tests, postural loading analyses, technology assisted assessments, videographic assessments, work analyses) * Safety in work environments (eg, hazard identification checklists, job severity indexes, lifting standards, risk assessment scales, standards for exposure limits) * Specific work conditions or activities (eg, handling checklists, job simulations, lifting models, preemployment screenings, task analysis checklists, workstation checklists) * Tools, devices, equipment, and workstations related to work actions, tasks, or activities (eg, observations, tool analysis checklists, vibration assessments) Body mechanics * Body mechanics during self-care, home management, work, community, or leisure actions, tasks, or activities (eg, activities of daily living [ADL] and instrumental activities of daily living [IADL] scales, observations, photographic assessments, technology-assisted assessments, videographic assessments) Tools Used for Gathering Data Tools for gathering data may include: * Accelerometers * Cameras and photographs * Checklists for exposure standards, hazards, lifting standards * Dynamometers * Electroneuromyographs * Environmental tests * Force platforms * Functional capacity evaluations * Goniometers * Hand function tests * Indexes * Interviews * Muscle tests * Observations * Physical capacity and endurance tests * Postural loading tests * Questionnaires * Scales * Screenings * Technology-assisted analysis systems * Video cameras and videotapes * Work analyses Data Generated Data are used in providing documentation and may include: Ergonomics * Characterizations of efficiency and effectiveness of use of tools, devices, and workstations * Characterizations of environmental hazards, health risks, and safety risks * Descriptions of tools, devices, equipment, and workstations * Descriptions and quantification of: - abnormal movement patterns associated with work actions, tasks, or activities - dexterity and coordination - functional capacity - repetition and work/rest cycle in - work actions, tasks, or activities - work actions, tasks, or activities * Presence or absence of actual, potential,or repetitive trauma in the work environment Body mechanics * Characterizations of abnormal or unsafe body mechanics * Descriptions and quantification of limitations in self-care, home management, work, community, and leisure actions, tasks, or activities Gait, Locomotion, and Balance Gait is the manner in which a person walks, characterized by rhythm, cadence, step, stride, and speed. Locomotion is the ability to move from one place to another. Balance is the ability to maintain the body in equilibrium with gravity both statically (ie, while stationary) and dynamically (ie, while moving). The physical therapist uses these tests and measures to assess disturbances in gait, locomotion, and balance and assess the risk for falling. The physical therapist also uses these tests and measures to determine whether the patient/client is a candidate for assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment. Gait, locomotion, and balance problems often involve difficulty in integrating sensory, motor, and neural processes. Results of tests and measures of gait, locomotion, and balance are integrated with the history and systems review fmdings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of gait, locomotion, and balance. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, peripheral vascular disease) - endocrine/metabolic (eg, cellulitis) - multiple systems (eg, Down syndrome) - musculoskeletal (eg, arthropathy Charcot's arthropathy neuropathic a. chondrocalcific arthropathy progressive polyarthritis with joint swelling and bony enlargement, most commonly in the small joints of the hand but also affecting other joints, characterized radiographically by narrowing of the joint space with subchondral erosions and sclerosis and frequently chondrocalcinosis. ; disorders of muscle, ligament,
and fascia; osteoarthrosis)- neuromuscular (eg, central vestibular disorders, peripheral neuropathy) - pulmonary (eg, emphysema) * Impairments in the following categories: - circulation (eg, claudication pain) - joint integrity and mobility (eg, hip pain with mobility) - motor function (eg, abnormal movement pattern) - muscle performance (eg, decreased power and endurance) - range of motion (eg, abnormal range with gait) - ventilation (eg, paradoxical breathing pattern on ambulation) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, difficulty with dressing because of abnormal sitting balance) - home management (eg, inability to perform yardwork because of decreased power) - work (job/school/play) (eg, inability to do shopping as household manager because of painful ambulation, inability as a parent to climb the stairs carrying a child because of decreased power) - community/leisure (eg, inability to coach a Little League team because of hip pain, inability to play shuffleboard because of dizziness) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired gait, locomotion, and balance: - increased risk for falls - risk-prone behaviors (eg, scatter rugs, unclearly marked steps) * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inadequate dynamic balance for climbing, limited leg strength for squatting) - health and wellness (eg, incomplete understanding of need for dynamic balance in all functional actions) Tests and Measures Tests and measures may include those that characterize or quantify: * Balance during functional activities with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment (eg, activities of daily living [ADL] scales, instrumental activities of dally living [IADL] scales, observations, videographic assessments) * Balance (dynamic and static) with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment (eg, balance scales, dizziness inventories, dynamic posturography, fall scales, motor impairment tests, observations, photographic assessments, postural control tests) * Gait and locomotion during functional activities with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment (eg, ADL scales, gait indexes, IADL scales, mobility skill profiles, observations, videographic assessments) * Gait and locomotion with or without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment (eg, dynamometry, electroneuromyography, footprint analyses, gait indexes, mobility skill profiles, observations, photographic assessments, technology-assisted assessments, videographic assessments, weight-bearing scales, wheelchair mobility tests) * Safety during gait, locomotion, and balance (eg, confidence scales, diaries, fall scales, functional assessment profiles, logs, reports) Tools Used for Gathering Data Tools for gathering data may include: * Batteries of tests * Cameras and photographs * Diaries * Dynamometers * Electroneuromyographs * Force platforms * Goniometers * Indexes * Inventories * Logs * Motion analysis systems * Observations * Postural control tests * Profiles * Rating scales * Reports * Scales * Technology-assisted analysis systems * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: Descriptions of: - gait and locomotion - gait, locomotion, and balance characteristics with or without use of devices or equipment - gait, locomotion, and balance on and in different physical environments - level of safety during gait, locomotion, and balance - static and dynamic balance - wheelchair maneuverability and mobility Integumentary Integrity Integumentary integrity is the intactness of the skin, including the ability of the skin to serve as a barrier to environmental threats (eg, bacteria, parasites). The physical therapist uses these tests and measures to assess the effects of a wide variety of disorders that result in skin and subcutaneous changes, including pressure and vascular, venous, arterial, diabetic, and necropathic ulcers; burns and other traumas; and a number of diseases (eg, soft tissue disorders). Results of tests and measures of integumentary integrity are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of integumentary integrity. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, deep vein thrombosis, peripheral vascular disease) - endocrine/metabolic (eg, diabetes, frostbite) - integumentary (eg, burn, frostbite, laceration, surgical wound) - multiple systems (eg, trauma) - musculoskeletal (eg, fracture, osteomyelitis) - neuromuscular (eg, coma, spinal cord injury) - pulmonary (eg, respiratory failure) * Impairments in the following categories: - aerobic capacity (eg, deconditioning) - circulation (eg, abnormal fluid distribution) - integumentary integrity (eg, burn eschar) - sensory integrity (eg, loss of sensation) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to bathe because of burn) - home management (eg, inability to wash dishes because of hand blisters) - work (job/school/play) (eg, inability to do construction work because of lower-extremity cellulitis, inability to hold a job because of pressure sore) - community/leisure (eg, inability to play organ at religious center because of loss of finger sensation, inability to skate because of frostbite) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired integumentary integrity: - obesity - risk-prone behaviors (eg, excessive exposure to sun or cold) - sedentary lifestyle - smoking history * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inadequate protection from sun during outdoor activities) - health and wellness (eg, limited comprehension of value of skin monitoring and protection) Tests and Measures Tests and measures may include those that characterize or quantify: Associated skin * Activities, positioning, and postures that produce or relieve trauma to the skin (eg, observations, pressure-sensing maps, scales) * Assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and equipment that may produce or relieve trauma to the skin (eg, observations, pressure-sensing maps, risk assessment scales) * Skin characteristics, including blistering, continuity of skin color, dermatitis, hair growth, mobility; nail growth, temperature, texture, and turgor (eg, observations, palpation, photographic assessments, thermography) Wound * Activities, positioning, and postures that aggravate the wound or scar or that produce or relieve trauma (eg, observations, pressure-sensing maps) * Burn (body charting, planimetry) * Signs of infection (eg, cultures, observations, palpation) * Wound characteristics, including bleeding, contraction, depth, drainage, exposed anatomical structures, location, odor, pigment, shape, size, staging and progression, tunneling, and undermining (eg, digital and grid measurement, grading of sores and ulcers, observations, palpation, photographic assessments, wound tracing) * Wound scar tissue characteristics, including banding, pliability, sensation, and texture (eg, observations, scarrating scales) Tools Used for Gathering Data Tools for gathering data may include: * Cameras and photographs * Charts * Culture kits * Grids * Observations * Palpation * Planimeters * Pressure-sensing devices * Rulers * Scales * Thermographs * Tracings, maps, graphs Data Generated Data are used in providing documentation and may include: Associated skin * Descriptions of activities and postures that aggravate or relieve skin trauma * Descriptions and quantifications of skin characteristics * Descriptions of: - blister - devices and equipment that may produce skin trauma - hair pattern - skin color and continuity Wound * Descriptions of activities and postures that aggravate or relieve wound or scar trauma * Descriptions of signs of infection * Descriptions and quantifications of: - burn (eg, size, type, depth) - wound characteristics - wound scar tissue characteristics Joint Integrity and Mobility Joint integrity is the intactness of the structure and shape of the joint, including its osteokinematic and arthrokinematic characteristics. The tests and measures of joint integrity assess the anatomic and biomechanical components of the joint. Joint mobility is the capacity of the joint to be moved passively, taking into account the structure and shape of the joint surface in addition to characteristics of the tissue surrounding the joint. The tests and measures of joint mobility assess the performance of accessory joint movements, which are not under voluntary control. The physical therapist uses these tests and measures to assess whether there is excessive motion (hypermobility) or limited motion (hypomobility) of the joint. Results of tests and measures of joint integrity and mobility are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of joint integrity and mobility. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - endocrine/metabolic (eg, gout, osteoporosis) - multiple systems (eg, vehicular trauma) - musculoskeletal (eg, fracture, osteoarthritis, rheumatoid arthritis, sprain) - neuromuscular (eg, cerebral palsy, Parkinson disease) - pulmonary (eg, restrictive lung disease) * Impairments in the following categories: - anthropometric characteristics (eg, abnormal girth of limb at the knee) - ergonomics and body mechanics (eg, decreased dexterity and coordination) - gait, locomotion, and balance (eg, uneven step length) - posture (eg, abnormal spinal alignment) - range of motion (eg, decreased muscle length) - ventilation (eg, abnormal breathing pattern) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to fasten garments because of limited range of motion) - home management (eg, inability to sew on a button because of Finger joint pain) - work (job/school/play) (eg, inability to clean teeth as a dental hygienist because of joint stiffness, inability to climb a ladder because of joint tightness) - community/leisure (eg, inability as a student to attend driver's education because of limited range of motion in neck, inability to play golf because of shoulder joint pain) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired joint integrity and mobility: - increased risk for falls - performance of tasks requiring repetitive motion * Health, wellness, and fitness needs: - fitness, including physical performance (eg, reduced shoulder mobility for weight lifting) - health and wellness (eg, insufficient awareness of impact of mobility exercises on ability to lift weight) Tests and Measures Tests and measures may include those that characterize or quantify: * Joint integrity and mobility (eg, apprehension, compression and distraction, drawer, glide, impingement, shear, and valgus/varus stress tests; arthrometry ar·throm·e·try (är-thr  m-tr )n. ; palpation)* Joint play movements, including end feel (all joints of the axial and appendicular 1. pertaining to the vermiform appendix. 2. pertaining to an appendage. ap·pen·dic·u·lar ( p skeletal system) (eg, palpation)* Specific body parts (eg, apprehension, compression and distraction, drawer, glide, impingement, shear, and valgus/varus stress tests; arthrometry) Tools Used for Gathering Data Tools for gathering data may include: * Arthrometers ar·throm·e·ter (är-thr m-tr)n. * Apprehension tests * Compression and distraction tests * Drawer tests * Glide tests * Impingement tests * Palpation * Shear tests * Valgus/varus stress tests Data Generated Data are used in providing documentation and may include: * Descriptions of: - accessory motion - bony and soft tissue restrictions during movement * Descriptions or quantifications of joint hypomobility or hypermobility * Presence of: - apprehension - joint impingement * Presence and severity of abnormal joint articulation Motor Function (Motor Control and Motor Learning) Motor function is the ability to learn or demonstrate the skillful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns. The physical therapist uses these tests and measures in the assessment of weakness, paralysis, dysfunctional movement patterns, abnormal timing, poor coordination, clumsiness, atypical movements, or dysfunctional postures. Results of tests and measures of motor function (motor control and motor learning) are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of motor function (motor control and motor learning). Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, cerebral vascular accident, congenital heart anomalies) - multiple systems (eg, encephalitis, meningitis, seizures) - musculoskeletal (eg, muscular dystrophy) - neuromuscular (eg, cerebral palsy, multiple sclerosis, Parkinson disease, spinal cord injury, traumatic brain injury, vestibular disorders) - pulmonary (eg, hyaline membrane disease) * Impairments in the following categories: - circulation (eg, increased heart rate with activities) - motor function (eg, irregular movement pattern) - muscle performance (eg, weakness) - orthotic, protective, and supportive devices (eg, dropfoot requiring an ankle-foot orthosis) - range of motion (eg, limited) - sensory integrity (eg, altered position sense) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, difficulty with combing hair because of weakness) - home management (eg, inability to clean the shower because of dysfunctional movement pattern) - work (job/school/play) (eg, inability to perform functions as toll collector because of dizziness, inability to sort mail because of clumsiness) - community/leisure (eg, inability to play softball because of poor coordination, inability to serve as greeter at senior citizen center because of muscle weakness and decreased endurance) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories.' - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired motor function: - increased risk for falls - lack of safety in all environments * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inability to control throwing motion, inadequate eye-hand coordination in sports) - health and wellness (eg, incomplete understanding of importance of value of motor planning and practice in task performance) Tests and Measures Tests and measures may include those that characterize or quantify: * Dexterity, coordination, and agility (eg, coordination screens, motor impairment tests, motor proficiency tests, observations, videographic assessments) * Electrophysiological integrity (eg, electroneuromyography) * Hand function (eg, fine and gross motor control tests, finger dexterity tests, manipulative ability tests, observations) * Initiation, modification, and control of movement patterns and voluntary postures (eg, activity indexes, developmental scales, gross motor function profiles, motor scales, movement assessment batteries, neuromotor tests, observations, physical performance tests, postural challenge tests, videographic assessments) Tools Used for Gathering Data Tools for gathering data may include: * Batteries of tests * Dexterity tests * Electroneuromyographs * Function tests * Hand manipulation tests * Indexes * Motor performance tests * Observations * Postural challenge tests * Profiles * Scales * Screens * Tilt boards * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Descriptions and quantifications of: - dexterity, coordination, and agility - hand movements - head, trunk, and limb movements - sensorimotor integration - voluntary, age-appropriate postures and movement patterns * Observations and descriptions of atypical movements * Quantifications of electrophysiological responses to stimulation Muscle Performance (Including Strength, Power, and Endurance) Muscle performance is the capacity of a muscle or a group of muscles to generate forces. Strength is the muscle force exerted by a muscle or a group of muscles to overcome a resistance under a specific set of circumstances. Power is the work produced per unit of time or the product of strength and speed. Endurance is the ability of muscle to sustain forces repeatedly or to generate forces over a period of time. The muscle force that can be measured depends on the interrelationships among such factors as the length of the muscle, the velocity of the muscle contraction, and the mechanical advantage. Recruitment of motor units, fuel storage, and fuel delivery, in addition to balance, timing, and sequencing of contraction, mediate integrated muscle performance. The physical therapist uses these tests and measures to determine the ability to produce, maintain, sustain, and modify movements that are prerequisite to functional activity. Results of tests and measures of muscle performance (including strength, power, and endurance) are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of muscle performance (including strength, power, and endurance). Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, congestive heart failure, vascular insufficiency) - endocrine/metabolic (eg, diabetes, Down syndrome, osteoporosis) - integumentary (eg, post-mastectomy lymphedema, scar) - multiple systems (eg, AIDS) - musculoskeletal (eg, amputation, muscular dystrophy, osteoarthritis, spinal stenosis, synovitis, tenosynovitis) - neuromuscular (eg, cerebral palsy, Guillain-Barre, multiple sclerosis) - pulmonary (eg, cystic fibrosis, emphysema, pneumonia) * Impairments in the following categories: - aerobic capacity (eg, decreased endurance) - gait, locomotion, and balance (eg, frequent falls, decreased stance phase) - muscle performance (eg, decreased gross strength, generalized muscle weakness) - posture (eg, abnormal body alignment) - ventilation (eg, abnormal breathing pattern) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to don and doff clothing because of proximal instability) - home management (eg, inability to squat to pick up laundry because of muscle weakness) - work (job/school/play) (eg, inability as an airline baggage handler to handle baggage because of inability to lift heavy objects, inability to carry objects because of decreased muscle endurance, inability to keep up with peers on playground because of decreased muscle endurance) - community/leisure (eg, inability to hike because of ankle weakness) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired muscle performance: - increased risk for falls - sedentary lifestyle * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inadequate muscle strength for aquatic sports, insufficient muscle endurance for long distance running) - health and wellness (eg, incomplete understanding of the need for strength before power) Tests and Measures Tests and measures may include those that characterize or quantify: * Electrophysiological integrity (eg, electroneuromyography) * Muscle strength, power, and endurance (eg, dynamometry, manual muscle tests, muscle performance tests, physical capacity tests, technology-assisted assessments, timed activity tests) * Muscle strength, power, and endurance during functional activities (eg, activities of daily living [ADL] scales, functional muscle tests, instrumental activities of daily living [IADL] scales, observations, videographic assessments) * Muscle tension (eg, palpation) Tools Used for Gathering Data Tools for gathering data may include: * Dynamometers * Electroneuromyographs * Functional muscle tests * Manual muscle tests * Muscle performance tests * Observations * Palpation * Physical capacity tests * Scales * Sphygmomanometers * Technology-assisted analysis systems * Timed activity tests * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Characterizations of: - electrophysiological responses to stimulation - muscle strength, power, and endurance * Presence and severity of pelvic-floor muscle weakness * Quantifications of: - levels of excitability of muscle - muscle strength, work, and power Neuromotor Development and Sensory Integration Neuromotor development is the acquisition and evolution of movement skills throughout the life span. Sensory integration is the ability to integrate information that is derived from the environment and that relates to movement. The physical therapist uses tests and measures to characterize movement skills in infants, children, and adults. The physical therapist also uses tests and measures to assess mobility; achievement of motor milestones; postural control; voluntary and involuntary movement; balance; righting and equilibrium reactions; eye-hand coordination; and other movement skills. Results of tests and measures of neuromotor development and sensory integration are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of neuromotor development and sensory integration. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems.' - cardiovascular (eg, cardiac or associated vessel disorders) - endocrine/metabolic (eg, fetal alcohol syndrome, lead poisoning) - multiple systems (eg, autism, birth prematurity, seizure disorder) - musculoskeletal (eg, congenital amputation) - neuromuscular (eg, hearing loss, visual deficit) - pulmonary (eg, anoxia altitude anoxia see under sickness. anemic anoxia that due to decrease in amount of hemoglobin or number of erythrocytes in the blood. anoxic anoxia that due to interference with the oxygen supply. histotoxic anoxia severe histotoxic hypoxia. , hypoxia)* Impairments in the following categories: - circulation (eg, abnormal heart rhythm) - gait, locomotion, and balance (eg, poor sitting posture) - motor function (eg, presence of involuntary movements) - muscle performance (eg, muscle weakness) - neuromotor development (eg, delayed motor skills) - posture (eg, lack of postural control) - prosthetic requirements (eg, poor balance with prosthesis) - ventilation (eg, asymmetrical expansion) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories.' - self-care (eg, inability to grasp bottle for feeding because of weakness) - home management (eg, inability to dust because of poor sensory integration) - work (job/school/play) (eg, inability to do assembly piecework because of poor eye-hand coordination, inability to play with peers in day care because of inability to crawl) - community/leisure (eg, inability to knit because of poor movement initiation, inability to vote in standing ballot booth because of inability to stand) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired neuromotor development and sensory integration: - increased risk for falls - poor nutritional status during gestation - substance abuse * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inappropriate timing or sequencing for skipping, limited ability to participate in organized play programs) - health and wellness (eg, lack of understanding of need for developmental screening) Tests and Measures Tests and measures may include those that characterize or quantify: * Acquisition and evolution of motor skills, including age-appropriate development (eg, activity indexes, developmental inventories and questionnaires, infant and toddler motor assessments, learning profiles, motor function tests, motor proficiency assessments, neuromotor assessments, reflex tests, screens, videographic assessments) * Oral motor function, phonation, and speech production (eg, interviews, observations) * Sensorimotor integration, including postural, equilibrium, and righting reactions (eg, behavioral assessment scales, motor and processing skill tests, observations, postural challenge tests, reflex tests, sensory profiles, visual perceptual skill tests) Tools Used for Gathering Data Tools for gathering data may include: * Batteries of tests * Behavioral assessment scales * Electrophysiological tests * Indexes * Interviews * Inventories * Motor assessment tests * Motor function tests * Neuromotor assessments * Observations * Postural challenge tests * Proficiency assessments * Profiles * Questionnaires * Reflex tests * Scales * Screens * Skill tests * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Descriptions and quantifications of: - behavioral response to stimulation - dexterity, coordination, and agility - movement skills, including age-appropriate development, gross and - fine motor skills, reflex development - oral motor function, phonation, and speech production - sensorimotor integration, including postural, equilibrium, and righting reactions * Observations and description of atypical movement Orthotic, Protective, and Supportive Devices Orthotic, protective, and supportive devices are implements and equipment used to support or protect weak or ineffective joints or muscles and serve to enhance performance. Orthotic devices include braces, casts, shoe inserts, and splints. Protective devices include braces, cushions, helmets, and protective taping. Supportive devices include compression garments, corsets, elastic wraps, mechanical ventilators, neck collars, serial casts, slings, supplemental oxygen, and supportive taping. The physical therapist uses these tests and measures to assess the need for devices in patients/clients not currently using them and to evaluate the appropriateness and fit of those devices already in use. Results of tests and measures of orthotic, protective, and supportive devices are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of orthotic, protective, and supportive devices. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, cerebral vascular accident, congestive heart failure, peripheral vascular disease) - endocrine/metabolic (eg, rheumatological disease) - multiple systems (eg, AIDS, trauma) - musculoskeletal (eg, amputation, status post joint replacement) - neuromuscular (eg, cerebellar ataxia, cerebral palsy) - pulmonary (eg, asthma, cystic fibrosis, reactive airways disease) * Impairments in the following categories: - anthropometric characteristics (eg, girth, height) - gait, locomotion, and balance (eg, impaired motor function) - integumentary integrity (eg, impaired sensation) - joint integrity and mobility (eg, joint hypermobility) - muscle performance (eg, weakness) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories.' - self-care (eg, inability to wash hair because of upper-extremity lymphedema) - home management (eg, inability to walk on uneven terrain because of ankle instability) - work (job/school/play) (eg, inability as a factory worker to lift repetitively on assembly line because of pain, inability to maintain head position in classroom because of poor motor function, inability to stand because of low back pain) - community/leisure (eg, inability to bowl because of wrist pain and weakness) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factor for improper use or lack of use of orthotic, protective, and supportive devices: - lack of safety awareness - lack of use of adequate protective devices during activity * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inadequate control of skis without orthotic device for ski boot) - health and wellness (eg, incomplete understanding of importance of orthotic evaluation and compliance with program) Tests and Measures Tests and measures may include those that characterize or quantify: * Components, alignment, fit, and ability to care for the orthotic, protective, and supportive devices and equipment (eg, interviews, logs, observations, pressure-sensing maps, reports) * Orthotic, protective, and supportive devices and equipment use during functional activities (eg, activities of daily living [ADL] scales, functional scales, instrumental activities of daily living [IADL] scales, interviews, observations, profiles) * Remediation of impairments, functional limitations, or disabilities with use of orthotic, protective, and supportive devices and equipment (eg, activity status indexes, ADL scales, aerobic capacity tests, functional performance inventories, health assessment questionnaires, LADL scales, pain scales, play scales, videographic assessments) * Safety during use of orthotic, protective, and supportive devices and equipment (eg, diaries, fall scales, interviews, logs, observations, reports) Tools Used for Gathering Data Tools for gathering data may include: * Aerobic capacity tests * Diaries * Indexes * Interviews * Inventories * Logs * Observations * Play scales * Pressure-sensing devices * Profiles * Questionnaires * Reports * Scales * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Descriptions of: - ability to use and care for devices and equipment - alignment and fit of the devices and equipment - components of orthotic, protective, or supportive devices and equipment - level of safety with devices and equipment - practicality of devices and equipment - remediation of impairment, functional limitation, or disability with devices and equipment * Quantifications of: - movement patterns with or without devices - physiological and functional effect and benefit of devices and equipment Pain Pain is a disturbed sensation that causes suffering or distress. The physical therapist uses these tests and measures to determine a cause or a mechanism for the pain and to assess the intensity, quality, and temporal and physical characteristics of any pain that is important to the patient and that may result in impairments, functional limitations, or disabilities. Results of tests and measures of pain are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of pain. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems.' - cardiovascular (eg, coronary artery disease, myocardial infarction) - endocrine/metabolic (eg, osteoporosis, rheumatological disease) - integumentary (eg, burn, incision, ulcer, wound) - multiple systems (eg, vehicular trauma) - musculoskeletal (eg, amputation, cumulative trauma, fracture, spinal stenosis, temporomandibular joint dysfunction) - neuromuscular (eg, nerve compression, spinal cord injury) - pulmonary (eg, lung cancer, status post thoracotomy) * Impairments in the following categories.' - circulation (eg, decreased ability to walk because of chest discomfort) - integumentary (eg, limited range of motion because of painful rash) - joint integrity (eg, decreased range of motion because of finger ache) - muscle performance (eg, weakness because of muscle burning) - pain (eg, decreased movement of spine because of stabbing back pain) - posture (eg, forward head position because of upper-back discomfort) - ventilation (eg, decreased expansion because of splinting of painful chest wall) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories.' - sell-care (eg, difficulty with eating because of jaw pain) - home management (eg, inability to shovel snow because of shoulder soreness) - work (job/school/play) (eg, inability as a parent to carry infant because of shooting knee pain, inability to mop floor because of chest pressure) - community/leisure (eg, inability to canoe because of backache, inability to keep up with grandchildren because legs ache while walking) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - sell-care - home management - work (job/school/play) - community/leisure * Risk factors for pain: - habitual suboptimal posture - risk-prone behaviors (eg, lack of use of safety gear, performance of tasks requiring repetitive motion) - sedentary lifestyle - smoking history * Health, wellness, and fitness needs: - fitness, including physical performance (eg, decreased ability to tolerate strength training because of pain, limited participation in leisure sports because of pain) - health and wellness (eg, limited information about living with pain) Tests and Measures Tests and measures may include those that characterize or quantify: * Pain, soreness, and nociception (eg, angina scales, analog scales, discrimination tests, dyspnea scales, pain drawings and maps, provocation tests, verbal and pictorial descriptor tests) * Pain in specific body parts (eg, pain indexes, pain questionnaires, structural provocation tests) Tools Used for Gathering Data Tools for gathering data may include: * Descriptor tests (verbal and pictorial) * Discrimination tests * Indexes * Pain drawings and maps * Provocation and structural provocation tests * Questionnaires * Scales Data Generated Data are used in providing documentation and may include: * Characterizations of activities or postures that aggravate or relieve pain * Descriptions and quantifications of pain according to specific body part * Localization of pain * Sensory and temporal qualities of pain * Severity of pain, soreness, and discomfort * Somatic distribution of pain Posture Posture is the alignment and positioning of the body in relation to gravity, center of mass, or base of support. The physical therapist uses these tests and measures to assess structural alignment. Good posture is a state of musculoskeletal balance that protects the supporting structures of the body against injury or progressive deformity. Results of tests and measures of posture are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of posture. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems.' - cardiovascular (eg, cerebral vascular accident) - endocrine/metabolic (eg, rheumatological disease) - genitourinary (eg, pelvic floor dysfunction, pregnancy) - multiple systems (eg, trauma) - musculoskeletal (eg, amputation, intervertebral disk disorders, scoliosis, joint replacement) - neuromuscular (eg, cerebral palsy, neurofibromatosis, spina bifida) - pulmonary (eg, pneumonectomy, restrictive lung disease) * Impairments in the following categories: - circulation (eg, decreased endurance) - orthotic, protective, and supportive devices (eg, swollen malaligned knee) - muscle performance (eg, weakness, imbalance) - pain (eg, decreased range of motion of lumbar spine) - posture (eg, leg length discrepancies) - range of motion (eg, decreased cervical range of motion) - ventilation (eg, asymmetrical expansion) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, difficulty with donning and doffing shoes and socks because of limited painful spinal range of motion) - home management (eg, inability to do laundry because of shortness of breath) - work (job/school/play) (eg, inability to bake because of painful upper-extremity postures, inability to compete on soccer team because of scoliosis) - community/leisure (eg, inability as a scout leader to camp and hike because of hip pain, inability to walk dog because of leg pain) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories.' - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired posture: - habitual suboptimal posture - smoking history * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inability to serve tennis ball with required speed, poor posture that limits time at computer workstation) - health and wellness (eg, inadequate information about need for posture stretching) Tests and Measures Tests and measures may include those that characterize or quantify: * Postural alignment and position (dynamic), including symmetry and deviation from midline (eg, observations, technology-assisted assessments, videographic assessments) * Postural alignment and position (static), including symmetry and deviation from midline (eg, grid measurement, observations, photographic assessments) * Specific body parts (eg, angle assessments, forward-bending test, goniometry, observations, palpation, positional tests) Tools Used for Gathering Data Tools for gathering data may include: * Angle assessments * Cameras and photographs * Goniometers * Grids * Observations * Palpation * Positional tests * Plumb lines * Tape measures * Technology-assisted analysis systems * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Quantifications of: - dynamic alignment, symmetry, and deviation during movement - postural alignment using posture grids - static alignment, symmetry, and deviation Prosthetic Requirements Prosthetic requirements are the biomechanical elements necessitated by the loss of a body part. A prosthesis is an artificial device used to replace a missing part of the body. The physical therapist uses these tests and measures to assess the effects and benefits, components, alignment and fit, and safe use of the prosthesis. Results of tests and measures of prosthetic requirements are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of prosthetic requirements. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, peripheral vascular disease) - endocrine/metabolic (eg, diabetes) - integumentary (eg, burn, frostbite) - multiple systems (eg, congenital anomalies, gangrene) - musculoskeletal (eg, amputation, compartment syndrome) * Impairments in the following categories: - aerobic capacity (eg, decreased endurance) - circulation (eg, decreased ankle motion) - gait, locomotion, and balance (eg, altered stride length) - muscle performance (eg, decreased muscle endurance) - pain (eg, claudication) - prosthetic requirements (eg, residual limb pain) Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to put on shoes because of edema) - home management (eg, inability to climb stairs because of leg pain) - work (job/school/play) (eg, inability to use a keyboard because of loss of fingers, inability to walk child to school because of distal limb ache) - community/leisure (eg, inability to engage in bird watching because of residual limb discomfort on uneven terrain, inability to ride bicycle to school because of poor prosthetic fit) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for improper use or lack of use of prosthesis: - obesity - risk of skin breakdown - sedentary lifestyle * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inability to participate in endurance activities with current prosthesis, inadequate prosthetic components or fit for running) - health and wellness (eg, inadequate knowledge about importance of prosthetic fit) Tests and Measures Tests and measures may include those that characterize or quantify: * Components, alignment, fit, and ability to care for the prosthetic device (eg, interviews, logs, observations, pressure-sensing maps, reports) * Prosthetic device use during functional activities (eg, activities of daily living [ADL] scales, functional scales, instrumental activities of daily living [IADL] scales, interviews, observations) * Remediation of impairments, functional limitations, or disabilities with use of the prosthetic device (eg, aerobic capacity tests, activity status indexes, ADL scales, functional performance inventories, health assessment questionnaires, IADL scales, pain scales, play scales, technology-assisted assessments, videographic assessments) * Residual limb or adjacent segment, including edema, range of motion, skin integrity, and strength (eg, goniometry, muscle tests, observations, palpation, photographic assessments, skin integrity tests, technology-assisted assessments, videographic assessments, volume measurement) * Safety during use of the prosthetic device (eg, diaries, fall scales, interviews, logs, observations, reports) Tools Used for Gathering Data Tools for gathering data may include: * Aerobic capacity tests * Cameras and photographs * Diaries * Goniometers * Indexes * Interviews * Inventories * Logs * Muscle tests * Observations * Palpation * Pressure-sensing devices * Profiles * Questionnaires * Reports * Scales * Skin integrity tests * Technology-assisted analysis systems * Video cameras and videotapes * Volumometers Data Generated Data are used in providing documentation and may include: * Descriptions and quantifications of: - ability to use and care for device and practicality of device - components of prosthetic devices - level of safety with device - residual limb or adjacent segment * Descriptions and quantifications of: - alignment and fit of the device - remediation of impairment, functional limitation, or disability with device * Quantifications of: - movement patterns with or without device - physiological and functional effects and benefits of device Range of Motion (Including Muscle Length) Range of motion (ROM) is the are through which movement occurs at a joint or a series of joints. Muscle length is the maximum extensibility of a muscle-tendon unit. Muscle length, in conjunction with joint integrity and soft tissue extensibility, determines flexibility. The physical therapist uses these tests and measures to assess the range of motion of a joint. Results of tests and measures of range of motion (including muscle length) are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records).The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of range of motion (including muscle length). Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - endocrine/metabolic (eg, rheumatological disease) - genitourinary (eg, pregnancy) - multiple systems (eg, trauma) - musculoskeletal (eg, avulsion avulsion n. the change in the border of two properties due to a sudden change in the natural course of a stream or river, when the border is defined by the channel of the waterway. The most famous American case is the Mississippi River's change which put Vicksburg on the other side of the river. of tendon; disorders of muscle, ligament, and fascia; fracture; osteoarthritis; scoliosis; spinal stenosis; sprain; strain) - neuromuscular (eg, Parkinson disease) - ventilation (eg, restrictive lung disease) * Impairments in the following categories: - assistive and adaptive devices (eg, swollen knee) - cranial and peripheral nerve integrity (eg, radiating leg pain) - gait, locomotion, and balance (eg, limp) - muscle performance (eg, muscle weakness) - range of motion (eg, limited elbow range of motion) - ventilation (eg, shortness of breath) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to put on stockings because of weakness) - home management (eg, inability to load dishwasher because of difficulty bending) - work (job/school/play) (eg, inability to cut hair because of painful swollen fingers, inability as a professional dancer to assume en pointe position because of painful arch) - community/leisure (eg, inability to roller blade because of ankle swelling, inability to serve as volunteer in hospital gift shop because of pain on standing) * Disability--that is, the inability or the restricted ability toperform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired range of motion: - increased risk for falls - habitual suboptimal posture - smoking history * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inadequate flexibility to participate in gymnastics, limited range of motion in shoulders for mural painting) - health and wellness (eg, incomplete understanding of relationship between mobility and pain-free functional activities) Tests and Measures Tests and measures may include those that characterize or quantify: * Functional ROM (eg, observations, squat testing, toe touch tests) * Joint active and passive movement (eg, goniometry, inclinometry, observations, photographic assessments, technology-assisted assessments, videographic assessments) * Muscle length, soft tissue extensibility, and flexibility (eg, contracture tests, goniometry, inclinometry, ligamentous tests, linear measurement, multisegment flexibility tests, palpation) Tools Used for Gathering Data Tools for gathering data may include: * Back ROM devices * Camera and photographs * Cervical protractors * Flexible rulers * Functional tests * Goniometers * Inclinometers * Ligamentous stress tests * Multisegment flexibility tests * Observations * Palpation * Scoliometers * Tape measures * Technology-assisted analysis systems * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Descriptions of muscle, joint, and soft tissue characteristics * Observations and descriptions of functional or multisegmental movement * Quantifications of: - musculotendinous extensibility ROM Reflex Integrity Reflex integrity is the intactness of the neural path involved in a reflex. A reflex is a stereotypic, involuntary reaction to any of a variety of sensory stimuli. The physical therapist uses these tests and measures to determine the excitability of the nervous system and the integrity of the neuromuscular system. Results of tests and measures of reflex integrity are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of reflex integrity. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, cerebral vascular accident) - multiple systems (eg, Guillain-Barre syndrome) - neuromuscular (eg, amyotrophic lateral sclerosis, cerebral palsy, coma, prematurity, traumatic brain injury) - pulmonary (eg, anoxia) * Impairments in the following categories: - assistive and adaptive devices (eg, limited mobility) - gait, locomotion, and balance (eg, poor balance) - integumentary integrity (eg, pressure sore) - motor function (eg, poor coordination) - muscle performance (eg, weakness) - neuromotor development and sensory integration (eg, delayed gross motor skills) - posture (eg, asymmetrical alignmen0 - range of motion (eg, hypermobility) * Functional limitations in the ability to perform actions, tasks, and activities in the following categories: - self-care (eg, difficulty with eating because of jaw pain with chewing) - home management (eg, inability to take trash cans out because of poor coordination) - work (job/school/play) (eg, inability to reach to restock shelves because of poor coordination) - community/leisure (eg, inability to hike with friends because of poor coordination and weakness, inability to obtain driver's license because of startle reflex, inability to run because of hypermobility) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired reflex integrity: - habitual suboptimal posture increased risk for falls * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inability to participate in leisure activities that involve jumping and hopping, inadequate knowledge of proper stretch techniques for sports participation) - health and wellness (eg, inadequate knowledge of relaxation) Tests and Measures Tests and measures may include those that characterize or quantify: * Deep reflexes (eg, myotatic reflex scale, observations, reflex tests) * Electrophysiological integrity (eg, electroneuromyography) * Postural reflexes and reactions, including righting, equilibrium, and protective reactions (eg, observations, postural challenge tests, reflex profiles, videographic assessments) * Primitive reflexes and reactions, including developmental (eg, reflex profiles, screening tests) * Resistance to passive stretch (eg, tone scales) * Superficial reflexes and reactions (eg, observations, provocation tests) Tools Used for Gathering Data Tools for gathering data may include: * Electroneuromyographs * Myotatic reflex scales * Observations * Postural challenge tests * Provocation tests * Reflex profiles * Reflex tests * Scales * Screens * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Characterizations and quantifications of: - age-appropriate reflexes - deep reflexes - electrophysiological responses to stimulation - postural reflexes and righting reactions - superficial reflexes Self-Care and Home Management (Including Activities of Daily Living and Instrumental Activities of Daily Living) Self-care management is the ability to perform activities of daily living (ADL), such as bed mobility, transfers, dressing, grooming, bathing, eating, and toileting. Home management is the ability to perform the more complex instrumental activities of daily living (IADL), such as structured play (for infants and children), maintaining a home, shopping, performing household chores, caring for dependents, and performing yard work. The physical therapist uses the results of these tests and measures to assess the level of performance of tasks necessary for independent living; the need for assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment; and the need for body mechanics training, organized functional training programs, or therapeutic exercise. Results of tests and measures of self-care and home management (including ADL and IADL) are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of self-care and home management (including ADL and IADL). Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, cerebral vascular accident, congestive heart failure, peripheral vascular disease) - endocrine/metabolic (eg, rheumatological disease) - genitourinary (eg, pelvic floor dysfunction) - multiple systems (eg, AIDS, trauma) - musculoskeletal (eg, amputation, joint replacement, spinal stenosis, spinal surgery) - neuromuscular (eg, cerebellar ataxia, cerebral palsy, multiple sclerosis, post-polio syndrome, spinal cord injury, traumatic brain injury) - pulmonary (eg, asthma, chronic obstructive pulmonary disease, cystic fibrosis, reactive airways disease) * Impairments in the following categories: - aerobic capacity (eg, decreased endurance, shortness of breath) - arousal, attention, cognition (eg, lack of safety awareness) - circulation (eg, abnormal heart rate and rhythm) - gait, locomotion, and balance (eg, falls) - muscle performance (eg, decreased power) - neuromotor development (eg, abnormal movement patterns) - orthotic, protective, and supportive devices (eg, wearing a corset) - posture (eg, severe kyphosis) - prosthetic requirements (eg, use of prosthesis) - range of motion (eg, decreased muscle length) - ventilation (eg, accessory muscle use) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to dress because of abnormal range of motion, inability to tie shoes as a first grader because of poor coordination) - home management (eg, inability to shop because of decreased endurance) - community/leisure (eg, inability to garden because of shortness of breath, inability to travel to visit relatives because of lack of safety awareness) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for limitations in self, are and home management: - habitual suboptimal posture - lack of safety awareness in all environments - risk-prone behaviors (eg, performance of tasks requiring repetitive motion, lack of use of safety gear) - sedentary lifestyle * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inadequate endurance to perform heavy chores) - health and wellness (eg, limited knowledge of adaptations to allow independent function) Tests and Measures Tests and measures may include those that characterize or quantify: * Ability to gain access to home environments (eg, barrier identification, observations, physical performance tests) * Ability to perform self-care and home management activities with or without assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and equipment (eg, ADL scales, aerobic capacity tests, IADL scales, interviews, observations, profiles) * Safety in self-care and home management activities and environments (eg, diaries, fall scales, interviews, logs, observations, reports, videographic assessments) Tools Used for Gathering Data Tools for gathering data may include: * Aerobic capacity tests * Barrier identification checklists * Diaries * Fall scales * Indexes * Interviews * Inventories * Logs * Observations * Physical performance tests * Profiles * Reports * Questionnaires * Scales * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Descriptions and quantifications of: - ability to participate in variety of environments - functional capacity - level of safety in self-care and home management activities - need for devices or equipment - physiological responses to activity Sensory Integrity Sensory integrity is the intactness of cortical sensory processing, including proprioception, pallesthesia, stereognosis, and topognosis. Proprioception is the reception of stimuli from within the body (eg, from muscles and tendons) and includes position sense (the awareness of joint position) and kinesthesia (the awareness of movement). Pallesthesia is the ability to sense mechanical vibration. Stereognosis is the ability to perceive, recognize, and name familiar objects. Topognosis is the ability to localize exactly a cutaneous sensation. The physical therapist uses the results of tests and measures to determine the integrity of the sensory, perceptual, and somatosensory processes. Results of tests and measures of sensory integrity are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of sensory integrity. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems.' - cardiovascular (eg, cerebral vascular accident, peripheral vascular disease) - endocrine/metabolic (eg, diabetes, rheumatological disease) - integumentary (eg, burn, frostbite, lymphedema) - multiple systems (eg,AIDS, Guillain-Barre syndrome, trauma) - musculoskeletal (eg, derangement of joint; disorders of bursa, synovia, and tendon) - neuromuscular (eg, cerebral palsy, developmental delay, spinal cord injury, traumatic brain injury) - pulmonary (eg, respiratory failure, ventilatory pump failure) * Impairments in the following categories: - circulation (eg, numb feet) - integumentary integrity (eg, redness under orthotic) - muscle performance (eg, decreased grip strength) - orthotic, protective, and supportive devices (eg, wears ankle foot orthosis) - posture (eg, forward head) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to put on trousers while standing because of loss of feeling in foot) - home management (eg, difficulty with sorting change because of numbness) - work (job/school/play) (eg, inability as a day care provider to change child's diaper because of loss of finger sensation, inability to operate cash register because of clumsiness) - community/leisure (eg, inability to drive car because of loss of spatial awareness, inability to play guitar because of hyperesthesia) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired sensory integrity: - lack of safety awareness in all environments - risk-prone behaviors (eg, working without protective gloves) - smoking history - substance abuse * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inadequate balance to compete in dancing competition, limited perception of arms and legs in space during ballroom dancing) - health and wellness (eg, inadequate understanding of role of proprioception in balance) Tests and Measures Tests and measures may include those that characterize or quantify: * Combined/cortical sensations (eg, stereognosis tests, tactile discrimination tests) * Deep sensations (eg, kinesthesiometry, observations, photographic assessments, vibration tests) * Electrophysiological integrity (eg, electroneuromyography) Tools Used for Gathering Data Tools for gathering data may include: * Cameras and photographs * Esthesiometers * Electroneuromyographs * Filaments * Kinesthesiometers * Observations * Palpation * Pressure scales * Sensory tests * Tuning forks Data Generated Data are used in providing documentation and may include: * Characterizations and quantifications of: - electrophysiological responses to stimulation - position and movement sense - sensory processing - sensory responses to provocation Ventilation and Respiration/Gas Exchange Ventilation is the movement of a volume of gas into and out of the lungs. Respiration is the exchange of oxygen and carbon dioxide across a membrane either in the lungs or at the cellular level. The physical therapist uses these tests and measures to determine whether the patient has an adequate ventilatory pump and oxygen uptake/carbon dioxide elimination system to meet the oxygen demands at rest, during aerobic exercise, and during the performance of activities of daily living. Results of tests and measures of ventilation and respiration/gas exchange are integrated with the history and systems review findings and the results of other tests and measures. All of these data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of ventilation and respiration/gas exchange. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, cerebral vascular accident, congestive heart failure, coronary artery disease) - endocrine/metabolic (eg, diabetes, rheumatological disease) - genitourinary (eg, pelvic floor dysfunction) - multiple systems (eg,AIDS, deconditioning, trauma) - musculoskeletal (eg, kyphoscoliosis, muscular dystrophy) - neuromuscular (eg, coma, cerebral palsy, Parkinson disease, spinal cord injury, traumatic brain injury) - pulmonary (eg, asthma, cystic fibrosis, chronic obstructive pulmonary disease, hyaline membrane disease, pneumonia, pulmonary edema, reactive airways disease, respiratory failure, restrictive lung disease, status post thoracotomy) * Impairments in the following categories: - aerobic capacity (eg, shortness of breath) - anthropometric characteristics (eg, pedal edema) - circulation (eg, abnormal heart rate, calf cramps with walking) - muscle performance (eg, decreased endurance) - posture (eg, scoliosis) - prosthetic requirements (eg, dyspnea on exertion while wearing prosthesis) - ventilation (eg, accessory muscle use) * Functional limitations in the ability to perform actions, tasks, or activities in the following categories: - self-care (eg, inability to put on socks because of shortness of breath) - home management (eg, inability to do yard work because of decreased power) - work (job/school/play) (eg, inability to preach sermons because of uncontrolled breathing pattern, inability to suck as neonate because of rapid respiratory rate) - community/leisure (eg, inability to participate in community gardening events because of dyspnea on exertion, inability to swim because of dyspnea and chest tightness) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for impaired ventilation and respiration/gas exchange: - risk-prone behaviors (eg, exercise in high-pollution environments, lack of understanding of the need for flu shot) - sedentary lifestyle - smoking history * Health, wellness, and fitness needs: - fitness, including physical performance (eg, inadequate oxygen consumption for participating in marathon running, inadequate peripheral response for running) - health and wellness (eg, incomplete understanding of necessity for paced breathing during activity) Tests and Measures Tests and measures may include those that characterize or quantify: * Pulmonary signs of respiration/gas exchange, including breath sounds (eg, gas analyses, observations, oximetry) * Pulmonary signs of ventilatory function, including airway protection; breath and voice sounds; respiratory rate, rhythm, and pattern; ventilatory flow, forces, and volumes (eg, airway clearance tests, observations, palpation, pulmonary function tests, ventilatory muscle force tests) * Pulmonary symptoms (eg, dyspnea and perceived exertion indexes and scales) Tools Used for Gathering Data Tools for gathering data may include: * Airway clearance tests * Force meters * Gas analyses * Indexes * Observations * Palpation * Pulse oximeters * Spirometers * Stethoscopes Data Generated Data are used in providing documentation and may include: * Descriptions and characterization of: - breath and voice sounds - chest wall and related structures - phonation - pulmonary-related symptoms - pulmonary vital signs - thoracoabdominal ventilatory patterns * Observations and descriptions of nail beds * Presence and level of cyanosis * Quantifications of: - ability to dear and protect airway - gas exchange and oxygen transport - pulmonary function and ventilatory mechanics Work (Job/School/Play), Community, and Leisure Integration or Reintegration (Including Instrumental Activities of Daily Living) Work (job/school/play) integration or reintegration is the process of assuming or resuming roles and functions at work (job/school/play), such as negotiating school environments, gaining access to work (job/school/play) environments and workstations, and participating in age-appropriate play activities. Community integration or reintegration is the process of assuming or resuming roles and functions in the community, such as gaining access to transportation (eg, driving a car, boarding a bus, negotiating a neighborhood), to community businesses and services (eg, bank, shops, parks), and to public facilities (eg, attending theaters, town hal meetings, and places of worship). Leisure integration or reintegration is the process of assuming or resuming roles and functions of avocational and enjoyable pastimes, such as recreational activities (eg, playing a sport) and age-appropriate hobbies (eg, collecting antiques, gardening, or making crafts). The physical therapist uses the results of work, community, and leisure integration or reintegration tests and measures to (1) make judgments as to whether a patient/client is currently prepared to assume or resume community or work (job/school/play) roles, including all instrumental activities of daily living (IADL), (2) determine when and how such integration or reintegration might occur, or (3) assess the need for assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment. The physical therapist also uses the results of these tests and measures to determine whether the patient/client is a candidate for a work hardening or work conditioning program. Results of tests and measures of work (job/school/play), community, and leisure integration or reintegration are integrated with the history and systems review findings and the results of other tests and measures. All of the data are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The results of these tests and measures may indicate the need to use or recommend other tests and measures or the need to consult with, or refer the patient/client to, another professional. Clinical Indications Clinical indications for the use of tests and measures are predicated on the history and systems review findings (eg, information provided by the patient/client, family, significant other, or caregiver; symptoms described by the patient/client; signs observed and documented during the systems review; and information derived from other sources and records). The findings may indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments, functional limitations, or disabilities that require a more definitive examination through the selection of tests and measures of work (job/school/play), community, and leisure integration or reintegration. Clinical indications for these tests and measures may include: * Pathology/pathophysiology (disease, disorder, or condition) in the following systems: - cardiovascular (eg, cerebral vascular accident, peripheral vascular disease) - endocrine/metabolic (eg, rheumatological disease) - genitourinary (eg, pelvic floor dysfunction) - multiple systems (eg,AIDS, trauma) - musculoskeletal (eg, amputation, status post joint replacement) - neuromuscular (eg, cerebellar ataxia, cerebral palsy) - pulmonary (eg, asthma, cystic fibrosis) * Impairments in the following categories: - circulation (eg, calf cramps with walking) - muscle performance (eg, decreased strength) - neuromotor development (eg, abnormal movement control) - posture (eg, pain on sitting) - range of motion (eg, decreased muscle length) - ventilation (eg, abnormal breathing pattern) * Functional limitations in the ability to perform actions, tasks, and activities in the following categories: - work (job/school/play) (eg, inability to sit at desk because of pain) - community/leisure (eg, inability to attend a concert because of incontinence, inability to board a bus because of muscle weakness, inability to gain access to recreational facilities because of abnormal movement control, inability to visit friends in neighborhood because of decreased endurance) * Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of required roles within the individual's sociocultural context--in the following categories: - self-care - home management - work (job/school/play) - community/leisure * Risk factors for limitations in work Gob/school/play), community, and leisure integration and reintegration: - lack of safety awareness in all environments * Health, wellness, and fitness needs.' - fitness, including physical performance (eg, inadequate motor skill to perform repeated lifting activities as part of job, inadequate muscle strength for lifting boxes to and from shelves) - health and wellness (eg, incomplete understanding of need for community support during reintegration) Tests and Measures Tests and measures may include those that characterize or quantify: * Ability to assume or resume work (job/school/play), community, and leisure activities with or without assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and equipment (eg, activity profiles, disability indexes, functional status questionnaires, IADL scales, observations, physical capacity tests) * Ability to gain access to work (job/school/play), community, and leisure environments (eg, barrier identification, interviews, observations, physical capacity tests, transportation assessments) * Safety in work (job/school/play), community, and leisure activities and environments (eg, diaries, fall scales, interviews, logs, observations, videographic assessments) Tools Used for Gathering Data Tools for gathering data may include: * Diaries * Indexes * Interviews * Logs * Observations * Physical capacity tests * Profiles * Questionnaires * Transportation assessments * Scales * Video cameras and videotapes Data Generated Data are used in providing documentation and may include: * Descriptions of: - level of safety in work (job/school/ play), community, and leisure activities - physiological responses to activity * Quantifications of: - ability to participate in variety of environments - functional capacity - need for devices or equipment |
|
||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion