What types of tests and measures do physical therapists use?

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 impairments, functional limitations, and disabilities and establish the diagnosis and the prognosis. Physical therapists may perform more than one test or measure at a time.

The physical therapist individualizes the selection of tests and measures, rather than basing selection solely on diagnosis. When examining a patient/client with impairment, functional limitation, or disability resulting from brain injury, for example, the physical therapist may decide to perform part or all of several tests and measures, based on the pattern of involvement.

This chapter contains 24 groupings of specific tests and measures (Fig. 5) that the physical therapist may decide to use during the examination. Tests and measures are listed in alphabetical order. Each pattern in Part Two contains a list of specific related tests and measures. Note: Physical therapists also may decide to use other tests and measures that are not described in the Guide.

Each grouping of tests and measures includes the following:

* General purposes of the tests and measures. 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 specific tests and measures depends on the findings of the history and systems review. The examination findings may indicate, for instance, that tests should be performed while the patient/client performs specific activities. In all cases, the purpose of tests and measures is to ensure the gathering of information that leads to an evaluation, a diagnosis, a prognosis, and the selection of appropriate interventions.

* Clinical indications, such as impairments, functional limitations, disabilities, or special requirements that may prompt the physical therapist to conduct the 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, community and work (job/school/play)

integration or reintegration, and leisure tasks,

movements, or activities

- Requirements of employment that specify

minimum capacity for performance

- Identified need to initiate or change a prevention or

wellness program

* Specific tests and measures methods and techniques)

* Types of data that ma be generated from the tests and measures

Other information that may be required for the examination includes: findings of other professionals; results of diagnostic imaging, clinical laboratory, and electrophysiologic studies; federal, state, and local work surveillance and safety reports and announcements; and observations of family, significant others, caregivers, and other interested persons.

An examination, evaluation, or intervention -- unless performed by a physical therapist -- is not physical therapy, nor should it be represented or reimbursed as such.

Aerobic Capacity and Endurance

Aerobic capacity and endurance are measures of the ability to perform work or participate in activity over time using the body's oxygen uptake and delivery and energy release mechanisms. During activity, the physical therapist uses tests ranging from simple determinations blood pressure, heart rate, and respiratory rate to complex calculations of oxygen consumption and carbon dioxide production to determine the appropriateness of the response to increased oxygen demand. Monitoring responses at rest and during and after activity may indicate the degree and severity of impairment, identify cardiopulmonary deficits that result in functional limitation, and indicate the need to use or recommend other tests and measures and specific interventions.

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- dizziness

- dyspnea at rest or on exertion 

- edema or lymphedema

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(including strength, power, and

especially endurance)

- impaired range of motion (ROM)

(including muscle length)

- impaired ventilation, respiration 

(gas exchange), and circulation

Specific Tests and Measures

Tests and measures may include:

* Assessment of autonomic responses to positional changes

* Assessment of perceived exertion, dyspnea, or angina during activity using rating-of-perceived-exertion (RPE) scales, dyspnea scales, anginal pain scales, or visual analog scales

* Assessment of performance during established exercise protocols (eg, treadmill, ergometer, 6-minute walk test, 3-minute step test)

* Assessment of standard vital signs (eg, blood pressure, heart rate, respiratory rate) at rest and during and after activity

* Assessment of thoracoabdominal movements and breathing patterns with activity

* Auscultation of the heart

* Auscultation of the lungs

* Auscultation of major vessels for bruits

* Interpretation of blood gas analysis or oxygen consumption ([VO.sub.2]) studies

* Monitoring via telemetry during activity

* Palpation of pulses

* Claudication time tests

* Pulse oximetry 

* Tests and measures of pulmonary function and ventilatory mechanics

* Performance or analysis of an electrocardiogram 

Data Generated

Data generated may include:

* Activities that aggravate or relieve symptoms

* Anaerobic threshold 

* Arrhythmias at rest and during activity

* Autonomic responses to positional changes

* Thoracoabdominal movement and breathing patterns with activity

* Inspiratory and expiratory muscle force before and after activity (including comparison of actual to predicted)

* Maximum oxygen consumption ([VO.sub.2]) (including comparison of actual to predicted)

* Oxygen consumption ([VO.sub.2]) for particular activity (including comparison of actual to predicted)

* Oxygen saturation ([SaO.sub.2]) at rest and during and after activity

* Peripheral vascular integrity

* Physical exertion scale grading and degree of dyspnea or angina with activity

* Standard vital signs (eg, blood pressure, heart rate, respiratory rate) at rest and during and after activity

* Symptoms that limit activity

* Ventilatory volumes and flow at rest and during and after activity (including comparison of actual to predicted)

Anthropometric Characteristics

Anthropometric characteristics describe human body measurements such as height, weight, girth, and body fat composition. The physical therapist uses these tests and measures to test for muscle atrophy, gauge the extent of edema, and establish a baseline to allow patients/clients to be compared to national norms on such variables as weight and body fat composition. Results of these tests and measures may indicate the need to use or recommend other tests and measures.

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- edema, lymphedema, or effusion 

- impaired aerobic capacity and

endurance

- impaired gait, locomotion, and

balance

- impaired muscle performance

(strength, power, endurance)

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange) and circulation

- pain

Specific Tests and Measures

Tests and measures may include:

* Assessment of activities and postures that aggravate or relieve edema, lymphedema, or effusion

* Assessment of edema through palpation and volume and girth measurements (eg, during pregnancy, in determining the effects of other medical or health-related conditions, during surgical procedures, after drug therapy)

* Measurement of body fat composition, using calipers, underwater weighing tanks, or electrical impedance 

* Measurement of height, weight, length, and girth

* Observation and palpation of trunk and extremities at rest and during and after activity

Data Generated

Data generated may include:

* Activities and postures that aggravate or relieve edema, lymphedema, or effusion

* Body fat composition

* Girths of extremities and chest and lengths of extremities in inches or centimeters

* Height in feet and inches or centimeters

* Integrity of lymphatic system 

* Volume displacement in liters

* Weight in pounds or kilograms

Arousal, Attention, and Cognition 

Arousal is the stimulation to action or to physiologic readiness for activity. Attention is selective awareness of a part or aspect of the environment or selective responsiveness to one class of stimuli. Cognition is the act or process of knowing, including both awareness and judgment. The physical therapist uses specific tests and measures to assess responsiveness; orientation to time, person, place, and situation; and ability to follow directions. These tests and measures guide the physical therapist in the selection of interventions by indicating whether the patient/client has the cognitive ability to participate in the plan of care.

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired reflex integrity

- impaired neuromotor development

and sensory integration 

- impaired aerobic capacity and

endurance

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

strength, power, endurance)

- impaired posture

- impaired sensory integrity

- impaired ventilation, respiration

gas exchange), and circulation

- pain

Specific Tests and Measures

Tests and measures may include:

* Assessment of arousal, attention, and cognition, using standardized instruments

* Assessment of factors that influence motivation level

* Assessment of level of consciousness

* Assessment of level of recall (eg, short-term and long-term memory)

* Assessment of orientation to time, person, place, and situation

* Screening for cognition (eg, to determine ability to process commands, to measure safety awareness)

* Screening for gross expressive (eg, verbalization) deficits

Data Generated

Data generated may include:

* Level of arousal, attention, or cognition deficits

* Scores on standardized instruments for measuring level of arousal, attention, or cognition

* Variation over time of arousal, attention, or cognition deficits

Assistive and Adaptive Devices

Assistive and adaptive devices include a variety of implements or equipment used to aid patients/clients in performing tasks or movements. Assistive devices include crutches, canes, walkers, wheelchairs, power devices, long-handled reachers, and static and dynamic splints. Adaptive devices include raised toilet seats, seating systems, and environmental controls. The physical therapist uses specific 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 determine how well the patient/client performs with it.

Clinical Indications Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- edema or lymphedema

impaired aerobic capacity and

endurance

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

pain

Specific Tests and Measures Tests and measures may include:

* Analysis of appropriate components of device

* Analysis of effects and benefits (including energy conservation and expenditure) while patient/client uses device

* Analysis of patient/client or caregiver ability to use and care for device

* Analysis of the potential to remediate impairment, functional limitation, or disability through use of a device

* Assessment of alignment and fit of the device and inspection of related changes in skin condition

* Assessment of safety during use of device

* Computer-assisted analysis of motion, initially without and then with device Review of reports provided by the patient/client, family, significant others, caregivers, or other professionals concerning use of or need for device

* Videotape analysis of the patient/ client using device

Data Generated Data generated may include:

* Ability to use the device and to understand its appropriate use and care

* Alignment of anatomical parts with the device

* Deviations and malfunctions that can be corrected or alleviated using a device

* Level of adherence to use of the device

* Patient/client expressions of comfort, cosmesis, and effectiveness using the device

* Practicality and ease of use of device

* Safety and effectiveness of the device in providing protection, promoting stability, or improving performance of tasks and activities

Community and Work (Job/School/Play) integration or Reintegration

(including instrumental Activities of Daily Living)

Community and work (job/school/play) integration or reintegration is the process of assuming roles in the community or at work. The physical therapist uses the following tests and measures to (1) make an informed judgment as to whether a patient/client is currently prepared to assume community or work roles, including all instrumental activities of daily living (IADL), or (2) determine when and how such integration or reintegration might occur. The physical therapist also uses these tests and measures to determine whether an individual is a candidate for a work hardening or work conditioning program. The physical therapist considers patient/client safety, perceptions, and expectations while performing the test and measures.

Clinical indications Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform community and work (job/school/play) integration or reintegration and leisure tasks, movements, or activities:

- impaired aerobic capacity and

endurance

- impaired arousal, attention, and

cognition

- impaired gait, locomotion, and

balance

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

pain

Specific Tests and Measures Tests and measures may include:

* Analysis of adaptive skills

* Analysis of community, work (job/ school/play), and leisure activities

* Analysis of community, work (job/ school/play), and leisure activities that are performed using assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and equipment

* Analysis of environment and work (job/school/play) tasks

* Assessment of autonomic responses to positional changes

* Assessment of functional capacity

* Assessment of physiologic responses during community, work job/ school/play), and leisure activities

* Assessment of safety in community and work (job/school/play) environments

* IADL scales or indexes

* Observation of response to nonroutine occurrences

* Questionnaires completed by and interviews conducted with the patient/client and others as appropriate

* Review of daily activities logs

* Review of reports provided by the patient/client, family, significant others, caregivers, other health care professionals, or other interested persons (eg, rehabilitation counselor, Workers' Compensation claims manager, employer)

Data Generated Data generated may include:

* Adaptive skills

* Aerobic capacity or endurance

* Appropriateness of assistive and adaptive devices

* Appropriateness of orthotic, protective, supportive, or prosthetic devices or equipment

* Daily activity level

* Effort in specific movement tasks

* Functional capacity for community and work (job/school/play) tasks

* Gross and fine motor function

* Attention and cognition deficits

* Physical, functional, behavioral, and vocational status

* Muscle strength, power, and endurance

* Numerical scores on standardized rating scales

* Performance of community and work (job/school/play) activities and level of dependence on human and mechanical assistance

* Prosthetic requirements

* Spatial and temporal requirements for performing specific tasks related to community and work (job/school/ play) activities

* Standard vital signs (blood pressure, heart rate, respiratory rate) at rest and during and after activity

* Strength, flexibility, and endurance

Cranial Nerve Integrity

Cranial nerve integrity involves somatic, visceral, and afferent and efferent components. The physical therapist uses cranial nerve integrity tests and measures to localize a dysfunction in the brain stem and to identify cranial nerves that merit an in-depth examination. The physical therapist uses a number of these tests to assess sensory and motor functions, such as taste, smell, and facial expression.

Clinical Indications Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired neuromotor development

and sensory integration

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired reflex integrity

- impaired sensory integrity

pain

Specific Tests and Measures Tests and measures may include:

* Assessment of dermatomes innervated by the cranial nerve

* Assessment of gag reflex 

* Assessment of muscles innervated by the cranial nerves

* Assessment of response to the following stimuli:

auditory

gustatory 

olfactory 

visual

vestibular 

* Assessment of swallowing

Data Generated Data generated may include:

* Constriction and dilation of pupils

* Equilibrium responses

* Eye movements

* Functional loss in muscles innervated by the cranial nerves

* Gag reflex integrity

* Gross auditory activity

* Pain, touch, temperature localization 

* Swallowing characteristics

* Taste loss

* Visual deficits

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 barriers 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 environment, sinks, bathrooms, counters, placement of controls or switches). The physical therapist uses these tests and measures, often in conjunction with portions of other tests and measures, 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.

Clinical Indications Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired aerobic capacity and

endurance

- impaired bowel and bladder

function

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- impaired sensory integrity

pain

Specific Tests and Measures Tests and measures may include:

* Analysis of physical space using photography or videotape

* Assessment of current and potential barriers

* Measurement of physical space

* Physical inspection of the environment

* Questionnaires completed by and interviews conducted with patient/ client and others as appropriate

Data Generated Data generated may include:

* Adaptations, additions, or modifications that would enhance safety

* Level of compliance with standards set forth in federal and state laws and regulations

* Recommendations for eliminating environmental barrier

* Space limitations and other barriers, including their dimensions, that limit ability to perform specific movement tasks during home, work (job/school/ play), and leisure activities

Ergonomics and Body Mechanics 

Ergonomics refers to the relationships among the worker, the work that is done, the tasks and activities inherent in that work, and the environment in which the work is performed. Ergonomics uses scientific and engineering principles to improve the safety, efficiency, and quality of movement involved in work. Body mechanics refers to the interrelationships of the muscles and joints as they maintain or adjust posture in response to environmental forces. The physical therapist uses the ergonomics and body mechanics tests and measures to examine the work environment on behalf of patients/clients and to determine 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 measure, particularly when a patient/client is returning to the work environment after an extended absence.

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations experienced during attempts to perform self-care, home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- abnormal body

alignment and movement

patterns

- impaired aerobic

capacity and

endurance

- impaired gait,

locomotion, and balance

- impaired joint integrity

and mobility

- impaired motor

function (motor control

and motor learning)

- impaired muscle

performance (strength,

power, endurance)

- impaired posture

- impaired sensory

integrity

- impaired ventilation,

respiration (gas

exchange), and

circulation

pain

Specific Tests and Measures

Ergonomics tests and measures may include:

* Analysis of the performance of selected tasks or activities

* Analysis of preferred postures during performance of tasks and activities

* Assessment of dexterity and coordination

* Assessment of safety in community and work (job/school/play) environments

* Assessment of work hardening or work conditioning needs, including identification of needs related to physical, functional, behavioral, and vocational status

* Assessment of work (job/school/play) performance through batteries of tests

* Computer-assisted motion analysis of patient/client at work

* Determination of dynamic capabilities and limitations during specific work (job/school/play) activities

* Ergonomics analysis of the work and its inherent tasks or activities, including:

- analysis of repetition/work/rest cycling during task or activity

- assessment of tools, devices, or equipment used

- assessment of vibration

- assessment of workstation

- computer-assisted motion analysis of performance of selected

movements or activities

- identification of essential functions of task or activity

- identification of sources of actual and potential trauma,

cumulative trauma, or repetitive stress

* Functional capacity evaluation, including:

- endurance required to perform aerobic endurance activities

- joint range of motion (ROM) used to perform task or activity

- postures required to perform task or activity

- strength required in the work postures necessary to perform

the task or activity

* Videotape analysis of the patient/client at work

Body mechanics tests and measures may include:

* Computer-assisted motion analysis of performance of selected movements or activities

* Determination of dynamic capabilities and limitations during specific work (job/school/play) activities

* Measurement of height, weight, length, and girth

* Observation of performance of selected movements or activities

* Videotape analysis of performance of selected movements or activities

Data Generated

Data generated may include:

* Aerobic capacity or endurance

* Body alignment, timing, and sequencing of component movements during specific job tasks or activities

* Chest and extremity girth

* Difficulty or pain expressed during the performance of specific job tasks or activities

* Effort in specific movement tasks

* Gross and fine motor function

* Height in feet and inches or meters and centimeters

* Physical, functional, behavioral, and vocational status

* Potential and actual ergonomic stressors

* Safety records and accident reports

* Strength, flexibility, and endurance

* Temporal and spatial characteristics of movements during job tasks or activities

* Weight in pounds or kilograms

* Work (job/school/play) performance

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 (eg, while stationary) and dynamically (eg, while walking). The physical therapist uses gait, locomotion, and balance tests and measures to investigate disturbances in gait, locomotion, and balance because they frequently lead to decreased mobility, a decline in functional independence, and an increased risk of falls. Gait, locomotion, and balance problems often involve difficulty in integrating sensory, motor, and neural processes. 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.

Clinical indications

Tests and measures are appropriate in the presence of

* Expectation or indication of one or more of the following impairments or functional limitations experienced during attempts to perform self-care, home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- dizziness

- impaired aerobic capacity and

endurance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

- pain

Specific Tests and Measures

Tests and measures may include:

* Analysis of arthrokinematic, biomechanical, kinematic, and kinetic characteristics of gait, locomotion, and balance, using electromyography (EMG), videotape, computer-assisted graphics, weight-bearing scales, and force plates

* Analysis of arthrokinematic, biomechanical, kinematic, and kinetic characteristics of gait, locomotion, and balance with and without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment

* Analysis of gait, locomotion, and balance on various terrains, in different physical environments, or in water

* Analysis of wheelchair management and mobility

* Assessment of autonomic responses to positional changes

* Assessment of safety

* Gait, locomotion, and balance assessment instruments

* Gait, locomotion, and balance profiles.

* Identification and quantification of gait characteristics

* Identification and quantification of static and dynamic balance characteristics

Data Generated

Data generated may include:

* Charts and videotapes that reflect gait, locomotion, and balance changes over time

* Energy expenditure requirements

* Gait cycle, gait deviations, and the safety and quality of gait and balance over time in different environments and on a variety of surfaces

* Number ratings from standardized gait-testing instruments

* Activities that aggravate or diminish difficulties with gait, locomotion, or balance

* Ability to negotiate varied surfaces and elevations

* Patient/client perception of gait, locomotion, and balance problems

* Physiologic responses during gait, locomotion, and balance activities

* Qualitative and quantitative descriptions of gait, locomotion, and balance

* Safety and quality of gait and the gait cycle over time using assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment

* Safety and quality of locomotion in different environments and over different terrains

* Safety awareness

* Weight-bearing status

Integumentary Integrity

Integumentary integrity is the health of the skin, including its ability to serve as a barrier to environmental threats (eg, bacteria, parasites). The physical therapist uses integumentary integrity tests and measures to assess the effects of a wide variety of problems 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). These tests and measures also are used to obtain more information about circulation through inspection of the skin or the nail beds.

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired bowel and

bladder function

- impaired gait, locomotion,

and balance

- impaired joint integrity and

mobility

- impaired motor function

motor control and motor

learning)

- impaired muscle

performance (strength, power,

endurance)

- impaired sensory integrity

- impaired ventilation,

respiration (gas exchange) and

circulation

- pain

Specific Tests and Measures

Tests and measures for skin associated with integumentary disruption may include:

* Assessment for presence of blistering 

* Assessment for presence of hair growth

* Assessment of activities, positioning, and postures that aggravate or relieve pain or other disturbed sensations

* Assessment of activities, positioning, postures, and assistive and adaptive devices that may result in trauma to associated skin

* Assessment of continuity of skin color (eg, redness in lightly pigmented skin, violescent coloration in darkly pigmented skin)

* Assessment of nail beds

* Assessment of sensation (eg, pain, temperature, tactile)

* Assessment of skin temperature as compared with that of an adjacent area or an opposite extremity (eg, using thermistors)

* Assessment of tissue mobility, turgor, and texture

Tests and measures for the wound may include:

* Assessment for presence of dermatitis (eg, rash, fungus)

* Assessment for presence of hair or nail growth

* Assessment for signs of infection

* Assessment of activities, positioning, and postures that aggravate the wound or scar or thai may produce additional trauma

* Assessment of bleeding

* Assessment of burn

* Assessment of ecchymosis 

* Assessment of exposed anatomical structures 

* Assessment of pigment (color)

* Assessment of sensation (eg, pain, temperature, tactile)

* Assessment of scar tissue (cicatrix), including banding, pliability, sensation, and texture

* Assessment of wound contraction, drainage, location, odor, shape, size, and depth (eg, linear, tracing, photography), tunneling, and undermining

* Assessment of wound tissue, including epithelium, granulation, mobility, necrosis, slough, texture, and turgor

Data Generated

Data generated may include:

* Activities and postures that aggravate the wound or that may produce pain or additional trauma

* Extremity characteristics in terms of color and temperature (in degrees or words)

* Grid photograph of wound

* Girths in inches or centimeters or volume displacement in milliliters

* Minimal erythematous dose reactions in seconds

* Skin condition

* Skin temperature in degrees

* Soft tissue and scar tissue (mobility and cicatrix) condition

* Wound characteristics (eg, inflamed, macerated, necrotic)

* Wound dimensions in square or cubic inches or centimeters

* Wound drainage characteristics (eg, serous, serosanguineous, pus, slough)

Joint integrity and Mobility

Joint integrity is the conformance of a joint to expected anatomic and biomechanical norms. joint mobility involves the capacity of a joint to be moved passively in certain ways that take into account the structure and shape of the joint surface in addition to characteristics of the tissue surrounding the joint. The assessment of joint mobility involves the performance of accessory joint movements by the physical therapist because these movements are not under the voluntary control of the patient. The physical therapist uses the joint integrity and mobility tests and measures to determine whether there is excessive or limited motion of the joint. Excessive joint motion necessitates a program of protection, whereas limited joint motion calls for interventions to increase mobility and enhance functional capability.

Clinical indications

Tests and measures are appropriate in the presence of

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- edema. lymphedema. or effusion

- impaired aerobic capacity and

endurance

- impaired gait, locomotion, and

balance

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- pain

- soft tissue swelling, inflammation,

or restriction

Specific Tests and Measures

Tests and measures may include:

* Analysis of the nature and quality of movement of the joint or body part during performance of specific movement tasks

* Assessment of joint hypermobility and hypomobility

* Assessment of pain and soreness

* Assessment of response to manual provocation tests 

* Assessment of soft tissue swelling, inflammation, or restriction

* Assessment of sprain 

Data Generated

Data generated may include:

* Clinical signs or pain in response to a specific movement or provocation 

* Joint mobility classification and grade

* Joint movement quality and quantity)

* Sprain classification and grade

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 motor function tests and measures in the diagnosis of underlying impairments and their contributions to functional limitation and disability. Deficits in motor function reflect the type, location, and extent of the impairment, which may be the result of pathology or other disorders. Weakness, paralysis, dysfunctional movement patterns, abnormal timing, poor coordination, clumsiness, involuntary movements, or dysfunctional postures may be manifestations of impaired motor function.

Clinical Indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired aerobic capacity and

endurance

- impaired arousal, attention, and

cognition

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired muscle performance

(strength, power, endurance)

- impaired neuromotor

development and sensory integration

- impaired posture

- impaired reflex integrity

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

- pain

- soft tissue swelling, inflammation,

or restriction

Specific Tests and Measures

Tests and measures may include:

* Analysis of gait, locomotion, and balance

* Analysis of head, trunk, and limb movement

* Analysis of myoelectric activities and neurophysiological integrity using electrophysiologic tests (eg, diagnostic and kinesiologic electromyography [EMG], motor nerve conduction)

* Analysis of posture during sitting, standing, and locomotor activities appropriate for age (eg, walking, hopping, skipping, running, jumping)

* Analysis of stereotypic movements

* Assessment of autonomic responses to positional changes

* Assessment of dexterity, coordination, and agility

* Assessment of postural, equilibrium, and righting reactions

* Assessment of sensorimotor integration

* Motor assessment scales

* Physical performance scales

Data Generated

Data generated may include:

* Abnormal movement patterns (eg, synergies, athetotic movements)

* Amplitude, duration, waveform, and frequency of normal or abnormal electrical potentials in muscles

* Conduction velocity along peripheral motor nerves 

* Coordination of maturation with stages of development

* Deviations from standardized age and sex norms for motor function (motor control and motor learning)

* Muscle activity characteristics during movement

* Physiologic responses during activities

* Skin and efficiency of motor function, including the ability to initiate, control, and terminate movement

* Timing, accuracy, sequencing, and number of repetitions of specific movement patterns and postures

Muscle Performance (Including Strength, Power, and Endurance)

Muscle performance is the capacity of a muscle to do work (force x distance). Muscle strength is the (measurable) force exerted by a muscle or a group of muscles to overcome a resistance in one maximal effort. Muscle power is work produced per unit of time or the product of strength and speed. Muscle endurance is the ability to contract the muscle repeatedly over a period of time. The performance of an individual muscle depends on its characteristics of length, tension, and velocity. Integrated muscle performance over time is mediated by neurologic stimulation, fuel storage, and fuel delivery in addition to balance, timing, and sequencing of contraction. The physical therapist uses muscle performance tests and measures to determine the ability to produce movements that a pre-requisite to functional activity.

Clinical Indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired aerobic capacity and

endurance

- impaired bowel and bladder

function

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

- pain

Specific Tests and Measures

Tests and measures may include:

* Analysis of functional muscle strength, power, and endurance

* Analysis of muscle strength, power, and endurance, using manual muscle tests or dynamometry 

* Assessment of muscle tone

* Assessment of pain and soreness

* Assessment of pelvic-floor musculature 

* Electrophysiologic tests (eg, electromyography [EMG], nerve conduction velocity)

Data Generated

Data generated may include:

* Amplitude, duration, waveform, and frequency of EMG signals

* Changes in muscle performance over time

* Consistency of effort and performance

* Force, velocity, torque, work, and power of muscle performance

* Muscle contraction characteristics (eg, maximal, painful, smooth, coordinated, cogwheel)

* Numbers, percentages, or letter grades from standardized grading systems for manual and functional muscle testing

* Pain, soreness, or other symptoms produced by provocation of muscle contractions

* Strength of the pelvic-floor musculature

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 from the environment to produce movement. The physical therapist uses neuromotor development and sensory integration tests and measures to assess motor capabilities in infants, children, and adults. The tests and measures may be used to assess mobility, achievement of motor milestones and healthy responses, postural control, and voluntary and involuntary movement. The physical therapist also uses these tests and measures to test balance, righting and equilibrium reactions, eye-hand coordination, and other motor capabilities.

Clinical Indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired aerobic capacity and

endurance

- impaired gait, locomotion, and

balance

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- impaired reflex integrity

- impaired sensory integrity

- pain

Specific Tests and Measures

Tests and measures may include:

* Analysis of age-appropriate and sex-appropriate development

* Assessment of arousal, attention, and cognition

* Analysis of gait and posture

* Analysis of involuntary movement

* Analysis of reflex movement patterns

* Analysis of sensory integration tests

* Analysis of voluntary movement

* Assessment of behavioral response

* Assessment of dexterity, coordination, and agility

* Assessment of postural, equilibrium, and righting reactions

* Assessment of gross and fine motor skills 

* Assessment of motor function (motor control and motor learning)

* Assessment of oromotor function, phonation, and speech production

Data Generated

Data generated may include:

* Movement patterns, postures, and sequences

* Movement asymmetries

* Postural alignment

* Primitive reflexes

* Gross and fine motor developmental level

* Information organization and processing quality

Orthotic, Protective, and Supportive Devices

Orthotic, protective, and supportive devices are used to support weak or ineffective joints or muscles and may serve to enhance performance. Orthotic devices include splints, braces, shoe inserts, and casts. Protective devices include braces, protective taping, cushions, and helmets. Supportive devices include supportive taping, compression garments, corsets, slings, neck collars, serial casts, elastic wraps, and oxygen. The physical therapist uses specific tests and measures to determine the need for orthotic, protective, and supportive devices in patients/clients not currently using them and to evaluate the appropriateness and fit of those devices already in use. The physical therapist correlates patient/client problems with available devices to make a choice that best serves the individual. For example, the physical therapist may have to choose between an orthosis that provides maximum control of motion and one that allows considerable movement.

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired aerobic capacity and

endurance

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

- pain

Specific Tests and Measures

Tests and measures may include:

* Analysis of ability to care for device independently

* Analysis of appropriate components of the device

* Analysis of effects and benefits (including energy conservation and expenditure) while patient/client wears the device

* Analysis of movement while patient/client wears the device, using computer-assisted graphic imaging and videotape

* Analysis of the potential to remediate impairment, functional limitation, or disability through use of the device

* Analysis of practicality and ease of use of the device

* Assessment of alignment and fit of the device and inspection of related changes in skin condition

* Assessment of patient/client or caregiver ability to put on and remove the device and to understand its use and care

* Assessment of patient/client use of the device

* Assessment of safety during use of the device

* Review of reports provided by the patient/client, family, significant others, caregivers, or other professionals concerning use of or need for the device

Data Generated

Data generated may include:

* Ability to put on, use, and remove the device and to understand its use and care

* Alignment of anatomical parts with the device

* Adherence to use of the device

* Deviations and dysfunctions that can be corrected or alleviated by the device

* Effectiveness of the device in providing protection, promoting stability, or improving performance of tasks and activities

* Energy expenditure requirements during use of die device

* Patient/client expressions of comfort, cosmesis, and effectiveness using the device

* Practicality and ease of use of the device

Pain

Pain is a disturbed sensation that causes suffering or distress. The physical therapist uses pain tests and measures to determine the intensity, quality, and temporal and physical characteristics of any pain that is important to the patient. The physical therapist may determine a cause or a mechanism for the pain through these tests and measures. The tests and measures also may be used to determine whether referral to another health care professional is appropriate.

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired aerobic capacity and

endurance

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

Specific Tests and Measures

Tests and measures may include:

* Analysis of pain behavior and reaction during specific movements and provocation tests

* Assessment of muscle soreness

* Assessment of pain and soreness with joint movement

* Assessment of pain perception (eg, phantom pain)

* Assessment of pain using questionnaires, graphs, behavioral scales, symptom magnification scales or indexes, or visual analog scales

Data Generated

Data generated may include:

* Activities that aggravate or relieve pain

* Behavior or pain reactions observed during particular movement tasks

* Muscle soreness classification and grade

* Numerical ratings from standardized rating instruments

* Pain patterns over time

* Pain reactions to cumulative stress or trauma

* Response to pain

* Response to noxious stimuli

* Response during specific movement tasks and to provocation tests

* Sensory and temporal qualities of pain

* Somatic distribution of pain

Posture

Posture is the alignment and positioning of the body in relation to gravity, center of mass, and base of support. The physical therapist uses posture tests and measures to assess structural abnormalities in addition to the ability to right the body against gravity. "Good posture" is a state of musculoskeletal balance that protects the supporting structures of the body against injury or progressive deformity. Findings from these tests and measures may lead the physical therapist to perform additional tests and measures (eg, joint integrity and mobility, respiration, ventilation [gas exchange], and circulation).

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- abnormal bony alignment

- impaired aerobic capacity and

endurance

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired sensory integrity

- pain

* Pregnancy

Specific Tests and Measures

Tests and measures may include:

* Analysis of resting posture in any position

* Analysis of static and dynamic postures, using computer-assisted imaging, posture grids, plumb lines, still photography, videotape, or visual analysis

Data Generated

Data generated may include:

* Alignment and symmetry of body landmarks within segmental planes, while at rest or in motion

* Postural alignment during standing, sitting, lying, or movement

* Postural deviations within lines or grid marks

Prosthetic Requirements

A prosthesis is an artificial device used to replace a missing part of the body. Physical therapists use specific tests and measures for patients/clients who might benefit from a prosthesis or for patients wearing a prosthesis. The physical therapist selects a prosthesis that will allow optimal freedom of movement and functional capability with minimal discomfort and inconvenience.

Clinical Indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired gait, locomotion, and

balance

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

strength, power, endurance)

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

- pain

* Loss of limb or body part

Specific Tests and Measures

Tests and measures may include:

* Analysis of appropriate components of device

* Analysis of effects and benefits (including energy conservation and expenditure) while patient/client wears device

* Analysis of movement while the patient/client wears device, using computer-assisted graphic imaging and videotape

* Analysis of the potential to remediate impairment, functional limitation, or disability through use of device

* Analysis of the practicality and ease of use of device

* Assessment of alignment and fit of device and inspection of related changes in skin condition

* Assessment of patient/client or caregiver ability to put on and remove device and to understand its use and care

* Assessment of patient/client use of device

* Assessment of residual limb or adjacent segment for range of motion, strength, skin integrity, and edema

* Assessment of safety during use of device

* Review of reports provided by patient/client, family, significant others, caregivers, or other professionals concerning use of or need for device

Data Generated

Data generated may include:

* Ability to put on, use, and remove the device and to understand its use and care

* Alignment of anatomical parts with the device

* Adherence to use of the device

* Deviations and dysfunctions that can be corrected or alleviated using the device

* Effectiveness of the device in providing protection, promoting stability, or improving performance of tasks and activities and enhancing function at home, at work job/school/play), and in community

* Energy expenditure requirements during use of the device

* Patient/client expressions of comfort, cosmesis, and effectiveness using the device

* Practicality and ease of use of the device

* Range of motion (ROM), strength, skin integrity, and edema in residual limb or adjacent segment

Range of Motion (Including Muscle Length)

Range of motion (ROM) is the space, distance, or angle through which movement occurs at a joint or a series of joints. Muscle length is measured at various joint angles through the range. Muscle length, in conjunction with joint integrity and soft tissue extensibility, determines flexibility. The physical therapist uses ROM tests and measures to determine the arthrokinematics and biomechanics of a joint, including flexibility and movement characteristics. Adequate ROM is valuable for injury prevention because it allows the tissues to adjust to imposed stresses. Loss of ROM is associated in most cases with loss of function.

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/ school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

- pain

Specific Tests and Measures

Tests and measures may include:

* Analysis of functional ROM

* Analysis of multisegmental movement

* Analysis of ROM using goniometers, tape measures, flexible rulers, inclinometers, photographic or electronic devices, or computer-assisted graphic imaging

* Assessment of muscle, joint, or soft tissue characteristics

Data Generated

Data generated may include:

* Deviations from planes in degrees or inches or centimeters

* Excursion distances in inches or centimeters

* Pain or tenderness in muscles, joints, and soft tissue during movements or activities that require elongation of muscle

* Passive tension during multisegmental movement that requires elongation of muscle

* Joint ROM in degrees

Reflex Integrity

A reflex is a stereotypic, involuntary reaction to any of a variety of sensory stimuli. The physical therapist uses reflex integrity tests and measures to determine the excitability of the nervous system and the integrity of the neuromuscular system.

Clinical Indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired arousal

- impaired gait, locomotion, and

balance

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired neuromotor

development and sensory integration

- impaired posture

- impaired sensory integrity

- pain

Specific Tests and Measures

Tests and measures may include:

* Assessment of developmentally appropriate reflexes over time

* Assessment of normal reflexes (eg, stretch reflex)

* Assessment of pathologic reflexes (eg, Babinski's reflex)

* Electrophysiological tests (eg, H-reflex)

Data Generated

Data generated may include:

* Normal or pathologic reflexes

* Variation in reflex activity over time or with positioning

Self-Care and Home Management (Including Activities of Daily Living and

Instrumental Activities of Daily Living)

Self-care includes activities of daily living (ADL), such as bed mobility, transfers, gait, locomotion, developmental activity, dressing, grooming, bathing, eating, and toileting. Home management includes more complex instrumental activities of daily living (IADL), such as maintaining a home, shopping, cooking, performing heavy household chores, managing money, driving a car or using public transportation, structured play (for infants and children), and negotiating school environments. The physical therapist uses the following tests and measures to determine the level of performance of the tasks necessary for independent living. The results of these tests and measures may lead the physical therapist to determine that the patient/client needs assistive and adaptive, orthotic, protective, supportive, or prosthetic devices or equipment; body mechanics training; organized functional training programs; or therapeutic exercise programs. The physical therapist considers patient/client safety, perceptions, and expectations while performing the tests and measures.

Clinical Indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care or home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- impaired aerobic capacity and

endurance

- impaired arousal, attention, and

cognition

- impaired body mechanics

- impaired bowel and bladder

function

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired neuromotor

development and sensory integration

- impaired posture

- impaired sensory integrity

- impaired ventilation, respiration

(gas exchange), and circulation

- pain

Specific Tests and Measures

Tests and measures may include:

* ADL or IADL scales or indexes

* Analysis of adaptive skills

* Analysis of environment and tasks

* Analysis of self-care and home management activities

* Analysis of self-care and home management activities that are performed using assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment

* Analysis of self-care performed in unfamiliar environments

* Assessment of ability to transfer

* Assessment of autonomic responses to positional changes

* Assessment of functional capacity

* Assessment of physiologic responses during self-care and home management activities

* Assessment of safety in self-care and home management activities

* Observation of response to non-routine occurrences

* Questionnaires completed by and interviews conducted with patient/client and others as appropriate

* Review of daily activities logs

* Review of reports provided by the patient/client, family, significant others, caregivers, or other professionals

Data Generated

Data generated may include:

* Ability to transfer

* Adaptive skills

* Aerobic capacity or endurance

* Appropriateness of assistive and adaptive devices

* Appropriateness of orthotic, protective, supportive, or prosthetic devices and equipment

* Daily activity level

* Effort in specific movement tasks

* Functional capacity for self-care and home management tasks

* Gross and fine motor function

* Attention and cognition deficits

* Movement patterns during performance of self-care and home management activities

* Muscle strength, power, and endurance

* Numerical scores on standardized rating scales

* Performance of self-care and home management activities and level of dependence on human and mechanical assistance

* Spatial and temporal requirements for performing specific tasks related to self-care and home management activities

* Standard vital signs (blood pressure, heart rate, respiratory rate) at rest and during and after activity

* Strength, flexibility, and endurance

Sensory integrity (Including Proprioception and Kinesthesia)

Sensory integrity includes peripheral sensory processing (eg, sensitivity to touch) and cortical sensory processing (eg, two-point and sharp/dull discrimination). Proprioception includes position sense and the awareness of the joints at rest. Kinesthesia is the awareness of movement. The physical therapist uses sensory integrity tests and measures to determine the integrity of the sensory, perceptual, or somatosensory processes. Sensory, perceptual, or somatosensory abnormalities are frequent indicators of pathology.

Clinical indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- edema, lymphedema, or effusion

- impaired arousal, attention, and

cognition

- impaired gait, locomotion, and

balance

- impaired joint integrity and

mobility

- impaired motor function (motor

control and motor learning)

- impaired muscle performance

(strength, power, endurance)

- impaired neuromotor

development and sensory integration

- impaired reflex integrity

- impaired posture

- impaired sensory integrity

impaired ventilation, respiration

(gas exchange), and circulation

- pain

Specific Tests and Measures

Tests and measures may include:

* Assessment of combined (cortical) sensations (eg, stereognosis, tactile localization, two-point discrimination, vibration, texture recognition)

* Assessment of deep (proprioceptive) sensations (eg, movement sense or kinesthesia, position sense)

* Assessment of gross receptive (eg, vision, hearing) abilities

* Assessment of superficial sensations (eg, sharp/dub discrimination, temperature, light touch, pressure)

* Electrophysiologic tests (eg, sensory nerve conduction)

Data Generated

Data generated may include:

* Accuracy of cortical perceptions (eg, tactile recognition of objects, recognition of symbols drawn on the skin, ability to localize touch sensations)

* Conduction times and velocities along peripheral or central musculoskeletal sensory pathways

* Joint position sense

* Perception of movement in the extremities

* Skin breakdown or injury that may cause decreased sensation

* Superficial sensory capacities

Ventilation, Respiration (Gas Exchange), and Circulation

Ventilation is the movement of a volume of gas into and out of the lungs. Respiration refers primarily to the exchange of oxygen and carbon dioxide across a membrane into and out of the lungs and at the cellular level. Circulation is the passage of blood through the heart, blood vessels, organs, and tissues; it also describes the oxygen delivery system. The physical therapist uses ventilation, respiration, and circulation tests and measures to determine whether the patient has an adequate ventilatory pump and oxygen uptake and delivery system to perform activities of daily living (ADL), ambulation, and aerobic exercise.

Clinical Indications

Tests and measures are appropriate in the presence of:

* Expectation or indication of one or more of the following impairments or functional limitations during attempts to perform self-care, home management, community and work (job/school/play) integration or reintegration, and leisure tasks, movements, or activities:

- abnormal breathing patterns or

abnormal blood gases

- abnormalities of heart rate, blood

pressure, respiratory rate or

pattern of breathing, or heart muscle

function

- dizziness

- dyspnea at rest or on exertion

- edema or lymphedema

- impaired aerobic capacity and

endurance

- airway clearance dysfunction

- impaired joint integrity and

mobility

- impaired muscle performance

(strength, power, endurance)

- impaired posture

- impaired ventilation, respiration

(gas exchange), and circulation

- pain

Specific Tests and Measures

Tests and measures may include:

* Analysis of thoracoabdominal movements and breathing patterns at rest and during activity and exercise

* Assessment and classification of edema through volume and girth measurements

* Assessment of ability to clear airway

* Assessment of activities that aggravate or relieve edema, pain, dyspnea, or other symptoms

* Assessment of autonomic responses to positional changes

* Assessment of capillary refill time

* Assessment of chest wall mobility, expansion, and excursion

* Assessment of cough and sputum 

* Assessment of perceived exertion and dyspnea

* Assessment of phonation

* Assessment of standard vital signs (eg, blood pressure, heart rate, respiratory rate) at rest and during and after activity

* Assessment of ventilatory muscle strength, power, and endurance

* Assessment of cyanosis 

* Auscultation and mediate percussion of the lungs

* Auscultation of major vessels for bruits

* Auscultation of the heart

* Interpretation of blood gas analysis or oxygen consumption ([VO.sub.2]) studies

* Palpation of chest wall (eg, tactile fremitus, pain, diaphragmatic motion)

* Palpation of pulses

* Pulse oximetry

* Tests and measures of pulmonary function and ventilatory mechanics

Data Generated

Data generated may include:

* Activities that aggravate or relieve symptoms

* Adequacy of airway protection mechanisms

* Chest wall mobility and expansion

* Cough, sputum, and phonation characteristics

* Edema (girth, volume displacement)

* Inspiratory and expiratory muscle force before and after activity (including comparison of actual to predicted)

* Normal and abnormal heart and lung sounds

* Oxygen saturation ([SaO.sub.2]) at rest and during and after activity

* Peripheral vascular integrity

* Pulse characteristics

* Rate of perceived exertion and dyspnea at rest and during activity

* Symptoms that limit activity

* Thoracoabdominal movements and breathing patterns at rest and during activity

* Ventilatory muscle performance (strength, power, and endurance) and ventilatory pump mechanics

* Ventilatory volumes and flow at rest and during and after activity (including comparison of actual with predicted)

* Vital signs (eg, blood pressure, heart rate, respiratory rate) at rest and during and after activity

* Work of breathing and ventilatory reserve capacity