Neuromuscular Practice Pattern

Transcription

1 ROM/Joint Mobility: Patient with complicated bracing/splinting needs, without further risk of CNS compromise, where bracing/splinting is critical to ensure stability of specific joints. Patient requires BID intervention until such time as optimal fit has been achieved. Patient with potentially reversible joint mobility/ ROM restrictions due to CNS insult, such that hypertonicity and/or lack of volitional control could severely impact the involved joint(s). Patient requires daily skilled therapy to optimize ROM. diagnosis, such that mobility program without Patient requires bracing/splinting to stabilize specific joints. Initial and optimal fitting achievable with QD intervention. Patient s/p CNS insult, presenting with ROM/joint mobility impairments. Patient/caregiver is independent and compliant with ROM program, making measurable gains in ROM/joint mobility. Patient requires TIW ROM diagnosis, where mobility Patient/ caregiver is independent and compliant with current ROM program, making measurable gains in ROM/joint mobility. Patient requires TIW ROM Patient s/p CNS insult, presenting with ROM/joint mobility impairments. Patient/caregiver is independent and compliant with ROM program, making measurable gains in ROM/joint mobility. Patient requires BIW ROM diagnosis, where mobility Patient/ caregiver is independent and compliant with current ROM program, making measurable gains in ROM/joint mobility. Patient requires BIW ROM maximal gains with ROM progression with Patient presents with the potential for a decline in ROM, and is therefore Patient with consistently well-fitting brace/splint, where the likelihood of change in fit is minimal, seen weekly to monitor for reassess as 1

2 ROM/Joint mobility (con t): Once brace fitting is achieved, patient/ caregiver requires QD intervention to achieve independence with brace management. Patient with well-fitting brace/splint, presenting with the potential for a change in fit due to underlying medical/ surgical conditions, thereby necessitating periodic readjustment. Patient with well-fitting brace/splint, presenting with the potential for a change in fit due to underlying medical/ surgical conditions, thereby necessitating periodic readjustment. Gait/Locomotion: Patient requires physical therapy intervention to optimize functional mobility. Patient presents with potential to meet goals within two interventions, and only criteria for discharge from hospital is achievement of physical therapy goals. Patient unable to tolerate one complete intervention; therefore, two briefer treatment sessions are warranted. impaired functional mobility, making significant daily gains toward achieving maximal functional independence. Patient with established mobility program that can be carried out by caregiver. program before therapist TIW to reassess Patient with established mobility program that can be carried out by caregiver. program before therapist BIW to reassess maximal gains with mobility program, seen weekly to ensure compliance and progression with Patient presents with the potential for a decline in mobility, and is therefore 2

3 Muscle Performance: No criteria for BID muscle performance intervention have been identified for the Neuromuscular Practice Pattern in the acute reversible condition, presenting with strength less than Fair, and an inability to carryout any aspect of strengthening program without skilled manual assistance. Patient/caregiver independent with a portion of strengthening program, presenting with the ability to achieve measurable strength gains through repetition of Patient requires skilled intervention TIW to advance/revise Patient/caregiver independent with a portion of strengthening program, presenting with the ability to achieve measurable strength gains through repetition of Patient requires skilled intervention BIW to advance/revise achieved independence/maximal gains with strengthening progression. Patient has the potential for a decline in strength, and is therefore monitored weekly for change in status and Arousal: No criteria for BID arousal intervention have been identified for the Cognitive Level III-VII and potential for daily improvement as evidenced by alteration in responses to skilled intervention. Cognitive Level I or II and potential for improvement as evidenced by alteration in responses to carried out by caregiver Cognitive Level I or II and potential for improvement as evidenced by alteration in responses to carried out by caregiver impaired arousal and medical instability. Patient has potential for improvement once medical status stabilizes. This patient will be Patient is in a prolonged impaired state of arousal with limited potential for improvement. This patient will be monitored 3

4 Arousal (con t): TIW to reassess and progress BIW to reassess and progress weekly for change in status and reassessment as Balance: No criteria for BID balance intervention have been identified for the making significant daily gains toward achieving maximal functional balance. Patient requires QD Patient with primary balance disorder, requiring education in compensatory techniques. Patient requires QD skilled reinforcement of compensatory techniques for effective implementation. in need of continued balance retraining. carried out by caregiver, TIW to reassess and progress mobility in need of continued balance retraining. carried out by caregiver, BIW to reassess and progress mobility Patient with acute balance impairment, presenting with limited current potential for improvement, but with anticipated future physical therapy needs for balance retraining. Patient seen weekly to monitor for change in status and 4

5 Motor Function/Control: No criteria for BID motor function/control intervention have been identified for the impairments, making significant daily gains toward regaining motor function/control. Patient requires QD skilled intervention to retain progress between Patient presents with impairments. Patient requires repetition of current program, which can be safely and effectively carried out by caregiver, before therapist TIW to reassess impairments. Patient requires repetition of current program, which can be safely and effectively carried out by caregiver, before therapist BIW to reassess maximal gains with motor function/ control progression. Patient has the potential for a decline in strength, and is 2006, Department of Rehabilitation Services, Brigham & Women s Hospital, Boston, MA 5