Treatment

Body Regions

Considerations for Physical Therapy Referral

Diagnosing patient appropriate for physical therapy intervention can be….

TAI CareConnections Outcomes System
The value of therapy cannot be measured exclusively in dollars and cents. Since 1996, our Outcomes System has collected clinical outcomes data from all TAI clinics and from other providers across the United States. The system facilitates the benchmarking of functional improvement, decrease in pain, perceived improvement, and return to work status. It allows clinicians, referring providers, and health plans to determine what their patients gain from the use of therapy services.

To assess value, you need to assess quality of care. We assess efficacy and efficiency of therapeutic intervention to determine patient outcomes and utilization.

Body Regions:

• Cervical / Thoracic Spine Conditions
• Lower Extremity
• Upper Extremity
• Lumbar

Cervical / Thoracic Spine Conditions

Considerations for Referral

Functional Limitations

• Inability to perform functional activities, such as driving, reading, or sitting
• Inability to perform job responsibilities
• Inability to participate in recreational activities
• Interrupted sleep due to cervical or thoracic pain
• Range of motion limited by pain
• Headaches
• Upper extremity numbness, tingling
• Weakness of spinal musculature
• Abnormal posture of shoulders, head, or cervical / thoracic spine
• Non-specific arm pain, face or jaw pain

Musculoskeletal Conditions

• Whiplash due to Motor Vehicle Accident
• Prolonged use of cervical collar
• Pre/post surgical exercise program
• Sprains/strains unresolved
• Prolonged positioning
• Postsurgical muscle spasm or joint stiffness
• Cervical or upper extremity weakness
• Cervical pain secondary to deconditioning following shoulder or lumbar surgery

Cervical / Thoracic Protocol

Examination

• History and Systems Review
• Tests and Measures
  • Cervical/thoracic ROM
  • Passive interverbal mobility
  • Neurological examination
  • Posture assessment
• Establish Plan of Care

Goals/Outcomes

• Centralized pain: 2/10 or less with alleviation of any radicular signs and symptoms
• Cervical/thoracic ROM: 80% of AMA guides and equal bilaterally
• Cervical
  Flexion 50˚     Extension 60˚
  Rotation 65˚   Sidebend 35˚
• Grip strength 90% of uninvolved extremity
• Restore balanced posture (head position, shoulder position, spinal curvatures)
• Return to previous functional status for ADL, vocational, recreational, and sport activities as identified by patient
• Independence in a progressive home exercise program emphasizing function
• Independent in a home exercise program emphasizing function

Lower Extremity

 

Considerations for Referral

Functional Limitations

• Dysfunctional gait pattern
• Instruction for utilization of assistive device
• Limited ROM in the joints of foot or ankle
• Weight bearing tolerance limited by pain
• Decreased strength
• Frequent falls
• Frequent loss of balance
• Inability to perform functional activities, such as walking or driving
• Inability to perform job responsibilities
• Inability to participate in recreational activities
• Prolonged pain, non-responsive to medication
• Fear of independent ambulation

Musculoskeletal Conditions

• Recurrent sprains/strains
• Prolonged utilization of assistive device
• Abnormal patellar mobility
• Development and instruction in home exercise program
• Pre/post surgical exercise program
• Postoperative edema
• Splint/brace application
• Pain with exercise/ADLs

Lower Extremity Protocol

• History and Systems Review
• Tests and Measures
  • Palpation
  • Gait Analysis, Locomotion, Balance
  • Strength, Muscle Performance
  • Postural Assessment
  • Lachman Test
  • ROM
  • Joint Integrity and Mobility
  • Footwear Analysis
  • Pain
  • Patellar Glides
• Establish Plan of Care

Goals/Outcomes

• Pain: 2/10 or less
• Pain-free, normal gait pattern without assistive device
• Normal ROM Foot/Ankle/Knee
• Strength: 5/5 on manual muscle test or equivalent to uninvolved leg
• Return to previous functional status for ADL, vocational, recreational and sport activities as identified by patient
• Independent in a progressive home exercise program emphasizing function
• Normal patellar mobility

Home Program

• Flexibility
• Strengthening
• Fitness walking/running/other sport progression
• Plyometrics
• Cryotherapy after activity
• Flexibility
• Gait drills/progression
• Self-care
• Orthotic Utilization
• Exercise program to maintain overall ROM

Upper Extremity

Considerations for Referral

Functional Limitations

• Limited shoulder or cervical/thoracic ROM
• Decreased strength
• Inability to perform functional activities, such as dressing, reaching, personal care, or driving
• Inability to perform job responsibilities
• Inability to participate in recreational activities
• Interrupted sleep due to shoulder pain
• Dysfunctional upper extremity movement during gait
• Decreased grip or upper extremity strength
• Limited ROM in the elbow joint

Musculoskeletal Conditions

• Capsular limitation
• Sling application
• Limited or abnormal scapular motion
• Pre/post surgical exercise program
• Splinting
• Prolonged edema
• Ulnar nerve transfer
• Hypomobile joint secondary to immobilization

Upper Extremity Protocol

Examination

• History and Systems Review
• Tests and Measures
  • Postural assessment
  • Upper extremity functional ROM assessment
  • Passive joint mobility
  • Assess elbow, wrist, and hand
  • Cervical screening
  • Shoulder girdle mobility
  • Palpation
  • Pain
• Establish Plan of Care

Goals/Outcomes

• Shoulder AROM: 80% of AMA guides
• Functional cervical ROM or a minimum of 80% of AMA guides
• Pain: 0/10 at rest, 2/10 or less with activity
• Strength: 4/5 on manual muscle test or equal to uninvolved side
• Functional activities
• Return to previous functional status for ADL, vocational, recreational, and sport activities as identified by patient
• Independence in a progressive home exercise program emphasizing function
• Grip strength: mean for age/gender norms

Home Program

• Stretching and strengthening
• Cardiovascular conditioning
• Self friction massage
• Progression to Return to Sport Guideline

 

Lumbar

Considerations for Referral

Functional Limitations

• Limited flexibility of lumbar spine, hamstrings, or pelvic motion
• Inability to move without pain or increased symptoms
• Walking limited secondary to back pain/symptoms
• Limited sitting tolerance
• Decreased strength in abdominal, back extensor, or musculature
• Need for daily bed rest
• Abnormal spinal curvature or posture
• Inability to perform functional activities, such as lifting, bending, or dressing
• Inability to perform job responsibilities
• Limited work tolerance
• Inability to participate in recreational activity
• Poor body mechanics or lifting techniques
• Interrupted sleep due to symptoms

 

Musculoskeletal Conditions

• Lumbar Sprain/Strain
• Pain greater than 3/10 or not resolved by medication
• Pre/post-surgical exercise program or functional training
• Repeat occurrence of back problems
• Neurological symptoms

Lumbar Protocol

Examination

• History and Systems Review
• Tests and Measures
  • Postural Assessment
  • ROM Assessment
  • Neurological examination to rule out other pathology
  • Joint integrity and mobility
  • Pain
  • Integumentary integrity
  • Strength
  • Palpation of muscles, tendons, and ligaments
  • Gait assessment
  • Lumbar mobility
  • Biomechanical screening
  • Soft tissue observation
  • Spinal, upper, and lower extremity mobility
• Establish Plan of Care

Goals/Outcomes

• Pain: 2/10 or less
• Restore functional levels of spinal ROM to a minimum of 80% of AMA guides
• Functional upper and lower extremity ROM
• Patient displays awareness of proper posture and body mechanics during ADL and vocational activities
• Pain-free ADL, vocational, recreational, and sport activities
• Independence in a progressive home exercise program emphasizing function

Home Program

• Stretching/strengthening exercises for maintenance of postural balance
• Cardiovascular conditioning
• Proper body mechanics and specific activity posturing monitoring
• Flexibility
• Abdominal strengthening
• Self-mobilization techniques
• Aerobic conditioning