Stroke Assessment

The stroke patient is referred to acute physical therapy. Upon initial examination and evaluation of the patient, the physical therapist (PT) is responsible for determining the nature, status, and extent of the stroke. Based on the patient history, review of systems, and the results of the tests and measures of the examination, the PT makes a “clinical judgment” based on the collected data. A diagnosis and prognosis is established once consultation with other health professionals, such as a neurologist, is reviewed. A plan of care is designed and short- and long-term goals are outlined. Physical therapy goals may include performance in transitioning between sitting and standing, posture, balancing while standing and walking, and improved gait
training. According to our textbook, motor development and control are affected in stroke patients. Motor control relearning is important in restoring neurodevelopment to pre-accident status. It is also important that the PT also educate the patient about the reasons behind these exercises. These interventions, which include physical therapy, speech therapy, and home exercises, are imperative in order to restore full independence. These interventions can change along the length of treatment and the PT is solely responsible for discharging the patient once goals are reached.
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The first topic which caught my attention on the Physical Therapy Board of California website was Section 1398.44 of the Physical Therapy Regulations.
This section states what physical therapist assistant are not allowed to. In the interest of saving space for my two other topics I will simply list a few from the list. The physical therapist assistant can not collect patient data prior to the physical therapist evaluation, document patient evaluation and reevaluation, write a discharge summary, and establish or change a plan of care.
The second section which caught my eye was Section 2620 of the Business and Professions (B&P) Code. Essentially this section states the extent of how much advice a licensed physical therapist in California can provide through the Internet or telephone. Again, I will simply list a few topics from the list. A physical therapist can instruct a person how to obtain physical therapy care in the State of California, can cite a possible range of treatment available, and offer wellness
advice.
The third topic which caught my attention was Senate Bill 1485, which states that a physical therapist can provide wellness if it’s within their scope of practice. The definition they provide for physical therapy is “the promotion and maintenance of physical fitness to enhance the bodily movement related to health and wellness of individuals through the use of physical therapy interventions.” However, if the treatment is for correction of a medical condition a diagnosis must be attained from a physician or duly licensed practitioner. http://www.ptbc.ca.gov/forms_pubs/ptasuper.shtml http://www.ptbc.ca.gov/forms_pubs/online_advice.shtml http://www.ptbc.ca.gov/forms_pubs/sb1485.shtml Wk-2-2
If a patient was referred to a physical therapist for pressure ulcers, the first thing that he/she would do would be the examination which would include an evaluation, diagnosis, prognosis, and determine a plan of care for the patient. An examination of the wound should include a thorough history and physical assessment of the cause, depth, and size of the wound and signs of infection. The skin adjacent to or otherwise associated with the wound should also be examined for any alteration from normal function (e.g., sensation temperature, hair growth, mobility, pliability) and appearance (e.g., texture and color). All ulcers, regardless of their cause, should be examined for size and depth. Along with the above assessments, the PT should also evaluate the patient’s ability to communicate and comprehend, joint mobility, muscle performance, gait, ventilation, circulation, and sensory.
After the plan of care is determined by the PT, the PTA would assist the PT in implementation of the plan which would include wound care and pressure relief.
Pressure ulcers should be cleansed and dressed in a way that provides a moist healing environment. Some pressure-relieving devices might include seat cushions, pre manufactured or custom cut foam, or air mattresses. The patient should be turned every 2 hours with equal time on each side. For positioning, the "rule of 30" is used. This means that the head of the bed is elevated to 30 degrees or less and the body is placed in a 30-degree laterally inclined position, when repositioned to either side. The PTA would make modifications to selected interventions either to progress the patient as directed by the PT or to ensure patient safety and comfort. A Physical Therapy Aid would assist in measuring, fitting, and reconditioning devices such as wheelchairs or foam cuts used by the
patient.
The PTA would also be responsible for keeping regularly scheduled documentation that should include risk assessment, skin evaluation, patient response to alterations in therapy, the rational for the alterations, and the outcome of the skin care program.
Pagliarulo MA. Introductio to Physical Therapy. 4th ed. Mosby;2012
National Pressure Ulcer Advisory Panel. Statement on Pressure Ulcer Prevention. http://www.npuap.org/positn1.htm Assessed January 29, 2012
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CAL-PT-PAC
The physical therapy profession has a political action committee called the CAL-PT-PAC. Their objective is to contribute to candidates that support the views of physical therapists. The focal point is only on physical therapy, so PAC is bi-partisan. Some people may not be interested in politics or understand how these decisions will affect your practice. We need to be active in the process so that the decisions are not made by others in the health profession. Have a voice, so you may be part of the decision making on how you will be licensed and regulated, who can have a physical therapy practice and where that practice can be, as well as the hours your staff will be able to work. This group does rely on contributions, as of 2011 their goal was to reach nearly $200,000, of which $134,313.99 was actually raised. http://ccapta.org/displaycommon.cfm?an=3 Vision 2020
By the year 2020, physical therapists will be accepted as doctors of Physical Therapy. They will be board-certified specialists which will allow a patient/client to have direct access to a Physical Therapist for management, prevention, and wellness services. http://www.apta.org/Vision2020/ APTA Membership Benefits
Did you know you could become a member of the APTA as a Physical Therapist Assistant student? To be eligible for membership you must first be enrolled in an accredited PTA program. Benefits include the following:
Access to make new contacts with peer support
Discovering areas of expertise in the field of Physical Therapy
Find scholarships, awards, and grants toward your education
Job search
Membership consists of dues at a National level and Chapter. The membership calculations for the Physical Therapist Assistant student are National dues of $80 and Chapter dues for the state of California of $23, for a total of $123 per year. http://www.apta.org/Benefits/Students/ http://www.apta.org/Membership/DuesDeductions/
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Occupational therapists are autonomous practitioners, who deliver occupational therapy services. They help patients improve their ability to perform tasks in living and working environment. They work with clients who suffers from a mentally, physically, developmentally, or emotionally disabiling condition. The goal for OTs is to help clients have independent, productive and satisfying lives.
OTs are responsible and accountable for all aspects of the delivery of occupational therapy services. Responsibilities includes evaluation, intervention planning, implementation, review and outcome evaluation of the clients. OTs are also responsible for the supervision of occupational therapy assistants(OTA) and aides. OT directs and initates the evaluation process, interprets the data and develops intervention plans. The OT and OTA will collaborate with the client to develop a plan. Under the supervision and direction of the OT, OTA will be responsible for the client's occupational therapy goals by planning and implementing therapeutic activities and interventions.The OTA will collect data according to the client's responses to the interventions and share it with the OT. Finally, with the help of the OTA, the OT is responsible for the client's outcome evaulation.
OTs are not only responsible for their clients, their role is to also continue education by seeking supervision and mentoring to seek the best practice approaches and promote professional growth.
Sources:
The American Occupational Therapy Association, Guidelines for Supervision, Roles, and Responsibilities. www.aota.org/convimages/members/areas2/docs/suprolres.pdf Accessed January 31, 2012
Bureau of Labor Statistics, Occupational Outlook Handbook, 2010-11 Edition. www.bls.gov/oco/ocos078.htm Accessed January 31, 2012