Upon diagnosis of pathology by a physician and referral of an individual to physical therapy, the physical therapist is responsible for examination, evaluation, diagnosis, prognosis, and intervention.
The examination includes a patient history and systems review of cardiovascular, pulmonary, integumentary, musculoskeletal, neuromuscular and/or cognitive status. Physical therapists also use a wide variety of tests and measures to determine extent of impairment and functional limitations. Some of the more common balance tests used include: Romberg, Functional Reach, Clinical Test for Sensory Interaction on Balance, Berg Balance Scale, Get Up and Go, Tinetti Performance Oriented Assessments of Balance and Gait, Fugl-Meyer Sensorimotor Assessment of Balance Performance, Functional Obstacle Course, and posturography. These tests assess tasks ranging from quiet and active standing to the ability to maneuver an obstacle course of different floor surfaces, obstacles and stairs.
Evaluation, diagnosis and prognosis
The therapist must use his or her clinical judgment and expertise to establish a physical therapy diagnosis and prognosis, including the plan of care. The diagnosis indicates the primary dysfunction(s) toward which intervention will be directed. The prognosis and plan of care must encompass many factors such as current level of function, comorbidity, familial and social considerations and overall health.
Intervention includes treatment of any impairments that hinder function, as described in the treatment section above. In addition, patient education is of utmost importance. Education may include information regarding: the prognosis and plan of care, specific exercises to perform outside of therapy sessions, fall and injury prevention, compensatory strategies, assistive or adaptive device recommendations and usage, and social/community resources.
Peggy Campbell Torpey, MPT, The Gale Group Inc., Gale, Detroit,