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PT Client Management Canvas Âť Initial Data Medical diagnosis (Dx):

Date of Dx: Year

Multiple sclerosis - relapsing-remitting

(10 years ago)

Month

Day

Client:

Physical Therapist:

Anna

(you!)

Date of birth: Year

Month

Day

Gender:

Date of intake: Year

Month

(age 35)

Day

1

Interview & informal observation

Here you can note any relevant data and information from the initial data and interview & informal observation the way you like. See sections 1 & 2 for the case-specific details.

Guidelines, evidence & remarks

ICF Comprehensive Core Set for MS (2011); NICE MS guideline (2003); Shumway-Cook et al. (2012); Paltamaa (2008); Rietberg et al. 2011 (Cochrane review)

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This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/ or send a letter to Creative Commons, 444 Castro Street, Suite 900, Mountain View, California, 94041, USA.


PT Client Management Canvas Âť Problem Tracking Problem list of activity limitation & participation restriction (existing, anticipated, patient- & non-patient identified)

Activities & participation

1

Lack of confidence in balance when reaching forward, picking up something from floor, looking over shoulder or turning around. (E)

2

Date

Baseline Functional measures

day 2

Client:

Physical Therapist:

Anna

(you!)

Date

Goal Functional measures

BBS: total score 47 / 56

day 14

Increased ability to maintain balance 52 / 56 points on BBS

day 1

ABC - scale: total score 68.5 / 100

day 14

Increased confidence in maintaining balance - 82.2 / 100 on ABC-scale

Date

Testing & predictive criteria

Date

Testing & predictive criteria

Date

Progress / discharge Functional measures

Date

Testing & predictive criteria

3

4

5

6

Problem #

Body functions & structures (and Contextual factors)

1

2

3

4

5

6

Hypotheses of causative impairments & other factors

1

Impaired ANTICIPATORY component of balance strategy

day 2

Observation: Loses control of balance day 9 in fast-pace self-initiated sway

Able to maintain balance in fast pace self-initiated sway

2

Impaired SOMATOsensory component of balance strategy

day 2

mCSTIB: foam - EO 10 sec; foam EC 8 sec

Able to stand on a foam with EO for 13 sec and EC for 11 sec

3

Impaired cognitive component of balance strategy

day 2

Observation: adding double-task day decreases control in self-initated sway 14

Able to maintain balance in fast pace self-initiated sway & double-task

4

Decreased LE force generation - R KNEE EXTENSORS & ANKLE DF

day 2

Isometric MRC: R knee extension 4/5; day R ankle DF 4/5 14

Maintain R knee extension & ankle DF force generation capacity

5

Decreased LE range of motion - REFUTED (see 'Examination')

6

Increased LE muscle tone - REFUTED (see 'Examination')

day 9

7

8

9

10

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This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/ or send a letter to Creative Commons, 444 Castro Street, Suite 900, Mountain View, California, 94041, USA.


Body functions & structures (and Contextual factors)

Activities & participation

PT Client Management Canvas Âť Examination

Client:

Physical Therapist:

Anna

(you!)

Tests & measurements

Findings

Indications

BBS

Total score 47 / 56

Supports P1

Items most specific to P1: functional reach 3 (20 cm); look over shoulder 3 (weight not fully shifted to R; slipper reach 3; 360 degree turn (R 10.8 sec, L 9.7 sec)

ABC - scale

Total score 68.5 / 100

Supports P1

Items most specific to P1: picking up slipper from floor 40; reaching at eye level 40; standing on tiptoes+reaching up 10; standing on chair+reaching 10; sweeping floor 40

Tests & measurements

Findings

Indications

Alignment

Equal weight distribution, trunk mid-line, normal base of support

Partly refutes H1

Observational analysis: self-initiated sway forward, backward, Loses balance control in fast sway in different directions. Adding a double task side-to-side (cognitive, motor) notably reduces balance control.

Supports H1, H3

Nudge test

Able to maintain balance, uses ankle strategy in small pertubation and hip strategy in large pertubation. Ankle DF symmetrical in pertubation backward.

Partly refutes H1

Modified CTSIB

Firm surface - EO 30 sec; firm surface - EC 30 sec; foam surface - EO 10 sec; foam surface - EC 8 sec

Supports H2

Isometric muscle force generation capacity - MRC-scale

R knee extension 4/5; R ankle DF 4/5; all others 5/5

Partly supports H4

Passive ROM - LE

Full L + R

Refutes H5

MAS

L + R 0/4

Refutes H5

www.getPTsmart.com

This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/ or send a letter to Creative Commons, 444 Castro Street, Suite 900, Mountain View, California, 94041, USA.


PT Client Management Canvas Âť Intervention

Client:

Physical Therapist:

Anna

(you!)

Problem #’s

Hypotheses #’s

Strategy

Tactic (description, intensity, duration & frequency)

1

H1, H2

Balance exercise anticipatory strategy

Task - specific training starting in closed environment and progressing to open environment. Intensity as tolerated.

Balance exercise sensory strategy

H1 - H3

Task - specific training on non-hard and non-flat surfaces. Start with eyes open, progress to eyes closed. Intensity as tolerated.

Progress to combined exercises for anticipatory and sensory strategies

Anna / PT

Attach double - tasking with secondary activity & cognitive task. Intensity as tolerated.

Progress to combined exercises for anticipatory and sensory strategies Progress to combined exercises for anticipatory and sensory strategies

H1 - H3

Functional tasks balance strategy

'Homework': practice problem specific tasks 2 x 15 minutes a day Anna in varying environments.

H4

Progreressive resistance training

Leg press; knee extension - 3 x 12 rep, resistance adjusted so that can do 12 reps.

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Progression & Remarks

Anna / PT

Attach double-tasking w. secondary activity & cognitive task. Use variable priority instructions. Intensity as tolerated.

H1 - H3

H2

Implemeter

Anna

This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/ or send a letter to Creative Commons, 444 Castro Street, Suite 900, Mountain View, California, 94041, USA.


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