Page 1

Client:

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

Date of Dx: Year

Month

Day

Date of birth: Year

Physical Therapist:

Month

Day

Gender:

Date of intake: Year

Month

Interview & informal observation

Guidelines, evidence & remarks

ICF Comprehensive Core Set for MS; Shumway-Cook et al. 2012

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Day


PT Client Management Canvas Âť Problem Tracking Problem list of activity limitation & participation restriction

Activities & participation

1

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

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 - day 52 / 56 points on BBS 13

BBS 52 / 56

day 1

ABC - scale: total score 68.5 / 100

day 14

Increased confidence in maintaining balance - 82.5 / 100 on ABC-scale

day 13

ABC 80 / 100

Date

Testing & predictive criteria

Date

Testing & predictive criteria

Date

Testing & predictive criteria

day 9

Able to maintain balance in self-initiated sway in fast pace

day 9 Able to maintain balance in self-initiated sway in fast pace

Date

Progress / discharge Functional measures

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 postural control

day 2

Self-initiated sway: loses balance is fast pace

2

Impaired SOMATOsensory component of balance strategy

day 2

mCSTIB: foam - EO 10 sec; foam- EC day 9 8 sec

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

day 9 foam - EO 20.3 sec; foam - EC 11.9 sec

3

Impaired cognitive component of balance strategy - NOT ASSESSED

4

Decreased LE force generation - R KNEE EXTENSORS & ANKLE DORSIFLEXORS

day 2

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

Maintain muscle force generation capacity

day 14

5

6

Isometric MRC: R knee extension 4; ankle dorsiflexion 4

Decreased LE range of motion - REFUTED

Increased LE muscle tone - REFUTED

7

8

9

10

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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 relevant to P1: functional reach 3 (20 cm); look over shoulder 3 (weight not fully shifted to R; slipper reach 3; one-foot stand 2 (R 2.0 sec, L 5.7sec) ABC - scale

Total score 68.5 / 100

Supports P1

Items most relevant to P1: picking up a slipper from floor 40; reaching at eye level 40; standing on tiptoes and reaching up 10; sweeping 40

Tests & measurements

Findings

Indications

Alignment

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

Partly refutes H1

Self-initiated sway forward, backward, side-to-side

Loses balance control when different directions done in fast pace

Supports H1

Nudge test

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

Partly refutes H1

Modified CTSIB

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

Supports H2

Isometric force generation - MRC- scale

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

Partly supports H4

Passive ROM - LE

Full L + R

Refutes H5

Modified Ashworth Scale

L + R 0/4

Refutes H5

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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 » Intervention

Client:

Physical Therapist:

Anna

(you!)

Problem #’s

Hypotheses #’s

Strategy

Tactic (description, intensity, duration & frequency)

1

H1, H3

Balance exercise anticipatory strategy

Task - specific training starting in closed environment and progressing to open environment

Implemeter

Progression & Remarks

Anna / PT

Progress to combined exercises for anticipatory and sensory strategies

Anna / PT

Progress to combined exercises for anticipatory and sensory strategies

Attach double-tasking with secondary activity & cognitive dimensions. Use variable priority instructions

H2, H3

Balance exercise sensory strategy

Task - specific training on non-hard surfaces. Start with eyes open, progress to eyes closed Attach double - tasking with secondary activity & cognitive dimensions

H1, H2, 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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Progress to combined exercises for anticipatory and sensory strategies

Anna

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/Anna_Canvas_72  

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