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

Date of Dx: Year

Multiple Sclerosis - secondary progressive

(2 years ago)

Month

Day

Client:

Physical Therapist:

Maya

(you!)

Date of birth: Year

Month

Day

Gender:

Date of intake: Year

Month

(age: 41)

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 Short 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

2

3

Client:

Physical Therapist:

Maya

(you!)

Date

Baseline Functional measures

Date

Goal Functional measures

Date

Progress / discharge Functional measures

Date

Testing & predictive criteria

Date

Testing & predictive criteria

Date

Testing & predictive criteria

Maya cannot walk 60m non-stop on flat hard surface outdoors using 1 crutch. (E)

Maya's walking speed is slow. (E)

Maya cannot walk from place to place in the rehab centre using 1 crutch. (NPIP-E)

4

5

6

Problem # 1

Body functions & structures (and Contextual factors)

1

2

3

4

5

6

2

3

4

5

6

Hypotheses of causative impairments & other factors

Disturbed gait pattern functions

Decreased postural control

Decreased muscle force generation capacity Disturbed proprioception

Increased LE muscle tone

Limited LE ROM

7

Low self-efficacy - REFERRAL TO PSYCHOLOGIST (see interview)

8

Insufficient assistive devices - REFERRAL TO OT (see interview)

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.


PT Client Management Canvas Âť Examination Tests & measurements

Client:

Physical Therapist:

Maya

(you!)

Findings

Indications

Findings

Indications

PSCQ: walking outside w/ 1 crutch - VAS & max. walking distance + time

Activities & participation

MSWS-12

25FWT (max speed, static start) w/ 1 crutch

25FWT (max speed, static start) w/ 2 crutches

Tests & measurements

Body functions & structures (and Contextual factors)

OGA

BBS

Upright motor control test

Isometric force generation – MRC-scale

Joint position & joint motion

MAS

Passive ROM

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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 Problem #’s

Hypotheses #’s

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Strategy

Tactic (description, intensity, duration & frequency)

Client:

Physical Therapist:

Maya

(you!)

Implemeter

Progression & Remarks

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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