Has demonstrated improvement in transfer ability, as amount of assistance needed
ID: 122219 • Letter: H
Question
Has demonstrated improvement in transfer ability, as amount of assistance needed has decreased.
Ambulated 75’ x 2 using wheeled walker, required minimal assistance for advancing walker and verbal cueing for proper pattern.
Patient reports pain in R knee @ 5/10 at rest, 8/10 with activity.
Nursing reports patient performed independent transfer in bathroom last night.
Has met weekly goal of independent bed mobility.
Patient says pain relief lasted for 4 hours after application of electrical stimulation at last intervention session.
Will ask wife to attend next intervention session to observe and assist with patient’s transfers.
Patient able to go up/down 3 steps w/ use of cane and 1 rail; independent with procedure after initial instruction in correct technique.
Performed AAROM x 10 to L knee flexion/extension; patient required total assistance for completing last 10 degrees of motion during final 3 repetitions of extension
May not be ready for d/c to lesser level of care as goal of independent transfer has not been met.
Will ask PT to assess need to joint mobilization techniques to L shoulder.
1. Based on the topics listed below, list at least two questions that the PTA needs to be thinking about to gather enough information to write a comprehensive daily note.
a. Pain:
b. Gait Training:
c. Ice Packs:
d. Transfers / bed mobility training:
e. Exercises:
f. Patient instructions:
3. Imagine that you have obtained “answers” to each of the questions you listed previously. Choose 2 of the above interventions and organize the answers into a Subjective (S) and Objective (O) section of a daily progress note:
(S)
(O)
(S)
(O)
4. From the listed S and O above, write how you could reflect upon in the assessment section to demonstrate whether or not the patient is making improvements in his mobility.
Explanation / Answer
The PTA or the Physical therapy assistant should definitely choose:
1. Pain:
Pain: The numeric pain scale allows the PT to know the absolute level of pain the patient is experiencing. The patient has expressed a pain of 5/10 i.e. moderate on resting, and a severe i.e.8/10 on activity in the right knee. assessment can be done using the GROC or Global rating of change scale by the Physical therapist. tHis scale should be followed with each day post training.
the rating is done as
-7 very worse, 7 very great deal better
-6 great deal worse 6 great deal better
-5 quite a bit worse 5 quite a bit better
-4 moderately worse 4 moderately btter
-3 somewhat worse 3 somewhat better
-2 little bit worse, 2 a little bit better
-1 bit worse 1- tiny bit better
It is observed that the relationship between changes in Numeric Pain rating scale and patient report on overall improvement of helath measured on GROC demonstrated reduction of around 30% to be clinically important. This will give comprehensive information on the improvement of the patient.
Key assessment of functional mobility is done by gait training, stair climbing, levels of assistance. The questionaire should include
If the physical therapist is supporting 75% of the work, then its maximal assistance. Now the patinet is on minimal assistance in terms of therapy as he is able to do flexion extension, and needs assistance only in the last 10 degrees. Analyse the gait.
Posture analysis, assesment of dextirity and coordination, postural equilibrium, muscle testing and sensory motor integration. self-paced gait speed is an outcome measure for gait training. It is the determinant for the ability to transfer. Timed stair ascending and descending can also be used as tools to assess. Prepare a TUG or time up and go test, to assess dynamic ability in series of locomotion, related mobility tasks.
3. Pain
S- Pain has improved from pain scale 8/10 to 3/10
O- BP 120/80 mm Hg, RR 12 cpm, PR- 80 beats per minute. T0-37 degree
Gait analysis
Subjective: analyse gait pattern, observe movement dysfunction, understand the poblematic phase and establish a treatment plan accordingly.
Objective: Measure stance time i.e. interval at which foot is on ground and stance is divided into 4 parts, heel strike to foot flat; foot flat through mid-stance, mid-stance through heel off, and heel off to toe off. Double leg support is 20% and single leg support is 40% of stance time.
step/stride length gives objective data- right step lenght should equal left step length
Average walking speed should improve to 3 mph.
Assessment:
Patient should improve in terms of objective ie apparent improvement in pain scale which is currently 8/10 on activity, it is subjective assessment and if the patient should not show grimace and discomfort and also use the GROC scale to rate improvement. This helps assessess clinical progress. Asides AROM ie. knee flexion 135-145 degrees, knee extension (0 degrees, PROM), Palpation, PA spinous processes, PA transverse processes, Strength of Quads, Hamstring, Gluts can be done. Assess the gait both subjectively and objectively and it should improve. Kinematic assessment of the biomechanical gait analysis can be used to scale the kinematic assessment from 1-10; 1 is not complex and 10 is very complex.
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