Overview on the Guide to Physical Therapist Practice and its implications for neurologic physical therapy

Neurology Report, Aug 1999 by Harro, Cathy C

Part Two of the Guide to Physical Therapist Practice describes the Preferred Practice Patterns which are organized into 4 sections: musculoskeletal patterns, neuromuscular patterns, cardiopulmonary patterns, and integumentary patterns. Each pattern includes a: (1) diagnostic label based on impairments, (2) list of patients included and excluded in that pattern, (3) list of likely tests and measures based on clinical indications, (4) prognosis and expected range of number of visits per single episode of care, including factors that may require a new episode of care, (5) list of likely interventions and anticipated goals for those interventions, and (6) expected outcomes and criteria for discharge. An episode of care is defined in the Guide as" all patient/client management activities provided, directed, or supervised by the physical therapist, from initial contact through discharge."'(APPendix 1-20) This definition has significant implications for neurologic physical therapy as patients are often seen for physical therapy along the continuum of care, from the acute care hospital to subacute or inpatient rehabilitation settings to outpatient or home health settings. For example, according to this definition, a single episode of care for a patient post-stroke would include a summation of physical therapy visits from all settings in which that patient received services, from the acute setting to the outpatient office. The expected range of visits for a patient post-stroke, which falls into Pattern 5-B, is 10 to 60 visits. Physical therapists in neurologic practice need to examine the practical application of the neuromuscular practice patterns and to validate or challenge the expected number of visits in the specific patterns. We need to critically question if these ranges represent the typical standard of practice in our current health care system and provide data on expected range of visits for an episode of care and expected outcomes for these patterns.

Seven neuromuscular patterns are identified in The Guide to Physical Therapist Practice:1

Pattern 5-A Impaired Motor Function and Sensory Integrity Associated with Congenital or Acquired Disorders of the Central Nervous System in Infancy, Childhood, and Adolescence;

Pattern 5-B Impaired Motor Function and Sensory Integrity Associated with Acquired Nonprogressive Disorders of the Central Nervous system in Adulthood;

Pattern 5-C Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System in Adulthood;

Pattern 5-D Impaired Motor Function and Sensory Integrity Associated with Peripheral Nerve Injury;

Pattern 5-E Impaired Motor Function and Sensory Integrity Associated with Acute or Chronic Polyneuropathies;

Pattern 5-F Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Spinal Cord; and

Pattern 5-G Impaired Arousal, Range of Motion, Sensory Integrity, and Motor Control Associated with Coma, Near Coma, or Vegetative State.