Using the Guide to Physical Therapist Practice in professional physical therapist education

Neurology Report, Aug 1999 by Nicholson, Diane E

Part One.'A Description of Patient/Client Management consists of 3 units: Who are Physical Therapists and What Do They Do, What Types of Tests and Measures Do Physical Therapists Use, and What Types of Interventions Do Physical Therapists Provide. Students are expected to reach an analysis level of performance in Bloom's taxonomy for Part One of the Guide. Although reading assignments, lecture, and large-group discussion are used to present the material in Part One, the discussions are the key for enabling students to reach an analysis level of performance. The unit Who are Physical Therapists and What Do They Do provides opportunities for several interesting discussions and debates. Discussions in this unit include (1) terminal degrees in professional education (eg, MPT versus DPT); (2) licensure and practice acts including the Model Practice Act;3 (3) accreditation and the Commission on Accreditation in Physical Therapy Education;4 (4) residency programs, postprofessional education, and clinical specialization; and (5) direct access, primary care, and triage for acute and chronic conditions. A discussion of practice settings includes not only "typical" settings but also "untapped" settings. Students are warned that in the near future supply and demand for physical therapists will require therapists to tap into nontraditional settings in order to find employment. For example, some facilities provide fee-for-service maintenance programs for patients poststroke. Others provide recreation (eg, skiing, horseback riding, and wheelchair basketball), prevention, and maintenance programs.

The elements of the patient/client management model are also presented: examination (history, systems review, tests and measures), evaluation, diagnosis, prognosis, intervention (coordination, communication and documentation; patient/client-related instruction; and direct interventions), outcomes, and discharge planning (including episode of care). Clarification of 2 terms is often necessary: diagnosis and episode of care.

Diagnosis is defined as a cluster of signs and symptoms in the Guide. Because the signs and symptoms are most often related to impairments, some individuals have started to use the terminology "physical therapy diagnosis" to distinguish between a diagnosis made by a physical therapist and a diagnosis made by a physician. However, the language "physical therapy diagnosis" is not consistent with the model of disablement in which the Guide is based. The model of disablement focuses on the patient (eg, a patient's pathology, impairment, function, and disability) and the terminology "physical therapy diagnosis" focuses on the provider. Some individuals use the terminology "impairmentbased diagnosis" and "pathology-based diagnosis" to avoid using provider-focused terminology. However, this terminology could be misleading, as one might assume that an "impairment-based diagnosis" is based solely on impairments. This is not the case. Patients with the same impairments but different pathologies may or may not have the same diagnosis. For example, 2 patients with the same impairment (a left hemiparesis of a Brunnstrom grade 35) have different diagnoses when 1 patient has a malignant brain tumor and the other patient has a traumatic brain injury. However, 2 patients with the same impairment (again, a left hemiparesis of a Brunnstrom grade 3) have the same diagnosis when one patient has a stroke and the other patient has a traumatic brain injury. Because of the problems with the terms "physical therapy diagnosis" and "impairment-based diagnosis" the terms "diagnosis" or"a diagnosis that is usually made by a physical therapist" are encouraged.