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

Neurology Report, Aug 1999 by Nicholson, Diane E

A single episode of care consists of all physical therapy activities from initial contact through discharge. However, several patients (especially those with neuromuscular pathology) require multiple episodes of care across several weeks, months, or years, and possibly across a lifetime (eg, a child with cerebral palsy). For example, a patient who is in an unresponsive state immediately after a traumatic brain injury may receive physical therapy services. These services may be discontinued if a physical therapist determines that the patient is no longer benefiting from services. At a later time, the patient may become more responsive and physical therapy services may be resumed. Resumption of physical therapy services after they have been discontinued results in multiple episodes of care. Other examples of when multiple episodes of care might be indicated include a change in the patient's impairment level, function level, environment, or caregiver. Note that episodes of care are not necessarily environment specific (eg, intensive care unit, acute care, rehabilitation unit) but instead each episode of care should be independent and have its own goals and anticipated outcomes.

Chapter One of the Guide closes with a unit on professional roles of physical therapists. These roles include consultation, education, critical inquiry, administration, and direction and supervision of physical therapist assistants, aides, and other support personnel. The emphasis in this area is on having physical therapist students understand the education and roles of assistants, aides, and other support personnel. Often the roles suggested in the Guide differ from the personal experiences students have had.

Chapter Two of the Guide focuses on the tests and measures physical therapists use. This chapter and the Glossary are presented simultaneously to students. The Guide presents 24 categories of tests and measures that are listed alphabetically. It is noted that the 24 categories are the same for both the Guide and the Model Practice Act.3 Students are advised to laminate a list of the 24 categories of tests and measures that they can carry with them in the clinic. Some students choose to copy Figure 1 on page 1 to 2 of the Guide which contains categories for both tests and measures and interventions. (Reprinted in this issue, see the Harro article.)

Distinctions between several terms are discussed. Specifically the difference between activities of daily living and instrumental activities of daily living is: between aerobic capacity and endurance; between adaptive and assistive devices; between posture, balance and postural control; and between motor control and motor learning. Health related quality of life and work (job/school/play) are also defined and discussed.

Chapter Three focuses on interventions physical therapists provide. The 3 components of interventions are coordination, communication, and documentation; patient/client related instruction; and direct interventions. The first component (coordination, communication, and documentation) and the Appendix termed Guidelines for Physical Therapy Documentation are presented simultaneously to students. The second component (patient/client related instruction) is presented only briefly, as students are informed that a course in the second year of the curriculum termed Physical Therapists as Educators will focus on patient/client education. The third component consists of 9 categories of direct interventions that are listed in order of preferred use. It is noted that therapeutic exercise and functional retraining lie at the core of most physical therapy plans of care and other direct interventions are used primarily to augment these 2 core interventions. It is also noted that the 2 categories of indirect interventions and the 9 categories of direct interventions are the same for both the Guide and the Model Practice Act. Students are advised to laminate a list of the 11 interventions that they can carry with them in the clinic. Again, some students choose to copy Figure 1 on page 1 to 2 of the Guide which contains categories for both the tests and measures and for the interventions. (Reprinted in this issue, see the Harro article.)