Neurologic Differential Diagnosis for Physical Therapy

Journal of Neurologic Physical Therapy, Dec 2004 by Sullivan, Katherine J, Hershberg, Julie, Howard, Robbin, Fisher, Beth E

CONCLUSION

These 2 cases illustrate the critical role that physical therapists have in the neurologic differential diagnosis process. The prompt referral to the physician which reflected the change in physical, cognitive, and functional status in case 1, as well as the inconsistency between a LMN presentation with an UMN diagnosis in case 2, led to determination of the correct diagnoses and implementation of appropriate treatment.

These cases reflect the neurologic knowledge base and clinical decision making process that are required of physical therapists. We have proposed a hypothetico-deductive clinical reasoning model to guide physical therapists in the neurologic differential diagnosis process. In addition, a clinical decision making algorithm is presented to illustrate the process involved in determining whether a patient presenting with neurologic findings is within the scope of physical therapy practice. As the profession makes the transition to autonomous practice, entry-level or transitional physical therapy doctorate programs should incorporate educational objectives and content that will prepare doctors of physical therapy for this level of practice.

REFERENCES

1 Guide to Physical Therapist Practice. 2nd ed. Alexandria, Va: American Physical Therapy Association; 2001.

2 A Normative Model of Physical Therapist Professional Education: Version 2004. Alexandria, Va: American Physical Therapy Association; 2004.

3 Fritz JM, Wainner RS. Examining diagnostic tests: an evidence-based perspective.Phys Tber.200l;8l: 1546-1564.

4 Boissonnault WG. Prevalence of comorbid conditions, surgeries, and medication use in a physical therapy outpatient population: a multicentered study. / Orthop Sports Phys Ther. 1999;29:5()6-519.

5 Echternach JL, Rothstein JM. Hypothesis-oriented algorithms. ,Pfrys Ther. 1989;69:559-564.

6 Rothstein JM, Echternach JL, Riddle DL.The HypothesisOriented Algorithm for Clinicians II (HOAC II): a guide for patient management. Phys Ther. 2003;83:455-470.

7 Greenwood MJ, Erhard RE, Jones DL. Differential diagnosis of the hip vs. lumbar spine: five case reports. / Orthop Sports Phys 7�e>:1998;27:3080 -315.

8 Quarrier NF,Wightman AB. A ballet dancer with chronic hip pain due to a lesser trochanter bony avulsion: the challenge of a differential diagnosis. / Orthop Sports Phys Ther. 1998;28:l68-173.

9 Gray JC. Diagnosis of intermittent vascular claudication in a patient with a diagnosis of sciatica. Phys Ther. 1999:79:582-590.

10 Cleland JA, Venzke JW. Dermatomyositis: evolution of a diagnosis. Phys Ther. 2003;83:932-945.

11 Walsworth MK, Mills JT, III, Michener LA. Diagnosing suprascapular neuropathy in patients with shoulder dysfunction: a report of 5 cases.Phys Ther. 20()4;84:359372.

12 Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen GM. Clinical reasoning strategies in physical therapy. Phys Ther. 2004;84:312-330.

13 Jensen GM, Gwyer J, Shepard KF. Expert practice in physical therapy. Phys Ther. 2000;80:28-43.

14 Delitto A, Snyder-Mackler L. The diagnostic process: Examples in orthopedic physical therapy. Phys Ther. 1995:75:203-211.

15 Victor M, Ropper A. Adam's and Victor's Principles of Neurology. 7th ed. New York, NY: McGraw-Hill; 2001.