PROACTIVE ASSESSMENT IS CRITICAL TO HIGH QUALITY PHYSICAL THERAPY CARE



Physical therapist assistants should strive to assess the effectiveness of applied interventions each time applied. Realistically there should be some effect—either quantitative or qualitative if the intervention is effective.

A well-constructed plan of care includes customized interventions designed to accomplish specific goals. However, given the variability in patient response, assessment of individual efficacy of interventions is important.





EYES AND HANDS: POWERFUL PHYSICAL THERAPY ASSESSMENT TOOLS



Physical therapist assistants must be sensitized to what to look for and what to feel for. Our eyes and hands are sensitive sensory receptors.

A patient’s facial expression, ease of movement, posture, and even skin color may be indicators of pain. An area that is warm to touch may be an indicator of inflammation. Assessing edema as pitting or non-pitting provides vascular information.


In previous classes you have learned the importance of palpation as well as signs of respiratory/cardiac distress. Constant assessment is key to maintaining safety and effective physical therapy.



SELECTED ASSESSMENT TESTS



Certainly, there are a myriad of special tests and assessments associated with the musculoskeletal and neuromuscular systems.

During your laboratory sessions, we will review and practice some of these. Certainly, if managing edema a physical therapist assistant should be very comfortable with circumferential measurement and volumetric water displacement techniques.


This semester, in PTA 5 you will learn about various ways to assess muscle strength including manual muscle testing. The use of manual muscle testing and other procedures attempt to assign objective values to a potentially subjective phenomenon so that progress and efficacy can be discerned.

The physical therapist assistant knowledge of muscular anatomy, and specifically muscles that cross over more than one joint emphasizes the significance of muscular excursion and its assessment.

Of course, as previously stated, pain must be assessed as to location, intensity, description, and behavior. The VAS and various pain questionnaires provide such oppportunities.

You have learned goniometry in PTA 2. However you will further apply it as well as explore inclinometer assessment.




CAPILLARY FLOW REVIEW





PTA ASSESSMENT OF EDEMA: VOLUMETRIC WATER DISPLACEMENT



When edema is confined to the distal extremities this method may be practical and accurate. A volumeter measures water displacement to record the volume that a submerged extremity displaces. (Principle: You don’t fill a bath tub up to the top and then get in because your body mass displaces a volume of water).


Repeated volumetric measurements can indicate changes in the amount of edema present.


1. The time of day of measurement should be the same

2. The temperature of the water should be the same

3. The depth of emersion of the extremity must be the same

4. The unit of measure must be constant (ounces, milliliters)


Volumetric water displacement may be considered the gold standard for measuring edema of distal extremities


Comparison measurement of involved versus uninvolved extremity is helpful in assessing extent of the edema


As in all assessment, documentation of results must be clear, concise, and accurate.


Disadvantage - Does not specify location of edema just that it is present.



PTA ASSESSMENT OF EDEMA: CIRCUMFERENTIAL MEASUREMENT



Circumferential Measurements - Use of tape measure to measure the girth of a limb segment.


1. Use a tape measure that does not stretch

2. Measure with the same tape each time

3. Measure by the same individual

4. Measure at the same time of day

5. Measure using the same bony landmarks

6. Measure using the same technique

7. Measure using the same unit of measure (cm). The clinician must be able to specifically and clearly document the result and procedure.


Disadvantage


Circumferential measurements do not directly measure edema. It includes contributing muscle, adipose, and other matter.



PHYSICAL THERAPIST ASSISTANTS CAN MONITOR VASCULAR AND PHYSIOLOGICAL ACTIVITY BY KNOWING WHAT THE COLORS MEAN



Ecchymosis is the medical term for bruises. These form when blood pools just deep to the skin. Bruises are caused by blood vessel breakage. Bruises look like a mark on the skin that’s black and blue or red to purple. Bruises change color as they heal and most don’t need treatment.


Unexplained bruises could be a sign of an underlying medical condition.


Bruises respond to the force of gravity and therefore, over time, may be pulled to areas distal to the injury.


The healing of bruises is directly related to enzymatic and other physiological variables and the ability of the vascular system to carry breakdown products away.


The resolution of healing takes place in stereotypical fashions on an approximate timeline.

Protraction of timelines may suggest additional medical issues that might affect physical therapy effectiveness.


Physical therapist assistants may assess the status of a bruise secondary to trauma such as a ligament strain to discern how robust the healing process may be.


Day 1: Pink/Red. Fresh, oxygen-rich blood has pooled under the skin. May be swollen and tender.


Day 2-6: Blue/Purple. Blood loses oxygen and causes swelling.


Day 7: Pale Green. Hemoglobin breaks down.


Day 10-14: Yellow or Green. Bruise fades as blood is reabsorbed.


Day 14+: Yellowish-Brown or Light Brown. Bruise disappears.





Sensation Assessment



Depending on the diagnosis and rehabilitation goals, a more objective measurement of sensation may be required. Changes in patients' perception to temperature, light touch, pinprick, vibration, two-point discrimination and other parameters may be indicators of progress of nervous system recovery as well as safe administration of physical agents. Effective physical therapist assistants are familiar with the various tools that assess sensation and are able to effectively use them in assessing progress and efficacy.



—CHECKPOINT—



This is a good time to pause and assess your knowledge of key concepts. Below are links to a few learning activities that might assist your mastery of the material.


Completing some of the tasks may also earn you class participation credit! However, most importantly it will assist in your learning.


You should attempt to complete the assignments without using your text, notes, etc., as they are designed to test your knowledge—just like taking a test in class—but without the grade consequences.


Tasks include mock exams, games, clinical scenarios, and more. Click/tap on the activities and see how much you know!


Matching
Mock Assessment Notes
Crossword puzzle