Non-patient Behaviours in Rehabilitation: Difference between revisions

mNo edit summary
mNo edit summary
Line 3: Line 3:
The problem list is heavily focused on impairments. In the NAGI model, the NPIP is generally a list of impairments that are contributing to the patients patho-anatomic hypothesis, functional limitations and disabilities. During movement assesment, this often identified through deficits in QQS & EF (quantity, quality, symptoms and/or end feel). Often, there is a disruption in the osteokinematics or arthrokinematics of a particular joint movement. There is also often a posture deficit that you may observe and include in your NPIP list.  
The problem list is heavily focused on impairments. In the NAGI model, the NPIP is generally a list of impairments that are contributing to the patients patho-anatomic hypothesis, functional limitations and disabilities. During movement assesment, this often identified through deficits in QQS & EF (quantity, quality, symptoms and/or end feel). Often, there is a disruption in the osteokinematics or arthrokinematics of a particular joint movement. There is also often a posture deficit that you may observe and include in your NPIP list.  


NPIP Examples:
Example: You have a patient with low back pain and radiographic evidence of a grade II spondylolisthesis. The pathoanatomic hypothesis may also be confirmed with segmental testing. You may feel a large neutral zone (laxity) with facet gliding at the L4/5 segment. You may also note a segmental shearing effect in the L4/5 region during spinal AROM that is observable. Therefore the patho-anatomic hypothesis is spondylolisthesis leading to excessive segmental shearing.&nbsp; <br><br>
 
#Kinesiophobia&nbsp;(as measured on Kinesiophobia scales)
#Impaired quadriceps strength/power (55% deficit as measured by hand-held dynamometer)
#Hypomobile anterior capsule of glenohumeral joint (as assessed through PROM and accessory joint assessment)
#Abnormal sitting posture (a kyphotic lumbar spine is observed during sitting and confirmed during subjective exam)
#Nutritional insufficiency impairing appropriate tissue healing (patient mentions that they skip 2 meals per day and are trying to lose weight)
#Scapular instability (as confirmed by observance of poor scapulo-humeral rhythym testing and confirmed with a positive scapular-assist test)
#Impaired healing in foot (confirmed with insensate foot with semmes-weinstein monofilament testing and prolonged history of diabetes and foot ulcers)
#Hypermobile L4-5 segment (confirmed with stress radiographs of lumbar spine to confirm spondylolisthesis, and/or segmental accessory joint assessment)
 
<br><br>

Revision as of 16:30, 10 September 2011

The clinician translates what psycho-social factors, patient behaviors, movement patterns, co-morbidities, abnormal forces and structural faults are contributing to the patients dysfunction.

The problem list is heavily focused on impairments. In the NAGI model, the NPIP is generally a list of impairments that are contributing to the patients patho-anatomic hypothesis, functional limitations and disabilities. During movement assesment, this often identified through deficits in QQS & EF (quantity, quality, symptoms and/or end feel). Often, there is a disruption in the osteokinematics or arthrokinematics of a particular joint movement. There is also often a posture deficit that you may observe and include in your NPIP list.

Example: You have a patient with low back pain and radiographic evidence of a grade II spondylolisthesis. The pathoanatomic hypothesis may also be confirmed with segmental testing. You may feel a large neutral zone (laxity) with facet gliding at the L4/5 segment. You may also note a segmental shearing effect in the L4/5 region during spinal AROM that is observable. Therefore the patho-anatomic hypothesis is spondylolisthesis leading to excessive segmental shearing.