Introduction to the Physical

Therapy Examination

By 2020, physical therapy

will be provided by physical

therapists who are doctors of
physical therapy, recognized by
consumers and other health care
professionals as practitioners of
choice to whom consumers have
direct access for the diagnosis of,
interventions for, and prevention of
impairments, functional limitations, and
disabilities related to movement,
function, and health.

The Guide to Physical Therapy

Practice

Developed by the APTA with

collaboration among hundreds of
physical therapists, from 1992-2001,
second edition

What Is APTA?
www.apta.org

The American
Physical Therapy
Association (APTA) is
a national
professional
organization
representing more
than 63,000
members. Its goal is
to foster
advancements in
physical therapy
practice, research,
and education

Practice Settings

Hospitals
Outpatient clinics
Rehabilitation Facilities
SNF/subacute
Education/research
Home
Schools
Corporate/industrial
Athletic/fitness facilities
Hospices

Purpose of the Guide

Describes PT practice in
general, using the
disablement model
Describes roles of PT in
primary, secondary, &
tertiary care; in
prevention and in the
promotion of health,
wellness and fitness

Purpose of the Guide

Describes settings in which PTs practice

Standardizes terminology in PT practice
Delineates tests & measures and
interventions
Delineates preferred practice patterns

The Guide to Physical Therapy

Practice

Describes three disablement models:

Nagi scheme
WHO, International Classification of
Impairments, Disabilities and Handicaps
National Center for Medical
Rehabilitation Research Classification

WHO

The Disablement Model

The purpose of a
disablement model
is to delineate the
consequences of
disease and injury at
the level of the
person and society.

All disablement models

function to explore the
interrelationships
between disease,
impairments, functional
limitations, disabilities,
handicaps and the
interaction of the
person with the
environment

Nagi Scheme

Active Pathology
Impairment
Functional Limitation
Disability

WHO/NAGI

Disease
Impairment
Disability
Handicap

WHO Disease: The intrinsic pathology

or disorder
NAGI Active Pathology: Interruption or
interference with normal processes, and
efforts of the organism to regain a
normal state

WHO/NAGI

Impairment:
WHO: Loss or abnormality of
psychological, or physiological or
anatomic structure or function at the
organ level
NAGI: Anatomical, physiological,
mental, or emotional abnormalities or
loss

WHO/NAGI

WHO Disability: Restriction or lack of

ability to perform an activity in a normal
manner
NAGI Functional limitation: Limitation
in performance at the level of the whole
organism or person

Process of Disablement

WHO Handicap: Disadvantage due to

impairment or disability that limits or prevents
fulfillment of a normal role-depending on age,
sex, sociocultural factors for the person

NAGI Disability: Limitation in performance of

socially defined roles and tasks within a
sociocultural and physical environment

Process of Disablement

WHO/NAGI

PTs provide services to individuals with

impairments, functional limitations,
disabilities, or changes in the physical
function and health status resulting
from injury, disease, or other causes

The APTA Guide to

PT Practice is
modeled after Nagi

the impact of
conditions on
function

Impairment

A direct and natural

consequence of
pathology or insult
Indicated by signs
and symptoms
Impairments can be:

Direct, Indirect or
Composite

Functional Limitation

Unable to perform activities of daily

living (ADL) and instrumental activities
of daily living in the manner the
individual is accustom to, usually
limiting some activities or compensation
or avoidance.

Handicap

Disability

Social disadvantage
of an impairment.
Cultural, social
economic and
environmental
consequences of a
disability

The discordance
between the actual
performance of the
individual and the
expectations of the
community.
The result of
impairment

Clinical Decision Making

What happens when a patient comes for

therapy?
What is the treatment planning process?
A series of interrelated steps that enable the
PT to plan an effective treatment compatible
with the needs and goals of the patient and
members of the health care team

DIAGNOSIS

OUTCOMES

Method of describing and monitoring patient

performance
Remediation of functional limitation &
disability
Optimization of patient/client satisfaction
What outcome is likely given the diagnosis?
Are outcomes realistic in the context of the
examination & evaluation data?

PROGNOSIS

EVALUATION

INTERVENTION

EXAMINATION

OUTCOME

EXAMINATION

HISTORY

Systems Review
Tests & Measures

continued

Environmental, Home & work barriers

Ergonomic & body mechanics
Gait, locomotion & balance
Integumentary Integrity
Joint Integrity & Mobility
Motor Function (motor control & motor
learning)

Tests & Measures

Past and current health status

Patient complaints
Identify health risk factors
Health restoration and prevention needs

Tests & Measures

Tests & Measures

continued

Prosthetic requirements
Range of motion (ROM)
Reflex integrity
Self care & home management (ADL &
IADL)
Sensory integrity
Ventilation & Respiration/gas exchange

Aerobic Capacity & Endurance

Anthropometric characteristics
Arousal, Attention & Cognition
Assistive & Adaptive Devices
Circulation (arterial, venous, lymphatic)
Cranial & peripheral nerve integrity

Tests & Measures

continued

Muscle performance (strength, power &

endurance)
Neuromotor development & sensory
integration
Orthotic, protective & supportive
devices
Pain
Posture

Factors Affecting the

Complexity of the Evaluation

Clinical findings
Loss of Function
Social
Considerations
Overall physical &
health status

The Evaluation Reflects:

Chronicity or severity of the current

problem
Possibility of multisite or multisystem
involvement
Presence of preexisting systemic
conditions or diseases
Stability of the condition

DIAGNOSIS
Label: cluster of signs and
symptoms, syndromes or
categories

Decision reached:
includes synthesizing the
information obtained during
the examination
Purpose: To guide the PT
to determine the most
appropriate interventions or
strategy

PROGNOSIS

Level of current impairment and

probability of prolonged impairment
Functional limitations & disability
Living environment
Potential discharge destinations & social
support

PROGNOSIS

The Physical Therapist should

consider

Prediction of improvements that may be

reached at various intervals during the
course of therapy
Establish a plan of care
Determine the degree to which
interventions are likely to achieve
anticipated goals and desire outcomes

Predicted optimal
level of
improvement in
function and the
amount of time
needed to reach
that level

Plan of care

Goals & outcomes

Multiple treatment options (general/
specific)
Frequency, duration, intensity of
intervention
Criteria for discharge

INTERVENTION

3 Components of Interventions

Procedures and techniques employed

by the PT to change the condition
consistent with the diagnosis and
prognosis

Implement Treatment Plan

Consider patient needs

Consider environmental needs/demands
Monitor response to treatment
Treatment modification

Evaluate Treatment Outcomes

Documentation &
Communication

Meaningful
accurate
timely
systematic

Coordination,
communication,
documentation
Patient/client related
instruction
Direct interventions

Continuous re-evaluation
Are the established goals being met?
Are the goals reasonable given the
diagnosis & prognosis?
Do the goals require modification?
Does the treatment require modification

Components of the
Musculoskeletal Exam
Valid
reliable
prompt
regularly recorded

Observation
Palpation
Mobility/stability exam
Neurological exam
functional exam

Observation

Body type

mesomorphic
ectomorphic
endomorphic

Palpation

Postural alignment,
symmetry,
deformities
Skin

edema
color changes

Mobility/Stability Exam

AROM
PROM
Resisted Movement
Testing
Joint Mobility
Testing
Special Tests

Swelling
Tenderness
Skin temperature
Arterial pulses
Crepitus
Bony Structure

Neurological Exam

MMT
DTRs
Sensory
Neural stretching
and compression
tests

Functional Exam

Performance based assessments

Self Assessments
ADLs:

Basic: Bed mobility, transfers, ambulation

IADLs: shopping cooking, communication
Level of assistance required
Outcome Measures