10 Examination & Evaluation

EMERGENCY PROCEDURES
& PRIMARY CARE IN

PHYSICAL THERAPY
DR . BINISH ADEEL PT
BSPT,DPT, MSAPT
ASSISTANT PROFESSOR
EXAMINATION/EVALUATION
PROLOGUE
an event or act that leads to another.
A primary objective of the examination process is deciding whether :
•PT intervention is appropriate
•Consultation with another health care provider is required along with PT intervention
•PT intervention is not indicated and the patient needs to be managed by another health care
provider
SYMPTOMS INVESTIGATION
•The symptom investigation includes subcategories of symptom location, onset (history) of
symptoms and behavior of symptoms
LOCATION OF SYMPTOMS
Use of a body chart helps to locate symptoms location, including pain, paresthesia , numbness
and weakness.
LOCATION OF SYMPTOMS
•Ithe figure it shows that the patient has low lumbar and right buttock pain (dull ache)
•The next question could be any pain, pins, needles, weakness and /or numbness at the back ,
down the leg or different areas/ parts of the body.
•The patients might not tell that they belly pain or facial pain because they have a rationale why
does my PT need to know if my stomach hurts?
•In addition patient may miss an area of less intensity.
•Asymptomatic area should be marked check on body chart. Why ?
•Patients description of symptoms
•For eg: patient tells she has pain, stiffness , aching, and sharp soreness over a body area.
•PT must assess each pain descriptor independently.
•Similar pattern (aggravating or relieving factors) would lead to know that three symptoms are
related to the same lesion.
•Pain from visceral region structures typically would be thought to be located in the anterior
chest wall or abdominal regions, but a number of viscera are located in the retroperitoneal
regions.
•Knowledge of potential pain patterns associated with viscera can guide the PT in selecting the
organ systems to screen with review of systems questioning.
•Finally, knowing the pain patterns associated with various diseases will help PTs know which
disorders should be suspected.
SYMPTOM HISTORY
•For many patients , the current episode of symptoms is not the first episode, if after 5 minute
conversation of incident of 20 years ago pain, PT might conclude that he has learned nothing
that influences todays cdm.
•To promote practice efficiency , start with the current or most recent episode , and then work
backward chronologically to the initial event..
•Impairments – related symptoms typically are associated with a traumatic incident , an accident
, repetitive overuse, or sustained postural strains. Many patients cannot relate the onset of their
symptoms to any particular incident or accident.
BEHAVIOUR OF SYMPTOMS
THE PT should ask questions about :
•The relationship symptoms have to rest, activities , time of day ( morning, midday, evening or
night ) and positions /postures.
•The consistancy, frequency and durations of symptoms , including fluctuations in intensity
•For neuro-musculoskeletal disorders a 24 hours period is adequate.
•Symptoms associated with movement disorders typically changes as the mechanical loads on
the body increase or decrease with time of day, onset or cessation of specific activities and
postures.
•Symptoms associated with visceral disease will vary in their behavior depending on the severity
of the disorder and the function of the structure.
•For eg: patients thoracic-spine pain is the result of the duodenal ulcer GI system activity may
later the symptoms. Pain due to ulcer will be reduced shortly after the patient eats , because
food acts as a buffer and a few hours after eating the pain will return or intensify.
•An inconsistent pattern of change in symptom intensity is not the only warning sign that may be
discovered during behavior of symptom questioning.
•Eg: patients notes right shoulder and wrist pain during the initial visit and at the second visit
reports right and left shoulder and left elbow and wrist pain. the patient cannot describe any
reason why the apparently new pains have started.
•Primary neurological, endocrine, or rheumatic disorders or adverse drug reactions may account
for a symptom pattern like this.
•Night pain
•Associated with serious pathology like cancer and infection.
•check .for red flags
•Many studies shows is associated with DJD
PATIENT HEALTH HISTORY INCLUDING
IDENTIFICATION OF HEALTH RISK FACTORS
•Patients demographics
•Patient’s social history
•Patients medical history
•Social habits
•Family history
‘THANKYO
U!

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EMERGENCY PROCEDURES

& PRIMARY CARE IN

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