McGraw-Hill's NPTE (National Physical Therapy Examination)

1314 Pages·2009·46.44 MB·English

by  Mark Dutton

.
s e c t o n

I
The Profession

Chapter 1
Plan of Care (POC)
Who are Physical Therapists,
Coordination of Care

and What Do They Do?
Progression of Care

Discharge Plan

Definition of Physical Therapy
Intervention
Scope of Practice
Coordination/Communication/
Education and Qualifications
Documentation
Practice Settings
Documentation
Hospital

APTA Guidelines for Documentation

Home Health Care

Basic Principles of Clinical

School System

Documentation

Private Practice
Patient/Client-Related Instruction
Clinical Education of Students
Procedural Interventions
Models of Disablement
Choosing an Intervention Strategy
The Five Elements of Patient/
Outcomes
Client Management
Discharge/Discontinuation
Examination of Intervention
Patient History Prevention and Promotion
Observation of Health, Wellness, and Fitness
Systems Review Members of the Health Care Team
Tests and Measures Physical Therapy Director

Pain Staff Physical Therapist

Evaluation

Physical Therapist Assistant

Diagnosis

Physical Therapy/Occupational

Prognosis

Therapy Aide

1
2 SECTION I. THE PROFESSION
Physical Therapy and Physical Chapter 2
Therapist Assistant Student Administration
Physical Therapy Volunteer
The United States Health Care System
Home Health Aide
Overview
OccupauonalTherap~t
Cost Containment
Certified Occupational Therapist
Increased Requirements and
Assistant
Justification
Speech-Language Pathologist
The Funding of Health Care
(Speech Therapist)
Publicly Funded Plans
Certified Orthotist
Quality of Care
Certified Prosthetist
Current Concerns About Quality
Respiratory Therapist
of Care
Respiratory Therapy Technician
Budgets-Fiscal Responsibilities
Certified (CRRT)
Budget
Primary Care Physician (PCP)
The Operating Budget
Physician's Assistant (PA)
The Capital Budget
Physiatrist
Budget Calendar
Chiropractor
Zero-Base Budget
Registered Nurse Expenses/Costs

Rehabilitation (Vocational) Accounts Payable

Counselor Accounts Receivable

Audiologist Health Care Regulations
Athletic Trainer (ATC) Fiscal Regulations
Social Worker Certificate of Need (CON)
Massage Therapist Regulations
Acupuncturist Patient Self-Determination
Risk Management Act of 1990
Measurement and Assessment Quality Assurance/Quality

Strategies Improvement

Program Development
Quality Assurance (QA)
Professional Standards
Continuous Quality Improvement
Guide for Professional Conduct (CQI)
of the Physical Therapist Utilization Review
Interpreting Ethical Principles Quality Regulations
Principle 1 Health Professionals Regulation
Principle 2 Health Insurance Regulation
Principle 3 Access-Related Insurance
Principle 4 Regulations
Principle 5 Americans with Disabilities Act
Principle 6 Cost-Related Insurance

Principle 7 Regulations

Principle 8 Voluntary Accreditation
Principle 9 Voluntary Accrediting Agencies
Principle 1I) Joint Commission on Accreditation
Principle 11 of Healthcare Organizations
Standards of Practice for Physical UCAHO)
Therapy and the Criteria Accreditation Council for
Preamble Services for Mentally Retarded
Legal/Ethical Considerations and Other Developmentally
Administration of the Physical Disabled Persons (AC-MRDD)
Therapy Service Commission on Accreditation of
Patient/Client Management Rehabi Iitation Faci Iities (CARF)
SECTION I. THE PROFESSION 3
Comprehensive Outpatient Incident/Occurrence Reporting
Rehabilitation Facility (CORF) Sentinel Event Reporting
The Typical JCAHO Accreditation Illegal Practice and Malpractice
Process Malpractice
Health Care Insurance: Informed Consent

Reimbursement Statutory Laws

Private Health Insurance Industry Licensure laws

Private Health Insurance Workers' Compensation Acts

Managed Health Care Systems Unions

Health Maintenance
Organizations (HMOs) Chapter 3
Point-of-Service (POS) Plans Research
Preferred Provider Organizations
Statistics
(PPOs)
Populations and Samples
Point-of-Purchase Plans
Variables and Types of Data
Primary Care Networks
Data Collection and Sampling
Government Health Insurance
Techniques
Medicare
Graphical Representation
Medicaid
of Organized Data
Balanced Budget Act of 1997
Data Description
(BBA)
Measures of Central Tendency
Health Care Financing
Measures of Variation
Administration (HCFA)
Measures of Position
Worker's Compensation
Probability

Personal Payment and Free Care
The Normal Distribution

Consumer-Driven Health Care
Confidence Intervals

Programs
Confidence Intervals for the Mean
Health Insurance and Portability
Confidence Intervals for Variances
Accountability Act (HIPAA)
and Standard Deviations
HIPAA Privacy Rule

Hypothesis Testing
HIPAA Terminology

Type I Errors
Medical Records
Type II Errors
Threats to Medical Record Privacy
Significance Level
Current Protections
Probability (p) Value
Personnel Supervision/
The Power of a Hypothesis Test
Management of the Department
z-Test
Management and Leadership
t-Test
Theories
Chi-Square and Analysis of Variance
Bass Theory of Leadership

(ANOVA)
Four-Framework Approach

Chi-Square

Managerial Grid

Analysis of Variance (ANOVA)

Management Styles
Analysis of Covariance (ANCOVA)

Managers Versus Leaders
Intraclass Correlation Coefficient

Meetings
Choosing the Correct Statistical
Job Descriptions
Test
Performance Appraisal
Research Design
Rating Systems

Control

Completing a Performance

Control Group

Appraisal

Experimental Group

Staff Motivation
Placebo Effect

Professional Growth
Random Assignment

Policy and Procedure Manuals
Definitions

Material Safety Data Sheet (MSDS)
4 SECTION I. THE PROFESSION
Use of Evidence-Based Practice (EBP) Muscle Tissue
Scientific Rigor by Type Muscle Function
of Research Design Pathology of Muscle
Instrumentation-Gold Standard Joint Classification
Sensitivity and Specificity Arthrokinematics
Validity Osteoki nematics
Construct Val idity Degrees of Freedom
Face Validity Close-Packed and Open-Packed
Content Validity Positions of the Joint
External Validity Capsular and Noncapsular Patterns
Internal Validity of Restriction
Criterion-Referenced Validity End-Feels
Prediction Value Arc of Pain
Likelihood Ratio Measuring Range of Motion
Reliability Grading Accessory Movements
Threats to Validity and Reliability Hypomobility, Hypermobility, and
Instabi Iity
Chapter 4 Kinesiology
Education General Principles of Biomechanics
Directional Terms
Motivation

Movements of the Body Segments
Maslow's Hierarchy of Needs

Planes of the Body

Learning Theories

Axes of the Body

Domains of Learning
Levers

Educational Activities
Flexibility

Decision-Making
Physiology
Problem-Solving
Physiology of Exercise
Sensory Motor Learn ing
Energy Systems
Learning Styles
Measures of Energy Expenditure
Analytical Learner
Body Mass Index (BM/)
Intuitive/Global Learner
Bioelectrical Impedance Analysis
Reasoning: Inductive Versus
The Metabolic Equivalent (MET)
Deductive Reasonings
Nutrients
Initiative: Active Versus Passive
Carbohydrates

Learning
Fats

Improving Compliance with
Proteins

Learning and Participation
Vitamins and Minerals

Community and Staff Education
Nerve and Muscle Physiology
Using Visual Aids
Resting Membrane Potential (RMP)
Cultural Influences
Action Potential
The Synapse
Chapter 5
Neurotransmitters
Fundamentals and Core Concepts
The Neuromuscular Junction
Tissues of the Body Thermoregulation
Epithelial tissue
Conservation and Production

Nervous Tissue
of Body Heat

Connective Tissue
The Immune System
Connective Tissue Proper T-Lymphocytes

Tendons and Ligaments Organs of the Immune System

Bone Immunodeficiency

Cartilage Tissue The Healing Process
Bursae Wound Healing

Connective Tissue Disorders Muscle Healing

i
i
_L
SECTION I. THE PROFESSION 5
Destruction Phase
Tomography
Repair Phase
Positron Emission Tomography
Remodeling Phase
(PET)
Ligament and Tendon Healing Magnetic Resonance Imaging
Phase I: Hemorrhagic Diagnostic Ultrasound
Phase II: Inflammatory Radionucleotide Scanning
Phase III: Proliferation Fluoroscopy
Phase IV: Remodeling and Transcranial Magnetic Stimulation
Maturation (TMS)
Articular Cartilage Healing
Magnetoencephalography (MEG)
Meniscal Healing
Miscellaneous Information
Extrinsic Pathway
Standard and Transmission-Based
Intrinsic Pathway
Precautions
Bone Healing The Intensive Care Unit
Imaging Studies Environment
Radiography Airways
Conventional Radiography Lines
Stress Radiograph Miscellaneous Equipment
Contrast-Enhanced Radiography
Who are Physical Therapists,
What Do They Do?
and
The Guide to Physical Therapist Practice referred to hereafter as
The Guide was developed by tlle American Physical Ther"py Association
(APTA) "to encourage a uniform approach to physical therapist practice
and to explain Lo the world the nature of thaL prnctice."l 'Ibe Guide is
divided into two parts:
~ Part 1 delineates the physical therapist's scope of practice and

describes patient management by physical therapist. (PTs).

~ Part 2 describes each of the di>lgnostic preferred practice pat­

terns of patients typically treated by PTs.
DEFINITION OF PHYSICAL THERAPY
The Guide defines physical therapy as follows:
Physical therapy includes diagnosis and management qf movement dys­

function and enhancement q(physical andfunctiona/ abilities; restora­

tion, maintenance, andpromotion ofoptimalphysicalfuncttotl, ('PUmal

fitness and weI/ness, and optimal quality oflife as it relates 10 movement

and health: and pret!(mtion of the onset, symptoms, and pTORression of

impairments, fi~nctional limitations, and disabilities that may result

/rum dil>eases, disorders, conditif.J1/s, or injuries,
SCOPE OF PRACTICE
Physical therapy is defmed as the care and services provided by or
under the direction and snpervi'iion of a physical therapist.:l
~ Physical therapbts are the only professionals who provide

physical therapy.

~ Physical fuerapist assistmt. (PTAs)-unUcr tlle direaion and super­

vision of the physical therapi....,t-are the only pamprofessionaL.,

who assL~ in the provision of physical theiJ.py interventions.

7
8 SECTION I. THE PROFESSION
EDUCATION AND QUALIFICATIONS
PTs are professionally educated at the college or university level and
are required to be licensed in the state (or states) in which they prac­
tice. Education programs for the preparation of physical therapists
have been recognized in some manner ~ince 1928, when the APTA Brst
published a list of approved programs'>
~ Graduates from 1926 to 1959 completed physical therapy cur­
ricula approved by appropriate accreditation bodies.
~ Graduates from 19(";0 to the present have successfully com­
--------------------, pleted professional physical therapist education programs
Study Pearl
accredited by the CommL.,sion on Accreditation in Physical
Therdpy Education CCAPTE). CAPTE also makes autonomous
CAPTEonly
decisions concerning the accreditation status of continuing
and PTA education
education programs for the physical therapists and physical
sitional£IDd.:,r ~PhYsic;rl Jh
therapist assistants.
:programs,
which arE! consi.

profeSsional Pro~aI]K. ••
The APTA house of delegates first authorized the education of
physical therapist assistants at the 1%7 Annual Conference.
PRACTICE SETTINGS
Physical therapists praCTice in a broad range of inpatient, outpatient,
and conununity-based settings, including those described in the next
sections and listed in Table 1-1.
HOSPITAL
Hospitals may be classified in a number of ways, including by,
~ Length of stay (short-term or long-term)
Acute-<eare (short-term hospital): An acute-care hospital can be
defined as a facility that provides hospital care to patients who
generally require a stay of up to 7 days, and whose focus is on a
physical or mental condition requiring immediate intervention
and constant medical attention, equipment, and personnel.
Following a stay in the acute-<:are hospital, the patient is typically
discharged to home or to another he-dlth-care facility.
Suhacute: Medical care is prOVided to patients who require
more than 7 but less than '\0 days' stay in a hospital, and who
have a more stable condition than those receiving acute care.
~ Teaching or nonteaching.
Teaching A hospital that serves as a teaching site for medicine,
dentistry, allied health, nursing program<;, or medical residency
programs.
Nonteaching: A hospital that has no teaching responsibilities or
one that serves as an elective site for health-relat{xJ. programs.
~ Major types of services: general, or specialities such as psychi­
atric, tubef<..."Ulosis, maternity) pediatrk, and ear, nose and throat
CENT)
~ Type of ownership or control: federal, state, or local b"wemrnent;
for-profit and nonprofit.
CHAPTER 1. WHO ARE PHYSICAL THERAPISTS, AND WHAT DO THEY DO? 9
TABLE I-I. PRACDCE SETTINGS
SETllNG CHARACTERTSTICS PHYSICAL TIIERAPIST ROLE
Hospital A ho...;;pital is <in institution whose primary function Refer to text.
is [Q provide inpatient diagno...<;tic and thempeutic
services for a wide variety of medical, surgical
and nonsurgical conditions. In addition, mo..;;!
hospitals provide some outpatient servkes,
p'Jrticularly emergency care.
Primary QJ re ... Bask: or entry-level health care, which includes The physical therapist serves a supportive role for
diagnostic, thempeutic, or preventive services. the primary care teams: providt:s examination,
... Care is proVided on an outpatient ha.5is by evaluation, diagnoses, prognosis, and
primary-care physicians, including family intervention for musculoskelecal and
practice physicians, internists, and p<;::uiatricians. neuromuscular dysfunctions.
Secondary care ... Services provided by medical specialists, such as Physical therapy involvement is minirI41l.
cardiologists, urologists, and dennatologists,
who generally do not have fIrs! contact with
[he patients.
... This level of <-'are may require inpatient
hospitalization or ambulatory same-day surgery.
Tertiary care (tertiary to- HigWy specialized care that is given to patients Physical therapy may be consulted on an
healrh care) in a hospital setting who are in danger of as··needed basis.
dis<Jbility Or death (organ tnmsplants. major
.'Ilurgical procedures).
... Services provided often require sophistkaLed
tedmologies (e.g.. neurosurgeons or interu;ivc
care units).
... Specialized care usually provided occ<fuse of <f
referral from primary or secondary medical care
personnel.
Transitional care unit ... Nonmedkally based facility, which may be in Physk<Jl therapy emphasiS is on improVing
group horne Of part of a continuum of functional skills for maximum independence to
rehabilitation center. prepare a patit.'nl for community reentry or for
... Typical stay is 4 to 8 months. tran.sfer to an a'llsisted-living/skilled nursing facility.
... Greater focus placed on compen'llation versus
restoration.
Skilled nursing ... A free-standing facility, or part of a hospital, An SNF musl be able to provide 24-hour nursing
faciHty (SNF) that is licensed and approved hy the state covef'"Jge, :md the availability of physical,
(Medicare certified), where eligible occupational, and speech therapy.
individuals receive skilled nursing care and Minimum u:'Ha .'set (MDS): federal data collection
appropriate rchahilitative and restorative services. system for as...'ie..."o.'>ing nursing home patients.
... Sometimes referred to as an e:r:tf?nded carefacility. .. The MDS for nursing facility residents is a
... Accepts p<Jtients in need of rehabilitation and comprehensive resideD[ assessment
medical care tilltt is of a lesser intensity than that iru;uumenl (RAT) that measures functional
received in the acute GUt" .serting of a hospital. scatus~ mental health status, and beilltvioml
.. Provides skilled nursing, rehabili~Hion. and stalUS 10 identify chronic care patient needs
various other health services on a daily basis. and fomlaJize a care plan in response to 18
... Medicare defines daily as seven days a week of re'llident assessment protocols (RAPs).
skilled nursing care and t1ve days a week of .. Under federal regulation, assessments arc
skilled therapy. conducted at a time of aJmjssion into a
.. Physician orders must be rewritten every 60 cLys. nursing facility, upon reUlm. from a 72-hollf
hospital admission, whenever there is a
significant change in status, 4uarterly, and
annually.
Acute rehabilitation .. Usually based in a mcdic<JI sening Physical therapist involved in the c-oordiruued
facility ... Provides early rehahilitation, .social, and services of medical, social, educational,
vocational services as SOOn as the patient is vocational, and the other rehabilitative services
medically stable. (OT, speech).
(Continued)
10 SEGION I. THE PROFESSION
TABLE 1-1. PRACTICE SETTINGS (Continued)
SETTING CHARACTERISTICS PHYSICAl THERAPIST ROLE
... Primary emphasis is to provide intensive physiCll
and cognitive restorative services in the early
months to disabled persons to facilitate their
return to maximum functional capacity.
... Typical stay is .'i to 4 months (short term).
Chronic care facility ... Long-tem1 care facility that is facility or The faciHty has a full range of rehabilitation

commullit~r' based. services (physical, occupational, and speech

... Sometimes refcncd to 3-<; extended rehabilitation. therapy) available .

... Designed for patients with permanent or residual
disabilities caused by a nonreversible pathologic
health condition. Also L1sed for patients who
demonstrate slower than expected progress.
... Used as a placement f:-lcili[y--60 days or longer,
but not for permanent stays.
Comprehensive ... CORPs must provide coordinated outpatient Physical therapy (~md occupational therapy and

outpatient diagnostic, therapeutic, and restorath·'e senlices, at speech-Iangu:lge pathology services) may he

rehahilitation a Single fi..'C.ed loc'atiun, to outpatienrs for the provided in an off-site location.

facility (CORF) rehabilitation of injunxl, tlisabled, or sick individuals.
... CORFs are surveyed every 6 years at a minimum.
Custodial care ... Provides medical or nonmedical serv"ices, which Physical therdpy involvement is minimal.
facility do not seek to cure but are necessary for patients
who are unable to care for themselves.
... Provided during periods when the medical
condition of the patient is not changing.
... Patient does not reqUire the continued
a<.lminllitration of medical care by qualified
medical personnel.
... This type of care is not lL'iually covered under
managed-care plans.
Hospice cut:' ... A facility or program that is licensed, certil1ed, or Physical therapy may be consulted on an
otherwise authorized by law, which provides as-needed basis.
supportive care for the terminally ill.
... Focuses on the physical, spiritual, emotional, Occupational therapy more commonly con~ulled.
psychological, financial, and legal neetls of the
dying patient and the family.
... Services provided by an inrerdisciplinary team of
professionals and perhaps volunteers in a variety
of settings, including hospitals, free-standing
facilities, and at home,
... Medicare and Medicaid require that at least 8a:Vo
of hospice care is provided at home. Eligibility
for reimbursement includes:
Medicare eligibility.
Certification of terminal illness (k~s than or
equal to 6 months of life) by physician.
Pl'csuna) care ... Optional Medicaid benefit that allows a state to Physical therapy mlY be consulted on an
pro"ide services to assist func1ionally impaired as-needed lYJsi5.
individuals in performing the activities of daily
living (e.g., bathing, dressing, feeding, grooming).
Ambulatory care ... Includes outpatient prevcmative, diagnostic, and
(outpatient care) treatment services that arc provided at medical Physical therapy may be consulted on an
offices, surgery centers, or outpatient clinics as-needed basis.
(induding private pmctice phy·sical therapy clinics,
outpatient satellites of institutions or hospitals).
... Designed tor patients who do not require
~
overnight hospitalization.
... More cost-effective than inpatiem care, and
therefore favored by managed-care plans.
CHAPTER 1. WHO ARE PHYSICAL THERAPISTS, AND WHAT DO THEY DO? 11
HOME HEALTH CARE
Home health care involves the provision of medical or health care by
a Home Health Agency (HHA), which may be governmental, volun­
tary, or private; nonprofit or for-profit. Home care services were intro­
duced to reduce the need for hospitalization and its associated costs.
An HHA provides part-time and intermittent skilled and nonskilled
services and other therapeutic services on a visiting basis to persons of
all ages in their homes. Patient eligibility includes:
~ Any patient who is homebound or who has great difficulty leav­
ing their home. A person may leave home for medical treatment
or short infrequent nonmedical absences such as a religious serv­
ice.
~ Medicaid waiver clients. The Medicaid Waiver for the Elderly
and Disabled (E&D Waiver) program is designed to provide
services to seniors and the disabled whose needs would other­
wise require them to live in a nursing home. The goal is for
clients to retain their independence by providing services that
allow them to live safely in their own homes and communities
for as long as it is appropriate.
~ A patient who requires skilled care from one of the following
disciplines: nursing, physical therapy, occupational therapy, or
speech therapy.
~ Physician certification. In the case of an elderly patient, recertifi­
cation by Medicare is required every 62 days. Medicare only
pays for skilled home health services that are proVided by a
Medicare-certified agency. At the time of writing, Medicare
defines intermittent as skilled nursing care needed or given on
fewer than 7 days each week, or less than 8 hours per day over
a period of 21 days (or less) with some exceptions in special
circumstances.
~ Patients who continue to demonstrate potential for progress.
The physical therapy focus includes:
~ Environmental safety including adequate lighting, securing
scatter rugs, handrails, wheelchair ramps, raised toilet seats.
~ Early intervention (refer to the "School System" section).
~ Addressing equipment needs:
Equipment ordered in the hospital is reimbursable.
Most adaptive equipment ordered in the home is not reim­
bursable. Exceptions include items such as wheelchairs, com­
modes, and hospital beds.
~ Observing for any evidence of substance abuse or physical
abuse:

Substance abuse should be reported immediately to the physician.

Physical abuse should be immediately communicated to the

proper authorities (varies from state to state).
SCHOOL SYSTEM
~ The major goal of physical therapy intervention in the school is
to enhance the child's level of function in the school setting.