Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Rehabilitation Guidelines
with ICF Classifications
Martin Kelley PT, DPT, OCS
John Kuhn MD
Phil McClure PT, PhD
Lori Michener PT, PhD, ATC, SCS
Mike Shaffer PT, OCS, ATC
Amee Seitz PT, DPT, OCS
Tim Uhl PT, PhD, ATC
sprain
Lessons learned from the spine…
1
Med Dx and PT Dx
Med Dx and PT Dx
Med Dx Rot Froz GH Treatment
Medical Diagnosis PT Diagnosis
or Cuff Shdr Instab Strategy
Pathoanatomic Sx Severity / Impairment
Primary Tissue “Irritability”
PT Dx
Pathology Current intensity Pain +/ +/ -- Activity
Stable over episode of Often changes over +++ +++ Mod
care episode of care
Guides general Rx Weak ++ / -- / + ++ / Strengthen
Guides specific rehab Rx
strategy +++ +++
May inform prognosis
Informs prognosis Stiff -- / + +++ -- Mob
Laxity -- /+ -- +++ Strength/
coord
Level 1
Level 2
Complaint of “Shoulder Symptom”
Pt c/o Shoulder Pain
Level 1
Screen Specific Phys Exam (D)
History, Basic PE, Red Flags
Key History (A)
Consultation
2
High Irritability (E) Moderate Irritability (F) Low Irritability (G)
(3/5 to categorize) (3/5 to categorize) (3/5 to categorize)
• High Pain (> 7/10) • Mod Pain (4-6/10) •Low Pain (< 3/10)
• night or rest pain • night or rest pain • night or rest pain
Rotator Cuff / Glenohumeral • consistent • none
Frozen Shoulder • intermittent
Impingement Instability • Pain before end ROM • Min pain w/overpressure
• Pain at end ROM
• AROM < PROM • AROM ~ PROM • AROM = PROM
• High Disability • Mod Disability • Low Disability
3rd Level Shoulder Classification •(DASH, ASES) •(DASH, ASES) •(DASH, ASES)
Irritability Level
Rx focus: Rx focus:
High Irritability High Irritability High Irritability Rx focus: • pain reduction • High demand functional
• pain reduction • impairments activity restoration
• basic function
Level 1
Level 2
Pt c/o Shoulder Pain
Level 2
Specific Phys Exam (D)
Key History (A) Rotator Cuff / Glenohumeral
Frozen Shoulder
Impingement Instability
NO Good Continue PT
Response to PT
YES YES until goals met
after 4-6 visits (H)
Hx and PE
consistent with Other Dx
Shdr Dx ? GH Arthritis Poor
Fractures
Continue to AC jt
Neural Entrap Adjust PT
NO Specific Dx Myofascial Referral Likely Explanation?
Fibromyalgia
Treatment
Inject, further dx, other NO Compliance, mis-dx, etc Yes
Post-Op
Referral / Other
Consultation