Clinical Reasoning in Physical Disabilities

by Dutton, Rebecca

• ISBN13: 9780683027402
• ISBN10: 0683027409
• Format: Paperback
• Copyright: 1995-06-01
• Publisher: Williams & Wilkins

Summary

Designed to teach clinical reasoning in the context of OT intervention in adult physical disabilities, this text shows students how to synthesize knowledge and implement a holistic approach to treatment. Useful case studies help students apply frames of reference and implement situational thinking. Linking statements are used throughout the text to show readers how to connect evaluation results to treatment goals, methods, and specific activities.

Table of Contents

Preface	vii
Section I Introduction	1	(28)
Clinical Reasoning	3	(9)
Characteristics of Clinical Reasoning?	3	(1)
Decision Tree Process	4	(1)
Strategies of Experienced Clinicians	5	(1)
Frames of Reference	5	(1)
Reflection-In-Action	6	(1)
Prospective Treatment Story	7	(1)
Therapist with a Three-Track Mind	7	(1)
Professional Growth	8	(1)
Preliminary Conclusions	9	(1)
Preview	9	(3)
Decision Tree Process	12	(17)
Creating Narrative Hypotheses	12	(2)
Designing an Evaluation Package	14	(5)
Interpreting Test Results	19	(1)
Generating Treatment Goals	20	(3)
Designing Treatment Activities	23	(3)
Feedback Loop During Implementation	26	(3)
Section II Biomechanical Frame of Reference	29	(50)
Introduction to Biomechanical Frame of Reference	31	(13)
Assumptions	31	(1)
Deficits Addressed	32	(1)
Evaluation Critiqued	33	(9)
Biomechanical Postulates Regarding Change	42	(2)
Biomechanical Postulates Regarding Intervention	44	(15)
Preventing Structural Damage	44	(1)
Regaining Structural Stability	44	(1)
Initiating Endurance Training	45	(1)
Reducing Peripheral Edema	46	(1)
Maintaining Joint Range of Motion	47	(1)
Increasing Joint Range of Motion	48	(4)
Maintaining Muscle Strength	52	(1)
Increasing Muscle Strength	52	(3)
Completing Endurance Training	55	(1)
Example of a Biomechanical Postulate Regarding Intervention	56	(3)
Biomechanical Case Simulation	59	(20)
Creating the Narrative Hypothesis and an Evaluation Plan	59	(2)
Results Evaluation	61	(3)
Interpreting Test Results	64	(4)
Identifying Deficits Not Addressed by the Biomechanical Frame of Reference	68	(3)
Generating Treatment Goals	71	(3)
Designing Treatment Activities	74	(5)
Section III Neurodevelopmental Frame of Reference	79	(84)
Introduction	81	(10)
Assumptions of Neurodevelopmental Treatment	81	(5)
Deficits Addressed by Neurodevelopmental Treatment	86	(1)
Neurophysicology of Motor Control	87	(4)
Neurodevelopmental Treatment Evaluation Critiqued	91	(25)
Reflex Development	91	(1)
Automatic Reactions	92	(4)
Evaluation of Synergy	96	(1)
Muscle Tone Evaluation	97	(3)
Deficits Ignored by Formal Evaluations	100	(2)
Normal Gross Motor Trends	102	(7)
Normal Fine Motor Trends	109	(7)
Neurodevelopmental Postulates Regarding Intervention	116	(7)
Inhibition Techniques	116	(3)
Facilitation Techniques	119	(1)
Three Stages of Inhibition and Facilitation	120	(1)
Examples of NDT Postulates Regarding Intervention	121	(2)
Neurodevelopmental Postulates Regarding Change	123	(16)
Axial Control Postulates	125	(3)
Automatic Reactions Postulates	128	(2)
Limb Control Postulates	130	(4)
Situational Thinking	134	(3)
One NDT Postulate Regarding Change	137	(2)
Neurodevelopmental Treatment Case Simulation	139	(24)
Creating Narrative Hypotheses and an Evaluation Plan	139	(2)
Evaluation Results	141	(3)
Interpreting the Test Results	144	(5)
Identifying Deficits Not Addressed by NDT	149	(4)
Generating Treatment Goals	153	(3)
Designing Treatment Activities	156	(7)
Section IV Rehabilitation Frame of Reference	163	(44)
Introduction to the Rehabilitation Frame of Reference	165	(10)
Assumptions	166	(2)
Function/Dysfunction Addressed	168	(1)
Evaluation Critiqued	168	(4)
Postulates Regarding Change	172	(3)
Rehabilitation Postulates Regarding Intervention	175	(14)
Adaptive Devices	175	(3)
Upper Extremity Orthotics	178	(1)
Environmental Modifications	178	(1)
Wheelchair Modifications	179	(1)
Ambulatory Devices	179	(2)
Adapted Procedures	181	(4)
Safety Education	185	(1)
Postulates Regarding Intervention	186	(3)
Rehabilitation Case Simulation: Arthritis	189	(18)
Creating Narrative Hypotheses and an Evaluation Plan	189	(2)
Evaluation Results	191	(3)
Interpreting the Test Results	194	(6)
Generating Treatment Goals	200	(3)
Designing a Treatment Activity	203	(4)
Section V Deficits Not Addressed	207	(54)
Psychosocial Issues	209	(11)
Model of Human Occupation	209	(3)
Sexuality	212	(2)
Stress Reactions	214	(2)
Mini-Case Study	216	(4)
Perceptual-Cognitive Issues	220	(18)
Arousal and Orientation	221	(1)
Attention	222	(3)
Ruling Out Central Nervous System Deficits	225	(1)
Ocular-Motor Deficits	226	(1)
Simple Visual Perception	226	(1)
Complex Visual Perception	226	(1)
Praxis	227	(1)
Memory	228	(2)
Executive Functions	230	(2)
What's Been De-emphasized	232	(1)
Evaluation Overview	232	(6)
Sensory-Motor Issues	238	(12)
Somatosensation	239	(5)
Coordination as Smoothness	244	(1)
Coordination of Two or More Body Parts	245	(1)
Mini-Case Study	246	(4)
Homeostatic Issues	250	(11)
Respiratory System	250	(2)
Cardiovascular System	252	(1)
Immune System	253	(2)
Integumentary System	255	(1)
Metabolic System	255	(1)
Urologic System	256	(1)
Skeletal System	257	(1)
Autonomic Nervous System	257	(4)
Section VI Combining Frames of Reference	261	(12)
Case Simulation: Burns	263	(10)
Pre-Grafting Stage	263	(5)
Grafting Stage	268	(2)
Post-Grafting Stage	270	(1)
Interactive Track	271	(2)
Appendix: Test Reliability, Validity, and Sensitivity	273	(4)
Figure and Table Credits	277	(2)
Index