Guidelines To Physical Therapist Practice (APTA)

Guidelines to Physical
Therapist Practice
Expanded Academic ASAP Print
Page 1 of 2
What Is Physical Therapy?(A Guide to Physical Therapist Practice).Physical

Therapy 81.1 (Jan 2001): p21. (560 words)
Full Text:COPYRIGHT 2001 American Physical Therapy Association, Inc.
Physical therapy is a dynamic profession with an established theoretical and scientific base and
widespread clinical applications in the restoration, maintenance, and promotion of optimal physical
function. For more than 750,000 people every day in the United States, physical therapists:
* Diagnose and manage movement dysfunction and enhance physical and functional abilities.
* Restore, maintain, and promote not only optimal physical function but optimal wellness and
fitness and optimal quality, of life as it relates to movement and health.
* Prevent the onset, symptoms, and progression of impairments, functional limitations, and
disabilities that may result from diseases, disorders, conditions, or injuries.
The terms "physical therapy" and "physiotherapy," and the terms "physical therapist" and
"physiotherapist," are synonymous.
As essential participants in the health care delivery system, physical therapists assume leadership
roles in rehabilitation; in prevention, health maintenance, and programs that promote health,
wellness, and fitness; and in professional and community organizations. Physical therapists also
play important roles both in developing standards for physical therapist practice and in developing
health care policy to ensure availability, accessibility, and optimal delivery of physical therapy
services. Physical therapy is covered by federal, state, and private insurance plans. The positive
impact of physical therapists' services on health-related quality of life is well accepted.
As clinicians, physical therapists engage in an examination process that includes taking the
patient/client history, conducting a systems review, and performing tests and measures to identify
potential and existing problems. To establish diagnoses, prognoses, and plans of care, physical
therapists perform evaluations, synthesizing the examination data and determining whether the
problems to be addressed are within the scope of physical therapist practice. Based on their
judgments about diagnoses and prognoses and based on patient/client goals, physical therapists
provide interventions (the interactions and procedures used in managing and instructing
patients/clients), conduct reexaminations, modify interventions as necessary to achieve
anticipated goals and expected outcomes, and develop and implement discharge plans.
The American Physical Therapy Association (APTA), the national membership organization
representing and promoting the profession of physical therapy, believes it is critically important for
those outside the profession to understand the role of physical therapists in the health care
delivery system and the unique services that physical therapists provide. APTA is committed to
informing consumers, other health care professionals, federal and state governments, and thirdparty payers about the benefits of physical therapy--and, more specifically, about the relationship
between health status and the services that are provided by physical therapists. APTA actively
supports outcomes research and strongly endorses all efforts to develop appropriate systems to
http://find.galegroup.com/itx/printdoc.do?contentSet=IAC-Documents&docType=IAC&i... 11/21/2008
Page 2 of 2
measure the results of patient/client management that is provided by physical therapists.

The patient/client management elements of examination, evaluation, diagnosis, and prognosis
should be represented and reimbursed as physical therapy only when they are performed by a
physical therapist. Physical therapists are the only professionals who provide physical therapy
examinations, evaluations, diagnoses, prognoses, and interventions. Physical therapist assistants,
under the direction and supervision of physical therapists, are the only paraprofessionals who
assist in the provision of physical therapy interventions. Intervention should be represented and
reimbursed as physical therapy only when performed by a physical therapist or by a physical
therapist assistant under the direction and supervision of a physical therapist.
APTA recommends that federal and state government agencies and other third-party payers
require physical therapy to be provided only by physical therapists or under the direction and
supervision of physical therapists.
Named Works: A Guide to Physical Therapist Practice (Book)

Source Citation:"What Is Physical Therapy?." Physical Therapy 81.1 (Jan 2001): 21. Expanded
Academic ASAP. Gale. University of Florida. 21 Nov. 2008
<http://find.galegroup.com/itx/start.do?prodId=EAIM>.
Gale Document Number:A70453287

Disclaimer: This information is not a tool for self-diagnosis or a substitute for professional care.
2008 Gale, Cengage Learning.
Page 1 of 2
Preface to the First Edition November 1997.(Guide to Physical Therapist

Practice).Marilyn Moffat, Andrew Guccione and Jayne Snyder. Physical
All health care professions are accountable to the various publics that they serve. The American
Physical Therapy Association (APTA) has developed Guide to Physical Therapist Practice ("the
Guide") to help physical therapists analyze their patient/client management and describe the
scope of their practice. The Guide is necessary not only to daily practice but to preparation of
students. It was used as a primary resource by the Commission on Accreditation in Physical
Therapy Education (CAPTE) during its revision of evaluative criteria for physical therapist
professional education programs and is an essential companion document to The Normative
Model of Physical Therapist Professional Education, Version 97.
Specifically, the Guide is designed to help physical therapists (1) enhance quality of care, (2)
improve patient/client satisfaction, (3) promote appropriate utilization of health care services, (4)
increase efficiency and reduce unwarranted variation in the provision of services, and (5) promote
cost reduction through prevention and wellness initiatives. The Guide also provides a framework
for physical therapist clinicians and researchers as they refine outcomes data collection and
analysis and develop questions for clinical research.
Groups other than physical therapists are important users of the Guide. Health care policymakers
and administrators can use the Guide in making informed decisions about health care service
delivery. Third-party payers and managed care providers can use the Guide in making informed
decisions about reasonableness of care and appropriate reimbursement. Health care and other
professionals can use the Guide to coordinate care with physical therapist colleagues more
efficiently.
As the Guide is disseminated throughout the profession and to other groups, the process of
revision and refinement will begin. We thank our colleagues who helped us make the Guide a
reality.
Marilyn Moffat, PT, PhD, FAPTA
(APTA President, 1991-1997)
Andrew Guccione, PT, PhD
Jayne Snyder, PT, MA
APTA Board Oversight Committee
Named Works: Guide to Physical Therapist Practice (Book)

Source Citation:Moffat, Marilyn, Andrew Guccione, and Jayne Snyder. "Preface to the First Edition
November 1997." Physical Therapy 81.1 (Jan 2001): 12. Expanded Academic ASAP. Gale. University of
Florida. 21 Nov. 2008
Page 2 of 2

Page 1 of 1
Foreword to the Second Edition January 2001.(Guide to Physical Therapist Practice).Ben

F Massey Jr. Physical Therapy 81.1 (Jan 2001): p13. (264 words)
The Guide to Physical Therapist Practice ("the Guide"), Parts One and Two, has represented a
living document, with a life that has already spanned more than 8 years. The first edition of the
Guide was the result of the expertise contributed by almost 1,000 physical therapist members of
the American Physical Therapy Association. Each individual shared not only his or her knowledge
and skills, but also time, energy, and commitment to a document that has dramatically affected the
practice environment. The Guide has been used in ways and by people we never had imagined-becoming an invaluable resource to clinicians, educators, administrators, legislators, and payers
throughout the health care community.
This second edition is a testament to its evolutionary nature. In reviewing the pages of this edition,
you will know that its strengths have been shaped by its users--all of whose comments and
questions received serious consideration. Hundreds of members have worked to respond to those
suggestions and to the demands of a changing practice environment, thereby ensuring that the
Guide encompasses the full scope of current physical therapist practice. To all of them, I extend
the deep appreciation of our profession and its Association.
The Guide will continue to grow and be revised based on research evidence and on changes in
examination and intervention strategies within practice. I invite you to be a part of its life by
bringing to the Association your questions, comments, and suggestions. Our united participation in
this evolutionary process will keep the Guide at the forefront of the profession.
Ben F Massey, Jr, PT
President
American Physical Therapy Association

Source Citation:Massey, Ben F Jr. "Foreword to the Second Edition January 2001." Physical
Therapy 81.1 (Jan 2001): 13. Expanded Academic ASAP. Gale. University of Florida. 21 Nov. 2008

Page 1 of 3
On the Second Edition of the Guide.(Guide to Physical Therapist Practice).Jules M

Rothstein. Physical Therapy 81.1 (Jan 2001): p6. (1458 words)
We begin the year with something different from the Journal's usual content--the second edition of
the Guide to Physical Therapist Practice. This document was developed by APTA to encourage a
uniform approach to physical therapist practice and to explain to the world the nature of that
practice.
This document has been in development for almost a decade. (See box on page 8 for an outline
of the process used to develop the Guide; further description is given in the Guide's Introduction.)
As the document itself emphasizes, the Guide is not a set of clinical guidelines, nor is it a set of
protocols or a listing of approved tests or interventions. The Guide forms a framework for
describing and implementing practice.
The patient/client management model put forth by the Guide appears to be widely used and has
provided physical therapists with a common conceptual approach to patient care, and in this way
the Guide has proven that it could be an invaluable adjunct to our literature. The second edition
contains expanded sections on such topics as diagnosis by physical therapists and the
disablement model. As with the first edition, much of what appears in the second edition will be
helpful to physical therapists in all areas of practice. And, as with the first edition, for both practical
and philosophical reasons, preferred practice patterns are supplied for a limited number of
conditions.
If the Guide is to continue playing a salutary role in our profession, physical therapists need to
understand what this new edition is--and what it is not. As indicated in the Guide's Introduction,
the Guide initially was developed in response to requests from legislative bodies. Given the nature
of that impetus, a process was developed and used to generate the Guide. I believe that the
process was credible and resulted in an important document that has helped to shape physical
therapy as it now exists. The process was not a peer-review process such as that used by
scholarly journals, and it did not result in the development of clinical guidelines that are in line with
current expectations of evidence-based practice. That was not the Guide's purpose.
Clinical guidelines are the product of intense scrutiny of the literature, and they are developed
using methods that are applied by experts with publication records who have knowledge in
guideline development. The distinctions between clinical guidelines and the Guide were
understood by the Association's leadership and the Guide's developers and are acknowledged in
the Guide. The process used to generate both the first and second editions of the Guide resulted
in the description of what are called "preferred practice patterns for selected patient/client
diagnostic groups." Whether these patterns will give rise over time to clinical guidelines that have
a more scholarly foundation or research support is up to the profession and our clinical
researchers. But we need to keep in mind that what we now have in the Guide are the opinions of
our colleagues on how to manage our patients and clients--and that is very different from evidence
for practice.
Page 2 of 3
Both the document and the discussion that led to its creation have benefited the profession, and
all those who worked on the Guide editions deserve our appreciation. The Guide, however, is a
work in progress, and I hope that the next edition will appear soon--one that will be created not
because of political necessity but because of our need to codify a growing body of scientific
knowledge. Given APTA's Clinical Research Agenda for Physical Therapy (Phys Ther.
2000;80:499-513), it is clear that we need more data, and we should share pride in a profession
that is willing to recognize its limitations and its responsibilities.
The Guide can be viewed as an attempt to develop the best possible document from a body of
clinical literature that still contains too many unanswered questions. Too often in the development
of the Guide, personal opinions were necessary because of the paucity of data. We should look
forward to a third edition that relies less on personal views and more on the evidence that
becomes available in the public arena, evidence that deals directly with clinical practice and that
has been published in peer-reviewed literature. Again, we see the importance of the Clinical
Research Agenda and the necessity of supporting the Foundation for Physical Therapy.
There were six purposes for creating the Guide (page S16). Every reader should consider to what
extent those purposes were met and to what extent they could be met. For instance, I believe that
the process used to develop the Guide could never achieve the stated goal of "standardizing
terminology used in and related to physical therapist practice." I believe that the Guide instead
contains an official or semi-official version of how terms should be used. As a peer-reviewed
journal, therefore, Physical Therapy will continue to depend on the preponderance of scientific
literature for the evolution of terms and definitions.
The Guide was designed to "delineate" tests, interventions, and preferred practice patterns. If we
use the traditional definition of delineate, the Guide should accurately convey what the tests,
interventions, and preferred practice patterns are. In other words, the Guide should provide lists,
which it does--and I believe that is good, because the structure of the Guide does not allow for
critical evaluation of tests and interventions.
Nonetheless, value judgments are expressed when it comes to a listing of preferred practice
patterns. By listing what is preferred, the developers have made an assertion that the Guide
describes what is thought to be best. We should be reminded, however, that preferring something
is not the same as having evidence that something is better than something else. Here again we
have the basic difference between clinical guidelines and the preferred practice patterns.
Guidelines should be developed based on evidence that speaks to the benefits of a form of
intervention, whereas the preferred practice patterns are patterns that are considered by the
Guide developers to be the most commonly used or the most appropriate.
Because of the extraordinary effort of many people, the Journal this month is publishing
something that can greatly enhance practice--when it is properly used. If the Guide is viewed as
containing immutable truths, however, we will be using it incorrectly. My hope is that the next
edition of the Guide will be based primarily on evidence--and that physical therapists will use that
evidence.
Guide to Physical Therapist Practice, Second Edition
In the August 1995 issue of Physical Therapy, the American Physical Therapy Association (APFA)
published A Guide to Physical Therapist Practice, Volume I: A Description of Patient
Management. Development continued with the addition of Volume II to delineate preferred
practice patterns. Volumes I and II were combined to become Parts One and Two of a single
document--Guide to Physical Therapist Practice--which was published in the Journal in November
Page 3 of 3
1997. Revisions were made to the Guide based on input from both the general membership and
the leadership of APTA and based on changes in APTA House of Delegates policies. These
revisions were published in the June 1999 and November 1999 issues of Physical Therapy.
Throughout 1999 and 2000, a Board-appointed Project Advisory Group revised Parts One and
Two of the Guide to further refine and clarify terminology and definitions used in the Guide. The
result--the second edition of the Guide (Parts One and Two)--is being published in this issue of the
Journal.
In 1998, APTA began development of Part Three of the Guide to catalog the tests and measures
that are used by physical therapists in the examination of patients/clients and in the
documentation of patient/client management outcomes. (This part of the Guide, intended as a
reference work, will be available on CD-ROM only.) One task force was charged by APTA's Board
to examine the available literature pertaining to tests and measures that are used in the
assessment of the cardiovascular/pulmonary, integumentary, musculoskeletal, and neuromuscular
systems. Another task force was charged to examine the available literature on tests and
measures of health status, health-related quality of life, and patient/client satisfaction. Field
reviews were conducted, using APTA's Board, all APTA components (sections and state
chapters), a sample of clinical specialists certified by the American Board of Physical Therapy
Specialties (ABPTS), and APTA's general membership. Presentations of the work-in-progress
were made at APTA Annual Conferences and APTA Combined Sections Meetings throughout
1999 and 2000.
The Part Three task forces also developed a template for documenting the history and systems
review components of examination and for documenting intervention, based on the essential data
elements of patient/client management described in the Guide. The template (Appendix 6 of the
Guide) were reviewed by all APTA components (sections and state chapters), a sample of
certified clinical specialists, and APTA's general membership.
Jules M Rothstein, PT, PhD, FAPTA Editor

Source Citation:Rothstein, Jules M. "On the Second Edition of the Guide." Physical Therapy 81.1 (Jan
2001): 6. Expanded Academic ASAP. Gale. University of Florida. 21 Nov. 2008

Page 1 of 13
Guide to Physical Therapist Practice: Revisions.Physical Therapy 79.6 (June

1999): p623. (3424 words)
In November 1997, Physical Therapy published APTA's Guide to Physical Therapist Practice (Guide). As
explained in its introduction, the Guide "represents expert consensus and contains preferred practice
patterns describing common sets of management strategies used by physical therapists for selected
patient/client diagnostic groups." The Guide is an evolving document. In April 1999, APTA published a
revised edition that contains ICD-9-CM code corrections and clarifications of terms. Parts Three and Four
of the Guide, scheduled for publication in 2000, will focus on a minimum data set for physical therapist
examination and on the reliability and validity of measurements obtained using specific tests and
measures.
The following pages list revisions that have been made to the Guide since 1997. PDF versions of some of
the revised Guide pages are available at APTA's Web site (http://www.apta.org). For more information
about the Guide, contact APTA's Department of Practice at 800/999-2782, ext 3176, or write to GUIDE,
Division of Practice and Research, d, 1111 North Fairfax Street, Alexandria, VA 22314-1488. The revised
Guide is available through APTA's Service Center, ext 3395 or via e-mail at svcctr@apta.org.
If you use the version of the Guide that was published in the November 1997 issue of Physical Therapy or
the book version of the Guide that was published in 1997, please note the following changes (in shaded
text):
Musculoskeletal Practice Patterns
Pattern E: Impaired Joint Mobility Muscle Performance, and Range of Motion Associated With Ligament
or Other Connective Tissue Disorders
Page 4E-2
ICD-9-CM code 729 was incorrectly worded. It has been
changed to:
729
Other disorders of soft tissues
729.9
Other and unspecified disorders
of soft tissue
Imbalance of posture
Pattern F: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated
With Localized Inflammation
Page 4F-2
ICD-9-Cm code 726.6 was incomplete. It has been
change to:
726.6
Enthesopathy of knee
Bursitis of knee, not otherwise specific
726.60
Page 2 of 13
Enthesopathy of knee, unspecified
Pattern G: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, or Reflex
Integrity Secondary to Spinal Disorders
Page 4G-2
ICD-9-CM codes 723.0 and 724.0 were incorrectly
worded. They have been changed to:
723.0
Spinal stenosis in cervical region
424.0
Spinal stenosis, other than cervical
Pattern H: Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated With Fracture
Page 4H-2
ICD-9-CM codes 715 and 821 were incorrectly worded.
They have been changed to:
715
Osteoarthrosis and allied disorders
821
Fracture of other and unspecified parts of
femur
Cardiopulmonary Practice Patterns
Pattern C: Impaired Ventilation, Respiration (Gas Exchange), and Aerobic Capacity Associated With
Airway Clearance Dysfunction
Page 6C-2
ICD-9-CM code 507.0 was incorrectly identified as
507.7 and has been changed to:
507.0
Due to inhalation of food or vomitus
Aspiration pneumonia
Pattern G: Impaired Ventilation With Mechanical Ventilation Secondary to Ventilatory Pump Dysfunction
Page 6G-2
ICD-9-CM codes 518 and 786.9 were incorrectly worded.
They have been changed to:
518
786.9
Other diseases of lung

518.8 Other diseases of lung
Other symptoms involving respiratory
system and chest
Pattern H: Impaired Ventilation and respiration (Gas Exchange) With Potential for Respiratory Failure
Page 6H-2
ICD-9-CM procedures code 54 was incorrectly worded.
It has been changed to:
54
Other operations on abdominal region
Pattern I: Impaired Ventilation and Respiration (Gas Exchange) With Mechanical Ventilation Secondary to
Respiratory Failure
Page 3 of 13
Page 6I-2
ICD-9-CM code 507.0 was incorrectly identified as 507
and has been changed to:
507.0
Due to inhalation of food or vomitus
Aspiration pneumonia
Integumentary Practice Patterns
Pattern A: Primary Prevention/Risk Factor Reduction for Integumentary Disorders
Page 7A-3
Added to the ICD-9-CM codes:
995
Certain adverse effects not elsewhere
classified
Pattern C: Impaired Integumentary Integrity Secondary to Partial-Thickness Skin Involvement and Scar
Formation
Page 7C-3
ICD-9-CM code 943.2 was incorrectly worded. It has
been changed to:
943.2
Blisters, epidermal loss[ second degree]
Appendix
Page Appendix 2-1 APTA's Standards of Practice for Physical Theraphy and the Criteria was updated to
the version approved by the APTA Board of Directors in March 1997, which can be found in the January
1999 issue of the Journal.
Numerical Index to ICD-9-CM Codes
[Pneumonitis] Due to inhalation of food or vomitus was incorrectly identified as ICD-9-CM code 507 it has
been changed to 507.0.
ICD-9-Cm code 719.8 Other specified disorders of joint is now listed as appearing in the following
patterns only: 4A, 4D, 4G, 4H, 4I.
Alphabetical Index to ICD-9-CM Codes
Atherosclerosis (440) is now listed as appearing in the following patterns only: 6D, 6E, 7A, 7E.
Burn of lower limb(s) (945) is now listed as appearing in the following patterns only: 6G, 7B, 7C, 7D
The following codes have been deleted from Burn of lower limb(s) (945):
Deep necrosis of uynderlying tissues [deep third degree] with loss of a
body part (945.2)
Deep necrosis of underlying tissues [deep third degree] without mention of
loss of a body (945.4)
Page 4 of 13
Chronic airway obstruction, not elsewhere classified has been deleted.

Complications of procedures, not elsewhere classified, other (998) is now listed as appearing in patterns
4D and (not 7F).
[Pneumonitis] Due to inhalation of food or vomitus was incorrectly identified as ICD-9-CM code 507.1 and
has been corrected to 507.0.
Pulmonary embolism and infarction (415.1) is now listed as appearing in pattern 61 (not 6E).
Rheumatoid arthritis and other inflammatory polyarthropathies (714) is now listed as appearing in the
following patterns only: 4A, 4C, 4D, 41, 6B.
If you use the Guide that was published in the November 1997 issue of Physical Therapy, the book
version of the Guide that was published in 1997, the second printing (1998) of the Guide, or CD-ROM
version 1998 of the Guide, please note the following changes (in shaded text):
Some Important Global Changes
"Represented and Reimbursed as Physical Therapy"
In Part One of the Guide, the statement intended specifically for payers ("an examination, evaluation, or
intervention-unless performed by a physical therapist or under the direction and supervision of a physical
therapist--is not physical therapy, nor should it be represented or reimbursed as such") was clarified and
expanded:
Examination, evaluation, diagnosis, and prognosis are physical therapy--and
should be represented and reimbursed as physical therapy--only when they
are performed by a physical therapist. Intervention is physical
therapy--and should be represented and reimbursed as physical therapy--only
when performed by a physical therapist or under the direction, delegation,
and supervision of a physical therapist.
From "Desired Outcomes" to "Expected Outcomes"
To emphasize that outcomes of patient/client management can and should be expected in a profession
that is based in science, desired outcomes has been changed to expected outcomes.
Discharge
The definition of discharge has has been clarified:
Discharged occurs at the end of an episode of care and is the end of
physical therapy services that have been provided during that episode. The
primary criterion for discharge: The anticipated goals and the expected
outcomes have been achieved. In consultation with appropriate individuals,
the physical therapist plans for discharge and provides for appropriate
follow-up or referral. Discharge does not occur with transfer, that is,
when a patient is moved from one site to another site within the same
setting or across settings during a single episode of care; however, ther
may be facility-specific or payer-specific requirements for documentation
regarding the conclusion of physical therapy services as the patient moves
between sites or across settings during that episode of care ...
Page 5 of 13
A new term, discontinuation of physical therapy services, has been added:

Discontinuation of physical therapy services occurs when (1) the
patient/client, caregiver, or legal guardian declines to continue
intervention, (2) the patient/client is unable to continue to progress
toward goals because of medical or psychosocial complications or because
financial/insurance resources have been expended, or (3) the physical
therapist determines that the patient/client will no longer benefit from
physical therapy....
Tumor versus Neoplasm
Based on preferred usage in the current health care literature, neoplasm has replaced tumor in most
instances.
Other New or Revised Definitions
Airway Clearance Techniques
The definition of airway clearance techniques has been clarified to include:
a broad group of activities used to manage or prevent consequences of acute
and chronic lung diseases and impairment, including those associated with
surgery. impaired mucociliary transport or impaired cough. Airway clearance
techniques may be used with therapeutic exercise, manual therapy
techniques, or mechanical modalities to improve airway protection,
ventilation, and respiration.
Episode of Care
The definition of episode of care has been expanded:
All patient/client management activities provided, directed, or supervised
by the physical therapist, from initial contact through discharge. Episode
of physical therapy care: Physical therapy services provided in an unbroken
sequence and related to physical therapist intervention for a given
condition or problem or related to a request from the patient/client,
family, or other health care provider. May include transfers between sites
within or across settings or reclassification of the patient/client
diagnostic group. Reclassification may alter the expected range of number
of visits and therefore may shorten or lengthen the episode of care. If
reclassification involves a condition, problem, or request that is not
related to the initial episode of care. a new episode of care may be
initiated. Episode of physical therapy maintenance: A series of occasional
clinical, educational, and administrative services related to maintenance
of current function. Episode of physical therapy prevention: A series of
occasional clinical, educational, and administrative services related to
primary and secondary prevention, wellness, health promotion, and
preservation of optimal function.
Manual Therapy Techniques, Manipulation, and Mobilization
The definitions of manual therapy techniques, manipulation, and mobilization have been clarified:
Manipulation
Page 6 of 13
A skilled passive hand movement that usually is performed with a small

amplitude at a high velocity at the end of the available range of motion.
Manual Therapy Techniques
A broad group of skilled hand movements, including but not limited to
mobilization and manipulation, used by the physical therapist to mobilize
or manipulate soft tissues and joints for the purpose of modulating pain;
increasing range of motion; reducing or eliminating soil tissue swelling,
inflammation, or restriction; inducing relaxation; improving contractile
and noncontractile tissue extensibility; and improving pulmonary function.
Mobilization
A skilled passive hand movement at the end of the available range of motion
that can be performed with variable speeds. Manipulation is one type of
mobilization.
Physical Therapist Assistant
To be consistent with APTA policy (Direction, Delegation and Supervision in Physical Therapy Services,
HOD 06-96-30-42), the definition has been changed:
The physical therapist assistant is a technically educated health care
provider who assists the physical therapist in the provision of physical
therapy. The physical therapist assistant is a graduate of a physical
therapist assistant associate degree program accredited by the Commission
on Accreditation in Physical Therapy Education (CAPTE).
Visit
The following definition has been added:
All encounters with a patient/client in a 24-hour period are summed as "one
visit." Range of visits: All visits within a single episode of care. The
range may be adjusted based on factors that may require a new episode of
care or that may modify frequency of and duration of episode.
The following items were defined within the Guide but were not included in the original Glossary. They
have been added to the Glossary as an aid to payers:
Goals
Goals generally relate to the remediation (to the extent possible) of
impairments.
Respiration
Primarily, the exchange of oxygen and carbon dioxide across a membrane into
and out of the lungs and at the cellular level.
Ventilation
The movement of a volume of gas into and out of the lungs.
Musculoskeletal Practice Patterns
Page 7 of 13
Pattern 4C: Impaired Muscle Performance

Page 4C-1
Upper and lower motor neuron disease has been deleted from the patient/client diagnostic group
exclusions.
Page 4C-2
Deleted from the ICD-9-CM codes:
781.0
Abnormal involuntary movements
Pattern 4G: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, or Reflex
Integrity Secondary to Spinal Disorders
Page 4G-2
724.3
Sciatica
Neuromuscular Practice Patterns
Pattern 5A: Impaired Motor Function and Sensory Integrity Associated With Congenital or Acquired
Disorders of the Central Nervous System in Infancy, Childhood, and Adolescence
Page 5A-1
Nonprogressive neoplasm has been added to the list of patient/client diagnostic group inclusions.
Progressive neoplasm has been added to the list of exclusions.
Page 5A-2
Deleted from
331
Other
331.3
331.4
the ICD-9-CM codes:

cerebral degenerations
Communicating hydrocephalus
Obstructive hydrocephalus

742.3 Congenital hydrocephalus
Pattern B: Impaired Motor Function and Sensory Integrity Associated With Acquired Nonprogressive
Disorders of the Central Nervous System in Adulthood
Page 5B-1
Nonprogressive neoplasm and central vestibular disorders have been added to the list of patient/client
diagnostic group inclusions. Progressive neoplasm has been added to the list of exclusions.
Page 5B-2
Several ICD-9-CM codes have been added:
Page 8 of 13
049 Other non-arthropod-borne viral diseases of the

central nervous system
049.9
Unspecified non-arthropod-borne viral
diseases of the central nervous system
Viral encephalitis, not otherwise specified
225 Benign neoplasm of brain and other parts of nervous
system
320 Bacterial meningitis
system
320.9
Meningitis due to unspecified bacterium
321 Meningitis due to other organisms
321.8
Meningititis due to other nonbacterial
organisms classified elsewhere
322 Meningitis of unspecified cause
322.9
Meningitis, unspecified
323 Encephalitis, myelitis, and encephalomyelitis
323.4
Other encephalitis due to intection classified
elsewhere
323.5
Encephalitis following immunization
procedures
323.6
Postintectious encephalitis
323.8
Other causes of encephalitis
323.9
Unspecified cause of encephalitis
331 Other cerebral degenerations
331.3
331.4
342 Hemiplegia and hemiparesis
343 Infantile cerebral palsy
345 Epilepsy
345.1
Generalized convulsive epilepsy
345.2
Petit mal status
345.3
Grand mal status
345.4
Partial epilepsy, with impairment of
consciousness
Epilepsy: partial: secondarily generalized
345.5
Partial epilepsy, without mention of
impairment of consciousness
Epilepsy: sensory-induced
345.9
Epilepsy, unspecified
348 Other conditions of brain
348.0
Cerebral cysts
348.1
Anoxic brain damage
348.3
Encephalopathy, unspecified
386 Vertiginous syndromes and other disorders of
vestibular system
386.5
Labyrinthine dystunction
431 Intracerebral hemorrhage
433 Occlusion and stenosis of precerebral arteries
434 Occlusion of cerebral arteries
435 Transient cerebral ischemia
435.1
Vertebral artery syndrome
435.8
Other specified transient cerebral ischemias
436 Acute, but ill-defined, cerebrovascular disease
437 Other and ill-defined cerebrovascular disease
442 Other aneurysm
442.8
Of other specified artery
444 Arterial embolism and thrombosis
444.9
Of unspecified artery
447 Other disorders of arteries and arterioles
Page 9 of 13
447.1
Stricture of artery
741 Spina bifida
742 Other congenital anomalies of nervous system
747 Other congenital anomalies of circulatory system
747.8
Other specified anomalies of circulatory
system
756 Other congenital musculoskeletal anomalies
756.1
Anomalies of spine
765 Discorders relating to short gestation and unspecified
low birthweight
767 Birth trauma
767.0
Subdural and cerebral hemorrhage
767.9
Birth trauma unspecified
768 Intrauterine hypoxia and birth asphyxia
768.5
Severe birth asphyxia
768.6
Mild or moderate birth asphyxia
768.9
Unspecified birth asphyxia in liveborn infant
771 Infections specific to the perinatal period
771.2
Other congenital infections
Congenital toxoplasmosis
780 General symptoms
780.3
Convulsions
781 Symptoms involving nervous and musculoskeletalsystems
781.2
Abnormality of gait
Gait: ataxic
781.3
Lack of coordination
Ataxia, not otherwise specified
799 Other ill-defined and unknown causes of morbidity
and mortality
799.0
Asphyxia
800 Fracture of vault of skull
801 Fracture of base of skull
803 Other and unqualified skull fractures
804 Multiple fractures involving skull or face with other bones
850 Consussion
851 Cerebral laceration and contusion
852 Subarachnoid, subdural, and extradural hemorrhage
following injury
853 Other and unspecified intracranial hemorrhagefollowing injury
854 Intracranial injury of other and unspecified nature
994 Effects of other external causes
994.1
Drowning and nonfatal submersion
Pattern 5C: Impaired Motor Function and Sensory Integrity Associated With Progressive Disorders of the
Central Nervous System in Adulthood
Page 5C- 1
Malignant brain tumor has been deleted from the list of patient/client diagnostic group inclusions.
Progressive neoplasm has been added to the list of exclusions.
Page 5C-2
042 Human immunodeficiency virus (HIV) disease
191 Malignant neoplasm of brain
Page 10 of 13
192 Malignant neoplasm of other and unspecified parts

of nervous system
237 Neoplasm of uncertain behavior of endocrine glands
and nervous system
237.5
Brain and spinal cord
331 Other cerebral degenerations
331.0
Alzheimer's disease
331.3
331.4
332 Parkinson's disease
333 Other extrapyramidal disease and abnormal movement
disorders
333.0
Other degenerative diseases of the basal
ganglia
333.3
Tics of organic origin
333.4
Huntington's chorea
333.9
Other and unspecified extrapyramidal
disease and abdominal movement disorders
334 Spinocerebellar disease
334.2
Primary cerebellar degeneration
334.3
Other cerebellar ataxia
334.8
Other spinocerebellar diseases
335 Anterior horn cell disease
335.2
Motor neuron disease
335.20 Amyotrophic lateral sclerosis
340 Multiple sclerosis
341 Other demyelinating diseases of central nervous system
341.8
Other demyelinating diseases of central
nervous system
Central demyelination of corpus callosum
341.9
Demyelinating disease of central nervous
system, unspecified
345 Epilepsy
345.4
Partial epilepsy, with impairment of
consciousness
Epilepsy: partial: secondarily generalized
345.5
Partial epilepsy, without mention of
impairment of consciousness
Epilepsy: sensory-induced
348 Other conditions of brain
348.9
Unspecified condition of brain
780 General symptoms
780.3
Convulsions
781 Symptoms involving nervous and musculoskeletal
systems
781.2
Abnormality of gait
Gait: ataxic
781.3
Lack of coordination
Ataxia, not otherwise specified
Pattern 5D: Impaired Motor Function and Sensory Integrity Associated With Peripheral Nerve Injury
Page 5D-1
Peripheral vestibular disorders (eg, labyrinthitis, parozysmal positional vertigo) has been added to the list
of patient/client diagnostic group inclusions.
Page 5D-2
Page 11 of 13

225 Benign neoplasm of brain and other parts of nervous
system
225.1
Cranial nerves
350 Trigeminal nerve disorders
350.1
Trigeminal neuralgia
352 Disorders of other cranial nerves
352.4
Disorders of accessory (11 th) nerve
352.5
Disorders of hypoglossal (12th) nerve
352.9
Unspecified disorder of cranial nerves
353 Nerve root and plexus disorders
353.0
Brachial plexus lesions
353.1
Lumbosacral plexus lesions
353.6
Phantom limb (syndrome)
354 Mononeuritis of upper limb and mononeuritis multiplex
354.2
Lesion of ulnar nerve
354.3
Lesion of radial nerve
355 Mononeuritis of lower limb and unspecified site
357 Inflammatory and toxic neuropathy
357.1
Polyneuropathy in collagen vascular disease
386 Vertiginous syndromes and other disorders of the
vestibular system
386.0
Meniere's disease
386.03 Active Meniere's disease, vestibular
386.1
Other and unspecified peripheral vertigo
386.3
Labyrinthitis
Pattern 5E: Impaired Motor Function and Sensory Integrity Associated With Acute or Chronic
Polyneuropathies
Page 5E-2
357.0
Acute infective polyneuritis
(Guillain-Barre syndrome)
Pattern 5F: Impaired Motor Function and Sensory Integrity Associated With Nonprogressive Disorders of
the Spinal Cord
Page 5F-2
192
198
Malignant neoplasm of other and

unspecified parts of nervous system
192.2
Spinal cord
Cauda eguina
Secondary malignant neoplasm of other
specified sites
198.3 Brain and spinal cord
Cardiopulmonary Practice Patterns

Pattern 6H: Impaired Ventilation and Respiration (Gas Exchange) With Potential for Respiratory Failure
Page 6H-2
Page 12 of 13

770
Other respiratory conditions of fetus and

newborn
770.7
Chronic respiratory disease arising
in the perinatal period
Bronchopulmonary dysplasia
Pattern 6I: Impaired Ventilation and Respiration (Gas Exchange) With Mechanical Ventilation Secondary
to Respiratory Failure
Page 6I-1
Immediate posttransplant (heart of lung or both), multisystem trauma, and sepsis have been added to the
list of patient/client diagnostic group inclusions.
Page 6I-2
770
Other respiratory conditions of fetus and

newborn
770.4
Primary atelactasis
770.7
Chronic respiratory diseases arising
in the perinatal period
Integumentary Practice Patterns Pattern 7A: Primary Prevention/Risk Factor Reduction for Integumentary
Disorders
Page 7A-1
Break in skin integrity has been added to the list of patient/client diagnostic group exclusions.
Page 7A-6
Total body surface area (TBSA) of burn has been deleted from the list of "Factors That May Modify
Frequency of Visits."
Pattern B: Impaired Integumentary Integrity Secondary to Superficial Skin Involvement
Page 7B-1
Any break in skin integrity has been deleted from the list of patient/client diagnostic group exclusions.
Pattern 7E: Impaired Integumentary Integrity Secondary to Skin Involvement Extending Into Fascia,
Muscle, or Bone
Page 7E-1
The title of this pattern has been corrected to "Impaired Integumentary Integrity Secondary to Skin
Involvement Extending Into Fascia, Muscle, or Bone ans Scar Formation."
Page 13 of 13
Page 7F: Impaired Anthropometric Dimensions Secondary to Lymphatic System Disorders

Page 7F-8
Under "specific direct interventions for "Physical Agents and Mechanical Modalities," the following items
have been deleted:
Compression therapies (eg, all compression devices, compression bandaging, compression garments)
Continuous passive motion (CPM)
Appendixes
Guidelines for Physical Therapy Documentation has been updated to the version approved by APTA's
Board of Directors in November 1998. Guide for Professional Conduct has been updated to the version
approved by APTA's Ethics and Judicial Committee in January 1999. These updated versions can be
obtained through APTA's Service Center, 800/999-2782, ext 3395, or svcctr@apta.org.
Numerical and Alphebetical Indexes to ICD-9-CM Codes
All of the above changes have been reflected in the Indexes. In addition, the following corrections have
been made:
Enthesopathy of knee, unspesified 726.60.... 4F has been added.
Viral encephalitis is listed under Infectious and parasitic diseases, other and unspecified.
Named Works: Guide to Physical Therapist Practice (Book) Analysis

Source Citation:"Guide to Physical Therapist Practice: Revisions." Physical Therapy 79.6 (June

Page 1 of 5
How and Why Was the Guide Developed?(A Guide to Physical Therapist
Practice).Physical Therapy 81.1 (Jan 2001): p23. (1665 words)
During the early 1990s, state legislative bodies began to request that health care professionals
develop practice parameters. In February 1992, at the request of one of the American Physical
Therapy Association's (APTA) state components, APTA's Board of Directors embarked on a
process to determine whether practice parameters could be delineated for the profession of
physical therapy. The Board initiated development of a document that would describe physical
therapist practice-content and processes--both for members of the physical therapy profession
and for health care policy makers and third-party payers.
The initial foundation for the document was laid by the Board-appointed Task Force on Practice
Parameters, whose work led to the appointment of the Task Force to Review Practice Parameters
and Taxonomy. The deliberations of these task forces and the materials that they produced
resulted in the Board's development of A Guide to Physical Therapist Practice, Volume I: A
Description of Patient Management ("Volume I").[1] This document was approved in March 1995
by the Board. In June 1995, APTA's House of Delegates approved the conceptual framework on
which Volume I was based and endorsed the Board's plan to develop Volume II using a process
of expert consensus. Volume I was published in the August 1995 issue of Physical Therapy.
Volume II was to be "composed of descriptions of preferred physical therapist practice for patient
groupings defined by common physical therapist management:" [Report to the 1997 House of
Delegates, Processes to Describe Physical Therapy Care for Specific Patient Conditions, RC 3295]
A Board-appointed Project Advisory Group and a Board Oversight Committee were charged to
lead the Volume II project. The members of the Project Advisory Group were chosen on the basis
of the following criteria:
* Broad knowledge of physical therapy
* Understanding of clinical policy development
* Familiarity with research in physical therapy
* Recognized decision-making abilities
In June 1995, the Project Advisory Group and the Board Oversight Committee met to refine the
project design. That September, the Committee selected 24 physical therapists to serve on one: of
four panels: cardiopulmonary, integumentary, musculoskeletal, and neuromuscular. Each Project
Advisory Group member was assigned as a liaison to one of the panels. Criteria for selection of
panel members included the following:
* Experience in the subject area
Page 2 of 5
* Knowledge of physical therapy literature

* Understanding of research and the use of data
* Expertise in documentation
* Experience in peer review
* Knowledge of broad areas of physical therapy
* Recognized ability to work with groups and reach a consensus
* Openness to a variety of treatment philosophies
* Willingness to commit to the entire project
Consideration also was given to creating panels whose collective clinical experience would
represent a wide range of patient/client age groups and practice settings.
Between October 1995 and September 1996, the panels developed preferred practice patterns
that were subsequently reviewed by more than 200 select reviewers. In addition, each pattern was
reviewed by APTA's Risk Management Committee, by physical therapists with reimbursement
expertise, by APTA's Reimbursement Department, and by APTA's legal counsel. In December
1996, revised drafts of the patterns were sent for broad-based review to more than 600 reviewers,
to APTA chapter and section presidents, to APTA members with risk management and
reimbursement expertise, and to other select reviewers. Input from the general membership was
obtained during open forums at APTA Annual Conferences and APTA Combined Sections
Meetings throughout 1996 and 1997.
In early 1997, Volume I and Volume II became Part One and Part Two of a single document ("the
Guide"). Revisions were made to Part One to reflect Part Two. In March 1997, the Board of
Directors approved the draft of Part Two; in June 1997, the House of Delegates approved the
conceptual framework on which Part Two is based. The first edition of the Guide was published in
the November 1997 issue of Physical Therapy.[2]
In 1998 and 1999, revisions were made to the Guide based on (1) input from both the general
membership and the leadership of APTA and (2) changes in House of Delegates policies. These
revisions were published in Physical Therapy.[3,4] During this period, the Association developed
forms (Appendix 6) to be used in clinical practice (both inpatient and outpatient settings) for
documenting the five elements of patient/client management that are described in the Guide:
examination, evaluation, diagnosis, prognosis (including plan of care), and interventions. In
addition, a patient/client satisfaction assessment was developed for inclusion in the Guide
(Appendix 7).[5]
In 1998, APTA began development of Part Three of the Guide to catalog the armamentarium of
tests and measures that are used by physical therapists in the examination of patients/clients and
in the documentation of patient/client management outcomes. (This part of the Guide, intended as
a reference work, is available on CD-ROM only.) One task force was charged by APTA's Board to
examine the available literature pertaining to tests and measures that are used in the assessment
of the cardiovascular/pulmonary, integumentary, musculoskeletal, and neuromuscular systems.
Another task force was charged to retrieve and review the available literature on tests and
measures of health status, health-related quality of life, and patient/client satisfaction.
Page 3 of 5
The two task forces met throughout 1999 and 2000 to search the peer-reviewed literature and
develop a comprehensive list of tests and measures that are used in physical therapist practice.
Field reviews were conducted, using APTA's Board, all APTA components (sections and state
chapters), a sample of clinical specialists certified by the American Board of Physical Therapy
Specialties (ABPTS), and APTA's general membership. Presentations of the work-in-progress
were made at APTA Annual Conferences and APTA Combined Sections Meetings throughout
1999 and 2000.
To complete their charge to catalog the armamentarium of tests and measures that are used in
physical therapist practice, the two task forces refined the template for documenting the history
and systems review components of examination and for documenting intervention, based on the
essential data elements of patient/client management described in the Guide. The template
(Appendix 6) was reviewed by all APTA components (sections and state chapters), a sample of
clinical specialists certified by ABPTS, and APTA's general membership.
Also throughout 1999 and 2000, Board-appointed Project Editors revised Part One and Part Two
of the Guide to reflect input from the general membership, the Task Force on Development of Part
Three of the Guide to Physical Therapist Practice (Second Edition), and the leadership of APTA
and to refine and clarify terminology and definitions used in the Guide.
Purposes of the Guide
APTA developed the Guide to Physical Therapist Practice as a resource not only for physical
therapist clinicians, educators, researchers, and students, but for health care policy makers,
administrators, managed care providers, third-party payers, and other professionals.
The Guide serves the following purposes:
1. To describe physical therapist practice in general, using the disablement model as the basis.
2. To describe the roles of physical therapists in primary, secondary, and tertiary care; in
prevention; and in the promotion of health, wellness, and fitness.
3. To describe the settings in which physical therapists practice.
4. To standardize terminology used in and related to physical therapist practice.
5. To delineate the tests and measures and the interventions that are used in physical therapist
practice.
6. To delineate preferred practice patterns that will help physical therapists (a) improve quality of
care, (b) enhance the positive outcomes of physical therapy services, (c) enhance patient/client
satisfaction, (d) promote appropriate utilization of health care services, (e) increase efficiency and
reduce unwarranted variation in the provision of services, and (f) diminish the economic burden of
disablement through prevention and the promotion of health, wellness, and fitness initiatives.
The Guide does not provide specific protocols for treatments, nor are the practice patterns
contained in the Guide intended to serve as clinical guidelines. Clinical guidelines usually are
based on a comprehensive search and systematic evaluation of peer-reviewed literature. The
Institute of Medicine has defined clinical guidelines as "systematically developed statements to
assist practitioner and patient decisions about appropriate health care for specific clinical
circumstances [emphasis added]."[6,7] The Guide was developed using expert consensus to
Page 4 of 5
identify common features of patient/client management for selected patient/client diagnostic

groups. The Guide is a first step toward the development of clinical guidelines in that it provides
patient/client diagnostic classifications and identities the array of current options for care.
The preferred practice patterns identify the breadth of physical therapist practice. They are the
boundaries within which the physical therapist may select and implement any of a number of
clinical alternatives based on consideration of a wide variety of factors, including individual
patient/client needs; the profession's code of ethics and standards of practice; and patient/client
age, culture, gender roles, race, sex, sexual orientation, and socioeconomic status. The Guide is
not intended to set forth the standard of care for which a physical therapist may be legally
responsible in any specific case.
Future Development of the Guide
The Guide to Physical Therapist Practice is an evolving document that will be systematically
revised as the physical therapy profession's knowledge base, scientific literature, and outcomes
research develop and as examination and intervention strategies change. The Guide is the
structure on which scientific evidence will be fastened, and, in turn, the evidence will reshape the
structure.
Notification of revisions will be published annually in Physical Therapy and will be posted on
APTA's Web site (www.apta.org).
[TABULAR DATA NOT REPRODUCIBLE IN ASCII]
References
[1] A Guide to Physical Therapist Practice, Volume I: A Description of Patient Management. Plays
Ther. 1995;75:707-764.
[2] Guide to Physical Therapist Practice. Phys Ther. 1997;77:1163-1650.
[3] Guide to Physical Therapist Practice. Revisions. Phys Ther. 1999;623-629.
[4] Guide to Physical Therapist Practice. Revisions. Phys Ther. 1999;1078-1081.
[5] Goldstein MS, Elliott SD, Guccione AA. The development of an instrument to measure
satisfaction with physical therapy. Phys Ther. 2000;80:853-863.
[6] Field M, Lohr K, eds. Clinical Practice Guidelines: Directions for a New Program. Washington,
DC: Institute of Medicine, National Academy Press; 1990.
[7] Field M, Lohr K, eds. Guidelines for Clinical Practice: From Development to Use. Washington,
DC: Institute of Medicine, National Academy Press; 1992.

Source Citation:"How and Why Was the Guide Developed?." Physical Therapy 81.1 (Jan
Page 5 of 5

Page 1 of 9
On What Concepts Is the Guide Based?(A Guide to Physical Therapist Practice).Physical

Three key concepts serve as the building blocks of the Guide and as the foundation of physical
therapist practice:
* The disablement model typifies physical therapist practice and is the model for understanding
and organizing practice.
* Physical therapist practice addresses the needs of both patients and clients through a continuum
of service across all delivery settings--in critical and intensive care units, outpatient clinics, longterm care facilities, school systems, and the workplace--by identifying health improvement
opportunities, providing interventions for existing and emerging problems, preventing or reducing
the risk of additional complications, and promoting wellness and fitness to enhance human
performance as it relates to movement and health. Patients are recipients of physical therapist
examination, evaluation, diagnosis, prognosis, and intervention and have a disease, disorder,
condition, impairment, functional limitation, or disability; clients engage the services of a physical
therapist and can benefit from the physical therapist's consultation, interventions, professional
advice, prevention services, or services promoting health, wellness, and fitness.
* Physical therapist practice includes the five essential elements of patient/client management
(examination; evaluation; diagnosis; prognosis, including the plan of care; and intervention), which
incorporate the principles of the disablement model.
The Disablement Model
The concept of disablement refers to the "various impact(s) of chronic and acute conditions on the
functioning of specific body systems, on basic human performance, and on people's functioning in
necessary, usual, expected, and personally desired roles in society."[1,2] Thus, the disablement
model is used to delineate the consequences of disease and injury both at the level of the person
and at the level of society. The disablement model provides the conceptual basis for all elements
of patient/client management that are provided by physical therapists. The Guide uses an
expanded disablement model[3,4] that provides both the theoretical framework for understanding
physical therapist practice and the classification scheme by which physical therapists make
diagnoses.
A number of disablement models have emerged during the past 3 decades; three models are
shown in Figure 1. All of the disablement models attempt to better delineate the interrelationships
among disease, impairments, functional limitations, disabilities, handicaps, and the "effects of the
interaction of the person with the environment,"[5] though the effects themselves may be defined
differently from model to model.
Nagi, a sociologist, was among the first to begin to challenge the appropriateness of the traditional
medical classification of disease for understanding the genesis of disability. He put forth a
Page 2 of 9
theoretical formulation based on the concepts of disease or active pathology, impairment,

functional limitation, and disability? Based on Nagi's model, active pathology is the interruption of
or interference with normal processes and the simultaneous efforts of the organism to restore
itself to a normal state by mobilizing the body's defense and coping mechanisms; impairment is
any loss or abnormality of anatomical, physiological, mental, or psychological structure or function;
functional limitation is the restriction of the ability to perform a physical action, task, or activity in
an efficient, typically expected, or competent manner at the level of the whole organism or person;
and disability is the inability to perform or a limitation in the performance of actions, tasks, and
activities usually expected in specific social roles that are customary for the individual or expected
for the person's status or role in a specific sociocultural context and physical environment.
In 1980, the World Health Organization (WHO) developed an alternative disablement model. In
WHO's International Classification of Impairments, Disabilities, and Handicaps (ICIDH),[9] disease
was defined as a pathological change that manifests itself as a health condition that is an
alteration or attribute of an individual's health status and that may lead to distress, interference
with daily activities, or contact with health services. Impairment was defined as abnormal changes
at the molecular, cellular, and tissue levels through abnormal structure or function at the organ
level; disability, as the restriction in or lack of ability to perform common activities in a manner or
within a range considered normal; and handicap, as the inability to function at the person-toperson level or person-to-environment level. Handicap indicated the social disadvantages related
to impairment or disability that limit or prevent fulfillment of a normal role. WHO is revising its
original formulation of the disablement model and in December 2000 released a pre-final version,
entitled ICIDH-2: International Classification of Functioning, Disability, and Health.[10]
In 1992, the National Center for Medical Rehabilitation and Research (NCMRR) published a
Page 3 of 9
disablement model that was derived from both the Nagi and WHO models and that used the
classifications of pathophysiology, impairment, functional limitation, disability, and societal
limitation." The NCMRR model rejected the negative connotation of the term "handicap" and
suggested replacing it with the term "societal limitations" to account for the restrictions--imposed
by society--that limit people's ability to participate independently in tasks, activities, and roles. In
1991, the Institute of Medicine (IOM) put forth its own disablement model to emphasize
prevention, suggesting that disability may be prevented through the control of physical and social
environmental risk factors in addition to biological and lifestyle risk factors.[12]
Although the various disablement models may seem to be quite different, the concepts in each of
them can be "cross-walked" to describe an entire spectrum of experience of illness and
disablement.
Guide Terminology
The terminology selected for the Guide framework is based on the disablement terms developed
initially by Nagi (pathology/pathophysiology, impairment, functional limitation, disability) and
incorporates the broadest possible interpretation of those terms. Figure 2 shows the scope of
physical therapist practice both within the context of the Nagi model and within the continuum of
health care services.[4]
Pathology/Pathophysiology (Disease, Disorder, or Condition)
Pathology/pathophysiology (disease, disorder, or condition) refers to an ongoing
pathological/pathophysiological state that is (1) characterized by a particular cluster of signs and
symptoms and (2) recognized by either the patient/client or the practitioner as "abnormal."
Pathology/pathophysiology (disease, disorder, or condition) is primarily identified at the cellular
level and usually is the physician's medical diagnosis. Disease may be the result of infection,
trauma, metabolic imbalance, degenerative processes, or other etiologies. Any single disorder
may disrupt the anatomical structures and physiological processes of one or more systems. The
Guide uses a broad definition of pathology/pathophysiology to include the interruption of normal
processes and to include other health threats, injury, and conditions produced by pathological or
pathophysiological states.
Many of the signs and symptoms that are important to the physical therapist--and many of the
conditions that affect a person's ability to function--are not associated with a single active
pathology/pathophysiology, nor are they always found to have an impact exclusively on a single
system or the system of origin. For example, a patient may have a medical diagnosis that
indicates the presence of fixed lesions from previous insults to a body part or organ, but these
lesions may not be associated with any current active pathological/pathophysiologic processes.
Signs and symptoms also may exist as long-term adaptations to the original disorder or injury.
Using the disablement model as a theoretical framework to describe physical therapist practice
does not negate the importance of the traditional medical diagnosis (eg,
pathology/pathophysiology, injury) in patient/client management by physical therapists. In fact,
changes at the cellular, tissue, and organ levels that are associated with disease and injury often
may predict the range and severity of impairments at the system level. The diagnosis of multiple
sclerosis, for instance, typically requires that the physical therapist understand the fatigue factors
that may be associated with the disease and how those factors must be addressed both in
examining the patient/client and in providing interventions. A diagnosis of multiple sclerosis by
itself, however, tells the physical therapist nothing about the impairments, functional limitations, or
disabilities that would be the focus of physical therapy intervention.
Page 4 of 9
Contrast two cases involving a diagnosis of multiple sclerosis. A 79-year-old woman who needs
only a posterior splint to walk efficiently and who is able to carry out all activities of daffy living
(ADL) and instrumental activities of daily living (IADL) with total independence has very different
needs from a 36-year-old woman who is postpartum and wheelchair dependent and who is unable
to take care of her family as a result of severe generalized weakness. Both patients/clients have
the same medical diagnosis, but the severity of impairments, functional limitations, and disabilities
are sharply different. The examination, evaluation, and subsequent diagnosis of those
impairments, functional limitations, and disabilities are the key contributions of the physical
therapist.
The complexity of interconnections among the four components of the disablement model is
indicative of the knowledge of pathology and pathophysiology that each physical therapist must
bring to bear in addressing impairments, functional limitations, and disabilities. In the case of a
patient/client who is referred to a physical therapist with a general diagnosis of "shoulder pain with
activity," for instance, the physical therapist has to perform an examination to differentiate among
several possible conditions in order to accurately manage the patient. It therefore is important for
the physical therapist to understand the many possible underlying causes for the pain. The
physical therapist's knowledge that different clusters of signs and symptoms are consistent with
underlying conditions--such as angina, osteoarthritis, or prior fracture--is incorporated into the
examination, evaluation, and intervention processes.
If the clinical findings on examination suggest a pathological or pathophysiological condition that is
inconsistent with the referring practitioner's diagnosis, or if the physical therapist notes an
underlying pathology or pathophysiology that was not previously identified, the therapist responds
appropriately, including returning the patient to the original referring practitioner or making a
referral to another practitioner. When the underlying cause is not identified, however, the physical
therapist proceeds with the examination by continually testing the signs and symptoms and by
providing interventions that are justified by changes in patient/client status.
Impairments
Impairments typically are the consequence of disease, pathological processes, or lesions. They
may be defined as alterations in anatomical, physiological, or psychological structures or functions
that both (1) result from underlying changes in the normal state and (2) contribute to illness.
Impairments occur at the tissue, organ, and system level, and they are indicated by signs and
symptoms. The Guide's diagnostic classification scheme uses the definition "abnormality of
structure or function" for its impairment classification.
Physical therapists most often quantify and qualify the signs and symptoms of impairment that are
associated with movement. Alterations of structure and function, such as abnormal muscle
strength, range of motion, or gait, would be classified and diagnosed as impairments by physical
therapists.
Page 5 of 9
The origin of some impairments is often' unclear. Poor posture, for example, is neither a disease
nor a pathological state; however, the muscle shortening and capsular tightness associated with
poor posture are still clinically significant. The physical therapist would diagnose them as
impairments that may be remedied by physical therapy intervention.
In the physical therapist's examination, impairments typically are measured using noninvasive
procedures--even those impairments that are associated with disease, disorders, and medical
conditions--and may predict risk for functional limitation or disability.
Functional Limitations
Functional limitations occur when impairments result in a restriction of the ability to perform a
physical action, task, or activity in an efficient, typically expected, or competent manner. In other
words, functional limitations occur as a result of the inability to perform the actions, tasks, and
activities that constitute the "usual activities" for a given individual, such as reaching for a box on
an overhead shelf. Functional limitations are measured by testing the performance of physical and
mental behaviors at the level of the person and should not be confused with diseases, disorders,
conditions, or impairments involving specific tissue, organ, or system abnormalities that result in
signs and symptoms.
The concept of functional limitations is based on a consensus about what is "normal." The Guide
uses the broad definition of functional limitations to look at the actions, tasks, or activities of that
whole person during his or her usual activities.
Functional limitations include sensorimotor performance in the execution of particular actions,
tasks, and activities (eg, rolling, getting out of bed, transferring, walking, climbing, bending, lifting,
carrying). These sensorimotor functional abilities underlie the daily, fundamental organized
patterns of behaviors that are classified as basic activities of daily living (ADL) (eg, feeding,
dressing, bathing, grooming, toileting). The more complex tasks associated with independent
community living (eg, use of public transportation, grocery shopping) are categorized as
instrumental activities of daily living (IADL). Successful performance of complex physical
functional activities, such as personal hygiene and housekeeping, typically requires integration of
cognitive and affective abilities as well as physical ones.
Although physical therapists are chiefly concerned with physical function, the effects of physical
therapy may go beyond improvement in physical function. For instance, physical therapists may
assess patient/client mental function, including a range of such cognitive activities as telling time
and calculating money transactions. Attention, concentration, memory, and judgment also may be
assessed.
Disability
The Guide defines disability broadly as the inability or restricted ability to perform actions, tasks,
and activities related to required self-care, home management, work (job/school/play), community,
and leisure roles in the individual's sociocultural context and physical environment.
Disability refers to patterns of behavior that have emerged over periods of time during which
functional limitations are severe enough that they cannot be overcome to maintain "normal" role
performance. Thus, the concept of disability includes deficits in the performance of ADL and IADL
that are broadly pertinent to many social roles. If a person has limited range of motion at the
shoulder but bathes independently by using a shower mitt and applies the available range of
motion at other joints to best mechanical advantage, that person is not "disabled," even though
Page 6 of 9
functional performance may be extremely limited without the use of an assistive device and
altered movement patterns.
Disability is characterized by discordance between actual performance in a particular role and the
expectations of the community regarding what are "normal" behaviors in that role. Labeling a
person as "disabled" requires a judgment, usually by a professional, that an individual's behaviors
are somehow inadequate, based on that professional's understanding of community expectations
about how a given activity should be accomplished (eg, in ways that are typical for a person's age,
sex, and cultural and social environment).
Disability depends on both the capacities of the individual and the expectations that are imposed
on the individual by those in the immediate social environment, most often family and caregivers.
Changing the expectations of a patient, family, or caregiver in a social context--for example, the
physical therapist explaining to family members the level of assistance that is needed for an elder
following stroke--may help to diminish disability as much as supplying the patient with assistive
devices or increasing the patient's physical ability to use them.
Interrelationships Among Disease, Impairments, Functional Limitations, and Disability
When the physical therapist has determined which impairments are related to the patient's
functional limitations, the therapist must determine which impairments may be remedied by
physical therapy intervention. If they cannot be remedied, the physical therapist can help the
patient compensate by using other abilities to accomplish the intended goal. The task or the
environment also may be modified so that the task can be performed within the restrictions that
the patient's condition imposes. These two approaches focus on "enablement" rather than
remediation of "disablement," and they may be characterized as the classical physical therapist
response to the disablement process.[3,13-17]
Disablement models have always included the concept of preventing progression toward
disability. "Unidirectional" causal progression--from disease to impairment to functional limitation
to disability, handicap, or societal limitation--"inexorably ... without the possibility of reversal"-should not be assumed.[5] In 1997, IOM revised its disablement model to show both the
interactions of the person with the environment and the "potential effects of rehabilitation and the
`enabling process'" (Fig. 3). The model suggests a bidirectional interaction among the
components, in which improvement in one component has an effect on the development or
progression of a preceding component. Disability was not included in the model because disability
"is not inherent in the individual but, rather, a function of the interaction of the individual and the
environment."[5] The "enabling-disabling process," therefore, recognizes that functional limitations
and disability may be reversed.[5]
Prevention and the Promotion of Health, Wellness, and Fitness in the Context of Disablement
Progression from a healthy state to pathology--or from pathology or impairment to disability--does
Page 7 of 9
not have to be inevitable. The physical therapist may prevent impairments, functional limitations,
or disabilities by identifying disablement risk factors during the diagnostic process and by buffering
the disablement process (Fig. 4). The patient/client management described in the Guide includes
three types of prevention:
* Primary prevention. Prevention of disease in a susceptible or potentially susceptible population

through specific measures such as general health promotion efforts.
* Secondary prevention. Efforts to decrease duration of illness, severity of disease, and sequelae
through early diagnosis and prompt intervention.
* Tertiary prevention. Efforts to decrease the degree of disability and promote rehabilitation and
restoration of function in patients with chronic and irreversible diseases. In the diagnostic process,
physical therapists identify risk factors for disability that may be independent of the disease or
pathology.
The Individual, the Environment, and Health-Related Quality-of-Life Factors
Many factors may have an impact on the disablement process (Fig. 4). These factors may include
individual and environmental factors that predispose or interact to create a person's disability.[2,5]
Individual factors include biological factors (eg, congenital conditions, genetic predispositions) and
demographic factors (eg, age, sex, education, income). Comorbidity, health habits, personal
behaviors, lifestyles, psychological traits (eg, motivation, coping), and social interactions and
relationships also influence the process of disablement. Furthermore, environmental factors--such
as available medical or rehabilitation care, medications and other therapies, and the physical and
social environment--may influence the process of disablement. Each of these factors may be
modified by prevention and the promotion of health, wellness, and fitness.
Health-related quality of life (HRQL) can be said to represent the total effect of individual and
environmental factors on function and health status. Three major dimensions of HRQL have been
described in the literature: the physical function component, which includes basic activities of daffy
living (ADL) (eg, bathing) and instrumental activities of daily living (IADL) (eg, shopping); the
psychological component, that is, the "various cognitive, perceptual, and personality traits" of a
person; and the social component, which involves the interaction of the person "within a larger
social context or structure."[18] As shown in Figure 5, the broad concept of HRQL encompasses
the disablement model. Other "non-health" factors that typically are not included in definitions of
functional limitation or disability contribute to an individual's sense of well being--and to both
overall quality of life and health-related quality of life. Such factors include economic status,
individual expectations and achievements, personal satisfaction with choices in life, and sense of
personal safety.
References
[1] Jette AM. Physical disablement concepts for physical therapy research and practice. Phys
Page 8 of 9
Ther. 1994;74:380-386.
[2] Verbrugge L, Jette A. The disablement process. Soc Sci Med. 1994;38:1-14.
[3] Guccione AA. Arthritis and the process of disablement. Phys Ther. 1994;74:408414.
[4] Guccione AA. Physical therapy diagnosis and the relationship between impairments and
function. Phys Ther. 1991;71:499-504.
[5] Brandt EN Jr, Pope AM, eds. Enabling America: Assessing the Role of Rehabilitation Science
and Engineering. Washington, DC: Institute of Medicine, National Academy Press; 1997:62-80.
[6] Nagi S. Some conceptual issues in disability and rehabilitation. In: Sussman M, ed. Sociology
and Rehabilitation. Washington, DC: American Sociological Association; 1965:100-113.
[7] Nagi S. Disability and Rehabilitation. Columbus, Ohio: Ohio State University Press; 1969.
[8] Nagi S. Disability concepts revisited: implications for prevention. In: Pope A, Tarlov A, eds.
Disability in America: Toward a National Agenda for Prevention. Washington, DC: Institute of
Medicine, National Academy Press; 1991.
[9] ICIDH: International Classification of Impairments, Disabilities, and Handicaps. Geneva,
Switzerland: World Health Organization; 1980.
[10] ICIDH-2: International Classification of Functioning, Disability and Health. Geneva,
Switzerland: World Health Organization; 2000.
[11] National Advisory Board on Medical Rehabilitation Research, Draft V: Report and Plan for
Medical Rehabilitation Research. Bethesda, Md: National Institutes of Health; 1992.
[12] Disability in America: Toward a National Agenda for Prevention. Washington, DC: Institute of
Medicine, National Academy Press; 1991.
[13] Craik RL. Disability following hip fracture. Phys Ther. 1994;74:387-398.
[14] Duncan PW. Stroke disability. Phys Ther. 1994;74:399-407.
[15] Delitto A. Are measures of function and disability important in low back care? Phys Ther.
1994;74:452-462.
Page 9 of 9
[16] Walsh M, Woodhouse LJ, Thomas SG, Finch E. Physical impairments and functional
limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects.
Phys Ther. 1998;78:248-258.
[17] Gill-Body KM, Beninato M, Krebs DE. Relationship among balance impairments, functional
performance, and disability in people with peripheral vestibular hypofunction. Phys Ther.
2000;80:748-758.
[18] Jette AM. Using health-related quality of life measures in physical therapy outcomes
research. Phys Ther. 1993;73:528-537.

Source Citation:"On What Concepts Is the Guide Based?." Physical Therapy 81.1 (Jan

Page 1 of 3
What Does the Guide Contain?(A Guide to Physical Therapist Practice).Physical

The Guide has five major components: the Introduction, which defines physical therapy, outlines
the Guide's development, and describes the concepts that underlie the Guide; Part One, which
delineates the physical therapist's scope of practice and describes the patient/client management
that is provided by physical therapists; Part Two, which delineates preferred practice patterns;
Part Three, available only on CD-ROM (June 2001), which catalogs the tests and measures that
are used in physical therapist practice; and the Appendixes, which include the core documents of
the American Physical Therapy Association and Guide-based documentation templates. The
Guide does not contain specific treatment protocols, does not provide clinical guidelines, and does
not set forth the standard of care for which a physical therapist may be legally responsible in any
specific case.
"Part One: A Description of Patient/Client Management"
Part One is an overview of physical therapists as health care professionals and their approach to
patient/client management, specifically:
* Physical therapist qualifications, roles, and practice settings
* The five elements of patient/client management (examination; evaluation; diagnosis; prognosis,
including plan of care; and intervention) provided by physical therapists
* Tests and measures that physical therapists frequently use, clinical indications that may prompt
the use of the tests and measures, tools that may be used to gather data, and types of data that
may be generated
* Interventions that physical therapists frequently provide, clinical considerations that may prompt
the selection of interventions, and anticipated goals and expected outcomes of intervention
"Part Two: Preferred Practice Patterns"
Part Two describes the boundaries within which the physical therapist may design and implement
plans of care for patients/clients who are classified into specific practice patterns. The patterns are
grouped under four categories of conditions: musculoskeletal, neuromuscular,
cardiovascular/pulmonary, and integumentary. Some patients/clients may be best managed
through classification in more than one pattern.
Each practice pattern describes the following:
* The specific patient/client diagnostic classification, including examples of (1) examination
findings that may support inclusion of patients/clients in the pattern or exclusion of patients/clients
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from the pattern and (2) examination findings that may require classification of patients/clients in a
different pattern or in more than one pattern
* The five elements of patient/client management for each pattern: examination (history, systems
review, and tests and measures), evaluation, diagnosis, prognosis (including plan of care and
expected range of number of visits), and interventions (including anticipated goals and expected
outcomes)
* Reexamination
* Global outcomes (impact on pathology/pathophysiology [disease, disorder, or condition],
impairments, functional limitations, and disabilities; risk reduction/ prevention; impact on health,
wellness, and fitness; impact on societal resources; patient/client satisfaction)
* Criteria for termination of physical therapy services
In addition, each pattern lists relevant ICD-9-CM codes. (These lists are intended as general
information and are not to be used for coding purposes.)
"Part Three: Specific Tests Used in Physical Therapist Practice"
Part Three (available on CD-ROM only) contains a listing of tests and measures used in the
assessment of the cardiovascular/pulmonary, integumentary, musculoskeletal, and neuromuscular
systems and a listing of tests and measures of health status, health-related quality of life, and
patient/client satisfaction. Citations in the peer-reviewed literature regarding the reliability and
validity of specific tests are included.
Appendixes
Appendix I contains the Guide glossary. Appendixes 2 through 4 contain the APTA core
documents on which physical therapist practice is based: Standards of Practice for Physical
Therapy and the Criteria (Appendix 2); Code of Ethics and Guide for Professional Conduct
(Appendix 3); and Standards of Ethical Conduct for the Physical Therapist Assistant and Guide for
Conduct of the Affiliate Member (Appendix 4). Appendix 5 contains Guidelines for Physical
Therapy Documentation. (Note: APTA documents are revised on a regular basis. For the most
recent versions of these documents, contact APTA's Service Center, svcctr@apta.org.) Appendix
6 contains the "Documentation Templates for Physical Therapist Patient/Client Management";
Appendix 7, the "Patient/Client Satisfaction Questionnaire."
Indexes
Both numerical and alphabetical indexes of the ICD-9-CM codes cited in the Guide are provided.

Source Citation:"What Does the Guide Contain?." Physical Therapy 81.1 (Jan 2001): 35. Expanded
Page 3 of 3
Page 1 of 17
Who Are Physical Therapists, and What Do They Do?(A Guide to Physical Therapist
Practice).Physical Therapy 81.1 (Jan 2001): p39. (7255 words)
Education and Qualifications

Physical therapists are professionally educated at the0 college or university level and are required to be
licensed in the state or states in which they practice. Graduates from 1926 to 1959 completed physical
therapy curricula approved by appropriate accreditation bodies. Graduates from 1960 to the present have
successfully completed professional physical therapist education programs accredited by the Commission
on Accreditation in Physical Therapy Education (CAPTE). As of January 2002, CAPTE accreditation is
limited to only those professional education programs that award the postbaccalaureate degree.
Physical therapists also may be certified as clinical specialists through the American Board of Physical
Therapy Specialties (ABPTS).
Practice Settings
Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings,
including the following:
* Hospitals (eg, critical care, intensive care, acute care, and subacute care settings)
* Outpatient clinics or offices
* Rehabilitation facilities
* Skilled nursing, extended care, or subacute facilities
* Homes
* Education or research centers
* Schools and playgrounds (preschool, primary, and secondary)
* Hospices
* Corporate or industrial health centers
* Industrial, workplace, or other occupational environments
* Athletic facilities (collegiate, amateur, and professional)
* Fitness centers and sports training facilities
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Patients and Clients

Physical therapists are committed to providing necessary and high-quality services to both patients and
clients. Patients are individuals who are the recipients of physical therapy examination, evaluation,
diagnosis, prognosis, and intervention and who have a disease, disorder, condition, impairment,
functional limitation, or disability. Clients are individuals who engage the services of a physical therapist
and who can benefit from the physical therapist's consultation, interventions, professional advice,
prevention services, or services promoting health, wellness, and fitness. Clients also are businesses,
school systems, and others to whom physical therapists provide services. The generally accepted
elements of patient/client management typically apply to both patients and clients.
Scope of Practice
Physical therapy is defined as the care and services provided by or under the direction and supervision of
a physical therapist. Physical therapists are the only professionals who provide physical therapy. Physical
therapist assistants--under the direction and supervision of the physical therapist--are the only
paraprofessionals who assist in the provision of physical therapy interventions. APTA therefore
recommends that federal and state government agencies and other third-party payers require physical
therapy to be provided only by a physical therapist or under the direction and supervision of a physical
therapist. Examination, evaluation, diagnosis, and prognosis should be represented and reimbursed as
physical therapy only when they are performed by a physical therapist. Intervention should be
represented and reimbursed as physical therapy only when performed by a physical therapist or by a
physical therapist assistant under the direction and supervision of a physical therapist.
Physical therapists:
* Provide services to patients/clients who have impairments, functional limitations, disabilities, or changes
in physical function and health status resulting from injury, disease, or other causes. In the context of the
model of disablement[1-4] on which this Guide is based, impairment is defined as loss or abnormality of
anatomical, physiological, mental, or psychological structure or function; functional limitation is defined as
restriction of the ability to perform, at the level of the whole person, a physical action, task, or activity in an
efficient, typically expected, or competent manner; and disability is defined as the inability to perform or a
limitation in the performance of actions, tasks, and activities usually expected in specific social roles that
are customary for the individual or expected for the person's status or role in a specific sociocultural
context and physical environment.
* Interact and practice in collaboration with a variety of professionals. The collaboration may be with
physicians, dentists, nurses, educators, social workers, occupational therapists, speech-language
pathologists, audiologists, and any other personnel involved with the patient/client. Physical therapists
acknowledge the need to educate and inform other professionals, government agencies, third-party
payers, and other health care consumers about the cost-efficient and clinically effective services that
physical therapists provide.
* Address risk. Physical therapists identify risk factors and behaviors that may impede optimal functioning.
* Provide prevention and promote health, wellness, and fitness. Physical therapists provide prevention
services that forestall or prevent functional decline and the need for more intense care. Through timely
and appropriate screening, examination, evaluation, diagnosis, prognosis, and intervention, physical
therapists frequently reduce or eliminate the need for costlier forms of care and also may shorten or even
eliminate institutional stays. Physical therapists also are involved in promoting health, wellness, and
fitness initiatives, including education and service provision, that stimulate the public to engage in healthy
behaviors.
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* Consult, educate, engage in critical inquiry, and administrate. Physical therapists provide consultative
services to health facilities, colleagues, businesses, and community organizations and agencies. They
provide education to patients/clients, students, facility staff, communities, and organizations and
agencies. Physical therapists also engage in research activities, particularly those related to
substantiating the outcomes of service provision. They provide administrative services in many different
types of practice, research, and education settings.
* Direct and supervise the physical therapy service, including support personnel. Physical therapists
oversee all aspects of the physical therapy service. They supervise the physical therapist assistant (PTA)
when PTAs provide physical therapy interventions as selected by the physical therapist. Physical
therapists also supervise any support personnel as they perform designated tasks related to the operation
of the physical therapy service.
Roles in Primary Care
Physical therapists have a major role to play in the provision of primary care, which has been defined as
the provision of integrated, accessible health care services by clinicians
who are accountable for addressing a large majority of personal health care
needs, developing a sustained partnership with patients, and practicing
within the context of family and community.[5]
APTA has endorsed the concepts of primary care set forth by the Institute of Medicine's Committee on the
Future of Primary Care,[5] including the following:
* Primary care can encompass myriad needs that go well beyond the capabilities and competencies of
individual caregivers and that require the involvement and interaction of varied practitioners.
* Primary care is not limited to the "first contact" or point of entry into the health care system.
* The primary care program is a comprehensive one.
On a daily basis, physical therapists practicing across acute, rehabilitative, and chronic stages of care
assist patients/clients in restoring health, alleviating pain, and examining, evaluating, and diagnosing
impairments, functional limitations, disabilities, or changes in physical function and health status resulting
from injury, disease, or other causes. Intervention, prevention, and the promotion of health, wellness, and
fitness are a vital part of the practice of physical therapists. As clinicians, physical therapists are well
positioned to provide services as members of primary care teams.
For acute musculoskeletal and neuromuscular conditions, triage and initial examination are appropriate
physical therapist responsibilities. The primary care team may function more efficiently when it includes
physical therapists, who can recognize musculoskeletal and neuromuscular disorders, perform
examinations and evaluations, establish a diagnosis and prognosis, and intervene without delay. For
patients/clients with low back pain, for example, physical therapists can provide immediate pain reduction
through programs for pain modification, strengthening, flexibility, endurance, and postural alignment;
instruction in activities of daily living (ADL); and work modification. Physical therapy intervention may
result not only in more efficient and effective patient care but also in more appropriate utilization of other
members of the primary care team. With physical therapists functioning in a primary care role and
delivering early intervention for work-related musculoskeletal injuries, time and productivity loss due to
injuries may be dramatically reduced.
For certain chronic conditions, physical therapists should be recognized as the principal providers of care
Page 4 of 17
within the collaborative primary care team. Physical therapists are well prepared to coordinate care
related to loss of physical function as a result of musculoskeletal, neuromuscular,
cardiovascular/pulmonary, or integumentary disorders. Through community-based agencies and school
systems, physical therapists coordinate and integrate provision of services to patients/clients with chronic
disorders.
Physical therapists also provide primary care in industrial or workplace settings, in which they manage the
occupational health services provided to employees and help prevent injury by designing or redesigning
the work environment. These services focus both on the individual and on the environment to ensure
comprehensive and appropriate intervention.
Roles in Secondary and Tertiary Care
Physical therapists play major roles in secondary and tertiary care. Patients with musculoskeletal,
neuromuscular, cardiovascular/pulmonary, or integumentary conditions may be treated initially by another
practitioner and then referred to physical therapists for secondary care. Physical therapists provide
secondary care in a wide range of settings, including acute care and rehabilitation hospitals, outpatient
clinics, home health, and school systems.
Tertiary care is provided by physical therapists in highly specialized, complex, and technology-based
settings (eg, heart and lung transplant services, burn units) or in response to other health care
practitioners' requests for consultation and specialized services (eg, for patients with spinal cord lesions
or closed-head trauma).
Roles in Prevention and in the Promotion of Health, Wellness, and Fitness
Physical therapists are involved in prevention; in promoting health, wellness, and fitness; and in
performing screening activities. These initiatives decrease costs by helping patients/clients (1) achieve
and restore optimal functional capacity; (2) minimize impairments, functional limitations, and disabilities
related to congenital and acquired conditions; (3) maintain health (thereby preventing further deterioration
or future illness); and (4) create appropriate environmental adaptations to enhance independent function.
There are three types of prevention in which physical therapists are involved:
* Primary prevention. Preventing a target condition in a susceptible or potentially susceptible population
through such specific measures as general health promotion efforts.
* Secondary prevention. Decreasing duration of illness, severity of disease, and number of sequelae
through early diagnosis and prompt intervention.
* Tertiary prevention. Limiting the degree of disability and promoting rehabilitation and restoration of
function in patients with chronic and irreversible diseases.
Physical therapists conduct screenings to determine the need for (1) primary, secondary, or tertiary
prevention services; (2) further examination, intervention, or consultation by a physical therapist; or (3)
referral to another practitioner. Candidates for screening generally are not patients/clients currently
receiving physical therapy services. Screening is based on a problem-focused, systematic collection and
analysis of data.
Examples of the prevention screening activities in which physical therapists engage include:
* Identification of lifestyle factors (eg, amount of exercise, stress, weight) that may lead to increased risk
Page 5 of 17
for serious health problems

* Identification of children who may need an examination for idiopathic scoliosis
* Identification of elderly individuals in a community center or nursing home who are at high risk for falls
* Identification of risk factors for neuromusculoskeletal injuries in the workplace
* Pre-performance testing of individuals who are active in sports
Examples of prevention activities and health, wellness, and fitness promotion activities in which physical
therapists engage include:
* Back schools, workplace redesign, strengthening, stretching, endurance exercise programs, and
postural training to prevent and manage low back pain
* Ergonomic redesign; strengthening, stretching, and endurance exercise programs; postural training to
prevent job-related disabilities, including trauma and repetitive stress injuries
* Exercise programs, including weight bearing and weight training, to increase bone mass and bone
density (especially in older adults with osteoporosis)
* Exercise programs, gait training, and balance and coordination activities to reduce the risk of falls--and
the risk of fractures from falls--in older adults
* Exercise programs and instruction in ADL (self-care, communication, and mobility skills required for
independence in daily living) and instrumental activities of daily living (IADL) (activities that are important
components of maintaining independent living, such as shopping and cooking) to decrease utilization of
health care services and enhance function in patients with cardiovascular/pulmonary disorders
* Exercise programs, cardiovascular conditioning, postural training, and instruction in ADL and IADL to
prevent disability and dysfunction in women who are pregnant
* Broad-based consumer education and advocacy programs to prevent problems (eg, prevent head injury
by promoting the use of helmets, prevent pulmonary disease by encouraging smoking cessation)
* Exercise programs to prevent or reduce the development of sequelae in individuals with life-long
conditions
The Five Elements of Patient/Client Management
The physical therapist integrates the five elements of patient/client management--examination, evaluation,
diagnosis, prognosis, and intervention--in a manner designed to optimize outcomes (Fig. 1). Appendix 6
contains a template for documenting the five elements of patient/client management.
Examination, evaluation, and the establishment of a diagnosis and a prognosis are all part of the process
that helps the physical therapist determine the most appropriate intervention(s) to address the outcomes
that are desired by the patient/client.
Examination
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Examination is required prior to the initial intervention and is performed for all patients/clients. The initial
examination is a comprehensive screening and specific testing process leading to diagnostic classification
or, as appropriate, to a referral to another practitioner. The examination has three components: the
patient/client history, the systems review, and tests and measures.
History. The history is a systematic gathering of data--from both the past and the present--related to why
the patient/client is seeking the services of the physical therapist. The data that are obtained (eg, through
interview, through review of the patient/client record, or from other sources) include demographic
information, social history, employment and work (job/school/play), growth and development, living
environment, general health status, social and health habits (past and current), family history,
medical/surgical history, current conditions or chief complaints, functional status and activity level,
medications, and other clinical tests. While taking the history, the physical therapist also identifies health
restoration and prevention needs and coexisting health problems that may have implications for
intervention.
This history typically is obtained through the gathering of data from the patient/client, family, significant
others, caregivers, and other interested individuals (eg, rehabilitation counselor, teacher, workers'
compensation claims manager, employer); through consultation with other members of the team; and
through review of the patient/client record. Figure 2 lists the types of data that may be generated from the
history.
Data from the history (Fig. 2) provide the initial information that the physical therapist uses to hypothesize
about the existence and origin of impairments or functional limitations that are commonly related to
medical conditions, sociodemographic factors, or personal characteristics. For example, in the case of a
78-year-old woman who has a medical diagnosis of Parkinson disease and who lives alone, the medical
diagnosis would suggest the possibility of the following impairments: loss of motor control, range ofmotion deficits, faulty posture, and decreased endurance for functional activities. Epidemiologic research
that is available about functional limitations of older women, however, suggests that performance of IADL
also may be problematic for that age group. Consequently, in this case, the physical therapist may use
the information obtained during the history as well as the epidemiological information to create a
"hypothesis" that would require further, in-depth examination during the tests-and-measures portion of the
examination.
Systems review. After organizing the available history information, the physical therapist begins the
"hands-on" component of the examination. The systems review is a brief or limited examination of (1) the
anatomical and physiological status of the cardiovascular/pulmonary, integumentary, musculoskeletal,
and neuromuscular systems and (2) the communication ability, affect, cognition, language, and learning
style of the patient. The physical therapist especially notes how each of these last five components affects
the ability to initiate, sustain, and modify purposeful movement for performance of an action, task, or
activity that is pertinent to function.
The systems review includes the following:
* For the cardiovascular/pulmonary system, the assessment of heart rate, respiratory rate, blood
pressure, and edema
* For the integumentary system, the assessment of skin integrity, skin color, and presence of scar
formation
* For the musculoskeletal system, the assessment of gross symmetry, gross range of motion, gross
strength, height, and weight
Page 7 of 17
* For the neuromuscular system, a general assessment of gross coordinated movement (eg, balance,
locomotion, transfers, and transitions)
* For communication ability, affect, cognition, language, and learning style, the assessment of the ability
to make needs known; consciousness; orientation (person, place, and time); expected
emotional/behavioral responses; and learning preferences (eg, learning barriers, education needs)
The systems review also assists the physical therapist in identifying possible problems that require
consultation with or referral to another provider.
Tests and measures. Tests and measures are the means of gathering data about the patient/client. From
the comprehensive identification and questioning processes of the history and systems review, the
physical therapist determines patient/client needs and generates diagnostic hypotheses that may be
further investigated by selecting specific tests and measures. These tests and measures are used to rule
in or rule out causes of impairment and functional limitations; to establish a diagnosis, prognosis, and plan
of care; and to select interventions.
The tests and measures that are performed as part of an initial examination should be only those that are
necessary to (1) confirm or reject a hypothesis about the factors that contribute to making the current
level of patient/client function less than optimal and (2) support the physical therapist's clinical judgments
about appropriate interventions, anticipated goals, and expected outcomes.
Before, during, and after administering the tests and measures, physical therapists gauge responses,
assess physical status, and obtain a more specific understanding of the condition and the diagnostic and
therapeutic requirements. There are 24 tests and measures that are commonly performed by physical
therapists. These tests and measures, tools used to gather data, and types of data generated are
discussed in detail in Chapter 2.
The physical therapist may decide to use one, more than one, or portions of several specific tests and
measures as part of the examination, based on the purpose of the visit, the complexity of the condition,
and the directions taken in the clinical decision-making process.
As the examination progresses, the physical therapist may identify additional problems that were not
uncovered by the history and systems review and may conclude that other specific tests and measures or
portions of other specific tests and measures are required to obtain sufficient data to perform an
evaluation, establish a diagnosis and a prognosis, and select interventions. The examination therefore
may be as brief or as lengthy as necessary. The physical therapist may decide that a full examination is
Page 8 of 17
necessary and then select appropriate tests and measures. Conversely, the physical therapist may
conclude from the history and systems review that further examination and intervention are not required,
that the patient/client should be referred to another practitioner, or both.
Tests and measures vary in the precision of their measurements; however, useful data may be generated
through various means. For instance, data generated from either a gross muscle test of a group of
muscles or from a very precise manual muscle test could be used to reject the hypothesis that muscle
performance is contributing to a functional deficit. Similarly, even though a functional assessment
instrument may quantify a large number of ADL or IADL, it may fail to detect the inability to perform a
particular task and activity that is most important to the patient.
The tests and measures that are selected by the physical therapist should yield data that are sufficiently
accurate and precise to allow the therapist to make a correct inference about the patient's/client's
condition. The selection of specific tests and measures and the depth of the examination vary based on
the age of the patient/client; severity of the problem; stage of recovery (acute, subacute, or chronic);
phase of rehabilitation (early, intermediate, late, return to activity); home, community, or work
(job/school/play) situation; and other relevant factors.
Evaluation
Physical therapists perform evaluations (make clinical judgments) based on the data gathered from the
examination. They synthesize all of the findings from the history, systems review, and tests and measures
to establish the diagnosis, prognosis, and plan of care. Factors that influence the complexity of the
evaluation process include the clinical findings, the extent of loss of function, social considerations, and
overall physical function and health status. The evaluation reflects the chronicity or severity of the current
problem, the possibility of multisite or multisystem involvement, the presence of preexisting systemic
conditions or diseases, and the stability of the condition. Physical therapists also consider the severity
and complexity of the current impairments and the probability of prolonged impairment, functional
limitation, and disability; the living environment; potential discharge destinations; and social support.
Diagnosis
Diagnostic labels may be used to describe multiple dimensions of the patient/client, ranging from the most
basic cellular level to the highest level of functioning--as a person in society. Although physicians typically
use labels that identify disease, disorder, or condition at the level of the cell, tissue, organ, or system,
physical therapists use labels that identify the impact of a condition on function at the level of the system
(especially the movement system) and at the level of the whole person.
The assigning of a diagnostic label through the classification of a patient/client within a specific practice
pattern is a decision reached as a result of a systematic process. This process includes integrating and
evaluating the data that are obtained during the examination (history, systems review, and tests and
measures) to describe the patient/client condition in terms that will guide the physical therapist in
determining the prognosis, plan of care, and intervention strategies. Thus the diagnostic label indicates
the primary dysfunctions toward which the physical therapist directs interventions. The diagnostic process
enables the physical therapist to verify the individual needs of each patient/client relative to similar
individuals who are classified in the same pattern while also capturing the unique concerns of the
patient/client in meeting those needs in a particular sociocultural and physical environment.
If the diagnostic process does not yield an identifiable cluster (eg, of signs or symptoms, impairments,
functional limitations, or disabilities), syndrome, or category, the physical therapist may administer
interventions for the alleviation of symptoms and remediation of impairments. As in all other cases, the
physical therapist is guided by patient/client responses to those interventions and may determine that a
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reexamination is in order and proceed accordingly.

The objective of the physical therapist's diagnostic process is the identification of discrepancies that exist
between the level of function that is desired by the patient/client and the capacity of the patient/client to
achieve that level. In carrying out the diagnostic process, physical therapists may need to obtain
additional information (including diagnostic labels) from other professionals. In addition, as the diagnostic
process continues, physical therapists may identify findings that should be shared with other
professionals (including referral sources) to ensure optimal care. If the diagnostic process reveals findings
that are outside the scope of the physical therapist's knowledge, experience, or expertise, the physical
therapist refers the patient/client to an appropriate practitioner.
Making a diagnosis requires the clinician to collect and sort data into categories according to a
classification scheme relevant to the clinician who is making the diagnosis. These classification schemes
should meet the following criteria:[6]
1. Classification schemes must be consistent with the boundaries placed on the profession by law (which
may regulate the application of certain types of diagnostic categories) and by society (which grants
approval for managing specific types of problems and conditions).
2. The tests and measures necessary for confirming the diagnosis must be within the legal purview of the
health care professional.
3. The label used to categorize a condition should describe the problem in a way that directs the selection
of interventions toward those interventions that are within the legal purview of the health care professional
who is making the diagnosis.
The preferred practice patterns in Part Two of the Guide describe the management of patients who are
grouped by clusters of impairments that commonly occur together, some of which are associated with
health conditions that impede optimal function. Each pattern represents a diagnostic classification. The
pattern title therefore reflects the diagnosis--or impairment classification--made by the physical therapist.
The diagnosis may or may not be associated with a health condition for patients/clients who are classified
into that pattern.
The physical therapist uses the classification scheme of the preferred practice patterns to complete a
diagnostic process that begins with the collection of data (examination), proceeds through the
organization and interpretation of data (evaluation), and culminates in the application of a label
(diagnosis).
Prognosis (Including the Plan of Care)
Once the diagnosis has been established, the physical therapist determines the prognosis and develops
the plan of care. The prognosis is the determination of the predicted optimal level of improvement in
function and the amount of time needed to reach that level, and also may include a prediction of levels of
improvement that may be reached at various intervals during the course of therapy.
The plan of care consists of statements that specify the anticipated goals and the expected outcomes,
predicted level of optimal improvement, specific interventions to be used, and proposed duration and
frequency of the interventions that are required to reach the anticipated goals and expected outcomes.
The plan of care therefore describes the specific patient/client management and the timing for
patient/client management for the episode of physical therapy care.
The plan of care is the culmination of the examination, diagnostic, and prognostic processes. It is
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established in collaboration with the patient/client and is based on the data gathered from the history,
systems review, and tests and measures and on the diagnosis determined by the physical therapist. In
designing the plan of care, the physical therapist analyzes and integrates the clinical implications of the
severity, complexity, and acuity of the pathology/pathophysiology (disease, disorder, or condition), the
impairments, the functional limitations, and the disabilities to establish the prognosis and predictions
about the likelihood of achieving the anticipated goals and expected outcomes.
The plan of care identifies anticipated goals and expected outcomes, taking into consideration the
expectations of the patient/client and appropriate others. (If required, the anticipated goals and expected
outcomes may be expressed as short-term and long-term goals.) Anticipated goals and expected
outcomes are the intended results of patient/client management and indicate the changes in impairments,
functional limitations, and disabilities and the changes in health, wellness, and fitness needs that are
expected as the result of implementing the plan of care. The anticipated goals and expected outcomes
also address risk reduction, prevention, impact on societal resources, and patient/client satisfaction. The
anticipated goals and expected outcomes in the plan should be measurable and time limited.
The plan of care includes the anticipated discharge plans. In consultation with appropriate individuals, the
physical therapist plans for discharge and provides for appropriate follow-up or referral. The primary
criterion for discharge is the achievement of the anticipated goals and expected outcomes. When physical
therapy services are terminated prior to achievement of anticipated goals and expected outcomes,
patient/client status and the rationale for termination are documented. For patients/clients who require
multiple episodes of care, periodic follow-up is needed over the life span to ensure safety and effective
adaptation following changes in physical status, caregivers, environment, or task demands.
Note: In the course of examining the patient/client and establishing the diagnosis and the prognosis, the
physical therapist may find evidence of physical abuse or domestic violence. Universal screening for
domestic violence is increasingly becoming a statutory requirement.
Intervention
Intervention is the purposeful interaction of the physical therapist with the patient/client and, when
appropriate, with other individuals involved in patient/client care, using various physical therapy
procedures and techniques to produce changes in the condition that are consistent with the diagnosis and
prognosis. Decisions about interventions are contingent on the timely monitoring of patient/client
response and the progress made toward achieving the anticipated goals and expected outcomes.
Physical therapist interventions consist of the following components:
* Coordination, communication, and documentation
* Patient/client-related instruction
* Procedural interventions, including
- therapeutic exercise
- functional training in self-care and home management (including ADL and IADL)
- functional training in work (job/school/play), community, and leisure integration and reintegration
(including IADL, work hardening, and work conditioning) manual therapy techniques (including
mobilization/manipulation)
- prescription, application, and, as appropriate, fabrication of devices and equipment (assistive, adaptive,
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orthotic, protective, supportive, and prosthetic)

- airway clearance techniques
- integumentary repair and protection techniques
- electrotherapeutic modalities
- physical agents and mechanical modalities
Coordination, communication, and documentation. These administrative and supportive processes are
intended to ensure that patients/clients receive appropriate, comprehensive, efficient, and effective quality
of care from admission through discharge. Coordination is the working together of all parties involved with
the patient/client. Communication is the exchange of information. Documentation is any entry into the
patient/client record--such as consultation reports, initial examination reports, progress notes, flow sheets,
checklists, reexamination reports, or summations of care--that identifies the care or service provided.
Physical therapists are responsible for coordination, communication, and documentation across all
settings for all patients/clients.
Administrative and support processes may include addressing required functions, such as advanced care
directives, individualized educational plans (IEPs) or individualized family service plans (IFSPs), informed
consent, and mandatory communication and reporting (eg, patient advocacy and abuse reporting);
admission and discharge planning; case management; collaboration and coordination with agencies;
communication across settings; cost-effective resource utilization; data collection, analysis, and reporting;
documentation across settings; interdisciplinary teamwork; and referrals to other professionals or
resources. Documentation should follow APTA's Guidelines for Physical Therapy Documentation
(Appendix 5).
Patient/client-related instruction. The process of informing, educating, or training patients/clients, families,
significant others, and caregivers is intended to promote and optimize physical therapy services.
Instruction may be related to the current condition; specific impairments, functional limitations, or
disabilities; plan of care; need for enhanced performance; transition to a different role or setting; risk
factors for developing a problem or dysfunction; or need for health, wellness, or fitness programs.
Physical therapists are responsible for patient/client-related instruction across all settings for all
patients/clients.
Procedural interventions. The physical therapist selects, applies, or modifies these interventions (listed
above) based on examination data, the evaluation, the diagnosis and the prognosis, and the anticipated
goals and expected outcomes for a particular patient in a specific patient/client practice pattern. Based on
patient/client response to interventions, the physical therapist may decide that reexamination is
necessary, a decision that may lead to the use of different interventions or, alternatively, the
discontinuation of care.
Chapter 3 details the types of procedural interventions commonly selected by the physical therapist.
Forming the core of most physical therapy plans of care are: therapeutic exercise, including aerobic
conditioning; functional training in self-care and home management activities, including ADL and IADL;
and functional training in work (job/school/play), community, and leisure integration or reintegration,
including IADL, work hardening, and work conditioning.
Factors that influence the complexity, frequency, and duration of the intervention and the decision-making
process may include the following: accessibility and availability of resources; adherence to the
intervention program; age; anatomical and physiological changes related to growth and development;
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caregiver consistency or expertise; chronicity or severity of the current condition; cognitive status;
comorbidities, complications, or secondary impairments; concurrent medical, surgical, and therapeutic
interventions; decline in functional independence; level of impairment; level of physical function; living
environment; multisite or multisystem involvement; nutritional status; overall health status; potential
discharge destinations; premorbid conditions; probability of prolonged impairment, functional limitation, or
disability; psychosocial and socioeconomic factors; psychomotor abilities; social support; and stability of
the condition.
Reexamination
Reexamination is the process of performing selected tests and measures after the initial examination to
evaluate progress and to modify or redirect interventions. Reexamination may be indicated more than
once during a single episode of care. It also may be performed over the course of a disease, disorder, or
condition, which for some patients/clients may be over the life span. Indications for reexamination include
new clinical findings or failure to respond to physical therapy interventions.
Outcomes
Throughout the entire episode of care, the physical therapist determines the anticipated goals and
expected outcomes for each intervention. Beginning with the history, the physical therapist identifies
patient/client expectations, perceived need for physical therapy services, personal goals, and desired
outcomes. The physical therapist then considers whether these goals and outcomes are realistic in the
context of the examination data and the evaluation. In establishing a diagnosis and a prognosis and
selecting interventions, the physical therapist asks the question, "What outcome is likely, given the
diagnosis?" The physical therapist may use reexamination to determine whether predicted outcomes are
reasonable and then modify them as necessary.
As the patient/client reaches the termination of physical therapy services and the end of the episode of
care, the physical therapist measures the global outcomes of the physical therapy services by
characterizing or quantifying the impact of the physical therapy interventions on the following domains:
* Pathology/pathophysiology (disease, disorder, or condition)
* Impairments
* Functional limitations
* Disabilities
* Risk reduction/prevention
* Health, wellness, and fitness
* Societal resources
* Patient/client satisfaction
The physical therapist engages in outcomes data collection and analysis-that is, the systematic review of
outcomes of care in relation to selected variables (eg, age, sex, diagnosis, interventions performed)--and
develops statistical reports for internal or external use.
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Episode of Care, Maintenance, or Prevention

An episode of physical therapy care consists of all physical therapy services that are (1) provided by a
physical therapist, (2) provided in an unbroken sequence, and (3) related to the physical therapy
interventions for a given condition or problem or related to a request from the patient/client, family, or
other provider. A defined number or identified range of number of visits will be established for an episode
of care. A visit consists of all physical therapy services provided in a 24-hour period. The episode of care
may include transfers between sites within or across settings or reclassification of the patient/client from
one preferred practice pattern to another. Reclassification may alter the expected range of number of
visits and therefore may shorten or lengthen the episode of care. If reclassification involves a condition,
problem, or request that is not related to the initial episode of care, a new episode of care may be
initiated.
A single episode of care should not be confused with multiple episodes of care that may be required by
certain individuals who are classified in particular patterns. For these patients/clients, periodic follow-up is
needed over a lifetime to ensure optimal function and safety following changes in physical status,
caregivers, the environment, or task demands.
An episode of physical therapy maintenance is a series of occasional clinical, educational, and
administrative services related to maintenance of current function. No defined number or range of number
of visits is established for this type of episode.
An episode of physical therapy prevention is a series of occasional clinical, educational, and
administrative services related to prevention, to the promotion of health, wellness, and fitness, and to the
preservation of optimal function. Prevention services; programs that promote health, wellness, and
fitness; and programs for maintenance of function are a vital part of the practice of physical therapy. No
defined number or range of number of visits is established for this type of episode.
Criteria for Termination of Physical Therapy Services
Two processes are used for terminating physical therapy services: discharge and discontinuation.
Discharge
Discharge is the process of ending physical therapy services that have been provided during a single
episode of care, when the anticipated goals and expected outcomes have been achieved. Discharge
does not occur with a transfer, that is when the patient is moved from one site to another site within the
same setting or across settings during a single episode of care. There may be facility-specific or payerspecific requirements for documentation regarding the conclusion of physical therapy services as the
patient moves between sites or across settings during the episode of care.
Discharge occurs based on the physical therapist's analysis of the achievement of anticipated goals and
expected outcomes. For patients/clients who require multiple episodes of care, periodic follow-up is
needed over the life span to ensure safety and effective adaptation following changes in physical status,
caregivers, environment, or task demands. In consultation with appropriate individuals, and in
consideration of the anticipated goals and expected outcomes, the physical therapist plans for discharge
and provides for appropriate follow-up or referral.
Discontinuation
Discontinuation is the process of ending physical therapy services that have been provided during a
single episode of care when (1) the patient/client, caregiver, or legal guardian declines to continue
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intervention; (2) the patient/client is unable to continue to progress toward anticipated goals and expected
outcomes because of medical or psychosocial complications or because financial/insurance resources
have been expended; or (3) the physical therapist determines that the patient/client will no longer benefit
from physical therapy. When termination of physical therapy service occurs prior to achievement of
anticipated goals and expected outcomes, patient/client status and the rationale for discontinuation are
documented.
In consultation with appropriate individuals, and in consideration of the anticipated goals and expected
outcomes, the physical therapist plans for discontinuation and provides for appropriate follow-up or
referral.
Other Professional Roles of the Physical Therapist Consultation
Consultation is the rendering of professional or expert opinion or advice by a physical therapist. The
consulting physical therapist applies highly specialized knowledge and skills to identify problems,
recommend solutions, or produce a specified outcome or product in a given amount of time on behalf of a
patient/client.
Patient-related consultation is a service provided by a physical therapist at the request of a patient,
another practitioner, or an organization either to recommend physical therapy services that are needed or
to evaluate the quality of physical therapy services being provided. Such consultation usually does not
involve actual intervention.
Client-related consultation is a service provided by a physical therapist at the request of an individual,
business, school, government agency, or other organization.
Examples of consultation activities in which physical therapists may engage include:
* Advising a referring practitioner about the indications for intervention
* Advising employers about the requirements of the Americans with Disabilities Act (ADA)
* Conducting a program to determine the suitability of employees for specific job assignments
* Developing programs that evaluate the effectiveness of an intervention plan in reducing work-related
injuries
* Educating other health care practitioners (eg, in injury prevention)
* Examining school environments and recommending changes to improve accessibility for students with
disabilities
* Instructing employers about job preplacement in accordance with provisions of the ADA
* Participating at the local, state, and federal levels in policymaking for physical therapy services
* Performing environmental assessments to minimize the risk of falls
* Providing peer review and utilization review services
* Responding to a request for a second opinion
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* Serving as an expert witness in legal proceedings

* Working with employees, labor unions, and government agencies to develop injury reduction and safety
programs
Education
Education is the process of imparting information or skills and instructing by precept, example, and
experience so that individuals acquire knowledge, master skills, or develop competence. In addition to
instructing patients/clients as an element of intervention, physical therapists may engage in education
activities such as the following:
* Planning and conducting academic education, clinical education, and continuing education programs for
physical therapists, other providers, and students
* Planning and conducting education programs for local, state, and federal agencies
* Planning and conducting programs for the public to increase awareness of issues in which physical
therapists have expertise
Critical Inquiry
Critical inquiry is the process of applying the principles of scientific methods to read and interpret
professional literature; participate in, plan, and conduct research; evaluate outcomes data; and assess
new concepts and technologies.
Examples of critical inquiry activities in which physical therapists may engage include:
* Analyzing and applying research findings to physical therapy practice and education
* Disseminating the results of research
* Evaluating the efficacy and effectiveness of both new and established interventions and technologies
* Participating in, planning, and conducting clinical, basic, or applied research
Administration
Administration is the skilled process of planning, directing, organizing, and managing human, technical,
environmental, and financial resources effectively and efficiently. Administration includes the
management, by individual physical therapists, of resources for patient/client management and for
organizational operations.
Examples of administration activities in which physical therapists engage include:
* Ensuring fiscally sound reimbursement for services rendered
* Budgeting for physical therapy services
* Managing staff resources, including the acquisition and development of clinical expertise and leadership
abilities
Page 16 of 17
* Monitoring quality of care and clinical productivity

* Negotiating and managing contracts
* Supervising physical therapist assistants, physical therapy aides, and other support personnel
The Physical Therapy Service: Direction and Supervision of Personnel
Direction and supervision are essential to the provision of high-quality physical therapy. The degree of
direction and supervision necessary for ensuring high-quality physical therapy depends on many factors,
including the education, experience, and responsibilities of the parties involved; the organizational
structure in which the physical therapy is provided; and applicable state law. In any case, supervision
should be readily available to the individual being supervised.
The director of a physical therapy service is a physical therapist who has demonstrated qualifications
based on education and experience in the field of physical therapy and who has accepted the inherent
responsibilities of the role. The director of a physical therapy service must:
* Establish guidelines and procedures that will delineate the functions and responsibilities of all levels of
physical therapy personnel in the service and the supervisory relationships inherent to the functions of the
service and the organization
* Ensure that the objectives of the service are efficiently and effectively achieved within the framework of
the stated purpose of the organization and in accordance with safe physical therapist practice
* Interpret administrative policies
* Act as a liaison between line staff and administration
* Foster the professional growth of the staff
Written practice and performance criteria should be available for all levels of physical therapy personnel in
a physical therapy service. Regularly scheduled performance appraisals should be conducted by the
supervisor based on applicable standards of practice and performance criteria. Responsibilities should be
commensurate with the qualifications--including experience, education, and training--of the individuals to
whom the responsibilities are assigned. When the physical therapist of record directs physical therapist
assistants to perform specific components of physical therapy interventions, that physical therapist
remains responsible for supervision of the plan of care. Regardless of the setting in which the services
are given, the following responsibilities must be borne solely by the physical therapist:
* Interpretation of referrals when available
* Initial examination, evaluation, diagnosis, and prognosis
* Development or modification of a plan of care that is based on the initial examination or the
reexamination and that includes physical therapy anticipated goals and expected outcomes
* Determination of (1) when the expertise and decision making capability of the physical therapist requires
the physical therapist to personally render physical therapy interventions and (2) when it may be
appropriate to utilize the physical therapist assistant. A physical therapist determines the most appropriate
utilization of the physical therapist assistant that will ensure the delivery of service that is safe, effective,
Page 17 of 17
and efficient.
* Provision of physical therapy interventions
* Reexamination of the patient/client in light of the anticipated goals and expected outcomes, and revision
of the plan of care when indicated
* Establishment of the discharge plan and documentation of discharge summary/status
* Oversight of all documentation for services rendered to each patient
References
[1] Nagi S. Some conceptual issues in disability and rehabilitation. In: Sussman M, ed. Sociology and
Rehabilitation. Washington, DC: American Sociological Association; 1965: 100-113.
[2] Nagi S. Disability and Rehabilitation. Columbus, Ohio: Ohio State University Press; 1969.
[3] Nagi S. Disability concepts revisited: implications for prevention. In: Pope A, Tarlov A, eds. Disability in
America: Toward a National Agenda for Prevention. Washington, DC: Institute of Medicine, National
Academy Press; 1991.
[4] Guccione AA. Physical therapy diagnosis and the relationship between impairments and function.
Phys Ther. 1991;71:499-504.
[5] Defining Primary Care:An Interim Report. Washington, DC: Institute of Medicine, National Academy
Press; 1995.
[6] Guccione AA. Geriatric Physical Therapy, 2nd ed. St Louis, Mo: Mosby; 2000.

Source Citation:"Who Are Physical Therapists, and What Do They Do?." Physical Therapy 81.1 (Jan

Page 1 of 82
What Types of Tests and Measures Do Physical Therapists Use?(A Guide to Physical
Therapist Practice).Physical Therapy 81.1 (Jan 2001): p51. (21248 words)
Introduction
Test and measures are the means of gathering information about the patient/client. Depending on
the data generated during the history and systems review, the physical therapist may use one or
more tests and measures, in whole or in part:
* To help identify and characterize signs and symptoms of pathology/pathophysiology,
impairments, functional limitations, and disabilities
* To establish the diagnosis and the prognosis, to select interventions, and to document changes
in patient/client status
* To indicate achievement of the outcomes that are the end points of care and thereby ensure
timely and appropriate discharge. Physical therapists may perform more than one test or obtain
more than one measurement at a time.
Physical therapists individualize the selection of tests and measures based on the history they
take and systems review they perform, rather than basing their selection on a previously
determined medical diagnosis. When examining a patient/client with impairments, functional
limitations, or disabilities resulting from brain injury, for instance, the physical therapist may decide
to perform part or all of several tests and measures, based on the signs and symptoms of that
particular patient.
What Is Measurement?
Obtaining measurements is an everyday part of physical therapist practice. APTA's Standards for
Tests and Measurements in Physical Therapy Practice[1] state that a measurement is the
"numeral assigned to an object, event, or person or the class (category) to which an object, event,
or person is assigned according to rules." Physical therapists obtain many different types of
measurements. Assessing the magnitude of a patient's report of pain, quantifying muscle
performance or range of motion, describing the various characteristics of a patient's gait pattern,
categorizing the assistance that a patient requires to dress--all of these are measurements. The
physical therapist collects data through many different methods, such as interviewing;
observation; questionnaires; palpation; auscultation; conducting performance based assessments;
electrophysiological testing; taking photographs and making other videographic recordings;
recording data using scales, indexes, and inventories; obtaining data through the use of
technology-assisted devices; administering patient/client self-assessment tests; and reviewing
patient/client diaries and logs.
Physical therapists use tests and measures to obtain measurements, which they then interpret to
identify:
Page 2 of 82
* Signs and symptoms of pathology/pathophysiology (disease, disorder, or condition), such as

joint tenderness, pain, elevated blood pressure with activity, numbness and tingling, and edema
* Impairments, such as aerobic capacity; anthropometric characteristics; arousal, attention, and
cognition; circulation; cranial and peripheral nerve integrity; ergonomics and body mechanics; gait,
locomotion, and balance; integumentary integrity; joint integrity and mobility; motor function;
muscle performance; neuromotor development and sensory integration; posture; range of motion;
reflex integrity; sensory integrity; and ventilation and respiration/gas exchange
* Functional limitations, such as work (job/school/ play), community, and leisure integration or
reintegration (including instrumental activities of daily living), ergonomics and body mechanics,
and self-care and home management (including activities of daily living and instrumental activities
of daily living)
* Disabilities, such as inability to engage in community, leisure, social, and work roles
* Device and equipment need and use, such as assistive and adaptive devices; orthotic,
protective, and supportive devices; and prosthetic devices
* Barriers, such as environmental, home, and work (job/school/play) barriers
In the evaluation process, the physical therapist synthesizes the examination data to establish the
diagnosis and prognosis (including the plan of care). The data gathered through the use of tests
and measures during initial examination provide information used for determining anticipated
goals and expected outcomes. These data may indicate initial abilities in performing actions,
tasks, and activities; establish criteria for placement decisions; and identify level of safety in
performing a particular task or risk of injury with continued performance with or without devices
and equipment. Reexamination at regular intervals during an episode of care enables the physical
therapist to measure and document changes in patient/client status and the progress that the
patient/client is making toward the anticipated goals and expected outcomes.
Whenever possible, physical therapists should use measurements whose reliability and validity
have been documented in the peer-reviewed literature. Reliable and valid measurements enable
physical therapists to gauge the certainty of their examination data and the appropriate scope of
inferences that may be drawn from those data. Reliability and validity are properties of a
measurement, not the test or measure that is used to obtain the measurement. A measurement is
reliable only under certain conditions and for certain types of patients/clients and is valid only for a
particular purpose.
Reliability and validity have not yet been reported for every measurement used by physical
therapists. Use of measurements without established reliability and validity may be appropriate,
however, especially when there are no alternatives-and provided that the physical therapist is
aware that those measurements may be prone to error and that, therefore, decisions made using
those measurements may be less certain.
Reliability of Measurements
Assessing a measurement's reliability is an attempt to identify sources of error.[2(p73-74)] A
measurement is said to be reliable when it is consistent time after time, with as little variation as
possible. Because all measurements have some error, however, the clinician must determine
whether a measurement is useful or whether there is so much error that the measurement is
rendered useless for a particular purpose.
Page 3 of 82
Two major types of reliability--test-retest and intratester/intertester--help determine how much

error exists in a measurement. Test-retest reliability is the consistency of repeated measurements
that are separated in time when there is no change in what is being measured; test-retest
reliability indicates the stability of a measurement. Intrarater reliability indicates the degree to
which measurements that are obtained by the same physical therapist at different times will be
consistent.
Interrater reliability indicates the degree to which measurements obtained by multiple therapists
will be consistent.[1] Interrater reliability is especially important-if different physical therapists
obtain different measurements when measuring the same phenomenon, the usefulness of the
measurements is limited.
There are two other forms of reliability: parallel-form reliability, which relates to measurements that
are obtained by using different versions of the same test or measure, and internal consistency, or
homogeneity, which relates to measurements that are obtained by using tests or measures with
multiple items or parts, where each part is supposed to measure one, and only one, concept.[1]
Validity of Measurements
Validity is the "degree to which a useful (meaningful) interpretation can be inferred from a
measurement."[1]
There are many forms of validity, including face validity, content validity, construct validity,
concurrent validity, and predictive validity.
Face validity exists when the measurement seems to reflect what is supposed to be measured-but
it does not depend on evidence. Goniometric measurements, for instance, have face validity as
measurements of joint position.
Content validity establishes the degree to which a measurement reflects the domain of interest.
For example, an instrument that is used to assess joint pain might generate data only regarding
pain on motion, not pain at rest or factors that aggravate or alleviate pain.
Construct validity is a theoretical form of validity that is established on the basis of evidence that a
measurement represents the underlying concept of what is to be measured.[1] For example, the
overall concept of "motor function" is the construct that underlies any particular test or measure of
motor function. There are no direct tests of construct validity. Theoretical evidence of construct
validity is often provided by demonstrating convergence if tests or measures believed to represent
the same construct are highly related. For example, a test of motor function, based on a particular
concept of what "motor function" means, should correlate highly with other tests or measures
based on similar conceptions of "motor function" or on concepts that are closely related to "motor
function," such as "dexterity" and "coordination." Evidence of construct validity is also found when
there is a low association, or divergence, between a test or measure of one particular construct
and other tests or measures reflecting distinctly different, or even unrelated, constructs. For
example, there should be a low association between a test or measure of "motor function" and
tests and measures that are based on the concepts of "aerobic conditioning" or "range of motion."
Concurrent validity exists when "an inferred interpretation is justified by comparing a measurement
with supporting evidence that was obtained at approximately the same time as the measurement
being validated."[1] The developers of a new balance test might compare the measurements
obtained using the new test to those obtained using an established balance test involving one
legged stance. The comparative method of establishing concurrent validity is particularly relevant
Page 4 of 82
for self-assessment instruments.

Predictive validity exists when "an inferred interpretation is justified by comparing a measurement
with supporting evidence that is obtained at a later point in time" and "examines the justification of
using a measurement to say something about future events or conditions."[1] The predictive
validity of a measurement of functional capacity might be established by verifying whether the
measurement indicates the likelihood of return to work. Knowing the predictive validity of a
measurement may facilitate the identification of achievable outcomes and increase the efficiency
of discharge planning.
Predictive validity also may provide the physical therapist with several kinds of information about
the value of selecting particular tests or measures for the examination. The sensitivity of a
measurement indicates the proportion of individuals with a positive finding who already have or
will have a particular characteristic or outcome.[1,3,4] In other words, sensitivity is the positive
predictive validity of the measurement. In contrast, the specificity of a measurement indicates the
proportion of people who have a negative finding on a test or measure who truly do not or will not
have a particular characteristic or outcome.[1,3,4] Thus, specificity is the negative predictive
validity of the test or measure.
Clinical Utility
In addition to reliability and validity of the measurements obtained with a given test or measure, a
physical therapist considers the clinical utility of the test or measure for a particular purpose.
Physical therapists should consider the precision of the data yielded by a test or measure and
whether it will meet the needs of the situation. Some measurements are only gross
measurements. Gross measurements may be useful for a population screen but may not be
useful for identifying a small change in patient/client status after intervention. The measurements
used by the physical therapist should always be sensitive enough to detect the degree of change
expected as a result of intervention. The physical therapist also should consider the time involved
in administering a test or measure, the cost of administering it, and such patient/client factors as
tolerance of testing positions and suitability of the test or measure to a particular population.
Guide Categories for Tests and Measures
This chapter contains 24 categories of tests and measures (Figure) that the physical therapist may
decide to use during an examination. Tests and measures are listed in alphabetical order. In Part
Two, each preferred practice pattern contains a list of tests and measures that are used in the
examination of patients/clients who are classified in the diagnostic group for that pattern. Part
Three of the Guide, available on CD-ROM, provides available information on tests and measures
used by physical therapists, including the reliability and validity of measurements that are obtained
using those tests and measures. Physical therapists may decide to use other tests and measures
that are not described in the Guide, following the principles stated in the Standards for, Tests and
Measurements in Physical Therapy Practice.[1]
Figure
Guide Categories for Tests and Measures
Aerobic Capacity/Endurance
Anthropometric Characteristics
Arousal, Attention, and Cognition
Assistive and Adaptive Devices
Circulation (Arterial, Venous, Lymphatic)
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Cranial and Peripheral Nerve Integrity

Environmental, Home, and Work (Job/School/Play) Barriers
Ergonomics and Body Mechanics
Gait, Locomotion, and Balance
Integumentary Integrity
Joint Integrity and Mobility
Motor Function (Motor Control and Motor Learning)
Muscle Performance (Including Strength, Power, and Endurance)
Neuromotor Development and Sensory Integration
Orthotic, Protective, and Supportive Devices
Pain
Posture
Prosthetic Requirements
Range of Motion (Including Muscle Length)
Reflex Integrity
Self-Care and Home Management (Including Activities of Daily Living
and Instrumental Activities of Daily Living)
Sensory Integrity
Ventilation and Respiration/Gas Exchange
Work (Job/School/Play), Community, and Leisure Integrity or
Reintegration
(Including Instrumental Activities of Daily Living)
* General definition and purpose of the test and measure. A definition and purpose of the test and
measure is provided. All tests and measures produce information used to identify the possible or
actual causes of difficulties during performance of essential everyday activities, work tasks, and
leisure pursuits. Selection of tests and measures depends on the findings of the history and
systems review. The examination findings may indicate, for instance, that tests should be
conducted while the patient/client performs specific activities. In all cases, the purpose of tests
and measures is to ensure the gathering of information that will lead to evaluation, diagnosis,
prognosis, and selection of appropriate interventions.
* Clinical indications. Examples of clinical indications that are identified during the history and
systems review are provided to indicate the use of tests and measures. Special requirements may
prompt the physical therapist to perform tests and measures. All tests and measures are
appropriate in the presence of:
- impairment, functional limitation, disability, developmental delay, injury, or suspected or identified
pathology that prevents or alters performance of daily activities, including self-care, home
management, work (job/school/play), community, and leisure actions, tasks, or activities
- requirements of employment that specify minimum capacity for performance
- identified risk factors
- need to initiate programs that promote health, wellness, or fitness
* Tests and measures (methods and techniques). Examples of specific tests and measures are
provided.
* Tools used for gathering data. A listing of tools used for collecting data is provided.
* Data generated. Types of data that may be generated from the tests and measures are listed.
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Other information that may be required for the examination includes findings of other
professionals; results of diagnostic imaging, clinical laboratory, and electrophysiological studies;
federal, state, and local work surveillance and safety reports and announcements; and the
reported observations of family members, significant others, caregivers, and other interested
people.
Physical therapists are the only professionals who provide physical therapy. Physical therapist
assistants--under the direction and supervision of the physical therapist-are the only
paraprofessionals who assist in the provision of physical therapy interventions. APTA
recommends that federal and state government agencies and other third-party payers require
physical therapy to be provided only by a physical therapist or under the direction and supervision
of a physical therapist. Examination, evaluation, diagnosis, and prognosis should be represented
and reimbursed as physical therapy only when performed by a physical therapist. Intervention
should be represented and reimbursed as physical therapy only when performed by a physical
therapist or by a physical therapist assistant under the direction and supervision of a physical
therapist. Note: The terms "physical therapy" and "physiotherapy," and the terms "physical
therapist" and "physiotherapist," are synonymous.
References
[1] American Physical Therapy Association. Standards for Tests and Measurements in Physical
Therapy Practice. Phys Ther. 1991;71:589-622.
[2] Rothstein JM, Echternach JL. Primer on Measurement: An Introductory Guide to Measurement
Issues. Alexandria, Va: American Physical Therapy Association; 1993.
[3] Jaeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature. III. How to use an
article about a diagnostic test. B. What are the results and how will they help me in caring for my
patients? The Evidence-Based Medicine Working Group. JAMA. 1994;271:703-707.
[4] Sackett DL, Straus SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and
Teach EBM. 2nd ed. New York, NY: Churchill Livingstone Inc; 2000.
Tests and Measures
Aerobic Capacity/Endurance
Aerobic capacity/endurance is the ability to perform work or participate in activity over time using
the body's oxygen uptake, delivery, and energy release mechanisms. During activity, the physical
therapist uses tests and measures ranging from simple measurements to complex calculations to
determine the appropriateness of patient/client responses to increased oxygen demand.
Responses that are monitored both at rest and during and after activity may indicate the degree of
severity of the impairment, functional limitation, or disability. Results of tests and measures of
aerobic capacity/endurance are integrated with the history and systems review findings and the
results of other tests and measures. All of these data are then synthesized during the evaluation
process to establish the diagnosis, the prognosis, and the plan of care, which includes the
selection of interventions. The results of these tests and measures may indicate the need to use
or recommend other tests and measures or the need to consult with, or refer the patient/client to,
another professional.
Clinical Indications
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Clinical indications for the use of tests and measures are predicated on the history and systems
review findings (eg, information provided by the patient/client, family, significant other, or
caregiver; symptoms described by the patient/client; signs observed and documented during the
systems review; and information derived from other sources and records). The findings may
indicate the presence of or risk for pathology/pathophysiology (disease, disorder, or condition),
impairments, functional limitations, or disabilities that require a more definitive examination
through the selection of tests and measures of aerobic capacity/endurance. Clinical indications for
these tests and measures may include:
* Pathology/pathophysiology (disease, disorder, or condition) in the following systems:
- cardiovascular (eg, cerebral vascular accident, coronary artery disease, peripheral vascular
disease)
- endocrine/metabolic (eg, osteoporosis) multiple systems (eg,AIDS, trauma)
- musculoskeletal (eg, arthritis)
- neuromuscular (eg, cerebral palsy, Parkinson disease)
- pulmonary (eg, emphysema, pulmonary fibrosis)
* Impairments in the following categories:
- circulation (eg, abnormal heart rate, rhythm, blood pressure)
- muscle performance (eg, generalized muscle weakness, decreased muscle endurance)
- posture (eg, abnormal body alignment)
- range of motion (eg, asymmetrical chest wall motion, thorax tightness)
- ventilation and respiration/gas exchange (eg, abnormal respiratory pattern, rate, rhythm)
* Functional limitations in the ability to perform actions, tasks, and activities in the following
categories:
- self-care (eg, inability to perform shower or overhead activities because of shortness of breath)
- home management (eg, inability to vacuum or make the bed because of chest discomfort)
- work (job/school/play) (eg, inability to keep up with peers during recess, inability as a parent to
carry a child up the stairs because of increasing sense of fatigue, inability to perform overhead
lifting tasks because of shortness of breath)
- community/leisure (eg, inability to walk to religious activities because of shortness of breath,
difficulty with gardening because of chest discomfort)
* Disability--that is, the inability or the restricted ability to perform actions, tasks, or activities of
required roles within the individual's sociocultural context--in the following categories:
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- self-care
- home management
- work (job/school/play)
- community/leisure
* Risk factors for impaired aerobic capacity:
- family history of cardiovascular or pulmonary disease
- obesity
- sedentary lifestyle
- smoking history
* Health, wellness, and fitness needs:
- fitness, including physical performance (eg, submaximal oxygen uptake for age and sex,
submaximal running efficiency for sprint)
- health and wellness (eg, incomplete understanding of role of aerobic capacity/endurance during
activities)
Tests and Measures
Tests and measures may include those that characterize or quantify:
* Aerobic capacity during functional activities (eg, activities of daily living [ADL] scales, indexes,
instrumental activities of daily living [IADL] scales, observations)
* Aerobic capacity during standardized exercise test protocols (eg, ergometry, step tests,
time/distance walk/run tests, treadmill tests, wheelchair tests)
* Cardiovascular signs and symptoms in response to increased oxygen demand with exercise or
activity, including pressures and flow; heart rate, rhythm, and sounds; and superficial vascular
responses (eg, angina, claudication, dyspnea, and exertion scales; electrocardiography;
observations; palpation; sphygmomanometry)
* Pulmonary signs and symptoms in response to increased oxygen demand with exercise or
activity, including breath and voice sounds; cyanosis; gas exchange; respiratory pattern, rate, and
rhythm; and ventilatory flow, force, and volume (eg, auscultation, dyspnea and exertion scales,
gas analyses, observations, oximetry, palpation, pulmonary function tests)
Tools Used for Gathering Data
Tools for gathering data may include:
* Devices for gas analysis
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* Electrocardiographs
* Ergometers
* Force meters
* Indexes
* Measured walkways
* Nomograms
* Observations
* Palpation
* Pulse oximeters
* Scales
* Sphygmomanometers
* Spirometers
* Steps
* Stethoscopes
* Stop watches
* Treadmills
Data Generated
Data are used in providing documentation and may include:
* Cardiovascular and pulmonary signs, symptoms, and responses per unit of work
* Gas volume, concentration, and flow per unit of work
* Heart rate, rhythm, and sounds per unit of work
* Oxygen uptake during functional activity
* Oxygen uptake, time and distance walked or bicycled, and maximum aerobic performance
* Peripheral vascular responses per unit of work
* Respiratory rate, rhythm, pattern, and breath sounds per unit of work
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Anthropometric characteristics are those traits that describe body dimensions, such as height,
weight, girth, and body fat composition. The physical therapist uses tests and measures to
quantify these traits. Results of tests and measures of anthropometric characteristics are
integrated with the history and systems review findings and the results of other tests and
measures. All of these data are then synthesized during the evaluation process to establish the
diagnosis, the prognosis, and the plan of care, which includes the selection of interventions. The
results of these tests and measures may indicate the need to use or recommend other tests and
measures or the need to consult with, or refer the patient/client to, another professional.
Clinical indications for tests and measures are predicated on the history and systems review
findings (egg, information provided by the patient/client, family, significant other, or caregiver;
symptoms described by the patient/client; signs observed and documented during the systems
review; and information derived from other sources and records). The findings may indicate the
presence of or risk for pathology/pathophysiology (disease, disorder, or condition), impairments,
functional limitations, or disabilities that require a more definitive examination through the
selection of tests and measures of anthropometric characteristics. Clinical indications for these
tests and measures may include:
- cardiovascular (eg, ascites, lymphedema) genitourinary (eg, pregnancy) multiple systems
(eg,AIDS, cancer)
- musculoskeletal (eg, amputation, muscular dystrophy)
- neuromuscular (eg, prematurity, spinal cord injury)
- pulmonary (eg, cystic fibrosis)
- circulation (eg, abnormal blood pressure, abnormal fluid distribution)
- muscle performance (eg, generalized muscle weakness)
- neuromotor development (eg, abnormal growth rate)
- range of motion (eg, abnormal fluid distribution)
- ventilation and respiration (eg, abnormal rate and rhythm)
* Functional limitations in the ability to perform actions, tasks, or fixed activities in the following
categories:
- self-care (eg, inability to dress and reach because of abnormal fat or fluid distribution)
- home management (eg, inability to get down on knees to clean floor because of weight
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abnormality)
- work (job/school/play) (eg, inability to assume parenting role because of impaired fluid
distribution from pregnancy, inability to gain access to classroom environment because of delayed
growth, inability to perform filing tasks because of decreased range of motion and muscle
weakness)
- community/leisure (eg,inability to fish because of generalized muscle weakness, inability to
participate in amateur sports because of edema, inability to participate in social activities because
of perceived body image as a result of impaired fluid distribution)
- self-care
- home management
- community/leisure
* Risk factors for impaired anthropometric characteristics:
- anorexia
- obesity
* Health, wellness, and fitness needs: - fitness, including physical performance (eg, inefficient
sprinting because of excess body fat, limited endurance for long-distance hiking because of
inappropriate body composition)
- health and wellness (eg, incomplete understanding of the relationship between nutrition and
body composition)
Tests and Measures
* Body composition (eg, body mass index, impedance measurement, skinfold thickness
measurement)
* Body dimensions (eg, body mass index, girth measurement, length measurement)
* Edema (eg, girth measurement, palpation, scales, volume measurement)
Fools for gathering data may include:
* Body mass index
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* Calipers
* Cameras and photographs
* Impedance devices
* Nomograms
* Palpation
* Rulers
* Scales
* Tape measures
* Volumometers
* Weight scales
Data Generated
* Height and weight
* Presence and severity of abnormal body fluid distribution
Arousal is a state of responsiveness to stimulation or action or of physiological readiness for
activity. Attention is the selective awareness of the environment or selective responsiveness to
stimuli. Cognition is the act or process of knowing, including both awareness and judgment. The
physical therapist uses tests and measures to characterize the patient's/client's responsiveness.
Results of tests and measures of arousal, attention, and cognition are integrated with the history
and systems review findings and the results of other tests and measures. All of these data are
then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the
plan of care, which includes the selection of interventions. The results of these tests and
measures may indicate the need to use or recommend other tests and measures or the need to
consult with, or refer the patient/client to, another professional.
through the selection of tests and measures of arousal, attention, and cognition. Clinical
indications for these tests and measures may include:
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- cardiovascular (eg, malignant hypertension, cerebral vascular accident)
- multiple systems (eg, Down syndrome)
- neuromuscular (eg, hydrocephalus, traumatic brain injury)
- pulmonary (eg, end-stage chronic obstructive pulmonary disease)
- arousal (eg, lack of response to stimulation)
- circulation (eg, abnormal blood pressure in shock)
- cognition (eg, inability to follow instructions)
- motor function (eg, inability to plan and carry out movement)
- ventilation and respiration (eg, hypoventilation, somnolence)
* Functional limitations in the ability to perform actions, tasks, or activities in the following
categories:
- self-care (eg, inability to perform bathroom transfers because of lack of safety awareness)
- home management (eg, decreased environmental mobility in the home because of lack of safety
awareness)
- work (job/school/play) (eg, inability to perform bricklaying because of inability to recall steps of
task, inability to play at age-appropriate level because of lack of internal desire to move)
- community/leisure (eg, inability to participate as volunteer at child's school because of
inattention, inability to participate in routine exercise program because of lack of interest)
- self-care
- home management
- community/leisure
* Risk factors for impaired arousal, attention, and cognition
- inability to manage stress
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- lack of motivation
- poor attitude
- fitness, including physical performance (eg, impaired judgment during workout, ineffective
attention and recall for complete training regimen)
- health and wellness (eg, incomplete understanding of the role of attention to safety during
activities)
Tests and Measures
* Arousal and attention (eg, adaptability tests, arousal and awareness scales, indexes, profiles,
questionnaires)
* Cognition, including ability to process commands (eg, developmental inventories, indexes,
interviews, mental state scales, observations, questionnaires, safety checklists)
* Communication (eg, functional communication profiles, interviews, inventories, observations,
questionnaires)
* Consciousness, including agitation and coma (eg, scales)
* Motivation (eg, adaptive behavior scales)
* Orientation to time, person, place, and situation (eg, attention tests, learning profiles, mental
state scales)
* Recall, including memory and retention (eg, assessment scales, interviews, questionnaires)
Tools Use for Data Collection
* Adaptability tests
* Attention tests
* Indexes
* Interviews
* Inventories
* Observations
* Profiles
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* Questionnaires
* Safety checklists
* Scales
* Screening tests
Data Generated
* Descriptions of short-term and long-term memory
* Presence and severity of:
- cognitive impairment
- coma
- communication deficits depression or impaired motivation impaired consciousness
* Quantifications or characterization of:
- ability to attend to task or to
- participate
- ability to recognize time, person, place, and situation
Assistive and adaptive devices are implements and equipment used to aid patients/clients in
performing tasks or movements. Assistive devices include crutches, canes, walkers, wheelchairs,
power devices, long-handled reachers, percussors, static and dynamic splints, and vibrators.
Adaptive devices include raised toilet seats, seating systems, and environmental controls. The
physical therapist uses tests and measures to determine whether a patient/client might benefit
from such a device or, when such a device already is in use, to assess how well the patient/client
performs with it. Results of tests and measures of assistive and adaptive devices are integrated
with the history and systems review findings and the results of other tests and measures. All of
these data are then synthesized during the evaluation process to establish the diagnosis, the
prognosis, and the plan of care, which indudes the selection of interventions. The results of these
tests and measures may indicate the need to use or recommend other tests and measures or the
need to consult with, or refer the patient/client to, another professional.
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through the selection of tests and measures of assistive and adaptive devices. Clinical indications
for these tests and measures may include:
- cardiovascular (eg, cerebral vascular accident, coronary artery disease)
- endocrine/metabolic (eg, diabetes)
- integumentary (eg, surgical wound, vascular ulcer)
- multiple systems (eg, sarcoidosis, trauma)
- musculoskeletal (eg, arthritis, sprain, strain)
- neuromuscular (eg, cerebral palsy, spina bifida, spinal cord injury)
- pulmonary (eg, amyotrophic lateral sclerosis, respiratory failure)
- aerobic capacity (eg, decreased endurance)
- gait, locomotion, and balance (eg, frequent falls)
- motor function (eg, inability to sit)
- muscle performance (eg, weakness)
- range of motion (eg, pain on reaching)
* Functional limitations in the ability to perform actions, tasks, or activities in following categories:
- self-care (eg, inability to dress because of difficulty with sitting)
- home management (eg, inability to remove items from closet shelf because of limited range of
motion)
- work (job/school/play) (eg, difficulty with keyboarding because of pain, inability to attend school
because of lack of endurance, inability to get to work because of distance that must be traveled to
work site)
- community/leisure (eg, inability to walk on uneven surfaces because of altered balance)
- self-care
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- home management
- community/leisure
* Risk factor for improper use or lack of use of assistive and adaptive devices
- inactivity
- fitness, including physical performance (eg, inability to participate in wheelchair sports, poor
wheelchair tolerance because of inadequate fit)
- health and wellness (eg, in adequate knowledge of how to regularly assess devices)
Tests and Measures
* Assistive or adaptive devices and equipment use during functional activities (eg, activities of
daily living [ADL], functional scales, instrumental activities of daily living [IADL] scales, interviews,
observations)
* Components, alignment, fit, and ability to care for the assistive or adaptive devices and
equipment (eg, interviews, logs, observations, pressure-sensing maps, reports)
* Remediation of impairments, functional limitations, or disabilities with use of assistive or adaptive
devices and equipment (eg, activity status indexes, ADL scales, aerobic capacity tests, functional
performance inventories, health assessment questionnaires, IADL scales, pain scales, play
scales, videographic assessments)
* Safety during use of assistive or adaptive devices and equipment (eg, diaries, fall scales,
interviews, logs, observations, reports)
* Activity status indexes
* Aerobic capacity tests
* Diaries
* Functional performance inventories
* Health assessment questionnaires
* Interviews
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* Logs
* Observations
* Pressure-sensing devices
* Reports
* Scales
* Video cameras and videotapes
Data Generated
* Descriptions of:
- alignment and fit of devices and equipment
- ability to use and care for devices and equipment
- components of assistive and adaptive devices and equipment level of safety with devices and
equipment
- practicality of devices and equipment
- remediation of impairment, functional limitation, or disability with devices and equipment
* Quantifications of:
- movement patterns with or without devices and equipment
- physiological and functional effect and benefit of devices and equipment
Circulation (Arterial, Venous, Lymphatic)
Circulation is the movement of blood through organs and tissues to deliver oxygen and to remove
carbon dioxide and the passive movement (drainage) of lymph through channels, organs, and
tissues for removal of cellular byproducts and inflammatory wastes. The physical therapist uses
the results of circulation tests and measures to determine whether the patient/client has adequate
cardiovascular pump, circulation, oxygen delivery, and lymphatic drainage systems to meet the
body's demands at rest and with activity. Results of tests and measures of circulation (arterial,
venous, lymphatic) are integrated with the history and systems review findings and the results of
other tests and measures. All of these data are then synthesized during the evaluation process to
establish the diagnosis, the prognosis, and the plan of care, which includes the selection of
interventions. The results of these tests and measures may indicate the need to use or
recommend other tests and measures or the need to consult with, or refer the patient/client to,
Page 19 of 82
systems review; and information derived from other sources and records).The findings may
through the selection of tests and measures of circulation (arterial, venous, lymphatic). Clinical
- cardiovascular (eg, atherosclerosis, coronary artery bypass graft, lymphedema)
- endocrine/metabolic (eg, diabetes, reflex sympathetic dystrophy)
- genitourinary (eg, renal failure)
- integumentary (eg, cellulitis, lymphadenitis)
- multiple systems (eg, cancer, trauma)
- musculoskeletal (eg, fracture)
- neuromuscular (eg, multiple sclerosis, spinal cord injury)
- aerobic capacity (eg, shortness of breath)
- circulation (eg, swollen feet)
- gait, locomotion, and balance (eg, dizziness on rising from sitting to standing position)
- muscle performance (eg, palpitations on stair climb)
- ventilation and respiration (eg, shortness of breath at night)
categories:
- self-care (eg, difficulty with eating because of indigestion)
- home management (eg, inability to mow lawn because of leg cramps)
- work (job/school/play) (eg, difficulty with loading cargo because of shortness of breath, inability
to support family financially because of shortness of breath with manual labor)
- community/leisure (eg, inability to play tennis because of chest and shoulder pain, inability to
walk to the senior center because of leg pain)
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- self-care
- home management
- community/leisure
* Risk factors for impaired circulation:
- obesity
- positive family history of cardiovascular disease
- smoking history
- fitness, including physical performance (eg, inadequate circulation for cross-country skiing,
inadequate protection of extremities during extended activities in cold weather )
- health and wellness (eg, incomplete understanding of importance of motion to circulation)
Tests and Measures
* Cardiovascular signs, including heart rate, rhythm, and sounds; pressures and flow; and
superficial vascular responses (eg, auscultation, claudication scales, electrocardiography, girth
measurement, observations, palpation, sphygmomanometry, thermography)
* Cardiovascular symptoms (eg, angina, claudication, dyspnea, and perceived exertion scales)
* Physiological responses to position change, including autonomic responses, central and
peripheral pressures, heart rate and rhythm, respiratory rate and rhythm, ventilatory pattern (eg,
auscultation, electrocardiography, observations, palpation, sphygmomanometry)
* Doppler ultrasonographs
* Electrocardiographs
* Observations
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* Palpation
* Scales
* Sphygmomanometers
* Stethoscopes
* Tape measures
* Thermographs
* Tilt tables
Data Generated
* Characterizations of:
- central pressure and volume
- intracranial pressure responses
- physiological responses to position change
* Descriptions of:
- peripheral arterial circulation
- peripheral lymphatic circulation
- peripheral venous circulation
- skin color
- nail changes
* Presence of bruits
* Presence and severity of:
- abnormal heart sounds
- abnormal heart rate or rhythm at rest
- cardiovascular signs and symptoms
- edema
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* Quantifications of cardiovascular pump demand

* Vital signs at rest
Cranial and Peripheral Nerve Integrity
Cranial nerve integrity is the intactness of the twelve pairs of nerves connected with the brain,
including their somatic, visceral, and afferent and efferent components. Peripheral nerve integrity
is the intactness of the spinal nerves, including their afferent and efferent components. The
physical therapist uses tests and measures to assess the cranial and peripheral nerves. Results of
tests and measures of cranial and peripheral nerve integrity are integrated with the history and
systems review findings and the results of other tests and measures. All of these data are then
synthesized during the evaluation process to establish the diagnosis, the prognosis, and the plan
of care, which includes the selection of interventions. The results of these tests and measures
may indicate the need to use or recommend other tests and measures or the need to consult with,
or refer the patient/client to, another professional.
through the selection of tests and measures of cranial and peripheral nerve integrity. Clinical
- cardiovascular (eg, cerebral vascular accident)
- endocrine/metabolic (eg, Meniere disease, viral encephalitis)
- integumentary disease/disorder (eg, neuropathic ulcer)
- multiple systems (eg, Guillain-Barre syndrome)
- neuromuscular (eg, Erb palsy, labyrinthitis)
- pulmonary (eg, amyotrophic lateral sclerosis)
- cranial nerve and peripheral nerve integrity (eg, numb and tingling fingers)
- gait, locomotion, and balance (eg, staggering gait)
- motor function (eg, numbness of foot leading to falls)
- muscle performance (eg, weakness of upper extremity)
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- ventilation (eg, decreased expansion and excursion)

categories:
- self-care (eg, difficulty with eating because of swallowing difficulties)
- home management (eg, decreased environmental mobility in the home because of
unsteadiness)
- work (job/school/play) (eg, inability to perform activities as a stuntperson because of difficulty
with coordination, inability to perform electrical wiring and circuitry because of numbness of
fingers)
- community/leisure (eg, inability to play cards because of proprioceptive deficit, inability to sing in
choir because of inadequate phonation control)
* Disability-that is, the inability or the restricted ability to perform actions, tasks, or activities of
required roles within the individual's sociocultural context-in the following categories:
- self-care
- home management
- community/leisure
* Risk factors for impaired cranial and peripheral nerve integrity.
- habitual suboptimal posture
- increased risk for falls
* Health, wellness, and fitness needs.'
- fitness, including physical performance (eg, inadequate hand control in school child, limited
neuromuscular control of jumping)
- health and wellness (eg, incomplete comprehension of value of sensation in gross motor
activities)
Tests and Measures
* Electrophysiological integrity (eg, electroneuromyography)
* Motor distribution of the cranial nerves (eg, dynamometry, muscle tests, observations)
* Motor distribution of the peripheral nerves (eg, dynamometry, muscle tests, observations,
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thoracic outlet tests)

* Response to neural provocation (eg, tension tests, vertebral artery compression tests)
* Response to stimuli, including auditory, gustatory, olfactory, pharyngeal, vestibular, and visual
(eg, observations, provocation tests)
* Sensory distribution of the cranial nerves (eg, discrimination tests; tactile tests, including coarse
and light touch, cold and heat, pain, pressure, and vibration)
* Sensory distribution of the peripheral nerves (eg, discrimination tests; tactile tests, including
coarse and light touch, cold and heat, pain, pressure, and vibration; thoracic outlet tests)
* Dynamometers
* Electroneuromyographs
* Muscle tests
* Observations
* Palpation
* Provocation tests
* Scales
* Sensory tests
Data Generated
* Descriptions and quantification of:
- sensory responses to provocation of cranial and peripheral nerves
- vestibular responses
* Descriptions of ability to swallow
* Presence or absence of gag reflex
* Quantifications of electrophysiological response to stimulation
* Response to neural provocation
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Environmental, home, and work (job/school/play) barriers are the physical impediments that keep
patients/clients from functioning optimally in their surroundings. The physical therapist uses the
results of tests and measures to identify any of a variety of possible impediments, including safety
hazards (eg, throw rugs, slippery surfaces), access problems (eg, narrow doors, thresholds, high
steps, absence of power doors or elevators), and home or office design barriers (eg, excessive
distances to negotiate, multistory environments, sinks, bathrooms,counters, placement of controls
or switches). The physical therapist also uses the results to suggest modifications to the
environment(eg, grab bars in the shower, ramps, raised toilet seats, increased lighting) that will
allow the patient/client to improve functioning in the home, workplace, and other settings.
Results of tests and measures of environmental, home, and work (job/school/play) barriers are
through the selection of tests and measures of environmental, home, and work (job/school/play)
barriers. Clinical indications for these tests and measures may include:
- cardiovascular (eg, congestive heart failure)
- multiple systems (eg, trauma)
- musculoskeletal (eg, amputation, joint replacement, muscular dystrophy)
- neuromuscular (eg, cerebral palsy, multiple sclerosis, traumatic brain injury)
- pulmonary (eg, chronic obstructive pulmonary disease)
* Impairments in the following categories.
- circulation (eg, calf cramps with walking)
- gait, locomotion, and balance (eg, ataxic gait)
- muscle performance (eg, decreased muscle strength and endurance)
- ventilation (eg, increased respiratory rate)
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categories:
- self-care (eg, inability to get into bathtub because of decreased muscle strength)
- home management (eg, inability to climb stairs to bathroom because of decreased muscle
endurance)
- work (job/school/play) (eg, inability as a student to gain wheelchair access to science station in
school because of station height, inability to enter building because no ramp is available)
- community/leisure (eg, inability to join friends on sailboat because of dock instability, inability to
walk on beach because of ataxic gait)
* Disability-that is, the inability or the restricted ability to perform actions, tasks, or activities of
- self-care
- home management
- community/leisure
* Risk factors for environmental, home, and work barriers.
- decreased accessibility to home, work (job/school/play), community, and leisure environments
- lack of emergency evacuation plan
- fitness, including physical performance (eg, inability to negotiate uneven terrains, limited ability to
gain access to outdoor trails)
- health and wellness (eg, incomplete understanding of how to assess terrains for more efficient
functioning)
Tests and Measures
* Current and potential barriers (eg, checklists, interviews, observations, questionnaires)
* Physical space and environment (eg, compliance standards, observations, photographic
assessments, questionnaires, structural specifications, technology-assisted assessments,
videographic assessments)
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Tools for gathering data include:
* Checklists
* Interviews
* Observations
* Questionnaires
* Structural specifications
* Technology-assisted analysis systems
Data Generated
* Descriptions of:
- barriers
- environment
* Documentation and description of compliance with regulatory standards
* Observations of environment
* Quantifications of physical space
Ergonomics is the relationship among the worker; the work that is done; the actions, tasks, or
activities inherent in that work (job/school/play); and the environment in which the work
(job/school/play) is performed. Ergonomics uses scientific and engineering principles to improve
safety, efficiency, and quality of movement involved in work (job/school/play). Body mechanics are
the interrelationships of the muscles and joints as they maintain or adjust posture in response to
forces placed on or generated by the body. The physical therapist uses these tests and measures
in examining both the worker and the work (job/school/play) environment and in determining the
potential for trauma or repetitive stress injuries from inappropriate workplace design. These tests
and measures may be conducted after a work injury or as a preventive step. The physical
therapist may conduct tests and measures as part of work hardening or work conditioning
programs and may use the results of tests and measures to develop such programs.
Results of tests and measures of ergonomics and body mechanics are integrated with the history
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and systems review findings and the results of other tests and measures. All of these data are
then synthesized during the evaluation process to establish the diagnosis, the prognosis, and the
plan of care, which includes the selection of interventions. The results of these tests and
through the selection of tests and measures of ergonomics and body mechanics. Clinical
- cardiovascular (eg, coronary artery disease)
- endocrine/metabolic (eg, pregnancy)
- multiple systems (eg, deconditioning)
- musculoskeletal (eg, repetitive strain injury, scoliosis, spinal stenosis)
- neuromuscular (eg, paroxysmal positional vertigo, spina bifida)
- pulmonary (eg, ventilatory pump disorders)
- aerobic capacity (eg, decreased endurance and shortness of breath)
- circulation (eg, abnormal heart rate and rhythm)
- gait, locomotion, and balance (eg, dizziness)
- muscle performance (eg, decreased power)
- range of motion (eg, decreased range of motion)
categories.
- home management (eg, inability to lift laundry basket because of decreased range of motion)
- community/leisure (eg, inability to bowl because of decreased muscle power, inability to deliver
meals-onwheels because of poor sitting tolerance)
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- self-care (eg, inability to tie shoes because of dizziness)

- work (job/school/play) (eg, inability to carry school back pack because of pain, inability to rotate
trunk at assembly line because of pain)
* Disablity--that is, the inability or the restricted ability to perform actions, tasks, or activities of
- self-care
- home management
- community/leisure
Risk factors for inefficient ergonomics and impaired body mechanics:
- hazardous work environment
- lack of safety awareness in all environments
- risk-prone behaviors (eg, lack of use of safety gear, performance of tasks requiring repetitive
motion)
- fitness, including physical performance (eg, inability to perform all workplace tasks, use of
inappropriate body mechanics for pushing)
- health and wellness (incomplete understanding of importance of correct body mechanics during
work tasks)
Tests and Measures
Ergonomics
* Dexterity and coordination during work (job/school/play) (eg, hand function tests, impairment
rating scales, manipulative ability tests)
* Functional capacity and performance during work actions, tasks, or activities (eg, accelerometry,
dynamometry, electroneuromyography, endurance tests,force platform tests, goniometry,
interviews, observations, photographic assessments, physical capacity tests, postural loading
analyses, technology assisted assessments, videographic assessments, work analyses)
* Safety in work environments (eg, hazard identification checklists, job severity indexes, lifting
standards, risk assessment scales, standards for exposure limits)
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* Specific work conditions or activities (eg, handling checklists, job simulations, lifting models,
preemployment screenings, task analysis checklists, workstation checklists)
* Tools, devices, equipment, and workstations related to work actions, tasks, or activities (eg,
observations, tool analysis checklists, vibration assessments)
Body mechanics
* Body mechanics during self-care, home management, work, community, or leisure actions,
tasks, or activities (eg, activities of daily living [ADL] and instrumental activities of daily living
[IADL] scales, observations, photographic assessments, technology-assisted assessments,
videographic assessments)
* Accelerometers
* Checklists for exposure standards, hazards, lifting standards
* Dynamometers
* Environmental tests
* Force platforms
* Functional capacity evaluations
* Goniometers
* Hand function tests
* Indexes
* Interviews
* Muscle tests
* Observations
* Physical capacity and endurance tests
* Postural loading tests
* Questionnaires
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* Scales
* Screenings
* Work analyses
Data Generated Data are used in providing documentation and may include:
Ergonomics
* Characterizations of efficiency and effectiveness of use of tools, devices, and workstations
* Characterizations of environmental hazards, health risks, and safety risks
* Descriptions of tools, devices, equipment, and workstations
* Descriptions and quantification of:
- abnormal movement patterns associated with work actions, tasks, or activities
- dexterity and coordination
- functional capacity
- repetition and work/rest cycle in
- work actions, tasks, or activities
- work actions, tasks, or activities
* Presence or absence of actual, potential,or repetitive trauma in the work environment
Body mechanics
* Characterizations of abnormal or unsafe body mechanics
* Descriptions and quantification of limitations in self-care, home management, work, community,
and leisure actions, tasks, or activities
Gait is the manner in which a person walks, characterized by rhythm, cadence, step, stride, and
speed. Locomotion is the ability to move from one place to another. Balance is the ability to
maintain the body in equilibrium with gravity both statically (ie, while stationary) and dynamically
(ie, while moving). The physical therapist uses these tests and measures to assess disturbances
in gait, locomotion, and balance and assess the risk for falling. The physical therapist also uses
these tests and measures to determine whether the patient/client is a candidate for assistive,
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adaptive, orthotic, protective, supportive, or prosthetic devices or equipment. Gait, locomotion,

and balance problems often involve difficulty in integrating sensory, motor, and neural processes.
Results of tests and measures of gait, locomotion, and balance are integrated with the history and
systems review fmdings and the results of other tests and measures. All of these data are then
through the selection of tests and measures of gait, locomotion, and balance. Clinical indications
for these tests and measures may include:
- cardiovascular (eg, peripheral vascular disease)
- endocrine/metabolic (eg, cellulitis)
- multiple systems (eg, Down syndrome)
- musculoskeletal (eg, arthropathy; disorders of muscle, ligament, and fascia; osteoarthrosis)
- neuromuscular (eg, central vestibular disorders, peripheral neuropathy)
- pulmonary (eg, emphysema)
- circulation (eg, claudication pain)
- joint integrity and mobility (eg, hip pain with mobility)
- motor function (eg, abnormal movement pattern)
- muscle performance (eg, decreased power and endurance)
- range of motion (eg, abnormal range with gait)
- ventilation (eg, paradoxical breathing pattern on ambulation)
categories:
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- self-care (eg, difficulty with dressing because of abnormal sitting balance)

- home management (eg, inability to perform yardwork because of decreased power)
- work (job/school/play) (eg, inability to do shopping as household manager because of painful
ambulation, inability as a parent to climb the stairs carrying a child because of decreased power)
- community/leisure (eg, inability to coach a Little League team because of hip pain, inability to
play shuffleboard because of dizziness)
- self-care
- home management
- community/leisure
* Risk factors for impaired gait, locomotion, and balance:
- risk-prone behaviors (eg, scatter rugs, unclearly marked steps)
- fitness, including physical performance (eg, inadequate dynamic balance for climbing, limited leg
strength for squatting)
- health and wellness (eg, incomplete understanding of need for dynamic balance in all functional
actions)
Tests and Measures
* Balance during functional activities with or without the use of assistive, adaptive, orthotic,
protective, supportive, or prosthetic devices or equipment (eg, activities of daily living [ADL]
scales, instrumental activities of dally living [IADL] scales, observations, videographic
assessments)
* Balance (dynamic and static) with or without the use of assistive, adaptive, orthotic, protective,
supportive, or prosthetic devices or equipment (eg, balance scales, dizziness inventories, dynamic
posturography, fall scales, motor impairment tests, observations, photographic assessments,
postural control tests)
* Gait and locomotion during functional activities with or without the use of assistive, adaptive,
orthotic, protective, supportive, or prosthetic devices or equipment (eg, ADL scales, gait indexes,
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IADL scales, mobility skill profiles, observations, videographic assessments)

* Gait and locomotion with or without the use of assistive, adaptive, orthotic, protective,
supportive, or prosthetic devices or equipment (eg, dynamometry, electroneuromyography,
footprint analyses, gait indexes, mobility skill profiles, observations, photographic assessments,
technology-assisted assessments, videographic assessments, weight-bearing scales, wheelchair
mobility tests)
* Safety during gait, locomotion, and balance (eg, confidence scales, diaries, fall scales, functional
assessment profiles, logs, reports)
* Batteries of tests
* Diaries
* Dynamometers
* Force platforms
* Goniometers
* Indexes
* Inventories
* Logs
* Motion analysis systems
* Observations
* Postural control tests
* Profiles
* Rating scales
* Reports
* Scales
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Data Generated
Descriptions of:
- gait and locomotion
- gait, locomotion, and balance characteristics with or without use of devices or equipment
- gait, locomotion, and balance on and in different physical environments
- level of safety during gait, locomotion, and balance
- static and dynamic balance
- wheelchair maneuverability and mobility
Integumentary integrity is the intactness of the skin, including the ability of the skin to serve as a
barrier to environmental threats (eg, bacteria, parasites). The physical therapist uses these tests
and measures to assess the effects of a wide variety of disorders that result in skin and
subcutaneous changes, including pressure and vascular, venous, arterial, diabetic, and
necropathic ulcers; burns and other traumas; and a number of diseases (eg, soft tissue disorders).
Results of tests and measures of integumentary integrity are integrated with the history and
systems review findings and the results of other tests and measures. All of these data are then
through the selection of tests and measures of integumentary integrity. Clinical indications for
- cardiovascular (eg, deep vein thrombosis, peripheral vascular disease)
- endocrine/metabolic (eg, diabetes, frostbite)
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- integumentary (eg, burn, frostbite, laceration, surgical wound)

- musculoskeletal (eg, fracture, osteomyelitis)
- neuromuscular (eg, coma, spinal cord injury)
- pulmonary (eg, respiratory failure)
- aerobic capacity (eg, deconditioning)
- circulation (eg, abnormal fluid distribution)
- integumentary integrity (eg, burn eschar)
- sensory integrity (eg, loss of sensation)
categories:
- self-care (eg, inability to bathe because of burn)
- home management (eg, inability to wash dishes because of hand blisters)
- work (job/school/play) (eg, inability to do construction work because of lower-extremity cellulitis,
inability to hold a job because of pressure sore)
- community/leisure (eg, inability to play organ at religious center because of loss of finger
sensation, inability to skate because of frostbite)
- self-care
- home management
- community/leisure
* Risk factors for impaired integumentary integrity:
- obesity
- risk-prone behaviors (eg, excessive exposure to sun or cold)
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- smoking history
- fitness, including physical performance (eg, inadequate protection from sun during outdoor
activities)
- health and wellness (eg, limited comprehension of value of skin monitoring and protection)
Tests and Measures
Associated skin
* Activities, positioning, and postures that produce or relieve trauma to the skin (eg, observations,
pressure-sensing maps, scales)
* Assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and equipment that
may produce or relieve trauma to the skin (eg, observations, pressure-sensing maps, risk
assessment scales)
* Skin characteristics, including blistering, continuity of skin color, dermatitis, hair growth, mobility;
nail growth, temperature, texture, and turgor (eg, observations, palpation, photographic
assessments, thermography)
Wound
* Activities, positioning, and postures that aggravate the wound or scar or that produce or relieve
trauma (eg, observations, pressure-sensing maps)
* Burn (body charting, planimetry)
* Signs of infection (eg, cultures, observations, palpation)
* Wound characteristics, including bleeding, contraction, depth, drainage, exposed anatomical
structures, location, odor, pigment, shape, size, staging and progression, tunneling, and
undermining (eg, digital and grid measurement, grading of sores and ulcers, observations,
palpation, photographic assessments, wound tracing)
* Wound scar tissue characteristics, including banding, pliability, sensation, and texture (eg,
observations, scarrating scales)
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* Charts
* Culture kits
* Grids
* Observations
* Palpation
* Planimeters
* Rulers
* Scales
* Thermographs
* Tracings, maps, graphs
Data Generated
Associated skin
* Descriptions of activities and postures that aggravate or relieve skin trauma
* Descriptions and quantifications of skin characteristics
* Descriptions of:
- blister
- devices and equipment that may produce skin trauma
- hair pattern
- skin color and continuity
Wound
* Descriptions of activities and postures that aggravate or relieve wound or scar trauma
* Descriptions of signs of infection
* Descriptions and quantifications of:
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- burn (eg, size, type, depth)

- wound characteristics
- wound scar tissue characteristics
Joint integrity is the intactness of the structure and shape of the joint, including its osteokinematic
and arthrokinematic characteristics. The tests and measures of joint integrity assess the anatomic
and biomechanical components of the joint. Joint mobility is the capacity of the joint to be moved
passively, taking into account the structure and shape of the joint surface in addition to
characteristics of the tissue surrounding the joint. The tests and measures of joint mobility assess
the performance of accessory joint movements, which are not under voluntary control. The
physical therapist uses these tests and measures to assess whether there is excessive motion
(hypermobility) or limited motion (hypomobility) of the joint. Results of tests and measures of joint
integrity and mobility are integrated with the history and systems review findings and the results of
other tests and measures. All of these data are then synthesized during the evaluation process to
through the selection of tests and measures of joint integrity and mobility. Clinical indications for
- endocrine/metabolic (eg, gout, osteoporosis)
- multiple systems (eg, vehicular trauma)
- musculoskeletal (eg, fracture, osteoarthritis, rheumatoid arthritis, sprain)
- neuromuscular (eg, cerebral palsy, Parkinson disease)
- pulmonary (eg, restrictive lung disease)
- anthropometric characteristics (eg, abnormal girth of limb at the knee)
- ergonomics and body mechanics (eg, decreased dexterity and coordination)
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- gait, locomotion, and balance (eg, uneven step length)

- posture (eg, abnormal spinal alignment)
- range of motion (eg, decreased muscle length)
- ventilation (eg, abnormal breathing pattern)
categories:
- self-care (eg, inability to fasten garments because of limited range of motion)
- home management (eg, inability to sew on a button because of Finger joint pain)
- work (job/school/play) (eg, inability to clean teeth as a dental hygienist because of joint stiffness,
inability to climb a ladder because of joint tightness)
- community/leisure (eg, inability as a student to attend driver's education because of limited range
of motion in neck, inability to play golf because of shoulder joint pain)
- self-care
- home management
- community/leisure
* Risk factors for impaired joint integrity and mobility:
- performance of tasks requiring repetitive motion
- fitness, including physical performance (eg, reduced shoulder mobility for weight lifting)
- health and wellness (eg, insufficient awareness of impact of mobility exercises on ability to lift
weight)
Tests and Measures
* Joint integrity and mobility (eg, apprehension, compression and distraction, drawer, glide,
impingement, shear, and valgus/varus stress tests; arthrometry; palpation)
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* Joint play movements, including end feel (all joints of the axial and appendicular skeletal system)
(eg, palpation)
* Specific body parts (eg, apprehension, compression and distraction, drawer, glide, impingement,
shear, and valgus/varus stress tests; arthrometry)
* Arthrometers
* Apprehension tests
* Compression and distraction tests
* Drawer tests
* Glide tests
* Impingement tests
* Palpation
* Shear tests
* Valgus/varus stress tests
Data Generated
* Descriptions of:
- accessory motion
- bony and soft tissue restrictions during movement
* Descriptions or quantifications of joint hypomobility or hypermobility
* Presence of:
- apprehension
- joint impingement
* Presence and severity of abnormal joint articulation
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Motor function is the ability to learn or demonstrate the skillful and efficient assumption,
maintenance, modification, and control of voluntary postures and movement patterns. The
physical therapist uses these tests and measures in the assessment of weakness, paralysis,
dysfunctional movement patterns, abnormal timing, poor coordination, clumsiness, atypical
movements, or dysfunctional postures. Results of tests and measures of motor function (motor
control and motor learning) are integrated with the history and systems review findings and the
results of other tests and measures. All of these data are then synthesized during the evaluation
process to establish the diagnosis, the prognosis, and the plan of care, which includes the
selection of interventions. The results of these tests and measures may indicate the need to use
or recommend other tests and measures or the need to consult with, or refer the patient/client to,
through the selection of tests and measures of motor function (motor control and motor learning).
Clinical indications for these tests and measures may include:
- cardiovascular (eg, cerebral vascular accident, congenital heart anomalies)
- multiple systems (eg, encephalitis, meningitis, seizures)
- musculoskeletal (eg, muscular dystrophy)
- neuromuscular (eg, cerebral palsy, multiple sclerosis, Parkinson disease, spinal cord injury,
traumatic brain injury, vestibular disorders)
- pulmonary (eg, hyaline membrane disease)
- circulation (eg, increased heart rate with activities)
- motor function (eg, irregular movement pattern)
- orthotic, protective, and supportive devices (eg, dropfoot requiring an ankle-foot orthosis)
- range of motion (eg, limited)
- sensory integrity (eg, altered position sense)
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categories:
- self-care (eg, difficulty with combing hair because of weakness)
- home management (eg, inability to clean the shower because of dysfunctional movement
pattern)
- work (job/school/play) (eg, inability to perform functions as toll collector because of dizziness,
inability to sort mail because of clumsiness)
- community/leisure (eg, inability to play softball because of poor coordination, inability to serve as
greeter at senior citizen center because of muscle weakness and decreased endurance)
required roles within the individual's sociocultural context--in the following categories.'
- self-care
- home management
- community/leisure
* Risk factors for impaired motor function:
- lack of safety in all environments
- fitness, including physical performance (eg, inability to control throwing motion, inadequate eyehand coordination in sports)
- health and wellness (eg, incomplete understanding of importance of value of motor planning and
practice in task performance)
Tests and Measures
* Dexterity, coordination, and agility (eg, coordination screens, motor impairment tests, motor
proficiency tests, observations, videographic assessments)
* Hand function (eg, fine and gross motor control tests, finger dexterity tests, manipulative ability
tests, observations)
* Initiation, modification, and control of movement patterns and voluntary postures (eg, activity
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indexes, developmental scales, gross motor function profiles, motor scales, movement
assessment batteries, neuromotor tests, observations, physical performance tests, postural
challenge tests, videographic assessments)
* Dexterity tests
* Function tests
* Hand manipulation tests
* Indexes
* Motor performance tests
* Observations
* Postural challenge tests
* Profiles
* Scales
* Screens
* Tilt boards
Data Generated
- dexterity, coordination, and agility
- hand movements
- head, trunk, and limb movements
- sensorimotor integration
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- voluntary, age-appropriate postures and movement patterns

* Observations and descriptions of atypical movements
* Quantifications of electrophysiological responses to stimulation
Muscle performance is the capacity of a muscle or a group of muscles to generate forces.
Strength is the muscle force exerted by a muscle or a group of muscles to overcome a resistance
under a specific set of circumstances. Power is the work produced per unit of time or the product
of strength and speed. Endurance is the ability of muscle to sustain forces repeatedly or to
generate forces over a period of time. The muscle force that can be measured depends on the
interrelationships among such factors as the length of the muscle, the velocity of the muscle
contraction, and the mechanical advantage. Recruitment of motor units, fuel storage, and fuel
delivery, in addition to balance, timing, and sequencing of contraction, mediate integrated muscle
performance. The physical therapist uses these tests and measures to determine the ability to
produce, maintain, sustain, and modify movements that are prerequisite to functional activity.
Results of tests and measures of muscle performance (including strength, power, and endurance)
are integrated with the history and systems review findings and the results of other tests and
through the selection of tests and measures of muscle performance (including strength, power,
and endurance). Clinical indications for these tests and measures may include:
- cardiovascular (eg, congestive heart failure, vascular insufficiency)
- endocrine/metabolic (eg, diabetes, Down syndrome, osteoporosis)
- integumentary (eg, post-mastectomy lymphedema, scar)
- multiple systems (eg, AIDS)
- musculoskeletal (eg, amputation, muscular dystrophy, osteoarthritis, spinal stenosis, synovitis,
tenosynovitis)
- neuromuscular (eg, cerebral palsy, Guillain-Barre, multiple sclerosis)
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- pulmonary (eg, cystic fibrosis, emphysema, pneumonia)

- gait, locomotion, and balance (eg, frequent falls, decreased stance phase)
- muscle performance (eg, decreased gross strength, generalized muscle weakness)
- posture (eg, abnormal body alignment)
categories:
- self-care (eg, inability to don and doff clothing because of proximal instability)
- home management (eg, inability to squat to pick up laundry because of muscle weakness)
- work (job/school/play) (eg, inability as an airline baggage handler to handle baggage because of
inability to lift heavy objects, inability to carry objects because of decreased muscle endurance,
inability to keep up with peers on playground because of decreased muscle endurance)
- community/leisure (eg, inability to hike because of ankle weakness)
- self-care
- home management
- community/leisure
* Risk factors for impaired muscle performance:
- fitness, including physical performance (eg, inadequate muscle strength for aquatic sports,
insufficient muscle endurance for long distance running)
- health and wellness (eg, incomplete understanding of the need for strength before power)
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Tests and Measures

* Muscle strength, power, and endurance (eg, dynamometry, manual muscle tests, muscle
performance tests, physical capacity tests, technology-assisted assessments, timed activity tests)
* Muscle strength, power, and endurance during functional activities (eg, activities of daily living
[ADL] scales, functional muscle tests, instrumental activities of daily living [IADL] scales,
observations, videographic assessments)
* Muscle tension (eg, palpation)
* Dynamometers
* Functional muscle tests
* Manual muscle tests
* Muscle performance tests
* Observations
* Palpation
* Physical capacity tests
* Scales
* Sphygmomanometers
* Timed activity tests
Data Generated
* Characterizations of:
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- electrophysiological responses to stimulation

- muscle strength, power, and endurance
* Presence and severity of pelvic-floor muscle weakness
- levels of excitability of muscle
- muscle strength, work, and power
Neuromotor development is the acquisition and evolution of movement skills throughout the life
span. Sensory integration is the ability to integrate information that is derived from the
environment and that relates to movement. The physical therapist uses tests and measures to
characterize movement skills in infants, children, and adults. The physical therapist also uses
tests and measures to assess mobility; achievement of motor milestones; postural control;
voluntary and involuntary movement; balance; righting and equilibrium reactions; eye-hand
coordination; and other movement skills. Results of tests and measures of neuromotor
development and sensory integration are integrated with the history and systems review findings
and the results of other tests and measures. All of these data are then synthesized during the
evaluation process to establish the diagnosis, the prognosis, and the plan of care, which includes
the selection of interventions. The results of these tests and measures may indicate the need to
use or recommend other tests and measures or the need to consult with, or refer the patient/client
to, another professional.
through the selection of tests and measures of neuromotor development and sensory integration.
* Pathology/pathophysiology (disease, disorder, or condition) in the following systems.'
- cardiovascular (eg, cardiac or associated vessel disorders)
- endocrine/metabolic (eg, fetal alcohol syndrome, lead poisoning)
- multiple systems (eg, autism, birth prematurity, seizure disorder)
- musculoskeletal (eg, congenital amputation)
- neuromuscular (eg, hearing loss, visual deficit)
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- pulmonary (eg, anoxia, hypoxia)

- circulation (eg, abnormal heart rhythm)
- gait, locomotion, and balance (eg, poor sitting posture)
- motor function (eg, presence of involuntary movements)
- muscle performance (eg, muscle weakness)
- neuromotor development (eg, delayed motor skills)
- posture (eg, lack of postural control)
- prosthetic requirements (eg, poor balance with prosthesis)
- ventilation (eg, asymmetrical expansion)
categories.'
- self-care (eg, inability to grasp bottle for feeding because of weakness)
- home management (eg, inability to dust because of poor sensory integration)
- work (job/school/play) (eg, inability to do assembly piecework because of poor eye-hand
coordination, inability to play with peers in day care because of inability to crawl)
- community/leisure (eg, inability to knit because of poor movement initiation, inability to vote in
standing ballot booth because of inability to stand)
- self-care
- home management
- community/leisure
* Risk factors for impaired neuromotor development and sensory integration:
- poor nutritional status during gestation
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- substance abuse
- fitness, including physical performance (eg, inappropriate timing or sequencing for skipping,
limited ability to participate in organized play programs)
- health and wellness (eg, lack of understanding of need for developmental screening)
Tests and Measures
* Acquisition and evolution of motor skills, including age-appropriate development (eg, activity
indexes, developmental inventories and questionnaires, infant and toddler motor assessments,
learning profiles, motor function tests, motor proficiency assessments, neuromotor assessments,
reflex tests, screens, videographic assessments)
* Oral motor function, phonation, and speech production (eg, interviews, observations)
* Sensorimotor integration, including postural, equilibrium, and righting reactions (eg, behavioral
assessment scales, motor and processing skill tests, observations, postural challenge tests, reflex
tests, sensory profiles, visual perceptual skill tests)
* Behavioral assessment scales
* Electrophysiological tests
* Indexes
* Interviews
* Inventories
* Motor assessment tests
* Motor function tests
* Neuromotor assessments
* Observations
* Proficiency assessments
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* Profiles
* Questionnaires
* Reflex tests
* Scales
* Screens
* Skill tests
Data Generated
- behavioral response to stimulation
- dexterity, coordination, and agility
- movement skills, including age-appropriate development, gross and
- fine motor skills, reflex development
- oral motor function, phonation, and speech production
- sensorimotor integration, including postural, equilibrium, and righting reactions
* Observations and description of atypical movement
Orthotic, protective, and supportive devices are implements and equipment used to support or
protect weak or ineffective joints or muscles and serve to enhance performance. Orthotic devices
include braces, casts, shoe inserts, and splints. Protective devices include braces, cushions,
helmets, and protective taping. Supportive devices include compression garments, corsets, elastic
wraps, mechanical ventilators, neck collars, serial casts, slings, supplemental oxygen, and
supportive taping. The physical therapist uses these tests and measures to assess the need for
devices in patients/clients not currently using them and to evaluate the appropriateness and fit of
those devices already in use. Results of tests and measures of orthotic, protective, and supportive
devices are integrated with the history and systems review findings and the results of other tests
and measures. All of these data are then synthesized during the evaluation process to establish
the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions.
The results of these tests and measures may indicate the need to use or recommend other tests
and measures or the need to consult with, or refer the patient/client to, another professional.
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through the selection of tests and measures of orthotic, protective, and supportive devices.
- cardiovascular (eg, cerebral vascular accident, congestive heart failure, peripheral vascular
disease)
- endocrine/metabolic (eg, rheumatological disease)
- multiple systems (eg, AIDS, trauma)
- musculoskeletal (eg, amputation, status post joint replacement)
- neuromuscular (eg, cerebellar ataxia, cerebral palsy)
- pulmonary (eg, asthma, cystic fibrosis, reactive airways disease)
- anthropometric characteristics (eg, girth, height)
- gait, locomotion, and balance (eg, impaired motor function)
- integumentary integrity (eg, impaired sensation)
- joint integrity and mobility (eg, joint hypermobility)
categories.'
- self-care (eg, inability to wash hair because of upper-extremity lymphedema)
- home management (eg, inability to walk on uneven terrain because of ankle instability)
- work (job/school/play) (eg, inability as a factory worker to lift repetitively on assembly line
because of pain, inability to maintain head position in classroom because of poor motor function,
inability to stand because of low back pain)
- community/leisure (eg, inability to bowl because of wrist pain and weakness)
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- self-care
- home management
- community/leisure
* Risk factor for improper use or lack of use of orthotic, protective, and supportive devices:
- lack of safety awareness
- lack of use of adequate protective devices during activity
- fitness, including physical performance (eg, inadequate control of skis without orthotic device for
ski boot)
- health and wellness (eg, incomplete understanding of importance of orthotic evaluation and
compliance with program)
Tests and Measures
* Components, alignment, fit, and ability to care for the orthotic, protective, and supportive devices
and equipment (eg, interviews, logs, observations, pressure-sensing maps, reports)
* Orthotic, protective, and supportive devices and equipment use during functional activities (eg,
activities of daily living [ADL] scales, functional scales, instrumental activities of daily living [IADL]
scales, interviews, observations, profiles)
* Remediation of impairments, functional limitations, or disabilities with use of orthotic, protective,
and supportive devices and equipment (eg, activity status indexes, ADL scales, aerobic capacity
tests, functional performance inventories, health assessment questionnaires, LADL scales, pain
scales, play scales, videographic assessments)
* Safety during use of orthotic, protective, and supportive devices and equipment (eg, diaries, fall
scales, interviews, logs, observations, reports)
* Diaries
* Indexes
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* Interviews
* Inventories
* Logs
* Observations
* Play scales
* Profiles
* Questionnaires
* Reports
* Scales
Data Generated
* Descriptions of:
- ability to use and care for devices and equipment
- alignment and fit of the devices and equipment
- components of orthotic, protective, or supportive devices and equipment
- level of safety with devices and equipment
- practicality of devices and equipment
- remediation of impairment, functional limitation, or disability with devices and equipment
- movement patterns with or without devices
- physiological and functional effect and benefit of devices and equipment
Pain
Pain is a disturbed sensation that causes suffering or distress. The physical therapist uses these
tests and measures to determine a cause or a mechanism for the pain and to assess the intensity,
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quality, and temporal and physical characteristics of any pain that is important to the patient and
that may result in impairments, functional limitations, or disabilities. Results of tests and measures
of pain are integrated with the history and systems review findings and the results of other tests
and measures. All of these data are then synthesized during the evaluation process to establish
the diagnosis, the prognosis, and the plan of care, which includes the selection of interventions.
The results of these tests and measures may indicate the need to use or recommend other tests
and measures or the need to consult with, or refer the patient/client to, another professional.
through the selection of tests and measures of pain. Clinical indications for these tests and
measures may include:
- cardiovascular (eg, coronary artery disease, myocardial infarction)
- endocrine/metabolic (eg, osteoporosis, rheumatological disease)
- integumentary (eg, burn, incision, ulcer, wound)
- multiple systems (eg, vehicular trauma)
- musculoskeletal (eg, amputation, cumulative trauma, fracture, spinal stenosis,
temporomandibular joint dysfunction)
- neuromuscular (eg, nerve compression, spinal cord injury)
- pulmonary (eg, lung cancer, status post thoracotomy)
* Impairments in the following categories.'
- circulation (eg, decreased ability to walk because of chest discomfort)
- integumentary (eg, limited range of motion because of painful rash)
- joint integrity (eg, decreased range of motion because of finger ache)
- muscle performance (eg, weakness because of muscle burning)
- pain (eg, decreased movement of spine because of stabbing back pain)
- posture (eg, forward head position because of upper-back discomfort)
- ventilation (eg, decreased expansion because of splinting of painful chest wall)
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categories.'
- sell-care (eg, difficulty with eating because of jaw pain)
- home management (eg, inability to shovel snow because of shoulder soreness)
- work (job/school/play) (eg, inability as a parent to carry infant because of shooting knee pain,
inability to mop floor because of chest pressure)
- community/leisure (eg, inability to canoe because of backache, inability to keep up with
grandchildren because legs ache while walking)
- sell-care
- home management
- community/leisure
* Risk factors for pain:
- risk-prone behaviors (eg, lack of use of safety gear, performance of tasks requiring repetitive
motion)
- smoking history
- fitness, including physical performance (eg, decreased ability to tolerate strength training
because of pain, limited participation in leisure sports because of pain)
- health and wellness (eg, limited information about living with pain)
Tests and Measures
* Pain, soreness, and nociception (eg, angina scales, analog scales, discrimination tests, dyspnea
scales, pain drawings and maps, provocation tests, verbal and pictorial descriptor tests)
* Pain in specific body parts (eg, pain indexes, pain questionnaires, structural provocation tests)
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* Descriptor tests (verbal and pictorial)
* Discrimination tests
* Indexes
* Pain drawings and maps
* Provocation and structural provocation tests
* Questionnaires
* Scales
Data Generated
* Characterizations of activities or postures that aggravate or relieve pain
* Descriptions and quantifications of pain according to specific body part
* Localization of pain
* Sensory and temporal qualities of pain
* Severity of pain, soreness, and discomfort
* Somatic distribution of pain
Posture
Posture is the alignment and positioning of the body in relation to gravity, center of mass, or base
of support. The physical therapist uses these tests and measures to assess structural alignment.
Good posture is a state of musculoskeletal balance that protects the supporting structures of the
body against injury or progressive deformity. Results of tests and measures of posture are
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through the selection of tests and measures of posture. Clinical indications for these tests and
measures may include:
- genitourinary (eg, pelvic floor dysfunction, pregnancy)
- musculoskeletal (eg, amputation, intervertebral disk disorders, scoliosis, joint replacement)
- neuromuscular (eg, cerebral palsy, neurofibromatosis, spina bifida)
- pulmonary (eg, pneumonectomy, restrictive lung disease)
- circulation (eg, decreased endurance)
- orthotic, protective, and supportive devices (eg, swollen malaligned knee)
- muscle performance (eg, weakness, imbalance)
- pain (eg, decreased range of motion of lumbar spine)
- posture (eg, leg length discrepancies)
- range of motion (eg, decreased cervical range of motion)
- ventilation (eg, asymmetrical expansion)
categories:
- self-care (eg, difficulty with donning and doffing shoes and socks because of limited painful
spinal range of motion)
- home management (eg, inability to do laundry because of shortness of
breath)
- work (job/school/play) (eg, inability to bake because of painful upper-extremity postures, inability
to compete on soccer team because of scoliosis)
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- community/leisure (eg, inability as a scout leader to camp and hike because of hip pain, inability
to walk dog because of leg pain)
required roles within the individual's sociocultural context--in the following categories.'
- self-care
- home management
- community/leisure
* Risk factors for impaired posture:
- smoking history
- fitness, including physical performance (eg, inability to serve tennis ball with required speed,
poor posture that limits time at computer workstation)
- health and wellness (eg, inadequate information about need for posture stretching)
Tests and Measures
* Postural alignment and position (dynamic), including symmetry and deviation from midline (eg,
observations, technology-assisted assessments, videographic assessments)
* Postural alignment and position (static), including symmetry and deviation from midline (eg, grid
measurement, observations, photographic assessments)
* Specific body parts (eg, angle assessments, forward-bending test, goniometry, observations,
palpation, positional tests)
* Angle assessments
* Goniometers
* Grids
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* Observations
* Palpation
* Positional tests
* Plumb lines
* Tape measures
Data Generated
- dynamic alignment, symmetry, and deviation during movement
- postural alignment using posture grids
- static alignment, symmetry, and deviation
Prosthetic requirements are the biomechanical elements necessitated by the loss of a body part.
A prosthesis is an artificial device used to replace a missing part of the body. The physical
therapist uses these tests and measures to assess the effects and benefits, components,
alignment and fit, and safe use of the prosthesis. Results of tests and measures of prosthetic
requirements are integrated with the history and systems review findings and the results of other
tests and measures. All of these data are then synthesized during the evaluation process to
through the selection of tests and measures of prosthetic requirements. Clinical indications for
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- cardiovascular (eg, peripheral vascular disease)

- endocrine/metabolic (eg, diabetes)
- integumentary (eg, burn, frostbite)
- multiple systems (eg, congenital anomalies, gangrene)
- musculoskeletal (eg, amputation, compartment syndrome)
- circulation (eg, decreased ankle motion)
- gait, locomotion, and balance (eg, altered stride length)
- muscle performance (eg, decreased muscle endurance)
- pain (eg, claudication)
- prosthetic requirements (eg, residual limb pain)
Functional limitations in the ability to perform actions, tasks, or activities in the following
categories:
- self-care (eg, inability to put on shoes because of edema)
- home management (eg, inability to climb stairs because of leg pain)
- work (job/school/play) (eg, inability to use a keyboard because of loss of fingers, inability to walk
child to school because of distal limb ache)
- community/leisure (eg, inability to engage in bird watching because of residual limb discomfort
on uneven terrain, inability to ride bicycle to school because of poor prosthetic fit)
- self-care
- home management
- community/leisure
* Risk factors for improper use or lack of use of prosthesis:
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- obesity
- risk of skin breakdown
- fitness, including physical performance (eg, inability to participate in endurance activities with
current prosthesis, inadequate prosthetic components or fit for running)
- health and wellness (eg, inadequate knowledge about importance of prosthetic fit)
Tests and Measures
* Components, alignment, fit, and ability to care for the prosthetic device (eg, interviews, logs,
observations, pressure-sensing maps, reports)
* Prosthetic device use during functional activities (eg, activities of daily living [ADL] scales,
functional scales, instrumental activities of daily living [IADL] scales, interviews, observations)
* Remediation of impairments, functional limitations, or disabilities with use of the prosthetic
device (eg, aerobic capacity tests, activity status indexes, ADL scales, functional performance
inventories, health assessment questionnaires, IADL scales, pain scales, play scales, technologyassisted assessments, videographic assessments)
* Residual limb or adjacent segment, including edema, range of motion, skin integrity, and
strength (eg, goniometry, muscle tests, observations, palpation, photographic assessments, skin
integrity tests, technology-assisted assessments, videographic assessments, volume
measurement)
* Safety during use of the prosthetic device (eg, diaries, fall scales, interviews, logs, observations,
reports)
* Diaries
* Goniometers
* Indexes
* Interviews
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* Inventories
* Logs
* Muscle tests
* Observations
* Palpation
* Profiles
* Questionnaires
* Reports
* Scales
* Skin integrity tests
* Volumometers
Data Generated
- ability to use and care for device and practicality of device
- components of prosthetic devices
- level of safety with device
- residual limb or adjacent segment
- alignment and fit of the device
- remediation of impairment, functional limitation, or disability with device
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- movement patterns with or without device

- physiological and functional effects and benefits of device
Range of motion (ROM) is the are through which movement occurs at a joint or a series of joints.
Muscle length is the maximum extensibility of a muscle-tendon unit. Muscle length, in conjunction
with joint integrity and soft tissue extensibility, determines flexibility. The physical therapist uses
these tests and measures to assess the range of motion of a joint. Results of tests and measures
of range of motion (including muscle length) are integrated with the history and systems review
findings and the results of other tests and measures. All of these data are then synthesized during
the evaluation process to establish the diagnosis, the prognosis, and the plan of care, which
includes the selection of interventions. The results of these tests and measures may indicate the
need to use or recommend other tests and measures or the need to consult with, or refer the
patient/client to, another professional.
systems review; and information derived from other sources and records).The findings may
through the selection of tests and measures of range of motion (including muscle length). Clinical
- genitourinary (eg, pregnancy)
- musculoskeletal (eg, avulsion of tendon; disorders of muscle, ligament, and fascia; fracture;
osteoarthritis; scoliosis; spinal stenosis; sprain; strain)
- neuromuscular (eg, Parkinson disease)
- ventilation (eg, restrictive lung disease)
- assistive and adaptive devices (eg, swollen knee)
- cranial and peripheral nerve integrity (eg, radiating leg pain)
- gait, locomotion, and balance (eg, limp)
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- muscle performance (eg, muscle weakness)

- range of motion (eg, limited elbow range of motion)
- ventilation (eg, shortness of breath)
categories:
- self-care (eg, inability to put on stockings because of weakness)
- home management (eg, inability to load dishwasher because of difficulty bending)
- work (job/school/play) (eg, inability to cut hair because of painful swollen fingers, inability as a
professional dancer to assume en pointe position because of painful arch)
- community/leisure (eg, inability to roller blade because of ankle swelling, inability to serve as
volunteer in hospital gift shop because of pain on standing)
* Disability--that is, the inability or the restricted ability toperform actions, tasks, or activities of
- self-care
- home management
- community/leisure
* Risk factors for impaired range of motion:
- smoking history
- fitness, including physical performance (eg, inadequate flexibility to participate in gymnastics,
limited range of motion in shoulders for mural painting)
- health and wellness (eg, incomplete understanding of relationship between mobility and painfree functional activities)
Tests and Measures
* Functional ROM (eg, observations, squat testing, toe touch tests)
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* Joint active and passive movement (eg, goniometry, inclinometry, observations, photographic
assessments, technology-assisted assessments, videographic assessments)
* Muscle length, soft tissue extensibility, and flexibility (eg, contracture tests, goniometry,
inclinometry, ligamentous tests, linear measurement, multisegment flexibility tests, palpation)
* Back ROM devices
* Camera and photographs
* Cervical protractors
* Flexible rulers
* Functional tests
* Goniometers
* Inclinometers
* Ligamentous stress tests
* Multisegment flexibility tests
* Observations
* Palpation
* Scoliometers
* Tape measures
Data Generated
* Descriptions of muscle, joint, and soft tissue characteristics
* Observations and descriptions of functional or multisegmental movement
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- musculotendinous extensibility ROM

Reflex Integrity
Reflex integrity is the intactness of the neural path involved in a reflex. A reflex is a stereotypic,
involuntary reaction to any of a variety of sensory stimuli. The physical therapist uses these tests
and measures to determine the excitability of the nervous system and the integrity of the
neuromuscular system. Results of tests and measures of reflex integrity are integrated with the
history and systems review findings and the results of other tests and measures. All of these data
are then synthesized during the evaluation process to establish the diagnosis, the prognosis, and
the plan of care, which includes the selection of interventions. The results of these tests and
through the selection of tests and measures of reflex integrity. Clinical indications for these tests
and measures may include:
- multiple systems (eg, Guillain-Barre syndrome)
- neuromuscular (eg, amyotrophic lateral sclerosis, cerebral palsy, coma, prematurity, traumatic
brain injury)
- pulmonary (eg, anoxia)
- assistive and adaptive devices (eg, limited mobility)
- gait, locomotion, and balance (eg, poor balance)
- integumentary integrity (eg, pressure sore)
- motor function (eg, poor coordination)
- neuromotor development and sensory integration (eg,
delayed gross motor skills)
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- posture (eg, asymmetrical alignmen0

- range of motion (eg, hypermobility)
categories:
- self-care (eg, difficulty with eating because of jaw pain with chewing)
- home management (eg, inability to take trash cans out because of poor coordination)
- work (job/school/play) (eg, inability to reach to restock shelves because of poor coordination)
- community/leisure (eg, inability to hike with friends because of poor coordination and weakness,
inability to obtain driver's license because of startle reflex, inability to run because of
hypermobility)
- self-care
- home management
- community/leisure
* Risk factors for impaired reflex integrity:
- habitual suboptimal posture increased risk for falls
- fitness, including physical performance (eg, inability to participate in leisure activities that involve
jumping and hopping, inadequate knowledge of proper stretch techniques for sports participation)
- health and wellness (eg, inadequate knowledge of relaxation)
Tests and Measures
* Deep reflexes (eg, myotatic reflex scale, observations, reflex tests)
* Postural reflexes and reactions, including righting, equilibrium, and protective reactions (eg,
observations, postural challenge tests, reflex profiles, videographic assessments)
* Primitive reflexes and reactions, including developmental (eg, reflex profiles, screening tests)
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* Resistance to passive stretch (eg, tone scales)

* Superficial reflexes and reactions (eg, observations, provocation tests)
* Myotatic reflex scales
* Observations
* Provocation tests
* Reflex profiles
* Reflex tests
* Scales
* Screens
Data Generated
* Characterizations and quantifications of:
- age-appropriate reflexes
- deep reflexes
- postural reflexes and righting reactions
- superficial reflexes
Self-Care and Home Management (Including Activities of Daily Living and Instrumental Activities
of Daily Living)
Self-care management is the ability to perform activities of daily living (ADL), such as bed mobility,
transfers, dressing, grooming, bathing, eating, and toileting. Home management is the ability to
perform the more complex instrumental activities of daily living (IADL), such as structured play (for
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infants and children), maintaining a home, shopping, performing household chores, caring for
dependents, and performing yard work. The physical therapist uses the results of these tests and
measures to assess the level of performance of tasks necessary for independent living; the need
for assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment; and the
need for body mechanics training, organized functional training programs, or therapeutic exercise.
Results of tests and measures of self-care and home management (including ADL and IADL) are
through the selection of tests and measures of self-care and home management (including ADL
and IADL). Clinical indications for these tests and measures may include:
- cardiovascular (eg, cerebral vascular accident, congestive heart failure, peripheral vascular
disease)
- genitourinary (eg, pelvic floor dysfunction)
- multiple systems (eg, AIDS, trauma)
- musculoskeletal (eg, amputation, joint replacement, spinal stenosis, spinal surgery)
- neuromuscular (eg, cerebellar ataxia, cerebral palsy, multiple sclerosis, post-polio syndrome,
spinal cord injury, traumatic brain injury)
- pulmonary (eg, asthma, chronic obstructive pulmonary disease, cystic fibrosis, reactive airways
disease)
- aerobic capacity (eg, decreased endurance, shortness of breath)
- arousal, attention, cognition (eg, lack of safety awareness)
- circulation (eg, abnormal heart rate and rhythm)
- gait, locomotion, and balance (eg, falls)
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- muscle performance (eg, decreased power)

- neuromotor development (eg, abnormal movement patterns)
- orthotic, protective, and supportive devices (eg, wearing a corset)
- posture (eg, severe kyphosis)
- prosthetic requirements (eg, use of prosthesis)
- ventilation (eg, accessory muscle use)
categories:
- self-care (eg, inability to dress because of abnormal range of motion, inability to tie shoes as a
first grader because of poor coordination)
- home management (eg, inability to shop because of decreased endurance)
- community/leisure (eg, inability to garden because of shortness of breath, inability to travel to
visit relatives because of lack of safety awareness)
- self-care
- home management
- community/leisure
* Risk factors for limitations in self, are and home management:
- risk-prone behaviors (eg, performance of tasks requiring repetitive motion, lack of use of safety
gear)
- fitness, including physical performance (eg, inadequate endurance to perform heavy chores)
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- health and wellness (eg, limited knowledge of adaptations to allow independent function)
Tests and Measures
* Ability to gain access to home environments (eg, barrier identification, observations, physical
performance tests)
* Ability to perform self-care and home management activities with or without assistive, adaptive,
orthotic, protective, supportive, or prosthetic devices and equipment (eg, ADL scales, aerobic
capacity tests, IADL scales, interviews, observations, profiles)
* Safety in self-care and home management activities and environments (eg, diaries, fall scales,
interviews, logs, observations, reports, videographic assessments)
* Barrier identification checklists
* Diaries
* Fall scales
* Indexes
* Interviews
* Inventories
* Logs
* Observations
* Physical performance tests
* Profiles
* Reports
* Questionnaires
* Scales
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Data Generated
- ability to participate in variety of environments
- level of safety in self-care and home management activities
- need for devices or equipment
- physiological responses to activity
Sensory Integrity
Sensory integrity is the intactness of cortical sensory processing, including proprioception,
pallesthesia, stereognosis, and topognosis. Proprioception is the reception of stimuli from within
the body (eg, from muscles and tendons) and includes position sense (the awareness of joint
position) and kinesthesia (the awareness of movement). Pallesthesia is the ability to sense
mechanical vibration. Stereognosis is the ability to perceive, recognize, and name familiar objects.
Topognosis is the ability to localize exactly a cutaneous sensation. The physical therapist uses the
results of tests and measures to determine the integrity of the sensory, perceptual, and
somatosensory processes. Results of tests and measures of sensory integrity are integrated with
the history and systems review findings and the results of other tests and measures. All of these
data are then synthesized during the evaluation process to establish the diagnosis, the prognosis,
and the plan of care, which includes the selection of interventions. The results of these tests and
through the selection of tests and measures of sensory integrity. Clinical indications for these tests
and measures may include:
- cardiovascular (eg, cerebral vascular accident, peripheral vascular disease)
- endocrine/metabolic (eg, diabetes, rheumatological disease)
- integumentary (eg, burn, frostbite, lymphedema)
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- multiple systems (eg,AIDS, Guillain-Barre syndrome, trauma)

- musculoskeletal (eg, derangement of joint; disorders of bursa, synovia, and tendon)
- neuromuscular (eg, cerebral palsy, developmental delay, spinal cord injury, traumatic brain
injury)
- pulmonary (eg, respiratory failure, ventilatory pump failure)
- circulation (eg, numb feet)
- integumentary integrity (eg, redness under orthotic)
- muscle performance (eg, decreased grip strength)
- orthotic, protective, and supportive devices (eg, wears ankle foot orthosis)
- posture (eg, forward head)
categories:
- self-care (eg, inability to put on trousers while standing because of loss of feeling in foot)
- home management (eg, difficulty with sorting change because of numbness)
- work (job/school/play) (eg, inability as a day care provider to change child's diaper because of
loss of finger sensation, inability to operate cash register because of clumsiness)
- community/leisure (eg, inability to drive car because of loss of spatial awareness, inability to play
guitar because of hyperesthesia)
- self-care
- home management
- community/leisure
* Risk factors for impaired sensory integrity:
- risk-prone behaviors (eg, working without protective gloves)
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- smoking history
- substance abuse
- fitness, including physical performance (eg, inadequate balance to compete in dancing
competition, limited perception of arms and legs in space during ballroom dancing)
- health and wellness (eg, inadequate understanding of role of proprioception in balance)
Tests and Measures
* Combined/cortical sensations (eg, stereognosis tests, tactile discrimination tests)
* Deep sensations (eg, kinesthesiometry, observations, photographic assessments, vibration
tests)
* Esthesiometers
* Filaments
* Kinesthesiometers
* Observations
* Palpation
* Pressure scales
* Sensory tests
* Tuning forks
Data Generated
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* Characterizations and quantifications of:

- position and movement sense
- sensory processing
- sensory responses to provocation
Ventilation and Respiration/Gas Exchange
Ventilation is the movement of a volume of gas into and out of the lungs. Respiration is the
exchange of oxygen and carbon dioxide across a membrane either in the lungs or at the cellular
level. The physical therapist uses these tests and measures to determine whether the patient has
an adequate ventilatory pump and oxygen uptake/carbon dioxide elimination system to meet the
oxygen demands at rest, during aerobic exercise, and during the performance of activities of daily
living. Results of tests and measures of ventilation and respiration/gas exchange are integrated
with the history and systems review findings and the results of other tests and measures. All of
these data are then synthesized during the evaluation process to establish the diagnosis, the
prognosis, and the plan of care, which includes the selection of interventions. The results of these
tests and measures may indicate the need to use or recommend other tests and measures or the
need to consult with, or refer the patient/client to, another professional.
through the selection of tests and measures of ventilation and respiration/gas exchange. Clinical
- cardiovascular (eg, cerebral vascular accident, congestive heart failure, coronary artery disease)
- endocrine/metabolic (eg, diabetes, rheumatological disease)
- multiple systems (eg,AIDS, deconditioning, trauma)
- musculoskeletal (eg, kyphoscoliosis, muscular dystrophy)
- neuromuscular (eg, coma, cerebral palsy, Parkinson disease, spinal cord injury, traumatic brain
injury)
- pulmonary (eg, asthma, cystic fibrosis, chronic obstructive pulmonary disease, hyaline
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membrane disease, pneumonia, pulmonary edema, reactive airways disease, respiratory failure,
restrictive lung disease, status post thoracotomy)
- aerobic capacity (eg, shortness of breath)
- anthropometric characteristics (eg, pedal edema)
- circulation (eg, abnormal heart rate, calf cramps with walking)
- muscle performance (eg, decreased endurance)
- posture (eg, scoliosis)
- prosthetic requirements (eg, dyspnea on exertion while wearing prosthesis)
- ventilation (eg, accessory muscle use)
categories:
- self-care (eg, inability to put on socks because of shortness of breath)
- home management (eg, inability to do yard work because of decreased power)
- work (job/school/play) (eg, inability to preach sermons because of uncontrolled breathing pattern,
inability to suck as neonate because of rapid respiratory rate)
- community/leisure (eg, inability to participate in community gardening events because of
dyspnea on exertion, inability to swim because of dyspnea and chest tightness)
- self-care
- home management
- community/leisure
* Risk factors for impaired ventilation and respiration/gas exchange:
- risk-prone behaviors (eg, exercise in high-pollution environments, lack of understanding of the
need for flu shot)
- smoking history
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- fitness, including physical performance (eg, inadequate oxygen consumption for participating in
marathon running, inadequate peripheral response for running)
- health and wellness (eg, incomplete understanding of necessity for paced breathing during
activity)
Tests and Measures
* Pulmonary signs of respiration/gas exchange, including breath sounds (eg, gas analyses,
observations, oximetry)
* Pulmonary signs of ventilatory function, including airway protection; breath and voice sounds;
respiratory rate, rhythm, and pattern; ventilatory flow, forces, and volumes (eg, airway clearance
tests, observations, palpation, pulmonary function tests, ventilatory muscle force tests)
* Pulmonary symptoms (eg, dyspnea and perceived exertion indexes and scales)
* Airway clearance tests
* Force meters
* Gas analyses
* Indexes
* Observations
* Palpation
* Pulse oximeters
* Spirometers
* Stethoscopes
Data Generated
* Descriptions and characterization of:
- breath and voice sounds
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- chest wall and related structures

- phonation
- pulmonary-related symptoms
- pulmonary vital signs
- thoracoabdominal ventilatory patterns
* Observations and descriptions of nail beds
* Presence and level of cyanosis
- ability to dear and protect airway
- gas exchange and oxygen transport
- pulmonary function and ventilatory mechanics
Work (Job/School/Play), Community, and Leisure Integration or Reintegration (Including
Instrumental Activities of Daily Living)
Work (job/school/play) integration or reintegration is the process of assuming or resuming roles
and functions at work (job/school/play), such as negotiating school environments, gaining access
to work (job/school/play) environments and workstations, and participating in age-appropriate play
activities. Community integration or reintegration is the process of assuming or resuming roles and
functions in the community, such as gaining access to transportation (eg, driving a car, boarding a
bus, negotiating a neighborhood), to community businesses and services (eg, bank, shops,
parks), and to public facilities (eg, attending theaters, town hal meetings, and places of worship).
Leisure integration or reintegration is the process of assuming or resuming roles and functions of
avocational and enjoyable pastimes, such as recreational activities (eg, playing a sport) and ageappropriate hobbies (eg, collecting antiques, gardening, or making crafts). The physical therapist
uses the results of work, community, and leisure integration or reintegration tests and measures to
(1) make judgments as to whether a patient/client is currently prepared to assume or resume
community or work (job/school/play) roles, including all instrumental activities of daily living (IADL),
(2) determine when and how such integration or reintegration might occur, or (3) assess the need
for assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment. The
physical therapist also uses the results of these tests and measures to determine whether the
patient/client is a candidate for a work hardening or work conditioning program.
Results of tests and measures of work (job/school/play), community, and leisure integration or
reintegration are integrated with the history and systems review findings and the results of other
tests and measures. All of the data are then synthesized during the evaluation process to
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through the selection of tests and measures of work (job/school/play), community, and leisure
integration or reintegration. Clinical indications for these tests and measures may include:
- cardiovascular (eg, cerebral vascular accident, peripheral vascular disease)
- multiple systems (eg,AIDS, trauma)
- musculoskeletal (eg, amputation, status post joint replacement)
- neuromuscular (eg, cerebellar ataxia, cerebral palsy)
- pulmonary (eg, asthma, cystic fibrosis)
- circulation (eg, calf cramps with walking)
- muscle performance (eg, decreased strength)
- neuromotor development (eg, abnormal movement control)
- posture (eg, pain on sitting)
categories:
- work (job/school/play) (eg, inability to sit at desk because of pain)
- community/leisure (eg, inability to attend a concert because of incontinence, inability to board a
bus because of muscle weakness, inability to gain access to recreational facilities because of
abnormal movement control, inability to visit friends in neighborhood because of decreased
endurance)
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- self-care
- home management
- community/leisure
* Risk factors for limitations in work Gob/school/play), community, and leisure integration and
reintegration:
- fitness, including physical performance (eg, inadequate motor skill to perform repeated lifting
activities as part of job, inadequate muscle strength for lifting boxes to and from shelves)
- health and wellness (eg, incomplete understanding of need for community support during
reintegration)
Tests and Measures
* Ability to assume or resume work (job/school/play), community, and leisure activities with or
without assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and equipment
(eg, activity profiles, disability indexes, functional status questionnaires, IADL scales,
observations, physical capacity tests)
* Ability to gain access to work (job/school/play), community, and leisure environments (eg, barrier
identification, interviews, observations, physical capacity tests, transportation assessments)
* Safety in work (job/school/play), community, and leisure activities and environments (eg, diaries,
fall scales, interviews, logs, observations, videographic assessments)
* Diaries
* Indexes
* Interviews
* Logs
* Observations
* Physical capacity tests
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* Profiles
* Questionnaires
* Transportation assessments
* Scales
Data Generated
* Descriptions of:
- level of safety in work (job/school/ play), community, and leisure activities
- physiological responses to activity
- ability to participate in variety of environments
- need for devices or equipment

Source Citation:"What Types of Tests and Measures Do Physical Therapists Use?." Physical

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What Types of Interventions Do Physical Therapists Provide?(A Guide to Physical

Therapist Practice).Physical Therapy 81.1 (Jan 2001): p105. (14732 words)
Introduction
In its broadest sense, intervention is the purposeful interaction of the physical therapist with the
patient/client--and, when appropriate, with other individuals involved in patient/client care--using
various methods and techniques to produce changes that are consistent with the examination and
reexamination findings, the evaluation, the diagnosis, and the prognosis. Decisions about
intervention are contingent on the timely monitoring of patient/client responses to interventions
and on the progress made toward anticipated goals and expected outcomes.
Physical therapist intervention consists of three major components (Figure):
* Procedural interventions
Coordination, communication, and documentation and patient/client-related instruction are
provided as part of intervention for all patients/clients. The use of procedural interventions varies,
however, because those interventions are selected, applied, or modified according to examination
and reexamination findings and the anticipated goals and expected outcomes for a particular
patient/client in a specific diagnostic group.
Physical therapist intervention encourages functional independence, emphasizes patient/clientrelated instruction, and promotes proactive, wellness-oriented lifestyles. Through appropriate
education and instruction, the patient/client is encouraged to develop habits that will maintain or
improve function, prevent recurrence of problems, and promote health, wellness, and fitness.
Selection of Procedural Interventions
Physical therapists select interventions based, on the complexity and severity of the clinical
problems. In determining the prognosis, the interventions to be used, and the likelihood of an
intervention's success, physical therapists also must consider the differences between the highest
level of function of which the individual is capable and the highest level of function that is likely to
be habitual for that individual. Patients/clients are more likely to achieve the anticipated goals and
expected outcomes that are determined with the physical therapist if they perceive a need to
function at the highest level of their ability--and if they are motivated to function habitually at that
level. Thus understanding the difference between what a person currently does and what that
person potentially could do is essential in making a prognosis and identifying realistic, achievable
goals and outcomes. Physical therapists ultimately must abide by the decisions of the
patient/client regarding actions, tasks, and activities that will be incorporated into a daily routine
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and regarding what constitutes a meaningful level of function.

The physical therapist's selection of procedural interventions should be based on:
* Examination findings (including those of the history, systems review, and tests and measures),
an evaluation, and a diagnosis that supports physical therapy intervention
* A prognosis that is associated with improved or maintained health status through risk reduction;
health, wellness, and fitness programs; or the remediation of impairments, functional limitations, or
disabilities
* A plan of care designed to improve, enhance, and maximize function through interventions of
appropriate intensity, frequency, and duration to achieve anticipated goals and expected
outcomes efficiently using available resources
The physical therapist selects, applies, or modifies one or more procedural interventions based on
anticipated goals and expected outcomes that have been developed with the patient/client.
Anticipated goals and expected outcomes relate to specific impairments, functional limitations, or
disabilities; signs or symptoms; risk reduction/prevention; and health, wellness, or fitness needs.
The anticipated goals and expected outcomes listed in the plan of care should be measurable and
time-specific.
In conjunction with coordination, communication, and documentation and patient/client-related
instruction, three categories of procedural interventions form the core of most physical therapy
plans of care: therapeutic exercise, functional training in self-care and home management, and
functional training in work (job/school/play), community, and leisure integration or reintegration.
The other categories of procedural interventions may be used when the examination, evaluation,
diagnosis, and prognosis indicate their necessity.
Factors that influence the complexity of both the examination process and the selection of
interventions may include chronicity or severity of current condition; level of current impairment
and probability of prolonged impairment, functional limitation, or disability; living environment;
multisite or multisystem involvement; overall physical function and health status; potential
discharge destinations; preexisting systemic conditions or diseases; social supports; and stability
of the condition.
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Through routine monitoring and reexamination, the physical therapist determines the need for any
alteration in an intervention or in the plan of care. The interventions used, including their frequency
and duration, are consistent with patient/client needs and physiological and cognitive status,
anticipated goals and expected outcomes, and resource constraints. The independent
performance of the procedure or technique by the patient/client (or significant other, family, or
caregiver) is encouraged following instruction in safe and effective application.
Failing to intervene appropriately to prevent illness or to habilitate or rehabilitate patients/clients
with impairments, functional limitations, and disabilities leads to greater costs for both the person
and society. The Guide provides administrators and policy makers with the information they need
to make decisions about the cost-effectiveness of physical therapist intervention.
Criteria for Termination of Physical Therapy Services
Discharge and discontinuation are the two processes used for terminating physical therapy
services.
Discharge is the process of ending physical therapy services that have been provided during a
single episode of care when the anticipated goals and expected outcomes have been achieved.
Discharge does not occur with a transfer (that is, when the patient is moved from one site to
another site within the same setting or across settings during a single episode of care). Although
there may be facility-specific or payer-specific requirements for documentation regarding the
conclusion of physical therapy services, discharge occurs based on the physical therapist's
analysis of the achievement of anticipated goals and expected outcomes. In consultation with
appropriate individuals, and in consideration of the anticipated goals and expected outcomes, the
physical therapist plans for discharge and provides for appropriate follow-up or referral.
Discontinuation is the process of ending physical therapy services that have been provided during
a single episode of care when (1) the patient/client, caregiver, or legal guardian declines to
continue intervention; (2) the patient/client is unable to continue to progress toward anticipated
goals and expected outcomes because of medical or psychosocial complications or because
financial/insurance resources have been expended; or (3) the physical therapist determines that
the patient/client will no longer benefit from physical therapy.
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In consultation with appropriate individuals, and in consideration of the anticipated goals and
expected outcomes, the physical therapist plans for discontinuation and provides for appropriate
follow-up or referral.
In this chapter, each component of physical therapist intervention--coordination, communication,
and documentation; patient/client-related instruction; and procedural interventions--is described,
including:
* General definitions. General definitions of each category of intervention are provided.
* Clinical considerations. Clinical considerations for selection of interventions are provided. For
procedural interventions, examples are given of the types of examination and diagnostic findings
that may indicate that a procedural intervention may be appropriate for a given patient/client.
Findings may include pathology/pathophysiology (disease, disorder, or condition); impairments;
functional limitations; disabilities; risk reduction/prevention needs; and health, wellness, and
fitness needs.
* Interventions. Examples of methods, procedures, or techniques that may be used are provided.
* Anticipated goals and expected outcomes. Anticipated goals and expected outcomes are
categorized according to a procedural intervention's impact on pathology/ pathophysiology;
impairments; functional limitations; disabilities; risk reduction/prevention; health, wellness, and
fitness; impact on societal resources; and patient/client satisfaction.
Coordination, Communication, and Documentation
Coordination, communication, and documentation are administrative and supportive processes
that are intended to ensure that patients/clients receive appropriate, comprehensive, efficient,
effective, and high-quality care from admission through discharge. Coordination is the working
together of all parties involved with the patient/client. Communication is the exchange of
information. Documentation is any entry into the patient/client record--such as consultation
reports, initial examination reports, progress notes, flow sheets, checklists, reexamination reports,
or summations of care--that identifies the care or service provided.
Administrative and support processes may include the addressing of such required functions as
advance directives, individualized education plans (IEPs), individualized family service plans
(IFSPs), informed consent, and mandatory communication and reporting (eg, patient advocacy
and abuse reporting); admission and discharge planning; case management; collaboration and
coordination with agencies; communication across settings; cost-effective resource utilization;
data collection, analysis, and reporting; documentation across settings; interdisciplinary teamwork;
and referrals to other professionals or resources.
Physical therapists are responsible for coordination, communication, and documentation across all
settings for all patients/clients.
Clinical Considerations
Considerations that may direct the type and specificity of interventions for coordination,
communication, and documentation may include:
* Patient/client seeks physical therapy services.
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* Patient/client is referred to physical therapy services.

* Patient/client condition indicates need for referral to physical therapy services.
* Patient/client requires referral from the physical therapist to another service or provider.
* Physical therapist obtains informed consent from patient/client in accordance with jurisdictional
law.
* Patient/client has signs or symptoms of physical abuse that must be reported in accordance with
jurisdictional law.
* Patient/client is admitted to or transferred across patient care settings.
* Physical therapy services are terminated (through discharge or discontinuation).
* Patient/client experiences changes in pathology/pathophysiology (disease, disorder, or
condition), impairments, functional limitations, disabilities, or overall health status.
* Patient/client is managed by interdisciplinary team.
* Physical therapist's plan of care for patient/client requires coordination of resources.
* Patient/client, family, significant other, or caregiver requests physical therapist participation in
coordination, communication, and documentation activities.
* Physical therapist is contacted by internal communities or external agencies related to
patient/client.
Interventions
Coordination, communication, and documentation may include:
* Addressing required functions
- advance directives
- IFSPs or IEPs
- informed consent
- mandatory communication and reporting (eg, patient advocacy and abuse reporting)
* Admission and discharge planning
* Case management
* Collaboration and coordination with agencies, including:
- equipment suppliers
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- home care agencies

- payer groups
- schools
- transportation agencies
* Communication across settings, including:
- case conferences
- documentation
- education plans
* Cost-effective resource utilization
* Data collection, analysis, and reporting
- outcome data
- peer review findings
- record reviews
* Documentation across settings, following APTA's Guidelines for Physical Therapy
Documentation (Appendix 5), including:
- changes in impairments, functional limitations, and disabilities
- changes in interventions
- elements of patient/client management (examination, evaluation, diagnosis, prognosis,
intervention)
- outcomes of intervention
* Interdisciplinary teamwork
- case conferences
- patient care rounds
- patient/client family meetings
* Referrals to other professionals or resources
Anticipated Goals and Expected Outcomes
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Anticipated goals and expected outcomes related to interventions for coordination,

communication, and documentation may include:
* Accountability for services is increased.
* Admission data and discharge planning are completed.
* Advance directives, IFSPs or IEPs, informed consent, and mandatory communication and
reporting (eg, patient advocacy and abuse reporting) are obtained or completed.
* Available resources are maximally utilized.
* Care is coordinated with patient/client, family, significant other, caregiver, and other
professionals.
* Case is managed throughout the episode of care.
* Collaboration and coordination occurs with agencies, including equipment suppliers, home care
agencies, payer groups, schools, and trarisportation agencies.
* Communication enhances risk reduction and prevention.
* Communication occurs across settings through case conferences, education plans, and
documentation.
* Data are collected, analyzed, and reported, including outcome data, peer review findings, and
record reviews.
* Decision making is enhanced regarding health, wellness, and fitness needs.
* Decision making is enhanced regarding patient/client health and the use of health care
resources by patient/client, family, significant others, and caregivers.
* Documentation occurs throughout patient/client management and across settings and follows
APTA's Guidelines for Physical Therapy Documentation (Appendix 5).
* Interdisciplinary collaboration occurs through case conferences, patient care rounds, and
patient/client family meetings.
* Patient/client, family, significant other, and caregiver understanding of anticipated goals and
expected outcomes is increased.
* Placement needs are determined.
* Referrals are made to other professionals or resources whenever necessary and appropriate.
* Resources are utilized in a cost-effective way.
Patient/Client-Related Instruction
Patient/client-related instruction is the process of informing, educating, or training patients/clients,
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families, significant others, and caregivers with the intent to promote and optimize physical
therapy services. Instruction may be related to the current condition (eg, specific impairments,
functional limitations, or disabilities); the plan of care; the need to enhance performance; transition
to a different role or setting; risk factors for developing a problem or dysfunction; or the need for
health, wellness, and fitness programs.
Physical therapists are responsible for patient/client-related instruction across all settings for all
patients/clients.
Considerations that may direct the type and specificity of interventions for patient/client-related
instruction may include:
* Patient/client requires instruction to optimize interventions that are designed to decrease
impairments, functional limitations, or disabilities.
* Patient/client requires instruction to reduce risk factors for pathology/pathophysiology (disease,
disorder, or condition), impairments, functional limitations, or disabilities.
* Patient/client requires instruction that is appropriate for impaired arousal, attention, and cognition
that may have an impact on learning and memory.
* Patient/client requires instruction that is appropriate for sensory impairment (eg, vision, hearing)
that may affect learning and skill acquisition.
* Patient/client requires instructional or educational assistive technology (eg, large print cards) or
environmental accommodations or modifications (eg, enhanced lighting, signage) that may be
required for effective learning and skill acquisition.
* Physical therapist identifies potential learning barriers (eg, beliefs, cultural expectations, and
language) that must be addressed prior to and throughout patient/client-related instruction and
education.
* Physical therapist identifies patient/client impairments, functional limitations, or disabilities that
indicate assistance (eg, caregiver, family member, equipment) is required for effective learning
and skill acquisition.
* Physical therapist provides instruction and education to patient/client and patient/client support
system regarding the plan of care.
* Physical therapist provides instruction when patient/client has identified personal goals for
enhanced performance.
* Physical therapist provides instruction when patient/client is transitioning across care settings or
performing in a new role that will require an increased or decreased level of service.
* Physical therapist provides instruction when patient/client will benefit from health, wellness, and
fitness programs.
Interventions
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Patient/client-related instruction may include:

* Instruction, education, and training of patients/clients and caregivers regarding
- current condition (pathology/pathophysiology [disease, disorder, or condition], impairments,
functional limitations, or disabilities)
- enhancement of performance
- health, wellness, and fitness programs
- plan of care
- risk factors for pathology/pathophysiology (disease, disorder, or condition), impairments,
functional limitations, or disabilities
- transitions across settings
- transitions to new roles
Anticipated goals and expected outcomes related to patient/client-related instruction may include:
* Ability to perform physical actions, tasks, or activities is improved.
* Awareness and use of community resources are improved.
* Behaviors that foster healthy habits, wellness, and prevention are acquired.
* Decision making is enhanced regarding patient/client health and the use of health care
* Disability associated with acute or chronic illnesses is reduced.
* Functional independence in activities of daily living (ADL) and instrumental activities of daily
living (IADL) is increased.
* Health status is improved.
* Intensity of care is decreased.
* Level of supervision required for task performance is decreased.
* Patient/client, family, significant other, and caregiver knowledge and awareness of the diagnosis,
prognosis, interventions, and anticipated goals and expected outcomes are increased.
* Patient/client knowledge of personal and environmental factors associated with the condition is
increased.
* Performance levels in self-care, home management, work (job/school/play), community or
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leisure actions, tasks, or activities are improved.

* Physical function is improved.
* Risk of recurrence of condition is reduced.
* Risk of secondary impairment is reduced.
* Safety of patient/client, family, significant others, and caregivers is improved.
* Self-management of symptoms is increased.
* Utilization and cost of health care services are decreased.
Therapeutic Exercise
Therapeutic exercise is the systematic performance or execution of planned physical movements,
postures, or activities intended to enable the patient/client to (1) remediate or prevent
impairments, (2) enhance function, (3) reduce risk, (4) optimize overall health, and (5) enhance
fitness and well-being. Therapeutic exercise may include aerobic and endurance conditioning and
reconditioning; agility training; balance training, both static and dynamic; body mechanics training;
breathing exercises; coordination exercises; developmental activities training; gait and locomotion
training; motor training; muscle lengthening; movement pattern training; neuromotor development
activities training; neuromuscular education or reeducation; perceptual training; postural
stabilization and training; range-of-motion exercises and soft tissue stretching; relaxation
exercises; and strength, power, and endurance exercises.
Physical therapists select, prescribe, and implement exercise activities when the examination
findings, diagnosis, and prognosis indicate the use of therapeutic exercise to enhance bone
density; enhance breathing; enhance or maintain physical performance; enhance performance in
activities of daily living (Al)L) and instrumental activities of daily living (IADL); improve safety;
increase aerobic capacity/endurance; increase muscle strength, power, and endurance; enhance
postural control and relaxation; increase sensory awareness; increase tolerance to activity;
prevent or remediate impairments, functional limitations, or disabilities to improve physical
function; enhance health, wellness, and fitness; reduce complications, pain, restriction, and
swelling; or reduce risk and increase safety during activity performance.
Examination findings that may direct the type and specificity of the procedural intervention may
include:
* Pathology/pathophysiology (disease, disorder, or condition), history (including risk factors) of
medical/surgical conditions, or signs and symptoms (eg, pain, shortness of breath, stress) in the
following systems:
- cardiovascular
- endocrine/metabolic
- genitourinary
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- integumentary
- multiple systems
- musculoskeletal
- neuromuscular
- pulmonary
- aerobic capacity/endurance (eg, decreased walk distance)
- anthropometric characteristics (eg, increased body mass index)
- arousal, attention, and cognition (eg, decreased motivation to participate in fitness activities)
- circulation (eg, abnormal elevation in heart rate with activity)
- cranial and peripheral nerve integrity (eg, difficulty with swallowing, risk of aspiration, positive
neural provocation response)
- ergonomics and body mechanics (eg, inability to squat because of weakness in gluteus maximus
and quadriceps femoris muscles)
- gait, locomotion, and balance (eg, inability to perform ankle dorsiflexion)
- integumentary integrity (eg, limited finger flexion as a result of dorsal burn scar)
- joint integrity and mobility (eg, limited range of motion in the shoulder)
- motor function (eg, uncoordinated limb movements)
- muscle performance (eg, weakness of lumbar stabilizers)
- neuromotor development and sensory integration (eg, delayed development)
- posture (eg, forward head, kyphosis)
- range of motion (eg, increased laxity in patellofemoral joint)
- reflex integrity (eg, poor balance in standing)
- sensory integrity (eg, lack of position sense)
- ventilation and respiration/gas exchange (eg, abnormal breathing patterns)
categories:
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- self-care (eg, difficulty with dressing, bathing)

- home management (eg, difficulty with raking, shoveling, making bed)
- work (job/school/play) (eg, difficulty with keyboarding, pushing, or pulling, difficulty with play
activities)
- community/leisure (eg, inability to negotiate steps and curbs)
- work (eg, inability to assume parenting role, inability to care for elderly relatives, inability to return
to work as a police officer)
- community/leisure (eg, difficulty with jogging or playing golf, inability to attend religious services)
* Risk reduction/prevention in the following areas:
- risk factors (eg, need to decrease body fat composition)
- recurrence of condition (eg, need to increase mobility and postural control for work
[job/school/play] actions, tasks, and activities)
- secondary impairments (eg, need to improve strength and balance for fall risk reduction)
- fitness, including physical performance (eg, need to improve golf-swing timing, need to maximize
gymnastic performance, need to maximize pelvic-floor muscle function)
- health and wellness (eg, need to improve balance for recreation, need to increase muscle
strength to help maintain bone density)
Interventions
Therapeutic exercise may include:
* Aerobic capacity/endurance conditioning or reconditioning
- aquatic programs
- gait and locomotor training
- increased workload over time
- movement efficiency and energy conservation training
- walking and wheelchair propulsion programs
* Balance, coordination, and agility training
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- developmental activities training

- motor function (motor control and motor learning) training or retraining
- neuromuscular education or reeducation
- perceptual training
- posture awareness training
- sensory training or retraining
- standardized, programmatic, complementary
- exercise approaches
- task-specific performance training
- vestibular training
* Body mechanics and postural stabilization
- body mechanics training
- postural control training
- postural stabilization activities
- posture awareness training
* Flexibility exercises
- muscle lengthening
- range of motion
- stretching
* Gait and locomotion training
- gait training
- implement and device training
- perceptual training
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- wheelchair training
* Neuromotor development training
- motor training
- movement pattern training
- neuromuscular education or reeducation
* Relaxation
- breathing strategies
- movement strategies
- relaxation techniques
* Strength, power, and endurance training for head, neck, limb, pelvic-floor, trunk, and ventilatory
muscles
- active assistive, active, and resistive exercises (including concentric, dynamic/ isotonic,
eccentric, isokinetic, isometric, and plyometric)
- aquatic programs
- standardized, programmatic, complementary exercise approaches
- task-specific performance training
Anticipated goals and expected outcomes related to therapeutic exercise may include:
* Impact on pathology/pathophysiology (disease, disorder, or condition)
- Atelectasis is decreased.
- Joint swelling, inflammation, or restriction is reduced.
- Nutrient delivery to tissue is increased.
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- Osteogenic effects of exercise are maximized.

- Pain is decreased.
- Physiological response to increased oxygen demand is improved.
- Soft tissue swelling, inflammation, or restriction is reduced.
- Symptoms associated with increased oxygen demand are decreased.
- Tissue perfusion and oxygenation are enhanced.
* Impact on impairments
- Aerobic capacity is increased.
- Airway clearance is improved.
- Balance is improved.
- Endurance is increased.
- Energy expenditure per unit of work is decreased.
- Gait, locomotion, and balance are improved.
- Integumentary integrity is improved.
- Joint integrity and mobility are improved.
- Motor function (motor control and motor learning) is improved.
- Muscle performance (strength, power, and endurance) is increased.
- Postural control is improved.
- Quality and quantity of movement between and across body segments are improved.
- Range of motion is improved.
- Relaxation is increased.
- Sensory awareness is increased.
- Ventilation and respiration/gas exchange are improved.
- Weight-bearing status is improved.
- Work of breathing is decreased.
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* Impact on functional limitations

- Ability to perform physical actions, tasks, or activities related to self-care, home management,
work (job/school/play), community, and leisure is improved.
- Level of supervision required for task performance is decreased.
- Performance of and independence in ADL and IADL with or without devices and equipment are
increased.
- Tolerance of positions and activities is increased.
* Impact on disabilities
- Ability to assume or resume required self-care, home management, work (job/school/play),
community, and leisure roles is improved.
- Preoperative and postoperative complications are reduced.
- Risk factors are reduced.
- Risk of recurrence of condition is reduced.
- Risk of secondary impairment is reduced.
- Safety is improved.
- Self-management of symptoms is improved.
* Impact on health, wellness, and fitness
- Fitness is improved.
- Health status is improved.
- Physical capacity is increased.
- Physical function is improved.
* Impact on societal resources
- Utilization of physical therapy services is optimized.
- Utilization of physical therapy services results in efficient use of health care dollars.
- Access, availability, and services provided are acceptable to patient/client.
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- Administrative management of practice is acceptable to patient/client.

- Clinical proficiency of physical therapist is acceptable to patient/client.
- Coordination of care is acceptable to patient/client.
- Cost of health care services is decreased.
- Intensity of care is decreased.
- Interpersonal skills of physical therapist are acceptable to patient/client, family, and significant
others.
- Sense of well-being is improved.
- Stressors are decreased.
Functional Training in Self-Care and Home Management (Including Activities of Daily Living and
Functional training in self-care and home management is the education and training of
patients/clients in activities of daffy living (ADL) and instrumental activities of daffy living (IADL).
Functional training in self-care and home management is intended to improve the ability to
perform physical actions, tasks, or activities in an efficient, typically expected, or competent
manner. Self-care includes ADL such as bed mobility, transfers, dressing, grooming, bathing,
eating, and toileting. Home management includes more complex IADL, such as caring for
dependents, maintaining a home, performing household chores and yard work, shopping, and
structured play (for infants and children). Activities may include accommodation to or modification
of environmental and home barriers; ADL and IADL training; guidance and instruction in injury
prevention or reduction; functional training programs; training in the use of assistive, adaptive,
orthotic, protective, supportive, or prosthetic devices and equipment during self-care and home
management activities; task simulation and adaptation; and travel training.
Physical therapists select, prescribe, and implement specific training activities when the
examination findings, diagnosis, and prognosis indicate the use of functional training in self-care
and home management to enhance health, wellness, and fitness; enhance musculoskeletal,
neuromuscular, and cardiovascular/pulmonary capabilities; improve body mechanics; increase
assumption or resumption of self-care or home management in a safe and efficient manner;
increase postural awareness; prevent or remediate impairments, functional limitations, or
disabilities to improve physical function; or reduce risk and increase safety during activity
performance.
include:
following systems:
- cardiovascular
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- genitourinary
- integumentary
- multiple systems
- musculoskeletal
- neuromuscular
- pulmonary
* Impairments that have an impact on function in self-care and home management actions, tasks,
and activities in the following categories:
- aerobic capacity/endurance (eg, shortness of breath interferes with raking, shoveling, mopping)
- anthropometric characteristics (eg, swollen arm interferes with grooming)
- arousal, attention and cognition (eg, inability to recall sequence of daily routine interferes with
dressing)
- circulation (eg, heart rate increases during hair drying)
- cranial and peripheral nerve integrity (eg, paresthesia interferes with bathing)
- ergonomics and body mechanics (eg, pain increases during vacuuming)
- gait, locomotion, and balance (eg, dizziness interferes with climbing stairs into home)
- integumentary integrity (eg, decreased sensation as a result of second degree burns of hand
interferes with personal hygiene)
- joint integrity and mobility (eg, hip and knee pain interferes with taking out trash)
- motor function (eg, loss of finger dexterity interferes with use of utensils)
- muscle performance (eg, decreased lower-extremity strength interferes with bathroom transfers)
- neuromotor development and sensory integration (eg, delayed development interferes with selfcare)
- posture (eg, cervical posture interferes with desk work)
- range of motion (eg, decreased shoulder range of motion interferes with reaching behind the
back to fasten buttons)
- reflex integrity (eg, primitive reflexes interfere with positioning for feeding)
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- sensory integrity (eg, altered proprioception interferes with yard work)

- ventilation and respiration (eg, decreased oxygen saturation interferes with showering)
categories:
- self-care (eg, inability to bottle feed independently, inability to dress and bathe)
- home management (eg, inability to perform meal preparation tasks)
- work (eg, inability to assume parenting roles)
- community/leisure (eg, inability to serve as volunteer in hospital coffee shop)
* Risk reduction/prevention needs in the following areas:
- risk factors (eg, need to learn correct biomechanics of lifting for daily activities)
- recurrence of condition (eg, need to use assistive device or equipment to perform tasks that are
likely to cause rein jury)
- secondary impairments (eg, need to relearn adaptive skills for self-care and home management)
- fitness, including physical performance (eg, need to increase endurance to complete self-care
tasks, need to maximize independence in self-care, need to maximize safety in home
management)
- health and wellness (eg, need to improve physical ability to paint landscapes, need to increase
ability to travel)
Interventions
Functional training in self-care and home management may include:
* ADL training
- bathing
- bed mobility and transfer training
- developmental activities
- dressing
- eating
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- grooming
- toileting
* Barrier accommodations or modifications
* Device and equipment use and training
- assistive and adaptive device or equipment training during ADL and IADL
- orthotic, protective, or supportive device or equipment training during self<are and home
management
- prosthetic device or equipment training during ADL and IADL
* Functional training programs
- back schools
- simulated environments and tasks
- task adaptation
- travel training
* IADL training
- caring for dependents
- home maintenance
- household chores
- shopping
- structured play for infants and children
- yard work
* Injury prevention or reduction
- injury prevention education during self-care and home management
- injury prevention or reduction with use of devices and equipment
- safety awareness training during self-care and home management
Anticipated goals and expected outcomes related to functional training in self-care and home
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management may include:

- Ability to perform physical actions, tasks, or activities related to self-care and home management
is improved.
increased.
- Ability to assume or resume required self-care and home management roles is improved.
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others.
Functional Training in Work (Job/School/Play), Community, and Leisure Integration or
Reintegration (Including Instrumental Activities of Daily Living, Work Hardening, and Work
Conditioning)
Functional training in work Gob/school/play), community, and leisure integration or reintegration is
the education and training of patients/clients in assumption and resumption of roles and functions
in the work environment, in the community, and during leisure activities so that (1) the physical
actions or activities required for these roles and functions are performed in an efficient, typically
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expected, or competent manner and (2) the expectations of work (job/school/play), community,
and leisure roles are fulfilled.
Work integration or reintegration into roles may include functions such as gaining access to work
(job/school/play) environments and workstations, participating in work hardening or work
conditioning programs, negotiating school environments, and participating in age-appropriate play
activities. Activities may include accommodations to or modifications of environmental and work
barriers; functional training programs (eg, work hardening or conditioning programs); guidance
and instruction in injury prevention or reduction; job coaching; leisure and play activity training;
training in instrumental activities of daily living OADL); task simulation and adaptation; training in
the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and equipment
during work (job/school/play), community, and leisure activities; and travel training. Community
integration or reintegration into roles may include activities such as gaining access to
transportation (eg, driving a car, boarding a bus), a neighborhood (eg, negotiating curbs, crossing
streets), community businesses and services (eg, banking, shopping), and public facilities (eg,
attending theaters, town hall meetings, and places of worship). Leisure integration or reintegration
is the process of assuming or resuming roles and functions of avocational and enjoyable
pastimes, such as recreational activities (eg, playing a sport) and age-appropriate hobbies (eg,
collecting antiques, gardening, or making crafts)
Physical therapists select, prescribe, and implement specific training activities when the
examination findings, diagnosis, and prognosis indicate the use of functional training in work
(job/school/play), community, and leisure integration or reintegration to enhance health, wellness,
and fitness; improve body mechanics; improve safety and efficiency of performance of work
(job/school/play), community, and leisure actions, tasks, and activities; increase independence in
work and community environments; increase postural awareness; prevent or remediate
impairments, functional limitations, or disabilities to improve physical function; or reduce risk.
include:
following systems:
- cardiovascular
- genitourinary
- integumentary
- multiple systems
- musculoskeletal
- neuromuscular
- pulmonary
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* Impairments that have an impact on function in work Gob/school/play), community, and leisure
integration or reintegration actions, tasks, and activities in the following categories:
- aerobic capacity/endurance (eg, shortness of breath interferes with loading delivery van)
- anthropometric characteristics (eg, obesity interferes with accessing transportation)
- arousal, attention, and cognition (eg, inability to recall sequencing in assembly-line processing
interferes with job)
- circulation (eg, chest pain interferes with walking during cold weather to catch bus)
- cranial and peripheral nerve integrity (eg, tingling of the feet interferes with pushing cart up ramp)
- ergonomics and body mechanics (eg, pain increases with squatting and reaching to stock
shelves)
- gait, locomotion, and balance (eg, unsteady gait interferes with walking in the park)
- integumentary integrity (eg, finger numbness interferes with manipulative skills)
- joint integrity and mobility (eg, elbow hypomobility interferes with driving a bus)
- motor function (eg, ataxic movements interfere with keyboarding)
- muscle performance (eg, decreased trunk strength interferes with participation in school physical
education activities)
- neuromotor development and sensory integration (eg, inability to go from sitting position to
standing position interferes with office activities)
- posture (eg, leg length discrepancy interferes with standing during food preparation)
- range of motion (eg, decreased shoulder and elbow range of motion interferes with tennis swing)
- reflex integrity (eg, decreased postural reflexes or reactions interfere with walking in a crowd)
- sensory integrity (eg, altered proprioception interferes with stadium stair climbing)
- ventilation and respiration (eg, shortness of breath interferes with postal carrier's mail delivery)
categories:
- work (job/school/play) integration or reintegration (eg, inability to perform manual labor)
- community/leisure integration or reintegration (eg, inability to get on and off a train, difficulty with
sports activities)
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- work (eg, inability to practice as a surgeon)

- community/leisure (eg, inability to participate in League of Women Voters, inability to participate
in local park cleanup, inability to participate as member of community soccer team)
- risk factors (eg, need to use correct protective equipment for a given task)
- recurrence of condition (eg, need to learn correct balance of work, rest, and stretching)
secondary impairments (eg, need to correctly train for each new task)
- fitness, including physical performance (eg, need to maximize independence or safety in work
[job/school/play]), community, and leisure; need to increase endurance to complete work
[job/school/play], community, and leisure tasks)
- health and wellness (eg, need to improve breathing efficiency for singing in choir, need to
increase strength for community environmental work)
Interventions
Functional training in work (job/school/play), community, and leisure integration or reintegration
may include:
* Barrier accommodations or modifications
* Device and equipment use and training
- assistive and adaptive device or equipment training during IADL
- orthotic, protective, or supportive device or equipment training during IADL
- prosthetic device or equipment training during IADL
* Functional training programs
- back schools
- job coaching
- simulated environments and tasks
- task adaptation
- task training
- travel training
- work conditioning
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- work hardening
* IADL training
- community service training involving instruments
- school and play activities training including tools and instruments
- work training with tools
* Injury prevention or reduction
- injury prevention education during work (job/school/play), community, and leisure integration or
reintegration
- injury prevention education with use of devices and equipment
- safety awareness training during work (job/school/play), community, and leisure integration or
reintegration
* Leisure and play activities and training
Anticipated goals and expected outcomes related to functional training in work (job/school/play),
community, and leisure integration or reintegration may include:
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- Ability to perform physical actions, tasks, or activities related to work (job/school/play),
community, and leisure integration or reintegration is improved.
- Performance of and independence in IADL with or without devices and equipment are increased.
- Ability to assume or resume required work (job/school/play), community, and leisure roles is
improved.
* Impact on societal resources - Costs of work-related injury or disability are reduced.
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others.
Manual Therapy Techniques (Including Mobilization/Manipulation)
Manual therapy techniques are skilled hand movements intended to improve tissue extensibility;
increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints;
modulate pain; and reduce soft tissue swelling, inflammation, or restriction. Procedures and
modalities may include manual lymphatic drainage, manual traction, massage,
mobilization/manipulation, and passive range of motion.
Physical therapists select, prescribe, and implement manual techniques when the examination
findings, diagnosis, and prognosis indicate use of manual therapy to decrease edema, pain,
spasm, or swelling; enhance health, wellness, and fitness; enhance or maintain physical
performance; increase the ability to move; or prevent or remediate impairments, functional
limitations, or disabilities to improve physical function.
include:
following systems:
- genitourinary
- integumentary
- multiple systems
- musculoskeletal
- neuromuscular
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- pulmonary
- vascular
- anthropometric characteristics (eg, increased limb girth)
- cranial and peripheral nerve integrity (eg, pain on forward bending)
- ergonomics and body mechanics (eg, inability to flex knee)
- gait, locomotion, and balance (eg, inability to flex hip)
- integumentary integrity (eg, decreased skin extensibility)
- joint integrity and mobility (eg, decreased joint play)
- motor function (eg, decreased agility)
- muscle performance (eg, decreased muscle strength)
- posture (eg, forward head)
- range of motion (eg, inability to flex, abduct, and externally rotate hip)
- ventilation and respiration (eg, decreased rib cage mobility)
categories:
- self-care (eg, difficulty with brushing teeth, combing hair, sit-to-stand activities)
- home management (eg, difficulty with carrying loads, painting, shoveling)
- work (job/school/play) (eg, difficulty with typing, driving a car)
- community/leisure (eg, inability to ride bicycle)
* Disability--that is, the inability or the restricted ability toperform actions, tasks, or activities of
- work (job/school/play) (eg, inability to assume role as family caregiver, inability to resume job as
first violinist in orchestra)
- community/leisure (eg, difficulty with varsity swimming, inability to volunteer at neighborhood
school)
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- risk factors (eg, need to perform preventive stretching)

- recurrence of condition (eg, need to learn cycle of dependent position/elevation for edema
control)
- secondary impairments (eg, need to continue home traction and massage to maintain mobility)
- fitness, including physical performance (eg, need to increase muscle length to optimize fitness,
need to maximize flexibility for ballet)
- health and wellness (eg, need to improve relaxation, need to increase flexibility for yoga)
Interventions
Manual therapy techniques may include:
* Manual lymphatic drainage
* Manual traction
* Massage
- connective tissue massage
- therapeutic massage
* Mobilization/manipulation
- soft tissue
- spinal and peripheral joints
* Passive range of motion
Anticipated goals and expected outcomes related to manual therapy techniques may include:
- Edema, lymphedema, or effusion is decreased.
- Neural compression is decreased
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- Ability to perform movement tasks is improved..
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- Administrative management of practice is acceptable to patient/client. Clinical proficiency of
physical therapist is acceptable to patient/client.
others.
Prescription, Application, and, as Appropriate, Fabrication of Devices and Equipment (Assistive,
Adaptive, Orthotic, Protective, Supportive, and Prosthetic)
Prescription, application, and, as appropriate, fabrication of assistive, adaptive, orthotic,
protective, supportive, and prosthetic devices and equipment are processes to select, provide,
and train for utilization of therapeutic implements and equipment that are intended to (1) aid
patients/clients in performing tasks or movements, (2) support weak or ineffective joints or
muscles and serve to enhance performance, (3) replace a missing part of the body, or (4) adapt
the environment to facilitate functional performance of activities related to self-care, home
management, work, community, and leisure. These devices and equipment may include adaptive,
assistive, orthotic, protective, supportive, and prosthetic devices.
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Physical therapists prescribe, apply, and, as appropriate, fabricate devices and equipment when
the examination findings, diagnosis, and prognosis indicate the use of devices and equipment to
decrease edema and swelling; enhance health, wellness, and fitness; enhance performance and
independence in activities of daily living (ADL) and instrumental activities of daily living (IADL);
enhance or maintain physical performance; increase alignment, mobility, or stability; prevent or
remediate impairments, functional limitations, or disabilities to improve physical function; protect
body parts; or reduce risk factors and complications.
include:
following systems:
- cardiovascular
- genitourinary
- integumentary
- multiple systems
- musculoskeletal
- neuromuscular
- pulmonary
- aerobic capacity/endurance (eg, increased shortness of breath during ambulation with
prosthesis)
- anthropometric characteristics (eg, weight gain interferes with orthotic fit)
- arousal, attention, and cognition (eg, decreased attention interferes with safety)
- circulation (eg, decreased peripheral circulation alters venous return)
- cranial and peripheral nerve integrity (eg, loss of sensation)
- ergonomics and body mechanics (eg, back pain)
- gait, locomotion, and balance (eg, footdrop)
- integumentary integrity (eg, pressure ulcer)
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- joint integrity and mobility (eg, joint hypermobility)

- motor function (eg, loss of coordination)
- muscle performance (eg, decreased lower-extremity strength)
- neuromotor development and sensory integration (eg, delayed development)
- posture (eg, abnormal foot alignment)
- range of motion (eg, increased hallux adduction)
- reflex integrity (eg, decreased protective reactions)
- sensory integrity (eg, altered proprioception)
- ventilation and respiration/gas exchange (eg, paradoxical breathing)
categories:
- self-care (eg, difficulty with entering bathtub)
- home management (eg, difficulty with keyboarding while ordering groceries)
- work (job/school/play) (eg, difficulty with violin playing)
- community/leisure (eg, difficulty with answering hotline telephones without headset, inability to
gain access to playground)
- work (eg, inability to lift child without back support, inability to stand comfortably without orthotics
while waitressing)
- community/leisure (eg, difficulty with jogging without pregnancy sling, inability to attend dancing
lessons without prosthesis)
- risk factors (eg, need to properly monitor skin)
- recurrence of condition (eg, need to use protective seating system)
- secondary impairments (eg, need to continue use of prosthetic device for activity)
- fitness, including physical performance (eg, need to maximize performance with knee brace at
the Special Olympics, need to enhance aerobic performance with supplemental oxygen)
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- health and wellness (eg, need to enhance endurance for dancing, need to improve use of
assistive, adaptive, orthotic, protective, supportive, or prosthetic device during violin practice)
Interventions
Prescription, application, and, as appropriate, fabrication of devices and equipment may include:
* Adaptive devices
- environmental controls
- hospital beds
- raised toilet seats
- seating systems
* Assistive devices
- canes
- crutches
- long-handled reachers
- percussors and vibrators
- power devices
- static and dynamic splints
- walkers
- wheelchairs
* Orthotic devices
- braces
- casts
- shoe inserts
- splints
* Prosthetic devices (lower-extremity and upper-extremity)
* Protective devices
- braces
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- cushions
- helmets
- protective taping
* Supportive devices
- compression garments
- corsets
- elastic wraps
- mechanical ventilators
- neck collars
- serial casts
- slings
- supplemental oxygen
- supportive taping
Anticipated goals and expected outcomes related to prescription, application, and, as appropriate,
fabrication of devices and equipment may include:
- Edema, lymphedema, or effusion is reduced.
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- Joint stability is in, proved.
- Optimal joint alignment is achieved.
- Optimal loading on a body part is achieved.
- Prosthetic fit is achieved.
increased.
Page 38 of 63
- Pressure on body tissues is reduced.

- Protection of body parts is increased.
- Stresses precipitating injury are decreased.
others.
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Airway clearance techniques are a group of therapeutic activities intended to manage or prevent
the consequences of impaired mucociliary transport or the inability to protect the airway (eg,
impaired cough). Techniques may include breathing strategies for airway clearance,
manual/mechanical techniques for airway clearance, positioning, and pulmonary postural
drainage.
Physical therapists select, prescribe, and implement airway clearance activities when the
examination findings, diagnosis, and prognosis indicate the use of airway clearance techniques to
enhance exercise performance; enhance health, wellness, or fitness; enhance or maintain
physical performance; improve cough; improve ventilation; prevent or remediate impairments,
functional limitations, or disabilities to improve physical function; or reduce risk factors and
complications.
include:
following systems:
- cardiovascular
- genitourinary
- integumentary
- multiple systems
- musculoskeletal
- neuromuscular
- pulmonary
- aerobic capacity/endurance (eg, persistent coughing)
- anthropometric characteristics (eg, decreased cough because of obesity)
- arousal, attention, and cognition (eg, inability to understand directions)
- circulation (eg, bilateral pedal edema)
Page 40 of 63
- cranial and peripheral nerve integrity (eg, decreased gag/cough reflex)

- joint integrity and mobility (eg, decreased thoracic mobility) muscle performance (eg, decreased
ventilatory muscle strength)
- neuromotor development and sensory integration (eg, coughing on change of position)
- posture (eg, decreased thoracic mobility because of scoliosis)
- ventilation and respiration (eg, increased secretions)
categories:
- self-care (eg, difficulty with dressing and bathing because of increased wheezing)
- home management (eg, difficulty with vacuuming because of persistent coughing)
- work (job/school/play) (eg, difficulty with repetitive overhead activities because of shortness of
breath)
- community/leisure (eg, inability to negotiate steps because of shortness of breath)
- work (eg, inability to assume role as caregiver of spouse, inability to return to work at a
construction site)
- community/leisure (eg, difficulty with walking to post office, inability to attend a theater
performance)
- risk factors (eg, need to pursue smoking cessation)
- recurrence of condition (eg, need to continue home airway clearance techniques)
- secondary impairments (eg, need to strengthen muscles of breathing)
- fitness, including physical performance (eg, need to increase diaphragmatic muscle strength,
need to maximize breathing capabilities during aerobic class)
- health and wellness (eg, need to increase relaxation for breathing control during speaking, need
to optimize oxygen use while providing elder services)
Interventions
Airway clearance techniques may include:
Page 41 of 63
* Breathing strategies
- active cycle of breathing or forced
- expiratory techniques
- assisted cough/huff techniques
- autogenic drainage
- paced breathing
- pursed lip breathing
- techniques to maximize ventilation (eg, maximum inspiratory hold, stair case breathing, manual
hyperinflation)
* Manual/mechanical techniques
- assistive devices
- chest percussion, vibration, and shaking
- chest wall manipulation
- suctioning
- ventilatory aids
* Positioning
- positioning to alter work of breathing
- positioning to maximize ventilation and perfusion
- pulmonary postural drainage
Anticipated goals and expected outcomes related to airway clearance techniques may include:
Page 42 of 63

- Cough is improved.
- Endurance is increased,
- Exercise tolerance is improved.
- Performance of and independence in activities of daily living (ADL) and instrumental activities of
daily living (IADL) with or without devices and equipment are increased.
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others.
Integumentary Repair and Protection Techniques
Integumentary repair and protection techniques involve the application of therapeutic procedures
and modalities that are intended to enhance wound perfusion, manage scar, promote an optimal
wound environment, remove excess exudate from a wound complex, and eliminate nonviable
tissue from a wound bed. Procedures and modalities may include debridement; dressings;
orthotic, protective, and supportive devices; physical agents and mechanical and
electrotherapeutic modalities; and topical agents.
Physical therapists select, prescribe, and implement procedures and modalities when the
examination findings, diaggnosis, and prognosis indicate the use of integumentary repair and
protection techniques to enhance tissue perfusion; enhance wound and soft tissue healing;
prevent or remediate impairments, functional limitations, or disabilities to improve physical
function; or reduce risk factors and complications.
Page 44 of 63
include:
following systems:
- cardiovascular
- genitourinary
- integumentary
- multiple systems
- musculoskeletal
- neuromuscular
- pulmonary
- anthropometric characteristics (eg, increased limb girth)
- circulation (eg, decreased peripheral perfusion) cranial and peripheral nerve integrity (eg,
decreased hand sensation as a result of burn)
- gait, locomotion, and balance (eg, decreased balance as a result of foot ulcer pain)
- integumentary integrity (eg, open wound) joint integrity and mobility (eg, limited elbow range of
motion because of scar)
- muscle performance (eg, limited strength because of wound pain)
- neuromotor development and sensory integration (eg, knee abrasions because of creeping)
- posture (eg, pressure ulcer because of prolonged sitting)
- range of motion (eg, decreased range of thorax motion as a result of surgical wound)
- reflex integrity (eg, altered withdrawal response)
- sensory integrity (eg, decreased proprioception)
- ventilation and respiration/gas exchange (eg, delayed wound healing because of impaired tissue
oxygenation)
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categories:
- self-care (eg, difficulty with wearing shoes as a result of edematous wound)
- home management (eg, difficulty with dish washing as a result of dermatitis)
- work (job/school/play) (eg, difficulty with lifting and bending because of burn scars, inability to sit
in school because of sacral decubitus ulcer)
- community/leisure (eg, inability to go to bank because of residual limb pressure ulcer)
- work (eg, inability to assume role as parent because of infected wound, inability to return to work
as a toll taker because of sensation loss in fingers)
- community/leisure (eg, inability to swim competitively because of skin breakdown, inability to
attend school social events because of low serf-esteem associated with facial scarring)
- risk factors (eg, need to properly monitor skin)
- recurrence of condition (eg, need to protect skin surfaces)
- secondary impairments (eg, need to maintain scar mobility)
- fitness, including physical performance (eg, need to limit sun exposure during gardening, need to
promote foot skin protection during marathon training)
- health and wellness (eg, need to improve nutrition and hydration, need to understand personal
and environmental factors that promote optimal health status)
Interventions
Integumentary repair and protection techniques may include:
* Debridement--nonselective
- enzymatic debridement
- wet dressings
- wet-to-dry dressings
- wet-to-moist dressings
* Debridement--selective
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- debridement with other agents (eg, autolysis)

- sharp debridement
* Dressings
- hydrogels
- vacuum-assisted closure
- wound coverings
* Oxygen therapy
- supplemental
- topical
* Topical agents
- cleansers
- creams
- moisturizers
- ointments
- sealants
Anticipated goals and expected outcomes related to integumentary repair and protection
techniques may include:
- Debridement of nonviable tissue is achieved.
- Soft tissue or wound healing is enhanced.
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- Wound size is reduced.
- Level of supervision required for task performance, is decreased.
Page 48 of 63
others.
Electrotherapeutic Modalities
Electrotherapeutic modalities are a broad group of agents that use electricity and are intended to
assist functional training; assist muscle force generation and contraction; decrease unwanted
muscular activity; increase the rate of healing of open wounds and soft tissue; maintain strength
after injury or surgery; modulate or decrease pain; or reduce or eliminate soft tissue swelling,
inflammation, or restriction. Modalities may include biofeedback, electrical stimulation (muscle and
nerve), and electrotherapeutic delivery of medication.
Physical therapists select, prescribe, and implement these modalities when the examination
Page 49 of 63
findings, diagnosis, and prognosis indicate the use of electrotherapeutic modalities to decrease
edema and swelling; enhance activity and task performance; enhance health, wellness, or fitness;
enhance or maintain physical performance; enhance wound healing; increase joint mobility,
muscle performance, and neuromuscular performance; increase tissue perfusion; prevent or
remediate impairments, functional limitations, or disabilities to improve physical function; or reduce
risk factors and complications.
The use of electrotherapeutic modalities in the absence of other interventions should not be
considered physical therapy unless there is documentation that justifies the necessity of their
exclusive use.
include:
following systems:
- cardiovascular
- genitourinary
- integumentary
- multiple systems
- musculoskeletal
- neuromuscular
- pulmonary
- aerobic capacity/endurance (eg, increased pain with activity)
- anthropometric characteristics (eg, edema)
- circulation (eg, increased limb girth)
- cranial and peripheral nerve integrity (eg, decreased muscle
- activity because of peripheral nerve compression)
- ergonomics and body mechanics (eg, abnormal sequencing of muscle activation)
- gait, locomotion, and balance (eg, incoordination in gait)
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- integumentary integrity (eg, open wound)

- joint integrity and mobility (eg, increased joint play)
- motor function (eg, muscle hypertonicity)
- muscle performance (eg, increased muscle spasm)
- neuromotor development and sensory integration (eg, atypical movement patterns)
- posture (eg, static deviation from midline)
- range of motion (eg, increased joint laxity)
- ventilation and respiration/gas exchange (eg, decreased rib cage symmetry)
categories:
- self-care (eg, difficulty with rolling, sitting, reaching; inability to dress and bathe)
- home management (eg, difficulty with cleaning, cooking, vacuuming)
- work (job/school/play) tasks (eg, difficulty with manual handling, shoveling)
- community/leisure (eg, difficulty with walking, lifting)
- work (eg, inability to return to work as court stenographer because of lack of coordination in
upper extremities, inability to take care of child because of loss of strength)
- community/leisure (eg, difficulty with card playing because of loss of dexterity, inability to visit
friends because of wound)
- risk factors (eg, need to learn stress management)
- recurrence of condition (eg, need to continue strengthening program)
- secondary impairments (eg, need to appropriately use transcutaneous electrical nerve
stimulation [TENS] for pain management)
- fitness, including physical performance (eg, need to routinely use functional electrical stimulation
[FES] to maximize muscle contraction)
- health and wellness (eg, need to increase muscle force to optimize bone density, need to
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modulate pain during hospital volunteering)

Interventions
Electrotherapeutic modalities may include:
* Biofeedback
* Electrotherapeutic delivery of medications
- iontophoresis
* Electrical stimulation
- electrical muscle stimulation (EMS)
- electrical stimulation for tissue repair (ESTR)
- functional electrical stimulation (FES)
- high voltage pulsed current (HVPC) neuromuscular electrical stimulation (NMES)
- transcutaneous electrical nerve stimulation (TENS)
Anticipated goals and expected outcomes related to electrotherapeutic modalities may include:
- Edema, lymphedema, or effusion is decreased.
- Osteogenic effects are enhanced.
- Soft tissue or wound healing is enhanced.
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- Tolerance of positions and activities is increased:
- Complications of immobility are reduced.
Page 53 of 63
others.
Physical Agents and Mechanical Modalities
Physical agents are a broad group of procedures using various forms of energy that are applied to
tissues in a systematic manner and that are intended to increase connective tissue extensibility;
increase the healing rate of open wounds and soft tissue; modulate pain; reduce or eliminate soft
tissue swelling, inflammation, or restriction associated with musculoskeletal injury or circulatory
dysfunction; remodel scar tissue; or treat skin conditions. These agents may include athermal,
cryotherapy, hydrotherapy, light, sound, and thermotherapy agents. Mechanical modalities are a
group of devices that use forces such as approximation, compression, and distraction and that are
intended to improve circulation, increase range of motion, modulate pain, or stabilize an area that
requires temporary support. These modalities may include compression therapies, gravityassisted compression devices, mechanical motion devices, and traction devices.
Physical therapists select, prescribe, and implement use of these agents and modalities when the
examination findings, diagnosis, and prognosis indicate the use of physical agents or mechanical
modalities to decrease neural compression; decrease pain and swelling; decrease soft tissue and
circulatory disorders; enhance airway clearance; enhance movement performance; enhance or
maintain physical performance; improve joint mobility; improve tissue perfusion; prevent or
remediate impairments, functional limitations, or disabilities to improve physical function; reduce
edema; or reduce risk factors and complications.
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The use of physical agents or mechanical modalities in the absence of other interventions should
not be considered physical therapy unless there is documentation that justifies the necessity of
their exclusive use.
include:
following systems:
- cardiovascular
- genitourinary
- integumentary
- multiple systems
- musculoskeletal
- neuromuscular
- pulmonary
- aerobic capacity/endurance (eg, decreased muscle endurance)
- anthropometric characteristics (eg, increased edema)
- circulation (eg, decreased peripheral circulation)
- cranial and peripheral nerve integrity (eg, neural compression)
- ergonomics and body mechanics (eg, segment instability)
- gait, locomotion, and balance (eg, antalgic gait)
- integumentary integrity (eg, skin condition irritated by device)
- joint integrity and mobility (eg, increased joint compression)
- muscle performance (eg, incontinence because of decreased muscle strength)
- neuromotor development and sensory integration (eg, limited tolerance to upright position)
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- posture (eg, abnormal postural alignment)

- range of motion (eg, postoperative limitation of motion)
- reflex integrity (eg, decreased deep reflex response)
- sensory integrity (eg, altered proprioception)
- ventilation and respiration (eg, small airway congestion)
categories:
- self-care (eg, difficulty with hair care and ironing, inability to maintain positions)
- work (job/school/play) (eg, difficulty with operating heavy machinery, difficulty with washing
windows)
- community/leisure (eg, difficulty with serving in soup kitchen)
- work (eg, inability to return to work as a taxi driver because of neck pain, inability to put child in
car seat because of back pain)
- community/leisure (eg, difficulty with jogging with baby stroller because of Achilles tendinitis,
inability to go to the movies as a result of incontinence)
- risk factors (eg, need to learn how to use proper lower-limb compressive garments)
- recurrence of condition (eg, need to continue daily standing program)
- secondary impairments (eg, need to participate in continuous exercise program)
- fitness, including physical performance (eg, need to increase muscle length for aquatics, need to
maximize pelvic-floor muscle function)
- health and wellness (eg, need to increase circulation during skating, need to modulate pain
during shopping)
Interventions
Physical agents may include:
* Athermal agents
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- pulsed electromagnetic fields

* Cryotherapy
- cold packs
- ice massage
- vapocoolant spray
* Hydrotherapy
- contrast bath
- pools
- pulsatile lavage
- whirlpool tanks
* Light agents
- infrared
- laser
- ultraviolet
* Sound agents
- phonophoresis
- ultrasound
* Thermotherapy
- dry heat
- hot packs
- paraffin baths
Mechanical modalities may include:
* Compression therapies
- compression bandaging
- compression garments
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- taping
- total contact casting
- vasopneumatic compression devices
* Gravity-assisted compression devices
- standing frame
- tilt table
* Mechanical motion devices
- continuous passive motion (CPM)
* Traction devices
- intermittent
- positional
- sustained
Anticipated goals and expected outcomes related to physical agents and mechanical modalities
may include:
- Debridement of nonviable tissue is achieved.
- Edema, lymphedema, or effusion is reduced.
- Neural compression is decreased.
- Osteogenic effects are enhanced.
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daily living OADL) with or without devices and equipment are increased.
- Complications of soft tissue and circulatory disorders are decreased.
- Stresses precipitating injury are decreased.
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others.
PART TWO: Preferred Practice Patterns
Musculoskeletal
Neuromuscular
Cardiovascular/Pulmonary
Integumentary
How to Use the Preferred Practice Patterns
Part Two contains the preferred practice patterns, which are grouped under flour categories of
conditions: Musculoskeletal (Chapter 4), Neuromuscular (Chapter 5), Cardiovascular/Pulmonary
(Chapter 6), and Integumentary (Chapter 7). A table of contents preceding each set of patterns
lists the pattern titles for that set. Below is an at-a-glance depiction of the contents of each pattern;
on the following pages, take a walk through one example of how physical therapists may use Part
Two in the management of patients/clients.
Contents of Each Pattern at a Glance
(1) Patient/Client Diagnostic Classification
* Criteria for inclusion (based on examination findings regarding risk factors or consequences of
pathology/pathophysiology [disease, disorder, or condition], impairments, functional limitations, or
disabilities)
* Criteria for exlusion from pattern or for multiple-pattern classification (based on examination
findings)
(2) ICD-9-CM Codes
Codes that may relate to the practice pattern--intended only for information purposes, not for
coding purposes
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(3) Examination
Description of the history, systems review, and tests and measures that generate data that help
the physical therapist confirm classification of the patients/clients in the pattern
(4) Evaluation, Diagnosis, and Prognosis
(Including Plan of Care)
Description of the evaluation, diagnostic, and prognostic processes, including the expected range
of number of visits and factors that may require a new episode of care or that may modify
frequency of visits and duration of the episode
(5) Intervention
A listing of the interventions that may be used for patients/clients who are classified in the pattern
(6) Reexamination, Global Outcomes, and Criteria for Termination of Physical Therapy Services
Description of when reexamination is indicated; measurement of global outcomes of physical
therapy services in 8 domains; the 2 ways in which physical therapy services are terminated
Examination
First, the patient/client provides a history. Through the history, the physical therapist gathers data-from both the past and the present--related to why the patient/client is seeking physical therapy
services. Through the history, the physical therapist learns the chief complaints of the
patient/client--in this example, the inability to walk without pain and a sensation of "buckling" in
both knees and the inability to participate in recreational sports.
Next, the physical therapist performs a systems review, which is a brief examination of the
anatomical and physiological status of the cardiovascular/pulmonary, integumentary,
musculoskeletal, and neuromuscular systems. The systems review not only helps focus the
examination, it indicates whether the patient/client should be referred for other health care
services in addition to physical therapy. In this example, the systems review findings indicate that
the patient/client has impairments in the cardiovascular/pulmonary system (high blood pressure at
rest), musculoskeletal system (impaired gross range of motion, impaired gross strength,
disproportionate weight for height), and neuromuscular system (impaired gait, impaired balance).
The systems review suggests there are no current impairments in the integumentary system;
however, the history shows the presence of diabetes, which is a risk factor for
cardiovascular/pulmonary, neuromuscular, and integumentary conditions. There are no limitations
in communication, affect, cognition, language, and learning style.
Based on the history and systems review findings, the physical therapist notes key clinical
indications for the use of particular tests and measures during the in-depth portion of the
examination. (For examples of clinical indications for the use of tests and measures, refer to
Chapter 2.) The key clinical indications in this case example: impaired gait; impaired joint integrity
and mobility; impaired muscle performance; and a history of diabetes, hypertension, and morbid
obesity. Based on these key clinical indications, the physical therapist decides to examine the
following test-and-measure categories in detail: aerobic capacity/endurance, circulation (arterial,
Page 61 of 63
venous, and lymphatic), community and work (job/school/play) integration or reintegration

(including instrumental activities of daily living [IADL]); environmental, home, and work
(job/school/play) barriers; gait, locomotion, and balance; joint integrity and mobility; muscle
performance (strength, power, and endurance); pain; range of motion (including muscle length);
self-care and home management (including activities of daily living [ADL] and IADL), and
ventilation and respiration/gas exchange. Due to the presence of cardiovascular/pulmonary risk
factors such as hypertension, the monitoring of vital signs during ambulation will be an important
part of the in-depth examination.
Evaluation, Diagnosis, and Prognosis (Including Plan of Care)
During the evaluation process, all data from the history, systems review, and tests and measures
are synthesized to establish the diagnosis and the prognosis, including the plan of care.
In this example, based on the evaluation of the history, systems review, and tests-and-measures
data, the physical therapist determines that the patient/client has the following primary
impairments: impaired joint integrity and mobility in the knees; decreased muscle performance;
decreased range of motion; and decreased aerobic capacity/endurance with ambulation. The
physical therapist hypothesizes that the morbid obesity may be contributing to the knee pain as
well as to the decrease in aerobic capacity/endurance.
The physical therapist notes the following functional limitations: difficulty in performing ADL and
IADL, inability to run bases during softball league games, and inability to perform heavy household
chores. Disability is noted in the following roles: community/leisure (inability to participate on the
league softball team), work (job/school/play) (inability to walk to different work sites within the
same plant), and home management (inability to perform as homemaker).
Even though patients/clients may be referred to physical therapy services with a medical
diagnosis, that does not tell the physical therapist how to manage the patient/client. The medical
diagnosis is a diagnostic label that identifies disease at the level of the cell, tissue, organ, or
system. In this case, for instance, the medical diagnosis may be osteoarthritis of the knees. The
physical therapist's diagnosis, however, is a diagnostic label that identifies the impact of a
condition on function at the level of the system (especially the movement system) and at the level
of the whole person. The physical therapist's goal is to restore function, and therefore the physical
therapist's examination, evaluation, and interventions focus on impairments, functional limitations,
disabilities, risk factor reduction, and prevention.
In this example, the physical therapist determines that decreased muscle performance, decreased
range of motion, and pain are the primary contributors to the identified functional limitations. The
physical therapist also has noted that the patient/client has decreased aerobic/capacity
endurance. The physical therapist therefore focuses on four preferred practice patterns: "Impaired
Muscle Performance" (Pattern 4C) "Impaired Joint Mobility, Motor Function, Muscle Performance,
and Range of Motion Associated With Connective Tissue Dysfunction" (Pattern 4D) "Impaired
Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With
Localized Inflammation" (Pattern 4E) and "Impaired Aerobic Capacity/Endurance Associated With
Deconditioning" (Pattern 6B).
The physical therapist considers the primary impairments to determine which of the four possible
patterns may be the most appropriate classification for the patient/client. The physical therapist
scans the inclusions and exclusions for each pattern and the ICD-9-CM codes that are listed in
each pattern. If the physical therapist remains uncertain about patient/client classification, the
tests-and-measures sections of the individual patterns may suggest additional tests and measures
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that the physical therapist can perform to confirm placement of the patient/client into a pattern.
In this example, the history and systems review show signs and symptoms of joint effusion but
indicate that joint integrity and mobility are not contributing factors. The physical therapist
therefore classifies the patient/client in "Impaired Joint Mobility, Motor Function, Muscle
Performance, and Range of Motion Associated With Localized Inflammation" (Pattern 4F). The
patient/client also has a history of diabetes. If the physical therapist determines that patient/client
monitoring for primary prevention of lower-extremity vascular problems and the need to increase
aerobic capacity are high priorities, the physical therapist may place the patient/client in an
additional pattern: "Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary
Disorders" (Pattern 6B).
Based on the evaluation, the physical therapist makes the prognosis--that is, determines the
predicted optimal level of improvement in function and the amount of time needed to reach that
level. The physical therapist refers to the evaluation section of the selected pattern to ascertain
whether the therapist's prediction of improvement, frequency of visits, and duration of episode of
care are consistent with the expected prognosis and range of number of visits for patients/clients
who are classified in that pattern. The physical therapist also notes any factors (eg, age, chronicity
or severity of the current condition, adherence to the intervention program) that may modify the
frequency of visits or duration of the episode.
In this example, on the basis of such modifying factors as extremely high patient/client motivation,
the physical therapist may determine that the patient/client will require fewer visits than are
expected to achieve the anticipated goals and expected outcomes for 80% of patients/clients who
are classified in the pattern. On the other hand, the presence of morbid obesity may indicate that
the patient/client may not be able to improve aerobic capacity/endurance at an expected rate. In
addition, if the hypertension and diabetes become uncontrolled, the ability of the patient/client to
participate in physical therapy may be affected.
Intervention
As part of the prognostic process, the physical therapist develops a plan of care. This plan
delineates the types of interventions (physical therapy procedures and techniques) to be used to
produce changes in the condition and in patient/client status, the frequency and duration of those
interventions, anticipated goals, expected outcomes, and discharge plans. Anticipated goals and
expected outcomes should be measurable and time limited.
Each pattern contains a listing of interventions that are likely to be used for patients/clients who
are classified in the pattern. Coordination, communication, and documentation and patient/clientrelated instruction are interventions that are provided to all patients/clients across all settings. The
use of procedural interventions varies for the particular patient/client in the specific pattern. (For
examples of clinical considerations for the use of procedural interventions, refer to Chapter 3.) In
this example, the physical therapist might select interventions that emphasize therapeutic
exercise, functional training in self-care and home management (including ADL and IADL), and
functional training in community and work (job/school/play) integration or reintegration (including
IADL, work hardening, and work conditioning) in addition to interventions to modulate pain and
diminish the effects of joint effusion.
Reexamination, Global Outcomes, and Criteria for Termination of Physical Therapy Services
Reexamination--the process of performing selected tests and measures after the initial
examination to determine progress and modify or redirect interventions--may be indicated more
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than once during a single episode of care. In this example, the physical therapist may decide to
perform a reexamination if the patient/client develops a new condition or shows no progress.
Throughout the entire episode of care, the physical therapist determines the anticipated goals and
expected outcomes for each intervention. These goals and outcomes are delineated in the shaded
boxes that accompany each list of interventions in each pattern. As the patient/ client reaches the
termination of physical therapy services and the end of the episode of care, the physical therapist
measures the global outcomes (that is, the impact) of the physical therapy services in the
following domains: pathology/pathophysiology (disease, disorder, or condition); impairments;
functional limitations; disabilities; risk reduction/prevention; impact on health, wellness, and
fitness; societal resources; and patient/client satisfaction.
The physical therapist uses two processes for terminating physical therapy services: discharge
and discontinuation. If the physical therapist determines that the anticipated goals and expected
outcomes have been achieved, the patient/client is discharged from physical therapy services.
Physical therapy services are discontinued (1) when the patient/client declines to continue
intervention, (2) when the patient/client is unable to continue to progress toward the anticipated
goals and expected outcomes because of medical or psychosocial complications or because
financial/insurance resources have been expended, or (3) when the physical therapist determines
that the patient/client will no longer benefit from physical therapy.
A template for documenting all aspects of patient/client management, including termination of
physical therapy services, is provided in Appendix 6. Patient/client satisfaction outcomes may be
collected using the Patient/Client Satisfaction Questionnaire in Appendix 7.

Source Citation:"What Types of Interventions Do Physical Therapists Provide?." Physical

Page 1 of 15
Who are physical therapists, and what do they do?(A Description of Patient/Client
Management)(Guide to Physical Therapy Practice).Physical Therapy 77.n11 (Nov
1997): pp1177(11). (5814 words)
Physical therapists are professionally educated at the college or university level and are required
to be licensed in the state or states in which they practice. Graduates from 1960 to the present
have successfully completed professional physical therapist education programs accredited by the
Commission on Accreditation in Physical Therapy Education (CAPTE). Graduates from 1926 to
1959 completed physical therapy curricula approved by appropriate accreditation bodies. The
CAPTE with limit its scope in 2002 to accredit only those professional programs that award the
postbaccalaureate degree.
Physical therapists also may obtain clinical specialist certification through the American Board of
Physical Therapy Specialties (ABPTS).
Practice Settings
Physical therapists practice in a broad range of inpatient, outpatient, and community-based
settings, including the following, in order of most common setting:
* Hospitals (eg, critical care, intensive care, acute care, and subacute care settings)
* Outpatient clinics or offices
* Rehabilitation facilities
* Skilled nursing, extended care, or subacute facilities
* Homes
* Education or research centers
* Schools and playgrounds (preschool, primary, and secondary)
* Hospices
* Corporate or industrial health centers
* Industrial, workplace, or other occupational environments
* Athletic facilities (collegiate, amateur, and professional)
* Fitness centers and sports training facilities
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Patients and Clients

Physical therapists are committed to providing necessary, appropriate, and high-quality health
care services to both patients and clients. Patients are individuals who are the recipients of
physical therapy care and direct intervention. Clients are individuals who are not necessarily sick
or injured but who can benefit from a physical therapist's consultation, professional advice, or
prevention services. Clients also are businesses, school systems, and others to whom physical
therapists provide services. The generally accepted elements of patient/client management
typically apply to both patients and clients.
Scope of Practice
Physical therapy is the care and services provided by or under the direction and supervision of a
physical therapist (Fig. 1). APTA emphasizes that an examination, evaluation, or intervention -unless provided by a physical therapist or under the direction and supervision of a physical
therapist -- is not physical therapy, nor should it be represented or reimbursed as such.
Figure 1. Model Definition of Physical Therapy for State Practice Acts(a) [BOD 02-97-03-06;
Amended BOD 03-95-24-64, BOD 06-94-03-04, BOD 03-93-18-46]
Physical therapy, which is the care and services provided by or under the direction and
supervision of a physical therapist includes:
1) Examining (history, systems review, and tests and measures) individuals with impairment,
functional limitation, and disability or other health-related conditions in order to determine a
diagnosis, prognosis, and intervention; tests and measures may include the following:
* Aerobic capacity and endurance
* Anthropometric characteristics
* Arousal, mentation, and cognition(b)
* Assistive and adaptive devices
* Community and work (job/school/play) integration or reintegration
* Cranial nerve integrity
* Environmental, home, and work (job/school/play) barriers
* Ergonomics and body mechanics
* Gait locomotion, and balance
* Integumentary integrity
* Joint integrity and mobility
* Motor function
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* Muscle performance
* Neuromotor development and sensory integration
* Orthotic, protective, and supportive devices
* Pain
* Posture
* Prosthetic requirements
* Range of motion
* Reflex integrity
* Self-care and home management
* Sensory integrity
* Ventilation, respiration, and circulation
2) Alleviating impairment and functional limitation by designing, implementing, and modifying
therapeutic interventions that may include, but are not limited to:
* Therapeutic exercise (including aerobic conditioning)
* Functional training in self-care and home management (including activities of daily living and
instrumental activities of daily living)
* Functional training in community and work (job/school/play) integration or reintegration activities
(including instrumental activities of daily living, work hardening, and work conditioning)
* Manual therapy techniques (including mobilization and manipulation)
* Prescription application, and, as appropriate, fabrication of assistive, adaptive, orthotic,
protective, supportive, and prosthetic devices and equipment
* Airway clearance techniques
* Wound management
* Electrotherapeutic modalities
* Physical agents and mechanical modalities
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3) Preventing injury, impairment, functional limitation, and disability, including the promotion and
maintenance of fitness, health, and quality of life in all age populations
4) Engaging in consultation, education, and research
(a) Direct interventions, which begin with "Therapeutic exercise," are listed in order of preferred
usage. (b) This category of tests and measures is referred to as "arousal, attention, and cognition"
in the Guide.
Physical therapists:
* Provide services to patients/clients who have impairments, functional limitations, disabilities, or
changes in physical function and health status resulting from injury, disease, or other causes. In
the context of the model of disablement(1,2) on which this Guide is based, impairment is defined
as loss or abnormality of physiological, psychological, or anatomical structure or function;
functional limitation, as restriction of the ability to perform -- at the level of the whole person -- a
physical action, activity, or task in an efficient, typically expected, or competent manner; and
disability, as the inability to engage in age-specific, gender-specific, or sex-specific roles in a
particular social context and physical environment.
* Interact and practice in collaboration with a variety of professionals, including physicians,
dentists, nurses, educators, social workers, occupational therapists, speech-language
pathologists, and audiologists. Physical therapists acknowledge the need to educate and inform
other professionals, government agencies, third-party payers, and other health care consumers
about the cost-efficient and clinically effective services that physical therapists render.
* Provide prevention and wellness services, including screening and health promotion. Physical
therapists are involved in wellness initiatives, including health promotion and education, that
stimulate the public to engage in healthy behaviors. They provide preventive care that forestalls or
prevents functional decline and the need for more intense care. Through timely and appropriate
screening, examination, evaluation, and intervention, they frequently reduce or eliminate the need
for costlier forms of care, such as surgery, and also may shorten or even eliminate institutional
stays.
* Consult, educate, engage in critical inquiry, and administrate.
* Direct and supervise physical therapy services, including support personnel.
Roles in Primary Care
Physical therapists have a major role to play in the provision of primary care, which has been
defined as
the provision of integrated, accessible health care services by clinicians who are accountable for
addressing a large majority of personal health care needs, developing a sustained partnership
with patients, and practicing within the context of family and community.(3)
APTA has endorsed the concepts of primary care set forth by the Institute of Medicine's
Committee on the Future of Primary Care,(3) including the following:
* Primary care can encompass a myriad of needs that go well beyond the capabilities and
competencies of individual caregivers and that require the involvement and interaction of varied
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practitioners.
* The "gatekeeper" concept is rejected because of the pejorative connotation that the primary care
practitioner's role is to manage costs and, for the most part, keep the "gate" closed.
* Primary care is not limited to the "first contact" or point of entry into the health care system.
* The primary care program is a comprehensive one.
* The role of family and community in the provision of primary care is an important one, and
caregivers and care-receivers function in the context of, and are dependent on, a wide range of
societal and environmental factors.
As clinicians involved in examination and in the evaluation, diagnosis, prognosis, intervention, and
prevention of musculoskeletal and neuromuscular disorders, physical therapists are well
positioned to provide those services as members of primary care teams. On a daily basis, physical
therapists practicing at acute, chronic, rehabilitative, and preventive stages of care assist
patients/clients in the following: restoring health; alleviating pain; and preventing the onset of
impairments, functional limitations, disabilities, or changes in physical function and health status
resulting from injury, disease, or other causes. Prevention and wellness activities, including health
promotion, are a vital part of physical therapy.
For acute musculoskeletal and neuromuscular conditions, triage and initial examination are
appropriate physical therapist responsibilities. The primary care team may function more efficiently
when it includes physical therapists, who can recognize musculoskeletal and neuromuscular
disorders, perform examinations and evaluations, and intervene without delay. For patients/clients
with low back pain, for example, physical therapists can provide immediate pain reduction and
programs for strengthening, flexibility, endurance, postural alignment, instruction in activities of
daily living, and work modification. Physical therapist intervention may result not only in more
efficient and effective patient care but in more Appropriate utilization of other members of the
primary care team. With physical therapists functioning in a primary care role and delivering early
intervention for work-related musculoskeletal injuries, time and productivity lost due to injuries may
be dramatically reduced.
For certain chronic conditions, physical therapists should be recognized as the principal providers
of care within the collaborative primary care team. Physical therapists are well prepared to
coordinate care related to loss of physical function as a result of musculoskeletal, neuromuscular,
cardiopulmonary, or integumentary disorders. Through community-based agencies, physical
therapists coordinate and integrate provision of services to patients/clients with chronic
neuromuscular and musculoskeletal disorders.
Physical therapists also provide primary care in industrial or workplace settings, in which they
manage the occupational health services provided to employees and prevent injury by designing
or redesigning the work environment. These services focus both on the individual and on the
environment to ensure comprehensive and appropriate intervention.
Roles in Secondary and Tertiary Care
Physical therapists play major roles in secondary and tertiary care. Patients with musculoskeletal,
neuromuscular, cardiopulmonary, or integumentary conditions frequently are treated initially by
another health care practitioner and then are referred to physical therapists for secondary care.
Physical therapists provide secondary care in a wide range of settings, from hospitals to
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preschools.
Tertiary care is provided by physical therapists in highly specialized, complex, and technologybased settings (eg, heart and lung transplant services, burn units) or when supplying specialized
services (eg, to patients with spinal cord lesions or closed--head trauma) in response to requests
for consultation that are made by other health care practitioners.
Roles in Prevention and Wellness (Including Screening Programs and
Health Promotion)
Physical therapists are involved in prevention and wellness activities, screening, and the
promotion of positive health behavior. These initiatives decrease costs by helping patients/clients
(1) achieve and restore optimal functional capacity, (2) minimize impairments, functional
limitations, and disabilities related to congenital and acquired conditions, (3) maintain health
(thereby preventing further deterioration or future illness), and (4) create appropriate
environmental adaptations to enhance independent function. There are three types of prevention:
* Primary prevention -- Preventing disease in a susceptible or potentially susceptible population
through such specific measures as general health promotion efforts
* Secondary prevention -- Decreasing duration of illness, severity of disease, and sequelae
through early diagnosis and prompt intervention
* Tertiary prevention -- Limiting the degree of disability and promoting rehabilitation and
restoration of function in patients with chronic and irreversible diseases
Physical therapists conduct screenings to determine the need for primary, secondary, or tertiary
prevention services; for further examination, intervention, or consultation by a physical therapist;
or for referral to another health care practitioner. Candidates for screening generally not
patients/clients currently receiving physical therapy services. Screening is based on a problemfocused, systematic collection and analysis of data. Examples of screening activities in which
physical therapists engage include:
* Identifying lifestyle factors (eg, amount of exercise, stress, weight) that may lead to increased
risk for serious health problems
* Identifying children who may need an examination for idiopathic scoliosis
* Identifying elderly individuals in a community center or nursing home who are at high risk for
slipping, tripping, or falling
* Identifying risk factors in the workplace
* Pre-performance testing of individuals who are active in sports
* Conducting prework screening programs
Examples of prevention and wellness activities in which physical therapists engage include:
* Back schools, workplace redesign, strengthening, stretching, endurance exercise programs, and
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postural training to prevent and treat low back pain, a condition afflicting millions of Americans
* Workplace redesign, strengthening, stretching, endurance exercise, and postural training to
prevent job-related disabilities, including trauma and repetitive stress injuries
* Exercise programs, including weight bearing and weight training, to increase bone mass and
bone density (especially important in older adults with osteoporosis)
* Exercise programs, gait training, and balance and coordination activities to reduce the risk of
falls and fractures from falls in older adults
* Exercise programs and instruction in activities of daily living (ADL) (self-care, communication,
and mobility skills required for independence in daily living) and instrumental activities of daily
living (IADL) (activities that are important components of maintaining independent living, such as
shopping and cooking) to decrease utilization of health care services and enhance function in
patients with cardiopulmonary disorders
* Exercise programs, cardiovascular conditioning, postural training, and instruction in ADL and
IADL to prevent disability and dysfunction in women who are pregnant
* Broad-based consumer education and advocacy programs to prevent problems (eg, prevent
head injury by promoting the use of helmets, prevent pulmonary disease by encouraging smoking
cessation)
The physical therapist integrates five elements of patient/client management -- examination,
evaluation, diagnosis, prognosis, and intervention -- in a manner designed to maximize outcomes
(Fig. 2). Examination, evaluation, and establishment of a diagnosis and a prognosis are all part of
the process that guides the therapist in determining the most appropriate intervention.
[ILLUSTRATION OMITTED]
Examination
Examination is required prior to any intervention and is performed for all patients/clients. The initial
examination, which is an investigation, has three components: the patient/client history, relevant
Systems reviews, and tests and measures.
History -- The history is an account of past and current health status. It includes identification of
complaints, provides the initial source of information about the patient/client, and also suggests
the individual's ability to benefit from physical therapy. While taking the history, the physical
therapist identifies health-risk factors, health restoration and prevention needs, and coexisting
health problems that have implications for intervention. This history commonly is obtained through
the gathering of data from the patient/client, family, significant others, caregivers, and other
interested persons (eg, rehabilitation counselor, Workers' Compensation claims manager,
employer); through consultation with other members of the health care team; and through review
of the medical record. Figure 3 lists the types of data that may be generated from the history.
[ILLUSTRATION OMITTED]
Systems Review -- The systems review is a brief or limited examination that provides additional
Page 8 of 15
information about the general health of the patient/client to help the physical therapist formulate a
diagnosis, a prognosis, and a plan of care and select direct interventions. The systems review
also assists the physical therapist in identifying possible health problems that require consultation
with or referral to another health care provide.
Data generated from a systems review that may affect subsequent examination and intervention
include: (1) physiologic and anatomic status (cardiopulmonary, integumentary, musculoskeletal,
and neuromuscular) and (2) communication ability, affect, cognition, language, and learning style.
Tests and Measures -- After analyzing all relevant information gathered from the history and
systems review, the physical therapist examines the patient/client more closely, selecting tests
and measures to elicit additional information. Before, during, and after administering the tests and
measures, physical therapists frequently apply their hands to the patient/client to gauge
responses, assess physical status, and obtain a more specific understanding of the condition and
the diagnostic and therapeutic requirements. Tests and measures commonly performed by
physical therapists and the types of data generated are listed in Figure I and are discussed in
detail in Chapter 2.
The physical therapist may decide to use one, more than one, or portions of several specific tests
and measures as part of the examination, based on the purpose of the visit, the complexity of the
condition, and the directions taken in the clinical decision-making process.
As the examination progresses, the physical therapist may identify additional problems that were
not uncovered by the history and systems review and may conclude that other specific tests and
measures or portions of other specific tests and measures are required to obtain sufficient data to
make an evaluation, establish a diagnosis and a prognosis, and select direct interventions. The
examination therefore may be as brief or as lengthy as necessary. For instance, the physical
therapist may conclude from the history and systems review that further examination and
management are not required, that the patient/client should be referred to another health care
practitioner, or both. Conversely, the physical therapist may decide that a full examination is
necessary and then select appropriate tests and measures. Physical therapists frequently perform
one or more reexaminations, which are examinations that take place after the initial examination is
completed. Because physical therapy is most often an ongoing process delivered over a period of
weeks for a single episode of care -- rather than one service delivered during a single visit -physical therapists rely on reexaminations to modify or redirect intervention and to evaluate
progress toward the anticipated goals and desired outcomes. If a reexamination is indicated (eg,
because of new clinical indications or failure to respond to intervention), the physical therapist
selects and administers additional specific tests and measures. The reexamination has an
important quality assurance component, as it allows the physical therapist to focus on the
relationship between the elements of patient/client management and the outcomes.
Note: In the course of examining and establishing the diagnosis and the prognosis, the physical
therapist may find evidence of physical abuse or domestic violence. In such cases, the physical
therapist is bound by ethical principles -- and may be bound by state law or regulation -- to report
such findings to the appropriate agencies.
Evaluation
Physical therapists perform evaluations (make clinical judgments) based on the data gathered
from the examination. Factors that influence the complexity of the examination and the evaluation
process include the clinical findings, extent of loss of function, social considerations, and the
patient's/client's overall physical function and health status. Thus, the evaluation reflects the
Page 9 of 15
chronicity or severity of the current problem, the possibility of multisite or multisystem involvement,
the presence of preexisting systemic conditions or diseases, and the stability of the condition.
Physical therapists also consider the level of the current impairments and the probability of
prolonged impairment, functional limitation, and disability; the living environment; potential
discharge destinations; and the social supports.
Diagnosis
A diagnosis is a label encompassing a cluster of signs and symptoms, syndromes, or categories.
It is the decision reached as a result of the diagnostic process, which includes evaluating the
information obtained during the examination; organizing it into clusters, syndromes, or categories;
and interpreting it.
The purpose of the diagnosis is to guide the physical therapist in determining the most appropriate
intervention strategy for each patient/client. In the event that the diagnostic process does not yield
an identifiable cluster, syndrome, or category, intervention may be guided by the alleviation of
symptoms and remediation of deficits. Alternatively, the physical therapist may determine that a
reexamination is in order and proceed accordingly. In carrying out the diagnostic process, physical
therapists may need to obtain additional information (including diagnostic labels) from other
professionals. In addition, as the diagnostic process continues, physical therapists may identify
findings that should be shared with other professionals, including referral sources, to ensure
optimal care. If the diagnostic process reveals findings that are outside the scope of the physical
therapist's knowledge, experience, or expertise, the physical therapist refers the patient/client to
an appropriate practitioner.
Prognosis
The prognosis includes the predicted optimal level of improvement in function and amount of time
needed to reach that level; it also may include a prediction of levels of improvement that may be
reached at various intervals during the course of therapy.
At this point in patient/client management, the physical therapist establishes plan of care. In
designing the plan of care, the physical therapist integrates all of the previous data, incorporates
all of the prognostic predictions, and determines the degree to which interventions are likely to
achieve anticipated goals and desired outcomes. Goals generally relate to the remediation (to the
extent possible) of impairments, whereas outcomes relate to minimization of functional limitation,
optimization of health status, prevention of disability, and optimization of patient/client satisfaction.
Thus, the plan of care specifies long-term and short-term goals and outcomes, the specific
interventions to be used, the duration and frequency of intervention required to reach the goals
and outcomes, and criteria for discharge.
Intervention
Intervention is the purposeful and skilled interaction of the physical therapist with the patient/client
and, when appropriate, with other individuals involved in patient/client care, using various physical
therapy procedures and techniques to produce changes in the condition consistent with the
diagnosis and prognosis. Decisions about intervention are contingent on the timely monitoring of
patient/client response and the progress made toward achieving the anticipated goals and the
desired outcomes. Physical therapist intervention has three components: coordination,
communication, and documentation; patient/client-related instruction; and direct interventions Fig.
1).
Page 10 of 15
Coordination, Communication, and Documentation - These services, which are provided for an
patients/clients, may include case management; communication (direct or indirect); coordination of
care with the patient/client, family, significant others, caregivers, other professionals, and other
interested persons; discharge planning; documentation of all elements of patient/client
management; education plans; patient care conferences; record reviews; and referrals to other
professionals or resources. Through these services, the physical therapist ensures appropriate,
coordinated, comprehensive, and cost-effective services between admission and discharge and
cost-effective and efficient integration or reintegration to home, community, and work
(job/school/play), and leisure environments. Documentation should follow APTA's Guidelines for
Physical Therapy Documentation (Appendix 7).
Patient/Client-Related instruction -- These services, which are provided to all patients/clients, may
include computer-assisted instruction, demonstration by patient/client or caregivers in the
appropriate environment, periodic reexamination and reassessment of the home program, use of
audiovisual aids for both teaching and home reference, use of demonstration and modeling for
teaching, verbal instruction, and written or pictorial instruction. The physical therapist uses these
services to educate the patient/client -- and also the family, significant others, caregivers, or other
professionals -- about the current condition, plan of care, and future transition to home, work, or
community roles. The physical therapist may include information and training in activities for
maintenance of function and primary and secondary prevention. The educational backgrounds,
needs, and learning styles of individuals must be taken into account during this process.
Direct interventions -- The physical therapist selects, applies, or modifies direct interventions
based on examination and evaluation data, the diagnosis and the prognosis, and the anticipated
goals and desired outcomes for a particular patient in a specific patient/client diagnostic group.
Based on the results of the interventions, the physical therapist may decide that reexamination is
necessary, a decision that may lead to the use of different interventions or, alternatively, the
discontinuation of care.
Chapter 3 details, in order of preferred usage, the types of direct interventions commonly selected
by the physical therapist. Forming the core of most physical therapy plans of care: therapeutic
exercise, including aerobic conditioning; functional training in self-care and home management
activities, including activities of daily living (ADL) and instrumental activities of daily living (IADL);
and functional training in community and work (job/school/play) integration or reintegration,
including IADL, work hardening, and work conditioning.
Factors that influence the complexity, frequency, and duration of the intervention and the decisionmaking process may include the following: anatomic and physiologic changes related to growth
and development; chronicity or severity of the current condition; cognitive status; level of
impairment; living environment; multisite or multisystem involvement; overall physical function and
health status; potential discharge destinations; preexisting systemic conditions or diseases;
probability of prolonged impairment, functional limitation, or disability; social supports; and stability
of the condition.
Outcomes
At each step of patient/client management, the physical therapist considers the possible outcomes
(remediation of functional limitation and disability, optimization of patient/client satisfaction, and
primary or secondary prevention).
Beginning with the history, the physical therapist identifies patient/client expectations for
therapeutic interventions, perceptions about the clinical situation, and desired outcomes. The
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physical therapist then considers whether these expectations and outcomes are realistic in the
context of the examination and evaluation data. In establishing a diagnosis and a prognosis and
selecting direct interventions, the physical therapist asks the question, "What outcome is likely,
given the diagnosis?" The physical therapist may use reexamination to determine whether
predicted outcomes are reasonable and then modify them as necessary.
The physical therapist engages in outcomes data collection and analysis -- that is, the systematic
review of outcomes of care in relation to selected variables (eg, age, sex, diagnosis, interventions
performed) -- and develops statistical reports for internal or external use.
Discharge Planning
Discharge -- the process of discontinuing interventions in a single episode of care--occurs based
on the physical therapist's analysis of the dynamic interplay between the achievement of
anticipated goals and the achievement of desired outcomes. Other indications for discharge
include the following:
* The patient/client declines to continue treatment.
* The patient/client is unable to continue to progress toward goals because of medical or
psychosocial complications.
* The physical therapist determines that the patient/client will no longer benefit from physical
therapy services.
In consultation with appropriate individuals, and in consideration of the goals and outcomes, the
physical therapist plans for discharge and provides for appropriate follow-up or referral. if the
physical therapist determines, through examination and evaluation, that intervention is unlikely to
be beneficial, the physical therapist discusses those findings and conclusions with the individuals
concerned, and there is no further physical therapist intervention. When a patient/client is
discharged prior to achievement of desired outcomes, patient/client status and the rationale for
discontinuation are documented.
A physical therapy episode of care consists of all patient/client management activities conducted
by a physical therapist from initial contact through discharge. A single episode of care should not
be confused with multiple episodes of care that may be required by certain individuals in particular
patient/client diagnostic groups. For these patients/clients, periodic follow-up is needed over a
lifetime to ensure safety and effective adaptation following changes in physical status, caregivers,
the environment, or task demands.
Other Professional Roles
Consultation Physical therapist consultants render professional or expert opinion or advice,
applying highly specialized knowledge and skills to identify problems, recommend solutions, or
produce a specified outcome or product in a given amount of time on behalf of a patient/client.
Patient-related consultation is a service provided by a physical therapist at the request of a
patient, health care practitioner, or health care organization either to recommend physical therapy
services that are needed or to evaluate the quality of physical therapy services being provided.
Such consultation usually does not involve actual treatment. Client-related consultation is a
service provided by a physical therapist at the request of an individual, business, school,
government agency, or other organization.
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Examples of consultation activities in which physical therapists engage include:

* Advising a referring practitioner about the indications for intervention
* Advising employers about the requirements of the Americans With Disabilities Act (ADA)
* Conducting a program to determine the suitability of employees for specific job assignments
* Developing programs that evaluate the effectiveness of an intervention plan in reducing workrelated injuries
* Educating other health care practitioners (eg, in injury prevention)
* Examining school environments and recommending changes to improve accessibility for
students with disabilities
* Instructing employers about job preplacement in accordance with provisions of the ADA
* Participating at the local, state, and federal levels in policymaking for physical therapy services
* Performing environmental assessments to minimize the risk of falls
* Providing peer review and utilization review services
* Responding to a request for a second opinion
* Serving as an expert witness in legal proceedings
* Working with employees, labor unions, and government agencies to develop injury reduction and
safety programs
Education Education is the process of imparting information or skills and instructing by precept,
example, and experience so that individuals acquire knowledge, master skills, or develop
competence. In addition to instructing patients/ clients as an element of intervention, physical
therapists may engage in education activities such as the following:
* Planning and conducting academic education, clinical education, and continuing education
programs for physical therapists, other health care providers, and students
* Planning and conducting education programs for local, state, and federal health agencies
* Planning and conducting programs for the public to increase awareness of issues in which
physical therapists have expertise
Critical inquiry Critical inquiry is the process of applying the principles of scientific methods to read
and interpret professional literature; participate in, plan, and conduct research; evaluate
outcomes; and assess new concepts and technologies.
Examples of critical inquiry activities in which physical therapists engage include:
* Analyzing and applying research findings to physical therapy practice and education
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* Disseminating the results of research

* Evaluating the efficacy and effectiveness of both new and established interventions and
technologies
* Participating in, planning, and conducting clinical, basic, or applied research
Administration Administration is the skilled process of planning, directing, organizing, and
managing human, technical, environmental, and financial resources effectively and efficiently.
Administration includes the management, by individual physical therapists, of resources for
patient/client management and for organizational operations.
Examples of administration activities in which physical therapists engage include:
* Ensuring fiscally sound reimbursement for services rendered
* Budgeting for physical therapy services
* Managing staff resources, including the acquisition and development of clinical expertise and
leadership abilities
* Monitoring quality of care and clinical productivity
* Negotiating and managing contracts
* Supervising physical therapist assistants, physical therapy aides, and other support personnel
The Physical Therapy Service: Direction and Supervision of Personnel Direction and supervision
are essential to the provision of high-quality physical therapy The degree of direction and
supervision necessary for ensuring high-quality physical therapy depends on many factors,
including the education, experience, and responsibilities of the parties involved (Fig. 4); the
organizational structure in which the physical therapy is provided; and applicable state law. In any
case, supervision should be readily available to the individual being supervised.
The director of a physical therapy service is a physical therapist who has demonstrated
qualifications based on education and experience in the field of physical therapy and who has
accepted the inherent responsibilities of the role. The director of a physical therapy service must:
* Establish guidelines and procedures that will delineate the functions and responsibilities of all
levels of physical therapy personnel in the service and the supervisory relationships inherent to
the functions of the service and the organization
* Ensure that the objectives of the service are efficiently and effectively achieved within the
framework of the stated purpose of the organization and in accordance with safe physical
therapist practice
* Interpret administrative policies
* Act as a liaison between line staff and administration
* Foster the professional growth of the staff
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Written practice and performance criteria should be available for all levels of physical therapy
personnel in a physical therapy service. Regularly scheduled performance appraisals should be
conducted by the supervisor based on applicable standards of practice and performance criteria.
Delegated responsibilities should be commensurate with the qualifications -- including experience,
education, and training -- of the individuals to whom the responsibilities are being assigned. When
the physical therapist of record delegates patient care responsibilities to physical therapist
assistants or other support personnel, that physical therapist holds responsibility for supervision of
the plan of care. Regardless of the setting in which the services are given, the following
responsibilities must be held solely by the physical therapist:
* Interpretation of referrals when available
* Initial examination, evaluation, problem identification, diagnosis, and prognosis
* Development or modification of a plan of care that is based on the initial examination and that
includes anticipated goals and desired outcomes
* Administration of intervention and, as appropriate, determination of (1) tasks that require the
expertise and decision-making capacity of the physical therapist and that must be personally
rendered by the physical therapist and (2) tasks that may be delegated. Prior to delegating any
procedure, the physical therapist should determine that the consequences of the procedure are
predictable, the situation is stable, and the basic indicators are not ambiguous and do not require
ongoing observation by the physical therapist.
* Delegation of the tasks to be rendered by the physical therapist assistant or other support
personnel, including, but not limited to, specific treatments, precautions, special problems, and
contraindicated procedures
* Timely review of treatment documentation, reexamination of the patient/client and the anticipated
goals and desired outcomes, and revision of the plan of care when indicated
* Establishment of the discharge plan and documentation of discharge summary or status
References
[1] Physical Disability. Special issue. Phys Ther. 1994;74:375-506.
[2] Verbrugge L, Jette A. The disablement process. Soc Sci Med. 1994;38:1-14,
[3] Defining Primary Care: An Interim Report. Washington, DC: Institute of Medicine, National
Academy Press; 1995.
Physical Therapist Assistants
The physical therapist assistant is an educated health care provider who assists the physical
therapist in the provision of physical therapy. The physical therapist assistant is a graduate of a
physical therapist assistant associate degree program accredited by an agency recognized by the
commission on Accreditation in Physical Therapy Education (CAPTE).
The physical therapist of record is the person who is directly responsible for the actions of the
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physical therapist assistant. The physical therapist assistant may perform physical therapy
procedures and related tasks that have been selected and delegated by the supervising physical
therapist. Where permitted by law, the physical therapist also may carry out routine operational
functions, including supervision of the physical aide and documentation of progress. The ability of
the physical therapist assistant to perform the selected and delegated tasks should be assessed
on an ongoing basis by the supervising physical therapist. The physical therapist assistant may
modify a specific intervention procedure in accordance with changes in patient/client status and
within the scope of the establish plan of care.
Physical Therapist Aides
The physical therapy aide is a non-licensed worker who is specifically trained under the direction
of a physical therapist. The physical therapy aide performs designated routine tasks related to the
operation of a physical therapy service delegated by the physical therapist or in accordance with
the law, by a physical therapist assistant.
The physical therapist of record is the person who is directly responsible for the actions of the
physical therapy aide. The physical therapy aide providers support that may include patientrelated and non-patient-related duties. The physical therapy aide functions only with the
continuous on-site supervision of the physical therapist or, where allowable by law or regulation,
the physical therapist assistant. Continuous on-site supervision requires the presence of the
physical therapist or physical therapist assistant in the immediate area.
Other Support Personnel
When other personnel (eg, exercise physiologists, athletic trainers, massage therapist) work within
the supervision of a physical therapy service, they should be employed under their appropriate
title. Any involvement in patient/client care activities should be within the limits of their education,
in accordance with applicable laws and regulations, and at the discretion of the physical therapist.
If such personnel function as an extension of the physical therapist's license, however, their title
and all services that they provide must be in accordance with state and federal laws and
regulations.
Source Citation:"Who are physical therapists, and what do they do?." Physical Therapy 77.n11 (Nov
1997): 1177(11). Expanded Academic ASAP. Gale. University of Florida. 21 Nov. 2008

Page 1 of 47
What types of tests and measures do physical therapists use?(A Description of

Patient/Client Management)(Guide to Physical Therapy Practice).Physical
Therapy 77.n11 (Nov 1997): pp1189(24). (9688 words)
Depending on the data generated during the history and systems review, the physical therapist
may use one or more tests and measures, in whole or in part, to help identify impairments,
functional limitations, and disabilities and establish the diagnosis and the prognosis. Physical
therapists may perform more than one test or measure at a time.
The physical therapist individualizes the selection of tests and measures, rather than basing
selection solely on diagnosis. When examining a patient/client with impairment, functional
limitation, or disability resulting from brain injury, for example, the physical therapist may decide to
perform part or all of several tests and measures, based on the pattern of involvement.
This chapter contains 24 groupings of specific tests and measures (Fig. 5) that the physical
therapist may decide to use during the examination. Tests and measures are listed in alphabetical
order. Each pattern in Part Two contains a list of specific related tests and measures. Note:
Physical therapists also may decide to use other tests and measures that are not described in the
Guide.
Each grouping of tests and measures includes the following:
* General purposes of the tests and measures. All tests and measures produce information used
to identify the possible or actual causes of difficulties during performance of essential everyday
activities, work tasks, and leisure pursuits. Selection of specific tests and measures depends on
the findings of the history and systems review. The examination findings may indicate, for
instance, that tests should be performed while the patient/client performs specific activities. In all
cases, the purpose of tests and measures is to ensure the gathering of information that leads to
an evaluation, a diagnosis, a prognosis, and the selection of appropriate interventions.
* Clinical indications, such as impairments, functional limitations, disabilities, or special
requirements that may prompt the physical therapist to conduct the tests and measures. All tests
and measures are appropriate in the presence of:
- Impairment, functional limitation, disability,
developmental delay, injury, or suspected or identified
pathology that prevents or alters performance of
daily activities, including self-care, home
management, community and work (job/school/play)
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integration or reintegration, and leisure tasks,

movements, or activities
- Requirements of employment that specify
minimum capacity for performance
- Identified need to initiate or change a prevention or
wellness program
* Specific tests and measures methods and techniques)
* Types of data that ma be generated from the tests and measures
Other information that may be required for the examination includes: findings of other
professionals; results of diagnostic imaging, clinical laboratory, and electrophysiologic studies;
federal, state, and local work surveillance and safety reports and announcements; and
observations of family, significant others, caregivers, and other interested persons.
An examination, evaluation, or intervention -- unless performed by a physical therapist -- is not
physical therapy, nor should it be represented or reimbursed as such.
Aerobic Capacity and Endurance
Aerobic capacity and endurance are measures of the ability to perform work or participate in
activity over time using the body's oxygen uptake and delivery and energy release mechanisms.
During activity, the physical therapist uses tests ranging from simple determinations blood
pressure, heart rate, and respiratory rate to complex calculations of oxygen consumption and
carbon dioxide production to determine the appropriateness of the response to increased oxygen
demand. Monitoring responses at rest and during and after activity may indicate the degree and
severity of impairment, identify cardiopulmonary deficits that result in functional limitation, and
indicate the need to use or recommend other tests and measures and specific interventions.
Clinical indications
Tests and measures are appropriate in the presence of:
* Expectation or indication of one or more of the following impairments or functional limitations
during attempts to perform self-care, home management, community and work (job/ school/play)
integration or reintegration, and leisure tasks, movements, or activities:
- dizziness
- dyspnea at rest or on exertion
- edema or lymphedema
- impaired gait, locomotion, and
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balance
- impaired joint integrity and
mobility
- impaired motor function (motor
control and motor learning)
- impaired muscle performance
(including strength, power, and
especially endurance)
- impaired range of motion (ROM)
(including muscle length)
- impaired ventilation, respiration
(gas exchange), and circulation
Specific Tests and Measures
Tests and measures may include:
* Assessment of autonomic responses to positional changes
* Assessment of perceived exertion, dyspnea, or angina during activity using rating-of-perceivedexertion (RPE) scales, dyspnea scales, anginal pain scales, or visual analog scales
* Assessment of performance during established exercise protocols (eg, treadmill, ergometer, 6minute walk test, 3-minute step test)
* Assessment of standard vital signs (eg, blood pressure, heart rate, respiratory rate) at rest and
during and after activity
* Assessment of thoracoabdominal movements and breathing patterns with activity
* Auscultation of the heart
* Auscultation of the lungs
* Auscultation of major vessels for bruits
* Interpretation of blood gas analysis or oxygen consumption ([VO.sub.2]) studies
* Monitoring via telemetry during activity
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* Palpation of pulses
* Claudication time tests
* Pulse oximetry
* Tests and measures of pulmonary function and ventilatory mechanics
* Performance or analysis of an electrocardiogram
Data Generated
Data generated may include:
* Activities that aggravate or relieve symptoms
* Anaerobic threshold
* Arrhythmias at rest and during activity
* Autonomic responses to positional changes
* Thoracoabdominal movement and breathing patterns with activity
* Inspiratory and expiratory muscle force before and after activity (including comparison of actual
to predicted)
* Maximum oxygen consumption ([VO.sub.2]) (including comparison of actual to predicted)
* Oxygen consumption ([VO.sub.2]) for particular activity (including comparison of actual to
predicted)
* Oxygen saturation ([SaO.sub.2]) at rest and during and after activity
* Peripheral vascular integrity
* Physical exertion scale grading and degree of dyspnea or angina with activity
* Standard vital signs (eg, blood pressure, heart rate, respiratory rate) at rest and during and after
activity
* Symptoms that limit activity
* Ventilatory volumes and flow at rest and during and after activity (including comparison of actual
to predicted)
Anthropometric characteristics describe human body measurements such as height, weight, girth,
and body fat composition. The physical therapist uses these tests and measures to test for muscle
atrophy, gauge the extent of edema, and establish a baseline to allow patients/clients to be
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compared to national norms on such variables as weight and body fat composition. Results of
these tests and measures may indicate the need to use or recommend other tests and measures.
- edema, lymphedema, or effusion
- impaired aerobic capacity and
endurance
balance
(strength, power, endurance)
- impaired sensory integrity
(gas exchange) and circulation
- pain
* Assessment of activities and postures that aggravate or relieve edema, lymphedema, or effusion
* Assessment of edema through palpation and volume and girth measurements (eg, during
pregnancy, in determining the effects of other medical or health-related conditions, during surgical
procedures, after drug therapy)
* Measurement of body fat composition, using calipers, underwater weighing tanks, or electrical
impedance
* Measurement of height, weight, length, and girth
* Observation and palpation of trunk and extremities at rest and during and after activity
Data Generated
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* Activities and postures that aggravate or relieve edema, lymphedema, or effusion
* Body fat composition
* Girths of extremities and chest and lengths of extremities in inches or centimeters
* Height in feet and inches or centimeters
* Integrity of lymphatic system
* Volume displacement in liters
* Weight in pounds or kilograms
Arousal is the stimulation to action or to physiologic readiness for activity. Attention is selective
awareness of a part or aspect of the environment or selective responsiveness to one class of
stimuli. Cognition is the act or process of knowing, including both awareness and judgment. The
physical therapist uses specific tests and measures to assess responsiveness; orientation to time,
person, place, and situation; and ability to follow directions. These tests and measures guide the
physical therapist in the selection of interventions by indicating whether the patient/client has the
cognitive ability to participate in the plan of care.
- impaired reflex integrity
- impaired neuromotor development
and sensory integration
endurance
balance
mobility
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strength, power, endurance)
- impaired posture
gas exchange), and circulation
- pain
* Assessment of arousal, attention, and cognition, using standardized instruments
* Assessment of factors that influence motivation level
* Assessment of level of consciousness
* Assessment of level of recall (eg, short-term and long-term memory)
* Assessment of orientation to time, person, place, and situation
* Screening for cognition (eg, to determine ability to process commands, to measure safety
awareness)
* Screening for gross expressive (eg, verbalization) deficits
Data Generated
* Level of arousal, attention, or cognition deficits
* Scores on standardized instruments for measuring level of arousal, attention, or cognition
* Variation over time of arousal, attention, or cognition deficits
Assistive and adaptive devices include a variety of implements or equipment used to aid
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patients/clients in performing tasks or movements. Assistive devices include crutches, canes,

walkers, wheelchairs, power devices, long-handled reachers, and static and dynamic splints.
Adaptive devices include raised toilet seats, seating systems, and environmental controls. The
physical therapist uses specific tests and measures to determine whether a patient/client might
benefit from such a device or, when such a device already is in use, to determine how well the
patient/client performs with it.
Clinical Indications Tests and measures are appropriate in the presence of:
impaired aerobic capacity and
endurance
balance
mobility
pain
Specific Tests and Measures Tests and measures may include:
* Analysis of appropriate components of device
* Analysis of effects and benefits (including energy conservation and expenditure) while
patient/client uses device
* Analysis of patient/client or caregiver ability to use and care for device
Page 9 of 47
* Analysis of the potential to remediate impairment, functional limitation, or disability through use
of a device
* Assessment of alignment and fit of the device and inspection of related changes in skin condition
* Assessment of safety during use of device
* Computer-assisted analysis of motion, initially without and then with device Review of reports
provided by the patient/client, family, significant others, caregivers, or other professionals
concerning use of or need for device
* Videotape analysis of the patient/ client using device
Data Generated Data generated may include:
* Ability to use the device and to understand its appropriate use and care
* Alignment of anatomical parts with the device
* Deviations and malfunctions that can be corrected or alleviated using a device
* Level of adherence to use of the device
* Patient/client expressions of comfort, cosmesis, and effectiveness using the device
* Practicality and ease of use of device
* Safety and effectiveness of the device in providing protection, promoting stability, or improving
performance of tasks and activities
Community and Work (Job/School/Play) integration or Reintegration
(including instrumental Activities of Daily Living)
Community and work (job/school/play) integration or reintegration is the process of assuming roles
in the community or at work. The physical therapist uses the following tests and measures to (1)
make an informed judgment as to whether a patient/client is currently prepared to assume
community or work roles, including all instrumental activities of daily living (IADL), or (2) determine
when and how such integration or reintegration might occur. The physical therapist also uses
these tests and measures to determine whether an individual is a candidate for a work hardening
or work conditioning program. The physical therapist considers patient/client safety, perceptions,
and expectations while performing the test and measures.
Clinical indications Tests and measures are appropriate in the presence of:
during attempts to perform community and work (job/school/play) integration or reintegration and
leisure tasks, movements, or activities:
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endurance
- impaired arousal, attention, and
cognition
balance
- impaired posture
pain
* Analysis of adaptive skills
* Analysis of community, work (job/ school/play), and leisure activities
* Analysis of community, work (job/ school/play), and leisure activities that are performed using
assistive, adaptive, orthotic, protective, supportive, or prosthetic devices and equipment
* Analysis of environment and work (job/school/play) tasks
* Assessment of functional capacity
* Assessment of physiologic responses during community, work job/ school/play), and leisure
activities
* Assessment of safety in community and work (job/school/play) environments
* IADL scales or indexes
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* Observation of response to nonroutine occurrences

* Questionnaires completed by and interviews conducted with the patient/client and others as
appropriate
* Review of daily activities logs
* Review of reports provided by the patient/client, family, significant others, caregivers, other
health care professionals, or other interested persons (eg, rehabilitation counselor, Workers'
Compensation claims manager, employer)
* Adaptive skills
* Aerobic capacity or endurance
* Appropriateness of assistive and adaptive devices
* Appropriateness of orthotic, protective, supportive, or prosthetic devices or equipment
* Daily activity level
* Effort in specific movement tasks
* Functional capacity for community and work (job/school/play) tasks
* Gross and fine motor function
* Attention and cognition deficits
* Physical, functional, behavioral, and vocational status
* Muscle strength, power, and endurance
* Numerical scores on standardized rating scales
* Performance of community and work (job/school/play) activities and level of dependence on
human and mechanical assistance
* Prosthetic requirements
* Spatial and temporal requirements for performing specific tasks related to community and work
(job/school/ play) activities
* Standard vital signs (blood pressure, heart rate, respiratory rate) at rest and during and after
activity
* Strength, flexibility, and endurance
Cranial Nerve Integrity
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Cranial nerve integrity involves somatic, visceral, and afferent and efferent components. The
physical therapist uses cranial nerve integrity tests and measures to localize a dysfunction in the
brain stem and to identify cranial nerves that merit an in-depth examination. The physical therapist
uses a number of these tests to assess sensory and motor functions, such as taste, smell, and
facial expression.
- impaired neuromotor development
and sensory integration
balance
mobility
pain
* Assessment of dermatomes innervated by the cranial nerve
* Assessment of gag reflex
* Assessment of muscles innervated by the cranial nerves
* Assessment of response to the following stimuli:
auditory
gustatory
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olfactory
visual
vestibular
* Assessment of swallowing
* Constriction and dilation of pupils
* Equilibrium responses
* Eye movements
* Functional loss in muscles innervated by the cranial nerves
* Gag reflex integrity
* Gross auditory activity
* Pain, touch, temperature localization
* Swallowing characteristics
* Taste loss
* Visual deficits
Environmental, Home, and Work (Job/school/play) Barriers
Environmental, home, and work (job/school/play) barriers are the physical impediments that keep
patients/clients from functioning optimally in their surroundings. The physical therapist uses the
barriers tests and measures to identify any of a variety of possible impediments, including safety
hazards (eg, throw rugs, slippery surfaces), access problems (eg, narrow doors, thresholds, high
steps, absence of power doors or elevators), and home or office design barriers (eg, excessive
distances to negotiate, multistory environment, sinks, bathrooms, counters, placement of controls
or switches). The physical therapist uses these tests and measures, often in conjunction with
portions of other tests and measures, to suggest modifications to the environment (eg, grab bars
in the shower, ramps, raised toilet seats, increased lighting) that will allow the patient/client to
improve functioning in the home, workplace, and other settings.
Page 14 of 47
endurance
- impaired bowel and bladder
function
balance
mobility
- impaired posture
pain
* Analysis of physical space using photography or videotape
* Assessment of current and potential barriers
* Measurement of physical space
* Physical inspection of the environment
* Questionnaires completed by and interviews conducted with patient/ client and others as
appropriate
* Adaptations, additions, or modifications that would enhance safety
* Level of compliance with standards set forth in federal and state laws and regulations
* Recommendations for eliminating environmental barrier
* Space limitations and other barriers, including their dimensions, that limit ability to perform
Page 15 of 47
specific movement tasks during home, work (job/school/ play), and leisure activities
Ergonomics refers to the relationships among the worker, the work that is done, the tasks and
activities inherent in that work, and the environment in which the work is performed. Ergonomics
uses scientific and engineering principles to improve the safety, efficiency, and quality of
movement involved in work. Body mechanics refers to the interrelationships of the muscles and
joints as they maintain or adjust posture in response to environmental forces. The physical
therapist uses the ergonomics and body mechanics tests and measures to examine the work
environment on behalf of patients/clients and to determine the potential for trauma or repetitive
stress injuries from inappropriate workplace design. These tests and measures may be conducted
after a work injury or as a preventive measure, particularly when a patient/client is returning to the
work environment after an extended absence.
experienced during attempts to perform self-care, home management, community and work
(job/school/play) integration or reintegration, and leisure tasks, movements, or activities:
- abnormal body
alignment and movement
patterns
- impaired aerobic
capacity and
endurance
- impaired gait,
locomotion, and balance
- impaired joint integrity
and mobility
- impaired motor
function (motor control
and motor learning)
- impaired muscle
Page 16 of 47
performance (strength,
power, endurance)
- impaired posture
- impaired sensory
integrity
- impaired ventilation,
respiration (gas
exchange), and
circulation
pain
Ergonomics tests and measures may include:
* Analysis of the performance of selected tasks or activities
* Analysis of preferred postures during performance of tasks and activities
* Assessment of dexterity and coordination
* Assessment of work hardening or work conditioning needs, including identification of needs
related to physical, functional, behavioral, and vocational status
* Assessment of work (job/school/play) performance through batteries of tests
* Computer-assisted motion analysis of patient/client at work
* Determination of dynamic capabilities and limitations during specific work (job/school/play)
activities
* Ergonomics analysis of the work and its inherent tasks or activities, including:
- analysis of repetition/work/rest cycling during task or activity
- assessment of tools, devices, or equipment used
- assessment of vibration
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- assessment of workstation
- computer-assisted motion analysis of performance of selected
movements or activities
- identification of essential functions of task or activity
- identification of sources of actual and potential trauma,
cumulative trauma, or repetitive stress
* Functional capacity evaluation, including:
- endurance required to perform aerobic endurance activities
- joint range of motion (ROM) used to perform task or activity
- postures required to perform task or activity
- strength required in the work postures necessary to perform
the task or activity
* Videotape analysis of the patient/client at work
Body mechanics tests and measures may include:
* Computer-assisted motion analysis of performance of selected movements or activities
activities
* Observation of performance of selected movements or activities
* Videotape analysis of performance of selected movements or activities
Data Generated
* Body alignment, timing, and sequencing of component movements during specific job tasks or
activities
* Chest and extremity girth
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* Difficulty or pain expressed during the performance of specific job tasks or activities
* Height in feet and inches or meters and centimeters
* Physical, functional, behavioral, and vocational status
* Potential and actual ergonomic stressors
* Safety records and accident reports
* Temporal and spatial characteristics of movements during job tasks or activities
* Weight in pounds or kilograms
* Work (job/school/play) performance
Gait is the manner in which a person walks, characterized by rhythm, cadence, step, stride, and
speed. Locomotion is the ability to move from one place to another. Balance is the ability to
maintain the body in equilibrium with gravity both statically (eg, while stationary) and dynamically
(eg, while walking). The physical therapist uses gait, locomotion, and balance tests and measures
to investigate disturbances in gait, locomotion, and balance because they frequently lead to
decreased mobility, a decline in functional independence, and an increased risk of falls. Gait,
locomotion, and balance problems often involve difficulty in integrating sensory, motor, and neural
processes. The physical therapist also uses these tests and measures to determine whether the
patient/client is a candidate for assistive, adaptive, orthotic, protective, supportive, or prosthetic
devices or equipment.
Tests and measures are appropriate in the presence of
experienced during attempts to perform self-care, home management, community and work
(job/school/play) integration or reintegration, and leisure tasks, movements, or activities:
- dizziness
endurance
Page 19 of 47
mobility
- impaired posture
- pain
* Analysis of arthrokinematic, biomechanical, kinematic, and kinetic characteristics of gait,
locomotion, and balance, using electromyography (EMG), videotape, computer-assisted graphics,
weight-bearing scales, and force plates
locomotion, and balance with and without the use of assistive, adaptive, orthotic, protective,
supportive, or prosthetic devices or equipment
* Analysis of gait, locomotion, and balance on various terrains, in different physical environments,
or in water
* Analysis of wheelchair management and mobility
* Assessment of safety
* Gait, locomotion, and balance assessment instruments
* Gait, locomotion, and balance profiles.
* Identification and quantification of gait characteristics
* Identification and quantification of static and dynamic balance characteristics
Data Generated
Page 20 of 47

* Charts and videotapes that reflect gait, locomotion, and balance changes over time
* Energy expenditure requirements
* Gait cycle, gait deviations, and the safety and quality of gait and balance over time in different
environments and on a variety of surfaces
* Number ratings from standardized gait-testing instruments
* Activities that aggravate or diminish difficulties with gait, locomotion, or balance
* Ability to negotiate varied surfaces and elevations
* Patient/client perception of gait, locomotion, and balance problems
* Physiologic responses during gait, locomotion, and balance activities
* Qualitative and quantitative descriptions of gait, locomotion, and balance
* Safety and quality of gait and the gait cycle over time using assistive, adaptive, orthotic,
protective, supportive, or prosthetic devices or equipment
* Safety and quality of locomotion in different environments and over different terrains
* Safety awareness
* Weight-bearing status
Integumentary integrity is the health of the skin, including its ability to serve as a barrier to
environmental threats (eg, bacteria, parasites). The physical therapist uses integumentary integrity
tests and measures to assess the effects of a wide variety of problems that result in skin and
subcutaneous changes, including pressure and vascular, venous, arterial, diabetic, and
necropathic ulcers; burns and other traumas; and a number of diseases (eg, soft tissue disorders).
These tests and measures also are used to obtain more information about circulation through
inspection of the skin or the nail beds.
during attempts to perform self-care, home management, community and work (job/school/play)
- impaired bowel and
bladder function
Page 21 of 47
- impaired gait, locomotion,

and balance
mobility
- impaired motor function
motor control and motor
learning)
- impaired muscle
performance (strength, power,
endurance)
- impaired ventilation,
respiration (gas exchange) and
circulation
- pain
Tests and measures for skin associated with integumentary disruption may include:
* Assessment for presence of blistering
* Assessment for presence of hair growth
* Assessment of activities, positioning, and postures that aggravate or relieve pain or other
disturbed sensations
* Assessment of activities, positioning, postures, and assistive and adaptive devices that may
result in trauma to associated skin
* Assessment of continuity of skin color (eg, redness in lightly pigmented skin, violescent
coloration in darkly pigmented skin)
* Assessment of nail beds
* Assessment of sensation (eg, pain, temperature, tactile)
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* Assessment of skin temperature as compared with that of an adjacent area or an opposite

extremity (eg, using thermistors)
* Assessment of tissue mobility, turgor, and texture
Tests and measures for the wound may include:
* Assessment for presence of dermatitis (eg, rash, fungus)
* Assessment for presence of hair or nail growth
* Assessment for signs of infection
* Assessment of activities, positioning, and postures that aggravate the wound or scar or thai may
produce additional trauma
* Assessment of bleeding
* Assessment of burn
* Assessment of ecchymosis
* Assessment of exposed anatomical structures
* Assessment of pigment (color)
* Assessment of scar tissue (cicatrix), including banding, pliability, sensation, and texture
* Assessment of wound contraction, drainage, location, odor, shape, size, and depth (eg, linear,
tracing, photography), tunneling, and undermining
* Assessment of wound tissue, including epithelium, granulation, mobility, necrosis, slough,
texture, and turgor
Data Generated
* Activities and postures that aggravate the wound or that may produce pain or additional trauma
* Extremity characteristics in terms of color and temperature (in degrees or words)
* Grid photograph of wound
* Girths in inches or centimeters or volume displacement in milliliters
* Minimal erythematous dose reactions in seconds
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* Skin condition
* Skin temperature in degrees
* Soft tissue and scar tissue (mobility and cicatrix) condition
* Wound characteristics (eg, inflamed, macerated, necrotic)
* Wound dimensions in square or cubic inches or centimeters
* Wound drainage characteristics (eg, serous, serosanguineous, pus, slough)
Joint integrity and Mobility
Joint integrity is the conformance of a joint to expected anatomic and biomechanical norms. joint
mobility involves the capacity of a joint to be moved passively in certain ways that take into
account the structure and shape of the joint surface in addition to characteristics of the tissue
surrounding the joint. The assessment of joint mobility involves the performance of accessory joint
movements by the physical therapist because these movements are not under the voluntary
control of the patient. The physical therapist uses the joint integrity and mobility tests and
measures to determine whether there is excessive or limited motion of the joint. Excessive joint
motion necessitates a program of protection, whereas limited joint motion calls for interventions to
increase mobility and enhance functional capability.
Tests and measures are appropriate in the presence of
- edema. lymphedema. or effusion
endurance
balance
- impaired posture
Page 24 of 47
- pain
- soft tissue swelling, inflammation,
or restriction
* Analysis of the nature and quality of movement of the joint or body part during performance of
specific movement tasks
* Assessment of joint hypermobility and hypomobility
* Assessment of pain and soreness
* Assessment of response to manual provocation tests
* Assessment of soft tissue swelling, inflammation, or restriction
* Assessment of sprain
Data Generated
* Clinical signs or pain in response to a specific movement or provocation
* Joint mobility classification and grade
* Joint movement quality and quantity)
* Sprain classification and grade
Motor function is the ability to learn or demonstrate the skillful and efficient assumption,
maintenance, modification, and control of voluntary postures and movement patterns. The
physical therapist uses motor function tests and measures in the diagnosis of underlying
impairments and their contributions to functional limitation and disability. Deficits in motor function
reflect the type, location, and extent of the impairment, which may be the result of pathology or
other disorders. Weakness, paralysis, dysfunctional movement patterns, abnormal timing, poor
coordination, clumsiness, involuntary movements, or dysfunctional postures may be
manifestations of impaired motor function.
Page 25 of 47
endurance
cognition
balance
mobility
- impaired neuromotor
development and sensory integration
- impaired posture
- pain
- soft tissue swelling, inflammation,
or restriction
* Analysis of gait, locomotion, and balance
* Analysis of head, trunk, and limb movement
Page 26 of 47
* Analysis of myoelectric activities and neurophysiological integrity using electrophysiologic tests

(eg, diagnostic and kinesiologic electromyography [EMG], motor nerve conduction)
* Analysis of posture during sitting, standing, and locomotor activities appropriate for age (eg,
walking, hopping, skipping, running, jumping)
* Analysis of stereotypic movements
* Assessment of dexterity, coordination, and agility
* Assessment of postural, equilibrium, and righting reactions
* Assessment of sensorimotor integration
* Motor assessment scales
* Physical performance scales
Data Generated
* Abnormal movement patterns (eg, synergies, athetotic movements)
* Amplitude, duration, waveform, and frequency of normal or abnormal electrical potentials in
muscles
* Conduction velocity along peripheral motor nerves
* Coordination of maturation with stages of development
* Deviations from standardized age and sex norms for motor function (motor control and motor
learning)
* Muscle activity characteristics during movement
* Physiologic responses during activities
* Skin and efficiency of motor function, including the ability to initiate, control, and terminate
movement
* Timing, accuracy, sequencing, and number of repetitions of specific movement patterns and
postures
Muscle performance is the capacity of a muscle to do work (force x distance). Muscle strength is
the (measurable) force exerted by a muscle or a group of muscles to overcome a resistance in
one maximal effort. Muscle power is work produced per unit of time or the product of strength and
Page 27 of 47
speed. Muscle endurance is the ability to contract the muscle repeatedly over a period of time.
The performance of an individual muscle depends on its characteristics of length, tension, and
velocity. Integrated muscle performance over time is mediated by neurologic stimulation, fuel
storage, and fuel delivery in addition to balance, timing, and sequencing of contraction. The
physical therapist uses muscle performance tests and measures to determine the ability to
produce movements that a pre-requisite to functional activity.
endurance
function
balance
mobility
- impaired posture
- pain
Page 28 of 47

* Analysis of functional muscle strength, power, and endurance
* Analysis of muscle strength, power, and endurance, using manual muscle tests or dynamometry
* Assessment of muscle tone
* Assessment of pelvic-floor musculature
* Electrophysiologic tests (eg, electromyography [EMG], nerve conduction velocity)
Data Generated
* Amplitude, duration, waveform, and frequency of EMG signals
* Changes in muscle performance over time
* Consistency of effort and performance
* Force, velocity, torque, work, and power of muscle performance
* Muscle contraction characteristics (eg, maximal, painful, smooth, coordinated, cogwheel)
* Numbers, percentages, or letter grades from standardized grading systems for manual and
functional muscle testing
* Pain, soreness, or other symptoms produced by provocation of muscle contractions
* Strength of the pelvic-floor musculature
Neuromotor development is the acquisition and evolution of movement skills throughout the life
span. Sensory integration is the ability to integrate information from the environment to produce
movement. The physical therapist uses neuromotor development and sensory integration tests
and measures to assess motor capabilities in infants, children, and adults. The tests and
measures may be used to assess mobility, achievement of motor milestones and healthy
responses, postural control, and voluntary and involuntary movement. The physical therapist also
uses these tests and measures to test balance, righting and equilibrium reactions, eye-hand
coordination, and other motor capabilities.
Page 29 of 47
endurance
balance
- impaired posture
- pain
* Analysis of age-appropriate and sex-appropriate development
* Assessment of arousal, attention, and cognition
* Analysis of gait and posture
* Analysis of involuntary movement
* Analysis of reflex movement patterns
* Analysis of sensory integration tests
* Analysis of voluntary movement
* Assessment of behavioral response
Page 30 of 47
* Assessment of gross and fine motor skills

* Assessment of motor function (motor control and motor learning)
* Assessment of oromotor function, phonation, and speech production
Data Generated
* Movement patterns, postures, and sequences
* Movement asymmetries
* Postural alignment
* Primitive reflexes
* Gross and fine motor developmental level
* Information organization and processing quality
Orthotic, protective, and supportive devices are used to support weak or ineffective joints or
muscles and may serve to enhance performance. Orthotic devices include splints, braces, shoe
inserts, and casts. Protective devices include braces, protective taping, cushions, and helmets.
Supportive devices include supportive taping, compression garments, corsets, slings, neck collars,
serial casts, elastic wraps, and oxygen. The physical therapist uses specific tests and measures to
determine the need for orthotic, protective, and supportive devices in patients/clients not currently
using them and to evaluate the appropriateness and fit of those devices already in use. The
physical therapist correlates patient/client problems with available devices to make a choice that
best serves the individual. For example, the physical therapist may have to choose between an
orthosis that provides maximum control of motion and one that allows considerable movement.
endurance
balance
Page 31 of 47

mobility
- impaired posture
- pain
* Analysis of ability to care for device independently
* Analysis of appropriate components of the device
patient/client wears the device
* Analysis of movement while patient/client wears the device, using computer-assisted graphic
imaging and videotape
of the device
* Analysis of practicality and ease of use of the device
* Assessment of alignment and fit of the device and inspection of related changes in skin condition
* Assessment of patient/client or caregiver ability to put on and remove the device and to
understand its use and care
* Assessment of patient/client use of the device
* Assessment of safety during use of the device
Page 32 of 47
* Review of reports provided by the patient/client, family, significant others, caregivers, or other
professionals concerning use of or need for the device
Data Generated
* Ability to put on, use, and remove the device and to understand its use and care
* Adherence to use of the device
* Deviations and dysfunctions that can be corrected or alleviated by the device
* Effectiveness of the device in providing protection, promoting stability, or improving performance
of tasks and activities
* Energy expenditure requirements during use of die device
* Practicality and ease of use of the device
Pain
Pain is a disturbed sensation that causes suffering or distress. The physical therapist uses pain
tests and measures to determine the intensity, quality, and temporal and physical characteristics
of any pain that is important to the patient. The physical therapist may determine a cause or a
mechanism for the pain through these tests and measures. The tests and measures also may be
used to determine whether referral to another health care professional is appropriate.
endurance
balance
mobility
Page 33 of 47

- impaired posture
* Analysis of pain behavior and reaction during specific movements and provocation tests
* Assessment of muscle soreness
* Assessment of pain and soreness with joint movement
* Assessment of pain perception (eg, phantom pain)
* Assessment of pain using questionnaires, graphs, behavioral scales, symptom magnification
scales or indexes, or visual analog scales
Data Generated
* Activities that aggravate or relieve pain
* Behavior or pain reactions observed during particular movement tasks
* Muscle soreness classification and grade
* Numerical ratings from standardized rating instruments
* Pain patterns over time
* Pain reactions to cumulative stress or trauma
* Response to pain
* Response to noxious stimuli
Page 34 of 47
* Response during specific movement tasks and to provocation tests

* Sensory and temporal qualities of pain
* Somatic distribution of pain
Posture
Posture is the alignment and positioning of the body in relation to gravity, center of mass, and
base of support. The physical therapist uses posture tests and measures to assess structural
abnormalities in addition to the ability to right the body against gravity. "Good posture" is a state of
musculoskeletal balance that protects the supporting structures of the body against injury or
progressive deformity. Findings from these tests and measures may lead the physical therapist to
perform additional tests and measures (eg, joint integrity and mobility, respiration, ventilation [gas
exchange], and circulation).
- abnormal bony alignment
endurance
balance
mobility
- pain
* Pregnancy
Page 35 of 47

* Analysis of resting posture in any position
* Analysis of static and dynamic postures, using computer-assisted imaging, posture grids, plumb
lines, still photography, videotape, or visual analysis
Data Generated
* Alignment and symmetry of body landmarks within segmental planes, while at rest or in motion
* Postural alignment during standing, sitting, lying, or movement
* Postural deviations within lines or grid marks
A prosthesis is an artificial device used to replace a missing part of the body. Physical therapists
use specific tests and measures for patients/clients who might benefit from a prosthesis or for
patients wearing a prosthesis. The physical therapist selects a prosthesis that will allow optimal
freedom of movement and functional capability with minimal discomfort and inconvenience.
balance
strength, power, endurance)
Page 36 of 47
- pain
* Loss of limb or body part
patient/client wears device
* Analysis of movement while the patient/client wears device, using computer-assisted graphic
of device
* Analysis of the practicality and ease of use of device
* Assessment of alignment and fit of device and inspection of related changes in skin condition
* Assessment of patient/client or caregiver ability to put on and remove device and to understand
its use and care
* Assessment of patient/client use of device
* Assessment of residual limb or adjacent segment for range of motion, strength, skin integrity,
and edema
* Review of reports provided by patient/client, family, significant others, caregivers, or other
professionals concerning use of or need for device
Data Generated
* Ability to put on, use, and remove the device and to understand its use and care
* Adherence to use of the device
* Deviations and dysfunctions that can be corrected or alleviated using the device
* Effectiveness of the device in providing protection, promoting stability, or improving performance
of tasks and activities and enhancing function at home, at work job/school/play), and in community
Page 37 of 47
* Energy expenditure requirements during use of the device

* Practicality and ease of use of the device
* Range of motion (ROM), strength, skin integrity, and edema in residual limb or adjacent segment
Range of motion (ROM) is the space, distance, or angle through which movement occurs at a joint
or a series of joints. Muscle length is measured at various joint angles through the range. Muscle
length, in conjunction with joint integrity and soft tissue extensibility, determines flexibility. The
physical therapist uses ROM tests and measures to determine the arthrokinematics and
biomechanics of a joint, including flexibility and movement characteristics. Adequate ROM is
valuable for injury prevention because it allows the tissues to adjust to imposed stresses. Loss of
ROM is associated in most cases with loss of function.
balance
mobility
- impaired posture
- pain
Page 38 of 47

* Analysis of functional ROM
* Analysis of multisegmental movement
* Analysis of ROM using goniometers, tape measures, flexible rulers, inclinometers, photographic
or electronic devices, or computer-assisted graphic imaging
* Assessment of muscle, joint, or soft tissue characteristics
Data Generated
* Deviations from planes in degrees or inches or centimeters
* Excursion distances in inches or centimeters
* Pain or tenderness in muscles, joints, and soft tissue during movements or activities that require
elongation of muscle
* Passive tension during multisegmental movement that requires elongation of muscle
* Joint ROM in degrees
Reflex Integrity
A reflex is a stereotypic, involuntary reaction to any of a variety of sensory stimuli. The physical
therapist uses reflex integrity tests and measures to determine the excitability of the nervous
system and the integrity of the neuromuscular system.
- impaired arousal
balance
Page 39 of 47

- impaired posture
- pain
* Assessment of developmentally appropriate reflexes over time
* Assessment of normal reflexes (eg, stretch reflex)
* Assessment of pathologic reflexes (eg, Babinski's reflex)
* Electrophysiological tests (eg, H-reflex)
Data Generated
* Normal or pathologic reflexes
* Variation in reflex activity over time or with positioning
Self-Care and Home Management (Including Activities of Daily Living and
Self-care includes activities of daily living (ADL), such as bed mobility, transfers, gait, locomotion,
developmental activity, dressing, grooming, bathing, eating, and toileting. Home management
includes more complex instrumental activities of daily living (IADL), such as maintaining a home,
shopping, cooking, performing heavy household chores, managing money, driving a car or using
public transportation, structured play (for infants and children), and negotiating school
environments. The physical therapist uses the following tests and measures to determine the level
of performance of the tasks necessary for independent living. The results of these tests and
measures may lead the physical therapist to determine that the patient/client needs assistive and
adaptive, orthotic, protective, supportive, or prosthetic devices or equipment; body mechanics
training; organized functional training programs; or therapeutic exercise programs. The physical
therapist considers patient/client safety, perceptions, and expectations while performing the tests
and measures.
Page 40 of 47
during attempts to perform self-care or home management, community and work (job/school/play)
endurance
cognition
- impaired body mechanics
function
balance
mobility
- impaired posture
Page 41 of 47
- pain
* ADL or IADL scales or indexes
* Analysis of environment and tasks
* Analysis of self-care and home management activities
* Analysis of self-care and home management activities that are performed using assistive,
adaptive, orthotic, protective, supportive, or prosthetic devices or equipment
* Analysis of self-care performed in unfamiliar environments
* Assessment of ability to transfer
* Assessment of physiologic responses during self-care and home management activities
* Assessment of safety in self-care and home management activities
* Observation of response to non-routine occurrences
* Questionnaires completed by and interviews conducted with patient/client and others as
appropriate
* Review of reports provided by the patient/client, family, significant others, caregivers, or other
professionals
Data Generated
* Ability to transfer
* Adaptive skills
* Appropriateness of assistive and adaptive devices
Page 42 of 47
* Appropriateness of orthotic, protective, supportive, or prosthetic devices and equipment

* Daily activity level
* Functional capacity for self-care and home management tasks
* Attention and cognition deficits
* Movement patterns during performance of self-care and home management activities
* Muscle strength, power, and endurance
* Numerical scores on standardized rating scales
* Performance of self-care and home management activities and level of dependence on human
and mechanical assistance
* Spatial and temporal requirements for performing specific tasks related to self-care and home
management activities
* Standard vital signs (blood pressure, heart rate, respiratory rate) at rest and during and after
activity
Sensory integrity (Including Proprioception and Kinesthesia)
Sensory integrity includes peripheral sensory processing (eg, sensitivity to touch) and cortical
sensory processing (eg, two-point and sharp/dull discrimination). Proprioception includes position
sense and the awareness of the joints at rest. Kinesthesia is the awareness of movement. The
physical therapist uses sensory integrity tests and measures to determine the integrity of the
sensory, perceptual, or somatosensory processes. Sensory, perceptual, or somatosensory
abnormalities are frequent indicators of pathology.
- edema, lymphedema, or effusion
cognition
Page 43 of 47

balance
mobility
- impaired posture
impaired ventilation, respiration
- pain
* Assessment of combined (cortical) sensations (eg, stereognosis, tactile localization, two-point
discrimination, vibration, texture recognition)
* Assessment of deep (proprioceptive) sensations (eg, movement sense or kinesthesia, position
sense)
* Assessment of gross receptive (eg, vision, hearing) abilities
* Assessment of superficial sensations (eg, sharp/dub discrimination, temperature, light touch,
pressure)
* Electrophysiologic tests (eg, sensory nerve conduction)
Data Generated
Page 44 of 47

* Accuracy of cortical perceptions (eg, tactile recognition of objects, recognition of symbols drawn
on the skin, ability to localize touch sensations)
* Conduction times and velocities along peripheral or central musculoskeletal sensory pathways
* Joint position sense
* Perception of movement in the extremities
* Skin breakdown or injury that may cause decreased sensation
* Superficial sensory capacities
Ventilation, Respiration (Gas Exchange), and Circulation
Ventilation is the movement of a volume of gas into and out of the lungs. Respiration refers
primarily to the exchange of oxygen and carbon dioxide across a membrane into and out of the
lungs and at the cellular level. Circulation is the passage of blood through the heart, blood
vessels, organs, and tissues; it also describes the oxygen delivery system. The physical therapist
uses ventilation, respiration, and circulation tests and measures to determine whether the patient
has an adequate ventilatory pump and oxygen uptake and delivery system to perform activities of
daily living (ADL), ambulation, and aerobic exercise.
- abnormal breathing patterns or
abnormal blood gases
- abnormalities of heart rate, blood
pressure, respiratory rate or
pattern of breathing, or heart muscle
function
- dizziness
- dyspnea at rest or on exertion
Page 45 of 47

endurance
- airway clearance dysfunction
mobility
- impaired posture
- pain
* Analysis of thoracoabdominal movements and breathing patterns at rest and during activity and
exercise
* Assessment and classification of edema through volume and girth measurements
* Assessment of ability to clear airway
* Assessment of activities that aggravate or relieve edema, pain, dyspnea, or other symptoms
* Assessment of capillary refill time
* Assessment of chest wall mobility, expansion, and excursion
* Assessment of cough and sputum
* Assessment of perceived exertion and dyspnea
* Assessment of phonation
Page 46 of 47
* Assessment of ventilatory muscle strength, power, and endurance

* Assessment of cyanosis
* Auscultation and mediate percussion of the lungs
* Palpation of chest wall (eg, tactile fremitus, pain, diaphragmatic motion)
* Pulse oximetry
Data Generated
* Activities that aggravate or relieve symptoms
* Adequacy of airway protection mechanisms
* Chest wall mobility and expansion
* Cough, sputum, and phonation characteristics
* Edema (girth, volume displacement)
* Inspiratory and expiratory muscle force before and after activity (including comparison of actual
to predicted)
* Normal and abnormal heart and lung sounds
* Oxygen saturation ([SaO.sub.2]) at rest and during and after activity
* Peripheral vascular integrity
* Pulse characteristics
* Rate of perceived exertion and dyspnea at rest and during activity
* Symptoms that limit activity
* Thoracoabdominal movements and breathing patterns at rest and during activity
Page 47 of 47
* Ventilatory muscle performance (strength, power, and endurance) and ventilatory pump
mechanics
* Ventilatory volumes and flow at rest and during and after activity (including comparison of actual
with predicted)
* Vital signs (eg, blood pressure, heart rate, respiratory rate) at rest and during and after activity
* Work of breathing and ventilatory reserve capacity
Source Citation:"What types of tests and measures do physical therapists use?." Physical
Therapy 77.n11 (Nov 1997): 1189(24). Expanded Academic ASAP. Gale. University of Florida. 21 Nov.
2008

Page 1 of 26
What types of interventions do physical therapists provide?(A Description of

Patient/Client Management)(Guide to Physical Therapy Practice).Physical
Introduction
Policy decisions about the use of physical therapy personnel and resources to manage
patients/clients with impairments, functional limitations, and disabilities should be based on
knowledge of the elements of the patient/client management that is provided by physical
therapists. Fading to intervene appropriately to prevent illness -- and failing to habilitate or
rehabilitate patients/clients with impairments, functional limitations, and disabilities -- lead to
greater costs at both the personal level and the societal level. The Guide provides administrators
and policymakers with the information they need to make decisions about the cost-effectiveness
of physical therapist intervention.
-- and, when appropriate, with other individuals involved in care -- using various methods and
techniques to produce changes in the condition that are consistent with the evaluation, diagnosis,
and prognosis. Decisions are contingent on the timely monitoring of response to intervention and
the progress made toward anticipated goals and desired outcomes.
Patient/client management provided by physical therapists includes ongoing examination,
evaluation, and modification of the plan of care when necessary. The physical therapist selects
interventions based on the complexity of the clinical problems. The plan of care includes
discharge planning that begins early and that is based on anticipated goals and desired outcomes
as determined by periodic reexamination. As soon as clinically appropriate, the patient/client is
informed of the prognosis and begins, with the assistance of the physical therapist, long-range
planning for managing any residual impairment, functional limitation, or disability. Through
appropriate education and instruction, the patient/client is encouraged to develop health habits
that will maintain or improve function, prevent recurrence of problems, and promote wellness.
Physical therapist intervention encourages functional independence, emphasizes patient/clientrelated instruction, and promotes proactive, wellness-oriented lifestyles. Physical therapists
actively facilitate the participation of the patient/client, family, significant others, and caregivers in
the plan of care.
Physical therapist intervention has three components: (1) coordination, communication, and
documentation, (2) patient/client-related instruction, and (3) direct interventions (Fig. 1).
Coordination, communication, and documentation and patient/client-related instruction are a part
of all patient/client management. Direct interventions vary because they are selected, applied, or
modified according to data and anticipated goals for a particular patient/client in a specific
diagnostic group. An examination, evaluation, or intervention -- unless performed by a physical
therapist -- is not physical therapy, nor should it be represented or reimbursed as such.
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Coordination, communication, and documentation are processes that ensure (1) appropriate,
coordinated, comprehensive, and cost-effective services between admission and discharge and
(2) cost-effective and efficient integration or reintegration into home, community, or work
(job/school/play) environments. These processes involve collaborating and coordinating with
agencies; coordinating and monitoring the delivery of available resources; coordinating data on
transition; coordinating the patient/client management provided by the physical therapist; ensuring
and facilitating access to health care services and resources and to appropriate community
resources; facilitating the development of the discharge plan; facilitating timely delivery of
available services; identifying current resources; providing information regarding the availability of
advocacy services; obtaining informed consent; protecting patient/client rights through procedural
safeguards and services,; providing information, consultation, and technical assistance; and
providing oversight for outcomes data collection and analysis.
Coordination, communication, and documentation are essential to all patient/client management.
They are used to identify or quantify:
* Comorbidities that may affect the plan of care, prognosis, or outcome
* Discharge destinations
* Impairment, functional limitation, or disability that will be the focus of the plan of care
* Interventions used, including frequency and duration
* Other interventions (eg, medications) that may affect outcomes
* Progress toward anticipated goals, using appropriate tests and measures
* Rehabilitation potential
Documentation is required at the onset of and throughout each episode of care. Clinical
documentation indicates, in order of sequence:
* Modes of interventions selected and the parameters of application
* Direct effects of each intervention in terms of impairment status (eg, change in level of pain,
sensation, reflexes, strength, endurance, range and quality of joint movement)
* Changes in functional limitation and disability, especially as they relate to meaningful, practical,
and sustained change in the life of the patient/client. If pain reduction is a goal, for example, the
outcome should be documented in terms of how the level of pain reduction relates to a change in
functional performance.
* Changes since previous intervention and any alteration in technique or intervention
Documentation should follow APTA's Guidelines for Physical Therapy Documentation (Appendix
7).
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Anticipated Goals
All benefits of coordination, communication, and documentation are measured in terms of
remediation or prevention of impairment, functional limitation, or disability. Specific goals may
include:
* Care is coordinated with patient/client, family, significant others, caregivers, and other
professionals.
* Decision making is enhanced regarding the health of patient/client and use of health care
* Other health care interventions (eg, medications) that may affect goals and outcomes are
identified.
* Patient/client, family, significant other, and caregiver understanding of expectations and goals
and outcomes is increased.
Specific Interventions
Coordination, communication, and documentation services may include:
* Case management
* Communication (direct or indirect)
* Coordination of care with the patient/client, family, significant others, caregivers, other
professionals, and other interested persons (eg, rehabilitation counselor, Workers' Compensation
claims manager, employer)
* Discharge planning
* Documentation of all elements of patient/client management
* Education plans
* Patient care conferences
* Record reviews
Patient/client-related instruction is the process of imparting information and developing skills to
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promote independence and to allow care to continue after discharge. Instruction should focus not
only on the patient but on the family, significant others, and caregivers regarding the current
condition, plan of care, and transition to roles at home, at work, or in the community, with the goal
of ensuring (1) short-term and long-term adherence to the interventions and (2) primary and
secondary prevention of future disability. The development of an instruction program should be
consistent with the goals of the plan of care and may include information about the cause of the
impairment, functional limitation, or disability; the prognosis; and the purposes and benefits and
risks of the intervention. All instruction should take into consideration the influences of
patient/client age, culture, gender roles, race, sex, sexual orientation, and socioeconomic status.
A patient/client-related instruction program should be developed for all patients for whom physical
therapy is indicated. A thorough examination must be performed to determine whether the
cognitive status, physical status, and resource status of the patient/client would allow independent
performance of a home program or whether family, significant other, or caregiver assistance is
required. When family, significant others, or caregivers -- including home health aides -- are
required to assist the patient/client with intervention procedures, they must be given instruction.
Anticipated Goals
All benefits of patient/client-related instruction programs are measured in terms of remediation or
prevention of impairment, functional limitation, or disability. Specific goals may include:
* Ability to perform physical tasks is increased.
* Decision making is enhanced regarding health of patient/client and use of health care resources
by patient/client, family, significant others, and caregivers.
prognosis, interventions, and goals and outcomes are increased.
increased.
* Performance levels in employment, recreational, or leisure activities are improved.
* Physical function and health status are improved.
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* Progress is enhanced through the participation of patient/client, family, significant others, and
caregivers.
* Risk of secondary impairments is reduced.
* Self-management of symptoms is increased.
Interventions
Activities to be included in the development of a patient/client-related instruction program may
include:
* Computer-assisted instruction
* Demonstration by patient/client or caregivers in the appropriate environment
* Periodic reexamination and reassessment of the home program
* Use of audiovisual aids for both teaching and home reference
* Use of demonstration and modeling for teaching
* Verbal instruction
* Written or pictorial instruction
Direct Interventions
The physical therapist selects, applies, or modifies one or more direct interventions (Fig. 1) based
on anticipated goals that are discussed with the patient/client and that relate to specific
impairments, functional limitations, and disabilities. Three of the direct interventions -- therapeutic
exercise, functional training in self-care and home management, and functional training in
community and work (job/school/play) integration or reintegration -- form the core elements of
most physical therapy plans of care. Plans of care frequently may include the use of other
interventions to augment therapeutic exercise and functional training. The use of any intervention,
unless performed by, a physical therapist or under the direction and supervision of a physical
therapist, is not physical therapy, nor should it be represented or reimbursed as such.
The physical therapist's selection of any direct intervention should be supported by the following:
* Examination findings (including those of the history, systems review, and tests and measures),
evaluation, and a diagnosis that supports physical therapist intervention
* Prognosis that is associated with improved or maintained health status through the remediation
of impairment, functional limitation, or disability
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* A plan of care designed to improve function through the use of interventions of appropriate
intensity, frequency and duration to achieve specific anticipated goals efficiently with available
resources
Physical therapists select interventions based on the data gathered during the examination
process and based on anticipated goals and desired outcomes. Factors that influence the
complexity of both the evaluation process and the intervention may include the following:
chronicity or severity of current condition; level of current impairment and probability of prolonged
impairment, functional limitation, or disability; living environment; multisite or multisystem
involvement; overall physical function and health status; potential discharge destinations;
preexisting systemic conditions or diseases; social supports; and stability of the condition.
Through routine monitoring and reexamination, the physical therapist determines the need for any
alteration in an intervention or in the plan of care. The interventions used, including their frequency
and duration, are consistent with patient/client needs and physiologic and cognitive status,
anticipated goals, and resource constraints. The independent performance of the procedure or
technique by the patient/client (or significant other, family, or caregiver) is encouraged following
instruction in safe and effective application.
Discontinuation of an intervention may be indicated because of lack of progress, lack of tolerance,
lack of motivation, attainment of optimal improvement or achievement of other desired outcomes,
or determination of a more effective alternative.
In the following pages, each type of direct intervention is described. Included are general criteria
for appropriate use of the intervention; possible methods, procedures, or techniques; and
anticipated goals.
Direct INterventions
Therapeutic Exercise including Aerobic Conditioning)
Therapeutic exercise includes a broad group of activities intended to improve strength, range of
motion (ROM) (including muscle length), endurance, breathing, balance, coordination, posture,
motor function (motor control and motor learning), motor development, or confidence when any of
a variety of problems constrains the ability to perform a functional activity. The physical therapist
targets problems with performance of a movement or task and specifically directs therapeutic
exercise to alleviate impairment, functional limitation, or disability.
Therapeutic exercise includes activities to improve physical function and health status (or reduce
or prevent disability) resulting from impairments by identifying specific performance goals that will
allow patients/clients to achieve a higher functional level in the home, school, workplace, or
community. Also included: activities that allow well clients to improve or maintain their health or
performance status (for work, recreational, or sports purposes) and prevent or minimize future
potential health problems. Therapeutic exercise also is a part of fitness and wellness programs
designed to promote overall well-being or, in general, to prevent complications related to inactivity
or overuse. The intervention may be used during pregnancy and the postpartum period to improve
function and reduce stress. it also may be used (with proper guidance) in patients with
hematologic and oncologic disorders to combat fatigue and systemic breakdowns. Therapeutic
exercise may prevent further complications and decrease utilization of health care resources
before, during, and after surgery or hospitalization.
Therapeutic exercise is performed actively, passively, or against resistance. When the
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patient/client cannot participate actively due to weakness or other problems, passive exercise may
be necessary. Resistance may be provided manually, by gravity, or through use of a weighted
apparatus or of mechanical or electromechanical devices. Aquatic physical therapy uses the
physical and hydrodynamic properties of water to facilitate performance.
Before applying therapeutic exercise, a thorough examination is performed to identify those
patients/clients for whom therapeutic exercise would be contraindicated or for whom therapeutic
exercise must be applied with caution. Candidates for therapeutic exercise include patients/clients
who:
* Are at risk of postsurgical complications
* Are at risk of developing or have developed impairment, functional limitation, or disability as a
result of defects in the following body systems:
- cardiovascular
- genitourinary
- integumentary
- lymphatic
- musculoskeletal
- neuromuscular
- pulmonary
* Engage in recreational, organized amateur, or professional athletics
* Are prepartum or postpartum
* Are restricted from performing necessary self-care, home management, community and work
(job/school /play) integration or reintegration, and leisure tasks, movements, or activities
Anticipated Goals All benefits of therapeutic exercise are measured in terms of remediation or
prevention of impairment, functional limitation, or disability. Specific goals related to therapeutic
exercise may include:
* Ability to performing physical tasks related to self-care, home management, community and work
(job/ school/ play) integration or reintegration, or leisure activities is increased.
* Aerobic capacity is increased.
* Airway clearance is improved.
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* Atelectasis is decreased.
* Balance is improved.
* Endurance is increased.
* Energy expenditure is decreased.
* Gait, locomotion, and balance are improved.
* Joint integrity and mobility are improved.
* Joint and soft tissue swelling, inflammation, or restriction is reduced.
* Motor function (motor control and motor learning) is improved.
* Muscle performance is increased.
* Need for assistive, adaptive, orthotic, protective, or supportive equipment and devices is
decreased.
* Nutrient delivery to tissue is increased.
* Osteogenic effects of exercise are maximized.
* Pain is decreased.
* Performance of and independence in activities of daily living (ADL) and instrumental activities of
daily living (IKDL) are increased.
* Physiologic response to increased oxygen demand is improved.
* Postural control is improved.
* Preoperative and postoperative complications are reduced.
* Quality and quantity of movement between and across body segments are improved.
* Risk factors are reduced.
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* Safety is improved.
* Self-management of symptoms is improved.
* Sense of well-being is improved.
* Sensory awareness is increased.
* Strength, power, and endurance are increased.
* Stress is decreased.
* Symptoms associated with increased oxygen demand are decreased.
* Tissue perfusion and oxygenation are enhanced.
* Tolerance to positions and activities is increased.
* Weight-bearing status is improved.
* Work of breathing is decreased.
Specific Direct interventions
Therapeutic exercise may include:
* Aerobic endurance activities using ergometers, treadmills, steppers, pulleys, weights, hydraulics,
elastic resistance bands, robotics, and mechanical or electromechanical devices
* Aquatic exercises
* Balance and coordination training
* Body mechanics and ergonomics training
* Breathing exercises and ventilatory muscle training
* Breathing strategies (eg, paced breathing, pursed-lip breathing)
* Conditioning and reconditioning (including ambulation activities with manual resuscitator bag or
portable ventilator
* Developmental activities training
* Gait, locomotion, and balance training
* Motor function (motor control and motor learning) training or retraining
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* Neuromuscular education or reeducation

* Neuromuscular relaxation, inhibition, and facilitation
* Perceptual training
* Posture awareness training
* Sensory training or retraining
* Strengthening:
- active
- active assistive
- resistive, using manual resistance,
pulleys, weights, hydraulics, elastic
resistance bands, robotics, and
mechanical or electromechanical
devices
* Stretching
* Structured play or leisure activities
Functional Training in Self-care and Home Management (Including Activities of Daily Living and
instrumental Activities of Daily Living)
Functional training in self-care and home management includes a broad group of performance
activities designed to (1) enhance neuromusculoskeletal, cardiovascular, and pulmonary
capacities and (2) integrate or return the patient/client to self-care or home management as
quickly and efficiently as possible. Functional training is used to improve the physical function and
health status of patients/clients with physical disability, impaired sensorimotor function, pain,
injury, or disease. Functional training also is used for well clients. It frequently is based on
activities associated with growth and development.
The physical therapist targets problems with performing a movement or task and specifically
directs the functional training to alleviate impairment, functional limitation, and disability. The
physical therapist may select from a number of options, including training in the following:
activities of daily living (ADL); instrumental activities of daily living (IADL); body mechanics;
therapeutic exercise; and use of therapeutic assistive, adaptive, orthotic, protective, supportive, or
prosthetic devices or equipment. Organized functional training programs such as back schools
also may be selected.
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Before applying functional training, a thorough examination is performed to identify those

patients/clients for whom functional training in self-care and home management would be
contraindicated or for whom functional training in self-care and home management must be
applied with caution.
Candidates for functional training in self-care and home management include patients/clients who:
- cardiovascular
- genitourinary
- integumentary
- lymphatic
- musculoskeletal
- neuromuscular
- pulmonary
result of surgical complications
* Are restricted from performing necessary self-care, home management, community, or work
job/school/play) integration or reintegration, or leisure tasks, movements, or activities
Anticipated Goals
All benefits of functional training in self-care and home management ate measured in terms of
remediation or prevention of impairment, functional limitation, and disability. Specific goals related
to functional training in self-care and home management may include:
* Ability to perform physical tasks related to self-care and home management (including ADL and
IADL) is increased.
* Ability to recognize a recurrence is increased, and intervention is sought in a timely manner.
* Performance of and independence in
* ADL and IADL are increased.
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* Safety is improved during performance of self-care and home management tasks and activities.
Functional training activities may include:
* ADL training (eg, bed mobility and transfer training, gait training, locomotion, developmental
activity, dressing, grooming, bathing, eating, toileting)
* Assistive and adaptive device or equipment training
* IADL training (eg, maintaining a home, shopping, cooking, home chores, heavy household
chores, money management, driving a car or using public transportation, structured play for
infants and children)
* Injury prevention or reduction training
* Organized functional training programs (eg, simulated environments and tasks)
* Orthotic, protective, or supportive device or equipment training
* Prosthetic device or equipment training
* Self-care or home management task adaptation
Functional Training in Community and Work (Job/school/play) integration or Reintegration
(Including instrumental Activities of Daily Living, Work Hardening, and Work Conditioning)
Functional training in community and work job/school/play) integration or reintegration includes a
broad group of activities designed to integrate or to return the patient/client to community, work
job/school/play), or leisure activities as quickly and efficiently as possible. It involves improving
physiologic capacities to facilitate the fulfillment of community- and work-related roles. Functional
training is used to improve the physical function and health status of patients/clients with physical
disability, impaired sensorimotor function, pain, injury, or disease; it also is used for well
individuals. It frequently is based on activities associated with growth and development.
The physical therapist targets the problems in performance of movements, community activities,
work tasks, or leisure activities and specifically directs the functional training to enable return to
the community, work, or leisure environment. A variety of approaches may be taken, depending
on patient/client needs; for example, the physical therapist may provide training in instrumental
activities of daily living (IADL) to a patient/client who needs to live more independently, and body
mechanics and posture awareness training to a patient/client who is deficient in those areas.
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Work hardening and work conditioning are specialized functional training programs designed to
reduce the impairment, functional limitation, or disability associated with work-related injuries.
Before applying functional training in community and work (job/school/play) integration or
reintegration, a thorough examination is performed to identify those patients/clients for whom
functional training would be contraindicated or for whom functional training must be applied with
caution.
Candidates for functional training in community and work (job/school/play) integration or
reintegration include patients/clients who:
- cardiovascular
- genitourinary
- integumentary
- lymphatic
- musculoskeletal
- neuromuscular
- pulmonary
result of surgical complications
* Are engaged in recreational, organized amateur, or professional athletics
* Are restricted from performing necessary self-care, home management, community or work
(job/school/play) integration or reintegration, or leisure tasks, movements, or activities
* Have a known work-related injury, impairment, functional limitation, or disability
Anticipated Goals
All benefits of functional training in community and work (job/school/play) reintegration and leisure
activities are measured in terms of remediation or prevention of impairment, functional limitation,
and disability. Specific goals related to functional training in community and work (job/ school/play)
integration or reintegration and leisure activities may include:
* Ability to perform physical tasks related to community and work (job/school/play) integration or
reintegration and leisure tasks, movements, or activities is increased.
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* Costs of work-related injury or disability are reduced.

* Performance of and independence in ADL and IADL are increased.
* Safety is improved during performance of community, work (job/ school/play), and leisure tasks
and activities.
Functional training activities in community and work integration or reintegration may include:
* Environmental, community, work job/school/play), or leisure task adaptation
* Ergonomic stressor reduction training
* IADL training (eg, shopping, cooking, home chores, heavy household chores, money
management, structured play for infants and children, negotiating school environments) job
coaching job simulation
* Leisure and play activity training
* Organized functional training programs (eg, back schools, simulated environments and tasks)
Manual Therapy Techniques (Including Mobilization and Manipulation)
Manual therapy techniques consist of a broad group of passive interventions in which physical
therapists use their hands to administer skilled movements designed to modulate pain; increase
joint range of motion (ROM); reduce or eliminate soft tissue swelling, inflammation, or restriction;
induce relaxation; improve contractile and noncontractile tissue extensibility; and improve
pulmonary function. These interventions involve a variety of techniques, such as the application of
graded forces.
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Physical therapists use manual therapy techniques to improve physical function and health status
(or reduce or prevent disability) resulting from impairments by identifying specific performance
goals that allow patients/clients to achieve a higher functional level in self-care, home
management, community and work (job/school/play) integration or reintegration, or leisure tasks
and activities.
Before applying manual therapy techniques, a thorough examination is performed to identify those
patients/clients for whom manual therapy would be contraindicated or for whom manual therapy
must be applied with caution. Candidates for manual therapy include patients/ clients with:
* Limited ROM
* Muscle spasm
* Pain
* Scar tissue or contracted tissue
* Soft tissue swelling, inflammation, or restriction
Anticipated Goals
All benefits of manual therapy techniques are measured in terms of a remediation or prevention of
impairment, functional limitation, and disability. Specific goals related to manual therapy
* Ability to perform movement tasks is increased.
* Edema, lymphedema, or effusion is decreased.
* Integumentary integrity is improved.
* joint integrity and mobility are improved.
* Muscle spasm is reduced.
* Soft tissue swelling, inflammation, or restriction is reduced.
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* Ventilation, respiration (gas exchange), and circulation are increased.

Specific Direct Interventions
Manual therapy techniques may include:
* Connective tissue massage
* Joint mobilization and manipulation
* Manual traction
* Passive ROM
* Soft tissue mobilization and manipulation
* Therapeutic massage
Prescription, application, and, as appropriate, fabrication of assistive, adaptive, orthotic,
protective, supportive, and prosthetic devices and equipment include the use of a broad group of
therapeutic appliances, implements, devices, and equipment to enhance performance of tasks or
movements, support weak or ineffective joints or muscles, protect body parts from injury, and
adapt the environment to facilitate activities of daily living (IADL) and instrumental activities of
daily living (IADL). These devices and equipment often are used in conjunction with therapeutic
exercise, functional training, work conditioning and work hardening, and other interventions and
should be selected in the context of patient/client needs and social and cultural environments.
The physical therapist targets the problems in performance of movements or tasks and selects (or
fabricates) the most appropriate device or equipment, then fits it and trains the patient/client in its
use and application. The goal is for the patient/client to function at a higher level and to decrease
functional limitation.
Before prescribing, applying, or, as appropriate, fabricating any device or equipment, a thorough
examination is performed to identify those patients/clients for whom these devices and equipment
would be contraindicated or for whom these therapeutic devices and equipment must be applied
with caution.
Candidates for these therapeutic devices and equipment include patients/clients who:
* Are at risk of developing impairment, functional limitation, or disability as a result of defects in the
following body systems:
- cardiovascular
Page 17 of 26
- genitourinary
- integumentary
- lymphatic
- musculoskeletal
- neuromuscular
- pulmonary * Are engaged in recreational, organized amateur, or professional athletics * Are
restricted from performing necessary self-care, home management, community and work
(job/school/play) integration or reintegration, and leisure tasks, movements, and activities
Anticipated Goals
All benefits of these therapeutic devices and equipment are measured in terms of remediation or
prevention of impairment, functional limitation, and disability. Specific goals related to the
prescription, application, and, as appropriate, fabrication of assistive, adaptive, orthotic, protective,
supportive, and prosthetic devices and equipment may include:
* Deformities are prevented.
* Independence in bed mobility, transfers, and gait is maximized.
* Edema or effusion is reduced.
* Joint stability is increased.
* Loading on a body part is decreased.
* Motor function (motor control and motor learning) is increased.
* Optimal joint alignment is achieved.
* Functional status is maintained while awaiting recovery.
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* Pressure areas (eg, pressure over bony prominence) are prevented.
* Prosthetic fit is achieved.
* Protection of body parts is increased.
* Stresses precipitating injury are decreased.
The selection of these therapeutic devices and equipment may include the prescription,
application, and, as appropriate, fabrication of:
* Adaptive devices (eg, raised toilet seats, seating systems, hospital beds, environmental controls)
* Assistive devices (eg, crutches, canes, walkers, wheel-chairs, power devices, long-handled
reachers, static and dynamic splints)
* Orthotic devices (eg, splints, braces, shoe inserts, casts)
* Prosthetic devices (eg, artificial limbs)
* Protective devices (eg, braces, protective taping, cushions, helmets)
* Supportive devices (eg, supportive taping, compression garments, corsets, slings, neck collars,
serial casts, elastic wraps, oxygen)
Airway clearance techniques include a broad group of activities used to manage or prevent
consequences of acute and chronic lung diseases and impairment, including those associated
with surgery. Airway clearance techniques may be used with therapeutic exercise, manual therapy
techniques, or mechanical modalities to improve pulmonary function.
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The physical therapist performs airway clearance techniques to improve physical function and
health status (or reduce or prevent disability) resulting from impairments, functional limitations,
and disabilities by identifying specific performance goals that allow the patient/client to achieve a
higher functional level in home management, community and work (job/school/play) integration or
reintegration, and leisure movements, tasks, and activities.
Before applying airway clearance techniques, a thorough examination is performed to identify
those patients/clients for whom these techniques would be contraindicated or for whom these
techniques must be applied with caution.
Candidates for airway clearance techniques include patients/clients who:
* Are at risk for postsurgical complications
* Are restricted from performing necessary self-care, home management; community and work
(job/school/ play) integration and reintegration and leisure tasks, movements, and activities
* Have altered breathing patterns
* Have impaired airway clearance
* Have impaired gas exchange
* Have impaired ventilatory pump
* Are at risk of developing impairment, functional limitation, or disability as a result of defects in the
following body systems:
- cardiovascular
- musculoskeletal
- neuromuscular
- pulmonary
Anticipated Goals
All benefits of airway clearance techniques are measured in terms of a remediation or prevention
of impairment, functional limitation, and disability. Specific goals related to airway clearance
* Cough is improved.
* Exercise tolerance is improved.
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* Independence in self-care for airway clearance techniques is increased.

* Need for an assistive device (mechanical ventilation) is decreased.
* Risk of secondary complications is reduced.
* Ventilation, respiration (gas exchange), and circulation are improved.
Airway clearance techniques may include:
* Active cycle of breathing or forced expiratory techniques
* Assistive cough techniques
* Assistive devices for airway clearance (eg, flutter valve)
* Autogenic drainage
* Chest percussion, vibration, and shaking
* Pulmonary postural drainage and positioning
* Suctioning
* Techniques to maximize ventilation (eg, maximum inspiratory hold, staircase breathing, manual
hyper-inflation)
Wound Management
Wound management includes procedures used to achieve a clean wound bed, promote a moist
wound environment, facilitate autolytic debridement, absorb excessive exudate from a wound
complex, and enhance perfusion and oxygen and nutrient delivery to tissues in addition to
management of the resulting scar. As a component of wound management, debridement is a
therapeutic procedure involving removal of nonviable tissue from a wound bed, most often by the
use of instruments, autolysis, therapeutic modalities, or enzymes.
The desired effects of wound management may be achieved in a variety of ways. The physical
therapist may use physical agents, electrotherapeutic and mechanical modalities, dressings,
topical agents, debridement, and oxygen therapy as part of a plan of care to alter the function of
Page 21 of 26
tissues and organ systems required for repair. Wound management interventions are used directly
by the physical therapist, based on patient/client needs and the direct physiological effects that
are required.
Before applying wound management techniques, a thorough examination is performed to identify
those patients/ clients for whom these interventions would be contraindicated or for whom the
interventions must be applied with caution.
Candidates for wound management include patients/clients with:
* Exuding wounds or reepithelialization or connective tissue repair or both
* Full- or partial-thickness skin involvement
* Nonviable tissue
* Signs of inflammation
Anticipated Goals
All benefits of wound management are measured in terms of remediation or prevention of
impairments, functional limitations, and disability. Specific goals related to wound management
may include:
* Complications are reduced.
* Debridement of nonviable tissue is achieved.
* Risk factors for infection are reduced.
* Wound and soft tissue healing is enhanced.
* Wound size is reduced.
Methods of wound management may include:
* Assistive and adaptive devices
* Debridement -- nonselective
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- wet dressings
* Debridement -- selective
- sharp debridement
* Dressings (eg, wound coverings, hydrogels, vacuum-assisted closure)
* Electrotherapeutic Modalities, (see Electrotherapeutic Modalities, page 3-13)
* Oxygen therapy (eg, topical, supplemental)
* Physical agents and mechanical modalities (see Physical Agents and Mechanical Modalities,
page 3-14)
* Topical agents (eg, ointments, moisturizers, creams, cleansers, sealants)
Electrotherapeutic modalities, which include a broad group of agents involving electricity, are used
by physical therapists to augment other active or functionally oriented procedures in the plan of
care. Specifically, these modalities are used to help patients/clients modulate or decrease pain;
reduce or eliminate soft tissue swelling, inflammation, or restriction; maintain strength after injury
or surgery; decrease unwanted muscular activity; assist muscle contraction in gait or other
functional training; or increase the rate of healing of open wounds and soft tissue.
Before applying electrotherapeutic modalities, a thorough examination is performed to identify
those patients/ clients for whom these interventions would be contraindicated or for whom these
interventions must be applied with caution.
Candidates for application of electrotherapeutic modalities include patients/ clients with:
* Impaired integumentary integrity
* Impaired motor function (motor control and motor learning)
* Impaired muscle performance
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* Muscle spasm
* Pain
Anticipated Goals
All benefits of electrotherapeutic procedures are measured in terms of remediation or prevention
of impairment, functional limitation, and disability. Specific goals related to electrotherapeutic
modalities may include:
* joint integrity and mobility are improved.
* Neuromuscular function is increased.
* Tissue perfusion and oxygenation are improved.
Electrotherapeutic modalities may include:
* Biofeedback
* Electrical muscle stimulation
* Functional electrical stimulation (FES)
* Iontophoresis
* Neuromuscular electrical stimulation (NMES)
Page 24 of 26
* Transcutaneous electrical nerve stimulation (TENS)

Physical agents and mechanical modalities are used by physical therapists in conjunction with or
in preparation for other interventions, such as therapeutic exercise and functional training.
Physical agents -- which involve thermal, acoustic, or radiant energy -- are used by physical
therapists in increasing connective tissue extensibility; modulating pain; reducing or eliminating
soft tissue swelling, inflammation, or restriction caused by musculoskeletal injury or circulatory
dysfunction; increasing the healing rate of open wounds and soft tissue; remodeling scar tissue; or
treating skin conditions. Mechanical modalities include a broad group of procedures used by
physical therapists in modulating pain; stabilizing an area that requires temporary support;
increasing range of motion (ROM); or applying distraction, approximation, or compression.
Before using either physical agents or mechanical modalities, a thorough examination is
performed to identify those patients/clients for whom these interventions would be contraindicated
or for whom the interventions must be applied with caution. Candidates for physical agents or
mechanical modalities include patients/clients with:
* Edema, lymphedema, or effusion
* Impaired integumentary integrity
* Impaired joint integrity and mobility
* Need for assisted weight bearing or upright activity support
* Impaired sensory integrity
* Pain
* Pulmonary secretion retention
Anticipated Goals
All benefits of physical agents and mechanical modalities are measured in terms of remediation or
prevention of impairment, functional limitation, and disability. Specific goals related to the use of
physical agents and mechanical modalities may include:
* Complications of soft tissue and circulatory disorders are decreased.
* Independence in airway clearance is achieved.
Page 25 of 26
* Edema, lymphedema, or effusion is reduced.

* Neural compression is decreased.
* Risk of secondary impairment is decreased.
* Tissue perfusion and oxygenation are improved.
Physical agents may include:
* Athermal modalities (eg, pulsed ultrasound, pulsed electromagnetic fields)
* Cryotherapy (eg, cold packs, ice massage, vapocoolant spray)
* Deep thermal modalities (eg, pulsed short-wave diathermy, ultrasound, phonophoresis)
* Hydrotherapy (eg, aquatic therapy, whirlpool tanks, contrast baths, pulsatile lavage)
* Phototherapy (eg, ultraviolet)
* Superficial thermal modalities (eg, heat, paraffin baths, hot packs, fluidotherapy)
* Compression therapies (eg, vasopneumatic compression devices, compression bandaging,
compression garments, taping, and total contact casting)
* Continuous passive motion (CPM)
* Mechanical percussors
* Tilt table or standing table
* Traction (sustained, intermittent, or positional)
Page 26 of 26
Source Citation:"What types of interventions do physical therapists provide?." Physical

2008

Page 1 of 234
Musculoskeletal. (includes related information)(Preferred Practice Patterns)(Guide to

Physical Therapy Practice).Physical Therapy 77.n11 (Nov 1997): pp1229
(138). (56576 words)
The following patterns describe the elements of patient/client management provided by physical
therapists -- examination (history, systems review, and tests and measures), evaluation,
diagnosis, prognosis, and intervention (with anticipated goals) -- in addition to reexamination,
outcomes, and criteria for discharge. Each pattern also describes primary prevention/risk factor
reduction strategies for the specific patient/client diagnostic group.
This preferred practice pattern describes the generally accepted elements of the patient/client
management that physical therapists provide for the patient/client diagnostic group specified
below. APTA emphasizes that preferred practice patterns are the boundaries within which a
physical therapist may select any of a number of clinical paths, based on consideration of a wide
variety of factors, such as individual patient/client needs; the profession's code of ethics and
standards of practice; and patient/client age, culture, gender roles, race, sex, sexual orientation,
and socioeconomic status.
Patient/Client Diagnostic Group
Patients/clients at risk of bone demineralization, with or without clinical signs of osteological
involvement.
INCLUDES patients/clients with:
* Activity-induced hormonal changes * Certain medications (eg, steroids) * Joint immobilization *
Known high risk (eg, based on sex, ethnicity, age, lifestyle, menstrual or hormonal changes
related to hysterectomy or menopause) * Nutritional deficiency * Prolonged non-weight-bearing
state
EXCLUDES patients/clients with:
* Acute fractures * Neoplasms of the bone * Osteogenesis imperfecta * Paget's disease
ICD-9-CM Codes
As of press time, the listing below contains the most typical ICD-9-CM codes related to this
preferred practice pattern. Because the patient/client diagnostic group is defined by impairments
and functional limitations and not by codes, it is possible for individuals to belong to the group
even though the codes may not apply to them.
This listing is intended for general information only and should not be used for coding purposes.
Codes should be confirmed by referring to the World Health Organization's International
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Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or to other ICD-9-CM

coding manuals that contain exclusion notes and instructions regarding fifth-digit requirements.
344 other paralytic syndromes 334.0 Quadriplegia and quadriparesis 344.1 Paraplegia
714 Rheumatoid arthritis and other inflammatory polyarthropathies
719 Other and unspecified disorders of joint 719.5 Stiffness of joint, not elsewhere classified 719.7
Difficulty in walking 719.8 Other specified disorders of joint (calcification of joint),
722 Intervertebral disk disorders 722.4 Degeneration of cervical intervertebral disk 722.5
Degeneration of thoracic or lumbar intervertebral disk 722.6 Degeneration of intervertebral disk,
site unspecified
728 Disorders of muscle, ligament, and fascia 728.2 muscular wasting and disuse atrophy, not
elsewhere classified
729 Other disorders of soft tissues 729.9 Other unspecified disorders of soft tissue
733 Other disorders of bone and cartilage 733.0 Osteoporosis
737 Curvature of spine 737.3 Kyphoscoliosis and scoliosis 737.4 Curvature of spine associated
with other conditions
Examination
Through the examination (history, systems review, and tests and measures), the physical
therapist identifies impairments, functional limitations, disabilities, or changes in physical function
and health status resulting from injury, disease, or other causes to establish the diagnosis and the
prognosis and to determine the intervention. The patient/client, family, significant others, and
caregivers participate by reporting activity performance and functional ability. The selection of
examination procedures and the depth of the examination vary based on patient/client age;
severity of the problem; stage of recovery (acute, subacute, chronic); phase of rehabilitation
(early, intermediate, late, return to activity); home, community, or work (job/school/play) situation;
and other relevant factors. For clinical indications and types of data generated by the tests and
measures, refer to Part One, Chapter 2.
History
Data generated from the history may include:
General Demographics
* Age * Primary language * Race/ethnicity * Sex
Social History
* Cultural beliefs and behaviors * Family and caregiver resources * Social interactions, social
activities, and support systems
Occupation/Employment
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* Current and prior community and work (job/school) activities

Growth and Development
* Hand and foot dominance * Developmental history
Living Environment
* Living environment and community characteristics * Projected discharge destinations
History of Current Condition
* Concerns that led patient/client to seek the services of a physical therapist * Concerns or needs
of patient/client who requires the services of a physical therapist * Current therapeutic
interventions * Mechanisms of injury or disease, including date of onset and course of events *
Onset and pattern of symptoms * Patient/client, family, significant other, and caregiver
expectations and goals for the therapeutic intervention * Patient/client, family, significant other,
and caregiver perceptions of patient's/ client's emotional response to the current clinical situation
Functional Status and Activity Level
* Current and prior functional status in self-care and home management activities, including
activities of daily living (ADL) and instrumental activities of daily living (IADL)
Medications
* Medications for current condition for which patient/client is seeking the services of a physical
therapist * Medications for other conditions
Other Tests and Measures
* Laboratory and diagnostic tests * Review of available records * Review of nutrition and hydration
Past History of Current Condition
* Prior therapeutic interventions * Prior medications
Past Medical/Surgical History
* Cardiopulmonary * Endocrine/metabolic * Gastrointestinal * Genitourinary * Integumentary *
Musculoskeletal * Neuromuscular * Pregnancy, delivery, and postpartum * Prior hospitalizations,
surgeries, and preexisting medical and other health-related conditions
Family History
* Familial health risks
Health Status (Self-Report, Family Report, Caregiver Report)
* General health perception * Physical function (eg, mobility, sleep patterns, energy, fatigue) *
Psychological function (eg, memory, reasoning ability, anxiety, depression, morale) * Role function
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(eg, worker, student, spouse, grandparent) * Social function (eg, social interaction, social activity,
social support)
Social Habits (Post and Current)
* Behavioral health risks (eg, smoking, drug abuse) * Level of physical fitness (self-care, home
management, community, work [job/school/play], and leisure activities)
Systems Review
The systems review may include:
Physiologic and anatomic status
* Cardiopulmonary * Integumentary * Musculoskeletal * Neuromuscular
Communication, affect, cognition, language, and learning style
Tests and Measures
Tests and measures for this pattern may include, in alphabetical order:
* Assessment of performance during established exercise protocols (eg, using treadmill,
ergometer, 6-minute walk test, 3-minute step test) * Assessment of standard vital signs (eg, blood
pressure, heart rate, respiratory rate) at rest and during and after activity
impedance * Measurement of height, weight, length, and girth
Community and Work (Job/School/Play) Integration or Reintegration
(Including IADL)
* Analysis of community, work (job/school/play), and leisure activities * Analysis of community,
work (job/school/play), and leisure activities that are performed using assistive, adaptive, orthotic,
protective, supportive, or prosthetic devices or equipment * Analysis of environment and work
(job/school/play) tasks * Review of daily activities logs * Review of reports provided by
patient/client, family, significant others, caregivers, other health care professionals, or other
interested persons (eg, rehabilitation counselor, Workers' Compensation claims manager,
employer)
* Functional capacity, evaluation, including:
- postures required to perform task or activity - strength required in the work postures necessary to
perform the work (job/school/play) task or activity
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specific movement tasks * Assessment of soft tissue swelling, inflammation, or restriction *
Assessment of joint hypermobility and hypomobility * Assessment of pain and soreness
walking, hopping, skipping, running, jumping) * Assessment of dexterity, coordination, and agility
Muscle Performance including Strength, Power, and Endurance)
Pain
Posture
* Analysis of resting posture in any position * Analysis of static and dynamic postures, using
computer-assisted imaging, posture grids, plumb fines, stiff photography, videotape, or visual
analysis
Range of Motion (ROM) (Including Muscle Length)
Self-Care and Home Management (Including ADL and IADL)
* Analysis of self-care and home management activities * Review of daily activities logs * Review
of reports provided by patient/client, family, significant others, caregivers, or other professionals
Evaluation, Diagnosis, and Prognosis
The physical therapist performs an evaluation (makes clinical judgments) for the purpose of
establishing he diagnosis and the prognosis. Factors that influence the complexity of the
evaluation include the clinical findings, extent of loss of function, social considerations, and overall
physical function and health status. A diagnosis is a label encompassing a cluster of signs and
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symptoms, syndromes, or categories. It is the result of the diagnostic process, which includes
evaluating, organizing, and interpreting examination data. The prognosis is the determination of
the optimal level of improvement that might be attained and the amount of time required to reach
that level. The prognosis also may include a prediction of the improvement levels that may be
reached at various intervals during the course of physical therapy During the prognostic process,
the physical therapist develops the plan of care, which specifies goals and outcomes, specific
direct interventions, the frequency of visits and duration of the episode of care required to achieve
goals and outcomes, and criteria for discharge.
The frequency of visits and duration of the episode of care may vary from a short episode with a
high intensity of intervention to a longer episode with a diminishing intensity of intervention.
Frequency and duration may vary greatly among patients/clients based on a variety of factors that
the physical therapist considers throughout the evaluation process, such as chronicity and severity
of the problem; stability of the condition; preexisting systemic conditions or diseases; probability of
prolonged impairment, functional limitation, or disability; multisite or multisystem involvement;
social supports; living environment; potential discharge destinations; patient/client and family
expectations; anatomic and physiologic changes related to growth and development; and
caregiver consistency or expertise.
Prognosis
Through lifestyle modification, patient/client at risk of low bone density will maintain bone mineral
density above fracture threshold.
Through lifestyle modification, patient/client with identified low bone density will reverse the
demineralization process and achieve bone mineral density above fracture threshold.
Expected Range of Number of Visits Per Episode of Care
3 to 18 This range represents the lower and upper limits of the number of physical therapist visits
required to achieve anticipated goals and desired outcomes. It is anticipated that 80% of
patients/clients in this diagnostic group will achieve the goals and outcomes within 3 to 18 visits
during a single continuous episode of care. Frequency of visits and duration of the episode of care
should be determined by the physical therapist to maximize effectiveness of care and efficiency of
service delivery.
Factors That May Modify Frequency of Visits
* Ability to transfer instruction to motor learning
* Accessibility of resources
* Age
* Availability of resources
* Caregiver (eg, family, home health aide) consistency or expertise
* Chronicity or severity of condition
* Comorbidities
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* Level of patient/client adherence to the intervention program

* Preexisting systemic conditions or diseases
* Psychosocial and socioeconomic stressors
* Support provided by family unit
Intervention
to produce changes in the condition that are consistent with the diagnosis and prognosis. In the
plan of care, the physical therapist determines the degree to which intervention is likely to achieve
anticipated goals (remediation of impairment) and desired outcomes (remediation of functional
limitation, secondary or primary prevention of disability, optimization of patient/client satisfaction).
In the event that the diagnostic process does not yield an identifiable cluster of signs and
symptoms, syndrome, or category (diagnosis), intervention may be guided by the alleviation of
symptoms and remediation of deficits. Intervention has three components. Communication,
coordination, and documentation and patient/client-related instruction are provided for all
patients/clients, whereas a variety of direct interventions may be selected, applied, or modified by
the physical therapist on the basis of the examination and evaluation findings, diagnosis, and
prognosis for a specific patient/client. For clinical indications for the direct interventions, refer to
Part One, Chapter 3.
Anticipated Goals
* Care is coordinated with client, family, significant others, caregivers, and other professionals.
* Decision making is enhanced regarding the health of client and use of health care resources by
client, family, significant others, and caregivers.
* Coordination of care with client, family, significant others, caregivers, other health care
professionals, and other interested persons (eg, rehabilitation counselor Workers' Compensation
* Documentation of all elements of client management
* Education plans
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Client-Related Instruction
Anticipated Goals
* Decision making is enhanced regarding health of client and use of health care resources by
client.
* Client knowledge of personal and environmental factors associated with the condition is
increased.
Specific interventions
* Demonstration by client in the appropriate environment
Direct interventions
Direct interventions for this pattern may include, in order of preferred usage:
Therapeutic Exercise (Including Aerobic Conditioning)
Anticipated Goals
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* Aerobic endurance activities using treadmills, ergometers, steppers, pulleys, weights, hydraulics,
* Aquatic exercises
* Breathing exercises
* Conditioning
* Motor function (motor control and motor learning) training
* Strengthening:
- active
- active assistive
- resistive, using manual resistance, pulleys, weights,
hydraulics, elastic resistance bands, robotics, and mechanical
or electromechanical devices
* Stretching
Functional Training in Self-Care and Home Management (Including Activities
of Daily Living [ADL] and Instrumental Activities of Doily Living [IADL])
Anticipated Goals
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activity, dressing, grooming, bathing, eating, toileting)
management, driving a car or using public transportation, structured play for infants and children)
Functional Training in Community and Work (Job/School/Play) integration or
Reintegration (Including IADL, Work Hardening, and Work Conditioning)
Anticipated Goals
* Performance of and independence in IADL are increased.
management, driving a car or using public transportation, structured play for infants and children,
negotiating school environments)
Prescription, Application, and, as Appropriate, Fabrication of Devices and
Equipment (Assistive, Adaptive, Orthotic, Protective, Supportive, and
Prosthetic)
Anticipated Goals
* Orthotic devices or equipment (eg, splints, braces, shoe inserts, casts)
* Protective devices or equipment (eg, braces, protective taping, compression, garment, corsets,
slings, neck collars, serial casts, elastic wraps, oxygen)
* Supportive devices or equipment (eg, supportive taping, compression garments, corsets, slings,
neck collars, elastic wraps, oxygen)
Outcomes
At each step of patient/client management, the physical therapist considers the desired outcomes.
Outcomes relate to functional limitation (restriction of the ability to perform, at the level of the
whole person, a physical action, activity, or task in an efficient, typically expected, or competent
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manner), disability (inability to engage in age-specific, gender-specific, or sex-specific roles in a

particular social context and physical environment), primary or secondary prevention, and
patient/client satisfaction. The physical therapist also identifies the patient's/client's expectations
for therapeutic interventions and perceptions about the clinical situation and considers whether
they are realistic, given the examination and evaluation findings. Optimal outcomes for
patients/clients in this pattern include:
Functional Limitation/Disability
* Consequences of falls are reduced.
* Health-related quality of life is enhanced.
* Optimal role function (eg, worker, student, spouse, grandparent) is maintained.
* Self-care and home management activities, including activities of daily living (ADL) -- and work
(job/school/play) and leisure activities, including instrumental activities of daily living (IADL) -- are
performed safely, efficiently, and at a maximal level of independence with or without devices and
equipment.
* Understanding of personal and environmental factors that promote optimal health status is
demonstrated.
* Understanding of prevention strategies is demonstrated.
Client Satisfaction
* Access, availability, and services provided are acceptable to client.
* Administrative management of practice is acceptable to client.
* Clinical proficiency of physical therapist is acceptable to client.
* Coordination and conformity of care are acceptable to client.
* Interpersonal skills of physical therapist are acceptable to client, family, and significant others.
Criteria for Discharge
Discharge is the process of discontinuing interventions that are being provided in a single episode
of care. Discharge occurs based on the physical therapist's analysis of the achievement of
anticipated goals (remediation of impairment, or loss or abnormality of physiological,
psychological, or anatomical structure or function) and desired outcomes (described above). In
consultation with appropriate individuals, the physical therapist plans for discharge and provides
for appropriate follow-up or referral. The primary criterion for discharge: The anticipated goals and
the desired outcomes have been achieved. Other indicators: patient/client, caregiver, or legal
guardian declines to continue intervention; patient/client is unable to continue to progress toward
goals because of medical or psychosocial complications; or the physical therapist determines that
the patient/client will no longer benefit from physical therapy. When discharge occurs prior to
achievement of goals and outcomes, patient/client status and the rationale for discontinuation are
documented. For patients/clients who require multiple episodes of care, periodic follow-up is
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needed over the fife span to ensure safety and effective adaptation following changes in physical
status, caregivers, environment, or task demands.
Primary Prevention/Risk Factor Reduction Strategies
Primary prevention is the prevention of disease in a susceptible or a potentially susceptible
population through specific strategies such as screening programs or through general health
promotion. Progression to pathology -- or from pathology or impairment to disability -- is not
inevitable. Physical therapist intervention can prevent impairment, functional limitation, or disability
by identifying disablement risk factors (eg, biological characteristics, demographic background,
lifestyle factors) and by buffering the disablement process with adaptive or supportive equipment,
an exercise program, education, or environmental modifications.
Identified Risk Factors for Disability
* Age
* Anthropometric characteristics (eg, excessive weight, leg-length discrepancy, body type)
* Attitude
* Design, equipment, or other barriers preventing optimal body mechanics or posture in home,
community, or work (job/school/play) environments
* Endocrine or hormonal status
* Habitual suboptimal body mechanics
* Lifestyle:
- fitness level or cardiopulmonary and musculoskeletal
deconditioning
- nutritional status (eg, calcium and vitamin D intake)
- physical activity level
- physical work job/school/play) demands
- psychosocial and socioeconomic stressors
- substance abuse (eg, smoking, alcohol, drugs)
* Medication history
* Muscle tightness or inflexibility (eg, hamstring muscles, hip flexors)
* Muscle weakness or imbalance (eg, trunk and hip muscles)
* Previous history of injury or surgery affecting spine, posture, or body mechanics
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* Systematic condition predisposing patient/client to spinal pain with radiculopathy

* Underlying spinal dysfunction (eg, postural dysfunction) in home, community, and work
(job/school/play) tasks and activities
* Community program evaluation and development
* Consultation (eg, work-site analysis, injury prevention, environmental and ergonomic
assessment)
* Lifestyle education and modification, including individual or group activities that highlight (1) the
relationship between risk factors (eg, substance abuse, physical activity and fitness level,
stressors, diet) and demineralization and (2) strategies to prevent demineralization
* Risk factor reduction through individual and group therapeutic exercise and symptom
management
* Screening programs (eg, scoliosis, athletic preparticipation, preemployment)
* Workplace, home, and community ergonomic analysis and modification
Impaired Posture
Patients/clients with functional limitation secondary to impaired posture with one or more of the
following:
* Associated muscle weakness or imbalance
* Associated pain
* Structural or functional deviation from normal posture
* Suboptimal joint mobility
* Appendicular postural deficits
* Cumulative effects of poor habitual posture in addition to poor work-related posture
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* Pregnancy-related postural changes

* Scoliosis or other excessive spinal curvature
* Neuromuscular disorders or disease (eg, spina bifida)
* Radicular signs
* Spinal stabilization (fusion or rodding), less than 1 year postsurgery
ICD-9-CM Codes
preferred practice pattern. Because die patient/client diagnostic group is defined by impairments
524 Dentofacial anomalies, including malocclusion
524.6 Temporomandibular joint disorders 718 Other derangement of joint
718.8 Other joint derangement, not elsewhere classified 719 Other and unspecified disorders of
joint
719.5 Stiffness of joint, not elsewhere classified
719.7 Difficulty in walking 722 Intervertebral disk disorders
722.4 Degeneration of cervical intervertebral disk
722.5 Degeneration of thoracic or lumbar intervertebral disk
722.6 Degeneration of intervertebral disk, site unspecified 723 Other disorders of cervical region
723.1 Cervicalgia 724 Other and unspecified disorders of back
724.2 Lumbago
Low back pain, low back syndrome, lumbalgia
724.9 Back disorders, other unspecified
Ankylosis of spine, not otherwise specified;
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compression of spinal nerve root, not elsewhere

classified; spinal disorders, not otherwise specified 728 Disorders of muscle, ligament, and fascia
728.2 Muscular wasting and disuse atrophy, not elsewhere classified
728.8 Other disorders of muscle, ligament, and fascia 729 Other disorders of soft tissues
729.9 Other and unspecified disorders of soft tissue 733 Other disorders of bone and cartilage
733.0 Osteoporosis 737 Curvature of spine
737.1 Kyphosis (acquired)
737.2 Lordosis (acquired)
737.3 Kyphoscoliosis and scoliosis 738 Other acquired deformity
738.4 Acquired spondylolisthesis 756 Other congenital musculoskeletal anomalies
756.1 Anomalies of spine 781 Symptoms involving nervous and musculoskeletal systems
781.2 Abnormality of gait
Gait: ataxic, paralytic, spastic, staggering
781.9 Other symptoms including nervous and musculoskelatal systems Abnormal posture
Examination
History
* Age
* Primary language
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* Race/ethnicity
* Sex
Social History
* Cultural beliefs and behaviors
* Family and caregiver resources
* Social interactions, social activities, and support systems
* Hand and foot dominance
* Developmental history
Living Environment
* Living environment and community characteristics
* Projected discharge destinations
* Concerns that led patient/client to seek the services of a physical therapist
* Concerns or needs of patient/client who requires the services of a physical therapist
* Current therapeutic interventions
* Mechanisms of injury or disease, including date of onset and course of events
* Onset and pattern of symptoms
* Patient/client, family, significant other, and caregiver expectations and goals for the therapeutic
intervention
* Patient/client, family, significant other, and caregiver perceptions of patient's/ client's emotional
response to the current clinical situation
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Medications
therapist
* Medications for other conditions
* Laboratory and diagnostic tests
* Review of available records
* Review of nutrition and hydration
* Prior therapeutic interventions
* Prior medications
* Cardiopulmonary
* Endocrine/metabolic
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
* Pregnancy, delivery, and postpartum
* Prior hospitalizations, surgeries, and preexisting medical and other health-related conditions
Family History
* General health perception
* Physical function (eg, mobility, sleep patterns, energy, fatigue)
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* Psychological function (eg, memory, reasoning ability, anxiety, depression, morale)

* Role function (eg, worker, student, spouse, grandparent)
* Social function (eg, social interaction, social activity, social support)
Social Habits (Past and Current)
* Behavioral health risks (eg, smoking, drug abuse)
* Level of physical fitness (self-care, home management, community, work [job/school/play], and
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
of device
Community and Work (Job/School/Play) Integration or Reintegration (Including IADL)
* Analysis of community, work (job/school/play), and leisure activities
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* Analysis of community, work (job/school/play), and leisure activities that are performed using
assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or equipment
* Assessment of physiologic responses during community, work (job/school/play), and leisure
activities
appropriate
* Review of reports provided by patient/client, family, significant others, caregivers, other health
care professionals, or other interested persons (eg, rehabilitation counselor, Workers'
appropriate
Ergonomics:
* Analysis of performance of selected tasks or activities
activities
* Ergonomic analysis of the work and its inherent tasks or
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activities, including:
- computer-assisted motion analysis during performance of
- selected movements or activities
- identification of sources of actual and potential trauma, cumulative trauma, or repetitive stress
- strength required in the work postures necessary to perform task or activity
* Videotape analysis of patient/client at work
Body mechanics:
* Computer-assisted motion analysis of the performance of selected movements or activities
activities
locomotion, and balance with and without the use of assistive, adaptive, orthotic, protective, or
supportive devices
or in water
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* Analysis of muscle strength, power, and endurance using manual muscle testing or
dynamometry
of device
* Analysis of practicality and ease of use of device
its use and care
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Pain
Posture
Reflex Integrity
appropriate
professionals
* Assessment of superficial sensations (eg, sharp/dull discrimination, temperature, light touch,
pressure) The physical therapist performs an evaluation (makes clinical judgments) for the
purpose of establishing the diagnosis and the prognosis. Factors that influence the complexity of
the evaluation include the clinical findings, extent of loss of function, social considerations, and
overall physical function and health status. A diagnosis is a label encompassing a cluster of signs
and symptoms, syndromes, or categories. It is the result of the diagnostic process, which includes
Page 23 of 234
reached at various intervals during the course of physical therapy. During the prognostic process,
Prognosis
Within 12 months, patient/client will demonstrate the ability to maintain preferred posture during
various activities (activities of daily living [ADL]; instrumental activities of daily living [IADL]; and
community, work, and leisure activities).
6 to 20
This range represents the lower and upper limits of the number of physical therapist visits required
to achieve anticipated goals and desired outcomes. It is anticipated that 80% of patients/clients in
this diagnostic group will achieve the goals and outcomes within 6 to 20 visits during a single
continuous episode of care. Frequency of visits and duration of the episode of care should be
determined by the physical therapist to maximize effectiveness of care and efficiency of service
delivery.
Factors That May Require New Episode of Care or That May Modify Frequency
of Visits/Duration of Episode
* Age
* Comorbidities
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Intervention
Anticipated Goals
professionals.
identified.
* Case management
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* Coordination of care with patient/client, family, significant others, caregivers, other health care
* Education plans
* Record reviews
Anticipated Goals
increased.
caregivers.
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* Risk of secondary, impairments is reduced.
Anticipated Goals
* Ability to perform physical tasks related to self-care, home management, community and work
(job/school/play) integration or reintegration, and leisure activities is increased.
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* Aquatic exercises
* Conditioning and reconditioning
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* Strengthening:
- active
- active assistive
- resistive, using manual resistance, pulleys, weights, hydraulics, elastic resistance bands,
robotics, and mechanical or electromechanical devices)
* Stretching
Functional Training in Self-Care and Home Management (Including ADL and
IADL)
Anticipated Goals
IADL) is increased.
* Safety is improved when performing self-care and home management tasks and activities.
activity, dressing, grooming, bathing, eating, and toileting)
Functional Training in Community and Work (Job/school/play) Integration or
Anticipated Goals
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* Safety is improved during performance of community and work (job/school/play) tasks and
activities.
* Environmental, community, work (job/school/play), or leisure task adaptation
* job coaching
* job simulation
Anticipated Goals
* Manual traction
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Prosthetic)
Anticipated Goals
* Adaptive devices or equipment (eg, raised toilet seats, seating systems, environmental controls)
* Assistive devices or equipment (eg, crutches, canes, walkers, wheelchairs, power devices, longhandled reachers, static and dynamic splints)
* Protective devices or equipment (eg, braces, protective taping, cushions, helmets)
* Supportive devices or equipment (eg, supportive taping, compression garment, corsets, slings,
Page 31 of 234
neck collars, serial casts, elastic wraps, oxygen)

Anticipated Goals
* Pain is decreased. joint integrity and mobility are improved.
* Biofeedback
Anticipated Goals
* Joint integrity and mobility are
* Risk of secondary impairments is
Physical agents:
* Cryotherapy (eg, cold pack, ice massage)
* Deep thermal modalities (eg, ultrasound, phonophoresis)
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Mechanical modalities:
Reexamination
The physical therapist relies on reexamination, the process of performing selected tests and
measures after the initial examination, to evaluate progress and to modify or redirect intervention.
Reexamination may be indicated more than once during a single episode of care. It also may be
performed over the course of a disease or a condition, which -- for some patient/client diagnostic
groups -- may be the life span. Indications for reexamination include new clinical findings or failure
to respond to intervention.
Outcomes
particular social context and physical environment),primary or secondary prevention, and
Functional Limitation/disability
* Health-related quality of life is improved.
* Optimal return to role function (eg, worker, student, spouse, grandparent) is achieved.
* Risk of disability associated with postural dysfunction is reduced.
* Safety of patient/client and caregivers is increased.
* Self-care and home management activities, including activities of daily living (ADL)--and work
job/school/play) and leisure activities, including instrumental activities of daily living (IADL) -- are
equipment.
demonstrated.
* Understanding of strategies to prevent further functional limitation and disability is demonstrated.
Patient/Client Satisfaction
* Access, availability, and services provided are acceptable to patient/client, family significant
others, and caregivers.
* Administrative management of practice is acceptable to patient/client, family, significant others,
and caregivers.
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* Clinical proficiency of physical therapist is acceptable to patient/client, family, significant others,

and caregivers.
* Coordination and conformity of care are acceptable to patient/client, family, significant others,
and caregivers.
* Interpersonal skills of physical therapist are acceptable to patient/client, family, significant others,
and caregivers.
Secondary Prevention
* Risk of functional decline is reduced.
* Risk of impairment or of impairment progression is reduced. Other secondary prevention
outcomes include:
* Need for additional physical therapist intervention is decreased.
* Patient/client adherence to the intervention program is maximized.
* Patient/client and caregivers are aware of the factors that may indicate need for reexamination
or a new episode of care, including changes in the following: caregiver status, community
adaptation, leisure activities, living environment, pathology or impairment that may affect function,
or home or work (job/school/play) settings.
* Professional recommendations are integrated into home, community, work (job/school/play), or
leisure environments.
needed over the life span to ensure safety and effective adaptation following changes in physical
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inevitable. Physical therapist intervention can prevent impairment, functional [imitation, or disability
* Age
* Age-related somatosensory changes
* Attitude
* Habitual suboptimal posture
* Inflexibility
* Lifestyle:
deconditioning
- physical activity level and demand
* Physical demands of work (job/school/play)
* Suboptimal particular extensibilty
* Community program evaluation and development (eg, retirement centers, senior centers,
assisted-living centers)
assessment)
stressors, diet) and posture and (2) strategies to prevent impaired posture
management
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* Screening programs (eg, school scoliosis screening program, programs identifying those with
postural dyscontrol tendencies)
Impaired Muscle Performance
Patients/clients with functional limitations secondary to impaired muscle performance.
* Cardiovascular insufficiency
* Disuse atrophy secondary to prolonged bed rest, congestive heart failure, chronic obstructive
pulmonary disease (COPD), pneumonia
* Dysfunction of the pelvic-floor musculature
* Muscle weakness due to immobilization or lack of activity
* Renal disease
* Vascular insufficiency,
* Amputation
* Primary capsular restriction
* Primary joint arthroplasty
* Primary localized inflammation
* Recent bony and surgical soft tissue procedures
* Recent fracture
* Upper and lower motor neuron disease
ICD-9-CM-Codes
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359 Muscular dystrophies and other myopathies 359.9 Myopathy, unspecified 410 Acute
myocardial infarction 428 Heart failure 428.0 Congestive heart failure 443 Other peripheral
vascular disease 482 Other bacterial pneumonia 492 Emphysema 492.8 Other emphysema 496
Chronic airway obstruction, not elsewhere classifed Chronic: obstructive pulmonary disease
(COPD), not otherwise specfied 618 Genital prolapse 618.8 Other specified genital prolapse
Incompetence or weakening of pelvic fundus; relaxation of vaginal outlet or pelvis 714
Rheumatoid arthritis and other inflammatory polyarthropathies 714.0 Rheumatoid arthritis 715
Osteoarthrosis and allied disorders 719 Other and unspecified disorders of joint 719.7 Difficulty in
walking 728 Disorders of muscle, ligament, and fascia 728.2 Muscular wasting and disuse
atrophy, not elsewhere classified 728.8 Other disorders of muscle, ligament, and fascia 728.85
Spasm of muscle 728.9 Unspecified disorder of muscle, ligament, and fascia 729 Other disorders
of soft tissues 729.1 Myalgia and myositis, unspecified 733 Other disorders of bone and cartilage
733.0 osteoporosis 733.1 Pathologic fracture 739 Nonallopathic lesions. not elsewhere classified
780 General symptoms 780.7 Malaise and fatigue 781 Symptoms involving nervous and
musculoskeletal systems 781.0 Abnormal involuntary movements 781.2 Abnormality of gait Gait
ataxic, paralytic, spastic, staggering 781.3 Lack of coordination Ataxia, not otherwise specified;
muscular incoordination 781.4 Transient paralysis of limb 781.9 Other symptoms involving
nervous and musculoskeletal systems Abnormal posture 786 Symptoms involving respiratory
system and other chest symptoms 786.0 Dyspnea and respiratory abnormalities 799 Other illdefined and unknown causes of morbidity and mortality 799.3 Debility, unspecified
Examination
History Data generated from the history may include:
* Age
* Primary language
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* Race/ethnicity
* Sex
Social History
Living Environment
intervention
* Patient/client, family, significant other, and caregiver perceptions of patient's/client's emotional
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Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
* Prior hospitalizations, surgeries, and
* preexisting medical and other health-related conditions
Family History
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leisure activities)
Systems Review The systems review may include:
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
Aerobic Capacity and Endurance * Assessment of autonomic responses to positional changes *
Assessment of perceived exertion, dyspnea, or angina during activity, using rating-of-perceivedexertion (RPE) scales, dyspnea scales, anginal pain scales, or visual analog scales Assessment
of performance during established exercise protocols eg, using treadmill, ergometer, 6- minute
walk test, 3-minute step test) * Assessment of standard vital signs (eg, blood pressure, heart rate,
respiratory rate) at rest and during and after activity
Anthropometric Characteristics * Assessment of activities and postures that aggravate or relieve
edema, lymphedema, or effusion * Assessment of edema through palpation and volume and girth
measurements (eg, during pregnancy, in determining the effects of other medical or health-related
conditions, during surgical procedures, after drug therapy) * Measurement of height, weight,
length, and girth * Observation and palpation of trunk, extremity, or body part at rest and during
and after activity
Assistive and Adaptive Devices * Analysis of effects and benefits (including energy conservation
and expenditure) while patient/client uses device * Analysis of the potential to remediate
impairment, functional limitation, or disability), through use of device Assessment of safety during
use of device * Review of reports provided by patient/client, family, significant others, caregivers,
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and other professionals concerning use of or need for device

Community and Work (Job/School/Play) Integration or Reintegration including IADL) * Analysis of
adaptive skills * Analysis of community, work (job/school/play), and leisure activities * Analysis of
community, work (job/school/play), and leisure activities that are performed using assistive,
adaptive, orthotic, protective, supportive, or prosthetic devices or equipment * Assessment of
autonomic responses to positional changes * Assessment of functional capacity * Assessment of
physiologic responses during community, work (job/school/play), and leisure activities *
Assessment of safety in community and work (job/school/play) environments * Review of daily
activities logs * Review of reports provided by patient/client, family, significant others, caregivers,
other health care professionals, or other interested persons (eg, rehabilitation counselor, Workers'
Environmental, Home, and Work (Job/School/Play) Barriers * Assessment of current and potential
barriers * Questionnaires completed by and interviews conducted with patient/client and others as
appropriate
Ergonomics: * Analysis of performance of selected tasks or activities * Analysis of preferred
postures during performance of tasks and activities * Assessment of dexterity and coordination *
Assessment of safety in community and work (job/school/play) environments * Assessment of
work (job/school/play) through batteries of tests * Assessment of workstation * Determination of
dynamic capabilities and limitations during specific work job/school/play) activities
Body mechanics: * Observation of performance of selected movements or activities
Gait, Locomotion, and Balance * Analysis of arthrokinematic, biomechanical, kinematic, and
kinetic characteristics of gait, locomotion, and balance with and without the use of assistive,
adaptive, orthotic, protective, supportive, or prosthetic devices or equipment * Assessment of
autonomic responses to positional changes * Assessment of safety
Joint integrity and Mobility * Analysis of the nature and quality of movement of the joint or body
part during the performance of specific movement tasks * Assessment of joint hypermobdity and
hypomobility * Assessment of pain and soreness
Muscle Performance including Strength, Power and Endurance) * Analysis of functional muscle
strength, power, and endurance * Analysis of muscle strength, power, and endurance using
manual muscle testing or dynamometry * Assessment of pain and soreness * Assessment of
pelvic-floor musculature * Electrophysiologic tests (eg, electromyography [EMG], nerve conduction
velocity [NCV)
Orthotic, Protective, and Supportive Devices * Analysis of appropriate components of device *
Analysis of effects and benefits (including energy conservation and expenditure) while
patient/client wears device * Analysis of the potential to remediate impairment, functional
limitation, or disability through use of device * Analysis of practicality and ease of use of device *
Assessment of alignment and fit of device and inspection of related changes in skin condition *
Assessment of patient/client or caregiver ability to put on and remove device and to understand its
use and care * Assessment of patient/client use of device * Assessment of safety during use of
device * Review of reports provided by patient/client, family, significant others, caregivers, or other
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Pain * Analysis of pain behavior and reaction during specific movements and provocation tests *
Assessment of muscle soreness * Assessment of pain and soreness with joint movement *
Assessment of pain using questionnaires, graphs, behavioral scales, symptom magnification
Posture * Analysis of resting posture in any position
Range of Motion (ROM) including Muscle Length) * Analysis of functional ROM * Analysis of
multisegmental movement * Analysis of ROM using goniometers, tape measures, flexible rulers,
inclinometers, photographic or electronic devices, or computer-assisted graphic imaging
Self-Care and Home Management (Including ADL and IADL) * Analysis of adaptive skills *
Analysis of environment and work (job/school/play) tasks * Analysis of self-care and home
management activities * Analysis of self-care and home management activities that are performed
using assistive, adaptive, orthotic, protective, and supportive devices and equipment *
Assessment of ability to transfer * Assessment of autonomic responses to positional changes *
Assessment of functional capacity * Assessment of physiologic responses during self-care and
home management activities * Questionnaires completed by and interviews conducted with
patient/client and others as appropriate * Review of daily activities logs * Review of reports
provided by patient/client, family, significant others, caregivers, or other professionals
Sensory integrity including Proprioception and Kinesthesia) * Assessment of deep (proprioceptive)
sensations (eg, movement sense or kinesthesia, position sense) * Assessment of superficial
sensations (eg, sharp/dull discrimination, temperature, fight touch, pressure)
Ventilation, Respiration (Gas Exchange), and Circulation * Analysis of thoracoabdominal
movements and breathing patterns at rest and during activity or exercise * Assessment of
activities that aggravate or relieve edema, pain, dyspnea, or other symptoms * Assessment of
chest wall mobility, expansion, and excursion * Assessment of perceived exertion and dyspnea *
Assessment of phonation * Assessment of standard vital signs (eg, blood pressure, heart rate,
respiratory rate) at rest and during and after activity * Assessment of ventilatory muscle strength,
power, and endurance * Palpation of chest wall (eg, tactile fremitus, pain, diaphragmatic motion)
establishing the diagnosis and the prognosis. Factors that influence the complexity of the
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Prognosis
Over the course of 2 to 10 months, patient/client will demonstrate a return to premorbid or highest
level of function.
service delivery.
Factors That May Require New Episode of Care or That May Modify
Frequency of Visits/Duration of Episode
* Ability to transfer instruction to motor learning * Accessibility of resources * Age * Availability of
resources * Caregiver (eg, family, home health aide) consistency or expertise * Chronicity or
severity of condition * Comorbidities * Level of patient/client adherence to the intervention program
* Preexisting systemic conditions or diseases * Psychosocial and socioeconomic stressors *
Support provided by family unit
Intervention
patients/clients, whereas a variety of direct interventions may be selected, applied, or modifed by
Anticipated Goals * Accountability for services is increased. * Available resources are maximally,
utilized. * Care is coordinated with patient/client, family, significant others, caregivers, and other
professionals. * Decision making is enhanced regarding tile health of patient/client and use of
health care resources by patient/client, family significant others, and caregivers. * Other health
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care interventions (eg, medications) that may affect goals and outcomes are identified. *
Patient/client, family, significant other, and caregiver understanding of expectations and goals and
outcomes is increased. * Placement needs are determined.
Specific interventions * Case management * Communication (direct or indirect) * Coordination of
care with patient/client, family, significant others, caregivers, other health care professionals, and
other interested persons eg, rehabilitation counselor, Workers' Compensation claims manager,
employer) * Discharge planning * Documentation of all elements of patient/client management *
Education plans * Patient care conferences * Record reviews * Referrals to other professionals or
resources
Patient/Client-related Instruction
Anticipated Goals * Ability to perform physical tasks is increased. * Awareness and use of
community resources are improved. * Behaviors that foster healthy habits. wellness, and
prevention are acquired. * Decision making is enhanced regarding health of patient/client and use
of health care resources by patient/client, family, significant others. and caregivers. * Disability
associated with acute or chronic illnesses is reduced. * Functional independence in activities of
daily living (ADL) and instrumental activities of daily living (IADL) is increased. * Intensity of care is
decreased. * Level of supervision required for task performance is decreased. * Patient/client,
family, significant other, and caregiver knowledge and awareness of the diagnosis, prognosis,
interventions, and goals and outcomes are increased. * Patient/client knowledge of personal and
environmental factors associated with the condition is increased. * Performance levels in
employment, recreational, or leisure activities are improved. * Physical function and health status
are improved. * Progress is enhanced through the participation of patient/client, family, significant
others, and caregivers. * Risk of recurrence of condition is reduced. * Risk of secondary
impairments is reduced. * Safety of patient/client, family. significant others, and caregivers is
improved. * Self-management of symptoms is improved. * Utilization and cost of health care
services are decreased.
Specific interventions * Computer-assisted instruction * Demonstration by patient/client or
caregivers in the appropriate environment * Periodic reexamination and reassessment of the
home program * Use of audiovisual aids for both teaching and home reference * Use of
demonstration and modeling for teaching * Verbal instruction * Written or pictorial instruction
Anticipated Goals
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* Pain decreased.
* Quality and quantity of movement between and across body segments are unproved.
* Aquatic exercises
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* Strengthening:
- active
- active assistive
robotics, and mechanical or electromechanical devices
* Stretching
Functional Training in Self-Care and Home-Management (Including ADL and
IADL)
Anticipated Goals
IADL) is increased.
* Performance of and independence m ADL and IADL are increased.
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Functional Training in Community and Work (Job/School/Play) Integration or
Reintegration (Including IADL, Work
Hardening, and Work Conditioning)
Anticipated Goals
reintegration and leisure tasks, movements, or activities is increased,
* Costs to work-related injury or disability are reduced.
* Safety is improved during performance of community and work tasks and activities.
* Tolerance to position
* Assistive and adaptive device and equipment training
* Job coaching
* Job simulation
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Prosthetic)
Anticipated Goals
* Overall independence is increased.
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* Assistive devices or equipment (eg, canes, crutches, walkers, wheelchairs, power devices, longhandled reachers, static and dynamic splints)
* Orthotic devices or equipment (eg, splits, braces, shoe inserts, casts)
* Protective devices or equipment (eg, braces, helmets, cushions, protective taping)
Anticipated Goals
* Edema, lymphedema, or lymphedema, is reduced.
* Soft tissue swelling, inflammation, and restriction are reduced.
* Biofeedback
Anticipated Goals
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* Complications from soft tissue and circulatory disorders are decreased.
* Edema, effusion, or lymphedema is reduced.
* Soft tissue swelling, inflammation, and restriction are reduced.
Physical agents:
* Cryotherapy (eg, cold packs, ice massage)
* Superficial thermal modalities (eg, heat, paraffin baths, hot packs, fluidotherapy) Mechanical
modalities:
* Compression therapies eg, vasopneumatic compression devices, compression bandaging,
compression garments, taping, total contact casting)
Reexamination
Outcomes
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* Health-related quality of fife is improved.
* Optimal return to role function (eg,
* worker, student, spouse, grandparent) is achieved.
* Risk of disability associated with muscle performance dysfunction is reduced.
equipment.
demonstrated.
* Access, availability, and services provided are acceptable to patient/client, family, significant
and caregivers.
and caregivers.
and caregivers.
and caregivers.
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outcomes include:
status,
Primary Prevention/risk Factor Reduction Strategies
* Age
* Attitude
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* Habitual suboptimal posture or body mechanics (eg, scapular retraction, forward-head position,
hyperextension of the knees)
* Lifestyle:
deconditioning
- physical work demands
* Musculotendinous tightness or inflexibitity (eg, Achilles tendon, hamstring muscles, pectoral
muscles)
* Musculotendinous weakness or imbalance (eg, quadriceps femoris. hamstring, rhomboid, lower
trapezius, pectoral muscles)
* Previous history. of injury or surgery affecting posture or body mechanics (eg, shoulder injury
resulting in forearm compensation, foot pain resulting in knee or hip compensation)
* Community program evaluation and development (eg, senior exercise programs, childbirth
education or pregnancy exercise program, youth activity programs)
assessment)
stressors, diet) and inflammatory conditions and (2) strategies to prevent these conditions
management
* Screening programs (eg, athletic preparticipation, preemployment)
Impaired Joint Mobility, Motor Function, Muscle Performance, and
Range of Motion Associated Wit Capsular Restriction
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Patients/clients with functional limitations as a primary result of capsular restriction following
prolonged joint immobilization. Patients/clients may have one or both of the following:
* Decreased range of motion
* Pain
* External supports or protective devices
* Protective muscle guarding
* Impaired reflex integrity or lack of voluntary movement
* Immobility as a primary result of prolonged bed rest
* Joint hemarthrosis, active sepsis, or deep vein thrombosis
* Traumatic wounds or burns not associated with prolonged immobilization
ICD-9-CM Codes
337 Disorders of the autonomic nervous system 337.2 Reflex sympathetic dystrophy 354
Mononeuritis of upper limb and mononeuritis multiplex 354.4 Causalgia of upper limb 524
Dentofacial anomalies, including malocclusion 524.6 Temporomandibular joint disorders 709
Other disorders of skin and subcutaneous tissue 709.2 Scar conditions and fibrosis of skin 714
Rheumatoid arthritis and other inflammatory polyarthropathies 714.0 Rheumatoid arthritis 715
Osteoarthrosis and allied disorders 716 Other and unspecified arthropathies 716.5 Unspecified
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polyarthropathy or polyarthritis 716.9 Arthropathy, unspecified

Inflammation of joint, not otherwise specified
718 Other derangement of joint 718.8 Other joint derangement, not elsewhere classified 719
Other and unspecified disorders of joint 719.7 Difficulty in walking 719.8 Other specified disorders
of joint Calcification of joint 726 Peripheral enthesopathies and allied syndromes 726.0 Adhesive
capsulitis of shoulder 726.1 Rotator cuff syndrome of shoulder and allied disorders 726.10
Disorders of bursae and tendons in shoulder region, unspecified 726.2 Other affections of
shoulder region, not elsewhere classified 726.9 Unspecified enthesopathy 726.90 Enthesopathy of
unspecified site
Tendinitis
727 Other disorders of synovium, tendon, and bursa 727.0 Synovitis and tenosynovitis 727.6
Rupture of tendon, nontraumatic 727.61 complete rupture of rotator cuff 727.8 Other disorders of
synovium, tendon, and bursa 727.91 Contracture of tendon (sheath) Short Achilles tendon
(acquired) 728 Disorders of muscle, ligament, and fascia 728.2 Muscular wasting and disuse
atrophy, not elsewhere classified 728.6 Contracture of palmar fascia Dupuytren's contracture
728.8 Other disorders of muscle, ligament, and fascia 728.85 Spasm of muscle 729 Other
disorders of soft tissue 729.8 Other musculoskeletal symptoms referable to limbs 729.81 swelling
of limb 730 Osteomyelitis, periostitis and other infections involving bone 733 Other disorders of
bone and cartilage 733.1 Pathologic fracture 733.8 Malunion and nonunion of fractures 733.82
Nonunion of fracture 802 Fracture of face bones 805 Fracture of vertebral column without mention
of spinal cord injury 808 Fracture of pelvis 811 Fracture of scapula 812 Fracture of humerus 812.4
Lower end, closed
Distal end of bumerus, elbow
813 Fracture of radius and ulna 813.4 Lower end, closed 813.41 Colles'fracture 813.5 Lower end,
open 813.51 Colles'fracture 814 Fracture of carpal bone(s) 814.0 Closed 815 Fracture of
metacarpal bone(s) 816 Fracture of one or more phalanges of hand 820 Fracture of neck of femur
821 Fracture of other and unspecified parts of femur 822 Fracture of patella 823 Fracture of tibia
and fibula 824 Fracture of woe 825 Fracture of one or more tarsal and metatarsal bones 840
Sprains and strains of shoulder and upper arm 840.4 Rotator cuff capsule) 879 Open wound of
other and unspecified sites, except limbs 998 Other complications of procedures, not elsewhere
classifed 998.5 Postoperative infection
Examination
(early, intermediate, late, return to activity); home, community, or work job/school/play) situation;
History
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* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Occupation/employment
Living Environment
* Patient/client, family, significant other, and caregiver expectations and goats for the therapeutic
intervention
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activities of daily living (ADL) and instrumental activities of daily living (ADL)
Medications
therapist
* Prior medications
Past Medical/surgical History
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
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* Level of physical fitness self-care, home management, community, work [job/school/play], and
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Communication, affect, cognition, lanquage, and learning style
Tests and Measures
of device
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* Review of reports provided by patient/client, significant others, family, caregivers, or other
* Videotape analysis of patient/client using device
activities
appropriate
appropriate
Ergonomics:
activities
or in water
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dynamometry
* Electrophysiologic tests (eg, electromyography [EMG])
of device
its use and care
Pain
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Posture
Reflex Integrity
appropriate
professionals
Sensory Integrity (Including Proprioception and Kinesthesia)
pressure)
that level. The prognosis also man, include a prediction of the improvement levels that may be
Page 61 of 234
Prognosis
Over the course of 4 months, patient/client will demonstrate a return to premorbid or highest level
of function.
6 to 36
delivery.
Factors That May Require New Episode of Care or That May Modify Frequency of Visits/Duration
of Episode
* Age
* Comorbidities
* Delayed healing
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Intervention
Anticipated Goals
professionals.
identified.
* Case management
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* Education plans
* Record reviews
Anticipated Goals
increased.
caregivers.
Page 64 of 234

Anticipated Goals
Page 65 of 234
* Aquatic exercises
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* Strengthening:
- active
- active assistive
* Stretching
IADL)
Anticipated Goals
IADL) is increased.
Functional Training in Community and Work Job/School/Play) integration or
Anticipated Goals
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* Safety is improved during performance of community, work (job/school/play), or leisure tasks
and activities.
* Environmental, community, work (job/school/play). or leisure task adaptation
management, driving car or using public transportation, structured play for infants and children,
* Job coaching
* Job simulation
* Organized functional training programs (eg. back schools, simulated environments and tasks)
Anticipated Goals
* Quality and quantity of movement between and across body segments is improved.
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* Manual traction
Prosthetic)
Anticipated Goals
Page 69 of 234

neck collars, serial casts, plastic wraps)
Anticipated Goals
* Biofeedback
* Iontophoresis
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Anticipated Goals
* Ability to perform movement tasks is increased:
* Complications resulting from soft tissue and circulatory disorders are decreased.
* Motor function (motor control and motor learning is improved.
* Soft tissue swelling, inflammation, restriction is reduced.
Physical agents:
* Cryotherapy (eg, cold pack, ice massage)
* Hydrotherapy (eg, whirlpool tanks, contrast baths, pulsatile lavage)
compressive garments, taping, total contact casting)
Reexamination
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Outcomes
manner), disability inability to engage in age-specific, gender-specific, or sex-specific roles in a
* Risk of disability associated with capsular restriction is reduced.
* Self-care and home management activities, including activities of daily living (ADL)-and work
performed safety, efficiently, and at a maximal level of independence with or without devices and
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
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* Risk of impairment or of impairment progression is reduced.
Other secondary prevention outcomes include:
or home or work job/school/play) settings.
status,
Prima prevention is the prevention of disease in a susceptible or a potentially susceptible
* Age
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* Attitude
* Cognitive status (eg, sufficient to understand risk reduction processes)
* Heredity
* Lifestyle:
- general physical condition
* Overly conservative medical management
* Pain tolerance
* Vascular integrity, including faster or slower metabolic or healing rates
education or pregnancy exercise program, youth activity programs)
assessment)
stressors, diet) and capsular restriction and (2) strategies to prevent related impairments.
management
Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated
With Ligament or Other Connective Tissue Disorders
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Patients/clients with functional limitation due to ligamentous sprain or musculotendinous strain.
Patients/clients may have any one or a combination of the following:
* Joint subluxation or dislocation
* Muscle guarding or weakness
* Swelling (edema) or effusion
* Ligamentous, cartilaginous, capsular, or fascial sprain
* Muscle and tendon strain
EXCLUDES patients with:
* Fractures
* Neurological dysfunction (upper motor neuron or lower motor neuron lesions)
* Open wounds and recent associated surgical procedures
* Radiculopathy, with or without spinal pain
ICD-9-CM Codes
524 Dentofacial anomalies, including malocclusion 524.6 Temporomandibular joint disorders
717 Internal derangement of knee 717.7 Chondromalacia of patella 717.8 Other internal
derangement of knee 717.9 Unspecified internal derangement of knee 718.8 Other joint
derangement, not elsewhere classified Instability of joint
718 Other derangement of joint
719 Other and unspecified disorders of joint
719.0 Effusion of joint 719.5 Stiffness of joint, not elsewhere classified
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724 Other and unspecified disorders of back 724.2 Lumbago Low, back pain, Low, back
syndrome, lumbalgia 724.3 Sciatica 724.9 Other unspecified back disorders Ankylosis of spine,
not otherwise specified; compression of spinal nerve root, not elsewhere classified; spinal disorder
not otherwise specified
726 Peripheral enthesopathies and allied syndromes 726.1 Rotator cuff syndrome of shoulder and
allied disorders
728 Disorders of muscle, ligament, and fascia 728.8 Other disorders of muscle, ligament, and
fascia 728.85 Spasm of muscle
729 Other an unspecified disorders of soft tissue 729.9 Other disorders of soft tissue Imbalance of
posture
830 Dislocation of jaw
831 Dislocation of shoulder
832 Dislocation of elbow
833 Dislocation of wrist
836 Dislocation of knee
837 Dislocation of ankle
838 Dislocation of foot
839 Other, multiple, and ill-defined dislocations 839.0 Cervical vertebra, closed 839.8 Multiple and
ill-defined, closed Arm;back; hand; multiple locations; except fingers or toes; other ill-defined
locations; unspecified location
840 Sprains and strains of shoulder and upper arm
841 Sprains and strains of elbow and forearm
842 Sprains and strains of wrist and hand
843 Sprains and strains of hip and thigh
844 Sprains and strains of knee and leg
845 Sprains and strains of ankle and foot
846 Sprains and strains of sacroiliac region
847 Sprains and strains of other and unspecified parts of back
848 Other and ill-defined sprains and strains 848.1 Jaw 848.3 Ribs 848.4 Sternum 848.5 Pelvis
Symphysis pubis
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Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 77 of 234

* Patient/client, family, significant other, and caregiver expectations and goals, for the therapeutic
intervention
Medications
therapist
* Prior medications
* Cardiopulmonary
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* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
* Level of physical fitness (self-care, home management, community, work (job/school/play], and
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary.
* Musculoskeletal
* Neuromuscular
Page 79 of 234

Tests and Measures
* Analysis of alignment and fit of device and inspection of related changes in skin condition
* Analysis of patient/client and caregiver ability to care for device
* Analysis of the potential to remediate impairment, functional limitation, or disability, through use
of device
* Review of reports provided by patient/client, family, significant others, caregivers, and other
Community and Work (Job/School/Play) integration or Reintegration (Including IADL)
activities
appropriate
Page 80 of 234

Ergonomics and Body Mechanics Ergonomics:
activities
* Ergonomic analysis of the work and its inherent tasks or activities, including:
- computer-assisted motion analysis of performance of selected movements or activities
Page 81 of 234

or in water
* Analysis of the nature and quality of movement of the joint or body part during the performance
of specific movement tasks
dynamometry
* Electrophysiologic tests (eg, electromyography [EMG])
* Analysis of the potential to remediate impairment, functional limitation. or disability through use
of device
its use and care
Page 82 of 234

Pain
* Assessment of activities and postures that aggravate or relieve pain or other disturbed
sensations
* Assessment of pain using questionnaires, graphs, behavioral scales. symptom magnification
Posture
appropriate
professionals
establishing diagnosis and the prognosis. Factors that influence the complexity of the evaluation
include the clinical findings, extent of loss of function, social considerations, and overall physical
function and health status. A diagnosis is a label encompassing a cluster of signs and symptoms,
Page 83 of 234
syndromes, or categories. It is the result of the diagnostic process, which includes evaluating,
organizing, and interpreting examination data. The prognosis is the determination of the optimal
level of improvement that might be attained and the amount of time required to reach that level.
The prognosis also may include a prediction of the improvement levels that may be reached at
various intervals during the course of physical therapy. During the prognostic process, the
physical therapist develops the plan of care, which specifies goals and outcomes, specific direct
interventions, the frequency of visits and duration of the episode of care required to achieve goals
Prognosis
Over the course of 2 weeks to 4 months, patient/client will demonstrate a return to premorbid or
highest level of function.
service delivery.
of Episode
* Age
* Comorbidities
Page 84 of 234

Intervention
Anticipated Goals
professionals.
identified.
* Case management
Page 85 of 234
* Education plans
* Record reviews
Anticipated Goals
increased.
caregivers.
Page 86 of 234

Direct interventions for this pattern may include, in order of preferred
usage:
Anticipated Goals
* Joint and soft tissue swelling, imflammation, or restriction is reduced.
* Level of supervision required for task performance is
* decreased.
Page 87 of 234
* Motor function (motor control and motor learning) is, improved.

* Risk of recurrence of condition is reduced,
* Aquatic exercises
Page 88 of 234

* Strengthening:
- active
- active assistive
hydraulics, elastic resistance, robotics, and mechanical or
electromechanical devices
* Stretching
IADL)
Anticipated Goals
IADL) is increased.
* Safety is improved during performance of self-care and home management task and activities.
* Assistive and adaptive device training
* Orthotic, protective, and supportive device training Direct interventions continued
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Anticipated Goals
* Cost of work-related injury or disability is reduced,
* Safety is improved during performance of community, work (job/school/play), and leisure tasks
and activities.
* Job coaching
* Job simulation
Anticipated Goals
* Ability to perform movement task is increased.
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* Manual traction
Prescription, Application, and, as Appropriate, Fabrication of Devices
and Equipment (Assistive, Adaptive, Orthotic, Protective, Supportive, and
Prosthetic)
Anticipated Goals
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* Orthotic devices or equipment (eg, splints, braces, shoe inserts, cushions, casts)
* Protective devices or equipment (eg, braces, helmets, protective taping)
neck collars,. serial casts, elastic wraps)
Anticipated Goals
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* Biofeedback
* Iontophoresis
Anticipated Goals
Specific Direct interventions Physical agents:
* (Cryotherapy (eg, cold packs, ice massage)
Page 93 of 234
Reexamination
groups -- may be the fife span. Indications for reexamination include new clinical findings or failure
Outcomes
* Risk of disability associated with ligament or other connective tissue disorders is reduced.
equipment.
demonstrated.
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* Access, availability, and services provide are acceptable to patient/client, family, significant
and caregivers.
and caregivers.
and caregivers.
and caregivers.
outcomes include:
Page 95 of 234
* Age
* Attitude
* Design, equipment, or other barriers preventing optimal body mechanics or posture underlying
spinal dysfunction (eg, postural dysfunction) in home, community, or work (job/school/play)
environments.
* Lifestyle:
deconditioning
* Systemic condition predisposing patient/client to spinal pain with radiculopathy
Page 96 of 234
education or pregnancy exercise programs, youth activity programs)
assessment)
* Lifestyle education and modification through individual or group activities that highlight (1) the
relationship between risk factors (eg, smoking, substance abuse, physical activity and fitness
level, stressors, diet) and sprain and strain and (2) strategies to prevent or reduce these
conditions
management
Impaired Joint Mobility, Motor Function, Muscle Performance, and
Range of Motion Associated Wit Localized inflammation
Patient/client Diagnostic Group
Patients/clients with functional limitation and impairment secondary to protective tissue response
of the synovial joint and the periarticular connective tissue. Patients/clients may or may not have
additional contributing factors (eg, workstation and tool design, work rates, physical fitness level,
pregnancy, habitual posture) with one or more of the following:
* Edema
* Inflammation of periarticular connective tissue
* Muscle weakness or strain
* Neurovascular changes
* Pain
* Sensory changes
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* Bursitis
* Capsulitis
* Epicondylitis
* Fasciitis
* Osteoarthritis
* Synovitis
* Tendinitis
* Associated postsurgical procedures
* Deep vein thrombosis (DVT)
* Dislocations
* Fractures
* Hemarthrosis
* Open wounds
* Sepsis
* Systemic disease processes
ICD-9-CM Codes
274 Gout 274.0 Gouty arthropathy 350 Trigeminal nerve disorders 350.1 Trigeminal neuralgia 353
Nerve root and plexus disorders 353.0 Brachial plexus lesions
Thoracic outlet syndrome
354 Mononeuritis of upper limb and mononeuritis multiplex 354.0 Carpal tunnel syndrome 354.2
Lesion of ulnar nerve
Page 98 of 234
Cubital tunnel syndrome

355 Mononeuritis of lower limb, unspecified site 355.6 Lesion of plantar nerve
Morton's neuroma
524 Dentofacial anomalies, including malocclusion 524.6 Temporomandibular joint disorders 682
Other cellulitis and abscess 715 Osteoarthrosis and allied disorders 716 Other and unspecified
arthropathies 716.6 unspecified monoarthritis knee) 716.66 Lower leg 716.9 Arthropathy,
unspecified
Inflammation of joint
718 Other derangement of joint 718.8 Other joint derangement, not elsewhere classified
Instability of joint
719 Other and unspecified disorders of joint 719.0 Effusion of joint 719.2 Villonodular synovitis
720 Ankylosing spondylitis and other inflammatory spondylopathies 720.2 Sacroiliitis, not
elsewhere classified 722 intervertebral disk disorders 724 Other and unspecified disorders of back
724.0 spinal stenosis, other than cervical 724.2 Lumbago
726 Peripheral enthesopathies and allied syndromes 726.0 Adhesive capsulitis of shoulder 726.1
Rotator cuff syndrome of shoulder and allied disorders 726.10 Disorders of bursae and tendons in
shoulder region, unspecified 726.2 Other affections of shoulder region, not elsewhere classified
726.3 Enthesopathy of elbow region 726.31 Medial epicondylitis 726.32 Lateral epicondylitis 726.5
Enthesopathy of hip region
Bursitis of hip
726.6 Enthesopathy of knee, unspecified
Bursitis of knee, not otherwise specified
726.9 Unspecified enthesopathy 726.90 Enthesopathy of unspecified site Tendinitis, not otherwise
specified 727 Other disorders of synovium, tendon, and bursa 727.0 Synovitis and tenosynovitis
727.04 Radial styloid tenosynovitis
de Quervain's disease
727.6 Rupture of tendon, nontraumatic 727.61 complete rupture of rotator cuff 727.9 Unspecified
disorder of synovium, tendon, and bursa 728 Disorders of muscle, ligament, and fascia 728.9
Unspecified disorder of muscle, ligament, and fascia 729 Other disorders of soft tissues 729.1
Myalgia and myositis, unspecified 729.2 Neuralgia, neuritis and radiculitis, unspecified 729.4
Fasciitis, unspecified 732 Osteochondropathies 732.9 Unspecified osteochondropathy 840
Sprains and strains of shoulder and upper arm 840.4 Rotator cuff capsule) 923 Contusion of
upper limb 924 Contusion of lower limb and other unspecified sites
Examination
Page 99 of 234
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
* Developmental History
Living Environment
Page 100 of 234

intervention
response to the current rent clinical situation
Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
Page 101 of 234
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
* Prior hospitalizations, surgeries, and preexisting medical and other health related conditions
Family History
* Physical function (eg, mobility, sleep
* patterns, energy, fatigue)
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Page 102 of 234

Tests and Measures
ergometer, 6- minute walk test, 3-minute step test)
of device
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* Review of daffy activities logs
Ergonomics:
* Computer-assisted motion analysis of patient/client at work (job/school/play)
* Determination of dynamic capabilities and limitations during specific work job/school/play)
activities
- computer-assisted motion analysis of patient/client during performance of selected movements
or activities
- identification of sources of actual or potential trauma, cumulative trauma, and repetitive stress
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- joint range of motion (ROM) used to performing task or activity

* Videotape analysis of patient/client at work Body mechanics:
* Determination of dynamic capabilities and limitations during specific work activities
or in water
For skin associated with integumentary disruption:
* Assessment of soft tissue swelling, inflammation or restriction.
Page 105 of 234
dynamometry
of device
its use and care
Pain
Posture
lines, still photography, video-tape, or visual analysis
Page 106 of 234

* Analysis of ROM using a goniometer, tape measure, flexible ruler, inclinometer, photographic or
electronic devices, or computer-assisted graphic imaging
* Assessment of muscle, joint, and soft tissue characteristics
Reflex Integrity
Self-care and Home Management including ADL and IADL)
pressure)
high intensity of intervention to a longer episode with a intensity of intervention. Frequency and
duration may vary greatly among patients/clients based on a variety of factors that the physical
therapist considers throughout the evaluation process, such as chronicity and severity of the
problem; stability of the condition; preexisting systemic conditions or diseases; probability of
Prognosis
1. Over the course of 8 to 16 weeks, patient/client with demonstrate a return to premorbid or
highest level of function.
Page 107 of 234
Expected Range of Number of

Visits Per Epis-ode of Care
6 to 24
this diagnostic group of achieve the goals and outcomes within 6 to 24 visits during a single
delivery.
Factors That May Require
New Episode of Care or
That May Modify Frequency of
Visits/Duration of Episode
* Age
* Associated medical interventions (eg, injections, medications, tests)
* Comorbidities
* Ongoing aggravating risk factors (eg,
* repetititve motion)
* Premorbid condition
Page 108 of 234
Intervention
Anticipated Goals
professionals.
* Decision making is enhanced regarding the health of Patient/client and use of health care
* Other health care interventions (eg medications) that may affect goals and outcomes are
identified.
* Case management
Page 109 of 234
* Education plans
* Record reviews
Anticipated Goals
* Behaviors that foster healthy habits, wellness and prevention are acquired.
by patient/client, family, significant others, and caregivers
* Disability associated with acute or chronic illness is reduced.
* Level of supervision required for task performance is de
* Patient/client, family, required,and caregiver knowledge and awareness of the diagnosis,
increased.
* Performance levels in employment, recreational, or leisure activities are improved
* Progress is enhanced through die participation of patient/client, others, and caregivers.
Page 110 of 234

Anticipated Goals
* Need for assistive, adaptive, orthotic, protective, or supportive devices is decreased.
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* Aquatic exercises
* Strengthening: - active - active assistive - resistive, using manual resistance, pulleys, weights,
hydraulics, elastic resistance bands, robotics, and mechanical or electromechanical devices
* Stretching
Page 112 of 234
IADL)
Anticipated Goals
IADL) is increased.
Functional Training in Community and Work Job/School/Play) integration
or Reintegration (Including IADL, Work Hardening, and Work Conditioning)
Anticipated Goals
* Performance of and independence in IADL is increased.
and activities.
Page 113 of 234

* Job coaching
* Job simulation
Anticipated Goals
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* Joint mobilization or manipulation

* Manual traction
and Equipment (Assistive, Adaptive, Orthotic, Protective, Supportive, and
Prosthetic)
Anticipated Goals
* Motor function (motor control and motor learning) is increased.
Page 115 of 234

Anticipated Goals
Page 116 of 234

* Iontophoresis
Anticipated Goals
Physical agents:
* Hydrotherapy (eg, whirlpool tanks, contrast baths)
* Superficial thermotherapy (eg, heat, paraffin baths, hot packs, fluidotherapy)
Page 117 of 234

Reexamination
Outcomes
* Risk of disability associated with localized inflammation is reduced.
equipment.
demonstrated.
Page 118 of 234

and caregivers.
and caregivers.
and caregivers.
and caregivers.
Page 119 of 234

* Age
* Attitude
* Habitual suboptimal posture or body mechanics (eg, scapular retraction, forward-head position,
hyperextension of the knees)
* Lifestyle:
- fitness level or cardiopulmonary and musculoskeletal deconditioning
* Musculotendinous tightness or inflexibility (eg, Achilles tendon, hamstring muscles, pectoral
muscles)
* Musculotendinous weakness or imbalance (eg, quadriceps femoris, hamstring, rhomboid, lower
trapezius, pectoral muscles)
* Previous history of injury or surgery affecting posture or body mechanics (eg, shoulder injury
resulting in forearm compensation, foot pain resulting in knee or hip compensation)
* Community program evaluation and development (eg. senior exercise programs, childbirth
Page 120 of 234
assessment)
* Lifestyle education and modification through individual or group activities that (1) highlight the
level, stressors) and inflammatory conditions and (2) strategies to prevent or reduce these
conditions.
management
* Screening programs (eg, scoliosis, athletic preparticipation, pre-employment)
Impaired Joint Mobility, Motor Function, Muscle Performance, Range of
Motion, or Reflex Integrity Secondary to Spinal Disorders
Patients/clients with functional limitations secondary to spinal impairment with or without
radiculopathy. Patients/clients may have any one or a combination of the following:
* Altered sensation
* Deep tendon reflex changes
* Muscle weakness
* Positive neural tension tests
* Associated surgical procedures
* Cervical, thoracic, or lumbar disk herniation
* Disk disease
* Nerve root compression
* Spinal stenosis
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* Stable spondylolisthesis
* Failed surgical procedures
* Fractures or unstable spondylolisthesis
* Neuromuscular disease
* Referred pain with systemic condition
* Sepsis
* Systemic condition (eg, ankylosing spondylitis, Scheurmann's disease, juvenile rheumatoid
arthritis, Reiter's disease)
* Traumatic spinal cord injury
* Tumor
ICD-9-CM Codes
even though the codes man not apply to them.
353 Nerve root and plexus disorders 715 Osteoarthrosis and allied disorders 716 Other an
unspecified arthropathies
716.9 Arthropathy, unspecified Inflammation of joint, not otherwise specified 718 Other
derangement of joint
718.3 Recurrent dislocation of joints
718.9 Unspecified derangement of joint 719 Other and unspecified disorders of joint
719.2 Villonodular synovitis
719.8 Other specified disorders of joint Calcification of joint 720 Ankylosing spondylitis and other
inflammatory spondylopathies 721 Spondylosis and allied disorders
721.1 Cervical spondylosis with myelopathy
721.4 Thoracic or lumbar spondylosis with myelopathy 722 Intervertebral disk disorders
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722.7 Intervertebral disk disorder with myelopathy

722.71 Cervical region
722.8 Postlaminectomy syndrome 723 Other disorders of cervical region
723.0 Spinal stenosis other than cervical 724 Other and unspecified disorders of back
724.0 Spinal stenosis, unspecified region
724.00 Spinal stenosis, unspecified region
724.2 Lumbago
724.9 Other unspecified back disorders 727 Other disorders of synovium, tendon, and bursa
727.0 Synovitis and tenosynovitis 728 Disorders of muscle, ligament, and fascia
728.2 Muscular wasting and disuse atrophy, not elsewhere classified
728.8 Other disorders of muscle, ligament, and fascia
728.85 Spasm of muscle
728.9 Unspecified disorder of muscle, ligament, and fascia 733 Other disorders of bone and
cartilage
733.0 Osteoporosis 738 Other acquired deformity
738.4 Acquired spondylolisthesis 756 Other congenital musculoskeletal anomalies
756.1 Anomalies of spine
756.12 Spondylolisthesis 846 Sprains and strains of sacroiliac region
846.0 Lumbosacral (joint) (ligament) 847 Sprains and strains of other and unspecified parts of
back
847.0 Neck 922 Contusion of trunk
922.3 Back
922.31 Back
922.32 Buttock
922.33 Interscapular region
Page 123 of 234
Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 124 of 234

intervention
Medications
therapist
* Prior medications
* Cardiopulmonary
Page 125 of 234
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
Social Habits Post and Current)
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
Page 126 of 234
* Neuromuscular
Tests and Measures
ergometer, 6-minute walk test, 3-minute step test)
of device
* Analysis of community, work (Job/school/play), and leisure activities that are performed using
activities
Page 127 of 234
appropriate
activities
* Endurance required to perform aerobic endurance activities
- assessment of joint range of motion (ROM) used to perform task or activity
- assessment of postures required to perform task or activity
- assessment of strength required in the work postures necessary to perform task or activity
- computer-assisted motion analysis during performance of selected movements or activities
Page 128 of 234
* Functional capacity evaluation, including assessment of:
- joint ROM used to perform task or activity
Body mechanics:
* Gait, locomotion, and balance profiles
* Assessment of sprain
Page 129 of 234

dynamometry
* Electrophysiologic tests (eg, electromyography [EMG], nerve conduction velocity [NCV])
Neuromotor Development and Sensory integration
* Assessment of dexterity, agility, and coordination
* Analysis of ability to care for device independently
of device
its use and care
Pain
Page 130 of 234

Posture
Reflex integrity
* Assessment of pathological reflexes (eg, Babinski's reflex)
Self-Care and Home Management including ADL and IADL)
* Analysis of environment
adaptive, orthotic, protective, or supportive devices and equipment
appropriate
professionals
Page 131 of 234

sense)
pressure)
Prognosis
level of function and integration or reintegration into home, community, work, or leisure activities
safely and efficiently.
8 to 24
delivery.
Page 132 of 234
* Ability to obtain job reclassification or redesign, including job or home
* Age
* Comorbidities
* Previous history of spine injury or surgery
Intervention
anticipated goals (remediation of impairment) and desired outcomes remediation of functional
prognosis for a specific patient/client.
Anticipated Goals
Page 133 of 234
professionals.
identified.
* Case management
* Education plans
* Record reviews
Anticipated Goals
Page 134 of 234
increased.
caregivers.
Page 135 of 234

Anticipated Goals
* Postoperative complications are reduced.
* Aquatic exercises
* Strengthening
- active
- active assistive
* Stretching
IADL)
Page 136 of 234
Anticipated Goals
IADL) is increased.
Anticipated Goals
reintegration and leisure tasks, movements, or activities increased.
and activities
Page 137 of 234

* Job coaching
* Job simulation
Anticipated Goals
* Soft tissue swelling, inflammation, or restriction is reduced,
Page 138 of 234

* Manual traction
* Soft tissue mobilization or manipulation
* Therapeutic massage Prescription, Application, and, as Appropriate, Fabrication of Devices and
Equipment (Assistive, Adaptive, Orthotic, Protective, Supportive, and Prosthetic)
Anticipated Goals
* Gait, locomotion and balance are improved. joint stability is increased.
* Performance of and independence ADL and IADL are increased.
Page 139 of 234
* Adaptive devices or equipment (eg, raised toilet seats, seating systems. environmental controls)
* Orthotic devices or equipment (eg, splints, braces, shoe inserts. casts)
* Protective devices or equipment (eg, braces. protective taping, cushions, helmets)
neck collars, serial casts, elastic wraps)
Anticipated Goals
* Ability to perform physical tasks is increased,
* Biofeedback
* Iontophoresis
Page 140 of 234

Anticipated Goals
* Ability to perform movement tasks is increased
* Edema, lymphedema, or effusion is reduced
* Joint integrity and mobility is improved.
* Tolerance to positions and activities is increased
Physical agents:
* Hydrotherapy (eg, whirlpool tanks, contrast baths, pulsatile lavage)
Reexamination
The physical therapist relies on reexamination, the process of performing of selected tests and
Reexamination may be indicated more than once during a single episode of care. It also man be
Outcomes
Outcomes relate to functional limitation (restriction of the ability to perform. at the level of the
Page 141 of 234
manner), disability, (inability to engage in age-specific. gender-specific, or sex-specific roles in a

particular social context and physical environment), primary, or secondary, prevention, and
* Risk of disability associated with spinal disorders is reduced.
equipment.
demonstrated.
and caregivers.
and caregivers,
* Coordination and conformity of care are acceptable to patient/client, family significant others,
and caregivers.
and caregivers.
Page 142 of 234

* Professional recommendations are integrated into home, community work (job/school/play), or
promotion. Progression to pathology -- or from pathology impairment to disability -- is not
lifestyle, factors) and by buffering the disablement process with adaptive or supportive equipment,
* Age
* Anthropometric characteristics (eg, excessive weight. leg-length discrepancy, body, type)
* Attitude
* Design, equipment, or other barriers preventing optimal body mechanics or posture underlying
spinal dysfunction (eg, postural dysfunction) in community, home, or work (job/school/play)
environments
Page 143 of 234

* Systemic condition predisposing patient/client to spinal pain with radiculopathy
* Lifestyle:
education or pregnancy, exercise programs, youth activity programs)
assessment)
level, stressors) and spinal pain and (2) strategies to prevent or reduce pain
management
Impaired Joint Mobility, Muscle Performance, and Range of Motion
Associated With Fracture
variety of factors, such as individual patient/client needs: the profession's code of ethics and
Page 144 of 234

Patients/clients with functional limitations and impairments secondary to fracture.
INCLUDES patients with:
* Activity-induced hormonal changes
* Certain medications (eg, steroids)
* Known high risk (eg, based on sex, ethnicity, age, lifestyle, menstrual or hormonal changes
related to hysterectomy or menopause)
* Nutritional deficiency
* Traumatic injuries
* Bone neoplasms
* Osteogenesis imperfecta
* Paget's disease
ICD-9-CM Codes
715 Osteoarthrosis and related disorders 719 Other an unspecified disorders of joint
719.5 Stiffness of joint, not elsewhere classified
719.8 Other specified disorders of joint Calcification ofjoint 722 Intervetebral disk disorders 726
Peripheral enthesopathies and allied syndromes
726.2 Other affections of shoulder region, not elsewhere classified Periarthritis of shoulder
scapulohumeral fibrositis 728 Disorders of muscle, ligament. and fascia
728.2 Muscle wasting and disuse atrophy, not elsewhere classified 729 Other disorders of soft
tissues
Page 145 of 234
729.9 Other and unspecified disorders of soft tissue Imbalance of posture 732
Osteochondropathies
732.4 Juvenile osteochondrosis of lower extremity, excluding foot tibial tubercle (of Osgoodschlatter) 733 Other disorders of bone and cartilage
733.0 Osteoporosis
733.1 Pathologic fracture
733.8 Malunion and nonunion of fracture
733.82 Nonunion of fracture 736 Other acquired deformities of limbs
736.8 Acquired deformities of other parts of limbs
736.81 Unequal leg length (acquired) 781 Symptoms involving nervous and musculoskeletal
systems
781.2 Abnormality of gait Gait: ataxia, paralitic, spastic, staggering 802 Fracture of face bones 805
Fracture of vertebral column without mention of spinal cord injury 808 Fracture of pelvis 810
Fracture of clavicle 811 Fracture of scapula 812 Fracture of humerus 813 Fracture of radius and
ulna
813.4 Lower end, closed
813.41 Colles'fracture
813.5 Lower end, open
813.51 Colles'fracture 814 Fracture of carpal bone(s) 815 Fracture of metacarpal bone(s) 816
Fracture of one or more phalanges of hand 820 Fracture of neck of femur 821 Fracture of other
unspecified parts of femur 822 Fracture of patella 823 Fracture of tibia and fibula 824 Fracture of
ankle 825 Fracture of one or more tarsal or metatarsal bones 826 Fracture of one or more
phalanges of foot
Examination
Through the examination (history systems review, and tests and measures), the physical terapist
identifies impairments, functional limitations, disabilities, or changes in physical function and
health status resulting from injury, disease, or other causes to establish the diagnosis and the
severity of the problem: stage of recovery (acute, subacute, chronic); phase of rehabilitation
Page 146 of 234
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
* Mechanisms of injury or disease. including date of onset and course of events
intervention
* Patient/client, family significant other, and caregiver perceptions of patient's/ clients emotional
Page 147 of 234

Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
* Prior hospitalizations, surgeries, and preexisting medical and other healthrelated conditions
Family History
Page 148 of 234

* Level of physical fitness (self-care, home management.. community, work [job/school/play], and
leisure activities)
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Communications, affect, cognition, language, and learning style
Tests and Measures Tests and measures for this pattern may, include, in alphabetical order:
* Assessment of standard vital signs (eg. blood pressure, heart rate, respiratory. rate) at rest and
* Analysis of alignment and fit of device and inspection of related changes in skin condition
Page 149 of 234

* Analysis of effects and benefits (including energy, conservation and expenditure) while
* Analysis of patient/client or caregiver ability to care for device
of device
* Analysis of environment, work (job/school,play), and leisure activities
activities
appropriate
Environmental, Home, and Work Job/School/Play) Barriers
appropriate
Page 150 of 234

related to physical, functional, behavioral and vocational status
activities
- endurance required to perform aerobic endurance activities joint range of motion (ROM) used to
perform task or activity postures required to perform task or activity strength required in the work
postures necessary to perform task or activity
* Analysis of arthrokinematic, biomechanical, kinematc, and kinetic characteristics of gait,
or in water
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* Assessment of joint hypermoblility and hypomobility
* Analysis of effects and benefits (including energy, conservation and expenditure) while
of device
its use and care
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Pain
* Analysis of pain behavior and reaction during specific movements and and provocation tests
Posture
adaptive, orthotic, protective, supportive, or prosthetic devices and equipment
Page 153 of 234

appropriate
* Review of reports provided by patient/client, family significant others, caregivers, or other
professionals
sense)
pressure)
establishing the diagnosis and the prognosis. Factors that influence the complexity, of the
high intensity, of intervention to a longer episode with a diminishing intensity of intervention.
of the problem; stability of the condition: preexisting systemic conditions or diseases; probability of
prolonged impairment, functional limitation, or disability; multisite or multisystem involvement:
Intervention
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prognosis for a specific patient/client.

Prognosis
Postfracture, patient/client will minimize rate of bone loss or will increase bone mineral density and
will achieve highest level of function.
6 to 18
delivery.
of Episode
* Accessibility, of resources
* Age
* Comorbidities
Anticipated Goals
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professionals.
identified.
* Case management
* Education plans
* Record reviews
Anticipated Goals
Page 156 of 234
increased.
caregivers.
Anticipated Goals
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* Need for assistive, adaptive, orthotic, protective, or supportive devices or equipment is
decreased.
* Osteogenic effects of exercise are maximized,
* Performance of and independence ADL and IADL are increased.
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* Aquatic exercises
* Body, mechanics and ergonomics training
* Strengthening:
- active
- active assistive
* Stretching
IADL)
Anticipated Goals
IADL) is increased.
Page 159 of 234

activity, dressing, grooming, bathing. eating, and toileting)
management, driving a car of using public transportation, structured play for infants and children)
Functional Training in Community and Work (Job/School/Play) Integration or Reintegration
including IADL, Work Hardening, and Work Conditioning)
Anticipated Goals
* Prosthetic devices are used appropriately.
and activities
* Tolerance to positions and activities is increased,
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* Job coaching
* Job simulation
Anticipated Goals * Ability to perform movement tasks is increased. * Motor function (motor control
and motor learning) is improved. * Muscle spasm is reduced. * Pain is decreased. * Quality and
quantity of movement between and across body segments are improved. * Risk of secondary
impairments is reduced. * Soft tissue swelling, inflammation, or restriction is reduced. * Tolerance
to positions and activities is increased. * Ventilation, respiration (gas exchange), and circulation
are improved.
Specific Direct interventions * Connective tissue massage * Soft tissue mobilization and
manipulation * Therapeutic massage
Equipment (Assistive, Adaptive, Orthotic, Protective, Supportive,
and Prosthetic)
Anticipated Goals * Ability to perform physical tasks is increased. * Deformities are prevented. *
Gait, locomotion, and balance are improved. * Intensity of care is decreased. * Joint stability is
increased. * Edema, lymphedema, or effusion is reduced. * Level of supervision required for task
performance is decreased. * Loading on a body part is decreased, * Motor function (motor control
and motor learning) is improved. * Optimal joint alignment is increased. * Pain is decreased. *
Performance of and independence in ADL and IADL are increased.. * Physical function and health
status are improved. * Protection of body parts is increased. joint integrity and mobility are
improved. * Risk of secondary impairments is reduced. * Safety is improved. * Sense of well-being
is improved. * Soft tissue swelling, inflammation, or restriction is reduced. * Tolerance to positions
and activities is increased. * Utilization and cost of health care services are decreased. * Weightbearing status is improved.
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Specific Direct interventions * Adaptive devices or equipment (eg, raised toilet seats,. seating
systems, environmental controls) * Assistive devices or equipment (eg, crutches, canes, walkers,
wheelchairs, power devices, long-handled reachers, static and dynamic splints) * Orthotic devices
or equipment (eg, splints, braces, shoe inserts, casts) * Prosthetic devices or equipment (eg,
artificial limbs) * Protective devices or equipment (eg, braces, protective taping, cushions.
helmets) * Supportive devices or equipment (eg, supportive taping, compression garments,.
corsets, slings, neck collars, serial casts. elastic wraps, oxygen)
Anticipated Goals * Ability to perform physical tasks is increased. * Complications are reduced. *
Edema, lymphedema, or effusion is reduced. * Motor function (motor control and motor learning)
is improved. * Muscle performance is increased. * Pain is decreased. * Joint integrity and mobility
are improved. * Risk of secondary impairments is reduced. * Soft tissue swelling, inflammation, or
restriction is reduced. * Wound and soft tissue healing is enhanced.
Specific Direct interventions * Electrical muscle stimulation * Neuromuscular electrical stimulation
(NMES) * Transcutaneous electrical nerve stimulation (TENS)
Anticipated Goals * Ability to perform movement tasks is increased. * Complications of soft tissue
and circulatory disorders are decreased. * Edema, lymphedema, or effusion is reduced. * Motor
function (motor control and motor learning) is improved. * Muscle spasm is decreased. * Pain is
decreased. * Joint integrity and mobility are improved. * Risk of secondary impairments is
reduced. * Soft tissue swelling, inflammation, or restriction is reduced. * Tolerance to positions and
activities is increased.
Specific Direct Interventions Physical agents: * Cryotherapy (eg, cold packs, ice massage) * Deep
thermal modalities (eg, ultrasound, phonophoresis) * Hydrotherapy (eg, aquatic therapy, whirlpool
tanks, contrast baths, pulsatile lavage) * Superficial thermal modalities (eg, heat, paraffin baths,
hot packs, fluidotherapy)
Reexamination
Reexamination maybe indicated more than once during a single episode of care. It also may be
performed over the course of a disease or a condition, which-for some patient/client diagnostic
groups-may be the life span, Indications for reexamination include new clinical findings or failure
Outcomes
whole person, a physical action, activity, or task in an efficient, typically expected. or competent
then, are realistic, given the examination and evaluation findings. Optimal outcomes for
Page 162 of 234
Functional Limitation/Disability * Health-related quality of life is improved. Optimal return to role

function (eg, worker, student, spouse. grandparent) is achieved. * Risk of disability associated with
fracture is reduced. * Safety of patient/client and caregivers is increased. * Self-care and home
management activities, including activities of daily living (ADL)-and work (job/school/play) and
leisure activities, including instrumental activities of daily living (IADL) -- are performed safely,
efficiently, and at a maximal level of independence with or without devices and equipment. *
Understanding of personal and environmental factors that promote optimal health status is
demonstrated. * Understanding of strategies to prevent further functional limitation and disability is
demonstrated.
Patient/Client Satisfaction * Access, availability and services provided are acceptable to
patient/client, family 11/2-. significant others, and caregivers. * Administrative management of
practice is acceptable to patient/client, family significant others, and caregivers. * Interpersonal
skills of physical therapist is acceptable to patient/client, family, significant others, and caregivers.
and caregivers. * Interpersonal skills of physical therapist are acceptable to patient/client, family,
significant others. and caregivers.
Secondary Prevention * Risk of functional decline is reduced. * Risk of impairment or of
impairment progression is reduced.
Other secondary prevention outcomes include: * Need for additional physical therapist intervention
is decreased. * Patient/client adherence to the intervention program is maximized. * Patient/client
and caregivers are aware of the factors that ma,%. indicate need for reexamination or a new
episode of care, including changes in the following: caregiver status, community adaptation,
leisure activities, living environment, pathology or impairment that may affect function, or home or
work (job/school/play) settings. * Professional recommendations are integrated into home,
community, work (job/school/play), or leisure environments * Utilization and cost of health care
services are decreased.
psychological, or anatomical structure or function) and desired outcomes (described above). in
the desired outcomes have been achieved. Other indicators: patient/client, caregiver, legal
needed over the life span to ensure safety, and effective adaptation following changes in physical
status. caregivers. environment. or task demands.
promotion. Progression to pathology-or from pathology or impairment to disability-is not inevitable.
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Physical therapist intervention can prevent impairment, functional limitation, or disability by

identifying disablement risk factors (eg, biological characteristics, demographic background,
Identified Risk Factors for Disability * Age * Anthropometric characteristics (eg, excessive weight,
leg-length discrepancy, body type) * Attitude * Design. equipment, or other barriers preventing
optimal body mechanics or posture underlying spinal dysfunction (eg, postural dysfunction) in
home, community, or work job/school/play) environments * Endocrine or hormonal status *
Habitual suboptimal body mechanics * Lifestyle: - fitness level or cardiopulmonary and
musculoskeletal deconditioning - nutritional status (calcium and vitamin D intake) - physical
activity level - physical work demands - psychosocial and socioeconomic stressors - substance
abuse (eg, smoking, alcohol, drugs) * Medication history * Muscle tightness or inflexibility (eg,
hamstring muscles, hip flexors) * Muscle weakness or imbalance (eg, trunk and hip muscles) *
Systematic condition predisposing patient/client to spinal pain with radiculopathy
Primary Prevention/Risk Factor Reduction Strategies * Community program evaluation and
development (eg, senior exercise programs, childbirth education or pregnancy exercise programs,
youth activity programs) * Consultation (eg, work-site analysis, injury prevention, environmental
and ergonomic assessment) * Lifestyle education and modification through individual or group
activities that highlight (1) the relationship between risk factors (eg, smoking, substance abuse,
physical activity and fitness level, stressors) and fracture and (2) strategies to prevent or reduce
fracture * Risk factor reduction through individual and group therapeutic exercise and symptom
management * Screening programs (eg, scoliosis, athletic preparticipation, pre-employment) *
Workplace. home, and community ergonomic analysis and modification
Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of
Motion Associated with Joint Arthroplasty
Patients/clients with functional limitations secondary to joint arthroplasty with total or partial
resurfacing of the joint.
* Ankylosing spondylitis
* Bone tumor
* Juvenile rheumatoid arthritis
* Osteoarthritis
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* Paget's disease
* Rheumatoid arthritis
* Small joint (eg, interphalangeal) and large joint arthroplasties (eg, hip)
* Steroid-induced avascular necrosis
* Temporomandibular joint (TMJ) syndrome
* Trauma
* Unrelated postoperative complications during recovery or rehabilitation (eg, fall with fracture,
proximal or distal to prosthesis)
ICD-9-CM Codes
As of press time, the listing below, contains the most typical ICD-9-CM codes related to this
524 Dentofacial anomalies, including malocclusion 524.6 Temporomandibular joint disorders
524.60 Temporomandibular joint disorders, unspecified 714 Rheumatoid arthritis and other
inflammatory polyarthropathies 714.0 Rheumatoid arthritis 715 Osteoarthrosis and allied disorders
716 Other and unspecified arthropathies 716.8 Other specified arthropathy 717 Internal
derangement of knee 717.9 Unspecified internal derangement of knee 718 Other derangement of
joint 718.9 Unspecified derangement of joint 719 Other and unspecified disorders of joint 719.5
Stiffness of joint. not elsewhere classified 719.7 Difficulty in walking 719.8 Other specified
disorders of joint Calcification of joint 729 Other disorders of soft tissue 729.8 Other
musculoskeletal symptoms referable to limbs 730 Osteomyelitis, periostitis, and other infections
involving bone 731 Osteitis deformans and osteopathies associated with other disorders classified
elsewhere 731.0 Osteitis deformans without mention of bone tumor Paget's disease of bone 733
Other disorders of bone and cartilage 733.1 Pathologic fracture 733.8 Malunion and nonunion of
fracture 808 Fracture of pelvis 808.0 Acetabulum, closed 812 Fracture of humerus 812.0 Upper
end, closed 812.00 Upper end, unspecified part 820 Fracture of neck of femur 820.8 Unspecified
part of neck of femur, closed 820.9 Unspecified part of neck of femur, open 835 Dislocation of hip
836 Dislocation of knee 836.5 Other dislocation of knee, closed 837 Dislocation of ankle 958
Certain early complications of trauma 958.3 Posttraumatic wound infection, not elsewhere
classified
Examination
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Through the examination (history, systems review,. and tests and measures), the physical
(early, intermediate, late. return to activity); home, community, or work (job/school/play) situation;
History and System Review
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
* Hand and and foot dominance
Living Environment
* Projected discharge destination(s)
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* Concerns that led the individual to seek the services of a physical therapist
* Concerns or needs of the individual requiring the services of a physical therapist
* Mechanism(s) of injury or disease, including date of onset and course of events
* Patient/client, family, significant other, and caregiver perceptions of the patient's/client's
emotional response to the current clinical situation
intervention
* Current and prior functional status in self-care and home management, including activities of
daily living (ADL) and instrumental activities of daily living (IADL)
Medications
* Medications for current condition
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
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* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
* Level of physical fitness (self-care, home management. community, work [job/school/play], and
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Test and Measures
Page 168 of 234
pregnancy in determining the effects of other medical or health-related conditions during surgical
of device
activities
appropriate
Page 169 of 234

appropriate
Ergonomics and Body Mechanics Ergonomics :
* Analysis of preferred postures during performance of tasks and activities Body mechanics:
* Determination of dynamic capabilities and limitations during specific work, (job/school/play)
activities
or in water
* Analysis of muscle strength. power, and endurance using manual muscle testing or
dynamometry
Page 170 of 234

of device
its use and care
Pain
* Assessment of pain using questionnaires, graphs. behavioral scales, symptom magnification
Posture
* Analysis of static and dynamic postures, using computer-assisted imaging, posture grids. plumb
lines. still photograph), videotape, or visual analysis
Range of Motion (ROM) Including Muscle Length)
* Assessment of muscle. joint, or soft tissue characteristics
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Self-care and Home Management (Including ADL and IADL)

* Analysis of self-care and home management activities that are performed using assistive, using
assistive. adaptive, orthotic. protective, or supportive devices and equipment
appropriate
professionals
Ventilation (Gas Exchange), Respiration, and Circulation
during and after activity,
evaluating, organizing. and interpreting examination data. The prognosis is the determination of
Page 172 of 234
Prognosis
Within 6 months, patient/client who has no surgical or postsurgical complications will demonstrate
improvement in impairment, functional limitation, and disability as compared with premorbid
status.
service delivery.
of Episode
* Age
* Caregiver (eg, family, home health aides) expertise and consistency
* Chronic dislocation
* Comorbidities (eg, sepsis, hemarthroses, or surgical or postoperative complications)
* Degree of system involvement (eg, rheumatoid arthritis, Parkinson's disease)
* Multiple arthroplasties within the same period
* Revision arthroplasty
* Type of surgical technique used cement or cementless)
* Wearing-bearing status
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Intervention
Invention, is the purpose and skilled interaction of the physical therapist with the patient/client to
produce changes in the condition that are consistent with the diagnosis and prognosis. In the plan
of care physical therapist determines the degree to which intervention is likely to achieve
patients/clients, whereas a variety of direct interventions may, be selected, applied, or modifed by,
Anticipated Goals
professionals.
resources by patient/client, family. significant others, and caregivers.
* Other health care interventions (eg, medications) that may affect goats and outcomes are
identified.
* Case management
professionals, and other interested persons (eg, rehabilitation counselor Workers'
* Compensation claims manager, employer)
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* Education plans
* Record reviews
* Referral to other professionals or resources
Patient/client-related instruction
Anticipated Goals
* Behaviors that foster healthy habits, and prevention are acquired.
* Functional independence in activities of that living (ADL) and instrumental activities of daily living
(IKDL) is increased.
* Patient/client, family significant other, and caregiver knowledge and awareness of the diagnosis,
increased.
* Physical function and health status are improved
caregivers.
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* Self-management of symptoms is improved

Direct Intervention
Anticipated Goals
* Ability to perform tasks related to self-care, home arguments (job/school/play) integration or
reintegration and leisure activities is increased.
* Aerobic capacity is
* Endurance is
* Gait, locomotion, and balance are improved
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* Performance of and independence in ADL and IKDL are increased.
* Physical function and health status are improved,
* Postural control is improved
* Safety is improved
* Self-management of symptoms is improved
* Sense of is improved.
* Aquatic exercises
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* Strengthening: active
- active assistive
- hydraulics, elastic resistance bands, robotics, and mechanical or electromechanical devices
* Stretching
IADL)
Anticipated Goals
IADL) is increased.
* Perfomance of and independence in ADL and IADL are increased.
* Safety is improved during performance of self-care and home management tasks and activities,
* Self-care or home management task adaptation
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Anticipated Goals
* Ability to perform physical tasks related to community, work (job/school/play), and leisure
activities is increased.
and activities
management, driving a car or using public transportation, structured plan, for infants and children)
* Job coaching
* Job simulation
Page 179 of 234
Anticipated Goals
* Scar mobility is increased.
Prosthetic)
Anticipated Goals
Page 180 of 234

* Soft tissue swelling, inflammation, or restriction is reduced
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Anticipated Goals
* Soft tissue swelling, inflammation. or restriction is reduced.
* Biofeedback
Anticipated Goals
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Physical agents:
* Hydrotherapy (eg, aquatic therapy), whirlpool tanks, contrast baths, pulsatile lavage)
Reexamination
Outcomes
Outcomes relate functional limitation (restriction of the ability to perform, at the level of the whole
person, a physical action, activity, or task in an efficient, typically, expected, or competent
* Optimal return to role function (eg. worker, student, spouse, grandparent) is achieved.
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* Risk of disability associated with joint arthroplasty is reduced.

* Self-care and home management activities including activities of daily living (ADL) -- and work
(job/school/play) and leisure activities, including instrumental activities of daily living IADL) -- are
equipment.
demonstrated.
* Access, availability,, and services provided are acceptable to patient/client, family significant
and caregivers.
and caregivers.
and caregivers.
and caregivers.
* Risk of impairment or of impairment
* progression is reduced.
or a new episode of care, including changes in the following: caregiver status, community,
* Professional recommendations are integrated into home, community work job/school/play), or
Page 184 of 234
* Utilzation and cost of health care services are decreased.
anticipated goals (remediation of impairment, or loss or abnormality of physiological.
consultation with appropriate individuals. the physical therapist plans for discharge and provides
the desired outcomes have been achieved, Other indicators: patient/client, caregiver, or legal
documented. For patients/client who require multiple episodes of care, periodic follow-up is
Primary Prevention/Risk Factor Reduction
Primary prevention is the prevention of disease in a susceptible or a potentially, susceptible
Identified Risk Factor5 for Disability
* Age
* Anthropometric characteristics (eg, excessive weight, leg-length discrepancy, genu valgum,
femoral or tibial torsion, foot deformities)
* Attitude
community work (job/school/play), or leisure activity environments
* Habitual suboptimum body mechanics in in work and leisure activities and activities of daily living
(ADL)
* Heredity
* Systemic diseases (eg, rheumatoid arthritis)
* Lifestyle:
Page 185 of 234
- overuse or improper movement patterns that stress joints

- physical activity level (lack of regular exercise)
* Muscle tightness or inflexibility
* Muscle weakness or imbalance
* Previous history of joint trauma or surgery
assessment)
* Lifestyle education and modification through individual or group activities that highlight the
level, stressors) and joint arthroplasty, or arthritis
management
* Screening programs (eg, youth sports, elderly foot clinics, senior centers)
Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of
Motion Associated With Bony or Soft Tissue Surgical Procedures
variety, of factors, such as individual patient/client needs- the profession's code of ethics and
Patients/clients with functional limitations following bony or soft tissue surgical procedures
Page 186 of 234
* Abrasion arthroplasty, open reduction internal fixation (ORIF), fusions, osteotomies,

laminectomies, and tibial tuberosity procedures
* External fixators, rod procedures bony debridement, and multiple fractures
* Fascial release procedures, debridement, decompression, meniscal repair or removal, labral
repair, removal of synovium, or soft tissue realignment
* Hardware removal, bone graft, and bone-lengthening procedures
* Hip fracture with ORIF stabilization
* Muscle or tendon or ligament repair or reconstruction. capsular reconstruction, stabilization, or
reefing
* Amputation
* Amputation, associated peripheral nerve lesions, and closed head trauma
* Breast reconstructive procedures
* Joint resurfacing and abrasion: muscle tendon transfers
* Nonunion of fractures
* Obstetric and gynecological surgical procedures
* Vascular or neurologic sequelae, nerve compression, muscle-lengthening procedures,
hemarthrosis, deep vein thrombosis, or sepsis
* Total joint arthroplasties, closed reduction, neoplasms, and primary soft tissue procedures
ICD-9-CM Codes
As of press time, the listing below contains the most typical ICD-9- CM codes related to this
preferred practice pattern. Because the patient/client diagnostic group is defined by impairment
715 Osteoarthrosis and allied disorders 717 Internal derangement of knee 717.8 Other internal
derangement of knee 718 Other derangement of joint 718.0 Articular cartilage disorder 718.2
Pathological dislocation 718.3 Recurrent dislocation of joint 718.4 Contracture of joint 718.40 Site
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unspecified 718.5 Ankylosis of joint 718.9 Unspecified derangement of joint 719 Other and
unspecified disorders of joint 721 Spondylosis and allied disorders 722 Intervertebral disk
disorders 722.7 Intervertebral disk disorder with myelopathy 723 Other disorders of cervical region
724 Other and unspecified disorders of back 724.0 Spinal stenosis, other than cervical 724.00
Spinal stenosis, unspecified region 724.3 Sciatica 726 Peripheral enthesopathies and allied
disorders 726.0 Adhesive capsulitis of shoulder 726.1 Rotator cuff syndrome and allied disorders
726.12 Bicipital tenosynovitis 726.2 Other affections of shoulder, not elsewhere classified
Periarthritis of shoulder scapulohumeral fibrositis 726.9 Unspecified enthesopathy 727 Other
disorders of synovium, tendon, and bursa 727.0 Synovitis and tenosynovitis 727.1 Bunion 727.4
Ganglion and cyst of synonum, tendon, and bursa 727.6 Rupture of tendon, nontraumatic 727.61
Complete rupture of rotator cuff 728 Disorders of muscle, ligament, and fascia 728.6 Contracture
of palmar fascia Dupuytren's contracture 731 Osteitis deformans and osteopathies associated with
other disorders classified elsewhere 731.0 Osteitis deformans without mention of bone trauma
Paget's disease of bone 732 Osteochondropathies 732.4 Juvenile osteochondrosis of lower
extremity, excluding foot tibial tubercle (of Osgood-Schlatter) 732.9 Unspecified
osteochondropathy 733 Other disorders of bone and cartilage 733.1 Pathologic fracture
Spontaneous fracture 733.13 Pathologic fracture of vertebrae 733.8 Malunion and nonunion of
fracture 733.82 Nonunion of fracture 736 Other acquired deformities of limbs 736.8 Acquired
deformities of other parts of limbs 736.81 Unequal leg length (acquired) 737 Curvature of spine
738 Other acquired deformity 738.4 Acquired spondylolistheses 756 other congenital
musculoskeletal anomalies 756.1 Anomalies of spine 756.12 Spondylolisthesis 802 Fracture of
face bones 805 Fracture of vertebral column without mention of spinal cord injury 808 Fracture of
pelvis 810 Fracture of clavicle 811 Fracture of scapula 812 Fracture of humerus 813 Fracture of
radius and ulna 814 Fracture of metacarpal bones(s) 815 Fracture of metacarpal bone(s) 816
Fracture of one or more phalanges of hand 820 Fracture of neck of femur 821 Fracture of other
and unspecified parts of femur 822 Fracture of patella 823 Fracture of tibia and fibula 824 Fracture
of ankle 825 Fracture of one or more tarsal and metatarsal bones 826 Fracture of one or more
phalanges of foot 830 Dislocation of jaw 831 Dislocation of shoulder 832 Dislocation of elbow 833
Dislocation of wrist 834 Dislocation of finger 835 Dislocation of hip 836 Dislocation of knee 836.0
Tear of medial cartilage or meniscus of knee, current 836.1 Tear of lateral cartilage or meniscus of
knee, current 836.2 Other tear of cartilage or meniscus of knee, current 836.5 Other dislocation of
knee, closed 837 Dislocation of ankle 838 Dislocation of foot 839 Other, multiple, and ill-defined
dislocations 839.0 Cervical vertebra, closed 839.3 Thoracic and lumbar vertebra, open 839.8
Multiple and ill-defined, closed Arm; back; hand; multiple locations, except for fingers or toes alone
840 Sprains and strains of shoulder and upper arm 840.4 Rotator cuff (capsule) 841 Sprains and
strains of elbow and forearm 842 Sprains and strains of wrist and hand 843 Sprains and strains of
hip and thigh 844 Sprains and strains of knee and leg 845 Sprains and strains of ankle and foot
846 Sprains and strains of sacroiliac region 847 Sprains and strains of other and unspecified parts
of back 848 Other and ill-defined sprains and strains
Examination
(early, intermediate, late, return to activity home, community, or work (job/school/play) situation;
Page 188 of 234
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 189 of 234
intervention
Medications
therapist
* Prior medications
Post Medical/Surgical History
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Page 190 of 234
Family History
* Social function (eg, social interaction. social activity, social support)
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Test and Measures
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* Observation and palpation of trunk, extremity, or body part at rest and during and after activity
of device
* Analysis of environment, work (job/school/play), and leisure activities
activities
* Assessment of safety in community and work (job/school/play) environment
appropriate
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appropriate
* Assessment of work, hardening or work conditioning needs, including identification of needs
activities
- computer-assisted motion analysis of performance of
selected movements or activities
cumulative trauma. or repetitive stress
Page 193 of 234

- strength required in the work postures necessary to
perform task or activity
activities
* Videotape analysis of patient/client performing selected movements or activities
or in water
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* Assessment of motor control and motor learning
dynamometry
patient,/client wears device
of device
* Analysis of movement while patient,/client wears device, using computer-assisted graphic
imaging or videotape
its use and care
Pain
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Posture
Reflex Integrity
Self-Care and Home Management (including ADL and IADL)
appropriate
Page 196 of 234

professionals
Sensory Integrity Including Proprioception and Kinesthesia)
sense)
pressure)
establishing the diagnosis and the prognosis. Factors that influence the complexity, of the
Prognosis
level of function.
Page 197 of 234
service delivery.
of Episode
* Age
* Comorbidities
* Delayed healing
* Nonunion of fractures and bone-lengthening procedures
Intervention
Page 198 of 234

Anticipated Goals
professionals.
identified.
* Case management
professionals. and other interested persons (eg, rehabilitation counselor, Workers' Compensation
claims manager employer)
* Education plans
* Record reviews
Anticipated Goals
Page 199 of 234
living ML) is increased.
increased.
caregivers.
Page 200 of 234

Anticipated Goals
* Endurance is in
* Joint and soft tissue swelling, inflammation, or restriction is reduced,
*Level of supervision required for task performance is decreased.
*Motor function (motor control and motor learning) is improved.
* Need for assistive, adaptive, orthotic, protective, or supportive devices or equipment is
decreased.
Page 201 of 234

* Aquatic exercises
* Strengthening:
- active
- active assistive
* Stretching
IADL)
Anticipated Goals
Page 202 of 234
* Ability to perform physical tasks related to self-care and home management including ADL and
IADL) is increased.
* Orthotic, protective, and supportive device or equipment training
Functional Training in Community and Work (Job/School/Play) Integration
Anticipated Goals
and activities
Page 203 of 234

* Job coaching
* Job simulation
Anticipated Goals
* Manual traction
Page 204 of 234
Prosthetic)
Anticipated Goals
* Joint integrity, and mobility are improved.
* Stress precipitating injury are decreased.
Page 205 of 234

* Prosthetic devices or equipment (eg, braces, protective taping, cushions, helmets)
Anticipated Goals
* Biofeedback
* Iontophoresis
Page 206 of 234

Anticipated Goals
* Wound and soft tissue heating is enhanced.
Specific Direct Interventions Physical agents include:
Mechanical modalities include:
compression documents, taping, total contact casting)
Reexamination
Page 207 of 234
groups--may be the life span. Indications for reexamination include new clinical findings or failure
Outcomes
* Risk of disability associated with bony or soft tissue surgical procedures is reduced.
* Self-care and home management activities, including activities of daily living (ADL)-and work
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
Page 208 of 234
and caregivers.
Page 209 of 234

* Age
* Anthropometric characteristics
* Attitude
* Habitual suboptimum body mechanics in work (job/school/play) and leisure activities and
activities of daily living (ADL)
* Heredity
* Systemic diseases (eg, rheumatoid arthritis)
* Lifestyle:
- physical activity level (lack of regular exercise)
* Muscle tightness
* Muscle weakness
* Previous history of injury
* Community program evaluation and development (eg, senior exercise programs, youth activity
programs)
assessment)
level, stressors) and bone trauma and (2) strategies to prevent or reduce trauma or the
consequences of trauma
management
* Screening programs and sites (eg, scoliosis, athletic preparticipation, preemployment)
Page 210 of 234

Impaired Gait, Locomotion, and Balance and Impaired Motor
Function Secondary to Lower-Extremity Amputation
Patients/clients with functional limitations due to acute or longstanding lower extremity amputation.
* Gait deviations or other mobility problems associated with recent amputation or effects of aging
* Ill-fitting prosthesis or identified prosthetic needs
* Bilateral amputation
* Congenital amputation (prosthetic needs only) joint contracture proximal to amputation
* Need for postsurgical edema management
* Residual limb revision
* Wound care needs associated with surgical site
* Congenital amputation and a need for developmental therapy
* Ipsilateral hemiparesis
ICD-9-CM Codes
Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or to other ICD-9-CM)
Page 211 of 234
353 Nerve root and plexus disorders 353.6 Phantom limb (syndrome) 718 Other derangement of
joint 718.4 Contracture of joint 718.45 Pelvic region and thigh 718.46 Lower leg 719 Other and
unspecified disorders of joint 719.7 Difficulty in walking 755 Other congenital deformities of limb
755.3 Reduction deformities of lower limb 781 Symptoms involving nervous and musculoskeletal
systems 781.2 Abnormality of gait Gait: ataxic, paralytic, spastic, staggering 897 Traumatic
amputation of leg(s) (complete) (partial) 997 Complications affecting specified body systems, not
elsewhere classified 997.6 Amputation stump complication
Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Page 212 of 234

Living Environment
intervention
Medications
therapist
Page 213 of 234

* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
leisure activities)
Systems Review
Page 214 of 234

* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
* Observation of chest movements and breathing patterns with activity
* Screening for level of cognition (eg, to determine ability to process commands, to measure
safety awareness)
Page 215 of 234

of device
* Review of reports provided by patient/client, family, significant others, caregivers. or other
activities
appropriate
Page 216 of 234

appropriate
- analysis of repetition/work/rest cycling during task or
activity
- determination of dynamic capabilities and limitations during
specific work (job/school/play) activities
- identification of essential functions of the job task or
activity
- identification of sources of actual or potential trauma, cumulative
trauma, or repetitive stress
- joint range of motion (ROM) used to perform task or
activity
Page 217 of 234

activities
or in water
Integumentary integrity For wound:
Page 218 of 234

dynamometry
of device
Pain
* Assessment of pain and soreness with joint movements
Page 219 of 234
Posture
tines, still photography, videotape, or visual analysis
* Analysis of appropriate components of a prosthetic device
* Analysis of movement while patient/client wears device, using computer-assisted graphic
of device
* Analysis of the practicality and ease of use of device
* Assessment of residual limb or adjacent segment for range of motion (ROM), strength, skin
integrity, and edema
its use and care
professionals
Page 220 of 234
* Analysis of self-care in unfamiliar environments
* Assessment of self-care and home management activities
appropriate
sense)
pressure)
Page 221 of 234

Prognosis
Over the course of 6 months, patient/client will demonstrate a return to premorbid or highest level
of function in activities of daily living (ADL) and instrumental activities of daily living (IADL) and in
community, work, and leisure activities.
service delivery.
of Episode
* Age
* Comorbidities (eg, contralateral hemiplegia, deconditioning)
* Condition of contralateral leg
* Patient/client motivation and adherence to the intervention program
* Psychological factors
Page 222 of 234
* Psychological and socioeconomic stressors

* Wound healing complications (eg, infection drainage)
Intervention
Anticipated Goals
professionals.
identified.
* Case management
Page 223 of 234
* Education plans
* Record reviews
Anticipated Goals
* intensity of care is decreased.
* Patient/client, family), significant other, and caregiver knowledge and awareness of the
diagnosis, prognosis, interventions, and goals and outcomes are increased.
increased.
* Progress is enhanced through the participation of patient/client, family, significant others,
caregivers.
Page 224 of 234

* Computer-assisted instruction Demonstration by patient/client or caregivers in the appropriate
environment
Anticipated Goals
Page 225 of 234
* Need for assistive devices is decreased.

* Tolerance of positions and activities is increased.
* Aquatic exercises
Page 226 of 234

* Strengthening:
- active
- active assistive
* Stretching
IADL)
Anticipated Goals
IADL) is increased.
* ADL training (eg, bed mobility, and transfer training, gait training, locomotion, developmental
* Body mechanics training
Page 227 of 234
Reintegration including IADL, Work Hardening, and Work Conditioning)
Anticipated Goals
reintegration and leisure tasks. movements, or activities is increased.
* Performance of and independence in IADL is increased.
* Safety is improved during performance of community, work (job/school/play) and leisure tasks
and activities
* Environmental, community,, work (job/school/play), or leisure task adaptation
* Job coaching
* Job Simulation
* Leisure and plan. activity training
Page 228 of 234

Manual Therapy Techniques including Mobilization and Manipulation)
Anticipated Goals
* Soft tissue mobilization and manipulation (eg, myofascial release)
Prosthetic)
Anticipated Goals
Page 229 of 234

* Loading on a body, part is decreased,
Page 230 of 234
* Prosthetic devices or equipment (eg, artificial limbs)
Anticipated Goals
Anticipated Goals
Page 231 of 234

compressive garments, taping)
Reexamination
performed over the course of a disease or a condition, which--for some patient/client diagnostic
groups-may be the life span. Indications for reexamination include new clinical findings or failure
Outcomes
* Optional return to role function (eg, worker, student, spouse, grandparent) is achieved.
* Risk of disability associated with lower-extremity amputation is reduced. Safety of patient/client
and caregivers is increased.
Page 232 of 234
(job/school/play) and leisure activities, including instrumental activities of daily living (IADL)--are
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
* Other secondary prevention outcomes include:
Page 233 of 234
consultation with, appropriate individuals, the physical therapist plans for discharge and provides
* Age
* Attitude
* Decreased skin integrity
* Decreased vascular integrity
* Diabetes
* Environmental hazards in home, community, and work (job/school/play)
* Heredity
* Lifestyle:
* Quality of skin care
Page 234 of 234
* Previous history of limb amputation

* Community program evaluation and development (eg, senior exercise program,YMCA or YWCA
programs)
* Consultation (eg, senior centers) lifestyle education and modification through individual or group
activities that highlight (1) the relationship between risk factors (eg, smoking, substance abuse,
physical activity and fitness level, stressors) and amputation and (2) strategies to prevent
amputation
management
* Screening programs (eg, elderly foot care clinics, senior centers, skilled nursing facility screening
programs)
Source Citation:"Musculoskeletal." Physical Therapy 77.n11 (Nov 1997): 1229(138). Expanded


Page 1 of 145
Neuromuscular. (includes related information)(Preferred Practice Patterns)(Guide to

(79). (34048 words)
outcomes, and criteria for discharge. Pattern D, "Impaired Motor and Sensory Function Associated
With Peripheral Nerve Injury," also includes primary prevention/risk factor reduction strategies.
Patients/clients with functional limitations associated with impaired motor function associated with
congenital or acquired disorders of the central nervous system in infancy, childhood, and
adolescence. Patients/clients may have any one or a combination of the following:
* Impaired affect
* Impaired arousal and attention
* Impaired balance
* Impaired cognition
* Impaired expressive or receptive communication
* Impaired oromotor function
* Impaired respiratory function
* Skeletal deficits
Page 2 of 145

* Anoxia or hypoxia
* Birth trauma
* Brain anomalies
* Cerebral palsy
* Genetic syndromes that affect the central nervous system
* Hydrocephalus
* Infectious disease that affect the central nervous system (eg, meningitis, encephalitis)
* Intracranial neurosurgical procedures
* Meningocele
* Myelocele
* Myelocystoceles
* Myelodysplasia
* Myelomeningocele
* Prematurity
* Tethered cord
* Traumatic brain injury
* Tumor
* Amputation
* Coma
* Medical instability
* Multisystem trauma
* Spinal cord injury secondary to trauma
* Tumor
Page 3 of 145
ICD-9-CM Codes
036 Meningococcal infection
036.1 Meningococcal encephalitis 052 Chickenpox
052.0 Postvaricella encephalitis 055 Measles
055.0 Postmeasles encephalitis 056 Rubella
056.0 With neurological complications 072 Mumps
072.2 Mumps encephalitis 090 Congenital syphilis
090.4 Juvenile neurosyphilis 320 Bacterial meningitis
320.9 Meningitis due to unspecified bacterium 321 Meningitis due to other organisms
321.8 Meningititis due to other nonbacterial organisms classified elsewhere 322 Meningitis of
unspecified cause
322.9 Meningitis, unspecified 323 Encephalitis, myelitis, and encephalomyelitis
323.4 Other encephalitis due to infection classified elsewhere
323.5 Encephalitis following immunization procedures
323.6 Postinfectious encephalitis
323.8 Other causes of encephalitis
323.9 Unspecified cause of encephalitis 331 Other cerebral degenerations
331.3 Communicating hydrocephalus
331.4 Obstructive hydrocephalus 333 Other extrapyramidal disease and abnormal movement
disorders
333.7 Symptomatic torsion dystonia
Athetoid cerebral palsy [Vogt's disease]; double
Page 4 of 145
athetosis (syndrome) 343 Infantile cerebral palsy 345 Epilepsy

345.1 Generalized convulsive epilepsy
345.2 Petit mal status
345.3 Grand mal status
345.9 Epilepsy, unspecified 348 Other conditions of brain
348.1 Anoxic brain damage
348.3 Encephalopathy, unspecified 741 Spina bifida 742 Other congenital anomalies of nervous
system 756 Other congenital musculoskeletal anomalies
756.1 Anomalies of spine 765 Disorders relating to short gestation and unspecified low birthweight
767 Birth trauma
767.0 Subdural and cerebral hemorrhage
767.9 Birth trauma unspecified 768 Intrauterine hypoxia and birth asphyxia
768.5 Severe birth asphyxia
768.6 Mild or moderate birth asphyxia
768.9 Unspecified birth asphyxia in liveborn infant 771 Infections specific to the perinatal period
771.2 Other congenital infections
Congenital toxoplasmosis 780 General symptoms
780.3 Convulsions 799 Other ill-defined and unknown causes of morbidity and mortality
799.0 Asphyxia 800 Fracture of vault of skull 801 Fracture of base of skull 803 Other and
unqualified skull fractures 804 Multiple fractures involving skull or face with other bones 850
Concussion 851 Cerebral laceration and contusion 852 Subarachnoid, subdural, and extradural
hemorrhage following injury 853 Other and unspecified intracranial hemorrhage following injury
854 Intracranial injury of other and unspecified nature 994 Effects of other external causes
994.1 Drowning and nonfatal submersion
Examination
Page 5 of 145
General Demographics * Age * Primary language * Race/ethnicity, * Sex
Social History * Cultural beliefs and behaviors * Family and caregiver resources * Social
interactions, social activities, and support systems
Occupation/Employment * Current and prior community and work (job/school) activities
Growth and Development * Hand and foot dominance * Developmental history
Living Environment * Living environment and community characteristics * Projected discharge
destinations
History of Current Condition * Concerns that led patient/client to seek the services of a physical
therapist * Concerns or needs of patient/client who requires the services of a physical therapist *
Current therapeutic interventions * Mechanisms of injury or disease, including date of onset and
course of events * Onset and pattern of symptoms * Patient/client, family, significant other, and
caregiver expectations and goals for the therapeutic intervention * Patient/client, family, significant
other, and caregiver perceptions of patient's/ client's emotional response to the current clinical
situation
Functional Status and Activity Level * Current and prior functional status in self-care and home
management activities, including activities of daily living (ADL) and instrumental activities of daily
living (IADL)
Medications * Medications for current condition for which patient/client is seeking the services of a
physical therapist * Medications for other conditions
Other Tests and Measures * Laboratory and diagnostic tests * Review of available records *
Review of nutrition and hydration
Past History of Current Condition * Prior therapeutic interventions * Prior medications
Past Medical/Surgical History * Cardiopulmonary * Endocrine/metabolic
Gastrointestinal * Genitourinary * Integumentary * Musculoskeletal * Neuromuscular * Pregnancy,
delivery, and postpartum * Prior hospitalizations, surgeries, and preexisting medical and other
health-related conditions
Family History * Familial health risks
Health Status (Self-Report, Family Report, Caregiver Report) * General health perception *
Physical function (eg, mobility, sleep patterns, energy, fatigue) * Psychological function (eg,
memory, reasoning ability, anxiety, depression, morale) * Role function (eg, worker, student,
spouse, grandparent) * Social function (eg, social interaction, social activity, social support)
Page 6 of 145
Social Habits (Past and Current) * Behavioral health risks (eg, smoking, drug abuse) * Level of
physical fitness self-care, home management, community, work [job/school/play], and leisure
activities)
Physiologic and anatomic status * Cardiopulmonary * Integumentary * Musculoskeletal *
Neuromuscular
Tests and Measures Test and measures for this pattern may include:
Aerobic Capacity and Endurance * Assessment of autonomic responses to positional changes *
Assessment of performance during established exercise protocols (eg, treadmills, ergometers, 6minute walk test, 3-minute step test) * Assessment of perceived exertion, dyspnea, or angina
during activity using rating-of-perceived-exertion (RPE) scales, dyspnea scales, anginal pain
scales, or visual analog scales * Assessment of standard vital signs (eg, blood pressure, heart
rate, respiratory rate) at rest and during and after activity * Assessment of thoracoabdominal
movements and breathing patterns with activity * Tests and measures of pulmonary function and
ventilatory mechanics
Anthropometric Characteristics * Assessment of activities and postures that aggravate or relieve
edema, lymphedema, or effusion * Assessment of edema through palpation and volume and girth
measurements (eg, during pregnancy, in determining the effects of other medical or health-related
conditions, during surgical procedures, after drug therapy) * Measurement of height, weight,
length, and girth
Arousal, Attention, and Cognition * Assessment of arousal, attention, and cognition using
standardized instruments * Assessment of factors that influence motivation level * Assessment of
level of consciousness * Assessment of level of recall (eg, short-term and long-term memory) *
Assessment of orientation to time, person, and place * Screening for gross expressive (eg,
verbalization)
Assistive and Adaptive Devices * Analysis of appropriate components of device * Analysis of
effects and benefits (including energy conservation and expenditure) while patient/client uses
device * Analysis of patient/client or caregiver ability to care for device * Analysis of the potential
to remediate impairment, functional limitation, or disability through use of device * Assessment of
alignment and fit of device and inspection of related changes in skin condition * Assessment of
safety during use of device * Computer-assisted analysis of motion, initially without and then with
device * Review of reports provided by patient/client, significant others, family, caregivers, or other
professionals concerning use of or need for device * Videotape analysis of patient/client using
device
Community and Work (Job/School/Play) integration or Reintegration (Including IADL) * Analysis of
adaptive skills * Analysis of community, work (job/school/play), and leisure activities * Analysis of
community, work (job/school/play), and leisure activities that are performed using assistive,
adaptive, orthotic, protective, supportive, or prosthetic devices or equipment * Analysis of
environment, work (job/school/play), and leisure activities * Assessment of physiologic responses
during community, work (job/school/play), and leisure activities * IADL scales or indexes *
Questionnaires completed by and interviews conducted with patient/client and others as
appropriate * Review of daily activities logs * Review of reports provided by patient/client, family,
Page 7 of 145
significant others, caregivers, or other professionals (eg, educators, rehabilitation counselor,

Workers' Compensation claims manager, employer)
Cranial Nerve integrity * Assessment of gag reflex * Assessment of response to the following
stimuli:
- auditory
- gustatory
- olfactory
- vestibular
- visual * Assessment of swallowing
Environmental, Home, and Work (Job/School/Play) Barriers * Analysis of physical space using
photography or videotape * Assessment of current and potential barriers * Measurement of
physical space * Physical inspection of the environment * Questionnaires completed by and
interviews conducted with patient/client and others as appropriate
Ergonomics and Body Mechanics Ergonomics: * Assessment of dexterity and coordination *
Assessment of safety in community and work (job/school/play) environments * Determination of
dynamic capabilities and limitations during specific work (job/school/play) activities
Body mechanics: * Measurement of height, weight, length, and girth * Observation of performance
of selected movements or activities * Videotape analysis of performance of selected movements
or activities
Gait, Locomotion, and Balance * Analysis of arthrokinematic, biomechanical, kinematic, and
kinetic characteristics of gait, locomotion, and balance, using electromyography (EMG), videotape,
computer-assisted graphics, weight-bearing scales, and force plates * Analysis of arthrokinematic,
biomechanical, kinematic, and kinetic characteristics of gait, locomotion, and balance with and
without the use of assistive, adaptive, orthotic, protective, supportive, or prosthetic devices or
equipment * Analysis of gait, locomotion, and balance on various terrains, in different physical
environments, or in water * Analysis of wheelchair management and mobility * Assessment of
safety * Gait, locomotion, and balance assessment instruments * Gait, locomotion, and balance
profiles
Integumentary Integrity For skin associated with integumentary disruption: * Assessment of
activities, positioning, and postures that aggravate or relieve pain or other disturbed sensations *
Assessment of activities, positioning, postures, and assistive and adaptive devices that may result
in trauma to associated skin
Joint Integrity and Mobility * Assessment of soft tissue swelling, inflammation, or restriction *
Analysis of the nature and quality of movement of the joint or body part during performance of
specific movement tasks * Assessment of joint hypermobility and hypomobility
Motor Function (Motor Control and Motor Learning) * Analysis of head, trunk, and limb movement
* Analysts of posture during sitting, standing, and locomotor activities appropriate for age (eg,
walking, hopping, skipping, running, jumping) * Analysis of stereotypic movements * Assessment
of dexterity, coordination, and agility * Assessment of postural, equilibrium, and righting reactions *
Page 8 of 145
Motor assessment scales * Physical performance scales

Muscle Performance (Including Strength, Power, and Endurance) * Analysis of functional muscle
strength, power, and endurance * Analysis of muscle strength, power, and endurance using
manual muscle testing or dynamometry * Assessment of muscle tone * Assessment of pelvic-floor
musculature * Electrophysiologic tests (eg, electromyography [EMG], nerve conduction velocity)
Neuromotor Development and Sensory integration * Analysis of age- and sex-appropriate
development * Analysis of gait and posture * Analysis of involuntary movement * Analysis of reflex
movement patterns * Analysis of sensory integration tests * Analysis of voluntary movement *
Assessment of behavioral response * Assessment of dexterity, agility, and coordination *
Assessment of postural, equilibrium, and righting reactions * Assessment of gross and fine motor
skills * Assessment of motor function
Orthotic, Protective, and Supportive Devices * Analysis of appropriate components of device *
Analysis of effects and benefits (including energy conservation and expenditure) while
patient/client wears device * Analysis of movement while patient/client uses device, using
computer-assisted graphic imaging or videotape * Analysis of the potential to remediate
impairment, functional limitation, or disability through use of device * Analysis of practicality and
ease of use of device * Assessment of patient/client or caregiver ability to put on and remove
device and to understand its use and care * Assessment of patient/client use of device *
Assessment of safety during use of device * Assessment of alignment and fit of device and
inspection of related changes in skin condition * Review of reports provided by patient/client,
family, significant others, caregivers, or other professionals concerning use of or need for device
Pain * Analysis of pain behavior and reaction during specific movements and provocation tests
Posture * Analysis of resting posture in any position * Analysis of static and dynamic postures,
using computer-assisted imaging, posture grids, plumb lines, still photography, videotape, or
visual analysis
Range of Motion (ROM) including Muscle Length) * Analysis of multisegmental movement *
Analysis of ROM using goniometers, tape measures, flexible rulers, inclinometers, photographic or
electronic devices, or computer-assisted graphic imaging * Assessment of muscle, joint, or soft
tissue characteristics
Reflex integrity * Assessment of developmentally appropriate reflexes over time * Assessment of
normal reflexes (eg, deep tendon reflex) * Assessment of pathological reflexes (eg, Babinski's
reflex)
Self-Care and Home Management (Including ADL and IADL) * ADL and IADL scales or indexes *
Analysis of self-care and home management activities * Analysis of self-care in unfamiliar
environments * Assessment of physiologic responses during self-care and home management
activities * Questionnaires completed by and interviews conducted with patient/client and others
as appropriate * Review of daily activities logs * Review of reports provided by patient/client,
family, significant others, caregivers, or other professionals (including educators)
Sensory integrity (Including Proprioception and Kinesthesia) * Assessment of combined (cortical)
sensations (eg, stereognosis, tactile localization, two-point discrimation, vibration, texture
recognition) * Assessment of deep (proprioceptive) sensations (eg, movement sense or
kinesthesia, position sense) * Assessment of gross receptive (eg, vision, hearing) deficits *
Assessment of superficial sensations (eg, sharp/dull discrimination, temperature, light touch,
Page 9 of 145
pressure)
Ventilation, Respiration (Gas Exchange), and Circulation * Assessment of chest wall mobility,
expansion, and excursion * Assessment of standard vital signs (eg, blood pressure, heart rate,
respiratory rate) at rest and during and after activity * Palpation of pulses
Prognosis
Patient/client will function with independence in home, school, work, and community
environments, within the context of the disability.
Depending on motor, perceptual, and cognitive deficits, patient/client will be completely
independent or may need varying levels of assistance (eg, family, caregiver, equipment) or
supervision to fulfill his or her various roles.
6 to 90
delivery.
Page 10 of 145
of Episode
* Age
* Comorbidities
* Development of complications or secondary impairments
These patients/clients may require multiple episodes of care over the lifetime to ensure safety and
effective adaptation following changes in physical status, caregivers, environment, or task
demands. Factors that may lead to these additional episodes of care include:
* Cognitive maturation
* Cumulative trauma
* Deconditioning
* Functional loss
* Increases in postural deficits
* Need for orthotic or adaptive equipment modification
* Periods of rapid growth
* Surgical intervention
* Transition in lifestyle
Intervention
Page 11 of 145
plan of care. the physical therapist determines the degree to which intervention is likely to achieve
limitation. secondary or primary prevention of disability, optimization of patient/client satisfaction).
Anticipated Goals
professionals.
identified.
* Case management
professionals, and other interested persons (eg, rehabilitation counselor, Workers'
* Education plans
Page 12 of 145

* Record reviews
Anticipated Goals
increased.
caregivers.
Page 13 of 145
Direct interventions for this pattern for man include, in order of preferred usage:
Anticipated Goals
* Need for assistive and adaptive devices is decreased.
* Risk, of secondary impairments is reduced.
Page 14 of 145
* Aquatic exercises
* Strengthening:
- active
- active assistive
- resistive
Page 15 of 145
* Stretching
* Structured play or leisure activities
IADL)
Anticipated Goals
IADL) is increased.
* Organized functional training programs (eg, simulated environment and tasks)
Functional Training in Community and Work (Job/School/Pay) Integration or
Reintegration (Including IADL and Work Conditioning)
Anticipated Goals
Page 16 of 145

and activities
* Organized functional training programs (simulated instruments and tasks)
Anticipated Goals
* Quality and quantity of movement between and across body segments is improved.
* Joint mobilization
* Manual traction
Page 17 of 145

* Soft tissue mobilization
Equipment (Assistive, Adaptive, Orthotic, Protective Supportive, and
Prosthetic)
Anticipated Goals
* Tolerance to positions and activities is improved.
Page 18 of 145

* Supportive devices or equipment (eg, supportive taping, compressive garments, corsets, slings,
neck collars, serial casting, elastic wraps, oxygen)
Anticipated Goals
* Neuromuscular function is increased.
* Biofeedback
Anticipated Goals
Reexamination
Outcomes
Page 19 of 145
manner), disability to engage in age-specific, gender-specific, or sex-specific roles in a particu]ar
social context and physical environment), primary or secondary prevention, and patient/client
satisfaction. The physical therapist also identifies the patient's/client's expectations for therapeutic
interventions and perceptions about the clinical situation and considers wether they are realistic,
given the examination and evaluation findings. Optimal outcomes for patients/clients in this pattern
include:
* Ability of caregivers to assist patient/client in functional activities and use of community
resources is increased.
* Optimal return to role function (eg. worker, student. spouse. grandparent) is achieved.
* Risk of disability associated with congenital or acquired disorders of the central nervous system
is reduced.
* Self-care and home management activities, including activities of daily living (ADL)-- and work
equipment.
demonstrated.
* Administrative management of practice is acceptable to patient/client, family significant others,
and caregivers.
and caregivers.
and caregivers.
and caregivers.
Page 20 of 145

* Patient/client and caregivers are aware of the factors that man, indicate need for reexamination
adaptation. leisure activities, living environment, pathology or impairment that may affect function,
the desired outcomes hate been achieved. Other indicators: patient/client, caregiver, or legal
Impaired Motor Function and Sensory Integrity Associated with Acquired
Nonprogressive Disorder of the Central Nervous System in Adulthood
standards of practice; and patient/client age, culture, gender roles. race, sex, sexual orientation,
Patients/clients with functional limitations associated with impaired motor and sensory function
Page 21 of 145
associated with acquired nonprogressive disorders of the central nervous system in adulthood.
* Impaired affect
* Impaired arousal and attention
* Impaired balance
* Impaired oromotor control
* Aneurysm
* Anoxia or hypoxia
* Nonmalignant brain tumor
* Cerebrovascular accident (stroke)
* Infectious disease that affects the central nervous system
* Intracranial neurosurigical procedures
* Seizures
* Tumor
* Amputation
* Coma
* Immature central nervous system
* Malignant brain tumor
Page 22 of 145
* Tumor
ICD-9-CM Codes
049 Other non-arthropod-borne viral diseases of the central nervous system 049.9 Unspecified
non-arthropod-borne viral diseases of the central nervous system Viral encephalitis, not otherwise
specified 322 Meningitis of unspecified cause 342 Hemiplegia and hemiparesis 348 Other
conditions of brain 348.0 Cerebral cysts 348.1 Anoxic brain damage 431 Intracerebral
hemorrhage 433 Occlusion and stenosis of precerebral arteries 434 Occlusion of cerebral arteries
435 Transient cerebral arteries 435.1 Vertebral artery syndrome 435.8 Other specified transient
cerebral ischemias 436 Acute, but ill-defined, cerebrovascular disease 437 Other and ill-defined
cerebrovascular disease 442 Other aneurysm 442.8 Of other specified artery 444 Arterial
embolism and thrombosis 444.9 Of unspecified artery 447 Other disorders of arteries and
arterioles 447.1 Stricture of artery 747 Other congenital anomalies of circulatory system 747.8
Other specified anomalies of circulatory system 851 Cerebral laceration and contusion 852
Subarachnoid, subdural, and extradural hemorrhage, following injury 854 Intracranial injury of
other and unspecified nature
Examination
severity of the problem: stage of recovery (acute, subacute, chronic): phase of rehabilitation
(early, intermediate, late, return to activity); home, community, or work (job/school/play situation;
History
* Age
Page 23 of 145
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
intervention
Page 24 of 145
Medications
therapist
Post History of Current Condition
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
* Pregnancy, delivery and postpartum
Family History
Page 25 of 145

leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Test and measures for this pattern may include:
Page 26 of 145
* Assessment of edema through palpation and volume and girth measurements (eg. during
procedures, after drug theraphy)
* Assessment of factors that influence motivation
of device
* Computer-assisted analysis of motion, initially without and then with device
including IADL)
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* Analysis of community, work, (job/school/play), and leisure activities that are performed using
activities
* Observation of responses to nonroutine occurrences
appropriate
* Review reports provided by patient/client, family, significant others, caregivers, or other
professionals (eg. rehabilitation counselor, Workers' Compensation claims manager, employer)
- auditory
- gustatory
- olfactory
- vestibular
- visual
Page 28 of 145

appropriate
Ergonomics:
related to physical, functional. behavioral, and vocational status
activities
Body Mechanics:
activities
locomotion. and balance using electromyography (EMG), videotape, computer-assisted graphics,
weight bearing scales, and force plates
or in water
Integumentary integrity
Page 29 of 145
* Analysis of head, trunk,, and limb movement
* Analysis of myoelectric activity and neurophysiological integrity using electrophysiologic tests
(eg, diagnostic and kinesiologic electromyography [EMG]. motor nerve conduction)
Muscle Performance (including Strength, Power, and Endurance)
dynamometry
* Electrophysiologic tests (eg, electromyography [EMG] and nerve conduction velocity [NCV])
Page 30 of 145

* Analysis of involuntary movement
* Assessment of motor function
* Analysis of movement while patient/client uses device, using computer-assisted graphic imaging
or videotape
of device
its use and care
Pain
Page 31 of 145

Posture
Reflex Integrity
* Electrophysiologic tests (eg, H-reflex)
Self-Care and Home-Management (Including ADL and IADL)
appropriate
professionals
Sensory Integrity
Page 32 of 145

sense)
* Assessment of superficial sensations (eg, sharp or dull discrimination, temperature, light touch,
pressure)
of the problem; stability, of the condition; preexisting sytemic conditions or diseases; probability of
prolonged impairment, functional limitation. or disability; multisite or multisystem involvement;
Prognosis
Patient/client will be integrated or reintegrated into age-appropriate home and community
environments with maximal independence, within the context of the disability.
Depending on residual motor, perceptual, and cognitive deficits, patient/client will be completely
independent and demonstrate a return to premorbid level of function or may need varyiny levels of
assistance (family, caregiver, equipment) or supervision to fulfill his or her various roles.
10 to 60
Page 33 of 145
delivery.
of Episode
* Age
* Caregiver (eg, family home health aide) consistency or expertise
* Comorbidities
* Decline in functional independence
* Exacerbation of illness
Intervention
symptoms, syndrome, or category (diagnosis), intervention may be quided by the alleviation of
symptoms, and remediation of deficits. Intervention has three components. Communication,
patients/client, whereas a variety of direct interventions may be selected, applied, or modified by
Page 34 of 145

Anticipated Goals
professionals.
resources by patient/client. family significant others, and caregivers.
identified.
* Case management
professions, and interested persons (eg, rehabilitation counselor, Workers' Compensation claims
manager, employer)
* Education plans
* Record reviews
* Referrals to other professionals or resources.
Anticipated Goals
Page 35 of 145
increased.
caregivers.
* Safety of patient/client, family significant others and caregivers is improved.
Page 36 of 145

Direct interventions for this pattern may include in order of preferred usage:
Anticipated Goals
* Ability to Perform Physical tasks related to self-care, home management, community and work
* Level of supervision required for task performance is decreased,
Page 37 of 145

* Aerobic endurance activities, using cycles, treadmills, steppers. Pulleys, weights, hydraulics,
elastic resistance bands robotics. and mechanical or electromechanical devices
* Aquatic exercises
* Gait, locomotion and balance training
* Strengthening
- active
- active assistive
- resistive, using manual resistance, pulleys, weights. hydraulics, elastic resistance bands,
* Stretching
IADL)
Page 38 of 145
Anticipated Goals
IADL) is increased.
management, driving a car or using public transportation)
or Reintegration (Including IADL and Work Conditioning)
Anticipated Goals
* Ability, to perform physical tasks related to community and work (job/school/play) integration or
and activities.
Page 39 of 145

* IADL training (eg, shopping, cooking, home chores, heavy
* household chores, money management, driving a car or using public transportation)
* Job coaching
* Job simulation
* Organized functional training programs (eg. simulated environments and tasks)
Anticipated Goals
Prosthetic)
Anticipated Goals
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* Assistive devices or equipment (eg, canes, crutches, walkers, wheelchair, power devices, longhandled reachers, static and dynamic splints)
neck collars, serial/casts elastic wraps oxygen) Electrotherapeutic Modalities
Anticipated Goals
Page 41 of 145

* Motor function (motor control and motor learning) is
improved.
* Biofeedback
Reexamination
Outcomes
* Ability of caregivers to assist patient/client in activities of daily living (ADL) and instrument
activities of daily living (IADL) and solve new problems is improved.
* Ability to solve problems enhances independence in task performance in varied environments.
* Risk of disability associated with acquired nonprogressive disorders of the central nervous
system is reduced.
Page 42 of 145

* Self-care and home management activities, including ADL -- and work (job/school/play) and
leisure activities, including IADL -- are performed safely, efficiently, and at a mammal level of
independence with or without devices and equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
outcomes include:
Page 43 of 145
Impaired Motor Function and Sensory Integrity Associated With Progressive
Disorders of the Central Nervous System in Adulthood
Patients/clients with functional limitations associated with impaired motor and sensory function
associated with progressive disorders of the central nervous system in adulthood. Patients/clients
may have any one or a combination of the following:
* Exacerbation or remission of symptoms with treatment (eg, with radiation, chemotherapy)
* Impaired affect
* Impaired autonomic function
* Impaired endurance
* Impaired motor function
* Progressive loss of function
Page 44 of 145

* Acquired immunodeficiency syndrome (AIDS)
* Alcoholic ataxia
* Alzheimer's disease
* Amyotrophic lateral sclerosis
* Basal ganglia disease
* Cerebellar ataxia
* Cerebellar disease
* Huntington's disease
* Idiopathic progressive cortical disease
* Intracranial neurosurgical procedures
* Malignant brain tumor
* Multiple sclerosis
* Parkinson's disease
* Parkinsonian symptoms
* Primary lateral palsy
* Progressive muscular atrophy
* Seizures
* Tumor
* Amputation
* Coma
* Poliomyelitis
Page 45 of 145
* Progressive nondemyelinating motor neuron diseases

ICD-9-CM Codes
preferred practice pattern. Because die patient/client diagnostic group is defined by impairments
042 Human immunodeficiency virus (HIV) disease 191 Malignant neoplasm of brain 237
Neoplasm of uncertain behavior of endocrine glands and nervous system 237.5 Brain and spinal
cord 331 Other cerebral degenerations 331.0 Alzheimer's disease 332 Parkinson's disease 333
Other extrapyramidal disease and abnormal movement disorders 333.0 Other degenerative
diseases of the basal ganglia 333.3 Tics of organic origin 333.4 Huntington's chorea 333.9 Other
and unspecified extrapyramidal disease and abdominal movement disorders 334 Spinocerebellar
disease 334.2 Primary cerebellar degeneration 334.3 Other cerebellar ataxia 334.8 Other
spinocerebellar diseases 335 Anterior horn cell disease 335.2 motor neuron disease 335.20
Amyotrophic lateral sclerosis 340 Multiple sclerosis 341 Other demyelinating diseases of central
nervous system 341.8 Other demyelinating diseases of central nervous system Central
demyelination of corpus callosum 341.9 Demyelinating disease of central nervous system,
unspecified 348 Other conditions of brain 348.9 Unspecified condition of brain Through the
examination (history, system review, and tests and measures). the physical therapist identifies
impairments. functional limitations, disabilities, or changes in physical function and health status
resulting from injury, disease, or other causes to establish the diagnosis and the prognosis and to
determine the intervention. The patient/client, family, significant others, and caregivers participate
by reporting activity performance and functional ability. The selection of examination procedures
and the depth of the examination vary based on patient/client age; severity of the problem; stage
of recovery acute, subacute, chronic); phase of rehabilitation (early, intermediate, late, return to
activity); home, community, or work job/school/play) situation; and other relevant factors. For
clinical indications and types of data generated by the tests and measures, refer to Part One,
Chapter 2.
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Page 46 of 145

Living Environment
intervention
Medications
therapist
Page 47 of 145

* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
* Prior hospitatizations, surgeries, and preexisting medical and other health-related conditions
Family History
Page 48 of 145

leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
* Assessment of perceived exertion, dyspnea, or angina during activity using rating-of-perceivedexertion (RPE) scales, dyspnea scales, anginal scales, or visual analog scales
* Assessment of arousal, attention, and cognition using standardized instruments
* Screening for gross expressive eg, verbalization) deficits
* Analysis Of effects and benefits including energy conservation and expenditure) while
Page 49 of 145

of device
* Review of reports provided by patient/client, family, significant others, caregivers, Or other
Community and Work Job/School/Play) Integration or Reintegration (Including IADL)
* Analysis of adaptive skins
* Analysis of community, work job/school/play), and leisure activities
* Analysis of community, work job/school/play), and leisure activities that are performed sing
assistive, adaptive, orthotic, protective, supportive, or Prosthetic devices or equipment
* Analyses of environment and work job/school/play) tasks
* Assessment of physiologic responses during community, work job/school/play), and leisure
activities
* Assessment of safety m community and work (job/school/play) environments
* Questionnaires Completed bY and interviews conducted with patient/client and others as
appropriate
care Professionals, or other interested persons (eg, rehabilitation counselor Workers'
Cranial Nerve integrity
* Assessment Of Muscles innervated by the cranial nerves
- auditory
Page 50 of 145
- gustatory
- olfactory
- vestibular
- visual
Environmental, Home, and Work (Job/school/play) Barriers
* Assessment Of current and potential barriers
appropriate
* Analysis of preferred Postures during performance of tasks and activities
Body mechanics:
activities
* Observation of performance of selected movements or activities videotape analysis of
Performance of selected movements or activities
* Analysis Of gait, locomotion, and balance on various terrain, in different physical environments,
or in water
Page 51 of 145
Motor Function (Motor Learning and Motor Control)
dynamometry
* Electrophysiologic tests (eg, electromyography [EMG], nerve conduction velocity [NCVI)
* Analysis of involuntary movements
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* Assessment of postural reactions

* Analysis of movement while patient/client uses device, using computer-assisted graphic imaging
and videotape
of device
its use and care
professionals
Pain
* Assessment of pain questionnaires, graphs, behavioral scales, symptom magnification scales or
indexes, or visual analog scales
Posture
Range of Motion (ROM) (including Muscle Length)
Page 53 of 145
Reflex integrity
appropriate
professionals
Sensory Integrity including Proprioception and Kinesthesia)
sense)
* Assessment of superficial sensations (eg, sharp/dull discrimination, temperature, tight touch,
pressure)
Page 54 of 145
the physical therapist develops the Plan of care, which specifies goals and outcomes, specific
Prognosis
Patient/client will be integrated or reintegrated into age-appropriate home, community, and work
environments, within the context of the disability.
Depending on the progression of motor, perceptual, and cognitive deficits, patient/client will need
varying levels of assistance family, caregiver, equipment) or supervision to fulfill his or her various
roles.
service delivery.
* Age
* Comorbidities
Page 55 of 145

Intervention
Anticipated Goals
professionals.
identified.
* Case management
Page 56 of 145
professionals, and other interested persons (eg, rehabilitation counselor, Workers'
* Education plans
* Record reviews
Anticipated Goals
* Intensity of care decreased.
increased.
caregivers.
Page 57 of 145

* Use of audiovisual aids for both teaching and home eference
Anticipated Goals
Page 58 of 145

* Aquatic exercises
Page 59 of 145

* Strengthening
- active
- active assistive
- resistive. using manual resistance, pulleys, weights, hydraulics, elastic resistance bands, robotic,
and mechanical or electromechanical devices
* Stretching
IADL)
Anticipated Goals
* Ability to perform physical tasks related to self-care and home management (including ADLs and
IADLs) is increased.
* IADL training (eg. shopping, cooking, home chores, heavy household chores, money
Page 60 of 145

Functional Training in Community and Work (Job,/School/Play)
Integration/ Reintegration (Including IADL and Work Conditioning)
Anticipated Goals
and activities
* IADL training (eg, shopping, cooking, home chores,heavy household chores, money
Anticipated Goals
Page 61 of 145

* Manual traction
Prosthetic)
Anticipated Goals
Page 62 of 145

* Adaptive devices or equipment (eg, raised toilet seats, seating systems, environmental controls,
and other devices)
Reexamination
The physical therapist relies on reexamination,the process of performing selected tests and
Reexamination may be indicated more during a single episode of care. It also may be performed
over the course of a disease or a condition, which -- for some patient/client diagnostic groups -maybe the life span. Indications for reexamination include new clinical findings or failure to
respond to intervention.
Outcomes
whole person. a physical action, activity or task in an efficient, typically expected, or competent
particular social context and physical environment), primary or secondary prevention,and
* Awareness and use of community resources are increased.
* Awareness of and response of family and caregivers is increased to modified or add assistive
and supportive devices necessary to maintain independence.
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* Optimal return to role function (eg, worker, student, spouse grandparent) is achieved.
* Risk of disability associated with progressive disorders of the central nervous system is reduced.
performed safely, efficiently and at a maximal level of independence with or without devices and
equipment.
demonstrated.
and caregivers.
* Clinical proficiency. of physical therapist is acceptable to patient/client, family significant others,
and caregivers.
* Coordination and conformity of care are acceptable to patient/client, family significant others,and
caregivers.
and caregivers.
Page 64 of 145
* Professional recommendations are integrated into home, community work (job/school/play), or

leisure environment.
Impaired Motor Function and Sensory Integrity Associated With Peripheral
Nerve Injury
management that physical therapist provide the patient/client diagnostic group specified below.
APTA emphasizes that preferred practice patterns are the boundaries within which has physical
therapist may select any of a number of clinical paths, based on consideration of a wide variety of
factors, such as individual patient/client needs; the profession's code of ethics and standards of
practice and patient/client age, culture, gender role, race, sex, sexual orientation, and
socioeconomic status.
Patients/clients who have functional limitations due to impaired motor and sensory function
associated with peripheral nerve injury. Patients/clients may have one or more of the following:
* Mobility deficits
* Motor changes
* Pain
* Reflex changes
* Sensory abnormalities
Page 65 of 145
* Compression and entrapment neuropathies (eg. Erb's palsy, acute traumatic or pregnancyinduced carpal tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, tarsal tunnel
syndrome)
* Traumatic and surgical nerve lesions (including macrotrauma and microtrauma) and surgical
repairs (including neuropraxia, axonotmesis, neurotmesis)
* Demyelinating disease
* Radiculopathies, reflex sympathetic dystrophy syndrome, Bell's palsy, Horner's syndrome
ICD-9 Codes
350 Trigeminnal nerve disorders
350.1 Trigeminal neuralgia 352 Disorders of other cranial nerves
352.4 Disorders of accessory (11th) nerve
352.5 Disorders of hypogossal (12th) nerve
352.9 Unspecified disorder of cranial nerves 353 Nerve root and plexus disorders
353.0 Brachial plexus lesions
353.1 Lumbosacral plexus lesions
353.6 Phantom limb (syndrome) 354 Mononeuritis of upper limb and mononeuritis multiplex
354.2 Lesion of ulnar nerve
354.3 Lesion of radial nerve 355 Mononeuritis of lower limb and unspecified site 357 Inflammatory
and toxic neuropathy
357.1 Polyneuropathy in collagen vascular disease
Examination
Page 66 of 145

prognosis and to determine the intervention. The patient/client, family significant others, and
severity of the problem: stage of recovery (acute, subacute, chronic); phase of rehabilitation (early
intermediate, late, return to activity); home, community, or work (job/school/play) situation: and
other relevant factors. For clinical indications and types of data generated by the tests and
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 67 of 145
* Concerns or needs of patient/client who requires the service of a physical therapist

* Mechanisms of injury or disease including date of onset and course of events
* Patient/client family, significant other, and caregiver expectations and goals for the therapeutic
intervention
* Patient/client, family significant other, and caregiver perceptions of patient's/client's emotional
Medications
* Medications for current condition for which patient/client is seeking the service of a physical
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
Page 68 of 145
* Integumentary
* Musculoskeletal
* Neuromuscular
* Prior hospitalizations. surgeries, and preexisting medical and other health-related conditions
Family History
* Psychological function (eg. memory reasoning ability, anxiety, depression, morale)
* Social function (eg, social interaction. social activity, social support)
* Behavioral health risks (eg, smoking. drug abuse)
* Level of physical fitness (self-care, home management, community, work [job/school/play,], and
leisure activities)
Systems Review
The system review man, include:
Physiologic and anotomic status
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
Page 69 of 145

of device
its use and care
professionals
* Analysis of adaptive skins
activities
appropriate
Page 70 of 145
* Review of reports provided by. patient/client, family, significant others, caregivers, other health
appropriate
Ergonomics:
* Assessment of safety, in community and work (job/school/play) environments
* Assessment of work (job/school/play) through batteries of tests
activities
analysis of repetition/work/rest cycling during task or activity
Body mechanics:
Page 71 of 145

activities
locomotion, and balance, using electromyography, (EMG), videotape, computer-assisted graphics,
locomotion, and balance with and without the use of assistive, adaptive, orthotic, protective.
or in water
* Identification of gait characteristics
* Assessment of the nature and quality of movement of the joint or body part during performance
of specific movement tasks
Page 72 of 145
* Assessment of motor control and motor learning
* Electrophysiologic tests (eg, diagnostic and kinesiologic electromyography [EMG]. motor nerve
conduction)
* Analysis of functional muscle strength. power, and endurance
* Analysis of muscle strength. power, and endurance using manual muscle testing or
dynamometry
* Analysis of the potential to remediate impairment, functional limitation, or disability, through use
of device
Pain
Posture
Page 73 of 145

* Analysis of ROM using goniometers, tape measures, flexible rulers, inclinometers. photographic
or electronic devices. or computer-assisted graphic imaging
Reflex Integrity
* Assessment of normal reflexes (eg, deep tendon reflex)
* Electrophysiologic tests (eg, H-reflex)
* Analysis of individual performing self-care and home management activities
appropriate
professionals
* Assessment of deep (proprioceptive) sensations (eg, movement sense or kinesthesia. position
sense)
pressure)
establishing the diagnosis and the prognosis. Factors that influence tile complexity of the
Page 74 of 145
reached at various intervals during the course of physical theraphy. During the prognostic
process, the physical therapist develops tile plan of care, which specifies goals and outcomes,
specific direct interventions, the frequency of visits and duration of the episode of care required to
achieve goals and outcomes, and criteria for discharge.
The frequency, of visits and duration of the episode of care man. vary, from a short episode with a
of the problem; stability of the condition: preexisting systematic conditions or diseases; probability
of prolonged impairment, functional limitation. or disability; multisite or multisystem involvement;
Prognosis
Over the course of 4 to 8 months. patient/client win return to premorbid or highest level of function.
12 to 56
to achieve anticipated goals and desired outcomes. It is anticipated that 80% of patient/clients in
delivery.
of Episode
* Ability to obtain job reclassification or redesign
* Age
* Chronicity, or severity of condition
Page 75 of 145
* Comorbidities
* Lesion differential diagnosis -- neuropraxis, axonotmesis, or neurotmesis
* Quality of surgical intervention
Intervention
plan of rare, the physical therapist determines the degree to which intervention is likely to achieve
In the event that die diagnostic process does not yield an identifiable cluster of signs and
the physical therapist on the basis of the examination and evaluation findings,diagnosis,and
Anticipated Goals
professionals.
identified.
Page 76 of 145
* Case management
* Education plans
* Record reviews
Anticipated Goals
* Ability to perform tasks is increased.
by patient/client,family,significant others,and caregivers.
living (ADL) is increased.
increased.
* Performance levels in employment, recreational or leisure activities are improved.
Page 77 of 145

caregivers.
* Written or pictorial instruction Direct interventions for this pattern ma,%. include. in order of
preferred usage:
Anticipated Goals
Page 78 of 145

* Aquatic exercises
* Developmental activities
* Neuromuscular relaxation. inhibition, and facilitation
* Strengthening
- active
- active assistive
- resistive, using manual resistance, pulleys, weights, hydraulics. elastic resistance bands,
Page 79 of 145
* Stretching
IADL)
Anticipated Goals
IADL) is increased.
* Risk of recurrence of condition is reduced. Safety is improved during performance of self-care
and home
* management tasks and activities.
* Organized functional training programs
Functional Training in Community and Work (Job/School/Play)
Reintegration including IADL, Work Hardening, and
Work Conditioning)
Anticipated Goals
* Performance of and independence in IADL are increased. Safety is improved during
performance of community, work (job/school/play), and leisure tasks and activities
Page 80 of 145

* Assistive, adaptive, supportive, or protective device training
management, driving a car or using public transportation, structured play for infants and children.
* Job coaching
* Job simulation
* Orthotic device training
Anticipated Goals
* Ability to perform movement tasks is increased,
* Muscle spasms are reduced.
* Risk of secondary impairments is reduced. Ventilation, respiration gas exchange), and
circulation are improved.
* Soft tissue mobilization or manipulation
and Equipment (Assistive, Adaptive, Orthotic,
Protective, Supportive, and Prosthetic)
Anticipated Goals
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* Edema, lymphedema, or effusion is reduced. joint stability is increased.
* Joint integrity, and mobility are improved.
* Adaptive devices or equipment (eg, raised toilet seats, seating systems. environmental controls,
and other devices)
Page 82 of 145
* Orthotic devices or equipment (eg, splints,. braces, shoe inserts. casts)

* Protective devices or equipment (eg. braces, protective taping, cushions. helmets)
* Supportive devices or equipment (eg. supportive taping, compression garments, corsets. slings.
neck collars, serial casts. elastic wraps, oxyen)
Anticipated Goals
* Joint integrity and mobility are improved, Motor function (motor control and motor learning) is
improved.
* Biofeedback
Anticipated Goals
Page 83 of 145
* Joint integrity and mobility are improved,

Physical agents:
* Athermal modalities (eg. pulsed ultrasound. pulsed electromagnetic fields)
* Cryotherapy (eg. cold packs. ice massage)
* Deep thermal modalities (eg, ultrasound. phonophoresis)
* Superficial thermal modalities (eg, heat, paraffin baths, hot packs. fluidotherapy)
Reexamination
Reexamination may be indicated more than once during a single episode of care. It also ma,.%,
be performed over the course of a disease or a condition, which -- for some patient/client
diagnostic groups--may be the life span. Indications for reexamination include new clinical findings
or failure to respond to intervention.
Outcomes
* Optimal return to role function (eg, worker. student, spouse, grandparent) is achieved.
* Risk of disability associated with peripheral nerve injury is reduced.
* Self-care and home management activities, including activities of daily living (ADL -- and work
Page 84 of 145
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
* Interpersonal skills of physical therapist are acceptable to patient/client family, significant others,
and caregivers.
outcomes include:
* Patient/client and caregivers are aware of the factors that man. indicate need for reexamination
anticipated goals (remediation of impairment, or loss or abnormality of physiologcal,
Page 85 of 145
the desired outcomes have been achieved. Other indicators: patient/client. caregiver, or legal
status,
promotion. Progression to pathology -- or from pathology or impairment to disability --is not
inevitable. Physical therapist intervention can prevent impairment, functional limitation, or
disability, by identifying disablement risk factors (eg, biological characteristics, demographic
background, lifestyle factors) and by buffering the disablement process with adaptive or supportive
equipment, an exercise program, education, or environmental modifications.
* Abnormal peripheral vascular conditions
* Age
* Altered sensibility
* Anthropometric characteristics (eg, excessive weight, leg-length discrepancny body type)
* Attitude
* Habitual suboptimal body mechanics (eg, lifting, reaching)
* Lifestyle:
deconditioning
- muscle tightness or inflexibility (eg, pectoralis major,
hamstring, and gastrocnemius-soleus muscles; spinal facets;
glenohumeral joint)
Page 86 of 145

- substance abuse (eg, smoking, \alcohol, drugs)
* Muscle weakness or imbalance (eg, trunk and hip, quadricep femoris, hamstring, rotator cuff and
wrist muscles, finger flexors and extensors)
* Design, equipment, or other barriers preventing optimal body, mechanics or posture
* Previous history of injury or surgery affecting extremities, spine, posture, or body, mechanics
(eg, recurrent lateral ankle sprains, persistent shoulder instability)
* Systemic condition predisposing patient/client to contractile or noncontractile deficiency (eg,
endocrine disorders, rheumatic diseases)
* Underlying spinal dysfunction (eg, postural dysfunction) in home, community or work
(job/school/play) environments
Primary Preventive interventions
assessment)
stressors) and peripheral nerve lesions and (2) prevention strategies
management
Impaired Motor Function and Sensory Integrity Associated With
Acute or Chronic Polyneuropathies
standards of practice; and patient/client age. culture. gender roles, race, sex, sexual orientation,
Page 87 of 145
Patients/clients with functional limitations due to impaired motor and sensory function associated
with acute or chronic polyneuropathies. Patients/clients ma,.%, have one or a combination of the
following:
* Autonomic nervous system dysfunction
* Skin and bone abnormalities
* Amputation
* Axonal polyneuropathies (diabetic. renal, and alcoholic)
* Guillain-Barre syndrome
* Leprosy
* Central nervous system lesions
* Coma
* Compression or traumatic neuropathies
* Mixed central nervous system and peripheral lesions
* Poliomyelitis
ICD-9-CM Codes
As of press time. the listing below contains the most typical ICD-9-CM codes related to this
and functional limitations and not by codes. it is possible for individuals to belong to the group
even though the codes man, not apply to them.
Classification of Diseases, Ninth Revision., Clinical Modification (ICD-9-CM) or to other ICD-9-CM
030 Leprosy 250 Diabetes mellitus 250.6 Diabetes with neurological manifestations 356
Hereditary and idiopathic peripheral neuropathy 356.4 Idiopathic progressive polyneuropathy
356.9 Unspecified 357 inflammatory and toxic neuropathy 357.2 Polyneuropathy in diabetes 357.4
Page 88 of 145
Polyneuropathy in other diseases classified elsewhere Uremia 357.5 Alcoholic polyneuropathy

357.7 Polyneuropathy due to other toxic agents
Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
* Social interactions. social activities, and support systems
* Current and prior community and
* work (job/school) activities
Living Environment
Page 89 of 145

* Patient/client, family, significant other,, and caregiver expectations and goals for the therapeutic
intervention
Medications
therapist Medications for other conditions
* Prior medications
* Cardiopulmonary
Page 90 of 145
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
* Physical function (eg, mobility, sleep patterns. energy, fatigue)
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
Page 91 of 145
* Neuromuscular
Tests and Measures
* Assessment of perceived exertion, dyspnea, or angina during activity using rating-of-perceivedexertion (RPE) scales, dyspnea scales. angina scales, or visual analog scales
pregnancy in determining the effects of other medical or health-related conditions,. during surgical
procedures. after drug therapy)
* Measurement of body fat composition, using calipers. underwater weighing tanks. or electrical
impedance
* Screening for level of cognition (eg, to determine ability to process commands to measure safety
awareness)
Page 92 of 145
of device
* Computer-assisted analysis of motion, initially without and then with device
* Analysis of community work (job/school/play), and leisure activities that are performed using
assistive, adaptive, orthotic, protective. supportive or prosthetic devices or equipment
* Analysis of environment work (job/school/play), and leisure activities
activities
appropriate
* Review of reports provided by patient/client family, significant others, caregivers, other health
Compensation claims manager employer)
Page 93 of 145

appropriate
activities
* Ergonomic analysis of the work and its irherent tasks or activities, including:
- strength required in the work postures necessary to perform
task or activity
Page 94 of 145

activities
or in water
* Identification and quantification of static and dynamic balance charactecristics
For wound:
* Assessment of activities, positioning, and postures that aggravate the wound or scar or that may
Page 95 of 145

* Measurement of soft tissue restrictions
* Analysis of myoelectric activity and neurophysiological integrity using electrophysiologic tests
(eg, diagnostic and kinesiologic electromyography [EMG], motor nerve conduction)
dynamometry
of device
Page 96 of 145

Pain
* Assessment of pain using questionnaires, graphs, behavioral
scales, symptom magnification scales or indexes, or visual analog scales
Posture
Reflex Integrity
* Assessment of normal reflexes (eg, deep tendon reflex)
appropriate
professionals
Page 97 of 145

sense)
* Assessment of superficial sensations (eg, sharp or dun discrimination, temperature, light touch,
pressure)
social supports; living environment: potential discharge destinations; patient/client and family
expectations; anatomic and physiologic changes related to growth and development: and
Prognosis
Patient/client will be integrated into age-appropriate home, community, and work environments,
within the context of the disability.
6 to 24
Page 98 of 145
delivery.
of Episode
* Acute events related to the neuropathy (eg, infected ulcer)
* Age
* Comorbidities
* Development of complications or secondary impairments (eg, progression of articular changes,
muscle weakness, or sensory loss)
* Development or progression of wound
* Mental competence of patient/client
*Preexisting systemic conditions or diseases
* Surgical intervention
Intervention
Page 99 of 145
Anticipated Goals
professionals.
identified.
* Case management
* Education plans
* Record reviews
Anticipated Goals
Page 100 of 145

increased.
caregivers.
Page 101 of 145

Anticipated Goals
* Need for assistive and adaptive devices is decreased.
* Risk of recurrence of injury or condition is decreased.
Page 102 of 145

* Aquatic exercises
* Strengthening - active - active assistive - resistive,using manual resistance, pulleys, weights,
hydraulics, elastic resistance bands, robotics, and mechanical or electromechanical devices
* Stretching
IADL)
Anticipated Goals
IADL) is increased.
* Safety when performing self-care and home management tasks and activities is improved.
* Tolerance to positions and activities is increased
Page 103 of 145
Reintegration (Including IADL and Work Conditioning)
Anticipated Goals
and activities
* Job coaching
* Job simulation
* Leisure and play activity
Page 104 of 145

Anticipated Goals
* Manual traction
Equipment (Assistive, Adaptive, Orthotic, Protective, Supportive,
and Prosthetic)
Anticipated Goals
* Joint comfort, alignment, and function are improved.
Page 105 of 145

*Level of supervision required for task performance is decreased.
* Stresses precipitating or perpetuating injury are minimized.
Anticipated Goals
Page 106 of 145

* Biofeedback
Anticipated Goals
Physical agents:
compression garments, taping, total contact casting)
Reexamination
Outcomes
Page 107 of 145
then- are realistic, given the examination and evaluation findings. Optimal outcomes for
* Optimal return to role function (eg. worker. student, spouse, grandparent) is achieved.
* Risk and cost of hospitalization are reduced.
* Risk of disability associated with acute or chronic polyneuropathies is reduced.
* Safety, independence, and efficiency of functional mobility (eg. gait, wheelchair, transfers) are
maximized.
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
* Interpersonal skills of physical therapist are acceptable to patient/client, family, significant others
and caregivers.
Page 108 of 145
adaptation, leisure activities, living environment. pathology or impairment that may affect function
* Professional recommendations are integrated into home, community, work (job/school/plan), or
Impaired Motor Function and Sensory Integrity Associated With
Nonprogressive Disorders of the Spinal Cord
standards of practice; and patient/client age, culture, gender roles, race, sex, sexual orientation.
Page 109 of 145
Patients/clients with functional limitations due to impaired motor function and sensation associated
with nonprogressive disorders of the spinal cord at an,%- age. Patients/clients may have any one
or a combination of the following:
* Impaired balance
* Impaired endurance
* Benign spinal tumor
* Complete and incomplete lesions
* Infectious diseases affecting the spinal cord
* Spinal compression secondary to osteomyelitis, spondylosis, herniated intervertebral disk. or
degenerative joint disease
* Spinal cord injury secondary to trauma
* Spinal fusion and spinal neurological procedures
* Amputation
* Coma
* Guillain-Barre syndrome
* Malignant tumor
* Meningocele
* Multiple sclerosis, amyotrophic lateral sclerosis
* Multiple system trauma
* Myelocele
* Myelomeningocele
Page 110 of 145
* Nerve root compression due to lumbar radiculopathy

* Orthopedic or spinal instability with unstabilized spine
* Progressive spinal cord injury or disease
* Tethered cord
CD-9-CM Codes
192 Malignant neoplasm of other and unspecified parts of nervous system 192.2 Spinal cord
Cauda equina 198 Secondary malignant neoplasm of other specified sites 198.3 Brain and spinal
cord 225 Benign neoplasm of brain and other parts of nervous system 225.3 Spinal cord Cauda
equina 237 Neoplasm of uncertain behavior of endocrine glands and nervous system 237.5 Brain
and spinal cord 239 Neoplasms of unspecified nature 239.7 Endocrine glands and other parts of
nervous system 336 Other diseases of spinal cord 344 Other paralytic syndromes 344.0
Quadriplegia and quadriparesis 344.1 Paraplegia 344.8 Other specified paralytic syndromes
344.89 Other specified paralytic syndrome Brown-Sequard's syndrome 721 Spondylosis and allied
disorders 721.1 Cervical spondylosis with myelopathy 721.4 Thoracic or lumbar spondylosis with
myelopathy 721.9 Spondylosis of unspecified site 721.91 With myelopathy 722 Intervertebral disk
disorders 722.7 Intervertebral disk disorder with myelopathy 730 Osteomyelitis, periostitis, and
other infections involving bone 730.2 Unspecified osteomyelitis 733 Other disorders of bone and
cartilage 733.1 Pathologic fracture 806 Fracture of vertebral column with spinal cord injury 839
Other. multiple, and ill-defined dislocations 839.0 Cervical vertebra, closed 839.1 Cervical
vertebra, open 839.2 Thoracic and lumbar vertebra, closed 839.3 Thoracic and lumbar vertebra,
open 839.4 Other vertebra, closed 839.5 Other vertebra, open 839.6 Other location, closed 839.7
Other location, open 839.8 Multiple and ill-defined, closed 839.9 Multiple and ill-defined, open 952
Spinal cord injury without evidence of spinal bone injury 952.0 Cervical 952.1 Dorsal [thoracic]
952.2 Lumbar
Examination
examination procedures and the depth of the examination vary based on patient/client age:
severity of the problem; stage of recovery (subacute, chronic); phase of rehabilitation (early,
intermediate, late, return to activity); home, community, or work (job/school/play)) situation; and
Page 111 of 145
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 112 of 145
intervention
Medications
* Medications for current condition for which patient/client is seeking the services of a Physical
therapist
* Medications for other condition
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Page 113 of 145
Family History
Health Status (Self-report, Family Report, Caregiver Report)
* Psychological function (eg, memory, reasoning ability, anxiety, depression. morale)
* Social activity (eg. social interaction. social activity, social support)
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Test and Measures
* Assessment of perceived exertion, dyspnea, or angina during activity using rating-of-perceived-
Page 114 of 145
exertion (RPE) scales, dyspnea scales, anginal pain scales, or visual analog scales
* Pulse oximetry
* Assessment of height. weight. length. and girth
of device
activities
Page 115 of 145

appropriate
appropriate
activities
analysis of repetition/work/rest cycling during task or
activity
Page 116 of 145

Body mechanics:
activities
* Analysis of arthrokinematic, biomechanical, kinematic. and kinetic characteristics of gait,
or in water
Page 117 of 145

* Analysis of posture during sitting, standing, and locomotor activities appropriate for age
dynamometry
* Electrophysiologic tests (eg, electromyography [EMG] and nerve conduction velocity [NCV])
of device
Page 118 of 145

Pain
* Assessment of pain using questionnaires, graphics, behavioral scales, symptom magnification
Posture
* Analysis of static and dynamic postures using computer-assisted imaging, posture grids, plumb
Reflex Integrity
appropriate
Page 119 of 145

sense)
pressure)
the physical therapist considers throughout the evaluation process, such as chronicity and
severity, of the problem; stability of the condition; preexisting systemic conditions or diseases;
probability of prolonged impairment, functional limitation, or disability; multisite or multisystem
involvement; social supports; living environment; potential discharge destinations; patient/client
and family expectations; anatomic and physiologic changes related to growth and development;
and caregiver consistency or expertise.
Prognosis
Patient/client will be integrated or reintegrated into age-appropriate home and community
environments with maximal independence, within the context of the disability.
Page 120 of 145
Depending on residual motor deficits. patient/client win become completely independent or will
need varying levels of assistance (eg, family, caregiver, equipment) to fulfill his or her various
roles.
4 to 150
continous episode of care. Frequency of visits and duration of the episode of care should be
delivery.
of Episode
* Age
* Caregiver (eg, family, home health aide) consistency, or expertise
* Comorbidities
Intervention
limitation, secondary or primary prevention of disability optimization of patient/client satisfaction).
symptoms, syndrome, or category (diagnosis), intervention man be guided by the alleviation of
Page 121 of 145

Anticipated Goals
professionals.
* Decision making is enhanced regarding the health of
* patient/client and use of health care resources by patient/client, family, significant others, and
caregivers.
identified.
* Case management
* Coordination of care with patient/client, family, significant others, caregivers other health care
* Education plans
* Record reviews
Page 122 of 145
Anticipated Goals
increased.
caregivers.
Page 123 of 145

Direct interventions for this pattern may include, in order of preferred
usage:
Anticipated Goals
* Performance of and independence in ADL arid IADL are increased.
Page 124 of 145
* Aquatic exercises
* Strengthening
- active
- active assistive
* Stretching
Page 125 of 145

IADL)
Anticipated Goals
IADL) is increased.
or Reintegration (Including IADL and Work Conditioning)
Anticipated Goals
* Ability to perform physical task related to community and work (job/school/play) integration or
* Safety is improved during performance of community, work (job/school/play) and leisure aft and
activities
* Risk of recurrence is decreased.
Page 126 of 145

* Environmental, community work (job/school/play), or leisure task adaptation
* Job coaching
* Job simulation
* Leisure activity training
* Orthotic protective, or supportive device or equipment training
Anticipated Goals
Page 127 of 145
Prosthetic)
Anticipated Goals
* Ability to perform physical task is increased.
* Adaptive devices or equipment (eg, raised toilet seats, seating systems environmental controls)
* Orthotic devices or equipment (eg, splints, braces, casts, shoe inserts, casts)
Airway Clearance
Anticipated Goals
* Disability associated with illness or injury is decreased.
Page 128 of 145
* Gas exchange is improved.

* Independence in self-care for airway clearance techniques is increased.
* Need for assistive device (mechanical ventilation) is decreased.
* Active cycle of breathing or forced expiratory technique
* Suctioning
hyperinflation)
Anticipated Goals
Page 129 of 145

* Biofeedback
Anticipated Goals
Reexamination
Outcomes
whole person, a physical action. activity, or task in an efficient, typically expected, or competent
then' are realistic, given the examination and evaluation findings. Optimal outcomes for
* Ability to participate in home, work (job/school/play), or leisure activities is increased.
* Health-related quality of life is improved, Opportunities for completion of psychosocial
development are optimized.
* Optimal return to role function (eg. worker, student, spouse, grandparent) is achieved.
Page 130 of 145
* Risk and cost of hospitalization are reduced.

* Risk of disability associated with nonprogressive disorders of the spinal cord is reduced.
* Safety, independence, and efficiency of functional mobility (eg, gait, wheelchair. transfers) are
maximized.
* Self-care and home management activities, including activities of daily living (ADI) -- and work
performed by patient/client and caregivers safely, efficiently, and at a maximal level of
independence with or without devices and equipment.
* Sexual roles and function are resumed.
demonstrated.
others. and caregivers.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
outcomes include:
* Patient/client and caregivers are aware of the factors that man, indicate need for reexamination
Page 131 of 145
documented. For patients/clients who require multiple episodes of care. periodic follow-up is
status, caregivers. environment, or task demands.
Impaired Arousal, Range of Motion, Sensory Integrity, and Motor Control
Associated With Coma, Near Coma, or Vegetative State
standards of practice: and patient/client age, culture, gender roles, race, sex, sexual orientation,
Patients with impaired arousal, range of motion (ROM), sensation and motor control associated
with coma, near coma, or persistent vegetative state at any age. Patients may have one or a
combination of the following:
* Autonomic nervous system dysfunction
* Skin and bone abnormalities
Page 132 of 145
* Anoxia
* Cerebrovascular accident (stroke)
* Infectious or inflammatory disease
* Tumor
* Amputation
* Pneumonia
ICD-9-CM Codes
049 Other non-arthropod-borne viral diseases of the central nervous system 049.9 Unspecified
non-arthropod-borne viral diseases of the central nervous system Viral encephalitis, not otherwise
specified 322 Meningitis of unspecified cause 342 Hemiplegia and hemiparesis 342.0 Flaccid
hemiplegia 348 Other conditions of brain 348.0 Cerebral cysts 348.1 Anoxic brain damage 431
Intracerebral hemorrhage 433 Occlusion and stenosis of precerebral arteries 433.0 Basilar artery
434 Occlusion of cerebral arteries 435 Transient cerebral ischemia 435.1 Vertebral artery
syndrome 435.8 Other specified transient cerebral ischemias 436 Acute, but ill-defined,
cerebrovascular disease 437 Other and ill-defined cerebrovascular disease 442 Other aneurysm
442.8 Of other specified artery 444 Arterial embolism and thrombosis 444.9 Of unspecified artery
447 Other disorders of arteries and arterioles 447.1 Stricture of artery 747 Other congenital
anomalies of circulatory system 747.8 Other specified anomalies of circulatory system 799 Other
ill-defined and unknown causes of morbidity and mortality 799.0 Asphyxia 850 Concussion 850.5
With loss of consciousness of unspecified duration 850.9 Concussion, unspecified 851 Cerebral
laceration and contusion 852 Subarachnoid, subdural, and extradural hemorrhage, following injury
853 Other and unspecified intracranial hemorrhage following injury 853.0 Without mention of open
intracranial wound 854 Intracranial injury of other and unspecified nature 994 Effects of other
external causes 994.1 Drowning and nonfatal submersion
Examination
Page 133 of 145
(early, intermediate, late, return to activity); home. community, or work (job/school/play) situation;
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
* Social interactions,. social activities, and support systems
Living Environment
Page 134 of 145

intervention
Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
Page 135 of 145
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Page 136 of 145
Test and Measures

Tests and measures for this pattern may include, in alphabetical o
* Assessment of postures that aggravate or relieve edema, lymphedema, or effusion
* Analysis of significant other, family, or caregiver ability to use and care for device
* Review of reports provided by family, significant others, caregivers, or other professionals
- auditory
- gustatory
- olfactory
- vestibular
- visual
Page 137 of 145
* Measurement of physical space using photography or videotape

* Questionnaires completed b%. and interviews conducted with patient/client and others as
appropriate
of device
* Asessment of alignment and fit of device and inspection of related changes in skin condition
* Assessment of family or caregiver ability to put on and remove device and to understand its use
and care
* Review of reports provided by family, significant others, caregivers, or other professionals
Pain
* Assessment of pain and soreness with movement
Posture
* Observation of resting posture assumed in any position
Page 138 of 145

Reflex Integrity
* Assessment of superficial sensations (eg. sharp/dull discrimination, temperature, light touch,
pressure)
* Assessment to determine presence of cyanosis
* Assessment of standard vital signs (eg, blood pressure, heart rate, respiratory rate) at rest
* Management of airway secretions
* Palpation of chest wall (eg. tactile fremitus, pain, diaphragmatic motion)
establishing diagnosis and the prognosis. Factors that influence the complexity of the evaluation
include the clinical findings, extent of loss of function, social considerations, and overall physical
function and health status. A diagnosis is a label encompassing a cluster of signs and symptoms,
syndromes, or categories. It is the result of the diagnostic process, which includes evaluating,
organizing, and interpreting examination data. The prognosis is the determination of the optimal
physical therapist develops the plan of care, which specifies goals and outcomes. specific direct
Page 139 of 145

Prognosis
Patient who continues in coma, near coma, or persistent vegetative state will have minimization of
secondary impairments.
5 to 20
to achieve anticipated goals and desired outcomes. It is anticipated that 80% of patients in this
diagnostic group will achieve the goals and outcomes within 5 to 20 visits during a single
delivery.
* Age
* Comorbidities
Intervention
symptoms, syndrome, or category (diagnosis), intervention may, be guided by the alleviation of
Page 140 of 145
patients/clients, whereas a variety, of direct interventions may be selected, applied, or modified by
Coordination, Community, and Documentation
Anticipated Goals
* Care is coordinated with family significant others, caregivers, and other professionals.
resources by family, significant others, and caregivers.
identified.
* Family, significant other and caregiver understanding of expectations and goals and outcomes is
increased.
* Case management
* Coordination of care with family, significant others, caregivers, other health care professionals,
and other interested persons
* Education plans
* Record reviews
Anticipated Goals
Page 141 of 145
* Awareness and use of community resources by family, significant others and caregivers
are improved
* Decision making is enhanced regarding health of patient/client and use of health care
resources by family significant other and
* Family, significant other, and caregiver knowledge and awareness of the diagnosis, prognosis,
interventions, and goals and outcomes are increased.
* Progress is enhanced through the participation of family, significant others and
caregivers.
* Demonstration by family or caregivers in the appropriate environment
Direct Interventions Direct interventions for this pattern may include, in order of preferred usage:
Anticipated Goals
Page 142 of 145
* Tolerance to positions is increased.

* Nueromuscular relaxation, inhibition, and facilitation
* Stretching
Functional Training in Self-Care and Home Management (Including ADL and IADL)
Anticipated Goals
* ADL training (eg, bed mobility and transfer training, bathing) for caregiver
* Assistive and adaptive device and equipment training for caregiver
* Body mechanics training for caregiver
* Orthotic, protective or supportive device or equipment training for caregiver
Anticipated Goals
* Joint mobility and integrity are improved.
Anticipated Goals
* Safety is improved
Page 143 of 145

* Adaptive devices or equipment (eg, hospital beds. seating systems)
* Assistive devices or equipment (eg, wheelchairs)
* Orthotic devices or equipment (eg, braces, splints)
* Protective devices or equipment (eg, braces, helmets cushions,
protective taping)
* Supportive devices or equipment (eg, supportive taping,
compression garments, corsets,-neck collars, slings, supportive
taping, elastic wraps, oxygen)
Anticipated Goals
* Risk of secondary complication is reduced.
* Assistive devices for airway. clearance (eg, flutter valve)
* Suctioning
* Techniques to maximize ventilation (eg. maximum inspiratory hold, staircase breathing, manual
hyperinflation)
Reexamination
The physical therapist relies on reexamination. the process of performing selected tests and
measures after the initial examination, to evaluate progress and to modified or redirect
intervention. Reexamination may be indicated more than once during a single episode of care. It
also may be performed over the course of a disease or a condition, which -- for some patient/client
diagnostic groups -- may be the life span. Indications for reexamination include new clinical
findings or failure to respond to intervention.
Outcomes
Page 144 of 145
particular social context and physical environment),primary or secondary prevention, and
for therapeutic intervention and perceptions about the clinical situation and considers whether they
are realistic, given the examination and evaluation findings. Optimal outcomes for patients/clients
in this pattern include:
* Activities of daily living (ADL) are performed safely, efficiently, and at a maximal level of
independence by caregivers.
* Appropriate placement according to level of function is determined.
* Disability associated with coma, near coma, or vegetative state is reduced.
* Potential for return to role function is maintained.
* Family significant other, and caregiver understanding of personal and environmental factors that
promote optimal health status is demonstrated.
* Family significant other, and caregiver understanding of strategies to prevent further functional
limitation and disability is demonstrated.
* Access, availability and services provided are acceptable to family, significant others, and
caregivers.
* Administrative management of practice is acceptable to family, significant others, and
caregivers.
* Clinical proficiency of physical therapist is acceptable to family significant others, and caregivers.
* Coordination and conformity of care are acceptable to family, significant others, and caregivers.
* Interpersonal skills of physical therapist are acceptable to family significant others, and
caregivers.
Page 145 of 145
* Family significant other, and caregiver adherence to the intervention program is maximized.
* Family, significant others, and caregivers are aware of the factors that may indicate need for
reexamination or a new episode of care, including changes in the following: medical status,
caregiver status, having environment, pathology or impairment that may affect function, or
resources.
* Professional recommendations are integrated into home and community environments.
guardian declines to continue intervention patient/client is unable to continue to progress toward
Source Citation:"Neuromuscular." Physical Therapy 77.n11 (Nov 1997): 1371(79). Expanded Academic
ASAP. Gale. University of Florida. 21 Nov. 2008

Page 1 of 188
Cardiopulmonary.(includes related information)(Preferred Practice Patterns)(Guide to

(104). (44288 words)
Preferred Practice Patterns: Cardiopulmonary

therapists -- examination (History, systems review, and tests and measures). evaluation,
outcomes, and criteria for discharge.
Primary Prevention/Risk Factor Reduction for Cardiopulmonary Disorders
Patients/clients with decreased maximum aerobic capacity who are at risk for developing cardiac
disease, pulmonary disease, or both, based on well-accepted risk factor profiles that have been
published in the literature.
INCLUDES patients/clients who may have several of the following:
* Diabetes
* Family history of heart disease
* Hypercholesterolemia or hyperlipidemia
* Hypertension
* Obesity
* Significant smoking history
Page 2 of 188
* Known diagnosis of heart disease

* Known diagnosis of pulmonary disease
ICD-9-CM Codes
preferred practice pattern. Because the patient/client dignostic group is defined by impairments
functional limitations and not by codes, it is possible for individuals to belong to the group even
though the codes may not apply to them.
250 Diabetes mellitus 272 Disorders of lipoid metabolism
272.0 Pure hypercholesterolemia 278 Obesity and other hyperalimentation
278.0 Obesity 305 Nondependent abuse of drugs
305.1 Tobacco use disorder 401 Essential hypertension
Factors Influencing Health Status and Contact With Health Services
V17 Family history of certain chronic, disabling diseases
V17.4 Other cardiovascular diseases
Examination
Through the examination (history, systems review, and measures) the physical therapist identifies
impairments, functional limitations, disabilities, or changes in physical function and health status
resulting from injury, disease, or other causes to establish the diagnosis and the prognosis and to
determine the intervention. The patient/client, family, significant others, and caregivers participate
by reporting activity performance and functional ability. The selection of examination procedures
and the depth of the examination vary based on patient/client age; severity of the problem; stage
of recovery (acute, subacute, chronic); phase of rehabilitation (early, intermediate, late, return to
activity); home, community, or work (job/school/play) situation; and other relevant factors. For
clinical indications and types of data generated by the tests and measures, refer to Part One,
Chapter 2.
History
* Age
Page 3 of 188
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
intervention
* Patient/client, family, significant other, and caregiver perceptions of patients/ client's emotional
Page 4 of 188
* Sleep patterns and positions
Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
Page 5 of 188

* level of physical fitness (self-care, home management, community, work [job/school/play], and
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Communication, effect, cognition, lanquage, and learning style
Tests and Measures
* Assessment of perceived exertion, dyspnea, or angina during activity, using rating-of-perceivedexertion (RPE) scales, dyspnea scales, anginal pain scales, or visual analog scales
Page 6 of 188

* interpretation of blood gas analysis or oxygen consumption ([VO.sub.2]) studies
* Pulse oximetry
impedance
activities
appropriate
Page 7 of 188
Ergonomics:
* Assessment of safety in work (job/school/play) environments
activities
* Analysis of muscle strength, power, and endurance, using manual muscle testing or
dynamometry
Posture
lines, still photography. videotape. or visual analysis
* Analysis of ROM using goniometers, tape measures, flexible rules, inclinometers, photographic
* Analysis of thoracoabdominal movements and breathing patterns at rest, during activity and
during exercise
Page 8 of 188

* Interpretation of blood gas analysis or oxygen consumption (VO.sub.2) studies
evaluation include the clinical findings, extent. of loss of function social considerations, and overall
the path" level of improvement that might be attained and the amount of time required to reach
Frequency and duration may vary greatly among patients/client based on a variety of factors that
of the problem; stability of the condition; preexisting systemic conditions or diseases; probability If
Prognosis
Patient/client will demonstrate independence in an aerobic exercise program and be able to
identify personal risk factors for cardiopulmonary disease and the methods he or she will use to
reduce risk.
Expected Range of Number of Visits Per Episode of Care 1 to 6 This range represents the lower
and upper limits of the number of physical therapist visits required to achieve anticipated goals
and desired outcomes. It is anticipated that 80% of patients/clients in this diagnostic group will
achieve the goals and outcomes within I to 6 visits during a single continuous episode of care.
Frequency of visits and duration of the episode of care should be determined by the physical
therapist to maximize effectiveness of care and efficiency of service delivery.
Page 9 of 188
Factors That May Modify Frequency of Visits

* Age
* Caregiver (eg, family home health aide) consistency or expertise
* Comorbidities
* Psychosocial and socioecomic stressors
* Support provided by family unit intervention
Intervention
plan of care, the physical therapist determined the degree to which intervention is likely to achieve
limitation, secondary or primary prevention of disability, organization of patient/client satisfaction).
Anticipated Goals
Page 10 of 188
patient/client, family, significant others, and caregivers.

* Education plans
Anticipated Goals
increased.
client.
* Physical function and health status are improved
Page 11 of 188
Direct interventions Direct interventions for this pattern may include, in order of preferred usage:
Anticipated Goals
* Aquatic exercises
* Strengthening:
- active
- active assistive
* Stretching
Functional Training in Self-care and Home Management (Including ADL and IADL)
Anticipated Goals
Page 12 of 188

Functional Training in Community and Work (Job/School/Play) Integration or Reintegration
(Including IADL, Work Hardening, and Work Conditioning)
Anticipated Goals
* Ability to perform physical tasks related to community and work (job/school/play) integration and
Outcomes
particular social context and physical environment ,primary or secondary prevention, and patient
client satisfaction. The physical therapist also identifies the patient's/client's expectations for
therapeutic interventions and perceptions about the clinical situation and considers whether they
are realistic, given the examination and evaluation findings. Optimal outcomes for patients/clients
in this pattern include:
equipment.
demonstrated.
Page 13 of 188

Client Satisfaction
* Access, availability and services provided are acceptable to client.
for appropriate follow-up or referml. The primary criterion for discharge: The anticipated goals and
the patient/client will no longer benefit from physical therapy When discharge occurs prior to
Impaired Aerobic Capacity and Endurance Secondary to Deconditioning Associated With
Systemic Disorders
Patients/clients with impaired aerobic capacity associated with systemic disorders that impair
mobility or interfere with systemic response to increased oxygen demand. Patients/clients may
have any one or a combination of the following:
* Decreased ability. To perform endurance conditioning
* Decreased independence in activities of daily living (ADL) or instrumental activities of daily living
IADL)
Page 14 of 188
* Immediate prior history, of bed rest for more than 48 hours

* Increased symptoms with increased activity
* History of inactivity secondary. To systemic impairment
* Acquired immune deficiency syndrome (AIDS)
* Cancer
* Cardiopulmonary disorders
* Chronic system failure
* Multisystem impairments
* Musculoskeletal disorders
* Neuromuscular disorders
* Acute cardiovascular pump failure
* Acute respiratory failure
* Airway clearance impairment
* Mechanical ventilation
ICD-9-CM Codes
As of press time, the listing below contains the most typical ICD-9-CM codes related to two
and functional limitations are not by codes, it is possible for individuals to belong to the group even
though the codes may not apply to them.
Classification of Diseases. Ninth Revision, Clinical Modification ICD-9-CM) or to other ICD-9-CM
coding manuals that contain exclusion notes add instructions regarding fifth-digit requirements.
042 Human immunodeficiency virus [HIV] disease Acquired immune deficiency sydrome [AIDS]
250 Diabetes mellitus
250.4 Diabetes with renal manifestations
250.8 Diabetes with other specified manifestations
Page 15 of 188
250.9 Diabetes with unspecified complications

332 Parkinson's disease
333 Other extrapyramidal disease and abnormal movement
disorders
333.0 Other degenerative diseases of the basal ganglia
333.3 Tics of organic origin
333.4 Huntington's chorea
333.9 Other and unspecified extrapyramidal disease and
abnormal movement disorders
334 Spinocerebellar disease
334.2 Primary cerebellar degeneration
335 Anterior horn cell disease
335.2 motor neuron disease
335.20 Amyotrophic lateral sclerosis
340 Multiple sclerosis
344 Other paralytic syndromes
344.0 Quadriplegia and quadriparesis
357 Inflammatory and toxic neuropathy
357.0 Acute infective polyneuritis
Guillain-Barre syndrome
359 Muscular dystrophies and other myopathies
359.1 Hereditary progressive muscular dystrophy
443 Other peripheral vascular disease
443.9 Peripheral vascular disease, unspecified
482 Other bacterial pneumonia
Page 16 of 188
482.2 Pneumonia due to Hemophiluss influenzae

482.9 Bacterial pneumonia unspecified
491 Chronic bronchitis
491.9 Unspecified chronic bronchitis
492 Emphysema
492.8 Other emphysema
493 Asthma
494 Bronchiectasis 496 Chronic airway obstruction, not elsewhere classified Chronic obstructive
pulmonary disease [COPD], not otherwise specified
508 Respiratory conditions due to other and unspecified external agents
508.9 Respiratory conditions, due to unspecified
external agent 513 Abscess of lung and mediastinum
513.0 Abscess of lung
514 Pulmonary congestion and hypostasis
516 Other alveolar and parietoalveolar pneumonopathy
516.9 Unspecified alveolar and parietoalveolar
pneumonopathy,
517 Lung involvement in conditions classified elsewhere
517.8 Lung involvement in other diseases classified
elsewhere
518 Other diseases of lung
518.0 Pulmonary collapse
518.89 Other diseases of lung, not elsewhere
classified
519 Other diseases of respiratory system
Page 17 of 188
519.4 Disorders of diaphragm

711 Arthropathy associated with infections
712 Crystal arthropathies
713 Arthropathy associated with other disorders classified
elsewhere
714 Rheumatoid arthritis and other inflammatory
polyarthropaties
715 Osteoarthrosis and allied disorders
786 Symptoms involving respiratory system and other chest
symptoms
786.0 Dyspnea and respiratory abnormalities
Procedure Codes
34 Operations on chest wall, pleura, mediastinum, and
diaphragm
34.9 Other operations on thorax
34.99 Other
54 Other operations on abdominal region
54.9 Other operations of abdominal region
54.99 Other
Examination
Page 18 of 188
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 19 of 188
intervention
Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Page 20 of 188

Family History
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
Page 21 of 188

* Pulse oximetry
impedance
* Observation and palpation of trunk and extremities at rest and during activity
Page 22 of 188
safety awareness)
of device
* Review of reports provided by patient/client, family, significant others, caregivers or other
activities
appropriate
* Review of reports provided by patient/client, family, significant others, caregivers, or other health
Page 23 of 188

* Physical inspection of environment
appropriate
activities
Page 24 of 188

* Videotape analysis of patient/client at work (job/school/play)
* Analysis of arthrokinematic, biomechanical, kinematic and kinetic characteristics of gait,
* Assessment of soft tissue swelling, inflammation or restriction
* Analysis of functional muscle strength
dynamometry
* Analysis of effects and benefits including energy conservation and expenditure) while
of device
Page 25 of 188
its use and care
Pain
* Analysis of pain behavior and reaction during specific movements and provocation
scales or indexes, and visual analog scales
Posture
* Analysis of static and dynamic postures, using computer-assisted imaging, posture girds, plumb
of device
its use and care
Page 26 of 188
Range of Motion (ROM) including Muscle Length)

* Assessment of muscle, joint, or soft tissue characteristics Analysis of ROM using goniometers,
tape measures, flexible rulers, inclinometers, photographic or electronic devices, or computerassisted graphic imaging
Self-Care and Home Management including ADL and IADL)
* ADL scales or indexes
appropriate
professionals
* Analysis of thoracoabdominal movements and breathing patterns at rest, during activity, and
during exercise
Page 27 of 188

* Assessment and classification of edema using volume and girth measurements
* Pulse oximetry
establishing he diagnosis and the prognosis. Factors that influence the complexity of the
Prognosis
Within 6 weeks, patient/client will demonstrate improved functional capacity and increased ability
to perform activities of dad), living (ADL) and instrumental activities of daily living (IADL) without
exacerbation of signs and symptoms, or patient/client will demonstrate an increase in muscle
strength and endurance and an increase in exercise tolerance.
Page 28 of 188

service delivery.
* Age
* Comorbidities
* Level of patient/client adherence to intervention program
Intervention
prognosis for a specific patient/client. F o r clinical indications for the direct interventions, refer to
Page 29 of 188

Anticipated Goals
professionals.
identified.
* Resources are maximally utilized.
* Case management
* Education plans
* Record reviews
Anticipated Goals
Page 30 of 188

by patient/client, f", significant others, and caregivers.
increased.
caregivers.
* Demonstration by patient/client or caregiver in the appropriate environment
Page 31 of 188
Anticipated Goals
* Aerobic endurance activities using treadmill, ergometer, steppers, pulleys, weights, hydraulics,
* Strengthening
- active
- active assistive
Page 32 of 188
* Stretching
IADL)
Anticipated Goals
* Ability, to recognize and initiate treatment of a recurrence is improved through increased selfmanagement of symptoms.
* Ability, to perform physical tasks related to self-care and home management (including ADL and
IADL) is increased.
* ADL training (eg, bed mobility, and transfer training, gait training locomotion, developmental
* IADL training (eg, maintaining a home, shopping, cooking, home chores, heavy, household
* Orthotic, protective, or supportive device training
Anticipated Goals
Prosthetic)
Anticipated Goals
Page 33 of 188

* Performance of and independence in ADL and AIDL are increased.
* Adaptive devices or equipment (eg, raised toilet seats., seating systems, environmental controls)
* Supportive devices or equipment (eg, supportive taping, corsets, neck collars, serial casts,
elastic wraps, oxygen)
Reexamination
Outcomes
Page 34 of 188
* Risk of disability associated with deconditioning associated with systemic disorders is reduced.
(job/school/play) and leisure activities, including instrumental activities of daily living (AIDL) -- are
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
* Level of patient/client adherence to the intervention program is maximized.
adaptation, leisure or leisure activities, living environment, pathology or impairment that may affect
function, or home or work (job/school/play) settings.
Page 35 of 188

the desired outcomes had been achieved. Other indicators: patient/client, caregiver, or legal
Impaired Ventilation, Respiration (Gas Exchange), and Aerobic Capacity
Associated With Airway Clearance Dysfunction
standards of practice; and patient/client age, culture, gender roles, ace, sex, sexual orientation,
Patients/clients with impaired airway clearance, respiration (gas exchange), or ventilation
accompanied by impaired aerobic capacity and impaired function. Patients/clients may have any
one or a combination of the following:
* Change in baseline breath sounds
* Change in baseline chest radiograph
* Dyspnea
* Impaired gas exchange
* Impaired performance in activities of daily living (ADL) or instrumental activities of daily living
(IADL)
* Increased work of breathing
Page 36 of 188
* Pulmonary infection, including frequent or recurring infections

* Acute lung disorders
* Acute or chronic oxygen dependency
* Bone marrow/cell transplants
* Cardiothoracic surgery
* Chronic obstructive pulmonary disease (COPD)
* Solid-organ transplants (eg, heart, lung, kidney)
* Tracheostomy or microtracheostomy
* Age of fewer than 4 months
* Multisystem failure
* Respiratory failure
ICD-9-CM Codes
coding manuals that contain exclusion notes and instruction regarding fifth-digit requirements.
136 Other and unspecified infectious and parasitic diseases 136.3 Pneumocytosis Pneumonia
due to Pneumocystis carinii 277 Other and unspecified disorders of metabolism 277.0 Cystic
fibrosis 482 Other bacterial pneumonia 482.2 Pneumonia due to Hemophilus influenzae
[H.influenzae] 482.9 Bacterial pneumonia unspecified 491 Chronic bronchitis 491.8 Other chronic
bronchitis 491.9 Unspecified chronic bronchitis 492 Emphysema 492.8 Other emphysema 493
Asthma 494 Bronchiectasis 496 Chronic airway obstruction, not elsewhere classified Chronic
obstructive pulmonary disease [COPD], not otherwise specified 500 Coal workers'
pneumoconiosis 501 Asbestosis 502 Pneumoconiosis due to other silica or silicates 503
Pneumoconiosis due to other inorganic dust 504 Pneumonopathy due to inhalation of other dust
505 Pneumoconiosis, unspecified 507 Pneumonitis due to solids and liquids 507.7 Due to
inhalation of food or vomitus Aspiration pneumonia 508 Respiratory conditions due to other and
Page 37 of 188
unspecified external agents 508.9 Respiratory conditions due to unspecified external agent 510
Empyema 511 Pleurisy 513 Abscess of lung and mediastinum 513.0 Abscess of lung 514
Pulmonary congestion and hypostasis 515 Postinflammatory pulmonary fibrosis 516 Other
alveolar and parietoalveolar pneumonopathy 516.9 Unspecified alveolar and parietoalveolar
pneumonopathy 518 Other diseases of lung 518.0 Pulmonary collapse 518.8 Other diseases of
lung 518.89 Other diseases of lung, not elsewhere classified 759 Other and unspecified
congenital anomalies 759.3 Situs inversus Kartagener's syndrome or triad 770 Other respiratory
conditions of fetus and newborn 770.7 Chronic respiratory disease arising in the perinatal period
Bronchopulmonary dysplasia 786 Symptoms involving respiratory system and other chest
symptoms 786.0 Dyspnea and respiratory abnormalities 786.00 Respiratory abnormality,
unspecified 786.5 Chest pain 786.52 Painful respiration 861 Injury to heart and lung 861.2 Lung,
without mention of open wound into thorax 861.21 Contusion 996 Complications peculiar to
certain specified procedures 996.0 Mechanical complication of cardiac device, implant, and graft
996.1 Mechanical complication of other vascular device, implant, and graft 996.2 Mechanical
complication of nervous system device, implant, and graft 996.3 Mechanical complication of
genitourinary device, implant, and graft 996.4 Mechanical complication of internal orthopedic
device, implant, and graft 996.5 Mechanical complication of other specified prosthetic device,
implant, and graft 996.8 Complications of transplanted organ 996.85 Bone marrow complications
997 Complications affecting specified body systems, not elsewhere classified 997.3 Respiratory
complications
Factors Influencing Health Status and Contact With Health Services V42 Organ or tissue replace
by transplant V42.0 Kidney V42.2 Heart valve V42.3 Skin V42.4 Bone V42.6 Lung V42.7 Liver
V42.8 Other specified organ or tissue V42.81 Bone marrow V42.82 Peripheral stem cells V42.83
Pancreas V42.89 Other
Procedures 32 Excision of lung and bronchus 34 Operations on chest wall, pleura, mediastinum,
and diaphragm 34.9 Other operations on thorax 34.99 Other 36 Operations on vessels of heart
36.1 Bypass anastomosis for heart revascularization 54 Other operations on abdominal region
54.9 Other operations of abdominal region 54.99 Other
Examination
examination procedures and the depth of the examination. based on patient/client age; severity of
the problem; stage of recovery acute, subacute, chronic); phase of rehabilitation (early,
intermediate, late, return to activity); home, community, or Work (job/school/play) situation; and
History
Data generated from the history may includes:
* Age
Page 38 of 188
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
intervention
Page 39 of 188
Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
Page 40 of 188

leisure activities)
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
Page 41 of 188

* Pulse oximetry
* Tests and measures of pulmonary posture and ventilatory mechanics
* Assessment of activities and postures that aggravate or relieve edema, lymphedema, or
effussion
of device
* Analysis of patient/client and caregiver ability to care for device.
* Review of reports provided by patient/client family, significant others, family, caregivers, or other
Page 42 of 188

* Assessment of automic responses to positional changes
activities
appropriate
care professionals, or other interested persons (eg, rehabilitation counselor Workers'
* Questionnaires completed by and interviews conducted with
* patient/client and others as appropriate
Integumentary Integrity For skin associated with integumentary disruption:
Page 43 of 188

For wound:
dynamometry
Patient/client wears device
of device
its use and care
Posture
fines, still photography, videotape, or visual analysis
Page 44 of 188

* Analysis of self-care in unfamiliar environment
* Review of daily activities log
during exercise
* Assessment and classification of edema using volume and girth measurements
* Palpation of chest wall (eg, tactile fremitus, pain, diaphrugmatic motion)
Page 45 of 188
* Pulse oximetry
Prognosis
Within 6 weeks, one of the following will occur:
* Patient/client will have an absence of secretions or will be able to clear secretions independently.
* Chest radiograph will return to baseline.
* Caregiver will be able to manage the secretions.
Patients/clients in this diagnostic group will achieve the goals and outcomes within 5 to 30 visits
service delivery.
of Episode
Page 46 of 188
* Comorbidities
Intervention
patients/clients, whereas a variety of direct interventions man, be selected, applied, or modified by
Anticipated Goals
* Care is coordinated with patient/client, family, significant others, caregivers, or other
professionals;
identified.
Page 47 of 188
* Case management
* Education plans
* Record reviews
Anticipated Goals
by patient,/client, family, significant others, and caregivers.
* Disability associated with acute or chromic illnesses is reduced.
* Functional independence activities of daily living (ADL) and instrumental activities of daily living
(IADL) is increased.
prognosis, interventions, and goals and outcome are increased.
Page 48 of 188
increased.
* Progress is enhanced through the participation of patient/client, family significant others, and
caregivers.
Anticipated Goals
Page 49 of 188

* Pyschologic response to increased oxygen demand is improved.
* Quality and quantity of movement between and across body segments are improved
* Tissue perfusion and oxygenation are improved,
* Aerobic endurance activities using ergometers, treadmill, steppers, pulleys, weights, hydraulics,
elastic resistance bands robotics, and mechanical or electromechanical devices
* Body, mechanics and ergonomics training
* Strengthening:
- active
- active assistive
* Stretching
Page 50 of 188
Anticipated Goals
IADL) is increased.
* ADL training (eg, bed mobility and transfer training,, gait training, locomotion, developmental
Functional Training in Community and Work (Job/School/Play) integration
Anticipated Goals
* Ability to perform physical tasks related to community and work job/school/play) integration and
reintegration and leisure tasks. movements, or activities is increased.
activities.
* Environmental, community. work job/school/play), or leisure task adaptation
infants and children, negotiating school environments)
* Orthotic,. protective, or supportive device and equipment training
Page 51 of 188

Anticipated Goals
Anticipated Goals
Page 52 of 188

* Breathing strategies (eg, training in paced breathing, pursed-lip breathing)
* Forced expiratory techniques
* Suctioning
hyperinflation)
Reexamination
Outcomes
* Risk of disability associated with airway clearance dysfunction is reduced.
Page 53 of 188
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
Page 54 of 188

Impaired Aerobic Capacity and Endurance Associate With
Cardiovascular Pump Dysfunction
PATTERN D
Patients/clients who have impaired aerobic capacity associated with cardiovascular pump
dysfunction and who may have one or a combination of the following:
* Abnormal heart rate response to increased oxygen demand
* Decreased ejection fraction (30%-50%)
* Exercise-induced myocardial ischemia (1-2 mm ST segment, depression)
* Functional capacity of less than or equal to 5 to 6 metabolic equivalent units (METs)
* Hypertensive blood pressure response to increased oxygen demand
* Nonmalignant arrhythmias
* Symptomatic response to increased oxygen demand
* Angioplasty or atherectomy
* Cardiomyopathy
Page 55 of 188
* Coronary artery bypass grafting

* Coronary artery disease
* Hypertensive heart disease
* Uncomplicated myocardial infarction
* Valvular heart disease
* Airway clearance impairment
* Heart failure
ICD-9-CM Codes
391 Rheumatic fever with heart involvement 394 Diseases of mitral valve 395 Diseases of aortic
valve 396 Diseases of mitral and aortic valves 397 Diseases of other endocardial structures 398
Other rheumatic heart disease 402 Hypertensive heart disease 403 Hypertensive renal disease
404 Hypertensive heart and renal disease 410 Acute myocardial infarction 411 Other acute and
subacute forms of ischemic heart disease 412 Old myocardial infarction 413 Angina pectoris 414
Other forms of chronic ischemic heart disease 416 Chronic pulmonary heart disease 416.0
Primary pulmonary hypertension
417 Other diseases of pulmonary circulation 417.0 Arteriovenous fistula of pulmonary vessels
422 Acute myocarditis 423 Other diseases of pericardium 423.2 Constrictive pericarditis
424 Other diseases of endocardium 424.0 Mitral valve disorders
425 Cardiomyopathy 426 Conduction disorders 426.0 Atrioventricular block, complete 426.1
Atrioventricular block, other and unspecified
427 Cardiac dysrhythmias 429 Ill-defined descriptions and complications of heart disease 429.0
Myocarditis, unspecified
Page 56 of 188
440 Atherosclerosis 441 Aortic aneurysm and dissection 443 Other peripheral vascular disease
Procedures
34 Operations on chest wall, pleura, mediastinum, and diaphragm 34.9 Other operations on
thorax 34.99 Other
36 Operations on vessels of heart 36.1 Bypass anastamosis for heart revascularization
Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
* Current and prior community and work job/school) activities
Page 57 of 188
* Developmental History
Living Environment
intervention
Medications
therapist
Page 58 of 188

* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
Health Status (Self-Report, Family
Report, Caregiver Report)
* Role function (eg, worker, student, spouse, grandparent) Social function (eg, social interaction,
social activity, social support)
leisure activities)
Systems Review
Page 59 of 188

* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
* Pulse oximetry
Page 60 of 188

* Measurement of body fat composition using calipers, underwater weighing tanks, or electrical
impedance
safety awareness)
of device
Community and Work (Job/School/Play) Integration or
Reintegration (Including IADL)
Page 61 of 188
activities
appropriate
appropriate
Ergonomics:
Page 62 of 188

activities
- analysis of repetition/work/rest cycling during task or activity - assessment of tools, devices, or
equipment used - assessment of vibration - assessment of workstation - computer-assisted
motion analysis of performance of selected movements or activities - identification of essential
functions of task or activity - identification of sources of actual and potential trauma, cumulative
trauma, or repetitive stress
* Videotape analysis of patient/client at work (job/school/play)
Body Mechanics:
Page 63 of 188
dynamometry
of device
its use and care
Pain
Posture
Page 64 of 188

Reflex integrity
* Assessment of pathologic reflexes (eg, Babinski's reflex)
appropriate
professionals
during exercise
* Assessment and classification of edema through volume and girth measurements
Page 65 of 188

* Pulse oximetry
Page 66 of 188

Prognosis
Within 12 weeks, patient/client will have a functional capacity of greater than or equal to 6
metabolic equivalent units (METS), will recognize signs and symptoms of cardiovascular
compromise, will be independent and safe with an aerobic exercise program, and will be able to
identify his or her own risk factors for heart disease and the interventions required to modify those
risk factors.
service delivery.
of Episode
* Age
* Comorbidities
Page 67 of 188
Intervention
Anticipated Goals
professionals.
* Decision making is enhanced regarding the health of patient/client and the use of health care
identified.
* Case management
Page 68 of 188
* Education plans
* Record reviews
Anticipated Goals
* Patient/client, family. significant other, and caregiver knowledge and awareness of the diagnosis,
prognosis. interventions., and goals and outcomes are increased.
increased.
caregivers.
Page 69 of 188

Anticipated Goals
Page 70 of 188

* Strengthening:
- active - active assistive - resistive, using manual resistance, pulleys, weights, hydraulics, elastic
resistance bands, robotics, and mechanical or electromechanical devices
* Stretching
IADL)
Anticipated Goals
IADL) is increased.
* Safety is improved during self-care and home management tasks and activities.
* Orthotic, protective, or supportive devices and equipment training
Anticipated Goals
Page 71 of 188
* Risk of recurrence is reduced.

activities.
* Ergonomic stressor reduction
* job simulation
Prosthetic)
Anticipated Goals
* Prostheses (eg, artificial limbs)
Page 72 of 188
* Protective devices or equipment (eg, braces. protective taping, cushions, helmets)

Anticipated Goals
hyperinflation)
Reexamination
The physical therapist relies on ree-xamination, the process of performing selected tests and
Outcomes
* Risk of disability associated with cardiovascular pump dysfunction is reduced.
Page 73 of 188

equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
outcomes include:
Page 74 of 188
psychological, or anatomical structure or function) and desired outcomes described above). In
the patient,/client will no longer benefit from physical therapy. When discharge occurs prior to
Impaired Aerobic Capacity and Endurance Associated With Cardiovascular Pump
Failure
Patients/clients who have impaired aerobic capacity associated with cardiovascular pump failure
and who may have any one or a combination of the following:
* Abnormal heart rate response to increased oxygen demand
* Complex ventricular arrhythmias
* Ejection fraction of less than 30%
* Flat or falling blood pressure response to increased oxygen demand
* Functional capacity of less than or equal to 4 or 5 metabolic equivalent units (METs)
* Severe exercise-induced myocardial ischemia ([is greater than]2 mm ST segment, depression)
* Symptomatic response to increased oxygen demand
* Atrioventricular block
* Cardiogenic shock
Page 75 of 188
* Cardiomyopathy
* Complicated myocardial infarction
* Membrane oxygenator
* Intra-aortic balloon pump support
* Left ventricular assist device
ICD-9-CM Codes
391 Rheumatic fever with heart involvement 394 Diseases of mitral valve 395 Diseases of aortic
valve 396 Diseases of mitral and aortic valves 397 Diseases of other endocardial structures 398
Other rheumatic heart disease 402 Hypertensive heart disease 403 Hypertensive renal disease
404 Hypertensive heart and renal disease 410 Acute myocardial infarction 411 Other acute and
subacute forms of ischemic heart disease 412 Old myocardial infarction 413 Angina pectoris 414
Other forms of chronic ischemic heart disease 415 Acute pulmonary heart disease 416 Chronic
pulmonary heart disease
416.0 Primary pulmonary hypertension 422 Acute myocarditis 423 Other diseases of pericardium
423.2 Constrictive pericarditis 424 Other diseases of endocardium
424.0 Mitral valve disorders 425 Cardiomyopathy 426 Conduction disorders
426.0 Atrioventricular block, complete
426.1 Atrioventricular block, other and unspecified 427 Cardiac dysrhythmias 428 Heart failure
428.0 Congestive heart failure 429 Ill-defined descriptions and complications of heart disease
429.0 Myocarditis, unspecified 440 Atherosclerosis 441 Aortic aneurysm and dissection 444
Arterial embolism and thrombosis
Page 76 of 188
Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 77 of 188

intervention
Medications
therapist
* Prior medications
* Cardiopulmonary
Page 78 of 188
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
Page 79 of 188
* Neuromuscular
Tests and Measures
* Pulse oximetry
Page 80 of 188
impedance
safety awareness)
of device
(Including IADL)
Page 81 of 188
activities
appropriate
appropriate
Ergonomics:
* Assessment of safety in work (job/school/play) environments Body Mechanics:
or in water
Page 82 of 188

dynamometry
of device
Page 83 of 188

its use and care
Pain
Posture
fines, still photography, video-tape, or visual analysis
Reflex Integrity
appropriate
* ADL scales and indexes
Page 84 of 188

professionals
during exercise
* Assessment classification of edema through volume and girth measurements
Page 85 of 188

* Palpation of chest wall (eg, tactile fremitus, pain, and diaphragmatic motion)
* Pulse oximetry
Prognosis
Within 12 weeks, patient/client will have increased functional capacity; will be independent and
safe with an aerobic exercise program; will be able to identify signs and symptoms of cardiac
compromise and his or her own risk factors for heart disease and the interventions that modify
those risks; and will demonstrate improved participation in activities of daily living (ADL) and
instrumental activities of daily living (IADL) without exacerbation of signs and symptoms.
14 to 44
Page 86 of 188
delivery.
of Episode
* Age
* Comorbidities
Intervention
Anticipated Goals
Page 87 of 188

professionals.
identified.
* Case management
* Education plans
* Record reviews
Anticipated Goals
Page 88 of 188
* Disability, associated with acute or chronic illnesses is reduced.

increased.
caregivers.
Anticipated Goals
Page 89 of 188
* Aerobic endurance activities
* Strengthening:
- active
- active assistive
* Stretching
IADL)
Anticipated Goals
IADL) is increased.
Page 90 of 188

* Orthotic, protective, or supportive device and equipment training
or Reintegration (Including IADL, Work
Anticipated Goals
reintegration and leisure tasks, movements, or activities is in
activities.
* Ergonomic stressor reduction
Page 91 of 188
* Job simulation
* Orthotic, protective, and supportive device or equipment training
Anticipated Goals
Reexamination
Page 92 of 188
Outcomes
* Risk of disability associated with cardiovascular pump failure is reduced.
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
Page 93 of 188

outcomes include:
* Level of patient/client adherence to the intervention program is maximized,
status,
Impaired Ventilation, Respiration (Gas Exchange), and Aerobic Capacity
and Endurance Associated With Ventilatory Pump Dysfunction
Patients/clients with impaired respiration (gas exchange), ventilation, respiratory muscle
performance (strength, power, endurance), and airway clearance accompanied by impaired
Page 94 of 188
aerobic capacity and functional limitation. Patients/clients may have any one or a combination of
the following:
* Abnormal respiratory rate and pattern
* Change in baseline breath sounds
* Decreased strength or endurance of ventilatory muscles
* Decreased vital capacity or tidal volume
* Dyspnea
* Frequent or recurring pulmonary infection
* Impaired cough
* Impaired gas exchange
* Impaired performance of activities of daily living (ADL) or instrumental activities of daily living
(IADL)
* Impaired posture
* Impaired secretion clearance
* Acute or chronic oxygen dependency
* Diaphragmatic disorders
* Intermittent negative pressure or assistive ventilatory support
* Musculoskeletal disorders affecting ventilation
* Neuromuscular disorders affecting ventilation
* Status pre-lung transplant
* Restrictive lung disease
* Tracheostomy/microtracheostomy
Page 95 of 188

* Mechanical ventilator dependency, 24 hours per day
ICD-9-CM Codes
045 Acute poliomyelitis 192 Malignant neoplasm of other and unspecified parts of nervous system
192.2 Spinal cord
Cauda equina 237 Neoplasm of uncertain behavior of endocrine glands and nervous system
237.5 Brain and spinal cord 277 Other and unspecified disorders of metabolism
277.0 Cystic fibrosis 332 Parkinson's disease 333 Other extrapyramidal disease and abnormal
movement disorders
333.0 Other degenerative diseases of the basal ganglia
333.3 Tics of organic origin
333.4 Huntington's chorea
333.9 Other and unspecified extrapyramidal disease abnormal movement disorders 334
Spinocerebellar disease
334.2 Primary cerebellar degeneration 335 Anterior horn cell disease
335.2 Motor neuron disease
335.20 Amyotrophic lateral sclerosis 340 Multiple sclerosis 343 Infantile cerebral palsy 344 Other
paralytic syndromes
344.0 Quadriplegia and quadriparesis 357 Inflammatory and toxic neuropathy
357.0 Acute infective polyneuritis
Guillain-Barre syndromes 359 Muscular dystrophies and other myopathies
359.1 Hereditary progressive muscular dystrophy 482 Other bacterial pneumonia
Page 96 of 188
482.9 Bacterial pneumonia unspecified 491 Chronic bronchitis

491.8 Other chronic bronchitis
491.9 Unspecified chronic bronchitis 492 Emphysema
492.8 Other emphysema 493 Asthma 494 Bronchiectasis 496 Chronic airway obstruction, not
elsewhere classified
Chronic obstructive pulmonary disease [COPD], not otherwise specified 513 Abscess of lung and
mediastinum
513.0 Abscess of lung 515 Postinflammatory pulmonary fibrosis 516 Other alveolar and
parietoalveolar pneumonopathy
516.9 Unspecified alveolar and parietoalveolar
pneumonopathy 518 Other diseases of lung
518.0 Pulmonary collapse
518.89 Other diseases of lung, not elsewhere
classified 519 Other diseases of respiratory system
519.4 Disorders of diaphragm 737 Curvature of spine
737.3 Kyphoscoliosis and scoliosis 770 Other respiratory conditions of fetus and newborn
770.7 Chronic respiratory diseases arising in the
perinatal period
Bronchopulmonary dysplasia 786 Symptoms involving respiratory system and other chest
symptoms
786.0 Dyspnea and respiratory abnormalities
786.00 Respiratory abnormality, unspecified
786.5 Chest, pain
786.52 Painful respiration 803 Other and unqualified skull fractures 850 Concussion 852
Subarachnoid, subdural, and extradural hemorrhage, following injury 853 Other and unspecified
intracranial hemorrhage following injury 854 Intracranial injury of other and unspecified nature 861
Injury to heart and lung
861.2 Lung, without mention of open wound into thorax
Page 97 of 188
861.21 Contusion 941 Burn of face, head, and neck 942 Burns of trunk 947 Burns of internal
organs
947.1 Larynx, trachea, and lung
947.9 Unspecified site
Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Page 98 of 188
Living Environment
Concerns that led patient/client to seek the services of a physical therapist
Concerns or needs of patient/client who requires the services of a physical therapist
intervention
Medications
therapist
Page 99 of 188
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
* General health perception * Physical function (eg, mobility, sleep patterns, energy, fatigue)
leisure activities)
Systems Review
* Cardiopulmonary
Page 100 of 188
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
* Pulse oximetry
Page 101 of 188

of device
Community and Work Job/School/Play) Integration or Reintegration (Including IADL)
activities
appropriate
Page 102 of 188

appropriate
For skin associated with integrumentary disruption:
Muscle Performance (Including ;Strength, Power, and Endurance)
dynamometry
Page 103 of 188
of device
its use and care
Pain
Posture
* ADL scales and indexes
Page 104 of 188

appropriate
professionals
during exercise
* Pulse oximetry
Page 105 of 188
Prognosis
Within 10 weeks, patient/client will have maximized ventilatory muscle strength, endurance, and
aerobic capacity, as demonstrated by maximal ventilatory independence, absence of secretions,
and maximal independence in activities of daily living (ADL) and instrumental activities of daily
living (IADL).
10 to 65
to achieve anticipated goals and desired outcomes. It is anticipated that 80% of patients clients in
delivery.
* Age
Page 106 of 188

* Comorbidities
Intervention
symptoms, syndrome, or category diagnosis), intervention may be guided by the alleviation of
Anticipated Goals
* Accountability for services is increased,
professionals.
identified.
Page 107 of 188
* Case management
* Education plans
* Record reviews
Anticipated Goals
* Decision making is enhanced regarding health patient/client and use of health care resources by
prognosis, interventions, and goals and outcomes are
* Patient/client knowledge of personal and environmental factors associate with the condition is
increased.
* Performance levels m employment, recreational, or leisure activities are improved.
Page 108 of 188

* Progress is enhanced through die participation of patient/client, family, sinificant others, and
caregivers.
Anticipated Goals
job/school/play) integration or reintegration, and leisure activities is increased.
* Need for ventilatory assistance is decreased.
Page 109 of 188

* Physiologic response to oxygen demand is improved.
* Strength., power, and endurance of the ventilatory muscles are increased.
* Strengthening:
- active
- active assistive
* Stretching
Functional Training in Self-Care and Home Management including ADL and IADL)
Anticipated Goals
IADL) is increased.
Page 110 of 188

* Safety, is improved during performance of self-care and home management tasks and activities.
Functional Training in Community and Work Job/school/play) Integration or Reintegration
including IADL, Work Hardening, and Work Conditioning)
Anticipated Goals
* Ability to perform physical tasks related to community and work job/school/play) integration and
activities.
* Environmental, community, work (job/school/play), and leisure task adaptation
* IDL training (eg, maintaining a home, shopping, cooking, home chores, heavy household chores,
money management, driving a car or using public transportation, structured play for infants and
children)
Adoptive, Orthotic, Protective, Supportive, and Prosthetic)
Page 111 of 188
Anticipated Goals
* Ability to perform physical tasks is increased. joint integrity and mobility are improved.
* Performance and independence in ADL and IADL are increased.
Anticipated Goals
* Risk of recurrence of condition is prevented.
* Ventilation, respiration gas exchange), and circulation are improved.
* Active cycle of breathing/forced expiratory technique
Page 112 of 188
* Breathing strategies (eg, training in paced breathing, pursed-lip breathing)

* Suctioning
hyperinflation)
Anticipated Goals
* Independence in airway clearance is increased.
Reexamination
Outcomes
Page 113 of 188
* optimal return to role function (eg, worker, student, spouse, grandparent) is achieved.
* Risk of disability associated with ventilatory pump dysfunction is reduced.
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
* Other secondary prevention outcomes include:
Page 114 of 188
of care. Discharge occurs based on the physical therapist's analysis of the achivement of
the desired outcomes have been achived. Other indicators: patient/client, caregiver, or legal
needed over die life span to ensure safety and effective adaptation following changes in physical
Impaired Ventilation With Mechanical Ventilation Secondary to Ventilatory Pump Dysfunction
Patients/clients who are ventilator dependent with impaired ventilatory pump and decreased
aerobic capacity and who may have associated impaired airway clearance. Patients/clients may
have any one or a combination of the following:
* Abnormal or adventitious breath sounds
* Abnormal physiologic response to increased oxygen demand
* Decreased strength or endurance of respiratory muscles
* Airway clearance dysfunction secondary to artificial airway
* Impaired performance of activities of daily living (ADL) or instrumental activities of daily living
(IADL)
INCLUDES patients/clients with (when not on mechanical ventilator):
* Abnormal respiratory rate and tidal volume at rest
Page 115 of 188
* Dyspnea
* Dyssynchronous or paradoxical breathing
* Neuromuscular disorders
* Progressive decrease in arterial oxygen pressure and increase in arterial carbon dioxide
pressure
* Ventilatory pump failure or chronic obstructive pulmonary disease (COPD)
* Mechanical ventilator dependency, 24 hours per day
* Adult respiratory distress syndrome
ICD-9-CM Codes
045 Acute poliomyelitis 192 Malignant neoplasm of other and unspecified parts of nervous system
192.2 spinal cord Cauda equina 237 Neoplasm of uncertain behavior of endocrine glands and
nervous system 237.5 Brain and spinal cord 239 Neoplasms of unspecified nature 239.9 site
unspecified 277 Other and unspecified disorders of metabolism 277.0 Cystic fibrosis 332
Parkinson's disease 333 Other extrapyramidal disease and abnormal movement disorders 333.4
Huntington's chorea 334 Spinocerebellar disease 334.2 Primary cerebellar degeneration 335
Anterior horn disease 335.2 Motor neuron disease 335.20 Amyotrophic lateral sclerosis 340
Multiple sclerosis 343 Infantile cerebral palsy 344 Other paralytic syndromes 344.0 Quadriplegia
and quadriparesis 348 Other conditions of brain 348.1 Anoxic brain damage 357 Inflammatory and
toxic neuropathy 357.0 Acute infective polyneuritis
Guillain-Barre syndrome 359 Muscular dystrophies and other myopathies 359.1 Hereditary
progressive muscle dystrophy 430 Subarachnoid hemorrhage 431 Intracerebral hemorrhage 432
Other and unspecified intracranial hemorrhage 434 Occlusion of cerebral arteries 434.1 Cerebral
embolism 492 Emphysema 492.8 Other emphysema 493 Asthma 496 Chronic airway obstruction,
not elsewhere classified Chronic obstructive pulmonary disease [COPD] 505 Pneumoconiosis,
Page 116 of 188
unspecified 515 Postinflammatory pulmonary fibrosis 518 Other diseases of lung 518 Other
diseases of lung 518.81 Respiratory failure 519 Other diseases of respiratory system 519.4
Disorders of diaphragm 786 Symptoms involving respiratory system and other chest symptoms
786.0 Dyspnea and respiratory abnormalities 786.9 Dyspnea 852 Subarachnoid, subdural, and
extradural hemorrhage, following injury 853 Other and unspecified intracranial hemorrhage
following injury 854 Intracranial injury of other and unspecified nature 941 Burn of face, head, and
neck 942 Burn of trunk, 943 Burn of upper limb, except wrist and hand 944 Burn of wrist(s) and
hand(s) 945 Burn of lower limb(s) 946 Burns of mutiple specified sites 947 Burn of internal organs
948 Burns classified according to extent of body surface involved 949 Burn, unspecified 977
Poisoning by other and unspecified drugs and medicinal substances 977.9 Unspecified drug or
medicinal substance
Procedures
96 Nonoperative intubation and irrigation 96.7 other continuous mechanical ventilation
Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Page 117 of 188
Living Environment
* Patient/client, family, significant other, and caregiver expectations and totals for the therapeutic
intervention
Medications
therapist
Page 118 of 188

* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
* Physical function(eg, mobility, sleep patterns, energy, fatigue)
Page 119 of 188

leisure activities)
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures Tests and measures for this pattern may include, in alphabetical order:
* Ausculation of the heart
* Ausculation of the lungs
* Interpretation of blood gas analysis or oxygen consumption (V[O.sub.2]) studies
* Pulse oximetry
Page 120 of 188
safety awareness)
of device
Community and Work (Job/School/Play) Integration/ Reintegration (Including IADL)
assistive, adaptive, orthotic, protective, supportive,.or prosthetic devices and equipment
* Analysis of environmental and (work job/school/play) tasks
* Assessment of physiologic responses during community, work, and leisure activities
Page 121 of 188
appropriate
* Review of reports provided by patient./client, family, significant others, caregivers, other health
care professionals, or other interested persons (eg, rehabilitation counselor Workers'
* Assessment of muscle innervated by the cranial nerves
appropriate
activities
Body Mechanics:
activities
Page 122 of 188
supportive, or prosthetic devices or equipment ,

Integumentary Integrity For skin associated with integumentary description:
specific movements
* Analysis of muscle strength power, and endurance by manual testing or dynamometry
Page 123 of 188
of device
* Analysis of practically and ease of use of device
its use and care
Pain
* Assessment of pain using questionnaires, graphs, behavioral scales, symptoms magnification
Posture
Reflex Integrity
* Assessment of postural, postural, equilibrium, and righting reactions
Page 124 of 188

appropriate
professionals
Ventilation Respiration (Gas Exchange), and Circulation
during exercise
* Assessment of standard vital signs (eg, blood pressure, heart rate, and respiratory rate) at rest
and during and after activity
* Assessment of respiratory muscle strength, power, and endurance
* Interpretation of blood gas analysis or oxygen consumption ([V[O.sub.2]) studies
* Pulse oximetry
Page 125 of 188

Prognosis
Within 3 weeks,patient/client with acute reversible ventilatory pump failure will be weaned from
mechanical ventilation and will demonstrate improved ventilatory muscle performance.
Patient/client will show an absence of secretions or be able to independently clear secretions and
win demonstrate independence in activities of daily living (ADL) and instrumental activities of daily
living (IDL).
Within 8 weeks, patient/client with prolonged ventilatory pump failure will be weaned from the
mechanical ventilator and with demonstrate improved ventilatory muscle performance.
Patient/client will show an absence of secretions or be able to clear independently or with
caregiver assistance and will demonstrate independence in ADL and IADL.
Patient/client with severe or chronic ventilatory failure with remain on mechanical ventilation and
within 8 weeks will be able to perform ADL and IADL with caregiver assistance. Patient/client will
show an absence of secretions or be able to clear secretions with caregiver assistance.
5 to 20
20 to 40
10 to 60 These ranges represent the lower and upper limits of the number of physical therapist
visits required to achieve anticipated goals and desired outcomes. It is anticipated that 80% of
Page 126 of 188
patients/client in this diagnostic group will achieve the goals and outcomes within these ranges
during a single continuous episode of care Frequency of visits and duration of the episode of care
should be determined by die physical therapist to maximize effectiveness of care and efficiency of
service delivery.
of Episode
* Age
* Comorbidities
Intervention
symptoms and remediation of deficits. intervention has three components. Communication,
Anticipated Goals
Page 127 of 188
* Availability resources are maximally utilized.

professionals.
resources by patient/client, family significant others, and caregivers.
identified.
* Case management
* Coordination of care with patient/client, family significant others, caregivers, other health care
* Education plans
* Record reviews
Anticipated Goals
* Behaviors that foster healthy habits, wellness, and prevention are
* Decision making is enhanced regarding heath of patient/client and use of health care, resources
Page 128 of 188

* Functional independence in activities of that daily living (ADL) and instrumental activities of daily
* Patient/client, family significant other, and caregiver knowledge and awareness of the diagnosis,
increased.
* Performance levels in employment recreational, or leisure activities are improved.
caregivers.
Page 129 of 188
Therapeutic Exercise (including Aerobic Conditioning)

Anticipated Goals
* Need for assistive equipment or device (mechanical ventilator) is decreased.
* Strength, power, and endurance of ventilatory muscles are increased.
* Symptoms associated with increased oxygen demand are increased.
* Tissue perfusion and oxygenation are increased.
* Tolerance for positions is increased.
* Neuromuscular reeducation
Page 130 of 188
* Strengthening
- active
- active assistive
* Stretching
Anticipated Goals
activity, dressing, grooming, bathing, and toileting)
Anticipated Goals
* Safety, is improved during performance of community and work (job/school/play) tasks and
activities.
Page 131 of 188

* Job simulation
Anticipated Goals
Prescription, Application and, as Appropriate, Fabrication of Devices and
Prosthetic)
Page 132 of 188
Anticipated Goals
* Assistive devices or equipment (eg, crutches, canes, walkers, wheelchairs, power devices, longhandled reachers, static and dynamics splints)
elastic wraps, oxygen )
Anticipated Goals
* Secondary complications are decreased.
* Ventilation, respiration (gas exchange) and circulation are improved.
Page 133 of 188

* Suctioning
* Techniques to maximize ventilation (eg, maximal inspiratory hold, staircase breathing, manual
hyperinflation)
Anticipated Goals
* Biofeedback
Anticipated Goals
* Independence in airway clearance is increased.
Reexamination
Outcomes
Page 134 of 188
patient/client satisfaction. The physical therapist also identities the patient's/client's expectations
* Risk of disability associated with ventilatory pump dysfunction is reduced.
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
Page 135 of 188

function, or home or work job/school/play) settings.
achievement of goats and outcomes, patient/client status and the rationale for discontinuation are
Impaired Ventilation and Respiration (Gas Exchange, With Potential for
Respiratory Failure
Patients/clients with acute respiratory distress and impaired ventilatory pump and gas exchange,
with potential for respiratory failure. Patients/clients may have one or a combination of the
following:
Page 136 of 188
* Central signs of cyanosis

* Dyspnea
* Dyssynchronous or paradoxical breathing pattern at rest
* Lethargy or confusion
* Oxygen saturation levels of less than 92% at rest
* Respiratory rate of greater than 32 at rest
* Use of accessory muscles at rest
* Acute or chronic neuromuscular dysfunction or trauma
* Acute pulmonary disease
* Asthma
* Cystic fibrosis
* Pneumonia
* Thoracic trauma
ICD-9-CM Codes
277 Other and unspecified disorders of metabolism 277.0 Cystic fibrosis 277.6 Other diseases of
circulating enzymes Alpha 1-antitrypsin deficiency
Page 137 of 188
482 Other bacterial pneumonia 482.2 Pneumonia due to Hemophilus influenzae [H.influenzae]
482.9 Bacterial pneumonia unspecified
491 Chronic bronchitis 491.8 Other chronic bronchitis 491.9 Unspecified chronic bronchitis
492 Emphysema 492.8 Other emphysema Emphysema (lung or pulmonary), not otherwise
specified
493 Asthma
494 Bronchiectasis
496 Chronic airway obstruction, not elsewhere classified Chronic obstructive pulmonary disease
[COPD]
513 Abscess of lung and mediastinum 513.0 Abscess of lung
514 Pulmonary congestion and hypostasis
516 Other alveolar and parietoalveolar pneumonopathy 516.9 Unspecified alveolar and
parietoalveolar pneumonopathy
518 Other diseases of lung 518.0 Pulmonary collapse 518.5 Pulmonary insufficiency following
trauma and surgery Adult respiratory distress syndrome
518.8 Other diseases of lung 518.89 Other diseases of lung, not elsewhere classified
519 Other diseases of respiratory system 519.4 Disorders of diaphragm
770 Other respiratory conditions of fetus and newborn 770.7 Chronic respiratory disease arising in
perinatal period Bronchopulmonary dysplasia
786 Symptoms involving respiratory system and other chest symptoms 786.0 Dyspnea and
respiratory abnormalities 786.00 Respiratory abnormality, unspecified 786.5 Chest pain 786.52
Painful respiration
861 Injury to heart and lung 861.2 Lung, without mention of open wound into thorax 861.21
Contusion
997 Complications affecting specified body systems, not elsewhere classified 997.3 Respiratory
complication
Procedures
34 Operations on chest wall, pleura, mediastinum, and diaphragm 34.9 Other operations on
thorax 34.99 Other
54 Other operations on abdominal wall 54.9 Other operations of abdominal region 54.99 Other
Examination
Page 138 of 188
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 139 of 188

intervention
Medications
therapist
* Prior medications
* Cardiopulmonary
Page 140 of 188
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Page 141 of 188

Tests and Measures
* Pulse oximetry
Page 142 of 188
walking, hopping, skipping)
Muscle Performance (including Strength, Power, and Endurance)
Page 143 of 188

of device
its use and care
Pain
Posture
Reflex integrity
Page 144 of 188

during exercise
* Assessment of ability to protect the airway
* Pulse oximetry
Page 145 of 188
Prognosis
Within 72 hours, patient/client will have adequate gas exchange, with ventilatory parameters
indicating ability to ventilate independently, or patient/client will be placed on mechanical
ventilation.
service delivery.
Factors That May Require New Episode of Care or That may Modify Frequency of Visits/Duration
of Episode
* Age
Page 146 of 188
* Comorbidities
Intervention
Anticipated Goals
professionals.
identified.
* Case management
Page 147 of 188

* Education plans
* Record reviews
Anticipated Goals
increased.
Page 148 of 188
caregivers.
* Safety of patient/client, family,significant others, and caregivers is improved.
Anticipated Goals
* Need for assistive device (mechanical ventilation) is decreased,
Page 149 of 188

* Strengthening
active
active assistive
resistive, using manual resistance, pulleys, weights,
* Stretching
Anticipated Goals
* IADL training (eg, maintaining a home, shopping, cooking, home chores, home household
Anticipated Goals
Page 150 of 188

Prescription, Application and, as Appropriate, Fabrication of Devices and Equipment (Assistive,
Anticipated Goals
* Motor function (motor control and motor learning) is improved with decreased dyspnea.
* Protective devices or equipment (eg, braces, protective taping, cushions. helmets)
Anticipated Goals
* Ventilation, respiration (gas exchange), and circulation is improved.
Page 151 of 188

* Suctioning
hyperinflation)
Reexamination
measures after the initial examination, evaluate progress and to modify or redirect intervention.
Outcomes
particular social context and physical environment) primary or secondary prevention, and
* Risk of disability associated with potential for respiratory failure is reduced.
Page 152 of 188
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
Page 153 of 188
Impaired Ventilation and Respiration (Gas Exchange) With
Mechanical Ventilation Secondary to Respiratory Failure
Patients/clients who are ventilator dependent with severely impaired gas exchange and impaired
ventilatory pump associated with airway clearance impairment. Patients/clients may have any one
or a combination of the following:
* Abnormal chest radiograph
* Airway clearance dysfunction
* Impaired respiration (gas exchange)
INCLUDES patients/clients with (when not on ventilator):
* Abnormal respiratory rate at rest
* Dyssynchronous or paradoxical breathing
* Inability to maintain arterial oxygen pressure (Pa[O.sub.2]) when receiving supplemental oxygen
* Progressive rise in arterial carbon dioxide pressure (Pa[CO.sub.2])
Page 154 of 188
* Severe dyspnea
* Adult respiratory distress syndrome
* Cardiothoratic surgery
* Multisystem failure
* Severe pneumonia
* Thoracic trauma
* Transplant rejection, infection, or failure
* Cardiovascular pump failure
ICD-9-CM Codes
As of press time, the Listing below contains the most typical ICD-9-CM codes related to this
136 Other and unspecified infectious and parasitic diseases 136.3 Pneumocystosis Pneumonia
due to pneumocystis carinii 277 Other and unspecified disorders of metabolism 277.0 Cystic
fibrosis 286 Coagulation defects 286.6 Defribrination syndrome Diffuse or disseminated
intravascular coagulation [DIC syndrome] 348 Other conditions of brain 348.1 Anoxic brain
damage 415 Acute Pulmonary heart disease 415.1 Pulmonary embolism and infarction 480 Viral
pneumonia 481 Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia] 482 Other
bacterial pneumonia 483 Pneumonia due to other specified organism 484 Pneumonia in infectious
diseases classified elsewhere 485 Bronchopneunonia, organism unspecified 486 Pneumonia,
organism unspecified 491 Chronic bronchitis 493 Asthma 495 Extrinsic allergic alveolitis 495.7
"Ventilation" pneumonitis 496 Chronic airway obstruction, not elsewhere classified Chronic
obstructive pulmonary disease [COPD] 507 Pneumonitis due to solids and liquids 507 Due to
inhalation of food or vomitus Aspiration pneumonia 511 Pleurisy 511.8 Other specified forms of
effusion, except tuberculous Hemothorax 512 Pneumothorax 512.8 Other spontaneous
pneumothorax 513 Abscess of lung and mediastinum 514 Pulmonary congestion and hypostasis
Pulmonary edema, not otherwise specified 517 Lung involvement in conditions classified
Page 155 of 188
elsewhere 518 Other diseases of lung 518.5 Pulmonary insufficiency following trauma and surgery
Adult respiratory distress syndrome 518.8 Other diseases of lung 518.81 Respiratory failure
518.82 Other pulmonary insufficiency, not elsewhere classified Acute respiratory distress 770
Other respiratory conditions of fetus and newborn 770.4 Primary atelactasis 770.7 Chronic
respiratory diseases aarising in the perinatal period Bronchopulmonary dysplasia 852
Subarachnoid, subdural, and extradural hemorrhage, following injury 853 Other and unspecified
intracranial hemorrhage, following injury 854 Intracnial injury of other and unspecified nature 861
Injury to heart and lung 861.2 Lung, without mention of open wound into thorax 861.21 Contusion
959 Injury, other and unspecified 996 Complications peculiar to certain specified procedures 996.0
Mechanical complication of cardiac device, implant, and graft 996.1 Mechanical complication of
other vascular device, implant, and graft 996.2 Mechanical complication of nervous system
device, implant, and graft 996.3 Mechanical complication of genitourinary device, implant, and
graft 996.4 Mechanical complication of internal orthopedic device, implant, and graft 996.5
Mechanical complication of other specified prosthetic device, implant, and graft 996.8
Complications of transplanted organ 996.85 Bone marrow
Factors influencing Health Status and Contact With Health Services V42 Organ or tissue replaced
by transplant V42.0 Kidney V42.1 Heart V42.4 Bone V42.6 Lung V42.7 Liver V42.8 Other
specified organ or tissue V42.81 Bone marrow
Procedures 32 Excision of lung and bronchus 34 Operations on chest wall, pleura, mediastinum,
and diaphragm 34.9 Other operations on thorax 34.99 Other 36 Operations on vessels of heart
36.1 Bypass anastomosis for heart revascularization 54 Other operations on abdominal region
54.9 Other operations of abdominal region 54.99 Other 96 Nonoperative intubation and irrigation
96.7 Other continuous mechanical ventilation
Examination
prognosis and to determine the intervention. The patient/client, facility, significant others, and
(early, intermediate, late, return to activity); home, community, or work job/school/play) situation;
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Page 156 of 188

Living Environment
intervention
Medications
Page 157 of 188
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
Health Status (Self-report, Family Report, Caregiver Report)
* Physical function (eg, mobolity, sleep patterns, energy, fatigue)
Page 158 of 188

* Level of physical fitness self-care, home management, community, work job/school/play], and
leisure activities)
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
* Assessment of perceived exertion, dyspnea, or angina during activity, using rating-of-perceivedexertion (RPE) scales, dyspnea scales,anginal pain scales, or visual analog scales
* Pulse oximetry
Page 159 of 188
safety awareness)
of device
* Review of reports provided by patient/client, significant others, family, caregivers, or other
Integumentary integrity For skin associated with integumentary disruption:
Page 160 of 188

* Assessment of tissue mobolity turgor and texture
specific movements
walking, hopping, skipping)
* Analysis of muscle strength, power, and endurance by manual muscle testing or dynamometry
* Analysis of effect; and benefits including energy conservation and expenditure) while
of device
its use and care
Page 161 of 188

Pain
Posture
* Analysis of ROM using goniometers, tape measures, flexible rulers, inclinometers, photograpbic
Reflex Integrity
Self-care and Home Management (Including ADL and IADL)
Page 162 of 188

appropriate
professionals
sense)
pressure)
during exercise
* Assessment of activities that aggravate or relieve edema, pain,
* dyspnea, or other symptoms
* Palpation of chest wall (eg, tactile, fremitus pain, diaphragmatic motion)
Page 163 of 188
* Pulse oximetry
Prognosis
Within 72 hours, patient/client with acute reversible respiratory failure will be weaned from
mechanical ventilation and will show an absence of secretions or be able to clear secretions
independently, or caregiver will be able to manage the secretions and the chest radiograph will
show significant improvement. Patient/client win demonstrate independence in activities of daily
living (ADL) and instrumental activities of daily living (IADL).
Within 3 weeks, patient/client with prolonged respiratory failure will be weaned from mechanical
ventilation and will show an absence of secretions or be able to clear secretions independently or
with caregiver assistance. The chest radiograph will be clear, return to baseline, or show
clearance of the acute process. Patient/client will demonstrate independence in ADL or IADL.
Patient/client with severe or chronic respiratory failure will remain mechanically ventilated
indefinitely and within 4 to 6 weeks will demonstrate ability to clear secretions independently or
with caregiver assistance. Patient/client will show improved participation in ADL and IADL.
Page 164 of 188
3 to 9
10 to 25
10 to 45
These ranges represent the lower and upper limits of the number of physical therapist visits
patients/clients in this diagnostic group will achieve the goals and outcomes within these ranges
during a single continuous episode of care Frequency of visits and duration of the episode of care
service delivery.
Factors That May Require New Episode of Care of That May Modify Frequency
* Age
* Comorbidities
Intervention
Page 165 of 188
Anticipated Goals
professionals.
identified.
* Case management
* Education plans
* Record reviews
Anticipated Goals
Page 166 of 188

* Functional independence in activities of daily living (ADL) and instrumental activities of daily,
increased.
* Progress is enhanced through the participation of patient/client, no, significant others, and
caregivers.
Page 167 of 188
Anticipated Goals
* Atelactasis is decreased.
* Aerobic endurance activities
* Strengthening
- active
- active assistive
- resistive
* Stretching
IADL)
Page 168 of 188
Anticipated Goals
Anticipated Goals
Prosthetic)
Anticipated Goals
Page 169 of 188

* Prosthetic devices or equipment (eg, braces, protective taping, cushions, helmets)
Anticipated Goals
* Suctioning
hyperinflation)
Re examination
Page 170 of 188
Outcomes
* Risk of disability associated with respiratory failure is reduced.
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
Page 171 of 188
Impaired Ventilation, Respiration (Gas Exchange), and Aerobic
Capacity and Endurance Secondary to Respiratory Failure in the Neonate
Page 172 of 188
Patients who are neonates or in early infancy (eg, up to 4 months of age) who have impaired gas
exchange and ventilatory pump related to prematurity; postmaturity; congenital heart, lung, or
diaphragm abnormalities; infection; complications of medical management; or impairments
secondary to other systemic dysfunctions. These patients often require mechanical ventilation and
may have any one or a combination of the following, on or off the ventilator:
* Apnea and bradycardia
* Cyanosis
* Impaired airway clearance
* Impaired cough
* Impaired respiration (gas exchange)
* Increased work of breathing
* Paradoxical and abnormal breathing pattern
* Physiologic intolerance of routine care
* Abdominal/thoracic surgery
* Bronchopulmonary dysplasia
* Congenital anomalies
* Hyaline membrane disease
* Intermittent or continuous ventilatory support
* Meconium aspiration syndrome
* Neurovascular disorders
* Pneumonia
* Age of more than 4 months
ICD- 9-CM Codes
Page 173 of 188
508 Respiratory condition due to unspecified and external agents 508.9 Respiratory condition due
to unspecified external agent 514 Pulmonary congestion and hypostasis 516 Other alveolar and
parietoalveolar pneumonopathy 516.9 Unspecified alveolar and parietoalveolar pneumonopathy
518 Other diseases of lung 518.0 Pulmonary collapse 518.8 Other diseases of lung 518.89 Other
diseases of lung, not elsewhere classified 553 Other hernia of abdominal cavity without mention of
obstruction or gangrene 553.3 Diaphragmatic hernia 769 Respiratory distress syndrome
Hyaline membrane disease (pulmonary)
770 Other respiratory conditions of fetus and newborn 770.1 Meconium aspiration syndrome
770.6 Transitory tachypnea of newborn 770.7 Chronic respiratory disease arising in the perinatal
period
786 Symptoms involving respiratory system and other chest symptoms 786.0 Dyspnea and
respiratory abnormalities 786.00 Respiratory abnormality, unspecified
Examination
History
* Age
* Primary Language
* Race/ethnicity
* Sex
Social History
Page 174 of 188

Living Environment
* living environment and community characteristics
intervention
activities of daily living (ADL) and instrumental activities of daily living (ML)
Medications
Page 175 of 188
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
Page 176 of 188

* Social Habits (Past and Current)
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary,
* Musculoskeletal
* Neuromuscular
Tests and Measures
* Assessment of ability to control body temperature
* Assessment of signs of infant respiratory distress (eg, sternal and intercostal retractions, nasal
flaring, paradoxical breathing pattern, expiratory grunting, cyanosis, pallor, apnea, bradycardia,
head bobbing) at rest, during activity (eg, routine care, evaluation, and treatment), and during
recovery
Page 177 of 188

* Pulse oximetry
Cranial Nerve integrity
- auditory
- gustatory
- olfactory
- vestibular
- visual
Page 178 of 188
* Assessment of tissue mobility, turgor, and texture For wound:
* Analysis of age-appropriate and sex-appropriate development
Page 179 of 188

of device
its use and care
Pain
Posture
Reflex Integrity
* Assessment of developmentally appropriate reflexes over time
* Assessment of postural, postural, equilibrium, and righting reactions
* Analysis of thoracoabdominal movements and breathing patterns at rest and during activity,
either on or off mechanical ventilation
Page 180 of 188

* Assessment of cardiopulmonary response to performance of
* ADL (eg, feeding)
* Assessment of chest wa]l mobility, expansion, and excursion
* Auscultation and mediate percussion of the lungs interpretation of blood gas analysis or oxygen
consumption ([VO.sub.2]) studies
* Palpation of chest wall (eg, tactile, fremitus, pain, diaphragmatic motion)
* Pulse oximetry
Page 181 of 188
prolonged impairment, functional limitation, or disability; multisite of multisystem involvement;
Prognosis
Within 6 to 12 months, patient will achieve developmental milestones appropriate to adjusted age
(based on prematurity). Within 6 months, patient will be weaned from the ventilator if applicable)
and from supplemental oxygen. Caregiver will be able to manage the secretions.
required to achieve anticipated goals and desired outcomes. It is anticipated that 80% of patients
in this diagnostic group will achieve the goals and outcomes within 16 to 84 visits during a single
delivery.
* Age
* Comorbidities
* Psychosocial and socioeconomic stressors of the family
Intervention
Page 182 of 188

Anticipated Goals
* Accountability for services is increased
* Care is coordinated with family, significant others, caregivers, and other professionals.
identified.
* Family, significant other, and caregiver understanding of expectations and goals and outcomes
is increased.
* Case management
* Coordination of care with family, significant others, caregivers, other health care professionals,
and other interested persons (eg, rehabilitation counselor, Workers' Compensation claims
manager, employer)
* Education plans
* Record reviews
Page 183 of 188

Anticipated Goals
* Awareness and use of community resources by family, significant others, and caregivers are
improved.
* Decision making is enhanced regarding health of patient/client and the use of health care
* Family, significant other, and caregiver knowledge and awareness of the diagnosis, prognosis,
interventions, and goals and outcomes are increased.
* Family and caregiver knowledge of personal and environmental factors associated with the
condition is increased.
* Progress is enhanced through the participation of family, significant others, and caregivers.
Page 184 of 188
Anticipated Goals
* Physical function is improved.
* Strength and endurance are increased.
* Neuromuscular education
* Sensory training
* Strengthening
Page 185 of 188
- active
- active assistive
* Stretching
Anticipated Goals
* ADL training (eg, bed mobility and transfer training, bathing) for caregiver
* Assistive and adaptive device and equipment training for caregiver
* Body mechanics training for caregiver
* Orthotic, protective, or supportive device or equipment training for caregiver
Anticipated Goals
* Soft tissue mobilization and manipulation Prescription, Application, and, as Appropriate,
Fabrication of Devices and Equipment (Assistive, Adaptive, Orthotic, Protective, Supportive, and
Prosthetic)
Anticipated Goals
Page 186 of 188

Anticipated Goals
* Suctioning
hyperinflation)
Reexamination
to, respond to intervention.
Outcomes
Page 187 of 188

* Developmental delays associated with functional limitations and disability are reduced.
* Risk of disability associated with respiratory failure is reduced.
* Access, availability, and services provided are acceptable to family, significant others, and
caregivers.
* Administrative management of practice is acceptable to family, significant others, and
caregivers.
* Clinical proficiency of physical therapist is acceptable to family, significant others, and
caregivers.
* Coordination and conformity of care are acceptable to family, significant others, and caregivers.
* Interpersonal skills of physical therapist are acceptable to family, significant others, and
caregivers.
outcomes include:
* Family and caregivers are aware of the factors that may indicate need for reexamination or a
new episode of care, including changes in the following: caregiver status; community adaptation;
leisure activities; living environment; pathology or impairment that may affect function; or home or
work (job/school/play) settings.
* Professional recommendations are integrated into home and community environments.
Page 188 of 188

Source Citation:"Cardiopulmonary." Physical Therapy 77.n11 (Nov 1997): 1451(104). Expanded


Page 1 of 114
Integumentary. (skin)(includes related information)(Preferred Practice Patterns)(Guide to

(62). (26320 words)
Preferred Practice Patterns: Integumentary

outcomes, and criteria for discharge.
Pattern A: Primary Prevention/Risk Factor Reduction for Integumentary Disorders 7A-1
Pattern B: Impaired Integumentary Integrity Secondary to Superficial Skin Involvement 7B-1
Pattern C: Impaired Integumentary Integrity Secondary to Partial-Thickness Skin Involvement and
Scar Formation 7C-1
Pattern D: Impaired Integumentary Integrity Secondary to Full-Thickness Skin Involvement and
Scar Formation 7D-1
Pattern E: Impaired Integumentary Integrity Secondary to Skin Involvement Extending Into Fascia,
Muscle, or Bone 7E-1
Pattern F: Impaired Anthropometric Dimensions Secondary to Lymphatic System Disorders 7F-1
Primary Prevention/Risk Factor Reduction for Integumentary Disorders
Patients/clients with a potential risk for disruption in the integument. Patients/clients may have any
one or a combination of the following:
* Edema
Page 2 of 114
* Inflammation
* Integument repaired by primary intention
* Ischemia
* Low or moderate risk assessment score (eg, for pressure, insensitivity)
* Pain
* Prior scar
INCLUDES patients/clients at any stage with:
* Amputation
* Central nervous system disorder
* Congestive heart failure
* Diabetes
* Obesity
* Spinal cord involvement
* Surgery
* Vascular disease
* Flaps
* Grafts
ICD-9-CM Codes
250 Diabetes mellitus 277 Other and unspecified disorders of metabolism 277.6 Other
deficiencies of circulating enzymes Hereditary angioedema 278 Obesity and other
hyperalimentation 278.0 Obesity 320 Bacterial meningitis 322 Meningitis of unspecified cause
Page 3 of 114
322.9 Meningitis, unspecified 323 Encephalitis, myelitis, and encephalomyelitis 331 Other cerebral
degenerations 331.7 Cerebral degeneration in diseases classified elsewhere 331.9 Cerebral
degeneration, unspecified 332 Parkinson's disease 333 Other extrapyramidal disease and
abnormal movement disorders 333.2 Myoclonus 334 Spinocerebellar disease 334.0 Friedreich's
ataxia 334.1 Hereditary spastic paraplegia 334.2 Primary cerebellar degeneration 334.9
Spinocerebellar disease, unspecified 335 Anterior horn cell disease 336 Other diseases of spinal
cord 336.0 Syringomyelia and syringobulbia 336.1 Vascular myelopathies 336.9 Unspecified
disease of spinal cord 337 Disorders of the autonomic nervous system 340 Multiple sclerosis 341
Other demyelinating diseases of central nervous system 342 Hemiplegia and hemiparesis 343
Infantile cerebral palsy 344 Other paralytic syndromes 344.0 Quadriplegia and quadriparesis
344.1 Paraplegia 344.3 Monoplegia of lower limb 353 Nerve root and plexus disorders 353.9
Unspecified nerve root and plexus disorder 357 Inflammatory and toxic neuropathy 357.2
Polyneuropathy in diabetes 357.3 Polyneuropathy in malignant disease 357.4 Polyneuropathy in
other diseases classified elsewhere 357.6 Polyneuropathy due to drugs 428 Heart failure 428.0
Congestive heart failure 435 Transient cerebral ischemia Cerebrovascular insufficiency (acute)
with transient focal neurological signs and symptoms; insufficiency of carotid artery 435.1
Vertebral artery syndrome 435.8 Other specified transient cerebral ischemias 440 Atherosclerosis
443 Other peripheral vascular disease 443.0 Raynaud's syndrome 443.1 Thromboangiitis
obliterans [Buerger's disease] 443.9 Peripheral vascular disease, unspecified 454 Varicose veins
of lower extremities 457 Noninfectious disorders of lymphatic channels 457.0 Postmastectomy
lymphedema syndrome 457.1 Other lymphedema 459 Other disorders of circulatory system 459.1
Postphlebitic syndrome 459.8 Other specified disorders of circulatory system 459.81 Venous
(peripheral) insufficiency, unspecified 459.9 Unspecified circulatory system disorder 581 Nephrotic
syndrome 581.9 Nephrotic syndrome with unspecified pathological lesion in kidney Nephritis with
edema, not otherwise specified 593 Other disorders of kidney and ureter 593.8 Other specified
disorders of kidney and ureter 593.81 Vascular disorders of kidney 686 Other local infections of
skin and subcutaneous tissue 686.9 Unspecified local infection of skin and subcutaneous tissue
701 Other hypertrophic and atrophic conditions of skin 701.4 Keloid scar Hypertrophic scar 709
Other disorders of skin and subcutaneous tissue 709.2 Scar conditions and fibrosis of skin 716
Other and unspecified arthropathies 716.6 Unspecified monoarthritis 719 Other and unspecified
disorders of joint 719.4 Pain in joint 728 Disorders of muscle, ligament, and fascia 728.9
Unspecified disorder of muscle, ligament, and fascia 729 Other disorders of soft tissues 729.5
Pain in limb 757 Congenital anomalies of the integument 757.0 Hereditary edema of legs 782
Symptoms involving skin and other integumentary tissue 782.0 Disturbance of skin sensation
782.3 Edema 895 Traumatic amputation of toe(s) (complete) (partial) 895.0 Without mention of
complication 896 Traumatic amputation of foot (complete) (partial) 896.2 Bilateral, without mention
of complication 897 Traumatic amputation of leg(s) (complete) (partial) 897.0 Unilateral, below
knee, without mention of complication 897.2 Unilateral, at or above knee, without mention of
complication 897.4 Unilateral, level not specified, without mention of complication 897.6 Bilateral
[any level], without mention of complication 995.1 Angioneurotic edema
Examination
Page 4 of 114
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 5 of 114
intervention
Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Page 6 of 114

Family History
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
Page 7 of 114
* Assessment of continuity of skin color (eg, redness in lightly pigmented skin, violescent in darkly
pigmented skin)
* Assessment of sensation (eg, pain, temperature, itch, tactile)
* Assessment of scar tissue (cicatrix), including banding, pliability sensation, and texture
of device
its use and care
Pain
Page 8 of 114
the optimal level of improvement that night be attained and the amount of time required to reach
Prognosis
Over the course of 1 to 3 weeks, patient/client or caregiver will be independent in skin inspection.
Patient/client will demonstrate knowledge of disease-preventing behavior and will demonstrate
knowledge of risk factors of integumentary disruption and methods to modify those risk factors.
Expected Range of Number of
Visits Per Episode of Care
1 to 6
Page 9 of 114
delivery.
Factors That May Modify
Frequency of Visits
* Age
* Allergic reaction (eg, to medication, tape, latex)
* Comorbidities (eg, chronic obstructive pulmonary disease, renal disease, cerebrovascular
accident)
* Immunosuppresion (eg, human immunodeficiency virus/acquired immunodeficiency syndrome
[HIV/AIDS], cancer)
* Need for ventilatory support
* Nutritional status
* Preexisting systemic conditions or diseases (eg, diabetes, peripheral vascular disease,
peripheral neuropathy)
* Presence of infection
* Total body surface area (TBSA) of burn
Intervention
Page 10 of 114

Anticipated Goals
* Education plans
Patient/client-related Instruction
Anticipated Goals
client.
increased.
Page 11 of 114

Anticipated Goals
* Nutrient delivery to tissue is increased.
* Sensory awareness is increased.
Page 12 of 114

Functional Training in Self-Care and Home Management (Including (ADL and
IADL)
Anticipated Goals
* Ability to recognize and initiate treatment of a recurrence is improved through increased selfmanagement of symptoms.
IADL) is increased.
Reintegration including IADL, Work Hardening, and Work Conditioning)
Anticipated Goals
* Ability to perform physical tasks related to community and work (Job/school/play) integration or
Anticipated Goals
* Integumentary integrity is improved.
Page 13 of 114

Prescription, Application, and, as Appropriate, Fabrication of Devices and Equipment
(Assistive, Adaptive Orthotic, Protective, Supportive, and Prosthetic)
Anticipated Goals
Page 14 of 114

Outcomes
equipment.
demonstrated.
Client Satisfaction
* Access, availability, and services provided are acceptable to client.
Page 15 of 114
needed over the fife span to ensure safety and effective adaptation following changes in physical
Impaired Integumentary Integrity Secondary to Superficial Skin Involvement
PATTERN B
Patients/clients with superficial skin involvement. Patients/clients may have any one or a
* Burns (first degree)
* Contusion
* Dermopathy
* Neuropathic ulcers (grade)
* Pressure ulcers (stage I)
* Vascular disease (eg, venous, arterial, diabetic)
* Cellulitis
* Dermatitis
* Any break in skin integrity
* Frostbite
Page 16 of 114
ICD-9-CM Codes
250 Diabetes mellitus 454 varicose veins of lower extremities 454.1 With inflammation 690
Erythematosquainous dermatosis 691 Atopic dermatitis and related conditions 692 Contact
dermatitis and other eczema 692.7 Due to solar radiation 692.71 Sunburn 700 Corns and
callosities 707 Chronic ulcer of skin 707.0 Decubitus ulcer 707.1 Ulcer of lower limbs, except
decubitus 731 Osteitis deformans and osteopathies associated with other disorders classified
elsewhere 731.8 Other bone involvement in diseases classified elsewhere 782 Symptoms
involving skin and other integumentary tissue 782.2 Localized superficial swelling, mass, or lump
782.7 Spontaneous ecchymoses 782.8 Changes in skin texture 920 Contusion of face, scalp, and
neck, except eye(s) 922 Contusion of trunk 922.0 Breast 922.1 Chest wall 922.2 Abdominal wall
922.31 Back 922.32 Buttock 922.33 Interscapular region 922.8 Multiple sites of trunk 923
Contusion of upper limb 923.0 Shoulder and upper arm 923.1 Elbow and forearm 923.2 Wrist and
hand(s), except finger(s) alone 923.3 Finger 923.8 Multiple sites of upper limb 924 Contusion of
lower limb and of other unspecified sites 924.0 Hip and thigh 924.1 Knee and lower leg 924.2
Ankle and foot, excluding toe(s) 924.3 Toe 924.4 Multiple sites of lower limb 942 Burn of trunk
942.1 Erythema [first degree] 943 Burn of upper limb, except wrist and hand 943.1 Erythema [first
degree] 944 Burn of wrist(s) and hand(s) 944.1 Erythema [first degree] 945 Burn of lower limb (s)
945.1 Erythema [first degree] 946 Burns of multiple specified sites 946.1 Erythema [first degree]
948 Burns classified according to extent of body surface involved 949 Burn, unspecified 949.1
Erythema [first degree]
Examination
therapist identifies impairment, functional limitations, disabilities, or changes in physical function
prognosis and to determine the intervention. The patient/client, family significant others, and
History
* Age
Page 17 of 114
* Primary language
* Race/ethnicity
* Sex
Social History
* Social interactions, social activities, and
support systems
* Current and prior community and
work job/school) activities
Living Environment
intervention
Page 18 of 114

Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Geritourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Page 19 of 114
Family History
* Behaviorl health risks (eg, smoking, drug abuse)
leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
* Assessment of edema through palpation and volume and girth
* measurements (eg, during pregnancy, in determining the effects of other medical or health-
Page 20 of 114
related conditions, during surgical procedures, after drug therapy)

* Assessment of level of recall (eg, short- and long-term memory)
* Assessment of patient/client and caregiver ability to care for device
Page 21 of 114

* Assessment of activities, devices, positioning, and postures that aggravate the wound or scar or
that may produce additional trauma
* Assessment of sensation (eg, pain, temperature, (tactile)
* Assessment of shape and size of skin involvement
of device
* Analysis of practically and ease of use of device
its use and care
Pain
Page 22 of 114
* Analysis of ROM using goniometers, tape measures, flexible rulers, inchnometers, photographic
Sensory Integrity
pressure)
* Assessment of capilary refill time
* Assessment of standard vital signs (eg, blood pressure, hearth rate, respiratory rate)
prolonged impairment, or disability; multisite or multisystem involvement; social supports; living
environment; potential discharge destinations; patient/client and family expectations; anatomic
and physiologic changes related to growth and development; and caregiver consistency or
expertise.
Prognosis
Over the course of 2 weeks, patient/client will show resolution of skin involvement.
1 to 6
Page 23 of 114
delivery.
of Episode
* Age
* Caregiver (eg, family, home heath aide) consistency or expertise
accident)
* Immunosuppression (eg, human immunodeficiency virus/acquired immunodeficiency syndrome
[HIV/AIDS], cancer)
* Level of patient/client adherence to
* the intervention program
Intervention
limitation, secondary or primary prevention of disability of optimization patient/client satisfaction).
Page 24 of 114
Anticipated Goals
* Available resources are maximally utilized
* Care is coordinated with patient/client, family significant others, caregivers, and other
professionals.
* Decision making is enhanced regarding the health of patient/client and die use of health care
identified.
* Case management
* Compensation claims manager, (employer)
* Education plans
* Record reviews
Anticipated Goals
Page 25 of 114

* Functional independence in activities of daily living (ADL) and instrumental activities of that living
* Patient/client knowledge of personal and environmental factors associated with the
condition is increased.
caregivers.
* Safety of patient/client family, significant others, and caregivers is improved.
Page 26 of 114

Anticipated Goals
Page 27 of 114

IADL)
Anticipated Goals
IADL) is increased.
or Reintegration Including IADL, Work Hardening, and Work Conditioning)
Anticipated Goals
* Risk of recurrence of conditions is reduced.
* Assistive and adaptive device or equipment training IADL training (eg, maintaining a home,
Page 28 of 114
shopping, cooking, home chores, heavy household chores, money management, driving a car or
using public transportation, structured play for infants and children)
Anticipated Goals
Prosthetic)
Anticipated Goals
Page 29 of 114

* Orthotic devices or equipment (eg, braces, shoe inserts, casts, splints, casts)
Wound Management
Anticipated Goals
* Dressings (eg, wound coverings)
Page 30 of 114
Anticipated Goals
* Wound and soft tissue heating is enhanced.
Anticipated Goals
* Risk of secondary impairments is decreased.
Physical agents:
Page 31 of 114
Reexamination
performed over the course of a disease or a condition, which for some patient/client diagnostic
Outcomes
* Risk of disability associated with superficial skin involvement is reduced.
equipment.
Understanding of personal and environmental factors that promote optimal health status is
demonstrated.
and caregivers.
and caregivers.
Page 32 of 114
and caregivers.
and caregivers.
Page 33 of 114

Patients/clients with partial-thickness skin involvement. Patients/clients may have any one or a
* Burns (second degree)
* Dermatologic disorders
* Hematoma
* Neuropathic ulcers (grade 1)
* Pressure ulcers (stage II)
* Prior scar
* Surgical wounds
* Traumatic injury
* Vascular ulcers (eg, venous, arterial, diabetic)
* Epidermolysis bullosa
* Immature scar
* Neoplasms (including Kaposi's sarcoma)
* Pemphigus vulgaris
* Status post-spinal cord injury
* Toxic epidermal necrolyzing syndrome (Stevens-Johnson syndrome)
* A total body surface area (TBSA) involvement of more than 25% in adults and more than 20% in
children who are medically unstable
* Acute amputation
* Frostbite
* Injury secondary to trauma (eg, multiple fractures, amputations, electricity-related injuries)
ICD-9-CM Codes
Page 34 of 114
Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding manuals that
contain exclusion notes and instructions regarding fifth-digit requirements.
017 Tuberculosis of other organs
017.0 Skin and subcutaneous cellular tissue 031 Diseases due to other mycobacteria
031.1 Cutaneous 216 Benign neoplasm of skin
216.5 Skin of trunk, except scrotum
216.6 Skin of upper limb, including shoulder
216.7 Skin of lower limb, including hip 232 Carcinoma in situ of skin
232.5 skin of trunk, except scrotum
232.7 skin of lower limb, including hip 239 Neoplasms of unspecified nature
239.2 Bone, soft tissue, and skin 454 Varicose veins of lower extremities
454.0 With ulcer
454.2 With ulcer and inflammation 682 Other cellulitis and abscess 686 Other local infections of
skin and subcutaneous tissue 694 Bullous dermatoses
694.5 Pemphigoid 695 Erythematous conditions
695.1 Erythema multiforme
695.4 Lupus erythematosus 696 Psoriasis and similar disorders
696.1 other psoriasis 701 Other hypertrophic and atrophic conditions of skin
701.0 Circumscribed scleroderma
701.3 Striae atrophicae Atrophy blanche (of Milian)
701.4 Keloid scar 707 Chronic ulcer of skin
707.0 Decubitus ulcer
Page 35 of 114
707.1 Ulcer of lower limbs, except decubitus

707.8 Chronic ulcer of other specified sites 709 Other disorders of skin and subcutaneous tissue
709.2 Scar conditions and fibrosis of skin
709.3 Degenerative skin disorders 757 Congenital anomalies of the integument 911 Superficial
injury of trunk
911.0 Abrasion or friction burn without mention of
infection
911.1 Abrasion or friction bum, infected
911.2 Blister without mention of infection
911.3 Blister, infected 912 Superficial injury of shoulder and upper arm
infection
912.1 Abrasion or friction bum, infected
912.3 Blister, infected 913 Superficial injury of elbow, forearm, and wrist
infection
913.1 Abrasion or friction burn, infected
913.3 Blister, infected 914 Superficial injury of hand(s), except finger(s) alone
infection
914.3 Blister, infected 915 Superficial injury of finger(s)
Page 36 of 114
infection
915.3 Blister, infected 916 Superficial injury of hip, thigh, leg, and ankle
infection
916.3 Blister, infected 917 Superficial injury of foot and toe(s)
infection
917.3 Blister, infected
942 Burn of trunk
942.2 Blisters, epidermal loss [second degree] 943 Burn of upper limb, except wrist and hand
943.2 Epidermal loss [second degree] 944 Burn of wrist(s) and hand(s)
944.2 Blisters, epidermal loss [second degree] 945 Burn of lower limb(s)
945.2 Blisters, epidermal loss [second degree] 946 Burns of multiple specified sites
946.2 Blisters, epidermal loss [second degree] 948 Burns classified according to extent of body
surface involved 949 Burn, unspecified
949.2 Blisters, epidermal loss [second degree]
Examination
Page 37 of 114
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Living Environment
Page 38 of 114

* Patient/client, family, significant other,
* and caregiver expectations and goals for the therapeutic intervention
Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
Page 39 of 114
* Neuromuscular
Family History
leisure activities)
Physiologic and anotomic status
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Page 40 of 114
* Assessment of patient/client and caregiver ability to care for device
For wound:
Page 41 of 114

* Assessment of scar tissue cicatrix), including banding, pliability, sensation, and texture
* Assessment of scar tissue mobility, turgor, and texture
* Assessment of wound contraction, drainage location, odor, shape, size, and depth (eg, linear,
tracing, photography)
* Assessment of wound tissue, including epithelium, granulation, necrosis, slough, texture, and
turgor
of device
its use and care
Page 42 of 114

Pain
pressure)
Prognosis
Page 43 of 114
Over the course of 4 weeks, patient/client will achieve wound closure.

service delivery.
of Episode
* Age
accident)
[HIV/AIDS], cancer)
Intervention
Page 44 of 114
Anticipated Goals
professionals.
identified.
* Case management
* Education plans
Page 45 of 114
* Record reviews
Anticipated Goals
increased.
caregivers.
Page 46 of 114
Anticipated Goals
* Postural control is improved,
Page 47 of 114
* Utilization and cost of health care services are decreased,

* Strengthening
Anticipated Goals
IADL) is increased.
Anticipated Goals
Page 48 of 114

Anticipated Goals
Prosthetic)
Anticipated Goals
Page 49 of 114

* Pressure areas (eg, pressure over bony prominences) are prevented
Wound Management
Anticipated Goals
Page 50 of 114

- wet dressings
- debridement with other agents (eg,
autolysis)
- sharp debridement
* Electrotherapeutic modalities (see Electrotherapeutic Modalities)
* Physical agents and mechanical modalities (see Physical Agents and Mechanical Modalities)
Anticipated Goals
Page 51 of 114

Anticipated Goals
Physical agents:
* Deep thermal modalities (eg, ultrasound, pulsed shortwave diathermy)
* Hydrotherapy (eg, whirlpool tanks, pulsatile lavage)
Re examination
Page 52 of 114
Outcomes
* Risk of disability associated with partial-thickness skin involvement and scar tissue is reduced.
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
Page 53 of 114
and caregivers.
outcomes include:
anticipated goats (remediation of impairment, or loss or abnormality of physiological,
Impaired Integumentary Integrity Secondary to Full-Thickness Skin
Involvement and Scar Formation
PATTERN D
Page 54 of 114
Patients/clients with full-thickness involvement. Patients/clients may have any one or a
* Burns
* Dermatologic disorders
* Hematoma
* Lymphostatic ulcers
* Necrotizing fasciitis
* Neuropathic ulcers (grade 2)
* Pressure ulcer (stage 3)
* Prior scar
* Vascular ulcers (eg, venous, arterial, diabetic)
* Abscess
* Frostbite
* Immature, hypertrophic, or keloid scar
* Neoplasm
* Surgical wound
* Toxic epidermal necrolysis (Stevens-Johnson syndrome)
* Amputations
* Crushing injury
* Electricity-related injury
* Lymphedema
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* Traumatic wound
ICD-9-CM Codes
017 Tuberculosis of other organs
017.0 Skin and subcutaneous cellular tissue 031 Diseases due to other mycobacteria
031.1 Cutaneous 036 Meningococcal infection
036.1 Meningococcal encephalitis 040 Other bacterial diseases
040.0 Gas gangrene 172 Malignant melanoma of skin
172.5 Trunk, except scrotum
172.6 Upper limb, including shoulder
172.7 Lower limb, including hip
172.8 Other specific sites of skin 173 Other malignant neoplasm of skin
173.5 Skin of trunk, except scrotum
173.7 Skin of lower limb, including hip
173.8 Other specified sites of skin 176 Kaposi's sarcoma
176.0 Skin 216 Benign neoplasm of skin 232 Carcinoma in situ of skin 239 Neoplasms of
unspecified nature 443 Other peripheral vascular disease
443.1 Thromboangiitis obliterans [Buerger's disease] 454 Varicose veins of lower extremities
454.0 With ulcer
454.2 With ulcer and inflammation 680 Carbuncle and furuncle
680.2 Trunk
Page 56 of 114
680.3 Upper arm and forearm

680.4 Hand
680.5 Buttock
680.6 Leg, except foot
680.7 Foot 681 Cellulitis and abscess of finger and toe
681.0 Finger
681.1 Toe 682 Other cellulitis and abscess
682.0 Face
682.2 Trunk
682.3 Upper arm and forearm
682.4 Hand, except fingers and thumb
682.5 Buttock
682.6 Leg, except foot
682.7 Foot, except toes 686 Other local infections of skin and subcutaneous tissue
686.0 Pyoderma
686.1 Pyogenic granuloma
686.8 Other specified local infections of skin and subcutaneous tissue 694 Bullous dermatoses
695 Erythematous conditions
695.1 Erythema multiforme
695.4 Lupus erythematosus 701 Other hypertrophic and atrophic conditions of skin
701.0 Circumscribed scleroderma
701.4 Keloid scar
701.5 Other abnormal granulation tissue 707 Chronic ulcer of skin
707.1 Ulcer of lower limbs, except decubitus
707.8 Chronic ulcer of other specified sites 709 Other disorders of skin and subcutaneous tissue
709.2 Scar conditions and fibrosis of skin
Page 57 of 114
709.3 Degenerative skin disorders 941 Burn of face, head, and neck
941.3 Full-thickness skin loss [third degree, not otherwise specified] 942 Burn of trunk
942.3 Full-thickness skin loss [third degree, not otherwise specified) 943 Burn of upper limb,
except wrist and hand
943.3 Full-thickness skin loss [third degree, not otherwise specified] 944 Burn of wrist(s) and hand
(s)
944.3 Full-thickness skin loss [third degree, not otherwise specified] 945 Burn of lower limb(s)
945.3 Full-thickness, skin loss [third degree, not otherwise specified] 946 Burns of multiple
specified sites
946.3 Full-thickness skin loss [third degree, not otherwise specified] 948 Burns classified
according to extent of body surface involved 949 Burn, unspecified
949.3 Full-thickness skin loss [third degree, not otherwise specified]
Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Social History
Page 58 of 114

Living Environment
intervention
Medications
therapist
Page 59 of 114

* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
Page 60 of 114

leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
Page 61 of 114

* Assessment of activities, positioning, and postures that aggravate the scar or that may produce
additional trauma
Page 62 of 114
* Assessment of scar mobility, turgor, and texture

* Assessment of wound contraction, drainage, location, odor, shape, size, depth (eg, linear,
tracing, photography), tunneling, and undermining
* Assessment of wound tissue, including epithelium, granulation, necrosis, slough, and texture
of device
its use and care
Pain
pressure)
Page 63 of 114

* Assessment of standard vital signs (eg, blood pressure, heart rate, respiratory rate)
evaluating, organizing, and interpreting data. The prognosis is the determination of the optimal
physical therapist develops the plan of care, which specifies goals and outcomes, specific direct
Prognosis
Wound
Over the course of 4 to 12 weeks, one of the following will occur:
* Wound will be clean and stable.
* Wound will be prepared for closure.
* Wound will be closed.
Scar
Over the course of 6 to 12 months, scar will be mature.
12 to 60
Page 64 of 114
delivery.
* Age
* Comorbidities (eg, chronic obstructive
* pulmonary disease, renal disease, cerebrovascular accident)
[IHV/AIDS), cancer)
Intervention
Page 65 of 114

Anticipated Goals
professionals.
identified.
* Case management
* Education plans
* Record reviews
Page 66 of 114

Anticipated Goals
increased.
* Progress is enhanced through the participation of patient/client, family, significant others and
caregivers.
Page 67 of 114

Anticipated Goals
* Strength is increased.
Page 68 of 114

* Strengthening
IADL)
Anticipated Goals
* Ability to recognize and intiate treatment of a recurrence is improved through increased selfmanagement of symptoms.
IADL) is increased.
Anticipated Goals
Page 69 of 114

* IADL training (eg, maintaining a time, shopping, cooking, home chores, heavy household chores,
money management, driving a car or using public transportation, structured play for infants and
children)
Anticipated Goals
Page 70 of 114
Prosthetic)
Anticipated Goals
* Pressure areas (eg, pressure over bony prominences) are prevented.
* Soft tissue swelling, inflammation, or restricted is reduced.
Page 71 of 114
Wound Management
Anticipated Goals
- wet dressings
- sharp debridement
* Electrotherapeutic modalities (see Electrotherapeutic
* Modalities)
Page 72 of 114

* Physical agents and mechanical modalities (see Physical Agents and Mechanical Modalities)
Anticipated Goals
* Electrical muscle Stimulation
Anticipated Goals
Physical agents:
Page 73 of 114
* Athermal modalities (eg, pulsed ultrasound, pulsed radio frequency energy)

* Hydrotherapy (eg, whirlpool tanks, pulsatile lavage)
* Superficial thermal modalities (eg, heat, paraffin baths, hot
* packs, fluidotherapy)
* Compression therapies (eg, all compression devices, compression bandaging, compression
garments, taping, and total contact casting)
Re examination
Outcomes
* Risk of disability associated with full-thickness skin involvement and scar formation is reduced.
Page 74 of 114
* Self-care and home management activities, including activities of daily living (IADL) -- and work
equipment.
demonstrated.
and caregivers.
and caregivers.
and caregivers.
and caregivers.
Page 75 of 114
Impaired Integumentary Integrity Secondary to Skin Involvement Extending
Into Fascia, Muscle, or Bone
Patients/clients with subcutaneous tissue involvement that may extend into underlying tissue;
patients/clients may have any one or a combination of the following:
* Abscess
* Hematoma
* Necrotizing fasciitis
* Neuropathic ulcers (grades 3, 4, 5)
* Pressure ulcers (stage 4)
* Surgical wounds
* Vascular ulcers (eg, venous, diabetic)
* Acute amputation
* Burn
Page 76 of 114
* Chronic surgical wound

* Electrical burns
* Frostbite
* Kaposi's sarcoma
* Lymphostatic ulcer
* Neoplasm
* Subcutaneous arterial ulcer
* Surgical wound
* Lymphedema
ICD-9-CM Codes
017 Tuberculosis of other organs 017.0 Skin and subcutaneous cellular tissue 036 Meningococcal
infection 036.2 Meningococcemia 171 Malignant neoplasm of connective and other soft tissue
171.2 Upper limb, including shoulder 171.3 Lower limb, including hip 171.5 Abdomen 171.6 Pelvis
171.8 Other specified sites of connective and other soft tissue 172 Malignant melanoma of skin
172.5 Trunk, excluding scrotum 172.6 Upper limb,includingshoulder 172.7 Lower limb, including
hip 172.8 Other specific sites of skin 173 Other malignant neoplasm of skin 173.5 Skin of trunk,
except scrotum 173.6 Skin of upper limb, including shoulder 173.7 Skin of lower limb, including hip
173.8 Other specified sites of skin 176 Kaposi's sarcoma 176.0 skin 176.1 Soft tissue 215 Other
benign neoplasm of connective and other soft tissue 215.2 Upper limb,including shoulder 215.3
Lower limb, including hip 215.6 Pelvis 239 Neoplasms of unspecified nature 239.2 Bone, soft
tissue, and skin 440 Atherosclerosis 440.2 Of native arteries of the extremities 440.24
Atherosclerosis of the extremities with gangrene 443 Other peripheral vascular disease 443.1
Thromboangiitis obliterans [Buerger's disease] 454 Varicose veins of lower extremities 454.0 With
ulcer 454.2 With ulcer and inflammation 674 Other and unspecified complications of the
perperium, not elsewhere classified 674.1 Disruption of cesarean wound 680 Carbuncle and
furuncle 680.2 Trunk 680.3 Upper arm and forearm 680.4 Hand 680.5 Buttock 680.6 Leg, except
foot 680.7 Foot 681 Cellulitis and abscess of finger and toe 681.0 Finger 686 Other local
infections of skin and subcutaneous tissue 686.8 Other specified local infections of skin and
subcutaneous tissue 707 Chronic ulcer of skin 707.0 Decubitus ulcer 707.1 Ulcer of lower limbs,
except decubitus 707.8 Chronic ulcer of other specified sites 710 Diffuse diseases of connective
Page 77 of 114
tissue 710.0 Systemic lupus erythematosus 710.1 Systemic sclerosis 710.3 Dermatomyositis 880
Open wound of shoulder and upper arm 881 Open wound of elbow, forearm, and wrist 882 Open
wound of hand except figer(s) alone 883 Open wound of finger(s) 884 Multiple and unspecified
open wound of upper limb 885 Traumatic amputation of thumb (complete) (partial) 886 Traumatic
amputation of other finger(s) (complete) (partial) 887 Traumatic amputation of arm and hand
(complete) (partial) 890 Open wound of hip and thigh 891 Open wound of knee, leg [except thigh],
and ankle 892 Open wound of foot except toe(s) alone 893 Open wound of toe(s) 894 Multiple
and unspecified open wound of lower limb 895 Traumatic amputation of toe(s) (complete) (partial)
896 Traumatic amputation of foot (complete) (partial) 897 Traumatic amputation of leg(s )
(complete) (partial) 927 Crushing injury of upper limb 928 Crushing injury of lower limb 929
Crushing injury of multiple and unspecified sites 941 Burn of face, head, and neck 941.4 Deep
necrosis of underlying tissues [deep third degree] without mention of loss of a body part 941.5
Deep necrosis of underlying tissues [deep third degree] with loss of a body part 942 Burn of trunk
942.4 Deep necrosis of underlying tissues [deep third degree] without mention of loss of a body
part 942.5 Deep necrosis of underlying tissues [deep third degree] with loss of a body part 943
Burn of upper limb, except wrist and hand 943.4 Deep necrosis of underlying tissues [deep third
degree] without mention of loss of a body part 943.5 Deep necrosis of underlying tissues [deep
third degree] with loss of a body part 944 Burn of wrist(s) and hand(s) 944.4 Deep necrosis of
underlying tissues [deep third degree] without mention of loss of a body part 944.5 Deep necrosis
of underlying tissues [deep third degree] with loss of a body part 946 Burns of multiple specified
sites 946.4 Deep necrosis of underlying tissues [deep third degree] without mention of loss of a
body part 946.5 Deep necrosis of underlying tissues [deep third degree] with loss of a body part
948 Burns classified according to extent of body surface involved 991 Effects of reduced
temperature 991.1 Frostbite of hand 991.2 Frostbite of foot 991.3 Frostbite of other and
unspecified sites 991.4 Immersion foot 991.5 Chilblains 998 Other complications of procedures,
not elsewhere classified 998.3 Disruption of operation wound
Examination
History
* Age
* Primary language
* Race/ethnicity
Page 78 of 114
* Sex
Social History
Living Environment
intervention
Page 79 of 114
Medications
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
Page 80 of 114

leisure activities)
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Test and Measures
* Observation and palpation of trunk and extremities at rest and during activity
Page 81 of 114

* Assessment for presence of dermatitis (eg, rush, fungus)
* Assessment of activities and postures that aggravate or relieve pain or other disturbed
sensations
* Asessment of tissue mobility, turgor, and texture For wound:
* Assessment for presence of hair and nail growth
Page 82 of 114
* Assessment of exposed anatomical structures
* Assessment of scar mobility, turgor, and texture
* Assessment of sensation (eg, pain, protective, temperature, tactile)
* Assessment of wound contraction, drainage, location, odor, shape, size, depth (eg, linear,
tracing, photography), tunneling and undermining
* Assessment of wound tissue, including epithelium, granulation, mobility, necrosis, slough,
texture, and turgor
of device
its use and care
Page 83 of 114
Pain
* Assessment of superficial sensations (eg, sharp/dull discrimination, temperature, fight touch,
pressure)
* Assessment of standard vital signs (eg, blood pressure, heart rate, respiratory rate)
Evaluation., Diagnosis, and Prognosis
The physical therapist performs an evaluation makes clinical judgments) for the purpose of
evaluating, organizing, and interpretion examination data. The prognosis is the determination of
the optimal level of improvement that might be answer and the amount of time required to reach
prolonged impairment, functional limitation, or disability; multisite or midtisystem involvement;
expectations; anatonxic and physiologic changes related to growth and development; and
Prognosis
Page 84 of 114
Wound Over the course of 4 to 16 weeks, one of the following will occur:
* Wound will be clean and stable.
* Wound will be prepared for closure.
* Wound will be closed.
Scar Over the course of 4 to 16 weeks, immature scar will be evident.
12 to 112
12 to 112
These ranges represents the lower and upper limits of the number of physical therapist visits
required to achieve the anticipated goals and desired outcomes. It is anticipated that 80% of
service delivery.
of Episode
* Age
* Comorbidities (eg, chronic obstructive
* Pulmonary disease, renal disease, cerebrovascular accident)
* Imununosuppression (eg, human immunodeficiency virus/acquired immunodeficiency syndrome
[HIV/AIDS], cancer)
* Intrusion beyond tissue-protective surface (eg, fascial plane, peritenon, periosteum)
Page 85 of 114

Intervention
anticipated goals (remediation of impairment) and desired outcomes remediation of functional
bmitation, secondary or primary prevention of disability, optimization of patient/client satisfaction).
Anticipated Goals
* Care is coordinated with patient/client, family significant others, caregivers, and other
professionals.
identified.
* Case management
Page 86 of 114

* Discharge planting
* Education plans
* Record reviews
Anticipated Goals
* Ability. to perform physical tasks is increased.
* Disability associated with acute or chromic illness is reduced.
living IADL) is increased.
increased.
Page 87 of 114
caregivers.
* Risk, of recurrence of condition is reduced.
Anticipated Goals
* Gait, locomotion, and balance are improved. joint integrity and mobility are improved.
* Preoperative and postoperative complication are reduced.
Page 88 of 114
* Safety is impaired.
* Strengthening
Functional Training in Self-care and Home Management (Including ADL and
IADL)
Anticipated Goals
IADL) is increased.
Page 89 of 114
Functional Training in Community and Work job/school/play) Integration
or Reintegration (Including IADL, Work
Anticipated Goals
chores, money management, driving a car or using public transportation, structured play for and
children)
Anticipated Goals
* Ability, to perform movement tasks is increased.
Page 90 of 114

Anticipated Goals
* Gait, locomotion, and balance are improved
* Joint integrity and mobility are improved joint stability is increased.
* Pressure areas (eg, pressure over bony prominence)are prevented
Page 91 of 114

* Orthotic devices or equipment (eg, solints, braces, shoe inserts, casts)
* Supportive devices or equipment (eg, supportive taping, compression garments, corsets, stings,
Wound Management
Anticipated Goals
* Physical function and health status are unproved.
* Risk of secondary improvement is reduced.
* Tissue perfussion and oxygenation are enhanced.
- wet dressings
Page 92 of 114
* Debridement-selective
- sharp debridement
* Electrotherapeutic modalities (see Electrotherapeutic Modalities)
* Physical agents and mechanical modalities (see Physical agents and Mechanical Modalities)
Anticipated Goals
* Edema, lymphederna, or effusion is decreased. joint integrity and mobility are improved.
Anticipated Goals
Page 93 of 114

* Risk of secondary impairment is decreased.
Physical agents:
* Athermal modalities (eg, pulsed ultrasound, pulsed radio frequency stimulation)
* Hydrotherapy (eg, whirlpool tanks, pulsatie lavage)
garments, taping, and total contact casting)
Re examination
measures after the initial examination, to evaluate progress and to modify, or redirect intervention.
Outcomes
Page 94 of 114
* Risk of disability), associated with skin involvement extending into fascia, muscle, or bone is
reduced.
* Self-care and home management activities, including activities of daily living
* ADL -- and work (job/school/play) and leisure activities, including instrumental activities of daily
living
* (ADL) -- are performed safely, efficiently, and at a maximal level of independence with or without
devices and equipment.
demonstrated.
* Understanding of strategies to prevent finger function limitation and disability is demonstrated.
and caregivers.
* Clinically proficiency of physical therapist is acceptable to patient/client, family, significant others,
and caregivers.
and caregivers.
and caregivers.
Page 95 of 114

adaptation, leisure or leisure activities, giving environment, pathology or impairment that may
affect function, or home or work (job/school/play) settings.
* Professional recommendation are integrated into home, community, work (job/school/play), or
of care. Discharge occurs based on the physical therapist analysis of the achievement of
anticipated goals (remediation of impairment, or loss or abnormality of physiological.
for appropriate follow-up or referral. The primary criterion for discharge: The participated goals
and the desired outcomes hate been achieved. Other indicators: patient/client, caregiver, or legal
guardian declines to continue intervention patient/client is unable to continue to progress toward
the patient/client will no longer benefit from physical therapy. N"en discharge occurs prior to
documented. F()r patients/clients who require multiple episodes of care, periodic follow-up is
status,
Impaired Anthropometric Dimensions Secondary to Lympathic System Disorders
Patients/clients with lymphatic system involvement. Patients/ clients may have any one or a
* Acquired immune deficiency syndrome (AIDS)
* Lymphedema
Page 96 of 114
* Status postcancer
* Status postinfection
* Status posttrauma
* Vascular/lymphatic malfunction
* Amputation with lymphedema
* Filariasis (elephantiasis)
* Multiple abdominal surgeries
* Postradiation status
* Status post-lymph node dissection in the groin or abdomen
* Status post-axillary lymph node dissection
* Reconstructive surgery
* Acute traumatic edema
* Acute surgical edema
* Congestive heart failure
* Deep vein thrombosis (DVT)
* Dependent edema
* Lymphangiosarcoma
* Lymphangitis
ICD-9-CM Codes
Page 97 of 114
040 Other bacterial diseases

040.0 Gas gangrene malignant edema) 176 Kaposi's sarcoma
176.5 Lymph nodes 457 Noninfectious disorders of lymphatic channels
457.0 Postmastectomy lymphedema syndrome
457.1 Other lymphedema
457.8 Other noninfectious disorders of lymphatic channels
457.9 Unspecified noninfectious disorder of lymphatic channels 646 Other complications of
pregnancy not elsewhere classified
646.1 Edema or excessive weight gain in pregnancy, without mention of hypertension 683 Acute
lymphadenitis 757 Congenital anomalies of the integument
757.0 Hereditary edema of legs 782 Symptoms involving skin and other integumentary tissue
782.8 Changes in skin texture 995 Certain adverse effects not elsewhere classified
995.1 Angioneurotic edema
Examination
History
* Age
* Primary language
* Race/ethnicity
* Sex
Page 98 of 114
Social History
Living Environment
intervention
Medications
Page 99 of 114
therapist
* Prior medications
* Cardiopulmonary
* Gastrointestinal
* Genitourinary
* Integumentary
* Musculoskeletal
* Neuromuscular
Family History
Page 100 of 114

leisure activities
Systems Review
* Cardiopulmonary
* Integumentary
* Musculoskeletal
* Neuromuscular
Tests and Measures
* Measurement of height, weight, length, and girth observation and palpation of trunk and
extremities at rest and during activity
safety awareness)
Page 101 of 114

* Analysis of effects and benefits including energy conservation and expenditure) while
professionals
coloration in darkly pigmented skin, signs of cellulitis, or infection)
* Assessment of tissue mobility, turgor, and texture (eg, dry, flaky, cracked skin)
For the wound:
* Assessment of drainage
Page 102 of 114

of device
its use and care
Pain
Sensory integrity including Proprioception and Kinesthesia)
pressure)
* Assessment of receptive (eg, vision, hearing) abilities
Page 103 of 114
Prognosis
Over the course of 1 to 8 weeks:
Patient/client with mild lymphedema (less than 3-cm differential between affected limb and
unaffected limb) will show decreased lymphatic congestion, allowing return to highest level of
function and quality of life.
Patient/client with moderate lymphedema (3- to 5-cm differential between affected limb and
Patient/client with severe lymphedema (5-plus-cm differential between affected limb and
Management of lymphatic involvement may he required over the life span.
5 to 7
7 to 14
14-20
Page 104 of 114
These ranges represent the lower and upper limits of the number of physical therapist visits
required to achieve the anticipated goals and desired outcomes. It is anticipated that 80% of
patients/ clients in this diagnostic group will achieve the goals and outcomes within these ranges
service delivery.
* Age
accident)
* Hardening, fibrosis of limb tissue
* Immunosuppression (eg, human
* Immunodeficiency virus/acquired immunodeficiency syndrome [HIV/AIDS], cancer)
* Lymphatic ulceration
* Multilimb involvement
* Presence of wound
Intervention
Page 105 of 114
symptoms and remediation of deficits. intervention has three components. Communication,
Anticipated Goals
professionals.
identified.
* Case management
Page 106 of 114
* Education plans
* Record reviews
Anticipated Goals
increased.
caregivers.
Page 107 of 114

Direct Intervention for this may include, in order of preferred usage:
Anticipated Goals
Page 108 of 114

* Strength is increased.
* Strengthening
Functional Training in Self-Care and Home Management (Including (ADL and
IADL)
Anticipated Goals
IADL) is increased.
Page 109 of 114
Functional Training in Community and Work (Job/School/Play) integration or Reintegration

(Including IADL, Work
Anticipated Goals
* Ability to perform physical tasks related to community and work (job/school/play) integr-ation and
Anticipated Goals
* Risk of secondary. impairments is reduced.
Page 110 of 114

and Equipment
(Assistive, Adaptive, Orthotic, Protective, Supportive and Prosthetic)
Anticipated Goals
* Pressure areas (eg, pressure over bony prominence) are prevented,
* Soft tissue swelling. inflammation, or restriction is reduced.
Page 111 of 114
* Protective devices or equipment (eg, braces, cushions, protective taping, helmets)
neck collars, serial casts, elastic wrap, oxygen)
Anticipated Goals
* Muscle performance is increased..
* Wound and soft tissue healing is enchanced.
Anticipated Goals
Page 112 of 114

Physical agents:
garments)
* Compression therapies (eg, vasopneumatic compression devices compression bandaging,
Reexamination
measures after the initial examination, to evaluate progress and to modify, or redirect intervention.
groups -- may be the life spain. Indications for reexamination include new clinical findings or
failure to respond to intervention.
Outcomes
* Optional return to role function (eg, worker, student, spouse, grandparent) is achieved.
* Risk of disability associated with lymphatic system disorders is reduced.
Page 113 of 114
equipment.
demonstrated.
and caregivers.
* Clinical proficiency of physical therapist is acceptable to patient/client, family significant others,
and caregivers.
and caregivers.
and caregivers.
outcomes include:
Page 114 of 114
status,
Source Citation:"Integumentary." Physical Therapy 77.n11 (Nov 1997): 1557(62). Expanded Academic

Page 1 of 9
Glossary.(Guide to Physical Therapy Practice).Physical Therapy 77.n11 (Nov

1997): pp1620(5). (3036 words)
Activities of daily living (ADL) The self-care, communication, and mobility skills (eg, bed mobility,
transfers, ambulation, dressing, grooming, bathing, eating, and toileting) required for
independence in everyday living.
Adaptive devices A variety of implements or equipment used to aid patients/clients in performing
movements, tasks, or activities. Adaptive devices include raised toilet seats, seating systems,
environmental controls, and other devices.
Aerobic activity/conditioning The performance of therapeutic exercise and activities to increase
endurance.
Aerobic capacity A measure of the ability to perform work or participate in activity over time using
the body's oxygen uptake and delivery and energy release mechanisms.
Airway clearance techniques A broad group of activities used to manage or prevent
consequences of acute and chronic lung diseases and impairment, including those associated
with surgery.
Anthropometric characteristics Human body measurements such as height, weight, girth, and
body fat composition.
Arthrokinematic Describing the motion of a joint without regard to the forces producing that motion
or resulting from it; describing the structure and shape of joint surfaces.
Assessment The measurement or quantification of a variable or the placement of a value on
something. Assessment should not be confused with examination or evaluation.
Assistive devices A variety of implements or equipment used to aid patients/clients in performing
tasks or movements. Assistive devices include crutches, canes, walkers, wheelchairs, power
devices, long-handled reachers, and static and dynamic splints.
Auscultation The act of listening to internal body sounds (eg, heart, lungs).
Autogenic drainage Airway clearance through the patient's/client's own efforts (eg, coughing).
Back school A structured educational program about low back problems, usually offered to a
group of patients/clients.
Balance The ability to maintain the body in equilibrium with gravity both statically (eg, while
stationary) and dynamically (eg, while walking).
Page 2 of 9
Barriers -- environmental, home, and work (job/school/ play) The physical impediments that keep
patients/clients from functioning optimally in their surroundings, including safety hazards (eg,
throw rugs, slippery surfaces), access problems (eg, narrow doors, high steps), and home or
office design difficulties (eg, excessive distance to negotiate, multistory environment).
Biofeedback A training technique that enables an individual to gain some element of voluntary
control over muscular or autonomic nervous system functions using a device that produces
auditory or visual stimuli.
Body mechanics The interrelationships of the muscles and joints as they maintain or adjust
posture in response to environmental forces.
Cardiovascular pump Structures responsible for maintaining cardiac output, including the cardiac
muscle, valves, arterial smooth muscle, and venous smooth muscle.
Cardiovascular pump dysfunction Abnormalities of the cardiac muscles, valves, conduction, or
circulation that interrupt or interfere with cardiac output or circulation.
Cicatrix Scar; the fibrous tissue replacing the normal tissues destroyed by injury or disease.
Clients Individuals who are not necessarily sick or injured but who can benefit from a physical
therapist's consultation, professional advice, or services. Clients are also businesses, school
systems, and others to whom physical therapists offer services.
Cognition The act or process of knowing, including both awareness and judgment.
Community and work (job/school/play) integration or reintegration The process of assuming or
resuming roles in the community or at work.
Compression therapy Treatment using devices or techniques that decrease the density of a part of
the body through the application of pressure.
Continuous passive motion (CPM) The use of a device that allows a joint (eg, the knee) to he
exercised without the involvement of the patient/client, often in the early postoperative period.
Contrast bath The immersion of an extremity in alternating hot and cold water.
Cosmesis A concern in rehabilitation, especially regarding surgical operations or burns, for the
appearance of the patient/client.
Cryotherapy Therapeutic application of cold (eg, ice).
Debridement Excision of contused and necrotic tissue from the surface of a wound. Autolytic: selfdebridement, that is, removal of contused or necrotic tissue through the action of enzymes in the
tissue. Sharp: debridement using a sharp instrument.
Deficit A lack or deficiency. Developmental: The difference between expected and actual (lower)
performance in an aspect of development (eg, motor, communication, social).
Developmental delay The failure to reach expected age-specific performance in one or more
areas of development (eg, motor, sensory-perceptual).
Page 3 of 9
Disability The inability to engage in age-specific, gender-related, and sex-specific roles in a

particular social context and physical environment.
Discharge The process of discontinuing interventions included in a single episode of care,
occurring when the anticipated goals and desired outcomes have been met. Other indicators for
discharge: The patient/client declines to continue care, the patient/client is unable to continue to
progress toward goals because of medical or psychosocial complications, or the physical therapist
determines that the patient/client will no longer benefit from physical therapy.
Dynamometry Measurement of the degree of muscle power.
Electrical potential The amount of electrical energy residing in specific tissues.
Electrical stimulation Intervention through the application of electricity.
Electrophysiologic testing The process of examining and recording the electrical responses of the
body.
Electromyography (EMG) The examining and recording of the electrical activity of a muscle.
Electrotherapeutic modalities A broad group of agents that use electricity to produce a therapeutic
effect.
Endurance The ability of a muscle to sustain forces or to repeatedly generate forces.
Episode of care All patient/client management activities provided, directed, or supervised by the
physical therapist, from initial contact through discharge.
Ergonomics The relationship among the worker, the work that is done, the tasks and activities
inherent in that work, and the environment in which the work is performed.
Ergonomics uses scientific and engineering principles to improve the safety, efficiency, and quality
of movement involved in work.
Evaluation A dynamic process in which the physical therapist makes clinical judgments based on
data gathered during the examination.
Examination The process of obtaining a history, performing relevant systems reviews, and
selecting and administering specific tests and measures.
Fluidotherapy "Dry whirlpool"; the application of dry heat through a fluidotherapy machine.
Force plate An embedded plate used to measure the force that a person exerts when walking.
Function Those activities identified by an individual as essential to support physical, social, and
psychological well-being and to create a personal sense of meaningful living.
Functional limitation Restriction of the ability to perform a physical action, activity, or task in an
efficient, typically expected efficient, or competent manner.
Functional muscle testing Performance-based muscle assessment in particular positions
Page 4 of 9
simulating functional tasks and activities and usually under specific test conditions.
Gait The manner in which a person walks, characterized by rhythm, cadence, step, stride, and
speed.
Goniometry Measurement of the angle of a joint or a series of joints.
History An account of past and present health status that includes the identification of complaints
and provides the initial source of information about the patient/client. The history also suggests the
individual's ability to benefit from physical therapy services.
Hydrotherapy Intervention using water.
Impairment A loss or abnormality of physiological, psychological, or anatomical structure or
function. Secondary: Impairments that originate from other, preexisting impairments.
Instrumental activities of daily living (IADL) Activities -- such as shopping, cooking, home chores,
heavy household chores, managing money, and structured play for infants and children -- that are
important components of maintaining independent living.
Intervention The purposeful and skilled interaction of the physical therapist with the patient/client,
and, when appropriate, with other individuals involved in care, using various methods and
techniques to produce changes in the condition.
Iontophoresis Introduction of ions into tissues by means of electric current.
Locomotion The ability to move from place to place.
Manipulation A passive therapeutic movement, usually of small amplitude and high velocity at the
end of the available range of motion.
Manual therapy A broad group of skilled hand movements used by the physical therapist to
mobilize soft tissues and joints for the purpose of modulating pain, increasing range of motion,
reducing or eliminating soft tissue inflammation, inducing relaxation, improving contractile and
noncontractile tissue extensibility, and improving pulmonary function.
Mechanical modalities A broad group of agents that use distraction, approximation, or
compression to produce a therapeutic effect.
Mobilization A passive therapeutic movement at the end of the available range of motion at
variable amplitudes and speed.
Modality A broad group of agents that may include thermal, acoustic, radiant, mechanical, or
electrical energy to produce physiologic changes in tissues for therapeutic purposes.
Motor control The ability of the central nervous system to control or direct the neuromotor system
in purposeful movement and postural adjustment by selective allocation of muscle tension across
appropriate joint segments.
Motor deficit Lack or deficiency of normal motor function (motor control and motor function) that
may be the result of pathology or other disorder. Weaknesses, paralysis, abnormal movement
Page 5 of 9
patterns, abnormal timing, coordination, clumsiness, involuntary movements, or abnormal

postures may be manifestations of impaired motor function (motor control and motor learning).
Motor function (motor control and motor learning) The ability to learn or demonstrate the skillful
and efficient assumption, maintenance, modification, and control of voluntary postures and
movement patterns. Fine: Refers to relatively delicate movements, such as using a fork and tying
a shoelace. Gross: Refers to larger-scale movements, such as assuming an upright position and
carrying a bag.
Motor learning A set of processes associated with practice or experience leading to relatively
permanent changes in the capability for producing skilled action.
Muscle tone The velocity-dependent resistance to stretch that muscle exhibits.
Orthotic devices Devices to support weak or ineffective joints or muscles, such as splints, braces,
shoe inserts, and casts.
Outcomes Outcomes are the results of patient/client management. They relate to remediation of
functional limitation and disability, primary or secondary prevention, and optimization of
patient/client satisfaction.
Outcomes Analysis A systematic examination of patient/client outcomes in relation to selected
patient/client variables (eg, age, sex, diagnosis, interventions performed); outcomes analysis may
be used in quality assessment, economic analysis of practice, and other processes.
Oxygen saturation the degree to which oxygen is present in a particular cell, tissue, organ, or
system.
Palpation Examination using the hands (eg, palpation of muscle spasm, palpation of the thoracic
cage).
Paraffin bath A superficial thermal modality using paraffin wax and mineral oil.
Patients individuals who are the recipients of physical therapy and direct intervention.
Percussion (diagnostic) A procedure in which the clinician taps a body part manually or with an
instrument to estimate its density.
Phototherapy Intervention using the application of fight.
Physical agent A form of thermal, acoustic, or radiant energy that is applied to tissues in a
systematic manner to achieve a therapeutic effect; a therapeutic modality used to treat physical
impairments.
Physical function Fundamental component of health status describing the state of those sensory
and motor skills necessary for mobility, work, and recreation.
Physical therapist A person who is a graduate of an accredited physical therapist education
program and is licensed to practice physical therapy.
Physical therapist assistant A person who is a graduate of an accredited physical therapist
Page 6 of 9
assistant education program and who assists the physical therapist in the provision of physical
therapy. The physical therapist assistant may perform physical therapy procedures and related
tasks that have been selected and delegated by the supervising physical therapist.
Physical therapy aide A nonlicensed worker, trained under the direction of a physical therapist,
who performs designated routine physical therapy tasks.
Plan of care Statements that specify the anticipated long-term and short-term goals and the
desired outcomes, predicted level of optimal improvement, specific interventions to be used,
duration and frequency of the intervention required to reach the goals and outcomes, and criteria
for discharge.
Pulmonary postural drainage Placing the body in a position that uses gravity to drain fluid from the
lungs.
Posture The alignment and positioning of the body in relation to gravity, center of mass, and basis
of support.
Power The ability to perform work over time.
Prevention Activities that are directed toward slowing or stopping the occurrence of both mental
and physical illness and disease, minimizing the effects of a disease or impairment on disability, or
reducing the severity or duration of an illness. Primary: Prevention of the development of disease
in a susceptible or potentially susceptible population through such specific measures as general
health promotion efforts. Secondary: Efforts to decrease the duration of illness, reduce severity of
diseases, and limit sequelae through early diagnosis and prompt intervention. Tertiary: Efforts to
limit the degree of disability and promote rehabilitation and restoration of function in
patients/clients with chronic and irreversible diseases.
Primary care The provision of integrated, accessible health care services by clinicians who are
accountable for addressing the majority of personal health care needs, developing a sustained
partnership with patients/clients, and practicing in the context of family and community. [Defining
Primary Care: An Interim Report. Washington, DC: Institute of Medicine, National Academy Press;
1995]
Prognosis: The determination of the level of optimal improvement that might be attained by the
patient/client and the amount of time needed to reach that level.
Proprioception The reception of stimuli from within the body (eg, from muscles and tendons);
includes position sense (the awareness of the joints at rest) and kinesthesia (the awareness of
movement).
Prosthesis An artificial device, often mechanical or electrical, used to replace a missing part of the
body.
Protective devices External supports to protect weak or ineffective joints or muscles. Protective
devices include braces, protective taping, cushions, and helmets.
Range of motion (ROM) (including muscle length) The space, distance, or angle through which
movement occurs at a joint or a series of joints.
Reexamination The process by which patient/client status is updated following the initial
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examination (because of new clinical indications, failure to respond to interventions, or failure to

establish progress from baseline data)
Referral A recommendation that a patient/client seek service from another health care provider or
resource.
Screening Determining the need for further examination or consultation by a physical therapist or
for referral to another health professional. Cognitive screening: Brief assessment of the
patient's/client's thinking process (eg, ability to process commands).
Self-care The set of activities that comprise daily living, such as bed mobility, transfers,
ambulation, dressing, grooming, bathing, eating, and toileting.
Sensory Having to do with sensations or the senses; including peripheral sensory processing (eg,
sensitivity to touch) and cortical sensory processing (eg, two-point and sharp/dull discrimination).
Sensory integration The ability to integrate information from the environment to produce normal
movement.
Serial casting A process in which the patient is recasted over a period of time, typically to achieve
increased range of motion of a particular body part.
Splinting Support of a body segment through application of an external device. Static: Customized
and prefabricated splints, inhibitory casts, and spinal and other braces that are designed to
maintain joints in a desired position. Dynamic: Customized and prefabricated supports that allow
for or control motion while providing support.
Strength Force-generating capacity of muscle.
Strengthening Active: A form of strength-building exercise in which the physical therapist applies
resistance through the range of motion of active movement. Assistive: A form of strength-building
exercise in which the physical therapist assists the patient/client through the available range of
motion. Resistive: Any form of active exercise in which a dynamic or static muscular contraction is
resisted by an outside force. The external force may be applied manually or mechanically.
Supportive devices External supports to protect weak or ineffective joints or muscles. Supportive
devices include supportive taping, compression garments, corsets, slings, neck collars, serial
casts, elastic wraps, and oxygen.
Transcutaneous electrical nerve stimulation (TENS) The use of electrical energy to stimulate
cutaneous and peripheral nerves via electrodes on the skin's surface.
Tests and measures Specific standardized methods and techniques used to gather data about the
patient/client after the history and systems review have been performed.
Therapeutic exercise A broad range of activities intended to improve strength, range of motion
(including muscle length), cardiovascular fitness, or flexibility or to otherwise increase a person's
functional capacity.
Thermistor An electrical resistor that uses a a semiconductor whose resistance varies sharply in a
known manner with the ambient temperature; used in determining temperature.
Page 8 of 9
Thermotherapy intervention through the application of heat, causing vasodilation to enhance the
healing process.
Traction The therapeutic use of manual or mechanical tension created by a pulling force to
produce a combination of distraction and gliding to relieve pain and increase tissue flexibility.
Transfer The process of relocating a body from one object or surface to another (eg, getting into
or out of bed, moving from a wheelchair to a chair).
Treatment The sum of all interventions provided by the physical therapist to a patient/client during
an episode of care.
Ultrasound A diagnostic or therapeutic technique using high-frequency sound waves to produce
heat. Pulsed ultrasound: The application of therapeutic ultrasound using predetermined
interrupted frequencies.
Ultraviolet A form of radiant energy using fight rays with wavelengths beyond the violet end of the
visible spectrum.
Vasopneumatic compression device A device to decrease edema by using compressive forces
that are applied to the body part.
Ventilatory pump Thoracic skeleton and skeletal muscles and their innervation responsible for
ventilation. The muscles include the diaphragm; the intercostal, scalene, and stern-ocleidomastoid
muscles; accessory muscles of ventilation; and the abdominal, triangular, and quadratus
lumborum muscles.
Ventilatory pump dysfunction Abnormalities of the thoracic skeleton, respiratory muscles, airways,
or lungs that interrupt or interfere with the work of breathing or ventilation.
Vestibular Describing the sense of balance located in the inner ear.
Visual analog scale A tool used in a pain examination that allows the patient/client to indicate
degree of pain by pointing to a visual representation of pain intensity.
Volume measurement The amount of fluid that has been displaced from a container (of any size)
following the introduction of part or all of the body.
Wellness concepts that embrace positive health behaviors (eg, exercise, nutrition, stress
reduction).
Work conditioning An intensive, work-related, goal-oriented conditioning program designed
specifically to restore systemic neuromusculoskeletal functions (eg, strength, endurance,
movement, flexibility, motor control) and cardiopulmonary functions. The objective of the work
conditioning program is to restore physical capacity and function to enable the patient/client to
return to work.
Work hardening Highly structured, goal-oriented, individualized treatment program designed to
return the client to work. Work hardening programs, which are interdisciplinary in nature, use real
or simulated work activities designed to restore physical, behavioral, and vocational functions.
Work hardening addresses issues of productivity, safety, physical tolerances, and worker
behaviors.
Page 9 of 9
Wound care Procedures used to achieve a clean wound bed, promote a moist environment or
facilitate autolytic debridement, or absorb excessive exudation from a wound complex.
Source Citation:"Glossary." Physical Therapy 77.n11 (Nov 1997): 1620(5). Expanded Academic

Page 1 of 8
Standards of practice for physical therapy and the accompanying criteria.(Guide to

(4). (1849 words)
PREAMBLE
The physical therapy profession is committed to providing an optimum level of service delivery
and to striving for excellence in practice. The House of Delegates of the American Physical
Therapy Association, as the formal body that represents the profession, attests to this
commitment by adopting and promoting the following Standards of Practice for Physical Therapy.
These Standards of Practice for Physical Theraphy are the profession's statement of conditions
and performances that are essential for provision of high-quality physical therapy. The Standards
provide a foundation for assessment of physical therapy practice.
I. LEGAL/ETHICAL CONSIDERATIONS
A. Legal Considerations
The physical therapist complies with all the legal requirements of jurisdictions regulating the
practice of physical therapy.
The physical therapist assistant complies with all the legal requirements of jurisdictions regulating
the work of the assistant.
B. Ethical Considerations
The physical therapist practices according to the Code of Ethics of the American Physical Therapy
Association.
The physical therapist assistant complies with the Standards of Ethical Conduct for the Physical
Therapist Assistant of the American Physical Therapy Association.
II. ADMINISTRATION OF THE PHYSICAL THERAPY SERVICE
A. Statement of Mission, Purposes, and Goals
The physical therapy service has a statement of mission, purposes, and goals that reflects the
needs and interests of the individuals served, the physical therapy personnel affiliated with the
service, and the community.
Criteria The statement:
* Defines the scope and limitations of the service.
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* Lists the goals and objectives of the service.

* Is reviewed annually.
B. Organizational Plan
The physical therapy service has a written organizational plan.
Criteria The plan:
* Describes relationships within the service and, where the physical therapy service is part of a
larger organization, between the physical therapy service and other components of the
organization.
* Ensures that the service is directed by a physical therapist.
* Defines supervisory structures within the service.
* Reflects current personnel functions.
C. Policies and Procedures
The physical therapy service has written policies and procedures that reflect the operation of the
service and that are consistent with the mission, purposes, and goals of the service.
Criteria
The policies and procedures, which are reviewed regularly and revised as necessary, address
pertinent information including (but not limited to) the following:
* Clinical education.
* Clinical research.
* Interdisciplinary collaboration.
* Criteria for access to, initiation of, continuation of, referral of, and termination of care.
* Equipment maintenance.
* Environmental safety.
* Fiscal management.
* Infection control.
* Job/position descriptions.
* Competency assessment.
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* Medical emergencies.
* Patient/client care policies and protocols.
* Patient/client rights.
* Personnel-related policies.
* Quality/performance improvement.
* Documentation.
* Staff orientation.
The policies and procedures meet the requirements of state law and external agencies.
D. Administration
A physical therapist is responsible for the direction of the physical therapy service.
Criteria The director:
* Ensures compliance with local, state, and federal requirements.
* Ensures compliance with current APTA documents, including Standards of Practice for Physical
Therapy, Guide for Professional Conduct, and Guide for Conduct of the Affiliate Member
* Ensures that services provided are consistent with the mission, purposes, and goals of the
service.
* Ensures that services are provided in accordance with established policies and procedures.
* Reviews and updates policies and procedures.
* Provides training that assures continued competence of physical therapy support personnel
* Provides for continuous in-service training on safety issues and for periodic safety inspection of
equipment by qualified individuals.
E. Fiscal Management
The director of the physical therapy service, in consultation with staff and appropriate
administrative personnel, is responsible for planning for, and allocation of, resources. Fiscal
planning and management of the service is based on sound accounting principles.
Criteria The fiscal management plan includes:
* Preparation and monitoring of a budget that provides for optimum use of resources.
* Accurate recording and reporting of financial information.
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* Conformance with legal requirements.

* Cost-effective utilization of resources.
* A fee schedule that is consistent with cost of services and that is within customary norms of
fairness and reasonableness.
F. Quality/Performance Improvement
The physical therapy service has a written plan for continuous improvement of the performance of
services provided.
Criteria The plan:
* Provides evidence of ongoing review and evaluation of the service.
* Provides a mechanism for documentation of performance improvement.
* Is consistent with requirements of external agencies, if applicable.
G. Staffing
The physical therapy personnel affiliated with the physical therapy service have demonstrated
competence and are sufficient to achieve the mission, purposes, and goals of the service.
Criteria The service:
* Meets all legal requirements regarding licensure and/or certification of appropriate personnel.
* Provides staff expertise that is appropriate to the patient/clients served.
* Provides for appropriate staff-to-patient/client ratios.
* Provides for appropriate ratios of support staff to professional staff.
H. Staff Development
The physical therapy service has a written plan that provides for appropriate and ongoing staff
development.
Criteria The plan:
* Provides for consideration of self-assessments, individual goal setting, and organization needs in
directing continuing education and learning activities.
* Includes strategies for long-term learning and professional development.
I. Physical Setting
The physical setting is designed to provide a safe and accessible environment that facilitates
fulfillment of the mission and achievement of the purposes and goals of the physical therapy
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service. The equipment is safe and sufficient to achieve the purposes and goals of physical
therapy.
Criteria The physical setting:
* Meets all applicable legal requirements for health and safety.
* Meets space needs appropriate for the number and type of patients/clients served.
The equipment:
* Meets all applicable legal requirements for health and safety.
* Is inspected routinely.
J. Interdisciplinary Collaboration
The physical therapy service collaborates with all appropriate disciplines.
Criteria The collaboration includes:
* An interdisciplinary team approach to patient/client care.
* Interdisciplinary patient/client and family education.
* Interdisciplinary staff development and continuing education.
III. PROVISION OF SERVICES
A. Informed Consent
The physical therapist has sole responsibility for providing information to the patient/client and for
obtaining the patient's/client's informed consent in accordance with jurisdictional law before
initiating physical therapy.
Criteria The information provided to the patien/client should include the following:
* A clear description of the proposed intervention/treatment.
* A statement of material (decisional) risks associated with the proposed intervaention/treatment.
* A statement of expected benefits of the proposed intervention/treatment.
* A comparison of the benefits and risks possible both with and without intervention/treatment.
* An explanation of reasonable alternatives to the recommended intervention/treatment.
Informed consent requires:
* Consent by a competent adult.
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* Consent by a parent/legal guardian as the surrogate decision maker when the adult patient/client
is not competent or when the patient/client is a minor
The patient's/client's acknowledgment of understanding and consent before the
intervention/treatment proceeds.
B. Initial Examination and Evaluation
The physical therapist performs and documents an initial examination and evaluates the results to
identify problems and determine the diagnosis prior to intervention/treatment.
Criteria The examination:
* Is documented, dated, and signed by the physical therapist who performed the examination.
* Identifies the physical therapy needs of the patient/client.
* Incorporates appropriate objective tests and measures to facilitate outcome measurement.
* Documents sufficient data to establish a plan of care.
* May result in recommendations for additional services to meet the needs of the patient/client.
C. Plan of Care
The physical therapist establishes and provides a plan of care for the individual based on the
results of the examination and evaluation and on patient/client needs.
The physical therapist involves the patient/client and appropriate others in the planning,
implementation, and assessment of the intervention/treatment program.
The physical therapist, in consultation with appropriate disciplines, plans for discharge of the
patient/client taking into consideration goal achievement, and provides for appropriate follow-up or
referral.
Criteria The plan of care includes:
* Realistic goals and expected functional outcomes.
* Intervention/treatment, including its frequency and duration.
* Documentation that is dated and signed by the physical therapist who established the plan of
care.
D. Intervention/Treatment
The physical therapist provides, or delegates and supervises, the physical therapy
intervention/treatment consistent with the results of the examination and evaluation and plan of
care.
The physical therapist documents, on an ongoing basis, services provided, responses to services,
Page 7 of 8
and changes in status relative to the plan of care.

Criteria The intervention/treatment is:
* Provided under the ongoing personal care or supervision of the physical therapist.
* Provided in such a way that delegated responsibilities are commensurate with the qualifications
and legal limitations of the physical therapy personnel involved in the intervention/treatment.
* Altered in accordance with changes in individual response or status.
* Provided at a level that is consistent with current physical therapy practice.
* Interdisciplinary when necessary to meet the needs of the patient/client.
Documentation of the services provided includes:
* Date and signature of the physical therapist and/or of the physical therapist assistant when
permissible by law.
E. Reexamination and Reevaluation
The physical therapist reexamines and reevaluates the individual continually and modifies or
discontinues the plan of care accordingly.
Criteria The physical therapist:
* Periodically documents, dates, and signs the patient/client reexamination and modifications of
the plan of care.
F. Discharge/Discontinuation of Treatment or Intervention
The physical therapist discharges the patient/client from physical therapy intervention/treatment
when the goals or projected outcomes for the patient/client have been met.
Physical therapy intervention/treatment shall be discontinued when the goals are achieved, the
patient/ client declines to continue care, the patient/client is unable to continue, or the physical
therapist determines that intervention/treatment is no longer warranted.
Criteria Discharge documentation shall include:
* The patient's/client's status at discharge and functional outcomes/goals achieved.
* Dating and signing of the discharge summary by the physical therapist
* When a patient/client is discharged prior to goal achievement, the patient's/client's status and the
rationale for discontinuation.
IV. EDUCATION
The physical therapist is responsible for individual professional development. The physical
Page 8 of 8
therapist assistant is responsible for individual career development.

The physical therapist participates in the education of physical therapist students, physical
therapist assistant students, and students in other health professions. The physical therapist
assistant participates in the education of physical therapist assistant students and other student
health professionals.
The physical therapist educates and provides consultation to consumers and the general public
regarding the purposes and benefits of physical therapy.
regarding the roles of the physical therapist and the physical therapist assistant.
Criteria
regarding the roles of the physical therapist, the physical therapist assistant, and other support
personnel.
V. RESEARCH
The physical therapist applies research findings to practice and encourages, participates in, and
promotes activities that establish the outcomes of physical therapist patient/client management.
The physical therapist supports collaborative and interdisciplinary research.
VI. COMMUNITY RESPONSIBILITY
The physical therapist demonstrates community responsibility by participating in community and
community agency activities, educating the public, formulating public policy, or providing pro bono
physical therapy services.
Criteria
The physical therapist demonstrates community responsibility by participating in community and
community agency activities; educating the public, including prevention and health promotion
activities; formulating public polity; or providing pro bono physical therapy services.
Source Citation:"Standards of practice for physical therapy and the accompanying criteria." Physical
2008

Page 1 of 2
Code of ethics.(Guide to Physical Therapy Practice).Physical Therapy 77.n11 (Nov

1997): pp1628(1). (173 words)
PREAMBLE
This Code of Ethics sets forth ethical principles for the physical therapy profession. Members of
this profession are responsible for maintaining and promoting ethical practice. This Code of
Ethics, adopted by the American Physical Therapy Association, shall be binding on physical
therapists who are members of the Association.
Principle 1
Physical therapists respect the rights and dignity of all individuals.
Principle 2
Physical therapists comply with the laws and regulations governing the practice of physical
therapy.
Principle 3
Physical therapists accept responsibility for the exercise of sound judgment.
Principle 4
Physical therapists maintain and promote high standards for physical therapy practice, education,
and research.
Principle 5
Physical therapists seek remuneration for their services that is deserved and reasonable.
Principle 6
Physical therapists provide accurate information to the consumer about the profession and about
those services they provide.
Principle 7
Physical therapists accept the responsibility to protect the public and the profession from
unethical, incompetent, or illegal acts.
Principle 8
Page 2 of 2
Physical therapists participate in efforts to address the health needs of the public.
Source Citation:"Code of ethics." Physical Therapy 77.n11 (Nov 1997): 1628(1). Expanded Academic

Page 1 of 7
Guide for professional conduct.(Guide to Physical Therapy Practice).Physical

PURPOSE
This Guide for Professional Conduct (Guide) is intended to serve physical therapists who are
members of the American Physical Therapy Association (Association) in interpreting the Code of
Ethics (Code) and matters of professional conduct. The Guide provides guidelines by which
physical therapists may determine the propriety of their conduct. The Code and the Guide apply to
all physical therapists who are Association members. These guidelines are subject to changes as
the dynamics of the profession change and as new patterns of health care delivery are developed
and accepted by the professional community and the public. This Guide is subject to monitoring
and timely revision by the judicial Committee of the Association.
INTERPRETING ETHICAL PRINCIPLES
The interpretations expressed in this Guide are not to be considered all inclusive of situations that
could evolve under a specific principle of the Code but reflect the opinions, decisions, and advice
of the judicial Committee. While the statements of ethical principles apply universally, specific
circumstances determine their appropriate application. Input related to current interpretations, or
to situations requiring interpretation, is encouraged from Association members.
PRINCIPLE I
Physical therapists respect the rights and dignity of an individuals.
1.1 Attitudes of Physical Therapists
A. Physical therapists shall recognize that each individual is different from all other individuals and
shall respect and be responsive to those differences. B. Physical therapists are to be guided at all
times by concern for the physical, psychological, and socioeconomic welfare of those individuals
entrusted to their care. C. Physical therapists shall not engage in conduct that constitutes
harassment or abuse of, or discrimination against, colleagues, associates, or others.
1.2 Confidential Information
A. Information relating to the physical therapist/patient relationship is confidential and may not be
communicated to a third party not involved in that patient's care without the prior written consent of
the patient, subject to applicable law. B. Information derived from component-sponsored peer
review shall be held confidential by the reviewer unless written permission to release the
information is obtained from the physical therapist who was reviewed. C. Information derived from
the working relationships of physical therapists shall be held confidential by all parties. D.
Information may be disclosed to appropriate authorities when it is necessary to protect the welfare
of an individual or the community. Such disclosure shall be in accordance with applicable law.
Page 2 of 7
1.3 Patient Relations

Physical therapists shall not engage in any sexual relation ship or activity, whether consensual or
nonconsensual, with any patient while a physical therapist/patient relationship exists.
1.4 Informed Consent
Physical therapists shall obtain patient informed consent before treatment.
PRINCIPLE 2
Physical therapists comply with the laws and regulations governing the practice of physical
therapy.
2.1 Professional Practice
Physical therapists shall provide consultation, evaluation, treatment, and preventive care, in
accordance with the laws and regulations of the jurisdiction(s) in which they practice.
PRINCIPLE 3
Physical therapists accept responsibility for the exercise of sound judgment.
3.1 Acceptance of Responsibility
A. Upon accepting an individual for provision of physical therapy services, physical therapists shall
assume the responsibility for evaluating that individual; planning, implementing, and supervising
the therapeutic program; reevaluating and changing that program; and maintaining adequate
records of the case, including progress reports. B. When the individual's needs are beyond the
scope of the physical therapist's expertise, or when additional services are indicated, the individual
shall be so informed and assisted in identifying a qualified provider. C. Regardless of practice
setting, physical therapists shall maintain the ability to make independent judgments. D. The
physical therapist shall not provide physical therapy services to a patient while under the influence
of a substance that impairs his or her ability to do so safely.
3.2 Delegation of Responsibility
A. Physical therapists shall not delegate to a less qualified person any activity which requires the
unique skill, knowledge, and judgment of the physical therapist. B. The primary responsibility for
physical therapy care rendered by supportive personnel rests with the supervising physical
therapist. Adequate supervision requires, at a minimum, that a supervising physical therapist
perform the following activities:
1. Designate or establish channels of written and oral communication.
2. Interpret available information concerning the individual under care.
3. Provide initial evaluation.
4. Develop plan of care, including short- and longterm goals.
Page 3 of 7
5. Select and delegate appropriate tasks of plan of care.

6. Assess competence of supportive personnel to perform assigned tasks.
7. Direct and supervise supportive personnel in delegated tasks.
8. Identify and document precautions, special problems, contraindications, goals, anticipated
progress, and plans for reevaluation.
9. Reevaluate, adjust plan of care when necessary, perform final evaluation, and establish followup plan.
3.3 Provision of Services
A. Physical therapists shall recognize the individual's freedom of choice in selection of physical
therapy services. B. Physical therapists' professional practices and their adherence to ethical
principles of the Association shall take preference over business practices. Provisions of services
for personal financial gain rather than for the need of the individual receiving the services are
unethical. C. When physical therapists judge that an individual will no longer benefit from their
services, they shall so inform the individual receiving the services. Physical therapists shall avoid
overutilization of their services. D. In the event of elective termination of a physical
therapist/patient relationship by the physical therapist, the therapist should take steps to transfer
the care of the patient, as appropriate, to another provider.
3.4 Referral Relationships
In a referral situation where the referring practitioner prescribes a treatment program, alteration of
that program or extension of physical therapy services beyond that program should be undertaken
in consultation with the referring practitioner.
3.5 Practice Arrangements
A. Participation in a business, partnership, corporation, or other entity does not exempt the
physical therapist, whether employer, partner, or stockholder, either individually or collectively,
from the obligation of promoting and maintaining the ethical principles of the Association. B.
Physical therapists shall advise their employer(s) of any employer practice which causes a
physical therapist to be in conflict with the ethical principles of the Association. Physical therapist
employees shall attempt to rectify aspects of their employment which are in conflict with the
ethical principles of the Association.
PRINCIPLE 4
Physical therapists maintain and promote high standards for physical therapy practice, education,
and research.
4.1 Continued Education
A. Physical therapists shall participate in educational activities which enhance their basic
knowledge and provide new knowledge. B. Whenever physical therapists provide continuing
education, they shall ensure that course content, objectives, and responsibilities of the
instructional faculty are accurately reflected in the promotion of the course.
Page 4 of 7
4.2 Review and Self Assessment

A. Physical therapists shall provide for utilization review of their services. B. Physical therapists
shall demonstrate their commitment to quality assurance by peer review and self-assessment.
4.3 Research
A. Physical therapists shall support research activities that contribute knowledge for improved
patient care. B. Physical therapists engaged in research shall ensure:
1. the consent of subjects;
2. confidentiality of the data on individual subjects and the personal identities of the subjects;
3. well-being of all subjects in compliance with facility regulations and laws of the jurisdiction in
which the research is conducted;
4. the absence of fraud and plagiarism;
5. full disclosure of support received;
6. appropriate acknowledgment of individuals making a contribution to the research;
7. that animal subjects used in research are treated humanely and in compliance with facility
regulations and laws of the jurisdiction in which the research experimentation is conducted. C.
Physical therapists shall report to appropriate authorities any acts in the conduct or presentation of
research that appear unethical or illegal.
4.4 Education
A. Physical therapists shall support quality education in academic and clinical settings. B. Physical
therapists functioning in the educational role are responsible to the students, the academic
institutions and the clinical settings for promoting ethical conduct in educational activities.
Whenever possible, the educator shall ensure:
1. the rights of students in the academic and clinical setting;
2. appropriate confidentiality of personal information;
3. professional conduct toward the student during the academic and clinical educational
processes;
4. assignment to clinical settings prepared to give the student a learning experience. C. Clinical
educators are responsible for reporting to the academic program student conduct which appears
to be unethical or illegal.
PRINCIPLE 5
Physical therapists seek remuneration for their services that is deserved and reasonable.
5.1 Fiscally Sound Remuneration
Page 5 of 7
A. Physical therapists shall never place their own financial interest above the welfare of individuals
under their care. B. Fees for physical therapy services should be reasonable for the service
performed, considering the setting in which it is provided, practice costs in the geographic area,
judgment of other organizations, and other relevant factors. C. Physical therapists should attempt
to ensure that providers, agencies, or other employers adopt physical therapy fee schedules that
are reasonable and that encourage access to necessary services.
5.2 Business Practices/Fee Arrangements
A. Physical therapists shall not:
1. directly or indirectly request, receive, or participate in the dividing, transferring, assigning,
rebating of an unearned fee.
2. profit by means of a credit or other valuable consideration, such as an unearned commission,
discount, or gratuity in connection with furnishing of physical therapy services. B. Unless laws
impose restrictions to the contrary, physical therapists who provide physical therapy services in a
business entity may pool fees and moneys received. Physical therapists may divide or apportion
these fees and moneys in accordance with the business agreement. C. Physical therapists may
enter into agreements with organizations to provide physical therapy services if such agreements
do not violate the ethical principles of the Association.
5.3 Endorsement of Equipment or Services
A. Physical therapists shall not use influence upon individuals under their care or their families for
utilization of equipment or services based upon the direct or indirect financial interest of the
physical therapist in such equipment or services. Realizing that these individuals will normally rely
on the physical therapists' advice, their best interest must always be maintained as well as their
right of free choice relating to the use of any equipment or service. While it cannot be considered
unethical for physical therapists to own or have a financial interest in equipment companies, or
services, they must act in accordance with law and nub full disclosure of their interest whenever
such companies or services become the source of equipment or services for individuals under
their care. B. Physical therapists may be remunerated for endorsement or advertisement of
equipment or services to the lay public, physical therapists, or other health professionals provided
they disclose any financial interest in the production, sale, or distribution of said equipment or
services. C. In endorsing or adverting equipment or services, physical therapists shall use sound
professional judgment and shall not give the appearance of Association endorsement.
5.4 Gifts and Other Considerations
A. Physical therapists shall not accept nor offer gifts or other considerations with obligatory
conditions attached. B. Physical therapists shall not accept or offer gifts or other considerations
that affect or give an objective appearance of affecting their professional judgment.
PRINCIPLE 6
Physical therapists provide accurate information to the consumer about the profession and about
those services they provide.
6.1 Information about the Profession
Physical therapists shall endeavor to educate the public to an awareness of the physical therapy
Page 6 of 7
profession through such means as publication of articles and participation in seminars, lectures,
and civic programs.
6.2 Information about Services
A. Information given to the public shall emphasize that individual problems cannot be treated
without individualized evaluation and plans/programs of care. B. Physical therapists may advertise
their services to the public. C. Physical therapists shall not use, or participate in the use of, any
form of communication containing a false, plagiarized, fraudulent, misleading, deceptive, unfair, or
sensational statement or claim. D. A paid advertisement shall be identified as such unless it is
apparent from the context that it is a paid advertisement.
PRINCIPLE 7
Physical therapists accept the responsibility to protect the public and the profession from
unethical, incompetent, or illegal acts.
7.1 Consumer Protection
A. Physical therapists shall report any conduct which appears to be unethical, incompetent or
illegal. B. Physical therapists may not participate in any arrangements in which patients are
exploited due to the referring sources enhancing their personal incomes as a result of referring for,
prescribing, or recommending physical therapy. C. Physical therapists shall be obligated to
safeguard the public from underutilization or overutilization of physical therapy services.
7.2 Disclosure
The physical therapist shall disclose to the patient if the referring practitioner derives
compensation from the provision of physical therapy. The physical therapist shall ensure that the
individual has freedom of choice in selecting a provider of physical therapy.
PRINCIPLE 8
Physical therapists participate in efforts to address the health needs of the public.
8.1 Pro Bono Service
Physical therapists should render pro bono publico (reduced or no fee) services to patients lacking
the ability to pay for services, as each physical therapist's practice permits.
Source Citation:"Guide for professional conduct." Physical Therapy 77.n11 (Nov 1997): 1629
(3). Expanded Academic ASAP. Gale. University of Florida. 21 Nov. 2008

Page 7 of 7
Page 1 of 1
Standards of ethical conduct for the physical therapist assistant.(Guide to Physical

Therapy Practice).Physical Therapy 77.n11 (Nov 1997): pp1632(1). (141 words)
PREAMBLE Physical therapist assistants are responsible for maintaining and promoting high
standards of conduct. These Standards of Ethical Conduct for the Physical Therapist Assistant
shall be binding on physical therapist assistants who are affiliate members of the Association.
STANDARD 1 Physical therapist assistants provide services under the supervision of a physical
therapist.
STANDARD 2 Physical therapist assistants respect the rights and dignity of all individuals.
STANDARD 3 Physical therapist assistants maintain and promote high standards in the provision
of services, giving the welfare of the patients their highest regard.
STANDARD 4 Physical therapist assistants provide services within the limits of the law.
STANDARD 5 Physical therapist assistants make those judgments that are commensurate with
their qualifications as physical therapist assistants.
STANDARD 6 Physical therapist assistants accept the responsibility to protect the public and the
profession from unethical, incompetent, or illegal acts.
Source Citation:"Standards of ethical conduct for the physical therapist assistant." Physical
2008

Page 1 of 4
Guide for the conduct of the affiliate member.(Guide to Physical Therapy

Practice).Physical Therapy 77.n11 (Nov 1997): pp1632(2). (959 words)
PURPOSE This Guide is intended to serve physical therapist assistants who are affiliate members
of the American Physical Therapy Association in the interpretation of the Standards of Ethical
Conduct for the Physical Therapist Assistant, providing guidelines by which they may determine
the propriety of their conduct. These guidelines are subject to change as new patterns of health
care delivery are developed and accepted by the professional community and the public. This
Guide is subject to monitoring and timely revision by the judicial Committee of the Association.
INTERPRETING STANDARDS The interpretations expressed in this Guide are not to be
considered all inclusive of situations that could evolve under a specific standard of the Standards
of Ethical Conductor the Physical Therapist Assistant but reflect the opinions, decisions, and
advice of the Judicial Committee. While the statements of ethical standards apply universally,
specific circumstances determine their appropriate application. Input related to current
interpretations, or to situations requiring interpretation, is encouraged from APTA members.
STANDARD 1 Physical therapist assistants provide services under the supervision of a physical
therapist.
1.1 Supervisory Relationships Physical therapist assistants shall work under the supervision and
direction of a physical therapist who is properly credentialed in the jurisdiction in which the
physical therapist assistant practices.
1.2 Performance of Service
A. Physical therapist assistants may not initiate or alter a treatment program without prior
evaluation by and approval of the supervising physical therapist.
B. Physical therapist assistants may modify a specific treatment procedure in accordance with
changes in patient status.
C. Physical therapist assistants may not interpret data beyond the scope of their physical therapist
assistant education.
D. Physical therapist assistants may respond to inquiries regarding patient status to appropriate
parties within the protocol established by a supervising physical therapist.
E. Physical therapist assistants shall refer inquiries regarding patient prognosis to a supervising
physical therapist.
STANDARD 2 Physical therapist assistants respect the rights and dignity of all individuals.
Page 2 of 4
2.1 Attitudes of Physical Therapist Assistants

A. Physical therapist assistants shall recognize that each individual is different from all other
individuals and respect and be responsive to those differences.
B. Physical therapist assistants shall be guided at all times by concern for the dignity and welfare
of those patients entrusted to their care.
C. Physical therapist assistants shall not engage in conduct that constitutes harassment or abuse
of, or discrimination against, colleagues, associates, or others,
2.2 Request for Release of Information
Physical therapist assistants shall refer all requests for release of confidential information to the
supervising physical therapist.
2.3 Protection of Privacy
Physical therapist assistants must treat as confidential all information relating to the personal
conditions and affairs of the persons whom they serve.
2.4 Patient Relations
Physical therapist assistants shall not engage in any sexual relationship or activity, whether
consensual or nonconsensual, with any patient while a physical therapist assistant/patient
relationship exits.
STANDARD 3
Physical therapist assistants maintain and promote high standards in the provision of services,
giving the welfare of patients their highest regard.
3.1 Information About Services
A. Physical therapist assistants may provide consumers with information regarding provision of
services within the protocol established by a supervising physical therapist.
B. Physical therapist assistants may not use or participate in the use of, any form of
communication containing a false, fraudulent, misleading, deceptive, unfair, or sensational
statement or claim.
3.2 Organizational Employment
Physical therapist assistants shall advise their employer(s) of any employer practice which causes
them to be in conflict with the Standards of Ethical Conduct for the Physical Therapist Assistant.
3.3 Endorsement of Equipment
Physical therapist assistants may not endorse equipment or exercise influence on patients or
families to purchase or lease equipment except as directed by a physical therapist acting in
accord with the stipulation in paragraph 5.3.a. of the Guide for Professional Conduct.
Page 3 of 4
3.4 Financial Consideration

Physical therapist assistants shall never place their own financial interest above the welfare of
their patients.
3.5 Exploitation of Patients
Physical therapist assistants shall not participate in any arrangements in which patients are
exploited. Such arrangements include situations where referring for, delegating, prescribing, or
recommending physical therapy services.
STANDARD 4
Physical therapist assistants provide services within the limits of the law.
4.1 Supervisory Relationships
Physical therapist assistant shall comply with all aspects of law. Regardless of the content of any
law, physical therapists assistants shall provide services only under the supervision and direction
of a physical therapist who is properly credentialed in the jurisdiction in which the physical
therapist assistant practices.
4.2 Representation
Physical therapist assistants shall not hold themselves out as physical therapists.
STANDARD 5
Physical therapist assistants make the most those judgments that are commensurate with their
qualifications as physical therapist assistants.
5.1 Patient Treatment A. Physical therapist assistants shall report all untoward patient responses
to a surprising physical therapist.
5.2 Patient Safety A. Physical therapist assistants may refuse to carry out treatment procedures
that they believe to be not in the best interest of the patient. B. The physical therapist assistant
shall not provide physical therapy services to a patient while under the influence of a substance
that impairs his or her ability to do so safely.
5.3 Qualifications
Physical therapist assistants may not carry out any procedure that they are not qualified to
provide.
5.4 Discontinuance of Treatment Program
Physical therapist assistants shall discontinue immediately any treatment procedures which in
their judgment appear to be harmful to the patient.
5.5 Continued Education
Page 4 of 4
Physical therapist assistants shall continue participation in var ious types of educational activities
which enhance their skills and knowledge and provide new skills and knowledge.
STANDARD 6
Physical therapist assistants accept the responsibility to pro tect the public and the profession
from unethical, income tent, or illegal acts.
6.1 Consumer Protection
Physical therapist assistants shall report any conduct which appears to be unethical or illegal.
Source Citation:"Guide for the conduct of the affiliate member." Physical Therapy 77.n11 (Nov

Page 1 of 5
Guidelines for physical therapy documentation.(Guide to Physical Therapy

Practice).Physical Therapy 77.n11 (Nov 1997): pp1634(3). (1628 words)
PREAMBLE
The American Physical Therapy Association (APTA) is committed to meeting the physical therapy
needs of society, to meeting the needs and interests of its members, and to developing and
improving the art and science of physical therapy, including practice, education, and research. To
help meet these responsibilities, the APTA Board of Directors has approved the following
guidelines for physical therapy documentation. It is recognized that these guidelines do not reflect
all of the unique documentation requirements associated with the many specialty areas within the
physical therapy profession. Applicable for both handwritten and electronic documentation
systems, these guidelines are intended to be used as a foundation for the development of more
specific documentation guidelines in specialty areas, while at the same time providing guidance
for the physical therapy profession across all practice settings.
OPERATIONAL DEFINITIONS
Guidelines: APTA defines "guidelines" as approved, non-binding statements of advice.
Documentation: Any entry into the client record, such as: consultation report, initial examination
report, progress note, flow sheet/checklist that identifies the care/service provided, reexamination,
or summation of care.
Authentication: The process used to verify that an entry is complete, accurate, and final.
Indications of authentication can include original written signatures and computer signatures" on
secured electronic record systems only.
I. GENERAL GUIDELINES
A. All documentation must comply with the applicable jurisdictional/regulatory requirements. 1. All
handwritten entries shall be made in ink and will include original signatures. Electronic entries
should be made with appropriate security and confidentiality provisions. 2. Informed consent: As
required by the APTA Standards of Practice for Physical Therapy and the Accompanying Criteria
2.1 The physical therapist has sole responsibility for providing information to the patient and for
obtaining the patient's informed consent in accordance with jurisdictional law before initiating
physical therapy. 2.2 Those deemed competent to give consent are competent adults. When the
adult is not competent, and in the case of minors, a parent or legal guardian consents as the
surrogate decision maker. 2.3 THe information provided to the patient should include the
following: (a) a clear description of the treatment ordered or recommended, (b) material
(decisional) risks associated with the proposed treatment, (c) expected benefits of treatment, (d)
comparison of the benefits and risks possible with and without treatment, and (e) reasonable
alternatives to the recommended treatment. The physical therapist should solicit questions from
Page 2 of 5
the patient and provide answers. The patient should be asked to acknowledge understanding and
consent before treatment proceeds.
Examples of ways in which to accomplish this documentation:
Ex 2.3.1 Signature of patient/ guardian on long or short consent form. Ex 2.3.2 Notation/entry of
what was explained by the physical therapist or the physical therapist assistant in the official
record. Ex 2.3.3 Filing of a completed consent checklist signed by the patient.
3. Charting errors should be corrected by drawing a single line through the error and initialing and
dating the chart or through the appropriate mechanism for electronic documentation that clearly
indicates that a change was made without deletion of the original record. 4. Identification.
4.1 Include patient's full name and identification number, if applicable, on all official documents.
4.2 All entries must be dated and authenticated with the provider's full name and appropriate
designation (eg, PT, PTA). 4.3 Documentation by students (SPT/SPTA) shall be authenticated by
a licensed physical therapist. 4.4 Documentation by graduates (GPT/GPTA) or others pending
receipt of an unrestricted license shall be authenticated by a licensed physical therapist. 5.
Documentation should include the manner in which physical therapy services are initiated.
Examples include:
Ex 5.1 Self-referral/direct access. Ex 5.2 Attachment of the referral/consultation request by a
qualified practitioner. Ex 5.3 File copy of correspondence to referral source as acknowledgment of
the referral.
II. INITIAL EXAMINATION AND EVALUATION/CONSULTATION
A. Documentation is required at the outset of each episode of physical therapy care. B. Elements
include: 1. Obtaining a history and identifying risk factors: 1. 1 History of the presenting problem,
current complaints, and precautions (including onset date). 1.2 Pertinent diagnoses and medical
history. 1.3 Demographic characteristics, including pertinent psychological, social, and
environmental factors. 1.4 Prior or concurrent services related to the current episode of physical
therapy care. 1.5 Comorbidities that may affect goals and treatment plan. 1.6 Statement of
patient's knowledge of problem. 1.7 Goals of patient (and family members, or significant others, if
appropriate). 2. Selecting and administering tests and measures to determine patient status in a
number of areas. The following is a partial list of these areas, with illustrative tests and measures:
2.1 Arousal, mentation, and cognition
Examples include objective findings related, but not limited, to the following areas:
Ex 2.1.1 Level of consciousness Ex 2.1.2 Ability to process commands Ex 2.1.3 Alertness Ex
2.1.4 Gross expressive and receptive language deficits
2.2 Neuromotor development and sensory integration
Examples include objective findings related, but not limited, to the following areas: Ex 2.2.1 Gross
and fine motor skills Ex 2.2.2 Reflex and movement patterns Ex 2.2.3 Dexterity, agility, and
coordination
2.3 Range of motion
Page 3 of 5
Ex 2.3.1 Extent of joint motion Ex 2.3.1 Pain and soreness of surrounding soft tissue Ex 2.3.2
Muscle length and flexibility
2.4 Muscle performance
Ex 2.4.1 Strength Ex 2.4.2 Power Ex 2.4.3 Endurance
2.5 Ventilation, respiration, and circulation
Ex 2.5.1 Vital signs Ex 2.5.2 Breathing patterns Ex 2.5.3 Heart sounds
2.6 Posture
Ex 2.6.1 Static posture Ex 2.6.2 Dynamic posture
2.7 Gait, locomotion, and balance
Ex 2.7.1 Characteristics of gait Ex 2.7.2 Functional ambulation Ex 2.7.3 Characteristics of balance
2.8 Self-care and home management status
Ex 2.8.1 Activities of daily living Ex 2.8.2 Functional capacity Ex 2.8.3 Static and dynamic strength
2.9 Community and work (job/school/play) integration/reintegration.
Ex 2.9.1 Instrumental activities of daily living Ex 2.9.3 Functional capacity Ex 2.9.3 Adaptive skills
3. Evaluation (a dynamic process in which the physical therapist makes clinical judgments based
on data gathered during the examination). 4. Diagnosis (a label encompassing a cluster of signs
and symptoms, syndromes, or categories that reflects the information obtained for the
examination). 5. Coals.
5.1 Patient (and family members or significant others, if appropriate) is involved in establishing
goals. 5.2 All goals are stated in measurable terms. 5.3 Goals arc linked to problems identified in
the examination. 5.4 Short- and long-term goals are established when applicable may include
potential for achieving goals). 6. Intervention plan or recommendation requirements:
6.1 Shall be related to realistic goals and expected functional outcomes. 6.2 Should include
frequency and duration to achieve the stated goals. 6.3 Should include patient and
Page 4 of 5
family/caregiver educational goals. 6.4 Should involve appropriate collaboration and coordination
of care with other professionals/services. 7. Authentication and appropriate designation of physical
therapist.
III. DOCUMENTATION OF THE CONTINUUM OF CARE
A. Intervention or service provided. 1 . Documentation is required for each patient visit/encounter.
Authentication is required for every note by the physical therapist or the physical therapist
assistant providing the service under the supervision of the physical therapist.
Examples include:
Ex 1.1 Checklist Ex 1.2 Flow sheet Ex 1.3 Graph Ex 1.4 Narrative
2. Elements may include:
2.1 Identification of specific interventions provided. 2.2 Equipment provided.
B. Patient status, progress, or regression. 1. Documentation is required for every visit/encounter.
Authentication is required for every note by the physical therapist or the physical therapist
assistant providing the service under the supervision of the physical therapist. 2. Elements may
include:
2.1 Subjective status of patient. 2.2 Changes in objective and measurable findings as they relate
to existing goals. 2.3 Adverse reaction to treatment. 2.4 Progression/regression of existing
therapeutic regimen, including patient education and adherence. 2.5 Communication/consultation
with providers/patient/family/significant other. 2.6 Authentication and appropriate designation of
either a physical therapist or a physical therapist assistant. C. Reexamination and Reevaluation 1.
Documentation is required monthly for patients seen at intervals of a month of less; if the patient is
seen less frequently, documentation is required for every visit or encounter. 2. Elements include:
2.1 Documentation of elements as identified in III.B.2.1 through III.B.2.5 to update patient's status.
2.2 Interpretation of findings and, when indicated, revision of goals. 2.3 When indicated, revision
of treatment plan, as directly correlated with documented goals. 2.4 Authentication and
appropriate designation of physical therapist.
IV. SUMMATION OF CARE
A. Documentation is required following conclusion of the current episode in the physical therapy
care sequence. B. Elements include: 1. Reason for discontinuation of service.
Examples include: Ex 1.1 Satisfactory goal achievement. Ex 1.2 Patient declines to continue care.
Ex 1.3 Patient is unable to continue to work toward goals due to medical or psychosocial
complications. 2. Current physical/functional status. 3. Degree of goal achievement and reasons
for goals not being achieved. 4. Discharge plan that includes written and verbal communication
related to the patient's continuing care.
Examples include: Ex 4.1 Home program. Ex 4.2 Referrals for additional services. Ex 4.3
Recommendations for follow-up physical therapy care. Ex 4.4 Family and caregiver training. Ex
4.5 Equipment provided. 5. Authentication and appropriate designation of physical therapist.
References
Page 5 of 5
[1.] Direction, Delegation and Supervision in Physical Therapy Services. HOD 06-96-30-4)
[2.] Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, Ill: Joint Commission
on Accreditation of Healthcare Organizations; 1996.
[3.] Glossary of Terms Related to Information Security. Schamburg, Ill: Computer-Based Patient
Record Institute; 1996
[4.] Guidelines for Establishing Information Security Policies at Organizations Using ComputerBased Patient Records. Schamburg, Ill: Computer-Based Patient Record Institute; 1995.
Adopted by the Board of Directors March 1997 Amended March 1993, June 1993, November
1994, March 1995, March 1997
Source Citation:"Guidelines for physical therapy documentation." Physical Therapy 77.n11 (Nov


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Guidelines to Physical

Expanded Academic ASAP Print

What Is Physical Therapy?(A Guide to Physical Therapist Practice).Physical

Full Text:COPYRIGHT 2001 American Physical Therapy Association, Inc.

Expanded Academic ASAP Print

measure the results of patient/client management that is provided by physical therapists.

Named Works: A Guide to Physical Therapist Practice (Book)

Gale Document Number:A70453287

2008 Gale, Cengage Learning.

Expanded Academic ASAP Print

Preface to the First Edition November 1997.(Guide to Physical Therapist

Full Text:COPYRIGHT 2001 American Physical Therapy Association, Inc.

Named Works: Guide to Physical Therapist Practice (Book)

Expanded Academic ASAP Print

Gale Document Number:A70453285

2008 Gale, Cengage Learning.

Expanded Academic ASAP Print

Foreword to the Second Edition January 2001.(Guide to Physical Therapist Practice).Ben

Full Text:COPYRIGHT 2001 American Physical Therapy Association, Inc.

Named Works: Guide to Physical Therapist Practice (Book)

Gale Document Number:A70453286

2008 Gale, Cengage Learning.

Expanded Academic ASAP Print

On the Second Edition of the Guide.(Guide to Physical Therapist Practice).Jules M

Full Text:COPYRIGHT 2001 American Physical Therapy Association, Inc.

Expanded Academic ASAP Print

Expanded Academic ASAP Print

Named Works: Guide to Physical Therapist Practice (Book)

Gale Document Number:A70453282

2008 Gale, Cengage Learning.

Expanded Academic ASAP Print

Guide to Physical Therapist Practice: Revisions.Physical Therapy 79.6 (June

Full Text:COPYRIGHT 1999 American Physical Therapy Association, Inc.

Expanded Academic ASAP Print

Enthesopathy of knee, unspecified

Other diseases of lung

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Chronic airway obstruction, not elsewhere classified has been deleted.

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A new term, discontinuation of physical therapy services, has been added:

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A skilled passive hand movement that usually is performed with a small

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Pattern 4C: Impaired Muscle Performance

the ICD-9-CM codes:

Added to the ICD-9-CM codes:

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049 Other non-arthropod-borne viral diseases of the

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192 Malignant neoplasm of other and unspecified parts

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Several ICD-9-CM codes have been added:

Malignant neoplasm of other and

Cardiopulmonary Practice Patterns

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Deleted from the ICD-9-CM codes:

Other respiratory conditions of fetus and

Other respiratory conditions of fetus and

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Page 7F: Impaired Anthropometric Dimensions Secondary to Lymphatic System Disorders

Named Works: Guide to Physical Therapist Practice (Book) Analysis