1. Integration of Physical Agents into Therapeutic Treatment Approaches: Observable Responses
Chapter 2

2. Examination, Evaluation, and Intervention
Examination – The process of obtaining history, performing relevant system reviews, and selecting and administering specific tests and measures
Evaluation – Process in which P.T. makes clinical judgments based on data gathered during examination
Intervention – Purposeful and skilled interaction of the P.T or P.T.A. with the patient/client

3. Observable responses to Interventions
Skin Color:
Initially observe condition & color of pt’s skin prior to Rx
Fairer the skin the “pinker” it looks when exposed to heat
Need to carefully watch darker skinned pt.
Circulatory Irregularities & skin blanching:
Blanching: describes the response to applied pressure on the surface o skin following an increase in local circulation
If no blanching then can indicate underlying tissue has impaired circulatory function & may indicate pt has increased sensitivity to heat or cold

4. Observable responses cont.
Mottling of the skin:
Follows superficial heat and is indicated by spotting patches of erythema
Molting is warning sign of potential overheating
Palpable observations:
Muscle guarding & spasm: Muscle guarding is an indication of motor units firing to protect area in response to trauma; Helps prevent movement from occurring in the injured area; Pt reports “feel a muscle spasm”; When treating muscle spasms important to palpate area before & after Rx
Skin surface temperature: Application of heat cause increase in skin surface temp & application of cold causes decrease in skin surface temp

5. Pain assessment
Pain is the most difficult complaint to quantify & document objectively
Visual & numerical analog pain scales:
0__________________________________10
No pain E.R. Pain
Pain ratings:
Ask “”what are you feeling now?” instead of yes/no questions
Anatomic pain drawings
Allow pt to locate just where he or she is experiencing discomfort
Facial expression of pain:
Facial muscles will contract in response to pain; “looks like” pt is in pain

6. Pain Scales

7. Questions to Ask
Questions should not reinforce the concept of pain by using “pain” in the question
Don’t ask “Do you still hurt?” or “Are you in pain?”
Ask “What are you feeling now?”

8. Other Means to Assess Pain
Facial expressions
Ability to perfrom activity
ROM
Pain meds decrease

9. Mobility & function
These are objective assessment tools for the pt complaining of pain
If following Rx a pt has increased ROM then usually one can assume pain has decreased

10. Edema Assessment
Edema is an abnormal increase in amount of interstitial fluid; May be diffuse or localized.
Circumferential joint measurement:
Use non-stretch tape measure
Use same tape each time
Same individual measures
Measure same time each day
Measure using same bony landmarks
Measure using same technique
Measure using same unit of measure (in or cm)

11. Edema assessment cont. Volumetric water displacement:
Used when edema confined to distal extremeities
Volumeter is device that measures water displacement to record volume that an extremity submerged in water occupies
Measure same time each day
Temp of water same
Depth of immersion of extremity same
Unit of measure same (ounce or mililiters)
Simply says there’s swelling, but not where

12. Edema Assessment cont. Joint mobility or Ease of movement:
Edema can impede joint movement
Measure ROM with goniometer
Performance of an activity limited by edema
ADL’s may be impaired by edema
Ex. Difficulty putting on sock & shoe with swollen ankle

13. Muscle spasm Assessment
Muscle spasm or muscle guarding may severely inhibit a pt’s recovery
Muscle tone & tissue compliance:
Muscle tone refers to resistance of the muscle to passive stretch or elongation (how tight it feels); Assumes shortened state & feels harder than uninvolved tissue when palpated
Postural assessment:
If patient has muscle guarding that involves postural muscles, pt’s posture may be affected;
Forward head posture is where head is displaced anteriorly on C-spine because o increases anterior & posterior muscle guarding
Range of mobility:
Increased muscle spasms = decreased joint ROM; need to measure

14. Muscle strength assessments
Can be accomplished either manually or with the use of sophisticated equipment
Manual muscle Test (MMT): determines strength by assessing specific muscle contractions or gross muscle actions (grades are given to muscle contraction)
CYBEX isokinetic dynamometer: is a machine that stabilizes & tests muscles