Physical therapists should understand the pathology, etiology, impairments in body structures and functions, and restrictions in activities and participation for all the individuals they serve. Those working with children must also understand all domains of child development and behavior and family functioning to provide appropriate examination, evaluation, diagnosis, prognosis, and intervention. The examination and evaluation processes are complex with children because almost everything is influenced by the child's developmental, functional, and behavioral level, which are in turn significantly influenced by environmental and personal contextual factors. Additionally, when obtaining information regarding the child's status, the therapist must usually disguise the examination as “play.” The child generally must be cooperative and actively engaged to display the highest level of performance. Therapists must be experts at eliciting best performance and making it all fun, thus making the examination process more complex and difficult than in other areas of physical therapy practice.
There are a variety of terms used to describe what the American Physical Therapy Association (APTA) Guide to Physical Therapist Practice (hereafter referred to as the Guide) (2001) labels “examination” and “evaluation.” As discussed in Chapter 1, many professionals, especially in pediatrics, continue to use the terms examination, evaluation, and assessment interchangeably. Others consider evaluation the process used to diagnose and identify atypical development or movement, whereas assessment is used to describe the process of collecting and organizing relevant information (Brenneman, 1999, p. 28), and some make no distinction at all. The Individuals with Disabilities Education Improvement Act (IDEA) (PL 108-446, 2004), the U.S. right-to-education law, uses the term evaluation to refer to the processes of examination and evaluation for eligibility for services, and assessment for program planning purposes.
This text uses the Guide's (APTA, 2001) terminology of examination for the physical process and evaluation for the dynamic, intellectual process of clinical decision making to determine the level of functioning of body functions and structures, activities, and participation. Under most situations, both processes occur simultaneously, so the terms are usually used together, except when there is a real distinction between the physical activity of the examination and the clinical judgment process of evaluation. In all settings, it is important to clarify the terminology used to avoid misunderstandings.
Factors Influencing Examination and Evaluation
Regardless of why a child comes to physical therapy for examination and evaluation, multiple factors must be considered to maximize the effectiveness of the process. Often these factors intertwine, resulting in overlapping and sometimes conflicting influences. The therapist must thoughtfully consider all applicable factors, then rely on his or her knowledge and clinical judgment to provide a skilled examination that is in the best interest of the child. Understanding the following factors will assist the therapist in determining location, time, style, and focus of examination, choosing which team members will be involved, selecting tests and measures to perform, and ...