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Chapter Objectives

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Upon completion of this chapter, the learner should be able to:

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  1. Outline the clinical decisions a therapist must make.

  2. Discuss the underlying principles and assumptions that are the basis for clinical decision-making.

  3. Contrast models of function and disablement and describe the important terminology for each.

  4. Discuss the values incorporated into all clinical decisions.

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Introduction

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Mrs. Driver is fearful that she may never be able to move her right arm and leg the way she could before the stroke. She states, emotionally, “Other than an occasional cold, I had never been ill in all my 86 years until this…” As the therapists who will be directing her rehabilitation, we have multiple decisions to make. From the first moment of our encounter with Mrs. Driver, we must intentionally begin to determine the examination tests and mea - sures that are appropriate. Mrs. Driver wants to know if she’ll ever be able to walk again or cook meals for her family, the things to which she most wants to return. We must use the history and examination data along with Mrs. Driver’s personal goals to make our individualized decisions about her prognosis and the intensity of intervention that will be best for her. Finally, based on the data from her examination, in the context of her prognosis, we must determine the specific intervention techniques to restore or optimize her body functions and maximize her ultimate recovery of functional activity. This book will guide the entire process!

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The Therapist’s Role in Rehabilitation

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There are multiple aspects of rehabilitation for individuals with neuromuscular disorders that are fascinating to consider and study. This book is designed to be a resource for the student initially gaining the knowledge and skill for neurological rehabilitation and for the practicing clinician who wants to update knowledge and skill of neurological rehabilitation. Each chapter of this book addresses specific aspects of the practical clinical decisions therapists make in daily practice for adult and pediatric patients who have neuromuscular disorders. Chapter 1 will present the principles and assumptions that are the basis for clinical decision-making, while Chapter 2 will present a framework for the process of clinical decision-making. Physical therapists (PTs) are the health-care experts in human movement. PTs improve a person’s ability to move and function through individualized examination, evaluation, and interventions, and practice “the science of healing and the art of caring” (APTA, 2008) while also promoting general fitness and health. Occupational therapists (OTs) employ “the therapeutic use of occupations, including everyday life activities with individuals, groups, populations, or organizations to support participation, performance, and function in roles and situations in home, school, workplace, community, and other settings (AOTA, 2015).” This includes evaluation of factors affecting activities of daily living (ADLs) and approaches and specific interventions to promote or enhance safety and performance in ADLs, instrumental ADLs, rest and sleep, education, work, play, leisure, ...

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