Skip to Main Content

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of this chapter, the learner should be able to demonstrate the following competencies and proficiencies concerning the development of a rehabilitation program:

  • Understand the importance of the evaluation process in determining and designing a therapeutic exercise program

  • Compose a problem list

  • Determine functional goals based on the problem list

  • Properly document patient progress during a rehabilitation program

  • Understand the documentation process for insurance reimbursement

  • Formulate a comprehensive therapeutic exercise program

  • Understand how designing a comprehensive therapeutic exercise program differs for certain populations

INTRODUCTION

In many cases the biggest challenge to the inexperienced rehabilitation specialist is designing, implementing, and progressing the rehabilitation program. What are the appropriate rehabilitation modalities that should be used for a Grade II ankle sprain? Would passive or active range of motion be more effective? Can strengthening exercises be implanted the first day, or should it wait until day 7? Would ice, ultrasound, electrical stimulation, or a combination of these modalities be beneficial before or after exercise? Unlike the evaluation process, which is clearly delineated into a specific step-by-step process, the rehabilitation process is rarely defined in such a straightforward manner. The initial chapter of this text is designed to provide the learner with a clearly delineated process to follow to design a comprehensive, functional evaluation plan that allows for continual assessment and modification throughout the entire rehabilitation process.

OVERVIEW OF THE EVALUATION PROCESS

Any good rehabilitation plan must begin with a thorough, well-designed evaluation. Whether the evaluator follows the HIPS, HOPS, or HOPER model of injury evaluation (Table 1-1), the results will be the same.1–5

Table 1-1VARIATION OF THE EVALUATION PROCESS

The evaluation process is ongoing, meaning that after the initial evaluation the patient should be re evaluated after the first treatment to determine if the treatment is on path to meet the goals set forth by the clinician and patient. The patient has to be evaluated prior to and after each additional treatment to determine whether the rehabilitation plan is working or needs to be changed completely, modified, or progressed to more difficult activities. The evaluation process can be divided into several key parts, as demonstrated in Box 1-1.1

BOX 1-1 THE EVALUATION PROCESS1,3

  • Evaluation of medical history/chart review

  • Subjective history

  • Visual inspection

  • Palpation

  • Active range of motion

  • Passive range of motion

    • Flexibility testing

    • Joint mobility testing

  • Strength assessment

    • Manual muscle testing

    • Resistive range of motion

  • Special tests

  • Proprioception

  • Neurological examination

  • Joint-specific examinations

    • Girth measurement

    • Limb-length measurement

Clinical Pearl 1-1

Evaluating the patient before and after every rehabilitation session ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.