Developing Protocols for Physical Therapy Robert Taylor United States This is a frequent request that I receive in person, mail, phone, and e-mail. I would like to address how one assesses the patient and develops a protocol that matches the need of the patient and client with the capabilities of the rehabilitation provider. Step 1: Statistics Develop a sense for your �statistics of repair.� If you operate on 10 cruciate patients, what is the outcome of these patients in your hands, not what has been published? Where are they at one week, six weeks, twelve weeks, and one year? Step 2: Outcome goals Based on the injury, diagnosis, and technique of repair establish outcome goals. For example, I want my TPLO patients to be ready for all activity and competition by 12 weeks post-op. Step 3: Capabilities and resources Look at your capabilities/resources. Who will provide the rehabilitation therapy? What resources can I commit? (Purchase U.S., E-stim, therapy pool?) How do I achieve patient/client compliance? How can we be paid? Step 4: Patient assessment Patient assessment. The post-operative status of patients undergoing the same procedure is always different. One needs to have a good working knowledge of the repair used and the temporal aspects of wound healing. A. Extra capsular vs. BTB allograft B. Goniometry C. Limb circumference (muscle mass) D. Scar assessment E. Proprioception F. Gait G. Published recovery details for given procedure H. Demeanor of patient I. Willingness of owner to be part of the solution Step 5: Patient/procedure specific protocol. �������������� Patient: 7 year �hunting� female Labrador Acute CCL tear < 2 weeks old �������������� Your Capabilities �Job dedicated� vet tech. �������������� Post-op patient assessment�first week Left rear leg (repair) �������������� Your Protocol i. PROM Q.I.D. Ice packs Q.I.D. ii. 2-3 weeks Leash walks iii. Reassessment�Phase II P.T. 3�6 weeks Muscle development iv. Reassessment Phase II 6-12 weeks T.E. �muscle specific With this stepwise format, one can design and implement a treatment protocol designed specifically for your patient, your clinic and PT capabilities.
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