AMERICAN PHYSICAL THERAPY ASSOCIATION, SECTION ON PEDIATRICS

Using APTA’s Guide to Physical Therapist Practice

in Pediatric Settings

What Is the Guide?

Section on Pediatics The Guide to Physical Therapist Practice (the Guide) is a resource that is intended to:
• Describe generally accepted physical therapist practice,
FACT SHEET • Standardize terminology, and
• Delineate preferred practice patterns.

The Guide was developed by the American Physical Therapy Association and expert
clinicians through a consensus process, and is divided into two parts.

Part I describes the elements of patient/client management and explains the tests and mea-
sures and interventions performed by therapists. Part II consists of the Preferred Practice
Patterns grouped into four system areas: musculoskeletal, neuromuscular, cardiopulmonary,
and integumentary. The practice patterns describe common sets of management strategies
used by physical therapists for selected patient/client groups and identify the range of cur-
rent options for care. How these two parts relate to your practice are further explored later
in this document.

The Guide is based on the process of enablement and the integration of prevention and
wellness strategies. The Guide is an evolving document that will be systematically revised
as the knowledge base of physical therapy, scientific literature, and outcomes research
develop and as examination and intervention strategies change.

The Guide is designed to help physical therapists:

• Enhance quality of care,
• Improve patient/client satisfaction,
S E C T I O N O N • Promote appropriate utilization of health care services,

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AMERICAN PHYSICAL THERAPY ASSOCIATION


• Increase efficiency and reduce unwarranted variation in provision of services, and
• Promote cost reduction through prevention and wellness initiatives.

What Is Patient/Client Management?

Section on Pediatrics Five elements of care define patient/client management within physical therapist
APTA practice:
1111 North Fairfax Street 1. Examination: A process of obtaining a history, performing relevant systems review,
Alexandria, VA 22314-1488 and selecting and administering specific tests and measures.
2. Evaluation: A dynamic process in which the physical therapist makes clinical judg-
Phone: 800/999-2782, ext. 3254
Fax: 703/706-8575 ments based on data gathered during the examination.
E-mail: [email protected] 3. Diagnosis: A label encompassing a cluster of signs related to impairments of the
four systems of the body (musculoskeletal, neuromuscular, cardiopulmonary, and
integumentary).
www.pediatricapta.org
4. Prognosis: The predicted optimal level of functional improvement, recommendation
for amount of service, and establishment of a plan of care.
5. Intervention: Purposeful and skilled interaction with the patient/client, including
coordination, communication, documentation, patient/client-related instruction,
and procedural interventions.
 How Do Practice Patterns Relate to Pediatric Conditions?
Section on Pediatics A child with a particular medical condition may have a physical therapy diagnosis of one
or more practice patterns. Some practice patterns, such as Neuromuscular Patterns 5B
(impaired neuromotor development) and 5C (nonprogressive CNS disorders–child), are
Using APTA’s
specific to pediatrics, whereas many other patterns, such as Musculoskeletal Pattern 4C
Guide to Physical
(impaired muscle performance) and Cardiopulmonary Pattern 6B (deconditioning) occur
Therapist Practice throughout the lifespan.
in Pediatric Settings
Why Is the Guide Important to Pediatric Practice?
FACT SHEET The Guide provides a framework for clinical decision making in physical therapy. To
provide high-quality pediatric physical therapy services, therapists need to consider
the Guide; other documents, such as federal and state legislation; practice setting; and
research-based evidence for practice decisions.

In collaboration with the child, family, and other health and educational team members,
therapists make decisions regarding the examination, evaluation, diagnosis, prognosis,
and intervention, as well as the intensity of service delivery, outcomes, and criteria for
discharge.

How Does Guide Terminology Apply to Pediatrics?

Guide terminology has specific applications to pediatric physical therapy, as outlined
below.

History
The Guide defines history as interviewing and reviewing medical records. These may
include:
• Past medical history
• Current health status
• Social history
• Identification of patient expectations and desired outcomes

In pediatric physical therapy, the interview is a central component of the examination and
promotes family-centered care. Therapists interview the child, family, and other profes-
sionals, and cover the following key topics:
• Child, family, and team outcomes
• Child/family activities and hobbies
• Amount of previous therapy, progress, current therapy
• Medications, surgeries
• Child/family attitudes and knowledge related to the diagnosis

Systems Review
S E C T I O N O N The Guide defines systems review as screening for:

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• General health of patient
• Identification of possible health problems requiring consultation and/or referral to
other providers
• Physiologic status of musculoskeletal, neuromuscular, cardiopulmonary, and
integumentary conditions
• May include ability to communicate, affect, cognition, language, and learning
style

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 In pediatric physical therapy, therapists consider a review of the various developmental
domains that influence a child’s function. These may include cognition; language and
Section on Pediatics
communication; social/emotional development; adaptive function; physical development,
including vision and hearing; and play.
Using APTA’s
Guide to Physical Tests and Measures
Therapist Practice In the Guide, tests and measures are used to gather specific information on the patient/
in Pediatric Settings client.
• The Guide provides a catalog of tests and measures in 24 categories, ranging from
aerobic capacity to gait and balance to neuromotor development
FACT SHEET • During the examination, assessment is defined as the measurement or quantifica-
tion of a variable or placement of a value on a behavior

Pediatric therapists can use the Guide’s information on tests and measures to select the
most appropriate tool to gather information on the child’s participation in the home,
school, and community; ability to perform activities; and body structure and functional
status. The term “assessment” in early intervention and school settings refers to an
ongoing process of collecting information to guide intervention planning.

Plan of Care
In the Guide, the plan of care is used to determine goals, outcomes, specific intervention
strategies, duration and frequency of intervention, and criteria for discharge. Outcomes
may include minimization of functional limitations and disability, optimization of health
status, prevention of disability, and optimization of patient/client satisfaction.

When pediatric physical therapists practice in early intervention and school settings,
their plan of care is driven by the child’s Individualized Family Service Plan or Education
Program. The Guide’s terminology for outcomes is consistent with the spirit of family-
identified outcomes in early intervention, as well as functional goals and objectives for
children in educational settings.

Intervention
Intervention includes coordination, communication, and documentation; patient/client-
related instruction; and procedural intervention.

Coordination, communication, and documentation means providing services to ensure

comprehensive and cost-effective care and efficient integration to home and community.

In pediatric settings, this component of intervention emphasizes the critical role of col-
laboration, consultation, and case management. Consideration is given to what health
professional, educational, or community referrals are needed for the child.

S E C T I O N O N
Patient/client-related instruction is providing education on current condition, resources,
plan of care, and future transitions.
PEDIATRICS
AMERICAN PHYSICAL THERAPY ASSOCIATION In pediatric settings, this aspect of intervention is a reciprocal sharing of information
among the therapist, child, and family. It recognizes the importance of self-determination
for the child. Home or school activity programs are developed within the context of daily
routines and activities.

Procedural intervention is used to determine core interventions, including therapeutic

exercise and functional training.

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 The Guide’s list of interventions provides the scope of procedures that are appropriate for
Section
Using on Pediatics
APTA’s a given practice pattern.
Guide to Physical
How Can I Order a Copy of the Guide?
Therapist Practice
Using APTA’s
inGuide
Pediatric Settings To order the Guide to Physical Therapist Practice, contact the Service Center at the
to Physical
American Physical Therapy Association at 800/999-2782, ext 3395, or visit APTA’s Web
Therapist Practice site at www.apta.org.
in Pediatric Settings
For More Information
If you have additional questions, would like to order additional copies of this fact sheet,
FACT SHEET
or would like to join the Section on Pediatrics, please contact the Executive Office of the
Section on Pediatrics of the American Physical Therapy Association at:
APTA Section on Pediatrics
1111 North Fairfax Street
Alexandria, VA 22314
800/999-2782, ext 3254
Fax: 703/706-8575
[email protected]

Or visit the Section’s Web site at www.pediatricapta.org.

S E C T I O N O N

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AMERICAN PHYSICAL THERAPY ASSOCIATION

© Copyright 2003 by the Practice Committee of the Section on Pediatrics, APTA, with special thanks to expert
contributor Lisa Chiarello, PT, PhD, PCS.