Download Goals of the OMT evaluation

OMT
EVALUATION
Dr. Asif Islam PT,SMC,UOS.
Goals of the OMT evaluation
The OMT evaluation is directed toward three goals:
1) Physical diagnosis
 To establish a physical, or biomechanical, diagnosis.
2) Indications and contraindications
 To identify indications and contraindications to treatment.
3) Measuring progress
 To establish a baseline for measuring progress.
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Diagnosis:
“determination of the nature of a cause of a disease”.
Medical diagnosis:
“Diagnosis based on information from sources such as
findings from a physical examination, interview with the patient or
family or both, medical history of the patient and family, and
clinical findings as reported by laboratory tests and radiologic
studies”.
Clinical diagnosis:
“Diagnosis based on signs, symptoms, and laboratory
findings during life”.
Differential diagnosis:
“the determination of which one of several diseases may be
producing the symptoms”.
Radiological diagnosis
Physical diagnosis
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“diagnosis based on information obtained by
inspection, palpation, percussion, and auscultation”.
Diagnosis based on a physical examination of a
patient.
refinement of the medical diagnosis and the
functional status
The physical diagnosis is based on a model of
somatic dysfunction that assumes a highly
interdependent relationship between musculoskeletal
symptoms and signs.
In the presence of somatic dysfunction, there is a
correlation between the patient's musculoskeletal
signs and the production, increase, or alleviation of
symptoms during a relevant examination
procedure.
 Musculoskeletal conditions that respond well to
treatment by manual therapy typically present
with a clear relationship between signs and
symptoms.
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An OMT evaluation that shows no
correlation between signs and symptoms
 usually indicates that the patient's problem
originates from outside of the
musculoskeletal system
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so that mechanical forms of treatment
such as manual therapy are less likely to
help.
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The manual therapist confirms the
initial physical diagnosis of somatic
dysfunction with a low-risk trial treatment
as an additional evaluation procedure.
For example, traction is the most common trial treatment
for a joint hypomobility.
If the trial treatment does not alleviate symptoms or
if symptoms are worsened, further evaluation is necessary
and a different trial treatment is tested.
Indications and contraindications
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Indications
Indications for treatment by manual therapy are based
more on the physical diagnosis than on the medical
diagnosis.
Restricted joint play (hypomobility)
an abnormal end-feel
are the most important criteria for deciding if
mobilization is indicated.
Grade III stretch mobilization is indicated when a
movement restriction (hypomobility) has an abnormal
end-feel and appears related to the patient's symptoms.
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Hypomobility presenting with a normal end-feel
and no symptoms ,
is not considered pathological, so not treated.
In such cases, the movement restriction is either
due to a
congenital anatomical variation,
Or the symptoms in that area are referred
from another structure.
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In patients who cannot yet tolerate examination or specific
treatment with a biomechanically significant force,
within-the slack (Grades I-IISZ), mobilizations and other
palliative modalities provide short -term symptom relief.
These symptom control treatments are primarily used as
a temporary measure to prepare a patient to tolerate
further specific examination or more intensive treatments
(for example, a Grade III stretch movement) that will
produce a more lasting effect.
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In patients with hypomobility due to muscle
spasm in the absence of tissue shortening,
relaxation mobilizations in the Grade I - II range
are generally effective.
In the presence of excessive joint play
(hypermobility), stabilizing (limiting) measures are
indicated and Grade III stretch mobilization is
contraindicated.
Contraindications for Mobilization
 Inflammatory
arthritis
 Malignancy
 Tuberculosis
 Osteoporosis
 Ligamentous
rupture
 Herniated disks with
nerve compression
 Bone disease
 Neurological
involvement
 Bone fracture
 Congenital bone
deformities
 Vascular disorders
 Joint effusion
May use I & II
mobilizations to
relieve pain
Specific contraindications to Grade III
stretch mobilization
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techniques include: » decreased joint play with a hard,
nonelastic end-feel in a hypomobile movement direction
» increased joint play with a very soft, elastic end-feel in a
hypermobile movement direction
» pain and protective muscle spasm during mobilization
» positive screening tests, for example, pain induced by
compression tests
Measuring progress
Changes in a patient's condition are assessed by monitoring
changes in one or more dominant symptoms and
comparing these changes with routine screening tests and
the patient's dominant signs.
Symptoms in the spine may include pain, changes in
sensation, a feeling of greater strength or ease of motion,
or reduced fatigue.
Physical signs of spinal origin may include altered joint
play, range of movement, reflexes, or changes in muscle
performance.
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Periodic reassessment of the patient's chief
complaints and dominant physical signs during a
treatment session guides treatment progression.
If reassessment reveals normalization of
function
(e.g., mobility) along with decreased symptoms,
Then treatment may continue as before or
progress in intensity.
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When reassessment during a treatment session
indicates that function is not normalizing
or that symptoms are not decreasing,
be alert to the need for further evaluation
to determine a
more appropriate technique,
positioning,
direction of force,
or treatment intensity.
Elements of the OMT evaluation
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4. Palpation (Includes tissue characteristics, structures)
5. Neurologic
and vascular examination
C. Medical diagnostic studies (Includes diagnostic imaging,
lab tests, » Diagnostic imaging (e.g., X-ray, bone scan,
CT scan, MRI)
» Laboratory tests (e.g., analysis of blood and other body
fluids)
» Electrodiagnostic tests (e.g., EMG, NCS)
» arthroscopy, arthroplasty
» Punctures (e.g., biopsy, aspiration)
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For instance, before treating a patient who is unable to
flex the lumbar spine,
you must first determine if the limitation is due to
pain (e.g., lumbar radiculopathy),
hypomobility e.g., soft tissue contracture,
intraarticular swelling,
disc herniation,
nerve root adhesion,
weakness (e.g., peripheral neuropathy, primary
muscle disease),
or a combination of those disorders.
D.D FOR OMT
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The OMT practitioner must make three major differential
diagnostic decisions when evaluating spinal somatic
dysfunction:
» Determine whether the somatic dysfunction is primarily
in the segment (e.g., the "anatomical joint") or associated
soft tissues, including neural structures .
» Determine if joint hypo- or hyper-mobility is present,
and whether it is pathological (i.e., associated with an
abnormal end-feel.
» Determine whether treatment should be directed
toward
pain control
or biomechanical dysfunction .
Diagnosis and trial treatment
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Through the physical examination the therapist
correlates the
patient's signs with their symptoms.
A relationship between musculoskeletal
signs and symptoms suggests a mechanical
component to a problem that should respond
well to treatment by manual therapy.
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Before initiating a treatment plan, you should be
confident in your answers to the following questions.
» Is there good correlation between the history and the
physical exam?
» What is the patient's diagnosis
(i.e., source of symptoms, mechanism of symptoms,
contributing factors)?
What are the treatment priorities?
» Do I have enough information to begin treatment
or should I reexamine the patient?
Should I refer this patient for further evaluation?
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» What is the prognosis?
Can I help this patient?
What treatment do I have to offer?
» Are there precautions or contraindications to
treatment?
» What is the patient's experience and understanding
of their problem?
What is the impact of this problem in their life?
What are their expectations of treatment?
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