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An Integrated Framework for Decision Making in Neurologic Physical Therapist Practice

M Schenkman, PT, PhD, is Professor and Director, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262 (USA)
JE Deutsch, PT, PhD, is Professor and Director of the Rivers Lab, Graduate Programs in Physical Therapy Program, Department of Developmental and Rehabilitation Sciences, University of Medicine and Dentistry of New Jersey, Newark, NJ
KM Gill-Body, PT, DPT, NCS, is Adjunct Clinical Associate Professor, Graduate Programs in Physical Therapy, MGH Institute of Health Professions, Boston, Mass

Address all correspondence to Dr Schenkman at: margaret.schenkman{at}uchsc.edu

Decision-making frameworks are used by clinicians to guide patient management, communicate with other health care providers, and educate patients and their families. A number of frameworks have been applied to guide clinical practice, but none are comprehensive in terms of patient management. This article proposes a unifying framework for application to decision making in the management of individuals who have neurologic dysfunction. The framework integrates both enablement and disablement perspectives. The framework has the following attributes: (1) it is patient-centered, (2) it is anchored by the patient/client management model from the Guide for Physical Therapist Practice, (3) it incorporates the Hypothesis-Oriented Algorithm for Clinicians (HOAC) at every step, and (4) it proposes a systematic approach to task analysis for interpretation of movement dysfunction. This framework provides a mechanism for making clinical decisions, developing clinical hypotheses, and formulating a plan of care. Application of the framework is illustrated with a case example of an individual with neurologic dysfunction.

Key Words: Clinical decision making • Models • Neurologic dysfunction

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