Prescreening

FCEase Manual

A well-constructed Functional must have certain components before it can be regarded as a comprehensive and safely performed test.

These components can be roughly divided into four (4) sections.

SECTION ONE

Client Interview

Scheduling and information for the client.

Consent Form (p. 30-32)

Client Information:

Client Health history (sample in back).
Symptoms and signs
Musculoskeletal evaluation
Billing Information – know who is paying

Subjective assessment of abilities (see client input sheet).
Job Information - this may include a worksite visit and assessment.
Psycho-social issues:
Don’t forget issues of TBI (mild head injury) or mild brain injury, there are many tests available for this purpose.

General Signs and Symptoms Indicating:

Occasionally a therapist will be referred a client who has suspected mechanical dysfunction but the symptoms do not seem to match the dysfunction. This can be particularly true when the client notes that after 3-4 therapy visits the symptoms were no better and in fact may have been worse. In those circumstances it may be best to reassess the client and rule out any possibility of either systemic or visceral dysfunction. The following is a general reference that can help you identify and briefly assess these various symptoms and help to determine if further diagnostics and physician follow up may be helpful before performing an FCE. Conservative prudent judgement is always best when unsure of a client’s medical status. This list is not a definitive source but rather to help you start thinking and investigating other sources of possible discomfort and symptoms in your clients. There are many good references available on the subject of differential diagnosis. It is helpful to have one in your library.

Infection: Fever, chills, malaise, fatigue, sweats (night), red rash, swelling, purulence, constant pain, painful, enlarged lymph nodes, superficial palpation or percussion tenderness, Tumors in lymph nodes are not usually tender to palpation. Infections in joint usually present with constant pain. Should be noted that elderly clients don’t always present with fevers during an infection due to the decreased thermoregulatory measures with age.

Pulmonary or Parietal Pleura: Cough, sputum, wheezing, shortness of breath, chest pain, pain worsened by deep inspiration, coughing up blood, decreased exercise capacity. Resp Rate > 18, altered breath sounds, HR >80

Cardiac: Arrhythmia (fast > 120, slow < 40), pauses, irregular pulse. Typical pain is squeezing, pressure, +/- radiating chest, neck, jaw, scapular or L arm pain, high or low blood pressure (>180, < 85 systolic), dizziness, syncope (fainting), peripheral swelling, shortness of breath. Aorta pain may present as a tearing, boring pain if dissecting

Vascular: Low amplitude pulse, coldness, paleness, swelling, constant pain, tearing or boring pain, color change. Vascular pain is constant, can be severe, unremitting and worsens with cold temperatures. Most common in legs. 1^st sign is claudication of calf or buttock when walking and goes away with rest. Arterial occlusion can cause pain in an organ, visceral or referred area depending on timing of occlusion and collateral circulation.

GI: Nausea, vomiting, weight loss, loss of appetite, changes in stool, bloody stool, diarrhoea, absence of bowel movements, abdominal pain, yellow eyes or skin. Can also have bloated abdomen

Renal: Costro Vertebral Angle (CVA) tenderness, L or R upper or lower quadrant or groin or genital pain (colicky), blood in urine, swelling of face, extremities, or abdomen

Oncologic: Constant or night pain, age>45, myelopathy signs (spine), history of previous primary tumor, pathologic fracture, generalized weakness, pain in multiple bony locations. Pain often insidious onset and gradually increasing. Masses may be present in the surface tissue or in lymph node (without tenderness).

Rheumatologic: Peripheral joint swelling, deformity, heat, redness, capsular restricted motion often in multiple sights, pain. Facial or skin rashes, proximal weakness. Seronegative can have asymmetrical joint involvement, often large joints, SI and other spine regions. Examples are Rheumatoid Arthritis, Scleroderma, ankylosing spondylitis, Lupus, Reiters syndrome.

Be aware of constant severe pain with increases in intensity, non-mechanical patterns and/or above symptoms or signs in association with musculoskeletal area pain in clients. Referral to a physician or medical practitioner is indicated when pain in a musculoskeletal region is accompanied by signs and symptoms indicating systemic or non-mechanical disease.

(See Sample Health History Form included in folder.)

Musculo - Skeletal Evaluation – Performed by PT, OT, ATC, Medical Practitioners, Physiotherapists, Occupational Therapists, and Assessed and Cleared by MD for other providers.

Before performing an FCE you should make sure that the client has been cleared by a physician to participate and that there are no known contraindications to the testing procedure.

If this information is not available you should take time and perform a musculoskeletal evaluation yourself so that results of FCE can be related back to the musculoskeletal dysfunction. The eval may include:

General physical condition

Should include assessment of posture, range of motion (ROM), mobility, strength, areas of muscle atrophy or hypertrophy, and edema.

The purpose of the Musculoskeletal evaluation is to identify specific, related or secondary problems, previous injuries or illness which may have resulted in functional deficits and underlying postural problems.

The structural eval will give clues to problems, or areas which will need specific observation, during testing or which could present as safety issues during the FCE (may also preclude testing).

This is also a time in which to determine the presence of cognitive barriers to understanding, language, and comprehension.

Through sample instructions the structural evaluation includes observation of static posture, observation of quality of movement, effects of simple repeated movements, a basic neurological screen (gait, heel/toe walk), sensory and reflex testing, and specific muscle testing as deemed necessary by the clinician.

While observing movements (sit to stand, walking, etc) the tester should make note of any compensatory or substitution patterns (limping, holding arm, bracing, etc) It is also at this time you take into consideration the diagnosis and medical records previously reviewed.

Data Input Sheet

Use appropriate sections as provided

A Worksite visit or interview may be required to provide job task details.

Hint:

It is a good idea to try to obtain workplace details in terms of reps/hr and kgs\ lbs weights in order to correlate with the F.C.E. report.