checking for pathology when there are no symptoms of disease.
Risk factor screening, need for further examination.
Common screening activities include Screening for life style factors.
Screening posture for scoliosis.
Identifying high risk factors for falling in older adults.
Per work screening.
- client’s history,
- systems review,
- specific tests and measures.
- Need of refferals.
Process in which the physical therapist makes clinical judgments based on data gathered during the examination. Identify possible problems that require consultation with referral to another provider.
Thus screening is always initial step to know if further examination or referral is needed.
Screening provides opportunities to prevent illness and refer potential pathologies before they become complicated and difficult to manage.
INTERVIEWING THE CLIENTNon-verbal Communication.
Appropriate interpersonal skills essential during the screening.
Words have a 7% impact on interpersonal communication ,tone of voice has 38%, body language has 55% impact.
1. Eye contact
Most common and powerful non-verbal communication.
Looking directly….conveying sincerity and respect.
In certain areas sign of disrespect.
Prolonged eye contact…sense of safety.
Avoiding eye-contact has negative implications.
Avoid staring, squinting or excessively blinking
Steady eye contact without staring indicates interest in the individual and pupil dilation indicates keen interest.
2. Body position.
During interview, Both comfortably seated with the eyes at the same level and shoulders squarely facing each other.
Stiff posture give negative while relaxed arm posture give positive impression.
Good posture ensure confidence and attention.
Some patients are comfortable with physical proximity( one arm length) while others may be offended.
Used instinctively to emphasize important points.
Lack of gesture,anger, lack of openness.
Gestures like playing with clothing, hair or jewelry are distracting.
5. Facial expressions
If facial expressions conflict with verbal messages???
Wrinkling the forehead….tension.
Yawning…boredom / tiredness
Cultural differences exist.
Needed for medical history and identification of health risks.
Start with using open, general questions…gently put.
Open ended question start with how and why?
Close-ended question…answer in simple yes or no…responses related to specific screening questions.
More directed question for specific information.
Used for effective communication.
L= listen with sympathy and understanding to the client’s perception of problem.
E = explain your perception of the prob.
A = acknowledge and discuss the differences and similarities.
R = recommend a course of action.
N = negotiate an agreement.
Most people speak at the rate of 110-140 words per min, yet think at seven times this rate.
Characteristics of professionalism include effective communication, professional appearance, timeliness, respect and displaying tactful and courteous behavior.
Screening For Mental Health
Mental health is influenced by multiple factors like memory, interpersonal relationships at work and at home, coping and stress management, social support, financial support, education, vocation, leisure activities and personal values.
Family history of mental health dysfunction is important.
Possible health problem
negative affect, depression, anxiety, fear, aggression or rage.
Depressed patients show slowness of thought and speech, impaired ability to concentrate and decreased motor activity.
12% of women and 7% of men experience depression at any one time.
Depression affect health, fitness and wellness and ultimately quality of life.
2 Question Initial Screening Test For Depression.
During the past month, have you often been bothered by feeling down, depressed or hopeless?
During the past month, have you often been bothered by little interest or pleasure in doing things?
Positive response to even 1 question is extremely sensitive and identify more than 90% of patients with major depression.
Only 60% specific and requires confirmation.
Restlessness, unusual, purposeless movements.
Non-existent sounds…..require referral.
Problems with memory and in tasks requiring concentration….need detailed examination.
Self-harm ideas, obsession with negative thoughts, loss of creative and imaginative thoughts, unclear decision making, foggy mental state, unpredictable behavior.
Stress include recent life changes or losses, changes in marital status or significant financial concerns.
some people show their stress while some do not.
Holmes And Rahe Social Readjustment Rating Scale.
Yea worth’s the adolescent life change event scale…a questionnaire listing personal, social and family changes.
Unrelenting stress…adrenaline, nor-adrenaline and cortisol released into blood stream increase heart rate, respiration, dilate the pupils and flush the skin.
Acute stress effect rational thinking
chronic impair both psychological and physiological functioning, HTN
Physiological changes during stress
ECG, GSR( galvanic skin response)…measurement of skin resistance to passage of electric current.
SCREENING FOR SUBSTANCE ABUSE
asks about attempts to cut down on drinking, annoyance with criticism about drinking, using alcohol as an eye-opener.
1.Red flags for substance abuse problems,Frequent absences from school or work
2.History of frequent trauma or accidental injuries.
3.Depression and anxiety.
4.Labile or variable HTN.
9. Odor of alcohol on breath
10. Enlarged, tender liver
11. Nasal / eye irritation
12. Labile B.P, tachycardia
13. Aftershave/ mouthwash syndrome
14. Odor of marijuana on clothing
15. Signs of chronic obstructive pulmonary disease, hepatitis B/C ,
Screening for physical abuse.
Physical, sexual and verbal abuse are prevalent.screening for intimate partner violence is essential.
Have u been Hit, kicked, punched or otherwise hurt by someone in past?
Do u feel safe in your current relationship.
Is there a partner from a previous relationship who is making you feel unsafe now?
A positive screen to yes to any of the three inquiries.Screening for an adjusted way of life.Health screening for a more all encompassing way to deal with medicinal services and preventive practice.Health screening spread all measurements of health.
As a part of a meeting or filled autonomously.Screening for health practices.Most obsessive conditions are a blend of hereditary qualities and way of life practices.
Way of life practices
Action and work out, recreation exercises, dozing/resting practices and nourishment.Screening for liquor use issue.More particular inquiries.
The inquiries prescribed by American Academy of family Physicians take after: At the point when was the last time you had more than five beverages in one day? (for men)
- More than fore beverages for females
- A positive screening answer in the most recent three months is essential.
- Appropriate referral.
- Appraisal of profound convictions.
- Constructive outcomes of profound conviction on wellbeing and health
- Pixie to know whether a man depends on a specific conviction framework.
- Values adding to or repudiating customary restorative convictions.
- Screening for all encompassing health.
- Questions identified with psyche, body and soul.
- All encompassing health score sheet.
- Physical and natural healthy body
- Mental and passionate healthy mind
- Social and otherworldly healthy soul
- Order as… endeavoring, supporting, keeping up, maintaining or surviving.
- Consistent medicinal screening tests and vaccinations.
- Encourage people to take an interest in other medicinal screening for yearly checkups and so forth.
- Consistent vaccination, lab tests, screening for growth, take after proposals for damage counteractive action.
- Consistent dental examination.