PT PRACTICE PATTERNS

Neuromuscular Practice Patterns

• Pattern 5A: Primary Prevention/Risk Reduction for Loss of
Balance and Falling
o Advanced age
o Alteration in senses (auditory, visual, somatosensory)
o Dementia
o Depression
o Dizziness
o Fear of falling
o History of falls
o Medications
o Musculoskeletal diseases
o Neuromuscular diseases
o Prolonged inactivity
o Vestibular pathology

• Pattern 5B: Impaired Neuromotor Development

o Alteration in senses (auditory, visual)
o Birth trauma
o Cognitive delay
o Developmental coordination disorder
o Developmental delay
o Dyspraxia
o Fetal alcohol syndrome
o Genetic syndromes
o Prematurity

• Pattern 5C: Impaired Motor Function and Sensory Integrity

Associated With Nonprogressive Disorders of the Central Nervous
System—Congenital Origin or Acquired in Infancy or Childhood
o Anoxia or hypoxia
• Birth trauma
• Brain anomalies
• Cerebral palsy
• Encephalitis
• Genetic syndromes affecting central nervous system (CNS)
• Hydrocephalus
 • Infectious disease affecting CNS
• Meningocele
• Neoplasm
• Prematurity
• Tethered cord
• Traumatic brain injury

• Pattern 5D: Impaired Motor Function and Sensory Integrity

Associated With Nonprogressive Disorders of the Central Nervous
System—Acquired in Adolescence or Adulthood
• Aneurysm
• Anoxia or hypoxia
• Bell palsy
• Cerebrovascular accident
• Infectious disease that affects the central nervous system
• Intracranial neurosurgical procedures
• Neoplasm
• Seizures
• Traumatic brain injury

• Pattern 5E: Impaired Motor Function and Sensory Integrity

Associated With Progressive Disorders of the Central Nervous
System
• Acquired immune deficiency syndrome
• Alcoholic ataxia
• Alzheimer disease
• Amyotrophic lateral sclerosis
• Basal ganglia disease
• Cerebellar ataxia
• Cerebellar disease
• Huntington disease
• Idiopathic progressive cortical disease
• Intracranial neurosurgical procedures
• Multiple sclerosis
• Neoplasm
• Parkinson disease
• Primary lateral palsy
• Progressive muscular atrophy
• Seizures
• Pattern 5F: Impaired Peripheral Nerve Integrity and Muscle
Performance Associated With Peripheral Nerve Injury
• Neuropathies
▪ Carpal tunnel syndrome
▪ Cubital tunnel syndrome
▪ Erb palsy
▪ Radial tunnel syndrome
▪ Tarsal tunnel syndrome
• Peripheral vestibular disorders
▪ Labyrinthitis
▪ Paroxysmal positional vertigo
• Surgical nerve lesions
• Traumatic nerve lesions

• Pattern 5G: Impaired Motor Function and Sensory Integrity

Associated With Acute or Chronic Polyneuropathies
• Amputation
• Axonal polyneuropathies
▪ Alcoholic
▪ Diabetic
▪ Renal
• Dysfunction of the autonomic nervous system
• Guillian-Barré syndrome
• Leprosy
• Post-polio syndrome
•
• Pattern 5H: Impaired Motor Function, Peripheral Nerve Integrity,
and Sensory Integrity Associated With Nonprogressive Disorders
of the Spinal Cord
• Benign spinal neoplasm
• Complete and incomplete spinal cord lesions
• Infectious diseases affecting the spinal cord
• Spinal cord compression
▪ Degenerative spinal joint disease
▪ Herniated intervertebral disk
▪ Osteomyelitis
▪ Spondylosis

• Pattern 5I: Impaired Arousal, Range of Motion, and Motor

Control Associated With Coma, Near Coma, or Vegetative State
 o Anoxia
o Birth trauma
o Cerebral vascular accident
o Infectious or inflammatory disease that affects the central nervous system
o Neoplasm
o Prematurity
o Traumatic brain injury

Musculoskeletal Practice Patterns

• Pattern 4A: Primary Prevention/Risk Reduction for Skeletal
Demineralization
o Chronic cardiovascular/pulmonary dysfunction
o Deconditioning
o Hormonal changes
o Hysterectomy
o Medications (eg, anti-epileptic medications, steroids, thyroid hormone)
o Menopause
o Nutritional deficiency
o Paget disease
o Prolonged non–weight-bearing state

• Pattern 4B: Impaired Posture

o Congenital torticollis
o Pain
o Pregnancy
o Repetitive stress syndrome
o Scheuermann disease
o Scoliosis, kyphoscoliosis

• Pattern 4C: Impaired Muscle Performance

o Acquired immune deficiency syndrome
o Chronic musculoskeletal dysfunction
o Chronic neuromuscular dysfunction
o Diabetes
o Down syndrome
o Pelvic floor dysfunction
o Renal disease
o Vascular insufficiency
• Pattern 4D: Impaired Joint Mobility, Motor Function, Muscle
Performance, and Range of Motion Associated With Connective
Tissue Dysfunction
o Joint subluxation or dislocation
o Ligamentous sprain
o Musculotendinous strain
o Pregnancy
o Prolonged joint immobilization
o Rheumatoid arthritis
o Scleroderma
o Systemic lupus erythematosus
o Temporomandibular joint syndrome

• Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle

Performance, and Range of Motion Associated With Localized
Inflammation
o Abnormal response to provocation
o Ankylosing spondylitis
o Bursitis
o Capsulitis
o Epicondylitis
o Fasciitis
o Gout
o Osteoarthritis
o Prenatal and postnatal soft tissue inflammation
o Synovitis
o Tendinitis

• Pattern 4F: Impaired Joint Mobility, Motor Function, Muscle

Performance, Range of Motion, and Reflex Integrity Associated
With Spinal Disorders
o Degenerative disk disease
o Disk herniations
o History of spinal surgery
o Spinal stenosis
o Spondylolisthesis

• Pattern 4G: Impaired Joint Mobility, Muscle Performance, and

Range of Motion Associated With Fracture
 o Bone demineralization
o Hormonal changes
o Medications (eg, anti-epileptic medications, steroids, thyroid hormone)
o Menopause
o Nutritional deficiency
o Prolonged non–weight-bearing state
o Trauma

• Pattern 4H: Impaired Joint Mobility, Motor Function, Muscle

Performance, and Range of Motion Associated With Joint
Arthroplasty
o Ankylosing spondylitis
o Arthroplasties
o Avascular necrosis due to steroid use
o Juvenile rheumatoid arthritis
o Neoplasms of the bone
o Osteoarthritis
o Rheumatoid arthritis
o Trauma

• Pattern 4I: Impaired Joint Mobility, Motor Function, Muscle

Performance, and Range of Motion Associated With Bony or Soft
Tissue Surgery
o Ankylosis
o Bone graft and lengthening procedures
o Cesarean section
o Connective tissue repair or reconstruction
o Fascial releases
o Fusions
o Internal debridement
o Internal knee derangement
o Intervertebral disk disorder
o Laminectomies
o Muscle, tendon, ligament, capsule repair or reconstruction
o Multisite fractures
o Open reduction internal fixation
o Osteotomies
o Tibial tuberosity procedures
• Pattern 4J: Impaired Motor Function, Muscle Performance,
Range of Motion, Gait, Locomotion, and Balance Associated With
Amputation
o Amputation
o Diabetes
o Frostbite
o Peripheral vascular disease
o Trauma

Integumentary Practice Patterns

• Pattern 7A: Primary Prevention/Risk Reduction for
Integumentary Disorders
o Amputation
o Congestive heart failure
o Diabetes
o Malnutrition
o Neuromuscular dysfunction
o Obesity
o Peripheral nerve involvement
o Polyneuropathy
o Prior scar
o Spinal cord involvement
o Surgery
o Vascular disease
• Pattern 7B: Impaired Integumentary Integrity Associated With
Superficial Skin Involvement
o Amputation
o Burns (superficial/first degree)
o Cellulitis
o Contusion
o Dermopathy
o Dermatitis
o Malnutrition
o Neuropathic ulcers (grade 0)
o Pressure ulcers (stage 2)
▪ Vascular disease
▪ Arterial
▪ Diabetic
• Pattern 7C: Impaired Integumentary Integrity Associated With
Partial-Thickness Skin Involvement and Scar Formation
o Amputation
o Burns (partial thickness/second degree)
o Dermatologic disorders
o Epidermolysis bullosa
o Hematoma
o Immature scar
o Malnutrition
o Neoplasms (including Kaposi’s sarcoma)
o Neuropathic ulcers (grade 1)
o Pressure ulcers (stage 2)
o Prior scar
o Status post spinal cord injury
o Surgical wounds
o Toxic epidermal necrolysis
o Traumatic injury
o Vascular ulcers
▪ Arterial
▪ Diabetic
▪ Venous

• Pattern 7D: Impaired Integumentary Integrity Associated With

Full-Thickness Skin Involvement and Scar Formation
o Abscess
o Amputation
o Burns
o Frostbite
o Hematoma
o Immature, hypertrophic, or keloid scar
o Lymphostatic ulcer
o Malnutrition
o Neoplasm
o Neuropathic ulcers (grade 2)
o Pressure ulcers (stage 3)
o Prior scar
o Surgical wounds
o Toxic epidermal necrolysis
o Vascular ulcers
▪ Arterial
▪ Diabetic
▪ Venous
• Pattern 7E: Impaired Integumentary Integrity Associated With
Skin Involvement Extending Into Fascia, Muscle, or Bone and Scar
Formation
o Abscess
o Burns
o Chronic surgical wound
o Electrical burns
o Frostbite
o Hematoma
o Kaposi’s sarcoma
o Lymphostatic ulcer
o Necrotizing fasciitis
o Neoplasm
o Neuropathic ulcers (grades 3, 4, 5)
o Pressure ulcers (stage 4)
o Recent amputation
o Subcutaneous arterial ulcer
o Surgical wounds
o Vascular ulcers
▪ Diabetic
▪ Venous

Cardiovascular Practice Patterns

• Pattern 6A: Primary Prevention/Risk Reduction for
Cardiovascular/Pulmonary Disorders
o Diabetes
o Family history of heart disease
o Hypercholesterolemia or hyperlipidemia
o Hypertension
o Obesity
o Sedentary lifestyle
o Smoking

• Pattern 6B: Impaired Aerobic Capacity/Endurance Associated

With Deconditioning
o Acquired immune deficiency syndrome
o Cancer
o Cardiovascular disorders
 o Chronic system failure
o Inactivity
o Multisystem impairments
o Musculoskeletal disorders
o Neuromuscular disorders
o Pulmonary disorders

• Pattern 6C: Impaired Ventilation, Respiration/Gas Exchange, and

Aerobic Capacity/Endurance Associated With Airway Clearance
Dysfunction
o Acute lung disorders
o Acute or chronic oxygen dependency
o Bone marrow/stem cell transplants
o Cardiothoracic surgery
o Change in baseline breath sounds
o Change in baseline chest radiograph
o Chronic obstructive pulmonary disease (COPD)
o Frequent or recurring pulmonary infection
o Solid-organ transplants (eg, heart, lung, kidney)
o Tracheostomy or microtracheostomy

• Pattern 6D: Impaired Aerobic Capacity/Endurance Associated

With Cardiovascular Pump Dysfunction or Failure
o Angioplasty or atherectomy
o Atrioventricular block
o Cardiogenic shock
o Cardiomyopathy
o Cardiothoracic surgery
o Complex ventricular arrhythmias
o Complicated myocardial infarction (failure); uncomplicated myocardial infarction
(dysfunction)
o Congenital cardiac anomalies
o Coronary artery disease
o Decrease in ejection fraction (EF) on exercise testing (EF of 30%-50% with
dysfunction; <30% with failure)
o Diabetes
o Exercise-induced myocardial ischemia (1-2 mm ST segment depression with
dysfunction; >2 mm ST segment with failure)
o Hypertensive heart disease
o Nonmalignant arrhythmias
o Valvular heart disease
• Pattern 6E: Impaired Ventilation and Respiration/Gas Exchange
Associated With Ventilatory Pump Dysfunction or Failure
o Elevated diaphragm and volume loss on chest radiograph
o Neuromuscular disorders
o Partial or complete diaphragmatic paralysis
o Poliomyelitis
o Pulmonary fibrosis
o Restrictive lung disease
o Severe kyphoscoliosis
o Spinal/cerebral neoplasm
o Spinal cord injury

• Pattern 6F: Impaired Ventilation and Respiration/Gas Exchange

Associated With Respiratory Failure
o Abnormal chest radiograph
o Acute neuromuscular dysfunction
o Adult respiratory distress syndrome
o Abnormal alveolar to arterial oxygen tension differences
o Asthma
o Cardiothoracic surgery
o Chronic obstructive pulmonary disease (COPD)
o Inability to maintain adequate oxygen tension with supplemental oxygen
o Multisystem failure
o Pneumonia
o Pre- and post-lung transplant or rejection
o Rapid rise in arterial carbon dioxide at rest or with activity
o Sepsis
o Thoracic or multisystem trauma

• Pattern 6G: Impaired Ventilation, Respiration/Gas Exchange, and

Aerobic Capacity/Endurance Associated With Respiratory Failure
in the Neonate
o Abdominal thoracic surgeries
o Apnea and bradycardia
o Bronchopulmonary dysphasia
o Congenital anomalies
o Hyaline membranes disease
o Meconium aspiration syndrome
o Neurovascular disorders
o Pneumonia
 o Rapid desaturation with movement or crying

• Pattern 6H: Impaired Circulation and Anthropometric

Dimensions Associated With Lymphatic System Disorders
o Acquired immune deficiency syndrome
o Cellulitis
o Filariasis
o Infection/sepsis
o Lymphedema
o Post-radiation
o Reconstructive surgery
o Reflex sympathetic dystrophy
o Status post lymph node dissection
o Trauma

• Pattern 6I: Impaired Aerobic Capacity, Muscle Performance,

Integumentary Integrity, and Mobility Associated With Peripheral
Venous Disorders
o Arthroplasty
o Cancer
o Congestive heart failure
o Deep vein thrombosis (DVT)
o Hematological disorders
o Hormonal contraception
o Hormone replacement therapy (HRT)
o Lower extremity fracture
o Neurological disorder affecting lower extremity musculature (SCI, MS, CVA)
o Obesity
o Pregnancy
o Recent immobilization
o Recent surgery
o Renal failure
o Smoking/tobacco use
o Superficial venous thrombosis
o Thrombophlebitis
o Trauma
o Venous hypertension
o Venous malformation
• Pattern 6J: Impaired Aerobic Capacity, Muscle Performance,
Blood Flow in the Legs, Integumentary Integrity, and Mobility
Associated With Peripheral Arterial Disorder
o Abnormal lower extremity pulse examination
o African Americans over age 50
o Age greater than 70 years; 50–69 years with history of smoking (10 pack years) or
diabetes; Age less than 50 years, with diabetes and one other atherosclerosis risk
factor (smoking, dyslipidemia, hypertension, or hyperhomocysteinemia)
o Aneurysm
o Arterial insufficiency
o Atherosclerosis; Family history of atherosclerosis
o Atherosclerotic coronary, carotid, or renal artery disease
o Cardiovascular disease
o Congenital abnormalities
o Diabetes
o Female gender predisposes a patient to more severe symptomatology and poorer
function
o History of wounds
o Hypercholesterolemia
o Hyperhomocysteinemia
o Hypertension
o Leg symptoms with exertion or ischemic rest pain
o Metabolic syndrome
o Obesity
o Physical inactivity
o Smoking/tobacco use
o Stroke
o Thromboembolic disease
o Trauma