PNF: Assessment ⇨ Treatment Planning

Based on Clinical Reasoning

Therapist : Date:___________

Patient: Med. Diagnosis:

Age: f□ m□ Occupation:
Hobbies: Medications:
Others (additional diagnosis, contraindications etc):

1. Main complaint (see Body Chart)

1.1 Subjective complaint/ limitation of activities in social life:
PIP: Patient identified Problems

1.2. Patients goals

2. History
2.1. Current History:

2.2 Past Medical History:

2.3 Personal factors: Facilitators / Barriers

2.4 Environmental factors: Facilitators/ Barriers

P.L.
3.1. Abilities on Participation Level:

3.2. Restriction on Participation Level:

Copyright by IPNFA® - 10-2017

Sakis Adamidis PT, PhD, IPNFA Adv. Instructor
4. ACTIVITY/ADL:

4.1 General impression:

4.2 Which activities are possible / What is the patient able to do?

4.3 What is the patient unable to do?

4.4 Check: ADL movements (UE, LE) / Posture / Gait see ( extra table) / Locomotion

4.5 list of hypothesis

5. Physical Examination on Body Function & Structure related to

ADL
Neurological/orthopedic examination, specific tests, others:

5.1 Create a table with strengths and negatives

5.2 Define the prognosis for the selected activity

Copyright by IPNFA® - 10-2017

Sakis Adamidis PT, PhD, IPNFA Adv. Instructor
6. Treatment focus summary
6.1. AL Primary Activity Limitation (Treated during the course)

C.I.
6.2. Hypothesis for Causal Impairment (Body Function & Body Structures)

Tests
6.3. Test for A.L.:

6.4. Test for C.I.:

Copyright by IPNFA® - 10-2017

Sakis Adamidis PT, PhD, IPNFA Adv. Instructor
7. PLANNING

Contra-indications/Red flags/Yellow flags

8.1 Checklist of treatment ideas:

Range of motion resistance direct / indirect agonistic / antagonistic

techniques

Static or dynamic (concentric / eccentric) muscle work emphasized basic

principle

Mat / table / parallel bars /....

Sources for reinforcement (good parts of the body)

Note: ___________________________________________________

8.2 THERAPEUTIC SELECTION

PNF Philosophy:

Basic principles and procedure:

Techniques:

Vital Functional:

Mat program:

Gait Class:

Patient’s positions for the first treatment units:

Patterns for the first treatment units:

Home exercises:

Copyright by IPNFA® - 10-2017

Sakis Adamidis PT, PhD, IPNFA Adv. Instructor
9. RETEST

1. test A.L.:

2. test C.I.:

Hypothesis C.I. remains the same □

New hypothesis:_____________________

Apendix to Assessment

Gait assessment
Aid necessary:

Habitual Gait Speed: 5m/10m/20m Gait speed Test:

Step length:

Gait Phases left

IC LR MST TST PSw ISw Msw TSw
Head

Trunk

Pelvis

Hip

Knee

Ankle/
Foot

Toes

Gait Phases right

IC LR MST TST PSw ISw Msw TSw
Head

Copyright by IPNFA® - 10-2017

Sakis Adamidis PT, PhD, IPNFA Adv. Instructor
 Trunk

Pelvis

Hip

Knee

Ankle/
Foot

Toes

Rocker:

Scores of other Gait Assessments, f.e. Dynamic Gait Index, 6Minute Gait Test, Functional Walking
Categories, FAC, TUG etc:

Copyright by IPNFA® - 10-2017

Sakis Adamidis PT, PhD, IPNFA Adv. Instructor