Initial evaluation formatInitial evaluation format

Dr. Ali Abd El-Monsif ThabetDr. Ali Abd El-Monsif Thabet

Goals Goals They are They are intended results of intended results of

patient managementpatient management that that indicate the indicate the changes in changes in impairment, functional impairment, functional limitations and disabilities, limitations and disabilities, and the changes in health, and the changes in health, wellness and fitness needs, that wellness and fitness needs, that are expected are expected as the result of as the result of implementing the plan of care. implementing the plan of care.

Goals Goals Through documentation Through documentation of these of these

goalsgoals, therapists express their , therapists express their knowledge of patient's knowledge of patient's specific specific problemsproblems, formulate the , formulate the prognosisprognosis, and provide the , and provide the foundationfoundation for developing an for developing an intervention plan intervention plan specific to the specific to the patient's needs.patient's needs.

GoalsGoalsThe process of setting goals The process of setting goals :-:-

expected outcomes should be emphasizedexpected outcomes should be emphasized:-:-

First,First, in establishing goals, the PT in establishing goals, the PT makes a makes a professional judgment about professional judgment about the the prognosisprognosis, , that is, the likelihood that is, the likelihood of functional recovery. The prognosis of functional recovery. The prognosis is a is a prediction about the futureprediction about the future, and , and depends on a very high level of depends on a very high level of skill, skill, knowledge, and experience. knowledge, and experience.

GoalsGoals Second, Second, is a is a collaborative effort collaborative effort

between the therapist and the between the therapist and the patientpatient and often the patient's family and often the patient's family and other professionals. "and other professionals. "Writing Writing Patient-Centered Functional GoalsPatient-Centered Functional Goals.". .".

That the goals be That the goals be focusedfocused on what the on what the patient wants to accomplishpatient wants to accomplish, for goals to , for goals to be truly patient-centered, they should be be truly patient-centered, they should be relevant to the patient's desired relevant to the patient's desired outcomesoutcomes, not to what the therapist , not to what the therapist thinks is 'best' for the patient."thinks is 'best' for the patient."

GoalsGoals Third, Third, goals should goals should guide the guide the

therapeutic process throughout its therapeutic process throughout its coursecourse. If rehabilitation is perceived as . If rehabilitation is perceived as a journey, goals are a statement of the a journey, goals are a statement of the destination that the patient and the PT destination that the patient and the PT are attempting to reachare attempting to reach. .

For goals to function effectively as a For goals to function effectively as a guide they should be guide they should be referred to referred to during during every treatment session, and between every treatment session, and between sessionssessions as the pt implements his as the pt implements his programprogram

GoalsGoalsLONG-TERM AND SHORT-TERM GOALSLONG-TERM AND SHORT-TERM GOALS The traditional approach to documenting The traditional approach to documenting

goals has been to distinguish between goals has been to distinguish between short-term and long-term goals. short-term and long-term goals.

Here the distinction is Here the distinction is based primarily based primarily on the time course of rehabilitationon the time course of rehabilitation. . For example, a typical long-term goal For example, a typical long-term goal might be:might be:

Patient will walk independently for Patient will walk independently for distances up to 1000 ft outdoors without distances up to 1000 ft outdoors without assistive devices within 1 month.assistive devices within 1 month.

GoalsGoals A short-term goal related to this long-A short-term goal related to this long-

term goal might beterm goal might be

Patient will walk 200 ft on level surfaces Patient will walk 200 ft on level surfaces indoors using a quad cane within 1wk.indoors using a quad cane within 1wk.

Thus the concept of a Thus the concept of a short-term goal short-term goal is is that it is an that it is an intermediate step intermediate step toward toward achieving the achieving the long-term goal.long-term goal.

This approach can be useful, especially This approach can be useful, especially in rehabilitation settings where in rehabilitation settings where treatment may continue for an extended treatment may continue for an extended periodperiod

Long term goalLong term goalPatient will walk independently for Patient will walk independently for

distances up to 1000 ft outdoors distances up to 1000 ft outdoors without assistive devices within 1 without assistive devices within 1 month.month.

Short term goalShort term goalPatient will walk 200 ft on level surfaces Patient will walk 200 ft on level surfaces

indoors using a quad cane within 1wk.indoors using a quad cane within 1wk.

GoalsGoalsWRITING GOALS AT THREE DIFFERENT LEVELSWRITING GOALS AT THREE DIFFERENT LEVELS The therapist establishes expected outcomes at three The therapist establishes expected outcomes at three

different levels: different levels: disability goals, functional goals, and disability goals, functional goals, and impairment goalsimpairment goals..

  Disability GoalsDisability Goals Disability goals Disability goals express the expected outcomes in express the expected outcomes in

terms of the terms of the specific roles that the patient wishes to specific roles that the patient wishes to be able to participate in. be able to participate in.

These goals provide the These goals provide the "big picture” "big picture” what is the what is the overall purpose of the overall purpose of the physical therapy physical therapy interventionintervention? ?

The disability goal for one patient may be to The disability goal for one patient may be to return return to work, for another to be able to care for her to work, for another to be able to care for her children, for a third to be able to go to mosque children, for a third to be able to go to mosque

GoalsGoalsFunctional GoalsFunctional Goals Functional goals Functional goals express the expected express the expected

outcomes in terms of the outcomes in terms of the skills needed to skills needed to participate in necessary or desired roles. participate in necessary or desired roles.

Functional goals are the key component of Functional goals are the key component of any goal section and they should any goal section and they should never be never be omittedomitted. .

For example, a functional goal may be to For example, a functional goal may be to walk from the bed to the bathroom, to walk from the bed to the bathroom, to put on a shirt, or to drink from a cup. put on a shirt, or to drink from a cup.

GoalsGoalsImpairment GoalsImpairment Goals Impairment goals Impairment goals express the expected express the expected

outcomes in terms of the outcomes in terms of the specific impairments specific impairments that contribute to the functional limitations. that contribute to the functional limitations.

For example, an impairment goal may be to For example, an impairment goal may be to achieve achieve 4/5 strength in the quadriceps, 4/5 strength in the quadriceps, increase range of motion (ROM) of the increase range of motion (ROM) of the knee flexion to 110°, knee flexion to 110°, or improve or improve symmetry of step length during gait,symmetry of step length during gait,

Impairment goals also may be viewed as Impairment goals also may be viewed as short-term goals used as benchmarks short-term goals used as benchmarks (steps) (steps) on the on the wayway to attaining to attaining functional goalsfunctional goals. .

GoalsGoals These goals are particularly important for These goals are particularly important for

patients who may have patients who may have serious limitations serious limitations in functional abilities, such as immediately in functional abilities, such as immediately after a after a stroke or spinal cord injury. stroke or spinal cord injury.

Changes in impairmentsChanges in impairments, such as strength, , such as strength, may be the only immediate demonstration of may be the only immediate demonstration of improvement in the patient's status, and they improvement in the patient's status, and they may therefore be more sensitive may therefore be more sensitive indicators indicators of progressof progress. .

The goal of therapy is then for the The goal of therapy is then for the improvements in impairmentsimprovements in impairments to ultimately to ultimately result in improved functional abilities.result in improved functional abilities.

GoalsGoalsLINKING IMPAIRMENT AND FUNCTIONAL GOALSLINKING IMPAIRMENT AND FUNCTIONAL GOALS Impairment goals must always be linked to the Impairment goals must always be linked to the

functional goals in some way. Sometimes functional goals in some way. Sometimes therapists link an impairment goal to a therapists link an impairment goal to a functional goal when they are writing the goal. functional goal when they are writing the goal.

For example, For example, "Pt. will increase ROM R "Pt. will increase ROM R shoulder flexion to 140°/180, so that patient shoulder flexion to 140°/180, so that patient will be able to comb his hair" will be able to comb his hair"

The increase in shoulder flexion may or may The increase in shoulder flexion may or may not be an important impairment/ short-term not be an important impairment/ short-term goal, depending on the goal, depending on the factors contributing factors contributing to the functional limitationto the functional limitation. .

GoalsGoals A primary reason that such goals often are A primary reason that such goals often are

not useful is that typically not useful is that typically more than one more than one impairment contributes to a functional impairment contributes to a functional limitation. limitation.

In the previous example the patient may In the previous example the patient may have a have a strength deficit strength deficit in addition to in addition to loss loss of ROM of ROM in the shoulder. Thus the patient in the shoulder. Thus the patient could attain the goal of improving ROM in could attain the goal of improving ROM in the shoulder, but if strength was not the shoulder, but if strength was not improved, the patient would improved, the patient would still not be still not be able to comb his hairable to comb his hair..

  

GoalsGoals In summary, the focus of therapy In summary, the focus of therapy

should be on achieving critical should be on achieving critical functional goals, and impairment goals functional goals, and impairment goals should be subordinate to attaining the should be subordinate to attaining the functional goals. functional goals.

Therefore initial evaluations often will Therefore initial evaluations often will not include explicitly stated impairment not include explicitly stated impairment goals, goals, but only rarely should the initial but only rarely should the initial evaluation not include explicitly stated evaluation not include explicitly stated functional goals.functional goals.

GoalsGoalsFUNDAMENTALS OF WELL-WRITTEN FUNDAMENTALS OF WELL-WRITTEN

FUNCTIONAL GOALSFUNCTIONAL GOALS

I- I- Goals are outcomes not processesGoals are outcomes not processes

The single most important The single most important characteristic of goals is that they are characteristic of goals is that they are outcomes not processes. outcomes not processes.

A A goal is something that the patient, goal is something that the patient, not the PT, will do. not the PT, will do.

The goal defines an The goal defines an end end state, state, not the not the processprocess that results in that state. that results in that state.

GoalsGoalsThe following is an example of a The following is an example of a poorly poorly

written written goal:goal:

Patient will be taught proper precautions Patient will be taught proper precautions following hip replacement surgery.following hip replacement surgery.

This is not a goal but a plan for This is not a goal but a plan for achieving the goal. achieving the goal.

A better, A better, more specific goal more specific goal would be as would be as follows:follows:

Patient will demonstrate proper hip Patient will demonstrate proper hip replacement precautions during bed replacement precautions during bed mobility, sitting, and transfer mobility, sitting, and transfer

GoalsGoalsII- Goals Should Be Concrete, Not AbstractII- Goals Should Be Concrete, Not Abstract One of the most challenging aspects of writing One of the most challenging aspects of writing

goals is expressing them in concrete terms. goals is expressing them in concrete terms. The following goal highlights this challenge:The following goal highlights this challenge:

Patient will demonstrate increased control Patient will demonstrate increased control during reaching movementsduring reaching movements

  

  

GoalsGoals This statement is hopelessly general and This statement is hopelessly general and

abstract. abstract. What is meant by "control What is meant by "control during reaching movements"? during reaching movements"? Ideally, Ideally, goals should be stated in terms of an goals should be stated in terms of an action action or functional task that the or functional task that the individual will perform and must include individual will perform and must include a concretely stated outcome, such as: a concretely stated outcome, such as:

Patient will reach to pick up a cup to Patient will reach to pick up a cup to drinkdrink

GoalsGoalsIII- Well-Written Goals Are III- Well-Written Goals Are Measurable and TestableMeasurable and Testable

The goal should be stated in such The goal should be stated in such a way that the measurement or a way that the measurement or testing procedure is explicit. The testing procedure is explicit. The following goal is neither following goal is neither measurable nor testable:measurable nor testable:

Patient will demonstrate good Patient will demonstrate good sitting balancesitting balance

GoalsGoals One of (many) problems with this goal is that One of (many) problems with this goal is that

it is unclear how sitting balance will be it is unclear how sitting balance will be tested. In particular, use of terms such as tested. In particular, use of terms such as good, fair, good, fair, and and poor is poor is not recommended not recommended because these terms usually imply because these terms usually imply something something different for each persondifferent for each person. A . A better way to write the goal is as follows:better way to write the goal is as follows:

Patient will be able to sit unsupported Patient will be able to sit unsupported on the edge of a mat table for up to 1 on the edge of a mat table for up to 1 minuteminute

Here the goal is stated in such a way that Here the goal is stated in such a way that the test is embedded in the goal itself. the test is embedded in the goal itself.

GoalsGoalsIV-Goals Are PredictiveIV-Goals Are Predictive Setting goals requires therapists to Setting goals requires therapists to

generate a prediction. generate a prediction. The goal The goal states that states that the patient will be the patient will be

able to accomplish something in the able to accomplish something in the future that he cannot accomplish now. future that he cannot accomplish now.

The prediction must be The prediction must be feasiblefeasible and at and at the same time the same time challengingchallenging. .

The therapist must also set a specific The therapist must also set a specific time within which this goal will be time within which this goal will be reached. reached.

GoalsGoals The predictions that therapists make in The predictions that therapists make in

setting goals will therefore not be perfectly setting goals will therefore not be perfectly accurate because individual patients differ accurate because individual patients differ from each other and from the average from each other and from the average results in clinical studies. results in clinical studies.

In general, it is better to In general, it is better to err on the side of err on the side of being too optimistic,being too optimistic, expecting a bit more expecting a bit more from the patients than they may be capable from the patients than they may be capable of achieving.of achieving.

If the PT is wrongIf the PT is wrong, then the consequence , then the consequence is that patients do not quite make it, but is that patients do not quite make it, but they are (usually) they are (usually) no worse than if more no worse than if more modest goals had been set. modest goals had been set.

GoalsGoals If, on the other hand, the PT errs on If, on the other hand, the PT errs on

the side of being the side of being too conservative too conservative in in patients' goals, the patients' goals, the consequenceconsequence may be that may be that patients do not patients do not accomplish what they were accomplish what they were capable of. capable of.

This approach does not advocate This approach does not advocate unrealistic optimism unrealistic optimism in setting in setting goals but instead reflects a goals but instead reflects a preference to challenge patients.preference to challenge patients.

  

GoalsGoalsV- V- Goals Are Determined in Goals Are Determined in

Collaboration with the Patient and Collaboration with the Patient and the Patients Familythe Patients Family

Collaboration with the patient and family is Collaboration with the patient and family is the most obvious of the fundamental the most obvious of the fundamental characteristics of goals and yet is the most characteristics of goals and yet is the most consistently violated principle. consistently violated principle.

Too often the therapist develops a set of Too often the therapist develops a set of goals goals at the time of writing the at the time of writing the initial initial evaluationevaluation, but because the , but because the patient is not patient is not present at the timepresent at the time, the therapist assumes , the therapist assumes that these are the goals most important to that these are the goals most important to the patient. the patient.

GoalsGoals Even more detrimental to the Even more detrimental to the

rehabilitation process is that the rehabilitation process is that the patient patient may not even be told what the goals may not even be told what the goals areare, or they are related only in the most , or they are related only in the most general terms. general terms.

If the goal is for the patient to be able to If the goal is for the patient to be able to walk 500 feet in 2 minutes, why not tell walk 500 feet in 2 minutes, why not tell him ? him ? in our experience, when patients are in our experience, when patients are aware of the specific aspects of a goal, aware of the specific aspects of a goal, they often they often work on it on their own timework on it on their own time..

GoalsGoals A goal has five necessary components: A goal has five necessary components: (1) Who will accomplish the goal ((1) Who will accomplish the goal (ActorActor). ). (2) The action that the individual will be (2) The action that the individual will be

able to perform (able to perform (BehaviorBehavior). ). (3) The circumstances under which the (3) The circumstances under which the

behavior is carried out (behavior is carried out (ConditionCondition). ). (4) A quantitative specification of (4) A quantitative specification of

performance (performance (DegreeDegree).). (5) The time period within which the goal (5) The time period within which the goal

will be achieved (will be achieved (Expected TimeExpected Time).).

GoalsGoalsEssential Components of a Well-Essential Components of a Well-

Written Functional Goal Written Functional Goal (ABCDE)(ABCDE)

ActorActor who will carry out the activitywho will carry out the activity usually the patient, occasionally usually the patient, occasionally

family member or other caregiverfamily member or other caregiver e.g., e.g., "Patient "Patient will..." or "Patient's will..." or "Patient's

wife will..."wife will..."

GoalsGoalsBehaviorBehaviordescription of the activity (in description of the activity (in

understandable terminology)understandable terminology)e.g., "...will walk..." or "...will e.g., "...will walk..." or "...will

transfer..." or" ...will put on transfer..." or" ...will put on shirt..."shirt..."

GoalsGoalsConditionCondition circumstances under which the circumstances under which the

behavior is carried outbehavior is carried out must include all essential elements must include all essential elements

of performance (e.g., assistive of performance (e.g., assistive devices, environmental context)devices, environmental context)

e.g., "...in hospital corridor with e.g., "...in hospital corridor with quad cane..." quad cane..."

GoalsGoalsDegreeDegree Quantitative specification of performanceQuantitative specification of performance examples of quantification: examples of quantification: rate of success or rate of success or

failurefailure, , degree or level of assistancedegree or level of assistance, , time time requiredrequired, , distancedistance, , number of repetitionsnumber of repetitions, , heart heart rate at end of activityrate at end of activity, etc., etc.

"...8/10 times successfully..." or "...in 4 "...8/10 times successfully..." or "...in 4 minutes..." or "...three blocks..." or "...500 feet..." minutes..." or "...three blocks..." or "...500 feet..." or "...with increase of heart rate to no more than or "...with increase of heart rate to no more than 110 beats/min..."110 beats/min..."

Qualitative aspects of performance Qualitative aspects of performance ""with with effective toe clearanceeffective toe clearance" "" "while maintaining while maintaining proper body mechanicsproper body mechanics""

GoalsGoalsExpected Time:- Expected Time:- how long it how long it will take to reach goalwill take to reach goal

► ► stated in days, weeks, stated in days, weeks, months, or, alternatively, months, or, alternatively, number of visits e.g., "...within number of visits e.g., "...within 2 weeks..." or "...within 3 2 weeks..." or "...within 3 therapy sessions..."therapy sessions..."

GoalsGoals All properly written All properly written functional functional goals goals

should include all five components. Thus should include all five components. Thus the following formula can be applied to the following formula can be applied to writing a functional goal:writing a functional goal:

Goal = Goal = A+ B + C + D + EA+ B + C + D + E Using this formula, the following goal Using this formula, the following goal

might be constructed:might be constructed:

Pt Pt ((ActorActor) ) will walk will walk ((BehaviorBehavior) ) on level on level surfaces with a walker surfaces with a walker ((ConditionsConditions) ) for a for a distance of 100 ft. in 2 min distance of 100 ft. in 2 min ((DegreeDegree) ) within 1 wk within 1 wk ((Expected TimeExpected Time).).

GoalsGoals Thus a wide range of goals can be Thus a wide range of goals can be

constructed by mixing and matching the constructed by mixing and matching the different components. The different components. The benefits of this benefits of this approach approach are twofold. are twofold.

FirstFirst, , goals will be properly writtengoals will be properly written, that , that is, not missing any essential components. is, not missing any essential components.

SecondSecond, this approach is designed to , this approach is designed to encourage encourage functionally oriented goals functionally oriented goals because the focus is on the because the focus is on the patientpatient and the and the actionaction he will be performing. he will be performing.

GoalsGoals THE ART OF WRITING PATIENT-CENTERED THE ART OF WRITING PATIENT-CENTERED

GOALS: GOALS: BEYOND THE FORMULABEYOND THE FORMULA If the writing of good documentation can be said If the writing of good documentation can be said

to be an art, then it is in the writing of goals that to be an art, then it is in the writing of goals that the artfulness is expressed. the artfulness is expressed.

The therapist must rise above the formula and The therapist must rise above the formula and create goals, in collaboration with the patient, create goals, in collaboration with the patient, which will guide the therapeutic process toward which will guide the therapeutic process toward the best possible outcome. the best possible outcome.

The key to creating artful goals is to make them The key to creating artful goals is to make them "patient-centered." "patient-centered." A patient-centered goal is A patient-centered goal is one expressed in terms of specific activities one expressed in terms of specific activities that are meaningful to the patientthat are meaningful to the patient. .

GoalsGoals The first step is to start with a fairly generic The first step is to start with a fairly generic

but still acceptable goal:but still acceptable goal:

Pt will walk on level surfaces with a walker Pt will walk on level surfaces with a walker and min A for a distance of 100 ft in 2 min and min A for a distance of 100 ft in 2 min within 1 wk.within 1 wk.

The goal can be reformulated so that it is The goal can be reformulated so that it is more patient-centered as follows:more patient-centered as follows:

Mr.\A (A) will walk (B) from his bedroom to Mr.\A (A) will walk (B) from his bedroom to his kitchen (C) with a walker (C) and his his kitchen (C) with a walker (C) and his wife's assistance (D) in 2 min (D) within 1 wk.wife's assistance (D) in 2 min (D) within 1 wk.(E)(E)

A simple change makes the goal much more A simple change makes the goal much more meaningful to the individual. meaningful to the individual.

GoalsGoals Disability GoalsDisability Goals Generally, disability goals can and should be Generally, disability goals can and should be

written just written just as functional goals as functional goals are are written. written. The difference The difference is that the activity is that the activity that is the subject of that is the subject of the goal is stated in the goal is stated in more general terms than it would be in more general terms than it would be in a functional goal. a functional goal.

Disability goals should each have at least Disability goals should each have at least four of the five critical components of a well-four of the five critical components of a well-written functional goal: Actor (A), Behavior written functional goal: Actor (A), Behavior (B), Condition (C), and Expect ed time (E). (B), Condition (C), and Expect ed time (E). The Degree (D) The Degree (D) may not be necessary when may not be necessary when writing disability goals. writing disability goals.

GoalsGoals The following statements are examples The following statements are examples

of disability goals:of disability goals: Example 1: Example 1: Pt Pt (A) will return to work (B) (A) will return to work (B)

as a bus driver (C) able to accomplish all as a bus driver (C) able to accomplish all regular duties (D) within 1 month (E).regular duties (D) within 1 month (E).

Example 2: Example 2: Pt Pt (A) will take care (B) of (A) will take care (B) of her two children at home (C) without her two children at home (C) without daytime assistance (D) within 2 mons daytime assistance (D) within 2 mons (E).(E).

Example 3: Example 3: Pt(A) will attend (B) school Pt(A) will attend (B) school services (C) within 6 wks (E).services (C) within 6 wks (E).

GoalsGoalsImpairment GoalsImpairment Goals Impairment goals are considered Impairment goals are considered optional for most evaluation optional for most evaluation reportsreports. .

They should be included only if They should be included only if specific impairment-level specific impairment-level objectives will be worked on during objectives will be worked on during therapy. In many clinical settings, therapy. In many clinical settings, referred to as referred to as therapy goals therapy goals or or short-term goalsshort-term goals. .

GoalsGoals It would not sound incorrect if a goal It would not sound incorrect if a goal

read "Pt will increase ROM in R knee." read "Pt will increase ROM in R knee." It then appears that the It then appears that the patient patient is doing is doing something specific to increase the ROM. something specific to increase the ROM.

Thus impairment goals are often stated Thus impairment goals are often stated without the without the Actor (A)Actor (A) explicitly explicitly specified, although the Behavior (B), specified, although the Behavior (B), Condition (C), Degree (D), and Expected Condition (C), Degree (D), and Expected Time (E) should be included. Time (E) should be included.   

GoalsGoals Some examples of impairment Some examples of impairment

goals:goals:Ex 1Ex 1:: Strength R shoulder flexion (C) will Strength R shoulder flexion (C) will

increase (B) to 4/5 (D) within 3 wks (E).increase (B) to 4/5 (D) within 3 wks (E).

Ex 2Ex 2:: Single limb stance on R leg (C) will Single limb stance on R leg (C) will improve (B) to 10 sec (D) within 2 wks (E).improve (B) to 10 sec (D) within 2 wks (E).

Ex 3: Ex 3: Pain in R shoulder (C) will decrease (B) Pain in R shoulder (C) will decrease (B) to 2/10 on VAS (D) within 1 wk (E).to 2/10 on VAS (D) within 1 wk (E).

Ex 4: Ex 4: Circumference of wound (C) will Circumference of wound (C) will decrease (B) to 2 cm (D) within 4 wks (E).decrease (B) to 2 cm (D) within 4 wks (E).

Ex 5:Ex 5: Passive ROM of L knee flexion (C) will Passive ROM of L knee flexion (C) will increase (B) to 110° (D) within 3 wks (E).increase (B) to 110° (D) within 3 wks (E).

GoalsGoals When When impairment goals are writtenimpairment goals are written, the , the

Assessment section Assessment section of a report should clearly of a report should clearly statestate that the that the specific impairments specific impairments are are contributing to the contributing to the patient's functional patient's functional problemsproblems. .

For example, if a goal is set to increase For example, if a goal is set to increase shoulder strength, then it should be clearly shoulder strength, then it should be clearly documented in the Assessment that weakness documented in the Assessment that weakness of shoulder musculature is contributing to of shoulder musculature is contributing to the patient's functional limitations.the patient's functional limitations.

A A common pitfall common pitfall when documenting when documenting impairment goals is to not specify the impairment goals is to not specify the Degree Degree (D)(D). .

Example :- Example :- ↓ pain in R ankle within 2 weeks.↓ pain in R ankle within 2 weeks.

GoalsGoalsDETERMINING EXPECTED TIMES FOR GOALSDETERMINING EXPECTED TIMES FOR GOALS Determining the appropriate expected time Determining the appropriate expected time

frames for a goal can be particularly frames for a goal can be particularly challenging. Inevitably, challenging. Inevitably, the physical therapist the physical therapist makes an educated guess about how the makes an educated guess about how the pathologic condition, medical history, and pathologic condition, medical history, and many other factors will affect how quickly a many other factors will affect how quickly a patient will achieve a goal. patient will achieve a goal.

Expected time frames are typically written in Expected time frames are typically written in weeks. In acute care hospital settings, goals weeks. In acute care hospital settings, goals can be set in terms of days. Time frames can can be set in terms of days. Time frames can also be written in terms of number of PT also be written in terms of number of PT sessions by which they are likely to be achieved sessions by which they are likely to be achieved (e.g. (e.g. Pt. will walk 200 ft. in hospital corridor Pt. will walk 200 ft. in hospital corridor with min A within 6 sessionswith min A within 6 sessions).).

GoalsGoals Documenting GoalsDocumenting Goals Setting: OutpatientSetting: Outpatient Name: Keisha Brown D.O.B.: Name: Keisha Brown D.O.B.: 1/9/85 1/9/85

DATE OF EVAL: DATE OF EVAL: 2/12/012/12/01 Current Condition: 16 y.o. female s/p fx R Current Condition: 16 y.o. female s/p fx R

distal tibia and fx R proximal humerus 1 distal tibia and fx R proximal humerus 1 wk ago 2° to MVA; NWB R LE.wk ago 2° to MVA; NWB R LE.

DISABILITY GOALDISABILITY GOAL Pt. will attend regular classroom in high Pt. will attend regular classroom in high

school and participate in all activities, school and participate in all activities, including extra-curricular sports, within 4 including extra-curricular sports, within 4 months.months.

FUNCTIONAL FUNCTIONAL GOALSGOALS 1.Pt. will demonstrate proper performance of 1.Pt. will demonstrate proper performance of

home program of active exercises within 3 days.home program of active exercises within 3 days. 2.Pt. will transfer wheelchair ↔ car using stand-2.Pt. will transfer wheelchair ↔ car using stand-

pilot transfer with min A of father or mother pilot transfer with min A of father or mother within 2 wks.within 2 wks.

3.Pt. will use motorized wheelchair 3.Pt. will use motorized wheelchair independently in school hallways, elevators, and independently in school hallways, elevators, and outside paved areas, while effectively avoiding outside paved areas, while effectively avoiding obstacles and keeping up with peers within 2 obstacles and keeping up with peers within 2 wks.wks.

IMPAIRMENT GOALIMPAIRMENT GOAL 1. Pt will tolerate R leg in dependent position 1. Pt will tolerate R leg in dependent position

for 30 min within 1 wk.for 30 min within 1 wk.

Thank you