Physical therapist’s clinical reasoning in patients with gait impairments from hemiplegia

THIS is the problem, there should be no reasoning involved. 

First you start with objective descriptions of the gait deficits, probably via this;

Pump iron the smart way with a motion-capture coach, repurposed for stroke

Second, based on the specific deficits the protocols to fix those deficits are used.

Physical therapist’s clinical reasoning in patients with gait impairments from hemiplegia

Jill Seale & Carolyn Utsey

Received 11 May 2017, Accepted 27 Nov 2018, Published online: 24 Jan 2019

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• https://doi.org/10.1080/09593985.2019.1567889

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ABSTRACT

Background: During stroke rehabilitation, physical therapists (PTs) perform gait analysis and design treatments(There should be no design, you chose the EXACT PROTOCOL for the deficit) based on this analysis.
Objectives: To investigate the current trends in PTs clinical reasoning in assessing and managing gait in persons with hemiplegia.
Design: A qualitative study using a phenomenological approach using a semi-structured interview protocol with FG.
Methods: Participants consisted of expert and novice PTs working in a neurologic rehabilitation setting. FG were conducted in person and via web. Constant comparative qualitative analysis was used to analyze the qualitative data.
Results: A total of 22 PTs participated in five FG (2 novice and 3 expert groups). From the analysis of qualitative data, five themes emerged. Novice and experienced clinicians: 1) take a systematic approach to examination and evaluation of persons with hemiplegia; 2) are in agreement in common gait deficits found in persons with hemiplegia; 3) may differ in their approach to treatment based on the amount of experience of the clinician; 4) generally agree on the manner in which orthotics are used in the management of persons with hemiplegia; and 5) demonstrate professional accountability to patients concerning the use of orthotic devices.
Conclusions: This qualitative study provided insight into the variability(There should be no variability) in PTs’ strategies for gait analysis, and their identification and interpretation of common deviations and impairments in persons with hemiplegia following stroke. Reluctance to utilize orthotics for patients with hemiplegia was a consistent theme across FG.