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Clinical Reasoning Process

Acknowledge: this reading is cited in The National Center for Equine Facilitated Therapy, http://www.nceft.org/pi_ar_clinical.shtml

Reference: The Clinical Reasoning Process, Medical Equipment and The Hippotherapy Treatment Strategy,    By Bethany A. Lee, MS, OTR and Claudia Vicas, MS, OTR
As physical, occupational and speech therapists, providing a skilled service in an allied health environment, we are bound by professional and ethical standards to ensure the safety and well-being of our patients. In our professional lives we must utilize clinical reasoning to predict the impact that each patients physical, psychosocial, emotional and cognitive status will have on the rehabilitation process.

Clinical reasoning is the analysis process which assists therapists when making decisions associated with the evaluation and treatment of a patient.

For the purpose of using clinical reasoning to evaluate a patient who has medical equipment in place (examples are ventilator equipment, g-tube, n-g tube, et. al.), let us consider the following questions:

1. Will this patient benefit from physical, occupational or speech therapy in the hippotherapy setting?
a. If you answer no to this question, go no further. This patient will be better served in another environment.

b. If you answer yes to this question, you may proceed in the clinical reasoning process.
2. Are there any possible contraindications for treatment utilizing hippotherapy as a treatment strategy other than medical devices?
a. If you answer yes to this question, go no further. This patient will be better served in another environment.

b. If you answer no to this question, you may proceed in the clinical reasoning process.
3. Ask yourself "Do I have the knowledge, training and expertise needed to manage this medical equipment and this patient in a responsible and safe manner, given the condition of the hippotherapy environment?'
a. If you answer yes to this question, the medical equipment itself does not present as a contraindication for treatment in the hippotherapy environment.

b. If you answered no to this question, you may proceed in the clinical reasoning process.

  4. Can I obtain the knowledge, training and expertise needed to manage this medical equipment in a responsible and safe manner?

a. If you answer no to this question, go no further. You should not treat this patient.

b. If you answer yes to this question, you may proceed in the clinical reasoning process.

5. If you can obtain the training you need to develop the skills necessary to manage this medical equipment and/or you can obtain assistance from a trained professional who is competent with this medical equipment, you may choose to treat this patient.

See more details at http://www.nceft.org/pi_ar_clinical.shtml

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