Prognosis, Plan of Care, and Intervention Selection
Core concepts
This domain links evaluation to a defensible plan: prognosis, goals, frequency and duration, and intervention choice. Understand prognostic indicators across conditions (stroke severity and time since onset, spinal cord injury level and completeness, traumatic brain injury severity, Parkinson disease stage, MS relapse vs progression, Guillain-Barré trajectory). Know the ICF framework, SMART goal writing, and task-specific and intensity-based training principles (neuroplasticity: specificity, repetition, salience, timing). Recognize the value of high-intensity gait training, constraint-induced movement therapy criteria, and locomotor training. Consider patient values, environment, and caregiver support.
Traps
Questions reward realistic, measurable goals and penalize vague ones. Watch for interventions mismatched to phase (e.g., high-intensity training in an unstable acute patient) or to prognosis. Do not set goals beyond realistic recovery windows without justification. Remember that intensity must be dosed to tolerance and safety.
Rule of thumb
Prognosis drives dosage: the more recovery potential and the more intact the system, the more aggressive and task-specific the plan. Write goals that specify the activity, assistance level, and timeframe.
Worked example
A patient 3 weeks post-stroke with moderate gait deficit: a plan emphasizing high-repetition, task-specific gait training at tolerated intensity, with a SMART goal to ambulate 50 m with contact guard in 4 weeks, is more defensible than a low-intensity general conditioning plan.