Pattern 7A: Primary Prevention/Risk Reduction for

Integumentary Disorders

Inclusion

The following examples of examination findings may support the inclusion of clients in this
pattern:

Risk Factors or Consequences of Pathology/Pathophysiology (Disease, Disorder, or

Condition)

 Amputation
 Congestive heart failure
 Diabetes
 Malnutrition
 Neuromuscular dysfunction
 Obesity
 Peripheral nerve involvement
 Polyneuropathy
 Prior scar
 Spinal cord involvement
 Surgery
 Vascular disease

Impairments of Body Functions and Structures, Activity Limitations, or Participation

Restrictions

 Decreased level of activity

 Decreased sensation
 Edema
 Inflammation
 Ischemia
 Pain
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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Examination

Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Tests and Measures for Pattern 7A

Tests and measures for this pattern may include those that characterize or quantify:

 Anthropometric Characteristics
 Assistive Technology
 Circulation (Arterial, Venous, Lymphatic)
 Cranial and Peripheral Nerve Integrity
 Integumentary Integrity
 Mental Functions
 Muscle Performance (Including Strength, Power, Endurance, and Length)
 Posture
 Sensory Integrity

Evaluation, Diagnosis, Prognosis (Including Plan of Care)

Read Principles of Physical Therapist Patient and Client Management.

Factors That May Require New Episode of Care or That May Modify Frequency of
Visits/Duration of Care:

 Accessibility and availability of resources

 Adherence to the intervention program
 Age
 Anatomical and physiological changes related to growth and development
 Caregiver consistency or expertise
 Chronicity or severity of the current condition
 Cognitive status
 Comorbidities, complications, or secondary impairments
 Concurrent medical, surgical, and therapeutic interventions
 Decline in functional independence
 Level of impairment
 Level of physical function
 Living environment
 Multisite or multisystem involvement
 Nutritional status
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 Overall health status

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 Potential discharge destinations

© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

  Premorbid conditions
 Probability of prolonged impairment, functional limitation, or disability
 Psychological and socioeconomic factors
 Psychomotor abilities
 Social support
 Stability of the condition

Intervention
Read Intervention.

The categories of interventions for this pattern are listed alphabetically, with patient or
client instruction first:

 Patient or Client Instruction

 Biophysical agents
 Functional Training in Self-Care and in Domestic, Education, Work, Community,
Social, and Civic Life
 Motor Function Training
 Therapeutic Exercise

Reexamination
Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Outcomes for Patients or Clients

Read Measurement and Outcomes.

Concluding an Episode of Care

Read “Criteria for Concluding an Episode of Care” under Intervention.
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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Pattern 7B: Impaired Integumentary Integrity
Associated With Superficial Skin Involvement

Inclusion

The following examples of examination findings may support the inclusion of clients in this
pattern:

Risk Factors or Consequences of Pathology/Pathophysiology (Disease, Disorder, or

Condition)

 Amputation
 Burns (superficial/first degree)
 Cellulitis
 Contusion
 Dermopathy
 Dermatitis
 Malnutrition
 Neuropathic ulcers (grade 0)
 Pressure ulcers (stage 2)
 Vascular disease

o Arterial
o Diabetic
o Venous

Impairments of Body Functions and Structures, Activity Limitations, or Participation

Restrictions

 Edema
 Impaired sensation
 Impairments associated with abnormal fluid distribution
 Impaired skin
 Ischemia
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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Exclusion or Multiple-Pattern Classification
The following examples of examination findings may support exclusion from this pattern or
classification into additional patterns. Depending on the level of severity or complexity of
the examination findings, the physical therapist may determine that the patient/client
would be more appropriately managed through (1) classification in an entirely different
pattern or (2) classification in both this and another pattern.

Findings That May Require Classification in a Different Pattern

 Frostbite
 Recent amputation

Findings That May Require Classification in Additional Patterns

 Superficial burn with inhalation injury

Examination

Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Tests and Measures for Pattern 7B

Tests and measures for this pattern may include those that characterize or quantify:

 Anthropometric Characteristics
 Assistive Technology
 Balance
 Circulation (Arterial, Venous, Lymphatic)
 Cranial and Peripheral Nerve Integrity
 Gait
 Integumentary Integrity
 Mobility (Including Locomotion)
 Muscle Performance (Including Strength, Power, Endurance, and Length)
 Pain
 Range of Motion
 Self-Care and Domestic Life
 Sensory Integrity
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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Evaluation, Diagnosis, Prognosis (Including Plan of Care)

Read Principles of Physical Therapist Patient and Client Management.

Factors That May Require New Episode of Care or That May Modify Frequency of
Visits/Duration of Care:

 Accessibility and availability of resources

 Adherence to the intervention program
 Age
 Anatomical and physiological changes related to growth and development
 Caregiver consistency or expertise
 Chronicity or severity of the current condition
 Comorbidities, complications, or secondary impairments
 Concurrent medical, surgical, and therapeutic interventions
 Level of impairment of body functions and structures
 Level of independence in activity and participation
 Living environment
 Mental status
 Multisite or multisystem involvement
 Nutritional status
 Overall health status
 Potential destinations at conclusion of care
 Premorbid conditions
 Probability of prolonged impairment of body functions and structures and
probability of activity limitations and participation restrictions
 Psychological and socioeconomic factors
 Psychomotor abilities
 Social support
 Stability of the condition

Intervention
Read Intervention.

The categories of interventions for this pattern are:

 Patient or Client Instruction

 Functional Training in Self-Care and in Domestic, Education, Work, Community,
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Social, and Civic Life

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 Integumentary Repair and Protection Techniques

© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

  Manual Therapy Techniques
 Motor Function Training
 Therapeutic Exercise

Reexamination
Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Outcomes for Patients or Clients

Read Measurement and Outcomes.

Concluding an Episode of Care

Read “Criteria for Concluding an Episode of Care” under Intervention.

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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Pattern 7C: Impaired Integumentary Integrity
Associated With Partial-Thickness Skin Involvement and
Scar Formation

Inclusion

The following examples of examination findings may support the inclusion of clients in this
pattern:

Risk Factors or Consequences of Pathology/Pathophysiology (Disease, Disorder, or

Condition)

 Amputation
 Burns (partial thickness/second degree)
 Dermatologic disorders
 Epidermolysis bullosa
 Hematoma
 Immature scar
 Malnutrition
 Neoplasms (including Kaposi’s sarcoma)
 Neuropathic ulcers (grade 1)
 Pressure ulcers (stage 2)
 Prior scar
 Status post spinal cord injury
 Surgical wounds
 Toxic epidermal necrolysis
 Traumatic injury
 Vascular ulcers

o Arterial
o Diabetic
o Venous

Impairments of Body Functions and Structures, Activity Limitations, or Participation

Restrictions

 Impairments associated with abnormal fluid distribution

 Impaired sensation
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 Impaired skin
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 Muscle weakness

© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Exclusion or Multiple-Pattern Classification
The following examples of examination findings may support exclusion from this pattern or
classification into additional patterns. Depending on the level of severity or complexity of
the examination findings, the physical therapist may determine that the patient/client
would be more appropriately managed through (1) classification in an entirely different
pattern or (2) classification in both this and another pattern.

Findings That May Require Classification in a Different Pattern

 Electricity-related injuries
 Frostbite
 Multiple fractures
 Recent amputation

Findings That May Require Classification in Additional Patterns

 Spinal cord injury

Examination

Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Tests and Measures for Pattern 7C

Tests and measures for this pattern may include those that characterize or quantify:

 Anthropometric Characteristics
 Assistive Technology
 Balance
 Circulation (Arterial, Venous, Lymphatic)
 Community, Social, and Civic Life
 Cranial and Peripheral Nerve Integrity
 Education Life
 Gait
 Integumentary Integrity
 Mobility (Including Locomotion)
 Muscle Performance (Including Strength, Power, Endurance, and Length)
Pain
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
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 Range of Motion

© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

  Self-Care and Domestic Life
 Sensory Integrity
 Work Life

Evaluation, Diagnosis, Prognosis (Including Plan of Care)

Read Principles of Physical Therapist Patient and Client Management.

Factors That May Require New Episode of Care or That May Modify Frequency of
Visits/Duration of Care:

 Accessibility and availability of resources

 Adherence to the intervention program
 Age
 Anatomical and physiological changes related to growth and development
 Caregiver consistency or expertise
 Chronicity or severity of the current condition
 Comorbidities, complications, or secondary impairments
 Concurrent medical, surgical, and therapeutic interventions
 Level of impairment of body functions and structures
 Level of independence in activity and participation
 Living environment
 Mental status
 Multisite or multisystem involvement
 Nutritional status
 Overall health status
 Potential destinations at conclusion of care
 Premorbid conditions
 Probability of prolonged impairment of body functions and structures and
probability of activity limitations and participation restrictions
 Psychological and socioeconomic factors
 Psychomotor abilities
 Social support
 Stability of the condition
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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Intervention
Read Intervention.

The categories of interventions for this pattern are:

 Patient or Client Instruction

 Functional Training in Self-Care and in Domestic, Education, Work, Community,
Social, and Civic Life
 Integumentary Repair and Protection Techniques
 Manual Therapy Techniques
 Motor Function Training
 Therapeutic Exercise

Reexamination
Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Outcomes for Patients or Clients

Read Measurement and Outcomes.

Concluding an Episode of Care

Read “Criteria for Concluding an Episode of Care” under Intervention.

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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Pattern 7D: Impaired Integumentary Integrity
Associated With Full-Thickness Skin Involvement and
Scar Formation

Inclusion

The following examples of examination findings may support the inclusion of clients in this
pattern:

Risk Factors or Consequences of Pathology/Pathophysiology (Disease, Disorder, or

Condition)

 Abscess
 Amputation
 Burns
 Frostbite
 Hematoma
 Immature, hypertrophic, or keloid scar
 Lymphostatic ulcer
 Malnutrition
 Neoplasm
 Neuropathic ulcers (grade 2)
 Pressure ulcers (stage 3)
 Prior scar
 Surgical wounds
 Toxic epidermal necrolysis
 Vascular ulcers
o Arterial
o Diabetic
o Venous

Impairments of Body Functions and Structures, Activity Limitations, or Participation

Restrictions

 Impairments associated with abnormal fluid distribution

 Impaired sensation
 Impaired skin
 Muscle weakness
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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Exclusion or Multiple-Pattern Classification
The following examples of examination findings may support exclusion from this pattern or
classification into additional patterns. Depending on the level of severity or complexity of
the examination findings, the physical therapist may determine that the patient/client
would be more appropriately managed through (1) classification in an entirely different
pattern or (2) classification in both this and another pattern.

Findings That May Require Classification in a Different Pattern

 Crushing injury
 Electricity related injury
 Lymphedema
 Recent amputation

Findings That May Require Classification in Additional Patterns

 Diabetic neuropathy

Examination

Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Tests and Measures for Pattern 7D

Tests and measures for this pattern may include those that characterize or quantify:

 Anthropometric Characteristics
 Assistive Technology
 Balance
 Circulation (Arterial, Venous, Lymphatic)
 Community, Social, and Civic Life
 Cranial and Peripheral Nerve Integrity
 Education Life
 Gait
 Integumentary Integrity
 Mobility (Including Locomotion)
 Muscle Performance (Including Strength, Power, Endurance, and Length)
 Pain
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 Range of Motion
 Sensory Integrity
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 Work Life

© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Evaluation, Diagnosis, Prognosis (Including Plan of Care)
Read Principles of Physical Therapist Patient and Client Management.

Factors That May Require New Episode of Care or That May Modify Frequency of
Visits/Duration of Care:

 Accessibility and availability of resources

 Adherence to the intervention program
 Age
 Anatomical and physiological changes related to growth and development
 Caregiver consistency or expertise
 Chronicity or severity of the current condition
 Comorbidities, complications, or secondary impairments
 Concurrent medical, surgical, and therapeutic interventions
 Level of impairment of body functions and structures
 Level of independence in activity and participation
 Living environment
 Mental status
 Multisite or multisystem involvement
 Nutritional status
 Overall health status
 Potential destinations at conclusion of care
 Premorbid conditions
 Probability of prolonged impairment of body functions and structures and
probability of activity limitations and participation restrictions
 Psychological and socioeconomic factors
 Psychomotor abilities
 Social support
 Stability of the condition

Intervention
Read Intervention.

The categories of interventions for this pattern are:

 Patient or Client Instruction

 Functional Training in Self-Care and in Domestic, Education, Work, Community,
Social, and Civic Life
 Integumentary Repair and Protection Techniques
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 Manual Therapy Techniques

 Motor Function Training
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 Therapeutic Exercise

© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Reexamination
Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Outcomes for Patients or Clients

Read Measurement and Outcomes.

Concluding an Episode of Care

Read “Criteria for Concluding an Episode of Care” under Intervention.

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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Pattern 7E: Impaired Integumentary Integrity
Associated With Skin Involvement Extending Into Fascia,
Muscle, or Bone and Scar Formation

Inclusion

The following examples of examination findings may support the inclusion of clients in this
pattern:

Risk Factors or Consequences of Pathology/Pathophysiology (Disease, Disorder, or

Condition)

 Abscess
 Burns
 Chronic surgical wound
 Electrical burns
 Frostbite
 Hematoma
 Kaposi’s sarcoma
 Lymphostatic ulcer
 Necrotizing fasciitis
 Neoplasm
 Neuropathic ulcers (grades 3, 4, 5)
 Pressure ulcers (stage 4)
 Recent amputation
 Subcutaneous arterial ulcer
 Surgical wounds
 Vascular ulcers

o Diabetic
o Venous

Impairments of Body Functions and Structures, Activity Limitations, or Participation

Restrictions

 Impaired joint integrity

 Impaired sensation
 Impaired skin
Impairments associated with abnormal fluid distribution
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
 Muscle weakness
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 Decreased range of motion

© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Exclusion or Multiple-Pattern Classification
The following examples of examination findings may support exclusion from this pattern or
classification into additional patterns. Depending on the level of severity or complexity of
the examination findings, the physical therapist may determine that the patient/client
would be more appropriately managed through (1) classification in an entirely different
pattern or (2) classification in both this and another pattern.

Findings That May Require Classification in a Different Pattern

 Impairments associated with lymphedema

Findings That May Require Classification in Additional Patterns

 Impairments associated with diabetes

Examination
Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Tests and Measures for Pattern 7E

Tests and measures for this pattern may include those that characterize or quantify:

 Anthropometric Characteristics
 Assistive Technology
 Balance
 Circulation (Arterial, Venous, Lymphatic)
 Community, Social, and Civic Life
 Cranial and Peripheral Nerve Integrity
 Education Life
 Gait
 Integumentary Integrity
 Mental Functions
 Mobility (Including Locomotion)
 Muscle Performance (Including Strength, Power, Endurance, and Length)
 Pain
 Posture
 Range of Motion
 Self-Care and Domestic Life
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 Sensory Integrity
 Skeletal Integrity
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 Work Life

© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

Evaluation, Diagnosis, Prognosis (Including Plan of Care)

Read Principles of Physical Therapist Patient and Client Management.

Factors That May Require New Episode of Care or That May Modify Frequency of
Visits/Duration of Care:

 Accessibility and availability of resources

 Adherence to the intervention program
 Age
 Anatomical and physiological changes related to growth and development
 Caregiver consistency or expertise
 Chronicity or severity of the current condition
 Comorbidities, complications, or secondary impairments
 Concurrent medical, surgical, and therapeutic interventions
 Level of impairment of body functions and structures
 Level of independence in activity and participation
 Living environment
 Mental status
 Multisite or multisystem involvement
 Nutritional status
 Overall health status
 Potential destinations at conclusion of care
 Premorbid conditions
 Probability of prolonged impairment of body functions and structures and
probability of activity limitations and participation restrictions
 Psychological and socioeconomic factors
 Psychomotor abilities
 Social support
 Stability of the condition

Intervention
Read Intervention.

The categories of interventions for this pattern are:

 Patient or Client Instruction

 Functional Training in Self-Care and in Domestic, Education, Work, Community,
18

Social, and Civic Life

Page

 Integumentary Repair and Protection Techniques

© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION

  Manual Therapy Techniques
 Motor Function Training
 Therapeutic Exercise

Reexamination
Read Physical Therapist Examination and Evaluation: Focus on Tests and Measures.

Outcomes for Patients or Clients

Read Measurement and Outcomes.

Concluding an Episode of Care

Read “Criteria for Concluding an Episode of Care” under Intervention.

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© 2014 AMERICAN PHYSICAL THERAPY ASSOCIATION