Stroke: Physiotherapy Assessment: Difference between revisions
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Revision as of 22:16, 4 May 2017
Original Editor - Naomi O'Reilly
Top Contributors - Naomi O'Reilly, Kim Jackson, Simisola Ajeyalemi, Vidya Acharya, WikiSysop, Adam Vallely Farrell, Rucha Gadgil and Amrita Patro
Introduction[edit | edit source]
According to Ryerson (2008)[1]assessment in neurological physiotherapy is a process of collecting information about disordered movement patterns, underlying impairments, activity restrictions, and societal participation for the purpose of intervention planning. While Bernhardt & Hill (2005)[2] outline that the purpose of assessment is to help the therapist determine the best intervention. Assessment is arguably the most important step in the rehabilitation process, as our clinical reasoning is based on the information it provides and provides the basis for our decision making throughout the rehabilitation process. Johnson & Thompson (1996) outlined that treatment can only be as good as the assessment on which it was based. So in order for us to progress and manage our treatment plan and ensure we are identifying out patients problems assessment should be an ongoing and continuous, and should allow us toindividualised, patient-centred goals and ultimately a tailor-made treatment plan for the individual.
Database[edit | edit source]
History of Present Condition
[edit | edit source]
- Date of Onset of Signs & Symptoms
- Progression of the Condition
- Medical Management
- Medical Observations
- Other Management
- Previous Therapy
- Results of Specific Investigations
Blood Tests
X-Rays
CT Scans
MRI Scans
Past Medical History
[edit | edit source]
- Co-morbidities
Consider the impact they may have on treatment and management - Previous Neurological Conditions
Transient Ischemic Attacks - Special Equipment
Suction Units
Special Seating
Gait Aids - Technology Dependency
Nasal Gastric Tube
Home Oxygen
Pacemaker - Previous Surgery
Abdominal Surgery
Joint Replacements - Risk Factors Related to further Neurological Incident
Hypertension
High Cholesterol
Diabetes Mellitus
Atrial Fibrillation - Medication History
Recognise any contraindications for Physiotherapy Treatment e.g. Timeframe to treat post Thrombolysis
Impact of Related Side Effects on Treatment e.g. Dantrolene can cause Nausea
Subjective[edit | edit source]
The subjective assessment is used to provide a detailed picture of how the present condition affects the patient. Always consider your verbal and non-verbal communication as this will influence your interaction, as will thh environment and your position in relation to the patient. Understanding what the patient was able to do pre-stroke is vital in order to guide your objective assessment, set appropriate, realistic goals to guide treatment and maintain patient motivation.[3]
Social History[edit | edit source]
- Social Situation
- Family Support
- Accommodation
- Social Service Support
Activity[edit | edit source]
- Normal Daily Routine
- Employment
- Leisure Activities
Mobility[edit | edit source]
- General
- Indoor
- Outdoor
- Steps & Stairs
- Falls
Personal Care[edit | edit source]
- Washing
- Dressing
- Continence
Other[edit | edit source]
- Vision
Do they wear glasses?
What do they wear them for? e.g Reading, Driving - Hearing
Do they wear a Hearing Aid?
Are they wearing it?
Is it Switched On / Working - Communication
Do they have difficulty expressing themselves or understanding your requests? - Swallowing
Do they have difficulty swallowing?
Do they cough or choke after eating or drinking? - Fatigue
Do they tire quickly? - Pain
- Perceptions of own Problems/Main Concern
- Expectations of Treatment
Objective[edit | edit source]
Posture and Balance[edit | edit source]
- Alignment
- Neglect
- Sitting Balance
- Standing Balance
Voluntary Movement[edit | edit source]
- Range of Movement
- Strength
- Endurance
- Coordination
Finger to Nose Test
Heel to Shin Test
Rapidly Alternating Movement
Involuntary Movement[edit | edit source]
- Tremor
- Clonus
- Chorea
- Associated Reactions
Tone[edit | edit source]
- Decreased
Flaccid - Increased
Spasticity
Rigidity (Cogwheel or Lead Pipe)
Reflexes[edit | edit source]
- Deep Tendon Reflexes
Biceps (C5/6)
Triceps (C7/8)
Knee (L3/4)
Ankle (S1/2) - Plantar Reflex (Babinski’s Sign)
- Hofmanns Reflex
Sensory[edit | edit source]
- Light Touch
- Pin Prick
- Two Point Discrimination
- Vibration Sense
- Proprioception
- Temperature
- Vision and Hearing
Functional Activities[edit | edit source]
- Bed Mobility
- Transfers
- Sitting Balance
- Standing Balance
- Upper Limb Function
- Lower Limb Function
- Mobility
- Stairs
Gait[edit | edit source]
- Pattern
- Distance
- Velocity
- Use of Walking Aids
- Orthotics
- Assistance
- Cognitive Status
- Attention
- Orientation
- Memory
Summary[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Ryerson S, Neurological Assessment: The Basis of Clinical Decision Making. In: Lennon S, Stokes M, editors. Pocketbook of Neurological Physiotherapy. Elsevier Health Sciences; 2008 Oct 10.
- ↑ Bernhardt J, Hill K. We Only Treat What It Occurs to us to Assess: The Importance of Knowledge-based Assessment. Science-based Rehabilitation: Theories into Practice. 2005:15-48.
- ↑ Jones K. Neurological Assessment: A Clinician's Guide. Elsevier Health Sciences; 2011 Nov 29.
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