Stroke: Physiotherapy Assessment

Original Editor - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson, Simisola Ajeyalemi, Vidya Acharya, Rucha Gadgil, Amrita Patro, WikiSysop and Adam Vallely Farrell  

Introduction

According to Ryerson (2008) 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) 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

Reviewing the patients medical chart and leasing with the medical team forms the initial element of any patient assessment, providing background data about the patient to assist us to determine if the patient is medically stable and ready for physiotherapy intervention.

Presenting Condition

• Diagnosis
  Type of Stroke e.g Ischemic or Haemorrhagic
  Location of Stroke e.g. Right of Left Hemisphere, MCA, PCA etc. 

History of Present Condition

• Date of Onset of Signs & Symptoms
  When did initial symptoms appear, where they sudden or did they come on gradually. This can have a bearing on what type of Medical Treatment options may be available to the patient.
• Progression of the Condition
  Look for changes in the initial symptoms, which may provide some information about the behavior of the condition and some prediction of prognosis e.g. has there been a change in the NIHSS Scale since addmission? Following treatment?
• Medical Management
  How has the condition been managed by the medical team? Did they require neurosurgery or other medical interventions?
• Medical Observations
  Provides information on how medically stable the patient is and on their suitability for assessment
• Other Management
  What other management is in place for the patient that your assessment may need to be scheduled around e.g. Nutritional and Feeding needs - if patient has not got adequate intake this could affect your assessment 
• Previous Therapy
  Has the pateint previously been involved in Physiotherapy? What are their expectations of physiotherapy?
• Results of Specific Investigations
  Results of these investigations assis us in having an overall understanding of the patients condition and provide us with specific information which allow us to predict the signs and symptoms that are likely to be present and assist us in planning our objective assessment e.g. in a cerebellar artery infarct we would expect our patient to have ataxia and therefore need to ensure our objective assessment caters for this. Please click on the links to find out more detailed information about these types of investigations.
  CT Scans
  MRI Scans 
  Blood Tests 
  X-Rays
  

Past Medical History 

• 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

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. 

Social History

• Social Situation
• Family Support
• Accommodation
• Social Service Support

Activity

• Normal Daily Routine
• Employment
• Leisure Activities

Mobility

• General
• Indoor
• Outdoor
• Steps & Stairs
• Falls

Personal Care

• Washing
• Dressing
• Continence

Other

• 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

Posture and Balance

• Alignment
• Neglect
• Sitting Balance
• Standing Balance
  

Voluntary Movement

• Range of Movement
• Strength
• Endurance
• Coordination
  Finger to Nose Test
  Heel to Shin Test
  Dysdiadochokinesia (Rapidly Alternating Movement)

Involuntary Movement

• Tremor
• Clonus
• Chorea
• Associated Reactions

Tone

• Decreased
  Flaccid
• Increased
  Spasticity
  Rigidity (Cogwheel or Lead Pipe)

Reflexes

• Deep Tendon Reflexes
  Biceps (C5/6)
  Triceps (C7/8)
  Knee (L3/4)
  Ankle (S1/2)
• Plantar Reflex (Babinski’s Sign)
• Hofmanns Reflex

Sensory

• Light Touch
• Pin Prick
• Two Point Discrimination
• Vibration Sense
• Proprioception
• Temperature
• Vision
  Vision plays an important role in balance and movement, therefore any deficits may have a huge impact on functional activities. As many as 40% of individuals with Stroke will present with visual deficits post-Stroke.
  Eyesight in the Older Person
• Hearing
  Hearing in the Older Person

Functional Activities

• Bed Mobility
• Transfers
• Sitting Balance
• Standing Balance
• Upper Limb Function
• Lower Limb Function
• Mobility
• Stairs

Gait

• Pattern
• Distance
• Velocity
• Use of Walking Aids
• Orthotics
• Assistance
• Cognitive Status
• Attention
• Orientation
• Memory
  

Video

Summary

Recent Related Research (from Pubmed)

References

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