Neurological Assessment: Difference between revisions

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<div class="editorbox"> '''Original Editor '''- [[User:User Name|Kim Jackson]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
<div class="editorbox"> '''Original Editor '''- [[User:User Name|Kim Jackson]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Introduction  ==
== Introduction  ==
In order to provide the best care and plan the best treatment a thorough assessment must be undertaken.  It is the most important step in the rehabilitation process, helps to guide our clinical reasoning and decision when making informed decisions about the rehabilitation process. Johnson &amp; Thompson (1996) outlined that treatment can only be as good as the assessment on which it was based<ref>Johnson J, Thompson AJ. Rehabilitation in a neuroscience centre: the role of expert assessment and selection. British Journal of Therapy and Rehabilitation. 1996 Jun;3(6):303-8.</ref>. So in order for us to progress and manage our treatment plan and ensure we are identifying out patients problems the assessment should be an ongoing and continuous process.  A neurological assessment focuses on the nervous system to assess and identify any abnormalities that affect function and activities of daily living. It should allow us to create individual, patient-centred goals and ultimately a tailor-made treatment plan based on the client's needs.  
In order to provide the best care and plan the best treatment a thorough assessment must be undertaken.  It is the most important step in the rehabilitation process, helps to guide our clinical reasoning and [[Decision Making Toolkits|decision]] when making informed decisions about the rehabilitation process. '''Johnson &amp; Thompson (1996)''' outlined that treatment can only be as good as the assessment on which it was based<ref>Johnson J, Thompson AJ. [https://www.semanticscholar.org/paper/Rehabilitation-in-a-neuroscience-centre%3A-the-role-Johnson-Thompson/d47fac1468baa44be9ee302b38cf7571b5208acf Rehabilitation in a neuroscience centre: the role of expert assessment and selection.] British Journal of Therapy and Rehabilitation. 1996 Jun;3(6):303-8.</ref>. So in order for us to progress and manage our treatment plan and ensure we are identifying out patients problems the assessment should be an ongoing and continuous process.  A neurological assessment focuses on the nervous system to assess and identify any abnormalities that affect function and activities of daily living. It should allow us to create individual, patient-centred goals and ultimately a tailor-made treatment plan based on the client's needs.  


== Database ==
So for the proper neurological assessment, we can use a [[SOAP Notes|SOAP]] format as a guide. Below we have a systematic flow for the assessment of the neurological patient.


=== History of Present Condition  ===
== Subjective Assessment ==
The subjective assessment is used to provide a detailed picture of how the present condition affects the patient.&nbsp;<ref>O'Sullivan SB, Schmitz TJ, Fulk G. [https://hsrc.himmelfarb.gwu.edu/books/85/ Physical rehabilitation.]F6th Edition.A Davis; 2019 Jan 25.</ref>


*Progression of the Condition
=== Demographic Data ===
*Date of Onset of Signs &amp; Symptoms
Name, Age, Gender, Occupation, Dominant hand, Address.<ref>Neurological Physiotherapy Evaluation Form. Available from: https://fac.ksu.edu.sa/sites/default/files/neurological_physiotherapy_evaluation_form_2_0.pdf. Lasted accessed: 4.3.2021</ref>
*Medical Management
 
*Medical Observations
=== Chief Complain ===
*Other management
What is his/her present complaint or problem for which he/she has visited you?
*Previous Therapy
 
*Results of Specific Investigations (X-rays, CT Scans, Blood Tests)
=== History of Present Condition ===
*Progression of the Condition.
*Date of Onset of Signs &amp; Symptoms.
*Medical Management.
*Medical Observations.
*Other management.
*Previous Therapy.
*Results of Specific Investigations ([[X-Rays|X-ray]]<nowiki/>s, [[CT Scans]], [[Blood Tests]].....etc


=== Past Medical History&nbsp;  ===
=== Past Medical History&nbsp;  ===


*Co-morbidities and other non-related conditions
*Co-morbidities and other non-related conditions.
*Special Equipment, Technology Dependency
*Special Equipment, Technology Dependency.
*Previous Surgery
*Previous Surgery.
*Medication History
*Medication History.
*History of any allergies.


== Subjective Assessment  ==
=== Personal History ===
Marital status, occupation,


The subjective assessment is used to provide a detailed picture of how the present condition affects the patient.&nbsp;
Activity
*Normal Daily Routine.
*Employment.
*Leisure Activities.
*Smoking and drinking habits.
Mobility
*General
*Indoor
*Outdoor
*Steps &&nbsp;Stairs
*[[Falls]]
Personal Care
*Washing
*Continence
*Dressing
Other
*Vision.
*Hearing.
*Swallowing.
*Fatigue.
*[[Pain Assessment|Pain.]]
*Perceptions of own Problems/Main Concern.
*Expectations of Treatment.


=== Social History ===
=== Family History ===
Total number of family members, his/her primary caretaker.


*Social Situation
=== Socioeconomic History ===
* Family income source
* Relationship with community people
* Social Situation
*Family Support
*Family Support
*Accommodation
*Accommodation
*Social Service Support
*Social Service Support


=== Activity ===
== Objective Assessment ==
 
=== On Observation  ===
# Built.
# [[Gait|Gait.]]
# Pattern of Movement.
# Mode of Ventilation.
# Type/ Pattern of Respiration
# [[Oedema Assessment|Oedema]]
# Muscle Wasting
# [[Pressure Ulcers|Pressure Sores]]
# Deformity
# [[Wound Assessment|Wounds]]
# External Appliances
# Involuntary Movement
#*[[Tremor]]
#*Clonus
#*[[Chorea]]
#*Associated Reactions
{{#ev:youtube|8pGGGMUObQ4}}<ref>Life Changing Surgery Halts Essential Tremors & Parkinson's Disease Symptoms. Available from: https://www.youtube.com/watch?v=8pGGGMUObQ4 Lasted accessed: 2021.4.3</ref>
 
# [[Posture]] and Balance
*Alignment and attitude of limbs
*Neglect
*Sitting [[Balance]]
*Standing Balance<br>
 
=== Vital Signs ===
[[Vital Signs|Vitals signs]] include
* [[Respiratory Assessment|Respiratory rate]]
* Temperature
* [[Pulse rate]]
* [[Blood Pressure|Blood pressure]]
* [[Oxygen|O2 saturation]]
 
=== On Examination ===


*Normal Daily Routine
==== Higher mental function ====
*Employment
*Leisure Activities


=== Mobility ===
===== Level of consciousness: [[Glasgow Coma Scale|Glasgow coma scale (GCS)]] =====
{{#ev:youtube|h2SIN7Mn0YA}}<ref>Glasgow Coma Scale made easy. Available from: https://www.youtube.com/watch?v=h2SIN7Mn0YA. Lasted accessed: 2021.4.3</ref>
===== Communication: =====
Aphasia ( Broca's, Wernicke's, Global)


*General
===== Cognition: =====
*Indoor
* Orientation:
*Outdoor
** Person
*Steps &amp;&nbsp;Stairs
** Place
*Falls
** Time
* Calculation
* Registration
* Attention
* Proverb Interpretation
* Memory
** Immediate
** Recent
** Remote
** Verbal
** Visual
* Language
* Visuospatial proficiency
There are various outcome tools via which we can address his/her cognitive status incorporating various components.<ref>Cognition. Stroke engine. Available from:https://strokengine.ca/en/assessments-by-topic/#assess-cog Lasted accessed: 2021.4.3</ref>
* [[Mini-Mental State Examination|Mini-mental Status Examination]]
* [[Mini-Cog]]
* [[Montreal Cognitive Assessment (MoCA)]]
 
===== Perception: =====
* Body Scheme/ Body Imaging
* [[Unilateral neglect|Neglect]]
* [[Agnosia]]
* [[Apraxia]]<ref>[https://www.researchgate.net/publication/348150797_PHYSIOTHERAPY_EVALUATION_IN_NEUROLOGICAL_PATIENTS PHYSIOTHERAPY EVALUATION IN NEUROLOGICAL PATIENTS.] Ozden Gokcek and Esra Dogru Huzmeli. Hatay Mustafa Kemal University Health Science Faculty, Physiotherapy and Rehabilitation Department,Hatay, Turkey</ref>
Common tools to assess perceptual problems  are:
* Star Cancellation Test.
* Line Bisection Test.
* Clock Drawing Test.
 
==== [[Cranial Nerves|Cranial nerve (CN) examination]] ====
{{#ev:youtube|sJBpai74tlU}}<ref>greeky Medics. Cranial Nerve Examination - OSCE Guide (New Version). Available from: https://www.youtube.com/watch?v=sJBpai74tlU. Lasted Accessed: 2021.4.3</ref>
 
==== Sensory examination ====
 
===== Superficial [[Sensation|Sensation]] =====
* Pain
* Temperature
* Touch
* Pressure
 
===== Deep Sensation =====
* Movement Sense
* [[Proprioception|Position Sense]]
* Vibration Sense
 
===== Cortical Sensation =====
* Tactile Localization
* [[Weber Two-Point Discrimination Test|2 point discrimination]]
* Stereognosis
* Barognosis
* Graphesthesia
* Texture Recognition
* Double Simultaneous Stimulation
 
==== Motor examination  ====
{{#ev:youtube|5ob5uJMgZOs}}<ref>UBC Medicine - Educational Media. UBC Medicine Neurology Clinical Skills - Motor, Sensory, and Reflex ExaminationAvailable from: https://www.youtube.com/watch?v=5ob5uJMgZOs Lasted accessed: 2021.4.3</ref>
===== Tone =====
*Decreased / Flaccid
*Increased<br>[[Spasticity]] (Clasp-knife)<br>[[Rigidity]] (Cogwheel or Lead Pipe)
*Outcome tools- [[Modified Ashworth Scale|Modified Modified Ashworth Scale (MMAS)]] and [[Tardieu Scale]]
 
===== [[Range of Motion]] =====
 
===== Strength =====
[[Muscle Strength Testing|Manual Muscle Testing (MMT)]] or [[Myotomes]] can be used.
 
===== Endurance =====
* Muscular
* Cardiovascular
 
===== Reflexes =====
*Deep Tendon [[Reflexes]]<br>Biceps (C5/6)<br>Triceps (C7/8)<br>Knee (L3/4)<br>Ankle (S1/2)
*Plantar Response ([[Babinski Sign|Babinski’s Sign]])
{{#ev:youtube|vkM-xX7KRR4}}<ref>How to test the Neurological Babinski Reflex for Upper Motor Neurone Lesion. Available from: https://www.youtube.com/watch?v=vkM-xX7KRR4. lasted accessed: 2021.4.3</ref>
 
===== Tightness/ [[Muscle Length Assessment and Treatment Related to Patellofemoral Pain|Muscle Length Testing]] =====


=== Personal Care ===
===== [[Leg Length Discrepancy|Limb length measurement]] =====


*Washing
===== [[Girth Measurement|Limb girth measurement]] =====
*Continence
*Dressing


=== Other ===
==== [[Balance]] (Static and Dynamic) ====
Outcome tools: [[Berg Balance Scale|Berg balance scale,]] [[Timed Up and Go Test (TUG)|Timed up and go test (TUG)]], [[Balance Evaluation Systems Test (BESTest)|BESTest]]


*Vision
==== Coordination ====
*Hearing
* Equilibrium
*Swallowing
* Non-equilibrium
*Fatigue
* [[Romberg Test|Romberg's test]]
*Pain
*Perceptions of own Problems/Main Concern
*Expectations of Treatment


== Objective Assessment ==
==== [[Gait]] ====
* Step Length
* Stride Length
* Base width
* Cadence
* Biomechanical Deviations


=== Posture and Balance  ===
=== Areas of Occupation<ref>https://pdfcoffee.com/ot-spackman-occupational-therapy-11thpdf-pdf-free.html</ref> ===


*Alignment
* Basic Activity of Daily Living (''feeding, dressing, bathing, grooming'')
*Neglect
* Instrumental Activity of Daily Living (''Mobility, Budgeting, cooking, cleaning, shopping'')
*Sitting Balance
* Education/ Work (Employment, Academics)
*Standing Balance<br>
* Play/Leisure Activities
* Social Participation (social interaction, community integration)
* Rest/Sleep (sleep hygiene, routine)


=== Voluntary Movement  ===
=== Client Factors ===


*Range of Movement
* Values (choices, actions, priorities)
*Strength
* Beliefs (cultural, religious perspectives)
*Endurance
* Spirituality
*Coordination&nbsp;<br>Finger to Nose Test<br>Heel to Shin Test<br>Rapidly Alternating Movement


=== Involuntary Movement  ===
=== Performance Patterns ===


*Tremor
* Habits
*Clonus
* Roles
*Chorea
* Routine/Rituals
*Associated Reactions


=== Tone  ===
==== Other System review ====
* '''Integumentary system:''' Skin Status, [[Pressure Ulcers|Pressure Sores]]
* '''Respiratory system:''' RS Status, Secretions, Pattern of breathing, Chest wall/[[Thoracic Anatomy|Thoracic spine]] deformity
* '''Cardiovascular system:''' Status: [[Deep Vein Thrombosis]]
* '''Musculoskeletal system:''' Contractures, Subluxations, [[Joint Range of Motion During Gait|Joint]] mobility, Other pathology
* '''Bowel and bladder function:''' [[Urinary Incontinence]]
* '''Gastrointestinal system:''' Status
* '''Autonomic system:''' Vasomotor,Pseudomotor, Trophic Changes, [[Orthostatic Hypotension|Postural Hypotension]], [[Complex Regional Pain Syndrome (CRPS)|Reflex Sympathetic Dystrophy]]


*Decreased / Flaccid
==== Functional Assessment ====
*Increased<br>Spasticity (Clasp-knife)<br>Rigidity (Cogwheel or Lead Pipe)
* [[Functional Independence Measure (FIM)|Functional Independence Measure]]
* [[Barthel Index|Modified Barthel Index]]
* [http://blogs.elon.edu/ptkids/files/2012/03/COPM.pdf Canadian Occupational Performance Measure]
* [https://strokengine.ca/en/assessments/assessment-of-motor-and-process-skills-amps/ Assessment of Motor and Process Skills]
* [https://pdf4pro.com/amp/cdn/the-role-checklist-moho-uic-edu-3fc721.pdf Role Checklist]
* [[Berg Balance Scale]]
* [https://health.utah.edu/sites/g/files/zrelqx131/files/files/migration/image/kels.pdf Kholman Evaluation of Living Skills]


=== Reflexes  ===
== Assessment ==


*Deep Tendon Reflexes<br>Biceps (C5/6)<br>Triceps (C7/8)<br>Knee (L3/4)<br>Ankle (S1/2)
=== Problem List ===
*Plantar Response (Babinski’s Sign)
Problem list can be generated from [[International Classification of Functioning, Disability and Health (ICF)|International Classification of Function, Disability, and Health (ICF).]]
{| width="100%" cellspacing="1" cellpadding="1"
|-
| {{#ev:youtube|kFkRa17hlVc|412}}
|}


=== Sensory  ===
=== Physiotherapy Diagnosis/Functional Diagnosis ===


*Light Touch
== Plan ==
*Pin Prick
=== [[Goal Setting in Rehabilitation|Goal Setting]] ===
*Two Point Discrimination
* Short term goal
*Vibration Sense
* Long term goal
*Joint Position Sense
*Temperature
*Vision and Hearing


=== Functional Activities ===
=== Treatment ===


*Bed Mobility
== Re-assessment == 
*Sitting Balance
*Transfers
*Upper Limb Function
*Mobility
*Stairs


=== Gait ===
Re-assessment includes re-testing objective measures such as outcome tools after a certain period of intervention. It helps to know the progression of the patient and in the determination of time to achieve the goal set. In re-assessment, it is very necessary to assess both facilitators and barriers for a better outcome. it is vital to let the patient, patient party, and other health professionals know about the result of the re-assessment and compare it with previous assessment results. It helps to plan further in treatment strategies.


*Pattern
==References==
*Distance
<references />
*Velocity
*Use of Walking Aids
*Orthoses
*Assistance
*Cognitive Status
*Attention
*Orientation
*Memory


[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Neurological - Assessment and Examination]]
[[Category:Neurological - Assessment and Examination]]

Latest revision as of 21:41, 5 October 2023

Original Editor - Kim Jackson Top Contributors - Manisha Shrestha, Kim Jackson, Shaimaa Eldib, Kirenga Bamurange Liliane, Admin, Rucha Gadgil and Kanzaa Rahim

Introduction[edit | edit source]

In order to provide the best care and plan the best treatment a thorough assessment must be undertaken. It is the most important step in the rehabilitation process, helps to guide our clinical reasoning and decision when making informed decisions about the rehabilitation process. Johnson & Thompson (1996) outlined that treatment can only be as good as the assessment on which it was based[1]. So in order for us to progress and manage our treatment plan and ensure we are identifying out patients problems the assessment should be an ongoing and continuous process. A neurological assessment focuses on the nervous system to assess and identify any abnormalities that affect function and activities of daily living. It should allow us to create individual, patient-centred goals and ultimately a tailor-made treatment plan based on the client's needs.

So for the proper neurological assessment, we can use a SOAP format as a guide. Below we have a systematic flow for the assessment of the neurological patient.

Subjective Assessment[edit | edit source]

The subjective assessment is used to provide a detailed picture of how the present condition affects the patient. [2]

Demographic Data[edit | edit source]

Name, Age, Gender, Occupation, Dominant hand, Address.[3]

Chief Complain[edit | edit source]

What is his/her present complaint or problem for which he/she has visited you?

History of Present Condition[edit | edit source]

  • Progression of the Condition.
  • Date of Onset of Signs & Symptoms.
  • Medical Management.
  • Medical Observations.
  • Other management.
  • Previous Therapy.
  • Results of Specific Investigations (X-rays, CT Scans, Blood Tests.....etc

Past Medical History [edit | edit source]

  • Co-morbidities and other non-related conditions.
  • Special Equipment, Technology Dependency.
  • Previous Surgery.
  • Medication History.
  • History of any allergies.

Personal History[edit | edit source]

Marital status, occupation,

Activity

  • Normal Daily Routine.
  • Employment.
  • Leisure Activities.
  • Smoking and drinking habits.

Mobility

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

Personal Care

  • Washing
  • Continence
  • Dressing

Other

  • Vision.
  • Hearing.
  • Swallowing.
  • Fatigue.
  • Pain.
  • Perceptions of own Problems/Main Concern.
  • Expectations of Treatment.

Family History[edit | edit source]

Total number of family members, his/her primary caretaker.

Socioeconomic History[edit | edit source]

  • Family income source
  • Relationship with community people
  • Social Situation
  • Family Support
  • Accommodation
  • Social Service Support

Objective Assessment[edit | edit source]

On Observation[edit | edit source]

  1. Built.
  2. Gait.
  3. Pattern of Movement.
  4. Mode of Ventilation.
  5. Type/ Pattern of Respiration
  6. Oedema
  7. Muscle Wasting
  8. Pressure Sores
  9. Deformity
  10. Wounds
  11. External Appliances
  12. Involuntary Movement

[4]

  1. Posture and Balance
  • Alignment and attitude of limbs
  • Neglect
  • Sitting Balance
  • Standing Balance

Vital Signs[edit | edit source]

Vitals signs include

On Examination[edit | edit source]

Higher mental function[edit | edit source]

Level of consciousness: Glasgow coma scale (GCS)[edit | edit source]

[5]

Communication:[edit | edit source]

Aphasia ( Broca's, Wernicke's, Global)

Cognition:[edit | edit source]
  • Orientation:
    • Person
    • Place
    • Time
  • Calculation
  • Registration
  • Attention
  • Proverb Interpretation
  • Memory
    • Immediate
    • Recent
    • Remote
    • Verbal
    • Visual
  • Language
  • Visuospatial proficiency

There are various outcome tools via which we can address his/her cognitive status incorporating various components.[6]

Perception:[edit | edit source]

Common tools to assess perceptual problems are:

  • Star Cancellation Test.
  • Line Bisection Test.
  • Clock Drawing Test.

Cranial nerve (CN) examination[edit | edit source]

[8]

Sensory examination[edit | edit source]

Superficial Sensation[edit | edit source]
  • Pain
  • Temperature
  • Touch
  • Pressure
Deep Sensation[edit | edit source]
Cortical Sensation[edit | edit source]
  • Tactile Localization
  • 2 point discrimination
  • Stereognosis
  • Barognosis
  • Graphesthesia
  • Texture Recognition
  • Double Simultaneous Stimulation

Motor examination[edit | edit source]

[9]

Tone[edit | edit source]
Range of Motion[edit | edit source]
Strength[edit | edit source]

Manual Muscle Testing (MMT) or Myotomes can be used.

Endurance[edit | edit source]
  • Muscular
  • Cardiovascular
Reflexes[edit | edit source]

[10]

Tightness/ Muscle Length Testing[edit | edit source]
Limb length measurement[edit | edit source]
Limb girth measurement[edit | edit source]

Balance (Static and Dynamic)[edit | edit source]

Outcome tools: Berg balance scale, Timed up and go test (TUG), BESTest

Coordination[edit | edit source]

Gait[edit | edit source]

  • Step Length
  • Stride Length
  • Base width
  • Cadence
  • Biomechanical Deviations

Areas of Occupation[11][edit | edit source]

  • Basic Activity of Daily Living (feeding, dressing, bathing, grooming)
  • Instrumental Activity of Daily Living (Mobility, Budgeting, cooking, cleaning, shopping)
  • Education/ Work (Employment, Academics)
  • Play/Leisure Activities
  • Social Participation (social interaction, community integration)
  • Rest/Sleep (sleep hygiene, routine)

Client Factors[edit | edit source]

  • Values (choices, actions, priorities)
  • Beliefs (cultural, religious perspectives)
  • Spirituality

Performance Patterns[edit | edit source]

  • Habits
  • Roles
  • Routine/Rituals

Other System review[edit | edit source]

Functional Assessment[edit | edit source]

Assessment[edit | edit source]

Problem List[edit | edit source]

Problem list can be generated from International Classification of Function, Disability, and Health (ICF).

Physiotherapy Diagnosis/Functional Diagnosis[edit | edit source]

Plan[edit | edit source]

Goal Setting[edit | edit source]

  • Short term goal
  • Long term goal

Treatment[edit | edit source]

Re-assessment[edit | edit source]

Re-assessment includes re-testing objective measures such as outcome tools after a certain period of intervention. It helps to know the progression of the patient and in the determination of time to achieve the goal set. In re-assessment, it is very necessary to assess both facilitators and barriers for a better outcome. it is vital to let the patient, patient party, and other health professionals know about the result of the re-assessment and compare it with previous assessment results. It helps to plan further in treatment strategies.

References[edit | edit source]

  1. ↑ Johnson J, Thompson AJ. Rehabilitation in a neuroscience centre: the role of expert assessment and selection. British Journal of Therapy and Rehabilitation. 1996 Jun;3(6):303-8.
  2. ↑ O'Sullivan SB, Schmitz TJ, Fulk G. Physical rehabilitation.F6th Edition.A Davis; 2019 Jan 25.
  3. ↑ Neurological Physiotherapy Evaluation Form. Available from: https://fac.ksu.edu.sa/sites/default/files/neurological_physiotherapy_evaluation_form_2_0.pdf. Lasted accessed: 4.3.2021
  4. ↑ Life Changing Surgery Halts Essential Tremors & Parkinson's Disease Symptoms. Available from: https://www.youtube.com/watch?v=8pGGGMUObQ4 Lasted accessed: 2021.4.3
  5. ↑ Glasgow Coma Scale made easy. Available from: https://www.youtube.com/watch?v=h2SIN7Mn0YA. Lasted accessed: 2021.4.3
  6. ↑ Cognition. Stroke engine. Available from:https://strokengine.ca/en/assessments-by-topic/#assess-cog Lasted accessed: 2021.4.3
  7. ↑ PHYSIOTHERAPY EVALUATION IN NEUROLOGICAL PATIENTS. Ozden Gokcek and Esra Dogru Huzmeli. Hatay Mustafa Kemal University Health Science Faculty, Physiotherapy and Rehabilitation Department,Hatay, Turkey
  8. ↑ greeky Medics. Cranial Nerve Examination - OSCE Guide (New Version). Available from: https://www.youtube.com/watch?v=sJBpai74tlU. Lasted Accessed: 2021.4.3
  9. ↑ UBC Medicine - Educational Media. UBC Medicine Neurology Clinical Skills - Motor, Sensory, and Reflex ExaminationAvailable from: https://www.youtube.com/watch?v=5ob5uJMgZOs Lasted accessed: 2021.4.3
  10. ↑ How to test the Neurological Babinski Reflex for Upper Motor Neurone Lesion. Available from: https://www.youtube.com/watch?v=vkM-xX7KRR4. lasted accessed: 2021.4.3
  11. ↑ https://pdfcoffee.com/ot-spackman-occupational-therapy-11thpdf-pdf-free.html
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