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 & 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. | 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 & 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. | ||
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. | 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. | ||
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=== Demographic Data === | === Demographic Data === | ||
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> | 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> | ||
=== Chief Complain === | === Chief Complain === | ||
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=== History of Present Condition === | === History of Present Condition === | ||
*Progression of the Condition | *Progression of the Condition. | ||
*Date of Onset of Signs & Symptoms | *Date of Onset of Signs & Symptoms. | ||
*Medical Management | *Medical Management. | ||
*Medical Observations | *Medical Observations. | ||
*Other management | *Other management. | ||
*Previous Therapy | *Previous Therapy. | ||
*Results of Specific Investigations (X- | *Results of Specific Investigations ([[X-Rays|X-ray]]<nowiki/>s, [[CT Scans]], [[Blood Tests]].....etc | ||
=== Past Medical History === | === Past Medical History === | ||
*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 | *History of any allergies. | ||
=== Personal History === | === Personal History === | ||
| Line 36: | Line 36: | ||
Activity | Activity | ||
*Normal Daily Routine | *Normal Daily Routine. | ||
*Employment | *Employment. | ||
*Leisure Activities | *Leisure Activities. | ||
*Smoking and drinking habits | *Smoking and drinking habits. | ||
Mobility | Mobility | ||
*General | *General | ||
*Indoor | *Indoor | ||
*Outdoor | *Outdoor | ||
*Steps & | *Steps & Stairs | ||
*Falls | *[[Falls]] | ||
Personal Care | Personal Care | ||
*Washing | *Washing | ||
| Line 51: | Line 51: | ||
*Dressing | *Dressing | ||
Other | Other | ||
*Vision | *Vision. | ||
*Hearing | *Hearing. | ||
*Swallowing | *Swallowing. | ||
*Fatigue | *Fatigue. | ||
*Pain | *[[Pain Assessment|Pain.]] | ||
*Perceptions of own Problems/Main Concern | *Perceptions of own Problems/Main Concern. | ||
*Expectations of Treatment | *Expectations of Treatment. | ||
=== Family History === | === Family History === | ||
Total number of family members, his/her primary caretaker | Total number of family members, his/her primary caretaker. | ||
=== Socioeconomic History === | === Socioeconomic History === | ||
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=== On Observation === | === On Observation === | ||
# Built | # Built. | ||
# Gait | # [[Gait|Gait.]] | ||
# Pattern of Movement | # Pattern of Movement. | ||
# Mode of Ventilation | # Mode of Ventilation. | ||
# Type/ Pattern of Respiration | # Type/ Pattern of Respiration | ||
# Oedema | # [[Oedema Assessment|Oedema]] | ||
# Muscle Wasting | # Muscle Wasting | ||
# Pressure Sores | # [[Pressure Ulcers|Pressure Sores]] | ||
# Deformity | # Deformity | ||
# Wounds | # [[Wound Assessment|Wounds]] | ||
# External Appliances | # External Appliances | ||
# Involuntary Movement | # Involuntary Movement | ||
#*Tremor | #*[[Tremor]] | ||
#*Clonus | #*Clonus | ||
#*Chorea | #*[[Chorea]] | ||
#*Associated Reactions | #*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> | {{#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 | # [[Posture]] and Balance | ||
*Alignment and attitude of limbs | *Alignment and attitude of limbs | ||
*Neglect | *Neglect | ||
*Sitting Balance | *Sitting [[Balance]] | ||
*Standing Balance<br> | *Standing Balance<br> | ||
=== Vital Signs === | === Vital Signs === | ||
[[Vital Signs|Vitals signs]] include | [[Vital Signs|Vitals signs]] include | ||
* Respiratory rate | * [[Respiratory Assessment|Respiratory rate]] | ||
* Temperature | * Temperature | ||
* Pulse rate | * [[Pulse rate]] | ||
* Blood pressure | * [[Blood Pressure|Blood pressure]] | ||
* O2 saturation | * [[Oxygen|O2 saturation]] | ||
=== On Examination === | === On Examination === | ||
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==== Higher mental function ==== | ==== Higher mental function ==== | ||
===== Level of consciousness: [[Glasgow Coma Scale| | ===== 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> | {{#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: ===== | ===== Communication: ===== | ||
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===== Cognition: ===== | ===== Cognition: ===== | ||
* Orientation: | * Orientation: | ||
** Person | ** Person | ||
** Place | ** Place | ||
** Time | ** Time | ||
* Calculation | * Calculation | ||
* Registration | * Registration | ||
* Attention | * Attention | ||
* Proverb Interpretation | * Proverb Interpretation | ||
* Memory | * Memory | ||
** Immediate | ** Immediate | ||
** Recent | ** Recent | ||
** Remote | ** Remote | ||
** Verbal | ** Verbal | ||
** Visual | ** Visual | ||
* Language | * Language | ||
* Visuospatial proficiency | * Visuospatial proficiency | ||
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* [[Mini-Mental State Examination|Mini-mental Status Examination]] | * [[Mini-Mental State Examination|Mini-mental Status Examination]] | ||
* [[Mini-Cog]] | * [[Mini-Cog]] | ||
* [[Montreal | * [[Montreal Cognitive Assessment (MoCA)]] | ||
===== Perception: ===== | ===== Perception: ===== | ||
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{{#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> | {{#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 | ===== Tightness/ [[Muscle Length Assessment and Treatment Related to Patellofemoral Pain|Muscle Length Testing]] ===== | ||
===== [[Leg Length Discrepancy|Limb length measurement]] ===== | ===== [[Leg Length Discrepancy|Limb length measurement]] ===== | ||
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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]] | 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]] | ||
==== | ==== Coordination ==== | ||
* Equilibrium | * Equilibrium | ||
* Non- | * Non-equilibrium | ||
* [[Romberg Test|Romberg's test]] | * [[Romberg Test|Romberg's test]] | ||
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* Cadence | * Cadence | ||
* Biomechanical Deviations | * Biomechanical Deviations | ||
=== Areas of Occupation<ref>https://pdfcoffee.com/ot-spackman-occupational-therapy-11thpdf-pdf-free.html</ref> === | |||
* 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 === | |||
* Values (choices, actions, priorities) | |||
* Beliefs (cultural, religious perspectives) | |||
* Spirituality | |||
=== Performance Patterns === | |||
* Habits | |||
* Roles | |||
* Routine/Rituals | |||
==== Other System review ==== | ==== Other System review ==== | ||
* '''Integumentary system:''' Skin Status, [[Pressure Ulcers|Pressure Sores]] | * '''Integumentary system:''' Skin Status, [[Pressure Ulcers|Pressure Sores]] | ||
* '''Respiratory system:''' RS Status, Secretions, Pattern of breathing, Chest wall/Thoracic spine deformity | * '''Respiratory system:''' RS Status, Secretions, Pattern of breathing, Chest wall/[[Thoracic Anatomy|Thoracic spine]] deformity | ||
* '''Cardiovascular system:''' Status: [[Deep Vein Thrombosis]] | * '''Cardiovascular system:''' Status: [[Deep Vein Thrombosis]] | ||
* '''Musculoskeletal system:''' Contractures, Subluxations, Joint mobility, Other pathology | * '''Musculoskeletal system:''' Contractures, Subluxations, [[Joint Range of Motion During Gait|Joint]] mobility, Other pathology | ||
* '''Bowel and bladder function:''' [[Incontinence]] | * '''Bowel and bladder function:''' [[Urinary Incontinence]] | ||
* '''Gastrointestinal system:''' Status | * '''Gastrointestinal system:''' Status | ||
* '''Autonomic system:''' Vasomotor,Pseudomotor, Trophic Changes, [[Orthostatic Hypotension|Postural Hypotension]], [[Complex Regional Pain Syndrome (CRPS)|Reflex Sympathetic Dystrophy]] | * '''Autonomic system:''' Vasomotor,Pseudomotor, Trophic Changes, [[Orthostatic Hypotension|Postural Hypotension]], [[Complex Regional Pain Syndrome (CRPS)|Reflex Sympathetic Dystrophy]] | ||
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* [[Functional Independence Measure (FIM)|Functional Independence Measure]] | * [[Functional Independence Measure (FIM)|Functional Independence Measure]] | ||
* [[Barthel Index|Modified Barthel Index]] | * [[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] | |||
== Assessment == | == Assessment == | ||
| Line 242: | Line 268: | ||
== Re-assessment == | == Re-assessment == | ||
Re-assessment includes | 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== | ==References== | ||
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]
- Built.
- Gait.
- Pattern of Movement.
- Mode of Ventilation.
- Type/ Pattern of Respiration
- Oedema
- Muscle Wasting
- Pressure Sores
- Deformity
- Wounds
- External Appliances
- Involuntary Movement
- Posture and Balance
- Alignment and attitude of limbs
- Neglect
- Sitting Balance
- Standing Balance
Vital Signs[edit | edit source]
Vitals signs include
- Respiratory rate
- Temperature
- Pulse rate
- Blood pressure
- O2 saturation
On Examination[edit | edit source]
Higher mental function[edit | edit source]
Level of consciousness: Glasgow coma scale (GCS)[edit | edit source]
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]
Sensory examination[edit | edit source]
Superficial Sensation[edit | edit source]
- Pain
- Temperature
- Touch
- Pressure
Deep Sensation[edit | edit source]
- Movement Sense
- Position Sense
- Vibration Sense
Cortical Sensation[edit | edit source]
- Tactile Localization
- 2 point discrimination
- Stereognosis
- Barognosis
- Graphesthesia
- Texture Recognition
- Double Simultaneous Stimulation
Motor examination[edit | edit source]
Tone[edit | edit source]
- Decreased / Flaccid
- Increased
Spasticity (Clasp-knife)
Rigidity (Cogwheel or Lead Pipe) - Outcome tools- Modified Modified Ashworth Scale (MMAS) and Tardieu Scale
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]
- Deep Tendon Reflexes
Biceps (C5/6)
Triceps (C7/8)
Knee (L3/4)
Ankle (S1/2) - Plantar Response (Babinski’s Sign)
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]
- Equilibrium
- Non-equilibrium
- Romberg's test
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]
- Integumentary system: Skin Status, Pressure Sores
- Respiratory system: RS Status, Secretions, Pattern of breathing, Chest wall/Thoracic spine deformity
- Cardiovascular system: Status: Deep Vein Thrombosis
- Musculoskeletal system: Contractures, Subluxations, Joint mobility, Other pathology
- Bowel and bladder function: Urinary Incontinence
- Gastrointestinal system: Status
- Autonomic system: Vasomotor,Pseudomotor, Trophic Changes, Postural Hypotension, Reflex Sympathetic Dystrophy
Functional Assessment[edit | edit source]
- Functional Independence Measure
- Modified Barthel Index
- Canadian Occupational Performance Measure
- Assessment of Motor and Process Skills
- Role Checklist
- Berg Balance Scale
- Kholman Evaluation of Living Skills
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]
- ↑ 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.
- ↑ O'Sullivan SB, Schmitz TJ, Fulk G. Physical rehabilitation.F6th Edition.A Davis; 2019 Jan 25.
- ↑ 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
- ↑ Life Changing Surgery Halts Essential Tremors & Parkinson's Disease Symptoms. Available from: https://www.youtube.com/watch?v=8pGGGMUObQ4 Lasted accessed: 2021.4.3
- ↑ Glasgow Coma Scale made easy. Available from: https://www.youtube.com/watch?v=h2SIN7Mn0YA. Lasted accessed: 2021.4.3
- ↑ Cognition. Stroke engine. Available from:https://strokengine.ca/en/assessments-by-topic/#assess-cog Lasted accessed: 2021.4.3
- ↑ PHYSIOTHERAPY EVALUATION IN NEUROLOGICAL PATIENTS. Ozden Gokcek and Esra Dogru Huzmeli. Hatay Mustafa Kemal University Health Science Faculty, Physiotherapy and Rehabilitation Department,Hatay, Turkey
- ↑ greeky Medics. Cranial Nerve Examination - OSCE Guide (New Version). Available from: https://www.youtube.com/watch?v=sJBpai74tlU. Lasted Accessed: 2021.4.3
- ↑ 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
- ↑ 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
- ↑ https://pdfcoffee.com/ot-spackman-occupational-therapy-11thpdf-pdf-free.html
