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 == | ||
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=== Chief Complain === | === Chief Complain === | ||
What is his/her present complaint or problem for which | What is his/her present complaint or problem for which he/she has visited you? | ||
=== History of Present Condition === | === History of Present Condition === | ||
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# Wounds | # Wounds | ||
# External Appliances | # External Appliances | ||
# Involuntary Movement | |||
#*Tremor | |||
#*Clonus | |||
#*Chorea | |||
#*Associated Reactions | |||
# Posture and Balance | # Posture and Balance | ||
*Alignment and attitude of limbs | *Alignment and attitude of limbs | ||
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=== Vital Signs === | === Vital Signs === | ||
Respiratory rate | * Respiratory rate | ||
* Temperature | |||
Temperature | * Pulse rate | ||
* Blood pressure | |||
Pulse rate | * O2 saturation | ||
Blood pressure | |||
O2 saturation | |||
=== On Examination === | === On Examination === | ||
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===== Level of consciousness: [[Glasgow Coma Scale|Glasscow coma scale (GCS)]] ===== | ===== Level of consciousness: [[Glasgow Coma Scale|Glasscow coma scale (GCS)]] ===== | ||
===== Communication: ===== | ===== Communication: ===== | ||
Aphasia ( Broca's, Wernicke's, Global) | Aphasia ( Broca's, Wernicke's, Global) | ||
Line 136: | Line 134: | ||
===== Perception: ===== | ===== Perception: ===== | ||
* Body Scheme/ Body Imaging | * Body Scheme/ Body Imaging | ||
* Agnosias | * Agnosias | ||
* Apraxias<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: | Common tools to assess perceptual problems are: | ||
* Star Cancellation Test. | * Star Cancellation Test. | ||
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* Clock Drawing Test. | * Clock Drawing Test. | ||
=== | ==== [[Cranial Nerves|Cranial nerve (CN) examination]] ==== | ||
==== Sensory examination ==== | |||
=== | ===== Superficial Sensation: ===== | ||
* Pain | |||
* Temperature | |||
* Touch | |||
* Pressure | |||
===== Deep Sensation: ===== | |||
* | * Movement Sense | ||
* | * Position Sense | ||
* | * Vibration Sense | ||
=== | ===== Cortical Sensation ===== | ||
* Tactile Localization | |||
* 2 point discrimination | |||
* Stereognosis | |||
* Barognosis | |||
* Graphesthesia | |||
* Texture Recognition | |||
* Double Simultaneous Stimulation | |||
==== Motor examination ==== | |||
===== Tone ===== | |||
*Decreased / Flaccid | *Decreased / Flaccid | ||
*Increased<br>Spasticity (Clasp-knife)<br>Rigidity (Cogwheel or Lead Pipe) | *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 Movement ===== | ||
===== Strength ===== | |||
[[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) | *Deep Tendon Reflexes<br>Biceps (C5/6)<br>Triceps (C7/8)<br>Knee (L3/4)<br>Ankle (S1/2) | ||
*Plantar Response (Babinski’s Sign) | *Plantar Response ([[Babinski Sign|Babinski’s Sign]]) | ||
===== Tightness/ [[Muscle length testing]] ===== | |||
===== [[Leg Length Discrepancy|Limb length measurement]] ===== | |||
===== [[Girth Measurement|Limb girth measurement]] ===== | |||
==== [[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]] | |||
==== Co-ordination ==== | |||
* Equilibrium | |||
* Non-equlibrium | |||
==== Gait ==== | |||
* Step Length | |||
* Stride Length | |||
* Base width | |||
* Cadence | |||
* Biomechanical Deviations | |||
==== Other System review ==== | |||
* '''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:''' Incontinence | |||
* '''Gastrointestinal system:''' Status | |||
* '''Autonomic system:''' Vasomotor,Pseudomotor,Trophic Changes,Postural Hypotension,Reflex Sympathetic Dystrophy | |||
==== Functional Assessment ==== | |||
* [[Functional Independence Measure (FIM)|Functional Independence Measure]] | |||
* [[Barthel Index|Modified Barthel Index]] | |||
=== Investigation Findings === | |||
== Problem List == | |||
== Physiotherapy Diagnosis/Functional Diagnosis == | |||
== | == Goal Setting == | ||
* Short term goal | |||
* Long term goal | |||
== Treament == | |||
== | == Re-assessment == | ||
== Plan == | |||
== | <clinicallyrelevant id="83459409" title="Babinski Sign Test" /> | ||
* | * | ||
==References== | ==References== |
Revision as of 09:17, 3 April 2021
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.
Subjective Assessment[edit | edit source]
The subjective assessment is used to provide a detailed picture of how the present condition affects the patient.
Demographic Data[edit | edit source]
Name, Age, Gender, Occupation, Dominant hand, Address
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)
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
- Tremor
- Clonus
- Chorea
- Associated Reactions
- Posture and Balance
- Alignment and attitude of limbs
- Neglect
- Sitting Balance
- Standing Balance
Vital Signs[edit | edit source]
- Respiratory rate
- Temperature
- Pulse rate
- Blood pressure
- O2 saturation
On Examination[edit | edit source]
Higher mental function[edit | edit source]
Level of consciousness: Glasscow 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.
Perception:[edit | edit source]
- Body Scheme/ Body Imaging
- Agnosias
- Apraxias[2]
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 Movement[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
Co-ordination[edit | edit source]
- Equilibrium
- Non-equlibrium
Gait[edit | edit source]
- Step Length
- Stride Length
- Base width
- Cadence
- Biomechanical Deviations
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: Incontinence
- Gastrointestinal system: Status
- Autonomic system: Vasomotor,Pseudomotor,Trophic Changes,Postural Hypotension,Reflex Sympathetic Dystrophy
Functional Assessment[edit | edit source]
Investigation Findings[edit | edit source]
Problem List[edit | edit source]
Physiotherapy Diagnosis/Functional Diagnosis[edit | edit source]
Goal Setting[edit | edit source]
- Short term goal
- Long term goal
Treament[edit | edit source]
Re-assessment[edit | edit source]
Plan[edit | edit source]
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.
- ↑ PHYSIOTHERAPY EVALUATION IN NEUROLOGICAL PATIENTS. Ozden Gokcek and Esra Dogru Huzmeli. Hatay Mustafa Kemal University Health Science Faculty, Physiotherapy and Rehabilitation Department,Hatay, Turkey