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. 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 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. | 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. | ||
== Subjective Assessment == | == Subjective Assessment == | ||
The subjective assessment is used to provide a detailed picture of how the present condition affects the patient. | The subjective assessment is used to provide a detailed picture of how the present condition affects the patient. <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> | ||
=== Demographic Data === | === Demographic Data === | ||
Name, Age, Gender, Occupation, Dominant hand, Address | 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 === | ||
| Line 128: | Line 128: | ||
* Language | * Language | ||
* Visuospatial proficiency | * Visuospatial proficiency | ||
There are various outcome tools via which we can address his/her cognitive status incorporating various components. | 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-Mental State Examination|Mini-mental Status Examination]] | ||
* [[Mini-cog]] | * [[Mini-cog]] | ||
| Line 147: | Line 147: | ||
==== Sensory examination ==== | ==== Sensory examination ==== | ||
===== Superficial [[Sensation|Sensation | ===== Superficial [[Sensation|Sensation]] ===== | ||
* Pain | * Pain | ||
* Temperature | * Temperature | ||
| Line 153: | Line 153: | ||
* Pressure | * Pressure | ||
===== Deep Sensation | ===== Deep Sensation ===== | ||
* Movement Sense | * Movement Sense | ||
* [[Proprioception|Position Sense]] | * [[Proprioception|Position Sense]] | ||
| Line 236: | Line 236: | ||
== Re-assessment == | == Re-assessment == | ||
Revision as of 10:58, 3 April 2021
Original Editor - Kim Jackson Top Contributors - Manisha Shrestha, Kim Jackson, Shaimaa Eldib, Kirenga Bamurange Liliane, Rucha Gadgil, Kanzaa Rahim and Admin
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)
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]
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: 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.[4]
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
Co-ordination[edit | edit source]
- Equilibrium
- Non-equlibrium
- Romberg's test
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]
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]
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
- ↑ 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
