Spinal Cord Injury Assessment Guiding Principles
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Top Contributors - Ewa Jaraczewska, Kim Jackson and Jess Bell
Introduction[edit | edit source]
Physiotherapy assessment of spinal cord injury is "the vision of the possibilities patient could attain in the perfect situation, and adapt it to the specific person's world".[1]
The description of health can be found in the International Classification of Functioning, Disability and Health (ICF). It offers a standard language to be used among health providers to describe healths-related state.[2] The use of ICF facilitates communication and understanding of team roles within a spinal cord injury multidisciplinary team. It challenges clinicians to think holistically. [3][4]The following components of health condition are included in the ICF: body functions and structures, activities, participation, environmental factors, personal factors.
The goal of the assessment is to collect information about disordered movement patterns, underlying impairments, activity restrictions, and societal participation and to identify the structural or functional mechanisms influencing the improvement for the purpose of intervention planning. [5][6][2]The assessment should be ongoing to tailor-make treatment plan based on observed changes in patient's function and behaviour.
Subjective Assessment[edit | edit source]
Body functions and structures[edit | edit source]
In this section physiotherapist asks questions and review medical record seeking information on current and past medical history, including:
- mechanism of injury: traumatic vs. non-traumatic
- presence or history of other injuries related to the primary reason for assessment
- medical management and current precautions
- progression of the condition
- pre-morbid medical history
- presence of complications related to the spinal cord injury, including myocitis ossificans, syringomyelia, spasticity, pressure sores, autonomic dysreflexia, infections, postural hypotension
Activity[edit | edit source]
Activity is defined as difficulty in performing physical action or tasks. In this section, physiotherapist ask about and observe patient's current and past abilities to perform activities of daily living with or without assistance of special equipment. Current equipment that patient uses may facilitate or restrict mobility. That include
- nasal gastric tube
- suctioning machine
- ventilator.
Physiotherapist must notice technology that patient uses: assistive device, standard or special wheelchair, etc.
Participation[edit | edit source]
The ICF defines participation as a "limitation in performing socially defined life task and roles".[7]It include socialising (interpersonal interaction and relationship), traveling, working, taking care of own health, taking care of the members of the family, own finances, play and leisure. [8]The limitations can be due to functional impairment related to a spinal cord injury and/or its secondary complications. Physiotherapist must acknowledge multidisciplinary team members who are involved in managing these limitations: speech language pathologist, nutritionist, dietician, wound care nurse, or a psychologist.
For this domain patient is asked about previous therapy, patient's goals and envisaged outcome.
Environmental factors[edit | edit source]
When discussing environmental factors, physiotherapist must include assessment of the barriers and resources in the community.[1] The following examples represent environmental factors:
- accessibility of the patient's residence: mountainous, rural or urban area, sandy
- weather conditions: hot, dry, snowy, windy
- distance from healthcare
- access to specialised service or technology
Personal factors[edit | edit source]
Objective Assessment[edit | edit source]
Outcome Measures[edit | edit source]
Team Communication/Team Roles[edit | edit source]
Goal Setting[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 Harding M. Spinal Cord Injury Physiotherapy Assessment, Prognosis, and Goal Setting Course. Physioplus 2022.
- ↑ 2.0 2.1 Bolliger M, Blight AR, Field-Fote EC, Musselman K, Rossignol S, Barthélemy D, Bouyer L, Popovic MR, Schwab JM, Boninger ML, Tansey KE. Lower extremity outcome measures: considerations for clinical trials in spinal cord injury. Spinal cord. 2018 Jul;56(7):628-42.
- ↑ Sykes C. Health Classifications 1 - An Introduction to the ICF. WCPT Keynotes. World Confederation for Physical Therapy. 2006.
- ↑ Rauch A, Cieza A, Stucki G. How to Apply the International Classification of Functioning, Disability and Health (ICF) for Rehabilitation Management in Clinical Practice. Eur J Phys Rehabil. 2008;44(3):329-42.
- ↑ Ryerson S. Neurological Assessment: The Basis of Clinical Decision Making. In: Lennon S, Stokes M, editors. Pocketbook of Neurological Physiotherapy. Elsevier Health Sciences; 2008 Oct 10.
- ↑ Bernhardt J, Hill K. We Only Treat What It Occurs to us to Assess: The Importance of Knowledge-based Assessment. Science-based Rehabilitation: Theories into Practice. 2005:15-48.
- ↑ Jette AM, Haley SM, Kooyoomjian JT. Are the ICF Activity and Participation dimensions distinct? J Rehabil Med. 2003 May;35(3):145-9.
- ↑ Alve YA, Bontje P. Factors Influencing Participation in Daily Activities by Persons With Spinal Cord Injury: Lessons Learned From an International Scoping Review. Top Spinal Cord Inj Rehabil. 2019 Winter;25(1):41-61. doi: 10.1310/sci2501-41. Erratum in: Top Spinal Cord Inj Rehabil. 2019 Spring;25(2):iv. PMID: 30774289; PMCID: PMC6368111.
