1. Introduction to Neurological Rehabilitation Flashcards
components of the examination of the neurological patient
- History: demographics, medications, social history, prior level function.
- Systems Review: cardiovascular, integumentary, musculoskeletal, neuromuscular, communication & cognitive abilities.
- Tests and Measures: objective information about specific impairments, activity limitations and participation restrictions.
The neuro patient examination process:
- Passive Range of Motion
- Active Range of Motion
- Motor Control
- Quality of movement
- Strength of motion vs individual muscle
- Muscle Tone
- Reflex Integrity
- Mental Status Exam
- Cranial Nerve Exam
- Sensory Exam – dermatome testing
- Coordination
- Pain
- Posture: sitting and standing
- Balance: sitting and standing, static and dynamic
- Functional activities: bed mobility, sit to stand, locomotion, developmental positions
- Outcomes measures
…during each initial patient evaluation and subsequent re-evaluation, physical therapists must decide whether to
treat the patient, refer the patient, or initiate both treatment and referral.
Patient management model in the neurological rehabilitation:
- Examination
- Evaluation
- Diagnosis
- Prognosis
- Plan of Care
- Re-examination
- Outcomes
Purpose of the History:
(Describe 3)
- To find out details about the nature, severity, frequency and pattern of the problem, as well as the past medical history.
- To find out To find out information about what precipitates or relieves symptoms
- To find out what previous treatments or examinations have been conducted
- To find out what other neurological symptoms are experienced needs to be collected.
- To find out about the difficulties patients may experience in daily life as a consequence of their movement problem, for example in terms of the home and community environment, the impact upon the social, school and work life and the impact upon social relationships.
- To identify the patients expectation/goals
When gathering a history, the physical therapist should be an active…
listener
Types of data generated from patient history:
(describe 3 in detail)
- General demographics: age, sex, race, primary language, education.
- Social History: family and caregiver resources, cultural beliefs
- Employment/Work (Job/School): current and prior.
- Functional status and Activity level: self-care, home management.
- Living environment: devices and equipment, community, and projected discharge destination.
- Medical/surgical history
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So what is the secret to the treatment of a neurological patient?
(Write at least three)
- Observational Skills
- A deep understanding of normal movement
- Good examination and evaluation skills
- A strong understanding of how the impairments affect movement
- Being able to connect the dots between impairments and function
- Prioritizing and sequencing interventions to address identified impairments
Models for patient management:
- Nagi Model: Pathology-Impairment- Functional Limitation- Disability
- ICF: Body functions and structure, Activity, Participation
- National Center for Medical Rehabilitation Research (NCMRR): Pathophysiology, impairment, functional limitations, disability, societal limitations
- Schenkman and Butler 1989, 1999: A multisystem model for management of the neurological patient
- Bennett & Karnes (1998): emphasis placed on assessing functional mobility and disabilities first and then determining what impairments may be contributing to the disabilities
Porter & Weiner said that
OBSERVATION IS KEY!!!
Models for Patient Management
A multisystem model for management of the neurological patient
Schenkman et al (1999):
Models of Patient mgmt
A model for assessment of disabilities and impairments in the neurological patient – emphasis placed on assessing functional mobility and disabilities first and then determining what impairments may be contributing to the disabilities
Bennett & Karnes (1998)
