9/18d Movemet System Screening Lab (Examination, Evaluation, Intervention) Flashcards
-ID clinical Measures used to screen patients in acute and subacute care -perform systems review to evaluate safety before mobilizing patients in acute and subacute care -apply movement systems framework to screening the activities of rolling, supine to sitting, sit to stand, and walking as seen in patients in acute and subacute care -integrate history, screening, and examination findings to create and modify plan of care for patients in acute or subacute care
Part 1:
History
- Obtain the following information:
- Age
- Chief Complaint
- Lab Results
- Diagnosis (Dx)
- Past Medical History (PMH)
- Medications
- Social
- Referral - Create a hypothesis about the situation based on medical history and the movement system ornament. Determine the prospective goal and activity for treatment
- Plan tests and measures to confirm hypothesis, determine what you need to bring with you
- Systems Review of the following: Cardiovascular pulmonary (CVP), Integumentary (Integ), Musculoskeletal (MSK), Neuromuscular (NMS), Communication/Cognition, Pain, SAFETY FIRST
Hard stops during the systems review
if something is out of range of what you would have expected
- acute distress = hyperventillating, profuse sweating
- elevated HR
- evaluate vitals
How do you analyze integument during systems review
- Skin/wounds clean and dry > no > continue with increased safety concerns AND discuss with nursing staff
- Skin/wounds clean and dry > yes > continue with screen
How do you analyze MSK during systems review
Ask yourself if there is adequate strength & ROM to get OOB:
- No, <3 -> Proceed with in-bed activities that are safe OR Get additional help/be prepared to provide assistance
- Yes, >3, <4 -> Guard closely
- Yes, strong against gravity -> continue with screen
How do you analyze NMS during systems review
- Adequate Motor control to get and remain OOB?
- No > Proceed with in-bed activities that are safe OR Get additional help/be prepared to provide assistance
- Yes, but unsteady at low levels > provide additional support/assistive device
- Yes > continue with screen - Adequate Sensory info for function?
- No > provide additional support/assistve device
- Yes > continue with screen
How do you analyze communication/cognition during systems review
Alert and grossly oriented?
- Impaired > Consult with medical team OR continue with increased safety concerns
- OK > continue with screen
How do you analyze pain during systems review
pain level?
- unexpected and incapacitating > consult with medical team
- Expected and tolerable > continue with screen
Common Elements for safety assessment
- Hemodynamics (approp measures)
- Integument (observation)
- MSK (define muscles and how)
- NMS (which tests and how)
- Communication and Pain (questions and observations)
CVP Screening elements
BP
RR
HR
MSK Screening
perform MMT sitting and supine for LE
perform force and motion screening for UE
NMS Screening
Sitting - ability to maintain posture, reaching (feedfoward), response to push (feedback)
Standing - ability to maintain posture, reaching or weight shift (feedforward), walking
-If warranted by history, light touch and proprioception screens
activities most interested in screening?
- rolling
- lying to sitting
- sitting
- sitting to standing
- walking
Basic requirements for rolling
- some amount of LE movement against gravity
- some amount of 1 UE movement
- Head and neck control
- trunk control
When do you know it’s safe to proceed with rolling?
Rolling
- Impaired
- Control
- Amount of Movement > examine strength and ROM in limited areas
- Speed of Movement
- Symmetry of Movement > examine strength and ROM in limited areas
- Symptom provocation > examine sub-components of motion for pain - Not Impaired > continue with screen
Basic requirements for lying to sit
- Head and neck control
- UE strength in 1 arm
- Trunk Strength
- LE Control
