Assessment Flashcards
Overview of subjective Ax
Involves gaining information about the patient and how their condition affects them as a person
• Personal to a particular patient but may originate from individuals other than the patient (relatives, carer, member of MDT)
• May be gathered through various communication methods including medical notes, conversations/ meetings and patient interview
• In terms of the ICF, the subjective examination gains information relating to: activity, participation, environmental factors and personal factors
aims of subjective Ax
- Provide a detailed picture of how the present condition affects the patient from a holistic viewpoint
- Identify the patient’s main problems as perceived by the patient
- Assist in setting of short and long term goals in collaboration with the patient
- Assist in the development of a relevant treatment plan
- Build rapport with the patient
what information do i get from the medical record
personal details diagnosis date of admission - hospital / rehab ward Hx of presenting illness CVA- location and type of lesion SCI- level of lesion, complete/incomplete TBI: location and type of lesion progressive neuro condition : type and progression relevant PMH surgical Hx results of Ix meds SHx PLOF med/speech/OT/Nursing entries
Information from bed chart
recents observations (HR, BP, O2, Sats, Temp) Current Meds
Pt Interview
• History of presenting illness
• Any symptoms that may affect physiotherapy treatment:
chest pain, dyspnoea, dizziness/ vertigo
• Respiratory: SOB, cough, wheeze, chest pain, secretions
• Vision: presence of diplopia or visual field loss
• Sensation: P&N/N
• Strength and power
• Coordination and balance
• Pain: specify shoulder and other pain (where, when, how
much, what gives relief)
• Dominance
• Past or present physiotherapy treatment
• Social history: family (dependents/ support), assistance/
services from external agencies (hygiene, meals, community access), accommodation (home environment – stairs, hobs, rails, assistive devices/ modifications), occupation, hobbies/ recreation, community mobility (driving, public transport)
• Previous level of function: home and community mobility (level of assistance, aids, exercise tolerance, independence with ADLs)
• Falls history: number of falls in last 6/12, causative factors, associated injuries
Patient’s perception of present level of function
• Patient’s perception of present ability to participate in daily
routines
• Patient’s perception of major problems
• Treatment goals
Overview of Objective Ax
- Involves gaining information related to the patient’s movement disorder and functional status using measurable tools and movement analysis
- In practical terms, assess how the patient moves and then investigate more specifically the reasons for the these movement patterns or behaviours
- In terms of the ICF, the objective examination gains information relating to: body structures and function and activity
- During ongoing treatment, continually re-assess the evaluate change and improvement
Aims of Objective Ax
- Identify the patient’s movement problems and potential causes of those problems in order to appropriately focus treatment
- Provide a baseline from which suitable short term and long term goals can be agreed with patient and from which the effectiveness of treatment can be evaluated
initial observations for Ox
- Level of consciousness
- General appearance
- Posture or deformities
- Skin condition
- Oedema
- Quality of spontaneous movement/ general movement patterns (weakness, tremor, dysdiadochokinesia etc)
- Facial symmetry and expression
- Speech
- Apparent neglect
- Presence of attachments
- Aids and appliance
- Gait and / or use of wheelchair
- Respiration – RR, breathing pattern, cough
- Attachments (O2, IV, IDC, IV, cardiac monitoring etc)
vision
- Visual acuity
- Eye movements – CN III, IV, VI
- Eye follow
- Convergence/ divergence
- Visual fields
- Hemianopia
- Visual inattention
sensation
- Light touch
- Double simultaneous stimulation
- Pinprick
- Temperature
- Proprioception
- Passive movement sense • Joint position sense
- Vibration
- Stereognosis
Flexibility, tone and spasticity
- Flexibility • PROM
- Muscle tone
- Resistance to PROM
- Spasticity
Quality of mvmt
- During testing movement and motor recovery always note:
- Is there spontaneous movement?
- Is it isolated?
- Is there evidence of patterning? If so, describe. • Is the movement antigravity?
- Trunk
- Lower Limbs
- Upper Limb
Muscle power
Oxford grading scale
• Standard muscle strength tests can only be recorded if the movement is fully isolated and tone is normal
• Use standard muscle tests on standard charts
co-ordination
• Co-ordination should only be assessed when full, isolated active movement is present. When testing co- ordination, the following should be noted: • Speed • Smoothness of the movement • Presence of dysmetria (undershooting or overshooting) • Timing / rhythm • Ability to follow a sequence • Upper limb • Finger to nose • Pronation/ supination • Hand tapping • Finger strumming • Lower limb • Foot tapping • Heel/knee/shin • Alternate hip flexion • Alternate hip and knee flexion • Cycling of legs
functional task analysis
- Functional task analysis involves observation of the functional movement and analysis of the components of the movement present / absent
- The primary aim is to observe the movement disorder and decide why the movement is abnormal
- When assessing functional tasks, analyse the following:
- Level of independence
- Independent
- Supervision
- Verbal cueing
- Minimal assistance X 1
- Movement components
- Causal factors
- Moderate assistance X 1 • Minimal assistance X 2
- Moderate assistance X 2 • Unable to perform
- When assessing functional tasks, analyse the following:
- Level of independence
- Independent
- Supervision
- Verbal cueing
- Minimal assistance X 1
- Movement components
- Causal factors
- Moderate assistance X 1 • Minimal assistance X 2
- Moderate assistance X 2 • Unable to perform
