Ax Flashcards
What to do prior to Subjective Ax
Consent and address yourself, check patient name and details.
What to check in PC and HPC
PC: Problems - impairment, activity, participation
HPC: How long they have had neurological disease - is it progressing/worsening, previous treatment - did it work or make it worse
What to ask/check in PMH
Systems:
- Neurological – any previous strokes, any other neurological event
- MSK – OA/RA, osteoporosis, fractures, soft tissue injuries, pain anywhere
- Respiratory – Chronic – COPD (CB, Emphysema), Asthma; Acute – pneumonia, surgery
- Cardiovascular – MI, CCF, surgery
- Urinary – kidney disease
- Endocrine - DDM
What to ask/check in DH
Condition specific:
PD – dopamine agonists - Madopar and Sinemet
CVA – anti-platelets (Clopidogrel) , anti-coagulants, cholesterol-reducing statins (Atorvastatin), BP medication, antispasmodics
MS – antispasmodics (Baclofen and Tinazadine), anti-inflammatories
TBI – antispasmodics (Baclofen and Tinazadine)
SCI – antispasmodics (Baclofen and Tinazadine)
What to check/ask in SH
5 main topics:
- Home – a bungalow, stairs, any equipment in place
- Support – patient have dependents; own support network
- Work – progressive disease (honesty to RTW), will they be able to get back to the same job?; goal setting
- Hobbies – achievable? Goal setting
- Mobility – previous mobility in ADLs (PADLs, DADLs)
What SQs to ask
- Falls – how many falls in past 6 months, during what activities, dizziness, did they lose consciousness? Did they hurt themselves? Are they worries about falling again - Falls Efficacy Scale (FES-1)
- Fatigue – Measured via Fatigue specific Outcome Measures i.e Fatigue Impact Scale. What makes it worse? What makes it better? Are they sleeping? How is their diet? Do they feel stressed? Do they exercise?
- Pain – do they have any pain? Where is it? Type of pain? SIN? Use a pain rating scale – NPRS.
What can you learn as you talk to the patient
- Communication -Hearing (hearing aids), Sight (glasses), Speech (receptive/expressive dysphasia), agnosia, Cognition, language barrier
- Consciousness – AVPU, GCS, AAOx3 – name, location, day/time
- Confusion level
- Emotional status
- Fatigue - able to establish how assessment/ treatment needs to be moderated according to this.
- Goals (why is this important? Every patient has individual needs – rehab must always be in their best interest)
What are you learning from Observation
Postural alignment in static/dynamic postures, movement patterns, compensations
What are you learning from AROM
Strength (3/5 oxford scale = AROM against gravity), quality of movement (smooth/co-ordinated/well-timed/effortless), involuntary movements, pain, range (estimate or measure if only one joint),
What are you learning from PROM
Is the joint limiting movement, what is the end range feel, Pain/ bony block/ stiffness/ contracture/ tone assessment, sensory awareness, anxious (facial expression)
What are the two different types of special testing
Sensory testing – tests sensory system, damage can happen anywhere along this pathway – sensory receptor, peripheral nerve, spinal cord, brainstem, thalamus, sensory cortex
Co-ordination testing – tests for cerebellum damage resulting in ataxia: can get truncal or appendicular ataxia or both depending on area of cerebellar damage. Appendicular ataxia is usually caused by lesions of the cerebellar hemispheres and associated pathways. Truncal ataxia is often caused by damage to the midline cerebellar vermis and associated pathways
What are sensory tests
Proprioceptive
Sharp/blunt
Two-point discrimination
Light/Deep touch
Stereognosis
Hot and Cold
Proprioception (demonstrate and describe how to do
this test)
Patients eyes closed; Moving one of the patient’s fingers or toes up and down and asking the patient to report which way it moves. Hold the digit lightly by the sides while doing this so that tactile inputs don’t provide significant clues to the direction of movement. The digit should be moved very slightly because normal individuals can detect movements that are barely perceptible by eye
Considerations:
UL: hand on elbow - support GH
LL: hand on knee - support leg
Sharp/blunt (demonstrate and describe how to do this test) –
Patients eyes closed; place sharp or blunt side on equal aspects of their non-affected side followed by affected side asking patient to report if it is sharp or blunt. Move in dermatomal fashion
Two-point discrimination (demonstrate and describe how to do this test)
Special pair of calipers, or a bent paper clip, alternating randomly between touching the patient with one or both points. The minimal separation (in mm) at which the patient can distinguish these stimuli should be recorded in each extremity.
Normal = distinguish 2-points at 3-4mm
Used for patients goal - work with finger mobility
