Ch 6 Global Observation, Mental Functions, and Components of Mobility and Function Flashcards
Global Observation
Demeanor or emotion
Appearance
Facial expression, voice, and body language
Source of pain or dysfunction
Compare with what patient says
Posture
Mobility/locomotion
Gait
Communication Assessment
Effective communication
Messages expressed in an understandable manner
Messages received as they were intended
Deficits may result from neurological or cognitive dysfunction or disease
Dysarthria
Speech difficulties due to impaired motor control
Dysphonia
Difficulty in voice production
Aphasia
Cognitive neurological disorder
Difficulty or inability to produce or understand language
Wernicke’s (receptive) - Aphasia
Rapid, effortless speech
Out of context
Broca’s (expressive) - Aphasia
Short, meaningful phrases
Requires great effort
Global - Aphasia
Receptive and expressive
Usually unable to communicate
What are the aspects of the communication assessment?
Language spoken
Hearing
Quantity of speech
Rate and volume of speech
Word articulation
Fluency
Simple Tests for Communication
Understanding of questions
Word comprehension
Repetition
Naming
Writing
Apraxia - Cognition Assessment
Impairment of cognitive processing
Inability to initiate or carry out learned purposeful tasks on command
Patient understands the task and has the desire and physical ability to complete the task
May be able to complete the task involuntarily
Attention
Attend to a specific stimulus or task
Orientation
Person, place, and time
Memory
Immediate, short-term, and long-term recall
Thought processes
Logic, coherence, and relevance
Calculation
Perform written or verbal mathematical calculations
Abstract thinking
Reason in an abstract fashion
Judgment
Reason in a concrete fashion
Spatial perception
Construct or draw an object with specific characteristics
Body perception
Self-awareness of own body
Object perception
Recognize objects through touch
Sensory Perception
Recognize numbers, letters, or shapes “drawn” on the skin
Mood
State of being
May not be outwardly expressed
Emotion
Felt and often outwardly expressed
Relatively temporary and easily changed
Common emotional/psychological disorders
Anxiety disorders
Mood disorders
Psychotic disorders
Somatoform disorders
Substance disorders
Personality disorders
Observation / Questionnaires - Emotional/Psychological Assess.
Posture and behavior
Personal hygiene, grooming, and clothing
Facial expression
Manner, affect, and relationship to person and things
Posture
Alignment of each body segment in relation to adjoining segments
Ideal skeletal alignment
Body’s center of mass direction over its base of support
Anterior pelvic tilt
Kyphotic-lordotic posture
Increased lumbar lordosis, hips in relative flexion, lengthened hamstrings and abdominals, and shortened iliopsoas, rectus femoris, and lower back extensors
Posterior pelvic tilt
Flat-back and swayback postures
Flattened lumbar lordosis, hips in neutral or relative extension, lengthened iliopsoas, and shortened hamstrings and abdominals
Structural faults
Result from congenital or developmental anomalies, disease, or trauma
Functional faults
Result from poor postural habits
Informal Assessment
Assess at first sight of patient and periodically throughout initial exam
Formal Assessment
Plumb line, well-trained eyes, palpation of landmarks, removal of excess layers of clothing
Landmarks in anterior, posterior, and lateral views
Standing, sitting, dynamically
Locomotion
The means of moving from one location to another
Walking, wheeling, crawling
Mobility
Body movements necessary to successfully walk, wheel, crawl
What does assessing mobility and locomotion allow?
Allow patients to perform or attempt to perform tasks that are difficult
Gain information regarding impairments
Accurately document initial ability to perform a skill
Explain why patients are performing tasks that are difficult
Gait - Stance phase
60% of gait cycle
Initial contact
Loading response
Midstance
Terminal stance
Preswing
Gait - Swing phase
40% of gait cycle
Initial swing
Midswing
Terminal swing
Gait cycle
All components of limb advancement
Stance phase
Begins when one foot makes contact with the floor and ends when same foot lifts off the floor
Swing phase
Begins when one foot lifts off the floor and ends when same foot makes contact with the floor
Stride length
Linear distance measured along the line of progression representing how far the body has traveled during one gait cycle
Step length
Linear distance measured along the line of progression representing how far one foot has traveled relative to the other foot through one gait cycle
Cadence
Number of steps taken in a specific amount of time
Velocity -gait
speed of ambulation
Width of base of support
Linear distance measured perpendicular to the line of progression from the center of the right point of contact to the center of the left point of contact
Antalgic
Shorter stance time on painful stance leg and shorter step length on uninvolved side
Ataxic
Unsteady or uncoordinated limb advancement in swing phase
Circumduction
Swinging one limb in circular motions (into abduction) to advance limb
Festinating
Short step length and primary weight bearing through forefeet and toes
Foot drop
Foot plantar flexed during swing phase due to weak or absent ankle dorsiflexors
Hip hiking
Elevation of ipsilateral pelvis in frontal plane during swing phase
Knee hyperextension
A rapid thrust of knee into hyperextension immediately after limb makes contact with the floor
Parkinsonian
Bilateral small, shuffling steps and slow movement
Scissoring
Adduction of swing limb during swing phase
Steppage
Often seen in presence of foot drop
Excessive hip and knee flexion of affected limb to clear foot during swing phase
Trendelenburg
During the stance phase on the affected side, the contralateral hip drops in the frontal plane, often accompanied by a compensatory trunk lean toward the stance side
Vaulting
Often seen when one limb has difficulty clearing the floor during swing phase
Characterized by plantar flexion of the ankle on the unaffected (stance) limb, with or without concurrent elevation of the pelvis on the affected (swing) limb
Basic activities of daily living (BADLs)
Self-care and independent living
Instrumental activities of daily living (IADLs)
Required by most people but not for independent living
Functional outcome measures
Questionnaires or surveys
Scores given for patient’s reported or observed ability to perform activities
Changes in scores can be interpreted as improvement or decline in function
Document progress or justify need to continue interventions
