Examination of the Neurologic patient

Question 1

Describe the importance of ‘Clinical Reasoning?’

Answer 1

During ‘Clinical Reasoning’, the patient’s key problem areas will be determined and prioritized to develop a treatment plan to strive for the most effective therapy program.

Question 2

What is observation? And the following step?

Answer 2

Begin with observation. Observing, or taking in information, should be fairly objective. When we look at a patient, we should all see the same things. Just like any other therapeutic skill, with structure and practice you can improve your evaluation skills. After we observe, we begin our interpretations. Interpretation helps us make sense of the information we’ve gathered. Interpretation is more subjective.

Question 3

Exemplify some questions to answer when you get you see the pation for the first time.

Answer 3

If you are seeing them in their room for the first time, notice how they are positioned. What is their level of awareness? Begin to gather information. If they come to therapy, watch how they enter the room. Are they in a wheelchair or are they ambulatory? Do they need assistance? What is their posture like? What is your general, overall impression of the patient?

Question 4

To determine if there is any neglect or disregard of their involved side, what we can look for?

Answer 4

• Do they turn their head toward you?
• Are they able to establish eye contact?
• Are they aware of their involved side?

Question 5

What sign indicates edema in hand, for example?

Answer 5

The wrinkles. When we compare to the contralateral side, the fewer wrinkles indicates edema.

Question 6

Exemplify questions you should do to determine the base of support.

Answer 6

1. Are both feet flat on the floor?
2. Is their weight evenly distributed or are they sitting or standing with their weight on one side more than the other.
3. Are they resting against the back of the chair or are they seated without a back support.
4. Do they use one or both upper extremities to support themselves?
5. Are they seated on a support surface that is firm or soft?

Question 7

What to look for to detect asymmetries?

Answer 7

• unilateral creases or skin folds
• bony prominences
• muscle atrophy
• position of head
• height of shoulders
• position of pelvis
• position of upper extremities
• position of lower extremities.

Question 8

It is not uncommon for stroke survivors to sit in a posterior pelvic tilt. What are the consequences?

Answer 8

When the pelvis is tipped posteriorly, the head and neck compensate by coming forward. This posture, although common, will affect the patient’s symmetry, trunk control and ability to move from sit to stand. It can also affect their breath control, ability to swallow and vital capacity.

Question 9

How to describe your patient’s movement components?

Answer 9

1. Identify the starting position (sitting, standing, sidelying or supine).
2. Identify each joint and their direction of movement or combinations of movement.
3. Describe if their movement is through full range or partial range.
4. Describe the quality of movement on the non involved side.

Question 10

How to describe the quality of movement of the involved side?

Answer 10

1. Does the patient move with selective, isolated control?
2. Are the movements in a pattern?
3. Describe the pattern of movement.
4. What movements or combinations of movements is the patient able to do?
5. Look proximal first and then more distal.
6. Continue to look from the front, the side and the back.
7. Ask your patient to move their sound side.
8. Compare the movement of the two sides.