Guidelines for Exam and Eval of People w/ Neuro Deficits Flashcards
informal observation
level of awareness
posture in seated
gait
wheelchair propulsion
devices
level of awareness
interaction w/ environment
eyes open
looking around
posture in seated
slouch
tilt
where is UE?
gait will be observed
if appropriate
gait
assistive device
stability
pattern
assistance
w/c propulsion checked
if appropriate
w/c propulsion
pattern
if in the w/c, then
any devices are noted
any devices
lap board
communication board
IV pole
what does the subjective exam establish
level of communication with patient
what should we get from the subjective exam
communication level
common questions
what happened to you? when?
what was your tx before you came here?
what activities do you do on your own?
what activities do you need help with?
do you have any pain?
where are you?
what date is it?
subjective exam includes
pt interview/family interview/ chart review
pt interview/family interview/ chart review
PMH
PSH
social history
vocation
recreation
what shouldnt we do with our cues –> subjective
lead patient w/ verbal and non-verbal cues
some questions should –> subjective
challenge short and long term memory
what does the subjective exam help with
better understand the pt’s mentation, cognition and emotional state
objective exam includes
formal observation
formal observation includes
systems review
sensation
communication
CN screening
vision
balance
gait
cerebellar tests
w/c eval
fxnal tests
berg balance
special tests
formal observation
posturing of extremities and trunk in sitting
posturing of extremities and trunk in standing (if appropriate)
systems review
cardiopulmonary
integument
MSK
NM
cardiopulmonary
heart sounds
vital signs
breathing patterns
sitting posture
integument
decubiti present
potential decubiti
areas of redness
prevention via communication w/ family/caregiver(s), nursing staff
MSK
posture
AROM of extremities and trunk
PROM of extremities
pain
NM
motor patterns of movement
tone
motor patterns of movement –> NM
synergy patterns
ataxic
athetoid
tone –> NM
normal
abnormal
abnormal tone –> NM
spasticity
rigidity (leadpipe, cogwheel)
modified ashworth scale
0-5
0 –> modified ashworth scale
no increase in muscle tone
1 -> modified ashworth scale
slight increase in muscle tone
manifested by catch and release or by minimal resistance at the end of the ROM when affected part(s) is moved in flexion or extension
2 -> modified ashworth scale
slight increase in muscle tone
manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
3 -> modified ashworth scale
more marked increase in muscle tone through most of ROM
but affects part(s) easily moved
4 -> modified ashworth scale
considerable increase in muscle tone
passive movement difficult
5 -> modified ashworth scale
affected part(s) rigid in flexion and extension
sensation
cutaneous
deep
combined cortical
cutaneous sensation
pain (sharp/dull)
temp
light tough
deep pressure
deep sensation
proprioceptive
kinesthesia
vibration
combined cortical sensation
stereognosis
graphesthesia
barognosis
two point discrimmination
communication
aphasia
aphasia
expressive - broca
receptive - wernikie
global
vision
field losses
most common vision field loss
homonymous hemianopia
left homonymous hemianopia
loss of left temporal and right nasal fields
d/t right brain insult
balance
sitting and standing
standing if appropriate
static and dynamic
gait will be checked
if appropriate
gait –> objective
ADs and gait deviations
swing phase
stance phase
cerebellar tests are checked
if appropriate
cerebellar tests
dysarthria
dysdiadochokinesia
dysmetria
dyssynergia
nystagmus
rebound phenomena
tremor - intention
w/c is checked
if appropriate
w/c eval
type
accessories
fit
type of w/c
manual
power
recliner
tilt in space
hemi
accessories of w/c
swing away removable leg rests
elevating leg rests
removable arm rests
desk arms
fit of w/c
adult regular
adult narrow
hemiplegic height
pediatric
ADL’s
basic ADLs (BADLs)
bed activities
transfers
self-care
instrumental ADLs
shopping
cooking
doing laundry
standardized fxnal tests and measures
fxnal independence measure
barthels index
fugl-meyer
TUG
fxnal reach
standardized tests for specific dx
hemiplegia
parkinsons
MS
ALS
HD
what should we correlate
subjective and objective findings
formulate
short and long term goals
plan of interventions
what should we be thinking of from day 1
d/c
we then
treat and asses
change if appropriate
