Intro to Neuro Rehab and Exam Flashcards
what are the goals of neuro rehab
- restore mobility and functional skills
- promote recovery via neuroplastic changes
- compensation/adaptation when recovery not likely
what is the continuum of care
- exam
- eval - synthesize info from exam
- diagnosis (PT)
- prognosis - POC and length of recovery
- intervention
- outcomes - did they get better or need to change POC
clinical reasoning vs clinical decisions
reasoning - problem solving
decisions - outcomes of reasoning process
what falls under the umbrella of clinical reasoning
process info
reach conclusions
determine actions
what influences clinical decision making
CLINICIAN: goals, experience, knowledge, values, psychosocial skills
PATIENT: goals, values/beliefs, psychosocial cultural educational physical factors
ENVIRONMENT: setting, resources, payers
what is the evolution of clinical decision making
novice > advanced beginner > competent > proficient > expert
how does clinical decision making differ between novice vs expert
novice - more skill acquisition driven
expert - reflective practice
what are the 3 major components of PT neuro exam
hx and subjective assessment
systems review
exam: BSF, activity and participation
what do the 3 major components of a PT neuro exam inform: (5)
eval -> critical analysis, synthesize exam data
PT diagnosis and prognosis
POC and goals
interventions
dc plan / conclusion of care
how are BSF/activity/participation assessed in the exam portion of a neuro exam
tests and measures - clinical and standardized
what are 3 components in history taking for a neuro exam
- PMH & current health status
- medical dx, imaging, tests/labs, meds, surgery, prior PT or other interventions
- age, gender, ethnicity, language, culture, religion, educational level, work/school hx, social/health habits
why is history important in your neuro exam
helps to create patient centered care
why is PMH and current health status important in a neuro exam
PMH - is what presenting w new or old, do you address this or focus on other areas
current health status - how does this compare to PLOF
what are 6 things to hit on in your subjective assessment
- PLOF *
- home environment
- goals
- culture
- limitations
- PLOF *
- family and friend support *
how is a systems review conducted
brief screening of systems
what does a brief screening of systems inform (2)
- used to identify areas of potential dysfunction that warrant further testing
- decisions regarding scope of care
why is it important to keep your systems review brief
would be too time consuming otherwise
what are the 8 things touched on in a CP systems review
- HR
- heart rhythm
- respiratory rate
- BP
- edema
- read a single lead EKG (if available)
- dyspnea, orthopnea
- cough
why is a CP exam important in neuro rehab
lot of neuro insults can be result of underlying CP issues
- while addressing neuro impairments, think ab if can handle intensity
what are examples of neuro insults due to underlying CP issues
vascular dementia
stroke
what are 4 things hit on in an integ systems review
- color
- cap refill
- integrity
- scars
what are 3 examples of how an integ systems review would important for neuro rehab
- wound could lead to infection
- skin breakdown can reduce ability for PT to work w them
- calluses on their feet - is that why they can’t feel the ground or is it sensory impairments
what are 5 things hit on in a MSK systems review
- gross symmetry / posture
- gross ROM
- gross strength
- height
- weight
why are height and weight looked at in a MSK systems review
can impact how someone moves around
- esp if have a SCI