Presenting Neurological Conditions

Question 1

what is the possible range of patients a physio could treat

Answer 1

anyone sufering from:
- stroke
- MS
- muscular dystrophy
- MND
- spinal injury
- brain injury
- vestibular problems (balance/ coordination/ postural/ vision/ ear)
- cerebral palsy
- function syndrome
- guillian barre
- neuro surgery

Question 2

what barriers might there be to completing a neuro assessment

Answer 2

• speech deficit in patient (expressive: can’t speak what they want to say/ receptive: cannot understand what to say)
• poor memory
• behavioural deficits e.g. attention issues/ impulsive
• confused
• drowsy
• disorientated

Question 3

what strategies might you use to complete a neurological assessment

Answer 3

• use less medical jargon
• planning ahead for outpatient assessments to have a competent person with the patient
• ring the next of kin/carers/family members to gain answers
• use pictures to point/use speech language therapist to see how they communicate
• deescalation techniques and don’t get too close to the agitated/stress patient
• for drowsy patients, go back the next day or if more chronic then contact family members
• disengagement – ask questions that they care about e.g. hobbies

Question 4

What information should you gain for the subjective assessment in terms of history taking?

Answer 4

• gain information from nursing handover/referral from other MDT
• event over the last 24 hours from nursing/medical/social plans
• planned intervention/investigations
• current mobility
• nutrition
• sleep

Question 5

What information should you gain for the history of presenting complaint?

Answer 5

• reason for admission/referral
• onset of symptoms
• progression since onset
• aggravating/easing factors
• sleep pattern

Question 6

What information should you gain for the presenting complaint?

Answer 6

• how are they now?
• symptoms of specific prompts, e.g. pain, weakness, sensation
• aggravating/ easing factors
• sleep pattern
• speech problem
• Visual problems
• hearing problems
• swallowing problems
• memory changes
• mood/behavioural changes

Question 7

What information should you gain for the past medical history of the subjective assessment?

Answer 7

• any cardiac medical attention
• any past respiratory medical attention
• any neurological medical attention
• past musculoskeletal, medical attention
• any mental health issues
• any pass surgeries
• any other conditions, for example, diabetes/thyroid problems

Question 8

What information should you get for the drug history section of the subjective assessment

Answer 8

• common conditions specific medication
• for a stroke: anticoagulant, blood pressure, medication
• for MS: immune suppresses
• for Parkinson’s disease: levodopa, dopamine agonist, COMT inhibitors, MOA-B Inhibitors.

Question 9

What other information should you get for the drug history section of the subjective assessment

Answer 9

• any analgesia
• antibiotics
• other medical history
• known allergies

Question 10

What information should you collect for the social history section of the subjective assessment?

Answer 10

• if patient lives, alone/with someone
• any additional support they may need for example, carers/family/neighbours/friends
• mobility status, e.g. walking aids, exercise tolerance
• false history and frequency
• PADLs: washing, dressing, toileting
• ADLs: cooking, housework, shopping
• hobbies – are they still able?
• occupation
• do they drive?
• smoking status
• alcohol intake

Question 11

What are some main problems that patients may want to set as a goal to overcome

Answer 11

• walking
• unable to use upper function
• Poor balance
• unable to get in/out of the car
• Poor cardiovascular fitness
• pain
• stiffness
• Falls
• can’t stand up from a chair
• can’t get out of bed independently