Week 1 - Assessment process Flashcards
Overall goal during assessment process
To discover what the patient’s problem is and provide a programme of treatment and exercises to improve things.
Key elements of a physiotherapy assessment
- Subjective interview / history
- Physical assessment
- Treatment
Why subjective interview?
- Build rapport
- Find out patient’s problem and what
they want to achieve - Functional problems:
- Activity limitations
Participation Restrictions - Find out patient’s
“story” - Begin to form hypothesis about cause
- Increase effectiveness of Rx outcome
Why physical assessment?*
- Gather baseline data:
Assessment (function, impairments)
Measurement
“Comparable signs” (impairments)
Test your hypothesis re cause:
contractile / non-contractile tissue
peripheral nerves
CNS
Other … eg metabolic, surgery … - Inform treatment / management plan
Assessment
- Provides a clinical picture
- Gathering of information (some
subjective) & measurements - Skill develops over time and with
clinical experience
E.GS - Subjective assessment
- patient’s
perspective is the most important
Changes in quality of movement
Often based on “feel” eg end-feel,
palpation
BUT - Is often subjective
- May not reflect change accurately
Measurement
- More precise / “objective
- Usually uses numerical outcomes
Tends to use a standardised method
more precise comparison over time
clear communication tool with others
can be used as a clear outcome measure
to motivate patients
BUT - Focuses on impairments - can change
but function stay the same
Does not provide the whole clinical
picture
Mr Singh has had a recent TKR but tells you that his knee feel swollen
and it feels as if it is going to give way when he stands up.
How would we assess?
- Might ask Mr Singh to explain in
more detail what he feels - Might ask him about his surgery,
expectations, health beliefs etc - Might assess his functional
movements - Might assess
“end feel” of knee
joint - Might assess nerve function etc
Mr Singh has had a recent TKR but tells you that his knee feel swollen
and it feels as if it is going to give way when he stands up.
How would we measure?
- Might measure the amount of
swelling around Mr Singh’s knee
(tape measure) - Might measure his AROM and
PROM - Might measure his muscle strength
- Might time how long it takes him
to get up from a chair and walk 5m
The physical assessment process
OVERVIEW
Observation
Functional assessment / assessment of activity limitation - how do you choose this?
What are you looking for?
AROM / PROM - joint movement measurement
Muscle Length tests
* Muscle performance measurement:
Isometric (quick) screening test of a muscle
MMT for more thorough muscle performance test
* Special tests for diagnostic purposes eg sensation testing (dematomes or nerve
distribution)
* Joint issues eg ligament tests, accessory joint movements
* Palpation - eg to see what is painful, to assess inflammation
Which factors may influence AROM?
- Muscle performance:
Nerve supply - blood supply
- inflammation after injury
pain inhibition
weakness (why might someone develop weakness?) - PROM factors!
Which factors may influence PROM?
- Muscle length
- Swelling
- Pain
- Non-contractile tissue:
Ligaments - Joint capsule limitations
- Joint pathology (eg OA, RA)
- Bone healing after fracture
Skin issues eg burns
Common injuries found around the knee ANTERIOR
Superior: Quadriceps Tendonitis
Quads Tendon Rupture
Lateral: ITB Syndrome
Lateral Meniscus Tear
LCL Injury
Dislocated Patella
Inferior: Patellar Tendonitis
Osgood Schlatters Disease
Osteochondritis Dissecans
SLJ Disease
Infrapatellar Bursitis
Patella: Patellofemoral Pain Syndrome
Chondromalacia Patella
Arthritis
Housemaids Knee
Bipartite Patella
Medial: MCL Sprain
Medial Meniscus Tear
Arthritis
Medial inferior: Medial Plica Syndrome
Pes Anserine Bursitis
Common injuries found around knee POSTERIOR
Lateral: Biceps Femoris
Tendinopathy
Behind knee: Bakers Cyst
Arthritis
ACL Tear
PCL Tear
Hyperextension
Lateral inferior: Lateral Head
Gastrocnemius Tear
Medial: Hamstring
Tendinopathy
Medial inferior: Medial Head
Gastrocnemius Tear
Inferior (calf): Calf Muscle Cramps
Calf Tear
DVT
SOAPIER ‘physio process’
- Gathering information
- Subjective assessment (S): what the patient says about their current status
- Objective assessment (O): what the therapist observes, tests and measures - Analysing the findings and making a plan (A & P)
- Performing a treatment/intervention (1)
- Evaluation of the intervention (E)
- Reassessment (and refer on as appropriate) (R)
This an objective assessment may include
- Observation
- Functional assessment
- Palpation
- Range of movement: e.g. Goniometry
- Muscle performance: e.g. Manual muscle testing (MMT)
- Balance assessment: e.g. Berg Balance Scale
