Week 6&7 Clinical Reasoning Flashcards
What does neurological physiotherapy assessment lead to?
Identification of clients impairments that limit ability to perform everyday functional activites or restrict participation in everyday societal roles
- The setting of SMART goals
- A tailored treatment plan for the individual
What is the subjective assessment?
- Gathering information from client’s records
- Interview wit client and relative/carers
- Gathering information of the MDT.
What is the objective examination?
- General observations
- Risk Assessment
- Functional Task Analysis
- Impairment Assessment
- Objective Outcome Measurement
What is the physiotherapist assessing in the subjective assessment?
– Activity
– Participation
– Environmental factors
– Personal factors
Where may subjective information originate form?
– The client
– Relatives or carers
– Members of the multidisciplinary team
How can subjective information be gathered?
– Interview with the client – Conversation with relatives or carers – Discussions with members of the MDT – Hospital medical record / chart – Community MDT reports – GP Referral letter
Components of the subjective examination
Personal details: Name, Address, Date of Birth, Next of kin
Informed consent
Present complaint
– Diagnosis
– The client’s main problem (s) at the present time
– The client’s goals and expectations of physiotherapy
• History of present complaint
Past Medical History
- Surgical History
- Medications
• Equipment / technology dependency
• Dominance
Vision
• Hearing
• Sensation e.g.
Pain
• Social history – Family situation / support – Accommodation – Hobbies / interests – Occupation • Client's perception of his/her present level of function • Client's ability to participate in daily routines, e.g. details of transfers, toileting etc.
Information that you should gather from the OT
• Details of testing in the following areas: – Perceptual – Memory and Cognition – Specific ADL problems • e.g. dressing, bathing, kitchen skills
Information you should gather form the speech pathologist
– Speech and language impairments
• Details to guide your communication approach during
physiotherapy sessions
– Swallowing impairments and any eating/drinking
instructions e.g. no thin fluids
Information to be gathered from other team members
• Social Worker
– Patient’s family and social situation
– Likely placement /care arrangements following
discharge from hospital
Components of the O/E
General Observations Risk Assessment Functional Task Analysis Impairment Assessment Objective Outcome Measurement
Aims of O/E:
• Identify the client’s movement problems and the potential
causes of those problems
– To ensure treatment is focussed appropriately
• Provide a baseline from which:
– Goals can be made with the client
– Treatment effectiveness can be evaluated
General observations during O/E
• Conscious level • Posture or deformities • Skin colour • Skin condition • Oedema • Quality of movement – spontaneous and voluntary – e.g. Facial symmetry and expression • Apparent neglect • Aids, orthoses and other equipment • Gait and/or use of wheelchair on arrival to physiotherapy
- Cognition
- Behaviour
What are the levels of independence?
– independent
– requires supervision
– requires verbal cuing
– requires minimal physical assistance x 1
– requires moderate physical assistance x 1
– requires physical assistance x 2
– unable to perform
Possible causes of a movement disorder
Possible causal factors: – Muscle weakness – Spasticity – Somato‐sensory, visual, vestibular or perceptual impairments – In‐coordination – Motor planning impairments – Difficulty initiating movement – Pain – Decreased joint ROM – Decreased muscle or neural length
Components of Impairment Assessment
Components • Strength and dexterity/co ordination • Flexibility – joint, muscle and neural length • Spasticity • Somato‐sensation • Vision Vestibular function • Motor planning / apraxia • Perception • Cranial nerves including vision/orofacial function • Pain • High level balance and mobility skills • Cardiovascular and respiratory endurance
Vision tests
Vision – Acuity – Eye movements • eye follow (pursuits) • voluntary saccades • convergence/divergence – visual field loss: hemianopia /quadrantanopia – visual inattention
Somato-sensation tests
• If primary somato‐sensation is intact
• Test somato‐sensory perception
– bilateral simultaneous stimulation
– stereognosis
Measurement in Neurological Physiotherapy includes:
- Impairment measures
– sensation, muscle power, spasticity, unilateral neglect etc - Functional mobility measures
- Standing Balance Tests
- Composite Scales e.g. Motor Assessment Scale
In practice these measures are integrated into the assessment
process
What are specific aims?
- Specific Aims
• Establish all specific aims that are relevant to achieving each
short term goal
• Consider all primary and secondary impairments that must be
addressed to enable the person to achieve the short term goal
e.g.
– increase strength in left hip extensors from grade 2 to grade
3 in one week
Progress reports should includee
– Changes in observations and measurements of activity or
impairments
– A re‐statement of goals in the light of the above changes
– An upgraded treatment plan
