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PHTY3140 > L2-3: Physiotherapy assessment of adults with neurological disorders > Flashcards

L2-3: Physiotherapy assessment of adults with neurological disorders Flashcards

1
Q

What are 3 specific problems/impairments that the process of assessment will identify in clinical reasoning in neurological physiotherapy? What happens after?

A
  1. interfere with the quality of movement
  2. – limit the ability to perform functional activities
  3. – restrict participation in everyday tasks

From this problem list, treatment goals andma treatment program can be developed

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2
Q

What are the 8 stages in the Neurological Physiotherapy Assessment Process?

A
  1. Gathering information from client’s records
  2. Initial Observations
  3. Subjective Examination / Interview
  4. Functional Task Analysis
  5. Impairment Assessment
  6. Objective Outcome Measurement
  7. Gathering Information from Other Therapists/Team Members
  8. Determining the Problem List
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3
Q

In Neurological physiotherapy, it is the _____ (same/different) clinical reasoning process for all clients. Not all of the assessment procedures described will be relevant to every client. It is up to the physiotherapist to determine the exact content of the _____ and the priority / order of the various components based on: Knowledge of the particular neurological condition. Client’s current stage within the continuum of care

A

same; assessment

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4
Q

What are 3 characteristics of patient assessment?

A
  1. The assessment should start with a conversation.
  2. It should not be a list of questions asked without purpose to fill in as much information as possible
  3. KEY PRACTISE TIP
    • If you don’t have a reason to ask that is relevant and key to commencement of your interaction…. STOP! – formulate a WHY
    • Find the reason before continuing with that question
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5
Q

What are 3 ways to extract data in regards to the patient’s history?

A
  1. Written
  2. Verbal
  3. 3rd hand report
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6
Q

What are 3 ways to review client’s records in the neurological assessment?

A
  1. Hospital medical record / chart
  2. Community reports
  3. Referral letter
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7
Q

What are 4 key information that must be extracted for the neurological assessment (client’s records)?

A
  1. pathology
  2. participation restrictions
  3. functional restrictions
  4. impairments
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8
Q

What are 9 key/relevant information from the medical chart (review medical records)?

A
  1. Personal details: name, Date of Birth, next of kin
  2. Diagnosis
  3. Date of Admission to Hospital
  4. History of the Presenting Illness
  5. Relevant Past Medical History eg Cardiovascular, Respiratory, Neurological, Musculoskeletal
  6. Surgical History
  7. Tests: X-rays; Biochemistry; CT scan or MRI, US / Doppler
  8. Medications
  9. Social background
    • Where lives, with whom, type of house, etc.
    • Occupation, interests, e.g. hobbies
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9
Q

Is it possible to get patients with no data?

A

No data? Off the street?

Many times patients will attend directly off the street without a referral… “Mr Physio, I heard you work with balance. I am having trouble picking my feet up and keep falling when walking on the sidewalk”

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10
Q

What are 15 features of the subjective examination in the neurological assessment?

A
  1. Ask relevant questions to establish clinical picture – start with establishing some basic goals of attendance
  2. Use a conversational mode not a stream of questions.
  3. Clarify problems as much as you can beforeproceeding to your objective examination
    • Eg. Falling When do they fall? Why? How frequently?
  4. History of presenting illness
  5. Client’s perception of his/her present level of function
  6. Client’s ability to participate in daily routines, e.g. details of transfers, toileting etc.
  7. Client’s perception of major problems, treatment goals (e.g. most important goal)
  8. Any existing medical symptoms that may affect your treatment e.g. dizziness, chest pain, dyspnoea, arthritis, numbness etc
  9. Vision
  10. Sensation
  11. Pain (where, when, how much, what gives relief)
  12. Hand dominance
  13. Social history
    1. Family
    2. Accommodation
    3. Hobbies
    4. Occupation roles
  14. Previous level of functioning
    • independence level
    • endurance
    • participation in physical activities
  15. Past or present physiotherapy treatment –what did this look like?
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11
Q

What are 3 things you should be able to comment on at the conclusion of the subjective examination in the neurological assessment?

A
  1. Communication problems
    • Clarity of speech, use of words
  2. Cognitive status
    • Matching medical records, making sense
  3. Client’s attitude, motivation and understanding of his/her present symptoms and situation
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12
Q

What are the 5 handling and facilitation principles? What acronym is used?

A
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13
Q

What are 11 initial observations in the neurological assessment?

A
  1. Conscious level
  2. Appearance
  3. Posture or deformities
  4. Skin colour
  5. Skin condition
  6. Oedema
  7. Facial movements
  8. Quality of movement
    • spontaneous and voluntary
    • e.g. Facial symmetry and expression
    • How the get out of a chair / walk to the room
  9. Apparent lack of awareness to self, environment
  10. Aids, orthoses and other equipment
  11. Gait and/or use of wheelchair
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14
Q

What are 4 features of safety that are important in the neurological assessment?

A
  1. Is the patient safe?
  2. Can they engage and not be harmed?
  3. Look at alignment of arms / legs, are they at risk of injury
  4. How do you decide best method to commence your physical examination?
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15
Q

What are 3 safe transfers to the plinth for the objective examination?

A
  1. If in wheelchair
  2. Need to decide on appropriate method of transfer
    • quickly assess active movements in arms, legs and trunk
    • information from chart / patient report
  3. Can you screen / assess for other issues that could impede a safe transfer?
    • Vision?
    • Sensation? (Hypersensitive)
    • Awareness of limbs / self
    • Verticality
    • Sense of balance
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16
Q

What are 5 characteristics of the quick screen in neurological assessment?

A
  1. Muscle activation
  2. Sensation
  3. Vision
  4. Sense of self (Where they are? –> sitting, upright?)
  5. Ability to follow instructions (Can not follow multiple commands)
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17
Q

What are the 2 key questions necessarily to be asked in safe transfers of the neurological assessment?

A
  1. Do you need one person or two?
  2. What level of assistance are you expecting to provide?
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18
Q

What are 2 solutions if you feel unsafe in transfers in the neurological assessment?

A
  1. Ask another therapist to assist in a two person controlled transfer
  2. If a standing transfer is not possible:
    • do a sliding transfer
    • use a hoist

Always observe the NO LIFT POLICY

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19
Q

What are 5 actions if you feel safe in transfers in the neurological assessment?

A
  1. Assist the patient to stand up before proceeding to transfer
  2. Note:
    • posture
    • balance
    • control at the hip and knee with loading
  3. Decide if you can safely transfer the patient
  4. Give the assistance necessary for a safe controlled transfer
  5. While doing so note:
    • posture
    • balance
    • weight shift
    • movement of the affected side
    • amount of assistance needed (from standby to maximal)
    • effect of effort on movement
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20
Q

What are 11 functional activities in the physical examination?

A
  1. Lifting bottom up off bed
  2. rolling
  3. sit up/lie down
  4. sitting activities (balance)
  5. standing up and sitting down
  6. Moving from one point to another (transfers)
  7. standing activities (balance)
  8. walking
  9. going up / down stairs / curbs
  10. running
  11. arm limb function (support, reach, grasp and manipulation)
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21
Q

In the physical examination of ORDER, you should always start with __________.

A

Functional Analysis of Task (FAT)

Able to screen but very unlikely to do a formal examination first. FAT is more important. Assessment might only be occasional (can activate muscle in one position but cannot in others)

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22
Q

What is the FAT stand for?

A

Functional Analysis of Task

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23
Q

What is the purpose of the Functional Analysis of Task (FAT)?

A

Analysis of movement quality and control during the performance of functional tasks

Highlights other areas that require detailed assessment…. Never test impairments until you have seen the patient do as many functional tasks as possible. WHY?

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24
Q

What are the 4 steps in ORDER of FAT?

A
  1. Request them to stand up, walk, reach
  2. Observation of the functional movement
  3. Observe deviations from normal movement
  4. Observe the essential components of the task that are present or absent or where control is poor
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25
Q

What is the next 2 steps after FAT in the physical examination?

A
  1. Functional analysis task
  2. Observe the movement disorder
  3. Consider why the movement is abnormal…think back to pathology
    • inability to selectively activate the appropriate muscles
    • altered tone
    • difficulty initiating movement
    • incoordination
    • sensory, visual or perceptual impairments
    • motor planning problems
    • loss of muscle or neural length or joint range of movement
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26
Q

What are 5 examples of DIRECT in ORDER in the physical exam?

A
  1. Can you stand up with your feet in line?
  2. Can you take bigger steps?
  3. Can you step over the line?
  4. Can you reach for the cup?
  5. Add in auditory cues… can you stand UP, UP , UP

OBSERVE FOR IMPROVED MOVEMENT

Sometimes not always muscle activation but due to apraxia (where patient has difficulty motor planning)

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27
Q

What are 2 movement components to record for each functional task?

A
  1. record any missing essential components
  2. describe any abnormal movements or strategies employed by the patient
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28
Q

What does E stand for in ORDER of the physical exam? What is the main purpose?

A

ENHANCE

Enhance the movement (usually done with DIRECT)

  • Add in some sensory or visual cues?
    • Feel the foot to the ground?
    • Enhance the muscle activation with load, compression, quick stretch, tactile input .
    • Enhance muscle relaxation or timing with speed
    • Can you see your feet , knee? Bend it more.

OBSERVE FOR IMPROVED MOVEMENT

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29
Q

What does R stand for in ORDER of the physical exam? What is the main purpose?

A
  • Replace with hands, aid, splint (always done with DIRECT and sometimes ENHANCE)
  • Observe is the movement quality improve?
30
Q

What are the 7 levels of independence for each functional task in the physical exam?

A
  1. independent
  2. requires supervision – close / distance
  3. requires verbal cuing
  4. requires minimal physical assistance x 1
  5. requires moderate physical assistance x 1
  6. requires physical assistance x 2
  7. unable to perform even with maximal assistance
31
Q

What are the 7 casual factors that link back to pathology and subjective (reasons for the abnormal task performance) for each functional task in the physical exam?

A
  1. lack of isolated control / selective movement
  2. abnormal tone (Eg. stiff and rigidity)
  3. decreased sensation
  4. decreased vision
  5. inattention
  6. decreased ROM
  7. pain etc.
32
Q

What are 2 things to observe when watching a patient video?

A
  1. View how the movement is enhanced with visual, tactile input / verbal support
  2. Consider possible causes / reasons they are unable to move
    • If you request a movement and it occurs – evidence of muscle activation
    • So why did they not move?
    • If you request a movement and it does not occur – evidence of possible motor deficits +
33
Q

Where to begin in the objective examination?

A

ALWAYS FUNCTION!

  • Be flexible about order of assessment of functional tasks
  • Higher level client - may assess standing balance and gait first
  • Lower level client - may lie down first and assess rolling … because they cannot stand with assistanc
34
Q

What are the 2 exams of the ENHANCE and REPLACE section of the physical examination?

A
  1. Exploring why a patient moves poorly
  2. Must link multiple functional movements to streamline your assessment
35
Q

What are the 2 characteristics of the impairment exploration?

A
  1. Quality of active movements
  2. Flexibility and muscle tone
36
Q

What is the purpose of “voluntary movement” in impairment exploration? What are 3 examples of what to ask?

A

Determine the amount and quality of voluntary movement the client is capable of producing (“movement return”)

37
Q

What are 3 questions to ask in the voluntary movement in impairment exploration?

A
  1. Was the client capable of antigravity movement?
  2. Was the client capable of antigravity movement through the full range?
  3. How much assistance was required? What type of assistance? Request? Direct? Enhance? Replace?
38
Q

What are 3 charcateristics of the “ quality of movemen” in voluntary movement in impairment exploration?

A
  1. Selectivity of movement
    • Was the movement performed in an isolated /selective manner i.e. was it normal?
  2. Presence of abnormal patterns of movements
    • e.g. Dorsiflexion only possible with hip and knee flexion
  3. Speed
  4. Control
  5. Endurance
39
Q

What are 3 questions to ask that “influence the quality of voluntary movement” (voluntary movement) in impairment interpretation?

A
  1. Did loss of muscle length or joint range affect active movement?
  2. Did sensory loss affect movement?
  3. What other impairments could be affecting movement quality?
40
Q

How is the impairment interpretation tested?

A

Movements are tested in appropriate positions while the patient is in that position – at times must consider two joint muscles and activation during function

41
Q

What are 6 characterisics of “sitting” as a quality of active movements in impairment interpretation?

A
  1. anterior and posterior pelvic tilt
  2. weight shift - anterior/posterior and lateral
  3. hip and knee flexion
  4. knee extension
  5. ankle dorsiflexion and plantarflexion
  6. ankle eversion and inversion
42
Q

What are 6 characterisics of “supine” as a quality of active movements in impairment interpretation?

A
  1. Hip & knee flexion and extension
  2. Hip abduction with the knee in extension
  3. Hip flexion with knee extension
  4. Dorsiflexion with the knee in extension
  5. Ankle inversion / eversion
  6. Toe extension / flexion
43
Q

What are 2 characterisics of “prone/sidelying” as a quality of active movements in impairment interpretation?

A
  1. hip extension
  2. knee flexion
44
Q

What is a characterisic of “sidelying” as a quality of active movements in impairment interpretation?

A

hip abduction

45
Q

What are 2 characteristics of flexibility and muscle tone in impairment interpretation (passively move the limb)?

A

Passively move the limbs

  1. muscle tone changes
  2. loss of muscle length, neural length and joint range of movement
46
Q

What are 4 characteristics of flexibility and muscle tone in impairment interpretation (potential problems)?

A
  1. Joint stiffness
  2. Decreased muscle length
  3. Decreased neural length
  4. Increased or decreased muscle tone
47
Q

What are 4 things to assess in flexibility and muscle tone in impairment interpretation?

A
  1. Joint ROM
  2. Muscle length
  3. Neural length
  4. Muscle tone
48
Q

What are 3 features when assessing muscle tone in flexibility and muscle tone in impairment interpretation?

A
  1. Is there overactivity at rest?
    • Reflex influence?
    • Influence of head or body position?
  2. Is there increased muscle tone with effort?
  3. Also note tremor, rigidity, chorea or other involuntary movements
49
Q

What are 4 features when assessing muscle power in flexibility and muscle tone in impairment interpretation?

A
  1. If there is muscle weakness and
  2. Movements are totally isolated in all positions
  3. Perform muscle strength tests on standard charts – BUT THROUGH RANGE OF TASK
  4. In the presence of abnormal tone or lack of isolated movement, this is inappropriate
50
Q

What are 6 features when assessing somato-sensation in impairment interpretation?

A
  1. If poor sensation is implied by movement quality or expected due to underlying pathology
  2. Initially test for primary sensory loss
  3. Primary sensory loss
    1. light touch
    2. passive movement sense
    3. joint position sense
  4. If primary senses intact
  5. Test interpretative aspects
    • bilateral simultaneous stimulation
    • stereognosis
  6. May also test
    • Pain (sharp / blunt)
    • Temperature (hot / cold)
51
Q

What are 4 characteristics of vision in the impairment interpretation?

A
  1. Acuity
  2. Eye movements
    • eye follow (pursuits)
    • voluntary saccades
    • convergence/divergence
    • nystagmus
  3. visual field loss: hemianopia /quadrantanopia
  4. visual inattention
52
Q

What is the visual field loss look like?

A
53
Q

Impairment interpretation depends on the nature (neuro-anatomy and physiology) of the _____ some areas will be more relevant for continued assessment.

A

neurological deficit

54
Q

What are 8 other impairment assessment areas?

A
  1. Vestibular function
  2. Motor planning / apraxia
  3. Perception
  4. Cranial nerves including vision/orofacial function
  5. Pain
  6. Coordination
  7. High level balance and walking skills
  8. Cardiovascular and respiratory endurance
55
Q

What is the Objective Outcome Measurement for the neurological assessment process?

A

Choose most relevant for pathology, function, goal of assessment

Done last –>not very important to get an objective measure –> rather get more information with subjective measures

56
Q

When is the Objective Outcome Measurement for the neurological assessment process done?

A

Done last –> not very important to get an objective measure –> rather get more information with subjective measures

57
Q

What are 5 measurements of motor function?

A
  1. Impairment measures
    • Sensation, muscle power, muscle tone,
  2. unilateral neglect
  3. Functional mobility measures
  4. Standing Balance Tests
  5. Composite Scales
    • Motor Assessment Scale
    • Elderly Mobility Scale
58
Q

What are the objective outcome measurement that are integrated into the assessment process?

A
  1. If you are analysing standing balance you should incorporate one or more appropriate objective measures of standing balance
  2. Choosing tasks must consider normal movement
  3. When you are analysing the task of lying to sitting, with a client who has suffered a stroke, it would be appropriate to complete the relevant section of the Motor Assessment Scale
  4. Can be done formally (quiet room, 3 trials) or informally
59
Q

What are 3 other team members for neurological assessment?

A
  1. Occupational therapist
  2. Speech therapist
  3. Social worker
60
Q

What are 3 information from an occupational therapist for the neurological assessment?

A
  1. Perceptual
  2. Memory and Cognition
  3. Specific ADL problems
    • e.g. dressing, bathing, kitchen skills
61
Q

What are 3 information from a speech pathologist for the neurological assessment?

A
  1. Speech impairments and results of specific tests
  2. Hints for management of speech problems during physiotherapy sessions
  3. Swallowing disorders and their management
62
Q

What are 2 information from a social worker in the neurological assessment?

A
  1. patient’s family and social situation
  2. likely placement /care arrangements following discharge from hospital
63
Q

What do you do on completion of the neurological physiotherapy assessment process?

A
  • Assimilate all of your findings
  • Establish the client’s problem list
  • A concise but thorough summary of the client’s problems
  • You should also attempt to prioritise the problems on the list
  • You must relate function to underlying impairments – e.g. Unable to transfer independently due to poor hip and knee control, poor balance. Lacks adequate hip extensors concentrically and knee extensors eccentrically, overactive and tight hip flexors
64
Q

What are 3 features in the problem list?

A
  1. functional problems
  2. primary impairments
  3. secondary impairments
65
Q

What are the steps in the clinical reasoning process?

A
  1. Evaluation – Initial Physiotherapy Assessment
  2. Assimilation of assessment findings into problem list
  3. Setting goals with the client
  4. Treatment Planning and Implementation
  5. Measure outcomes (reassessment) / modifying goals and upgrading treatment plan
66
Q

What is the Motor Assessment Scale (MAS)?

A

Patients post stroke

  • 8 Functional tasks
  • Performance, quality

Limitation

  • No assessment of transfers and wheelchair skills
  1. supine to sidelying
  2. Supine to sitting
  3. Balanced sitting
  4. Sitting to standing
  5. Walking
  6. Upper arm function
  7. Hand activites
  8. Advanced hand activities
67
Q

What are 8 movements in Motor Assessment Scale (MAS)?

A
  1. supine to sidelying
  2. Supine to sitting
  3. Balanced sitting
  4. Sitting to standing
  5. Walking
  6. Upper arm function
  7. Hand activites
  8. Advanced hand activities
68
Q

What is the score of the Motor Assessment Scale (MAS)?

A
  • Score from 0-6
    • 0 = completely dependent
    • 6 = independent, efficient function
  • Total score = 48
  • Item score can be used seperately
  • Sitting ability at 6 weeks has been shown to be predictive of long term outcome
69
Q

What are 7 characteristics of the MAS (with each item being recorded on a scale of 0-6)?

A
  1. 7 point ordinal scale
  2. Ordinal scale should not be tallied
  3. Scales were developed according to the author’s knowledge of the recovery of motor function post stroke
  4. Detailed scoring criteria are provided for levels 1-6
  5. No scoring criteria provided for level 0
    • If the patient cannot complete the activity required for a score of 1 then they should be scored 0 for that item.
  6. Patients are given the score for the last item they can achieve for items 1-6
  7. Items 7 and 8 need to have a score allocated for each tasks
    • E.g. item 8 if able to pick up jellybeans and comb hair, but unable to draw horizontal lines tick for those achieved and mark an X for those not achieved.
70
Q

What are 4 characteristics of motor guideline?

A
  1. The test should preferable be carried out in a quiet private room or in a curtained off area
  2. Allocate one low wide plinth (with curtains) in your facility as the MAS testing area
  3. Ensure only the standardised equipment is used
  4. Every test area should have a MAS test kit
    • Keep equipment in an appropriate box
    • Never move box from the test area
    • Don’t use kit equipment for other purposes

PHTY3140 (28 decks)

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