Week 6&7 Clinical Reasoning

Question 1

What does neurological physiotherapy assessment lead to?

Answer 1

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

Question 2

What is the subjective assessment?

Answer 2

• Gathering information from client’s records
• Interview wit client and relative/carers
• Gathering information of the MDT.

Question 3

What is the objective examination?

Answer 3

• General observations
• Risk Assessment
• Functional Task Analysis
• Impairment Assessment
• Objective Outcome Measurement

Question 4

What is the physiotherapist assessing in the subjective assessment?

Answer 4

– Activity
– Participation
– Environmental factors
– Personal factors

Question 5

Where may subjective information originate form?

Answer 5

– The client
– Relatives or carers
– Members of the multidisciplinary team

Question 6

How can subjective information be gathered?

Answer 6

– 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

Question 7

Components of the subjective examination

Answer 7

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.

Question 8

Information that you should gather from the OT

Answer 8

• Details of testing in the following areas:
– Perceptual
– Memory and Cognition
– Specific ADL problems
• e.g. dressing, bathing, kitchen skills

Question 9

Information you should gather form the speech pathologist

Answer 9

– 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

Question 10

Information to be gathered from other team members

Answer 10

• Social Worker
– Patient’s family and social situation
– Likely placement /care arrangements following
discharge from hospital

Question 11

Components of the O/E

Answer 11

General Observations
Risk Assessment
Functional Task Analysis
Impairment Assessment
Objective Outcome Measurement

Question 12

Aims of O/E:

Answer 12

• 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

Question 13

General observations during O/E

Answer 13

• 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

Question 14

What are the levels of independence?

Answer 14

– 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

Question 15

Possible causes of a movement disorder

Answer 15

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

Question 16

Components of Impairment Assessment

Answer 16

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

Question 17

Vision tests

Answer 17

Vision
– Acuity
– Eye movements
• eye follow (pursuits)
• voluntary saccades
• convergence/divergence
– visual field loss: hemianopia /quadrantanopia
– visual inattention

Question 18

Somato-sensation tests

Answer 18

• If primary somato‐sensation is intact
• Test somato‐sensory perception
– bilateral simultaneous stimulation
– stereognosis

Question 19

Measurement in Neurological Physiotherapy includes:

Answer 19

1. Impairment measures
   – sensation, muscle power, spasticity, unilateral neglect etc
2. Functional mobility measures
3. Standing Balance Tests
4. Composite Scales e.g. Motor Assessment Scale
   In practice these measures are integrated into the assessment
   process

Question 20

What are specific aims?

Answer 20

3. 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

Question 21

Progress reports should includee

Answer 21

– 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