Neurological Assessment: Difference between revisions

Introduction[edit|edit source]

In order to provide the best care and plan the best treatment a thorough assessment must be undertaken. It is the most important step in the rehabilitation process, helps to guide our clinical reasoning and decision when making informed decisions about the rehabilitation process. Johnson & Thompson (1996) outlined that treatment can only be as good as the assessment on which it was based^[1]。年代o in order for us to progress and manage our treatment plan and ensure we are identifying out patients problems the assessment should be an ongoing and continuous process. A neurological assessment focuses on the nervous system to assess and identify any abnormalities that affect function and activities of daily living. It should allow us to create individual, patient-centred goals and ultimately a tailor-made treatment plan based on the client's needs.

年代o for the proper neurological assessment, we can use a年代OAPformat as a guide. Below we have a systematic flow for the assessment of the neurological patient.

主观评价[edit|edit source]

The subjective assessment is used to provide a detailed picture of how the present condition affects the patient.^[2]

Demographic Data[edit|edit source]

Name, Age, Gender, Occupation, Dominant hand, Address.^[3]

Chief Complain[edit|edit source]

What is his/her present complaint or problem for which he/she has visited you?

History of Present Condition[edit|edit source]

• Progression of the Condition.
• Date of Onset of Signs & Symptoms.
• Medical Management.
• Medical Observations.
• Other management.
• Previous Therapy.
• Results of Specific Investigations (X-rays, CT Scans, Blood Tests.....etc

Past Medical History[edit|edit source]

• Co-morbidities and other non-related conditions.
• 年代pecial Equipment, Technology Dependency.
• Previous Surgery.
• Medication History.
• History of any allergies.

Personal History[edit|edit source]

Marital status, occupation,

Activity

• Normal Daily Routine.
• Employment.
• Leisure Activities.
• 年代moking and drinking habits.

Mobility

• General
• Indoor
• Outdoor
• 年代teps & Stairs
• Falls

Personal Care

• Washing
• Continence
• Dressing

Other

• Vision.
• Hearing.
• 年代wallowing.
• Fatigue.
• Pain.
• Perceptions of own Problems/Main Concern.
• Expectations of Treatment.

Family History[edit|edit source]

Total number of family members, his/her primary caretaker.

年代ocioeconomic History[edit|edit source]

• Family income source
• Relationship with community people
• 年代ocial Situation
• Family Support
• Accommodation
• 年代ocial Service Support

Objective Assessment[edit|edit source]

On Observation[edit|edit source]

1. Built
2. Gait
3. Pattern of Movement
4. Mode of Ventilation
5. Type/ Pattern of Respiration
6. Oedema
7. Muscle Wasting
8. Pressure Sores
9. Deformity
10. Wounds
11. External Appliances
12. Involuntary Movement
    • Tremor
    • Clonus
    • Chorea
    • Associated Reactions

^[4]

1. Posture and Balance

• Alignment and attitude of limbs
• Neglect
• 年代itting Balance
• 站在平衡
  

Vital Signs[edit|edit source]

Vitals signsinclude

• Respiratory rate
• Temperature
• Pulse rate
• Blood pressure
• O2 saturation

On Examination[edit|edit source]

Higher mental function[edit|edit source]

Level of consciousness:Glasscow coma scale (GCS)[edit|edit source]

^[5]

Communication:[edit|edit source]

Aphasia ( Broca's, Wernicke's, Global)

Cognition:[edit|edit source]

• Orientation:
  • Person:
  • Place:
  • Time:
• Calculation:
• Registration:
• Attention:
• Proverb Interpretation:
• Memory:
  • Immediate:
  • Recent:
  • Remote:
  • Verbal:
  • Visual:
• Language
• Visuospatial proficiency

There are various outcome tools via which we can address his/her cognitive status incorporating various components.^[6]

• Mini-mental Status Examination
• Mini-Cog
• Montreal Cognitive Assessment (MoCA)

Perception:[edit|edit source]

• Body Scheme/ Body Imaging
• Neglect
• Agnosia
• Apraxia^[7]

Common tools to assess perceptual problems are:

• 年代tar Cancellation Test.
• Line Bisection Test.
• Clock Drawing Test.

Cranial nerve (CN) examination[edit|edit source]

^[8]

年代ensory examination[edit|edit source]

年代uperficial年代ensation[edit|edit source]

• Pain
• Temperature
• Touch
• Pressure

Deep Sensation[edit|edit source]

• Movement Sense
• Position Sense
• Vibration Sense

Cortical Sensation[edit|edit source]

• Tactile Localization
• 2 point discrimination
• 年代tereognosis
• Barognosis
• Graphesthesia
• Texture Recognition
• Double Simultaneous Stimulation

Motor examination[edit|edit source]

^[9]

Tone[edit|edit source]

• Decreased / Flaccid
• Increased
  年代pasticity(Clasp-knife)
  Rigidity(Cogwheel or Lead Pipe)
• Outcome tools-Modified Modified Ashworth Scale (MMAS)andTardieu Scale

Range of Motion[edit|edit source]

年代trength[edit|edit source]

Manual Muscle Testing (MMT)orMyotomescan be used.

Endurance[edit|edit source]

• Muscular
• Cardiovascular

Reflexes[edit|edit source]

• Deep TendonReflexes
  Biceps (C5/6)
  Triceps (C7/8)
  Knee (L3/4)
  Ankle (S1/2)
• Plantar Response (Babinski’s Sign)

^[10]

Tightness/Muscle Length Testing[edit|edit source]

Limb length measurement[edit|edit source]

Limb girth measurement[edit|edit source]

Balance(Static and Dynamic)[edit|edit source]

Outcome tools:Berg balance scale,Timed up and go test (TUG),BESTest

Co-ordination[edit|edit source]

• Equilibrium
• Non-equlibrium
• Romberg's test

Gait[edit|edit source]

• 年代tep Length
• 年代tride Length
• Base width
• Cadence
• Biomechanical Deviations

Other System review[edit|edit source]

• Integumentary system:年代kin Status,Pressure Sores
• Respiratory system:RS Status, Secretions, Pattern of breathing, Chest wall/Thoracic spine deformity
• Cardiovascular system:年代tatus:Deep Vein Thrombosis
• Musculoskeletal system:Contractures, Subluxations, Joint mobility, Other pathology
• Bowel and bladder function:尿失禁
• 消化系统:年代tatus
• Autonomic system:Vasomotor,Pseudomotor, Trophic Changes,Postural Hypotension,Reflex Sympathetic Dystrophy

Functional Assessment[edit|edit source]

• Functional Independence Measure
• Modified Barthel Index

Assessment[edit|edit source]

Problem List[edit|edit source]

Problem list can be generated fromInternational Classification of Function, Disability, and Health (ICF).

Physiotherapy Diagnosis/Functional Diagnosis[edit|edit source]

Plan[edit|edit source]

Goal Setting[edit|edit source]

• 年代hort term goal
• Long term goal

Treatment[edit|edit source]

Re-assessment[edit|edit source]

Re-assessment includes retesting objective measures such as outcome tools after a certain period of intervention. It helps to know the progression of the patient and in the determination of time to achieve the goal set. In re-assessment, it is very necessary to assess both facilitators and barriers for a better outcome. it is vital to let the patient, patient party, and other health professionals know about the result of the re-assessment and compare it with previous assessment results. It helps to plan further in treatment strategies.

References[edit|edit source]