Neurological Assessment

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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 anddecisionwhen 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]. So 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.

So for the proper neurological assessment, we can use aSOAPformat 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.
  • 以前的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.
  • Special Equipment, Technology Dependency.
  • 以前的Surgery.
  • Medication History.
  • History of any allergies.

Personal History[edit|edit source]

Marital status, occupation,

活动

  • 没有rmal Daily Routine.
  • 就业。
  • Leisure Activities.
  • Smoking and drinking habits.

流动性

  • General
  • Indoor
  • Outdoor
  • Steps & Stairs
  • Falls

Personal Care

  • Washing
  • Continence
  • Dressing

Other

  • Vision.
  • Hearing.
  • Swallowing.
  • 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.

Socioeconomic History[edit|edit source]

  • Family income source
  • Relationship with community people
  • Social Situation
  • Family Support
  • Accommodation
  • Social 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

[4]

  1. Postureand Balance
  • Alignment and attitude of limbs
  • Neglect
  • SittingBalance
  • Standing Balance

Vital Signs[edit|edit source]

Vitals signsinclude

On Examination[edit|edit source]

Higher mental function[edit|edit source]

Level of consciousness:Glasgow 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]

Perception:[edit|edit source]

Common tools to assess perceptual problems are:

  • Star Cancellation Test.
  • Line Bisection Test.
  • Clock Drawing Test.

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

[8]

Sensory examination[edit|edit source]

SuperficialSensation[edit|edit source]
  • Pain
  • Temperature
  • Touch
  • Pressure
Deep Sensation[edit|edit source]
Cortical Sensation[edit|edit source]
  • Tactile Localization
  • 2 point discrimination
  • Stereognosis
  • Barognosis
  • Graphesthesia
  • Texture Recognition
  • Double Simultaneous Stimulation

Motor examination[edit|edit source]

[9]

Tone[edit|edit source]
Range of Motion[edit|edit source]
Strength[edit|edit source]

Manual Muscle Testing (MMT)orMyotomescan be used.

Endurance[edit|edit source]
  • Muscular
  • Cardiovascular
Reflexes[edit|edit source]

[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

Coordination[edit|edit source]

Gait[edit|edit source]

  • Step Length
  • Stride Length
  • Base width
  • Cadence
  • 生物力学的偏差

Other System review[edit|edit source]

Functional Assessment[edit|edit source]

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]

  • Short term goal
  • Long term goal

Treatment[edit|edit source]

Re-assessment[edit|edit source]

Re-assessment includes re-testing 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.

参考文献[edit|edit source]

  1. ↑Johnson J, Thompson AJ.Rehabilitation in a neuroscience centre: the role of expert assessment and selection.British Journal of Therapy and Rehabilitation. 1996 Jun;3(6):303-8.
  2. ↑O'Sullivan SB, Schmitz TJ, Fulk G.Physical rehabilitation.F6th Edition.A Davis; 2019 Jan 25.
  3. ↑Neurological Physiotherapy Evaluation Form. Available from:https://fac.ksu.edu.sa/sites/default/files/neurological_physiotherapy_evaluation_form_2_0.pdf. Lasted accessed: 4.3.2021
  4. ↑Life Changing Surgery Halts Essential Tremors & Parkinson's Disease Symptoms. Available from:https://www.youtube.com/watch?v=8pGGGMUObQ4Lasted accessed: 2021.4.3
  5. ↑Glasgow Coma Scale made easy. Available from:https://www.youtube.com/watch?v=h2SIN7Mn0YA. Lasted accessed: 2021.4.3
  6. ↑Cognition. Stroke engine. Available from:https://strokengine.ca/en/assessments-by-topic/#assess-cogLasted accessed: 2021.4.3
  7. ↑PHYSIOTHERAPY EVALUATION IN NEUROLOGICAL PATIENTS.Ozden Gokcek and Esra Dogru Huzmeli. Hatay Mustafa Kemal University Health Science Faculty, Physiotherapy and Rehabilitation Department,Hatay, Turkey
  8. ↑greeky Medics. Cranial Nerve Examination - OSCE Guide (New Version). Available from:https://www.youtube.com/watch?v=sJBpai74tlU. Lasted Accessed: 2021.4.3
  9. ↑UBC Medicine - Educational Media. UBC Medicine Neurology Clinical Skills - Motor, Sensory, and Reflex ExaminationAvailable from:https://www.youtube.com/watch?v=5ob5uJMgZOsLasted accessed: 2021.4.3
  10. ↑How to test the Neurological Babinski Reflex for Upper Motor Neurone Lesion. Available from:https://www.youtube.com/watch?v=vkM-xX7KRR4. lasted accessed: 2021.4.3
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