Saturday, November 27, 2010

Physiotherapy Assessment of Hemiplegia

Patient ID                               :
Name                                       :                                              
Age & Gender                                    :
Address                                   :                                               Primary Language                   :
Occupation                              :
Life Style                                :           Non Smoker:               Smoke             /Day
                                                            No Alcoholic:              Alcohol           /Day
                                                            No Exercise:                Exercise           /Day
Living Environment                :           Home and Work Barriers
History                        :
Current condition            :

Past Medical/Surgical     :

Medications                :
Lab investigations       :           Hb                               :
                                                ESR                             :
                                                Blood sugar (F)           :
                                                Blood sugar (PP)         :
                                                Serum Electrolytes      :
Diagnostic tests           :           CT                                           -                      
                                                MRI                                        -
                                                Bone scan                                -
                                                EMG                                       -
                                                Nerve conduction studies       -
CNS                            :           Conscious/ Semiconscious/ Unconscious
Higher Function          :           Confused/ Not oriented/ Oriented
                                                MMSE
Orientation
Score one point for each correct answer:
What is the: time, date, day, month, year? Maximum: 5 points
What is the name of: this ward, hospital, district, town, country? 5 points
Registration
Name three objects only once. Score up to a maximum of 3 points for each correct repetition. 3 points
Repeat the objects until the patient can repeat them accurately (in order to test recall later).
Attention and calculation
Ask the patient to subtract 7 from 100 and then 7 from the result four more times.
Score 1 point for each correct subtraction. 5 points
Recall
Ask the patient to repeat the names of the three objects learnt in the registration test. 3 points
Language
Score 1 point for each of two simple objects named (e.g. pen and a watch). 2 points
Score 1 point for an accurate repetition of the phrase: 'No ifs, ands or buts'. 1 point
Give a 3-stage command, scoring 1 point for each part correctly carried out; e.g. 'With the index finger of your right hand touch your nose and then your left ear'. 3 points
Write 'Close your eyes' on a blank piece of paper and ask the patient to follow the written command. Score 1 point if the patient closes the eyes. 1 point
Ask the patient to write a sentence. Score 1 point if the sentence is sensible and contains a noun and a verb. 1 point Draw a pair of intersecting pentagons with each side approximately 1 inch long. Score 1 point if it is correctly copied. 1 point
TOTAL MAXIMUM SCORE 30 POINTS
Cranial Nerve Integrity:
1st
2nd  (Rt/Lt)
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Motor Function           :
Bulk                :
Tone                :           Modified Ashworth Scale for Grading hypertonia
  • 0 -No increase in muscle tone
  • 1 -Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension
  • 1+ -Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
  • 2 -More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
  • 3 -Considerable increase in muscle tone, passive movement difficult
  • 4 -Affected part(s) rigid in flexion or extension
Power              :           MMT
Shoulder
--------------------------
Hip
--------------------------
Elbow
--------------------------
Knee
--------------------------
Wrist
--------------------------
Ankle
--------------------------
Hand
--------------------------
Foot
--------------------------
Reflexes (rt/lt)                         :
Biceps
--------------------------
Knee
--------------------------
Triceps
--------------------------
Ankle
--------------------------
Supinator
--------------------------
Plantar
--------------------------
 Range of Motion (rt/lt)          :
Shoulder
--------------------------
Hip
--------------------------
Elbow
--------------------------
Knee
--------------------------
Wrist & Hand
--------------------------
Ankle & Feet
--------------------------
End-Feel                                 :
Voluntary Movement Patterns:
Head

Trunk

Rt UL

Lt UL

Rt LL

Lt LL

Stereotypical Movements       :


Posture                                    :
Standing

Sitting

Locomotive

Balance                                   :
Co-ordination                          :
Sensorymotor Integrity           :
Motor Planning                       :
Gait & Locomotion                 :
            Wheelchair management and mobility
            With and without the use of assistive devices
Sensory Assessment    :
            Superficial Sensations :
            Deep Sensations          :
Pain Assessment         :
Area of Pain                :
Nature of Pain             :
            Chronology of Pain     :
            Aggravating Factors   :
Relieving Factors        :
Visual Analog Scale    :
 
0          1          2          3          4          5          6          7          8          9          10
Functional Ability skills          :
            Functional Mobility
            Basic ADL’s
            Instrumental ADL’s
            Assistive and adaptive devices
Aerobic Capacity and Endurance:


Physiotherapy Aims in Acute stage: -
a.       To prevent respiratory complication
b.      To prevent circulatory complication
c.       To ensure proper positioning
Physiotherapy Aims in Rehabilitation stage: -
a.       To prevent future secondary soft tissue adaptation
b.      To decrease abnormal muscle tone and promote voluntary movements
c.       To retrain functional tasks
d.       To prepare patient and relative for future challenges
 Follow Up: 

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