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: