Evaluation and Assessment of the Client with Neurological Dysfunction

definition of recovery

return to or emergence of a desired level of function

functional recovery

can occur even if the nervous system doesn’t change (with neuroplasticity)

definition of restoration

healing of brain tissue and amelioration of an imapairment

restoration vs recovery

recovery can happen without full restoration if the pt feels that they can do what they want to

examples of compensation

atypical movement patterns substituting for impairments, assistive devices, reorganization of neural pathways through neuroplasticity

question asked about recovery

recovery of what function

question asked about restoration

restoration of what impairment

question asked about compensation

compensation for which impairment

characteristics of long term goals

developed in partnership, set at level of activities or participation, sets the POC

components of a pt goal

subject, action verb, functional performance, condition, criteria (measure of success)

what should not be included in a goal

body function/structure

what determines treatment interventions

impairments that prevent the pt from reaching their goal

what are impairments not included in the goal

too many to treat, may not be relevant to function, can be compensated for

organization of testing

determine activity and participation limitations (subjective and PROMs) → evaluate body structure and function impairments (objective) → special tests based on unique pt needs/goals

common evaluation assessments to assess activity and participation level

transfers/STS, gait assessment, balance assessment

quantitative vs qualitative measures

want to measure both but qualitative measures are more important for treatment interventions

standardized measurement tool for balance in stroke pts

postural assessment scale for stroke (PASS)

characteristics of PASS

tests dynamic balance (during transitional movements), specific for post-stroke, for pts who cannot complete FGA, compares pt to themself

characteristics of functional independence measure (FIM)

required by medicare, assesses self-care, mobility, cognition, does not capture progress unless going from low to high level

PT aspect of FIM

transfers and mobility

characteristics of stroke impact scale (SIS)

self-report of difficulties, assess on level of body structure/function, activities, participation

UE activity and participation measures post stroke

ARAT, 9 hole peg test, DASH, WMFT

when should mental status be assess more formally

in a TBI or stroke where they have the capacity to gain it back

components of a body assessment post-stroke

palpation, strength (observe compensation), movement quality, abnormal synergies, muscle tone, coordination

why is MMT and HHD not the best assessment of strength

lack of individuation, altered muscle tone give false data

how to assess functional strength

ROM, fugl meyer, coordination tests, functional tests

issues with assessing PROM

contractures, spasticity, lack of sensation

characteristics of fugl meyer assessment

combines tests of reflexes and active movements, focuses on strength, abnormal synergy and tone, UE and LE components

how to assess muscle tone

PROM, ashworth scale, modified tardieu

what does the ashworth scale test

amount of resistance to quick passive stretch

difference between modified tardieu and ashworth scale

more objective way to assess spasticity with quality and angle measurements, also tested at slow and fast speeds

how to assess coordination

rapidly alternating movements (RAM) and multi-joint movements (MJM)

what is involved in muscle coordination

correct timing, prediction, smoothness, accuracy

considerations for coordination testing

sensory impairments can appear as incoordination, cannot be accurately assess when there is weakness or abnormal tone

components of movement quality

speed, involuntary movements, timing, sequencing, posture, fatiguability

examples of abnormal postures

dystonia, parkinsonian posture, contractures

characteristics of abnormal synergies

UMN damage, involuntary, non-modifiable, difficulty isolating individual muscles, difficulty combining muscles outside of a synergy

UE flexor synergy

scapular retraction/elevation, shoulder abduction/ER, elbow flexion/supination, wrist and finger flexion

LE extensor synergy

hip extension/adduction/IR, knee extension, ankle PF/inversion, toe flexion

parts of motor dysfunction

tremor, praxis, bradykinesia

components of somatosensory function testing

light touch, proprioception, vibration, pain

common locations of pain post-stroke

shoulder, back, knee

core outcome measures

ABC, berg, FGA, 10MWT, 6MWT, 5xSTS, GAS

stroke-specific outcome measures that are not included in the core outcome measures

PASS, SIS, FIM, fugl-meyer

4 objectives of an eval

measure primary impairments, set goals, plan treatment, satisfy payor