Intro to Neurological PT Examination and Intervention

What is the purpose of the neuro screen?

quick screen to clear the NS or ID problem, is there a problem associated with the NS or neurological disorder? Are pt’s signs and symptoms consistent with their diagnosis? Is there a need for referral to another provider? do neuro symptoms require further investigation?

what is the purpose of the neuro exam?

includes all screening items, integrated into a more comprehensive examination. used to test function of nervous system when an underlying problem is suspected or diagnosis already known, gives information about red flags, baseline range of impairments/activity limitations, what you can treat versus what you cannot

what are outcome measures used for?

to quantify function and assess change over time

What needs to be reviewed during the medical record review?

• general demographics

• past medical/surgical history

• social history

• medications

• other clinical tests/results

• PT orders and activity orders

• current condition

• restrictions of precautions

• functional status and activity level

what are the components of the comprehensive neurological examination?

pt history and systems review, observation, mental status examination, tests and measures, outcome measures

what things need to be assessed during the mental examination?

if the pt is awake, oriented, alert. if the pt is aware of what’s going on and the surroundings, responding appropriately to questions, tracking you with their eyes are you move around the room, and memory (long and short term)

what kinds of questions should be prioritized in acute care?

cognition/communication, home environment, ADs, barriers to return to home, pt personal goals, PMH/PSH, hx of PT, pain and pain management methods at home, vision/auditory challenges, hand dominance, sensory changes and edema, braces or orthotics

what questions should be prioritized in inpatient rehab?

cognition/communication, home environment, ADs, barriers to return to home, pt personal goals, PMH/PSH, hx of PT, pain and pain management methods at home, vision/auditory challenges, hand dominance, sensory changes and edema, but focus will be more on activity level questions to help formulate therapy goals

what questions should be prioritized in outpatient settings?

what brings them to therapy/goals, what have they tried before for the problem and have they had therapy in the past, may need to focus on more participation level questions to help formulate goals

what tests and measures are taken in the neuro exam?

mental status, cranial nerve integrity, autonomic function, sensory integrity, sensory integration, joint integrity and mobility, muscle performance and strength/power, motor function, coordination, postural control and balance, gait/locomotion, aerobic capacity/endurance, functional mobility

what are the core set of outcome measures in neurologic physical therapy?

• Berg Balance scale

• functional gait assessment

• activities specific balance confidence scale

• 10 meter walk test

• 6 minute walk test

• 5 x STS

• TUG Cognitive

what are the components of the PCMM?

Examination, evaluation (then referral/consultation if needed), diagnosis and prognosis, intervention, and outcomes

what is the movement system framework?

framework used to inform clinical reasoning and decision making and culminates in the movement system diagnosis by emphasizing movement analysis as central to clinical examination

what are the components of the movement system framework?

• assess movement patterns and task performance

• ID movement related impairment

• dev treatment plan targetign specific movement deficits

• implement evidence based interventions

• monitor outcomes and modify treatment strategies as needed

• educate patients on self management and preventions strategies

what is the purpose of the task analysis?

evaluate movement strategies during functional tasks and ID barriers to task success (PT can vary the task to regress or progress in response to pt performance)

what are the potential movement system diagnoses?

• movement patter deficit

• force production deficit

• fractionated movement deficit

• sensory selection and weighting deficit

• sensory detection deficit

• dysmetria

• strength/power

• control

• endurance

What are current CPGs in neurologic PT?

• vestibular hypofunction

• core set of outcome measure in neuro PT

• locomotor CPG for chronic stroke, SCI, TBI

• locomotor CPG for subacute stroke, SCI, TBI

• use of AFO and FES post-stroke

• concussion CPG

• parkinsons’s disease CPGs

• balance rehab and falls prevention in neurologic populations