OSCE Practice

What form of screeners would you assess for someone with bradykinesia (Parkinsons)?

1) Finger Taps

2) Finger Nose Finger

3) Rapid Alternative Movements (RAM)

Assess Finger Taps

Ask patient to tap the thumb and index finger together

• Cue them to tap as FAST and BIG as they can (Fully extend the fingers)

• Evaluate for slow and incomplete (small) finger movements

• Test one hand at a time

Look for:

• Small and slow movements

Document as intact/impaired

Assess Finger Nose Finger (Bradykinesia)

Ask patient to touch their nose with a finger tip, THEN extend the finger to touch the OT’s finger

• Repeat several times

ONLY FOR BRADYKINESIA:

• Keep finger in the SAME location directly in front of the patients face

Look for:

• Slow movements

• Incomplete reaching

Document as intact/impaired

Assess Rapid Alternating Movement (RAM) *Bradykinesia*

1) Demonstrate

• Ask client to rotate the forearm into supination/pronation (using full rotation)

• Test ONE ARM AT A TIME

• DON’T cue patient to move as fast as possible

Look For:

• SLOW and INCOMPLETE movements of forearm and hand

Document as intact/impaired

What is the difference between Ataxia & Bradykinesia?

Ataxia: (Cerebellum Damage)

• INTENTION tremors

• During VOLUNTARY movement

• Increase as limb apporoaches its intended goal

• No tremor while resting

Parkinsons (Basal Ganglia Damage)

• Involuntary Movement

• Rest tremors

What form of screeners would you assess for someone with ataxia?

1) Pen Cap Test

2) Finger Nose Finger

3) Rapid Alternating Movements (RAM)

Assess the Pen Cap Test

1) Give the client a pen cap

2) Hold pen steady directly in front of client & ask them to place the cap on the pen

3) Move the pen to different positions in space

What to look for:

• Watch how the pen cap approaches the pen

• Look for rhythmic oscillations/tremors that become more pronounced near the target

• Voluntary limb movement (Tremor starts as limb approaches to intended goal)

Document as intact/impaired

Impaired: Upper extremity shakes as patient places the pen cap on the pen

Assess Finger Nose Finger (Ataxia)

1) Ask client to touch their nose with their fingertip and then extend their finger to touch OT finger

• Repeat several times (VARY the position of the OT’s finger)

Looking for:(When reaching target)

• Movement smoothness

• Tremor

• Accuracy

Evaluate:

• Coordination

• Dysmetria

Document as intact/impaired

Assess Rapid Alternative Movement (RAM) *ATAXIA*

1) Ask client to rotate the forearm into supination/pronation (using full rotation)

• Test ONE ARM AT A TIME

• ASK them to do it as fast as possible?

Look for:

• Speed

• Rhythm

• Smoothness

Evaluate:

• Rapid Alternating Movement

• Dysdiadochokinesia (Difficulty performing RAPID ALTERNATING movements)

Document as intact/impaired

What type of test is used to assess balance?

Rhomberg Test

Assess the Rhomberg Test

1) Position the client standing with feet TOGETHER (touching) + Arms relaxed at the sides

• Ensure enough space to prevent injury if they lose balance (Stay close to patient)

Eyes Open:

a) Ask client to stand still maintaining the same position for 20-30 seconds

• Observe for swaying/difficulty maintaining posture

Eyes Closed:

b) Ask client to close their eyes while maintaining the same position for another 20-30 seconds

• Observe for increased swaying or loss of balance (Be ready to support patient if needed)

IF CLIENT DOESN’T SWAY OR FALL (With eyes CLOSED)

• Gently NUDGE the shoulders from BEHIND or SIDE (Intent is slight displacement NOT forceful push)

Look for:

• Corrective response to minor disturbances

Healthy response: Quick corrective movements to maintain balance

Document (+ or -) at which testing was stopped because of swaying or loss of balance

What does the trigeminal nerve test assess?

Sensation and motor on the 3 different layers of the phase

1) Opthalmic

2) Maxillary

3) Mandibular

Assess Trigeminal nerve Screening (SENSORY ONLY)

“I’m going to evaluate the sensation on your face today, do you mind if I touch you?”

“I’m going to touch you with this Q-tip, let me know where you feel it”

START: Brush the cotton stimulus on the uninvolved side (to get a baseline) THEN the involved side

• Write down the spot you touched before moving on to the touch another spot

1) Seat Client and ask them to close their eyes

3) Use a cotton swab to stroke the forehead, cheek, jaw, and chin

4) Ask client to verbally identify the facial area touched (yes/no) (Maybe point at it?)

• Map areas of numbness on document

• Touch 3x in the 3 different layers of the face (Opthalmic, Maxillary, Mandibular)

• Document a “+” with a circle on each spot you touched her ( AND she felt it)

DEFICIT:

• If the client didn’t feel it with the cotton side, repeat with the bare wooden end of cotton swab

• Document a “-” with a circle on each spot you touched her

NO SENSORY DETECTION:

• Document a “0” with a circle on the spot you touched her

Assess Trigeminal Nerve Screen (MOTOR ONLY)