Subjective Assessment in Neurological Physiotherapy

Assessment is the starting point for clinical reasoning.
The ICF framework is used for assessment, clinical reasoning, problem lists, goal setting, and measuring health, ability, and disability.
Background knowledge about the health condition (pathophysiology, anatomy, prognosis) is essential.

Impairments: Deficits in body structures and functions (e.g., active range of movement, strength, sensation) are identified.
Activities and Participation: Review tasks people participate in and their limitations.
Contextual Factors: Gather information about environmental and personal factors (e.g., home, work, access to services).
The subjective assessment gathers information about impairments and the impact on activities and participation, while objective assessment practically completes these items.

Facilitates decision making and treatment planning.
Helps determine prognosis and clarify expectations.
Assists with considering the need for other disciplines or services.
There is no standard process; assessment varies based on condition, setting, and prognosis.

Gather patient identifiers (name, date of birth, address).
Review details regarding the presenting complaint and history.
Obtain medical imaging results, vital signs, and medical precautions.
Collect information on past medical history, surgical history, and medications.
Note social situation, home environment, family history, handedness, and driving status.

Introduce yourself, your role, and gain consent.
Check patient identifiers.
Confirm gathered information (past medical history, symptoms, reason for referral).
Ask about patient's goals, expectations, perceptions, and beliefs.
Inquire about pain, fatigue, vision, hearing, sensory problems, and respiratory issues.
Assess mobility, function, falls, continence, vertigo, dizziness, and nausea.

Observe patient's insight, attitudes, beliefs, knowledge, and understanding.
Note communication or speech issues, cognitive issues, mood, mental state, and behavior.
Look for signs of pain, discomfort, fatigue, and spontaneous movements.
Observe breathing and respiratory status.
Monitor for signs of a deteriorating patient.

Patient Identifiers: Name, date of birth, address (for correct patient identification and background information).
Presenting Complaint: Main problem and patient's understanding of why they are seeking assistance.
History of Presenting Complaint: Underlying diagnosis, associated events, date of onset, and changes so far.
Imaging and Tests: Imaging tests and their results.
Precautions and Contraindications: Safety limitations.
Medical Stability: Vital signs (blood pressure, heart rate, respiratory rate, temperature) to determine safety for assessment and treatment.
Past Medical History and Past Surgical History: Comorbidities that might impact assessment and management.
Medications: Potential implications for timing of therapy.
Social History: Work, hobbies, and comparison of usual vs. current abilities.
Home Environment: Access, steps, stairs, and available supports.
Family History: Relevant medical issues.
Other Details: Handedness, driving status, and involvement of other professionals.

Orientation: Check orientation to time, place, and person.
Goals and Expectations: Understand what the person is aiming for.
Previous Treatments: What worked or didn't work in the past.
Pain and Fatigue: Assess and consider impact on assessment and treatment.
Vision and Hearing: Pre-existing deficits or changes.
Sensory Changes: Awareness of any sensory challenges.
Respiratory Function: Screen for respiratory issues, especially in acute/subacute settings.
Mobility: Compare recent prior mobility status to current status.
Falls: History of falls, near misses, and possible causes.
Continence: Understand the occurrence of any incontinence.
Dizziness: Note any occurrences of dizziness.

In the inpatient acute setting, patients may often be drowsy, minimally responsive or in a vegetative state.
Be able to monitor thoroughly around a deterioration in medical status at all times.

Tests or scales that accurately measure a health attribute.
Used to identify problems, evaluate disease progression, and assess the effectiveness of interventions.
May motivate patients and justify the need for physiotherapy.
Examples: Stroke Impact Scale, Activity Specific Balance Confidence Scale, Frenchay Activities Index, SF-36, Rivermead Post Concussion Symptoms Questionnaire, Borg Rating of Perceived Exertion.

Goals should be actively selected, intentionally created, and shared.
Dependent on organizational constraints, disease characteristics, and patient preferences.
SMART goals are useful, but it's important to instill hope.
Can improve patient motivation, clinical teamwork, and self-regulation.
Collaborative goal setting involves the patient, family, and therapists.
Goals should be client-centered, documented, well-defined, specific, challenging, and reviewed.
Consider nuances with communication, cognition, and insight.
The goal needs to be difficult or challenging enough to get the optimal level of task performance.