NITHIN NAIR

ASSESSMENT
 HISTORY
 Type of injury and site
 Age
 PTA duration
 Job
 Home environment
 Educational level
 Previous injuries
 ASSESSMENT
 CLIENT AND FAMILY DATA

 Perception of the limitations

 Goals
 Personal factors
 Socio – economic factors relating to
participation limitations
 ASSESSMENT
 OTHER HEALTH CARE TEAM MEMBER’S EVALUATION

 Conduct a complete review of the case paper

of the patient before actually seeing the
patient as he/she may not be medically stable
and to know about the complications and the
precautions to be taken during the
examination and subsequent treatment.
 ASSESSMENT
 OBSERVATION

 ICU – Note the setting of the various

assistive and recording device.
 Attitude of the limb
 Site and extent of scar (healed/non-healed)
 Other associated fractures and injury
 Presence of swelling or oedema
 CLINICAL RATING SCALES
 GLASGOW COMA SCALE

RANCHOS LOS AMIGOS LEVEL OF

COGNITIVE FUNCTIONING
GLASGOW COMA SCALE
RANCHOS LOS AMIGOS
 QUESTION
• Discuss ICF & Management of a 28 yr old
male who have suffered with RTA & Had
head injury 1 month back. He is presently
in hospital ward with RLA Level V & VI
and exhibits increased extensor tone in
right lower extremity 3 on modified
Ashworth scale.
 RLA LEVELS I,II,III
Decreased or low-level response levels of
recovery.
Examination – Acute care – Chart review
Medical Status – Stable/Unstable?
Ventilator / ICP Monitor
Are there any other weight bearing or
ROM precautions – pertaining to other
orthopedic injuries?
 ASSESSMENT
 KEY QUESTIONS TO ADDRESS
 What posture is the patient in?
 Are the patient’s eyes open or closed
 Is the patient able to respond to auditory or visual
stimulation?
 Is the patient able to vocalize?
 Does the patient exhibit any active movement
(purposeful/non-purposeful)
 Does the patient react to tactile/painful stimulation?
 Do the patient’s vital signs change when external
stimulation is presented?
 RLA LEVEL IV
Confused-Agitated level of recovery
 Examination – extremely challenging – agitated
and prone to emotional outbursts.
 Verbally acting out – physically hurting
 Confused – poor memory, decreased attention
span.
 Difficult to gather data – patient non-cooperative
 Utilize observational skills and ability to estimate
 RLA LEVEL IV
 Examine – functional mobility
 Balance – sitting/standing
 Determine patient’s cognitive abilities?
• Orientation
• Memory
• Insight
• Safety awareness
• Alertness
 ASSESSMENT
 KEY QUESTIONS TO ADDRESS
 Is the patient able to follow commands – one
step, two step, multistep?
 Is the patient oriented to person, place or
time?
 Does the patient recognize family members?
 Beneficial to consult with other team
members
 RLA LEVEL V & VI
 Confused-Inappropriate and Confused-Appropriate
levels of recovery
Confused, but follows simple commands
More formal and accurate examination
Modified examination – Difficulty in
performing complex tasks
Ongoing examination
 RLA LEVEL V & VI
 EXAMINATION
Attention & Cognition
Cranial nerves
Balance
Strength
ADL Skills
Functional mobility
Sensory Integrity
 RLA LEVEL V & VI
 EXAMINATION
Determine functional ability –
opened/closed environment
Out come measures
Examination of motor control – tone ,
coordination, movement patterns.
 RLA LEVEL V & VI
 KEY QUESTIONS TO ADDRESS
 How well is the balance maintained throughout
the tasks?
 How long does it take to initiate or complete
task?
 Is the patient able to perform task
consistently?
 Does the patient perform the task efficiently –
minimal amount of energy expenditure?
 Can the patient shift the weight forward?
Maintain normal body alignment - Sit to stand?
 RLA LEVEL VII & VIII
 Appropriate response level of recovery
 Patient is discharged from IPD
 Weaning from external support
 Therapy delivered – emphasis on community re-
entry, return to work or college, cognitive,
behavioral and psychosocial issues.
 Same examination as in level V & VI
 REFERENCE
NEUROLOGICAL REHABILITATION – DARCY
UMPHRED
PHYSICAL REHABILITATION – SUSAN B
O’SULLIVAN
PHYSIOTHERAPY IN NEURO CONDITIONS –
GLADY SAMUEL RAJ
WWW.GOOGLE.COM (FOR SCALES)