NITHIN NAIR

ASSESSMENT HISTORY Type of injury and siteAgePTA duration Job Home environmentEducational levelPrevious injuries

ASSESSMENT CLIENT AND FAMILY DATA

Perception of the limitations GoalsPersonal factorsSocio – 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 limbSite and extent of scar (healed/non-

healed)Other associated fractures and injuryPresence 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,IIIDecreased or low-level response levels of

recovery.Examination – Acute care – Chart review Medical Status – Stable/Unstable?Ventilator / ICP MonitorAre 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 IVConfused-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 recoveryConfused, but follows simple commandsMore formal and accurate examinationModified examination – Difficulty in

performing complex tasksOngoing examination

RLA LEVEL V & VI EXAMINATIONAttention & CognitionCranial nervesBalanceStrengthADL SkillsFunctional mobility Sensory Integrity

RLA LEVEL V & VI

EXAMINATIONDetermine functional ability –

opened/closed environmentOut come measuresExamination 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

REFERENCENEUROLOGICAL REHABILITATION –

DARCY UMPHREDPHYSICAL REHABILITATION – SUSAN

B O’SULLIVANPHYSIOTHERAPY IN NEURO

CONDITIONS – GLADY SAMUEL RAJWWW.GOOGLE.COM (FOR SCALES)