GENERAL NEUROLOGICAL GENERAL NEUROLOGICAL ASSESSMENTASSESSMENT

ICF – ICF – International Classification of International Classification of Functioning, Disability and HealthFunctioning, Disability and Health

• Body structure and functions– Impairments

• Problems in body function or structure such as a significant deviation or loss

• Activities– Is defined as the execution or performance of a

task or action by an individual• Participation

– Is an individual’s involvement in life situations in relation to health conditions, body function and structure, activities and contextual factors.

Physiotherapy AssessmentPhysiotherapy Assessment• Subjective

– Info comes from patient– Most important is HoPC

• Objective Assessment– Measurements taken for objective

markers

Subjective Subjective AssessmentAssessment

What are the What are the components?components?

General assessmentGeneral assessment

NEUROLOGICAL HISTORYNEUROLOGICAL HISTORY• Age • Sex• Handedness• Occupation• History of present complaint• Neurological screening questions• Past medical history• Drug, family & social history

HoPCHoPC• Start with open question• Time and course

– The onset, over few seconds, minutes hours, days, weeks, etc

• Progression– Continuous or intermittent, stabilized or

progressed• Pattern

– Frequency & duration

HoPCHoPC• Also determine aggravating and

relieving factors• Prior treatment & investigations• Current neurological state

– Abilities and disabilities• Hypothesis generation & neurological

symptoms• Screen for other neurological

symptoms– Headaches,fits,blackouts,episodes of numbness or tingling

Objective Objective AssessmentAssessment

What are the What are the components?components?

Neurological objective Neurological objective AssessmentAssessment

• Speech– Aphasia – a disorder of speech– Dysphonia - Disturbance of voice

production– Dysathria – difficulties at different levels

Unconscious Unconscious Patient!!!!Patient!!!!What do we do???What do we do???

Mental state and higher Mental state and higher functionfunction

• Mental state– Mood, vegetative symptoms, delusions,

hallucinations & illusions• Higher Function

– Attention & orientation, memory, calculation, abstract thought, spatial, visual & body perception, Apraxia.

AssessmentAssessment• Divided in 2 parts

– Resuscitation – use neurological ABC– Examination – follow Glascow Coma

Scale• Aimed at finding or excluding focal

neurological abnormalities• Determining the level of consciousness &

neurological function

EXAMINATION OF SENSORY EXAMINATION OF SENSORY FUNCTIONFUNCTION

•Superficial Sensation•Deep Sensation•Combined Cortical Sensation

MUSCULOSKELETAL MUSCULOSKELETAL EXAMINATIONEXAMINATION

• Observation/Inspection• Palpation• Range of Motion• Muscle Performance• Special Tests

MOTOR FUNCTION EXAMINATIONMOTOR FUNCTION EXAMINATION• Mental status• Arousal• Sensory integrity and integration• Joint integrity, Postural Alignment

and Mobility• Tone

Cont…..

Cont……….• Reflex Integrity• Cranial Nerve Integrity• Muscle Performance• Voluntary Movement Patterns• Functional Task Analysis• Postural Control and Balance

EXAMINATION OF EXAMINATION OF COORDINATIIONCOORDINATIION

•Equilibrium Coordination Tests

•Non Equilibrium Coordination Tests

Examination of Gait

The therapist look out for symmetry,The therapist look out for symmetry,duration of swing, and Stance duration of swing, and Stance phase, muscle activation around the phase, muscle activation around the ankles, knees, hips and trunk, arm ankles, knees, hips and trunk, arm swing, trunk rotation, balance and swing, trunk rotation, balance and speed.speed.

Examination of Functional Status and Activity Level

REFERENCEREFERENCE• Fuller.G.(2004).Neurological

Examination made easy.3rd ed.UK; Elsevier.

• The rehabilitation specialists handbook

• Physical Rehabilitation, V Edi., - Susan B. O’ Sullivan