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. What would you like to do?
Perform item 1 on the MAS
Perfrom item 2 on the MAS
Perform item 3 on the MAS
Perform item 4 on the MAS
Perform item 6 on the MAS
Perform item 7 on the MAS
Perform item 8 on the MAS
What are possible problems for supine to sidelying?
- - using stronger/ normal side only
- - using momentum
- - lack of awarenes of affected arm or side
- - lack of body rot as a result of mm tightness or increased tone
- NEVER ASK PT TO ROLL ONTO HEMIPLEGIC ARM
What are possible problems for pt sidelying to sitting over the edge of the bed?
- - always stand on the good side
- - inability to activate mm appropriately
- - immobility in trunk- why?
- - decrease postural awareness
- - influence of tone or tonic reflexes
What do you look for when you assess a pts balanced sitting?
- - observe at rest- sitting posture- hand hold
- - describe sitting posture
- - weight distribution
- - adequate anterior pelvic tilt
- - adequate trunk and neck ext -
- -head balanced on level shoulders
- - record length of time position can be held
What problems do you need to look for with balanced sitting?
- - if pt leans or falls- why- what direction
- - is he aware of falling- motor control- sensory loss- spatial neglect- verticality
- - is pt afraid, eyesight dependent, dizzy
What else should you observe with balanced sitting?
- pt initiated perturbations/displacements (anticipatory control)
- -head movements
- - rotate body to R/L
- - touch imaginary quadrant- lean approx 30 degrees to side and cross midline
- - touch toes R and Left, touch floor between feet
- - reach sideways to touch floor
- External perturbations/displacements (reactive control)
- - external push applied in ant/post and lateral directions
- - sit on balance board
Assess a pts standing up and sitting down and what do you look for?
- - if pt indpendent, observe in standingup alone, give close supervision if neessary.
- - look for
- - lack of appropriate force generation in mm (bi/unilateral)
- - lack of DF, shortened calf mm, mm tone or oedema in ankle
- - lack of forward inclination of trunk
- - overcompensation by unaffected side (pusher)- unawareness of side; sensory loss; vertically
- - does pt lean backwards? extensor tone?
Assess someones balanced standing
- - pt should be challanged but safe
- - observe standing alignment at rest- ability tohold position (steady state/ static balance)
- - describe standing posture- even weight bearing, hips extended, knees extended, erect trunk, hips over feet, shoulder over hips, head balances on level shoulders
- - repeat with eyes closed, repeat with narrow BOS, sinlge stance, stride stance, tandem stance
What are possible problems with balanced standing?
- - can the pt stand unsupported or not
- - qualitatively, note BOS and postural alignment
- - if pt is unstable, note direction and query reason for falling. Is pt affraid of falling?
- - does lack of jt range or mm length affect balance
Once assessed balanced standing what should you assess?
- - balanced standing with initiated/ anticipatory control
- - stand and turn head to L and R
- - turn body
- - stand and reach outside BOS, to side and cross midline
- - bend down to touch floor or pick up object
- - step and touch to l and R
- -External perturbations/ displacement (reactive control)- therapist displaces pt and records reaction ie equilibrium and stepping reactions
- - recording using objetive measure eg marsden test and sternal push
What can you use to assess your pts objective and functional balance testing?
- - TUG
- - Step test
- - Functional reach
- - berg balance
What are the assessments of sensation?
- - light touch
- - double stimulation
- - pain
- - temp
- - proprioception
- - stereognosis
What tract are you testing with proprioception, deep touch and vibration?
- dorsal tract
How do you test the lateral tracts?
- pain and temp
How do you test the ventral tracts?
What is the general rule that you screen all your neurological pts by?
- - light touch
- - sharp/blunt
- - proprioception
- if impaired you will do more discrimination tests such as tactile localisation, stereognosis, double simultaneous stima and 2 point discrim
How do you test sensation with light touch?
- - test with cotton woll
- - test for localisation of stimulus and comprasion with 'normal' side ie tell me when you/where i am touchign you and does it feel normal. You may give numbers to help with the comparison
- NOT IF LMN LESION IS SUSPECTED, TEST DERMATOMAL DISTRIBUTION
Perform a double simultaneous stimulation to test sensation?
- - touch exactly the same place on both side at the same time after touching each side individually and ascertaining that ligh touch is present
- - ask which side am i touching now
- - inability to fell two stimulu together denotes sensory inattention
Perform the sensation test pain
- - pin prick
- - test where no contraindications to piercing skin, not particularly functional modality
Perform the sensation test of temperature for sensation
- - important for safety consdierations
- - must ascertained before any thermal treatment or electrotherapeutic modality
- - test with two test tubes (stoppered) containing cold and warm water
What are the two types of sensation tests for proprioception?
- - jt position sense (static)- inability to copy the position of one limb held by examiner with the other (normal) side. Note proximal- distal variation- ability at specific jts. Be careful with handling not to give tactile cues
- - passive movement (dynamic) - move one jt and ask if the pt can fell moveemtn- which jt and what direction
Perform the sensation test sterognosis
- test the ability to recognise objects of different size, shape and texture by feel. Do not show pt testing objects first. Pt needs reasonable light touch, proprioception and finger mveoment to perform this tes. Example of objects: small plastic bead or marble, safety pin, screw, piece of cotton, wool, cube
Assessment of coordination
- - entwined with balance and movement
- - with functional movementsshould observe for speed, timing, rhythm, smoothness and ability to follow a sequence of actions
- - do movements under or overshoot
- - ability to perform a learnt skill should be compared with ability to learn a new skill
What are the possible causes of inco-ordination?
- - hypotonia
- - weakness
- - proprioceptive or tactile loss
- - loss of dexterity
- - ataxia
- - vestibular dysfunction
- - compare movements on both sides of body
What are the tests for coordination?
- - finger to nose- pt touches his nose then therapist inderx finger held up in front of pt. therapist may move finger. may do eyes open or closed
- - pronation/ supination- pt attmepts quickly alternating movements
- - hand tapping- pts taps hand on thigh or able- add a beat to copy
- - finger stumming- tap each finger in order, may add a particular order
- - heel/knee/shin- pt slides heel up and down shin. May be done in supine or sitting
- alternate hip and knee flexion- observe movement performed slowly and then faster. Pt is supine
- - cycling of legs- supine- ride a bicycle with hip and knee flexion/ extension
- - alternate hip flex sitting
- - foot tapping0 ptalternately DF ankle and taps foot
What are some high level functions for coorbination, balance and mobility?
- - tandem walking- pt walking in straight line with one foot directly in front of other and in contact
- - heel then toe walking
- - braiding- grape vine- walking
- - running, skipping, hopping. Note speed and rhythm
- - start jumps- start with stride jumps and then add arms as well. May clap hands over head
- - cross over jumps- stride jumps with legs crossing alternately front and back
- - skpping with a rope
- - bouncing balls- different combinations of one hand or alt hands
NOTE PG 123- kinesthetic sensations
What is grapaesthesia?
- - drawing letters on palm
- - start with unaffected then move to affected side
2 point discrimination test
- - mesure device
- - start wide and move closer to when pt can discriminate 2 points from 1
- - index finger
- - thenar crease
- use chork- point- pt eyes closed- ask then to show u where u pointed to
- pg 117-118
- - measure scale 0-6
- - for first 6 1 is easiest and 6 hardest
- - can do in an order of items
- - if they cannot do the basic one for items 1-6. They get 0. Have 3 times to do it
- - encouragement but no specific feedback
- - make sure pt knows you are timing them
What would you like to do?
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