stroke evaluation – reasoning form - physiotherapy
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Stroke Evaluation – Reasoning Form
JSSCPT Department Of PMRC Page 1of 12
The following are the areas to be taken into consideration during evaluation of
Stroke with reasoning for the same
1. Age:
2. Gender:
3. Diagnosis:
4. History :
5. Higher mental functions:
6. Perceptual deficits:
7. Cranial nerve evaluation :
8. Posture observation :
9. Range of Motion :
10. Muscle tone :
11. Sensory evaluation :
12. Involuntary movement :
13. Muscle strength :
14. Voluntary Control Grading :
15. Hand function :
16. Reflex evaluation :
17. Balance :
18. Coordination :
19. Endurance :
20. Ambulation :
21. Aerobic capacity and endurance :
22. Transfers :
23. Functional activity :
24. Orthotic devices and assistive aids been used for all functional
activity,ambulation and others.:
25. Condition specific outcome measures:
26. Therapy recreation:
27. Home evaluation:
PROGRESS REPORT FORM
In the progress report form the following has to be mentioned in relation to the
baseline measurements, which is taken at the time of admission.
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1. CROMS/FIM status
2. Cognitive and Perceptual measurements
3. HMF status:
4. Tonal changes
5. Hand function
6. Balance and coordination
7. Ambulation status
8. Medication and nutritional status
9. Therapy recreation status
10. Home evaluation report
11. Orthotics and assistive devices use.
DISCHARGE SUMMARY FORM
The discharge summary should include the status of the patient at the time of
admission and weekly goals set and achieved and the status of patient at the
time of discharge.
It should also have the HEP (Home Exercise Programme) status, Care takers
education material and review dates for follow up.
1. Age:
It matters as it will signify the ADL
dependence
To plan for the new job responsibilities
2. Gender
Consideration to be taken during Personal hygiene-
Menstrual cycle
3. Diagnosis
Type of stroke- Hemorrhagic or
Ischemic (Gives the status of prognosis)
Location Of stroke (Will signify the
impairment and functional loss both
physically and psychologically)
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4. History
The following details are must from the history
Date of onset of signs and symptoms
Progression of the condition (any signs
of recovery)
Medical management and surgical
management for the same (If done
surgery the type of surgery burr hole
and flap removal will tell the prognosis
and stay in ICU and Hospital)
Medicational status: Need to check
pharmacokinetics of the drug and
window period to schedule the therapy.
Importance to be given for any
antiepileptic drugs and drugs taken to
reduce spasticity.
Nutrition and feeding status (Any
presence of NSG tube or PEG will
suggest non intact ness of gag reflex)
also persistence of cough and altered
breathing pattern may suggest
aspirational pneumonia.
Results of specific investigations
(Radiological reports)
Co Morbidities (DM, HTN, Obesity,
Seizures, renal and hepatic status, any
others)
Status of speech
o Normal
o Aphasia (Sensory, Motor,
Global)
o Dysarthria (Labial, Lingual.
Spastic)
Use of any specific equipment
o Suction kit to remove secretions
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from NSG or Tracheostomy
tubes,
o Type of mattress using on the bed
which can relieve the pressure
o Any orthotics like Bobath sling,
AFO
Technological assistance
o Consideration to be given if
patient is using any pacemakers,
hearing aids.
Old surgery which is relevant for
present status eg:Joint replacement
surgery’s
Risk factors eg: Balance. Cognitive and
Cardiovascular status
o Balance: premorbid status of
balance
o Cognitive: Any signs of dementia
can affect the motor learning
component.
CVS: Any signs of BP changes, Postural hypotension
5. Family
background
Vocational demand
Family support and Bread winners of
the family
Expense of the family
Expectation of the family or care takers
Whether they are able to understand the
nature of disease and importance of the
treatment.
6. House and
work place
evaluation
Accessibility to home and work place
(Which also includes Number of rooms,
Width of passage, Type and condition
of flooring staircase details, Kitchen
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and toilet accessibility and use. Position
of lights, switches, power points)
In work place to know whether the
client c continue the job or does he/she
requires a change)
7. Problem
solving skills
Does the patient understands step by
step explanation
Does the patient require major guide
stops
8. Affective
component
Patient understanding of his disability
Does the patient have Realistic goals
Does the patient accept his or her
responsibility
Emotional status of the patient
9. Sleep
disturbance
Any change in the sleeping pattern due
to pain, emotional disturbance or others
as it will affect the rehabilitation
10. Skin
evaluation
Vulnerable skin over bony prominences
Scar tissue break downs
11. Higher mental
functions
(Should
consider the
following )
Orientation, memory and attention (for
immediate memory and attention use
Digit span test)
Other functions to be considered are
Calculation, Abstract thinking and
Insight and judgment
Objective scale: MOCA in Native
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language: MOCA scale will screen an
individual’s cognitive dysfunction.
(The values obtained from the scale will
signify the cognitive impairment of the
individual and will affect the physical
activity as there will be lack in the
motor learning component. Assessment
of cognitive function could enhance
decision making in what rehabilitation
strategy might be potentially useful )
12. Perceptual
deficits
The perceptual deficits will affect the physical
functioning of the individual in turn will affect the
rehabilitation. Identification of the same is important
in planning the success of rehabilitation.
Body scheme and body image
disorders:
o Anosognosia, Somatoagnosia (
The patient will point to the body
parts named by tester or imitate
the movements of the therapist)
o Right and left discrimination ,
o Unilateral neglect ( For unilateral
neglect- Therapist needs to
observe an individual’s ADL and
can also use Line bisection test,
Figure cancellation test , Copying
and drawing test )
Agnosia: Visual object, Auditory and
Tactile (Test used are Good glass and
Kaplan test)
Spatial relation disorders: Figure
ground discrimination, Topographic
discrimination, depth and distance
perception, vertical disorientation,
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position in space ( The test used are
Ayres Figure ground test, Observation
of the functional task, RPAB, A-ONE)
Apraxia : Ideomotor, Ideational and Buccofacial :
Objective way to measure it is by Using Apraxia Screen of
Tulia (AST)
13. Cranial nerve
evaluation
All the 12 pairs of cranial nerve
evaluation to be done including the
reflexes.
o Olfactory Nerve:
Has to correlate the diagnosis, blood
supply of the brain affected and to
determine the cranial nerves that would
have damaged.
Facial palsy origin is it central or
peripheral
14. Posture
observation
Alignment of the shoulder to be noted
in static and dynamic postures
Palpation to be done with any presence
of sulcus sign. ( Palpate between
acromion and superior aspect of
humeral head )
Can also use Verniar caliper for the
measurement of Finger width scale
X ray of the shoulder.
Grading of shoulder subluxation by Van
Langenberghe and Hogan Scale
Use of any orthotic devices (Bobath
sling) to be noted
Any signs of unilateral neglect to be
noted
Listing phenomenon to be noted ( Loss
of lateral balance and fall towards the
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paralyzed side )
Attitude of the limbs
15. Range of
Motion
Of all available joints
Any signs of tightness, Contracture to
be noted
Any immobilization device used (Other
orthotics)
16. Muscle tone
(To be
compared with
normal side)
Quality
o Is the tone same always, or
fluctuating, happens during
change in the position
o Is it symmetrical
o Is it dependent on time – Day or
night it changes
o Is it activity based.
Quantity:
o MAS or TARDUE scale to be
taken if there is Hypertonia-
Spasticity ( MAS Is simple ,
reliable test done near bed side
where as TARDUE scale is more
valid and reliable but takes more
time to do on patient)
17. Sensory
evaluation:
28. The sensory evaluation depends upon the status of
HMF of the individual .If the patient has issues in
HMF therapist cannot do the sensory evaluation as
the values of the sensory evaluation is highly
subjective .
The superficial, Deep and Cortical
sensation to be taken with use of
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standard equipment’s
18. Involuntary
movement
Presence of nay involuntary movements
like Tremor, Clonus, Chorea
19. Muscle
strength
29. ( The therapist should remember the following No
isolation of movement will happen till stage 6,
Synergy will dominate, MMT is done at its best if
isolation of movement is present )
Of all available muscle of both sides
Any trick movements
Any immobilization device being used
Can use hand held dynamometer-
Group muscle strength
20. Voluntary
Control
Grading
30. : To Use Brunnstrom VCG for UE, LE and Hand
21. Hand function
Use of ART
Power and precision grip
Recovery of hand functions.
22. Reflex
evaluation
Note that the position of the patient,
Correct tapping site and adequate
tapping stimulus should be given and
the results to be compared with normal
side.
If needed facilitation for the reflex to be
given by Clenching the teeth, Gripping
of an object or Jendrassiks maneuver
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DTR and grading for UL and LL
Pathological reflex:
o Babinski sign ( Extensor
response suggest Pyramidal tract
involvement)
o Oppenheim reflex,
o Chaddock sign
o Hoffmann’s reflex.(Presence of
the same indicate pyramidal tract
involvement)
23. Balance
Presence of protective extension
reaction
Presence of equilibrium reaction
Presence of static and dynamic balance
reaction
BBS scale : Is a 14 item objective
performance measure that assesses
static balance and fall risk in adults
24. Coordination
Coordination skill prior injury
Kinesthetic awareness
Timing
Accuracy of movement
25. Endurance
EEI to be taken
Screening for CV system to be done
26. Ambulation
Wheel chair or walking
If walking how many people assistance
to be noted.
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If walking to do video graphic
evaluation
Use of Functional gait scales
Observe the associated movements
(Trunk rotation, arm swing, pelvic
rotation, Hip hiking, Hip rotation)
Use of hemi walker or any other
assistive device for ambulation to be
noted
Indoor and outdoor ambulation (Even
and uneven surface)
Dual task ambulation
27. Aerobic
capacity and
endurance
Treadmill
Fatigue level
Rest period
28. Transfers
Indoor: Mat, Chair, Bath bench,
Commode
Car transfers
29. Functional
activity
CROMS/ FIM
30. Orthotic
devices and
assistive aidss.
been used for all functional activity, ambulation and other
31. Condition
specific
outcome
Modified ashworth scale
CROMS/FIM
BBS
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measures
Fugyl Mayer Assessment of motor
recovery
ART
Community balance and mobility scale
32. Therapy
recreation:
31. Therapy recreation will be either indoor or outdoor.
The activity will be decided on basis of need for the
patient which will assist in achieving the goals stated
by patient or decided by rehab team.
33. Home
evaluation:
32. Home evaluation will be done to assess the
facilitators and barriers which will affect the
functional activity of the patient.
The areas to be considered are
Pathway from road to house
Any obstacles in the main door, rear
door for entry and exit of the patient
with and without wheel chair.
Access and safety of living room, bed
room, kitchen, toilets and other areas
where the person uses.