Neurological Evaluation

[ptburak]

Hi everybody! I am a pt student in Turkey.Now I am erasmus student in spain.Here I am working in a neurology clinic.But I dont know any rehabilitation.Because I am at second class.I must evaulate patients.But I dont know anything.
Is there anyone who will send me some documents about neurological evaluation (scales, forms etc)?And may you send me some samples evaluated hemiplegia patient?And where can I find detailed information about illness (hemiplegia,...) (I couldnt find at pubmed)?

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[gcoe]

Hi ptburak

This is a huge question. It may be that different countries in the European Union have different scopes of practice as well as different standards. I don't know what spanish students use so it may be good to find out what the your school recommends. I think you need to be quite systematic about developing your assessment skills. I would recommend you get a couple of really good textbooks.

http://www.bookdepository.co.uk/book.../Motor-Control

This books is an excellent textbook that takes you through the motor control of the normal, changes through the life span, abnormal control and management of control. In the management chapters it gives you all the tests you could need. It is a very up-to-date text and our students use it and find great value. There are also nice reviews of neurophysiology and motor control and motor learning theories -all aimed at the physio. One of the bet science-based textbooks for neurological physiotherapy.

One limitation is that it doesn't talk about specific neurological diseases or injuries. Instead it looks at disorders in relation to:

1. postural control
2. mobility
3. reaching and grasping and hand manipulation.

this is good because every patient with a neurological condition is different - and as physios we don't treat the medical condition, we treat the presenting disorders of control.

So you would need to supplement it with a good textbook covering specific conditions. There are a number good websites for information. On the web Medline-Plus at the NLM gives condition-specific information for both patients and practitioners

But a good text that covers neurological and neurosurgical conditions is:

http://www.bookdepository.co.uk/book...ry-Illustrated

This book is not written specifically for physios but lays out each condition clearly and includes it's medical diagnosis including medical examination and medical or surgical management. It makes use of lots of diagrams which are easy to understand. There is also a great section on all the common imaging and diagnostic equipment that your patients may have undergone.

You might also like to consider buying a pocket book for ready reference. .There are three choices of pocket books

http://www.bookdepository.co.uk/book...sts-Pocketbook

Dictionary of Physiotherapy by Stuart B. Porter - 9780750688338 at The Book Depository

Amazon.com: Rehabilitation Specialists Handbook 3rd edition: JulesMRothstein: Books

You just need to buy one of them as but they are good because they are quick to refer to - small and easy carry them around with you. the don't just cover neurology.

The first two are British and the last one is American. The first one is what our students use and they seem to like . However the last one is the best quality but is considerably bigger.

Best of luck with your studies. You are brave learning in a a country with a different language

[ptburak]

Very thanks for your answer.You are right.It is a huge question.All right, is there anyone who will able to send me some samples that evaluated hemiplegia patient?

[Fyzzio]

Hi,
maybe we don't understand your question. ???

Firstly: what do your colleagues use? Can they not provide you with the commonly used assessment form of the unit?

Secondly:
These days, the trend is to use assessment forms which go alongside the ICF model (WHO | International Classification of Functioning, Disability and Health (ICF).
Meaning, that you use a general Physiotherapy assessment form, regardless of disease and complete only the neccessary components.
Example: If the patient suffers from pain, elevate on the topic, using outcome measures (e.g. the Visual Analogue Scale or body charts) and whatever is commonly used in your country. If the patient does not suffer from pain - comment that this is not currently applicable.
For a hemiplegic patient, look at impairments like e.g. strength and tone and functional components (see gcoe's suggestions). Depending on the severity of these patients, you will have to include neurological, but also respiratory, musculoskeletal aspects into the physical examination, so, yes, the assessment is huge.

It will be pretty much impossible to send you an assessment sample, since privacy and ethical responsibilities would not allow this. I hope you understand.

If you have not been given any guidelines on the assessment of neurological patients, you will have to get some of the suggested books, in order to do an appropriate assessment and analyse your findings. This will ultimately help you with making informed clinical decisions and justify re-assessments and treatment.

Kind regards,
Fyzzio

[gcoe]

Hi ptburak

I agree with Fyzzio. Neurological physiotherapy is very complex. There is a huge amount of basic and applied science that goes into conducting a good assessment and coming up with an effective management plan. You can't learn this from samples of evaluations of hemiplegia. Each hemiplegic patient presents somewhat differently and is faced with a different set of problems. Relying on forms doesn't teach you what to do. Outcome measures and tests are an important part of assessment but you really have to understand why you are using them. And they are only a small part of assessment. Some examples of the basic tools of your trade are such things as:

understanding the biomechanics of activities
applying your anatomy and physiology of normal movement
Identifying and understanding deviations from normal movement
Identifying why those deviations may be happening (impairments)
Identifying and applying outcome measures that are reliable valid and responsive
selecting tests for impairments based on the reliability validity and diagnostic accuracy of those tests
Identifying and applying management techniques that have evidence for their effectiveness

...And so it goes on. I would recommend you get on and read as much as you can about the knowledge behind neurological physiotherapy.

[ptburak]

Very thanks for your answeres...

[ptburak]

Hi again,
May someone write a general treatment program for acute hemiplegic patient (together with theirs goals)?I need some samples.

[noemigaudenzi]

I'm later for your problems.
But...We use:
Trunk control test
Modified Barthel Index
Motricity Index
Functional Ambulation Categories

And sometimes

Berg Balance Scale
Catherine Bergego Scale (for neglect)
Scale for Contraversive Pushing (for Pusher Behaviour)

You can find all in pubmed or in google!

And to treat, you can read our scheme in evidencebasednursing site (it's in Italian language, but Spanish people can understand!), it's an old work, but it's good to do the first experiences!

And all gcoe suggestion are useful!
Good work

[noemigaudenzi]

motor relearning programme (in spoken english countries is very note!)
bobath programme (the same)
but... if you want something better: perfetti and grimaldi!!!!