Special Questions!

[crypticdice]

Hi,

I'm studying physio, but my uni has not taught us anything on neuro. So I was just wondering if there are any special questions for a neuro subjective assessment??

Thanks for all your help!

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[gcoe]

I find it hard to believe your university has failed to teach you anything on neurological physiotherapy. This is such a basic branch of physiotherapy practice.

Questions used in the history in neurological physiotherapy have a lot to do not just with neurology but with the context the patient is being seen - which is usually some form of rehabilitation. For example, while there may be a limited number of questions exclusive to the stroke patient or the patient with PD, Questions about social history, physical access to home and community etc are shared with all patients in rehabilitation, whether the patient is an amputee, has GBS, multiple orthopaedic trauma, or is frail.

In fact using a prescriptive check-list can be quite limiting and there really is quite and art as well as a science to taking a good history.

One good starting point is to have an overall perspective and the WHO International Classification of Functioning, Disability and Health (ICF) is a great place to start. By the time one has completed the history and examination a complete picture where each component of the ICF is completed is a good aim. So have a read of an introduction to the ICF. Lots of material is available at the WHO website.

However I understand that when you are starting out you need something concrete to start with so here is some points a history should include (but not necessarily be limited to):

• History of the presenting complaint
• Main symptoms (these can be different from what seems obvious. For example we may see the patient as weak but there main concern is an overwhelming fatigue)
• Diagnosis and medical investigations
• any medical and surgical interventions for complaint
• Past medical history and comorbidites (consider how these may affect physiotherapy and prognosis)
• Medication list (consider how these may affect physiotherapy and prognosis)
• Previous level of function (activity and participation)
• level of function at the onset of the problem
• current level of function (getting these three snapshots will not only tell you what a patient has lost and may want to get back to if possible, but also about there rate of progress so far, which is important for prognosis.
• physio management to date and response to treatment
• Social history (particularly carers, supports and getting a picture about relative isolation or involvement in the community)
• occupation and whether retired (can help with forming goals)
• leisure interests (can help with forming goals)
• understanding of the condition (very important as neurological disease is often difficult for patients to comprehend, particularly if they have cognitive problems
• Current aspirations (important for goals setting at the end of the examination)
• Physical access to house, within house and to community (think of steps rails ramps crossing roads)

Quite a long list eh. But remember a lot of this information can be accessed from patients notes. In fact sometimes it is important not to overwhelm the patient with questions. Likewise the patent notes are often extensive in the case of rehabilitation and may be a more accurate record for many of these questions. So often the questions you ask the patient have more to do with filling in the missing information not in in the notes.

Personally I think that one of the most important aspects of the history is not gaining information but building rapport with the patient. You will often be working with the patient for an extended period of time so gaining a good impressions and demonstrating empathy not only sets up a good working relationship but often improves the accuracy of the information you

An alternative Model of neurological assessment have a look at this presentation. Personally I find it too medical and not social enough but see what you think:

Physiotherapy Assessment in Neurology

[crypticdice]

Wow thank you so much! This really is very helpful!

Yes, hard to believe, but my uni never taught us subjective and objective assessment of a neuro patient, and have only allocated us 1 week to learn neuro treatment!

Thanks again!