Physiotherapy Assessment

Sisay.D( MSc, PT)

Overview of PT Assessment
• the process of identification of the condition, needs,
abilities and preferences of a patient.
• Patient assessment is an on-going and
continual process
• assessment is important for the selection of
intervention strategies, goal setting, prognosis
and the evaluation of the progression made
towards the treatment goals.
CONT…
• It is the most important step in the rehabilitation process,

helps to guide our clinical reasoning and decision when

making informed decisions about the rehabilitation process.

• The purpose of assessment is to help the therapist determine

the best intervention.

Neurological physiotherapy

• Neurological physiotherapy treats patients with

neurological conditions, which are movement and
functional disorders caused by impairments
affecting the brain, spinal cord and the nervous
system.
Neurological Assessments
• Assessment in neurological physiotherapy is a
process of collecting information about
o disordered movement patterns
o underlying impairments
o activity restrictions and societal participation of
people with neurological pathology for the purpose
of intervention planning.
Cont.…..
• A neurological assessment focuses on the
nervous system to assess and identify any
abnormalities that affect function and activities
of daily living.
• It should allow us to create individual, patient-
centered goals and ultimately a tailor-made
treatment plan based on the client's needs.
Some of the conditions Includes ….
• Stroke
• TBI
• Multiple Sclerosis.
• Parkinson's Disease
• GBS
• Spinal Cord Injury
• Meningitis
• Transverse Myelitis
• Myasthenia Gravis
• Motor Neuron Diseases………
Assessment can be
Subjective assessments Objective assessments
Subjective assessment

The subjective examination is collecting information

from the clients regarding their problem.

 It used to search for key information and reviews

of a patient’s condition, pain and general health

history.

No measurements are used.

Cont.…
• subjective assessment allows you to structure your

questions for the objective assessments and get to the

bottom of the issue.

• Information verbally provided By the patient/ care

givers.

• Medical record / chart revision can be a source of this

information.
subjective assessment includes…
• Demographic Variables

• Chief Compliant

• Medical diagnosis

• History Of Presenting Illness (HPI)

• Past medical history

• Investigation

• Personal history
CONT….
• Family History

• Socioeconomic history

• Associated medical problems

• List of functional problems / ICF

• Patient expectation

• Subjective Markers
Demographic data
• It’s a collection of the basic characteristics about the patient.

Why?
 It helps you deliver personalized care.

 You can better target your campaigns.

 Data provides insight on areas you can improve/ RESEARCH /

 Guide the billing process/INSURANCE

 Streamline patient communications.

 Improve patient care.

Demographic variables/characteristics
▫ Sex
▫ Date/Time of Assessment
▫ race
▫ Name
▫ Primary Language
▫ Patient Id No/MRN(medical
▫ Occupation
record number)
▫ Education level
▫ Age ▫ Address for Communication
▫ Height ▫ Referred by

▫ Weight ▫ Handedness

▫ BMI
Chief Compliant
• referred to as presenting problems.

• clinical syndrome or reasons for visit.

• It’s a reason a client’s seek to visit a medical center.

• Patients own word.

• Lead your client to came up with physiotherapeutic

aspects.
Medical diagnosis
• The diagnosis performed by a medical doctor will focus on the
recognition of the disease and possible ways to treat it.
• primarily classify the causes of disease, disorders, and injury.
▫ Example :
 stroke – ischemic/ hemorrhagic
 Spinal cord injury
 Multiple sclerosis
 Meningitis
HPI
• A description of the development of the patient’s present

illness.

• a chronological description of the progression of the

patient’s presenting illness.

• first sign and symptom to the present.

• Describe the course of the patient's illness/Mechanism of

Injury.

sign vs. symptom?

Cont.….
• When it began?
• How did it start?
• Duration of the symptom?
• Progression of symptoms since its onset?
• Any developments of symptoms?
• Character of the symptoms?
• Location where the symptoms began?
Cont.…
• Previously suffered from same problem: Yes / No
▫ If yes, previous treatment taken
a. Medical
b. Surgical
c. Physiotherapy
• If no, present treatment undergoing
a. Medical
b. Surgical
c. Physiotherapy
CONT…
• Any medication given in each health institution
orderly.
• Progression after medication/treatment.
• Present treatment undergoing
▫ a. Medical b. Surgical c. Physiotherapy

• A 24hrs behavior of signs and symptoms on

Activities.
INVESTIGATIONS/EXAMINATION
• a clinical test or investigation offered to or carried out on a

person/client.

▫ Laboratory blood tests for specific antibodies

▫ Radiographic Examination: X-ray, CT scan, MRI, DEXA (Bone

Density Scan),

▫ Positron Emission Tomography (PET) and Ultrasound etc……

▫ Neurologic Examination.(nerve conduction velocity) NCV

Past Medical History (PMH)
• Past diseases
• Surgeries and drugs history with dosage
• History of Hospitalizations
• Prior treatments
• History of diabetes, Hypertension, Peptic ulcer disease, Coronary
artery diseases
• Respiratory diseases/Asthma
• Musculoskeletal injury
• Cancer/AIDS/TB
• Medications, Allergies
Family history
• Stays with family

▫ Yes / No

• Stays at Home

▫ Yes / No

• Have helpers to attend

▫ Yes / No

• Takes self-help

▫ Yes / No
Cont.…
• Medical problems run in the family, including the patient's
disorder.
▫ Asthma Hyper lipideamia
▫ Hypertension Tuberculosis
▫ HIV
▫ Diabetes mellitus
▫ Hereditary disorder/Birth defects
▫ Coronary artery disease
▫ Heart failure
▫ Cancer
PERSONNEL HISTORY
• life style:
▫ sedentary, active, regular physical exercise
• Habits:
▫ smoking, alcohol, tobacco, drug abuse, chat chewing
• sleep pattern
• food preference:
▫ veg/non-veg, personality type:
• education level
Socio-economic history
• dwelling place
• Urban/rural, own/rented, picture of the patient's social
situation.
• lay out details like presence of stairs, etc.
• level of support available at home
• marital status: single/married/widowed/separated
• economic status: poor/low/middle/high and medical
insurance if any:
Associated medical problem
• Problem or disorders that can be related to the
current medical diagnosis.
List of functional problem
• Patients subjective complaints about his/her
daily activities.
• Should be re assessed in the objective
assessment .
• Difficult vs. unable
• Exam..
▫ Difficulty of sitting
▫ Difficulty to roll to right side.
▫ Unable to stand
▫ Unable to walk
PATIENT EXPECTATIONS:
• with reference to healthcare, refer to the anticipation or

the belief about what is to be encountered in a

consultation or in the healthcare system.

• It’s the patients need in terms of medical service.

• Should be patients own word.

CHECK RED FLAGS and YELLOW FLAGS
• RED FLAGS: red flags for musculoskeletal disorders,
which are indicators of possible serious pathology.
▫ inflammatory or neurological conditions
▫ musculoskeletal damage or disorders,
▫ circulatory problems
▫ suspected infections, tumours or systemic disease.
• If you suspect any red flags the patient must seek
urgent medical attention.
Signs of serious pathology

• Cauda equina syndrome

• fracture
• tumour
• unremitting night pain, sudden weight loss of
10pounds over 3 months,
• previous history of cancer
• saddle anesthesia
• Genito Urinary (bladder & bowel incontinence)
YELLOW FLAGS
• Yellow flags are psychosocial indicators suggesting an increased
risk of
▫ progression to long-term distress.
▫ UMN symptoms
▫ Progressive weakness
▫ Psychosocial stress
▫ Multiple joint inflammation
▫ Skin changes
▫ ANS symptoms
▫ Fainting
▫ Vertigo
Subjective markers

• Points that directs the objective assessment.

• Key points from subjective assessment.

• Helps To guide the objective assessment for

better intervention plan.

Objective Assessment
• Objective assessment involves the collection of data that
you can observe and measure about the client’s state
of health.
• Typically, an objective assessment is conducted following
the collection of subjective data.
• The purpose of the objective assessment is to identify
normal and abnormal findings.
Observation
• Color of skin
▫ Pale/pallor---unusual lightness of skin
▫ Cyanosed/ dark bluish
▫ Erythema/Redness
▫ Normal
Cont.…
• Texture of skin:
▫ Dry / Shiny / Scaly / Broken / Normal
• Scar tissue: A scar is a mark left on the skin after a
wound or injury has healed.
▫ Regular, Keloid, Hypertrophic scars
• Built of patient:
▫ Ectomorph / thin
▫ Endomorphic / obese
▫ Mesomorphic/ normal
Cont.….
• Swelling: abnormal enlargement of a body part.
▫ Present / Absent
• Muscle Wasting: loss or thinning of your muscle
tissue/ decrease in muscle mass.
▫ Atrophied / Hypertrophied / Normal
• Unwanted muscle movements:
▫ Fasciculation /Tremor/ Tics/Myoclonus/Chorea and
Athetosis
Cont.….
• Attitude of the limbs/joints:
▫ Flexed / Extended; Abducted / Adducted; Int / Ext
Rotated
• Deformities:
▫ Present / Absent
▫ Region (upper limb / lower limb / spine)
▫ Side (right / left)
▫ Area (the exact part of the body)
▫ Type (fixed / mobile)
Cont.….
• Look External appliances
▫ Catheter
▫ Intravenous cannula.. (IV) Cannula /Nasal cannula
▫ Nasogastric tube (Ng tube)
▫ Any assistive device
▫ Tracheal intubation
▫ Mechanical ventilator
• Posture
▫ Sitting: Altered / Deviated / Normal
▫ Standing: Altered / Deviated / Normal
▫ Lying: Altered / Deviated / Normal
Cont.…..
cont.…
• Ambulation (explain the mode of Locomotion noticed):
▫ Ambulates normally.
▫ Ambulates with difficulty and without assistive
devices.
▫ Ambulates with assistive devices
▫ Ambulates in wheelchair
▫ Bed ridden
▫ Bed bound
Cont.….
• Pressure Sore: Injury to skin and underlying tissue resulting from
prolonged pressure on the skin.

▫ Non blanchable erythema of intact skin = Stage 1

▫ Abrasions, blister or shallow crater (At dermis and
epidermis) = Stage 2
▫ Deep crater, necrosis = Stage 3
▫ Extensive destruction, necrosis up to muscle and bone =
Stage 4

• Type/ Pattern of Respiration

Level of consciousness
• If there is an altered mental status asses the Glasgow
Coma Score
▫ Comatic
▫ Stupor
▫ Obtunded
▫ Semiconscious or Lethargic
▫ Conscious
• GCS
▫ The initial score correlates with the severity of brain injury
and prognosis.
CONT….
• Glasgow coma scale
▫ score for eye opening
▫ score for best verbal response
▫ score for best motor response

• Maximum score is 15 which has the best prognosis.

• Minimum score is 3 which has the worst prognosis.
• Scores of 8 or above have a good chance for recovery.
• Scores of 3-5 are potentially fatal.
Orientations
• Orientation: (Awareness of Time / Person / Place):
▫ Not oriented=0
▫ Partially oriented = 1
▫ Semi oriented = 2
▫ Fully oriented = 3
• Memory :
▫ Short term
▫ Intermediate
▫ Long term
Behavior & Communication

• Behavior: Abnormal / Moody / Co-operative.

• Communication:
▫ Speech
 Normal Impaired
 Dysphasic - Expressive /Receptive
 Dysarthria
Sensation
• Superficial
▫ Fine touch (use cotton / butter paper)
 Hyperaesthesia / Hypaesthesia / Paraesthesia /
Anaesthesia

▫ Pain (use pin / back of knee hammer)

 Hyperalgesia / Hypoalgesia / Analgesia

▫ Temperature (use test tubes with cold / warm water):

or dorsum of hand.
 Differentiatable / Non – Differentiatable / Anesthesia
Deep sensation
• Crude/light touch (use blunt end of knee
hammer)
▫ Hyperesthesia / Hypaesthesia / Paraesthesia / Anesthesia
• Vibration (use thumb / reinforsed index finger)
▫ Painful / Altered / Normal
• Proprioception (Movement):
▫ Appreciable / Not – appreciable
Palpation
• Warmth: Present / Absent
• Tenderness:
▫ Complains of pain = 1
▫ Complains of pain and embraces = 2
▫ Embraces and withdraws limb = 3
▫ Does not allow palpation = 4
• Edema:
▫ Pitting: pressure applied to the skin leaves an indent
or pit in the skin.
▫ Non Pitting.
Cont.….
• Tone: muscle tone is the amount of tension (or
resistance to movement) in muscles.
▫ Hypotonic or Flaccid
▫ Toned or Normal
▫ Hypertonic or Tight
• Muscle tone assessed by
▫ Passive movement
▫ Palpation
Reflex
• Superficial
• Deep tendon reflex (DTR)
▫ Reflex hammer
▫ Biceps tendon
▫ Triceps
▫ Bracioradialis
▫ Patellar
▫ Achilles
Muscle strength
• is the ability to exert maximal force in one single contraction, such
as lifting a weight that you could lift only once before needing a
short break.
• Assessed by manual muscle testing(MMT).
• MMT
▫ Is a standardized set of assessments that measure muscle strength and
function.
▫ Its for a group of muscle not for single muscle.
▫ 5 scale of grading
BALANCE
• Balance (static and dynamic balance)
▫ Sitting:
▫ Standing
• Static
▫ 0=Unable to do
▫ 1 = with human support
▫ 2 = Using aid
▫ 3 = Needs supervision
▫ 4 = Independent
• Dynamic balance
▫ Reaching out activities
 Able / Unable
• Perturbation
 Able / Unable
ICF ?? OBJECTIVE SUMMARY
• ???
Problem list
• A summary of patients problem from subjective and
objective assessment.
▫ EXAM…
 Pain
 Muscle weakness
 Decreased ROM
 Sensory abnormality/ decreased sensation
 Decreased tone/Hypotonic
 Functional problems…
Physiotherapy diagnosis
• physical therapists primarily classify the consequences
that result from the medical problem.
• a generalized summary of patients problem in a single
sentence.
Goal of treatment
• Short term
• long term
• Goal writing should Follow SMART principle.
▫ Specific
▫ Measurable
▫ Achievable
▫ Realistic
▫ Time bounded
Treatments
• Treatments which are problem oriented.
• Include patients in treatment planning/ pt value.
• Follow FITT
▫ Frequency
▫ Intensity
▫ Type
▫ time