NEURO PHYSIOTHERAPY ASSESSMENT

NEURO PHYSIOTHERAPY ASSESSMENT

1. NEUROPHYSIOTHERAPY ASSESSMENT

Age:
Gender

+ Occupation
\ + Handedness:

+ DoE:

+ Body Weight, Height, BMI

. I Diagnosis:

HISTORY:
| | + Histor TS
| | + Past medical & suíical histo
| + Family ist
E & personal stor
+ Functional his
+ Environmental history |

JATED PROBLEMS:

+ Diabetes
# Cardine Di
+ Oiler Ortbopedis Dysfunction e

JENS 7

| A ouh ear, moor, an)
| + ruso 601 100bpn oe
rro sil, bch rad & lat pe
| tet Hm Roc popliteal oral pes € bilis posterior pue
es eu, pos fil ple
\ + od pressure = 90.120030 mm

1 2 van ware

2. Dr, Dradycudia & fll R

qa a fant:
+ Respiratory rate adult: 12-16 rim, in
fe it , 02 Saturation, Pupil Size,

‘© Duration: Acute, Sub Acute, Chronic
‘© Aggravating Factors

© Reliving Factors: 7
Severity Mil

Moderate, Severe
Intensity OF Pain
Type OF Pain: /

may be indicat

increase ICP

0-60 rim S
Equality & Reactivity To Light)

Type OFF: Structure
“Camping, Dll, Actin Muscle
Sharp, Shootin, = Nerve Root
seta Nerve ie
ing, Pressure L Ach Sympathie Newe
Deep. Nagging, Dull Bone
Sharp, ever, Ile = Fracture

‘Throbbing, Diffuse

Fist impressions:
+ Coming through the door

Reel into door frame? Cera
+ Size and shape of pt

Nor dwarfism. Excessive i
Gait and posture
Try and observe without the pt knowin
= Look for kyphosis, solisis ete
Muscular weakness, fotdrop, circumduc

General observatinn

© Built: Ectomorphie, Mesomosphie, Endomon
+ Posture:
= Standing siting & lying position
= Anterior, posterior & lateral views
Swelling/edema:
+ Involuntary movement:

‘Stooping, flexed rig posture? Parkinsonism

tion of limb use spasticity ete

= Tey and correlate observations with known disorders

NVATIN.parEL

3. “© Anite of tinh

Sey Tope tine Taverne.

+ | Shoulder abduetion & ER, elbow | Knee flexion, ale DF &
Flexion | sion, fret supination, write | Inversion, 106 DF
& fingers flexion

Scapularreiseianfkvaton, | Mipfesion, abduction & ER,

Tip extension, adduetion & TR,

Scapular proton shoud
Se i ikle PF &

‘adduction & IR, elbow extension, | Knee extension,
forearm pronation, wrist & finger | inversion, toe PF
flexion

Extension

= En A Temiplegc Favingadducted & IR shoulder, Menea & pronated elbow wäh
‘wrist and fingers Nexed suggest stage of spastic
+ Estemalappinces:
= Functional aids: walking ads alter
7 Protesive ads: orthotic! prosthetics device (catheter, calipers sl
hecha
+ Gait
Eg —circumductor gait: hemiplegin
A A OS

1, braces,

ai gait posterior column injury SC /cerebellar problems

2 Seigocng git past CP nto pot bl

= Types oFrespiration See
- ThoracoSibdominal (female)
2° bdomino thoracic (male) |
Using of accessory muscles Of respiration - weakness of diaphragm /above C4
sci
Tropic changes:
= Deformites:

Wasting /hypertoohy:
Facial expresion:

+ Tendemess: pan on palpation

ado
No complains of pala
Complains of pain
jin wa

Sami skin temperature
8 Muscle spas cramp:

2 Spas occurs during rest activi (du 0 electrolyte & metaboli alerts)
© Cramp oxcurs afr excessive tenuous activities (due o rection ul Nat Cat.

NIVATINPATEL

4. = dep of dee

mB LENGTH MEASU

[Troemeasrenen

THIS bets

as |

per ind: Cline ine pao US Sat
Lower md: ee

GIRIH MEASUREMENT:

Comense

Noé

[soma Ma ]
Piven us |)
Tonne “eo |
N
_A _— VA le
y me
a a

5. Muse

+ Offéntaion oF ine, plas

ime, place, day, year or season
+ Memory (Imimetfae short term & long term memory)
+ “Behaviour (co-operative & unco-operatve)

Attention (sustained, alternative, focused/selective & divided: attention)

+ Speech disorders

ADS: dieu 10 Say the words (e.g- person may ty lo Say! “Kitchen but it may

ome ou “pen” oreven “chika”

= Dysarthria: impairment of ech production

‘Spastic dysarthria: Pt have diffieulty to spe
associated with spasticity, ve Babinski si
reflex

«+ Extrapyramidal dysarthria: speech hypophonie & monat
EEE typo (ack of fail expression can be hyperkineiie
(Parkinson) & hypokineti huntingtons)

psp)" & 'R' There is usually
y increase jaw jerk & phanngea!

jonus. There is usually

es from loud to soft &
tly

© Ataxie dysarthria: speech is inegula, slr

incor
ce labials such as

archythmie. Word merge one with another or are sp

+ UMN dysarthria: facial paralysis makes it difficult to pronouns
syrups ont" dW", Tongue & palatal pualysis/ weakness produces nasal
speech,

moy be normal with rest at the beginning Ofen

ess & hoarseness

+ Myasthenia dysarthria: ot

sentences but changes as speech progresses. Pala

ree ne
ue
mosca recia Innere
a eee
a ley ng sulting sesh on Mur |

right hemisphere)
Anomis aphasia: unable to find correct

5 NVATINPATEL

4 in spontancous speech & writing

6. Apraxia
vial function in the face of

+ Prin reihe nah 1 perform an individual or sequen!

intact moto, sensory and coordinative abilities

+ Methods of testing
© The examiner must be certain th fas no deficits of ste
Sensation orcoordiaion that would interfere with his or her abi

the required ass.
+ Ideomotoraprasi: This form of apraxia refers the mabiliy ofa patient to carry out
A single purposeful movement sucha a alte or o demonstrate how to turn a key in
lock orto comb ones bai |
tint understand the tsk and are ob
performed, but cannot perform ito coman
Teomotoraprasias may be seen with conductive aphasias

o formulate how it should be

© Eg Blowing, Hanmering, Bring Teel Shaving

|
. manne |

7. (CRANIAL NERVE EXAMINATION:

asa |

Sympromstsign of

‘Optic (8) |

reflex

function Assessment ig
SIS GAS) | Sell ee Amos
| Asses visual equi
Vision | visual ed, pupillary Qu

(Oceulomotor (M)

Trochlear (M)

Trigeminal (M)

Abducent (M)

TON)

| Giossop

rs

Bye

| Eye movement

| Fava
sensation &

Eye movemen
aca
| expression, an

Assess position oF eel
test eye movemels,

| pupi
Test

St sensation of
face, comenl reflex,
sess strength oF

(sic slp) long
roman

deviation of eye

Facial anaesthesia, loss
of pain, loss of

Medial eye deviation

Paralysis of fiat

muscles, loss oftaste

Sensation, dry mouth,
less of herimation

Loss of taste

Atrophy / deviation of

NIVATIN PATEL

9. ps
Ft ‘Occipital Longus Colli, be
a protbernce | SCM, Rester aia
Capitis
Y Horizontal |
Supacaviclr | Trapezius, Lemor Be
the os fossa na None | haviete
Rese! bee ca Tip of the AC | Trapezius, Levator | None
ne Fi ene
ee
N Teal eo |. Sra
pe antecubital | Infraspinatus, Nowe
fase | eto bis |
ee re |
Towne | ON extn PES
er Inden me
Middle finger | " are Triceps ring fingers
4 a aa
Java Ulnar Deviator adjacent
A a | Thumb Adducton Sa ring or fong

| Meiiaisiieor

Apex of axilla

||
Ares eve do not appear o!

¿ue to her paolo;

han I elbow Mexion 6
forward £ backwand ol

‘chest wall. Neck Mesion at any thoracic level

fingers, along
ortogelher

urate |

Fics

signs (etaneous analgesia) are

re common. Root

thigh

Addduetors

man Scare thy av i oan al
Mann 2
Taine
dias lone None Groin
Sy LU |Beincen TI2 ps
Le pue -
: 12 foret | anni None | Anterimieh

Media femoral | Pros. Quadriceps. |
condyle | IMA Op |

Knee jek

Tiedt ence
nero Lae
les

10. Ti
Extemsor Halluces
Extensor Halluces,
“Peroneals, Gluteus

Knee jerk
ZZ

Dorsum afthe ae on
15 || | is
‘BITE Joint Hamstring & Calf
‘Atopy

3 toes

Calf & Hamstein

Lateral Weel) Ges, Peroncals, |

Plantar Flexors

endo-Actilles

lateral foo
lateral leg to
knee, plantar

Medial aspect

| Lateral aspect
of leg, medial

| aspect of foot_|

Popiteal fossa | Same As ST Except

Lateral leg,
Knee & hee!

se inteniine | Re | TAs
Tschial lr

= tuberosity None

si Perianal area |

| Genitals &
anus)

|

MOTOR ASSESSMI

[Dat

T ron RE

Flexion (207

Extension (20) |

béton (45) —
Audıcion 00)

ation (ST

Alco 487

kk

Flexion (13)

Titan (107

ue. a il

|
|

11. Wee

‘COMMENTS:

LEFT
RIGHT MOVEMENT ae
pato pl
Lak TE HIPIOINT
Flexor
Extensor
ductos

External tos

KNEEJOINT

Flexor

ANKLE JOINT

External rotos

~Supintor

WRIST JOINT

Sve movement of he mb being tested
> hypotonie, normal. hypertonic or dystonic

a

12. i

F

La m Am 3

Clinical Kat

as arte m |

—, Complete 65 0
Flnccidiy een isis, a]
Tray Dm ey |
> Na von m J
Tiger tonic (mil to moderate) — UNN Exuagvamıda

overeypertonciy UMN / Extrapyramidal lesion

+. Emi (acid) AHC & peripheral ni son, Dereseabsent muscle One |
Riis ineease tone in both antagonist & agonist msl props
'© Lead pipe rigidity (constant rigidity):Resistan is felt throughout ROM
à Cog el iy (let gis: Commons present Parkinsonism
> Righty i
+ Dani ton & posturing fk & LL in extension € À
ein. Lesion cba alle na alas ease yt
D mn D meer A ada
a Si Suinedconaton& posturing of tank & ins in fl 9” 0°
Een Lesions ned mais ste, creel, spinal or cerebral conil |
Baul ram cho Hy oy

Fepeiive involuntary moveme
inerese in both agonist $ rp Fs passive movement is
jnereased there is ncress in resistance o passive mo

MODIFIED ASHWORTH SCALE

ress aiid of he nz af cpu ames |
ig vee in A | |

TARDIEU SCALE

ja of voluntary come
Presence of spi
Positive Babinski’ 581
Presence of sy

‘Quality of perfor

ay patel
Kein any PO

ane rue of sexing

13. |

* Midrange of motion is usualy selected as iis he mos functional range & easiest for
a muscle group to work
+ Chosen position should be i antigravity positon oases the muscle par
function
= ORUNSTROMGRADIS —— = :
Grade] No cowacton
‘Grade 1 | lan EEE TE
Grade [Taal al range of maton mpatem
Cakes ao pam (ms pam

Graded [Initial halt range m Kolamon and Tao men

Grades

Full ange oF motion insolation but a

sin patera On

|

Grade © | Fullrange of motton in ¡olation and con take resista

ce Tike normal

MOVEMENT

PORT

Flex

sensor

KNELJOINT
Flexo
ANKLL JOINT

Eventos
SHOULDEK JOINT

ELUOW JOIN
Pisos _

roma

NATI PA TEL

14. Ms
nenas —

al dene —
Ua dvs —

TOmMERTS: |

MEDICALRE CIE
[Gradeo [No movement 2

Grade 1 EDEN ss |
E an mn |
a em |

[Grade 4 [Active movement against gravity ands Bere |
> or a
HIP STRENGTH § PINCH STRENGIH ASSESSMENT: nd dynamometer

DH SIGNS IN UMN SYNDROME
= ue | |

Ir Weakness

5 5 = ¡sal

Inn upper & lower int

a Pesorlis muscle
> Biceps brah
ps bach
Flexor digitorum profundos & super
Estensor don
Lombricals

Loner stem
E tip flexors (Thomas te)

2 ces femoris (Ely es)
3, Hamsrings (SLR. Tripod sien)
Fargo sea ta (Ober tet)

Gastocnenis

Beamstring length sine

van MPATEL

15. © Sitand reach test

REFLEX ASSESSMENT:

> Deep tendon retlexes (Clinical Ra

Scale of DIR)

GradeQ_[o Absent _T_No visi or palpable musts coman on eee
S light or sluggish muscle contraction with tle or no joint
Grate 1 Hiporenevia | men Renforcement may be regul lo eeitresponst |
Grade Y fr Sight muscle contraction with Sight joint movement

| Grades [ro |

easly visible sk muscle on with moderate joint

Gradea pere | Strong msl conta
[cados 4 (Cioms [Strong muscle c

Unpertimb | Right | Lett
Bicepses.c |

= af sri
© Neurontuscutar Junction: No = i
À Peripheral nerve: Diminished to absent usually ou

portion to weakness. This is
because the afferent

Superficial reflexes are rarely depress

sd in proportion.

ation of individual rvs roots ofthe shin and must tested i

+ Spinalgord and brain stem: Such ne
peras below the level ofthe lesion. During
Alesis, th spinal rflexes below tl
SIIC elens are hypoative at & below t

level of lesion &
age of spinal shock
also hypooetive

Conic spinal trash QIMN): peras y in spe i eae
isnt abdominal rater eleves om he son ate ï

fy Be ins

afe no consisten kp
appearance some of te
Classically th
em ni 0 th
‘isilyabnonna

© Piychagenie Normal Or irc in ps oF roponse

sustch se are poire Pendlar mention
see how os onen Han nt the et ng

> Superticil reneses

16. Faire (CET?

Horgen nen
RE DST
ROULE SE
KENEIES

JAUTOMANIEREHLENES)
A ae th es ion
© Integration - 56 onl
Testing position Cchildin spine with had in milo, support the child
it posa halfiayeten spine and u
rude = support the infant’ head and ol wil one Trois
neck to drop back to allow the anterior
Response observed ie shoulders
tre
unctional ignific a indicate a brain

© Testing y ne
à Procedure = pet st rs area for the C7 area othe

<The baby Wi esend his ams 1% files hough his refs

D convuerurxes
Das
: ht position ná legs extended

17. ® Present since bi
+ Disappears-by 2 montis

E

ven stroking

+ Response — im Fand internal rotation of exe led
vith plan

+ Present at birth

+ Integrated = mois

Sucking Reflex

‘Onset begins at 2
Integration - 25 mont
Testi

Proced

weeks gestation

NE Onset 28 w

nd in midline and hands on ches

+ Response An
7. Stoning reos

Ingram
nein ih inant forward and gently mows ths in fr
sing

© Response observed -

main, hythmical nd eordinaed steps

18. canse - poomature infos Lien to walk ind tue-heel fare
yl nak na hos pac

M LEVEL REFLEX
fes > STZ

“Gti in gute position onthe floor ori

+ trou pestes th ed foward and then extn i backwards

. Response observed RCE Wi Posies Texion of the upper
{tenes and trs elo TET TN en oi ead wil
eee enfin Pon ole ver

+ Lategration- 46 month
+ Testing portion =ipine)

© Procedure geil turn the ifs head to one ic

+ Response observed = UL an of apposite Se sin

exion and onthe

ARE One peta pre EA ss ESS

ih and TES

an hi one sde
TES
a dd a La 3 mon

19. ‘CORTICAL LEVEL REFLEX

This consists ofall he equilibrium reactions
+ Us

lly checked on lt board or rocking board

CO-ORDINATION ASSESSMENT

NON EQUILIBRIUM: Test should be

formed fist with yes open & then with ees
closed. Abnormal responses include à ya

ual deviation om the holding” position a
iminished quality of response with sion occluded. Unless etherwise indicated, fst ae
performed withthe paient in siting postion

2 Foottapping >

Key o grading
fo

[Le Severe pen movement are very arsine EN
117 esciion & ctricos movement

Two

_ | performance deteriorate» ls
val paient, 0 accomplish activ ii

EQUILIRIUN:

Standing at narrow BOS

Without using band it

svi poss

be compl
BALANCE ASSESS

Sai balance: dung
+ Die balance dar

ie postu balance contol
dynamic posture balance control
+ Funcional balance: during fontions| aiviies (walking. sf stair climbing ete)

DAT

20. ave they ba polen
om peu at

ore as pt ear fallness, nausea /

Fee rancor amago Iv su

es constant?

VENEN een any gener eats changes, new meee al rua / ree
ture ifetins-
re there anyother nu

Beer reste wa meskes ein peer tn?

aa a
‘Good Pris able to maintain balance without support ESA
sb a ena sg corn (ami) |

thor standing on on:

+ Dynamic activi
opine o St siting reach out & pertrbations, sito stand standing each out &
perturbations, walking,

pet wo bance and compensate wh ne ur sre aces cup
[Roy Con on ata Dane

1. |Eyesopen Ending on normal sure, senos systems
inst (vision, vestibular & somatosenson) _
3 [Eyes coso on normal face Vests & annlosnson,

SIEHT:
compromisos |

Visual & cure

somatosensory

‘Observation of say in each cojin is wade ss
Minimal suas

ikl sway

3. Medea sway

‘Standardize balance assess

21. SMENT

+ Assess on level & uneven surface, ramp, curbs & stairs

Assess with or without the use of adaptive, asistive, olhari/prostetie devices or
‘equipment a self-selected speed

+ Describe arm swing. ankle, knee, hip, trunk and hea movement
+ Record: Cadence

‘SPATIAL TEMPORAL
+ Step length Step time
Stride length Stride time
Base of support Single limb suppor time
Fick angle (toe out angle) Double lint support ime _—

Neurological gait abnormalities

+ Cerebetlaratase galt Drunken gi tee a cms stagering, unsteady es
cine bal de base ga & the pr may a ie sd, beck o ward
à Seeley aa at ica 1 al bay wand who a apt i the Be

renos ssl. conan mils tan may appear nema Wh
Sed poy corded

. ty ait (Spastic hemiparetic gait): holds the arm tightly to the side in rigich
Sn no aoe na swing ds thee ily m sesion & feed

nis tle upward on the

There is characteristic tightness of amstrings & 1A
lin” orig” wi eu

ALS)
ended. The gal ios, Mi Kanne sts
+ Sicppage (equine) gat: ie

is with foot drop

© Myoathie waddling gite
(DMD € Prenant Indy)

ing with lumbar hypertordosis

+ Senile (eantios) gat: hee gaits present i old age pis who have no neurological
ul are unsetin of thse balance & postr reves. The it takes on the
ss seen when a hey person walks on sippy suce: velit lo

ipso
+ sper hint ga wai
Aroésque, dancing pani

en & wide bs.

18 il abundant extraneous movement, I may Took hisrionie

(bass ganglia order Humington disease)

© Functional gat sues: Dynamic gai index
© Tamed walking et: 6

le Walk fs, 12 minute walk est

22. jn, rebound phenomenon

Soy asia Hypotoni

of eecbeltum es. ee
an mans Y Possilediorder —,
sagas: exraocoular | Medullohlstuma

mov abnormalities

ses one,

vermis (parace) | Gat ataxia ‘Alcoholic degeneration
encens) _ Appendieuar ataxia Tumor; stroke
Panserebellar Allofabove paraneoplastic

BLADDER INVOLVEMENT:

+ Uninhibited bladder: Characters by contin
lesion

+ SpastiiautomaticIreiex blader: Loss of sensation of filling of bladder & urge 10
anne Bladder automatically empties after being filled, Seen in lesion above S2

+ Fiaceid/autonomouslatonie bladder: Loss of sensation of ling of bladder & ur

> mp ing blader, Uses erede Mali manoeuvre to empty Seen |

ous dribbling of urine seen in frontal lobe

mary | Pi

sympathie

rrsympathieie (82,83,

ter ro,
rem

Contraction
Relaxation

eral sphincter | Contaeton |
o |

Dribatin of wine
| lesion ca sino
ks = bladder

jon ell is inte

+ Spastic bowel dysfunction (UMN) in
Rares has continence. Spastic bvse dysfunction with spastic conta
anal sphincter

+ Face bowel dysfunction (MIN) injury at $2-4 Deveation rfl 1 destroyed
Occasion incontinence, Field sphincter

FUNCTIONAL ASSESSMENT

{Physical function (BADUIADL)
Assess ay to pation bse ADL like dessin. wooing and ease
‘Assess ab opero instrumental ADL Ike drin
‘Assess funciona bis line gelling up ra chal (antigravity contol
‘Assess functional ities like walking on level sue & siting down (essen
control)
sexy abi toparon slcare hon tement activites wit ori
fl rt rectivlprostlc devices € equipment
TO in Mode Dane nde. Function Independence Mean,
Brumcnial ADL Assessment Seak(Law TADI Seule)

DATE

23. ‘+ Psychological functions (mental status & affective function):

Social function (performance

social roles):

SPECIAL TEST
= Hand
© Romberg tes

[Neural tension test
‘Applause sign / clapping test
Hallpike est

Phallens test & Moments test
Timels sig
Kemig's test & brudjinski's test te

2 CT Scan/MRI
CSF Examination
Angiography

= Myelogram
EMGINCV

TREATM

T GOALS

SHORT TERM GOALS TONGT

TREATMENT PLAN

‘NIVATI NIPATCL