University of Manitoba - MPT: Neurological Clinical Skills Checklist

Transcription

1 Name: Site: Assessment Skills Observed Performed Becoming A. Gross motor function i. Describe movement strategies (quality, devices, timeliness, independence): supine sidelying sit stand supine long sitting sit sit transfer bridging scooting up and down, side to side in supine scooting along bed in sitting (laterally, forward, backward) sit/stand floor ii. Administer and score the Chedoke McMaster Stroke Assessment Activity Inventory iii. Administer and score the Timed Up and Go iv. Describe components of the Functional Independence Measure v. Describe other standardized measures of gross motor function and transfers B. Motor Assessment Observed Performed Becoming i. Assess AROM, PROM, and tone upper extremity lower extremity ii. Describe the findings of the tone assessment low tone spasticity rigidity clonus iii. Describe standardized measures of tone (e.g. the modified Ashworth Scale) iv. Be able to test and discriminate between normal and abnormal Babinski Clonus Deep tendon reflexes v. Assess for abnormal movement synergies (u/e, l/e) (AKA motor selectivity) identify and describe flaccid, reflexive movement, voluntary movement in synergy, voluntary movement out of synergy, normal movement vi. Administer and score the Chedoke McMaster Stroke Assessment Impairment Inventory vii. Describe other standardized measures of sensori-motor recovery after brain injury viii. Recognize involuntary movement dystonia

2 Assessment Skills Observed Performed Becoming tremor athetoid choreiform associated movements ix. Assess strength of upper and lower extremities x. Assess non-equilibrium tests of coordination dysdiadochokinesia o rapid alternating movements o tapping dysdiadochokinesia (continued) o other tests dysmetria o finger-nose o heel-shin o other tests rebound xi. Determine spinal cord injury levels according to ASIA scale C. Sensation and proprioception Observed Performed Becoming i. Assess discriminative touch: touch awareness touch localization sensory extinction touch pressure threshold two-point discrimination ii. Assess proprioception: joint position joint motion stereognosis vibration iii. Assess pain sharp/dull iv. Assess temperature perception D. Visual Screen i. acuity i. depth perception ii. visual field deficit iii. gaze control

3 E. Perception and Cognition Observed Performed Becoming i. Recognize / describe perceptual impairments: body scheme anosognosia unilateral neglect position in space limb apraxia figure ground perception ii. Assess orientation x 3 iii. Recognize / describe cognitive impairments: attention orientation memory problem solving/ executive functioning iv. Describe Mini Mental State Exam results v. Recognize communication impairments F. Postural control / balance Observed Performed Becoming i. Assess sitting posture/alignment ii. Assess sitting balance static internal perturbations external perturbations changing sensory environment iii. Assess standing posture/alignment iv. Assess standing (bipedal) balance static internal perturbations external perturbations changing sensory environment v. Administer and score the Berg Balance Scale vi. Perform the modified mctsib (modified Clinical Test for Sensory Interaction in Balance) vii. Describe other standardized measures of balance viii. Higher level reactions recognize equilibrium reactions recognize righting reactions recognize protective reactions ix. Vestibular Perform the Dix Hallpike assessment maneuver Reposition for Benign Paroxysmal Positional Vertigo (BPPV)

4 G. Gait Observed Performed Becoming i. Assess and describe the following aspects of gait: degree of independence use of aid distance speed quality of gait pattern (gait deviations seen in swing + stance components) directions surfaces distractions other circumstances (e.g. crossing a busy street, carrying objects, wind) gait variations (e.g. climbing stairs, running, hopping, skipping, jumping etc.) ii. Describe standardized tests for measuring ambulation and gait. Treatment Skills Observed Performed i. Be prepared to utilize alternate communication strategies with a non-verbal client ii. Describe precautions and variations of positioning for treatment of clients with increased ICP iii. Apply motor learning principles to all treatment of activity limitations i.e. gait, reaching, sit to stand, transfers etc.. Scheduling practice o Practice vs. rest o Variable practice o Context effects (random vs. blocked) Type of Practice o Whole vs. part o Transfer tasks o Mental practice o Guidance Feedback o Knowledge of performance o Knowledge of results iv. Apply Facilitation Techniques safely and appropriately Icing Vibration Tapping Quick stretch Weight bearing (joint compression) Tonic labyrinthine inverted position Special senses Becoming

5 Treatment Skills Observed Performed Becoming Physical cues v. Apply Inhibitory Techniques safely and appropriately Neutral warmth Maintained touch or pressure Slow stretch Rocking, rolling Pressure over muscle insertion Weight bearing (joint compression) of normal body weight Prolonged use of ice Vibration vi. Measure a client for a basic transport wheelchair vii. Be prepared to discuss need for orthotic (AFO etc.) with an orthotist and /or physician A. Interventions - Postural Control Observed Performed i. In Sitting ii. iii. Teach and assist client into neutral pelvic tilt ( correct sitting posture) o From behind, beside and in front of client o With 1 person and 2 person assist Teach and assist client with lateral weight shift o From beside and in front of client Teach and assist client with scooting forward and sideways Impose movement to challenge client i.e. move arms, head, trunk, step with foot etc.. o Change environment to challenge client i.e. height of seat etc. Standing o Impose movement to challenge client i.e. move arms, step with foot etc. o Change environment to challenge client i.e. reduce base of support, stand on sponge etc. Walking o Impose movement to challenge client i.e. walk in different directions, change the width of the base, carry object etc. o Change environment to challenge client i.e walk on different surfaces etc.

6 B. Bed Mobility and Functional activities Observed Performed Becoming i. Utilize motor learning issues discussed above ii. Teach & assist client to roll side to side with various techniques iii. Teach & assist client to sit up in bed (long sit) iv. Teach & assist client to sit up to the side (both sides) with various techniques v. Teach & assist client to lie down from sitting (both sides) with various techniques vi. Teach & assist client to get up and down to the floor from sitting and standing with various techniques vii. Sit to stand Teach and assist client to move from sit t<-> stand Change environment to challenge client Change amount of assistance given to client C. Gait Re-education Observed Performed Becoming i. Demonstrate part task activities in sitting, squat, high sitting, or standing as appropriate to the task (sometimes called gait preparation / pre-gait activities) to assist the client in maximizing gait strategies such as: Postural support and stability Weight bearing o Stepping forward o Stepping up Weight shift Stance swing Incorporate motor learning principles (scheduling of practice and type of practice) with part task activities ii. Demonstrate use of alternate aids for gait treatment iii. Demonstrate the adaptation of gait to various tasks such as: stairs opening door carrying objects obstacle course iv. Utilize motor learning strategies such as types of feedback and / or guidance to assist client with gait pattern Demonstrate and describe progression of guidance in gait treatment o E.g. facilitation of whole task activity / gait pattern v. Demonstrate and describe progression of activities (stability mobility) in gait treatment

7 D. Upper Extremity Re-education Observed Performed Becoming i. discriminate treatment of transport and manipulation phases ii. incorporate postural control activities appropriate for upper limb dysfunction iii. apply different techniques to stretch soft tissue structures that contribute to hemiplegic shoulder pain iv. select, apply and evaluate effectiveness of support systems for the hemiplegic upper limb slings taping/strapping positioning devices to prevent subluxation/injury for various positions (w/c, supine, sit, sidelying) v. apply activities on a stable surface progressing to mobile surfaces progressing to movements where the distal segment move on a stable proximal base: static body moves on arm body and arm move together arm moves on body vi. apply other therapeutic techniques taught/learned in previous years electrical modalities (FES, TNS, Jobst, IFC ) progressive resisted exercise motor learning principles E. Treatment Skills for Specific Conditions Observed Becoming Parkinson s Disease: o techniques to decrease freezing and help initiate movement o techniques to decrease shuffling when walking o techniques to improve posture Spinal Cord Injury: o lateral sliding board transfer techniques o bed mobility including rolling, supine long sitting o floor transfer techniques