Module 3c: ASSESSMENT PROCEDURES Module 3c: ASSESSMENT PROCEDURES

Module 3c:

ASSESSMENTPROCEDURES

Module 3c:

ASSESSMENTPROCEDURES

A. VISUAL ACUITY TESTA. VISUAL ACUITY TEST

Stand six (6) meters away from the patient.

Stand six (6) meters away from the patient.

Step 1:Step 1:

Select a plain background where there is no glare to affect his/her vision.

Select a plain background where there is no glare to affect his/her vision.


Ask the patient to cover one eye using the palm of his/her hand.

Ask the patient to cover one eye using the palm of his/her hand.

Step 2:Step 2:

If he/she is normally wearing corrective eyeglasses, ask him/her to keep them on duringthe test.

If he/she is normally wearing corrective eyeglasses, ask him/her to keep them on duringthe test.


Step 3:Step 3:

If he/she answers correctly, repeat the exercise three (3) more times.

If he/she answers correctly, repeat the exercise three (3) more times.

Hold out your hand and display any number of fingers. Ask him/her how many fingers are displayed.

Hold out your hand and display any number of fingers. Ask him/her how many fingers are displayed.


If the patient cannot see at six (6) meters, move one (1) meter closer and repeat the test (or until you are at a distance where he/she is able to correctly identify the number of fingers).

If the patient cannot see at six (6) meters, move one (1) meter closer and repeat the test (or until you are at a distance where he/she is able to correctly identify the number of fingers).

Step 4:Step 4:

Record the actual distance of visual acuity in meters.

Record the actual distance of visual acuity in meters.


If the patient still cannot see at one (1) meter, move closer and wave your hand in front of his/her face.

If the patient still cannot see at one (1) meter, move closer and wave your hand in front of his/her face.

Step 5:Step 5:

If he/she cannot see any movement, shine a flashlight into each of his/her eyes.

If he/she cannot see any movement, shine a flashlight into each of his/her eyes.

If he/she is able to see movement or light, there is still a possibility that sight can be restored.

If he/she is able to see movement or light, there is still a possibility that sight can be restored.

B. SENSORY NERVE FUNCTION ASSESSMENT AT PRIMARY LEVELS


The ideal device for sensitivity testing is the graded monofilament.

The ideal device for sensitivity testing is the graded monofilament.



However, in areas (clinics or Health Centers) where these are not available, you may use an ordinary ball pen.

However, in areas (clinics or Health Centers) where these are not available, you may use an ordinary ball pen.

Conduct the test in a quiet place where the patient will not be disturbed by other people.


Step 1:Step 1:

Do not try to do the test with other people standing by.


Ask and listen:Ask and listen:

Step 2:Step 2:

• Have there been any changes in skin condition?

• Have there been any changes in skin condition?

If the answer to any of these is “yes,” ask when first noticed & record findings.


• Is there any change in how things feel by touch?

• Is there any difficulty doing normal tasks?

• Is there any change in how things feel by touch?

• Is there any difficulty doing normal tasks?

Sit down with the patient and explain why and how the test will be done.

Sit down with the patient and explain why and how the test will be done.

Step 3:Step 3:

Show him/her how the ball pen is used to touch the skin (90° angle to the skin & as light as possible).

Show him/her how the ball pen is used to touch the skin (90° angle to the skin & as light as possible).

Step 4:Step 4:

• Touch an area of normal skin & ask him/her to point to that area.

• Touch an area of normal skin & ask him/her to point to that area.

• Now, ask him/her to close his/her eyes.• Repeat the test on normal skin, this time

with his/her eyes closed, and ask him/ her to point to the area touched by the ball pen.

• Now, ask him/her to close his/her eyes.• Repeat the test on normal skin, this time

with his/her eyes closed, and ask him/ her to point to the area touched by the ball pen.

• Keep the patient’s hand steady by letting it rest on your own hand.


Step 5: HANDSStep 5: HANDS




• Ask the patient to close his/her eyes and point to the spot you will touch with the ball pen (see diagram).


Sensitivity test for the Median Nerve.

Sensitivity test for the Ulnar Nerve.

• If he/she correctly points to the places touched, record with a check mark () on the patient’s chart. If not, mark with an X.



• Repeat with the other hand.• Repeat with the other hand.

Step 6: FEETStep 6: FEET



• Ask the patient to rest his/her right ankle on his/her left knee.

• Ask the patient to rest his/her right ankle on his/her left knee.

Sensitivity test for the Posterior Tibial Nerve.

Step 6: FEETStep 6: FEET



• Repeat with the other foot.• Repeat with the other foot.

Prev. TestPrev. Test

Current Test

Current Test

All points felt

All points felt

All points feltAll points felt

ActionActionAfter 2 WeeksAfter 2 Weeks

ActionAction

Continue monthly assessment


Decisions:Decisions:Compare results with previous sensory

test and look for any changes.Compare results with previous sensory

test and look for any changes.


Current Test

Current Test

All points felt

All points felt

ONE point NOT feltONE point NOT felt


ActionAction

Advise patient to report any changes & arrange to test after 2 weeks






Current Test

Current Test

All points felt

All points felt



ActionAction






No change or betterNo change or better




Current Test

Current Test

All points felt

All points felt



ActionAction









2 or more points NOT felt


Give PrednisoneGive Prednisone


Current Test

Current Test

All points felt

All points felt




ActionAction






Current Test

Current Test

All points felt

All points felt




ActionAction





BetterBetter Continue Prednisone & assess monthly

Continue Prednisone & assess monthly


Current Test

Current Test

All points felt

All points felt




ActionAction






Continue Prednisone & assess monthlyNo changeNo change


Current Test

Current Test

All points felt

All points felt




ActionAction






Continue Prednisone & assess monthlyNo changeNo change

WorseWorse Refer immediately for further management

Refer immediately for further management


Current Test

Current Test

One point NOT felt

One point NOT felt



ActionAction







Current Test

Current Test

One point NOT felt

One point NOT felt

Two or more points NOT felt



ActionAction






Current Test

Current Test

One point NOT felt

One point NOT felt




ActionAction








Current Test

Current Test

One point NOT felt

One point NOT felt




ActionAction







No changeNo change


Current Test

Current Test

One point NOT felt

One point NOT felt




ActionAction







No changeNo change




Current Test

Current Test

More than one point NOT felt




ActionAction







Current Test

Current Test





ActionAction








C. MOTOR NERVE FUNCTION ASSESSMENT AT PRIMARY LEVELS

C. MOTOR NERVE FUNCTION ASSESSMENT AT PRIMARY LEVELS



Step 1:Step 1:



Ask and listen:Ask and listen:

Step 2:Step 2:

• Has there been any difficulty in doing normal tasks (fastening buttons, holding tools, combing hair, etc.)?

• Has there been any difficulty in doing normal tasks (fastening buttons, holding tools, combing hair, etc.)?



• Has he/she noticed any difficulty keeping sandals on his/her feet?

• Does he/she have any difficulty closing his/her eyes?

• Has he/she noticed any difficulty keeping sandals on his/her feet?

• Does he/she have any difficulty closing his/her eyes?

To test for muscle strength:To test for muscle strength:

Step 3: Facial Nerve AssessmentStep 3: Facial Nerve Assessment

• The key movement is eye closure.• The key movement is eye closure.

• The patient should sit comfortably and the test should be explained carefully.

• Tell the patient to close his/her eyes lightly as if asleep. If he/she can close his/her eyes then his/her muscles are either strong or weak, NOT paralyzed.

• The patient should sit comfortably and the test should be explained carefully.

• Tell the patient to close his/her eyes lightly as if asleep. If he/she can close his/her eyes then his/her muscles are either strong or weak, NOT paralyzed.


Step 3: Facial Nerve AssessmentStep 3: Facial Nerve Assessment

• Tell the patient to close his/her eyes as firmly as possible and resist with all his/her strength while you try to open them with your fingers.

• Tell the patient to close his/her eyes as firmly as possible and resist with all his/her strength while you try to open them with your fingers.

• Place your index finger just below the eyebrow and your thumb on the cheek bone.

• Place your index finger just below the eyebrow and your thumb on the cheek bone.

• Move your fingers apart and try to open the eyelids.

• Move your fingers apart and try to open the eyelids.

Voluntary muscle test for the Facial Nerve.

Findings:Findings:

Step 3: Facial Nerve Assessment:Step 3: Facial Nerve Assessment:

• If you cannot open his/her eyelid, then the muscle is strong.

• If you cannot open his/her eyelid, then the muscle is strong.

• If you can open the eyelid, the muscle is weak.

• If you can open the eyelid, the muscle is weak.

• Record your findings.• Record your findings.

• If he/she cannot close his/her eyelids completely, measure the lid gap.

• If he/she cannot close his/her eyelids completely, measure the lid gap.


Step 4: Ulnar Nerve Assessment:Step 4: Ulnar Nerve Assessment:

• The key movement is little finger out.• The key movement is little finger out.

• Let the patient’s hand rest on your hand.• Let the patient’s hand rest on your hand.• With all his/her fingers straight, ask

him/her to move his/her little finger away from his/her other fingers. If he/she can move this finger outward, his/her muscle is either strong or weak, NOT paralyzed.

• With all his/her fingers straight, ask him/her to move his/her little finger away from his/her other fingers. If he/she can move this finger outward, his/her muscle is either strong or weak, NOT paralyzed.


• Tell the patient to resist with all his/her strength while you try to push his/her little finger inward.

• Tell the patient to resist with all his/her strength while you try to push his/her little finger inward.

• Push with your index finger at the base of his/her small finger, NOT at the top.

• Push with your index finger at the base of his/her small finger, NOT at the top.


Voluntary muscle test for the Ulnar Nerve.

Findings:Findings:

• If you cannot push his/her little finger in, then the muscle is strong.

• If you cannot push his/her little finger in, then the muscle is strong.

• If you can push it in, the muscle is weak.• If you can push it in, the muscle is weak.

• Repeat with the other hand and record your findings.


• If he/she was not able to move the little finger at all, the muscle is paralyzed.

• If he/she was not able to move the little finger at all, the muscle is paralyzed.



• The key movement is thumb up.• The key movement is thumb up.

• Let the patient’s hand rest on your hand, palm facing upwards.

• Let the patient’s hand rest on your hand, palm facing upwards.

• Ask him/her to move his thumb towards his/her face so that it is perpendicular to the palm. If he/she can move the thumb up, his/her muscle is either strong or weak, NOT paralyzed.

• Ask him/her to move his thumb towards his/her face so that it is perpendicular to the palm. If he/she can move the thumb up, his/her muscle is either strong or weak, NOT paralyzed.

Step 5: Median Nerve Assessment:Step 5: Median Nerve Assessment:


• Tell the patient to resist with all his/her strength while you try to push the thumb back towards his/her palm.

• Tell the patient to resist with all his/her strength while you try to push the thumb back towards his/her palm.

• Push with your index finger at the base of his thumb, NOT at the top.

• Push with your index finger at the base of his thumb, NOT at the top.


Voluntary muscle test for the Median Nerve.

Findings:Findings:

• If you cannot push his/her thumb back towards his/her palm, then the muscle is strong.

• If you cannot push his/her thumb back towards his/her palm, then the muscle is strong.

• If you can push it back, the muscle is weak.

• If you can push it back, the muscle is weak.

• If he was not able to move his thumb upwards at all, the muscle is paralyzed.

• If he was not able to move his thumb upwards at all, the muscle is paralyzed.





• The key movement is wrist up.• The key movement is wrist up.

• Hold his/her arm gently but firmly near the wrist.

• Hold his/her arm gently but firmly near the wrist.

• Ask him/her to make a loose fist, then fully extend his/her wrist as shown. If he/she can extend his/her wrist, the muscle is either strong or weak, NOT paralyzed.

• Ask him/her to make a loose fist, then fully extend his/her wrist as shown. If he/she can extend his/her wrist, the muscle is either strong or weak, NOT paralyzed.

Step 6: Radial Nerve Assessment:Step 6: Radial Nerve Assessment:


• Tell the patient to resist with all his/her strength while you try to push the back of his/her hand using moderate force as shown.

• Tell the patient to resist with all his/her strength while you try to push the back of his/her hand using moderate force as shown.


Voluntary muscle test for the Radial Nerve.

Findings:Findings:

• If you cannot push his/her hand down with moderate force, then the muscle is strong.

• If you cannot push his/her hand down with moderate force, then the muscle is strong.

• If you can push the hand down, the muscle is weak.

• If you can push the hand down, the muscle is weak.

• If he/she was not able to extend his/her wrist at all, the muscle is paralyzed.

• If he/she was not able to extend his/her wrist at all, the muscle is paralyzed.





• The key movement is foot up.• The key movement is foot up.

• The patient should sit comfortably with both feet flat on the floor.

• The patient should sit comfortably with both feet flat on the floor.

• Ask him/her to lift his/her foot up as high as possible while keeping his/her heel on the floor. If he/she can lift his/her foot, the muscle is either strong or weak, NOT paralyzed.

• Ask him/her to lift his/her foot up as high as possible while keeping his/her heel on the floor. If he/she can lift his/her foot, the muscle is either strong or weak, NOT paralyzed.

Step 7: Common Peroneal Nerve Assessment:Step 7: Common Peroneal Nerve Assessment:


• Tell the patient to resist with all his strength while you try to push his foot down as shown.

• Tell the patient to resist with all his strength while you try to push his foot down as shown.


Voluntary muscle test for the Common Peroneal Nerve.

Findings:Findings:

• If you cannot push his/her foot down, then the muscle is strong.

• If you cannot push his/her foot down, then the muscle is strong.

• If you can push the foot down, the muscle is weak.

• If you can push the foot down, the muscle is weak.

• If he/she was not able to move his/her foot upwards at all, the muscle is paralyzed.

• If he/she was not able to move his/her foot upwards at all, the muscle is paralyzed.

• Repeat with the other foot and record your findings.

• Repeat with the other foot and record your findings.


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Module 3c: ASSESSMENT PROCEDURES Module 3c: ASSESSMENT PROCEDURES