Stroke Evaluation – Reasoning Form - Physiotherapy

Stroke Evaluation – Reasoning Form

JSSCPT Department Of PMRC Page 1of 12

The following are the areas to be taken into consideration during evaluation of

Stroke with reasoning for the same

1. Age:

2. Gender:

3. Diagnosis:

4. History :

5. Higher mental functions:

6. Perceptual deficits:

7. Cranial nerve evaluation :

8. Posture observation :

9. Range of Motion :

10. Muscle tone :

11. Sensory evaluation :

12. Involuntary movement :

13. Muscle strength :

14. Voluntary Control Grading :

15. Hand function :

16. Reflex evaluation :

17. Balance :

18. Coordination :

19. Endurance :

20. Ambulation :

21. Aerobic capacity and endurance :

22. Transfers :

23. Functional activity :

24. Orthotic devices and assistive aids been used for all functional

activity,ambulation and others.:

25. Condition specific outcome measures:

26. Therapy recreation:

27. Home evaluation:

PROGRESS REPORT FORM

In the progress report form the following has to be mentioned in relation to the

baseline measurements, which is taken at the time of admission.



1. CROMS/FIM status

2. Cognitive and Perceptual measurements

3. HMF status:

4. Tonal changes

5. Hand function

6. Balance and coordination

7. Ambulation status

8. Medication and nutritional status

9. Therapy recreation status

10. Home evaluation report

11. Orthotics and assistive devices use.

DISCHARGE SUMMARY FORM

The discharge summary should include the status of the patient at the time of

admission and weekly goals set and achieved and the status of patient at the

time of discharge.

It should also have the HEP (Home Exercise Programme) status, Care takers

education material and review dates for follow up.

1. Age:

It matters as it will signify the ADL

dependence

To plan for the new job responsibilities

2. Gender

Consideration to be taken during Personal hygiene-

Menstrual cycle

3. Diagnosis

Type of stroke- Hemorrhagic or

Ischemic (Gives the status of prognosis)

Location Of stroke (Will signify the

impairment and functional loss both

physically and psychologically)



4. History

The following details are must from the history

Date of onset of signs and symptoms

Progression of the condition (any signs

of recovery)

Medical management and surgical

management for the same (If done

surgery the type of surgery burr hole

and flap removal will tell the prognosis

and stay in ICU and Hospital)

Medicational status: Need to check

pharmacokinetics of the drug and

window period to schedule the therapy.

Importance to be given for any

antiepileptic drugs and drugs taken to

reduce spasticity.

Nutrition and feeding status (Any

presence of NSG tube or PEG will

suggest non intact ness of gag reflex)

also persistence of cough and altered

breathing pattern may suggest

aspirational pneumonia.

Results of specific investigations

(Radiological reports)

Co Morbidities (DM, HTN, Obesity,

Seizures, renal and hepatic status, any

others)

Status of speech

o Normal

o Aphasia (Sensory, Motor,

Global)

o Dysarthria (Labial, Lingual.

Spastic)

Use of any specific equipment

o Suction kit to remove secretions



from NSG or Tracheostomy

tubes,

o Type of mattress using on the bed

which can relieve the pressure

o Any orthotics like Bobath sling,

AFO

Technological assistance

o Consideration to be given if

patient is using any pacemakers,

hearing aids.

Old surgery which is relevant for

present status eg:Joint replacement

surgery’s

Risk factors eg: Balance. Cognitive and

Cardiovascular status

o Balance: premorbid status of

balance

o Cognitive: Any signs of dementia

can affect the motor learning

component.

CVS: Any signs of BP changes, Postural hypotension

5. Family

background

Vocational demand

Family support and Bread winners of

the family

Expense of the family

Expectation of the family or care takers

Whether they are able to understand the

nature of disease and importance of the

treatment.

6. House and

work place

evaluation

Accessibility to home and work place

(Which also includes Number of rooms,

Width of passage, Type and condition

of flooring staircase details, Kitchen



and toilet accessibility and use. Position

of lights, switches, power points)

In work place to know whether the

client c continue the job or does he/she

requires a change)

7. Problem

solving skills

Does the patient understands step by

step explanation

Does the patient require major guide

stops

8. Affective

component

Patient understanding of his disability

Does the patient have Realistic goals

Does the patient accept his or her

responsibility

Emotional status of the patient

9. Sleep

disturbance

Any change in the sleeping pattern due

to pain, emotional disturbance or others

as it will affect the rehabilitation

10. Skin

evaluation

Vulnerable skin over bony prominences

Scar tissue break downs

11. Higher mental

functions

(Should

consider the

following )

Orientation, memory and attention (for

immediate memory and attention use

Digit span test)

Other functions to be considered are

Calculation, Abstract thinking and

Insight and judgment

Objective scale: MOCA in Native



language: MOCA scale will screen an

individual’s cognitive dysfunction.

(The values obtained from the scale will

signify the cognitive impairment of the

individual and will affect the physical

activity as there will be lack in the

motor learning component. Assessment

of cognitive function could enhance

decision making in what rehabilitation

strategy might be potentially useful )

12. Perceptual

deficits

The perceptual deficits will affect the physical

functioning of the individual in turn will affect the

rehabilitation. Identification of the same is important

in planning the success of rehabilitation.

Body scheme and body image

disorders:

o Anosognosia, Somatoagnosia (

The patient will point to the body

parts named by tester or imitate

the movements of the therapist)

o Right and left discrimination ,

o Unilateral neglect ( For unilateral

neglect- Therapist needs to

observe an individual’s ADL and

can also use Line bisection test,

Figure cancellation test , Copying

and drawing test )

Agnosia: Visual object, Auditory and

Tactile (Test used are Good glass and

Kaplan test)

Spatial relation disorders: Figure

ground discrimination, Topographic

discrimination, depth and distance

perception, vertical disorientation,



position in space ( The test used are

Ayres Figure ground test, Observation

of the functional task, RPAB, A-ONE)

Apraxia : Ideomotor, Ideational and Buccofacial :

Objective way to measure it is by Using Apraxia Screen of

Tulia (AST)

13. Cranial nerve

evaluation

All the 12 pairs of cranial nerve

evaluation to be done including the

reflexes.

o Olfactory Nerve:

Has to correlate the diagnosis, blood

supply of the brain affected and to

determine the cranial nerves that would

have damaged.

Facial palsy origin is it central or

peripheral

14. Posture

observation

Alignment of the shoulder to be noted

in static and dynamic postures

Palpation to be done with any presence

of sulcus sign. ( Palpate between

acromion and superior aspect of

humeral head )

Can also use Verniar caliper for the

measurement of Finger width scale

X ray of the shoulder.

Grading of shoulder subluxation by Van

Langenberghe and Hogan Scale

Use of any orthotic devices (Bobath

sling) to be noted

Any signs of unilateral neglect to be

noted

Listing phenomenon to be noted ( Loss

of lateral balance and fall towards the



paralyzed side )

Attitude of the limbs

15. Range of

Motion

Of all available joints

Any signs of tightness, Contracture to

be noted

Any immobilization device used (Other

orthotics)

16. Muscle tone

(To be

compared with

normal side)

Quality

o Is the tone same always, or

fluctuating, happens during

change in the position

o Is it symmetrical

o Is it dependent on time – Day or

night it changes

o Is it activity based.

Quantity:

o MAS or TARDUE scale to be

taken if there is Hypertonia-

Spasticity ( MAS Is simple ,

reliable test done near bed side

where as TARDUE scale is more

valid and reliable but takes more

time to do on patient)

17. Sensory

evaluation:

28. The sensory evaluation depends upon the status of

HMF of the individual .If the patient has issues in

HMF therapist cannot do the sensory evaluation as

the values of the sensory evaluation is highly

subjective .

The superficial, Deep and Cortical

sensation to be taken with use of



standard equipment’s

18. Involuntary

movement

Presence of nay involuntary movements

like Tremor, Clonus, Chorea

19. Muscle

strength

29. ( The therapist should remember the following No

isolation of movement will happen till stage 6,

Synergy will dominate, MMT is done at its best if

isolation of movement is present )

Of all available muscle of both sides

Any trick movements

Any immobilization device being used

Can use hand held dynamometer-

Group muscle strength

20. Voluntary

Control

Grading

30. : To Use Brunnstrom VCG for UE, LE and Hand

21. Hand function

Use of ART

Power and precision grip

Recovery of hand functions.

22. Reflex

evaluation

Note that the position of the patient,

Correct tapping site and adequate

tapping stimulus should be given and

the results to be compared with normal

side.

If needed facilitation for the reflex to be

given by Clenching the teeth, Gripping

of an object or Jendrassiks maneuver



DTR and grading for UL and LL

Pathological reflex:

o Babinski sign ( Extensor

response suggest Pyramidal tract

involvement)

o Oppenheim reflex,

o Chaddock sign

o Hoffmann’s reflex.(Presence of

the same indicate pyramidal tract

involvement)

23. Balance

Presence of protective extension

reaction

Presence of equilibrium reaction

Presence of static and dynamic balance

reaction

BBS scale : Is a 14 item objective

performance measure that assesses

static balance and fall risk in adults

24. Coordination

Coordination skill prior injury

Kinesthetic awareness

Timing

Accuracy of movement

25. Endurance

EEI to be taken

Screening for CV system to be done

26. Ambulation

Wheel chair or walking

If walking how many people assistance

to be noted.



If walking to do video graphic

evaluation

Use of Functional gait scales

Observe the associated movements

(Trunk rotation, arm swing, pelvic

rotation, Hip hiking, Hip rotation)

Use of hemi walker or any other

assistive device for ambulation to be

noted

Indoor and outdoor ambulation (Even

and uneven surface)

Dual task ambulation

27. Aerobic

capacity and

endurance

Treadmill

Fatigue level

Rest period

28. Transfers

Indoor: Mat, Chair, Bath bench,

Commode

Car transfers

29. Functional

activity

CROMS/ FIM

30. Orthotic

devices and

assistive aidss.

been used for all functional activity, ambulation and other

31. Condition

specific

outcome

Modified ashworth scale

CROMS/FIM

BBS



measures

Fugyl Mayer Assessment of motor

recovery

ART

Community balance and mobility scale

32. Therapy

recreation:

31. Therapy recreation will be either indoor or outdoor.

The activity will be decided on basis of need for the

patient which will assist in achieving the goals stated

by patient or decided by rehab team.

33. Home

evaluation:

32. Home evaluation will be done to assess the

facilitators and barriers which will affect the

functional activity of the patient.

The areas to be considered are

Pathway from road to house

Any obstacles in the main door, rear

door for entry and exit of the patient

with and without wheel chair.

Access and safety of living room, bed

room, kitchen, toilets and other areas

where the person uses.

Documents

Stroke Evaluation – Reasoning Form - Physiotherapy