Assessment

S: When working in the neurology field, your assessment is very important. This is partially because physiotherapists play a very significant role in the overall handling of the pt. handling meaning both, assessing, treating and providing feasible discharge options. When dealing in particular with stroke pts, the medical team will do the appropriate tests to decide what the underlying pathology is. This normally means a CT scan. However this test is not always reliable in determining the type or cause of stroke. Many other assessment tools are used based on the pts presentation and symptoms. Many of these assessments are performed by the physiotherapist. The assessment also extends to things such as mobility status that the nurses will use when caring for the pt.
T: The task is to fill out a thorough stroke assessment form to use as a baseline as well as an indicator of impairment and problem list. However to also think outside the box and not just focusing on filling out the generic form, but also looking at the pt holistically from the very first time you see them.
A: I was given a pt that I had to conduct an initial assessment. The stroke ward that I am working on is an acute ward. This means that we are the initial health care they seek and there has been no previous physiotherapy input into this pt. this makes the assessment even more important because it is pivotal that the physiotherapist does not miss any vital details. Prior to seeing this pt I went onto the ward and read through their medical file. This was to give me a general idea as to what I was expecting and some background social and medical history. After I became familiar with the pts medical notes I consulted the nursing staff for any other useful information. Then I approached the pt in their bed and this is where the assessment began. I was sure to be very observant from the time I first laid eyes on them. I had gained an idea from my notes what I wanted to assess and I was already looking for particular things. I then took a brief verbal history from the pt and then accompanied them to the gym. Once at the gym I went through the thorough generic stroke assessment form.
R: The result came with some help from my supervisor. My supervisor, being a very experienced and knowledgeable physiotherapist was able to guide me through the assessment to get all the information I needed. The result was, I gained a very thorough assessment, which allowed me to determine all the impairments forming my problem list. This gave me a baseline to refer to on discharge. I also gained a good understanding of the pts mobility and ambulatory status. This helped me inform the nurses what the most appropriate form of transfer was. It also allowed me to choose the best transfer that would allow the pt to move in a way that facilitated normal movement, to help the brain recognize normal movement while it was still “plastic”.
E: overall I thing the result was good. However a stroke assessment is not an easy method to grasp. Having never performed a proper stroke assessment before, I think there were plenty of things I could have done differently. For example, almost all stroke pts suffer very heavily form fatigue and drowsiness. On my initial assessment I perhaps was to methodical with the assessment sheet rather than using some common sense. I went ahead and tested everything in order, which is not necessarily in order of importance. As the assessment moved on, my pt became very tired and fatigued and I still hadn’t assessed some very important indicators. I should really have assessed them in order of importance so that I could decide upon things such as their transfer status and ambulation.
S: Some strategies I would have found helpful include –
- Becoming very familiar with the assessment form so that you know what questions you should be asking and don’t have to refer to the sheet to often.
- Being able to tick off certain parts of the assessment without having to formally assess them. Such as when testing active muscle control, watching them when they get out of bed will give you a good idea of lower limb strength. This is good for saving time.
- Understanding all the terms in the assessment form and how to assess them. The difference between receptive and expressive dysphasia can be hard to differentiate, so by first understanding what each means, will give a good idea of how to assess for them.