C- Spine

Chart Review:

Diagnosis prior to surgery

Surgery date
Type of surgery
What cervical level?
Activity orders
Immobilizer orders
Past medical history
Past surgical history

Common Symptoms/Problem Areas:

Upper body dressing limitation
Impaired sensation at hands
UE strength deficits
Specifics to Test During Evaluation:

Sensation in hands
Raise shoulders to 90 degrees
Coordination
Grasp strength
Evaluate surgical dressing

Client Education:
C-spine precautions: no shoulder flexion greater than 90 degrees, no yes/no
head motion, and no lifting greater than 5 pounds
Upper body dressing technique to maintain precautions
Collar fit and care

L-Spine

Chart Review:

Diagnosis prior to surgery

Surgery date
Type of surgery
What lumbar level?
Activity orders: head of bed flat, shower, ambulation with assist
Brace orders: when & where does the patient don/doff brace ex/ don LSO
EBO for OOB activity
Past medical history
Past surgical history
Common Symptoms/Problem Areas:
Lower body ADLs- due to inability to bend, some patient may not have
enough LE ROM to complete task
Bed mobility- must log roll without twisting spine
Impaired sensation in LE
LE weakness
Specifics to Test During Evaluation:
Sensation in lower extremities
Bed mobility- test log roll performance
Lower body dressing- assess LE ROM to see if they can avoid bending
during task
Strength in LEs
Evaluate surgical dressing
Client education:

Spinal precautions: no bending, lifting greater than 10 pounds, or twisting

Lower body ADLs techniques to maintain precautions
Brace fit and care
AE to assist with lower body ADLs: sock aid, reacher, and long handled
sponge

Knee

Chart Review:

Weight bearing status

Activity orders
Immobilizer orders
Diagnosis prior to surgery
Surgery date
Type of surgery
Past medical history
Past surgical history

Common Symptoms/Problem Areas:

Lower body dressing- due to immobilizer and/or decreased LE ROM
Standing tolerance
Knee buckling- possible due to nerve block
Specifics to Test During Evaluation:
Bed mobility- do they need assist with surgery leg, are they able to perform
straight leg raise? If so, keep immobilizer on
Lower body dressing ability
Standing tolerance
Functional mobility
Evaluate surgical dressing
Client Education:
Weight bearing status
Immobilizer orders and fit
AE if needed due to decreased LE ROM

Hip
Chart Review:

Weight bearing status

Activity orders
Diagnosis prior to surgery
Surgery date
Type of surgery
Past medical history
Past surgical history

Common Symptoms/Problem Areas:

Bed mobility
Standing tolerance
Lower body ADLs
Specifics to Test During Evaluation:
Bed mobility- evaluate how much patient can do on own without breaking
precautions
Functional transfers
Lower body dressing
Evaluate surgical dressing
Client Education:
Hip precautions: hip flexion past 90 degrees, crossing legs, and internal
rotation
Adaptive lower body ADL techniques
Bed mobility- bridging
Functional transfers
AE: leg lifter to assist with bed mobility, hip kit to assist with lower body
dressing, and long handled sponge to assist with lower body dressing.

Right Side Stroke

Chart Review:

Area of the brain involved

Activity orders
Past medical history
Past surgical history
tPA- bedrest orders

Common Symptoms/Problem Areas:

Left side weakness, neglect, visual field cut, motor apraxia, and sensation
loss
Reduced insight, impulsive, attention difficulties,
Specifics to Test During Evaluation:

Cognition: orientation, ability to follow multi-step instructions

Sensation- light touch, localized touch
Coordination- hand eye tasks
ROM
Strength- MMT
Neglect- visual tracking

Client Education:

Family education
Neuro-muscular reeducation
Awareness of deficit
Safety Awareness
Positioning of affected extremity

Left Side Stroke

Chart Review:

Area of the brain involved

Activity orders
Past medical history
Past surgical history
tPA- bedrest orders

Common Symptoms/Problem Areas:

Right side weakness, impaired sensation, visual field cut

Receptive & expressive aphasia
Bilateral motor apraxia
Decreased organization and sequencing

Specifics to Test During Evaluation:

Cognition: comprehension/expression
Sensation: light touch, localized touch
Coordination: hand eye tasks
ROM
Strength: MMT

Client Education:

Family education
Neuro-muscular reeducation
Awareness of deficit
Safety Awareness
Positioning of affected extremity

Frontal Lobe Stroke

Chart Review:

Area of the brain involved

Activity orders
Past medical history
Past surgical history
tPA

Common Symptoms/Problem Areas:

Contralateral hemiplegia
Contralateral Jacksonian Seizures
Left CVA: Brocas aphasia, alexia, agraphia
Right CVA: Brocas aphasia if right hemi dominant
Executive functions, motor planning, emotions, judgement

Specifics to Test During Evaluation:

Cognition: orientation, short term memory, ability to follow multi-step
instructions, communication
Sensation: light touch, localized touch
Coordination: hand eye tasks
ROM
Strength- MMT
Neglect- visual tracking
Client Education:
Family education
Neuro-muscular reeducation
Awareness of deficit

Safety awareness

Occipital Lobe Stroke

Chart Review:

Area of the brain involved

Activity orders
Past medical history
Past surgical history
tPA- bedrest orders

Common Symptoms/Problem Areas:

Contralateral weakness
Contralateral neglect
Left CVA: visual hallucinations, contralateral visual field loss, cortical
blindness
Right CVA: visual hallucinations, contralateral visual field loss, cortical
blindness
Difficulty reading and writing
Difficulty visually locating objects
Specifics to Test During Evaluation:

Cognition: orientation, ability to follow multi-step instructions

Sensation: light touch, localized touch
Coordination: hand eye tasks
ROM
Strength- MMT
Neglect: visual tracking
Visual Fields

Client Education:

Family education
Neuro-muscular reeducation
Awareness of deficit
Safety Awareness

Parietal Lobe Stroke

Chart Review:

Area of the brain involved

Activity orders
Past medical history
Past surgical history
tPA- bedrest orders

Common Symptoms/Problem Areas:

Contralateral hemi-sensory loss

Contralateral sensory seizures
Left CVA: inferior visual field loss, anomia, alexia, agraphia, acalcula
Right CVA: inferior visual field loss, hemineglect, astereogenosis,
constructional apraxia

Specifics to Test During Evaluation:

Cognition: orientation, ability to follow multi-step instructions

Sensation: light touch, localized touch
Coordination: hand eye task
ROM
Strength- MMT
Visual Field
Visual spatial deficits: accurate reach for items

Client Education:

Family education
Neuro-muscular reeducation
Awareness of deficit
Safety Awareness

Temporal Lobe Stroke

Chart Review:

Area of the brain involved

Activity orders
Past medical history
Past surgical history
tPA- bedrest orders

Common Symptoms/Problem Areas:

Visual and auditory disturbances

Memory loss
Aggressive behavior
Difficulty understanding spoken words
Left CVA: Wernickes aphasia, automatism- purposeless behavior

Specifics to Test During Evaluation:

Cognition: memory, receptive language

Sensation: light touch, localized touch
Coordination: hand eye tasks, accurate placement of items
Strength- MMT
ROM
Visual Field
Auditory: interpretation of sounds

Client Education:

Family education
Neuro-muscular reeducation
Awareness of deficit
Safety Awareness

Vertebrobasilar Artery System

Chart Review:

Area of the brain involved

Activity orders
Past medical history
Past surgical history
tPA- bedrest orders

Common Symptoms/Problem Areas:

Vertigo, nausea, disturbance of consciousness, headache

Visual disturbance: nystagmus, diplopia, pupillary changes
Visual field deficits
Speech deficits: dysarthria, dysphonia
Ataxia
Sensory disturbances: affecting pain and temperature
Swallowing difficulities- important to note oral care and feeding ADLs

Specifics to Test During Evaluation:

Cognition: orientation, memory, receptive language

Sensation: light touch, localized touch, temperature
Coordination: hand eye tasks, accurate placement of items
Strength- MMT
ROM
Dizziness during mobility

Client Education:

Family education
Neuro-muscular reeducation
Awareness of deficit
Safety Awareness