NEUROLOGICAL PHYSIOTHERAPY ASSESSMENT CHART

SUBJECTIVE EXAMINATION

NAME:

AGE:

SEX :

RACE:

OCCUPATION:

HANDEDNESS:

DATE OF ADMISSION:

CHIEF COMPLAINTS:

HISTORY:

 PRESENT HISTORY
 PAST HISTORY
 MEDICAL HISTORY
 FAMILY HISTORY
 PERSONAL HISTORY
 SOCIAL HISTORY

OBJECTIVE EXAMINATIONS
ON OBSERVATION

BUILD

ATTITUDE OF LIMBS

 IN LYING
 IN SITTING
 IN STANDING

POSTURE

 AP VIEW
 PA VIEW
 LATERAL VIEW

GAIT ANAYALYSIS

DEFORMITIES
ANY EXTERNAL APPLIANCES:

ON PALAPATIONS

TENDERNESS

SKIN TEMPERATURE

SWELLING OEDEMA

CLUBBING

ON EXAMINATIONS

HIGHER MENTAL FUNCTIONS

ORIENTAION

MEMORY

 SHORT TERM
 LONG TERM
 REMOTE

BEHAVIOUR
SPEECH
INTELLIGENCE

CRANIAL NERVER ASSESSMENT

MOTOR EXAMINATIONS

A. MUSCLE GIRTH MEASUREMENT

B. MUSCLE POWER
C. TONE

AXIAL

UPPER LIMBS

LOWER LIMBS

VOLUNTARY CONTROL EXAMINATIONS

REFLEXES:

 0 = No response
 1+ = Low normal or diminished
 2+ = Normal
 3+ = Brisker than normal. But may not indicate disease
 4+ = Hyperactive very brisk spinal cord disorder
  SPINAL REFLEXES:
 SUPERFICIAL REFLEXES:
 ABDOMINAL:
 BABINSKIS SIGN:

 DEEP TENDON REFLEXES

 BICEPS
 TRICEPS
 SUPINATOR
 KNEE JERK
 ANKLE JERK

MYOTOME TESTING

DERMATOME TESTING

MUSCLE LENGTH TESTING

CONTRACTURES/DEFORMITIES

SENSORY EXAMINATIONS

SOMATIC

SUPERFICIAL

 LIGHT TOUCH
 PAIN
 TEMPERATURE

DEEP

 VIBRATIONS SENSE
 JOINT POSITIONS SENSE

CORTICAL

 STEREOGONOSISI
 GRAPHESTHESIA
 BARAGNOSIS

DISCRIMINATIVE

 TWO POINT DISCRIMINATION

DERMATOME TESTING

ROM MEASUREMENT
  UPPER LIMB
 LOWER LIMB
 SPINE

LIMB LENGTH MEASUREMENT

 TURE
 APPARENT

ABNORMAL MOVEMENTS

BALANCE AND CO-ORDINATIONS

BALANCE

 STATIC
 DYNAMIC

CO-ORDINATION

 FINGER TO NOSE TEST

 DYSDIADOKOKINESIA
 HEEL TO SHIN
 WASH BASIN SIGN
 ROMBERGS SIGN
 TANDEM WALKING

BLADDER/BOWEL CONTROL

CARDIO RESPIRATORY

VITAL SIGNS

 TEMPERATURE
 PULSE RATE
 RESPIRATORY RATE
 BLOOD PRESSURE

BREATING PATTERN

CHEST EXPANSION

CHEST DEFORMITY

AUSCULTATION

LUNG SECRETIONS

GASTROINTESTINAL EXAMINATIONS:
FUNCTIONAL ACTIVITY EXAMINATION

 EATING
 DRINKING
 BATHING
 TOILETING
 COMBING

PROVISIONAL DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

INVESTIGATIONS

DIAGNOSIS

PROBLEM LISTING

PLAN OF TRETMENT

 SHORT TERM GOAL

 LONG TERM GOAL

PHYSIOTHERAPY MANAGEMENT