ASSESSMENTS IN PHYSICAL DYSFUNCTION

By Sylvester Wakulwa

OCCUPATIONAL THERAPY DIAGNOSIS

 Descriptive – highlights specific deficits identified at each level of function impacting on the
ability to engage in an Occupation
 Explanatory – Occupational Therapy hypothesis about possible cause of the functional deficit
 Cue - Based on clinical manifestations
 Pathological – consider the cause

Outcomes of Occupational therapy interventions

 Function
 Occupational performance
 Health and wellbeing
 Quality of life

Assessment: The process of collecting, analyzing and interpreting information

It is a planned collection, interpretation and documentation of a functional status of individuals in

relation to capacity to perform valued activities (Rodgers and Holm 1989)

Evaluation: Gathering of data in specific areas

Assessment is guided by

 Observation
 Interaction with patients
 Medical records
 Diagnostic tools
 Paradigm of practise

Reasons for assessment

 To create rapport
  To identify need for Occupational Therapy
 To identify problems
 To set goals/objectives
 To prepare treatment plan
 To monitor progress

Sources of data

 Medical records
 Patients’ history
 Lab and Radiological examinations
 Occupational therapy tests
 Physical Examinations

Process of assessment

1. Collection of data
2. Organization of data
3. Interpretation of data

Steps of assessment

1. Orientation and creating rapport

a) Introduction
 Client’s identity and your own identity through Personal particulars
 Inform the client of your intention and the requirements for the assessment process
 Seek consent
 Ask whether the client has understood the process
2. Medical history
a) Chief complain - from the patient perspective
b) Present medical history – history of presenting illness, from when the problem started
to now. What happened? When did it happen? Where it happened? (Incident Location),
How it happened? Then what followed, what’s current?
 c) Past medical history – any other medical condition or complain the patient might have
other than the present condition
3. Social History
a) Personal social history - about the individual client
b) Family social history - associated family members
c) Family medical history – pre existing congenital / inheritable medical in the family
4. Physical examination/general observation
a) General outlook of the client
b) Gross examination – Body symmetry, gait, assistive devices, missing body parts, obvious
deformities
c) Local examination- Specific to where the problem is – scarring, bandages, skin color,
swelling/oedema
5. Occupational performance assessment
a) Occupational performance areas
Assess difficulties in
 ADL
 Work
 Leisure
b) Occupational performance context
 Environmental barriers
 Attitudinal barriers
c) Occupational performance components
 JROM
 Muscle tone
 Muscle strength
 Endurance
 Sensation
 Balance and coordination
 Hand function
 Cognitive evaluations
6. Problems identified
List the problems as identified from evaluations
 7. Goals/ Objectives
 State your intentions based on the problems identified from the evaluations
 A goal is a general skill to be achieved.
 An objective is a specific skill that the patient must acquire to achieve a goal
 Short term goals
 Long term goals
8. Treatment plan
 Treatment plan is a roadmap that will be followed through the treatment.
 The treatment plan is built around the problems that the patient brings into the treatment
 It details the therapeutic interventions;
 What is going to be done
 When it is going to be done
 How it is going to be done
 The guiding frameworks
 The precautions to take to avoid negative effect
9. Implementation
Put the plan to action
10. Re- evaluation
 After implementation re-evaluate to ascertain the achievement of goals
 Depending on the outcome, you can discharge, re plan, refer or seek second opinion

MAIN COMPONENTS ASSESSMENTS

JOINT RANGE OF MOTION

The extend of movement occurring at a joint

Ways of measuring ROM

 Linear/ruler
 Goniometer
 Photograph
 Drawing/tracing

Factors limiting ROM

  Muscle tension
 Contractures/stiffnes/shortentening
 Pain
 Muscle bulk
 Expertise

Goniometry

Is the measurement of a joint range of motion by use of a goniometer

The goniometer

Gonio – Angle

Metron – Measure

Types

 Large / Small
 Full circle / Half circle

Parts

 Axis
 Protractor
 Stationary arm
 Mobile arm

Procedure for measuring ROM

1. Knowledge of body parts and movement

2. Knowledge of goniometry
3. Assess the patient and determine need for carrying out goniometry
4. Explain and demonstrate procedure to the patient
5. Expose the area to be measured and establish landmarks
6. Stabilize the proximal joints
7. Ask the patient to move the joint actively
 8. Place the goniometer appropriately
9. Move the joint passively to maximum
10. Record readings in 3 figures

SELECTED ROMs

JOINT AND ALLOWABLE AXIS STATIONARY ARM MOBILE ARM

RANGES OF MOTION
Shoulder flexion Distal acromion process Parallel to trunk Parallel to Humerus
(0 – 170) lateral aspect
Shoulder extension As above As above As above
(0 – 60)
Shoulder abduction Acromion process As above As above
(0-170) posterior
Internal rotation Olecranon process of Perpendicular to the Parallel to forearm
(0-70) elbow (elbow at 900) flow
External rotation As above As above As above
(0-80)
Elbow flexion from Over lateral epicondyle Parallel to humerus Parallel to radius
extension (0-150)
Elbow Flexion to As above As above As above
extension (30-180)
Supination (0-90) Elbow flexed at 900, Perpendicular to the Parallel to the pen
holding a pen in a fist floor
Pronation (0-90) As above As above As above
Wrist flexion Lateral aspect of wrist Parallel to radius Parallel to index M-C
(0-80) at anatomical snuff box
Wrist extension As above As above As above
(0-70)
Ulnar deviation Dorsum wrist 3rd M-C Center of forearm Parallel to 3rd M-C
 (0-30)
Radial deviation As above As above As above
(0-20)
MP flexion Dorsum MP joint Dorsum MC Dorsum proximal
(0-90) phalanx
PIP flexion Dorsum of PIP joint Over proximal phalanx Over middle phalanx
(0-110)
DIP flexion (0-90) Dorsum DIP joint Over middle phalanx Over distal phalanx

MUSCLE STRENGTH

The ability of a muscle to sustain effort

Ways of measurement

 Dynamometer
 Pinchometer
 Manual Testing

Manual Muscle Testing (MMT) – the measurement of strength in a muscle using manual means
Factors determining muscle strength
 Gravity
 Substitution
 Temperature
 Fatigue

Procedure
 Knowledge
 Explain
 stabilize
 Observe
 Resist
 Record/grade
  Interpret

Grading

0 Zero Nothing observed

1 Trace Tension observed on palpation, evidence of contractions but no movement
2 Poor Full range of motion , Gravity eliminated
3 Fair Full range of motion, against gravity
4 Good Full range of motion, against gravity with some resistance
5 Normal full range of motion against gravity with maximum resistance

MUSCLE TONE

 The tension within a muscle

 The resistance to passive stretch
 Measuring muscle tone
 Palpate the muscle belly
 Move the joint passively through ROM and observe resistance

State of muscle tone

 Hypertonia (Spasticity)
 Hypotonia (Flaccidity)
 Athetoid
 Rigidity
 Ataxic

ENDURANCE

 Ability to sustain effort over a period of time

 Measure of stamina and fitness
 Measure of fatigue

Related to

 Intensity
 Duration
  Frequency

SENSATION

 Testing of feelings
 Must be done when eyes are occluded
 Types
 Light touch
 Deep pressure
 Pain
 Temperature
 Stereognosis
 Proprioception
 Kinaesthesia