REHABILITATION

ASSESSMENTPingMiao,MDDepartmentofRehabilitationmedicineThesecondaffiliatedhospitalofGuangzhouMedicalUniversity1.REHABILITATION

ASSESSMENTPingContentsIntroductionMeasuresofimpairment(muscle,joint,cognitive...)Measuresofdisability(activityofdailylife...)Measuresofhandicap2.ContentsIntroduction2.TofindtheproblemsWhatkindofdysfunctioncongenital：heartproblems，etc.postnatal：CP，stroke，SCI,TBI,etcsecodary：contracturefollowingfracture，muscleatrophyafterperipheralnerveinjury,andsoonHowmanydysfunctionsPhysically,speech,psychological,socialaspectHowseverityofdysfunctionsOnpatientandhis/herfamily3.TofindtheproblemsWhatkindTosettreatmentgoalsshort-termgoalsCanbetouchedbyeffortswithinafewdaysorweekslong-termgoalsCanbeachievedforlongtime(terminal)Fromshort-termgoalstolong-termoneMustconsiderthefactorsage、profession、culturalbackgroud、familyconditions4.Tosettreatmentgoalsshort-teAssesstreatmenteffectsIsourtreatmentplaneffective?Yes/NoShouldthetreatmentplanbecontiniunedorshouldbeadjustedaccordingtomeasurementsYes/No5.AssesstreatmenteffectsIsour

Physicalexaminationandrehabilitationmeasurementhavesomethingincommonbutnotthesame.PurposeTimesWaysIntroduction6.Introduction6.7.7.8.8.ObjectivesofMeasurementTofindproblemsTosettreatmentgoalsToplantreatmentschedulesToassesstheeffectivenessTopredictoutcomesToanalyzethecost-effecitveReasonsforassessing9.ObjectivesofMeasurementTofiLevelsshouldbemeasuredimpairmentdisabilityhandicap10.LevelsshouldbemeasuredimpaiDevelopmentofICIDHInternationalClassificationofImpairments,Disabilities,andHandicaps(ICIDH)

1980，WHOdiseaseimpairmentdisabilityhandicap疾病病損殘疾殘障

(器官水平)(個(gè)體水平)(社會(huì)水平)

structure

abilityactivity/participation

TraditionalModelofMedicine:Etiology

Pathology

clinicalfeaturesLevels11.DevelopmentofICIDHInternatApplicationofICIDHDifferentcousesAmputeeinthelowerlimbCan`twalkCan`tgotoschool/workimpairmentdisabilityhandicapOrgansADLSocialactivityAtthelevelof12.ApplicationofICIDHDifferentApplicationofICIDHStroke/TBIHemiplagiaCan`tlookafterHim-/her-selfCan`twork/Jointhesociallife

impairmentdisabilityhandicaporgansADLSociallifeAtthelevelof13.ApplicationofICIDHStroke/TBI14.14.IntroductionPurposePlanatreatmentprogramandestablishoutcomesEvaluateresultsoftreatmentprogramModifytreatmentprogram15.IntroductionPurpose15.IntroductionGoodassessmentisdependentupon:KnowledgeoffunctionalanatomyHistoryCompleteexamination16.IntroductionGoodassessmentisClinicalEvaluationSequenceHistoryInspectionPalpationFunctionalTestingNeurologicalTesting17.ClinicalEvaluationSequenceHicategoryofmeasurmentRatioScalesInervalScalesOrdinalScalesNorminalScales18.categoryofmeasurmentRatioScRatioScalesFeaturesHasazeropointthatreprestnsthecompletabsenceofthequatityrepresented.TheintervalsamongallsuccessiveunitsonthescalemustbeequalinsizeCan`thaveaminusornegativevalue.%isaformofratioExamplesROMLimblengthTimetocompletanactivityVitalcapacityNerveconductionvelocity19.RatioScalesFeatures19.InervalScalesFeaturesLackofazeropointTheunitmustbeequalsizeExamplesBodytemperatureFunctinalscalesPsychologicaltests20.InervalScalesFeatures20.OrdinalScalesFeaturesMayhaveonly2categoriesPresent/absentDependent/independentExamplesMMTADLFugle-Meyer`sscale21.OrdinalScalesFeatures21.NorminalScalesFeaturesTheunitsarecategorywithoutindicatingtheorderorrankofthedifferencesMaybelabeledwithnumberals,letters,orwords,butthelablesdonotidicateorderorrankExamplesClassificationofgenders,diseaseStroke,Cerebralpalsy22.NorminalScalesFeatures22.QuantitativeandQualitativeScalesUnitsareassumedtobeofequalsizeAcontinuousscaleEqualsizesubunitsDistance:m,cm,mm,etcExamplesRatioscalesIntervalscalesCategorieshavenosizeCan`tbedivisibleintoequal-sizedsubcategoriesTendonreflexSittingbalanceExamplesNominalscales23.QuantitativeandQualitativeSvalidsensitivespecificreliable(inter-rater,test-retest)appropriateacceptable24.valid24.Procedureswhentomeasurewhattobemeasuredhowtomeasure25.ProcedureswhentomeasurewhatWhentomeasureInitialstageMiddlestageTerminalstageAtfollow-upDuringthetreatmentandtraining,evaluationcanberepeatedbyseveraltimes.Itusuallystartfromtheevaluationandendontheevaluation.26.WhentomeasureInitialstageMiInitialstage（firstmeasurement)WhenshouldbeconductedBeforephyiotherapyobjectivesFindtheproblemsanditsstatusInvestigatethepotentialofrehabilitationandrelatedfactorsAsevidenceofthetreatmentplanningAsthebaselineofreassessment27.Initialstage（firstmeasuremenMiddlestage(repeatedmeasurements)WhenshouldberepeatedOnceat1-2wksforthosewithquickrecoveryEarlyphaseorinpatientsOnceat3-4wksforthosewithslowrecoveryChronicphaseoroutpatientsobjectivesTofindanyimprovementanditsextendTodecideifanyadjustmentisneeded28.Middlestage(repeatedmeasuremeTerminalstage（final）WhenshouldbemeasuredBeforefinishingthephysiotherapyoratdischargeobjectivesToinvestigatetherehabeffectivenessAchivementshasbeenreachedToplandischageprogramContinuinetreatmentReferedtooutpatientorcommunity29.Terminalstage（final）WhenshoFollow-upWhenshouldbeVariationamongpatientsanddiseasesEachmonth,2-3monthsor6monthsobjectivesDeterminethefunctionofpatientDecidewhetherpatientneedstofuthertreatment30.Follow-upWhenshouldbe30.specificPhysicalfunctioncognitionlanguageSocialactivitiespsychologyglobalimpairmentdisabilityhandicapWhattobemeasured31.specificPhysicalfunctioncogniPhysicalfunctionMuscletoneROMBalanceMMTWalking???AschworthSpasticityScaleWhatshouldbemeasuredinneurorehabMotorAssessmentScaleBergBalanceScaleCompositeSpasticityScaleTheTimed“Up&Go”testFugle-MeyerMovementAssessmentReachTestBrunnstroumRoveryStages32.PhysicalfunctionMuscletoneRODatacollectionMedicalhistoryMedicalnotesFindtheproblemsassessmentDecidewhattoandhowtoassessStarttoassessDatarecordingDataanalysisFunctinaldiagnosisSettreatmentgoalsTreatmentplanAssessmentprocedues33.DatacollectionMedicalhistoryEvaluation效度信度sensitivetyvalidreliabilityIntra-raterInter-ratercriterion-relatedvalidation

content-relatedvalidationconstruct-relatedvalidationToevaluatethemethodologybeingused34.Evaluation效度信度sensitivetyvalid

RulesofS.O.A.Parewidelyuseallovertheworld:S(subjectivedata)：maincomplaintandsymptomofthepatients;O(objectivedata)：objectivesymptomandfunctionalbehaviorofthepatientsA(assessment)：analyzeandclassifytheabove-mentionedmaterials;P(plan)：setatreatmentplan.

Ⅱ.Methodsofevaluation35.RulesofS.O.A.Parewidel

Ⅱ.Methodsofevaluation36.Ⅱ.Methodsofevaluation36.SpecificEvaluation37.SpecificEvaluation37.SpecificEvaluation-MotorabilityevaluationMusclestrengthRangeofmotionMusculartoneMuscularenduranceGaitanalysisBalanceCoordination38.SpecificEvaluation-MotorabilManualmuscletest

(MMT)39.Manualmuscletest

(MMT)39.ManualMuscleTesting(MMT)Definition:subjectivetestingdonebythetherapisttoassessapatientsmusclestrength.Themusclestrengthisgradedtobeeithernormal,good,fair,poor,traceorzero.40.ManualMuscleTesting(MMT)DefMuscleGradesNormal:patientholdscontractionagainstmaximalresistanceatendrangeGood:patientholdscontractionagainstmoderateresistanceatendrangeFair:patientmovesthroughfullrangeofmotionagainstgravitybutunabletoholdagainstresistanceatendrangePoor:patientmovesthroughfullrangeofmotioninagravityminimizedpositionTrace:therapistpalpatesmusclecontractionaspatientattemptstomoveZero:therapistisunabletopalpateanymusclecontractionaspatientattemptstomove41.MuscleGradesNormal:patienthMuscleGradesNormal= 5/5Good= 4/5Fair= 3/5Poor = 2/5Trace= 1/5Zero= 0/542.MuscleGradesNormal= 5/542.ImportantpointsonmanualmuscletestingNeedtoplacepatientinstandardizedpositionIsolateonlyonejointmotionDon’tallowpatienttocompensateforweaknessComparesamemusclebilaterallyBeconsistentandreliablewithtesting43.ImportantpointsonmanualmusManualResistanceStabilizelimbproximallyResistanceprovideddistallyonbonetowhichmuscleattachesWatchforcompensation44.ManualResistance44.45.45.VIDEODEMOPRACTICEQ&A46.46.AttentionduringtheMMT1.Correctposture,limbpositionandnecessarysettlement.2.Makesurethepatientsunderstandtherequestandpurposeofmovement,sothatavoidingthefakemovementorcompensation.3.Whilethemusclestrengthreachthelevel4,resistanceisprovidedtothedistalareaofthelimb.47.AttentionduringtheMMT47.4.KeepavoidingtheMMTafterlongtimeexercisesormeals.5.Thepositionwhichismeasuredshouldbeexposedtothetherapistsordoctors.6.Remembertocomparewiththecontralaterallimb.48.48.MuscletestMeasurebyequipments1.GeneralequipmenttestGrippingtestPinchingtestDorsalmuscletestⅡ.MethodsofEvaluation-Muscletest49.MuscletestⅡ.MethodsofEvaluMuscletone

(ModifiedAshworthScale)50.Muscletone

(ModifiedAshworth51.51.Rangeofmotion

(ROM)52.Rangeofmotion

(ROM)52.RangeofMotion

(ROM)53.RangeofMotion

(ROM)53.MeasuringToolsGoniometerInclinometerElectrogoniometer54.MeasuringToolsGoniometer54.55.55.HowtomeasuretheROMofupperlimbs/lowerlimbs/trunk?Ⅱ.MethodsofEvaluation-ROMThreefactors(1)Axis(2)Stationaryarm(3)Movingarm56.HowtomeasuretheROMofuppe57.57.ROMMeasurementInformedconsentPositionthepatientPlacejointinzerostartingpositionStabilizeproximalsegmentofthejointMovepatientpassivelythroughavailableROMDetermineend-feelPalpatelandmarksAligngoniometerPassivelyoractivelytakepatientthroughavailableROMCheckalignmentReadgoniometer58ROMMeasurementInformedconsen59.59.Shoulderflexion(180°)Supinewitharmsatsides-liftoverheadStationaryarm-lateralmidlineofthoraxAxis-midpointoflateralaspectofacromionprocessMovingarm:lateralmidlineofthehumerustowardlateralhumeralepicondyle60.Shoulderflexion(180°)60.ShoulderExtension(60)Pronewitharmsatsides-trytoraisearmStationaryArm:lateralmidlineofthoraxAxis:midpointoflateralaspectofacromionprocessMovingArm:lateralmidlineofhumerustowardlateralhumeralepicondyle61.ShoulderExtension(60)61.ShoulderAbductionSupinewithshoulderatsideinanatomicalposition-raisearmoverheadStationaryArm:ParalleltosternumAxis:AnterioraspectofacromionprocessMovingArm:Anteriormidlineofhumerustowardmedialhumeralepicondyle62.ShoulderAbduction62.External/LateralRotation

Internal/MedialRotation63.External/LateralRotation

InteElbowFlexionSupinewithhandsbysideswithtowelunderarm-flexelbowStationaryarm:lateralmidlineofhumerustowardacromionprocessAxis:LateralepicondyleofHumerusMovingArm:Lateralmidlineofradiustowardradialstyloidprocess64.ElbowFlexion64.65.65.66.66.67.67.68.68.69.69.70.70.RangeofMotion(ROM)HelpstoassessfunctionalstatusComparebilaterallyTestjointsproximalanddistaltoinjuredareaOnlyperformifdonotsuspectafracture71.RangeofMotion(ROM)HelpstoImportantpointsonGoniometricmeasurementMotionsmeasuredcanbeeitheractiveorpassiveStandardizedtechniquesareusedforeachjointJointsshouldbeadequatelystabilizedduringmeasurement72.ImportantpointsonGoniometriPassiveRangeofMotion(PROM)ClinicalDefinition:Therapistmovesselectedjoint(s)throughfullrangeofmotionwithnoassistancefromthepatientActiveRangeofMotion(AROM)73.PassiveRangeofMotion(PROM)ImportantpointsonpassiverangeofmotionAdequatelystabilizepatientsjointsasyoumovethem.(somepatientsmayhavenoactivemovement)Don’tcausepainotherthanstretchingPerform5-10motionsperjointmovementFamiliarizeyourselfwithnormaldirectionsanddegreesofmovementforeachjointListentopatient74.ImportantpointsonpassiveraContraindicationsPatientisunabletovoluntarilycontractinjuredmusclePatientisunabletoperformAROMUnderlyingfracturesiteisnothealedInvolvedtissuesarenotyethealed75.Contraindications75.Ⅱ.MethodsofEvaluation-ROM76.Ⅱ.MethodsofEvaluation-ROM

Elbowflexion0°to160°extension145°to0°Forarmpronation(rotationinward)0°to90°supination(rotationoutward)0°to90°Ⅱ.MethodsofEvaluation-ROM77.EWristflexion0°to90°extension0°to70°abduction0°to25°adduction0°to65°Ⅱ.MethodsofEvaluation-ROM78.WristⅡ

Hipflexion0°to125°extension115°to0°hyperextension(straighteningbeyondnormalrange0°to15°abduction0°to45°adduction45°to0°lateralrotation(rotationawayfromcenterofbody)0°to45°medialrotation(rotationtowardscenterofbody)0°to45°79.HipKneeflexion0°to130°extension120°to0°80.KneeAnkleplantarflexion(movementdownward)0°to50°dorsiflexion(movementupward)0°to20°81.AnklMini-MentalState

Examination

(MMSE)82.Mini-MentalState

ExaminationThe

mini–mentalstate

examination

(MMSE)

isa30-pointquestionnairethatisusedextensivelyinclinicalandresearchsettingstomeasurecognitiveimpairment.Itiscommonlyusedin

medicine

andalliedhealthtoscreenfor

dementia.Itisalsousedtoestimatetheseverityandprogressionofcognitiveimpairmentandtofollowthecourseofcognitivechangesinanindividualovertime83.The

mini–mentalstateexaminatAdministrationofthetesttakesbetween5–10minutesandexaminesfunctionsincluding

registration,

attentionandcalculation,

recall,

language,abilitytofollowsimplecommands

and

orientation.84.AdministrationofthetesttakAdvantagestotheMMSEincluderequiringnospecializedequipmentortrainingforadministration,andhasbothvalidityandreliabilityforthediagnosisandlongitudinalassessmentofAlzheimer'sDisease.ThemostfrequentlynoteddisadvantageoftheMMSErelatestoitslackofsensitivitytomildcognitiveimpairment85.AdvantagestotheMMSEincludeAnyscoregreaterthanorequalto27points(outof30)indicatesanormalcognition.Belowthis,scorescanindicatesevere(≤9points),moderate(10–18points)ormild(19–24points)cognitiveimpairment.Therawscoremayalsoneedtobecorrectedforeducationalattainmentandage.86.AnyscoregreaterthanorequaActivityofdailylife

(ADL)87.Activityofdailylife

(ADL)87Bathing:includesgroomingactivitiessuchasshaving,andbrushingteethandhairDressing:choosingappropriategarmentsandbeingabletodressandundress,havingnotroublewithbuttons,zippersorotherfastenersEating:beingabletofeedoneself88.Bathing:includesgroomingactTransferring:beingabletowalk,or,ifnotambulatory,beingabletotransferoneselffrombedtowheelchairandbackContinence:beingabletocontrolone’sbowelsandbladder,ormanageone’sincontinenceindependentlyToileting:beingabletousethetoilet89.Transferring:beingabletowaModifiedBarthelIndexScore(MBI)TheMBIisameasureofactivitiesofdailyliving,whichshowsthedegreeofindependenceofapatientfromanyassistance.Itcovers10domainsoffunctioning(activities):bowelcontrol,bladdercontrol,aswellashelpwithgrooming,toiletuse,feeding,transfers,walking,dressing,climbingstairs,andbathing.

Totalscoresmayrangefrom0to100,withhigherscoresindicatinggreaterindependence.90.ModifiedBarthelIndexScore(Others91.Others91.BalanceDefinition:MaintainingcenterofmasswithinyourbaseofsupportOtherTerminologyusedtodescribebalance:CenterofGravityEquilibriumConeofStability92.BalanceDefinition:Maintaining

Ⅱ.Methodofevaluation93.Ⅱ.Methodofevaluation93.GaitOthertermsusedtodescribegait:Ambulation/LocomotionControlledmovementofyourbaseofsupport.94.GaitOthertermsusedtodescriGaitAssessments95.GaitAssessments95.96.96.Measuresofperception-cognition感知、認(rèn)知評(píng)價(jià)Measuresofanxietyanddepression焦慮和憂郁評(píng)估MeasuresofTraumaticbraininjury腦外傷(TBI)評(píng)估Self-assessmentandself-efficacyscales自我評(píng)價(jià)（生活質(zhì)量評(píng)價(jià)）97.Measuresofperception-cogni