Use clinical reasoning skills to develop a hypothesis
Perform additional tests /hypothesis testing
Treat
Subjective History:
Presenting condition
History of presenting condition
Past medical surgical history
Social history
Drug history
Remember to check which is their dominant hand!
Objective Assessment - Vision & Posture:
start patient in sitting, progress to standing - more postural adjustments
variety of objects scattered om table in front of patient and ask them to point at an object:
start by something ipsilaterally in central vision/near field (centrally to the right or left depending on which arm theyre using, as it easier) - only eyes move
contralaterally in central vision/near field
ipsilaterally in near peripheral vision, then contralaterally - eyes and head move
ipsilaterally in far peripheral vision, then contralaterally - eyes, head and trunk move
Assessment of Reach and Grasp:
Consider the property of objects to be reached and grasped:
Different sized objects - small, medium, large
Objects with different weights
Robust and fragile objects
Different textures/ friction properties
Assessment of Reach and Grasp:
Consider distance and space reaching to:
start nearipsilaterally ->
nearcontralaterally ->
near peripheryipsilaterally ->
near peripherycontralaterally ->
faripsilaterally ->
farcontralaterally
also consider height - include reaching high and low (again start ipsilaterally)
Assessment of Reach and Grasp:
Get them to use in function where appropriate
Start in sitting but progress to standing
Observe what is happening at each of the six phases (n.b. do a tug in stabilization phase!!)
Assessment of Transport Phase:
Acceleration: Does hand open at the start of movement? Range, speed and timing of shoulder, elbow, forearm wrist (extension / radial deviation) and hand movement
Deceleration, is hand at right aperture by time reaches object? Timing? Grip appropriate for object?
Trajectory, smooth arc?
Assessment of Stabilisation Phase:
Appropriate grip?
Can maintain against a tug?
Are they crushing the object?
Assessment of Manipulation Phase:
Can they use in function?
Shift
Translation
Rotation
Assessment of Release Phase:
In controlled, planned, accurate way?
Wrist position
Aperture size
Outcome Measures:
Which level of ICF?
aim to have at least 2 outcome measures - 1 impairment based measure, 1 activity based measure (more important)
Valid for your population
Sensitivity for your patient?
FEASIBILITY!
intra rater reliability vs inter rater reliability
Clinical reasoning - Perform tests to confirm/refute your hypothesis - cause of problem:
Visual problems (oculomotor tests)
Postural problems (ROM, weakness/proprioception?)
Soft tissue shortening /contracture causing loss of ROM