Assessment of R&G

• Process of Assessing R&G:

  1. Subjective assessment
  2. Objective assessment
  3. Identify missing components
  4. Use clinical reasoning skills to develop a hypothesis
  5. Perform additional tests /hypothesis testing
  6. 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 near ipsilaterally ->
  • near contralaterally ->
  • near periphery ipsilaterally ->
  • near periphery contralaterally ->
  • far ipsilaterally ->
  • far contralaterally
  • 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
  • Bony block causing loss of ROM
  • Weakness
  • Reduced cutaneous sensation
  • Reduced proprioception
  • Reduced stereognosis
  • Pain
  • Fear/anxiety