Assessment of R&G

    Cards (12)

    • 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