Hemi Assessment

8/10/2019 Hemi Assessment

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1. Collecting data:1.1- Personal information:

-Name: T.T.

-Age: 46 years old.

-Profession: furniture painter.

- Diagnosis: left CVA/ right hemiplegia

-Dominant side: Right side.

-Date of accident: /3/2013

-Date of starting physiotherapy: 1/10/2013

-Physiotherapist name: Mrs. Miriam Al Haber.

1.2- History:

The patient has a history of blood hypertension. The patient had a first hemorrhagic stroke, thislead to a case of right hemiplegic patient, he transferred to the hospital and still for 40 days inComa, then start with physiotherapy sessions.

1.3- Risk factors:

-Hypertension.

- slightly obese.

Didnt make exercises.

2. Assessment plan:

2.1- General assessment

2.2- Pyramidal hypertonia

2.3-Assosciated problems

2.4- Neurologic assessment

2.5- Trophic assessment


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2.6- Orthopedic and Articular assessment

2.7- Muscular assessment

2.8-functional assessment

2.9- Gait assessment

2.1- General assessment:The patient entered the physiotherapy center using cane without any assistance.

2.2- Pyramidal hypertonia assessment:

Intensity of hypertonia Right side

V1 V3Hip Flexor I3 I3Internal Rotation I2 I2Adductor I1 I2

knee flexor I3 I3Ankle Plantar flexor I4 I4Shoulder Flexor I4 I4

Adductor I3 I4Internal Rotation I4 I4

Elbow flexor I3 I3

Forearm Pronator I3 I4Wrist Flexor I3 I3Fingers flexor I3 I3

2.3-Assosciated problems:

-No aphasia.

-Apraxia

-Agnosia

-Ataxia

-Balance impairement


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2.5- Trophic assessment:

A-Cutaneous assessment:

There is slight edema in the right affected side comparative to the normal left side in the lowerlimb.

B- Muscular assessment:

-There are no muscular contractures.

-Slight amyotrophic muscles appeared in the muscles of right shoulder and hand.

Conclusion:

-Normal cutaneous trophicity.

-Slight muscular amyotrophic.

2.6- Articular assessment:

a. Observation: (at rest)I- Upper limb scheme:

i. Shoulder internal rotation.ii. Elbow flexion..

iii. Wrist and fingers flexion.iv. Thumb adduction.

II- Lower limb scheme:i. Hip slight adduction- external rotation.

ii. Slight ankle eversion with plantar flexion.iii. Knee flexion.

b. Palpation:

There is no presence of any joint dislocation or deformities.

c. Mobilization:

There is limitation in the whole upper limb.

In the lower limb in active mobilization the patient can perform knee flexion but accompaniedwith hip external rotation, while in passive mobilization there is no limitation except ankledorsiflextion and inversion.


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2.7- Muscular assessment:

A- Analytic motor testing:

Joint Muscle group Grade(right) Grade(left)

ShoulderE/F 0 4

Abd/Add 0 4ER/IR 0 4

Elbow F/E 0 4Sup/pro 0 4

Wrist F/E 1/0 4Fingers F/E 1/0 4Thumb Abd/Add 1 -/1 - 4

HipE/F 3/3 4

Abd/Add 2/3 4

IR/ER 1/2 4Knee F/E 3/3 4Ankle Plantar/dorsi F 1/1 4

Inversion/Eversion 0/1 4

Grades: 0: no contraction

1: palpable contraction, no movement

2: contraction produces movement

3: movement against light resistance

4: movement against high resistance

5: normal movement

Conclusion:

There is general muscle weakness

B- Global testing:

Movement GradeHand on mouth 0Hand on the opposite shoulder 0Elbow extension + shoulder abduction 0Hand on the opposite knee 0Knee E + plantar flexion 2


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Type of walk: Fauchage gait.- He cannot walk alone without using a technical aid. - He cannot divided his body weight on his lower limb

TreatmentObjectives:

Short term:

Maintain good orthopedic state Strength muscles of left side Stretch retracted muscles Accelerate motor recovery Ameliorate ADL functions Improve equilibrium and balance Correction of gait

Long term:

Give maximum independence to the patient. Attempt an autonomic correct gait. Maintenance functional upper limb if possible.


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Treatment application:

*Passive mobilization for all joints of right side especially external rotation , abduction andflexion of shoulder , extension of elbow , supination of forearm , movements of thumb ,extension of wrist and fingers , external rotation and abduction of hip , dorsiflexion of ankle

*Active ROM &Active resisted ROM:

-shoulder flex, ext, IR, ER, abd, add

-elbow flex, ext

-forearm pronation supination

-wrist ext, flex

-fingers flex, ext

-hip flex, ext, IR, ER, abd, add

-knee flex, ext

-ankle dorsiflexion, plantar flex, inversion, eversion

*Bridge exercise for strengthening hip extensors

*Put the patient in a posture of fingers ext, elbow ext, shoulder flexion and the patient to

stabilize his upper limb in this posture.

*In later stages he moves his arm actively to the posture.

-Bicycling.

-walking between parallel bars.

Documents

Hemi Assessment