NEUROLOGICAL ASSESSMENT

Name:- ______________________Age____________________________Sex_______________
Occupation:-_________________________________________________
Address:-________________________Contact:-____________________________________
Dominance:-_________________________________
Diagnosis:-___________________________________
Co.Morbidity(includes all risk factors any associated illness):-___________________________________________________________________________________
___________________________________________________________________________________
History Of Present Illness:-
(onset,progression,history till date)
___________________________________________________________________________________
___________________________________________________________________________________
Past History:-__________________________________________________________________
___________________________________________________________________________________
Medical History:-_______________________________________________________________
Personal History:-______________________________________________________________
Family History:-________________________________________________________________
Social History:-_________________________________________________________________

EXAMINATION:-
1.General Examination:-
(include vitals)

2.Higher Functions:-
          #Glassgow Coma Scale
                                        * Eye opening
                                        * Verbal response
                                        * Motor response
           #Mini Mental Scale
           #Speech,Vision,Hearing,Intelligence,Behaviour.
3.Cranial Nerve Examination:-
   Tone :- Ashworth Scale
4.Sensory Examination:-
(Normal,Reduced,Absent)
___________________________________________________________________________________
#Superficial Sensations                     #Deep Sensations
Pain___________________                           Joint Position Sensation
Temperature____________                           Proximal,         Distal
Crude Touch_____________                          Vibration,
Pressure__________________                       Perception:Depth,Height,Space,Distance
                                                       Body IMAGE -size,shape,colour
#Cortical Sensations:-
    *Tactile Localisation
    *2 Point Discrimination
    *Graphesthesia
    *Steriognosis
    *Cortical Extn
    *Barognosis

5.Reflexes:-              Right                      Left
   Biceps
   Triceps
   Supinator
   Knee
   Ankle
   Plantar
6.Motor Examination:-____________________________________________________
  #Nutrition:-______________________________________________________________
                   (Skin                                          Muscle girth)
 #Tone:-
             *Hypotonia:-
           
             *Hypertonia:- Spasticity                         Rigidity
                                                         1.Lead Pipe       2.Cog Wheel
 #ROM & Tightness:-
 #Contracture:-
   (include Limb Length if required)

7.Involuntary Movements:-
                    Tremors:-At Rest/Activity
                    Athetosis/Chorea/Dystonia/Associated Reaction/Hemiballismus
                    Associated Reaction

8.Voluntary Control:-

9.Test For Co ordination:-

10.Stream Format(sheet attached):-

11.Posture:-
     In case of in-patient,bed-redden patient:Posture-more of attitude of
     patient and Berg Balance Scale:-
12.Strategy Assessment:-

13.GAIT Assessment:-(Dynamic Gait Index),Balance

14.BARTHEL'S INDEX:-

15.Investigation and Drug history

ICDIH2:-

Diagnosis:-

Mnagement:- STG                                         LTG


Follow Up:-

exercises to prevent arthritis

Cerebral palsy - PubMed Health

Cerebral palsy - PubMed Health

ANTENATAL CARE (ANC)

                                          AIMS
To prepare female mentally and physically for physiological changes during pregnancy ,delivery and to keep them fit in the role of parents.
To prepare the perspective parents for the birth and care of the baby for parenthood.
To motivate,council and guide them to increase their confidence.
 Provide them a forum for the perspective parents to meet each other and discuss aspects of hopes,fears,problems, and expectations.
                         EXERCISES AND ERGONOMICS
EXERCISE TO MAINTAIN PROPER POSTURE AND TO AVOID POSTURAL PROBLEMS LIKE PIVD,LOW BACK PAIN,ROUNDED SHOULDER etc.
Back care and lifting in various positions:-
                                       STANDING :
Stand and walk straight,strecth head up out of shoulder.to check your posture is correct or not lean back against a wall.
Do ankle pumps to keep circulation good and ease muscle tension.
                                       SITTING :
As spinal structures have to undergo many pressures during pregnancy its care is important .while sitting for long time into the chair place a small cushion or a pillow behind the low back as to maintain the lumbar curve and to reduce the srtecth on the posterior spinal structures.foot should be rested on floor .
                                        SLEEPING POSITIONS :
while getting up from lying position turn to side lying and then should get up to avoid abdominal strain from sitting up or lying straight down.for most women supine from prone is acceptable as the weight of the body is taken on the bed,with a pillow placed under the abdomen and another beneath the knee.
                                        LIFTING ADVICE :
When lifting from the floor ,it is important to ensure that the weight is light enough to be filled comfortably and not to bend from back, bend from knee.
                               

Is smoking injurious to health?

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ANKYLOSING SPONDYLITIS

Ankylosing spondylitis mostly occurs in males,affects the axial and spinal skeleton with stiff spine,painfull back and x-ray shows typical bomboo spine structure which is important in diagnosis of disease.It is a variant type of RA.It is an inflammatory disease of spine.Inflamation of spinal synovial joints progressing to ankylosis.SACRO-ILLIATES lesion is seen.
                                  CLINICAL FEATURES :-
1) general malaise
2) pain in -shoulder joint (with involvement of AC joint),
               -jaws(with involvement of TMJ),
               -over insertion of TA (due to enthesitis)
               -chest region(due to sternoclavicular,costo-vertebral and costo-     sternal joints involvement
3) painful breathing movements of thorax leading to reduced chest expansion
4) limited shoulder ROM due to pain and muscle spasm
5) reduced lumbar flexion and thoracic rotation
6) flattening of lumbar curve due to weakness of lumbar paraspinal muscles and
    sacro-illiac involement
7) gradually progressing thoracic kyphosis
8) hip flexion deformity
9) HLA B-27 positive
                              PHYSIOTHERAPY MANAGEMENT :-
GOALS:- is to relieve pain,assist resolution of inflammation,prevention of deformities,maintaining spinal mobility,maintaining chest expansion,posture correction and maintaining functional independency of patient.
http://www.healthline.com/health/ankylosing-spondylitis/effects-on-body

FROZEN SHOULDER

Frozen shoulder, or adhesive capsulitis, is characterized by pain in the shoulder, sometimes leading into the upper arm and shoulder blade. This may cause a decrease in shoulder movement, stiffness of the shoulder joint. Frozen shoulder can be secondary to other medical problems such as thyroid illness, Parkinson disease, and cardiac disease and post-surgery. It may also be secondary to a fracture

 of the shoulder or arm, tendonitis, trauma or other condition requiring shoulder immobilization for a period of time. During this time, the capsule of the shoulder joint becomes inflamed and thickened, sometimes contracted.

Patients often complain of an intense pain, dull or aching, with difficulties sleeping and a very restricted range of motion. The decrease in the range of motion decrease usually shows a pattern; some movements are more affected than others. In time this condition leads to decreased strength and stability, as well as scapular stability, and therefore reduced arm function in different degrees.

The normal course of frozen shoulder has three stages: freezing, frozen and thawing, which can last up to 2 years. Frozen Shoulder is a self-limited condition. However, physiotherapy has been proven to shorten the healing process. After assessing the physical and functional restrictions and impairments, the physiotherapist will aim the treatment towards pain and inflammation reduction, and restoration of the motion.

Only 20% of people with frozen shoulder actually have to undergo surgery. The other 80% can significantly reduce their pain if not completely abolish their frozen shoulder with exercise.
If you have a well structured exercise program you can actually find relief in 1-3 months.

There are many different treatments that people have used to combat their adhesive capsulitis; however the 'best' treatment is to make sure the patient uses frozen shoulder exercises which take advantage of a multi-level protocol.

Using a multi-level treatment protocol means that the person is not focusing on one aspect only of dealing with the problems and symptoms, rather that they are dealing with all of the issues associated with their frozen shoulder. Treatments such as this will help cover all of the bases and allow proper motion, flexibility, strength and pain reduction, which will make certain that your shoulder pain will be treated and eliminated much faster than not.

To have true success is treating adhesive capsulitis, the patient must be sure to include a good, quality stretching protocol, as well as increasing strength, treating soft-tissue issues, and working on increasing range of motion in all directions.