Transcript Chapter 4- ESHE 365

4
Evaluation
and Assessment
Evaluation
The means by which one seeks
information on severity, irritability,
nature, and stage of injury
Subjective elements
Objective elements
Subjective Evaluation
History of the injury
Past medical history
Special questions
Additional information
Pain profile
Objective Evaluation
Observation and visual inspection
Range of motion
Accessory joint mobility
Muscle performance
Special tests
Palpation
Functional testing
comparable sign: a sign produced by
active or passive movement or test
that reproduces the patient’s
symptom, such as pain or protective
muscle spasm
Observation
and Visual Inspection
Start when patient enters room.
Note gait, stance, posture, guarding,
use of the injured segment.
Note swelling, discoloration, scars.
Range of Motion
Active range of motion
Passive range of motion
End-feel
Accessory Joint Mobility
Cannot be produced actively by
patient but is necessary for full,
normal motion of joint
Evaluated with joint mobilization
techniques
Look for stiffness, amplitude of
available mobility, end-feel, pain
Compare bilaterally
Muscle Performance
Evaluation of muscle strength and
endurance
Manual isometric tests, isotonic
evaluation, isokinetic machines
Special Tests
Are used to determine
aggressiveness of treatment
Are specific to body segment and
tissue
Neurological Testing
Sensory, motor, reflex testing
Signs and symptoms distal to
acromion process in upper extremity
and distal to gluteal fold in lower
extremity
Palpation
Performed after other tests
Temperature, tone, edema, mobility of
skin and subcutaneous tissue
Crepitus, nodules, spasm, scar-tissue
mobility, tissue consistency
From superficial to deep
Only as deep as necessary
Functional Testing
Irritability and severity of injury
dictate if and when tests are
performed.
Agility, coordination, proprioception
are key.
Evaluate for smoothness of
movement, fullness of motion, quality
of performance.
Assessment
Conclusions based on results of
evaluation
Used to determine problems and
goals
When is it done?
After initial evaluation
Continually during program
Prior to return to participation
Identifying Problems
and Goals
Problems
Based on subjective and objective
findings
Form basis for setting goals
Goals
Goal for every problem
No goal without problem
General and specific
Long term and short term
Plan for Treatment
Includes plan of action to achieve
goals
Includes frequency, duration,
components of treatment
Changes as goals change
Continual Assessment
Necessary throughout treatment
program to determine effectiveness of
treatment
Before treatment, after treatment,
throughout treatment
Advances in program based on
results
Functional Assessment
Done prior to return to sport
participation
Determines readiness to return to full
participation
Must be individualized based on
sport, position in sport, and level of
competition
Rehabilitation Records
Record keeping is essential for judging
the treatment’s effectiveness, for
communicating with other care givers, as
a reference in the event of reinjury,
insurance claims, and as a legal
document.
SOAP Format
S = Subjective
O = Objective
A = Assessment
P = Plan
Types of Records
Initial evaluation record
Each treatment record
Progress note
Discharge summary
Diploma