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University of Manitoba - MPT: Neurological Clinical Skills (University of Manitoba)

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University of Manitoba - MPT: Neurological Clinical Skills Checklist
Revised February, 2017
Name:____________________ Site:____________________
Assessment Skills
Observed
Performed
Becoming
Confident
Confident
A. Gross motor function
i. Describe movement strategies
(quality, devices, timeliness, independence):
−
supine→sidelying→sit→stand
−
supine→long sitting
− sit→sit transfer
−
bridging
− “scooting” up and down, side to side in supine
−
“scooting” along bed in sitting (laterally, forward,
backward)
−
sit/stand↔floor
ii. Administer and score the Chedoke McMaster Stroke
Assessment Activity Inventory
iii. Administer and score the Timed Up and Go
iv. Describe components of the Functional Independence
Measure
v. Describe other standardized measures of gross motor
function and transfers
B. Motor Assessment
Observed
Performed
Becoming
Confident
Confident
i. Assess AROM, PROM, and tone
− upper extremity
−
lower extremity
ii. Describe the findings of the tone assessment
− low tone
−
spasticity
−
rigidity
− clonus
iii. Describe standardized measures of tone (e.g. the modified
Ashworth Scale)
iv. Be able to test and discriminate between normal and
abnormal
−
Babinski
−
Clonus
− Deep tendon reflexes
v. Assess for abnormal movement synergies (u/e, l/e) (AKA
motor selectivity)
−
identify and describe flaccid, reflexive movement,
voluntary movement in “synergy”, voluntary movement
out of “synergy”, “normal” movement
vi. Administer and score the Chedoke McMaster Stroke
Assessment Impairment Inventory
vii. Describe other standardized measures of sensori-motor
recovery after brain injury
viii. Recognize involuntary movement
−
dystonia
University of Manitoba - MPT: Neurological Clinical Skills Checklist
Revised February, 2017
Assessment Skills
Observed
Performed
Becoming
Confident
Confident
−
tremor
−
athetoid
− choreiform
− associated movements
ix. Assess strength of upper and lower extremities
x. Assess non-equilibrium tests of coordination
− dysdiadochokinesia
o rapid alternating movements
o tapping
− dysdiadochokinesia (continued)
o other tests
−
dysmetria
o finger-nose
o heel-shin
o other tests
− rebound
xi. Determine spinal cord injury levels according to ASIA scale
C. Sensation and proprioception
Observed
Performed
Becoming
Confident
Confident
i. Assess discriminative touch:
− touch awareness
− touch localization
−
sensory extinction
− touch pressure threshold
− two-point discrimination
ii. Assess proprioception:
− joint position
− joint motion
−
stereognosis
−
vibration
iii. Assess pain – sharp/dull
iv. Assess temperature perception
D. Visual Screen
i. acuity
i. depth perception
ii. visual field deficit
iii. gaze control
University of Manitoba - MPT: Neurological Clinical Skills Checklist
Revised February, 2017
E. Perception and Cognition
Observed
Performed
Becoming
Confident
Confident
i. Recognize / describe perceptual impairments:
−
body scheme
− anosognosia
− unilateral neglect
−
position in space
− limb apraxia
− figure ground perception
ii. Assess orientation x 3
iii. Recognize / describe cognitive impairments:
− attention
−
orientation
−
memory
− problem solving/ executive functioning
iv. Describe Mini Mental State Exam results
v. Recognize communication impairments
F. Postural control / balance
Observed
Performed
Becoming
Confident
Confident
i. Assess sitting posture/alignment
ii. Assess sitting balance
−
static
− internal perturbations
− external perturbations
−
changing sensory environment
iii. Assess standing posture/alignment
iv. Assess standing (bipedal) balance
−
static
− internal perturbations
− external perturbations
−
changing sensory environment
v. Administer and score the Berg Balance Scale
vi. Perform the modified mCTSIB (modified Clinical Test for
Sensory Interaction in Balance)
vii. Describe other standardized measures of balance
viii. Higher level reactions
−
recognize equilibrium reactions
− recognize righting reactions
− recognize protective reactions
ix. Vestibular
−
Perform the Dix Hallpike assessment maneuver
−
Reposition for Benign Paroxysmal Positional Vertigo
(BPPV)
University of Manitoba - MPT: Neurological Clinical Skills Checklist
Revised February, 2017
G. Gait
Observed
Performed
Becoming
Confident
Confident
i. Assess and describe the following aspects of gait:
−
degree of independence
− use of aid
− distance
−
speed
−
quality of gait pattern (gait deviations seen in swing +
stance components)
− directions
− surfaces
−
distractions
−
other circumstances (e.g. crossing a busy street, carrying
objects, wind)
−
gait variations (e.g. climbing stairs, running, hopping,
skipping, jumping etc.)
ii. Describe standardized tests for measuring ambulation and
gait.
Treatment Skills
Observed
Performed
Becoming
Confident
i. Be prepared to utilize alternate communication strategies
with a non-verbal client
ii. Describe precautions and variations of positioning for
treatment of clients with increased ICP
iii. Apply motor learning principles to all treatment of activity
limitations
i.e. gait, reaching, sit to stand, transfers etc..
− Scheduling practice
o Practice vs. rest
o Variable practice
o Context effects (random vs. blocked)
− Type of Practice
o Whole vs. part
o Transfer tasks
o Mental practice
o Guidance
−
Feedback
o Knowledge of performance
o Knowledge of results
iv. Apply Facilitation Techniques safely and appropriately
− Icing
− Vibration
−
Tapping
− Quick stretch
− Weight bearing (joint compression)
−
Tonic labyrinthine inverted position
−
Special senses
University of Manitoba - MPT: Neurological Clinical Skills Checklist
Revised February, 2017
Treatment Skills
Observed
Performed
Becoming
Confident
− Physical cues
v. Apply Inhibitory Techniques safely and appropriately
−
Neutral warmth
− Maintained touch or pressure
− Slow stretch
−
Rocking, rolling
− Pressure over muscle insertion
−
Weight bearing (joint compression) of normal body
weight
− Prolonged use of ice
−
Vibration
vi. Measure a client for a basic transport wheelchair
vii. Be prepared to discuss need for orthotic (AFO etc.) with an
orthotist and /or physician
A. Interventions - Postural Control
Observed
Performed
i. In Sitting
−
Teach and assist client into neutral pelvic tilt (‘correct’
sitting posture)
o From behind, beside and in front of client
o With 1 person and 2 person assist
− Teach and assist client with lateral weight shift
o From beside and in front of client
−
Teach and assist client with scooting forward and
sideways
−
Impose movement to challenge client i.e. move arms,
head, trunk, step with foot etc..
o Change environment to challenge client i.e. height
of seat etc.
ii. Standing
o Impose movement to challenge client i.e. move
arms, step with foot etc.
o Change environment to challenge client i.e. reduce
base of support, stand on sponge etc.
iii. Walking
o Impose movement to challenge client i.e. walk in
different directions, change the width of the base,
carry object etc.
o Change environment to challenge client i.e walk on
different surfaces etc.
University of Manitoba - MPT: Neurological Clinical Skills Checklist
Revised February, 2017
B. Bed Mobility and Functional activities
Observed
Performed
Becoming
Confident
Confident
i. Utilize motor learning issues discussed above
ii. Teach & assist client to roll side to side with various
techniques
iii. Teach & assist client to sit up in bed (long sit)
iv. Teach & assist client to sit up to the side (both sides) with
various techniques
v. Teach & assist client to lie down from sitting (both sides) with
various techniques
vi. Teach & assist client to get up and down to the floor from
sitting and standing with various techniques
vii. Sit to stand
−
Teach and assist client to move from sit t<-> stand
− Change environment to challenge client
− Change amount of assistance given to client
C. Gait Re-education
Observed
Performed
Becoming
Confident
Confident
i. Demonstrate part task activities in sitting, squat, high sitting,
or standing as appropriate to the task (sometimes called gait
preparation / pre-gait activities) to assist the client in
maximizing gait strategies such as:
−
Postural support and stability
− Weight bearing
o Stepping forward
o Stepping up
−
Weight shift
− Stance
− swing
−
Incorporate motor learning principles (scheduling of
practice and type of practice) with part task
activities
ii. Demonstrate use of alternate aids for gait treatment
iii. Demonstrate the adaptation of gait to various tasks such as:
− stairs
−
opening door
−
carrying objects
− obstacle course
iv. Utilize motor learning strategies such as types of feedback
and / or guidance to assist client with gait pattern
−
Demonstrate and describe progression of guidance
in gait treatment
o E.g. ‘facilitation’ of whole task activity / gait
pattern
v. Demonstrate and describe progression of activities (stability
– mobility) in gait treatment
University of Manitoba - MPT: Neurological Clinical Skills Checklist
Revised February, 2017
D. Upper Extremity Re-education
Observed
Performed
Becoming
Confident
Confident
i. discriminate treatment of transport and manipulation
phases
ii. incorporate postural control activities appropriate for
upper limb dysfunction
iii. apply different techniques to stretch soft tissue structures
that contribute to hemiplegic shoulder pain
iv. select, apply and evaluate effectiveness of support systems
for the hemiplegic upper limb
• slings
• taping/strapping
• positioning devices to prevent subluxation/injury
for various positions (w/c, supine, sit, sidelying)
v. apply activities on a stable surface progressing to mobile
surfaces progressing to movements where the distal
segment move on a stable proximal base:
• static
• body moves on arm
• body and arm move together
• arm moves on body
vi. apply other therapeutic techniques taught/learned in
previous years
• electrical modalities (FES, TNS, Jobst, IFC…)
• progressive resisted exercise
• motor learning principles
E. Treatment Skills for Specific Conditions
Observed
Becoming
Confident
Confident
Parkinson’s Disease:
o techniques to decrease freezing and help initiate
movement
o techniques to decrease shuffling when walking
o techniques to improve posture
Spinal Cord Injury:
o lateral sliding board transfer techniques
o bed mobility including rolling, supine → long sitting
o floor transfer techniques
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Completed 11 May 2022

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