Neuro Notes Clin(BookFi.org)

Neuro Notes Clinical Pocket Guide Claudia B. Fenderson, PT, EdD, PCS Wen K. Ling, PT, PhD Purchase additional copies of this book at your health science bookstore or directly from F.A. Davis by shopping online at www.fadavis.com or by calling 800-323-3555 (US) or 800-665-1148 (CAN) A Davis Note’s Book F.A. Davis Company • Philadelphia

F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2009 by F. A. Davis Company All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechani- cal, photocopying, recording, or otherwise, without written permission from the publisher. Printed in China Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Margaret Biblis Developmental Editor: Yvonne Gillam Manager of Content Development: George Lang Art and Design Manager: Carolyn O’Brien Reviewers: Carol Ann Davidson, PT, DSc, NCS; Judith A. Dewane, MHS, PT, NCS; Richard DiFabio, BS, MS, PhD, PT; Cindy Flom-Meland, PT, PhD, NCS; Kathleen M. Gill-Body, DPT, MS, NCS; Kimberly B. Harbst, PT, PhD; Liane Hewitt, OTR/L; Erin E. Hussey, PT, DPT, MS; M. Kathleen Kelly, PhD, PT; Gary Krasilovsky, PT, PhD; Jeffrey Krug, PT; Hélène Larin, PhD; Jennifer A. Mai, PT, DPT, MS; Marsha Neville-Smith, MS, OTR; Sean C. Newton, PT, PhD; Myles Quiben, DPT, PT, GCS, NCS; Joellen Roller, PT, EdD, DPT; Summer San Lucas, DPT; Don Straube, PT, MS, NCS; Linda J. Tsoumas, PT, EdD; Elizabeth Lawrence Weiss, PhD, PT; Karen Wingert, PT, DPT, RN As new scientific information becomes available through basic and clinical research, recom- mended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regard- ing dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. ISBN 10: 0-8036-1747-X ISBN 13: 978-0-8036-1747-6 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1746-X 09 ϩ $.25. Intro, PT Exam, Peds, CNS-NP, and Poly-PNS Tabs by Claudia B. Fenderson Intro, PT Exam, CNS-P, PNS Injury, and SCI Tabs by Wen K. Ling

Place 27⁄8 ϫ 27⁄8 Sticky Notes here for a convenient and refillable note HIPAA Compliant OSHA Compliant Waterproof and Reusable Wipe-Free Pages Write directly onto any page of Neuro Notes with a ballpoint pen. Wipe old entries off with an alcohol pad and reuse. INTRO PT EXAM PEDS CNS-NP CNS-P PNS POLY-PNS SCI INJURY

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Preface This book is written for physical therapists, physical therapy students, and related health professionals. It is a clinical guide for the assessment of patients with neuromuscular disorders. Please use the tables in the INTRO tab to quickly find information on specific diseases/disorders or test and measures. In addition to the content you’ll find here, we have also provided bonus content on the DavisPlus Web site for this book. On the Web site you will find content regarding neurological diagnostic tests and additional infor- mation about diseases and disorders, including special tests, additional assessments, differential diagnosis, prognosis, surgery, and referrals to other health-care providers. There is also a glossary of neurological terms commonly used by PTs. Please visit http://davisplus.fadavis.com to review the bonus material. Claudia B. Fenderson Wen K. Ling

1 Directory of Diagnoses and Tests and Measures ICD-9-CM CODES ICD Code Page 357.0 287 Disease/Disorder 357.5 287 Acute infective polyneuritis 331.0 194 Alcoholic neuropathy 335.20 199 Alzheimer’s disease 442 156 Amyotrophic lateral sclerosis 444 156 Aneurysm 337.3 304 Arterial embolism and thrombosis 351.0 255 Autonomic dysreflexia 353.0 129 Bell’s palsy 354.0 267 Brachial plexus lesions 386.2 151 Carpal tunnel syndrome 334.2 215 Central vestibular dysfunction 343 93 Cerebellar degeneration 427 156 Cerebral palsy 850 173 Cerebrovascular accident 315.4 104 Concussion 357.2 287 Developmental coordination disorder 765 126 Diabetic neuropathy Disorders related to short gestation and 345 111 unspecified low birth weight 345.1 Epilepsy 345.2 Generalized convulsive epilepsy 345.3 Epileptic absence status (Petit mal status) 345.4 Tonic-Clonic (Grand mal status) Partial epilepsy, with impairment of consciousness Continued INTRO

INTRO ICD-9-CM CODES—Cont’d Disease/Disorder ICD Code Page Partial epilepsy, without mention of 345.5 impairment of consciousness 345.9 130 Epilepsy, unspecified 353.0 255 Erb’s palsy 351 303 Facial nerve disorders 806 295 Fracture of vertebral column with spinal cord injury 357.0 118 Guillain-Barré syndrome 359.1 219, Hereditary progressive muscular dystrophy 042 257 Human immunodeficiency virus (HIV) 225 333.4 115 Huntington’s disease 742.3 93 Hydrocephalus—congenital 343 173 Infantile cerebral palsy 854 Intracranial injury of other and unspecified nature 768 125 Intrauterine hypoxia and birth asphyxia 354.2 273 Lesion of ulnar nerve 354.3 271 Lesion of radial nerve 355.2 199 Lou Gehrig’s disease 088.81 230 Lyme disease 386.0 281 Meniere’s disease 354 Mononeuritis of upper limb and mononeuritis 267 multiplex 354.0 271 Carpal tunnel syndrome 354.3 273 Radial nerve lesion 354.2 235 Ulnar nerve lesion 340 118 Multiple sclerosis 359.1 Muscular dystrophy 359.0 Congenital hereditary muscular dystrophy 359.1 Hereditary progressive muscular dystrophy 2

3 ICD-9-CM CODES—Cont’d Disease/Disorder ICD Code Page 357 287 Polyneuropathy in other diseases 173 191.0 Neoplasm 191.1 208 Cerebrum 191.3 Frontal lobe 191.2 Parietal lobe 191.4 Temporal lobe 191.6 Occipital lobe 225 Cerebellum 225.1 303 Neoplasm of brain and other parts of nervous 225.3 ??? system, benign Cranial nerves 344.2 243 Spinal cord 344.1 287 344.00 287 Other specified paralytic syndromes 344.01 287 Paraplegia 344.02 271 Quadriplegia, quadriparesis 344.03 135 C1–C4 complete C1–C4 incomplete 332 C5–C7 complete 357.2 Parkinson’s disease 357.6 Polyneuropathy in diabetes 357.7 Polyneuropathy due to drugs 354.3 Polyneuropathy due to other toxic agents 330.8 Radial nerve lesion 724.3 263 Rett syndrome (under other specified cerebral 722.10 degenerations in childhood) 722.10 139 140 Sciatica (infectional) 995.55 Due to displacement of intervertebral disc Herniation, nucleus pulposus 741 Shaken baby syndrome Spina bifida Continued INTRO

INTRO ICD-9-CM CODES—Cont’d Disease/Disorder ICD Code Page 952 303 Spinal cord injury without evidence of spinal bone injury 952.0 173 Cervical 952.1 Dorsal (thoracic) 952.2 Lumbar 852 Subarachnoid, subdural and extradural hemorrhage following injury 853 Other and unspecified intracranial hemorrhage following injury 852 173 350.1 284 Traumatic brain injury 354.2 273 386.0 281 Trigeminal neuralgia 386.1 151 Ulnar nerve lesion 386.2 386.3 Vertiginous syndromes and other disorders of vestibular system Ménie`re’s disease Other and unspecified peripheral vertigo Vertigo of central origin Tests and Measures Functions Tool(s) Page Aerobic Capacity Borg’s Rating of Perceived Exertion 15 and Endurance 15 Energy Expenditure Index Anthropometric 16 Characteristics Body Mass Index 17–18 Arousal, Attention, Growth charts Cognition, and Glasgow Coma Scale 18 Communication GOAT or Post Traumatic Amnesia Scale 182 184 Pediatric Glasgow Coma Scale 185–192 Rancho Los Amigos Levels of Cognitive 19 Mini Mental State Exam 4

5 Tests and Measures—Cont’d Functions Tool(s) Page DavisPlus Assistive and Wheelchair Checklist Adaptive Devices 22 Circulation (Arterial, Edema Rating Scale 22–23 Venous, and Lymphatic) 34 Cranial and Cranial Nerve Assessment 41 Peripheral Nerve 44 Integrity 39 Environmental, Environmental Recommendations 48 Home, and Work (job/school/play) 40 Barriers 39 53 Gait, Locomotion, Berg Balance Scale 38 and Balance Clinical Test for Sensory Interaction in Balance 38 Functional Reach Test 38 Modified Clinical Test for Sensory 44 Interaction in Balance (M-CTSIB) 59 Multidirectional Reach Test 60 One-legged Stance Test 48 Pediatric Balance Scale 60 64 Performance Oriented Mobility Assessment Continued Romberg Test Tandem (Sharpened) Romberg Test Timed Get Up and Go Test Tinetti’s Falls Efficacy Scale Gait, Locomotion, 4-Item Dynamic Gait Index and Balance Performance Oriented Mobility Assessment Timed Walking Tests Integumentary Classification of Pressure Sores Integrity INTRO

INTRO Tests and Measures—Cont’d Functions Tool(s) Page 68 Motor Function and Rivermead Mobility Index Coordination (Motor 311 Control and Motor Learning) Muscle Performance Clinically Relevant Myotomes (Strength, Power, and Endurance) Neuromotor APGAR scores DavisPlus Normal Growth and Development 70 Development and Sensory Integration Pain FLACC (Face, legs, activity, 78 Reflex Integrity cry, consolability) Scale 76 Ransford Pain Drawings 77 Universal Pain Assessment Tool 81 82 Grading Reflexes 83–86 Modified Ashworth Scale of Spasticity Primitive Reflexes and Reactions Self-Care and Bowel and Bladder Control Checklist 87 91 Home Management Katz Index of Independence in Activities 90 of Daily Living 91 Ventilation, Medical Research Council Dyspnea Scale Respiration, and Gas Exchange Work, Community, Environmental Checklist and Leisure Katz Index of Activities of Daily Living Integration or Reintegration 6

7 Tests and Measures—Cont’d Functions Tool(s) Page Disease Specific Eng’s System of Classification 135 Tests and Measures of Recovery of Brachial Plexus Palsy 108 102 Gubbay Test of Motor Proficiency 146 Milani-Comparetti Motor Development Screening Test 124 Segmental Nerve Supply of Lumbar 168–173 and Sacral Nerve Roots (for Spina Bifida) DavisPlus 205–208 Vignos Functional Rating Scale for Duchenne Muscular Dystrophy 279 DavisPlus Motor Assessment Scale for Stroke DavisPlus Postural Assessment Scale for Stroke 250–252 Amyotrophic Lateral Sclerosis Functional DavisPlus Rating Scale-Revised 293 Dizziness Handicap Inventory Kurtzke Expanded Disability Status Scale (for patients with MS) Expanded Disability Status Scale (EDSS) Movement Disorder Society—Sponsored Revision of Unified Parkinson’s Disease Rating Scale (MDS-UPRDS) Version International Standards for Neurological Classification of Spinal Cord Injury Subjective Peripheral Neuropathy Screen INTRO

INTRO Physical Therapy Examination for Patients with Neuromuscular Disorders Sensory Function Neuroanatomy and Pathology Pathways Sensations Symptoms Posterior (dorsal) Deep touch, 2-point Ipsilateral loss columns discrimination, vibration, joint position Contralateral loss Lateral spino-thalamic Pain & temperature Contralateral loss tract Anterior spino-thalamic Nondiscriminative touch tract Posterior (dorsal) column Lateral SL Lateral corticospinal Th C spinothalamic tract tract S CL L Th C Th S Rubrospinal tract Vestibulospinal Ventral Anterior tract corticospinal spinothalamic tract tract S: Sacral L: Lumbar TH: Thoracic C: Cervical 8

9 Motor Function Neuroanatomy and Pathology Pathways Functions Symptoms Lateral corticospinal Contralateral limb Spasticity, Babinski’s sign, tract voluntary movement synergistic movement Ventral corticospinal Ipsilateral limb Spasticity, Babinski’s sign, tract voluntary movement synergistic movement Rubrospinal tract Muscle tone of flexors Spasticity Vestibulospinal tract Ipsilateral upright Impaired posture & posture & anti-gravity balance musculature Autonomic Nervous System Functions Organ and System Sympathetic Nervous Parasympathetic Pupils System Nervous System Saliva & tear glands Constricts Dilates Stimulates salivation Bronchi (airways) & tearing Blood vessels Inhibits salivation Constricts Heart & tearing Gastrointestinal Slows heartbeat system Relaxes Stimulates digestion (increases peristalsis Adrenal medulla Constricts & dilates intestinal blood vessels) Urinary bladder Accelerates heartbeat Contracts Inhibits digestion (slows peristalsis & decreases digestive enzyme secretion) Stimulates epinephrine & norepinephrine secretion Relaxes Medical Red Flags Red Flags indicate medical emergency situations. If the following signs or symptoms are demonstrated, terminate examination and intervention; then immediately call for medical assistance. PT EXAM

PT EXAM ■ Abnormal breath or heart sounds ■ Blood pressure (systolic blood pressure Ͼ200 mm Hg or Ͻ90 mm Hg; diastolic blood pressure Ͼ110 mm Hg) ■ Chest pain caused by exertion ■ Clonus onset ■ Cyanosis ■ Diaphoresis (excessive sweating) ■ Drastic mental status changes (sudden disorientation, confusion, drowsiness, lethargy) ■ Drastic mood changes (anxiety, apprehension) ■ Myasthenia crisis: muscle weakness interfering with vital functions (e.g., breathing, swallowing) ■ Nausea & vomiting in patients with shunts ■ Oxygen saturation Ͻ90% ■ Seizure (lasting more than 5 minutes; two or more sequential seizures without recovery of consciousness) ■ Sudden: ■ Ataxia onset ■ Blood pressure changes (increase or decrease) ■ Coordination changes ■ Muscle tone changes (increase or decrease) ■ Pulse changes (regular to irregular; dropping by Ͼ15 bpm; exceed- ing 75% of age-expected maximum) ■ Severe headache ■ Weakness, hemiparesis or paralysis ■ Syncope ■ Transient paralysis ■ Vision or speech distortion (slurred or hoarse voice) Instruments Used for a Neuromuscular Examination ■ Blood pressure cuff ■ Frenzel lenses ■ Circular disk (two point ■ Monofilament test kit ■ Cotton swab or a cotton ball to discrimination) ■ Extracts (vanilla & lemon) to test test light touch ■ Reflex hammer (with a small brush olfactory nerve ■ Flashlight and sharp/dull metal component) 10

■ Stereognosis testing materials 11 (penny, key, paper clip, & a small brown bag) ■ Tape measure ■ Tongue depressor ■ Stethoscope ■ Tuning fork (512 Hz) ■ Universal goniometer Physical Therapy Examination History: Date of birth: Age: Gender: M F Marital status: M S D W Race: Native Caucasian African Hispanic Asian Other American American Primary language: Highest level of education Employment/school: Chief complaint: Date of onset: Handedness: Right Left Family support/living arrangements Medications: Herbal supplements: Previous hospitalizations: Previous surgery: Developmental history Do you smoke? If yes, how often? Do you drink alcohol? If yes, how often? Do you use illegal drugs? If yes, what drugs & how often? Do you use illegal IV drugs? If yes, what drugs & how often? PT EXAM

PT EXAM Consideration: When discussing prenatal history of child, ask ques- tions sensitively to avoid having parents feel that they are at fault for their child’s problems. Medical Screening Have you ever experienced or been told that you have any of the following? Y/N Y/N Asthma Chronic bronchitis Emphysema Shortness of breath Chest pain High blood pressure Heart disease Blood clot Stroke Head injury/concussion Dizziness Fainting Epilepsy/seizures Migraine/other headaches Arthritis Osteoporosis Gout Cancer Diabetes Visual loss Ear infections Hearing loss Allergies Chemical dependency AIDS/HIV Depression Kidney disease Urinary tract infection Hepatitis/jaundice Thyroid problems Bowel/bladder problem Blood disorder Anemia Pregnancy Fibromyalgia Other: describe 12

13 Results Medical Tests Have you had any of the following? Test Yes/No Radiograph CT Scan MRI PET SPECT Ultrasound Bone Scan Blood tests Biopsy EMG or NCV ECG/stress test Other (list) Vital Signs Should be taken: ■ Initially on all patients for baseline ■ For all sessions for patients who are medically unstable or have risk factors for cardiopulmonary complications ■ To assess response to intervention Temperature Rate Pulse Rhythm Quality Respiratory rate Blood pressure PT EXAM

PT EXAM Normal body temp is 98.6°F Ϯ 1° or 37°C Ϯ 1.5° Older adults’ body temp may be lower (96.5-97.5°F). Age Pulse Respiratory Systolic Diastolic (beats/min) Rate Blood Pressure Blood Pressure Preterm 120–160 30–60 32–52 13–29 Newborn 100–160 30–60 50–70 29–45 3 months 100–160 30–60 65–105 34–68 6 months 110–160 24–38 70–118 50–70 1 year 22–30 66–126 41–91 3 years 90–150 22–30 74–124 39–89 5 years 80–125 20–24 79–119 45–85 10 years 70–115 16–22 92–132 53–83 14 years 60–100 14–20 100–140 60–90 Adults 60–100 12–20 95–119 60–79 Older adults 60–90 15–22 90–140 60–90 Findings 60–90 Source: Available at: http://www.emedicinehealth.com/pediatric_vital_signs/article_em.htm. Accessed January 16, 2007. Tests and Measures Aerobic Capacity/Endurance ■ Assess blood pressure (BP), respiratory rate (RR), & heart rate (HR) (wrist, carotid, and/or pedal) in supine, sitting, & standing, at rest & during & after exercise ■ If available, review pulse oximetry, blood gas, tidal volume, & vital capacity ■ Administer a 2- or 6-minute walk test ■ Administer Borg Rating of Perceived Exertion after walk test or other physical activity 14

15 The Borg Rating of Perceived Exertion Instruct the patient to rate their perception of exertion while performing exercise by combining all sensations and feelings of physical stress, effort and fatigue. Explain that the scale ranges from 6 to 20, where 6 means “no exertion at all” and 20 means “maximal exertion.” Image rights not available. PT EXAM

PT EXAM Energy Expenditure Index Walking heart rate Resting heart rate Walking speed Energy expenditure index (beats/meter) (Walking HR Ϫ Resting HR Ϭ Walking speed) Source: Rose J, et al. The energy expenditure index: A method to quantitate and compare walking energy expenditure for children and adolescents. J Ped Orthopedics. 1991;1(5):571–578. Calculated as the walking heart rate minus the resting heart rate divided by the walking speed to cover 55 meters; recorded as beats per meter. Anthropometric Characteristics Assessment ■ Record weight, height, & body mass index (BMI) ■ Underweight Յ18.5 ■ Normal 18.5–24.9 ■ Overweight 25–29.9 ■ Obese Ն30 Source: Available at: http://www.nhlbisupport.com/bmi/bmicalc.htm. Accessed November 27, 2007. Weight (kg) Height (m) BMI (kg/m2) (2.2 lbs ϭ 1 kg) (1 in. ϭ 0.025 m) (weight/height2) ■ Measure body dimensions (girth measurements, head circumference, leg length, arm length, & torso length) ■ For children’s normal weight, height, & head circumference, see following graphs: 16

17 NAME RECORD # Birth to 36 months—Boys Birth to 36 months: Boys Head circumference-for-age and Weight-for-length percentiles Birth 3 6 9 12 15 18 21 24 27 30 33 36 H in cm AGE (MONTHS) cm in H E A 52 97 52 E D 20 90 A 50 75 20 D 50 50 C C I 19 25 48 19 I 48 R 46 10 R 44 3 C 18 42 46 18 C U 40 U 38 M 44 M F F 17 17 E E 42 R R E 16 E N 50 N 22 48 C C E 15 21 46 E 20 44 14 36 97 19 42 34 18 40 90 13 75 17 38 32 16 36 50 12 34 30 25 15 32 10 14 30 W 24 11 22 10 3 20 9 13 E 12 28 I 11 26 G 24 H 10 22 T 9 20 18 8 8 18 16 W 16 7 7 14 E 14 6 12 I 12 5 6 G 10 4 lb H8 3 5 T6 2 LENGTH kg 4 1 kg 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98100 cm 2 lb 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 in Date Age Weight Length Head Circ. Comment cm 46 48 50 52 54 56 58 60 62 in 18 19 20 21 22 23 24 Source: Available at: http://www.cdc.gov/nchs/data/nhanes/growthcharts/set1clinical/ cj41c017.pdf. Accessed October 1, 2007. PT EXAM

PT EXAM Birth to 36 months—Girls Birth to 36 months: Girls NAME Head circumference-for-age and RECORD # Weight-for-length percentiles Birth 3 6 9 12 15 18 21 24 27 30 33 36 H in cm AGE (MONTHS) cm in H E A 52 52 E D 20 50 97 48 A 50 90 20 D 75 C C I 19 50 19 I 48 R 46 25 R 44 10 C 18 42 3 46 18 C U 40 U 38 M 44 M 17 F F 17 E E 42 R R E 16 E N 50 N 22 48 C C E 15 21 46 E 20 44 14 36 97 19 42 40 34 90 18 38 13 36 75 17 34 32 32 50 16 30 W 12 25 30 15 E 28 I 10 14 26 G 3 24 H 13 22 T 20 12 18 16 24 11 11 14 10 12 22 10 9 lb 20 8 9 18 7 8 W 16 6 E 14 5 7 I 12 4 G 10 3 6 H8 2 T6 1 LENGTH 5 kg kg 4 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98100 cm 2 lb 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 in Date Age Weight Length Head Circ. Comment cm 46 48 50 52 54 56 58 60 62 in 18 19 20 21 22 23 24 Source: Available at: http://www.cdc.gov/nchs/data/nhanes/growthcharts/set2clinical/ cj41c070.pdf. Accessed October 1, 2007. 18

19 Arousal, Attention, and Cognition: Assessment ■ Administer: ■ Glasgow Coma Scale: (refer to Tab 4) ■ Galveston Orientation and Amnesia Test (GOAT): (refer to Tab 4) ■ Rancho Los Amigos Levels of Cognitive Function—Revised: (refer to Tab 4) ■ Mini-Mental State Examination (MMSE): to assess cognition, mental status, & orientation (30 point max; anything Ͼ24 is normal) MMSE Sample Items Orientation to Time “What is the date?” Registration “Listen carefully. I am going to say three words. You say them back after I stop. Ready? Here they are . . . APPLE (pause), PENNY (pause), TABLE (pause). Now repeat those words back to me.” (Repeat up to 5 times, but score only the first trial.) Naming “What is this?” (Point to a pencil or pen.) Reading “Please read this and do what it says.” (Show examinee the words on the stimulus form.) CLOSE YOUR EYES Source: Reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc., 16204 North Florida Avenue, Lutz, Florida 33549, from the Mini Mental State Examination, by Marshal Folstein and Susan Folstein, Copyright 1975, 1998, 2001 by Mini Mental LLC, Inc. Published 2001 by Psychological Assessment Resources, Inc. Further repro- duction is prohibited without permission of PAR Inc. The MMSE can be purchased from PAR, Inc. by calling (813) 968-3003. PT EXAM

PT EXAM Assess ■ Communication ■ Determine primary language ■ Ask patient to point to named objects (door or window) in the vicinity to assess receptive language ■ Ask patient to state name, address, & occupation to assess expres- sive language ■ Orientation to time, place, & person ■ Recall ability including: ■ Short-term memory: ask patient to repeat three unrelated words & recite them a couple of minutes later ■ Long-term memory: ask patient to name three former U.S. presidents (consider other option for patients who are foreign born) ■ Ability to calculate: ask patient to add, multiply, & subtract a few numbers Pediatric Arousal, Attention, Cognition, and Communication Also see the Neuromotor Development and Sensory Integration sec- tion later in this Tab ■ Pediatric Glasgow Coma Scale (Refer to Tab 4) Assistive and Adaptive Devices ■ Determine the need for assistive or adaptive devices & equipment for functional activities ■ Assess components, alignment, fit, & ability to care for assistive or adaptive devices & equipment ■ Assess safety during use of assistive or adaptive devices & equipment ■ Assess wheelchair mobility skills: ■ Propulsion on level surfaces & ramps ■ Opening doors ■ Completing a wheelie (if appropriate) ■ Negotiating curbs ■ Administer the Pediatric Evaluation of Disability Inventory (avail- able at: http://harcourtassessment.com/pedi) 20

21 Circulation (Arterial, Venous, and Lymphatic) (“Circulation” in subsequent Tabs) Assessment Assess vital signs: ■ Initially for baseline (all patients) ■ In all sessions involving patients who are medically unstable or who have cardiopulmonary risk factors ■ To assess the response to intervention Depending on severity of patient’s condition, consider assessing: ■ BP in supine, sitting, & standing ■ HR, rhythm & sounds in supine, sitting, & standing (wrist, pedal, or carotid) ■ BP & HR at rest & during & after activities ■ Perceived exertion rate after activity (see Borg Rating of Perceived Exertion under Aerobic Capacity/Endurance) ■ Pulse oximetry ■ Edema via upper & lower limb girth measurements in supine, sitting, & standing PT EXAM

PT EXAM Edema Rating Scale Score Descriptor(s) Findings 1ϩ Mild pitting, slight indentation, barely perceptible 2ϩ swelling 3ϩ Moderate pitting with indentation of less than 5 mm that subsides rapidly 4ϩ Deep pitting, indentation of 5 to 10 mm that remains for a short while; extremity is visibly swollen Very deep pitting, indentation of more than 10 mm that lasts for a long time; extremity appears very swollen Cranial and Peripheral Nerve Integrity Cranial Nerves ■ Assess motor and sensory components of cranial nerves I Olfactory Nerve Function: Sense of smell Test: Test one nostril at a time (close off the other nostril) Test: Use two bottles of artificial extract (e.g., vanilla & lemon); ask patient to sniff & identify the scents 22