Topic One- Assessment

SITUATION
A 62 year old man was admitted to SCGH with prostate cancer, that on review with an MRI showed that it had metastasized into spinal bony mets. He was scheduled for a T3-T5 laminectomy, and even though the surgery was successful, the bony mets had already impinged to much on the spinal cord, leaving him with severe weakness in his lower limbs, confining him to a wheelchair. He was previously a laborer, but know lives down south and is a maintenance worker at the caravan park, which he lives at. His caravan has 2 front steps with a rail, however, if his power in his legs does not return after being at shenton park rehab facility, living at the caravan poses some difficulties, however he has family living in perth that he could stay with as a last resort. This man was very motivated to participate in physio sessions, as he wants very much to return to the caravan park, and back to his original daily life routine.

TASK
The objective assessment of this man, needs to be done on a regular basis and we need to make sure his spinal condition doesnt become worse/ the symptoms start to ascend, therefore the assessment needs to also be very thourough. I had to test his sensation (light touch, 2 point discrimination, proprioception), power, tone and balance.

ACTION
I began my objective assessment of this man by giving a brief example of why it is important to do a thorough assessment, so we could baseline any deficits to make sure his neuro conditions don't worsen. I start with him supine on the plinth and went through to assess his muscle strength, checking all of his lower limbs muscles groups. I then tested the tone of his lower limbs then got him up into sitting for balance assessment, including static then dynamic balance. This was all done in the physio gym, however my observations started back in his room when he showed us his ability to independently get from supine to sitting then independently slide board transferred from his bed to his wheelchair. I them observed his upper limb strength when he was able to propel himself and manoeuvre his wheelchair from his room to the physio gym.

RESULT
From my assessment, I found that the man had severe weakening of his lower limb muscles, with all muscle groups scoring ~ 2 (R) and ~1 (L). His static sitting balance was fine, however he WB mainly on his L side, therefore lost balance easily when reaching to the left. He was overactive in his shoulder girdles during external perturbations, showing minimal use of his core muscles to stabilize him.

EVALUATION
I think the process of my assessment could have been more smooth, and therefore have been more time efficient and i might have then had the time to be able to assess his sensation. During the assessment of his muscle strength i should have done all the assessments for each muscle in supine, and then in sidelying for antigravity positioning, instead of going through the muscle groups and make him switch positions, as that would have possibly fatigued him and affected his strength scores. However i did make sure i did everything i need to do lying down before i got him up into sitting to test his balance. I think i could also work on my hand placement, especially when handling heavy lower limbs like my patients. I did fumble around a bit till i did get the right position for me, and this also would have wasted assessment time. I do however think i did the tests correctly and got accurate results.

STRATEGIES
I think for future assessments, I need to have a clear outline in my head of what needs to be done and in what order that would be the most time efficient for a thorough assessment. I think this will also come with more practice of the techniques and proper handling that works for me.