Initial Evaluation

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Initial Evaluation - December 20, 2001 10:24:00 PM

Ist

Posts: 2
Joined: December 20, 2001
From: Manila,Philippines
Status: offline

Hi guys,
i learn a lot things this semester but it looks like i have to practice more on doing initial evaluation, and i want to do it perfectly, would you guys help me

Post #: 1

Re: Initial Evaluation - December 21, 2001 4:58:00 AM

mcap

Posts: 652
Joined: February 8, 2000
Status: offline

There is no substitute for experience. I can only offer you basic, obvious advice. Try to work with good people, ask lots of questions, read, read, read and take good courses. Those should help....

good luck....

mcap

(in reply to Ist)

Post #: 2

Re: Initial Evaluation - December 21, 2001 1:07:00 PM

jma

Posts: 2414
Joined: August 24, 2000
From: NY
Status: offline

Hello,
I know exactly what you are going through. I felt the same way when I started and had to learn how to do evals. Its very different doing it than listening to the course through you professor. You have been taught the fundamentals and that is what you should start with.
At the minimum, depending on where you are doing your affiliation, you should refamiliarize yourself with the form they use for evaluations. You should know how to measure ROM for all extremities and trunk area as well knowing all the grades for MMT. You have these in the lectures or in the books you used. Carry a stethescope so you can practice taking blood pressure and learn how to calculate HR. Carry a goniometer with you at all times. Carry neuro hammer so you can test reflexes. Go over proprioception and kinesthesia for sensory information. Use the forms at your affiliation site to ask the important questions about previous medical and surgical surgeries. Other than these basic skills, the rest will come from your clinical instructor and what he/she wants in terms of an evaluation. Good luck

(in reply to Ist)

Post #: 3

Re: Initial Evaluation - December 21, 2001 3:16:00 PM

Andrew M. Ball MS MBA PT

Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline

Whoa, Whoa, Whoa,

Let's not make assumptions here. Not everyone in PT practices in outpatient ortho or neuro. In developmental pediatrics (say, 0-5 y.o.), for example, knowing how to use a goniometer, or how to conduct MMT, isn't nearly as important as knowing developmental milestones and movement compensations in later months resulting from poor development of specific muscle groups in earlier ones. Frankly, I find most ortho and neuro therapists ill prepared in this regard . . . and it's CRITICALLY important in terms of both areas of practice. Perhaps moreso than MMT or goniometrics.

My stethescope (and the need to conduct any kind of cardiopulmonary evaluation), though critical when doing acute care peds at Universtiy of Rochester a few years back, has been used MABYE 4 times in as many years.

SOOOOOO. What kinds of evaluations are you going to be expected to do???? Functional evaluations? Evaluations of pediatric neurodevelopment??? Gait Analysis??? Electrophysiologic Assessment??? Athletic Orthopedics????

Drew

[This message has been edited by Andrew M. Ball MS MBA PT (edited December 21, 2001).]

(in reply to Ist)

Post #: 4

Re: Initial Evaluation - December 21, 2001 4:09:00 PM

jma

Posts: 2414
Joined: August 24, 2000
From: NY
Status: offline

Good point Andrew,
I just finished my last rotation in an acute care setting and all that I mentioned above was what I used during my evaluations.
If you are going to acute care Ist, you may need some of the things I mentioned.

(in reply to Ist)

Post #: 5

Re: Initial Evaluation - January 12, 2002 8:53:00 PM

anurag_iph

Posts: 13
Joined: December 6, 2001
From: delhi,india
Status: offline

friends
initiaj evaluation is ,i feel the most important part of any therapy,more so for us...
vital is to observe a patientwhen he comes towards you,his gait(if walking),his posture,facial expressions can help you learn more about him than he may actually tell as he doesn't know at that time that he is under observation....
that initial half a minute is the crux if you are willing enough
one needs to have a very quick eye for relevant observations. i don't want that we should try to model ourselves on sherlock holmes but we do need to develop this ability.after all, wecan always get better.
as alrready mentioned ,the ability to listen
is vital.to make the patient feel that you care will make him feel more confident about you...
perhaps i'm going too much into the psycho aspect,but it atleast adds some icing to the cake..
so,happy diagnosis

------------------
anurag

(in reply to Ist)

Post #: 6

Re: Initial Evaluation - January 14, 2002 4:07:00 PM

PTupdate.com

Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline

As others have said, the eval is so very important. As a student, and new practitioner, don't hestitate to "over-evaluate". So what if you grabbed too much extraneous information, no harm done! Over time you will learn what questions to ask, what complaints to listen for, and before you know it, you will be telling the patient what their symptoms are before they have the chance to tell you! That quite often impresses them, and provides them with a sense of security that you have a clue what is happening! Nothing beats time and patients.

I remember when I first began practicing, and a fellow clinician taught me a different method for determining cervical mobility. No matter how I tried, I couldn't feel what I was supposed to feel. She told me to practice mobility on EVERY neck patient for the next six month, regardless if they even needed the mobility checked! In time, I developed such a keen awareness that is now second nature!

Good luck!

(in reply to Ist)

Post #: 7

Re: Initial Evaluation - January 14, 2002 6:28:00 PM

Sebastian Asselbergs

Posts: 1204
Joined: September 29, 1999
From: Barrie, Canada
Status: offline

sjbird5 - I agree 100% with your post.
ptupdate: I would like to suggest to "1st" to take your suggestions with a few extra pointers: always ask the patient if you can check their neck range of motion - we cannot "use them" without consent. And be careful about trying to impress patients with knowing their symptoms before they mention them - it creates the risk that you interrupt the flow of a history, or set yourself up looking a fool when wrong (and believe me, NO-ONE is perfect) and thus making a not-so great first impression.....
When I used to be a CI and an occasional lecturer, my biggest "push" was: In any eval, keep asking the patient - spend lots of time on the history and/or chart - and then let the history/chart guide your choice of tests. It usually will give you some idea of what tissues/structures may be involved - "what am I testing for".
You already know more than most people ever know of their body - time and work and practice and curiosity will only increase your knowledge and skill.
Enjoy!
BTW, you'll NEVER be perfect.....
sebastian (50 years old and still learnin')

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Post #: 8

Re: Initial Evaluation - January 21, 2002 6:41:00 PM

JSSSH

Posts: 45
Joined: September 10, 2000
From: Kingston, Ontario, Canada
Status: offline

Wow! These are all very good pointers for a PT student like me.

I have the same problem on evaluation when I went on my 1st clnical placement last July. A few patients presented with symptoms (calf pain) that I couldn't figure out what's wrong after exhausting all the special tests I know.

My CI told me to give them a "common diagnosis" and modify Rx in a trial-and-error method.

What is your advice?

(in reply to Ist)

Post #: 9

Re: Initial Evaluation - January 22, 2002 3:02:00 AM

Sebastian Asselbergs

Posts: 1204
Joined: September 29, 1999
From: Barrie, Canada
Status: offline

To be blunt: I do not agree with your CI. I would expect from my students that they ask for real help, i.e. the CI taking a look at the patient. This is common in any mentor/student relationship and if you have exhausted your kniwledge, you (and the dept or clinic you are in) owe it to the patient to get the expertise of the CI as well. Will this affect the relationship between you and the patient?
Probably. Some will respect you more for being professional enough to NOT let ego and pride and image stand in the way. Some may not like it. It helps if, when addressing a patient for the first time, you make it clear that there might be an instance that you will get advice "in their best interest". This will help set the stage.

Hope this is of help.
Sebastian

(in reply to Ist)

Post #: 10

Re: Initial Evaluation - January 23, 2002 5:49:00 PM

PTupdate.com

Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline

Dear JSSSH,
Perhaps your CI told you to give a "general diagnosis" because he/she can't figure out what is wrong [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG] Why don't you present your findings with this patient here, and let some of us help you out!
Duffy

(in reply to Ist)

Post #: 11

Re: Initial Evaluation - January 29, 2002 5:21:00 PM

JSSSH

Posts: 45
Joined: September 10, 2000
From: Kingston, Ontario, Canada
Status: offline

1. I think my CI taught me a lot and honestly, I can't expect her to have answers to every case. =)

I am more concerned to know what the real PTs out there will do if you don't know what is wrong with the patient? What do you tell the patient in the first session? How are you going to prescibe Rx or home ex?

2. Thanks for helping me to solve this "misery". Note: I don't remember all details about that patient now.

The patient is a ?40 yo woman who complained of bilat calf pain / soreness which is worst in the evening. She somtimes felt numbness after sitting for a long time. She is a homeworker and does not participate in rigorous sports activities. (In retrospect, I could have asked her if she went on a hiking trip recently but I think she had those symptoms for a while and she finally seek help as it got worst)

I think I did Thompson test for Achilles tendon rupture, Homan's sign for DVT and probably tested gastroc /soleus length and hamstring length. They were all insignificant, I think. Toe standing might be ?limited by pain or ?normal.

I know for sure she can feel hot and cold (quite sensitive to hot) and likely has normal patella and Archilles reflex.

I don't know any common calf pain disorder and thus don't know what to do! (it's not like I can say OA knee!).

Rx: tried ?US, IFC and finally SWD.
Home ex: probably ankle pumping if prolonged sitting, toe standing, might be some stretching

Thanks!

(in reply to Ist)

Post #: 12

Re: Initial Evaluation - February 12, 2002 4:30:00 PM

Jacob Barr

Posts: 4
Joined: February 10, 2002
Status: offline

A few things I find essential for initial evaluations:

- "Observe dear physician (therapist), the
patient is showing you the cure"

- Listen, Listen, Listen....we have TWO EARS
and ONE MOUTH for a reason!!!

- Do not feel the need to perform a treatment
on the first visit

(in reply to Ist)

Post #: 13