CONTRIBUTORS

PUAN MISNAH BT ROSLAM, HOSP. SERDANG

PUAN CHUA SIEW KUAN, HTAR
PUAN K. MUTHU LETCHUMI, HTAR
PUAN SUKMAWATI BT IBRAHIM SHUKRI, HKL
BEST STATEMENT OF STROKE ASSESSMENT
BEST STATEMENT OF STROKE ASSESSMENT
DATA STATEMENT KNOWLEDGE SKILL
Doctors Diagosis CVA with Rt
Hemiperesis
Lt Hemiplegia
Ischeamic Infarction
Subarachnoid
Haemorrhage
Intracerebral
Haemorrhage
Cerebral Infarction
Ischaemic Stroke
Cerebral Thrombosis
Cerebral
Haemorrhage.
nderstanding the
anatom! and
ph!siolog! of the
brain
nderstand the
pathoph!siolog!ical
mechanism of stroke
Able to retrie"e
information from
patient medical record
Doctors !aag"!"t Conser"ati"e #
on medication for
stabili$ation
%. nderstand the doctor&s
management on the
condition
%. Able to e"aluate
current status of the
patient
Able to take
precaution
accordingl!
2
BEST STATEMENT OF STROKE ASSESSMENT
DATA STATEMENT KNOWLEDGE SKILL
Pro#$"!s 'atient c(o sudden
feeling of cold and
giddiness with
weakness of Rt arm
and Rt leg.
'atient c(o inabilit! to
mo"e right upper limb
and lower limb.
'atient c(o inabilit! to
get up of bed.
nable to dress up
independentl!.
Lack of bowel and
bladder control
)rite remarks if not
applicable
e.g.* patient in coma(
unreliable +drows!,
nderstanding
functional
anatom! and
ph!siolog! of the
brain and
correlate it with
the patient&s
complaint.
Able to
communicate
effecti"el! with the
patient or carer to
gather the
information.
Able to
understand the
patient&s
problems.
S%"cia$ &'"stio
-eneral condition(health
'atient looks ill and
emotionall!
depressed.
'atient is comatosed*
nderstanding the
patient&s status*
presentation and
clinical features in
Abilit! to ha"e
listening and
reasoning skill
3
BEST STATEMENT OF STROKE ASSESSMENT
'atient is on
"entimask and
uncooperati"e.
relation to the
condition.
DATA STATEMENT KNOWLEDGE SKILL
S%"cia$ &'"stio
'.H/ (Surger!
I/ ( .RI ( /0ra!
.edication ( Steroid
'atient is a known case of
1. and on follow0up in
pri"ate clinic.
'atient is a h!pertensi"e
case for 2 !ears and on
medication.
State3
date of onset*
date and t!pe of
surger! *
medication started
Intracranial bleeding
Intracranial atherosclorosis.
1ate of CT scan ( .RI ( I/
and their findings
Anti0h!pertensi"e drug eg3
atenolol
nderstand the patho0
ph!siological changes
of the condition.
Abilit! to read and
understand CT scan (
.RI ( I/ report s.
nderstand the
effects of medication
in relation to
treatment
Able to obser"e the
patient&s clinical
presentation.
Able to relate the
information gathered to
the patient&s problem.
Able to retrie"e
information from patient
medical
record
Able to identif! the
name of medication
prescribed.
Able to take
precaution
accordingl! eg3
4
BEST STATEMENT OF STROKE ASSESSMENT
1iabetic 1rug eg 3
.etmofine
Anti0Coogulant drug
eg3Ticlid
atenolol # causing
di$$iness +side
effects,
DATA STATEMENT KNOWLEDGE SKILL
S%"cia$ &'"stios3
Home ( social Situation
T!pe of house
're0current episode
Current status
4ccupation 3

'atient sta!s with his wife in a
single store! terrace house.
'atient sta!s alone in a 5lat at
fourth floor.
'atient is home carer
independent ( home carer
dependent ( home alone (
institution.
'atient is home carer
independent ( home carer
dependent ( home alone (
institution.
'atient work as a clerk in a
bank for %6 !ears.
'atient was a construction
worker and doing lifting hea"!
metal rods weighted about 760
86 kgs.
nderstand the home
situation where the
patient li"e in.
nderstanding the
famil! support s!stem
towards patient.
nderstand nature of
work
nderstand le"el of
patient&s A1L
Abilit! to anal!se the
possible difficulties
faced b! patient
Able to pro"ide
appropriate ad"ise to
the patient ( carer
Abilit! to anal!se
degree of patient9s
independenc!.
Able to compare the
degree of patient 9s
independenc! (
mobilit!.( coping skill.

Able to plan
appropriate
alternati"e acti"ities (
tasks
Able to plan approriate
treatment plan to enable
5
BEST STATEMENT OF STROKE ASSESSMENT
Hobb! 3 'atient likes to do reading and
watching tele"ision.
'atient use to :og three times
a week for 86 minutes.
patient to go back to work (
able to continue hobb!
DATA STATEMENT KNOWLEDGE SKILL
S%"cia$ &'"stio3
Incontinence 3
;ladder 3 <es ( =o
;owel 3 <es ( =o
'atient has bowel
and bladder
incontinence. He is
on condom and C;1
nderstanding
prognosis of patient
nderstanding the
patient&s
management in
personal h!giene*
care for the catheter*
C;1 and pre"ention
of pressure sores.
>nable to plan
appropriate treatment
Able to teach carer on
patient&s h!giene*
check on pressure
areas etc.
CURRENT HISTOR(
T!pe of lesion
Site of Lesion
.otor deficit
Haemorrhagic*
infarction or embolism
( trombotic.
Cortical ( subcortical (
brain stem (
cerebellar
Right (left ( bilateral (
neither
nderstand the
anatom! of the brain
and patho0ph!siolog!
of the condition.
Able to co0relate
clinical presentation
to t!pe of lesion and
site of lesion
6
BEST STATEMENT OF STROKE ASSESSMENT
1ate of onset 1ate and t!pe of
surger!
nderstand the procedure of
the surger! and the
Able to retrie"e
rele"ant information
from patient record
DATA STATEMENT KNOWLEDGE SKILL
Past )istor*
're"ious stroke
're"ious TIA
're"ious mobilit!
Comments3
;rief histor! on the
onset
<es ( =o
<es( =o
normal ( limited
e.g. ambulate with
walking aids for 7
!ears after stroke
in"ol"ement of the
affected structure.
nderstand the
prognosis of patient
>nable to plan of
treatment based on
pre"ious mobilit!
O#s"r+atio
-eneral appearance
>/ample
If the patient comatose*
%. -lasgow coma scale
If the patient conscious
7. Come in b! wheel chair
accompanied b! wife* with
poor sitting posture
nderstand the
clinical presentation
of the condition.
>nable to identif!
ma:or problems
7
BEST STATEMENT OF STROKE ASSESSMENT
1ominant hand
.ental(cogniti"e impairment
R ( L
<es ( =o
nable to recogni$e place*
time * person.
DATA STATEMENT KNOWLEDGE SKILL
O#s"r+atio
Communication impairment
Visual field deficit
Hearing deficit
'erceptual status
-ait
>/pressi"e (
recepti"e (.none
1escription30
0'atient has d!sarthia*
unable to communicate
'atient using glasses
<es (=o
=A1 ( Impaired
=A1 (Impaired
Anal!se an! abnormalit!
and inade?uate walking
e.g.*
stance phase of affected leg
Lack of e/tension of
hip and dorsifle/ion at
ankles
Lack of controlled
nderstand the
clinical presentation
of the condition.
>nable to identif!
ma:or problems
Able to plan for
retraining of the
missing component
8
BEST STATEMENT OF STROKE ASSESSMENT
knee fle/ion
e/tension from 60%2@
DATA STATEMENT KNOWLEDGE SKILL
Pa$%atio
Sensation
Light touch
'ain
Comment
.uscle tone3
Comment3
Sensation3 intact
+=A1,
=A1( impaired (
absent
=A1( impaired
=A1 ( H!pertone (
h!potone
+refer to .otor
assessment Scale
=o. A #general
tone,
Able to
understand the
effect of the
condition on
sensor!
in"ol"ement
Able to understand
the effect of the
condition on muscle
tone.
Able to carr! out the
sensor! tests.with
usage of assessment
tools # cotton wool(
pin
Able to carr! out the
tests to differentiate
muscle tones.
Pro%rioc"%ti+"
pper limb
Lower limb
=A1 ( impaired
=A1 ( impaired
nderstand the
relation of the
condition on
Able to perform
propriocepti"e tests.
9
BEST STATEMENT OF STROKE ASSESSMENT
proprioception. >nable to e"aluate
:oint sense
Rag" o, !otio
pper limb
'assi"e range of
motion3 5ull
nderstand the
anatom! of the :oint*
>nable to e"aluate
(detect shortening or
DATA STATEMENT KNOWLEDGE SKILL
Lower limb
Co!%$icatio -ot)"rs
'ainful shoulder
Comment3
Sublu/ed shoulder
Comment3
Chest complication3
Comment3
'assi"e range of
motion3
Limited at outer range (
+use goniometer to measure
the limited range,
<es ( =o
+ if !es grade the intensit! of
pain eg. VAS ,
<es ( =o
+ if <es * measure the gap ,
<es ( =o
+If <es* describe the
problem e.g.
0secretion retention
0impairment of respirator!
function ,
muscle and their function
Able to understand
the condition and its
relation with the
in"ol"ement of the
structures and organ.
contracture
>nable to identif! the
possible complication
Able to e"aluate and
use measuring tools
appropriatel! ie3
goniometer* Visual
analog scale +pain,
10
BEST STATEMENT OF STROKE ASSESSMENT
4ro0facial function
Comment3
<es ( =o
+if <es* describe the
problem* e.g.*
0patient has d!sphagia.
0 patient has Lt facial pals!,
nderstanding the
lesion and affected
site of the brain that
related to patient&s
clinical presentations.
DATA STATEMENT KNOWLEDGE SKILL
Mo+"!"t a. /'ctio
Scoring 3 'oor 5air -ood
Shoulder3
>lbow 3
5orearm3
Mo+"!"t a. /'ctio
)rist3
Hand3
>/ample3
'oor # no mo"ement or
flickering mo"ement
5air and -ood to utili$e
.AS Item B * C* D
e.g.*
Item B pper0Arm 5unction
Scoring E0 Sitting hold
e/tended arm in forward
fle/ion at A6@ to bod! for 7
seconds
4r refer to .otor
Assessment Scale =o. B*C*D
Able to understand
the effect of the
condition on
mo"ement and
function.
Able to understand
the effect of the
condition on
mo"ement and
function.
>nable to assess and
identif! the problems
Able to use .otor
Assessment Scale as
a measuring tool in
assessing the
functions.
11
BEST STATEMENT OF STROKE ASSESSMENT
/'ctioa$ Aa$*sis
Scoring3
6 # ma/imum dependent
%0 ma/imum assistance
70moderate assistance
Refer to scoring and add
comment if necessar!
e.g.*
scoring 7 # moderate
nderstand the
possible problems
faced b! patient on
>nable to anal!se
functional abilit!
DATA STATEMENT KNOWLEDGE SKILL
80minimum assistance
E0independent
Transfer bed chair
Transfer )(C Toilet
/'ctioa$ Aa$*sis
Shifting abilit!
Supine side l!ing
Side l!ing sitting
assistance with 7 helpers (
mechanical de"ices
or
refer to .otor Assessment
Scale Item% %* 7* 8* E* 2
Refer to scoring and add
comment if necessar!
e.g.*
scoring 7 # moderate
assistance with 7 helpers (
mechanical de"ices
or
refer to .otor Assessment
Scale Item% %* 7* 8* E* 2
functional acti"ities.
nderstand the
possible problems
faced b! patient on
functional acti"ities
>nable to anal!se
functional abilit!
12
BEST STATEMENT OF STROKE ASSESSMENT
Sitting standing
Sitting
Standing
Ambulation

DATA STATEMENT KNOWLEDGE SKILL
P)*siot)"ra%* I!%r"ssio
Retention of secretion
due to reduce coughing
effort and thickness of
the sputum
'oor balanced sitting
due to lack of postural
muscle acti"ation
nable to maintain
standing position due to
weakness of e/tensor
of affected limb
'atient has complete
nderstand the clinical
reasoning on the
patient&s clinical
presentations.
Retention of secretion
due to reduce coughing
effort and thickness of
the sputum
'oor balanced sitting
due to lack of postural
muscle acti"ation
nable to maintain
standing position due to
weakness of e/tensor
of affected limb
'atient has complete
loss of balance on the
>nable to anal!se the
findings and plan the
appropriate treatment
>nable to prioriti$e
the needs
13
BEST STATEMENT OF STROKE ASSESSMENT
loss of balance on the
affected side due to
muscle weakness.
Impairment of
respirator! function
affected side due to
muscle weakness.
Impairment of
respirator! function.
nderstand the
needs based on the
findings.
DATA STATEMENT KNOWLEDGE SKILL
Sensor! motor impairment
.uscle weakness
Stiffness and shortened
muscle length
Adapti"e motor beha"ior
Soft tissue contracture
Shoulder pain
Left sided neglect
0lack of de/terit!
0difficult! in eliciting and
sustaining muscle acti"it!
0 difficult! in generating and
timing force
0difficult! in generating and
controlling s!nergistic
muscle acti"it!
disused* immobilit!*
impairment
Increase tone with t!pical
spastic posture
Shortened soft tissue
14
BEST STATEMENT OF STROKE ASSESSMENT
Impingement
naware or ignore the left
side of bod!
DATA STATEMENT KNOWLEDGE SKILL
S)ort T"r! Goa$s %.To increase muscle
strength
7. To increase skill* control
and functional performance
8.To increase e/tensibilit!
and decrease stiffness of
muscles
E. To impro"e strength*
endurance* fle/ibilit! and
coordination
0Increase force generating
capacit!
0Increase coordination of
muscle acti"ation
0Impro"e firing and
s!nchroni$ation of motor
units and impro"ed angonist*
antagonist and s!nergic
coordination
0increase length and
impro"e muscular mechanic
0positi"e effect of ph!sical
conditioning program
0weakness due to
Able to30
Carr! out resisted
e/ercise
Carr! out task related
e/ercise
15
BEST STATEMENT OF STROKE ASSESSMENT
impairment affecting muscle
acti"ation and secondar! to
disuse changes
0e/ercise and training will be
an increase in neural
acti"ation and neural
adaptation
Able to carr! out ph!sical
conditioning program3
0strength training
0repetition e/ercise
DATA STATEMENT KNOWLEDGE SKILL
2. To impro"e functional
performance
B. 4ptimi$ing skill ac?uisition
0're or post lesion inacti"it!
in addition to the direct effect
of muscle acti"ation.
05luenc! of mo"ement is an
criterion of skilled motor
beha"ior
0de"eloped skill mo"ement
0 reduce the adapti"e motor
mo"ement
0increase ease of mo"ement
with decreased muscle
stiffness
0 greater efficienc! in force
production
Strengthening e/ercise
Task related practice
Repetition mo"ements
Task related training
Repetition of task
16
BEST STATEMENT OF STROKE ASSESSMENT
0increase muscular efficienc!F
result of training* muscles
become more effecti"e in
producing tension* recruiting
fewer motor units or lowering of
firing rate of motor units
DATA STATEMENT KNOWLEDGE SKILL
C.. To impro"e circulation
and pre"ent stiffness
D.To impro"e circulation and
pre"enting stiffness
A. To pre"ent muscles
shortening and :oint
stiffness
%6. To pre"ent retention and
pooling of secretion*
atelectasis*
add to patient&s comfort
0.usculoskeletal integrit!
0Add to patient&s comfort
.aintain at risk muscles in a
lengthened position e.g
adductors of shoulder* long
finger and thumb fle/or*
plantar fle/ors* hip and knee
fle/ors
01epressed le"el of
consciousness
0impaired swallowing
mechanism
0diminished gag refle/
Range of motion e/ercise
0passi"e mo"ement
Range of mo"ement
e/ercise
Acti"e e/ercises*
Task related training
Regular and fre?uent turning
0percussion* "ibration* rib
springing* mechanical
suction
17
BEST STATEMENT OF STROKE ASSESSMENT
bronchopneumonia
DATA STATEMENT KNOWLEDGE SKILL
Log T"r! Goa$s Log t"r! goa$ o,
r")a#i$itatio
%.To reduce impairment and
minimi$ed disabilit!
7. To impro"e
?ualit! of life
0 to impro"e functional
outcome
0to achie"e optional
functional outcome
0to optimi$e performance of
functional action
0 scientificall! based and
acti"e task related training
appear to affect brain
reorgani$ation than the
common approaches
+ ;obath* =1T,
0)hat the patient do
following stroke* the use to
which the! put their affected
limbs * and e/periences*
appear to affect brain
reorgani$ation
0 e"idence from the gi"en
biomechanical information in
anal!sis training of action
/'ctioa$ !otor traiig
0anticipate and pre"ent soft
tissue contracture
0elicit muscle acti"it! utili$ing
kinesiological principle such
as elimination of gra"it!*
eccentric* concentric*
isometric contraction
0trai !otor cotro$
To acti"ate muscle
s!nergicall!
To acti"ate muscle at
a particular length
To sustain muscle
18
BEST STATEMENT OF STROKE ASSESSMENT
such as sit to stand* walking
* reaching and manipulation
contraction under
certain load
conditions
To increase speed
and mo"ement
5or a particular goal
such as standing*
walking* reaching*
stair climbing*
DATA STATEMENT KNOWLEDGE SKILL
P$a o, Tr"at!"t
Chest ph!siotherap!
.o"ement reeducation
e.g.*
acti"e strengthening elbow
e/tensor +antagonist ,
5unctional (task0related
training
pain relief e.g.* T>=S
'atient ( Carer education
nderstand the effect
of each t!pe of
treatment choosed.
nderstand the
importance of
patient ( carer
education
>nable to plan
effecti"e and rele"ant
treatment
>nable to prescribe
rele"ant home e/ercise
programme
>nable to monitor the
patient (carer
19
BEST STATEMENT OF STROKE ASSESSMENT
compliance

DATA STATEMENT KNOWLEDGE SKILL
Progr"ss ot"
S
O
A
P
Same as in initial
assessment
chest ph!siotherap!
half l!ing position
0manual techni?ue
+chest
percussion("ibration,
0breathing e/ercise
mo"ement
reeducation0 sitt* Rt
hand reaching
forward to touch
ob:ects %60%2 min.
Able to plan treatment
and e/ercise
according to short
term goal
able to implement
treatment
appropriatel!
20
BEST STATEMENT OF STROKE ASSESSMENT
train sit to stand and
"ice0"ersa for %60%2
min.
application of T>=s to
Rt shoulder


DATA STATEMENT KNOWLEDGE SKILL
Progr"ss ot"
2. 1emonstration and
clear e/planation on home
e/ercise program

Able to plan treatment
and e/ercise
according to short
term goal
able to implement
treatment
appropriatel!

21
BEST STATEMENT OF STROKE ASSESSMENT
DATA STATEMENT KNOWLEDGE SKILL
S)ort T"r! Goa$s
+ Later on in
patient&s progress ,
>/amples*
short term goals of +date, achie"ed
new short term goals 3
sit unsupported with weight well forward
and e"enl! distributed within 7(27

short term goals of +date, achie"ed
new short term goals 3
To achie"e left shoulder reaching forward
in sitting within 7(27
short term goals of +date, achie"ed
new short term goals 3
To enable patient to stand without help
within 7(27
>nable to
prioriti$e the
needs
>nable to
plan and
treat
appropriatel!
22
BEST STATEMENT OF STROKE ASSESSMENT
BEST STATEMENT UNDER EACH HEADINGS
G""ra$ co.itio3
'atient is drows!* arousal.
'atient is illF "ital sign unstable
'atient is alert* orientated to place and time.
'atient is weak* unable to mo"e right side of bod!.
'atient is comfortable* nil complaint
'atient is restless* unable to obe! command
'atient is restless* unable to do e/ercises
23
BEST STATEMENT OF STROKE ASSESSMENT
'atient is cheerful* keen to do e/ercise.
'atient is sedated* not respond to call.
'atient is confused* unable to follow instruction
'atient is mobile* A1L independent
'atient tired easil!* low e/ercise tolerance
Pro#$"!s1
;ed ridden* with pressure sore o"er sacrum
;ed ridden with secretion retention
;ed ridden with incontinence
;ed ridden with poor bed mobilit!.
.o"ement of affected limb is slow* incomplete.
Increasing spasticit! with shortened forearm fle/or
Stiffness of elbow :oint with shortened forearm fle/or
.o"ement is slow and incomplete
1ementia* has difficult! in following treatment program
24
BEST STATEMENT OF STROKE ASSESSMENT
Left sided neglect
Hemianopia +"isual field defect,
Cogniti"e impairment
)eakness of left upper limb with impaired mo"ement
La/it! of glenohumerus :oint with shoulder pain
Has difficult! to initiate mo"ement without affected limb supported.
Hand mo"ement is slow in holding and releasing ob:ects
5ine mo"ement of hand is clums! due to lack of de/terit!
1ense hemiplegia
)asting of muscles
)eakness of affected upper and lower limb
nable to walk without support
nable to walk without walking aid
5ear of fall* unable to walk without super"ision
Risk of fall due to poor "ision( poor balance
25
BEST STATEMENT OF STROKE ASSESSMENT
Gait
Slow in push off in propelling and balancing bod! mass o"er the feet
Slow in heel strike due to incomplete ankle dorsi fle/ion of ankle
Insufficient transferring of bod! weight in stance phase of gait
Small strike* especiall! during turning
=ormal gait
Insufficient hip e/tension in push off phase of gait

'atient walks with rotated hip towards affected side with insufficient hip e/tension in push off phase of gait
)alking is slow but stead!
Abrupt steps* mo"ements of lower limbs not finel! coordinated in walking.
5airl! good hip control in ambulation
'atient walks with small steps during turning.
Able to walk with minimal super"ision
Able to walk but occasionall! fumbles.
=ormal gait with slow speed
26
BEST STATEMENT OF STROKE ASSESSMENT
27