I. Assessment of functional impairment
(A) The purpose of assessment.
1.To collect the patient’s physical function, family situation, social environment, etc., and to grasp the content of the patient’s impairment.
2.To quantify the physical function and residual ability of the patient.
3.To analyze the difference between the degree of patient’s impairment and the normal standard.
4.Provide a basis for the development of rehabilitation treatment plans.
5.Provide objective indicators for the effect of therapeutic education.
6.Provide criteria for the classification of disability levels and provide a basis for the goal of re-integration into society.
Therefore, evaluation is an inherent concept in rehabilitation medicine. In order to emphasize the scientific and accurate nature of rehabilitation medicine, to understand the effects of rehabilitation treatment, and to continuously improve and enhance rehabilitation techniques, it is necessary to strive to learn and master the methods of evaluation.
(II) Principles of evaluation
1. Importance of overall developmental evaluation
The function of the brain is the commander of both the mind and the body. Some kind of cause of injury to the non-selected parts of the brain, both adults and children whose disorders are multifaceted. Cerebral palsy has been reported to have 9l% of repetitive disorders. However, movement disorders in infancy are often indeterminate and abnormal development is seen as the day grows older, symptoms become apparent in early childhood, and various changes occur through adolescence due to environmental influences. Therefore, the evaluation of cerebral palsy must be based on the principle that the overall development of normal children should be used as a control for all aspects of evaluation. At the same time, the concept of “evaluation for the sake of healing” should be kept in mind.
2. Abnormal developmental characteristics of children with cerebral palsy – immaturity and abnormality
The dysfunctions of children with cerebral palsy include primary impairments that damage the immature brain and secondary impairments that develop later with developmental disorders (abnormal development). Therefore, the physiotherapist (nurse) must evaluate and develop a treatment plan based on these immature and abnormal characteristics to promote normal motor development and suppress abnormal movements and postures. The functional factors that remain in the primary disorder are primitive and immature, i.e., developmentally delayed or arrested in our usual evaluation. Secondary impairments are the abnormalities that we see in the normal development of children with cerebral palsy in our evaluations. The two are epiphenomenal and often difficult to distinguish. However, when evaluating and planning treatment for children with cerebral palsy, it is important to note that infants and children are not as abnormal as older children, and even if the evaluation is mild, there is a risk of misdiagnosis. Even if the evaluation is mild, there is a possibility of misdiagnosis.
(C) Process of evaluation
It can be generally divided into the stages of data collection, analysis and research, goal setting and treatment plan development. Specifically, that is, the state of the child with cerebral palsy is observed, through examination and measurement. It is necessary to assess which aspects of the child are normal and which aspects are abnormal from both mental and physical aspects, that is to say, what level of motor development the subject child has reached, what kind of posture and movement is expressed, and then the development of postural reflexes is checked in terms of the maturity of the central nervous system. In addition, in most cases, the so-called motor effect organs, such as the muscular and skeletal systems, are also examined and measured, and combined with neurological examinations, the type and degree of the disease is evaluated, and the presence of combined damage is assessed, and a series of plans are formulated in the treatment plan, such as long-term and short-term goals, which physical therapy techniques should be used, and how to guide parents in the community.
In treatment facilities such as hospital rehabilitation departments and cerebral palsy treatment centers, pediatric neurologists or rehabilitation doctors, physiotherapists, occupational therapists, psychologists, caregivers (nurses), and teachers should be combined into treatment teams to evaluate and discuss treatment plans separately or centrally. In the community, community doctors, physiotherapists, occupational therapists, and community workers should evaluate and discuss the program. The discussion should be centered around the purpose of serving the medical treatment.
The evaluation should begin with an understanding of the principles of evaluation, followed by an evaluation in the order of measurement of motor development, measurement of postural reflexes, neurological examination, measurement of joint range of motion, examination of contracture deformation, measurement of muscle strength, and measurement of movements of daily living (ADL).
(iv) Assessment content.
1.Assessment of joint mobility
2.Grading of cerebral palsy
3.Assessment of muscle tone 4.Primitive reflexes
5.Assessment of physical developmental disorders
6. Assessment of motor dysfunction
(1) Assessment of abnormal posture and movement (2) Assessment of coordination function Ataxic movement examination, involuntary movement examination, etc.
(3)Muscle strength assessment
7.Assessment of special sensory disorders
8.Assessment of activities of daily living
9.Assessment of speech dysfunction
10.Assessment of intellectual disability
11.Comprehensive assessment