OCCUPATIONAL THERAPY POST COVID-19 REHABILITATION EVALUATION

  OCCUPATIONAL THERAPY  POST COVID-19 REHABILITATION  EVALUATION

1. DEMOGRAPHIC DATA:

9. Name:

10. Age:

11. Sex:

12. Date of evaluation:

13. Hospital NO(IP/OP):

14. Address:

15. D.O.A:

16. D.O.E:

17. Associated problems:

18. Reason for referral:

19. Methods of evaluation :

· History taking

· Interview

· Behaviour observation

· Standardized test

 

2. CHIEF COMPLAINTS

· SUBJECTIVE (Patients own words, why he/she has come here, recorded even if unable to speak or irrelevant)

 

· OBJECTIVE (Patient party’s word, relationship reliability)

3. FELT NEEDS

 

 

4. HISTORY

 

4.1 GENERAL HISTORY

· Onset

· Location

· Duration

· Characteristics

· Aggravating & Precipitating factor

· Relieving factor

· Current situation

· Effects on ADL

· Previous diagnosis

· Previous management & efficacy

 

4.2 MEDICAL HISTORY:   

 

1. PAST MEDICAL HISTORY

       

· History of illness

· Duration of illness

· Duration of hospital stay (mention  hospital,place,etc..)

· Medications given

· Any radiodiagnosis test done

· Complications developed or managed

 

2. PRESENT HISTORY

· Reason to come here

· At present o.t, p.t,

· Whether under control on medication and duration

· Any other illness

 

 

 

4.3 FAMILY HISTORY:

 

 

4.4  EDUCATIONAL HISTORY

       

          4.4 VOCATIONAL HISTORY

 

4.5  SOCIO-ECONOMIC STATUS

 

4.6  LEISURE HISTORY  

 

 

4.7  FUNCTIONAL  STATUS HISTORY

 

 

4.8 REVIEW SYSTEM ANALYSIS HISTORY

 

5. ON OBSERVATION

· Breathlessness

· Wheezing

· Degree of comfort/ distress

· Position to aid respiration

· Diaphoresis

· Speech( with breath/ not)

· Colour

· Nutritional status

· Hydration status

· Mental status

· Cough

· Came alone/with caregiver

· Position in seening the patients (standing/ sitting/walking )

· Body build

· Posture in  sitting  and standing

· Balance in sitting and standing

· Health status

· Facial expression (sad/ cheerful)

· Attitudes of limb

8. Shoulder

9. Elbow

10. Wrist

11. Fingers

12. Hip

13. Knee

14. Ankle

· Gait pattern

· Any accessory things attached to the body Any mobility

6. ON EXAMINATION

              6.0 CARDINAL SIGNS& SYMPTOMS:

COUGH:

1. Quality

2. Severity

3. Timing

4. Duration : greater than 2 weeks( screening for TB)

SPUTUM:

1. Colour

2. Amount

3. Consistency

4. Prevalence, odour, foul taste

5. Time of day , worse

HEMOPTYSIS:

1. Amount of blood

2. Frank blood/ mixed with sputum

3. Association with leg pain, chest pain, shortness of breath

SHORTNESS OF BREATH:

1. Exercise tolerance

2. Posture- orthopnea/tripoding

3. Shortness of breath at rest

4. Association with paroxysmal nocturnal dyspnea

5. Associated swelling of ankles / recent weight gain

CYANOSIS:

1. Central Vs peripheral

2. When does it happen

3. Any recent changes in pattern of associated

4. Associated wheeze

CHEST PAIN:

1. Associated symptoms

2. Relation to effort, exercise meals, bending over

3. Explore the pain carefully- include quality, radiation, severity, timing

FAINTING/ SYNCOPE

1. Weakness, light headedness, loss of consciousness

2. Relation to postural change, vertigo/ neurological symptoms

EXTREMITIES

1. Oedema

2. Intermittent claudication( exercise including leg pain)

3. Tingling

4. Leg cramps/ rest at pain

5. Presence of varicose veins

6.1 GENERAL APPERANCE /VITAL SIGNS

VITAL SIGNS

1. Temperature

2. Pulse

3. Respiratory rate

4. SP O2

5. BP

6. Peak flow

              6.2 LEVEL OF CONSCIOUSNESS (ACCORDIND TO GCS, RLA STAGE)

             6.3 SPECIAL SENSES

1. Vision

2. Hearing

3. Speech

              6.4 SENSORY EVALUATION

                                 SENSORY AWARENESS

1. Detection

2. Discrimination

3. Quantification

4. Recognization

                                 SUPERFICIAL

1. Light touch

2. Crude touch

3. Pain

4. Temperature

5. Two point discrimination

                                 DEEP SENSATION

1. Vibration

2. Pressure

3. Propiroception

4. Kinesthesia

                              CORTICAL SENSATION

                                     1 .Baragnosis

                                     2. Sterognosis  

         6.5 HIGHER CRTICAL FUNCTION

                            APRAXIA

1. Ideomotor

2. Ideational

3. Limb

4. Constructional

5. Dressing

COGNITION

1. Listening

2. Attention

3. Concentration

4. Orientation

5. Memory

6. Judgement

7. Problem solving

8. Visual sequencing

9. Generalization

10. Categorization

11. Abstract thinking

                         PERCEPTION

1. Body scheme

2. Right left discrimination

3. Form constancy

4. Position in space

5. Figure ground perception

6. Depth perception

7. Topographical orientation

8. Colour identification

9. Unilateral neglect

 

 6.6 CRANIAL NERVE TESTING

Olfactory
Optic
Occulomotor
Trochlear
Trigeminal
Abducent
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoghossal

 

 

   6.7 COORDINATION

          NON EQUILIBRIUM

· Finger to nose

· Finger to finger

· Heel to shin

 

  6.8 RANGE OF MOTION (GONIOMETER-)            

JOINT	RIGHT				LEFT
SHOULDER	AROM		PROM		AROM		PROM
Flexion
Extension
Abduction
Adduction
Internal     Rotation
External   rotation
ELBOW	RIGHT				LEFT
	AROM		PROM		AROM		PROM
Flexion
Extension
FOREARM	RIGHT				LEFT
Supination
Pronation
WRIST	RIGHT			LEFT
Flexion
Extension
Ulnar    deviation
Radial Deviation

 

 

HIP	RIGHT		LEFT
	AROM	PROM	AROM	PROM
Flexion
Extension
Abduction
Adduction
Internal rotation
External rotation
KNEE
Flexion
Extension
ANKLE
Dorsi flexion
Plantar flexion
Inversion
Eversion

 

6.8 MUSCLE TONE/MUSCLE POWER (MAS, MMT)

JOINTS	MUSCLE GROUP	RIGHT			LEFT
SHOULDER	Flexors
	Extensors
	Abductors
	Adductors
	Internal      rotators
	External      rotators
ELBOW	Flexors
	Extensors
FOREARM	Flexors
	Extenxors
WRIST	Flexors
	Extensors
FINGERS	Flexors
	Extensors
HIP	Flexors
	Extensors
	Abductors
	Adductors
	Internal      rotators
	External      rotators
KNEEE	Flexors
	Extensors
ANKLE	Dorsi flexors
	Plantar  flexors

 

6.9 DEEEP TENTON REFLEX

	RIGHT	LEFT
Biceps
Triceps
Supinator
Knee
Ankle
Babinski sign

 

6.10 VOLUNTARY CONTROL

		RIGHT	LEFT
SHOULDER	Flexors
	Extensors
	Abductors
	Adductors
	Internal rotators
	External rotators
ELBOW	Flexors
	Extensors
FOREARM	Flexors
	Extensors
WRIST	Flexors
	Extensors
HIP	Flexors
	Extensors
	Abductors
	Adductors
	Internal rotators
	External rotators
KNEEE	Flexors
	Extensors
ANKLE	Dorsi flexors
	Plantar flexors

 

6.11 HAND FUNCTION

1. INITIATION

2. REACH

· Forward

· Midline

· Overhead

· Backward

· Sideways

3. GRASP

· Spherical

· Cylindrical

· Palmar

· Hook

4. PLACEMENT

5. RELEASE

· Voluntary

· In voluntary

6. IN HAND MANIPULATION

· Translation

· Shifting

· Cascading

· Spanning

                      7. PRECESSION HANDLING

· Pad to pad

· Tip to tip

· Pad to side

· Key pinch

· Medial triphoid

· Lateral traiphoid

                       8. NON-PREHENSILE

· Push

· Pull

· Clapping

· Rotation

6.12 FUNCTIONAL ABILITIES

                     ACCORDING TO FUNCTIONAL ABILITY GRADING

BED MOBILITY
Prone to supine
Supine to prone
Sitting from supine
Prone on elbow
Prone on palm
Quadriped
Kneeling
PUSH-UP
Static push up
Endurance
Clearance
STOOPING
At  knee  level
At ankle level
At ground level

 

6.13 BALANCE AND STABILITY

POSITION	STATIC	DYNAMIC
Long leg sitting
High sitting
Quadriped
Kneeling
Squating
Standing
Walking

 

  6.15 POSTURE

POSITION	STATIC	DYNAMIC
Sitting
Standing

 

    6.17 GAIT EVALUATION

           1. Gait cycle

           2. Gait terminology

    6.18 ADL EVALUATION (ACCORDIND TO FIM SCALE)

           1. SELFCARE

· Eating

· Grooming

· Bathing

· Dressing u/b

· Dressing l/b

· Toileting

          2. SPHINCTER CONTROL

· Bladder

· Bowel

          3. TRANSFERS

· Bed,chair,wheelchair

· Tub/shower

· Toilet

          4. LOCOMOTION

· Walking/wheelchair

· Stairs

         5. COMMUNICATION

· Comprehension

· Expression

         6. SOCIAL COGNITION

· Social interaction

· Problem solving

· Memory

    6.19 VOCATIONAL EVALUATION

· What type of job (worker/supervisor/owner)

· Job discription

· Working hours

· Mode of transport

· Working hours

· With or without assistance

· Work involves standing/sitting/walking/lifting

· Rest period available

· Toilet facilities

· Any architectural barriers faced

· Possibilities of adaptation and modifications

     6.20 HOME EVALUATION

· Type of house(concrete house/hut)

· No of room

· Water facilities

· Residing on ground floor/first floor,etc.,

· Own house/rented/company quarters

· Toilet facilities

· No of steps

· Level of switches

 

     6.21 PSYCHOLOGICAL STATUS EVALUATION

 

 

 

 

 

7.  PROBLEM INDENDIFIED

 

 

8. GOAL  DETERMINATION

      Short term goal

 

      Long term goal

 

9. APPROACHES

     Techniques

 

     Activities or Exercises

 

10. DOCUMENTATION AND PROGRESS NOTES