week 1

Today i was asked to carry out an asssesement on Patients A's range of movement. Patient A is post right sided stroke, his rehabillitation has been quite sucessful. Patient A is capable of ambulating independently. He has full passive ROM of his right upper limb however he has very little active ROM. I began my assessement with explaining what the process was going to involve and gaining consent. I then proceded to measure his PROM using a goniometer. This was relatively easy as i could control the movement however i had difficulties with measuring AROM. I found Patient A had many compensatory movement patterns that he had developed in order to carry out his ADL's. I then decided to give verbal ques to try to prompt him to stabilise and isolate the movement. I found this was not enough guidance for my patient so i had to try an alternate tactic. I decided to use my own hands to stabilise the body part that was not being used and asked my patient to stop when he reached his end of range. This enabled me to reduce the compensatory movement however it complicated the measuring process as i could not hold the goniometer properlyand my patient had difficulties maintaining end range whilst i measured due to poor strength. In retrospect i should have noted prior to the assessement that i would have difficulties measuring AROM on the patient by myself. I should have asked my supervisor what the best way was to carry out the assessment. When i did discuss the challenges i encountered with my supervisor, she gave me a few alternate positions that i could put him in to do the measurements, to best minimise the compensatory movement. I will use these positions when i re assess patient A's ROM next.