Yoransev Rehab Centre Neuro Evaluation Name: esta \eeumet Date of evaluation: |. | ~7 | 2023 AgeSex: 91 Contact number gq Zl 81 2512 Diagnosis: ¢ yy (RP wealor Attenders contact number: Occupation; Mail Id: Referring physician: Address: Chief Complaints: pe Drftcculky 4a dpeech. “Jer Sart 3 Yoors History of present illness: Dade csty tn cormplaints o @ side weaken pur & UL Bpeed, , Carnamductory gait. Past Medical History: Drug Details (Concomitant / Past - related to present illness) | Drug Name Dosage Frequency | Current / Past ] ” - i came iwe ceaigation Ray CP sean, MRI) On Observation: Static posture analysis: Independent Position e.g. Supine iving. Prone ving side lying, sitting, standing: Joint Attitude of the Body Part Head: Flexion / Extension / Neutral Lateral flexion to L/ R/ Neural Rotation to L/ Rv Neutral Shoulder Girdle | L: Protraction / Retraction/Neutral rotraction / Retraction/Neutral L: Elevation / Depression /Neutral levation/ Depression /Neutral Shoulder L: FleSion/Extension/ Neutral R: FleXion / Extension/ Neutral L: Abduction/Adduction/Neutral ‘bduction/ Adduction/Neutral L: Internal rotation/ External rotation / | R: Internal rotation/ External rotation / | | Neutral Neutral Elbow [LL Flexi6n / Extension R: Flexion / Extension Forearm L: Pronation/Supination/ Mid-prone L; Pronation/Supination/ Mid -prone Wrist L: Flexion/ Extension R: Flexin/ Extension L; Radial Deviation / Ulnar Deviation | R: Radial Deviation / Ulnar Deviation [Fingers Trunk Flexion / Extension / Neutral Lateral Flexion to L / R / Neutral Rotation to L /R/ Neutral Hip L: Flexion / Extension/ Neutral R: Flexion / Extension / Neutral L: Abduction/Adduction/Neutral R: Abduction/Adduction/Neutral L: Internal rotation/ External rotation / | R: Internal rotation/ External rotation / Neutral Neutral Knee’ L: Flexion/ Extension R: Flexioh/ Extension | Ankle L: Dorsi flexion / Plantar flexion / R: Dorsi flexion / PlantarFlexion / Neutral Neutral iid pr Toes R Right: Le eeoppaivationi ‘Higher Mental function: * eae ‘Alert [7] Lethargic [J © Comprehending: [7] © Oriented: Time [__] Place Person [__] Attention: Selective attention: [~] Sustained attention: [—_] Divided attention: [— ] Normal: | ~ Impaired: [__] Speech Normal: Slurring of speech: [_-}- Stuttering of speech: Dysarthric: Dysphasic:ination: afiial Nerve * ‘Motwrexamination: | Reflexes | Babinski I [Biceps | Triceps [ Brachioradialis ror | Achilles Tendon ieeps Modified Ashworth gradi Balance: If required attach Berg Balance Scale: (57 coe} | | I I t | | | 4 Right Nowmod Left Balance Assessment Sitting Standing Feedforward static Feed backward static Feedforward dynamic Feed backward dynamicGait assessment: Cruimducher geart mild PF Sensation: [Voy mat jon assessment: (IF required attach coordination assessment) tip Abeluckior Right ‘Superficial sensation Left Pain perception Temperature Touch Pressure Deep sensation Kinesthesia Proprioceptive Vibration ‘Combined cortical sensation Stereognosis Two-point discrimination Double simultaneous stimulation Graphesthesia Recognition of texture Bargnosis Tactile localization kre On \© Fanetional tndependence Measure (FIM) Butt onobity inckepod and mp VheSi Starnes of loft Yt Functional Status ining Comm, | a | Grooming Toilet Hygiene: “Deed Mobiliqy = FIM SCORE (FOR FUNCTIONAL STATUS): = Depenident 75-100, 2+ Max Assist 50-74 days 3 Mov. Assist 50.7496, 4 = Min Assist <25% Supervision 6~ Modified inep. 7 ~ Indep. Functional Goal: Mele rq Trelapendank tr Aol. Sh i Pa mabidity — & sirenah - Grad Pyolnen’ Long term goal: own beakanet: Tmprove Atte mite Physiotherapy Management: Active Awe Crewnse Quovest