Client Assessment: Part 5

 C.H.A.R.T.S.

The "T" section of the assessment stands for Tissue Characteristics.  This is where you assess the length, strength, play, and tone of the joints/muscles.  You perform manual muscle tests, palpate the muscle belly and insertion/origin areas in search on tenderness (comparable sign), nodules, etc.  You also conduct functional tests such as sit to stand transfers, bending/lifting and stair climbing.

The "S" section stands for Special Tests.  These are tests that will help assess the integrity and involvment of ligaments, joints and tendon in your client's chief complaints.  Some special tests can determine ACL laxity or tears, rotator cuff tendinitis, elbow tendinitis, etc.  This will help guide your program design.

The past few blog entries should provide you with basic guidelines for performing a thorough client assessment.    Feel free to email me at nicparm7777@aol.com with any questions or comments. 

Client Assessment Part 4

C.H.A.R.T.S.

"R" Stands for Range Of Motion (ROM)

During your client assessment, you will want to evaluate the range of motion, particularly of the area related to the chief complaint.  You are looking for the 3 R's (Range or quantity, Resistance or quality/willingness to move, and Reactivity to the movement).  Be  especially attentive to the "Comparable Sign." The comparable sign is the client's chief complaint or symptom.  If you have your client perform an action that causes pain, however it is not the same pain that he is usually complaining about, then it is not the comparable sign.  Reproducing the symptoms/comparable sign will help you figure out the source of the problem. 

First have your client perform the movement actively.  If he feels symptoms, then you take him through the movement passively.  Lastly, test that movement resistively to assess strength.  With each of these, you are always looking for the 3 R's.  If there is pain prior to applying resistant, your client is highly reactive. Pain with resistance means he is moderately reactive.  While pain after resistance means low reactivity. 

A normal result of active range of motion is as follows:

-smooth motion at all speeds

-full ROM

-Pain free

-Normal strength

Abnormal result of active range of motion is:

-client resists movement

-painful area in the movement

-pain at end range

-compensations are observed

-you hear joint noises/crackling

Limited active range of motion may be a sign of the following:

-weakness

-tightness

-nerve issues

-internal derangement (you can use special tests to figure this out)

-pain

-tight joint capsule

What does Passive Testing tell you (you take your client through the movement)?

-Normal and pain free means no lesion

-Normal and painful may mean a minor sprain

-Hypomobile and painfree may mean a muscle contracture or joint adhesion

-Hypomobile and painful means acute sprain with guarding

-Hypermobile and painfree means a complete rupture of the tendon

-Hypermobile and painful may mean a partial tear

What does Resistive Testing tell you?

-Strong and no pain: no lesion

-Strong and painful: minor lesion

-Weak and painless: nerve damage or complete rupture

-Weak and painful: partial rupture

When performing Resistive Testing, remember the following:

-Isolate one motion for the test

-Test one joint at a time

-Test the motion at its mid range

-Increase your applied resistance slowly (do not crank on it)

-Hold the resistance 5 seconds

The above information should help a great deal in figuring out the cause of your client's condition. 

Client Assessment Part 3

C.H.A.R.T.S.

"A" is for Asymmetries

After taking an extensive history and finding out what your client's chief complaint is, you will want to begin gathering objective measures as a baseline status.  The first observation should be your client's posture. 

From the back, look for the following:

1. Foot position: are the toes pointing in or out, or is the foot flat?

2. Check out muscle mass: Is one calf bulkier than the other?

3. Position on the knees: Are they pointed in towards eachother or is it bowlegged?

4. Check for scoliosis: Does the spine have an 'S' curve?

5.  What about shoulder position: Is one shoulder elevated?

From a lateral view:

1.  Is the knee flexed or hyperextended?

2.  Is there an arch in the lower back?

3.  Is there a rounded upper back, rounded shoulders or a forward head posture?

With this section, you rely heavily on your observation skills and vision to determine asymmetries.  Noting these asymmetries will help a great deal in customizing an exercise plan with goals for your client. Setting up a plumb line to assist in your facility may help. 

Next we will discuss Range of Motion ('R' in C.H.A.R.T.S.)

Client Assessment Part 2

C.H.A.R.T.S.

"H"  Stands for History

During the assessment, it is important to gather information regarding patient history in order to determine the "health state" (behaviors/activities) as well as the "injury/disease state."  Knowing where your client was, helps to determine their goals as well as the extent of their injury.  During the patient history, you will want to gather the following information:

1.  General demographics: age, gender

2.  Growth/development: hand/foot dominance

3.  Present problem/complaint

4.  Past medical/surgical history

5.  Present medications: pain meds, muscle relaxants, anti-inflammatories

6.  Family history

7.  Vocational/Recreational info: Is their occupation a contributory factor? Ergonomics?

Following this section of the assessment, you will plan an in depth physical examination.  This is where you ask yourself:

1.  What are possible hypotheses for the cause of your client's problem? 

2.  How aggressive can you be with their training?  

Next entry will be "A" for Assymetries.

Another Acronym To Help Organize a Detailed Assessment

C.H.A.R.T.S.

When first meeting a client/patient or upon re-assessing that client to assess progress, a good guidance system to help accurately collect information is to base the assessment on the acronym C.H.A.R.T.S.  In the next few blog entries, I will break down each section.  Today, I will discuss "C".

"C" stands for Chief Complaint.  This is the subjective section of the client/patient interview/assessment.  Here you are finding out why that person is seeking your assistance.  It is also during this interview that you will decide whether there are other possible causes of the client's issues, especially any life-threatening pathologies that may contraindicate your services.  If the client has a complaint of pain, you will use the O-P-Q-R-S-T question format (previous blog entry) to analyze that.  Again, it is during the interview process that you want to rule out any other serious pathology that the client may have.  Some things the client may tell you that would lead you to believe there is a more serious issue are the following:

1.  Unexplained weight loss - Was he/she trying to lose weight?

2. Malaise/decrease in energy level

3. Fever/chills

4. Weakness/numbness

5. Fainting (loss of consciousness) or syncope (no loss of consciousness)

6. Pain at night

7. Pain at rest that is not affected by position change

8. Bowel or bladder problems

Also check out the previous blog entry on "Red Flags"

Lastly, you will want to assess that client's response to working with you. 
1. Did he/she have an unusual response?
2. Was there any symptom magnification?
3. Did the symptoms improve but then return for no reason?
4. Was their pain unaffected by your session/treatment?
5. Was the pain worsened by the session/treatment (considering you were not being too aggressive)?

 

All of the above information should help guide you in obtaining an in-depth description of your client's or patient's problem and will later help you in developing goals and customizing a program.  Next entry will focus on "H" for History of the condition.