Evaluation/Clinical Assessment
The evaluation of patients with these challenges is really not that different from any of the evaluations that we use with other populations. It consists of clinical assessment, outcomes, measures and tools, developing a plan of care, understanding the importance of our evaluations in contributing to medical necessity, and serving as communication to collaborate with the prosthetist. I will give you some resources and some references.
Our clinical assessment includes many of the aspects of a standard evaluation. We want to consider the demographics, our patient's past medical history, their prosthetic history, the condition of their limbs, their occupation and the requirements of that occupation, their levels of function, their range of motion, strength, myosite evaluation, functional evaluation and outcomes measures.
Demographics
Now we are going to talk a little bit more about all of these aspects specifically. The demographic aspect is kind of a no-brainer for most of us. Right? We want to make sure that we have identifiers, like our patient's name and their date of birth. We often will include things like their chronological age, their height, their weight, their hand dominance, especially prior to an acquired loss, and then their diagnosis, which is the reason for referral to occupational therapy. Sometimes our patients have comorbidities and related challenges, and we will talk about those in a few minutes.
Past Medical History
We also want to look at our patient's medical history. We want to know what their general medical history was before their time of loss. If it's congenital, we want to know everything aside from their limb loss; any surgeries that they may have had or any comorbidities. For example, if we are seeing someone who lost their limb due to a blast injury, some of their comorbidities may be related to perceptual deficits, brain injury, etc. If our patient has lost their limb due to a disease process, there may be sensation issues or lack of vascular sufficiency so we want to be aware of some of those as well.
What medications are our patients taking? And we want to be aware of any potential side effects of those because some of those side effects can impact learning. Some side effects may account for a short attention span, a higher frustration level, or a host of other problems that can impact how they learn.
We want to get a history of limb loss. I have to say that when I am conducting an evaluation for a first-time patient I do not really jump into this particular area. I wait until I have established a little bit of a relationship before I ask my patients to talk about something that may be painful for them.
