Preparing for a neurological placement

 Published: 12/08/2021

Updated: 20/04/2023

These are my tips for preparing for a neurological placement. 

Disclaimer: My neurological placement was at a specialist centre for brain injuries, however, I also saw stroke and multiple sclerosis patients.

Suggested preparation

1. Know your brain functional anatomy (e.g. when the parietal lobe is damaged, I would expect the following symptoms)
2. Look at commonly used outcome measures (FIST, Modified Rivermead Mobility Index and WHIM)
3. Make sure you know your normal gait cycle inside and out
4. Have a basic understanding of the pathophysiology of conditions you will commonly see in your area
5. Know where contractures or muscle shortening are most common in bed-bound or chair-bound patients
6. Have a basic understanding of the cause and grading of pressure sores

Brain functional anatomy resource

Simple explanatory video with a review section in about the last 4 minutes of the video.

Outcome measure links and explanations

·        The Functional Independence Measure (FIM) is a global measure of disability and can be scored alone or with the additional 12 items that formulate the Functional Assessment Measure (FAM): https://www.kcl.ac.uk/cicelysaunders/attachments/Tools-FIMFAM-FAM-items-only.pdf

• Berg Balance scale https://www.physio-pedia.com/Berg_Balance_Scale
•  Wessex Head Injury Matrix (WHIM) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717515/#:~:text=Outcome%20measure%20to%20assess%20cognition,or%20in%20response%20to%20stimulation.
• Modified Rivermead Mobility Index https://www.physio-pedia.com/Rivermead_Mobility_Index
• Modified Ashworth Scale https://www.youtube.com/watch?
• Tardieu Scale https://www.physio-pedia.com/Tardieu_Scale 
• Functional In Sitting Test (FIST) - Outcome measure overview: https://www.samuelmerritt.edu/fist   Item scoring explanation: https://www.samuelmerritt.edu/fist/items

Gait cycle resources

• Moore, S., Schurr, K., Wales, A., Moseley, A. and Herbert, R. (1993) ‘Observation and analysis of hemiplegic gait: swing phase’, Australian Journal of Physiotherapy, 39, pp.271-278.
• Moseley, A., Wales, A., Herbert, R., Schuur, K. and Moore, S. (1993) ‘Observation and analysis of hemiplegic gait: stance phase’, Australian Journal of Physiotherapy, 39, pp.259-267. 

Where muscle contractures or muscle shortening are most commonly found

Muscles

• Calves
• Hamstrings
• Adductors
• Hip Flexors

Movement affected

• Ankle dorsiflexion
• Knee extension
• Hip abduction
• Hip extension

Pressure sores

https://www.nice.org.uk/guidance/cg179/chapter/1-Recommendations#prevention-adults

Other resources I found useful for my placement

·        Prolonged disorders of consciousness following sudden-onset brain injury: national clinical guidelines: https://www.rcplondon.ac.uk/guidelines-policy/prolonged-disorders-consciousness-following-sudden-onset-brain-injury-national-clinical-guidelines (useful for the types of consciousness and the differences between reflective and purposeful reactions)

• Headway - the brain injury association is a charity set up to give help and support to people affected by brain injury: https://www.headway.org.uk/
• Clinical Physio on-demand and live webinars: https://www.clinicalphysio.com/

Final tips for the placement

1. Be as flexible as you can, each patient will provide unique challenges and impairments
2. The management is based upon each patient's problem (e.g. sitting balance, gait etc)
3. Ask lots of questions
4. Don't expect to remember the whole neurological assessment (even qualified physiotherapists go through their own mental checklists to check they haven't missed anything)
5. Bring any transferable knowledge you have (e.g. respiratory experience for trache patients and balance training knowledge).  

Parkinson's disease gait impairment videos