Wednesday, January 18, 2012

Translating measurement findings into rehabilitation practice: An example using Fugl-Meyer Assessment-Upper Extremity with patients following stroke

I know they think they are doing something useful but assessments without a diagnosis are worthless. Take foot-drop for example. The assessment would just say that it exists.
Are you saying that the therapy protocol would be the same for each diagnosis; dead motor cortex, dead pre-motor cortex, dead executive control, damaged motor cortex, damaged pre-motor cortex,damaged executive control. Think about it.
This points out the current bad practice of neurologists and PMR doctors just giving out ET(evaluate and treat) orders to therapists. Why are we even seeing them?
http://www.rehab.research.va.gov/jour/11/4810/pdf/velozo4810.pdf
Abstract—Standardized assessments are critical for advancing
clinical rehabilitation, yet assessment scores often provide little
information for rehabilitation treatment planning. A keyform
recovery map is an innovative way for a therapist to record
patient responses to standardized assessment items. The form
enables a therapist to view the specific items that a patient can
or cannot perform. This information can assist a therapist in tailoring
treatments to a patient’s individual ability level. We demonstrate
how a keyform recovery map can be used to inform
clinical treatment planning for individuals with stroke-related
upper-limb motor impairment. A keyform map of poststroke
upper-limb recovery defined by items of the Fugl-Meyer
Assessment-Upper Extremity (FMA-UE) was generated by a
previously published Rasch analysis. Three individuals with
stroke enrolled in a separate research study were randomly
selected from each of the three impairment strata of the FMAUE.
Their performance on each item was displayed on the
FMA-UE keyform. The forms directly connected qualitative
descriptions of patients’ motor ability to assessment measures,
thereby suggesting appropriate shorter and longer term rehabilitation
goals. This study demonstrates how measurement theory
can be used to translate a standardized assessment into a useful,
evidence-based tool for making clinical practice decisions.
INTRODUCTION
Clinical rehabilitation therapists have been challenged,
if not mandated, to use standardized assessments
as part of clinical practice. Educational accreditation
standards and practice frameworks for clinical rehabilitation
disciplines such as physical and occupational therapy
require that students learn and use standardized
assessments [1–2]. More recently, the growing demand
for evidence-based practice carries with it an implicit
mandate to use reliable and valid standardized assessments
as the basis of clinical decision making [3–6].
In spite of this foundational training and best-practice
focus, standardized assessments are used infrequently

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