1. Module 3c: ASSESSMENT PROCEDURES Module 3c: ASSESSMENT PROCEDURES

2. A.VISUAL ACUITY TEST Stand six (6) meters away from the patient. Step 1: Select a plain background where there is no glare to affect his/her vision.

3. A.VISUAL ACUITY TEST Ask the patient to cover one eye using the palm of his/her hand. Step 2: If he/she is normally wearing corrective eyeglasses, ask him/her to keep them on during the test. If he/she is normally wearing corrective eyeglasses, ask him/her to keep them on during the test.

4. A.VISUAL ACUITY TEST Step 3: If he/she answers correctly, repeat the exercise three (3) more times. Hold out your hand and display any number of fingers. Ask him/her how many fingers are displayed.

5. A.VISUAL ACUITY TEST If the patient cannot see at six (6) meters, move one (1) meter closer and repeat the test (or until you are at a distance where he/she is able to correctly identify the number of fingers). Step 4: Record the actual distance of visual acuity in meters.

6. A.VISUAL ACUITY TEST If the patient still cannot see at one (1) meter, move closer and wave your hand in front of his/her face. Step 5: If he/she cannot see any movement, shine a flashlight into each of his/her eyes. If he/she is able to see movement or light, there is still a possibility that sight can be restored.

7. B.SENSORY NERVE FUNCTION ASSESSMENT AT PRIMARY LEVELS The ideal device for sensitivity testing is the graded monofilament.

8. B.SENSORY NERVE FUNCTION ASSESSMENT AT PRIMARY LEVELS However, in areas (clinics or Health Centers) where these are not available, you may use an ordinary ball pen.

9. Conduct the test in a quiet place where the patient will not be disturbed by other people. Step 1: Do not try to do the test with other people standing by.

10. Ask and listen: Step 2: Have there been any changes in skin condition? If the answer to any of these is “yes,” ask when first noticed & record findings. Is there any change in how things feel by touch? Is there any difficulty doing normal tasks? Is there any change in how things feel by touch? Is there any difficulty doing normal tasks?

11. Sit down with the patient and explain why and how the test will be done. Step 3: Show him/her how the ball pen is used to touch the skin (90° angle to the skin & as light as possible).

12. Step 4: Touch an area of normal skin & ask him/her to point to that area. Now, ask him/her to close his/her eyes. Repeat the test on normal skin, this time with his/her eyes closed, and ask him/ her to point to the area touched by the ball pen. Now, ask him/her to close his/her eyes. Repeat the test on normal skin, this time with his/her eyes closed, and ask him/ her to point to the area touched by the ball pen.

13. Keep the patient’s hand steady by letting it rest on your own hand. Step 5: HANDS

14. Keep the patient’s hand steady by letting it rest on your own hand. Step 5: HANDS Ask the patient to close his/her eyes and point to the spot you will touch with the ball pen (see diagram).

15. Sensitivity test for the Median Nerve.

16. Sensitivity test for the Ulnar Nerve.

17. If he/she correctly points to the places touched, record with a check mark ( ) on the patient’s chart. If not, mark with an X. Step 5: HANDS Repeat with the other hand.

18. Step 6: FEET Ask the patient to close his/her eyes and point to the spot you will touch with the ball pen (see diagram). Ask the patient to rest his/her right ankle on his/her left knee.

19. Sensitivity test for the Posterior Tibial Nerve.

20. Step 6: FEET If he/she correctly points to the places touched, record with a check mark ( ) on the patient’s chart. If not, mark with an X. Repeat with the other foot.

21. Prev. Test Current Test Current Test All points felt Action After 2 Weeks Action Continue monthly assessment Decisions: Compare results with previous sensory test and look for any changes.

22. Prev. Test Current Test Current Test All points felt ONE point NOT felt Action After 2 Weeks Action Advise patient to report any changes & arrange to test after 2 weeks Decisions: Compare results with previous sensory test and look for any changes.

23. Prev. Test Current Test Current Test All points felt ONE point NOT felt Action After 2 Weeks Action Advise patient to report any changes & arrange to test after 2 weeks Decisions: Compare results with previous sensory test and look for any changes. No change or better Continue monthly assessment

24. Prev. Test Current Test Current Test All points felt ONE point NOT felt Action After 2 Weeks Action Advise patient to report any changes & arrange to test after 2 weeks Decisions: Compare results with previous sensory test and look for any changes. No change or better Continue monthly assessment 2 or more points NOT felt Give Prednisone

25. Prev. Test Current Test Current Test All points felt 2 or more points NOT felt Action After 2 Weeks Action Give Prednisone Decisions: Compare results with previous sensory test and look for any changes.

26. Prev. Test Current Test Current Test All points felt 2 or more points NOT felt Action After 2 Weeks Action Give Prednisone Decisions: Compare results with previous sensory test and look for any changes. Better Continue Prednisone & assess monthly

27. Prev. Test Current Test Current Test All points felt 2 or more points NOT felt Action After 2 Weeks Action Give Prednisone Decisions: Compare results with previous sensory test and look for any changes. Better Continue Prednisone & assess monthly No change

28. Prev. Test Current Test Current Test All points felt 2 or more points NOT felt Action After 2 Weeks Action Give Prednisone Decisions: Compare results with previous sensory test and look for any changes. Better Continue Prednisone & assess monthly No change Worse Refer immediately for further management

29. Prev. Test Current Test Current Test One point NOT felt No change or better Action After 2 Weeks Action Continue monthly assessment Decisions: Compare results with previous sensory test and look for any changes.

30. Prev. Test Current Test Current Test One point NOT felt Two or more points NOT felt Action After 2 Weeks Action Give Prednisone Decisions: Compare results with previous sensory test and look for any changes.

31. Prev. Test Current Test Current Test One point NOT felt Two or more points NOT felt Action After 2 Weeks Action Give Prednisone Decisions: Compare results with previous sensory test and look for any changes. Better Continue Prednisone & assess monthly

32. Prev. Test Current Test Current Test One point NOT felt Two or more points NOT felt Action After 2 Weeks Action Give Prednisone Decisions: Compare results with previous sensory test and look for any changes. Better Continue Prednisone & assess monthly No change

33. Prev. Test Current Test Current Test One point NOT felt Two or more points NOT felt Action After 2 Weeks Action Give Prednisone Decisions: Compare results with previous sensory test and look for any changes. Better Continue Prednisone & assess monthly No change Worse Refer immediately for further management

34. Prev. Test Current Test Current Test More than one point NOT felt No change or better Action After 2 Weeks Action Continue monthly assessment Decisions: Compare results with previous sensory test and look for any changes.

35. Prev. Test Current Test Current Test More than one point NOT felt No change or better Action After 2 Weeks Action Continue monthly assessment Decisions: Compare results with previous sensory test and look for any changes. Worse Refer immediately for further management

36. C.MOTOR NERVE FUNCTION ASSESSMENT AT PRIMARY LEVELS Conduct the test in a quiet place where the patient will not be disturbed by other people. Step 1: Do not try to do the test with other people standing by.

37. Ask and listen: Step 2: Has there been any difficulty in doing normal tasks (fastening buttons, holding tools, combing hair, etc.)? If the answer to any of these is “yes,” ask when first noticed & record findings. Has he/she noticed any difficulty keeping sandals on his/her feet? Does he/she have any difficulty closing his/her eyes? Has he/she noticed any difficulty keeping sandals on his/her feet? Does he/she have any difficulty closing his/her eyes?

38. To test for muscle strength: Step 3: Facial Nerve Assessment The key movement is eye closure. The patient should sit comfortably and the test should be explained carefully. Tell the patient to close his/her eyes lightly as if asleep. If he/she can close his/her eyes then his/her muscles are either strong or weak, NOT paralyzed. The patient should sit comfortably and the test should be explained carefully. Tell the patient to close his/her eyes lightly as if asleep. If he/she can close his/her eyes then his/her muscles are either strong or weak, NOT paralyzed.

39. To test for muscle strength: Step 3: Facial Nerve Assessment Tell the patient to close his/her eyes as firmly as possible and resist with all his/her strength while you try to open them with your fingers. Place your index finger just below the eyebrow and your thumb on the cheek bone. Move your fingers apart and try to open the eyelids.

40. Voluntary muscle test for the Facial Nerve.

41. Findings: Step 3: Facial Nerve Assessment: If you cannot open his/her eyelid, then the muscle is strong. If you can open the eyelid, the muscle is weak. Record your findings. If he/she cannot close his/her eyelids completely, measure the lid gap.

42. To test for muscle strength: Step 4: Ulnar Nerve Assessment: The key movement is little finger out. Let the patient’s hand rest on your hand. With all his/her fingers straight, ask him/her to move his/her little finger away from his/her other fingers. If he/she can move this finger outward, his/her muscle is either strong or weak, NOT paralyzed.

43. To test for muscle strength: Tell the patient to resist with all his/her strength while you try to push his/her little finger inward. Push with your index finger at the base of his/her small finger, NOT at the top. Step 4: Ulnar Nerve Assessment:

44. Voluntary muscle test for the Ulnar Nerve.

45. Findings: If you cannot push his/her little finger in, then the muscle is strong. If you can push it in, the muscle is weak. Repeat with the other hand and record your findings. If he/she was not able to move the little finger at all, the muscle is paralyzed. Step 4: Ulnar Nerve Assessment:

46. To test for muscle strength: The key movement is thumb up. Let the patient’s hand rest on your hand, palm facing upwards. Ask him/her to move his thumb towards his/her face so that it is perpendicular to the palm. If he/she can move the thumb up, his/her muscle is either strong or weak, NOT paralyzed. Step 5: Median Nerve Assessment:

47. To test for muscle strength: Tell the patient to resist with all his/her strength while you try to push the thumb back towards his/her palm. Push with your index finger at the base of his thumb, NOT at the top. Step 5: Median Nerve Assessment:

48. Voluntary muscle test for the Median Nerve.

49. Findings: If you cannot push his/her thumb back towards his/her palm, then the muscle is strong. If you can push it back, the muscle is weak. If he was not able to move his thumb upwards at all, the muscle is paralyzed. Repeat with the other hand and record your findings. Step 5: Median Nerve Assessment:

50. To test for muscle strength: The key movement is wrist up. Hold his/her arm gently but firmly near the wrist. Ask him/her to make a loose fist, then fully extend his/her wrist as shown. If he/she can extend his/her wrist, the muscle is either strong or weak, NOT paralyzed. Step 6: Radial Nerve Assessment:

51. To test for muscle strength: Tell the patient to resist with all his/her strength while you try to push the back of his/her hand using moderate force as shown. Step 6: Radial Nerve Assessment:

52. Voluntary muscle test for the Radial Nerve.

53. Findings: If you cannot push his/her hand down with moderate force, then the muscle is strong. If you can push the hand down, the muscle is weak. If he/she was not able to extend his/her wrist at all, the muscle is paralyzed. Repeat with the other hand and record your findings. Step 6: Radial Nerve Assessment:

54. To test for muscle strength: The key movement is foot up. The patient should sit comfortably with both feet flat on the floor. Ask him/her to lift his/her foot up as high as possible while keeping his/her heel on the floor. If he/she can lift his/her foot, the muscle is either strong or weak, NOT paralyzed. Step 7: Common Peroneal Nerve Assessment:

55. To test for muscle strength: Tell the patient to resist with all his strength while you try to push his foot down as shown. Step 7: Common Peroneal Nerve Assessment:

56. Voluntary muscle test for the Common Peroneal Nerve.

57. Findings: If you cannot push his/her foot down, then the muscle is strong. If you can push the foot down, the muscle is weak. If he/she was not able to move his/her foot upwards at all, the muscle is paralyzed. Repeat with the other foot and record your findings. Step 7: Common Peroneal Nerve Assessment: