Progressive Resistive Exercise Therapy

Running Head: ASSESSMENT TOOLS
ASSESSMENT TOOLS
Name of the Student
Name of the University
Author’s Note

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Case Study 1
Meri is a Maori New Zealander widow of 54 year old and lives in Rotorua. She has 3
children who live in Australia and New Zealand and her time in acute care was coming to an
end. She was admitted to the hospital because she experienced stroke 2 weeks back. She wants to
leave the healthcare and go back to her house, where she is lives with her sister. Her sister keeps
visiting her to assist her regarding her personal needs, but Meri only wants to get back to her
home where she can liver her life with independence without the interference of other people.
Meri has been given a team of clinicians that includes occupational therapists, physiotherapists,
nurse, speech language therapists, social worker and rehabilitation center. Meri has some health
complications that needs to be taken care of with the help of culturally appropriate assessment
tools. Her mobility is restricted because she is unable to move independently and needs support
for her daily tasks and personal care routines, she feels fatigued and has cognitive deficits, lacks
confidence with communication (aphasia), and has limited use of her right arm. There are some
assessment tools used for assessing the medical condition of patients in a medical setting. An
assessment tools depends on the type of condition a person has such as Nottingham Extended
Activities of Daily Living Scale (NEADL) is used for the patients who suffer from stroke and
Berg Balance scale that is used as a geriatric assessment specifically for patients with immobility
and stroke. These assessment tools will be used for identifying rehabilitation needs for Meri.
NEADL is a widely used scale to measure disability and chronic diseases through a score
sheet that gives a score regarding the intensity of the health complication. It has questions about
the daily professional and domestic tasks that requires their efforts and gives a result about their
medical condition (Wu et al., 2016). It is a set of 20-30 questions that has questions about the
daily activities such as the walking routine of a person, the activity of climbing stairs, how often

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the car is used, walking over uneven ground, crossing roads, travelling on public transports,
manage to feed their own selves, manage to make drinks on their own, taking hot drinks from
one room to another, washing clothes on our own, cooking by themselves, managing finances on
their own, able to wash small items on their own, doing the housework on their own, able to do
their own shopping, reading books or newspaper, using television, writing letters, being social
and meeting people, able to manage their own garden and driving the car by themselves. These
questions are answered with the help of different options such as No, With Help, On your own
with difficulty and On your own (Drummond et al., 2017). The options chosen in this
questionnaire has scores, which is calculated after the assessment is done. Meri had issues in her
mobility and this is the reason she had complains of immobility, so this will be the appropriate
tool of assessment for her health conditions. Due to stroke several cognitive impairment occurs
that can lead to certain neuromuscular and nervous system disorders. This can increase issues in
communication and social interaction due to lack of confidence. This assessment tool focuses on
all aspects that are needed for our daily tasks, which makes it accurate and increases validity.
Berg Balance scale is used to measure the balance and ability in older adults. It is a
qualitative measure that is done with the help of functional activities to assess the balance in
older adults during any physical health complication or disability. The normal functions are such
as bending, standing, transferring, reaching, putting feet together, stooping down to pick
something, standing in a single leg stance, using feet in a Romberg position (Downs, Marquez &
Chiarelli, 2014). It has a 5 point scale in which 0 suggests the minimum functionality and 4
suggests that there are no complications. The overall score ranges from 0-56 and it is a reliable
assessment tool because it guarantees validity and reliability. It is a performance based measure
that helps in assessing the balance and risk of falls in the older population. It is popular for acute

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day care patients because this scale is mostly used in high functioning adults in active
communities, which makes this scale give a ceiling effects that is unpredictable. It is a widely
used assessment tool and is the best for evaluating the balance of a person especially in people
with immobility or physical impairment (Maeda et al., 2015).
These two assessment tools will Meri’s team in analyzing her complications that lead to
her treatment in the rehabilitation. It will give a wider idea about his condition and the
convenient way of handling the complication.
Case Study 2
James is a 43 year old, Maori who lives in New Zealand with no caretaker. In the
OREBRO Musculoskeletal Pain Screening Questionnaire: Short Form, he got a score of 75 that
qualified him for the ACC Pain Management Services. His recent concern is his mobility in
physical functionality and pain during movements. He went through a stable symptomatic
compression fracture of T12 and L1 when he participated in a motocross (dirt bike) event
(Gopinath et al., 2015). His fracture has healed but currently he is 6 months post injury and he is
assessed by 3 health professionals. The goals for his assessment was that he needs to improve his
self-efficacy and catastrophe according to the decrease in his PCS and PSEQ scores (Nicholas et
al., 2017). James is an overweight so he needs to reduce his BMI and adapt ways to decrease his
depression and stress in the DASS21 scale. Eventually, he needs to improve his physical activity
by being able to walk 20 minutes on a flat surface, lift 8 kg from ground to waist, and mow his
lawn over 2 sessions.
The assessment forms by the 3 health professionals such as the nurse, physiotherapist and
occupational therapist will be utilized to meet his goals because the score sheets from different

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assessment tools gives an idea about his complications in various parts of his body. The Orebro
short-form interprets that he has a very high pain in his body and the pain interference in itself is
high, and this suggests that his physical pain is in a critical stage that is going out of his control
(Beales et al., 2016). The DASS21 score sheet suggests that his depression and stress is in the
severe range, his self-efficacy was measured with the PSEQ and PCS score that gave a score of 8
suggesting a severe range. He is an overweight so his BMI was 27.4. His functional abilities
assessment displayed his capabilities in physical movement, which was moderate according to
his condition. In the second and final assessment after his care and treatment his assessment
sheet turned out to be normal. His Orebro short-form was in the normal range, pain severity was
moderate, pain interference was low, his depression and stress levels were low as well, PSEQ
and PSC scores were low but BMI was still the same without any significant change. Eventually,
his functional abilities assessment were improved and he was able to lift and stand in the upright
position (Fuhro et al., 2016). These inputs will be utilized to improve his mobility and his mental
health conditions but from the final assessment sheet it is evident that his condition is enhanced
from before, except his BMI. This assessment will be used to reduce his BMI and decrease his
weight through several methods. He will be given physical activities with moderate mobility
according to his condition and his diet will be altered so that he is able to reduce his weight with
a consistency (Nanthakumar et al., 2015).
The effectiveness for James will be analyzed by utilizing the assessment data provided
from the perspective of the 3 health professionals. There is a vast difference seen between both
the assessment sheets after the monitoring and supervision of health professionals because the
nurse will assess his vital signs that includes his body mass index and enquiry about his daily
activities, the physiotherapist assessed his Orebro-short form, pain severity, pain interferences

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and his functional abilities. Whereas, the occupational therapist is useful for assessing the
DASS21 form, which focuses on anxiety, depression and stress. These 3 have been selected for
their specializations and experiences they offer for revival of James’s health conditions. The
Orebro short-form was essential in determining the pain and complications due to his fracture,
which also gave an idea about his mobility in lifting and walking. He works in an engineering
workshop with moderate work in his office and he worked 40 hours per week before his injury
but it ended up to 35 hours per week after his injury. The assessment data is beneficial for his
treatment and surveillance because it shows a clear picture about his fractures as well as his
mental health. These assessment sheets were utilized by the health professionals, which led to his
improvement in the final assessment sheet. His scores turned out to be effective for him because
the Orebro short-form sheet detected that he was qualified for the ACC Pain Management
Services. It can be said that these assessment tools are essential in the healthcare sector due to its
efficiency and accuracy in determining the pain and mobility of a patient. It also calculated the
score of the mental distress a patient is going through. It is a full health profile including fracture
condition, mental health and weight issues.
Occupational therapists can manage chronic pain in the patient with the help of different
pain management activity and self-management approaches. Assessment of pain and
rehabilitation of the patient are two important roles of the occupational therapists. In this case
study, different questionnaires are used; such as VAS, DASS 21, PSEQ and PCS scales. VAS
(Visual Analogue Scale) is a psychometric test where patient can rate the pain from “no pain at
all” to “my pain is as bad as it possible” (Delgado et al.,2018). This scale analyses the pain
during pharmacological pain management therapy. VAS scale measures the intensity of pain
which is used to analyze the condition of rheumatic diseases among the diverse adult population.

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VAS is more sensitive to the small changes and simple ordinal scale such as mild or slight,
moderate or severe. VAS needs less than one minute for the assessment. DASS 21 is a self-report
instrument and needs no special skills for administering the scale in the assessment of patient’s
condition. The therapists should recognize depression, stress and anxiety after the injury. To
reduce depression and anxiety in the patient, the therapists can involve him into non-strenuous
social activities. PSEQ questionnaire is used for validating and identifying the chronic lower
back pain assessment (Chiarotto et al., 2016). Pain Self Efficacy Questionnaire is used for
assessing the confidence of the patient during the pain management treatment. Therapist should
consider the BMI of the patient to suggest proper interventions to achieve satisfactory goals for
reducing pain. If the BMI index is more than 27, the patient is considered as overweight. BMI or
Body Mass Index should be controlled in a way that the individual should score between 18.5 -
24.9 as this range of score signifies normal weight of an individual (Campbell et al., 2016). PCS
or Pain Catastrophizing Scale assesses psychometric as well as the pain experiences of the
patient with different phrases (Tuna et al., 2018). Therapists can involve instrumental ADL
trainings to the patients (Afzal et al., 2019). Therapist should include 5 sit to stand test to suggest
better intervention to the patient. Gross motor coordination, fine motor coordination, seating
tolerance are the aspects where the occupational therapists can suggest different interventions.
The patient is over-weight so that physical exercises to reduce weight should be involved in the
plan of interventions to achieve the goals. Scores after the final assessment of patient’s condition
shows that the pain has been reduced. Relaxation and visual interventions are used in the
enhancement of the physical activity with the cognitive development of the patient. Progressive
resistive exercise supports to increase the ability to lift weight of 8kg (Yousefian, Sadeghi, &
Kahlaee, 2017). To improve the walking ability of the patient therapist could take the help of

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different types of walking aids such as canes, walkers and crutches. He should be assisted by the
occupational therapist to increase the mobility. Mobility training and GAIT trainings are
associated with the treatment of the pain management in a patient with lower back pain.

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