This document discusses the assessment and management of a 28-year-old male who suffered a head injury in a motor vehicle accident one month prior. He is currently in the hospital at Ranchos Los Amigos Level V-VI, exhibiting increased extensor tone in his right lower extremity. The document outlines the key components of assessing a patient at different RLA levels including their medical status, cognitive function, functional mobility, and motor control. It provides questions to address at each level to thoroughly examine the patient and monitor their recovery progress.

1. NITHIN NAIR

2. ASSESSMENT
 HISTORY
 Type of injury and site
Age
PTA duration
Job
Home environment
Educational level
Previous injuries

3. ASSESSMENT
 CLIENT AND FAMILY DATA
Perception of the limitations
Goals
Personal factors
Socio – economic factors relating to
participation limitations

4. ASSESSMENT
 OTHER HEALTH CARE TEAM MEMBER’S EVALUATION
Conduct a complete review of the case paper
of the patient before actually seeing the
patient as he/she may not be medically stable
and to know about the complications and the
precautions to be taken during the
examination and subsequent treatment.

5. ASSESSMENT
 OBSERVATION
ICU – Note the setting of the various
assistive and recording device.
Attitude of the limb
Site and extent of scar (healed/non-healed)
Other associated fractures and injury
Presence of swelling or oedema

6. CLINICAL RATING SCALES
 GLASGOW COMA SCALE
RANCHOS LOS AMIGOS LEVEL OF
COGNITIVE FUNCTIONING

7. GLASGOW COMA SCALE

8. RANCHOS LOS AMIGOS

9. QUESTION
• Discuss ICF & Management of a 28 yr old
male who have suffered with RTA & Had
head injury 1 month back. He is presently
in hospital ward with RLA Level V & VI
and exhibits increased extensor tone in
right lower extremity 3 on modified
Ashworth scale.

10. RLA LEVELS I,II,III
Decreased or low-level response levels of
recovery.
Examination – Acute care – Chart review
Medical Status – Stable/Unstable?
Ventilator / ICP Monitor
Are there any other weight bearing or
ROM precautions – pertaining to other
orthopedic injuries?

11. ASSESSMENT
 KEY QUESTIONS TO ADDRESS
 What posture is the patient in?
 Are the patient’s eyes open or closed
 Is the patient able to respond to auditory or visual
stimulation?
 Is the patient able to vocalize?
 Does the patient exhibit any active movement
(purposeful/non-purposeful)
 Does the patient react to tactile/painful stimulation?
 Do the patient’s vital signs change when external
stimulation is presented?

12. RLA LEVEL IV
Confused-Agitated level of recovery
 Examination – extremely challenging – agitated
and prone to emotional outbursts.
 Verbally acting out – physically hurting
 Confused – poor memory, decreased attention
span.
 Difficult to gather data – patient non-cooperative
 Utilize observational skills and ability to estimate

13. RLA LEVEL IV
 Examine – functional mobility
 Balance – sitting/standing
 Determine patient’s cognitive abilities?
• Orientation
• Memory
• Insight
• Safety awareness
• Alertness

14. ASSESSMENT
 KEY QUESTIONS TO ADDRESS
 Is the patient able to follow commands – one
step, two step, multistep?
 Is the patient oriented to person, place or
time?
 Does the patient recognize family members?
 Beneficial to consult with other team
members

15. RLA LEVEL V & VI
 Confused-Inappropriate and Confused-Appropriate
levels of recovery
Confused, but follows simple commands
More formal and accurate examination
Modified examination – Difficulty in
performing complex tasks
Ongoing examination

16. RLA LEVEL V & VI
 EXAMINATION
Attention & Cognition
Cranial nerves
Balance
Strength
ADL Skills
Functional mobility
Sensory Integrity

17. RLA LEVEL V & VI
 EXAMINATION
Determine functional ability –
opened/closed environment
Out come measures
Examination of motor control – tone ,
coordination, movement patterns.

18. RLA LEVEL V & VI
 KEY QUESTIONS TO ADDRESS
 How well is the balance maintained throughout
the tasks?
 How long does it take to initiate or complete
task?
 Is the patient able to perform task
consistently?
 Does the patient perform the task efficiently –
minimal amount of energy expenditure?
 Can the patient shift the weight forward?
Maintain normal body alignment - Sit to stand?

19. RLA LEVEL VII & VIII
 Appropriate response level of recovery
 Patient is discharged from IPD
 Weaning from external support
 Therapy delivered – emphasis on community re-
entry, return to work or college, cognitive,
behavioral and psychosocial issues.
 Same examination as in level V & VI

20. REFERENCE
NEUROLOGICAL REHABILITATION –
DARCY UMPHRED
PHYSICAL REHABILITATION – SUSAN
B O’SULLIVAN
PHYSIOTHERAPY IN NEURO
CONDITIONS – GLADY SAMUEL RAJ
WWW.GOOGLE.COM (FOR SCALES)