As any therapist should know, the initial assessment is unarguably the most important session one can have with a client. Therapy and training depend on an accurate client history, clear tests and measurements and some indication from the first treatment or training that the session is headed in the right direction. Reassessment within the first session will immediately indicate whether the therapist needs to quickly adjust treatment techniques to ensure a positive outcome. Ongoing re-assessment during each session also enable the client to become aware of progress, which is extremely motivating especially if radical changes occur, as they do with FST and other effective manual therapies.
Depending on the therapist and the client, FST assessment may include all or some of the following:
- Subjective interview: It is our experience that a successful interview may provide up to 75% of the information needed to lead the rest of the assessment to an accurate diagnosis. This includes but is not limited to:
o Sleep pattern if known – is/are current symptom(s) related to sleep pattern?
o Medications and side-effects thereof, if known or suspected.
o Occupation to see if it’s a contributing factor.
o Relevant family history.
o Special questions related to cancer, Lyme’s disease, etc.
- Objective tests and/or measurements (note: most tests in manual therapy require static and/or dynamic palpation). Client observation including how client responds to interview, voice quality, energy level, etc. This includes but is not limited to:
o Functional static and dynamic movement patterns relevant to the client including but not limited to:
- ADLs, for example, transfers stand to sit; stand or sit to recumbent; sleeping and driving positions, etc.
- Movement pattern peculiar to the problem at hand, as well as related patterns
- Osteokinematic and arthrokinematic tests
- Osseo-ligamentous integrity-stability tests
- Neurological tests including but not limited to:
- Motor control of specific movement patterns
- Cranial nerves
- Vestibular and other balance tests
- Dermatomes and/or peripheral nerve sensation
- Deep tendon reflexes
- Central nervous system and/or peripheral nerve tension-glide-slide mobility
- Visual tests
- Manual therapy scans: may use all or some of the above to rule out or rule in dysfunction above and/or below the symptomatic region as a contribution to the clinical problem.
- Provocation tests: may use all or some of above to reproduce symptoms so as to have something tangible and relevant to re-assess and guide treatment.
- Therapy localization tests: a specific quick test to temporarily activate what is weak or inhibited and/or inhibit what is over facilitated.
- Assessment: summary of all the findings to provide a differential diagnosis or diagnoses.
- Plan: short and long-term goal setting.
In my next blog, I will focus on the essentials of the subjective interview with your client/patient which, in my experience, can provide up to 75% of the information needed to guide which direction your session should take for best outcomes.
[Note: excerpted from my book “Fascial Stretch Therapy™” available at Amazon.com here: http://budurl.com/FSTbook]
Chris Frederick, PT