Hi Robyn!
Great question! From what I can tell, it depends on the inpatient setting (i.e. hospital, SNF, etc) and, even then, there are not specific guidelines. For these situations, we are directed to each individual state’s practice act and the policies of the facility.
Please check out this link referencing the APTA and see if this answers your question!
Thank you for choosing our course to help you with your studying!
Melissa
In my experience, differentiating between central and peripheral dysfunction starts with their subjective explanation of their symptoms. I listen and probe for key words to help me determine my differential diagnoses (vertigo, imbalance, light-headed, swimming) along with when they experience their symptoms – such as always with head movement or not. I, then, complete a thorough oculomotor exam including individual tests for the CNS and peripheral vestibular system. Collectively, this will help identify any “red flags” implying any undetected CNS involvement such as a tumor. If this is suspected, I would continue my evaluation with cranial nerve testing, reflex testing, etc. Oculomotor testing that is normal with the exception of VOR or head-thrust test would imply vestibular hypofunction and I would further evaluate balance and coordination. A normal oculomotor exam with no apparent peripheral dysfunction would direct me to the possibility of migraines, motion sensitivity, or something of that nature.
Oculomotor Exam
smooth pursuit (central function)
– spontaneous nystagmus (peripheral)
– gaze evoked nystagmus (central)
saccades (central)
convergence/divergence (central)
VOR (peripheral)
VOR cancellation
head-thrust (peripheral)
optokinetic stimulation (central)
Hope that helps!
Great question, Suzanne! I do not test for 1 RM in the clinic because usually these patients have a multitude of impairments and may be unsafe. I feel that 1 RM is something used more in the healthy population or near discharge depending on the level of the patient and what they are trying to return to.
That being said, there is a way to use % of the 1 RM to get optimal results for resistance training. Below I’ve listed the training intensity vs. number of repetitions that can be used when determining amount of resistance for your patients. Note: The number of reps listed means that at the patient is only physically able to complete that number, no more, with good form in one set. Use clinical judgment to determine what percentage to start your patients at.
100% of 1 RM = 1 rep
95% of 1 RM = 2 reps
90% of 1 RM = 4 reps
85% of 1 RM = 6 reps
80% of 1 RM = 8 reps
75% of 1 RM = 10 reps
70% of 1 RM = 12 reps
65% of 1 RM = 14 reps
60% of 1 RM = 16 reps
Does that help?