CHAPTER 17 Objective assessment (general observation)
These signs will primarily be observed as the patient enters the department, or during the subjective and objective assessments. They may not be formally assessed by the therapist but may require referral to another professional as appropriate.
Does the patient wear glasses? What do they wear them for? Will they need them on for therapy? When was their last eye check? Often individuals have retained old glasses that are now unsuitable.
This will have been apparent during the subjective assessment. Do they wear a hearing aid? Is it switched on? Is it clogged with wax? If they are not wearing one, should they be? Be sensitive when questioning the patient, poor concentration/attention may present similarly.
Does the patient have a problem expressing her/himself or understanding your requests? This could be related to the points above or a deficit of speech or cognition.
Does the patient have trouble concentrating during the assessment? Do they have difficulty understanding instructions or solving a simple problem? Do they have difficulty dressing or undressing? Do they perform tasks in the wrong order or miss out elements of the task?
Any cognitive and perceptual deficit will have implications for your communication with the patient and hence the success of any interaction. S3.33 may give the therapist some insight into the cause of these presentations.
Does the patient appear unkempt? This may indicate that the patient is not coping at home. Sensitive questioning may be required but this is not essential immediately. Presentation of certain postures may also be indicative of a clinical pathology. For example, a slouched, flexed posture in combination with other signs and symptoms may suggest clinical depression.
Does the patient behave inappropriately (physically or verbally)? Are they inappropriately euphoric or tearful? Are they aggressive? Any aggressive behaviour needs to be highlighted to the rest of the multidisciplinary team (MDT) and a risk assessment carried out. These presentations could indicate damage to the frontal lobe, limbic system or may reflect a mental health problem. As such differential diagnosis is crucial, these complex presentations require a comprehensive assessment by a competent professional.