Rivermead Visual Gait Assessment

08-04-2021

Rivermead Visual Gait Assessment

Rivermead Cognitive Assessment
Gait Assessment Rating Scale
Functional Gait Assessment
Rivermead Assessment Tool
Gait Assessment Nursing

Clinical Placement I (PHT 5901)

Seven of the 15 articles studied the Tinetti Gait Scale (TGS), 2 studied the Rivermead Visual Gait Assessment (RVGA), 1 studied the Gait Assessment and Intervention Tool (G.A.I.T.), 3 studied the Wisconsin Gait Scale, and one of them compared the TGS and the G.A.I.T.The scale that appears to be the most suitable for both clinical practice. 'Visual gait analysis the development of a clinical October 24th, 1995 - Lord S Halligan P Wade D Objectives To develop and evaluate a four point scale visual gait assessment form the Rivermead Visual Gait Assessment RVGA for clinical use with patients with. Outcome assessments were measured at baseline and post‐treatment Weeks 6 and 12. Spasticity was assessed by Modified Ashworth Scale and Tardieu Scale. Balance and gait functions were assessed by Berg Balance Scale, Timed Up and Go test, and Rivermead Visual Gait Assessment. Background: Visual gait assessment is a cost-effective clinical method to assess post-stroke gait deviations. The Rivermead Visual Gait Assessment (RVGA) is a one such measure that assesses the kinematic aspect of the gait deviations in stroke.

Between January and April of the first year of the Master’s program, students complete the first clinical placement I with physiotherapists working in long term care facilities. The students are divided into teams. Each week teams receive presentations and participate in practical sessions with physiotherapists on different service sectors in long term care. The program runs Tuesday afternoons from 1:00 to 4:00 pm. Teams have the opportunity to rotate through each service sector; i.e. neurology, geriatric rehabilitation, complex continuing care, and occupational health. The focus of this first clinical experience is on the evaluation of movement. The sessions also include an inter-professional component with emphasis on the role of other health care disciplines in the evaluation of movement. The final four weeks of the placement students shadow an assigned physiotherapist (clinical instructor) at a long term care facility.

Clinical Placement II (PHT 5902)

Clinical placement 2 is a five-week full-time placement occurring in the first year of the Master’s program. This placement can take place with physiotherapists (clinical instructors) working in the practice areas of musculoskeletal and / or neurology. The student will require close supervision when managing patients with frequent monitoring and feedback. By the end of the placement, the student should begin to share a caseload with the clinical instructor.
Clinical Placement II

The student should, with supervision and assistance as needed, be able to assess:

Perception of pain using an objective scale;

Surface anatomy (palpation);

Joint range in relation to and feel, spasm and pain;

Active, passive and resisted movements using selective tension testing;

Joint range of motion using appropriate instruments;

Muscle strength (using the numerical grading system);

Deep tendon reflexes;

Movement analysis;

Sensation (tactile, proprioceptive and thermal);

Posture (normal and abnormal);

Gait (normal and abnormal);

Need for standard ambulation aids;

State of consciousness (Glasgow);

Muscle tone (hypertonicity with the aid of the Ashworth scale, hypotonicity, rigidity, dystonia and associated reactions);

Fine and gross motor skills;

Functional activities;

Patterns of voluntary movement (synergy and out of synergy);

Co-ordination;

Balance, Mobility and functional abilities with outcome measures: Duncan Functional Reach Test, Berg Balance Scale, Tinetti Scale, Clinical Test for Sensory Interaction in Balance, Timed Up and Go, Dynamic Gait Index, Speed of Walking over 10m, Borg Scale and Functional Independence Measure.

Treatment Techniques reviewed in class:

Rehabilitation with the Systems approach;

Transfer and mobility training;

Re-education of upper extremity control;

Gait training (treatment of the different phases);

Passive mobilisation and muscle stretching (exercises to improve range of motion and flexibility);

Stimulation techniques for impaired sensation (exteroceptive and proprioceptive);

Exercise to improve activity tolerance;

Feedback (verbal, visual and manual guidance);

Exercise within functional context;

Exercises to improve fine and gross motor skills;

Functional sequence (mat work);

Different assistive devices or orthotic;.

Exercises to develop muscle strength (isometric, eccentric and concentric exercises);

Exercises to develop joint range of motion;

Exercises to improve posture;

Exercises to improve muscular flexibility;

Exercise therapy – active, passive and active-assisted movements;

Massage;

Relaxation techniques;

Vertebral manual traction;

Bandaging;

Measuring for and instructing clients in the use of ambulation aids (crutches, canes and walkers).

Hot packs;

Wax bath;

Russe current and Electrical muscle stimulation (e.g. Respond II);

Pneumatic compression unit;

Cryotherapy (ice cube massage, immersion and ice packs);

Cervical and lumbar mechanical traction;

Hydrotherapy (pool and Hubbard tank);

Ultrasound and laser;

T.E.N.S;

Interferential currents;

Iontophoresis;

Introduction to electro-acupuncture.

Clinical Placement III (PHT 6903)

Clinical placement 3 is a five-week full-time placement occurring during the second year of the Master’s program. This placement can take place in the musculoskeletal, cardio-respiratory and/or neurological practice areas. At the beginning of the placement the student will require clinical supervision 75% of the time managing patients. By the end of the clinical placement the student should require clinical supervision less than 50% of the time and should be able to maintain 30% of a full-time physiotherapist’s case load.

The student should, with assistance as needed, be able to:

Interview the client / family to obtain relevant subjective data;

Identify pertinent information from the client’s records;

Develop and utilize observational skills;

Assess perception of pain using an objective scale;

Develop and utilize palpation skills (surface anatomy);

Assess joint range in relation to end feel, spasm and pain;

Perform an assessment using selective tension testing with active, passive and resisted movements;

Measure joint range of motion using appropriate instruments;

Measure limb girth and leg length;

Test ligamentous stability of the peripheral and vertebral joints (upper quadrant only);

Assess muscle strength (using the numerical grading system);

Establish a differential diagnosis (using specific tests for each joint);

Test deep tendon reflexes;

Perform movement analysis;

Test sensation (tactile, proprioceptive and thermal);

Develop nerve stimulation (for diagnosis);

Assess posture (normal and abnormal);

Assess gait (normal and abnormal);

Assess the need for standard ambulation aids;

Perform a rheumatological assessment, taking into account the active phase of the pathology, damaged joints and tender points;

Assess state of consciousness (Glasgow);

Assess functional communication skills (aphasia, dysarthria);

Assess cranial nerve function;

Assess muscle tone (hypertonicity with the aide of the Ashworth scale, hypotonicity, rigidity, dystonia and associated reactions);

Assess fine and gross motor skills;

Assess postural control;

Assess functional activities;

Assess patterns of voluntary movement (synergy and out of synergy);

Assess deep tendon reflexes;

Assess co-ordination;

Determine the Influence of other systems (cardiac, pulmonary, urinary, etc.);

Assess balance, mobility and functional abilities with outcome measures: Duncan Functional Reach Test, Berg Balance Scale, Tinetti Scale, Clinical Test for Sensory Interaction in Balance, Timed Up and Go, Dynamic Gait Index, Speed of walking over 10 meters, Borg Scale and Functional Independence Measure, Short Physical Performance Battery, Community Balance and Mobility Scale;

Use an observational gait assessment (without a specific scale), Functional gait assessment;

Complete a gait assessment rating scale, Rivermead visual gait assessment;

Assess motor control and sensory status in patients with spinal cord injuries with the aid of the ASIA classification;

Assess motor control in patients with a CVA, with the aide of the Chedoke-McMaster Stroke Assessment;

Assess static and dynamic balance using the Gentile’s taxonomy;

Assess the presence of Benign Paroxysmal Positional Vertigo with the aid of the Dix-Hallpike Manoeuvre;

Assess using IPPA (inspection, palpation, percussion and auscultation);

Assess rate and pattern of respiration;

Assess central and peripheral cyanosis;

Assess cough (intensity) / secretions (volume & colour);

Assess the use of accessory muscles;

Take a pulse;

Take blood pressure;

Assess the area, intensity, the phase of inspiration / expiration, normal and abnormal breath sounds;

Treatment Techniques reviewed in class:

Exercises to develop muscle strength (isometric, eccentric and concentric exercises);

Exercises to develop joint range of motion;

Exercises to improve posture;
Exercises to improve muscular flexibility;

Exercise therapy – active, passive and active-assisted movements;

Massage;

Relaxation techniques;

Vertebral manual traction;

Bandaging;

Use of different assistive devices. Measuring for and instructing clients in the use of ambulation aids (crutches, canes and walkers);

Treatment planning for the following conditions: back and neck pain, fractures (weight bearing and non-weight bearing), tendon ruptures, sprains, subluxations and total hip and knee replacements, soft tissue injuries;

Hot packs;

Wax bath;

Peripheral nerve stimulation;

Russe current and Electrical muscle stimulation (e.g. Respond II);

Pneumatic compression unit;

Cryotherapy (ice cube massage, immersion and ice packs);

Cervical and lumbar mechanical traction;

Hydrotherapy (pool and Hubbard tank);

Ultrasound;

T.E.N.S.;

Interferential currents;

Iontophoresis;

Laser;

Rehabilitation with the Systems approach;

Transfer and mobility training;

Re-education of equilibrium and postural control in sitting and standing;

Re-education of upper extremity control;

Gait training (treatment of the different phases);

Passive mobilisation and muscle stretching (exercises to improve range of motion and flexibility);

Stimulation techniques for impaired sensation (exteroceptive and proprioceptive);

Exercise to improve activity tolerance;

Feedback (verbal, visual, manual guidance and biofeedback);

Exercise within functional context;

Motor learning approach to treatment;

Facilitation and inhibition techniques;

Exercises to improve fine and gross motor skills;

Equilibrium exercises in a functional context and with the use of Gentile’s taxonomy;

Work on the functional sequence (mat work);

Breathing exercises (diaphragmatic, pursed lip breathing);

Coughing techniques (assisted, splinting and forced expiratory technique);

Secretions mobilisation techniques [percussion, vibration, postural drainage, autogenic drainage, positive expiratory pressure devices (acapella, flutter)];

Massage, rib lifts, inter-costal stretches to improve ventilation;

Positioning, transfers, mobilisation and ventilation / perfusion matching to improve cardiorespiratory status;

Suctioning (oral, tracheostomy tube, endotracheal tube).

Rivermead Cognitive Assessment

Clinical Placement IV (PHT 6904)

Clinical placement 4 is a five-week full-time placement occurring during the second year of the Master’s program. This placement can take place in musculoskeletal, cardio-respiratory and / or neurological practice areas. At the beginning of the placement the student will require clinical supervision 50% of the time managing patients. By the end of the clinical placement the student should be able to maintain 50% of a full-time physiotherapist’s case load.
Clinical Placements III and IV
The student should, with assistance as needed, be able to:

Interview the client / family to obtain relevant subjective data;

Identify pertinent information from the client’s records;

Develop and utilize observational skills;

Assess perception of pain using an objective scale;

Develop and utilize palpation skills (surface anatomy);

Assess joint range in relation to end feel, spasm and pain;

Perform an assessment using selective tension testing with active, passive and resisted movements;

Measure joint range of motion using appropriate instruments;

Measure limb girth and leg length;

Test ligamentous stability of the peripheral and vertebral joints (upper quadrant only);

Assess muscle strength (using the numerical grading system);

Establish a differential diagnosis (using specific tests for each joint);

Test deep tendon reflexes;

Perform movement analysis;

Test sensation (tactile, proprioceptive and thermal);

Develop nerve stimulation (for diagnosis);

Assess posture (normal and abnormal);

Assess gait (normal and abnormal);

Assess the need for standard ambulation aids;

Perform a rheumatological assessment, taking into account the active phase of the pathology, damaged joints and tender points;

Assess state of consciousness (Glasgow);

Assess functional communication skills (aphasia, dysarthria);

Assess cranial nerve function;

Assess muscle tone (hypertonicity with the aide of the Ashworth scale, hypotonicity, rigidity, dystonia and associated reactions);

Assess fine and gross motor skills;

Assess postural control;

Assess functional activities;

Assess patterns of voluntary movement (synergy and out of synergy);

Assess deep tendon reflexes;

Assess co-ordination;

Determine the Influence of other systems (cardiac, pulmonary, urinary, etc.);
Assess balance, mobility and functional abilities with outcome measures: Duncan Functional Reach Test, Berg Balance Scale, Tinetti Scale, Clinical Test for Sensory Interaction in Balance, Timed Up and Go, Dynamic Gait Index, Speed of walking over 10 meters, Borg Scale and Functional Independence Measure, Short Physical Performance Battery, Community Balance and Mobility Scale;

Use an observational gait assessment (without a specific scale), Functional gait assessment;

Complete a gait assessment rating scale, Rivermead visual gait assessment;

Assess motor control and sensory status in patients with spinal cord injuries with the aid of the ASIA classification;

Assess motor control in patients with a CVA, with the aide of the Chedoke-McMaster Stroke Assessment;

Gait Assessment Rating Scale

Assess static and dynamic balance using the Gentile’s taxonomy;

Assess the presence of Benign Paroxysmal Positional Vertigo with the aid of the Dix-Hallpike Manoeuvre;

Assess using IPPA (inspection, palpation, percussion and auscultation);

Assess rate and pattern of respiration;

Assess central and peripheral cyanosis;

Assess cough (intensity) / secretions (volume & colour);

Assess the use of accessory muscles;

Take a pulse;

Take blood pressure;

Assess the area, intensity, the phase of inspiration / expiration, normal and abnormal breath sounds;

Treatment Techniques reviewed in class:

Exercises to develop muscle strength (isometric, eccentric and concentric exercises);

Exercises to develop joint range of motion;

Exercises to improve posture;

Exercises to improve muscular flexibility;

Exercise therapy – active, passive and active-assisted movements;

Massage;

Relaxation techniques;

Vertebral manual traction;

Bandaging;

Use of different assistive devices. Measuring for and instructing clients in the use of ambulation aids (crutches, canes and walkers);

Hot packs;

Wax bath;

Peripheral nerve stimulation;

Russe current and Electrical muscle stimulation (e.g. Respond II);

Pneumatic compression unit;

Cryotherapy (ice cube massage, immersion and ice packs);

Cervical and lumbar mechanical traction;

Hydrotherapy (pool and Hubbard tank);

Ultrasound;

T.E.N.S.;

Interferential currents;

Iontophoresis;

Laser;

Rehabilitation with the Systems approach;

Transfer and mobility training;

Re-education of equilibrium and postural control in sitting and standing;

Re-education of upper extremity control;
Gait training (treatment of the different phases);

Passive mobilisation and muscle stretching (exercises to improve range of motion and flexibility);

Stimulation techniques for impaired sensation (exteroceptive and proprioceptive);

Exercise to improve activity tolerance;

Feedback (verbal, visual, manual guidance and biofeedback);

Exercise within functional context;

Motor learning approach to treatment;

Facilitation and inhibition techniques;

Exercises to improve fine and gross motor skills;

Equilibrium exercises in a functional context and with the use of Gentile’s taxonomy;

Work on the functional sequence (mat work);

Breathing exercises (diaphragmatic, pursed lip breathing);

Coughing techniques (assisted, splinting and forced expiratory technique);

Secretions mobilisation techniques [percussion, vibration, postural drainage, autogenic drainage, positive expiratory pressure devices (acapella, flutter)];

Massage, rib lifts, inter-costal stretches to improve ventilation;

Positioning, transfers, mobilisation and ventilation / perfusion matching to improve cardiorespiratory status;

Suctioning (oral, tracheostomy tube, endotracheal tube);

Clinical Placement V (PHT 6905)

Clinical placement 5 is a six-week full-time placement occurring during the second year of the Master’s program. This placement can take place in any area of physiotherapy practice. At this level the student should be consistent and proficient in simple tasks. By the end of the clinical placement the student should be able to maintain 75% of a full-time physiotherapist’s case load.
Clinical Placements V and VI
The student should, with assistance as needed, be able to:

Interview the client / family to obtain relevant subjective data;

Identify pertinent information from the client’s records;

Make a differential diagnosis of a systemic problem, which could mimic a musculo-skeletal problem;

Develop and utilize observational skills;

Assess perception of pain using an objective scale;

Develop and utilize palpation skills (surface anatomy);

Assess joint range in relation to end feel, spasm and pain;

Perform an assessment using selective tension testing with active, passive and resisted movements;

Measure joint range of motion using appropriate instruments;

Measure limb girth and leg length;

Test ligamentous stability of the peripheral and vertebral joints;

Assess muscle strength (using the numerical grading system);

Establish a differential diagnosis (using specific tests for each joint);

Test deep tendon reflexes;

Perform movement analysis;

Test sensation (tactile, proprioceptive and thermal);

Develop nerve stimulation (for diagnosis);

Assess posture (normal and abnormal);

Assess gait (normal and abnormal);

Assess the need for standard ambulation aids;

Perform a rheumatological assessment, taking into account the active phase of the pathology, damaged joints and tender points;

Assess the upper and lower quadrant: specific assessment of each joint using Maitland technique (manual therapy);

Perform a cervical and lumbar scan;

Assess state of consciousness (Glasgow);

Assess functional communication skills (aphasia, dysarthria);

Cranial nerve function;

Assess muscle tone (hypertonicity with the aide of the Ashworth scale, hypotonicity, rigidity, dystonia and associated reactions);

Assess fine and gross motor skills;

Assess postural control;

Assess functional activities;

Assess patterns of voluntary movement (synergy and out of synergy);

Assess deep tendon reflexes;

Assess co-ordination;

Use an observational gait assessment (without a specific scale), Functional gait assessment;
Complete a gait assessment rating scale, Rivermead visual gait assessment;
Assess motor control and sensory status in patients with spinal cord injuries with the aid of the ASIA classification;

Assess motor control in patients with a CVA, with the aide of the Chedoke-McMaster Stroke Assessment;

Assess static and dynamic balance using the Gentile’s taxonomy;

Assess the presence of Benign Paroxysmal Positional Vertigo with the aid of the Dix-Hallpike Manoeuvre;

Assess using IPPA (inspection, palpation, percussion and auscultation);

Assess rate and pattern of respiration;

Assess central and peripheral cyanosis;

Assess cough (intensity) / secretions (volume & colour);

Assess the use of accessory muscles;

Take a pulse;

Take blood pressure;

Assess the area, intensity, the phase of inspiration / expiration, normal and abnormal breath sounds;

Treatment Techniques reviewed in class:

Exercises to develop muscle strength (isometric, eccentric and concentric exercises);

Exercises to develop joint range of motion;

Exercises to improve posture;

Exercises to improve muscular flexibility;

Exercise therapy – active, passive and active-assisted movements;

Massage;

Relaxation techniques;

Vertebral manual traction;

Bandaging;

Use of different assistive devices. Measuring for and instructing clients in the use of ambulation aids (crutches, canes and walkers);

Management of amputees including: stump bandaging, developing specific exercise programs and gait training. (Clinical placement VI only);

Principles and applications of prosthetics and orthotics. (Clinical placement VI only);

Principles of manual therapy treatments;

Manual therapy: upper and lower quadrant;

Accessory movements of the peripheral and vertebral joints;

Hot packs;

Wax bath;

Peripheral nerve stimulation;

Russe current and electrical muscle stimulation (e.g. Respond II);

Pneumatic compression unit;

Cryotherapy (ice cube massage, immersion and ice packs);

Cervical and lumbar mechanical traction;

Hydrotherapy (pool and Hubbard tank);

Ultrasound;

T.E.N.S.;

Interferential currents;

Iontophoresis;

Laser;

Rehabilitation with the Systems approach;

Transfer and mobility training;

Re-education of equilibrium and postural control in sitting and standing;

Re-education of upper extremity control;

Gait training (treatment of the different phases);

Passive mobilisation and muscle stretching (exercises to improve range of motion and flexibility);

Stimulation techniques for impaired sensation (exteroceptive and proprioceptive);

Exercise to improve activity tolerance;

Feedback (verbal, visual, manual guidance and biofeedback);

Exercise within functional context;

Motor learning approach to treatment;

Facilitation and inhibition techniques;

Exercises to improve fine and gross motor skills;

Equilibrium exercises in a functional context and with the use of Gentile’s taxonomy;

Work on the functional sequence (mat work);

Breathing exercises (diaphragmatic, pursed lip breathing);

Coughing techniques (assisted, splinting and forced expiratory technique);

Secretions mobilisation techniques [percussion, vibration, postural drainage, autogenic drainage, positive expiratory pressure devices (acapella, flutter)];

Massage, rib lifts, inter-costal stretches to improve ventilation;

Positioning, transfers, mobilisation and ventilation / perfusion matching to improve cardiorespiratory status;

Suctioning (oral, tracheostomy tube, endotracheal tube).

Clinical Placement VI (PHT 6906)

Clinical placement 6 is a six-week full-time placement occurring near the completion of the second year of the Master’s program. This placement can take place in any area of physiotherapy practice. At this level the student should be consistent and proficient in simple tasks. By the end of the clinical placement the student should be able to maintain 75% of a full-time physiotherapist’s case load.
Clinical Placements V and VI
The student should, with assistance as needed, be able to: