The initial assessment is when I get to know you. As an assessment specialist, I believe that a complete history, careful movement evaluations, and stability testing are essential foundations for any therapy type.
Understanding Pain Assessment
Most of my clients come in with pain. I consider myself a pain assessment specialist. However, my work is not in managing pain. Instead, I work to discover the root causing of the motor function problems that cause the pain. These include muscle imbalances, scars, ligament problems, joint compression, etc. Pain is incredibly complex and not always related to the movement disorders that I endeavour to rehab. When they are, almost invariably, the pain is not where the problem is. The 90-minute Initial Assessment includes the following:
- A full history and discussion of current complaints, including pain assessment, analysis of physical discomfort, current movement habits and stressors.
- A standing posture evaluation.
- Movement evaluation of global movement patterns, and movement patterns related to the primary complaints
- Breathing mechanics analysis
- Reflexive stability testing
- Core stability evaluation through muscle testing of core muscles
Clients should prepare to share a full history. This history includes accidents (both minor and major), injuries and physical traumas, surgeries and physical complaints from birth. If you are coming in for an initial assessment, you might take some time to compile this history before you arrive. Please ask living parents about birth trauma and early childhood accidents. I also take into account emotional stressors.
Many of my clients find posture evaluation one of the most interesting parts of the initial assessment. The posture evaluation often helps my clients see how aches and pains in different parts of their bodies are tightly related. It begins with an assessment of how the weight is shared in the feet, correlated with the posture of the rest of the body. Along with the client, I examine relationships between the different parts of the body to one another in all three planes. I take care to educate my clients during this process. I also look at rotational patterns at the ankle, pelvis and neck. These can easily create torsion through the whole system. This part of the evaluation will also often include assessment of excessive tone (tension, trigger points, muscle knots) through the body.
After standing posture evaluation, I will assess some basic global movement patterns. In it’s most basic form, the movement evaluation includes the toe touch pattern, the overhead reach pattern and global rotation patterns. If the client comes with pain in a specific area, such as the hip, I would also do a movement assessment of that joint. Orthopedic tests are also sometimes included in this part of the assessment.
Breathing Mechanics Analysis
Breathing is our most fundamental movement habit. It exists in both the realm of conscious and unconscious movement. It has a very high priority in organizing motor function. Further, breathing also establishes the foundation for core stability. Breathing mechanics analysis is included in this first session as well. Breathing mechanics can consist of 1) testing motor function of the respiratory diaphragm, 2) testing neural patency of muscles of exhalation and their coordination with the respiratory diaphragm 3) assessing movement capacity in the abdomen and thorax 4) CO2 tolerance assessment, and 5) vagal tone assessment.
Reflexive Stability Testing
Reflexive stability testing is also called perturbation. It assesses a client’s ability to recover from an external disturbance to stability with reactive postural control. Moreover, it offers key information on core stability. I begin this type of testing in a neutral standing position, and progress it to split stance and single leg stance testing. Those with lack of reflexive stability are more likely to fall following a loss of balance. However, the client might be unaware of their lack of stability because of compensation patterns that can hide it in routine movement. Reflexive stability testing can allow me, as an assessor, to hone in on areas of particular significant to global motor control issues.
Initial and Follow Up sessions may also include:
- Assessment for radiculopathy and peripheral nerve entrapment
- Eye movement exams
- Jaw movement assessments
- Instruction on self release techniques
- Corrective strategies such as myofascial release and pin and stretch release
- Scar release and rehabilitation
- Guided neuromotor activation
- Corrective exercise
- Breathing exercises and drills
FAQ – Frequently Asked Questions
- How long is the Initial Assessment? The initial Assessment is 90 minutes long.
- How much does the Initial Assessment Cost? The costs of this session is $150 including HST. Read more about Fees here.
- Does the Initial Assessment include rehab and exercises? Usually there is time for corrections and exercises during the first session. However, occasionally there isn’t enough time. In this case corrections will be done during a follow up session.