What it is built on
- Stroke rehabilitation. Stroke Foundation, Australian and New Zealand Living Clinical Guidelines for Stroke Management
- Measures. Berg Balance Scale; 10-metre walk test; Modified Ashworth Scale
How to use it: Free Evidence-Based Physiotherapy Note Templates
History
- Date of stroke Short answer
- Side affected Choose one: Left · Right · Both · Unclear
- Hospital course and medical history Written answer
- Home and family support Written answer
- Patient and family goals Written answer
Assessment
- Tone (Modified Ashworth) and sensation Written answer
- Movement and strength Written answer
- Berg Balance Scale (out of 56) Number
- 10-metre walk test (m/s) Number
- Bed mobility and transfers Written answer
- Arm and hand function Written answer
- Communication, swallowing and cognition notes Written answer
Plan
- Clinical impression Written answer
- Treatment today Written answer
- Home program and family training Written answer
- Plan and frequency Written answer
A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.