General OSCE Process

Question 1

Process of AROM Station

Answer 1

1. Introduce Yourself
2. Explain - You plan on having a look at the movement in a particular area of their body
3. Informed Consent - This will involve me helping to manipulate these movements with my hands. Are you okay with this? Do you have any questions?
4. Get them to take off the necessary clothing (Again, gain consent and explain why we need to do this)
5. Patient Positioning
   - On the bed
   - Adjust the bed height
6. Modesty Towel
7. Make sure part is exposed
8. Demonstrate/Explain the movement you want them to complete
9. Ask if the patient has any resting pain
10. Observe the patient doing this movement on both sides, verbalise the comparison and give a visual estimate of the angle
11. ASK THE PATIENT WHAT THEY FEEL AND WHERE
12. Measure one side with the goniometer (state that you would normally measure 3 times)
13. Provide an over-pressure on the joint
14. Do the same on the opposite leg and again provide a statement of comparison

Question 2

Process of PROM Station

Answer 2

1. Introduce Yourself
2. Explain - You plan on having a look at the movement in a particular area of their body
3. Informed Consent - This will involve me helping to manipulate these movements with my hands. Are you okay with this? Do you have any questions?
4. Get them to take off the necessary clothing (Again, gain consent and explain why we need to do this)
5. Patient Positioning
   - On the bed
   - Adjust the bed height
6. Modesty Towel
7. Make sure part is exposed
8. Ask the patient if they have any resting pain
9. Ask the patient to completely relax as you are going to do all the work
10. Make sure you are in the correct position to complete the motion
11. Guide them through the movement keeping in constant communication if they feel any pain, what they feel and where they feel it.
12. Reach the first resistance (R1) and state that, and ask them if you are okay to go a little further (R2).

Question 3

Process of Palpation Station

Answer 3

1. Introduce Yourself
2. Explain - You are going to feel through some of the structures to see if you can pinpoint the pain they are experiencing
3. Informed Consent - This will involve me feeling through some structures and in order to do this I would like them to remove some clothing (if necessary)
4. Patient Positioning
   - On the bed (If necessary)
   - Adjust the bed height
5. Modesty Towel
6. Make sure part is exposed
7. Ask the patient if they have any resting pain
8. Be able to see the patients face if possible
9. Palpate the muscle origin, insertion and boarders
10. Have the patient perform movements to make the anatomy more prominent (if necessary)

Question 4

Muscle Length Testing

Answer 4

1. Introduce Yourself
2. Explain - You plan on having a look at the flexibility through a part of their body and why.
3. Informed Consent - This will involve me helping to manipulate these movements with my hands. Are you okay with this? Do you have any questions?
4. Get them to take off the necessary clothing (Again, gain consent and explain why we need to do this)
5. Patient Positioning
   - On the bed
   - Adjust the bed height
6. Modesty Towel
7. Make sure part is exposed
8. Ask the patient if they have any resting pain
9. Cue the patient to relax
10. Guide them through the movement
11. For 2-Joint muscles, complete the movement at one joint first before moving at the other joint
12. Ask the patient what they feel and where
13. Complete on both sides and provide a comparison to the patient.

Question 5

Muscle Strength Testing

Answer 5

1. Introduce Yourself
2. Explain - You plan on having a look at the strength they have in a certain area of the body.
3. Informed Consent - This will involve me providing some resistance through some of these movements with my hands. Are you okay with this? Do you have any questions?
4. Get them to take off the necessary clothing (Again, gain consent and explain why we need to do this)
5. Patient Positioning
   - On the bed
   - Adjust the bed height
6. Modesty Towel
7. Make sure part is exposed
8. Demonstrate/Explain the movement you want them to complete
9. Ask if the patient has any resting pain
10. Have the patient start at a G3, provide a resistance if at part of the movement they are not working against gravity.
11. Move through G4 and G5 movements on both sides
12. Ask them how hard they are working to determine the grade
13. Ask them where they feel like they are working
14. Correct any trick movements.
15. Make sure you rationalise why you are doing either an isotonic or isometric movement

Question 6

Exercise Prescription Station

Answer 6

1. Introduce yourself
2. Explain that you would like to have them complete some exercises based off of their condition.
3. Gain informed consent - to show them the exercise and also that when you show them you may correct some of their positioning if need be.
4. Also get them to expose the part, so you can clearly see the part
5. Make sure the space is clear and safe
6. Demonstrate the exercise
7. Have them trial the exercise
8. Prescribe the dosage relative to strength, endurance or stretching and explain why
9. Have them complete the sets and reps of the exercise, so that you can be sure that the exercise is not too hard. Also ask them where they are feeling it so it is in the right spot.
10. Provide them with a way they can make it harder or easier
11. Confirm the exercise and dosage with the patient.

Question 7

Vertebrobasiliar Insufficiency (VBI)

Answer 7

1. Perform anytime you are doing anything in the cervical area (AROM, PROM, Palpation, Muscle strength/length or exercise).
2. Ask the patient if they have been having any recent headaches or pain in the neck region. That have been different from normal.
3. Have they had a incidents of trauma to the head or neck recently?
4. Ask the 5 D’s
   - Dizziness
   - Double vision
   - Difficulty Speaking
   - Difficulty Swallowing
   - Drop attacks (sudden collapse)

Ask the 3 N’s
- Nystagmus (Eye flickering)
- Nausea or vomiting
- Numbness around the mouth

Complete the positional Testing (End range of rotation testing
- Do one side and hold for 10 seconds
- Wait 10 seconds before going to the other side and hold for another 10 seconds