Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination Page 5
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30Pain ________________________________________________________________________________
Pain ________________________________________________________________________________
Headache in combination with neck pain
Headache in combination with neck pain
Tonsillar pillar or external ear pain with swallowing,
Unilateral and pulsating headache
talking, or coughing
Sudden onset neck and occipital pain
Abdominal pain
Chest, neck, and arm pain
Sensory abnormalities___________________________________________________________________
Sensory abnormalities___________________________________________________________________
Peri-oral numbness and paraesthesiae
Quadrilateral paraesthesiae
Unilateral facial paraesthesiae
Trigeminal distribution paraesthesiae
Trigeminal distribution paraesthesiae
Strength___________________________________________________________________________
Strength___________________________________________________________________________
Transient quadriplegia
Facial weakness
Arm fatigue-paralysis
General fatigue
Generalized arm and leg weakness
Chronic fatigue
Visual
abnormalities__________________________________________________________________
Loss of color vision
Loss of color vision
Constant diplopia
Constant diplopia
Visual fi eld defi cits
Visual fi eld defi cits
Tilt illusion
Tilt illusion
Blurry vision
Blurry vision
Photophobia
Photophobia
Diplopia with head movement
Diplopia with head movement
Mental and psychological
status_________________________________________________________
Decreased cognition
Decreased cognition
Stupor
Stupor
Acute confusion
Acute confusion
Anxiety
Anxiety
Memory defi cits
Memory defi cits
Depression
Depression
Other_______________________________________________________________________________
Diaphoresis
Diaphoresis
Coughing
Coughing
Hot fl ushed skin
Hot fl ushed skin
Cyanosis
Cyanosis
Myoclonus
Myoclonus
Oedema legs
Oedema legs
Muscular twitching
Muscular twitching
Claudication
Claudication
Spastic bladder
Spastic bladder
Feeling of choking
Feeling of choking
Discharge from the ear
Discharge from the ear
Feeling of unreality
Feeling of unreality
Thirst
Thirst
Fear of losing control
Fear of losing control
Polyuria
Polyuria
Fear of dying
Fear of dying
Polyphagia
Polyphagia
Insomnia
Insomnia
Unexplained weight loss
Unexplained weight loss
Gastro-esophageal refl ux
Gastro-esophageal refl ux
Palpitations
Palpitations
Drop attacks
Drop attacks
Shortness of breath
Shortness of breath
Remitting-relapsing neurological dysfunction
Remitting-relapsing neurological dysfunction
Current history__________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Diagnostic tests_________________________________________________________________________
_______________________________________________________________________________________
Occupation_____________________________________________________________________________
Leisure time____________________________________________________________________________
Social history N/A _______________________________________________________________________
General health Unexplained weight loss +/- Night pain +/- Consistent pattern of night pain +/- Loss of appetite +/-
Other_______________________________________________________________________
226 / The Journal of Manual & Manipulative Therapy, 2005
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