Your SlideShare is downloading. ×
Principles of physical examination
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Principles of physical examination

174
views

Published on


0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
174
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Principles of the Physical Examination Robert Freeman
  • 2. Why do a Physical Exam? • Allows interpretation of gait data • Check outputs from gait data • Place the data in context Pelvic Obliquity 25 -25 Up Down deg Hip Ab/Adduction 20 -20 Add Abd deg Pelvic Rotation 40 -40 Int Ext deg Hip Rotation 60 -60 Int Ext deg
  • 3. What do we Measure? • Joint Ranges – Muscle lengths – Capsular tightness • Bone version / deformity • Strength • Selective Control • Evidence of Neurology (spasticity, dystonia…) • Essential core data set and tailored tests
  • 4. Who does the Exam? • Appropriately trained clinician • Assistant
  • 5. Training • CMAS standards 3 The laboratory must keep a log for each staff member containing, a) The identity of any professional registration body, along with the registration number b) Evidence of gait laboratory induction training for new staff… c) Annual update of repeatability measures (where applicable). 4 Repeatability testing is required:- a) For each test carried out by the clinical movement analysis service where clinical judgment is required
  • 6. RJAH Repeatability • Reduced set of – Clinical examination (JB, WB, KE, NE, RF, SJ, AR) • Hip Ab/Add, Pop ang, In/eversion, Anteversion, Staheli, BMS
  • 7. Hip Abduction Hip Adduction Anteversion Staheli SJ 30.0 20.0 15.0 -10.0 NE 25.0 20.0 5.0 -5.0 JB 25.0 20.0 5.0 0.0 WB 35.0 20.0 10.0 -10.0 KE 25.0 20.0 5.0 0.0 APR 25.0 30.0 10.0 -10.0 RF 30.0 20.0 5.0 0.0 Mean 27.9 21.4 7.9 -5.0
  • 8. Popliteal Angle Leg Length BMA Inversion Eversion SJ 35.0 80.6 35.0 10.0 0.0 NE 30.0 82.0 30.0 10.0 0.0 JB 25.0 81.0 35.0 25.0 0.0 WB 40.0 80.0 30.0 20.0 -5.0 KE 20.0 82.5 30.0 10.0 0.0 APR 25.0 82.0 30.0 30.0 0.0 RF 25.0 83.0 25.0 15.0 10.0 Mean 28.6 81.6 30.7 17.1 0.7
  • 9. Goniometry
  • 10. Muscle length • Muscles that cross single joint – How much force • Biarticular muscles – Stabilise one joint measure other – To determine if capsular tightness or muscle, stabilised joint should allow max ROM.
  • 11. Muscle Strength • 0 none • 1 flicker • 2 gravity eliminated • 3 against gravity • 4- some resistance • 4 moderate resistance • 4+ Submaximal movement against resist • 5 full strength
  • 12. length force 0° 135° Strength
  • 13. Tone / Spasticity • Modified Ashworth – What speed – 0, 1, 1+, 2, 3, 4 • Modified Tardieu Test – Record an angle – Slow movement length – Fast movement spasticity
  • 14. Selectivity • Selective Control Assessment – 0 Unable – 1 Impaired – 2 Normal
  • 15. Standing / Walking
  • 16. Supine
  • 17. Hip
  • 18. Hip • Extension
  • 19. Hip Adductors
  • 20. Knee • Popliteal angle • Patella alta • Lag
  • 21. Ankle • Silfverskiöld test • Clonus, catch
  • 22. Subtalar inversion / eversion
  • 23. Subtalar Complex • Inv + N - 0 - N + Eve • Inv + N - 0 - N + Eve • Inv + N - 0 - N + Eve • Inv + N - 0 - N + Eve
  • 24. Prone
  • 25. Duncan Ely
  • 26. Hip Version
  • 27. Tibial Version • Bimalleolar axis
  • 28. Hind Foot Forefoot
  • 29. Sitting
  • 30. Confusion Test