Principles of physical examination

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Principles of physical examination

  1. 1. Principles of the Physical Examination Robert Freeman
  2. 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. 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. 4. Who does the Exam? • Appropriately trained clinician • Assistant
  5. 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. 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. 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. 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. 9. Goniometry
  10. 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. 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. 12. length force 0° 135° Strength
  13. 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. 14. Selectivity • Selective Control Assessment – 0 Unable – 1 Impaired – 2 Normal
  15. 15. Standing / Walking
  16. 16. Supine
  17. 17. Hip
  18. 18. Hip • Extension
  19. 19. Hip Adductors
  20. 20. Knee • Popliteal angle • Patella alta • Lag
  21. 21. Ankle • Silfverskiöld test • Clonus, catch
  22. 22. Subtalar inversion / eversion
  23. 23. Subtalar Complex • Inv + N - 0 - N + Eve • Inv + N - 0 - N + Eve • Inv + N - 0 - N + Eve • Inv + N - 0 - N + Eve
  24. 24. Prone
  25. 25. Duncan Ely
  26. 26. Hip Version
  27. 27. Tibial Version • Bimalleolar axis
  28. 28. Hind Foot Forefoot
  29. 29. Sitting
  30. 30. Confusion Test

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