physical therapy assessment
DESCRIPTION
Outlines physical therapy assessment steps, tests & measuresTRANSCRIPT
SUBJECTIVE DATA
QUESTION GUIDELINES
Describe the onset of the symptoms or mechanism of injury.Determine whether symptoms are recent, recurrent, or insidious.
Determine whether perpetuating circumstances exist.
Describe how the symptoms are perceived.Establish the location, type, and nature of the pain or symptoms.
Determine whether the pain and symptoms fit into a Pattern:
Segmental reference zonesNerve root patterns Extra segmental reference patterns(Dural reference, myofascial pain patterns, peripheral nerve patterns, or circulatory pain)
Describe the behavior of the symptoms through a 24-hour period while carrying out typical daily activities.
Identify which motions or positions cause or ease the symptoms.
Determine how severe or how functionally limiting the problem is. (Functional limitations in terms of daily living, work, family, social, and recreational activities)
Determine how irritable the problem is by how easily the symptoms are evoked and how long they last.
Describe any previous history of the condition. Find out if there has been previous treatment for the problem and the results of the treatment.
Describe related history, such as any medical or surgical intervention.
Briefly describe general health, medications, and x-ray or other pertinent studies that have been performed. Identify any medical conditions that may alert you to using special precautions or to contraindications to any testing procedures.
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PAIN
Pain Descriptions and Related Structures
Type o f Pain Structure
Cramping, dull, aching Muscle
Sharp, shooting Nerve root
Sharp, bright, lightning-like Nerve
Burning, pressure-like, stinging, aching Sympathetic nerve
Deep, nagging, dull Bone
Sharp, severe, intolerable Fracture
Throbbing, diffuse Vasculature
INSPECTION
Helps to focus and individualize physical examination
SENSORIUM
Alert awake and attentive to normal stimulationLethargic drowsy, may fall asleep if not stimulatedObtunded difficult to arouse, frequently confused when awakeStupor responds only to strong, noxious stimuli: returns to
unconscious stateComa cannot be aroused
ORIENTATION
Awareness of Time, Person, and Place (oriented x 3)
AMBULATORY STATUS
Note patient’s mode of locomotion (wheelchair, ambulatory with or without assistive device, bedridden, bed bound etc.)
SKIN (color, texture, presence of lesions, scars)
PRESSURE SORES
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Stage 1 non-blanchable erythema of intact skinStage 2 abrasion, blister, or shallow crater (epidermis & dermis)Stage 3 deep crater, necrosis/damage of necrotic tissueStage 4 extensive destruction, tissue necrosis extending up to
muscle and bone
BODY BUILD
Ectomorphic thin, prominence of structures from ectodermMesomorphic muscular, prominence of structures from mesoderm Endomorphic heavy, fat body built, prominence of structures from
endoderm
PALPATION
PALPATION GUIDELINES
Note differences in tissue tension, muscle tone & textureNote differences in tissue thicknessIdentify palpable anomaliesDefine areas of tendernessTemperature variationsPulses, tremors, fasciculationsDryness, excessive moistureAbnormal sensation
Remember!! Palpate uninvolved part first and painful areas last
TENDERNESS (Pain upon palpation)
Tenderness Scale/Grading 1 complains of pain2 complains of pain & winces3 winces & withdraws limb4 patient won’t allow palpation
EDEMA
Grading of Edema Mild 1+ < ¼” depth of depressionModerate 2+ ¼” to ½” depth of
depressionSevere 3+ ½” to 1” depth of depression
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VITAL SIGNS
BLOOD PRESSURE
Adult Blood Pressure Normal <120 mmHg / <80 mmHg Pre-HTN 120-139 mmHg/80-89 mmHg
Stage 1 140-159 mmHg/90-99 mmHgStage 2 ≥ 160 mmHg/100 mmHg
Infant Blood Pressure < 2 y.o. 106-110 mmHg/59-63 mmHg3-5 y.o. 113-116 mmHg/67-74 mmHg
Factors that may alter the Blood Pressure
Elevate BP Lowers BP
Pain Recent mealAuscultatory gap DehydrationSleeplessness Auscultatory gapRecent smokingDistended bowel/bladderRecent exerciseChilling
PULSE RATE
Adult Pulse Rate Normal 60-100 bpm (avg. 70 bpm)Tachycardia >100 bpmBradycardia < 60 bpm
Infant Pulse rate Normal 70-170 bpm (avg. 120 bpm)
Pulse Grading 4+ Bounding3+ Increased2+ Brisk, expected1+ Diminished, weaker than expected0 Absent, unable to palpate
RESPIRATORY RATE
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Adult RR Normal 12-20 cpmTachypnea > 20 cpmHyperpnea increase depth and rate
Infant RR Normal 30-60 cpm
Dyspnea (shortness of breath) scale +1 mild, noticeable to px
+2 mild, noticeable to observer
+3 moderate, can continue+4 severe, can’t continue
TEMPERATURE
Normal 98.6˚F or 37˚CConversion ˚F= [˚C x 9/5] + 32
˚C= [˚F-32] x 5/9
Types of Fever Intermittent alternate b/n pyrexia & normal and
subnormal within 24 hr period
Relapsing/Recurrent alternate b/n pyrexia & normal
lapse for > 24 hrSustained/Constant consistently elevated
temperature
SENSORY ASSESSMENT
Sensory impairments interfere with acquisition of new motor skills since
motor learning is dependent on sensory information and feedback
SENSORY ASSESSMENT PRINCIPLES
Sensory assessment is completed prior to any testing that involves active motor function
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Initial screening for mental status (arousal, attention, orientation, cognition & memory), vision & memory should be done prior to performing sensory tests.
Patient should be instructed not to guess if uncertain about the response
Demonstrate the test to orient the patient on what to expect and what response is needed
Test order: Superficial—Deep—Cortical & Distal to Proximal Apply the stimuli in a random order to avoid giving patient “clues” to the correct response
It is good to use a chart or picture to represent the areas with sensory problem so as to easily identify if a certain pattern exists
EXAMINATION PROTOCOL
Superficial sensation Pain Use sharp end of a pin, avoid applying stimuli close to each otherLet finger slide over the pin
Light touch Use cotton or camel hair brush
Pressure Use thumb enough to indent skin
Temperature Use test tubes with warm (41-50˚F) and cold (104-113˚F)
Response When patient feels stimuli, respond with yes, now or unable to tell
Deep sensation Kinesthesia Move the extremity passively in initial, mid or terminal
range with very minimal grip to reduce tactile stimulation
Response Describe direction as up or down, in or out while the extremity is in motion. Also patient can imitate the movement in opposite extremity.
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Proprioception The extremity is held in a static position in initial, mid or terminal range with very minimal grip to reduce tactile stimulation
Response Describe direction as up or down, in or out while the extremity is in static position. Also patient can imitate the movement in opposite extremity.
Vibration Place the base of a vibrating tuning fork on a bony prominence. Random application of vibrating and non vibrating stimuli should be done. Patient should also be given earphones to remove the auditory clues.
Response Verbally identify the vibrating stimuli
Cortical sensation Stereognosis The patient is given a familiar
object to be held and manipulated
Response The patient is asked to identify the object verbally
Tactile localization Therapist touches different areas in patient skin
surfaceResponse Patient points out the area
that the therapist touchesTwo-point Discrimination Applies simultaneous stimuli
on the patient’s skinResponse Identify if the perception of
one or two stimuliGraphesthesia Trace letters, numbers or
designs on skinResponse Identify what is the traced
figure
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MUSCULOSKELETAL ASSESSMENT
PATIENT HISTORY & INTERVIEW
Symptom Onset sudden, gradual, insidious, traumaticLocation localized, diffuse, deep, superficial, changes,
spreadsQuality severity, characteristicBehavior aggravating factors, relieving factors
Illustrations: Numerical Pain Rating Scales
Circle the number which best represents the intensity of your pain
0 1 2 3 4 5 6 7 8 9 10No Pain Worst Pain
ImaginablePrevious Care/Medical History Previous occurrence of the
condition, treatments received and its effects
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Past medical history Other significant conditions
Medications Medications taken, type, frequency, dose
Treatment goals Patient’s hopes for outcome
Occupational, recreational, social history patient’s work and activities, architectural barriers, environmental accessibility
Illustrations: Rate Patient’s Function
What percentage of your work activities are you able to perform?
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Illustrations: Rate Patient’s Function
What percentage of your home activities are you able to perform?
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Illustrations: Rate Patient’s Function
What percentage of your recreational activities are you able to perform?
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
RANGE OF MOTION
Things to remember Normal side is tested first, unless bilateral movements are needed
AROM-PROM-Isometric movements
Painful movements are done last
Apply over pressure at end of range with care
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Over pressure maybe applied to point of pain but not beyond
Resisted isometrics are done with the joint in resting position
Active ROM Often estimated except if more accurate measurement is needed, goniometer should be usedIf can be performed by patient easily without pain or other symptoms, then passive testing is usually not necessary
Attention!!Limitations in AROM may indicate affection of either contractile or
none contractile tissue or both. The examiner must perform further testing
to isolate the cause.
Passive ROM Slightly greater than AROMTested for amount of motion (goniometric value), effect on symptom, end feel, and pattern of limitation
Attention!!!Limitations in passive ROM maybe d/t bone or joint abnormalities or tightness of these structures. Pain during this test is usually related to pinching, stretching, or moving of non-contractile tissue.
Effect on Symptom Pain aggravated or persistent in passive usually indicates non-contractile structures (bones, joint, ligaments, cartilage etc.)
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End Feel Abnormal End Feels
End Feel Examples
Soft Occurs sooner or later in the ROM than is usual, or in a joint that normally has a firm or hard end-feel. Feels boggy
FirmOccurs sooner or later in the ROM than is usual, or in a joint that normally has a soft or hard end-feel.
HardOccurs sooner or later in the ROM than is usual, or in a joint that normally has a soft or firm end-feel.A bony grating or bony block is felt.
EmptyNo real end-feel because pain prevents reaching end of ROM. No resistance is felt except for patient’s
protective muscle splinting or muscle spasm
Soft tissue edema Synovitis
Increased muscular tonusCapsular, muscular, liga-mentous shortening
Chondromalacia OsteoarthritisLoose bodies in joint Myositis ossificansFracture
Acute joint inflammation BursitisAbscessFracture
Psychogenic Disorder
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Pattern of Limitation Capsular Patterns
Can be due to 2 situations
a. Joint effusion or synovial inflammation (acute stage)
b. Relative capsular fibrosis (chronic stage)
Attention!!!Determine what causes the capsular pattern, if it is inflammation treatment is same for acute stage. If the cause is fibrosis, treatment is same for chronic stage.
Non-Capsular Patterns
Usually involve one or two motions of a joint. Cause can be d/t structures other than the joint capsule. (internal joint derangement, adhesions of part of joint capsule, ligament shortening, muscle strain and shortening)
Capsular Patterns
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ROM ValuesAVERAGE RANGES OF MOTION FOR THE UPPER EXTREMITIES
IN DEGREES FROM SELECTED SOURCES
Joint Motion values
A
of Orthopaedic,Kendall Motion values
Shoulder Flexion 0-180 Hip Flexion 0-120Extension 0-60 Extension 0-30Abduction 0-180 Abduction 0-45Medial rotation 0-70 Adduction 0-30Lateral 0-90 ER/IR 0-45
Elbow Flexion 0-150 Knee Flexion 0-135
Joint Pattern
Shoulder
Elbow
Forearm
Wrist
CMC 1 2-5
UE digit
Hip
Knee
Ankle
Subtalar
Midtarsal
Metatarsalphalangeal joint 1
Metatarsalphalangeal joint 2-5
IP joint
ER>ABD>IR
F>E
Pronation=Supination
F=E
ABD & EXTEqual restriction in all direction
F>E
IR, F, ABD
F>E
PF>DF
Varus restricted
Restricted DF, PF, ABD, medial rotation
E>F
Tend toward Flexion
Tend toward extension
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Forearm Pronation 0-80 Ankle PF 0-50Supination 0-80 DF 0-20
Wrist Extension 0-70 Inversion 0-35Flexion 0-80 Eversion 0-15Radial 0-20 Subtalar Inv/Evr 0-5Ulnar deviation 0-30 Great toe
ThumbCMC Abduction 0-70 MTP flexion 0-45
Flexion 0-15 extension 0-70Extension 0-20 PI flexion 0-90Opposition Tip of thumb to
or tip of fifth digit Lesser toe
MTP flexion 0-40
MCP Flexion 0-50 extension 0-40IP Flexion 0-80 PIP flexion 0-35
Digits DIP flexion 0-30Second -FifthMCP Flexion 0-90
Hyperextensio 0-45Abduction
PIP Flexion 0-100DIP Flexion 0-90
Hyperextension
0-10
ACESSORY JOINT MOTIONS
Tested if PROM is limited or painful; Tested for amount of motion, effect on symptoms, and end feel.
Accessory joint motion grades 0 ankylosed1 considerable hypomobility2 slight hypomobility3 normal4 slight hypermobility5 considerable hypermobility6 unstable
Grades 0 & 6 surgery considered, joint mobilization not indicatedGrades 1 & 2 joint mobilization to increase joint extensibilityGrades 4 & 5 increasing joint extensibility not indicated; taping,
bracing, strengthening indicated
RESISTED ISOMETRIC TESTING
Joint should be placed in a position midway through the range, to produce
minimal tension in inert structures.
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RESULTS OF RESISTEDISOMETRIC TESTING
Findings Possible Pathologies
Strong and painless There is no lesion or neurological deficit involving the tested muscle and tendon.
Strong and painful There is a minor lesion of the tested mus-cle or tendon.
Weak and painless There is a disorder of the nervous system, neuromuscular junction, or a complete rupture of the tested muscle or tendon, or disuse atrophy.
Weak and painful There is a serious, painful pathology such as a fracture or neoplasm. Other pos-sibilities include an acute inflammatory process that inhibits muscle contraction, or a partial rupture of the tested muscle or tendon.
Remember!!! Burasae can produce pain in isometric contraction if it’s inflamed even though it’s non-contractile
MANUAL MUSCLE TESTING
Manual Muscle Testing Grades
Grades Criteria
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Normal N 5 10Full available ROM, against
gravity, strong manualresistance
Good Plus G+ 5– 9Full available ROM, against
gravity, nearly strongmanual resistance
Good G 4 8Full available ROM, against
gravity, moderate manualresistance
Good Minus G– 4– 7Full available ROM, against
gravity, nearly moderatemanual resistance
Fair Plus F+ 3+ 6Full available ROM, against
gravity, slight manualresistance
Fair F 3 5 Full available ROM, againstgravity, no resistance
Fair Minus F– 3– 4 At least 50% of ROM, againstgravity, no resistance
Poor Plus P+ 2+ 3Full available ROM, gravity
minimized, slight manualresistance
Poor P 2 2 Full available ROM, gravityminimized, no resistance
Poor Minus P– 2– 1At least 50% of ROM, gravity
minimized, no resistance
Trace Plus T+ 1+ Minimal observable motion
(less than 50% ROM), gravity minimized, no resistance
Trace T 1 TNo observable motion, palpable
muscle contraction, no resistance
Zero 0 0 0No observable or palpable muscle contraction
CLOSE-OPEN PACKED POSITION
Resting (Loose/open Packed) Position of Joints
Joint Position
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Facet (spine) Midway between flexion and extensionTemporomandibular Mouth slightly open (freeway space)
Glenohumeral 55° abduction, 30° horizontal adductionAcromioclavicuiar Arm resting by side in normal physiological positionSternoclavicular Arm resting by side in normal physiological positionUlnohumeral (elbow) 70° flexion, 10° supinationRadiohumeral Full extension, full supinationProximal radioulnar 70° flexion, 35° supinationDistal radioulnar 10° supinationRadiocarpal (wrist) Neutral with slight ulnar deviationCarpometacarpal Midway between abduction-adduction and flexion-extensionMetacarpophalangeal Slight flexion
Interphalangeal Slight flexionHip 30° flexion, 30° abduction, slight lateral rotationKnee 25° flexionTalocrural (ankle) 10° plantar flexion, midway between maximum inversion and eversionSubtalar Midway between extremes of range of movementMidtarsal Midway between extremes of range of movementTarsometatarsal Midway between extremes of range of movementMetatarsophalangeal Neutral
Close Packed Position of Joints Joint Position
Facet (spine) ExtensionTemporomandibular Clenched teethGlenohumeral Abduction and lateral rotationAcromioclavicular Arm abducted to 90°Sternoclavicular Maximum shoulder elevationUlnohumeral (elbow) ExtensionRadiohumeral Elbow flexed 90°, forearm supinated 5°Proximal radioulnar 5° supinationDistal radioulnar 5° supinationRadiocarpal (wrist) Extension with radial deviationMetacarpophalangeal Full flexion (fingers)Metacarpophalangeal Full opposition (thumb)Interphalangeal Full extensionHip Full extension, medial rotation*Knee Full extension, lateral rotation of tibiaTalocrural (ankle) Maximum dorsiflexion
Subtalar SupinationMidtarsal SupinationTarsometatarsal SupinationMetatarsophalangeal Full extension
MOTOR EVALUATION
TONE
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Modified Ashworth Scale
Grade Description
0 No increase in muscle tone.
1 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the ROM when the affected part(s) is moved in flexion or extension.
1+ Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM.
2 More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved.
3 Considerable increase in muscle tone, passive movement difficult.
4 Affected part(s) rigid in flexion or extension.
DEEP TENDON REFLEXES
Jaw (trigeminal)Biceps (C5, C6)Triceps (C7, C8)Hamstrings (L5, S1, S2)Patellar (L2, L3, L4)Ankle (S1, S2)
Grade Evaluation Response Characteristics
0 Absent No visible or palpable muscle contraction with reinforcement.
1+ Hyporeflexia Slight or sluggish muscle contraction withlittle or no joint movement. Reinforcement may be required to elicit a reflex response.
2+ Normal Slight muscle contraction with slight joint movement.
3+ Hyperreflexia Clearly visible, brisk muscle contraction with moderate joint movement.
4+ Abnormal Strong muscle contraction with one to three beats of clonus.
Reflex spread to contralateral side may be noted.
5+ Abnormal Strong muscle contraction with sustained clonus. Reflex spread to contralateral side maybe noted
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BALANCE
FUNCTIONAL BALANCE GRADES
Normal Patient is able to maintain steady balance without support (static).Accepts maximal challenge and can shift weight in all directions (dynamic).
Good Patient is able to maintain balance without support (static).Accepts moderate challenge; able to maintain balance while picking object off floor (dynamic).
Fair Patient is able to maintain balance with handhold (static). Accepts minimal challenge; able to maintain balance while turning head/trunk (dynamic).
Poor Patient requires handhold and assistance (static).
CTSIB (Clinical Test for Sensory Interaction in Balance
1 2 3 4 5 6
1. Eyes open, fixed support
2. Eyes closed, fixed support
3. Visual conflict, fixed support
4. Eyes open, moving surface
5. Eyes closed, moving support
6. Visual conflict moving support
Result-Interpretation
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2,3,5,6 Visual loss5, 6 Vestibular loss4, 5, 6 Surface, somatosensory input3, 4, 5, 6Sensory selection
COORDINATION ASSESSMENT
NON-EQUILIBRIUM TESTS
Tests should be performed first with eyes open and then with eyes closed. Abnormal responses include a gradual deviation from the "holding' position and/or a diminished quality of response with vision occluded. Unless otherwise indicated, tests are performed with the patient in a sitting position.
TEST PROCEDURE1. Finger to nose
2. Finger to therapist's finger
3. Finger to finger
4. Alternate nose to finger
5. Finger opposition
The shoulder is abducted to 90 degrees with the elbow extended. The patient is asked to bring the tip of the index finger to the tip of the nose. Alterations may be made in the initial starting position to assess performance from different planes of motion.
The patient and therapist sit opposite each other. The therapist's index finger is held in front of the patient. The patient is asked to touch the tip of the index finger to the therapist's index finger. The position of the therapist's finger may be altered during testing to assess ability to change distance, direction, and force of movement.
Both shoulders are abducted to 90 degrees with the elbows extended. The patient is asked to bring both hands toward the midline and approximate the index fingers from opposing hands.
The patient alternately touches the tip of the nose and the tip of the therapist's finger with the index finger. The position of the therapist's finger may be altered during testing to assess ability to change distance, direction, and force of movement.
The patient touches the tip of the thumb to
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6. Mass grasp
7. Pronation/supination
8. Rebound test
9. Tapping (hand)
10.Tapping (foot)
11.Pointing and past pointing
the tip of each finger in sequence. Speed may be gradually increased.
An alternation is made between opening and closing fist (from finger flexion to full extension). Speed may be gradually increased.
With elbows flexed to 90 degrees and held close to body, the patient alternately turns the palms up and down. This test also may be performed with shoulders flexed to 90 degrees and elbows extended. Speed may be gradually increased. The ability to reverse movements between opposing muscle groups can be assessed at many joints. Examples include active alternation between flexion and extension of the knee, ankle, elbow, fingers, and so forth.
The patient is positioned with the elbow flexed. The therapist applies sufficient manual resistance to produce an isometric contraction of biceps. Resistance is suddenly released. Normally, the opposing muscle group (triceps) will contract and "check" movement of the limb. Many other muscle groups can be tested for this phenomenon, such as the shoulder abductors or flexors, elbow extensors, and so forth.
With the elbow flexed and the forearm pronated, the patient is asked to "tap" the hand on the knee.
The patient is asked to "tap" the ball of one foot on the floor without raising the knee; heel maintains contact with floor.
The patient and therapist are opposite each other, either sitting or standing. Both patient and therapist bring shoulders to a horizontal position of 90 degrees of flexion with elbows extended. Index fingers are touching or the patient's finger may rest lightly on the therapist's. The patient is asked to fully flex the shoulder (fingers will be pointing toward ceiling) and then return to the horizontal position such that index fingers will again approximate. Both arms should be tested, either separately or simultaneously. A normal response consists of an accurate return to the starting
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12.Alternate heel to knee; heel to toe
13.Toe to examiner's finger
14.Heel on shin
15.Drawing a circle
16.Fixation or position holding
position. In an abnormal response, there is typically a "past pointing," or movement beyond the target. Several variations to this test include movements in other directions such as toward 90 degrees of shoulder abduction or toward 0 degrees of shoulder flexion finger will point toward floor). Following each movement, the patient is asked to return to the initial .horizontal starting position.
From a supine position, the patient is asked to touch the knee and big toe alternately with the heel of the opposite extremity.
From a supine position, the patient is instructed to touch the great toe to the examiner's finger. The position of finger may be altered during testing to assess ability to change distance, direction, and force of movement.
From a supine position, the heel of one foot is slid up and down the shin of the opposite lower extremity.
The patient draws an imaginary circle in the air with either upper or lower extremity (a table or the floor also may be used). This also may be done using a figure-eight pattern. Thistest may be performed in the supine position for lower extremity assessment.
Upper extremity: The patient holds arms horizontally in front (sitting or standing). Lower extremity: The patient is asked to hold the knee in an extended position (sitting).
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EQUILIBRIUM COORDINATION TESTS
1. Standing in a normal, comfortable posture.
2. Standing, feet together (narrow base of support).3. Standing, with one foot directly in front of the other in
tandem position (toe of one foot touching heel of opposite foot).
4. Standing on one foot.5. Arm position may be altered in each of the above
postures (i.e., arms at side, over head, hands on waist, and so forth).
6. Displace balance unexpectedly (while carefully guarding patient).
7. Standing, alternate between forward trunk flexion and return to neutral.
8. Standing, laterally flex trunk to each side.9. Standing: eyes open (EO) to eyes closed (EC) ability to
maintain an upright posture without visual input is referred to as a positive Romberg sign.
10. Standing in tandem position eyes open (EO) to eyes closed (EC) (Sharpened Romberg).
11. Walking, placing the heel of one foot directly in front of the toe of the opposite foot (tandem walking).
12. Walking along a straight line drawn or taped to the floor, or place feet on floor markers while walking.
13. Walk sideways, backward, or cross-stepping.14. March in place.15. Alter speed of ambulatory activities; observe patient
walking at normal speed, as fast as possible, and as slow as possible.
16. Stop and start abruptly while walking.17. Walk and pivot (turn 90, 180, or 360 degrees).18. Walk in a circle, alternate directions.19. Walk on heels or toes.20. Walk with horizontal and vertical head turns.21. Step over or around obstacles.22. Stair climbing with and without using handrail; one
step at-a-time versus step-over-step.23. Agility activities (coordinated movement with upright
balance); jumping jacks, alternate flexing and extending the knees while sitting on a Swiss ball.
Impairment Sample Test
Dysdiadochokinesia F i n g e r t o n o s e Alternate nose to finger Pronation/supination Knee f lexion/extension Walking, alter speed or direction
Dysmetria Pointing and past pointing Drawing a circle or figure eight Heel on shin.
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Placing feet on floor markers while walking
Movement decomposition Finger to nose (dyssynergia) Finger to therapist's finger
Alternate heel to knee Toe to examiner's finger
Hypotonia Passive movement Deep tendon reflexes
Tremor (intention) Observation during functional ac-tivities (tremor will typically
increase as target is approached or movement speed increased)
Alternate nose to fingerFinger to finger
Finger to therapist's finger Toe to examiner's finger
Tremor (resting) Observation of patient at rest Observation during functional ac-tivities (tremor will diminish significantly or disappear with movement)
Tremor (postural) Observation of steadiness of normal standing posture
Asthenia Fixation or position holding (upper and lower extremity)
Application of manual resistance to assess muscle strength
Rigidity P a s s i v e m o v e m e n t Observation during functional ac-
tivities Observation of resting posture(s)
Bradykinesia Walking, observation of arm swing and trunk motions
Walking, alter speed and direction Request that a movement or gait activity be stopped abruptly Observation of functional activities: timed tests
Disturbances of posture Fixation or position holding (upper and lower extremity)
Displace balance unexpectedly in s i t t i ng o r s tand ing Standing, alter base of support (e.g.,
one foot directly in frontof the other; standing on one
foot)
Disturbances of gait Walk along a straight line
Walk sideways, backward March in place
Alter speed and direction of ambu-latory activities
Walk in a circle
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GAIT ANALYSIS
GAIT TERMS
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TRUNK DEVIATIONS: STANCE PHASE
HIP DEVIATIONS: STANCE PHASE
HIP DEVIATIONS: SWING PHASE
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KNEE DEVIATIONS: STANCE PHASE
KNEE DEVIATIONS: SWING PHASE
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ANKLE & FOOT DEVIATIONS: SWING PHASE
ANKLE & FOOT DEVIATIONS: STANCE PHASE
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RATING FOR GAIT ANALYSIS
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FUNCTIONAL ANALYSIS
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Barthel's index of activities of daily living (BAI)
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Functional Independence Measure (FIM)
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Katz Index of ADL
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