ASSESSMENT AND EVALUATION Ahmed Alhowimel. ASSESSMENT AND EVALUATION Good assessment is dependent...
-
Upload
logan-reeves -
Category
Documents
-
view
217 -
download
0
Transcript of ASSESSMENT AND EVALUATION Ahmed Alhowimel. ASSESSMENT AND EVALUATION Good assessment is dependent...
ASSESSMENT AND EVALUATION
Ahmed Alhowimel
ASSESSMENT AND EVALUATION Good assessment is dependent upon: Knowledge of functional anatomy History Complete examination
EVALUATION
Structure governs function Anatomy is the structure Biomechanics/physiology are the function
EVALUATION PURPOSE Develop database to establish Patient’s level of function
Plan a treatment program and establish outcomes
Evaluate results of treatment program
Modify treatment program
CLINICAL EVALUATION SEQUENCE
History
Inspection
Palpation
Functional Testing A/P/ROM Ligamentous Testing Special Tests
Neurological Testing
HISTORY
Most important portion of exam Any special test should confirm what is learned in the history
Key questions(identify forces on the body) Acute Injury= What is the mechanism Chronic Injury= Are there changes in treatment routines/equipment/posture
HISTORY
Mechanism How did injury occur Macrotrauma (single traumatic force) Microtrauma (accumulation of repeated forces)
Relevant Sounds or sensations Pop “Giving Way”
Location of symptoms Localized Referred(pain from another source) Isolated vs. diffuse
Onset and duration of symptoms Immediate pain v. chronic Classification for overuse injuries Stage 1 Pain after activity
Stage 2 Pain during/after activity
Stage 3 Constant pain
Description of symptoms Sharp/dull/achy Intermittent v. constant Weakness Paresthesia (numbness/tingling) Dysfunction/ inability to perform activity
Change in symptoms Intensity change with specific motions, postures, treatment, modalities, medications
Previous history Previous injury When did previous episode occur Who evaluated and treated injury Diagnosis Course of treatment/rehab/surgery performed Did previous treatment plan decrease symptoms
Related history to opposite body part Previous history of injury to uninvolved side
General health status congenital abnormality/disease
INSPECTION
Gait
Gross Deformity
fracture/discoloration/serious bleeding
Swelling (localized v. diffuse)
Bilateral Symmetry
Discoloration
Keloids (surgical scars)
Infection Redness/warmth/pus/swelling/red streaks/lymph nodes
GIRTH MEASUREMENTS
Swelling Identify joint line using bony landmarks
Atrophy Make incremental marks (2,4,6 inch) from jt. line
Lay tape symmetrically around body
Take 3 measurement and record average
Repeat and record for uninjured limb
PALPATION
Detect tissue damage Bones (rule out fracture) Ligaments/tendons Soft tissue Pulses
Point tenderness Visualize structure which lie beneath fingers Compare bilaterally
Trigger Points Palpated points in muscle which refer pain to another body area
Change in tissue density (or feel of tissue) may indicate: Muscle spasm Hemorrhage Edema Scarring Myositis ossificans
Crepitus- repeated crackling sensations or sound emanating from the joint or tissue
Symmetry Compare muscle tone, bony prominence
Increased tissue temperature Indicates active inflammatory process
RANGE OF MOTION (ROM) Helps to assess functional status
Compare bilaterally
Test joints proximal and distal to injured area
FUNCTIONAL TESTINGAROM
Contraindications:
immature fracture sites
newly repaired
Cardinal Planes (test all planes of ROM)
Painful ARC
compression within range
FUNCTIONAL TESTINGPROM
Quantity of available movement
“End feel” reach limit of available ROM
Most accurate method is with goniometry measurements
NORMAL END FEELPHYSIOLOGICALHard Bone contacting bone
elbow extension
Soft Soft tissue approximation
elbow flexion
Firm Capsule stretch(ext of MCP jt)
Ligament Stretch(forearm supination)Muscle Stretch(hip flexion with knee
extended)
ABNORMAL END FEELPATHOLOGICAL
SoftSoft tissue edema
synovitis
FirmCapsular,muscular, ligamentous shortening
Hardosteoarthritis
Fracture
EmptyBursitis, Joint inflammation
FUNCTIONAL TESTING RROM Contraindications for RROM Patient is unable to voluntarily contract injured muscle
Patient is unable to perform AROM Underlying fracture site is not healed Involved tissues are not yet healed
Manual Resistance Stabilize limb proximally Resistance provided distally on bone to which muscle attaches
Watch for compensation
GRADING SYSTEM FOR MANUAL MUSCLE TESTING 0/5 Zero No contraction
1/5 Trace Palpable contraction No muscle movement
2/5 Poor Able to move body part through gravity
eliminated
3/5 Fair Move against gravity throughout ROM
4/5 Good Moderate resistance
5/5 Normal Maximal resistance
CLINICAL SIGNIFICANCE
Strength Pain Finding Good None Normal
Good Present Minor soft tissue
injury
Weak Present Major injury
Weak None Neurological or Rupture or
Chronic
LIGAMENTOUS AND CAPSULAR TESTINGLigamentous testing
compare bilaterally
compare with baseline measures
correct positioning
(if incorrect positioning may lead to false results)
SPECIAL TESTS
Specific procedures applied to joint to determine presence of injury
Unique to each structure
Bilateral comparison
NEUROLOGICAL (RADIATING PAIN) Involves Upper/lower quarter screen of: Sensory (dermatome) Motor (myotome) DTR (Deep Tendon Reflex)
SENSORY TESTINGBilateralDermatone Area of skin innervated by a single nerve root
Slight stroke over area/pin prickSharp v. dullHot v. cold
Motor TestingManuel Muscle Testing
POSTURAL ASSESSMENT
WHAT IS POSTURE? Defined:
“The position of the body at a given point in time.” (Starkey)
“A set of muscle contractions that place the body in the necessary location from which a movement is performed.” (Enoka)
“The situation or disposition of the several parts of the body with respect to each other for a particular purpose.” (Webster)
WHAT IS GOOD POSTURE?
posture serves as a reference point.
Ideal posture… Distributes gravitational stress for balanced muscle
function. Allows joints to move in their mid range to minimize stress
on ligaments and articular surfaces. Effective for the individual’s activities of daily living. Allows the individual to avoid injury.
POSTURAL DEVELOPMENT
Birth Entire spine concave
forward (flexed) “Primary curves”
Thoracic spine Sacrum
Developmental
(usually around 3 mos.) Secondary curves Cervical spine Lumbar spine
POSTURAL DEVELOPMENT
Factors affecting postureBony contoursLaxity of ligamentous structuresFascial & musculotendinous tightnessMuscle tonusPelvic angleJoint position & mobility
POSTURAL DEVELOPMENT Causes of poor posture
Positional factors Appearance of increased height (social stigma)
Muscle imbalances/contractures Pain Respiratory conditions
Typically can be managed conservatively through therapeutic ex & education
POSTURAL DEVELOPMENT
Causes of poor posture Structural factors Congenital anomalies Developmental problems Trauma Disease
Not typically easily managed
EXAMPLE: TOTAL SPINAL POSTURE Ideal
1.1. Head sits straight on Head sits straight on shoulders shoulders nose in-line c/ nose in-line c/
manubrium, manubrium, xiphoid, umbilicusxiphoid, umbilicus
Earlobes in-line Earlobes in-line with acromion with acromion processprocess
2.2. Shoulders and Shoulders and clavicles level are clavicles level are equalequal
3.3. normal appearance of normal appearance of ShouldersShoulders
4.4. Arms equidistant from Arms equidistant from trunktrunk
5.5. Normal spinal curvesNormal spinal curves
6.6. Iliac crests, ASIS’s & Iliac crests, ASIS’s & PSIS’s .PSIS’s .
7.7. ASIS sit lower than PSISASIS sit lower than PSIS8.8. Gluteal folds and knee Gluteal folds and knee
joints evenjoints even9.9. Patellae point forwardPatellae point forward10.10. No Genu conditions No Genu conditions
notednoted11.11. Heads of fibula and all Heads of fibula and all
malleoli levelmalleoli level12.12. Achilles tendons & Achilles tendons &
heels appear to be heels appear to be straightstraight
13.13. Evident archesEvident arches
GOOD SPINAL POSTURE
WHAT IS BAD POSTURE?
Any position that deviates from “good posture”
Static Standing Sitting Sleeping
Dynamic Running Throwing, etc.
Correct posture “Position in which minimum stress is placed
on each joint.”
Faulty posture Any position that increases stress on joints
COMMON SPINAL DEFORMITIES LordosisLordosisExcessive anterior curvature of the spine
Exaggeration of normal curves in the cervical & lumbar spines
COMMON SPINAL DEFORMITIES
Lordosis causes: Postural deformity Lax muscles (esp. abs) Heavy abdomen Hip flexion contracture Spondylolisthesis Congential problems Fashion (high heels)
COMMON SPINAL DEFORMITIES
Swayback deformity :Increased pelvic inclination (40)
Typically includes kyphosis
COMMON SPINAL DEFORMITIES
KyphosisExcessive posterior curvature of the spineRound backHumpback/gibbusFlat backDowager’s Hump
COMMON SPINAL DEFORMITIES
ScoliosisNonstructural“Functional”May be related to leg length discrepancy
StructuralLacks normal flexibilityAsymmetric movements
COMMONLY SEEN POSTURAL DEVIATIONS
Shoulder/ScapulaWinging Scapula
Head and C-Spine
HIPS
History
Inspection
Palpation
Special (Functional) Tests
RELEVANT HISTORY Identify factors that
influence posture
OveruseNeurological Problems
PainLack of awareness
Ms weakness/ Imbalance
Hypermobile JtsHypomobile JtsFlexibilityBony AbnormalityLeg Length Disc.
INSPECTION Use of a plumb line
Anatomical reference3 views
Lateral (sagittal plane movements)
Anterior (frontal/ transverse plane movements)
Posterior (frontal/ transverse plane movements)
OBSERVATION Body typeEctomorphMesomorphEndomorph
LATERAL VIEW
Look for:@ ankle?@ knee?@ hip?@ shoulder?@ neck?@ head?
Anterior view Head straight on shouldersHead straight on shoulders Shoulders levelShoulders level Clavicles/AC jointsClavicles/AC joints Sternum & ribsSternum & ribs Waist angles & arm Waist angles & arm positionspositions
Carrying anglesCarrying angles Iliac crestsIliac crests ASISASIS PatellaePatellae KneesKnees Fibular headsFibular heads
Malleoli levelMalleoli levelArchesArchesFoot rotationFoot rotationBowing of bonesBowing of bonesDiastematomyelia (hairy Diastematomyelia (hairy
patches)patches)Pigmented lesionsPigmented lesions
Café au lait spotsCafé au lait spots
Anterior view
POSTERIOR VIEW
Look for:@ heel?@ pelvis?@ lumbar spine?@ scapulae?@ neck?@ head?
PALPATION
In assessment position (i.e., standing), palpate:
Laterally ASIS vs. PSIS
Anteriorly Patellae Iliac Crests ASIS heights Lateral Malleolar heights
Fibular Head heights
Shoulder heights
PosteriorlyPSIS positionsSpinal alignmentScapular positions
FUNCTIONAL TESTS
Assess muscular length ROM Resting muscle length
OTHER TECHNOLOGY
Video Analysis
3D Motion Analysis
Sway Measurement Tools
Force PlateBiodex Stability SystemNeuroCom