CLINICAL AND EXPERIMENTAL DIAGNOSTICS
Transcript of CLINICAL AND EXPERIMENTAL DIAGNOSTICS
CLINICAL AND EXPERIMENTALCLINICAL AND EXPERIMENTALDIAGNOSTICS DIAGNOSTICS
IN KINEZIOLOGY AND PHYSIOTHERAPYIN KINEZIOLOGY AND PHYSIOTHERAPY
KristkováKristková Veronika , BCVeronika , BCMíková Marcela, MAMíková Marcela, MA
Basic vital function – respiration, feeding etc.
Postural system
Locomotor system
Motor skills, Manipulation
Communication
EntryEntry for for diagnosticsdiagnostics ��MOVEMENTMOVEMENT
MOVEMENTMOVEMENT ��logisticslogistics + + excitabilityexcitability ofof neuronsneurons + + posturalpostural settingssettings + + maintainingmaintaining ofof orientatedorientated postureposture in in gravitygravity + + smoothsmooth changeschanges ofof posturepostureduringduring movementmovement + + automatisationsautomatisations ofof stereotypicalstereotypical movementsmovements andand theirtheircontrolcontrol + + generationgeneration ofof alternativealternative schemasschemas (by (by unpainfullunpainfull nociceptionnociception) ) �� targettarget, , tasktask orientatedorientated movementmovement
Véle, 1997
ASSESSMENT OF MOVEMENTS
StrengthROM Coordination
StructureFunction
Posture
�� jointsjoints�� ligamentsligaments�� musclesmuscles�� fasciasfascias�� skinskin
�� musclemuscle -- MUMU�� PNSPNS�� CNSCNS
Power
�� CP CP fcnfcn�� ANSANS
Tone Stability
DIAGNOSTIC METHODSDIAGNOSTIC METHODS
Art of observation
Art of palpationAspectionAspectionPalpationPalpation
AnamnesisAnamnesis
TestingTesting, , measurementmeasurementQuestionaryQuestionary, , scalesscales
EMPIRICSUBJEKTIVE ???
KinesiologicalKinesiological researchresearch
OBJECTIVE ?!!
MUSCLE TESTINGMUSCLE TESTING001 1 –– musclemuscle jerkjerk2 2 –– movementmovement „„withoutwithout gravitygravity“, „“, „withoutwithout weightweight““3 3 –– fullfull ROM ROM againstagainst gravitygravity4 4 –– againstagainst moderatemoderate resistanceresistance5 5 –– fullfull ROM, ROM, againstagainst maximalmaximal resistanceresistance
? ? –– standard standard conditionsconditions, , subjectivesubjective, , onlyonly anatomicalanatomical planesplanes, , mostlymostly in in supinesupine positionposition, not , not suitablesuitable andand not not sufficient sufficient for for centralcentral disordersdisorders ofof movementmovement
KendallsVl. Janda
CLINICAL METHODSCLINICAL METHODS
GoniometryGoniometry--anatomicalanatomical planesplanes -- SFTRSFTR--goniometergoniometer--assessmentassessment ofof functionalfunctional ROMROM
S: 30 S: 30 –– 0 0 –– 180 180 S: S: extext –– 0 0 –– flxflxF: 180 F: 180 –– 0 0 –– 40 40 F: F: abdabd –– 0 0 –– addaddT (R): 90 T (R): 90 –– 0 0 –– 90 90 T(R): ER T(R): ER –– 0 0 –– IR …IR …
? ? –– ±± subjektivesubjektive, ROM , ROM onlyonly in in anatomicalanatomical planesplanes, , mostlymostly in in supinesupine positionposition
AntropometryAntropometry-- circumferencecircumference-- lenghtlenght
CLINICAL METHODSCLINICAL METHODS
ExaminationExamination ofof manualmanual medicinemedicine
-- conceptconcept ofof barriersbarriers for for differentdifferent tissues tissues -- specialspecial technicstechnics for for examinationexamination ofof jointsjoints –– activeactive and and passive movementspassive movements x x jointjoint playplay-- palpationpalpation ofof slideingslideing andand reactivityreactivity ofof soft soft tissuestissues ––skin, skin, subcutissubcutis, , fasciasfascias, , musclesmuscles
LewitRychlíkováHoppenfeld
CLINICAL METHODSCLINICAL METHODS
Examination of Examination of motor motor skills in the skills in the 11stst year of lifeyear of life
-- „A „A brainbrain expressesexpresses itselfitself throughthrough motor motor skills skills “ “ ((examinationexamination ofof motor motor skillsskills inin thethe 11stst yearyear ofof lifelife matchesmatches to to levellevel of of CNS maturity) CNS maturity) -- examination of spontaneous postural activityexamination of spontaneous postural activity-- examinationexamination ofof posturalpostural reactivityreactivity –– 7 7 positionposition tests tests -- Dg. Dg. –– threatthreat ofof movementmovement developmentdevelopment ((centralcentral coordination coordination
disorderdisorder, CCP, …), CCP, …)
VojtaCLINICAL METHODSCLINICAL METHODS
QuestionaresQuestionares –– ScalesScales –– IndexesIndexes
CLINICAL METHODSCLINICAL METHODS
IMPAIRMENT DISABILITY HANDICAPImpairment – related to structure – haematom, ischaemie, fracture, visceral, neuromyosceletal…Disability – disability in performance, communication, personalcare, locomotion, dexterous…Handicap – handicap in orientation, physical self – sufficiency(ADL), employing, social integration…
Assesement of independance, mobility, possibility of employment, social integration, economical independance, prognosis – IDH scale 0-9
FIM – Functonal Independence Measure (1987, USA)
MMSE – Mini Mental State dle Folsteina
PULSES (1957) – FHDSVP (Moskowitz)
KATZ (1963)
BARTHEL INDEX (1965)
KENNY (1965), RAP
BARTHEL INDEX
Activity Score
Feeding0 = unable5 = needs help cutting, spreading butter, etc., or requires modified diet10 = independent
0 5 10
Bathing0 = dependent5 = independent (or in shower)
0 5
Grooming0 = needs to help with personal care5 = independent face/hair/teeth/shaving (implements provided)
0 5
Dressing0 = dependent5 = needs help but can do about half unaided10 = independent (including buttons, zips, laces, etc.)
0 5 10
Bowels0 = incontinent (or needs to be given enemas)5 = occasional accident10 = continent
0 5 10
Bladder0 = incontinent, or catheterized and unable to manage alone5 = occasional accident10 = continent
0 5 10
Toilet Use0 = dependent5 = needs some help, but can do something alone10 = independent (on and off, dressing, wiping)
0 5 10
Transfers (bed to chair and back)0 = unable, no sitting balance5 = major help (one or two people, physical), can sit10 = minor help (verbal or physical)15 = independent
0 510 15
Mobility (on level surfaces)0 = immobile or < 50 yards5 = wheelchair independent, including corners, > 50yards10 = walks with help of one person (verbal or physical) > 50 yards15 = independent (but may use any aid; for example,stick) > 50 yards
0 51015
Stairs0 = unable5 = needs help (verbal, physical, carrying aid)10 = independent
0 510
TOTAL (0 - 100) ________
Patient Name: __________________ Rater: ____________________ Date: / / :
INSTRUMENTAL INSTRUMENTAL METMETHHODODSS
Expectations ?- help at diagnostics- solving of kineziological questions- participation in therapy- assesement of therapy efficiency- comparison of various approaches of therapy- more objective documentation
INSTRUMENTAL EXAMINATION METHODSINSTRUMENTAL EXAMINATION METHODS
Kinematic Dynamic Others • videographic method
(kinematic analysis) • goniometry • accelerometry • measuring of time
parametres • speedometry
• dynamometry • dynamography • pedobarography
• EMG,SEMG • X - rays • NMR • CT • Moire • Virtual reality • Tapping
MethodsMethods ofof kinesiologicalkinesiological researchresearch
M. Janura, 2002
3D (spacial)
2 video cameras(at least)
2D (plane)
1 video camera X
Videographic examination methodVideographic examination method
Movement record → digitalisation of the record (defining of selectedpoints position, 2D) → transformation of coordinates (3D) → basiclenght and angle characteristics.
M. Janura, 2002
KINOGRAMS (sagital plane)
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Murcková P. et al., KBTK FTK
EXPORTS:EXPORTS:-- componentscomponents ofof groundground reactionreactionforceforce (GRF) (GRF) FxFx, Fy, , Fy, FzFz-- momentsmoments MxMx, My, , My, MzMz
TENSOMETRIC FORCE PLATES TENSOMETRIC FORCE PLATES
SDx
SDy
[cm]
[cm]
AREA
Confidentellipse
COPCOP - center of pressure=> position data COP (x, y) => set of COP (1000 Hz)=> 95%95% ellipse ofellipse of confidenceconfidence
COMP. DYNAM. POSTUROGRAPHY COMP. DYNAM. POSTUROGRAPHY –– NeurocomNeurocom**diagnosticaldiagnostical andand therapeuticaltherapeutical modul*modul*
Principle of SEMG
•• IndicationIndication musclemuscle activationactivation / / deactivationdeactivation ~~ TIMINGTIMING•• MagnitudeMagnitude ofof electricalelectrical activityactivity ofof musclemuscle ~~ correlation correlation
STRENGTH STRENGTH –– SEMG SEMG signalsignal•• ApplicationsApplications ofof SEMG SEMG –– as a as a fatiguefatigue indexindex
SURFACE ELEKTROMYOGRAPHYSURFACE ELEKTROMYOGRAPHY
INTERFERENCE PATTERNINTERFERENCE PATTERN�� sumationsumation AP AP ofof many MU + many MU + theirtheir interference interference
Application
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