Patient Examination: Tests and Measures

1. Patient Examination:  Tests and Measures Rehab 536

2. Examination: Tests and Measures What do you know? What do you need to know?

3. Examination: Purpose Identify specific location of lesion Differentiate type of tissue involved Contractile Nervous Inert Identify specific structure Biceps tendon Median nerve

4. Examination: Purpose Identify specific functional limitation Examine impact of injury or disability on ability to function in every day life Identify activities that cause symptoms are limited by symptoms Hypothesize underlying impairments

5. Examination: Tests and Measures Posture Palpation AROM/PROM End-feel Muscle Length Strength Sensation Special tests Anthropometric Characteristics Functional Mobility including Gait Balance

6. Examination-- AROM Information about ROM, power, control, willingness to move Observe amount, quality, and arc of pain Incorporate information from history- repetitions, sustained position Impaired by pain ?weakness paralysis ?spasm tissue shortening ?length-tension relationship

7. Examination- PROM Performed by examiner with patient relaxed Limited by muscle contraction or spasm soft tissue contracture pain neurological deficit

8. Examination- End Feel Feeling imparted to examiner�s hands at end of ROM Normal bone-to-bone Soft-tissue approximation Soft-tissue stretch Abnormal all of above at unexpected point in ROM Muscle spasm ?capsular Springy block ?empty

9. Examination- Capsular Pattern Characteristic pattern of proportional joint limitation associated with total joint involvement capsular contraction muscle spasm generalized osteophyte formation Does not indicate type of joint pathology must assess end feel

10. Examination- Inert Tissue Pain- AROM and PROM painful in same direction, no pain with resisted isometrics Patterns of limitation All directions- arthritis, capsulitis Pain with limited motion or hypermobility sprain, local capsular adhesion, internal derangement Painfree, limited, bony endfeel Osteophytes with symptomless arthritis

11. Examination-  Resisted Isometrics Tests contractile tissue and neurological integrity Performed in neutral or resting position no stress to inert structures optimal strength Interpretation of weakness Neurological etiology- no pain Contractile etiology- + pain

12. Examination- Contractile Pain AROM and PROM in opposite direction, resisted isometrics same direction as AROM Patterns strong and painful- local lesion weak and painful- severe lesion weak and painfree- rupture or neurological

13. Examination-Reflexes and Sensory Reflexes Deep tendon ?Superficial ?Pathological Sensory Scan or Detailed Compare R/L, proximal/distal map area of loss- dermatome, peripheral, stocking/glove Tests- light touch, deep pressure, pain, temperature, vibration, joint motion and position

14. Examination- Special Tests Provocative tests designed to test the integrity of specific anatomical structures glenoid labrum alar ligament meniscus of knee ACL Diagnostic

15. Examination:  Functional Assessment Identify specific functional limitations Examine impact of injury or disability on ability to function in every day life Identify activities that cause symptoms are limited by symptoms Hypothesize underlying impairments

16. Examination-  Functional Assessment Action Level Success Time Level of independence Effort Assistive devices Movement Level- Kinematic Analysis Phases of the activity Body segments Symmetry

17. Examination:  Functional Assessment Include all pertinent mobility skills Bed mobility roll, scoot, supine ?? sit Transfers bed, chair, toilet, floor, stand Balance sitting, standing, static, dynamic, reactive, proactive Ambulation- indoor, outdoor, stairs, ramps W/C propulsion or driving

18. Examination:  Functional Assessment Gather specific objective, measurable data related to each functional activity Technique Equipment required Level of assistance required Duration or distance Speed Safety Efficiency Hypothesize underlying impairments

19. Examination:  Functional Assessment If patient cannot perform skill, can s/he direct? If mobility performed by or assisted by a caregiver, assess the caregiver�s technique.

20. Examination:  Functional Assessment Gather objective measures using valid, reliable tests and measures Clearly describe activity Levels of assist Functional balance tests Functional Reach Test (FRT) Timed Up and Go (TUG) Berg Balance Test (BBT)

21. Examination:  Functional Assessment Gather objective measures using valid, reliable tests and measures Functional walking tests Tinetti Assessment Tool Dynamic Gait Index (DGI) Gait speed and endurance 10-meter Walk Test 3, 6, 12- Minute Walk Tests

22. Examination: Tests and Measures Testing sequence Efficiency Energy conservation Begin in presenting position Plan ahead Gather all equipment and supplies Arrange the testing area Arrange for assistance if needed Modify the techniques to the patient�s abilities

23. Patient Examination Tests and Measures Questions?

24. Selection of Tests and Measures: SCI 12:15 Selection of tests & measures for pt with SCI Review patient history Review systems review and scan exam findings Identify systems with current impairment and/or history of pathology Select appropriate tests and measures Indicate rationale for gathering information Prioritize tests and measures (most important, least important) 12:45 Merge groups, compare and discuss 1:00 Large group discussion 1:20 Wrap-up selection of tests & measures for SCI 1:20 Break

25. Patient Interviewing 1:30 Video of interview (paraplegia 2� spina bifida) Identify objective measures for functional mobility skills Transfers (bed, toilet, tub, car, floor) Ambulation (level and stairs) W/C propulsion Fall history Identify 4 patient goals 1:55 Discussion of interview video 2:10 Wrap-up, questions? 2:20 Conclude Review patient history, systems review, and scan exam findings for Sue (CVA) identify tests and measures Review stroke chapter in O�Sullivan and Schmitz Bring printed copies of functional tests and measures

26. Evaluation

27. Evaluation