Vous êtes sur la page 1sur 38

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 zones
Nerve 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

1
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.

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 stimulation


Lethargic drowsy, may fall asleep if not stimulated
Obtunded difficult to arouse, frequently confused when awake
Stupor responds only to strong, noxious stimuli: returns to
unconscious state
Coma cannot be aroused

ORIENTATION

2
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

Stage 1 non-blanchable erythema of intact skin


Stage 2 abrasion, blister, or shallow crater (epidermis &
dermis)
Stage 3 deep crater, necrosis/damage of necrotic tissue
Stage 4 extensive destruction, tissue necrosis extending up to
muscle and bone

BODY BUILD

Ectomorphic thin, prominence of structures from ectoderm


Mesomorphic 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 & texture


Note differences in tissue thickness
Identify palpable anomalies
Define areas of tenderness
Temperature variations
Pulses, tremors, fasciculations
Dryness, excessive moisture
Abnormal sensation

Remember!! Palpate uninvolved part first and painful areas last

TENDERNESS (Pain upon palpation)

3
Tenderness Scale/Grading 1 complains of pain
2 complains of pain & winces
3 winces & withdraws limb
4 patient won’t allow palpation

EDEMA

Grading of Edema Mild 1+ < ¼” depth of


depression
Moderate 2+ ¼” to ½” depth of
depression
Severe 3+ ½” to 1” depth of depression

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 mmHg
Stage 2 ≥ 160 mmHg/100 mmHg

Infant Blood Pressure < 2 y.o. 106-110 mmHg/59-63 mmHg


3-5 y.o. 113-116 mmHg/67-74 mmHg

Factors that may alter the Blood Pressure

Elevate BP Lowers BP

Pain Recent meal


Auscultatory gap Dehydration
Sleeplessness Auscultatory
gap
Recent smoking
Distended bowel/bladder
Recent exercise
Chilling

4
PULSE RATE

Adult Pulse Rate Normal 60-100 bpm (avg. 70 bpm)


Tachycardia >100 bpm
Bradycardia < 60 bpm

Infant Pulse rate Normal 70-170 bpm (avg. 120 bpm)

Pulse Grading 4+ Bounding


3+ Increased
2+ Brisk, expected
1+ Diminished, weaker than expected
0 Absent, unable to palpate

RESPIRATORY RATE

Adult RR Normal 12-20 cpm


Tachypnea > 20 cpm
Hyperpnea 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˚C


Conversion ˚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

5
Relapsing/Recurrent alternate b/n pyrexia &
normal
lapse for > 24 hr
Sustained/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

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 other

6
Let 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.
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

7
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
surface
Response Patient points out the
area that the therapist
touches
Two-point
Discrimination Applies simultaneous
stimuli on the patient’s
skin
Response Identify if the perception
of one or two stimuli
Graphesthesia Trace letters, numbers or
designs on skin
Response Identify what is the
traced figure

8
9
MUSCULOSKELETAL ASSESSMENT

PATIENT HISTORY & INTERVIEW

Symptom Onset sudden, gradual, insidious, traumatic


Location localized, diffuse, deep, superficial,
changes, spreads
Quality severity, characteristic
Behavior 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 10
No Pain Worst
Pain

Imaginable
Previous Care/Medical History Previous occurrence of the
condition, treatments received
and its effects

Past medical history Other significant conditions

Medications Medications taken, type,


frequency, dose
Treatment goals Patient’s hopes for outcome

10
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

Over pressure maybe applied to point of


pain but not beyond

11
Resisted isometrics are done with the joint
in resting position

Active ROM Often estimated except if more accurate


measurement is needed, goniometer
should be used
If 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 AROM


Tested 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.)

12
End Feel Abnormal End Feels

End Feel Examples


Soft
Occurs sooner or later in the Soft tissue edema
ROM than is usual, or in a Synovitis
joint that normally has a
firm or hard end-feel. Feels
boggy

Firm
Occurs sooner or later in the Increased muscular tonus
ROM than is usual, or in a Capsular, muscular, liga-
joint that normally has a mentous shortening
soft or hard end-feel.

Hard
Chondromalacia
Occurs sooner or later in the
Osteoarthritis
ROM than is usual, or in a
Loose bodies in joint
joint that normally has a
Myositis ossificans
soft or firm end-feel.
Fracture
A bony grating or bony
block is felt.

Empty
No real end-feel because Acute joint inflammation
pain prevents reaching end Bursitis
of ROM. No resistance is Abscess
felt except for patient’s Fracture

protective muscle splinting Psychogenic Disorder


or muscle spasm

13
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

14
Joint Pattern
Shoulder ER>ABD>IR

Elbow F>E

Forearm Pronation=Supination

Wrist F=E

CMC 1 ABD & EXT


2-5 Equal restriction in all
direction

UE digit F>E

Hip IR, F, ABD

Knee F>E

Ankle PF>DF

Subtalar Varus restricted

Midtarsal Restricted DF, PF, ABD,


medial rotation

Metatarsalphalangeal joint E>F


1
Tend toward Flexion
Metatarsalphalangeal joint
2-5
Tend toward extension
IP joint

ROM Values
AVERAGE RANGES OF MOTION FOR THE UPPER EXTREMITIES
IN DEGREES FROM SELECTED SOURCES

Joint Motion values Motion values


Shoulder Flexion 0-180 Hip Flexion 0-120
Extension 0-60 Extension 0-30
Abduction 0-180 Abduction 0-45
Medial rotation 0-70 Adduction 0-30

15
Lateral 0-90 ER/IR 0-45
Elbow Flexion 0-150 Knee Flexion 0-135
Forearm Pronation 0-80 Ankle PF 0-50
Supination 0-80 DF 0-20
Wrist Extension 0-70 Inversion 0-35
Flexion 0-80 Eversion 0-15
Radial 0-20 Subtalar Inv/Evr 0-5
Ulnar deviation 0-30 Great toe
Thumb
CMC Abduction 0-70 MTP flexion 0-45
Flexion 0-15 extension 0-70
Extension 0-20 PI flexion 0-90
Opposition Tip of thumb to
or tip of fifth digit Lesser toe
MTP flexion 0-40
MCP Flexion 0-50 extension 0-40
IP Flexion 0-80 PIP flexion 0-35
Digits DIP flexion 0-30
Second -
Fifth
MCP Flexion 0-90
Hyperextensio 0-45
Abduction
PIP Flexion 0-100
DIP Flexion 0-90
Hyperextensio 0-10
n
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 ankylosed


1 considerable
hypomobility
2 slight hypomobility
3 normal
4 slight hypermobility
5 considerable
hypermobility
6 unstable

Grades 0 & 6 surgery considered, joint mobilization not


indicated
Grades 1 & 2 joint mobilization to increase joint extensibility
Grades 4 & 5 increasing joint extensibility not indicated;
taping, bracing, strengthening indicated

16
RESISTED ISOMETRIC TESTING

Joint should be placed in a position midway through the range, to


produce
minimal tension in inert structures.

RESULTS OF RESISTED
ISOMETRIC 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


muscle 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
possibilities 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

17
MANUAL MUSCLE TESTING

Manual Muscle Testing Grades

Grades Criteria
Normal N 5 10
Full available ROM, against
gravity, strong manual
resistance
Good Plus G+ 5– 9
Full available ROM, against
gravity, nearly strong
manual resistance
Good G 4 8
Full available ROM, against
gravity, moderate manual
resistance
Good Minus G– 4– 7
Full available ROM, against
gravity, nearly moderate
manual resistance

Fair Plus F+ 3+ 6
Full available ROM, against
gravity, slight manual
resistance
Fair F 3 5
Full available ROM, against
gravity, no resistance
Fair Minus F– 3– 4
At least 50% of ROM, against
gravity, no resistance
Poor Plus P+ 2+ 3
Full available ROM, gravity
minimized, slight manual
resistance
Poor P 2 2
Full available ROM, gravity
minimized, no resistance
Poor Minus P– 2– 1
At least 50% of ROM, gravity
minimized, no resistance

Trace Plus T+ 1+ Minimal observable motion

(less than 50% ROM), gravity


minimized, no resistance

18
Trace T 1 T
No observable motion, palpable
muscle contraction, no resistance

Zero 0 0 0
No observable or palpable muscle
contraction

CLOSE-OPEN PACKED POSITION

Resting (Loose/open Packed) Position of Joints


Joint Position

Facet (spine) Midway between flexion and extension


Temporomandibular Mouth slightly open (freeway space)
Glenohumeral 55° abduction, 30° horizontal adduction
Acromioclavicuiar Arm resting by side in normal physiological position
Sternoclavicular Arm resting by side in normal physiological position
Ulnohumeral (elbow) 70° flexion, 10° supination
Radiohumeral Full extension, full supination
Proximal radioulnar 70° flexion, 35° supination
Distal radioulnar 10° supination
Radiocarpal (wrist) Neutral with slight ulnar deviation
Carpometacarpal Midway between abduction-adduction and flexion-
extension
Metacarpophalangeal Slight flexion
Interphalangeal Slight flexion
Hip 30° flexion, 30° abduction, slight lateral rotation
Knee 25° flexion
Talocrural (ankle) 10° plantar flexion, midway between maximum inversion
and eversion
Subtalar Midway between extremes of range of movement
Midtarsal Midway between extremes of range of movement
Tarsometatarsal Midway between extremes of range of movement
Metatarsophalangeal Neutral

Close Packed Position of Joints


Joint Position
Facet (spine) Extension
Temporomandibular Clenched teeth
Glenohumeral Abduction and lateral rotation
Acromioclavicular Arm abducted to 90°
Sternoclavicular Maximum shoulder elevation
Ulnohumeral (elbow) Extension
Radiohumeral Elbow flexed 90°, forearm supinated 5°
Proximal radioulnar 5° supination
Distal radioulnar 5° supination
Radiocarpal (wrist) Extension with radial deviation
Metacarpophalangeal Full flexion (fingers)

19
Metacarpophalangeal Full opposition (thumb)
Interphalangeal Full extension
Hip Full extension, medial rotation*
Knee Full extension, lateral rotation of tibia
Talocrural (ankle) Maximum dorsiflexion
Subtalar Supination
Midtarsal Supination
Tarsometatarsal Supination
Metatarsophalangeal Full extension

MOTOR EVALUATION

TONE

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)

20
Grade Evaluation Response Characteristics

0 Absent No visible or palpable muscle


contraction
with reinforcement.

1+ Hyporeflexia Slight or sluggish muscle contraction with


little 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

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

21
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

22
Result-Interpretation

2,3,5,6 Visual loss


5, 6 Vestibular loss
4, 5, 6 Surface, somatosensory input
3, 4, 5, 6 Sensory 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.

23
TEST PROCEDURE
1. Finger to nose 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.

2. Finger to therapist's finger 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.

3. Finger to finger
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.
4. Alternate nose to finger
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.

5. Finger opposition
The patient touches the tip of the thumb to
the tip of each finger in sequence. Speed
may be gradually increased.
6. Mass grasp
An alternation is made between opening
and closing fist (from finger flexion to full
extension). Speed may be gradually
7. Pronation/supination 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.
8. Rebound test

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
24 groups can be tested for this phenomenon,
such as the shoulder abductors or flexors,
elbow extensors, and so forth.

9. Tapping (hand)
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

25
the knees while sitting on a Swiss ball.

Impairment Sample Test


Dysdiadochokinesia Fi n g e r t o n o s e
Alternate nose to finger
Pronation/supination
Knee
f l ex i o n / ex t e n s i o n
Walking, alter speed or
direction

Dysmetria Pointing and past


pointing
Drawing a circle or figure
eight
Heel on shin.
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 activities (tremor will typically
increase as target is
approached or movement speed increased)
Alternate nose to finger
Finger to finger
Finger to therapist's
finger
Toe to examiner's
finger

Tremor (resting) Observation of patient at rest


Observation during functional
activities (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

26
Rigidity Passiv e moveme nt
Observation during functional
activities
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
sitting or standing
Standing, alter base of support
(e.g., one foot directly in front
of 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 ambulatory
activities
Walk in a circle

27
GAIT ANALYSIS

GAIT TERMS

TRUNK DEVIATIONS: STANCE PHASE

28
HIP DEVIATIONS: STANCE PHASE

HIP DEVIATIONS: SWING PHASE

29
KNEE DEVIATIONS: STANCE PHASE

KNEE DEVIATIONS: SWING PHASE

ANKLE & FOOT DEVIATIONS: SWING


PHASE

30
ANKLE & FOOT DEVIATIONS: STANCE
PHASE

31
RATING FOR GAIT ANALYSIS

32
FUNCTIONAL ANALYSIS

Barthel's index of activities of daily


living (BAI)

33
Functional Independence Measure (FIM)

34
35
36
37
38