PT 142: Assessment in Physical Therapy

Laboratory Session

Anthropometric
Measurements

Edited for instruction by:

GILBERT O. MADRIAGA, PTRP

Minerva Zaniebeth A. Gomez, PTRP

Kristofferson G. Mendoza, PTRP
Gilbert O. Madriaga, PTRP
Authors
All Rights Reserved 2008
 Obectives
At the end of the session, the student will be able to:

 Describe the general principles and methods of

anthropometry

 Determine the relevant anthropometric

characteristic needed to be measured given a
sample case

 On a simulated patient, perform correctly and

efficiently the following anthropometric
characteristics commonly seen in the clinics: limb
girth, muscle bulk, leg length, head circumference
 Objectives
 Select the proper landmarks given a specific
anthropometric measurement

 Use and manipulate anthropometric tools correctly and

efficiently

 Discuss the probable significance of anthropometric

findings

 Record anthropometric findings accurately using

clear and understandable language in an
acceptable format
 Objectives
 Report correctly results of anthropometric
measurements to a simulated patient

 Identify other anthropometric measurements for

edema or swelling
General Principles
and Methods
What is anthropometry?

ANTROPO - human

METRY - measurement
What is anthropometry?

 The study of human dimensions

 The measurement of traits that describe

body dimensions
What is anthropometry?

 The physical measurement of the human

body which provides therapists with
building blocks for understanding the
complexities of the human form and how
it interfaces with the environment
What to measure?

 In physical therapy, anthropometry may

include the assessment of
 Edema
 Localized swelling
 Joint effusion
 Muscular changes
 Asymmetry of body parts
 Effects of surgical procedures
Why measure?

 Aid the clinician in determining the

patients impairments and in providing the
appropriate treatment

 Provides a baseline to monitor the

rehabilitation outcome
 effective treatment vs. patient deterioration
Why measure?

 Provides feedback and motivation to

patients

 Aid in designing equipment and materials

for special population such as children,
elderly and the differently-abled
Why measure?

 Also provides important information in the

design of objects and spaces used by the
normal population (i.e. ergonomics)
Types of Measurement

Static Anthropometry

 Refers to actual sizes of body

components, and is taken with the body
fixed or in standard positions
Types of Measurement

Dynamic Anthropometry

 Refers to the ability of the body to

perform certain tasks with certain
distances, spaces or enclosure

 Taken with the body in various working

positions and is related to body
performance
Factors Affecting
Anthropometry
 Gender
 Males have less fat tissue and more muscle
bulk
 Fat accumulation difers in reions for men
and women

 Aging
 Stature decreases and body weight
increases after 30 years
 Body weight decreases after 50 (M), 60 (F)
Factors Affecting
Anthropometry
 Ethnicity
 Lower body weights for those who live in
tropical countries
 Body proportions differ depending on
ethnicity
 Differences diminish due to migration

 Occupation
 Some occupations are self-selective
Factors Affecting
Anthropometry
 Tools
 Tape measure
 Steel tape
 Volumeter
 Anthropometer
 Caliper
Using the Tape Measure

 Measure in centimeters
 Lie the tape measure flat on the body part
 The tape measure should be stretched out and
not slack
 If the segment to be measured is irregular or
conical in shape, the proximal part of the tape
should be flat
 When measuring circumference, surround the
body part without undue constricting pressure
Measurements
Commonly
Performed in the
Clinics
Leg Length Measurement

Indications
 postural deviations
 gait deviations
 checking for leg
length discrepancy
True leg length
discrepancy
vs.
Apparent leg length
discrepancy
True Leg Length
Measurement
Position
 Supine with the legs 15-20 cm apart (4-8 in)
and parallel to each other
 Pelvis is balance or in level with lower limbs
 Abduction / adduction contracture?

Landmarks
 ASIS to lateral malleolus
 ASIS to medial malleolus affected by muscle
wasting, obesity or knee deformities
True Leg Length
Measurement
Values
 A difference of 1 to 1.5 cm is still considered
normal but may still cause symptoms

Validity and Reliability

 Valid and reliable in measuring leg length
discrepancy (Beattie, 1990)
 Increase reliability by getting the mean of two
measurements
 Potential sources of error: muscle bulk and
palpation
Apparent Leg Length
Measurement
Position
 same as true leg length measurement

Landmarks
 tip of xiphisternum or umbilicus to medial
malleolus
 affected by muscle wasting, obesity or
asymmetric positioning the xiphisternum,
umbilicus or the lower limb
True Leg Length
Measurement
Values
 If true leg length measurement is normal but
the umbilicus to malleolus is different, then a
functional leg length discrepancy is present
Segmental Leg Length
Measurement
Landmark:
to determine the site of occurrence of shortening
 highest point of the iliac crest to greater
trochanter
 for changes in neck shaft angle

 greater trochanter to lateral knee joint line

 for femoral shaft length

 medial knee joint line to medial malleolus

 for tibial length
Leg Length Measurement
 Muscle Bulk Measurement
Indications
 conditions where a
decrease (or
increase) in muscle
bulk is expected
 Atrophy (SCI,
fractures, CVA)
 Hypertrophy
(Duchene muscular
dystrophy)
Muscle Bulk Measurement
Position
 Supine or sitting provided that the segment be
assessed is well supported

Note:
 If the affectation is unilateral, measure the
uninvolved extremity prior to measuring the
affected part.
 The muscles should be at rest when muscle
bulk is measured
Muscle Bulk Measurement

Landmarks
 Identify a stable bony landmark at the proximal
part of the segment to measured (1)

 Identify the area of the segment where the

muscle bulk is the greatest (2)

 Measure the distance between (1) and (2).

Record this as the measurement landmark.
Muscle Bulk Measurement

Procedure
 Measure the circumference of the segment
around the identified measurement landmark.

 Measure the other extremity using the same

landmarks

Limitation
 Individual muscles cannot be measured
Limb Girth Measurement

Indications
 Swelling
 Joint effusion
 Edema
Limb Girth Measurement:
Swelling / Joint effusion
Position
 Supine or sitting provided that the
segment be assessed is well supported

Landmarks
 Identify a stable bony landmark closest to
the area of swelling
Limb Girth Measurement:
Swelling / Joint effusion
Procedure
 Measure the circumference of the segment
around the identified measurement landmark

 Measure every 4 cm (2 inches) proximally or

distally depending on the extent of the swelling

 Measurement should extend beyond the

obviously involved area in both directions if at
all possible
Limb Girth Measurement:
Swelling / Joint effusion
Procedure
 Measure the other extremity using the same
landmarks to compare

 Measurement should preferably be from a

point of zero difference to another point of zero
difference
Limb Girth Measurement:
Edema
Position
 Supine or sitting provided that the
segment be assessed is well supported
 Limb Girth Measurement:
Edema
Edema up to… Landmarks
…fingers  base of the fingers
 PIPs (together) 2nd & 5th digits as reference
 DIPs (together) 2nd & 5th digits as reference
…wrist The previous landmarks plus…
 MCPs
 thumb webline
 wrist joint (radial styloid)
…elbow The previous landmarks plus…
The radial styloid then measure every 4 cm
(2 inch) proximally
 Limb Girth Measurement:
Edema
Edema up to… Landmarks
…shoulder The previous landmarks plus…
The lateral epicondyle then measure every 4
cm (2 inch) proximally
 Limb Girth Measurement:
Edema
Edema up to… Landmarks
…toes  base of the toes
 PIPs (together) 2nd & 5th digits as reference
 DIPs (together) 2nd & 5th digits as reference
…ankle The previous landmarks plus…
The MTP then measure every 4 cm (2 inch)
proximally
…knee The previous landmarks plus…
The lateral malleolus then measure every 4
cm (2 inch) proximally
 Limb Girth Measurement:
Edema
Edema up to… Landmarks
…hip The previous landmarks plus…
The lateral knee joint then measure every 4
cm (2 inch) proximally
Head Circumference

Indications
 Hydrocephalus
 Microcephalus
Head Circumference

Position
 Supine or sitting provided that the patient
is able to maintain the head upright

Landmarks
 Inion (external occipital protuberance) to
the forehead just above the supraorbital
ridge
Head Circumference

Values
at birth 35 cm (13.8 inches)
1 year 33% increase
6 years 50% increase
10 years twice from birth
Head Circumference

Values
at birth 35 cm Normal caucasian
1st 4 months plus 0.5 inch per month
5 to 12 months plus 0.25 inch per month
2 years plus 1 inch per whole year or
plus 0.25 inch per 3 months
3 to 5 years plus 0.5 inch per year
6 to 20 years plus 0.5 inch per 5 year
Other
anthropometric
measures
Volumetric Displacement
 For edema and swelling

 Uses a volumeter

 Patient dips the extremity in the volumeter filled

with water while the therapist takes note of the
amount of water displaced

 Highest reliability and validity among measures

of edema/swelling

 Clinics don’t usually have volumeters

Static Measurements

Indication
 Usually for ergonomics

Position
 Standing
 Person stands erect and looks straight
ahead, with arms in relaxed position on the
side
Static Measurement
Position
 Seated
 Person sits erect and looks straight ahead.
 Thighs are parallel to the floor, and the knees are
bent to 90 degrees flat on the floor.
 Upper arm is relaxed and perpendicular to the
horizontal plane, while forearm is at a right angle to
the upper arm
 Measurements are done using a horizontal
reference point, ground, seat, vertical reference
point
Antrhopometer
Static Measurement
Conventions
 Height – vertical measurement
 Length – horizontal measurements in the
sagittal plane
 Breadth – horizontal measurements in the
coronal plane
Static Measurement
Most Common Measurements
Stature Thigh thickness
Eye height Buttock-knee length
Shoulder height Buttock-popliteal length
Elbow height Knee height
Hip height Popliteal height
Knuckle height Shoulder breadth
Sitting height Hip breadth
Sitting eye height Hip breadth
Sitting shoulder height Shoulder-elbow length
Shoulder elbow height Elbow-fingertip length
Static Measurement
Most Common Measurements
Upper limb length
Shoulder-grip length
Standing vertical grip reach
Sitting vertical grip reach
Dynamic Measurement

 Rapid Upper Limb Assessment (RULA) –

 survey method developed for use in
ergonomic investigations of workplaces
where work related upper limb disorders are
reported.
 screening tool that assesses biomechanical
and postural loading on the whole body with
particular attention to the neck, trunk and
upper limbs.
Steps

 Step 1 Observing and selecting the posture(s)

to assess
 A RULA assessment represent a moment in the
work cycle.
 Step 2 Scoring and recording the posture
 Decide whether the left, right or both upper arms are to be
assessed.
 Longest held versus the worst posture
 www.rula.co.uk
 Step 3 Action Level
 At risk to MSD’s?
Assembly line
Thank You