Slide 1

CHAPTER 5: EXAMINATION

PROCEDURES

PT: 151

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 2 Introduction p. 117

• Effective PT is based on a sound examination and evaluation.

• Also important to identify potential life threatening or emergency conditions and/or the need to refer out.

• Examination is defined as (by the Guide) as a “comprehensive screening and specific testing process leading to diagnostic classification or, as appropriate, to a referral to another practitioner”

• Evaluation is defined as “dynamic process in which the PT makes clinical judgments based on data gathered during the examination”

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 3 Introduction

• Three types of “formal” examinations and

evaluations used when a patient receives PT:

– An initial examination and evaluation

– Interim examination and evaluation

– A discharge examination and evaluation

• This chapter will focus on initial examination and

evaluation process and include discussion of the role

of the PTA in the interim and discharge

examinations.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 4 Patient History p. 118

• Investigation of patient’s history

• Can be obtained by:

– Patient’s medical chart

– Intake form

– Other supporting medical documentation

– Patient

– Family member

• Specific patient goals will be obtained. Can also see how realistic the patient is about outcomes. (PT and PTA may foresee that ambulation with an AD on hard surface is realistic goal, while the patient is planning on returning to golf)

• Must be conducted in private area- confidentiality.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 5 HISTORY

80% of the time, the diagnosis is

made in the first 60 seconds of

contact. (Sackett, et al)

Examination will then support or

disprove this hypothesis, leading to a

final hypothesis during the evaluation.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 6 Systems Review p 119

• “Clears” several systems that are potentially

involved or implicated in patient’s performance

or progress.

• Identify potential system abnormalities that

require referral back to MD. (GI, urinary,

cardiopulmonary)

• This is a system’s review; PT’s do not diagnose

a medical disease or pathology.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 7 Systems Review

• The PT communicates with the MD regarding

signs and symptoms that cause concern, not

suggesting the presence of a specific disease.

• Purpose: to determine if the pt. needs a

medical referral

• PT and PTA’s must be able to recognize

medical emergencies.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 8 Systems Review

Integumentary

Cardiopulmonary

Neurological

Musculoskeletal

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 9 Skin Cancer

A – asymmetry

B – border irregularity

C – color variation within the lesion

D – diameter > 6 mm (pencil eraser)

E - evolution over time

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 10 Skin Cancer

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 11 DVT

Calf pain, edema, redness, warm to the touch

Recent surgery or immobilization

Calf pain that increases with standing/walking and

decreases with rest/elevation

Positive cuff sign – pain with 160-180 mm HG (BP

cuff around calf)

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 12 Myocardial Infarction

Chest pain

Palor, sweating, nausea/vomiting

Left arm pain > Right arm pain

Jaw pain

Male over the age of 40

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 13 Myocardial Infarction

Female over the age of 50.

History of high cholesterol

Symptoms lasting longer than 30 mins.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 14 Cancer

5% weight gain or loss over a 4-6 week

period

> 50 yrs old

History of CA

Colon CA: change in stool shape or diameter,

bloody stool

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 15 Tests and Measures p 119

• Selection of appropriate tests and

measures is performed by PT

• PTA ROLE: To assist PT, the PTA may

repeat selected tests/measures at interim

and discharge.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 16

• Communication between PT and PTA is vital.

– The PTA may identify additional clinical signs

and symptoms when performing delegated

tests and measures, this requires

communication to PT so that the PT can

determine additional tests to be performed

and who should perform them.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 17 Vital Signs p 120

• Very important aspect in examination, provides

baseline cardiopulmonary function and screens any

potential emergencies that may occur during session.

• BP, pulse, and respirations must be assessed and

documented especially for the older patients or

patients with multiple medical issues.

• Vitals are taken frequently before, during and

after a session.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 18 Vital signs

Adult norms: HR 60-90, BP 120/80, RR

<20 bpm

Infant: HR higher, BP lower, RR higher

Approaches adult values around age of

6 years old

Geriatric: BP, HR, and RR all higher

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 19 Observation p 121

Visual inspection

PT performs on exam

PTA must be able to communicate relevant

observations during treatment.

Observation of movement patterns, areas of

swelling/edema, atrophy, skin integrity,

contractures, and other skeletal or joint

abnormalities.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 20 Arousal, Attention, Cognition p 122

Provides information of how well the

patient will be able to voluntarily

participate in therapy as well as follow

directions, memory.

Arousal: Responsiveness to situation.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 21 Common descriptors:

Alert (awake and attentive)

Lethargic (drowsy, falls asleep)

Obtunded (hard to arouse from sleep, confused

when awake)

Stuporous (responsive only to strong, noxious

stimuli)

Comatose (nonresponsive to any type of

stimulation)

Persistent vegetative state (state of

unconsciousness with regular sleep/wake cycles).

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 22 Arousal, Attention, Cognition p 122

Ability to follow directions: 1 step or multi-step

directions.

Short term/long term memory assessment:

Short term: provide list of 7 numbers or 5-7

words and ask the patient to repeat

immediately and then 5 minutes later.

Long term: assess ability to recall historical

facts or dates of marriage, birth, etc.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 23 Arousal, Attention, Cognition p 122

Attention: awareness to environment and

ability to focus on specific stimulus without

distraction.

Orientation: assessed according to orientation

to person, place, time and situation.

Documented according to how many domains

the person can correctly name “Oriented x

4/4;3/3” , Oriented x 2/4 (person, place)

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 24 Sensation p 123-124

• Assessment of patient’s sensory integrity allows

therapist to identify the extent of impairment

of the sensory system.

• PT can identify areas that may have been

damaged. (dermatomes)

• Exteroceptive = superficial sensation

• Cortical Sensations = discriminative touch

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 25 Sensation p 123-124

– Exteroceptive (superficial) and

proprioceptive (deep) senses: Light touch,

superficial pain, temperature, pressure,

vibration, joint position (proprioception), and

joint movement sense (kinesthesia)

– Combine sensations (cortical sensations):

Examples include 2 point discrimination,

bilateral simultaneous touch, texture

recognition, sterognosis, graphesthesia, and

barognosis.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 26 Dermatomes p. 125

C2 - posterior head

C3 - posteriolateral neck

C4 - sternoclavicular joint

C5 – lateral upper arm

C6 – lateral forearm, thumb

C7 – middle finger, palmer surface

C8 – little finger/ulnar part of hand

T1 – medial forearm

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 27 Dermatomes

L1 – upper ant. thigh

L2 – mid. ant thigh

L3 – medial knee

L4 – medial malleolus

L5 – dorsum of 3rd

MTP

S1 – lat foot/heel

S2 – popliteal fossa

S3 – ischial tuberosity

S4 – perianal area

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 28 Sensation

1st, ask patient what they are sensing.

2nd, perform a quick scan of sensation to find

out if any abnormalities are present

3rd , perform a demo of the test on the

opposite side? WHY???

Then specific sensation tests are performed as

detailed next slide.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 29 Sensation- Extroceptive and Proprioceptive

pp. 124 - 126

Light touch: Using a cotton ball particle, touch

the skin, “tell me when you feel me touching you

by saying now”

Location of touch: Using your thumb or

fingertip, apply pressure firm enough to indent

the skin. “tell me when you feel the stimulus by

saying now”.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 30 Sensation- Extroceptive and

Proprioceptive pg. 127

Fast pain: Using a large paperclip Apply

uniform pressure. “Tell me whether this feels

sharp or dull.”

Temperature: Fill one test tube with hot water,

the other with cold water. “Tell me whether this

feels warm, cold, or you are unable to tell me”

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 31 Sensation- Combine (cortical)

sensations pg. 126

2 point discrimination: Use an instrument (like

caliper) with 2 ends apart. Then in successive

applications, the therapist then places the tips

closer together and asks the patient to say

when the points are perceived as one.

Texture recognition: The therapist gives the

patient cutouts of fabrics with different

textures and the patient is directed to identify

the texture perceived (soft, rough, thick, thin)

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 32 Sensation- Combine (cortical)

sensations pg. 127

Stereognosis: Common items (ie. paperclips,

keys, dice, coins) are placed in patient’s hand

and they are asked to identify the object by

touching and feeling it.

Barognosis: The therapist gives the patient

objects of different weights and asks the

patient to identify which item is heaviest.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 33 CONSCIOUS PROPRIOCEPTION-p.127

Proprioception: Use fingertip grip over the

boney prominence of the lateral joint surfaces.

Tell the patient words to identify ROM positions

(initial, mid-, or terminal range). Move the joint

through a ROM then hold in static position. Ask

them to duplicate the motion on other

extremity.

Tests: knowing where limbs are in space

STATICALLY; has functional implications.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 34 Sensation- Extroceptive and

Proprioceptive pg. 127

Kinesthesia: Use fingertip grip, over boney

prominences of the lateral joint surfaces. Move

the joint passively in small increments up into

flexion (bending) or back to start which is

extension (straightening) , and ask the patient

to indicate the direction of movement.

Tests: knowing when the joint is moving,

perception of the joint AS IT MOVES has

implications with movement activities.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 35 Grading Sensation and

Proprioception

Normal – equal to other side or

100% accuracy

Impaired - 50%-100% accuracy

Absent – less than 50% accuracy

Use an odd number of trials to

determine outcome ( 3/3 = normal;

2/3 = impaired; 0-1/3=absent)

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 36 Motor Examination p 128

Assessment of Muscular Tone:

Muscle tone is defined as: ability or

readiness of muscle to contract, which is

dependent upon the excitation of the motor

pool in the spinal cord.

There should be an appropriate amount of

tone present to allow the individual to

perform a movement that is synergistic,

appropriate in strength and in intensity.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 37 Motor Examination pg. 129

Assessment of Muscular Tone:

A range of tone can be found with

neurologically involved patients.

Flaccidity: absence of tone

Hypotonicity: Decreased tone

Hypertonicity: Increased tone

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 38 Motor Examination pg. 129

Rigidity: state of severe hypertonicity that

results in an inability to move the extremity,

passively or actively, and with limitation in all

directions.

Spasticity: abnormal velocity-depedent

muscle tone: faster the limb is moved: more

resistance.

Assessed with the Modified Ashworth Scale

(page 139, table 5-3)

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 39 Modified Ashworth Scale p. 130

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 40 Motor Examination: Assessment of Strength

Manual Muscle Testing: Performed to

identify possible decreases in strength.

Weakness in muscle due to

musculoskeletal and peripheral nerve

injury means a problem along the nerve,

at the muscle/nerve junction or within the

muscle tissue itself = LMN lesion

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 41

Weakness due to CNS damage is caused by a

problem with the spinal cord or brain and

comes from inside the spinal or cranial skeletal

system. = UMN lesion

Weakness may also be due to disuse, which is

not a pathology but an impairment caused by

inactivity.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 42 Motor Examination: Assessment of Synergy

pg 132

Stereotypical movements with neurological

insults.

Important for PTA’s to identify these abnormal

patterns and understand their implications in

terms of facilitating normal movement.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 43 Motor Examination p132, Table5-4

FLEXION SYNERGY

Upper Limbs

Scapular retraction, elevation or

hyperextension.

Shoulder abduction, external rotation.

Elbow flexion *** (strongest)

Forearm supination

Wrist and finger flexion.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 44 Flexion Synergy cont.

Lower Limbs

Hip flexion****, abduction, external

rotation

Knee flexion

Ankle dorsiflexion, inversion

Toe Dorsiflexion

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 45 LE Flexion Synergy

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 46 UE Flexion Synergy

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 47 Motor Examination

EXTENSION SYNERGY

Upper Limbs

Scapular protaction

Shoulder adduction***, internal rotation

Elbow Extension

Forearm pronation***

Wrist and finger flexion

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 48 Extension Synergy cont.

Lower Limbs

Hip extension, adduction***, internal

rotation

Knee extension***, ankle

plantarflexion***, inversion

Toe plantarflexion

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 49 LE Extension Synergy

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 50 UE Extension Synergy

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 51

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 52 Developmental Reflexes p133-4

The reemergence of one or more of these

reflexes or the absence of the higher level

reactions in older children or adults can have a

significant impact on muscle tone, the ability to

isolate movements, balance, and functional

skills such as feeding and ambulation.

Review Table 5-5, page 135-136

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 53 Coordination p 134

The ability to perform smooth, accurate, controlled

motor responses that are characterized by

appropriate speed, distance, direction, timing, and

muscle tension. Gives the clinician information about

the ability of synergisitc muscle groups to produce a

smooth, coordinated, purposeful movement.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 54 Coordination pg 134

Non-weight bearing Coordination Tests:

Nose-finger-nose: Ask pt. to touch his nose with index finger, then touch your finger, then touch pt. nose. Inability to perform this test with smooth coordination is termed dysmetria (past pointing)

Rapid alternating movement: pt hold elbows flexed to 90 degrees and close to body, and then perform alternate pronation and supination of forearm. Inability to perform this is termed dysdiadochokinesia.

Heel to Shin: Pt in supine, asked to lift one leg up, use the heel of that leg to touch the kneecap of contralateral leg and then slide heel down shin (ataxia).

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 55 Coordination

Weight bearing Coordination Tests:

1. Have pt stand with narrow BOS (feet together)

2. Have patient stand one foot in front of another (tandem).

3. Have patient in standing and have him or her take steps

follwing footprints placed on floor by therapist.

4. Have patient walk along straight line drawn or taped on

floor.

5. Have pt walk sideways, backward, or using cross steps.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 56 Coordination

Grading Scale:

Normal: smooth accurate, and controlled

Impaired: movement is slow or jerky

Absent: pt unable to perform

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 57 Cranial Nerves p 137

Mnemonics: Odor Of Orangutan Terrified Tarzan

After Forty Voracious Gorillas Viciously Attacked

Him.

On Old Olympus’

Towering Top, A Finn and

German Drank(Viewed) Some

Hops.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 58

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 59 Cranial Nerve Assessment p 137

These nerves originate in brainstem and innervate the head,

neck, and face.

Cranial Nerve I: Olfactory Nerve

Pt closes eyes, and then sniffs a cotton swab with non-noxious

odor (coffee, lemon, vanilla) and is asked to identify odor.

Cranial Nerve II: Optic Nerve

Test visual acuity: pt cover 1 eye and hold magazine 2-4

feet away and ask patient to read specific line.

Test visual field: sit in front of pt, ask patient to cover 1 eye

and look straight ahead with other. Examiner places a finger

out of the field and gradually brings it into view and asks pt

when they first see object.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 60 Cranial Nerve Assessment p 137

Cranial Nerves III, IV, VI: Oculomotor, Trochlear, and

Abducens Nerves

Hold up pen approximately 12 in. from pt. face

and asks pt to keep his or her eyes on pen.

Examiner moves pen up and down (CN III), down

and in (CN IV) and toward the nose to see if the

two eyes converge (CN III), and to laterally to both

sides (CN VI). The ability of eyes to track equally

and appropriately is also observed during this test.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 61 Cranial Nerve Assessment

Cranial Nerve V: Trigeminal Nerve

Test light touch and sharp/dull sensation of face or

tests strength of muscles of mastication

Cranial Nerve VII: Facial Nerve

Perform a manual muscle test of muscles of facial

expression (see Clarkson)

Cranial Nerve VIII: Vestibulocochlear Nerve/Auditory:

Test hearing, rub fingers close to pt ears and check

if pt can hear it

Test vestibular component: ask pt to stand on foam

with eyes close and observe sway.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 62 Cranial Nerve Assessment

Cranial Nerve IX: Glossopharyngeal Nerve

Assess gag reflex by moving tongue

depressor around in back of mouth

Cranial Nerve XII: Hypoglossal Nerve

Ask client to protrude tongue to check for

fasciculations, which are odd, nonvolitional

movements on the surface of the tongue.

Ask pt to protrude tongue and then observe

if she or he can move it rapidly from side to

side.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 63 Balance pg. 138

Important component of neuromuscular

examination.

Balance is essential for an individual to

maintain postural stability or equilibrium in

which the center of mass (COM) is maintained

within the boundaries of the BOS.

The limits of stability (LOS) is defined as “the

maximum angle from vertical that can be

tolerated without loss of balance”

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 64 Balance p 138

When the COM moves beyond the LOS:

When perturbations come from rear, the

extensor muscles of hip, trunk, and neck to

prevent pt from falling forward.

When perturbations come from front, the hip

flexors, quads, abdominal muscles, and neck

flexors activate to prevent pt from falling

backwards.

When perturbations come from side: lateral

flexors of trunk and neck will activate.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 65 Balance

3 strategies a patient will utilize when LOS is

reached.

BOS is fixed while COM is disturbed

Ankle Strategy: COM shifts forward or backward

over ankle joints and used when balance

disturbances are small

Hip Strategy: COM is larger and faster and the

COM shifts forward, backward, or laterally over

hip joints

Brings about a realignment of BOS under the COM

Stepping Strategy: large, fast balance

disturbances.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 66 Balance: Assess Static and Dynamic Balance

Static/Quite: ability to maintain upright in

steady, nonmoving state

Dynamic/Active: pt’s ability to maintain

upright posture while performing activities

that move the COG within or outside of the

BOS

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 67 Grading Balance pg. 143

Normal: pt is able to maintain steady balance without support

and able to maintain steady position after being challenged.

Dynamic- could be in form of perturbations or performing

activities that will make COG fall outside of BOS

Good: pt is able to maintain balance without support (static)

and is able to maintain position after being moderately

challenged (dynamic)

Fair: pt is able to maintain position with handhold (static) and

is able to accept minimal challenge (dynamic)

Poor: pt requires assistance of hand hold and clinical support

to maintain position (static) and is unable to accept any

challenge (dynamic)

Unable: pt needs maximal assistance to maintain position

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 68 Balance

Romberg Test: Ask patient to stand feet together with eyes

open, then eyes closed.

Positive if pt able to maintain position with eyes open, but has

excessive sway or loses balance with eyes closed.

Sharpened Romberg

Same test but feet are placed in tandem

These tests are used to determine increased sway which may be

due to problems with somatosensory, visual, or vestibular systems.

The Clinical Test for Sensory Interaction on Balance (CTSIB)

Assesses integrity of various systems responsible for balance.

Uses thick foam pad and japanese lantern.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 69 Functional Ability pg. 142

Assess the following:

Rolling side to side

Supine to/from sitting

Maintaining sitting position

Transfers

Sitting to/from stand

Maintaining standing position

Locomotion in from or walking or propelling w/c

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 70 Functional Ability

Assessment: Qualitative:

Describe the motion as normal or

abnormal (include description)

Describe how much, if any,

assistance is necessary

List amount of time it takes patient

to complete task.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 71 Assistance levels pg. 144

*based on how much effort is put forth by patient, not by PTA*

Independent: Patient consistently performs the skill

safely with no one present and in a timely manner. If

assistive device is needed, include name of device

Supervision or Setup: Patient performs 100% of

task, but requires verbal cueing, someone standing by,

or someone must set up items.

Contact Guarding: Patient performs 100% of task,

but person assisting gives full attention to pt and has

hands on pt for possible assistance or possible loss of

balance.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 72 Assistance levels pg. 144

Minimal Assistance: Patient expends 75% or

more of effort for the task.

Moderate Assistance: Pt expends 50-75% of

effort for task

Maximum Assistance: Pt expends 25-50% of

effort for task

Dependent: Patient expends less than 25% of

effort for task.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 73 Standardized Impairment and

Functional Tests pg. 144

Berg Balance Scale: assessment of balance via

performance of several everyday tasks.

Developed for elderly. Involves 14 balance

items and based on their ability to perform

these tasks and given score of 0,1,2,3,4. Takes

15-20 minutes to complete.

Normative Values:

<36= 100% at fall risk

<45 requires assistive device

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 74 Standardized Impairment and

Functional Tests

Functional Reach Test: Use with elderly and involves

measurement of pt’s ability to reach forward while

standing, without falling. Takes 5 minutes to

complete

Normative Values:

20-40 year olds: Males: 16.7 inches, Females: 14.6

inches

41-69: Males: 14.9 inches, females: 13.8 inches

70-87: Males: 13.2 inches, females: 10.5 inches.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 75 Standardized Impairments and

Functional Tests

Tinetti Assessment Tool: Used with elderly population and has balance and gait components. 16 items, some scored as 0 or 1 or 0, 1, or 2. Takes 10-15 minutes to complete.

Timed Up and Go (TUG): measure time it takes for an individual to stand up from firm chair and walk 3 meters, turn around and sit down. Takes 5 minutes or less.

Normative Values: <10 seconds: normal, >30 seconds: dependent on most activities of daily living and mobility skills

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 76 Standardized Impairments and

Functional Tests

Fugl-Meyer Assessment of Physical Performance:

developed for adults who have suffered a stroke

and looks at motor recovery, balance, sensation,

and motion. Takes 30-40 minutes to complete and

items given a score of 0, 1, or 2.

Motor Assessment Scale: used with adult patients

who have suffered stroke, includes 9 items including

15-30 minutes. Looks at functional movements and

tone.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Slide 77 Standardized Impairment and

Functional Tests

The Barthel Index: Measures amount of

assistance required by an individual on 10

items of mobility and self-care ADL’s. Used

with adults with any diagnosis. Tool takes 5-20

minutes.

Functional Independence Measure: (FIM):

designed to assess the degree of assistance

required by pt at the beginning and end of

rehabilitation.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________