Components of Postural Eval - Class 7 Flashcards by Victoria Caridi

what does a postural eval involve

identification of the location of the body segments in relation to the LOG

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in relation to the LOG

what’s in front of/behind

what is medial or lateral

is it symmetrical

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postural evaluation requires

great proficiency by the examiner

d/t many postural deviations being subtle

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for a postural eval the pt must be

adequately undressed

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how should the pt start

in a comfortable position

may not even want to tell them were checking their posture –> they’ll try and correct it

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if a pt wears an orthotic device

assess w/ and w/o and note changes

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components of a postural eval

postural history

observation and inspection

muscle length assessment

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is poor posture usually what motivates a pt to seek tx

sxs produced by pathology caused by or causing the postural abnormality compels the pt to seek tx

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if a child is being examined

obtain prenatal and postnatal history

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what does prenatal history include

health of the mother during pregnancy

any complications during pregnancy or delivery

any meds taken by the mother during that period
–> esp first trimester

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what should the postural history include

history of the problem

pt’s general condition and health

family history

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what should be obtained to determine whether posture is contributing to the problem

MOI

type, location and severity of sxs

side dominance

ADLs

driving, sitting and sleeping patterns

level and intensity of exercise

medical history

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MOI –> overuse injuries associated w/ postural faults

insidious onset

no specific cause of pain

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what does a non specific mechanism or time of injury indicate

injury is possibly caused by poor posture

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common responses to questioning that may point towards postural involvement

insidious onset of pain

pain worsening as the day progresses

pain w/ specific postures

complaints of intermittent pain

vague or generalized pain

initially starts as an ache

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pain associated w/ specific postures

hurts when they sit/stand for too long

hurts when they twist

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pain that initially starts as an ache

progressively worsened over time

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many postural dysfxns are worse/produced more

in the evening

after the individuals has maintained the posture all day

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what should we ask about the sxs

are they constant or intermittent

are they worse at a certain time of the day

which positions/postures increase/decrease sxs

what type of pain are you experiencing

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side dominance –> if one side is for most tasts

bilateral limb imbalances are likely to occur

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bilateral limb imbalances

exposing the pt to overuse injuries

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what should we ask about ADLs

what is the pt’s usual day like

which type of activities does the pt perform and for waht duration and frequency

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what is the pt’s usual day like

many people have a repetitive daily schedule

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driving, sitting and sleeping postures

ask if anything has changed in the person’s daily routine

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changes in a routine

provide info about the instigating factor pt may not thing it is a big change, but it could be the root of their issue

level and intensity of exercise

does the pt exercise regularly or at all has their exercise routine changed

medical history

family history previous illnesses, operations or severe injuries history of other conditions previous tx deformity difficulty breathing

family history

of any back problems or special problems -congenital problem -spinal fusion -scoliosis

previous illnesses, operations or severe injuries

ex: thoracic surgery

history of other conditions

connective tissue dzs RA marfans syndrome

previous tx

if they had PT --> what helped/what didnt help

deformity

is it present is it progressive is it stationary

difficulty breathing

thoracic spine affects rib cage --> rib cage affects breathing

what should we ask about the medical history concerning a child

if/when had been a growth spurt puberty difficulty fitting into clothing

female puberty

when did their period begin does their back pain tend to be associated w/ their period

when does female puberty occur

almost always occurs after their peak growth of height usually around age 11

male puberty

voice change usually around age 13

observation and inspection should be

systemic and thorough

observation and inspection should be performed

for standing, sitting, supine and in prone positions

observation and inspection --> standing

should note body type and emotional attitude

how should we observe a pt in standing

anterior, lateral, posterior view forward flexion

what are we going to find during observation and inspection

things we will later go back and look at a little more closely

inspection of leg length discrepancy

2 categories of LLD

structural (true) fxnal (apparent)

structural LLD

actual difference in the length of the the tibia or femur of one leg compared to the other

what is structural LLD caused by

disruption of the growth plate of one of the bones congenital anomaly

how are measurements of structural LLD taken

ASIS to medial malleolus

when is a discrepancy considered significant --> structural LLD

10-20mm

what happens if measurements are asymmetrical --> structural LLD

put pt in hooklying --> observe from the front and from the side

observing from the front --> structural LLD

one knee appears higher than the other tibia is longer on that side

observing from the side --> structural LLD

one knee appears more in front of the other femur is longer on that side

fxnal LLD

attributed to something other than the length of the tibia +/or femur

what is fxnal LLD caused by

tightness of muscles or joint structures muscular weakness in the LE or spine

how are measurements taken fxnal LLD

medial malleolus to the umbilicus

when is measurement of fxnal LLD meaningful

test for true LLD is negative

how do we determine LLD

block method

most clinically reliable and valid way of determining an LLD

how does the block method work

pt stand on firm surface w/ feet shoulder width apart palpate and note starting levels of iliac crest

if heights are uneven --> block method

blocks of known thickness (measured in mm) are placed under the shorter leg until the iliac crests are of equal height

how is LLD calculated --> block method

totaling the sum of the heights of the individual blocks

what is the height where tx is frequently considered --> LLD

10-20 mm

radiographs and CT evals

most accurate methods of assessing LLD

muscle length assessment is apart of

physical (objective) exam

what does the muscle length assessment attempt to do

objectively measure if specific muscles are shortened or elongated --> may contribute to postural abnormality

if muscles crossing a joint are abnormally shortened

abnormal stresses may be placed on the joint or necessary mobility required for normal fxning may be lacking

if muscle crossing a joint is abnormally elongated

joint maybe affected by abnormal stresses or may lack the stability required for normal fxning