objective assessment Flashcards
what is an objective assessment?
- involves collecting observable and measurable data about a patient’s health
- observing client’s gait and vital signs
what is an objective assessment an assessment of and what is it informed by?
- physical assessment of the patient
- informed by subjective assessment
what are the three aspects you should ensure in an objective assessment?
- ensure patient/ model is comfortable
- ensure own posture and position is optimal
- ensure the body part you are examining is visible
what should you seek before assessment?
- consent
what does objective assessment vary with?
- speciality
- patient cohort
- individual patient presentation
what are some general observations? (11)
- age
- gender
- build
- walking aids
- glasses/ hearing aids
- facial expression e.g., pain
- posture
- involuntary movements
- function
- balance
- other aspects e.g., speech, behaviour
what are some of the specific observations?
- posture
- muscle bulk e.g., same on each side
- soft tissues e.g., swelling
- gait
- function e.g., sit to stand
- patients attitude
what is posture?
- position of the body in space
what does posture allow?
- function and most efficient movement to occur
describe postural dysfunction
- leads to altered loading increasing risk of pain and injury
- increasing effort of movement
what aspects affect posture?
- pain
- fatigue
- strength
- ROM
- muscle stiffness e.g., spasticity
- emotions
- occupations e.g., office jobs
- hobbies
- age and maternity
- handedness
what is the ideal alignment ?
- plumb line
describe the position of the plumb line
- through external auditory meatus
- through odontoid process of axis
- midway through shoulder
- through bodies of lumbar vertebrae
- through sacral promontory
- slightly posterior to centre of hip joint
- slightly anterior to axis of knee joint
- slightly anterior to lateral malleolus
- through calcaneocuboid joint
describe head/ neck in ideal alignment
- no rotation or side flexion of cervical spine
describe shoulder/ upper limb of ideal alignment
- should be level
- palms facing sides
- scapula should be flat against back and lie between T2 and T7
- distance from spine to scapula should be equal
- look at space between arms and trunks> should be equal on each side
describe thoracic spine in ideal alignment
- slight kyphosis
- no scoliosis
describe lumbar spine in ideal alignment
- slight lordosis
- no scoliosis
describe pelvis in ideal alignment
- no lateral tilt
- no protraction/ retraction
describe hip in ideal alignment
- neutral
- not flexed or extended
describe knees in ideal alignment
- not flexed or hyperextended
- no valgus/ varus
describe ankles/ feet in ideal alignment
- foot position
- equal toe- out angle (8-10 degrees)
- plantigrade
- no over pronation/ supination
describe ‘other’ features of ideal posture alignment
- equal weight bearing between left and right feet
describe kyphosis
- curving of the spine that causes bowing or rounding og the back
- skouding position
describe lordosis
- posture where the pelvis is titled forward, causing hip flexion
describe flat back posture
- lower spine loses its natural curvature and becomes flat over time
describe sway back position
- exaggerated curves in the spine
- forward tilting hips so appearance of leaning back when standing
what can you find from soft tissue
- colour and texture of skin e.g., pallor or redness
- presence of scars
- abnormal skin creases
- swelling of soft tissues/ joint
what does callus of feat give an idea of?
- pressure of walking
how can you measure muscle bulk if abnormality suspected?
- using a tape measure
what are the two main benefits of measuring range of motion?
+ aids clinical reasoning
+ acts as baseline measure> tells us if patient’s ROM deteriorates over time or improves with treatment
what is active range of motion? what questions can be raised?
- voluntary and unassisted
- looks at quality of movement
- are there compensations? is the movement well controlled
what is passive range of motion? what can it differentiate between?
- no/ minimal muscle activity
- may use as a diagnostic tool to differentiate non- contractile vs contractile components of clinical posture
what are the three ways of measuring range of motion in clinical posture?
- goniometry
- visual estimation ‘eye balling’
- tape measures
what are contra- indications?
- measuring ROM causes disruption to healing so its inappropriate
what are the three main contra- indications?
- interrupting healing process after injury/ surgery
- suspected fracture/ dislocation/ subluxation
- suspected myositis ossificans or ectopic ossification
what are cautions?
- should take extra care when dealing with people with cautions
what are some cautions?
- pain
- inflammation
- medication for pain/ muscle relaxants
- osteoporosis
- hypermobility
- haemophilia
- region of a haematoma
- suspected bony ankylosis
- soft tissue disruption e.g., sprain
- recently healed fracture
- after prolonged immobilisation
what else is important when measuring knee extension and why?
- position of hip as muscles cross over both e.g., hamstrings
what is passive insufficiency?
- shortness of a two joint or multi joint muscle, length of muscle is not sufficient to permit normal elongation over both joints simultaneously
what is an example of passive insufficiency?
- short hamstrings
what is muscle lag?
- active extension lag (quadriceps lag) is a function of a quadriceps weakness
- Q lag presents itself in patients who maintain full passive ROM but are limited in active extension ROM
what is muscle lag due to? what else can it be called?
- due to weakness
- patient may not have the strength to reach full ROM
- extensor lag
what is contractures?
- lack of full passive ROM of a joint resulting from structural changes of non- bony tissues such as muscles, tendons, ligaments, joint capsules and/ or skin
