Observation & Postural Assessment

Question 1

Principles of Assessment

Answer 1

Tell the patient what you are doing

Test the normal (unaffected) side first

Do active movements first, then passive movements, then resisted isometric movements

Do painful movements last

Apply overpressure with care to test end feels

Repeat movements or sustain certain postures or positions if history indicates

Do resisted isometric movements in resting position

Remember that with passive movements and ligamentous testing, both the degree and quality (end feel) of opening are important

With ligamentous testing, repeat with increasing stress

With myotome( muscle) testing, make sure that contractions are held for 5 seconds

Warn the patient of possible exacerbations

Maintain the patient’s dignity (don’t say st defentive)

Refer if necessary

Question 2

Objective Data

Answer 2

Includes findings from the physical examination and the results of any tests

Question 3

Observations

Answer 3

The visual clues the therapist looks for in order to gain objective information about the patient’s condition

Observations are recorded on the patient’s health history chart

Observations begin as soon as the therapist meets the patient and include some of the following

Functional abilities, obvious aids (wheel chair,…), facial expressions, perceived emotions

A more organized and detailed observation is achieved with a postural assessment

Patients notice the difference between a massage therapist who takes the time to honor their space and adjust to it and one who tries to make the patient fit into a routine method of massage application

It is important to pay attention to the patient visually to assess the patient’s general presence, their vitality and their sympathetic state

Body language is individualized for each person and cannot be generalized to mean one specific thing. It is the therapist’s responsibility to learn what a gesture means for a particular individual

Question 4

Postural Assessment

Answer 4

A more organized and detailed observation is achieved with a postural assessment

This analyzes the imbalances in the patient’s posture that may contribute to the patient’s condition

Posture is a synthesis of the positions of all the body’s joints at any given time. This can be the patient’s habitual position or the position taken during an activity

Over time, if postural imbalances continue, an adaptive shortening of the muscles and fascia elsewhere in the body occurs in response to the stretched tissues-this stabilizes the body’s posture

Question 5

Postural Assessment Strategies

Answer 5

During the assessment, the bony prominences and joint positions provide landmarks for bilateral comparison
Relative muscle bulk and muscle outlines are observed bilaterally for symmetry

The assessment should begin at the feet, moving towards the head to understand how gravity is acting on the patient’s body and to note as many indicators of imbalances as possible

Both anterior, posterior and left and right lateral views are assessed

Question 6

Postural Assessment Equipment

Plumb Line

Answer 6

Plumb Line

Is used as a reference line to check alignments in the patient’s body

It should be long enough to reach from the ceiling to the floor and is suspended so it almost touches the floor

Question 7

Postural Assessment Equipment

Grid Board

Answer 7

Grid Board

A background with a grid marked on it, the squares should be at least 5 cm squared and mounted to the wall

The grid board should be larger than an average adult patient (ex. 200x100cm)
The bottom of the grid should touch the floor

Question 8

Postural Assessment Equipment

Goniometer

Answer 8

Goniometer

To accurately measure pelvic angles

A measuring tape is also useful, especially if the goniometer doesn’t have a ruler markered on one arm

Question 9

Recording the Results

Answer 9

The findings are recorded on a body chart to provide a baseline of the patient’s progress and the effectiveness of the therapist’s plan

All findings, asymmetrical or symmetrical are recorded

The patient’s posture should be reassessed regularly

Question 10

Anterior Landmarks

Answer 10

Check the medial longitudinal arches

Compare the levels of the superior surfaces of both patellae

Check the levels of the ASIS’s

Check the levels of the iliac crests

Check the levels and angles of the clavicles

Assess the position of the head

Check the levels of both external auditory meatus

Question 11

Posterior Landmarks

Answer 11

Compare the levels of the medial malleoli

Compare the levels of the fibular heads

Check the levels of both greater trochanters

Check the levels of the PSIS’s

Check the levels of the iliac crests

Assess the levels of the inferior borders of both scapulae and compare the distance from the medial borders of the scapulae and spinous processes of the spine

Check the levels of the acromioclavicular joints

Check the levels of both external auditory meatus

Question 12

Lateral Landmarks

Answer 12

Both left and right lateral views must be assessed and the following landmarks should be in line with each other

Lateral malleolus (slightly anterior)

Head of the fibula (slightly anterior)

Greater trochanter

Acromion

External auditory meatus

The levels of the PSIS and ASIS must be checked for the pelvic angle

Normal position for the female pelvis is 5-10 degrees

Normal position for the male pelvis is 0-5 degrees

Question 13

Further Assessment

Answer 13

A thorough postural assessment will check both bony prominences as well as joint positions and soft tissue differences. All of these should be observed bilaterally for symmetry

These assessments can be done separately or together in the order that they occur

The following slides list what other observations should be made

Question 14

Anterior View

Answer 14

Observe the orientation of the feet (toe in/toe out)
Check for pronation or supination
Assess the knees for valgus or varus orientation
Compare the relative bulk of the quadricep muscles
Compare the levels of the fingertips
Assess the shape of the rib cage
Assess the position of the head
Observe the position of the mandible
Record any scars

Question 15

Posterior View

Answer 15

Assess the heights of the medial longitudinal arches of both feet. (vòm chân)
Look for asymmetries in the orientation or width of both the achilles tendons
Assess the relative muscle bulk of the gastrocnemius, soleus, hamstring and gluteal muscles
Assess the skin fold levels at the knees and glutes
Observe the spinous processes
Check for symmetry of any skin folds present on the torso
Observe the orientation of the patient’s arm relative to the trunk

Question 16

Lateral View

Answer 16

Assess the orientation of the knees
Assess for rotation of the pelvis
Check for possible lumbar hyperlordosis (ưỡn quá)
Assess whether the shoulder is in a protracted, retracted or neutral position
Check for cervical hyperlordosis

Question 17

Procedure for the Standing Position

Answer 17

Have the patient use a symmetric stance (both the hip and knee joints assume a position of extension to provide for the most efficient weight-bearing position
The feet should be shoulder width apart

Question 18

Deformities

Answer 18

Deformities may take the form of restricted ROM (flexion deformity), malalignment (genu varum), alteration in the shape of a bone (fracture), or alteration in the relationship of two articulating structures (subluxation)

Question 19

Structural Deformities

Answer 19

Present even at rest
Ex. torticollis, fracture, scoliosis, kyphosis

Question 20

Functional Deformities

Answer 20

Are the result of assumed postures and disappear when posture is changed

Ex. A scoliosis due to a short leg, a pes planus on weight bearing may disappear on non-weight bearing

Question 21

Palpation - Definition

Answer 21

Palpation is the placement of the therapists hand on the client’s tissues to assess their condition. The skill of palpation takes many years to develop, it is cumulative.

How to palpate effectively:

Always performed bilaterally, starting with the unaffected side

Initiated with the palmar surface of the hand and light pressure, then leads toward using the fingertips and increasing the pressure

Knowing the anatomy and the direction of the fibres of the underlying tissue helps to differentiate specific tissues.

Example: A specific muscle can be palpated by locating its attachments, then have the client contract the muscle under the palpating hand/fingers: feel the difference in the tissue.

Question 22

The Four “T”s of Palpation:

Answer 22

The Four “T”s of Palpation: Q
Temperature:
tissue may be hot indicating inflammation (infection)
tissue may be cool indicating ischemia (lack of blood supply).

Texture:
swelling or edema is present - tissue feels hard or boggy
muscle wasting - tissue feels soft with no resistance
adhesions - the tissue feels stuck together and rough
crepitus - a palpable roughness with movement, sometimes accompanied by a “crunching” sound

Tenderness:
pain is indicated if the client winces or pulls away with tissue compression, may be unable to palpate due to pain.

Tone:
muscle tone refers to a muscle being slightly and continuously contracted at all times. This helps to maintain posture. Tone should feel the same for the whole muscle group as well as all muscles.

Question 23

Observations when palpating a client

Answer 23

Tension & texture differences
Tissue thickness differences
Abnormalities
Temperature variation
Pulses, tremors, and fasciculations
Dryness or excessive moisture
Abnormal sensation
Pathological state of tissue