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Peds Neuro > Pediatric Range of Motion and Flexibility Examination > Flashcards

Pediatric Range of Motion and Flexibility Examination Flashcards

1
Q

What age related factors might influence examination of ROM/flexibility?

A
  • Ability to follow directions
  • Ability to stay still (minimize position changes)
  • Buy in
  • Educate and explain what you are going to do and why before you do it
  • Must ask permission from a legal guardian before you do it
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2
Q

Age Related Factors

A
  • Growth and Development of the musculoskeletal system
  • Cognitive and Language Development
  • Social/Emotional Development
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3
Q

What should you start with?

A

Observation

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4
Q

Causes of abnormal flexility and skeletal alignment

A
  • lack of weight bearing
  • abnormal muscle tone
  • muscle paralysis
  • weakness
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5
Q

Range of motion strategies

A
  • visual estimation
  • motion analysis
  • still photography
  • goniometry
  • other joint motion measurement tools
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6
Q

Pros and Cons of Visual Estimation

A

Pros: easy, no equipment needed, fast, functional

Cons: lack of reliability, not standardized procedure

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7
Q

What is visual estimation most useful for?

A

Screening
Medically fragile/ICU

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8
Q

Pros and Cons of Motion Analysis System

A

Pros: precise, accurate, reliable

Cons: cost, need for special equipment/location

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9
Q

What is motion analysis most useful for?

A
  • Pre surgical examination: cerebral palsy/myelomeningocele
  • To evaluate impact of new interventions
  • Research
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10
Q

Pros and Cons of Still Photography

A

Pros: Permanent record, good for difficult to measure areas (cervical spine)

Cons: picture may capture movement transition

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11
Q

When is still photography most useful?

A

When evaluating static postures
Difficult to measure regions

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12
Q

Pros and Cons of Goniometry

A

Pros: standardized procedure, more reliable than observation

Cons: immature skeletal development leads to poor definition of landmarks, weaker inter-rater reliability

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13
Q

When is goniometry most useful?

A
  • Baseline assessment
  • Outcomes assessment
  • Long term follow-up
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14
Q

To Improve reliability of goniometry…

A
  • Consistent procedure: goniometer placement, child and tester position, stabilization technique
  • Use one rater if possible
  • Child with CP - PROM before measurement, more limb slowly 3 times
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15
Q

How many degrees of change do you need to see before you can assume there is true change in ROM

A

15-20 degrees

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16
Q

Recent literature says that what is most important?

A

critical values needed for function!

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17
Q

Which type of reliability is better in children with MD, DS, CP, and MM

A

Intra-Rater

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18
Q

Other factors that can impact the reliability of goniometry?

A
  • Meds
  • Time of Day
19
Q

Child factors that can impact the reliability of goniometry?

A
  • Attention span
  • Interest in activity
  • Motivation
20
Q

Other tools used to measure joint motion

A
  • Arthrodial protractor
  • Inclinometer
21
Q

Do not measure over clothes

A
22
Q

What is the most appropriate test for measuring hip extension for a child w/ UMN Syndrome/CP?

A

Prone Hip Extension Test

23
Q

Galeazzi’s sign

A
  • Make sure pelvis is neutral
  • Bend hips and knees up (make sure heels and toes are aligned evenly)
  • thumb on axis and finger on PSIS to make sure pelvis is neutral
24
Q

Thomas Test

A
  • Calibrate inclinometer
  • Align the pelvis
  • Don’t over flex hips
  • Go through motion 3 times before measuring
25
Q

Prone Hip Extension Test

A
  • ASIS on table, pubic symphysis not on table
  • Do not allow limb to move off plane
  • Stabilize pelvis
  • Go through motion 3 times before measuring
26
Q

Hip Adduction Test

A
  • Flex contralateral hip to 90 degrees
  • Use over under grip
  • Flex, abd, extend hip then allow it to drop into adduction (+ if it doesn’t touch table)
  • Go through motion 3 times then measure
  • Put inclinometer mid-shaft of femur
27
Q

Prone Internal and External Hip Rotation

A
  • Focus on asymmetry between internal and external rotation
  • No abduction or adduction in the leg
  • Double check pelvis is stable by putting inclinometer on sacrum
  • Put inclinometer on mid tibia
28
Q

Torsion:

A
  • normal amount of twist present in the long bone (femur)
29
Q

Femoral Torsion:

A
  • Angle formed by an axis drawn along the head and neck of the femur and another through the femoral condyles
30
Q

Antetorsion

A
  • Head and neck of the femur are rotated forward in the sagittal plane relative to the femoral condyles
31
Q

Femoral Torsion Test/ Craig’s/ Ryder’s Test

A
  • Neutral
  • Two fingers split on lat aspect of thigh
  • Feel pop between fingers
  • Add 20 degrees to the table top measurement
32
Q

How to document femoral torsion

A
  • 10 degrees femoral torsion (actual = 30 degrees)
33
Q

How to document hamstring length

A

“lacking 50 degrees of extension”

34
Q

Popliteal Angle

A
  • make sure pelvis is neutral
  • Flex hip to 90 and straighten leg
  • 3 reps then gentle overpressure
35
Q

Double popliteal angle?

A
36
Q

Why should you test varus and valgus at the knee in supine first?

A

To rule out effect of weakness, knee flexion contracture, rotation

37
Q

Normal Varus/Valgus

A
  • Birth: 15 degrees varus
  • 5 degrees in first year
  • 3-4 years: 10-15 degrees of valgus
  • 6-7 years: 5 degree valgus
  • Resolves by adulthood or very slight
38
Q

Goniometry landmarks for valgus/varus at knee

A

fulcrum: midpoint of patella
long arms: tibial tuberosity and ASIS

39
Q

Measuring Tibia-Femoral Angle in Standing

A
  • body in neutral position
  • Same goniometry landmarks
40
Q

2 Ways to Measure Tibial Torsion

A
  • Thigh-Foot Angle
  • Transmalleolar Angle
41
Q

Can you do thigh foot angle measurement on someone with a forefoot deformity?

A

No

42
Q

Considerations when measuring dorsiflexion

A
  • Isolate hind foot motion by slightly inverting (supinating) foot (locks midtarsal joint)
  • Test with knee extended (gastroc limitation) and knee flexed (soleus limitation)
43
Q

When do you see longitudinal arch in standing?

A

3-4 years old

44
Q

What does foot posture and arch look like before 3-4 years

A
  • Normal: flexible flat foot (see arch when stand on toes or extends great toe)
  • Abnormal: right flat foot

Peds Neuro (19 decks)

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