Pediatric Range of Motion and Flexibility Examination Flashcards
What age related factors might influence examination of ROM/flexibility?
- 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
Age Related Factors
- Growth and Development of the musculoskeletal system
- Cognitive and Language Development
- Social/Emotional Development
What should you start with?
Observation
Causes of abnormal flexility and skeletal alignment
- lack of weight bearing
- abnormal muscle tone
- muscle paralysis
- weakness
Range of motion strategies
- visual estimation
- motion analysis
- still photography
- goniometry
- other joint motion measurement tools
Pros and Cons of Visual Estimation
Pros: easy, no equipment needed, fast, functional
Cons: lack of reliability, not standardized procedure
What is visual estimation most useful for?
Screening
Medically fragile/ICU
Pros and Cons of Motion Analysis System
Pros: precise, accurate, reliable
Cons: cost, need for special equipment/location
What is motion analysis most useful for?
- Pre surgical examination: cerebral palsy/myelomeningocele
- To evaluate impact of new interventions
- Research
Pros and Cons of Still Photography
Pros: Permanent record, good for difficult to measure areas (cervical spine)
Cons: picture may capture movement transition
When is still photography most useful?
When evaluating static postures
Difficult to measure regions
Pros and Cons of Goniometry
Pros: standardized procedure, more reliable than observation
Cons: immature skeletal development leads to poor definition of landmarks, weaker inter-rater reliability
When is goniometry most useful?
- Baseline assessment
- Outcomes assessment
- Long term follow-up
To Improve reliability of goniometry…
- 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
How many degrees of change do you need to see before you can assume there is true change in ROM
15-20 degrees
Recent literature says that what is most important?
critical values needed for function!
Which type of reliability is better in children with MD, DS, CP, and MM
Intra-Rater
Other factors that can impact the reliability of goniometry?
- Meds
- Time of Day
Child factors that can impact the reliability of goniometry?
- Attention span
- Interest in activity
- Motivation
Other tools used to measure joint motion
- Arthrodial protractor
- Inclinometer
Do not measure over clothes
What is the most appropriate test for measuring hip extension for a child w/ UMN Syndrome/CP?
Prone Hip Extension Test
Galeazzi’s sign
- 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
Thomas Test
- Calibrate inclinometer
- Align the pelvis
- Don’t over flex hips
- Go through motion 3 times before measuring
Prone Hip Extension Test
- 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
Hip Adduction Test
- 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
Prone Internal and External Hip Rotation
- 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
Torsion:
- normal amount of twist present in the long bone (femur)
Femoral Torsion:
- Angle formed by an axis drawn along the head and neck of the femur and another through the femoral condyles
Antetorsion
- Head and neck of the femur are rotated forward in the sagittal plane relative to the femoral condyles
Femoral Torsion Test/ Craig’s/ Ryder’s Test
- Neutral
- Two fingers split on lat aspect of thigh
- Feel pop between fingers
- Add 20 degrees to the table top measurement
How to document femoral torsion
- 10 degrees femoral torsion (actual = 30 degrees)
How to document hamstring length
“lacking 50 degrees of extension”
Popliteal Angle
- make sure pelvis is neutral
- Flex hip to 90 and straighten leg
- 3 reps then gentle overpressure
Double popliteal angle?
Why should you test varus and valgus at the knee in supine first?
To rule out effect of weakness, knee flexion contracture, rotation
Normal Varus/Valgus
- 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
Goniometry landmarks for valgus/varus at knee
fulcrum: midpoint of patella
long arms: tibial tuberosity and ASIS
Measuring Tibia-Femoral Angle in Standing
- body in neutral position
- Same goniometry landmarks
2 Ways to Measure Tibial Torsion
- Thigh-Foot Angle
- Transmalleolar Angle
Can you do thigh foot angle measurement on someone with a forefoot deformity?
No
Considerations when measuring dorsiflexion
- Isolate hind foot motion by slightly inverting (supinating) foot (locks midtarsal joint)
- Test with knee extended (gastroc limitation) and knee flexed (soleus limitation)
When do you see longitudinal arch in standing?
3-4 years old
What does foot posture and arch look like before 3-4 years
- Normal: flexible flat foot (see arch when stand on toes or extends great toe)
- Abnormal: right flat foot
