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
