ROM And Flexibility

Question 1

What age related factors do we keep in mind when working with kids

Answer 1

Working on a dynamic system
- growth and development of MSK system
- cognitive and language development
- social/emotional development

Question 2

What are some possible causes of abnormal flexibility and skeletal alignment

Answer 2

Lack of WBing
Abnormal muscle tone
Muscle paralysis
Weakness

Question 3

Pros and cons of visual estimation to measure ROM?

Answer 3

PROS - easy, no equipment, fast, functional
CONS - lack of reliability, not standardized

Question 4

Pros and cons of motion analysis system to measure ROM?

Answer 4

PROS - precise, accurate, reliable
CONS - cost, need for special equipment/location

Question 5

Pros and cons of still photography to measure ROM?

Answer 5

PROS - permanent record, good for difficult to measure areas
CONS - picture may capture movement transitions

Question 6

Pros and cons of goniometry to measure ROM?

Answer 6

PROS - standardized procedure, more reliable than observation (intra-rater)
CONS - immature skeletal development, poor definition of landmarks, weaker inter-rater reliability

Question 7

When is visual estimation useful for?

Answer 7

Screening
Medically fragile /ICU settings

Question 8

When is motion analysis useful for?

Answer 8

Pre-surgical examination — specifically for CP or MM
Evaluarte impact for new interventions
Research

Question 9

When is still photography useful for?

Answer 9

When evaluating static postures
Difficult to measure regions like c spine

Question 10

When is Goni useful for?

Answer 10

Baseline assessments
Outcome assessments
Long term follow up

Question 11

What is okay to consider true change in ROM

Answer 11

15-20 degree change

Question 12

How do you assess leg length

Answer 12

First screen with Galeazzi Sign. If there is a difference then measure true leg length from ASIS to medial malleoli

Question 13

What is femoral torsion

Answer 13

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

Question 14

What is femoral antetorsion

Answer 14

Head and neck of femur are rotated forward in sagittal plane relative to femoral condyles
Aka medial femoral torsion

Question 15

What are trends of femoral antetorsion from birth to adults

Answer 15

Newborns - 40deg
5 year olds - 23-26 deg
8 year olds - 20 deg
Adults - 10-15 deg

Question 16

How can you measure hamstring length?

Answer 16

Single popliteal angle or double popliteal angle
— use double popliteal angle when the patient has increased lumbar lordosis or anterior pelvic tilt that impedes the ability of the hamstrings to fully lengthen

Question 17

How do you measure for varus/valgus in the LE?

Answer 17

Test in supine first in order to rule out the effect of weakness, knee flexion contracture and rotation in the coronal plane.
You can measure distance of the ankles from each other if they present with genu valgum or measure the distance between the knees if they present with genu varum.
Then do the same measurement but with Goni in standing to see the effects of WBing

Question 18

What are normal values of varus/valgas throughout life?

Answer 18

Birth = 15deg varus
1 year old = 5 deg varus
3-4 year olds = 10-15deg valgus
6-7 year olds = 5 deg valgus
Adults = resolves if not a tiny bit of valgus

Question 19

How do you measure tibial torsion

Answer 19

Can use thigh foot angle or trans maleolar angle
Use transmalleolar angle when the child presents with a forefoot abnormality.
- thigh foot - use line between malleoli and line up with 2nd toe for measurement
- transmalleolar - use line between malleoli and then draw a line directly perpendicular to it and measure.

Question 20

What are some considerations when measuring Dorsiflexion

Answer 20

Isolate the hind foot motion by slightly inverting/supinating the foot to lock the midtarsal joints
- should test with knees extended to see gastroc limitation or knees bent to see soleus limitation.

Question 21

What are the normal foot postures and arches?

Answer 21

No longitudinal arch in standing until 3-4 years old
Before that — normal to have a flexible foot and you might be able to see the arch when they stand on their toes or extend the big toe
If child appears to have a flat foot, check the gastroc and soleus length

Question 22

What are age trends for tibial torsion

Answer 22

Birth = [-15 internal] -30 internal tibial — +20 external tibial torsion
Age 3 = [+5 extenal] -10 internal tib — +20 external tibial torsion
Mid childhood to skeletal maturity = [+10 ext] -5 internal — +30 external tibial torsion