SUBJECTIVE DATA

QUESTION GUIDELINES
Describe the onset of the symptoms or mechanism of injury.
Determine whether symptoms are recent, recurrent, or
insidious.
Determine whether perpetuating circumstances exist.
Describe how the symptoms are perceived.
Establish the location, type, and nature of the pain or
symptoms.
Determine whether the pain and symptoms fit into
a Pattern:
Segmental reference ones
!erve root patterns
Extra segmental reference patterns
"Dural reference, myofascial pain patterns,
peripheral nerve patterns, or circulatory
pain#
Describe the behavior of the symptoms through a
$%&hour period while carrying out typical daily
activities.
'dentify which motions or positions cause or ease the
symptoms.
Determine how severe or how functionally limiting
the problem is. "(unctional limitations in terms of
daily living, wor), family, social, and recreational
activities#
Determine how irritable the problem is by how
easily the symptoms are evo)ed and how long
they last.
Describe any previous history of the condition. (ind
out if there has been previous treatment for the
problem and the results of the treatment.
Describe related history, such as any medical or surgical
1
intervention.
*riefly describe general health, medications, and x&ray or other
pertinent studies that have been performed. 'dentify any medical
conditions that may alert you to using special precautions or to
contraindications to any testing procedures.
PAIN
Pain Descriptions and +elated Structures
,ype of Pain Structure
-ramping, dull, aching .uscle
Sharp, shooting !erve root
Sharp, bright, lightning&li)e !erve
*urning, pressure&li)e, stinging, aching Sympathetic nerve
Deep, nagging, dull *one
Sharp, severe, intolerable (racture
,hrobbing, diffuse /asculature
INSPECTION
Helps to focus and individualize physical examination
SENSORIUM
0lert awa)e and attentive to normal stimulation
1ethargic drowsy, may fall asleep if not stimulated
2btunded difficult to arouse, fre3uently confused when awa)e
Stupor responds only to strong, noxious stimuli: returns to
unconscious state
-oma cannot be aroused
ORIENTATION
2
0wareness of ,ime, Person, and Place "oriented x 4#
AMBULATORY STATUS
!ote patient5s mode of locomotion "wheelchair, ambulatory with or
without assistive device, bedridden, bed bound etc.#
SKIN "color, texture, presence of lesions, scars#
PRESSURE SORES
Stage 6 non&blanchable erythema of intact s)in
Stage $ abrasion, blister, or shallow crater "epidermis 7
dermis#
Stage 4 deep crater, necrosis8damage of necrotic tissue
Stage % extensive destruction, tissue necrosis extending up to
muscle and bone
BODY BUILD
Ectomorphic thin, prominence of structures from ectoderm
.esomorphic muscular, prominence of structures from
mesoderm
Endomorphic heavy, fat body built, prominence of structures
from endoderm
PALPATION
PALPATION GUIDELINES
!ote differences in tissue tension, muscle tone 7 texture
!ote differences in tissue thic)ness
'dentify palpable anomalies
Define areas of tenderness
,emperature variations
Pulses, tremors, fasciculations
Dryness, excessive moisture
0bnormal sensation
+emember99 Palpate uninvolved part first and painful areas last
TENDERNESS (Pain upon palpation)
3
,enderness Scale8:rading 6 complains of pain
$ complains of pain 7 winces
4 winces 7 withdraws limb
% patient won5t allow palpation
EDEMA
:rading of Edema .ild 6; < => depth of
depression
.oderate $; => to ?> depth of
depression
Severe 4; ?> to 6> depth of depression
VITAL SIGNS
BLOOD PRESSURE
0dult *lood Pressure !ormal <6$@ mmAg 8 <B@ mmAg
Pre&A,! 6$@&64C mmAg8B@&BC mmAg
Stage 6 6%@&6DC mmAg8C@&CC mmAg
Stage $ E 6F@ mmAg86@@ mmAg
'nfant *lood Pressure < $ y.o. 6@F&66@ mmAg8DC&F4 mmAg
4&D y.o. 664&66F mmAg8FG&G% mmAg
(actors that may alter the *lood Pressure
Elevate *P 1owers *P
Pain +ecent meal
0uscultatory gap Dehydration
Sleeplessness 0uscultatory
gap
+ecent smo)ing
Distended bowel8bladder
+ecent exercise
-hilling
4
PULSE RATE
0dult Pulse +ate !ormal F@&6@@ bpm "avg. G@ bpm#
,achycardia H6@@ bpm
*radycardia < F@ bpm
'nfant Pulse rate !ormal G@&6G@ bpm "avg. 6$@ bpm#
Pulse :rading %; *ounding
4; 'ncreased
$; *ris), expected
6; Diminished, wea)er than expected
@ 0bsent, unable to palpate
RESPIRATORY RATE
0dult ++ !ormal 6$&$@ cpm
,achypnea H $@ cpm
Ayperpnea increase depth and rate
'nfant ++ !ormal 4@&F@ cpm
Dyspnea "shortness of breath# scale ;6 mild, noticeable
to px
;$ mild, noticeable to
observer
;4 moderate, can
continue
;% severe, can5t
continue
TEMPERATURE
!ormal CB.FI( or 4GI-
-onversion I(J KI- x C8DL ; 4$
I-J KI(&4$L x D8C
,ypes of (ever 'ntermittent alternate b8n pyrexia 7
normal and
subnormal within $% hr period
5
+elapsing8+ecurrent alternate b8n pyrexia 7
normal
lapse for H $% hr
Sustained8-onstant consistently elevated
temperature
SENSORY ASSESSMENT
Sensory impairments interfere with acquisition of new motor skills
since
motor learning is dependent on sensory information and feedback
SENSORY ASSESSMENT PRINCIPLES
Sensory assessment is completed prior to any testing that
involves active motor function
'nitial screening for mental status "arousal, attention,
orientation, cognition 7 memory#, vision 7 memory should be
done prior to performing sensory tests.
Patient should be instructed not to guess if uncertain about the
response
Demonstrate the test to orient the patient on what to expect
and what response is needed
,est order: SuperficialMDeepM-ortical 7 Distal to Proximal
0pply the stimuli in a random order to avoid giving patient Nclues>
to the correct response
't is good to use a chart or picture to represent the areas with
sensory problem so as to easily identify if a certain pattern exists
EXAMINATION PROTOCOL
Superficial sensation Pain Ose sharp end of a pin,
avoid
applying stimuli close to
each other
6
1et finger slide over the
pin
1ight touch Ose cotton or camel hair
brush
Pressure Ose thumb enough to
indent s)in
,emperature Ose test tubes with warm
"%6&D@I(# and cold "6@%&
664I(#
+esponse Phen patient feels
stimuli, respond with yes,
now or unable to tell
Deep sensation Qinesthesia .ove the extremity
passively
in initial, mid or terminal
range
with very minimal grip to
reduce tactile stimulation
+esponse Describe direction as up
or down, in or out while
the extremity is in
motion. 0lso patient can
imitate the movement in
opposite extremity.
Proprioception ,he extremity is held in a
static position in initial,
mid or terminal range
with very minimal grip to
reduce tactile stimulation
+esponse Describe direction as up
or down, in or out while
the extremity is in static
position. 0lso patient can
imitate the movement in
opposite extremity.
/ibration Place the base of a
vibrating tuning for) on a
bony prominence.
+andom application of
vibrating and non
vibrating stimuli should
be done. Patient should
also be given earphones
7
to remove the auditory
clues.
+esponse /erbally identify the
vibrating stimuli
-ortical sensation Stereognosis ,he patient is given a
familiar
object to be held and
manipulated
+esponse ,he patient is as)ed to
identify the object
verbally
,actile localiation ,herapist touches
different
areas in patient s)in
surface
+esponse Patient points out the
area that the therapist
touches
,wo&point
Discrimination 0pplies simultaneous
stimuli on the patient5s
s)in
+esponse 'dentify if the perception
of one or two stimuli
:raphesthesia ,race letters, numbers or
designs on s)in
+esponse 'dentify what is the
traced figure
8
9
MUSCULOSKELETAL ASSESSMENT
PATIENT HISTORY & INTERVIEW
Symptom 2nset sudden, gradual, insidious, traumatic
1ocation localied, diffuse, deep, superficial,
changes, spreads
Ruality severity, characteristic
*ehavior aggravating factors, relieving factors
'llustrations: !umerical Pain +ating Scales
-ircle the number which best represents the intensity of your pain
0 1 2 3 ! " # $ % 10
!o Pain Porst
Pain

'maginable
Previous -are8.edical Aistory Previous occurrence of the
condition, treatments received
and its effects
Past medical history 2ther significant conditions
.edications .edications ta)en, type,
fre3uency, dose
,reatment goals Patient5s hopes for outcome
10
2ccupational, recreational, social history patient5s wor) and
activities, architectural
barriers, environmental
accessibility
'llustrations: +ate Patient5s (unction
Phat percentage of your wor) activities are you able to performS
0& 10& 20& 30& 0& !0& "0& #0& $0& %0& 100&
'llustrations: +ate Patient5s (unction
Phat percentage of your home activities are you able to performS
0& 10& 20& 30& 0& !0& "0& #0& $0& %0& 100&
'llustrations: +ate Patient5s (unction
Phat percentage of your recreational activities are you able to performS
0& 10& 20& 30& 0& !0& "0& #0& $0& %0& 100&
RANGE O' MOTION
,hings to remember !ormal side is tested first, unless bilateral
movements are needed
0+2.&P+2.&'sometric movements
Painful movements are done last
0pply over pressure at end of range with
care
2ver pressure maybe applied to point of
pain but not beyond
11
+esisted isometrics are done with the joint
in resting position
0ctive +2. 2ften estimated except if more accurate
measurement is needed, goniometer
should be used
'f can be performed by patient easily
without pain or other symptoms, then
passive testing is usually not necessary
0ttention99
1imitations in 0+2. may indicate affection of either contractile or
none
contractile tissue or both. ,he examiner must perform further
testing to
isolate the cause.
Passive +2. Slightly greater than 0+2.
,ested for amount of motion "goniometric value#,
effect on symptom, end feel, and pattern of
limitation
0ttention999
1imitations in passive +2. maybe d8t bone or joint abnormalities
or tightness of these structures. Pain during this test is usually
related to pinching, stretching, or moving of non&contractile tissue.
Effect on Symptom Pain aggravated or persistent in
passive usually indicates non&
contractile structures "bones, joint,
ligaments, cartilage etc.#
12
End (eel 0bnormal End (eels
End (eel Examples
Soft
2ccurs sooner or later in the
+2. than is usual, or in a
joint that normally has a
firm or hard end&feel. (eels
boggy
(irm
2ccurs sooner or later in the
+2. than is usual, or in a
joint that normally has a
soft or hard end&feel.
Aard
2ccurs sooner or later in the
+2. than is usual, or in a
joint that normally has a
soft or firm end&feel.
0 bony grating or bony
bloc) is felt.
Empty
!o real end&feel because
pain prevents reaching end
of +2.. !o resistance is
felt except for patient5s
protective muscle splinting
or muscle spasm
Soft tissue edema
Synovitis
'ncreased muscular tonus
-apsular, muscular, liga&
mentous shortening
-hondromalacia
2steoarthritis
1oose bodies in joint
.yositis ossificans
(racture
0cute joint inflammation
*ursitis
0bscess
(racture
Psychogenic Disorder
13
Pattern of 1imitation -apsular Patterns
Can be due to situations
a. Toint effusion or synovial
inflammation "acute stage#
b. +elative capsular fibrosis "chronic
stage#
0ttention999
Determine what causes the capsular pattern, if it is inflammation
treatment is same for acute stage. 'f the cause is fibrosis,
treatment is same for chronic stage.
!on&-apsular Patterns
!sually involve one or two motions
of a "oint# Cause can be d$t
structures other than the "oint
capsule# %internal "oint derangement&
adhesions of part of "oint capsule&
ligament shortening& muscle strain
and shortening)
-apsular Patterns
14
+2. /alues
0/E+0:E +0!:ES 2( .2,'2! (2+ ,AE OPPE+ EU,+E.','ES
'! DE:+EES (+2. SE1E-,ED S2O+-ES
J()*+ M(+)(* ,-./01 M(+)(* ,-./01
Shoulder (lexion @&6B@
Aip (lexion @&6$@
Extension @&F@ Extension @&4@
0bduction @&6B@ 0bduction @&%D
.edial rotation @&G@ 0dduction @&4@
Toint Pattern
Shoulder
Elbow
(orearm
Prist
-.- 6
$&D
OE digit
Aip
Qnee
0n)le
Subtalar
.idtarsal
.etatarsalphalangeal joint
6
.etatarsalphalangeal joint
$&D
'P joint
E+H0*DH'+
(HE
PronationJSupination
(JE
0*D 7 EU,
E3ual restriction in all
direction
(HE
'+, (, 0*D
(HE
P(HD(
/arus restricted
+estricted D(, P(, 0*D,
medial rotation
EH(
,end toward (lexion
,end toward extension
15
1ateral @&C@ E+8'+ @&%D
Elbow (lexion @&6D@ Qnee (lexion @&64D
(orearm Pronation @&B@ 0n)le P( @&D@
Supination @&B@ D( @&$@
Prist Extension @&G@ 'nversion @&4D
(lexion @&B@ Eversion @&6D
+adial @&$@ Subtalar 'nv8Evr @&D
Olnar deviation @&4@ :reat toe
,humb
-.- 0bduction @&G@ .,P flexion @&%D
(lexion @&6D extension @&G@
Extension @&$@ P' flexion @&C@
2pposition ,ip of thumb to
or tip of fifth digit 1esser toe
.,P
flexion
@&%@
.-P (lexion @&D@ extension @&%@
'P (lexion @&B@
P'P flexion @&4D
Digits D'P flexion @&4@
Second &
(ifth
.-P (lexion @&C@
Ayperextensio @&%D
0bduction
P'P (lexion @&6@@
D'P (lexion @&C@
Ayperextensio
n
@&6@
ACESSORY JOINT MOTIONS
'ested if P()* is limited or painful+ 'ested for amount of motion&
effect on symptoms& and end feel#
0ccessory joint motion grades @ an)ylosed
6 considerable
hypomobility
$ slight hypomobility
4 normal
% slight hypermobility
D considerable
hypermobility
F unstable
:rades @ 7 F surgery considered, joint mobiliation not
indicated
:rades 6 7 $ joint mobiliation to increase joint extensibility
:rades % 7 D increasing joint extensibility not indicatedV
taping, bracing, strengthening indicated
16
RESISTED ISOMETRIC TESTING
,oint should be placed in a position midway through the range& to
produce
minimal tension in inert structures#
+ESO1,S 2( +ES'S,ED
'S2.E,+'- ,ES,'!:
(indings Possible Pathologies
Strong and painless ,here is no lesion or neurological
deficit involving the tested muscle and
tendon.
Strong and painful ,here is a minor lesion of the tested
muscle or tendon.
Pea) and painless ,here is a disorder of the nervous
system, neuromuscular junction, or a
complete rupture of the tested muscle
or tendon, or disuse atrophy.
Pea) and painful ,here is a serious, painful pathology
such as a fracture or neoplasm. 2ther
possibilities include an acute
inflammatory process that inhibits
muscle contraction, or a partial
rupture of the tested muscle or
tendon.
+emember999 *urasae can produce pain in isometric contraction if
it5s inflamed even though it5s non&
contractile
17
MANUAL MUSCLE TESTING
.anual .uscle ,esting :rades
G2-301 C2)+02)-
!ormal ! D 6@
(ull available ROM4 against
gravity, strong manual
resistance
:ood Plus :; DW C
(ull available +2., against
gravity, nearly strong
manual resistance
:ood : % B
(ull available ROM4 against
gravity, moderate manual
resistance
:ood .inus :W %W G
(ull available +2., against
gravity, nearly moderate
manual resistance
(air Plus (; 4; F
(ull available ROM4 against
gravity, slight manual
resistance
(air ( 4 D
(ull available ROM4 against
gravity, no resistance
(air .inus (W 4W %
0t least D@X of ROM4 against
gravity, no resistance
Poor Plus P; $; 4
(ull available ROM4 gravity
minimied, slight manual
resistance
Poor P $ $
(ull available ROM4 gravity
minimied, no resistance
Poor .inus PW $W 6
0t least D@X of ROM4 gravity
minimied, no resistance
,race Plus ,; 6; .inimal observable motion
"less than D@X ROM54 gravity
minimied, no resistance
18
,race , 6 ,
!o observable motion, palpable
muscle contraction, no resistance
Yero @ @ @
!o observable or palpable muscle
contraction
CLOSE6OPEN PACKED POSITION
+esting "1oose8open Pac)ed# Position of Toints
J()*+ P(1)+)(*
(acet "spine# .idway between flexion and extension
,emporomandibular .outh slightly open "freeway space#
:lenohumeral DDZ abduction, 4@Z horiontal adduction
0cromioclavicuiar 0rm resting by side in normal physiological position
Sternoclavicular 0rm resting by side in normal physiological position
Olnohumeral "elbow# G@Z flexion, 6@Z supination
+adiohumeral (ull extension, full supination
Proximal radioulnar G@Z flexion, 4DZ supination
Distal radioulnar 6@Z supination
+adiocarpal "wrist# !eutral with slight ulnar deviation
-arpometacarpal .idway between abduction&adduction and flexion&
extension
.etacarpophalangeal Slight flexion
'nterphalangeal Slight flexion
Aip 4@Z flexion, 4@Z abduction, slight lateral rotation
Qnee $DZ flexion
,alocrural "an)le# 6@Z plantar flexion, midway between maximum inversion
and eversion
Subtalar .idway between extremes of range of movement
.idtarsal .idway between extremes of range of movement
,arsometatarsal .idway between extremes of range of movement
.etatarsophalangeal !eutral
-lose Pac)ed Position of Toints
J()*+ P(1)+)(*
(acet "spine# Extension
,emporomandibular -lenched teeth
:lenohumeral 0bduction and lateral rotation
0cromioclavicular 0rm abducted to C@Z
Sternoclavicular .aximum shoulder elevation
Olnohumeral "elbow# Extension
+adiohumeral Elbow flexed C@Z, forearm supinated DZ
Proximal radioulnar DZ supination
Distal radioulnar DZ supination
+adiocarpal "wrist# Extension with radial deviation
.etacarpophalangeal (ull flexion "fingers#
19
.etacarpophalangeal (ull opposition "thumb#
'nterphalangeal (ull extension
Aip (ull extension, medial rotation[
Qnee (ull extension, lateral rotation of tibia
,alocrural "an)le# .aximum dorsiflexion
Subtalar Supination
.idtarsal Supination
,arsometatarsal Supination
.etatarsophalangeal (ull extension
MOTOR EVALUATION
TONE
.odified 0shworth Scale
:rade Description
@ !o increase in muscle tone.
6 Slight increase in muscle tone, manifested by a catch and release or
by minimal resistance at the end of the +2. when the affected
part"s# is moved in flexion or extension.
6; Slight increase in muscle tone, manifested by a catch, followed by
minimal resistance throughout the remainder "less than half# of the
+2..
$ .ore mar)ed increase in muscle tone through most of the +2., but
affected part"s# easily moved.
4 -onsiderable increase in muscle tone, passive movement difficult.
% 0ffected part"s# rigid in flexion or extension.
DEEP TENDON RE'LEXES
Taw "trigeminal#
*iceps "-D, -F#
,riceps "-G, -B#
Aamstrings "1D, S6, S$#
Patellar "1$, 14, 1%#
0n)le "S6, S$#
20
:rade Evaluation +esponse -haracteristics
@ 0bsent !o visible or palpable muscle
contraction
with reinforcement.
6; Ayporeflexia Slight or sluggish muscle contraction with
little or no joint movement. +einforcement
may be re3uired to elicit a reflex response.
$; !ormal Slight muscle contraction with slight
joint
movement.
4; Ayperreflexia -learly visible, bris) muscle
contraction
with moderate joint movement.
%; 0bnormal Strong muscle contraction with one to three
beats of clonus.
+eflex spread to contralateral side may be
noted.
D; 0bnormal Strong muscle contraction with
sustained clonus. +eflex spread to
contralateral side maybe noted
BALANCE
(O!-,'2!01 *010!-E :+0DES
!ormal Patient is able to maintain steady balance without support
"static#.
0ccepts maximal challenge and can shift weight in all directions
"dynamic#.
:ood Patient is able to maintain balance without support "static#.
0ccepts moderate challengeV able to maintain balance while
pic)ing object off floor "dynamic#.
(air Patient is able to maintain balance with handhold "static#. 0ccepts
minimal challengeV able to maintain balance while turning
head8trun) "dynamic#.
Poor Patient re3uires handhold and assistance "static#.
-,S'* "-linical ,est for Sensory 'nteraction in *alance
21
6 $ 4 % D F
6. Eyes open,
fixed support
$. Eyes closed,
fixed support
4. /isual
conflict, fixed
support
%. Eyes open,
moving
surface
D. Eyes closed,
moving
support
F. /isual
conflict
moving
support
22
+esult&'nterpretation
$,4,D,F /isual loss
D, F /estibular loss
%, D, F Surface, somatosensory input
4, %, D, F Sensory selection
COORDINATION ASSESSMENT
NON6EQUILIBRIUM TESTS
'ests should be performed first with eyes open and then
with eyes closed# -bnormal responses include a gradual
deviation from the .holding/ position and$or a
diminished quality of response with vision occluded#
!nless otherwise indicated& tests are performed with
the patient in a sitting position#
23
TEST PROCEDURE
17 (inger to nose
27 (inger to therapist\s finger
37 (inger to finger
7 0lternate nose to finger
!7 (inger opposition
"7 .ass grasp
#7 Pronation8supination
$7 +ebound test
%7 ,apping "hand#
,he shoulder is abducted to C@ degrees
with the elbow extended. ,he patient is
as)ed to bring the tip of the index finger
to the tip of the nose. 0lterations may
be made in the initial starting position
to assess performance from different
planes of motion.
,he patient and therapist sit opposite each
other. ,he therapist\s index finger is held in
front of the patient. ,he patient is as)ed to
touch the tip of the index finger to the
therapist\s index finger. ,he position of the
therapist\s finger may be altered during
testing to assess ability to change
distance, direction, and force of
movement.
*oth shoulders are abducted to C@ degrees
with the elbows extended. ,he patient is
as)ed to bring both hands toward the
midline and approximate the index fingers
from opposing hands.
,he patient alternately touches the tip of
the nose and the tip of the therapist\s
finger with the index finger. ,he position
of the therapist\s finger may be altered
during testing to assess ability to change
distance, direction, and force of
movement.
,he patient touches the tip of the thumb to
the tip of each finger in se3uence. Speed
may be gradually increased.
0n alternation is made between opening
and closing fist "from finger flexion to full
extension#. Speed may be gradually
increased.
Pith elbows flexed to C@ degrees and held
close to body, the patient alternately turns
the palms up and down. ,his test also may
be performed with shoulders flexed to C@
degrees and elbows extended. Speed may
be gradually increased. ,he ability to
reverse movements between opposing
muscle groups can be assessed at many
joints. Examples include active alternation
between flexion and extension of the )nee,
an)le, elbow, fingers, and so forth.
,he patient is positioned with the elbow
flexed. ,he therapist applies sufficient
manual resistance to produce an isometric
contraction of biceps. +esistance is suddenly
released. !ormally, the opposing muscle
group "triceps# will contract and ]chec)]
movement of the limb. .any other muscle
groups can be tested for this phenomenon,
such as the shoulder abductors or flexors,
elbow extensors, and so forth.
24
EQUILIBRIUM COORDINATION
TESTS
6.Standing in a normal, comfortable posture.
$.Standing, feet together "narrow base of support#.
4.Standing, with one foot directly in front of the other
in tandem position "toe of one foot touching heel of
opposite foot#.
%.Standing on one foot.
D.0rm position may be altered in each of the above
postures "i.e., arms at side, over head, hands on
waist, and so forth#.
F.Displace balance unexpectedly "while carefully
guarding patient#.
G.Standing, alternate between forward trun) flexion
and return to neutral.
B.Standing, laterally flex trun) to each side.
C.Standing: eyes open "E2# to eyes closed "E-# ability
to maintain an upright posture without visual input is
referred to as a positive (omberg sign#
6@.Standing in tandem position eyes open "E2# to
eyes closed "E-# %Sharpened (omberg)#
66.Pal)ing, placing the heel of one foot directly in
front of the toe of the opposite foot "tandem
wal)ing#.
6$.Pal)ing along a straight line drawn or taped to
the floor, or place feet on floor mar)ers while
wal)ing.
64.Pal) sideways, bac)ward, or cross&stepping.
6%..arch in place.
6D.0lter speed of ambulatory activitiesV observe
patient wal)ing at normal speed, as fast as possible,
and as slow as possible.
6F.Stop and start abruptly while wal)ing.
6G.Pal) and pivot "turn C@, 6B@, or 4F@ degrees#.
6B.Pal) in a circle, alternate directions.
6C.Pal) on heels or toes.
$@.Pal) with horiontal and vertical head turns.
$6.Step over or around obstacles.
$$.Stair climbing with and without using handrailV
one step at&a&time versus step&over&step.
$4.0gility activities "coordinated movement with upright
balance#V jumping jac)s, alternate flexing and extending
25
the )nees while sitting on a Swiss ball.
'mpairment Sample ,est
Dysdiadocho)inesia (i n g e r t o n o s e
0lternate nose to finger
Pronation8supination
Qnee
f l exi on8 ext ensi on
Pal)ing, alter speed or
direction
Dysmetria Pointing and past
pointing
Drawing a circle or figure
eight
Aeel on shin.
Placing feet on floor mar)ers
while wal)ing
.ovement decomposition (inger to nose
"dyssynergia# (inger to
therapist\s finger
0lternate heel
to )nee
,oe to examiner\s
finger
Aypotonia Passive
movement
Deep tendon
reflexes
,remor "intention# 2bservation during
functional activities "tremor will typically
increase as target is
approached or movement speed increased#
0lternate nose to finger
(inger to finger
(inger to therapist\s
finger
,oe to examiner\s
finger
,remor "resting# 2bservation of patient at rest
2bservation during functional
activities "tremor will diminish
significantly or disappear with
movement#
,remor "postural# 2bservation of steadiness of
normal standing posture
0sthenia (ixation or position holding "upper
and lower extremity#
0pplication of manual resistance
to assess muscle strength
26
+igidity Pa s s i v e mo v e me n t
2bservation during functional
activities
2bservation of resting
posture"s#
*rady)inesia Pal)ing, observation of arm
swing and trun) motions
Pal)ing, alter speed and
direction +e3uest that a
movement or gait
activity be stopped abruptly
2bservation of functional
activities:
timed tests
Disturbances of posture (ixation or position holding
"upper and lower extremity#
Displace balance unexpectedly in
s i t t i ng or st andi ng
Standing, alter base of support
"e.g., one foot directly in front
of the otherV standing on
one foot#
Disturbances of gait Pal) along a
straight line
Pal) sideways,
bac)ward
.arch in place
0lter speed and
direction of ambulatory
activities
Pal) in a circle
27
GAIT ANALYSIS
GAIT TERMS
TRUNK DEVIATIONS8 STANCE PHASE
28
HIP DEVIATIONS8 STANCE PHASE
HIP DEVIATIONS8 SWING PHASE
29
KNEE DEVIATIONS8 STANCE PHASE
KNEE DEVIATIONS8 SWING PHASE
ANKLE & 'OOT DEVIATIONS8 SWING
PHASE
30
ANKLE & 'OOT DEVIATIONS8 STANCE
PHASE
31
RATING 'OR GAIT ANALYSIS
32
'UNCTIONAL ANALYSIS
B-2+90.:1 )*30; (< -=+),)+)01 (< 3-).>
.),)*? (BAI5
33
'/*=+)(*-. I*30@0*30*=0 M0-1/20 ('IM5
34
35
36
37
38