FUNCTIONAL ASSESSMENT

5. CT SCAN
➢ Thins cross section or slices taken at any specific
levels
➢ Provide excellent bony architectural detail

6. MRI
➢ Least radiation (no side effect)
➢ Noninvasive, painless imaging technique that uses
exposure to magnetic fields, not ionizing radiation,
to obtain an image of bone and soft tissue

7. DISCOGRAPHY
➢ Injection of small amount of radio- opaque dye into
the nucleus pulpous of an IV disc under radiographic
guidance

8. FLOUROSCOPY
➢ Have the greatest radiation and rarely used
➢ Shows motion in joint through x ray imaging

FUNCTIONAL ASSESMENT

INTRODUCTION: The ultimate objective of any rehabilitation program is to

return the individual to a lifestyle that is close to the premorbid level of function
as possible, or alternatively, to maximize the current potential for function to
maintain it. Every individual values the ability to live independently. Functional
activities encompass all those tasks, activities and roles that identify a person
as an independent adult or as a child progressing toward adult independence.
 FUNCTIONAL ASSESSMENT

FUNCTIONAL LIMITATION
➢ inability of an individual to perform action or activity in the way
that is done by most people usually as a result of impairment
DISABILITY
➢ characterized by discordance between the actual performance of
an individual in a particular role and the expectations of the
community regarding what is normal for an adult
➢ Inability to perform social roles typical independent adults, taking
into account age, sex, social and cultural factors.

II. EXAMINATION OF FUNCTION

Functional assessment is accomplished through the application of selected test

and measures that yield data that can be used as:
1. Baseline information for setting function oriented goals and
outcome intervention
2. Indication of patient’s initial abilities and progression toward more
complex functional level
3. Criteria for placement decision
4. Manifestation of an individual ‘s level of safety in performing a
particular task and risk of injury with continued performance
5. Evidence of the effectiveness of a specific intervention on function

TYPES OF MEASUREMENT
1. PERFORMANCE-BASED ASSESMENT
➢ Administered by a therapist who observes the
patient during the performance of an activity
➢ Searching for an indication of what a patient can do
under a specific set of circumstances
➢ Chosen with the intention of making interferences
about how the patient will perform
2. SELF ASSESSMENT
➢ Patient is ask directly by therapist through the use of
self-administered assessment instrument
➢ Questions are asked in a standard format and
answers are recorded as specified by the
predetermined choices
➢ NOTE if patient completed the format with the help
of others
 MOTOR ASSESSMENT

MOTOR CONTROL ASSESSMENT

DEFINITION OF TERMS:
REFLEX
➢ Movements that are genetically predetermined and
be seen through normal growth and development
MOTOR SKILL
➢ Are learned through interaction and exploration of
the environment
MOTOR PROGRAM
➢ Is an abstract representation that when initiated,
result in the production of the coordinated
movement sequence.
MOTOR PLAN
➢ Is an idea or plan for purposeful movement that is
made up of several component motor programs
COORDINATION
➢ Refers to the patterning of environmental objects
and events

A. FLEXIBILITY
1. Available ROM- an important element of functional
movement
2. Tightness- NO ROM, present PROM
3. Contracture- NO ROM and PROM; a fixed resistance
resulting from fibrosis of tissue resistance surrounding a
joint
B. TONE
➢ Define as the resistance of muscle to passive
elongation or stretch
➢ Represents the degree of residual contraction in
normally innervated, resting muscle or steady state
contraction.
1. Muscle tone- the resistance to passive
elongation or stretch
2. Postural tone- a pattern of muscular
tension that exist through the body and
affects group of muscles
 MOTOR ASSESSMENT

2. RIGIDITY
➢ Lesion on the basal ganglia
➢ Velocity independent

CLASSIFICATION:

1. DECORTICATE
➢ Sustained contraction and
posturing of the trunk and lower
limbs in extension and upper
limb in flexion, movable
➢ Lesion at Diencephalon
2. DECEREBRATE
➢ Sustained contraction and
posturing of the trunk and lower
limbs in a position of full
extension, movable
➢ Lesion at brainstem
3. OPISTHOTONUS
➢ Strong sustained contraction
and posturing of the extensor
muscles of the neck and trunk,
immovable

TYPES:
1. COGWHEEL RIGIDITY- rachet like
response to passive movement
characterized by an alternating letting go
and increasing resistance to movement
2. LEADPIPE RIGIDITY- constant
rigidity
 MOTOR ASSESSMENT

➢ Findings: normoflexia
➢ Significance: intact reflex arc
EXAMPLE:
Brachialis Reflex- C5, C6
Biceps Reflex- C5, C6
Triceps Reflex- C7, C8
Hamstrings Reflex-
Patellar Reflex- L3, L4
Ankle Reflex (Achilles’ tendon)- S1, S2
LEGEND:
O Areflexive 3+ hyperreflexive
1+ hyporeflexive 4+ clonus
2+ normal

*JENDRASIC MANEUVER- strategy to relax the muscle to be treated

LE- hold
UE- put an object between the knees
ALL BODY PARTS- clench teeth

PATHOLOGIC REFLEXES:
REFLEX STIMULUS REACTION
Babinski Stroke the lateral aspect of Extension of the big toe and fanning
the sol of other toes
Gordons Squeeze the calf muscle Extension of the big toe and fanning
of other toes
Piotrowski Percussion of the tibialis Dorsiflexion and supination of the
anterior muscle foot
Rossolimos Tapping of the plantar aspect Plantar flexion and flexion of the
of the toes toes
Schaeffers Pinching of the Achilles Flexion of the foot and toes
tendon
Chaddoks Stroke on the lateral side of Extension of the big toe and fanning
the foot of other toes
Oppeuhem Stroke the antero-medial of Extension of the big toe and fanning
the tibia of other toes
Brodzinski Passive flexion of one limb Other limb will also follow

Hoffmans Flexion of the thumb Flexion of the other digits

 MOTOR ASSESSMENT

D. POSTURAL CONTROL
1. Normal posture requires the least amount of the paraspinal
muscular recruitment. In normal posture, the line of gravity
passes from C1 to C7 v
2. Vertebral bodies to T1 and the lumbosacral junction and
passes through the common axis of the hip joint or
slightly behind it. It passes in front of the sacroiliac
articulation and knee joint and then in front of the
ankle joint.
3. Postural Orientation- involves the control of relative
positions of the body parts by skeletal muscles with respect
to gravity.
4. Postural stability- is defined as the condition in which all
the forces acting on the body are balanced such as that the
center of mass is within the stability limits, boundaries of
the BOS.
5. Reactive control occurs in response to external forces
displacing COM or movement of BOS.
6. Proactive control occurs in anticipation of internally
generated, destabilizing forces imposed on the body’s own
movements
7. Adaptive postural control allows the individual to
appropriate modify sensory and motor systems in response
to changing task and environmental demands.

LIMITS OF STABILITY
➢ To maintain a certain position
➢ is defined as the maximum angle from the vertical that can be
tolerated without loss of balance
➢ NORMAL PERSON: (anterior-posterior) LOS in standing
is approx. 12 degree
(medial-lateral) LOS in standing position
is approx. 16 degrees
➢ Normal stance width: 4 inches
 POSTURAL ASSESSMENT

Thoracic Anterior to Erector Spinae Vertebral

the vertebra Ligaments
Lumbrosacral Anterior to Erector Spinae Vertebral
Junction the vertebra Ligaments
Hip Posterior to Iliopsoas Iliofemoral
the vertebra ligament
Thoracic Anterior to Erector Spinae Vertebral
the vertebra Ligaments
Knee Anterior to Gastrocnemius and Cruciate Ligament
the knee jt. hamstring muscles and Posterior
capsule
Ankle Anterior to Soleus muscle
the knee jt.
POSTURAL ASSESSMENT

ANTERIOR VIEW

-head in midline
-jaw posture is normal
-tip of the nose is in line with the manubrium sternum, xiphisternal, and
umbilicus
-trapezuis neck line is equal on both sides
-shoulders are level
-clavicles and AC joints are equal and level
-waist angles are equal
-carrying angle at each elbow is equal
-palms of both hands face the body in the relaxed standing position
-highpoints of the iliac crest are the same height on each side
-ASIS are level
-pubic bones are level at the symphysis pubis
-patellae of the knees point straight ahead
-knees are straight
-heads of the fibula are level
-the medial and lateral malleoli of the ankles are level
-Two arches are present in the feet and equal on the two sides
-feet angle out equally
 SENSORY ASSESSMENT

CLINICAL INDICATIONS
1. Edema, lymphedema, or effusion
2. Impaired gait, locomotion and balance
3. Impaired joint integrity and mobility
4. Impaired motor function (motor control and learning)
5. Impaired muscle performance (strength, power, and endurance)
6. Impaired neuromotor development and sensory integration
7. Impaired reflex integrity
8. Impaired posture
9. Impaired ventilation, respiration (gas exchange) 0and circulation
10. Pain

1. AROUSAL
➢ The psychological readiness
➢ Assessed by using traditionally accepted key terms and definitions
to describe the patient’s level of consciousness
o ALERT
➢ Patient is awake and attentive to
normal level of stimulation
➢ Interactions with the therapist are
normal and appropriate
o LETHARGIC
➢ The patient appears drowsy and may
fall asleep if not stimulated in some
way
➢ Interactions with the therapist may be
get sidetracked
➢ Patient may have difficult in focusing
or maintaining attention on a question
or task
o OBTUNDED
➢ Patient is difficult to arouse from a
somnolent state and is frequently
confused when awake
➢ Repeated stimulation is required to
maintain consciousness
 SENSORY ASSESSMENT

o CALCULATION ABILITY
➢ Assesses foundational mathematical
abilities
o PROVERB INTERPRETATION
➢ Tests the patient’s ability to interpret
use of words outside of their usual
context or meaning

1. MEMORY
➢ Both long and short term memory

2. HEARING
➢ Gross hearing can be made by observing the patient’s response to
Conversation

3. VISUAL ACUITY
➢ Gross visual assessment can be made by use of standard Snellen
chart

CLASSIFICATION OF THE SENSORY SYSTEM

1. RECEPTOR
DIVISIONS:
a. Superficial
➢ Superficial sensations
➢ Receive stimuli from outer
environment via skin, and
subcutaneous tissue
➢ Responsible for perception of pain,
temperature, light touch, and pressure
b. Deep Sensation
Proprioreceptors are responsible for deep sensations,
receives stimuli from muscles, tendons, ligaments, joints
and fascia and are responsible for position sense and
awareness of joint ate rest movements, movement
awareness and vibration
 SENSORY ASSESSMENT

DESIGN AND FUNCTION OF SENSORY RECEPTORS

1. MECHANO RECEPTORS
A. CUTANEOUS RECEPTOR
➢ Located at the terminal portion of the afferent fibers

1. Free Nerve Ending

• Found through the body
• Stimulation results in perception of pain, temperature, touch,
pressure, tickle and itch sensation.

2. Hair Follicle
• Goosebumps
• Located at the base of the hair
• Combination of the hair follicle and nerve provides a sensitive
receptor
• Sensitive to mechanical movement and touch

3. Merkel’s Disks
• Below epidermis
• Sensitive to low-intensity touch, as well as to velocity of touch
• Provide for the ability to perceive continuous contact of objects
against the skin and have important role in two-point
discrimination and localization touch.
4. Ruffinis Endings
• Rude touch
• Deeper layer of the epidermis
• Involved with the perception of touch and pressure
5. Krause’s End-Bulb
• Dermis
• Have a contributing role in the perception of touch and
pressure
 SENSORY ASSESSMENT

d. Pacinian Corpuscles
➢ Located at the fascia and respond to vibratory
stimuli and deep pressure
2. Joint Receptor
a. Golgi Tendon Endings
➢ Located I the ligaments and function to detect the
rate of joint movement
b. Free Nerve Endings
➢ Found in joint capsule and ligaments
➢ Respond to pain and crude awareness of joint
motion
c. Ruffini Endings
➢ Located in joint capsule and ligaments
➢ Responsible for the direction and velocity of joint
movement
d. Paciniform Endings
➢ Found in the joint capsule and primarily monitor
rapid joint movement

2. THERMORECEPTORS
• Respond to changes in temperature
• Cold and warmth receptor

3. NOCICETORS
• Respond to noxious stimuli and result in the perception of pain
• Pain: free nerve ending

4. CHEMORECEPTOR
• Respond to chemical substances and are responsible for taste,
smell, oxygen levels in arterial blood, carbon dioxide
concentration, osmolality of body fluids
 SENSORY ASSESSMENT

UPPER QUARTER SCREEN LOWER QUARTER SCREEN

C2 Occipital Protuberance L1 Upper Anterior Thigh
C3 Supraclavicular Fossa L2 Middle Anterior Thigh
C4 Acromioclavicular Fossa L3 Medial Femoral Condyle
C5 Lateral Cubital Fossa L4 Medial Malleolus
C6 Thumb L5 Dorsum of the 3rd MTP joint
C7 Middle Finger S1 Lateral Heel
C8 Little Finger S2 Popliteal Fossa
T1 Medial Antecubital Fossa S3 Ischial Tuberosity
T2 Apex of Axilla S4-S5 Perineal Area
T3 3rd ICS T10 Umbilical aArea
T4 4th ICS/nipple line T11 Below Umbillicus
T5 Inframammary Fold T12 Inguinal Area

SUPERFICIAL SENSATIONS

1. PAIN
➢ Use sharp end of safety pin or paperclip
➢ The patient is asked verbally indicate when a
stimulus is felt
➢ All areas of the body should be tested
2. TEMNPERATURE
➢ Use two test tubes with stopper
➢ One filled with warmth water and the other one is
crushed ice
➢ Range: Cold 5-10C/ Warmth 40-45C
➢ Test tubes are randomly placed in contact with the
skin are to be tested. All skin surface should be
tested
➢ The patient is asked to indicate when stimulus is felt
and to reply warm or cold or enable to tell
 SENSORY ASSESSMENT

3. VIBRATION
➢ Requires tuning fork that vibrates at 128Hz
➢ The ability to perceive a vibratory stimulus is tested by
placing at the base of a vibrating tuning fork on a bony
prominence, if intact the patient perceives the vibration
➢ The patient is asked to respond verbally identifying the
stimulus as vibrating or non-vibrating each time the base of
the fork is placed in contact with bony prominence

COMBINED CORTICAL SENSATIONS

1. STEREOGNOSIS
➢ Testing a tactile object recognition requires use of
items of differing size and shape
➢ The patient is given an object. Allow to manipulate
the object and then asked to identify the item
verbally

2. TACTILE LOCALIZATION
➢ This test asses the ability to localize touch sensation
on the skin
➢ The patient is asked to identify the location of the
stimulus by pointing the area or verbal description
➢ The patient eyes maybe open during response
component tests

3. TWO-POINT DISCRIMINATION
➢ Assesses the ability to perceive two points applied to
the skin simultaneously
➢ The patient is asked to identify the perception of
one or two stimuli