BASIC MEASUREMENTS AND ASSESSMENT IN PHYSIOTHERAPY - PowerPoint Presentation

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BASIC MEASUREMENTS AND ASSESSMENT IN PHYSIOTHERAPY

Istanbul Gelisim UniversityDepartment of Physiotherapy and Rehabilitation

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PERIOD PLAN

DEFINITION AND HISTORY OF PHYSIOTHERAPY PATIENT’s STORY AND EVALUATIONBASIC PRINCIPLES OF MOVEMENTPOSTURAL ANALYSISSHORTNESS TESTINGFLEXIBILITY AND EVALUATIONMUSCLE-SKELETAL SYSTEM (INSPECTION-PALPASION)ANTROPOMETRIC MEASUREMENTSNORMAL JOINT MOVEMENTSMUSCLE STRENGTH ASSESSMENTS

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DEFINITION AND HISTORY OF PHYSIOTHERAPY

Physiotherapy:The treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery.

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Rehabilitation

is the treatment for the regeneration of lost mobility, both congenital or later.Health: Not just a lack of disease and disability, but a complete state of physical, spiritual and social well-being.

Disease: A

 state of deterioration in health caused by some changes in organism.

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Impairment: A psychological, physiological and anatomical (physical) structure

abnormality or an absence in health and in functions (WHO). The disorder can be temporary or permanent. Disabled: The persons who are incapable of following the requirements of normal life because they lost their physical, mental, emotional and social abilities with varying degrees.

Handicap

: 

It is defined as a restriction or non-fulfillment of the expected roles of the person due to a disorder or an apology due to age, gender and social factors

.

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The history of physiotherapy goes back to the time of Hippocrates.Patients were tried to be treated with massage, manual therapy methods or hydrotherapy, namely water treatment properties.

The Royal Central Institute of Gymnastics (RCIG), founded in Sweden in 1813, is the first institution to be known for physical therapy.There was massage, manipulation and exercise.In Turkey, in 1961  Prof. Dr. Ihsan Dogramaci opened the School of Physical Therapy and Rehabilitation

at

Hacettepe

University

.

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Royal

Central Institute of Gymnastics (RCIG)

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PATIENT’s story

AND EVALUATIONThe patient's story begins with the observation of the external appearance of the patient, such as behavior, expression and posture, as soon as the patient enters the room.Thus, without getting a comprehensive story, a general perspective about the patient and the disease would be gained.

Before discussing with the patient, the file should be reviewed and regular notes should be kept

The date of each test and treatment change should be recorded regularly

Home programs should also be recorded in the file

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General principles in taking the story

Main complaint The story of the disease (symptoms)Functional history of the patientResume-family history of the patientReview of systemsSocial storyWork-related storyPsychological and psychiatric storyCardio-vascular and disease risk factorsDrugs taken

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Main Complaint

The basic question about what patient needsThe aim here is to learn the patient's complaint in the same way as he expresses his or her own wordsIt plays an important role in stating

sympathetic symptoms, identifying and shaping the disease

Whether or not there is loss of function should also be considered when determining the main complaint

If there is a loss of function, the factor that causes it should be identified in the complaint of the patient

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The story of the disease (symptoms):

While telling the patient what he is in, the story of the patient is takenFindings such as loss of sensation and weakness are taken verbally from the patient as a result of careful listening of the patients.Then special questions about symptoms are passedThe patient should be allowed to tell the all of storyDuring the interview, each problem must be addressed separately

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Functional

story:Assessment of the disease from rehabilitation perspective often leads to loss of functionIn the functional story, after the disease, the remaining capacity should be assessedThe patient should be known not only at the functional state at that moment

but

also

the functional level

before

disease

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Resume-family

history:During the life of the patient, information about health, functional abilities, and operations should be obtained.Family history is also important in terms of congenital problems and heart diseases.

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Review of body systems

 :Cardio-vascular, pulmonary, neurological, musculoskeletal systems should be reviewed both in the patient file and in the patient's history.The state of body functions in treatment and education is important.

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Social story

:It should be learned with whom and where the patient lives, where to go after the treatment, whether the home where he lives is appropriate for the disease, and the effectiveness of the family in providing care at home.Standard household life, diet, smoking, alcohol, drug addiction should be noted.

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Work-related(

occupational)story:It is important to learn the level of education, job and where the patient is working, special skills other than work hobbies.It is also important to cover treatment costsPsychological history:

The social and psychological state before and after the illness, the point of view on life and disease is important

.

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Cardio

-vascular disease risk factors:Risk factors that may cause progression of the disease should be investigatedReceived medications:Medications used by the patient and their daily doses should be recorded

After the story is taken, the physical evaluation is started

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EVALUATION

S: Subjective Evaluation (Story and Observation)

O:

Objective

Evaluation (

Tests

)

A:

Analysis (Analysis of Information Obtained)

P:

Plan (Planning of Treatment Program)

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ObjectIve evaluatIon

Neurological evaluationMusculoskeletal, soft tissue and

joint

evaluation

Evaluation of

cardiac

and

pulmonary

system

Skin

Bladder

and

bowel

function

Aches

Functional

evaluation

Evaluation of Daily

living

activities

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Neurological Evaluation

Mental State : The criteria such as place, time, person orientation, memory, attention, calculation ability, behavior, level of consciousness of the patient are taken into consideration.Motor System : Palpation sensitivity, hardness, decreased or increased tonus and nodules.Sensory System : Pain, hot, cold, touch sensation, vibration, two-point separation, anesthesia (complete loss of all senses), hypoesthesia (loss of sensation), paresthesia (needling, tingling sensation),

dysthesis

(pain sensation), hyperesthesia (hypersensitivity) evaluated.

R

eflexes

Vision, Hearing, Swallowing and Speaking

Walking and

Ambula

tion

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MENTAL STATUS

If the general condition of the patient is serious, the glasgow coma scale is used.This scale consists of three basic evaluations:1- Opening of eyes (automatic, voluntary)2- V

erbal

answers (speaking, orientation, conscious communication, using inappropriate and incomprehensible words)

3- 

M

otor

system response (making orders and utterances, abnormal flexor and extender responses)

These criteria belonging to patient and disease are evaluated with scoring system and mental status is determined.

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GLASGOW COMA SCALEAccording

to the the best and worst answers that the person gives, the total point is

calculated based on the total of 15 points

.

The total score value is determined.

GCS score: scored between (3-15).

If there is 15,

oriented

if 13 - 14 confused,

if 8 - 13 stupor,

if 3 - 8

pericoma

,

3 is defined as coma.

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Eye Opening

G4 Spontaneously opens the eyes.

G3 opens the eyes with oral stimuli.

G2 opens the eyes with a painful stimulus.

G1 No painful stimulus response

.

Motor

Response

M6 sleeping with the order.

M5 is localizing the painful stimulus.

M4 Attracts limb with painful stimulus.

M3 Abnormal flexion on the extremity with painful stimulus.

M2 Abnormal extension on the extremity with painful stimulation.

M1 No painful stimulus response.

Verbal Answer

S5 Normal, or

ien

te

d

responding.

S4 speaks confused.

S3 responds with inappropriate words.

S2 makes unbelievable sounds.

S1 No response.

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Motor sYstem

Spontaneous motor activityFasciculationsTremorROMStrength, shortness and flexibility evaluationsEndurance

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REFLEXES

Deep tendon reflexes, superficial reflexes and pathological reflexes are evaluatedFor example, deep tendon reflexes defined as a reflex that examines the conduction function of the nerves from the spinal cord to the muscles that bring movement stimuli are hyperactive in upper motor neuron lesions and decreased or lost in lower motor neuron lesions.Upper extremities : biceps, triceps, styloradial reflexesLower extremities : patellar and

achilles

reflexes

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sight, hearing, swallowing and speaking

AnopsiaAphasiaDysphasiaAphoniaDysphoniaDysarthria

must be evaluated

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Aphasic: The result of damage to the brain the speech is not understood.

Speech is in the frontal lobe of the left brainUnderstanding is the temporal lobe of the left brainWriting and reading are in the side-upper parietal lobe of the left brain

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There are three types of aphasia(

sensory, motor and total):Sensory aphasia, speech (+), understanding (-)Motor aphasia, speech (-), understanding (+)Total aphasia, speaking (-), understanding (-)Dysphasia: Patients have difficulty in finding words and names.Afoni: Loss of sound. The cause is usually the disease or injury of the nerves controlling the speech muscles.

Dysphonia: Sound disorders that

generally

involve the larynx

impairment

Disartry

: The command from the brain is correct, but there is a problem with the organs that help to speak as a result of

misformation

of the joint.

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Walking and ambulatıon

Walking analysisWalking with orthesis or prothesisAproxia (unable to move correctly)

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Musculoskeletal System, Soft Tissue and Joint Evaluation

Observation-palpationPassive and Active Motion Muscle Strength TestsJoint

Stability

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The right and left sides of the body are examined symmetrically in the observation starting with the entry of the patientIf there is asymmetry, it should be saved

Posture, atrophy, edema, scar tissue, skin changes should be observedMuscle, joint, bone should be palpableSpasm, edema, sensitivity should be recordedJoint limitation should be evaluated with goniometric measurements

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Evaluation of Cardiac and Pulmonary System

Efor TestsLung Function TestsChest Antropometric MeasurementsSkinShould

be examined in terms of

Trophic disorders

Bladder and Bowel Function

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Pain

Scales are used.Functional Assessment

Evaluation of Daily Life Activities

Determining the level of independence: eating, dental care, bed-bath-toilet transfers, dressing, driving, wheelchair use

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BASIC PRINCIPLES OF MOVEMENT

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Axis: the line around which you movePlane: area where the axis is perpendicular and the movement is made

They are the three planes and axes that pass through the body, and they are perpendicular to each other.The point where all of them intersect is the center of gravity.Center of gravity: S2 equals 1-2 cm of the vertebra.

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SAGITTAL AXIS

It is a line that runs horizontally from front to back. The axis is on the frontal plane.The frontal plane passes through the body from right to left, separating the body from front to back.Sagittal axis, movements in frontal plane:the abductionAdductionLateral flexionThe two movements are excluded from movements in this axis and plane.Radial deviation: The hand is going to the abduction towards the thumb.

Ulnar deviation: The hand is going to the abduction towards the thumb.

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FRONTAL AXIS

The frontal axis is a line extending horizontally from right to left. The axis is in the sagittal plane.The sagittal plane passes through the middle of the body from the front to the back and divides the body into the right and left halves.Frontal axis sagittal plane movements:flexionextensionThe two movements on the stand are out of motion in this axis and plane.Dorsiflexion: pulling the foot upward

Plantar flexion: Downward pushing of the foot

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VERTICAL-LONGITUDINAL AXIS

It is a line parallel to the gravity line and in the craniocaudal direction.Axis is in horizontal plane.Horizontal plane divides body into upper and lower parts.Vertical axis Horizontal plane movements:Horizontal abductionHorizontal adductionInternal rotationExternal rotation

pronation

supination

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Other movements in the body

Scapular movementselevationDepressionthe protractionthe retractionFoot movementsthe inversioneversionthe circumduction

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Contraction types

Isometric (static)Isotonic (dynamic) (concentric)eccentricisokinetic

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Factors affecting effective use of muscle contraction

Leverage system1st class leverage2nd class leverage3rd class leverageApplication angleLength-Strength relationship

Structure of muscles (force and speed)

Anatomy

The muscle leverage system

Action involved

muscles

 (agonist, antagonist, synergist, fixator)

Coordination of muscle function

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Leverage system

The movement of each joint in the body is reversible.Bone, lever armJoints; supportMuscles, strengthForce * force arm

=

load

*

load

arm

1st

class

leverage

 (

keeping

the

head

upright

)

Force ---

support

(

joint

) ---

load

(

neck

muscles

effective

)

2nd

class

leverage

 (

rise

at

finger

tip)

Support

---

load

---

force

(

gastro

effective

)

3rd

class

leverage

 (

forearm

flexure

)

Support

---

force

---

load

(

biceps

effective

)

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1st class leverage is the advantage for speed and movement.2nd class leverage is advantage for power. Force is more than arm load arm.

3rd grade leverage is the advantage for speed.Application angle and length-force relation'0' degree - used for force stabilizationWhen approaching 90 degrees, most of the strength is for rotationAll force at 90 degrees is for

rotation

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Starting from the extended position of the muscle, the muscular contraction will produce more force than the contraction starting from the shortened position.For this reason, if the muscle is to be reduced in strength for a certain movement, the muscle should be placed in its shortened position.