Examination
Aids
AFO / KAFO
- ankle foot orthosis
- knee ankle foot orthosis
GRAFO
- ground reaction AFO
Kaye walker
- seat on it
- co-ordinates walking
Reciprocal Gait Orthoses
Sitting
Short adducted leg - dislocated hip
Scoliosis
Kyphosis - query secondary tight hamstrings
Walking
Decreased velocity
Coronal Plane
- scissoring / tight adductors)
- asymmetrical arm swing / hemiplegia
- LLD / hip dislocation
Sagittal
- equinus / jump / crouch
A. Equinus
- ankle in equinus
- knee straight or in recurvatum
- hip extends full
B. Jump
- equinus of ankle
- flexion of knees and hips, never extend fully
C. Crouch
- ankle in dorsiflexion
- over lengthening of T Achilles
- have to flex knees and hips to regain centre of balance
Lower Limb
R1 - do slowly
R2 - do quickly
Looking for a difference between the R1 and R2
- if reduced ROM on R2, have spasticity / dynamic element
- amenable to botox
Supine
1. Psoas
- FFD / Thomas test
- must test knee first
- do over edge of bed if FFD knee
2. Adductors
- scissored gait if bilateral
- apparent leg length inequality if unilateral
- Trendelenburg gait
- decreased hip abduction
3. Hamstrings
- FFD at knee
- knee flexed at start of stance phase
Popliteal angle (hip flexed at 90°)
- straight is 0˚
Unable to sit up with legs straight
- decreased SLR
- can't touch toes
4. Triceps Surae
- ankle equinus
- tiptoe gait
Silverskiold test
- distinguish between the gastrocnemius and soleus
- test ankle DF range with knee flexed and extended
- if gastrocnemius tight, reduced DF with knee extended
On side
5. Iliotibial Tract
Obers' test
- patient on side and flex knee with hip in neutral abduction then as flex knee further hip abducts
Prone
6. Quadriceps
- stiff leg gait
- inability to flex knee with hip extended suggests tight rectus
Ely test (RF)
- child prone
- when the knee is flexed the hip flexes suggesting tight RF
7. Rotational profile
Tone
Increased / clonus / clasp knife
Reflexes
Increased
Primitive Reflexes
Moro
- child supine in arms, allow head to drop back
- arms & legs stick out in extension
- disappears by 4 months
Parachute
- arms and legs extend when child held prone
- appears at 5 months
Labyrinthine
- tone reduced & arms/legs flex when prone but increased tone & extended arms & legs with supine position
Upper Limbs
General
- resting position
- contractures
- joint stability
Hand placement
- ability to place hand in space
- < 10 seconds
Stereognosis
- ability to identify ojects in hand without looking