Examination

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