static assessment

Members do not see these Ads. Sign Up.

:sinking:
please forgive a second year student for asking:

why dont we ask patients to wiggle their toes and show a range of movement with their feet (to show relevant motor skills) as standard?

or would this not be 'allowed' in static assesment because it is dynamic in nature?

 

Hi Jane

As no one has answer you and I´m waiting on some plastic to heat up.......

What does wiggling the toes tell you ? - Not much

It does not really address Range of motion as how do you determine in degrees the measurement, then you need to define normal from your wiggle test and then .... Well as you can see it starts getting more and more complex.

But it does bring up an important point for you to think about, ROM is not really that important - Stiffness in a direction is. I could get any joint to move X degrees with enough force, maybe destroying the joint forever - but the point is this we should be considering Joint stiffness in a direction of all joints, but then it gets complex again.

But the wiggles test or all testing you perform should have a purpose, the wiggles test I don´t see the purpose.

Good luck with the studies and hope that the above helps

 

Your question is a bit confusing in that there are two different ways to interpret it. Is the question, is this test static of dynamic; or is the question should this test be done at all.

I don't care if it's static or dynamic.

I could see using this test as quick motor assessment and I actually have asked patients to do it when it would help establish a diagnosis. If they can wiggle their toes there are a lot of things that are intact (motor neuron, muscle, tendon, and joint. And arguably some cognitive function.) If it's not intact, you then have to figure out what is wrong.

I don't use the test that often. As with any test, the result should change what you do. In this case, if they are unable to wiggle their toes, I would do a lot more work up. If you are going to do muscle strength testing anyway, there is not much point in asking them to wiggle their toes.

Hope that helps.

Eric

 

Do you really need to ask your patient to wiggle their toes to see if they can wiggle their toes? You should be able to see that when they are taking off shoes and socks/pulling the fluff from between their toes and depositing on your clinic room floor before stating helpfully that they have put on new socks and washed their feet especially for coming to see you.

Ok, I'm drifting off topic a bit but I nearly always insist on watching the patient walk in and watch them take off their shoes and socks etc. You'd be amazed at how much information you get from just watching. Saves you asking non essential information.

I'm not sure what a static assessment is and, to be honest, I'm not sure what value there is in segregating the different types other than for ease of documentation/reporting. Like Mike said, the test has to tell you something or it's not worth doing. Whether it is static or dynamic is irrelevant to how you prescribe.

Think on this. What tests actually alter your prescription?

Robin

 

The question stems from an essay i am required to write, to discuss how much diagnostic information can be gained from a couch (Range of movement assessment - based on peer publications) and purely a patient standing assessment ........I am asked to discuss what these clues can tell me about the patients gait- without seeing them walk.
I have finished my essay and in it spoke about callus distribution, foot deformities, hips, leg length discrepancy, wear and crease markings on footwear, Hallux function ect..... however whilst i was writing i was struck by the peer publications .....they seem to consider manual range of movement as 'available' but dismiss the possibility of the patients inability to mobilise their own digits......how then is this range of movement? Thank you to everyone who replied x

 

That make a bit more sense now . What might have been a more interesting answer, for the sake of brassing off your lecturers might have been to say that they might give some clues to how a patient might walk, but what is the point when you can just make them walk and then observe that.

The only thing you can say with a reasonable degree of certainty is that the things you have assessed on the couch exists(in your opinion). Whether they will have a prescribed effect on gait according to what you might have been taught is anyones guess.

Here's an example. You assess the range of ankle dorsiflexion of a given patients foot on the bed. Measured with a goniometer, it is +5 degrees with the knee extended. HOw hard did you push. Might you push as hard as the next practitioner. Perhaps the next practitioner is a bit wimpy and when they push up they meet resistance earlier and say that the patient actually only has -2/3 with knee extended(we'll not get on to margin of error)

Your conclusion might be that you feel the patient has normal range of talo crural range of motion and should have normal sagittal plane progression throughout stance phase. Your colleague, on the other hand, determines that the same patient that he has statically assessed on the couch might display some early heel rise or compensatory pronation as a result of the tight gastro soleus musculature.

What you end up with is compounded error based on assumptions and errors in measurement. The question then is, what can you do with that ankle joint range of motion information that you, or your (mythical)colleague has correctly/incorrectly assessed.

Does it relate to the problem that the patient presents with?

Does it/should it have the ability to affect your prescription?

Is there a more valid test that might give more information/be correlated with pathology? But correlation is not causation so you have to be careful even with that.

With regards to wiggling toes, it sounds more like a discrepancy between range of motion passively and actively? Again, it is not something I would test routinely. If I thought it might be relevant, I might look at it.

One final thing and I'll get off my soap box. When it comes to biomechanics assessments, why do universities continue to make assessments of normal subjects and assessing arbitrary measures for the sake of assessing them. Why not concentrate on pathology and things that you might expect to see in a foot that has a given pathology and the reason why you might see it, what forces acting on the foot would lead to such a pathology and how one would reduce the pathological forces. I wish I could go back 10 years and have someone ask me the same question. It would have saved me 7 or 8 years blindly stabbing in the dark to find reasons why what I was assessing didn't make any sense and may not relate to the pathology.

Phew! Right, I'm done

Cheers

 

thank you for your help and comments x

 

Funny thing I know do more " measurements" than I did 12 months ago.

While they are not degree and mm measurements I spend more time recording findings both weight bearing and non weight bearing - almost all to do with stiffness " measurements " and almost useless to anyone else - but I work alone and make my own devices and organise most of my treatment plans for patients so see the benefits to patients.

I think the whole measurement debate has 2 issues

1. Are they useful and change treatment prescription values ie not just a device but treatment - yes but not all measurements and not for compared to ´normal ´whatever that is.

2. Do measurements taken with a goniometer or feel have any value to another person who assesses the patient - Goniometer - no, Feel measurements as in describing felt muscle imbalance and stiffness - yes, but only as in - I noted a imbalance or increased or decreased stiffness at ......

And I believe these " measurements" help to show why tissue is stressed and change treatment prescription values as I don´t think treatment is all about an orthotic device in a shoe, part of the treatment plan sometimes

 

Mike, I couldn't agree more - for me the "measurement" of stiffness is more important than anything else. So in effect, I am always looking at quality of movement as opposed to range. I neglected to say any of this in previous posts as (with all due respect to the OP) the OP is a student and stiffness is a tough concept to get a hold of at the best of times, let alone when in second year at uni.

In addition, change of prescription does not always refer to the device in my case. It could be anything from advice to strengthening ex's or nerve glides.