clinical and experimental diagnostics

CLINICAL AND EXPERIMENTALCLINICAL AND EXPERIMENTALDIAGNOSTICS DIAGNOSTICS

IN KINEZIOLOGY AND PHYSIOTHERAPYIN KINEZIOLOGY AND PHYSIOTHERAPY

KristkováKristková Veronika , BCVeronika , BCMíková Marcela, MAMíková Marcela, MA

Basic vital function – respiration, feeding etc.

Postural system

Locomotor system

Motor skills, Manipulation

Communication

EntryEntry for for diagnosticsdiagnostics ��MOVEMENTMOVEMENT

MOVEMENTMOVEMENT ��logisticslogistics + + excitabilityexcitability ofof neuronsneurons + + posturalpostural settingssettings + + maintainingmaintaining ofof orientatedorientated postureposture in in gravitygravity + + smoothsmooth changeschanges ofof posturepostureduringduring movementmovement + + automatisationsautomatisations ofof stereotypicalstereotypical movementsmovements andand theirtheircontrolcontrol + + generationgeneration ofof alternativealternative schemasschemas (by (by unpainfullunpainfull nociceptionnociception) ) �� targettarget, , tasktask orientatedorientated movementmovement

Véle, 1997

ASSESSMENT OF MOVEMENTS

StrengthROM Coordination

StructureFunction

Posture

�� jointsjoints�� ligamentsligaments�� musclesmuscles�� fasciasfascias�� skinskin

�� musclemuscle -- MUMU�� PNSPNS�� CNSCNS

Power

�� CP CP fcnfcn�� ANSANS

Tone Stability

DIAGNOSTIC METHODSDIAGNOSTIC METHODS

Art of observation

Art of palpationAspectionAspectionPalpationPalpation

AnamnesisAnamnesis

TestingTesting, , measurementmeasurementQuestionaryQuestionary, , scalesscales

EMPIRICSUBJEKTIVE ???

KinesiologicalKinesiological researchresearch

OBJECTIVE ?!!

MUSCLE TESTINGMUSCLE TESTING001 1 –– musclemuscle jerkjerk2 2 –– movementmovement „„withoutwithout gravitygravity“, „“, „withoutwithout weightweight““3 3 –– fullfull ROM ROM againstagainst gravitygravity4 4 –– againstagainst moderatemoderate resistanceresistance5 5 –– fullfull ROM, ROM, againstagainst maximalmaximal resistanceresistance

? ? –– standard standard conditionsconditions, , subjectivesubjective, , onlyonly anatomicalanatomical planesplanes, , mostlymostly in in supinesupine positionposition, not , not suitablesuitable andand not not sufficient sufficient for for centralcentral disordersdisorders ofof movementmovement

KendallsVl. Janda

CLINICAL METHODSCLINICAL METHODS

GoniometryGoniometry--anatomicalanatomical planesplanes -- SFTRSFTR--goniometergoniometer--assessmentassessment ofof functionalfunctional ROMROM

S: 30 S: 30 –– 0 0 –– 180 180 S: S: extext –– 0 0 –– flxflxF: 180 F: 180 –– 0 0 –– 40 40 F: F: abdabd –– 0 0 –– addaddT (R): 90 T (R): 90 –– 0 0 –– 90 90 T(R): ER T(R): ER –– 0 0 –– IR …IR …

? ? –– ±± subjektivesubjektive, ROM , ROM onlyonly in in anatomicalanatomical planesplanes, , mostlymostly in in supinesupine positionposition

AntropometryAntropometry-- circumferencecircumference-- lenghtlenght


ExaminationExamination ofof manualmanual medicinemedicine

-- conceptconcept ofof barriersbarriers for for differentdifferent tissues tissues -- specialspecial technicstechnics for for examinationexamination ofof jointsjoints –– activeactive and and passive movementspassive movements x x jointjoint playplay-- palpationpalpation ofof slideingslideing andand reactivityreactivity ofof soft soft tissuestissues ––skin, skin, subcutissubcutis, , fasciasfascias, , musclesmuscles

LewitRychlíkováHoppenfeld


Examination of Examination of motor motor skills in the skills in the 11stst year of lifeyear of life

-- „A „A brainbrain expressesexpresses itselfitself throughthrough motor motor skills skills “ “ ((examinationexamination ofof motor motor skillsskills inin thethe 11stst yearyear ofof lifelife matchesmatches to to levellevel of of CNS maturity) CNS maturity) -- examination of spontaneous postural activityexamination of spontaneous postural activity-- examinationexamination ofof posturalpostural reactivityreactivity –– 7 7 positionposition tests tests -- Dg. Dg. –– threatthreat ofof movementmovement developmentdevelopment ((centralcentral coordination coordination

disorderdisorder, CCP, …), CCP, …)

VojtaCLINICAL METHODSCLINICAL METHODS

QuestionaresQuestionares –– ScalesScales –– IndexesIndexes


IMPAIRMENT DISABILITY HANDICAPImpairment – related to structure – haematom, ischaemie, fracture, visceral, neuromyosceletal…Disability – disability in performance, communication, personalcare, locomotion, dexterous…Handicap – handicap in orientation, physical self – sufficiency(ADL), employing, social integration…

Assesement of independance, mobility, possibility of employment, social integration, economical independance, prognosis – IDH scale 0-9

FIM – Functonal Independence Measure (1987, USA)

MMSE – Mini Mental State dle Folsteina

PULSES (1957) – FHDSVP (Moskowitz)

KATZ (1963)

BARTHEL INDEX (1965)

KENNY (1965), RAP

BARTHEL INDEX

Activity Score

Feeding0 = unable5 = needs help cutting, spreading butter, etc., or requires modified diet10 = independent

0 5 10

Bathing0 = dependent5 = independent (or in shower)

0 5

Grooming0 = needs to help with personal care5 = independent face/hair/teeth/shaving (implements provided)

0 5

Dressing0 = dependent5 = needs help but can do about half unaided10 = independent (including buttons, zips, laces, etc.)

0 5 10

Bowels0 = incontinent (or needs to be given enemas)5 = occasional accident10 = continent

0 5 10

Bladder0 = incontinent, or catheterized and unable to manage alone5 = occasional accident10 = continent

0 5 10

Toilet Use0 = dependent5 = needs some help, but can do something alone10 = independent (on and off, dressing, wiping)

0 5 10

Transfers (bed to chair and back)0 = unable, no sitting balance5 = major help (one or two people, physical), can sit10 = minor help (verbal or physical)15 = independent

0 510 15

Mobility (on level surfaces)0 = immobile or < 50 yards5 = wheelchair independent, including corners, > 50yards10 = walks with help of one person (verbal or physical) > 50 yards15 = independent (but may use any aid; for example,stick) > 50 yards

0 51015

Stairs0 = unable5 = needs help (verbal, physical, carrying aid)10 = independent

0 510

TOTAL (0 - 100) ________

Patient Name: __________________ Rater: ____________________ Date: / / :

INSTRUMENTAL INSTRUMENTAL METMETHHODODSS

Expectations ?- help at diagnostics- solving of kineziological questions- participation in therapy- assesement of therapy efficiency- comparison of various approaches of therapy- more objective documentation

INSTRUMENTAL EXAMINATION METHODSINSTRUMENTAL EXAMINATION METHODS

Kinematic Dynamic Others • videographic method

(kinematic analysis) • goniometry • accelerometry • measuring of time

parametres • speedometry

• dynamometry • dynamography • pedobarography

• EMG,SEMG • X - rays • NMR • CT • Moire • Virtual reality • Tapping

MethodsMethods ofof kinesiologicalkinesiological researchresearch

M. Janura, 2002

3D (spacial)

2 video cameras(at least)

2D (plane)

1 video camera X

Videographic examination methodVideographic examination method

Movement record → digitalisation of the record (defining of selectedpoints position, 2D) → transformation of coordinates (3D) → basiclenght and angle characteristics.

M. Janura, 2002

KINOGRAMS (sagital plane)

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Murcková P. et al., KBTK FTK

EXPORTS:EXPORTS:-- componentscomponents ofof groundground reactionreactionforceforce (GRF) (GRF) FxFx, Fy, , Fy, FzFz-- momentsmoments MxMx, My, , My, MzMz

TENSOMETRIC FORCE PLATES TENSOMETRIC FORCE PLATES

SDx

SDy

[cm]

[cm]

AREA

Confidentellipse

COPCOP - center of pressure=> position data COP (x, y) => set of COP (1000 Hz)=> 95%95% ellipse ofellipse of confidenceconfidence

COMP. DYNAM. POSTUROGRAPHY COMP. DYNAM. POSTUROGRAPHY –– NeurocomNeurocom**diagnosticaldiagnostical andand therapeuticaltherapeutical modul*modul*

Principle of SEMG

•• IndicationIndication musclemuscle activationactivation / / deactivationdeactivation ~~ TIMINGTIMING•• MagnitudeMagnitude ofof electricalelectrical activityactivity ofof musclemuscle ~~ correlation correlation

STRENGTH STRENGTH –– SEMG SEMG signalsignal•• ApplicationsApplications ofof SEMG SEMG –– as a as a fatiguefatigue indexindex

SURFACE ELEKTROMYOGRAPHYSURFACE ELEKTROMYOGRAPHY

INTERFERENCE PATTERNINTERFERENCE PATTERN�� sumationsumation AP AP ofof many MU + many MU + theirtheir interference interference

Application

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DIAGNOSTIC DIAGNOSTIC ofof CLINICAL KINESIOLOGYCLINICAL KINESIOLOGYExperienceExperience, , practice practice + + ClinicalClinical research research

= EFFECTIVE THERAPY= EFFECTIVE THERAPY

clinical and experimental diagnostics

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