I stress in my class to focus on what the patient cannot do functionally to guide your evaluation and treatment by asking “What activity or activities do you have difficulty performing”.
This is beneficial for the following reasons:
1. We now have functional goals which are vital for insurance reimbursement
2. We now can break the activity down into its components and determine where the dysfunction is and what type of dysfunction exists.
3. As a result we will be able to provide the appropriate treatment to restore function.
I was recently given such a case study and asked to evaluate and treat the following functional limitations.
- Patient is unable to negotiate stairs
- Patient is unable to balance on one foot to don clothes
Significant patient history is the following:
- Total toe replacement over 5 years ago on the R.
- Trendelenberg gait on the right
When we observe this patient we notice the following:
- Bilateral pronated feet
- Right hallux extension, approximately 3 degrees in neutral
- Diminished push off phase of gait.
My evaluation will be as follows: There are u-tube links next to the various evaluations
- For negotiating stairs I will evaluate:
- ROM of dorsiflexion with the knee bent in stepping (going up and going down). The knee should come forward over the toes. Going up: http://www.youtube.com/watch?v=-3JxExXQKM0&feature=relmfu Going down: http://www.youtube.com/watch?v=KMCieNrpwfo
- Pelvic Depression with the leading leg on descending stairs, it should drop 2 inches:http://www.youtube.com/watch?v=047nRKXzBpw&feature=relmfu
- Hamstring Contraction. You should feel a contraction with your hand. http://www.youtube.com/watch?v=JEyM4as3YRQ&feature=relmfu
- For Single leg Balance I will evaluate:
- PROM of the hallux to neutral
- AROM of the hallux in flexion
- Observing where motion occurs (motion = instability) Single leg balance
