As most of you know I have found great success in my practice
using Diagnostic Motion Evaluation (DME) and the ARMS technique, there are
occasion where I am amazed by what I find and the result in my patient's range of motion when I apply both
techniques. I was particularly surprised by this result as the patient has neurological tone secondary to Cerebral Palsy.
The following is an example of the power of (DME), I can say with
certainty that I would not have fathomed that restriction in the big toe would
have such an impact on open chain dorsiflexion as it did with this patient.
I had been working with a woman who was born with a mild case of
Cerebral Palsy. Upon my most recent evaluation of her walking, I
determined that we need to work on Open Chain Dorsiflexion on her affected
side. Her primary therapist and I filmed her performing Bilateral AROM
Dorsiflexion in the open chain. The film can be found at:
We also measured goniometrically, AROM to be lacking 24 degrees
Dorsiflexion on her R. ankle.
Because of the tone in her foot and ankle, her primary therapist
and I were dubious about what if any AROM we could achieve. Keeping with the
principles of Diagnostic Motion Evaluation I tested PROM going from Distal to
Proximal beginning with the distal hallux (big toe). I found that there were structural
restrictions there and treated with ARMS, I continued to evaluate and treat the
hallux for a few minutes, no longer than 3, this was the result.
To see before and after side by side copy and paste this link www.sigproed.com/res_before_after.html#neuropatient_dorsifexion
FULL ACTIVE DORSIFLEXION RIGHT EQUAL TO LEFT WITH
MOBILIZATION ONLY TO THE HALLUX!!
This caused me to ponder how to differentiate between
palpating tone and structural dysfunction. I came up with the following
differences:
- Structural Restrictions will be point tender, tone will not
- Tone may elicit clonus, structural restrictions will not
Her next goal is to be able to achieve open chain ankle
circles. Stay tuned, I will be posting her 2 week follow up next week.
