Examination methods in rehabilitation, 6.12.2021
Mgr. Veronika Mrkvicová, Ph.D.
Physiotherapy departement, MF MU
The conclusion

Introduction
•At the core of each new patient meeting in any physical therapy setting is the patient
examination. This is the first component in a cycle that includes the entire physical therapy
episode of care
•The patient examination consists of:
•the patient history (the informations relevant to the patient’s condition are gathered. The
physiotherapist begins to formulate hypotheses about the patient’s condition)
•a systems review (a brief assessment of the cardiovascular/pulmonary, integumentary,
musculoskeletal, and neuromuscular systems, the patient’s cognitive, language and learning
abilities)
•tests and measures (selected based on hypotheses formed during the history-taking process and
findings during the systems review)

Patient assessment
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Patient assessment
•Often a patient is referred for a “prescribed” physical therapy by a medical doctor following a
medical diagnosis
•The physical therapist should certainly analyze this biomedical diagnosis but under no
circumstances can the diagnosis replace the physical therapist’s own careful examination
•Only the physiotherapist´s examination can accurately define this particular patient’s individual
combination of symptoms, their intensity and expression (physiotherapy diagnosis)

Patient assessment
•If the physiotherapists examination is thoughtful, purposeful, skilled, and efficient, forming
evaluative opinions and making decisions about, a patient’s care plan should not be difficult
•If the examination is lacking in quality or substance, then the evaluation, care plan, and
possibly the patient’s outcomes may suffer
•What separates experienced physiotherapist from beginner physiotherapist is the ability to apply
knowledge and skill, in conjunction with the ability to intuitively alter the examination or
intervention based on self-reflection, prior experience, and individual patient characteristics

Patient assessment - overview
•Patients history
•Present illness
•Medical history
•Family history
•Social history
•Sport history
•Rehabilitation history
•Medications
•Physiological functions
•Allergies
•Abusus
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Patient assessment - overview
•Pain analysis
•Intensity, location, quality, onset, duration, alleviating and aggravating factors
•VAS
Visual Analogue Scale | Yale Assessment Module Training

Patient assessment - overview
•Physical examination
•Overall aspection
•Body type
•Temperature
•Heart rate and breathing rate
•Blood pressure
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•Neurological examination
•Cognitive functions
•Motor exam and reflexes
•Sensitivity exam
•Special tests

Patient assessment - overview
•Range of motion (ROM)
•Upper limbs
•Lower limbs
•Spine
•Normal/decreased/increased ROM (hypermobility)
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Patient assessment - overview
•Muscle strength testing
•Muscle shortness testing
•Movement pattern testing

Patient assessment - overview
•Muscle tone testing


Patient assessment - overview
•Functional evaluation
•Balance
•Coordination
•Gait

Patient assessment - overview
•Activity limitations and participation restrictions
•Mobility
•Transfers
•Balance
•ADL (activities of daily living)
•The use of assisted devices

Patient assessment - overview
•Conclusion and main findings
•Environmental and personal factors
•Body structure and function impairments
•Activity limitations and participation restriction
•

Patient assessment - overview
•Treatment plan (short and long term)


Musculoskeletal assessment
•Posture assessment – standing/sitting posture, single leg stance posture (body proportions,
alignment of body parts, muscle contours, condition and creases of the skin)
•Palpation (bony tissues – alignment and position, and soft tissues – temperature, consistency,
pain)
•ROM assessment
•Muscle assessment – strength, length
•Movement patterns, gait, functional evaluation

Musculoskeletal assessment
•The focus of observation is not only on objectively verifiable data and dysfunctions, but also on
the significance of these dysfunctions for the patient’s quality of life and living conditions
•
•In other words, physical therapists not only adhere to the rules of biomedical thinking frequent
in clinical medicine, they also base their intervention on a biopsychosocial view (such as that
expressed in the ICF (= International Classification of Functioning, Disability, and Health)
•
•Just as important as the extent to which movement is restricted, and how this restriction could be
reduced or even resolved, is the issue of everyday activities for which the patient urgently
requires unrestricted movement
•
•Does restriction mean incapacity for employment or is it, despite being inconvenient, of secondary
importance to quality of life?

Musculoskeletal assessment
•The motivation and cooperation of the patient are influenced quite decisively by such subjective
factors and finding out about them is therefore an indispensable step in the examination and
treatment process
•
•All this applies equally, if not even more so, if the patient accesses the physical therapist
directly without a referral or “prescription.”
•

Musculoskeletal assessment
•The experienced therapist succeeds in maintaining a constant interplay between the examination and
treatment process because the results of the one determine the form of the other, and at certain
points of the treatment a reexamination becomes necessary
•
•For the therapist who is still learning (= student), this is too ambitious – student first learn
and practice the steps and techniques of careful physical therapeutic diagnosis, just as the
student also learns and practices the steps and techniques of the therapeutic process
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•Then, with increasing practice and experience, the physiotherapy student will be able to bring
them both into line and structure the transitions smoothly

Conclusion
•a physical therapeutic diagnosis is a prerequisite for treating patients individually and
effectively in order to help them to enjoy the best possible participation in life in the best-case
scenario
•careful examination ensures that treatment starts with the patient’s main problem, takes advantage
of the patient’s own resources and—in the best-case scenario—leads to the intended result

Thank you for your attention
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•“Physiotherapy without careful examination is like a tree without roots.”
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