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Physical Therapy Examination and
Assessment
Antje Hueter-Becker
Physical Therapy Teacher
and Physical Therapist
Neckargemünd, Germany
Mechthild Doelken
Physical Therapist
School for Physical Therapists
Mannheim, Germany
360 illustrations
Thieme
Stuttgart · New York · Delhi · Rio
Library of Congress Cataloging-in-Publication Data is available from the publisher.
This book is an authorized translation of the 2nd German edition published and copyrighted 2011 by Georg
Thieme Verlag, Stuttgart. Title of the German edition: Untersuchen in der Physiotherapie.
Translator: Stephanie Kramer, Berlin, Germany
Illustrator: Martin Hoffmann, Elchingen, Germany
© 2015 Georg Thieme Verlag KG
Thieme Publishers Stuttgart
Rüdigerstrasse 14, 70469 Stuttgart,
Germany, +49 [0]711 8931 421
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Contents
Preface
Contributors
1 The Physical Therapy Process: Examination, Clinical
Reasoning, and Reflection
Elly Hengeveld
1 The Physical Therapy Process: Examination, Clinical Reasoning, and
Reflection
1.1 The Physical Therapy Process
1.1.1 The Physical Therapy Examination
1.1.2 Paradigms in Physical Therapy
1.1.3 Physical Therapy Diagnosis
1.2 Clinical Reasoning as Part of the Physical Therapy Process
1.3 Critical Phases in the Physical Therapy Process—Reflection Phases
1.3.1 Goals of Physical Therapy Examination Procedures
1.3.2 Assessment
1.3.3 Initial Assessment
1.3.4 Reassessment
1.3.5 Assessment During the Application of Treatment
1.3.6 Reflection after Two to Three Sessions
1.3.7 Retrospective Assessment
1.3.8 Final Analytical Assessment
2 Examination of Structures and Functions of the Locomotor
System
2 Examination of Structures and Functions of the Locomotor System
2.1 Testing Structures
2.1.1 Joint Measurement According to the Neutral Zero Method
BarbaraTrinkle
2.1.2 Tests of Muscle Function
BarbaraTrinkle
2.1.3 Body Mass Index (BMI)
Jan Cabri
2.1.4 Measurement of the Skin Folds
Jan Cabri
2.1.5 Examining the Joint and the Surrounding Structures
Mechthild Doelken
2.1.6 Integration of Peripheral Nerves in the Examination of the Locomotor
System
Brigitte Tampin
2.2 Testing of General Functions
Jan Cabri
2.2.1 Amundsen’s Ordinal Scale for Activities of Daily Living (ADL)
2.2.2 The Functional Status Index (FSI)
2.2.3 The Roland-Morris Questionnaire
2.2.4 The Barthel Index
2.2.5 Functional Performance Evaluation (FPE)
2.2.6 Hand-held Devices (HHD)
2.2.7 Isokinetic Dynamometry
3 Examining Posture and Muscle Balance
Salah Bacha
3 Examining Posture and Muscle Balance
3.1 Posture
3.1.1 Static Posture
3.1.2 Posture and Gravity
3.1.3 Posture and the Sensory System
3.1.4 Posture and Bone Loading
3.1.5 Posture and the Rotary Moment of the Joints
3.1.6 Posture and Muscle Adaptation
3.2 Diagnosis
3.2.1 Idealized Posture as a Reference
3.2.2 Examination of Posture
3.2.3 Observational Parameters for Assessing Joint Position
3.2.4 Dynamic Posture
3.3 Musculature
3.3.1 Basic Principles
3.3.2 The Tasks of the Myofascial System
3.3.3 Functional Classification of the Musculature in the Myofascial System
3.3.4 Response to Dysfunction
3.3.5 Sources of Dysfunction
3.3.6 Interpretation of Posture
4 Pain as the Chief Symptom
Mechthild Doelken
4 Pain as the Chief Symptom
4.1 Theoretical Foundations of Pain as a Chief Symptom
4.1.1 Definitions
4.1.2 Pain Perception
4.1.3 Classification of Pain
4.1.4 Causes of Pain
4.1.5 Nociceptors
4.1.6 Transmission of Pain Impulses
4.1.7 Behavior Strategies at the Level of the Therapist–Patient Relationship
4.2 Physical Therapy Examination of Patients Whose Chief Symptom is
Pain
4.2.1 Patient History
4.2.2 Documentation of Pain History
4.2.3 Movement Behavior
4.2.4 Symptoms of Altered Tonicity Affecting the Musculature
4.2.5 Nociceptive Receptor Pain from the Structures of the Locomotor System
4.2.6 Neuroanatomy of the Peripheral and Spinal Nerves
4.2.7 Pain Measurement (Algesimetry)
5 Examining Cardiopulmonary Functions
5 Examining Cardiopulmonary Functions
5.1 Respiration—Examining the Pulmonary System
Petra Kirchner
5.1.1 Useful Information on Breathing
5.1.2 Sample Examination Scheme
5.1.3 Examination Steps
5.1.4 Example of Examination
5.2 Examination of Cardiac Functions
Andreas Fruend
5.2.1 How Can You Determine Cardiac Capacity and Adaptability?
5.2.2 Preparing the Examination
5.2.3 Examining Objective Criteria
5.2.4 Examining Subjective Criteria
5.2.5 Evaluation
Appendix
Subject Index
Preface
“Physiotherapy without careful examination is like a tree without roots.”
Often—almost always in Germany—a patient is referred for or “prescribed”
physical therapy by a doctor following a medical diagnosis. The physical
therapist should certainly scrutinize this biomedical diagnosis but under no
circumstances can the diagnosis replace the physical therapist’s own careful
examination. That is to say, only the examination can accurately define this
particular patient’s individual combination of symptoms, their intensity and
expression.
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 customary in clinical medicine, they
also base their intervention on a biopsychosocial view such as that expressed in
the International Classification of Functioning, Disability, and Health (ICF). 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? 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.”
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 re-
examination becomes necessary. For the therapist who is still learning, this is too
ambitious—he or she must first learn and practice the steps and techniques of
careful physical therapeutic diagnosis, just as he or she also learns and practices
the steps and techniques of the therapeutic process. Then, with increasing
practice and experience, he or she will be able to bring them both into line and
structure the transitions smoothly.
The contents of this book contribute to this gradual development of
