1. Principles of the Physical
Examination
Robert Freeman

2. Why do a Physical Exam?
• Allows interpretation of gait data
• Check outputs from gait data
• Place the data in context
Pelvic Obliquity
25
-25
Up
Down
deg
Hip Ab/Adduction
20
-20
Add
Abd
deg
Pelvic Rotation
40
-40
Int
Ext
deg
Hip Rotation
60
-60
Int
Ext
deg

3. What do we Measure?
• Joint Ranges
– Muscle lengths
– Capsular tightness
• Bone version / deformity
• Strength
• Selective Control
• Evidence of Neurology (spasticity, dystonia…)
• Essential core data set and tailored tests

4. Who does the Exam?
• Appropriately trained clinician
• Assistant

5. Training
• CMAS standards
3 The laboratory must keep a log for each staff member containing,
a) The identity of any professional registration body, along with the
registration number
b) Evidence of gait laboratory induction training for new staff…
c) Annual update of repeatability measures (where applicable).
4 Repeatability testing is required:-
a) For each test carried out by the clinical movement analysis service
where clinical judgment is required

6. RJAH Repeatability
• Reduced set of
– Clinical examination (JB, WB, KE, NE, RF, SJ, AR)
• Hip Ab/Add, Pop ang, In/eversion, Anteversion, Staheli,
BMS

7. Hip Abduction Hip Adduction Anteversion Staheli
SJ 30.0 20.0 15.0 -10.0
NE 25.0 20.0 5.0 -5.0
JB 25.0 20.0 5.0 0.0
WB 35.0 20.0 10.0 -10.0
KE 25.0 20.0 5.0 0.0
APR 25.0 30.0 10.0 -10.0
RF 30.0 20.0 5.0 0.0
Mean 27.9 21.4 7.9 -5.0

8. Popliteal Angle Leg Length BMA Inversion Eversion
SJ 35.0 80.6 35.0 10.0 0.0
NE 30.0 82.0 30.0 10.0 0.0
JB 25.0 81.0 35.0 25.0 0.0
WB 40.0 80.0 30.0 20.0 -5.0
KE 20.0 82.5 30.0 10.0 0.0
APR 25.0 82.0 30.0 30.0 0.0
RF 25.0 83.0 25.0 15.0 10.0
Mean 28.6 81.6 30.7 17.1 0.7

9. Goniometry

11. Muscle length
• Muscles that cross single joint
– How much force
• Biarticular muscles
– Stabilise one joint measure other
– To determine if capsular tightness or muscle,
stabilised joint should allow max ROM.

14. Muscle Strength
• 0 none
• 1 flicker
• 2 gravity eliminated
• 3 against gravity
• 4- some resistance
• 4 moderate resistance
• 4+ Submaximal movement against resist
• 5 full strength

15. length
force
0° 135°
Strength

16. Tone / Spasticity
• Modified Ashworth
– What speed
– 0, 1, 1+, 2, 3, 4
• Modified Tardieu Test
– Record an angle
– Slow movement length
– Fast movement spasticity

17. Selectivity
• Selective Control Assessment
– 0 Unable
– 1 Impaired
– 2 Normal

19. Standing / Walking

20. Supine

21. Hip

22. Hip
• Extension

23. Hip Adductors

24. Knee
• Popliteal angle
• Patella alta
• Lag

25. Ankle
• Silfverskiöld test
• Clonus, catch

28. Subtalar inversion / eversion

29. Subtalar Complex
• Inv + N - 0 - N + Eve
• Inv + N - 0 - N + Eve
• Inv + N - 0 - N + Eve
• Inv + N - 0 - N + Eve

30. Prone

31. Duncan Ely

32. Hip Version

33. Tibial Version
• Bimalleolar axis

34. Hind Foot Forefoot

35. Sitting

36. Confusion Test