Fundamentals of Examination in Physiotherapy

By Klejda Tani

"The Fundamentals of Examination in Physiotherapy" book provides a comprehensive, systematic guide to the examination, assessment and clinical reasoning processes needed by clinicians when managing patients with musculoskeletal and neurological conditions. It is designed for physiotherapy/manual therapy students and their teachers but is also ideal for those in the first years of their practice as an educational support for patient assessment. Also, students and practitioners of massage therapy, osteopathy, chiropractic, sports medicine, athletic training, and fitness instruction.

 

This book is divided into 6 chapters, which are introduction to:

 

1. General examination such anamnesis and vital sign examination. 
2. Static postural assessment and observation. Detailed procedures are explained for executing postural assessments from standing posterior, lateral, and anterior views.
3. Anthropometry and somatometry where you will learn the principles of the anthropometric measurements needed in the practice.
4. Dynamic postural assessment, where you will learn gait examination and detailed evaluation of the spine movement
5. In the Goniometry chapter you will learn the normal range of motion for each movement and joint, patient positioning, goniometric alignment, goniometric positioning, and measurement rules.
6. Neurological examination, such as cranial nerve examination, examination of the reflexes, cognitive function examination and sensitivity examination.

 

"The Fundamentals of Examination in Physiotherapy" is a very detailed book that succinctly breaks down the procedures and guides to an excellent and well-practiced examination of a patient by physiotherapists.

 

1. Provides a logical approach to patient examination to enhance clinical reasoning
2. Templated step-by-step sequence of illustrations and text creates an accessible tool for use in teaching and practice
3. Many photographs visually demonstrate techniques while enhancing descriptions in the text
4. Provides precise and concise explanation of all the content which is necessary for a strong foundation for practical and clinical assessments
5. The content of the book compiles and covers the practical curriculum of assessment in various universities.
 

• Language: English
• Publisher: Klejda Tani
• Release date: Sep 18, 2022
• ISBN: 9798215012970

Klejda Tani

Klejda Tani PhD graduated from Charles University in Prague, Czech Republic, where she studied both "Bachelor" and "Master of Science" degree in the field of Physiotherapy. She completed her Doctorate studies in Physiotherapy at the University of Medicine. She is part of the academic circle at various universities in Albania and Europe. Klejda is the founder of the digital training platform www.onlinelearncourses.com and the professional center TREKA, where she is a trainer in various professional courses in the field of physiotherapy.

Book preview

1. GENERAL EXAMINATION

The fundamental for determining a therapeutic program is the assessment of the patient's clinical symptoms. During the physiotherapeutic examination, we are mainly based on the patient's symptomatology, which can be cured or improved with physiotherapeutic techniques.

1.1 ANAMNESIS

Anamnesis is the process of collecting information from the patient. This information helps the physiotherapist in his/her clinical reasoning, to find the diagnosis or to understand the patient's clinical condition and to cure it.

As in other fields of medicine, in the physiotherapeutic assessment, the diagnosis of functional disorders of the locomotor system is initially based on anamnesis. Details of the anamnesis, obtained during the questions asked to the patient, are an integral and inseparable part of the clinical examination that follows.

With the development of diagnostic techniques for determining any diagnosis in medicine, it is thought that anamnesis is not so important, but according to various literature, it is said that in more than 50% of patients, the cause of the disease is found only during anamnesis questions. The information obtained from the anamnesis is extremely important when determining the cause of a patient's symptoms.

When asking questions during the anamnesis, we focus on the circumstances of the origin of the symptoms (e.g., lifting a heavy weight, trauma, etc.) and the continuity of the symptoms, especially information, which is based on the pain felt by the patient (pain at night, the character of pain, distribution of pain, etc.). During the anamnesis, we also get information about the social and family situation, employment, the difficulties the patient faces in relation to his current problem, etc.

At the beginning of the history (anamnesis) taking, the physiotherapist should always be the first to introduce himself to the patient, acting ethically and showing respect to him. Much attention should also be paid to the physical distance between the patient and the physiotherapist, which should not be too close or too far apart. The environment where the anamnesis is performed should be personal so that the patient has individual treatment. And the annoying presence of relatives, who can influence the anamnesis, should be avoided (this is excluded in pediatric patients).

During the anamnesis, the questions must be clear, understandable, simple and with a defined goal so that the patient is confident in his answers. The time of taking the anamnesis should be sufficient so that the patient can make a complete description of his/her personal symptoms. In various cases, questions are also asked during the patient's clinical examination. When questioning the patient, it is advisable for the physiotherapist to take notes in the patient's personal file.

At the end of the anamnesis, all the information is summarized. The physiotherapist asks additional questions where the patient's answers could be unclear, and the physiotherapeutic examination plan is drawn up. In many cases, the anamnesis can be evaluated even after a few days when all the necessary information about the patient's symptomatology has been obtained. The information obtained from the anamnesis is always evaluated and analyzed in the context of the clinical examination.

Anamnesis components

Personal anamnesis – diagnosis / actual symptoms

Family history (anamnesis)

Social anamnesis

Occupational anamnesis

Sports anamnesis

Pharmacological anamnesis

Gynecological anamnesis

Abuses

Basic data that is obtained before starting specific questions

Identification data:

−  Name / surname

−  Date of birth / Age

−  Personal ID

−  Place of residence

−  Health insurance

−  Date and time of examination

Personal Anamnesis

Personal anamnesis may be direct or indirect, depending on the patient.

In direct anamnesis, information is obtained from direct communication with the patient. The physiotherapist asks the patient specific and open-ended questions.

During indirect anamnesis (external anamnesis), obtaining information is done through specific questions from the patient's family members, colleagues, medical staff in the ward, and the patient's medical record. Indirect anamnesis is done only in cases where the patient is unable to communicate for health reasons and in pediatric patients.

During the personal anamnesis, information is obtained about the patient's current diagnosis and past illnesses. For the current diagnosis, we are based on seven main questions, which give us detailed information on the patient's symptoms.

Seven basic questions about the current diagnosis:

What is the actual problem?

Where are the symptoms observed? (Body area)

When did the complaints/symptoms appear?

The time when the symptoms appear is constant, intermittent, or permanent.

How do the complaints/symptoms feel?

We ask specific questions about the pain.

Do they have stabbing sensation, pulling sensation, superficial or deep pain, or throbbing pain? The patient's sensations provide information on the origin of the pain.

How are symptoms triggered, worsened, or relieved?

How long have you had symptoms?

What have you done so far?

We ask if the patient was previously treated with physiotherapy and what type of therapy s/he did. We also ask whether the patient received drug treatment or not.

Next, after completing the seven questions on the patient's current symptoms, information is obtained about past or secondary illnesses that the patient has in chronological order. Questions are asked if the patient has had operations in the past, trauma, metabolic diseases (such as diabetes), cardiological diseases (hypertension, heart operations, etc.), pneumological diseases (bronchial asthma, COPD, allergies, etc.). The patient's personal health history is important to decide on a better and clear treatment plan, defining the indications and contraindications during the therapy.

Family history (anamnesis)

During the family anamnesis, questions are asked about inherited diseases and genetic diseases of the closest family members. Information is obtained on the incidence of serious diseases of close family members (such as diabetes, ischemic heart disease, hypertension, hemophilia, tumors, etc.)

Social anamnesis

During the social anamnesis, we focus on questions related to the patient's social situation. For example, if the place of residence affects the patient's current symptoms, such as when the patient uses crutches and must go up and down stairs to get into the house, then this affects their quality of life. We ask about the patient's family situation, if he is married, single, or divorced, if he has children, and if he has help from family members.

Occupational anamnesis

During this anamnesis, the patient is asked about the nature of his work and the work environment. It is important to have information, whether the work is stereotyped, without much physical movement, or the patient has an active and physically tiring job. What is the most frequent static position of the patient during his work, if he works sitting or standing, and what kind of movements does he perform most often?

If the patient's work is physically tiring, we ask if he carries weights and how he carries them. We ask about the work environment, whether he or she works in a warm or cold climate and how much this affects the symptoms he or she currently has.

We ask the patient if he likes his job or if he is thinking of changing it and what could be the reason.

Sport anamnesis

The patient's activity outside work is of great importance to us, especially sports activity. The patient should be asked if he engages in recreational sports activities or is a professional athlete. Does the current problem and symptoms have a negative effect on the sports activity, as well as if he has had various traumas during different sports activities? Here we must consider the frequent traumas that occur during the specific sports