Practical Postural Techniques for Speech Therapists and Physiotherapists: Difference between revisions
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This page will discuss the practical components of the postural assessment of a patient that may be useful for speech therapists. The theoretical aspects of the postural assessment are discussed [[Postural Principles Useful in Speech Therapy - Part 1|here]] and [[Postural Principles Useful in Speech Therapy - Part 2|here]], and deglutition is discussed in detail [[Deglutition|here]]. | This page will discuss the practical components of the postural assessment of a patient that may be useful for speech therapists. The theoretical aspects of the postural assessment are discussed [[Postural Principles Useful in Speech Therapy - Part 1|here]] and [[Postural Principles Useful in Speech Therapy - Part 2|here]], and deglutition is discussed in detail [[Deglutition|here]]. | ||
When assessing a patient’s posture, it is important to remain two or three metres from the patient in order to observe them fully. If you are using a postural grid app, it is important to be consistent in terms of the patient’s position each time you take pictures.<ref>Banfi M. Practical Assessment for Postural Principles Useful in Speech Therapy Course. Physioplus, 2021.</ref> For more information on using digital photography as an aid to postural assessment, please see the following articles: | When assessing a patient’s posture, it is important to remain two or three metres from the patient in order to observe them fully. If you are using a postural grid app, it is important to be consistent in terms of the patient’s position each time you take pictures.<ref name=":0">Banfi M. Practical Assessment for Postural Principles Useful in Speech Therapy Course. Physioplus, 2021.</ref> For more information on using digital photography as an aid to postural assessment, please see the following articles: | ||
* [https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-017-0146-7 Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years]<ref>Stolinski L, Kozinoga M, Czaprowski D, Tyrakowski M, Cerny P, Suzuki N et al. Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years. Scoliosis Spinal Disord. 2017;12:38. </ref> | * [https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-017-0146-7 Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years]<ref>Stolinski L, Kozinoga M, Czaprowski D, Tyrakowski M, Cerny P, Suzuki N et al. [https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-017-0146-7 Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years]. Scoliosis Spinal Disord. 2017;12:38. </ref> | ||
* [https://journals.sagepub.com/doi/10.1177/2309499020960834 Spinal postural alignment measurements using markerless digital photography]<ref>Hida M, Wada C, Imai R, Kitagawa K, Okamatsu S, Ohnishi T et al. Spinal postural alignment measurements using markerless digital photography. J Orthop Surg (Hong Kong). 2020;28(3):2309499020960834.</ref> | * [https://journals.sagepub.com/doi/10.1177/2309499020960834 Spinal postural alignment measurements using markerless digital photography]<ref>Hida M, Wada C, Imai R, Kitagawa K, Okamatsu S, Ohnishi T et al. [https://journals.sagepub.com/doi/10.1177/2309499020960834 Spinal postural alignment measurements using markerless digital photography]. J Orthop Surg (Hong Kong). 2020;28(3):2309499020960834.</ref> | ||
== Evaluation in the Upright Position == | |||
The visual assessment of a patient should start in an upright, neutral position. In this position, it is important to verify the function of the vestibulospinal reflex.<ref name=":0" /> The vestibulospinal reflex works to maintain balance and posture by coordinating head movement with the action of the spinal muscles.<ref>Casale J, Browne T, Murray I, et al. Physiology, Vestibular System. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: [[/www.ncbi.nlm.nih.gov/books/NBK532978/|https://www.ncbi.nlm.nih.gov/books/NBK532978/]] </ref> The Rhomberg and Fukuda tests can be used to assess this function.<ref name=":0" /> | |||
=== Rhomberg Test === | |||
The Rhomberg test is performed as follows:<ref name=":0" /><ref>Forbes J, Cronovich H. Romberg Test. [Updated 2020 Sep 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: [[/www.ncbi.nlm.nih.gov/books/NBK563187/|https://www.ncbi.nlm.nih.gov/books/NBK563187/]] </ref> | |||
* The patient stands with his / her feet together and arms crossed or held next to the body | |||
* This position should be held for 30 seconds with eyes open, and then for 30 seconds with eyes closed | |||
* The therapist observes the patient from the front and back | |||
* In a normal test, there will be a slight, gentle oscillation | |||
* In an abnormal test, the patient: | |||
** Is unable to maintain the test position without opening his / her eyes | |||
** Has to increase his / her base of support to maintain the position | |||
** Experiences large oscillations | |||
If your patient has an abnormal Rhomberg, it is necessary to stop testing and refer on for medical review as it may indicate a neurological problem.<ref name=":0" /> | |||
=== Fukuda Test === | |||
The Fukuda test evaluates the tension of the rotatory action of the postural chain<ref name=":0" /> and is performed as follows:<ref name=":0" /><ref name=":1">Zhang YB, Wang WQ. [https://journals.sagepub.com/doi/pdf/10.1177/147323001103900431 Reliability of the Fukuda stepping test to determine the side of vestibular dysfunction]. J Int Med Res. 2011;39(4):1432-7.</ref> | |||
* The patient stands with arms extended in a circle with a radius of one metre | |||
* This circle is divided into sections | |||
* The patient is asked to step in place 50 times with his / her eyes closed and try not to move from his / her initial position | |||
* The room should be quiet and dimly lit in order to reduce the chance that patients use light or sound to orient themselves | |||
* The angle of rotation (i.e. deviation) and the distance of displacement (i.e. lateral shift) is measured | |||
* A result is considered abnormal when a patient:<ref name=":1" /> | |||
** Deviates more than 45 degrees | |||
** Has more than a one metre lateral shift | |||
== References == | |||
[[Category:Course Pages]] | [[Category:Course Pages]] | ||
[[Category:Physioplus Content]] | [[Category:Physioplus Content]] | ||
Revision as of 03:53, 14 July 2021
Original Editor - Jess Bell based on the course by Mauro Banfi
Top Contributors - Jess Bell, Kim Jackson and Kirenga Bamurange Liliane
Top Contributors - Jess Bell, Kim Jackson and Kirenga Bamurange Liliane
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (14/07/2021)
Introduction[edit | edit source]
There is a known link between posture and vocal quality[1] and posture and swallowing.[2][3] When working with patients who have vocal problems or swallowing dysfunction, it is essential to be able to assess the impact of posture on these functions and vice versa.
This page will discuss the practical components of the postural assessment of a patient that may be useful for speech therapists. The theoretical aspects of the postural assessment are discussed here and here, and deglutition is discussed in detail here.
When assessing a patient’s posture, it is important to remain two or three metres from the patient in order to observe them fully. If you are using a postural grid app, it is important to be consistent in terms of the patient’s position each time you take pictures.[4] For more information on using digital photography as an aid to postural assessment, please see the following articles:
- Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years[5]
- Spinal postural alignment measurements using markerless digital photography[6]
Evaluation in the Upright Position[edit | edit source]
The visual assessment of a patient should start in an upright, neutral position. In this position, it is important to verify the function of the vestibulospinal reflex.[4] The vestibulospinal reflex works to maintain balance and posture by coordinating head movement with the action of the spinal muscles.[7] The Rhomberg and Fukuda tests can be used to assess this function.[4]
Rhomberg Test[edit | edit source]
The Rhomberg test is performed as follows:[4][8]
- The patient stands with his / her feet together and arms crossed or held next to the body
- This position should be held for 30 seconds with eyes open, and then for 30 seconds with eyes closed
- The therapist observes the patient from the front and back
- In a normal test, there will be a slight, gentle oscillation
- In an abnormal test, the patient:
- Is unable to maintain the test position without opening his / her eyes
- Has to increase his / her base of support to maintain the position
- Experiences large oscillations
If your patient has an abnormal Rhomberg, it is necessary to stop testing and refer on for medical review as it may indicate a neurological problem.[4]
Fukuda Test[edit | edit source]
The Fukuda test evaluates the tension of the rotatory action of the postural chain[4] and is performed as follows:[4][9]
- The patient stands with arms extended in a circle with a radius of one metre
- This circle is divided into sections
- The patient is asked to step in place 50 times with his / her eyes closed and try not to move from his / her initial position
- The room should be quiet and dimly lit in order to reduce the chance that patients use light or sound to orient themselves
- The angle of rotation (i.e. deviation) and the distance of displacement (i.e. lateral shift) is measured
- A result is considered abnormal when a patient:[9]
- Deviates more than 45 degrees
- Has more than a one metre lateral shift
References[edit | edit source]
- ↑ Caçador M, Paço J. The influence of posture and balance on voice: a review: A influência da postura e do equilíbrio na voz: revisão. Gaz Med [Internet]. 2018;5(2).
- ↑ Bordoni B, Morabito B, Mitrano R, Simonelli M, Toccafondi A. The anatomical relationships of the tongue with the body system. Cureus. 2018;10(12):e3695.
- ↑ Alghadir AH, Zafar H, Al-Eisa ES, Iqbal ZA. Effect of posture on swallowing. Afr Health Sci. 2017;17(1):133-7.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Banfi M. Practical Assessment for Postural Principles Useful in Speech Therapy Course. Physioplus, 2021.
- ↑ Stolinski L, Kozinoga M, Czaprowski D, Tyrakowski M, Cerny P, Suzuki N et al. Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years. Scoliosis Spinal Disord. 2017;12:38.
- ↑ Hida M, Wada C, Imai R, Kitagawa K, Okamatsu S, Ohnishi T et al. Spinal postural alignment measurements using markerless digital photography. J Orthop Surg (Hong Kong). 2020;28(3):2309499020960834.
- ↑ Casale J, Browne T, Murray I, et al. Physiology, Vestibular System. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532978/
- ↑ Forbes J, Cronovich H. Romberg Test. [Updated 2020 Sep 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563187/
- ↑ 9.0 9.1 Zhang YB, Wang WQ. Reliability of the Fukuda stepping test to determine the side of vestibular dysfunction. J Int Med Res. 2011;39(4):1432-7.
