Multiple Body System Analysis Across the Lifespan: Difference between revisions
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* The Roland-Morris Disability Questionnaire | * The Roland-Morris Disability Questionnaire | ||
* The Upper Extremity Functional Scale | * The Upper Extremity Functional Scale | ||
Table 1 provides examples of functional tests for musculoskeletal system assessment for children/adolescents, adults and older adults as well as examples of changes that occur in the system across the lifespan. | |||
{| class="wikitable" | {| class="wikitable" | ||
|+'''Functional Tests for Musculoskeletal System Assessment''' | |+'''Table 1. Functional Tests for Musculoskeletal System Assessment''' | ||
! | ! | ||
!Children/Adolescents | !Children/Adolescents | ||
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* Older adults often report difficulty with stair climbing, and it is reported as one of the top five most difficult tasks to perform. <ref>Gagliano-Jucá T, Li Z, Pencina KM, Traustadóttir T, Travison TG, Woodhouse L, Basaria S, Tsitouras PD, Harman SM, Bhasin S, Storer TW. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984416/pdf/gerona_75_6_1167.pdf The Stair Climb Power Test as an Efficacy Outcome in Randomized Trials of Function Promoting Therapies in Older Men.] J Gerontol A Biol Sci Med Sci. 2020 May 22;75(6):1167-1175. </ref> | * Older adults often report difficulty with stair climbing, and it is reported as one of the top five most difficult tasks to perform. <ref>Gagliano-Jucá T, Li Z, Pencina KM, Traustadóttir T, Travison TG, Woodhouse L, Basaria S, Tsitouras PD, Harman SM, Bhasin S, Storer TW. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984416/pdf/gerona_75_6_1167.pdf The Stair Climb Power Test as an Efficacy Outcome in Randomized Trials of Function Promoting Therapies in Older Men.] J Gerontol A Biol Sci Med Sci. 2020 May 22;75(6):1167-1175. </ref> | ||
* Ability to climb stairs can help to assess hip and knee strength and stability <ref name=":4">Kapoor E. Multiple Body System Analysis Across the Lifespan. Plus course 2024</ref> | * Ability to climb stairs can help to assess hip and knee strength and stability <ref name=":4">Kapoor E. Multiple Body System Analysis Across the Lifespan. Plus course 2024</ref> | ||
* "The use of stair-climbing speed as an assessment tool should include both stair ascent and descent because differences in these speeds seem to be indicators of stair-climbing ability".<ref>Brodowski H, Andres N, Gumny M, Eicher C, Steinhagen-Thiessen E, Tannen A, Kiselev J.[[/www.magonlinelibrary.com/doi/abs/10.12968/ijtr.2020.0137|Reliability of stair-climbing speed in two cohorts of older adults.]]International Journal of Therapy and Rehabilitation 2021; 28(11):1-15. </ref> | * "The use of stair-climbing speed as an assessment tool should include both stair ascent and descent because differences in these speeds seem to be indicators of stair-climbing ability".<ref>Brodowski H, Andres N, Gumny M, Eicher C, Steinhagen-Thiessen E, Tannen A, Kiselev J.[[/www.magonlinelibrary.com/doi/abs/10.12968/ijtr.2020.0137|Reliability of stair-climbing speed in two cohorts of older adults.]]International Journal of Therapy and Rehabilitation 2021; 28(11):1-15. </ref> | ||
|- | |- | ||
|Flexibility/Range of motion | |Flexibility/Range of motion | ||
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|'''Chest wall mobility:''' | |'''Chest wall mobility:''' | ||
''Age 3 through adulthood:'' | ''Age 3 through adulthood:'' | ||
Chest wall mobility measurement for '''tidal volume excursion''': <ref name=":2">Massery, M. "If You Can't Breathe, You Can't Function" continuing education class 20 hrs. 2008, Chicago, IL. USA [[/www.masserypt.com/|www.MasseryPT.com]] </ref> | Chest wall mobility measurement for '''tidal volume excursion''': <ref name=":2">Massery, M. "If You Can't Breathe, You Can't Function" continuing education class 20 hrs. 2008, Chicago, IL. USA [[/www.masserypt.com/|www.MasseryPT.com]] </ref> | ||
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* Lumbar spine mobility is greater in children than in adults | * Lumbar spine mobility is greater in children than in adults | ||
* Caution must be applied during visual estimation of spine position as intra-rater and inter-rater reliability of visual assessment is poor<ref name=":3">Kondratek M, Krauss J, Stiller C, Olson R. [https://journals.lww.com/pedpt/fulltext/2007/01930/normative_values_for_active_lumbar_range_of_motion.9.aspx Normative values for active lumbar range of motion in children.] Pediatr Phys Ther. 2007 Fall;19(3):236-44.</ref> | * Caution must be applied during visual estimation of spine position as intra-rater and inter-rater reliability of visual assessment is poor<ref name=":3">Kondratek M, Krauss J, Stiller C, Olson R. [https://journals.lww.com/pedpt/fulltext/2007/01930/normative_values_for_active_lumbar_range_of_motion.9.aspx Normative values for active lumbar range of motion in children.] Pediatr Phys Ther. 2007 Fall;19(3):236-44.</ref> | ||
* Muscle weakness, abnormal positioning, and abnormal movement patterns may lead to abnormal spinal mobility. <ref name=":3" /> | * Muscle weakness, abnormal positioning, and abnormal movement patterns may lead to abnormal spinal mobility. <ref name=":3" /> | ||
|'''Chest wall mobility:''' | |'''Chest wall mobility:''' | ||
* Chest wall mobility measurement for '''tidal volume excursion''' is the same as for children | * Chest wall mobility measurement for '''tidal volume excursion''' is the same as for children | ||
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Measurement in the standing position using the inclinometer technique:<ref>Waddell G, Somerville D, Henderson I, Newton M. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17:617–28.</ref> | Measurement in the standing position using the inclinometer technique:<ref>Waddell G, Somerville D, Henderson I, Newton M. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17:617–28.</ref> | ||
* ''Lumbar flexion:'' the difference between thoracolumbar flexion and pelvic flexion measures. | * ''Lumbar flexion:'' the difference between thoracolumbar flexion and pelvic flexion measures. | ||
* ''Lumbar extension:'' arching the trunk backwards. | * ''Lumbar extension:'' arching the trunk backwards. | ||
* ''Right and left side-bending'': a composite value of average side-bending. | * ''Right and left side-bending'': a composite value of average side-bending. | ||
|'''Chest wall mobility:''' | |'''Chest wall mobility:''' | ||
* Chest wall mobility measurement for '''tidal volume excursion''' is the same as for children | * Chest wall mobility measurement for '''tidal volume excursion''' is the same as for children | ||
* Chest wall measurement for '''vital capacity''' is the same as for children | * Chest wall measurement for '''vital capacity''' is the same as for children | ||
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|Functional Pain Scale (FPS) is a tool for the objective assessment of pain and its impact on sleep, ability to complete activities of daily living (ADLs), and concentration:<ref>Adeboye A, Hart R, Senapathi SH, Ali N, Holman L, Thomas HW. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425136/pdf/cureus-0013-00000016847.pdf Assessment of Functional Pain Score by Comparing to Traditional Pain Scores.] Cureus. 2021 Aug 3;13(8):e16847.</ref> | |Functional Pain Scale (FPS) is a tool for the objective assessment of pain and its impact on sleep, ability to complete activities of daily living (ADLs), and concentration:<ref>Adeboye A, Hart R, Senapathi SH, Ali N, Holman L, Thomas HW. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425136/pdf/cureus-0013-00000016847.pdf Assessment of Functional Pain Score by Comparing to Traditional Pain Scores.] Cureus. 2021 Aug 3;13(8):e16847.</ref> | ||
* First, the patient is asked if they have pain. If there is no answer due to pain, their pain is rated a “10” | * First, the patient is asked if they have pain. If there is no answer due to pain, their pain is rated a “10” | ||
* Next, the patient is asked if the pain is tolerable or intolerable (intolerable pain is rated “5” or greater). | * Next, the patient is asked if the pain is tolerable or intolerable (intolerable pain is rated “5” or greater). | ||
* Finally, how the pain interferes with passive vs. active activities is determined. | * Finally, how the pain interferes with passive vs. active activities is determined. | ||
| | | | ||
* The Functional Pain Scale is "an effective way to assess pain in the elderly and has proven helpful in identifying changes in pain". <ref>BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet. Available from https://instruct.uwo.ca/kinesiology/9641/Assessments/Biological/FPS.html [last access 22.03.2024]</ref> | * The Functional Pain Scale is "an effective way to assess pain in the elderly and has proven helpful in identifying changes in pain". <ref>BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet. Available from https://instruct.uwo.ca/kinesiology/9641/Assessments/Biological/FPS.html [last access 22.03.2024]</ref> | ||
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* Physical activity and calcium and vitamin D intake are interventions that improve BMD in older children.<ref name=":5" /> | * Physical activity and calcium and vitamin D intake are interventions that improve BMD in older children.<ref name=":5" /> | ||
| | | | ||
* | * Calcium, vitamin D, and BMD deficiencies are common in adults with coeliac disease.<ref name=":4" /> | ||
* Patients with chronic obstructive pulmonary diseases and on long-term corticosteroids are more prone to having decreased BMD.<ref name=":4" /> | * Patients with chronic obstructive pulmonary diseases and on long-term corticosteroids are more prone to having decreased BMD.<ref name=":4" /> | ||
* Patients with haemophilia or other bleeding disorders and patients who are on long-term anticoagulation present with a higher incidence of decreased BMD.<ref name=":4" /> | * Patients with haemophilia or other bleeding disorders and patients who are on long-term anticoagulation present with a higher incidence of decreased BMD.<ref name=":4" /> | ||
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|Core Stability | |Core Stability | ||
| | | | ||
* Core stability is a dynamic control of trunk pressures to optimize postural stability (balance). | * Core stability is a dynamic control of trunk pressures to optimize postural stability (balance). | ||
* Breathing mechanics ( roles of the diaphragm) are linked to postural control through multi-system interactions. | * Breathing mechanics ( roles of the diaphragm) are linked to postural control through multi-system interactions. | ||
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** Static and dynamic balance | ** Static and dynamic balance | ||
* Interoception | * Interoception | ||
Table 2 provides examples of functional tests for neurological system assessment for children/adolescents, adults and older adults as well as examples of changes that occur in the system across the lifespan. | |||
{| class="wikitable" | {| class="wikitable" | ||
|+Functional Tests for Neurological System Assessment | |+Table 2. Functional Tests for Neurological System Assessment | ||
! | ! | ||
!Children/Adolescents | !Children/Adolescents | ||
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* Static balance develops before the 3rd year of age. | * Static balance develops before the 3rd year of age. | ||
* Static balance tests include a ''flamingo test, a one-leg stance on a low beam, or a tandem stance on the force plate''. | * Static balance tests include a ''flamingo test, a one-leg stance on a low beam, or a tandem stance on the force plate''. | ||
* '''Dynamic balance''' is defined as the ability to remain stable while performing movements or actions. | * '''Dynamic balance''' is defined as the ability to remain stable while performing movements or actions. | ||
* Dynamic balance develops between the 3rd and 7th years. | * Dynamic balance develops between the 3rd and 7th years. | ||
* Dynamic balance tests include ''low-beam walking test.'' | * Dynamic balance tests include ''low-beam walking test.'' | ||
| | | | ||
* Vestibular signal impairment is associated with balance disorders and spatial disorientation in neurodegenerative diseases, including Alzheimer's and Parkinson's disease. <ref>Coto J, Alvarez CL, Cejas I, Colbert BM, Levin BE, Huppert J, Rundek T, Balaban C, Blanton SH, Lee DJ, Loewenstein D, Hoffer M, Liu XZ. [https://www.sciencedirect.com/science/article/pii/S1672293021000271 Peripheral vestibular system: Age-related vestibular loss and associated deficits.] J Otol. 2021 Oct;16(4):258-265. </ref> | * Vestibular signal impairment is associated with balance disorders and spatial disorientation in neurodegenerative diseases, including Alzheimer's and Parkinson's disease. <ref>Coto J, Alvarez CL, Cejas I, Colbert BM, Levin BE, Huppert J, Rundek T, Balaban C, Blanton SH, Lee DJ, Loewenstein D, Hoffer M, Liu XZ. [https://www.sciencedirect.com/science/article/pii/S1672293021000271 Peripheral vestibular system: Age-related vestibular loss and associated deficits.] J Otol. 2021 Oct;16(4):258-265. </ref> | ||
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* Function performance tests include postural activities and movements which occur in the course of everyday life: | * Function performance tests include postural activities and movements which occur in the course of everyday life: | ||
** Romberg Test | ** Romberg Test | ||
** The uni pedal stance test (UST) | ** The uni pedal stance test (UST) | ||
** The four-square step test (FSST) | ** The four-square step test (FSST) | ||
** The timed up-and-go test | ** The timed up-and-go test | ||
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=== Interception === | === Interception === | ||
Interception is the ability to perceive internal bodily states. Our perception of internal body signals influences our emotions, decision-making, and sense of self. | Interception is the ability to perceive internal bodily states. Our perception of internal body signals influences our emotions, decision-making, and sense of self. | ||
This video explores the concept of interception: | |||
This optional video explores the concept of interception: | |||
{{#ev:youtube|v=rms5I02Rzg0&t=39s|300}}<ref>Neuroscience News. Exploring Interoception: The Neuroscience of Internal Body Signals - Neuroscience News. Available from: https://www.youtube.com/watch?v=rms5I02Rzg0&t=39s [last accessed 23/3/2024]</ref> | {{#ev:youtube|v=rms5I02Rzg0&t=39s|300}}<ref>Neuroscience News. Exploring Interoception: The Neuroscience of Internal Body Signals - Neuroscience News. Available from: https://www.youtube.com/watch?v=rms5I02Rzg0&t=39s [last accessed 23/3/2024]</ref> | ||
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* Prune belly syndrome (PBS) is associated with laxity of the abdominal wall musculature. Children with PBS often experience gastrointestinal complications due to inability to generate adequate intra-abdominal pressure.<ref name=":4" /><ref>Arlen AM, Nawaf C, Kirsch AJ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689549/pdf/phmt-10-75.pdf Prune belly syndrome: current perspectives]. Pediatric Health Med Ther. 2019 Aug 6;10:75-81.</ref> | * Prune belly syndrome (PBS) is associated with laxity of the abdominal wall musculature. Children with PBS often experience gastrointestinal complications due to inability to generate adequate intra-abdominal pressure.<ref name=":4" /><ref>Arlen AM, Nawaf C, Kirsch AJ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689549/pdf/phmt-10-75.pdf Prune belly syndrome: current perspectives]. Pediatric Health Med Ther. 2019 Aug 6;10:75-81.</ref> | ||
* Hypotonic trunk in children with cerebral palsy affects their ability to maintain appropriate level of intra-abdominal pressure. It is a main factor in development of digestive issues, including upset stomach, vomiting, bloating, and constipation.<ref>Cerebral Palsy Digestive Issues and Health. Available from https://www.cerebralpalsyguidance.com/cerebral-palsy/associated-disorders/digestive-issues-and-health/ [last access 24.03.2024]</ref> | * Hypotonic trunk in children with cerebral palsy affects their ability to maintain appropriate level of intra-abdominal pressure. It is a main factor in development of digestive issues, including upset stomach, vomiting, bloating, and constipation.<ref>Cerebral Palsy Digestive Issues and Health. Available from https://www.cerebralpalsyguidance.com/cerebral-palsy/associated-disorders/digestive-issues-and-health/ [last access 24.03.2024]</ref> | ||
* Pes excavatum is caused by tendon of the diaphragm pulling down without adequate strength of the abdominals and the intercostals to stabilise the rib cage and counteract that pull of the central tendon. The chest wall is caving creating per excavatum. This may be one of the risk factors in constipation. The therapy goal is to strengthen the core and provide the counter-resistance for this central tendon pull so that the child can generate the amount of pressure needed. Increase in the intra abdominal pressure can help with constipation.<ref name=":4" /> | |||
'''Adults''' | '''Adults''' | ||
* Strength training in healthy males focusing on improving strength of the trunk rotators, improves the ability to generate higher levels of voluntarily induced intra-abdominal pressure and increases the rate of intra-abdominal pressure development during functional situations.<ref>Cresswell AG, Blake PL, Thorstensson A. The effect of an abdominal muscle training program on intra-abdominal pressure. Scand J Rehabil Med. 1994 Jun;26(2):79-86.</ref> | * Strength training in healthy males focusing on improving strength of the trunk rotators, improves the ability to generate higher levels of voluntarily induced intra-abdominal pressure and increases the rate of intra-abdominal pressure development during functional situations.<ref>Cresswell AG, Blake PL, Thorstensson A. The effect of an abdominal muscle training program on intra-abdominal pressure. Scand J Rehabil Med. 1994 Jun;26(2):79-86.</ref> | ||
* Patients with cystic fibrosis or asthma presenting with a chronic cough should be screened for stress urinary incontinence.<ref name=":4" /> | |||
'''Older Adults:'''<ref>Bajaj JS, Long M. [https://journals.lww.com/ajg/fulltext/2023/03000/exploring_gi_diseases_across_the_lifespan.1.aspx Exploring GI Diseases Across the Lifespan.] The American Journal of Gastroenterology 118(3):p 381-382, March 2023.</ref> | '''Older Adults:'''<ref>Bajaj JS, Long M. [https://journals.lww.com/ajg/fulltext/2023/03000/exploring_gi_diseases_across_the_lifespan.1.aspx Exploring GI Diseases Across the Lifespan.] The American Journal of Gastroenterology 118(3):p 381-382, March 2023.</ref> | ||
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== Cardiopulmonary System == | == Cardiopulmonary System == | ||
The following functions of the cardiopulmonary system should be considered when assessing the system across the lifespan: | |||
* Breathing mechanics and patterns | |||
* Sleep quality | |||
* Oxygen saturation and blood pressure | |||
{| class="wikitable" | |||
|+Table. 3 Cardiopulmonary System Across the Lifespan | |||
! | |||
!Children/Adolesents | |||
!Adults | |||
!Older Adults | |||
|- | |||
|Breathing mechanics and patterns | |||
| | |||
* Infants’ respiratory system is less efficient than adult's<ref name=":13">Trachsel D, Erb TO, Hammer J, von Ungern-Sternberg BS. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9135024/pdf/PAN-32-108.pdf Developmental respiratory physiology.] Paediatr Anaesth. 2022 Feb;32(2):108-117.</ref> | |||
* 12 months and younger infants are more dependent on diaphragmatic breathing. The main role of the intercostal muscles is chest stabilisation during inspiration.<ref name=":13" /> | |||
* Infants' ribs are positioned more horizontally than adults'. Ribs move up with inspiration. The absence of up-and-out rib movement limits the infant's capacity to increase tidal volumes.<ref>How are children different. Available from https://www.rch.org.au/trauma-service/manual/how-are-children-different/ [last access 25.3.2024]</ref> | |||
* Severe spinal muscle atrophy leads to [https://www.oxfordreference.com/display/10.1093/oi/authority.20110803100305151 paradoxical breathing]. | |||
| | |||
* The position of the trunk influences chest wall kinematics and breathing patterns. When trunk flexion increases, rib cage displacement and tidal volume are progressively reduced. <ref>Romei M, Mauro AL, D’angelo MG, Turconi AC, Bresolin N, Pedotti A, Aliverti A. Effects of gender and posture on thoraco-abdominal kinematics during quiet breathing in healthy adults. Respiratory physiology & neurobiology. 2010 Jul 31;172(3):184-91.</ref> | |||
| | |||
* Loss of elasticity and a decline in chest wall compliance | |||
* Increased rigidity of the chest wall due to osteoporosis and postural changes | |||
* Weakness of intercostal and accessory muscles of respiration | |||
* Functional assessment may include the following observations:<ref name=":4" /> | |||
** Ability to speak sentences at different lengths without shortness of breath | |||
** Ability to sing a song | |||
** Ability to carry on conversation during activities | |||
|- | |||
|Sleep quality | |||
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|- | |||
|Oxygen saturation and blood pressure | |||
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== Mental Health System == | == Mental Health System == |
Revision as of 01:17, 26 March 2024
Original Editor - User Name
Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson
Introduction[edit | edit source]
Musculoskeletal System[edit | edit source]
The functional capacity of the musculoskeletal system should be assessed within the context of school, play, work, daily activities, and sports. Due to differences in the levels of reliability and validity for the functional tests, a combination of a questionnaire and a functional test appears to be the best instrument to assess the functional capacity of the musculoskeletal system.[1] The following questionnaires are recommended:[1]
- The Oswestry Disability Index
- The Pain Disability Index
- The Roland-Morris Disability Questionnaire
- The Upper Extremity Functional Scale
Table 1 provides examples of functional tests for musculoskeletal system assessment for children/adolescents, adults and older adults as well as examples of changes that occur in the system across the lifespan.
Children/Adolescents | Adults | Older Adults | |
---|---|---|---|
Muscle strength
(Functional assessment to include sit-to-stand and stairs) |
|
1MMSTST: ranges from 8.1(patient with stroke), 24 (advanced lung disease)[5] to 50 (healthy male adult)[6] |
|
Flexibility/Range of motion
(spinal and chest wall mobility) |
Chest wall mobility:
Age 3 through adulthood: Chest wall mobility measurement for tidal volume excursion: [11]
Pediatric:
Spinal mobility:
|
Chest wall mobility:
Spinal mobility: Measurement in the standing position using the inclinometer technique:[13]
|
Chest wall mobility:
Spinal mobility: Measurement as for adults.
|
Pain |
|
Functional Pain Scale (FPS) is a tool for the objective assessment of pain and its impact on sleep, ability to complete activities of daily living (ADLs), and concentration:[16]
|
|
Bone Mineral Density |
|
| |
Core Stability |
|
Same as in children/adolescents | Same as in children/adolescents |
Neurological System[edit | edit source]
"Neurons that fire together, wire together."[9]--Eena Kapoor
"Each time we practise that certain type of movement or certain type of action, we're laying down those pathways in our brain."[9]--Eena Kapoor
Components of the neurological system examination include :
- Proprioception
- Ability to determine body segment positions and movements in space[22]
- Vestibular system, including the ability to coordinate movement with balance
- Static and dynamic balance
- Interoception
Table 2 provides examples of functional tests for neurological system assessment for children/adolescents, adults and older adults as well as examples of changes that occur in the system across the lifespan.
Children/Adolescents | Adults | Older Adults | |
---|---|---|---|
Proprioception |
|
There are three main testing techniques for assessing proprioception in adults: |
|
Vestibular system |
|
|
|
Interception[edit | edit source]
Interception is the ability to perceive internal bodily states. Our perception of internal body signals influences our emotions, decision-making, and sense of self.
This optional video explores the concept of interception:
For a detailed assessment of the neurological system, please refer to the Neurological Screening course.
Integumentary System[edit | edit source]
Adequate skin and other connective tissue mobility is needed for free movement of the underlying structures to provide postural support and assure proper ventilation.[11] If fascial restrictions are present, they may cause multiple impairments.
The skin is one of the largest organs of the body. It has many functions, including the following:[29]
- Structural barrier
- Thermoregulation
- An impact on the cardiovascular system because it regulates body's temperature.
- Contributes to sensation for neuromuscular control
- Provides fascial mobility for range of motion of the joint
Learn more about the integumentary system from this Physiopedia article.
Skin diseases including atopic dermatitis, psoriasis, and allergic or irritant contact dermatitis affect skin transepidermal water loss (TEWL, the amount of water loss through the epidermis through evaporation), hydration, and acidity.[30]
Children/Adolescents:
- Skin barrier function is weaker than in adult
- "Changing infant skin barrier is not a deficit but beneficial as adaptive flexibility allowing constant optimisation, balancing growth, thermoregulation, water barrier and protective functions. "[30]
- Newborns have the lowest skin hydration and water content. [31]
- Premature infants have high TEWL at birth leading to skin's immature barrier function and thinner epidermal layers. It causes increased insensible water loss.[30]
- Neonatal skin has higher pH compared to older paediatric and adult patients. Mature skin pH is maintained between 4.5 to 6.0.[30]
- Paediatric skin have tendency to develop xerosis and excessively dry skin, particularly on the exposed facial skin. It can lead to development irritant or allergic contact dermatitis.[32]
- Scarring from G-tube or a chest tube placement can cause severe restriction in child's trunk mobility and abdominal mobility.[9]
Adults:
- Extrinsic ageing includes chronic exposure to various environmental elements such as the sun, air/water pollution, smoking, diet, exercise, stress, lifestyle, repetitive muscle contractions, gravity, or general diseases.[33]
- Intrinsic ageing is a natural process resulting from oxidative cellular metabolism and is influenced by genetics, metabolism, hormonal, immunological, cardiovascular, gastrointestinal, psychogenic, degenerative, or neoplastic disease.[33]
- In women, the skin thickens to 25 to 30 years of age, followed by a progressive declination of all skin layers as age progresses.[33]
- Androgens, cortisol, progesterone and thyroid hormone influence skin health. For example, thyroid hormone "regulates the metabolic rate of the body and helps regulate epidermal cell proliferation, differentiation, hair and nail growth, wound healing, and skin hydration by affecting the function of dermal fibroblasts."[33]
Older Adults:[34]
- Skin is thinner and less elastic
- Age spots/Liver spots tends to develop
- Blood vessels under the skin become more fragile causing bruising or bleeding under the skin
- Decrease in oil production leading to dry and itchy skin
- Decrease in subcutaneous tissue with increasing risk for pressure injuries and hypothermia
- Decrease in sweat function increasing risk for overheating
- Increase risk for skin cancer
Gastrointestinal System[edit | edit source]
- Gastrointestinal system occupies majority of space in the abdominal compartment.
- The abdominal compartment is surrounded by the following structures:
- The diaphragm and abdominal wall anteriorly
- Spine posteriorly
- Costal arch on both sides
- Pelvis on the bottom
- The abdominal compartment contains multiple solid and hollow organs, adipose tissue and major blood vessels. They are located intra- and/ or retroperitoneally.
- The healthy functioning of the GI system depends on body's ability to generate intra-abdominal pressure.
Children/Adolescents:
- Prune belly syndrome (PBS) is associated with laxity of the abdominal wall musculature. Children with PBS often experience gastrointestinal complications due to inability to generate adequate intra-abdominal pressure.[9][35]
- Hypotonic trunk in children with cerebral palsy affects their ability to maintain appropriate level of intra-abdominal pressure. It is a main factor in development of digestive issues, including upset stomach, vomiting, bloating, and constipation.[36]
- Pes excavatum is caused by tendon of the diaphragm pulling down without adequate strength of the abdominals and the intercostals to stabilise the rib cage and counteract that pull of the central tendon. The chest wall is caving creating per excavatum. This may be one of the risk factors in constipation. The therapy goal is to strengthen the core and provide the counter-resistance for this central tendon pull so that the child can generate the amount of pressure needed. Increase in the intra abdominal pressure can help with constipation.[9]
Adults
- Strength training in healthy males focusing on improving strength of the trunk rotators, improves the ability to generate higher levels of voluntarily induced intra-abdominal pressure and increases the rate of intra-abdominal pressure development during functional situations.[37]
- Patients with cystic fibrosis or asthma presenting with a chronic cough should be screened for stress urinary incontinence.[9]
Older Adults:[38]
- The strength of the esophageal contractions and the tension in the upper esophageal sphincter decrease
- Stomach lining's capacity to resist damage decreases which may lead to peptic ulcer disease
- Stomach elasticity decreases
- Reduction in physical activity and exercises and pelvic floor weakness may become factors in constipation or feral incontinence.
Cardiopulmonary System[edit | edit source]
The following functions of the cardiopulmonary system should be considered when assessing the system across the lifespan:
- Breathing mechanics and patterns
- Sleep quality
- Oxygen saturation and blood pressure
Children/Adolesents | Adults | Older Adults | |
---|---|---|---|
Breathing mechanics and patterns |
|
|
|
Sleep quality | |||
Oxygen saturation and blood pressure |
Mental Health System[edit | edit source]
Resources[edit | edit source]
- https://www.researchgate.net/profile/Margaret-Schenkman/publication/20341766_A_Model_for_Multisystem_Evaluation_Treatment_of_Individuals_with_Parkinson%27s_Disease/links/0c96051786d5fb1da5000000/A-Model-for-Multisystem-Evaluation-Treatment-of-Individuals-with-Parkinsons-Disease.pdf
- https://www.masserypt.com/wp-content/uploads/2016/02/MasseryCh28AsthmaCampbellPedPTTextbook2006.pdf
References[edit | edit source]
- ↑ 1.0 1.1 Wind H, Gouttebarge V, Kuijer PP, Frings-Dresen MH. Assessment of functional capacity of the musculoskeletal system in the context of work, daily living, and sport: a systematic review. J Occup Rehabil. 2005 Jun;15(2):253-72.
- ↑ Falk B, Dotan R. Child-adult differences in the recovery from high-intensity exercise. Exerc Sport Sci Rev. 2006 Jul;34(3):107-12.
- ↑ Haile SR, Fühner T, Granacher U, Stocker J, Radtke T, Kriemler S. Reference values and validation of the 1-minute sit-to-stand test in healthy 5-16-year-old youth: a cross-sectional study. BMJ Open. 2021 May 7;11(5):e049143.
- ↑ 4.0 4.1 Schorling DC, Rawer R, Kuhlmann I, Müller C, Pechmann A, Kirschner J. Mechanographic analysis of the timed 4 stair climb test - methodology and reference data of healthy children and adolescents. J Musculoskelet Neuronal Interact. 2023 Mar 1;23(1):4-25.
- ↑ Watson K, Winship P, Cavalheri V, Vicary C, Stray S, Bear N, Hill K. In adults with advanced lung disease, the 1-minute sit-to-stand test underestimates exertional desaturation compared with the 6-minute walk test: an observational study. J Physiother. 2023 Apr;69(2):108-113.
- ↑ Bohannon RW, Crouch R. 1-Minute Sit-to-Stand Test: SYSTEMATIC REVIEW OF PROCEDURES, PERFORMANCE, AND CLINIMETRIC PROPERTIES. J Cardiopulm Rehabil Prev. 2019 Jan;39(1):2-8.
- ↑ Strassmann A, Steurer-Stey C, Lana KD, Zoller M, Turk AJ, Suter P, Puhan MA. Population-based reference values for the 1-min sit-to-stand test. Int J Public Health. 2013 Dec;58(6):949-53.
- ↑ Gagliano-Jucá T, Li Z, Pencina KM, Traustadóttir T, Travison TG, Woodhouse L, Basaria S, Tsitouras PD, Harman SM, Bhasin S, Storer TW. The Stair Climb Power Test as an Efficacy Outcome in Randomized Trials of Function Promoting Therapies in Older Men. J Gerontol A Biol Sci Med Sci. 2020 May 22;75(6):1167-1175.
- ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 Kapoor E. Multiple Body System Analysis Across the Lifespan. Plus course 2024
- ↑ Brodowski H, Andres N, Gumny M, Eicher C, Steinhagen-Thiessen E, Tannen A, Kiselev J.Reliability of stair-climbing speed in two cohorts of older adults.International Journal of Therapy and Rehabilitation 2021; 28(11):1-15.
- ↑ 11.0 11.1 11.2 Massery, M. "If You Can't Breathe, You Can't Function" continuing education class 20 hrs. 2008, Chicago, IL. USA www.MasseryPT.com
- ↑ 12.0 12.1 Kondratek M, Krauss J, Stiller C, Olson R. Normative values for active lumbar range of motion in children. Pediatr Phys Ther. 2007 Fall;19(3):236-44.
- ↑ Waddell G, Somerville D, Henderson I, Newton M. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17:617–28.
- ↑ Saidu IA, Maduagwu SM, Abbas AD, Adetunji OO, Jajere AM. Lumbar spinal mobility changes among adults with advancing age. J Midlife Health. 2011 Jul;2(2):65-71.
- ↑ Sansone L, Gentile C, Grasso EA, Di Ludovico A, La Bella S, Chiarelli F, Breda L. Pain Evaluation and Treatment in Children: A Practical Approach. Children (Basel). 2023 Jul 13;10(7):1212.
- ↑ Adeboye A, Hart R, Senapathi SH, Ali N, Holman L, Thomas HW. Assessment of Functional Pain Score by Comparing to Traditional Pain Scores. Cureus. 2021 Aug 3;13(8):e16847.
- ↑ BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet. Available from https://instruct.uwo.ca/kinesiology/9641/Assessments/Biological/FPS.html [last access 22.03.2024]
- ↑ 18.0 18.1 McVey MK, Geraghty AA, O'Brien EC, McKenna MJ, Kilbane MT, Crowley RK, Twomey PJ, McAuliffe FM. The impact of diet, body composition, and physical activity on child bone mineral density at five years of age-findings from the ROLO Kids Study. Eur J Pediatr. 2020 Jan;179(1):121-131.
- ↑ Padilla Colón CJ, Molina-Vicenty IL, Frontera-Rodríguez M, García-Ferré A, Rivera BP, Cintrón-Vélez G, Frontera-Rodríguez S. Muscle and Bone Mass Loss in the Elderly Population: Advances in diagnosis and treatment. J Biomed (Syd). 2018;3:40-49.
- ↑ 20.0 20.1 Liu CK, Leng X, Hsu FC, et al. The impact of sarcopenia on a physical activity intervention: the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P) J Nutr Health Aging. 2014;18(1):59–64.
- ↑ Johnston AP, De Lisio M, Parise G. Resistance training, sarcopenia, and the mitochondrial theory of ageing. Appl Physiol Nutr Metab. 2008 Feb;33(1):191-9.
- ↑ Han J, Waddington G, Adams R, Anson J, Liu Y. Assessing proprioception: A critical review of methods. J Sport Health Sci. 2016 Mar;5(1):80-90.
- ↑ 23.0 23.1 23.2 23.3 23.4 Chu VWT. Assessing Proprioception in Children: A Review. J Mot Behav. 2017 Jul-Aug;49(4):458-466.
- ↑ 24.0 24.1 Yang N, Waddington G, Adams R, Han J. Joint position reproduction and joint position discrimination at the ankle are not related. Somatosens Mot Res. 2020 Jun;37(2):97-105.
- ↑ 25.0 25.1 25.2 25.3 Ferlinc A, Fabiani E, Velnar T, Gradisnik L. The Importance and Role of Proprioception in the Elderly: a Short Review. Mater Sociomed. 2019 Sep;31(3):219-221.
- ↑ Coto J, Alvarez CL, Cejas I, Colbert BM, Levin BE, Huppert J, Rundek T, Balaban C, Blanton SH, Lee DJ, Loewenstein D, Hoffer M, Liu XZ. Peripheral vestibular system: Age-related vestibular loss and associated deficits. J Otol. 2021 Oct;16(4):258-265.
- ↑ 27.0 27.1 27.2 Nnodim JO, Yung RL. Balance and its Clinical Assessment in Older Adults - A Review. J Geriatr Med Gerontol. 2015;1(1):003.
- ↑ Neuroscience News. Exploring Interoception: The Neuroscience of Internal Body Signals - Neuroscience News. Available from: https://www.youtube.com/watch?v=rms5I02Rzg0&t=39s [last accessed 23/3/2024]
- ↑ Lucas K, Todd P, Ness BM. A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Integumentary System. Int J Sports Phys Ther. 2021 Dec 1;17(1):74-80.
- ↑ 30.0 30.1 30.2 30.3 King A, Balaji S, Keswani SG. Biology and function of fetal and pediatric skin. Facial Plast Surg Clin North Am. 2013 Feb;21(1):1-6.
- ↑ Fluhr JW, Darlenski R, Lachmann N, Baudouin C, Msika P, De Belilovsky C, Hachem JP. Infant epidermal skin physiology: adaptation after birth. Br J Dermatol. 2012 Mar;166(3):483-90.
- ↑ Giusti F, Martella A, Bertoni L, Seidenari S. Skin barrier, hydration, and pH of the skin of infants under 2 years of age. Pediatr Dermatol. 2001 Mar-Apr;18(2):93-6.
- ↑ 33.0 33.1 33.2 33.3 Knaggs H, Lephart ED. Enhancing Skin Anti-Aging through Healthy Lifestyle Factors. Cosmetics. 2023; 10(5):142.
- ↑ Russell-Goldman E, Murphy GF. The Pathobiology of Skin Aging: New Insights into an Old Dilemma. Am J Pathol. 2020 Jul;190(7):1356-1369.
- ↑ Arlen AM, Nawaf C, Kirsch AJ. Prune belly syndrome: current perspectives. Pediatric Health Med Ther. 2019 Aug 6;10:75-81.
- ↑ Cerebral Palsy Digestive Issues and Health. Available from https://www.cerebralpalsyguidance.com/cerebral-palsy/associated-disorders/digestive-issues-and-health/ [last access 24.03.2024]
- ↑ Cresswell AG, Blake PL, Thorstensson A. The effect of an abdominal muscle training program on intra-abdominal pressure. Scand J Rehabil Med. 1994 Jun;26(2):79-86.
- ↑ Bajaj JS, Long M. Exploring GI Diseases Across the Lifespan. The American Journal of Gastroenterology 118(3):p 381-382, March 2023.
- ↑ 39.0 39.1 Trachsel D, Erb TO, Hammer J, von Ungern-Sternberg BS. Developmental respiratory physiology. Paediatr Anaesth. 2022 Feb;32(2):108-117.
- ↑ How are children different. Available from https://www.rch.org.au/trauma-service/manual/how-are-children-different/ [last access 25.3.2024]
- ↑ Romei M, Mauro AL, D’angelo MG, Turconi AC, Bresolin N, Pedotti A, Aliverti A. Effects of gender and posture on thoraco-abdominal kinematics during quiet breathing in healthy adults. Respiratory physiology & neurobiology. 2010 Jul 31;172(3):184-91.