Multiple Body System Analysis Across the Lifespan

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Introduction[edit | edit source]

Musculoskeletal System[edit | edit source]

The assessment of the functional capacity of the musculoskeletal system should be completed within the context of school, play, work, daily activities, and sport. Due to differences in the levels of reliability and validity for the functional tests, a combination of a questionnaire and a functional test appear to be the best instrument to assess functional capacity of the musculoskeletal system.[1] The following questionnairs are recommended:[1]

  • the Oswestry Disability Index
  • the Pain Disability Index
  • the Roland-Morris Disability Questionnaire
  • the Upper Extremity Functional Scale
Functional Tests for Musculoskeletal System Assessment
Children/Adolescents Adults Older people
Muscle strength

(Functional assessment to include sit to stand and stairs)

  • Maximal volitional muscular force, contractile velocity and muscular power are lower than adults.
  • Children recover faster than adults from high-intensity, short-term exercise.[2]
  • A 1-minute sit-to-stand (1MSTST) test to quantify exercise capacity measures how many times per minute an individual can stand up and sit on a chair standardised for height.). In ages 5-16, the median number of repetitions is 51-65 [3]
  • The Stair Climbing Tests (SCTs) reflect coordination ability.[4] The literature describes it in many ways. In one protocol, participants stood with both feet on the lower plateau of the device. The step-down manoeuvre is performed accordingly. The instructions included the following:[4]
    • Climb the four stairs as quickly as possible without running
    • Stand still on the upper plateau
    • Use the handrail if necessary.
 1MMSTST: ranges from 8.1(patient with stroke), 24 (advanced lung disease)[5] to 50 (healthy male adult)[6]
  • 1MMSTST in healthy older men and women aged 75-79 years ranges between 22-37 [7]
  • Difficulty in climbing stairs has been reported as a marker of functional decline that can lead to loss of independence
  • Older adults often report difficulty with stair climbing, and it is reported as one of the top five most difficult tasks to perform. [8]
  • Ability to climb stairs can help to assess hip and knee strength and stability [9]
  • "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".[10]
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]

  • 3rd rib site: approximately 2/8th
  • Xyphoid site: approximately 3/8th
  • 1/2 distance site: 4/8th

Pediatric:

  • 3rd rib site: approximately 1/8th
  • Xyphoid site: approximately 2/8th
  • 1/2 distance site: 3/8th


Chest wall measurement for vital capacity:[11]

  • From 1-1/2" to 4"
  • Become larger as the measurement moves lower on the chest wall
  • variable due to chest size

Spinal mobility:

  • Assessing over-lengthened vs tight muscle
  • 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[12]
  • Muscle weakness, abnormal positioning, and abnormal movement patterns may lead to abnormal spinal mobility. [12]
 Chest wall mobility:
  • 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

Spinal mobility:

Measurement in the standing position using the inclinometer technique:[13]

  • Lumbar flexion: the difference between thoracolumbar flexion and pelvic flexion measures.
  • Lumbar extension: arching the trunk backwards.
  • Right and left side-bending: a composite value of average side-bending.
 Chest wall mobility:
  • 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

Spinal mobility:

Measurement as for adults.

  • Lumbar extension had the greatest decrease in ROM with age due to abdominal and back muscle weakness, tightness of the hamstrings or a person's fear of losing balance during testing[14]
Pain
  • Children are not always able to indicate the localization of pain.
  • Children between three and seven years of age can articulate the intensity of pain.[15]
 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]
  • First, the patient is asked if they have pain. If 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).  
  • Finally, it is determined how the pain interferes with passive vs. active activities.
  • The Functional Pain Scale is "an effective way to assess pain in the elderly and has proven helpful in identifying changes in pain". [17]
Bone Mineral Density
  • Low bone mineral density (BMD)in early childhood is considered a greater risk for bone fractures.[18]
  • Physical activity and calcium and vitamin D intake are interventions that improve BMD in older children.[18]
  • Deficiencies in calcium, vitamin D, and BMD are common in adults with coeliac disease.[9]
  • Patients with chronic obstructive pulmonary diseases and on long-term corticosteroids are more prone to having decreased BMD.[9]
  • Patients with haemophilia or other bleeding disorders and patients who are on long-term anticoagulation present with a higher incidence of decreased BMD.[9]
  • Bone mineral density decreases with age.[19]
  • "By the age of 80, it is estimated that 40% of the muscle mass present at age 20 is lost."[20]
  • Osteopenia is a condition associated with bone mass loss.[20]
  • Osteopenia often progresses to osteoporosis.
  • Strength training can stimulate hypertrophy and increase muscle strength to counteract the loss of muscle mass.[21]
Core Stability
  • 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.
  • Core stability extends from the vocal folds on the top of the trunk to the pelvic floor on the bottom.[9]
 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 ability to coordinate movement with balance
    • Static and dynamic balance
  • Interoception
Functional Tests for Neurological System Assessment
Children/Adolescents Adults Older People
Proprioception
  • Difficulties with motor coordination and planning may be linked with difficulty in proprioception.[23]
  • Studies link poor proprioception to difficulties with handwriting.[23]
  • Poor proprioception has been linked to cerebral palsy, developmental coordination disorder, autism spectrum disorder, and children with joint hypermobility. [23]
  • Indirect Assessments of Proprioception include parents’ reports or clinician's observation checklist.[23]
  • Direct Assessments of Proprioceptive Function include The Sensory Integration and Praxis Test.[23]
  • Assessments of Proprioceptive Reflex confirm intact proprioceptive afferents.
 There are three main testing techniques for assessing proprioception in adults:
  • Threshold to detection of passive motion (TTDPM).
  • Joint position reproduction (JPR), known as joint position matching. [24]
  • Active movement extent discrimination assessment (AMEDA).[24]
  • Ageing is associated with a decline in proprioceptive function.[25]
  • Proprioception is required for normal functioning of the body during movements and in maintaining balance. [25]
  • Decline in proprioception due to ageing affects mobility and increase the risk of falls.[25]
  • Balance deficits are link to proprioceptive functions decline during the ageing process.[25]
Vestibular system
  • "Static balance is defined as the ability to sustain various positions of the contour line and the base of support."
  • 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.
  • 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 tests include low-beam walking test.
  • Vestibular signals impairment is associated with balance disorders and spatial disorientation in neurodegenerative diseases, including Alzheimer's and Parkinson's disease. [26]
  • Balance testing may include Romberg Test of Standing Balance on Firm and Compliant Support Surfaces.
    • Balance test on a foam-padded surface with eyes closed
  • 20-50% of older adults are diagnosed with balance impairment.[27]
  • 20 – 30% of older adults experience one or more falls annually.[27]
  • Ageing is associated with a decline in organ function, and the widespread presence of diseases in the balance control systems predisposes older adults to balance impairment.[27]
  • Function performance tests include postural activities and movements which occur in the course of everyday life:
    • Romberg Test
    • The uni pedal stance test (UST)
    • The four-square step test (FSST)
    • The timed up-and-go test
    • Functional reach test (FRT)

Interception[edit | edit source]

Interception is human's ability to perceive internal bodily states. It is our perception of internal body signals, influences our emotions, decision-making, and sense of self. This video explores the concept of interception:

For 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.

Gastrointestinal System[edit | edit source]

Cardiopulmonary System[edit | edit source]

Mental Health System[edit | edit source]

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ 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.
  2. ↑ Falk B, Dotan R. Child-adult differences in the recovery from high-intensity exercise. Exerc Sport Sci Rev. 2006 Jul;34(3):107-12.
  3. ↑ 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. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Kapoor E. Multiple Body System Analysis Across the Lifespan. Plus course 2024
  10. ↑ 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. ↑ 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. ↑ 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.
  13. ↑ Waddell G, Somerville D, Henderson I, Newton M. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17:617–28.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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. ↑ 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.
  19. ↑ 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. ↑ 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.
  21. ↑ Johnston AP, De Lisio M, Parise G. Resistance training, sarcopenia, and the mitochondrial theory of aging. Appl Physiol Nutr Metab. 2008 Feb;33(1):191-9.
  22. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
  26. ↑ 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. ↑ 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.
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