This will be a look and proceed case
- Look at patient AND around him
- Note walking aids/ wheel chair/ Orthoses (GRAFO)
- Observe if patient is sitting with head control (if has head control, it means this is not GMFCS 5)
- Walk - if possible
- Note the gait
- Diplegic = Sutherlands classification
- Hemiplegic = Winters classification
- Observe the use of walking aids
- Sit on edge of bed or remain on chair
- Look closely at the neck, palpate for any VP shunt tube
- Look at the chest for pacemaker like device - vagus nerve stimulator (VNS) for seizure control
- Look for any structural scoliosis from the back - comment it is sweeping or double curve [or ask patient lean forward]
- Lift up shirt to look for scars of correction even if no scoliosis
- Comment on pelvic obliquity
- Look at the Upper limbs while patient sitting
- Shoulder internal rotation,
- Hands - for hand in palm deformity
- Lie down supine [”I will examine patient from distal to proximal joints”]
- Ankle Joint / Foot
- Check mobility of ankle joint
- Look careful for scars for previous transfers
- Silverskoid test - positive
- Knee joint
- Check for knee contractures ➔ prepare for thomas test with leg off side of bed
- “Popliteal angle is x; Ideally, for each joint i am examining, I will examine the R1 which is the fast passive motion and R2 which is the slow passive motion to differentiate spasticity vs contracture, but due to time constraints, I will not do that now”
- Hip joint
- Thomas test
- Galeazzi test - to evaluate for shortening at femur to suggest posterior dislocation
- Lie down prone
- Craig’s test - expect femoral anteversion
- Offer to do Staheli test (practically difficult)
- Practically same test for hip flexion deformity as Thomas test, just opposite
- Prone, pelvis at edge and stabilised, angle between horizontal line and thigh is degree of hip flexion contracture [Normal 10-20 °]
- If unable to life down, then do the examination on Chair
- Hip Ideally to do Thomas test for FFD
- Gross Galeazzi - looking at the level of the patella, appears symmetrical, does not indicate gross posterior hip dislocation, unless both are affected
- Popliteal Angle - usually done prone with hip in 90 degrees - current in this position
- Phelp test while sitting
- Ideally to do duncan ely test, Craig’s test
- Complete my exam with
- Full neurological exam
- Assessing the patient’s function in his ADL
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