Physiotherapy Assessment for Backbone Deformities
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Backbone Deformities Physiotherapy Assessment
Physiotherapy Assessment for Backbone Deformities
Family Name Profession/School Age
Diagram of affected sites Diagnosis Origin
Medical history
Main Problem Breathing capacity
Leg length difference: Height in sitting position: Height in standing position:
RISSER: Pain Yes / No where, when & how? Puberty Stage:
COBB ANGLE (for scoliosis): Patient’s goal:
Rib hump (for thoracic scoliosis):
Ilio-lumbar angle:
Scapulas position: Activity Level
Fitting: Sedentary Low Medium High
Other orthopaedic deformities:
Comments Balance with and Static sitting balance Good / Fair / Poor without compensation for hip tilt Standing balance Good / Fair / Poor
Muscular length/contractures
Muscles right Left
Hip Flexor (Psoas) Flexible / Flexible / Fixed Fixed Knee Extensor (Quadriceps) Flexible / Flexible / Fixed Fixed Knee Flexor (Hamstrings) Flexible / Flexible / Fixed Fixed Piriformis Flexible / Flexible / Fixed Fixed Quadratus lumburum Flexible / Flexible / Fixed Fixed Trapezius Flexible / Flexible / Fixed Fixed Pectoralis Flexible / Flexible / Fixed Fixed Shoulder internal rotators Flexible / Flexible / Fixed Fixed
Handicap international- Pakistan 2006 Backbone Deformities Physiotherapy Assessment
TRUNK
Abdominals: strength:
Paravertebral muscles: strength:
HIP
Adduction R L Abduction R L Flexion R L Extension R L
Degrees: Degrees: Degrees: Degrees: Strength: Strength: Strength: Strength:
Internal rotation R L External rotation R L
Degrees: Degrees: Strength: Strength:
KNEE
Extension R L Flexion R L
Degrees: Degrees: Strength: Strength:
ANKLE AND FOOT
Plantar flexion R L Dorsiflexion R L Supination R L Pronation R L
Degrees: Degrees: Degrees: Degrees: Strength: Strength: Strength: Strength: Handicap international- Pakistan 2006 Backbone Deformities Physiotherapy Assessment
SHOULDER
Abduction R L Adduction R L Flexion R L Extension R L
Degrees: Degrees: Degrees: Degrees: Strength: Strength: Strength: Strength:
External rotation R L Internal rotation R L
Degrees: Degrees: Strength: Strength:
COMMENTS:
Problem list 1. 2. 3.
Treatment Goals 1. 2. 3.
Treatment Plans 1.
2.
3.
4.
5.
6.
Handicap international- Pakistan 2006 Backbone Deformities Physiotherapy Assessment
Signature Date
Handicap international- Pakistan 2006