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