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