Standard medical patient history

Standard medical patient history

for patients with paralyses

An individual orthosis for patients with paralyses is exclusively produced for its user. Body measurements, muscle strength, gait characteristics etc. are examples for patient related data determined during the medical patient history. Number and accuracy of the gathered data have a great effect on the orthosis.

In the online workshop for the standard medical patient history, we show all relevant steps. Use the standard orthotic treatment sheet for patients with paralyses to write down the data. It serves as basis for the Orthosis Configurator.

1 – Body Weight and Height

Step 1/2

Körpergewicht

Body weight

Determine the patient's body weight. Take foreseeable changings into consideration (e.g. weight gain by growth).

Step 2/2

Körpergröße

Body height

Determine the patient's body height. Take foreseeable changings into consideration (growth).

2 – Activity Level

Step 1/1

Activity Level

Activity Level

Evaluate the activity level together with your patient while already taking into consideration foreseeable changings: 1. Indoor walker 2. Restricted outdoor walker 3. Unrestricted outdoor walker 4. Unrestricted outdoor walker with high demands.

3 – Gait Characteristics

Step 1/2

Trendelenburg-Duchenne sign

Trendelenburg-Duchenne sign

Prüfen Sie im Einbeinstand die Kompensationsmechanismen nach Trendelenburg und Duchenne. Senkung des Beckens auf der nicht belasteten Seite = positives Trendelenburg-Zeichen. Neigung des Oberkörpers zur belasteten Seite = positives Duchenne-Zeichen.

Step 2/2

Bending forward of the upper body

Bending forward of the upper body

Bending forward the upper body shifts the body's centre of gravity further forward and therefore affects the orthosis. Make sure that the patient stands as upright as possible and, if applicable, adjust the height of orthopaedic appliances.

4 – Joint Angles

Step 1/3

Genu varum/genu valgum

Genu varum/genu valgum

Measure the maximum instability in genu varum or genu valgum as well as the corrected position.

Step 2/3

Genu recurvatum/flexion contracture in the knee

Genu recurvatum/flexion contracture in the knee

Measure the maximum genu recurvatum or the flexion contracture in the knee. Also measure the corrected position and make sure the knee angle is physiological.

Step 3/3

Flexion contracture in the hip

Flexion contracture in the hip

Apply the Thomas test to assess if the patient has a hip flexion contracture. The patient lies on the back. Bring the leg not to be tested into hip flexion with the knee bent. Place the other hand under the lumbar vertebrae to check the delordosing of the lumbar spine. Measure the hip flexion angle on the side to be tested.

5 – ap Measurement

Step 1/1

ap measurement at knee height

ap measurement at knee height

Determine the ap measurement with callipers.

6 – Range of Motion of the Upper Ankle Joint

Step 1/7

Pitch of the shoe

Pitch of the shoe

Determine the pitch (X) of the shoe (difference between heel height (A) and sole thickness (B) in ball area). Measure (A) and (B) and apply the formula X = A - B. Then, transfer the determined pitch to the h-Cast.

Step 2/7

Range of motion in the upper ankle joint considering the pitch of the shoe

Range of motion in the upper ankle joint considering the pitch of the shoe

Neutral position
The range of motion in the upper ankle joint is measured based on the neutral position. Place the patient on the h-Cast considering the shoe's pitch. If the patient is in his individual normal posture, you have determined the neutral position in the upper ankle joint.

Step 3/7

Range of motion in the upper ankle joint considering the pitch of the shoe

Range of motion in the upper ankle joint considering the pitch of the shoe

Based on the neutral position, measure the range of motion of the upper ankle joint in dorsiflexion and plantar flexion.

Step 4/7

Leg length discrepancy

Leg length discrepancy

Place the patient on the h-Cast and determine the effective leg length discrepancy. Control the result by using e.g. a laser plumb bob. The plumb bob should fall from the 7th cervical vertebra (C7) through the cleft between the buttocks and the middle of the supportive area of both feet.

Step 5/7

Range of motion in the upper ankle joint considering the leg length compensation and the pitch of the shoe

Range of motion in the upper ankle joint considering the leg length compensation and the pitch of the shoe

Neutral position
The range of motion in the upper ankle joint is measured based on the neutral position. Place the patient on the h-Cast considering the leg length compensation and the shoe's pitch. If the patient is in his individual normal posture, you have determined the neutral position in the upper ankle joint.

Step 6/7

Range of motion in the upper ankle joint considering the leg length compensation and the pitch of the shoe

Range of motion in the upper ankle joint considering the leg length compensation and the pitch of the shoe

Based on the neutral position, measure the range of motion of the upper ankle joint in dorsiflexion and plantar flexion.

Step 7/7

Rolling off line

Rolling off line

The rolling off line of the foot shifts posteriorly because of e.g. a unilateral height compensation which leads to a shortened forefoot lever. Make sure to compensate this fact when producing the orthosis.

7 – Muscle Strength Foot

Step 1/11

Muscle Strength Foot

Step 2/11

Dorsiflexion muscle strength 5 and 4

Dorsiflexion muscle strength 5 and 4

The patient lies on the stomach, the foot of the leg to be tested hangs over the edge of the bed. Steady the lower leg with one hand and push against the dorsum of the foot with the other hand. Have the patient bring the foot in dorsiflexion. At complete range of motion against gravity with full resistance, the muscle strength is 5. At complete range of motion against gravity with some resistance, the muscle strength is 4.

Step 3/11

Dorsiflexion muscle strength 3

Dorsiflexion muscle strength 3

The patient sits, the lower legs hang over the edge of the bed. Steady the lower leg with one hand. Have the patient bring the foot in dorsiflexion. At complete range of motion against gravity, the muscle strength is 3.

Step 4/11

Dorsiflexion muscle strength 2

Dorsiflexion muscle strength 2

The patient lies on the side of the leg to be tested. Place one hand under the foot so that is does not rest on the bed anymore. Have the patient bring the foot in dorsiflexion. At complete range of motion with gravity eliminated, the muscle strength is 2.

Step 5/11

Dorsiflexion muscle strength 1 and 0

Dorsiflexion muscle strength 1 and 0

The patient lies on the side of the leg to be tested. Place one hand under the foot so that is does not rest on the bed anymore. Have the patient bring the foot in dorsiflexion. Palpate if there is any muscle activity. At slight contraction with no joint motion, the muscle strength is 1. At no evidence of contraction, there is a total paralysis and the muscle strength is 0.

Step 6/11

Step 7/11

Toe stance

Toe stance

Check if the patient is able to lift the own body weight up to the tiptoes (standing on one leg) on the leg to be tested. He can lean on something or you help him. Have the patient repeat the process either for about 15 times or hold the toe stance for about 30 seconds. Only if that is possible can you select Yes. If the patient is not able to do either of those, select No.

Step 8/11

Plantar flexion muscle strength 5 and 4

Plantar flexion muscle strength 5 and 4

The patient lies on the stomach, the foot of the leg to be tested hangs over the edge of the bed. Steady the distal lower leg with one hand. Push against the toes from below with the other hand. Have the patient bring the foot in plantar flexion. At complete range of motion against gravity with full resistance, the muscle strength is 5. At complete range of motion against gravity with some resistance, the muscle strength is 4.

Step 9/11

Plantar flexion muscle strength 3

Plantar flexion muscle strength 3

The patient lies on the stomach, the leg to be tested is slightly flexed. Have the patient bring the foot in plantar flexion. At complete range of motion against gravity, the muscle strength is 3.

Step 10/11

Plantar flexion muscle strength 2

Plantar flexion muscle strength 2

The patient lies on the side of the leg to be tested. Place one hand under the foot so that is does not rest on the bed anymore. Have the patient bring the foot in plantar flexion. At complete range of motion with gravity eliminated, the muscle strength is 2.

Step 11/11

Plantar flexion muscle strength 1 and 0

Plantar flexion muscle strength 1 and 0

The patient lies on the side of the leg to be tested. Place one hand under the foot so that is does not rest on the bed anymore. Have the patient bring the foot in plantar flexion. Palpate if there is any muscle activity. At slight contraction with no joint motion, the muscle strength is 1. At no evidence of contraction, there is a total paralysis and the muscle strength is 0.

8 – Muscle Strength Knee

Step 1/10

Muscle Strength Knee

Step 2/10

Knee extension muscle strength 5 and 4

Knee extension muscle strength 5 and 4

The patient sits, the lower legs hang over the edge of the bed. Steady the thigh with one hand. Push against the lower leg above the foot with the other hand. Have the patient bring the knee in extension. At complete range of motion against gravity with full resistance, the muscle strength is 5. At complete range of motion against gravity with some resistance, the muscle strength is 4.

Step 3/10

Knee extension muscle strength 3

Knee extension muscle strength 3

The patient sits, the lower legs hang over the edge of the bed. Steady the thigh with one hand. Have the patient bring the knee in extension. At complete range of motion against gravity, the muscle strength is 3.

Step 4/10

Knee extension muscle strength 2

Knee extension muscle strength 2

The patient lies on the side of the leg not to be tested. Support and lift the upper leg. Steady the pelvis with the other hand. The leg to be tested is slightly flexed. Have the patient bring the knee in extension. At complete range of motion with gravity eliminated, the muscle strength is 2.

Step 5/10

Knee extension muscle strength 1 and 0

Knee extension muscle strength 1 and 0

The patient lies on the back, the leg to be tested is slightly flexed in hip and knee. The other leg remains extended. Have the patient bring the knee in extension. Palpate if there is any muscle activity. At slight contraction with no joint motion, the muscle strength is 1. At no evidence of contraction, there is a total paralysis and the muscle strength is 0.

Step 6/10

Muskelstatus Knieflexion

Step 7/10

Knee flexion muscle strength 5 and 4

Knee flexion muscle strength 5 and 4

The patient lies on the stomach, one foot hangs over the edge of the bed and the leg to be tested is flexed. Steady the thigh with one hand. Push against the foot with the other hand. Have the patient bring the knee in flexion. At complete range of motion against gravity with full resistance, the muscle strength is 5. At complete range of motion against gravity with some resistance, the muscle strength is 4.

Step 8/10

Knee flexion muscle strength 3

Knee flexion muscle strength 3

The patient lies on the stomach, one foot hangs over the edge of the bed and the leg to be tested is flexed. Steady the thigh with one hand. Have the patient bring the knee in flexion. At complete range of motion against gravity, the muscle strength is 3.

Step 9/10

Knee flexion muscle strength 2

Knee flexion muscle strength 2

The patient lies on the side of the leg not to be tested, the upper leg is slightly, the leg below strongly flexed. Support and lift the upper leg. Steady the pelvis with the other hand. Have the patient bring the knee in flexion. At complete range of motion with gravity eliminated, the muscle strength is 2.

Step 10/10

Knee flexion muscle strength 1 and 0

Knee flexion muscle strength 1 and 0

The patient lies on the stomach, one foot hangs over the edge of the bed and the leg to be tested is slightly flexed. Support the flexed leg with one hand. Have the patient bring the knee in flexion. With the other hand, palpate if there is any muscle activity. At slight contraction with no joint motion, the muscle strength is 1. At no evidence of contraction, there is a total paralysis and the muscle strength is 0.

9 – Muscle Strength Hip

Step 1/10

Muscle Strength Hip

Step 2/10

Hip flexion muscle strength 5 and 4

Hip flexion muscle strength 5 and 4

The patient lies on the back, the legs hang over the edge of the bed. Steady the pelvis with one hand. Push against the leg near the knee with the other hand. Have the patient bring the hip in flexion. At complete range of motion against gravity with full resistance, the muscle strength is 5. At complete range of motion against gravity with some resistance, the muscle strength is 4.

Step 3/10

Hip flexion muscle strength 3

Hip flexion muscle strength 3

The patient lies on the back, the legs hang over the edge of the bed. Steady the pelvis with one hand. Have the patient bring the hip in flexion. At complete range of motion against gravity, the muscle strength is 3.

Step 4/10

Hip flexion muscle strength 2

Hip flexion muscle strength 2

The patient lies on the side of the leg not to be tested, the leg to be tested is slightly flexed in hip and knee. Support and lift the upper leg. Steady the pelvis with the other hand. Have the patient bring the hip in flexion. At complete range of motion with gravity eliminated, the muscle strength is 2.

Step 5/10

Hip flexion muscle strength 1 and 0

Hip flexion muscle strength 1 and 0

The patient lies on the back, hip and knee are slightly flexed. Support the flexed knee with one hand. Have the patient bring the hip in flexion. With the other hand, palpate if there is any muscle activity. At slight contraction with no joint motion, the muscle strength is 1. At no evidence of contraction, there is a total paralysis and the muscle strength is 0.

Step 6/10

Muskelstatus Hüftextension

Step 7/10

Hip extension muscle strength 5 and 4

Hip extension muscle strength 5 and 4

The patient lies on the stomach, the feet hang over the edge of the bed. Steady the pelvis with one hand. Push against the thigh with the other hand. Have the patient bring the hip in extension. At complete range of motion against gravity with full resistance, the muscle strength is 5. At complete range of motion against gravity with some resistance, the muscle strength is 4.

Step 8/10

Hip extension muscle strength 3

Hip extension muscle strength 3

The patient lies on the stomach, the feet hang over the edge of the bed. Steady the pelvis with one hand. Have the patient bring the hip in extension. At complete range of motion against gravity, the muscle strength is 3.

Step 9/10

Hip extension muscle strength 2

Hip extension muscle strength 2

The patient lies on the side of the leg not to be tested, the upper leg is slightly, the leg below strongly flexed. Support and lift the upper leg. Steady the pelvis with the other hand. Have the patient bring the hip in extension. At complete range of motion with gravity eliminated, the muscle strength is 2.

Step 10/10

Hip extension muscle strength 1 and 0

Hip extension muscle strength 1 and 0

The patient lies on the stomach. Have the patient bring the hip in extension. Palpate if there is any muscle activity. At slight contraction with no joint motion, the muscle strength is 1. At no evidence of contraction, there is a total paralysis and the muscle strength is 0.