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PT 142: Assessment in Physical Therapy Laboratory Session Anthropometric Measurements Edited for instruction by: GILBERT O. MADRIAGA, PTRP Minerva Zaniebeth A. Gomez, PTRP Kristofferson G. Mendoza, PTRP Gilbert O. Madriaga, PTRP All Rights Reserved 2008 Authors Obectives At the end of the session, the student will be able to: Describe the general principles and methods of anthropometry Determine the relevant anthropometric characteristic needed to be measured given a sample case On a simulated patient, perform correctly and efficiently the following anthropometric characteristics commonly seen in the clinics: limb girth, muscle bulk, leg length, head circumference Obectives Select the proper landmarks given a specific anthropometric measurement Use and manipulate anthropometric tools correctly and efficiently Discuss the probable significance of anthropometric findings Record anthropometric findings accurately using clear and understandable language in an acceptable format Obectives Report correctly results of anthropometric measurements to a simulated patient Identify other anthropometric measurements for edema or swelling General Principles and Methods What is anthropometry? ANTROPO - human METRY - measurement What is anthropometry? The study of human dimensions The measurement of traits that describe body dimensions What is anthropometry? The physical measurement of the human body which provides therapists with building blocks for understanding the complexities of the human form and how it interfaces with the environment What to measure? In physical therapy, anthropometry may include the assessment of Edema Localized swelling Joint effusion Muscular changes Asymmetry of body parts Effects of surgical procedures Why measure? Aids the clinician in determining the patients impairments and in providing the appropriate treatment Provides a baseline to monitor the rehabilitation outcome effective treatment vs. patient deterioration Why measure? Provides feedback and motivation to patients Aids in designing equipment and materials for special population such as children, elderly and the differently-abled Why measure? Also provides important information in the design of objects and spaces used by the normal population (i.e. ergonomics) Types of Measurement Static Anthropometry Refers to actual sizes of body components, and is taken with the body fixed or in standard positions Types of Measurement Dynamic Anthropometry Refers to the ability of the body to perform certain tasks with certain distances, spaces or enclosure Taken with the body in various working positions and is related to body performance Factors Affecting Anthropometry Gender Males have less fat tissue and more muscle bulk Fat accumulation difers in reions for men and women Aging Stature decreases and body weight increases after 30 years Body weight decreases after 50 (M), 60 (F) Factors Affecting Anthropometry Ethnicity Lower body weights for those who live in tropical countries Body proportions differ depending on ethnicity Differences diminish due to migration Occupation Some occupations are self-selective Factors Affecting Anthropometry Tools Tape measure Steel tape Volumeter Anthropometer Caliper Using the Tape Measure Measure in centimeters Lie the tape measure flat on the body part The tape measure should be stretched out and not slack If the segment to be measured is irregular or conical in shape, the proximal part of the tape should be flat When measuring circumference, surround the body part without undue constricting pressure Measurements Commonly Performed in the Clinics Leg Length Measurement Indications postural deviations gait deviations checking for leg length discrepancy True leg length discrepancy vs. Apparent leg length discrepancy True Leg Length Measurement Position Supine with the legs 15-20 cm apart (4-8 in) and parallel to each other Pelvis is balance or in level with lower limbs Abduction / adduction contracture? Landmarks ASIS to lateral malleolus ASIS to medial malleolus affected by muscle wasting, obesity or knee deformities True Leg Length Measurement Values A difference of 1 to 1.5 cm is still considered normal but may still cause symptoms Validity and Reliability Valid and reliable in measuring leg length discrepancy (Beattie, 1990) Increase reliability by getting the mean of two measurements Potential sources of error: muscle bulk and palpation Apparent Leg Length Measurement Position same as true leg length measurement Landmarks tip of xiphisternum or umbilicus to medial malleolus affected by muscle wasting, obesity or asymmetric positioning the xiphisternum, umbilicus or the lower limb True Leg Length Measurement Values If true leg length measurement is normal but the umbilicus to malleolus is different, then a functional leg length discrepancy is present Segmental Leg Length Measurement Landmark: to determine the site of occurrence of shortening highest point of the iliac crest to greater trochanter for changes in neck shaft angle greater trochanter to lateral knee joint line for femoral shaft length medial knee joint line to medial malleolus for tibial length Leg Length Measurement Muscle Bulk Measurement Indications conditions where a decrease (or increase) in muscle bulk is expected Atrophy (SCI, fractures, CVA) Hypertrophy (Duchene muscular dystrophy) Muscle Bulk Measurement Position Supine or sitting provided that the segment be assessed is well supported Note: If the affectation is unilateral, measure the uninvolved extremity prior to measuring the affected part. The muscles should be at rest when muscle bulk is measured Muscle Bulk Measurement Landmarks Identify a stable bony landmark at the proximal part of the segment to measured (1) Identify the area of the segment where the muscle bulk is the greatest (2) Measure the distance between (1) and (2). Record this as the measurement landmark. Muscle Bulk Measurement Procedure Measure the circumference of the segment around the identified measurement landmark. Measure the other extremity using the same landmarks Limitation Individual muscles cannot be measured Limb Girth Measurement Indications Swelling Joint effusion Edema Limb Girth Measurement: Swelling / Joint effusion Position Supine or sitting provided that the segment be assessed is well supported Landmarks Identify a stable bony landmark closest to the area of swelling Limb Girth Measurement: Swelling / Joint effusion Procedure Measure the circumference of the segment around the identified measurement landmark Measure every 4 cm (2 inches) proximally or distally depending on the extent of the swelling Measurement should extend beyond the obviously involved area in both directions if at all possible Limb Girth Measurement: Swelling / Joint effusion Procedure Measure the other extremity using the same landmarks to compare Measurement should preferably be from a point of zero difference to another point of zero difference Limb Girth Measurement: Edema Position Supine or sitting provided that the segment be assessed is well supported Limb Girth Measurement: Edema Edema up to… Landmarks …fingers base of the fingers PIPs (together) 2nd & 5th digits as reference DIPs (together) 2nd & 5th digits as reference The previous landmarks plus… MCPs thumb webline wrist joint (radial styloid) The previous landmarks plus… The radial styloid then measure every 4 cm (2 inch) proximally …wrist …elbow Limb Girth Measurement: Edema Edema up to… Landmarks …shoulder The previous landmarks plus… The lateral epicondyle then measure every 4 cm (2 inch) proximally Limb Girth Measurement: Edema Edema up to… Landmarks …toes base of the toes PIPs (together) 2nd & 5th digits as reference DIPs (together) 2nd & 5th digits as reference …ankle The previous landmarks plus… The MTP then measure every 4 cm (2 inch) proximally The previous landmarks plus… The lateral malleolus then measure every 4 cm (2 inch) proximally …knee Limb Girth Measurement: Edema Edema up to… Landmarks …hip The previous landmarks plus… The lateral knee joint then measure every 4 cm (2 inch) proximally Head Circumference Indications Hydrocephalus Microcephalus Head Circumference Position Supine or sitting provided that the patient is able to maintain the head upright Landmarks Inion (external occipital protuberance) to the forehead just above the supraorbital ridge Head Circumference Values at birth 35 cm (13.8 inches) 1 year 33% increase 6 years 50% increase 10 years twice from birth Head Circumference Values at birth 35 cm Normal caucasian 1st 4 months plus 0.5 inch per month 5 to 12 months plus 0.25 inch per month 2 years plus 1 inch per whole year or plus 0.25 inch per 3 months 3 to 5 years plus 0.5 inch per year 6 to 20 years plus 0.5 inch per 5 year Other anthropometric measures Volumetric Displacement For edema and swelling Uses a volumeter Patient dips the extremity in the volumeter filled with water while the therapist takes note of the amount of water displaced Highest reliability and validity among measures of edema/swelling Clinics don’t usually have volumeters Static Measurements Indication Usually for ergonomics Position Standing Person stands erect and looks straight ahead, with arms in relaxed position on the side Static Measurement Position Seated Person sits erect and looks straight ahead. Thighs are parallel to the floor, and the knees are bent to 90 degrees flat on the floor. Upper arm is relaxed and perpendicular to the horizontal plane, while forearm is at a right angle to the upper arm Measurements are done using a horizontal reference point, ground, seat, vertical reference point Antrhopometer Static Measurement Conventions Height – vertical measurement Length – horizontal measurements in the sagittal plane Breadth – horizontal measurements in the coronal plane Static Measurement Most Common Measurements Stature Eye height Shoulder height Elbow height Hip height Knuckle height Sitting height Sitting eye height Sitting shoulder height Shoulder elbow height Thigh thickness Buttock-knee length Buttock-popliteal length Knee height Popliteal height Shoulder breadth Hip breadth Hip breadth Shoulder-elbow length Elbow-fingertip length Static Measurement Most Common Measurements Upper limb length Shoulder-grip length Standing vertical grip reach Sitting vertical grip reach Dynamic Measurement Rapid Upper Limb Assessment (RULA) – survey method developed for use in ergonomic investigations of workplaces where work related upper limb disorders are reported. screening tool that assesses biomechanical and postural loading on the whole body with particular attention to the neck, trunk and upper limbs. Steps Step 1 Observing and selecting the posture(s) to assess A RULA assessment represent a moment in the work cycle. Step 2 Scoring and recording the posture Decide whether the left, right or both upper arms are to be assessed. Longest held versus the worst posture www.rula.co.uk Step 3 Action Level At risk to MSD’s? Assembly line Thank You