Transcript Limb Girth Measurement

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
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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
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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