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18.3: Objective Assessment

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    15684
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    An objective assessment with clearly defined parameters is essential, to formulate a patient specific rehab programme.

    Posture changes over time. Repeated incorrect posture over time becomes habitual progressing into a movement pattern. Poor spinal posture inhibits appropriate use of the core.

    Breathing habits as with posture, become habitual.

    The normal muscle ratio of breathing is mostly diaphragmatic with a smaller lateral thoracic component and the least from the thoracic apex. This becomes disordered and the normal bellows-action of the lungs, filling from the oxygenated bases rather than the apices, is compromised. The decrease in diaphragmatic work (often due to splinting) results in less efficient breathing. Furthermore, the core is loaded from the top leading to greater dysfunction.

    Abdominal wall

    The abdominal wall is assessed for skin changes, muscle tone and integrity, and myofascial trigger points (TPs). Many abdominal TPs will refer to the abdominopelvic area. Symptoms of pain and discomfort include vulvodynia, coccydynia, levator ani syndrome, vulvar vestibulitis, dyspareunia, vaginismus and pelvic floor tension myalgia.

    Visceral effects include frequency-urgency syndrome, interstitial cystitis and irritable bowel syndrome (IBS). TPs can exacerbate, and in extreme cases, cause pudendal neuralgia/nerve entrapment.

    Neurological testing of dermatomes is mandatory and if any abnormality is detected, warrants further testing of S24.

    External perineal examination

    Observations of skin, mucosa and scarring are noted. The movement relationship between the perineal body and PF is observed.

    Internal digital examination

    A digital vaginal exam is indicated in all patients except those who cannot give consent, and those who are not yet sexually active. The international guidelines are continually being updated to include qualitative measures. As with all assessments, quantitative outcomes are recorded.

    Palpation – anterior, lateral and posterior walls are assessed for laxity and movement in response to changes in IAP. Physiotherapists do not grade according to POPQ although should be familiar with the scale. Any areas of focal tenderness are explored as trigger points.

    Perfect Score

    The subject performs a maximal contraction against the therapist’s index finger. P records power according to a Modified Oxford Scale With a brief consistent rest between contractions, the following are assessed: E records endurance to a max of 10seconds at said power R records repetitions to a max of 10 repetitions at said power and endurance.

    After 1 minute rest:

    F records fast contractions to a max of 10 before fatigue ECT reminds us that every contraction is timed to formulate a patient specific formula Therefore: 4/8/4//7 records a good contraction, held for 8 seconds, repeated 4 times before fatigue; and after a minutes rest, 7 quick contractions before fatigue.

    Table \(\PageIndex{1}\): Muscle Testing - the modified Oxford Scale

    Score Response on fingers
    0 - nil Muscle bulk present/absent
    1 - flicker/very weak (min) Very weak/fluctuating
    2 - weak (poor) Increase in tension
    3 - moderate (reasonable) Lift
    4 - some strength (good) Lift + resistance
    5 - strong (max) Lift + strong resistance

    Initiation and stability

    The speed and control of initiation and the stability of the contraction are noted, along with any coupled movement and breathing patterns.

    Voluntary contraction – absent/ present

    Is the subject able to perform a satisfactory PFC?

    Involuntary contraction - absent/present

    Does the PF automatically kick-in with increased IAP?

    Voluntary relaxation - absent/ present

    Is the subject able to relax appropriately?

    Involuntary relaxation - absent/ present

    Does the PF relax with defaecation?

    Technique

    An overall assessment of the ease of activation and appropriate coactivation of the abdominopelvic unit is recorded. A strong PF contraction with breath-holding is non-functional and therefore needs rehab.

    QOL question

    A quality of life questionnaire allows the subject to self-grade. If you were to spend the rest of your life with your symptoms as they are now how would you feel?

    If indicated – spine, hip/pelvic girdle, myotomes, reflexes, sensation, biofeedback Behaviour

    Two consecutive days (48 hour) of behaviour are charted, be it fluid intaket/output or food diary. Symptoms (notably leakage) are noted.
    Score


    This page titled 18.3: Objective Assessment is shared under a CC BY-NC-SA 2.5 license and was authored, remixed, and/or curated by Stephen Jeffery and Peter de Jong via source content that was edited to the style and standards of the LibreTexts platform; a detailed edit history is available upon request.