Pediatric Osteopathic Examination

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Pediatric Osteopathic Examination

• American College of Osteopathic Pediatricians
• Robert Hostoffer, DO,FACOP, FAAP
• edited by
• Eric Hegybeli, DO, FACOP

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1 General Appearance

• Include assessment of cranium
• Visually
• Palpation
• Evaluate Body Symmetry

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2 Gait Assessment

• General assessment
• Also to include
• Heel to toe
• Tip toe
• Heel walk

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Heel to toe
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Demonstrate the procedure on patient in front of
director
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Tip toe
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Demonstrate the procedure on patient in front of
director
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Heel walking
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Demonstrate the procedure on patient in front of
director
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3 Knee bend
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Demonstrate the procedure on patient in front of
director
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4 Balance
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Demonstrate the procedure on patient in front of
director
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5 Spine inspection
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Demonstrate the procedure on patient in front of
director
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Demonstrate the procedure on patient in front of
director
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7 Horizontal Plane Levelness
Posterior

• Physician stands behind patient, who is standing
  also
• Physician palpates posterior landmarks
  bilaterally
• Landmarks are mastoid processes, acromion
  processes, inf angle of scapula, iliac crests,
  PSISs, sup aspect of greater trochanters

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A few more slides would need to be inserted to
show how to assess all mentioned landmarks
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Assess symmetry of acromion processes
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Assess symmetry of inferior scapular angles
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Assess symmetry of PSISs
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Demonstrate the procedure on patient in front of
director
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8 Horizontal Plane Levelness
Anterior

• Physician stands on right side of patient, who is
  lying supine on the table
• Physician palpates anterior landmarks bilaterally
• Landmarks iliac crests, ASISs, pubic
  tubercles, medial malleoli
• It is important use the hip flop to level out
  the pelvis first, before assessing malleoli and
  leg length (see next slide)

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Hip Flop to level out pelvis
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Demonstrate the procedure on patient in front of
director
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9 Cervical Spine Testing
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Rotation
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Demonstrate the procedure on patient in front of
director
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Flexion/extension
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Demonstrate the procedure on patient in front of
director
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Side bending
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Demonstrate the procedure on patient in front of
director
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10 Thoracic Spine Testing
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Side bending
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Demonstrate the procedure on patient in front of
director
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Flexion/Extension
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Demonstrate the procedure on patient in front of
director
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ThoracoLumbar Rotation
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Demonstrate the procedure on patient in front of
director
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11 Standing Flexion Test (screen for leg or
pelvic dysfunction)
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12 Hip Drop Test (screens for lumbar or
thoracolumbar dysfunction)

• Add picture
• (see p 642 in Foundations text, 2nd ed)

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13 Pelvic Side Shift (screens for sacral
dysfunction)

• Add picture
• (see p 643 in Foundations text, 2nd ed)

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14 Palpate first rib

• Would add a picture of this assessment the
  physician stands behind the patient, puts fingers
  on superior aspect of shoulders/traps bilaterally
  and pulls them back so as to be able to palpate
  the superior aspect of the first rib and check
  for levelness, if one higher than the other.
• See p 643 in Foundations 2nd ed

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15 Palpate rib angles for tenderness

• See p644 in the Foundations text for illustration

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16 Palpate Ribcage motion

• Pump Handle Ribs (1-3)
• Bucket Handle ribs (4-10)
• Caliper ribs (11 12)

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Chest expansion (Pump Handle)
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Demonstrate the procedure on patient in front of
director
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Chest Expansion (Bucket Handle)
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Demonstrate the procedure on patient in front of
director
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Chest Expansion (Caliper Ribs)

• Insert picture of physician palpating ribs 11 12
  along the patients sides

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Demonstrate the procedure on patient in front of
director
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17 Hip movement (includes straight leg raise
test)
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Demonstrate the procedure on patient in front of
director
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Hip Movement
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Demonstrate the procedure on patient in front of
director
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Innervation Table
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Perform again the entire exam for your director.
Print the check list.
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Check list

• General appearance (including vault hold)
• Heel to toe
• Tip toe
• Heel walking
• Knee bend
• Balance
• Spine inspection
• Upper extremity screen
• Horizontal plane levelness
• (anterior/posterior)
• Cervical rotation
• Cervical flexion and extension

• Cervical sidebending
• Thoracic sidebending
• Thoracic flexion and extension
• ThoracoLumbar rotation
• Standing Flexion Test
• Hip Drop Test
• Pelvic Side Shift Test
• Palpate 1st Rib
• Palpate Rib Angles
• Chest expansion
• Hip flexion (Straight Leg Raise)
• Hip extension
• Hip abduction and adduction

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Certificate of Completion

• I, _________________________, successfully
  completed the Pediatric OMT Module on __ __ 20__
• Signatures
• Pediatric Resident ____________________
• Pediatric Residency Director____________
• ( Please print and give to program director.)

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Congratulations