4/7/2016 Skeletal 

Integrity — Guide to Phys. Therapist Prac.

Skeletal Integrity

Skeletal integrity is the optimal alignment, density, and soundness of the bony structures of the body.

The physical therapist uses tests and measures to assess an individual's risk for decreased bone mineral density
(BMD), bony malformations, and abnormal bony movements.

Examples of Clinical Indications:

Risk factors for impaired skeletal integrity

Chronic illness history

Habitual suboptimal posture

Long periods of bed rest

Poor nutrition or malabsorptive disorders

Recent fall or injury

Health, wellness, and တtness needs

Fitness, including physical performance (eg, limited performance of recreational activities,

decreased weight-bearing activities as part of normal routine)

Health and wellness (eg, decreased bone density as part of aging)

Pathology or health condition

Musculoskeletal (eg, osteopenia, osteoporosis, osteogenesisimperfecta)

Neuromuscular (eg, cerebral palsy [CP], spina biတda)

Pulmonary (eg, cystic တbrosis [CF])

Multisystem (eg, rheumatoid arthritis [RA])

Impairments of body functions and structures

Muscle performance (eg, weakness, imbalance)

Posture (eg, severe kyphosis, back pain)

Range of motion (eg, decreased shoulder range of motion)

Skeletal integrity (eg, edema, excess bony movement not at a joint)

Ventilation (eg, limited or asymmetrical thoracic expansion)

Activity limitations and participation restrictions

Self-care (eg, di†culty donning and do†ng shoes and socks due to limited and painful spinal
range of motion)

Domestic life (eg, inability to do laundry due to dyspnea)

Education life (eg, inability to sit at a computer workstation due to painful head and neck
postures)

Work life (eg, inability to stand at a counter due to low back pain)

Community, social, and civic life (eg, inability to participate in community ballet due to acute foot
pain)

Examples of What Tests and Measures May Characterize or Quantify:

Signs of decreased BMD (eg, height measurements, posture changes) Speciတc Tests and
Measures in PTNow

Signs and symptoms of interrupted bony integrity (eg, erythema, pain, edema, point tenderness
at mid-sections of long bones) Speciတc Tests and Measures in PTNow

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4/7/2016 Skeletal Integrity — Guide to Phys. Therapist Prac.

Examples of Data-Gathering Tools:

Cameras and photographs

Goniometers

Palpation

Plumb lines

Posture grids

Tape measures

Examples of Data Used in Documentation:

Descriptions of bony alignment and symmetry

Edema

Erythema

Extremity girth compared with contralateral side

Postural measurements, including alignment of bony structures

Postural alignment using posture grids

Last updated August 1, 2014.

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