Neurology Edited by Professor Emeritus Desire' Dubounet, IMUNE

3.3 The Spine3.3a General Principles of MeasurementBecause small, inaccessible spinal joints do not readily lend themselves toexternal visual observation required by goniometric measurement,standard goniometric techniques for measuring spinal movement can behighly inaccurate. Furthermore, the mobility of spinal segments isconfounded by motion above and below the points of measurement. Forexample, forward hunching of the shoulders may increase the perceiveddegree of cervical flexion, unless the degrees of forward flexion of theshoulders is also measured. Hence, regional spinal motion is a compoundmotion, and it is essential to measure simultaneously motion of both theupper and lower extremes of that region. For this reason, measurementtechniques using inclinometers are necessary to obtain reliable spinalmobility measurements.Pain, fear, acute spasm, or neuromuscular inhibition maytemporarily decrease spinal movement. Acute spasm is a phenomenoninduced by recent overload and is a contraindication to the assessment ofimpairment of spinal mobility at that point in time. Impairment evaluationshould be performed when a person's condition has become static andwell-stabilized following completion of all necessary passive, surgical, andrehabilitative treatment, thus precluding measurement when acuteprocesses remain active. If acute spasm is observed by the examiner, itshould be noted in the report and the mobility measurements recorded forcomparison purposes only. The patient must be reexamined in a few daysor weeks when spasm has resolved, in order to obtain a valid mobilitymeasurement.Pain, fear of injury, or neuromuscular inhibition may also limitmobility by diminishing effort. Such limitations provide inaccurately lowand inconsistent mobility measurements, leading to improperly inflatedimpairment values. Reproducibility of abnormal motion is currently theonly known way to validate optimum effort. The examiner must take atleast three consecutive mobility measurements, which must fall within +/-10% or 5° (whichever is greater) of each other to be consideredconsistent. Measurements may be repeated up to six times untilconsecutive measurements fall within this guideline. However, ifinconsistency persists, the measurements are invalid and that portion ofthe examination is then disqualified.