Video 2: Wall-to-occiput distance (WOD) & rib-pelvis distance

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Lesson 15: Balance and falls risk assessment in an older person with osteoporosis and aggressive behaviour  Video content Video 2: Wall-to-occiput distance (WOD) & rib-pelvis distance

The anamnesis should usually cover issues related to body height. The difference in height can be analyzed with respect to the changes that take place over the course of 1 year (a decrease in body height of more than 0.5 cm means a risk of fracture, a decrease in body height of more than 1 cm means a risk of fracture) Another option is to calculate the Historical Height Loss (HHL), during which a 5 cm decrease compared to peak height increases the risk of falling eightfold. 

Additional options for identifying hidden vertebral fractures and postural deterioration: 

Wall-to-occiput distance (WOD): 

Because postural compensatory changes may be present, it is important to measure the upper back. During the examination, the patient stands close to the wall so that: his back and heels rest against the wall, his head looks forward. The examiner measures the distance between the wall and the occipital protuberance. 

A WOD greater than 5 cm indicates a vertebral fracture of the thoracic spine and an increase in kyphosis. 

The average distance  

over the 3 trials was used to categorize the participants into 3 groups according severity of kyphosis, including mild  

(≤5.0 cm), moderate (5.1–8.0 cm), and severe (>8.0 cm) 

The average distance over the 3 trials was used to categorize the participants into 3 groups according severity of kyphosis, including mild (≤5.0 cm), moderate (5.1–8.0 cm), and severe (>8.0 cm) 

Another method for estimating the size of kyphosis is the rib-pelvis distance: during the examination, the vertical distance between the lower edge of the eleventh rib and the upper surface of the iliac crest is measured in the armpit line. Two finger widths or less means a positive test. 

Vertebral fractures of the lumbar spine can cause postural changes and compensations. 

The distance between the ribs and the pelvis (iliocostal distance) can be easily measured. During the measurement: positioned behind the patient, after palpating the lower ribs and the iliac crest, determine the vertical distance in the midline of the armpit (with a centimeter tape or finger width). 

An RPD smaller than 2 fingers or 3.6 cm indicates a vertebral fracture in the lumbar spine. 

The test can also be used for follow-up to identify changes in posture. 

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