Skip to 0 minutes and 5 secondsThe head to toe assessment gives us the opportunity to gather clues from the physiological presentation of the patient. This first video clip covers the initial meeting with the patient, observation of gait and balance and also spinal assessment. Whilst your watching consider which health conditions may be diagnosed from these first observations. As he walks into the room I am noting his general appearance, watching his gait and noticing any physical abnormalities. Hello, I’m Nicky. I’m going to be doing a head to toe assessment of you today. That will involve lifting up some clothing, you doing some movements and me doing a physical examination on you, is that OK? That’s fine.

Skip to 0 minutes and 58 secondsLovely, if you have a seat for a second I’ll just go and wash my hands. Sure

Skip to 1 minute and 11 secondsBefore we start the physical examination of the patient we need to ensure that we are not compromising infection control. We either wash our hands thoroughly or use alcohol gel the choice depends on your situation in hospital or clinic or surgery or in the patient's home either way ensure your hands are thoroughly clean and dry before touching the patient.

Skip to 1 minute and 47 secondsNow, can I ask you a few questions? Can you confirm your name and date of birth please? Yes, it’s John Smith and my date of birth is 29 March 1985. That’s lovely, thank you. And can you tell me what date it is and what year? It’s the 20 June Wednesday 2018. Lovely, thank you. And where are we at this moment. At Coventry Hospital. Excellent. Thank you. If I was concerned with the patient’s mental status or the ability to give consent I would do a full mini mental test at this point. Right, we can go onto the physical examination now. Would you like to stand up for me please?

Skip to 2 minutes and 25 secondsFirst of all I am going to test your balance, so if you stand for me here I want you to stand with your feet together and close your eyes and I will be here to make sure that you don’t wobble. I will observe the patient for excessive swaying for one minute. That’s lovely, you can open your eyes thank you. If you stand now with your feet shoulder width apart and put your hands up with your palms facing up. Lovely, now close your eyes again for me. I am observing for palmar drift. This can take up to 30 seconds and is a sign of an upper motor neuron problem.

Skip to 3 minutes and 5 secondsNow you can open your eyes, bring your wrists up to flexed, that’s smashing. And just hold them like that for a few seconds. I am looking for liver flap or asterixis which is a sign of carbon dioxide retention or liver failure. That’s excellent, thank you, you can put your arms down. I’m just going to go round the back and examine your spine. So I am going to press on various bits of your spine, I want you to tell me if it hurts at any point. I am looking for any obvious issues with spinal alignment such as kyphosis, scoliosis or lordosis. Also I want to elicit any spinal pain before I ask the patient to do any movements. Any pain anywhere?

Skip to 3 minutes and 49 secondsNo. Right, lovely. You don’t have any back problems at all. No, none at all. Or neck? No. Lovely. I just want you to run through a few movements with me. If you copy my movements. Sure. So if you bend down towards your toes, lovely. If you bend back to look at the ceiling and then come back upright again, bring your hand down your side of your leg towards your knee and the other side towards your knee. I am observing for any restriction of movement due to pain or abnormality. That’s smashing, thank you. Lovely, have a seat

Head to toe (part 1)

In this section we demonstrate the full head-to-toe examination in six video sections.

Before you start watching, we encourage you to print the head to toe assessment mark sheet available in the Downloads section below and follow this as you watch.

This first video (1/6), covers the initial meeting with the patient, observation of gait and balance, and spinal assessment.


Your task

Consider which health conditions may be diagnosed in these first few observations.

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This video is from the free online course:

An Introduction to Physical Health Assessment

Coventry University