Virtual or Video-pGALS (V-pGALS)

V-pGALS aims to facilitate assessment in the context of remote / telehealth clinics.

V-pGALS includes amended / additional manoeuvres to pGALS derived from components of pREMS Hip and Spine.

The Table below lists V-pGALS components: * denotes the amends / additions to pGALS. 'TP' refers to a Telepresenter who may be a parent, carer or a health care professional.

The V-pGALS Table is available as a pdf download (checklist).

There is a pdf download V-pGALS to demonstrate the manoeuvres (graphic).

Further information about telehealth in paediatric rheumatology is provided and includes a link to a webinar and live demonstration of V-pGALS.

QUESTIONS

Any pain (joint/muscle/back) scale 0-10*

Any morning stiffness / Gelling [in minutes]*

Difficulty with dressing or undressing?

Difficulty walking or going up or downstairs?

GAIT

Standing posture: swelling, alignment, rash, deformity, wasting, posture, feet

Walk & turn, walk on heels, walk on tiptoe: ability, foot posture, limp

ARMS

Observation: nails, skin, muscles, deformity

Hold hands out straight: elbow, wrist, finger extension

Make a fist (*‘cat claw’/‘monkey paw’): supination, full flexion fingers

Pinch index finger & thumb: small finger joints, key grip strength

Touch individual fingers to thumb: small finger joints, dexterity,

TP to squeeze MCP joints*: tenderness grade (0-10)

Hands palm to palm / back to back: wrist flexion/extension

Reach arms up, head back: elbow, wrist, neck extension

Hands behind neck: shoulder abduction, external rotation

LEGS

Observation: nails, skin / soles, muscles, posture, alignment, leg length, flat feet

TP feels knee: at rest & on moving. Check for warmth, swelling, crepitus. If swollen ask TP if swelling feels soft (grape like) or hard (stone)?

TP assess movement of hips: leg roll* or prone lying*(‘X’/‘W’ leg position*)

TP assess range of movement knees: full extend and heel to buttock

Squat*: active knee flexion, restriction at ankle

Balance on tip toes*

1-leg stand*: balance, Trendelenberg

Sit cross legged & stand up*: fluency, balance, power

SPINE

Observation: skin, muscles, posture, normal lordosis, deformity

Touch ear to shoulder: cervical spine lateral flexion

Open mouth (1-3 fingers) & move jaw side-to-side*

Bend forward and touch toes

TP to assess sacroiliac joint tenderness [grade 0-10]*