APA prac 1 Flashcards
step by step guide according to rubric
-Set up environment & safety (breaks, stoppers, not only socks etc.)
-Introduction of self/role & sanitise
“My role as a physio is to assess, diagnose & treat a range of conditions… like how you have come in today for ???”
“I am here to help and offer my assistance as we work together to get you back to feeling your healthiest and best self!”
-Patient condition explanation - empathy link
-Intervention explanation & benefits (justify WHY)
-Opportunity to ask Qs consent & removal of clothing if required (acknowledge sensitive topics with caution)
-Contraindications
-Assessment with confidence
-Feedback
consent EX
Q1 do you understand what I’ve said?
Q2 do you have any questions
Q3 are you happy to proceed on that basis?
“see you’ve injured your _____, need to examine this area along with the structure around it. Therefore, do you mind changing into shorts?”
steps for massage
- Intro/consent - what, how, why, continue?
- consent for expose of area
- Assess before treatment intervention
- Make sure client is comfortable & appropriate use of towels
-Explain the placement of towel & its reasoning to client - to avoid clothing getting dirty - Ask client if they are sensitive if using a certain cream/oil
- Apply treatment intervention
-Tell the patient what you’re doing and why
-Constantly ask Qs & give feedback
-Pain or discomfort? - be careful getting up
-dizziness
-leave time to get changed
“Your skin looks good - no signs of any infection”
“do you have any allergies, I plan on using ____”
Consent
Ask for feedback throughout
“see you’ve injured your _____, need to see this area along with the structure around it. Therefore, do you mind changing into shorts?”
If the question indicates a condition and asks for test-retest, yes. If not, then you do not have to.
contraindications of massage
Acute contusions
* Breaks down clot, instead of keeping it
Acute inflammatory conditions
* Increase bleeding
* First 72 hours want present of inflammatory indicators as this starts the scarring process
Severe varicose veins
* Can cause blockage & compression, leading to a stroke
* Avoid the local area of them, send to doctor if across the whole leg
Open wounds/ Abscesses
* Interrupt healing & lead to further bleeding, introduce infection
Skin infections
* Swelling
* Redness
* Temperature (hot)
Failed or incomplete fracture healing
Thrombophlebitis and embolisms
indications/benefits of massage
Increased ROM or movement of muscle/joint
Stretch scar tissue/adhesions
Alleviate muscle cramps
Decrease pain
Remove edema
Increase blood flow
Lymphatic drainage
stroking
Stroking - stroking of the skin in any direction with the hand & palm moulding to the contours of the tissue
Travel from distal to proximal (bottom to top)
1. One hand is used to perform a short stroke with a fairly light touch, can be fast or slow
2. Second hand performs the same movement overlapping the first.
Slow stroking will relax and sedate and decrease muscle tone
Faster strokes will stimulate superficial blood flow, accelerate lymph drainage
effleurage
Effleurage - stroking utilizes longitudinal sweeping motion covering large areas of the body
Application
* Travel from distal to proximal (bottom to top)
* Usually applied in direction of lymphatic flow
* Like stroking (can have a bit more pressure) & also can be reinforced with one hand over the other, or using lightly clenched fist
kneading
Kneading - circular motion – tissue moved in a circular manner on the underlying tissue
* Performed with the palm, fingers or forehand
Application
Travel from proximal-distal or distal-proximal
1. Perform a circular movement with pressure on the upward part for about 25% of the circumference
2. Contact is still maintained for the rest of the circle
3. Contact is lifted to move on to the next circle
petrissage (picking up)
Petrissage - rhythmic lifting, rolling and squeezing of subcutaneous tissue
* Can incorporate wringing and kneading
* Performed across the muscle (usually)
* Travel from distal to proximal (bottom to top), but aim to pull tissue up & grasp it
* Hands stay relaxed, thumbs used from the hand
Application
Don’t pinch - it is a grasp & pull technique
1. Tissues compressed against underlying structures, then ‘picked up’, lifted, squeezed and released
trigger point
Trigger point therapy - direct pressure to specific point and held till pain subsides
· May not be able to apply pressure through skin if clothing is worn
Application
1. Deep stroking is performed by tips of fingers or thumbs
2. Direct/firm pressure may be applied to the specific point by thumb
3. Held like this usually until discomfort is said to be easing (8-12s)
4. Ease the pressure
5. Always stretch after trigger pointing
isotonic muscle strength test
OXFORD scale grade 0-5
isotonic muscle strength grades
Oxford
Grades 0-2 Muscle is acting on limb across gravity
0 no muscle flicker
1 muscle flicker
2 can move limb through ROM across gravity with the limb supported by therapist
Grades 3-5
Muscle is acting on limb against gravity
3 can move limb through ROM against gravity
4 can move limb through ROM against gravity and moderate resistance applied by therapist
5 can move limb through ROM against gravity & maximal resistance applied by therapist
hip abductors isotonic muscle strength test
Oxford
Grade 2 - lying supine (back)
-Move leg out to side with guidance
Grades 3-5 - lying on side with test side up
-Lift leg up with help from physio (stabilise at the hip)
-Lift leg up without help from physio
-Apply minimal resistance to thigh & work through ROM
-Apply maximal resistance to the thigh & work through ROM
hip extensors isotonic muscle strength test
Grade 0/1 - prone
-Patient attempts to squeeze glute with knee at 90° angle
Grade 2 - Lying on side with test side up
* Support leg at knee & hip & ask if they can move their leg backwards towards physio
* “move leg back towards me”
Grade 3-5 - lying prone (stomach)
-Ask the patient to flex knee to 90°
-Ask patient to extend/lift leg up towards the ceiling (stabilise at the trunk)
-Apply minimal resistance to hamstring & work through ROM
-Apply maximal resistance to hamstring & work through ROM
hip flexors isotonic muscle strength test
Grade 2 - Lying on side with test side up
-Support leg from inner side & ask them to slightly bend their knee
-Ask if they can move their leg forwards
Grades 3-5 - sitting over side of bed
-Patient holds onto side of the bed & assist hip flexion by lifting bent knee upwards
-Ask patient to lift their knee bent upwards (stabilise at the hip)
-Apply minimal resistance over quad & work through ROM
-Apply maximal resistance over quad & work through ROM
knee extensors isotonic muscle strength test
Grade 0/1 - lying on back
* Get patient to squeeze thigh
Grade 2 - lying on side with test side up
-Guide patient’s upper leg and have it slightly bent
-Get patient to try to straighten their knee
Grades 3-5 - sitting over side of bed
- Assess knee extension by straightening leg up towards ceiling with support
- Ask patient to straightening leg towards ceiling
- Apply minimal resistance over shin & work through ROM
- Apply maximal resistance over shin & work through ROM
knee flexors isotonic muscle strength test
Grade 0/1 - prone
-Physio supports leg with knee in partial flexion
-Get patient to squeeze hamstrings?
Grade 2 - lying on side with test side up
-Patient bends the leg at the knee back towards the physio
Grades 3-5 - Lying prone (stomach)
-Assess knee flexion by getting patient to bend leg towards their face
-With the knee at a 90° angle, apply minimal resistance at back of the calf towards the plinth, while getting patient to still bend their leg towards their face
-Do the same but with maximal resistance
isometric manual muscle testing
Position for grades 3, 4 & 5
Muscle is acting on limb against gravity
3 can move limb through ROM against gravity/can hold against gravity at the ROM to be tested
4 can move limb through ROM against gravity/can hold against gravity at the ROM to be tested
5 can hold limb in position against gravity & maximal resistance
hip abductors isometric manual muscle testing
Grades 3-5 - lying on side with test side up
-Lift leg up with help from physio (stabilise at the hip)
-Lift leg up without help from physio
-Apply minimal resistance to thigh & work through ROM
-Apply maximal resistance to the thigh & work through ROM
hip extensors isometric manual muscle testing
Grade 3-5 - lying prone (stomach)
-Ask the patient to flex knee to 90°
-Ask patient to extend/lift leg up towards the ceiling (stabilise at the trunk)
-Apply minimal resistance to hamstring & work through ROM
-Apply maximal resistance to hamstring & work through ROM
hip flexors isometric manual muscle testing
Grades 3-5 - sitting over side of bed
-Patient holds onto side of the bed & assist hip flexion by lifting bent knee upwards
-Ask patient to lift their knee bent upwards (stabilise at the hip)
-Apply minimal resistance over quad & work through ROM
-Apply maximal resistance over quad & work through ROM
knee extensors isometric manual muscle testing
Grades 3-5 - sitting over side of bed
- Assess knee extension by straightening leg up towards ceiling with support
- Ask patient to straightening leg towards ceiling
- Apply minimal resistance over shin & work through ROM
- Apply maximal resistance over shin & work through ROM
knee flexors isometric manual muscle testing
Grades 3-5 - Lying prone (stomach)
-Assess knee flexion by getting patient to bend leg towards their face
-With the knee at a 90° angle, apply minimal resistance at back of the calf towards the plinth, while getting patient to still bend their leg towards their face
-Do the same but with maximal resistance
steps to apply heat
- Ensure care of environment to reduce risk of slip & infection spread
- Inform risks of heat burns & gaining consent
Risks:- Burns can occur at 45°C+
- Fainting: may only be noticeable when standing up after treatment, encourage patient to get up slowly
- Assess for contraindications
- “Your skin looks good - no signs of any infection”
- Prepare patient including assessment of sensation (hot with test tubes or teaspoons)
- Prepare heat pack including wrapping & 2cm protective layer (at least 8 layers of towel or 2 layers of towel & the heat pack cover)
- Apply heat pack to patient, give appropriate warning & leave a bell with patient
Warn/instruct patient:- All you should feel is a comfortable warmth
- It should not feel hot.
- If it does feel hot it could be burning you
- Let me know immediately so I can remove the heat or put in more protective towel.
- Check the heat pack & patient comfort after 5 mins for adverse reactions (dizziness/fainting)
- Apply heat pack for 10-15mins
contraindications to heat
excessive pain, swelling or oedema, acute injury, impaired sensation, wet dressing/adhesive tape, open wounds
benefits of heat
assist with ____ injury, healing benefits associated with heat
steps to apply cold
- Ensure care of environment to reduce risk of slip & infection spread
- Inform risks of cold burns & gaining consent
- Assess for contraindications
- “Your skin looks good - no signs of any infection”
- Prepare patient including assessment of sensation (cold with test tubes or teaspoons)
- Prepare crushed ice pack including damp towelling & single layer
- Apply ice pack to patient to cover entire area with a compression bandage, give appropriate warning & leave a bell with patient
Warn/instruct patient:- All you should feel is a comfortable cold
- It should not feel icy cold
- If it does feel too cold it could be harming you
- Let me know immediately so I can remove the cold or put in more protective towel.
- Check the cool pack & patient comfort after 5 mins for adverse reactions
- For areas >2cm adipose tissue - apply cool pack for 20-30mins, every 2 hours
- For areas <2cm adipose tissue - apply cool pack for no more than 10mins OR insulating material b/n cold application & skin
AFTER
-might feel tender or numb, but stress importance of this being temporary and to seek assistance if numbness does not go away
what cold is used for
Manage the magnitude of the inflammatory process, blood flow, initial swelling, secondary injury & pain
* Can also be used as an aid for recovery by these means
contraindications to cold
Excessive pain, sensitivity to the cold, persistent numbness, severe cognitive impairment (dementia), deep vein thrombosis
benefits to cold
assist with ____ injury, healing benefits associated with heat
FWB
Full Weight Bearing (FWB) - no restrictions with weight bearing status
NWB
Full Weight Bearing (FWB) - no restrictions with weight bearing status
PWB
Partial Weight Bearing (PWB) - 0 to 50% weight through affected limb
WBAT
Weight Bearing As Tolerated (WBAT) - 50 to 100% weight through affected limb
PTWB
Protected Weight Bearing (PTWB )- weight bearing as tolerated but gait aids are mandatory at all times until further follow-up with the surgeon
TWB
Touch Weight Bearing (TWB) - Light touch for balance only (10% weight), only minimal weight allowed i.e. not enough to crush an eggshell under their foot
step to with crutches
crutches, affected leg, good leg
step through with crutches
crutches & affected leg, good leg
step to with frame
frame, affected leg, good leg
step through with frame
frame & affected leg, good leg
NWB pattern
step to
-crutches/gait aid, good leg
-affected leg doesn’t touch the floor
steps to prescribe axillary crutches
- Intro & consent
- Ensure general patient wellbeing
- Balance, coordination, prior experience with gait aids, if they’ve experienced nausea/dizziness?
- Ask about home environment
- Are there stairs? Rails for supports? Does their doorway fit the crutches?
*recommend limit of stairs/use elevator
- Are there stairs? Rails for supports? Does their doorway fit the crutches?
- Check stoppers & safety
- Set crutch height, set handles
- Explain WB status & marching
- Demonstrate gait pattern
- Demonstrate navigating stairs (if required)
steps to prescribe elbow crutches
- Intro & consent
- Ensure general patient wellbeing
- Balance, coordination, prior experience with gait aids, if they’ve experienced nausea/dizziness?
- Ask about home environment
- Are there stairs? Rails for supports? Does their doorway fit the crutches?
*recommend limit of stairs/use elevator
- Are there stairs? Rails for supports? Does their doorway fit the crutches?
- Check stoppers & safety
- Set crutch height, set handles
- Explain WB status & marching
- Demonstrate gait pattern
Demonstrate navigating stairs (if required)
sit to stand with crutches (left & right)
Left injury
* Crutches on right side (unaffected)
* Left arm on bed beside patient
* Use both arms to help patient up
* Dizzy?
Right injury
* Crutches on left side (unaffected)
* Right arm on bed beside patient
* Use both arms to help patient up
* Dizzy?
sit to stand with frame (left & right)
Left injury
* Right arm on gait aid, left arm on bed beside patient
* Use both arms to help patient up
* Dizzy?
Right injury
* Left arm on gait aid, right arm on bed beside patient
* Use both arms to help patient up
* Dizzy?
stand to sit with crutches (left & right)
Left injury
* Crutches on right side (unaffected)
* Left arm on bed beside patient
* Use both arms to help patient down
* Dizzy?
Right injury
* Crutches on left side (unaffected)
* Right arm on bed beside patient
* Use both arms to help patient down
* Dizzy?
stand to sit with frame (left & right)
Left injury
* Right arm on gait aid, left arm on arm rest OR both hands on frame?
* Use both arms to help patient down
* Dizzy?
Right injury
* Left arm on gait aid, right arm on bed beside patient OR both hands on frame
* Use both arms to help patient down
* Dizzy?
mobility assessment
ALWAYS a pick up frame (NWB or PWB)
Mobility assessment steps
Start with unaffected, then do affected
1. sensation testing
2. Patient lower limb AROM (ankle, knees, hips)
3. Patient lower limb strength (Ankle plantarflexion, ankle dorsiflexion, quads over fulcrum, SLR hip, glute)
4. Patient upper limb ROM
5. Transfer to sitting on edge of the bed
6. Reaction to sitting on edge of bed
7. Gait aid usage
8. Before transfer
9. Practice stand
10. Measure up for gait aid
11. Transfer process
12. Transfer to sitting
13. Once seated
mobility steps 1-6
- sensation testing
Broad screening (light touch)- Inner thigh
- Outer thigh
- Calf (check for DVT) - “no signs of heat or swelling”)
- Bottom of feet
- Top of feet
- Patient lower limb AROM (ankle, knees, hips)
- Ankles - point & flex toes per side
- Hips - abduct & adduct
- Knee - knee bend to chest
- Patient lower limb strength (Ankle plantarflexion, ankle dorsiflexion, quads over fulcrum, SLR hip)
Ankle- Push toes down against hand, swap & hold top of foot to flex toes to face
Hip strength - Lift ankle up to ceiling per side
Quads over fulcrum - Tense with towel under knee - try to straighten leg up
Glutes - glute bridge lying on back
- Push toes down against hand, swap & hold top of foot to flex toes to face
- Patient upper limb ROM
-Push down through bed & use their arms to lift up - Transfer to sitting on edge of the bed
Hip injury = sit patient to opposite side of injury- Right hip, swing to left side
Ankle/knee injury = sit patient to same side of injury
To conduct - Bend knees up (shuffle to side if needed)
- Cross arm over body to hold the side of the plinth
- Guide legs up & around to help them sit up - encourage use of arm strength too
- Right hip, swing to left side
- Reaction to sitting on edge of bed
Dizziness?
mobility steps 7-13
- Gait aid usage
Explain how to use gait aid
Step to - gait aid, affected leg, good leg
Step through - gait aid & affected leg, good leg - Before transfer
* May feel dizzy, let me know, etc.
* Reinstate contraindications
* Describe transfer (sit up, walk, sit down)
* Lower bed so feet are on the floor comfortable - Practice stand
Left injury- Right arm on gait aid, left arm on bed beside patient
- Use both arms to help patient up
- Dizzy?
Right injury - Left arm on gait aid, right arm on bed beside patient
- Use both arms to help patient up
- Dizzy?
- Measure up for gait aid
* Adjust to wrist crease
-Practice marching - Transfer process
* Adjust to wrist crease
Practice marching? - Transfer to sitting
Left injury- Right arm on gait aid, left arm on arm rest
- Use both arms to help patient down
- Dizzy?
Right injury - Left arm on gait aid, right arm on bed beside patient
- Use both arms to help patient down
- Dizzy?
- Once seated
* Support affected limb (feels okay?)
* Deep breaths
* Ankle movements
