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fall B 2024 > assessmemt midterm > Flashcards

assessmemt midterm Flashcards

1
Q

methods and principles

A

function
pathophysiology
pathomechanics
screening & PT diagnosis
therapeutic exercise
manual therapy
sensory training
cognition training
neuro-orthopedic
advanced performance
motor learning
EBP

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2
Q

history

A

intake forms
review of systems/lifestyle
self reported measures
pt interview

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3
Q

systems review

A

cardiopulm
integ
msk
neuromuscular
cognitive

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4
Q

tests and measures

A

ROM
muscle test
reflex/sensory if needed
joint play
palpation - last

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5
Q

3 diagnosis classifications

A

patho-anatomical
movement system
treatment response

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6
Q

enhanced expectations of patient

A

encouragement and obtainable goals increase confidence
confidence increase performance
success increases dopaminergic reward

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7
Q

patient autonomy increases

A

motivation
performance
learning
error detection

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8
Q

burnout buffer

A

high empathy = low burnout

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9
Q

cornerstone of communiction

A

gets it - competence
gets me - compassion

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10
Q

parts of competence

A

professional setting, background, clothing
punctual, private, continuous care
treatment duration and follow up
diagnosis/prognosis/treatment clarity
eliminate hedge words
blend treatment maps - pt and PT goals

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11
Q

parts of compassion

A

bookend with affirmation, kind handshake, smile
pace emotions the lead
open ended questions, active listening, backtracking
positive, solution based, yet language
monitor nonverbal state and biases
use touch to assist and treat patients

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12
Q

rules to medical improv

A

be comfortable with uncomfortable
be an active listener
accept what you are given
have fun

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13
Q

the patient’s story

A

positives
impairments
chief complaint
treatment
participation

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14
Q

what makes allied health different?

A

from physicians - need multiple visits
from nurses - no standard of care

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15
Q

what is a patient interview?

A

subjective examination
80% of information needed to clarify symptoms

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16
Q

what do you discuss during the patient interview?

A

chief complaint
past medical and surgical history
social/personal history
family history
review of symptoms

ask a catch all question to end interview

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17
Q

interview strategies

A

funnel technique - open and closed ended questions
avoid asking leading questions
the role of science

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18
Q

what do we mean by who?

A

demographics
patient history
patient’s life and living environment
current condition
primary language spoken
medications
MOI
systems review
home layout
stress
sleep

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19
Q

what do we need by who specific to inpatient setting?

A

medical record - surgical, dietary
nursing assessment - pain, level of assist, discharge plan

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20
Q

systems review - active vs passive

A

active
~cardiovascular/pulmonary
~integumentary
~CPRs

passive
~cognitive
~musculoskeletal
~neuromuscular

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21
Q

what do we mean by what?

A

current chief complaint
SINSS
labs or diagnostics

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22
Q

what is SINSS

A

severity - symptom or pain
irritability - how quickly provoked
nature - description
stage - acute, subacute, chronic
stability - improving, same, worse

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23
Q

what do we mean by when?

A

take me through a typical day
aggravating factors
easing factors

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24
Q

what do we mean by where?

A

point to area of symptoms
some may not be localized

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25
Q

review of systems

A

read intake paperwork
look for associated signs and symptoms

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26
Q

what 3 things does communication require

A

motor function of speech
sensory process of hearing
cognitive process of comprehension/interpretation

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27
Q

assessing communication

A

does not need to be formal and extensive
language spoken
hearing
quantity - rapid change is a red flag

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28
Q

5 things cognition includes

A

orientation
attention
memory
problem solving
perception

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29
Q

when is cognitive assessment a priority?

A

diagnosis has cognitive problems
demonstrates confusion or difficulty with answering

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30
Q

what is the preview?

A

summary of the patient history

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31
Q

define medical screening

A

detect diseased before actual symptoms occurs

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32
Q

screening for referral

A

pt already has symptoms
determining if condition can be treated with PT

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33
Q

our goal as PTs

A

recognize when to treat, refer or treat and refer

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34
Q

levels of access and screening

A

primary - direct access
secondary - had some medical screening
tertiary - had one or more medical exams

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35
Q

what are the reasons for screening?

A

direct access
quicker and sicker
signed prescription - no visit
medical specialization - may miss if out of their special
progression of disease
patient self disclosure - rest of the story
does not tell you the whole story
presence of red and yellow flags

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36
Q

four classifications to direct interventions from the PT guide

A

msk
neuromuscular
cardiopul
integ

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37
Q

what are red flags?

A

warnings

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38
Q

what are yellow flags?

A

additional considerations, psychosocial

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39
Q

examples of red flags

A

previous history of cancer
age
bilateral symptoms
change in mentation
night pain
true insidious onset
constitutional symptoms
does not improve with PT

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40
Q

examples of constitutional symptoms

A

affects general well-being

fatigue and malaise
nausea/vomiting
pallor
weight loss
dizziness/syncope
diaphoresis - sweat

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41
Q

if patient has shoulder pain, where can pain refer from?

A

neck
chest
abdomen/viscera

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42
Q

what systems do PTs screen?

A

cardiovascular
pulmonary
integumentary
gastrointestinal
hepatic/biliary
urogenital
endocrine/metabolic

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43
Q

what to look for in cardiovascular system?

A

chest, back, neck, shoulder pain
abnormal vitals
dyspnea
cough
edema
vascular insufficiency

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44
Q

assessing edema

A

document position, location, r and l, units of measurement

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45
Q

assessing vascular sufficiency

A

peripheral pulses
venous filling time - normal 5-15 sec
capillary refill time

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46
Q

associated signs and symptoms with pulmonary system?

A

dyspnea
cough
cyanosis
clubbing of nails
altered breathing patterns

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47
Q

3 P’s for pulmonary

A

postion
palpation
pleuritic (do respiratory movements increase pain)

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48
Q

s&s for integumentary

A

color
temperature
texture
integrity
turgor - skin tenting

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49
Q

ABCDE to assess skin

A

asymmetry
border
color
diameter
evolution/elevation

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50
Q

signs of inflammation

A

color - well defined redness
temp - mild to mod increase
pain - proportionate to injury
swelling - mild to mod; consistent with wound

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51
Q

signs of infection

A

color - red larger than expected
temp - mod to severe; have fever
pain - excessive for wound
swelling - mod to severe; not consistent with wound

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52
Q

what are the three factors of moovement?

A

individual
task
environment

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53
Q

three factors of the individual

A

cognition - psychosocial
action - neuromuscular
perception - somatosensory

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54
Q

three factors of the task

A

postural control - stability abd orientation
mobility - move cog
extremity function

these can be discrete or continuous

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55
Q

two factors of the environment

A

regulatory - requires a different movement
non-regulatory - does not need to change movement

both may affect performance

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56
Q

self reported measures

A

can address any portion of ICF

broad category
patient reported questionnaires
often standardized

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57
Q

impairment based measures

A

combine body structure and function

examples:
motor function
ROM
joint integrity and mobility
sensory integrity
reflex integrity
peripheral nerve integrity
posture
pain
aerobic capacity/endurance
gait, locomotion, balance

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58
Q

physical performance measures

A

body function and activities

examples:
trunk endurance testing
movement patterns
jump/hop test
stength/power testing
lifting tests
throwing tests
speed/agility/quickness testing
multi plane aerobic endurance
multi plane balance/proprioception testing

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59
Q

functional performance testing

A

activities and participation

compilation of tests
given t end of rehabilitation
test selection

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60
Q

what is motor learning?

A

set of processes associated with practice or experience that lead to relatively permanent changes in the capacity for skilled movement

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61
Q

what is adaptation

A

flexible movement
short term memory

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62
Q

what is learning

A

also flexible
relatively permanent
long term memory

63
Q

retention of learning

A

deeply learned skills can be performed under stress and at same time of other skills

deep learning dependent on practice/expertise

64
Q

how to challenge the patient’s learning?

A

increased force/speed
narrow successful range
add contextual interference and variability
decreased rest
secondary tasks
renaming cues

65
Q

what is measurement?

A

numeral assigned to an object, event, or person to which an object, event, or person is assigned according to rules

66
Q

what do standardized tests and outcome measures do?

A

contribute to EBP
compare patient between sessions
improve communication and care
increased of efficiency
helps recognize improvements
facilitate reimbursement

67
Q

why should be use evidence based tests and measures?

A

compare based on age group
set goals
re-examine and determine changes
assess outcomes

68
Q

selecting best measure: self report vs performance

A

SR yield individual’s perception

P provide data to therapist about level of impairment

69
Q

selecting best measure: general vs specific

A

general can be used with all individuals
condition specific
body region specific

70
Q

selecting best measure: reliability

A

yields consistent results
longer = more reliable

71
Q

selecting best measure: supportive research

A

one circumstance does not equal all curcumstances

72
Q

selecting best measure: validity

A

criterion related - gold standard
construct related
content related

73
Q

selecting best measure: responsiveness

A

distingush true change from measurable error

minimal detectable change
minimal clinically important difference

74
Q

selecting best measure: clinical utility

A

appropriateness of test for application
precision to measure change
interpretability
acceptability to individual
time and cost

75
Q

selecting best measure: psychometrics

A

functional ability
changes in pain

76
Q

clinical decision making

A

should have strong psychometric properties and close match of outcome tool with individual

baseline
throughout POC - treat, refer, treat and refer

77
Q

define diagnosis

A

process to classify individual into diagnostic category
helps determine prognosis and POC

78
Q

diagnostic tests have three potential purposes

A

focuses examination
identify problems that require referral
treatment based classification

79
Q

what are special tests?

A

diagnostic/screening
give persuasive info
look at patterns and clusters

80
Q

clinical prediction rules

A

intended to improve accuracy of diagnostic assessments

81
Q

generalized hypermobility

A

ability to move joints beyond normal ROM
increases risk of injury

82
Q

GI system signs and sympoms

A

symptoms affected by food
nausea/vomiting
diarrhea
abdominal pain
dysphagia/odynophagia

83
Q

hepatic and biliary signs and symptoms

A

ascites
jaundice
nail bed changes
palmar erythema
CTS/TTS-like symptoms symmetrically bilaterally

84
Q

urogential signs and symptoms

A

any changes in urinary habits

85
Q

pituitary S&S

A

changes in urination

86
Q

adrenal S&S

A

hyper - bronze skin, weight loss
hypo - striae, weight gain

87
Q

thyroid S&S

A

hyper - increased HR, weight loss, extra metabolism
hypo- fatigue, weakness, myalgias, less metabolism

88
Q

pancreas S&S

A

hypoglycemia - pallor, perspiration, weak, shaky, irritable

89
Q

cutaneous pain

A

localized with one finger

90
Q

somatic pain

A

superficial - easily localize
deep somatic - poorly localized
no neurologic signs

91
Q

neuropathic pain

A

sharp, shooting, burning, electric
evoked by non-noxious stimuli
does not respond to typical pain meds

92
Q

referred pain

A

pain felt in area from from site of nociception

multi segmental innervation
embryologic development
direct pressure and shared pathways

93
Q

visceral pain

A

poorly localized
can have visceral somatic response
associated with ANS response

94
Q

visceral pain patterns

A

constant
intense
unrelieved by rest or change of position
does not fit expected pattern

95
Q

psychogenic pain

A

emotional overlay

96
Q

pulse

A

rate: 60-100 in adults
rhythm: reg or irreg
force: 0-4

97
Q

respiration

A

rate: 12-20 breaths/min in adults
rhythm: reg or irreg
depth: deep, normal, shallow

98
Q

blood pressure

A

must be taken with pain in neck, upper quadrant, TOS

99
Q

oxygen saturation

A

95%+ is normal
90% warrants referral

100
Q

core body temp

A

96.4 - 99.1
always take with back pain of unknown case

101
Q

define palpation

A

identifying features and structures externally

tissue quality, temp, texture, consistency

102
Q

how do we palpate?

A

consent
drape
expose the skin
use bony landmarks
start with light pressure

103
Q

what is palpation essential for?

A

aligning a goniometer
identifying landmarks
determining/assessing muscle contraction

104
Q

do bones feel larger or smaller upon palpation than they actually are?

A

larger

105
Q

what is active insufficiency?

A

when a prime mover becomes shortened to a point that it cannot generate or maintain active tension

106
Q

example of active insufficiency

A

max. extension of knee then flexion of hip

have more hip flexion when knee is flexed than extended

107
Q

what is passive insufficiency?

A

when a two joint muscle cannot lengthen to the extent required to allow full ROM of all joints it crosses simultaneously

108
Q

example of passive insufficiency

A

unable to flex trunk fully without bending knees
-passive hamstring insufficiency

109
Q

describe one joint muscle testing

A

end feel should be firm
examples: soleus, adductor brevis

110
Q

describe two joint muscle testing

A

lengthen muscle fully across one joint, then measure the motion at the second joint
examples: gastroc, triceps

111
Q

describe manual muscle testing

A

easy and efficient
assess strength
ordinal values
on the subjective side

112
Q

steps to performing a MMT

A

put pt in appropriate test position
position yourself for maximal force
instruct pt to go through full AROM
apply resistance at mid range
grade the test

113
Q

describe dynamometry

A

more objective
takes more time that MMT
requires equipment
ratio level data

114
Q

MMT grading: 0

A

no palpable contraction

115
Q

MMT grading: 1

A

palpable contraction

116
Q

MMT grading: 2-

A

partial ROM in gravity reduced position

117
Q

MMT grading: 2

A

full ROM in gravity reduced position
OR
partial (<50%) ROM against gravity

118
Q

MMT grading: 3-

A

able to move through greater than 50% ROM against gravity

119
Q

MMT grading: 3

A

completes ROM against gravity; no resistance

120
Q

MMT grading: 3+

A

full anti-gravity ROM and able to hold minimal resistance

121
Q

MMT grading: 4-

A

full anti-gravity ROM and breaks between minimal and moderate resistance

122
Q

MMT grading: 4

A

full anti-gravity ROM and able to hold moderate resistance

123
Q

MMT grading: 4+

A

full anti-gravity ROM and breaks between moderate and maximum resistance

124
Q

MMT grading: 5

A

full anti-gravity ROM and able to hold maximum resistance

125
Q

when is MMT most reliable?

A

when same PT is consistently testing their own pts

126
Q

what is an end feel? describe firm, hard, soft

A

type of resistance you feel when passively moving a joint

firm: stretch - finger extension
hard: bone on bone - elbow extension
soft: soft tissue approximation - elbow flexion

127
Q

abnormal empty end feel

A

cannot reach end feel, usually due to pain

other causes: joint inflammation, fracture, bursitis

128
Q

what causes an abnormal firm end feel?

A

increased tone
tightening of capsule
ligament shortening

129
Q

what causes an abnormal hard end feel?

A

fracture
OA
osteophyte formation

130
Q

what causes an abnormal soft end feel?

A

edema
synovitis
ligament instability or tear

131
Q

goni reading: if the arms start apart

A

use the number farther from the moving arm

132
Q

goni reading: if the arms start at 90 deg

A

use the number that shows the difference

133
Q

goni reading: if the arms start together

A

use the number closest to the moving arm

134
Q

process for conducting goni movement

A

position pt
have pt actively move limb
align goni
palpate if needed
read and record AROM
passively move limb through full ROM
read and record PROM and end feel

135
Q

why does ROM matter?

A

reproducibility
assessing progress
end feels give you info

136
Q

what is a capsular pattern?

A

pattern of restricted motion
indicates a problem
occurs with lesion in joint capsule

137
Q

what is a non-capsular pattern?

A

limitation in ROM not in capsular pattern

138
Q

what is osteokinematic movement?

A

movement you see

139
Q

what is arthrokinematic movement?

A

movement you feel
necessary for full ROM
not under voluntary muscular control

this is what joint play assesses

140
Q

roll

A

new points on new points
same direction as the moving bone

141
Q

slide

A

single point on new points

142
Q

spin

A

single point rotates on single point
rarely alone

143
Q

what (roll/slide/spin) causes the most significant restriction in joint?

A

slide/glide

must have knowledge of slide direction to restore normal motion

144
Q

define close-packed

A

greatest stability
max joint congruency
ligaments/capsule pulled tight
often at end ROM

145
Q

define open-packed

A

position of greatest mobility - least stable
least joint congruency
ligaments/capsule are slack

146
Q

how to assess joint play?

A

position joint to be tested in open packed position
identify direction of force
position yourself and apply force

147
Q

grading of joint play (0-6)

A

0 - ankylosed
1 - significant hypomobility
2 - hypomobility
3 - normal
4 - hypermobility
5 - significant hypermobility
6 - subluxation

148
Q

why does joint play matter?

A

determine where limitations are

149
Q

how to test for myotomes?

A

position pt
place joint in mid range
apply resistance - consistent phrasing

150
Q

grading for myotomes/dermatomes

A

absent
diminished
symmetrical

151
Q

how to test for reflexes

A

position pt
identify tendon
apply a firm joint
observe excursion of distal segment

152
Q

grading for reflexes

A

0 = nor response; abnormal
1+ = slight but present response; could be normal
2+ = brisk response; normal
3+ =. very brisk response; could be normal
4+ = repeating response; abnormal

153
Q

how to test for dermatomes

A

using a cotton ball or brush

show pt how it feels normally
have pt close eyes
using equal pressure, gently touch one side at a time

fall B 2024 (12 decks)

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