assessmemt midterm Flashcards
methods and principles
function
pathophysiology
pathomechanics
screening & PT diagnosis
therapeutic exercise
manual therapy
sensory training
cognition training
neuro-orthopedic
advanced performance
motor learning
EBP
history
intake forms
review of systems/lifestyle
self reported measures
pt interview
systems review
cardiopulm
integ
msk
neuromuscular
cognitive
tests and measures
ROM
muscle test
reflex/sensory if needed
joint play
palpation - last
3 diagnosis classifications
patho-anatomical
movement system
treatment response
enhanced expectations of patient
encouragement and obtainable goals increase confidence
confidence increase performance
success increases dopaminergic reward
patient autonomy increases
motivation
performance
learning
error detection
burnout buffer
high empathy = low burnout
cornerstone of communiction
gets it - competence
gets me - compassion
parts of competence
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
parts of compassion
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
rules to medical improv
be comfortable with uncomfortable
be an active listener
accept what you are given
have fun
the patient’s story
positives
impairments
chief complaint
treatment
participation
what makes allied health different?
from physicians - need multiple visits
from nurses - no standard of care
what is a patient interview?
subjective examination
80% of information needed to clarify symptoms
what do you discuss during the patient interview?
chief complaint
past medical and surgical history
social/personal history
family history
review of symptoms
ask a catch all question to end interview
interview strategies
funnel technique - open and closed ended questions
avoid asking leading questions
the role of science
what do we mean by who?
demographics
patient history
patient’s life and living environment
current condition
primary language spoken
medications
MOI
systems review
home layout
stress
sleep
what do we need by who specific to inpatient setting?
medical record - surgical, dietary
nursing assessment - pain, level of assist, discharge plan
systems review - active vs passive
active
~cardiovascular/pulmonary
~integumentary
~CPRs
passive
~cognitive
~musculoskeletal
~neuromuscular
what do we mean by what?
current chief complaint
SINSS
labs or diagnostics
what is SINSS
severity - symptom or pain
irritability - how quickly provoked
nature - description
stage - acute, subacute, chronic
stability - improving, same, worse
what do we mean by when?
take me through a typical day
aggravating factors
easing factors
what do we mean by where?
point to area of symptoms
some may not be localized
review of systems
read intake paperwork
look for associated signs and symptoms
what 3 things does communication require
motor function of speech
sensory process of hearing
cognitive process of comprehension/interpretation
assessing communication
does not need to be formal and extensive
language spoken
hearing
quantity - rapid change is a red flag
5 things cognition includes
orientation
attention
memory
problem solving
perception
when is cognitive assessment a priority?
diagnosis has cognitive problems
demonstrates confusion or difficulty with answering
what is the preview?
summary of the patient history
define medical screening
detect diseased before actual symptoms occurs
screening for referral
pt already has symptoms
determining if condition can be treated with PT
our goal as PTs
recognize when to treat, refer or treat and refer
levels of access and screening
primary - direct access
secondary - had some medical screening
tertiary - had one or more medical exams
what are the reasons for screening?
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
four classifications to direct interventions from the PT guide
msk
neuromuscular
cardiopul
integ
what are red flags?
warnings
what are yellow flags?
additional considerations, psychosocial
examples of red flags
previous history of cancer
age
bilateral symptoms
change in mentation
night pain
true insidious onset
constitutional symptoms
does not improve with PT
examples of constitutional symptoms
affects general well-being
fatigue and malaise
nausea/vomiting
pallor
weight loss
dizziness/syncope
diaphoresis - sweat
if patient has shoulder pain, where can pain refer from?
neck
chest
abdomen/viscera
what systems do PTs screen?
cardiovascular
pulmonary
integumentary
gastrointestinal
hepatic/biliary
urogenital
endocrine/metabolic
what to look for in cardiovascular system?
chest, back, neck, shoulder pain
abnormal vitals
dyspnea
cough
edema
vascular insufficiency
assessing edema
document position, location, r and l, units of measurement
assessing vascular sufficiency
peripheral pulses
venous filling time - normal 5-15 sec
capillary refill time
associated signs and symptoms with pulmonary system?
dyspnea
cough
cyanosis
clubbing of nails
altered breathing patterns
3 P’s for pulmonary
postion
palpation
pleuritic (do respiratory movements increase pain)
s&s for integumentary
color
temperature
texture
integrity
turgor - skin tenting
ABCDE to assess skin
asymmetry
border
color
diameter
evolution/elevation
signs of inflammation
color - well defined redness
temp - mild to mod increase
pain - proportionate to injury
swelling - mild to mod; consistent with wound
signs of infection
color - red larger than expected
temp - mod to severe; have fever
pain - excessive for wound
swelling - mod to severe; not consistent with wound
what are the three factors of moovement?
individual
task
environment
three factors of the individual
cognition - psychosocial
action - neuromuscular
perception - somatosensory
three factors of the task
postural control - stability abd orientation
mobility - move cog
extremity function
these can be discrete or continuous
two factors of the environment
regulatory - requires a different movement
non-regulatory - does not need to change movement
both may affect performance
self reported measures
can address any portion of ICF
broad category
patient reported questionnaires
often standardized
impairment based measures
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
physical performance measures
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
functional performance testing
activities and participation
compilation of tests
given t end of rehabilitation
test selection
what is motor learning?
set of processes associated with practice or experience that lead to relatively permanent changes in the capacity for skilled movement
what is adaptation
flexible movement
short term memory
what is learning
also flexible
relatively permanent
long term memory
retention of learning
deeply learned skills can be performed under stress and at same time of other skills
deep learning dependent on practice/expertise
how to challenge the patient’s learning?
increased force/speed
narrow successful range
add contextual interference and variability
decreased rest
secondary tasks
renaming cues
what is measurement?
numeral assigned to an object, event, or person to which an object, event, or person is assigned according to rules
what do standardized tests and outcome measures do?
contribute to EBP
compare patient between sessions
improve communication and care
increased of efficiency
helps recognize improvements
facilitate reimbursement
why should be use evidence based tests and measures?
compare based on age group
set goals
re-examine and determine changes
assess outcomes
selecting best measure: self report vs performance
SR yield individual’s perception
P provide data to therapist about level of impairment
selecting best measure: general vs specific
general can be used with all individuals
condition specific
body region specific
selecting best measure: reliability
yields consistent results
longer = more reliable
selecting best measure: supportive research
one circumstance does not equal all curcumstances
selecting best measure: validity
criterion related - gold standard
construct related
content related
selecting best measure: responsiveness
distingush true change from measurable error
minimal detectable change
minimal clinically important difference
selecting best measure: clinical utility
appropriateness of test for application
precision to measure change
interpretability
acceptability to individual
time and cost
selecting best measure: psychometrics
functional ability
changes in pain
clinical decision making
should have strong psychometric properties and close match of outcome tool with individual
baseline
throughout POC - treat, refer, treat and refer
define diagnosis
process to classify individual into diagnostic category
helps determine prognosis and POC
diagnostic tests have three potential purposes
focuses examination
identify problems that require referral
treatment based classification
what are special tests?
diagnostic/screening
give persuasive info
look at patterns and clusters
clinical prediction rules
intended to improve accuracy of diagnostic assessments
generalized hypermobility
ability to move joints beyond normal ROM
increases risk of injury
GI system signs and sympoms
symptoms affected by food
nausea/vomiting
diarrhea
abdominal pain
dysphagia/odynophagia
hepatic and biliary signs and symptoms
ascites
jaundice
nail bed changes
palmar erythema
CTS/TTS-like symptoms symmetrically bilaterally
urogential signs and symptoms
any changes in urinary habits
pituitary S&S
changes in urination
adrenal S&S
hyper - bronze skin, weight loss
hypo - striae, weight gain
thyroid S&S
hyper - increased HR, weight loss, extra metabolism
hypo- fatigue, weakness, myalgias, less metabolism
pancreas S&S
hypoglycemia - pallor, perspiration, weak, shaky, irritable
cutaneous pain
localized with one finger
somatic pain
superficial - easily localize
deep somatic - poorly localized
no neurologic signs
neuropathic pain
sharp, shooting, burning, electric
evoked by non-noxious stimuli
does not respond to typical pain meds
referred pain
pain felt in area from from site of nociception
multi segmental innervation
embryologic development
direct pressure and shared pathways
visceral pain
poorly localized
can have visceral somatic response
associated with ANS response
visceral pain patterns
constant
intense
unrelieved by rest or change of position
does not fit expected pattern
psychogenic pain
emotional overlay
pulse
rate: 60-100 in adults
rhythm: reg or irreg
force: 0-4
respiration
rate: 12-20 breaths/min in adults
rhythm: reg or irreg
depth: deep, normal, shallow
blood pressure
must be taken with pain in neck, upper quadrant, TOS
oxygen saturation
95%+ is normal
90% warrants referral
core body temp
96.4 - 99.1
always take with back pain of unknown case
define palpation
identifying features and structures externally
tissue quality, temp, texture, consistency
how do we palpate?
consent
drape
expose the skin
use bony landmarks
start with light pressure
what is palpation essential for?
aligning a goniometer
identifying landmarks
determining/assessing muscle contraction
do bones feel larger or smaller upon palpation than they actually are?
larger
what is active insufficiency?
when a prime mover becomes shortened to a point that it cannot generate or maintain active tension
example of active insufficiency
max. extension of knee then flexion of hip
have more hip flexion when knee is flexed than extended
what is passive insufficiency?
when a two joint muscle cannot lengthen to the extent required to allow full ROM of all joints it crosses simultaneously
example of passive insufficiency
unable to flex trunk fully without bending knees
-passive hamstring insufficiency
describe one joint muscle testing
end feel should be firm
examples: soleus, adductor brevis
describe two joint muscle testing
lengthen muscle fully across one joint, then measure the motion at the second joint
examples: gastroc, triceps
describe manual muscle testing
easy and efficient
assess strength
ordinal values
on the subjective side
steps to performing a MMT
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
describe dynamometry
more objective
takes more time that MMT
requires equipment
ratio level data
MMT grading: 0
no palpable contraction
MMT grading: 1
palpable contraction
MMT grading: 2-
partial ROM in gravity reduced position
MMT grading: 2
full ROM in gravity reduced position
OR
partial (<50%) ROM against gravity
MMT grading: 3-
able to move through greater than 50% ROM against gravity
MMT grading: 3
completes ROM against gravity; no resistance
MMT grading: 3+
full anti-gravity ROM and able to hold minimal resistance
MMT grading: 4-
full anti-gravity ROM and breaks between minimal and moderate resistance
MMT grading: 4
full anti-gravity ROM and able to hold moderate resistance
MMT grading: 4+
full anti-gravity ROM and breaks between moderate and maximum resistance
MMT grading: 5
full anti-gravity ROM and able to hold maximum resistance
when is MMT most reliable?
when same PT is consistently testing their own pts
what is an end feel? describe firm, hard, soft
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
abnormal empty end feel
cannot reach end feel, usually due to pain
other causes: joint inflammation, fracture, bursitis
what causes an abnormal firm end feel?
increased tone
tightening of capsule
ligament shortening
what causes an abnormal hard end feel?
fracture
OA
osteophyte formation
what causes an abnormal soft end feel?
edema
synovitis
ligament instability or tear
goni reading: if the arms start apart
use the number farther from the moving arm
goni reading: if the arms start at 90 deg
use the number that shows the difference
goni reading: if the arms start together
use the number closest to the moving arm
process for conducting goni movement
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
why does ROM matter?
reproducibility
assessing progress
end feels give you info
what is a capsular pattern?
pattern of restricted motion
indicates a problem
occurs with lesion in joint capsule
what is a non-capsular pattern?
limitation in ROM not in capsular pattern
what is osteokinematic movement?
movement you see
what is arthrokinematic movement?
movement you feel
necessary for full ROM
not under voluntary muscular control
this is what joint play assesses
roll
new points on new points
same direction as the moving bone
slide
single point on new points
spin
single point rotates on single point
rarely alone
what (roll/slide/spin) causes the most significant restriction in joint?
slide/glide
must have knowledge of slide direction to restore normal motion
define close-packed
greatest stability
max joint congruency
ligaments/capsule pulled tight
often at end ROM
define open-packed
position of greatest mobility - least stable
least joint congruency
ligaments/capsule are slack
how to assess joint play?
position joint to be tested in open packed position
identify direction of force
position yourself and apply force
grading of joint play (0-6)
0 - ankylosed
1 - significant hypomobility
2 - hypomobility
3 - normal
4 - hypermobility
5 - significant hypermobility
6 - subluxation
why does joint play matter?
determine where limitations are
how to test for myotomes?
position pt
place joint in mid range
apply resistance - consistent phrasing
grading for myotomes/dermatomes
absent
diminished
symmetrical
how to test for reflexes
position pt
identify tendon
apply a firm joint
observe excursion of distal segment
grading for reflexes
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
how to test for dermatomes
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
