chapter 5 Flashcards
diagnosis
cluster of signs and symptoms associated with a disorder of body structure/function
Examination
the process of obtaining a history, performing systems review, and administering specific tests and measures.
Evaluation
dynamic process in which PT makes clinical judgements based on data gathered during examination.
WHo does the examination and evaluation?
performed by PT.
-specific data collection can be performed at the request of a PT by a PTA.
initial information of examination is collected prior to meeting client for the first time. info such as…
-medical diagnosis
-patients chief complaint
-patients present illness
-onset of patients primary problem
-patients past history
-personal info
-patients lifestyle
Pain description
-part of patients history, should be taken prior to and after treatment.
-includes location, extension or radiation, intensity, duration, frequency, and progression
two major pain measurements used in PT
1) Visual Analog Scale
2) Numerical Rating system
Visual Analog scale
-consists of a 10cm unmarked line, either vertical or horizontal
-has verbal or pictorial anchors indication continuum from no pain at one end to serve pain at the other end.
-patient is asked to mark pain
How is the mark measured?
-with a ruler and expressed in cm
-10cm=severe pain
Numerical Rating system
-easier to use than VAS & most common
-“if 0 is no pain and 10 is the worst pain imaginable, how would you rate your pain.”
Sensory examination
tests for superficial, deep, and combined sensations
Superficial
-first to be done
-consists of temperature, light touch, pressure.
-if impairments found then you move on
deep
consist of kinesthesia, proprioception, and vibration
combined
-tactile localization
-two-point discrimination
-stereognosis
-Barognosis
-graphesthesia
cranial nerve integrity
examination of function of the 12 pairs of cranial nerves that are distributed in the head and neck (expect for cranial nerve 10, vagus nerve).
cranial nerve integrity is recommended to what kind of patients?
-patients who may have lesions of the brain, brainstem, and cervical spine.
anthropometrics
-measurements that give information about the length, girth, and volume of a patients body.
-height, weight, and body mass index assed
why is info from anthropometrics important?
-to identify the equality of a patients legs
-or the amount of edema a patient may have in a limb.
Mentation, hearing, and visual examination
-evaluates the patients ability to concentrate and respond
-examines patients attention, orientation, and cognition.
attention
patients awareness of the environment or ability to focus on specific stimulus without distraction
orientation
patients awareness of time, person, and place
cognition
examines memory awareness, reasoning, language use, learning, etc.
Range of motion
-evaluates the amount of excursion through which a joint or a series of joints can move.
Goniometer
used to measure ROM in degrees
Manual muscle testing
-evaluates the strength of specific muscles
-identifies patterns of muscle weakness
Rating categories for MMR
normal(5)
good(4)
fair (3)
poor(2)
trace activity(1)
absent activity (0)
Muscle tone
-Amount of tension in muscles in relaxed state
-allows bodies be upright when standing and sitting
Different types of muscle tones
-spasticity
-rigidity
-flaccidity
tonal abnormalities
-hypertonia
-hypotonia
-dystonia
Flaccidity
-lack of tension when muscle is at rest
-not allowed to create tension for muscle to move
spasticity
Abnormal muscle tightness due to prolonged muscle contraction
Balance and control
evaluates the patients ability to control positions of the body and body parts using skeletal muscles with respect to gravity
-PATIENT MAY LEAN TOWARDS AFFECTED SIDE
balance examinations
-Berg Balance test
-timed up and go
-tinetti performance oriented mobility assessment
function examination
determines the effect of the condition or injury on the patients daily life.
Gait examination
-accessed from front, behind, and from side.
-observing from the pelvis and lumbar spine down to foot and ankle, also movements in upper limbs and trunk.
gait cycle
-the moment the patients one lower extremity touches the ground to the moment the same lower extremity contacts the ground again.
What is also important to remember during gait examination?
patients footwear and feet, to observe any wearing down of heels and socks and formation of blisters, corns, etc.
Outcomes measures
-measures look at the patients functional abilities and identify if the physical therapy intervention is moving toward predicted outcome.
Orthopedic examination
-Utilize special tests that examine the integrity of muscoskeletal components.
Joint play movement
-used by orthopedic
-examines the amount of passive motion available within a joint and help to differentiate what structure may be injured.
A positive NEER test indicates…
impingement of shoulder structures.
During neurological examination the PTA has to consider both the therapeutic interventions and?
psychosocial aspects of rehabilitation
What are the most common cardiac diagnosis referred for direct physical therapy?
-coronary artery disease
-congestive heart failure
What are the most chronic lung diseases for which pulmonary rehabilitation is needed?
–chronic obstructive pulmonary diseases
-asthma
Types of pain seen in cardiac examination
-chest pain
-angina (repetitive chest pain)
-myocardial infarction pain (heavy chest squeezing)
-edema
-dyspnea (shortness of breath)
Physical examination of cardiac patients
-assessing patients pulses (femoral, popliteal, pedal, radial)
-listening to heart sounds
-bp
-counting respiration
Cardiovascular signs and symptoms
-Diaphoresis (excess sweating with decreased cardiac output)
-cyanotic skin (blue skin)
-bilateral edema= coronary heart disease
-unilateral edema= thrombophlebitis
Elements of pulmonary examination
-interviewing patient about chiefs complainants
-patients history of occupation
-patients habits (smoking)
physical pulmonary examination
-similar to cardiac with addition of inspection and palpation of neck and thorax.
-listening to abnormal respiration and expiration
-evaluation of xrays
Pediatric examinations
-PT and PTAs need specific knowledge about theories of child development, motor control, motor learning, etc.
Pediatric examination consists of…
-patients history in regard to childs mothers pregnancy’s
-birth history
-childs medical history
Screen testings
-DONE BY PHYSICANS AND NURSE PRACTITIONERS
EX of screen testings
-APGAR screening (for newborns 1-5 minutes after birth
-Denver Developmental Screening Test
-Bayley Scales of Infant Development
EX of neonatal reflexes
-flexor withdrawal reflex
-crossed extension reflex
-sucking reflex
-plantar grasp reflex
-STNR (6-8MO.)
Elements of examination of children and adolescents
-examined for ongoing health needs, mobility needs (walkers), functional changes
standardized tests used to examine children and adolescents
-Peabody Developmental Motor Scales
-Bruininks-Oseretsky Test of motor proficiency
elements of geriatric initial examination and evaluation include
Patient and family/caregiver interview
Pain assessment
Physical examinations
Psychosocial
Functional
Environmental
Environmental examination
-done to the patients home or institution where patients lives.
3 zones of burn wounds
1) the zone of coagulation, cells are dead
2)zone of stasis, cells are injured and can die without specialized treatment
3)zone of hyperemia, injury is minimal and cells can recover
rules of nines for estimating the % of body surface areas
-head=9%
-each upper extremity= 9%
-back of trunk=18%
-front of trunk=18%
-each lower extremity=18%
-perineum=1%
Therapeutic exercise
Interventions that use muscular contraction
bodily movement
and physical activates.
frequency
how often the exercise is performed
-SEVERAL TIMES A DAY
duration
represents the time period that exercise is necessary
-EVERYDAy
Classification of ROM exercises (3)
1)passive ROM exercises
2)active ROM exercise
3) active assistive ROM exercise
Passive ROM exercises
-joint is moved by PT, PTA, or mechanical device without any muscle contraction by patient.
EX of when to use PROM
-patient is unable to move joint
-active range of motion is prohibited
-after surgery or injury
-coma
Active Range of motion exercises
-ROM movement is performed actively by patient.
EX of when to use AROM exercieses
-increase muscular strength
-promote coordination and motor skills
-increase blood circulation
-preparation for ADLs
Active assisted range of motion exercises
-used when patient needs help to complete AROM.
-patient is able to assist in desired motion but cannot perform it independently.
two types of assistance
1)manual- by PT OR PTA
2)mechanical- cane, overhead pulleys
3 types of strengthening exercises
1)isometric
2)isotonic
3)isokinetic
isometric
-Tightening of specific muscles or group of muscles.
-recommended when joint is in pain, inflammed, or surgery
EX of isometric exercise
quadriceps sets
Isotonic exercises
-concentric or eccentric muscular contractions.
-exercise with constant load but uncontrolled speed of movement
concentric muscular contraction causes muscle to —–, eccentric muscular contraction causes muscles to—
shorten, lengthen
EX of isotonic exercies
biceps curl
isokinetic exercise
-has predetermined velocity of muscle shortening or lengthening, take place at a constant speed.
-done by special machines
Flexibility exercises
therapeutic maneuver that increase mobility of soft tissues and improves ROM by elongating structures.
3 ways to stretch
-manual passive stretching
-self-stretching
-ballistic stretching (high speed, high intensity)
types of manual therapy
MAINLY USED IN ORTHOPEDIC
-massage
-manipulations
-mobilizations
Manipulations
Short,sharp movements to push joint beyond normal range
phases of cardiac reabilitation
-Phase I takes place in hospital(family support)
-Phase II takes place in outpatient settings (patient education, exercises)
-Phase III takes place when patient is discharged but continues in community based program
What do pulmonary physical therapy interventions concentrate on?
-secretion removal techniques
