Exam 2 Flashcards by Michelle Era

What is Orientation x 1,2,3?

(x1) - Person: If they know who they are
(x2) - Place: If they know where they are
(x3) - Time: If they know the date or the season

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Why do we test for leg length?

To determine a descrepency from one side to another

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How do you measure for leg length?

With patient in Supine

ASIS to Medial Malleoli (true leg length)
Umbilicus to Medial Malleoli (pelvic obliquity may scew results)
Greater Trochanter to Lateral Malleolus

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Why do we measure girth?

To measure atrophy or edema in an extremity

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How do you measure for girth?

With a tape measure wrapped around a specific point on an extremity
With a volumeter
- Fill the volumeter with water till it overflows
- Allow the overflow to stop naturally
- Instruct the patient to slowly immerse the extremity into the volumeter with the hand open and relaxed. If there is a bar, the hand should rest on the bar in the web space between the 3rd and 4th digits. The foot should rest on the bottom
- Allow the water to displace into the measuring container until it stops.
- Read the measurement on a flat surface at eye level

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What is a Dermatome?

The skin area that is supplied by the sensory fibers of a spinal nerve

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What are the different types of Superficial Sensory Tests?

Pain (pt. differentiates between sharp and dull pain)
Tempurature (pt. differentiates between hot and cold)
Light touch (pt. feels for light touch with a cotton ball)
Pressure (pt. feels for pressure)

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What is Monofilament Testing?

It is used for testing loss of protective sensation of the feet in diabetic patients and those at risk for developing neuropathic foot ulcers

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What are the different types of Deep Sensory Tests?

Kinesthesia (pt. can determine which direction the joint is moving)
Proprioception (pt. can determine which position the joint is in)
Vibration (pt. can feel vibration)

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What are the different types of Cortical Tests?

Stereognosis (pt. can recognize different objects by touch)
Two-point descrimination (pt. can percieve two points when they both touch the pt. at the same time)
Graphesthesia (pt. can recognize a symbol that is drawn on their skin)

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What are the grades for Reflex Testing?

0 = No responce
1+ = minimal responce, no joint movement
2+ = Normal responce
3+ = brisk responce
4+ = hyperactive responce/clonus
5+ = sustained clonus

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What are the different Reflexes, their spinal segment, and response?

Biceps/ C5/ Elbow Flexion
Brachioradialis/ C6/ Elbow Flexion
Triceps/ C7/ Elbow Extension
Quadriceps/ L4/ Knee Extension
Achilles/ S1/ Plantar Flexion

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What is Tone?

The resistance of muscle to passive elongation or stretch

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What are the descriptors for abnormal Tone?

Hypotonia: Flaccidity
Hypertonia: Spacicity, rigidity, clonus, leadpipe, cogwheel
Dystonia: Twisting/ writhing movement

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What is a Myotome?

A group of muscles that one spinal nerve innervates.

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Myotome for C5

“Stay Alive” Shoulder Abduction

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Myotome for C5, C6

“Pick up Sticks” Elbow Flexion

Myotome for C7

“Up to Heaven” Elbow Extension

Myotome for C8

“Ulnar Deviate” Ulnar Deviation

Myotome for L1, L2

“Lift up your Shoe” Hip Flexion

Myotome for L3, L4

“Kick the Door” Knee Extension

Myotome for L4, L5

“Up to the Sky” Dorsiflexion, and Toe Extension

Myotome for S1

“The Race has Begun” Plantar Flexion/ Eversion

What are the Contraindications for Goniometry?

Muscle contraction can cause injury (AROM)
Joint motion can impede healing (PROM)
Ex. immediately post-op, dislocation, non healed fx

What are the Precautions for Goniometry?

- Pain/inflammation/infection - Recently healed fx - Osteoporosis - Hypermobility - Hemophilia or Hematoma - Meds (ie: muscle relaxants)

What are the goals and purposes of doing Goniometry?

- Establish goals - Determine Progress or lack of - Provides objective data - Helps with fabrication of equipment - Motivate the pt.

What are the parts of the Goniometer

- Axis: Point in the center of the round part around which everything rotates - Stationary arm: Arm attached to the round part - Moveable arm: Arm by itself

What are substitution movements and how do you prevent them?

Substitution movements are when the pt. moves joints other than the one being measured in order to recieve better results. You can prevent them by placing your hands on a patient in a way that stablizes the joint and giving your pt. verbal cues to not make any substitution movements.

Normal AROM in the joints of the Hip

- Flexion = 120 deg - Extension = 30 deg - Abduction = 45 deg - Adduction = 30 deg - Internal Rotation = 45 deg - External Rotaion = 45 deg

Normal AROM in the joints of the Knee

- Flexion = 135 deg | - Extension = 0 deg

Normal AROM in the joints of the Ankle

- Plantar Flexion = 50 deg - Dorsiflexion = 20 deg - Inversion = 35 deg - Eversion = 15 deg

What are the start positions testing the joints in the LE

Pt. is Supine or Prone with Hips and Knees Extended to 0 deg and Ankles flexed to 90 deg

What does Validity mean in terms of Goniometry?

Does the instrument measure what it's supposed to measure

What does Reliability mean in terms of Goniometry?

Does the instrument yeild the same results on repeated uses by either the same operator or different operators

What are some strategies to improve Reliability?

- The same tester - Pt. in same position - Same goniometer - Proper size goniometer - Measurement taken at same time of day - Measurement taken at same sequence in treatment - Measurement taken at eye level

What are the key anatomical landmarks of the LE

- Iliac Crest - ASIS - PSIS - Ischial Tuberosity - Greater Trochanter - Medial and Lateral Condyles of Femur - Patella - Head of Fibula - Tibial Tuberosity - Medial and Later Malleoli - Achilles Tendon - Tuberosity of the Navicular Bone - Base of the 5th Metatarsal - Head of the 1st Metatarsal - Calcaneus

What are the contraindications for MMT?

- Pain - Inflammation - Severe Inflammatory Disease - Severe Cardiac/Respiratory Disease

What are the Precautions for MMT?

- Recent Surgery - History of Disc Pathology - CV- watch for Valsalva - When overwork is detrimental

What are the Indications for MMT?

- Data Collection - Document progress toward goals - To see if treatment is effective

Describe the process of MMT, including the MMT Screen.

- Explanation and instruction - Determine ROM - Test uninvolved side first - Test involved side AROM against gravity (Screen) - Depending on Screen results; proceed from there

How do you grade muscle strength using whole numbers only?

5- Full ROM against gravity (MAX resistance) 4- Full ROM against gravity (MOD resistance) 3- Full ROM against gravity (No resistance) 2- Full ROM against gravity (Gravity Eliminated) 1- No movement, flicker of muscle contraction 0- Nothing