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PHTH 508: Foundations of Patient Assessment > Exam 2 Prep > Flashcards

Exam 2 Prep Flashcards

1
Q

What are William’s flexion exercises? What is the rationale behind them?

A

-Posterior pelvic tilt: strengthens the abdominals
-Single and double knee to chest: opens the posterior elements
-Hamstring stretch: keeps the posterior longitudinal ligament taught

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2
Q

What does lumbar spine extension do to the disc?

A

If the disc is protruding, lumbar spine extension “closes the barn door” on the disc

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3
Q

What must be ruled out before the McKenzie method is used?

A

-Rule out major underlying systemic disease
-Rule out major structural pathology of the spine

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4
Q

What are the three diagnostic categories of the McKenzie method?

A

-Postural
-Dysfunction (flexion or extension)
-Derangement

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5
Q

What is the criteria for diagnosing postural syndrome?

A

-Younger
-Insidious onset (not any specific injury)
-No acute episodes or trauma
-Delayed onset pain with extended static positions
-Localized ache

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6
Q

What are findings in the physical exam that could lead to diagnosis of postural syndrome?

A

-Abnormal sagittal plane posture (no lateral shift)
-Fully correctable
-No movement limitations
-Negative neuroscan

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7
Q

What is the dysfunction syndrome?

A

-Patient will say “something is stiff”
-Flexion (pain at end range flexion, posterior element tightness)
-Extension (pain at end range extension, anterior element tightness)

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8
Q

What are criteria for diagnosing dysfunction syndrome?

A

-Older
-Episodes of acute dysfunction
-Localized pain (w/ exception of an adherent nerve root)

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9
Q

What are objective findings that would lead to the diagnosis for dysfunction syndrome?

A

-Loss of normal posture and range of motion
-Negative neuroscan
-Unidirectional stiffness
-Movement into stiffness aggravates end range pain
-With repeated movement pain is relatively unchanged or mildly better

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10
Q

What are objective findings for flexion dysfunction?

A

-Increased lordosis
-Limited forward bending
-Loss of lumbar curve reversal
-Hamstring tightness

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11
Q

What are some ways to manage flexion dysfunction?

A

-Williams flexion exercises
-Childs pose
-Cat in cat-cow

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12
Q

What are some objective findings for extension dysfunction?

A

-Loss of lordosis
-Limited backward bending

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13
Q

What are some ways to manage extension dysfunction?

A

-Cobras
-Extension over ball
-Extension over bolster

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14
Q

What is derangement syndrome?

A

-A disc lesion

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15
Q

What are some criteria for diagnosing derangement syndrome?

A

-Age (middle aged people)
-Hx of progressive episodes
-Mechanism of injury (flexion, twisting, or loading)
-Localized and/or referred symptoms

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16
Q

What are different postures that can be associated with derangement syndrome? Why do people have these postures?

A

-Guarded flexion
-Lateral shift
-To get off of the disc

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17
Q

What are objective findings that can help diagnose posterior derangement syndrome?

A

-Positive neuroscan
-Repeated movements will quickly exacerbate symptoms either centrally or peripherally, or can improve or worsen limitations in range

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18
Q

What happens if you correct someone’s lateral shift and the symptoms stay localized? What if symptoms go down the leg?

A

-If symptoms stay localized then it is reducible and the disc is no longer protruding
-If the symptoms go down the leg then it is irreducible and you should not treat it

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19
Q

What happens if you put someone into flexion or extension and the symptoms stay localized? What if symptoms go down the leg?

A

-If symptoms stay localized then it is reducible
-If symptoms go down the leg then it is irreducible

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20
Q

What can you do if someone has irreducible posterior derangement?

A

-Mechanical traction
-Educate patient on how to self traction

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21
Q

What can you do if someone has a reducible posterior derangement?

A

-Give them McKenzie’s extension exercises
-Target progressive end range loading into extension

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22
Q

What does one spinal segment consist of?

A

-Adjacent two halves of vertebrae
-Disc
-Facets
-Associated ligaments
-Associated muscle, fascia, and integument innervated by the spinal nerve

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23
Q

What is the orientation of the cervical facet joints?

A

~45 degrees

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24
Q

What is the orientation of the thoracic facet joints?

A

Vertical

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25
Q

What is the orientation of the lumbar facet joints?

A

Horizontal

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26
Q

What are the normative values for cervical flexion?

A

45-50 degrees

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27
Q

What are the normative values for cervical extension?

A

85 degrees

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28
Q

What are the normative values for cervical rotation?

A

70-90 degrees

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29
Q

What are the normative values for cervical side bending?

A

40 degrees

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30
Q

How do you palpate L5 spinous process?

A

-Find the top of the iliac crests and go medially, you will find the spinous process of L4
-Bring your finger down until you find the spinous process of L5

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31
Q

What are physical agent modalities?

A

-Thermal
-Acoustic
-Electromagnetic
-Electrical
-Mechanical energy
-Transmission of low, medium, or high frequency energies into tissues to stimulate them in ways that are not possible by the patient

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32
Q

What types of physical therapy modalities are there?

A

-Superficial heat and cold
-Intermittent pneumatic compression
-Traction
-Hydrotherapy
-Deep heating agents
-Electrotherapies
-Cold light laser

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33
Q

What type of electrotherapy is used to stimulate muscle contraction?

A

Neuromuscular electrical stimulation (NMES)

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34
Q

What type of electrotherapy is used to modulate pain?

A

Transcutaneous electrical nerve stimulation (TENS)

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35
Q

What else can electrotherapy be used for?

A

To promote edema reduction and wound healing

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36
Q

What mechanical modalities are there?

A

-Hydrotherapy
-Intermittent pneumatic compression
-Mechanical traction

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37
Q

What are indications for intermittent pneumatic compression?

A

-Traumatic edema
-Stump reduction following amputation
-Wound healing
-Prevention of DVT
-Venous stasis ulcers
-Lymphedema

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38
Q

What are contraindications for intermittent pneumatic compression?

A

-Acute pulmonary edema
-Congestive heart failure
-Uncontrolled hypertension
-Acute or recent DVT’s
-Infection

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39
Q

What is a typical protocol for intermittent pneumatic compression?

A

-Continuous with very low intermittent pressure
-Pressure must be below diastolic
-15-30 minutes
-Stop if swelling in other areas is seen, pt has SOB, or numbness

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40
Q

How are modalities commonly applied?

A

In combination with each other (i.e. ice and TENS)

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41
Q

What are different ways to heat/cool the body?

A

-Conduction
-Convection
-Conversion
-Radiation
-Evaporation

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42
Q

What is conduction?

A

Direct contact between two objects must occur and they must have different temperatures

43
Q

What is convection?

A

There is a medium present and heat is transferred from the circulating medium to the tissue

44
Q

What is conversion?

A

Converts a non-thermal form of energy (mechanical, electrical, chemical) into heat

45
Q

What is radiation?

A

Direct transfer of energy from a material with a greater temperature but there is no medium or direct contact (infrared lamp)

46
Q

What is evaporation?

A

-Material that absorbs energy and changes it from liquid to a gas vapor
-Fluoromethane spray
-Historically known as Travell’s Spray and Stretch

47
Q

What are indications for therapeutic heat?

A

-General and muscle relaxation
-Pain control
-Increased ROM/decreased joint stiffness
-Promote healing (increased circulation, increased oxygen, increased metabolic rate)

48
Q

What are the effects of vigorous heat?

A

-Vasodilation
-Increased oxygen hemoglobin dissociation
-Neuromuscular effects (increased nerve conduction velocity)

49
Q

What are contraindications for therapeutic heat?

A

-Acute injury or inflammation
-Recent or potential hemorrhage
-Thrombophlebitis
-Impaired sensation
-Impaired cognition
-Malignancy
-IR radiation of the eyes

50
Q

What are precautions for therapeutic heat?

A

-Pregnancy
-Impaired circulation
-Poor thermal regulation
-Edema
-Cardiac insufficiency
-Metal in the area
-Paraffin over an open wound
-Where topical counterirritants have recently been used

51
Q

What are adverse effects of superficial heat?

A

-Burns
-Fainting
-Bleeding
-Skin and eye damage from infrared

52
Q

What are methods of application for superficial heat?

A

-Moist heat
-Electric heating pads
-Whirlpool
-Paraffin
-Infrared

53
Q

How many layers should be between the skin and the heat pack?

A

6-12 layers

54
Q

What temperature should the heat packs be for mild heat? What about for vigorous heating?

A

-Mild heat: < 40C (104F)
-Vigorous heating: 40-45C (105-113F)

55
Q

How long is muscle strength decreased for after using heat?

A

-30 minutes after
-Increased for the next two hours compared to pre-treatment

56
Q

What are the effects of heat combined with stretch?

A

-Increased tissue extensibility
-Expect about 3-6% length gain with some loss following 24 hours

57
Q

What are different applications of cold?

A

-Ice pack
-Ice massage
-Ice bath
-Fluoromethane spray

58
Q

What are indications for therapeutic cold?

A

-Acute and sub-acute musculoskeletal trauma and inflammation
-Hemodynamic effects (vasoconstriction)
-Pain control (anesthetic effect, lowers nerve conduction velocity)

59
Q

When can tissue damage occur with tissue cooling?

A

-At 15C (59F) tissue damage can occur
-At -4 and -10C (14-39F) tissue death can occur

60
Q

How long should cold applications be applied for?

A

No longer than 10-15 minutes

61
Q

How can you make a cold pack at home?

A

-1 part rubbing alcohol
-3 parts water
-Place in freezer

62
Q

How long should ice massage be applied for?

A

8-10 minutes (but that may be too long, usually only 5 minutes)

63
Q

What are the stages of sensation with cold therapy?

A

-Stage I: cold, 1-3 minutes
-Stage II: burning, 3-5 minutes
-Stage III: aching, 5-7 minutes
-Stage IV: numbness, 7+ minutes

64
Q

What are the neuromuscular effects of cold therapy?

A

-Temporary decrease in spasticity which may be due to decreased nerve sensitivity
-After 45 minutes of ice application there is decreased hyper-reflexia and is sometimes used on pts with spasticity due to UMN lesion

65
Q

What are indications for cold therapy?

A

-Inflammation control
-Edema control
-Pain control
-Modification of spasticity
-Facilitation of strength

66
Q

What are contraindications of cold therapy?

A

-Cold hypersensitivity
-Cold intolerance
-Raynaud’s disease (bc hands and feet vasocontrict & get really cold)
-Over a regenerating nerve
-Over an area with circulatory compromise or peripheral vascular disease

67
Q

How long should patients avoid activities that typically aggravate their symptoms for after icing?

A

1-2 hours after because the analgesia may mask pain

68
Q

How quickly do nerves regenerate?

A

An inch a month

69
Q

What are precautions with cold therapy?

A

-Superficial main branch of a nerve
-Open wound
-Hypertension
-Poor sensation or cognition
-Very young or very old patients

70
Q

What are adverse effects of cold therapy?

A

-Tissue death
-Frostbite
-Nerve damage
-Unwanted vasodilation

71
Q

What are forms of hydrotherapy?

A

-Whirlpool
-Jacuzzi’s and pools

72
Q

What are indications for hydrotherapy?

A

-Alternative exercise medium
-Wound care
-Advantages of immersion properties
-Pain reducing environment

73
Q

What is aquatic physical therapy?

A

A therapeutic procedure which attempts to improve function through the application of therapeutic aquatic exercises

74
Q

What are general benefits of aquatic physical therapy?

A

-Improve circulation, strength and endurance, balance, and coordination
-Increased range of motion
-Decrease tissue swelling
-Normalize muscle tone
-Protect joints during exercise
-Reduce stress

75
Q

What are indications for aquatic therapy?

A

-Orthopedic conditions
-Weight-bearing restrictions
-Joint replacement
-Obesity
-Pre/post-natal dysfunction
-Neurologic conditions (Parkinson’s, MS, CP)
-Spinal cord injury
-Rheumatologic conditions

76
Q

What are unique properties of water that are an important part of aquatic PT?

A

-Buoyancy
-Hydrostatic pressure
-Drag
-Temperature

77
Q

What is bouyancy?

A

-Archimedes’ Principle
-Upward force that works opposite of gravity
-Gives relative weightlessness and unloads joints, making movement easier

78
Q

What is the percentage of weight bearing when immersed to the waist? What about to the mid-chest and neck?

A

-54% at waist
-35% at mid-chest
-8% at neck

79
Q

What is hydrostatic pressure?

A

-Pascal’s Law
-Pressure exerted on immersed objects
-Pressure will increase with depth

80
Q

How does hydrostatic pressure help in aquatic PT?

A

-Increased pressure decreases effusion
-Assists in venous return
-Induces bradycardia and centralizes peripheral blood flow

81
Q

What is drag?

A

-Cumulative effects of turbulence and fluid viscosity acting on an object in motion
-As movement speed increases, so does resistance
-Moving water past the patient required more work to maintain same position
-Equipment increases amount of drag

82
Q

How can temperature of the water help in aquatic therapy?

A

-Water retains heat 1000X more than air
-Body is less able to dissipate heat in water
-Water can penetrate to deeper tissues with increases time

83
Q

What are the temperature guidelines for aquatic therapy?

A

-79-82F for cardiovascular training and aerobic exercise
-84-90F for flexibility, gait training, and relaxation
-91F for therapeutic exercise for patients with acute painful MSK injuries

84
Q

How much does hydrostatic pressure on the chest wall increase the work of breathing?

A

By 65%

85
Q

What are contraindications for aquatic therapy?

A

-Cardiac failure
-Respiratory dysfunction
-Severe peripheral vascular disease
-Danger of bleeding or hemorrhage
-Severe kidney disease
-Open wounds, colostomy, and skin infections
-Water and airborne diseases
-Bowel and bladder incontinence
-Uncontrolled seizures

86
Q

What are precautions for aquatic therapy?

A

-Fear of water
-Neurologic/cognitive disorders
-Seizures
-Cardiac dysfunction
-Small open wounds
-Skin conditions or irritations to pool chemicals

87
Q

What types of exercise can be done in the pool?

A

-Stretching (increased relaxation)
-Strengthening (drag, speed)
-Aerobic conditioning
-Balance (no fear of falling from being in water)

88
Q

What populations is aquatic therapy good for?

A

-Pregnant people (reduces weight bearing)
-Those with sensory issues (elicits greater somatosensory input)
-People with arthritis (unloads joints)

89
Q

What are current techniques in aquatic therapy?

A

-Aquatic PNF
-BackHab (back rehab and gait training)
-Fluid Moves- Feldenkrais
-Watsu

90
Q

What is BackHab?

A

-Back rehabilitation
-Gait re-training
-Focus on coordination of all body parts

91
Q

What is Fluid Moves/Feldenkrais?

A

-Uses gentle movement and directed attention
-Aims to increase ease and range of motion, flexibility, coordination, and enhance functional integration

92
Q

What is Watsu?

A

-Client held or cradles in warm water while provider stabilizes or moves one body segment, resulting in a stretch of another segment due to drag
-Used for pain reduction, increased ROM, increased circulation, psychological problems, relaxation, and stress reduction
-Also used in orthopedic problems, pregnancy, physical disbility, etc.

93
Q

What type of equipment is used in aquatic therapy?

A

-Collars, rings, belts, vests
-Dumbbells
-Gloves, fins, paddles, boots
-Kickboards and mats

94
Q

What are different types of tape?

A

-Leukotape
-Athletic tape
-Kinesio/rock tape

95
Q

What is athletic tape used for?

A

-Used by PTs/ATCs
-Purpose is to provide support
-Flexible, cloth tape
-Easily torn
-Not elastic
-Stiffer than kinesio/rock tape

96
Q

What is athletic tape commonly used for?

A

-Ankle sprains/instability
-Wrist

97
Q

What is leukotape?

A

-Rigid, cloth tape
-Requires scissors to cut
-Purpose is to provide support and positioning
-Used in McConnell taping

98
Q

What is McConnell taping?

A

-Developed by Jenny McConnell
-Tape applications designed to unload soft tissue
-Research on patellofemoral, shoulder, and lumbar pathology

99
Q

What is kinesio tape?

A

-Developed in 1970s in Japan
-Elastic, flexible tape
-Designed to assist in healing traumatized tissues
-Used for increased lymph drainage, muscle inhibition or facilitation
-Must be applied in a specific direction

100
Q

How does taping help reduce bruising and swelling?

A

-Opens lymph channels and promotes reabsorption to reduce bruising and swelling

101
Q

What is rock tape?

A

-Knock off of kinesio tape
-Sturdier than kinesio tape
-Doesn’t matter what direction tape is applied

102
Q

What is the purpose of kinesio/rock tape?

A

-Pain mitigation
-Neurosensory input
-Decompression
-Skin to brain connection

103
Q

What are precautions of taping?

A

-History of tape irritation
-No experience with tape
-Blood thinners
-Hormone cycle
-Lighter/ginger skin types

104
Q

What are contraindications of taping?

A

-Open wounds
-Active infection
-Active cancer site
-Kidney/congestive heart failure
-Overstretch of tape ends
-History of skin reactions

PHTH 508: Foundations of Patient Assessment (7 decks)

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