Important terms Flashcards
Purpose of Health History
- Develop a trusting and supportive relationship
- Gather information
- Offer information
- Retain a record of what happened in a consultation
Health History - Presenting complain
Onset (when and how)
Site
Quality
Intensity (/10): right now, average, at best, at worst
Radiation/Referrals
Timing (pattern)
Progression (from start to now)
Associated Symptoms
Aggravating Factors
Relieving Factors
No Effect
Health History - Complaint History
Previous episodes, past ttt for complaint, previous investigations
Health History - Medical History
- Medications
- Prescribed
- Self-prescribed
- Herbs
- Supplements
- Vitamins
- Major illnesses
- Injuries/Accidents/Trauma
- Surgeries
- Relevant Family History
Health History - Systems History
Cardiovascular
Respiratory
Gastrointestinal
Reproductive
Genitourinary
Endocrine
Neurological
Dental/Optical
Ears/Eyes/Nose/Throat
Diet/Tobacco/Alcohol/Rec. Drug Use/QOL
Historical Factors:
Psychosocial History
Dental & Opthalmic
Red Flags
- Onset of new complaint under age of 20 or over 50
- Persistent night pain
- Constant unremitting pain
- Pain that does not change with
position/movement - Loss of appetite
- Unexplained weight loss
- SOB
- Constant unexplained fatigue
- Chest pain
- Constant and severe extremity pain
- Frequent or severe abdominal pain
- Changes in bladder function
- Frequent nausea and/or vomiting
- Fever and/or night sweats
- Recent onset HA (with no previous Hx)
- Sudden onset severe neck pain (with no Hx
injury/trauma) - Changes in vision, speech and hearing
- Changes in balance and coordination
- Sudden weakness
- Progressive neurological symptoms
- Neurological symptoms over more than one
dermatome - Bilateral neurological symptoms
TART
Tissue Texture Change
Asymmetry
ROM (loss)
Tenderness
Receptors in the skin
Mechanoreceptors (sense pressure)
e.g. Meissner’s corpuscle, Merkel’s disk, Pancinian corpusle, Ruffini’s endings
Proprioception (ability to sense position in space)
e.g. muscle spindle, golgi tendon organ
Nociceptors (sense potential danger)
e.g free nerve endings
Thermoreceptors (temperature)
e.g. free nerve endings, hypothalmic thermostat
Skin screening - looking for?
- lumps & bumps
- scars
- unusual colours or hair distribution
- rashes
- scars/lesions
- common conditions
- anything that looks odd!
Palpating Skin
Temperature
Skin thickness
Skin drag
Vitality
Roughness/Smoothness
Skin Mobility
Basics of Examination - Steps
- Assess blood pressure
- Clinical examinations
- Observation, regional & functional screening examination
- AROM
5.PROM - Palpation of musculoskeletal structures
- Joint play/segmental definition
- Special tests
Observation, regional & functional screening examination
Observation (e.g. swelling, redness, bruising)
Functional movements / Activities of daily living
Gait
Posture
Cervical spine motion
Upper extremity screen
Lumbar / Thoracic motion
Thoracic cage
Lower extremity screen
Fear avoidance beliefs and movements
goals
daily difficulties
Physiologic Barrier
both active and passive structures (AROM)
Elastic Barrier
Testing passive structures: Joint capsule, ligaments etc. (PROM, Joint Play)
Anatomical barrier
Theoretical limit before tissue damage occurs
Resisted Isometric testing - Grade 5
Normal - Complete range of motion (ROM) against gravity with
full resistance
Resisted Isometric testing - Grade 4
Good - Complete ROM against gravity with some resistance
Resisted Isometric testing - Grade 3
Fair - Complete ROM against gravity with no resistance;
active ROM
Resisted Isometric testing - Grade 2
Poor - Complete ROM with some assistance and gravity
eliminated
Resisted Isometric testing - Grade 1
Trace - Evidence of slight muscular contraction, no joint
motion evident
Resisted Isometric testing - Grade 0
Zero - No evidence of muscle contraction
Sensitivity
probability of actually having the condition (if test positive)
Specificity
probability of not having the condition (if test negative)
Minor adverse reactions
Increased muscle pain
- Joint stiffness / soreness
- Tiredness, headache
Major adverse reactions
- Disc herniation
- Cauda equina syndrome
- Fracture
- Joint sprain
- Stroke
Absolute contraindications
- Weak bone e.g osteoporosis, osteopenia
- Neurological dysfunction (particularly progressive) e.g cauda equina syndrome, Guillain-Barré syndrome
- Vascular insufficiency (especially in head and neck) e.g Peripheral vascular disease, previous history of stroke
- Lack of a working diagnosis
- Pain and/or excessive tissue feedback
- Non-compliance by the patient (ie. consent not given)
Relative contraindications
- Intervertebral disc herniation
- Patients’ age and general health status
- Pregnancy (especially in the 1st trimester)
- Gross degenerative change (ie. severe osteoarthritis)
- Calcification of the aorta
- Active inflammatory disease (ie. rheumatoid arthritis, gout)
- Previous history of malignancy (ie. cancer)- Acute or chronic systemic disease
- Vertigo
- Long term steroid therapy
- Severe scoliosis
- Adverse reaction by the patient to treatment
- Patient who has recently been treated by another practitioner
- Patients with a psychological dependency on treatment
Cardiovascular - History questions
When was the last time you had your blood pressure checked? If recently, can you recall if it was high or low?
Do you experience chest/arm pain? Any SOB? Any lower limb swelling or cramps? Any varicose veins?
Respiratory - History questions
Do you experience any shortness of breath (SOB)? Do you have a persistent cough or wheezing? Any chest pain or sinus congestion?
Gastrointestinal - History questions
Do you experience indigestion or heartburn/reflux? Any recent nausea/vomiting? Any food intolerances or bloating/flatulence? Do you have irritable or inflammatory bowel disease?
Have you experienced any recent change to bowel function or stools such as constipation or diarrhea? Have you noticed blood in your stools?
Reproductive - History questions
Do you have a regular menstruation cycle? Do you experience any pain or irregularity with your menstrual cycle? Any history of endometrial or ovarian disorders or cysts?
Do you have any children or could you currently be pregnant? (If pregnancy history, note number and nature of births)
Any testicular pain or swelling?
Have you noticed a change to sexual function?
Genitourinary - History questions
Have you noticed a change in urinary frequency or pain during urination? Have you noticed blood in urine or change in colour?
Have you experienced any change with urinary flow or urgency/incontinence? Any history of kidney stones?
Any history of urinary tract infections (UTI) or sexually transmitted infections (STI)?
Endocrine - History questions
Have you noticed any heat or cold intolerances? Any change to skin hair or nails? Have you noticed excessive thirst or increased frequency in urination?
Neurological - History questions
Do you experience any numbness or tingling? Any weakness or tremors? Do you experience dizziness, fainting or loss of balance? Have you noticed any change to your memory, personality or behavior?
Dental & Opthalmic - History questions
Have you recently had any dental work? Do you experience any jaw pain? Do you wear glasses or contacts? If so, what for?
Ears/Eyes/Nose/Throat - History questions
Do you experience hearing loss or ringing in the ears? Do you wear a hearing aid? Any loss of balance or balance issues?
Psychosocial History questions -
Diet/Tobacco/Alcohol/Rec. Drug Use/QOL
What is your diet like?
Do you smoke or drink alcohol? Do you take any recreational drugs? (If so, frequency and duration)
Any history of anxiety or depression?
What is your current workload like and stress levels? How would you rate your quality of life?
Myofascial release (direct)
Muscle is simultaneously stretched whilst a longitudinal soft tissue technique is applied for 60-90 seconds or until tissue texture change is achieved
INDICATIONS: Painful, healing or shortened muscles
MET for muscles
Stretch the muscle to the restrictive barrier as you would a normal stretch
Get the patient to the isometrically contract the muscle lightly against your unyielding resistance for 3-7 seconds
Repeat 3-5 times and retest
MET for joints
Take the joint to the restrictive barrier as you would a normal articulation techniques
Get the patient to do the opposite movement lightly against your unyielding resistance for 3-7 seconds
Repeat 3-5 times and retest
Acute Pain
Pain that lasts no more than 3-6 months and that generally resolves within its normal healing
