Intro to PT Chapter 9 Flashcards
Systems review
Cardiovascular and Pulminary
HR, Respiratory Rate, Edema
Systems review
Integumentary system
scar formation, pliablility, skin color, skin integrity
Systems review
musculoskeletal system
gross symmetry, gross range of motion, gross strength, height, and weight
Systems review
neuromuscular system
gross coordinated movement (eg, balance, gait, locomotion, transfers, and transitions) and motor function (motor control and motor learning)
Systems review
communication ability, affect, cognition, language, and learning
ssessment of the individual’s ability to make needs known, consciousness, orientation (person, place, and time), expected emotional/behavioral responses, and learning preferences (eg, learning barriers, education needs). The systems review for a pediatric patient also may include consideration of the safety and well-being, nutrition, behavior and attention, and self-determination.
Dysfunctions of musculoskeletal system
may be result of traumatic or repeated stress to tissue, structural imbalances of muscle or bone, congenital conditions, surgery or degenerative changes.
Result in: weakness or fatigue, pain, stiffness, edema, los of ROM.
PTs to diagnose must
understand anatomy, biomechanics, pathokeinesiology, and exercise physiology.
Chronic Pain
pain that lingers long after the initial injury
Acute pain
pain felt immediatly after an injury
CDC - non pharmacologic therapies, including physical therapy… can amerliorate chronic pain.
Systemic Diseases that impair musculoskeletal system:
rheumatoid arthritis, obesity or cancer.
Subjective examination
verbal description of the condition
Objective examination
Quantitative measurements to determine status of the body and the condition
History
Current and past health status. Interview of patient + health record + consulting with health care team.
Therapeutic alliance
insight into the patient’s view of the problem and facilitate patient motivation and improve outcomes. Develops as part of interview.
Patient interview
”s” information in soap note - often gives enough information to make a list of possible diagnoses.
ROS review of systems
Objective portion of soap note. systems review assists the therapist in plan of care and may identify further health problems that require consultation.
Tests and measures
Baseline values for things. Assist in reaching diagnosis.
Observation
Looking phase of examination - for instance, standing or sitting postures of patient and asymmetric body contours, swelling. abnormal curvature of the spine and joint subluxations. Preliminary gait assessment.
Active rainge of motion
ability to move a limb voluntarily through an arc of mevement.
PROM
amount of movement that is obtained by the therapist moving the segment without assistance from the patient.
Hypomobile joint
less motion than is considered functional
Hypermobile joint
excessive motion
goniometry
most common measurement technique to document amount of joint motion available.
ROM comparisons
typically compared to ROM on unaffected side.
Strength
amount of force produced during voluntary muscular contraction
Resisted test
assessing the status of the muscles and tendons. this determines the general strength of a muscle group and shows if the group is weak or painful.
manual muscle testing (MMT)
specific grade to a specific muscle.
Grade 0 - Zero (0/5): No contraction.
Grade 1 - Trace (1/5): Slight contraction, no movement.
Grade 2- - Poor Minus (2-/5): Less than full ROM in a gravity-eliminated position.
Grade 2 - Poor (2/5): Full ROM in a gravity-eliminated position.
Grade 2+ - Poor Plus (2+/5): Moves through partial ROM against gravity.
Grade 3- - Fair Minus (3-/5): Moves through more than half ROM against gravity but less than full ROM.
Grade 3 - Fair (3/5): Full ROM against gravity but no additional resistance.
Grade 3+ - Fair Plus (3+/5): Full ROM against gravity with minimal resistance.
Grade 4- - Good Minus (4-/5): Full ROM against gravity with less than moderate resistance.
Grade 4 - Good (4/5): Full ROM against gravity with moderate resistance.
Grade 4+ - Good Plus (4+/5): Full ROM against gravity with nearly maximal resistance.
Grade 5 - Normal (5/5): Full ROM against gravity with maximal resistance.
Flexibility
ability to move a lim segment through a specific ROM.
Accessory motion
soft tissue surrounding the joint must be pliable to allow movement between joint surfaces. The ability of the joint surfaces, to glide, roll, and spin on each other. ability of crossing muscles to lengthen
Flexibility importance
posture and body mechanics.
90 90 STRAIGHT LEG RAISE
measures flexibility of hamstring.
Functional tests
ability to perform activities of daily living.
Eating
Dressing and undressing
Bathing and grooming
bed and bathroom
Transfer and ambulatory
other - like dial a telephone, use a sicors. et cetra.
More agressive functional tests
hop test, jump tests, lunge tests, excursion tests, and balance tests.
Outcome measures
Standardized tests that measure an actual or percieved activity limitation and participation restriction. measure initial degree of limitation and compare to changes after treatment. SF-36 PSFS.
Outcome measures
SF-36
Medical Outcomes Study 36-item short form.
Outcome measures
PSFS
patient specific functional scale - five activities theat they are having difficulty in performing because of their injury or condition.
Lower Extremity functional scale
Lists 20 activities and asks if the lower limb problem is causing problems. Patient rates 0-extreme difficulty or unable to 4 no difficulty and then is given a score out of 80 possible points.
Special tests
examine individual joints to indicate the presence or absence of a particular problem to confirm or reinforce diagnosis.
special tests
Phalen test for nerve compression
Special tests
Hawkins test for shoulder impingement
Special tests
ACL Lachman test
Special tests
Palpation
to assess what is going on below the skin and what musculoskeletal structures rare involved in an injury.
MSK US
diagnostic ultrasound that uses soundwaves to bounce off tissues and produce an image.
musculoskeletal ultrasonography
Other imaging from other medical professionals
CT MRI - important for PT to incoporate the results of medical imaging into the clinical decision-making process.
Regional interdependence
refers to the relationship that exists between anatomical regions of the body. For instance a pain in the knee could be because of a muscle imballance at the hip. Proximal and distal regions should be considered.
Goals
decrease pain, edema, increase strength and motion. Long term goal:
optimal level of functioning.
Plan of Care
Which interventions will result in improvement in a patient’s function.
Goals of patient and desired outcome.
Intervations
patient client instruction, biophysical agents, manual techniques (including soft tissue and joint mobilization), therapeutic exercise, and home exercise programs.
Patient/client education
educating patient about diagnosis and about exercises to be performed at home. Chronic pain causing changes in the brain also mentioned. Healthy habits. Body mechanics.
Must consider personal issues, such as culture,
values, and so on
Information on the diagnosis
Explanation, demonstration of exercises
Biophysical agents
Thermal agents, ultrasound, electrotherapy. TENS. NMES - whirlpool
Paraffin treatment
135 degree paraffin wax. Hand or foot put in.
Fuidotherapy
corncobs finaely chopped to a sawdust type substance. Heated to the desired stemp and circulated by air pressure around the involved body part.
Ultrasound
high-frequency sound waves penetrate tissue and increase tissue temp. to promote healing and reduce pain.
short-wave diathermy
use of electromagnetic energy to produce deep therapeutic heating effects.
Cryotherapy.
physical agent of choice for patients who have acute injuries with sewlling or pain. reduce post-exercise soreness. Cod packs, ice massage, or cold used in conjunction with compression.
TENS
Transcutaneous Electrical Nerve Stimulation - treatment of pain in lower back. Electrodes placed on skin that stimulate muscles and nerves to reduce pain and swelling, increase strength, ROM and wound healing.
Additional biophysical agents
mechanical traction, hyperbaric oxygen, biofeedback, laser therapy, and extracorpreal shockwave therapy.
ESWT
Extracorpreal Shockwave Therapy - high pressure sonic waves that penetrate through human tissue.
Manual Therapy techniques
soft tissue techniques and joint mobilization
Soft Tissue techniques
include masage, myofacial release, neural tissue mobilization and dry needling.
Soft Tissue techniques
massage
involves the systematic use of various manual strokes to produce certain physiologic, mechanical and psychological effects.
Sweedish - relax
vigorous- before activity to promote blood flow
transverse friction massage - promote proper healing and flexibility.
Soft Tissue techniques
Myofascial release
stretching layers of the body’s fascia. soften restrictions that are limiting normal movement.
Neural tissue mobilization
addresses issues that arise because of a decreased ability of neural tissue to slide and glide through and along connective tissue.
Nerves are moved and stretched to allow for normal movement.
Dry Needling
Putting needles into trigger points to reduce pain and muscle tension.
Joint Mobilization
used when a patient’s disfunction is the result of joint stiffness or hypomobility
applies specific passive movements of varying amplitude to a joint, in either an oscillatory or a sustained manner.
Therapeutic Exercise
Core of most rehabilitation programs. human body has the ability to react and respond to physical stresses placed on it.
ROM AROM and PROM
Passive Range of Motion - therapist moves involved part
Active assisted range of motion - Pt moves through part of range, therapist moves involved part rest of range.
Active range of motion - pt moves involved part through the range
active free exercise
exercises in which patient doesn’t recieve any support or resistence. example: pendulum exercises.
active-resisted exercies
external force resists the movement.
Muscular strength
is the maximal amount of tension an individual can produce in one repetition (low reps.)
Muscle endurance
ability to produce and sustain tension over a prolong period (high reps)
Muscle power
amount of work produced by the muscle in a given amount of time. (jumping)
classification of resisted exercises
Isometric
muscle contraction without visible joint movement - pushing against a wall.
classification of resisted exercises
Isotonic concentric
Muscle contraction that controls joint motion, resulting in muscle shortening - Curl dumbell up.
Isotonic eccentric
Muscle contraction that produces or conrols joint motion, resulting in muscle lenggthening - exteding elbow with dumbell in a controlled manner.
Isokinetic
A concentric or eccentric muscle contraction that occurs at a constant speed- knee extension using a isokinnetic device.
Core strengthening
strengthening of the deep postural muscles of the lumbar and cirvical spine.
Flexibility exercise
soft tissue has ability to change length and adapt over time in response to stress.
contract-relax
requires the shortened muscle actively contract before stretching force is applied.
Balance
ability to maintain body position in equilibrium. Nervous and musculoskeletal systems to interact with environment.
Bosu
balance trainer.
aerobic training
exercise performed over a long period at low intensity. Large muscle groups in a rhythmic type of activity.
functional exercises
exercises mimicking functional movements and activities.
closed kinetic chain exercise
when one joint affects the movement at other joints and the distal segment is not free to move. example: squats, pushups
open kinetic chain exercise
end limb segment distal is free to move. example leg extension machine
Aquatic Therapy
Greeks aad Romens used therapeutic bths for relaxation and pain reduction.
1920s- poliomyelitis children
Aquatic Physical Therapy
beneficial for a variety of orthopaedic dysfunctions. - buoyancy, viscosity and hydrostatic pressure both physiologic and phsychological. Lower impact. Relaxation and warmthh - psychological.
Home exercise program
allows the patient to assume responsibility for their care. Only performing exercises in the clinic is usually not suffiicient.
Bursitis
Inflammation of bursae (fluid-filled sacs that decrease
friction)
Overuse Injuries
Tendinopathy
Tendinitis (inflammation of the tendon)
Tendinosis (degenerative changes from overuse)
Overuse Injuries
Nerve entrapment
Pressure on peripheral nerve from surrounding
structures
Overuse Injuries
Ligament sprain
Overstretched
Traumatic Injuries
Fracture
Bone breaks
Traumatic Injuries
Muscle strain
Tear of muscle fiber
Traumatic Injuries
Total joint arthroplasty
Replacement of joint with artificial surfaces
Surgical Conditions
Amputation
Removal of part of entire limb
Surgical Conditions
Medical Conditions
Rheumatoid arthritis
Obesity
Cancer
May cause pain, weakness, and loss of function
Evaluation
The evaluation is a clinical judgment based on
the findings of the examination and identifies:
Impairments
Activity limitations
Participation restrictions
diagnosis
provides a categorization of the
findings.
The prognosis, or prediction of level of
improvement, includes:
Creating a plan of care (identifies goals, outcomes,
interventions)
Short-term goals for musculoskeletal conditions,
commonly:
* Decrease pain and edema
* Increase strength and motion
Long-term goals
* Achieve an optimal level of function
