Lab Exam Flashcards
Pain Sensation what tool do we use to assess pain, and what manner?
Sterilized safety pin.
Alternating randomly between the sharp and dull side of the safety pin.
True or False. Patient sight does not have to be occluded during pain sensation testing?
False.
What does a patient have to do to when is being tested for pain sensation?
Indicate if it is the sharp or dull following application
Correct response to pain sensation means?
intact protective sensation
Incorrect response to pain sensation means?
Absent of protective sensation
How do we test for temperature awareness ?
Apply rest tubes filled with hot or cold fluid to areas of hand/UE.
What does the patient have to do when is being tested from temperature awareness?
Indicate if tube is hot or cold
Correct response to temperature awareness means?
Intact temperature awareness
InCorrect response to temperature awareness means?
Absent of temperature awareness.
What static two point discrimination test for?
Receptors density and mapping for improvement following nerve repair
How do we begin the test for TPD?
Test the fingertips with light pressure, stop when skin begins to blanch.
Randomly test one or two points on the radial and ulnar aspects of each digits fro 10 applications.
At what distance btween each pin do we begin with TPD?
Begins with distance of 5 mm between testing points
What patient respond should be when testing TPD?
Responds with 1 or 2 or I don’t know
True or False.7/10 correct responses at that number of millimeters of distance between 2 points can terminate the test as it normal senation?
True
1-5 mm indicates?
Normal 2 point
6-10 mm indicates?
fair static 2 point
11-15 mm indicates?
poor static 2 point
1 point perceived indicates what?
Protective sensation only
No point perceived indicates what?
Anestheric area.
What do we beging with Moving Two Point testing?
Begin with distance of 8 mm between points
Moving Two Point how does testing look like?
randomly select 1 or 2 points and move proximal to distal on the distal phalanx parallel to the longitudinal axis of the finger (so adjacent nerves are not stimulated)
Moving Two Point if patient responds correctly what do we do?
decrease the distance between points
What responses should be in place during Moving Two Point
1, 2, or I dont know
how many times does patient have to respond Moving Two Point to be terminated ?
7/10
2-4 mm ages 4-60?
normal
4-6mm ages 60+?
normal
What does monofilament testing measures?
Light and deep touch
Light touch is important for ?
fine discriminatory hand use
Deep touch is important for?
Protective sensation
With whom is monofilament testing good to use with ?
nerve entrampments
True or False? Monofilaments come in a set of 20 or a screen kit of 5?
Ture
Monofilaments are color coded why?
To correspond to threshold caregories
What Monofilamet should we start with ?
1.65
What is the procedure of Monofilament testing ?
Start with 1.65
apply for 1 - 1.5 sec (it should bend)
Lift for 1 -1.5 sec
Repeat 3 times in the same spot for filaments 1.65 to 4.8
Filaments higher then 4.08 are only applied once
Randomly select areas in the hand to test
What should the patient say during monofilament testing?
Pt says touch when they feel the monofilament
What do you do if patient feels or does not feel the monofilament?
Record the number on the ahnd grid if the pt does NOT perceive filament proceed to the next thicker monofilament up to 6.65.
Green Indicates?
Normal light touch 1.65-2.83
Blue Indicates?
Diminished light touch 3.22-3.61
Purple Indicates?
Dminished Protective senstation 3.84-4.31
Red Indicates?
Loss of protective sensation 4.56-6.65 loss of protective sensation
Untestable indicates?
inability to feel the largest monofilament.
Grip Testing what is the process ?
Should be measured with a calibrated dynamometer
Second rung of the dynamometer is used for standard testing (if different used it should be documented)
How many trials do we have to have when measuring grip testing?
average of 3 trials should be scored (unless painful).
Grip Testing How is it calculated ?
Average of 3 trials Grip held for 3 seconds 15 seconds intervals between traisl Compare to uninvolved side Compare to established norms.
What is the standard position during grip testing?
Patient seated with arm adducted at side
Elbow flexed to 90, forearm in neutral, wrist at 15-30 of extension and 0-15 ulnar deviation
Patient instructed to squeeze as hard as possible
Therapist gently supports the base of the dynamometer
Dynamometer 5 rungs measure?
1st measures intrinsics
2nd standard grip
3rd someone has a large hand
4th and 5th rung extrinsic strength.
Pinch Testing what are they?
2 point pinch (tip to tip) 3 point pinch (3 jaw chuck) Lateral pinch (key pinch)
Pinch testing position
patient seated,
elbow flexed 90 degrees
arm abducted at side
forearm neutral
What observation of edema consist of ?
Visualization, color, location touch; temperature, rebounding/pitting Sings and symptoms of infection open areas scarring
What volumetry of edema consist of ?
Volumeter, beaker and 500ml graduated cylinder
Figure of eigth methods uses what?
tape measure
Circumferential measurement uses what?
Use of tape measure of circumferential measurement device
what is going on in the sage of Acute edema?
Transudate edema
COnsist of excess H2O and electrolytes
pits and rebounds
what is going on in the sage of Sub-Acute edema?
Consits of large plasma proteins: is viscous
Slow to rebound after pitting
what is going on in the sage of Chronic edema?
Indurated edema is hard and nonpitting
Fibrotic - consists of large plasma proteins that have been trapped over time.
Figure of Eigth Method ?
Begin at the distal wrist crease of the palmar side of the wrist .
Wrap tape measure In an ulnar direction
Bring the tape diagonally across the dorsum of the hand to the 2nd MCP joint
The tape was then wrapped across the ventral surface of the 5th MCP joint
Continure over the palmar crease of the 5th digit brining the tape back across the dorsum surface to the starting point.
What factors may influence results of volumetry ?
Time of day
Exercise
Forearm position
Water temp
Citcumferential measurement consist of?
Using flexible tape measure or finger circumference gauge
Wrap tape measure around body part
Use bony landmarks to and document accurately increase retest reliability
Dont allow tape measure to dig into skin
What are edema treatments?
Low stretch bandages Self-adherent wrap (coban) Kinesotaping Chip bag Exercise Edema gloves Manual edema mobilization
Exercises for Edema?
Diaphragmatic breathing
Should start at the trunk
low level aerobic exercises
followed by shoulder/elbow ROM, wrist/hand fisting overhead
Treatement of Edema; Cold?
Initiates vasoconstricion causing decreased outflow.
should not be <59 15C
Percaustions are? nerve damage, impaired sensation, digit replantation
Treatement of Edema; Elevation?
Decreased outflow via decreasing arterial hydrostatic pressure
Stimulates lymph flow via increasing hydrostatic pressure
Position of hand: Elbow above shoulder, wrist above elbow, hand above wrist, ELbow should not be in extreme flexion
Precautions: digit replantation R side hemiparesis L stroke.
What type of compression garment we have?
Elastic gloves, stockinette, and coban wrap
Treatement of Edema; Compression
Light compression increases the absorption of small molecules in fluid
Too tight will restrict fluid flow causing more edema.
Treatement of Edema; Chip bag
For small localized edema
Compression depends on mix of foam.
Treatement of Edema; Retrograde massage
Light stokes working distal to proximal
Treatement of Edema; Manual Edema Mobilization
Used to reduce subacute edema. ONly regular edema in subacure or chronic stage
Light massage is provided to prevent collapse of the lymph pathways
What are contradications to Manual Edema Mobilization?
Infections areas of inflammation Hematoma or clot Active cancer CHF, severe cardiac or pulmonary problem Renal failure Primary lymphedema or lymphedema from mastectomy wounds
Treatement of Edema; Kinesotape
Promotes absorption of large and samll molecules via increasing the available space between skin and connective tissue
Creates a pull on the anchor filaments in the lymphatic system
Treatement of Edema; Pump Point Stimulation (MEM)
Simultaneous, synchronous movement of therapist two hands in a U pattern over areas of lymph bundles
Therapist does 20-30 U’s in one area before proceeding to the next area of pump points.
NEED TO BE TRAINED
U hand movement pattern..
Pattern of hand on skin
Very light pressure
Pulls skin lightly distal then circles back up and around
Clearing U’s skin Tractioning Pattern
Start proximal and moves to the distal part of the limb
Minimum of 5 Us are done in 3 sections to create interstitial pressure changes
Flowing U’s Lymp Movement Pattern
Distal moves prximal
Moving one U after another from distal to proximal is repeated 5 times
The flowing U pattern is performed all the way to the contralaterl upper quadrant
Followed by active muscle contracion in each segment.
