Lecture 1-7 Review Flashcards
what is the APTA vision 2020
a. Giving direct access to a PT without a referral and knowing when something is outside your scope of expertise
- What is the difference between the physical therapy examination and evaluation? Be specific.
Examination: Gathering the information
-Medical, social, conditions, complaints, onset, functional status, medications, body systems review, tests and measures
Evaluation :Using the information gathered
-Diagnosis, prognosis, plan of care
- List the purposes of the PT interview with the patient/client
- Establishing a trusting relationship
- Patient education: background about the patient and what makes them unique - reason for referral
- understanding of physical therapy and their condition
- -if anything has changed since their referral - finding underlying conditions or dysfunctions causing the problem
- what should be explored and how intense the exam should be
- -priority, possible, pointless
What is the concordant sign?
Activity of motion that reproduces the patient symptom or chief complaint
examples of verbal communication
i. Empathy,
ii. Friendliness
iii. Courteous
iv. Humor
v. Explanations
vi. Education
vii. Summarize and clarification
examples of nonverbal communication
nodding
leaning forward
body orientation
examples of expressive communication
respectful tone pitch voice inflection facial expression body language
what is receptive communication
active listening
1. paying attention to body language, tone and pitch while truly listening
should you document while patient is talking?
Don’t do both
i. Document during natural pauses in the conversation
ii. Explain you need to write things down
Identify potential barriers and influences to the patient/client treatment.
Language, culture, level of education, psychological, and social
i. Home situation
ii. Mental state
iii. Inability to read
iv. Beliefs
v. ESL
what is an outcome measure, give examples of each type
An outcome measure is a way to assess patients current ability and to evaluate patient before and after treatment
- Patient reported outcome
- Questionnaires - Functional Outcome
- Berg Balance Scale
Should you review the paperwork with your patient to make sure it is free of errors or misreading of the questions? Why?
Yes, make sure they understand all questions so nothing is miscommunicated and so you have all the accurate information from the patient
What is the NPRS?
numerical pain rating scale
0 being no pain, 10 being go to the hospital
When you are observing the patient in the clinic, what types of things can you determine, just through observation?
a. Observe patient in the waiting area or when they walk into the room
b. Visible defects, abnormalities of alignment, skin, posture, body symmetry,
c. Observe throughout the session
How should you prepare the environment for when you first meet a patient and begin the interview?
Greet them
introduce yourself,
gain their trust with small talk
patient privacy,
make sure they are comfortable,
minimize distractions
Explain subjective reporting of pain.
Basically getting the patients view of the pain, how are they feeling, don’t downplay their pain, look at big picture
What is the chief complaint?
What brings you to therapy, why are you seeking care, describe where and when it happened
what is the mechanism of injury
- acute and chronic
- what makes it better, what makes it worse
- better in the morning or night
What symptom behavior is important to gather from the patient?
a. When is it better or worse, does pain increase or decrease when pain goes on
b. Location of symptoms
What factors about their life must you identify to help you understand the patient problem?
a. Life, living environment
b. Employment/school
c. Current and previous activity
d. Psychosocial
e. Medical history
What is a differential diagnosis?
Recognizing elements of a patients condition that may require another medical professional for treatment besides PT
What is a systems review
A systems review is a screening of all body systems such as the cardiovascular, pulmonary, and gastrointestinal systems that allow or screening beyond the chief complaint, which could span outside the scope of physical therapy
Identify nonverbal pain indicators.
Facial expressions, bracing, restlessness, rubbing, vocal noises
what is a red flag
- a sign of concerning pathology
2. physical risk factors that can be associated with other medical conditions
Explain a key red flag for cardiovascular and pulmonary systems.
Pain or heaviness in the chest could mean issues with the lungs and or blood flow and would refer the patient to a different health professional outside the scope of PT
Explain a red flag for intra-abdominal area.
A patient having frequent heartburn or indigestion would be an example of this and would refer them to a professional outside the scope of PT
explain a key neurologic red flag.
Problems with balance, coordination, or falling could indicate Guillain Barre
What is a yellow flag? Explain.
Psychosocial risk factor with an injury that can be seen through
i. Attitudes
ii. Behaviors
- -Extended rest and avoid daily activities
iii. Compensation issues
iv. Emotions
v. work
What is the purpose of screening beyond what is normally assessed in a physical therapy examination and evaluation?
To find out if the patients needs are beyond our scope of practice and if they should seek another medical professional for treatment. It will ensure the patient gets the treatment they require and will keep us safe as PT’s
What is body mechanics
How to move your body in a safe way. Most optimal way to move. If you have good mechanics you will be balanced and controlled
What is the purpose of having good body mechanics
To avoid injury and move efficiently. Keep your body in its best condition
What is Valsalva? Why is it important?
Attempting forced exhalation with a closed glottis. Holding your breath to increase intraabdominal pressure because it stabilizes the core. Needs to be avoided because it could rupture blood vessels
What are the key components of positioning your body to optimize body mechanics?
Engage core. Keep your center of mass and the object you are lifting close together. The closer the object is, the less work you have to do. Keep a wide base. Keep your vertical line of gravity within your base of support- don’t lean forwards of backwards. Don’t lift object- it is better to roll, push, pull or slide instead.
What is the base of support?
Refers to the area beneath the object or person, which includes its points of contact
What could potentially occur if body mechanics are poor? Why? How?
a. Loss of balance. Occurs when a persons center of gravity goes outside their base of support. Not keeping the object close enough to their body.
b. Injury. Muscle strain. Body is not in most efficient position
What are 3 types of lifting techniques
a. Power lift
b. Golfers lift
c. Dead squat lift
What is the purpose of having good posture?
Poor posture can cause injury due to prolonged tension
What are some tips to reducing stress on posture in standing? In sitting?
- Standing
i. Put your foot on a stool because it promotes a neutral spine. Alternate feet - Sitting
i. Elbows, knees and hips level at 90 degree flexion with feet on the floor, forearms supported, and back fully supported by the chair
What is the difference between PROM, AAROM, and AROM?
a. Passive is when another person or device is moving the limb through the available ROM
b. Active assisted ROM is when the client needs assistance or device or other body part to bring limb through available ROM
c. Active ROM is when the client is able to move the limb through full available motion
What are sources of error with reading a goniometer?
a. Failure to read at eye level
b. Failure to read proper scale
c. Lack of patient cooperation
d. PT expectations
e. Intra-rater reliability
What is the difference between intra-rater and inter-rater reliability?
- Intra-rater: same PT at different times
2. Inter-rater: two different testers getting the same measurement
When documenting ROM or manual muscle testing (MMT), what information must be included for it to be correct?
- ROM
i. Joint
ii. Side
iii. Degrees
iv. Motion
v. Position - MMT
i. Joint
ii. Side
iii. Grade
iv. Muscle tested
What is a joint end feel
a. Each joint has a characteristic feel to the resistance encountered at the end of the normal ROM
i. Bony
ii. Soft tissue approximation
What is muscle length and what does it tell us?
- Muscle length is the ability of the muscle crossing a joint to lengthen
- Allows the joint to move through full available range of motion
- It tells us that joints rely on muscle force production for movement
- -ROM and muscle performance
- -Length and strength are factors - Abnormal muscle length leads to
- -Altered ROM
- -Abnormal movement patterns
- -Compensatory movement patterns
- -Can result in pain
What is manual muscle testing? What do you need to know to test a muscle or muscle group appropriately?
- MMT is testing a muscle against gravity
- You need to know where gravity is and what is the action of the muscle or muscle group that you are testing
- Knowledge required
i. Muscle attachments
ii. Line of pull
iii. Function of participating muscles
iv. Testing patterns
v. Patterns of substitution
vi. Sensitivity to MM contraction, bulk
vii. Normal ROM
viii. Muscle innervation
ix. Effects of fatigue
What is the difference between 0-3 grading and 4-5 grading
a. 0-3 only using gravity as resistance
b. 4-5 manual resistance is applied
What kinds of instructions to the patients are required when measuring ROM, MMT, muscle length?
a. Tell the patient what you are going to do
b. Ensure patient is able to get into the position
