midterm 1 Flashcards
open-ended q’s
invite pt to give narrative response; broad and general
closed-ended q’s
definitive response from pt
graded-response q’s
quantify pt’s experience
multiple-option q’s
few options for pts to answer
aching
muscular
burning
neural, muscular
shooting, lightning, electrical
nerve root irritation
coldness
may be due to lack of blood flow
hotness
localized inflammation or infection
clicking, snapping, popping
ligament/tendon dysfunction
joint locking
cartilage tear, loose body, joint malalignment
global weakness/fatigue, no clear pattern
cardiovascular dysfunction
whole body pain
central somatization, “chronic pain”
joint pain/stiffness, worse in AM
inflammatory
joint pain/stiffness, worse w/ activity
degenerative
back pain worse in AM, better after a few hours, and worse in PM
disc pathology
pain varies throughout day, activity, or position
muscular
constant, intense pain, worse in PM + wakes pt from sleep w/o relief
malignancy (RED FLAG)
red flags requiring IMMEDIATE attention
- anginal pain not relieved in 10-20 minutes
- anginal pain w/ nausea, vomiting, profuse sweating
- diabetic pt who is confused, lethargic, or changes in mental alertness + function
- onset of incontinence or saddle anesthesia
- anaphylactic shock symptoms (hives, asthma, tachycardia, hypotension, anxiety, N/V)
ABCS of radiographic evaluation
a > alignment
b > bone density
c > cartilage spaces
s > soft tissues
vital signs
HR, BP, O2 sat, RR, temperature, pain
nominal measures
checklist of activities and pt responds w/ either “yes or no”, “independent or dependent”, “able or unable to do”
ordinal measures
outcome is measured in rank order (not equal intervals)
interval/ratio measures
equal intervals b/w responses
- interval: #’s start at 1 (ie. girth)
- ratio: #’s start at 0 (ie. joint degrees)
reliability
dependable, accurate, predictable, and w/o variation time after time
- test-retest = over time
- intra-rater = w/in same rater
- inter-rater = b/w raters
face validity
instrument measures what it claims to measure
content validity
subcomponents of instrument adequately cover entire construct
6 components of ADLs
bathing, dressing, toileting, transfers, walking, feeding
floor effect
too difficult, produces low scores
ceiling effect
too easy, produces high scores
gold standard measure of balance
BERG balance scale
MDC
minimal detectable change
- statistical #, no significant change in pt
MCID
minimal clinically important difference
- clinical #, meaningful change in pt
“ability” type scale
higher # w/ improving condition
- ie. LEFS, UEFS, UEFI
“disability” type scale
lower # w/ improving condition
- ie. ODI, NDI, qDASH
household ambulator
< 0.40 m/s
limited community ambulator
0.40 - 0.80 m/s
community ambulator
> 0.80 m/s
DCML
light touch ID + localization, fine touch, vibration, proprioception, kinesthesia
spinothalamic tract
crude touch, pain, temperature
discriminative sensation testing
stereognosis, graphesthesia, 2-point discrimination, point localization
hypotonic
- injury or compression along nerve pathway (LMNL)
- unilateral
hypertonic
- CNS pathology (UMNL)
- bilateral
DTR grading
0: no reflex
1+: minimal response
2+: normal
3+: overly brisk response
4+: extremely brisk response, clonus, cross-over
DTR’s
C5 = biceps, elbow flexion
C6 = brachioradialis, elbow flexion
C7 = triceps, elbow extension
L4 = patellar, knee extension
S1 = achilles, ankle PF
pupillary light reflex
- CN II: contralateral pupil constriction (sympathetic)
- CN III: ipsilateral pupil constriction (parasympathetic)
oculomotor (CN III) innervation
medial + inferior + superior rectus, inferior oblique, levator palpebrae superioris
trochlear (CN IV) innervation
superior oblique
abducens (CN VI) innervation
lateral rectus
oculomotor palsy
dilated pupil, drooping eyelid (ptosis), eye drifting lateral + down
bell’s palsy
- LMNL > CN VII impairment
- motor: paralysis of ipsilateral half of face
- sensory: loss of taste on anterior 2/3 tongue
- parasympathetic: loss of tear + saliva production
global signs of cerebellar dysfunction
ataxia, tremors, hypotonia, dysarthria, eye deviations
ataxia
lack of control of body movements; decreased movement coordination
dysmetria
error in trajectory due to abnormal range, rate, and/or force of motion
dysdiadochokinesia
impaired ability to perform rapid alternating movements
UMNL presentation
- hyperreflexia
- pathologic reflexes = clonus, babinski, hoffman’s, pronator drift
- increased muscle tone/spasticity
- underlying weakness
LMNL presentation
- hyporeflexia
- muscle weakness + atrophy
- sensory changes along dermatome or peripheral nerve distribution
anesthesia
complete loss of sensation
hypoesthesia
abnormally decreased sensitivity to stimulation
hyperesthesia
abnormally increased sensitivity to stimulation
hypoalgesia
diminished sensitivity to pain
hyperalgesia
increased sensitivity to pain
astereognosis
inability to recognize familiar objects by sense of touch
atopognosis
inability to correctly locate sensation
abaragnosis
inability to distinguish b/w different weights
paresthesia
abnormal sensation such as numbness, prickling, burning, or tingling
dysesthesia
impairment of any sensation, especially touch
paralysis
loss or impairment of motor or sensory function in a body part due to lesion in neural or muscular symptoms
hemiparaplegia
paralysis of lower half of one side of body
hemiparesis
muscular weakness or partial paralysis affecting one side of body
hemiparesthesia
abnormal sensation to one side of body
hemiplegia
paralysis of one side of body
paraparesis
partial paralysis of LEs
paraplegia
paralysis of LEs + lower part of body
tetraplegia, quadriplegia
paralysis of all 4 extremities
triplegia
paralysis of 3 extremities
diplegia
paralysis in either both UEs or LEs
ROM testing
perform before MMT
AROM
- subject’s willingness to move
- coordination, muscle strength, joint ROM
- contractile tissue integrity
PROM
- integrity of joint surfaces
- extensibility of capsule, ligaments, muscles, fascia, skin
- end feels
- should be slightly greater than AROM
hypomobility
decrease in PROM that is less than normal values
hypermobility
increase in PROM that exceeds normal values
end feel
feeling experienced by examiner that is a barrier to further motion at end of PROM
capsular pattern
pattern of restriction of PROM of joint in presence of pathological conditions
- ER > abduction > IR
- abnormal
hard end feel
bone approximating bone (bone-to-bone)
- ie. elbow extension
firm end feel
tissue stretch
- ie. wrist flexion
soft end feel
soft tissue approximation
- ie. elbow or knee flexion
empty end feel
no resistance
- presence of pain
- always abnormal
grade 5
full ROM against gravity, maximum resistance
grade 4
full ROM against gravity, moderate resistance
grade 3+
full ROM against gravity, minimal resistance
grade 3
full ROM against gravity, no resistance
grade 3-
> 50% ROM against gravity, but full ROM in gravity-reduced
grade 2+
< 50% ROM against gravity, but full ROM in gravity-reduced
grade 2
full ROM in gravity-reduced
grade 2-
partial ROM in gravity-reduced
grade 1
palpable contraction (trace ROM)
grade 0
nothing palpable (no ROM)
spine - grade 5
full ROM against gravity, maximum resistance
spine - grade 4
full ROM against gravity, moderate resistance
spine - grade 3
full ROM against gravity, arms by side
spine - grade 2
partial ROM against gravity
spine - grade 1
palpable contraction, no trunk motion
spine - grade 0
nothing palpable
MMT indications
- strong + painless = everything intact
- strong + painful = minor lesion
- weak + painful = major lesion
- weak + painless = complete lesion, neurologic deficit
