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Midterm Exam Flashcards

1
Q

What is important for initial goals of rehabilition

A

Restoring mobility and thee ability to perform ADLS

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2
Q

4 examples of short term goals

A
  • Increase function by 50% over the next 2 weeks
  • Decrease pain by 50% over the next 2 weeks
  • Increase aROM by 30%
  • Increase flexibility by 40%
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3
Q

3 examples of long term goals

A

Obtain 90% strength and 100% flexibility within 6 weeks
Ability to sit for 3 hours without pain
Ability to perform ADL’s (Laundry/Vacuuming) pain free

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4
Q

6 tenants of movement screening

A

• Baseline measurement – DO NOT PERFORM ON
ACUTE PATIENTS
• Outcome assessment
• Pattern recognition
• Make sure patient understands movement but without cueing
• Want to see their natural movement
• Max of 3 attempts for each movement

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5
Q

What are two screens that can be performed for movement?

A

Functional Movement Screen - FMS

Magnificent 7 - Mag 7

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6
Q

7 movements of FMS

A
  1. Deep squat
  2. Hurdle step
  3. Inline lunge
  4. *Shoulder mobility
  5. ASLR
  6. *Trunk stability pushup
  7. *Rotary stability
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7
Q

What three tests in FMS require a clearing test first?

A

Shoulder mobility
Trunk stability push-up
Rotary stability

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8
Q

The 7 Mag 7

A
  1. ROM of area of c/c
  2. Wall angel/T4 mobility
  3. Overhead squat
  4. Single leg stance
  5. Single leg squat
  6. Lunge to Kneeling
  7. Respiration
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9
Q

Scoring for movement screens (with some recommended followup)

A

• 0 = pain (not a stretch) Perform Ortho eval
• 1 = can’t perform movement/at least 50% loss of ROM
Correction (mobilization or stabilization)
• 2 = performs movement with compensation
(imperfect)/looks OK, but dysfunction is present
• 3 = performs movement without compensation
(perfect)

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10
Q

Goal of movement screen scoring

A

All 7 tests should achieve a 2 (14pts)

15 or above with some 3’s and 1’s or 0’s is worse than a 14 with all 2’s

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11
Q

the three systems responsible for stabilization

A

Passive Stabilization
Active Stabilization
Neuromuscular Control

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12
Q

The stabilization systems breakdown

A

p - Vertebrae, Intervertebral discs, Ligaments, Joint capsules and Zygapophyseal joints.
a - Stabilizing muscles (Multifidi, Transversus abdominis, Diaphragm, etc.)
n - Motor control, Coordination, Proprioception

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13
Q

Standard and additional views for structural instability

A

Standard: A-P and lateral
Additional: Stress Views- Flexion/Extension

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14
Q

Imaging is nt indicated within the first six months if the following are met

A 
No neurologic symptoms
No constitutional symptoms
No history of trauma
No symptoms of malignancy
Patient is 18 to 50 years old
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15
Q

Spondylolisthesis types

A

– Type I: Dysplastic (congenital)
– *Type II: Isthmic (stress Fx in the parsinterarticularis)
– Type III: Degenerative (degeneration of the IVD’s)
– Type IV: Traumatic (acute Fx’s)
– Type V: Pathological (bone disease/Infections/tumors)

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16
Q

Functional instability findings from history

A 
Complaints of “giving way” or “going out”
Recurrent episodes
Pain during sudden or trivial activities
Pain during transitional activities
Pain with sustained postures
Difficulty with unsupported sitting
Short term relief from manual therapy
17
Q

Functional instability findings from exam

A 
Aberrant movement pattern during active trunk flexion
Painful arc on return
Minor’s Sign (“thigh climbing”)
Catching or locking
Reversal of lumbopelvic rhythm
(+) Prone Instability Test
18
Q

Passive Leg Extension Test suggests what?

A

An unstable spondylolisthesis

19
Q

4 clues leaning towards response to stabilization exercises

A

(+) Prone Instability test
Patient <40y.o.
Bilat. SLR Flexibility over >91*
Aberrant Lx Flexion

20
Q

Management for instability

A 
• Diaphragmatic Breathing
• Abdominal bracing/Neutral pelvis
• Hip hinging
• Lumbar stabilization exercises
– Quad. Track/Bridge Track/Side Bridge Track
• CMT to adjacent areas
21
Q

Rehabilitation strategy for disc injuries

A

Address postural or muscle imbalances
Eval and train: Cx joint dysfunction, scapula stabilizers and breathing
Retrain proprioception
Work on muscle endurance

22
Q

What to assess when checking posture

A

Thx extension with motion palpation: T4 Mobility
Pec evaluation with length test: Sternal portion
Controlled head nodding (not retraction): Look for shaking/ratcheting = Indicates deep Cx flexor weakness
Shoulder abduction movement pattern: Shldr hiking/imbalances from side to side
Breathing/Respiration: Muscles involved are also postural muscles

23
Q

Management for problems with thoracic extension

A
  • Manipulation
  • Bruggers Relief Position
  • Foam rolling
  • Table Walks
  • Lat. Pull-downs
  • Banded Pull-a-parts
  • Serratus Punch
24
Q

Management for problems with tight thoracic muscles

A
  • PIR - Suboccipitals, Upper traps, Levator scap

* Doorway/Wall Corner Pec stretch

25
Q

Management for problems with weak thoracic muscles

A 
Controlled Nodding
Craniocervical flexion exercise with biofeedback (BP cuff)
Chin retraction
Wall Angel 
Serratus punch (Thera-band/KB)
Push-up plus
26
Q

Faulty Breathing Patterns

A

Shallow breathing
• Decreased expiration
• Recurrent mid-thoracic pain
Faulty inspiration = Chest breathing/lifting up of sternum vertically, Upper trap, levator scap, and scalene over-activity, Overstraining C/S musculature, Recurrent cervical syndromes
• Paradoxical breathing = Abdominal expansion during expiration

27
Q

Acute Care Interventions

A
  • Active ROM
  • Passive ROM
  • Cx Isometrics
  • Directional preference (McKenzie)
28
Q

4 Step Rehab Strategy

A 
•Strategy 1
Evaluate and Train Deep Neck Stabilizers
•Strategy 2
Assess and Treat Posture and Respiration
•Strategy 3
Address Muscle Imbalance of Large Torque Producers (upper cross)
•Strategy 4
Retrain Sensory Motor Response Loop
29
Q

5 things to touch on in assessment of posture

A

Anterior head carriage – fixed, habitual, dynamic
Thoracic kyphosis exercises - T4 Mobility Exercises/Foam Rolling/Table Walks
Respiration assessment: upright, supine, prone
Teach basic abdominal breathing
Abdominal breathing with bracing exercises

30
Q

3 portions of neurodynamics

A
  • Mechanical interface: Anything that resides next to the nervous system: tendon, muscles, bone, IVDs, ligaments, fascia, blood vessels, etc.
  • Innervated tissues: Skin, muscles, bone, fascia, and blood vessels
  • Neural structures: Nerve, Axon, etc…
31
Q

Effect of tension on blood flow

A

8% elongation reduces venous blood flow
15% elongation reduces all blood flow

A 6% strain held for an hour reduced nerve conduction by 70%. The longer the stretch the increased likelihood of producing adverseeffects

32
Q

Effect of compression on nerve roots

A

30-50 mm Hg causes hypoxia, impaired conduction and axonal transport

advanced rehab (1 decks)

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