Module 3 Flashcards
What is objective assessment in relation to subjective assessment?
-Subjective exam needs to be incredibly thoruogh- after this exam we must have a good idea/hypothesis about what could be wrong and how we could treat it
* Confirm or reject what we were thinking
* ROM or functional or strength test, running, jumping, walking etc depending on what their problem is
* Dictated from what we find in our subjective
What is AROM?
- Active: patient does the movement themselves
- Moves as far as they can throughout their joint Rom- as far as they can- finding out why they cant move to the full ROM
- Measuring with a goniometer and note any symptoms
Different situations where different equipment may be suitable (inclinometer, tape measure)
What factors may stop the full ROM of a joint?
Joint stiffness, swelling of soft tissue, pain, fracture, dislocation, and there are medical conditions such as osteoarthritis, rheumatoid arthritis, sepsis to name a few, muscle tightness and weakness, soft tissue apposition as well
Where do you place the goni on the limb?
Right in the middle of the joint (joint axis of rotation), aligning one arm with the proximal segment and the other with the distal segment
How to use a goni effectively with accurate readings
- Measure in the direction of movement
* Think about how far they have moved
* -If In doubt, check the moving arm position aligns with the correct amount at the start and count upwards accordingly
* Two different numbers that are visible- thinking about- if the patient has moved their joint less than 90 degrees
* 50 degrees instead of 130
AROM- Extension movements exceptions
- For extension movements, where the end goal is to have a straight joing (elbow, knee, hip) we term this end point 0 degrees, the more I bend, the number keepts going up
- Full extension is 0 degree- the amount of flexion he still has in his inability to extend his legs
- If PT is unable to achieve this movement, them their reading would be negative- 10 degrees
- For joints such as shoulder, ankle, where we consider neutral is the position where the movement is, the same rule doesn’t apply
- Arm is straight by side, bringing forwards (up for flexion) backwards *up for extension)
Terminal extension- full extension
Measuring AROM dorsiflexion and plantarflexion
- Landmarks that we line up with- proximal arm (along the head of the fibula on the outside of the shank, and lateral malleolus)
- Distal landmark- base of the 5th metatarsal- offset of the angle making it not accurate- neutral position, but the ankle is not.
- Distal arm needs to be parallel to the base of the foot
- Use head of fibula, but move the axis so that is goes across the lateral malleolus and then the distal movement is the base of the foot
Validity and reliability of AROM testing
- Validity: Does what we are measuring actually capture what we are intending to measure? (Is the measure we obtain with the goniometer actually reflective of how the joint has moved)
- Reliability: how reproducible my measure is (If I repeat the same test will the results be the same? (intra-rater reliability)
- Multiple therapists conduct the same test on the same patient (inter-rater reliability)
- Trust the measurement that we are getting
How to ensure validity of AROM testing
- Correct landmarks
- Correct axis
- Correct plane of movement (if I am measuring flexion, it must only happen in that saggital plane, going up, no abduction or rotation)
How to ensure reliability of AROM testing
- Consistent instructions to the patient ( I would like you to move your knee to your chest as far as you can, don’t change between measurements)
Consistent method of measurement and patient position
-Accurate and equal encouragement (go go go, and go only once for an example)
ROM and pain introduction
-Pain is one of the main reasons why they can not facilitate active range of motion
-Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
-Pain is always subjective
-Avoiding harming our patients- we might have to to minic their usual function to gain information
-Numerical pain rating scale (NPRS) 0 to 10
-Visual analogue scale (VAS) 0-10
-Area of pain- anatomy; patterns of pain referral
-Type of pain (sharp, dull, lancinating, ache etc), type of tissue (pathology)
Irritability in ROM
-Relates to the exacerbation of symptoms
1. -The activity and vigour of the activity
2. -Knowledge of the degree and quality of the increased symptoms caused by the activity
3. -Knowledge of how long it takes for the increased symptoms to subside to the level prior to provocation
-How much we can push the patient without making them a lot worse
-Allows an assessment of how treatment can be progressed
-Allows an assessment of what treatment may be chosen
What is overpressure?
- Passive movement at the end of AROM
- No muscle activity
- Overcome tissue compliance
- Is there a range of motion and they just can’t complete it themselves?
- Manually move their shank etc- feeling for any change in resistance
- P1 (first change in magnitude of resistance) and P2 (cannot overcome resistance)
- Patient relaxed in the end range- taking them any further passively
Whats EOR and when does it happen?
End of range and it is when the patient stops moving themselves and then we go onto overpressure
Whats R1 and R2?
Resistance 1 and Resistance 2
- 1 is when you first feel a bit of resistance and resistance 2 is when the joint cant be moved anymore (OP)
