Patient-Client Management Flashcards
What does examination refer to?
the gathering of information from the chart, other caregivers, the patient, the patient’s family, caretakers, and friends
What does evaluation refer to?
the level of judgment necessary to make sense of the findings in order to identify a relationship between the symptoms reported and the signs of disturbed function
What does the strength of an examination rely on?
The accuracy of the findings of the testing procedures
What are the 2 main categories of diagnostic tests?
- tests that result in a discrete outcome (present/absent, disease/not disease, mild/moderate/severe, etc.)
- tests that result in a continuous outcome (data on interval or a scale of measurement such as degrees of range of motion)
What are 3 characteristics that deem a test useful?
- Reliability
- Validity
- Significance
When is a test considered reliable?
if it produces precise, accurate, and reproducible information
When is a test considered valid?
Determined upon the degree to which it measures what it purports to be measuring, and how well it correctly classifies individuals with or without a particular disease
When is a test considered significant?
When the test can describe the probability of something happening
What are the 2 categories in which examination tools can be divided?
- Performance-based or self-report measures
- Generic or disease-specific measures
What do performance-based measures involve?
The clinician’s performance of the test or observation of the patient’s performance
What are some examples of performance-based measures?
special tests, balance tests, etc.
What do self-report measures involve?
The patient’s rating his/her performance during activities
What are disease-specific measures?
Questionnaires that concentrate on a region of primary interest that is generally relevant to the patient & clinician (focuses on populations, symptoms, function)
What are the 3 components of the examination process?
- Patient history
- Systems review
- Tests and measures
If a patient’s pain has a recent onset what is likely the source of pain
inflammation
If a patient’s pain has am insidious or gradual onset what is likely the source of pain
predisposing factors such as changes in ADLs, exercise, etc.
Mechanical pain is thought to be the result of what?
sustained deformation of collagen
How can you determine if pan is chemical in nature?
it is less affected by movement/position
What are the 4 major sources of referred pain?
- Neurogenic
- Vasculogenic
- Viscerogenic
- Spondylogenic
3 are the characteristics that an irritable structure had?
- a progressive increase in the severity of pain with movement or specific posture
- symptoms increased with minimal activity
- increased latent response of symptoms
What are the 3 stages of healing and their associated timelines?
- Acute present for 7-10 days
- Subacute present for 10 days to several weeks
- Chronic present for more than several weeks
Why do prolonged symptoms usually indicate a poorer prognosis?
It may indicate the presence of chronic pain syndrome
Musculoskeletal conditions are typically aggravated with _____ and ______ with rest
movement
alleviated
Stimulation of the cutaneous A-delta fibers leads to what type of pain?
pricking
Stimulation of the cutaneous C fibers leads to what type of pain?
burning or dull pain
What are the 7 behavioral indicators that suggest motivational-affective pain?
MADISON
- Multiple complaints
- Authenticity claims in an attempt to convince the clinician that the symptoms are present
- Denial of the negative effect the pain is having on function
- Interpersonal variability (different complaints to different staff)
- Singularity of symptoms (special consideration requested by patient)
- The clinician is singled out and patient is dependent upon them
- Nothing works
Imaging tests have a ___ sensitivity but a ____ specificity, so they are used in clinical decision-making but should not be used in isolation
high
low
Structural deformities are present at ____.
rest
Functional deformities are a result of what?
postures and disappear when posture is changed
What is normal body temperature?
96.5F-99.4F
What is normal respiratory rate?
8-14 breaths per minute
Who developed the scanning examination?
Cyriax
What are the 3 purposes of the scanning exam?
to help rule out the possibility of symptom referral from other areas, to ensure that all possible causes of the symptoms are examined, and to ensure a correct diagnosis
Shoulder abduction tests which spinal root level?
C5
Elbow flexion and wrist extension tests which spinal root level?
C6
Elbow extension and wrist flexion tests which spinal root level?
C7
Finger flexion tests which spinal root level?
C8
Finger abduction tests which spinal root level?
T1
Hip flexion tests which spinal root levels?
L1-L2
Knee extension tests which spinal root levels?
L2-L4
Hamstrings tests which spinal root levels?
L4-S3
Dorsiflexion with inversion tests which spinal root level?
L4
Great toe extension tests which spinal root level?
L5
Plantarflexion with eversion tests which spinal root level?
S1
Hip extension tests which spinal root levels?
L5-S2
Which movements should be tested last?
Those that are known or suspected to cause pain are performed last
What is a joint’s capsular pattern of restriction?
a limitation of pain and movement in a joint-specific ratio, which is usually present with arthritis, or following prolonged immobilization
What is the GH joint capsular pattern of restriction?
ER > abduction > IR
What is the humeroulnar joint capsular pattern of restriction?
flexion > extension
What is the hip joint capsular pattern of restriction?
IR > flexion > abduction
What occurs at the zygapophyseal (facet) joints during flexion?
They glide superiorly (open)
What occurs at the zygapophyseal (facet) joints during extension?
They glide inferiorly (close)
Who introduced the concept of the end-feel?
Cyriax
If AROM and PROM are limited or painful in the same direction what tissue is affected?
inert tissue
If AROM and PROM are limited or painful in the opposite direction what tissue is affected?
contractile tissue
If a muscle contraction is weak and painless what is affected?
There is palsy or complete rupture of musculotendinous unit
If a muscle contraction is weak and painful what is affected?
minor to serious pathology such as muscle tear or inflammation
If a muscle contraction is strong and painful what is the problem?
grade I contractile lesion
Pain that does not occur during the test, but occurs upon the release of the contraction is thought to have an ______ source
articular
What is passive insufficiency?
the point at which a muscle is not capable of generating its maximum force because it is stretched too far
What is defined as the ability to demonstrate the skillful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns
Motor Function
What are the criteria for simple motor patterns?
That the movement is…
- performed exactly in the desired position
- smooth and of a constant speed
- follows the shortest and most efficient path
- performed in its full range
What are the criteria for complex motor patterns?
- Synchronization between the primary movers in the distal and proximal regions
- Smooth propagation of motion from one region of the body to another
- absence of inefficient movement patterns or muscle recruitment
- optimal relationships between the speed of motion initiated in one region vs. other regions
List some relevant physiological issues
functions of body systems, healing status, energy systems, adaptation and overall fitness level
List some relevant biomechanical issues
functional anatomy, direction/planes of motion and stress, kinematics, and kinetics
List some relevant motor behavior issues
proprioception, perception, transfer, practice, learning, control, coordination, and performance
What are the 2 categories of special tests according to intent?
- Provocative tests
- Clearing tests
Describe provocative tests
They are tests that are designed to put pressure on an involved structure and reproduce the symptoms
Describe clearing tests
They are tests that can rule out a structure or region as a potential source of the patient’s symptoms
Describe pattern recognition
Occurs when the patient conforms to a previously learned pattern of disease
Define test validity
The degree to which a test measures what it purports to be measuring. In other words, how well it correctly classifies individuals with or without a particular disease
What are the 2 concepts that are directly related to validity?
Sensitivity and Specificity
What is sensitivity?
the proportion of patients with a disorder who test positive
When sensitivity of a symptom is high, a negative response rules ___ the disorder
out
SnNout
What is specificity?
the proportion of patients without the disorder that test negativy
When specificity is high, a positive test rules ___ the disorder
in
SpPin
What are the goals of the examination?
to identify and define the patient’s problem(s) and design an intervention plan
