Postural Assessment Flashcards
Use of postural assessment
- Overall observation
- Gathering info
- Monitor progress
- Positional changes
Procedure for posturalA
Explain to client, observe body in 3 diff position (ant, latx2, post),
Plumb line aligned to patient, perform from feet upwards, orthotics (first with device in, and then without, record device), in habitual, relaxed standing posture, record results
Factors affecting posture
Bone: ligament laxity, pelvic angles, position of jt+mobility, bony contours
Neurogenic inflow/outflow thru int
Muscle: hypertonic muscle, fascial restriction (nerve imping), tonus of muscle passive and cont contraction) - paralysis/atrophy,
evb fmna
structural factor of poor posture
Leg length discrepancy, scoliosis, hemivertebrae, pes planus
Postural factors of poor posture
poor habit{slouching}, muscle imbalance {spasm}, pain, age {osteoperosis}, respiratory {asthma}, excess weight, peer pressure {hide height via slouching}, assistive device {cane}
Anterior view - posturalA vertical landmarks
between the feet, pubis symphysis, umbilicus, xiphoid, suprasternal notch, nasal bones
Anterior view - posturalA horizontal landmarks
*Foot angle (slight outward),
malleoli (med. malleoli slight ant to lat, lat more inferiorly),
Level: fibular head, ASIS, iliac crest, shoulders (symmetrical level)
Lateral view - posturalA Vertical Ldmk
Ant. to lat. malleolus Fibular head Greater trochanter Acromium Bodies of cervical vertebrae External auditory meatus
Lateral view - posturalA Horizontal Ldmk
*Pelvic angle (normal - 8 to 30 degrees lvl)
Knee (flex), chest, spine curvature
Posterior view - PosturalA Vertical Ldmk
Between the feet
S2 - center of gravity is ant.
C7 - prom. in spine
Inion - Ext. occ. prot
Posterior view - posturalA Horizontal Ldmk
Straight or angled?: Heels, achilles tendon,
Level: popliteal fossa, gluteal fold, PSIS, spine of scapula/inferior angles, shoulder
Midline: Head
Pain assessment - Characterize in terms of (3)
Area (where it is/perceived to be located), nature (quality{sharp, dull, hot, etc.}), behavior (when better or worse)
Pain is a ____ of ___ and ____ experiences
Nociception is { }, choose: subjective/objective. May or may not lead to a _______ of pain
combination of subjective and objective experience
Transmission of noxious stimuli from tissue to brain (objective), perception
Degrees of pain (3):
Acute: 48-72 hrs (unbearable, early), Sub Acute: 3Days-3Mths (be cautious using this decree), Chronic 3 mths+
Tissue type pain (3)
Dermatomic: superficial soft tissues, localized
Radicular pain: nerve roots, shooting electric, dermatomal pattern
Sclerotomic: deep somatic tissues, poorly localized, aching (kidney stone, menstrual cramp)
Type of pain characteristic (3):
PROJECTED: irritation of nerve pathways themselves creating afferent input from an area (nerve root) - numbness in hand
REFERRED: pain in a different area outside of site of irritation/lesion (GH capsule felt in lateral brachial, heart/right arm)
RADIATING: radiates outward from site of lesion. myofascial trigger pt
REFLEX: Hyperalgesia (sensitivity to pain) and hyperesthesia (sensitivity of senses) and vasomotor (vessel dilation), sudomotor (sweat), trophic change, oft involves entire limb (e.g. autonomic phenom)
Afferent
Efferent
AFFERENT: Carry impulses toward a center (nerve carries message to brain- nerve irritation)
EFFERENT: carry impulses from the brain and spinal cord (phantom limb pain)
MFTP (myofascial trigger pt) criteria (2)
Predictable and reproducible.
Tissue Sensitivity: Most sensitive (3)
Fibrous Capsule
Periosteum
Skin
Tissue Sensitivity: Moderate sensitive (3)
Subchondral bone (bone under cartilage) ligament, tendon
Tissue Sensitivity: Less sensitive (2)
Cortical bone: ossification of bone
Muscle
Tissue Sensitivity: Insensitive (4)
Fibrocartilage
Articular cartilage
Synovium (CT inside jt capsule)
Menisci
Nerve Fibers: Large Myelinated (Fast Fibers) are sensitive to (3)
Large schawn cells:
Pressure
Vibration
Proprioception (where things are in space)
Nerve Fibers: Small Myelinated are sensitive to (3)
Fast fibers:
Dermatomic
Pain
Temperature
Nerve Fibers: Small Unmyelinated
Slow Fibers
Sclerotomic pathway/pain > childbirth
Least sensitive to: pressure, but all nerve fibers respond to touch/pressure
Trigger pt cardinal signs (6)
Jump Sign (patient withdraws, or jolts) Twitch response Referred Pain Pattern (reproducible, predictable) Taut Band Exquisite (sharp/intense) pain Autonomic phenom
Nerve root irritation signs (5)
Paresthesia (burning/prickling mostly in extremities) Sharp Well localized Deep, ache Muscle weakness
Peripheral nerve irritation is _____ to nerve root irritation and always present with _____ and ___ depending on ____ or ____ irritation
DISTAL to nerve rt irritation and present with PARESTHESIA and MUSCLE WEAKNESS dep on MOTOR or SENSORY irritaiton
Reflex scale 0-4 and pathology:
Peripheral Nerve Lesion (PNL) Low Motor Neuron Lesion
0: Absent
1: Diminished
2: Normal
CNS Upper motor neuron lesion
3: Exaggerated
4: Brisk/Clonus (neurological, involuntary contractions)
Muscle s___n signs (4):
Strain:
Edema, pain with AROM (active), no pain with PROM (passive), increased pain with RROM (resist)
Treatmnt for Acute Injury no swelling or chronic (4)
Mvmt
Exercise
Therapy
Heat
Treatment for Acute injury with swelling (5)
Pressure Rest Ice Compression Elevate
Joint s____n signs (2)
Sprain:
Pain with all ROM.
Common pulses (7)
Radial, ulnar Carotid Femoral Tibial, dorsal popliteal
