Quiz 2 Flashcards
how is the PSFS implemented?
the patient is asked to name at least 3 activities that they are struggling with and would like to get back to and rate their ability to perform each on a scale of 0 (unable to perform) to 10 (able to perform at pre-injury level)
average score is taken out of a possible 10
the PSFS is valid, reliable, and responsive in populations with…
knee dysfunction
cervical radiculopathy
acute LBP
mechanical back pain
neck dysfunction
what is the MDC of the PSFS?
1.0-2.5 PSFS points
neck dysfunction, knee dysfunction, cervical radiculopathy, chronic LBP, and COPD
what is the MCID of the PSFS?
spinal stenosis: 1.34
UE musculoskeletal: 1.2
what are the goals of body mechanics?
protection and jt conservation
lower COM = ____ stability
greater
larger BOS = ____ stability
greater
legs are _________ spine is ____________
source of force, means of force transfer
is pushing or pulling easier on the lumbar spine?
pushing
bending forward pushes spinal disc material _____
posteriorly
bending backward pushes spinal disc material _____
anteriorly
does bending forward or backward help take pressure off the foramina?
bending backward
what is proper stand to sit position?
legs touch chair
descend by leading w/ buttocks and lowering legs
sit toward front to middle of chair (don’t aim for back)
slide back
use arm to assist
what is proper sit to stand mechanics?
slide forward in chair
feet under thighs
use arms to push is able
lead with head
don’t flex neck
maintain lumbar lordosis
push up with legs
what are proper body mechanics when going down to lift something?
position body close to object
wide BOS
knee flexion and move hips posteriorly w/straight spine
what are proper body mechanics when coming up to lift something?
keep object close to body
engage core
don’t hold breath
lead with head
push up with legs
legs are source of force, spine is means of force transfer
when pushing and pulling use ____ leg/arm(s)
both
what is ergonomics?
the science and practice of sitting and designing jobs and workplaces to match the capabilities and limitations of the human body
what is the purpose of ergonomics?
to help prevent injury
reduce fatigue and discomfort
increase productivity
improve quality of work
improve job satisfaction
what is a work site analysis?
assessing for job demands and correcting ergonomics
what items are on the ergonomics checklist?
posture
force
repetitions
vibration
temperatures
repetitive reach items on a desk should be within how many inches?
13-18 inches
occasionally reach items on a desk should be within how many inches?
21-26 inches
at what level should the computer monitor be?
at eye level
arms should be positioned ____ to the floor when seated
parallel
how should feet be positioned when seated?
flat on the floor
what are the postural requirements?
must be energy efficient
must minimalize stress to the musculoskeletal system
must focus on function
what is static posture?
erect, bipedal stance in humans
what is the basis for understanding dynamic posture?
static posture
when are you susceptible to muscle fatigue, altered blood flow, and perturbations?
in static posture
what type of posture requires low energy and minimal muscle activity?
static posture
what is BOS?
the area from the heels to toes and foot to foot
where is the COM/COG located in static posture?
anterior to S2
how many degree is postural sway in the sagittal plane?
12 deg (6 front, 6 back)
how many degrees is postural sway in the frontal plane?
16 deg (8 to each side)
posture is a ____ not a ____
activity, position
what is posture?
a dynamic and complex interaction between a variety of body systems
what is postural control?
the ability to maintain stability of the body and body segments in response to forces that threaten to disturb the body’s structural equilibrium
t/f: postural control requires precise function from a variety of body systems
true!
what is COG/COM?
the point on a structure from which gravity exerts its force
what is LOG?
vector that runs vertically from COG and determines the location of gravitational forces acting on the body
is the LOG within or outside the BOS in standing?
within
is the LOG within or outside the BOS in motion?
outside
what is center of pressure (COP)? where is it located?
center of distributed forces
b/w the feet in bipedal stance and within foot in single leg stance
what is the point at which the ground rxn forces are acting?
COP
in erect standing the GRF ___LOG
=
the horizontal distance b/w ___ and ___ determines the need for additional support
LOG, GRF
ideal posture is determined by ___
LOG
where is the LOG in relation to the ankle?
4-6 cm anterior
where is the LOG in relation to the knee
anterior
where is the LOG in relation to the hip?
posterior
what is normal pelvic tilt (ASIS-PSIS angle)?
12 deg
what is normal sacral inclination?
30-40 degrees
what is normal lumbar lordosis?
20-70 deg
where is the apex of the lumbar lordosis?
L3/L4
what is normal thoracic kyphosis?
20-50 deg
what is normal cervical lordosis?
20-30 deg
where does the LOG fall in relation to the ear?
along the tragus of the ear
what are common postural deviations?
weakened thoracic extensors
increased thoracic kyphosis
possible reduced lumbar lordosis
tightened pecs
what is flat back posture?
mild thoracic kyphosis and forward head
LOG posterior to the hips
post hip tilt
flexed lumbar spine
weakened thoracic muscles
tight pecs
potentially weakened hip flexors
what is the kypho-lordotic posture?
axis for knees and ankles is too anterior
anterior pelvic tilt
increased lumbar lordosis and thoracic kyphosis
forward neck flexion in cervical spine
weak glutes and back extensors
what is swayback posture?
very forward head
posterior pelvic tilt
decreased lumbar lordosis
what is scoliosis?
frontal plane alignment deviation
scoliosis creates an abnormal ____ curve of the spine
lateral
what is a common cause of scoliosis?
leg length discrepansy
what is structural scoliosis?
changes in the skeletal system
what is functional scoliosis?
curve caused by a changeable reason
what is compensated scoliosis?
C7 and S1/2 are lined up w/curve in b/w
what is uncompensated scoliosis?
C7 and S1/2 aren’t lined up
what do you look at/for in a scoliosis check?
rib hump, arm spaces, pelvic angle, spinal curve, and scap heights
what are the causes of upper and lower crossed syndromes?
poor postural habits
muscles imbalances (like tight or lengthened muscles)
what is upper crossed syndrome?
tight upper trap, levator scap, and pecs
lengthened deep cervical muscles, serratus anterior, rhomboids, and mid and lower traps
rounded shoulders and protracted scap
forward head posture
increased cervical lordosis and thoracic kyphosis
what is lower crossed syndrome?
tight hip flexors and back extensors
lengthened abdominals and glutes
knee hyperextension
biceps fem lengthening
increased lumbar lordosis
protruding abdomen
anterior pelvic tilt
lower crossed syndrome can result in ____ movement of the COG
anterior
what is genu recurvatum?
hyperextended knees
patients with genu recurvatum may also have what deformity at the ankle?
aquinas deformity where the ankle can’t dorsiflex and get out of plantar flexion
genu recurvatum puts excessive stress on what structure?
the posterior knee
what is genu valgus?
knock knees
increased valgus angle/medial angle
decreased lateral angle
what is genu varum?
increased lateral angle
decreased valgus angle/medial angle
bowlegged
what is the normal foot arch?
a straight line b/w the med mal, navicular, and head of 1st metatarsal (Feiss line)
what is pes planus ?
overpronated foot
dropped navicular
flat foot
what is hallux abductus valgus?
usually a biomechanical issue
big toe curves out
may see calluses and/or bone growth
what are torsions?
twist in a bone
what is toe in position?
medial rotation
pigeon toed
what is rectus position?
straight AP alignment of the feet
what is toe out position?
lateral rotation
what is pes cavus?
high arches
navicular is higher up
what is normal BMI?
18.5-24.9
what is the ectomorph body type?
skinny, hard to gain weight, slender frame, narrow chest and abdomen, smaller body structure, fast metabolism, narrow shoulders and hips
what is the mesomorph body type?
medium build, rectangular/wedge body, wider/broader shoulders, fairly lean, can gain muscles easily, usually strong, more muscles of arms and legs
what is the endomorph body type?
short in stature, difficult time losing body fat,bulky physique, rounder body, gain fat and muscles easily, wide shoulders and hips
what is hypomobility?
decrease in quantity of motion
what is hypermobility/instability?
increase in quantity of motion
more likely to dislocate or sublux
what is a painful arc?
pain in a portion of the ROM
what are the characteristics of abnormal motion?
hypomobility
hypermobility
aprehension to movement
painful arc
presence of crepitus/jt sounds/vibrations
pain during/at end of range
abnormal end feel
AROM not similar to PROM
compensation/aberrent motion (unusual way to get through motion)
reduction in motion may result from factors of _____ or _____ origin
musculoskeletal, non-musculoskeletal
t/f: hypomobility may be normal in advanced age
true
how do we determine if hypomobility is normal?
see if it’s bilateral
dif-abnormal
similar-normal
what type of abnormal motion is this:
results from laxity in capsuloligamentous complex (CLC) and changes in jt surfaces, trauma, or genetic connective tissue disorders
hypermobility
what is capsular pattern?
restricted CLC resulting in loss of motion specific to that jt
what is an example of a classic capsular pattern that exists in joints?
osteoarthritis
what is noncapsular pattern?
loss of motion doesn’t follow a characteritic patterns and may be related to isolated capsular restrictions or some other cause
what are the components that make up quality of movement?
coordination, neuromuscular performance, motor control, and motor performance
to assess normalcy we must assess what 2 characteristics of motion?
quantity and quality of motion
what is the quantity of motion?
defines the degree to which a jt moves through a given ROM
what is the quality of motion?
defines the manner in which a jt moves
what is muscle length?
functional excursion of a muscle from its fully lengthened position to its fully shortened position
what is muscle play?
ability of a muscle to move transversely relative to underlying tissue
one jt muscles are often measured through _____ ROM
passive
the expectation is that one jt muscles should allow max ____
PROM
what is passive insufficiency?
multi jt muscles lengthened across both jts and cannot lengthen anymore
what is active insufficiency?
multi jt muscles that are so contracted, they can’t create any more actin/myosin overlap
t/f: to assess the length of a multi-joint muscles, the joint is held statically while the other is moved through its full ROM
true!
measurement of the ____ joint moved provides quantification of muscles length
last
what is classic motion?
osteokinematic motion
how is osteokinematic motion quantified?
using goniometry
what are accessory/component movements?
arthrokinematics
which is more challenging to evaluate osteokinematics or arthrokinematics?
arthrokinematics
what is rolling motion in arthrokinematics?
angular movement
approximation of new points of one jt surface w/new points on another surface
direction of the roll is always in the same direction as what?
the segment being displaced
what is gliding motion in arthrokinematics?
when jt surfaces are congruent and a single point on one jt surface is repeatedly contacting new points on the other jt surface
when the convex is moving on the concave, the roll and glide are in ____ direction
opposite
when the concave is moving on the convex, the roll and glide are in ____ direction
same
what is the exception to the convex-concave principle?
external rotation where there is a posterior glide
what ROM provides info regarding the following?
willingness to move, coordination, muscles function, jt ROM, quality of motion
screening technique to direct other aspects of care
symptoms/limitations that may be assocated with the stretch/contraction of the tissues
AROM
what ROM is a reflection of true jt ROM?
PROM
is PROM or AROM normally greater?
PROM
should PROM testing come before or after MMT?
before
what is CPP?
position of a jt in which least deg of mobility b/w articular surfaces is available
what is OPP?
position of max mobility
t/f: jt surfaces are generally incongruous, except in one specific position
true!
what 2 criteria should be considered for CPP/OPP?
jt congruency and CLC extensibility
determining OPP/CPP can be best accomplished through what?
jt play
normalcy of end feels is determined by what 3 factors?
- does the end feel match that which is expected for the jt being tested?
- does the end feel match that which is expected based on the direction of the motion?
- does the end feel occur at the proper place w/in the ROM?
what is the starting position for all motions?
anatomical position
motion begins at __ deg and proceeds to __ deg
0-180
where is 0 deg in the transverse plane motion?
midway through the motion
when positioning for goniometry, what segment is stabilized?
the proximal segment
starting position for goniometry is __ deg
0
t/f: you should reduce the effects of periarticular tissues in goniometry
true!
if the measurement is not taken in a standard position, what should you do?
document the position measured in
what is the body of the goniometer?
the circular portion with the degree marks
what is the stationary arm of the goniometer?
the arm typically alignment with the proximally stabilized segment of the jt or the body
what is the moveable arm of the goniometer?
the arm typically aligned with the mobile segment of the jt
the stationary arm is aligned with the _____ axis of the ____ segment of the jt
longitudinal, proximal
the moveable arm is aligned with the _____ axis of the ______ segment of the jt
longitudinal, distal
how should you view the goniometer?
at eye level
how could these measurements be documented?
5 degrees of hyperextension
115 degrees of flexion
5-0-115
how could the following measurement be documented?
elbow flexion of 140 deg
0-140 deg
what do negative #s often denote what about pt’s ROM?
motion which is unable to achieve neutral
what is the purpose of goniometry?
to measure the angle created at a jt by adjacent bones
decreased measurement error=_____ reliability
increased
in goniometry, is the intra or inter-rater reliability greater?
intrarater reliability is greater
why do we provide passive overstretch in goniometry?
to feel the end range and look for reproduction of symptoms
what is the SPADI test?
self-administered measure of the patient’s perception of
their shoulder pain and disability in an outpatient setting.
what are the SPADI subscales?
pain and disability
what is the standard error of measure of the SPADI?
8.9 for pain
7.2 for functional
6.2 overall
what is MDC of the SPADI?
shoulder arthroplasty: 18
adhesive capsulitis: 17
shoulder disability: 21.5
what is the MCID of the SPADI?
8-13
what is the test-retest reliability of the SPADI?
0.64-0.66
lacks strong reliability
strongest in AROM which ranged from 0.56-0.8
what is the DASH?
measures patient’s disability in doing everyday tasks
what is the test-retest reliability of the DASH?
ICC of 0.96
what is the predictive validity of the DASH?
> 0.69
what is the MDC of the DASH?
1.96 for proximal humeral fractures
12.2 for adults with musculoskeletal UE problems
10 for intercollegiate athletes
what is the MCID for the DASH?
10.2 for adults with UE musculoskeletal complaints undergoing surgery
what is the LEFS?
20 questions on patient reported LE function
are there any subscales for the LEFS?
no
what is the scale of the LEFS?
each item has a max score of 4 with 4 being no difficulty and 0 being extreme difficulty
is a higher LEFS good or bad?
good bc its a FUNCTIONAL scale not a DISABILITY scale
what is the standard measure of error for the LEFS?
ACL Reconstruction → 3.7 points
various LE Injuries → 3.9 points
TKA & THA → 3.7 points
orthopaedic Rehab Ward → 4 points
what is the MDC of the LEFS?
ACL Reconstruction → 8.7 points
various LE Injuries → 9 points
hip Impairment → 7 points
TKA & THA → 9 points
what is the MCID of the LEFS?
ACL reconstruction: 9 points
various LE injuries: 9 points
hip impairments: 6 points
TKA & THA: 9 points
what is the test-retest reliability of the LEFS?
various LE injuries: excellent (r = 0.86)
TKA & THA: excellent (r = 0.85)
TKA & THA due to OA: excellent (r = 0.86)
hip impairments: excellent (r = 0.86)
do you want a higher or lower score on a disability scale?
lower
do you want a higher or lower score on a functional scale?
higher
