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E&M > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

Strength

A

Force extended by muscle or group of muscles to overcome resistance in one max effort

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2
Q

Power

A

Work produced per unit of time

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3
Q

Endurance

A

Ability of muscle to contract repeatedly over time

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4
Q

MMT

A

Performed to examine capability of muscle or muscle group to function in mvt and ability to provide stability and support when other segments may be moving

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5
Q

Agonist or Prime Mover

A

Muscle of muscle group that makes major contributions to mvt at joint

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6
Q

Antagonist

A

Muscle or muscle group that has opposite action to prime mover

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7
Q

Synergist

A

Muscle that contracts and works along w/ agonist to produce desired mvt

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8
Q

Neutralizing or Counteracting Synergist

A

Muscles that contract to prevent unwanted mvts produced by prime mover

Ex: hamstrings

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9
Q

Conjoint Synergist

A

Two or more muscles that work together to produce desired mvt

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10
Q

Stabilizing or Floating Synergist

A

Muscles that prevent mvt or control mvt at joints proximal to moving jt to provide stable base

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11
Q

Why MMT

A

Determine relative strength of muscles

Appreciate effect of muscle length imbalances

Determine status of peripheral nerve or spinal root functioning

Differential diagnosis

Examine pt motivation and ability to follow directions

Establish baseline, determine improvement, modify treatment

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12
Q

Precautions

A

Extreme pain and edema

Extreme weakness

Conditions where MD advises against resistive and/or isometric exercise

Cardiac conditions

Osteoporosis

Limitations in pt’s cognitive or emotional status

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13
Q

Probable Contraindications

A

Recent unhealed fracture

Serious muscle, tendon, ligament tear

Neoplasm

Pain of unknown etiology

Thrombophlebitis

Tissue inflammation

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14
Q

General Instructions

A

Intro to pt, explain, and demonstrate

Have pt perform AROM and observe for substitutions

Place pt in recommended test position (if they can’t perform AROM through full range, reposition pt in gravity-eliminated position)

Expose muscle and jt

Optimize body mechanics and stabilize proximal components as necessary

Encourage max effort and apply graded resistance

Check pt status

Record MMT grade

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15
Q

Break Test

A

After segment has completed its range, resistance is applied near distal end of segment to which muscle attaches

Pt is asked to hold and not allow tester to “break” hold w/ resistance

Commonly used

More objective than active resistive test

Functional muscle strength and fatigue difficult to assess using this method

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16
Q

Active Resistive/Dynamic Testing

A

Graded manual resistance against direction of mvt (through related ROM)

Difficult to grade, but may be necessary w/ certain medical conditions, such as unstable angina, acute MI

May be more beneficial to asses endurance and patterns of substitution

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17
Q

MMT Grades - 5 (Normal)

A

Cannot break hold against max resistance

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18
Q

MMT Grades - 4 (Good)

A

Can tolerate strong resistance

Muscles gives/yields w/ max resistance

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19
Q

MMT Grades - 3+ (Fair Plus)

A

Holds end position against resistance

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20
Q

MMT Grades - 3 (Fair)

A

Completes full ROM against gravity

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21
Q

MMT Grades - 3- (Fair Minus)

A

Does not complete ROM but but greater than half range

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22
Q

MMT Grades - 2+ (Poor Plus)

A

Initiates mvt against gravity OR in gravity minimized position w/ slight resistance

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23
Q

MMT Grades - 2 (Poor)

A

Completes full ROM in gravity eliminated position

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24
Q

MMT Grades - 2- (Poor Minus)

A

Completes partial ROM in gravity eliminated position

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25
Q

MMT Grades - 1 (Trace)

A

Examiner can detect visually or by palpation some contractile activity, but no mvt of part

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26
Q

MMT Grades - 0 (Zero)

A

Muscle is completely quiet

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27
Q

To Improve Reliability

A

Standardize position

Stabilization of proximal body parts

Using grading criteria

Use same examiner

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28
Q

Other Methods of Measuring Strength

A

Hand-held dynamometry - values vary w/

  • Method of applying resistance (make vs. break test)
  • Body position in relation to gravity
  • Joint angle
  • Lever arm
  • Stabilization
  • Examiner’s strength

Isokinetic dynamometry - can also measure torque, work, endurance

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29
Q

Muscle Weakness

A

When finding muscle weakness, assess muscle length

Muscle is tight - usually strong

Muscle that is lengthened - harder to produce strength, weaker

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30
Q

Stretch Weakness

A

From muscles remaining in elongated condition, however, slight beyond neutral physiological rest positions but not beyond normal range of muscle length

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31
Q

Over-Stretch Weakness

A

From 2-jt or multi-jt muscles, weakness results from repetitive or habitual positions that elongate that muscles beyond normal range of muscle length

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32
Q

Intervention

A

Lack of use

Overwork/fatigue

Stretch/strain

Neurological impairment

Exercise

Rest

Relieve prior to exercise

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33
Q

Iliopsoas

A

Hip flexion

Psoas - L2-4
Iliacus - Femoral N L2-3

Fair and above - short sitting

Resistance - pt lifts knee toward ceiling, resisted over distal thigh proximal to knee jt downward toward floor

Below fair - sidelying w/ tested leg uppermost, supported by examiner; lower limb flexed for stability

Sartorius - see ER and abd

TFL - IR and add

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34
Q

Sartorius

A

Hip flex, abd, ER and knee flex

Femoral nerve L2-4

Fair and above - short sitting

Resistance - pt slides foot up shin, resistance applied at lateral knee to hip flex/abd, above medial ankle to knee flex and hip ER

Below fair - supine, support limb as necessary

Substitutions - iliopsoas or RF - see no abd or ER

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35
Q

Glut Max/Hamstrings

A

Hip ext

Gmax - inf gluteal nerve L5-S2
Hamstrings - sciatic (tibial) nerve L5-S2

Fair and above - prone

Resistance - pt entire leg, applied on post leg above ankle or post thigh down toward floor; Gmax - flex knee

Below fair - sidelying w/ tested leg uppermost, supported by examiner

36
Q

Glut Med and Min

A

Hip abd

Sup glut n L4-S1

Fair and above - sidelying with test leg uppermost, hip slightly extended and pelvis rotated forward, lower leg flexed

Resistance - pt lifts leg toward ceiling, over lateral side of thigh just proximal to knee or at ankle

Below fair - supine, therapist supports at ankle to decrease friction

Substitutions

  • Using lateral trunk - see hip hike
  • Hip flexors - see ER/pelvic retraction
  • TFL - hip flexes or if hip starts in flex
37
Q

TFL

A

Hip abd

Inf glut n L4-S1

Fair and above - sidelying with test leg uppermost, hip flexed to 45 degrees

Resistance - pt abducts leg, applied over distal femur toward floor

Below fair - long sitting, backward trunk lean up to 45, hands behind for support, therapist lifts leg to decrease friction

38
Q

Hip Adductors

A

Pectineus - femoral nerve - L2-4

All others - obturator nerve - L2-4

Fair and above - sidelying with test leg lowermost, upper limb supported by therapist in slight abd

Resistance - pt adducts lower legs toward ceiling, applied down toward table on medial surface of distal femur

Below fair - supine, therapist supports at ankle to decrease friction

Substitutions

  • Hip flex - IR and post pelvic tilt, turn toward spine
  • Hamstrings - ER and ant pelvic tilt, turn toward prone
39
Q

Hip ER

A

Obturator ext - obturator nerve L3-4
Obt int and sup gem - n to obt int L5-S1
Qfem and inf gem - n to qfem L5-S1
Piriformis - n to piriformis S1-2

Fair and above - short sitting

Resistance - pt rotates hip-foot moves toward other leg, above medial ankle in lateral direction (other hand provides counter pressure over lateral distal thigh in medial direction

Below fair - Supine test limb stats in IR or short sitting w/ sight resistance from IR position

Substitution

  • Lifting contralateral hip or trunk leaning
  • Knee flex
  • Hip abd
40
Q

Hip IR

A

Glut min/med, TFL

Fair and above - shorting sitting

Resistance - pt rotates hip-foot moves away from other leg, above lateral ankle in medial direction (other hand provides counter pressure over medial distal thigh in lateral direction

Below fair - Supine test limb stats in ER or short sitting w/ sight resistance from ER position

Substitution

  • Lifting ipsilateral hip or trunk leaning
  • Knee ext
  • Hip add/ext
41
Q

Hamstrings

A

Knee flexion

Semis and bicep long head - sciatic (tibial) L5-S2
Biceps short head - sciatic (common peroneal) L5-S2

Fair and above - prone

Resistance

  • All flex knee - toward knee ext
  • Semis - leg IR (down and out toward knee ext)
  • Biceps - leg ER (down and in toward knee ext)

Below fair - sidelying w/ test limb supported by examiner

Substitutions

  • Hip flex - see hip flex
  • Sartorius - see hip flex, ER
  • Gracilis - see hip add
  • Gastroc - see ankle DF to stretch gastroc resulting in knee flex
42
Q

Quads

A

Knee ext

Femoral n L2-4

Fair and above - short sitting

Resistance - pt extends knee, over anterior distal tibia just above ankle toward knee flexion

Below fair - sidelying w/ test limb supported by examiner

Substitutions - Hip IR allows passive knee ext

43
Q

Interesting Facts about Pain

A

Most common reason ppl visit healthcare provides

LBP is second most common

Chronic pain affects more people than DM, heart disease, and cancer combined

Spinal pain, arthritis, and headaches - most common sources of pain

44
Q

Pain Physiology

A

Noxius stimuli - mechanical, thermal and/or chemical (transduction or nociception)

Site of stimuli - spinal cord - brain stem - thalamus/cortex and higher levels of brain (transmission or pain cognition)

End result of activity - pain becomes conscious multidimensional experience (perception or suffering and pain behavior)

  • Reticular system - action and asses
  • Somatosensory cortex - identify signal and relate it to past
  • Limbic system - emotions, behavior, processing

Signal can be changed or inhibited (modulation - send more inflammatory markers or signals to heighten pain)

45
Q

Peripheral and Central Sensitization

A

Abnormal facilitation of descending modulation of pain

Peripheral - afferent nociceptive input increased (constant, persistent LBP - brain lengthens time, so there is heightened sensitivity, jumpy, tender) - occurs when there is inflammation of either peripheral tissues or neural connective tissue as protective mechanism

Central - increased excitability in dorsal horn and inflammatory chemical mediators up-regulate (occurs in fibromyalgia, myofascial pain syndrome, TMJ disorder, neuropathic pain) - constant, terminal illness, long term pain

Both can persist even when cause has removed

46
Q

Gait Control Theory

A

Presynaptic inhibition of transmission cell - preventing pain stimuli from being transmitted to brain

W/ sufficient stimulus of nerve endings, “gate” can be closed (i.e. through massage, TENS, vibration)

Descending inhibition is possible at all levels of the nervous system and is opioid sensitive; however, can also be enhanced thru placebos, antidepressants, and anticonvulsants

47
Q

Biomedical Model

A

Health = absence of disease

Every disease can be explained in terms of underlying problem

Focuses on physical and biological factors of disease

Diagnosis, treat, and cure

X-rays, blood work, surgery, chemotherapy, meds, hospitalization

48
Q

Biopsychosocial Model

A

Absence of tissue damage/disease DOES NOT always = health (chronic pain)

Physiological and psychological components that are associated w/ chronic illness/pain

Suffering, pain behavior, chronic pain syndrome

Peripheral and central sensitization

49
Q

Acute Pain

A

Associated w/ tissue damage or threat of damage

Resolves once healed or threat resolves

Physiological signs - sweating, pallor, nausea, HR or BP changes

50
Q

Recurrent Pain

A

Repeated episodes of acute pain

51
Q

Persistent Pain

A

Acute pain that continues when cause is not resolved

As long as disease remains, pain remains

Associated w/ chronic diseases such as OA or diabetic peripheral neuropathy

Pain proportional to tissue damage and nociceptive input

52
Q

Chronic Pain

A

Pain that persists more than 3 months

Long lasting, persistent, and of sufficient duration and intensity to negatively affect a pt’s well being, function, and QOL

Persists past healing phase w/ impairment greater than anticipated based on physical findings or injury and occurs in absence of observed tissue injury/damage

Treatment of such should address secondary pathology and perpetuating factors than focus on presumed initial insult/injury

53
Q

Chronic Pain Syndrome

A

Doctor shopping

Dependency on health care system for multiple medial problems

Preoccupation w/ pain, significant pain behavior

Passive-dependent personality traits

Denial of emotional or family conflicts

Significant disruption in many areas

Feelings of isolation and loneliness

Being demanding, angry, or skeptical

Lack of insight into self-defeating behaviors

Use of pain as symbolic means of communication

54
Q

Pain Assessment

A

Pain has no objective or specific measurement tool like ROM or strength

Chronic pain could have acute or subacute conditions in addition to their chronic pain

PRQST, SOCRATES, OLD CARTS

Standard tools for quantifying pain severity: VAS (visual analogue scale) and NRS (numeric rating scale)

Pain questionnaires and outcome measures to measure both nonspecific and disease-specific aspects of pain and can assess special populations

55
Q

PQRST

A 
Provoking/precipitating factors 
Quality of pain
Region and radiation 
Severity or associated symptoms
Temporal factors/timing
56
Q

SOCRATES

A 
Site 
Onset 
Character 
Radiation
Associations
Time Course
Exacerbating/relieving 
Severity
57
Q

OLD CARTS

A

Onset - sudden/gradual/insidious, mechanics of injury if trauma, first time/recurrence

Location - where, has it changed, does it change w/ activity/body positions

Duration - how long does it last

Characteristics - type, how sever

Aggravating/Relieving - what makes it change (increase/decrease), red glad is pain doesn’t change even if directed by therapist, pain behavior over last 48 hours

Temporal - when does it occur

Severity - number ranking, adjectives

58
Q

Pain Assessment - Body Diagrams

A

Specific anatomical location of pain

Referred pain

Trigger points

Myofascial pain

59
Q

Pain Assessment - Pain Evaluation

A

Psychosocial

Physical

60
Q

Pain Assessment - Patient Interview

A

For chronic and persistent pain

Pain history

Past treatments, meds, health care provides

Stressors

Perception of cause of continued pain

Ask when pt will know he/she will be better

61
Q

Complex Regional Pain Syndrome (CRPS)

A

Type 1 - Reflex Sympathetic Dystrophy (RSD) - occurs after an illness/injury that didn’t directly damage nerves of affected limb

Type 2 - distinct nerve damage

Symptoms vary and change over time and may spread

  • Continous burning or throbbing pain
  • Sensitivity to touch/cold
  • Changes in skin temp, color, texture
  • Changes in hair/nail growth
  • Jt stiffness, swelling, damage
  • Muscle spasms, atrophy
  • Decreased ability to move
62
Q

Central Pain Syndrome

A

Caused by damage to the CNS (brain, brain stem, spinal cord)

Stroke, PD, MS, epilepsy, SCI

Most common symptom is burning, “pins and needles” and/or pressing, lacerating, aching pain

63
Q

Physical Exam

A

Posture

Mvt patterns

AROM/PROM

Muscle strength

Neurological exam

64
Q

Cyriax Concepts - Active Mvt

A

Specific soft tissue can’t be incriminated

Provides into about pt’s ability to move, painful range and possible location of originating pain

65
Q

Cyriax Concepts - Passive Mvt

A

Tests inert structures (jt capsules, ligament bursa, fascia)

Provides gross assessment of length of extra-articular and periarticular soft tissue

66
Q

Cyriax Concepts - Active vs. Passive Mvt

A

If both are restricted and/or painful in same direction, pattern is indicative of a capsular or arthrogenic lesion (capsular pattern - AROM is hard/painful, passive is limited and can’t go further - something wrong in capsule - limited in same direction)

If active/passive actions are restricted and/or painful in opposite directions, it’s indicative of contractile lesion

67
Q

Cyriax Concepts - Resistive Motion

A

Isolation of contractile tissue (muscle, tendon, bony insertion) by isometric contraction in midrange of jt motion

Exceptions - fracture close to muscle insertion causing shifting of fractured ends OR inflamed structure underlying muscle

68
Q

Cyriax Concepts - Resisted Isometric Testing

A

Strong and painless - WNL or referred pain from another area

Strong and painful - minor lesion of tested muscle or tendon

Weak and painless - disorder of NS or neuromuscular junction, total rupture of tested muscle/tendons, disuse atrophy

Weak and painful - major lesion such as fx and neoplasm, acute inflammation inhibiting muscle contraction, partial rupture of tested muscle or tendon

69
Q

Painful Arc Test

A

Test for subacromial impingement syndrome

Pain w/ active shoulder abd 60-120 degrees

70
Q

Referred Pain

A

Trigger pts - refers to pain when pressure is applied or when irritable

Pathology - heart attack, appendicitis, gall bladder attack

Nerve root impingement - dermatomal distribution

71
Q

Pain w/ Repetitive Mvts

A

Intermittment claudication - most commonly in distal 1/3 of leg when walking

72
Q

Painful Joint Position

A

Assumption of resting position

Results in least amt of pain

Typically where jt capsule is laxest

Shoulder - scapular plane abd 55 deg, IR, and 30 deg add

Hip - 30 deg abd, 30 deg flex, slight ER

Knee - 25 deg flex

Ankle - 10 deg PF

73
Q

Waddell’s Test for LBP

A

Type 1 - tenderness - superficial/non-anatomic (doesn’t correspond to dermatome pattern, referred pattern, very superficial, skin discomfort on light palpation or tenderness)

Type 2 - simulations - axial loading/rotation (press thru head, pain increases; rotation - turn whole body - feel pain - positive)

Type 3 - distraction - SLR (shooting pain down when lying down, but no pain when sitting and extending knee - positive)

Type 4 - regional disturbances - weakness/sensory (numbness, weakness, can’t move limb

Type 5 - overreaction - exaggerated painful response to stimulus that is not reproduced when same stimulus is given later

Screening for nonorganic, psych, and social elements to client’s pain syndrome

Does not signifying malingering

Score >3 indicative only of symptom magnification or possible illness behavior

74
Q

Pain Assessment in Nonverbal Patient

A

Position statement w/ clinical practice recommendations (hierarchy)

Self report

Search for potential causes of pain

Observe patient behaviors

Surrogate reporting

Attempt analgesic trial

75
Q

Appropriate Ages for Pain Scales

A

18-24 months - locate and identify that there is pain

3 years - intensity (no pain, little pain, lot of pain)

4-7 years - concrete measures such as Poker Chips = pieces of hurt

5-7 years - VAS esp color versions

10-12 years - verbal scales and affect

76
Q

Pain Scales for Children

A

Could be used w/ pts w/ cognitive deficits - must consider cognitive abilities (need to know how to count by rote AND ability to estimate quantities using #s)

Faces pain rating scale

Behavioral scale

  • CHEOPS pain scale (>1 yr)
  • FLACC (face, legs, activity, cry, consolability) scale (0-3 yrs of age or non-verbal pts)
  • Non-communicating children’s pain checklist (NCCPC) - vocal, social, facial, activity, body and limbs, physiological
77
Q

VAS/NRS

A

Developed to provide simple way to record subjective estimates of pain intensity

Can be used for acute/chronic pain (esp when attempting to determine changes in pain due to position, wt bearing, mvt, activity)

Must give consistent anchors for ends (0 and max number)

78
Q

PAINE - Pain Assessment in Noncommunicative Elderly Persons

A

4 sections - 7 levels - motor, vocal, and unusual behaviors, activity involvement

1 section - yes/no/don’t know/NA - physical signs such as falls, swelling, changes in vital signs

79
Q

NCCPC - Non-Communication Children’s Pain Checklist

A

Designed for children 3-18 years who are unable to speak b/c of cognitive impairments or disabilities

Post-operative version for pain after surgery or procedures done in hospital

Categories: vocal, social, facial, activity, body and limbs, physiological, eating/sleeping

80
Q

MPQ - McGill Pain Questionnaire

A

Developed to provide quantitative profile of person’s perception of pain

Categories - sensory, affection, evaluations descriptors

Includes body diagram and VAS scale

81
Q

MSPQ - Modified Somatic Perception Questionnaire

A

1-2 minutes

Developed to measure somatic and automatic perceptions (stomach churning, legs feel weak)

Higher score - worse pain

82
Q

Pain Catastrophizing Scale

A

Thoughts and feelings that pt has when they are in pain

Higher numbers in women vs men

Chronic pain

83
Q

RMDQ - Roland-Morris Disability Questionnaire

A

24 item self-report questionnaire

How LBP affects functional activities

84
Q

PDI - Pain Disability Index

A

5 mins to administer

Designed to measure pain related disability

ADLS/IADLs - home, recreation, social work, sexual, self care and support (eating, breathing, sleeping)

Higher score - more disability

85
Q

Revised Oswestry Disability Index

A

1-2 minutes

Measures how pain has affected ability to manage daily life

10 sections - pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, traveling, changing degree of pain

Higher score, greater disability

86
Q

FABQ - Fear-Avoidance Beliefs Questionnaire

A

Cognitive beliefs about role of pain on ability to perform physical and work activities

E&M (4 decks)

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