readings Flashcards
study of goniometry
measurement of angles created by human joints
arthrokinematic motions are measured by
comparing to the same motion on the contralateral side of the body
passive joint motions are used to find
the tissue that is limiting motion
arthrokinematics
movement of joint surfaces
movements of joint surfaces descriptions
slides, spins and rolls
slide/glide
translatory motion
sliding of one joint surface over another
spin
rotary motion
all points rotate around a fixed axis
roll
rotary motion
convex joint surface movement
convex surface rolls in the same direction as angular motion of bone but slides in opposite direction
concave joint surface movement
concave surface rolls and slides in the same direction as the angular motion of the bone
arthokinematic motions examined for
amount of motion
tissue resistance at end feel
effect on patients symptoms
osteokinematics
gross movement of the shafts of bones
osteokinematic movements
rotatory motion
three planes
sagittal
frontal
transverse
motions of sagittal plane
flexion and extension
axis of sagittal plane
medial lateral axis
frontal plane motions
abduction and adduction
frontal plane axis
anterior posterior axis
transverse plane motions
rotation
transverse planee axis
vertical axis
can goniometers measure motions in more than one plane?
no
1 degree of freedom of motion
joint that allows motion in only one plane
Range of motion
arc of motion occurring around a joint or series of joints
0 to 180 degree notation system
upper and lower extremity joints are at 0 degrees for flexion-extension and abduction-adduction when in anatomical position
when extremity joints are halfway between medial and lateral rotation they are at 0 degrees rotation
hyperextension
greater than normal extension ROM
180 to 0 degree notation system
anatomical potion is 180 degrees
360 degree notation
anatomical position is 180 degrees
flexion and abduction begin at 180 degrees and arc towards 0 degrees
extension and adduction begin at 180 degrees an arc towards 360 degrees
active range of motion
arc of motion during unassisted voluntary joint motion
AROM tells us
willingness to move
coordination
muscle strength
joint ROM
pain during AROM
contracting/stretching of contractile tissues
stretching/pinching of non contractile tissues
passive range of motion
arc of motion attained by an examiner without help from the subject
is PROM and AROM greater
PROM because small amount of joint under involuntary control
does PROM depend on muscle strength and coordination?
no
pain during PROM
due to moving, stretching or pinching of non contractile structures
end range: due to stretching of contractile and non contractile structures
end-feel
barrier to further motion at the end of PROM
soft end feel
soft tissue approximation
firm end feeel
muscular, capsular, ligamentous stretch
hard end feel
bone contracting bone
hypo mobility
decrease in PROM substantially less than normal values
potential causes of hypomobiilty
osteoarthritis, rheumatoid arthritis, adhesive capsulitis, spinal disorders, immobilization after fracture, scar development after burns, stroke, head trauma, cerebral palsy
non capsular pattern of restricted motion is caused by
structures other than entire joint capsule
internal joint derangement, adhesion of part of joint capsule, ligament shortening, muscle strain, muscle contractures
motions of a joint in capsular vs noncapsular
capsular: all or most motions
non capsular: one or two motions
hyper mobility
increase in PROM above normal values for gender and age
causes of hypermobility
Ehlers-danlos syndrome, Marfan syndrome, rheumatic disease, osteogenesis imperfecta, Down syndrome
ROM evaluation
should be compared to contralateral side
then compare to age and gender norms if available
age related effects of ROM may also be
joint specific
gender related effects or ROM are also
joint and motion specific and have greater differences in adults
maximal muscle length
greatest extensibility of a muscle tendon unit
passive insufficiency
inability of a muscle to lengthen and allow full ROM at all the joints the muscle crosses
how does different testing position alter ROM
more taut soft tissue structures- limit ROM
more lax soft tissue structures- increase ROM
why is stabilization during ROM testing important?
to fix proximal segment to determine accurate ROM
stationary arm of goniometer is aligned with
proximal segment of the joint
moving arm of the goniometer is aligned
parallel to the longitudinal axis of the distal segment of the joint
therapeutic exercise
systematic, planned performance of movements, postures, or physical activities to restore function, reduce risk factors and optimize health
physical therapy patient
has impairments and function deficits and is receiving PT to improve function
physical therapy client
has no diagnosed dysfunction and is getting PT to promote wellness
balance
ability to align the body and move without falling
cardiopulmonary fitness
ability to perform repetitive, total body movements for a period of time
coordination
performing movement with proper timing and sequencing
flexibility/ mobility
moving freely without restriction through ROM
muscular performance
strength, power, and muscular endurance
neuromuscular control
interaction of sensory and motor systems to produce coordinated movement
stability
ability of the neuromuscular system to hold a body segment stable
components of physical function
muscle performance
cardiopulmonary/ endurance
mobility/ flexibility
neuromuscular control/ coordination
stability
balance/ postural equilibrium
how are therapeutic exercises selected?
based on the underlying cause
what factors influence patient safety?
health history
environment
performance of exercise
patient education
International Classification of Function, Disability, and Health (ICF)
bio psycho social model that puts more emphasis on how people are impacted by their health conditions
composite impairment
result of multiple underlying causes and caused by combination of primary and secondary impairments
what is a PT trying to resolve with treatment
elimination or reduction of functionally relevant impairments
basic activities of daily living (BADL)
bathing
dressing
feeding
instrumental activities of daily living (IADL)
occupational
school related
housekeeping
recreational
what level(s) of prevention is physical therapy implemented for?
primary, secondary, and tertiary prevention
clinical prediction rules
predict likely responses of patients to treatment
five components of the process of patient management
comprehensive examination
evolution of data
diagnosis based on function, limitations and disability
prognosis and plan of care
interventions
elements of evaluation
health history
systems review
tests and measures
purpose of systems review
find abnormalities that require further testing
what is a PT classifying in a diagnosis?
dysfunction
prognosis
prediction of patient’s optimal level of function that is expected from treatment plan
factors that impact prognosis
familiarity with patient’s health
knowledge of tissue healing
experience
knowledge of efficacy of tests and accuracy of findings
plan of care includes
goals
functional outcomes
time frame
specific interventions
frequency and duration
discharge plans
areas of PT intervention
coordination, communication, documentation
interventions
patient-related instruction
stage of motor learning for fine tuning a motor task
associative
why is there no specific muscle length tests for one joint muscles?
the indirect measurement of length of one joint muscles is the same as measurement of passive joint ROM
passive insufficiency
inability of a muscle to length and allow full ROM at all the joints it crosses
how is the length of a two joint muscle assessed?
measuring passive ROM in the direction opposite to the muscle’s action at the second joint
how is the length of a multi-joint muscle assessed?
measuring passive ROM in the direction opposite so that the muscle is lengthened over all the muscles the joint crosses except for the last one
kinesiology
study of movement
kinematics
motion of the body without regard to the forces or torques that may produce motion
two types of motion
translation and rotation
translation
all of the rigid body moves parallel to and in the same direction as the rest of the body
rotation
rigid body moves in a circular path around a pivot point and all points in the body rotate in the same angular direction across the same number of degrees
three variables of kinematics
position
velocity
acceleration
osteokinematics
motion of bones relative to thee planes of the body
degrees of freedom
number of independent directions of movements allowed at a joint (up to 3)
arthrology
study of the classification, structure and function of joints
synarthrosis
junction between bones that allows slight to essentially no movement
fibrous joints
stabilized by specialized dense connective tissues
fibrous joint examples
skull, tibiofibular joint
cartilaginous joints
stabilized by flexible fibrocartilage or hyaline cartilage
examples of cartilaginous joints
symphysis pubis, vertebrae, manubriosternal
diathesis/ synovial joints
allow moderate to extensive motion
hinge joint
motion occurs in a plane located at right angles to the axis of rotation
examples of hinge joints
humeri-ulnar joint
interphalangeal joint
pivot joint
central pin surrounded by a larger cylinder that is parallel to the axis of rotation
examples of a pivot joint
humeroradial joint
atlanto-axial joint
ellipsoid joint
one part has a convex elongated surface in one dimension that is mated with another elongate concave surface on the other that allows biplanar motions and restricts spinning
example of ellipsoid joint
radoiocarpal joint
ball and socket joint
spheric convex surface paired with a cup-like socket that has motion in three planes and allows spinning without dislocation
examples of ball and socket joint
glenohumeral joint
hip joint
plane joint
two flat or relatively flat surfaces that combine sliding and some rotation of one side in respect to the other
examples of plane joints
carpometacarpal joints
inter carpal joints
inter tarsal joints
saddle joint
one surface is concave and one is convex and they are at right angles to each other that allows motion in two planes by limits spin
examples of saddle joints
carpometacarpal joint of the thumb
sternoclavicular joint
condyloid joint
convex surface paired with a cup-like socket that is relatively shallow and allows two degrees of freedom
examples of condyloid joints
metacarpophalangeal joint
knee joint
ovoid joint
paired mating surfaces that are imperfectly spheric. one surface is convex and the other is concave
type 1 collagen
thick fibers that elongate very little when placed under tension- stiff/strong and found in ligaments and fibrous joint capsules
type 2 collagen
thinner fibers with less tensile strength- provide framework for shape maintenance
elastin fibers
interweaving fibrils that resist stretching but have more give when elongated
materials that make up connective tissue
fibrous proteins
ground substance
cells
dense connective tissue
fibrous layer of joint capsule, ligaments and tendons- adapt to physical stimuli
articular cartilage
specialized hyaline cartilage that forms load bearing surface of joints - avascular
fibrocartilage
mix of dense connective tissue and articular cartilage that provides resilience and shock absorption of articular cartilage and the tensile strength of ligaments and tendons
anterior ligaments of the hip joint
iliofemoral
pubofemoral
posterior ligament of hip joint
ischiofemoral
type and degrees of freedom of hip joint
synovial ball and socket
3 degrees of freedom
axis of motion of hip joint
femoral head
normal hip flexion ROM
120 degrees
normal hip extension ROM
30 degrees
normal hip abduction ROM
40 degrees
normal hip adduction
20 degrees
two muscles that limit hip extension in Thomas test
illiopsoas and rectus femoris
medial rotation of hip ROM
40 degrees
lateral rotation of hip ROM
50 degrees
relationship between BMI and ROM at hip
higher BMI, decreased ROM
passive insufficiency
ROM of a joint is limited by the muscle’s length
joint mobilization is in the same direction as what part of joint movement
sliding
compression of a joint
decrease in joint space
distraction of a joint
pulling apart and increasing joint space
traction of a joint
longitudinal pull
joint mobilization is used to treat
pain and guarding
stretching is used to treat
restricted movement
contradictions to mobilization
hypermobility
joint effusion
inflammation
grade 1 oscillations
small amplitude oscillations at the beginning of range
grade 2 oscillations
large amplitude oscillations at mid range
grade 3 oscillations
large amplitude oscillations reaching end range
grade 4 oscillations
small amplitude oscillations at end range
grade 1 sustained joint play
small amplitude distraction with no stress placed on joint capsule
grade 2 sustained joint play
enough distraction to tighten tissues around the joint
grade 3 sustained joint play
distraction with large enough amplitude to apply stretch to joint capsule
