Skills Check 1 Flashcards
1) What is overpressure
- Is this large or small amounts of pressure / oscillations?
- What are you trying to do or find out with overpressure?
- Can it be done with AROM and PROM
2)
- Why would you have a pt do AROM
- Why would you do PROM on a pt
- Would you have pt do AROM or PROM first?
2A) The KEY to making sure PROM works is:
3) Explain a Contractile vs. Non-contractile injury
4)
- If pt has pain 1/2 way through AROM, obviously something is preventing that motion. It could be contractile or non-contractile. You don’t know. So what would you do?
5) What is Resisted Static Contraction (RSC)
- Why do you do them?
- If they have a strong isometric contraction but painful, what might we conclude
- If they have a weak isometric contraction but painful, what might we conclude
- If they have a strong isometric contraction but NO pain, what might we conclude
- If they have a weak isometric contraction but NO pain, what might we conclude
6) So 4 findings from a RSC
7) What are Passive Physiolgocial Movements (PPM)
8) What are Passive Accessory Movement (PAM)
8A) Which one (from 2 above) is osteokinematic, which is arthrokinematic?
9) What are the GRADES you’d assign to
9A) Are the grades from question above the same for PPM and PAM
- What is different about grading between PPM and PAM
10)
- Grade I and II are to assess:
- Grade III and IV are to assess
11) What is difference between a dermatome and myotome:
- Dermatome for L4/L5 vs. a myotome for L4/L5
12) For a friction massage, explain what it is and why we’d do it
- What is the ‘common extensor tendon’
- How would you do a friction massage of biceps muscle
1) You have someone go through ROM (AROM or PROM) and then you as PT apply a little bit more pressure past that point. It is SMALL oscillations with slight extra force past normal ROM
- Small
- End feel
- Yes
2)
- AROM: See what the pt can do themselves. Determine their ROM, pain, abilities themselves
- PROM: For mobilization or therapy (stretch, create movement, etc.). Also to essentially determine if the pt has a contractile vs. a non-contractile injury.
- It depends. Typically AROM to see what they can do first. But if they are injured, start with PROM then move them more to AROM.
2A) Patient has to be totally relaxed
3)
- Contractile: An issue with muscle or tendon
- Non-contractile: An issue OUTSIDE the muscle or tendon, thus an issue with ligament, bursitis, capsule, etc.
4) Do PROM of same motion. If there is pain again at same point during PROM, you probably have a capsular, bursitis, ligament issue (NON-contractile). If you can go through entire ROM with NO pain, then most likely it is a contractile issue with a muscle or tendon.
5) It is a mid ROM isometric contraction
- This helps us know whether injury/pain is contractile vs non-contractile. We’re trying to figure out if they have pain or weakness.
- Slight tear of muscle/tendon
- BIG tear of muscle/tendon
- Normal (or referred pain)
- Complete tear/rupture
6) Strong and Painful Weak and Painful Strong and Painless Weak and Painless
7) Movements the pt can do themselves (shoulder flexion, hip extension, etc.)
8) Components of normal movement, but patient can’t do themselves (shoulder glide by a PT, drawer test at knee)
8A)
- Osteokinematic = PPM
- Arthrokinematic = PAM
9)
- Grade I: Small oscillation movement at beginning of ROM
- Grade II: Big oscillation movement at beginning of ROM (from start to mid ROM)
- Grade III: Big oscillation movement from mid-end ROM
- Grade IV: Small oscillation movement at end of ROM
9A) Yes
- PPM is obvious … a large ROM (shoulder flexion). But PAM is much harder since the movement is so small, limited, etc.
10)
- I and II: Pain
- III and IV: Stiffness, ROM, and mobility
11) Dermatome is to access skin sensation for that nerve root, myotome is to access muscle activation for that same nerve root.
- So dermatome for L4/L5 would be feeling portions of lower leg on skin, but myotome is having them do plantar flexion or big toe extension motions to ensure they can.
12) Find a tendon (suprispinatus, paterllar tendon, common extensor, etc.) and you rub against the fibers. You are doing this to break up the microtrauma scar tissue to try to get the fibers to heal properly. This breaks up fibers, causes inflammation and healing to occur and then allows fibers to heal properly with movement.
- In forearm, the common place where all extensor tendons of forearm attach near lateral epicondyle of the humerus.
- Same way. Place thumb on belly or tendon (where you think or know tear is) and rub. You can also grab the belly itself and rub the whole muscle belly.
Practice and review LQS (lower quarter screens)
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Review from Lab 1 the Musculoskeletal exam (and at some point add that to my document of interview outline questions)
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Go through entire Lab 1 handout to review the other things
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Below are flashcards on Lab 2 handout
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1) What 2 pulses on foot should you check with diabetic patients
2) Where would you palpate to find those pulses
3) How do you measure or grade a pulse
4) What is capillary refill test
5) What is the Rubor of Dependency exam:
- How is this test performed
- What type of pt would this be performed on
- Can you check both the plantar and dorsal side of the foot, and why?
6) What is the ABI
- How is it performed
- How is it calculated
- What are norms and caution amounts
- Why do we do this test
- Do you test both sides (right and left)
- Do you test both dorsalis pedis and post. tibial arteries?
7) What is the Mobility / Vision Test
- Why do we do this?
8) What is a Monofilament
- Why is it used
- Explain the test
- How is it scored?
- Would you poke in a wound?
9) Explain the basics of what you’d do with a footwear assessment with a pt with diabetes
10) With gait, do you want to observe your patient’s gait with shoes on or off?
- When should shoes be on?
11) With regards to gait, what are the 2 major phases of gait
- What are sub steps of STANCE phase
- What are sub steps of SWING phase
12) In lab we got a gait assessment checklist. What do the gray and white boxes represent:
13) Briefly explain below what each of these gait deformities are:
- Hammer Toes
- Claw Toes
- Bunion / Bony Prominence
- Pes Planus
- Pes Cavus
- Hallux Limitus:
- Rear/Forefoot Varus
- PF 1st Ray/Forefoot Valgus
- Dorsiflexed First Ray
- Equinus / Calcaneus
- Drop Foot
- Charcot Fracture
- Partial Foot Amputation
1) Dorsalis pedis and tibialis posterior
2)
- Dorsalis Pedis: Top (dorsal) part of foot between 2nd and 3rd rays
- Tibialis Posterior: Medial Malleolus (it is deep and thus faint)
3) 0 = No pulse 1+ = pulse barely present 2+ = diminished pulse 3+ = normal pulse (easily felt) 4+ = bounding pulse (means excess fluid in blood or edema suggesting a cardiovascular issue)
4) Pinch finger / toe nail and press firmly. Then release. The blood should fill within 3 seconds. If it does not = positive test
5) Test to determine arterial insufficiency/circulation in the LE (feet).
- Patient lays supine and PT notes color of soles of feet. Feet should be pinkish, but with impaired circulation it would be more white. Elevate leg to 45 deg and hold it there (60 secs). If skin color quickly changes to white, suggest arterial insufficiency. But when you lower leg, the pink normal coloring should return within 15-30 secs. If it lasts longer than 30 secs to refill = arterial insufficiency.
- Diabetic
- Yes. Plantar side determines arterial insufficiency. Dorsal side determines venous insufficiency.
6) ABI = Anke Brachial Index. It is a test to determine blood circulation throughout body.
- Take blood pressure at brachial artery, and at the ankle.
- Take Ankle / Brachial. So if ankle systolic BP is 118 and Brachial systolic BP is 130 you’d take ankle / brachial.
- Normal should be around 1 or slightly higher. .8-1.0 = mild peripheral arterial disease (PAD). .5-.8 = moderate peripheral arterial disease. Higher numbers (1.3 + might suggest diabetes)
- To measure arterial perfusion in lower legs, to help determine if someone has diabetes.
- YES
- YES. Do ankle BP and measure BP at post tibialis and then do it again and measure at dorsalis pedis pulse.
7) When you place a mark on the plantar surface of a pt’s foot (have pt close their eyes). Then have them open their eyes and point generally to where it is, and then have them find the mark on their foot.
- This first part helps you know if they felt/sensed it in the right area. Then you check to see if they can find it which will tell you if they can check their own feet or not (for diabetic patients)
8) Little tool used to check someone’s sensation (the tool we got that is in the shape of a foot with a string coming out to poke someone’s plantar foot.
- It tests whether someone can feel sensation on plantar (and dorsal) foot or not, for diabetic patients.
- A positive test is when the pt can NOT sense more than 4 of the spots per foot.
- No
9) Just observe your pt’s shoes to determine wear patterns. If a pt had decreased sensation, they need more protection and stability.
10) Well at first you can do it with shoes on, then move to shoes off.
- Keep shoes on if pt has balance issues
11) Stance and Swing
- LR (loading response), MSI (mid-stance), TSt (terminal stance), PSw (Pre-swing).
- ISw (initial swing), MSw (mid-swing), TSw (terminal swing)
12) Gray boxes mean things don’t happen in that stage. White boxes mean things are happening in that phase.
1) So with a diabetic pt, what are some high risk or red flag signs they have issues
2) What might you do to care for such pts
1)
- Reduced sensation
- Reduces pulses
- Presense of a foot deformity
- History of or presense of foot wounds/ulcers
- History of amputation
2)
- Patient education
- Instruct in self care
- Foot checks
- Help heal wounds
- Orthotics
- Cleansing / moisturizing
- Offloading with assistive devices
- ROM / stretch / strengthening exercises
1) Are PT’s massage therapists?
- What is the difference between a massage and a PT’s soft tissue mobilization?
- T or F: Massage (or soft tissue mobilization) does help release muscle spasms, stiffness and pain, and do gait control theory?
- What is major reason we do a friction massage, for example
2) When we do friction massage, whether on a scar trying to heal, or a muscle/lig/tendon … what are we really doing?
3) *** What is Wolff’s Law or concept
- What is example of the body builder?
4) What is friction massage:
- How long should you do friction massage?
- Is friction massage painful?
- Does the PT push hard?
- Examples in class of tendons we practiced friction massage on?
5) If someone had an open wound, would you do friction massage?
- What if it is a newly closed wound
6) What is Myofascial release:
- Why do we do it
- How do we do it?
- Is there a lot of research proving it works
7) What is ischemic pressure (or acupuncture)
8) What is J stroking
9) What is skin rolling
10) What is sub-occipital release
1) NO. We do not do massaging on pt’s. We do soft tissue mobilization?
- PT’s are targeting a specific area that is injured to try and restore function/movement to that tissue.
- TRUE
- To do microtrauma to area to help bring blood to area to help heal it.
2) When you get an injury, scar tissue comes and lays down collagen fibers down. Those fibers are laid down in a very disoriented way. Our goal is to disrupt the superficial layer, create microtrauma (inflammation and bring blood to area) to help lay down more/new fibers. THEN get pt moving, because movement helps those newly laid fibers orient in the right way. THUS, when fibers are lying the correct anatomical way, it helps facilitate improved or normal physiologic movement.
3) Whether for bone, ligaments, or muscle … it will not improve or strengthen unless stress and strain is placed on the tissue.
- A body builder gets huge muscles and STRONGER by creating strain on the muscle fibers. This strengthens them. Same concept when a PT does soft tissue mobilization on a tendon or ligament or muscle.
4) Applying quite a bit of pressure in a very specific localized area PERPENDICULAR to the muscle fibers. Goal is to do what was mentioned in point 2 above.
- 5 mins, or until it goes red (or numb)
- Yes it is a little painful
- Yes, PT should push hard to where skin and muscle are moving
- Supraspinatus, patellar, common extensor, biceps (muscle belly)
5) NO
- No, probably not. You wait until it has scarred over and then just know what phase of healing they are in to create friction without rupturing wound/incision.
6) Apply gentle pressure to area and then hold it (a sustained hold).
- To release the fascia from off the muscle belly
- Crossed hand longitudinal stretching where you cross hands, press firmly down and pull skin apart (away from muscle belly below)
- ??? not really
7) Idea is to create small microtrauma to area as a way to help stimulate healing and blood flow to help allieviate pain and stiffness.
8) Put pressure on skin in affected area and then release in a J shape. Do it for same reason as all those listed above.
9) Pinch skin and go up an area and keep walking up that area till you find a painful spot. It is done for same reason listed above.
10) Use the lumbrical grip / alligator hand grip, and prop occiput up onto your finger tips. Hold pt up for a while. This helps with headaches or neck pain.
1) What are the 4 steps to traditional massage … and briefly explain what each is
2) A few reasons why a PT might do a “massage”
3) Keys to do before, during, and after a massage
1)
- Effleurage: Start out to just relax the patient. Soft gently gliding/stroking motions over the area. Try to find tight area or knots.
- Petrissage: Now after pt is relaxed, start getting firmer and deeper in those knots and tight areas.
- Tapotement: This is not relaxing, it is blows or hacks (karate chops) to the area. You can give blows with ulnar side of hands, cupping hand, etc.
2) Relax the pt, get their muscle knots out, help alleviate pain (gait control theory), and build rapport.
3) Proper draping, make sure pt is comfortable, overly-communicate, protect yourself with having someone else there, etc.
A few other soft tissue mobilization techniques:
1) What is erector spinae / quadratus lumborum muscle bending and strumming
2) What is Hamstrings with fist or hamstring play
3) Foam rolling / tennis ball
4) Milking Massage
1) Have pt lay on their side. You use body weight to push down on the pt’s scapula and hips to stretch the QL and erector spinae muscles. Then grab erector spinae muscle and knead it, pull it, loosen it, massage it.
2) Knead or knuckle the hamstrings
3) Ball used for a muscle knot or trigger point. Put trigger point on the ball and roll on it up, down, over, across, etc. Put weight onto the ball. Lay down, sit down, lean into a wall - however you want.
Foam Roller: use foam roller to roll on / over a specific muscle with tightness to release knot or myofascial release
4) Cup hand and put over UE or LE and cup and pull excess fluid to, or push back to the heart for edema or lymphedema.
Below are flashcards on lab 4:
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1) Explain the calculated STJ (subtalor joint) neutral assessment:
- What is figure 4 position
- How do you actually calculate this
2) What is calcaneal varus vs. calcaneal valgus
- A positive number from calculated STJ (from above) would be calcaneal varus or valugus
3) What is the ‘Palpated STJ Neutral’ assessment:
4) What is standing or weightbearing STJ assessment:
5) If someone is slightly rearfoot or forefoot varus when in NWB position, what will they be standing in a weight bearing position?
6) Would someone roll their ankle more if they had pes planus or pes cavus?
1) Put pt in prone so they are NWB (non weight bearing). Pt should go into figure 4 position (cross one leg back over onto opposite knee on posterior side). Then grab the pt’s calcaneus and pull it into max eversion and measure. Then do the same in max inversion and measure.
- Cross one leg over to opposite side knee
- Take Inverison ROM + Eversion ROM and / 3. Then take Everson ROM - whatever you got = calculated STJ neutral.
SO if inversion was 26 and eversion was 6. I’d take 26+6 = 32. 32 / 3 = 10.2. Then 6-10.2 = -4.2
2) Remember ‘where is the pig’ … so calcaneus varus has bottom portion more IN, and upper portion more out (opposite with valgus).
- Positive = Valgus, Negative = Varus
3) Put pt in prone NWB (same as above). Now PT will grab the outside of the lateral foot and move foot into in/eversion back and forth while using the other hand to feel the talor dome moving. When talor dome is neutral (equal on both sides) then PT holds foot in neutral position and looks down the foot. First PT will look at rearfoot, then PT will look for forefoot. If rearfoot is valgus, most likely the forefoot will be as well. Compare sides.
4) Have pt stand and now you palpate the STJ. Get pt to swing back and forth until you feel STJ is in neutral. Once they are in neutral you can eyeball it or measure it, but as the pt relaxes, you’ll see them move into a valgus or varus position (whatever their natural position is … which for most people is NOT STJ neutral).
5) Opposite. If they are varus in NWB, they’d be valgus in WB.
6) Pes cavus
1) What is the Foot Posture Index (FPI)
- Scores go from a -2, -1, 0, 1, 2 … scoring a negative number means =
- Scores go from a -2, -1, 0, 1, 2 … scoring a positive number means =
- Score of 0 means =
- If you are not sure between 2 numbers that are close, do what?
- What do the scores help us know (if we scored a pt using this index)
1) Essentially a way to view, measure, and grade foot posture. It helps you assess things like STJ neutral position (inversion or eversion position), longitudinal arch positions (flat foot vs cavus)
- Person is more supinated
- Person is more pronated
- More neutral
- Score closer to 0
- Whether an orthodic needs to be used or not
1) What is treadmill gait analysis
- What are you looking for?
2) T or F: We all pronate
- Pronating is good
- Over pronating is bad
1) Put a pt on a treadmill and just record or watch their gate
- Circumduction of foot, drop foot, ‘too many toes’ out or in, rearfoot pro/supination, swing vs. stance phase issues, rockers, pes cavus vs pes planus
2) True
- True
- True
