Test 2 Flashcards
what are some self-reported measures tests?
- Falls Efficay Scale (FES)
- Activities-Specific Balance Confidence Scale (ABC)
- Patient Specific Functional Scale (PSFS)
what is the FES?
16 item questionnaire
measures fear or concern of falling
what is the ABC?
similar to FES but expands to daily acitivities
measures an individual’s confidence in his/her ability to perform daily activities w/o falling
what is the PSFS used for?
to quantify activity limitations and measure functional outcome for pts
name some gait/balance assessment tests
- 6 minute walk test
- Timed Up and Go (TUG) test
- Berg Balance Scale
- Functional Reach Test
- Balance Evauation Systems Test (BESTest)
- full version
- MiniBest
- BreifBest
- Tinetti Performance Oriented Mobility Assessment
describe the 6 min walk test
measures the distance covered in 6 minutes while walking at a comfortable pace
In what populations can the 6 min walk test be used?
- Arthritis
- MS
- Parkinson’s Disease
- acquired brain injury
- stroke
there are normative values for _______ and ________ in the 6 minute walk test
gender and age
describe the TUG Test
tests mobility, balance, walking ability, and fall risk
used mostly in the elderly
score decreases sig w/mobility impairments
In what populations can the TUG test be used?
- Arthritis/Joint conditions
- CP
- MS
- Parkinson’s Disease
- Neurological and vestibular conditions/disorders
what the Berg Balance scale?
objective measurement of static and dynamic balance abilities
14 functional tasks commonly performed in everyday life
In what populations can the Berg Balance scale be used?
- Arthritis/Joint diseases
- MS
- Parkinson’s Disease
- Neurologic Conditions
- Brain injuries/stroke
describe the functional reach test
quick screen of balance in elderly
max distance one can reach forward beyond arm’s length while maintaining a fixed BOS in the standing position
scores >_____ on the functional reach test indicated limited functional balance
7 inches
what is the BESTest?
balance test with 36 items grouped into 6 systems
what are the 6 systems included in the BESTest?
- biomechanical constraints
- stability limits/verticality
- anticipatory postural adjustments
- postural responses
- sensory orientation
- stability in gait
describe the MiniBest
shortened version of BESTest
has 4 scoring domains:
anticipatory
postural response
sensory orintation
gait balance
what is the BriefBest
abbreviated version designed to assese 6 different aspects contributing to postural control in standing and walking
describe the Tinetti Performance Oriented Mobility Assessment
used to measure gait and balance abilities
16 total items (9 balance and 7 gait)
what categories are involved in a mental status screen?
- Appearance and behavior
- attention and orientation
- attention/memory
what is the Mini Mental State Exam?
widely known test of cognition
score of >25 indicates cognitive impairment
celing effect w/mild impairments
categories included in the Mini-Mental State Exam
- Orientation
- Registration
- Attention and Calculation
- Recall
- Language
T/F: the Mini-Mental State Exam is free
False it costs money to use
what is the Montreal Cognitive Assessment (MoCA)?
a rapid screen instrument for mild cognitive dysfunction
>26 is considered normal
takes ~10 min to administer
what testing areas are included in the MoCA?
- Visuospatial/Executive
- Naming (animals)
- Memory
- Attention and Concentration
- Abstraction
- Delayed Recall
- Orientation
what are ICD-10 codes used for?
medical and PT diagnoses of our patients
describe the ICD-10 code structure
- category (first 3 characters)
- etiology, anatomic site, severity (4th-6th characters)
how do you choose the correct ICD-10 code?
report specific diagnosis codes when they are supported by the available medical record doc and clinical knowledge of the patient’s health condition
T/F: we want to choose a vague ICD-10 code?
TRUE, leaves us more wiggle room
signs, symptoms or unspecified codes are best
you code at the __________
level you can confirm
what codes are used for interventions?
CPT-4 codes
what does CPT stand for?
Current Procedural Terminology
T/F: CPT-4 codes are required to receive payment
TRUE
depends on insurance but mostly true
most CPT codes that are available to PTs are located in the _______
97000 series called Physical Medicine and Rehab
what is the 8 minute rule?
bill one unit for treatment greater than or equal to 8 minutes through and including 22 minutes
Units breakdown for CPT codes
- 8 -22 minutes = 1 unit
- 23-37 minutes = 2 units
- 38-52 minutes = 3 units
- 53 -67 minutes = 4 units
- 68-82 minutes = 5 units
T/F: most PT practices under bill and use the wrong codes?
TRUE
how does compensation work with CPT codes?
payment policy is determined by each individual payer and insurance
CPT 97110 Therapeutic Exercise
develop strength and endurance, ROM and flexibility
CPT 97530 Therapeutic Activities
direct (one-on-one) patient contact by the provider (use of dynamic activites to improve functional performance)
T/F: antropometry is a key component of nutritional staus assessment in children and adults?
TRUE
what are some methods for measuring antropometrics?
- Body weight/height (BMI)
- girth measurements (waist to hip ratio/limb girth)
- skinfold calipers
- hydrostatic weighing (gold standard)
- Bod pod
- electrical impedance
- limb length
- finger pressure (peripheral edema)
what is considered a normal BMI?
18.5 - 24.9
how is waist to hip ratio determined?
waist measurement taken at narrowest part of the torso (above the umbilicus and below the xiphoid process)
hip measurement taken at max circumference of the hip
name a limb circumference technique we did earlier this year
Figure-8 ankle measurement
describe the technique required for skinfold measurements
- grasp skin firmly by thumb and index finger
- place caliper 1 cm below hold
- maintain grip while releasing caliper
- wait 2 sec to read caliper to nearest 0.5 mm
- take 2 measurements at each site, alternating sites
when should a 3rd skinfold measurement be taken?
if the 2 measurements differ by more than 1 mm
written goals should be used to determine what?
- progress
- allow for adjustment of clinical impression
- prognosis, duration and frequency of the episode of care
- conclucsion of care and intervention plan
Goal writing needs to be ________
- patient/client centered
- unbiased and objective
- quantifiable/measurable
- relates to a particular use or purpose and is therefore functional
- has a time frame
what are 2 types of options of Daily notes?
- S.O.A.P
- S.I.R.P
what does SIRP stand for?
- Status
- Intervention
- response
- Plan
what are the elements of the Patient/Client Management Model?
- Examination
- Evauation
- Diagnosis
- Prognosis
- Intervention
- Outcomes
what occurs during the examination in the Patient/Client Management Model?
examine the pt. and collect data through the history, systems review, and tests and measures
what occurs during the evaluation in the patient/client management model?
evaluate the data and ID the problems
what occurs during the diagnosis portion of the patient/client management model?
determination of the diagnosis and prognosis
when is the POC implemented in the patient/client management model?
during Intervention
What is the HOAC?
a clinical decision making model that generates hypotheses and facilitates the use of science and evidence in practice to confirm or refute hypothesis
What does HOAC-II stand for?
Hypothesis-Oriented Algorithm for Clinicans II
how does the HOAC-II differ from the Patient/Client Management Model?
HOAC-II involves the patient in decision making and provides payers with better justification
In the HOAC-II model the problem is almost always a _______________
functional deficit
how can patient problems be divided/subdivided in the HOAC?
- Exisiting
- Anticipated
- Patient ID
- non-patient identified
What are the steps in the HOAC-II?
- Initial data collection
- Generate patient identified problems (PIP) list
- Exam strategy
- Conduct exam and analyze data
- Add Non-patient identified problems (NPIP) to problem list
- Justification for hypothesis
- Hypotheses about cuase
- Refine Problem List
- Goals
- Establish testing critera
- Establish predicitive criteria
- Reassessment Plan
- Plan and implement intervention
What is included in the hypotheses formed at the end of the HOAC?
determination of probable cause as well as magnitude of deficits
followed by subsequent quantifable steps that must be achieved to eliminate the identified problem
T/F: In PT, pathologies are often unchanged even though impairments or functional limitations are reduced or eliminated?
TRUE
Goals are written/expressed almost exclusively as __________
functional activities
All goals must represent ________
meaningul accomplishments
- functional task analysis
- short-term vs. long-term goals
define testing criteria
level of improvement in impairment needed to eliminate the problem
predictive criteria are related to ________
risk factors
Define tactics as it pertains to the HOAC
specific elements of intervention (frequency, duration, intensity)
What should goals be/include?
- patient/client centered
- unbiased and objectable
- quantifiable/measurable
- relates to a particular use or purpose and is therefore functional
- have a time frame
what is the purpose of muscle length testing?
to determine the greatest extensibility of a muscle-tendon unit
how would you determine muscle length at a one joint muscle?
via goni measurement of PROM of motion opposite to action of muscle of interest
how would you measure muscle length in a two joint muscle?
lengthen the muscle across one joint and then asses ROM available at the second joint
how do you know when elbow extension is limited by a short bicep?
elbow extension will be limited when:
shoulder is postioned in full extension and the forearm is in full pronation
what else can limit elbow extension?
- joint surfaces
- shortening of the anterior capsule/collateral ligaments
- other muscles such as brachialis/brachioradialis
what would indicate that something other than a short biceps is limiting elbow extension?
if elbow ext is limited regardless of shoulder position
describe the muscle length test for the biceps brachii
- position pt. in supine at edge of table
- flex the elbow fully, then move the shoulder into full ext while holding the forearm in pronation
- test ends when resistance (should be firm end-feel) is felt
- hold and measure w/goni
how do you know when elbow flexion is limited by the triceps brachii?
elbow flexion will be limited when the shoulder is positioned in full flexion
what else (other than the long head of triceps) can limit elbow flexion and how do you know?
abnormalities of joint surfaces
shortening of the posterior capsule
muscles that cross only the elbow (anconeus, M/L tricep)
elbow flexion will be limited regardless of shoulder position
describe the set up for muscle length testing of the triceps brachii
- supine at edge of table
- ext the elbow and move shoulder into full flexion w/00 of abduction
- supinate the forearm
- move the elbow into flexion until you feel resistance
describe how to measure the pectoralis major length
- position pt in supine w/hands behind head
- stabilize contralateral trunk/shoulder
- measure the distance between the olecranon and the table
describe how to measure the pectoralis minor length
- position the pt in supine with netural shoulder and elbow extended and palms facing up
- measure the distance between the posterior acromion and the table
what is considered “tight” for the pectoralis minor length test?
a distance greater than 1 inch
differences compared to the contralateral side
what does the Thomas Test measure?
hip flexors muscle length
**there are a lot of compensations
describe how to perform the Thomas Test
- position the pt at the end edge of the table w/lower thighs, knees, and legs off the table
- assist the pt into supine position by supporting pt’s back and flex hips and knees
- flex hips and knees enough to flatten low back and pelvis onto table
- stabilize hip not being tested in flexion
- extend hip being tested toward table (involved hip and knee should be relaxed)
Goni alignments for Thomas Test (for hip flexors)
- Fulcrum = greater trochanter
- Stationary = lateral midline of the pelvis
- Moving = lateral midline of the femur (lateral epicondyle as ref)
what else can the Thomas Test be used to measure?
(other than hip flexors)
- rectus femoris
- abductor/adductors
- sartorius tightness
*use goni landmarks that test each of those ROMs
what are some possible abnormal findings during the Thomas Test?
- unable to reach hip extension in testing position
- Hip moves into ABD + ER + Knee flex
- Hip moves into ABD + IR
- Knee extends and is not flexed at 900
- Hip moves into ADD
if you are unable to reach adequate hip extension in the testing position during the Thomas Test what may be the cause?
hip flexors may be shortened
What is most likely the cause of the hip moving into
ABD + ER + Knee flexion during the Thomas Test?
Sartorius may be shortened
What is most likely the cause of the Hip moving into
ABD + IR during the Thomas Test?
TFL may be shortened
What is most likely the cause of the knee extending out and not remaining at 900 during the Thomas Test?
Rectus femoris may be shortened
What is most likely the cause of the hip moving into ADD during the Thomas Test?
The adductors may be tight
(pectineus, adductor longus, adductor brevis)
Alternate name for the testing Hamstring muscle length?
SLR test
describe how to perform the SLR test
- position the pt supine w/knee extended, hip in 00 flex, ext, ABD, ADD and rotation
- stabilize knee being tested at 00
- flex the hip by lifting the LE off the table while keeping the knee in 00 extension
what is considered a normal length for the SLR Test?
70-800 of hip flex w/knee extended
Describe how to test the distal hamstring length
- position the pt in supine w/involved hip flexed to 900 and 0 of ABD/ADD/Rotation
- uninvolved leg w/knee in 00 ext and hip in 00 everything
- stabilize femur to prevent Rotation/ABD/ADD
- Extend the knee to the end of RO
- stop the motion when resistance is felt and hip begins to move into extensino
what is the distal hamstring length test also called?
popliteal angle test
what are the main differences between the proximal and distal hamstring length?
- goni placement
- prox => fulcrum over greater troch
- distal => fulcrum over lateral epicondyle of femur
- knee angle
- prox => knee is full extended
- distal => knee starts off flexed
- hip angle
- prox => hip starts at 00 flex
- distal => hip starts at 900 flex
describe how to perform the muscle length test for the rectus femoris
- position the pt. prone w/feet off end of table
- knees extended, hips in 00 everything
- stabilize posterior hip to maintain neutral position
- flex the knee towards buttocks
- end ROM occurs when reistance is felt from ant thigh
what is another name for the rectus femoris muscle length test?
Ely Test
if knee flex is limited when the hip is in a flexed position and the pt is prone what is most likely the cause?
NOT from a short rectus
most likely from abnormalities of joint structure
or
short one joint knee extensor
What does the Ober Test examine?
length of TFL and IT band that ABD the hip
describe how to perform the Ober Test
- position pt in side-lying near back edge of table w/involved leg on top
- stabilize top iliac crest to stabilize the pelvis
- bottom hip and flexed knee stabilize trunk
- support the involved leg by holding under med aspect of knee and lower leg
- flex the hip and knee to 900
- keep knee flexed and move the hip into ABD and Ext and then lower the hip into ADD and lower toward table
what does the IT band limit?
hip ADD
hip Ext, ER (a little)
Knee flexion (a little)
shortening of the IT band can contribute to what?
- LBP
- ITB friction syndrome
- patellofemoral pain
goni alignment for the Ober Test
- Fulcrum = over ASIS
- Stationary = parallel to the opposite ASIS
- Movement arm = ant midline of femur (patella as ref)
how is the modified Ober Test different from the standard Ober Test?
the knee is held in extension in the modified version
what does the modified Ober Test do?
evaluate the length of the hip abductors
How many ways are there to evaluate the muscle length of the Gastrocnemius?
2
describe how to perform the muscle length test for the Gastroc in supine
- position pt in supine w/knee extended and foot in neutrl EV/IN
- hold knee in full extension
- dorsiflex the ankle to end ROM by pushing across plantar aspect of met heads
Goni alignment for Gastroc muscle length testing in supine
- Fulcrum = over lateral aspect of lateral malleolus
- Stationary = lateral midline of fibular, fibular head as ref
- Moving = parallel to the lateral aspect of 5th met
T/F: if the gastroc is short it will limit ankle DF when the knee if flexed
FALSE - when the knee is extended it will limit ankle DF
If DF is limited regardless of what position the knee is in, what may be the cause?
abnormalities of ankle joint surfaces
shortening of the joint capsule
shortening of ligaments
shortening of the soleus
describe how to perform the muscle length test for the Gastroc in standing
- maintain the knee in full ext
- ensure heel remains in contact w/floor
- pt DF ankle by leaning body foward
- test ends when the individual feels tension in the post calf and knee, or if further DF causes the knee to flex and heel to lift of the floor
how much hip flexion is required for putting on socks?
120 of flexion
In order to walk on level surfaces how much function hip flexion is required?
0-300
in order to ascend stairs, how much hip flexion is required?
1-0-66
in order to descend stairs, how much hip flexion is required?
1-0-45
