The Evaluation Process Pt. 2 Flashcards
1
Q
Observation begins when?
A
the moment the client meets the evaluator
2
Q
Observation starts with a ____ ____ –> ____ and ____.
A
- visual inspection
- locally and globally
3
Q
Local observation is where:
A
- at site of injury
- at joint above and below
4
Q
Global observation is where:
A
- whole body
- extremity, trunk
- kinetic chain
5
Q
Local observation is looking for signs of ….
A
- trauma or injury
- inflammation
6
Q
Signs of trauma or injury include:
A
- deformity
- discolorations
- contusions
- crepitus
- abrasions
- avulsions
- penetrations and punctures
- burns
- lacerations
- swelling
- symmetry
- tenderness
- instability
- crepitation
7
Q
How to expose sign of inflammation:
A
- bilateral comparison
- view joint of chief complaint
8
Q
Characteristics of inflammatory response:
A
SHARP
9
Q
SHARP stands for:
A
- swelling
- heat
- altered function
- redness
- pain
10
Q
Global observations is looking at…
A
- alignment and posture
- gait
- functions of ADL
- observe pain
11
Q
What to look for with alignment and posture:
A
- position of the joints
- relative to injury, relative to context
12
Q
What to look for with gait:
A
- weight bearing (WB) of lower extremity (LE)
- movement of UE while in gait
13
Q
We should observe pain through…
A
- apprehension in movement
- compensatory movement
- carrying position
- facial expression
14
Q
Considerations for observation:
A
- alignment vs malalignment
- symmetries vs asymmetries
- multiple viewpoints
- many positions or postures depending on context
- understanding the kinetic chain and compensatory movements
15
Q
Alignment vs malalignment: ______ comparisons of _____.
A
- bilateral
- extremities
16
Q
How to assess symmetries vs asymmetries:
A
- bony landmarks
- muscle girth or tone
- limb orientation
17
Q
Multiple viewpoints:
A
- anterior
- lateral
- posterior
18
Q
Many positions or postures depending on context includes:
A
- standing
- sitting
- functional position
- sport specific position
- position in movement or while moving
19
Q
Understanding the kinetic chain and compensatory movements includes looking at…
A
- joints above or below
- joint’s injury affect to movement (stress)
20
Q
Lateral view of standing alignment: what anatomical landmarks should we look at?
A
- back of ear
- middle of shoulder
- middle of greater trochanter
- back of patellae
- front of malleolus
21
Q
Anterior view of standing alignment: what anatomical landmarks should we look at?
A
- shoulders
- nipple line
- ASIS
- hands
- patellae
22
Q
Posterior view of standing alignment: what anatomical landmarks should we look at?
A
- shoulders
- scapulae
- elbows
- posterior dimples
- hands
- popliteal fossae
23
Q
Global affect of alignment: balanced posture:
A
smaller forward bending pressure
24
Q
Global affect of alignment: flat back:
A
- forward head
- greater forward bending pressure
- upper back extensors weak
- chest muscles short, tight
25
Global affect of alignment: swayback:
- forward head
- greater forward bending pressure
- upper back extensors weak
- chest muscles short, tight
26
Global affect of alignment: kephotic-lordotic:
- forward head
- greater forward bending pressure
- upper back extensors weak
- chest muscles short, tight
27
Postures change with ____.
age
28
What is text neck?
- postural position
- curve of repetitive stress
- early disk degeneration in the cervical spine
29
2 components of observational assessment of posture:
- views
| - findings
30
Views of posture includes:
- standing, sitting, functional work or sport
| - anterior, lateral, posterior views
31
Findings of posture includes:
- comment on notable
| - report on remarkable
32
Report on remarkable includes:
- identify alignment imbalances
- different from
- deviate from
33
When looking at the impact of balance in observation, consider...
- the upright or standing alignment
| - the musculature (imbalance)
34
Factors influencing alignment and a posture:
- structural abnormalities (spine, leg length)
- neurological dysfunction
- vestibular dysfunction
- pain
- fatigue
- joint pathology
- respiratory conditions
- muscle dysfunction (imbalance)
- vision
- age
- habit (height, body image)
35
Common malalignments of LE alignments:
- genu valgum, genu varum
- patella baja, patella alta
- high arch, flat arch
36
Common malalignments of UE alignments:
- winged scapula
- sway back, lumbar lordosis, thoracic kyphosis, forward head
- gorilla hands, internal rotation
- cubitus varus, cubitus valgus
- step deformity, piano key
- malangulation
37
ROM:
the distance and direction a joint can move to achieve its maximal potential
38
How is ROM measured?
- quantified (degrees eyeball, goniometer, %)
| - descriptor (full)
39
Is ROM the same as flexibility?
no
40
ROM terms:
- flexion, extension, hyperextension
- abduction adduction
- int rot, ext rot.
- circumduction
41
Evaluation of ROM is used to:
- assess inert and contractile tissue components at joint
- assess joint movement or joint function
- assess strength in selective tissue testing
- assess pain with that ROM of a structure (severity)
42
Assessing inert and contractile tissue components at joint is used to ....
differentiate between tissues
43
Assessing joint movement or function can include...
1 ROM (joint specific) or sum of ROMs (pattern, functional movement)
44
Compare ROM ______, check _____ side first.
- bilaterally
| - unaffected
45
ROM is _____ many times, since it is a useful measure in assessing _____.
- reassessed
| - progress
46
3 components of assessing and evaluating AROM:
- range (measured by degrees, % quantified)
- visually observing the quality of motion (ease, speed)
- Q pain location; when in movement (painful arc); grade /10
47
Cause of limited AROM or pain in AROM:
- not yet determined
- can be:
- surrounding tissues
- condition of the joint or bones
- swelling
- joint
- muscle weakness/inhibition
- referred pain
48
How to measure ROM:
- goniometer
| - estimate eye ball
49
Goniometer:
- degrees
| - poor reliability
50
Estimate eye ball:
- degrees
| - %
51
In PROM, muscles are not _____, contractile tissues are _____.
- activated
| - relaxed
52
3 components of assessing and evaluating PROM:
- ROM at joint (degrees)
- examiner feeling the end range or end point (descriptor)
- Q pain: grade, where
53
Cause of pain or limited range of motion (deficiency) or abnormal end in PROM:
- not determined yet
- can be:
- swelling
- joint locking
- ligament injury
- muscle injury
- neurologic issue
- bone injury
54
End feel:
the sensation imparted to the examiner's hands at the end of the available ROM
55
Normal end feels: check for...
- soft tissue approximation
- capsular (joint)
- bone to bone
56
Soft tissue approximation should feel:
- soft and spongy
| - gradual painless stop (elbow flexion)
57
Capsular (joint) should feel:
abrupt, hard, firm end point with only a little give (shoulder rotation)
58
Bone to bone should feel:
a distinct and abrupt end point where 2 hard surfaces come in contact with another (elbow extension)
59
Abnormal end feels:
- empty
- spasm
- loose
- springy block
60
Empty feel:
- movement definitely beyond the anatomical limit
| - pain prevents body part from moving through normal ROM (ligament rupture)
61
Spasm feel:
involuntary muscle contraction that prevents normal ROM due to pain (muscle spasm)
62
Loose feel:
extreme hypermobility (chronic ankle sprain)
63
Springy block feel:
a rebound at the end of motion (meniscal tear or loose body formation)
64
RROM assesses status of ____ _____ (____ or ____).
- contractile tissue
| - muscle or tendon
65
In RROM, we can ____ or ____ specific contractile tissue or focus on _____ of muscles that activate that range.
- isolate or target
| - groups
66
2 components of assessing and evaluating RROM:
- q pain (location, painful-painless/grade)
| - strength (assess strong-weak-absent)
67
RROM we need ____ grade.
bilateral
68
Grade RROM on a scale out of ____.
5
69
Cause of pain or weakness in RROM:
- not determined yet
- can be:
- muscle or tendon strain
- pain inhibition
- peripheral nerve or nerve root injury
- psychological overlay
70
Grade 5 strength:
- 100%
- normal
- complete ROM against gravity with full resistance
71
Grade 4 strength:
- 75%
- good
- complete ROM against gravity, with some resistance
72
Grade 3 strength:
- 50%
- fair
- complete ROM against gravity, with no reisstance
73
Grade 2 strength:
- 25%
- poor
- complete ROM with a gravity omitted
74
Grade 1 strength:
- 10%
- trace
- evidence of slight contractility, with no joint motion
75
Grade 0 strength:
- 0%
- zero
- no evidence of muscle contractility
76
RROM is used to assess:
- strength
| - pain
77
Group of muscles shoulder abduction RROM:
- joint RROM
- muscles are compared bilaterally and graded numerically
- mid range position
- test for abduction muscles
78
Muscle specificity (MMT) shoulder abduction RROM:
- joint RROM that specifically targets a muscle
- positions of muscle isolation testing
- muscles are compared bilaterally and graded numerically
- test for anterior deltoid
79
Cyriax orthopedic method of assessment:
- ROM evaluation
- '+' = pain
- '-' = no pain
80
When looking at ROM pain, differentiate between...
contractile tissue and inert (non-contractile) tissue
81
ROM exercises are used to ...
preserve or restore flexibility and mobility of the joint
82
3 classifications of ROM exercises:
- PROM
- AROM
- Active-assisted ROM
83
PROM exercises:
assistance is provided by another individual to move the joint through a ROM
84
AROM exercises:
you perform the movement
85
Active-assisted ROM exercises:
- you perform the movement to your limit and then assistance is provided to produce a great ROM
- contract-relax; contract-contract
- PNF = pattern for ROM
86
MMT is used to assess ____ and _____ of a _____ muscle.
- strength
- integrity
- specific
87
MMT may be the same as ... but we add...
- joint ROM testing
| - muscle isolation (specificity)
88
MMT is compared ____ and graded in _____. ____ is noted.
- bilaterally
- strength
- pain
89
Special tests:
clinical orthopedic tests (special) used to further distinguish between pathologic and normal tissue
90
Special tests are designed to ____ ____ or ____ ____ specific musculoskeletal problems.
- rule in
| - rule out
91
Special tests assess integrity of a ____ tissue type such as...
- specific
- ligament
- meniscus
- bursa
- muscle
- nerve
- joint
92
Examples of types of special tests:
- stability tests of a joint
- stress tests
- anthropometric assessments
93
FMT =
functional movement tests
94
FMT used to assess client _____ and /or _____.
- function
| - progress
95
FMP should reflect types of ____ that patient will experience during ____ activities such as...
- stresses
- normal
- activity, work, sport, ADL
96
FMT can assess ____ or _____. Inspect for potential tissue ____ or ____.
- pain
- discomfort
- stress
- strain
97
With FMT, observe for _____ motions. Instruct for a ____, _____ movement pattern.
- compensatory
- slow
- controlled
98
Ideally, FMT lend themselves to a _____ system to assess movement _____ and _____.
- grading
- efficiency
- success
99
When should palpation be done? Why?
- end of objective assessment
| - can cause pain
100
When should palpation be performed in instances of acute injury on field?
- immediately
- light palpation for SHARP
- may warrant referral to physician/EMS
101
Deeper palpation might...
- probing may elicit pain
| - detracting from later evaluation stages
102
Purpose of palpation is to...
localize pathologic tissue involved
103
Palpation should be performed in a ____ fashion including...
- sequential
- bones
- joints
- soft tissue
104
Palpation should include ____ comparison.
bilateral
105
Palpate to assess for:
- pain
- point tenderness
- trigger points
- tissue quality
- crepitus
- temperature
- symmetry
106
3 components of assessment:
- IOS
- impression
- diagnosis
107
There should be ____ diagnosis.
more than one = differential diagnosis
108
How to rule of differential diagnosis?
- diagnostic testing (xray, MRI, blood work etc.)
| - further evaluation (expertise)
109
Plan is a outline of ____ based on ....
- goals
| - subjective assessment (history) and objective assessment (the findings and problem list)
110
Plan is needed to address ____ and ____ recorded.
signs and symptoms
111
For every significant sign and symptom, a corresponding _____ should be set.
goal
112
Plan is based on ____ which is supported by ____ _____ and ______.
- goals
- healing timelines
- processes
113
Need to set ____ and ____ ____ goals.
short and long term
114
Decisions on RTP had a list of criteria to be safe:
- full ROM
- 100% strength
- pain free
- full participation; unrestricted (able to perform sport skills)
- psychological readiness
115
Primary list of short-term goals: direct or pertaining to:
- treatment of site, prevention of secondary complication
- pain
- flexibility/ROM
- strength
- proprioceptive
- posutre
- cardio/fitness
- education/psychological readiness
- RTA
116
Examples of long term goals:
- address ADL
- address psychological concerns
- introduce functional progressions
- core/posture stability
- educate on injury, limitations, restrictions
117
How to achieve goal of decreasing pain:
- PRICE
- medication (refer)
- rest (psych)
- modalities (pain relief)
- acupuncture (refer)
118
How to achieve goal of increasing strength:
- isometric
- concentric
- isokinetic
- eccentric
- resistance training (may refer)
119
How to achieve goal of increasing neuromuscular training:
- balance
| - hand-eye coordination
120
How to achieve goal of correcting alignment:
- orthotics (refer)
- taping, bracing
- stretching
- strengthening
- posture education
121
When rehab is occurring, ____-_____ evaluations must be performed to ____ progress.
- follow-up
| - monitor
122
Seeing the client regularly allows for frequent ____.
modifications
123
Progress evaluations should be based on ...
- healing timelines
- pain
- functional progress
- client's response to the previous treatment or home program given
124
Documentation and charting progress identifies ____ plans.
future
