Term
| What is the order and components of patient assessment? |
|
Definition
1) Patient History
2) Vitals
3) Observation/Inspection
4) Percussion
5) Palpation
6) Specialized Testing
7) ROM
8) Posture/Gait Evaluation
9) Chiropractic Analysis
10 Neurological Evaluation
11) Orthopedic Evaluation
12) Functional Evaluation
13) Diagnosis
14) Complicating Factors
15) Treatment Plan |
|
|
Term
| What is the order of assessing patient history? |
|
Definition
1) PATIENT HISTORY
A) Chief complaint
B) Have patient describe and point to where pain is
C) History of pain and previous treatments for similar conditions
D) Effects on ADLs and function (
E) Past medical history (AMPLE and HISTORY are the pneumonics)
F) Family History
-Cancer, heart disease, stroke, diabetes
G) Social history
F) Form a clinical impression and working diagnosis |
|
|
Term
| What are the elements of the Chief Complaint? |
|
Definition
– who, what, where, when and why
- Onset of pain
- Palliative
- Provocative
- Quality of pain
- Radiation of pain (most important location is most distal pain)
- Setting (when, how)
- Timing (AM pain = inflammatory / PM pain mechanical) |
|
|
Term
| Past medical history components? |
|
Definition
(AMPLE and HISTORY are the pneumonics)
-Allergies
-Medications
-Past medical history (HISTORY is pneumonic)
-Last meal/menstruation
-Events of chief complaint (OPPQRST)
-Hospitalizations
-Injuries
-Sugar (diabetes)
-Tumors
-Operations
-Review of systems
-Youth diseases |
|
|
Term
| What is the order and components of Vitals? |
|
Definition
Height
B) Weight
C) Pulse (assess rate, rhythm and amplitude)
-Normal 70 -90 bpm.
D) Respiration
-Normal 12 -20 breaths/min.
E) Blood pressure (record what position BP is measured in)
-140/90 = mild hypertension
-160/90 = moderate hypertension
-180/90 = severe hypertension
F) Temperature
-Normal 98.6 degrees F |
|
|
Term
| What is the order and components of Observation? |
|
Definition
Looking for:
A) Discoloration
B) Abrasions
C) Scars
D) Abrasions
E) Edema
F) Deformity
G) Body type (endomorph, mesomorph, ectomorph) |
|
|
Term
| What is the order and components of Percussion? |
|
Definition
(rules out fracture so we can continue with hand on evaluation)
- Can use reflex hammer, hands, tuning fork or Ultra Sound device to produce spinal pain
- If (+) for pain = refer for X-Ray and/or ortho/neuro consult
- Once X-Ray and consult rule out red flags, the patient can be referred back to chiro for rehab |
|
|
Term
| What are the components of Palpation? |
|
Definition
Looking for:
A) Pain
B) Asymmetry
C) Altered biomechanics
D) Spasm
E) Abnormal tissue temperature |
|
|
Term
| Why would we perform specialized testing? |
|
Definition
- Rule out red flags
- DDX
- Decide if patient needs to be referred to another health care provider |
|
|
Term
|
Definition
-Fracture
-Infection
-Tumor
-Dislocation
-Inflammatory disease
-Myelopathy
*Abdominal aortic aneurysm and osteoporosis also need to be considered for seniors
F.I.T.D.I.M. |
|
|
Term
| When would a NCV test be indicated? |
|
Definition
| – evaluates sensory and motor nerves (can be done 6 days after onset of pain) |
|
|
Term
| When would a EMG be indicated? |
|
Definition
| evaluates sensory, motor and paraspinals (can be done 21 days after onset of pain) |
|
|
Term
| What are we looking for when assessing ROM? |
|
Definition
What are we documenting?
-Pain
-Restriction
-Abnormal movement patterns |
|
|
Term
|
Definition
-Spine – inclinometer
-Extremities – goniometer |
|
|
Term
| Explain Postural and Gait analysis? |
|
Definition
Posture evaluated in three positions:
A) Anterior Posterior
B) Lateral
C) Posterior Anterior
Gait Analysis – document only obvious faults |
|
|
Term
| Name the components of a Neuro exam? |
|
Definition
A) Mental status exam
B) Cranial nerve evaluation
C) Motor evaluation
D) Sensory evaluation
E) Deep tendon reflexes
F) Pathological reflexes
G) Gait/coordination |
|
|
Term
| How would you assess the 12 cranial nerves(CN)? |
|
Definition
CN1 – Smell (use coffee)
CN2 – Snellen chart and Funduscopic exam
CN 3/4/6 – Visual fields of gaze and divergence with penlight
CN 5 – Muscles of mastication- clench teeth and palpate masseter and temporalis
CN 7 – Facial muscles – raise eyebrows, smile and frown
CN 8 – Hearing
CN 9 – Swallowing
CN 10 – Gag reflex
CN 11 – Upper trapeziums muscle test (graded)
CN 12 – Tongue in cheek and resist pressure against tongue |
|
|
Term
| How would you assess the motor system in the Neuro exam? |
|
Definition
C5 – Shoulder abduction L2 – Hip flexion
C6- Elbow flexion/Wrist extension L3 – Knee extension
C7 – Elbow extension / Wrist flexion L4 – Ankle dorsiflexion / Foot inversion
T1 – Finger abduction (Interossei) L5 – Big toe extension / Heel walk
S1 – Plantar flexion/ Toe walk |
|
|
Term
| Explain the Lovett scale for Motor function? |
|
Definition
0/5 – No trace muscle movement
1/5 – Visible movement of muscle but not joint
2/5 – Movement of joint without gravity
3/5 – Movement of joint with gravity but no resistance
4/5 – Able to resist against minimal resistance
5/5 – Able to resist against maximal resistance (normal) |
|
|
Term
| Perform a Sensory test for the dermatomes of the body? |
|
Definition
C5 – Deltoid/ lateral arm L1/2 – Upper groin
C6 – 1st digit / lateral forearm L3 – Medial upper leg to knee
C7 – 3rd digit L4 – Medial leg / medial foot
C8 – 5th digit / medial forearm L5 – Space b/t 1st and 2nd toes
S1 – Lateral foot |
|
|
Term
| Explain the upper and lower extremity Deep Tendon Reflexes? |
|
Definition
C5 – Biceps L2 – 4 – Patellar
C6 – Brachioradialis L5 – Medial hamstring
C7 – Triceps S1 – Achilles |
|
|
Term
| What scale do we use to grade DTR's(Deep Tendon Reflexes)? |
|
Definition
Wexler scale
0 – Absent
1+ - Hypoactive
2+ - Normal
3+ - Hyperactive
4+ - Transient clonus (UMN disease)
5+ - Sustained disease (UMN disease) |
|
|
Term
| What are the Pathological reflexes? |
|
Definition
1) Babinski response – stroke lateral foot from heel to ball of foot
(+) – Extension of big toe and fanning of 2nd – 5th toes (document as patient showed Babinski response, no such thing as a positive Babinski test)
2) Hoffman response – Flick distal phalanx of 3rd or 4th digit
(+) – Clawing of fingers/flexion of fingers
2) Oppenheim – Stroke anterior medial tibial surface
(+) – Extension of big toe and fanning of 2nd – 5th toes
4) Chaddock – Stroke lateral foot beneath lateral malleolas
(+) – Extension of big toe and fanning of 2nd – 5th toes |
|
|
Term
| Problems with Gait and Coordination could be indicative of? |
|
Definition
| cerebellar disorders and proprioceptive issues |
|
|
Term
| How could you assess Gait and Coordination? |
|
Definition
1) Tandem Gait
2) Heel to shin
3) Romberg’s test
4) Point to point
5) Rapid alternating movements |
|
|
Term
| Explain the tandem gait test? |
|
Definition
– walk heel to toe
(+) - Lack of coordination reveals ataxia |
|
|
Term
| Explain the heel to shin test? |
|
Definition
– heel on shin and run down leg, foot and big toe
(+) - Breaking contact of heel on leg reveals leg dystaxia |
|
|
Term
|
Definition
test – Stand with eyes open for 20 seconds followed by eyes closed
(+) – Excessive swaying/falling = posterior column disorder |
|
|
Term
| Explain the point to point test? |
|
Definition
– Touch nose followed by distant target and repeat
(+) – Poor accuracy and clumsy movement reveals dysmetria |
|
|
Term
| Describe the rapid alternating movements test? |
|
Definition
| – Slap back of hand on thigh followed by palm of hand and repeat several times. |
|
|
Term
| How determine primary and secondary diagnosis? |
|
Definition
A) Primary diagnosis – generally related to tissue involved
B) Secondary diagnosis – generally functional in nature
* Secondary diagnosis becomes primary diagnosis when beginning active care |
|
|
Term
| What are the components (generally) of the treatment plan? |
|
Definition
A) Short Term Goals
B) Intermediate Goals
C) Long Term Goals
D) Final Goals |
|
|
Term
| Acid phosphatase would test for what? |
|
Definition
| – Prostate CA (metastatic) |
|
|
Term
| Albumin/Globulin Ratio would test for what? |
|
Definition
| – multiple myeloma (low or inverse ratio) |
|
|
Term
|
Definition
|
|
Term
| Alpha Fetoprotein would test for what? |
|
Definition
| – hepatic/testicular carcinoma, spina bifida |
|
|
Term
| Anti-double stranded DNA antibody (Anti –dsDNA) would test for what? |
|
Definition
|
|
Term
| Anti-nuclear antibody screen (ANA) would test for what? |
|
Definition
| – SLE, rheumatic disorders |
|
|
Term
| Anti-streptolysin-o titre (ASO titre) would test for what? |
|
Definition
|
|
Term
| Testing positive for increased Calcium would indicate? |
|
Definition
| – increased in metastatic bone tumors (non-specific) |
|
|
Term
| Elevated levels of Creatine Phosphokinase (CPK) would indicate? |
|
Definition
| – Muscle damage (MI, trauma), cerebrovascular accident |
|
|
Term
| Elevated ESR would indicate? |
|
Definition
| – general marker of inflammation |
|
|
Term
| Elevated Globulin levels would indicate? |
|
Definition
| – multiple myeloma, leukemia, infection |
|
|
Term
| Elevated Glucose is common in diabetics and? |
|
Definition
| – Many patients with DISH will also be diabetic |
|
|
Term
| HLA-B27 would test for what? |
|
Definition
| – Seronegative spondyloarthropathy marker (Ankylosing Spondyloarthritis, Reiter’s Syndrome, Enteropathic Arthritis, Psoriatic Arthritis) |
|
|
Term
| Lupus Erythematosus Cell Preparation (LE Prep) would test for what? |
|
Definition
|
|
Term
| Rheumatoid factor would be positive in which conditions? |
|
Definition
| – (+) in most rheumatologic disorders |
|
|
Term
| Serum Protein Electrophoresis would be used to evaluate? |
|
Definition
| – multiple myeloma, SLE, RA, infections |
|
|
Term
| Schilling Test would be used to evaluate? |
|
Definition
|
|
Term
| Serum Glutamic Oxaloacetic Transaminase (SGOT) increase would indicate? |
|
Definition
| – Liver DZ, MI, muscle DZ |
|
|
Term
| What tests are on a Bone panel ? |
|
Definition
evaluate potential red flags and diseases of bone
1) Serum Protein Electrophoresis – multiple myeloma, lupus, RA, infections
2) Alkaline Phosphatase – bone tumor, Paget’s
3) Calcium – (increased) - bone tumor, Paget’s, osteoporosis, sarcoidosis
4) Phosphorus – metabolic bone disease, healing fracture
5) Prostate Specific Antigen
6) Protein – carcinoma, multiple myeloma
7) Complete Blood Count – WBC are decreased in chronic infection and increased in acute infections, tumors and arthritis (mild increase). Anemia seen in certain malignancies. |
|
|
Term
| What tests are on a Arthritis Panel? |
|
Definition
1) Uric Acid – Gout
2) C –Reactive Protein – soft tissue inflammation
3) ESR – non-specific indicator of inflammation
4) RA Latex – RA, Lupus, scleroderma
5) Anti-nuclear antibody (ANA) – RA, Lupus, collagen vascular disorders
6) HLA-B27 – Ankylosing Spondylitis, seronegative spondyloarthropathies |
|
|
Term
| What tests are on aJoint Pain/Swelling Panel? |
|
Definition
1) Heavy Metal Screen
2) Synovial fluid analysis – inflammation, septic arthritis, gout, infection, trauma
3) Markers on arthritis panel – Uric acid, C-Reactive Protein, ESR, RA Latex, ANA, HLA-B27 |
|
|
Term
| What tests are on a Lupus (SLE panel) ? |
|
Definition
– know this cold for oral exam
1) ANA Screen
2) Anti – dsDNA
3) ASO titre
4) LE Prep
5) RA latex
6) Serum Protein Electrophoresis
7) Rheumatoid factor
8) ESR – Big increase in ESR is characteristic of SLE |
|
|
Term
| What tests are on a Kidney Panel? |
|
Definition
1) BUN
2) Creatinine
3) Uric Acid
4) BUN/creatinine ratio |
|
|
Term
| What test are on a Liver Panel? |
|
Definition
1) Calcium/Albumin ratio
2) Total protein
3) Albumin
4) Total bilirubin
5) Globulin
6) SGPT (SGOT secondary |
|
|
Term
| What test are included in a Liver Panel? |
|
Definition
1) Calcium/Albumin ratio
2) Total protein
3) Albumin
4) Total bilirubin
5) Globulin
6) SGPT (SGOT secondary |
|
|
Term
| Which tests are included on a Heart Panel? |
|
Definition
1) SGOT (SGPT secondary)
2) Cholesterol (<200 normal)
3) Triglycerides (<130 normal)
4) HDL cholesterol (>40 ideal)
5) LDL (<100 ideal)
6) Cholesterol/HDL ratio |
|
|
Term
| What lab test could you use to evaluate osteoporosis? |
|
Definition
(Lab work usually normal. DEXA scan gold standard.)
1) Serum Calcium
2) Phosphate
3) Alkaline Phosphatase |
|
|
Term
| What is the typical presentation for Multiple Myeloma? |
|
Definition
- >30 yo (usually 6th decade of life) with CC of unexplained bone pain (usually in thoracic and lumbar spine)
*MRI shows changes earlier than X-Ray
*Bone marrow biopsy confirms diagnosis |
|
|
Term
| What Lab tests would be ordered on a Multiple Myeloma profile? |
|
Definition
1) CBC – anemia
2) ESR – increased
3) A/G Ratio (low or reversed)
4) Serum Protein Electrophoresis
5) Total protein – increased
*Urinalysis – Bence Jones Proteins
*X-Ray shows lytic lesions and osteopenia |
|
|
Term
| What tests are included in a Metastatic Carcinoma profile? |
|
Definition
1) Alkaline Phosphatase – increased
2) Calcium – increased
3) ESR / C-Reactive Protein – increased
* X-Ray – osteoblastic and lytic lesions with possible compression fractures |
|
|
Term
| What are some of the clues in the patients history to help rule out Metastatic disease? |
|
Definition
1) Cancer
- History of cancer
- Unexplained weight loss
- Pain not better with rest
- Age > 50 years old
2) Fracture
- History of major trauma
- Minor trauma > 50 years old
- Prolonged use of steroids
- Known osteoporosis
- > 70 years old without minor/major trauma
3) Infection
- Fever >100 degrees F
- Immunosuppression
- Recent infection
- Known IV drug use
- Prolonged use of corticosteroids |
|
|
Term
| What is the purpose of OUTCOME ASSESSMENT FORMS? |
|
Definition
Purpose:
1) Objective way to document subjective information
2) Establish baselines
3) Establish Medical necessity
4) Measure change over time
5) Make treatment outcome based
6) Get patient feedback
7) Make clinical decisions |
|
|
Term
| Name some General Health OA's(outcome assessment's) |
|
Definition
| – Health Status Questionnaire, Rand 36 |
|
|
Term
| Name some Pain Perception OA's? |
|
Definition
| Quadruple Visual Analogue Scale |
|
|
Term
| Name some Condition Specific OA's? |
|
Definition
| 3) – Carpal Tunnel Syndrome Questionnaire, Oswestry |
|
|
Term
| Name some Condition Specific OA's? |
|
Definition
| Carpal Tunnel Syndrome Questionnaire, Oswestry |
|
|
Term
| Name a Disability Prediction OA? |
|
Definition
| – Vermont Disability Index |
|
|
Term
| Name a Patient Satisfaction OA? |
|
Definition
| Chiropractic Satisfaction Questionnaire |
|
|
Term
| Name a Psychometric Assessment OA? |
|
Definition
| Modified Somatic Perception Questionnaire |
|
|
Term
| Name a Job Satisfaction OA? |
|
Definition
|
|
Term
|
Definition
| Risk Factor Assessment Form |
|
|
Term
| Examples of subjective outcome assessment are? |
|
Definition
1) OA forms
2) Activity of daily living restrictions – what can’t the patient do b/c of pain
3) Pain medication – compare how much medication needed from beginning of treatment until re-evaluation |
|
|
Term
| Examples of objective outcome assessment are? |
|
Definition
| Any examination baseline – ROM, flexibility, strength, endurance, proprioception, aerobic capacity, etc. |
|
|
Term
| What do we do for final care and case closure/discharge? |
|
Definition
1) Release patient from care – explain that they have reached maximum medical necessity
2) Activity modification – spine sparing, ergonomics, etc.
3) Home exercises – discuss that exercises need to be done 1-2x/week to maintain strength gains
4) Supportive care – discuss if condition worsens, function decreases or symptoms return that they can return for treatment
5) Refer – if necessary to another health care professional
6) Document discharge plan in chart
7) Schedule future re-evaluation in 6 months to ensure compliance with home program |
|
|
Term
| What do we do for final care and case closure/discharge? |
|
Definition
1) Release patient from care – explain that they have reached maximum medical necessity
2) Activity modification – spine sparing, ergonomics, etc.
3) Home exercises – discuss that exercises need to be done 1-2x/week to maintain strength gains
4) Supportive care – discuss if condition worsens, function decreases or symptoms return that they can return for treatment
5) Refer – if necessary to another health care professional
6) Document discharge plan in chart
7) Schedule future re-evaluation in 6 months to ensure compliance with home program
8) Have patient fill out General Health form 6 months after discharge to document treatment efficacy |
|
|
Term
| Pre-requisites on examination before beginning active care: |
|
Definition
1) Pain free ROM
2) No signs of inflammation (red, heat, edema, sharp pain)
3) Good biomechanics/movement patterns |
|
|
Term
| Goals of treatment Short term |
|
Definition
| – decrease pain, inflammation and spasm; eliminate stressor (activity modification) |
|
|
Term
| Goals of Treatment intermediate? |
|
Definition
| increase flexibility/ROM, improve mechanics/movement patterns, prevent deconditioning |
|
|
Term
| Goals of Treatment Long term ? |
|
Definition
| Pain free ROM, increase flexibility, proprioception, strength, endurance and aerobic capacity |
|
|
Term
| Goals of treatment Final phase of care? |
|
Definition
| pre-injury status, handle symptoms of ADL with self management |
|
|
Term
| What Medical Clearance Issues you be aware of before initiating active care? |
|
Definition
1) Post-op patient – written clearance from surgeon
2) Pregnant patient – written clearance from OB/GYN
3) Patient who was categorized as increased risk after cardiac screen – written clearance from cardiologist/PCP |
|
|
Term
| Contraindications to exercise/active care would include? |
|
Definition
1) Hyper/hypotension
2) Congestive heart failure
3) Arrhythmias
4) Acute/local infection
5) Embolism
6) Aneurysm
7) Recent MI |
|
|
Term
| Protocol when referring a patient to an outside source would include? |
|
Definition
1) Record in notes – medical professional’s name, date, contact person and reason for referral
2) Patient signs release of records so you can send report to outside Dr.
3) Follow up with doctor
4) Report and document outcome |
|
|
Term
| Courses of action if the patient stops improving under your care could include? |
|
Definition
1) Re-evaluate
2) Re-check for yellow and red flags
3) Consider referral for imaging
4) Change treatment plan
5) Make sure stressor is removed (activity modification)
6) Consider referral to another healthcare professional |
|
|
Term
| All patients fall under 3 categories of diagnostic triage: - Examination allows us to put patient in 1 of 3 categories that dictate the proper treatment necessary for spinal pain, what are the categories? |
|
Definition
1) Red flags (<1%) – patient history and exam are very sensitive to find
2) Nerve root disorder (9%) – pain radiates below the elbow/knee, (+) MSR
3) Mechanical pain (90%) – pain dependant on posture, poor sensitivity with ortho tests, McKenzie evaluation appropriate |
|
|
Term
Strength hierarchy for lower back muscle groups are?
What is the extensor/flexor ratio? |
|
Definition
-Extensors > Flexors > Lateral Flexors > Rotators
-Extensor: Flexor Ratio is 1.3:1 |
|
|
Term
Methods of evaluating strength: to establish baselines
A) Static strength baselines(isometric) –
B) Isotonic strength baseline |
|
Definition
A)Static-measures peak
value maximum voluntary contraction
1) Dynamometer
2) Tensiometer
3) Blood pressure cuff
4) Strain gauge
5) J-Tech (high tech method)
B) Isotonic
1) 10 RM – safest and best choice for an office environment
2) 1 RM
*10 RM = 75% of 1 RM |
|
|
Term
|
Definition
(Specific Adaptations of Imposed Demands)
-Muscle will adapt and perform according to the demands placed on it
-Allows restoration of function |
|
|
Term
| How does Davis’ Law apply to rehabilitation? |
|
Definition
| exercises should mimic stresses of ADL as closely as possible, it describes how soft tissue models along imposed demands |
|
|
Term
| How does Progressive Overload affect strength gains? |
|
Definition
-Key to muscle strengthening
-Load must be progressively increased in order to achieve strength gains |
|
|
Term
| Maintenance of strength gains require what amount of exercise? At what rate do you loose strength? |
|
Definition
- Loss of strength gains occurs at 1/3 of the rate it was gained (if you trained for 3 months it will take 9 months without training to lose the gains)
- 1 – 2 training sessions per week of maximal muscle contraction will maintain strength gains
- Important to discuss this with patient when discharging |
|
|
Term
| When could you use Plyometric Training in Rehab? What effect does it have? |
|
Definition
Patient must excel at strength, flexibility and proprioception before beginning a plyometric program
-Done at the end of rehab/active care
-Trains explosion, power and quickness |
|
|
Term
| What are some examples of Plyometric training? What are the phases of Plyometric training? |
|
Definition
Examples: box jump, tuck jump, scissor kick, lateral hop, etc.
-Produces energy in 3 phases – concentric (elastic component stores energy), amortization, eccentric (elastic component releases energy) |
|
|
Term
| Name the basic progressions within a rehab position(ex. quadruped)? |
|
Definition
1) Non-weight bearing Weight bearing
2) Simple cardinal movements Complex movements
3) Balanced surfaces Labile surfaces
4) Low resistance High resistance
5) Low reps High reps
6) Short ROM/Slow velocity Full ROM/Fast velocity |
|
|
Term
| What signs and symptoms would you keep an eye out for when initiating a cardio program? |
|
Definition
Risk Factor Assessment:
(Signs and Symptoms of cardiopulmonary disease obtained form patient history)
1) Ischemic pain – chest, jaw, neck, arm
2) Shortness of breath
3) Dizziness/syncope
4) Ankle edema
5) Tachycardia
6) Intermittent claudication |
|
|
Term
| What risk factors would you look out for before starting a Cardio program? |
|
Definition
1) Smoker
2) Hypertension
3) Diabetes
4) Obesity
5) Hypercholesterolemia
6) Sedentary lifestyle
7) Family history of MI (<55yo –father/brother, <65yo-mother/sister)
8) Age (>45yo –male, >55yo –female) |
|
|
Term
| What tests would be ordered for a patient with a positive PARQ or risk factors? |
|
Definition
1) EKG – (12 lead) – measures heart rhythm/conduction
2) Stress test – graded exposure or chemical (dobutamine/adenosine)
3) Echocardiogram – evaluated the structure of the heart
4) Chest X-Ray
5) MRI |
|
|
Term
| What must be obtained if a patient has an increased risk or apparent disease and a (+) PAR-Q before baseline testing and aerobic training? |
|
Definition
| -Written medical clearance from their Cardiologist or PCP |
|
|
Term
| How do we screen for any potential pulmonary issue that would contraindicate aerobic activity? |
|
Definition
|
|
Term
| Aerobic Baseline testing includes? |
|
Definition
- be comfortable discussing YMCA/Harvard
1) Resting HR
2) YMCA step test – easier to perform (deconditioned patient)
3) Harvard Step Test – more difficult to perform (athlete)
4) Rockport 1 mile fitness walk
5) Airdyne bike/treadmill test
6) Balke treadmill test |
|
|
Term
| How do we monitor exertion during exercise? |
|
Definition
Monitoring HR during exercise:
1) Perceived rate of exertion (PRE)
2) Heart rate monitor – Polar, wrist watch, sensors on exercise equipment
3) Palpate – carotid, radial pulses |
|
|
Term
| How do we quantify the Rate of Perceived Exertion? |
|
Definition
| Borg RPE Scale measures perceived exertion. In medicine this is used to document the patient's exertion during a test. The original scale introduced by Gunnar Borg rated exertion on a scale of 6-20. |
|
|
Term
| What are the components of the Aerobic prescription? |
|
Definition
1) Mode
2) Frequency - 3-5 times/week
3) Intensity (cardiac training zones)
4) Duration |
|
|
Term
| Define MODE in the Aerobic Prescription? |
|
Definition
How the patient will train;
treadmill, bike, elliptical, etc. Choose what fits patient best. (i.e.: if the patient is stenotic and prefers to sit, use a recumbent bike) |
|
|
Term
| What intensity corresponds with the different training levels aerobically? |
|
Definition
-50 – 60% VO2 max - warm up/maintenance
-60 – 70% VO2 max - fat burn/weight loss
-70 – 80% VO2 max - aerobic
-80 – 90% VO2 max - anaerobic
-90 – 100% - considered VO2 max |
|
|
Term
| What level of intensity do we start someone who is deconditioned? |
|
Definition
- 40 – 50% VO2 max and gradually increase over time
*Less trained patient require more recovery days |
|
|
Term
| Why do we care about cardio-respiratory fitness with our patients? |
|
Definition
-Want to make sure they can perform rehab
-If the patient has no fitness they won’t be able to maintain stability during activity
-Research shows an inverse relationship between aerobic capacity and musculoskeletal pain |
|
|
Term
| What 3 systems that control balance in the body: |
|
Definition
PROPRIOCEPTION
1) Visual
2) Vestibular
3) Proprioceptive |
|
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Term
| How do we assess proprioception? |
|
Definition
1) 1 leg standing test
2) Romberg’s test
3) Platform stabilometry |
|
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Term
| Name 2 ways to perform balance/prorioceptive tests: |
|
Definition
1) Static – evaluating a patient in a position for a period of time
2) Dynamic – maintenance of balance while on the move (i.e.: rocker/wobble board progressions) |
|
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Term
| Why does closing the eyes challenge the proprioceptive system? |
|
Definition
-It removes one of the three systems (vision) and removes some sensory feedback
-Challenges the mechanoreceptors |
|
|
Term
| Why is proprioceptive input important? |
|
Definition
Why is proprioceptive input important?
-Joints in our body have nerve receptors that inform our brain about the exact position and movement that occurs during activity
-Efficient proprioception is vital for coordinated movement
-Poor proprioception can cause repetitive stress injury |
|
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Term
| How would you progress Proprioceptive activity? |
|
Definition
1) Bilateral stance Unilateral stance
2) Stable Unstable surfaces
3) Eyes open Eyes closed
4) Conscious control Unconscious control (distractions –i.e.: Otis Rings) |
|
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Term
| What labile surfaces would use to progress from stable to unstable? |
|
Definition
1) Flat ground
2) Balance pads (green blue black)
3) Rocker board
4) Wobble board
5) Bosu ball
6) Balance sandals |
|
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Term
| Name the progressions within the Abdominal brace? |
|
Definition
1) Supine – create brace and hold
2) Quadriped – create brace and hold
3) Sitting (chair or ball) – create brace and hold
4) Standing – create brace and hold
– can add perturbations and dynamic movement to challenge once static position is achieved |
|
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Term
| Name the progressions within the Posterior pelvic tilt? |
|
Definition
1) Supine pelvic tilts
2) Hold PPT and march
3) Hold PPT and slide one leg back and forth
4) Progress like abdominal brace from supine to quadruped, sitting and standing
5) PPT on biofeedback cuff – 40 mmHg |
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Term
| With parydoxal Breathing, what are goals in training? |
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Definition
| – goal: 6-8 minutes with 1:2 ratio inhalation: exhalation |
|
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Term
| What is the progression in re teaching faulty breathing patterns? |
|
Definition
1) Patient self palpation – chest and abdomen contact – want abdomen rising primarily
2) Patient self palpation – lower lateral ribs – looking for lateral excursion
3) Dr. palpates abdomen and T10 to facilitate proper breathing
4) Dr. palpates lateral ribs to facilitate lateral rib excursion
5) Theraband assist – wrap theraband around abdomen and patient breathes with abdominal movement and lateral rib |
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|
Term
|
Definition
Side Plank
Bird Dog
Curl up |
|
|
Term
| What is the progression within the Curl up? |
|
Definition
1) back McGill curl up with elbows on floor
2) McGill curl up with elbows raised off of floor
3) McGill curl up with hands behind head (fingers are not clasped)
4) McGill curl curl up with a static hold
5) McGill curl up with static hold and deep breathing (challenges deep stabilizers)
6) McGill curl up with gym ball on upper back
7) McGill curl u with gym ball on lower |
|
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Term
| What are the progressions within the Bird Dog? |
|
Definition
1) Quadruped w/ brace and hold (isometric)
2) Quadruped w/ brace while rocking back and forth (lift one hand or knee at a time)
3) Quadruped w/brace while raising one arm or leg at a time
4) Quadruped w/ brace while raising opposite arm/leg at same time (bird dog position)
5) Quadruped w/ brace and touch opposite arm and leg underneath body
6) Quadruped w/ brace on a ball with knees on floor (isometric hold)
7) Quadruped w/ brace on ball with toes on floor (isometric hold)
8) Quadruped w/brace on ball and raise opposite arm and leg
– progress from reps to static holds (6-8 sec) |
|
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Term
| What are the progressions within the Side bridge? |
|
Definition
1) Lean against wall
2) Side bridge from knees
3) Side bridge from knees and add twist
4) Side bridge from feet
5) Side bridge from feet and roll to other side
6) Side bridge with top leg abduction
7) Side bridge from a gym ball |
|
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Term
| What are the progressions of the Dead bug ? |
|
Definition
(Reference Liebenson’s DVD for alternatives for the dead bug)
1) Supine – touch opposite knee
2) Supine (knees 90 degrees/knees 90 degrees) – touch opposite knee
3) Same position as #2 – hold ball between hands and knees and rotate 10 – 20 degrees in opposite directions
4) Same positions as #2 – static hold against perturbations
5) Repeat #1 - #4 on a ½ foam roll
6) Repeat #1 - #2 on a full foam roll |
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Term
| Dynamic balance activity could be progressed how? |
|
Definition
1) Rocker board – keep board in middle (silent)
2) Rocker board – tap board front and back, side to side and diagonal
3) Wobble board – keep in middle (silent)
4) Wobble board – tap back and forth
5) Wobble board – counterclockwise/counterclockwise
6) Progress #1- #5 to eyes closed
7) Add distractions – tasks (i.e.: have a catch with a ball)
8) Progress #1 - #5 with 1 leg standing |
|
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Term
| Display the Short foot progression? |
|
Definition
1) Establish/model short foot (passive modeling)
2) Move foot in different spots and remodel
3) Progress to different positions (standing)
4) Add movement in standing (leaning, semi squat)
5) Stagger stance and model short foot
6) 1 leg stance and short foot |
|
|
Term
| How would we progress the Bridge? |
|
Definition
1) Bridge with feet flat on the floor (progress to heels on floor)
2) Bridge with marching
3) Single leg bridge
4) Gym ball bridge (ball behind knees)
5) Gym ball bridge (ball behind heels)
6) Gym ball bridge with leg curl |
|
|
Term
| What is the Lunge progression? |
|
Definition
1) Janda forward lean with step
2) Front lunge
3) Back lunge (g-max)
4) Side lunge (g-med)
5) Star lunges (Gary Gray) |
|
|
Term
| How would we initiate and progress the Squat? |
|
Definition
1) Hip hinge
2) Wall squat w/ ball
3) Squat facing wall
4) Squat with back to wall
5) Standard squat to 80 degrees
6) Squat with theraband around knees (facilitate abductors/ext. rot)
7) Squat on labile surface (balance pads, bosu)
8) Squat with resistance bands
9) Free weight/dumbbell squat
10) 1 leg squat |
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Term
| How do we initiate and progress the Push up plus? |
|
Definition
1) Wall push up (+)
2) Quadriped push up (+)
3) Quadriped push up (+) with rocking back and forth
4) Quadriped push up (+) with arm reach
5) Tripod push up (+)
6) Push up (+) with one hand on labile surface (ball, rocker board)
7) Push up (+) on gym ball |
|
|
Term
| Where do we initiate a Hamstring progression, progress it... |
|
Definition
Supine, so it's supported.
1) Supine bridge (gym ball behind knees)
2) Supine bridge (gym ball behind knees) and roll knees to chest
3) Supine bridge (gm ball behind heels)
4) Supine bridge (gym ball behind heels) and roll knees to chest
5) Supine bridge (gym ball behind heels) and single leg curl |
|
|
Term
| How do we progress the Superman/start up? |
|
Definition
1) Feet on wall and ball under abdomen – extend with arms at sides
2) Feet on wall and ball under abdomen – extend with arms crossed in front of body
3) Feet on wall and ball under abdomen – extend with arms straight ahead |
|
|
Term
| Explain the Cervical Brace track beginning to end? |
|
Definition
– patient must be able to chin tuck before this
1) Quadriped position – create brace (retract and hold)
2) Quadriped w/brace – rock back and forth
3) Quadriped w/ brace – arm reach bird dog
4) Quadriped w/brace – balance book on back of neck
5) Quadriped w/ brace – balance book on back of neck with rocking
6) Quadriped w/ brace – balance book on back of neck with arm |
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|
Term
| A patient has difficulty with chin poking, how could you cue them to correct the faulty movement pattern? |
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Definition
| Push the tongue to the roof of the mouth to activate the deep neck flexors |
|
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Term
| What is the progression of T4 mobilization? |
|
Definition
1) Supine T/S extension on a ball
2) Supine T/S extension on a foam roller
3) Lay on foam roller parallel to spine – bring elbows/shoulders into 90/90 position and hold
4) Prayer stretch
5) Lewitt mobilization
6) Upper back cat/camel
7) Chiropractic adjustment (AP)
8) Wall slides/snow angel |
|
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Term
| How would you assess lumbar ROM, what are the normative values? |
|
Definition
- Dual inclinometer placed on T12 and the sacrum
Flexion – 65 degrees
Extension – 30 degrees
Lateral Flexion – 25 degrees |
|
|
Term
| How would you assess cervical ROM, what are the normative values? |
|
Definition
- Dual inclinometer placed on EOP and T1
Flexion – 50 degrees
Extension – 63 degrees
Lateral flexion – 45 degrees
Rotation – 85 degrees |
|
|
Term
|
Definition
Flexion – 180 degrees
Extension – 45 degrees
Abduction - 180 degrees
Adduction – 45 degrees
Internal rotation – 90 degrees (start with fist up)
External rotation – 45 degrees (start with fist up) |
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|
Term
| What is Normal Elbow ROM? |
|
Definition
Flexion – 150 degrees
Extension – 0 degrees
Pronation – 80 degrees (start with thumb up)
Supination – 80 degrees (start with thumb up) |
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Term
| Normal wrist ROM would be? |
|
Definition
Flexion – 75 degrees
Extension – 65 degrees
Ulnar deviation – 30 degrees
Radial deviation – 20 degrees |
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|
Term
| How do we test for a shortened muscle? |
|
Definition
-General screen is a postural assessment (i.e.: rounded shoulders)
-More specific is to lengthen the muscle and quantify with a dual inclinometer to establish a baseline |
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Term
| Contraindications to stretching would include? |
|
Definition
1) Lack of stability
2) Vascular compromise
3) Active inflammation
4) Excessive pain |
|
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Term
| Post Isometric Relaxation (PIR) goals? |
|
Definition
-Goal is to relax tissues that are overactive(inhibition)
-Is a bridge between passive and active are since the patient is involved
-joint mobilization |
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Term
| Post Facilitation Stretch (PFS) goals would include: |
|
Definition
-Goal is to lengthen tissue
-Treatment for shortened tissue and muscle tightness
Stretch muscle
Muscle inhibition |
|
|
Term
| Types of Proprioceptive Neuromuscular Facilitation (PNF) techniques are: |
|
Definition
A) Stretching techniques
1) Hold-Relax
2) Contract-Relax
3) Contract Relax Antagonist Contract (CRAC) |
|
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Term
| PNF Strengthening Techniques would include? |
|
Definition
1) Reversal of Antagonist
2) Rhythmic Stabilization
3) Rhythmic initiation
4) Combination of Isotonics |
|
|
Term
What are the parameters for Acute IFC?
Interferential Current |
|
Definition
1) Interferential Current
ACUTE – 80 – 150 Hz – 20 minutes – Intensity to patient perception for the purpose of encephalon release- blocks deep pain and reduces edema |
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Term
What are the parameters and treatment goals for Subacute IFC?
Interferential Current |
|
Definition
| SUBACUTE – 1-10 Hz – 20 minutes – Intensity to patient tolerance for the purpose of endorphin release - increases circulation and reduces spasm |
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Term
| What are the goals and parameters for chronic IFC? Interferential Current |
|
Definition
| CHRONIC – 10 – 100 Hz – 20 minutes – Intensity to patient tolerance for the purpose of reducing muscle tone and increasing circulation |
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Term
| Interferential Current contraindications include? |
|
Definition
| – Patients with sensory disturbance (diabetic), malignancies, infections and hemorrhage. |
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|
Term
|
Definition
- 890 nanometers at 800 milowats – output is minimum of 200 Joules for anti-inflammatory and 4,000 Joules for pain control
-Doctor and patient should wear protective goggles |
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|
Term
| What are the physiologic benefits of Cold Laser? |
|
Definition
| - Dilates arteries (forms NO2), breaks down adhesions, reduces pain and inflammation, enhances lymphatic drainage, soft tissue and nerve healing. |
|
|
Term
| Contraindications of Cold Laser therapy? |
|
Definition
| – Malignancy, pregnancy, thyroid disorders |
|
|
Term
| Conditions treatable by Cold Laser would include? |
|
Definition
| – cartilage, tendon, ligament, nerve and soft tissue derangement |
|
|
Term
| What is the method for applying Cold Laser Treatment? |
|
Definition
| (Method) - 3 X 90 second treatments per session |
|
|
Term
| What frequencies would you use for ultrasound for deep and superficial penetration? |
|
Definition
(Frequency) – 1 MHz – Deep penetration (2 ½ in.)
3 MHz - Superficial penetration (1/4 in.) |
|
|
Term
| Which intensity wold you use while applying ultrasound for thick skin vs thin skin? Acute vs. Chronic? |
|
Definition
Acute (thin skin- i.e.: forearm, ankle) - .5 – 1.0 W/CM2
Acute (thick skin – i.e.: thigh, buttock) – 1.0 – 1.5 W/CM2
Chronic (thin skin) – 1.0 – 1.5 W/CM2
Chronic (thick skin) – 1.5 – 2.0 W/CM2 |
|
|
Term
| What effect does changing the duty cycle on the US treatment have? |
|
Definition
– Continuous – adhesions, myofascitis, fibrous tissues
-Pulsed – (20% / 50%) – acute conditions |
|
|
Term
| What physiologic response does a patient have to US treatment? |
|
Definition
| – increased circulation, reduces inflammation, breaks up adhesions |
|
|
Term
| What treatment parameters would you use with Cryotherapy? |
|
Definition
therapy of choice for acute inflammatory phase
(Time) – 10 minutes (C/Spine, elbow, wrist, ankle)
-15 minutes (T/Spine, knee, shoulder)
-20 minutes (L/Spine, pelvis, thigh)
(Frequency) – Minimum: 2-4x/day
-Maximum: every hour |
|
|
Term
| Explain the Phases of Acute Inflammation? |
|
Definition
PHASE 1 – Inflammatory phase – 0 – 72 hours
PHASE 2 – REPAIR PHASE – 3 days – 6 weeks
PHASE 3 – REMODELING – 3 weeks – 1 year |
|
|
Term
| PHASE 1 – Inflammatory phase – 0 – 72 hours has several stages, explain? |
|
Definition
A) Stage 1 (Peri-trauma) – 1st 0 – 6 hours
B) Stage 2 (Active inflammation) – 2 – 24 hours
C) Stage 3 (Passive inflammation) – (24 – 72 hours) |
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Term
| PHASE 2 – REPAIR PHASE – (3 days – 6 weeks) has several stages, list them? |
|
Definition
A) Stage 1 (Early Healing) – Days 3 -6
B) Stage 2 (Established Healing) – Days 7 -14 |
|
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Term
| What occurs in Stage 1 (Peri-trauma)? When does it occur and how long does it last? |
|
Definition
– 1st 0 – 6 hours
-Cell damage occurs to effected tissue
-Inflammation results for protection, cleaning and framework for healing
-Want to control inflammation to prevent tissue hypoxia/damage |
|
|
Term
What rehab consideration are there in
Phase I, stage 1 acute inflammation?(peri-trauma) |
|
Definition
Rehab considerations:
1) PRICE
2) Cross over effect – can rehab uninjured limb right away to aid improvement |
|
|
Term
| What occurs in Stage 2 (Active inflammation)? When does it occur and how long does it last? |
|
Definition
– 2 – 24 hours
-Vasodilation with increased fibroblasts and microphages
-4 classic signs of inflammation: red, heat, swelling, pain |
|
|
Term
What rehab consideration are there in
Phase I, stage acute inflammation?(active inflammation) |
|
Definition
Rehab considerations:
1) Modalities
2) CMT / Flexion-Distraction |
|
|
Term
| What occurs in Stage 3 (Passive inflammation)? When does it occur and how long does it last? |
|
Definition
– (24 – 72 hours)
-Re-vascularization and continues increased fibroblasts |
|
|
Term
| Goals of treatment for inflammatory phase would be? |
|
Definition
| : reduce inflammation, pain and spasm; remove stressor (ADL modification) |
|
|
Term
| Phase 2 (Repair Phase)Stage 1 (Early Healing) occurs when? What are the physiologic components? |
|
Definition
– Days 3 -6
-Rehab very important to increase muscle regeneration and minimize collagen formation
-Continued increase in fibroblastic activity
-Repair phase can only begin when stressor is removed
-Immature connective tissue is formed |
|
|
Term
What rehab consideration are there in
Phase II, stage 1 acute inflammation? |
|
Definition
1) PROM – within functional range (15 degrees of physiological overflow)
-Lines up scar tissue efficiently to form a small, flexible scar (Davis’ Law)
-Tension placed on tissue stimulates growth
2) Active assisted activity – progression from PROM
-Repetition reduces resistance in the neural pathway (Sherrington’s Law of Reciprocal Inhibition)
3) PIR/PNF – gain flexibility |
|
|
Term
| Phase 2 (Repair Phase)Stage (Established Healing) occurs when? What are the physiologic components? |
|
Definition
– Days 7 -14
-Collagen, muscle and capillary re-growth well underway
-Full ROM has almost been established with rehab |
|
|
Term
What rehab consideration are there in
Phase II, stage 2 (Established Healing)? |
|
Definition
1) Isometrics
2) PIR/PNF/McKenzie
3) Stabilization/Spine sparing
4) Aerobics
5) Breathing
6) CMT |
|
|
Term
| Goals of treatment for repair phase: |
|
Definition
| Increase ROM, flexibility, prevent deconditioning, remove stressor |
|
|
Term
| What occurs in PHASE 3 REMODELING? When does it occur and how long does it last? |
|
Definition
– 3 weeks – 1 year
-Remodeling doesn't begin until soft tissue healing is complete
-Collagen matrix is mature and a decrease in fibroblastic activity occurs |
|
|
Term
What rehab consideration are there in
Phase III? |
|
Definition
Rehab considerations:
1)Isotonics – Zinovieff Delorme-Watkins McQueen – 3 -5 X/WK
2)Flexibility – more aggressive – PFS, PNF
3)Proprioception – progressing patient
4)Aerobics
5)Gait/Posture/Stability |
|
|
Term
| Goals of the remodeling stage would be? |
|
Definition
| Increase strength (hypertrophy), endurance, flexibility, aerobic capacity, proprioception and stability. |
|
|
Term
| What are the Characteristics of scar tissue: |
|
Definition
1) Decreased tensile strength
2) Decreased flexibility
3) Decreased circulation
4) Hypersensitive |
|
|
Term
| How does the Cross Over Effect apply to rehab? |
|
Definition
-Rehabilitation of an extremity should always include the “good” side
-Especially important in post-op during period where patient can’t participate in rehabilitation
-States that improvement on one side of the body can positively affect the opposite of the body due to the cross over effect |
|
|
Term
| Physiological Overflow applies to rehab how? |
|
Definition
| - There is a 15 degree progression into the painful motion of each side of the exercised range of motion even though that ROM has not been exercised (i.e.: if a patient can only go 30 degrees of rotation during a PROM exercise, they are actually receiving benefits within 45 degrees of rotation |
|
|
Term
| What is the Functional Range? |
|
Definition
-Training that maximally challenges the muscle system while minimizing the strain on the osteoligamentous structures
-It is essentially a pain free range with good mechanics that all exercise should be performed in |
|
|
Term
| How could you use Sherrington’s Law of Facilitation to improve rehab outcomes? |
|
Definition
-Important for early rehab to maintain proper functional motor patterns
-With the use of passive and passive assisted exercise this loss can be minimized
-During injury the body conserves energy by choosing motor patterns that are more energy efficient that forms bad habits and new compensatory motor patterns
-Repetition of correct motor patterns (to create an Engram) will ensure proper motor patterns during ADLs |
|
|
Term
| Name and explain 4 manual soft tissue techniques |
|
Definition
1) Nimmo – 7-10 second hold on tender spot / repeat 3 -4X per muscle
2) Positional release technique – Approximate the origin and insertion of the soft tissue until you find a spot that is less painful – hold the pressure for 10 seconds – 2 minutes until the pain is significantly decreased
3) PIR/PNF
4) Active Release Technique/Graston/ConnecTX |
|
|
Term
| What do we do first with all lumbopelvic rehab/stability exercise? |
|
Definition
| -Find neutral spine and brace – then build the exercise off of this |
|
|
Term
| How do we groove correct motor patterns? |
|
Definition
| -Repetition of movement with perfect form (Sherrington’s Law of Facilitation) in the functional range |
|
|
Term
| Instruct the patient on Abdominal Hollowing; |
|
Definition
-Draw in naval to recruit/activate transversus abdominus
-Purpose is to activate a muscle that is inhibited after injury
-Abdominal hollowing was designed to re-educate the motor system
-It was not designed for patients who need increased stability during ADLs
-Abdominal hollowing by itself does not stabilize the spine because it focuses on only one of the spinal stabilizers |
|
|
Term
| Abdominal Bracing is different than hollowing in which way? |
|
Definition
-Activates 3 layers of the abdominal wall (TA, internal oblique and external oblique)
-Is an effective way to increase spinal stability during ADLs
-Prepares torso for loading
-Only need 5% MVC during ADLs and 10% during vigorous activity |
|
|
Term
| Test to evaluate falling in the elderly would include: |
|
Definition
1) 1 leg standing test
2) Timed up and go test
3) 4 square test |
|
|
Term
| Test to evaluate falling in the elderly would include: |
|
Definition
1) 1 leg standing test
2) Timed up and go test
3) 4 square test |
|
|
Term
| What are instructions for a home stretching program? |
|
Definition
1) Warm up
2) Hold stretch: 15 – 20 seconds
3) 2 – 5 repetitions bilaterally
4) Rest: 15 seconds between stretches
5) Perform daily to change muscle length (3x/wk afterwards to maintain) |
|
|
Term
| What is the difference between spasm and hypertonicity? |
|
Definition
-Spasm – acute and short term – trigger point
-Hypertonicity – chronic due to muscle imbalance – connective tissue tension |
|
|
Term
| Two low-tech tests to see if a patient needs lumbar stability rehab: |
|
Definition
1)McGill’s P to A Shear test
2)Vleeming’s SLR test
3)IAP test
4)Janda's P to A standing test |
|
|
Term
| 4 basic tenets of core stability training are? |
|
Definition
• Stabilization exercise is generally safe
• Mild discomfort is alright
• If pain increases stop the exercise
• Perform slowly, with good form
• Breathe normally |
|
|
Term
| Core Stability in the Anterior Plane could be achieved performing which exercise? |
|
Definition
Anterior Plane
Curl Up
Dead Bug
Front Plank
Stir the Pot |
|
|
Term
| Core Stability in the Posterior Plane could be achieved performing which exercise? |
|
Definition
Posterior Plane
Bird Dog hand/arm
Glute Bridge
Hamstring Curl
Superman/girl |
|
|
Term
| Core Stability in the Rotary Plane could be achieved performing which exercise? |
|
Definition
Bird Dog Alternate Arms & Hands
Side Plank Rolling into Front Plank
Plank Single Arm Lift
Stick Work
McGills 1 arm chest press |
|
|
Term
| Discuss the importance of scapular movement in glenohumeral function? |
|
Definition
Stabilizes the shoulder( when shoulder is packed) so the GH can operate properly and efficiently
Muscle imbalances can disturb movement/rhythm
GH to ST 2:1
Cannot retract (pack) the scapulae without proper thoracic extension |
|
|
Term
| How do you perform Jull's Cervico-Cranial coordination test? |
|
Definition
Testing isometric endurance
-the patient performs the head nod to first target of 22 mm and holds for 10 sec.
-If patient can perform 3 repetitions of 10-sec holds with good form, the test is progressed to next pressure target.
Signs of poor endurance:
-patient cannot hold pressure steady
-superficial flexors are recruited
-pressure level is held, but with jerky action
-Pain-free patients can ave. hold at 26mmHg
-Chronic head,neck pain patients have difficulty holding steady at 22-24mm Hg |
|
|
Term
| Provide a qualitative analysis of hip abduction? |
|
Definition
Janda's Hip Abduction
Test: Side lying raise leg to ceiling. Fail:
1.cephalad pelvis shift at initiation 1st 40 degrees = Q.L. substitution 2. hip flexion = TFL 3. hip ext rot = piriformis 4. pelvic rotation = g med weak |
|
|
Term
| Provide a quantitative analysis of hip strength? |
|
Definition
10 RM
1 RM
Jtech
Dynamometer |
|
|
Term
| Provide a means of identifying functional deficits in Hip extension? |
|
Definition
Janda’s Hip Extension
Patient prone and asked to extend the hip with the knee straight. |
|
|
Term
| Positive findings(deficits) in Janda's hip extension test are; |
|
Definition
Fail: 1.Anterior pelvic tilt at initiation (lumbar substitution)
2. Lumbar hyper extension or trunk rotation before 10 degrees 3. Knee flexion (hamstring substitution) 4. Delayed glute max Grade strength at 10 degrees |
|
|
Term
| Thomas/Modified Thomas test vary in which way? |
|
Definition
| Test: Thomas; Pt supine on table,Knee to chest and lie back on table. Modified Thomas Pt supine on table with other leg dangling off(Ischial tuberosites on the edge of the bench). |
|
|
Term
| What are the common faults on the Thomas/modified Thomas test? |
|
Definition
1.Thigh horizontal – tight hip flexors
2.Knee >90 degrees tight rectus femoris
3.Thigh horizontal knee <90 degrees – iliopsoas
4.Thigh abduction – TFL adduction single joint adductors |
|
|
Term
| How would you have a patient perform the One legged standing test? |
|
Definition
-Have the patient stand with one leg flexed to 30 degrees.
-Analysis of the ability of the patient to maintain single leg balance - (30s) with the eyes open (20s) with the eyes closed if under 55 y/o - is a helpful insight to kinetic chain function in a closed (functional) chain position.
-Repeating the procedure with eyes closed isolates proprioceptive ability. Look for and document compensation. Timing of this ability may be used in goal setting when considering rehab program
-Relate to normative values |
|
|
Term
| Name a Quantitative test for Lateral chain endurance? |
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Definition
Side Plank Endurance – Evaluates QL, Obliques (side trunk stabilizers)
Dysfunction: 5 sec. difference is significant &/or 85% less normal value, <45 sec. = severe dysfunction |
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Term
| Name a Quantitative test for Anterior chain Endurance? |
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Definition
Front Plank Endurace Test
Watch for Ant. Pelvic Tilt
Dysfunction Females <60 sec., Males <90 sec |
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Term
| Functional analysis of the shoulder is evaluated via? |
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Definition
A. Arm/Shoulder abduction Test
B. Push Up Test
C. T4 mobility screen
D. Wall Angel
E. Active T4 Extension Test
F. Cooks shoulder mobility test
G. Cooks Press up test |
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Term
| Functional analysis of the Cervical spine is evaluated via? |
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Definition
A. Jull's
B. Active ROM (Liebenson)
C. Deep Neck Flexor testing |
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Term
| How would you perform the Deep Neck Flexor test? |
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Definition
a.k.a. Head/neck pre-position test
-patient lies supine
-dr. tucks patients chin/nods head
-dr. pre-position’s patient’s head 1 cm off table and asks patient to hold
Fail if:
Head raises or lowers
Chin pokes
Shaking < 20 secs |
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Term
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Definition
Flexion - 180 degrees
Extension- 45 degrees
Abduction- 180 degrees
Adduction - 45 degrees
Int Rotation- 90 degrees
Ext Rotation- 45 degrees |
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Term
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Definition
Flexion - 150 degrees
Extension- 0
Pronation- 80 degrees
Supination- 80 degrees |
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Term
| ROM of the Wrist(normal): |
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Definition
Flexion - 75
Extension - 65
Ulnar Dev.- 30
Radial Dev.- 20 |
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Term
| How do you test Range of Motion? |
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Definition
Answer: Active, Passive and Resisted
Spinal ROM; Dual Axis inclinometer
Extremity ROM; Goniometer, Arthodial Protractor |
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Term
| Normative ROM values of the Knee: |
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Definition
Flexion - 85-95 degrees (Wyatt) 147.9 degrees (Liebenson)
Extension - 0-10 degrees
Lateral bending- 15-25 degrees
Rotation - 25-35 degrees |
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Term
| What is the normal ROM at the Ankle? |
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Definition
Dorsiflexion - 15-20 degrees (Wyatt) ; 22.5 degrees (Liebenson)
Plantar flexion – 65 degrees
Inversion - 5 degrees
Eversion - 5 degrees |
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Term
| Have the patient Arm abduction Test, discuss common faults? |
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Definition
-Have patient abduct arm
-Fail if: scapular elevation prior to 60 degrees abduction
(inhibited lower trap; overactive upper trap) |
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Term
| Have the patient perform the Wall Angel? |
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Definition
stand 6 inches from wall with arms abd 90 degrees, elbows flexed 90 degrees and palms supinated
try to flatten back against wall |
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Term
| Common faults of the Wall angel? |
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Definition
-Arms can't touch wall in a supinated position (tight pecs and other shoulder girdle internal rotators)
-Anterior rib cage lifted (oblique diaphragm due to T/L junction hyperextension and failure of oblique abdominal slings to centrate the rib cage)
-Failure to centrate C0-C1 junction or bring lumbar spine to within 1 inch of the wall due to a fixed thoracic kyphosis |
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Term
| Have patient perform the Active T4 Extension Test? Common faults would include? |
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Definition
-while standing, actively extend both arms overhead
Fail if:
-anterior head movement
-lumbar hyperextension
-arms don’t become vertical |
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Term
| How would baseline aerobic potential in the compromised? |
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Definition
| Bruce and Balke lab testing is appropriate for the compromised, if they’re not available we could perform an estimation, administer a PARQ and send them out for clearance if necessary. |
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Term
| Name the progressions of the Curl up? |
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Definition
Beginner – elbows on floor
2. Intermed. – Raise elbows
3. Advanced – hands on head
4. Super adv. – curl-up & hold with deep breathing
5. “ - on gymball
- upper back
- lower back
6. “ - obliques on gymball |
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Term
| Show how the patient would perform the IAP Test? |
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Definition
Initial position
Patient supine
Triple flexion of the legs
The lower legs supported
Hip abduction corresponds
to the width of the shoulders,
slight external rotation at the
hips
The therapist brings the patient’s chest passively into the caudal, expiratory position Then the support is removed from under the patient’s legs
The patients holds this position actively |
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Term
| How do MET's work(muscle energy techniques)? |
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Definition
Reflex inhibition(2 types)
Reciprocal inhibition
Autogenic inhibition |
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Term
| How would you describe Autogenic Inhibition? |
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Definition
-is the neurological process whereby proprioceptors (golgi tendon organs) located at the musculotendinous junction detect an increase in tension in that muscle. When a certain amount of tension is detected, the muscle is then inhibited in the spinal cord, preventing it from contracting. As a result, the muscle will relax.
-contraction of the same muscle that's being stretched causing relaxation |
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Term
| How would you define Reciprocal inhibition? |
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Definition
-is the process by which the contraction of an antagonist muscle neurologically inhibits the contraction of the antagonist muscle. This occurs as a motor neuron that causes contraction in the agonist muscle synapses, or transfers its signal to an inhibitory neuron that will inhibit the antagonist muscle. In other words, the antagonist muscle will relax, or be prevented from contracting.
Reciprocal inhibition may also contribute to muscle imbalances. If an agonist muscle is hypertonic, or overactive, its antagonist will be inhibited, causing lengthening and a decrease in functional control. This will further allow the agonist to tighten, or shorten, creating a cyclical pattern of dysfunction |
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Term
| How would you instruct a patient with yellow flags to self manage their pain? |
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Definition
-advice;ADL modification
-reassurance;hurt does not equal harm
-graded exposure-slow resumption of activity
-sparing strategies
-pacing;when activities resume do not overload
-if progress Plautus refer for counciling |
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Term
| What are the risk factors for curve progression in scoliotic patients? |
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Definition
-time until skeletal maturation
-structural deformity(wedge vertebrae)
-curve greater than 20 degrees when first found |
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Term
| Treatment Goals of Scoliosis patients would include? |
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Definition
Increase ROM
Increase Proprioception
Increase Strength
Increase Hand Eye coordination in non dominant hand
Baseline Curve |
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Term
| What risk factors could you provide for Osteoporosis patients? |
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Definition
Family Hx
Smoker
Heavy Alcohol use
Sedentary
Petite
Hx of Anorexia
Asian or Eastern European Decent
Corticosteroids |
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Term
| How would you rehab a osteoporosis patient? |
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Definition
-Nutrition-bone minerals
-Aerobics-maintain or loose weight
-Resistance Training-Weight bearing/closed chain
-Fall prevention(proprio)
-Lifestyle changes(quit smoking/drinking)
-Referral-if Dexascan doesn't show plateau of bone loss
RX-Phosphomax |
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Term
| How would you evaluate the fall risk in the elderly? |
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Definition
-Timed up and go test
-Four Square step test
-One legged standing(in a corner or a good spot) |
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Term
| Four square step test is performed how? |
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Definition
-Patient steps over four canes set-up like a cross on the floor with the tips of the canes facing together.
-At the start of the test, the patient stands on the upper left square.
-The stepping sequence is (clockwise):
Square 1, square 2, square 4, square 3, return to square 1
-Then (counterclockwise):
Back to square 3, square 4, square 2, and end in square 1. |
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Term
| How is the Timed Up and Go test (TUG) is performed ? |
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Definition
-it uses the time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. During the test, the person is expected to wear their regular footwear and use any mobility aids that they would normally require.
-is a simple test used to assess a person's mobility and requires both static and dynamic balance. |
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Term
| How could you deferentially diagnose vascular claudication from spinal stenosis? |
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Definition
Imaging(Ultrasound and MRI)
Stoop test-have patient walk until symptoms then flex patient
(improved with flexion-neurogenic claudication)
(worsened with flexion-Vascular claudication) |
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Term
| How would you rehab a patient with Spinal stenosis? |
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Definition
-Avoid extension
-Pelvic Tilts
-Cox F/D
-Stabilization exercises
-Senory motor training |
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Term
| When rehabbing a pregnant patient what should you first do? |
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Definition
-take a BP to rule out preeclampsia
-Get clearance from the OB
-Get clearance from GP |
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Term
| What are some benefits to exercising during pregnancy? |
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Definition
-Shorter Labor
-Improved psychological well being
-Decreased LBP
-Decreased risk of preeclampsia |
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Term
| What are the risks of exercising when pregnant? |
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Definition
-Increased risk of injury
-Increased fetal temperature(3x risk of neural tube defects)
-Dehydration |
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Term
| Signs and symptoms that are contraindications to exercise in pregnant patients would include? |
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Definition
-Preeclampsia
-Persistent bleeding
-High risk pregnancy
-Anemia
-Chronic respiratory disease |
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Term
| How would you devise a Aerobic prescription for a Pregnant patient? |
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Definition
-Safest in 2nd trimester(inc rate of miscarriage in 1st)
Frequency-start at 3x's per week
Duration-15 min,progress to 30
Mode-low impact or non weight bearing
Intensity-conversation pace 60-70% VO2 max |
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Term
| How would you design a Resistance program for a Pregnant patient? |
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Definition
-Rehab the mirror image(focus on posterior pelvic tilts)
-Kiegels
-decrease postural syndromes(upper crossed, etc.)
-Avoid supine exercises after 1st Tri
-No Valsalva's |
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Term
| What benefits would exercise have on a post par tum patient? |
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Definition
-Dec. stress
-Dec. Post par tum depression
-Improve bladder control(keigel)
-Improved sleep
(preeclampsia and cesaerian must have OB clearance) |
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Term
| What post surgical considerations should you have with a hip patient? |
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Definition
-Avoid over 70 degrees flexion
-Avoid Adduction past midline
-Avoid Internal rotation |
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Term
| What post surgical considerations should you have with a knee patient |
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Definition
-No open chain kinematics(closed only)
-Stress proprioceptive input
-Stress gaining full ROM |
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Term
| What would post surgical goals /considerations for shoulder patient? |
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Definition
-PROM to AROM
-Cross over effect
-Isometric strengthening
-Progressive muscle training |
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Term
| How long until a post surgical lumbar fusion patient is eligible to participate in a rehab program? |
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Definition
-3 Months
-Walk as much as soon as possible
-No bending,lifting or twisting |
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Term
When would a rehab program for a cervical fusion patient begin
? |
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Definition
6 weeks for basic rehab
6 months for advanced(ROM & Strengthening)
No lifting overhead for first 6 weeks
No Retraction exercises |
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Term
| What would the indications be for a patient to require an aquatic program? |
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Definition
-Weight bearing limitations
-Severe Pain
-Significant Weakness
-Instability limits land based rehab
-Mobility restrictions unresponsive to regular rehab
-Pregnant or Obese |
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Term
| What contraindications would there be to an aquatic program? |
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Definition
-Uncontrolled Hyper/Hypotension
-Open wounds
-Bowel/bladder incontinence
-Fever/Infection
-Seizerue |
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Term
| What would classify a Grade III sprain? |
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Definition
Diffuse, significant edema
Weight bearing Impossible
Complete tear
Instability testing Definite
4-26 weeks return to activity |
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Term
| What would classify a Grade II sprain? |
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Definition
Localized, moderate
Weight bearing Difficult without crutches
Partial tear
Instability testing-None
2-6 weeks return to activity |
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Term
| How would you classify a Grade I sprain? |
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Definition
Localized, slight edema
Full or partial weight bearing without significant pain
Ligament stretch
Instability testing-None
return to activity 11 days |
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Term
| Explain the procedure for a Single Leg Squat? |
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Definition
Squat to approximately 30 degrees of hip flexion on one leg, or perform off step 8-20 cm high with non-weight bearing leg straight until heal touches floor
If the patient cannot perform an alternate way is to have them step down from a 12" platform. |
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Term
| What are some common faults in the single leg squat? |
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Definition
Knee valgosity
Lumbar flexion
Anterior patellar shear
Trendelenberg sign
Hyper-pronation |
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Term
Have the patient perfom Reflex Stability/Vele’s forward lean
Test: |
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Definition
Lean forward without bending at the waist.
Fail: delayed or absent gripping of toes, breaking at the lumbar spine |
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Term
| Functional evaluation with the Squat is performed how? |
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Definition
Test: Place your feet apart at shoulder width, with arms ahead or supported. Squat until your thighs are parallel to the floor.
Normal: ability to squat below horizontal with good form (neutral lordosis, patellofemoral stability)
Ideal: ability to squat with arms overhead as per Cook's Functional Movement Screen
Fail: < depth of squat, hyperpronation, knee valgus, knee beyond line of toes (hip capsule tight) lumbar hyper ext/flex |
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Term
| What are some common faults in the single leg squat? |
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Definition
Knee valgosity
Lumbar flexion
Anterior patellar shear
Trendelenberg sign
Hyper-pronation |
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Term
| Name the tests of the FMS? |
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Definition
In Line Lunge
Hurdle Step Test
Rotary Stability
Overhead Squat
In Line Lunge
Shoulder Mobility
Torso Stability
Active SLR |
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