Term
| what type of exercise prescription is frequently associated with neck pain? |
|
Definition
• Active exercises are necessary
to strengthen and stabilise those weakened segments of the cervical spine.
• First, find a dose of strengthening exercises that will work without causing pain.
• → Mild isometric exercises with the neck in a comfortable neutral position
Circumduction neck exercises
(neck rolls) that were often recommended in the past
have been found to localise the forces to the unstable area and compound the instability that is present. |
|
|
Term
| T/F? If free flexion and extension motion can be obtained, rotation and/or side bending will introduce group motion rather than single segmental motion. |
|
Definition
|
|
Term
| should, F/E exercises, rotational exercises or SB exercises be prescribed first for spinal strengthening? Why? |
|
Definition
| Flexion and extension exericses should precede exercises involving rotation and sidebending. This order comes from the
biomechanical concept that flexion
& extension are pure and uncoupled motions. |
|
|
Term
| which lumbar segment is most mobile? |
|
Definition
|
|
Term
| T/F Common to find L5 extended (backward bent) while the upper lumbar region is flexed. |
|
Definition
|
|
Term
| HOw can you reduce l5 hyperextension in extension exercises for the lumbars? |
|
Definition
| Extension exercises can be performed comfortably if you position your patient prone on the table and place a pillow or pillows under the pelvis to flex L5. |
|
|
Term
| T/F Lumbar discs usually will not tolerate an extension load of the lumbar spine. |
|
Definition
| F - cant tolerate a flexion load. despite this, flexion exercises are usually prescribed |
|
|
Term
| • Any form of therapeutic
intervention that intends to
engage the self-regulating
mechanisms of the body
(rather than attempting to
impose solutions on these)
is left with the following 3 choices/objectives. Name and explain them: |
|
Definition
o 1. To attempt to
reduce or remove
the adaptive demands being
imposed on the individual
• e.g. by changing habits of use, whether postural, functional, respiratory, nutritional or other
o 2. To try to enhance the ability of the individual, or the local region, to handle biomechanical, biochemical and/or psychosocial adaptive demands.
o 3. To treat symptoms |
|
|
Term
| • How do you achieve objectives? (OCF & BLT) (12) |
|
Definition
o • Gather and record evidence
o • Identify dysfunctional patterns
o • Evaluate pain
o • Reason clinically (what might be agg/rel/maintaining symptoms)
o Record patient’s own thinking
o Make judgements about general health
o Consider other factors
o Formulate hypothesis
o Create a treatment and management/referral plan
o Discuss diagnosis, prognosis and treatment plan with patient
o Regularly review treatment plan and revise as necessary. |
|
|
Term
| Describe force, leverage and contact involved in OCF? |
|
Definition
o Very small amount of effort required
o • Leverage is applied by subtle use of arm muscles to guide the hands
o • Hands are the contact only, moulding to the part being treated.
o • Palpating/contact hands should be neutral, allowing the patient’s body to organize itself around these contacts, which become ‘organizational fulcrums’. |
|
|
Term
| How do you know when release has occurred? |
|
Definition
o A sense of steady and strong pulsation or greater warmth enters the area.
o • A very definite change (reduction) in palpated tone is noted.
o • The tissues which are being held seem to ‘lengthen’ or ‘free up’.
o • On a wider, whole-body level such phenomena may also involve deeper emotional release, sometimes called ‘emotional discharge’.
• This may be accompanied by all or any of the following:
Change in skin colour
Perspiration
Change in breathing pattern
Rapid eye movement and restlessness.
Fasciculation - trembling / twitching
• The patient may express a wish to vomit or cry or may simply begin crying or laughing. |
|
|
Term
| name the 4 cranial manipulation approaches: |
|
Definition
direct techniques
indirect techniques
separation/disengagement techniques
moulding |
|
|
Term
| who are direct cranial techniques indicated for? |
|
Definition
| infants and young people, rather than adult restrictions |
|
|
Term
| what do indirect cranial techniques involve? |
|
Definition
Can involve exaggeration of distortion, pattern or restriction
. Can bring soft tissues (reciprocal tension membranes, muscles, etc.)
and bones towards the
direction of their greatest ease. Hold there until a spontaneous release occurs. |
|
|
Term
| what is the objective of separation? |
|
Definition
| free motion at the suture or articulation |
|
|
Term
|
Definition
o This approach applies to the treatment of tissues which are still soft and pliable, as in the infant skull.
o Distorted structures are held in a manner which moulds their contours
towards a more normal status,
in either form or resiliency. |
|
|
Term
| what are the 5 assisting or activating forces in cranial manipulation? |
|
Definition
1) inherent motion
2) respiratory assistance
3) fascial influences
4) still point application
5) Sacral influence on the cranium |
|
|
Term
| describe what is meant by inherent motion regarding cranial manipulation? |
|
Definition
| There are a number of rhythmic, pulsating forces which together to form
a ‘cranial rhythmic impulse’ = CRI
. This is used to assist the freeing of restricted sutures by ‘fluid direction’ or V-spread |
|
|
Term
| T/F CNS is derived from endoderm with covering of mesenchyme |
|
Definition
| F - CNS is derived from ectoderm with covering of mesenchyme |
|
|
Term
| • Mesenchyme under stretch becomes membrane, and under compression becomes cartilage.
• As neural tube folds - 2 layers of mesenchyme fuse to become the falx cerebri and tentorium cerebellum |
|
Definition
| this is all very interesting... but not at this time of day. |
|
|
Term
| name 4 parts of the occipital bone present at birth |
|
Definition
Basilar
Squama
2 x condylar parts
nb. Unwinding the birth pattern can start with the condylar part |
|
|
Term
| list the expectations of ageing: |
|
Definition
• Continuing process of maturation
• Look inward for a sense of meaning
• Accept accomplishments in life
• as adequate.
• Older adults generally experience higher levels of self-efficacy and self-esteem compared with younger individuals.
• However, unexpected or catastrophic life events are especially stressful and less likely to be handled well. |
|
|
Term
| Contast integrity vs dispair in the elderly. |
|
Definition
• Competing drives in old age
o Despair and depression
• can be related to the knowledge that the life span is increasingly limited and to the loss of a spouse, friends and career
o Integrity
• wisdom & perspective that
comes with experience.
• Coping mechanisms will
be extremely helpful in old age when changes occur in many areas of social and individual functioning. |
|
|
Term
| List some processes which alter during ageing (13) |
|
Definition
• Special senses: hearing, vision, taste, smell, sensation
• mobility
• Cognition
• Flexibility
• Temperature regulation
• Mental health
• Voice
• Skin thickness
• Immunity
• Balance
• Resilience
• Memory
• Muscle mass, fat:muscle ratio |
|
|
Term
| what are the goals of multidisciplinary care for the elderly? (2) |
|
Definition
- maintain health
- optimise function |
|
|
Term
| What should be considered in diagnosis of the elderly? |
|
Definition
• Testing function > barriers
• Examining for degenerative change in systems
• NMS system
• CVS
• Mental state
• Medication review
• Family support
• Cognition |
|
|
Term
| Name 5 factors that have significant effects on pharmacokinetics and must be considered in prescribing drugs for the elderly. |
|
Definition
↓ in height
↓ lean body mass
↓ body water
↑ body fat
considerable
decline in the number of nephrons,
→ significant decline in creatinine
clearance |
|
|
Term
| Immunologic changes associated with ageing consist of: |
|
Definition
o ↓ T-cell function
o ↓ antibody production
o ↑ in autoantibodies |
|
|
Term
| what are the goals for osteopathy in geriatric care? |
|
Definition
• → Optimise function
• → Avoid institutionalisation
• → Maintain the patient, as much as possible, in the community.
in order to do this: there is a need for:
• → Careful multi-dimensional evaluation
• → A plan that stresses health maintenance and disease prevention. |
|
|
Term
| Special clinical concerns with the elderly: (6) |
|
Definition
o Dementia
o
Delirium
o Falls
o Iatrogenic illness
o Inappropriate immobility
o Unnecessary hospitalisation |
|
|
Term
| What is dementia? What is the most common type of dementia? |
|
Definition
Large group of illnesses that cause a progressive decline in function, loss of memory & ability to
think & learn.
Most common type is Alzheimer's disease (50-70% of all cases) |
|
|
Term
| What are the early signs of dementia? |
|
Definition
• Gradual onset
• • Dysfunction of multiple spheres of intellect such as memory, abstract thinking, and judgement
• Unaltered state of consciousness
• Inability to perform ADLs
• Memory loss that affects day-to-day function
• Difficulty performing familiar tasks
• Confusion about time & place
• Problems with language
• Problems with abstract thinking
• poor or decreased judgment
• Problems misplacing things
• Changes in personality or behaviour
• A loss of initiative |
|
|
Term
| What should be included in the assessment of a patient with dementia? |
|
Definition
o • A detailed medical history, from patient and close relative or friend.
o • A thorough physical & neurological examination
o • Sensory and movement function
o • Identify any medical conditions which may worsen the confusion associated with dementia
o Laboratory tests for possible illness
o Neuropsychological testing for abilities & specific problem areas
o Other specialized tests: chest x-ray, ECG or CT scan
o Mental status test (memory, ability to read, write & calculate)
o • Psychiatric assessment (depression can mimic dementia; anxiety or delusions) |
|
|
Term
| List the diagnostic criteria of dementia: |
|
Definition
• • Memory impairment
• • Aphasia (language)
• • Apraxia (motor activities)
• • Agnosia (recognition)
• • Disturbance in executive functioning
(i.e.planning, organisation, sequencing, abstracting)
• • Significant impairment in social or occupational functioning
• • A significant decline from a previous level of functioning
• • Gradual onset and continuing cognitive decline. |
|
|
Term
|
Definition
o Unlike dementia, delirium is a potentially life-threatening illness
o Sudden onset
o associated with clouded state of consciousness and disturbed sleep-wake cycle
o It is often a result of a toxic or metabolic disturbance.
o It is important to differentiate dementia from delirium. |
|
|
Term
| List the diagnostic criteria of delirium? |
|
Definition
o Diagnostic criteria:
• Disturbance of consciousness
• Reduced ability to focus, sustain, or shift attention.
• A change in cognition (such as memory deficit, disorientation, language disturbance)
• The development of a perceptual disturbance
• the disturbance develops over a short time (usually hours to days) and tends to fluctuate during the course of the day.
• Caused by a general medical condition. |
|
|
Term
|
Definition
• • Changes in postural control
• • ↓ in proprioception
• • ↓ in muscle tone
• • ↓ vision
• • Slower righting reflex
• • ↑ in postural sway
• • ↑ DJD
• • ↑ strokes
• • ↑ peripheral neuropathy |
|
|
Term
| List some of the intrinsic causes of falls in the elderly |
|
Definition
Syncope (fainting)
Drop attacks (carotid sinus hypersensitivity)
Cardiac dysrhythmias
Strokes
TIAs (Transient Ischaemic Attacks)
Seizures
Parkinson disease
Orthostatic hypotension.
Drugs such as anti-hypertensives, sedatives, antipsychotics, and hypoglycaemics |
|
|
Term
| The elderly are particularly prone to iatrogenic disorders , Why? |
|
Definition
- altered homeostasis
- physisicans failure to recognise special needs of the elderly |
|
|
Term
| Consequences of prolonged immobility in the elderly include: |
|
Definition
• Pressure sores
• Pneumonia
• Venous thromboembolism
• Contractures
• Urinary incontinence |
|
|
Term
| discuss indicated techniques for the elderly. What technique is contraindicated? |
|
Definition
o The increased frequency of osteoporosis and decline in bone mineral density with age should discourage the use of certain high-thrust, high-velocity techniques in the elderly.
o Range of motion (articulation), respiratory, MET, and OCF techniques are all beneficial approaches for geriatric patients. |
|
|
Term
| why i it important that the elderly exercises? |
|
Definition
o - ↑ muscular strength
o - ↑ VO2max
o - Relieves pain and joint stiffness
o - ↑ flexibility
o
- ↑ balance/coordination → ↓ falls
o - ↑ mental health
- ↓ stress |
|
|
Term
| how do you help an elderdy individual take responsibility for their own health? |
|
Definition
• Identifying causes
• Teaching more efficient and less strenuous body usage
• Raising awareness of posture
• Providing individually tailored exercise programmes both for rehabilitation and prevention
• Teaching relaxation techniques to reduce stress.
• Working in conjunction with other practitioners
• Osteopaths work towards long-term prevention as the result of a cooperative effort b/w patient & practitioner |
|
|
Term
|
Definition
• The treatment of
chronic disabilities
through physical means
to help patients return to a comfortable, productive life.
• Medical rehabilitation is the provision of medical and allied health services specifically aimed at treating conditions to achieve healing, recovery and rebuilding - to reach a natural or harmonious state of physical, physiological & psychological health & lifestyle wellness. |
|
|
Term
| What are the objectives of rehabilitation? (4+1) |
|
Definition
• (Pain relief)
• Functional improvement or maintenance
• Training in essential activities
• Functional testing of strength, mobility, breathing capacity, and coordination.
• AIM: To achieve optimal restoration of quality of life so that full potential for recovery is reached. |
|
|
Term
| when does rehab begin? (4) |
|
Definition
• After acute stage of injury
• At start of convalescence
• When the patient is ready
• As soon as possible |
|
|
Term
| What is the difference between impairment, disability and handicap? |
|
Definition
• Impairment (psychological, physiologic, anatomical)
• Disability (restriction due to impairment)
• Handicap (disadvantage).
Though patients may have
multiple impairments, these might
not cause disabilities or handicaps
unless they affect the patient’s
ability to function in the home or community. |
|
|
Term
| How what considerations are made to summarise and manage rehab patients? |
|
Definition
The osteopath formulates a problem-oriented summary that identifies the patient’s major problems, which will include pertinent impairments, functional deficits, and medical and surgical issues.
• Management plan:
o From the summary, make a plan:
o - Treatment options for rehab
o
- Osteopathic treatment
o
- Exercise
o – Diet
o
- Others? |
|
|
Term
| what are the extrinsic and intrinsic factors involved with low back pain? |
|
Definition
o Evaluate extrinsic risk factors:
• Occupational
• Recreational
• Environmental
o Evaluate intrinsic (patient-related) risk factors:
• Age & gender
• Familial
• Postural
• Mobility
• Strength and fitness |
|
|
Term
| discuss the osteopathic role in the rehabilitation of low back pain? |
|
Definition
• • Treat as appropriate to restore symmetry,
full ROM, optimal tissue tension & to relieve pain.
• A comprehensive approach includes therapeutic exercise designed to establish & maintain musculoskeletal structural integrity.
• Exercise:
o Maximising the patient’s
involvement in a
therapeutic exercise program is needed to optimise functional outcome.
o Strengthening - upper & lower abdo mm Stretching – LES, gluteals, hip flexors, hamstrings Pelvic tilt to ↓ lordosis
Exercise to ↑ flexibility
• May also look at: shoes, bed, car, occupational ergonomics, and other activities.
• Advise patient regarding what to look for: comfort, symmetry, ease of motion |
|
|
Term
| list some common dysfunctions associated with spondylolisthesis. |
|
Definition
•
• Iliopsoas spasm
• • Gluteal and piriformis spasm
• • Flexed upper lumbar dysfunction
• • SI/sacral torsion dysfunction
• • Innominate dysfunction |
|
|
Term
| Carpal tunnel syndrome treatment considerations? |
|
Definition
o OMT, stretching, braces/splints, ice, strengthening exercises, and NSAIDs.
o • Surgery is usually a last resort.
o • Early diagnosis & treatment improves the chances for successful functional recovery.
o Consider:
• ’Opening’ the carpal tunnel with stretching & release of transverse carpal ligament to ↑ space within the canal, → ↓ pressure on median n.
This reverses the natural tendency toward flexion of the carpal tunnel.
• Release of the true myofascial component of the carpal canal, the attachment of the abductor pollicis brevis muscle.
• Indirect stretch of the distal carpal canal with internal distension/dilation of the canal. |
|
|
Term
| explain the mechanism of injury of whiplash? |
|
Definition
o Cervical spine hyperextension due to a collision from the front or rear.
o Injury may involve ligaments, tendons, & muscles
o Must also consider potential injury to nerve root, CNs, or associated joints such as the TMJ. |
|
|
Term
| Diagnostic criteria for whiplash? |
|
Definition
o History of neck & head pain
o Associated stiffness and fatigue
o Physical examination freq reveals:
• • ↓ ROM of neck
• • Tenderness to palpation (both anteriorly & posteriorly)
• • Facet joint tenderness
o Must attend to SD of other areas of the spine and assess areas of sympathetic hyperactivity. |
|
|
Term
| 3 general treatment approaches for whiplash? |
|
Definition
for pain or sleep disturbance
• • physical therapy modalities
o • any therapeutic exercise program that focuses on appropriate neck muscle position & posture |
|
|
Term
| describe useful techniques for treatment of ankle sprains |
|
Definition
| o Myofascial and indirect techs
• MET, articulation & other direct techs
useful as swelling ↓.
• For persistent ankle pain use direct MFR of medial deltoid ligament & fascial structures.
• OMT is useful to ↓ oedema & pain,
allowing Pt to begin a functional ankle rehabilitation program sooner.
• Also useful to treat secondary symptoms (such as LBP) that occur from change in gait after injury |
|
|
Term
|
Definition
o Direct trauma
o Stress fracture
o Osteoporosis
o Pathological fracture |
|
|
Term
| 4 complications of rib fracture: |
|
Definition
• Flail chest
• Pneumothorax
• Visceral damage
• Atelectasis |
|
|
Term
| List osteopathic treatment approaches for rib fractures |
|
Definition
• Rest from aggravating activities
• Protective padding
• Exercises to improve posture, flexibility and strength, and to prevent localized lung collapse
• Activity modification advice
• A graduated return to activity plan
• STT
• BLT, functional, FPR, SCS–all indirect techniques
• Joint mobilization (usually following completion of fracture healing)
• Breathing/thoracic exercises
• Education |
|
|
Term
| The 5 core principles that reflect contemporary practice in injury management include: |
|
Definition
o 1. Demonstration of measurable treatment effectiveness
o 2. A biopsychosocial approach for the management of pain 3. Empowering workers to manage their injury;
o 4. Treatment goals that focus on function & return to work 5. Treatment delivery based on the best available evidence. |
|
|
Term
| How can an injured worker adapt their work situation to allow early return to work? |
|
Definition
• reduced hours
• alternative duties
• job sharing
• assistive aids
• anything else that may suit the circumstances. |
|
|
Term
| list 7 outcomes of osteopathic management for injury |
|
Definition
o 1. Reduce pain & swelling
o 2. Facilitate appropriate circulation and drainage
o 3. Improve mobility
o 4. Facilitate normal function
o 5. Improve strength
o 6. Teach self-management techniques
o 7. Educate regarding prevention
(o 1. Know your anatomy – structure
2
o . Understand physiology – function
o 3. Be competent in your techniques
o 4. Communicate effectively
o 5. Follow up) |
|
|
