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PT Semiar

Midterm Exam

Pathology/Injunry Disease, disorder, condition (ex. MS, Lupus, Tendinitis)
Impairments altercations in anat/phys, or psychological structures or functions (ex.broken bone, ACL tear)
Functional Limitation Inability to perform physical task or activity (ex. not being able to dress yourself)
Active Pathology Bob presents to PT with diagnosis of Insulin Dependent Diabetes Mellitus. Based on Nagi model, this is best described as:
Functional Limitation Helga presents to PT and reports inability to dress herself independently. Based on Nagi model, this is:
Impairment Barry presents to PT with decreased strength with arm abduction. Based on Nagi model, this is:
Disability Minnie presents to PT and reports an inability to continue working on the assembly line at the local GM auto plant. Based on Nagi model this is:
Disability Inability or limitation in performing activities related to s0ciocultural context (role in society; not able to do occupation)
Disablement Process/ Model- Nagi Pathology/Injury, Impairment, Functional limitation, Disability
Primary Level of intervention Health promotions, screens, ect
secondary level of prevention decrease duration/ sequelae by early diagnosis & intervention
Tertiary level of intervention limiting degree of disability for chronic/ irreversible conditions
examination Includes : History, Systems Review, and Test & Measures
Tests and Measures -Clinical indications, specific tests/measures, type of data generated (scales, numbers, ect) -23 Categories -some are included in more that one category -each category includes:
Interventions -Coordination, communication, and documentation -patient/client related instruction -direct interventions (seen most in clinic)
Preffered Practice Patterns How many of each: -Musculoskeletal -Neuromuscular -Cariopulmonary -Integumentary
Benefits to the Guide to Practice -Integrates the disabled process/model -maximizes patient/client management justifies plan of care - facilitates consistent use of terminology -facilitates the design of clinical pathways -concise documentation of goals and outcomes
Benefits continued: - Consistent education of entry-level clinicians -Facilitates clinical research collection of consistent data -Provides a benchmark for PT practice -Guides the development of effective strategies for responding to reimbursement issues
Patient/Client Management (5) -Evaluation -Examination -Diagnosis -Prognosis -Intervention
Systems Approach -Examination -Evaluation -Rehabilitation -Wellness/Fitness
Evalutation Includes: Subjective examination-what they tell you objective examination-find out yourself assessment-what you think they need plan
Examination -History -Specific Testing -Tests and Objective Measures -Diagnostic Classification -Comprehensive Screening -Prior to intervention -identify impairments, func limits, disabilities, changes in physical func and health status bc injury, disease ec
Cancer -Persistent night pain -constant pain -unexplained weight loss (10-15lb n <2 weeks) -loss of appetite -unusual lums or growths -unwarranted fatigue
Cardiovascular -SOB -dizziness -heaviness in chest -pulsating ("throbbing") pain -constant & severe LE (calf) or UE pain -discolored or painful feet -swelling
Gastrointestinal/Genitourinary -frequent of severe abdominal pain -frequent heartburn or indigestion -frequent nausea or vomiting -change in bladder function (UTI) -Unusual menstrual irregularity
Neurological -change in hearing -frequent or severe HA without Hx of injury -problems with swallowing or speech -visual changes -problems with balance, coordination, falling -drop attacks -sudden weakness
Miscellaneous -fever or night sweats -emotional disturbances -sweling or redness in joint w/o hx of injury -pregnancy
Crepitus Cinema sign Vertigo Tinnitus Popping, rubbing together Patella Maltracking (long time sitting) Room is spinning -Ringing in ear
TYPES OF PAIN: Bone Vascular-> Muscle~ Nerve: Deep, boring, localized ->diffuse, aching, poorly localized ~dull, aching, cramping :sharp, shooting, bright, lightening like
Subjective Exam All should be talked about in _____ exam: -Occupation -Recreation -Functional Limitations -Personal Goals -family history
1. Observation 2. AROM 3. PROM & End Feel 4. Isometric/Selective Tissue 5. Muscle Length/ myofascia 6. Muscle Strength 7. Joint Mobilization 8. Functional Tests 9. Special Tests 10. Movement analysis 11. Palpation for tenderness 12. Neurologica Sequence of Examination (1-12) Starting with: 1) Observation &______ for condition
Observation -starts in waiting room Looking at: alignment, bony contours, soft tissue contours, deformity, limb position, skin/scars, attitude, facial expressions, willingness to move, -Palpate for condition! (red, hot, swollen)
-Test normal side first -AROM before PROM -Test painful motions last -Repeat or sustain isometrics Over pressure Degree and quality of ligament testing -myotomes -warn or exacerbation -refer if necessary Principles of Examinations -things to remember during objective exam ex. don't do this first
Active Motion Ask: When and where the pain is Look at: Quality/intensity of sx reaction, restriction, rhythm pattern willingness
Passive Motion & End Feel -where, when, intensity, quality of pain -Normal end Feel: --boney=hard --soft tissue=soft --tissue stretch=firm -Capsular pattern
Capsular pattern pattern of motion restriction if wrong, may suggest entire capsule is restricted ex. knee: flexion more limited than extension
-bony -Empty -Muscle spasm -Capsular -Springy Block Abnormal End Feels: -to muscle there -can't get to it, too much pain -twitching -stiff; no give -too much collagen; stops&boucnes; lack of motion
-size: hypertrophy, atrophy, swelling -length -strength -tissue texture -facilitation or inhibition Contractile tissue we're assessing for (6)
Selective Tissue Testing Testing muscle lenght & contractile properties
Selective Tissue Tension (Resisted) vs Manual Muscle Testing vs Myotome Testing Do these for what three tests? -Grade of Strength -Isolate specific tissues -Does the contraction change the patient's symptoms?
Contractile Tissue -1st Degree muscle strain (muscle or tendon) -2nd Degree muscle Strain (severe lesion at joint or bony structure) -3rd degree muscle strain; Rupture or neurological Contractile Tissue Testing -Strong & pain free -Strong & Painful -Weak & painful -Weak & pain free
Functional Assessment -ADLs-activities of daily living -Work related tasks -Recreational activities -Sports activities
Special Tests -Confirms a tentative diagnosis -helps with differential diagnosis -shows signs that show up during rest of exam -don't do until later in eval Universal Tests- some tests fit in 2 categories - Unusual signs
Motion Analysis -gait assessment -treadmill walking -lifting -sport specific -work related -motion analysis equipment -after you have measures, use and apply them to this
Palpation for Tenderness Palpate for condition Palpate for provocation Does it hurt?
Neurological -Segmental Distribution -Neuromuscular -Neurovascular -Neural Tissue Tension Tests
Problem List -list of what is not normal -rate: pain, strength, measurements, mobility, ect -this is created by measures found in exam
-pain , strength, ROM, joint mobility, muscle length/pliability, proprioception, tissue texture abnormalities, girth, ambulation, special function, functional index Problem lists includes (11)
Goals important bc: -lets you know you're doing your job -come up with treatment plan for each goal -insurance looks at this -treatment plan is working if succeed in these -if not reached, change things up
Problem List Summary of objective findings
Assessment - Problem List - Short Term and Long Term goals - Prognosis
Prognosis - how someone will respond to PT -ex. want to increase flexibility of hamstring to increase ability to go up stairs
Plan of Care -Specific interventions that address the objective findings (short & long term goals) -Duration and frequency of threrapy
Ligaments Bands of grossly parallel fibrous connective tissue that "tie" or "bind" bones together at or near the margins of bony articulation -named for bony attachment, shape, relationship o the joint, or relationship to each other
Gross Ligamentous Structure -dense, white bands of connective tissue -functional stubunits -have poor blood supply but are not inert -capsuloligamentous relationship -synergistic relationship
Ligamentous function -Passive guidance of bone position and function -Joint Stabilization during the introduction of applied loads -Mechanoreceptor: position receptor feeding info back to CNS affecting quantity and quality of muscle firing
Mechanoreceptor what action of the ligament shut down the quads when ACL tore
C-Type Nerve Fibers ACL contains them Pain nerve fibers
Ligament Ultrastructural Organization Bony interface with fibrocartilaginous cells (Sharpy's fibers') Midsubstance made of fibroblast and crossfibers
Biochemical comoposition of ligaments 2/3 H2O 1/3 SOLID - 75% collagen - proteoglycans -elastin
Soft Tissue mechanics of ligaments load-deformation behavior stress and strain fiber recruitment depends on joint at time of loading
Ligament Viscosity "fluid like" qualities Load relaxation Cyclic Loading - these means ligaments can be trained these properties in ligaments are dominant in kids
Ligament elasticity Ligament has the ability to completely recover to its resting length - these behaviors dominant at larger loads
Factors affecting ligamentous Integrity -Size of the ligament -Age of the host (ligaments peak energy absorbing ability at skeletal maturity) position of the joint at moment of loading
Use it or lose it -bony insertions recover more quickly than the midsubstance Effects of immobilization "moto"
Effects of exercise on ligaments -ligament becomes stronger and stiffer w/o exercise is about 80-90% its mechanical potential -this can add 10-20% of ligamentous strength
MCL First limit to valgus force
triad MCL, Medial Meniscus, ACL
PCL Secondary to valgus restraint Primary restraint to posterior translation 90%
Meniscofemoral ligament ligament of humphrey ligament of wrisberg -> help to prevent posterior translation ->both are taut with internal rotation of the tibia
ACL -Primary restraint to anterior translation -Restraint to internal tibial rotation with PCL. Secondary restraint to valgus w/PCL
Grade 1 Grade 2 Grade 3 Incomplete tear (no instability) more significant partial tear with some noted instability Complete tear with complete instability
Position of injury Range of instability in ligamentous injury is related to
Ligament Healing time frames -10 days to 2 weeks for full recovery -2-3 weeks of rehab/rest (protective) -2-3 weeks progressive rehab -3-6 weeks modified to progressive -may take 3-6 months before 70-80% of original strength Ligament Healing Time Frames: Grade 1 (First Degree) Grade 2 (2nd) Grade 3
ACL graft reconstruction Graft - Autograph (self), Allograph (dead), Xenograft(other animal), Artificial graft Accelerated Rehab- BPTB graph; Shelbourne & Nitz(has patients move earlier)
-graft failure (hs would stretch) -stability -morbidity -cosmesis BPTB vs HS grafts Concerns
Tendon -dense connective tissue -distal larger & better developed -proximal is shorter, smaller, and has fleshy attachment to bone -collagen inserts into bone at 90 degree angle
Chemical Composition of Tendon -Collagen (70-80% type 1) -Ground substances (GAGS & H2O) -Water -extracellular processing-cross linking leads to the load bearing ability -don't have good blood supply -hemoglobin gives nutrients to these (when smoke CO2 goes in and not O2)
Collagen Disorders -Syndromes that are related to a decrease in COLLAGEN CROSS LINKING Ehler-Danlos Syndrom Osteogenesis Imperfecta Marfan Syndrome
small to large Tendon structure goes fromsmall to large or large to small?
cross sectional size and length longer=stretchier bigger=hold greater load amount of force resisted by tendons and absolute change in length during load is dependent on..
Protein degradation exceeds sythesis= decreased collagen Collagen and crosslink concentration decline and tendon weakens effects of immobility of tendons
extrinsic tendinitis tendinitis that is not caused by tendon itself but by an outside factor -Rotator cuff -ITB frichtion syndrome
Intrinsic Tendinitis -inflammation due to change or inadequacies within structure -due to inability for the tendon to match physical demands placed on it -overuse injury -Patellar, achilles, HS, or adductor all this
menisci -outer 1/3 is vascularized by genicular artery -flexion/extension -tibial rotation -help improve congruence in knee
meniscal tears verticle, radial, horizontal (cleavage), "bucket handle", "parrot beak", flap
Chondromalacia can have anywhere but common at knees -breakdown of articular cartilage; worse than arthritis
Plica syndrom thickened portions of capsule synovial _____ it inflates in knee
Osgood Schlatter -bony epiphysis (growing pains) -bone grows faster than muscle especially at joint -patellar tendon pulls on bone at growth plate!
Posture -3 dimensional alignment of body skeletal and soft tissue structure -optimal weight attenuation, shock absorption, and functional capactiy -optimal energy expenditure -efficient neuromuscular control -articulations protected mid-range
Primary curvature -"c" shpaed -concave anteriorly -present at birth -thoracic spine and sacrum
Secondary curvature -concave posteriorly -cervical: 3 months -lumbar:6-8 months
lordosis -saggital plane curvature with posterior concavity and anterior convexity -"bending backwards" -"hollow/saddleback"
kyphosis =curvature in saggital plane with anterior concavity and posterior convexity -"hump-back"
scoliosis -lateral curvature of spine -always associated with rotation -includes side-bending -"crooked"
Genu VALGUM -lateral tibial torsion -lateral patellar subluxation -subtalar pronation -excessive hip adduction -hip medial rotation
Genu VARUM (varus) -Tibial varum (excessive leads to ankle sprain) -medial tibial tornsion -hip lateral rotation -hip abduction
genu Recurvatum -ankle plantar flexion -anterior pelvic tilt -knee hyper extended -tight achilles -usually excessive pronate
genuflextion knee is flexed
tibial torsion -out toeing -excessive subtalar suppination
factors affecting posture -bony architecture -ligament laxity -muscle tone -lumbopelvic position -joint position/mobility -neurogenic outflow (nerve signals) -disease, pain, vision, hearing, respiration, work, weight, height, activity
endomorphic -heavier or fat build -large concave/convex joints -plenty of bulk ex. sumo wrestlers
ectomorphic -thin body build - small flat joints -limited muscle bulk -relatively low body weight
mesomorphic -sturdy, muscular body build -rectangular outline
congenital torticollis "turtle" -sidebending and rotation to opposite direction
lateral stabalizers quadratus lumborum, obliques, hip abductors and adductors inverters: tibialis posterior, FDL, FHL everters: peroneals -erector spinae
weak- left side neck, spine, and oblique tight-right side neck, spine, oblique if head is rotated right and side bend right -left should is higher -thoracolumbar: side bent toward right and right side of pelvis higher ---what muscles weak and what strong?
adducted if sidebent left and rotated right at the trunk, and left hip is higher...abducted or adducted at hips
weakened muscles that are shorted are going to be
congenital scoliosis -appreciable lateral convexity -caused by specific congenitally anomalous vertebrae (born with it) defects of formation: failure of vertebra part of vertebral segment (hemivertebra) defects of segmentation: failure of segmentation
idiopathic scholiosis -lateral curvature of the spine in an otherwise healthy child -no evidence of underlying neurologic or muscular disorders -no developmental anomalies -infantile (before 3)l juvinile (to puberty), adolescent (after puberty)
the type of scoliosis it is named after the direction in which the curve heads toward and the part of the spine (ex. right thoracic curve-curves at right shoulder)
cobb method -measuring angle/degree of scholiosis -30-40 degrees curve is not as harmful bc succession with back braces ->50 degrees bad
measuring or rotation -pedicles should be equidistant from midline -pedicle move toward midline=+1 - pedicle in midline=+2
torsional force with sidebending you get ______ force
paul harrington -though of rods in the back to fix scoliosis
ideal plumb alignment: -external auditory meatus -bodies of cervicle vertebrae -tip of acromion and shoulder joint -bodies of lumbar vertebrae -high point of iliac crest -greater trocanter, posterior to hipjoint -anterior to knee joint axis -anterior to lateral malleolu
static posture bring body parts close to line of gravity (plumb line) -rigid posture minimizes mvmnt of body -traditional posture
Created by: kruffer
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