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PT Semiar
Midterm Exam
| Term | Definition |
|---|---|
| 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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