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 |