Midterm Exam
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| Pathology/Injunry | Disease, disorder, condition
(ex. MS, Lupus, Tendinitis)
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| Impairments | altercations in anat/phys, or psychological structures or functions (ex.broken bone, ACL tear)
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| Functional Limitation | Inability to perform physical task or activity (ex. not being able to dress yourself)
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| Active Pathology | Bob presents to PT with diagnosis of Insulin Dependent Diabetes Mellitus. Based on Nagi model, this is best described as:
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| Functional Limitation | Helga presents to PT and reports inability to dress herself independently. Based on Nagi model, this is:
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| Impairment | Barry presents to PT with decreased strength with arm abduction. Based on Nagi model, this is:
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| 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:
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| Disability | Inability or limitation in performing activities related to s0ciocultural context (role in society; not able to do occupation)
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| Disablement Process/ Model- Nagi | Pathology/Injury, Impairment, Functional limitation, Disability
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| Primary Level of intervention | Health promotions, screens, ect
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| secondary level of prevention | decrease duration/ sequelae by early diagnosis & intervention
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| Tertiary level of intervention | limiting degree of disability for chronic/ irreversible conditions
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| examination | Includes : History, Systems Review, and Test & Measures
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| 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:
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| Interventions | -Coordination, communication, and documentation
-patient/client related instruction
-direct interventions (seen most in clinic)
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| Preffered Practice Patterns | How many of each:
-Musculoskeletal
-Neuromuscular
-Cariopulmonary
-Integumentary
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| 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
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| 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
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| Patient/Client Management (5) | -Evaluation
-Examination
-Diagnosis
-Prognosis
-Intervention
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| Systems Approach | -Examination
-Evaluation
-Rehabilitation
-Wellness/Fitness
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| Evalutation | Includes:
Subjective examination-what they tell you
objective examination-find out yourself
assessment-what you think they need
plan
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| 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
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| Cancer | -Persistent night pain
-constant pain
-unexplained weight loss (10-15lb n <2 weeks)
-loss of appetite
-unusual lums or growths
-unwarranted fatigue
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| Cardiovascular | -SOB
-dizziness
-heaviness in chest
-pulsating ("throbbing") pain
-constant & severe LE (calf) or UE pain
-discolored or painful feet
-swelling
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| Gastrointestinal/Genitourinary | -frequent of severe abdominal pain
-frequent heartburn or indigestion
-frequent nausea or vomiting
-change in bladder function (UTI)
-Unusual menstrual irregularity
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| 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
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| Miscellaneous | -fever or night sweats
-emotional disturbances
-sweling or redness in joint w/o hx of injury
-pregnancy
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| Crepitus Cinema sign Vertigo Tinnitus | Popping, rubbing together
Patella Maltracking (long time sitting)
Room is spinning
-Ringing in ear
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| TYPES OF PAIN: Bone Vascular-> Muscle~ Nerve: |
Deep, boring, localized
->diffuse, aching, poorly localized
~dull, aching, cramping
:sharp, shooting, bright, lightening like
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| Subjective Exam | All should be talked about in _____ exam:
-Occupation
-Recreation
-Functional Limitations
-Personal Goals
-family history
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| 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
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| 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)
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| -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
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| Active Motion | Ask:
When and where the pain is
Look at:
Quality/intensity of sx
reaction, restriction, rhythm
pattern
willingness
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| Passive Motion & End Feel | -where, when, intensity, quality of pain
-Normal end Feel:
--boney=hard
--soft tissue=soft
--tissue stretch=firm
-Capsular pattern
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| Capsular pattern | pattern of motion restriction
if wrong, may suggest entire capsule is restricted
ex. knee: flexion more limited than extension
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| -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
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| -size: hypertrophy, atrophy, swelling -length -strength -tissue texture -facilitation or inhibition | Contractile tissue we're assessing for (6)
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| Selective Tissue Testing | Testing muscle lenght & contractile properties
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| 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?
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| 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
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| Functional Assessment | -ADLs-activities of daily living
-Work related tasks
-Recreational activities
-Sports activities
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| 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
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| Motion Analysis | -gait assessment
-treadmill walking
-lifting
-sport specific
-work related
-motion analysis equipment
-after you have measures, use and apply them to this
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| Palpation for Tenderness | Palpate for condition
Palpate for provocation
Does it hurt?
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| Neurological | -Segmental Distribution
-Neuromuscular
-Neurovascular
-Neural Tissue Tension Tests
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| Problem List | -list of what is not normal
-rate: pain, strength, measurements, mobility, ect
-this is created by measures found in exam
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| -pain , strength, ROM, joint mobility, muscle length/pliability, proprioception, tissue texture abnormalities, girth, ambulation, special function, functional index | Problem lists includes (11)
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| 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
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| Problem List | Summary of objective findings
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| Assessment | - Problem List
- Short Term and Long Term goals
- Prognosis
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| Prognosis | - how someone will respond to PT
-ex. want to increase flexibility of hamstring to increase ability to go up stairs
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| Plan of Care | -Specific interventions that address the objective findings (short & long term goals)
-Duration and frequency of threrapy
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| 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
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| Gross Ligamentous Structure | -dense, white bands of connective tissue
-functional stubunits
-have poor blood supply but are not inert
-capsuloligamentous relationship
-synergistic relationship
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| 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
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| Mechanoreceptor | what action of the ligament shut down the quads when ACL tore
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| C-Type Nerve Fibers | ACL contains them
Pain nerve fibers
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| Ligament Ultrastructural Organization | Bony interface with fibrocartilaginous cells
(Sharpy's fibers')
Midsubstance made of fibroblast and crossfibers
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| Biochemical comoposition of ligaments | 2/3 H2O
1/3 SOLID
- 75% collagen
- proteoglycans
-elastin
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| Soft Tissue mechanics of ligaments | load-deformation behavior
stress and strain
fiber recruitment depends on joint at time of loading
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| Ligament Viscosity | "fluid like" qualities
Load relaxation
Cyclic Loading
- these means ligaments can be trained
these properties in ligaments are dominant in kids
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| Ligament elasticity | Ligament has the ability to completely recover to its resting length
- these behaviors dominant at larger loads
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| 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
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| Use it or lose it -bony insertions recover more quickly than the midsubstance | Effects of immobilization "moto"
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| 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
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| MCL | First limit to valgus force
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| triad | MCL, Medial Meniscus, ACL
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| PCL | Secondary to valgus restraint
Primary restraint to posterior translation 90%
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| Meniscofemoral ligament | ligament of humphrey
ligament of wrisberg
-> help to prevent posterior translation
->both are taut with internal rotation of the tibia
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| ACL | -Primary restraint to anterior translation
-Restraint to internal tibial rotation with PCL. Secondary restraint to valgus w/PCL
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| Grade 1 Grade 2 Grade 3 | Incomplete tear (no instability)
more significant partial tear with some noted instability
Complete tear with complete instability
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| Position of injury | Range of instability in ligamentous injury is related to
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| 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
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| ACL graft reconstruction | Graft - Autograph (self), Allograph (dead), Xenograft(other animal), Artificial graft
Accelerated Rehab- BPTB graph; Shelbourne & Nitz(has patients move earlier)
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| -graft failure (hs would stretch) -stability -morbidity -cosmesis | BPTB vs HS grafts Concerns
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| 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
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| 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)
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| Collagen Disorders -Syndromes that are related to a decrease in COLLAGEN CROSS LINKING | Ehler-Danlos Syndrom
Osteogenesis Imperfecta
Marfan Syndrome
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| small to large | Tendon structure goes fromsmall to large or large to small?
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| 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..
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| Protein degradation exceeds sythesis= decreased collagen Collagen and crosslink concentration decline and tendon weakens | effects of immobility of tendons
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| extrinsic tendinitis | tendinitis that is not caused by tendon itself but by an outside factor
-Rotator cuff
-ITB frichtion syndrome
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| 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
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| menisci | -outer 1/3 is vascularized by genicular artery
-flexion/extension
-tibial rotation
-help improve congruence in knee
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| meniscal tears | verticle, radial, horizontal (cleavage), "bucket handle", "parrot beak", flap
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| Chondromalacia | can have anywhere but common at knees
-breakdown of articular cartilage; worse than arthritis
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| Plica syndrom | thickened portions of capsule
synovial _____
it inflates in knee
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| Osgood Schlatter | -bony epiphysis (growing pains)
-bone grows faster than muscle especially at joint
-patellar tendon pulls on bone at growth plate!
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| 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
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| Primary curvature | -"c" shpaed
-concave anteriorly
-present at birth
-thoracic spine and sacrum
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| Secondary curvature | -concave posteriorly
-cervical: 3 months
-lumbar:6-8 months
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| lordosis | -saggital plane curvature with posterior concavity and anterior convexity
-"bending backwards"
-"hollow/saddleback"
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| kyphosis | =curvature in saggital plane with anterior concavity and posterior convexity
-"hump-back"
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| scoliosis | -lateral curvature of spine
-always associated with rotation
-includes side-bending
-"crooked"
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| Genu VALGUM | -lateral tibial torsion
-lateral patellar subluxation
-subtalar pronation
-excessive hip adduction
-hip medial rotation
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| Genu VARUM (varus) | -Tibial varum (excessive leads to ankle sprain)
-medial tibial tornsion
-hip lateral rotation
-hip abduction
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| genu Recurvatum | -ankle plantar flexion
-anterior pelvic tilt
-knee hyper extended
-tight achilles
-usually excessive pronate
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| genuflextion | knee is flexed
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| tibial torsion | -out toeing
-excessive subtalar suppination
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| 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
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| endomorphic | -heavier or fat build
-large concave/convex joints
-plenty of bulk
ex. sumo wrestlers
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| ectomorphic | -thin body build
- small flat joints
-limited muscle bulk
-relatively low body weight
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| mesomorphic | -sturdy, muscular body build
-rectangular outline
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| congenital torticollis "turtle" | -sidebending and rotation to opposite direction
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| lateral stabalizers | quadratus lumborum, obliques, hip abductors and adductors
inverters: tibialis posterior, FDL, FHL
everters: peroneals
-erector spinae
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| 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?
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| adducted | if sidebent left and rotated right at the trunk, and left hip is higher...abducted or adducted at hips
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| weakened | muscles that are shorted are going to be
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| 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
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| 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)
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| 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)
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| cobb method | -measuring angle/degree of scholiosis
-30-40 degrees curve is not as harmful bc succession with back braces
->50 degrees bad
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| measuring or rotation | -pedicles should be equidistant from midline
-pedicle move toward midline=+1
- pedicle in midline=+2
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| torsional force | with sidebending you get ______ force
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| paul harrington | -though of rods in the back to fix scoliosis
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| 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
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| static posture | bring body parts close to line of gravity (plumb line)
-rigid posture minimizes mvmnt of body
-traditional posture
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