Class 1 Overview & Fundamentals

Question 1

History Taking Priorities

Answer 1

• Location
• Stage of healing
• Severity
• MOI
• Learn provoking and relieving factors
• Establish affected function (ADLs, hobbies)
• Integrate info from other healthcare providers

Question 2

History Taking
The 4 quadrants

Answer 2

• Primary complaint Qs:
• Specific condition Qs:
• Lifestyle & ADLs Qs
• General health history Qs

Question 3

How to choose assessments:

Answer 3

• Approach 1 - rule-in a condition or affected tissue
• Approach 2 - rule-out a condition or affected tissue
• Approach 3 - red flag/safety
• Approach 4 - more information to direct your treatment
  Gathering info which backs up your clinical impression is helpful to direct your treatment.

Question 4

NEER protocol

Answer 4

• Name
• Explain (the process and your rationale)
• Execute (unaffected first, affected last)
• Results (verbalise results to the body and how that influences your treatment approach; accurately chart results)

Question 5

Principles:

Answer 5

• Superficial-deep-superficial
• General-specific-general
• Peripheral-central-peripheral
• Proximal-distal-proximal

Question 6

when giving home care we should:

Answer 6

1. Demo the home care
2. Observe the person doing the home care
3. Seek feedback about the home care (does it feel safe & effective)
4. Modify based on the person’s feedback
5. Express clear FIDS

Question 7

An ongoing plan should include

Answer 7

• a summary of treatment so far
• FIDS of ongoing treatment (next session and how many more sessions)
• reason/benefit of continuing treatment
• techniques/areas for future treatments
• asking consent to follow-up by email or phone and the reason for follow-up

Question 8

Goals need to have

Answer 8

• the objective (Increase AROM flexion),
• the technique (using G3 posterior glide mobilisation),
• and the tissue (to the L shoulder)

Question 9

Informed Consent
ABCDE

Answer 9

• A = areas of the body where treatment (including assessment and homecare) will be delivered
• B = benefits
• C = cautions/possible negative effects
• D = draping, disrobing, positioning
• E = empower and encourage (explain your rationale and encourage questions. Confirm consent to treatment)

Question 10

Stages of Healing Review - Acute

Answer 10

• Defined by the presence of edema,.
• Our goal is to reduce edema with RICE; manual lymphatic drainage; proximal massage, especially as it will help open up lymphatic pathways.
• We don’t work on, stretch, or apply heat to or distal to the affected tissue.
• Be careful with direct pressure or compression on the tissue. Use pillows.
• Be careful with position of the limb. Elevation is generally good; do not leave in a dependent position.

Question 11

Stages of Healing Review - Early Subacute

Answer 11

• Defined by a clear reduction in edema, though small amounts may be present and increase after increased use.
• Both pain and restriction of movement have lessened with the lessened edema, though still exist.
• We don’t work on, stretch, or apply heat to the affected tissue.
• Note, by affected tissue, we mean the site of an orthopedic injury. For example, in a hamstring strain, the site of the strain is the affected tissue. A GTO technique on the hamstrings which is not the site of injury is okay.

Question 12

Stages of Healing Review - Late Subacute

Answer 12

• Now that pain is generally mild and experienced only at end-range of movement, the focus switches to decreasing trigger points, pain, adhesions; promoting functional scar tissue formation; improving range and quality of movement, and increasing strength.
• We now work on-site.
• We can use pretty much whatever technique we’d like, with the caveat that we start with less aggressive techniques for less time than are used in chronic conditions

Question 13

Stages of Healing Review - Chronic

Answer 13

• There are still potential condition-specific precautions in chronic. Eg, it never makes sense to put someone into a MOI such as a dislocation; it never makes sense to stretch flaccid tissue or hypermobile joints.

Question 14

Acute History

Answer 14

• Just happened
• Mod-sev loss of function/ADLs

Question 15

Acute Observation

Answer 15

• SHARP

Question 16

Acute Movement

Answer 16

• Mod-sev limitation in range and pain with movement (edema and muscle guarding)

Question 17

Early subacute History

Answer 17

• Swelling has gone down
• Sli improvement in function but hasn’t really improved since swelling dissipated

Question 18

Early Subacute Observation

Answer 18

• If bruising, red/blue/purple

Question 19

Early Subacute Movement

Answer 19

• Generally painful throughout entire range of movement

Question 20

Late Subacute History

Answer 20

• Function has improved since the injury, eg, where previously it was difficult to dress, now it is easy

Question 21

Late Subacute Observation

Answer 21

• If bruising, yellow/green/brown

Question 22

Late Subacute Movement

Answer 22

• Generally painful only at end-range of movement/POP

Question 23

Chronic History

Answer 23

ADLs would be back to normal unless the injury was very severe

Question 24

Chronic Observation

Answer 24

• No Bruising

Question 25

Chronic Movement

Answer 25

* Generally not painful, but possible to have pain with tissue stress (load or POP)