Exam 1 Flashcards
(32 cards)
Whats on a chart review?
onset (date/reason)
current condition
comorbitites
home/living status
why patient needs pt
precuations
medications
overall tolerance to activity
Vital signs: normal values, what they mean, abnormal vitals
Normal:
Pulse= 60-100 bpm
respiratory rate= 12-20 breaths per minute
Blood presure= 120/80 mmhg
temp= 98.6 or 37 C
Pain and pulse oximetry
Abormal:
brachycardia= less than 60 bpm
tachycardia= greater than 100 bpm
bradynpnea= less than 12 breaths per minute
tachypnea= greater than 20 breaths per minute
hypertension= 140/90 mm or higher
hypotension= lesser than 90/60 mmhg
Pain medications
include examples, indication,
Opioids (Narcotics)
Examples: Oxycodone, Percocet, Dilaudid, Fentanyl, Morphine, Codeine
Indication: Severe pain management, often used post-surgery.
Non-Opioids (Over-the-Counter Medications)
Examples: Acetaminophen (Tylenol), NSAIDs (Aspirin, Naproxen, Ibuprofen, Celecoxib)
Indication: Pain relief, fever reduction, anti-inflammatory.
High blood pressure medication
include examples, indication,
ACE Inhibitors
Examples: Benazepril, Lisinopril
Indication: Prevents blood vessel constriction by inhibiting angiotensin II, used to lower blood pressure.
Diuretics
Examples: Lasix, Bumex, Lozol
Indication: Reduces blood volume, helping to lower blood pressure.
Beta-Blockers
Examples: Atenolol, Nadolol, Propranolol
Indication: Lowers blood pressure by reducing heart rate and force of contraction.
Anti-inflammatory medications
include examples, indications,
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Examples: Aspirin, Ibuprofen, Naproxen Sodium, Diclofenac, Celecoxib
Indication: Treats pain, fever, and inflammation.
.
Corticosteroids
Examples: Prednisone, Cortisone, Triamcinolone, Dexamethasone
Indication: Strong anti-inflammatory agents used for conditions like arthritis, lupus, and certain cancers.
Cholestrol-lowering medications
examples and indications
Examples: Lipitor, Crestor, Zocor
Indication: Reduce cholesterol levels to lower the risk of heart attack or stroke.
Blood thinners
Examples and indications
Anticoagulants
Examples: Eliquis, Heparin, Warfarin (Coumadin)
Indication: Purpose is to reduce
coagulation of blood and
reduce clotting. Prevents blood clots in patients at risk of stroke or heart attack.
Antiplatelet Medications
Examples: Aspirin, Plavix
Purpose is to keep
platelets from sticking to
each other and to walls of
blood vessels
often prescribed to
decrease risk of future
blood clots. Not as strong
as anti-coagulants
Psychotropic drugs
examples and indications
Examples: Antidepressants, anti-anxiety meds, mood stabilizers, antipsychotics, ADHD meds
Indication: Alters mood, behavior, or perception, used in various mental health conditions.
Reflexes their spinal levels and how to document
Spinal Levels:
Achilles Reflex: S1
Patellar Reflex: L2-L4
Biceps Reflex: C5-C6
Triceps Reflex: C6-c7
brachioradialis-c5,c6
How to Document:
0: No response
1+: Diminished
2+: Normal
3+: Brisker than average
4+: Hyperactive with clonus
Primitive Reflexes (babinski and hoffman)
Babinski Reflex: Stroke the plantar surface of the foot. A positive test indicates upper motor neuron involvement and is signified by the extension of the big toe and fanning of the other toes.
Hoffman’s Reflex: Flick the nail of the middle finger, and a positive response is the flexion of the thumb and index finger, indicating upper motor neuron dysfunction (e.g., cervical myelopathy).
Goniometry: How to Do It, Landmarks for Shoulder Motions, Normal Ranges
Shoulder Flexion:
Normal Range: 0° to 180°
Landmarks:
Fulcrum: Lateral aspect of the greater tubercle of the humerus.
Stationary Arm: Parallel to the midaxillary line of the thorax.
Moving Arm: Aligned with the lateral midline of the humerus, using the lateral epicondyle as a reference.
Shoulder Extension:
Normal Range: 0° to 60°
Landmarks:
Fulcrum: Lateral aspect of the greater tubercle of the humerus.
Stationary Arm: Parallel to the midaxillary line of the thorax.
Moving Arm: Aligned with the lateral midline of the humerus, using the lateral epicondyle as a reference.
Shoulder Abduction:
Normal Range: 0° to 180°
Landmarks:
Fulcrum: Anterior aspect of the acromion process.
Stationary Arm: Parallel to the midline of the sternum.
Moving Arm: Aligned with the anterior midline of the humerus, using the medial epicondyle as a reference.
Shoulder Adduction:
Normal Range: 0° (return to neutral after abduction; typically not measured beyond neutral).
Landmarks:
Same as abduction.
Shoulder Internal Rotation:
Normal Range: 0° to 70°
Landmarks:
Fulcrum: Olecranon process of the ulna.
Stationary Arm: Perpendicular to the floor.
Moving Arm: Aligned with the ulna, using the ulnar styloid process as a reference.
Shoulder External Rotation:
Normal Range: 0° to 90°
Landmarks:
Fulcrum: Olecranon process of the ulna.
Stationary Arm: Perpendicular to the floor.
Moving Arm: Aligned with the ulna, using the ulnar styloid process as a refere
Capsular Pattern of Shoulder – What Does It Mean?
Capsular Pattern: A specific, predictable pattern of motion loss that indicates a problem with the joint capsule.
For the Shoulder:
The capsular pattern is loss of external rotation > abduction > internal rotation.
What it means: The presence of this pattern indicates that the joint capsule is the source of limitation, often seen in conditions such as arthritis, capsular inflammation, capsular tightness, intra-articular surface.
Anterior portion (limits external rotation)
Posterior portion (limits internal rotation)
Inferior portion (limits abduction)
Reliability – Inter-rater and Intra-rater
Inter-rater Reliability: Refers to the consistency between different examiners.
Margin of Error: Generally 5-6 degrees, due to variability in technique and examiner skill.
Intra-rater Reliability: Refers to the consistency of measurements when taken by the same examiner.
Margin of Error: Typically smaller (3-4 degrees), since the same examiner is repeating the measurement.
MMT: Grading Scales, How to Do It, Limitations of It
5 (Normal): Full ROM against gravity with maximum resistance.
4+: Holds position against
moderate to strong pressure
4 (Go Full ROM against gravity with moderate resistance.
4- Holds position
against slight to moderate pressure
3+: Holds test position against slight pressure
3 (Fair): Full ROM against gravity with no resistance.
3-: Gradual release from test position in against-gravity position. (In
against-gravity position, moves through more than 50% ROM)
2+: Moves through partial ROM
against gravity (first 50%). In gravity
eliminated position, moves to end range and
holds against pressure
2 (Poor): Full ROM in gravity-eliminated position.
2-: Moves through partial ROM
in gravity minimized position
1 (Trace): Palpable contraction, no movement.
0 (Zero): No contraction observed.
Limitations of MMT:
Subjective: The amount of resistance applied can vary between testers, making it somewhat subjective.
Not Sensitive to Small Changes: MMT detects gross changes in muscle strength but is not sensitive enough to detect subtle differences.
Not Suitable for CNS Disorders: In patients with central nervous system disorders, MMT may not be able to accurately reflect functional strength.
Other Types of Muscle Testing
Isokinetic Muscle Testing
Measures muscle strength at different velocities. Provides a detailed analysis of muscle strength throughout a joint’s full range of motion
Handheld Dynamometry
A portable device used to measure muscle force output.
Norms for Isokinetic Tests (Quad/Hamstring Ratio)
Quad/Hamstring Ratio:
The quadriceps to hamstring strength ratio should generally be 3:2 (or 60% hamstring strength to quadriceps strength).
Clinical Significance: This ratio is used to assess muscle balance around the knee, which is important for injury prevention (e.g., ACL injuries).
Advantages and Disadvantages of Isokinetic Testing
Advantages:
Allows us to test at different velocities
Provides quantifiable measures of force
output (to the nearest foot/lb)
Provides graphic display of force output
during entire contraction
Allows us to measure force of concentric,
eccentric and isometric muscle contractions
Can also test power and endurance
Disadvantages:
expensive
Time consuming
Not all joints can be tested
Testers need to be trained
Does not always relate to function
Primary Impairments vs Secondary Impairments
Primary Impairments: Direct result of pathology (e.g., muscle weakness due to stroke).
Secondary Impairments: Develop as a consequence of the primary impairment (e.g., decreased endurance or joint contracture due to immobility from weakness).
Convex/Concave Rule
If a concave surface moves on a convex surface, the roll and glide occur in the same direction.
If a convex surface moves on a concave surface, the roll occurs in the same direction as the bone movement, but the glide occurs in the opposite direction
Nagi & ICF Models
Nagi Model:
Pathology → Impairment(consequence of pathology, like reduced rom, decreases balance, strength endurance. → Functional Limitation (ability to perform a task )→ Disability.
Describes the progression from a medical condition (pathology) to a disability affecting daily life.
ICF Model:
The International Classification of Functioning, Disability, and Health (ICF) emphasizes functioning rather than just disability.
It includes:
Health Condition: The disease or disorder.
Body Function/Structure: Impairments such as limited ROM or strength.
Activity: Limitations in performing tasks (e.g., walking, dressing).
Participation: Restrictions in societal roles (e.g., work, community participation)
Passive and Active insuffiency?
Passive Insufficiency
Passive Insufficiency: Occurs when a muscle cannot stretch enough across two joints to allow for full ROM at both joints.
Example: The hamstrings are stretched when the hip is flexed and the knee is extended, limiting the ROM at the hip or knee.
Active Insufficiency: Occurs when a muscle is shortened across two joints and cannot generate maximal force.
Example: The hamstrings are actively insufficient when attempting to contract while the hip is extended and the knee is flexed.
How to Test the Length of a Muscle
Muscle Length Testing: Stretch the muscle across both joints it crosses and measure the length at one of those joints.
Example: For hamstrings, extend the hip and flex the knee to measure the muscle length.
Capsular Patterns – What It Means if the Patient Is in One
Capsular Pattern: A pattern of motion restriction that is characteristic of a joint capsule issue (e.g., arthritis or capsulitis).
Shoulder: External rotation is most restricted, followed by abduction, and then internal rotation.
AROM vs PROM – What Are the Differences?
Active Range of Motion (AROM): Movement performed by the patient voluntarily.
Significance: AROM provides information about strength, coordination, and willingness to move.
Passive Range of Motion (PROM): Movement performed by the therapist, with no assistance from the patient.
Significance: PROM provides information about joint integrity and flexibility, but not about muscle strength.
