Exam I Flashcards
(129 cards)
1
Q
what are the four components of the Nagi Model?
A
Pathology → Dysfunction → Functional Limitation → Disability
2
Q
what is impairment? what are some examples?
A
impairment is synonymous with dysfunction
examples: decreased ROM, decreased strength
3
Q
what is tissue impairment? what are some examples?
A
more detailed than impairment, but less specific than tissue-specific impairments
examples: torn muscle (causing decreased ROM), weak rotator cuff muscles
4
Q
what is tissue-specific impairment (TSI)? what are some examples?
A
reference impairments to the actual tissue that is involved and the side of the body the pathology is located
examples: partial tear of the left supraspinatus muscle, weakness of the right infraspinatus muscle
5
Q
can swelling be considered a tissue-specific impairment?
A
never, swelling is only considered an impairment
6
Q
what is swelling inside the joint called?
A
effusion
7
Q
what is swelling outside of the joint called?
A
edema
8
Q
what is a functional goal?
A
- something that is measurable and functional
- increasing range of motion is NOT a functional goal; however, increasing the range of motion to allow the patient to reach overhead into a cabinet is a functional goal
9
Q
what is the biomedical model?
A
disability is directly caused by a disease, trauma, etc.
cause → cure
10
Q
what is the biopsychosocial model?
A
integrates biological, social, and psychological factors
11
Q
what is symptom?
A
subjective complaint, what the patient tells you
12
Q
what is a sign?
A
what can be observed and measured
13
Q
what is etiology?
A
- cause or the start of the impairment; can be identified by asking questions such as: “How did this happen?”, “When did this happen?”, etc.
- the cause may often be unknown
14
Q
what is pathogenesis?
A
pathological process of disease
15
Q
what are Clinical Manifestations/Clinical Features?
A
another way of saying, “Signs and Symptoms”
16
Q
what are examination step, test, and finding?
A
examination step: the step performed
examination test: test or measure performed during specific examination step
examination finding: data obtained from a specific test or measure
17
Q
what is a joint manipulation (mobilization)?
A
a skilled passive movement to a joint
18
Q
what are steps 1-6 of a clinical examination?
A
(1) Intake Forms Assessment
(2) Initial Observation
(3) History
(4) Systems Review
(5) Screening
(6) Structural Inspection
*IIH - Triple S
19
Q
what are steps 7-12 of a clinical examination?
A
(7) Palpation for Condition
(8) Joint Active ROM
(9) Joint Passive ROM
(10) Muscle Selective Tissue Tension
(11) MLT
(12) MMT
*PJJ - Triple M
20
Q
what are steps 13-18 of a clinical examination?
A
(13) Special Tests
(14) Neurovascular
(15) Palpation for Tenderness
(16) Movement Analysis
(17) Diagnostic Imaging
(18) Evaluation/Diagnosis/Prognosis
*SNP - MDE
21
Q
what are the 5 normal end feels?
A
(1) normal muscle/soft tissue approximation
(2) normal muscle
(3) normal ligament
(4) normal cartilage/bone
(5) normal capsular
22
Q
what are the 9 abnormal end feels?
A
- CJ - BAD - CAPS
(1) capsule tightness
(2) joint adhesions
(3) bony block
(4) abnormal cartilage
(5) displaced meniscus
(6) capsule/ligament laxity
(7) abnormal muscle
(8) pannus
(9) swelling
23
Q
is pain an end feel?
A
no; the therapist can’t feel the pain
24
Q
what are the cardinal signs of inflammation? (5)
A
(1) Color - redness
(2) Temperature - heat
(3) Swelling - fluid
(4) Pain
(5) Loss of function
25
is every swollen state inflamed?
inflammation IS swelling, BUT not every type swelling is inflammation because fluid can be present without an active process of healing
26
what is inflammation defined as?
the swelling that presents immediately after an injury; this is when the damaged tissue is being broken down, and the body is attempting to replace the damaged cells with healthy ones
27
what are the steps of patient management leading to optimal outcomes? (6)
(1) examination
(2) evaluation
(3) diagnosis
(4) prognosis
(5) intervention
(6) outcomes
28
what are the purposes of an examination? (3)
(1) as a screen to determine if the patient needs PT
(2) determine if the patient needs a referral
(3) provides starting point for intervention and way to measure progress
29
what is involved with the evaluation? (2)
(1) dynamic process requiring critical thinking and judgement based on data from examination
(2) determine TSIs and potential problems
30
what is involved with the diagnosis?
the diagnosis is two-fold; it's both the process of the evaluation and evaluating data from the examination to help determine the most appropriate intervention strategies
31
what is the difference between a diagnosis by an MD and a PT?
MDs diagnose disease and pathology; PTs diagnose tissue and movement impairments
32
what is involved with the prognosis?
determine the level of optimal improvement that might be attained through our intervention and the amount of time required to reach that level
33
what is involved with the intervention?
the plan of care, which involves the purposeful and skilled interaction of the physical therapist with the patient
34
what is involved with the outcomes?
the results of our patient/client management; it is how much improvement, or lack thereof, the patient gained
35
what is disability defined as?
the inability to perform actions, tasks and activities related to required self-care, home management, etc.
36
how are the 18 steps of a clinical examination progressed?
the steps progress from least aggressive to the most aggressive
37
what is a structural dysfunction? can physical therapists change structural problems?
a dysfunction due to the shape of the bone; structural changes can't be attained by a physical therapist's hands
38
what is a functional dysfunction? can physical therapists change functional problems?
a dysfunction due to soft tissue problems (ex. tight muscles, weakness, joint laxity, etc.); these dysfunctions can be changed by manual therapy and changes to the muscular system
39
what types of examination findings do you get from performing palpation for condition?
warmth, swelling, scar, atrophy, scar, moisture, gap in muscle
40
what are the tissue-specific impairments that can be determined solely by palpation for condition?
edema only; effusion can be suspected with palpation for condition but can't be confirmed until PROM accessory has been performed
41
what are six characteristics of normal AROM?
(1) takes place smoothly-regardless of speed
(2) adequate relaxation of antagonists
(3) range is full-according to body type
(4) pain free
(5) muscles are of normal strength since they have to move through the range against gravity
(6) will be less than passive ROM
42
what are six characteristics of dysfunctional AROM?
(1) limited range
(2) unwillingness to move
(3) painful arc (pain in the middle of ROM, typically used about the GH joint flexion and abduction)
(4) compensatory movement
(5) presence of crepitus (noises)
(6) pain at the end of range
43
which ROM is greater, PROM or AROM?
PROM is always greater than AROM, there is no exception to this rule
44
what are the two types of PROM?
(1) Classical (Osteokinematic) movement
| (2) Accessory (Arthrokinematic) movement
45
what 3 pieces of data must you obtain from PROM?
(1) quantity: normal, hyper, hypomobile (also ROM for goni measurements)
(2) quality: end-feel
(3) patient response: pain, tightness, increased symptoms
46
why is mobility of a joint tested before the length of soft tissue?
tissue length cannot be evaluated if joint ROM is limited (ex. an MLT test on a joint with capsule tightness will yield a false positive)
47
what are the five findings that all capsular patterns have?
(1) decreased AROM
(2) decreased classical PROM quantity
(3) decreased classical PROM quality
(4) decreased accessory PROM quantity
(5) decreased accessory PROM quality
48
what is the purpose of MSTT testing?
to determine the dysfunction that is present within the musculotendinous unit
49
what tissue impairment is present with MSTT findings:
Resistance: can hold
Pain: No
What tests are needed to confirm?
tissue impairment: normal
| further tests: none
50
what tissue impairment is present with MSTT findings:
Resistance: can hold
Pain: Yes
What tests are needed to confirm?
```
tissue impairment: tendonitis/osis
further tests:
(1) palpation for tenderness
(2) MLT/PROM Classical
(3) palpation for condition
```
51
what tissue impairment is present with MSTT findings:
Resistance: can NOT hold
Pain: Yes
What tests are needed to confirm?
tissue impairment: partial tear
further tests:
(1) palpation for condition
(2) palpation for tenderness
52
what tissue impairment is present with MSTT findings:
Resistance: can NOT hold
Pain: No
What tests are needed to confirm?
tissue impairment: complete tear
further tests:
(1) palpation for condition
(2) MMT
53
when would an MMT be held during an examination?
when an MSTT is painful; if pain is present during submax contraction, it will be present with maximal contraction
54
when would an MLT be held during an examination?
when an MSTT is both WEAK and PAINFUL; this indicates a possible partial tear, which could be made worse by an MLT
55
how should palpation for tenderness be evaluated? (3)
(1) performed toward the end of the examinations as to not prematurely aggravate the patient
(2) palpate using 1 finger
(3) gradually palpate into the tissue with greater depth
56
what is an accessory motion?
motions that accompany the classical motions; synonymous with arthrokinematic movement
57
what are the two types of accessory movements?
(1) component motions
| (2) joint play motions
58
what are component motions?
motions that take place at a joint surface in order to facilitate a particular movement
(ex. glides)
59
what are joint play motions?
detect the ability of a joint to relieve and absorb extrinsic forces
(ex. distractions and tilts)
60
are component motions or joint play motions under voluntary control?
component motions are under voluntary control; joint play motions are NOT under voluntary control
61
if a concave surface moves on a convex surface, in which direction are the roll and glides?
the roll and glide are in the same direction
62
if a convex surface moves on a concave surface, in which direction are the roll and glides?
the roll and glide are in opposite directions
63
what direction is the roll in relationship to the osteokinematic (classical) motion?
the roll and classical motion are always in the same direction
64
what is traction? where is the application of force?
traction is used to separate joint surfaces and to make room for neural elements; force is applied along the axis of the long bone (parallel)
65
what is distraction? where is the application of force?
distraction manipulations are intended to create joint separation; force is applied perpendicular to the concave surface of the joint
66
what are the purposes of manipulation? (6)
(1) Examination and treatment of accessory motion
(2) Restore normal motion
(3) Improves function and performance
(4) Decreases pain
(5) Improves tolerance to insult
(6) Aids nutrition and repair
67
describe the motion during Grade I, II, III, IV mobilizations
Grade I - gentle, 10-25%
Grade II - 0-50% oscillating
Grade III - 50-90% oscillating
Grade IV - 100% end range, hold for 10 seconds
68
what effect do each grade of joint mobilization have?
Grade I - Neurophysiological (for pain)
Grade II - Neurophysiological & Mechanical (decreased viscosity)
Grade III - Mechanical (decreased viscosity and tissue stretching)
Grade IV - Mechanical (capsular stretch)
69
what is the purpose of putting the joint in a loose packed position for mobilizations?
the tissues surrounding the joint are on the most amount of slack; attempting to isolate the joint capsule
70
how is an MSTT performed?
with 2 fingers, having the patient hold for 3 seconds
71
what is the main difference between tendonitis and tendonosis?
tendonitis has inflammation present while tendonosis does not
72
who created the classification for joint mobilization grades?
Geoffrey Maitland
73
what are the criteria to adhere to when performing a manipulation? (8)
(1) Patient position
(2) Therapist Position
(3) Loose pack position
(4) Joint alignment
(5) Stabilizing hand
(6) Manipulating hand
(7) Direction of force
(8) Amount of force
74
what is a tissue specific impairment that can cause altered joint alignment?
capsule or ligament laxity, instability or hypermobility
75
what are the principles of treatment? (6)
(1) Do no Harm
(2) Base treatment on accurate diagnosis and prognosis
(3) Select treatment with specific aims
(4) Cooperate with the laws of nature
(5) Be realistic and practical in your treatment
(6) Select treatment for your patient as an individual
76
what is the main difference between how a physician treats patients compared to how a PT treats patients?
therapy is disability oriented rather than pathology oriented
77
what elements must be known before selecting a treatment? (5)
(1) tissue specific impairment
(2) stage of condition
(3) tissue reactivity
(4) subject reactivity
(5) functional goals
78
what is the difference between an adhesion at a joint compared to a tight capsule?
an adhesion limits motion in one direction, while capsule tightness that limits motion in all directions
79
what are the stages of condition?
(1) immediate behavior
(2) acute behavior
(3) sub-acute behavior
(4) chronic behavior
(5) chronic condition
80
what classifies an injury as displaying acute behavior for the state of condition?
- the condition is worsening
| - cardinal signs of inflammation are commonly present
81
what classifies an injury as displaying sub-acute behavior for the state of condition?
- the condition is starting to improve
- warmth and swelling is commonly present
- pain can be present, but the pain is improving
82
what classifies an injury as displaying chronic behavior for the state of condition?
- the condition is stable
- warmth is absent
- typically pain has resolved
83
what classifies an injury as displaying a chronic condition for the state of condition?
- signs or symptoms have become persistent well beyond a tissue full healing
- might have swelling, but no active inflammation
- majority of tissue has healed, but maybe not properly
84
what are the time frames for healing?
- Inflammatory healing: 3-14 days
- Proliferation: 2 weeks - 1-2 months
- Remodeling: anytime greater than 1-2 months
85
what stage of condition is someone considered to be in after immobilization?
sub-acute
86
what are the therapeutic goals of an injury presenting with acute behavior?
prevent the condition from worsening; decrease the swelling, pain, and protect the injured area
87
what are the therapeutic goals of an injury presenting with sub-acute behavior?
continue to facilitate the healing process; tissue is still fragile and must be treated delicately as to not cause re-injury and result in the patient digressing back into an acute stage
88
what are the therapeutic goals of an injury presenting with chronic behavior?
restore the tissue back to normal; during this stage you can begin “fixing” the problem
89
what are the therapeutic goals of an injury presenting with chronic condition?
determine why the patient has persistent signs/symptoms despite healing being complete
90
what is tissue reactivity?
how irritable the tissue is; delicate tissue will present with pain
91
what are the three classifications of tissue reactivity?
(1) High - pain is present before an end-feel can be reached, or resistance of tissue
(2) Moderate - able to determine end-feel and the patient complained of pain
(3) Low - able to determine end-feel with no pain
92
how is tissue reactivity determined?
by applying a tensile load to the tissue; MUST BE A PASSIVE STEP
93
determining tissue reactivity must be a passive or an active step?
PASSIVE
94
If a patient reported pain during the performance of MSTT would you continue on and perform MMT?
no; if you have pain during a sub-max contraction, pain will obviously be present during max contraction
95
what are the three classifications of subject reactivity?
(1) High - patient can't carry out their functional tasks due to complaints (pain)
(2) Moderate - patient can carry out activity, but has pain after, OR has pain during activity but is able to complete the task
(3) Low - patient can carry out functional tasks without complaints during; may or may not have post activity complaints
96
what are four aspects that make a functional goal?
(1) measurable
(2) objective
(3) applicable
(4) realistic
97
what are the four treatment categories of intervention?
(1) palliative
(2) preparatory
(3) corrective
(4) supportive
98
what is a palliative treatment intervention defined as?
easing symptoms and complaints without necessarily taking away the cause
99
what is involved with palliative treatment interventions?
treatment should attempt to relieve whatever complaint your patient is reporting; modalities (IFC, CP, etc.), gentle massage, grade I and grade II manipulations, therex @ 50% 1-RM
100
a patient presenting with high tissue reactivity will always require what type of treatment?
palliative
101
what is a cardinal sign that quite often (but not always) sets a patient apart from being in an acute SOC verses a sub-acute SOC?
redness
102
what is a preparatory treatment intervention defined as?
preparing the tissue for the corrective treatment; prior to performing the treatment that most directly targets the overall impairment, you will need to prepare, or "warm-up", the tissue for whatever is about to come
103
what is involved with preparatory treatment interventions?
heat could be used before stretching, CP to decrease swelling, mobilizations to decrease joint viscosity, therex @ 50% 1-RM to increase blood flow, etc.
104
what SOC would heat NOT be used as a modality?
acute SOC; you don't apply heat to active inflammation
105
what is a corrective treatment intervention defined as?
this is the treatment that attempts to actually “correct" or "fix” the impairment (ex. strengthening to correct a weakness, or joint manipulation grades III or IV to correct a capsule tightness)
106
what is one of the most important corrective interventions that EVERY patient should receive?
patient education; you MUST always educate the patient in something specific to them
107
what is involved with corrective treatment interventions?
typically some form of exercise; (ex. consider that coordination exercise (60% of 1 RM/25-30 reps) is necessary for tonic muscles, whereas, strength exercise (80% of 1 RM/ 10 reps) is necessary for phasic muscles
108
what is a supportive treatment intervention defined as?
all activities the patient performs to “support” the purpose behind treatments incorporated within the Palliative, Preparatory and Corrective treatments
109
what is involved with supportive treatment interventions?
anything you have the patient do in the clinic have them do at home, which includes MHP, CP, self mobilization, exercise, etc.
this also involves working on functional goals
110
what treatment intervention will ALWAYS be used with all patient?
supportive
111
what is one thing you MUST know prior to treatment?
TSI(s)
112
what treatment intervention should never introduce anything new?
supportive; supportive only emphasizes what was done in the clinic
113
what exercise rep range is utilized in cartilage, ligaments, and tendons? what is the purpose of this exercise scheme?
30+ reps (w/o fatigue)
| Purpose: Vascularity, Nutrition, Hydration
114
what exercise rep range is utilized in tonic muscles for vascularity, for coordination/endurance, and for strength?
Vascularity: 30+ reps (w/o fatigue)
Coordination/Endurance: 25-30 (w/ fatigue)
Strength: N/A
115
what exercise rep range is utilized in phasic muscles for vascularity, for coordination/endurance, and for strength?
Vascularity: 30+ reps (w/o fatigue)
Coordination/Endurance: 15-20 reps (w/ fatigue)
Strength: 8-12 reps (w/ fatigue)
116
how much rest time should be allocated between sets and what is the frequency at which you would perform for exercise for vascularity, for coordination/endurance, and for strength?
Vascularity: 6x per day (or more)
Coordination/Endurance: 1-2x per day
Strength: once every 48-72 hours
117
what are the signs and symptoms of synovitis?
symptoms: decreased willingness to move the joint actively
signs: effusion within 20-60 minutes, warm joint, empty (swelling end-feel)
118
what are the signs and symptoms of hemarthrosis?
symptoms: Decreased willingness to move the joint actively, pain with attempt to move from loose-packed position
signs: immediate effusion, hot, very painful, empty end-feels (with pain)
119
what are the signs and symptoms of bursitis?
symptoms: pain with specific movements but not at rest
signs: possible painful arch, possible pain with muscle contraction, tenderness w/palpation
120
what are the signs and symptoms of tendonitis?
symptoms: pain with specific movements
signs: MSST: strong/painful, tenderness with palpation, possible painful arch
121
what are the signs and symptoms of partial tear muscle/tendon?
symptoms: pain and weakness with specific movements, usually pain at rest
signs: MSTT: weak/painful, possible painful arch, painful passive passive stretch, tenderness to palpation, and decreased function
122
what are the signs and symptoms of a complete tear of muscle/tendon?
symptoms: unable to perform certain activities, no pain at rest
signs: MSTT: weak/painless, possible gap felt in palpation
123
what are the signs and symptoms of a dislocation?
symptoms: specific etiology, pain and inability to perform certain movements
signs: decreased AROM, decreased classical movements with muscle guarding end-feel (with pain), hypermobility (acessory), malalignment
124
what are the signs and symptoms of a subluxation?
symptoms: non-specific etiology
signs: local tenderness and inflammation, pain w/stress test, possible muscle guarding, painful end-feel, no hypermobility
125
what are the symptoms of ligament strains for grades 1, 2 and 3?
Grade 1: mild pain within 24 hours of injury
Grade 2: pain limiting activity
Grade 3: Inability or decreased ability to weight bear and/or perform activity
126
what are the signs of ligament strains for grades 1, 2 and 3?
Grade 1: local tenderness and inflammation, pain w/stress test, possible muscle guarding, painful end-feel, not hypermobile
Grade 2: pain and some hypermobility w/stress test, local inflammation and pain w/palpation
Grade 3: instability w/stress test (mod-marked hypermobility), local inflammation and pain w/palpation
127
what are the grades used for distraction?
Grade I - bunch the skin
Grade II - bunch skin, 0-50% oscillating
Grade III - bunch skin, 50-90% oscillating
Grade IV - bunch skin, 100% end range, hold for 10 seconds
128
where is the direction of force applied during a glide?
the direction of force is parallel to the concave surface of the joint
129
where is the direction of force applied during a distraction?
the direction of force is perpendicular to the concave surface of the joint
