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1

What is gait?

The manner in which a person walks

2

What is a step?

From the heel strike of one foot to the next heel strike of the contralateral (opposite) foot

3

What is step length?

The distance between steps

4

What is a stride?

From the heel strike of one foot to the next heel strike of the ipsilateral (same) heel strike. (lasts 1 sec)

5

What is speed?

The rate of linear forward motion of the body

6

What is cadence?

The number of steps taken per unit of time. Steps/min

7

What is the general cadence for adult men

110 steps/min

8

What is the general cadence for adult women

116 steps/min

9

What is the general cadence for start of jogging/running

180 steps/min

10

How do you increase gait speed?

By increasing stride length, & cadence

11

What is a step width?

The linear distance between midpoint of heel of one foot and the same point on the other foot completing the step.

12

What is the general step width?

Usually 3 and half inches, but can vary from 1-5 inches

13

The step width is ____ in elderly and infants

Wider/larger

14

What are the phases of the gait cycle?

Initial contact, loading response, mid-stance, terminal stance, pre-swing, initial swing, mid-swing, and terminal swing

15

What percent is the stance phase of the total gait cycle?

62%

16

What percent is the swing phase of the total gait cycle?

38-50%

17

What is initial contact in the phases of gait?

The moment when the foot contacts the ground

18

What is loading response in the phases of gait?

Weight rapidly transferred onto outstretched limb

19

What is mid stance in the phases of gait?

Body progresses over a single, stable limb

20

What is terminal stance in the phases of gait?

Body moves ahead of limb and weight is transferred to forefoot. Rapid unloading of limb occurs as weight is transferred to contralateral(opposite) limb

21

What is pre-swing in the phases of gait?

Rapid unloading of limb occurs as weight is transferred to contralateral limb

22

What is initial swing in the phases of gait?

Thigh begins to advance as foot comes off the floor

23

What is mid swing in the phases of gait?

Thigh continues to advance as the knee begins to extend

24

What is terminal swing in the phases of gait?

Knee extends as the limb prepares for the contact with the ground.

25

What is happening in the other limb when the reference limb is going through initial contact and loading response?

Pre-swing

26

What is happening in the other limb when the reference limb is going through mid-stance?

Initial swing and 1st part of mid swing

27

What is happening in the other limb when the reference limb is going through terminal stance?

2nd part of mid swing and terminal swing

28

What is happening in the other limb when the reference limb is going through pre- swing?

Initial contact and loading response

29

What is happening in the other limb when the reference limb is going through initial swing and 1st part of mid-swing?

Mid-stance

30

What is happening in the other limb when the reference limb is going through 2nd part of mid-swing and terminal swing?

Terminal stance

31

Loading response(2nd phase) begins with ____ and ends with __

Begins with foot contact and ends with opposite limb toe off

32

Mid stance(3rd phase) begins with ___ and ends with ___

Begins with opposite limb toe off and ends with ipsilateral heel rise

33

Terminal stance(4th phase) begins with ___ and ends with ____

Begins with ipsilateral heel rise and ends with opposite limb foot contact

34

Pre swing starts(5th phase) with __ and ends with ___

Starts with opposite foot contact and ends with ipsilateral toe off

35

Initial swing (6th phase) starts with ___ and ends with ____

Starts with ipsilateral toe off and ends when the medial malleoli are aligned

36

Mid swing (7th phase) begins with ___ and ends with ____

Begins with the medial malleoli aligned and ends when the ipsilateral tibia is perpendicular to the ground

37

Terminal swing (8th phase) begins with ___ and ends with ___

Begins with the tibia perpendicular to the floor and ends when the ipsilateral foot strikes the floor

38

Where should the PT be positioned during gait training?

Behind the patient and to the side that is being treated. Place one hand with a supinated grip and the other hand in front of the shoulder

39

What assistive devices should be used with 3-point gait?

Crutches or walker

40

Assisted devices to use for a patient that has one leg affected and full weight bearing on the other leg is ___

Crutches or a front wheeled walker

41

Where in the 5 elements of patient management does the subjective exam fall?

Examination and evaluation

42

What is the primary objective of the initial PT visit called?

Phase 1 differential diagnosis

43

What question is asked in the Phase 1 differential diagnosis?

Does this patient belong in my clinic?

44

Will the subjective exam ever need to come back in play?

Yes

45

What is the typical subjective exam flow?

1. Review Baseline Information/Chart Review
2. Establish Rapport
3. Gather General Information
4.Analyze Information/ Hypothesis Generation
5. Gather Specific Information
6. Plan Objective Exam

46

80% of info needed to make a diagnosis is contained in the ___

Subjective exam

47

What happens in the Review Baseline Information/Chart Review of the subjective exam flow?

• Provides needed information, like:
- General Health Status
- Imaging findings
- Operative reports
- Past medical history and/or treatments
- Medications

48

What part of the subjective flow may be the examination?

Review Baseline Information/Chart Review

49

What happens in the Establish Rapport of the subjective exam flow?

• Welcoming introductions
• Establish effective communication and
rapport
• Explanation of perspective
• Clarification of patient expectations
• Sequence of first session – exam process and patients role

50

What happens in the gather general information step of the subjective exam flow?

• Patient profile (age, gender...)
• Chief complaint
• Body chart
• Present Episode
• Past History
• Aggravating/Easing Factors
• Relationship between regions
• 24-hour behavior
• Patient Goals
• Patient Expectations

51

The ___ fills out the body chart

The patient

52

Problem area characteristics of of the body chart

• Location of each area of pain / symptoms
• Quality / Type of symptoms
• Depth of symptoms
• Frequency / Constancy of symptoms
• Relationships between areas of symptoms
• Clearing relevant areas

53

What are the two pain rating scales?

- Numerical Pain Rating Scale (NPRS): o a scale of 1-10
- Visual Analog Scale (VAS) for pain

54

Which pain rating scale is used the most?

The NPRS

55

What are radicular symptoms?

direct stimulation of a nerve root results
in a sharp, lancinating pain, well-localized to the dermatome.

56

What is a visceral referral symptom?

kidney, pancreas, cardiac, etc. - can mimic or masquerade as musculoskeletal pain.

57

What is a somatic referral symptom?

symptoms that arise from referral of a
musculoskeletal structure (i.e. facet jt.)

58

What is a trigger point symptom?

hypersensitive spot typically in skeletal muscle that can be associated with a taut band

59

What happens in the gather specific information step of the subjective exam flow?

• Date of onset
• Mode of onset (injury, any precipitating factors?)
• Gradual onset
• Sudden onset
• Immediate or delayed symptoms after injury?
• Pain and Swelling
• Are symptoms getting better, worse, or status quo?
• Any treatment to date? Effects?
• 24-hour behavior

60

What are the two factors of the behavior of symptoms that are very important?

- Aggravating and easing factors

61

What is a systems review?

Where we are asking questions that relate to the different systems of a given patient

62

What does a systems review do?

It helps us identify red flags

63

What are red flags?

Signs and/or symptoms that may warrant immediate communication with the referring provider or may warrant a referral/consultation to another healthcare practitioner

64

The present of a single red flag is usually ____ and must be ___

Not much of a concern, and must be put into context with the rest of the patient's presentation(age, gender, med history...)

65

What is a category 1 red flag?

Factors that require immediate medical attention

66

What is a category 2 red flag?

Factors that require subjective questioning and precautionary examination and treatment procedures

67

What is a category 3 red flag?

Factors that require further physical testing and differential analysis

68

What is a yellow flag?

Factors that increase the risk of developing, or perpetuating long-term disability and work loss

69

A yellow flag may warrant ___

May warrant a referral/consultation to a mental health practitioner

70

Examples of a yellow flag

Psychosocial issues:

• Fear avoidant behavior
• Pain catastrophizing
• Loss of pleasure in doing things, feeling hopeless
• High levels of anxiety
• Suicidal ideation

71

What do we do to further refine our hypothesis of a patient?

Establish SINSS

72

What does SINSS stand for?

Severity
Irritability
Nature
Stage
Stability

73

What is severity?

The intensity of the patients symptoms as they relate to a functional activity

74

How is severity rated?

• Minimal = Minimal to no pain (0-3/10), symptoms do not limit or hinder activity

• Moderate = Pain reduces activity levels to 40-70% of normal, pain
rated at 4-7/10

• High = Pain symptoms severely reduce or stop activities; ADLs are
are avoided or severely limited, pain rated at 8-10/10

75

What is irritability?

Time for symptoms to come on and go away

76

How is irritability rated?

• Low = Tolerates repetitive or sustained activities, can cont. activity after the onset of pain, pain eases in short amount of time

• Moderate = Tolerates brief activities or positions < 10 min, cont. light activities after the onset of pain, pain eases in similar time as onset (may be longer)

• High = Activity not tolerated – are avoided, unable to continue activity after the onset of pain, symptoms takes a long time to ease (>30 minutes)

77

What are the two types of nature of a pain?

• Musculoskeletal vs. Non-Musculoskeletal

78

The type of pain often relays information to the clinician regarding the _____

type of tissue involved

79

The nature of pain is a reflection of ____

differential diagnosis and systems review

80

What is the stage?

Time frame since the onset of symptoms

81

What are the stages of pain?

• Acute pain: Recent onset (0-6 weeks)

• Sub-acute pain: Pain may be due to later stages of tissue healing or early stages of developing chronic symptoms (6-12 weeks).

• Chronic pain: Longer duration – usually past expected recovery time
(> 3 months)

82

What is stability?

The progression of the patients pain (or symptoms) over time

83

What are the ways to classify the stability of a patient's pain?

Is the patients pain:
• Getting better
• Staying the same
• Getting worse

84

If a patient has a high severity & irritability we may ____

Limit the SINSS, so as to not make them worse

85

If a patient has a low irritability we may ____

Not limit the exam, so as to reproduce the symptomsNot limit the exam, so as to reproduce the symptoms

86

Other things SINSS helps us understand

- Contraindications to the examination?
- Vigor of exam?
- Which structures will I examine?
- Will I do a neurological exam?
- Which examination techniques will I perform?

87

What are the reasons to screen a patient?

• Sicker patient/client base: more comorbidities
• Quicker: earlier mobility/discharge of hospital pts same day
surgery
• Disease progression
• Patient/client disclosure
• Presence of one or more yellow (caution) or red (warning) flags
• Direct Access: people coming off the street

88

What is direct access?

The right of the public to obtain examination, evaluation and intervention from a licensed PT w/out previous examination by or referral from a physician, gatekeeper or other practitioner

89

What is primary care?

“…integrated, accessible healthcare by clinicians
who are accountable for addressing a large
majority of personal health care needs,
developing sustained partnerships with
patients…”

90

What is a diagnosis?

Recognition of disease/disorder usually via a collection of relevant signs and symptoms

91

What is a differential diagnosis?

Systematic method to identify the cause
(MSK or non-MSK) of a patient’s symptoms

92

What is a prognosis?

Predicted optimal level of improvement in function taking in consideration of comorbidities, motivation, psychosocial
factors, patient values/goals

93

What are constitutional signs?

are general signs/symptoms that are present when illness is present

94

What are the means of communication?

-Verbal
-Non-verbal
- Written

95

Verbal cues convey ___ of the message

7%

96

Vocal cues are __ of communication

38%

97

Facial cues are __of communication

55%

98

What is effective communication?

Message sent = message received.

New information makes sense to a person by
comparing it to what is already in their minds

99

Sources of communication error

• Language
• Psychological (listener)
• Environmental
• Speech (speaker)

100

Questioning techniques

• Speak slowly
• Speak deliberately
• Keep questions short
• Ask one question at a time
• Begin with open-ended and non-leading questions
• PAUSE – wait for and LISTEN TO response
• Confirm understanding with restatement or
paraphrasing strategies

101

What are open ended questions?

Questions that allows the patient elaborate on their answers

102

Definition of encoding barriers?

The process of selecting and organizing symbols to represent a message requires skill and knowledge.

103

What are the obstacles that can interfere with an effective message?

- Lack of Sensitivity to Receiver
- Lack of Basic Communication Skills
- Insufficient Knowledge of the Subject.
- Information Overload
- . Emotional Interference

104

Transmitting barriers are...

Things that get in the way of message transmission are sometimes called
“noise.”

105

Types transmitting barriers

- Physical Distractions
- Conflicting Messages
- Channel Barriers
- Long Communication Chain

106

Decoding Barriers. The communication cycle may break down at the receiving end for some of these
reasons:

- Lack of Interest
- Lack of Knowledge
- Lack of Communication Skills
- Emotional Distractions
- Physical Distractions

107

Responding Barriers—The communication cycle may be broken if feedback is unsuccessful:

- No Provision for Feedback
- Inadequate Feedback

108

What are the 4 categories of non-verbal communication?

Physical
Aesthetic
Signs
Symbolic

109

What is physical non- verbal communication?

This is the personal type of communication. It includes facial expressions, tone of voice, sense of touch, sense of smell, and body motions.

110

What is aesthetic non- verbal communication?

This is the type of communication that takes place through creative expressions: playing instrumental music, dancing, painting and sculpturing

111

What is signs non- verbal communication?

This is the mechanical type of communication, which includes the use of signal flags, the
21-gun salute, horns, and sirens

112

What is symbolic non- verbal communication?

This is the type of communication that makes use of religious, status, or ego-building symbols.

113

What are the static features of non- verbal communication?

Distance
Orientation
Posture
Physical contact

114

Static feature: Distance is characterized by...

The distance one stands from another frequently conveys a non-verbal message. In
some cultures it is a sign of attraction, while in others it may reflect status or the intensity of the exchange.

115

Static feature: orientation is characterized by...

People may present themselves in various ways: face-to-face, side-to-side, or even back-to-back. For example, cooperating people are likely to sit side-by-side while competitors
frequently face one another

116

Static feature: posture is characterized by...

Are we slouched or erect? Are our legs crossed or our arms
folded ? Such postures convey a degree of formality and the degree of relaxation in the
communication exchange.

117

Static feature: physical contact is characterized by...

Shaking hands, touching, holding, embracing, pushing, or patting on the back
all convey messages. They reflect an element of intimacy or a feeling of (or lack of) attraction.

118

What are the dynamic features of non- verbal communication?

- Facial expressions
- Gestures
- Looking

119

Dynamic feature: facial expressions is characterized by...

A smile, frown, raised eyebrow, yawn, and sneer all convey information. Facial expressions continually change during interaction and are monitored constantly by the recipient. There is evidence that the meaning of these expressions may be similar across cultures.

120

Dynamic feature: gestures is characterized by...

One of the most frequently observed, but least understood, cues is a hand movement. Most people use hand movements regularly when talking. While some gestures (e.g., a clenched
fist) have universal meanings, most of the others are individually learned and idiosyncratic.

121

Dynamic feature: looking is characterized by...

A major feature of social communication is eye contact. It can convey emotion, signal
when to talk or finish, or aversion. The frequency of contact may suggest either interest or boredom.

122

Definition of non-verbal communication according to Tortoriello, Blott, and DeWine

". . . the exchange of messages primarily through non-linguistic means, including: kinesics (body language), facial expressions and eye contact, tactile communication, space and territory, environment, paralanguage (vocal but non-linguistic cues), and the use of silence and time."

123

Empathic communication is described by Coulehan et al as...

language that aides the process of healing by bolstering patient’s strengths, validating their perspective, and teaching them how to grow to be more self-reliant

124

What are the habits in the 4- habit model?

- Invest in the beginning
- Elicit the patient's perspective
- Demonstrate empathy
- Invest in the end

125

Characteristics of : Invest in the beginning

- Create rapport quickly
- Elicit patient concerns
- Plan the visit with the patient

126

Characteristics of : Elicit the
patient’s perspective

- Ask for patient ideas
- Elicit specific requests
- Explore the impact on the
patient’s life

127

Characteristics of: Demonstrate
empathy

- Be open to patient’s emotions
- Make at least one empathic
statement
- Convey empathy nonverbally
- Be aware of your own
reactions

128

Characteristics of: Invest in the
end

- Deliver diagnostic information
- Provide education
- Involve patient in making
decisions
- Complete the visit

129

Where does the objective exam fall in the 5 elements of patient management?

Evaluation and examination

130

The subjective exam is equal to what kind of hypothesis?

Hypothesis generation

131

The objective exam is equal to what kind of hypothesis?

Hypothesis refinement

132

What are the goals of the objective exam?

• Look for patterns of movement & restrictions
• Reproduce symptoms or produce comparable sign(s)
• Systematic approach to confirm or rule out your working hypothesis and differentials

133

Things to consider during an objective exam?

• Get baseline symptoms
• Look for two sets of data:
- What the patient feels (*subjective asterisks*)
- Key comparable signs (*objective asterisks*)
• Do painful movements & tests last if possible

134

What is the layout of an objective exam?

1. Collect / Test / Measure Objective Data
2. Analyze Data / Establish Working Diagnosis
3. Determine Prognosis
4. Formulate a Plan of Treatment

135

What are the 3 components of motion testing?

• Active ROM (Physiologic) motion testing
• Passive ROM (Physiologic) motion testing
• Joint Play (Accessory) motion testing

136

What are the 3 essential assessment for diagnosis?

• Quality of the movement
- Movement pattern, asymmetry, end-feel
• Quantity of movement
• Symptom response

137

Definition of AROM

The patient's ability to actively move on their own

138

_____ are applied to normal ROM to reproduce symptoms when necessary

Progressions

139

During PROM, examiner takes joint through ROM with patient ____

relaxed

140

Each movement in PROM is compared with ___

opposite side (preferred) or accepted norms

141

PROM is used when...?

AROM is altered or painful

142

Motion testing helps us determine whether to move to ___ or move to __

Pain
• Pain is the dominant factor in patient’s disorder
• Range to first onset of pain (and just beyond)

Resistance
• Assess for stiffness/ hypomobility
• Apply overpressure to assess end-feel and symptom
response

143

What does PROM help understand?

Helps understand if there's any limitations in the ROM (hypomobility) or if the patient has an excessive amount of ROM (hypermobility)

144

What are the 2 instruments for measuring ROM?

- Goniometer
- Bubble inclinometer

145

What are the ROM general procedures?

• Assess range of motion bilaterally (unaffected side first)
• Recommend two repetitions for each movement
• First repetition: Visually assess movement quality,
quantity, and symptom response
• Second Repetition: Joint measurement as needed

146

What are the ROM specific procedures?

Patient in base position
• Locate pertinent bony landmarks
• Place goniometer axis of motion at the approximate axis of joint motion
• Align stationary and moving arms along the appropriate body parts and in line with identified bony landmarks
• Move the joint through it’s active or passive ROM
• Read the goniometer at appropriate ranges of motion

147

Things to record when documenting a ROM measurement

- The type of ROM: AROM or PROM
- Right or left extremity
- The joint and the direction of motion
- The quantity of motion achieved
- Symptom changes

148

Things to keep ROM measurement in check

• Goniometer measurement error +/- 5 degrees
• Reliability varies widely
• Intra-rater generally better than inter-rater reliability
• Reliability can be enhanced

149

When is reliability enhanced?

- When we use a standardized test position
- When we use the correct goniometer size
- When the same person evaluates each measurement

150

What is accessory joint mobility/motion?

The ability to passively move a joint through arthrokinematic (accessory) motion that make up a gross osteokinematic (physiologic) motion

151

How is accessory joint motion assessed?

Passively by the examiner, but cannot be performed actively by the patient

152

What is osteokinematics?

Directions the bones move when motion occurs. AKA: “physiologic motions”

153

Osteokinematics is characterized by ___ motion during ___ movement

Visible motion during voluntary movement

154

Osteokinematics is typically described as ..

movement around a specific joint axis and within a particular joint plane

155

What are physiologic motions?

Movement in one of the 3 cardinal planes occurs at right
angles to the joint axis

156

What are the physiologic joint motions?

- Flexion and Extension
- Abduction and Adduction
- Internal and External Rotation, - Horizontal ABD/ADD

157

What are the joint planes?

- Sagittal
- Frontal (Coronal)
- Transverse (Horizontal)

158

What are the joint axes?

- Frontal
- Sagittal
- Longitudinal (Vertical)

159

What is arthrokinematics?

motion between the joint surfaces during
movement.
AKA: “ accessory motions or joint play”

160

Arthrokinematics is described as motion that should occur _____

within the joint to allow normal
range of motion (osteokinematic) to occur

161

Arthrokinematics is characterized as being ___ and ____

Invisible and involuntary

162

What are types of accessory motions?

- Roll
- Slide (glide)
- Spin

163

Accessory motion: Roll

Various points on one surface contact many points on another surface

164

Accessory motion: Slide (glide)

One point of one surface in contact with many points on another surface

165

Accessory motion: Spin

One point of one surface in contact with one point on another surface.

166

What are the two types of Concave-Convex “Rule”

Convex on Concave and Concave on Convex

167

What is Convex on Concave?

Convex surface moving on fixed concave surface

168

In Convex on Concave, Roll and Glide accessory motions occur in the _____ directions.

OPPOSITE

169

In Convex on Concave, Movement of bone is in ____ direction to movement of joint (glide).

OPPOSITE

170

What is Concave on Convex?

Concave surface moving on fixed convex surface

171

In Concave on Convex, Roll and Glide accessory motions
occur in the_____ direction.

SAME

172

In Concave on Convex, Movement of the bone is in ___ direction as movement of joint surface.

SAME

173

What are the two types of joint positions?

- Open-Packed (Loose)
- Close-Packed

174

Characteristics of Open-packed (Loose)

Ligaments and capsule in
position of greatest laxity
• Joint surfaces are maximally
separated
• Minimal congruency between joint surfaces
• Proper position to assess joint play and to mobilize!

175

Characteristics of Close-packed

• Ligaments and capsule are taut
• Joint surfaces are maximally
contacted
• Maximal congruency between joint surfaces
• Position of maximal stability
• POOR position to assess joint play or to mobilize!

176

What is end- feel?

The sensation you “feel” in the joint as it reaches the end of the range of motion

177

What does end-feel do?

• Assesses the quality of motion
• Assists in identifying pathology

178

Normal end- feels: bone to bone

– hard, unyielding sensation; painless
• Example: elbow extension

179

Normal end- feels: Soft-Tissue approximation

– soft, yielding compression
• Example: muscle contact with elbow or knee flexion

180

Normal end- feels: Tissue Stretch

– hard or firm (springy) type of movement with a slight give
• Feeling of springy or elastic resistance
• Example: shoulder rotation, knee extension

181

What is hard capsular abnormal end feel?

Hard or firm end feel, thicker feeling than normal tissue
stretch
• Abrupt onset after smooth, friction-free movement
• Seen in chronic conditions

182

What is soft capsular abnormal end feel?

– Boggy, very soft, mushy end feel typically accompanied joint
effusion
• Stiffness early in range and increases until end range
• Seen in acute conditions

183

Abnormal end feel: Muscle spasm

sudden and hard end feel; dramatic arrest in movement accompanied with pain; usually due to subconscious effort to protect an injured joint or structure

184

Abnormal end feel: Bone to Bone

hard, unyielding sensation similar to normal bone to bone
• Restriction occurs before normal end range is expected
• Example: osteophyte formation

185

Abnormal end feel: Springy Block

also a firm end feel, similar to tissue stretch
• Restriction occurs before normal end range is expected
• Usually has a rebound effect indicating internal derangement in the joint (i.e., meniscal tear)

186

Abnormal end feel: Empty

no mechanical resistance, but considerable pain is produced by movement

187

What is capsular pattern?

Characteristic pattern of motion restriction when joint capsule is involved (contracted)

188

What are the two components of muscle testing?

- Muscle length testing (flexibility test)
- Muscle strength testing (manual muscle testing MMT & resisted isometric test)

189

What is the purpose of muscle length test (flexibility tests)?

To determine if range of muscle length is normal, limited, or excessive

190

What is the most common form of muscle strength testing?

Manual muscle testing (MMT)

191

What is the purpose of muscle strength test?

Helps us to find and measure muscle strength to determine the person's ability to voluntarily contract a muscle or muscle group using gravity or applied manual assistance

192

The manual muscle test helps...

determine the degree of muscle weakness from either disease, injury or atrophy that may have occurred for a patient

193

Indications for Muscle Strength Testing

• Diagnosis of peripheral nerve injury or nerve root injuries
• Effects of spinal cord injury & potential recovery
• Basis for treatment planning and prognosis
• Provide measure for treatment progress
• Basis for supportive devices/orthoses

194

MMT General Procedures

1. Position patient
2. Explanation / PROM
3. Screen Test / AROM
4. Palpate
5. Apply resistance
6. Grade

195

Grading of MMT characeristics

• Attempt to express strength objectively
• Consider age, gender differences
• Name and number grades
• Gravity lessened
• Against gravity

196

In the muscle grading system, a 3- or above allow _____ gravity going through ___ ROM

- vertical motion against gravity
- going through full ROM

197

In the muscle grading system, a 2+ or below allow _____ gravity going through ___ ROM

Allow supported horizontal motion: gravity is lessened

198

Factors Reducing Grading Accuracy

• Pain
• Limited Joint ROM
• Muscle Hypertonicity/Spasticity
• Others: Fatigue, cognition, cultural/social norms

199

What are the limitations of MMT?

- Hard to determine which muscle is being tested
- Different physical shapes patients
- Inter rater ability

200

A normal (5) is described as:

Holds test position against strong to maximum resistance.

201

Good + (4+) is described as

Holds test position against moderate to strong resistance.

202

A good (4) is described as:

Holds test position with moderate resistance

203

A good- (4-) is described as:

Holds test position against slight to moderate resistance.

204

A fair + (3+) is described as:

Full ROM against gravity; able to hold end ROM against slight resistance

205

A fair (3) is described as:

Full ROM against gravity; able to hold end ROM without added resistance

206

A fair - (3-) is described as:

FullROM against gravity; unable to hold end ROM (gradual release occurs)

207

A poor + (2+) is described as:

Completes partial(< ½) ROM against gravity or slight resistance in gravity minimized position

208

A poor (2) is described as:

Completes full ROM in a gravity minimized position

209

A poor- (2-) is described as:

Completes partial ROMin a gravity minimized position

210

A trace (1) is described as:

Slight, palpable contraction; no joint movement

211

A zero (0) is described as:

No palpable evidence of muscle contraction

212

For muscle grading from 4- to 5, the patient should be positioned ____

To allow VERTICAL MOTION against gravity

213

For muscle grading from 2+ to 3+, patients should be positioned _____

To allow VERTICAL MOTION against gravity

214

For muscle grading from 2 to 2-, patients should be positioned ____

To allow supported HORIZONTAL MOTION; gravity lessened

215

For muscle grading from 0 to 1, patients should be positioned _____

To allow palpation of muscle with NO MOTION

216

What movement happens in the frontal plane?

Abduction and adduction

217

What movement happens in the sagittal plane?

Flexion and extension

218

What movement happens in the transverse plane?

Internal and external rotation