HOC 2 Flashcards
1
Q
Lower back complaints can be divided into non-specific and specific lower back complaints.
Explain the difference between the two and give some examples?
A
Non-specific lower back complaints are complaints of the lower back without a clear cause found for example in X-rays, blood tests, etc.
Specific lower back complaints can be proven. Examples of specific lower back complaints are a hernia nuclei pulposi (HNP) or vertebral fracture.
2
Q
Specific neck complaints are provable through imaging tests.
What are some examples of specific neck complaints?
A
Examples of specific neck complaints are: cervical radicular syndrome, cervical myelopathy, neck complaints as a result of rheumatoid arthritis.
3
Q
What is the name of the categorisation of neck and back complaints into specific and non-specific complaints?
A
Triage.
4
Q
Explain the categories of the Triage, inc. percentages of sufferers.
A
Back complaints ->
- Non-specific back complaints (90%).
- Specific back complaints (10%).
- Radiculopathy (8%).
5
Q
What signs and symptoms suggest a Lumbar Radiculopathy?
A
- Unilateral pain in the leg > backache.
- Pain usually radiates to the foot/toes.
- Not only discogenic cause (pain originating from a damaged vertebral disc, particularly due to degenerative disc disease).
- Paraesthesia, sensibility disorder.
- Neuromeningeal stimulus
- reduced straight leg raising, slump.
- Reduced motor, sensory or reflex function
- matching one segment.
6
Q
Explain how pressure on a disc causes radicular syndrome?
A
If the nucleus pulpous pushes through the annulus fibrosis (herniation), it can compress the nerve root.
7
Q
What are the Red flags for Lower back pain?
Accord. THIM there is total = 10
A
- First episode with LRP <20yr or >50yr
- Significant trauma?
- Recently unexplained weight loss ( >5kg / month)
- Malignant conditions in history.
- Fever
- Deformities (e.g. lumbar kyphosis)
- Long-term use of corticosteroids
- Intravenous administration of medicines.
- Progressive non-mechanical pain.
- Night time pain / pain that remains at night.
8
Q
Specific low back pain is divided into two categories, name and explain them…
A
Lumbosacral radicular syndrome, a form of specific low back pain characterised by radicular pain in one leg, which may or may not be associated with neurological deficits.
Back pain resulting from a possibly serious underlying specific disorder, such as (osteoporotic) vertebral fractures, malignities, ankylosing spondylitis, severe forms of vertebral canal stenosis, or severe forms of spondylolisthesis.
9
Q
What are the Red flags for Thorax?
Accord. THIM there is total = 9
A
- Recent trauma?
- Already existing (unexplained fever)
- Recently unexplained weight loss ( >5kg / month)
- Long-term use of corticosteroids
- Constant pain that does not decrease when changing position.
- Cancer in history.
- General feeling of unwell / malaise.
- Night time pain.
- Extensive neurological signs and symptoms.
10
Q
How many grades of Neck pain are there?
A
4
11
Q
Describe Neck pain Grade 1?
A
Neck pain and associated disorders with no signs or symptoms suggestive of major structural pathology and no or minor interference with activities of daily living.
A patient may say… I have pain in my neck, but am able to do just about everything. I am completely healthy.
12
Q
Describe Neck pain Grade 2?
A
Neck pain without signs or symptoms indicative of major structural pathology but which may significantly affect daily activities.
A patient may say… I have neck pain and many things have become impossible for me to do. I am significantly limited in my life. I am otherwise entirely healthy.
13
Q
Describe Neck pain Grade 3?
A
Neck pain without signs or symptoms indicative of major structural pathology but with neurological symptoms possibly caused by cervical herniated disc or spinal stenosis, such as reduced tendon reflexes, muscle weakness, or sensory disorders (hypoesthesia or hyperesthesia) in the upper extremity.
Cervical Radiculopathy?
14
Q
Describe Neck pain Grade 4?
A
Neck pain with signs or symptoms indicative of SERIOUS STRUCTURAL PATHOLOGY. Major structural pathologies include (but are not limited to) fracture, vertebral dislocation, injury to the spinal cord, infection, neoplasm, or systemic disease including the inflammatory arthropathies.
15
Q
What are the Red flags for Neck pain which could suggest a major structural pathology (Grade 4).
(Accord. THIM there is total = 9)
A
- Recent trauma?
- Already existing (unexplained fever)
- Recently unexplained weight loss ( >5kg / month)
- Long-term use of corticosteroids
- Constant pain that does not decrease when changing position.
- Cancer in history.
- General feeling of unwell / malaise.
- Night time pain.
- Extensive neurological signs and symptoms.
16
Q
What is the Epidemiology of NSLBC patients?
A
60 to 90% lifetime prevalence 50-250 per 1000 people a year 70% has one single consult 50% recovers within a week 80 to 90% recovers within 4 to 6 weeks 95% recovers within 3 months
17
Q
What is a guideline based on and why is it important for the treatment of a patient?
A
Based on:
- Science (evidence).
- Professional insights (what are the experiences/findings of our colleagues).
- Social insight.
Should lead to:
- Effectiveness
- Efficiency
- Tailored care
18
Q
Which three measuring instruments are recommended when diagnosing LBC?
A
Numeric rating scale (NRS)
Patient Specific Complaints (PSC)
Quebec back pain disability scale (QBPDS)
19
Q
How many Patient profiles are there for LBP?
A
3.
20
Q
Describe LBP patient profile 1?
A
Profile 1
Non-specific lower back pain with a normal course of recovery.
21
Q
Describe LBP patient profile 2?
A
Profile 2
Non-specific lower back pain with a divergent course, without dominant psychosocial recovery-hindering factors.
22
Q
Describe LBP patient profile 3?
A
Profile 3
Non-specific lower back pain with dominant psychosocial recovery-hindering factors.
23
Q
What is considered a ‘Normal course’ for LBC?
A
- When activities and participation gradually increase with time (up to the level of before the episode of complaints).
- Often the pain will reduce as well. This does not always mean that the lower back pain disappears completely, but rather that it does not (or no longer) impede performing the activities and participation.
24
Q
What is considered a ‘Divergent course’ for LBC?
A
- When the limitations and participation problems do not reduce with time, but rather stay the same or even increase.
- We consider it to be a divergent course and delayed recovery if there is no clear increase of activities and decrease in participation problems within 3 weeks.
25
Which 4 Factors (as listed in the powerpoint) can delay the recovery of lower back pain.
1. Back pain-related factors: high level of activity limitations, radiating pain, wide-spread pain.
2. Individual factors: at a later age, poor general state of health.
3. Psychosocial factors: psychological and psychosocial stress, pain-related fears/avoiding behaviour, somatisation, depression.
4. Work-related factors: poor relationships with colleagues, demanding physical jobs.
26
Which three systems ensure the stability of the spine?
1. The neural system: Nerves + CNS.
2. Active system: Muscles, Tendons.
3. Passive system: Vertebrae, Disci, Ligaments.
27
Explain the concepts of instability?
Loss of a normal pattern of spinal motion causes pain and/or neurologic dysfunction.
28
Explain the concepts of neutral zone?
The neutral zone (NZ) is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. The NZ appears to be a clinically important measure of spinal stability function. Its size may increase with injury to the spinal column, which in turn may result in spinal instability or low-back pain.
29
What are the clinical symptoms for the LSC?
Poor propriocepsis and reduced lumbar control (hesitating/pivoting)
Reduced strength/endurance in local muscles at the level of the unstable segmental area
Aberrant movement (abnormal course of movement)
Pain in static postures which are maintained for long periods of time
Gower’s sign: the patient ‘walks’ his hands back to neutral position
Movement too large (1 or 2 segments) during flexion-extension
Reduced willingness to move or fear of moving
Hyper mobility (during posterior/anterior (P-A) spring test)
Increased muscle tension/defensive tension
Poor posture and postural changes such as lateral shift and change of lordosis
Frequent audible cracking/popping/clicking sounds during a movement
Hypomobility of contiguous segments
30
Name and explain the three phases of the “Motor Learning Model” and the differences between those stages
Cognitive stage - Isolated training of the local muscular system, without involving the global muscular system.
Associative stage - Teaching specific partial movements, involving the global muscular system and checking for co-contraction of the local muscular system.
Autonomous stage - Integrating specific movements into ADL.
31
What are some causes of Pregnancy-related pelvic girdle pain?
- Hyper-mobility as a result of pregnancy.
- Trauma during pregnancy.
- Difficult childbirth.
- Wrong posture.
- Muscles that close the legs are too strong.
- The abdominal, buttock and back muscles and the muscles that spread the legs are too weak.
- The pelvic floor is too strong.
32
Where is pain most commonly felt in patients with Pregnancy-related pelvic girdle pain?
Pain
- Pubic bone
- Coccyx
- SI joint, lower back
33
Which activities become difficult with Pregnancy-related pelvic girdle pain?
Difficult activities
- Turning over in bed
- Staying in the same position
- Getting up from a (particularly low) couch or chair
- Standing up, sitting, walking or walking stairs for longer periods of time
- Bending down
- Getting in and out of the bath tub or shower
- Getting dressed and undressed (standing on one leg)
34
When perfoming a specific examination on a patient with Pregnancy-related pelvic girdle pain;
1) Which movements is pain and/or weakness most likely to be produced?
2) Which two tests will have a positive result?
3) hat can be established using an echograph?
1)
- Weakness and/or pain during forceful abduction of the hips (spreading the legs).
- Weakness and/or pain during forceful adduction of the hips (moving spread legs together).
2)
- PPPP test positive
- ASLR (Active Straight Leg Raise) test positive
+
- A pelvis strap/manual compression has a positive influence on pain and strength
3)
- The patient uses the stabilising pelvic muscles incorrectly. This can be established by using echographs, among other techniques.
35
Name 5 measuring instruments for Pregnancy-related pelvic girdle pain?
```
VAS = Visual Analogue Scale
RDQ = Roland Disability Questionnaire
IPA = Impact on Participation and Autonomy
BPS = Behavioural Pain Scale
PHODA = PHotograph series Of Daily Activities.
```
36
What are the 4 main goals when (actively) treating a patients with Pregnancy-related pelvic girdle pain?
- Advice and instruction
- Unblocking
- Stabilising
- Practice
37
When should you refer your patient to a pelvic physiotherapist specialist?
1. Urinary incontinence
2. Pain in the lower abdomen
3. Pain during peeing, bowel movement, having sex
4. No progress despite advice and practice.
38
List some Red flags for Pregnancy-related pelvic girdle pain? (before and after pregnancy).
* Persistent pain in the pelvic and lower back region that cannot be explained.
* Other physical symptoms including symptoms of the abdomen, organs and/or minor pelvis.
* Radiating pain in one or both legs that extends beyond the knee.
* The pain in the legs is more dominant than the pain in pelvis and lower back.
* Aggravated or severe loss of motor function.
* Aggravated or severe loss of sensory function.
* Total malaise.
* History of malignancy or trauma.
39
During the anamnesis of a lumbosacral radicular syndrome patient, the main independent predicting factors are..?
- Pain in the leg
- Typical (mono-radicular) pain in dermatome
- Increased pain in the leg when the pressure increases.
40
During the Physical examination of a lumbosacral radicular syndrome patient, what are you going to ask the patient to do and what will you examine?
- Finger-floor distance >25cm (modern SLR)
- Examining muscle weakness (myotomes)
- Further neurological examination;
Reflex and sensibility examination
41
When is imaging indicated for a patient with lumbosacral radicular syndrome?
When surgery is considered, or if there are certain red flags.
Neurological examination (level determination) to support imaging techniques.
42
If you suspect a patient has grade 3 neck pain, which too tests should the physical therapist carry out to confirm this suspicion?
Spurling’s test and/or the traction/distraction test.
Grade neck pain III is deemed likely if one or both tests have a positive outcome.
43
If the results of the Spurling’s test and/or the traction/distraction test for grade 3 neck pain are negative but grade 3 neck pain is still suspected, what test can the physical therapist do next?
Upper Limb Tension Test (ULTT)*- for the brachial plexus/median nerve to exclude (negative result) Grade III neck pain.
44
Which 2 assessment tools/instruments are to be completed before (in order to predict the course of the neck pain and to serve as baseline for treatment goals) and after (to evaluate recovery and outcomes) treatment?
How many point difference should there be to establish improvement or deterioration of symptoms?
- Patient-Specific Functional Scale (PSFS) questionnaire.
- Numeric Pain Rating Scale (NPRS).
There should minimally be a 2-point difference in both measurements (on a 0–10 scale) to establish improvement or deterioration of symptoms.
45
Which imaging studies could be recommended by the physical therapist?
The physical therapist should not recommend imaging studies because of the limited level of evidence supporting their use and the substantial chance of false-positive findings.
46
How many treatment profiles are there for Neck complaints?
4.
| A,B,C,D.
47
Describe the case characteristics of a patient in treatment profile A.
Neck pain.
Grade I and II neck pain with a normal course.
Neck pain that (to a greater or lesser extent) has an impact on daily activities and which is expected to improve within the first 6 weeks after the onset of symptoms
48
Describe the case characteristics of a patient in treatment profile B.
Neck pain.
Grade I and II neck pain with risk factors for a deviant course of recovery but no psychosocial factors that could delay recovery.
Neck pain that (to a greater or lesser extent) affects daily activities and which is not expected to improve or which may even worsen within the first 6 weeks of the onset of symptoms or complaints. Psychosocial factors that could impede recovery are not present
49
Describe the case characteristics of a patient in treatment profile C.
Neck pain.
Grade I and II neck pain with risk factors for a deviant course of recovery, and psychosocial factors that delay or inhibit recovery.
Neck pain that (to a greater or lesser extent) affects daily activities and which is not expected to improve or which may even worsen within the first 6 weeks after the onset of symptoms or complaints. Psychosocial factors that could impede recovery are present.
50
Describe the case characteristics of a patient in treatment profile D.
Neck pain.
Grade III neck pain.
Neck pain with neurological signs and symptoms.
51
What Information and Advise would you offer to a Patient in treatment profile A?
Neck pain.
* Reassure the patient by explaining that neck pain has a favorable course in most patients, that it is not harmful, and that an in- crease in pain is not related to damage to body functions and structures.
* Advise the patient to remain physically active. Explain that recovery may benefit from a moderate and gradual increase in the level of exercise, a gradual increase in the level of activities, and the continuation of, or return to, work (if necessary, with adaptation of tasks or duties or work-related care).
* Avoid any recommendations that might encourage the patient to remain passive. Instead, advise them to embrace a physically active lifestyle and active coping style.
52
What is important to establish for a patient with Grade 3 neck pain?
The patient may benefit from physical therapy; however, because of potentially serious underlying pathology, it is vital that a 10 clear timeline is established beforehand.
53
You have client with Grade I/II neck pain with deviant recovery.
What should the treatment you apply focus on?
Treatment should focus on influencing risk factors (physical and non-physical) that may delay recovery, particularly psychosocial factors. It is less effective to focus on the patient’s pain because this may increase awareness of pain and resulting pain behavior.
54
What does 'MTT' mean?
| What is it's purpose?
Medical training theory.
| Is an active form of therapy which aims to provide optimal support to wound healing processes:
55
What are the 6 fundamental movement skills?
You can use ... "Silly Sausages Soon Find Crazy Eggs"
for help.
1. Speed
2. Stability
3. Endurance
4. Strength
5. Flexibility.
6. *Coordination*
*Coordination, the control of the motor system, is a functional way of training these different aspects.*
56
What are the characteristics of a person still in the cognitive learning stage?
A lot of demonstrating and imitating
Patient copies therapist
Many errors allowed
Adequate feedback is important: aimed at the execution! No feedback during the execution! Knowledge of performance and result
Trial and error
No fatigue
57
What are the characteristics of a person still in the Associative learning stage?
Procedural learning
No need to be flawless
Patient is able to identify his/her own mistakes
A lot of variation in exercise material
Besides feedback about the execution, now also feedback about the results.
No fatigue
58
What is the difference between stability and coordination?
Stability is defined as maintaining the ends of the bones in the correct position in relation to each other, in order to maintain a position and/or allow a certain movement.
The following systems are involved in keeping the joints stable:
The passive system: the passive stabilisers; capsule, ligaments, bones
Active system: the active stabilisers; muscles
Neural system: movement control; sensors and receptors, nerves, spinal cord and brain.
Where as...
Coordination is moving is a complex collaboration between the central as well as the peripheral nervous system, the muscles and the joints.
Coordination is the organisation of the motor system.
It includes the deciding the amount of strength, direction and speed needed to ensure that a movement is performed effectively and efficiently.
59
What are the parameters of coordination/stability?
Neuromuscular overload should take place around the joint.
When the exercise can no longer be performed technically (1 correction is allowed), after that the exercise should be interrupted.
Series: 4-6
(Variation between the series is desirable).
Repetitions: 3 to max. 40
(aimed towards function)
Break between series: 10-30 seconds
(Duration of the break should be adjusted to prevent fatigue).
Movement speed: depends on exercise and function.
60
What are the characteristics of a person still in the Autonomous learning stage?
Should be ADL specific.
Attention is free to focus on other processes
Accuracy, timing and speed increased
Accurate feedback is important. Knowledge of performance and result.
61
What are the three phases of physiological recovery in relation to bone, connective tissue and tendon tissue?
Inflammatory phase.
Proliferation phase.
(Early) Remodelling phase.
62
What stage of tissue recovery should you not start training?
Inflammatory phase
63
What does the following terms mean?
1. Rubor
2. Calor
3. Dolor
4. Tumour
5. Functio laesa
Tip to remember... Remember To Fold Draws Carefully.
1. Redness of the skin
2. Heat
3. Pain
4. Swelling
5. Loss or disturbance of function
64
Which type of pain involves tissue damage? C-fibre or A-Delta pain.
C-Fibre involves tissue damage.
65
What are some characteristics of primary pain / A-delta pain?
- Phylogenetically relatively young.
- Smaller receptive area, less overlap and penetrate the skin more superficially.
- Local pain.
66
What are some characteristics of secondary pain / C-fibre pain?
- Phylogenetically relatively older.
- Thin, slow, non-myelinated fibre.
- Pain is diffuse / difficult to localise.
67
During training which type of pain should not be present and why?
No c-fibre stimulus should be felt as it could indicate tissue is being damaged.
68
When making your diagnosis, you are trying to establish the nature of the health problem.
Which two "ingredients" determine the scale of the health problem?
1. Definitive hypothesis.
| 2. Request for help.
69
There are 3 different types of Medical diagnosis.
What are they called?
Who formulates a medical diagnosis and what happens if the physiotherapist does not have one?
1. Pathologic diagnosis - ICD (international classification of diseases) used for pathologic diagnosis (e.g. rheumatoid arthritis).
2. Symptomatic diagnosis (e.g. lower back pain).
3. Nosologic diagnosis - is an agreement based on describing specific symptoms which are idiopathic (e.g. fibromyalgia)
A medical diagnosis is formulated by a GP.
If they have not been referred to you by a GP and there is no medical diagnosis. The Physiotherapist must formulate their own physiotherapeutic diagnosis.
70
What is the minimum information needed to make a final hypothesis and physiotherapeutic diagnosis?
- Age and Request for help. (PIP/NPIP/Request for help).
- Nature of the health problem (ICF), course and development (timeline) and prognosis:
- personal factors.
- external / environmental factors.
- underlying medical factors.
- Timeline (course of recovery, e.g. connective tissue recovery time.
- Expected recovery (prognosis).
71
What two outcomes should you make from your prognosis and which information can lead you to making the prognosis?
1) How realistic is the expected final target / treatment request?
2) How long will it take to reach this final target?
1) Yellow flags (Most important).
2) Phases of tissue recovery.
72
Name the 7 factors that could impede recovery.
1. Age
2. Nature of affected tissue.
3. General state of health / other diagnoses.
- Use of medication
- Surgeries / Trauma
- Congenital
4. Recurrences
5. (Ability to cope with) Stress as a personal factor.
6. Stress as an exogenous / environmental factor.
- Family / relations / living environment / financial
work / sports / school / studies.
7. Behavioural factors (Yellow flags) incl. damaging habits / addictions (compliance / illness beliefs).
73
Name the 5 steps in the examination / diagnostics phase.
1. (Referral) Registration
- initial hypothesis.
2. Anamnesis
- Adjusted hypothesis
3. Examination on ICF level.
4. Clinimetrics.
5. Definitive hypothesis.
74
Name the 3 steps in the treatment / therapeutic phase.
1. Advise treatments targets.
2. Treatment.
3. Evaluation.
75
What is Supercompensation (Training law) and what is the time frame?
If the duration and intensity of the training are appropriate and the resting phase is long enough, the recovery ends up on a higher level than before.
After training session there is a recovery period which lasts 2-3 days. After that then you are at supercompensation. Without training you will return to the initial level after 3 more days.
76
What is Overload (training law) and which two factors should be looked at when training overload?
In principle trainings should become heavier and longer than the original entry level.
1. Duration - Amount of time training lasts, reps, series e.t.c.
2. Intensity - The percentage of the maximum capacity at which the training is performed.
77
What is 'Diminishing returns' training law?
Increasing training effort and the principle of supercompensation has its limits. In the initial phase of training, people will make enormous progression by providing a certain training stimulus. However the returns from this training will diminish over time.
78
What is 'Sustainability' (Training law)?
Improved performance over a longer period of training will, in the case the training is not executed for a while, slowly diminish.
This means that after training, there is a need for maintenance to counter reversibility.
79
What is 'Specificity' (training law)?
You become better at what you train..
This means that you exercise therapy should be designed so that your exercises can make a transfer to the ADL/sports related-related-enviroment.
80
What is the structure of strength training?
```
Start ->
Low resistance and many reps ->
Resistance up / fewer reps ->
1RM ->
Resistance down and movement speed increses ->
Sports-specific movements ->
Finish.
```
Extra information.
First you have the acute phase.. This is to train technique and endurance.
Next in the basic training you are making hypertrophy.
Then in the capacity phase you are adding explosiveness and speed.
Lastly the Return to play phase, in which it becomes more functional e.g. plyometrics (jump training) / sport-specific.
81
What is a maximal test?
By using an appropriate build-up , try to reach their maximum resistance during an exercise.
82
What is a sub maximal test?
Estimated load at 60-70%
Execution should be technically correct
1st series = Warming up
Test: Count the number of reps and then calculate the 1 Rm according to the Holten diagram.
83
What is a Baseline and how do you set one?
The baseline is always determined for each exercise. (It doesn't matter if its strength, stability, hypertrophy or sub-maximal strength).
This means that the first series is always a try-out. (i.e. determining the baseline).
Whilst you determine the baseline you should always take the appropriate parameters into account. (This means that you can play around with weight, reps and breaks in-between series, depending on the matching energy systems).
84
What is Movement speed in secs for...
STRENGTH ENDURANCE
concentric - fixed - eccentric
(Speed variables)
2 - 0 - 2
85
What is Movement speed in secs for...
HYPERTROPHY
concentric - fixed - eccentric
(Speed variables)
1 - 0 - 1
86
What is Movement speed in secs for...
MAXIMUM STRENGTH
concentric - fixed - eccentric
(Speed variables)
1 - 0 - 2
87
What is Movement speed in secs for...
SPEED STRENGTH
concentric - fixed - eccentric
(Speed variables)
Max no. of reps within 8-10 secs
| Speed=Max
88
What is Movement speed in secs for...
EXPLOSIVE STRENGTH
concentric - fixed - eccentric
(Speed variables)
Max - 0 - 2
89
What is Movement speed in secs for...
PLYOMETRICS
concentric - fixed - eccentric
(Speed variables)
Following in speed from eccentric component towards concentric component.
90
What scale can be used to monitor training of endurance athletes?
Five-zone intensity scale.
It takes into account VO2 max, Heart rate, Lactate, Typical accumulated duration within zone.
(Seiler, 2010)
91
Which questions are important in relation to the treatment plan?
Was the referral for physiotherapy justified?
Which physiotherapeutic objectives are there for this patient?
Which strategy can help achieve these objectives?
Which physiotherapeutic exercises will be performed?
Which measuring instruments will be used?
Who will be the treating physiotherapist?
92
Order the following terms, relevant to the anamnesis.
- Participation
- Function/Disorder.
- Activity
Participation ->
Activity ->
Function/Disorder.
93
What should be "out of the way", with regard to behaviour, before the beginning of the treatment plan?
Deviant behaviour
94
What are the "contents" of a treatment plan diagnosis?
- Inform and advise.
- Treat the joint first and produce exertion afterwards.
- Find if FMS are affected by doing exercises.
You should also be formulating the final target (movement functioning / life quality connected to the PIP/NPIP/patient's care request).
Formulate smart learning targets
95
What does SMART stand for?
```
Specific
Measurable
Attainable
Relevant
Time-based
```
96
What are the Red flags for the shoulder?
1. (Recent) Trauma?
2. Already existing (unexplained fever)?
3. Recent unexplained weight loss (> 5kg / a month)?
4. Long-term use of corticosteroids?
5. Constant pain that does not decrease at rest or when changing position.
6. Cancer in history?
7. General feeling of being unwell / malaise?
97
Guideline of subacromial complaints.
Below are some of the listed signals for severe pathology, which differential diagnostic disorders could they signal?
1 - Severe and/or persisting complaints, two-sided shoulder complaints, physical complaints elsewhere, fever malaise or weight loss?
2 - Intense radiating pain, tingling in arm or hand, correlating with neck movements or reduced strength of arm or hand muscles?
3 - Dyspnea / chest pains?
4 - Joint issues elsewhere, rheumatoid arthritis in the medical history, signs of synovitis such as a heat or fever?
5 - Complaints which do not match the age, for example movement limitations at a young age?
1. Infectious processes such as septic arthritis, polymyalgia rheumatic, an internal condition such as cholecystitis.
2. Cervical radicular syndrome
3. Pneumonia, angina pectoris, acute coronary syndrome.
4. Rheumatoid arthritis.
5. ??
Also referred pain, abnormal reflexes and reduced strength.
98
What is the course of (general) shoulder complaints?
- About 30% recovery after 6 weeks
- 50% after 6 months
- 60% after 12 months
The course of the complaint depends on the nature of the condition and he patients age.
99
What are some unfavourable prognostic factors for the development of (general) shoulder complaints?
- Long-term complaints at the first consult;
- Severe pain;
- A gradual development of the complaints;
- Neck pain;
- Functional disorders of the CTT;
- Repetitive movements and unfavourable (re-occuring) work-related and psychological factors.
- Glenohumeral instability and scapulothoracic dysfunction may cause or maintain the complaints.
100
What is a normal course of an acute ankle sprain?
- A ‘normal’ recovery process should result in functional recovery and cure without residual complaints (such as functional instability).
- Most patients will have resumed their sports activities at the same level as before the trauma within 12 weeks.
- Will normally be able to walk again within one to two weeks.
101
If a 'normal' course isn't seen, patients should be assessed to identify impediments, which in the case of inversion trauma may include:
('Abnormal course')
- Relevant concomitant pathology impeding ‘normal’ recovery (such as arthrosis);
- An ‘out-of-control’ inflammatory response;
- Unexplained pain that the patient is unable to control in any way;
- Inadequate adjustment of the patient’s behaviour in terms of posture and movement (relative or absolute overload);
- Being afraid to put weight on the ankle;
- Re-injury
- Pre-existent instability of the ankle.
102
How do you test functional instability after an acute ankle sprain?
• Assess the patient’s gait.
• Can the patient stand still on one leg after jumping and
landing on the affected leg?
• Can the patient walk on toes or heels?
• Is the patient capable of complex load-bearing activities
including dual tasks?
103
Below are the phases in tissue recovery with regards to an Acute ankle sprain.
Add to each the Phase, Tissue recovery and symptoms.
1. Phase 1
2. Phase 2
3. Phase 3
4. Phase 4a
5. Phase 5b
1. Inflammation - 0-3 days
- Pain at rest, swelling and hematoma, No full weight on ankle.
2. Proliferation - 4-10 days
- Foot can be actively moved to neutral position, Swelling reduced, Putting weight on foot, no complete heel-to-toe movement, Possible fear of movement.
3. Early-remodelling phase - 11-21 days.
- Hematoma still present, Normal heel-to-toe movement, Pain and fear of movement during ADL.
4. Late-remodelling phase - 3 to 6 weeks.
- No more hematoma, Dorsal flexion possible
a. transfer 1: preferred load-bearing capacity in ADL and at work.
5. Late-remodelling phase - 6 to 8 or 12 weeks.
- b. *transfer 2: preferred load-bearing capacity at high-level or top-level sports.*
104
What items are measured in the Function score by De et al.?
What is the total score?
How many points would it take at the first examination, within 5 days of the trauma, to expect the patient to resume their normal ADL within 14 days?
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Pain
Dynamical stability
Load-bearing capacity
Swelling
Gait
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Total score = 100 points.
40 Points or over and then they can expect to resume their normal ADL within 14 days.
105
Since acute ankle injuries may involve fractures, the guideline committee recommends applying the 1) .................................. for fracture diagnostics in the acute phase (up to 7 days after the trauma).
According to these 'rules' an 2)................. examination of the ankle or mid-foot is indicated if the patient reports 3)............ on the specific spots.
1) Ottawa ankle rules
2) X-ray
3) Pain
106
What are the three steps of human emotion?
1. Activating event
2. Consideration (cognition)
3. Consequence in:
- Emotion
- Behaviour
107
Cognitive behaviour..
What is Motivational behaviour?
What is Motivational focus?
MOTIVATIONAL BEHAVIOUR
- Behaviour we show for a specific reason.
MOTIVATIONAL FOCUS
- Having a goal and focusing on this in behaviour and actions.
- Ego-directed goals:
You demonstrate that you can beat the other.
The action is not the goal in itself, the goal is rather the result, disregarding the effort made.
Learning is not necessary or desirable.
```
- Task-directed goals:
Obtaining and demonstrating skills.
You get the hang of something.
The goal is in the action itself -> Intrinsic
The ability to learn
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108
Name and describe the two types of "Conditioned behaviour"..
Conditioned behaviour
- Classic conditioning (Watson et al. 1920)
Associating two events
Stimulus and response changes
- Operant conditioning (Skinner, 1935)
Consequence of stimulus to response
Rewarding/reinforcing behaviour
Provoking desired behaviour
109
What is Climate and what are the two types?
Environment or context in which focus is stimulated or inhibited.
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- Task-directed
The task or activity is the goal
Intrinsic motivation
Interest in the task or activity
Enjoying the task or activity
Feeling positive about gaining a skill
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- Ego-directed
Measuring strength with yourself or another person
The task or activity is not the goal, winning is.
Predictor of pressure and tension
Possibly avoiding behaviour, lack of compliance to therapy
110
Name and describe the two types of 'Reinforcement"
- Intrinsic reinforcement
For example by propriocepsis
- Extrinsic reinforcement
Teaching a movement by the physiotherapist.
111
Define Problem-oriented behavioural coping...
Solving the problem and regaining control over the problem.
112
Define Problem-oriented cognitive coping..
The patient views the problem differently, this includes the reframing or revaluing the problem.
113
Define Emotion-oriented behavioural coping..
Activities which distract tension tone down the negative emotions (biting your nails, smoking, drinking, etc.). This is unfavourable in case of long-term stressors, as the patient is not working on reducing the stressor.
114
Define Emotion-oriented cognitive coping..
Talking about and expressing emotions can reduce the arousal. Emotional inhibition, repression, defensive avoidance and denying can create more distance to the problem.
115
What is Attribution?
| What are the 4 types of attribution?
Attributing a specific consequence to a specific cause
1. Attributing physical discomforts to a situation (somatisation)
2. Attributing everything that could possibly happen to a situation (catastrophizing)
3. Attributing a complaint inwards (the self) (internalising)
4. Attributing a complaint outwards (externalising)
116
Whats the difference between Life events and Hassles?
Life events: Bigger things that happen in life
All these events require a human being to reorient and readapt themselves, and often to process a loss.
The opposite can also happen: positive events also require a reorientation: marriage, living together, job promotion.
Hassles: Daily troubles
Constant daily tension slowly develops
By stretching the capacity, the heavy load goes unrecognised.
The moment that the balance tips over is seen too late.
Pressure from the environment.
Structurally impossible to fix it yourself.
117
Explain the RPS form (Explanatory model) and suggest why it's useful for a physiotherapist.
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It helps the physiotherapist to analyse the patient’s health problem.
Making connections (drawing arrows) makes the analysis visible and is therefore a useful instrument.
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118
Explain the The movement continuum model by Cott..
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A closer look at movements thinking about the following:
Molecular
Subcellular
Cellular
Tissue
Organ / control system
Body part
Body
Human being in an environment
Human being in a society
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119
Describe the Fear-avoidance model?
The fear-avoidance model by Vlaeyen is a model which attempts to explain chronicity from a negative point of view about pain and illness.
This will increase the pain, as well as the related fear. The fear causes you to avoid the pain (=movements causing pain) and as a result you become inactive, develop more complaints: a vicious cycle.
The only way to get out is to face your fear (through cognition) and break the cycle.
120
What is the psychosocial model describing?
A model which represents the different roles which psychosocial factors play in the development and course of complaints and illnesses.
121
What is the System-theoretical model?
The system theory assumes that a human being can only truly be understood in the context of his relationships. Despite the fact that we often think that a person has a fixed character, we see people behaving differently in different contexts. They are different at work than at home, different with their mothers than with their mothers-in-law and different again at the sports club than with their children. People have a large behavioural repertory and for each situation shift into different behaviour. This means that people are very sensitive to context.
122
What questions make up the Core of the 'Common sense model of illness'?
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What is wrong with me?
How long will it last?
What are the consequences?
How can I get it under control?
What caused it?
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123
What is the 'Pain model' / 'Loeser's egg'?
First of all, there is the painful stimulus, the nocicepsis. Then the pain perception. This is followed by pain experience and the translation into pain behaviour.
Loeser used differently sized circles to clarify this. This way, the pain stimulus could be a tiny circle, and the behaviour can be huge in comparison. The opposite can also happen
