Kines-Written Test 4

Question 1

What is the definition of posture?

Answer 1

posture is the position of your body parts in relation to each other at any given time.

Question 2

What is the difference between static and dynamic posture?

Answer 2

static posture is sitting, lying, or standing. Dynamic posture is the body moving from one position to another.

Question 3

Explain how posture relates to your COG and BOS

Answer 3

Posture deals with alignment of various body segments. Each joint involved with weight bearing can be considered a postural segment. We are stable when our COG is over our BOS. As we move within our “posture”, we have to maintain range within our BOS, or we will fall; like offset blocks on a column.

Question 4

What factors might affect postural sway?

Answer 4

The higher our COG with decreased BOS equals an increase in postural sway. (postural sway is controlled by the plantar flexors and dorsiflexors)

Question 5

What keeps us balanced and holds us upright?

Answer 5

Our muscles, but ligaments play a part too. The muscles most involved are the antigravity muscles.

Question 6

What are the anti-gravity muscles?

Answer 6

Hip and knee extensors, trunk and neck extensors, and to a lesser degree trunk and neck flexors, lateral benders, hip abductors and adductors, ankle pronators and supinators.

Question 7

What does normal postural alignment look like from the frontal view?

Answer 7

line should be directly along the midsagittal plane, passing through the head, shoulders, sternum, hips, legs, knees, ankles and feet.

Question 8

What does normal postural alignment look like from the lateral view?

Answer 8

Plum line should run through the head (earlobe), shoulder (acromion process), thoracic spine (anterior to vertebral bodies), lumbar bodies, pelvis, hip (greater trochanter), knee (posterior to patella), and ankle (slightly anterior to the lateral malleolus)

Question 9

What does normal postural alignment look like from the posterior view?

Answer 9

line should pass along the midsagittal plane through the head, shoulders, spinous processes, hips (gluteal cleft), legs, knees, ankles.

Question 10

Abnormal postural alignment, things to look for when assessing posture. (head, shoulders, spine, scapula,sternum)

Answer 10

head- not flexed, hyper flexed, laterally bend. shoulders- level, not elevated, depressed, or excessive retraction or protraction.
spine- not too much curvature such as kyphosis, excessive lordosis, scoliosis, rib hump, or spinal rotation.
Scapula- level, not winging or uneven in any direction.
Sternum- centered in midline

Question 11

Abnormal postural alignment, things to look for when assessing posture. (pelvis, hip, legs, knees, ankles, feet)

Answer 11

Pelvis- level, PSIS and ASIS should level at transverse plane, ASIS and pubic symphysis should level in vertical plane, and both ASIS and PSIS should be level with one another on its opposite side.
Hip- through the greater trochanter, slightly posterior to the hip joint axis and nothing more or less.
legs- slightly apart
knees- not bowed (genu varus) or knock kneed (genu valgus), hyperextended (genu recurvatum), or not fully extended. Also, tibial torsion.
Ankles- normal arch in feet, not flat footed, calcaneus should be straight, level.
Feet- slight outward toeing, not pigeon toed or duck footed, toes aren’t presenting hallux valgus or hammer toes.

Question 12

What does anteroposterior gravity line mean?

Answer 12

dividing the body from anterior to posterior (lateral view)

Question 13

What is a lateral gravity line?

Answer 13

dividing the body equally into 2 halves (posterior or anterior view)

Question 14

Compare and contrast running with walking.

Answer 14

Walking is the manner or way in which you move from place to place with your feet. Gait is the process or components of walking. Within gait there is a nonsupported period; time in which neither foot is in contact with the ground. This only occurs during running. Other than speed this is the biggest difference of the two.

Question 15

Define gait cycle/stride

Answer 15

between the time when one foot touches the floor and the time the same foot touches the floor again (total of two steps)

Question 16

Define Stride Length

Answer 16

distance traveled during the gait cycle/stride

Question 17

Define Step

Answer 17

one-half of a stride

Question 18

Define Step Length

Answer 18

distance between the heel strike of one foot and the heel strike of the other foot.

Question 19

Define Cadence

Answer 19

number of steps taken per minute

Question 20

Define Stance Phase

Answer 20

when the foot is in contact with the ground (60% of gait cycle)

Question 21

Define Swing Phase

Answer 21

when the foot is not in contact with the ground (40% of gait cycle)

Question 22

Define Double Support

Answer 22

when both feet are in contact with the ground at the same time (each period takes up about 10% of the gait cycle)

Question 23

Define Non-Support

Answer 23

time in which neither foot is in contact with the ground (occurs during running)

Question 24

Define Single Support

Answer 24

when only one foot is in contact with the ground (each period takes up about 40% of the gait cycle)

Question 25

What are the traditional terms associated with the analysis of the stance phase?

Answer 25

heel strike, foot flat, midstance, heel-off, toe-off

Question 26

Define heel strike

Answer 26

the initial contact, when the heel contacts the ground

Question 27

Define foot flat

Answer 27

the loading response; plantar surface of the foot in contact with the ground.

Question 28

Define midstance

Answer 28

the midstance; point at which the body passes over the weight bearing leg

Question 29

Define Heel-Off

Answer 29

the terminal stance; heel leaves the ground, while the ball of the foot and toes remain in contact with the ground

Question 30

Define Toe-Off

Answer 30

the pre-swing; toe leaves the ground, ending stance phase

Question 31

Define the traditional terms associated with the analysis of the swing phase.

Answer 31

Acceleration- the initial swing; the swing leg begins to move forward Midswing- the midswing; the swing (non-weight bearing) leg is directly under the body Deceleration- the terminal swing; the leg is slowing down in preparation for the heel strike

Question 32

What are gait-related factors?

Answer 32

vertical displacement of the COG, horizontal displacement of the COG, width of walking base, lateral pelvic tilt, arm swing and trunk rotation.

Question 33

Define vertical displacement of the COG

Answer 33

while walking, if you were to hold a piece of chalk next to you against a blackboard, you would see it drew a wavelike line. The normal amount of this displacement is approx. 2 inches, being the highest at midstance and lowest at heel strike.

Question 34

Define horizontal displacement of the COG

Answer 34

as the body shifts from side to side. Greatest during the single support phase at midstance. Displacement is usually about 2 inches.

Question 35

Define width of walking base

Answer 35

distance from one heel successive midpoint of one foot to the other on the other foot during walking. Ranges about 2-4 inches.

Question 36

Define Lateral Pelvic Tilt

Answer 36

when walking, your hips move up and down as your pelvis on each side drops down slightly. This is when weight is removed from the leg at toe-off (pre-swing). Sometimes referred to as Trendelenburg sign.

Question 37

Define arm swing and trunk rotation

Answer 37

the arms should swing with the opposite leg. The trunk rotates forward, as the leg progresses through the swing phase. Arms swinging in opposition to trunk rotation control the amount of trunk rotation by providing counter rotation.

Question 38

Sore foot or antalgic gait

Answer 38

less weight bearing time on the sore foot (decreased time of stance phase). Reciprocal arm swing shortens as the step length is shortened, exaggerated and often abducted.

Question 39

Weak Plantar Flexors (triceps surae group) Gait

Answer 39

there is no heel rise at push off, resulting in a shortened step length on the unaffected side.

Question 40

Weak dorsiflexors gait

Answer 40

(insufficient strength)- the foot will land with a fairly flat foot (no dorsiflexion), the toes will strike first which is referred to as an equinus gait. The body may not be able to support the body weight after heel strike and move toward foot flat resulting in foot slap. Gravity will cause the ankle to move into plantar flexion during the swing phase, known as drop foot. As a result of foot drop, the person has to bend the knee higher (like marching), to clear the foot from the ground. This is called a steppage gait.

Question 41

Weak knee extensors

Answer 41

person may lean forward over the quad muscles at the early part of stance phase. By leaning forward at the hip the COG is shifted forward, and the line of force now falls in front of the knee; the will force the knee backward into extension. Sometimes the person uses their body's momentum to throw their leg forward to get the knee straight.

Question 42

Weak hip flexors

Answer 42

increased trunk rotation, use body's momentum to throw leg forward (huge energy expenditure)

Question 43

Weak knee flexors

Answer 43

during stance phase, the knee will go into excessive hyperextension, referred to as genu recurvatum gait. Without the hamstrings to slow the forward swing of the lower leg during the deceleration part of the swing phase, the knee snaps into extension.

Question 44

Weak hip extensors

Answer 44

(gluteus maximus gait) the trunk quickly shifts posteriorly at heel strike. This shifts the body's COG posteriorly over the gluteus maximus, moving the line of force posterior to the hip joints. This backward-forward movement is referred to as a rocking horse gait.

Question 45

Weak hip abductors

Answer 45

(gluteus medius gait) person shifts the trunk over the affected side during the stance phase. For left weakness the body leans to the left during the legs stance phase, and the right side of the pelvis drops when the right leg leaves the ground and beings swing phase. Referred to as Trendelenburg gait.

Question 46

Patient with fused ankle

Answer 46

(triple arthrodesis) shortened stride length. Difficulty walking on uneven ground because of the loss of pronation and supination.

Question 47

Patient with a fused knee

Answer 47

if fused in extension the knee won't be able to shorten in swing phase. To compensate the person must (1) rise up on the toes of the uninvolved leg (vaulting gait), (2) hike hip of involved side (3) swing the leg out to the side or (4) do some variation of the three methods. Could result in a circumducted gait or abducted gait.

Question 48

Patient with plantar flexion contracture

Answer 48

person will lift knee higher during swing phase, and the toes will land first during heel strike. Person may leave the knee bent to compensate for the lengthened limb on the affected side.

Question 49

Patient with knee flexion contracture

Answer 49

will result in excessive dorsiflexion during midstance and an early heel rise during push off. There is also a shortened step length of the unaffected side.

Question 50

Patient with leg length discrepancy

Answer 50

vaulting off the shorter limb or circumducting the longer leg, to clear the ground during swing phase of the longer leg. Moderate discrepancy is 3-5 inches. Severe is more than 5 inches.

Question 51

Patient with hip flexion contracture

Answer 51

leaning forward to the affected side, wider BOS, never have full knee extension. Circumduct the opposite leg, or possible vaulting.

Question 52

Patient with a spastic gait where the lower extremities are adducted and plantar flexed

Answer 52

(scissor gait) most evident during swing phase, when the unsupported leg swings against or across the stance leg. Trunk may lean over the stance leg as the swing phase, when the unsupported leg swings against or across the stance leg. Trunk may lean over the stance leg as the swing phase leg attempts to past it. Arms more abducted to compensate for balance and narrow gait. (common in people with cerebral palsy, AKA crouch gait; which is bilateral lower extremity involvement seen in spastic diplegia.)

Question 53

Biceps Reflex Test

Answer 53

is a reflex test that examines the function of the C5 reflex arc and the C6 reflex arc. The test is performed by using a tendon hammer to quickly depress the biceps brachii tendon as it passes through the cubital fossa. Specifically, the test activates the stretch receptors inside the biceps brachii muscle which communicates mainly with the C5 spinal nerve and partially with the C6 spinal nerve to induce a reflex contraction of the biceps muscle and jerk of the forearm.

Question 54

Brachioradialis Reflex Test

Answer 54

(also known as supinator reflex) is observed during a neurological exam by striking the brachioradialis tendon (at its insertion at the base of the wrist into the radial styloid process (radial side of wrist around 4 inches proximal to base of thumb)) directly with a hammer when the patient's arm is relaxing. This reflex is carried by the radial nerve (spinal level: C5,C6). The reflex should cause slight wrist extension and/or radial deviation, supination and slight elbow flexion.

Question 55

Triceps Reflex Test

Answer 55

a deep tendon reflex, is a reflex as it elicits involuntary contraction of the triceps brachii muscle. It is initiated by the Cervical (of the neck region) spinal nerve 7 nerve root (the small segment of the nerve that emerges from the spinal cord). The reflex is tested as part of the neurological examination to assess the sensory and motor pathways within the C7 and C8 spinal nerves. The deep tendon reflex of the triceps is evaluating spinal levels C6, C7, and C8.The test is performed by tapping the triceps tendon with the sharp end of a reflex hammer while the forearm is hanging loose at a right angle to the arm. A sudden contraction of the triceps muscle causes extension,and indicates a normal reflex.

Question 56

Tinel Sign Test

Answer 56

is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve. For example, in carpal tunnel syndrome where the median nerve is compressed at the wrist, Tinel's sign is often "positive" causing tingling in the thumb, index, middle finger and the radial half of the fourth digit. Tinel's sign is sometimes referred to as "distal tingling on percussion" or DTP. This distal sign of regeneration can be expected during different stage of somatosensory recovery.

Question 57

What are the neurological levels of C5?

Answer 57

Motor: Deltoid Reflex: Biceps Sensation: Lateral upper arm

Question 58

What are the neurological levels of C6?

Answer 58

Motor: Biceps/Wrist Extensors Reflex: Brachioradialis Sensation: Lateral Lower arm

Question 59

What are the neurological levels of C7?

Answer 59

Motor: Triceps Reflex: Triceps Sensation: Middle Finger

Question 60

What are the neurological levels of C8?

Answer 60

Suspected: spinal cord injury Motor: Thumb Extensors Reflex: None Sensation: Medial aspect of lower arm

Question 61

What are the neurological levels of T1?

Answer 61

Suspected: bulging or ruptured disk, DDD Motor: Finger Abduction Reflex: None Sensation: Medial aspect of elbow and upper arm.

Question 62

What is a cervical distraction test?

Answer 62

To test for the presence of cervical radioculopathy. Patient lies supine and the neck is comfortably positioned. Examiner securely grasps the patient's head under the occiput and chin and gradually applies an axial traction. A positive test is the reduction or elimination of symptoms

Question 63

What is compression of the cervical spine test?

Answer 63

Patient seated, you standing behind them. Place patient's head/neck in neutral then gradually compress straight down with your fingers laced over the top of the patient's head and your elbows resting on their shoulders. Release pressure slowly. Positive Result: -pain, paresthesia (tingling/prickling), numbness radiating to upper extremity. ``` Positive Result May Mean: -nerve root compression (radiculopathy) due to: 1. cervical disc herniation 2. spinal stenosis 3. a positive test that reproduces arm symptoms suggests C6-C8 nerve root irritation -foraminal encroachments (osteophytes) -space occupying lesions ```

Question 64

What is a Valsalva Test?

Answer 64

How to Test: -Ask patient to bear down/pretend they're straining on the toilet for 2-3 seconds or alternatively blow on their thumb like they're trying really hard to blow up a balloon. - Test is positive if their pain/peripheral symptoms worsen. - Used to confirm suspicion of HERNIATED DISC or SPACE OCCUPYING LESION (SOL) in spinal cord or the IVF.

Question 65

What is the Adson test?

Answer 65

Used to assess subclavian artery as in thoracic outlet syndrome. Take patient's radial pulse, and as you continue to feel the pulse, abduct, extend, and deep breath and turn his head toward the arm being examined. If there is compression of the subclavian artery, there will be a significant decrease in the strength of the pulse.

Question 66

What is the neurological control test for the upper extremity?

Answer 66

Patient stands with arms flexed to 90 degrees with eyes closed. Patient is asked to hold this position for 30 seconds. Examiner notes drifts outward or downward which may indicate a brain lesion.

Question 67

What is the neurological control test for the lower extremity?

Answer 67

Patient sits with legs extended out in front without touching the ground. Holds for 20-30 seconds. If drift is noted, then suspect a brain lesion.

Question 68

What is the Romberg test?

Answer 68

Patient asked to stand with feet together, arms at side with eyes open. Assess balance then ask patient to close eyes for at least 30 seconds. (some suggest 60 seconds) Note any balance problems. Positive Romberg= patient sways excessively or falls to one side. A true positive Romberg is when the patient falls or loses his balance. Suggest a possible lesion involving the peripheral nerves or conditions affecting the dorsal columns of the spinal cord. (upper motor neuron issue)

Question 69

What is the finger-to-nose coordination test?

Answer 69

Patients stands or sits with eyes open and is asked to bring the index finger to the nose. Test is repeated with eyes closed. Repeat several times and at increasing speed.

Question 70

What is the finger-to-thumb coordination test?

Answer 70

Oppose each finger to thumb on each hand, increasing speed.

Question 71

What is the hand flip coordination test?

Answer 71

Alternatively touch the back of stationary hand with front and back of test hand fingers. If person can't do this, it is called dysdiadokineses.

Question 72

What is the heel-to-knee coordination test?

Answer 72

you look for ataxia, needs to be performed smoothly

Question 73

What is the proprioception (movement sense) test?

Answer 73

Testing to see if patient knows what movements are occurring on extremities

Question 74

What is the proprioception position in space test?

Answer 74

Testing to see if patient knows where their extremity is when they move it.

Question 75

What is Thomas Test?

Answer 75

Patient supine, flex knee, flatten back and then extend hip so that leg lies flat. Tight hip flexors if cannot let legs lie flat down against table.

Question 76

What is the Ober Test?

Answer 76

Test for tight TFL- sidelying and let test leg adduct down to other leg.

Question 77

What is the Drawer's Sign Test?

Answer 77

Supine with knees flexed and resting on table. Test for cruciates. Sit on foot, put hands right around top of lower leg, complete anterior and posterior movement.

Question 78

What is the Lachman's Test?

Answer 78

Supine with one knee slightly flexed and resting in examiner's hands. Test for cruciates.

Question 79

What does the Patellar deep tendon reflex tell you about?

Answer 79

It tells you about the integrity of the L4 nerve.

Question 80

What is the McMurray's Test?

Answer 80

Test for meniscal problems in the knee. Lay patient supine, flex the hip and knee, palpate medially, rotate tibia externally on the femur and extend while applying a valgus stress. Reverse for lateral meniscus. You might be able to hear something, or feeling popping. Ask patient do you feel better, worse, or the same?

Question 81

What is the apprehension test for patellar dislocation?

Answer 81

Supine, attempt to move the patella laterally. Might involve q-angle.

Question 82

What is the patella femoral grinding test?

Answer 82

supine, push patella distally and then have patient contract quads while providing resistance to the patella.

Question 83

What is the ankle jerk test?

Answer 83

(S1) Have patient seated, not touching the floor, relax, then passively dorsiflex the foot. Hit the gastrocnemius.

Question 84

What are the neurological levels for L4?

Answer 84

Motor: tibialis anterior (DF and INV) Reflex: knee jerk Sensation: medial aspect of leg

Question 85

What are the neurological levels for L5?

Answer 85

Motor: Extensor Hallicus Longus (raise big toe) Reflex: None Sensation: Dorsum of foot

Question 86

What are the neurological levels for SI?

Answer 86

Motor: Peroneals (eversion) Reflex: Ankle Jerk Sensation: Lateral aspect of foot and lower leg

Question 87

What is the Babinski test?

Answer 87

Stimulate from heel laterally and across MT medially. Positive= flare toes up. Negative= curl toes down. Positive suggest an UMN lesion. Will see a positive in stroke patients.

Question 88

What is the straight leg test?

Answer 88

Patient is supine, support above heel, passively flex hip 30-45 degrees. Positive if you increase pain on the opposite side.

Question 89

What is the test for hamstring tightness?

Answer 89

If patient can do a straight leg raise and come up 60 degrees, they don't have tight hamstrings.

Question 90

What is the Hoover Test?

Answer 90

Test to see if patient is really cooperating or not. Patient sits supine, cup under their heels, have patient raise one leg. He will always push down on other if really trying.

Question 91

What is the Patrick or Fabere Test?

Answer 91

Supine, test leg ER with foot resting on opposite knee. Compress opposite pelvis and test medial aspect of knee. Positive= problems with SI Joint.

Question 92

What is the Holman's Sign or test?

Answer 92

To test for a DVT. Foot and knee is extended, dorsiflex the foot, if pain is felt in gastrocnemius, this is a positive holman's sign. Do not confuse with tight plantar flexors.

Question 93

What is the Sharp/Dull Sensation Test used for?

Answer 93

Tactile discrimination is the ability to differentiate information received through the sense of touch. This is often tested during neurological examination and represents a higher level of neurological function involving the cerebral cortex. Examples include the ability to discriminate between sharp and dull objects touching the skin, and light touching of the skin.

Question 94

What is the light touch test used for?

Answer 94

Tactile discrimination is the ability to differentiate information received through the sense of touch. This is often tested during neurological examination and represents a higher level of neurological function involving the cerebral cortex. Examples include the ability to discriminate between sharp and dull objects touching the skin, and light touching of the skin. Many diseases of the higher centers of the brain can be diagnosed by the specific loss of abilities of tactile discrimination.