L3: Ageing Systems and Assessment Part 2 Flashcards
1
Q
What are 10 assessment etiquettes for older persons?
A
- Must be client-centred
- more conversational than MSK interview
- Be professional and respectful
- You are dealing with ‘seniors’ & ‘consumers’
- Position yourself at patient’s eye level
- Not looking down (having superiority)
- Patient position – standing, sitting in chair, bed?
- How is their sitting balance, can they maintain a sitting posture –> must put in well supported position (not challenging them during the interview)
- Speak slowly and at an appropriate tone
- Do not shout if your older patient is deaf
- Sit on side of best hearing and where you can be seen
- Ask simple questions, using lay terminology…
- Allow patients to answer for themselves
- Interrogate sparingly for communicating patient
- Provide direction to rambling patient
- Listen carefully to a patient’s response
- Often contains answers to multiple questions
- Avoid repetition
- Formulate client-centred goals which:
- Consider physical & psychosocial factors
- Incorporate multi-focal interventions
- Are achievable and measureable
2
Q
What is the best lay term version of: “Have you noticed any neuropathetic changes on the plantar surface of your feet?”
A
“Have you experienced any different sensations at the bottom of your feet? Any tingling, numbness”
3
Q
What are the first 3 things to ask in the patient interview?
A
- Demographic details
- How would you like to be addressed?
- What is the main problem/s from referral and/or from the older patient?
- Main problem for referral: For physio and patient’s understanding (often don’t match so need to know
- History relating to current problem/s including:
- Insidious/traumatic onset
- Date of onset
- Behaviour
- Irritating/relieving factors
- Previous treatment
- Might have already been to a physio/health professional ..etc and ask about effectiveness
4
Q
What is the clinical rationale for asking: demographic details, main problem for referral and history relating to current problem?
A
Identifies the need for any special considerations
5
Q
What are 8 additional things to ask in the interview apart from demographic details, main problem for referral and history relating to current problem?
A
- Investigations:
- Past results to be ordered?
- Tests to be requested?
- Complete medical and surgical history:
- Cardiac
- Respiratory (Arterial gas reports)
- Musculoskeletal
- Neurological
- Diabetes
- Cancer
- Injury
- Surgery
- Complete medications list
- Past & current use
- Social history:
- Home: Setting? Access?
- Living: Alone/with family?
- Employment?
- Hobbies/Recreation/Sport?
- Limitations to activity?
- Functional Status:
- History and risk of falls
- Current level of assistive support – maintain/reduce?
- Activity tolerance
6
Q
What is a risk factor for falls in older people?
A
3 or more co-morbidities
7
Q
What are the 3 clinical rationale for asking: investigations and complete medical and surgical history?
A
- Multiple chronic conditions: falls risk factor
- Modifications to assessment / treatment
- Potential for improvement in condition
8
Q
What are the 4 clinical rationale for asking: complete medications list and past and current use?
A
- Used to justify the need for physiotherapeutic intervention
- Polypharmacy: falls risk factor
- Identify symptoms which may be medication side effects
- Eg. dizziness, headaches, cramps –> can be due to side effects of drugs rather than actually treatment/exercises given
- Timing of medication vs. treatment
- Take medication before treatment
- Eg. Take Levodopa-carbidopa before treatment in Parkinson’s
9
Q
______ usually comes before mediation management
A
Physio
10
Q
What are the 3 clinical rationale for asking: social history?
A
- Identify usual activities/exercise/fitness to assist goal-setting
- Help developing SHARED goals –> SMART goals (eg. quantitative)
- Establish functional level required for safe return to home
- Identify areas of need for greater support (family/external)
11
Q
What are the 3 clinical rationale for asking: functional status?
A
- Determines safety
- Assists prescription of appropriate dosage/ duration of treatment and adaptations needed
- Level of support required:
- At home (physical and assistive devices)
- During assessment/treatment sessions
12
Q
What are the 4 clinical rationale for communication?
A
- Establishes need for alternative methods of communication?
- Determines appropriate level of language/terminology
- Evidence of trust
- Need for a translator
13
Q
What are the 4 clinical rationale for cognition?
A
- Impacts communication
- Ability to give consent
- Memory & attention
- Level of anxiety & stress
14
Q
What is dysphasia in regards to communication?
A
Difficulty to put words in phrase, difficulty comprehending
15
Q
What is dysarthia in regards to communication? What is a common management option?
A
Can comprehend language just difficulty to speak- speech production is challenged (speechie –> good)
- Use emotional cards (respond using pointing)
16
Q
What is the Melbourne Edge Test?
A
- Determines contrast sensitivity
- Important to see edges of steps or tables when colour contrast is not possible
- Important for depth perception
- Test of which direction the line is in - Vertical - Diagonal - Horizontal
17
Q
How to test Visual Acuity?
A
6= distance away from chart
6/x = size of the letter
18
Q
Why must you to test for Tactile Acuity?
A
- Tactile sensory loss: danger of foot injuries
- Footwear needed when exercising and at most times
- Safety of environment i.e. hot cement burns on bare feet
19
Q
How to test for Tactile Acuity?
A
- Diabetes or neuropathy
- Tested with monofilament
- Perpendicular to skin
- Can they feel the monofilament
20
Q
How to test for 2 Point Discrimination?
A
- 2 points - To skin location
- Can you tell whether you feel 2 points or one
- Bring points closer
- Patient can feel one point (while still 2 point discrimination)
21
Q
How to test for Vibration?
A
- Start of vibration and can’t feel any more
- Outcome: duration
22
Q
How to test for Temperature Perception?
A
- Very important to test prior to delivering heat or ice treatments
- Hot water and cold - Which one they can feel)
23
Q
How to test for Joint Position Sense?
A
- Proprioceptive loss: ↓ joint protection – changing surfaces and impaired reaction times
- Most common at knees and ankles Perform joint reproduction
- Measure of error in degrees between 2 degrees
24
Q
What are 8 characteristics of the respiratory pattern in interview and observation?
A
- Observe for SOB (shortness of breath) (talking/walking)
- Muscle atrophy/tightness
- Posture
- Auxiliary breathing
- Respiration rate
- Any audible sounds (cough, wheeze, rattles)
- O2 delivery, flow rate, SaO2%
- Ability to swallow
25
What is auxiliary breathing?
Use muscles of chest and arms to breath ; fixating arms - elevated shoulders - use upper body to breath rather than diaphragm
26
What are 3 characteristics of continence in interview and observation?
1. Bladder and/or bowel
2. Patterns/frequency of incontinence (medication, aids-pads, after caffeine)
3. Any aids being used?
27
What are the 2 clinical rationale for continence?
1. Avoidance of activity (stress incontinence)?
2. Some forms of incontinence can be managed with physiotherapy
28
What are 6 features that need to be noted in regards to pain?
1. Type
2. Cause
3. Location (including referred)
4. Irritating/relieving factors
5. Severity
6. Management
29
What are 4 the clinical rationale for pain?
1. History of cancer – new pain Indicate metastasis --\> cancer spread to a new area
2. Osteoporosis – new pain after cough/sneeze/twisting Increase intra-abdominal pressure --\> fracture of vertebrae or ribs
3. Timing of treatment vs medication?
4. Change in pain – treatment effect (improvement or aggravation)
30
What are 7 characteristics of the oedema and skin?
1. Swelling of ankles
2. Pitting oedema
3. Skin integrity (thin/fragile)
4. Bruising (warfarin?)
5. Wounds (± management)
6. Circulation
7. Peripheral pulses
31
What are 5 clinical rationale for oedema and skin?
1. Potential for pressure area formation
2. Prevention of soft tissue damage (handling/equipment/techniques)
3. Test peripheral pulses
* Dorsalis pedis, posterior tibial, popliteal and femoral pulses
4. Skin atrophy must be noted
5. Assessment/treatment limited by oedema
32
What is bilateral swelling like?
Systemic --\> commonly kidneys
33
What is unilateral swelling like?
MSK
34
What is pitting oedema?
Pressing --\> waiting for time skin goes back to normal
35
What is bruising due to?
* Stroke, CVD
* Warfarin --\> anticoagulant
* Can bruise very easily --\> need to be gentle and aware of this in treatment
36
What is peripheral pulses?
Clear sign of peripheral vascular (arterial) disease
37
What are some special questions?
Dizziness, nausea, vomiting
38
What are some 10 observations?
1. Facial expression (or lack)
* Look like they are in pain Parkinson's --\> vacant expression
2. Posture: kyphosis, scoliosis
3. Movement (e.g. tremor, lack of arm swing)
* Parkinson's
4. Skin condition (legs/arms)
5. Swelling: legs and/or arms, bilateral or unilateral Diagnostic options?
6. Obvious deformities (e.g. valgus knees, bunions, crooked toes) Offset --\> balance control
7. Obvious scars: surgery suggested by location (e.g. neck - thyroidectomy?)
8. Walking aid/s: Used safely and correctly?
9. Avoidance behaviours reflecting pain
10. Footwear/orthotics: Appropriate and safe?
39
If in the interview, the patient has poor skin condition, what should the objective assessment be?
Check peripheral pulses
40
If in the interview, the patient has dizziness when rolling, what should the objective assessment be?
Vestibular assessment
41
If in the interview, the patient falls, what should the objective assessment be?
Balance assessment
42
If in the interview, the patient has had a past TKR what should the objective assessment be?
Proprioception, ROM, muscle strength
43
If there are any abnormality or deviation from normal gait patterns? What are 7 features should be observed during gait?
Aid used correctly Suitable footwear Base of support- narrow or wide Hip extension Trunk rotation Arm swing Asymmetries/limping Footfall pattern (Cadence-look and listen) Able to move head and maintain balance
44
What are 6 characteristics of sit to stand?
1. Use of arms
2. Ankle flexibility
3. Foot positioning
4. Equal weight-bearing
5. Trunk flexion
6. Movement initiation/contro
45
What are 5 characteristics of bed mobility?
1. Trunk rotation/flexibility
2. Rolling/bridging ability
3. Initiation of movement
4. Movement pattern
5. Lying-sitting transfer
46
What are 7 characteristics of stair negotiation?
1. Step to or step through pattern
2. Step-over-step pattern
3. Use of handrails
4. Foot clearance
5. Lower limb ROM & muscle strength
6. Support body weight
7. Single limb and double limb phase
47
What are 7 characteristics of fine motor control?
1. Pincer grip
2. Grip strength
3. Supination/pronation
4. Upper limb support
5. Movement control
6. ROM
7. ADLs
48
What are 7 characteristics of reaching?
1. Scapular movement
2. Posture
3. Compensatory strategies
4. Shoulder ROM
5. Sitting balance
6. Reach outside of BOS
7. ADLs
49
What are 5 characteristics of balance challenges?
1. Control centre of mass over ↓ base of support
2. ROM, muscle strength
3. Concentration
4. Lifting a load
50
What are 5 characteristics of negotiating obstacles
1. Awareness of environment
2. Judgement of hazards
3. Accurate motor response
4. ROM, muscle strength
5. Single- and double-limb balance performance
51
What are 3 characteristics of dual tasks?
1. Multiple skills (walking straight, turning, STS)
2. Prioritising tasks
3. Gait stability
52
What are 5 things that need to be assessed in the functional analysis of motor tasks?
1. Level of independence
2. Assistance required
3. Quality of movement
4. Missing components
5. Likely impairments contributing to functional impairment
53
What are 5 things to in regards to joint ROM (local movement patterns)?
1. End feel
2. Soft tissue resistance
3. Crepitus in joints
4. Muscle tone/spasticity
5. Tightness
54
What are 6 things that must be involved in recording?
1. Sufficient detail to tell the story of the patient • Use heading and dot points
2. Only use standard abbreviations……
3. Include problem list in order of importance after Ax
* Most important at top
4. State short- and long-term goals
* May relate to an outcome measure (i.e. to be able to walk to the bathroom independently twice a day)
5. Treatment documented
* Include any warnings/contraindications to treatment and special testing completed where indicated (i.e. skin temperature sensation)
55
What does Ax stand for?
Assessment
56
What does # stand for?
Fracture
57
What does THR stand for?
Total hip replacement
58
What does PVD stand for?
Peripheral vascular disease
59
What does Ca stand for?
Calcium
60
What does EO/EC stand for?
Eyes open/eyes closed
61
What does 3/12 stand for?
3 months
62
What does ABGs stand for?
Arterial blood gas reports
63
Use ______ findings to consider precautions and contraindications to treatment choices/positions used
assessment
64
What are 4 contraindications for aquatic therapy?
1. Open wounds/bleeding
2. Acute infection
3. Active joint inflammation
4. Incontinence
65
What is a contraindication for electrotherapy?
Cancer/Malignancy
66
What are 4 contraindications for manipulations?
1. Ankylosing spondylosis
2. Malignancy
3. RA
4. OP
67
What are 2 contraindications for thermal treatments?
1. Peripheral vascular disease
2. Open wounds/bleeding
68
What are 3 characteristics of clinical reasoning?
1. Prioritise problems (as perceived by the patient)
2. Set realistic goals with your patient
3. Include management of all current problems &prevention interventions
* e.g. OA knees – balance, muscle strengthening & proprioceptive exercises
69
What are 3 characteristics of outcomes measures?
1. Choose relevant, repeatable and measurable outcomes
2. Don’t duplicate – choose a range of outcome measures
* 10m walk & 6MWT – both needed?
3. Think globally using ICF framework
* Specific measures of impairment: Pain, ROM, Muscle Strength
* Functional measures: Physical Mobility Scale, Elderly Mobility Scale
* Balance measures: Timed Up and Go, Berg Balance Test
* Participation: Self-perceived health questionnaires/quality of life
70
What are 6 features of goal-setting?
1. What is the reason for physiotherapy referral?
2. What are the expectations of the older person? (or referring source?)
3. What movement difficulties is the patient experiencing?
4. What is the patient’s preferred level of function?
5. How can we close the gap between current and preferred movement capability/function?
6. Context – need to understand a patient’s physical & social surroundings and external environment
71
What does the ICF Framework look like?
72
What are 10 constraints to goal setting and treatment?
1. Inability to articulate goals clearly (communication/cognitive impairments)
2. No clear idea of the potential for change in movement/function
3. Unable to take responsibility for helping to plan treatment
4. Dependent on physiotherapist
5. Do not wish to make treatment decisions
6. Patient not ready to take part in treatment
7. Not acknowledging they have a problem
8. Minimising of a problem
9. Excuses regarding: access, environment, assistance
10. Dependency on family/carers to perform ADLs
73
What are 4 characteristics of patient goals determined by living situation (impact of environment)?
1. Rural and remote: ability to walk over uneven ground
2. RACF vs. small flat: walking distance
3. Living alone/with family: help required for ADLs?
4. Leisure activities occurring outside of accommodation
74
What are 4 characteristics of patient goals determined by home visits (impact of environment)?
1. Functional level required for safe return to home
2. Stairs, uneven ground, multi-tasking situations etc.
3. External environmental and indoor safety issues
4. Impact of items identified on patient goal setting for safety and discharge needs
75
What are 6 characteristics of the role of family and caregivers (social environment)?
1. Cognitive assistance – medication
2. Behavioural assistance – motivation
3. Physical assistance – transfers/mobility/dressing
4. Travel assistance – shopping/appointments
5. Financial assistance – purchasing equipment (RACFs)
6. Home & community service utilisation – meals on wheels
76
What are 3 characteristics of the care committments (social environment)?
1. Ensure family understands responsibility of care
2. Need to acquire new skills to undertake care requirements (taught by physio/OT)
3. Availability of respite services and access
77
What are 6 characteristics of the caregiver constraints (social environment)?
1. No family
2. Distance from family to patient’s home
3. Too many other commitments
4. Dysfunctional families
5. Do not assume that the family will be able to provide care for an older person on discharge from hospital
6. Potential problems due to neglect
78
What is an important thing to know about community-based services?
Are they available/accessible to the patient (transport/cost)?
79
What are 4 characteristics of the home exercise programs?
1. Need to be attractive and relevant to encourage participation
2. What can the patient do independently and safely
3. Identify which treatments require supervision/hands-on facilitation
4. Family/friends may not be available to help with home exercise programs
80
What are 5 things that are important to consider in regards to management for older persons?
1. Patient safety (including specific environmental hazards)
2. Where will the patient be doing their home exercise program?
3. What space is available – impact on choice of exercises
4. What equipment is available – use of task specific or assistive resources?
5. Use your face-to-face treatment time wisely
