Paper 1 Questions

Question 1

Briefly explain the classification of 3 levers in human movement. 6

Answer 1

1. 1. First order: are levers in which the fulcrum is situated between the effort and the load.
2. Second order lever: are levers where the resistance always lies between the fulcrum and the effort.
3. Third order levers: are levers in which the effort is always placed between the resistance and the fulcrum.

Question 2

Describe three principles of strength training. 6

Answer 2

1. Overload: Increase in demand to force bodily adaptation. To stimulate an improvement in the physical condition of the body, it must experience physical stresses greater than those it would normally encounter.
2. SAID (Specific Adaptation to Imposed Demands):

• Specificity: Changes occur to the parts that are stressed. Type of training effects produced by the exercise are specific to that type of exercise. Must be specific to the type of sport/activity.
• Training Adaptation: Body’s response to physical stress. When the body is subjected to appropriate overload, it will adapt to physical demands.
• Transfer of training: Carry over or cross over training. Training effect can occur from exercised limb to unexercised contra lateral limb.
• Individual Differences: Training must meet individual needs. Genetic, individual commitment, level of physical & mental maturity.
  3. Reversibility: Stop strengthening the muscles will weakening the muscles. Detraining

Question 3

Using hypertension as a health condition, explain three levels of disease prevention: 6

Answer 3

1. Primary: Health promotion watch diet and increase exercise to reduce the risk.
2. Secondary: Routine screening to identify at risk patients. Can then advocate lifestyle change
3. Tertiary: Administration of anti-hypertensive to help symptoms.

Question 4

Define disability using the biopsychosocial model. 3

Answer 4

Disabilities is an umbrella term for the dynamic interaction:

1. impairments,
2. activity limitations,
3. participation restrictions
4. and contextual factors e.g.personal and environmental factors.

Question 5

List 2 barriers to effective communication. 1

Answer 5

1. Time constraint – don’t appear rushed
2. Environment – interruptions and privacy
3. Cultural differences – seek information about pt’s cultural norms
4. Writing notes continuously during pt interview
5. Using Jargon
6. Language difference and vocabulary use-learn key words
7. Age difference
8. Attitudes and Beliefs
9. “Dr Google”- patients are knowledgeable make sure they have they the right information

Question 6

List 3 types of muscle contractions. 3

Answer 6

1. Concentric
2. Eccentric
3. Isometric

Question 7

Mr Ntuli has full range of movement in all of his limbs and your treatments include passive movements. Which type and method of passive movements would you do when treating him? 2

Answer 7

1. I would use physiological passive movements
2. I would use the relaxed method of passive movements

Question 8

Outline precautions and contraindications for applications of passive movements. 8

Answer 8

Precautions:

1. No overzealous stretching , especially around the elbow myositis ossificans
2. Myositis ossificans : do gentle movements within pain free range
3. Pain medication and muscle relaxants :prevents patient from responding appropriately

Contraindications:

1. Immediately following surgical procedures to tendons, ligaments, muscles, joint capsule or skin
2. In the region of a dislocated joint or an unhealed/unfixed fracture

Question 9

You are treating 2 patients in the intensive care unit, one with cerebra oedema and one with decreased cerebral perfusion. How would you position each of these patients and why? 4

Answer 9

Cerebral Oedema:

Intracranial pressure is highly dependent on posture, being higher in patients
who are lying flat and lower when sitting up

Decreased Cerebral perfusion :

When patients who are hypovolaemic are in sitting, they may have reduced
cerebral perfusion and possibly increased cerebral ischaemia these patients have to lie flat.

Question 10

Explain the difference between an active, passive and assisted transfer using a patient as an example. 6

Answer 10

1. Active: The patient is able to move from one area to another, without assistance
2. Assisted transfer: The patient has some ability to load bear, but requires some assistance to move from one area to another
3. Passive transfer: The HCP moves takes all the load and moves the patient from one area to another

Question 11

List 5 principles of therapeutic exercise that you will incorporate into group rehabillitation. 5

Answer 11

1. Before starting with exercises:advice on contraindications and precautions.
2. Begin and end with breathing exercises and coughing.
3. Intersperse breathing exercises within the exercise sets.
4. Warm up-large mobilizing and stretching exercises.
5. Main-easiest to hardest.
6. Cool-down and stretch.
7. Change exercises to avoid boredom. Usage of equipment; music and games “

Question 12

Define disability using the medical model. 2

Answer 12

The medical model views impairments as a medical ‘problem’ that belongs to that particular individual

Question 13

List two common causes of disabillity in south africa. 2

Answer 13

Adults:

1. MVA
2. Non-communicable disease
3. Trauma
4. HIV
5. TB

Children:

1. HIV
2. Malnutrition

Question 14

Zain, a 19 year old soccer player, was tackled during a match, 4 days ago and now presents with left hip pain and swelling. Name the plane and axis at which hip flexion movement occurs. 2

Answer 14

Saggital plane about the frontal axis

Question 15

Zain, a 19 year old soccer player, was tackled during a match, 4 days ago and now presents with left hip pain and swelling. Explain the principles of training when treating this patient. 12

Answer 15

1. Overload: Increase in demand to force bodily adaptation. To stimulate an improvement in the physical condition of the body, it must experience physical stresses greater than those it would normally encounter
2. Specificity: Changes occur to the parts that are stressed. Type of training effects produced by the exercise are specific to that type of exercise. Must be specific to the type of sport/activity.
3. Training Adaptation: Body’s response to physical stress. When the body is subjected to appropriate overload, it will adapt to physical demands.
4. Transfer of training: Carry over or cross over training. Training effect can occur from exercised limb to unexercised contra lateral limb.
5. Individual Differences: Training must meet individual needs. Genetic, individual commitment, level of physical & mental maturity.
6. Reversibility: Stop strengthening the muscles will weakening the muscle. Detraining reflected by a reduction in muscle performance, begins within a week or two after the cessation of resistance exercises and continues until training effects are lost

Question 16

Prescribe an exercise to increase hip flexor strength in supine position. 3

Answer 16

1. In supine position, have patient flex right knee and extend left knee.
2. Calculate 1RM weight for hip flexion of left hip (attaching weight to the ankle)
3. Prescribe 80% of 1RM weight
4. Perform hip flexion 8 reps x 3 sets

Question 17

Explain the difference between phsyiological and accessory passive movements. 4

Answer 17

Physiological passive movements: Movements performed for the patient , which the patient would BE able to perform if they had muscle activity (e.g. Elbow flexion)

Accessory passive movements: Movements performed for the patient, which the patient would NOT be able to perform even if they had muscle activity (e.g. Individual vertebral bone OR individual carpal/tarsal bone movements)

Question 18

Mrs Ndlovu is in hospital following a stroke which has resulted in right-side hemiplegia. Expalin how you would assist Mrs. Ndlovu to move sideways to the edge of the bed using bridging. 5

Answer 18

1. Always support the affected leg: right leg
2. Move patient to the side while in a bridging position.
3. Assist/facilitate lateral movement of the pelvis
4. Move patient up in bed while in a bridging position.
5. Remind patient to push up with their feet

Question 19

Mrs Ndlovu is in hospital following a stroke which has resulted in right-side hemiplegia. List 3 locking points that must be supported when ding a standing transfer with Mrs. Ndlovu. 3

Answer 19

1. PT uses their knee to grip pt’s weak knee (right)
2. PT’s hand over pelvis/waistband of hemiplegic side (right)
3. Pt’s weak arm (right) tucked in under PT’s arm

Question 20

Name the 2 levels of the ICF that are influence by Mrs Ndlovu’s ability to perform an ADL.

Answer 20

Activity and participation level

Question 21

Explain the social model of disability. 2

Answer 21

Also referred to as the Rights Model. Disability results from the interaction between persons with impairments and attitudina l and environmental barriers that hinder full and effective participation in society on an equal basis with others.

Question 22

What are the main goals of community physiotherapy?2

Answer 22

The goals of physiotherapy in this field are to promote health, prevent and reduce disabilities thus improving and maintaining quality of life.

Question 23

Explain professional behaviour and give an example.3

Answer 23

Develop and produce health care practitioners (physiotherapists) who can perform duties in a manner that is reliable, informed, compassionate, ethical and sensitive to
diversity.

Question 24

List 5 advantages of group rehabilitation. 5

Answer 24

1. Time saving and cost effective.
2. Motivating ( support confidence
3. See other people with the same disability increases self acceptance.
4. Friendships encourages patient interaction
5. Progress from individual treatment to self responsibility and care.
6. Learn to work with others team spirit

Question 25

List 5 benefits of strengthening exercises. 5

Answer 25

1. •Enhance muscle performance. 2. •Increase strength of connective tissue. 3. •Greater mineral density. 4. •Decreased stress on joints during physical activity. 5. •Reduced risk of soft tissue injury during activity. 6. Possible improvement in balance 7. Enhanced physical performance during daily living, occupational, recreational activities. 8. Positive changes in body composition: ­lean muscle mass & body fat↓ 9. Enhanced feeling of physical well-being.

Question 26

List 4 aims of passive movements. 4

Answer 26

1. To prevent contractures 2. To prevent soft tissue adhesions 3. To maintain joint range 4. To improve joint range

Question 27

Explain 2 therapeutic considerations of activities of daily living.4

Answer 27

1. Should be as economic and as normal as possible 2. Economic: Use of cost effective devices/improvise 3. Normal: Alignment/Posture/Sequencing 4. Should be activities they do regularly to promote self responsibility 5. Reeducation should be task orientated 6. Should fit into the patient’s daily routine 7. Focus on the patient’s highest level of function

Question 28

List the models used to define disbaility. 5

Answer 28

1. Moral model 2. Medical model 3. Philanthropic model 4. Social model 5. Biopsychosocial model

Question 29

Explain two ways you could demonstrate professional behaviour as a physiotherapy student.

Answer 29

Aim of instilling professional behaviour and practice: Develop and produce health care practitioners (physiotherapists) who can perform duties in a manner that is reliable, informed, compassionate, ethical and sensitive to diversity. Therefore, as a physio student I can make sure I am always on time for class and that I do the recquired reading so I am informed about what is going on.

Question 30

List the five elements of well-being. 5

Answer 30

1. • Career/profession 2. • Social 3. • Financial 4. • Physical 5. • Mental/psychological/emotional 6. • Community/environmental 7. • Cultural/spiritual I want to be a physiotherapist for a sports team. Therefore, to satisfy this element of well-being I must achieve this goal.

Question 31

Explain the primary prevention of disease and give an example. 2

Answer 31

Primary level of prevention: Directed at healthy people (not yet exposed) and aim to keep people healthy and prevent them from getting disease e.g. hygiene, abstain, safe sex, immunization

Question 32

Give three characterisitics of an adult learner. 3

Answer 32

1. Autonomous (independent) and self directed 2. Bring life experiences to learning 3. Goal oriented 4. Practical 5. Relevancy oriented 6. Need for respect

Question 33

Give two principes of group therapy. 2

Answer 33

1. Have a group therapy plan 2. Select patients/clients carefully 3. Prepare the area venue access, size, safety etc. 4. Start with an ice breaker joke; game 5. Inform patients/clients about the goals of the group 6. Select exercises appropriately according to the group (patient/client) needs 7. Apply the principles of therapeutic exercises: 8. Change exercises / positions to avoid boredom 9. Usage of equipment; Music and Games 10. Finish/Start with education

Question 34

Mr Davis has weakness on the right side of his body due to stroke. He has full range of movement in all of his joints. Your treatment of Mr Davis includes passive movements and temporary wheelchair prescription among other things. What type of wheelchair would you prescribe for Mr Davis? 2

Answer 34

A self propelled chair with a double push rim, with left side drive

Question 35

List 5 principles of relaxed rhythmical passive movements. 5

Answer 35

1. The patient must be relaxed and supported 2. Explain what you are going to do and why 3. The therapist should stand so that either gravity or the body weight can be used to make the movement effective 4. The hand grip must be comfortable to the patient 5. The motion should be smooth and rhythmical and maintained at even tempo 6. The sequence of movement should be decided: e.g. proximal distal 7. The limb must be well supported throughout movement

Question 36

You've been asked to teach nursing staff about safe lifting techniques when transferring patients. Explain five principles you woud cover in your lecture.

Answer 36

I would cover: 1. Reasons for correct lifting 2. Body mechanics 3. Principles of lifting 4. Types of transfers 5. Types of grips.

Question 37

Name the lifting technique you would teach the nursing staff to use when lifting a patient with complete paralysis of all limbs and trunk.

Answer 37

3 man transfer or draw sheet transfer

Question 38

Explain health education and its importance to health care delivery

Answer 38

1. •Any planned, organized and structured activity which promotes health or illness related learning, done for informed and uninformed participants. 2. •It is a combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes

Question 39

List three types of disabilities.

Answer 39

1. Difficulty seeing(blind) 2. Difficulty moving(physical) 3. Difficulty hearing and speaking 4. Mental: difficulty learning, psychiatric, head injured people 5. Intellectual: difficulty in learning and retaining new information 6. Fits(convulsions) 7. No feeling hands and feet

Question 40

Name the plane and axis at which hip abduction movement occurs. 2

Answer 40

Frontal plane through the sagiital axis

Question 41

Explain one precaution to resistanc exercises.

Answer 41

1. •Valsalva manoeuvre 2. •Substitute motions 3. •Compensatory effort 4. •Overtraining and overwork 5. •Exercise induced muscle soreness * –Acute soreness * –Delayed onset muscle soreness – self study

Question 42

Explain 5 possible roles you would have as a health educator. 10

Answer 42

1. Assessment of the individual and community needs for health education. 2. Planning effective health education programs. 3. Implementing health education programs. 4. Coordinating the position of a set of health education services. 5. Acting as a resource person for health education. 6. Communicating health and health education needs concerns and resources. 7. Evaluating defectiveness of health education.

Question 43

Mrs Jones had a head injury and now presents with weakness on the left side of her body. She still needs help transferring from one surface to another and sometimes uses a wheelchair for long distances. Her physiotherapist did her lower and upper limb passive movement when she was still unconscious and she has always had full range of motion in all her joints. Discuss 5 reasons why postioning in her bed is important.

Answer 43

1. Attempt to inhibit the abnormal posture typical of hemiplegia 2. Sensory stimulation through weight bearing on the affected side 3. Stimulation of awareness of the affected side 4. Prevention of pressure sores 5. Prevention of soft tissue contractures 6. Maintenance of a clear airway and reduction of the risk of aspiration

Question 44

The patient's physical, psychological and social needs should be taken into account when selecting a wheelchair. Discuss this statement. 12

Answer 44

When prescribing a wheelchair, there are many factors to consider.You need to consider the patients physical, psychological and social needs when selecting a wheelchair. What are their physical abilities, also include endurance and whether or not they will manage different surfaces such as an incline. Is the patient ready to be more independent or are they still fearful? Consider the medical condition, including their age and their weight. How long will the wheelchair need to be used? Special wheelchairs are needed for patients that have had bilateral lower limb amputations and who cannot use a prosthesis. The loss of both limbs moves the centre of gravity further back and they will therefore need an anti-tipping device to stop them from falling backwards Patients that have a dense hemiplegia will require a wheelchair with a single push-rim Patients with high cervical lesions will need wheelchairs with extended back supports to provide better positioning.

Question 45

What is the difference between forced and relaxed passive movement.4

Answer 45

Relaxed: The limb/joint is moved within the available ROM to maintain ROM Forced The limb/joint is moved beyond the available ROM to increase ROM

Question 46

What is the difference between a standing and sitting transfer?2

Answer 46

1. Standing transfers: patient takes weight on one or both legs 2. Sitting transfers: patient takes weight on arms

Question 47

Why is it important for physiotherapists to know correct lifting techniques? 3

Answer 47

1. Incorrect lifting can result in back injuries e.g. disc lesions and muscle strains 2. The physiotherapist (PT) lifts and transfers patients all day 3. The PT also needs to lift objects and place them in a proper place 4. It is also the PT’s responsibility to teach correct liftingmethods to the general public and to patients

Question 48

Which principles of lifting would apply when two or more people lift? 4

Answer 48

If two or more people lift together they should: 1. Be nearly the same height 2. Carry approximately the same weight 3. One person should give a clear signal 4. The stronger person should be at the head side

Question 49

What type of wheelchair will people with paralysis of all limbs and the trunk use?

Answer 49

An electric wheelchair

Question 50

What type of wheelchair will people with paralysis of the arm and leg on the same side use?

Answer 50

Should use a wheelchair with a double push rim which is either left or right drive depending on which side is affected

Question 51

What type of wheelchair will people with bilateral above the knee amputation use?

Answer 51

Should use a wheelchair with rear wheels shifted backwards

Question 52

Why is a wheelchair removable armrest preferred to a fixed armrest?

Answer 52

Removable armrests are important for transfers and working comfortably at a desk.

Question 53

In what instance would you use a tipping lever of a wheelchair?

Answer 53

For tipping chair when going up a curb/stair

Question 54

Define reflective practice.

Answer 54

Reflective practie is a process by which you: 1. stop and think about your practice 2. conciously analyse your decision making 3. draw on theory and relate it to what you do in practice

Question 55

List three components of refelective writing.

Answer 55

1. Describe- what happened. 2. Interpret-what does the experience mean to the person as a learner, thinker, writer 3. Evaluate-how valuable was the experience? 4. Plan- what will the person do with their learning.

Question 56

Explain three techniques that you would use to develop a therapeutic relationship.

Answer 56

1. correct greeting, showing care, calling him Mr main. 2. Listening to his story, showing understanding and allowing him to tell his story and explain his hardships. 3. To give genuine feedback. Not to lye to him but rather telling him the truth in a positive, thoughtful manner.