Week 1 - ROM & Gait/Posture

Question 1

What is the order for ROM testing?

Answer 1

Active ROM - Done by the patient 100%
Passive ROM - Done by the examiner 100%
Resisted ROM - resisted isometric movement usually tested in neutral position

Question 2

What side should we always start on?

Answer 2

The unaffected/non painful side of the patient

Question 3

Any movements that are painful are done last to prevent an ___ of painful symptoms to the next movement

Answer 3

overflow

Question 4

What does active ROM test?

Answer 4

Contractile, nervous and inert tissues that are moved

Question 5

_____ tissue have tension placed on them by stretching or contraction

Answer 5

Contractile

Question 6

____ tissue and their sheaths have tension put on them by stretching

Answer 6

Nervous

Question 7

____ tissue includes all tissues that are not contractile or neurological (ligaments, bursae, bone, cartilage, and the capsule)

Answer 7

Inert

Question 8

For active ROM, the examiner should note:

Answer 8

• When and where during each movement the onset of pain occurs
• Whether the intensity and quality of pain increases with the movement
• The reaction of the patient to the pain
• The degree of restriction
• The rhythm and quality of movement
• The movement of associated joints
• The willingness of the patient to move the part
• Any limitation and its nature (ask why?

Question 9

Active movement may be abnormal for reasons such as:

Answer 9

Pain (common cause)
Muscle weakness
Paralysis
Spasm
Other causes including tight or shortened tissues, altered length-tension relationships, modified neuromuscular factors, and joint-muscle interaction

Question 10

Passive ROM is usually normal, full range, and pain free, with possibly some pain at the end
of ROM when ___or ___ is stretched

Answer 10

contractile
nervous tissue

Question 11

For passive ROM is not only the degree (amount) of movement but also the ____ of the movement that is important

Answer 11

quality (end-feel)

Question 12

When the examiner is doing passive range of motion testing, the appropriate ___ is
applied gently and repeated several times. The ___ is increased up to but not
beyond the point of pain and is done in ____

Answer 12

stress
stress
all ranges

Question 13

For passive ROM, the examiner should note:

Answer 13

Any Differences in ROM between active and passive movements may be
caused by:
* Spasm
* Muscle Deficiency
* Neurological deficit,
* Contractures
* Pain

Question 14

The sensation that the examiner feels in the joint as it reaches the end of ROM is called:

Answer 14

End-feel

Question 15

____ is applied at the end of ROM to determine end feel

Answer 15

overpressure

Question 16

Evaluation of end feel can help you:

Answer 16

• Assess the type of pathology present
• Determine a prognosis for the condition
• Learn the severity or stage of the problem

Question 17

What are normal end feels and examples

Answer 17

Bone to bone - elbow extension
Soft tissue approximation - Knee flexion
Tissue stretch - Ankle dorsiflexion, shoulder lateral rotation, finger extension

Question 18

What are abnormal end feels and examples

Answer 18

Early muscle spasm - protective spasm following injury
Late muscle spasm - spasm resulting from instability or pain
“Mushy” tissue stretch - tight muscle
Spasticity - upper motor neuron lesion
Hard capsular - frozen shoulder
Soft capsular - synovitis, soft tissue edema
Bone to bone - osteophyte formation
Empty - acute subacromial bursitis
Springy block - meniscus tear

Question 19

Describe muscle grading on a 0-5 scale

Answer 19

5 - Normal - Complete ROM against gravity with full resistance
4 - Good - Complete ROM against gravity with some resistance
3 - Fair - Complete ROM against gravity with no resistance
2 - Poor - Complete ROM with some assistance and gravity eliminated
1 - Trace - Evidence of slight muscular contraction; no joint motion evident
0 - Zero - No evidence of muscle contraction

Question 20

Describe the pain sensations and associated structure

Answer 20

Muscle - Cramping, dull, achy
Joint capsule, ligament - Dull, achy
Nerve root - Sharp, shooting
Nerve - Sharp, bright, lightening-like
Sympathetic n. - Burning, pressure-like, stinging, achy
Bone - Deep, nagging, dull
Fracture - Sharp, severe, intolerable
Vasculature - Throbbing, diffuse

Question 21

Resisted ROM finds problems in ___ tissues

Answer 21

contractile

Question 22

Testing is always done with the patient in ____ so that minimal
tension is placed on the inert tissue.

Answer 22

neutral position

Question 23

True or False: In resisted ROM, the patient is asked to contract the muscle as strongly as possible while the examiner resists for a few seconds to prevent any movement from occurring

Answer 23

True

Question 24

In resisted ROM, the examiner ensures that ___ is isometric and controls the amount of ___ exerted

Answer 24

contraction
force

Question 24

Both ___ and ___ demonstrate symptoms if contractile tissue is affected

Answer 24

active ROM resisted ROM

Question 24

For resisted ROM, _____ must be used to determine if there is weakness or not

Answer 24

muscle strength grading

Question 24

What are the 3 views for postural assessment

Answer 24

anterior, lateral (both sides), posterior

Question 25

Review the characteristics of anterior view

Answer 25

Head (Jaw, Nose, Ears) * is head straight / tilted to one side / rotated * may be result of weak muscles, trauma, hearing loss * Nose is inline with manubrium Shoulders * Trapezius , AC joints * symmetrical with no deviation * deviation may be from dislocations of AC or SC joints or fractures * dominant shoulder may be slightly sloped downward Chest * Other * no protrusion, depression or lateralization Pelvis (Iliac crests, ASIS, Pubic bones) * waist angles are equal * arms equal distance from the waist * patella should point straight ahead * knees may be in genu varum or valgum Feet (Feet arches, Feet angle) * check for equal arches * Are toes pointed out or pigeon toed?

Question 26

Review the characteristics of lateral view

Answer 26

Ear lobe * in line with the tip of the shoulder (acromion) and high point of the iliac crest * a forward poking chin may correspond with lumbar lordosis Spinal segments * spine has normal curvature * large glut max muscles or excessive fat may give the appearance of exaggerated lordosis * examine the spine in relation to the sacrum not * The Shoulders * look for rounded shoulders * possibly caused by tight pectoral * The Knees * normally slightly flexed 0 to 5 degrees * hyperextended knees likely with increased lumbar lordosis * increased flexion seen with tight hamstrings * Ideally the centre of Gravity/Plumb Line passes through the following * anatomical landmarks * External auditory meatus * Humeral head and acromion * Middle of the body of L3 vertebrae * Greater trochanter * Just behind the mid knee

Question 26

Review the characteristics of posterior view

Answer 26

* Mastoid process AC joint * Inferior scapula * spines and inferior angles should be level * PSIS * should be level, one higher than the other may indicate a leg length discrepancy, or rotational problem * Assess the in forward flexion (skyline view): * Asymmetry of rib cage (rib humping) * Asymmetry in the spinal musculature * Kyphosis * Whether lumbar spine straightens or flexes * Any restrictions to forward bending * Just anterior to the lateral malleolus

Question 27

What are the 2 phases of gait analysis

Answer 27

1) Stance Phase - When the foot is on the ground (60% of gait cycle) 2) Swing Phase - When the foot is moving forward (40% of gait cycle.

Question 27

What are the components of the stance phase

Answer 27

heelstrike foot flat midstance push off acceleration midswing deceleration

Question 28

What are the 3 causes for abnormal gait patterns?

Answer 28

1: Due to a pathology or injury in a specific joint 2: Compensation for an injury or a pathology in other joints on the ipsilateral side 3: Compensation for an injury of a pathology on the contralateral limb

Question 29

What are the different abnormal gait patterns

Answer 29

* Arthrogenic Gait * Ataxic Gait * Gluteus Maximus Gait * Trendelenburg’s Gait * Hemiplegic Gait * Parkinsonian Gait * Scissors Gait * Drop Foot Gait

Question 30

Describe arthrogenic gait

Answer 30

- Stiff hip or Knee - Results from stiffness, laxity, or deformity, and it may be painful or painless

Question 31

Describe ataxic gait

Answer 31

- Stagger Gait with Exaggerated Movements - Patient presents with poor sensation or lacks muscle coordination, poor balance and a wide broad base stance - Results usually from damage to the cerebellum.

Question 32

Describe gluteus maximus gait

Answer 32

- The Backward Lurch of the Trunk - Results from a weak gluteus Maximus. - Patient thrusts the thorax posteriorly at heel strike to maintain hip extension of the stance leg

Question 33

Describe trendelenburg's gait

Answer 33

- gluteus medius gait - Results from weak gluteus med/minimus - During the stance phase, patient exhibits an excessive lateral list where the thorax moves to keep centre of gravity over the stance leg - Also, the Trendelenburg test will also be positive

Question 34

Describe hemiplegic gait

Answer 34

- Presents as a swinging of the paraplegic leg outward and ahead in a circle or pushes it ahead. Also, the affected upper limb is carried across the trunk for balance

Question 35

Describe parkinsonian gait

Answer 35

- FESTINATED GAIT - The neck, trunk, and knees of a patient are flexed. There is also a SHUFFLING or rapid short steps. Arms are held stiffly and the patient may lean forward and walk progressively faster as though unable to stop (Festinating)

Question 36

Describe scissors gait

Answer 36

- A result of spastic paralysis of the hip adductor muscles. This causes the knees to be drawn together so that the legs can be swung forward only with great effort.

Question 37

Describe steppage/foot drop gait

Answer 37

- Results from weak or paralyzed dorsiflexor muscles. To avoid dragging the toes against the ground, the patient lifts the knee higher than normal. Initial contact, the foot SLAPS on the ground.