Ortho Eval/planning -2

Front 1

What is the objective examinations purpose

Back 1

to observe, measire, and quantify patient's signs

Front 2

what 3 measurements are included in near every objective examination

Back 2

1) pain measurement (visual-analog scale)
2) range of motion
3) strength

Front 3

what does the objective exam attempt to quantify and give examples (5)

Back 3

measurements of function of the patient
1) walking distance
2) stairs climbing
3) sitting tolerance
4) interventions
5) standing tolerance

Front 4

Where are the interventions included in documentation

Back 4

objective section

Front 5

what are signs

Back 5

measurable, concrete findings

Front 6

what is the objective exam planned according to

Back 6

the information gathered during the subjective exam

Front 7

what is the key concept that you must keep in mind during the objective exam

Back 7

to NOT overlook other possibilties, which is why we do tests to rule out other pathologies

Front 8

What are the concepts that must be considered before starting objective exam

Back 8

1) all possible sources of patients pain
2) are further tests needed before pursuing exam
3)establish extent of exam
4) determine the cause of the "cause of the" pain

Front 9

what establishes the extent to which we proceed with the examination

Back 9

1) does pain allow objective examination?
2) does subjective exam suggest easily irritable disorder?
3) does nature and history of pain indicate caution?

Front 10

How do we know if the disorder is easily irritable

Back 10

based on activity causing the pain, severity of the pain caused, duration before pain subsides

Front 11

what indicates "caution" in proceeding through an objective exam

Back 11

1) pathology
2) how easy it is to cause bouts
3) possibility of imminent nerve root compresion

Front 12

what is the key to successful intervention

Back 12

determining the cause of the cause of the pain.... hopefully leads to resolution of the problem

Front 13

what are the 5 elements of the Objective examination

Back 13

1) observation
2) Function
3) Palpation
4) Neurological Exam
5) Special additional tests

Front 14

what are the 5 key obserrvations made in the objective exam

Back 14

1) posture (habit, compensatory positiion for avoiding pain)

2) shape (deformation, swelling, atrophy)

3) functional movements (general ADL, gait patterns)

4) skin (color, scar tissue, calluses)

5) aids (cane, crutches, corset, spint, sling, wheel chair, etc)

Front 15

what are "active movements" (why do we test)

Back 15

movments performed to test for mobility, strength and pain

Front 16

what are "passive movements" (why do we test)

Back 16

movements performed to test for mobility and pain

Front 17

what are the 2 methods for performing passive movement

Back 17

1) take limb through available ROM if patient unable to move limb due to weakness/pain related to active movement

2) gentle overpressure when actie movements are symptom free

Front 18

Which method of PROM is most applicable for anatomical movements

Back 18

Either method (overpressure or taking full through range)

Front 19

which method of PROM is most applicable for functional movements

Back 19

Use of overpressure

Front 20

AROM test what type of movements

Back 20

functional and anatomical movements

Front 21

Passive movements test what type of movement

Back 21

anatomical and functional movement

Front 22

what are the measurements from PROM compared to? AROM?

Back 22

PROM and AROM: compare involved side to uninvolved side AND compare both sides to normal expected values

Front 23

PROM tests what structures

Back 23

inter structures only

Front 24

AROM tests form what structures

Back 24

intert and contractile structures

Front 25

what joints are examined when assessing motion

Back 25

the joints proximal and distal to the disability

Front 26

what 3 items should be examined when doing AROM (when applicable)

Back 26

1) specific movements that aggravate the pain
2) avctive movments under load (causes compression of the joint surfaces)
3) movements for specific purpose (i.e. thoracic outlet)

Front 27

In both PROM and AROM you are noting areas of the range in which what 3 primary things occur

Back 27

pain, crepitus, spasm

Front 28

what important piece of information do we get in PROM that we do not get in AROM

Back 28

end feel

Front 29

what is "resisted movement" (why we perform it)

Back 29

to test specific muscles or muscle groups for strength and/or reproduction of pain

Front 30

what position should resisted movement be done in... and why

Back 30

a neutral joint position so that it places the inert structures in a "non-stretched" position

Front 31

what force of resistance do we use for resisted movement, and why?

Back 31

maximal resistance so that the joint movement does not occur

Front 32

What movements does Resisted movement test

Back 32

movements in all planes of motion and functional movements

Front 33

strength tests ______ fibers and endurance tests ______ fibers

Back 33

strength tests phasic muscle fibers

endurance tests tonic or postural muscle fibers

Front 34

what structures does resisted movements test

Back 34

contractile structures only

Front 35

what is an "isometric action"

Back 35

an action in which the distance from the origin of the muscle to its insertion remains the same

Front 36

most resisted movements cause what type of muscle action

Back 36

isometric

Front 37

what must be considered before an arthrogenic diagnosis is excluded (regarding resisted motion)

Back 37

isometric movements cau cause some gliding in the joint AND muscles usually have a compression effect on the joint articular surfaces

Front 38

What are the muscle grades?
numerical and literal

Back 38

5/5= normal
4/5= good
3/5= fair
2/5= poor
1/5= trace
0/5= no palpable muscle action

Front 39

what are the two "arthrokinematic motions" and what information to they provide us with

Back 39

gliding/distraction: test joint play

compression: provoke articular surfaces

Front 40

what are the 5 categories testing function

Back 40

1) active motion
2) passive motion
3) Resisted motion
4) all special tests
5) arthrokinematic motion

Front 41

what are the 5 layers of palpation we address

Back 41

1) skin and sub q tissue
2) muscle and tendonds with attachments to muscle and bone
3) tendon sheaths and bursae
4) joints (capsule, ligaments)
5) nerves and blood vessels

Front 42

swelling in a joint is called ______ swelling where as in sub q tissue is called______

Back 42

Joint swelling: effusion
SubQ swelling: edema

Front 43

Palpation of the skin checks for

Back 43

temperature, texture, hypo-hyeraestesia, sweating, consistency of subQ tissue, mobility

Front 44

palpation of the muscle and tendons checks for

Back 44

tenderness in resting and stretched positions, tone, trigger points, contractures, adhesions

Front 45

palpation of the muscle sheaths and bursae checks for

Back 45

thickness, crepitus, and tenderness

Front 46

palation of the joints checks for

Back 46

swelling, alignment, positional faults, tenderness

Front 47

palpation of the nerves and blood vessels checks for

Back 47

integrity of peripheral nervces (sensitive to tapping) and circulation (pulse)

Front 48

The neurological exam has what 5 parts

Back 48

1) nerve trunk
2) nerve root
3) sensory function
4) motor function
5) central nervouse system function

Front 49

how do you test the nerve trunk

Back 49

stretching or pressure (elicit pain)

Front 50

How do you test the nerve roots?

Back 50

myotomes, dermatomes and deep tendon reflexes

Front 51

how do you test sensory function

Back 51

cutaneous sensation and joint position

Front 52

how do you test motor function

Back 52

central and peripheral paresis

Front 53

how do you test central nervouse system function

Back 53

coordination and balance

Front 54

what are the special additional tests that could be included in the objective examination

Back 54

medical imaging, laboratory tests, electrodiagnosis, punctures, referred pain

Front 55

what occurs if the extremity joint presumed to be affected is found to be normal

Back 55

examinations of the other joints in the affected limb and in the spine must be performed

Front 56

what 6 things should the therapist ask him/herself after the examination

Back 56

1) is the clinical picture clear?
2) are the subjective and objective findings correlated and complementary?
3) Have i identified the structure at fault?
4) what is the stage of the injury
5) have i identified the causative factor
6) what intervention can be done

Front 57

______ and ______ shuould be assessed each visit and any changes recorded

Back 57

significant signs and symptoms

Front 58

what is the therapist trying to determine in the assessment

Back 58

the clinical impression- diagnosis

Front 59

what are the three important items included in an assessment

Back 59

1) structure at fault
2) stage of the injury
3) cause of the injury

Front 60

in addition to the clinical assessment what 4 items should be included

Back 60

1) list of problems (related to the impaired function)
2) short- and long-term goals related to these problems
3) immediate response of the patient (patient tolerated intervention well)
4) rehabilitation potential (prognosis)

Front 61

what is the "definitoin" of the plan of care

Back 61

the planned intervention based on the goals of the patient

Front 62

what 5 things should be included in the initial plan of care

Back 62

1) frequency of visits per day or week
2) type of intervention the patient will receive
3) where the care will be administered
4) plan for future tests or consultations with other appropriate professionals
5) equipment ordered or to be ordered

Front 63

when do you discontinue treatment

Back 63

when LONG term goals are achieved

Front 64

if no improvement at a point of reassessment of the patient what are the possible explanations for this

Back 64

1) wrong diagnosis
2) lack of compliance
3) progressive non-treatable diagnosis
4) wrong treatment for the patient

Front 65

when you reassess the patient what are the 3 "outcomes" that you could expect

Back 65

1) no improvement
2) long term goals achieved --> discontinue treatment
3) improvement --> continue plan

Front 66

What are the steps to a PT solving a problem

Back 66

1) identify the problem
2) analysis and synthesis of the information
3) development of alternate solutions
4) selection of one solution through a process of reasoning
5) preparation of a plan to implement the solution selected
6) implementation of plan
7) evaluation of success and efficiency of plan and revision of plan accordingly

Front 67

what is the purpose of a short term goal

Back 67

provide a clinical direction toward a long term goal/functional outcome

Front 68

what are the 3 things you should ask yourslef when writing a goal

Back 68

1) is the goal measurable?
2) is it functional?
3) how long will it take to achieve the goal?

Front 69

what are the key elements of the subjective progress note

Back 69

1) any response to intervention indicated by patient
2) any changes to the condition that are or ARE not related to intervention
3) pain behavior
4) functions that are still altered/impaired by the pathology
5) changes in other interventions used (i.e. medications)

Front 70

what are the key elements of the objective progress note

Back 70

1) intervention administered
2) results of objective tests to monitor progress

Front 71

what are the key elements of the asssessment progress note

Back 71

tolerance of the patient to interventions and patients overall status

Front 72

what are the key elements of the plan in the progress note

Back 72

any changes in the plan of care and the intent to continue

Front 73

what are the key elements of the subjective discharge note

Back 73

1) initial diagnosis and date of initial visit
2) number of visits
3) intervention performed
4) response to the intervention indicated by patient
5) residual pain
6) functions that are still altered/impaired by pathology
7) changes in other interventions used (medication dosage)

Front 74

what are the key elements of the objective discharge note

Back 74

results of objective tests to monitor final status (compared to intitial status)

Front 75

what are the key elements of the assessment discharge note

Back 75

tolerance of the patient to interventions and a general note on the patients overall status

Front 76

what are the key elements of the plan in the discharge note

Back 76

1) where the patient is going
2) equipment/intervention needs
3) referral to other services