ATS 700 - Written Exam 2 *Updated 6/17* (pain not included yet)

What are medical records?

A collection of data recorded when a patient seeks medical treatment.

What is the purpose of medical records and why are they important?

- to document diagnosis

- to help communication between providers

- to document what you have done, or why you did not perform something

- to keep information confidential

What are the Statute of Limitations regarding medical records?

10 years for minors, and 6 years for adults

- medical records should be kept 6-10 years after the last point of contact

What are types of medical records?

written medical history, injury reports, treatment logs, personal information cards, injury evaluations and progress notes

Describe Confidentiality

information that should remain private, can be shared if written consent is given

Describe Electronic Medical Records (EMR)

localized, single-practice digital charts

ex. ATS only used within UWL

Describe Electronic Health Records (EHR)

comprehensive, interoperable systems designed to be securely shared across multiple healthcare organizations, specialists, and hospitals

ex. EPIC

Describe HIPAA

Health Insurance Portability and Accountability Act

- ensures privacy and security of patient's medical information

What are some HIPAA Compliance and Best Practices?

- using a secure login and password

- gaining patient/athlete consent

- share and explain the patient their rights

- continually taking HIPAA training, staying up to date with new practices

Describe FERPA

Family Educational Rights and Privacy Act

- ensures privacy and protection or student education records (which can also cover student athlete medical records)

What are some FERPA Compliance and Best Practices?

- using a secure login and password

- informing and explaining students and parents (if minors) their rights

- keeping and updating FERPA Forms for student athletes'

- using ethical judgement (hypotheticals to gain advice from other professionals who do not have access)

What is an NPI and why is it important?

National Provider Identifier

- unique and standard identification number required for each healthcare provider in the United States

- it provides recognition, makes billing and 3rd party reimbursement easier

- mandated by HIPAA

What is a Patient Oriented Outcome and why is it important for documentation?

any report of a patient's health that comes directly from the patient without provider interpretation

- its important for holistic patient care, shared decision-making, self-interpretation of progress and quality of life

Describe a Pre Participation Exam (PPE)

done 6-8 weeks prior to start of the season/participation

- two ways to do this

1. go to PCP and have them perform the exam and sign documents

2. station exams, where you go in a line from station to station to get checked out by healthcare specialists (ex, blood pressure, cardiac, GI, vision, etc.)

What is the Evaluation Process?

assesses injury or illness

What is Program Planning?

the process of setting up a plan to fix the injury/illness

ex. rehabilitation, modalities, equipment or braces, and a timeline

What are the primary goals of rehabilitation?

- to heal or improve the injury/illness

- to prevent re-injury

- to provide education on lifestyle improvement

Describe Diagnosis

to provide a name or classification

- can be done by gathering information to eliminate wrong answers to leave just the correct answer

What are ICD-10 codes?

International Classification of Diseases

- codes that tell you a patient's diagnosis, symptoms, or injuries

- used in 3rd party reinbursment

What are CPT codes?

Current Procedural Terminology

- codes that refer to the treatments and services provided for a patient

- used with ICD-10 for billing and documentation

Describe SOAP in the Evaluation Process

Subjective - what the patient tells you

Objective - what the provider observes/measures

Assessment - diagnosis, what pathology they might have

Program/Plan - next steps for recovery and treatment

What are the steps that should be taken during the Program/Plan phase of SOAP?

- develop a plan based on goals of treatment and a plan of care (important to factor in problem list, psychological and socioeconomic status of pt)

- implement plan

- evaluate and adapt plan (as needed)

- utilize a home program (which decreases time in the clinic, and increases overall healing)

What knowledge should an AT have to provide proper care?

- sport knowledge (physical demands of positions/sports, and differing rules)

- anatomy (palpation, structures)

- biomechanics (how the body normally moves)

- medical terminology

Define Etiology

cause of injury/illness

Define Pathology

structural and functional changes caused by disease

Define Symptom

a subjective measure

- a sensation that the person feels from the disorder

Define Sign

objective evidence of disease

- noted by the provider

Define Prognosis

the probable outcome from the injury/illness

What is HIPS/HOPS?

the components of an evaluation

H - history

O/I - observation/inspection

P - palpation

S - Special/Stress Tests

Define History

most important part of an evaluation

- explaining what lead them to being injured

- 95% of the injury can be discovered through history

- use active listening

- ask open-ended questions

What is the MAPPSSO accronym?

M - mechanism of injury

A - acute or chronic

P - pain

P - previous injury

S - sounds

S - signs and symptoms

O - other (anything else that may be pertinent information)

What does it mean to compare bilaterally and what do you look for?

compare the healthy side to the involved side

looking at:

- posture

- signs of swelling

- deformity

- differences in skin color and texture

- muscle tone/atrophy

- old scars

How to correctly palpate a patient during an examination?

- start away from the injury or on the other side of the body

- inform the patient of what you are doing (builds trust and rapport)

What should you identify during palpation?

- point tenderness

- crepitus

- swelling

- malalignment of a joint or bone

- other deformities

What are the three ROM tests?

active, passive, and resistive

Describe Active ROM

performed by patient; increases muscle strength

- for grading you note on if motion was [full or limited] and [was painful or had no pain]

Describe Passive ROM

performed by the provider on the patient

- for grading you note on if motion was [full or limited] and [was painful or had no pain]

Describe Resisted ROM

differs from MMT by using light resistance during full rom movement to provoke symptoms and identify which contractile tissues are injured

- uses 0-5, +/- scale

Describe Manual Muscle Testing

assesses a the strength of a specific muscle at 50% of full rom

- uses 0-5, +/- scale

Define Ligamentous Tests

apply stress in one of the cardinal planes to a joint's ligament or capsule

- you detect end-feels, relative laxity, and pain

Grading for Ligament Sprain

Grade 1: slight stretch of the ligament

Grade 2: partial tearing or opening of a joint/ligament

Grade 3: complete tear of ligament or joint capsule

Describe the 3 End-Feels

1. hard - bone to bone

2. soft tissue aproximation - muscle/other tissue is in the way

3. tissue stretch - where tissue cannot stretch any further ex. dorsiflexion or wrist extension/flexion

Special Special Tests

apply stress to isolate a specific anatomical structure or function, describe results in negatives and positives

ex. Lachman Test

How to grade if a special test is good/accurate?

Sensitivity, Specificity, and Predicted Value

Define Neurological Tests

assess motor and sensory nerve function to determine if there is damage to the nerve root or peripheral nerve dysfunction

Define Dermatomes

area of skin innervated by cutaneous branches of single spinal nerve, test skin sensation

Define Myotomes

a nerve root or nerve roots of the spinal cord from which the nerves innervate a muscle, test muscle strength

Define Reflexes

testing tendons for their automatic involuntary movements

What are the circulatory tests?

skin temperature and color, pulses, and capillary refill

Functional Tests

determines whether an isolated impairment affects the athlete's ability to perform everyday activities, or sport specific movements

What are the basic examination principles?

- do not harm the patient

- tell the athlete what you are doing

- test the normal side first

- ROM: active first, then passive

- warn patient of possible exacerbations (soreness in the following day)

- refer if necessary

What are the steps of presenting an evaluation?

- give the highlights of the history and the inspection

- specific area of palpable tenderness

- limitations to ROM

- highlights of MMT

- positive special tests

- circulation/neurological assessment

- your personal assessment (your thoughts on dx)

What is a problems list?

issues you notice or pick up on during the examination

ex. rom, pain, strength

- they help guide your treatment goals and plan

Describe the Soreness Rules

1. no soreness from previous day = advance (intensity, volume, or difficulty) in rehab exercises

2. soreness at first, but goes away with warm up = stay at the same level/amount/intensity of rehab

3. soreness that stays post-warmup = pull back, limit, or take the day off from rehab

What is the normal recovery window for tendinitis rupture?

3-7 weeks

What is the normal recovery time for Muscle Strains?

Exercise Induced (DOMS): 0-3 days

Grade 1: 0 days - 4 weeks

Grade 2: 3 weeks - 3 months

Grade 3: 5 weeks - 6 months

What is the normal recovery time for Ligament Sprains?

Grade 1: 4 days - 4 weeks

Grade 2: 3 weeks - 6 months

Grade 3: 5 weeks - 1 year

Recovery Time for Ligament Grafts?

2 months - 2 years

Recovery Time for Bone

5 weeks - 3 months

Which heal better: extra-articular ligaments, or intra-articular ligaments?

extra-articular ligaments - better vascularization

What are the general return to sport guidelines?

>90% strength

>90% functional testing score

absence of effusion

absence of pain

full active range of motion

Compare short-term and long term goals

Long Term Goals set a timeline and direction for your work and attention.

Short Term Goals are smaller steps/checkpoints set along the pathway to reaching the long-term goal

- give you ample feedback to make tweaks/alterations to be able to reach your long term goal

What are the Goals of Rehabilitation?

- do not necessarily have to be done in order because some over lap, but some have to done before others

1. decrease pain

2. decrease the effects of the inflammatory response to trauma

3. return to full active and pain-free range of motion

4. decrease effusion (swelling within the joint)

5. return to full muscular strength, power, and endurance

6. return to asymptomatic functional activities at the pre-injury level

What are the 3 stages/phases of rehabilitation?

Acute, Subacute, Chronic/Return-to-Sport

Describe the Acute Phase of Rehabilitation

usually lasts 4-6 days

- control inflammation

- minimize deleterious effects of immobilization

- reduce joint effusion

- maintain condition of noninjured areas (cross training)

Describe the Subacute Phase of Rehabilitation

- continue to control inflammation

- progressively increase mobility (joint mobes, stretching, rom)

- progressively strengthen muscles (isometric to isotonic)

- continue to maintain condition to noninjured areas (cross training and cardiovascular endurance)

Describe the Chronic/Return-to-Play Phase of Rehabilitation

- decrease pain from adhesions

- increase extensibility of other structures

- progress strengthening of affected and supporting musculature

- progress proprioception, coordination and agility

What are the types of practice (in relation to motor learning)?

physical, mental, whole, part, blocked (environment), random (environment), and random-controlled (environment)

What is Intrinsic Feedback?

Response produced information that is available from one's sensory system

- visual

- proprioceptive

- auditory

What is Extrinsic Feedback?

Feedback from an external source (video, coach, etc.)

- Knowledge of Performance (KP)

- Knowledge of Results (KR)

Describe Knowledge of Performance

four types

- verbal descriptive: being told that you are making an error

- verbal prescriptive: identify error and give a direction to correct

- visual descriptive: watching yourself (through video) make an error and recognizing

- visual prescriptive: watching and recognizing an error you made, and being able to fix/correct it

Describe Knowledge of Results

external feedback the performer gets through the end result of a performance

ex. goniometer measurements, amount of weight, force, range, etc.

What does more frequent feedback produce?

better skill acquisition

What does less frequent feedback produce?

better learning

What are the basic strategies to implement motor learning in rehabilitation?

- provide a focused environment

- give clear instructions

- proper demonstrate

- provide good feedback

What does passive range of motion do?

help maintain the rom a patient already has

What does active range of motion do

help increase force production or produce more range of motion

What are ways to increase neuromuscular strength/endurance?

static (isometric) and dynamic movements

ex of dynamic: concentric/eccentric, isotonic, variable resistance, manual resistance, isokinestic

Describe Progressive Resistive Exercise

strength building methods to increase either increase muscle tissue or "toning"

- low resistence & high repitition = tone

- DARPE: daily adjusted progressive resisted exercise (progressive overload) = strength

What is pain?

a subjective, unpleasant sensory and emotional experience associated with actual or potential tissue damage

- affected by mood, culture, age, past experiences, etc.

- a protective mechanism from the brain

What are the manifestations of pain?

can be described as a wide range of sensations

- burning, throbbing, tingling, prickly, itchiness, or other odd descriptions (strings pulling, water running on skin, ants crawling on skin)

Describe the Order Neurons and Afferent Pathway of Pain

1.) sensation is detected by first order neurons and sends signals to the spinal cord

2.) signal is transferred to the second order neuron in the spinal cord and carries the information up to the thalamus

3.) the third order neuron sends the signal from the thalamus to the cerebral cortex

Describe Nocioceptors

specialized nerve endings (sensory receptors) that respond to potentially damaging stimuli

ex.) mechanical, thermal, or chemical energy

- activate