Exam 2 (Part 2) - from other user

What model's primary goal is to identify if patients are appropriate for mechanical therapy or need referral to another provider?

MDT/McKenzie Method

What are 5 goals of MDT?

1. Accurately understand the patient's presentation and behavior of symptoms

2. Determine the most appropriate and effective treatment plan

3. Eliminate symptoms and restore full function

4. Empower the patient to self treat and prevent recurrences

5. Help inform patients if other medical advice testing is needed

What are the 3 keys to success for use of MDT?

1) Meticulous assessment

2) Emphasize educating patient in self-management

3) Appropriate use of progression forces

What are the 4 provisional MDT classifications? Which is MC?

1) Derangement (MC)

2) Dysfunction

3) Postural

4) Other

What is end range stress of normal structures?

Postural Syndrome

What are the 3 characteristics of postural syndrome?

1) Decreased ROM

2) Pain at end of ROM

3) Normal load on shortened tissues leads to symptoms

What is anatomical disruption or displacement within the motion segment (IVD and/or spinal segment)?

Derangement Syndrome

What are 3 characteristics of Derangement syndrome?

1) MC

2) Directional preference in response to loading strategies

3) Centralization in common (only in derangement!!)

What is symptoms moving away from the center of the body into the extremities?

Peripheralization

What is symptoms retreating toward the center of the body, closer to the spine?

Centralization

What are the 4 characteristics of centralization?

1) Only found in derangement syndrome

2) Usually rapid and always lasting changes

3) Reliably assessed

4) Occurs in response to loading strategies

T/F: Centralization is only found in derangement syndrome

TRUE

What are the 3 types/subclasses of derangement syndrome?

1) Anterior

2) Posterior

3) Posteriolateral

Which subclass of derangement syndrome demonstrates flexion analgia (kyphotic with decreased extension ROM)? What directional preference of loading is therapeutic for this?

Posterior Derangement

Therapeutic = extension loading

Which subclass of derangement syndrome demonstrates lordotic analgia (increased lordosis w/ decreased flexion ROM)? What directional preference of loading is therapeutic for this?

Anterior Derangement

Therapeutic = flexion loading

Which subclass of derangement syndrome demonstrates normal flexion, but extension is reduced? What directional preference of loading is therapeutic for this?

Posterolateral Derangement

Treatment = repeated lateral glide movements followed by extension loading

What frequency would be an average starting point for most patients for MDT?

10x every 2-3 hours

What are the 4 progression of forces, in order from least forces to most forces applied in MDT?

LEAST

1) Patient generated forces

2) Patient overpressure

3) Clinician overpressure

4) Clinician mobilization techniques

MOST

What role does patient positioning and overpressure play in progression of forces in MDT?

Can increase or decrease ROM

What is a principle of reflex motion based on posture and movement in children, assessing spontaneous movement, primitive reflexes, and postural reactions?

Vojta Therapy

Reflex locomotion in Vojta Therapy is activated from what 3 positions?

Prone

Supine

Side-lying

How many zones can be stimulated from the occiput to the calcaneus through proprioceptive stimuli in Vojta Therapy, which stimulate basic movement patterns that are programmed genetically to each persons CNS?

10 zones

Movement patterns in Vojta Therapy that he discovered and displayed by the child is dependent on the maturation of the brain, and these patterns show _______ way of movement

Ideal

In Vojta Therapy, developmentally, ________ milestones are typical for these certain months of age in the first 12 months of life

Monthly

What is a functional diagnostic treatment approach based on the principles of developmental kinesiology and the fact that correct body posture & movement flow are dictated by the body posture & movements of healthy children?

Dynamic Neuromuscular Stabilization (DNS)

T/F: All children develop motor skills int he same way

TRUE

-- development of movement is genetically coded and depends on the function of a healthy nervous system

DNS compares a patients posture and movement patterns to developmental models of what?

Healthy infants

Emphasis is placed on what two things in DNS?

1) Precise position in every joints and coordination of trunk stabilizing musculature

2) Correct breathing techniques

What is the goal of DNS?

Balance effects of internal forces of muscles that act on the spine and joints

In DNS, joint centration and proper stabilization can only be realized when each developmental position has been mastered by the child. if the child does not master, then what occurs?

Compensation patterns arise

What is the optimal positioning for the loading of a joint, either peripheral or centrally located, that allows for the most effective mechanical advantage, having the greatest interosseous contact to allow for optimal load transfer within the joint and through the kinetic chain?

Joint centration

T/F: Joint centration is programmed in the brain, so a normal CNS will lead to normal muscle function

TRUE

Which plane of movement does stabilization need to be mastered before moving to other planes of stabilization?

Sagittal plane

What pressure increases when balancing the spinal extensors? What is it important for?

Intra-abdominal pressure (IAP)

important for cross syndromes

- Creates "open scissors" postural dysfunction causing tight erector spinae and iliopsoas since some muscles over-facilitates and some under-facilitated

What is functional stabilization? Does it only occur locally at joints or is it more important as a global pattern of stabilization?

a global pattern

-- can occur at certain joints but needs to involve entire kinetic chain of musculature

What is a more optimal breathing pattern: nasal breathing or mouth breathing? Why is that and why is it important for proper stabilization?

Nasal breathing

Optimal for global stabilization, activates the parasympathetic nervous system, and affects head posture

What positions can you perform DNS assessment? (i.e. just one or two positions or is there a wide array?)

Wide array

What is the most important muscle for inhalation? Exhalation?

Diaphragm

Elastic recoil

What role do muscles used for breathing play in spinal stability?

controlling intra-abdominal pressure and reducing the stress on the spine through cooperative action with the abdominal and pelvic floor muscles

During a normal breathing pattern, Inhalation draws the diaphragm _______ the pelvic floor symmetrically, and the lower rib cage moves proportionally and symmetrically in a _________, _______, & ______ direction

The abdominal walls expand equally in a _________ manner, while the sternum moves __________. The intercostal spaces will __________ minimally at the end of inhalation

Toward

Lateral, ventral & Dorsal

Cylindrical

Ventrally

Expand

What dysfunctional breathing pattern is excessive upward movement of the sternum and shoulder girdles, with minimal abdominal movement?

Chest/Apical breathing

What dysfunctional breathing pattern is when the abdomen draws in during inhalation and out during exhalation?

Paradoxical breathing

What 4 areas are observed and palpated during an objective seated assessment?

1) Upper traps and levator scapula

2) Scalene & first rib

3) Intercostal spaces of T11-T12 laterally

4) anterior, lateral, & posterior abdomen with the thumb webs of both hands wrapped around the iliac crest

What are the steps for patient self-assessment of breathing while supine?

Perform supine with hips flexed so that feet are flat on the table or with legs elevated on a supported surface so that hips and knees are bent to 90 degrees

During patient self-assessment of breathing while supine, where should the patient place their hands? Where do they want to start focusing on the breath coming from?

One hand on chest, one hand on abdomen

Feeling for expansion/filling of the abdomen anteriorly and laterally

During patient self-assessment of breathing while supine, where would you move their hands to ensure they're breathing in a cylindrical fashion? (3)

1) Move both hands cupped around abdomen feeling for anterior and lateral expansion

2) Move one hand over abdomen and one hand beneath low back feeling for anterior and posterior expansion

3) Place thumbs inferior and medial to ASIS to feel for expansion/pressurization into lower abdomen and pelvis

What is the number 1 chronic disability?

Musculoskeletal health

Movement shold be part of an assessment because it leads to a better diagnosis through what 4 things?

1) Finding cause

2) Explaining source

3) Determining effective treatment

4) Shortening treatment time

What is the location the individual is feeling pain?

(TQ)

Source

What is creating pain in the individuals system, which may or may not be the same location as the source?

(TQ)

Cause

T/F: We categorize movements by measuring human body parts

FALSE

- categorize human movement PATTERNS (not measuring body parts)

What is the one way your body and brain get all of your parts working together without a fitness load?

Human movement patterns

When do we have justification to go look at the individual parts?

(TQ)

When a pattern is dysfunctional, you have justification to look at parts

What are seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient's primary complaint? What does this lead to?

(TQ)

Regional Interdependence

Leads to compensation

What type of joints are intended to produce movement in 3 planes? What type of restrictions are these prone to?

(TQ)

Mobile joints

prone to mobility restrictions

What are the 6 mobile joints?

occiput, shoulder, wrist, hip, thoracics, ankle

What type of joints are intended to produce movement in primarily 1 plane? What restrictions are these prone to?

Stable joints

Stability limitations

What are the 5 stable joints?

Lumbar, knee, elbow, scapula, cervicals

Study tip for the mobile/stable joints:

Alternating pattern as we go up from ankle to wrist →

Ankle (mobile), Knee (stable), Hip (mobile), Lumbar (stable), Thoracic (mobile), Scapula (stable), Genohumeral (mobile), Lower cervical (stabile), Upper Cervical (mobile), Elbow (stable), Wrist (mobile)

What is a movement limitation problem?

(TQ)

mobility dysfunction (MD)

What is the general rule for determining a true MD?

Active & Passive movement dysfunctional

What is a dysfunctional strategy or motor control dysfunction?

stability/motor control dysfunction (SMCD)

What is a general rule for determining a true SMCD?

Active Dysfunctional, BUT Passive is FUNCTIONAL

What impact does nociception have on efferent (motor) output?

Nociception results in altered motor control by reduced efferent activity of corresponding muscle(s)

What impact does nociception have on afferent (sensory) input?

Nociception results in altered motor control by reduced afferent activity

How do you categorize/score one of the top tier screens based on the scoring system? Which score(s) do we care the most about and breakout first? Which do we care the least about and not break out at all?

FN (Least important)

FP

DP

DN (Most important)

What are the basic rules of the SFMA? (5)

1) no warmup

2) if it's there, it's there

3) picky

4) no shoes

5) monkey see monkey do

What are the major determinants of gait all attempting to minimize?

minimizing center of mass (CoM) movement and minimizing overall energy expenditure

What are the major determinants of gait (3)?

1) Slight knee flexion (20 degrees) → Minimizes up/down CoM

2) Pelvic list/drop**

3) Posterior pelvic rotation

During pelvic list/drop, is it the stance leg hip or the swing leg hip that drops downward? Why does this occur?

As the foot impacts the ground, the pelvic drops downward on the opposite side (swing leg hip); Minimizes vertical movement of CoM (energy efficient)

How much lateral movement/translation is normal during pelvic list/drop?

Normal drop = 1 inch of lateral translation

What mechanism helps to dissipate braking forces?

Posterior Pelvic Rotation → Swing leg hits ground, the pelvis rotates posteriorly to dissipate the forces created from the heel hitting the ground

Reduce the energy expenditure by minimizing the movement of CoM

What are the key areas to evaluate in gait? (8)

1) Arm swing in sagittal and transverse plane

2) Hip flexion/extension and transverse plane (anteversion/retroversion)

3) Knee flexion/extension and frontal plane (valgus/varus)

4) Ankle mortise in sagittal plane (dorsiflexion/plantar flexion)

5) Calcaneus in the frontal plane (eversion/inversion)

6) Forefoot in frontal plane (pronation/supination)

7) First ray (MTP) in sagittal plane (extension/dorsiflexion)

8) Toe-in/out in transverse plane (internal/external rotation)

T/F: You can make treatment implications based on gait analysis alone

FALSE

you cannot

Recognize the common dysfunctions that may be present during gait assessment? (12)

1) Asymmetrical arm swing or excessive elbow flexion

- Note: usually the result of something from the hips, pelvis, or lower extremity

2) Excessive center of mass vertical movement

3) Excessive contralateral hip drop (>4-6 degrees) or lateral translation (> 1 inch*)

4) Inadequate hip extension (<10 degrees*)

5) Excessive femoral anteversion (internal rotation) and adduction (w knee valgus)

6) Excessive knee valgus (medial collapse/drift)

7) Excessive or inadequate knee flexion during midstance

8) Excessive toe-out (external rotation)

9) Inadequate ankle dorsiflexion

10) Excessive subtalar (calcaneal) eversion from heel strike to end of mid-stance phase

11) Excessive forefoot (mid-tarsal) pronation

12) Inadequate first ray dorsiflexion (extension)

What should we do as a double-check for gait analysis findings?

investigate abnormalities/dysfunction further with a local biomechanical assessment

What types of injuries are low-arched runners most susceptible to suffering?

Soft tissue injuries & injuries along the inside of their foot/leg (esp. knee and ankle)

What types of injuries are high-arched runners most susceptible to suffering?

More bony injuries (stress fractures) & injuries along their outer foot/leg (iliotibial band friction syndrome, ankle sprains, etc.)

What is the first thing to look at when assessing a running injury?

Individual's training logs in conjunction with their running experience

-- Most people progress/jump into it too quickly without letting the body adapt

What impact does stretching have on running injuries? (2)

Stretching:

- Not a generalized recommendation to reduce injury risk

- BUT if you make someone who usually stretches not do their warm-up stretching, their risk of injury nearly doubles

What impact does strength training have on running injuries? (3)

Strength Training:

- Helps increase running economy

- Increases "load capacity" and reduces stress/strain on tissues

- Reduce injury rates

Which of the following is a primary muscle of inhalation and a necessary component of producing optimal core/spine stability?

Rectus abdominis

Diaphragm

Subcostals

Transversus thoracis

Iliacus

Diaphragm

ULNT4 involves elbow flexion with full pronation and extension of the wrist/fingers to bring the nerve to tension. This test is specifically for:

Sciatic nerve

Radial nerve

Musculocutaneous nerve

Median nerve

Femoral nerve

Ulnar nerve

Ulnar Nerve

Where are primitive reflexes and spontaneous general movements that are present at birth located within the nervous system?

Cortical level

Cerebellum

Subcortical level

Spine and brain stem level

Spine and brain stem level

Which of the following is a commonly weak and inhibited muscle of lower crossed syndrome?

Lateral hamstring

Gluteus maximus

Adductor magnus

Iliopsoas

Gluteus maximus

According to Mechanical Diagnosis & Therapy (MDT), which of the following is a characteristic of derangement syndrome?

- Normal loading on shortened tissues leads to symptoms

- Full, pain-free range of motion

- Directional preference in response to loading strategies

- Results from poor posture

- Directional preference in response to loading strategies

Which of the following is NOT considered a mechanical function of the nervous system?

- Be able to forcefully contract to shorten its length

- Be compressible

- Slide in its container to facilitate movement

- Withstand tension

- Be able to forcefully contract to shorten its length

Which of the following is a symptom specific to nerve pathology and typically indicates a positive neurodynamic test?

Widespread (poorly localized) dull/achy pain

Radiating numbness/tingling

Temperature changes such as cold hands/feet

Localized sharp/shooting pain with joint movement

Radiating numbness/tingling

Which MDT (mechanical diagnosis and therapy) derangement classification typically presents with decreased flexion ROM and may have increased lordotic antalgia?

Lateral derangement

Transverse derangement

Anterior derangement

Posterolateral derangement

Posterior derangement

Anterior derangement

Which of the following is considered a goal of mechanical diagnosis & therapy (MDT)?

- Provide increased referral for imaging and surgery

- Empower the patient to be reliant on doctor-applied passive treatment

- Accurately understand the patient's presentation and behavior of symptoms

- Restore symptoms and eliminate function

- Accurately understand the patient's presentation and behavior of symptoms

T/F: When you create a motor skill, it is stored in the brain forever and cannot be changed.

TRUE

Smaller, deep muscles that span a single peripheral joint and provide dynamic proprioceptive feedback describes which of the following?

Global movers

Global stabilizers

Local stabilizers

Passive insufficiency

Local movers

Active insufficiency

Local movers

Which of the following is considered an important physical factor that impacts our movements?

Skin elasticity

Time of day

Axon-to-dendrite ratio

Proprioception

Osseous stiffness

Proprioception

________________ is achieved by moving the neural structures in the area in question without moving the musculoskeletal tissues in the same region. This is key because it is really the only way to confirm a nervous system diagnosis.

Neurodynamic summation

Structural differentiation

TikTok flossing

Nerve flatteners

Structural differentiation

Which of the following is regarded as an important consideration during the performance of neurodynamic testing?

Time of day the test is being performed

Duration of testing

Patient's pain tolerance

Depth of compression being used

Duration of testing

________________ problems involve poor timing, sequencing, coordination and synergy of the neuromuscular system which manifests in dysfunctional movement.

Subluxation

Motor control

Gastrointestinal

Psychosocial

Structural differentiation

Motor control

Which of the following is a commonly weak muscle observed in upper crossed syndrome?

Levator scapulae

Upper trapezius

Pectoralis major

Lower trapezius

Sternocleidomastoid

Lower trapezius

The only way to know if someone is truly learning a motor skill is to:

- Give them bandwidth feedback

- Do a performance test immediately after practice

- Perform a retention test

- Provide video feedback

Perform a retention test

The optimal positioning for the loading of a joint, either peripheral or centrally located that allows for the most effective mechanical advantage describes which DNS concept?

Joint centration

Sagittal stabilization

Intrabdominal pressure (IAP)

Reflex locomotion

Joint centration

Which type of feedback is our best form of feedback because it is always available during performance and testing situations?

Bandwidth feedback

Delayed feedback

Fading feedback

Intrinsic feedback

Augmented feedback

Intrinsic feedback