Week 1: Principles and Concepts of PT Evaluation

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Physical Therapists

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Physical Therapists

provide care to patients/clients of all ages who have impairments, activity limitations, and participation restrictions.

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Patient/Client Management Model

  • applied for the purposes of rehabilitation, habilitation, maintenance, of health or function, prevention of functional decline, and in healthy person: enhancement of of performance

  • on going on iterative process that begins during the very first contact with patient or client including when the PT starts gathering patient/client health information

  • examination, evaluation, prognosis, and intervention

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Examination

  • comprehensive screening and specific testing process leading to diagnosis and/or appropriate referral

  • subjective and objective measures

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Evaluation

  • synthesis of all data gathered from examination process to establish diagnosis, prognosis, and POC

  • deflects the severity of current problem, possibility of multi-system involvement, presence of pre-existing systemic conditions/diseases, and stability of conditions

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Red Flag

  • any S/Sx that would indicate the problem is not MSk dso

  • serious problem that should be referred to appropriate health professionals

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Yellow Flag

any S/Sx that denotes problems that may be more severe requiring a more extensive examination.

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Open-Ended Question

  • narrative information

  • preferred way of questioning

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Closed/Direct Questions

  • specific information/answer

  • often used to fill details given from open-ended questions

  • answerable by yes or no

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Pain

an unpleasant, sensory and emotional experience associated with actual or potential tissue damage, or describe in terms of such damage.

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Acute

  • often severe, continuous, and disabling

  • more irritable

  • associated with anxiety

  • type of pain that is new - injury just happened

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Chronic

  • aggravating; not intense

  • previous experiences; pt knows how to deal with it

  • associated with depression

  • with patient for a long time, common with work-related MSK injuries

  • caused mostly by poor posture

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Primary Hyperalgesia

  • when tissue has been damaged, the substances that are released lead to inflammation and peripheral sensitization of nociceptors

  • results in localized pain

  • occurs during acute pain

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Secondary Hyperalgesia

  • if the new injury does not follow a normal healing pathway and becomes chronic, central sensitization may occur

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Acute Injuries

present for 7-10 days

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Subacute Injuries

10 days - 7 weeks

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Chronic Injuries

more than 7 weeks

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Constant Pain

type of pain that suggest chemical irritation, tumors, or visceral regions.

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Periodic/Occasional Pain

type of pain associated with activity, position or posture that brings out the symptoms.

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Episodic Pain

type of pain related to some activity.

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Locking

  • joint cannot be moved through full ROM

  • caused by meniscal tear

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Giving Way

  • feel of the joint to buckle

  • muscle weakness

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Laxity

  • excessive ROM of the joint

  • no pathology present

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Flexibility

  • ability of one or more joint to be moved on available ROM

  • depends on the function of contractile tissues, primarily the ligaments and joint capsule resistance

  • can be static: available of ROM of one or more joint or dynamic: ease of movement

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Instability

  • inability to control the joint during its movement

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Translational Instability

  • pathologic/mechanical

  • loss of control of small arthrokinematic joint movements that occur when pt. tries to stabilize the joint during movement

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Anatomical Instability

  • clinical/gross

  • instability/pathological hypermobility

  • excess or gross physiological movement in the joint where the pt. becomes apprehensive at the end of the ROM because of the subluxation or dislocation is imminent

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Function Instability

  • inability to control wither arthrokinematic or osteokinematic movement in the available ROM either consciously or unconsciously during functional movement

  • evident during high speed or loaded movement

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Voluntary Instability

initiated by muscle contraction.

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Involuntary Instability

initiated by positioning.

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Circle Concept of Instability

injury to one side of the joint can cause injury to other side/parts of the joint.

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Observation

  • looking or inspection phase

  • done to gain information and visible defects, functional deficits, or abnormalities of patient

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Vital Signs

indicators of the body's physiological status and response to physical activity, environmental conditions, and emotional stressors.

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Scanning Examination

  • developed by James Cyriax

  • emphasizes the joints of the body, their movement and stability

  • necessary to examine all appropriate tissues remains sound

  • assessment of spinal cord, nerve roots, and peripheral nerves

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Active Movements

  • physiological movements

  • used to check if there is any pain or discomfort in the ROM

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Passive Moments

  • anatomical movements

  • motion is done by PT and pt is relaxed through out (0 contraction_

  • the PT should know if pain or restriction predominates

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End Feel

the sensation the examiners "feels" in the joint as it reaches the end ROM.

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Soft End Feel

soft tissues approximation.

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Firm End Feel

muscular/capsular/ligamentous.

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Hard End Feel

bone to bone contact.

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Capsular Pattern

pattern of limitation or restriction

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Joint Play

  • also termed as "accessory movement"

  • it is a small ROM that can be obtained only passively by the examiner

  • not under voluntary control, important for full painless functions and full ROM of joints

  • necessary to make sure joints is functioning normally

  • < 4mm = normal

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Loose Packed Position

minimal congruency between the articular surfaces and is in position of greatest laxity and passive separation

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Closed Packed Position

  • two joint surfaces fit together precisely-congruent

  • joint surfaces are tightly compressed

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Spasticity

refers to muscle tone in which there may be collapse of muscle tone during testing.

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Rigidity

refers to involuntary resistance being maintained during passive movement and without collapse of muscle.

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Flaccidity

no muscle tone.

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Edema

is an abnormal accumulation of fluid of a body part.

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Special Test

  • to determine whether a particular type of disease, condition, or injury is present

  • if (+), may indicate a disease or condition

  • if (-), does necessarily rule out the disease

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Diagnostic Imaging

  • used to confirm and establish a diagnostic

  • used to determine the severity of an injury

  • used to determine the progression of a disease

  • determine the stage of healing

  • enhance patient treatment

  • determine anatomical alignment

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Plain Film Radiography

  • conventional plain film radiography "x-rays"

  • anatomical position; patient

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Alignment Bone Density Cartilage Space Soft Tissues

ABCD Radiographic Analysis

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Arthrography

invasive technique in which air, a water-soluble contrast material containing iodine, or a combination of the two (double contrast) is injected into a joint space, and a radiograph is take of the joint.

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Computed Arthrography

provides a three-dimensional definition of the joint, and the dye helps to delineate articular surfaces and joint margins.

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Venogram and Arteriogram

used to diagnose arteriosclerosis, investigate tumors, and demonstrate blockage after traumatic injury.

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Myelography

  • an invasive imaging technique that is used to visualize the soft tissues within the spine

  • a water-soluble readiopaque dye is injected into the epidural space by spinal puncture

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Tomography

  • has become a common imaging technique for musculoskeletal disorders, especially when computed enhanced (CT scan)

  • it produces cross-sectional imaging of the tissues

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Magnetic Resonance Imaging

noninvasive painless imaging technique with high contrast resolution that uses exposure to magnetic fields, not ionizing radiation, to obtain an image of bone and soft tissue.

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Radionuclide Scanning

  • uses chemicals labeled with radioactive isotopes which are injected intravenously several hours before the scan to localize specific organs that concentrate a particular chemical.

  • useful for skeletal metastasis, stress fractures, and osteomyelitis

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Discography

  • injecting a small amount of radiopaque dye into the nucleus pulposus of an IV disc under radiographic guidance,

  • used to determine disruptions in the nucleus pulposus or annular fibers of the disc

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Fluoroscopy

used to show motion in joints through X-ray imaging, guidance technique for injections.

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Diagnostic Ultrasound

involves transmission of high frequency sound waves into the tissue by a transduce through complete agent by calculation of the time it takes for the echo to return to the transducer for different interfaces.

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Xeroradiography

used when margins between areas of different densities need to be exaggerated.

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