CP4 Midterm Review

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the most prominent injury in students receiving adjustments is in the _____/______ region

neck/shoulder

the most prominent injury in student administering adjustments is the _____/______ region

hand/wrist

what is the second most common injury in students receiving adjustments?

shoulder

what may be considered the single most important element of an effective HVLA thrust?

acceleration

what are the 4 stages of competence?

unconsciously unskilled, consciously unskilled, consciously skilled, unconsciously skilled

what stage of competence is our goal when entering clinic?

consciously skilled

what stage of competence should we be at 2-3 years into practice?

unconsciously skilled

what are the 3 domains of bloom’s taxonomy?

cognitive, affective, and psychomotor

what describes the learner’s ability to process information in a meaningful way? Involving comprehension, knowledge, and application

cognitive

what describes learners' attitudes and feelings that are a result of the learning process? This involves your ability to receive feedback, value that feedback, and apply it

affective

what describes the learners' ability to use motor skills to learn?

psychomotor

which of the 7 stages of learning in the psychomotor domains are we in as CP 4 students?

guided response

what is the overall trend in high velocity low amplitude forcedevelopment

an increase with experience that begins after 2 years of experience, accelerates in year 3, and then tapers off

at greater levels of experience the total force amplitude ________ while the rate of force application (acceleration) ________

decreases; increases

______ is a branch of mechanics that deals with the motion of objects, including displacement, velocity, and acceleration, without taking into account the forces that produce the motion. Examples: Flexion, extension, rotation, and lateral flexion (movement of a joint complex), Anterior, posterior medial and lateral gliding (movement of one bone), Distraction, Compression

kinematics

______ is the study of relationships between the force system acting on a body and the changes it produces in body motion. Examples: torque, work, momementum, power, force.

kinetics

______ is described as the specific movements that occur at the articulating joint surfaces

arthrokinematics

_______ is described the physiologic movement possible at each joint when muscles contract or when gravity acts on the bone to move it

osteokinematics

______ closure refers to the grooves and ridges of the interlocking joint surfaces protects the joints against shearing forces

form

______ closure refers to the other forces acting across the SI provided by ligaments, muscular slings, and the thoracolumbar fascia to create stability

force

what are the two purposes of the Vleeming's Active Straight Leg Raise (ASLR)?

assess force closure mechanisms of SIJ and check for lumbopelvic instability

What does the "Keystone Effect" describe?

The shape of the sacrum- wider at the top and wedged between the ilium increasing strength and stability of the pelvic ring.

________ is the ability of a test to correctly identify those with the disease (true positive rate). In medical terms, it is the percentage of people who test positive for a disease that have that disease.

sensitivity

_______ is the ability of the test to correctly identify those without the disease (true negative rate), the extent to which a diagnostic test is specific for a particular condition, trait, etc.

specificity

what are the clinical prediction rules for SI pain? (Cluster of Laslett)

3 or more positive pain provocation SIJ tests have sensitivity of 91% and specificity of 78%

What type of joint are the SI Joints?

Diarthrodial

what best describes the SIJ in children?

relatively mobile, surrounded by pliable capsule

what best describes the SIJ in puberty to adulthood?

transforms from a diarthrodial joint to a modified synarthrodial joint. articular surfaces develop numerous reciprocally contoured elevations and depressions

what best describes the SIJ in the fourth-fifth decades?

joint capsule increasingly fibrotic; osteophytes & other structural defects common

what best describes the SIJ in the sixth decade?

some ligaments have been shown to ossify

what best describes the SIJ in the eighth decade?

hyaline cartilage thins & deteriorates; about 10% of the population show complete fusion

What types of motion occur at the SIJ?

rotation and translation

how much rotation occurs at the SIJ?

1-4 degrees

how much translation occurs at the SIJ?

1-2mm

What cartilage is on each side of the pubis symphysis?

hyaline

what makes up the disc in the middle of the pubis symphysis?

fibrocartilage

What type of joint is the pubic symphysis?

nonsynovial ampiarthrotic

with nutation, how does the sacral base move?

anterior and inferior

with counter nutation, how does the sacral base move?

posterior and superior

Nutation occurs with (L5-S1) lumbosacral ___________

extension

Counter Nutation occurs with (L5-S1) lumbosacral ___________

flexion

How does the PSIS moves with the motion flexion of the SIJ?

posterior and inferior

The PSIS moves _________ & _________with motion of extension of the SIJ

anterior; superior

Which muscles are involved in the Posterior Oblique muscle sling?

latissimus dorsi, contralateral gluteus maximus, and bicep femoris

Which muscles are involved in the Anterior Oblique muscle sling?

pecs, internal and external obliques, and transverse abdominus

Which muscles are involved in the Posterior/Longitudinal muscle sling?

multifidus, deep layer of thoracolumbar fascia, and sacrotuberous ligament

Which ligaments of the SIJ restrict posterior movement of the sacral apex?

sacrotuberous and sacrospinous

Which ligament of the SIJ restrict anterior movement of the sacral base?

posterior sacroiliac

Which ligament of the SIJ restricts lateral flexion of the lumbar spine and anterior movement of the sacral base?

iliolumbar

What are the 5 components of the Faye Model of the Vertebral Subluxation Complex (VSC)?

neuropathophysiology, kinesiopathophysiology, myopathology, histopathology, and biochemical change

According to Faye, what is the rationale for adjustment?

find hypomobility, use adjustive procedure to mobilize, reasses

what does Faye’s rationale for adjustment affect directly?

kinesiopathology

_______ is defined as: Reproducibility or consistency of measurement or diagnosis (inter vs. intraexaminer)

reliability

_______ is defined as: degree to which the test actually evaluates what is intended

validity

___________ is defined as: reflects improvement or worsening in the condition or function it is measuring

responsiveness

___________ is defined as: practical usefulness of a diagnostic test, value the procedure has in directing effective patient care

utility

T/F: Joint dysfunction complex or Vertebral Subluxation complex can be confirmed or excluded by the presence or absence of pain alone?

false (pain is subjective)

T/F: Joint pain can differentiate between joint hypo/hypermobility or instability

false (Joint pain is often poorly localized and the site of pain is often not always the site of pathology)

T/F: Pain associated with inflammation is more constant

true

T/F: Mechanical joint pain has pain free intervals, while an inflammatory process would result in constant pain

true

What type of thrust is performed at or near the level of the dysfunctional joint? (It is used in the cervical, thoracic, lumbar, pelvis, and extremity joints)

short lever

A _______-_______ thrust is at some distance from the level of the dysfunctional joint. May be used only in the thoraco-lumbar (T12-L1), lumbar, and pelvic joints when additional leverage and/or force is needed

long lever

What are the characteristics of a specific spinal manipulation?

focus on one point, HVLA thrust, typically short lever and specific contacts

What are the characteristics of a general spinal manipulation?

mobilize multiple joints, HVLA, typically long lever contacts and long lever thrust

T/F: It can be concluded that chiropractic adjustments are specific to one spinal segment without affecting adjacent segments

false (Research shows that chiropractic adjustments affect spinal segments above and below the thrust)

a _______ thrust involves contacting the inferior segment of the joint to be adjusted, as well as rotating all the joints above the contact in the opposite way as the thrust

resisted

What type of thrust involves contacting the superior segment of the joint to be adjusted, as well as rotating all the joints above the contact in the same way as the thurst?

assisted

In what direction is a joint manipulation usually delivered?

into direction of reduced joint motion

What is the most common injury site to chiropractors performing an adjustment?

wrist/hand/fingers

The articular facets of L1-L3 lie primarily in the ___________ plane and transition to the _________ plane from L4-L5 to L5-S1

sagittal; coronal

What is the normal range of the lordotic curve?

20-60 degrees

what is the average lordotic curve?

45 degrees

The typical lumbosacral angle of _____ degrees produces an anterior shear force at L5-S1 equal to _____% of body weight

40; 64

increased sacral base angle = ______ shear force, ______ lumbar lordosis, ______ stress on the facet joints, and ______ pelvic tilt

increased; increased; increased; anterior

decreased sacral base angle = _____ pelvic tilt, ______ lumbar lordosis, ______ weight bearing and stress on the disc, _______ the spine's ability to absorb axial compression

posterior; decreased; increased; decreasing

With L/S flexion, the inferior facets move _________ and _______ on the superior facets

superior; anterior

With L/S extension, the inferior facets move _________ and _______ on the superior facets

inferior; posterior

With L/S rotation, the facets on the side of rotation will __________, as the facets on the opposite side will __________

separate; approximate

With L/S lateral flexion, the inferior facets move _________ on the side of lateral flexion and _______ on the contralateral side of lateral flexion

inferior; superior

Movement performed within a given plane is associated with an automatic movement in another plane (d/t muscle action, articular facet alignment, etc.) defines what?

spinal coupling

What is the classical idea of spinal coupling throughout the spine in cervical and upper thoracic?

lateral flexion with ipsi rotation of vertebral BODY and contra rotation of SP

What is the classical idea of spinal coupling throughout the spine in mid thoracic through lumbar?

lateral flexion with contra rotation of vertebral BODY and ipsi rotation of SP

What movement occurs with Type 1 Lumbar Coupling?

lateral flexion with contra rotation

what is responsible for type 1 lumbar coupling?

quadratus lumborum

What movement occurs with Type 2 Lumbar Coupling?

lateral flexion with ipsi rotation

what is responsible for type 2 lumbar coupling?

sacrospinalis and multifidus

What movement occurs with Type 3 Lumbar Coupling?

segmental aberrant lateral flexion with normal couple rotation

what is responsible for type 3 lumbar coupling?

Faulty disc mechanics, overdominant quadratus lumborum, or intertransversalis

What movement occurs with Type 4 Lumbar Coupling?

segmental aberrant lateral flexion and rotation

what is responsible for type 4 lumbar coupling?

faulty disc mechanics, imbalance of psoas or multifidi

When standing, the lumbar segments are subject to anterior shear forces due to the reaction to ______ forces, _______ weight, and the _______ curve

ground; body; lordotic

T/F: Prone thoracic adjustments are more localized/specific tribonucleation

true

Normal Lumbo-Pelvic Rhythm = The first ______ degrees of torso flexion consist of lumbar spine flexion followed by an additional ______ degrees of hip flexion.

60; 30

Normal Lumbo-Pelvic Rhythm =The first 60 degrees of flexion involve _______ contraction of the lumbar _______ muscles, followed by an additional 30 degrees of hip flexion after _______ of the ______ muscles

eccentric; paraspinal; relaxation; gluteal

Approximately 75% of trunk flexion and extension occurs in the _______ spine

lumbar