Foundations of PT Quiz 3

Cervical Flexion ROM

0-40 degrees

Extension ROM

0-50 degrees

Cervical lateral flexion ROM

0-45 degrees

Cervical Rotation ROM

0-80 degrees

Patient position for Cervical Flexion and Extension Goni

Patient is sitting, proper t spine support

Fulcrum position for Cervical Flexion and Extension

External auditory meatus (EAM)

Stationary Arm position for Cervical Flexion/Extension Goni

Perpendicular or parallel to ground

Moving arm position for Cervical Flexion/Extension ROM

Base of nares (or parallel with tongue depressor)

Lower inclinometer position for Cervical Flexion

T1 spinous process

Upper inclinometer position for Cervical Flexion

Top of head

Lower inclinometer position for Cervical Extension

Root of spine of scapula (most medial aspect of scapular spine)

Upper inclinometer position for Cervical Extension

Top of head

Patient position for Cervical Lateral Flexion Goniometry

Sitting with proper T spine support

Stabilize shoulder girdle+chest

Fulcrum position for Cervical Lateral Flexion Goni

C7 spinous process

Stationary arm position for Cervical Lateral Flexion Goni

Along thoracic spinous process (perpendicular to the ground)

Moving arm position for Cervical Lateral Flexion Goni

Dorsal midline of head

Lower inclinometer position for Lateral Flexion

T1 spinous process

Upper inclinometer position for Lateral Flexion

Top of head (frontal plane)

Patient position for Cervical Rotation Goni

Sitting with proper thoracolumbar posture/suppport

Stabilize shoulder girdle+chest

Fulcrum position for Cervical Rotation Goni

Center of cranial aspect of head

Stationary arm position for Cervical Rotation Goni

Parallel to imaginary line between the two acromial processes

Moving arm position for Cervical Rotation Goni

Tip of nose

Inclinometer position for Cervical Rotation

Middle of forehead

Primary muscles of Cervical Extension MMT

Longissimus cervicis

Semispinalis cervicis

Iliocostalis cervicis

Upper trapezius

Patient position for Cervical Extension MMT

Prone, head over edge of bed, arms straight at sides

Therapist stands beside patient, initially supports head

Cervical Extension MMT Palpations

Palpate neck extensors in mid region of cervical spine

Apply resistance to back of head: parieto-occipital region, apply resistance straight downward

Where should the therapist support during Cervical Extension MMT?

Hand under chin in case support is needed

Primary muscles of cervical flexion MMT

SCM

Longus coli

Scalenus anterior

Patient position for cervical flexion mmt

Hook lying in supine

Arms at sides

Head on plinth

NO pillow

Therapist position for Cervical Flexion MMT

Head of bed, then move to side of bed

Palpation for Cervical Flexion MMT

Patient’s chin is tucked

Palpate SCM bilaterally

Resistance for Cervical Flexion MMT

2 fingers under chin

Cervical Rotation MMT Primary Muscles

Multiple, but palpate SCM

Patient position for Cervical Rotation MMT

Supine, hook lying, arms by side

Therapist position for Cervical Rotation MMT

At head of table, facing patient

Starting position for cervical rotation MMT

Full rotation, test is turn towrd neutral, then hold against resistance in midline

Rotation MMT Grades 2, 1, 0

Patient is seated, high back chair for next support. Patient attempts side to side rotation without additional movements

Cue is “keep your chin level”

Thoracolumbar flexion normal ROM

0-60 degrees

Thoracolumbar Extension normal ROM

Thoracolumbar lateral flexion normal ROM

0-35 degrees

Thoracolumbar rotation normal ROM

00-45 ROM

Thoracolumbar Flexion/Extension Inclinometer Patient Position

Standing with feet shoulder width apart, cervical thoracic and lumbar spine neutral in lateral flexion and rotation

Thoracolumbar flexion and extension upper inclinometer

T1 spinous process

Thoracolumbar flexion and extension lower inclinometer

Sacrum at S2 (at level of BOTTOM of PSIS)

Thoracolumbar Flexion stabilization

stabilize pelvis to prevent anterior tilt

Thoracolumbar extension stabilization

Pelvic rotation indicates the end of ROM

Thoracolumbar lateral flexion upper inclinometer

T1

Thoracolumbar lateral flexion lower inclinometer

S2

Patient position for Thoracolumbar Rotation Goni

Sitting

Proper thoracolumbar posture

Feet on floor with stable pelvis

Seat without a back preferred

Stabilization: Pelvis to prevent pelvic rotation

Fulcrum position for Thoracolumbar rotation goni

Center of cranial aspect of head

Stationary arm position for Thoracolumbar Rotation Goni

Parallel to imaginary line between prominent tubercles of iliac crests

Moving arm position for Thoracolumbar Rotation Goni

Parallel to imaginary line between acromial processes

Trunk flexion MMT primary muscles

Rectus abdominis

Internal+External obliques

Patient position for Trunk Flexion MMT

Supine, no pillow, legs straight

Therapist stands to one side

Palpation for Trunk Flexion MMT

Rectus abdominis over umbilicus

Stabilization: Weight of Pt’s straight legs. If pelvis moves due to weak hip flexors, stabilize across pelvis

Resistance for Trunk Flexion MMT

No direct resistance, hand position changes resistance

Grade 5: Hands behind head

Grade 4: Hands across chest

Grade 3: Arms straight forward

Trunk Rotation MMT Primary Muscles

Internal+External Obliques

Patient position for Trunk Rotation MMT

Supine

Legs straight

Fingertips behind head

No pillow

Therapist stands beside patient (TEST BOTH SIDES)

Palpation for Trunk rotation MMT

Bilaterally across line from ASIS—>Rib cage (more lateral than rectus abominis)

When are external oblliques active?

Active on side opposite rotation

When are internal obliques active?

Active on side toward rotation

Resistance for Trunk Rotation MMT

Patient arm position

Primary muscles for Trunk Extension MMT

Iliocostalis thoracis

Iliocostalis lumborum

Longissimus thoracis

Spinalis thoracis

Patient position for Trunk Extension MMT

Prone, head of bed is lowered so thoracic spine starts in some flexion

Xiphoid process at crease in bed

Palpation for Trunk Extension MMT

Lumbar and thoracic paraspinals

Stabilization for Trunk Extension MMT

Across posterior pelvis- SACRUM. NOT the lumbar spine

No therapist applied resistance

Thomas Test

Patient sits with butt near edge of table

Examiner asks pt to sit supine

Non test knee is flexed toward chest

Flex non test hip until lumbar spine flattens against table, patient holds that leg

Observe opposite/test leg

Thomas Test Observations

Thigh rests on table+knee flexes to 90=negative

Thigh doesn’t reach table+knee can’t flex to 90: iliopsoas

Thigh reaches table only as knee extends/knee can’t reach 90: rectus femoris

Thigh elevated+knee can’t flex: both

Ober Test

Patient is sidelying, bottom leg flexed for stability, stabilize pelvis to prevent rotation/depression

Cradle top leg, knee flexed to 90, abduct, extend, allow leg to drop toward floor. Extension is performed to clear greater trochanter

Negative=leg falls BELOW horizontal

Positive=Leg DOES NOT reach horizontal

Modified Ober Test

Knee EXTENDED to 90, the rest is the same as the regular Ober test

Latissimus dorsi length test

Negative=arms reach table/180 flexion without lumbar compensation

Positive=don’t reach table/180

Triceps length test

Positive=less elbow flexion in muscle length position than traditional goniometry, or end feel changes to muscle stretch

Biceps length test

Positive=decreased shoulder extension when elbow is extended=muscle tightness at end range

Finger flexors length test

Extend wrist with elbow+fingers extended+muscle tightness at end range

Finger extensors length test

Flex wrist with elbow extended+fingers flexed; compare wrist flexion with standard PROM. No +/- reference standard

Reclining wheel chair

Hip angle opens beyond 90 degrees

Risk=high shear forces along sacrum during re elevation

Indications for Reclining Wheelchair

Severe hip extension tightness

Orthostatic hypotension

Catheterization

Tilt in Space wheel chair

Seat to back angle staysfixed

Does this without sacral shear forces

What does the tilt in space wheelchair provide

Pressure relief

Tone control

Transport/Companion Wheelchair

Lightweight

Small rear casters

Requires attendant propulsion

Lacks ergonimic postural support

Best for short community outings

Wheels of wheelchair

Standard=24 inches

Small wheels=5 inches

Drive wheels/tires

Pneumatic—→absorbs shock

Solid polyurethane—>Eliminates fall risk

Handrims

Standard=aluminum/chrome

Projection/Coated=For impaired grip, example: C6 SCI

Front casters

Turning drag, BUT can catch on cracks (Small)

Large casters (8 inch) better for rough outdoor terrain

Wheel locks

Push to lock or pull to lock

Used for stable transfers

Anti tippers

Prevent tipping during propulsion training

Arm rests

Desk length—>table access

Leg rests

Can be: swing away, elevating

Assist with lower extremity edema management, hamstring ROM limitations

Why cushions matter

Pelvic stability

Neutral orientation

Ischial pressure redistribution

Backrest and Lateral Pads

Basic sling fabric to right countoured backrests

Lateral trunk supports: used to stabilize scoliosis, asymmetrical tone, poor core control

Wheel chair seatbelt=restraint if…

it restricts freedom of movement, or user cannot release it independently

Use of restraint often requires an official doctor’s order in clinical, hospital, or long term care settings

If patient CAN independently unbuckle wheelchair seatbelt….

It may be classified as a positoning device rather than a restraint, and may not require a prescription, depending on state/facility

Anti tippers

prevents wheel chair from tipping

Before bed mobility

Chart review/introduction

Systems screen, safety check

Gather what you need: AD, shoes, wheelchair etc

Ask premission, make sure bed is locked

Position yourself for good body mechanics, never force or pull on a weak limb

What should you consider before bed mobility

Pressure points

Finger nails

Jewelry

Hair

Bed mobility precautions

Don’t rush

wait for patient signs of distress

engage patient as much as possible

Facilitate normal/safe movement patterns

Minimize shearing forces to protect skin

Consider precautions/contraindications

Supine scooting

Side to side, up/down bed

Rolling Supine—>Side Lying

Eyes+head turn first, trunk naturally follows head

Abduct the shoulder on side you’re rolling towards

Bend the knee OPPOSITE the direction of the roll

Reach across body, then use foot of bent leg to push the trunk into sidelying

Complete the roll

Segmental Roll vs Log Roll

Log roll is used in parapalegic/paralyzed patients, segmental roll for everyone else

Big wheels

24 inches, can be larger or smaller

Handrim is suggested for self propulsion and protects the patientls hands

Big wheels in rear=described as most practical for general purposes

Big wheels in front=advantage is turning around in a small space