Physical Therapy Exam Study Notes

Week 1: Patient Interview and Analysis; Cranial Nerve Exam

• Assessment Mode Key: WE (Written Exam), IO (In-class Observation), HA (Homework Assignment), LA (Lab Activity), PE (Practical Examination)

• Course Objectives: Students will be able to demonstrate the listed items with successful participation.

A. Patient Interview and History

• Goals of Patient Interview/History (WE):

  • Recognize its relation to the entire clinical reasoning algorithm for patient evaluation and treatment.

• Components of the History (WE, HA, Q, LA):

  • List and understand all components.

    The history

    Triage: making the decision that the pt belongs in your office ( Is it a Neuromuscular skeletal problem)

    Differential diagnosis: ranking the

  • Understand analyzing data leads to a working diagnosis and planning tests and measures.

• Pain Definition (WE, HA, Q):

  • Define pain according to the International Society for the Study of Pain.

  • Describe the Neuromatrix theory of pain.

• Methods to Assess Pain (WE, HA, Q):

  • List 4 methods:

    • Numeric pain rating scale

    • Self-report outcomes measures

    • Body charts/ diagrams

    • Observation of movement

  • Understand the reason for each method.

• Symptoms of Chronic Pain Syndrome/Central Sensitization (WE, HA, Q):

  • Recognize symptoms in a patient.

• Differentiate Pain Types (WE, HA, Q):

  • Classify pain as:

    • Somatic

    • Somatic referred

    • Radicular

    • Visceral referred

    • Nociceptive

    • Peripheral neuropathic

    • Central sensitization pain

• Factors Suggesting Neuromusculoskeletal Nature (WE, HA, Q):

  • Select factors from patient History.

• SINSS Analysis (WE, HA, Q):

  • Recognize SINSS concepts: severity, irritability, nature, stage, and stability.

  • Describe derivation from History and meaning.

• Yellow Flags (WE, HA, Q):

  • Define/give examples of yellow flags indicating heightened fear avoidance beliefs or behaviors.

• Red Flags (WE, HA, Q):

  • Recognize/categorize red flags suggestive of systemic disease requiring referral/consultation.

• Factors Assisting with Prognosis and Goal Development (WE, HA, Q):

  • Select factors from patient History to assist with determining prognosis/recovery and developing short/long-term goals.

• Indications for Cranial Nerve Exam (WE, HA, Q, PE):

  • Understand indications.

B. Analysis of History Data and Cranial Nerve Exam

• Differential Diagnoses (WE, HA, IO, LA):

  • Given a written case study, take the History data and analyze it to make differential diagnoses (medical and PT diagnoses).

• Practical Exam:

  • Be able to perform a Cranial Nerve Exam and interpret the results of that test.

Week 2: Types of DX Schemes; Lower Quarter Neuro Screen

A. Diagnostic Classification Systems and Neuro Screen

• Diagnostic Classification Systems (WE):

  • Recognize and define:

    • Acute injury medical pathology

    • Non-acute medical or pathology-based

    • Treatment-based classification

    • Impairment-based

    • Central Sensitization (pain based)

• Common Medical Diagnoses (WE, HA, Q):

  • Identify based on clusters of signs and symptoms or case scenario related to the musculoskeletal or neurological systems

• Altered Motor Control (WE, HA, Q):

  • Describe the concept as a treatment-based diagnostic classification and give examples.

• Relevant Impairments (WE, HA, Q):

  • Recognize impairments linked to functional limitations/activities/movement/participation restrictions.

• Crucial Points for Diagnosis in PT Evaluation (WE, HA, Q):

  • Understand the two main places where diagnoses are crucial in clinical reasoning.

• Types of Diagnoses (WE, HA, Q):

  • Understand different types:

    • Nociceptive pain vs central sensitization pain

    • Medical diagnosis

    • PT or movement diagnosis

    • Impairment-based diagnosis

  • Recognize symptoms in History indicating different diagnoses.

• Nerve Root vs Peripheral Nerve Injury (WE, HA, Q):

  • Understand the difference and how they are differentiated with tests.

• Indications for Lower Quarter Neuro Screen (WE, HA, Q, PE):

  • Understand indications.

B. Differential Diagnoses and Lower Quarter Neuro Screen

• Differential Diagnoses (WE, HA, IO, LA):

  • Develop a broad list of differential diagnoses given a course-long scenario.

• Practical Exam:

  • Perform a Lower Quarter Neuro screen and interpret the results.

Week 3: Tests & Measures, Upper Motor Neuron Screen/Tests

A. Tests & Measures and Upper Motor Neuron

• History Dictates Tests & Measures (WE):

  • Understand how it dictates the focus, comprehensiveness, and aggressiveness.

• Purposes of Tests & Measures (WE, HA):

  • Confirm/refine/refute differential diagnoses.

  • Find relevant impairments/contributing factors to treat.

• Diagnostic Movement Tests (WE, HA, Q):

  • Understand the purposes.

• Purpose of 16 Types of Tests & Measures (WE, HA, Q):

  • Understand the purpose of all sixteen types.

• Joint Motion Terminology (WE, HA, Q):

  • Explain terminology and concepts of joint motion and the concave/convex rule.

  • Determine direction of arthrokinematic motion using anatomical knowledge.

• Reasons for Limited Joint Motion (WE, HA, Q):

  • Understand/differentiate between the three main reasons a patient's joint may not be able to move through its full motion.

• Factors to Discuss with Patient (WE, HA, Q):

  • Indicate and explain the three main factors (diagnosis, prognosis, and today's treatment) that should be discussed with the patient after the History and Tests & Measures.

• Indications for Upper Quarter Neuro Screen (WE, HA, Q):

  • Understand indications and interpret findings.

• Purpose of Special Tests (WE, HA, Q):

  • Articulate the purpose; interpret positive findings via sensitivity, specificity, and likelihood ratio.

• Hypothesis of Body Structure/Tissue at Fault (WE, HA, Q):

  • Generate the mostly likely hypothesis using selective tissue tension principles and results of AROM, PROM, and Resisted Static (isometric) tests for the upper extremity.

B. Tests Selection and Upper Motor Neuron Exam

• Tests & Measures Selection (LA, PE):

  • Choose Tests & Measures to:

    • Confirm/refine/refute primary differential diagnosis (medical and PT diagnoses).

    • Find relevant impairments to treat (course-long scenario).

• Practical Exam:
  * Perform an Upper Quarter Neuro screen and interpret results.
  * Perform three upper motor neuron tests and interpret results.

Week 4: PT Intervention: Manual Therapy

A. Manual Therapy Intervention

• Three Required Parts of Intervention (WE, HA, Q):

  • Understand the three different required parts.

• Within- vs Between-Sessions Change (WE, HA, Q):

  • Describe the importance and difference.

• Stages of Healing and Rehabilitation (WE, HA, Q):

  • Understand for a patient with an acute injury.

• Categories of Manual Therapy and Techniques (WE, HA, Q):

  • List/understand the three categories and describe Treatment techniques.

• Key Mechanisms of Manual Therapy (WE, HA, Q):

  • Understand and explain how manual therapy works.

• Integration of Manual Therapy (WE, HA, Q):

  • Understand it's rarely used in isolation and integrates into a multi-modal treatment plan.

• Testing vs Treating with Joint Mobilization (WE, HA, IO, LA):

  • Describe the difference between testing Passive Accessory Motion and treating a patient using joint mobilization as an intervention.

• Passive Accessory Motion Grading System (WE, HA, IO, LA):

  • Articulate the grading system and how pain is involved.

• Contraindications for Joint Mobilization and Spinal Manipulation (WE, HA, Q):

  • List contraindications for joint mobilization and absolute contraindications for spinal manipulation.

• Patient Education (WE, HA, Q):

  • Provide education that explains risks/side effects and benefits of joint mobilization.

• Hypothesis of Body Structure/Tissue at Fault (WE, HA, Q):

  • Generate the mostly likely hypothesis using selective tissue tension principles and results of AROM, PROM, and Resisted Static (isometric) tests for the upper extremity.

B. Appropriateness and Assessment of Manual Therapy

• Appropriateness of Manual Therapy (LA, PE):

  • Determine if manual therapy is appropriate for the patient (course-long scenario).

• Following live demonstrations:
  * The student will perform a test of muscle length for a passive SLR, and passive accessory movement at the wrist to practice principles of assessment of Passive Accessory Motion tests to determine the availability of range, the relationship of pain and resistance within range, and determine the presence or absence of hypermobility or hypomobility on a peer.

Week 5: PT Intervention: Therapeutic Exercise

A. Therapeutic Exercise

• Reasons to Treat with Therapeutic Exercise (WE, HA, Q):

  • List reasons and impairments that may be treated.

• Continuum of Therapeutic Exercise (WE, HA, Q):

  • Understand the terminology involves a large continuum from isometric muscle contraction and small movement to high level functional activity.

• Chronic Pain Syndrome/Central Sensitization (WE, HA, Q):

  • Understand patients need a multidimensional approach and a particular exercise approach (graded exercise).

• Principles of Neuroplasticity (WE, HA, Q):

  • Understand the principles.

• Tissue Healing Stages (WE, HA, Q):

  • Understand the tissue healing stages and the types of exercise that are appropriate for each stage.

• General Management Strategies for Pain (WE, HA, Q):

  • Select general management strategies that may be used to address pain.

• Management of Mobility Impairments (WE, HA, Q):

  • Identify general concepts (AROM, PROM, stretching, MET, functional integration) related to management of mobility impairments (mobility deficits) with therapeutic exercise.

• Management of Movement Coordination Impairments (WE, HA, Q):

  • Identify general concepts related to management of movement coordination impairments with therapeutic exercise. (NWB to WB progression, static stability, dynamic stability, functional integration)

• Contraindications and Precautions to ROM Exercises (WE, HA, Q):

  • Indicate general contraindications and precautions.

• Contraindications to Stretching (WE, HA, Q):

  • Recall absolute contraindications to stretching of tissues that cross a joint.

• Contraindications and Precautions for Resistance Exercise (WE, HA):

  • Recall general contraindications and precautions for and during resistance exercise.

• Definitions: Strength, Endurance, Power, Plyometrics (WE, HA, Q):

  • Define muscle strength, endurance, muscle power and/or plyometrics.

• Indications for Resistance Exercise Modes (WE, HA, Q):

  • List and describe general indications for various modes of resistance exercise (isometric, isotonic, concentric, eccentric, isokinetic).

• Static and Dynamic Balance Training Exercises (WE, HA, Q):

  • Identify examples of static and dynamic balance training exercises.

B. Home Exercise Program

• Home Exercise Program Selection (WE, HA, IO, LA):

  • Choose a home exercise program that matches the patient’s contributing factors and in-clinic treatment (course-long case).