1
Q
How would you describe primary care physical therapy and the responsibilities of the physical therapist in that role?
A
PTs practicing in Primary Care modes can offer more efficiently and can help reduce cost for patients.
- This helps produce better outcomes, and ensures optimal resources and decreases cost.
2
Q
What are some lessons that Primary Care and PTs have learned from the Military?What is the Capabilities Model?
A
The US military has experienced critical shortages of physicians. As a result, after the Vietnam War the military had to develop models of health care that can be an example for a civilian practice environment facing the same problem
- The “Capabilities Model” allows all providers to serve at their full level of training, share responsibility and efficiently treat patients.
3
Q
What are some barriers translating such the Capabilities Model to civilian care?
A
- There were high co-pays
- Medicare doesn’t recognize PTs as Primary Care Providers
4
Q
Where do Social and Structural Determinants of Health fit in the ICF model?
A
They are contextual, so in the Environmental and Personal Factors
5
Q
What is the definition of Social Determinants of Health? What impact do the social determinants of health have on the individual patient?
A
- Social determinants are non-medical factors that influence health outcomes.
- Social Determinants have been found to be more important than healthcare and lifestyle choices in influencing health outcomes; also accounts for 30-50% of health outcomes
6
Q
What constitutes as a Social Determinant of Health? (5)
A
- Education Access and Quality
- Health Care Access and Quality
- Neighborhood and Built Environment
- Social and Community Context
- Economic Stability
7
Q
What is the difference between a Medial Diagnosis and a Physical Therapy Diagnosis?
A
Medical Diagnosis:
- Focuses on Causes of disease, disorders and injury
- Eval. and treatment of Disease
Physical Therapy Diagnosis:
- Consequences of disease, disorders and injury
- Eval. and treatment of dysfunction
8
Q
What factors need to be considered when making a physical therapy diagnosis?
A
- The Identification of activity limitations, participation restrictions, and contextual factors through a detailed subjective exam
– The Identification of Primary and Secondary impairments through the performance of a structured objective exam
9
Q
How does the ICF Framework and SMART format help to structure patient-centered goals?
A
The use of ICF and SMART helps us figure out goals that are specific to the patients activity limitations/participation restrictions, allows us to measure the progress of those goals, and allows us to figure out if the goals are attainable/relevant to the patient in a timely matter
10
Q
How can you utilize the ICF Framework to make all of the necessary considerations for an appropriate physical therapy diagnosis?
A
- ICF uses both medical and social model as a bio-psycho-social synthesis, and it does not focus one’s disease, illness or disability alone
- Conceptualizes a patients functioning as a dynamic interaction between a person’s health condition, environment and personal factors for a holistic understanding of health
11
Q
What are the necessary components of a patient’s health condition to consider when determining an appropriate prognosis?
A
- Demographic Factors: Age, Sex, Occupation
- Disease-Specific Factors: Stage, Severity, and Natural History
- Medical Comorbidites: Cardiovascular disease, Arthritis, Obesity, Diabetes, Cognitive. Impairments.
- Bio-behavioral Comorbidites: Depression, Elevated fear-avoidance beliefs, Expectations of recovery, Incentive for Recovery, Self-Efficacy and Locus Control
12
Q
How may a patient present in the Acute stage (SOC)? What should the goal of intervention be? What components should an acute stage goal include?
A
Highly irritable, and Highly severe.
The goal of intervention is symptom modulation
- Components of an Acute stage goal may include:
–Pain Rating (Ex. 8/10)
–Functional component (Ex. Increase lumbar extension)
–Activity component (Ex. Walking)
13
Q
How may a patient present in the Subacute stage (SOC)? What should the goal of intervention be? What components should a subacute stage goal include?
A
Stable, Moderately irritable and moderately severe.
The goal of intervention is movement control
- Components of a Subacute goal should at least include:
–Functional component {something measurable} (Ex. Shoulder flexion)
–Activity component (Ex. Lift dishes)
–Participation component (Ex. lifting dishes into their overhead kitchen cabinet)
14
Q
How may a patient present in the Chronic stage (SOC)? What should the goal of intervention be? What components should a Chronic stage goal include?
A
Stable state of low severity and low irritability.
The goal of intervention is functional optimization
- Components of a Chronic goal should at least include:
-Activity component (Ex. Throw)
-Participation component (Ex. Throwing a ball in their high school baseball game)
15
Q
How may a patient present in the Chronic (Unstable) stage (SOC)? What should the goal of intervention be? What components should a Chronic (Unstable) stage goal include?
A
A state of variable and unpredictable severity and irritability.
The goal of intervention is functional optimization
This stage is typically accompanied by a nociplastic MOP!
- Components of a Chronic (Unstable) goal should at least include:
–Activity component {Measurable} (Ex. Walking)
-Participation component (Ex. Checking their mailbox)
16
Q
How will the different stages of change within the Transtheoretical Model of Change inform patient education?
A
As the patient progresses through the different stages of change, they start outweighing the pros over the cons and start taking their health/condition more seriously. The patient will finish with high self-efficacy
17
Q
What happens if a person has low levels of health literacy?
A
Low health literacy is associated with poor health outcomes, including increased hospitalization rates, fewer preventive screening, and higher rates of disease and mortality
18
Q
What is the difference between Internal Locus and External Locus of control?
A
Individuals with internal locus of control believe that their personal actions and choices have a direct bearing on the outcomes they experience.
Individuals with external locus of control feel that events are caused by fate, powerful others, or other factors out of their control.
(Patients with internal locus of control are more likely to seek information about their health problems and choices)
19
Q
What is Motivational Interviewing?
A
A collaborative, person-centered form of guiding to elicit and strengthen motivation for change
- In other words we tap into the persons motivational processes to help facilitate change that is congruent with the person’s own values.
20
Q
What are the 5 principles of Motivational Interviewing?
A
- Express Empathy
- Develop Discrepancy
- Avoid Argumentation
- Roll with Resistance
- Support Self-Efficacy
“don’t argue or be pushy, be optimistic/supportive, explore inconsistencies between the problem behavior and clients goals”
21
Q
With Motivational Interviewing, what is the OARS technique?
A
OARS is an acronym
O: Open ended questions
A: Affirmations
R: Reflective listening
S: Summaries
22
Q
With Motivational Interviewing, what is the difference between Change Talk and Sustain Talk?
A
Change Talk: Is client speech that favors movement in the direction of change
Sustain Talk: Is client speech that favors the status quo
23
Q
What is the amount of time that an adult should spend engaged in Moderate-intensity physical activity per week?
A
150 to 300 minutes a week
(The adults that have Chronic conditions or disabilities should also follow this if they can)
24
Q
What is the amount of time that an adult should spend engaged in Vigorous-intensity physical activity per week?
A
75 to 150 minutes a week
(The adults that have Chronic conditions or disabilities should also follow this if they can)
25
What should Older Adults do as part of their weekly physical activity?
Older adults should do multicomponent activities, which includes balance training as well as aerobic and muscle strengthening activities.
-They should determine their level of effort relative to their level of fitness
26
What is the amount of time that women during pregnancy and the postpartum period should spend engaged in Moderate-intensity physical activity per week?
Should at least do 150 min
27
Can women during pregnancy and the postpartum period engage in vigorous-intensity activity?
Yes, women who have habitually engaged in vigorous-intensity workouts before can continue.
28
What is a Bone-to-Bone (Hard) End-Feel?
(Normal End-Feel)
Hard End-Feel at end of mobility because of a normal anatomical structure (Elbow extension)
29
What is a Soft Tissue End-Feel?
(Normal End-Feel)
When soft tissue presses against soft tissue at end of mobility (Knee flexion with hip flexed)
30
What is a Tissue Stretch End-Feel?
(Normal End-Feel)
Firm End-Feel that gives with overpressure at end of expected mobility (Ankle DF with knee flexed)
31
What is a Muscular Stretch End-Feel?
(Normal End-Feel)
Elastic recoil of muscle-tendon unit under tension
(Knee extension with hip flexed)
32
What is the cause of a Springy End-Feel? (Abnormal End-Feel)
This is produced by articular surface rebounding from intra-articular meniscus or disk; the impression is that if forced further, something will give way.
33
What are the characteristics of Springy End-Feel?(Abnormal End-Feel)
Rebound sensation as if pushing off a rubber pad
34
What are the cause of a Boggy End-Feel?
(Abnormal End-Feel)
Produced by viscous fluid (blood) within joint
35
What is the characteristics of a Boggy End-Feel?(Abnormal End-Feel)
"Squishy" sensation as joint is moved toward its end-range; further forcing feels as if it will burst joint
36
What are the causes of a Muscle guarding/Spasm End-Feel?
(Abnormal End-Feel)
Produced by reflex and reactive muscle contraction in response to irritation of nociceptor, predominantly in articular structures and muscle; forcing it further feels as if nothing will give
37
What are the characteristics of a Muscle guarding/Spasm End-Feel? (Abnormal End-Feel)
Abrupt and "Twangy" end to a movement that is unyielding while the structure is being threatened but disappears when threat is removed
38
What are the causes of Empty End-Feel?
(Abnormal End-Feel)
Produced solely by pain; further forcing increases pain to unacceptable levels
39
What are the characteristics of Empty End-Feel?(Abnormal End-Feel)
Limitation of motion has no tissue resistance component, and resistance is from the patient being unable to tolerate further motion due to severe pain
40
What are the causes of Facilitation End-Feel?(Abnormal End-Feel)
Not truly an End-Feel, as facilitated hypertonicity does not restrict motion; it can, however, be perceived near end-range
41
What are the characteristics of a Facilitation End-Feel?(Abnormal End-Feel)
Light resistance as from constant light muscle contraction throughout the latter half of range that does not prevent the end of the range from being reached; resistance is unaffected by the rate of the movement
42
For Manual Therapy, what is the appropriate technique base on Pain (Barrier) and Empty end-feel?
No technique is appropriate
(From chart in book)
43
For Manual Therapy, what is the appropriate technique base on Pain (Barrier) and Spasm end-feel?
No Technique is appropriate
44
For Manual Therapy, what is the appropriate technique base on Pain (Barrier) and and Capsular end-feel?
Oscillations
45
For Manual Therapy, what is the appropriate technique base on Joint Adhesions (Barrier) and an Early Capsular end-feel?
Passive Articular Motion Stretch
46
For Manual Therapy, what is the appropriate technique base on Muscle Adhesions (Barrier) and an Early Elastic end-feel?
Passive Physiologic Motion Stretch
47
For Manual Therapy, what is the appropriate technique base on Hypertonicity (Barrier) and an Facilitation end-feel?
Hold-Relax PNF Stretch
48
For Manual Therapy, what is the appropriate technique base on Bone (Barrier) and and Boney end-feel?
No technique is appropriate
49
What are the goals for intervention in the acute phase or High Irritability?
- RICE
- POLICE:
--Protection- Avoid excessive loading to injured
tissue
--Optimal loading- guide fibroblast to lay down
new collagen in line of stress
--Ice- Cryotherapy to reduce edema, effusion and
hematoma
--Compression- Elastic bandage/tape to reduce
effusion
--Elevation- Aid venous return to reduce edema
(From BB)
50
What are the goals for intervention in the subacute phase?
*Progress to address more nuanced impairments to body structure and function, activity limitation, and participation restriction*
- Patient will have increased pain-free ROM
- Treatment goals:
--Modify the forming collagen (Type 3)
--Modify faulty joint mechanics
--Orient new collagen fibers parallel to lines of force they must withstand
--Prevent scar cross-linking and contractures
(From BB)
51
What are the Therapeutic exercises and Manual Therapy techniques used in the subacute phase?
The therapeutic exercises are based on established goals and functional needs
- When establishing exercise prescription you must use correct application of forces and address poor movement quality and compromised motor control
For Manual therapy there should be applies control stress to healing tissue (gentle joint mobs., soft tissue mobs., and gentle contract-relax)
- If too aggressive this can disrupt/delay healing
52
What are the goals for intervention in the chronic phase?
- Gradual return to full pain-free ROM
- Progressive muscular qualities based on functional needs (Strength, power, endurance, and speed)
53
What are the therapeutic exercise and Manual Therapy techniques used in the Chronic phase?
The therapeutic exercises are **focused on function**
- Exercises that mimic functional movement patterns in actual environment
- Use functional assessments to track progress: reduced use of goni and MMT
For Manual therapy you should restore accessory motion and increase tissue extensibility
- Accessory motion graded: Manipulations (3-4)
- Extensibility: Passive stretch and myofascial release
54
What is the difference between Mobilization and Manipulation?
Mobilization = Non-thrust technique
Manipulation = Thrust technique
55
What are Physiological movements?
Movement preformed actively by the patient which can be examined for quality and symptom response
56
What are Accessory Movement/Joint Play?
Movements that cannot be preformed by the individual, including spins, rolls, and glides/slides which accompany physiological movement
57
What is an absolute contraindication for Manual Techniques (MT)? What are some examples?
A situation that makes a particular treatment or procedure absolutely inadvisable
Some ex:
- Infection
- Malignancy
- Recent Fracture
- Hematoma
- Inappropriate end-feel
- Rheumatoid Arthritis (IN a state of an exacerbation)
58
What is a Relative Contraindication for Manual Therapy (MT)? What are some examples?
A situation where a treatment can be used but caution should be used
Some ex:
- Joint effusion or inflammation
- Rheumatoid Arthritis (NOT in a state of an exacerbation)
- Pregnancy
- Steroid or anticoagulant therapy
- Presence of neurological signs
59
What are the indications for Joint Mobilizations?
They are similar to Manual Therapy indications, also includes:
- Increasing joint extensibility and joint ROM
- Decreasing pain
- Promotes muscle relaxation
- Improve muscle performance
(Also helps with muscle guarding, lengthening of tissue around the joint, neuromuscular influences on muscle-tone and proprioceptive influences)
60
What are Precautions/ contraindications for Joint Mobilizations?
They are the same as Manual Therapy, also includes:
- Joint Hypermobility
- Acute Inflammation
- Acute Joint Effusion
61
What are some Absolute Contraindications for Manipulations?
- Poor integrity or ligamentous or bony structure
- Spinal cord damage
- Unremitting Night Pain
etc.
62
What are some Relative Contraindications/Precautions for Manipulations?
- Minor osteoporosis/osteopenia
- HNP (Herniated Disc Pulposus) w/ radiculopathy
- Sings of spinal instability
- Down syndrome
etc.
63
What is the Concave - Convex Rule? (Concave on Convex ; Convex on Concave)
Concave on Convex: The roll and glide are in the same direction
Convex on Concave: The roll and glide are in opposite direction
64
What is the Kaltenborn technique for joint mobilization?
The Kaltenborn's technique use a combination of distraction and mobilization to reduce pain and mobilize hypomobile joints
65
What are the Grades for Kaltenborn technique?
Grade 1-*Piccolo* (Loosen): This grade involves a distraction force that neutralizes separation without producing any joint separation.
Grade 2-*Slack* (Take up slack): This grade of distraction separates the articulating surfaces and eliminates the play in joint capsules. Its typically used for the initial treatment to determine the sensitivity of the joint
Grade 3-*Stretch*: This is designed to stretch the joint capsule and the soft tissue surrounding the joint to increase mobility.
66
According to Maitland, what is a Grade 1 Joint Oscillation?
A small amplitude technique (about 25%) performed at the beginning of the available ROM
*0-25%*
(Move within anatomical range with moving into resistance, for Neurophysiological effects)
67
According to Maitland, what is a Grade 2 Joint Oscillation?
A large amplitude movement in the middle of the ROM(the middle of 50%)
*25-50%*
(Move within anatomical range with moving into resistance, for Neurophysiological effects)
68
According to Maitland, what is a Grade 3 Joint Oscillation?
A large Amplitude movement at the end of the ROM (the last 50%)
*50-75%*
(Performed at anatomical range that engages the end range barrier to lengthen stretched tissues and for neurophysiological effects)
69
According to Maitland, what is a Grade 4 Joint Oscillations?
A Small amplitude movement at the end of the ROM (The last 25%)
*75-100%*
(Performed at anatomical range that engages the end range barrier to lengthen stretched tissues and for neurophysiological effects)
70
According to Maitland, what is a Grade 5 Joint Mobilization?
A movement that exceeds the resistance barrier, commonly referred to as a high velocity thrust with low amplitude technique or manipulation.
(Patient is less likely to guard against the movement, and this maximizes neurophysiologic and mechanical effects)
71
What are Maitland's Grade 1 and Grade 2 mobilizations for?
Used solely for pain relief and muscle guarding and has no direct mechanical effect on the restricting barrier, it does this by joint lubrication and circulation in tissues related to the joint.
(Reduces muscle guarding and pain, improves compliance with therapeutic exercise program)
72
What are Maitland's Grade 3 and Grade 4 mobilizations for?
Used primarily as stretching maneuvers, also has a mechanical and neurophysiologic effect, also may activate inhibitory joint and muscle spindle receptors reducing restrictions to movement
(Reduces muscle guarding and pain, releases adhesions and collagen cross-linkage)
73
What are the advantages of Grade 5 manipulations?
- The patient is less likely to guard against the movement
- Maximizes neurophysiologic and mechanical effects
74
What are considerations a clinician must have when doing Joint Mobilizations? (7)
- The position of the joint to be treated must be appropriate for the stage of healing and skill of PT.
*Resting or open packed for acute SOC or inexperienced PT*
- One half of the joint should be stabilized, the other half is mobilized
- Should not move into or through the point of pain
- The Velocity and amplitude are carefully considered, based on goal, restore ROM or alleviate pain
- One movement at a time at one joint only
- After a few movements, the patient is reassessed if the joint is in the acute healing stage and less frequently in other stages
- The Intervention should be discontinued for the day when a large improvement has been obtained or when the improvement ceases
75
With joint mobilization, Grade 3 and Grade 4 can be further subdivided into what?
They can be further subdivided into Grades 3+ (++) and Grade 4+ (++), indicating that once the end of the range has been reached, a further stretch is given to impart a mechanical force on the movement restriction.
76
What are contraindications for Grade 5 mobilization (High velocity thrust)?
- The inability of the patient to relax, any technique should feel comfortable to the patient
- Cervical techniques should not be performed at the end of the overall cervical spine's physiological movement range, especially for extension and rotation
- A past medical history that includes any condition that can weaken bone or collagen, any condition that may create abnormal hypomobility, any condition involving a joint fusion
- The risk of damage to developing growth epiphysis
77
What is PNF?
*Proprioceptive Neuromuscular Facilitation*
- A Manual technique that promotes a neuromuscular response through stimulation of the proprioceptors
78
What are structural dysfunctions? How can it affect the body?
(Myofascial and articular hyper/hypomobilites)
- This affects the body's capacity to assume and perform optimal postures and motions
79
What are Neuromuscular dysfunctions? What does it cause?
(An inability to efficiently perform purposeful movements)
- Cause repetitive, abnormal, and stressful usage of that articular and myofascial systems, often precipitating structural dysfunctions and symptoms
80
In PNF, What are agonist?
Work to produce movement
81
In PNF, what are antagonist?
Relax to allow movement
82
In PNF, what are neutralizers?
Inhibit a muscle from performing more than one action
83
In PNF, what are supporters?
Stabilize the trunk and proximal extremities
84
In PNF, what are Fixators?
Hold bones steady
85
What are contextual Mechanisms of Manual Therapy?
Contextual mechanisms influence patient outcome.
Common factors across all intervention: Placebo, Nocebo
86
What is the difference between Patient Factor Expectation and Patient Factor Beliefs?
Patient Factor Expectation is the expectation of a successful or unsuccessful outcome
Patient Factor Beliefs is the preconceived notion of treatment effectiveness matters
87
What is Therapeutic Alliance?
The bond between patient and provider
- This is a significant predictor of success with manual therapy
88
What is Reflection-In-Action?
Considerations during manual therapy interventions
(Patient body language, changes to resting muscle tone, oscillations speed and grade)
89
What is Reflection-On-Action?
Considerations after manual therapy intervention
90
How should PTs utilize PTAs?
PTA's should:
- collect objective data as directed by PT
- Administer PT intervention that does not require immediate and continuous assessment
- PTA should not alter/modify the POC without consulting PT
**PTA cant do Mobs, sharp debridement, dry needling**
91
For Therapeutic Exercise what are Muscle Performance Principles?
- Activation: Low grade exercise, neuromuscular e-stime
- Motor control/coordination: Establish normal movement patterns in available ROM (Single plane then Multi-plane, proprioception, balance, low resistance high reps till movement pattern is automated)
- Endurance: Submaximal load with higher reps (Improving muscle endurance not cardiopulmonary)
- Strength: High resistance/low reps, prolonged breaks
- Power: Resistance and reps match functional needs (Force-Velocity Relationship)
92
What are some signs of Overtraining?
- Inability to recover after exercise
- Decline in physical performance
- Muscle Soreness
- Fatigue
*Can be caused by insufficient recovery, rest, and unloading*
93
If a test has a Sensitivity closer to 100%, what would this tell you?
The closer the sensitivity is to 100% in the presence of a test with a **Negative Result**, the stronger the ability of the clinical measure to RULE OUT the potential for a particular diagnosis.
94
If a test has a Specificity closer to 100%, what would this tell you?
The closer the specificity is to 100% in the presence of a test with a **Positive Result**, the stronger the ability of the clinical measure to RULE IN the potential for a particular diagnosis
Term 2
flashcards
Decks in class (45)
# Cards
-
Gross 2 Gluteal Region *Muscle, Nerve, and Actions (Moore’s Def.)24
-
Gross 2 Pelvis, Gluteal Region, and Hip26
-
Gross 2 Femoral Region *Muscles, Nerves and Actions52
-
Gross 2 Femoral Region38
-
Gross 2 Knee50
-
Gross 2 Cutaneous Nerves of leg *Root, and Distribution*28
-
Gross 2 Lower Leg **Muscles, Nerves, Actions40
-
Gross 2 Lower Leg18
-
Gross 2 Foot and Ankle61
-
Gross Clinical Q & A17
-
Gross 2 Neck and Head Region *Muscle attachments, Nerves, and Actions*60
-
Gross 2 Head and Neck Lect.41
-
Gross 2 Cranium and Cranial Nerves76
-
Gross 2 Vasculature, TMJ, Eye, Ear and Mouth66
-
Sutures of Cranium10
-
FMC (Unit 1)31
-
FMC (Unit 2 Communication and Therapeutic Alliance)18
-
FMC (Unit 3 Story of Patient)10
-
FMC (Unit 4 Patient Presentation)46
-
FMC Test 2 *Periarticular Tissue*62
-
FMC Test 2 *Tendon Healing & Tendinopathy*44
-
FMC Test 2 *Peripheral Nerve*18
-
FMC Test 2 *Neurotmesis, Neuropraxia, Axonotmesis*31
-
FMC Test 2 *Bone*20
-
FMC Test 2 *Weird things nerves do*2
-
FMC Unit 8 Parts 1-3 *Psychosocial Aspect of Care*36
-
FMC Test 2 Units 4-7 *Psychosocial Aspects of Care*35
-
FMC Test 2 Unit 8-9 *Psychosocial Aspects of Care*27
-
Movement Science (Exam 1)117
-
Movement Science Unit 546
-
Movement Science Unit 688
-
Movement Science Unit 730
-
Applied 269
-
AA2 Final72
-
Gross 2 Abdominal Wall46
-
Gross 2 Abdominal Quadrant contents37
-
Gross 2 Posterior Abdominal Wall61
-
Gross 2 *Abdominal Viscera*57
-
Gross 2 Pelvic Region and Perineum66
-
Biomechanics Final *Hip*76
-
Biomechanics Final *Knee*50
-
Biomechanics Final *Foot and Ankle*27
-
Biomechanics *Gait/Balance/Posture*79
-
Movement Science Final68
-
FMC Final94
