What is the Filtered Approach?
- hypothetical deductive reasoning
- develop a hypothesis
- try to rule-in/out hypothesis
- refine the hypothesis
- facts & logical rules
What is the difference between the clinical reasoning of Hypothetical Deductive and Gestalt?
Hypothetical Deductive - filtered approach, starts with overview, standardized, based on probability, early in career
Gestalt - pattern recognition, starts small, not standardized, used later in career
When having your patient perform AROM during your regional examination what are you looking for?
- if movement is functional (normal length)
- if movement is dysfunctional (short)
- painful or non-painful
When having your patient perform AROM during your regional examination when do you know or its indicated to perform PROM?
- if AROM is dysfunctional (short)
During your regional examination you are performing PROM on your patient, when do you know if your suppose to apply overpressure?
- if PROM is dysfunctional (short)
Why would you want to apply overpressure to a joint?
- to determine the end-feel
- firm/hard = joint
- elastic = soft tissue
- empty = pain
During your regional examination how are you going to determine what joints you need to check the accessory motion and why?
- if it’s PROM is dysfunctional (short)
- to determine if hypo- or hyper- compared bilaterally
- does accessory motions reproduce symptoms
During your regional examination what is your indication that you need to check muscle length of a joint?
- if the joint has an elastic end-feel
During your regional examination how the heck do you know when or when not to check manual muscle test?
- not appropriate with moderate to high levels of pain
- weak & pain-free = neurological lesion or full thickness tear (not sure but I am not MMT this dude)
- weak & painful = major muscle tear (probably not this guy either, maybe flip a quarter heads for MMT and tails no MMT)
Using the Staged Rehabilitation System what is the appropriate treatment order?
1st - Pain/Inflammation
2nd - Mobility Dysfunction (jt mobility then TED)
3rd - Stability/Motor Control Dysfunctions
What are the four major categories in the Staged Rehabilitation System?
- Pain/Inflammation
- Mobility
- Stability/Muscle Performance
- Neuromuscular/Functional Training
What region specific information is critical to your examination with your patient who has a acute cervical injury?
High Risk factors
- pt older than 65
- dangerous mechanism of injury
- paresthesia in extremities (pins & needles)
Low Risk factors
- simple rear-end motor vehicle collision
- sitting position in the emergency department
- ambulatory at any time
- delayed (not immediate) onset of neck pain
- absence of midline cervical-spine tenderness
Can pt rotate 45° left and right
If a patient demonstrate ataxia walking back to the exam room what should you do?
- refer the patient
What resisted muscle test is there for testing a patient with a stays in a forward head posture for an extended period time?
- deep neck flexor endurance
- 30 sec is normal
- want 60 sec if pt has headache
What region specific information is critical to your examination with your patient who has a shoulder injury and why?
- TUBS “torn loose” or AMBRI “born loose”
- a traumatic causation of injury means you refer the patient
- a minor trauma, multi directional instability, bilateral means you treat the patient
What region specific information is critical to your examination with your patient who has a elbow injury and why?
- observe to see if the patient is extending his arm fully, if not perform elbow extension test, refer if test is positive.
- if patient can’t extend arm fully he/she may have a structural deformity that needs to be determined via x-ray
What region specific observation is critical to your examination with your patient who has a hand/wrist injury and why?
- atrophy of the thenar (median n.) and/or hypothenar (ulnar n.) muscles of the hand can indicate nerve involvement.
