MS- Lecture 3 (part 1)

kms013's version from 2016-01-31 04:44


Question Answer
MS evaluation is a ___ and ___ method to insure that nothing is overlooked. systematic, sequential
Evaluation should be: ___, ____, and ____.Organized, thorough, reproducible.
A correct PT dx depends on: accurate pt history (have to ask the right questions), diligent observation (quantity and quality), thorough physical examination (rule in/out), understanding of clinical S&S (development of patterns), knowledge of functional anatomy (movement patterns.)
What's the goal of PT and successful PT outcomes depend on...accurate PT diagnosis, knowledge of appropriate interventions (treatment strategies and tactics), constant reassessment (comparable sign), knowledge of appropriate progression/regression (clinical reasoning), achievement of pt goals (working toward improving function)
Assessment:Based on all the info gathered during the eval, clinician must make professional opinion of what is causing the pt's problems, general recommendations, rehab potential, and potential barriers.
Plan: After assessment, clinician develops POC. Consists of patient focused measurable goals and specific plan of intervention including frequency and duration.
Top 5 red flags from subjective;Rapid weight loss, unrelenting symptoms (nothing relieves, always the same), night pain, night sweats, non-anatomic distribution (example: whole leg numbness)
General red flags during an exam:Fever associated with joint effusion and pain, point tenderness and pain with percussion or weight bearing
Purpose of examinationDetermine pieces (impairments) you think are leading to the patient's movement dysfunction, rule in/out working hypothesis and differential dx, look to prove yourself wrong first, don't confuse completeness with exhaustiveness.
Comparable signGoal of examination is to reproduce pt's symptoms, identify weak links in the chain that is causing movement dysfunction
Fifteen principles of examination1. Tell pt what you're doing. 2. Test the normal/uninvolved side first. 3. Do active movements first, then passive, then resisted isometrics. 4. Do painful movements last. 5. If AROM is not full, apply PROM with care to test endfeel if not too painful. 6. Repeat movements or sustain certain postures or positions if history indicates. 7. Do resisted isometric movements in neutral/resting position. 8. During PROM and ligamentous testing, assess both the quantity (amount) of movement, and quality (end feel) of opening. 9. With ligamentous testing, repeat with increasing stress. 10. With myotome testing, hold contraction 5 seconds. 11. Palpate at the end to confirm the location of the problem. 12. Warn the pt of possible exacerbations following the examination. 13. Everything you do in the exam has a purpose. 14. Maintain the pt's dignity. 15. Refer if necessary.
Generic FORM examination:Functional assessment, Observation, ROM, Mobility, Strength, Special tests (RMSS= palpation)
Functional assessmentBest time to see natural movement , look at what pt is willing (pain) and able (mobility/stability) to do from a functional standpoint: have pt perform without specific instruction because you want to see how they'll accomplish it on their own.
If pt is unable to complete an activity due to pain ___ due to restricted motion (___) or due to uncontrolled motion (____).stop the activity (may lead to false positives), mobility issue, stability issue
Functional assessment leads to ____.Clues as to what parts you need to assess (if mobility, joint/soft tissue; if stability, NM control, strength, endurance, pain)
Purpose of observationInspection phase to gain info on visible defects, functional deficits, abnormalities of alignment (clinician should note pt's way of moving, general posture, manner, attitude, willingness to cooperate, any signs of overt pain behavior.)
Observation key points:Pt's body alignment, any obvious deformity (knee contracture, genu recurvatum), bony contours (normal and symmetrical vs. obvious deviation such as genu valgum or coxa varum), are there any soft tissue contours (muscle wasting, limb swelling, joint effusion. Are limb positions equal and symmetrical (apparent leg length discrepancy), are the colors and textures of skin normal, are there any braces or scars to indicate recent injury or surgery, is there any crepitus, snapping, or abnormal sounds in pt's joints when the pt moves them; is there any heat swelling or redness (inflammation) ---> determine if swelling is intramuscular, pericapsular, intra-articular (effusion); what attitude does the pt appear to have toward the condition, examiner, or PT; does the pt appear apprehensive, restless, resentful, or depressed. What is the pt's facial expression (discomfort, distress, lacking sleep). Is the pt willing to move (are patterns of movement normal ---> gait dysfunction, compensatory movements, etc.)

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