Musculoskeletal Exam 1 (ROM, DTR testing)

Reliability

"Good to excellent" w/standardized procedures; having the correct device w/consistent procedures would both be related to validity or reliability?

Empty

Acute joint inflammation, bursitis, abscess, fracture, or psychogenic disorder may have this abnormal end feel

Visit encounter

This note type includes factors that required treatment to be modified, factors that affect goal achievement, communication/consultation w/other providers of care (including non-medical), and authorization/appropriate designation of the PT

End of care

This note type includes final pt remarks, including functional change and changes in tests/measures

End of care

This note type includes list of interventions at final day and summary of interventions throughout treatment

End of care

This note type includes remaining issues and discharge destination/status

Reassessment

This note type is also known as a monthly progress note, recertification note, re-exam note, or re-eval note

Reassessment

This note type is written to determine changes in pt status or to modify/redirect intervention accordingly

Reassessment

This note type is written to identify new clinical findings/lack of progress or need for consultation w/or referral to another provider

Somatic

This pain is a severe chronic/aching pain that is inconsistent w/injury or pathology to specific anatomical structures and cannot be explained by any physical cause bc the sensory input can come from so many different structures supplied by the same nerve root

Episodic

This pain is related to specific activities; at the same time the examiner should be observing the pt and noting if pain appears constant, pt appears to be lacking sleep due to pain, and if pt moves around a great deal in attempt to find comfort

Muscle

This pain is usually hard to localize, is dull/aching, often aggravated by injury, and may be referred to other areas

Test performance/evaluation of muscle strength/length

Fundamental components of MMT are these

Listening to patient

Often an examiner can make a diagnosis by simply doing this

Constant

This pain suggests chemical irritation, tumors, or possibly visceral lesions; it is always there though intensity may vary

Bone

This pain tends to be deep, boring, and localized

Vascular

This pain tends to be diffuse, aching, and poorly localized and may be referred to other areas of the body

Referred

This pain tends to be felt deeply, its boundaries are indistinct, and it radiates segmentally w/o crossing the midline

Nerve

This pain tends to be sharp/lancinating, bright, and burning and also tends to run in the distribution of specific nerves

Osteokinematics

This refers to the gross movement of the shafts of bones rather than the movement of joint surfaces

Yellow flags

These may include multiple nerve root involvement, abnormal sensation (non-dermatome/peripheral nerve patterns), saddle anesthesia, UMN, or fainting/drop attacks

Red flags

These may include severe pain w/no history of trauma/injury, severe spasm, psychologic overlay, bowel/bladder dysfunction, or constitutional signs (fever, chills, night sweats, weight change, malaise, fatigue)

Yellow flags

These may include vertigo, ANS symptoms, progressive weakness/gait disturbances, multiple inflamed joints, psychological stress, or circulatory/skin changes

HIPAA

These regulations prevent unauthorized access to private health info

Anatomical instability

This (aka clinical/gross or pathological hypermobility) refers to excessive/gross physiological movement in a joint where pt becomes apprehensive at end of ROM bc subluxation or dislocation is imminent

Translational instability

This (aka pathological or mechanical) refers to loss of control of small, arthrokinematic joint movements that occur when pt attempts to stabilize joint during movement

Patellar

This DTR is innervated at the L3-4 level

Medial hams

This DTR is innervated at the L5-S1 level

Empty

This abnormal end feel may have no real end feel bc pain prevents reaching end of ROM or no resistance felt except for protective splinting/muscle spasm

Scanning exam

This can be used to rule out symptoms from one part of the body to another

Circle concept of instability

This concept states that injury to structures on one side of a joint leading to instability can at the same time cause injury to structures on the other side or other parts of the joint

7

This cranial nerve is known to be responsible for issues related to Bell's Palsy

Goniometric

This data provides a basis for fabricating orthoses/adaptive equipment and formal disability ratings

Marfan syndrome

This disorder usually causes long bone with hypermobility; Abraham Lincoln was said to have it

DTR

This evaluates pathways of lower motor neurons

Pain/dysfunction

This in regards to weakness, CT, arthritis, motivation, and instability may be factors that affect ROM

Involuntary

This instability is the result of positioning

Scanning/clearing exam

This is a "quick look" (5-10 mins) of a part of the body involving the spine/extremities

End feel

This is a characteristic which is experienced by clinician performing PROM of a joint, usually by applying slight overpressure at end of range

Ehlers-Danlos syndrome

This is a genetic disorder that usually effects CT, has varying degrees and every case is different; may lead to hypermobility (pt's can so much as sneeze and dislocate shoulder)

Capsular pattern

This is a pathological condition involving entire joint capsule resulting in particular/proportional pattern of limitation involving all/most passive motions of joint

Osteogenesis imperfecta

This is a pediatric condition that may lead to hypermobility and proneness to bone fractures

Peripheral nerve distribution

This is a specific area of skin innervated by a nerve

Dermatome

This is a specific area of skin supplied by fibers of a single nerve root

Arthrokinematics

This is a term used to refer to the movement of joint surfaces

Paresthesia

This is abnormal sensation in absence of specific stimulation

Secondary care

This is acute care/rehab hospitals, outpatient clinics, home health, school systems

Myotome

This is all musculature derived from a given somite and therefore innervated by the same segmental nerve

Sclerotome

This is an area of bone/fascia supplied by an individual nerve root

Hypermobility

This is an increase in passive ROM that exceeds normal values for that joint, relative to age/gender

Impairment

This is anatomic, physiologic, mental or emotional abnormalities or loss

Osteokinematics

This is generally not concerned w/joint articular surface movement; however, you must be concerned about quality as well as quantity of movement

Tertiary care

This is highly specialized, complex, and technology based settings

Early detection

This is important for reducing morbidity and mortality in skin cancer patients

Pathology

This is interruption/interference w/normal processes/efforts of the body to be healthy

Functional limitation

This is limitation in performance of the whole person

Anasthesia

This is loss of sensation (partial or full)

Primary Care

This is provision of integrated accessible health services by clinicians who are accountable for addressing large majority of health needs, developing partnership w/patients and practicing in context of family/community

Spasticity

This is seen in UMN lesions and is a form of hypertonicity that offers increased resistance to stretch involving primarily flexors in UE and extensors in LE and may be associated w/muscle weakness

Neutral zero method

This is the 0 to 180 degree system of notation widely used throughout the world

Sarcomere

This is the basic unit of muscle fiber

Lateral rotation, abduction, medial rotation

This is the capsular pattern for the Glenohumeral joint

Flexion, abduction, medial rotation

This is the capsular pattern for the hip

Flexion, extension, supination, pronation

This is the capsular pattern for the radiohumeral joint

Full abduction, lateral rotation

This is the close packed position for the Glenohumeral joint

Extension, medial rotation, abduction

This is the close packed position for the hip

Elbow flexed 90, forearm supinated 5

This is the close packed position for the radiohumeral joint

90 degree abduction

This is the close packed position of the AC joint

Full elevation/protraction

This is the close packed position of the SC joint

Disablement

This is the consequence of disease

Reliability

This is the consistency btwn successive measurements of the same variable, on the same subject, under the same conditions

Validity

This is the degree to which an instrument measures what is purpoted to measure

Validity

This is the degree to which an instrument measures what it is purpoted to measure; the extent to which it fulfills it's purpose

Introduction/explanation

This is the first step of measuring joint motion

Confirmation of understanding

This is the last step of measuring joint motion

Disability

This is the limitation in performance of socially defined roles/tasks

+/- 5 degrees

This is the margin of error in regards to variable reliability of measuring joints

Brachioradialis

This is the only muscle in the body that extends from the distal end of 1 bone to the distal end of another

40-55 abduction, 30 horiz adduction/scapular plane

This is the open packed position for the Glenohumeral joint

30 flexion, 30 abduction, slight lateral rotation

This is the open packed position for the hip

Full extension/supination

This is the open packed position for the radiohumeral joint

Arm at side

This is the open packed position of the AC or SC joint

Rehabilitation

This is the reverse of disablement and the goal of PT

Ed Pio

This is the type of documentation that PT is moving toward

MMT

This is the ultimate example of "hands on" care, is both an art and science, and few professions utilize it to the extent that PT's do

Dysesthesia

This is unpleasant/abnormal sensation

Gravity

This is used as the basis for applying resistance in MMT

Guide to PT practice

This is used to delineate tests/measures used in PT practice, interventions used in PT practice, and to show preferred practice patterns

Strength testing

This is used to determine the capability of muscles or muscle groups to function in movement and their ability to provide stability/support

Angle

This is what the word "Gonia" means

Measure

This is what the word Metron means

Malaise

This may be described as "I don't feel myself" or "I just don't feel good" and is considered a red flag

Depression

This may coexist with chronic musculoskeletal disorders (like LBP) and is associated w/poor health outcomes

Functional instability

This may mean either or both types of instability and implies inability to control either arthrokinematic or osteokinematic movement in available ROM either consciously or unconsciously

MMT

This may provide a basis for corrective surgery

End of care

This note type includes any future activity and authorization/appropriate designation of the PT

Visit encounter

This note type includes client self-reports, interventions/equipment provided, changes in client status related to plan of care, and adverse rxns to interventions

End of care

This note type includes effects of treatment and status of goals, and co-morbidities affecting goal treatment

0-180

In goniometry, angles typically have this range in degrees

L3-4

Knee extension generally occurs from this myotome

Soft

Knee flexion under normal circumstances would have this end feel

Last

When should you perform painful/provocative movements in the exam?

Anything less than 3/5

You should not apply resistance in MMT with a grade of this

ROM

Abnormal end feels and capsular patterns should be reported during documentation of this

Cervical sidebending/rotation

C2-3 myotomes are known to be responsible for these movements

Shoulder elevation

C3-4 myotomes are known to be responsible for these movements

Shoulder abduction, IR/ER, elbow flexion

C5 myotomes are known to be responsible for these movements

Elbow flexion, wrist extension, pronation

C6 myotomes are known to be responsible for these movements

Elbow extension, wrist flexion

C7 myotomes are known to be responsible for these movements

Finger/thumb extension/flexion

C8 myotomes are known to be responsible for these movements

Hand intrinsics, dorsal/ventral interossei

C8-T1 myotomes are known to be responsible for these movements

Center coordinator for clinical education

CCCE

Health care

Documentation is a dynamic process and always changing; formats are expected to change as this changes

Multiple

Does intertester refer to one or multiple testers?

Hip flexion

L1-2 (some L3) myotomes are known to be responsible for these movements

Hip adduction

L2-3 myotomes are known to be responsible for these movements

Knee extension

L3-4 myotomes are known to be responsible for these movements

Dorsiflexion

L4-5 myotomes are known to be responsible for these movements

Electrogoniometers

These are used primarily in research to obtain dynamic joint measurements

Joint/motion

ROM tends to decline w/age, but is generally specific to this (use age appropriate norms comparing ROM)

Tendons

These are white, fibrous bands that attach muscles to bones; have great tensile strength but practically inelastic and resistant to stretch

Subacute

These conditions are those that have been present for 10 days to 7 weeks

Chronic

These conditions are those that have been present for 7 weeks or longer

Acute

These conditions are those that have been present for 7-10 days

Scanning exam

You should use this when there is altered sensation in a limb or the patient presents with abnormal patterns

Objective

"pt instructed to continue to maintain R LE elevated while sitting at desk during day" would be found in this part of SOAP

Bridges between main MMT grades

+ or - MMT grades can serve as these

Spine

2 standardized outcome measures for this are the Oswestry disability and neck disability index

Firm

80% of the time a joint will have this end feel

AROM/PROM

A critical concept to understand with MMT is the relationship of these as it is a basic principle of PT pt exam

Capsular, muscular, ligamentous

A firm normal end feel can be one of these types of stretches

Pathology

A hip fracture, RCT, or MS would be considered a type of this

Hypo

A reflex grade of +1 would be regarded as this

Normal

A reflex grade of +2 would be regarded as this

Hyper

A reflex grade of +3 would be regarded as this

+3

A reflex grade of Hyper would have this #

+1

A reflex grade of Hypo would have this #

+2

A reflex grade of Normal would have this #

6mm

A warning sign of skin cancer is if the diameter of a suspect lesion is greater than this (pencil eraser tip)

Detail

Accuracy of MMT demands attention to this

Strength, coordination/control, willingness to move

AROM can tell you these characeteristics that PROM can't

25-50

After the 1st encounter, this % of physicians/patients disagreed about why patient came to see them

Anterior-posterior

All motions in the frontal plane take place around this axis (such as ab/adduction)

Medial-lateral

All motions of the sagittal plane take place around this axis

No activity

An MMT grade of 0 would be this

Trace

An MMT grade of 1 would be this

Poor

An MMT grade of 2 would be this

Fair

An MMT grade of 3 would be this

Good

An MMT grade of 4 would be this

Normal

An MMT grade of 5 would be this

Soft tissue edema/synovitis

An abnormal soft end feel may be caused by these

Complete range against gravity

At 3/5 MMT grade, pt has ability to move part thru this but can't hold against external resistance

Disablement

An example of this would be the effects on body functions, task performance, and life roles

Disability

An example of this would be the inability to care for children, inability to work as a plumber, or inability to play tennis

Functional limitation

An example of this would be the inability to walk >1 mile, inability to transfer in/out of bed independently

L4-5

Ankle dorsiflexion generally occurs from this myotome

L5-S1

Ankle inversion/eversion generally occur from this myotome

Sensory

Are the lateral/medial antebrachial cutaneous nerves sensory, motor, or both?

Joints

Arthrokinematics refers to the surfaces of these

Screening

As defined by the Guide to PT practice, this is determining the need for furthers exams or consultation by a PT or for referral to another health professional

0

At this MMT grade there is no palpable or visible contraction; no perception of movement

3

At this MMT grade, pt has ability to move part thru complete range against gravity but can't hold against external resistance

Bilateral

B

Inclinometers (bubble/electric), CROM/BROM

Besides goniometers, electrogoniometers, tape measures, and flexible rules, what are other instruments you can use to measure joint motion?

Head nodding/OA motion

C1-2 myotome is related to these movements

Cervical range of motion

CROM

Yes

Can goniometric data provide a basis for establishing/aiding in diagnosis?

Arthritis/gout

Capsular pattern conditions w/considerable joint effusion or synovial inflammation may include these

Low grade/resolution of acute capsular inflammation, joint immobilization

Capsular pattern conditions w/relative capsular fibrosis (increase collagen formation) may include these

Particular/proportional

Capsular pattern is a pathological condition involving entire joint capsule resulting in this pattern of limitation involving all/most passive motions of joint

Frozen shoulder

Capsular, muscular, ligamentous, and fascial shortening may otherwise be known as this

C2-3

Cervical sidebending/rotation generally occur from this myotome

Nailbeds

Check pt capillary refill by pressing on these

Capillary refill

Check pt this by pressing on nailbeds

Hard

Chondromalacia, osteoarthritis, loose joint bodies, or myositis ossificans may have this abnormal end feel

Hard

Chondromalacia, osteoarthritis, or fracture may have this abnormal end feel

Capsular pattern

Conditions w/considerable joint effusion or synovial inflammation may be considered a type of this

Capsular pattern

Conditions w/relative capsular fibrosis (increase collagen formation) may be considered a type of this

Physical/psychological

Depression is associated with increased disability of these types

UE

DASH is a standardized outcome measure for this area of the body

Doctor of osteopathy

DO

Deep tendon reflex

DTR

LMN

DTR evaluates pathways of these

Unemployment

Depression is associated with increased likelihood of this

Either

Do abnormal end feels occur sooner or later than normally expected?

Rotation in transverse plane

Each joint has a zero/starting point; recall anatomical position is a reference starting point except for this

Neuropathic

Each specific tissue pain is sometimes grouped as this pain and follows specific anatomical pathways and affect specific anatomical structures

Ulnar olecranon process and humeral olecranon fossa

Elbow extension has a hard end feel due to contact btwn these

Hard

Elbow extension should normally have this end feel

C6

Elbow flexion, wrist extension, and pronation generally occur from this myotome

Hard

Elbow hyperextension should have an end feel of bone to bone or otherwise this

Functional Outcome Reporting

FOR

Outcome measures

Every initial eval should formulate a baseline for this

Baseline

Every initial eval should formulate this for outcome measures

Subjective/Objective

Examination relates to these parts of SOAP notes

Foot/ankle abilities measure

FAAM

Ankle

FAAM is a standardized outcome measure for this area of the body

Gravity/weight of limb

In MMT, with anything less than 3/5 grade do not apply resistance but instead this is the resistance

Palmar RU lig of inferior RU joint, interosseous membrance,

Forearm supination has ligament stretch w/firm end feel due to tension in this

Ligament

Forearm supination should normally have a firm end feel due to the stretch of this

Firm

Forearm supination should normally have this end feel

Exacerbation

General principles of examination include doing sub-maximal to maximal (ramp up, ramp down) and inform pt of possible this from exam

Joint dysfunction

Goniometric data provides a basis for the presence/absence of this

Sliding filament

Good MMT technique can be related to a good working knowledge of this theory

Results/establish functional diagnosis

Good MMT technique demands good working knowledge of being able to assess this

Opposite side

Good MMT technique demands good working knowledge of being able to compare muscles with this

Atrophied contour

Good MMT technique demands good working knowledge of being able to distinguish normal from this

Grade

Good MMT technique demands good working knowledge of being able to do "this" in regards to resistance

Position or movement/substitutions

Good MMT technique demands good working knowledge of being able to recognize abnormal this

Pull

Good MMT technique demands good working knowledge of muscle length/tension relathionships, normal muscle strength/wide spectrum of normal, joint ROM/joint limitations, and muscle line of this

Palpate

Good MMT technique means you should be able to do this muscle and/or tendon and detect activity (contraction and relaxed)

Detect activity

Good MMT technique means you should be able to palpate muscle and/or tendon and do this (both contraction and relaxed)

L5

Great toe extension, hip abduction, and medial hamstrings activation generally occur from this myotome

Home exercise program

HEP

C8-T1

Hand intrinsics (ventral/dorsal interossei) generally occur from this myotome

L4-5

Having someone walk up on their heels during a clearing exam (dorsiflexion) would incorporate these myotomes

S1-2

Having someone walk up on their toes during a clearing exam (plantarflexion) would incorporate these myotomes

C1-2

Head nodding/OA motion myotome is related to these nerve roots

L2-3

Hip adduction generally occurs from this myotome

Muscle

Hip flexion w/knee extended should normally have a firm end feel due to the stretch of this

Firm

Hip flexion w/knee extended should normally have this end feel

<2%

How many patients continue providing history once they are interrupted?

Once unless new issue arises

How many times do you need to write an initial examination note?

Every 30 days

How often are Reassessment notes required in KY?

Every visit

How often are visit encounter notes required?

HE greater than 90

Hypermobility in the MCP joints can be measured as this

HE greater than 10

Hypermobility in the elbow can be measured as this

HE greater than 10

Hypermobility in the knee can be measured as this

Apposition to forearm

Hypermobility in the thumb can be measured as this

Flexion w/knees extended, palms on floor

Hypermobility in the trunk can be measured as this

Diagnosis

ICD codes are for this (used to be ICD-9 but now ICD-10)

International classification of fxning/disability/health

ICF

Insulin dependent diabetes mellitus

IDDM

1

If a muscle movement is strong but painful then there may be a minor lesion with this grade

2

If a muscle movement is weak and painful then there may be a moderate to severe lesion with this grade

Neural loss/avulsion

If a muscle movement is weak but painfree then you may assume this

C5 or Axillary nerve

If a pt reports paresthesia along lateral aspect of arm, what are the 2 possible sources of the problem?

Secondary hyperalgesia

If injury does not follow a normal healing pathway and becomes chronic, central sensitization (aka this) may occur

Central sensitization

If injury does not follow a normal healing pathway and becomes chronic, this (aka secondary hyperalgesia) may occur

Distally

If symptoms are peripheralizing, then they are moving in this direction

Radiography

In criterion-related validity, this is the gold standard

AROM

In general, should AROM or PROM be performed first?

Centralization of symptoms

If the area of pain becomes smaller or more localized as it improves it is called this

Peripheralization of symptoms

If the area of pain enlarges or becomes more distal as the lesion worsens it is called this

Periodic/occasional

If this pain is present, examiner should try to determine the activity, position, or posture that irritates or brings on symptoms as this may help determine what tissues are at fault; more likely to be mechanical and related to movement/stress

Firm

If you gently apply overpressure to MCP extension it should have this end feel under normal circumstances

Firm

If you gently apply overpressure to ankle dorsiflexion it should have this end feel under normal circumstances

Hard

If you gently apply overpressure to elbow extension it should have this end feel under normal circumstances

Soft

If you gently apply overpressure to elbow flexion it should have this end feel under normal circumstances

22 mins

In 1989, the average time spent in an MD office was 16 minutes; what was it in 2009?

Gravity lessened positioning

In MMT, with anything less than 3/5 grade do not apply resistance but instead gravity/weight of limb is the resistance; this is now key

UMN

In regards to LMN vs. UMN, this would be related to spastic weakness, absent/reduced superficial reflexes, increased pathological reflexes, and extensor plantar responses

Both

In regards to MMT, is it better to know nerve root or peripheral nerve innervations of each muscle?

Gravity

In regards to MMT, this is almost always a factor except when it comes to movement of fingers and toes

Functional activities

In regards to MMT, you should observe pt in these before "formal exam" starts

LMN

In regards to UMN vs. LMN lesions, flaccid weakness, muscle atrophy, and fasiculations/fibrillations would be caused by this

UMN

In regards to UMN vs. LMN lesions, hypertonicity and hyperreflexia (DTRs) would be caused be this

LMN

In regards to UMN vs. LMN lesions, hypotonicity and hypoflexia would caused by this

ADL

In regards to documentation, focus on functional in the language; look at how the pt functioned previously in these: such as in work, school, play, community, and leisure

MOI

In regards to finding out if there is any inciting trauma (macrotrauma) or repetitive activity (microtrauma), this is finding out what this is or if there are any predisposing factors

Absent response

In regards to grading reflex responses, a 0 would be this

Goniometer, landmarks, test position, examiner/subject role

In regards to measuring joint motion, the first step is introduction/explanation followed by explanation/demonstration of these (in order) and lastly confirmation of subject's understanding

Patient perceptions

In regards to outcome measures, new emphasis is now being placed on this

Every 30 days

In regards to re-exam, re-eval or progress notes, how often do these need to be written in KY?

Objective

In regards to signs vs. symptoms, signs are more this

Subjective

In regards to signs vs. symptoms, symptoms are more this

Signs

In regards to signs vs. symptoms, these are more objective

Symptoms

In regards to signs vs. symptoms, these are more subjective

Suspect lesions

In regards to skin cancer, PTs have the opportunity to observe exposed body areas (especially dorsal surface) and can aid in detection of these

Substitution patterns

In regards to substitution/stabilization, you need to recognize common these

Goniometer

In regards to what to record in joint motion, you need to document the type of this used

Acute on chronic

In these cases, injured tissues usually have been reinjured

Hard

In this abnormal end feel, bony grating may be felt

Empty

In this abnormal end feel, the pt's protective muscle splinting/spasm is felt

Fusiform

In this muscle structure, fibers are arranged essentially parallel to line from origin to insertions, and fasciculi terminate at both ends of muscle in flat tendons

Pennate

In this muscle structure, fibers are inserted obliquely into tendon(s) that extend length of muscle on one side or thru belly of muscle

Criterion-related

In this type of validity, radiography is the gold standard

Firm

Increased muscle tone, or capsular/muscular/ligamentous/fascial shortening may have this abnormal end feel

Great toe extension, hip abduction, medial hamstrings

L5 myotomes are known to be responsible for these movements

Ankle inversion/eversion

L5-S1 myotomes are known to be responsible for these movements

Intratester

Is an intratester or intertester exam more reliable?

Symptom

Is instability a sign or symptom?

Sign

Is laxity a sign or symptom?

Symptom

Is pain a sign or symptom?

Sign

Is palpation tenderness a sign or symptom?

UMN

Is spasticity having to do with UMN or LMN lesions?

Knee

LEFS is a standardized outcome measure for this area of the body

70-90

It is estimated this % of all patient diagnoses can be made on patient history

Involuntary

It is important to treat this type of motion (such as rotation of MCP joints) in order to help treat dysfunction

Reliability

Joint (simple vs. complex), motion, technique would all be related to validity or reliability?

Non-capsular

Joint derangement, adhesions, contractures would all be considered this type of pattern

Hypermobility

Laxity of soft tissue (ligs, capsules, muscles) may lead to this

Hard

Loose bodies/bony block or myositis ossificans may have this abnormal end feel

L spine, pelvis, LE

Lower quarter scans involve these areas

Capsule

MCP extension should normally have a firm end feel due to the stretch of this

Firm

MCP extension should normally have this end feel

Activities patient may return to

MMT may assist PT in determining discharge criteria for pt's and determining this

Establish/measure rehab goals

MMT may assist PT in establishing a baseline from which to do this

Differential

MMT may assist in establishing this type of diagnosis

Patient's neuromuscular status, progress, prognosis

MMT may provide a record of this

Treatment of M-S/N-M problems

MMT may provide an adequate data base from which to plan this

Voluntary

MMT only assesses this type of strength

5 seconds

MMT should last about this long for each test

UMN

MMT should not be used in pt's with these type of lesions

High

MMT should not be used in pt's with this type of tone

Neuromuscular

Many conditions of this type are characterized by muscle weakness

Fasciculi

Muscle fibers are arranged in bundles called this

Bony/soft tissue

Musculoskeletal Preferred Practice Patterns include: skeletal demineralization, posture, muscle performance, CT dysfunction, Localized inflammation, Spinal disorders, Fracture, Joint arthroplasty, these type surgeries, Amputation

Joint

Musculoskeletal Preferred Practice Patterns include: skeletal demineralization, posture, muscle performance, CT dysfunction, Localized inflammation, Spinal disorders, Fracture, this arthroplasty, Bony/soft tissue surgery, Amputation

CT

Musculoskeletal Preferred Practice Patterns include: skeletal demineralization, posture, muscle performance, this dysfunction, Localized inflammation, Spinal disorders, Fracture, Joint arthroplasty, Bony/soft tissue surgery, Amputation

Demineralization

Musculoskeletal Preferred Practice Patterns include: skeletal this, posture, muscle performance, CT dysfunction, Localized inflammation, Spinal disorders, Fracture, Joint arthroplasty, Bony/soft tissue surgery, Amputation

Countries/health disciplines/services/time

One aim of the ICF is to permit comparison of data across these

Comparison of data

One aim of the ICF is to permit this across countries, health care disciplines, services, and time

Scientific basis

One aim of the ICF is to provide this for consequences of health conditions

Systematic coding scheme

One aim of the ICF is to provide this from health information systems

ICF

One aim of this is to provide a systematic coding scheme for health information systems - international comparisons of epidemiological and other data has suffered from a lack of uniform systems

ICF

One aim of this is to stimulate better care and services to improve the participation in society of people with disablements - this is central to improving quality of life and facilitating the autonomy of persons with disablements

ICF

One aim of this is to stimulate research on the consequences of health conditions - this will facilitate the development of more effective interventions

Repeat movements, sustain postures/positions

One general principle of examination is to do this if history indicates

Economic burden of disablement

One goal of the the Guide to PT practice is to delineate preferred practice patterns that will help PTs diminish this thru prevention, health promotion, wellness, and fitness initiatives

Eccentric

One limitation of MMT is that it does not address the ability to have this type of muscle contraction

Repeated contractions

One limitation of MMT is that it does not address the ability to perform these

Dynamic

One limitation of MMT is that it does not address these capabilities of pt's muscle

Muscle contraction

One limitation to MMT is that it does not address rate of this

Different parts of range

One limitation to MMT is that it does not address the ability to contract at these

Kind of person w/disease

Osler stated it is more important to know this than the sort of disease a person has

Problem Oriented Medical Record

POMR

Progressive resistance training

PRE

Pt reported outcome

PRO measure

Joint capsule, ligaments, muscles, fascia, skin

PROM can tell you about the extensibility of these

Pt specific fxnal scale

PSFS

Visual inspection, bony landmark palpations, accurate alignment of goniometer

PT's judge the validity/content of most ROM measurements based on anatomical knowledge and applied skills of these

Anatomical knowledge

PT's judge the validity/content of most ROM measurements based on this and applied skills of visual inspection, bony landmark palpations, and accurate alignment of the goniometer

Validity/content

PT's judge this of most ROM measurements based on anatomical knowledge and applied skills of visual inspection, bony landmark palpations, and accurate alignment of the goniometer

Mid range/resting

Perform MMT in this position

S1-2

Plantarflexion and lateral hamstrings activation generally occur from this myotome

Perpendicular

Resistance in MMT is usually applied in this manner to lever arm to which muscle attaches, in direction opposite to muscle line of pull

Opposite

Resistance in MMT is usually applied perpendicular to lever arm to which muscle attaches, in direction this way to muscle line of pull

Visit/encounter notes

These are the 4 primary note types: 1. Initial exam 2. ??? 3. Re-exam/Re-eval/Progress note 4. Discharge/Discontinuation summary

Joints/motions to test

Prior to beginning a goniometric eval, determine this, organize test sequence by body position, gather equipment, and prepare explanation of procedure to client

Explanation of procedure to client

Prior to beginning a goniometric eval, determine which joints/motions to test, organize test sequence by body position, gather equipment, and prepare this

Test sequence by body position

Prior to beginning a goniometric eval, determine which joints/motions to test, organize this, gather equipment, and prepare explanation of procedure to client

As often as necessary

Prn

Sequential method

Regardless of which system is selected for assessment, the examiner should establish this to ensure that nothing is overlooked

Reliability

Repeated measures (mean) and using the same amount of force each time (AROM or PROM) are ways to increase this

Distal

Resistance in MMT is usually applied at this end of segment to which muscle attaches, usually crossing only one joint (exceptions: hip abductors, scapular muscles, trunk muscles, pain, etc.)

>15 years

Risk factors for melanoma skin cancer include this age

Redness

Risk factors for nonmelanoma skin cancer include prolonged this after sun exposure

Tan

Risk factors for nonmelanoma skin cancer include the inability to do this

Older

Risk factors for nonmelanoma skin cancer include this age range

Male

Risk factors for nonmelanoma skin cancer include this gender

Melanoma

Risk factors for this skin cancer include changing moles or having many moles

Melanoma

Risk factors for this skin cancer include medical conditions of chronic osteomyelitis, burn scars, skin ulcers, xeroderma pigmentosum, and HPV infection

Melanoma

Risk factors for this skin cancer include personal/family history, sun sensitivity, excessive sun exposure, and living near equator

Prescription/treatment

Rx

Plantarflexion, lateral hamstrings

S1 (and some S2) myotomes are known to be responsible for these movements

Short arc quads

SAC

Slide board

SB

Re-exam/Re-eval/Progress note

These are the 4 primary note types: 1. Initial exam 2. Visit/encounter notes 3. ??? 4. Discharge/Discontinuation summary

Specific dermatome/peripheral nerve distribution

Sensory disturbances (-sthesia's) can be along these

Discharge/Discontinuation summary

These are the 4 primary note types: 1. Initial exam 2. Visit/encounter notes 3. Re-exam/Re-eval/Progress note 4. ???

Narrative, POMR, SOAP, FOR

These are the 4 types of documentation

Common substitution patterns

Shoulder ER for limited supination and lateral trunk flexion for limited hip rotation are examples of these

C5

Shoulder abduction, IR, ER, and elbow flexion generally occur from this myotome

C3-4

Shoulder elevation generally occurs from this myotome

MMT

Sister Kenney, Catherine Worthingtham, Jacquelin Perry, Marian Williams, Helen Hislop, and the Kendalls are all early PT pioneers in this

1/5

Skin cancer affects this many Americans at some point in their life

Soft

Soft tissue edema or synovitis may have this abnormal end feel

Reliability

Specific positioning, proper stabilization, and proper use of anatomical landmarks are ways to increase this

Soft, Firm, Hard, Springy block, Empty

These are the abnormal/pathological types of end feels

Roll, spin, slide

These are the basic movements of arthrokinematics of joints

ROM

Technique, position, experience, and time of day are all factors that may affect this along with weight/body type/BMI and gender

Pain at ROM extremes especially horiz adduction/full elevation

These are the capsular patterns of the AC and SC joints

Body function/structure

The ICF model replaces "impairment" with this

Activities

The ICF model replaces "limitation" with this

Participation

The ICF model replaces "restrictions" with this

Children's Hospital

The Kendalls were renowned for their MMT work in Baltimore at this hospital; they created the 1st edition of "The Bible of MMT" as it is known in 1949

Content validity

The accurate application of knowledge and skills, combined w/interpreting results as measurement of ROM only, provide sufficient evidence to ensure this

0-9

The beighton hypermobility score ranks hypermobility on this scale

C6

The biceps brachii, pronator teres, and brachioradialis all come from this nerve root but have different peripheral nerve innervations

Musculocutaneous

The biceps, brachialis, and coricobrachialis are innervated by this nerve at the C6 myotome

C6

The brachialis, coricobrachialis, brachioradialis, supinator, teres major, subscapularis, and serratus anterior are all innervated from this myotome

Radial

The brachioradialis and supinator are innervated by this nerve at the C6 myotome

Axillary

The deltoids and teres minor are innervated by this nerve at the C5 myotome

C5

The deltoids, infraspinatus, and rhomboids all come from this nerve root but have different peripheral nerve innervations

Impairment/fxnal limitation/disability

The disablement model is interested in progression and interrelationship of these

Trigger points

These are localized areas of hyperirritability within the tissues tender to compression, often accompanied by tight bands of tissue and if sufficiently hypersensitive may give rise to referred pain that is steady, deep, and aching

Examination/Evaluation/Diagnosis/Prognosis/Intervention/Outcomes

These are the elements of PT practice

L5

The fibularis longus, extensor hallucis longus, and semitendinosus all come from this nerve root but have different peripheral nerve innervations

S1

The gastrocnemius is generally activated from this primary nerve root

Obturator

The gracilis is innervated by this nerve at the L2 myotome

Femoral

The iliacus, sartorius, and pectineus are innervated by this nerve at the L2 myotome

L2

The iliacus, sartorius, pectineus, and gracilis are all innervated from this myotome

Passive insufficiency

The inability of a muscle to lengthen and allow full ROM at all of the joints the muscle crosses is termed this

S1-2

The lateral hamstrings reflex & Achilles reflex are innervated at this level

Aponeuroses

These are sheets of dense CT and are glistening white in color; they furnish broad origins for the latissimus dorsi

L5

The medial hamstrings are generally activated from this primary nerve root

L5-S1

The medial hamstrings reflex is innervated at this level

L3-4

The patellar reflex is innervated at this level

Red flags

These are signs/symptoms that indicate need for medical consultation/referral to physician (such as severe unremitting pain, pain unaffected by meds/position, or severe night pain)

Soft, Firm, Hard

These are the normal/physiological types of end feels

MMT

The philosophy of this is "break testing" or "don't let me move you"

PT performing intervention

The position of the APTA is that PT examination, evaluation, diagnosis, and prognosis shall be documented, dated, and authenticated by who?

L1-2

The psoas major/minor are both innervated from these myotomes

L4

The quadriceps are generally activated from this primary nerve root

History of present illness/chief complaint

The reason the pt has come for help is often referred to as this

Dorsal scapular

The rhomboids are innervated by this nerve at the C5 myotome

C5

The rhomboids, supraspinatus, infraspinatus, deltoids, and teres minor are all innervated from this myotome

Fibrocartilaginous membranes

The sacroiliac joint and symphysis pubis are considered to be slightly moveable and are held together by strong these

Long thoracic

The serratus anterior is innervated by this nerve at the C6 myotome

Initial exam

These are the 4 primary note types: 1. ??? 2. Visit/encounter notes 3. Re-exam/Re-eval/Progress note 4. Discharge/Discontinuation summary

Subscapular

The subscapularis is innervated by this nerve at the C6 myotome

Suprascapular

The supraspinatus and infraspinatus are innervated by this nerve at the C5 myotome

Lower subscapular

The teres major is innervated by this nerve at the C6 myotome

L5

The tibialis posterior is generally activated from this primary nerve root

Achilles/lateral hams

These DTR is innervated at the S1-2 level

Musculoskeletal

These Preferred Practice Patterns include: skeletal demineralization, posture, muscle performance, CT dysfunction, Localized inflammation, Spinal disorders, Fracture, Joint arthroplasty, Bony/soft tissue surgery, Amputation

Examination, Evaluation, Diagnosis, Prognosis, Intervention, Outcomes

These are all the elements of Ed Pio (Patient/Client Mgmt Model)

Yellow flags

These are findings in pt history that indicate more extensive exam may be required (like abnormal signs/symptoms, bilateral symptoms, peripheralizing symptoms, neurological symptoms)

0-180 degree notation

This system is most common when documenting goniometric measures

360 degree notation

This system of notation also defines anatomical position as 180 degrees but the motions of flexion/abduction begin at 180 and proceed in an arc toward 0; motions of extension/adduction begin at 180 and proceed in an arc toward 360

180 to 0 degree notation

This system of notation defines anatomical position as 180 degrees; ROM begins at 180 degrees and proceeds in an arc towards 0 degrees

PROM

This type of ROM can tell you about the extensibility of joint capsule, ligaments, muscles, fascia, and skin

PROM

This type of ROM can tell you about the integrity of joint surfaces

Empty

This type of abnormal end feel may be caused by acute joint inflammation, bursitis, abscess, fracture, or psychogenic disorder

Soft

This type of abnormal end feel may be described as "boggy"

Firm

This type of abnormal end feel may be marked by increased muscle tone or capsular/muscular/ligamentous/fascial shortening

Soft

This type of abnormal end feel may feel boggy

Rheumatic

This type of disease destroys the synovial lining of moveable joints and may lead to hypermobility

Coordination/Communication/Documentation

This type of intervention involves patient care conferences, records review, and discharge planning

Direct

This type of intervention involves therapeutic exercise, manual therapy, debridement, and wound care

Adjunct

This type of intervention may involve physical agents and electromodalities

People first

This type of language does not identify disability as predominant characteristic

People first

This type of language used disability as the secondary attribute

Clinician based

This type of outcome measure includes joint ROM, strength, alignment, stability

Clinician based

This type of outcome measure is considered "objective," inferring functional ability

Gravity lessen

To do this with MMT is to minimize the effect of gravity either thru PROM or changing angle of movement to lessen gravity's effects; you never "eliminate" gravity!

Hypermobility

Trauma or hereditary/CT disorders (such as Ehlers-Danlos syndrome, Marfan syndrome, rheumatic diseases, osteogenesis imperfecta, and Down Syndrome) may lead to this

Head, neck, UE

Upper quarter scans involve these areas

Radicular, spinal cord/long track

Use the scanning exam when there are these types of signs or trauma with these types of signs

Trauma

Use the scanning exam when there is no history of this

Psychogenic

Use the scanning exam when there is suspected this type of pain

Impairments

Weak glute muscles, decreased hip ROM would be considered types of these

Examination, Evaluation, Diagnosis, Prognosis, Intervention

What parts of Ed Pio are included to the initial examination?

Babinski

What reflex test does this illustrate?

Hoffman

What reflex test does this illustrate?

Oppenheim

What reflex test does this illustrate?

Break

When applying resistance in MMT, begin to GRADUALLY remove resistance when pt begins to do "this"

Muscle belly

When applying resistance in MMT, do NOT apply over this or if it causes pain

Max tolerable intensity

When applying resistance in MMT, use Graded resistance - even, not jerky: "bell curve" of resistance, give pt time to meet resistance, allow pt to build to this

Graded

When applying resistance in MMT, use this type of resistance - even, not jerky: "bell curve" of resistance, give pt time to meet resistance, allow pt to build to max tolerable intensity

4-5 secs

When applying resistance/force in MMT you generally will apply it for this amount of time

Uninvolved/normal

When examining the body, should you test the involved/affected or uninvolved/normal side first?

0-3

When grading reflexes, they range from these numerical values

Bilaterally

When grading reflexes, you should always compare in this manner

Both

When it comes to gross strength testing/screening vs detailed MMT, which has value?

Deviation or use of alternative position

When recording joint motion, it is important to also record description of this

Spasm/crepitus

When recording joint motion, it is important to also record objective information such as this

Pain/discomfort

When recording joint motion, it is important to also record subjective information such as this

Evolving

When screening for skin cancer, the ABCDE checklist may be used with this being E

Primary hyperalgesia

When tissue has been damaged, substances are released leading to inflammation and peripheral sensitization of the nociceptors (aka this) resulting in localized pain

Peripheral sensitization

When tissue has been damaged, substances are released leading to inflammation and this of the nociceptors (aka primary hyperalgesia) resulting in localized pain

Visible movement of part

With 1/5 MMT grade, thru palpation/observation, palpable contraction is felt or tendon is prominent, but no this

Palpable contraction

With 1/5 MMT grade, thru palpation/observation, this is felt or tendon is prominent, but no visible movement of part

Gravity lessened

With 2/5 MMT grade, there is the ability to move part thru range with this

Against gravity plus moderate resistance

With 4/5 MMT grade, same as 3/5 but holds this without breaking

Against gravity plus maximal resistance

With 5/5 MMT grade, same as 3/5 but holds this

Strength deficiencies

With MMT, use range/strength grades for cases when ROM is limited due to joint, not these

ROM is limited due to joint

With MMT, use range/strength grades for cases with this, not strength deficiencies

Anything >3/5

With MMT, you can apply resistance at these grades

SFTR

Writing a goniometric measure as 10-0-135 would be incorporating this method

D

You assess a pt's UE DTRs as part of a screening exam; the most appropriate location to elicit the brachioradialis reflex is: A) radial tuberosity, B) antecubital fossa, C) biceps tendon, D) styloid process of radius

C

You attempt to assess the integrity of the L4 spinal level; what DTR would provide the most useful info? A) lateral hamstrings reflex, B) medial hamstrings reflex, C) patellar reflex, D) Achilles reflex

C

You determine that a pt has 0-135 degs of passive knee flex & 0-120 degs of active knee flex; the most appropriate form of testing to help clarify the difference in ROM values is: A) passive joint motion testing, B) special tests isolating flexibility, C) MMTs, D) diagnostic imaging

Joint end feel

You should apply overpressure with care to test this