PTH220 posture and Final
kyphosis causes
Compression fracture of thoracic vertebra. Weak thoracic extensors & stretched posterior ligaments. Tight anterior longitudinal ligament & anterior chest muscles. Habit/lifestyle.
Reliability is the extent to which a particular assessment tool accurately measures what it is supposed to measure.
False
Stance phase comprises 8% of the gait cycle
False
T/F Axis for measuring wrist joint ulnar deviation should be the pisiform
False
T/F Maintaining good posture minimizes stresses and strains to your joints, tendons & ligaments from prolonged gravity pulling your body ....
False
Which of the following occur normally during mid stance?
Gastroc and soleus muscles working eccentrically to control excessive forward movement of the tibia on a flat foot
Single support occurs at toe off and heel strike of opposite legs
False (Foot flat to Toe Off or Acceleration to Deceleration)
T/F When trying to measure to determine if a patient has genu valgus, a PTA should recognize that the Q angle is the measurement needed, and the most accurate method to measure this would be placing the axis of the goniometer in line with the lateral epicondyle of the knee to be assessed, the moving arm along the lateral midline of the fibula in line with the lateral malleoli and the stationary arm along the lateral midline of the femur in line with the greater trochanter
False. (This is the alignment for knee ROM, not Q angle which is axis mid patella, stationary arm mid anterior femur and distal arm to tibia tuberosity)
All of the following would characterize an antalgic or "sore foot gait" except:
a prolonged stance phase on the involved limb
Lifestyle, tight cervical extensors, elongated flexors.
forward head
Non-structural scoliosis, slouching posture in one who sits for prolonged periods are examples of what common postural deviation
functional
What muscle is responsible for controlling the ankle as it moves from plantar flexion in foot flat to dorsiflexion in mid stance
gastrocsoleus contracting eccentrically
Abducted (protracted) scapula tx
Postural re-education, posture straps. Weight lifters train retractors to balance pec workouts. Stretch tight pec majors & serratus. Strengthen middle trapezius & Rhomboids.
kyphosis tx
Strengthen back extensors. Braces/splints to thoracic spine.
Cubital Valgus: tx
Strengthen wrist & finger flexors & pronators. Stretch wrist & finger extensors & supinator. Tape/splint elbow until healed if traumatic onset
Shoulder Laterally Rotated tx
Stretch tight ER strengthen weak IR. Screen for thoracic outlet syndrome.
Cubital Varus tx
Stretch wrist & finger flexors & pronators. Strengthen wrist & finger extensors & supinator. Tape/splint elbow until healed
Common Postural Deviations
Structural Functional Neurological Forward head/head off Rounded shoulders/tilted shoulder girdle Flexed trunk/stooped Genu varus/valgus Pes palnus/cavus (low arch/ high arch claw foot Bunions
The function of the hip extensors and hamstrings at terminal swing includes all of the following EXCEPT:
To flex the knee for shock absorption during stance phase
MMT reliability studies indicate that 90% of the time, MMT is considered a reliable strength assessment tool within one full MMT grade +/-
True
Muscles that cross more than one joint are generally more efficient than those that span only one joint.
True
Patient assessment results are the basis of all therapy treatments.
True
Patient's with plantar flexion contracture of 10-50 degrees will have difficulty with all phases of gait except initial swing
True
Physiologically, muscles are capable of generating their greatest tension during an eccentric contraction, less when contracting isometrically and the least when contracting concentrically.
True
ITWY's strengthens
middle, lower traps and rhomboids, anything that does retraction
Those with facet joint pathology, a flexed position may be better tolerated since this position will decrease stress placed on the posterior structures. why ?
more space for those nerves to come out
Patients with poor balance lack _______, which is defined as the ability to maintain all forces acting on the body to keep the center of gravity within the base of support.
postural equilibrium
scoliosis and kyphosis secondary to compression fracture are examples of what common postural deviation
structural
forward shoulders causes
Tight pec major & minor & serratus. Weak mid & lower trap & rhomboids.
causes of elevated scapula
Tight upper trapezius & scalenes on high side. Carrying heavy object on one side.
cervical rotation causes
"Torticollus" or birth defect. Habit. Spasm of SCM. Facet joint lock.
PROM for your patient's entire (R) arm is WNL. In the sitting position with your patient's arm supported entirely on the table, the patient is only able to actively extend her (R) elbow 150-45 degrees. What muscle are you testing and what would be the most accurate MMT grade to record?
(R) triceps brachii 2-/5. Patient needs AAROM exercise program to improve elbow strength
When analyzing a patient's posture from a lateral view all of the following bony landmarks should line up together along the line of gravity or "plumb line."
-through the earlobe -through the acromion -Through the bodies of the lumbar vertebra -slightly posterior to the hip joint through the greater trochanter -slightly anterior to the knee joint -slightly anterior to the lateral malleolus
Cervical Flexion
0 inches from start to end of motion 0-45
Which of the following would be the most accurate MMT grade to assign to a muscle that cannot move through any ROM cannot produce a muscle contraction, nothing felt on palpation nor visual inspection
0/5
If an MMT is repeated by several PT/PTA's and the same grades are obtained, then the MMT is said to be reliable. What is generally accepted as inter tester reliability?
1/2 grade
What position is the ankle in at mid-stance
10 degrees dorsiflexion
Spinal extension
2 inches from start to end of motion 0-20/30
In inches, what is the normal base of support during walking?
2-4
Spinal Flexion
4 inches from start to end of motion 0-80
Cervical sidebending
5 inches from start to end of motion 0-45
Cervical roation
5 inches from start to end of motion 0-45 up to 75
An efficient Gross Muscle Test of the entire body by a skilled clinician to determine areas of functional weakness should only take ____ minutes to perform
5 minutes
Cervical extension/hyper extension
7-10 inches from start to end of motion 0-45
Which of the following pathologies would be MOST likely to cause instability in stance and be considered a safety risk for ambulation?
Acutely torn lateral ligament of the ankle.
The grading systems used by PT'PTA's to assess muscle strength is based on the following four factors:
Amount of resistance given manually ability of the muscle to move a part through complete test ROM is a measure of muscle strength evidence of the presence or absence of palpable muscle contraction is critical to strength evaluations Grades are obtained based on the effects of gravity (parallel or w/ gravity= minimized) against gravity = AG
Which of the following represents the most normal ankle/foot goniometric measurement?
Ankle eversion 0-15
Patient has a +1 biceps reflex but lacks sensation along the lateral shoulder, down the radial forearm down into the thumb and index finger. Which of the following statements is most true?
Appears to have LMNL, with irritation along the C5-C6 nerve root
Patient has a +3 patella reflex, + plantar reflex and is very hypersensitive to pain, light touch, graphesthesia along the knee and medial aspect of distal leg. Which of the following would be most accurate to document in the patient's SOAP note?
Appears to have UMNL, with irritation along the L5-S1 nerve root (hyper is UMNL)
Your supervising therapist has asked you to administer either the Berg or the POMA (Tinetti) test on your patient and document results. You should recognize that these are assessments of your patient's _______. Components of these tests are _____.
Balance. Components are having the patient stand up, walk, reach, turn around, and sit down
Barrel Chest causes
Causes: increased overall AP diameter of rib cage indicative of respiratory difficulties with COPD. Tight scapula adductor, weak abdominals & internal intercostals
Causes: Excessive Cervical Lordosis:
Causes: Overhead jobs, long distance biking, tight capital extensors, weakened capital flexors. "WHIPLASH"
Pectus Excavatum (Funnel Chest) tx
Chest breathing. Anterior chest mobilization. Stretch pectoral & intercostals muscles. Strengthen thoracic extensors & posterior scapula muscles.
increased carrying angle of more than 10-15°
Cubital Valgus:
(Gunstock deformity inward angle of more than 10-15°)
Cubital Varus
Pectus Excavatum (Funnel Chest) causes
Depression of anterior thorax & sternum. Tight upper abdominals, shoulder adductors, pectoralis minor & intercostals muscles. Weak thoracic extensors & posterior scapula muscles.
List four primary reasons why a PT/PTA should perform patient assessments
Develop a database plan treatment evaluate results of treatment modify/terminate treatment
At normal walking speeds, during what phase of gait is weight bearing being transferred from the other leg onto the reference leg?
During foot flat
If your patient's elbow PROM is 5-0-75, all of the following would be true EXCEPT:
Elbow flexion is hyper mobile and the triceps brachia muscle needs to be strengthened
A muscle that has a Fair grade is one that has 20% muscle force. Patient is only able to move through full ROM, gravity minimized.
False
During heel strike or initial contact component of gait, the knee is at 0 degrees of extension, the ankle is at 20 degrees of dorsiflexion and the hip is at 30 degrees of flexion
False
During terminal stance or heel off the foot is plantar flexing concentrically to propel the limb into swing phase
False
Foot slap gait is most often caused by paralysis of the gastroc soleus muscle group
False
If a patient demonstrates weakness on a specific muscle test, then a therapist or assistant should follow up this test with a gross muscle test.
False
Your patient is 17 years old who just underwent major reconstructive surgery to the (L) knee to correct genu valgus and torn ACL. The patient was NWB for 6 weeks and has been cleared by the physician to begin WBAT. Initially had poor balance when attempting to walk w/o crutches. After a week of therapy, you are asked to document the status of this patient's balance. The patient is able to walk independently on level terrain, but tends to be unstable on stairs, ramps, and gravel without assistive devices requiring only verbal cues to shift weight onto the involved limb and to maintain upright posture. Which ion the following would be most appropriate to document in the patient's SOAP note?
Good ambulatory balance, SBA on uneven terrain
Which of the following PROM measurements has the most limited motion in the direction measured and would need stretching exercises to improve function?
HIP IR is 5-15
Lateral Head Tilt Causes:
Habit tight or spasmy scalenes.
Mrs. White has a plantar flexion contracture of her (R) ankle (10-60 degrees PF). You might expect to see all of the following gait deviations EXCEPT:
Hiking of the (L) hip during stance phase on the (R) leg
Gait analysis of Mr. Green's gait shows that he is spending 60% of the gait cycle in double support (double stance phase). This indicates:
His gait is slower than normal
Sitting with a decreased lumbar lordosis will increase pressure on the____and posterior structures.
IV disc
Your patient has normal PROM in her (R) hip, but sonly able to actively flex her right hip 0-100 degrees w/ her spine stabilized in the sitting position. What muscle are you testing and which grade would be most accurate?
Iliopsoas = 3-/5
During normal gait, at which phase of the gait cycle is the knee bent to its maximum amount? How many degrees?
Initial swing, 60 degrees
All of the following should be working in normal gait pattern for pre-swing (toe off)
Knee is moving from 60 degrees of flexion to 30 degrees of flexion
What characterizes a right positive Trendelenburg
Left pelvis drops when weight bearing on the right
Specific muscle palpation should be performed during ___ muscle strength assessments, but is NOT necessary when a PTA is performing a quick, symmetrical strength assessment as in _____.
MMT Gross muscle test
When explaining the effects of postural exercises, a PTA should be able to include all of the following potential benefits of good postural alignment education and training
Maintaining good posture when you sit, stand and move about actually requires less energy expenditure than trying to hold yourself upright in a faulty posture, thus you should feel fatigued by the end of the day Normal postural alignment allows you better flexibility and ease of movement thereby improving your balance and coordination.
Cubital Varus causes
Mal-union elbow fracture. Displaced capitulum. Stretched Radial collateral ligament. Weak wrist/finger extensors & supinator.
What phase follows foot flat during the stance phase?
Midstance
In which position is the contralateral limb if the right lower extremity is in mid stance?
Midswing
The gluteus medium on the reference limb contracts isometrically to keep the pelvis level during all of the following phases EXCEPT:
Midswing
What phase of gait has maximum knee flexion?
Midswing
adducted shoulder tx
Modalities to relax spasms. Manual therapy. Stretch middle trapezius & Rhomboid. Strengthen serratus, pectoralis major & minor.
What is the most logical reason why a person might exhibit a foot slap gait deviation?
Moderate weakness (3/5) in the tibias anterior
Your patient is able to maintain unsupported static and dynamic standing balance postural orientation with the eyes open. When the patient closes his eyes, 100% of the time he needs mod-max assist to prevent him from falling backwards and to the left. Which of the following is the most accurate regarding this patient?
Patient has a + Romberg sign.
What are the most common substitution movements a patient will make during measurement of hip medial rotation?
Pelvic hiking with ischial tuberosities off sitting surface, side bending contralateral, hip abduction
Treatments: Excessive Cervical Lordosis:
Postural re-education. Modalities to manage spasms. Chin tuck. Neck braces for damaged ligaments. Strengthen levator scapula & Rectus Capitus Anterior, longus capitus, SCM. Stretch Rectus Capitus Posterior, Upper Trap .
forward shoulders Treatments
Postural re-education. "Pinch & hold shoulder blades back". Strengthen scapula retractors. Stretch pec minor & major (doorway stretch) . Wand exercises prone (Kendall & Kendall).
Treatments: elevated scapula
Postural re-education. Carry objects symmetrically Stretch tight trap II & scalenes. Strengthen scapula depressors (lower trapezius)
Lateral Head Tilt Treatments:
Postural training, change in work station/lifestyle. Stretch scalenes on tilt side, strengthen opposite scalenes.
tx for forward head
Postural training, set up work station differently. Stretch upper trapezius & levator scapula. Strengthen cervical flexors.
winging scapula Treatments:
Postural training. Strengthen serratus anterior Prevent brachial plexus injury.
Treatments: Flat cervical curve (no lordosis in neck)
Postural training. Stretch longus colli, longus capitus & RCA. Strengthen neck extensors=cervical erector spinae, splenius capitus & cervicis.
At normal walking speeds, the rectus femurs has to perform a complex function at the ________ phase of gait when it must contract and shorten at the hip and lengthen at the knee
Preswing
During which phase of the gait cycle does the ankle reach its maximal plantar flexion range, and what is this range?
Preswing 20 degrees
Tommy injured his (L) knee playing soccer yesterday. He is wearing a knee immobilizer that prevents any knee movement. What phase(s) of the gait cycle will be most affected by this orthosis?
Preswing, initial swing, and midswing
In what ways does a walker interfere with or prevent a normal gait pattern?
Prevents arm swing and trunk rotation thus decreasing momentum, slowing the person down, and increasing energy expenditure
A PTA should expect that damage to the anterolateral spinothalamic track will lead to which sensory impairment?
Problems discriminating pain, temperature, and deep pressure
Barrel Chest tx
Respiratory therapy...blow out the birthday candles, smell the roses, pursed lip breathing. Strengthen forced exhalation muscles.
Line of Gravity (LOG) - a vertical line drawn through the body's center of gravity (COG), slightly anterior to ___ (how do you palpate)
S2. (find PSIS, go to midline and down a little bit)
Mrs. Jones has bilateral osteoarthritis in her hips with decreased internal rotation (lacks 10 degrees or -10 hip IR), and decreased hip hyperextension (0 degrees). How might these impairments affect her gait?
She will exhibit an increased foot angle and will go directly from midstance to preswing
cervical rotation treatments
Splints / positioning. Stretch tight SCM (side of ear tilt), strengthen opposite. Cervical mobilization/ traction. Modalities for pain control.
Select the most appropriate technique that a PTA should perform to get the most valid reading for wrist flexion and extension
Stabilize the forearm to prevent pronation/supination, elbow flexion/extension
In what position would you position your patient to exert the least amount of pressure on the spinal disks thereby decreasing their low back pain? Standing, forward bending and reaching to the floor to stretch out tight low back muscles sitting with feet up on stool with spin in posterior pelvic tilt to stretch out back muscles. Standing or sitting with slight lumbar lordosis sidelying with pelvis rotated forward & shoulders rotated posteriorly
Standing or sitting with slight lumbar lordosis
The distance from heel strike of one foot to heel strike of the opposite foot is:
Step length
Which of the following statements are true about running?
Step width decreases, there is a period of non-support, and there is no period of double support
Which of the following abnormal gait patterns is characterized by excessive knee and hip flexion during swing phase?
Steppage gait
___ places the least amount of pressure on the IV disc. 1. a horizontal line should intersect many of the same head, neck, and trunk and marks as in standing. 2. disc pressures decrease to about 25% of body weight 3. Resting surface should be firm enough to support normal lordosis yet soft enough to conform to and support body curves.
Supine
At normal speeds, when the reference limb is in initial contact, what phase of gait is the opposite limb usually in?
Terminal stance
Which of the following should occur normally during mid stance?
The gastroc and soles muscles are working eccentrically to control excessive forward movement of the tibia on a flat foot.
What muscle is responsible for controlling the ankle as it moves from plantar flexion in foot flat to dorsiflexion in mid stance?
The gastrocsoleus contracting eccentrically
During normal terminal stance:
The hip is hyperextended 10 degrees, the knee is at neutral, and the ankle is dorsiflexed
If your patient's shoulder flexion PROM is 20-100, a PTA should recognize ALL of the following are correct except:
The patient has a shoulder flexion contracture of 80 degrees and these shoulder flexors need to be stretched into flexion
a PTA assesses kinesthesia in a 61 year old male patient with Parkinson's disease. Which of the following patient responses should a PTA recognize as most appropriate for a normal kinesthesia rating when the therapist moves the (R) UE into abduction elbow flexion, supination, wrist extension 3x fast
The patient responds by moving his (l) UE into abduction, elbow flexion, supination, wrist extension 3X as fast as he is able
Abducted (protracted) scapula causes
Tight serratus anterior & pectoralis major muscles Weak middle trapezius & rhomboids.
Shoulder Laterally Rotated causes
Tight lateral rotators (teres minor, infraspinatus) Weak medial rotators (subscapularis)
Causes: Flat cervical curve (no lordosis in neck)
Tight neck flexors and weakened cervical extensors. Overstretched posterior neck muscles.
What is the primary function of the quadriceps at loading response?
To lessen the impact on the knee joint as the weight is shifted onto the reference limb by contracting eccentrically to allow the knee to bend slightly for shock absorption
After initial evaluation, and prior to the first treatment with a patient, a PTA should perform a quick ROM screening test for indicated body segments to determine the need for a follow up goniometric measure.
True
Each single support period accounts for approximately 40% of the gait cycle
True
Genu recurvatum gait deviation is commonly caused by weakness of both quadriceps and hamstrings and excessive tightness of achilles tendon during mid stance phase of gait
True
T/F A patient with partial damage to the spinal cord may be expected to have 3+ to 4+ DTR?
True
T/F Maintaining good posture when you sit, stand and move about actually requires less energy expenditure than trying to hold yourself upright in a faulty posture, thus you should feel fatigued by the end of the day
True
The purpose of performing a muscle length assessment is to determine whether or not a joint LOM is due to muscle tightness across the joint
True
A person with a 2+/5 gluteus medium weakness on the (R) will exhibit all of the following EXCEPT:
Unable to raise the (R) leg at all against gravity while sidling on the (L) side
Information about changes in head position that can affect muscle tone, posture, movement and equilibrium are conveyed to the brain via which type of sensory receptor?
Vestibuloreceptors
your patient has winging scapula bilaterally with the (L) side higher than the right, mild chin rotation to the (R). Select the most probable causes Tight (R) SCM. Weak serratus anterior muscles bilaterally. Tight (L) trap 2 & (L) levator scapula. Tight (L) SCM. Weak (L) trap 2 & (L) levator scapula. Tight serratus anterior muscles bilaterally.
Weak serratus anterior muscles bilaterally. Tight (L) trap 2 & (L) levator scapula. Tight (L) SCM. Tight serratus anterior muscles bilaterally.
winging scapula causes
Weak/paralyzed serratus anterior due to birth defect improper crutch walking poor conditioning of upper body.
PTA's should be aware of 3 variables that affect grading muscle strength.
Weight of the limb or distal segment being moved against the horizontal effect of gravity weight of the limb, plus effect of gravity on the limb when the motion occurs perpendicular to the effect of gravity. weight of the limb, plus the effect of gravity plus manual resistance
Forward head posture
When the head juts forward so that the pt ears are not lined up with the shoulders
What gait deviations would you see in a person's gait that would indicate that they had poor balance?
Wide step width, arms held out to side, slow speed at cadence.
how would a PTA measure Q angle
axis mid patella, stationary arm mid anterior femur and distal arm to tibia tuberosity
"Stretch the ____, strengthen the ____."
cave, hump
thoracic spine is ____anteriorly and ____posteriorly
concave, convex
cervical spine is ____anteriorly and ____posteriorly
convex, concave
lumbar spine is ____anteriorly and ____posteriorly
convex, concave
5 uses for MMT
establish basis for muscle re-education and strengthening exercises determine how functional a pt. may be determine if a pt. may need an AD and justify ordering assist PT in determining and modifying diagnoses determine a patient's prognosis
Cubital Valgus: Causes
excessive loose elbow capsule. Stretched ulnar collateral ligament. Weak wrist/finger flexors.
The dorsiflexors contract eccentrically at______, and if they are too weak to do their job, the patient will exhibit a _________ gait deviation.
foot flat, foot slap
The term that means the patient has maintained their ability to recognize numbers, letters, or objects traced on the palm during sensory testing
graphesthesia
During swing phase, a person with weak dorsiflexors may do all of the following EXCEPT:
hike the hip on the uninvolved side
The combination of excessive elongated muscle length, looseness of joint capsule structures and laxity of supportive ligaments can cause ___ around a joint
hypermobility
a person who has had a CVA my have a lower shoulder and shortened trunk on the weak side are examples of what common postural deviation
neurological
Another term used for the deep sensory cells that detect pain
nociceptors
When determining whether muscle flexibility might be the cause of a LOM, muscles that are elongated or stretched over two or more joints may develop __________.
passive insufficiency
causes of excessive cervical lordosis. tight capital extensors weakened capital flexors
people with bifocals overhead jobs long distance biking "whiplash"
When performing sensory or sensation testing, a PTA should know that all of the following are important to gathering accurate, valid data EXCEPT:
performing the tests with variable speeds...fast or slow...to make sure the patient pays attention
Great position for posterior spinal disc herniations, but if patient has a history of neck pathology,
prone
A muscle must be _____ enough to provide stability to a joint and _____ enough to allow normal mobility.
short long
posture that disc pressures about 75% of body weight.
side lying
how should you sit if you have disc pathology,
sitting with a slightly increased lumbar curve
adducted shoulder causes
spasms of rhomboids & middle trapezius.
certain types of postural deviations are due to bony mal-unions of poorly healed fractures, from congenital bone deformities or from fused bony structures after injury. These are called ____ deformities. the best intervention to normalize posture for these patients would be _____.
structural postural deviations. Intervention: surgical repair and follow up rehab to stretch shortened muscles and strengthen lengthened muscles
how do you strengthen cervical flexors
supine on plinth. bring chin to chest and eccentrically contract as you bring your head back
how should you correct pt sitting posture
tell them to set a timer to spend 10 minutes every hour on the hour in good sitting posture. (if you don't do it incrementally, it could cause pain.)
alignment for knee ROM
the axis of the goniometer in line with the lateral epicondyle of the knee to be assessed, the moving arm along the lateral midline of the fibula in line with the lateral malleoli and the stationary arm along the lateral midline of the femur in line with the greater trochanter
Equinus gait is an abnormal gait deviation characterized by
the person walking on the balls of their feet
What are the "Tom, Dick, & Harry" muscles?
tibialis posterior, flexor digitorum longus, flexor hallucis longus
Your patient stands in knee recurvatum posture. which of the following would be the LEAST likely cause for this postural abnormality? Tight hamstrings Tight gastrocnemius & soleus muscles Tight hip flexors Weak hamstrings Relaxed standing habit, hanging on ACL ligament.
tight hamstrings tight hip flexors
forward head posture is demonstrated with tightness of the cervical suboccipital muscles T or F
true
