Exam 1
Define a Grade 2/5 for MMT
-Able to complete full or available ROM in a GM position
Define a Grade 3-/5 for MMT
-Able to complete greater then 1/2 of available motion AG
Define a Grade 2+/5 for MMT
-Able to complete less then 1/2 of available range of motion in AG -Able to do full ROM in GM with mild resistance
Define a Grade 2-/5 for MMT
-Able to complete partial ROM in a GM position
What are some possible causes for Hypomobility?
-Abnormal joint surfaces -Passive shortening of the joint capsule, ligament, muscle, fascia, or skin -Inflammation of previous structures
What is the Patient/Client Management Format
-Based on The guide to physical therapist practice -broken down into 6 categories
What are 2 types of Hypomobility?
-Capsular Patterns -Non-Capsular Patterns
Define a Grade 3+/5 for MMT
-Completes full AROM.available motion AG -tolerates against mild resistance
Define a Grade 3/5 for MMT
-Completes full AROM/available AG -Does NOT tolerate any resistance -as soon as resistance is applied it breaks
What are types of goals in a traditional model under the intervention category of the Patient/Client Management documentation?
-Expected outcomes: long term goals -Anticipated goals: short-term goals
Define Clinical Reasoning
Use of inquiry; analyzing, synthesizing, and interpreting information; providing alternative solutions to complex issues and situations
What is the Test and Measures portion of an examination used for?
Used to establish a diagnosis and prognosis, select intervention, and document changes in status, also used to indicate achievement of outcomes (goals) through re-assessment
Define the Available Range in a MMT
When a contracture of fixed joint limitation limits joint range of motion the patient performs only with the available range
How weakness determined in a MMT
When you see deviation in the path of motion
What are some thing that are evaluated in a Communication, Cognition, affect, learning barriers review?
Whether the patient can do age appropriate communication, if they are cognitively in tact, if they have any visual problems, etc
Can you still do goniometry measurements if there are precautions?
YES, just maybe be a bit more careful
Are osteokinematics measured with Goniometry?
YESSSS
Define Environmental Factors according to the ICF Model
the physical, social and attitudinal environment in which people like and conduct their lives
Give an example of the difference between osteokinematics and arthrokinematics
Arthrokinematics occurs at the GHJ but osteokinematics occur at the humerus
Why do we do Muscle Length Testing?
Assessed to determine cause of joint hypo- and hyper mobility
What are the different types of functional activities?
Community, social, civic life, education life, self-care, domestic life, work life
What is the Medical Model of disability?
Disability is a direct result of disease, trauma, or health condition -medical care is required to. Correct the problem
What is the social model of disability?
Disability is a socially-created problem, unaccommodating physical environment and negative social attitudes -political & social change required to correct the problem
What is the Biopsychosocial model of disability?
Disability is the result of the diesease, trauma, or health condition AND socially related constraints and attitudes
What does the Nagi Model focus on?
Disablement
What are some examples of activities?
Doing laundry, being a college student, tennis player, delivering meals on wheels, etc.
What are the components of the Plan of Care under the Intervention category of the Patient/Client Management documentation?
-Frequency and Duration of the POC -Coordination and communication -Patient-related instruction -Interventions
Describe the Transverse Plane
-Goes in a horizontal direction -Divides the body into upper and lower halves -Rotation motions occur in this plane -Axis is vertical in a cranial-caudal direction
Describe the Sagittal Plane
-Goes in an anterior-posterior direction -Divides the body into right and left halves -Flexion/extension occur in this motion -The axis is medial-lateral
Describe the Frontal Plane
-Goes in the Left-Right direction -Divides the body into the anterior and posterior halves -Abduction/Adduction motions occur in this plane -The axis is anterior-posterior
What are the parts of the ICF model?
-Health condition -Body Function & Structure -Activity Limitations -Participation Restrictions -Environmental Factors -Personal Factors -Barriers -Facilitators
What are some examples of Impairments under the Examination category of the Patient/Client Management format of documentation?
-Identified problems of the body (ROM, Muscle tightness) -Systems Review
What components of the Patient/Client Management model make up the P (plan of care) portion of the SOAP Note
-Intervention -Outcomes
Define a Grade 5/5 for MMT
-Normal -Unable to break the hold position -Accompanied by full AROM/available AG
What information is gathered when documenting Tests and Measures?
-Observable or measurable -used to rule out causes of impairments, activity limitations, and participation restrictions
What are the types of goals in a text model under the intervention category of the Patient/Client Management documentation?
-Participation goals (expected outcomes) -Activity goals (functional goals) -Impairment goals
What are the 2 formats of documentation
-Patient/Client Management Format -SOAP Note Format
Which components of the SOAP note make up the Examination portion of the Patient/Client Management form of Documentation?
-Problem or Diagnosis -S (subjective) -O (objective)
What are some examples of Reasons For Referral under the Examination category of the Patient/Client Management format of Documentation?
-Pt. Info/demographics -Current condition -PMH -Medications -Social history/Participation -PLF -Review of Systems
What is the Purpose of Documentation?
-Record what was done -Communicate with other health care professionals -Justification of care to 3rd party payers -Discharge planning -Organization & planning -Quality assurance -Outcomes research
What is documented when doing an examination of a history?
-Review of systems -Demographics -Current condition/chief complaint -Patient Goals -Prior level of function -Social History -Employment status -Medications -Growth and Development -Living environment -General Health Status -Social/health status -Family -Patient medical/surgical history -Functional status/activity level -Other clinical tests
Why are Tests and Measures necessary?
-To confirm or reject a hypothesis -To support the PT's clinical judgements about the diagnosis, prognosis and POC
Define a Grade 4/5 for MMT
-Tolerates strong, but less then normal resistance -Can withstand moderate resistance -Full AROM/available AG
What information do you include when documenting a discharge note?
-a summary from the previous progress note or a complete summary of the total progress of patient from initial assessment
What are some factors that affect the amount of pressure applied during a Break Test
-age -body type of the subject -segment being tested -presence of pain -amount of leverage available to the examiner
How is information listed when documenting?
-by using table format
What are contraindications to goniometry
-dislocation or unstable joint -unstable fracture -immediately after surgical procedures to the tendon, ligament, muscle, joint, joint capsule, or skin
What can MMT help us determine
-level of function -diagnosis -need for supportive devices -basis for muscle re-education and exercise -track progress
When documenting Range Of Motion, what value is anatomical position or neutral position?
0deg
What part of the ICF model would involve the inability to transfer from bed to chair
Activity limitation
What part of the ICF model would involve the inability to wash dishes
Activity limitation
Define resistance
Applied force acting in opposition to the contracting muscle
What is the Diagnosis portion of the Patient/Client Management Model
Identification of primary dysfunction toward which we will guide our prognosis, POC, and interventions
What are impairments of body structures and function?
Identified problems in body function or structure such as a significant deviation or loss
Define Critical Thinking
Identify, articulate and analyze problems, distinguish relevant information, differentiate among facts
In the Patient/Client Management Documentation format what is the Examination component?
Includes: -Reason for referral -Activities -Impairments
Define Hypermobility
Increase in PROM beyond normal values
Define Personal Factors according to the ICF Model
Influence how disability is experienced by the individual.
What are some thing that are evaluated in an Integumentary System review?
Information about integument disruption, continuity of skin color, skin palibility, or texture
Define Stabilization in a MMT
Methods used by the therapist to ensure that only the test segments move
Define Gravity Minimized (GM)
Motion occurring in the horizontal plane, rarely is resistance applied, testing surface should be free of friction
Define Combination Motions
Movements occurring in multiple degrees of freedom
Define Against Gravity (AG)
Muscles contracting against downward gravitational forces
Can Goniometry measure combination motions?
NOOOO, it is restricted to just one plane
Does the S (subjective) component of a SOAP note include observations made by the therapist?
NOOOOO
Can arthrokinematics be measured with Goniometry?
NOOOOOOO
Are Muscle Length Tests done actively or passively?
PASSIVELY
Define Non-Capsular patterns of hypomobility
PROM limitation not proportioned in capsular pattern
Does AROM or PROM typically get a greater value?
PROM typically gets a slightly greater value
What part of the ICF model would involve the inability to eat with family
Participation restriction
Define Capsular patterns of hypomobility
Pathology of the entire joint capsule with resulting motion restrictions in predictable pattern and portion
What are the 4 types of Abnormal End-Feel
Soft, Firm, Hard, and Empty
What are the 3 types of Normal End-Feel
Soft, firm, and Hard
Define Activity according to the ICF Model
The execution of a task or action by an individual
What is the S (subjective) component of a SOAP note?
The therapist states information received from the patient that is relevant to the patient's present condition
In the Patient/Client Management Documentation format what is the Diagnosis category?
1. Diagnosis is a process: analysis of the cause or nature of the condition, situation, or problem 2. Diagnosis is a product: statement that identifies the nature or the cause of the problem
What are the elements of the Patient/Client Management Model?
1. Examination 2. Evaluation 3. Diagnosis 4. Prognosis 5. Intervention 6. Outcomes
What are the 6 categories of the Patient/Client Management Format
1. Examination 2. Evaluation 3. Diagnosis 4. Prognosis 5. Intervention (POC) 6. Outcomes
What is involved in the Examination portion of the Patient/Client Management Model?
1. History (intake forms, med history, history of injury) 2. Systems Review (determine which body system needs more info) 3. Tests and Measures (gather more objective info, Goni, etc)
What are the benefits of the ICF mode?
1. Provides a standardized language 2. Framework to describe function in the presence of a health condition
How much of a degree difference is needed in intra-rater reliability to determine if there is improvement or worsening
5-10 degrees
How much of a degree difference is needed in Inter-rater reliability to determine if there is improvement or worsening
6-12 degrees
What is the difference between a PT diagnosis and a Medical Diagnosis?
A PT diagnosis focuses more on the impairments, activity limitations, & participation limitations of the disease. A Medical Diagnosis is just the specific condition
What is an inclinometer
A gravity dependent measure of the difference between long axis of distal segment and line of gravity after movement through ROM
Define Manual Muscle testing
A method to measure and define muscle strength, and the subjects ability to contract muscle/muscle group voluntarily
What is an evaluation statement
A written statement summarizing major findings (impairments, limitations, and restrictions) and providing justification for ongoing PT services
Is AROM or PROM performed first?
AROM is performed first
Define Inter-rater Reliability
Amount of agreement between repeated measurements by different raters (deviation of 5-6 degrees is acceptable)
Define Intra-rather Reliability
Amount of agreement between repeated measurements by the same rater (deviation of 4-5 deg is acceptable)
Define Reliability
Amount of consistency between successive measurements of the same variable, on the same subject, under the same conditions
Define Body Structures according to the ICF Model
Anatomical parts of the body such as organ, limbs, and their components
Gender, age, coping styles, social background, education, profession, past and current experience, behavior patterns and character are all types of... A. Environmental Factors B. Personal Factors
B. Personal Factors
Define Content Validity:
Based on our knowledge of anatomy, bony landmarks, and accurate alignment the goniometer appears to measure and represent the true joint ROM in degrees
How do you stabilize for Goniometry measurements?
By stabilizing the body and proximal segment to isolate specific joint motion
How do you determine normal mobility?
By testing the opposite side
How is Joint End-Feel determined
By the structure of each joint, or by the examiner who applies slight over pressure and the end of the motion
Define Joint End-Feel
Characteristic feel during PROM when there is a barrier to motion; the end of the range of motion
Where can you find information about the patient's History?
Chart review, referral information, patient, family, or caregiver interview
What is the Intervention portion of the Patient/Client Management Model?
Culmination of examination, diagnostic, and prognostic process, and statements outlining your plan to manage the current episode of physical therapy care
What does the ICD-10 model describe?
Describes health by providing a diagnosis of disease, disorder and other health conditions (used for medical coding and policy making)
After completing a systems review what is a PT able to do?
Determine if the patient is appropriate to be seen by a PT -treat -refer -treat and refer
Why do we use Goniometry?
Determine presence or absence of impairment, establish PT diagnosis, develop prognosis, goals & outcomes, evaluate progress, or lack of progress towards a goal, modify treatment, modify patient, research effectiveness of treatment, make orthotics and adaptive equipment
Define Activity Limitations according to the ICF Model
Difficulties an individual may have in executing activities
Define Validity
Degree to which the instrument of question measures the variable of interest
What does the Nagi Model describe?
Emphasizes the disability and limitations that remain when the pre-pathological state cannot be achieved
What is the evaluation portion of the Patient/Client Management profile used for?
Establish rationale for PT diagnosis, prognosis, and POC
What components of the Patient/Client Management model make up the A (assessment) portion of the SOAP Note
Evaluation
What are the parts of a Goniometer
Fulcrum (axis), proximal arm, distal arm/moveable arm
What is the focus of the ICF model?
Function and disability a an interaction between the health condition and environmental, social, and personal factors
What are some examples of Activities under the Examination category of the Patient/Client Management format of Documentation?
Functional activities that are assessed/involved
What is involved in taking a History of a patient?
Gathering data related to -past history -overall health status -current symptoms
What are some thing that are evaluated in a Neuromuscular system review?
Gross coordinate movements such as balance, gait, locomotion, transfers, and transitions and motor function
What are some thing that are evaluated in a Musculoskeletal system review?
Gross symmetry during standing, sitting, activities, gross ROM, gross strength, pt height and weight, etc.
What are some thing that are evaluated in a cardiovascular/pulmonary review?
HR, RR, BP, edema (because it is a circulatory issue), etc.
What part of the ICF model would involve decreased range of motion
Impairment
When do you feel a Normal End-Feel?
In PROM
Define Face Validity:
Instrument appears to measure joint angles
What does ICF stand for?
International Classification of Functioning, Disability, and Health
Define Participation according to the ICF Model
Involvement in a life situation
In the Patient/Client Management Documentation format what is the Intervention category?
It includes: -Goals (traditional model) -Goals (text model) -Plan of Care (POC)
What is involved in the Systems Review?
It is a brief, hands on examination of body systems to determine areas on intact function and dysfunction
In the Patient/Client Management Documentation format what is the Evaluation category?
It is an assessment statement that PT's use to identify the main problems that will be addressed in therapy -CAN ONLY BE DONE BY A PT
Is the Nagi Model linear or non-linear in nature?
It is linear in nature
What is the SOAP Note Format
It is used more commonly for daily notes or progress notes
In the Patient/Client Management Documentation format what is the Outcomes cagtegory?
It is used to determine if the PT POC is effective and meeting the needs of the patient -it is not on the initial note -Its common in the daily note/progress note/discharge assessment
Define arthrokinematics:
Joint play or accessory motions, between one articulating joint surface moving relative to another
Define Criterion Validity
Justification by comparison to gold standard
What can cause Hypermobility?
Laxity, abnormality of joint surfaces, trauma to joint, genetic/hereditary conditions
What is a Break Test
Manual resistance AFTER actively moved or passively placed into test position -Resistance is applied and the patient can either withstand the force or they break under the force
Define Goniometry
Measurement of angles -Goni (angle) - Meton (measure)
Define a Grade 0/5 for MMT
No muscle activity on palpating or visual inspection
What information do you include when documenting a progress note?
Only the information obtained while re-examining the patient during the therapy session
Who can perform the examination phase of the Patient/Client Management Model?
Physical Therapists (NOT a PTA)
Define Body Functions according to the ICF Model
Physiological functions of body systems
Define Osteokinematics
Physiological movement, and gross movements of bones associated with joints
What is the P (Intervention Plan) component of a SOAP note?
Plan for the interventions that the patient will receive in upcoming sessions, including changes in intervention strategy
What is the Prognosis of the Patient/Client Management Model
Prediction of optimal/maximal improvement in function and amount of time needed to reach that level of function (LOF)
When is the Examination portion of the Patient/Client Management Model required?
Prior to PT intervention
Define Participation Restrictions according to the ICF Model
Problems an individual may experience in involvement in life situations
Define Impairments according to the ICF Model
Problems in body function or structure such as a significant deviation or loss
Are Goniometry values reported as a range or as a static number
RANGE
Define Problem Solving
Recognize and define problems, analyzes data, develop and implement solutions, and evaluate outcome
What is the Outcomes portion of the Patient/Client Management Model?
Results of interventions in the management of the PT diagnosis, can be shown through Progress Notes and Discharge Notes
What is the O (objective) component of a SOAP note?
Results of tests and measurements performed, specifically as related to the stated goals -MUST CLEARLY SHOW EVIDENCE OF "SKILLED NEED"
What are the 4 components of a SOAP Note
S- subjective O- objective A- assessment P- plan
Are Muscle Length Tests reported as a range or as a static number
STATIC NUMBER
Define the Test Segment in a MMT
Segment of the body that the patient moves during the test
In the Patient/Client Management Documentation format what is the Prognosis category?
Summary of the patient's potential to benefit from physical therapy (why PT is indicated or not indicated)
Define Hypomobility
Sustainable decrease in PROM
TRUE or FALSE Specific ROM is not reported in the results of the musculoskeletal systems review
TRUE
TRUE or FALSE. The Diagnosis statement can go at the beginning of the assessment statement
TRUE
TRUE or FALSE. You don't list the specific descriptions about a wound under the Integumentary System review?
TRUE
TRUE or FALSE. Pain makes a MMT invalid
TRUE, because the patient wont perform to the best of their ability due to the presence of pain
Which part of a SOAP note does History go under?
The S portion
Define Active Range Of Motion:
The arc of motion attained by patient, unassisted, and voluntary
Define Passive Range Of Motion:
The arc of motion attained by therapist, no active role by patient
What is muscle length?
The greatest extensibility of muscle tendon unit
Define Positioning in a MMT
The patient moves the limb into the testing position or the therapist places the limb in the testing position -this ensures correct positioning
Define the Test Range in a MMT
The portion of the total joint range that is expected to move against gravity, resistance, or friction
What is the Problem component of a SOAP note?
The problem or diagnosis is the first section of the SOAP note and can be stated as the patient's chief complaint
What is the A (assessment) component of a SOAP note?
The progress being made toward the patient's goals -discussion of any factors that would require modification of the frequency or intensity in the POC
Define the Test Position in a MMT
The starting position for the test -can be either against gravity or gravity minimized (in the horizontal plane)
Define a Grade 1/5 for MMT
Visual or palpating detection of muscle activity without any movement
Does MMT test muscle groups as a whole or individually?
Whole muscle groups, but positioning and cuing can help to test individual muscle groups
Define Normal Mobility
within normal range of predicted values gives age, sex, and joint in question
