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
