EXAM 1 PT (up until acute care)

Roll and Glide: Femur and Tibia

-*femur*: flex knee, bone move posterior so ROLL posterior, femur must GLIDE anterior (convex surface so glide opp direction bone movement) -extension: femurs move anterior so femur roll anterior and glide posterior -must do this so not roll off of tibial plateau! -*tibia*: flex knee, tibia posterior so roll and glide also post (concave = same direction), extend tibia move anterior so roll and glide anterior

Functional Independence Measure (FIM)

-*important* -objectively measure level of physical assistance we give pt, measure off of pt not how hard it is for you to help them 1. Independent 2. Modified independent: use of assistive device but no physical assistance (you do not set up device or bring to them) 3. Supervision or Set up: use walker safely on own but you supervise, help them set up and bring to them 4. Min Assit: pt performs *75%* or more of task (hand on pt) 5. Mod assist: pt performs *74-50%* 6. Max Assest: *49-25%* 7. Total Assist: *less than 25%* or requires more than 1 person to assist (very weak, one pt block knees other stab head etc) -*when in doubt, grade pt down*

ROM definition and Dependent Upon

-amount of available joint motion -dependent upon: -integrity joint surfaces -mobility and pliability soft tissues -degree of soft tissue approx -degree fibrosis -age and gender -co morbidities

Fundamental Signs and Symptoms to look for Intolerance

-*important* --> red flags -20 mmhg change in systolic BP and 10 in Diastolic -tachycardia (fast HR) or Bradycardia (slow) -increased respiratory rate (hypervent, scared or something going on in lungs) -decreased oxygen saturation -complaints of dizzyness, nausea, slurring of speech -look at these and see if something else going on but always look at pt bc # may be inaccurate and they could be OK

Acute Care Inpatient Care Settings and Role of PT in Acute Setting

-14 days or less in hospital usually -goal is to discharge pt as soon as pt medically stable -help decide where they go 1. Long Term Acute Care: certified hospitals (no ER) patient stay longer than 25 days, with more than 1 serious condition (wound and ventilator) 2. Long Term Care: therapy 1-3 days/week for 30-60 minutes, nursing services (meals made for them) 3. Inpatient/Acut Rehab Unit: 3 hours of therapy/day, 24 hour nursing (stroke, brain injury) 4. Skilled Nursing Facility: after 3 days of hospital stay, therapy services <3 hrs per day, MD in charge, 24 hour nursing, medications and custodial care (help feed etc) -*PT* treat and ID movement dysfunction, MD treat disease -member of team (OT, nurses, MD), educate paitent, family, caregiver, discharge planning -common conditions: total hip replacement, total knee, spine surgery, orthopedic fractures, transplant, pneumonia, hear attack, acute stroke, cardiac bypass, organ failure, *dehydration, fall* (most common)

Advantages of AROM and PROM

-AROM: measure first, allow you to see pt move, how much they are willing to move -observation of functional task allow you to see move of mult joints -PROM: allow examiner to determine total ROM that pt possess -provide with info to determine any limitations to full ROM (endfeel) -must know their SINS (to tell how aggressive tx can be)

Define BOS and COG

-BOS: body parts in contact with supporting surface and area between supporting structures -COG: point around which mass of body equally dist

Kinematics and Arthrokinematics vs Osteokinematics

-Kinematics: describe human movement without regard to cause of motion 1. Arthro: movement of joint surfaces -roll: rotary motion between the joint surfaces (always occur same direction as bone movement) -glide: translation between the joint surfaces (we measure: concAve = same direction as osteokinematic motion, convEx = run away from ex so opp) -convex femur on tibia, extend knee = bone moving anterior so convex femur roll anterior but glide posterior -roll and glide occur SIMULTANEOUSLY to preserve joint integrity 2. Osteokinematics: quality and degree of motion observed of the whole bone -******result of the Arthrokinematics motions****** -occurs in planes of movement (frontal, sagittal, transverse)

Types of Strength Assessments

-Manually (MMT and hand held dynamometer), electronically, functional assessments (sit to stand, different from SKM test or calf raise) -handheld dynamometry you and isokinetic (same speed) dyn are limited in ability to accurately assess *lower grades* of SKM strength but very sensitive to higher grades 1. Functional Assessments: *categories*: balance, excursion, lunge, step up/down, jump and hop tests -*ex*: 30 second chair stands, 6 min walk test, single limb balance, step ups, squats (SL or DL)

Weight Bearing Restrictions and Orthopedic Fractures

-NWB -Toe Touch WB (TTWB): 10% weight can be put on floor (don't crush egg under foot) -PWB: 50% of their weight on surgical limb -WBAT: pain is guide to how much weight put on limb -FWB: full weight bearing -Fractures: ORIF or OREF (hardware placed internally to stabilize bone vs externally) -casts, walking cast, footwear, assistive devices

What Generally Occur in Exam for Assessing Kinematics

-Observation -movement/task analysis (systems review as needed) -ROM: keep position in mind, start with least irritated SKM --AROM and PROM (for ROM AROM is first then you do PROM to see if can go farther -Neuro Screeningm Exam: should be early on in exam to see reflexes, dermatome (area of skin single nerve innervates) myotome (multiple SKM single nerve innervates) -Specific MMT/Strength Testing

What we FEEL for when Assess Osteo and Arthrokinematics

-Quantity of motion: hypermobile, hypomobile, normal -Quality of Motion: stiff, catching, smooth -End Feel: normal or abnormal -normal: bony, firm (capsular and muscular) or softor -abnormal: springy, boggy (lots of fluid, feels mushy) empty, pain

Rom vs Muscle Length

-ROM: motion available at any single joint (range of degrees) -SKM length: ability of SKM surrounding joint to lengthen, allowing one joint or a series to move through the available ratings of motion -used to refer to END RANGE measurement of muscle across a joint (so this is what usually limits ROM, singe number) -SKM pass over one joint, ROM and range of SKM length will be same -SKM pass over 2 joints, range of SKM length < total ROM of joint which SKM passes EXAMPLE: Gastroc vs Soleus (PF) 1. Gastroc: if skm plantar flex it Woolf limit DF (so put towel under knee to bend so gastroc relaxed so not longest SKM can be so not limit DF when do it, take SKM length out of equation so can just get ROM of joint) -when measure ankle DF ROM with towel under knee = same as soleus SKM length bc it only crosses that one joint! -so if want to measure SKM LENGTH: where 2 joint SKM involved, SKM must be ELONGATED across both joints so can get total length (gastroc = extend knee and DF ankle, bc gastroc PF and flex knee so have it in extended knee pos and DF ankle so lengthened) -if want to get joint ROM where 2 joint skim involved, uninvolved joint should be in shortened pos (measure DF without impact gastroc = flex knee so gastroc short) -hamstring length have person flex hip in supine and extend knee to LENGTHEN SKM bc cross 2 joints (have lengthen at both areas, so bc hammies extend hip nad flex knee have them in the flexed hip and extended knee position so lengthened)

Dypsnea, Syncope, Eschar, Cyanosis, Ecchymosis, diaphoresis, hemoptysis

-SOB, loss of consciousness, black necrotic tissue, blue skin from hypoxia, bruising (subdermal hemmorage), sweat, cough blood

Wound Re Evaluation

-Wounds constantly changing and must be re assesses freq so the POC can be up dates (weekly and as needed) -want to see signs of healing in *2 weeks* otherwise adjust treatment plan -would expect wound size SA to be 30% smaller at week 4 in order to heal in 12 weeks

Strength Definition and Types of SKM Contractions

-ability of SKM to develop force or toque -force generates over single episode against immovable resistance -muscle must produce force in static position and throughout Joint ROM -Muscle Strength: maximal force a muscle or group can generate at specified determines velocity -*types*: isotonic (same tension/force), isokinetic (same speed), isometric (same length) -MMT is isometric contraction/strength

Signs and Symptoms Requiring Immediate ER visit

-angina (chest pain) not relieved in 20 min -angina with nausea, sweating (heart attack) -bowel or bladder incontinence/ saddle anesthsia (numb inner thights = spinal cord compression) -inadequate ventialtion symptoms (cardio pulm failure) -PT with diabetes confused, lethargic, change in mental function (diabetic coma) -positive Mcburneys point (right side lower quad stomach) or rebound tenderness (let go and pain) (appendicitis)

Intercostal Space for Each pulmonary Auscultation Site

-aortic: right 2nd -pulmonary: left 2nd -tricuspid: 4th -mitral: 5th

Acute Care Precautions

-before PT go into room always remember INFECTION CONTROL AND PREVENTION for you and pt and other pts -assume every interaction with pt is infectious -Have Isolation Precautions Created bY CDC applied to pts that have some type of infection that can be spread 1. Contact precautions: wash hands, wear gloves, gowns 2. Droplet Precautions: something that spread via cough or sneeze (secretions = flu) -hand wash in and out, gown, surgical mask 3. Airborne Precautions: things that spread in air, negative pressure room where things filtered out (TB) -wear special mask (n95 respirator) and hand hygiene -*also* be aware of *physician orders*, surgical procedure, weight bearing status, know physician (bc diff ones want diff things)

RED FLAGS Integumentary System Screen

-bilateral edema of hands or feet that is unexplained by injury -edema involving the face or arm that is present with discoloration of chest, arm or face, loss of carotid pulses, dysphasia, wheeling, chest pain, headaches, dizzy (CV problems) -total body edema or total quadrant -short breath + edema -calf pain and Edema after trauma = trauma at quad but pain in calf could be sign of clot (DVT) could go to lungs and heart if untreated -progressive edema -edema occurs simultaneously with fever sweats, chills -Edema toys body part with red streaks -edema warm or hot adn painful to palpate (infection)

LUB DUB Heart Sounds

-blood flow from body to right side of heart atrium thru tricuspid to ventricle then thru pulmonry valve to pulmonary vein to lungs -from lungs go to left heart atria thru mitral valve to ventricle thru aortic valve to aorta and body -aorta = to body, left side of heart -pulmonary veins = right side of heart, to lungs or from lungs to left side of heart -LUB: first sound closure mitral and tricuspid valves (blood going from R/L atria to L/R ventricles) -DUB: second, closure of aortic adn pulmonic (valves closing blood from R/L ventricles to body (aorta/left) and lungs (pulmonary artery/right heart)

Kinematics: Osteo and Arthrokinematic Motion

-both occur simultaneously during movement and are directly proportional -normal Arthrokinematics motion "must* occur for full range Osteokinematics motion/less joint ROM (lower arthro = lower Osseo BUT lower Osteo not nec mean because of lower arthro, can be affected by SKM length, swelling, pain, strength deficits) 1. *Osteokinematic Motion*: Bone movement when moving around joint axis -measured as an angle in degrees (knee flexion/ext etc) -assess via AROM and PROM 2. *Arthrokinematic Motion*: movement occurring on the joints surfaces (depends on the surfaces) -3 motions: roll (tire on cement), glide (hit brakes, slides on ground) , spin (hit gas tires spin road stay same) -are able to assess glide with our hands, *linear* movement of one bone on another (glide always accompany roll) -want to assess in OPEN PACKED joint position (bc everything loose) -*difficult* to treat the roll, *easier* to treat the glide -roll always occur in *same direction* as the Osteokinematics motion/bone movement -*concave* (moving joint surface concave, glide occurs in same direction as Osteokinematics motion) -*convex*: opposite -so *restriction* in motion on convex surface, assess glide motion in off direction of restricted motion, concave same

What Info try and Collect During patient centered Interview

-chief complaint -general demographics -past medical/surgery history -medications -general health status -family history -other clinical tests/findings -functional status/activity level -socail history/health habits -employment/job/school/play -liviing environ -goals

Some Integumentary Signs that Could cause Referral to MD

-color: erythema (redness), red streaks -scar formation, dry skin, drainage, edema, changes in hair or nails, changing in sweating, skin temp, texture, mobility, pitting edema, pulses

Evaluation Components

-data collected during exam synthesized and analyzed to determine diagnosis, prognosis and POC -ID potential problems outside scope of PT practice (serious health issue, immediate referral MD) 1. *Diagnosis*: end result exam and eval, ID source and nature of problem 2. *Prognosis*: determine level of optimal improvement possible (how long take and will fully recover?) -patient education and patient responsibility important, frequency and # visits, POC 3. *Intervention*: to prevent changes in function consistent with diagnosis and prognosis, reassess condition and progress 4. *Outcomes*: impact of PT interventions, functional outcome measures (tools questionnaires), did they achieve their GOALS? -SUMMARY: clinical judgements based on data collected during exam, ID potential problems outside of PT practice, ID if problem appropriate for PT, developed goals, treatment plan and generate PT involvement

Name Each Lift

-deep squat: hips below knees, need hip mobility and ankle DF, flex to maintain lordosis spine -power squat: half squat, hips above knees -single limb stance: pick up small things (balance) -half kneeling lift: better chance to get closer to object, still balance involved but good if have bad ROM for other lifts -traditional: ant post with feet bring object COG close to you (same with all lifts but this esp)

Implications of Bad Posture

-deviations from optimal posture may result in unless Joint movements and SKM action --SKM shortness brings SKM origin and insertion closer together and if persist long time then SKM stay short --SKM weakness = separation or origins and insertion (lengthening) --so stay in these stretched or shortened pos = AFFECTS SKM ABILITY TO PRODUCE FORCE

Hoe to Determine Cause of Pain/ Loss of Joint ROM

-observe the movement -perform AROM and PROM (AROM first) and assess *end feels* and resistance to motion -perform accessory joint glides: if normal, abnormal (loss of glide), end feel -text Muscle length

ROM and range SKM length crossing over joints

1 joint cross: ROM and range SKM length same 2 joints: ROM > range SKM length -measure ROM 2 joints: SKM at uninvolved joint must be shortened -SKM length 2 joints, SKM must be lengthened at both

CV System Pre Screen Checklist and RED FLAGS

-dyspnea (shortness of breath), palpitations (irregular pulse), syncope (loss of consciousness), pain with sweats, cough, chest pain, peripheral edema, cold hands/feet, open wounds, skin discoloration -if yes answered to any of these ask more open ended questions -special questions during exam include have you had heart attack, heart disease, abnormal ECG, rheumatoid fever, pacemaker, medications, cardia risk factors (high BP, genetics, high cholesterol) 1. Dyspnea: shortness of breath (SOB) -orthopnea: *red Flag* If SOB related to position (esp lying supine) -may suggest CHE, mitral valve regurgitation, asthma, COPD -sudden arousal at night with shortness of breath -severe at rest (collapsed lung) 2. Palpitations: irregular heartbeat or fluttering in chest -frequency and duration key -*red flag* If have these symptoms with irregular palp: chest pain, lightheaded, dyspnea, diaphoresis (sweat) etc -Falls (blackouts vs loss of balance) -family history of sudden death from heart issue 3. Peripheral Edema: can be assoc with venous insufficiency (not bring blood from tissues to heart) DVT (same idea, lower legs clot vein) and pulmonary hypertension -is it bilateral = *RED FLAG* (Congestive heart failure likely) -pitting from edema? Slow vs fast onset? Associated signs (pain, redness etc) 4. Leg Pain: calf or post thigh pain with walking on an incline or up flight of stairs -weak or absent femoral/pop/post tib/dorsalis pedis PULSES = *RED FLAG* -dry thin scaly skin that is cold to touch (arterial issue, not bring blood to area) vs warm (venous issue, not bring blood out)

Stethoscope Bell vs Diaphragm

-earpieces face anterior (away from you) -Diaphragm: best for high frequency, ALL lung sounds (normal and ab), most heart sounds (normal adn ab), FIRM pressure -Bell (concave): best for listening to low freq, hear some heart sounds (abnormal) and LIGHT pressure -BOTH SIDES SHOULD BE USED FOR *CARDIAC* AUSCULTATIONS -pulmonary just diaphragm ok

Why Pre Screen CV and Pulmonary System and

-everyone has heart and lungs so important to eval even if come in for something else -sig overlap between symptoms of CV and pulmonary (so cant just look at symptom for diagnosis) -Can often reveal co morbidities (presence 2 chronic disease), hidden disease, adverse drug reactions

Sizing Device: grip aligned with, elbow angle, space between axilla nad head

-greater torch, 20-25 deg, 2 inches

Follow up Questions for Skin Lesion or Swelling

-have you noticed this before, how long -recently changes size color -talked to MD? -know cause? -how does the rash feel? Any aggravates? -better or worsening? Painful? = -pitting or non pitting? (Swelling) -change in diet? Change in meds? -24 hour behavior

Lordosis and Pelvic Tilt

-high lordosis = anterior tilt of pelvis (hip more flexed) -low = posterior tilt so hips less flexed

Wound History Qs

-how did it start -how long has it been present -is pain present -sensation in tact -how has it been treated in past -culture and radiology results -risk assessment resuts (pressure, diabetic, vascular)

Documenting ROM is PT unable to maintain neutral (knee flex and ext)

-if unable to reach 0* knee extension record range of knee flexion as Supine AROM L knee flexion: 10-90* -knee extension can't achieve 0* just put Supine AROM L knee extension: -10* (bc no range, can't even go into full extension let alone hyperextension

Edema and causes

-imbalance of starling law of equilibrium (balance of filtration (going out) and resorption (coming in)) -results in excess fluid in interstitial spaces/tissues -can be multifactorial in cause -impedes healing regardless of etiology (cause of disease) bc to congested/swelled so cant circulate nutrients there -localized, unilateral, bilateral, systemic -Causes: trauma, infection, venous or lymphatic pathology, obstruction of lymph nodes, medications, organ pathology (liver, kidney, pancreas, hormonal imbalances)

Where do ROM deficits fit into ICF model and what affects it?

-impairment -hip flexion (impairment) = prevent from sitting (body func/struc) = not go to work (participation restriction) -affected by changes across lifespan (flex down, mobility down), gender, culture (sitting on floor, different way locomote), occupation and recreational activites, anatomy

Tissue Healing (Times and Frames)

-inflamm begins 48-72 hrs lasts 7-10 days -proliferative tisssue formation: 10days - 6wk -remodeling 6wk - 12 mo -acute <14days -subacute 14-3mo -chronic > 3 mo

Wound Etiology: types of wounds

-investigating the cause of the wound 1. Pressure Injury: typically located over bony prominences (exceptions if device caused wound) -prolonged pressure = ischemia = eventual cell death -classified using stages to describe amount of tissue destruction (6 stages) -*factors that contribute to dev*: impaired circulation (already have arterial blood flow issue, not take munch pressure to obstruct flow there), decreased mobility, predisposing illness (diabetes, RA), diminished mental cap (not moving as much), incontinence (poo/pee), poor nutrition/hydration, past history pressure injuries (weaker where have had before), poorly fitting splints/braces 2. Vascular Injury: partial (superficial) or full (SKM tendon) thickness A) Arterial: lack of adequate blood flow to SKM *(ischemia)* -usually found on toes, feet and distal 3rd of leg -tend to have very little drainage (bc no fluid going there), pt increased pain with leg elevation (have to work against gravity to bring fluid there) B) Venous: incompetent valves = fluid overload in lower extremities = *edema* -typically found on distal medial 3rd of leg -heavy amounts of drainage, elevation improves symptoms (fluid work with gravity to leave area) 3. Neutropathic Wound: aka diabetic ulcers -various neuropathic (sensory, motor, autonomic) contribute to changes in foot which can lead to ulceration -typically found on plantar surface of foot (can lead to change in contruction of foot, gait) 4. Traumatic Wound: wide variety of caused (shear forces, gun shot) 5. Surgical Wound: man made wounds due to surgical procedure, debridement, incision, drainage

Possible Barriers to Wounds Healing

-maceration: softening of skin from moisture, white/grey wrinkled appearance -epibole: rolled edge, skin cells grow down into wound, create canal -hyperkeratosis: callus, hypertrophied thickening of tissue, epithelial cells not grow over callus so wound in middle of callus and not heal -hypergranulation: bulbous and friable granulation tissue, often arises above level of periwound skin (pt response to injury too good, too much tissue)

TIM VADETUCONE

-method to make broad range of hypo based on symp (look at symp and determine everything that could explain it) Trauma Inflammatory (septic/aseptic w/ infection or not) Metabolic Vascular Degenerative Tumor (benign/malignant) Congenital (born with) Neurologic/psychogenic

Sit to stand crutch position, 3 pt gait when do you movehandrail which side should be on 1. ascend/descend stairs no railing 2. With railing 3. Ascending stairs cane no railing (unilateral assistive device) 4. descending stairs no railing (curb)

-on weak side (affected) -when the crutches move (after pt move) -handrail on unaffected side (so you guard affected) 1. ASCEND no railing: good go to heaven bad to hell --> *good leg first* then device then *bad last* -DESCEND: *assistive first*, bad leg, good 2. ASCEND railing: good side by railing, you guard bad -front feet walker on step above, back on your step -pt grasp front grip, *good leg first*, lift using UE and good LE, bad leg, walker -DESCEND: front feet of walker step below, back on same step -pt grasp rear handgrip, *bad leg first* then lower with UE and good leg then good leg then walker 3. ascend stairs no railing cane: *step up with unaffected LE to elevate body* then affected LE and cane ascend 4. descend: *step down with affected LE and both crutches* simultaneously while balancing on unaffected LE, then unaffected step down

Red Flag and 10 Item ID

-presence of sign or symptom found in history, systems review or test adn measures that may indicate need for referral to physician or ER visit -10 item ID: correctly ID red flag in 95% of pts Have you recently experiences... 1. Abnormal sensations (numbness, pins and needles) 2. Headaches 3. Night pain 4. Sustained morning sickness 5. Light headedness 6. Trauma 7. Night sweats 8. Constipation 9. Easily bruising 10. Changes in vision

ICF Model and Draw

-provide a framework for communicating and studying impact of disease (acute or chronic) on an individual's ability to interact with their environ (common language/terminology) -looks at person in their own environ -"consider health from a biological, indiv and societal perspective." -emphasizes components of health rather than conseq of disease (participation rather than disability) IDs *3 Levels of Human Function*: 1. Function at level of body parts 2. Whole person (activities) 3. Whole person and complete environ (participation) -test treat reasses!

Posture Definition

-relative alignment/arrangement of all parts of body -composite of postiions all joints -less strain on structures and least amount SKM effort is good posture

Parts of pt Management Acute Care:

-same structure as outpatient 1. *Examination* systems review: CV, Pulm, Integumentary, MSK, Cognitive, Neuromuscular (do we need to focus on specific areas of impairments?) -tests and measures: vitals assessment (at each point pt change position re assess), strength (MMT), power (get our of chair, measurement of strength adn time), ROM, cognition, function, balance -history: chart review, medical team, subjective interview, family or caregiver -tests, chief complaints, medical history, surgeries, activity level and functional level 2. *Evaluation*: clinical judgments formulates -are they OK for PT, *red flags*, further info needed? -treat, treat with more info or not treat 3.*Diagnosis*: what you think is going on 4.*Prognosis*: includes POC, if going to fully recover and how long 5. *Interventions*: skilled techniques (transfer training etc) 5. *Outcomes*: results of PT interventions (gait speed etc) -*discharge planning* is an important element -think about what pt needs to be able to do at home, level of assistance needed (mod independent etc), support network, where are thy going

Steps for patient centered interview

-seeing patient as person not injury, beginning of exam 1. Setting the stage: welcome pt, use their name, introduce, say what going to do and your role, ensure comfort and make sure pt at ease 2. Determine agenda and chief complaint: indicate time available, indicate own needs, obtain list of all issues pt wants to discuss (i.e specific symptoms, requests) 3. History of present illness non focused: ask open ended beginning q and link to chief complaint, interactive listening, look at their nonverbal cues and verbal cues 4. History of present illness, focused: symptom story (obtain pts narrative of symptoms), personal story (personal context of symp), emotional story (how affecting emotionally), expand story/deepen as needed 5. Transition to Clinician centered interview: give brief summary, check accuracy, indicate that style will change if pt ready

Ideal Posture

-stable, maintains bodies COM over BOS (COM = point around which mass of body equally dist, BOS = body part in contact with supporting surface and area between supporting stuc) -minimized stress and strain on tissues both statically and dynamically -minimize energy cost -GRF line should pass through scull, bodies of lumbar vert, sacrum, slightly post to center of hip joint, slightly anterior to axis of knee joint, through calcaneocuboid joint (ant to maleolus)

Principles of alignment, Joints and muscles

-stretch weakness can occur in one joint SKM that remain in a lengthened pos -muscle weakness allows sep of origin and insertion of SKM -muscle shortness brings pts together -joint pos indicate which SKM appear elongated and shortened -faulty allignment results in undue stress and strain on bones, joints, SKM

Constitutional Symptoms and When become Red Flag

-vague symptoms that could be related to a number of body systems 1. Fatigue: becomes red flag when tiredness interferes with person's ability to carry out daily activites at home work or social AND > 2-4 weeks 2. Fever Chills Sweats: red flag when unknown origin, > 99.5, present 2-3 weeks and physician not aware (sign of infection, cancers, tissue disorders) 3. Weight Loss: red flag when indiv reports a loss 5-10% body weight without change in diet or activity OR 10-15 lb in 2 weeks 4. Nausea and Vomiting: red flag if unknown origin AND MD is not aware OR progressivly worsening 5. Change in Mentation (mental state): may indicate dimentia, head injury, adverse rxn to drug, determine if new onset or worsening of present status, unknown cause = bad

Validity and Reliability

-validity: test measured what designed to measure (MMT has high validity) -reliability: ability to reproduce same result (lots of practice helps this) -MMT high validity, variable reliability (based on experience of clinician)

Q's to Ask with Abnormal Signs/Symp

-when did it begin -know why -has it changed -notice any other unusual symptom -is physician aware

Joint Accessory Motion Def: Closed and Open Packed Position

1. *Close Packed*: only one close packed position for each joint -position of joint where maximal tautness major ligaments, maximal surface congruity, minimal joint volume, maximal *stability* of joint -movements toward closed packed pos require an element of compression (compression = everything tightened up) 2. *Open Packed*: all positions away from closed packed (not just 1 for each joint) but used synonymously with resting position which each joint just have 1 -position of joint where slackened gentlemen major ligaments, minimal surface congruency, minimal joint surface contact, max joint volume, minimal *stability* of joint -movements toward open packed involve an element of distraction/separation (everything loosening up) -SO resting/open packed = most *glide) of a joint bc loose, so want to test joint accessory motion in resting/open packed pos

Physical Therapy Exam Components

1. *History*: chief complaint/ current conditions, general demographics, family history, medications, past medical/surgical history, functional status and activity level, social history/health habits, living environment, patients goals -can get via chart review, medical records, subjective interview (OPEN ENDED Q'S, specific to help guide convo, organized) -want to dev relationship, *ID red flags*, determine if PT can't help, determine activity limitations, participation restrictions, goals 2. *Systems Review*: brief screening exam to make sure everything ok so can move on (cardiopulmonary (HR, BP), integumentary/skin (Temp, Edema, palpating, how it looks), neuromuscular/gait balance/reflex, musculoskeletal/posture ROM strength, cognition) 3. *Tests and Measures*: continuous expansion systems review, objective data (ROM, strength) to ID impairments (flexibility, strength), narrow down hypo for diagnosis -analysis and synthesis of these lead to EVALUATION

ROM values and end feels, documentation joints

1. *Knee Flexion*: 0-150, soft -Supine AROM Left Knee Flexion: 10-95 -Supine PROM Left Knee Flexion: 0-140 with firm endfeel 2. *Knee Ext*: 0, firm (capsular) -Supine AROM Left Knee Extension: 0-2 (2 degrees hyper) -"" PROM: 0-7 with firm endfeel -"" PROM: -10 (cant reach 0) 3. *Ankle Composite DF*: 0-20 (start at 90), firm (capsular) -Supine AROM Right Ankle Composite Dorsiflexion: 0-9 -"" PROM: 0-16 with firm endfeel 4. *PF*: 0-50, firm -Supine AROM Right Ankle Composite Plantarflexion: 0-32 -"" PROM: 0-38 with firm endfeel 5. *1st MTP Ext*: 0-70, firm (capsular) -Supine AROM Left 1st MTP Extension: 0-35 -""PROM: 0-46 with a firm endfeel 6. *Hip Flex*: 0-120, *no endfeel* due to motion of pelvis indicating end (post tilt) -Supine PROM Left Hip Flexion: 5-115 (*only PROM*), no endfeel noted) 7. *IR*: 0-45, firm -Seated AROM Left Hip Internal Rotation: 0-30 -""PROM: 0-41 with firm endfeel 8. *ER*: 0-45, firm -Seated AROM Left Hip External Rotation: 0-36 -"" PROM: 0-49 with firm endfeel 9. *Abduction*: 0-45, *no endfeel* due to feel for compensation (ASIS go superior/shift up indicating pelvic tilt R/L) -Supine PROM Left Hip Abduction: 0-37 (*only PROM*, no endfeel noted) 10. *Adduction*: 0-30, *no endfeel* due to compensation (ASIS go down) -Supine PROM Left Hip Adduction: 0-25 (*only PROM*, no endfeel noted) 11. *90/90*: normal knee ext value at end = 155, firm endfeel -Supine 90/90 PROM Right Knee Extension: 130 with firm endfeel 12. *SLR*: normal hip flexion end value 62, *no endfeel* due to compensation knee flex, pelvic tilt -Supine PROM Right Hip Flexion: 51*

Precautions: Sternal, Total Hip Arthroplasty (post and ant approach), Spine

1. *Sternal*:6-8weeks in hospital (soft tissue and bone healing time, open heart surgery example) -no lifting more than 5-10 lbs -avoid heavy WB of UE -avoid reaching posteriorly with both arms (stretch chest) 2. *Hip post*: hip flexion greater 90 deg -hip asdduction greater than neutral (do not cross midline) -hip IR 3. *ant*: avoid extreme hip extension -avoid ER 4. *spine*: 6-8 week timeframe -BLT (bending lifting twisting): no spine flexion, rotation, lifting greater 5-10 lb ---> *remember may depend on surgeon/pt*

RED FLAGS (12)

1. *fatigue* if interfere with daily activities, social life, work AND >2-4 weeks 2. *Fever* >99.5, unknown origin, >2wks, no MD consult 3. *weight loss* lose 5-10% body weight no change diet or ex, lose or gain 10-15 lb 2 weeks 4. *nausea* unknown origin and MD not aware OR worsening 5. *Orthpnea* (SOB when lying flat) severe at rest, related to position (esp supine) 6. *palpitations* (irregular heart beat or fluttering) if have with chest pain, lightheaded, dypsnea (SOB) diaphoresis (sweat) 7. *Peripheral Edema*: bilateral (CHF), whole body edema, sudden onset without traumatic event 8. *leg pain* with weak/absent pulses femoral, popliteal, post tib, dorsalis pedis 9. *cough* hemoptysis (blood) 10. *raised or elevated HR* w/ nausea, chest pain, SOB 11. *high BP* >180 systolic, >110 diastolic = emergence medical treatment especially with headache, dizzy, nausea 12. *high respiratory rate* w/ light headed, weak, chest discomfort

Describe and list Advantages/Disadvantages of 4 point gait pattern, 2, modified 4 and 2, 3 point, modified 3

1. 4 point: bilateral crutches or canes -involved device, uninvolved leg, uninvovled device, involved leg -stable, low energy expenditure, stimulates normal gait 2. 2 point: bilateral crutches/canes -simultaneous movement crutch and opp foot -uninvolved device with involved limb then opposite -stable pattern, low energy expenditure, stimulates normal gait *faster than 4 point* 3. Modified 4 and 2: one crutch/cane -assistive device on side opposite involved limb (good side) -same pattern as 4 or 2 point just use one device -*widen BOS* and *moves COG away from dysfunctional side* 4. 3 point: NWB using walker or crutches -advance walker or crutches then uninvolved limb forwards -less stable pattern, faster pace, *hihg energy expenditure*, *UE strength req* 5. Mod 3 point: PWB walker or crutches/cane -Walker: advance walker then involved limb to walker then uninvolved *last* -Crutches: assistive devices advanced, involved lib then *uninvolved last* -more stable than 3 point, slower, less energy expenditure, less strength required

AROM and PROM what shows and what dependent on

1. AROM: quantity, willingness, integrity of *contractile AND non contractile tissues*, symptom reproduction, pattern of motion restriction -reduced vs normal vs excessive 2. PROM: information regarding the integrity of the inert tissues (*non contractile tissues*) -allows for assessments of *end feel*, feel what limiting joint

ICF Domains and Contextual Factors and examples of each

1. Body Structure and Function: anatomical parts of body, physiological functions of the body systems -IMPAIRMENTS = problems in structure or function that affect their activity/participation (balance, pain, weakness, ROM, muscle tone, contracture, HR/BP) 2. Activity: execution of task or aciton -Activity LIMITATIONS: difficulties in executing tasks/activities (walking, feeding, dressing) -interventions typically at activity and impairment level 3. Participation: involvement in life situation -participation RESTRICTION (AL SET A PR) (social relat, home life, work, education, social life) Contextual Factors: A) Environmental: refers to all aspects of external world that impact persons functin (products and tech, natural environ, support and relat, attitudes, services/systems/policies) B) Personal Factors: background of an indivs life, features of indiv NOT part of the health condition (sex, race, age, health conditions, lifestyle habits, social background)

End Feels for ROM

1. Bony: approximation of 2 bones with abrupt hard stop to obtaining more motion 2. Firm: capsular and muscular -capsular: motion is limited by joint capsule/noncontractile tissues producing a firm endfeel with slight amount of give (stiffer than muscular) -muscular: motion is limited by muscular tension, not as firm as capsular endfeel 3. Soft: approximation of soft tissue that is limiting further ROM (knee flexion, big biceps) 4. Pathological endfeels: -empty: motion is limited due to pts complaint of pain -muscular spasm -when a normal feel is found when or where it is not expected

Palpation sites pulses

1. Carotid: inferior to angle of jaw and anterior to SCM SKM 2. Brachial: medial to biceps tendon 3. Radial: at wrist on collar forearm medial to stylus process radius 4. Femoral Artery: inferior to inguinal, halfway between ASIS and pubic tubercle -supine with hip in ER and Abe and rest foot opp knee 5. Popliteal: deepest structure against joint capsule -knee flexed supine or sitting 6. Post Tibial: behind medical maleolus -foot NWB tendons slack 7. Dorsalis Pedis: along Dorsum of foot, midline or slightly medial

Wound Assessment: Vascular Wounds, Edema

1. Vascular Wounds -need to asses circulatory status in relation to wound -skin temperature, pulses -venous and arterial tests 2. Edema: need to obtain objective measurements to track progress -girth measurements (tape measure for circumference, use bony landmarks for consistency)--compare to other limb -volumetric measurements (h20 displacement)

Pulmonary System RED FLAGS

1. Coughing: can have pulmonary or CV implications -chonicity (>3 weeks) -many causes (asthma, smoking etc) -productive (color odor, consistency, hemoptysis (*COUGH BLOOD = RED FLAG*)) 2. Digital Clubbing: appearance of blue nail beds, bulbous enlargement of fingertips' -assoc with significant chronic hypoxemia (low O2 in blood) 3. Wheezing: abnormal respiratory sound audible to the ear -high pitches sound caused by partial obstruction of airways (asthma) or status asthmaticus (asthma attacks follow each other immed = *RED FLAG*) 4. Altered breathing Patterns and Chest Wall Morphology: accessory SKM hypertrophy -kyphoscoliosis: combo scoliosis and kyphosis, can restrict lung function -sleep apnea: not breath so no O2 to System

Integumentary Screen: DVT, Cellulitis, Arterial Insuff, Venous insuff, Lymphedema

1. DVT: clot in veins of lower leg, area of clot is red adn very tender/painful to touch 2. Cellulitis: skin infection caused by bacteria, toe infection but redness on whole leg for ex 3. Arterial Insuff: red in color but cold to touch (not get blood here) 4. Venous Insufficiency: iron start to stain skin bc no venous return , varicose veins, enlarged veins 5. Lymphedema: lymphatic system help veins so also lead to edema (not take fluid out)

Observations of Integumentary System (what symptoms you can see)

1. Erythema (redness): bacterial infection? 2. skin color: petechiae (small dots) and purpura (large dots) -ecchymosis: bruise/collection of blood under skin (look at location and pattern adn see if coincides with injury described -lateral ankle sprain bruising, see if symmetry between ankles -red streaks (where I'd streaks start): infection, progressing ? -hemosiderin: staining of skin from iron left in tissue bc insufficient venous return 3. Color: cyanosis (blue color) from hypoxia -peripheral (fingertips) or central (tongue- not enough O2 though blood over whole body) -jaundice: yellow orange color indicates liver or gallbladder path -pale or ashen = anemia/bad circulation, flushed not after exercise = fever, sunburn, exertion -scleroderma: rash spread without touching area, changes beyond where touch (autoimmune disorder, body attack itself), vs poison ivy, spread where touch 4. Spots: not just a mole, Skin cancer? 5. Skin Cancer: neoplasticism skin lesions (abnormal mole) 6. Hair Follicles: abnormal hair loss, pattern of hair loss (bilateral, only one area) --> skin disease, circulation problem, hormone problem 7. Nail Beds: change in nails is one early sign of longstanding illness -kidney disease, nutritional status, PA, Liver disease -clubbing of nails: CV and Lung disease and AIDS (poor absorption of nutrition) -yellow nails from respiratory disease (poor O2) 8. Edema: location, pattern, symmetry

Procedure Testing ROM

1. Explain procedure to patient 2. Properly position pt in test position (positioning different for measuring ROM and SKM length 3. Stabilize proximal joint segment 4. Instruct the pt on the motion to be performed 5. Palpate bony landmarks and take initial measurement (not really need to do if they can reach 0) 6. Move patient through available ROM 7. Re palate landmarks and take end measurement 8. Return to initial test position 9. Record pts measurement

MMT Steps

1. Explain purpose of the MMT (what it is and why) -drape as needed -use proper body mechanics 2. Place pt in gravity resisted position and stabilize proximal Joint seg while PROM (to demonstrate movement) -test *uninvolved/strong* side first 3. patient perform via AROM from starting and you *palpate* SKM to see if contracting and correct if needed 4. Apply resistance (if can do full ROM against gravity so level 3, if not put in gravity eliminated position so hip flexion have sidelying) -forearm direction that force need to be/opposite of their internal force (leg ext = down, DF = down adn out bc they are in inversion (up and in)) -use *body weight*, gradual, 3-5 seconds to max then ease off -stop as soon as break position -resistance applied to distal segment of joint being tested -if *compensate* correct them and have do again 5. Apply appropriate grade -use *their ROM* so even if not normal ROM just compares to what they can do (they are able to AROM what you PROM)

Steps for MMT testing

1. Instruct pt on what doing 2. PROM (you do) -start with *strong leg* 3. AROM, palpate for SKM contract -if compensate, correct them and have do again 4. MMT, add resistance gradually to max and back off slow -make sure forearm is in direction force should be (leg ext straight down, DF push down and out bc they out foot up and in) -use body weight and appropriate ergonomics -stop test when *break position* 5. Assess grade and repeat on other limb

Steps for Wound Evaluation

1. Location: describe anatomically and specifically using bony landmarks (right greater torch not right hip) 2. Measurements: always documented L x W x depth in cm -Length is the longest aspect head to toe of visible would (draw imaginary lines to match up points if one area is protruding!) -width is the widest aspect (side to side) of visible wound (perpendicular to length) -depth = deepest part -undermining (destruction of conn tissue between dermis and subcut, kind of like a flap), tunneling (tract connecting 2 wounds), sinus (long narrow opening along fascia plane that extends to wound edge) -all are measured using clock method (12 o'clock, 8 o'clock etc, 12 o'clock at head of pt) 3. Wound Bed: -color: healthy (pink, red) necrotic (yellow = slough, Eschar = black) -MUST REMOVE NECROTIC TISSUE TO HEAL -visible structures: exposed bone, tendon, joint cap (want to protect these to maintain func and prevent infection) 4. Drainage: use all senses, amount, colors, smell -serous (clear, light yellow, serosanguinous (pink), sanguinous (blood, red), purple to (pus) 5. Periwound Skin: area around wound -asses for presence/a sense of hair, callous, edema, scarring -skin hydration (maceration vs dry skin) -color: erythema (red), ischemia (white), hemosiderin staining -palate for mobility -assess for information (hard Edema that's been there for a while) 6. Pain: pain at site or somewhere else, objectively rate 7. Signs and symptoms of infection: foul odor after clean , purple to drainiage (puss), fever, cellulitis (pain inflamm erythema) -culture > 10^5 CFU = infection, less = contamination 8. Sensation: sharp/dull, light touch, vibrations, proprioception (can feel what is going on in body/pebble in shoe) 9. Strength and motion: in area of wound -modify testing as needed so skin integrity not comp -check with MD for any restrictions -May need more specific eval or area to dev approp ther ex or compensation mech 10. GOALS: must be time oriented and measurable (stop drainage, relieve pain, reduce edema, improve func mob)

MMT vs Manual Muscle Screen

1. Manual Muscle Screen: muscle group places in position of convenience (have pt 1 position test all SKM) -provides quick overview of pts strength -testing *muslce groups* rather than specific muscles -*not quantifiable* -used to determine weak or strong, painful or painless 2. MMT: used to det capability of muscles or groups to function movement and ability to provide stab and support -*measure muscle strength* but more of an assessment of weakness -ability of a SKM to develop tension against resistance in a particular position (isometric assessment of muscle strength) -perform to get objective measurement, can retest to assess improvements, provide manner communication with other clinicians, relate results to AL or PR

Past Medical Info that can be sign of Red Flag and Potential Red Flag Information/Trends of Symptoms

1. Medical Info -personal or family history cancer -recent (last 6 weeks) infection esp when followed by neuro symp (joint pain, back pain) -recurrent colds/flu cyclical pattern -recent history trauma (car accident or fall) -minor trauma in older adult with osteopenia (softening bone) or osteoporosis (thinning of bone) -history of immunosuppression (HIV, steroids, cancer, organ transplant) -history injection drug use (infection) 2. Trends -unknown cause -gradual, progressive or cyclical presentation of symptoms (worse better worse) -pain unrelieved by rest or change is pos -symtoms appear out of prop to injury -symp persist beyonf expected time frame -PT unable to alter symp during exam or onwards

Steps for PT Centered Interview

1. Set Stage 2. Determine agenda and chief complaint 3. Get history of present illness (non focused) 4. History of present illness inquire about symptom story, personal adn emotional story (focused) 5. Trans to clinician centered

Pivot Transfers to Strong and Weak Sides and Blocking Legs Why Good/Bad

1. Transfer to Strong Side: transfer here when weak side very weak -block strong leg *always for first transfer* bc not know how "strong" it is -block weak leg when *PT think strong leg can stab indep* 2. Transfer to weak side: block strong leg makes transfer more therapeutic by *increase WB on weak side* -block weak leg *ensures safety of weaker leg*

CV and Pulmonary Screening Exam

1. body temp: fever body temp > 37.5* C (99.5* F) -associated conditions can be infection, cancer, connective tissue disorders (RA) -if present > or equal to 2 weeks AND pt not seen MD = *RED FLAG AND NEED IMMEDIATE REFERRAL* -if fever >102 for several days then go to urgent care 2. HR including pulse regularity and quality: palPate site most commonly carotid for self or radial for practitioner -normal resting HR between 60-100bpm (tachycardia = >100bpm, bradycardia = <60 bpm) -other associated symptoms of chest pain, diaphoresis (sweating), SOB, nausea = *RED FLAG* 3. cardiac auscultation: heart sounds (heart murmur) 4. BP: 120/80 is normal anything over 2 values = pre hypertension -*resting BP >180 systolic and/or 110 diastolic* = emergency med tx -esp with other signs and symptoms of instability (headache, dizzy, nausea, blurry vision) = *RED FLAG* 5. RR (resp rate): pulmonary auscultation is an adjunct -potential source of error if pt knows you are counting breaths so best to do after taking BP bc they still think you are taking BP -10-14/min, 12-18/min normal resting (varies) -elevated rate may be cause of emergency care if chest discomfort, light headed Ess., weakness, wheeling etc = *RED FLAG* 6. pulmonary auscultation (listen to lungs) 7. pain

Integumentary Screening: Palpation (edema, causes, signs, how measure)

1. pitting and fibrosis: sign of longstanding Edema, thick, also happen with edema that has high protein content (lymphedema) -record time it takes for pitting to resolve and quality of Edema (viscosity- easily pits, some pitting, non pitting, brawny edema (hard), skit tightness) (presence of fibrosis, >fibrosis = faster resolution of pit) -Pitting caused by congestive heart failure, venous insufficiency, lymphedema (as fibrosis develop, pitting is difficult) -measure via volumetric water displacement or using tape measure or circumferential measurements (add up cones of leg/arm) -cannot interchange water disp and calculated volume using circumference measurements

Temp Diff in wounds significant, UE and LE circumstance measurements taken every

3 degrees, UE 4, LE 10

Grades of MMT

5/5: "normal" -completion of full ROM against gravity; maintains position against MAX resistance 4/5 "good" -completion of full ROM against gravity; maintains position against MOD resistance 3+/5 "fair +" -completion of full ROM against gravity; maintains position against MIN resistance 3/5: "fair" -completion of full ROM against gravity, cant hold against any resistance 3-/5: "fair -" -completion of >50% ROM against gravity, full ROM in gravity eliminated pos 2+/5 "poor +" -completion of up to 50% ROM against gravity, full ROM in gravity eliminated position 2/5: "poor" -cannot perform motion against gravity, completion of full ROM in gravity eliminated pos 2-/5 "poor-" Completion of partial ROM in gravity eliminated pos 1/5: "trace" -palpable contraction of SKM, NO MOVEMENT through ROM 0/5: "zero" -no palpable or visible contraction

Why Screen Integumentary System?

=may be first signs of systemic pathology (something wrong with body system) -inflamm/inflamm disease (local inflamm from trauma or something like RA) -infection -immunologic disorders (immense system high or low) -organ dysfunction -cancer (skin cancer, breast cancer recoccuremce sign = skin rash) -after screen think if they are appropriate for PT or of back to MD, or what POC will help them

Skin Cancer ABCDE

A: asymmetry: is 1/2 mole different from other half B: border irregularity C: color (uneven) D: diameter (> 6mm) E: Evolution: changes over time

Acute vs Outpatient Setting Questioning

ACUTE: determine cognition (name, birthdate, why you are here), reason for visit (what brought you to hospital), determine prior level function, determine discharge situation (describe your home/apt, do you have help etc), ask if aware about precautions, when took pain meds OUTPATIENT: reason for visit (what brings you in here), location of symptoms (show me, where), mechanism of injury (when did this problem begin), 24 hour behavior (change over day?), aggravating/alleviating factors

Standard Vital Signs

Body temp, HR, Cardiac Auscultaion, Pulmonary Ausc, BP, RR, Pain

Red Flag Findings with Cancer, Neuro, CV, GI

Cancer: persistent pain at night, constant pain anywhere, unexplained weight loss, loss of apetite, unusual lumps Neuro: cahnges in hearing, headaches, problem with swallowing, change in speech, fainting, sudden weakness CV: shortness of breath, dizzy, pain in chest, pulsating pain anywhere, severe pain lower leg or arm, swelling GI: frequent nausea/vom, change in bladder func, unusual menstrual, severe ab pain/ heartburn

Goal of Exam and Eval

Determine if PT is appropriate for patient Develop hypothesis/diagnosis

Goals of Patient Interview

Develop rapport (connect with pt) establish theraputic relat (how going to do it, what PT is) and information adn data collection to see if pt is appropriate for PT

What is the Difference between diagnosis and prognosis?

Diagnosis is both the process and end result of examining evaluation data which is organized into clusters, syndromes or categories to determine prognosis and approp intervention Prognosis is level of optimal imrpovement that may be attained through intervention and amount of time required

ICF Patient Example: Fractured Distal Radius

Domains: 1. Body Struc and Function: Impairment = decreased pronation and supination, decreased thumb mobility, decreased wrist flex/ext, decreased grip strength 2. Activity: Limitation = difficulty holding pencil, typing, holding drum sticks, dribbling 3. Participation: Restrictions = problems completing school work, unable to compete drumline/bball Contextual Factors: Environ (single parent home, no healkth insurance, senior star bball player, in home with lots of doorknobs (aka cant turn them etc) manual transmission car) adn Personal (14 yo old male)

Components of PT Man

Examination (things axamine, document in first eval (ROM, strength) talk to PT, form relationship) Evaluation (make clinical judgements from info gathered in exam, make hypo to guide POC), what do those tests tell me? Diagnosis (sometimes given by doc, sometimes need to discover Prognosis (how long you think it will take them to recover/will they recover) Intervention (how will you help, plan of action, family edu and at home protocol) Outcomes (self reported outcome measures, what you examine)

Capsular Endfeel

Firm end feel with slight give

Exam Components

Hostory/Chart Review Systems Review (look at 5 symp cardiopulm, integumentary, neuromusc, musk skel, cognition and do screen) --> hypotheses Specific Tests and measures --> narrow hypo Clinical Diagnosis

Musculoskeletal vs Systemic Pain and Visceral Pain

Musckuloskeletal: usually decrase with cessation of activity -generally lessens at night -aggravated with mechanical stress -usually continuous or INTERMITTENT (sit pain up, stand take a bit to go down, related to movement) Systemic (affects tissues, organs, body as whole) -reduced by pressure (pressure on tissue make better) -disturbs sleep -not aggravated by mechanical stress -usually constant or in WAVES (highs and lows, not related to movement) -BOTH can be continuous tho Visceral: source of pain from internal organs and heart (all body organs in trunk or abdomen) -NOT well localized -pain referred to site where organ located at fetal dev (or what nerves innervate) -heart attack, pain left arm or kidney pain = post lumbar region -bc can mimic musckulo SKM pain can't ID based on location alone, need more info

Normal, Prehypertension, Stage 1 hyper, Stage 2

Normal: >120/>80 Pre: 120-139/80-89 1: 140-159/90-99 2: >160/>100

Most Important Section of Medical Chart

Physicians orders: need to see where to start and clarification (PWB< NWB, limitations, restrictions)

Sign vs Symptom

Sign: something observed by secondary person Symptom: something reported by patient

PF And DF at what joint

Talocrural

Posture Axes

Through external auditory meatus Through odontoid process of axis Through bodies of lumbar vert Slightly posterior to center of hip joint Slightly anterior to axis of knee Through cancaneocuboid joint

SINS

Used to determine how aggressive the PT exam may proceed 1. Severity: intensity of symp, limitiation in activities, examples (scale 0-10, mild mod severe other pain scales etc) 2. Irritability: time of ONSET, time required for symp to DISSIPATE, relationship between these times and magnitude of symp (i.e. Throwing first pitch = pain last 20 mins = highirritability while 100 pitches pain 10 mins = low) 3. Nature: description of symptoms (tingling, weakness, sweating, not just focused on pain) and therapist interpretation of the possible pathology (hypo list --> tingling = nerve issue?) 4. Stage: progeression and stability of symptoms (improving, stay same, worsen) or time frame for injury/tissue healing (how far along is healing process; inflammatory response 48-72 hours can last 7-10 days, tissue formation 10 days - 6 wk, remodeling 6 wk - 12 mo or acute < 14 days/subacute 14-3 months/chronic > 3 months )