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Steps in the patient management process
patient interview examination evaluation plan of care reassessment TERM 2
patient interview
DEFINITION 2 develop a hypothesis of casual and contributing factors TERM 3
Examination
DEFINITION 3 perform a specific and systematic examination to identify causal and contributing factors TERM 4
evaluation
DEFINITION 4 formulate a diagnosis to direct PT treatment TERM 5
plan of care
DEFINITION 5 provide a well-designed treatment strategy based on the diagnosis and contributing factors
What is the purpose of tests and measures?
Confirm or reject a hypothesis about the source of a patients condition or current level of functioning Provide evidence to justify physical therapy diagnosis, prognosis, and plan of care Gives you something to document and to gauge patient progress TERM 7
CDM and Testing
DEFINITION 7 What test is really important for me to do here? Priority Which tests are going to give me the most bang for my buck? 1. Priority vital to understand the patient's condition and plan for interventions
- Possible might provide useful information
- Pointless not likely to provide any useful information TERM 8
Considerations for
testing
DEFINITION 8 Information learned from the patient history how well is patient going to tolerate this examination based on pain? What is known about the patients condition Acuity or irritability of the patients condition where am I in the healing process? How irritable is it? SINSHow many tests can the patient tolerateHow strenuous the tests/measures can be Complexity of patients condition how many tests do you need to perform? Overlying conditions may affect Extraneous variables can patient do what I need them to do? Cognitive stateBiopsychosocial factorsComorbidities TERM 9
Psychometric properties of Evidenced Based
Practice
DEFINITION 9 reliabilityvalidity sensitivityspecificitypositive/negative predictive value TERM 10
Reliability
DEFINITION 10 comes from PT aka repeat-ability
Why strength test?
Differentiate between pathologies Differentiate between levels of spinal injury myotomes Identify patterns of impairment which can facilitate diagnosis To determine a patients ability to perform ADLs/ IADLs To assess the patients ability to resume activities (leisure or work) TERM 17
Assumptions of strength
testing
DEFINITION 17 Every muscle is a prime mover of some motion No two muscles have the exact same function Where one muscle fails, another will substitute when possible Requires knowledge of agonist-antagonist action Roll of muscle in fixation and substitution Length and strength are defined in terms of joint movement TERM 18
Strength vs. Power
DEFINITION 18 Strength -- ability to move a heavy object or resist being moved by a force without regard to time work ex. body builder, 1RM, Break Test Power -- ability to generate as much force as possible as fast as possible work/time ex. crossfit, swing a bat, gold tee off, sprint, vertical jump TERM 19
3 approaches to muscle strength
testing
DEFINITION 19 isotonicisokineticisometric TERM 20
Isotonic
testing
DEFINITION 20 Free weights or resistance machines 1RM (rep max) Inefficient (taxing and time consuming) Lack of portability Exposure to injury Tests gross strength of muscle group; no isolation
Isokinetic
testing
controlled resistance Peak torque High reliability Gross strength; no isolation Expensive and sophisticated equipment Lack of portability Not good for people who dont have ability to overcome gravity TERM 22
Isometric
testing
DEFINITION 22 Test against immovable force Eliminates confounders (length variability, velocity) MMT or Hand Held Dynamometer Only provides data for one point in ROM No or very portable equipment necessary TERM 23
Considerations when choosing a
measurement tool
DEFINITION 23 Patients strength Patients age Testing environment Testing method Most quantifiable data TERM 24
Describe the Consideration for patient's age
DEFINITION 24
- Children Observe function Unable to participate (follow directions consistently) in more reliable testing Not quantifiable
- Elderly Patients May not understand instructions due to cognitive deficits May not tolerate certain positions May not have motor control or balance to participate TERM 25
MMT has been sufficiently validated for what
grades?
DEFINITION 25 0-5/
What is the better choice for testing for
grades greater than 4/
use of functional testsincreased strength suggests increased performance but shouldn't we measure the performance? TERM 32
How is MMT an art?
DEFINITION 32 Handle injured and painful parts with care Position the patient to avoid discomfort or pain Gentleness required to test weak muscles Ability to apply resistance to facilitate optimal response TERM 33
How is MMT a science?
DEFINITION 33 Rigorous attention to form Perform test in a manner which ensures high Validity Reliability TERM 34
Importance of Palpation in Muscle
Testing
DEFINITION 34 Ability to palpate each muscle Ability to palpate subtle contractions Distinguish the muscle and its tendon Distinguish between normal and atrophied contour Recognize abnormality of position or movement TERM 35
MMT performance considerations that cannot
be controlled?
DEFINITION 35 Number and firing rate of motor units activated Muscle cross-sectional area Fiber type composition
MMT performance considerations that can be
controlled?
Length of muscle cell at time of contraction Patient positioning Stabilization used Point of force application Use of motivation know if its pain inhibited or just weak, push through the pain just once TERM 37
Rule of Testing Muscles?**
DEFINITION 37 ALWAYS TEST THE UNAFFECTED STRUCTURE/SIDE FIRST BEFORE TESTING THE AFFECTED SIDE TERM 38
What is a make
test?
DEFINITION 38 A patient pushes against you with force assessing the ability of the muscle to contractnot a good measure since you have no way to quantify the force and measure the strenghth since you yourself did not apply the force TERM 39
Break test
DEFINITION 39 PT pushes against patient with known amount of force creating maximal isometric contraction"don't let me move you"useful because you as PT know how much force you created TERM 40
What is the difference between manual
muscle testing and manual muscle screening?
DEFINITION 40 MMT extensive time, effort, attention to details position and techniques must be standardized requires strict adherence to rules of gravity MMS quick overview of pt's strength to I.D. areas of weakness for further investigation use of convenience positions rather than specific rapid survey of gross strength so can only classify muscle as "strong" or "weak" can't be documented
How would muscles that are too short
present?
usually strong would maintain opposing groups in a lengthened position ex. bugling biceps in a body builder TERM 47
What is the range of joint motion and how is it
measured?
DEFINITION 47 measured with a goniometer, inclinometer or tape measure measures the degrees of motion available at the joint If you can't move through the entire ROM, more often there is limiting muscle or muscle group TERM 48
What is range of muscle length and how is it
measured?
DEFINITION 48 measured with a goniometer, inclinometer or tape measure the length of the muscle measured is in degrees of motion for single joint muscles, ROM = length for two joint muscles, muscle length is 80% of the combined ROM of both joints it crosses TERM 49
What is active insufficiency?
DEFINITION 49 occurs when a muscle reaches a point where it cannot shorten any farther occurs to the agonist EXAMPLE: biceps brachii actively insufficient when elbow and shoulder are flexed with forearm in supination TERM 50
What is passive insufficiency?
DEFINITION 50 when a muscle cannot be elongated any farther without damage to the fibers occurs to the antagonist EXAMPLE: biceps brachii passively insufficient when elbow and shoulder are extended with forearm in pronation
