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what are the five elements of patient management
- examination: comprenensive screening process
- evaluation: clinical judgement from info
- Diagnosis: describes/identifies the impact of a condition or disease process on the level of the system and at the level of the whole person
- Prognosis: predicted optimal level of improvement in function
- intervention: at/pt techniques and procedures
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to diagnose you need to have...
- (poppl)
- Proper interview skills
- observe clinical signs and symptoms
- palpation tests
- physical examination
- labratory and diagnostic imaging techniques
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what is the purpose of an evaluation
- to fully understand a patients problems
- from patients and clinical perspective
- physical basis for symptoms that the patient is complaining of
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Soap notes....
- Subjective: history symptoms
- Objective: observation, signs palpation, neurological, circulatory
- Assessment: conclusion from info
- Plan: treatment, rehab, referral, re-eval
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Sequential Method...
- CORN
- comprehensive
- organized
- reproducible
- not random
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During eval... kinetic chain
connected and compensation
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During eval... Bilateral comparison
- uninvolved vs involved
- gain trust, rapport, base line comparison
- shows partient what to expect
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Patient history (drips)
- Develop rapport
- repetition (ask Qs in diff way)
- interviewing
- past injuries, surgeries
- social/family history
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History Considerations.... POOP
- pain location
- occupation, sport, position
- onset
- previous ans similar injury
- ... consitency of pain
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observation? GLAC
- Gait: etc walking pattern
- looking/inspection
- Assess symmetries that may be related to pathology
- clothing may interfere
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Scanning...?
- survey of body
- 10 seconds
- involves educated guess
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scanning...? (overt pain behavior)
- gaurding
- bracing
- rubbing
- grimacing
- sighing
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some observations..? BOSS
- body alignment: anterior/lateral
- obvious deformity: structural, functional, dynamic
- scars
- soft tissure contours
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palpations...?
- move distally to injured part
- patient relaxed
- body part supported
- with a purpose
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palpations (tissue)
- tension: spasticity, ridgity, flaccid
- texture: direction of fibers
- thickness: edema, swelling
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Examination Principles..
- voluntary consent
- some tests casuse pain: painful motions done last
- confirms or refutes suspected diagnosis
- systematic
- care needed for irritable conditions
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examination uninvolved test first
- unless bilateral movement is needed
- bilateral comparison:
- sets standards/base/norm
- show patient what to expect
- develop trust
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AROM...
- (active range of motion)
- on contractile tissue (mm)
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PROM
- Passive range of motion (helper)
- inert tissue (non mm)
- quality of end feel
- at the end of motion how does it feel?
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AROM and PROM
- done individually
- incomplete arom followed by overpressure (prom)
- use caution
- determine end feel
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more on end feels
- bone to bone
- soft tissue
- tissue stretch
- not normal ones (MECS)
- mm spasm
- capsular
- empty (missing ligs)
- springy block (bone fragment maybe)
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spinal cords and nerve roots!
- there are 31
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 cocygeal
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types of nerve roots
- dermatome: senseory distribution, area of skin innervated by nerve root
- myotome: group of mms innervated by nerve root
- sclerotome: bone or fascia innervated by nerve root
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types of nerve injuries
- myelopathy: spinal cord/brain lesion
- radciulopathy: nerve root lesion
- plexopathy: plexus branch lesion
- neuropathy: peripheral nerve lesion
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nerve issues :(
- burner stinger: compression of root, cause atrophy
- referred pain: distance from actual injury
- neural tension: puts nerve on stretch
- nerve palsy: paralysis
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specific joints
- diff between contractile, inert, and nervous tissue
- hypomobile: is decreased motion
- hypermobile: increased motion
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active movements and physiological barriers
- caused by...
- pain
- weakness
- nerve lesion
- (cheat by using accessory motions)
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Passive movements and anatomical barriers
pain!!!
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Manual MM/myotome testing
- Held for 5 secs to detereming weakness
- joint in neutral/resting position/mid range of motion
- may have to test in diff range to illicit symptoms
- at times, dont let pain interfere w/ test
- (except when suspecting fracture)
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MMT grading scale
- 5: full rom with max resistance
- 4: full rom with mod resistance
- 3: full rom against gravity
- 2: full rom with gravity eliminated
- 1: no rom, slight contraction
- 0: no palpable contraction
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ligamentous stress tests and joint play movements
- STRAG
- stress to pain
- tests ligaments and capsule
- repeated
- avoid spasm or mm guarding
- gentle pressure
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loose packed position
- least amnt of stress
- greatest joint capacity
- least amnt of contract surface
- position when doing a mobilization/ligament test
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close packed position
- max tension
- joint surfaces in contract
- max joint stability
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