Prac Viva

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  1. What is the kind of history that a pt presenting with Lsp problems?
    • - pain, stiffness, weakness, instability?
    • - status- getting better or worse
    • - body chart- area of pain, paraesthesia, areas above/ below, clear areas
    • a tick= area is fine
    • x = area of pins and needles and numbness
  2. What qu do u ask the pt about their history?
    • - 24hr behaviour- am stiffness, day, evening- night, sleep position
    • - aggravating factors- sitting, sit to stand, standing, walking, bending, prolonged bending, lifting- cough, sneze (valsalva manoeuvres)
    • - easing factors- rest, movt, position
    • - irritability- mechanical/ inflam- howeasy to aggravate/relieve
    • - how long can you stand for before you get your pain
  3. What are the special qu that must be asked of a pt with Lsp problems?
    • - cauda equina- since back pain, do you have trouble controlling your bladder/ bowel? Or saddle pareasthesia/ anaesthesia
    • - spinal cord- bilateral limb pareasthesia- glove/ sock distribution, unsteadiness on feet (ataxia)
    • - general health
    • - if an recent unexplained weight loss
    • - medication
    • - long term medication- steriods/ anticoagulants
    • - recent x-rays
    • - past illness, surgery, Ca
    • - red flad- you may need to link between what they tell you and mechanical problems
  4. What past history will you ask your Lsp pt of?
    • - of this episode
    • - previous episode- how long to get better- baseline for realistic goals
    • - trauma
    • - surgery
  5. What yellow flags or psychosocial qu/ things do we need to find out about a pt with Lsp?
    • - occupation
    • - work status- do they feel supported
    • - home- sport, hobbies
    • - concerns about return to work, return to activites
    • - pts perspective on their condition- what they think is going on
  6. Conduct a physical examination on ur Lsp pt.
    • obs- posture, scoliosis, pelvic shift, wasting
    • functional movt- sit- stand, walk, standingon one leg
    • Observe- quality, rhythm, range, pain behaviour, spasm
    • -standing on one leg u can get ur pt into ipsilateral compression
    • - ridgid in mm spasm- crease formation where they use, dip at L4/5- step
  7. Conduct Lsp active movts with your patient
    • flex
    • ext
    • LF
    • Rot (sitting)- test in sitting- stabilise pelvis
    • OP- stabilise pelvis and OP, OP when reproducing P
    • Quadrant- closing-ext and side flexion
    • - opening- flex and SF
    • repeate movts to see if there is a response with P
    • Sustained movts
  8. Conduct a neurological examination of a pt with Lsp problems
    • - is essential as a precaution pain, PN and numbness
    • - sensation
    • - power (s1 in standing)
    • - reflexes
    • -babinski
    • - clonus
  9. What are the neurodynamic tests for the Lsp?
    • sensitivity of nervous system to mechanical stressors
    • - SLR
    • - passive neck flexion
    • - prone knee bend PKB
  10. Perform the SLR neurodynamic test
    • - +/-sensiting manoeuvres (DF, IR, NF)
    • - hold heel in your hand
    • - lock knee in ext
    • - do a few so the pt gets use to and relaxes their mm
    • - If PF eases it is neuro
  11. Conduct the neurodynamic test passive neck flexion?
    • pt supine legs in ext
    • start with a small head nod
    • progress to excess neck flexion
  12. Conduct a PKB neurodynamic test on your lumbar spine pt
    • - pt prone
    • - knees bent together and relax
    • - lift head up into ext
    • - wind up the femoral nerve
    • 'their pain'
    • Standardise
  13. Palpate the area of a Lsp pt
    • - soft tissue- feel for heat and mm spasm
    • -PAVIMS
    • - central PA
    • - Unilateral PA- both sides
    • - transverse- push spinour process across- this increases unilateral flexion
  14. Conduct the PPIVMS on ur pt with Lsp problems
    • Pt sidelying
    • You are feeling for what level the lack of movt where you need to treat
    • - flex
    • - ext
    • - LF
    • - Rot
    • Supports pts legs on yours move pt into flex
  15. What are the basic treatment for a pt with Lsp problems
    • PAIVMS:
    • - Central- to increase extension
    • - unilateral- increase ext and lateral flex same side
    • - transverse- open other side and increase rot to the same side
    • - rotation
  16. How can you treat a pt using a rot technique
    • Grades 1- 4
    • 1- knees bent and together- to fel L5 need to be in more flex
    • pt hand on be small rot movements and rock down the femur, hands over the greater trochanter
    • 2- sameas above but arm on side rokin opposites
    • 3- bottomr leg nearly in ext and top leg still flex. Arm still on ribs and rock top
    • 4- pull bottomw shoulder out so pt is nearly flat on back
  17. lateral flex treatment
    • 1-4
    • - used to close with restriction
    • - push up thelateral side- one small, two large
  18. Lsp treatment- distraction
    • longitudinal caudad
    • Single leg
    • Bilateral
    • Pt supine- knees flex position, get on bed as well and pull down
Card Set:
Prac Viva
2012-05-31 06:01:06
Lumbar Spine

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