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What are the 5 sub-classifications within the treatment based classification system?
- Conditioning and Increased Exercise Tolerance
- Pain Control
- Reduce Headache
What is the goal of classification by physical therapists?
To use the examination process to ID groups of patients who are most likely to respond to a particular type of intervention.
What is required to be present in mechanical neck pain?
- pain in the area of the cervical or upper thoracic spine
- Pain, paresthesia, or other changes in cutaneous sensation of spinal origin located in the upper thoracic, shoulder, or arm area
- Alteration in relexes or loss of motor function in the upper extremities, again from spinal origin
Describe presentation of a patient that may require referral related to spinal fractures.
- Major trauma
- Severe limitation during neck AROM in all directions
Describe presentation of a patient that may require referral related to cervical myelopathy.
- Sensory changes in the hands
- Muscle wasting of hand intrinsics
- Unsteady gait
- Hoffmann reflex
- Bowel and bladder disturdances
- Multisegmental weakness, sensory changes, or both
Describe presentation of a patient that may require referral related to neoplastic conditions.
- Over 50 yo
- Previous history of cancer
- Unexplained weight loss
- Constant pain, no relief with bed rest
- Night pain
Describe presentation of a patient that may require referral related to upper cervical ligamentous instability.
- Occipital headache and numbness
- Severe limitation during neck AROM in all directions
- Signs of cervical myelopathy
Describe presentation of a patient that may require referral related to vertebral artery insufficiency.
- Drop attacks
- Dizziness or lightheadedness related to neck movement
- Dysphasia - difficulty swollowing
- Dysarthria - difficulty talkingor slurring of speech
- Diplopia - double vision
- Positive cranial nerve signs
Describe presentation of a patient that may require referral related to inflammatory or systemic disease.
- Temperature >100 degF
- Blood pressure >160/95
- Resting pule >100 bpm
- Resting respiration >25bpm
What are the most common cancers to metastasize to the spine?
When should an alert and stable trauma patient have cervical spine radiographs?
- High-risk factors: age >65; paresthesias in the extremities; dangerous mechanism of injury (fall >1 meter or 5 stairs, MVC >60mph)
- When you cannot assess ROM
- Not able to actively rotate 45 deg bilat
What are the recommendations for goals when treating patients with fear avoidance beliefs?
- Emphasis on active rehab and positive reinforcement of functional accomplishments.
- graded exercise programs that direct attention toward attaining certain functional goals and away from the symptom of pain.
- Graduated exposure to specific activities that a patient fears as potentially painful or difficult.
What amount of change is indicative of a true change in the patient's status on the numeric pain scale?
What is the minimum detectable change for the NDI?
Scores greater than what percentage indicate that patients may have a substantial nonmovement-related component to their symptoms?
What is the capsular patern of the cervical spine?
Full flexion, limited extension, and symmetrical limitations of side bending and rotation.
Describe the elevate arm stress test (Roos).
- Abduct arms to 90 deg, laterally rotate shoulder, and flex elbow to 90 so the elbows are slightly behind the frontal plane.
- Patient then opens and closes the hands slowly for 3 minutes.
- Positive with onset of patients symptoms, heaviness, or profound weakness of the arm, or numbness and tingling of the hand.
Are the test for thoracic outlet specific?
No, this leads to high false-positive rates.
What makes up the test item cluster for cervical radiculopathy?
- Positive Spurling test
- Positive distraction test
- Positive upper limb tension test
- Presence of less than 60 deg rotation ROM to the involved side
What muscles are stretched with patient in right sidelying, neck flexion, R side bend, and R rotation?
Left levator scapulae, splenius cervicis, and posterior scalenes
How is the upper trap and SCM stretched?
- Supine with patient reaching with UE on side to be stretched
- Flex, side bend away, and rotate towards
How are the anterior and middle scalene stretched?
- Patient's head and neck off the table
- Support the occiput with one hand and place the shoulder on the patient's forehead
- Maintain upper cervical flexion while stabilizing the patient's superior medial clavicle and first rib
- Translate the head and neck from anterior to posterior while keeping the CV junction flexed
- Then take the neck into side bending away and rotation towards
What is the gold standard for establishing the diagnosis of both lumbar and cervical radiculopathy?
Describe the manual technique for treating an elevated first rib.
- Patient seated, therapist's lower extremity on the side opposite to be treated to stablize the patient
- Contact the first rib lateral to the transverse process of T1
- Side bentd toward and rotate away the side to be treated
- Use a thrust or non-thrust inferior directed glide on the rib
What is the capsular pattern of the cervical spine?
Loss of extension, with equal restriction in side bending and rotation ROM.
Describe the mechanical tration parameters for treatment on an arthritic cervical spine in the mobility sub-classification.
- 10% to 15% body weight with minimum set to zero
- Performed in 24 deg flexion
- 5:1 on:off time ratio
Describe the self stretch for the anterior and middle scalene muscles.
- Patient uses a towel to stabilize the first rib
- Perform chin tuck
- Side bend away
- Rotate towards