Escolar Documentos
Profissional Documentos
Cultura Documentos
QUESTION GUIDELINES
1
intervention.
PAIN
INSPECTION
SENSORIUM
ORIENTATION
2
Awareness of Time, Person, and Place (oriented x 3)
AMBULATORY STATUS
PRESSURE SORES
BODY BUILD
PALPATION
PALPATION GUIDELINES
3
Tenderness Scale/Grading 1 complains of pain
2 complains of pain & winces
3 winces & withdraws limb
4 patient won’t allow palpation
EDEMA
VITAL SIGNS
BLOOD PRESSURE
Elevate BP Lowers BP
4
PULSE RATE
RESPIRATORY RATE
TEMPERATURE
5
Relapsing/Recurrent alternate b/n pyrexia &
normal
lapse for > 24 hr
Sustained/Constant consistently elevated
temperature
SENSORY ASSESSMENT
Sensory impairments interfere with acquisition of new motor skills
since
motor learning is dependent on sensory information and feedback
EXAMINATION PROTOCOL
6
Let finger slide over the
pin
Light touch Use cotton or camel hair
brush
Pressure Use thumb enough to
indent skin
Temperature Use test tubes with warm
(41-50˚F) and cold (104-
113˚F)
Response When patient feels
stimuli, respond with yes,
now or unable to tell
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to remove the auditory
clues.
Response Verbally identify the
vibrating stimuli
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9
MUSCULOSKELETAL ASSESSMENT
Circle the number which best represents the intensity of your pain
0 1 2 3 4 5 6 7 8 9 10
No Pain Worst
Pain
Imaginable
Previous Care/Medical History Previous occurrence of the
condition, treatments received
and its effects
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Occupational, recreational, social history patient’s work and
activities, architectural
barriers, environmental
accessibility
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
RANGE OF MOTION
AROM-PROM-Isometric movements
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Resisted isometrics are done with the joint
in resting position
Attention!!
Limitations in AROM may indicate affection of either contractile or
none
contractile tissue or both. The examiner must perform further
testing to
isolate the cause.
Attention!!!
Limitations in passive ROM maybe d/t bone or joint abnormalities
or tightness of these structures. Pain during this test is usually
related to pinching, stretching, or moving of non-contractile tissue.
12
End Feel Abnormal End Feels
Firm
Occurs sooner or later in the Increased muscular tonus
ROM than is usual, or in a Capsular, muscular, liga-
joint that normally has a mentous shortening
soft or hard end-feel.
Hard
Chondromalacia
Occurs sooner or later in the
Osteoarthritis
ROM than is usual, or in a
Loose bodies in joint
joint that normally has a
Myositis ossificans
soft or firm end-feel.
Fracture
A bony grating or bony
block is felt.
Empty
No real end-feel because Acute joint inflammation
pain prevents reaching end Bursitis
of ROM. No resistance is Abscess
felt except for patient’s Fracture
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Pattern of Limitation Capsular Patterns
Attention!!!
Determine what causes the capsular pattern, if it is inflammation
treatment is same for acute stage. If the cause is fibrosis,
treatment is same for chronic stage.
Non-Capsular Patterns
Capsular Patterns
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Joint Pattern
Shoulder ER>ABD>IR
Elbow F>E
Forearm Pronation=Supination
Wrist F=E
UE digit F>E
Knee F>E
Ankle PF>DF
ROM Values
AVERAGE RANGES OF MOTION FOR THE UPPER EXTREMITIES
IN DEGREES FROM SELECTED SOURCES
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Lateral 0-90 ER/IR 0-45
Elbow Flexion 0-150 Knee Flexion 0-135
Forearm Pronation 0-80 Ankle PF 0-50
Supination 0-80 DF 0-20
Wrist Extension 0-70 Inversion 0-35
Flexion 0-80 Eversion 0-15
Radial 0-20 Subtalar Inv/Evr 0-5
Ulnar deviation 0-30 Great toe
Thumb
CMC Abduction 0-70 MTP flexion 0-45
Flexion 0-15 extension 0-70
Extension 0-20 PI flexion 0-90
Opposition Tip of thumb to
or tip of fifth digit Lesser toe
MTP flexion 0-40
MCP Flexion 0-50 extension 0-40
IP Flexion 0-80 PIP flexion 0-35
Digits DIP flexion 0-30
Second -
Fifth
MCP Flexion 0-90
Hyperextensio 0-45
Abduction
PIP Flexion 0-100
DIP Flexion 0-90
Hyperextensio 0-10
n
ACESSORY JOINT MOTIONS
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RESISTED ISOMETRIC TESTING
RESULTS OF RESISTED
ISOMETRIC TESTING
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MANUAL MUSCLE TESTING
Grades Criteria
Normal N 5 10
Full available ROM, against
gravity, strong manual
resistance
Good Plus G+ 5– 9
Full available ROM, against
gravity, nearly strong
manual resistance
Good G 4 8
Full available ROM, against
gravity, moderate manual
resistance
Good Minus G– 4– 7
Full available ROM, against
gravity, nearly moderate
manual resistance
Fair Plus F+ 3+ 6
Full available ROM, against
gravity, slight manual
resistance
Fair F 3 5
Full available ROM, against
gravity, no resistance
Fair Minus F– 3– 4
At least 50% of ROM, against
gravity, no resistance
Poor Plus P+ 2+ 3
Full available ROM, gravity
minimized, slight manual
resistance
Poor P 2 2
Full available ROM, gravity
minimized, no resistance
Poor Minus P– 2– 1
At least 50% of ROM, gravity
minimized, no resistance
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Trace T 1 T
No observable motion, palpable
muscle contraction, no resistance
Zero 0 0 0
No observable or palpable muscle
contraction
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Metacarpophalangeal Full opposition (thumb)
Interphalangeal Full extension
Hip Full extension, medial rotation*
Knee Full extension, lateral rotation of tibia
Talocrural (ankle) Maximum dorsiflexion
Subtalar Supination
Midtarsal Supination
Tarsometatarsal Supination
Metatarsophalangeal Full extension
MOTOR EVALUATION
TONE
Grade Description
0 No increase in muscle tone.
2 More marked increase in muscle tone through most of the ROM, but
affected part(s) easily moved.
Jaw (trigeminal)
Biceps (C5, C6)
Triceps (C7, C8)
Hamstrings (L5, S1, S2)
Patellar (L2, L3, L4)
Ankle (S1, S2)
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Grade Evaluation Response Characteristics
BALANCE
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1 2 3 4 5 6
1. Eyes open,
fixed support
2. Eyes closed,
fixed support
3. Visual
conflict, fixed
support
4. Eyes open,
moving
surface
5. Eyes closed,
moving
support
6. Visual
conflict
moving
support
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Result-Interpretation
COORDINATION ASSESSMENT
NON-EQUILIBRIUM TESTS
23
TEST PROCEDURE
1. Finger to nose The shoulder is abducted to 90 degrees
with the elbow extended. The patient is
asked to bring the tip of the index finger
to the tip of the nose. Alterations may
be made in the initial starting position
to assess performance from different
planes of motion.
2. Finger to therapist's finger The patient and therapist sit opposite each
other. The therapist's index finger is held in
front of the patient. The patient is asked to
touch the tip of the index finger to the
therapist's index finger. The position of the
therapist's finger may be altered during
testing to assess ability to change
distance, direction, and force of
movement.
3. Finger to finger
Both shoulders are abducted to 90 degrees
with the elbows extended. The patient is
asked to bring both hands toward the
midline and approximate the index fingers
from opposing hands.
4. Alternate nose to finger
The patient alternately touches the tip of
the nose and the tip of the therapist's
finger with the index finger. The position
of the therapist's finger may be altered
during testing to assess ability to change
distance, direction, and force of
movement.
5. Finger opposition
The patient touches the tip of the thumb to
the tip of each finger in sequence. Speed
may be gradually increased.
6. Mass grasp
An alternation is made between opening
and closing fist (from finger flexion to full
extension). Speed may be gradually
7. Pronation/supination increased.
9. Tapping (hand)
EQUILIBRIUM COORDINATION
TESTS
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the knees while sitting on a Swiss ball.
Hypotonia Passive
movement
Deep tendon
reflexes
26
Rigidity Passiv e moveme nt
Observation during functional
activities
Observation of resting
posture(s)
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GAIT ANALYSIS
GAIT TERMS
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HIP DEVIATIONS: STANCE PHASE
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KNEE DEVIATIONS: STANCE PHASE
30
ANKLE & FOOT DEVIATIONS: STANCE
PHASE
31
RATING FOR GAIT ANALYSIS
32
FUNCTIONAL ANALYSIS
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Functional Independence Measure (FIM)
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