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180 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is an "outcome" with respect to health status? ***
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changes in health status that may be associated with exposure to an intervention
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Assessment instruments need to be: ***
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- valid (measure what they are supposed to)
- reliable (repeatable) - clinically relevant |
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Name some types of assessment instruments. ***
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- surveys
- questionnaires - interview - performance measurements - gross observation - computerized testing - manual testing - mechanical testing |
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What is the ICF? ***
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International Classification of Functioning, Disability, and Health
- a classification of health-related domains - endorsed in 2001 as international standard - WHOs framework or “ruler” for measuring health and disability at both individual and population levels |
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What is the international standard for measuring health and disability of individuals and/or populations? ***
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International Classification of Functioning, Disability, and Health (ICF)
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What two lists comprise the ICF? ***
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1) body functions and structure
2) activity and participation (environmental factors considered also) http://www.who.int/classifications/icf/en |
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What body structure and function measures are organized by the ICF? ***
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- Manual Muscle Test (MMT) – muscle strength
- Goniometry – joint range of motion - Modified Ashworth Scale – muscle tone - Glasgow Coma Scale – neurological scale to describe conscious state of a person - Rancho Levels of Cognitive Function (LOCF) (TBI) – levels of cognitive functioning - Mini Mental State Exam (MMSE) – cognitive impairment screen - ASIA* impairment scale – standard neurological classification of spinal cord injury - Fugl-Meyer assessment of sensorimotor recovery after stroke (FMA) – stroke-specific, performance-based, impairment index - National Institutes of Health Stroke Scale (NIHSS) – communicates several deficits s/p CVA, 25 is major, 4 or less minor *American Spinal Injury Association |
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What activity measures are organized by the ICF? ***
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- Functional Independence Measure (FIM) - common measure for describing functional status of patients
- 6-minute walk test (6MWT) – useful measure of functional capacity for patients with moderate to severe impairments - Motor Activity Log (MAL) – assessment tool for use of paretic UE use in ADLs for patients s/p CVA - Dynamic Gait Index – assessment of functional status ambulation in ADLs - Timed Up & Go (TUG) – basic functional mobility/fall risk quick assessment - Berg Balance Scale (BBS) – tests balance from a variety of positions (0-4) - Functional Reach test – single item test, quick screen for balance problems - Performance Oriented Mobility Assessment (POMA) – quantitative assessment of balance and gait, can be performed bedside in about 5 mins. |
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What participation measures are organized by the ICF? ***
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- Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) – patient questionnaire used to document and quantify mobility (self-report)
- MOS SF-36 – medical outcome study, short-form, 36 items, may be used to determine cost-effectiveness of treatment - Activities-specific Balance Confidence Scale (ABC) – patient questionnaire regarding confidence in completing ADLs requiring balance - Stroke Impact Scale (SIS) – subjective reporting measurement of functional ability |
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What broad categories of measures are organized by the ICF? ***
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- body structure and function meausres
- activity measures - participation measures |
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What is an ICD code? ***
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- International Statistical Classification of Diseases and Related Health Problems (ICD-10) (1992), (ICD-11 by 2015)
- for use in the public domain, published by the World Health Organization (WHO) - every health condition assigned to a category and given a unique code up to 6 characters long - used worldwide for consistency, statistics, and reimbursement (Example: 2011 ICD-9-CM Diagnosis Code 524.52 : limited mandibular range of motion |
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Describe the Functional Independence Measure (FIM). ***
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- measure of disability (vs. impairment*) for a variety of patient diagnoses
- measures level of patient independence in several categories: ---- self-care ---- sphincter control ---- transfers ---- locomotion (locomotion scale includes steps, level vs. uneven, distance, and amount of assistance required) ---- communication, and ---- social cognition * remember the Nagi Model of Disablement: - active pathology (e.g., OA) - creates impairment, (e.g., loss of ROM, muscle weakness) - which creates functional limitations, (e.g., slow gait, unable to rise from chair) - which create a disability (e.g., does not leave house, does not work) that progressively affects a person from the cellular level, to the body system level, to the whole person level, to the level of the person's relationship with society although the WHO doesn't follow the Nagi model and tends to lump them together; definition of "disabilities" from their website: "Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives." |
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What are the major categories of the FIM? ***
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self care
- eating - grooming - bathing - dressing UE - dressing LE* sphincter control - toileting (pull down, wipe, pull up)* - bladder (level and frequency of accidents) - bowel (level and frequency of accidents) transfers - transfer bed* - transfer toilet* - tub/shower transfers* locomotion - locomotion (walk/WC)* - stairs* communication and social cognition - comprehension - expression - social interaction - problem solving - memory * - typically what is done in rehab |
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List the levels of the FIM scale. ***
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0 – not done by patient or helper
1 – total assist (or requires 2 people to assist) patient performs < 25% 2 – maximum assist, patient performs 25-49% of task (or 1 of 3 tasks) 3 –moderate assist, patient performs 50-74% of task (or 2 of 3) 4 – minimum assistance contact guard or steadying assist, patient > 75% of task 5 – supervision only, no touch, set up, verbal cueing 6 – modified independence, assistive device, more time, safety 7 – independent and safe |
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List the levels of locomotion (walk/WC) on the FIM scale. ***
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1 – pt. < 25%, 2 people required, or walks/wheels < 50 ft.
2 – pt. 25-49% at least 50 ft. 3 – pt. provides 50-75% effort 150 ft 4 – contact guard 150 ft. (necessary vs. required) 5 – supervision, cueing, no touch 150 ft. 6 – walk/wc AD 150 ft, more time, safety 7 – walk/wc ind & safe, min.150 ft. |
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List the levels of locomotion (stairs; 12-14) on the FIM scale. ***
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0 – does not go up and down stairs
1 – Pt. < 25% or assist of 2 people, or < 4 stairs 2 – pt. 25 – 49% up and down 4 – 6 steps 3 – pt. 50-74% for one flight of stairs 4 – pt. 75% for one flight of stairs 5 – requires supervision (exception: 4-6 stairs ind) 6 – requires support of handrail &/or cane 7 – goes up & down flight of stairs ind |
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A PTA provides gait training to a 63 y/o male pt. 2 wks s/p ® TKA in a rehabilitation unit. The PTA provides CGA and the pt. ambulates 100 ft. with a cane. How should the PTA record this patient’s locomotion FIM score?
a. 6 – modified independent b. 4 – CGA c. 2 – max assist d. 3 – moderate assist |
c. 2 – max assist
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A 27 y/o pt. s/p ® AKA navigates up and down a flight of stairs by scooting up and down on his buttocks. What is his FIM score?
a. 7 b. 6 c. 5 d. 4 Explain your answer. |
a. 7
he is able to navigate the stairs independently and safely, although not in the "traditional" manner |
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Name some of the causes of LBP. ***
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- sprain, strain, spasm
- HNP - SI joint dysfunction - poor posture (static and/or dynamic) - overuse - decline of physical fitness/muscle weakness - tumor/cyst - degeneration |
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List the types of lower back exercises. ***
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- flexibility
- mechanical - strengthening of back extensor mm - strengthening of core mm |
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For what purposes are flexibility exercises used? ***
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to help overcome tightness, spasm, overuse, sprain, strain, etc.
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What is a good starting duration and number of repetitions for flexibility exercises? ***
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- hold 30 seconds
- approx. 3 reps per side |
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List some of the more common flexibility exercises. ***
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- posterior pelvic tilt
- SKTC/DKTC - piriformis stretch - trunk rotation |
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What other muscles should be considered when prescribing flexibility exercises? ***
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the hamstrings, as tight hamstrings often contribute to spasm, tightness, etc in the low back
(tight hamstrings tend to reduce anterior pelvic tilt and the normal lumbar lordosis, reducing the spine's shock absorbing capabilites) |
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How may DKTC and SKTC flexibility exercises be progressed? ***
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- pull is stronger if preceded by a posterior pelvic tilt (usu. DKTC)
- pull is strongest with addition of straightening of contralateral leg (SKTC, obviously) |
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For what pathology is the piriformis stretch especially suited? ***
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SI joint torsion
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Which muscles do trunk rotations primarily target? ***
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- quadratus lumborum
- paraspinals |
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How may trunk rotations be progressed?
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by straightening the leg(s)
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What is one important advantage of the piriformis stretch? ***
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unlike other LB exercises (SKTC, DKTC, etc.) it may be done while seated (ankle on opposite knee, lean forward) and thus may conveniently be done throughout the day at a desk
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What is the purpose of mechanical exercises for the lower back? ***
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- to push the escaping nucleus pulposus back into the center of the disc and
- to centralize the symptoms |
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Who first brought awareness to the diagnosis and exercise treatment of HNP? ***
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Dr. Robin McKenzie, a PT from NZ and founder of the McKenzie method which advocates self-treatment over manual therapy procedures
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Describe development of an HNP. ***
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- microtears occur over time in the annulus fibrosus
- nuclear material (nucleus pulposus) migrates through the broken concentric rings of the annulus - pressure on spinal nerves causes LBP and/or radiating nerve pain |
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Where are the most common sites for lumbar disc herniation? ***
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- L5-S1
- L4-L5 |
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In which direction does HNP material tend to flow/bulge? Why? ***
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- posterio-laterally
- this is where the posterior longitudinal ligament (PLL) is the weakest |
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List the four stages of disc injury. ***
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- degeneration (protrusion)
- prolapse - extrusion - sequestration |
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What is disc protrusion (degeneration)? ***
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- disc bulges
- no injury to annulus fibrosus |
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What is disc prolapse? ***
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- nucleus pulposus pushes into the outermost fibers of annulus fibrosus
- results in bulge in wall of disc |
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What is disc extrusion? ***
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- annulus fibrosus is perforated and nucleus pulposus material moves into the epidural space
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What is disc sequestration? ***
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- discal fragments outside the disc proper are free in the spinal canal
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List some exercises for mechanical LBP. ***
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back extension exercises are best:
- bending backwards (standing) - raising head/torso from prone (e.g., cobra) - plank |
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What is the goal of back extension exercises for mechanical LBP? ***
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centralization of symptoms
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How is spinal extension from the prone postion progressed? ***
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- pt able to lift head
- then up on elbows - then with hands under shoulders, arms fully extended, and ASISs still contacting mat/floor |
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What is the purpose behind strengthening exercises for LB? ***
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can be used:
- at any stage of the healing process (acute, subacute, or chronic), or - as a preventative measure |
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Low-back and core strengthening exercises are a ______ of flexibility and mechanical exercises. ***
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progression
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Describe the McKenzie protocol for tx of HNP. ***
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- approximately 3 days of mechanical exercise to eliminate pain
- followed by core/back strengthening exercise |
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Are all LBP patients treated with the same exercises? ***
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no, the therapist must know the cause
(e.g., a pt with a posterior HNP may find his symptoms aggravated by DKTC) |
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When attempting to centralize radiating LBP with mechanical exercise, a pt experiences a decrease in leg pain, but an increase in the LBP. Is this OK? ***
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yes
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For which pathology is the Adson's test administered? ***
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thoracic outlet syndrome
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How is Adson's test administered? ***
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- pt seated or standing
- while palpating radial pulse, move arm into ABD, EXT, and ER - have pt rotate head to same side, take deep breath, and hold http://www.youtube.com/watch?v=z5uIH69ke4E |
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What constitutes a positive Adson's test? ***
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absence or diminishing of radial pulse
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For which pathology is the Apprehension test administered? ***
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for anterior glenohumeral instability
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How is the Apprehension test administered? ***
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- pt supine or seated
- ABD arm to 90° and slowly ER the shoulder http://www.youtube.com/watch?v=qKqJRrms4u8 |
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What constitutes a positive Apprehension test? ***
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a look of apprehension or alarm on the pt's face or feeling of instability
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For which pathology is the Neer's test administered? ***
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impingement
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How is the Neer's test administered? ***
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- pt seated or standing
- passively take arm into flexion w/ humerus in IR http://www.youtube.com/watch?v=nq6x7f31tZ0 |
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What constitutes a positive Neer's test? ***
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pain indicating impingement of supraspinatus or long head of biceps
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What test can help diagnose thoracic outlet syndrome? ***
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Adson's test
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What test can help diagnose glenohumeral anterior instability? ***
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Apprehension test
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What tests can help diagnose impingement at the shoulder? ***
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- Neer's test
- Hawkins/Kennedy test - Empty can test |
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For which pathology is the Hawkins/Kennedy test administered? ***
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impingement at the shoulder
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How is the Hawkins/Kennedy test administered? ***
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- pt seated or standing
- flex shoulder to 90°, flex elbow to 90°, then IR shoulder http://www.youtube.com/watch?v=q9P8zDYsERs |
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What constitutes a positive Hawkins/Kennedy test? ***
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pain due to impingement of supraspinatus against coracoacromial arch
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For which pathology is the empty can test administered? ***
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impingement, tear, or tendonitis of supraspinatus
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How is the empty can test administered? ***
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- pt seated or standing
- flex shoulder 90°, IR with elbow extended - administer "break test" http://www.youtube.com/watch?v=qjHOqydDhxo |
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What constitutes a positive empty can test? ***
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pain or weakness indicating impingement, tear, or tendonitis of supraspinatus tendon
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For which pathology is the drop arm test administered? ***
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- rotator cuff/supraspinatus tears
- most effective on moderate to severe tears |
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How is the drop arm test administered? ***
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- pt standing; raises arm(s) overhead (videos only abduct to 90°)
- then pt attempts to lower arm(s) slowly http://www.youtube.com/watch?v=ZhN1_ZJyUnk |
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What constitutes a positive drop arm test? ***
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pt cannot slowly lower the arm (it drops) or slowly lowering it creates a great deal of pain
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What test can help diagnose a tear in the rotator cuff/supraspinatus? ***
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drop arm test
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For which pathology is the Speed's test administered? ***
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tear of the biceps tendon/muscle or labrum
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How is the Speed's test administered? ***
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- pt seated or standing with shoulder flexed 75°-90°, elbow extended and forearm supinated
- pt attempts to elevate arm against resistance/resists examiner's downward pressure on arm http://www.youtube.com/watch?v=U-1sZbl5o2A |
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What constitutes a positive Speed's test? ***
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pain in the bicipital groove area
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What test can help diagnose a biceps tendon or muscle tear or labral tear? ***
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Speed's test
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For what pathology is the Clunk test administered? ***
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labral tear or detachment
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How is the Clunk test administered? ***
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- pt supine with arm elevated 160° in scapular plane
- examiner compresses the humeral head, moves it caudally, then circumducts the arm both clockwise and counterclockwise http://www.youtube.com/watch?feature=endscreen&NR=1&v=qy19mEJ89Sc |
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What constitutes a positive Clunk test? ***
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a "clunk" or grinding that reproduces pain or locking of the GH joint, indicating a labral tear
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What test(s) can help diagnose a glenoid labral tear? ***
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- Speed's test
- Clunk test - O'Brien's test for SLAP lesion |
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For which pathology is an O'Brien's test administered? ***
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labral tear or SLAP* lesion (although rotator cuff or AC joint pathology may produce a false positive)
* SLAP - superior labral tear, anterior-posterior |
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How is an O'Brien's test administered? ***
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- pt seated or standing
- arm flexed to 90°, horizontally adducted to 10°, and thumb pointing downward - examiner pushes downward against pt resistance and repeats with thumb pointing up http://www.youtube.com/watch?v=gaDhqFP4lCE |
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What constitutes a positive O'Brien's test? ***
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- pain or clicking in GH joint with thumb pointing downward
- no pain or clicking in GH joint with thumb pointing upward (although rotator cuff or AC joint pathology may produce a false positive) |
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For which pathology is the Phalen's test administered? ***
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carpal tunnel syndrome
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How is the Phalen's test administered? ***
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- pt places both wrists in maximal flexion with dorsal surfaces in full contact
- hold for up to 60 seconds http://www.youtube.com/watch?v=952eYGo19gE |
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What constitutes a positive result on the Phalen's test? ***
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- numbness or tingling
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What test(s) can help diagnose carpal tunnel syndrome? ***
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- Phalen's test
- Tinel's sign |
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For which pathology is the Tinel's sign indicative? ***
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carpal tunnel syndrome
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How is the test for Tinel's sign administered? ***
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- pt's UE supported in supination
- examiner taps volar surface of wrist |
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What constitutes a positive test for Tinel's sign? ***
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tingling in the median nerve distribution
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For which pathology is the Finkelstein test administered? ***
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deQuervain's syndrome
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How is the Finkelstein test administered? ***
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- pt forms a fist around the thumb
- then ulnarly deviates wrist http://www.youtube.com/watch?v=RfyXClxY_E0 |
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What constitutes a positive Finkelstein test? ***
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pain along the APL and EPB
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Specs for kinesio tape ***
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- water-resistant
- no latex (acrylic) - can be used almost anywhere (proximal to distal and vice versa) |
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Origin of kinesio tape ***
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- Japan, 1979
- Dr. Kenzo Kase |
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Stages at which kinesio tape can be used ***
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- acute
- subacute - chronic - preventative |
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May kinesio tape be used with other modalities? ***
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yes, it may be used with heat, cryotherapy, etc.
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Describe the stretch of kinesio tape. ***
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- has a 10% stretch on the paper
- elastic stretch between 40% and 60% - beyond 60% or so, you lose the elasticity (so don't pull too tightly!) |
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In what direction(s) does kinesio tape stretch? ***
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only longitudinally
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What is the purpose of the "wave" pattern on the kinesio tape? ***
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to promote circulation
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What is the incidental benefit noted with black kinesio tape? ***
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black absorbs light, thus provides some incidental heating to tissue
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What are the 5 primary reasons for using kinesio tape? ***
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- to correct skin
- circulatory/lymphatic drainage - fascia - muscle - joint |
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How is kinesio taping documented? ***
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as neuromuscular reeducation
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What functions does kinesio tape perform on the skin? ***
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- controls pain
- reduces inflammation - reduces swelling - equalizes temperature (black?) (lifting skin = convolution) |
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What functions does kinesio tape perform on the muscle? ***
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- relieves pain
- increases ROM - nomalizes tension - reduces fatigue - assists in tissue recovery |
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What are the four "zones" in kinesio taping? ***
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- anchor
- therapeutic zone - tail - tail end |
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What is the first 1-2 inches of the kinesio tape (when applied to the body) called? ***
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the anchor
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What shapes of kinesio tape are available? ***
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- I
- Y - X - fan |
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How is kinesio tape used to inhibit (motion, stretch, action, etc.)? ***
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- applied distal to proximal (or insertion to origin)
- with 15-25% tension |
DPI
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How is kinesio tape used to facilitate (motion, stretch, drainage, etc.)? ***
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- applied proximal to distal (or origin to insertion)
- with 15-35% tension |
PDF
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Is the kinesio tape applied with more or less stretch for facilitating drainage? ***
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with less stretch
(increase stretch for stability) |
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How much stretch is appliled at the anchor and/or tail end? ***
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none
(you start with an anchor applied with no stretch, hold the end of the anchor with your finger, stretch the recommended therapeutic amount for the therapeutic zone, then hold the end of the therapeutic zone with your finger and lay down the tail end with no stretch) |
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For what types of issues is kinesio tape used for facilitation? ***
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for weak muscles (e.g., foot drop)
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For what types of issues is kinesio tape applied for inhibition? ***
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to relieve tension
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How can you visually differentiate between kinesio tape applied for facilitation and kinesio tape applied for inhibition? ***
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you cannot tell which is which by simply looking at a kinesio tape application
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For what pathologies is kinesio tape used at the joint? ***
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- realignment (e.g., patellar tracking)
- balancing pull of agonist-antagonist - to reduce guarding - to relieve pain |
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Once the kinesio tape is laid down, what must the therapist do to "activate" it? ***
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rub to activate the heat-sensitive adhesive
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What should skin conditions be at the site of kinesio taping? ***
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skin should be:
- oil-free - dry - clip or shave hair - tape 30-40 minutes before sweating, swimming, etc. so body heat will finish off the adhesive effects |
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When kinesio taping, one should be sure to tape the ____ and the _____.
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- the pain AND the cause
(typically one joint below and 1 joint above the issue) |
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How is kinesio tape removed? ***
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- should lose adhesion between 3-7 days
- if removal is desired before that, remove in the direction of hair growth and pull at a low angle or roll off (tapping the skin as you do can help) |
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How do kinesio and McConnell taping differ (e.g., for patellar tracking issues)? ***
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- kinesio tape for patellar tracking will start with the anchor at the medial knee and go lateral, because the elasticity will then pull the patella back toward the medial anchor
- McConnell taping is just the opposite; without the elasticity, you want to start lateral, pushing the kneecap medially as you lay down the tape in that direction |
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What should you do if someone dislocates the prosthesis after a THR? ***
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call 911 immediately, because they're:
a) going to be in extreme pain b) headed back to surgery |
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Some THR patients are being d/c without the standard precautions (NWB, no adduction past midline, no IR, no hip flexion past 90°). In these cases, what should the therapist do? ***
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double check the precautions and follow the physician's order
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What is a good visual cue to give a THR patient to prevent him/her from flexing the hip past 90°? ***
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have the patient place a pen/pencil on the knee, and tell him/her to not let it roll TOWARD the body
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What is a good cue to give a patient who is TTWB or PWB to help them place the appropriate amount of weight on the extremity? ***
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have the patient step as if there is an egg under the foot that he/she is trying not to break
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Why does a THR tend to cause the patient pain in the mid-lateral thigh? ***
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because the stem of the prosthesis is drilled down into the femur
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Can you have a THR patient perform stretching exercises? ***
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yes, as long as you follow any precautions given
(e.g., not flexing the hip past 90°--the patient should still be able to get a good HS stretch without passing 90°, should be able to do a figure-4 piriformis stretch) |
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What causes the pain of OA? ***
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lesions in the articular cartilage
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What is the difference in rehabilitation of a THR and TKR? ***
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- for the hip, you want to guard against excess motion
- for the knee, you want motion, especially to prevent contractures (they need to get full extension) |
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Following THR/TKR surgery, what constitutes the pain? ***
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- the OA pain is gone because the ends of the bone and articular cartilage is gone
- recovery is getting over the pain of the surgery (stretched/cut musculature, the insult of the insertion of the end of the prosthesis into the bone, etc.) |
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Which hurt more, THRs or TKRs? ***
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TKRs
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What is most important for the patient to do following TKR? ***
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they need to work to get back to 0° of knee extension or they may develop contractures that may never be overcome (except by knee manipulation)
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What is the best way to approach moving edema following THR/TKR? ***
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- start by massaging the lymph nodes in the region to get fluid moving
- then bring the fluid over from the site of the swelling and hold to prevent backflow |
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What is ORIF? ***
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open reduction, internal fixation
(they open you up and put in pins, screws, etc.) |
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What post-surgical weight-bearing status is usually given to TKR/TKA patients? ***
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WBAT from the beginning
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Every exercise program should include a(n)..... ***
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aerobic component
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Why should every exercise program include an aerobic component? ****
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increased circulation and oxygen enhance the healing process
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What is the minimum amount of aerobic activity that should be in all exercise programs? ***
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at least 10 minutes
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What is the purpose of scar tissue mobs? ***
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to keep the scar tissue separate and mobile over underlying tissues, so it doesn't "scar down" and adhere to the underlying tissue
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Approximately how long will it take a THR/TKA patient to adjust to the metal-bone bridge? ***
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3-6 months
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What ROM at the knee is needed to properly sit and stand? ***
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past 90°, ideally 110° to 120°
(try standing with your knees at 90°, you throw out your back, rely too heavily on UE, etc.) |
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What is a KFC? ***
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knee flexion contracture
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Which knee motion is a posterior glide done to enhance? ***
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flexion
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Which knee motion is an anterior glide done to enhance? ***
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extension
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What is a knee manipulation? ***
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pt is put under (again) and the drs. move it to full extension, breaking scar tissue, etc.
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The pt claims to be doing 120° knee flexion according to the CPM machine. Should you believe it? ***
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verify, as the machines may be off by 10°- 15°; use a goniometer
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What was the "old" procedure for ACL reconstruction? ***
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new ACL formed from middle 1/3 of patellar tendon
(patellar tendonitis was a common sequela) |
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What is the "new" procedure for ACL reconstruction? ***
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new ACL formed from the semitendinosus muscle
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What is important to stress to pts doing exercises with weights/therabands etc.? ***
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they need to be working both
- concentrically and - eccentrically |
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What is the proper way of performing an SLR? ***
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- quad set
- lock the knee - dorsiflex foot - THEN lift leg |
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How many repetitions should be done to:
- increase power? - increase strength? - promote endurance and revasuclarization? |
-- 3 to 8
-- 10 to 15 -- 25 to 30 |
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What is the purpose behind McConnell taping? ***
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the tape is not the "cure"; it is there to provide support and allow exercise tolerance so the pt may strengthen supporting structures
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What is Clark's sign? ***
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- checks for improper patellar tracking
(pt long sitting, place web between thumb and forefinger over superior patella and squeeze slightly; have patient perform quad set and check for popping, crunching, etc.) |
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Name one way of improving patellar tracking. ***
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- strengthen VMO with SAQ, adding a ball squeeze between the knees
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How is median nerve neural mobilization/stretching done? ***
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with patient supine:
- abduct shoulder 110° (therapist restrains elevation of shoulder girdle) - ER shoulder - supinate forearm - extend wrist - extend fingers and thumb - contralateral bend of neck for additional tension |
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How is radial nerve neural mobilization/stretching done? ***
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with patient supine:
- depress shoulder girdle - IR shoulder - extend elbow - pronate forearm - flex wrist - deviate ulnarly - flex thumb (inside fist) - contralateral bend of neck for additional tension |
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How is ulnar nerve neural mobilization/stretching done? ***
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with patient supine:
- extend wrist - pronate forearm - flex elbow - ER shoulder - abduct shoulder - depress shoulder girdle - contralateral bend of neck for additional tension |
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What is "flossing"? ***
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therapist performs a neural "on/off" gliding motion without a sustained stretch for approximately 1 minute
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Within what range is "flossing" done? ***
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therapist may "floss" within the symptom-free range of the nerve
(do NOT overstretch a nerve; this could cause long-standing or permanent disruption to nerve function) |
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FIM score 0 - overall ***
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not done by pt or helper
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FIM score 0 - locomotion ***
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pt does not locomote
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FIM score 0 - stairs ***
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pt does not go up/down stairs
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FIM score 1 - overall ***
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- total assist
- pt does less than 25% of task - or needs 2-man assist |
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FIM score 1 - locomotion ***
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- pt does less than 25% of task
- locomotes less than 50 feet - or needs 2-man assist |
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FIM score 1 - stairs ***
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- pt does less than 25% of task
- climbs less than 4 stairs - or needs 2-man assist |
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FIM score 2 - overall ***
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- max assist
- pt does 25-49% of task - or 1 of 3 tasks |
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FIM score 2 - locomotion ***
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- pt does 25-49% of task
- locomotes at least 50 feet |
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FIM score 2 - stairs ***
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- pt does 25-49% of task
- goes up/down 4-6 stairs |
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FIM score 3 - overall ***
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- mod assist
- pt does 50-74% of task - or 2 of 3 tasks |
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FIM score 3 - locomotion ***
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- pt does 50-75% of task
- locomotes at least 150 feet |
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FIM score 3 - stairs ***
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- pt does 50-74% of task
- for 1 flight of stairs |
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FIM score 4 - overall ***
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- min assist
- pt does more than 75% of task - CGA |
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FIM score 4 - locomotion ***
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- CGA
- locomotes at least 150 feet |
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FIM score 4 - stairs ***
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- pt does 75% of task for 1 flight of stairs
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FIM score 5 - overall ***
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- supervision only (sup only)
- no touch, setup, or verbal cueing |
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FIM score 5 - locomotion ***
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- supervision only
- locomotes at least 150 feet |
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FIM score 5 - stairs ***
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- supervision only
- or 4-6 stairs independently |
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FIM score 6 - overall ***
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- modified independent
- requires AD or more time |
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FIM score 6 - locomotion ***
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- locomotes at least 150 feet with AD
- but needs extra time |
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FIM score 6 - stairs ***
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- completes 1 flight but needs AD or handrail
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FIM score 7 - overall ***
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independent and safe
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FIM score 7 - locomotion ***
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- walk or WC independently and safely for at least 150 feet
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FIM score 7 - stairs ***
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- independently and safely completes 1 flight of 12-14 stairs
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