Ptha 2435 - Rehab Techniques - Cameron And Monroe Book And Hays Lecture - Exam 1

Front 1

What is physical rehabilitation? ***

Back 1

- a goal-oriented treatment process that is intended to maximize independence in (not “cure”) individuals with compromised function due to primary pathological processes and resultant impairments

- includes pt and/or family

Front 2

What are the goals of physical rehabilitation? ***

Back 2

- to optimize patient function at home, in the community, and at work

- focused on the patient's own goals

Front 3

What is a physiatrist? What is their role in rehabilitation? ***

Back 3

- physicians who specialize in physical medicine and rehabilitation

- often oversee the care of patients requiring rehabilitation, typically in in-patient rehab hospitals

Front 4

What is the role of a physical therapist with respect to rehabilitation? ***

Back 4

according to the Guide, they:

- “diagnose and manage movement dysfunction and enhance physical and functional abilities”

- “restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health”

- “prevent the onset, symptoms and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries”

Front 5

What is the role of an occupational therapist with respect to rehabilitation? ***

Back 5

according to the American Occupational Therapy Association, they

“prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries”

Front 6

Besides physiatrists, physical therapists, and occupational therapists, who else plays a role in providing physical rehabilitation? ***

Back 6

- physical therapIST assistants
- certified occupational THERAPY assistants
- nurses
- speech language pathologists
- neuropsychologists
- others, to include social workers, case managers, other physicians, etc.

Front 7

What are the four aspects in the Nagi model of disablement? ***

Back 7

- pathology
- impairment
- functional limitation
- disability

Front 8

Give an example of each aspect of the Nagi disablement model for the musculoskeletal system. ***

Back 8

- pathology - total knee joint replacement
- impairment - knee extension limited to -10 degrees
- functional limitation - unable to walk downstairs without a cane
- disability - unable to carry laundry down stairs at home

Front 9

Give an example of each aspect of the Nagi disablement model for the neuromuscular system. ***

Back 9

- pathology - stroke
- impairment - right upper and lower extremity weakness
- functional limitation - unable to lift arm above head
- disability - unable to wash and style own hair

Front 10

Give an example of each aspect of the Nagi disablement model for the cardiopulmonary system. ***

Back 10

- pathology - heart failure
- impairment - left ventricular ejection fraction 30%
- functional limitation - walking limited to 1/2 block
- disability - unable to complete grocery shopping on foot, uses electrically powered cart

Front 11

Give an example of each aspect of the Nagi disablement model for the integumentary system. ***

Back 11

- pathology - pressure ulcer
- impairment - 2 cm X 3 cm, 0.5 cm deep stage IV wound over left heel
- functional limitation - unable to bear weight on left lower extremity
- disability - unable to live at home because assistance required to transfer from bed to chair or toilet

Front 12

Define "pathology" with respect to the Nagi and World Health Organization disablement models. ***

Back 12

disease or injury
(e.g., left CVA)

(The book has, "...alteration of anatomy or physiology that is due to disease or injury and describes a specific disease process or diagnosis."

The Guide defines pathology as "an abnormality characterized by a particular cluster of signs and symptoms and recognized by either the patient or practitioner as abnormal.")

Front 13

Define "impairment" with respect to the Nagi and World Health Organization disablement models. ***

Back 13

abnormality of structure or function
(e.g., right hemiplegia and severe weakness of right upper and lower extremities--expressed in the Objective section of the SOAP note)

(The Nagi model defines impairment as "disruptions in anatomical, physiological, or psychological structures or functions as the result of some underlying pathology."

The Guide defines it as "a loss or abnormality of anatomical, physiological, mental, or psychological structure or function.")

Front 14

Define "functional limitation" with respect to the Nagi and World Health Organization disablement models. ***

Back 14

restrictions in the ability to perform components of daily life
(e.g., unable to sit or stand without supervision, can not lift a fork with right hand)

(The Nagi model defines functional limitation as "a restriction in the ability to perform an activity in an efficient, typically expected, or competent manner."

The Guide defines it as "the restriction of the ability to perform, at the level of the whole person, a physical action, task, or activity in an efficient, typically expected, or competent manner.")

Front 15

Define "disability" with respect to the Nagi and World Health Organization disablement models. ***

Back 15

inability to perform typical activities of daily living
(e.g., unable to walk to the kitchen table or feed self using right hand)

(The Nagi model defines disability as the inability to perform activities required for self-care, home, work, or community roles, taking into account the barriers presented by society to performing expected roles in the face of functional limitations."

The Guide defines disability as "the inability to perform or a limitation in the performance of actions, tasks, and activities usually expected in specific social roles that are customary for the individual or expected for the person's status or role in a specific sociocultural context and physical environment.)

Front 16

What is the role of the Guide to Physical Therapist/Physical Therapist Assistant Practice? ***

Back 16

- “to encourage a uniform approach to physical therapist practice and to explain to the world the nature of that practice”

- forms a framework for describing the scope and content of PT practice using standardized terms and a standardized practice model.

Front 17

How is the Guide to Physical Therapist/Physical Therapist Assistant Practice organized? ***

Back 17

- divided into two parts:

Part 1 – delineates the PT’s scope of practice & describes patient management by PT’s

Part 2 – describes each of the diagnostic preferred practice patterns of patients typically treated by PT’s. (see page 6)

Front 18

According to the Guide to Physical Therapist/Physical Therapist Assistant Practice, patient management by PT’s involves... ***

Back 18

- examination
- evaluation
- diagnosis
- prognosis
- intervention

Front 19

What is skeletal demineralization? ***

Back 19

refers to a loss of mass and calcium content from the bones

Front 20

Name two types of skeletal demineralization. ***

Back 20

- osteopenia (less severe)

- osteoporosis (more severe)

Front 21

Describe secondary osteoporosis. ***

Back 21

a sequela to another disease or disorder such as:
- osteomalacia (osteoid, the new organic matrix of bone does not mineralize correctly) or

- hyperparathyroidism (too much PTH released)

Front 22

Skeletal demineralization of any etiology is caused by an imbalance between.... ***

Back 22

bone formation and bone resorption

Front 23

List some common causes of skeletal demineralization. ***

Back 23

- genetics
- lack of proper nutrition
- hormonal imbalances
- inadequate physical activity
- life choices
- disease and health challenges
- socioeconomic circumstances
- environment

Front 24

What bones comprise the axial skeleton? ***

Back 24

- cranium
- vertebral column
- ribs
- sternum
- pelvis

Front 25

What bones comprise the appendicular skeleton? ***

Back 25

bones of the upper and lower limbs

Front 26

Another term for compact bone ***

Back 26

cortical bone

Front 27

Other terms for spongy bone ***

Back 27

- cancellous

- trabecular

Front 28

What is contained in the medullary canal? ***

Back 28

- bone marrow

- fat

Front 29

Where in the skeleton is trabecular bone commonly located? ***

Back 29

- axial skeleton
- pelvis
- other flat bones
- ends of long bones of the appendicular skeleton
are composed primarily of trabecular bone

Front 30

How much of the axial skeleton is comprised of cancellous bone? ***

Back 30

- 70% of the volume

- 35% of the weight

Front 31

Which type of bone is more metabolically active, cortical or cancellous? ***

Back 31

cancellous/trabecular/spongy bone

it responds both more quickly and to a greater degree to changes in mineral homeostasis

Front 32

What are the average rates of remodeling for both cortical and cancellous bone? ***

Back 32

approximately
- 3% of cortical and
- 7% of cancellous bone
remodels each year

Front 33

At what age does bone remodeling cease? ***

Back 33

it doesn't

it continues throughout life

Front 34

What balance must be maintained to ensure stable bone mineral density? ***

Back 34

the balance between
- bone resorption and
- bone formation

Front 35

What three types of cells are involved in bone remodeling? ***

Back 35

- osteoclasts
- osteoblasts
- osteocytes

Front 36

What do osteoclasts do? ***

Back 36

resorb bone and form resorption cavities in areas of bone turnover

Front 37

What do osteoblasts do? ***

Back 37

synthesize new bone matrix and osteoid to fill the cavities created by the osteoclasts

Front 38

What are osteocytes? ***

Back 38

osteoblasts that have become surrounded by mineralized bone

Front 39

What controls bone remodeling? ***

Back 39

controlled by levels of circulating hormones, including:
- estrogen
- testosterone
- calcitonin
- parathyroid hormone (PTH)
- 1,25-dihydroxyvitamin D

and also by ongoing mechanical stresses from gravity, weight bearing, and the pull on the bones by contracting muscles

Front 40

When does bone mass typically increase? Decrease? ***

Back 40

generally, bone mass:
- increases until the third or fourth decade (epiphyses close around ages 13-25, but diameter increases until the 20s or 30s)
- stabilizes until age 45 to 50 years
- then starts to decline

Front 41

What are the two types of involutional bone loss we discussed? ***

Back 41

- Type I - postmenopausal osteoporosis

- Type II - senile osteoporosis

Front 42

Describe Type I involutional bone loss. ***

Back 42

- affects postmenopausal women (hormone-driven)
- high turnover state, especially of trabecular bone (up to 3X > normal)
- increases fracture risk of trabecular bones
- causes slight loss in cortical bone

Front 43

What types of fractures are commonly seen with Type I involutional bone loss? ***

Back 43

- vertebral compression fractures

- Colles' fractures

Front 44

Describe Type II involutional bone loss. ***

Back 44

- affects both genders after age 70 (age-related)
- low turnover state
- affects cortical and trabecular bone almost equally
- increase morbidity and mortality

Front 45

What types of fractures are commonly seen with Type II involutional bone loss? ***

Back 45

- hip fractures
- wedged vertebral fractures
- proximal humeral fractures
- pelvic fractures
- proximal tibial fractures

Tthe trabecular thinning also causes gradual vertebral collapse, anterior wedging of thoracic vertebrae, and gradual and usually painless spinal deformities in the elderly, such as "dowager's hump.")

Front 46

List some modifiable risks for skeletal demineralization. ***

Back 46

- low calcium intake
- low vitamin D (esp. in cold-weather areas)
- physical inactivity
- cigarette smoking
- excessive alcohol intake

- estrogen deficiency
- use of specific medications
- prolonged overuse of thyroid hormone

Front 47

List some nonmodifiable risks for skeletal demineralization. ***

Back 47

- gender (F:M = 5:1)
- age
- race (primarily European and Asian descent)
- body size (small, slender frames)
- early menopause
- family history

Front 48

List some risk factors associated with low bone mass. ***

Back 48

- old age
- residence in cold geographic area
- vitamin D deficiency

- gastrectomy
- intestinal malabsorption associated with:
---- diseases of small intestine
---- cholangiolitic disorders of the liver
---- biliary obstruction
---- chronic pancreatic insufficiency

- long-term use of:
---- anticonvulsants
---- tranquilizers
---- sedatives
---- muscle relaxants
---- diuretics
---- antacids containing aluminum hydroxide
---- corticosteroids

- history of:
---- hyperparathyroidism
---- chronic renal failure
---- renal tubular defects (decreased reabsorption of phosphate)

Front 49

During the examination phase, what does the patient history include? ***

Back 49

- age
- gender
- past medical/surgical history
- current and past medication use (including supplements)
- family history
- functional status
- present and past activity levels
- history of the present condition
- patient's goals

Front 50

During the examination phase, what do the systems checks consist of? ***

Back 50

- musculoskeletal testing (posture, anthropometric characteristics, ROM, muscle performance)
- neuromuscular testing (pain, esp dermatomal pain patterns on trunk)
- cardiopulmonary testing (SOB, reduced lung/chest volume)

Front 51

During the examination phase, what do the tests and measures consist of? ***

Back 51

- functional testing (balance and gait)

- medical testing of bone mineral density (finger densitometry, heel ultrasonography, DXA)

Front 52

What types of testing are done on the musculoskeletal system for patients with potential skeletal demineralization? ***

Back 52

postural screening
- very important in patients with osteoporosis, especially for kyphosis

height measurement
- height loss (esp. >1”) is suggestive of low bone mass; osteoporotic fractures often do not cause symptoms, but may result in increased/increasing thoracic kyphosis and loss of height

ROM testing
- decreased ROM in shoulder flexion and external rotation, hip extension (can't lift or rotate your arms very much if you're all bent over)
- knee flexion and ankle dorsiflexion are often noted to compensate for the kyphosis (so pt can walk more upright)
- decreased ROM of the cervical spine, shoulders, hips, knees, and ankles

muscle strength
- patients with skeletal demineralization often also have weak muscles
- muscles on constant stretch are weakened (shoulder depressors/retractors, hip and knee extensors, spinal extensors)

Front 53

What types of testing are done on the neuromuscular system for patients with potential skeletal demineralization? ***

Back 53

patients may complain of:
- chest pain
- rib pain
- shortness of breath
- scapular pain or
- visceral pain
- dermotomal pain around trunk

due to anterior collapse of vertebral body, alteration in the shape of the intervertebral foramen, and pressure on spinal nerves

Front 54

What types of testing are done on the cardiopulmonary system for patients with potential skeletal demineralization? ***

Back 54

aerobic capacity

(severe thoracic kyphosis can produce a decrease in aerobic capacity due to reduced lung/chest volume)

Front 55

What types of testing are done on the functional status of patients with potential skeletal demineralization? ***

Back 55

balance and gait testing

(patients with osteoporosis appear to have altered balance and decreased stability as a result of kyphosis and falls can easily result in fractures)

Front 56

List three types of medical testing for bone mineral density. Which one is the "gold standard" test? ***

Back 56

- finger densitometry
- heel ultrasonography

- dual-energy x-ray absorptiometry (DXA/DEXA) – gold standard

Front 57

If examination of a patient reveals height loss of more than one inch, what is the evaluation/likely diagnosis within preferred practice pattern 4A? ***

Back 57

- possible asymptomatic bone loss
- postural dysfunction

Front 58

If examination of a patient reveals height loss of more than one inch, what is the prognosis (based on outcome research) within preferred practice pattern 4A? ***

Back 58

- potential risk for bone loss and vertebral compression fractures

- improve with exercise and patient education

Front 59

If examination of a patient reveals thoracic kyphosis, what is the evaluation/likely diagnosis within preferred practice pattern 4A? ***

Back 59

- potential to compromise cardiorespiratory system
- decreased balance
- possible single or multiple vertebral compression fractures

Front 60

If examination of a patient reveals thoracic kyphosis, what is the prognosis (based on outcome research) within preferred practice pattern 4A? ***

Back 60

- can be improved or maintained with exercise, bracing, patient education

- at increased risk for possible additional fractures

Front 61

If examination of a patient reveals acute pain, what is the evaluation/likely diagnosis within preferred practice pattern 4A? ***

Back 61

- possible new fracture

- decreased physical performance and function

Front 62

If examination of a patient reveals acute pain, what is the prognosis (based on outcome research) within preferred practice pattern 4A? ***

Back 62

- self-limited over 6-8 weeks

- can be decreased by intermittent bed rest, modalities, positioning, bracing

Front 63

If examination of a patient reveals chronic pain, what is the evaluation/likely diagnosis within preferred practice pattern 4A? ***

Back 63

changes in soft tissues; tightness, weakness

Front 64

If examination of a patient reveals chronic pain, what is the prognosis (based on outcome research) within preferred practice pattern 4A? ***

Back 64

can decrease with compliance to appropriate education, exercise program, bracing

Front 65

If examination of a patient reveals decreased ROM, what is the evaluation/likely diagnosis within preferred practice pattern 4A? ***

Back 65

chronically shortened soft tissue

Front 66

If examination of a patient reveals decreased ROM, what is the prognosis (based on outcome research) within preferred practice pattern 4A? ***

Back 66

can be modified with exercise

Front 67

If examination of a patient reveals muscle weakness, what is the evaluation/likely diagnosis within preferred practice pattern 4A? ***

Back 67

chronically lengthened and/or atrophied soft tissues

Front 68

If examination of a patient reveals muscle weakness, what is the prognosis (based on outcome research) within preferred practice pattern 4A? ***

Back 68

can be modified with exercise

Front 69

If examination of a patient reveals decreased balance, what is the evaluation/likely diagnosis within preferred practice pattern 4A? ***

Back 69

increased potential for fracture from falls

Front 70

If examination of a patient reveals decreased balance, what is the prognosis (based on outcome research) within preferred practice pattern 4A? ***

Back 70

can be improved with balance training

Front 71

If examination of a patient reveals decreased endurance, what is the evaluation/likely diagnosis within preferred practice pattern 4A? ***

Back 71

- compromised cardiopulmonary function

- decreased mobility

Front 72

If examination of a patient reveals decreased endurance, what is the prognosis (based on outcome research) within preferred practice pattern 4A? ***

Back 72

can be improved with endurance training

Front 73

What is preferred practice pattern 4A? ***

Back 73

primary prevention/risk reduction for skeletal demineralization

Front 74

List some interventions for skeletal demineralization. ***

Back 74

- aerobic exercise
- resistance training
- weight-bearing exercise
- body mechanics training
- medications
- diet optimization

Front 75

How does aerobic exercise function as an intervention for skeletal demineralization? ***

Back 75

when coupled with weight bearing, it can improve function and increase BMD in patients with osteoporosis

Front 76

How does resistance training function as an intervention for skeletal demineralization? ***

Back 76

- can help maintain bone density
- can help improve postural control and stability to decrease the risk of falls
- the increase in muscle mass produced by muscle strengthening may also reduce fracture risk by providing additional protection should a fall occur (padding)

Front 77

How does weight-bearing exercise function as an intervention for skeletal demineralization? ***

Back 77

- especially effective when coupled with aerobic exercise
- should be used through both the upper and lower extremities (e.g., quadruped)
- should begin early in life, during the normal growth period

Front 78

Which type(s) of spinal exercise have the best results in lowering the incidence of new fractures in patients with spinal osteoporosis? ***

Back 78

spinal extension

(incidence of new fractures was only 16%)

Front 79

Which type(s) of spinal exercise have the worst results in lowering the incidence of new fractures in patients with spinal osteoporosis? ***

Back 79

spinal flexion

(incidence of new fractures was 89%--even more than no exercise at all, which was 67%; combining flexion and extension produced an incidence of 53%)

Front 80

How did progressive resisted back extension affect the risk of vertebral fractures, and for how long? ***

Back 80

lowered the risk of vertebral fractures for up to 8 years after termination of the exercise program

Front 81

In what position should patients with skeletal demineralization be encouraged to hold their spines? ***

Back 81

in a neutral position; keeping a neutral spine

Front 82

What should be encouraged/avoided when educating patients with skeletal demineralization on body mechanics? ***

Back 82

- exercises that put patients into flexed postures should be modified or avoided

- maintaining good posture in sitting and standing requires constant self-monitoring (pictures help--photograph the patient and show them their own posture; many do not realize how poor their posture actually is)

- patients should be taught to maintain excellent body mechanics and posture while performing daily activities (e.g., brushing teeth with knees flexed instead of bending over at the sink)

Front 83

What types of medications are most commonly prescribed for people with skeletal demineralization? ***

Back 83

- most medications prescribed for people with skeletal demineralization are antiresorptive agents [bisphosphonates, selective estrogen receptor modulators (SERMs), calcitonin, and more recently parathyroid hormone]

- although estrogen does decrease bone loss, because of its associated risk its use is generally not recommended

Front 84

What is likely the most important modifiable factor for preventing osteoporosis? ***

Back 84

sufficient calcium and vitamin D intake

Front 85

What are some conservative intervention measures taken for osteoporotic spinal fractures? ***

Back 85

- bed rest and narcotic analgesics are generally recommended for pain control

- because of adverse effects, though, bracing is used to decrease pain while patient stays mobile (however, patient compliance with a bulky, uncomfortable brace is often an issue)

Front 86

What are some invasive intervention measures taken for osteoporotic spinal fractures? ***

Back 86

- vertebroplasty is injection of bone cement into the area

- kyphoplasty involves inflating a collapsed area of bone and elevating the endplates, then injecting bone cement

Front 87

In which of the following would you expect to find shortness or tightness in a patient with long-standing osteoporosis?

a. gluteals
b. hip flexors
c. scapular retractors
d. pectorals
e. a and c
f. b and d

Back 87

f. b and d

Front 88

Thoracic kyphosis is best measured with which of the following?

a. inclinometer
b. goniometer
c. dynamometer
d. flexicurve

Back 88

d. flexicurve

Front 89

Which of the following exercise regimes is least effective for preventing excessive bone loss?

a. resistance training
b. stair climbing
c. swimming
d. soccer

Back 89

c. swimming

Front 90

Which of the following is probably the most influential risk factor for osteoporosis?

a. race
b. genetics
c. body build
d. diet

Back 90

b. genetics

Front 91

Without sufficient vitamin D, calcium would be excreted rather than resorbed by the kidneys. What other critical role does vitamin D play in the prevention of osteoporosis?

a. it causes calcium to be released from the intestine and enter the bloodstream
b. it causes an excretion of calcium from the teeth into the bone
c. it increases the action of melanocytes
d. it decreases the anabolic effects of glucocorticoids

Back 91

a. it causes calcium to be released from the intestine and enter the bloodstream

Front 92

Which impairment should cause the greatest concern for the patient with osteoporosis?

a. decreased scapular strength
b. increased deformity
c. decreased balance
d. decreased endurance

Back 92

c. decreased balance

Front 93

Which of the following would NOT be part of an immediate plan to manage a patient with an acute vertebral compression fracture?

a. postural training
b. log rolling in bed
c. resistive exercise
d. TENS

Back 93

c. resistive exercise

Front 94

What is posture? ***

Back 94

- the relative alignment of body parts
- includes the relationship of the body parts to each other and to the body’s base of support.

- start at BOS
- posture may be assessed statically or dynamically

Front 95

In what states may posture be assessed? ***

Back 95

- statically
- dynamically

Front 96

What is static posture? ***

Back 96

- body at rest

- posture seen in standing, sitting, lying, task performing position

Front 97

What is dynamic posture? ***

Back 97

- body in motion

- posture during activities such as walking, running, moving from one position to another, etc.

Front 98

What is "ideal posture"? ***

Back 98

- ideal body part alignment, also known as "good posture," "ideal posture," "ideal alignment," or "neutral posture," is the position in which:
- the center of mass is centered over the base of support.
- this is a position of muscular and skeletal balance.

- there is no universally agreed-upon "ideal posture"
(in fact, there is little research supporting a relationship between musculoskeletal pain and postural alignment)

Front 99

Ideal posture is a position of muscular and skeletal _____. ***

Back 99

balance

Front 100

Ideal posture requires ______ energy expenditure to maintain balanced alignment. ***

Back 100

minimal

(it requires minimal, but not the least possible energy expenditure--that would be a slumped posture in which ligaments, rather than muscles stabilize weight-bearing joints)

Front 101

Ideal posture should permit efficient mechanical joint action and limit...

Back 101

wear and tear on the joints

Front 102

What anatomical features should be aligned when observing "ideal posture" from a lateral view? ***

Back 102

- earlobe/external auditory meatus
- bodies of cervical vertebrae
- shoulder joint/acromion midline
- midline of trunk
- bodies of lumbar vertebrae
- greater trochanter
- slightly anterior to midline of knee
- slightly anterior to lateral malleolus

Front 103

What is postural sway? ***

Back 103

even when one appears to be completely still, one will actually constantly sway:
- forward and back (up to 16 degrees) and
- side to side (up to 12 degrees)

- this may vary with body morphology and gender
- it has been hypothesized that it may act as a pump to aid venous return

Front 104

How far (in degrees) forward and back, and side to side, is normal postural sway? ***

Back 104

- up to 16 degrees forward and back (8 each way I take it?)

- up to 12 degrees side to side (6 each way?)

Front 105

What are the three basic sitting postures (chair)? ***

Back 105

- anterior/forward sitting
- middle/erect sitting
- posterior sitting

Front 106

Describe anterior (or forward) sitting. ***

Back 106

when either the anterior rotation of the pelvis or increased kyphosis of the spine result in more than 25% of the body’s weight being transmitted through the feet to the floor, and the COG is anterior to the ischial tuberosities

Front 107

What are some other types of sitting that are recommended for persons who are more comfortable sitting with a lordosis? ***

Back 107

besides anterior/forward sitting

- kneeling on a Balans chair
- perching/active sitting

Front 108

Describe middle/erect sitting. ***

Back 108

- sitting with the COG directly over the ischial tuberosities with approximately 25% of the body's weight transmitted through the feet to the floor.

- intradiscal pressure at middle sitting is less than anterior sitting but more than posterior sitting.

Front 109

Which sitting posture creates the least amount of intradiscal pressure? The most? ***

Back 109

- posterior sitting

- anterior sitting

Front 110

Describe posterior sitting. ***

Back 110

- COG is behind the ischial tuberosities (posterior pelvic tilt) and less than 25% of the body’s weight is transmitted through the feet to the floor

- seated position with the least amount of intradiscal pressure when supported

- this pressure is always higher in sitting rather than in standing postures

Front 111

Is intradiscal pressure greater when sitting or standing? ***

Back 111

sitting, regardless of position

(even the position that creates the least amount of intradiscal pressure--posterior sitting--creates more pressure than standing)

Front 112

How does Cameron suggest reducing intradiscal pressure and low back pain when sitting? ***

Back 112

providing support for lumbar spine when sitting to promote greater lordosis

Front 113

How many anatomical positions are there? ***

Back 113

- there is only one standard anatomical position

- it is the specific alignment of the body used as the position of reference for describing the anatomical planes and axes

Front 114

Describe the position of body parts in optimal erect posture (anterior/posterior views.) ***

Back 114

- eyes --- horizontally level
- shoulders --- horizontally level
- scapulae --- flat against the thorax, 30º anterior to the frontal plane, approximately 6” apart

- elbows --- neutral or slight carrying angle for males, females slight to moderate
- pelvis --- ASIS & PSIS horizontally level
- hips --- neutral rotation, abduction & adduction

- knees --- patellae face directly forward; popliteal crease faces directly forward; Q angle approximately 13º in males & 18º in females
- feet --- neither pronated nor supinated; toes relaxed without varus or valgus; calcaneus in mild valgus

Front 115

Describe the position of body parts in optimal erect posture (lateral view.) ***

Back 115

- cervical spine --- slight lordosis; supports head with minimal effort without upward, downward, or sideways tilt, rotation, or retraction
- humerus --- less than one third of humeral head anterior to anterior aspect of the acromion

- thoracic --- kyphosis 34º
- lumbar --- lordosis 64º

- pelvis --- ASIS on same vertical plane as pubic symphysis
- knee --- neutral, neither flexed nor hyperextended

Front 116

List some modifiable causes of poor posture. ***

Back 116

- changes in muscle length
- changes in muscle strength
- alterations in joint ROM
- muscle spasm
- protective positioning due to pain or habit

Front 117

What are some possible causes of muscle strength and/or length impairments? ***

Back 117

- lack of variety in movements and positions

- frequent performance of repetitive activities

Front 118

List some nonmodifiable causes of poor posture. ***

Back 118

- structural variations
- damage to basic components that maintain posture (bones, joints, muscles, nervous system)

Front 119

What are some structural variations that could constitute nonmodifiable causes of impaired posture. ***

Back 119

- leg length discrepancy
- fixed spinal scoliosis
- excessive femoral anteversion

Front 120

What are some causes of damage to basic components that maintain posture that could constitute nonmodifiable causes of impaired posture? ***

Back 120

- injury (e.g., vertebral compression fractures)
- disease (e.g., RA or OA)
- CNS disorders (e.g., TBI, CVA, cerebral palsy) which may impair posture by altering muscle tone, strength, control and/or sensation

Front 121

What are the two broad categories of scoliosis? ***

Back 121

- structural (idiopathic) scoliosis

- non-structural (functional), postural scoliosis

Front 122

Describe structural (idiopathic) scoliosis. ***

Back 122

irreversible lateral curve with fixed rotation of the vertebrae.
- vertebral bodies rotate toward convex side and spinous processes rotate away
- forward bending produces posterior rib hump on convex side
- can not be corrected by positioning or voluntary effort

Front 123

Describe non-structural (functional) postural scoliosis. ***

Back 123

reversible – can be changed with:
- forward/ side bending positional changes or correction of leg length discrepancy
- no rotational changes
- can be caused by unilateral paravertebral muscle spasm

Front 124

What type of pelvic tilt is produced by a short/stiff rectus femoris? ***

Back 124

anterior pelvic tilt

Front 125

What type of pelvic tilt is produced by a short rectus abdominis? ***

Back 125

posterior pelvic tilt

Front 126

What postural abnormalities may be caused by a lengthened serratus anterior and why? ***

Back 126

may allow adduction and/or downward tilt of the scapula because of the unopposed pull of the shorter rhomboids

Front 127

What effect can the dominant hand have on posture? ***

Back 127

on the side of the dominant hand, the shoulder tends to appear depressed, and the hip elevated

Front 128

What is the difference between kyphosis-lordosis posture and swayback posture? ***

Back 128

they both present with excessive kyphosis in the thoracic vertebrae, but the swayback posture has less lordosis in the lumbar vertebrae and the pelvis is tilted posteriorly; the kyphosis-lordosis posture has increased lumbar lordosis and an anterior pelvic tilt

Front 129

What is kyphosis-lordosis posture? ***

Back 129

- increased lumbar lordosis & thoracic kyphosis
- anterior pelvic tilt &
- forward head

may include:
- abducted scapulae
- forward shoulders &
- either knee flexion or hyperextension (genu recurvatum)

Front 130

What is flatback posture? ***

Back 130

- reduced lumbar lordosis
- posterior pelvic tilt &
- hip & knee hyperextension

common to find
- reduced kyphosis
- cervical lordodis &
- gluteal prominence

Front 131

What is swayback posture? ***

Back 131

- reduced lumbar lordosis &
- posterior pelvic tilt, but
- hips are anterior to the humeral heads and lateral malleoli

common to find
- genu recurvatum
- increased thoracic kyphosis &
- abducted scapulae.

Front 132

What misalignment is common to all three postural faults (kyphosis-lordosis, flatback, and swayback)? ***

Back 132

forward head

Front 133

What types of interventions are used for postural correction? ***

Back 133

- postural education, instruction and training
- stretching and mobilization
- stabilization
- exercise/strengthening

Front 134

What types of stretching and mobilization techniques are used for postural correction? ***

Back 134

if due to decreased ROM because of spasm, mm tension, scar tissue, or contracture, a combination of treatments may include:
- massage
- myofascial release
- specific stretching exercises &
- exercises to activate (contract or shorten) the mm’s opposing the restricted tissue
- PNF techniques (contract-relax, hold-relax)

- low-load stretch in a splint or cast can be helpful. (e.g., serial casting, Dynasplints)
- modalities that increase tissue temperature can be helpful before stretching.
- cryotherapy can be used before lengthening tissues that have pain, mm spasm, or inflammation, and after stretching to assist in limiting response (pain, spasm, inflammation)
- electrical stimulation may be used
- joint mobilizations may be helpful

Front 135

What types of stabilization are used for postural correction? ***

Back 135

if joint laxity, instability, or mm weakness then
- strengthening of surrounding muscles
- stabilization with splinting and
- education regarding proper positioning and avoidance of vulnerable positions

- it is important to know which mm require strengthening & which do not
- strengthen weak muscles, while avoiding further strengthening of mm that are stronger than other mm in the same region
(e.g., if patient has stooped, rounded shoulders from hunching over a desk/keyboard, the pectoral muscles are likely to be tight, while the rhomboids are overstretched and weak; you would not want to further strengthen the tight pectorals or stretch the already stretched rhomboids--in fact, you would do just the opposite--stretch the pectorals and strengthen the rhomboids)

Front 136

How is exercise/strengthening used for postural correction? ***

Back 136

- the weak, overstretched muscles need to be strengthened (as the tight ones need to be stretched)

Examples:
- increasing back extensor strength with back strengthening exercises was found to reduce excessive kyphosis in otherwise healthy women aged 49 to 65 years

- exercises that activate the thoracic and lumbar erector spinae & multifidi are not recommended for individuals with intervertebral disc compression injuries because they may exert excessive compressive forces on the spinal discs

Front 137

Base of support is which of the following?

a. the type of surface one is standing on
b. the area, projected on the ground, of the broadest/widest part of the body
c. the area of the body in contact with the supporting surface
d. the feet

Back 137

c. the area of the body in contact with the supporting surface

Front 138

Static posture may be assessed during which activity?

a. sitting
b. walking
c. pushing
d. moving from sit to stand

Back 138

a. sitting

Front 139

Postural control and postural orientation are needed most for which of the following activities?

a. jumping
b. sliding into first base
c. moving from sit to stand
d. running

Back 139

c. moving from sit to stand

Front 140

Postural sway tends to increase with all of the following EXCEPT:

a. intention
b. alcohol consumption
c. lower back pain
d. fatigue

Back 140

a. intention

Front 141

The zero position for measuring joint ROM for most joints is based on which of the following?

a. ideal alignment
b. anatomical position
c. American Academy of Orthopedics standards
d. the sagittal plane

Back 141

b. anatomical position

Front 142

Sitting with a thigh-torso angle greater than 90 degrees is thought to do which of the following?

a. reduce the lumbar lordosis.
b. increase the likelihood of tilting the pelvis posteriorly.
c. be a bad idea for seated work at a computer.
d. produce a lumbar lordosis similar to that in standing.

Back 142

d. produce a lumbar lordosis similar to that in standing.

Front 143

Stability is increased by all of the following EXCEPT:

a. widening the base of support
b. lowering the center of mass
c. lowering the center of gravity
d. narrowing the base of support

Back 143

d. narrowing the base of support

Front 144

Carrying a backpack is likely to cause the body to compensate by which of the following?

a. pulling the shoulders back
b. extending the thoracic spine
c. flexing the hips
d. extending the lumbar spine

Back 144

c. flexing the hips

Front 145

Which of the following characterizes swayback posture?

a. anterior pelvic tilt and increased lumbar lordosis
b. posterior pelvic tilt and increased lumbar lordosis
c. anterior pelvic tilt and decreased lumbar lordosis
d. posterior pelvic tilt and decreased lumbar lordosis

Back 145

d. posterior pelvic tilt and decreased lumbar lordosis

Front 146

During postural assessment, all of the following should be in vertical alignment EXCEPT:

a. external auditory meatus and greater trochanter of the hip
b. external auditory meatus and acromion
c. occiput and sacrum
d. ASIS and greater trochanter of the hip

Back 146

d. ASIS and greater trochanter of the hip

Front 147

Rehabilitation generally addresses the ______ of pathology, rather than the ______ _____.

Back 147

- sequelae

- pathology itself

Front 148

Rehabilitation is not directed at ______ ______.

Back 148

curing disease

Front 149

Rehabilitation focuses particularly on sequelae that impact physical functioning and activity and uses interventions that are _____ and ______ in nature to promote progress toward functional goals.

Back 149

- noninvasive

- physical

Front 150

Physical rehabilitation focuses on ...

Back 150

improving impairments and functional limitations, not on curing disease

Front 151

What body systems are the (most common) focus of physical rehabilitation?

Back 151

- neuromuscular
- musculoskeletal
- cardiopulmonary
- integumentary

Front 152

How are outcomes in physical therapy typically measured? Where should the focus actually be? Why?

Back 152

- outcomes are commonly measured in terms of impairments (e.g., Did we increase the ROM in the elbow?)

- focus should be on changes in functional limitations and disabilities, based on patient's own goals. We are not fixing an elbow, we are helping them live their lives in the manner in which they choose

Front 153

What is the ICIDH?

Back 153

- the International Classification of Impariments, Disabilities, and Handicaps

- the first classification scheme published by the WHO in 1980

- based on the work of Wood

Front 154

What is the ICF?

Back 154

- International Classification of Functioning, Disability, and Health-2

- the revised classification scheme published by the WHO in 2001

Front 155

How has the focus of disablement models changed over the years?

Back 155

they are increasingly focusing on abilities instead of restrictions and limitations

Front 156

Upon which disablement model is the Guide to Physical Therapist Practice based?

Back 156

the Nagi disablement model

Front 157

At what body system level does pathology typically occur?

Back 157

cellular level

Front 158

At what body system level does impairment typically occur?

Back 158

organ or organ system level

Front 159

An impairment is equivalent to a ____ or an objective measure.

Back 159

sign

Front 160

Do impairments always cause functional limitations?

Back 160

not necessarily, at least at first

(e.g., a patient who has reduced vital capacity, but never places enough of a demand on the respiratory system to experience functional limitation.)

Front 161

How do the primary focuses of medical treatment and rehabilitation differ?

Back 161

- medical treatment generally focuses on the underlying pathology or disease

- rehabilitation focuses primarily on reversing or minimizing associated impairments, functional limitations, and disabilities

Front 162

When setting rehabilitation goals, where should the focus be?

Back 162

not only on the impairment, but also at the level of functional limitation and disability as they relate to the patient's goals

Front 163

How is "examination" defined by the Guide?

Back 163

a comprehensive screening and specific testing process leading to diagnostic classification or, as appropriate, to a referral to another practitioner

Front 164

What are the three components of examination?

Back 164

- patient history
- systems review
- tests and measures

Front 165

What types of information are included in the patient history?

Back 165

- why patient is seeking care
- past and current functional status and activity level

may also include:
- patient's general demographics
- social history
- employment or work
- growth and development
- living environment
- general health status
- social and health habits
- family history
- medical and surgical history
- medications
- results of previously performed clinical tests

Front 166

How is patient history gathered?

Back 166

- interviewing the patient, caretakers or family members
- review of medical records

Front 167

What is a systems review?

Back 167

- the first "hands-on" component of the examination

- involves a brief or limited examination of the status of the cardiopulmonary, integumentary, musculoskeletal, and neuromuscular systems and the communication ability, affect, cognition, language, and learning style of the patient

- used to identify information not presented in the patient history and to identify if other health problems should be considered in the diagnosis, prognosis and plan of care, or indicate the need for referral to another health provider

Front 168

What is the purpose of the patient history?

Back 168

the history, and particularly the pattern of symptoms will give the clinician an idea of the nature of the patient's problem and indicate the most efficient course for the rest of the examination

Front 169

What is the purpose of the systems review?

Back 169

it is used to target areas requiring further examination and define areas that may cause complications or indicate a need for precautions during the tests and measures and intervention processes

Front 170

The patient history and systems review are used to generate _____ ______.

Back 170

diagnostic hypotheses

Front 171

Once the patient history and systems review are used to generate diagnostic hypotheses, what is the next step?

Back 171

tests and measures

Front 172

How are the specific tests and/or measures chosen?

Back 172

once the patient history and systems review provide diagnostic hypotheses, tests and measures of the musculoskeletal, neuromuscular, cardiopulmonary, and integumentary systems, as well as tests of patient function are then selected to rule in or rule out causes of impairment and functional limitations

Front 173

How are the results of tests and measures used?

Back 173

to establish
- diagnosis
- prognosis
- and plan of care

Front 174

What is an evaluation?

Back 174

a clinical judgment based on the data gathered during the examination

Front 175

What is involved in the evaluation process?

Back 175

it involves synthesizing the findings from all the components of the examination to establish the patient's diagnosis and prognosis

Front 176

According to the Guide, PTs use diagnostic labels that....

Back 176

identify the impact of a condition on function at the level of the system (especially the movement system) and at the level of the whole person

Front 177

How do PTs assign a diagnostic label?

Back 177

by classifying patients/clients within a specified preferred practice pattern

Front 178

What are preferred practice patterns?

Back 178

the diagnostic labels used by PTs to identify the impact of a condition on function at the level of the system (especially the movement system) and at the level of the whole person

Front 179

What is a prognosis?

Back 179

- the determination of the predicted optimal level of improvement in function and the amount of time needed to reach that level

- it may also include a prediction of the improvement that may be reached at various intervals during the course of therapy (STGs)

Front 180

Besides predicted optimal level of improvement in function and the amount of time to reach that level, what else should be included in the prognosis?

Back 180

plan of care that outlines specific interventions to be used and proposed duration and frequency of the interventions that are required to reach the anticipated goals and expected outcomes

Front 181

What are interventions?

Back 181

the purposeful interaction of the physical therapist with the patient using various physical therapy procedures and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis

Front 182

What may be included in interventions?

Back 182

- coordination
- communication
- documentation
- patient/client-related instruction
- procedural interventions such as therapeutic exercise and physical agents

Front 183

Diagnosis

Back 183

- a process and a label

- the diagnostic process includes integrating and evaluating the data obtained during the examination to describe the patient condition in terms that will guide the prognosis, the plan of care, and intervention strategies

- as a label, it denotes the disease or syndrome a person has or is believed to have and the use of scientific or clinical methods to establish the cause and nature of a person's illness

Front 184

What are the categories of required roles used in the Guide?

Back 184

- self-care
- home management
- work (job/school/play)
- community/leisure

Front 185

Disease

Back 185

a pathological condition or abnormal entity with a characteristic group of signs and symptoms affecting the body and with known or unknown etiology; a condition marked by subjective complaints, a specific history, and clinical signs, symptoms, and laboratory or radiological findings

Front 186

Disorder

Back 186

derangement or abnormality of function (anatomical or physiological); pathology

Front 187

Dysfunction

Back 187

disturbance, impairment, or abnormality of function of an organ

Front 188

Function

Back 188

those activities identified by an individual as essential to support physical, social, and psychological well-being and create a personal sense of meaningful living

Front 189

Goals

Back 189

- the intended results of patient management; goals indicate changes in impairment, functional limitation, and disability and changes in health, wellness, and fitness needs that are expected as a result of implementing the plan of care

- should be measurable and time-limited (if required may be expressed as short-term and long-term)

Front 190

Rehabilitation

Back 190

- a set of actions designed to restore, following disease or injury, the ability to function in a normal or near-normal manner

- a goal-oriented treatment process that is intended to maximize independence in individuals with compromised function due to primary pathological processes and resultant impairments

Front 191

Screening

Back 191

determining the need for further examination or consultation

Front 192

Signs

Back 192

objective evidence of physical abnormality

Front 193

Symptoms

Back 193

subjective evidence of physical abnormality

Front 194

Treatment

Back 194

the sum of all interventions provided by a clinician during an episode of care

Front 195

When bone loss exceeds bone formation, the resultant net loss of bone mass causes skeletal fragility due to:

Back 195

- trabecular thinning and discontinuity
- loss of horizontal bridges
- trabecular microfractures

Front 196

What minerals are stored in the bones?

Back 196

- calcium and
- phosphorus
primarily

Front 197

Approximately ___% of the mass of he skeleton is cortical bone.

Back 197

80

Front 198

bone remodels in response to....

Back 198

the demands placed upon it

Front 199

Describe involutional bone loss.

Back 199

- age-related bone loss that occurs in both cortical and trabecular bone

- it's a long, slow, continuous process that occurs in both men and women beginning at around age 35-40

- accelerates in women after menopause

Front 200

List some causes of secondary osteoporosis.

Back 200

- glucocorticoid use associated with RA and asthma (inhibits osteoblast function)
- hyperthyroidism
- hyperprolactinemia
- hyperparathyroidism
- malignancies
- renal failure
- diabetes mellitus
- Down syndrome
- drug use (alcohol, marijuana, heparin)

Front 201

List some dietary causes of osteoporosis.

Back 201

- poor availability of food
- eating disorders
- malabsorption syndromes

all can result in poor calcium uptake and osteoporosis due to loss of calcium from bones

Front 202

Besides primary, secondary, and dietary causes of osteoporosis, what else may reduce BMD?

Back 202

immobilization

Front 203

How well does bone mineral content and total body calcium respond to reambulation after prolonged immobilization?

Back 203

bone mineral content and total body calcium increase at a similar rate to their loss with reambulation

Front 204

Recommended calcium intake

Back 204

- for all men under age 65 and premenopausal women or postmenopausal women on HRT - 1,000 mg per day

- for postmenopausal women not on HRT, men over 65 and people with osteopenia/osteoporosis - 1,500 mg per day

- up to 2,000 mg per day appears safe, although higher intake is associated with increased risk of kidney stones

Front 205

Recommended vitamin D intake

Back 205

- children - 200 IU per day
- age 51-70 - 400 IU per day (assume all adults, 18 to 51 as well)
- healthy adults over 70 - 600 IU per day

(although the NIH recommends 400 IU for the first year, 600 IU from age 1 to age 70, and 800 IU over age 70)

Front 206

How is spinal curvature measured?

Back 206

-Debrunner's kyphometer or

- surveyor's flexicurve

Front 207

What is the most common manifestation of osteoporosis?

Back 207

vertebral compression fractures

Front 208

What are the symptoms of vertebral compression fractures?

Back 208

- 2/3 are asymptomatic
- often do not cause pain
- most will cause height loss

Front 209

What can DXA/DEXA measure?

Back 209

- hip bone density
- spine bone density
- total body bone density

Front 210

How are DXA/DEXA scans scored?

Back 210

- T-score - number of standard deviations the subject's score is away from that of a normal young female

- Z-score - number of standard deviations the subject's score is away from an age-, weight-, ethnicity-, and gender-matched patient

Front 211

Rehabilitation intervention for patients with skeletal demineralization is intended to:

Back 211

- increase bone mass
- slow bone loss and/or
- reduce fracture risk

Front 212

Where should site-specific strengthening exercises be focused in patients with skeletal demineralization?

Back 212

in muscles supporting
- trunk
- hips
- upper extremities

because these areas are at greatest risk for fracture

Front 213

Is swimming recommended for patients trying to increase BMD?

Back 213

- swimming's effects on BMD are controversial, but whether or not BMD is increased, water offers a relatively safe environment for exercise for those at risk of fracture

- the patient can therefore achieve the other benefits of exercise safely

Front 214

Where are the effects of weight-bearing exercise for patients with or at risk of skeletal demineralization primarily noted?

Back 214

primarily, the effects of weight bearing exercise are noted in the spine, with some effect noted at hip and forearm BMD as well

Front 215

When should weight-bearing impact exercise be used?

Back 215

it should begin early in life during the normal growth period, because it can increase peak bone strength and mass by as much as 30%

Front 216

Although exercise later in life has only a small impact on BMD, being physically active can affect bones by:

Back 216

reducing the incidence of hip fracture by up to 50% in those over 65, likely due to improved balance and strength and therefore reduced incidence of falls

Front 217

What is the best treatment for skeletal demineralization?

Back 217

prevention (duh!) through appropriate physical activity and diet during early childhood to maximize bone accretion during growth

Front 218

List some preventative measures for skeletal demineralization.

Back 218

- weight-bearing activity (any activity that requires upright mobility against gravity)
- resistive exercise regimes (should be site-specific, progressive, and exceed normal daily loading)

Front 219

Alendronate

Back 219

Fosamax - a bisphosphonate delivered by tablet

Front 220

Bisphosphonate

Back 220

group of antiresorptive compounds used for the prevention and treatment of osteoporosis in postmenopausal women and in men, as well as those patients with Paget's disease or steroid-induced osteoporosis

Front 221

Bone mineral density (BMD)

Back 221

amount of bone mass present; typically measured in the lumbar spine and hip

Front 222

Calcitonin

Back 222

hormone (usually salmon) used for treatment of postmenopausal osteoporosis and pain from vertebral compression fracture; Miacalcin is delivered by nasal spray

Front 223

Debrunner's kyphometer

Back 223

metal device, similar to an inclinometer, used to measure kyphosis

Front 224

Flexicurve

Back 224

a 48-cm strip of lead covered with synthetic rubber used to map the kypholordotic curve

Front 225

Glucocorticoid

Back 225

medication used to decrease inflammation in chronic conditions such as RA, and as an antirejection drug after organ transplant

Front 226

Osteopenia

Back 226

bone mass between 1.0 and 2.5 standard deviations below the mean for young normals

Front 227

Osteoporosis

Back 227

bone loss greater than 2.5 standard deviations below the mean for young normals; decreased bone mass with disruption of normal architecture resulting in increased fragility and increased risk of fracture

Front 228

Risedronate

Back 228

Actonel - a bisphosphoneate

Front 229

Selective estrogen receptor modulator (SERM)

Back 229

compounds that act like estrogen on bone without affecting breast or uterine tissue

Front 230

Stadiometer

Back 230

measurement device to examine height; can be mounted on the wall or be free-standing

Front 231

What is impaired posture?

Back 231

any postural abnormality that affects function

Front 232

What is the base of support?

Back 232

the area of the body in contact with the supporting surface
(in typical standing, the BOS is the area around the outer edges of the feet)

Front 233

What controls posture?

Back 233

the CNS, which integrates sensory information from the visual, proprioceptive and vestibular systems to direct the muscles to achieve balance

Front 234

What is postural control?

Back 234

control of the body for stability and orientation to the environment regardless of position or posture

Front 235

What is postural orientation?

Back 235

the ability to maintain the appropriate relationship between body parts and between the body and the environment during the performance of a task

Front 236

What are the advantages and disadvantages of erect, bipedal stance?

Back 236

- advantage - UEs free for fine and gross motor tasks

- disadvantages - small BOS, high COG, high pressures on the vertebral column, pelvis, and LEs

Front 237

What is center of gravity?

Back 237

a point about which gravity and the weight of a body act on one another to maintain equilibrium

Front 238

Ideal posture is thought to minimize...

Back 238

the risk of injury or progressive deformity to supporting structures in all functional positions

Front 239

Ideal posture requires minimal energy expenditure to maintain alignment. What posture requires the least amount of energy expenditure?

Back 239

a slumped posture in which ligaments, rather than muscles stabilize weight-bearing joints

Front 240

What other conditions must be normal to support ideal posture?

Back 240

- muscle tone
- flexibility
- neuromuscular control
- reflexes

Front 241

What increases standing postural sway? What decreases it?

Back 241

increases
- fatigue
- low back pain
- advanced age
- stroke
- osteoporosis
- alcohol consumption

decreases
- intention
- lightly touching stable object
- visual cues

Front 242

Which postural sway is greater--when standing or when sitting unsupported?

Back 242

sitting unsupported

Front 243

How should eyes appear in ideal standing posture from an anterior view?

Back 243

horizontally level

Front 244

How should shoulders appear in ideal standing posture from an anterior or posterior view?

Back 244

- horizontally level
- superior angle slightly below horizontal axis through T1

Front 245

How should scapulae appear in ideal standing posture from a posterior view?

Back 245

- flat against thorax
- 30 degrees anterior to the frontal plane
- approximately 6 inches apart (each approximately 3 inches from midline)
- medial border parallel to spine

Front 246

How should elbows appear in ideal standing posture from an anterior or posterior view?

Back 246

- neutral or slight carrying angle for males

- slight to moderate carrying angle for females

Front 247

What is the carrying angle?

Back 247

a valgus angle of the elbow that may be seen clearly when the arm is positioned with the shoulder in neutral flexion/extension and full external rotation with the elbow extended

Front 248

How should wrists appear in ideal standing posture from an anterior or posterior view?

Back 248

neutral, in neither flexion nor extension

Front 249

How should hands appear in ideal standing posture from an anterior or posterior view?

Back 249

face medially, toward the body

Front 250

How should the ribs and sternum appear in ideal standing posture from an anterior view?

Back 250

- ribs and the lateral contours of the rib cage symmetrical

- infrasternal angle is 90 degrees

Front 251

How should the pelvis appear in ideal standing posture from an anterior or posterior view?

Back 251

ASISs and PSISs horizontally level

Front 252

How should the hips appear in ideal standing posture from an anterior or posterior view?

Back 252

- neutral rotation
- neutral abduction
- neutral adduction

Front 253

How should the knees appear in ideal standing posture from an anterior or posterior view?

Back 253

- patellae face directly forward
- popliteal creases face directly directly forward
- Q-angle approximately 13 degrees in males, 18 degrees in females

Front 254

What is the Q-angle?

Back 254

the angle formed from the intersection of a line drawn from the ASIS through the center of the patella and a line drawn from the center of the tibial tubercle through the center of the patella

Front 255

How should the feet appear in ideal standing posture from an anterior or posterior view?

Back 255

- neither pronated nor supinated
- toes relaxed and without varus or valgus
- calcaneus in mild valgus

Front 256

How should the spine appear in ideal standing posture from a posterior view?

Back 256

vertically straight with the occiput directly over the sacrum

Front 257

How should the cervical spine appear in ideal standing posture from a lateral view?

Back 257

- slight lordosis
- supporting head with minimal muscular effort
- without upward, downward, or sideways tilt, rotation, or retraction

Front 258

What is lordosis?

Back 258

an anterior spinal curve or a curve that has an anterior convexity

Front 259

What is retraction?

Back 259

posterior movement of the clavicle, scapula, head, etc.

Front 260

What is kyphosis?

Back 260

a posterior spinal curve or a spinal curve with a posterior convexity

Front 261

How should the humerus appear in ideal standing posture from a lateral view?

Back 261

- less than 1/3 of humeral head anterior to anterior aspect of the acromion

- proximal and distal ends in the same (frontal) plane

Front 262

How should the elbow appear in ideal standing posture from a lateral view?

Back 262

- extension or slight flexion
- antecubital fossae face anteromedially
- olecranon faces posteriorly

Front 263

How should the thoracic spine appear in ideal standing posture from a lateral view?

Back 263

kyphosis of 34 degrees for adults and 38 degrees for adolescents (averages based on x-rays)

Front 264

How should the ribs and sternum appear in ideal standing posture from a lateral view?

Back 264

- contours of the ribcage symmetrical in the frontal plane

- no rotation of ribcage

Front 265

How should the lumbar spine appear in ideal standing posture from a lateral view?

Back 265

lordosis of 64 degrees for adults and adolescents (average based on x-rays)

Front 266

How should the pelvis appear in ideal standing posture from a lateral view?

Back 266

ASISs in same vertical plane as pubic symphysis

Front 267

How should the knees appear in ideal standing posture from a lateral view?

Back 267

neutral position, neither flexed nor hyperextended

Front 268

How should the spine appear in ideal standing posture from a lateral view?

Back 268

bodies of the cervical vertebrae are in vertical alignment with bodies of lumbar vertebrae

(I assume on x-ray?)

Front 269

What factors can affect ideal sitting posture?

Back 269

- where a person is sitting
- the person's habits
- the task being performed

Front 270

Forward sitting

Back 270

sitting in a posture with the lumbar lordosis diminished or reversed, or an increased kyphosis of the spine

Front 271

In most sitting postures, the pelvis rotates _______ and the lumbar lordosis ______.

Back 271

- posteriorly

- reduces

Front 272

The _____ the thigh-torso angle, the more the lumbar lordosis decreases.

Back 272

smaller (as in sitting with the knees higher than the hips)

Front 273

What is the perceived benefit of sitting with a larger thigh-torso angle?

Back 273

with the knees lower than the hips, the posture more closely approximates standing, and promotes maintenance of lumbar lordosis

Front 274

What is perching?

Back 274

sitting with an open thigh-torso angle by
- sitting at the forward edge of the seat,
- sitting on a seat that can tilt forward
- sitting on a tall stool, or
- sitting on a gym ball or specialized chair

Front 275

What is active sitting?

Back 275

involves sitting at the front of the chair with the torso leaning forward, placing the COG anterior to the ischial tuberosities with the lower extremity muscles actively supporting the sitting posture

Front 276

What are the benefits of active sitting?

Back 276

allows the spine to be in the ideal position found in standing and provides a wide BOS to stabilize the spine when static and during repetitive movement and loading

Front 277

Scoliosis

Back 277

a lateral deviation from the normally straight vertical line of the vertebral column

Front 278

Anteversion

Back 278

anterior tipping of an organ or part

in the femur, an angle of more than the normal 15-degree anterior angulation of the femoral neck to the long axis of the shaft

Front 279

What conditions are commonly associated with increased thoracic kyphosis?

Back 279

- osteoporosis
- aging
- ankylosing spondylitis

Front 280

What pathology can cause a barrel chest?

Back 280

COPD

Front 281

Barrel chest

Back 281

an increase in the anteroposterior diameter of the ribcage

Front 282

Flatback

Back 282

a posture of diminished lordosis of the lumbar spine

Front 283

Active sitting

Back 283

sitting with
- the ischial tuberosities at the forward edge of the seat,
- the pelvis and lumbar spine in a neutral position,
- the feet spread apart (either forward and back or side to side) and
- a slight forward lean at the hips

Front 284

Calcaneal valgus

Back 284

the calcaneus is angled with the inferior portion lateral to the superior portion; calcaneal eversion

Front 285

Kyphosis-lordosis

Back 285

a posture with excessive thoracic kyphosis and excessive lumbar lordosis

Front 286

Center of mass

Back 286

a point that is at the center of the total body mass

Front 287

Line of gravity

Back 287

a vertical line dropped form the body's COG

Front 288

Patella alta

Back 288

the patella is positioned more proximal than normal

Front 289

Patella baja

Back 289

the patella is positioned so that the distance between the inferior pole of the patella and the tibial tubercle is less than two-thirds of the length of the patella

Front 290

Pectus carinatum/gallinatum

Back 290

excessive prominence of the sternum

Front 291

Pectus excavatum/recurvatum

Back 291

excessive depression of the sternum

Front 292

Retroversion

Back 292

the tipping backward of an organ or part

Front 293

Squinting (or convergent) patellae

Back 293

patellae that appear tilted medially (toward one another)

Front 294

Swayback

Back 294

a posture with the pelvis in posterior tilt and the hips swayed forward in relation to the feet resulting in hip joint extension

Front 295

Valgus

Back 295

the distal bony segment is aligned laterally in comparison with the proximal segment

Front 296

Varus

Back 296

the distal bony segment is aligned medially in comparison with the proximal segment

Front 297

What are some common variations from ideal alignment at the spine?

Back 297

- forward head
- excessive kyphosis
- excessive lordosis
- kyphosis-lordosis
- swayback
- flat back
- scoliosis

Front 298

What are some common variations from ideal alignment at the rib cage and sternum?

Back 298

- asymmetry of the rib cage in the frontal or sagittal planes
- barrel chest
- pectus excavatum/recuvatum
- pectus carinatum/gallinatum
- increase or decreasein the infrasternal angle from 90 degrees

Front 299

What are some common variations from ideal alignment at the scapulae?

Back 299

- elevation
- depression
- upward tilt
- downward tilt
- abduction
- adduction
- winging
- anterior tilt

Front 300

What are some common variations from ideal alignment at the shoulder?

Back 300

- forward shoulder
- depressed shoulder
- abduction
- medial rotation
- lateral rotation
- flexion
- extension
- elevated humeral head
- subluxed humeral head
- humeral head more than 50% anterior to the anterior aspect of the acromion

Front 301

What are some common variations from ideal alignment at the elbow?

Back 301

- flexion
- hyperextension
- excessive carrying angle

Front 302

What are some common variations from ideal alignment at the forearm?

Back 302

- pronation

- supination

Front 303

What are some common variations from ideal alignment at the wrist?

Back 303

- flexion
- extension
- ulnar deviation
- radial deviation

Front 304

What are some common variations from ideal alignment at the hand/fingers?

Back 304

- ulnar drift
- boutonniere deformity
- swan-neck deformity

Front 305

What are some common variations from ideal alignment at the hip/femur?

Back 305

- femoral anteversion (ante-torsion)
- femoral retroversion (retrotorsion)
- coxa vara
- coxa valga
- femoral medial rotation
- femoral lateral rotation

Front 306

What are some common variations from ideal alignment at the knee?

Back 306

- flexion
- hyperextension
- Q-angle greater than 13 degrees for men and 18 degrees for women
- patella alta
- patella baja
- "squinting" patellae

Front 307

What are some common variations from ideal alignment at the tibia?

Back 307

- tibial medial torsion
- tibial lateral torsion
- tibial varum

Front 308

What are some common variations from ideal alignment at the feet?

Back 308

- pes planus
- pes cavus
- calcaneal varum
- excessive calcaneal valgus

Front 309

What are some common variations from ideal alignment at the toes?

Back 309

- hallux valgus
- hammer toes
- claw toes
- mallet toes
- overlapping toes
- Morton's toe
- bunions

Front 310

Ideally, when should the clinician begin observing the patient's posture?

Back 310

when the patient is unaware that the examination has begun, thus is likely to be in his/her "usual" posture

Front 311

On observation of posture, what is the clinician looking for (in broad terms)?

Back 311

- use of assistive device
- guarding
- limitation of movement
- compensatory movements

Front 312

Posture is evaluated relative to ideal alignment and deviations from ideal are described....

Back 312

in terms of how the body parts have moved away from that ideal posture to their current position

Front 313

The point at which the three mid-planes intersect the body is the _____.

Back 313

COG

Front 314

The LOG is the vertical line formed by the intersection of...

Back 314

the midsagittal and midfrontal (midcoronal) planes

Front 315

Scoliosis always has both sidebending and rotational components because....

Back 315

lateral flexion and rotation of the spine occur together as coupled movements

Front 316

In ideal alignment (lateral view), the LOG passes anterior to the joint line at the ankle, and this causes a _____ moment.

Back 316

dorsiflexion

(the gastrocnemius and soleus must work to prevent forward motion of the tibia when standing in ideal alignment)

Front 317

In ideal alignment (lateral view), the LOG passes anterior to the joint line at the knee, and this causes an ______ moment.

Back 317

extension

(the hamstrings must work to prevent hyperextension of the knee)

Front 318

In ideal alignment (lateral view), the LOG passes slightly posterior to the joint line at the hip, and this causes an ______ moment.

Back 318

extension

(the quadriceps and other hip flexors must work to prevent posterior rotation of the pelvis)

Front 319

Opposing pulls of muscles on the ______ and _____ _____ help maintain ideal alignment of the pelvis.

Back 319

- ASISs
- symphysis pubis

in ideal posture, both are in the same coronal plane

Front 320

The diagnostic category for impaired posture is preferred practice pattern ___.

Back 320

4B - impaired posture

Front 321

What factor can increase postural sway while seated?

Back 321

if the feet are unsupported

Front 322

Should the patient choose anterior/forward sitting, middle/erect sitting, or posterior sitting?

Back 322

- the patient needs to select whichever position is the most comfortable

- patients need to find their own individual neutral spine

Front 323

According to her handout, which muscles are especially prone to tightness?

Back 323

- sternocleidomastoid
- scalenes
- pectoralis major
- iliopsoas
- rectus femoris
- tensor fascia latae

- levator scapulae
- upper trapezius
- erector spinae
- quadratus lumborum

- piriformis
- hamstrings
- gastroc-soleus

Front 324

According to her handout, which muscles are especially prone to weakness?

Back 324

- short cervical flexors
- serratus anterior
- rectus abdominis
- vastus medialis and lateralis
- tibialis anterior

- extensors of upper limb (latissimus dorsi, teres major, posterior deltoid, pectoralis major, long head of triceps)
- lower trapezius
- gluteus maximus, medius, minimus

Front 325

In which direction do the spinous processes deviate in a scoliotic spine?

Back 325

toward the concave side

Front 326

In which direction do the vertebral bodies deviate in a scoliotic spine?

Back 326

toward the convex side