709 1.2 + 1.3  Lumbar spine and Pelvis
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Questions and Answers

What should you know at the end of the subjective assessment?

  • The client's goals and the treatment plan (correct)
  • The treatment plan and evaluation method
  • The evaluation method and client's goals
  • The assessment findings and treatment plan

What should you have at the end of the objective assessment?

  • Treatment plan, initial treatment, and evaluation method
  • Client's goals, treatment plan, and evaluation method
  • Client's goals, assessment findings, and treatment plan
  • Assessment findings, treatment plan, and evaluation method (correct)

What should you know after each reassessment of a treatment?

  • Client's goals and next treatment component (correct)
  • Objective assessment findings and reassessment plan
  • Effectiveness of treatment and client's goals
  • Initial treatment and reassessment findings

Which phase comes after research in the clinical decision-making model?

<p>Evaluation (C)</p> Signup and view all the answers

What does the figure below illustrate?

<p>Physiotherapy practice structure and logic (C)</p> Signup and view all the answers

According to Darrah et al. (2006), what do peripheral and spinal musculoskeletal conditions share?

<p>Core principles of assessment and treatment (B)</p> Signup and view all the answers

How is somatic referred pain defined?

<p>Pain felt in a region innervated by nerves different from the actual source of pain (A)</p> Signup and view all the answers

How is somatic referred pain commonly perceived by patients?

<p>Dull and cramp-like (C)</p> Signup and view all the answers

What is the current literature's stance on the concept of sclerotomes?

<p>Not supported (C)</p> Signup and view all the answers

Which nerve roots consistently follow a dermatomal pattern into the lower extremity?

<p>L5 and S1 (C)</p> Signup and view all the answers

What is the most common quality of radicular pain extending past the ankle?

<p>Sharp and localized (B)</p> Signup and view all the answers

What type of characteristics are linked to the types of pain pathways associated with leg pain?

<p>Both nociceptive and neuropathic characteristics (C)</p> Signup and view all the answers

Based on the text, what does radicular pain projected into the big toe most likely originate from?

<p>L5 nerve root (A)</p> Signup and view all the answers

What is the current literature's view on whether L1 and L2 nerve roots cause radicular pain into their respective dermatomes?

<p>'More research is needed' (D)</p> Signup and view all the answers

'An unpleasant sensory and emotional experience associated with actual or potential tissue damage' is a definition provided by which association?

<p>'International Association for the Study of Pain' (D)</p> Signup and view all the answers

'An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage' is a revised definition provided in what year?

<p>'2020' (C)</p> Signup and view all the answers

What is emphasized in the text regarding treatment sessions?

<p>Knowing where to start in the next session (B)</p> Signup and view all the answers

What do clinicians target when treating someone with an ACL rupture?

<p>Person's impairments (C)</p> Signup and view all the answers

Which statement best describes the approach in treating non-specific low back pain?

<p>Addressing patterns of impairments across various elements (C)</p> Signup and view all the answers

What percentage of people with spinal conditions have a specific diagnosis according to the text?

<p>&lt; 10% (B)</p> Signup and view all the answers

What kind of pain is common in the remaining 90% of people with spinal conditions?

<p>Mechanical back or neck pain (A)</p> Signup and view all the answers

In treating someone with an ACL rupture, what kind of impairments are typically targeted?

<p>Motion impairment (B)</p> Signup and view all the answers

What is the main focus when considering treatment for non-specific low back pain?

<p>Targeting impairments based on patterns (A)</p> Signup and view all the answers

How are muscles described in relation to articulations in the text?

<p>Muscles span one or two joints (B)</p> Signup and view all the answers

What does the 5D's in the cervical spine assessment help determine?

<p>Risk of vertebral artery involvement (D)</p> Signup and view all the answers

Which of the following is NOT considered a cauda equina sign in spinal assessment?

<p>Night sweats (B)</p> Signup and view all the answers

What does the term 'malaise' refer to in the context of general health assessment?

<p>Feeling of general discomfort and uneasiness (B)</p> Signup and view all the answers

What type of symptoms are associated with glove and stocking paraesthesia in spinal assessments?

<p>Tingling and numbness in the extremities (A)</p> Signup and view all the answers

What is one of the key elements to be confirmed when reviewing red flags during medical history screening?

<p>Client's goals (A)</p> Signup and view all the answers

'SMART Goal Framework' is used to ensure that goals are:

<p>Client-centered and achievable (C)</p> Signup and view all the answers

What may help make a patient more comfortable in sidelying?

<p>A pillow under their knees (A)</p> Signup and view all the answers

What is better for a patient: standing or walking?

<p>Walking (C)</p> Signup and view all the answers

What behavior is common and not indicative of a red flag regarding night pain?

<p>Pain wakes the patient at night but eases after changing position (A)</p> Signup and view all the answers

What is typically true about back pain in the morning according to the text?

<p>It is worse at the end of the day (A)</p> Signup and view all the answers

What type of onset is not typical for canal stenosis as mentioned in the text?

<p>Sudden onset (A)</p> Signup and view all the answers

What type of history may vary depending on a client's specific situation?

<p>Social history (C)</p> Signup and view all the answers

What section of a client history includes information about their housing situation and family support?

<p>Social/Environmental history (C)</p> Signup and view all the answers

Which factor may suggest certain diagnoses or clinical patterns in individuals with low back or pelvic symptoms?

<p>&quot;Sudden onset&quot; and predisposing factors (D)</p> Signup and view all the answers

What might be advised for individuals who need to stand for long periods according to the text?

<p>Keeping one foot up, adjusting work height, etc. (D)</p> Signup and view all the answers

What is typically true about leg pain by the end of the day according to the text?

<p>It becomes more constant by the end of the day (B)</p> Signup and view all the answers

Why is having a clear structure to history-taking important in physiotherapy practice?

<p>To ensure all necessary information is obtained (D)</p> Signup and view all the answers

What is the purpose of an open-ended question during information gathering in physiotherapy practice?

<p>To efficiently gather important information and make the client feel listened to (A)</p> Signup and view all the answers

Why is asking about the location of a patient's symptoms important in physiotherapy assessment?

<p>To determine potential pain referral patterns (B)</p> Signup and view all the answers

What does a neuroanatomically plausible structure or location help determine in physiotherapy assessment?

<p>The source of the client's symptoms (C)</p> Signup and view all the answers

Which area is NOT typically asked about when reviewing symptom location in physiotherapy assessment?

<p>Shoulders (B)</p> Signup and view all the answers

What is an example of information that can be gathered from an open-ended question during a physiotherapy session?

<p>Insights into the client's goals and expectations (A)</p> Signup and view all the answers

What is the purpose of using body charts in patient assessments?

<p>To indicate where pain is located and describe the type of symptoms experienced (C)</p> Signup and view all the answers

Why is knowledge of potential pain referral patterns crucial in physiotherapy assessment?

<p>To identify whether a given structure could produce symptoms in the described area (B)</p> Signup and view all the answers

What is true about the locations of symptoms shown on a body map?

<p>They can increase or decrease the likelihood of specific conditions (B)</p> Signup and view all the answers

What is an important benefit of having a structure to history-taking in physiotherapy practice?

<p>To provide a framework for obtaining all necessary information (D)</p> Signup and view all the answers

What caution should be taken when asking questions related to symptom behavior?

<p>Be wary of assuming certain activities make the symptoms worse (D)</p> Signup and view all the answers

Why is it important to gather preliminary information before starting a conversation with a client in physiotherapy practice?

<p>To have an idea of what to ask during the conversation with the client (D)</p> Signup and view all the answers

Which factor is typically indicative of people with Non-Specific Low Back Pain (NSLBP) according to the text?

<p>Experiencing increased leg pain after sneezing (A)</p> Signup and view all the answers

Why should questions about symptom location be specific in physiotherapy assessment?

<p>To obtain accurate information on the extent and distribution of symptoms (B)</p> Signup and view all the answers

According to the information provided, what can be a possible cause of increased back and leg pain after sneezing?

<p>A sudden onset of discogenic origin back pain (D)</p> Signup and view all the answers

How do most people with Non-Specific Low Back Pain (NSLBP) feel when sitting according to the text?

<p>Often worse when sitting in flexion (C)</p> Signup and view all the answers

What is a potential easing factor for leg pain after sitting according to the information provided?

<p>'Crook lying' position after sitting for a few minutes (D)</p> Signup and view all the answers

Why is it important to inquire about how a person gets up from sitting according to the text?

<p>'Extension' movements may guide management plans (A)</p> Signup and view all the answers

'Crook lying' and 'crook sitting' positions are mentioned in relation to what type of condition?

<p>'Piriformis syndrome' (A)</p> Signup and view all the answers

Which activity often worsens sitting symptoms for people with Non-Specific Low Back Pain (NSLBP)?

<p>Sitting in a straight chair for extended periods (A)</p> Signup and view all the answers

Study Notes

History Taking

  • A structured approach to history taking is essential in physiotherapy practice
  • It ensures all necessary information is obtained, reduces cognitive load, and provides a structure for the client
  • The assessment starts with preliminary information, including:
    • Referral
    • Previous investigations
    • Client-completed screening form
    • Introduction (including who you are, your role, and your expectations of the session)
    • Open-ended question (90-second rule) to gather information about the client's concerns and goals

Body Chart

  • The body chart is a useful tool to document the location and type of symptoms
  • It helps to identify the source of symptoms and potential pain referral patterns
  • Components of the body chart include:
    • Symptom location (specific and detailed)
    • Type of symptoms (e.g., pain, paraesthesia, anaesthesia)
    • Spatial continuity (i.e., connections between symptoms)
    • Relevant areas (e.g., low back, upper back, neck, abdomen, groin, legs, feet)
    • Saddle paraesthesia/anaesthesia (potential cauda equina lesion)

Behaviour of Symptoms

  • Behaviour of symptoms includes:
    • Constant or intermittent symptoms
    • Relationship between symptoms
    • Open questions to gather more information (e.g., when symptoms are better or worse)
    • Functional activities/work/sport
    • Coughing/sneezing
    • Standing
    • Sitting
    • Walking
    • Lying
    • Irritability
    • Red flag questions (if necessary)

Clinical Reasoning

  • Clinical decision-making model involves:
    • Theory
    • Assessment
    • Intervention
    • Research and evaluation
  • The model helps guide physiotherapy practice and ensures a structured approach to treatment

Somatic Referred Pain

  • Somatic referred pain is defined as pain perceived as arising from a region of the body innervated by nerves or branches of nerves other than those that innervate the actual source of pain
  • It occurs due to convergence of afferent neurons from different areas of the body onto a common interneuron before being relayed to higher centers
  • Characteristics of somatic referred pain include:
    • Deep, achy, diffuse, and poorly localized
    • Dull and cramp-like
    • Not necessarily following a segmental pattern into the lower extremity

Radicular Pain

  • Radicular pain refers to pain that originates from a spinal nerve root
  • Patterns of radicular pain are not always clear-cut and may not follow a dermatomal pattern
  • Radicular pain from L5 and S1 nerve roots consistently follows a dermatomal pattern into the lower extremity, while pain from L3, L4, and S2 nerve roots is less consistent

Diagnosis in Spinal Conditions

  • Less than 10% of people with low back pain have a specific diagnosis such as spinal canal stenosis, spondylolisthesis, or fractures

  • The remaining 90% have non-specific low back pain or mechanical back pain

  • Diagnosis is not essential for treatment, as physiotherapists target impairments across the four elements (motion, force, motor control, and energy) in the context of personal and environmental factors### General Health Screening

  • Special questions include:

    • Other relevant medical history and regular medication
    • Other relevant surgical history
    • Other relevant family medical history
    • Other relevant lifestyle: exercise and physical activity
    • Other relevant habits: smoking, alcohol, etc
    • Night sweats, night pain, weight loss, confusion, fatigue
    • Malaise: Feeling of general discomfort, uneasiness, being “out of sorts”

Cervical Spine

  • 5D’s to determine risk of vertebral artery involvement:
    • Dizziness
    • Dysarthria (speech)
    • Dysphagia (swallow)
    • Diplopia (vision)
    • Drop attacks

Spine

  • Cord signs:
    • Glove and stocking paraesthesia
    • Balance problems
    • Postural hypotension
  • Cauda equina signs:
    • Bowel or bladder changes (urinary retention, unable to control anal sphincter)

Cognitive Impairment

  • In older person:
    • Depression
    • Delirium
    • Dementia

Goals

  • Confirm client goals using the SMART Goal Framework
  • Ensure goals are client-centered

Social History

  • Obtain information on:
    • Housing situation and other members of the household
    • Family or friend support
    • Employment (demands of work and relationship with employer)
    • Hobbies

Red Flags and Yellow Flags

  • Review screening form for red flag questions
  • Identify yellow flags (psychosocial factors)

Physical Assessment

  • Plan for physical assessment:
    • What to assess
    • How to assess
    • Consider limiting assessment due to irritability
    • May need to adjust techniques for comfort (e.g., pillow under knees)

Client History

  • Cover past medical history, including:
    • Onset of symptoms
    • Mechanism of injury (if applicable)
    • Predisposing factors
    • Behaviour/progress of symptoms since onset
    • Functional status
    • Perception of primary symptoms
    • Current and previous examinations/tests/treatments

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Description

Learn about the similarities and differences in assessment and treatment principles for individuals with peripheral and spinal musculoskeletal conditions. Explore a clinical decision-making model and elements of collecting cues and information.

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