Lecture #3 - Spinal Motion Assessment
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Questions and Answers

What crucial information must be established before proceeding with a spinal motion assessment?

That everything is safe.

What steps should be taken regarding fractures before further spinal assessment?

Screen and refer before any further assessment.

Identify the three critical rule-outs according to the Canadian C-Spine Rules.

Fractures, ligaments, and vertebral/internal carotid arteries.

What two considerations must be made to determine if motion assessment is appropriate?

<p>Whether active and/or passive movement is being performed and if all or some movements are included.</p> Signup and view all the answers

How does the movement of the vertebral column vary?

<p>It varies according to spinal region and the individual.</p> Signup and view all the answers

What movement occurs at a motion segment involving two vertebrae?

<p>The more superior vertebral body moves on the more inferior vertebral body.</p> Signup and view all the answers

In which regions of the spine is the range of motion (ROM) greatest?

<p>Cervical and lumbar regions.</p> Signup and view all the answers

What does the acronym FLLARD stand for in terms of the degrees of freedom in the spine?

<p>Flexion, Extension, Lateral Flexion, Lateral Translation, Anterior/Posterior Translation, and Rotation.</p> Signup and view all the answers

What is the percentage increase in the intervertebral foramen space during flexion?

<p>20-30%</p> Signup and view all the answers

What should be monitored to prevent excessive opening during cervical flexion?

<p>Ensure the mouth doesn't open.</p> Signup and view all the answers

In which position should a patient be placed for thoracic spine extension exercises?

<p>Standing.</p> Signup and view all the answers

What is critical to ensure during passive range of motion (PROM) assessments of the spine?

<p>Patient positioning.</p> Signup and view all the answers

What is one indication of upper motor neuron pathology during spinal flexion?

<p>Shooting pain down the spine.</p> Signup and view all the answers

What should you observe for during active range of motion (AROM) of the spine?

<p>Smoothness and compensation.</p> Signup and view all the answers

What are the two criteria for joint normality in a PPIVM assessment?

<p>Normal range and normal end-feel.</p> Signup and view all the answers

What is a common mistake when performing lumbar spine extension?

<p>Not moving into extension, but just returning to neutral.</p> Signup and view all the answers

What patient posture can help when performing PROM of the thoracic spine?

<p>Side lying position.</p> Signup and view all the answers

What should practitioners ensure before pressing on the glenohumeral area?

<p>That the person doesn’t have a GH instability.</p> Signup and view all the answers

What does a 'swipe' to one side during cervical flexion indicate?

<p>A facet dysfunction.</p> Signup and view all the answers

How often is protraction performed during cervical assessments?

<p>Almost never.</p> Signup and view all the answers

What is an essential aspect of therapist positioning during assessments?

<p>Good body mechanics with the table at an appropriate height.</p> Signup and view all the answers

What should you cue a patient to do about their head during thoracic spine movements?

<p>Let the head go back if there is no dizziness.</p> Signup and view all the answers

What is the primary purpose of using the PAIVM technique in spinal assessment?

<p>To evaluate intervertebral motion and joint glide abnormalities.</p> Signup and view all the answers

How does the PPIVM technique differ from the PROM approach?

<p>PPIVM focuses on assessing small portions of the spine segmentally, while PROM evaluates the entire range of motion of a joint.</p> Signup and view all the answers

In the context of accessory motion evaluation, what does the term 'tissue resistance' refer to?

<p>Tissue resistance is the limit of motion felt as the joint surfaces approach their end of the elastic phase.</p> Signup and view all the answers

Why might accessory joint hypermobility exist despite normal or restricted physiological motion?

<p>Hypermobility can occur due to guarding and compensatory mechanisms within adjacent segments.</p> Signup and view all the answers

What positioning is critical for initiating PAIVM testing?

<p>The joint should be positioned in the resting or loose packed position.</p> Signup and view all the answers

List the three essential checks to perform on joints before assessing PPIVMs.

<p>Strength, length, and function.</p> Signup and view all the answers

What implications arise if a patient's joint glide is restricted during assessment?

<p>It typically indicates issues with the joint capsule or periarticular tissues.</p> Signup and view all the answers

How can comparing a joint's excursion to the opposite side be problematic?

<p>The comparison assumes the opposite side is not impaired, which may not always be true.</p> Signup and view all the answers

What corrective behavior is often observed in individuals with hypermobile segments?

<p>They commonly attempt to create stability in adjacent segments to compensate.</p> Signup and view all the answers

What is the significance of segmental motion assessment in spinal evaluations?

<p>It allows for a detailed understanding of movement dysfunction at specific spinal levels.</p> Signup and view all the answers

How does the superior vertebra rotate around the horizontal axis?

<p>Anteriorly and posteriorly.</p> Signup and view all the answers

What determines the motion available in the spine?

<p>The shape and orientation of the articulations, size and location of articulating processes, and the ligaments and muscles.</p> Signup and view all the answers

What is the significance of coupled motion in the spine?

<p>Coupled motion indicates that movement around one axis is consistently associated with movement around another axis.</p> Signup and view all the answers

What type of motion does the atlantoaxial joint primarily facilitate?

<p>Substantial rotation with small amounts of flexion and extension.</p> Signup and view all the answers

What movements are primarily limited in the capsular pattern of the cervical spine?

<p>Side bending and rotation are equally limited, with flexion less limited than extension.</p> Signup and view all the answers

What variables are crucial in determining the available motion at each spine region?

<p>Compliance of fibrocartilage, age, disc-vertebral height ratio, disease, dimensions of end plates, and gender.</p> Signup and view all the answers

What three tools are commonly used to measure physiological motion of the spine?

<p>Inclinometers, goniometers, and measuring tapes.</p> Signup and view all the answers

In which region of the spine are side glides practiced?

<p>The cervical spine.</p> Signup and view all the answers

What defines hypomobile, normal, and hypermobile conditions in arthrokinematic mobility?

<p>Hypomobile indicates limited movement, normal indicates expected movement, and hypermobile indicates excessive movement.</p> Signup and view all the answers

What aspects should you assess for active range of motion (AROM)?

<p>Pain, palpation, observation, range of motion, and cueing or correction.</p> Signup and view all the answers

How does flexion of the cervical spine relate to C2 prominence?

<p>The prominence of C2 may indicate upper cervical instability during flexion.</p> Signup and view all the answers

What additional factors, besides those described by Dutton, influence spinal motion?

<p>Willingness to go through range of motion, resistance of muscles and ligaments, individual strength, and presence of pain.</p> Signup and view all the answers

What is the function of arthrokinematic movement?

<p>It is the movement between two articulating surfaces without reference to external forces.</p> Signup and view all the answers

What represents the range of motion recording legend for pain-free ROM?

<p>A blank entry signifies pain-free ROM.</p> Signup and view all the answers

Why is it important to adjust neck positioning when assessing vertebral segments?

<p>Adjusting neck positioning is crucial to accurately feel the movement of individual vertebral segments, especially since each segment has different end feels.</p> Signup and view all the answers

Describe the variability in sensation during side bending (SB) assessments.

<p>During side bending assessments, the sensation can vary between the spinous processes and can experience gapping or closing based on the direction of movement.</p> Signup and view all the answers

What is the challenge associated with mobilization and manipulation techniques in the literature?

<p>The reliability and specificity of mobilization and manipulation techniques are heavily challenged, despite their appealing appearance.</p> Signup and view all the answers

What are the four types of posterior-anterior influence vertebral mobilization (PAIVMs)?

<p>The four types of PAIVMs are PACVP, side glides, TVP, and PAUVP.</p> Signup and view all the answers

In what positions must PACVPs and PAUVPs be performed for the thoracic and lumbar spine?

<p>PACVPs and PAUVPs must be performed in the prone position for the thoracic and lumbar spine.</p> Signup and view all the answers

How can the hand positioning vary between assessing the C spine and the L spine?

<p>In the C spine, clinicians typically use a thumb-on-thumb technique, while in the L spine, the angle may need adjustments due to the lordotic curve.</p> Signup and view all the answers

What technique is commonly used for side glides in the cervical spine?

<p>Side glides in the cervical spine often involve applying pressure on the articular pillars.</p> Signup and view all the answers

What is a significant risk when performing PAIVMs in patients with spinal instability?

<p>Performing PAIVMs in patients with spinal instability can aggravate their condition and result in complications.</p> Signup and view all the answers

How does movement assessment differ between palpating TSPs and SPs?

<p>Palpating TSPs involves pushing laterally and away from the spinous processes, while SPs are pushed directly on or off to the side.</p> Signup and view all the answers

What is the typical patient positioning required for transverse vertebral pressure (TVP)?

<p>The typical patient positioning required for TVP is supine or prone.</p> Signup and view all the answers

What should clinicians consider when assessing the lumbar spine because of its lordotic curve?

<p>Clinicians should consider adjusting their angle slightly to accommodate the lumbar spine's lordotic curve.</p> Signup and view all the answers

Why is palpating the transverse processes (TSPs) in the lumbar spine considered challenging?

<p>Palpating the TSPs in the lumbar spine is challenging due to their depth of more than an inch and their position beneath various tissues.</p> Signup and view all the answers

What is the significance of the PACVP technique in vertebral assessment?

<p>The PACVP technique is significant as it replicates end feel assessments, which can indicate segmental mobility and stability.</p> Signup and view all the answers

What is the biggest advantage of using thumb-related techniques for mobilization over ulnar border techniques?

<p>Thumb-related techniques generally allow clinicians to feel more precise motions and end feels compared to ulnar border techniques.</p> Signup and view all the answers

In the context of spinal motion assessment, what factors increase the risk of cervical artery compromise?

<p>Risks include ligament instability, fractures, and involvement of arteries such as the vertebral or internal carotid arteries.</p> Signup and view all the answers

Why is it essential to determine whether to use active or passive movements during a spinal motion assessment?

<p>This determination affects patient safety and influences the accuracy of the assessment outcomes.</p> Signup and view all the answers

What is a key consideration for maximizing patient comfort during motion assessments?

<p>Correct patient positioning is crucial for minimizing discomfort and ensuring effective movement assessment.</p> Signup and view all the answers

Identify how movement at a motion segment is typically described in spinal assessments.

<p>Movement is described by the orientation of the more superior vertebral body in relation to the more inferior vertebral body.</p> Signup and view all the answers

How does the total range of motion within the spine integrate movements across different segments?

<p>Total range of motion is achieved through sequential movements across segments, where each segment contributes a small degree of movement.</p> Signup and view all the answers

During a spinal motion assessment, how should practitioners respond to findings of fractures or ligament instability?

<p>Practitioners must screen or refer patients before proceeding with further assessments in cases of fractures or instability.</p> Signup and view all the answers

What role do the alar and transverse ligaments play in spinal stability, particularly during assessments?

<p>These ligaments are critical stabilizers of the cranio-vertebral region, impacting the safety and integrity of motion assessments.</p> Signup and view all the answers

Explain the importance of the acronym FLLARD in the context of spinal movement assessment.

<p>FLLARD encapsulates the six degrees of freedom in spinal movement: Flexion, Extension, Lateral flexion, Lateral translation, Anterior/ posterior translation, and Rotation.</p> Signup and view all the answers

What is the least likely movement to cause pain while facilitating end range movements?

<p>A PPIVM.</p> Signup and view all the answers

What are the two main types of evaluation in spinal assessment?

<p>Local and regional evaluation.</p> Signup and view all the answers

What is a primary factor implicated when joint glide is restricted?

<p>The joint capsule.</p> Signup and view all the answers

Can contractile tissues be completely ruled out in cases of restricted motion?

<p>No.</p> Signup and view all the answers

What three assessments must be done before evaluating PPIVMs?

<p>Strength, length, and function.</p> Signup and view all the answers

What technique is utilized to maintain segmental assessment during spinal examination?

<p>Assessment segment-by-segment with side flexion.</p> Signup and view all the answers

Why might accessory joint hypermobility exist even if physiological motion is normal?

<p>Due to guarding and the body's mechanism of stability.</p> Signup and view all the answers

When initiating PAIVM testing, what position should the joint be in?

<p>The resting (or loose packed) position.</p> Signup and view all the answers

In terms of accessory motion evaluation, what does tissue resistance indicate?

<p>It indicates reaching the limit of available motion.</p> Signup and view all the answers

What can affect the reliability of joint excursion comparisons during assessments?

<p>Assumed normality of the opposite side.</p> Signup and view all the answers

Explain how positioning of the neck influences the assessment of vertebral movement.

<p>The positioning of the neck is crucial, as it allows for proper movement assessment at each vertebral segment, enabling clearer differentiation of movement quality.</p> Signup and view all the answers

What is the significance of feeling movement between specific segments like C3-C4 compared to C6-C7?

<p>It is significant because the anatomical orientation and movement quality change between segments, which affects the assessment of mobility and restrictions.</p> Signup and view all the answers

How do side-bending assessments vary between right and left sides in cervical vertebrae?

<p>Right side bending will typically cause closing on the left side of the spinous processes and gapping on the right side, and vice versa for left side bending.</p> Signup and view all the answers

Discuss the key challenge faced in isolating movement to one vertebral segment during manipulation.

<p>The key challenge lies in accurately targeting and assessing a single segment amidst the complexity of the surrounding structures and movements of adjacent segments.</p> Signup and view all the answers

What are the four types of PAIVMs and their primary function?

<p>The four types are PACVP, Side Glides, TVP, and PAUVP, and they primarily replicate instability tests of the spine.</p> Signup and view all the answers

Why is the PACVP technique significant for spinal assessment?

<p>PACVP is significant because it applies central pressure to the spinous processes, facilitating an understanding of central vertebral mobility.</p> Signup and view all the answers

What adjustments are necessary when assessing the lumbar spine due to its lordotic curve?

<p>It's necessary to adjust the angle of pressure to account for the lordotic curve, especially on L4-L5 where inclination is more pronounced.</p> Signup and view all the answers

How should the clinician position themselves when performing PACVP on the cervical spine?

<p>The clinician should position themselves either supine or prone with their thumbs interlaced to maintain stability while applying pressure.</p> Signup and view all the answers

Describe how to differentiate between rib motions and thoracic spinous processes during assessment.

<p>Differentiation is made by careful palpation, ensuring to assess movement on the articular pillars while avoiding rib involvement to accurately gauge vertebral mobility.</p> Signup and view all the answers

Why must care be taken during PAIVMs when assessing for spinal instability?

<p>Care must be taken because the tests can provoke instability if a significant issue is present, potentially worsening the patient's condition.</p> Signup and view all the answers

What does 'tissue resistance' refer to in the context of spinal assessments?

<p>Tissue resistance refers to the palpated resistance that clinicians feel when assessing the quality of movement and integrity of the spinal tissues.</p> Signup and view all the answers

What considerations must be made for hand positioning when executing the PAUVP technique?

<p>Hand positioning should utilize the ulnar border for patient comfort and the medial border of the fifth metacarpal to ensure effective pressure application.</p> Signup and view all the answers

How are lateral side glides relevant to cervical spine assessment?

<p>Lateral side glides are crucial as they assess lateral mobility and segmental involvement, revealing potential dysfunctions in the cervical spine.</p> Signup and view all the answers

Why is the feeling of segmental movement variable between different patients?

<p>Segmental movement feeling varies due to individual anatomical differences, muscle tension, and the presence of any pain or pathology during assessment.</p> Signup and view all the answers

What spinal movements are coupled with ipsilateral side bending?

<p>Rotation occurs ipsilaterally with side bending.</p> Signup and view all the answers

What determines the coupling motion variation in the spine?

<p>Coupling motion varies by region and segment within the spine.</p> Signup and view all the answers

What are the main types of motion that occur in the spine?

<p>The main types of motion are osteokinematic and arthrokinematic movements.</p> Signup and view all the answers

What factors contribute to the available motion in spinal regions?

<p>The shape, orientation of articulations, and the ligaments and muscles at each segment contribute to their movement potential.</p> Signup and view all the answers

What is the significance of the cervicocephalic and cervicobrachial subcategories?

<p>These subcategories help facilitate targeted assessment and treatment strategies for the upper and lower cervical spine.</p> Signup and view all the answers

What is the role of fibrocartilage compliance in spinal motion?

<p>Compliance of the fibrocartilage influences flexibility and motion range of the spine.</p> Signup and view all the answers

Describe the role of the atlantoaxial joint in spinal motion?

<p>The atlantoaxial joint primarily facilitates rotation in the cervical spine.</p> Signup and view all the answers

In what way does aging affect spinal motion availability?

<p>Aging typically results in decreased spinal mobility due to changes in disc height and overall vertebral health.</p> Signup and view all the answers

How do the dimensions and shape of vertebral end plates affect motion?

<p>The dimensions and shape dictate the possible articulatory movements between adjacent vertebrae.</p> Signup and view all the answers

What defines the capsular pattern of restriction in the cervical spine?

<p>In the cervical spine, side bending and rotation are equally restricted, while flexion is less restricted than extension.</p> Signup and view all the answers

What is the outcome of full, pain-free osteokinematic motion?

<p>It indicates optimal joint mobility and overall spinal health.</p> Signup and view all the answers

What limits the range of motion during spine assessments?

<p>Pain, structural abnormalities, and muscular resistance may limit range of motion during assessments.</p> Signup and view all the answers

Which tools are essential for measuring physiological spine motion?

<p>Common tools include inclinometers, goniometers, and measuring tapes.</p> Signup and view all the answers

Explain the concept of hypomobility in spinal assessment.

<p>Hypomobility refers to a notable restriction in joint movement compared to normal range.</p> Signup and view all the answers

What should be maintained to ensure effective cervical flexion assessment measurement?

<p>The mouth should not open during the measurement.</p> Signup and view all the answers

What position should the patient maintain during thoracic spine extension exercises?

<p>The patient should stand with arms resting on shoulders and elbows flexed to 90 degrees.</p> Signup and view all the answers

What spinal movement pattern is indicated by evaluating smoothness during active range of motion?

<p>Smoothness indicates an absence of compensatory movements or instability.</p> Signup and view all the answers

What should be monitored to prevent compensatory involvement during thoracic extension?

<p>Lumbar spine motion needs to be limited or locked down.</p> Signup and view all the answers

What benefit can be observed through the effect of spinal flexion on intervertebral foramen?

<p>Increased space may relieve spinal nerve root compression symptoms.</p> Signup and view all the answers

When is it indicated to assess for myofascial restrictions during spinal movements?

<p>It is indicated when repeat movements provoke notable differences in symptoms.</p> Signup and view all the answers

Which technique is beneficial for assessing segmental physiological motion through PPIVM?

<p>Motion palpation is critical to assess normal joint mobility.</p> Signup and view all the answers

What two conditions must be present for a joint to be considered normal during PPIVM assessment?

<p>Normal range and normal end-feel are required for a joint's normal classification.</p> Signup and view all the answers

How does the position of the head affect PROM of lower thoracic spine assessment?

<p>Positioning the head off the edge of the bed may limit range of motion less.</p> Signup and view all the answers

What observation is critical when a patient exhibits potential upper motor neuron pathology during spinal flexion?

<p>The presence of shooting pain down the spine is a significant indicator.</p> Signup and view all the answers

What role does therapist positioning play in conducting a successful PPIVM assessment?

<p>It ensures good body mechanics and proximity to the patient for effective palpation.</p> Signup and view all the answers

What aspect of thoracic motion must be carefully cued to the patient to avoid complications?

<p>The patient should be instructed to allow the head to flex and extend appropriately.</p> Signup and view all the answers

What evaluation can indicate a poor curvature in the spine during PPIVM assessment?

<p>Presence of hinging points during motion palpation can reveal curvature issues.</p> Signup and view all the answers

What is one primary concern regarding the reliability of PPIVM assessments?

<p>Their inter-rater reliability can vary significantly, leading to inconsistent outcomes.</p> Signup and view all the answers

What is the significance of using the elbows during active thoracic spine extension assessment?

<p>Elbows should be pulled back to promote thoracic extension while stabilizing posture.</p> Signup and view all the answers

What are the main factors to consider during a spinal motion assessment?

<p>Bone health, ligament status, blood flow, and vulnerability of the spinal cord.</p> Signup and view all the answers

How is motion described at a motion segment of the spine?

<p>It is described by the superior vertebral body moving on the inferior vertebral body.</p> Signup and view all the answers

What two movement types are essential to consider when assessing motion appropriateness?

<p>Whether to perform active and/or passive movement, and whether to assess all or some movements.</p> Signup and view all the answers

What role does patient positioning play in motion assessment?

<p>It affects convenience, patient comfort, and the impact of gravity on the assessment.</p> Signup and view all the answers

Why is it important to screen for vertebral artery involvement during motion assessment?

<p>Because it can pose significant risks during spinal movement evaluations.</p> Signup and view all the answers

What sequence of movements typically occurs during spinal motion?

<p>Movement starts at the upper vertebra and continues sequentially down the spine.</p> Signup and view all the answers

What are the six degrees of freedom in spinal motion indicated by the acronym FLLARD?

<p>Flexion, extension, lateral flexion, lateral translation, anterior/posterior translation, and rotation.</p> Signup and view all the answers

What must be evaluated before proceeding with a motion assessment following a fracture?

<p>A thorough screening and potential referral must occur prior to assessment.</p> Signup and view all the answers

What is the primary technique used to assess joint glides in segmental motion testing?

<p>PAIVM (Passive Accessory Intervertebral Movements)</p> Signup and view all the answers

What positioning is most suitable for initiating PAIVM testing?

<p>The joint should be positioned in the resting or loose packed position.</p> Signup and view all the answers

In spinal assessments, what is the significant implication of a restricted joint glide?

<p>It often indicates involvement of the joint capsule or periarticular tissues.</p> Signup and view all the answers

What three aspects must be assessed at joints before performing a PPIVM?

<p>Strength, length, and function.</p> Signup and view all the answers

How does a PPIVM differ from a PROM in terms of the area being assessed?

<p>PPIVM assesses smaller portions of the spine segmentally, whereas PROM examines overall range of motion.</p> Signup and view all the answers

What aspect of the strength-strain curve is theoretically relevant to accessory motion evaluation?

<p>It pertains to the transition between the end of the elastic phase and the beginning of the plastic phase.</p> Signup and view all the answers

What technique is suggested for assessing motion segment by segment during side glides?

<p>Using a technique that incorporates a bit of side flexion.</p> Signup and view all the answers

What does the presence of hypomobile segments adjacent to hypermobile segments indicate?

<p>It suggests the body's mechanism to compensate for instability.</p> Signup and view all the answers

What should be avoided during cervical flexion to maintain spinal stability?

<p>Ensure the mount doesn’t open.</p> Signup and view all the answers

What is a common cue for thoracic spine movements to ensure proper body alignment?

<p>Instruct the patient to stick their chest forward.</p> Signup and view all the answers

How can the clinician assess for myofascial restrictions during movement repetition?

<p>By observing the influence of the restrictions on subsequent movements.</p> Signup and view all the answers

What should practitioners consider regarding patient positioning during passive range of motion (PROM) assessments?

<p>Patient should be relaxed and well-supported in a neutral spinal position.</p> Signup and view all the answers

What two conditions should clinicians observe for during active range of motion (AROM) of the spine?

<p>Smoothness and compensation.</p> Signup and view all the answers

What does a 'swipe' during cervical flexion indicate about the cervical spine's biomechanics?

<p>It indicates possible facet dysfunction.</p> Signup and view all the answers

What can excessive use of back muscles indicate during lower T spine PROM?

<p>It may suggest that the movements are more active-assisted than truly passive.</p> Signup and view all the answers

What should the clinician ensure before performing passive joint assessments on the glenohumeral area?

<p>Check that the person doesn't have glenohumeral instability.</p> Signup and view all the answers

How should the thorax be handled to assess thoracic spine flexion?

<p>Move the shoulders rather than the thorax itself.</p> Signup and view all the answers

What phenomenon may be indicated by the presence of shooting pain during spinal flexion?

<p>Upper motor neuron pathology.</p> Signup and view all the answers

What technique specifies that normal joint motion must include normal end-feel and range?

<p>PPIVM assessment.</p> Signup and view all the answers

Why is inter-rater reliability a significant concern in PPIVM assessments?

<p>It affects the consistency and accuracy of the findings.</p> Signup and view all the answers

What should practitioners ensure regarding the therapist's position during spinal assessments?

<p>The therapist should maintain good body mechanics and be as close to the patient as possible.</p> Signup and view all the answers

What sequence should be followed when performing PPIVMs?

<p>Start away from the restricted and painful segments.</p> Signup and view all the answers

What adjustment must be made when assessing movement between different vertebral segments?

<p>The overall position of the neck must be adjusted to feel movement at the specific segment being examined.</p> Signup and view all the answers

Explain the significance of feeling the end feel of different cervical segments during assessment.

<p>Feeling the end feel helps to differentiate the mobility and stability of each segment, which may vary from C3 to C6.</p> Signup and view all the answers

Describe the logic behind feeling multiple segments during spinal assessments.

<p>Feeling multiple segments allows for a more comprehensive understanding of spinal motion and alignment across the region.</p> Signup and view all the answers

Why is it challenging to isolate one vertebral segment during rotation assessments?

<p>Isolating one segment is challenging because the movement often affects adjacent segments, complicating the assessment.</p> Signup and view all the answers

In what positions should posterior to anterior central vertebral pressure (PACVP) be performed for the thoracic and lumbar spine?

<p>PACVP should be performed with the patient in a prone position for both the thoracic and lumbar spine.</p> Signup and view all the answers

What is the role of side glides in cervical spine assessment?

<p>Side glides are used to evaluate lateral mobility and to assist in assessing segmental motion in the cervical spine.</p> Signup and view all the answers

How should the clinician position their hands when performing PAIVMs?

<p>Clinicians should interlace their fingers with the thumb on thumb technique to maintain stability and control.</p> Signup and view all the answers

What is the consideration for assessing the lumbar spine due to its anatomical structure?

<p>The lordotic curve may necessitate changing the angle of approach to accurately assess vertebral motion.</p> Signup and view all the answers

Mention one common mistake made during lumbar spine extension assessments.

<p>A common mistake is failing to account for the patient’s lordotic curve during the assessment.</p> Signup and view all the answers

Describe the expected sensation during side bending assessments.

<p>The sensation during side bending can vary, often felt between the spinous processes and laterally.</p> Signup and view all the answers

What is the primary concern with performing PAIVMs on a patient with instability?

<p>PAIVMs may aggravate any existing instability, necessitating caution during assessment.</p> Signup and view all the answers

Identify the technique used in PAUVPs that assesses rotation in a truer sense.

<p>Transverse vertebral pressure (TVP) is used to assess rotation accurately without anterior gliding.</p> Signup and view all the answers

What major limitation should clinicians be aware of when palpating the TSPs in the lumbar region?

<p>The TSPs in the lumbar region may be deeply located, roughly one inch from the posterior aspect of the back.</p> Signup and view all the answers

How should clinicians adjust their assessment techniques across different regions of the spine?

<p>Clinicians must tailor their techniques to account for the unique anatomical features and mobility limits of each spinal region.</p> Signup and view all the answers

Explain the significance of coupled motion in the spine and provide an example.

<p>Coupled motion is significant as it describes the association of movement around one axis with movement around another. For example, when side bending to the left, some right rotation occurs simultaneously.</p> Signup and view all the answers

How does the shape and orientation of articulations affect motion in the spine?

<p>The shape and orientation of articulations dictate the types of movements allowed, such as flexion, extension, and rotation, by defining the available space and angles for movement. These anatomical characteristics determine the overall functional motion capabilities of the spine.</p> Signup and view all the answers

Discuss the impact of age on spinal motion availability.

<p>As individuals age, the compliance of fibrocartilage decreases, disc height may reduce, and degenerative diseases can develop, collectively limiting spinal motion. This change is part of the natural aging process affecting overall spinal health.</p> Signup and view all the answers

Why is it important to distinguish between osteokinematic and arthrokinematic movement in spinal assessments?

<p>Distinguishing between osteokinematic and arthrokinematic movements is crucial because they represent different aspects of spinal motion: osteokinematic involves gross movements of bones, while arthrokinematic deals with the movement at joint surfaces. This differentiation aids in identifying specific limitations and guiding treatment.</p> Signup and view all the answers

What role do ligaments play in governing spinal motion?

<p>Ligaments provide stability and limit excessive movements in the spine, thus governing the range and type of motion that can occur in various segments. They ensure that spinal movements fall within a safe and functional range.</p> Signup and view all the answers

Describe the variation in coupled motion between flexed and neutral postures.

<p>In flexed postures, the coupled motion pattern differs compared to neutral due to altered biomechanical relationships in the spine. Specific segmental interactions may change, resulting in different degrees of movement and possibly pain responses.</p> Signup and view all the answers

What implications do the dimensions and shape of adjacent vertebral end plates have on spinal motion?

<p>The dimensions and shape of adjacent vertebral end plates influence the distribution of forces and ranges of motion at the joints, thereby affecting stability and mobility in the spine. Variations can lead to different mechanical behaviors and potential for injury.</p> Signup and view all the answers

How do external factors, such as pain and individual strength, affect range of motion?

<p>External factors like pain can limit range of motion by causing protective muscle guarding, while individual strength impacts the capacity to achieve full motion. Together, these factors can hinder functional movements and impact rehabilitation.</p> Signup and view all the answers

What movement restrictions characterize the capsular pattern of the cervical spine?

<p>The capsular pattern of the cervical spine shows that side bending and rotation are equally limited, while flexion is less limited than extension. This pattern can indicate specific joint issues during assessment.</p> Signup and view all the answers

Explain the relationship between the upper cervical spine's design and its movement capabilities.

<p>The upper cervical spine's ellipsoidal and horizontal plane joint design facilitates substantial flexion and extension while allowing limited side bending and rotation. This specialized structure is critical for head mobility.</p> Signup and view all the answers

What factors influence the resistance of muscles and ligaments during spinal motion assessments?

<p>The resistance of muscles and ligaments is influenced by muscle strength, elasticity, and tension levels. External factors like fatigue and injury can also impact this resistance at the time of assessment.</p> Signup and view all the answers

Identify the significance of the lumbar spine's restricted rotation.

<p>The lumbar spine's restricted rotation is significant because it prevents excessive strain on the intervertebral discs and surrounding structures, preserving spinal integrity. This limitation is crucial for maintaining stability during various activities.</p> Signup and view all the answers

How does willingness to engage in range of motion (ROM) impact spinal assessments?

<p>Willingness to engage in ROM significantly impacts assessments by influencing the patient's ability to perform movements and report discomfort, thereby affecting the accuracy of the evaluation outcomes. This psychological aspect must be considered when interpreting results.</p> Signup and view all the answers

Discuss how the presence of pain alters the assessment of spinal range of motion.

<p>The presence of pain can significantly alter assessment outcomes by limiting the patient's willingness or capability to perform certain movements, leading to misleading results regarding overall spinal mobility. Assessing pain reactions is thus vital for an accurate evaluation.</p> Signup and view all the answers

Study Notes

Spinal Motion Assessment Precautions

  • Review precautions in POA. Obtain during detailed history.
  • Four main factors to assess: bone health, ligament status/instability, blood flow, spinal cord vulnerability.
  • Establish safety before motion assessment.
  • Screen/refer for fractures before further assessment.
  • Review Canadian C-spine rules.
  • Three critical rule-outs:
    • Fractures (cranio-vertebral/cranio-sacral region; alar & transverse ligaments).
    • Ligaments (concern for any/segmental motion assessment).
    • Vertebral/internal carotid arteries (cervical spine).
  • Determine appropriateness of motion assessment:
    • Active and/or passive movements?
    • All or some movements?

Spinal Motion Assessment Positioning

  • Patient positioning/load/strain significantly impacts motion assessment. Reasons: convenience, comfort, maximizing/limiting gravity influence.
  • Vertebral column movement varies by spinal region and individual.
  • Segmental movement is small, but can produce large combined movement. Superior vertebra moves on inferior vertebra, regardless of moving vertebra. (e.g., T8 rotating left on T9 when lifting shoulder; T9 rotating on T8 when lifting pelvis).
  • Motion described using the anterior surface of the vertebral body.
  • Cervical and lumbar have largest ROM.
  • Motion occurs sequentially (e.g., T2 rotates left on T3 to end range; then T3 on T4, and so on).
  • Six degrees of freedom (FLLARD): Flexion/extension/hyperextension, Lateral flexion, Lateral translation, Anterior/posterior translation, Rotation, Distraction/compression.

Superior & Inferior Vertebra Motions

  • Superior vertebra rotation: Anteriorly (FLEX), Posteriorly (EXT).
  • Superior vertebra sagittal translation: Somewhat forward (FLEX), Somewhat backward (EXT).
  • Superior segment TSP motion: More anteriorly (FLEX), More posteriorly (EXT).
  • Superior vertebra inferior facet/inferior vertebra superior facet motion: Superiorly (FLEX), Inferiorly (EXT).
  • Sagittal axis motion: Rotation (always component of SB, except atlantoaxial).
  • Horizontal axis motion: Translation.
  • Longitudinal axis motion: Rotation.

Coupled Motion

  • Coupled motion: Motion around one axis consistently associated with motion around another (e.g., SB left = some rotation).
  • Ipsilateral/contralateral motion (mechanism unknown).
  • Coupled motion varies by position, region, and segment.

Determinants of Spinal Motion

  • Six variables to determine motion per region (CADDDD is a G):
    • Fibrocartilage compliance.
    • Age.
    • Disc-vertebral height ratio.
    • Disease.
    • Adjacent vertebral end plate dimensions/shape.
    • Gender.
  • Four additional factors (WRIP):
    • Willingness to go through ROM.
    • Resistance of muscles/ligaments.
    • Individual strength.
    • Presence of pain.
  • Shape/orientation of articulations, size/location of processes, ligaments/muscles govern available motion.

Spinal Region Articular Surfaces

  • Lower cervical: Flat/oval, oblique plane.
  • Thoracic: Almost vertical.
  • Lumbar: Marked upward/downward projection.
  • All facilitate flexion/extension/side flexion/rotation. (Lumbar has notably less rotation).

Upper Cervical Spine

  • Occiput-C1: Ellipsoidal articular surfaces, horizontal plane, substantial flexion/extension, small side flexion/rotation.
  • C1-C2: Horizontal plane, along median atlantoaxial joint, facilitates substantial cervical rotation, small flexion/extension/side flexion.

Types of Spinal Motion

  • Osteokinematic: Muscle contraction/gravity changes bone position (AROM, PROM, PPIVMs). Goal: Full, pain-free motion. Usually not done in isolation.
  • Arthrokinematic: Movement between articulating surfaces without external forces (PAIVMs).

Spinal Regions

  • C spine subdivided mechanically into: cervicocephalic/upper C spine, cervicobrachial/lower C spine.

Resting/Close-packed/Capsular Pattern

  • Cervical: Side bend/rotation equally limited, flexion less than extension.
  • Thoracic/Lumbar: Not detailed.

Spinal Assessment Movements

  • Five assessed movements: Flexion, extension, side bending, rotation, and combinations.
  • Three measurement tools: Inclinometers, goniometers, measuring tapes (often eyeballed).

ROM Recording Legend Aspects

  • Pain-free ROM (-)
  • Pain provocation with ROM (X, )
  • Radicular symptoms (↑, ↓)

Osteokinematic/Arthrokinematic Mobility Grades

  • Six grades (0-6), describing limitations and treatments (increase in motion from 0–6 corresponds with treatment: None, Mobilization, Manipulation, No treatment, Stabilization Exercises, External support, Fusion.

Arthrokinematic Mobility Quantification

  • Three terms: Hypomobile, Normal, Hypermobile.

AROM Considerations

  • Pain, palpation, observation, ROM, cueing/correction

PROM Considerations

  • Patient relaxed, pain, ROM, end feel

PPIVM Considerations

  • Pain, mobility, end feel

Side Glides

  • Performed in cervical spine.

AROM Table 1

  • C/T/L Spine flexion: Cue head tilt/nod forward for C-spine; for T spine use elbow to pull back and still maintaining the original position.
  • C-spine extensions: let the head go back.
  • Lumbar extension: Hands over buttock to help maintain a proper position.

PROM Table 2

  • Critical aspect is patient positioning.
  • True Passive movement in T & L Spine is more assisted than passively performed.

Isometric Assessment

  • Flexion: Shooting pain possible upper motor neuron pathology.
  • Unusual flexion/extension movement swipes: Possible facet dysfunction.

AROM Observation

  • Smoothness and compensation.

PPIVMs (Motion Palpation)

  • Positioning varies by region.
  • Neutral spinal position and relaxed patient positioning is crucial.
  • Technique: Slow, rhythmic, relaxing movements; relax palpating hand; palpate movements, do not create/block.
  • Inter-rater reliability is a concern.
  • Normal ROM and end feel are indicators of normal joint.
  • Indications (pain, hinging, poor curvature).

PAIVMs (Accessory Joint Mobilization):

  • Replicate instability tests; caution needed.
  • Four types: PACVP, Side glides, TVP, PAUVP.
  • PACVPs & PAUVPS performed prone in T/L spine. C Spine: supine or prone.
  • Identify & differentiate between TSPs/ribs for proper assessments.
  • Lumbar considerations: Lordotic curve adjustments.
  • Careful attention to identifying thoracic TPs/ribs; segment differences in palpation and excursion.
  • Initiate by positioning joint in resting position (loose packed position) for testing.

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Description

This quiz covers essential precautions and positioning strategies for spinal motion assessments. Participants will review critical factors such as bone health, ligament status, and safety protocols. Additionally, information on patient positioning and its effects on assessment is included.

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