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• The exam consists of 30 questions and has a 40-minute time limit.
• An extra 5 minutes are provided to account for environmental scanning and setup.
• The time allotted for the exam remains the same, regardless of when it is opened.
• The exam is on Thursday 2/13, starting at 7:30 pm.
• The exam is currently available for download.
• The deadline to download the exam is 7 pm on Thursday 2/13.
• All unopened exams will be removed from devices at 8:15 pm.
• The password for the exam will be posted on Blackboard at 7:15 pm.
• Students can begin the exam once the password is provided
• The deadline to upload the completed exam is 9:30 pm on Thursday 2/13.
• Students experiencing technical issues should email as soon as possible, requests will not be considered after Sunday.

Exam breakdown: Lifting Mechanics

• Comprises 25-30% of the exam
• Includes general lifting mechanics principles
• Includes center of mass, base of support and joint position concepts
• Includes knowledge about the types of lifts

Exam breakdown: Positioning/Patient Handling

• Comprises 10-15% of the exam
• Includes ergonomics and workplace considerations
• Includes patient position considerations in various positions (bed, wheelchair, etc)
• Includes gait belt application/use

Exam breakdown: Systems Review

• Comprises 15-25% of the exam

Exam breakdown: ROM and Joint Integrity

• Comprises 20-30% of the exam
• Encompasses end feels, normative values, stabilization, and general concepts

Exam breakdown: ICF/Pt Client Model

• Comprises 10-15% of the exam

General Study Outline

• Lifting techniques
• Staggered stance, arms at 90 degrees posture mechanics
• ICF Model
• Distinction between activity limitation and participation restriction (STS vs Playing basketball)
• Purpose of Review of Systems
• Contents of systems review
• What is included in the systems review
• BP evaluation within systems review (Cardio)
• Where strength testing is directed (Musculoskeletal)
• Where reflexes are directed (Neuro)
• Planes of movement (Sagittal, Transverse, Frontal)
• End feels (Hard, firm, soft)
• Indication of an empty end feel (pain)

Unit 1: Patient Posture & Positioning

• Importance of positioning includes safety
• Importance of positioning includes comfort
• Precautions include maintaining head/neck in neutral
• Precautions include extremities supported.
• Precautions include following diagnosis-specific guidelines.
• Avoid: spinal/thoracic rotation, bending, forward head, and chest compression
• Avoid: scapular abduction
• Avoid: adduction and IR of GH joint
• Avoid: Knee hyperextension and prolonged flexion
• Avoid: Hip adduction or IR/ER

Patient positions

• Supine: on spine/back
• Prone: on stomach
• Sidelying: pillow between knees
• Semi-Fowler's: head of bed elevated around 30 degrees
• Fowler's: head of bed elevated around 60 degrees
• Sims': lateral recumbent, torso prone, upper leg bent
• Trendelenberg: head lower than feet

Safe Patient Handling

• Use gait belts with teeth
• Belts go around narrowest part of patient
• Use underhand grip, usually behind patient

Body Mechanics

• Conserve energy, reduce injury risk, reduce stress and strain
• Abdominal bracing (tightening of abdominals) provides better muscle activation for spinal stability
• Valsalva: potentially harmful - rise in BP
• Maintain a close center of gravity and wide base of support
• Short level arms
• Normal lumbar lordosis, avoid trunk rotation and flexion
• Position feet in staggered stance in direction of the motion
• Carry loads on waist or back
• Alternate hands when possible
• Shoulder carry for heavy or bulky items

Review of Systems

• Part of history taking (subjective)
• Screening major body systems
• Directs the systems review

Systems Review (objective)

• Doing something to test the system
• Directs further tests and measures
• Cardiovascular: vital signs
• Integumentary: observation and testing
• Musculoskeletal: observation and testing
• Neurological: observation and testing
• Communication/cognition: ability, affect, language, consciousness, orientation
• Movement: observation in context with function and performance

Gross Neuromuscular Observation

• Assess function of CNS/PNS
• Guide for more in depth testing
• Patient specific
• Observation of motor function, fluidity of motion, and balance
• No need to test all 12 cranial nerves if not needed
• Coordination screening:
• Dysdiadokinesia: Unable to perform rapid movement (supination and pronation in lab)
• Heel-to-shin
• Reflex screening:
• Absent, present, exaggerated

Integumentary Observation

• Rashes, lesions, nodules, edema, incisions, wounds
• Unusual hair loss or breakage
• Increases hair growth (hirsutism) Change in nail beds
• Itching (pruritus)
• Screen for color, moisture, palpation characteristics, symmetry, and shape
• Volumetric measurement/displacement to measure edema
• Water displaced is an objective measure for charting
• Palpate for texture, firmness, turgor (elasticity), mobility, temperature
• Capillary refill test
• Used for discoloration and/or numbness and tingling in extremities
• Press on nailbed to turn white and see how long to refill

• 3 sec = blood flow compromised Cannot test with nail polish on

Gross Musculoskeletal Observation

• Bony alignment, contours, symmetry
• Posture
• Hypertrophy, atrophy
• UE and LE ROM screening:
• AROM across all cardinal planes against gravity
• Goal = to determine ROM limitations that could limit function
• If pain-free, therapist provides overpressure to feel quality and quantity of tissue resistance (end feel)
• Muscle strength screening:
• Quick assessment of general strength
• Test major muscle groups
• Not trying to break them
• Will change based on acute care vs orthopaedic

Cardiovascular Observation

• Vitals:
• HR
• RR
• BP
• SpO2

Unit 2: Range of Motion

• Arthrokinematics: movement of joint surfaces (roll, glide, spin)
• Osteokinematics: movement of bones
• AROM: patient moves a joint through available ROM without assistance from therapist
• AAROM: active motion is assisted by therapist
• PROM: therapist moves the patient's joint through available ROM without assistance from patient
• Gravity resisted ROM: patient is working against gravity to move body part
• Gravity assisted ROM: gravity assists patient in moving body part
• Gravity eliminated ROM: movement happens in plane perpendicular to gravity, neither assisting or resisting

End Feel

• End feel is the resistance encountered at the end of normal PROM
• Hard: bony and abrupt, no further motion can occur (elbow ext)
• Firm: slight give due to joint capsule and surrounding non-contractile tissue limitations at end range (shoulder flexion)
• Soft: mushy due to soft tissue compression (elbow and knee flexion)
• Reliability: overall consistency of a measurement, repeatability
• Validity: accuracy of measurement, measuring what is intended to be measured
• Factors impacting ROM:
• Gender
• Age
• Build
• Ligament and joint capsule laxity
• Extensibility of skin and subcutaneous tissue
• Culture, occupation, recreation

Joint Integrity

• Arthrokinematics:
• Roll: multiple points contact multiple points (tire on the road)
• Spin: single point rotates on a single point (top rotating in one spot)
• Slide/Glide: single point contacts multiple points (tire skidding on ice)
• Distraction: separation of joint surfaces (used in combo with joint mobilizations to increase stretch of the capsule)
• Compression: approximation of joint surfaces (improves stability, occurs with muscle contraction)
• Concave on convex: roll and slide occur in the SAME direction
• Convex on concave: roll and slide occur in OPPOSITE directions
• Open-packed: joint surfaces are in the least contact and ligaments/capsules are on the most slack, allowing for greatest joint mobility
• Closed-packed: joint surfaces are in most contact and ligaments/capsules are on least amount of slack, allowing for least joint mobility
• R1: the 1st resistance met from the joint capsule
• R2: pushing into the 1st resistance, a 2nd level of resistance will be felt as tissue elasticity is taken up, where end feel is assessed.

Lifting Mechanics: General

• Proper body mechanics conserve energy, reduce risk for injury, reduce stress and strain on body part, and help prevent burnout and fatigue
• Bracing is the tightening of the abdominals rather than drawing in the abs in case of hollowing
• Should be used whenever loads are lifted or moved. Provides stability to the spine
• Load is easier to lift when closer to the body
• Before attempting to move a load, COG should be as close to object's COG as possible, and widen BOS to ensure stability and balance
• Stabilize trunk, maintain normal posture and back alignment, avoid trunk rotation with flex or rot'n
• Warm up before and lift

Actions For Proper Body Mechanics

• Position yourself so COG and object's COG are as close as possible
• Increase your BOS
• Position UE close to your trunk so you can use them in a shortened position as short level arms
• Muscles will function efficiently and require a lower torque when object is held close to your body.
• The vertical gravity line (VGL) bisects the body in sagittal plane, indicates vertical positioning of COG, must be within BOS for optimal balance and stability
• Lumbar spine should be maintained in its normal or neutral position of lordosis when lifting is performed.
• Flexion of hips and knees allows lifter to lower COG and provides an effective position for muscles of LE to perform.
• Avoid Valsalva maneuver when contracting abs.

Reaching & Carrying

• Move object from high space to lower before reaching to carry them or raise yourself to object to reach and carry it.
• Stand on ladder to bring the center of body closer to the object. Avoid twisting.
• Carry at level of waist or in a pack on back with both straps.
• Alternate hands or balance load between two hands when carrying
• Heavy, bulky objects should be carried on shoulders.
• Lower object or raise your position to reach for objects
• Objects at arm length should be brought closer to the body before lifting to reduce torque
• When carrying, hold the object close to you, use arms as short levers, maintain object's COG to your COG.

Pushing v. Pulling

• Ensure arms and legs are partially flexed to avoid strain at maximum end ROM
• Use a crouched or semisquat position to push or pull - lowers COG to objects COG, increasing stability & reducing energy expenditure
• Force should be applied parallel to the surface over which the object is to be moved and in line for desired movement - reduces friction

Types of Lifts

• Deep squat involves hips below level of knees
• Power lift involves hips remain above the level of knees
• Straight leg lift has knees that are only slightly flexed or may be fully extended
• One-leg stance lift (Golfer's lift) is used for light objects that can be easily lifted with one UE
• Half-kneeling lift involves aligning body by kneeling on one knee positioned behind the object with opposite LE foot flat and hip and knee flexed approximately 90 degrees.
• Traditional lift: perform deep squat to provide low COG and wide BOS, grab handles of object and bring closer to body by using UE flexors.
• Stoop lift: when the object rests below level of waist but can be reached without squatting

Patient Positioning

• Supine involves head supported with the bed flat, pillow underneath knees (if no contraindications are present); avoid excessive neck and upper back flexion or rounded shoulders
• Prone involves head supported with the bed flat, the pelvis supported with the pillow and a rolled towel under each anterior shoulder area to adduct scapulae and protect the head of the humerus.
• Side-Lying involves supporting head, bed flat, pillow placed between knees, and one pillow under the upper arm.
• Semi-Fowler's involves head supported with head of bed elevated about 30 degrees
• Fowler's involves the patient supine and the head of the bed placed at a 45-degree angle.
• Trendelenburg involves the patient being supine with a 15-30 degree decline

Gait Belt Application/Use

• Communicate with your Patient
• Put the belt around the patient around waist level (depending on surgical site/stitches)
• "Teeth" first
• Snug not tight
• Gripping a Gait Belt: underhand grip, usually behind the patient

Systems review breakdown

• Physical exam begins the Systems Review
• Cardiovascular: Vital signs
• Integumentary and Surface Anatomy: Observation & Testing
• Musculoskeletal System: Observation & Testing
• Neurological System: Observation & Testing
• Communication and Cognition: Ability, affect, language, consciousness, orientation
• Movement: Observation in context with function and performance

Patient Management Model Review

• Patient Examination occurs during the examination portion of the PMM
• During the examination, the physical therapist conducts tests and measures
• The outcomes of the tests and measures help guide the PT through the model

"Right Shoulder abduction to 140 degrees, able to go into extension”= R shoulder abduction 0-140 degrees "Left Elbow extension to 3 degrees past neutral, able to go into flexion to 150 degrees" = L elbow ROM 3-0-150 degrees

• End Feel: resistance felt by the therapist at the end of a passive movement
• Soft feel: soft tissue approximation, ie muscle compressing muscle
• Hard feel: bony approximation
• Firm feel: firm tissue resistance from contractile structures, joint capsule, ligaments, and surrounding connective tissue
• Joint integrity is assessed by considering several factors during the patient examination: AROM, PROM, Joint mobility
• Why do we test joint integrity?
• Information on capsule and joint: quantity of motion present, quality of motion, symptom reproduction, and end feel
• Help determine causes for impairments
• Why do we test joint mobility?
• Full joint mobility is necessary for full ROM
• To assess for joint-specific causes of pain
• To help determine causes for impairments
• Accessory motion: the motion occurring at the joint surfaces
• Component motion: the joint surface motions that are suspected to occur with osteokinematic motions
• Passive Intervertebral Motion (PIVM): a specific mobility test for segmental spinal mobility
• Open-packed position of joint: anatomical position where the joint surfaces are in the least contact and ligaments/capsule are on the most slack, allowing for the greatest joint mobility
• Closed-packed position: anatomical position where the joint surfaces are in the most contact and/or ligaments/capsule are on the least amount of slack, allowing for the least joint mobility
• Joint Hypermobility: excessive motion as compared to what is expected for a given joint or as compared bilaterally
• Joint Hypomobility: limited joint motion as compared to what is expected for a given joint or as compared bilaterally
• Soft End-Feels: gradual increase in resistance as tissues are compressed between body parts
• Firm End Feel abrupt increase in resistance with varying creep (or give), depending on the barrier being stretched
• Hard End Feel: abrupt and immediate stop as bone contacts another bone