Week 1 Introduction to Physmed 2024 Asynchronous Lecture BMS150 PDF

Range of Motion Testing • The Correct Order • Active ROM - Done by the patient 100% • Passive ROM - Done by the examiner 100% • Resisted ROM - resisted isometric movement usually tested in neutral position • This is done this way so that the examiner has a better idea of what the patient can do befo...

Range of Motion Testing • The Correct Order • Active ROM - Done by the patient 100% • Passive ROM - Done by the examiner 100% • Resisted ROM - resisted isometric movement usually tested in neutral position • This is done this way so that the examiner has a better idea of what the patient can do before getting the structures fully involved/tested • Always start with the UNAFFECTED/NON PAINFUL SIDE of patient. This will give you a true sense of the ROM that should be achieved on the affected side. • Any movements that are painful are done last, if possible. This will be described by the patient in history taking. This is to prevent an “overflow” of painful symptoms to the next movement which may in fact actually be pain free ACTIVE ROM (AROM) • Performed by the patient • Will test: Contractile, nervous, and inert tissues that are moved • Contractile tissues have tension placed on them by stretching or contraction • Nervous tissue and their sheaths have tension put on them by stretching • Inert tissue includes all tissues that are not contractile or neurological (ligaments, bursae, bone, cartilage, and the capsule) • Examiner should note: • When and where during each movement the onset of pain occurs • Whether the intensity and quality of pain increases with the movement • The reaction of the patient to the pain • The degree of restriction • The rhythm and quality of movement • The movement of associated joints • The willingness of the patient to move the part • Any limitation and its nature (ask why?) ACTIVE ROM (AROM) • Active movement may be abnormal for several reasons, and the examiner must try to differentiate the cause. • Pain is a common cause for abnormal movement • Muscle weakness • Paralysis • Spasm • Other causes include tight or shortened tissues, altered length-tension relationships, modified neuromuscular factors, and joint-muscle interaction. PASSIVE ROM (PROM) • Performed by the examiner while the patient is relaxed • PROM is usually normal, full range, and pain free, with possibly some pain at the end of ROM when contractile or nervous tissue is stretched • For passive ROM, it is not only the degree (i.e., the amount) of movement but also the quality (i.e., the end feel) of the movement that is important. • When the examiner is doing passive range of motion testing, the appropriate stress is applied gently and repeated several times. The stress is increased up to but not beyond the point of pain and is done in all ranges. • Examiner should note: • Any Differences in ROM between active and passive movements may be caused by: • Spasm • Muscle Deficiency • Neurological deficit, • Contractures • Pain END FEEL • The sensation that the examiner feels in the joint as it reaches the end of ROM • Overpressure is applied at the end of ROM to determine END FEEL • Evaluation of end feel can help you: • Assess the type of pathology present • Determine a prognosis for the condition • Learn the severity or stage of the problem END FEELS (NORM VS ABNORMAL) Muscle Strength Grading Grade Value Muscle strength 5 Normal 4 Good 3 Fair Complete ROM against gravity with no resistance 2 Poor Complete ROM with some assistance and gravity eliminated 1 Trace Evidence of slight muscular contraction; no joint motion evident 0 Zero No evidence of muscle contraction Complete ROM against gravity with full resistance Complete ROM against gravity with some resistance Pain Sensation and Associated Structure Muscle Cramping, dull, achy Joint capsule, ligament Dull, achy Nerve root Sharp, shooting Nerve Sharp, bright, lightening-like Sympathetic n. Burning, pressure-like, stinging, achy Bone Deep, nagging, dull Fracture Sharp, severe, intolerable Vasculature Throbbing, diffuse RESISTED ROM (RROM) • Finds problems in contractile tissues • Testing is always done with the patient in Neutral position so that minimal tension is placed on the inert tissue. • The patient is asked to contract the muscle as strongly as possible while the examiner resists for a few seconds to prevent any movement from occurring • To keep movement to a minimum, it is best for the examiner to position the joint properly in the resting position and then to say to the patient, "Don't Iet me move you, " • In this way, the examiner can ensure that the contraction is isometric and can control the amount of force exerted. • Both AROM and RROM demonstrate symptoms if contractile tissue is affected • Muscle Strength Grading must be used to determine if there is weakness or not Postural Assessment What is “correct” vs “faulty” posture? Common factors affecting posture: Many…. How do we assess it? Patient should be in adequate dress, in their “natural” state and in their habitual relaxed posture Consider behaviour and affect of patient Three Views: anterior, lateral X2, posterior Postural Assessment Checklist ANTERIOR VIEW • • • • Head (Jaw, Nose, Ears) is head straight / tilted to one side / rotated may be result of weak muscles, trauma, hearing loss Nose is inline with manubrium Shoulders • • • • Trapezius , AC joints symmetrical with no deviation deviation may be from dislocations of AC or SC joints or fractures dominant shoulder may be slightly sloped downward Chest • Other • no protrusion, depression or lateralization Pelvis (Iliac crests, ASIS, Pubic bones) • waist angles are equal • arms equal distance from the waist • patella should point straight ahead • knees may be in genu varum or valgum Feet (Feet arches, Feet angle) • check for equal arches • Are toes pointed out or pigeon toed? LATERAL VIEW • • • • • Ear lobe in line with the tip of the shoulder (acromion) and high point of the iliac crest a forward poking chin may correspond with lumbar lordosis Spinal segments spine has normal curvature large glut max muscles or excessive fat may give the appearance of exaggerated lordosis • examine the spine in relation to the sacrum not • The Shoulders • look for rounded shoulders • possibly caused by tight pectoral • • • • The Knees normally slightly flexed 0 to 5 degrees hyperextended knees likely with increased lumbar lordosis increased flexion seen with tight hamstrings • • • • • • • Ideally the centre of Gravity/Plumb Line passes through the following anatomical landmarks External auditory meatus Humeral head and acromion Middle of the body of L3 vertebrae Greater trochanter Just behind the mid knee POSTERIOR VIEW • • • • • • • • • • • • Mastoid process AC joint Inferior scapula spines and inferior angles should be level PSIS should be level, one higher than the other may indicate a leg length discrepancy, or rotational problem Assess the in forward flexion (skyline view): Asymmetry of rib cage (rib humping) Asymmetry in the spinal musculature Kyphosis Whether lumbar spine straightens or flexes Any restrictions to forward bending Just anterior to the lateral malleolus Gait Analysis Definition: manner or style of walking Examination of gait begins as soon as the patient enters the room. Pay attention to any obvious limp or deformity of the extremity that may be affecting a normal gait. There are 2 phases to the normal walking cycle: 1) Stance Phase - When the foot is on the ground (60% of gait cycle) 2) Swing Phase - When the foot is moving forward (40% of gait cycle. Note: One gait cycle is from heel strike of one limb to the next heel strike of that same limb Gait Analysis - Stance Phase Gait Analysis - Stance Phase Abnormal Gait Patterns Identification and Causes • 1: Due to a pathology or injury in a specific joint • 2: Compensation for an injury or a pathology in other joints on the ipsilateral side • 3: Compensation for an injury of a pathology on the contralateral limb Abnormal Gait Patterns • Arthrogenic Gait • Ataxic Gait • Gluteus Maximus Gait • Trendelenburg’s Gait • Hemiplegic Gait • Parkinsonian Gait • Scissors Gait • Drop Foot Gait • Arthrogenic Gait • Stiff hip or Knee • Results from stiffness, laxity, or deformity, it may be painful or painless and • Ataxic Gait - Stagger Gait with Exaggerated Movements • Patient presents with poor sensation or lacks muscle coordination, poor balance and a wide broad base stance • Results usually from damage to the cerebellum. • Gluteus Maximus Gait - The Backward Lurch of the Trunk • Results from a weak gluteus Maximus. • Patient thrusts the thorax posteriorly at heel strike to maintain hip extension of the stance leg • Trendelenburg’s Gait - Gluteus Medius Gait • Results from weak gluteus med/minimus • During the stance phase, patient exhibits an excessive lateral list where the thorax moves to keep centre of gravity over the stance leg • Also, the Trendelenburg test will also be positive • Hemiplegic Gait • Presents as a swinging of the paraplegic leg outward and ahead in a circle or pushes it ahead. Also, the affected upper limb is carried across the trunk for balance • Parkinsonian Gait - FESTINATED GAIT • The neck, trunk, and knees of a patient are flexed. There is also a SHUFFLING or rapid short steps. Arms are held stiffly and the patient may lean forward and walk progressively faster as though unable to stop (Festinating) • Scissors Gait • A result of spastic paralysis of the hip adductor muscles. This causes the knees to be drawn together so that the legs can be swung forward only with great effort. • Steppage or Drop Foot Gait • Results from weak or paralyzed dorsiflexor muscles. To avoid dragging the toes against the ground, the patient lifts the knee higher than normal. Initial contact, the foot SLAPS on the ground. THE END