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Sti Exam

Terms in this set (131)

Musculoskeletal impairments
Impairments and outcome
Psychoneuroimmunology
Impairments (stress) and outcome
Multisystem
Impairments: pain and swelling (edema, joint effusion, lymphedema & outcome
Cardiopulmonary
Impairments and outcomes
Neurological
Impairments and outcomes
Timing of intervention
Treatment (after condition) & wellness (anytime in life)
Focus intervention
Treatment ( sign and symptoms of condition & impairments in body structure/fcns grades 1-4) wellness (body structure and fcns w/ grade 0)
Client examination
Examine body structure fcns. (Treatments - id impairments result from condition) & (wellness- id body structure and fcns related to wellness goals).
overall goal of intervention
Treatment (id and manage impairment results from condition) & wellness (optimize well-being across physical, mental, spiritual, and social domains)
clinical reasoning process
Complete clinical reasoning process (treatment and wellness)
Clinical reasoning processes outcomes
based therapeutic effects of massage. Treatment ( specific outcomes to id impairments in body structures and fcns) & wellness (specific outcomes related to id body structure and fcn)
Evaluation
Review client, conduct subjective and objective, analysis findings and confirm issue
Treatment planning
Id client impairment/wellness goals and specific outcomes. Select right treatment techniques and plan of care.
Treatment
Deliver treatment planned and conduct re-examination then modify (ongoing)
discharge
Id discharges needs and make plan, discharge when outcomes are reached.
Clapping or cupping
Postural drainage and airway clearance
Tapping or "point hacking"
Suitable for the face and common to use for neuromuscular facilitation
Clapping or cupping
Applied over rib cage where less overlying muscle is. Can use on large muscles, but beating is preferred.
Pounding
Loose fist and use of ulnar surface. Position near midline. Usage for larger, thicker muscle groups such as glutei and hamstrings.
Beating or rapping
Loose fist and heel of hand. Over larger muscles.
contraindications (list)
Physical illness, nausea, fever 101.5+ ; severe pain ; *acute pain ; advanced respiratory, kidney or liver failure.
Contraindications (list)
Rashes, boils, open wounds, skin infection; metastatic cancer including skin tumors
Contraindications (list)
Haemophilla, haemorrhage, severe ecchymosis; whiplash w/in 24-48 hrs ; acute inflammation disorder (rheumatoid arthritis) ; thrombophlebitis ; severe varicose veins.
Contraindications (list)
Severe atherosclerosis esp. ant. Neck; unstable medical condition (unstable hypertension, acute Myocardial infraction , acute CVA cerebral vascular accident (stroke)); aneurysms; frostbite (complete loss of sensation)
Precautions list
Endangerment site; medication; lack sensation CVA, diabetes, drug, etho; hyperaesthesia, rheumatoid arthritis; immune depression (transplants, AIDS, Chronic fatigue).
Precautions (list)
Drug withdraw & Psy. Conditions; recent neuro injury (CVA, CHI, SCI, muscle spasms or tone changes), osteoporosis; facial massage with contacts lens; lymphedema (need specialist can make condition worst).
malignant melanoma
Guidelines for checking Acronym ABCDE; common in fair skinned, has a lot of moles, 1:90-100 get
Which if the scenarios below would be an indication that it is time to stop the technique of inhibitive distraction
The patient reports a worsening of symptoms, the patient reports their headache has dissipated or you feel a softening or relaxation in the suboccipital muscles
Where to you place your fingertips for the cranial inhibitive distraction technique
At the base of the occiput; alleviate tension in neck extensor muscles and for headaches
Contraindication
a sign, symptoms, evaluation or diagnosis that directs the therapist to avoid applying a certain procedure
Which of the following is one of the lymphatic drainage sites we will use for the effleurage stroke of the thoracolumbar region
Axilla (and trap region)
When positioning a patient in prone, which of the following are important considerations?
Placing pillow under the shins can help prevent excessive plantar flexion of the ankle and decrease pressure on the knees, asking the patient if they are comfortable lying on their stomach and asking the patient if they are comfortable once they are positioned
Which of the following could be examples of complementary treatments for cranial inhibitive distraction?
Postural re-education, ergonomic education and recommendations, stretching of the tight muscles and strengthening of weak muscles
Which of the following would be considered contraindications to percussive techniques when applied in the area mentioned?
On the back in a patient with a rib fracture, (over a muscle spasm in the erector spinae)
Which of the following are potential physiological effects of massage

Increased circulation

Decreased venous return

Decreased muscle tone

A and c
A and C
Which of the following are potential psychological effects of massage

Decreased anxiety

Decreased mental relaxation

Increased pain

A and B
Decreased Anxiety
Which of the following are essential elements of establishing and maintaining a professional relationship.

Communication

Discussing personal topics

Asking permission

Sitting on the treatment table

A and C are correct
A and C are correct
Which of the following are NOT appropriate when performing massage on a patient.

Obtaining informed consent prior to initiating treatment

Discussing politics

Treating a patient in a private locked room with no one else in the clinic

Asking permission

B and C
B and C
When initiating a therapeutic relationship, which of the following is necessary.

Listen to the patient and their responses

Perform a thorough evaluation

Explain your findings to the patient

Explain the treatment to the patient

All of the above
All of the above
When you are a patient in the Massage and soft Tissue Palpation class, which of the following are your responsibilities.

Provide your partner with feedback

Relax and forget everything

Let your partner know if anything is painful or uncomfortable

A and C
A and C
When performing effleurage, which body mechanics rules apply

maintain a neutral spine

bend from the waist when moving your hands toward the drainage sites

weight shift to direct your force

forarms should be perpendicular to your force

a and c are correct
a and c are correct
Which of the following is one of the lymphatic drainage sites we will use for the effleurage stroke of the thoracolumbar region?

middle trap

inferior scapula

occiput

axilla
axilla
Describe the process of obtaining informed consent.
From the Guide to Physical Therapy Practice, "The physical therapist has sole responsibility for providing information to the patient/client and for obtaining informed consent in accordance with jurisdictional law before initiating intervention. "

"The information provided to patients/clients:

· Clearly describes the proposed intervention
· Delineates material (decisional) risks associated with the proposed intervention
· Identifies expected benefits of the proposed intervention
· Compares the benefits and risks possible both with and without the proposed intervention
· Explains reasonable alternatives to the proposed intervention"


** for the purpose of this class we will always tell the patient what we would like to do and ask permission since it is too early in your curriculum to discuss all the other components of obtaining consent.
Define a precaution as it relates to physical therapy treatment
Precautions are protective measures implemented in advance to minimize the chance of injury to a patient. These are diseases or dysfunctions that are present that would cause you to consider the risk of certain strokes or the application of manual techniques in certain areas. When a precaution is present you will "proceed with caution". You can still perform massage, but you need to consider the techniques you are using, the pressure you apply and the location of the pressure to avoid causing harm to your patient
Define a contraindication as it relates to physical therapy treatment
Contraindications serve to specify certain diseases and dysfunctions that render a therapy undesirable or improper. Performing massage on a patient when a contraindication is present could potentially cause harm. DO NOT DO massage when a contraindication is present.
Read the slides titled "general principles". Why is it important to perform a thorough evaluation of the patient prior to initiating massage or any other manual treatment? Why is it important to always ask permission?
A thorough evaluation is necessary before initiating massage so the treating therapist can determine if any contraindications or precautions are present and avoid massage if it is inappropriate. Additionally, during the evaluation, you will determine a physical therapy diagnosis and develop a plan of care. This will all be explained to your patient prior to initiating massage so they can make an informed decision as to if they consent to the treatment you are proposing. Asking permission is important because the patient's treatment is under their control. Asking permission for everything makes it clear to the patient that you respect them and you will not perform any treatment they are not comfortable with. Ultimately the patient is in charge.
Re-read the list of contraindications to massage. What is thrombophlebitis?

Why would it be important to avoid massage in a patient with this medical condition?
Thrombophlebitis is an inflammation of a vein in relation to a clot. The most serious complication occurs when the blood clot dislodges, traveling through the heart and occluding the capillaries of the lungs. This is a pulmonary embolism , which can be potentially life threatening.
Listed below are the "a,b,c's of malignancy. After each, write specifically what about each of these things would make a lesion suspicious. In other words, C is for color- what color or colors on a mole would make you suspicious of a malignancy?

-Asymmetry-

-Borders-

-Color-

-Diameter-

-Evolution-
A. Assymetry- if you bisect the mole top to bottom or right to left, each side should be the same.
B. Borders-irregular (jagged borders that are not smooth)
C. Color-variegated (multiple colors)
D. Diameter-greater than 1 cm (bigger than a pencil eracer)
E. Evolution-changing over time
Massage has been shown to increase circulation more than active exercise.

True or False
False
Massage has been shown to lessen soreness associated with DOMS.

True or False
True
In the study by Crossman et al, the patients that received massage on their hamstrings demonstrated an increase in their SLR ROM immediately after and one week later.

True or False
Flase
In the study by Weinberg et al, the authors found that patient who received massage were more likely to have a positive mood state immediately after compared to subjects that played racquetball and tennis.

True or False
True
In the study by Field T, Schanberg et al, the authors concluded that massage may be a useful adjunct in the treatment of bulimia.

True or False
True
In the study by Hernandez-Reif M, the authors found a reduction in diastolic BP in both the massage group and the progressive relaxation group.

True or False
False
Massage has been reported as a treatment technique that can be used to relieve pain. What are the two theories listed in the lecture that may explain why massage might relieve pain in some people.
Massage has been reported to relieve pain:
One hypothesis for this effect is that massage activates the 'pain gate' mechanism (gate control theory of pain). Cutaneous mechanoreceptors are stimulated by touch and transmit information through large (i.e., thickly myelinated), fast conducting nerve fibers. These impulses block the passage of painful stimuli entering the same segment along small (i.e., unmyelinated or thinly myelinated), slowly conducting neurons.
Another hypothesis postulates that massage increases plasma Beta-endorphins. Endorphins (or endogenous morphines) are chemical substances produced in the brain and spinal cord that act as opiates and produce analgesia by binding to opiate receptors involved in pain perception thus increasing the threshold for pain.
What signs, symptoms, or characteristics of fibromyalgia are also present in patients with myofascial pain syndrome.
disturbed sleep, negative test work-ups
What signs, symptoms, or characteristics of fibromyalgia differ from those present in patients with myofascial pain syndrome.
myofascial pain syndrome: trigger points, fibromyalgia: fatigue
Trigger points are a hallmark sign of fibromyalgia

True or False
False
Which would be true of tender points

They occur in the muscle belly

They produce pain only under the site of palpation

They refer pain elsewhere

They can be active or latent
They produce pain only under the site of palpation
Latent trigger points do not produce pain at rest.

True or Fasle
True
Myofascial trigger points may occur from all of the following except..

Lack of exercise

Cumulative trauma

Nutritional deficiencies

Moist hot packs
Moist hot packs
A positive "compression test" and "jump sign" may indicate

Fibromyalgia

Myofascial pain syndrome

Mechanical dysfunction
Myofascial pain syndrome
A patient with a global distribution of pain, disturbed sleep and symptoms lasting 6 months would most likely fall in to the category of

Fibromyalgia

Myofascial pain syndrome

Mechanical dysfunction
Fibromyalgia
A patient that presents with knee pain that is worse with extension and decreased patellar mobility would most likely fall in to the category of

Fibromyalgia

Myofascial pain syndrome

Mechanical dysfunction
Mechanical dysfunction
Secondary lymhphedema is due to a congenital deformity of the lymphatic system.

True or False
False
Primary lymphedema can develop any time during life or be present at birth.

True or False
True
Secondary lymphedema can result from breast cancer, radiation therapy or filariasis, among other things.

True or False
True
Manual lymph drainage is usually used in conjunction with what other physical therapy treatments. (mark all that apply)

active exercise

kneading

patient education

effleurage massage

antiseptic moisturizing cream

compression bandages
active exercise
patient education
antiseptic moisturizing cream
compression bandages
Which of the following would be included in the patient education for a patient with lymphedema.

Recognizing signs of infection

Adding heavy weight lifting exercises to HEP

Sleep with the limb elevated

Avoid sunscreen on the affected extremity

Carry purse on opposite side
Recognizing signs of infection
Sleep with the limb elevated
Carry purse on opposite side
You are seeing a patient with a diagnosis of lymphedema. The patient's soft tissue feels firm when you palpate. There is no pitting or reduction of edema with elevation. What stage of lymphedema is this patient most likely in?

stage 0

stage 1

stage 2

stage 3
stage 2
You are seeing a patient with a diagnosis of lymphedema with no obvious signs or symptoms. What stage of lymphedema is this patient in?

stage 0

stage 1

stage 2

stage 3
stage 0
As a physical therapist, you will see many patients with limb swelling. How will you differentiate normal swelling from lymphedema? If you suspect lymphedema, what is the most appropriate course of action?
lymphedema will persist overtime and be asymmetrical. suspect lymphedema=cease massage & re-evaluate
Typically a lubricant like lotion or oil is used when performing cross friction massage.

True or False
Flase
What is the typical duration of a CFM/TFM treatment for acute lesions?
1 minute
What is the name of the physician that first described the technique of transverse friction
James Cyriax, MD
Which of the following would be considered hypothesized effects of cross friction for connective tissue repair.

decreasing phagocytosis

hyperaemia

increasing collagen cross links

orderly alignment of collagen fibers
hyperaemia
orderly alignment of collagen fibers
What is the typical duration of a CFM/TFM treatment for chronic lesions?
3-5 Minutes
The technique of transverse friction could be described as all of the following except

Repetitive

Specific

Non-gliding

General
general
Define phagocytosis.
Phagocytosis is a mechanism to remove pathogens and cell debris in which phagocytes (mostly white blood cells) "eat" the dead tissue and break it down to smaller pieces for removal. One proposed effect of cross friction is facilitating phagocytosis, which would facilitate the healing process.
Which of the following would be contraindications to transverse friction. Mark all that apply.

Rheumatoid arthritis

Bursitis

tendonitis

ligament sprain

haematoma
Rheumatoid arthritis
Bursitis
haematoma
What is a physiological effect of massage that has to do with muscle tone?
decreased muscle tone (relaxation)
Why would massage produce harmful results? (3)
1. presence of disease/dysfunction
2. failure to avoid/modify technique
3. inappropriate application
What are contraindications to massage?
1. fever >101.5, nausea, illness
2. acute conditions
3. ADVANCED respiratory, kidney or liver failure
4. hemophilia, hemorrhage, severe ecchymosis
5. whiplash within 24-48 hrs
6. thrombophelitis
7. SEVERE varicose veins
8. acute RA, local inflammation from recent trauma
9. SEVERE athersclerosis
10. acute MI, unstable hypertension, acute CVA
11. aneurysm
12. frostbite
What are precautions to massage?
1. RA in the remission stage
2. endangerment sites
3. diminished sensation
4. medication
5. hyperaesthesia (RSD)
6. immune system depression
7. drug withdrawal
8. recent CVA, CHI, SCI
9. osteoporosis
10. contacts
11. lymphedema
What are the 3 types of skin cancer?
1. malignant melanoma
2. basal cell carcinoma
3. squamous cell carcinoma
What does multiple shades of a mole signify?
malignancy
What cancer does not metastisize, hurt or itch?
basal cell
What cell affects the epithelial layer of the skin?
squamous
circulation
massage may increase circulation, but affects are inferior to exercise
DOMS
lessens DOMS, but not proven to affect the DOMS related decrease in muscle strength and length
pain
-no affect on plasma endorphin levels
-in subjects with pain, elevated plasma endorphin levels 5-90 min post massage
connective tissue mobility
-burn patients: no increase in ROM/scar pliability
-short term effects on hamstring mobility
cardiovascular
-no effect on cardiac post MI
-does decrease HR/stroke volume in healthy patients
-decrease diastolic BP in hypertensive pt
-decrease systolic in anxious pt
MN excitability
decrease MN excitability in healthy and SCI patients
What are the treatment options for fibromyalgia?
1. medications
2. low intensity aerobic ex
mechanical dysfunction
impaired, altered function of the somatic system (ligs, tendons, etc)
Is MD identifiable on a physical exam?
yes
Do MD patients have problems sleeping?
no
What type of pain does a myofascial pain syndrome patient have?
regional
Is medical testing + or - for MPS and fibromyalgia?
-
What syndrome is associated with trigger points?
myofascial pain syndrome
What are the 2 types of trigger points?
-active
-latent (must be aggravated)
Who is affected more by fibromyalgia?
men
radiculopathy model of MPS
-result of peripheral neuropathy/radiculopathy
energy crisis hypothesis of MPS
overabundance of calcium
motor end plate hypothesis of MPS
-dysfunction of MEP
What is the integrated model of MPS?
-dysfunction of MEP with a calcium leakage
What are the 2 types of palpation to determine trigger points?
1. flat- parallel to taut band
2. pincer- move parallel along taut band to find trigger point
Connective tissue repairs in how many stages?
3
1. vascular inflammatory (24-48 hrs)- phagocytosis
2. repair regeneration- fibroblasts create new, mechanically weaker collagen
3. remodeling-maturation- rearrangement of new tissue
What does transverse friction help?
phagocytosis, fiber orientation, prevent adhesion formation, hyperemia
Which statement is true regarding tender points?
They produce pain only under the site of palpation
A positive compression test and jump sign may indicate
myofascial pain syndrome
A patient with a global distribution of pain, disturbed sleep and symptoms lasting 6 months would most likely fall in to the category of
fibromyalgia
A patient that presents with knee pain that is worse with extension and decreased patellar mobility would most likely fall in to the category of
mechanical dysfunction
(T/F)Trigger points are a hallmark sign of fibromyalgia.
False
Myofascial trigger points may occur as a result of all of the following except
moist hot packs
(T/F)Latent trigger points do not produce pain at rest
True
Which of the following statements is true regarding active trigger points?
all of the above
Which of the following is a treatment that could be used to address trigger points
ischemic compression
A hallmark characteristic of a trigger point is
referred pain consistent with Travel and Simons trigger point mapping
Primary lymphedema can be the result of:
Hypoplasia
Which of the following is true regarding lymphedema? 1) Stage 2 of lymphedema consists of pitting edema and is reversible, 2) Mastectomy and lumpectomy due to breast cancer is the second cause of lymphedema in the U.S., 3) If untreated, lymphedema can resolve on its own, 4) Treatment of lymphedema includes manual lymphatic drainage (massage), low-stretch compression bandages and active exercise
4
The best way to determine if someone has lymphedema is to
Conduct a thorough interview and examination
Possible causes of unexplained swelling that would be a contraindication to lymphedema treatment include
Non-managed deep vein thrombosis (DVT)
Your patient presents to the clinic for their 3rd lymphedema treatment session to their right arm. After removing the bandages from your patients arm, you notice the patient has developed a red, hot rash on the dorsum of the forearm. Upon further questioning the patient reports feeling "ill", and reports a low grade fever. Appropriate interventions for today's treatment session include:
Wash the arm, take girth measurements, and call the patient's doctor. Defer all other interventions until infection has been ruled out.
The technique of cross friction could be described as all of the following except:
general
Which of the following would be contraindications to friction if friction were applies to that area? (Mark all that apply)
Rheumatoid arthritis, Haematoma, Bursitis
What is the typical duration of a friction treatment for acute lesions?
1 minute
What is the typical duration of a friction treatment for chronic lesions?
3-5 minutes
T or F. Typically a lubricant like lotion or oil is used when performing cross friction.
False
Which of the following would be considered hypothesized effects of cross friction for connective tissue repair. (Circle all that apply)
hyperaemia & orderly arrangement of collagen fibers
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