The document describes the assessment of the motor system, including muscle bulk, tone, strength, reflexes, coordination, and involuntary movements. Key parts of the exam include inspection and measurement of major muscle groups to assess for wasting or hypertrophy. Tone is evaluated by passive movement of joints. Muscle strength is tested against resistance on a scale of 0-5. Coordination is tested using tasks like finger-nose testing. Gait and presence of tremors or other involuntary movements are also noted. The document provides guidance on documenting exam findings in a report.
Muscle energy techniques (MET) involve voluntary muscle contractions by the patient against a counterforce applied by the practitioner. The goal is to move restrictive barriers and normalize muscle and fascial restrictions. Key elements include controlled joint positioning, patient-applied muscle contractions in a specific direction, and operator counterforce. MET can be used to lengthen shortened muscles, strengthen weakened muscles, reduce pain and edema, and increase joint mobility. It relies on principles like post-isometric relaxation and reciprocal inhibition. Careful technique and patient/practitioner coordination are important for success. MET can help many somatic dysfunctions but requires an understanding of indications and contraindications.
The document discusses the H-reflex, which is a monosynaptic reflex elicited by electrically stimulating sensory neurons that monitor muscle stretch. Specifically:
- The H-reflex was discovered in 1918 and involves stimulating Ia fibers that monitor muscle stretch rate, which triggers a reflex response through the spinal cord and back to the same muscle.
- It is consistently obtained by stimulating the tibial nerve below the knee and recording from the gastrocnemius-soleus muscle, but can also be recorded in the median nerve and femoral nerve.
- To record the H-reflex, active and reference electrodes are placed on the calf muscles and ground electrode is placed between the stimulating and active electrodes.
The document describes exercises called Frenkel's Exercises designed to help compensate for ataxia. [1] The exercises involve coordinated movements of the legs, arms, and torso both while lying down and sitting, as well as standing and walking exercises. [2] They are meant to improve coordination, not strength, and should be done slowly and carefully with adequate rest between exercises. [3]
A 40-year-old female presented with pain and swelling in her left arm and itching all over her body for 5 days. She was diagnosed with cellulitis and tenosynovitis in her left hand based on physical exam findings and investigations. She was treated with IV and IM antibiotics, analgesics, antacids, anticoagulants, and oral antidiabetic and steroidal medications. Upon discharge, she was advised to follow-up after 1 week while continuing several oral medications including antibiotics, analgesics, and steroids. The pharmacist noted a potential drug interaction between the diclofenac and prednisolone prescribed and recommended monitoring for bleeding risks.
The document provides information on performing a sensory examination, including testing superficial sensations like pain, temperature, and touch. It also describes evaluating deep sensations such as proprioception, vibration, and kinesthesia. Finally, it discusses assessing combined cortical sensations including stereognosis, graphesthesia, and two-point discrimination. The examination involves testing various areas of the body using specific tools and techniques, and having the patient respond verbally or by physical demonstration to identify sensations.
Assessment and Management of Frozen ShoulderThe Arm Clinic
The Arm Clinic's Mr Mike Walton presents his thoughts on assessment and management of Frozen Shoulder. Presentation for The Arm Clinic educational event #stiffshoulder at The Wilmslow Hospital, 29th April 2016.
The document discusses Margaret Rood's approach to neurorehabilitation, which uses controlled sensory input to facilitate motor control. Rood believed motor functions develop from primitive reflexes through stimulation of appropriate sensory receptors. Her approach uses techniques like light touch, brushing, icing, stretching, resistance, tapping, and vestibular stimulation to activate cutaneous and proprioceptive receptors. While Rood's theory aimed to improve motor function, some aspects are outdated and more research is needed to evaluate the physiological effects of her techniques.
Muscle energy techniques (MET) involve voluntary muscle contractions by the patient against a counterforce applied by the practitioner. The goal is to move restrictive barriers and normalize muscle and fascial restrictions. Key elements include controlled joint positioning, patient-applied muscle contractions in a specific direction, and operator counterforce. MET can be used to lengthen shortened muscles, strengthen weakened muscles, reduce pain and edema, and increase joint mobility. It relies on principles like post-isometric relaxation and reciprocal inhibition. Careful technique and patient/practitioner coordination are important for success. MET can help many somatic dysfunctions but requires an understanding of indications and contraindications.
The document discusses the H-reflex, which is a monosynaptic reflex elicited by electrically stimulating sensory neurons that monitor muscle stretch. Specifically:
- The H-reflex was discovered in 1918 and involves stimulating Ia fibers that monitor muscle stretch rate, which triggers a reflex response through the spinal cord and back to the same muscle.
- It is consistently obtained by stimulating the tibial nerve below the knee and recording from the gastrocnemius-soleus muscle, but can also be recorded in the median nerve and femoral nerve.
- To record the H-reflex, active and reference electrodes are placed on the calf muscles and ground electrode is placed between the stimulating and active electrodes.
The document describes exercises called Frenkel's Exercises designed to help compensate for ataxia. [1] The exercises involve coordinated movements of the legs, arms, and torso both while lying down and sitting, as well as standing and walking exercises. [2] They are meant to improve coordination, not strength, and should be done slowly and carefully with adequate rest between exercises. [3]
A 40-year-old female presented with pain and swelling in her left arm and itching all over her body for 5 days. She was diagnosed with cellulitis and tenosynovitis in her left hand based on physical exam findings and investigations. She was treated with IV and IM antibiotics, analgesics, antacids, anticoagulants, and oral antidiabetic and steroidal medications. Upon discharge, she was advised to follow-up after 1 week while continuing several oral medications including antibiotics, analgesics, and steroids. The pharmacist noted a potential drug interaction between the diclofenac and prednisolone prescribed and recommended monitoring for bleeding risks.
The document provides information on performing a sensory examination, including testing superficial sensations like pain, temperature, and touch. It also describes evaluating deep sensations such as proprioception, vibration, and kinesthesia. Finally, it discusses assessing combined cortical sensations including stereognosis, graphesthesia, and two-point discrimination. The examination involves testing various areas of the body using specific tools and techniques, and having the patient respond verbally or by physical demonstration to identify sensations.
Assessment and Management of Frozen ShoulderThe Arm Clinic
The Arm Clinic's Mr Mike Walton presents his thoughts on assessment and management of Frozen Shoulder. Presentation for The Arm Clinic educational event #stiffshoulder at The Wilmslow Hospital, 29th April 2016.
The document discusses Margaret Rood's approach to neurorehabilitation, which uses controlled sensory input to facilitate motor control. Rood believed motor functions develop from primitive reflexes through stimulation of appropriate sensory receptors. Her approach uses techniques like light touch, brushing, icing, stretching, resistance, tapping, and vestibular stimulation to activate cutaneous and proprioceptive receptors. While Rood's theory aimed to improve motor function, some aspects are outdated and more research is needed to evaluate the physiological effects of her techniques.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
This document discusses various special tests used to evaluate the shoulder joint. It provides details on range of motion tests and impingement tests for the rotator cuff as well as tests for the acromioclavicular joint, bicep tendon, and shoulder instability. Impingement is classified based on the cause and grade. Specific tests described include Neer's impingement test, Hawkins-Kennedy test, empty can test, and others. Tests for the acromioclavicular joint, biceps tendon, and shoulder instability include the painful arc test, Yergason test, anterior apprehension test, and more.
This document presents an overview of selected resistance training regimens, including progressive resistance exercise, circuit weight training, and isokinetic training. It describes progressive resistance exercise regimens like the Delorme and Oxford models which gradually increase weight loads over sets. Circuit weight training involves continuous exercises performed at stations targeting major muscle groups. Isokinetic training maintains a constant velocity of movement using specialized machines, typically starting at medium speeds for rehabilitation.
This document provides an overview of reflexes, including:
1. It defines reflexes as involuntary responses to sensory stimuli and describes the basic reflex arc components.
2. It classifies reflexes based on various criteria and describes how reflexes are graded from absent to exaggerated.
3. It provides instructions for properly eliciting reflexes and lists examples of deep, superficial, and pathological reflexes as well as signs of exaggerated and diminished reflexes.
Spasticity, rigidity, hypotonia, dystonia, decerebrate rigidity, and decorticate rigidity are abnormal tones that can occur. Examination of tone includes initial observation, passive and active motion testing using scales like the Modified Ashworth Scale. Typical patterns of spasticity in upper and lower limbs are described for upper motor neuron lesions.
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
Special Tests for Lower Leg, Ankle, and FootJulie Jane
This document describes various physical examination tests for the lower leg, ankle, and foot. It provides procedures and implications for tests that assess the neutral position of the talus, leg and foot alignment, tibial torsion, ligamentous instability, and other conditions. Key tests include those for the anterior drawer test of the ankle, tibial torsion in sitting and supine positions, leg-heel alignment, and Feiss line to assess for flat foot. The document contains detailed steps for examiners to accurately perform various physical exams of the lower extremity.
Gait training Physiotherapy perspective.pptxSusan Jose
do you know what is gait?
lets know more this presentation.
can physiotherapist help you with your walking abilities. click on the above slide to know more.
This document provides an overview of physiotherapy for urological surgeries and procedures. It discusses common urological diseases, procedures such as nephrectomy, cystectomy, prostatectomy, and their pre-operative and post-operative physiotherapy. Complications of urological surgeries are also outlined. Physiotherapy focuses on breathing exercises, coughing, range of motion exercises, posture correction, and pelvic floor exercises pre-operatively and post-operatively to aid recovery.
Rood's approach is a neurophysiological approach developed by Margaret Rood in 1940 that uses controlled sensory input to activate motor patterns. It is based on the premise that motor output depends on sensory input and follows a normal developmental sequence. The goals of Rood's approach include normalizing muscle tone through facilitating light mobilizing muscles and inhibiting heavy stabilizing muscles, treating patients at their functional developmental level, directing movement towards functional goals, and using repetition to form new motor patterns. Sensory techniques like light touch, vibration, and vestibular stimulation are used to facilitate muscles, while techniques like rocking, stroking and maintained stretch inhibit muscles. The approach is applied based on a patient's specific impairments like spasticity or
This document discusses fatigue, including its definition, types, causes, symptoms, and assessment. It defines fatigue as tiredness or diminished energy that interferes with normal activities. Fatigue can be acute or chronic, and local or general. Common causes include lack of sleep, stress, illness, and advancing age. Symptoms include forgetfulness and lack of interest. Assessment involves history, physical exam, and potentially blood tests and imaging. Tests evaluate things like anaerobic capacity, aerobic capacity, and muscle strength and fatigue. Questionnaires can also assess fatigue severity.
This document contains an orthopaedic assessment form with sections for subjective and objective information. The subjective section includes the patient's history and chief complaint. The objective section documents vital signs, physical exam findings including range of motion tests and muscle strength tests, and sensory and reflex assessments. The objective findings will be used to inform the assessment and plan.
Proprioception refers to the sense of the position and movement of the body. It is detected by receptors in muscles, joints, and skin. Proprioceptive signals are sent to the central nervous system. The parietal cortex integrates proprioceptive information. Proprioception can be affected by factors like age, fatigue, injury, and diseases like Parkinson's. Proprioceptive training aims to enhance joint awareness and can help prevent injuries in sports. Body ownership refers to the sense that a body part belongs to one's own body, as shown in experiments with rubber hands.
Frozen Shoulder Physiotherapy ManagementVishal Deep
Adhesive capsulitis is characterized by painful restriction of shoulder movement. Management includes corticosteroid injections to reduce inflammation, NSAIDs for pain, and manipulation under anesthesia or mobilization to improve range of motion. Physiotherapy goals are to reduce pain through ultrasound, mobilization, and stretching, improve range of motion through passive, active assisted, and active exercises, and strengthen muscles with isometrics, rotator cuff exercises, and scapular exercises. A home program including pendular exercises and aquatic therapy is also recommended.
The document discusses the sensory system and how it processes and transmits sensory information from peripheral receptors to the sensory cortex. It describes how different sensory modalities like pain, temperature, vibration and proprioception are carried by different nerve fiber types and pathways in the body. It provides details on testing various sensory modalities and how the patterns of sensory loss can help localize lesions to different parts of the central or peripheral nervous system.
This document provides an overview of nerve conduction studies and electromyography. It discusses the anatomy and neurophysiology relevant to understanding these diagnostic tests. The key points covered include:
1) Nerve conduction studies and electromyography are used to diagnose disorders of the peripheral nervous system including motor and sensory neurons, nerve roots, plexuses, nerves, neuromuscular junctions and muscles.
2) The tests provide information about the fiber types involved, the underlying nerve pathophysiology, and help narrow the differential diagnosis.
3) The document reviews the fundamentals and principles of nerve conduction studies and electromyography including motor, sensory and mixed nerve conduction studies and the patterns that can indicate conditions like ax
The document outlines a rehabilitation program following arthroscopic Bankart repair surgery in 4 phases. Phase 1 focuses on controlling pain and inflammation while gradually increasing range of motion and strengthening. Phase 2 enhances strength and continues increasing range of motion. Phase 3 aims to achieve full range of motion and improve strength and neuromuscular control. Phase 4 maximizes strength, endurance, control and initiates sport specific exercises to return to pre-injury activity levels. Each phase progresses exercises and intensities over several weeks to meet outlined goals.
Frenkel exercises are a series of movements developed to treat patients with loss of proprioception. The exercises start simple and increase in difficulty, using visual and auditory cues to facilitate restoration of smooth, coordinated movement. Key principles are concentration, precision, and repetition of movements like limb motions and transfers of weight. Exercises progress from lying to sitting to standing positions and incorporate movement of the legs, arms, and whole body. The goal is to improve coordination, balance, proprioception and control through attention to rhythmic counting and placement of limbs in specific positions.
This document provides a case study of a 70-year-old male patient diagnosed with prostate cancer with bone metastasis and cord compression. It summarizes the patient's medical history, physical examination findings, assessment results, treatment plan, and follow up evaluation. The patient is dependent for most activities of daily living due to paraplegia and requires maximum assistance for transfers and mobility. The physiotherapy treatment plan focuses on improving range of motion, muscle tone, joint control, and functional mobility through exercises and positioning.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
This document discusses various special tests used to evaluate the shoulder joint. It provides details on range of motion tests and impingement tests for the rotator cuff as well as tests for the acromioclavicular joint, bicep tendon, and shoulder instability. Impingement is classified based on the cause and grade. Specific tests described include Neer's impingement test, Hawkins-Kennedy test, empty can test, and others. Tests for the acromioclavicular joint, biceps tendon, and shoulder instability include the painful arc test, Yergason test, anterior apprehension test, and more.
This document presents an overview of selected resistance training regimens, including progressive resistance exercise, circuit weight training, and isokinetic training. It describes progressive resistance exercise regimens like the Delorme and Oxford models which gradually increase weight loads over sets. Circuit weight training involves continuous exercises performed at stations targeting major muscle groups. Isokinetic training maintains a constant velocity of movement using specialized machines, typically starting at medium speeds for rehabilitation.
This document provides an overview of reflexes, including:
1. It defines reflexes as involuntary responses to sensory stimuli and describes the basic reflex arc components.
2. It classifies reflexes based on various criteria and describes how reflexes are graded from absent to exaggerated.
3. It provides instructions for properly eliciting reflexes and lists examples of deep, superficial, and pathological reflexes as well as signs of exaggerated and diminished reflexes.
Spasticity, rigidity, hypotonia, dystonia, decerebrate rigidity, and decorticate rigidity are abnormal tones that can occur. Examination of tone includes initial observation, passive and active motion testing using scales like the Modified Ashworth Scale. Typical patterns of spasticity in upper and lower limbs are described for upper motor neuron lesions.
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
Special Tests for Lower Leg, Ankle, and FootJulie Jane
This document describes various physical examination tests for the lower leg, ankle, and foot. It provides procedures and implications for tests that assess the neutral position of the talus, leg and foot alignment, tibial torsion, ligamentous instability, and other conditions. Key tests include those for the anterior drawer test of the ankle, tibial torsion in sitting and supine positions, leg-heel alignment, and Feiss line to assess for flat foot. The document contains detailed steps for examiners to accurately perform various physical exams of the lower extremity.
Gait training Physiotherapy perspective.pptxSusan Jose
do you know what is gait?
lets know more this presentation.
can physiotherapist help you with your walking abilities. click on the above slide to know more.
This document provides an overview of physiotherapy for urological surgeries and procedures. It discusses common urological diseases, procedures such as nephrectomy, cystectomy, prostatectomy, and their pre-operative and post-operative physiotherapy. Complications of urological surgeries are also outlined. Physiotherapy focuses on breathing exercises, coughing, range of motion exercises, posture correction, and pelvic floor exercises pre-operatively and post-operatively to aid recovery.
Rood's approach is a neurophysiological approach developed by Margaret Rood in 1940 that uses controlled sensory input to activate motor patterns. It is based on the premise that motor output depends on sensory input and follows a normal developmental sequence. The goals of Rood's approach include normalizing muscle tone through facilitating light mobilizing muscles and inhibiting heavy stabilizing muscles, treating patients at their functional developmental level, directing movement towards functional goals, and using repetition to form new motor patterns. Sensory techniques like light touch, vibration, and vestibular stimulation are used to facilitate muscles, while techniques like rocking, stroking and maintained stretch inhibit muscles. The approach is applied based on a patient's specific impairments like spasticity or
This document discusses fatigue, including its definition, types, causes, symptoms, and assessment. It defines fatigue as tiredness or diminished energy that interferes with normal activities. Fatigue can be acute or chronic, and local or general. Common causes include lack of sleep, stress, illness, and advancing age. Symptoms include forgetfulness and lack of interest. Assessment involves history, physical exam, and potentially blood tests and imaging. Tests evaluate things like anaerobic capacity, aerobic capacity, and muscle strength and fatigue. Questionnaires can also assess fatigue severity.
This document contains an orthopaedic assessment form with sections for subjective and objective information. The subjective section includes the patient's history and chief complaint. The objective section documents vital signs, physical exam findings including range of motion tests and muscle strength tests, and sensory and reflex assessments. The objective findings will be used to inform the assessment and plan.
Proprioception refers to the sense of the position and movement of the body. It is detected by receptors in muscles, joints, and skin. Proprioceptive signals are sent to the central nervous system. The parietal cortex integrates proprioceptive information. Proprioception can be affected by factors like age, fatigue, injury, and diseases like Parkinson's. Proprioceptive training aims to enhance joint awareness and can help prevent injuries in sports. Body ownership refers to the sense that a body part belongs to one's own body, as shown in experiments with rubber hands.
Frozen Shoulder Physiotherapy ManagementVishal Deep
Adhesive capsulitis is characterized by painful restriction of shoulder movement. Management includes corticosteroid injections to reduce inflammation, NSAIDs for pain, and manipulation under anesthesia or mobilization to improve range of motion. Physiotherapy goals are to reduce pain through ultrasound, mobilization, and stretching, improve range of motion through passive, active assisted, and active exercises, and strengthen muscles with isometrics, rotator cuff exercises, and scapular exercises. A home program including pendular exercises and aquatic therapy is also recommended.
The document discusses the sensory system and how it processes and transmits sensory information from peripheral receptors to the sensory cortex. It describes how different sensory modalities like pain, temperature, vibration and proprioception are carried by different nerve fiber types and pathways in the body. It provides details on testing various sensory modalities and how the patterns of sensory loss can help localize lesions to different parts of the central or peripheral nervous system.
This document provides an overview of nerve conduction studies and electromyography. It discusses the anatomy and neurophysiology relevant to understanding these diagnostic tests. The key points covered include:
1) Nerve conduction studies and electromyography are used to diagnose disorders of the peripheral nervous system including motor and sensory neurons, nerve roots, plexuses, nerves, neuromuscular junctions and muscles.
2) The tests provide information about the fiber types involved, the underlying nerve pathophysiology, and help narrow the differential diagnosis.
3) The document reviews the fundamentals and principles of nerve conduction studies and electromyography including motor, sensory and mixed nerve conduction studies and the patterns that can indicate conditions like ax
The document outlines a rehabilitation program following arthroscopic Bankart repair surgery in 4 phases. Phase 1 focuses on controlling pain and inflammation while gradually increasing range of motion and strengthening. Phase 2 enhances strength and continues increasing range of motion. Phase 3 aims to achieve full range of motion and improve strength and neuromuscular control. Phase 4 maximizes strength, endurance, control and initiates sport specific exercises to return to pre-injury activity levels. Each phase progresses exercises and intensities over several weeks to meet outlined goals.
Frenkel exercises are a series of movements developed to treat patients with loss of proprioception. The exercises start simple and increase in difficulty, using visual and auditory cues to facilitate restoration of smooth, coordinated movement. Key principles are concentration, precision, and repetition of movements like limb motions and transfers of weight. Exercises progress from lying to sitting to standing positions and incorporate movement of the legs, arms, and whole body. The goal is to improve coordination, balance, proprioception and control through attention to rhythmic counting and placement of limbs in specific positions.
This document provides a case study of a 70-year-old male patient diagnosed with prostate cancer with bone metastasis and cord compression. It summarizes the patient's medical history, physical examination findings, assessment results, treatment plan, and follow up evaluation. The patient is dependent for most activities of daily living due to paraplegia and requires maximum assistance for transfers and mobility. The physiotherapy treatment plan focuses on improving range of motion, muscle tone, joint control, and functional mobility through exercises and positioning.
Lumbar spinal stenosis, laminectomy, prolapsed intervertebral discYangtze university
Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back that puts pressure on the spinal cord and nerves. It commonly occurs in people over 50 due to age-related wear and tear causing bone spurs or thickened ligaments. The best test for diagnosis is an MRI of the lumbar spine, which will show if there is compression of the spinal cord or nerves. Conservative treatment includes medications like NSAIDs, muscle relaxants, and epidural steroid injections, as well as physical therapy. Surgery such as laminectomy or discectomy may be considered if conservative measures fail to provide relief from pain and symptoms.
The document provides guidance on performing a motor system examination, including assessing muscle bulk, tone, power, and coordination. It outlines how to examine the muscles of the neck, shoulders, arms, trunk and legs. Key points covered include testing specific muscle groups, identifying patterns of weakness, avoiding misleads, and grading scales for muscle tone. The examination involves inspection, palpation, specific movements against resistance and evaluation of posture and gait.
This document provides information on how to test various reflexes. It defines reflexes and lists the aims of testing reflexes. It describes the apparatus needed and types of reflexes including superficial, deep tendon, and visceral reflexes. For each reflex, it provides details on the procedure, expected response, involved nerves and significance. The document concludes with an example report format for documenting reflex examination findings.
This document provides an outline for examining the extremities and back. It details the key steps for inspection, palpation, range of motion testing, vascular examination, and special tests of the major joints. The examination involves inspecting for signs of injury or deformity, palpating for tenderness or deformity, assessing active and passive range of motion, checking pulses, capillary refill, and lymph nodes, and performing clinical tests for conditions like rotator cuff injuries, knee ligament tears, or nerve root compression. Special attention should be given to anatomy and comparing both sides of the body.
The document provides guidance on performing a neurological examination, including inspection, assessment of tone, power/strength, reflexes, and coordination. It describes how to examine the upper limbs, testing muscle strength for different actions like shoulder abduction, arm flexion, and wrist flexion. Reflexes like biceps, triceps, and brachioradialis are also discussed. The document then provides similar guidance for examining the lower limbs, outlining techniques to assess tone and check for ankle clonus.
The document discusses the nervous system and how to assess it. It describes the three parts of the nervous system and the five steps of a neurological assessment: history collection, physical exam, differential diagnosis, diagnostic evaluation, and management plan. The physical exam involves assessing consciousness, cranial nerves, motor skills, reflexes, and sensory functions. It provides details on how to test each cranial nerve and reflex. Diagnostic tests that can further evaluate the nervous system like CT, MRI, PET, and EEG are also outlined.
The document provides information on evaluating and treating shoulder joint issues. It describes functional activities and ranges of motion to assess, specific tests for examining the shoulder joint, nerves, and identifying conditions like impingement, instability, and hypomobility. Management approaches are outlined including protection phases using modalities and range of motion, controlled motion phases adding isometrics and manual therapy, and return to function phases with strengthening exercises and functional training.
Part 4 examination of motor and sensory systemAtul Saswat
This document summarizes the examination of the motor and sensory systems. It describes how to examine muscle bulk, tone, power, and involuntary movements. It also outlines how to test various sensory modalities like pain, touch, temperature, proprioception, vibration, and cortical sensations. Key points examined include muscle wasting, tone (loss or increase), power grading, reflexes, coordination, dermatomes, and signs for proprioception. Assessment methods are provided for each test with normal and abnormal findings.
Jose Austine- Orthopaedic evaluation of cerebral palsyJose Austine
This document provides an overview of cerebral palsy (CP), including its history, definition, classification, etiology, assessment, and orthopedic evaluation. CP is caused by non-progressive brain lesions early in development that result in abnormal muscle tone and movement. It is important to correctly classify a patient's CP based on their motor function and movement disorder. A thorough orthopedic evaluation includes assessing medical history, physical exam of muscle tone and strength, contractures, deformities, and gait. Gait analysis through observation and in a lab helps document the patient's movement and plan for surgical interventions. The goal of evaluation and classification is to guide appropriate treatment and management of CP.
What is a PowerPoint presentation or PPT? Answer: A combination of various slides depicting a graphical and visual interpretation of data, to present information in a more creative and interactive manner is called a PowerPoint presentation or PPT.
Cervical spondylosis is a common cause of neck pain and stiffness that occurs due to wear and tear on the cervical vertebrae. It involves degeneration of the discs and joints between the vertebrae. Symptoms include neck pain that may radiate to the arms, numbness, weakness, and stiffness. Diagnosis is made through x-rays or MRI showing abnormalities. Most cases are treated successfully with conservative measures like physical therapy, medications, and lifestyle changes, while a small percentage may require surgery.
A physiatrist is a doctor who specializes in physical medicine and rehabilitation. They focus on improving patients' function and quality of life by treating problems ranging from minor injuries to spinal cord injuries. Physiatrists utilize treatments like physical therapy, medication, injections, and bracing to reduce pain and treat conditions like arthritis, back pain, and nerve injuries without surgery when possible.
This document provides information about examining the motor system, including anatomy of motor pathways in the brain and spinal cord, inspection of muscles, and testing of muscle tone, power, and specific muscles. It describes how to examine muscles of the shoulder, elbow, wrist/hand, hip, and other areas, including specific tests to evaluate individual muscles like deltoid, biceps, gluteus maximus, and others. The document provides detailed instructions on posture and resistance for testing each muscle.
Assessment of shoulder injuries in primary care Monis Khan
1. The document discusses common shoulder injuries seen in primary care including AC joint separations, clavicular fractures, shoulder dislocations, and proximal humeral fractures.
2. It provides details on the mechanism of injury, physical exam findings, appropriate imaging, management guidelines, and potential complications for each condition.
3. Special tests are described to clinically assess the rotator cuff muscles and identify injuries to the supraspinatus, infraspinatus, teres minor, and subscapularis.
1) Frozen shoulder is characterized by a stiff and painful shoulder with dense capsular adhesions and significant loss of range of motion over 3-4 stages lasting 2-3 years.
2) Symptoms include dull shoulder pain worsened by movement. Examination reveals limited active and passive range of motion in all directions.
3) Treatment includes oral anti-inflammatory medications, corticosteroid injections, physical therapy focusing on stretching and range of motion exercises, and sometimes manipulation or surgery.
This case report describes an uncommon case of a 25-year old male football lineman who presented with low back pain. MRI revealed a herniated disc at L5-S1. Surgery was expected to be a microdiscectomy but had to be changed to a discectomy with laminotomy due to extensive damage. During surgery, the surgeon had to repair the dura and bundled nerves around the herniated disc. Though an uncommon presentation, the patient made a full recovery after surgery and returned to normal activities.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
2. ASSESSMENT OF MOTOR SYSTEM
A. Bulk of muscle
B. Tone of the muscle
C. Strenght of the muscle
D. Reflexes
E. Co-ordination of movements
F. Gait
G. Presence and Absence of involuntary movements.
2
Dr.DivyaAJ
4. INSPECTION AND PALPATION OF MUSCLE
Requires full exposure of muscle
Looks for asymmetry, inspecting both proximally and
distally
Note any deformities
measure the circumference of
arm, foearm
thigh and leg identical level on both side.
mention in report in cm
compare on both sides
4
Dr.DivyaAJ
5. MEASURING THE BULK OF MUSCLE
at above and below knee joint
at above and below elbow joint
measure using meter tape on both right and left side. and
record
RIGHT side LEFT side
ABOVE KNEE
JOINT 7 cm
20 cm 20 cm
BELOW KnEE
JOINT 7 cm
14 cm 14 cm
ABOVE ELBOW
JOINT 8 cm
16 cm 16 cm
BELOW ELBOW
JOINT 8 CM
10 cm 10cm 5
Dr.DivyaAJ
11. COMMON ABNORMALITIES
1. Lower Motor Neuron lesion cause in specific muscle
atrophy
2. Upper Motor Neuron damage can cause disuse atrophy
of muscle groups
3. Certain occupation and sports leads to muscle
Hypertrophy
4. Wasting of muscle is associated with diseases like
rheumatoid arthritis,Cachexia
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12. Fasciculation: looks like a regular twitches under the
skin overlying the muscle at rest ,commonly seen in
lower motor neurone lesion
Myoclonic jerk : it is the sudden shock like contraction
of one or more muscles, associated with epilepsy, diffuse
brain damage and dementia
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14. TONE OF MUSCLE
Definition
Certain amount of tension present in the resting muscle
due to low frequency and asynchronous discharge of α -
motor neuron which produces resistance of a muscle to
strecth( or lengthening).
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18. ASSESSMENT OF MUSCLE TONE
Tone is the resistance felt by examiner when moving a
joint passively through its range of movement.
site to check
upper extremities - wrist and elbow joint
lower extremities -knee level, ankle joint
common abnormalities Muscle Tone may be
decreased(hypotonia) or increased (hypertonia)
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19. HOW CLINICALLY
passively moving the
joint of subject n one
hand and in another hand
palpate the muscle in
passive movement .
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20. • Hypotonia: is decreased tone
• seen physiologicaly
1. resting muscle tone in sleep
and usually associated with disease
1. polio myelitis
2. tabes dorsalis etc
• Hypertonia: there are two principal types of
hyper tonia
1 .spasticity
2. rigidity 20
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21. SPASTICITY
means increased tone throughout range of motion
and there is sudden release (catch) so called"
Clasp knife effect." (activation of inverse strecth
reflex)
Seen in upper motor neurone lesion pyramidal
pathway lesion
In second type there is equal resistance in both
agonistic and antagonistic muscles at any point so
called" Plastic or lead pipe rigidity"
Seen in extrapyramidal lesion
Spasticity is velocity dependent (sudden release)
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23. RIGIDITY
In increase the tone of muscle with no range of
motion
The agonist and antagonist contract alternatively
rapidly so-called" Cog wheel rigidity"
Seen in extrapyramidal diseases such as
Parkinson's disease.
Rigidity is not velocity dependent (continuous).
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28. GENERAL EXAMINATION PRINCIPLES
Power
1. Use power grading scale
2. Test 2 Movements of each joint (agonist and
antagonist)
3. Alway compare left and right side at each level
4. work from proximal to distal
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29. TESTING FOR THE MUSCLES OF UPPER LIMB
1. Abuductor pollicis brevis
2. Interossei and lumbricals
3. Flexors of the fingers
4. Flexors of the wrist
5. Extensor of the wrist
6. Brachioradialis
7. Biceps
8. Triceps
9. Supraspinatus and Deltoid
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30. TESTING MOVEMENT AND MUSCLE POWER
score description
0 absent voluntary contraction
1 feeble contractions that are
unable to move a joint
2 movement with gravity
eliminated
3 movement against Gravity
4 movement against partial
resistance
5 full strength( movement
against full resistance)
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43. SLN
O
MUSCLE TONE RIGHT
SIDE
LEFT SIDE
1. Abuductor pollicis brevis NORMAL NORMAL
2. Interossei and lumbricals NORMAL NORMAL
3. Flexors of the fingers NORMAL NORMAL
4. Flexors of the wrist NORMAL NORMAL
5. Extensors of the wrist NORMAL NORMAL
6. Brachioradialis NORMAL NORMAL
7. Biceps NORMAL NORMAL
8. Triceps NORMAL NORMAL
9. Supraspinatus and Deltoid NORMAL NORMAL
10.
Babinski's rising test NORMAL NORMAL
11.
diaphargm NORMAL NORMAL
12.
trapezius NORMAL NORMAL
13
Abuctors of hip NORMAL NORMAL
14.
Adductors of hip NORMAL NORMAL
15.
flexsors of hip NORMAL NORMAL
16.
extensors of hip NORMAL NORMAL
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44. SLNO MUSCLE TONE RIGHT SIDE LEFT SIDE
1. flexsors of knee NORMAL NORMAL
2. extensors of knee NORMAL NORMAL
3. dorsiflexsors of foot NORMAL NORMAL
4. plantar flexsors of foot NORMAL NORMAL
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45. MUSCLES OF THE TRUNK
muscles of abdomen:
Babinski's rising up
sign
Diaphargm
Trapezius
upper part
lower part
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46. MUSCLE OF THE LOWER LIMB
Extensor of the hip
Flexors of the hip
abuctors of hip
adductors of hip
Flexors of the knee
Extensor of the knee
Dorsiflexion and plantar flexion of the feet
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56. SLN
O
MUSCLE power RIGHT
SIDE
LEFT SIDE
1. Abuductor pollicis brevis 5 5
2. Interossei and lumbricals 5 5
3. Flexors of the fingers 5 5
4. Flexors of the wrist 5 5
5. Extensors of the wrist 5 5
6. Brachioradialis 5 5
7. Biceps 5 5
8. Triceps 5 5
9. Supraspinatus and Deltoid 5 5
10.
Babinski's rising test 5 5
11.
diaphargm 5 5
12.
trapezius 5 5
13
Abuctors of hip 5 5
14.
Adductors of hip 5 5
15.
flexsors of hip 5 5
16.
extensors of hip 5 5
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57. SLNO MUSCLE power RIGHT SIDE LEFT SIDE
1. flexsors of knee 5 5
2. extensors of knee 5 5
3. dorsiflexsors of foot 5 5
4. plantar flexsors of foot 5 5
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58. PARALYSIS
first to weakness or loss of voluntary movement
1. monoplegia paralysis of one extremity only
2. Paraplegia asymmetrical paralysis of both
extremity
3. quadriplegia paralysis of all four extremities
4. hemiplegia paralysis of one side of the body
limited by median line
5. crossed paralysis a paralysis of one or more
ipsilateral cranial nerve and contralateral
hemiplegia
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61. ULTIMATE GOAL OF STRENGTH TESTING
is to decide
? neurogenic weakness by which muscle movements
are affected
? upper or lower motor neuron
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65. CO-ORDINATION OF MOVEMENTS
means the smooth recruitment, interaction and
cooperation of separate muscles or group of
muscles in order to perform a definite motor act.
it depends on
sense of position of limb
cerebellar function
the state of tone of muscles
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66. TESTS FOR CO-ORDINATION
in upper limb
1. finger nose test :R/L
2. Drawing a circle in air:R/L
3. Diadochokinesia:R/L
in lower limb
1. Knee heel test:R/L
2. drawing circle in air:R/L
walking on a striaght line
Rhomberg's test
With eyes open
with eyes closed 66
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71. ATAXIA
A disturbance in the coordination of muscle
movement is called Ataxia.
Sensory Ataxia
Cerebellar Ataxia
Sensory Ataxia may be compensated by vision
disturbance of movement may be apparent only on
closing eyes.
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73. SLN
O
TEST RIGHT SIDE LEFT SIDE
A in upper limb
1.finger nose test :
ABLE TO DO ABLE TO DO
2.Drawing a circle in air ABLE TO DO ABLE TO DO
3.Diadochokinesia ABLE TO DO ABLE TO DO
B in lower limb
1. Knee heel test
ABLE TO DO ABLE TO DO
2.drawing circle in air: ABLE TO DO ABLE TO DO
C walking on a striaght line ABLE TO DO
D. Rhomberg's test
1.With eyes opeN
NEGATIVE
2.with eyes closed NEGATIVE 73
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79. TREMORS
Oscillatory movement about a joint or group of
joints (alternating contraction and relaxation of
muscles)
common types
1. Physiological tremor OR fine tremors:
Anixety,Hyperthyroidism,
2. Coarse tremors (slow) :
3. Intention tremors : cerebellar damage
4. resting tremorsParkinson's disease
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82. Higher mental examination
1. General appearance and behaviour:normal
2. Emotional state:normal
3. Orientation to time,place,person :oriented
4. No hallucination,delusion,illusion
5. Intelligence: normal
6. Memory : recent and remote :normal
7. Speech :normal and no dysarthria
8. Language: normal
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83. MOTOR SYSTEM EXAMINATION
1. NUTURITION OR BULK OF MUSCLE
2. TONE OF MUSCLE
3. REFLEX
4. POWER OF MUSCLE
5. CO-ORDINATION OF MOVEMENT
6. GAIT
7. INVOLUNTARY MOVEMENTS
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84. BULK OF MUSCLE
RIGHT side LEFT side
ABOVE KNEE JOINT
7 cm
--cm --cm
BELOW KnEE JOINT
7 cm
--cm --cm
ABOVE ELBOW
JOINT 8 cm
--cm --cm
BELOW ELBOW
JOINT 8 CM
--cm --cm
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85. SLN
O
MUSCLE TONE RIGHT
SIDE
LEFT SIDE
1. Abuductor pollicis brevis NORMAL NORMAL
2. Interossei and lumbricals NORMAL NORMAL
3. Flexors of the fingers NORMAL NORMAL
4. Flexors of the wrist NORMAL NORMAL
5. Extensors of the wrist NORMAL NORMAL
6. Brachioradialis NORMAL NORMAL
7. Biceps NORMAL NORMAL
8. Triceps NORMAL NORMAL
9. Supraspinatus and Deltoid NORMAL NORMAL
10.
Babinski's rising test NORMAL NORMAL
11.
diaphargm NORMAL NORMAL
12.
trapezius NORMAL NORMAL
13
Abuctors of hip NORMAL NORMAL
14.
Adductors of hip NORMAL NORMAL
15.
flexsors of hip NORMAL NORMAL
16.
extensors of hip NORMAL NORMAL
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86. SLNO MUSCLE TONE RIGHT SIDE LEFT SIDE
1. flexsors of knee NORMAL NORMAL
2. extensors of knee NORMAL NORMAL
3. dorsiflexsors of foot NORMAL NORMAL
4. plantar flexsors of foot NORMAL NORMAL
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87. SLN
O
MUSCLE power RIGHT
SIDE
LEFT SIDE
1. Abuductor pollicis brevis 5 5
2. Interossei and lumbricals 5 5
3. Flexors of the fingers 5 5
4. Flexors of the wrist 5 5
5. Extensors of the wrist 5 5
6. Brachioradialis 5 5
7. Biceps 5 5
8. Triceps 5 5
9. Supraspinatus and Deltoid 5 5
10.
Babinski's rising test 5 5
11.
diaphargm 5 5
12.
trapezius 5 5
13
Abuctors of hip 5 5
14.
Adductors of hip 5 5
15.
flexsors of hip 5 5
16.
extensors of hip 5 5
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88. SLNO MUSCLE power RIGHT SIDE LEFT SIDE
1. flexsors of knee 5 5
2. extensors of knee 5 5
3. dorsiflexsors of foot 5 5
4. plantar flexsors of foot 5 5
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89. SLN
O
TEST of co-ordination RIGHT SIDE LEFT SIDE
A in upper limb
1.finger nose test :
ABLE TO DO ABLE TO DO
2.Drawing a circle in air ABLE TO DO ABLE TO DO
3.Diadochokinesia ABLE TO DO ABLE TO DO
B in lower limb
1. Knee heel test
ABLE TO DO ABLE TO DO
2.drawing circle in air: ABLE TO DO ABLE TO DO
C walking on a striaght line ABLE TO DO
D. Rhomberg's test
1.With eyes opeN
NEGATIVE
2.with eyes closed NEGATIVE
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90. gait is normal
no abnormal involuntory movements
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91. ASSIGNMENT
Difference b/w UMN AND LMN Lesion
Difference b/w spascity and rigidity
difference b/w muscle spindle and golgi tendon
organ
difference b/w tone and power assessment
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95. ASSIGNMENTS
1. Difference between spasticity and rigidity
2. Difference between muscle spindle and golgi
tendon organ
3. Draw a neat labelled diagram of muscle spindle
4. How length and force in muscle controlled and
maintaned?
5. Higer center functions in maintaince of muscle
tone
6. physiological basis of spasticity , clasp knife
phenomenon.
7. Difference between UMN and IMN.
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