National institute on aging in 2021
83% of adults in 60s-70s had used at least 1 prescription drug in the last 30 days
about 33% had used 5+ drugs
70-90% of evaluation is done in subjective (talking to people)
subjective examination questions
- Do they have an existing disease?
- What else is going on?
- Family history that can increase risk of health problems?
- What meds they on?
S. Examination Process
- chart review
- medication review
- Look at PROs (patient-reported outcome)
- Talk to the patient (Funnel Technique)
- Systems review
- Check your red/yellow (mental health) flags
- screening questions
- 3-5 diagnosis
- objective testing
S.E: Good questions to ask
- WHat brings you in today?
- How can I help you?
- When did it start?
- Have you PT before?
- Ever had surgery?
- medical emergency
- ask if they have a "plan"
- need to ask permission to take them to ER
- Join and muscle function assessment
- Active ROm
- Manual muscle testing
- passive ROM
- Joint stability testing
- Stress Testing
- Joint play
Objective Examination: Vitals
BP (systolic/distaolic). heart rate, respiratory rate
Objective Examination: palpation
- not very reliable/quantitative => more qualitative
- bones, ligaments, muscles and tendons
- palpate all structures, begin away from pain site and progress toward suspected injury
Objective Examination: Joint and muscle funtion assessment
- perform bilaterally
- which test depends on you
- AROM, PROM, manual testing, joint stability testing, stress testing, joint play
Objective Examination: Active ROM
- how much the patient can move themselves
- Goniometry- the center of goni is the center of joint you are moving
Objective Examination: Manual muscle testing
- at midrange of joint
- stabilize limb proximatly => press distal to muscle attachment=> grade up => do not let me move you
- testing force output
Objective Examination: Passive ROM
- patient is relaxed, provider moves the joint
- if range ok (no pain) => provide over-pressure
- PROM>ROM => muscular problem
- AROM> PROM (and limited)=> may be joint problem
Objective Examination: Joint stability testing
- apply specific stress to noncontractile tissue
- hypermobile (more laxity than normal)
- hypomobile (below normal laxity)
- laxity (clinical; sign of the amount of "give" in a joint, shown in stress testing
- instability (join't inability to function under stresses of function activity)
Objective Examination: Stress testing (compare bilaterally)
- Grade I, firm: slight ligament stretch, pain, regular laxity
- Grade II, soft: partial tearing of fibers, increased joint play ("opens up") in compare to other side,
- Grade II, empty: complete tearing, excessive tearing, restricted by tendons (2nd restraints)
- rolling, spinning, gliding
- procedure: relaxe patient in loose-pack position, apply glide/distractinf stress, assessed degree of movement, compare bilaterally
- specific to selected tissues
- results compared: side to side, cause provocation, cause alleviation
- reported as positive or negative
- is a nerve root involved?
- symptoms: numbness or weird sensations, abnormally weak
- dermatomes: which parts of skin are innervated by which nerve groups (preform bilaterally)
neurological screening: dermatomes
- which parts of skin are innervated by which nerve groups (preform bilaterally)
- patient eyes closed and head turned away
- discrimination test: light tough, sharp and dull, 2-point
- tests another muscle innervated by same nerve root
- 1 muscle weak= suspect muscle pathology or peripheral nerve pathology
- 2 muscles weak= suspect nerve root od peripheral nerve pathology
- increased response neuron lesion = upper motor
- decreased response neuron lesion = lower motor
- Deep tendon reflex (DTR)= muscle stretched+relaxed, patient look away, strike tendon with reflex hammer (0-4+ // 2= normal response)
Lower quarter neuro screen
Upper neuro screen
- capillary refill (nail beds)
- pulses (LE: femoral, posterior tibial, dorsal pedal) (UE: brachial, radial, ulnar), systemic (carotid)