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What are the 5 sub-classifications within the treatment based classification system?
- Mobility
- Centralization
- Conditioning and Increased Exercise Tolerance
- Pain Control
- Reduce Headache
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What is the goal of classification by physical therapists?
To use the examination process to ID groups of patients who are most likely to respond to a particular type of intervention.
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What is required to be present in mechanical neck pain?
- pain in the area of the cervical or upper thoracic spine
- Pain, paresthesia, or other changes in cutaneous sensation of spinal origin located in the upper thoracic, shoulder, or arm area
- Alteration in relexes or loss of motor function in the upper extremities, again from spinal origin
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Describe presentation of a patient that may require referral related to spinal fractures.
- Major trauma
- Severe limitation during neck AROM in all directions
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Describe presentation of a patient that may require referral related to cervical myelopathy.
- Sensory changes in the hands
- Muscle wasting of hand intrinsics
- Unsteady gait
- Hoffmann reflex
- Hyperrelexia
- Bowel and bladder disturdances
- Multisegmental weakness, sensory changes, or both
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Describe presentation of a patient that may require referral related to neoplastic conditions.
- Over 50 yo
- Previous history of cancer
- Unexplained weight loss
- Constant pain, no relief with bed rest
- Night pain
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Describe presentation of a patient that may require referral related to upper cervical ligamentous instability.
- Occipital headache and numbness
- Severe limitation during neck AROM in all directions
- Signs of cervical myelopathy
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Describe presentation of a patient that may require referral related to vertebral artery insufficiency.
- Drop attacks
- Dizziness or lightheadedness related to neck movement
- Dysphasia - difficulty swollowing
- Dysarthria - difficulty talkingor slurring of speech
- Diplopia - double vision
- Positive cranial nerve signs
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Describe presentation of a patient that may require referral related to inflammatory or systemic disease.
- Temperature >100 degF
- Blood pressure >160/95
- Resting pule >100 bpm
- Resting respiration >25bpm
- Fatigue
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What are the most common cancers to metastasize to the spine?
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When should an alert and stable trauma patient have cervical spine radiographs?
- High-risk factors: age >65; paresthesias in the extremities; dangerous mechanism of injury (fall >1 meter or 5 stairs, MVC >60mph)
- When you cannot assess ROM
- Not able to actively rotate 45 deg bilat
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What are the recommendations for goals when treating patients with fear avoidance beliefs?
- Emphasis on active rehab and positive reinforcement of functional accomplishments.
- graded exercise programs that direct attention toward attaining certain functional goals and away from the symptom of pain.
- Graduated exposure to specific activities that a patient fears as potentially painful or difficult.
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What amount of change is indicative of a true change in the patient's status on the numeric pain scale?
2 points
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What is the minimum detectable change for the NDI?
9%
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Scores greater than what percentage indicate that patients may have a substantial nonmovement-related component to their symptoms?
60%
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What is the capsular patern of the cervical spine?
Full flexion, limited extension, and symmetrical limitations of side bending and rotation.
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Describe the elevate arm stress test (Roos).
- Abduct arms to 90 deg, laterally rotate shoulder, and flex elbow to 90 so the elbows are slightly behind the frontal plane.
- Patient then opens and closes the hands slowly for 3 minutes.
- Positive with onset of patients symptoms, heaviness, or profound weakness of the arm, or numbness and tingling of the hand.
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Are the test for thoracic outlet specific?
No, this leads to high false-positive rates.
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What makes up the test item cluster for cervical radiculopathy?
- Positive Spurling test
- Positive distraction test
- Positive upper limb tension test
- Presence of less than 60 deg rotation ROM to the involved side
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What muscles are stretched with patient in right sidelying, neck flexion, R side bend, and R rotation?
Left levator scapulae, splenius cervicis, and posterior scalenes
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How is the upper trap and SCM stretched?
- Supine with patient reaching with UE on side to be stretched
- Flex, side bend away, and rotate towards
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How are the anterior and middle scalene stretched?
- Patient's head and neck off the table
- Support the occiput with one hand and place the shoulder on the patient's forehead
- Maintain upper cervical flexion while stabilizing the patient's superior medial clavicle and first rib
- Translate the head and neck from anterior to posterior while keeping the CV junction flexed
- Then take the neck into side bending away and rotation towards
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What is the gold standard for establishing the diagnosis of both lumbar and cervical radiculopathy?
Needle EMG
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Describe the manual technique for treating an elevated first rib.
- Patient seated, therapist's lower extremity on the side opposite to be treated to stablize the patient
- Contact the first rib lateral to the transverse process of T1
- Side bentd toward and rotate away the side to be treated
- Use a thrust or non-thrust inferior directed glide on the rib
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What is the capsular pattern of the cervical spine?
Loss of extension, with equal restriction in side bending and rotation ROM.
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Describe the mechanical tration parameters for treatment on an arthritic cervical spine in the mobility sub-classification.
- 10% to 15% body weight with minimum set to zero
- Performed in 24 deg flexion
- 5:1 on:off time ratio
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Describe the self stretch for the anterior and middle scalene muscles.
- Patient uses a towel to stabilize the first rib
- Perform chin tuck
- Side bend away
- Rotate towards
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