Mastermind Study Group
January 2016
Bonus CCR
Copyright © 2015 PT Final Exam
“What can I do differently?”
“The Journey is the Reward”
“It’s the transformation within yourself that’s
important...”
“Study with a smile!”
Copyright © 2015 PT Final Exam
Wahoo Week 5 of Recitation Sessions!
• NPTE is only 2 weeks away!
• PT Final Exam reviews and feedback
• We are compensated based on your ratings of us– the higher the rating, the
better our compensation=)
• I am available and here for you!
Copyright © 2015 PT Final Exam
Psych your self up, NOT out!
Smile!!!
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Tonight’s Plan...
Informal review of musculoskeletal & misc. topics!
Copyright © 2015 PT Final Exam
Shoulder Special Tests
TEST:
RTC Tear
Labrum Tear
?
?
Biceps Tendon
X
X
?
?
X
X
?
?
?
?
?
Impingement
X
X
X
X
X
Copyright © 2015 PT Final Exam
Shoulder Special Tests
TEST:
RTC Tear
Labrum Tear
Hawkins Kennedy
Neer’s
Biceps Tendon
X
X
Yergesons’s
Speed’s
X
X
O’brien’s
Clunk Sign
Empty Can Test
Drop Arm Test
Lift-Off Test
Impingement
X
X
X
X
X
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TMJ – Muscles of Mastication
Muscles
Action
Temporalis
Elevates mandible, posterior fibers retract
Masseter
Elevates mandible, closure of mouth
Lateral Pterygoid
Depresses and protracts mandible to open
mouth.
Medial Pterygoid
Elevates the mandible and assists in closing
the jaw. Unilaterally assists the lateral
pterygoids in moving the jaw side-to-side
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TMJ Movement
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•
•
•
Deviations
Lateral pterygoid
Medial pterygoid
Deviation to the RIGHT...
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•
•
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Left LP pulls L condyle anterior
Left MP pulls mandible to the right “think medial pulls to the middle”
Right condyle rotates/pivots right
Left condyle glides and pivots right
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Common Postural Imbalances
• Forward head
• Rounded shoulders
• Anterior pelvic tilt
• Posterior pelvic tilt
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Forward Head with
Rounded Shoulders
oCommonly a result from poor sleeping positions,
driving stress, computer neck, whiplash, and faulty
breathing habits.
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Forward Head with
Rounded Shoulders
oWhat musculature is weak?
oWhat musculature is tight?
oHow to correct?
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Forward Head with
Rounded Shoulders
oWeak (lengthened) = neck flexors, and scapular
retractors/thoracic extensors
oTight (shortened) = pectorals, upper trap,
suboccipitals
oIntervention = stretch to lengthen, and strengthen
to shorten appropriate soft tissue
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Posture of Hips - Rotated Pelvis
• Anterior vs. Posterior pelvic tilt
• Most common cause is sedentary lifestyle, decreased activity
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Posture of Hips – Rotated Pelvis
• What musculature is weak?
• What musculature is tight?
• How to correct?
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Posture of Hips – (Anterior) Rotated Pelvis
• Weak = glutes, hamstrings,
abdominals
• Tight = psoas, quads, erector
spinae
• Intervention = stretch to
lengthen, and strengthen to
shorten appropriate soft tissue
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Posture of Hips – (Posterior) Rotated Pelvis
• Weak = psoas, quads, erector
spinae
• Tight = glutes, hamstrings,
abdominals
• Intervention = stretch to
lengthen, and strengthen to
shorten appropriate soft
tissue
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Muscle Energy Techniques (MET)
• A direct and active technique, which engages a restrictive barrier and
requires patient’s participation with effort.
• Commonly used to reposition a dysfunctional joint and treat the affected
musculature.
• Physiological effect –
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•
•
Golgi tendon organ activation results in direct inhibition of agonist muscles
A reflexive reciprocal inhibition occurs at the antagonistic muscles
As the patient relaxes, agonist and antagonist muscles remain inhibited allowing the
joint to be moved further into the restricted range of motion.
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Common MET Example
• Rotated Pelvic Innominate
• How to assess?
• What’s tight?
• What’s weak?
• How to correct?
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Common MET Example
• Ex: Right (Anterior) rotated right pelvic innominate:
• Assessment: Supine to sit test, checking medial malleoli
• Tight: hip flexors, trunk extensors on side of anterior rotation
• Weak: hip extensors, trunk flexors on side of anterior rotation
• Intervention: Contract-hold technique of hip extensors
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Common MET Example
• Ex: PROM and inferior joint glide for GH jt to improve shoulder flexion
• Assessment:
• Tight:
• Weak:
• Intervention:
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Common MET Example
• Ex: PROM and inferior joint glide for GH jt to improve shoulder flexion
• Assessment: Check end range
• Tight: posterior capsule, lat dorsi
• Weak: anterior delt, possible supraspinatus
• Intervention: Contract-relax technique
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Technique Differences
Contract Relax
Hold Relax
“Active assisted”
Can be done individually or with assistance
Isotonic contraction
Isometric contraction
Facilitates relaxation in order to stretch a muscle
Stretching facilitated by GTO to allow reflexive
relaxation of muscle.
Copyright © 2015 PT Final Exam
Incontinence
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•
•
•
Stress incontinence – exercising, coughing, sneezing, or laughing. The activity
causes the sphincter muscle, which normally holds your urine in the bladder, to
weaken and release urine.
Urge incontinence (OAB)– feel a sudden and strong urge, or need, to urinate. Very
soon after the urge strikes, you lose control of your bladder. Could be due to
damage of nerves in bladder or damage to other parts of nervous system.
Overflow incontinence - occurs when you urinate but do not completely empty
the bladder. Later, you may lose some urine. Overflow incontinence can also be
called “dribbling”. Could be due to conditions that block flow of urine such as
tumors or enlarged prostate.
Functional incontinence - may have problems thinking, moving, or
communicating that prevent them from reaching a toilet. Ex: mental/physical
problems preventing getting to a bathroom = dementia or arthritis
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Incontinence
• Stress incontinence – strengthen pelvic floor, timed voiding (keep
a log of when urination frequently occurs)
• Urge incontinence – strengthen pelvic floor, bladder retraining
• Overflow incontinence – multi-factorial treatment approach
depending on cause
• Functional incontinence – behavioral approach, lifestyle
approach, medications
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Incontinence
• Helpful site on incontinence...
http://ugwne.com/urinary-incontinence-condition-treatmentprevention.html
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
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•
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•
•
•
Antalgic Gait
Ataxic Gait
Equines Gait
Glut Max Gait
Glut Med Gait
Hemiplegic Gait
Parkinson Gait
Weak Quads Gait
Scissor Gait
Steppage Gait
Toe In/Out Gait
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait –
• Equines Gait –
• Glut Max Gait –
• Glut Med Gait –
• Hemiplegic Gait –
• Parkinson Gait –
• Weak Quads Gait –
• Scissor Gait –
• Steppage Gait –
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait –
• Glut Max Gait –
• Glut Med Gait –
• Hemiplegic Gait –
• Parkinson Gait –
• Weak Quads Gait –
• Scissor Gait –
• Steppage Gait –
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait – spastic triceps surae, seen more plantarflexion
• Glut Max Gait –
• Glut Med Gait –
• Hemiplegic Gait –
• Parkinson Gait –
• Weak Quads Gait –
• Scissor Gait –
• Steppage Gait –
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait – spastic triceps surae, seen more plantarflexion
• Glut Max Gait – backwards lean, weak glut max
• Glut Med Gait –
• Hemiplegic Gait –
• Parkinson Gait –
• Weak Quads Gait –
• Scissor Gait –
• Steppage Gait –
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait – spastic triceps surae, seen more plantarflexion
• Glut Max Gait – backwards lean, weak glut max
• Glut Med Gait – can have contralateral trunk lean towards stance leg
• Hemiplegic Gait –
• Parkinson Gait –
• Weak Quads Gait –
• Scissor Gait –
• Steppage Gait –
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait – spastic triceps surae, seen more plantarflexion
• Glut Max Gait – backwards lean, weak glut max
• Glut Med Gait – can have contralateral trunk lean towards stance leg
• Hemiplegic Gait – circumducted, DF weakness or spastic PF’s
• Parkinson Gait –
• Weak Quads Gait –
• Scissor Gait –
• Steppage Gait –
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait – spastic triceps surae, seen more plantarflexion
• Glut Max Gait – backwards lean, weak glut max
• Glut Med Gait – can have contralateral trunk lean towards stance leg
• Hemiplegic Gait – circumducted, DF weakness or spastic PF’s
• Parkinson Gait – festinating, difficulty initiating movements
• Weak Quads Gait –
• Scissor Gait –
• Steppage Gait –
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait – spastic triceps surae, seen more plantarflexion
• Glut Max Gait – backwards lean, weak glut max
• Glut Med Gait – can have contralateral trunk lean towards stance leg
• Hemiplegic Gait – circumducted, DF weakness or spastic PF’s
• Parkinson Gait – festinating, difficulty initiating movements
• Weak Quads Gait – forward lurch during initial contact
• Scissor Gait –
• Steppage Gait –
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait – spastic triceps surae, seen more plantarflexion
• Glut Max Gait – backwards lean, weak glut max
• Glut Med Gait – can have contralateral trunk lean towards stance leg
• Hemiplegic Gait – circumducted, DF weakness or spastic PF’s
• Parkinson Gait – festinating, difficulty initiating movements
• Weak Quads Gait – forward lurch during initial contact
• Scissor Gait – spastic adductors
• Steppage Gait –
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait – spastic triceps surae, seen more plantarflexion
• Glut Max Gait – backwards lean, weak glut max
• Glut Med Gait – can have contralateral trunk lean towards stance leg
• Hemiplegic Gait – circumducted, DF weakness or spastic PF’s
• Parkinson Gait – festinating, difficulty initiating movements
• Weak Quads Gait – forward lurch during initial contact
• Scissor Gait – spastic adductors
• Steppage Gait – swing phase – see increased knee/hip flexion
• Toe In/Out Gait –
Copyright © 2015 PT Final Exam
Common Abnormal Gait Patterns
• Antalgic Gait – short stride length on contralateral leg
• Ataxic Gait – wide steps, wide BOS
• Equines Gait – spastic triceps surae, seen more plantarflexion
• Glut Max Gait – backwards lean, weak glut max
• Glut Med Gait – can have contralateral trunk lean towards stance leg
• Hemiplegic Gait – circumducted, DF weakness or spastic PF’s
• Parkinson Gait – festinating, difficulty initiating movements
• Weak Quads Gait – forward lurch during initial contact
• Scissor Gait – spastic adductors
• Steppage Gait – swing phase – see increased knee/hip flexion
• Toe In/Out Gait – femoral antiversion/retroversion
Copyright © 2015 PT Final Exam
Catching Up...
• Assignments – fill in gaps or empty notes on all topics, and make
additions
• Organize your study guide
• Begin reviewing your study guide
• Practice exams – PEATs!
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Reviewing
• “Weakness Lists” – create new ones, and review old ones
• Review practice exams correct and incorrect answers – “Careless
vs. Clueless”
• Be able to verbally explain concepts/topics to someone else
• Use multiple methods of learning and reviewing
• Ex: Writing, Listening, Speaking, Drawing, Watching
Copyright © 2015 PT Final Exam
Test Taking Strategies
• Keep taking practice exams at or close to the time you are taking the NPTE
(Training Specificity)
• Prepare the same way each test day – what you eat and drink, testing
environment, even your clothes!
• Get excited!
• Take your “scheduled break” and go walk around putting the first 2 sections
behind you, and get excited for the last 3 sections!
• Stay excited!
Copyright © 2015 PT Final Exam
Test Taking Strategies
• Read the question first and cover up the answer options
• Answer what the question is actually asking
• Look at the root or prefix of words that you do not know to better
understand what the word mean
• Review your “marked” questions at the end of each section if you have extra
time, if you are right on time, then keep just keep moving.
• Answer options with “always” or “never” in them are usually not the correct
answer choice
Copyright © 2015 PT Final Exam
Last Minute Items!
• NPTE is only 2 weeks away! Get PUMPED!
• PT Final Exam reviews and feedback
• We are compensated based on your ratings of us– the higher our rating, the
better our compensation =)
• I am available and here for you!
Copyright © 2015 PT Final Exam
“What can I do differently?”
“The Journey is the Reward”
“It’s the transformation within yourself that’s
important...”
“Study with a smile!”
Copyright © 2015 PT Final Exam
Session Links
•
•
•
•
•
•
1. TMJ video https://www.youtube.com/watch?v=MLtvtmwKR-w
2. TMJ glides
https://www.google.com/?gws_rd=ssl#q=which+glide+for+opening+TMJ
3. MET http://www.humankinetics.com/excerpts/excerpts/correctly-use-muscleenergy-technique
4. MET versus PNF http://functionalanatomie.com/treatments/stretchingexercises/
5. Training in
Incontinence http://www.emedicinehealth.com/incontinence/page7_em.htm
6. Gait deviations in O&P http://www.oandplibrary.org/alp/chap14-01.asp
Copyright © 2015 PT Final Exam