Rehab careers- standard 15 INJURY EVALUATIONS Rehab careers- standard 15

Bell Work 4-17-18 What does SOAP stand for? What are leading questions you could ask someone who is having pain? A grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bones is called?

Standard 15 Describe evidence-based techniques and procedures for evaluating common medical conditions, disabilities, and injuries. Discuss at minimum the procedures surrounding inspection/observation, palpation, testing of flexibility, endurance, and strength, special evaluation techniques, and neurological testing. Role-play practicing these skills on a classmate and/or family member, or within in a lab/clinical setting.

Evidence-based MEDICINE Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information Masic I, Miokovic M, Muhamedagic B. Evidence Based Medicine – New Approaches and Challenges. Acta Informatica Medica. 2008;16(4):219-225. doi:10.5455/aim.2008.16.219-225. In other words… individualize all treatments and use what has been evidentially proven to work!

QUICK REVIEW… WHAT DOES SOAP STAND FOR? WHAT DOES HIPS/HOPS STAND FOR? SUBJECTIVE (Patient’s Information) OBJECTIVE (HCP’s Findings) ASSESSMENT (Special Tests) PLAN (Treatment Plan) WHAT DOES HIPS/HOPS STAND FOR? HISTORY (Patient’s Information) INSPECTION/OBSERVATION (HCP’s Findings) PALPATION (Hands-on Evaluation) SPECIAL TESTS THIS INFORMATION IS CRUCIAL WHEN GOING THROUGH A MEDICAL EVALUATION!

Manual Muscle Test http://highered. mheducation  Assessment of muscle strength.  Evaluates the function and strength of individual muscles and muscle groups based on the effective performance of a movement in relation to the forces of gravity and manual resistance. Scale of 0 to 5 with 0 being a low score and no movement and 5 being a normal score with good ROM

MMT Scale 0/5: no contraction 1/5: muscle flicker, but no movement 2/5: movement possible, but not against gravity 3/5: movement possible against gravity, but not against resistance by the examiner 4/5: movement possible against some resistance by the examiner Can be subdivided further into 4–/5, 4/5, and 4+/5 5/5: normal strength

A PATIENT COMES IN TO YOUR CLINIC…

SOAP NOTE SCENARIOS Use your SOAP Notes form and fill in the correct information based on the scenarios provided. BE SURE TO INCLUDE YOUR ASSESSMENT OF WHAT IS WRONG AND YOUR PLAN!!

1.

Patient 1 WHAT DO YOU DO FIRST?? SUBJECTIVE INFORMATION 16y/o Male Playing Basketball at school this afternoon, went to shoot a layup and came down wrong on his foot Felt and heard a “pop” on the outside of his L) ankle Immediately swelled up (as seen in picture) Has never injured this ankle before WHAT DO YOU DO NEXT?

Objective findings WHAT DO YOU DO NEXT? OBJECTIVE INFORMATION Pt. Tender at Lateral Malleolus (name given to the bone on the outside of the ankle joint.) Limited AROM & PROM MMT 3/5 DORSIFLEXION MMT 3/5 PLANTARFLEXION MMT 2/5 INVERSION MMT 3/5 EVERSION WHAT DO YOU DO NEXT?

Ankle assessment TALAR TILT TEST ANTERIOR DRAWER (ANKLE) KLEIGER’S TEST (EXTERNAL ROTATION) THOMPSON’S TEST COMPRESSION TEST RESULTS: Talar Tilt + Thompson’s Test - Anterior Drawer + Compression Test - Kleiger’s Test -

YOUR TURN TO PRACTICE… Using the written guidelines provided, practice on each other all of the ANKLE assessment specialty tests. BE CAREFUL AND PROFESSIONAL WHEN PERFORMING THESE TESTS! DO NOT DO ANYTHING TO CAUSE HARM! DON’T FORGET TO RECORD YOUR ASSESSMENT AND PLAN FOR PATIENT 1 IN YOUR SOAP NOTES!

2.

Patient 2 WHAT DO YOU DO FIRST?? SUBJECTIVE INFORMATION 22y/o Female Went for a run after work two days ago when a dog started chasing her. She jumped over a fence and when she came down she felt a “pop” in her L) knee Immediately swelled up (as seen in picture) Has never injured this knee before Unable to walk without assistance. Had crutches at home and has been using them since the injury. Has been putting ice on her knee at night and taking NSAIDS. WHAT DO YOU DO NEXT?

Objective findings WHAT DO YOU DO NEXT? OBJECTIVE INFORMATION Pt. Tender at inferior aspect of the apex (lowest part) of the patella Limited AROM & PROM (passive and active) MMT 3/5 Knee Extension MMT 3/5 Knee Flexion WHAT DO YOU DO NEXT?

Knee assessment RESULTS: ANTERIOR DRAWER – McMURRAY’S Test - PALPATION RANGE OF MOTION ANTERIOR & POSTERIOR DRAWER VALGUS & VARUS STRESS TEST McMURRAY’S TEST RESULTS: ANTERIOR DRAWER – McMURRAY’S Test - VALGUS STRESS TEST - VARUS STRESS TEST -

YOUR TURN TO PRACTICE… Using the written guidelines provided, practice on each other all of the KNEE assessment specialty tests. BE CAREFUL AND PROFESSIONAL WHEN PERFORMING THESE TESTS! DO NOT DO ANYTHING TO CAUSE HARM! DON’T FORGET TO RECORD YOUR ASSESSMENT AND PLAN FOR PATIENT 2 IN YOUR SOAP NOTES!

3.

Patient 3 WHAT DO YOU DO FIRST?? SUBJECTIVE INFORMATION 18y/o Male Was playing baseball and slid into home plate. Immediately felt a pop and was unable to move his arm. When he stood up his shoulder “looked funny” (as seen in picture) Was told he had a “loose shoulder”, but has never injured it like this before. Immediately got ice out of the dugout and came into the ATR. WHAT DO YOU DO NEXT?

Objective findings WHAT DO YOU DO NEXT? OBJECTIVE INFORMATION Pt. Tender at AC Joint Unable to perform AROM & PROM MMT 0/5 Shoulder Abduction MMT 0/5 Shoulder Flexion MMT 0/5 Shoulder Extension *Shoulder “popped back in place” while doing objective findings* WHAT DO YOU DO NEXT?

Shoulder assessment PALPATION RANGE OF MOTION (AROM & PROM) CODMAN’S PENDULUM EMPTY CAN TEST LIFT-OFF TEST NEER’S IMPINGEMENT HAWKIN’S KENNEDY IMPINGEMENT LOAD & SHIFT APPREHENSION RELOCATION SULCUS SIGN O’BRIEN’S TEST RESULTS: Codman’s Pendulum – Hawkin’s Kennedy Impingement – Empty Can Test + Load & Shift + Lift-Off Test + Apprehension Relocation + Neer’s Impingement – Sulcus Sign + O’Brien’s Test –

YOUR TURN TO PRACTICE… Using the written guidelines provided, practice on each other all of the SHOULDER assessment specialty tests. BE CAREFUL AND PROFESSIONAL WHEN PERFORMING THESE TESTS! DO NOT DO ANYTHING TO CAUSE HARM! DON’T FORGET TO RECORD YOUR ASSESSMENT AND PLAN FOR PATIENT 3 IN YOUR SOAP NOTES!