DPT 724 - Midterm Study Guide || with Complete Solutions.
What is the IFOMPT? 2004, 2016 correct answers IFOMPT (2004)
- "...a specialized area of physiotherapy/physical therapy for the management of neuro-
musculoskeletal conditions, based on clinical reasoning, manual techniques and therapeutic
exercises"
IFOMPT (2016)
- "Orthopaedic Manipulative Therapy (OMT) is a specialisation within physical therapy, which
is concerned with the prevention and conservative management of pain and other symptoms of
neuromusculoskeletal dysfunction in the spine and extremeties."
What is clinical reasoning? correct answers Thinking and decision making processes used in
clinical practice (Higgs and Jones, 2000)
- Clinical reasoning consists of data gathering, organization, and interpretation; hypothesis
generation and testing; and critical evaluation of alternative diagnostic and treatment strategies.
(Jones and Rivett, 2004)
- Examples: Navigation of history taking, Evidence based tests and measures, Differential
diagnosis development, POC development, Treatment decisions, Patient progression, And much
more!
What are manual techniques? correct answers Guide to PT practice
- "Skilled hand movements intended to improve tissue extensibility; increase range of motion;
induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft
tissue swelling inflammation or restriction."
What is therex? correct answers The systematic, planned performance of bodily movements,
postures, or physical activities intended to provide a patient with a means to:
- Remediate or prevent impairments
- Improve, restore, or enhance physical function
- Prevent or reduce health related risk factors
- Optimize overall health status, fitness, or sense of well bei
What are some common manual therapy techniques? correct answers - Passive accessory
mobilization/manipulation
--- This is what you think of for your more "traditional" mobilization/manipulation techniques
- Passive physiological mobilization/ manipulation
--- Larger motions that patients can often perform by themselves (think global spinal
flexion/extension rather than segmental motion)
- Soft tissue mobilization/manipulation
- Muscle Energy Techniques (MET)
- Proprioceptive Neuromuscular Facilitation (PNF)
- Mobilization with Movement (MWM)
- Others?
What is joint mobilization vs. manipulation? correct answers Mobilization
,- Passive techniques designed to restore full painless joint function by rhythmic, repetitive
passive movements to the patients tolerance, in voluntary and/or accessory ranges
Manipulation
- An accurately localized or globally applied single, quick, and decisive movement of small
amplitude, following careful positioning of the patient.
- Generally it proceeds quickly enough that the relaxed patient cannot perceive its occurrence.
What are the Maitland grades of mob/manip? correct answers - Grade I: small amplitude
rhythmic oscillating mobilization in early ROM
- Grade II: large amplitude rhythmic oscillating mobilization in midrange of movement
- Grade III: large amplitude rhythmic oscillating mobilization to point of limitation in range of
movement
- Grade IV: small amplitude rhythmic oscillating mobilization at the end of available range of
movement
- Grade V (thrust manipulation): small amplitude, quick thrust at the end of available range of
movement
What are the Kaltenborn grades of mob/manip? correct answers - Grade I: neutralizes joint
pressure without separation of joint surfaces
- Grade II: separates articulating surfaces, taking up slack or eliminating play within the joint
- Grade III: stretching of soft tissue surrounding the joint
How does the APTA define mob/manip? correct answers "A manual therapy technique
comprising of a continuum of skilled passive movements to the joints or related soft tissues (or
both) that are applied at varying speeds and amplitudes, including small amplitude/high velocity
therapeutic movement."
What is the Arkansas experience? correct answers - In 1997, the Arkansas chapter attained direct
access, defined PT, and attempted to include manual therapy in their definition of PT.
- ACA (American Chiropractic Association) opposed the bill and struck a compromise with the
Ark PTA to include "mobilization" but PTs were prohibited from "manipulation" as defined by
the Chiropractic practice act.
- Mobilization defined as "passive movement accomplished within normal joint range of motion
of the joint, but excluding spinal manipulation and adjustment."
- Manipulation defined as, "the skillful or dexterous treatment whereby a corrective force or
passive movement of the joint is made to re-align vertebrae or articulations to their normal
juxtaposition."
What was the Arkansas Supreme Court case in 2002/5? correct answers AR Law Passed in 2002
allowed the chiropractic board to investigate and fine a PT
- PT fined $10,000 by chiropractic board
- PT lost at appeals court, but only ruled on if the Chiropractic board had the jurisdiction to issue
the fine.
- In 2005, the PT lost legal appeal in the Arkansas Supreme court.
,Who is Dr. James Cunning, PT and why is he important to our work with manual therapy?
correct answers - American Academy of Manipulative Therapy & Spinal Manipulation Institute.
--- Spinal manipulative therapy.
--- Dry needling.
- The Chiropractic Board sent Dr. Dunning a cease and desist letter in Feb 2008 for a course he
was teaching in AL related to manipulation of the spine.
- Then challenged that his practice was advertising chiropractic when it advertised the treatment
of spinal manipulation.
- Eventually the Alabama Supreme court found in favor of Dr. Dunning in January 2012.
Who has utilized manipulation in their practice through history? How has it been proposed to
work? correct answers - Bone Setters
- Osteopathic Physicians (D.O.)
- Allopathic Physicians (M.D.)
- Chiropractors
- Physical Therapists
What is Bone Setting (17th and 18th centuries)? correct answers Belief that bones could be out
of place
- Audible "pop" was thought to be bone going back into place
Techniques were passed down within families.
- No supporting knowledge for anatomical or physiological basis at the time.
1871 Wharton Hood published "On Bone Setting"
- He believed the audible pop heard in a manipulation was an adhesion being broken.
- First publication on manipulation by an MD
What is osteopathic medicine? correct answers - Founded by Andrew Taylor Still in 1874.
- Theory that disease processes manifest themselves in the neuro-musculoskeletal system
compromising lymphatic, vascular and neural tissues.
- Exam focus on joint asymmetries, movement restrictions, and soft tissue changes.
- Treatments included mobilization, manipulation, and MET.
- The theoretical framework: "normalizing" restricted joints could improve blood, lymph and
nerve "flow" influencing certain diseases.
- 1928 Osteopathic physicians (DO) in the United States gained equal rights with allopathic
physicians (MD) in the armed forces and within each state by 1970.
- Many osteopathic physicians continue to use mobilization and manipulation today as an adjunct
to traditional medical interventions.
What is chiropractic? correct answers - 1895 Daniel David Palmer founded chiropractic from the
Greek chier (hand) and praxis (done by hand).
- Theoretical Framework:
--- "The Law of the Nerve": Sub-luxed vertebrae can impinge structures including lymphatic,
blood vessels, and nerves which can alter nerve impulses and impact systems of the organism.
Spinal adjustments can therefore cause improvements functionally and organically.
- Similar to Osteopathic, with more emphasis on the role of the spinal nerve.
, - Exam focuses on asymmetry and restrictions in the spine and extremities with thrust
manipulation being the primary mode of treating those findings.
- Today many Chiropractors have abandoned the theory that disease can be cured by spinal
manipulation and focus more specifically on spinal and extremity impairments.
- Both Osteopathic and Chiropractic medicine have contributed to the knowledge base physical
therapists have regarding manipulation.
Who are the influential people in manual PT? correct answers - Cyriax
- Grieve
- Kaltenborn
- Janda
- Maitland
- McKenzie
- Mennell
- Paris
Describe physical therapy and medical manipulation. correct answers - 1899 Physiotherapy
founded in England.
- Cyriax and Mennell.
--- Influential physicians who trained physical therapists in techniques including manipulation.
- 1921 Physical therapy established in the US.
- Development of arthrokinematics in the 1930's
- Kaltenborn applied theories of arthrokinematics to joint manipulation, an approach distinctive
to physical therapy.
- 1974 Orthopedic section of the APTA formed and the International Federation of Orthopedic
Manipulative Therapists (IFOMT) was founded.
- 1979 Paris published "Mobilization of the Spine" which outlined indications, contra-indications
and biomechanical principles of mobilization/ manipulation.
- Mckenzie's extension based theories and centralization phenomena became popularized in the
late 1970's.
- 1990's Mulligan introduced mobilization with movement (MWM).
- 1991 AAOMPT was formed
Who practices present day manual therapy? correct answers - Osteopathic
- Medical
- Chiropractic
- Physical Therapy
Describe EBP in manual therapy. correct answers - Many of the foundations of manual therapy
were developed through clinical practice without significant scientific support.
- Evidence based practice has evolved since the 1970's and has resulted in critical evaluation of
many aspects physical therapy practice.
- There are many areas still requiring further scientific research.
- It is an ongoing process and should be incorporated into clinical reasoning and decision
making.
