MOBILITY HAS TO BE EITHER RELATED TO WALKING OR MOBILITY OF THE PART. THE QUESTION WILL SPECIFY THIS. IF THE SCENARIO REQUIRES BALANCE EXERCISE RELATE THIS TO WALKING WHEN YOU REASON OUT THE EXERCISE TO THE PATIENT.

I WILL REQUEST THE INVIGILATOR TO PUT THIS UP ON SCREEN.

WE DISCUSSED 3 MAXIMUM BUT MINIMUM OF 2 AND SHOW PROGRESSION FOR EACH.

CHOOSE FUNCTIONAL ASSESSMENTS THAT ARE SIMPLE AND FIT WITHIN THE TIME. A 10MTS WALK TEST WILL BE EASIER TO DO AT HOME/COMMUNITY. SO THINK COMMUNITY FOR ALL ASPECTS OF YOUR ASSESSMENTS AND TREATMENT.

THE SCENARIO WILL TELL YOU WHERE THE PROBLEM IS AND THEN FOCUS ON THAT PART. EX SHOULDER CLASS OR BACK CLASS. FOR BALANCE CLASS EXERCISE SHOULD COVER STRENGTH, FLEXIBILTY AND BALANCE. DON'T FORGET YOUR WARM AND COOL DOWN EXERCISE.

THREE EXERCISES AND THEN ONE WARM UP AND ONE COOL DOWN WILL BE GOOD.

NO YOU WILL NOT HAVE TIME FOR AN ASSESSMENT IN THE EXAM. SO COVER THE SM STRATEGIES LIKE GOALS, EDUCATION, EXERCISES, MOTIVATION, MONITORING, REVIEW, SAFETY. USE THE RUBRIC TO SEE WAHT ELEMENTS NEED TO BE COVERED.

The assessment of the lower back should follow the standard approach of any regional assessment: history, observation, active movements, passive movements, special tests, all as appropriate

Assessment:- Pulse Rate, Heart Rate, Walking Test, Borg Perceived Exertion Scale

What do we do for the cardio-resp training?

Training :- Please see link

1. Patients can present with many different problems

2. Determine the main problems and the affect each has on the patient in the case study

3. Consider what assessment tools you need to best assess the problems you have identified.

4. Have justification and rationale for the tools you have used

I AGREE. DON'T FORGET THE OTHER ELEMENTS OF SM TOO.

FIND SIMPLER OPTIONS THAT MEET THE SAME AIM. THINK CHRONIC, THINK COMMUNITY (LIMITED RESOURCES AND TIME), THINK FUNCTIONAL ESPECIALLY FOR NEURO.

YOUR EXACT TIMINGS WILL BE SENT TO YOU BY THE ADMINISTRATORS.

SIMILAR ONES TO STROKE. BUT LOOK ON SHIRLEY RYAN WEBSITE FOR SPECIFIC EXAMPLES.

IF IT IS NOT ON THE LIST THEN NO.

Yes

IT WILL BE ONE OR THE OTHER THAT IS SUITABLE FOR CARDIO RESPIRATORY OR OTHER ELEMENTS.

MOBILITY COULD BE WALKING OR MOBILITY (STRETCHING, FLEXIBILITY, MOBILISATION) OF THE PART AS IN MSK. STRENGTHENING REFERS TO MUSCLE/GROUP OF MUSCLES BEING STRENGTHENED.

CR EXERCISES CAN BE RESPIRATORY TRAINING, BREATHING ETC.,

ENDURANCE EXERCISES CAN BE FOR ENTIRE BODY TO IMPROVE TOLERANCE AND ENDURANCE AND FATIGUE (APPLICABLE TO NEURO, MSK OR CR PATIENTS)

USUALLY EDUCATION IS A PART OF GROUP EXERCISES PROGRAMME. BUT WHEN THEY EXTEND OVER 12 WEEKS ONE WEEK CAN BE DEDICATED TO TEACHING THE PATIENTS ABOUT THE CONDITION. HOWEVER, SINCE THIS IS A 10 MIN SESSION START WITH INTRO AND GOAL AND LEAVE OUT INFORMATION ON DISEASE PATHOLOGY ETC.,

Yes it would and you would be thinking about its application (treatment skill), Reasoning and Justification, Conduct and Communication with model and examiner, -so as with other assessment skills there is a fair bit to think about

Yes, goniometry is accepted as a a more precise and reliable method of measurement for certain joints with greater intra-rater and inter-rater reliability E.g. Hip, Knee, Ankle, Elbow, Shoulder, Wrist and Hand. However, accuracy will decrease and is more difficult when attempting to measure spinal mobility therefore other methods of assessing ROM ought to be considered.

Lungs - Pulmonary Rehabilitation Perspectives

Hearts - Cardiac Rehabilitation Perspectives

Cardiac Rehabilitation Programme

Yes. Rating pain intensity, using a verbal NRS, is a sensible and appropriate way to quantify a patient's pain

Please use a variety of sources such as NICE guidelines and peer reviewed literature to inform assessment and management strategies. https://www.nice.org.uk/guidance/ng226

There is also a helpful literature review of peer reviewed sources that informed the NICE guidance and may help you with your reading to inform choice of exercises 'Evidence review for the clinical and cost- effectiveness of exercise for the management of osteoarthritis' https://www.nice.org.uk/guidance/ng226/evidence/c-clinical-and-cost-effectiveness-of-exercise-for-the-management-of-osteoarthritis-pdf-11250452848

For further information and sources on behaviour change interventions for example: joint protection principles, cognitive- behavioural therapy and educational programmes please see the following review with a range of peer reviewed literature sources listed which have been used to further inform NICE guidance. https://www.nice.org.uk/guidance/ng226/evidence/k-clinical-and-cost-effectiveness-of-treatment-packages-for-the-management-of-osteoarthritis-pdf-405016302424

Versus arthritis and their website has some helpful information for patients. https://www.versusarthritis.org/about-arthritis/

This is not an exhaustive list and further independent reading, research, and critical appraisal will be necessary.

It's useful to state what you mean by "on here". However, a standard approach to any clinical assessment is:

Clinical history

Observation

Active movements (if appropriate)

Palpation

Passive movements (of appropriate)

Special tests (if appropriate)

Regarding low back pain (LBP), as you have been told on several occasions, there are multiple mechanisms, sources (i.e. tissues), and causes (i.e. pathology) that could give rise to LBP. You have been shown several tests that relate to these. For example, the Straight Leg Raising Test is one special test that measures mechanical sensitivity in the sciatic nerve and the nerve roots from which it is constituted (i.e. L4-S2), which would indicate neuropathic pain. There are also special tests to check nerve conduction, both afferent (sensory: peripheral nerve and dermatome) and efferent (motor: peripheral nerves and myotomes). Deep tendon reflexes are also special tests. Disc provocation tests (see Mark Laslett's work) are special tests. Referral for blood tests (e.g. inflammatory markers) are also special tests. Your clinical reasoning should tell you which tests are appropriate. In addition, special tests have properties such as sensitivity and specificity, which relate to how well they can identify a particular condition or pathology; this is more advanced but something to bear in mind and start looking into.

Yes, please do start to read around the literature!

Yes-Research has shown this can show clinical meaning change

Observation is an important component of a clinical assessment of any condition, including back pain. Examples of its importance include: observing antalgic posture, scoliosis, active ranges of motion, gait, rashes (including psoriasis, which has an association with axial spondyloarthritis), signs of neurological deficit, etc. Testing vitals can also be included under observation.

However, in isolation, observation is insufficient and you should incorporate the following approach:

Clinical history

Observation

Active movements (if appropriate)

Palpation

Passive movements (if appropriate)

Special tests (if appropriate)

Inflammatory conditions (RA, AxSpA, polymyalgia rheumatica, psoriatic arthritis, etc...) were covered in your lectures and may feature in the case studies. You should also show your awareness and knowledge of these conditions when considering differential diagnoses for pain presentations (back pain, upper limb pain, lower limb pain, etc.).

In addition to lectures, you had a specific practical session on appropriate exercises for RA of the hands and upper limb (based on the SARAH Trial), so these would be useful to revise. There will definitely be RA cases amongst those used in the assessment.

The nature of inflammatory conditions makes them become chronic. However, you will be aware that chronic pain is not limited to inflammatory conditions and so awareness of other conditions that may become chronic (OA, neuropathic pain, pain, etc.) will be necessary too.

1. Walk tests can be used to assess the patient.

2. You can choose the walk test you would use

3. Justify the reasons for selecting the test

4. BUT THINK CAREFULLY HOW MUCH TIME YOU HAVE TO DEMONSTRATE THIS SO YOU CAN COMPLETE THE OTHER SECOND ASSESSMENT COMPONENT IN THE ALLOCATED TIME

5. THEREFORE YOU COULD CONSIDER THE 2 MINUTE WALK TEST AS IT IS A MEASURE - The 2MWT is to be a reliable and valid test for the assessment of exercise capacity and responsive following rehabilitation in patients with moderate-to-severe COPD. It is practical, simple, and well-tolerated by patients with severe COPD symptoms.

1. Identify the dominant pain mechanism: either nociceptive, neuropathic, nociplastic, or inflammatory

2. Identify the most likely source (i.e. tissue) in which the mechanism is in operation (e.g. bone, muscle, viscera, nerve, ligament, etc.)

3. Identify the most likely cause that has triggered this mechanism in this tissue (e.g. bone fracture, muscle tear, malignancy, nerve compression, ligament rupture, etc.)

4. Base your intervention upon the above – ideally, this would (be a referral to) reverse or remove the cause, but often this is not possible, or too risky, and we have to try to resolve the problem through other means

As you know, we incorporate the following:

Clinical history – no problem in the home

Observation – no problem

Active movements – no problem

Palpation – no problem

Passive movements – possible , if the patient can lie down. However, passive movement are not fundamental to LBP assessment.

Special tests – Power and sensory testing (e.g. peripheral nerves, myotomes, dermatomes, tendon reflexes) can all be assessed either in sitting or supine (on the couch); some neurodynamic testing is also possible (slump test in sitting, straight leg raising lying supine on a couch, etc.).

MARK THE AREA AND REPEAT THE SAME LENGTH FOR THE ENTIRE PERIOD TO MEASURE THE DISTANCE.

Most often you don't in real life. But since there are only 4 people ask them to settle them in.

MS IS NOT INCLUDED EVEN THOUGH IT WAS TAUGHT. BUT RA WAS TAUGHT AND IT WILL BE INCLUDED.

CHRONIC PAIN INCLUDES RA. I BELIEVE YOU WERE TAUGHT RA. HENCE IN THE SESSIONS WE DISCUSSED INCLUDING THIS AND THE EXAM GUIDELINES WERE UPDATED. HENCE RA IS INCLUDED IN THE EXAM.

1) Cardio-respiratory exercises can include ACBT, Other breathing exercise, positioning and breathing - respond to the case study as set

2) Aerobic/ endurance - yes please look at the examples provided form the Trusts that are posted in Canvas - just make the prescription (FITT) case appropriate.

3) TUG and similar tests yes as reliable and valid outcome measures measures

2) Patient centred goal setting

3) Exercise management and prescription, implementation and supervision for independent activity outside of a class

4) Physio and Patient self monitoring

5) Wider support and services / other professionals

6) Plan for review, on-line, hybrid, face to face ?

7)P/S and Wellbeing - work within scope (find out about support, social engagement, personal responses to their illness and disease burden - emotional and psychological needs - key in COPD and MI

This is one of the model exam scenario on Canvas.

Question: ***** For mobility exercises, other than stretching or ROM exercises, can sit-to-stand or side-stepping be considered as mobility exercises to help this patient return to walking, or are these categorised as strengthening exercises, for which I will get no mark when doing these in a mobility ex. question?