DHA Physiotherapist cheat sheet

Subjective examination (history, symptom behaviour, red flags) precedes objective testing; irritability, nature and stage guide test selection.

Active range of motion is assessed before passive; capsular pattern suggests whole-joint restriction, non-capsular pattern suggests localized structure.

Muscle strength graded 0-5 (Oxford scale): 3 = antigravity full range, 5 = normal against maximal resistance.

Reflex grading 0-4+: 2+ is normal; sustained clonus and Babinski sign indicate upper motor neuron involvement.

Sensation tested by dermatome for light touch and pinprick; vibration and proprioception for dorsal column integrity.

Special tests have limited value in isolation; a positive test combined with concordant history raises post-test probability.

Outcome measures (e.g., numeric pain rating, region-specific function scales) recorded at baseline and discharge for objective comparison.

Informed consent is obtained before assessment; chaperone offered for intimate or sensitive examination.

Ottawa ankle rules: radiography indicated if pain in malleolar zone plus bone tenderness or inability to bear weight four steps.

Cauda equina red flags: saddle anaesthesia, bladder or bowel dysfunction, bilateral leg weakness require urgent referral.

Cyriax capsular patterns: shoulder external rotation most limited; hip internal rotation and extension most limited.

Rotator cuff tendinopathy managed with progressive loading; complete acute tears with pseudoparalysis warrant surgical referral.

Tissue healing phases: inflammation (0-7 days), proliferation (up to ~6 weeks), remodelling (months); loading progressed accordingly.

Anterior cruciate ligament: Lachman test most sensitive; pivot shift most specific.

Mechanical low back pain: directional preference testing (McKenzie) guides exercise direction; centralization indicates favourable prognosis.

Fracture signs: point tenderness, deformity, crepitus, inability to weight-bear - immobilize and refer for imaging.

Upper motor neuron lesion: hyperreflexia, spasticity, positive Babinski, clonus; lower motor neuron: flaccidity, atrophy, fasciculation, areflexia.

Stroke: thrombolysis window typically up to 4.5 hours; early mobilization within 24-48 hours when medically stable.

Modified Ashworth Scale grades 0-4 for spasticity; grade 1+ indicates catch then minimal resistance through remaining range.

Rancho Los Amigos levels I-VIII describe recovery of consciousness and cognition after traumatic brain injury.

Berg Balance Scale score below 45 predicts increased fall risk; 41-56 indicates independent balance.

Guillain-Barre syndrome: ascending flaccid weakness, areflexia, albuminocytologic dissociation; monitor vital capacity for respiratory decline.

Multiple sclerosis: fatigue management, cooling strategies, and interval training preferred over continuous high-load exercise.

Parkinson disease: amplitude-based gait training (cueing, big steps) targets bradykinesia and freezing of gait.

Normal resting values: respiratory rate 12-20/min, tidal volume ~500 mL, SpO2 94-100% on room air.

Borg 6-20 scale rates perceived exertion; target 12-14 (moderate) for stable cardiac rehabilitation.

6-minute walk test: record distance, SpO2, heart rate, dyspnea; a fall in SpO2 below 88% is a stopping criterion.

Active cycle of breathing technique: breathing control, thoracic expansion exercises, forced expiration technique.

Postural drainage positions are matched to lung segments; avoid head-down tilt in raised intracranial pressure or uncontrolled hypertension.

Incentive spirometry targets sustained maximal inspiration to prevent atelectasis postoperatively.

Cardiac rehabilitation phases: inpatient (phase I), outpatient (II), maintenance (III); exercise prescribed from a symptom-limited test.

Signs to terminate exercise: chest pain, dizziness, SpO2 drop below 85-88%, arrhythmia, disproportionate dyspnea.

Gross motor milestones: head control ~3 months, sitting ~6 months, walking ~12-15 months; variation within ranges is normal.

Apgar score assessed at 1 and 5 minutes (activity, pulse, grimace, appearance, respiration); not a predictor of long-term outcome alone.

Cerebral palsy classified by GMFCS levels I-V; tone types include spastic, dyskinetic, ataxic, and mixed.

Infant reflexes: Moro and palmar grasp present at birth, integrate by ~4-6 months; persistence suggests neurological concern.

Geriatric falls: timed up-and-go over 12 seconds indicates increased fall risk; multifactorial assessment recommended.

Sarcopenia managed with progressive resistance training plus adequate protein intake; screen grip strength and gait speed.

Osteoporosis: avoid spinal flexion with loading and high-impact exercise in severe disease; weight-bearing exercise preserves bone.

Polypharmacy in older adults increases fall and orthostatic hypotension risk; review medications before exercise prescription.

TENS: conventional high frequency (80-120 Hz, short pulse) for pain gating; low frequency (2-4 Hz) for endorphin release.

Ultrasound: continuous mode for thermal effect, pulsed for non-thermal; avoid over epiphyses, malignancy, pacemaker, or pregnant uterus.

Therapeutic ultrasound dose typically 0.5-3 W/cm2; intensity reduced over bony prominences and acute inflammation.

Cryotherapy reduces inflammation and pain; contraindicated in cold hypersensitivity, Raynaud phenomenon, and impaired sensation.

Shortwave diathermy contraindicated with metal implants in the field, pacemakers, and over growing epiphyses.

Interferential current uses two medium-frequency currents producing a low-frequency beat; avoid across the thorax in cardiac disease.

Laser therapy dose measured in joules; eye protection mandatory; avoid over malignancy and photosensitive tissue.

Electrical stimulation for muscle re-education uses motor-level intensity producing visible contraction without excessive pain.

Informed consent requires capacity, disclosure of risks and benefits, and voluntariness; documented before intervention.

Confidentiality: information shared only with consent or legal mandate; minimum necessary disclosure principle applies.

Infection control: hand hygiene is the single most effective measure; standard precautions apply to all patients.

Manual handling: use hoists and equipment; avoid lifting loads beyond safe limits; assess patient before transfer.

Incident reporting is mandatory for adverse events and near misses; reports are non-punitive and support system improvement.

Scope of practice: refer or escalate when presentation exceeds competence or requires medical diagnosis.

Documentation must be contemporaneous, objective, signed, and retained per local regulation.

Boundary and dual-relationship awareness: declare conflicts of interest; avoid treating family in a professional capacity where avoidable.

Vital sign screening before exercise: resting heart rate, blood pressure, respiratory rate, temperature, SpO2.

Cardiac red flags: crushing chest pain, syncope, unexplained dyspnea - stop and escalate immediately.

Neurological screening: myotomes, dermatomes, deep tendon reflexes, and upper motor neuron signs when symptoms suggest central involvement.

Vascular screening: check pulses, capillary refill, and calf pain pattern for deep vein thrombosis before mobilization.

Oncologic red flags: unexplained weight loss, night pain unrelieved by rest, history of cancer - refer for medical review.

Inflammatory arthropathy features: morning stiffness over 30-60 minutes, improvement with activity, systemic symptoms.

Outcome measure selection should match the patient's condition, be validated, and be repeatable for progress tracking.

Reassessment frequency is set by clinical change and risk; document objective change at each review.