Transcript
INSTRUCTIONAL DESIGN
---------------------------------------------------------------------------------------------------------------------------------------------------------Topic Description Assessment and Evaluation of Acute Ankle Sprain Assessment and evaluation of acute ankle sprain is a 2-hour lecture and laboratory that comprised of basic principles of anatomy including osteology, arthrokinematics and biomechanics of ankle and foot and identification and pathophysiology of ankle sprain. This topic will also remind the PT volunteers on how to evaluate and assess ankle sprain through signs and symptoms; grading of tenderness; grading of severity of ankle sprain; ROM, MMT and Special Test; medical/surgical management; and diagnostic procedure and differential diagnosis in ankle sprain. This topic will also help to remind the PT volunteers how to perform proper treatment and management of acute, subacute and chronic ankle sprain.
Needs Assessment: Contextual Analysis Learner’s Description
The PT volunteers are expected to have prior knowledge on the basic principles of anatomy and pathophysiology of ankle sprain, evaluation and assessment of ankle sprain, and treatment and management of acute, subacute and chronic ankle sprain. Learning Styles The PT volunteers were assessed using the Gregorc Style Indicator and the results showed that the 4 PT volunteers were Concrete Sequential type of learners. To them, reality consists of what they can detect through their physical sense of sight, touch, taste and smell. They notice and recall details easily and remember facts, specific information, sequence and rules with ease. Hands on is a good way for them to learn and remember facts easily. Learner’s Environment The lecture and laboratory will be held in an air-conditioned room equipped with all the necessary treatment modalities and materials to assist and stimulate learning. At the end of the topic, the PT volunteers will be able to: Cognitive Objectives:
1.Review the anatomical background of ankle and foot. 2.Describe the osteology, arthrokinematics and biokinematics of ankle and foot. 3.List the different etiology and mechanism of injury of ankle sprain. 4.Cite the different pathological background of acute, subactue and chronic inflammation and healing process 5.Cite the different epidemiological background of acute ankle sprain 6.List the different sign and symptoms of acute ankle sprain 7.Review the different grading of tenderness 8.Review the different assessment methods of ROM and MMT on ankle joint 9.Cite the different Special test on ankle sprain 10.Describe the different Diagnostic procedure and differential diagnosis on ankle sprain 11.Discuss the different medical and surgical management in ankle sprain
12.Arrange the different possible problem list of patient with ankle sprain 13.Arrange the short term goals and long term of patient with acute ankle sprain 14.Formulate the appropriate treatment plan for the patient using different physical modalities and therapeutic exercises on patient
with acute ankle sprain. Affective Objectives:
1.Discuss the different stages of inflammation and ankle sprain 2.Discuss the different grading of severity of ankle sprain
Psychomotor Objective:
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Construct different home exercise program for the patient with acute ankle sprain with provided handouts Observe proper handling and sensitivity to patient needs Promote proper communication to motivate patients for home exercise program given
Objectives cal background of ankle and foot
Content ground of ankle and Foot
Learning Strategies
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Time Allotment
Evaluation
· Review the anatomi- Anatomical back-
· Describe the osteolo- Kinesiology and
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gy , Biokinematics Biomechanics of ankle and arthrokinematicsand Foot of ankle and foot
· List the different etiol- Identification and
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ogy and mechanism pathophysiology of anof injury of ankle kle and Foot sprain · Cite the different Pathological background of acute,subactue and chronic inflammation and healing process · Discuss the different stages of inflammation and ankle sprain
· Cite the different epi- Epidemiology of Ankle
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demiological back- Sprain ground of acute ankle sprain
· List the different sign ·
and symptoms of acute ankle sprain · Review the different · grading of tenderness. · · Discuss the different grading of severity of ankle sprain · Review the different assessment methods of ROM and MMT on ankle joint · Cite the different Special test on ankle sprain
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Evaluation and Assessment of Ankle Sprain ROM and MMT of ankle joint Special test of ankle and foot
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· Describe the different Diagnostic and Differ-
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Diagnostic proce- ential diagnosis of dure and differential acute ankle sprain diagnosis on ankle sprain
· Discuss the different
· Medical Treatment
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medical and surgical and Management management in anof Acute ankle kle sprain sprain · Arrange the different · Construction of possible problem list Long term Goal of patient with ankle and Short term in sprain accordance to the · Arrange the short term prioritization of goals and long term problem list of patient with acute ankle sprain
· Formulate the appro-
· Different superficial
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priate treatment plan heating and for the patient using cryotherapy in difdifferent physical ferent phases of inmodalities and therflammation apeutic exercises on · Prescription writing patient with acute ankle sprain.
· Construct different
· Home exercise Pro-
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home exercise program for the patient with acute ankle sprain · Observe proper handling and sensitivity to patient needs · Promote proper communication to motivate patients for home exercise program given
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INSTRUCTIONAL DESIGN ( HANDOUT FOR ANKLE SPRAIN)
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ANATOMY OF THE ANKLE JOINT Bones and Joints of the ankle The ankle is made up of 4 distinct bones, the tibia, fibula, talus and calcaneus. The interaction between these bones allows for movement of the joint in certain planes. In turn, the ankle is made up of 3 separate joints: Talocrural Joint: This is a hinge joint formed by the distal ends of the fibula and tibula that enclose the upper surface of the talus. It allows for both dorsiflexion (decreasing the angle between the foot and the shin) and plantarflexion (increasing the angle). 2. Inferior tibiofibular Joint: This is strong joint between the lower surfaces of the tibia and fibula. This is supported by the inferior tibiofibular ligament. 3. Subtalar Joint: This joint comprises of the articulating surfaces of the talus and the calcaneus. It provides shock absorption and the movements of inversion and eversion (inward and outward ankle movements respectively) occur here. Ligaments of the ankle joint
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The ligaments of the ankle joint are comprised mainly of the collateral ligaments, both medial (inner) and lateral (outer). These are extremely important in the stability of the ankle itself: A. Lateral Collateral Ligament: The lateral collateral ligament prevents excessive inversion. It is considerably weaker than the larger medial ligament and thus sprains to the lateral ligament are much more common. It is made up of 3 individual bands:
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Anterior talofibular ligament (AFTL): passes from the fibula to the front of the talus bone. Calcaneofibular ligament (CFL)- connects the calcaneus and the fibula Posterior talofibular Ligament (PTFL)- passes from the back of the fibula to the rear surface of the calcaneus.
B. Medial Collateral Ligament: The medial ligament also known as the deltoid ligament is considerably thicker than the lateral ligament and spreads out in a fan shape to cover the distal (bottom) end of the tibia and the inner surfaces of the talus, navicular, and calcaneus
ANKLE SPRAIN
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A Sprain is an Overstretching or Tearing of a Ligament. 85% of all ankle injuries are lateral sprains, which are caused by rolling the foot inward. This stretches or tears the ligaments that hold the ankle and foot bones together and can lead to instability and re-injury.
IMPORTANCE IN REHABILITATION · Spraining an ankle can increase your risk of re-injury as much as 40-70%. Mismanagement may result in long-term disability, but proper post-injury care, rehabilitation exercises and bracing can decrease this risk. The information below can help you prevent re-injury. TO SPEED UP RECOVERY
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Immediately Begin Using P R-I-C-E o Protection – Your ankle may be splinted, taped, or braced to prevent re-injury. o Rest – You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping. o Ice - Place a plastic bag with ice on the ankle for 20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications. o Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wrap tighter around foot, and loosen as you go up ankle and calf. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold. o Elevation – Make sure to elevate the ankle above heart level as much as possible (hip level is acceptable during class).
TO RESTORE RANGE OF MOTION · Recommendation: Begin stretches and exercises listed here until your appointment with the physical therapist or athletic trainer. If pain worsens from doing them, then stop the exercises. · Ankle circles · Move your ankle in circles one direction, then the other.
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Perform 10 reps, 3-4 times per day, progressing until motion is equal in both ankles. Stretching with overpressure In a seated position, point foot downward, upward, and to both sides, adding a gentle overpressure with your hand to increase the stretch. Perform 3-4 times per day, until motion is equal in both ankles.
Range of Motion and MMT of ankle and Foot TO REGAIN CALF FLEXIBILITY · Initially after an ankle sprain, it is difficult to bend the ankle backwards, or dorsiflex. This makes it difficult to walk without limping or to go down stairs. Frequently one will rotate the injured foot outward as you step forward. · The following exercise will be helpful in regaining the upwards ankle movement. · Hold the stretch initially for 10-15 seconds, progressing to 30 seconds in a gentle pain-free stretch, for 2-3 sets, 2-3 times per day. Do not bounce! · As bearing weight on the injured foot becomes easier, then the stretches below will be helpful in regaining the lost motion upwards. To stretch the gastrocnemiusmuscle: · Place the injured foot behind the other with your injured foot pointing forward.
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Keep your heels down and back leg straight. Slowly bend your front knee until you feel the calf stretch in the back leg. To stretch the soleus muscle: Place the injured foot behind the other with your foot pointing forward. Keeping your heels down, slowly bend your back knee until you feel a heel stretch in the back leg.
TO REGAIN STRENGTH · Strong leg muscles help stabilize the ankle and help prevent future injuries. · Frequency: 3 sets of 10 repetitions, 5-7 days per week · Tie the ends of an exercise band and shut in a door, or tie to a dresser. · Sit with your legs out in front of you, facing the door/ dresser and loop the band over the top of your foot. · Pull your foot up toward you, against the band. · With the band still in place, sit parallel to door/dresser and loop the band over the inside of your foot.
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Pull your foot inward against the band. Do NOT rotate entire leg inward, only the ankle. ankle_sprain With the band still in place, sit parallel with the door/dresser on your other side and loop the band over the outside of your foot. Pull your foot outward against the band. Hold onto the end of the band with your hands and loop the band around the bottom of your foot. With leg out in front of you, push foot downward against the band.
TO REGAIN BALANCE · It has been found that people with poor balance have 2-3 times the number of ankle injuries compared to those with good balance. Therefore, balance exercises are great for injury prevention! · If you are able to stand on one leg without pain, then begin by simply standing on the leg with the injured ankle with no support. Progress to a 30 second hold. The next challenge is to stand on a pillow for 30 seconds. Standing on a couch cushion, or two pillows is the next progression
This is not a comprehensive reconditioning program, but will get you on your way to recovery. If you are not progressing steadily, contact your health care provider. References · “Ankle Instability,” Sports Medicine & Arthroscopy Review; 2009; Vol. 17(2); p139-145 · “Relationship Between Balance Ability, Training and Sports Injury Risk,” Sports Med; 2007; 37(6); p547-556
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