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While exercising on a treadmill a patient reports a rate of perceived exertion of 15 on the 6 – 20 Borg RPE Scale. Assuming the patient’s response appropriately reflects their effort, which of the following correctly estimates their expected hear rate and perceived level of work?

Explain how data results from this test should be used by the PT to determine the client’s level of fitness / aerobic capacity and predict their ability to tolerate activity. (1.5pt)

Questions #51.   The patient case is repeated here for your convenience Mary is a 55-year-old female with CC of 3-month history of left sided neck and central – left upper back/scapula pain. SH: married with twin 10 year old children; she is trained as a research lab. technician but is currently a homemaker. CLOF: Mary reports she is having a “hard time keeping with her husband and children” and increasing difficulty managing her home. Even minor activities such as reaching to upper cabinets/closets, lifting and carrying groceries or laundry result in significant pain. As a result she has been very sedentary lately and feels that she fatigues easily. PLOF: Independent in all BADLs and IADLs, worked full time  PMH:  hypercholestemia (210mg/dL) SH: current smoker – 1 pack per day x 35 years MEDS: takes Tylenol for current pain; started taking over the counter allergy medicine, Zyrtec, by mouth 3 weeks ago because of recent nasal congestion and cough. She is self referred to PT with goals to decrease pain, return to regular activities and exercise, and to feel good enough to be able to start part-time work. PHYSICAL EXAMINATION: Posture and Observation: Posterior pelvic tilt, increased thoracic kyphosis, Mod forward head, C – spine in L side bend.   Height:  1.75 meters  (69 in)    Weight: 55 kg  (121 lbs)       BMI: 18.28 VSs at rest: HR 84 bpm, reg ;  RR 22,  upper chest breathing pattern  BP  120/75 Active Range of Motion: Cervical spine: flexion 0 to 30 degrees; extension 0 to 25 degrees; rotation (R) 0 to 40 degrees, (L) 0 to 15 degrees; sidebending (R) 0 to 30 degrees, (L) 0 to 20 degrees MMT Strength Testing: Upper trapezius (B) 5/5; middle trapezius (R) 3/5, (L) 2/5; lower trapezius (B) 2/5; sternocleidomastoid (B) 2/5; trunk curl 3/5; bilat leg lowering (abdominals)  2/5; Palpation: Tender to light pressure in suboccipital region, medial upper and mid trapezius, SCM origin & insertion L > R Function: sitting tol. 20 mins, standing tol. 15 mins, can lift 5lbs from knee to waist and waist to shoulder level with mild increase in discomfort; unable to lift heavier loads due to significant increase in pain, unable to lift loads from floor level, unable to reach/lift overhead due to pain.  Amb. independently indoor and outdoors w/o assistive device, up to ½ mile on level surfaces with reports of fatigue and increased discomfort/pain; Amb. elevations independently w/o AD but uses 1 rail on stairs for stability.   Question #51 Write a participation level LTG for this patient including all required elements. (1)  

You advise the 59 yo patient in the previous question to make an appointment with their primary care physician to discuss their concerns.  What is your most appropriate next step for this patient?

Mary is a 55-year-old female with CC of 3-month history of left sided neck and central – left upper back/scapula pain. SH: married with twin 10 year old children; she is trained as a research lab. technician but is currently a homemaker. CLOF: Mary reports she is having a “hard time keeping with her husband and children” and increasing difficulty managing her home. Even minor activities such as reaching to upper cabinets/closets, lifting and carrying groceries or laundry result in significant pain. As a result she has been very sedentary lately and feels that she fatigues easily. PLOF: Independent in all BADLs and IADLs, worked full time  PMH:  hypercholestemia (210mg/dL) SH: current smoker – 1 pack per day x 35 years MEDS: takes Tylenol for current pain; started taking over the counter allergy medicine, Zyrtec, by mouth 3 weeks ago because of recent nasal congestion and cough. She is self referred to PT with goals to decrease pain, return to regular activities and exercise, and to feel good enough to be able to start part-time work. PHYSICAL EXAMINATION: Posture and Observation: Posterior pelvic tilt, increased thoracic kyphosis, Mod forward head, C – spine in L side bend.   Height:  1.75 meters  (69 in)    Weight: 55 kg  (121 lbs)       BMI: 18.28 VSs at rest: HR 84 bpm, reg ;  RR 22,  upper chest breathing pattern  BP  120/75 Active Range of Motion: Cervical spine: flexion 0 to 30 degrees; extension 0 to 25 degrees; rotation (R) 0 to 40 degrees, (L) 0 to 15 degrees; sidebending (R) 0 to 30 degrees, (L) 0 to 20 degrees MMT Strength Testing: Upper trapezius (B) 5/5; middle trapezius (R) 3/5, (L) 2/5; lower trapezius (B) 2/5; sternocleidomastoid (B) 2/5; trunk curl 3/5; bilat leg lowering (abdominals)  2/5; Palpation: Tender to light pressure in suboccipital region, medial upper and mid trapezius, SCM origin & insertion L > R Function: sitting tol. 20 mins, standing tol. 15 mins, can lift 5lbs from knee to waist and waist to shoulder level with mild increase in discomfort; unable to lift heavier loads due to significant increase in pain, unable to lift loads from floor level, unable to reach/lift overhead due to pain.  Amb. independently indoor and outdoors w/o assistive device, up to ½ mile on level surfaces with reports of fatigue and increased discomfort/pain; Amb. elevations independently w/o AD but uses 1 rail on stairs for stability.     Question 39  List 4 KEY follow up (FUP) questions/topics that should be asked of this patient within the Review of Systems and screening for referral process.  These questions should help guide the PT in deciding whether PT and/or referal is approprriate. (2 pts)

Question 41 Having cleared any concerns you may have regarding the patient’s medical status, you wish to examine her aerobic capacity. Given what you know about this patient, state which test of aerobic capacity is best suited to use for her and explain your rationale for selecting this test rather than some of the alternatives. (1pt)

Your 55 year old patient reports that they walk at a comfortable pace 3 x/week for 30 minutes and lifts weights x2/week at their local gym. Does this patient’s activity level meet the ACSM recommended guidelines for physical activity?

A patient presents with c/o pain in R. knee during ambulation. Exam findings: R. knee AROM is decreased and painful; PROM is normal with “stretch like discomfort pain” at end range of Flex; Isometric testing of knee Ext reproduces pain. Given these findings, which of the following statements is the MOST appropriate clinical deduction regarding the likely source of this patient’s pain?

Data collected from a 25 yo patient includes the following findings:  Steps per day: 2500 ;  BMI 32. Which one of the following patient descriptions best fits this profile?

List 3 activity limitations in this patient  (1.5 pts)