How To Ace Your CMTO OSCE Exam: Assessment 2

 This station is a long one, so be mindful of time as you only have 10 minutes to complete all tasks and give your clinical impression.

Introduction

Therapist: "Normally, I would do this assessment on both sides of your body, but for the sake of this exam, I will only check one side. You may feel some pain, but please let me know if it's too much, and I will adjust or stop the assessment. You can also ask me to stop at any time."

Steps in a Pain Assessment

1. Posture Test

   • What it is: Checking your body’s alignment and posture.
   • Why it’s done: To see if there are any imbalances or misalignments.

2. Gait Test

   • What it is: Observing the way you walk.
   • Why it’s done: To identify any abnormalities in your walking pattern.

*Don't spend a lot of time assessing these two unless it's absolutely necessary to do so.

1. Active Free Range of Motion (ROM) of Affected Joint

   • What it is: You move the joint on your own.
   • Why it’s done: To see how much movement you have and where it hurts.

2. Passive Relaxed ROM of Affected Joint

   • What it is: The therapist moves the joint for the client.
   • Why it’s done: To check the joint’s range without your muscles working.

3. Active Resisted ROM

   • What it is: Client moves their joint while the therapist provides resistance.
   • Why it’s done: To test the strength and pain response of the muscles.

1. Palpate 4 T’s: Texture, Temperature, Tone, Tenderness

   • What it is: Feeling the area for texture, temperature, muscle tone, and tenderness.
   • Why it’s done: To gather information about the condition of the tissues.

2. Myotomes

   • What it is: Region of the muscle innervated by a single nerve root
   • Why it’s done: To check if the nerves controlling these muscles are working properly.
   • Example: "I will ask you to push against my hand to test your muscle strength."

3. Dermatomes

   • What it is: Region of the skin supplied by specific spinal nerves.
   • Why it’s done: To see if there are any changes in sensation.
   • Example: "I will lightly touch different areas of your skin to check for normal sensation."

4. Deep Tendon Reflex Testing

   • What it is: Using a small hammer to tap on tendons.
   • Why it’s done: To check your reflexes and nerve function.
   • Example: "I will gently tap below your knee to check your reflex response."

5. Special Orthopedic Tests Above & Below Joints

   • What it is: Performing specific tests on the joints above and below the affected area.
   • Why it’s done: To ensure other joints are not contributing to the problem.
   • Example: "I will perform a few tests on your hip and ankle to see if they are affecting your knee pain."

6. Special Orthopedic Tests on the Affected Joint

   • What it is: Performing several tests on the joint in question.
   • Why it’s done: To assess the exact issue.
   • Example: "I will perform a series of tests on your knee to pinpoint the problem."

Conclusion

Therapist: "My clinical impression is that you may have _________. This assessment helps us understand your condition better and plan the right treatment for you."

Analogies for Myotomes and Dermatomes

• Myotomes: Think of myotomes like testing the strength of different branches of a tree (your nerves) to ensure they’re all strong and healthy.
• Dermatomes: Imagine dermatomes as checking the sensitivity of different parts of a blanket (your skin) to make sure it feels the same everywhere.