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[Music]
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good day sir i'm your student nurse mara
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mark vegas from bsn1c
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and this is my video presentation the
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third demonstration in assessing the
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musculoskeletal system of my patient the
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purpose of this assessment is to
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establish baseline data for subsequent
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evaluation for the equipment that we
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will be using for the assessment we will
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be using agoniometer and a tape measure
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for the performance prior to performing
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the procedure
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introduce yourself and verify the
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client's identity using the agency
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protocol
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explain to the client what you are going
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to do why it is necessary and how he or
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she can participate
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discuss how the result will be used in
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planning further care or treatments
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okay good afternoon mom i am barbara
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marquez and i will be your nurse for
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today may i know about your full name
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mom
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my name
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is your birthday
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1968 your age i'm 52
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okay so the procedure that i will be
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doing mom is that i am going to check
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and observe your muscles your bones and
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your joints so this is done for us to
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know if there is any abnormalities that
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is present to your musculoskeletal
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system would that be okay with you sure
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perform hand hygiene and observe
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appropriate infection control procedure
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and provide for a client privacy
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okay all the doors and all the parties
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mom are now closed to ensure your
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privacy okay
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inquire if the client has any history of
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the following such as a muscle pain
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the onset
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the location the character the
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associated phenomena for example the
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redness and the swelling of joints
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the aggravating and elevating factors
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the limitations of movement or inability
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to perform activities of a daily living
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previous sports injuries and loss of
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function without pain came on so i'm
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going to ask you questions and i promise
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that all information that i've gotten
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from you will remain confidential okay
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sure okay so do you feel pain or
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stiffness into your arms into your back
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and to your thighs
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no
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okay so can you walk up and down stairs
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without any difficulties
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yes
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okay so can you dress yourself in
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everyday clothes without any
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difficulties mom yes
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okay
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so in a few minutes now we're going to
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start okay sure
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so let's now proceed to assessing the
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muscles of my patient
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so first we need to inspect for the
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muscle size
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compare the muscles on the other side of
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the body
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the arms thighs and calf to the same
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muscles on the other side okay so i'm
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going to inspect your muscles for size
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[Music]
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can you stand up for me mom
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[Music]
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okay so you have an equal size on both
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sides of your body which is actually
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normal
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for any discrepancies measure the
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muscles with the tape inspect the
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muscles and tendons for contractures
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okay mom next i am going to inspect the
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muscles for contractors
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[Music]
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[Music]
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okay so i don't see any contracture
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small
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okay inspect the muscles for tremors for
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example by having the client to hold the
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arms out in front of the body okay mom
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so i'm going to inspect the muscles for
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tremors so i want you to do this
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[Music]
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so
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there is no shaking
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no concentrations
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and
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no tremors
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okay test muscle strength compare the
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right side with the left side for this
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sternocleidomastoid
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the client turns the head onto one side
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against the resistance of your hand
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repeat with the other side okay mom the
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next that i am going to do is that i am
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going to test your muscle strength so
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the muscle strength should be equal
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bilaterally and fully resist your
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opposing force okay
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okay so can you sit for me mom
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[Music]
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okay thank you okay mom so the first
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that i am going to check is your stereo
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play domastoid so i want you to look at
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your right
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look at your left
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move up
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and look down
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okay so we can also have them to do that
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against resistance
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[Music]
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okay very good
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for the trophies use the client shrugs
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the shoulders against the resistance of
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your hands pokemon for your trapezius
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can you shrug your shoulder for me
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okay
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[Music]
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okay thank you
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for the deltoid the client holds arm up
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and dresses while you try to push it
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down okay mom can you please raise your
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arms
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okay
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[Music]
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for the biceps the client fully extend
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each arms and tries to flex it while you
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attempt to hold arms in extension okay
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mom next i am going to check for your
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biceps so can you stand up for me
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okay so i am going to attempt to hold
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your arms in extension okay so then you
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watch your arm
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[Music]
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okay i'll go over the other side
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for the triceps the client flexes each
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arm and then tries to extend it
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against your attempt to keep arm in
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flexion
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okay next mom is for your triceps so i'm
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going to keep your arm in flexion so can
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you flex your arm again for me mom
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okay
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yeah i go over the other side lecture
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arm
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[Music]
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okay
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for the wrist and finger muscles the
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client spreads the fingers
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and resists as you attempt to push your
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fingers together
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okay next mom is for your wrist and your
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finger muscles so can you spread your
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fingers for me
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e
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for your mom
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[Music]
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okay very good for the grip strength the
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client grasp your index and your middle
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finger
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while you try to pull the fingers out
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okay mom you may now see it
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okay so for your grip strength mom i
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want you to grasp my index and my middle
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finger while i'm trying to pull the
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fingers out okay
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[Music]
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okay the other side
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[Music]
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for the hip muscles
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the client is supine
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both legs extended
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the client raises one leg at a time
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while you attempt to hold it down okay
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mom next is for your hip muscles so i
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want you to lay down for me
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okay mom can you raise your one leg and
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i'm going to attempt to hold it down
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okay
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[Music]
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i'll go over the other side
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can you raise your leg
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for the hip abduction the client is
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supine
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both legs extend them
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place your hands on the lateral surface
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of each knee and then decline express
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the legs apart against your resistance
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okay mom next is for your hip abduction
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so i'm going to place my hands
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on the lateral surface of each knee and
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you're going to spread your legs against
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my resistance okay
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so try to spread your legs mom
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[Music]
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okay at the other side
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try to spread
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[Music]
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for the hip abduction the client is in
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the same position as for the hip
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abduction
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place your hands between the knees and
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then the client bring the legs together
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against your resistance
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okay next mom is for your hip adduction
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so i'm going to place my hands between
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your knees
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and you're going to bring your legs
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together against my resistance okay okay
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okay try to bring it together
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[Music]
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here the other side
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for the hamstring the client is supine
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both knees bent
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the client resist while you attempt to
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straighten the legs
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okay mom next is for your hamstring so
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can you bend your knees for me
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okay so i'm going to attempt to
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straighten your legs okay okay
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[Music]
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for the quad triceps the client is
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supine
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knee partially extended and the client
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will resist while you attempt to flex
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the knees okay mom so for your
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quadriceps i want you to extend your
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knees for me
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okay so i am going to attempt to flex
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your knees okay
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[Music]
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okay
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for the muscles of ankles and foot
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the client resists when you attempt to
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dorsiflex the foot
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and again resist when you attempt to
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flex the foot
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okay next mom is for the muscles of your
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ankles and feet
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okay
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the other side
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okay
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[Music]
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okay
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so let's reproceed in assessing the
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bones of my patient so first we need to
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inspect this skeleton for structure
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okay mom next is that i'm going to
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inspect your skeletons for structures so
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can you sit for me mom
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[Music]
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okay
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[Music]
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okay so can you stand up for me
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okay so i can't see any deformities mom
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which is nice
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next is we have to palpate the bones to
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locate any areas of edema or tenderness
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okay mom next i am going to call picture
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bowls to locate any areas of edema or
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tenderness okay so i'm going to
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calculate and tell me if you feel
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anything okay
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okay
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[Music]
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do you feel pain or any tenderness
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[Music]
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[Music]
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okay so there's no swallowing and no
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tenderness
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okay mom next i am going to palpate to
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locate any areas of the edema okay
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okay
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so i'm going to calculate it
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[Music]
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okay and the other side
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[Music]
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[Music]
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let's now proceed in assessing the
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joints
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inspect the joints for swelling
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how to palpate each joint for tenderness
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smoothness of movement swelling
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gravitation and the presence of no juice
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okay next i am going to inspect and
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palpate your joists for any swelling
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tenderness proper taping or
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no juice okay
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[Music]
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so i can see any swelling your upper
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extremities
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and going down to your lower extremities
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okay
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no tenderness
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and no noodles
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and your joints move smoothly
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[Music]
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assess joint range of motion
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as declined to move
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selected body parts the amount of joint
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movement can be measured by a goniometer
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a device that can measure the angle of
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the joint in degrees okay mom next i am
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going to assess your joint ratio of
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motion so first your next range of
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motion so i want you to move your head
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at your right
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at your left
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loop up
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and down
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okay so can you move your head laterally
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on your left and to your right shoulders
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[Music]
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okay so for your rotation mom
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can you move your head as far as
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possible to your left and to your right
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[Music]
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okay mom so next is for your arm range
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of motion so what i want you to do mommy
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is follow what i do okay
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okay so can you stand up for me
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okay so can you lift your arms over your
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head
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and down
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[Music]
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at your side
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and put them behind your head
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and at your back
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at your shoulder
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same shoulder
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and bring your arms at your side
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bring your elbows back
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[Music]
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and keep your arms straight
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and back okay
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palms down
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palms up
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grease up
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wrist down
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spread your fingers
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and make a feast
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okay very good okay mom next is for your
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trunk range of motion so can you bend
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forward for me mom
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okay
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bend back
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okay very good so can you bend at your
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side
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okay the other side
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so for your trunk rotation mom can you
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move the upper part of your body to the
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other side
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[Music]
00:19:02
okay very good okay mom so the first
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thing that i am going to do is that i am
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going to lift your leg up
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and your knees towards your chest
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and bring back again to the bed
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okay so i'm going to do this three times
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okay
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okay one
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[Music]
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two
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three
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four
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three
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okay i'll go on the other side
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i'm going to
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leave and your knees towards your chest
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one
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two
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three
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three
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okay
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okay mom for the next one i am going to
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bring your leg out to the side and back
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in okay
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okay okay mom so i am going to do this
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three times okay
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okay
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two do you feel pain
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three
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okay i'll go over the other side
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one
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[Music]
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okay mom next i am going to roll your
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leg in and out okay
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okay i'm going to do this three times
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also
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okay so one
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two
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[Music]
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three
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okay the other side
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one
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two
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three
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okay mom
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next month for your uncle i am going to
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move your ankle
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up
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and down okay so i'm going to do this
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three times okay okay
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one
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[Music]
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two
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three
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okay the other side
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one
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two
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three
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okay
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okay mom for the next one i am going to
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turn your foot in and out okay
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so i'm going to do this three times
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okay
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okay
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one
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little bit
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three
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okay i'll go with the other side
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one
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two
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three
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okay okay mom for the last one i am
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going to twirl your ankle okay okay
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okay so i'm going to troll it three
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times
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one
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two
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[Music]
00:22:12
three
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okay on the other side
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one
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two
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[Music]
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three
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okay
00:22:28
now we can now document the findings of
00:22:31
the client's record using a form or
00:22:34
checklist supplemented by a narrative
00:22:36
report if appropriate for the evaluation
00:22:40
perform a detailed follow-up examination
00:22:43
on the other systems based on the
00:22:46
findings debated from the expected or
00:22:49
the normal to the client the late
00:22:51
defined based on the previous assessment
00:22:53
data if available
00:22:55
and last report the divisions from the
00:22:58
expected or the normal findings to the
00:23:01
primary care provider