Real NPTE: Memorize 7

Which of the following is the most appropriate technique to improve the flexibility of the hip flexors? 1) Active hip extension to end range, followed by isometric hip flexion. 2) Resisted hip extension using cuff weights, followed by active hip flexion. 3) Placing the patient in prone with pillows positioned under the abdomen. 4) Gentle, sustained passive hip extension.

1) This exercise requires the addition of active relaxation of the hip flexors and active or passive movement into hip extension to be effective. 2) This is a strengthening exercise, active movement of tight muscles does not activate a relaxation response, an isometric contraction is required. 3) Tight muscles need to be taken to their most lengthened position before maintaining the position. 4) Gentle, sustained passive hip extension is appropriate method of stretching tight tissues. In short = to lengthen shortened muscles they need to be placed in their most lengthened position, you need active relaxation of the muscle at some point and if resisting, isometric contractions are what you do.

Edema scale

1+ = indentation is barely detectable 2+ = slight indentation visible when skin is depressed, returns to normal in 15 seconds 3+ = deeper indentation when pressed and returns to normal within 30 seconds 4+ = indentation lasts for more than 30 seconds

DTR grading scale

0 = No response, absent 1+ = diminished response, low normal 2+ = Average, expected response, normal 3+ = Brisker than average, slightly hyperreflexic 4+ = very brisk/hyperactive w/ clonus (usually indicative of disease) (1+ to 3+ is considered normal)

Functional Independence Measure (FIM): scoring

1 = total assistance (patient performs less than 25% of effort) 2 = maximal assistance (patient performs 25% to 49% of effort) 3 = moderate assistance (patient performs 50 to 74% of effort) 4 = minimal assistance (patient performs greater than 75% of the effort) 5 = supervision (verbal cues, setup, standby) 6 = modified independent (requires assisted or adapted device) 7 = independent

A patient with a right transtibial amputation is referred for prosthetic gait training. Examination of gait reveals lateral trunk bending toward the right side during right midstance. The MOST likely cause of this problem is that the: 1. foot is too far medially inset. 2. socket is in excessive adduction. 3. foot is too far posteriorly set. 4. prosthesis is too short.

1. A prosthetic foot that is too far medially inset would cause the prosthetic foot to lean laterally. 2. A socket in excessive adduction would cause the prosthetic foot to lean medially. 3. A prosthetic foot that is too far posteriorly set would cause early heel rise. 4. A prosthesis that is too short would cause lateral trunk bending toward the ipsilateral side during midstance on that side.

Which of the following methods is BEST to assess a patient's passive range of motion of the shoulder? 1. The patient produces the movement by raising a cane with both upper extremities. 2. The patient produces the movement with assistance of the opposite upper extremity. 3. The physical therapist moves the extremity to the end of the available range. 4. The physical therapist moves the extremity beyond the tissue resistance.

1. Use of a cane and both upper limbs describes active assistive range of motion rather than passive (p. 52). 2. Producing the movement with assistance of the opposite upper extremity describes active assistive range of motion rather than passive (p. 52). 3. Passive range of motion is produced entirely by an external force. It should be performed within the available range. (p. 52) 4. Movement of an extremity beyond tissue resistance by the therapist is a stretching maneuver rather than a determination of the available passive range (p. 75).

A patient who is performing a vigorous treadmill test is MOST likely to have an immediate increase in which of the following physiologic responses? 1. Respiration rate to raise blood pH levels 2. Respiration rate to lower blood pH levels 3. Rate of excretion of hydrogen ions by the kidneys to raise blood pH levels 4. Rate of excretion of hydrogen ions by the kidneys to lower blood pH levels

1. Vigorous exercise produces lactic acid, which would lower the pH of blood unless compensatory mechanisms are in place. Increasing the rate of respiration reduces the alveolar partial pressure of arterial carbon dioxide (PaCO2), resulting in less acidity (higher pH) in the blood to prevent an imbalance. (p. 201) 2. Lactic acid pushes the blood ion concentration in the direction of becoming more acidic. The increase in respiration rate helps compensate by increasing blood alkalinity (higher pH). (p. 201) 3. As opposed to the respiratory system, the renal system is involved in more long-term acid-base balance maintenance. The respiratory system plays more of a role in acute responses. (p. 203) 4. As opposed to the respiratory system, the renal system is involved in more long-term acid-base balance maintenance. The respiratory system plays more of a role in acute responses. Lactic acid buildup during exercise leads to a lower pH. The kidneys would work to raise the pH back toward normal. (p. 203)

Run me through ligament sprain grading: end feels, pain, swelling, healing time, etc.

1st degree sprain (4-6 weeks) = localized pain, no swelling, no instability or laxity 2nd degree sprain (8-10 weeks) = pain, swelling, mild laxity but end feel present, decreased strength (because lack stability) 3rd degree sprain (longer, require some degree of immobilization or surgery) = pain (or not), swelling, significant laxity with no end feel

CTSIB: procedure and indication

6 conditions: Firm surface: eyes open (1), eyes closed (2), visual conflict shield (3) Foam surface: eyes open (4), eyes closed (5), visual conflict shield (6) 4, 5, and 6 challenge somatosensory system 2, 3, 5, and 6 challenge visual system 5 and 6 challenge vestibular system (because can't rely on vision or proprioception) Try to maintain each position for 30 seconds and measure the amount of sway (modified is the 4 conditions without the visual conflict shield)

Functional Reach Test: scoring, indication for fall risk

<6 = significant risk for falls 6-10 = moderate risk for falls

Gillette Test: position, procedure, what is a positive and what does it indicate

Articular restriction of SI joint Position = standing, therapist palpating PSIS and S2 Procedure = patient flexes PSIS side Positive = PSIS moves cranially (it should move caudally when you flex hip since the innominate should rotate posteriorly) Also called stork test (class notes)

Alar ligament test: position, procedure, what is a positive and what does it indicate

Assesses integrity of alar ligament Position = patient sitting with slight side bend Procedure = palpate sides of C2 SP and then rotate away Positive = there is more than 20 degrees of rotation and the SP does not move at all (should move contralaterally into finger if alar ligament intact)

Modified Sharp Purser Test: position, procedure, what is a positive and what does it indicate

Assesses integrity of atlantoaxial joint (the stabilizers of the dens on the atlas) Position = patient sitting with slight cervical forward bend Procedure = stabilize C2 and provide a posterior force on head Positive = myelopathic symptoms with forward bending, decreased symptoms with posterior force (because head is moving on atlas which it shouldn't do)

Transverse ligament test: position, procedure, what is a positive and what does it indicate

Assesses integrity of atlantoaxial joint (the stabilizers of the dens on the atlas- transverse ligament) Position = patient supine Procedure = Thumbs on anterior C2 and push towards table, fingers lift up on occiput (trying to shear AA joint) Positive = myelopathic symptoms with stress

Vitamin D: absorption and function

Absorption = found in very few foods but produced endogenously when UV rays strike the skin and trigger vitamin D synthesis Function = promote calcium absorption (normal bone mineralization and prevent hypokalemic tetany)

Duration of lumbar traction: Acute phase Maximum

Acute phase = 15 minutes for intermittent, 10 minutes for sustained Maximum = 30 minutes, unless you are in the subacute/chronic phase and the patient reports progressive improvement in symptoms (page 721)

CVA positioning: Compare sidelying on affected side vs. unaffected side

Affected side: Shoulder = protracted, flexed Elbow = extended Wrist = neutral Forearm = supinated Unaffected side: Shoulder = protracted, flexed (so lying on flat part of shoulder instead of shoulder blade) Elbow = extended Forearm = pronated

Standing Flexion Test: position, procedure, what is a positive and what does it indicate

Articular restriction of SI joint Position = standing with feet 12 inches apart with therapist palpating PSIS Procedure = Patient bends forward Positive = one PSIS moving further cranially than the other PSIS (page 111)

Compare anterior stress fracture and anterior shin splits: mechanism, pain location, pain characteristics, ankle mobility

Anterior stress fracture Mechanism = repetitive loading, overuse (jumping, running) Location = focal with point tenderness <5 cm in length Pain characteristics = pain present at rest (especially night) and with activity Ankle mobility = normal Anterior shin splits - issue with anterior tibialis Mechanism = repetitive loading, overuse (jumping, running) Location = non- focal with point tenderness >5 cm in length Pain characteristics = dull pain with stretching, and present at the end and beginning of the workout (but not inbetween) Ankle mobility = limited (because stretching is painful)

Nail clubbing: appearance, conditions associated

Appearance = bulbous enlargement of the ends Causes (CLUB) = Chron's or cardiac disease Lung cancer or other things that cause hypoxia Ulcerative colitiis Biliary cirrhosis

Onycholysis: appearance, conditions associated

Appearance = loosening of the nail plate from the distal edge onward Cause (SHORT) = often seen with trauma including overzealous manicures, repetitive nail tapping, nail picking Sarcoidosis Hyperthyroidism/Graves disease OCD Reactive arthritis Trauma

Koilonychia: appearance, conditions associated

Appearance = shape of a spoon, can be congenital and inherited Cause (STIR) = Syphilis Thyroid dysfunction Iron-deficiency anemia Rheumatic fever

Leukonychia: appearance, conditions associated

Appearance = whitening of the nail plate with bands, lines or white spots throughout Causes (CAMERA) = Cancer treatment Alcoholism Myocardial infarction Eating disorders Renal failure Anxiety

Sitting flexion Test: position, procedure, what is a positive and what does it indicate

Articular restriction of SI joint Position = seated with knees flexed to 90 degrees and feet on the floor, hips abducted so patient can lean forward Procedure = therapist palpates bilateral PSIS and has patient lean forward Positive = asymmetry in movement of PSIS (they should move equally) (page 111)

Compare these arrhythmias (what do they look like, what should you do): Atrial flutter Atrial fibrillation Ventricular fibrillation Ventricular tachycardia

Atrial flutter (saw tooth pattern, QRS complex normal) = new onset report to physician, not a medical emergency UNLESS accompanied by life threatening signs/symptoms (i.e. loss of consciousness) Atrial fibrillation (erratic quivering of atria, QRS complex normal) = new onset report to physician, not a medical emergency UNLESS accompanied by life threatening signs/symptoms (i.e. loss of consciousness) Ventricular tachycardia (more than 3 consecutive PVCs at a rate of > 150 bpm) = life threatening arrhythmia, alert EMS Ventricular fibrillation (wild, erratic) = medical emergency, alert EMS, requires immediate defibrillation (page 426)

What are the 4 types of multiple sclerosis? Brief description?

Primary progressive = continuous, steady decline with or without occasional plateaus Secondary progressive = relapsing remitting followed by progression (with or without occasional relapse) Relapsing remitting = most common (85%) clearly defined acute attacks with full recovery or with residual deficits after recovery Progressive relapsing = most rare, clear acute relapses with periods in between having continued disease progression

Reactive hyperemia: procedure and position of dependency (arterial vs. venous)

Procedure = elevate LE to empty blood from superficial veins, hang leg over table in dependent position and record time for veins on top of foot to refill > 30 seconds for rubor = arterial insufficiency < 10 seconds for rubor = venous insufficiency

ADA: threshold requirements (sliding doors, other doors, carpet)

Sliding doors = 3/4 of an inch Other doors = 1/2 an inch Carpet = 1/2 inch of pile or less (page 771)

SCFE: what is it, symptoms, demographic, treatment

Slipped capital femoral epiphysis Demographic = male, adolescent, high activity level, obesity What is it = femoral physis fracture (anterior displacement of femoral neck) Symptoms = groin and medial thigh pain (similar to OA), limp, lacking IR and abduction Treatment = protected or NWB, surgical pinning (good prognosis if treated early) (class notes)

ADA: ramp specficiations (slope, width, landing)

Slope = 1:12 rise:run (8.3% grade) Width = 36 inches (hallways also 36 inches, doorways 32 inches) Landing = 5 feet by 5 feet (because need 60 inches to U-turn) (page 770)

Murphy's sign: position, procedure, what is a positive and what does it indicate

Gallbladder (or kidney pathology according to PEAT) Position = supine, fingers below costal margin (to the right of rectus abdominus), other hand same place on back Procedure = patient breathes out, you firmly palpate, hold, and then instruct the patient to breathe in deeply (L side first where it should be negative, then R side) Positive = sudden pain or abdominal muscle tensing (keeping you out of the area) Pain with palplation of gall bladder (seen with cholecystitis)

How to varum/valgus progress as a child ages?

Newborn = moderate genu varum (bowlegged) 1.5 to 2 years = legs straight 2.5 years = genu valgum 4-6 years = legs straight

C-section: activities to avoid and how long

No lifting any items heavier than the infant for at least 6 weeks post-partum check After 6 weeks, gradually increase lifting over time in order to allow healing scar tissue to accommodate, strengthen and stretch

Compare the function of middle deltoid in open chain and closed chain

Open chain = shoulder abduction Closed chain (like shoulder abduction isometrically against wall) = the origin (scapular spine) moves toward the fixed insertion (deltoid tuberosity) which results in scapular downward rotation

PVC naming: Two in a row Every other QRS complex is PVC Three in a row Every third QRS complex is PVC

Couplet = two consecutive PVCs Triplet = three consecutive PVCs Bigeminy = every other QRS complex is a PVC Trigeminy = every third QRS complex is a PVC

Compare these GI syndromes: Crohn's disease IBS Ulcerative colitis

Crohn's disease = primarily inflammation of the GI tract (anywhere) leading to abdominal pain, cramping, diarrhea, malnutrition, etc. Ulcerative colitis = chronic inflammation and formation of ulcers of the terminal GI tract (rectum and sigmoid colon), blood in stools and abdominal pain/cramping Irritable bowel syndrome = NO structural changes to intestinal tissue, muscular walls either contract too much (diarrhea) or too little (constipation) (649, 654, 648)

Peripheral nerve entrapments: what nerve is entrapped and what are the hallmarks Cubital tunnel syndrome Radial tunnel syndrome Pronator syndrome

Cubital tunnel syndrome (ulnar nerve) = sensory changes and/or pain in the 4th and 5th finger Radial tunnel syndrome (radial nerve) = pain and weakness in distal muscles, NO SENSORY LOSS (compression is distal to superficial radial nerve) Pronator syndrome (median nerve) = sensory changes in digits 1-3, pain in forearm with forceful pronation, hand weakness

LCP: what is it, symptoms, demographic, treatment

Demographic = most common in boys 4-8 years old What is it = ischemic event to femoral epiphysis (subsequent necrosis and collapse) - baby avascular necrosis Symptoms = limp that worsens with activity, ache in hip or knee, thigh atrophy (which can last for a long time), LOM hip abduction Treatment = abduction brace, surgery (better outcomes if younger) (class notes)

What is the order of donning/doffing PPE?

Don: Mask, gown, gloves Doff: Gloves, gown, mask -Gloves never touch mask -Gloves always come first (doff) or last (don)

ADA: doorway, hallway and ramp width specifications

Doorway = 32 inches Hallway = 36 inches Ramp = 36 inches (page 771)

Diabetes: footwear considerations (fit, leather or non-leather, fasteners or no fasteners, etc.)

Fasteners = ALL shoes should have laces, straps or velcro to keep your foot secure and reduce frictional forces Fit = should be snug and secure, specifically around the heel, to help prevent friction Leather = shoes should have leather uppers (i.e. dorsal side of foot) because that helps conform to the top of the foot but non-leather soles (because they are usually hard and non-cushioned)

Compare flexion and extension synergies after CVA

Flexion synergy: Shoulder flexion, ER, and abduction Elbow flexion and supination Extension synergy: (waiter's tip) Shoulder adduction, IR Elbow extension and pronation

Exercise post-partum: what to focus on and what to avoid

From delivery through initial 6 weeks Focus on = isometric abdominal and pelvic floor setting with proper activation and no "bulge" or pressure feeling Avoid = elevate the pelvis during exercise (air embolus), sustained and forceful end range activities if provocative (still have ligament laxity until patients stop breast feeding)

Quadratus Lumborum: function, attachments (vaguely),

Function = spine extension, lateral flexion, fixes 12th rib during inspiration Superior attachment = medial 1/2 inferior 12th rib, lumbar TPs Inferior attachment = internal lip iliac crest

Associative stage What stage of motor learning? Environment: closed, open Practice time: distributed, mass Practice order: blocked, random Part or whole training

How do I do the task? (2nd stage) Closed environment with progression to open environment Distributed practice as needed Random order (ABABC) Whole training (practice part training as needed)

Autonomous stage What stage of motor learning? Environment: closed, open Practice time: distributed, mass Practice order: blocked, random Part or whole training

How do I master the task? (3rd stage) Open environment Massed practice (practice time greater than rest time) Random order Whole training only

Ideational vs Ideomotor apraxia

Ideational (conception problem) = difficulty preforming a movement when the "idea" of the movement is lost (can easily perform one step movements but not multistep movements) Ideomotor (performance problem) = inability to perform purposeful movements when there is no loss of strength, sensation or ROM (can't perform on command but can do it when left on their own)

Thomas test: muscles tested and what position will the leg be in

Iliopsoas - extended lower extremity flexes at hip Rectus femoris = unable to bend knee to 90 degrees Tensor fascia latae = hip abducts (page 106)

What are the main hallmarks of each of these conditions? Impetigo Interstitial cystitis Atrophic scarring Myalgic encephalomyelitis

Impetigo = highly contagious skin infection, usually in children, face and mount Interstitial cystitis = painful bladder condition with unknown etiology that causes urinary frequency and urgency Atrophic scarring = embedded scars when there is no muscle or fat, acne or chicken pox scars are often atrophic Myalgic encephalomyelitis = chronic fatigue syndrome, profound fatigue, sleep abnormalities, and pain, that are made worse by exertion

Chrohn's disease: what is it, common symptoms

Inflammatory bowel disease: lining of GI tract becomes inflamed Common symptoms (can range from mild to life threatening) = abdominal pain, cramping, diarrhea, blood in stool, GI tract ulcers, weight loss, malnutrition, etc. (page 745)

What is Horner's syndrome?

Injury to the cervical sympathetic chain MAP: Miosis (small pupil) Anhidrosis of ipsilateral face (sweating) Ptosis (drooping eyelid)

Osteoporosis: compare primary and secondary and give some examples

Primary = includes idiopathic, postmenopausal and senile/involutional (occurs in patients that are at least 70, proportionate cortical and trabecular bone loss) osteoporosis Secondary = any osteoporosis due to a primary disease process (i.e. malabsorption syndrome, alcoholism, endocrine disorders) or as a result of certain medications (i.e. corticosteroids, heparin, anticonvulsants)

ADA: parking space specifications (length, width, amount accessible)

Length = 20 feet Width = 8 feet Amount accessible = approximately 2% of total spaces must be accessible (page 771)

ADA: wheelchair turning radius specifications (length, width)

Length = 72 inches (6 feet) Width = 60 inches (5 feet) This makes sense because the landing of a ramp has to be 5 feet by 5 feet

McBurney's point: location and what does pain at this point indicate?

Location = 1/3 to 2/3 of the way from umbilicus to ASIS Appendicitis (pinch an inch is a gentler way of doing this)

Tinetti: max score, fall risk scores

Max = 28 Low fall risk = > 24 Moderate = 19-24 High = <19

PaO2 levels: normal and below

Normal = 80-100 mm Hg Mild hypoxemia = 60-80 mmHg Moderate = 40-60 mmHg Severe = < 40 mmHg (page 409)

Scapular winging: muscle, nerve, roots

Occurs when an injury to the long thoracic nerve (C5 ,C6, C7) weakens or paralyzes the serratus anterior muscle, causing the medial border of the scapula to rise away from the rib cage

PVCs: what should you do?

One PVC in isolation = continue with exercise, monitor vitals Three consecutive PVCs = ventricular tachycardia, medial emergency, call EMS Six PVCs in one strip (not necessarily consecutive) = call EMS (page 427)

Compare the function of latissimus dorsi in open chain and closed chain

Open chain (i.e. lat pull downs) = shoulder extension, adduction and IR Closed chain (i.e. push-up pressure relief) = the origin (iliac crest) comes toward the insertion (intertubecular groove) which causes scapular depression and pelvic elevation

Force needed for lumbar mechanical traction to: Overcome friction Separate joint spaces First time

Overcome friction = 25% BW (need to overcome friction to get any movement at lumbar spine) - this will stretch soft tissues, and reduce muscle spasm and disc protrusion Separate joint spaces = 50% First time = do not exceed 30 pounds during the first time (also do 5 minutes and see what happens, if symptoms peripheralize then discontinue treatment) (page 721)

Compare Phalen's and reverse Phalen's test

PER = Reverse Phalen's has wrist extension PF = Phalen's is wrist flexion Both for carpal tunnel, hold for 60 seconds, tingling is positive

Uterine prolapse treatment: physical therapy and surgical

Physical therapy Pelvic floor and abdominal muscle training particularly focused on power and endurance Need to be able to contract these muscles without recreating prolapse pressure for exercises to be helpful Positioning patient gravity eliminated might help this Surgical Implantation of a pessary (support device)

Screw home mechanism: purpose, open chain vs. closed chain

Purpose = increases knee-joint stability by locking the femur on the tibia when the knee is fully extended Open chain = tibia externally rotates on femur Closed chain = femur internally rotates on tibia

GH abduction: scapular movement and purpose of scapular contribution

Purpose = optimize subacromial space, keep RTC muscle length tension relationship and provide base of support for humerus Scapular contribution = 30 degrees of GH abduction, THEN 2:1 ration of GH to ST joint contribution (so 60 degrees of upward rotation needed for full GH abduction)

What movements are contraindicated with osteoporosis?

Resisted trunk flexion or rotation Twisting motions like a golf swing Abrupt or explosive loading Hyperflexion movements like picking up something from the floor from standing

Gaenlen's Test: position, procedure, what is a positive and what does it indicate

SI joint dysfunction Position = Thomas test position (non-painful knee to chest) Procedure = PT pushes patient's hanging leg toward the ground Positive = pain in the ipsilateral SI joint (provocation test) (class notes)

Complex Regional Pain Syndrome (CRPS): signs and symptoms, top treatments

STAMP Sensory = allodynia (pain from stimulus that doesn't usually cause pain), hyper/hypoalgesia, hypo/hyperesthesia Trophic = hair, skin, nails Autonomic = swelling, edema, sweating Muscle = atrophy, weakness, contractures Pain Top treatments = Active range of motion, functional training and TENS

Briefly describe these tests: Schober's test Prone instability test

Schober's test = measure the degree of lumbar flexion, ankylosing spondylitis Prone instability test = sees is pain is decreased with muscle activation, first feet on floor and press down on back, then lift up feet and press down on back and see how pain changes, positive = less pain with muscle activation

Herpes zoster: what is it, common symptoms

Shingles (chicken pox in children) Once exposed can lay dormant in neural for years (or forever) Symptoms = unilateral painful itching or burning sensation caused by the virus's attack on nerve fibers, also systemic effects like fever, body aches, chills, and fatigue (page 648)

Pregnancy: positions to avoid

Supine - avoid after 4 months for long durations (especially exercise in this position) Right side lying - always lay on left side to minimize compression on vena cava Prone - avoid whenever it becomes uncomfortable or by 7 months

Lumbar traction: prone vs. supine positioning

Supine = more common, associated with flexion, biases opening posterior structures (facets, IV foramen), spinal stenosis Prone = associated with extension, biases opening anterior structures (disk spaces), disk protrusions (page 720)

Lumbar traction: sustained vs. intermittent traction

Sustained = for patients whose symptoms are exaggerated with movement (i.e. acute injuries, this reduces the stretch reflex) Intermittent (there is always some amount of force even during rest periods) = for joint mobilization or for patients who can't tolerate sustained traction (page 721)

Ober's test: position, procedure, what is a positive and what does it indicate

TFL or ITB and tightness Position = side lying with lower leg flexed at hip and knee Procedure = therapist moves the test leg into hip extension and abduction and then attempts to slowly lower the test leg Positive = inability of the test leg to adduct or touch the table (page 106)

Hemiplegic shoulder: positioning and subluxation

The most common type of subluxation is an inferior subluxation Weakness and the weight of a heavy arm result in downward rotation of the scapula and subsequent inferior subluxation

Hiatal hernia: what is it, what do avoid

The upper part of the stomach bulges through an opening in your diaphragm leading to GERD Avoid = supine or recumbent exercises (stomach pulls further into thorax), exercises that involve bending or exercises that increase abdominal pressure (i.e. valsalva maneuver)

Tibialis anterior vs. posterior: distal attachments and function

Tibialis anterior: Distal attachment = base of MT 1, medial cuneiform Function = dorsiflexion, inversion, support medial longitudinal arch Tibialis posterior: Distal attachment = navicular tuberosity, cuneiform, cuboid, bases of MT 2-4 Function = inversion, weak PF

What are the ADA requirements for sinks and toilets?

Toilet = 17-19 inches from floor to top of toilet Bathroom sink = not less than 29 inch height, 17 inch minimum depth (page 771)

Lumbar traction: indication or contraindication? Unremitting pain Spinal ligament contractures Disk herniation Lumbar spine instability Cancer Muscle guarding Pregnancy Subacute joint inflammation Trauma Cardiac problems

Unremitting pain = contraindication Spinal ligament contractures = indication Disk herniation = indication Lumbar spine instability = contraindication Cancer = contraindication Muscle guarding = indication Pregnancy = contraindication (able to do cervical but not lumbar) Subacute joint inflammation = indication Trauma = contraindication (if diagnostic tests have not ruled out other medical conditions) Cardiac problems = contraindication, along with pulmonary problems and vascular conditions (page 721)

Cervical traction: how do you bias lower vs. upper vertebrae

Upper cervical spine = 0-5 degrees of flexion Middle cervical spine = 10-20 degrees of flexion Lower cervical spine = 25-35 degrees of flexion Basically increased flexion biases the lower vertebrae (page 721)

Rotation of the scapula: main muscles for upward and downward rotation

Upward = upper trap and lower trap (force couple), serratus anterior (helps fix scapula, weak = winging), deltoid (upward rotation accompanies abduction) Downward = levator scapulae, rhomboids, latissimus dorsi and pectoralis minor

Cognitive stage What stage of motor learning? Environment: closed, open Practice time: distributed, mass Practice order: blocked, random Part or whole training

What do I do? (1st stage) Closed environment Distributed practice (rest time greater than practice time) Blocked order (same task repeatedly) Part training if possible

When pushing a wheelchair for a patient, which wheels should touch the ground first when descending a curb using a forward approach?

When descending a curb in a wheelchair using a forward approach, the clinician tilts the wheelchair slightly backwards and then descends the curb with the weight on the larger, more stable back wheels The back wheels should touch first with any descending strategy because they are more stable

ADA: doorway specifications (depth, width)

Width = 32 inches Depth = 24 inches (page 771)

How do you palpate supraspinatus?

You have to bring it anterior to the acromion IR and extension of the arm (have the patient put their arm behind their back) This will bring the supraspinatus anterior and inferior to the AC joint