NPTE July 2019

Manual Muscle Testing (MMT)

"Isometric muscle testing" so is dynamometry Allows therapist to assign specific grade to a muscle, based on whether patient can hold the limb against gravity, how much manual resistance can be tolerated and whether joint has full ROM

severe damage to the brainstem causes what

"brain death" primitive functions that are essential to survival majoirity of CNs origniate here

Axonotmesis

- A more severe grade injury to a peripheral nerve - Reversible injury to damaged fibers since they maintain an anatomical relationship with each other - damage occurs to the axons with preservation of the endoneurium (neural connective tissue sheath), epineurium, schawann cells, and supporting structures - Distal Wallerian degeneration can occur - The nerve can regenerate distal to the site of the lesion at a rate of 1mm per day - Recover is spontaneous and varies from spotty to no recovery; surgery may be required for repair - Traction, compression, and crush injuries are the most common

wrapping guidelines

- Elastic wrap should not have any wrinkles - Diagonal and angular patterns - Do not wrap in circular patterns - Provide pressure distally to enhance shaping - Anchor wraps above the knee for transtibial amputations - Anchor wraps around pelvis of transfemoral amputations - Promote full elbow extension for transradial amputations - Promote full knee extensions for transtibial amputations - Promote full hip extension for transfemoral amputations - Secure the wrap with tape, do not use clips - Use 6 inch wrap for transfemoral amputations - Rewrap frequently to maintain adequate pressure

procedural learning

- Learning tasks that can be performed without attention or concentration to the task; task is learned by forming movement habits (developing a habit through repetitive practice)

neurapraxia

- Mildest form of injury - conduction block usually due to myelin dysfunction - Axon continuity preserved - epineurium peri and endo intact - Nerve conduction is preserved proximal and distal to the lesion - Nerve fibers are not damaged, no evidence of nerve degeneration is noted - Symptoms: Pain, minimal muscle atrophy, numbness or greater loss of motor and sensory function, diminished proprioception - Recovery is rapid and complete and will occur within 4-6 weeks - Pressure injuries are the most common

Two main arteries that supply the brain

- Vertebral A. - Internal Carotid A. branches of these main arteries form the circle of willis

Elbow Extension ROM

0

Knee Flexion ROM Requirement for Gait

0-60 degrees Max flexion at initial swing and start of midswing 0 degrees flexion at terminal swing (tibia perp to ground)

1st Carpometacarpal Abduction ROM

0-70

Shoulder Medial Rotation ROM

0-70

goals for vestibular rehab

1. Improve balance 2. Improve trunk stability 3. increase strength and ROM in order to improve MSK balance responses and strategies 4. decrease the rate and risk of falls 5. Minimize dizziness

Recommended Sequence for Goniometry

1. Place the subject in the recommended testing position 2. Stabilize the proximal joint segment 3. Move the distal joint segment through the available range of motion, make sure that the passive range of motion is performed slowly, the end of the range is attained, and the end-feel is determined 4. Make a clinical estimate of the range of motion 5. Return the distal joint segment to the starting position 6. Palpate bony anatomical landmarks 7. Align the goniometer 8. Read and record the starting position, remove the goniometer 9. Stabilzie the proximal joint segment 10. Move the distal segment through the full range of motion 11. Replace and realign the goniometer, palpate the anatomical landmarks again if necessary 12. Read and record the range of motion

Stages of Gripping

1. The hand opens fully, which requires activation of the wrist and finger extensor musculature as well as the hand instrinsics 2. The fingers position around the object and close to grasp the object, which requires activation of the finger flexor musculature as well as the hand instrinsics 3. The forece of teh grasps is modified based on the shape, weight, fragile, and surface characteristics of the object 4. The obejct is released by opening the hand, which again requires activation of the extensor musculature

olfactory nerve/optic

1/2 smell: nose identify familiar odors SENSORY

blood pressure limits during phase I of cardiac rehab

10 mmHg increase in systolic diastolic above 110mmHg less than 110 is acceptable HR >130 contra or >20 beat above resting for MI >30 for post surgical

T10 sensory testing

10th intercostal space or umbilicus

T11 sensory testing

11th intercostal space between T10-T12

Healthy Range of Body Fat =

12-18% for Males 18-23% for Females

elevated BP

120-129 over <80

Q Angle

13 degrees is normal male 18 degrees female ASIS to the midpatella/tibial tubercle

stage 1 BP

130-139 systolic OR 80-89 diastolic

% interstitial fluid collected by lymphatic system

15%

normal platelet count and when can serious bleeding occur

150,000-400,000 below 15,000-20,000

hot pack layer counts has how many

2

left lung has how many lobes

2 (upper and lower) lingula of the left upper lobe is analogous to the right middle lobe

How long should you hold MMT?

2 second build 6 second max 2 second decline so 10 seconds?

ttest vs ztest vs chisquare test vs ANOVE

2 variabes for first two compares nominal data aka gender, yes no 3 or more variables

deflate BP cuff by how many mmHg per second

2-3 to identify korotkoff sounds 20 mmHg above the patients estimate systolic value

ulnar and radial deviation

20 30

lachman how much flexion

20-30 degrees functional position and all parts of ACL are taut

scoliosis brace how long per day

23 hours can remove for athletics or hygiene

HCO3- mean value

24 mEq/L (22-26 mEq/L)

Tibiofemoral joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

25 degrees flexion Femur is convex Tibia is concave Same direction

Patellofemoral joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

25 degrees flexion Patella is convex Femur is concave Opposite direction

Open and Closed Pack Position of Knee

25 degrees flexion (anatomical position) Full extension, lateral rotation of tibia

fast rate walking toe out

3 degrees

glascow coma scale how many levesl

3-15 higher means greater level of consciousness determines arousal and cerebral cortex function neuro assessment

Hip joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

30 degrees flexion 30 degrees abduction Slight lateral rotation Femur is convex Acetabulum is concave Opposite direction

Open and Closed Pack Position of Hip

30 degrees flexion, 30 degrees abduction, slight lateral rotation (anatomical position) Full extension, medial rotation

doorway clearnce for wheelchair

32 inches 36 is for corridor

TMJ Opening ROM (Depression)

35-50mm

Which portion of tidal volume is typically involved in respiratory exchange?

350 ml out of 500 ml

ramp should be how wide

36 inches

PaCO2 mean value

40 mmHg at sea level breathing ambient air (35-45 mmHg)

trigeminal nerve

5 V touch, pain on skin of face, mucous membranes of nose, sinuses, mouth, anterior tongue voluntary control of muscles of mastication corneal reflex, face sensation, clench teeth, push down on chin to separate jaw MIXED cotton and safety pin asked sharp dull inspect for imapired sensation or inability to differentiate between sharp and dull protrusion, retrustion and lateral deviation of the mouth for motor component

cycling at 10 mph how many mets

5-6

bicycling is not recommended for patients with platelet levels below...

50,000

progressive exercise is contraindicated with low platelet levels at what number

50,000

Normal tidal volume

500 mL

Glenohumeral joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

55 degrees abduction 30 degrees horizontal abduction Glenoid is concave Humerus is convex Opposite direction

abducens nerve

6 VI voluntary control of lateral rectus muscle of eye lateral gaze MOTOR abduct eyes inspect for inability

sit with hand support for an extended period of time age

6-7 mo also bring objects to midline, hold a bottle with 2 hands, and roll to prone

how many towel layers do yu need on a hot pack

6-8

minimum space required to turn 180 degrees in a standard wheelchair

60 inches

lowest risk for infection

65 year old with iron-deficiency anemia anemia does affect immunity and was only a small difference in age for the other answers 55, 50, 60

Normal distribution curve and SD

68 95 99

free speed walking toe out

7 degrees

pH mean value

7.4 (7.35-7.45)

Open and Closed Pack Position of Ulnohumeral (elbow)

70 degrees flexion, 10 degrees supination (anatomical position) Extension

Which value would best reflect the intrapleural pressure during the resting phase of ventilation?

760 millimeters of mercury

false ribs

8-10

glossopharyngeal nerve

9 IX or VIIII touch pain of posterior tongue taste of posterior tongue voluntary motor of select muscles of pharynx autonomic partiod gland gag reflex ability to swalloW MIXED touch the pharynx for gag reflex with tongue depressor distinguish objects by taste on posterior tongue esp sour and bitter

MTP makes up how much of gouty arthritis cases?

90% knee and ankle much smaller

SaO2 mean value

95-98%

normal oxygen saturation

95-98%

PaO2 mean value

97 mmHg at sea level breathing ambient air (80-100 mmHg)

RR below what is a guideline to terminate opioid use

<10 normal is 12-20

normal BP

<120 over <80

cystic fibrosis

A genetic disorder that is present at birth and affects both the respiratory and digestive systems. autosomal recessive

Stress-Strain Curve

A graphic representation that depicts the relationship between the amount of force (stress) applied to connective tissue and the amount of deformation (strain) it experiences

Tabetic Gait Pattern

A high stepping ataxic gait pattern in which the feet slap the ground. I.E. from tabes dorsalis which is a type of neurosyphilis

laminectomy

A laminectomy is usually performed in the presence of a disk protrusion or spinal stenosis. A complete laminectomy involves the removal of the entire lamina, the spinous process, and the associated ligamentum flavum.

Antalgic Gait Pattern

A protective gait pattern where the stance time is decreased to avoid weight bearing on the involved side due to pain. This is typically associated with a rapid and shorter swing phase of the uninvolved limb. Causes of antalgic gait include disease (usually bone or joint), joint inflammation, or injuries to muscles, tendons, and/or ligaments

Cerebellar Gait Pattern

A staggering gait pattern seen in cerebellar disease Causes include alcohol abuse, certain medications, stroke, tumor, cerebral palsy, brain degeneration and multiple sclerosis

postural hypotension (increasing fall risk) most common sx of

ACE inhibitor agents bc decrease blood pressure and afterload by suppressing the enzyme that converts angiotension I to angiotension II pt must avoid suddent changes in position due to risk of dizziness and fainting from hypotension antiepileptic increases fall risk not because of postural hypotensions but becuse of ataxia, confusion, and cogntiive impairments anticoag do not increase risk of fall just of bleeding, hemorrhage and GI distress antispasticity increases fall risk but because of drowsiness, confusion, and dizziness (dizziness not same as postural hypotension)

Adhesive Capsulitis GOLD

AKA frozen shoulder Enigmatic shoulder disorder characterized by inflammation and fibrotic thickening of the anterior joint capsule f the shoulder, the inflamed capsule becomes adherent to the humeral head and undegoes contracture (decreasess space also means less synovial fluid and further irritation), this condition is characterized by the symptoms of limitation of GH motion and pain Primary vs secondary Primary - occurs spontaneously Secondary - results from an underlying condition No known etiology but it is associated with diabetes, thyroid abdnormalities, and CP conditions Secondary AC can result from trauma, immobilization, complex regional pain syndrome, rheumatoid arthritis, abdominal disorders, and psychogenic disorders Orthopedic instrinsic disorderes that may initiate this process include supraspinatus tendonitis, partial tear of he rotator cuff, and bicipital tendonitis, adhesive capsulitis occurs more in the middle-aged population with females having a greater incidence than males Occurs in 2% of the population and in 11% in people with diabetes, 10-15% develop bilateral Acute - pain that radiates below the elbow and awakens the patient at night, passive range limited at this phase due to pain and guarding Chronic - localized around the lateral brachial region, pt is not awakened by pain and passive range is limited due to capsular stiffness Presents with loss of GH motion, restricted elevation and lateral rotation Arthrogram can assist with the diagnosis (detects the volume of fluid within the capsule, normal is 16-20 and in this it holds 5-10ml) To confirm use clinical evaluation and PMH (may be limited in abduction and lateral rotation but all planes are affected, anterioinferior joint capsule is tight, pain with stretching, restriction with passive and active range of motion Additional findings - muscle spasms around the shoulder 2/2 muscle gaurding, loss of reciprocal arm swing and disuse atrophy Self limiting process than can take over 112 months in its course, surgery to break up ahesions is last resort Acute PT - icing or superficial heat, gentle mobs, pendulum, isometric stregnthening Chronic PT - ultasound, higher mobs, increase the extensibility of capsule, PNF to restore range HEP - self stretching but avoid abduction 2/2 risk of damage to subacromial tissue PT for 3-5 mo Nonlnear pattern of recovery Spontaneous recovery is said to take 12-24 months in duration 7-14% experience some permanent loss of ROM, usually asymptomatic and may not impair a patients functional ability Similar to acute bursitis = pain that is intense and throbbing over the alteral brachail region but it only lasts for a few days and will resolve within a few weeks

elevation of the upper ribs increases the...

AP diameter of the chest

Anaerobic GLucolysis

ATP during high intensity, short duration but longer than 15 second (400-800m) Glucose, pyruvic acid, forms ATP Does not require oxygen Results in formation of lactic acid which causes muscular fatigue 50% slower than phosphocreatine Up to 30-40 seconds It does not requir oxygen It uses only carbs It releases enough energy for the resynthesis of only small amounts of ATP

Elasticity

Ability of soft tissue to return to its previous length after a stretch is no longer applied

Power vs Endurance

Ability to move weight with speed vs ability to exert sub-max force against resistance for an extended period of time Strength is the ability of a muscle to exert maximal force against resistance (i.e. 1RM), the difference between strength and power is the speed

Standard Acceleration

Acceleration begins when toe off is complete and the reference limb swings until positioned directly under the body

Reversibility Principle

Adaptions seen with resistance training are reversible if the body is not regularly challenged with the same level of resistance or greater Begins within 1-2 weeks of stopping an exercise program

Hip Adduction (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Adductor Magnus, Pectineus, Gracilis Supine w/ nontest limb ABD, test limb in ADD, knees extended Stabilize the anterolateral aspect of the ips pelvis The dynamometer placed on medial aspect of distal thigh just proximal to knee Resistance perpendicular to thigh in direction of hip ABD

Diagnoses Associated with Capsular Patterns

Adhesive capsulitis

Type I Muscle Fibers

Aerobic Red Tonic Slow twitch Slow oxidative Low fatigability High cap density High myoglobin conent Smaller fibers Extensive blood supply Large amount of mitochond Marathon, swimming

Intensity

Amount of weight Strength = 6-12 rep at high weight Endurance = 20+ reps at low weight Power = 1-3 reps at high weight Weight can be expressed as a percentage of the patient's 1RM

spontaneous nystagmus

An imbalance of vestibular signals to the oculomotor neuron that causes a constant drift in one direction that is countered by a quick movement in the opposite direction. typically occurs after an acute vestibular lesion and will last approximately 24 hours

Effusion

An increased volume of fluid within a joint capsule

Type II Muscle Fibers

Anaerobic White Phasic Fast twitch Fast glucolytic High fatigability Low cap density Low myoglobin content Larger fibers Less blood supply Fewer mitochondria High jump, sprinting

Acromioclavicular joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

Anatomical position Clavicle is convex Acromion is concave Opposite direction

Joint Play

Arthrokinematic movement that happens between joint surfaces when an external force creates passive motion at the joint Not under voluntary control Cannot be achieved by active muscular contraction Mobilizations move into "joint play" "Accessory motions" Allows a clinician to determine necessity for intervention (i.e. mobilization, strengthening) Perform in loose packed position

Spinal Fusion

Axial pain with unstable spinal segments, advanced arthritis, or uncontrolled peripheral pain Restrictions on lifting, bending, twisting, formal OP doesnt start for 6 weeks, may use brace if surgeon does not use instrumentation to stabilize the segments, if it is used therapy can start earlier and be more aggressive

ATNR

Birth-6 months; turns head to stimulus, extend extremities on face side, flex extremities on skull side

Bouchards nodes

Bouchard's nodes are found at the proximal interphalangeal joints and are characteristic of osteoarthritis in the hands. The nodes are often tender in the early stages of osteoarthritis and can lead to restrictions in range of motion and fine motor skills.

Elbow Flexion #2 (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Brachialis, brachioradialis Seated with arm supported on table, shoulder abducted to 90 degrees, elbow flexed to 90, full pronation of forearm Stabilize over the lateral aspect of the ips arm The dynamometer is placed over the dorsal aspect of the distal forearm just proximal to the wrist Resistance is perpendicular to the forearm in the direction of elbow extension

hemtologic disorder what should you monitor

CBC bc will require daily monitoring

Isokinetic Exercise

Constant maximal speed and variable load I.e. biodex machine Reaction force is identical to the force applied to the equipment

Resting claudication

Contraindication to exercise Decrease peripheral pulses Cool skin BP 165/90 mmHG Top two would only limit ambulation if blood flow was markedly diminished or absent

light touch

Cotton ball, light pressure with finger

Indications Circumferential Measurements

Edema, atrophy/hypertrophy, and waist-to-hip ratio

C7 Myotome

Elbow extension Wrist flexion

C5-C6 Myotome

Elbow flexion

Cozen's Test

Epicondylitis Indicates lateral epicondylitis The patient is positioned in sitting with the elbow in slight flexion, the therapist places his/her thumb on the patient's lateral epicondyle while stabilizing the elbow joint, the patient is asked to make a fist, pronate the forearm, radially deviate, and extend the wrist against resistance A positive test is indicated by pain in the lateral epicondyle region or muscle weakness

Mill's Test

Epicondylitis Indicates lateral epicondylitis The patient is positioned in sitting, the therapist palpates the lateral epicondyle, pronates the patient's forearm, flexes the wrist, and extends the elbow A positive test is indicated by pain in the lateral epicondyle

Lateral Epicondylitis Test

Epicondylitis Indicates lateral epicondylitis The patient is positioned in sitting, the therapist stabilizes the elbow with one hand and places the other hand on the dorsal aspect of the patient's hand distal to the proximal interphalangeal joint, the patient is asked to extend the third digit against resistance A positive test is indicated by pain in the lateral epicondyle region or muscle weakness and may be indicative of lateral epicondylitis

Medial Epicondylitis Test

Epicondylitis Indicates medial epicondylitis The patient is positioned in sitting, the therapist palpates the medial epicondyle and supinates the patient's forearm, extends the wrist, and extends the elbow A positive test is indicated by pain in the medial epicondylar region

Exercise Sequence

Exercise large muscle groups before small Multijoint before single joint High intensity before low intensity

Atlanto-occipital Joint

Extension and side flexion are equally limited

First Metatarsophalangeal Joint

Extension then flexion

Wrist Extension (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Extensor Carpi Radialis Longus & Brevis Extensor Carpi Ulnaris Seated with forearm in neutral rotation, wrist extended, forearm supported on table Stabilize the radial side of the arm The dynamometer is placed on the dorsal surface of the hand just distal to the wrist Resistsance is perpendicular to the hand in the direction of wrist flexion

Colles Fracture BRONZE

FOOSH fall on outstretched hand Transverse fracture of the distal radius, occuring in either an intra or extrarticular location due to the direct trauma, the mechanism of injury typcally causes the lunate to act as a wedge resulting in a shear force and dorsal displacement of the radius, damage to structrues on the ulnar aspect of the wrist such as the ulnar collateral ligament or styloid process are also common occurrences with a FOOSH Likely preesent with pain and edema in close proximity to the fracture site, a dinner fork or bayonet deformity may be present in severe fractures as a result of dorsal displacment of the distal radius, carpals and hand in relation to the forearm Xray confirms MRI for ligamentous or soft tissue damage

four point gait pattern what WB

FWB

Reactive Control

Feedback Automatic postural response In response to external disturbances. During gait and with disruptions to gait cycle. Ankle, hip, step 1. The ankle strategy is seen with slower, smaller disturbances and when standing on a firm and flat surface. 2. The hip strategy is seen with larger, rapid disturbances or standing on compliant or uneven surfaces. 3. The stepping strategy is seen when the external disturbance is a new experience, or it is large and/or rapid.

Proactive Anticipatory Control

Feedforward Anticipatory postural adjustments To prevent disturbance, prior to voluntary movement. During voluntary COM movements in stance.

Risk for pressure ulcers

Female African American Advanced age Conditions that cause immobility

T1 Myotome

Finger abduction

Radiocarpal (wrist) Joint

Flexion and extension equally limited

Interphalangeal Joints

Flexion then extension

Synovial Joints (Diarthroses)

Free Movement Uniaxial (elbow, atlantoaxial just pivoting) Biaxial (saddle, condyloid aka metacarpophalangeal joint of finger) Multiaxial (ball ad socket hip joint, plane joints - gliding capral joints)

Good/Faulty Posture of the Hips, Pelvis, and Spine Side View

Front of pelvis and thighs are in a straight line Butt not prom in back bur slope slightly downward Spine with 4 curves Neck and low back = forward Upper back and sacrum backward Sacral is fixed and others are flexible It shoulder not have a lordosis or front of thighs form angle with pelvis Swayback ad flat back the pelvis is tilted backwards One side lateral curve C curve Two side lateral curse S curve

Distal Radioulnar Joint

Full range of movement, pain at extremes of rotation

(Dyna) - Pt Position, Direction of Resistance

GE position Direction is perpendicular in opposite direction

L5 Myotome

Great toe extension

multiple gestation

HIGH RISK fetal mortality rate is 4x that of single births twins have increased frequency of congenital anomalies, placenta previa, abruptio placentae, preeclampsia, cord accidents, and malpresentations

Heberdens nodes

Heberden's nodes consist of palpable osteophytes in the distal interphalangeal joints and are usually seen in women, but not men. This finding is a characteristic of osteoarthritis which is a chronic disease that causes degeneration of articular cartilage, primarily in weight bearing joints.

Standard Heel Off

Heel off is the point in which the heel of the stance limb leaves the ground

Ely's Test

Hip contracture/tightness Rectus femoris contracture The patient is positioned in prone while the therapist passively flexes the patient's knee A positive test is indicated by spontaneous hip flexion occuring simultaneously with knee flexion

90-90 Straight Leg Raise Test

Hip contracture/tightness The patient is positioned in supine and is asked to stabilize the hips in 90 degrees of flexion with the knees relaxed. The therapist instructs the patient to alternately extend each knee as much as possible while maintaining the hips in 90 degrees of flexion. A positive test is indicated by the knee remaining in 20 degrees or more of flexion and is indicative of hamstring tightness.

Tripod Sign

Hip contracture/tightness The patient is sitting with the knees flexed to 90 degrees over the edge of a table, the therapist passively extends one knee A positive test is indicated by tightness in the hamstrings or extension of the trunk in order to limit the effect of the tight hamstrings

ACL Reconstruction

If causing pain or instability Autograft preferred Bone patellar tendon bone graft is gold standard bc bone to bone healing Gracilis or semitendinosis is also cmmon but not as strong bc tendon to bone healing protocols vary widely but immob in hinged brace locked in extension and WB restrict with good wuad control can unlock brace full knee extension emphasis isometrics closed chain exercises open chain between 0-45 degrees graft tissue most vulnerable at 6-8 weeks after surgery as tendon transforms into ligamentous tissue failure happens at this time due to poor complaince 100% at 12-16 mo after return to sport at 6 months return to sport if no pain or effusion, full ROM, no instability, quad strength 85-90 of opp leg, hamstring 90-100%, functional testing that is 85-90% of opp leg

Good/Faulty Abdomen Posture

In young children, up to about the age of 10 it is normal to protrude somewhat but in older adults it should be flat Should not... Protrude or have the lower part protrude while the upper part is pulled in

Proprioceptive Neuromuscular Facilitation (PNF) Stretching

Incorporates active muscle contractions into stretching techniques, muscular contraction is thought to lead to muscle relaxation through the principles of autogenic or reciprocal inhibition and results in greater gains in muscle flexibility Because these techniquesexert their effects on muscle fibers, they are more effective at treating range of motion limitations due to muscle spasm as opposed to connective tissue tightness Other theories include increased patient tolerance to the stretch and length changes secondary to the viscoelastic properties of muscle Not effective with spasticity or paralysis becayse it requires active muscular control from the patient Common techniques - contract-relax, agonist contraction, and contract-relax with agonist contraction

Sulcus Sign

Inferior instability (under "dislocation" section) In standing, the therapist positions the patient's arm in 20-50 degrees of abduction, the therapist then grasps the patients elbow and pulls the arm inferiorly The test is positive if a sulcus sign is noted (i.e. depression seen between the acromion and humeral head) Can be measured by the vertical length of the depression Grades 1+ for <1cm 2+ for 1-2cm 3+ fr >2cm

Bursitis

Inflammation of bursae Limitations in AROM 2/2 pain and swelling

Rancho Swing Phase includes...

Initial swing Midswing Terminal swing

spinal puncture lumbar

Invasive procedure that inserts a needle through the lumbar below L1-L2 to get a CSF sample. most common at L3-L4. Can rule out meningitis, hemorrhage, tumor, infection, inflamm

Myocardial ischemia

Inverted T wave ST segment depression

When testing a two-joint muscle....

It must be elongated over one joint to shorten the other I.e. rectus femoris Seated Knee is flexed (elongated over one joint because this muscle extends the knee) Hip is flexed (shorted over the other joint because this muscle flexes the hip) If it is shortened it will be ineffective during the test

Patellar tendon is pressure tolerant and redness in this area is not a concern as long as ....

It resolves within 10-20 min 20 min for fibular shaft

Arthrokinematics-osteokinematics

Joint motion-bone movements

L3-L4 Myotome

Knee extension

patellar reflex innervation

L3-L4

patellar tendon reflex

L3-L4

Patella Reflex Innervation Level

L4

medial hamstring reflex innervatin

L5-S1

Glenohumeral Joint Capsular Pattern

Lateral rotation, abduction, then medial rotation

Shoulder Extension (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Lats Teres Major Posterior Deltoid Sidelying with shoulder extended 45 degrees, full IR, elbow extended, arm on upper surface Stabilize over the superior aspect of the ips shoulder The dynamometer is placed on the anterior aspect of the distal humerus proximal to the elbow Resistance is perpendicular to the humerus in the direction of shoulder flexion

Hoover test what is it for

Malingering Dispute claim of paresis Other leg will push down during SlR

Isotonic Exercise

Muscle exerts constant tension Muscle movement with a constant load I.e. handheld weights Concentric and eccentric Shorten vs lengthen

Most common "side effects" of resistance training

Muscle fatigue (s/s = muscle pain, cramping, tremors, slow or jerky movements, can't complete full ROM, substitution patterns, decrease load or give rest break - not predictable with mysathenia gravis, MS, or CV disease may need longer recovery) Delayed onset muscle soreness (more likely with eccentric exercise and high intensity and newly doing resistance training, peaks at two days and can last for several days) Valsalva maneuver (increases internal pressure to stabilize the spine but generally leads to undesirable effects on the CV system, should be avoided in ALL patients but especially with CP disease, intervertebral disc pathology, or eye surgery - to avoid vaslsava try to breathe rhythmically and to exhale during the portion of the exercise that requires the most exertion)

Adaption to Strength Training

Muscle fiber hypertrophy Fiber type remodeling from IIB to IIA Increased neuromuscular activity (number of motor units, firing rate) Decreased or no change in capillary bed density Decreased mitochondrial density Increased stores of ATP, creatine phosphate, and other energy sources Increased tensile strength of tendons and ligaments Increased bone mineral density Increased lean body mass Decreased body fat percentage

Eccentric Contraction

Muscle lengthens as it maintains tension

Clonus procedure

Muscle on slack aka gastroc in slight knee flexion

Concentric Contraction

Muscle shortens as it maintains tension (make test)

Possible reasons for muscle weakness...

Nerve involvement, disuse atrophy, stretch weakness, and pain/fatigue

Cervical radiculitis is the same as

Nerve root compression i.e. during Spurling's test

Elbow Flexion Test

Neurological Dysfunction at the Elbow Indicates cubital tunnel syndrome The patient full flexes both elbows while extending their wrists and holds the position for 3-5 min, the test is considered positive for cubital tunnel syndrome if tingling or paresthesia is noted in the ulnar nerve distribution of the forearm and hand

Pinch Grip Test

Neurological Dysfunction at the Elbow Pathology of the anterior interosseous nerve The patient is asked to pinch the tips of the index finger and thumb together, if the patient cannot pinch tip to tip and instead presses the pads of the fingers together, the test is positive

Rectus Abdominis

O: Pubic crest and pubic symphysis I: Xiphoid process of the sternum and costal cartilages of ribs 5-7 A: Trunk flexion N: Intercostal (T7-T11)

Middle Trapezius

O: Spinous processes of T1-T4 I: Medial portion of the acromion and superior portion of the spine of the scapula A: Scapular retraction N: Accessory (cranial nerve XI)

Underweight vs overweight heat productiin

Overweight generate up to 18% more heat than underweight

backwards stepping elongates what muscles

PFs and hamstrings

Bizzare QRS complex

PVC

Acromioclavicular Joint

Pain at extremes of range of movement

Sternoclavicular Joint

Pain at extremes of range of movement

allodynia

Pain due to a stimulus that does not normally provoke pain

Endogenous Opioids

Pain regulation is also controlled by endogenous opioids known as opiopeptins (also know as endorphins), these substances bind to opioid receptors which are located throughout the nervous system resulting in inhibition of pain signals, opiopeptins have a direct effect on nerve signals by controlling the amount of calcium and potassium that momve into and out of the cell during depolarization, they also have an indirect effect on nerve signals by inhibiting the release of GABA, a substance that normally inhibits that activitu of structures that help to control pain, such as A beta fibers

Tibiofibular Joint

Pain when joint is stressed

Shoulder Horizontal Adduction (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Pectoralis Major Seated w/ shoulder in 90* ABD, full horizontal ADD, elbow flexed 90*; arm supported on table Stabilize over superior aspect of ips shoulder The dynamometer is placed over ant. aspect of distal humerus just proximal to elbow Resistance is perpendicular to humerus direction of shoulder horizontal ABD

Barlow's Test

Pediatric test The patient is positioned in supine with the hips flexed to 90 degrees and the knees flexed, the therapist tests each hip individually by stabilizing the femur and pelvis with one hand while the other hand moves the test leg into adduction while applying forward pressure posterior to the greater trochanter A positive test is indicated by a clikc or clink and may be indicative of a hip dislocation being reduced Variation of Ortolani's test

Laminectomy

Performed for disc protrusion or spinal stenosis Restrictions on weight that can be lifted and AROM like extension

Cauda Equina Syndrome SILVER

Peripheral nerve injury that results from damage and loss of function involving two or more nerves of the cauda equina associated with numerous mechanisms of injury and typically presents as a complex of symptoms SC extends to L1 typically and terminates with the conus medullaris paired lower lumbar, sacral and coccygeal nerve roots extend beyond the conus medullaris and are termed the cauda equina whichprovides sensory innervation tot he saddle area of the lowe rextremtiies, LE motor innervation and PARASYMPATHETIC innervation to the BB, and voluntary control over the sphinceters these nerves are more suspeptible to damage that most other nerve roots pairs due to apoorly deveoped protective epineurium and the tendency for edema to form even with mild injury can result from comproession from disc fx or stenosis, trauma or infectious condiions such as absecess or tuberculosis tumor or iatrogenic factors may be slow or develop rapidly if slow hard to diangose altered reflexes, pain and decreased strength and sensation are common severe back pain, functional impairment, diminsihed sensatin in the saddle dsitributin BB dysfunction i.e. retention or incontinence and sexual dysfuncton are also common incdience is higher in adults however chldren with spinal birth defects can also be at increased risk MRI to see tumor or abscess bony compression use xray or CT perineal sensation needed and rectal tone should be assessed surgery and medical interventions directed toward nerve root decompression not fatal but can signal an emergency surgery since delayed interventin may limit long term outcomes CES does not have aprojected outcome based on degree of primary and secondary damage PT to continue until goals are attained if realistic SELF LIMITING condition however the longer a patient is sx prior to intervention the less likely the patient is to achieve a complete recovery morbidity is typically assocaited with long term effects indlcuing weakness and BB dysfunction other complications can be development of decubitus ulcers or thrombus formation

Talocrural Joint

Plantar flexion, dorsiflexion

Toe down instead of heel strike is caused by

Plantar flexor spasticity Plantar flexor contracture Weak dorsiflexors Dorsiflexor paralysis Leg length discrepancy Hindfoot pain

Center of Mass

Point at the center of the total body mass Center of Gravity - The vertical projection of the center of mass to the ground

Shoulder Horizontal Abduction (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Posterior Deltoid Seated w/ shoulder ABD to 90*, full horizontal ABD, humerus in neutral rotation, elbow flexed 90*; UE supported Stabilize over superior aspect of ips shoulder; prevent trunk rotation The dynamometer is placed over post. aspect of distal humerus, proximal to elbow Resistance is perpendicular to humerus in direction of shoulder horizontal ADD

UE/LE Screening

Postural assessment AROM Passive OP

Sacroiliac, Symphysis Pubis, and Sacrococcygeal Joints

Ppain when joints are stressed

constant practice

Practice of a given task under a uniform condition

Precision Grip includes

Prehension grip Accurate and precise movements Radial side of the hand Digital i..e. three finger pinch pulp to pulp contact between the thumn index finer and middle finger like holding pencil Lateral prehension contact between the thumb and lateral side of the index finger i.e. when using a key Tip prehension i.e. tip pinch thumb opposition so taht the tip of the thumb contacts the top of anotehr finger i.e. holding a needle

Ranchos Preswing

Preswing begins when the other foot touches the ground (aka initial contact) and ends when the stance foot reaches toe off

Multiple Sclerosis GOLD

Produces patches of demyelination that decreases the efficiency of nerve impulse transmission sx vary based on the location and the extent of demyelination within the brain and spinal cord myelin breakdown results in plaque development, decreased enrve conduction velocity, and eventaul failure of impulse transmission lesions are scattered throughout the central nervous system and do not follow a particular pattern etiology unknown genetics, viral infections, and environment all play a role theorized that a slow acting virus initiates the autoimmune response in individuals that have environmntal and genetic factors for the disease indcidence is higher in caucasians between the ages of 20 and 35 years 2x as common in WOMEN higher incidence in women in temperate climates 30-80 in 100,000 250-350,000 current cases can occur at any age relapsing remitting 85% secondary progressive primary progressive progressive relapsing initial sx include visual problems, paresthesias and sensory changes, clumsiness, weakness, ataxia, balance dysfunction and fatigue frequency and intensity of exacerbations may indicate the speed/course of disease MRI as baseline for lesions evoked potentials may demonstrate slowed nerve conduction cerebrospinal fluid can be analyzed for elevated concentration of gamma globulin and protein levels diagnosis = two separate pt reported attacks with two separate lesions kurtzke expanded disability status scale majority experience progressive degeneration through periods of exacerbations and remissions as the disease advacnes, exacerbations leav egreater ongoing disability and the length of remissions decrease ongoing sx can incldue emotional lability, depression, dementia, psych problems, spasticity, tremor, weakness, paralysis, sexual dysfunction and loss of bowel and bladder control ABC drugs immunomodulatory meds exercise in the morning to avoid fatigue bc are well rested freq rest breaks prevent disuse atrophy I/M PT will NOT alter the progression of the disease process but rather treat the current symtoms and assist the patient to attain the highest level of function factors that influence exacerbations include heat stress infection trauma and pregnancy generally a disease that creates permanent damage and disability most patients live for many years and die from secondary complications such as disuse atrophy, pressure sores, contratures, patholigcal fractures, renal infeciton and peumonia if left untreated 50% will require a w/c within 15 years post diagnosis overall mortality rate and long term outcome correlates to age at diagnosis, number of attacks and exacerbations, frequency and duration of remissions, and type of MS suicide is also seven times higher twhen compared to the same age control group without MS similar to dystonia (muscles contract uncontrollably) which is a neurologic syndrome that presents with involuntary and sustained muscle contractions that cause repetitive movements, can be idiopathic which has a genetic basis and accounts for 2/3 of cases, secondary dystonia usually results from brain damage or CNS damage no definitive tests to diagnose dystonia can have spontaneous remission in 25-30% of cases

hoffmans reflex

Purpose: Upper motor neuron lesion Method: PT flicks/tap/snap the distal phalanx of the index, middle, or ring finger. Positive Test: Reflex flexion of the index finger and thumb

Knee Extension (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Quad Side-lying on side to be tested, hip of lower limb extended, knee in 10* flexion Stabilize the medial aspect of distal femur Dynamometer on anterior aspect of distal leg just proximal to ankle Resistance perpendicular to leg in direction of knee flexion

Ballistic Stretching

Quick, jerky movements that result in a rapid change in muscle length Placed near end range and then bounces back and forth High intensity, short duration Because it occurs quickly it activates muscle spindles and results in greater resistance to stretch therefore it is not as effective for improving tissue extensibility though it may be more effective when preparing the muscles for athletic activity Also more likely to lead to muscle soreness and injury due to the high intensity of stretch force

cerebellum

RAM posture balance through muscle tone and positioning of extrems two hemispheres of GRAY matter IPSILATERAL imapirment when damaged produces ataxia, nystagmus, tremor, hypermetria, poor coord, deficits in postural reflexes, balance, and equilibrium

Rocker bottom shoe used for

Reduction of the function or replace the lost function of a joint, relieve MT pain, shorten the gait cycle and assist with DF Reduces extension in great toe which can help decrease pain

Reliability and Validity of Goni

Reliable (possessing repeatability of measures) and valid (meaningful interpretation can be inferred through the measure) when performed by a trained individual following the recommended procedure

Toe/Partial Toe Disarticulation Amputation

Removal of toe at joint

extrinsic (augmented) feedback

Represents the information that can be provided while a task or movement is in progress or subsequent to the movement. This is typically in the form of verbal feedback or manual contacts. current research supports reducing the extrinsic feedback (fading of feedback) in order to ultimately enhance learning

Pros and cons of MMT

Requires no equipment other than examiners hands, highly portable and inexpensive. A disadvantage is that this type of testing provides muscle strength data at only one point of ROM, subjective in higher grades MMT is standardized, MMscreening is convenient (lacks positioning with regard to gravity)

Partial Foot/Ray Resection

Resection of the 3rd, 4th, 5th metatarsals and digits

Rotator Cuff Tendonitis GOLD

Repetitive overhead activities can produce impingement of the supraspinatus tendon immediately proximal to the graeter tubeercle of the humerus Caused by an inabhility of a weak supraspinatus to adequately depress the head of the humerus during elevation of the arm As a result the humerus translates superorly due to the disprportionate action of the deltoid muscle Primary = intrinsic or extrinsic factors within the subacromial space Secondary = poor mechanics or instability at the shoulder Supraspin most common may see bicipital or infra as well as bursitis coexisting swimming, tennis, baseball, painting and other manual labor excessive use to prolonged period of inactivity can also produce this condition individuals 25-40 years old are most likely to develop this condition Presetns with difficulty with overhead actviities and a dull ache following periods of activity, the patient may experience feeling of weakness and identify pain between 60-120 degrees of active abduction (during arc), pain with palpation of musculoteninous junction and with stretching or resisted contraction of the muscle pain increases at night (same as bicep rupture/tendonitis) and difficulty sleeping on the affected side, difficulty dressing and repetitive shoulder motions such as lifting, reaching throwin swining or pushing and pulling with the involed upper extremity MRI not usually used because of highcost Xray for bony stuff Often presents in association with impingement syndrome which involves the flenoid labrum, supraspin, long head of the biceps and subacromial bursa it is extremely difficult to determine through exam the exact level of involvment of each of the identified structures management - cryo, act mod, ROM, and rest Acute = make sure all ROM and strengethning is pain free because the rotator cuff muscles are dependent on adqquate blood supply and oxygen pulleys and cane are used start sterngthening with arm at side to avoid impingement elastic tubing or handheld weight preferred want entire rotator cuff strong before initiating overhead activities shoudler shrugs and push ups with the arms abduction 90 degrees can be used to strengthen upper trap and serratus anterioer this type of activity promotes elevation of the *acromion* without direction contact with the rotator cuff Return to PLOF within 4-6 weeks outcome dependent on patietns classification Stage I - less than 25 years old and consists of localized inflamm edema and minimal bleeding around the rotator cuff Stage II - progressive deterioration of the tissues surrounding the rotator cuff and is common in 25-40 year old patients Stage III - end stage and is usually found in patients over 40 years of age, there is usually disruption and or rupture of numerous soft tissue structures Failure to treat = sig activity modifications, more aggressive surgery such as subacromial decompression prolonged inflamm can lead to eventual tearing of the cuff Can look like tear

Best position for diaphragmatic breathing training for weak diaphragm and hypertensive patient

Reverse trendelenberg Where the head is elevated on an incline Uses gravity to reduce weight of abdominal contents on the diaphragm (unlike supine where they are very heavy, can reduce functional residual capacity of the lungs by as much as 50%)

Distal IP Splint

Rigid volar or dorsal tip of finger to prox portion of middle phalanx tx for mallet finger, DIP fx, DIP arthritis when treating mallet finger, the DIP joint should be placed in neutral or slight hyperextension to allow for healing of the damaged extensor tendon allow structres to heal or to rest a painful for inflammed joint

3 Types of Movements at Joints

Roll, slide, spin

Infraspinatus Test

Rotator cuff pathology/impingement Infraspinatus strain/tear The patient stands with their elbow flexed to 90 degrees and the shoulder in 45 degrees of medial rotation, the patient then resists as the therapist applies a medially directed force tot he forearm Pain or weakness indicates the presence of an infraspinatus strain/tear

Lift Off Sign (Medial Rotation Lag Sign)

Rotator cuff pathology/impingement Lesion to subscap The patient stands and places the dorsum of their hand on their low back, the patient is adsked to move their hand away from their back, if they are unable to do this, the therapist should passsively move the patient's hand away from their back and see if they can hold the position An inability to hold the position indicates that a subscapularis lesion is present

Hawkins-Kennedy Impingement Test

Rotator cuff pathology/impingement Shoulder impingement The patient is positioned in sitting or standing, the therapist flexes the patient's shoulder to 90 degrees and then medially rotates the arm A positive test is indicated by pain and may be indicative of shoulder impingement involving the suprapinatus tendon

Deep Sensory Receptors

Ruffini Endings Paciniform Endings Golgi Ligament Endings Free Nerve Endings

Diaphragm referral

Shoulder or lumbar spine

Metacarpophalangeal joints of digits 2-5

Slight flexion Phalanges are concave Metacarpals are convex Same direction

Proximal and distal interphalangeal joints of digits 2-5

Slight flexion Proximal phalanges are convex Distal phalanges are concave Same direction

Interphalangeal joints of the toes: resting position, convex or concave for all motions, arthrokinematic/osteo motion

Slight flexion Proximal phalanges are convex Distal phalanges are concave Same direction

Open and Closed Pack Position of Interphalangeal Joint

Slight flexion (anatomical position) Full extension

Abnormal Soft End-Feel

Soft tissue approximation I.E. edema synovitis ligament instability/tear

Normal Soft End-Feel

Soft tissue approximation I.E. elbow flexion knee flexion

SAID Principle

Specific Adaptations to Imposed Demands Body will adapt according to the specific type of training that is utilized Training should specifically mirror the desired goal If want power train power not strength or endurance

Force-Velocity Relationship

Speed of a muscle contraction affects the force that the muscle can produce For concentric, as speed increases, force of contraction decreases During eccentric, as the speed of contraction increases, the force of contraction also increases

stage 1 of frozen shoulder

Stage 1 is characterized by the gradual onset of pain with decreased movement and night pain. The patient typically presents with a loss of external rotation motion with intact rotator cuff strength. The duration of this stage is usually less than three months.

Standard Terminology

Stance Phase (heel strike, foot flat, midstance, heel off, toe off) Swing Phase (acceleration, midswing, deceleration)

Temporal Variables of Gait

Stance Time Single support time (occurs twice during a single gait cycle) Double support time (does not exist during running, the time of double support increases as the speed of gait decreases) Stride duration (time between right heel strike and the following right heel strike) Step Duration (time between right heel strike and left heel strike) Cadence (the number of steps an individual will walk over a period of time)

Isometric Contraction

Static strength (break test)

Normal Firm End-Feel

Stretch I.E. ankle dorsiflexion finger extension hip medial rotation forearm supination Most are firm

Abnormal Firm End-Feel

Stretch I.E. increased tone tightening of the capsule ligament shortening

Distance Variables of Gait

Stride length (distance measured between the right heel strike and the following right heel strike) The average stride length for an adult is 56 inches! Step length (distance measured between the right heel strike and the left heel strike) The average value for an adult is 110-120 steps per min! Width of base of support (distance measures between the left and right foot during progression of gait, the distance decreases as cadence increases) The average base of support for an adult is two to four inches!

Contusion

Sudden blow that damages superficial and deep structures Tx = active range of motion, ice and compression

Proximal Radioulnar Joint

Supination then pronation

Digital Amputation

Surgical removal of a digit at either the metacarpophalangeal, proximal interphalangeal or distal interphalangeal level

Tarsal Tunnel Syndrome BRONZE

TIbial nerve, posterior tibial artery, and tendons of the flexor hallucis longus, tib posterior, and flexor digitorum longus pass through here occurs as a result of compression of the nerve as it passes through causing neurpathy in the distribution of the nerve injuried by compression motor and sensory distrub caused by isntrinsic like tumor or scar tissue or extrinsic like crush injury or severe ankle sprain or tension facrors i.e. pes panus or hindfoot deformity presnts with pain, numbness, paresthesias int he foot that may be initially mistaken for plantar fasticisis antalgic gait pattern is common when sx are exacerbated rest alleviates but does not compeltely resolve symtpoms atrophy may be visibly osberved and confirmed with MMT long standing might show trophic changes neuropathy confirmed thorugh EMG or nerve condution velocity testing to confirm this diagnosis though the etiology of the neuropathy must be confirmed by MRI or ultasound xray to see if bony structreus contibute family history of neuropathy or hammer toes or cavus foot may also assist in confirming the diagnosis?

Wright Test (Hyperabduction Test)

TOS The patient is positioned in sitting or supine, the therapist moves the patient's arm overhead in the frontal plane while monitoring the patient's radial pulse A positive test is indicated by an absent or diminished radial pulse and may be indicative of compression in the costoclavicular space

what traditional outcome measures can you use with amputees

TUG and 6MWT

Talipes equinovarus

Talipes equinovarus, also known as "clubfoot," is a deformity characterized by adduction of the forefoot, varus positioning of the hindfoot, and plantar flexion at the ankle. This is a congenital abnormality which can be corrected surgically. Assessment for deformities such as talipes equinovarus should be performed when examining the extremities of a newborn.

Lisfranc Amputation

Tarsometatarsal Surgical removal of the metatarsals. The amputation preserves the dorsiflexors and plantar flexors.

Grade I Strain

Tendon Localized pain, min swelling, tenderness

Grade III Strain

Tendon A palpable defect of the muscle, severe pain, and poor motor function

Proprioception

The ability to tell where one's body is in space statically

distributed practice

The amount of rest time between trials is equal to or is greater than the amount of practice time for each trial

myodesis

The anchoring of muscle tissue or tendon to bone using sutures that are passed through small holes drilled in the bone. This procedure is performed as part of the amputation closure process.

Muscle Activity at Loading Response

The ankle dorsiflexors act eccentrically to control lowering of the foot towards the ground. The quads contract eccentrically to control knee flexion as the limb accepts the weight of the body. In the latter portion of this phase, the plantar flexors eccentrically control dorsiflexion as the tibia moves over the foot. The quad contraction becomes concentric to draw the femur forward over the tibia. Throughout the loading response phase, the hip extensors contract concentrically to produce hip extension.

Muscle Activity during Midswing

The ankle dorsiflexors continue to contract concentrically to maintain dorsiflexion. Knee and hip muscle activity are minimal during this phase since forward momentum allows for advancement of the limb.

The anterior apprehension test for the shoulder places the joint in which position?

The anterior apprehension test for the shoulder places the joint in which position?

effective radiating area

The area of the transducer from which the ultrasound energy radiates always slightly smaller than the total size of the transducer head relevant when considering the size of the transducer to utilzie and the duration of treatment

Archimedes' Principle

The buoyant force on an object submerged is equal to the weight of the fluid that is displaced by the object. From the buoyant force, the volume or average density of the object can be determined.

Pain-spasm-pain Cycle

The cycle in which nociceptor activation results in transmission cell activation that stimulates anterior horn cells to cause muscles to contract. This produces compression of blood vessels, accumulation of chemical irritants, mechanical compression of the nociceptor, and a resultant increase in nociceptor activation.

Lateral vs Anterior Spinothalamic tract

The lateral spinothalamic tract transmits pain and temperature. The anterior spinothalamic tract (or ventral spinothalamic tract) transmits crude touch and firm pressure.

Stress-relaxation

The longer a stretching force is maintained, the more the tension within the tissue decreases, therefore less force is required to maintain the same tissue length

Capsular Patterns

The motion(s) that will be limited if the capsule is the limiting structure

Thompson Test

The patient is positioned in prone with the feet extended over the edge of a table. The therapist asks the patient to relax and proceeds to squeeze the muscle belly of the gastrocnemius and soleus muscles. A positive test is indicated by the absence of plantar flexion and may be indicative of a ruptured Achilles tendon.

Thessaly Test

The patient stands on one leg with approximately 5 degrees of knee flexion while the therapist provides their hands to assist the patient with their balance, the patient then rotates the femur on the tibia laterally and medially three times, the test is then repeated with a 20 degree knee bend, if the patient has joint line discomfort or catching or locking in the knee, the test is positive for a meniscal tear This test should be performed on the unaffected extremity first and then the affected extremity

Length-Tension Relationship

The relationship of muscle length to its ability to generate strong contractions. Maximum tension (contraction strength) is achieved at sarcomere lengths between 2.0 and 2.2 microns. Tension decreases outside of this range

5/5 MMT

The subject completes range of motion against gravity with maximal resistance Normal

Plantar Fascitis GOLD

Thin layer of tough tissue that supports the arch of the foot Inflammatory process of the aponeurosis at its origin on the calcaneus Chronic overuse develops secondary to repetitive stretching of the plantar fascia through excessive foot pronation during the loading phase of gait, this results in stress at the calcaneal origin Injust can occur to the plantar fascia itself and cause microtearing, inflamm and pain THe abductor hallucis, fleor digitorum brevis, and quadratus plantea muscles share the same origin on the medial tubercle and may also become inflammed Causes are excessive pronation, tightness of the foot and calf musculature, obesity and possessing a high arch A person participating in enduance sports such as runing and dancing or a person that walks a lot on the job area at risk More common in the middle aged population and it also occurs in younger people but usually inc ombination with calcaneal apophysitis Presents with severe pain in nthe heel when first standing up in the morning when the fascia is contracted stiff and cold, this pain has also been reported to radiate proximally up the calf or distally to the toes (most common symtptom that relates to this specifc diagnosis) Pain typicalyl subsides for a few hours during the day but increases with prolonged activity or when the patient has been nonweight beraing and resumes a weight beraing posture Pain has also been described by patients as pain that move around Point tenderness at insertion unilateral and tightness in the achilles tendon MRI can be used to confirm but not normal to do only if pain persists Bony hypertrophy can occur at the origin of the plantar fascia resulting in a heel spur Heel spurs develop initially as calcium deposits that form due to the repetitive stress and inflammation in the plantar fascia Local corticosteroid injections or antinflamm meds Deep friction massafe shoe modification heel insert orthotic heel cup and casting Night tensions splints may be indicated if symptoms persist PLOF in 8 weeks total resolution can take up to 12 mo good outcomes 10% develop chronic disabling symptoms Tarsal tunnel is similar tibial nerve passes beween medial malleolus and calcaneus pain in WB but not with direct palpation of the plantar fascia numbness burning tingling paresthesia b/c of entraphmen due to inflamm or ticheking of flexor retinaculum

Distraction Test

This test is used for patients who are currently experiencing radicular symptoms, with the patient sitting, the therapist places one hand under the patients chin and the other hand under the occiput, the therapist then applies an upward distraction force, the test is positive for cervical nerve root compression if pain is decreased with the distraction force

exoskeletal shank

This type of shank consists of a rigid external frame covered with a thin layer of tinted plastic to match the skin color distally

C8 Myotome

Thumb extension

Ankle Dorsiflexion (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Tibialis Anterior Side-lying on side to be tested; DF at ankle Stabilize the medial aspect of the distal leg Dynamometer on dorsal aspect of foot near metatarsal heads Resistance perpendicular to dorsum of foot in direction of ankle PF

Subtalar Inversion (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Tibialis Posterior Supine w/ LE extended, ankle in slight PF, subtalar joint inversion Stabilze the anteromedial aspect of tibia Dynamometer on medial aspect of foot near base of first metatarsal Resistance perpendicular to medial aspect of foot in direction of subtalar eversion

1st Carpometacarpal Opposition ROM

Tip of thumb to base of fifth digit

Clawing of toes is caused by

Toe flexor spasticity Positive support reflex

Standard Toe Off

Toe off is the point in which only the toe of the stance limb remains on the ground

Chopart's Amputation

Transverse Tarsal Amputation through the talonavicular and calcaneocuboid joints. The amputation preserves the plantar flexors, but sacrifices the dorsiflexors often resulting in an equinus contracture.

Silver sulfadizine (Silvadene)

Treats burns, usually with open method of wound care, used to avoid acid-bas complications, keeps eschar soft, making debridement easier can cause GI problems allergic reactions and leuopenia aka below 5000

Class I Lever

Tricep Seesaw Very few it body

Elbow Extension (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Triceps Brachii Anconeus Seated with arm supported on table, shoulder abducted to 90 degrees, elbow partially flexed, forearm supinated Stabilize over the anterior aspect of the ips arm The dynamometer is placed on the dorsal surface of the forearm just proximal to the wrist Resistance is perpendicular in the direction of elbow flexion

Down Syndrome GOLD

Trisomy 21 occurs when there is an error in cell division either through nondisjunction (95%) translocation (4%) or mosaicism (1%) and the cell nucleus results in 47 chromosomes nondisjunction occurs when faulty cell diviision results in three specific chromosomes instead of two and extra chromosomes are then replicated for every cell trans occurs when part of a cromosome breaks off during cell division and attaches to another chromosome - the total is still 46 but down syndrome exists mosaicism occurs right after fertilization when nondisjuncition occurs in the initial cell divisions mix of cells with 46 and 47 chromosomes the pair of 21st chromosomes is responsible for down syndrome when those three faulty cell dviisions occurs during cell diviiosn etiology unknown theories - increase in materanal age and age of the oocyte, virus, paternal age, medical exposure, reproductive medications, intrinsic predispositions 1 in 800-1000 live birhts 350,000 living with DS most common cause of intellectual disability hypotonia, flattened nasal bridge, almond shaped eyes, abnormally shaped ears, simian line (palmar crease) epicanthal folds, enlargement of tongue, congenital heart disease, developmental delay and variety of MSK disorders pregnant mom can be tested for alpha fetoprotein, human chorionic gonadotropin and unconjugated estrogen levels (the triple screen) chorionic villus sampling, amniocentesis or percutaneous umbillical blood sampling detected 60-70% of the time after birth chronomose analysis called karyotype can be performed to confirm mainlydiagnosed through physical characteristics at birth Peabody developmental motor scales bayley scales of infant development WEE-FIM assessment of cough and clearnce of secretions secondary complications include atlantoaxial instability, sensory, hearing, and visual impairments, umbilical hernia, respiratory compromise, and alzheimers disease also have increased incidence of celiac disease, epilepsy, constipation, as well as blood, dermatologic, and MSK disorders PT focus on developmental delay, hypotonia, laxity of the ligamnts, and poor strength and learning strategies based on level of intellect regularly have signifcant verbal-motor impiarments when they verbally respond to a timulus *PT will NOT accelerate developmental milestones, but will help the patient avoid compensatory patterns with static positioning and mobility (aka teach optimal movement patterns)* routine exercise for HEP to avoid obesity and inactivity positioning and handling are key components in order to maximize proper alignment and minimize patholoigcal relfexes, malalignment and instability I/M PT basis less than normal life expectancy but is close to normal because of medical advacnes higher mortality because of congenital heart defects and GI anomolies immune system dysfinction, repeated resp infections, onset of leukemia, pulmonary hypertension, and complications from alzhemiers disease 80% will reach 55 similar to prader-willi, a genetic disorder that occurs when there is a partial deletion of chromosome 15 characteristics include hypotonia, difficultesi feedng during infancy, short stature, excessive appetite, and obesity through childhood, learning disabilites also exist

head-hips relationship

UE weight bearing is used as a fulcrum for activity head opposite of hips

UMN vs LMN effects

UMN - hyperactive relfexes, mild atrophy from disuse, no fasciculations, tone LMN - dimished or absent relfexes, atrophy, fasciculations, hypotonic to flaccid

hyperactive DTRs indicates

UMN lesion

lead pipe rigidity

Uniform, constant resistance as limb is moved

Improve posture with PNF

Up and away motions

Cerebral Palsy GOLD

Umbrella term used to describe a group of non progressive movement disorders that result from brain damage CP is the most common cause of permanent disability in children hemorrhage below the lining of the ventricles, damage to the central nervous system that caused neuropathy and anoxia, and hypoxia that caused encephalopathy hypoxic and ischemic injruies disrupt normal metabolism that result in global damage to the devleoping fetus CP is classified by neuro dysfunction and extremity involvement spastic CP involves upper motor neuron damage athetoid CP involves damamge to the basal ganglia risk factors are prenatal (80%) and postnatal (20%) prenatal include Rh incompatibility, materanal malnutrition, hypothyroidism, infection, diabetes, and chromosome abnormalities perinatal include multiple or peremature births, breech, low birth weight, prolapsed cord, placenta abruption and asphyxia post natal include CVA, head trauma, neonatal infection, and brain tumor the most common cause of CP is prenatal cerebral hypoxia CP is the second most common neuro impairment seenin children (following intellectual disability) CP is a neuromuscular disorder of posure and controlled movement however clinical presentation is highly variable based on the area and extent of CNS damage may present with high tone, low tone or athetoid movement classified as monoplegia, hemiplegia, quadriplegia mild mod or severe general characterisitics include motor delays, abdnomral muscle tone and motor control, relfex abnormalities, poor postural control, high risk for hip dislocations, and balance impairments intellect, visiion, hearing, and perceptual skills are usually altered in conjunction with CP all other characteristics are classification dependent If CP is suspecgted through clinical findings, including seizures an EEG may be performed xray of the hip may rule out hip dislocation blood and urine if suspect metabolic cause observation usually will diagnose CP secondary to the observed outward characteristics (aka clinical diagnosis) complications can include aspiration, pneumonia, contractures, scoliosis, and constipation intellectal disability and epilepsy are present in 50-60% of cases common comorbidities include learning disability, seisurre disorders, vision and hearing impairments, bowel and bladder dysfunction, microcephalus and hydrocephalus secondary imparimetns may include psychosocial issues for the patient and family members management = PT for neurodevelopmental treatment and sensory integratin techniques surgery may be necesary for hip correction, contracture release, motor point block, dorsal rhizotomy or correction of scoliosis PT is meant to maximize a patient level of current function and prevent secondary loss if a patient is going to ambulate this will occur by the age of eight the abiliyt or inability to ambualte will have a large impact on the direction and goals of therapeutic intevention CP is non progressive but permanent condition prognosis of mild to moderate CP is near normal lifespan 50% of children with severe CP die by the age of 10 similar to arthrogryposis multiplex congenita AMC occurs in utero and is also considered to be nonprogressive AMC is a neuromuscular syndrome classified into three forms the infant is born with multiple contractures and may have fibrous bands that developed in place of muscles a patient with AMC should have a normal life expectancy and is typcally of normal intelligence* it is usually difficult fort these individuals to live indpendently due to their level of physical disabiltiy Outcome measures: Barthel index, bayley scale of infant development, bruininks-oseretsky test of motor proficiency, Alberta infant motor scale, pediatric evaluation of disability inventory, auscultation lunges, adapted pain scale

Power Grip includes

Used when a strong or foreful grip is needed Fingers in flexion and ulnar deviation and slight extension Cylindrical grasp soda can Fist grasp simialr to cylindrical but narrower object so that the thumb and fingers overlap hammer Spherical grasp fingers are sep from each other and there is greater amount of thumb opposition baseball Hook grasp use of the second and thrd interphalangeal joints to create a hook to hold an object, hook is controled by the forearm flexors and extensors, handle such as a pail

Second to Fifth Metatarsophalageal Joint

Variable

Insufficient hip flexion at initial contact is caused by

Weak hip flexors Hip flexor paralysis Hip extensor spasticity Insufficient hip flexion ROM

Exaggerated knee flexion at contact is caused by

Weak quadriceps Quadriceps paralysis Hamstrings spasticity Insufficient extension ROM

Rancho Los Amigos Terminology

Weight acceptance (initial contact and loading response) Single limb support (midstance and terminal stance) Swing limb advancement (pre-swing) Initial swing (midswing and terminal swing)

Normal Sway

What is the normal anteroposterior sway at quiet stance in young adults? Definition 5-7 mm Term What is the normal mediolateral sway at quiet stance in young adults? Definition 3-4 mm

When wrapping a residual limb of a patient following a transtibial amputation, what size elastic bandages would be the most appropriate?

When wrapping the residual limb of a patient who has had a transtibial amputation, two four-inch bandages should be used. The limb should be wrapped with a figure-eight pattern for equal pressure and appropriate limb shaping.

Which test is used to differentiate between restrictive and obstructive diseases?

Which test is used to differentiate between restrictive and obstructive diseases? x-ray airway conductance stress test static lung volumes Correct Answer: static lung volumes Static lung volumes include total lung capacity, functional residual capacity, and residual volume. These measures are useful in differentiating restrictive and obstructive diseases as well as detecting hyperinflation

Cervical Flexion Rotation Test

With the patient in supine, the therapist fully flexes the patient's cervical spine, the therapist then rotates the cervical spine in each direction while maintaining flexion, the patient should have approx 45 degrees of rotation in each direction, if the patient has limited rotation in this position then the dysfunction is likely occuring at the atlantoaxial joint, this test can also be used as a provocative test for cervicogenic headache

decorticate rigidity

a characteristc of a corticospinal lesion at the level of the brainstem that results in the trunk and lower extremities positioned in extension and the upper extremities are positioned in flexion arms look like stroke posturing

decerebrate rigidity

a characteristic of corticospinal lesion at the level of the brainstem that results in extensin of the trunk and all extremities arms look like tip taker

chopping

a combination of bilateral upper extremity asymmetrical extensor patterns performed as a closed-chain activity

motor program

a concept of a central motor pattern that can be activated by sensory stimuli or central processes. Motor programs are seen as containing the rules for creating spatial and temporal patterns of motor activity needed to carry out a given motor task

myoelectric prosthesis

a device using electromyography signals to control movements of the prosthesis with surface electrodes or implantable wires

neologistic

a new word that is coined especially by a person affected with schizophrenia, is meaningless except to the coiner, and is typically a combination of two existing words or a shortening or distortion of an existing word

metal upright AFO is normally prescribed for

a patient that has fluctuating tone and/or sensory deficit may be locked in neutral at the ankle joint if an increase in TONE exists or in the absence of voluntary motion

cephalic to caudal

a person develops head and UE control prior to trunk and LE control. general acquisition from the direction of head to toe

performance

a temporary change in motor behavior seen during a particular session of practice that is a result of many variables, however, only one variable is focusing on the act of learning performance is not an absolute measure of leraning since there are multiple variables that potentially affect performance

suspension

a term used to describe how the prosthetic socket is attached to the residual limb common types of suspension include vacuum, shuttle lock, suction, wasit belt and harness

paresthesia

abnormal sensation such as tingling, pins and needles or burning sensations

analgesia

absence of pain while remaining conscious

anesthesia

absence of touch sensation

bronchi branch many times before terminating in the...

acinus or respiratory unit of the lung

Bell's Palsy SILVER

acute onset of sensory and motor deficits in structures applied by the facial nerve the result of abnormal pressure on the facial nerve, commonly associated with edema or inflammation primarily affects the muscles associated with facial expression however it can impact saliva and tear production facial nerve is cranial nerve 7 (VII) nerve of facial expression associated with taste sensation on the anterior aspect of the tongue and voluntary motor control of most facial muscles nerve originates in the brainstem traveling with the vestibulocochlear nerve cranial nerve VIII 8 around middle ear structures before exiting through the stylomastod foramen and passing through the parotid gland where it divides into five major branches etiology is typically viral and most frequently caused by the herpes simplex virus though it has also been linked to epstein barr virus, varicella zoster virus and HIV after inital exposure the virus remains dormant for a period of time and once reactivated it reproduces and travels along the nerve infecting the schwann cells that surround the nerve the innume systems inflammatory resposne produces abnormal pressure on the nerve and results in subsequent symptoms can be sudden or progressover a few days affects only one side typically begin with a feeling of generalized stiffness or tightness a facial droop is the most recongnizable other sx include difficulties with motor skills that may interfere with eye and mouth closure, eating, and facial exp i.e. one sided smiling decreased taste sensatin, altered tear and saliva production, and increased auditory sensitivity may also be reported MRI or CT can assist in identifying the presence of an infectin or structual abnormality i.e. tumor or fx whcih may be the cause of the pressure blood tests and imaging may be used to rule out condition that mimic it like lyme disease and CVA EMG can be utilized to evaluate the extent and severity of nerve damage prelim diagnosis made with functional assessment of facial muscle perofrmance and symmetry with smiling, frowning, clsing the eyes, baring the teeth and raising the eyebrows management limited to education, monitoring and use of antiinflamm to releive pressure on the nerve PT focused on prevention of long term deficits which may occurf with paralysisrelated to muscle shortening and recovery realted muscle weakness or dimished coordination moist heat can help maintain pliable musclulature and increase comfort biofeedbackk and NMES canhelp too eye drops or ointments and eye rotection esp during sleep may be indicated if the patient cannot fully close the eye or produce tears in order to sheild the eye from debris and injury that may cause corneal scratching self limiting condition**** that is not life threatening majoiryt experience spontaneous recovery which may occur in a matter of weeks depending on the severity recovery can take up to 6 months once recovery is compelte, patients do not typically have residual functional deficits of the condition though uncommon long term complciations may occur these may include altered sense of taste, partial or total paralysis due to nerve damage, synkinesis (misswirling of nerves causes involuntary movments) resulting from abnormal nerve regeneration or partial to complete blindness due to eye injuries

what type of surgery can you do for DVT

add a "filter" to the vena cava to prevent clots from reaching the lungs

color of hand (regaining color) what test

allens test

angle of inclination

alterante method of expressing slope percent grade 100% completely vertical 0% horizontal rise/runx100

S1 key muscles

ankle plantar flexors (gastroc and soleus)

automatic postural strategies

ankle, hip, suspensory, stepping

sensory stimulation techniques for facilitation

approximation joint compression icing light touch quick stretch resistance tapping traction

examples of hypokinesia

apraxia rigidity bradykinesia

aortic valve

between the left ventricle and the aorta

pulmonary valve

between the right ventricle and pulmonary artery goes into the pulmonary trunk which divides into right and left pulmonary arteries serving the right and left lungs

subdural space

between the ura and arachoid

muscles that help with a forward raise pressure relief

biceps and deltoid in C5 tetraplegia

left AV valve aka

bicuspid/mitral valve controls blood between the left atrium and the left ventricle

hip knee ankle foot orthosis HKAFO

bilateral extension to the hips and a pelvic band can control rotation at the hip and abduction/addcution heavy and restricts patients to a swing to or swing thorugh gait pattern

magnetic resonance imaging MRI

brain scan non invasive detailed images including tissues organs bones and nerves rule out tumors, MS and head trauma

weird female male situations

bring a female to watch do not give to another therapist if have the option to have someone watch

heel wedge

can be applied to the medial heel to prevent excessive hindfoot eversion or to the lateral heel to prevent excessive hindfoot inversioon can be used to treat sx associated with pes planus or pes cavus

dysnmaic response foot

can be articulating or non keel has the capability to store and return some energy may hae a split keel to allow for improved surface accomodation

corticosteroids are contraindicated in daibetes because

can elevate BS

Amyotrophic Lateral Sclerosis ALS GOLD

chronic degenerative disease that produces both upper and lower motor neuron impairments demyelination, axonal swelling, and atrophy withiin the cerebral cortex, premotorareas, sensory cortex, and temporal cortex cause the symtpoms of ALS rapid degeneration and demyelintaion occur in the giant pyramidal cells of the cerebral cortex and affect araes of the corticospinal tracts, cell bdies of the lower motor neurons in the gray matter, andterior horn cells, and areas within the precentral gyrus of the cortex rapid degen causes denervation of muscle fiebrs, muscle atrphy and weakness etiology unknown theories - genetic inheritance as an autosomal ominant trait, slow acting virus, metabolic disturbances, toxicity of lead and aluminum familial 5-10% of cases, risk is higher in men and usually occurs betwenn 40 and 70 years of age presentation - upper and lower motor neuron involvement LMN = asymmetric muscle weakness, cramping, atrphy usually found in hands muscle weakness due to denervation eventually cuases significant fasciculations, atrophy, and wastinf o the muscles spreads throughout the body and follows distal to proximal path UMN = loss of inhibition of the muscle, incoordination, spasticity, clonus and a postiive babinski bulbar involvement incldues dysarthria, dysphagia, and emotional lability initally may only have one but eventually will have both upper and lower motor neuron sx will exhibit fatigue, oral motor impairment, fasciculations, spasticity, motor paralysis and eventual respiratory paralysis electromyography, muscle biopsy (verifies lower motor neuron involvement vs muscle disease), spinal tap (higher protein content), CT scan normal until late in disease diganosis cannot occur until a neurologist rules out other neuro disorders such as MS, SC tumor, MD, lyme disease and syringomyelia diangosis depends on symtpoms, pt with motor impairment and no sensory is aprimary indicator of ALS self care and home index - barthel index may also exhibit paralysis of vocal cords, swallowing impairment, contracutres, decubiti, and difficulty breathing requiring ventilatory support sensation eye movement and bowel and bladder function remain intact *** riluzole (rilutek) meds effect on progression long term effects are unknown may also use an anticholinergic PT for QOL and LOW-level exercise bronchial hygiene PT does not hhinder progression of ALS average course of 2-5 years with 20-30% surviving longer than 5 years if diganosed before 50 usualyl longer in course death occurs from respiratory failure similar to MD which is a group of inherited disorders that are progressive and exhibit degeneration of muscles without sensory or neural impairment progressive weakness occurs to the msucles fibers seondary to the absense of dystrophin within the skeletal muscles presents early in life and usually shortens life expectancy disuse atrphy, muscle deterioration, contracutes, and cardiac/resp weakness are common of this disease process a patient usually dies from resp/cardiac complciations secondary to the primary disease process ATOPHY OF HANDS RECENT CHOKING

serous vs serosanguineous vs senguiuneos vs purulent

clear normal pink normal red either good new blood vessel or disruption of blood vessel yellow infection

atrial systole

contraction of the right and left atria pushing blood into the ventricles

aging on skin

decrease in elasticity (collagen and elastin shrink) decrease in turgor (resistance of skin to deformation, i.e. pinching the skin and observing how quickly it returns to its resting position due to thinning of epithealial layers) decrease in secretions of sebaceous glands (dry) increase in dryness increased risk for damage and tearing

habituation

decrease in response that will occur as a result of consistent exposure to a non-painful stimuli

Thoracic Outlet Syndrome GOLD

describes a group of disorders that presents with symptoms seconadry to neurovasscular compression of fibers of teh rbachial plexus usually occurs between the points of the interscalene triangle and the inferior border of the axilla compression of the nerves and blood supply can also occur as they pass over the first rib brachial plexus nerve trunks, subclavian vascular supply, and axillary artery **** nerve injury can result in neurapraxia with segmental degeneration and progress to axonotmesis due to continued unrelieved compression contrib factors - presence of a cervical rib, an abnormal first rib, postural deviations or changes, body composiiotn, chronic hyperabduction of the arm, hypertrophy or spasms of the scalene msucles, degenerative disroders, an elongated cervical transverse process presents with sx based on nerve and or vascular compression typical sx = diffuse pain in the arm most often at night, paresthesias in the fingers and through the UE, weakness and muscle wasting, poor posture, edema, and discoloration if upper plexus is involved, pain will be reported in the neck that may radiate to the face and may follow the lateral aspect f the forearm into the hand if the lower plexus is involved pain is reported in the back of the neck and shoulder which will radiate over the ulnar distribution of the hand sx are aggravated with poor posure, lifting, and movements overhead xray for bony abnormalities nerve conduction velocity tests if neuropathy exists otherwise dx relies soley on history provocative testing and physical exam additional findings may be that the patient has difficulty sleeping due to excessive pillows or malpositioning of the arm the patient may hae difficulty at work with carrying items on the affected side or with driving a car most commonly affects people between 30-40 years of age with WOMEN more affected 2-3x more than men PT to modify posture, breathing patterns and positioning and gentle stretching modalities such as transcutaneous enrve stimulation US and biofeedback if conserv fails may require surgery such as decompression most patients with thoracic outlet syndrome have positive results from PT and are able to return to their previous level of function within four to eight weeks if sx persist for 3-4 months surgery may be warranted 75% of patients post surgery have a psotivie response however complications of surgrey can include winging of the scapula, pneumothorax and nerve compression no sginficant difference between surgical ressection of the first rib and successful conservative management similar to a radial nerve lesion pt will present with an inability to extend the wrist, thumb and fingers the patient will also present with impaired grip stregnth and coordination splinting is recommended PROM is necessary to prevent secondary impairments such as contractures holding phone between shoulder and ear carrying heavy breif case

a flutter is treated with what med

digoxin

rhomboids innervated by

dorsal scapular nerve

L5 sensory testing

dorsum of the foot at the third MTP joint

T8 sensory testing

eight intercostal space between T6 and T10

direction central vs peripheral lesion

either bidriectional or unidirectional unidirectional with the fast segment of movement indicating the opposite direction of the lesion

adams closed loop theory

emphasis on sensory feedback as an ongoing process for the nervous system to compare current movement with stored information on memory of past movement high emphasis on the concept of practice

radiation burn

excessive exposure to ionizing radiation (i.e. ultaviolet radiation from the sun) more uniform not scattered

superior joint capsule of the shoulder

extension and adduction

tectospinal tract descending

extrapyramidal motor tract responsible for contralateral postural muscle tone associated with auditory/visual stimuli

peroneal nerve injury caused by

femur, tibia, or fibula fracture positioning during surgical procedures

T5 sensory testing

fifth intercostal space midway between T4 and T6

T4 sensory testing

fourth intercostal space at the nipple line

MSC nerve injury caused by

fracture of the clavicle

asthenia

generalized weakness typcially secondary to cerebellar pathology

limb synergies

group of muscles that produce a predictable pattern of mvmt in flexion or extension patterns

cerebellar hyper or hypotonia

hypo typically

hematocrit is most likely to be affected by

hypovolemia immediately rises after a burn and then gradually decreases with fluid replacement

kinesthesia

identify direction and extent of movement of a joint or body part

dysprosody

impairment in the rhythm and inflection of speech

muscles innervated by the anterior cord of the brachial plexus

infraspinatus

S3 sensory testing

ischial tuberosity

ball of the foot

just behind toes common area for metatarsalgaia

galant reflex

lateral flexion of trunk to side of stimulus which is touching the skin along the spine from the shoulder to the hip 30 weeks of gestation to two months VERY YOUNG WHEN IT DISAPPEARS

S1 sensory testing

lateral heel

optimal level of LDL

less than 100 higher increase risk of coronary artery disease

white blood cells

leukocytes protect against infection a low number of WBCs (leukopenia) increases the risk of infection a high number of WBCs (leukocytosis) can indicate an infection or leukemia 5 types: neutrophils, lymphocytes, monocytes, eosinophils, basophils

L5 key muscles

long toe extensors (extensor hallucis longus)

largest amount of gray matter found in what part of the spine

lumbar

Spinal Cord Injury - Complete C7 Tetraplegia GOLD

majority of traumatic spinal cord injuries result from compression, flexion or extension of the spine with or without rotation classififed as a concussion, contusion or laceration can result in primary or secondary neural destruction traumatic injury results in a physiological and biochemical chain of events that results in vascular impairment and permanent tissue/nerve damage injury through disruption of the membrane, displacement or compression of the spinal cord, and subsequent hemorrhage and vascular damage secondary damage occurs beyond the level of injury due to biochemicals that are released as a result of the damage this process destorys adjacent cells and neural tracts due to acute inflammation and can last for days or even weeks after injury for this case, C7 is the most distal segment of the spinal cord that both the motor and sensory components remain intact 250,000 persons living with SCI in the US MVA, violence, and falls are top causes of SCI higher in MEN 80% and caucasians incidence over 50% happen between 15 and 30 years of age spinal shock, total depression of all nervous system function below the level of the lesion occurs immediately following injury and may last for several days presentation includes total flaccid paralysis and loss of all reflexes and sensation surgical intervention may be required dafter injury in order to stabilize the psinal cord throug decompression and fusion at the site of injury A halo device is commonly used with cervical injuries to stabilize the spine as spinal shock subsides, a patient will experience an increase in muscle tone below the level of lesion and relfexes reappear spasticity will evolve and may become problematic autonomic dysreflexia and loss of thermoregulation may be impaired secondary to autonomic nervous system dysfunction C7 tetraplegia in particular will also present with impaired cough and ability to clear secretions, altered breathing pattern, and poor endurance, the patient is at high risk for contractures and impaired skin integ xrays of spine myelogram or tomogram may be useful to confirm the extent of surrounding damage at the level of the injury american spinal injury association ASIA - standard neuro classification of spinal cord injury sensory/motor exam pulmonary function test most common complications include orthostatic hypotension, pressure sores, spasticity, heterotipic ossification, and autonomic dysreflexia AD is considered a medical emergency and requires immediate attention to remove the noxious stimuli and lower the blood pressure or the patient will be at risk for subarachnoid hemorrhage other findigns that require medical management will be sexual dysfunction, respiratory complications, and pain management (neurogenic, cnetral cord, perpheral nerve or MSK pain) acute - stabilization rehab next phase immediated started on methyprednisolone (corticosteroid), lipid peroxidation inhibitors, and drugs that block opriate receptors SEEM TO CONTROL AMOUNT OF SECONDARY DAMAGE and improve neuro outcome once medically stable inpatient rehab will last typically 6-8 weeks should initially focus on ROM, positioning and respiratory management head-hips relationship for moveent is vital typical outcome of C7 tetra = independence with feeding, grooming and dressing self ROM independent manual wheelchair mobility indpendent transfers indpeendent driving with adapted car indpendent living with adpative equipment is possible will NOT regain innervation below C7 level if complete SCI bc no cure at this time triceps, EPL/B, extrinsic finger extensors, FCR will remain the lowest innervated muscles 40% have a life expectancy over 45 similar to brown-sequards syndrome which is a condition that results from injury to one side of the SC motor function, proprioception, and vibration are lost ipsilaterally to the lesion and vibration pain and temperature are absent contralateral to the lesion

peak expiratory flow (PEF)

max flow of air during the beginning of a forced expiratory maneuver

arm cycle ergometer vs treadmill

max oxygen consumption will be 20-30% lower bc of smaller muscles same for volitonal fatigue

T1 sensory testing

medial side of antecubital fossa

L2 sensory testing

midanterior thigh

C7 sensory testing

middle finger

T12 sensory testing

midpoint of inguinal ligament

question says patient in "unable to prevent" hyperextension what should you do

modify the workstation strengthening or teaching him something wont change what activity he has to do

motor vs sensory stimulation

motor = low freq and long phase duration sensory = high frequency and short duration sensory requires lower amplitude than motor

T9 sensory testing

ninth intercostal space midway between T8 and T10

can you modify documentation from a previous treatment session?

no, fraud put it in the days documentation with objective findings along with the patients claim

sympathetic vs para

norepinephrine (generally stimulatory) vs acetylcholine (generally inhibitory)

slope of ramp (rise:run)

one inch of rise for every 12 inches of run

sinus tarsi

opening in the middle of the subtalar joint

corticosteroids side effects

osteoporosis muscle wasting skin breakdown cataracts adrenocorticosuppression hyperglycemia

Peripheral vs central vertigo

p- episodic and short duration autonomic symptoms present precipitating factor pallor, sweating nausea and vomiting auditory fullness tinnitus etiology - BPPV, menieres disease, infection, trauma/tumor, metabolic disorders, acute alcohol intoxication c- autonomic symptoms less severe loss of consciousness can occur neuroligcal sx including diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria etiology - meningitis, migraine HA, complications of neuro origin post ear infections, trauma/tumor, cerebellar degeneration disorders i.e. alcoholism, MS

lidocaine ionto

pain and inflamm

basophils WBC

participate in allergic responses

LE D2 Extension

pelvis: depression hip: extension + adduction + ER knee: flexion or extension ankle and toes: PF + inv

LE D1 Flexion

pelvis: protraction hip: flexion + adduction + ER knee: flexion or extension ankle and toes: dorsiflexion and inversion swing phase of gait ascending stairs

LE D1 extension

pelvis: retraction hip: extension + abduction + IR knee: flexion or extension ankle and toes: PF + eversion

superficial pain

perceive noxious stimulus using a pen cap, paper clip end or pin

temperature

percieve warm and cold test tubes avoid extreme temps ask pt to make comparisions "is it the same temperature or different" in different areas testing for temp will also predict pain since sensory receptors overlap

prevention of DVT

prophylactic anticoag, maintaining a positioning schedule, range of motion, proper positioning to avoid excessive venous stasis, and use of elastic stockings

increased fremitus with decreased breath sounds

pulmonary edema consolidation (area of lung filled with fluid) atelectasis (partial collapse)

corticospinal tract (anterior) descending

pyramidal motor tract responsible for ipsialteral voluntary, discrete, and skilled movements

Souque's phenomenon

raising the involved UE above 100 degrees with elbow extension with produce extension and abduction of the fingers

dendrite

recveives signals from other neurons

lengthening the hamstrings in CP does what

reduce a knee flexion contracture and result in improved knee extension during gait

superficial reflexes

response to stimulation of the receptiors within the skin polysnaptic reflex not like muscle stretch or deep tendon

sinus node artery

right coronary artery supplies the right atrium

right marginal artery

right coronary artery supplies the right ventricle

enzymatic debridement is selective or non

selevtive

grafts for ACL reconstruction

semitendinosus and gracilis

T1 key muscles

small finger abductors (abductor digiti minimi)

craig-scott knee ankle foot orthosis

specfically for people with paraplegia design allowws a person to stand with a posterior lean of the trunk

pulsatile lavage

specific wound irrigation technique serves as an externally applied force

babinski reflex

stroke the lateral aspect of the sole from the heel to the ball of the foot and medially to the base of the great toewith the blunt end of a reflex hammer abnormal = extension of the great toe and flexion of the other toes aka plantar reflex

myoplasty

suturing amputated muscle flaps together over the end of a bone following an amputation

systemic pain

systemic pain is difficult to reproduce unrelieved by rest or change in position

right chambers collect blood from....

the body and pump it to the lungs

oscillopsia

the illusory perception of stationary objects moving

myocardium

thick contractile middle later of muscle cells that forms the bulk of the heart wall

thenar vs hypothenar

thumb vs pinky

C4 sensory testing

top of AC joint

K-Level 1

transfers amulate on level surfaces fixed cadence limited or unlimited household ambulator single axis and constant friction mechanism for knee SACH and single axis for foot/ankle

random practice

varying practice amongst different tasks

paresis vs plegia

weakness vs paralysis

carina

where the trachea divides into right and left bronchi

acl tear immeidate imaging what do you do

xray to rule out fracture

purulent sputum

yellowish-greenish lung abscess refers to necrosis of pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by infection asthma - mucoid pulmonary edema - frothy tuberculosis - blood-tinged

do pressure ulcers require immediate attention?

yes

is an increase of 20mmHg in BP during exercise normal

yes

Subscapularis

O: Subscapular fossa of the scapula I: Lesser tubercle of the humerus A: Shoulder medial rotation; humeral head stabilization within the glenoid cavity N: Upper subscapular, lower subscapular (C5-C6)

Serratus Anterior

O: Superior borders of ribs 1-8 I: Anterior surface of the medial border of the scapula A: Scapula protraction and upward rotation N: Long thoracic (C5-C7)

Supraspinatus

O: Supraspinous fossa of the scapula I: Greater tubercle of the humerus A: Shoulder abduction; humeral head stabilization within the glenoid cavity N: Suprascapular (C4-C6)

Levator Scapulae

O: Transverse processes of C1-C4 I: Medial border of the scapula, between the superior angle and root of the spine A: Scapula elevation and downward rotation; neck side bending and rotation ipsilaterally N: Dorsal scapular (C5)

Total Knee Arthroplasty GOLD

OA decrease jotn spcae and osteophyte formation occurs to the femoral condyles, tibial articulating surface and the dorsal side of the patella high impact sports or trauma to the knee at risk for arthitits and TKA obesity, varus/valgus deformity, infection, RA, hemophilia, crystal deposition diseases, AVN 130,000 TKA performed each year severe knee pan that worsens with motion and weight bearing, impaired ROM, possible deformity of the knee and impaired mobility skills Night pain is common and may include localized or diffuse pain stiffness swelling lockign and giving way xray CT MRI to determine extent xray post op to ensure proper fit arthritis ipact measrement toll can cause sleep disorders or depression contraindiactions include active infection of the knee, sevrere obestity, genu recurvatum, arterial insuff, neuropathic joint, and mental illness post surg ocmplications = infection, vascular damage, patellofemoral instablity, fracture surrounding prothesis, PE, nerve damage, losening of prosthesis and arthrofibrosis management = knee immoilizer, elevation of limn, CPM machine cemeneted knee = PWB or WBAT noncememeted = TTWB for up to 6 weeks for the bone to grow and affix to the prosthesis d/c goal of 90 degrees flexion and 0 degrees knee extension precautions for several months after surgery aka avoid squatting, quick pivot, do not use pillows under the knee while in bed, and avoid low seated closed chain once WBAT will benefit from PT pain releif and full freturn to PLOF within 8-12 weeks hgihly successful may have minor limitations in knee range of motion may losen but generally life expect between 15 and 20 years similar to patellectomy indicated for a communuted fracture that cannot be repaired with inteval fixatin can include entire patella or just the inferior or superiir pole of the patella retinaculum and extensor mechanism are repaired with eh surgical procedure and patient is immobilzied for 6-8 weeks ocne rehab is initated the atient starts with ROM and closed chain exercises

If conVEX is moving on concave then which ways are the roll and glide?

OPPOSITE

UE D1 Flexion

Scapula: elevation + abduction + upward rotation Shoulder: flexion + adduction + ER Elbow: flex or extension Forearm: Supination Wrist: Flex + Radial Deviation Finger: Flex + Add Thumb: Add Fxtn: hand-to-mouth

Flexor Carpi Radialis

O: Medial epicondyle of the humerus and deep antebrachial fascia I: Base of the second and third metacarpal bones A: Wrist flexion and radial deviation N: Median (C6-C7) ANTERIOR FOREARM

Gastrocnemius

O: Medial head - posterior portion of the medial femoral condyle Lateral head - posterior portion of the lateral femoral condyle I: Posterior portion of the calcaneus A: Ankle plantar flexion N: Tibial (L5-S2) POSTERIOR LEG

Vastus Medialis

O: Medial supracondylar line of the femur, distal part of the intertrochanteric line, and medial linea aspera I: Proximal patella and the tibial tuberosity via the patellar liagment A: Knee extension N: Femoral (L2-L4) ANTERIOR THIGH

Posterior Deltoid

O: Posterior border of the spine of the scapula I: Deltoid tuberosity of the humerus A: Shoulder extension, lateral rotation, and horizontal abduction N: Axillary (C5-C6)

Quadratus Lumborum

O: Posterior iliac crest and iliolumbar ligament I: Transverse processes of L1-L4 and the inferior border of rib 12 A: Trunk extension and ipsilateral side bending N: Subcostal (T12) and ventral rami of (L1-L4)

Passive Insufficiency

When a two-joint muscle is lengthened over both joints simultaneously (if full ROM is limited by the length of the muscle) a biarticulate muscle cannot achieve full ROM simultaneously I.E. With the hamstrings in the fully lengthened position (knee extended), you cannot achieve full hip flexion. If this occurs, incomplete ROM will be observed at the hip. With the hamstrings in the shortened position (knee flexed), you can achieve full hip flexion.

wear schedule

"break in" schedule is normally prescribed for the first few weeks of wear this allow for montioring slow accommodation to the senation of WBing general rule to start with one hour a day of total wear time, with half of the time spent ambulating every 30 min or immediately after walking the skin shoud be inspected if tolerated, an hour is added each day while still respecting the 50% rule of rest:use if the skin is showing no signs of breakdown the amount of time between inspections is gradually expanded by 15-30 min eventually the wearer will be able to toelrate the prosthesis for extended periods of time without having to remove the prosthesis

rating of 12 on RPE

"fairly light to somewhat hard"

vagus nerve

10 X touch, pain in pharynx, larynx and bronchi taste in tongue and epiglottis voluntary motor of muscles of palate, pharynx, and larynx autonomic of thoracic and abdominal viscera gag relfex ability to swallow say AH MIXED touch pharynx with tongue depressor if gag relfex absent, therapist should carefully assess the movement of the sfot palate and uvula

compression garmets pressure ranges between

10 and 50 mmhg 10 not enough for an ambulatory patient 16-18 "off the shelf" stockings to prevent DVT for patients IN BED 20-30 controls scar formation 30-40 control edema in AMB patients

Open and Closed Pack Position of Talocrural (ankle)

10 degrees PF, midway between max inversion and eversion (anatomical position) Maximum dorsiflexion

Talocrural joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

10 degrees plantarflexion Midway between max inversion and eversion Talus is convex Tibia and fibula are concave Opposite direction

Distal radioulnar joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

10 degrees supination Ulna is convex Radius is concave Same direction

Open and Closed Pack Position of Distal Radioulnar Joint

10 degrees supination (anatomical position) 5 degrees supination

how much does your systolic BP rise with each MET

10 mmHg with a possible plateau (just like HR) with peak exercise >50 rise is commmon during graded exercise

DeLorme vs Oxford

10 reps of 50% of 10 rep max to 75% to 100% three sets total Oxford is opposite

%s of TV, IRV, RV, FRC

10% 55-60% 25% 40%

% Time Between Right Heel Initial Contact and Left Pre-Swing

10% Time of double limb support

% Time Between Left Heel Initial Contact and Right Pre-Swing

10% Time of double limb support

stand briefly without support, transition from supine to sitting or quadruped, pull to stand through half kneel and princer grasp

10-11 months

TMJ Side to Side ROM (Lateral Excursion)

10-12mm

brunnstrom how many levels

7 7 is normal 6 no spasticity 5 less spactiicty 4 movement outside of synergy 3 voluntary movement in synergies 2 movement in associated reactions and spacticity develops 1 absensce of associated reactions neuro recovery progression through abdnormal tone and spasticity

facial nerve

7 VII taste anterior tongue voluntary control of facial muscles, autonomic lacrimal, submandibular, and sublingual glands MIXED distinguish between sweet and salty on anterior tongue mimic facial expressions

Ulnohumeral joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

70 degrees flexion 10 degrees supination Humerus is convex Ulna is concave Same direction

fregly-graybiel test battery

8 test conditions looks at time spent in each test position and the number of steps that a patient takes without falling 5 trials of each condition are performed i.e. stand on beam eyes closed and open walk on beam eyes open sharpened romberg standing eyes open and closed one leg walking on floor with eyes closed score on pass/fail basis assess and treat balance dysfunction does not help diagnose cause

max aerobic capacity for men and women range between

8-12 METS older adults = 5-8 METS highly trained = 15-20 METS walking 3mph = 3.5 METS

manipulate toys in sitting, raise themselves from supine to sit, pull to stand with support and trasnfer obects with controlled release

8-9 months

normal body temp

98.6 F 37 degrees C increase or decrease of 1 degrees for a given individual can be considered normal

Interpretation of BMI (normative value)

<18.5 Underweight *18.5 - 24.9 Normal* Normative Value to know 25.0 - 29.9 Overweight 30.0 - 34.9 Obesity (Class 1) 35.0 - 39.9 Obesity (Class 2) >40.0 Extreme Obesity (Class 3)

hyperglycemia

>130 polyuria body trying to remove excess glucose hyperventilation (caused by diabetic ketoacidosis, wants to control the acidity levels withiin the blood by expelling excess carbon dioxide)

what sx can you have with diastasis recti

>2cm low back pain due to a limited abiloity for the abdominal muscles to stabilize the pelvis and lumbar spine

hyperkalemia

>8.5 cardiac arrest or respiratory paralysis

stage 2 BP

>=140 systolic OR >=90 diastolic

Energy Costs During Ambulation

?

Festinating Gait Pattern

A gait pattern where a patient walks on toes as though pushes. It starts slowly, increases, and may continue until the patient grasps an object in order to stop. I.E. with parkinsons

Vaulting Gait Pattern

A gait pattern where the swing leg advances by compensating through the combination of elevation of the pelvis and plantar flexion of the stance leg. I.E. limb length discrepancy or stiff leg

Spastic Gait Pattern

A gait pattern with stiff movement, toes seeming to catch and drag, legs held together, and hip and knee joints slightly flexed. Commonly seen in spastic paraplegia

tay sachs disease

A human genetic disease caused by a recessive allele that leads to the accumulation of certain lipids in the brain. Seizures, blindness, and degeneration of motor and mental performance usually become manifest a few months after birth. carired by eastern european jewish population

Non-capsular pattern

A limitation in a joint in any pattern other than a capsular one, and may indicate the presence of either a derangement, a restriction of one part of the joint capsule, or an extra-articular lesion, that obstructs joint motion Joint derangement - Internal derangement of the knee (IDK), for the purposes of VAC, is a chronic disorder of the knee due to a torn, ruptured or deranged meniscus of the knee, or a partial or complete cruciate rupture, with or without injury to the capsular ligament of the knee, resulting in ongoing or intermittent signs and symptoms such as pain, instability, or abnormal mobility of that knee.

Patellar Tap Test

The patient is positioned in supine with the knee flexed or extended to a point of discomfort. The therapist applies a slight tap over the patella. A positive test is indicated if the patella appears to be floating and may be indicative of joint effusion.

Varus Stress Test of the Knee

The patient is positioned in supine with the knee flexed to 20-30 degrees, the therapist positioned one hand on the lateral surface of the patient's ankle and the other hand on the medial surface of the knee, the therapist applies a varus force to the knee with the distal hand A positive test is indicated by excessive varus movement and may be indicative of a lateral collateral ligament sprain A positive test with the knee in full extension may be indicative of damage to the lateral collateral ligament, posterior cruciate lig*, arcuate complex and posteromedial capsule

Valgus Stress Test of the Knee

The patient is positioned in supine with the knee flexed to 20-30 degrees, the therapist positions one hand on the medial surface of the patient's ankle and the other hand on the lateral surface of the knee, the therapist applies a valgus force to the knee with the distal hand A positive test is indicated by excessive valgus movement and may be indicative of a medial collateral ligament sprain A positive test with the knee in full extension may be indicative of damage to the medial collateral ligament, posterior cruciate lig*, posterior oblique lig and posteromedial capsule

Slocum Test

The patient is positioned in supine with the knee flexed to 90 degrees and the hip flexed to 45 degrees, the therapist rotates the patient's foot 30 degrees medially to test anterolateral instability, the therapist stabilizes the lower leg by sitting on the forefoot, the therapist grasps the patient's proximal tibia with two hands, places their thumbs on the tibial plateau, and administers an anterior directed force to the tibia on the femur A positive test is indicated by movement of the tibia occurring primarily on the lateral side and may be indicative of anterolateral instability, the test can also be performed to assess anteromedial instability by rotating the patient's foot 15 degrees laterally

Gluteus Maximus

O: Posterior sacrum, lateral coccyx, posterior gluteal line of the ilium, fascia of the erector spinae and gluteus medius, and the sacrotuberous ligament I: Iliotibial tract of the fascia lata and the gluteal tuberosity of the femur A: Hip extension and lateral rotation N: Inferior gluteal (L4-S2)

Soleus

O: Posterior surface of proximal fibula and soleal line of the tibia I: Posterior portion of the calcaneus A: Ankle plantar flexion N: Tibial (L5-S2) POSTERIOR LEG

Vastus Intermedius

O: Proximal two-thirds of the anterior and lateral femur I: Proximal patella and the tibial tuberosity via the patellar ligament A: Knee extension N: Femoral (L2-L4) ANTERIOR THIGH

Iliopsoas

O: Psoas major - transverse processes and lateral bodies of T12-L5 Iliacus - superior iliac fossa and iliac crest I: Lesser trochanter of the femur A: Hip flexion; trunk side bending ipsilaterally N: Femoral (L1-L3)

Rhomboid Major

O: Spinous processes of T2-T5 I: Medial border of the scapula between the scapular spine and inferior angle A: Scapular retraction and downward rotation N: Dorsal scapular (C4-C5)

Lower Trapezius

O: Spinous processes of T5-T12 I: Tubercle on the spine of the scapula A: Scapula depression and upward rotation N: Accessory (cranial nerve XI)

acute burn produces hypermetabolism that results in...

increased O2 comsumption increased minute ventilation increased core temperature intravascular, interstitial and intracellular fluids are all diminished

seat depth WC

increased pressure to the distal posterior thighs measured from posterior buttock along the lateral thigh to the popliteal fold and then subtract approx 2 inches to avoid pressure from the front edge of the seat standard is 16 inches

LMN disease

lesion affects nerves or their axons at or below the level of the brainstem, usually within the final common pathway ventral gray column of sc may also be affected sx= flaccidity ot weakness of the involved muscle, decreased tone, fasciculations, muscle atophy and decreased or absent reflexes

absent DTRs mean...

lesion in the arc if accompanied by sensory then means its in the afferent/dorsal horn if accompanied by paralysis in efferent/ventral horn

high activity level what type of wheelchair

lightweight chair with a rigid frame folding frame is not good for high activity levels because it does not provide enough durability, stability, and smooth ride

vaulting and early toe off is caused by

limited dorsiflexion

hyperlipidemia treated with what med

lipitor

plasma

liquid component of blood in which the blood cells and plaelets are suspended consists of water, electrolytes and proteins, and accounts for more than HALF of the total blood volume plasma is important in regulating blood pressure and temperature

C8 sensory testing

little finger

partial hand amputation considerations

loss of a portion of digit/hand function limb sparing technique utilized when functional pinch can be perserved toe transfer to replace a thumb may be considered if prothesis fails

transtibial amputation considersations

loss of active foot and ankle motions weight bearing in the prosthesis should be distributed over the total residual limb areas of primary weight bearing should be pressure tolerant adaptations required for balance susceptible to both knee and hip flexion contractures

highest risk for infection

malabsorption syndrome (poor nutrition like deficiency in protein, vitamin A, vitamin E or zinc can result in reduced function of the T cells and B cells which aid in immune function) AIDS (destruction of lymphocytes) corticosteroid use (suppressed immune system)

normal CO value

male at rest = 4.5 to 5.0 L/min women produce slightly less can increase to 25L/min during exercise

congenital heart defects

malformation of the interior walls or valves of the heart of the major arteries and veins near the heart that are present at birth blood flow through the heart may be slows, blocked, or misdirected most common type of birth defect

left neglect and diminished proprioception how do you help

manual assistance on left facilitates motor activity and weight bearing as well as proprioception

proximal to distal

midline of the body as the reference point, trunk control (midline stability) is acquired first with subsequent gain in distal control (extremties)

vertigo central vs peripheral lesion

mild significant

hydrogel

moisture-retentive primary dressing that provide a moist environment for wound healing not typically used for prophyalxis but used to prevent a wound from dehydrating and impeding the healing process

complete vs incomplete

no preserved motor or sensory function below the level of the lesion scattered motor function, sensory function or both below the level of the lesion

Sternocleidomastoid

O: Sternal head - anterior surface of the upper manubrium Clavicular head - medial third of the clavicle I: Mastoid process and lateral portion of superior nuchal line A: Neck flexion, ipsilateral side bending, and contralateral rotation N: Accessory (cranial nerve XI)

PNF alternating isometrics

stability isometric contractions are performed alternating from muscles on one side of the joint to the other side wihtout rest emphasizes endurance and strengthening same as bridge but staying in bridge position and the therapist switches hand placement

PNF slow reversal hold

stability, controlled mobility, skill using slow reversal with the addition of an isometric contraction that is performed at the end of each movement in order to gain stability

to safely cross the street what to you need to be able to do

walk at a specific velocity most important measure of a patients ability to safely cross the street

fair balance, good strength, and occasionally impulsive what AD

walker not cane, crutches, or lofstrand crutches

ape hand

wasting of the thenar eminence weakness with thumb flexion and opposition thumb falls back in line with the other digits since the pull of the thumb extensors is stronger than the thumb flexors

resistive isometrics in a complete tear

weak and pain-free

left hemisphere CVA

weakness, paralysis of right side increased frustration decreased processing possible aphasia possible dysphagia pssible motor apraxia (ideomotor and ideational) decreased discrimination between left and right right hemianopsia

right hemisphere CVA

weakness, paralysis of the left side decreased attention span left hemianopsia decreased awareness and judgement memory deficits left inattention decreased abstract thinking emotional lability impulsive behaviors decreased spatial orientation

reciprocating gait orthosis with what diagnosis

spina bifida more like a spinal cord injury than the other answers of CP, leg perth, and down syndrome

laminectomy is for

spinal stenosis

electrical burn

spread over a larger area (enterance wound, several poorly defined exit wounds) often appear dry which likely occurs seondary to the electrical cauterization of the blood vessels if it passes through the heart it can result in the development of cardiac arrhytmias

removable full-length arm rests are best for

squat pivot or slideboard transfers not necessary for stand pivot

deep pain

squeeze forearm or calf muscle alternative between deep and light

peripheral chemoreceptors respond to

(located in the carotid bodies) hypoxemia by increasing ventilation

central chemoreceptors respond to

(located in the medulla) increase in the partial pressure of CO2 and hydrogen ion by increasing ventilation

vestibuloocular retraining therapeutic guidelines

- Vestibular reflex (VOR) and vestibulospinal reflex (VSR) stimulation exercises - Ocular motor exervise - Balance exercise - Gait exercise - Combo exercises (obstacle course, functioning in a public place) - Habituation training exercises (use only with apporopriate patient) - Individualize each program based on the patient's specific impairments (rehab versus compensation training) - Use of practice, feedback, and repetition are vital for skill refinement - Use of gravity, varying surface conditions, visual conditions, and environmental cues should be included in therapeutic planning - The center of gravity must be controlled at each stage of treatment - Strategy (hip, ankle, stepping, suspense) training should be implemented during treatment so that strategies become automatic responses. - Force plate systems, electromyography biofeedback, optokietic visual stimulation, and videography are all technical systems that can provide feedback to motor learning during vestibular rehabilitation - Foam, mirrors, rocker boards, BAPS boards, Swiss balls, foam rollers, trampolines, and wedges are lower "tech" treatment tools that are successfully used for vestibular rehab

vestibuloocular reflex (VOR)

- allows for head/eye movement coordination - supports gaze stabilization through eye movement that counters movements of the head - maintains stable image on retina during movement

knee disarticulation considerations

-LOSS OF ALL KNEE, ANKLE AND FOOT FUNCTION -THE RESIDUAL LIMB CAN WEIGHT BEAR THROUGH ITS END -SUSCEPTIBLE TO HIP FLEXION CONTRACTURE -KNEE AXIS OF THE PROSTHESIS IS BELOW THE NATURAL AXIS OF THE KNEE -GAIT DEVIATIONS CAN OCCUR SECONDARY TO THE MALALIGNMENT OF THE KNEE AXIS

Close Packed Position

-maximum congruency -maximum ligament and capsule tightness -minimal joint space -good position for static load bearing -joint injury with dynamic unexpected movement -poor position for joint mobilization

Knee Extension ROM Requirement for Gait

0 degrees Max at initial contact and terminal stance

Distal tibiofibular joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

0 degrees plantarflexion Tibia is concave Fibula is convex Opposite direction

what ribs only connect to 1 vertebrae

1, 10-12 the rest connect to TWO

true ribs

1-7

MMT Steps

1. Explanation (verbally with demonstration) 2. Positioning (comfortably on a firm surface, ensures muscle fibers are correctly aligned and ensures test consistency, here the patient should also be properly draped) 3. Stabilization (manually or externally, applied to the proximal segment offering counter pressure to the resistance, critical to prevent substitution and maintain test validity) 4. AROM (patient movees through the test movement actively against gravity - it is acceptable for the therapist to passively move the patient's joint through the test movement as well to demonstrate what is expected - therapist will then palpate the muscle for activity and also notes any substitutions, adaptive shortening or contractures, the joint is then returned to the starting position but if the patient is unable to perform the muscle action against gravity, it is at this time that they shall be palced in a gravity-minimized position 5. Test (uninvoled side first to determine normal strength before being repeated on the involved side, therapist will altert the patient that resistance will be applied and then applies it in a direction opposite to the line of pull of the muscle fibers and in a smooth and gradual fashion, resistance is released immediately if there is any sign of pain or discomfort, the proper location for the application of resistance is typically - with few exceptions - as far distal as possible from the axis of movement on the movin segment without crossing another joint, the test is repeated 3 times and the muscle strength is determined Grade is determined by the therapists observation, perception, and palpation of the patients performance during the application of the test

right lung has how many lobes

3 (upper middle and lower)

any ramp with more than what amoubt of feet or horizontal run would require more than one section with a landing area on a ramp

30 feet

Swing phase is what % of the gait cycle?

40%

jogging at 5mph how many mets

7-8

Proximal radioulnar joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

70 degrees flexion 35 degrees supination Radius is convex Ulna is concave Opposite direction

Open and Closed Pack Position of Proximal Radioulnar Joint

70 degrees flexion, 35 degrees supination 5 degrees supination

acceptable target heart rate

70-85% of max heart rate or 50-70% of max oxygen uptake

vestibulocochlear (acousic nerve)

8 VIII hearing: ear balance: ear hear watch ticking hearing tests balance and cooridnation SENSORY inability to hear ticking watch at 18-24 inches or a significant bilateral difference alternative tests (weber and rinne which require a 512 tuning fork)

rancho los amigos levels of cognitive functioning

8 levels, lower is worse 1. no response (patient appears to be in a deep sleep and is competely unresponsive to any stimuli) 2. generalized response (pt reacts inconsistently and non-purposefully to stimuli in a nonspecific manner, responses are limited and often the same regardless of stimulus presented, responses may be physiological changes, gross body movements, and or vocalizations) 3. localized response (pt reacts specifically but inconsistently to stimuli, responses are directly related to the type of stimulus presented, may follow simple commands such as closing the eyes or squeezing the hand in an inconsistent, delayed manner) 4. confused-agitated (patient is in a heightened state of activity, behavior is bizarre and non-purposeful relative to the immediate environment, does not discriminate among persons or objects, is unable to cooperate directly with treatment efforts, verbalizations frequently are incoherent and/or inappropriate to the environemnt, confabulation may be present, gross attention to environment is very breif, selective attention is often non-existent, patient lacks short and long term recall) 5. confused-inappropriate (patient is able to respond to simple commands fairly consistently, however, with increased complexity of commands or lack of any external structure, responses are non-purposeful, random, or fragmented, demonstrates gross attention to the environment but is highly distractible and lacks the ability to focus attention on a specific task, with structure though may be able to converse on a social automatic level for short periods of time, verbalization is often inappropriate and confabulatory, memory is severely impaired, often shows inappropriate use of objects and may perform previously learned tasks with structure but is unable to learn new information) 6. confused-appropriate (patient shows goal-directed behavior but is dependent on external input or direction, follows simple directions consistently and shows carryover for relearned tasts such as self-care, responses may be incorrect due to memory problems but they are appropriate to the situation, past memories show more depth and detail than recent memory) 7. automatic-appropriate (patient appears appropriate and oriented within the hospital and home setting, goes through daily routine automatically but frequently robot-like, patient shows minimal to no confusion and has shallow recall of activities, shows carryover for new learning, but at a decreased rate, with structure is able to initiate social or recreational activities; judgement remains impaired) 8. purposeful-appropriate (patient is able to recall and integrate past and recent events and is aware of and responsive to environment shows carryover for new learning and needs no supervision once activities are learned, may continue to show a decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judement in emergencies or unusual circumstances

what rating on RPE would indicate max effort

>17 "very hard"

Comminuted Fracture

A bone that breaks into fragments at the site of injury

Closed Fracture (Simple)

A break in a bone where the skin over the site remains intact

Parkinsonian Gait Pattern

A gait pattern marked by increased forward flexion of the trunk and knees, gait is shuffling with quick and small steps, festinating may occur

Capsular Pattern

A limitation of pain and movement in a joint specific ratio, which is usually present with arthritis, or following prolonged immobilization

Long Arm Splint

A long arm splint is a rigid splint that covers the elbow joint (typically posterior), spanning from the wrist to the distal humerus used to immob the elbow joint to allow for healing following injury or surgery prevents elbow flexion and extension as well as sup and pronation may be done following an elbow or proximal forearm fx or to treat a soft tissue inury such as tendonitis or tendon repair typically placed in 90 degrees of flexion with the foerarm in neutral

Muscle Insufficiency

A muscle contraction that is less than optimal due to an extremely lengthened or shortened position of the muscle (two types)

Numerical Rating Scale

A tool used to assess pain intensity by rating pain on a scale of 0-10 or 0-100, the 0 represents no discernable pain and the 10 or 100 represents the worst pain ever, the information is used as a baseline and should be reassessed at regular intervals in order to monitor progress, this scale is easy to administer, assess, and monitor

Visual Analogue Scale

A tool used to assess pain intensity using a 10-15cm line with the left anchor indicating no pain and the right anchor indicating the worst pain you can have, the level of percieved pain is indicaated on the line and is reassessed frequently over the course of physical therapy to record changes and progess, and to predict patient outcome, this scale can be highly sensitive if small inrements such aas millimeters are used to measure the patients point of pain on the scale This scale is a valid tool if measurements are taken accurately

Achilles Tendon Repair GOLD

Active patients Casted with ankle in slight PF NWB for first several weeks then cast or boot in neutral with PWB but this has been started much sooner recently has been found to cause less restriction take caution with stretching exercises of AT or active PF until tendon is well healed

Sternoclavicular joint: resting position, convex or concave for elevation/depression + protraction/retraction, arthrokinematic/osteo motion

Anatomical position Elevation/depression: clavicle is convex and sternum is concave Protraction/retraction: sternum is convex and clavicle is concave Opposite direction Same direction

L4-L5 Myotome

Ankle dorsiflexion

S1 Myotome

Ankle plantar flexion

Shoulder flexion (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Anterior deltoid Coracobrachialis Patient is sidelying with shoulder flexed to 90 degrees, neutral rotation and elbow extended, arm on upper surface Stabilize over the superior aspect of ipsilateral shoulder, avoid anterior deltoid The dynamometer is placed on the anterior aspect of the distal humerus, proximal to the elbow Resistance is perpendicular to the humerus in direction of shoulder extension

Proximal Interphalangeal Flexion

Axis over dorsal aspect of the proximal interphalangeal joint Stationary arm over the dorsal midline of the proximal phalanx Moveable arm over the dorsal midline of the middle phalanx

before vs after DIDEA

BEFORE 1 in 5 children with disabilities was educated over 1 million children with disabilities were excluded from the education system 3.5 million children with disabilities did not receive appropriate services AFTER currently 6.5 million children with disabilities are served 96% of students with disabilities are now served in a regular school setting there is an increase in the number of children from birth to three that receive services

Normal Hard End-Feel

Bone to bone I.E. elbow extension sometimes eversion

stages of recovery

Brunnstrom separates neurological recovery into seven separate stages based on progression through abnormal tone and spasticity. These seven stages of recovery describe tone, reflex activity, and volitional movement

extension injuries of the spine most often affect

C4-C5

Biceps Reflex Innervation Level

C5

Bunnel-Littler Test

Contracture/Tightness of the Wrist/Hand The patient is positioned in sitting with the metacarpophalangeal joint held in slight extension, the therapist attempts to move the proximal interphalangeal joint into flexion, if the proximal interphalangeal joint does not flex with the metacarpophalangeal joint extended, there may be a tight intrinsic muscle or capsular tightness, if the proximal interphalangeal joint fully flexes with the metacarpophalangeal joint inslight flexion, there may be instrinsic muscle tightness without capsular tightness

Tight Retinacular Ligament Test

Contracture/Tightness of the Wrist/Hand The proximal interphalangeal joint is held in a neutral position while the therapist attempts to flex the distal interphalangeal joint, if the therapist is unable to flex the distal interphalangeal joint, the retinacular ligaments or capsule may be tight, if the therapist is able to flex the distal interphalangeal joint with the proximal interphalangeal joint in flexion, the retinacular ligaments may be tight and the capsule may be normal

Heel lift or cushion for calcaneal bone spur

Cushion

Posterior Cruciate Ligament Sprain SILVER

Dashboard injury grade III = complete rupture most PCL tears occur whre the ligament attaches to the tibia isolated PCL injuries are far less common than ACL PCL often occur with concurrent damage to the ACL, collaterals and menisci High agility with muscle weakkness and poor dynamic stability increases risk acute trauma, heard a pop with immediate onset of pain and swelling not as debilitating as ACL complain of feelings of instability with walking and pain with descending stairs or squatting xray to rule of fx or see if avlusion fx occured MRI to confrim ligament injury arthrometer ay also be used rto identify laxity avoid open chain hamstring exercises bc they place a posterior shear force on the knee and will not let the ligament heal do well with conservative tx esp if improve quad strength to stabilize knee grade 1 or 2 full recovery and do not require surgery large marjoity can return to athletics functional bracing may be necessary though all ligament deficient knees they will be more prone to meniscal damange in the years following their injury

Standard Deceleration

Deceleration begins directly after midswing, as the swing limb begins to extend, and ends just prior to heel strike

Murphy Sign

Dislocated lunate The patient is positioned in sitting or standing and is asked to make a fist A positive test is indicated by the patient's third metacarpal remaining level with the second and fourth metacarpals

Grip Dynamometer

Dominant grip strength is five to ten pounds greater than the non-dominant hand Exert Maximal force against the dynamometer Pros: simple, well researched, norms Cons: adjustment for hand size if done wrong will affect outcomes

Antidiarrheal

Donnagel Kapectolin

Midtarsal Joint

Dorsiflexion then plantar flexion then adduction then medial rotation

Which medical condition would result in the shortest life expectancy? cystic fibrosis Down syndrome Duchenne muscular dystrophy sickle cell anemia

Duchenne muscular dystrophy is a genetic disorder affecting males. The life expectancy has increased into the 30s due to advancing cardiac and respiratory medical management.

Duchenne muscular dystrophy is most appropriately classified as a/an:

Duchenne muscular dystrophy is an X-linked recessive disorder caused by mutations in the dystrophin gene. Since it is X-linked recessive, males are affected clinically and females are usually carriers.

Creep

Due to the viscoelastic property, soft tissue that is stretched for a sustained duration will elongate and not return to its original length after the load has been removed, the principle of creep is the basis for stretching

Hip Capsular Pattern

Flexion then abduction, then medial rotation (sometimes medial rotation is most limited)

Temporal Lobe Function/Impairment

Function: primary auditory processing and olfaction, wernicke's area (typically located in the left hemisphere) includes ability to understand and produce meaningful speech, verbal and general memory, assists with understanding language, the rear of the temporal lobe enables humans to interpret other peoples emotions and reactions Impairment: learning deficits, Wernicke's aphasia (receptive deficit), antisocial, aggressive behavior, difficulty with facial recognition, difficulty with memory/memory loss, inability to categorize objects impairs comprehension of spoken language more kinesthetic appraoch during therapy relaying on demonstration new learning is availible but patient are usually unable to recall the steps taht surround the new skill

Standard Heel Strike

Heel strike is the instant that the heel touches the ground to begin stance phase

Inferior glide of the femur on the acetabulum would be most effective to increase...

Hip abduction

lower limb flexor synergy

Hip abduction/ER Knee flexion Ankle DF/supination Big toe extension, flexion of other toes CHARACTERIZED BY GREAT TOE EXTENSION AND FLEXION OF THE REAMINING TOES SECONDARY TO SPASTICITY

Thomas Test

Hip contracture/tightness Hip flexion contracture The patient is positioned in supine with the legs fully extended, the patient is asked to bring one of his/her knees to the chest in order to flatten the lumbar spine, the therapist observes the position of the contralateral hip while the patient holds the flexed hip A positive test is indicated by the straight leg rising from the table Straight = rectus Bent = iliopsoas

100% bioavailability

IV

Sciatica Secondary to a Herniated Disk GOLD

IV disk that buldges and protrudes posterolaterally against a nerve root sciatica is compression of L4-S3 other causes include tumor infection spondylolisthesis narrowing and blood clots nucleus pulposus has bulged secondary to weaknening of the outer annulus fibrosis and posterior longtiudinal ligament nerve becomes inflammed and subsequently more damamged natual aging process most common contributing factor each decade the composiiton of the annulus is altered and decreases in stability most often seen in patients between 40 and 60 years old characterized by low back and gluteal pain that radiates down the back of the thigh along the sciatic nerve dsitribution can be dull aching or sharp can be sudden or gradual can go all the way to the toes radiologic testing and electrophysiologic studies can beperforemd initially to assist with dianosis other imaging may incldue myelogram, discography, CT scan or MRI blood work may assist with differential funcitonal ambulation profile oswestry mcgill pain pain increases with sitting or when lifting forward bending or twisting sneezing and coughing can exacerbate the pain prolonged bed rest in CONTAINDICATED And will not relieve pain on a long term basis even though it seems as if it will help short term bed rest is okay epidural injections of cortisone and local anesthetics but will not alter the root of the problem mckenzie exercises swimming stationary bike and walking lifting squatting and climbing are CONTRAINIDICATED * due to the sig increase in disc pressure most herniations will spontaneously decrease in size with conservative tx majority of patients improve with two to four months of conserv tx however 2% undergo surgery common surgery = laminectomy, discetomy, chemonucleolysis, laser discectomy laminotomy healing of the disc can occur and scarring can reinfoce the posterior aspect and annular fibers so taht it is protected from further protrusion resortaion of functional mobility is plasuible but surgery can be necessary if conserv doesnt work similar to spinal stenosis which can cause sciatica sx that would indicate spinal stenosis include lower extrem weakness with or without sciatica, back and leg pain after ambulating a short distance, increasing sx with continued ambulation, and relief of sx through flexion

Hip Flexion (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Iliacus Psoas Major Sidelying with leg to be tested lowermost, hip and knee to be tested are flexed to 90 degrees Stabilize the pelvis The dynamometer is placed on the anterior aspect of the distal thigh just proximal to the knee Resistance is perpendicular to the thigh in the direction of hip extension

Overload Principle

In order for a muscle to adapt and become stronger, the load that is palced on it must be greater than what it is normally acccustomed to

Adaption to Endurance Training

Increased capillary bed density Increased mitochondiral density Increased stores of ATP, creatinine phos, and other energy sources Increased tensile strength of tendons and ligaments Increased bone mineral density Decreased body fat percentage

Genu Varum

Increased compression of medial condyles Increased tension of lateral ligaments

Shoulder Lateral Rotation (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Infraspinatus Teres Minor Seated w/ shoulder ADD & in neutral rotation, elbow flexed to 90* Stabilize of the lateral aspect of the ips arm Over dorsal aspect of the distal forearm just proximal to the wrist Resistance is perpendicular to forearm in direction of medial rotation

Ranchos Initial Swing

Initial swing begins when the stance foot lifts from the floor (toe off) and ends with maximal knee flexion during swing

Heel lift during midstance is caused by

Insufficient dorsiflexion range Plantar flexor spasticity

Thoracic Spine

Lateral flexion and rotation equally limited Then extension

Lachman Test

Ligamentous Instability of the Knee The patient is positioned in supine with the knee flexed to 20-30 degrees, the therapist stabilizes the distal femur with one had and places the other hand on he prox tibia, the therapist applies an anterior directed force to the tibia on the femur A positive test is indicated by excessive anterior transplation of the tibia on the femur with a diminished or absent end-point and may be indicative of an ACL injury

Anterior Drawer Test

Ligamentous Instability of the Knee The patient is positioned in supine with the knee flexed to 90 and the hip flexed to 45, the therapist stabilizes the lower leg by sitting on the forefoot, the therapist grasps the patient's prox tibia with two hands, places their thumbs on the tibial plateau, and administers an anterior directed force to the tibia on the femur A positive test is indicated by excessive anterior translation of the tibia on the femur with a diminished or absent end-point and may be indicative of an ACL injury

Talocalcaneal Joint (Subtalar)

Limitation of varus range of movement

Length-Tension Relationship

Max force at near normal resting length

Adjustable Hand Spacing (Grip Dyna) and Position/Procedure

Maximum force produced at 2nd setting Standing or sitting Arm at side, elbow flexed to 90 degrees with forearm in neutral as well as the wrist in neutral Both hands are tested *alternately* First or second attempt is strongest Careful of fatigue 3 squeezes for each hand Record handle number and serial number

heavy work

Method used to develop stability by performance an activity (work) against gravity or resistance. Heavy work focuses on the strengthening of postural muscles.

Q angle

Mid point of the patella ASIS Tibial tubercle 18 degrees for female 13 degrees for male Angle of quad muscle force If greater angle associated with patellar tracking dysfunction, sublux of patella, increased femoral ante version or lateral tibial torsion

Open and Closed Pack Position of Temporomandibular Joint

Mouth slightly open (freeway space) (anatomical position) Clenched teeth

Carpal Compression Test (Median Nerve Compression Test)

Neurological Dysfunction of the Wrist/Hand The therapist holds the patient's wrist with both hands and applies pressure over the median nerve in the carpal tunnel for 30 seconds, the test may also be performed by placing the patient's wrist in 60 degrees of flexion before applying pressure The test is positive for carpal tunnel syndrome if the patient experiences pain or paresthesia in the median nerve distribution

Toes ROM Requirement for Gait

Neutral until terminal stance where the MP joint becomes extended (joint between the tarsal bones and phalanges?)

Gliding vs oscillation

Oscillation: movements that glides or slides articulating surfaces in appropriate directions

tenodesis

Patients with tetraplegia that do not possess motor control for grasp can utilize the tight finger flexors in combination with wrist extension to produce a form of grasp

Phenobarbital

Prevent seizures Although also causes sedation which can reduce agitation just not the primary purpose

Primary OA vs secondary OA

Primary due to old age no known cause Secondary due to another reason

Alzheimer's Disease GOLD

Progressive neurological disorder that results in deterioration and irreversible damage within the cerebral cortex and subcortical areas of the brain The loss of neurons results from the breakdown of severeal processes that would normally sustain the brain cells neurons hat are normally involed with ach transmission deteriorate within the cerebral cortex postmortem biopsy reveals neurofibrillary tangles within cytoplasm amyloid plaques and cerebral atrophy amyloid plaques contain fragmented axona, altered glial cells and callular waste that reslts in a inflammatory response that causes further damage to the nervous system amyloid can cause atrphy of the smooth msucle of the arteries of the brain predisposing them to rupture etiology unknown hypothesizes - lower level of neurotransmitters, higher levesl of aluminum in brain tissue, genetic inheritance, autoimmune disease, abnormal processing of amyloid and virus 4.5 million in US higher incidence in women andhigher inc with age 20% over 80 6% over 65 change in higher cortical functions subtle changes in memory impaired concentration difficulty with new learning loss of orientation, word finding difficulties emotional lability depresiion poor judgement and impaired ability to perform self care middle stage includes behavioral and motor problems such as aphasia apraxia perseveration agitation and violet or socially unacceptable behavior that can iclude wondering eventually all ability to learn is lost and long term memory also disappears end stage characterized by severe intelletual and physical destruction vegetaative symtpoms including incontinence functional dependence inability to speak and seizure activity postmortem biopsy reveals the neurofibrillary tangles and amyloid plaques MRI can be used to assess signs of atophy in brain and can rule out other conditions single phantom emission computed tomography SPECT may be used to determine brain activity and predict potential for alz disease blood work urine and spinal fluid may be required to rule out other disease that may cause signs of dementia pt must demonstrate at least 2 deficits of cognitiion memory and related cog functioning with the *absence* of all other brain disease or disturbances in consciousness that may contribute to the identified ddeficits end stage high risk for infection and pneumonia may experiences complications from a vegatative state such as contractures decubiti fracture and pulmonary compromise management - drug therapies usually only last in effect for 6 to 9 months including tacrine (cognex), donepezil (aricept), and rivastigmine (exelon) inhibit acetylcholinesterase can have substantial side effects modify home layout for success easily be able to find items HEP continue with activity, memory book later stages participate in assissted HEP, exercise and everyday activities such as folding laundry to avoid restlessness and wandering PT indicated intermittentily throughout the course of the disease will not alter or cease the progression of the disease 4th leading cause of death in older adults course is 7-8 years leading cause of death is infection or dehydrtion looks similar to multiinfarct dementia >70 years old in males and progresses in a step like manner hypertension is a primary risk factor and depression is commmon may also experience hemjplegia and emotional labbiity

Semi rigid Unna Paste, Air Splint

Reduces post op edma provides soft tissue support allows for earlier amb provides protection easily changable does not protect as well as rigid requires more changing than rigid may loosen and allow for development of edema

Radial Gutter Splint

Rigid splint that covers the radial side of the forearm and hand as well as the second and third digits the splint includes a thenar hole to allow for free movement of the thumb used to immob the metacarpals and pahalnges and is used after fx of these strcutures when splinting, the MCP joints are placed in 60-90 degrees of flexion with the IP joints in full extension and the wrist in slight extension

Toe walking is a functional test for what innervation level

S1

closing of mitral and tricuspid values what heart sound

S1 S2 is aortic and pulmonary

Knee Flexion (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Semitendinosus, Semimembranosus, Biceps Femoris Side-lying on side to be tested, hip of lower limb extended, knee flexed to 90* Stabilize the medial aspect of the distal femur Dynamometer on posterior aspect of distal leg just proximal to ankle Resistance perpendicular to leg in direction of knee extension

US used frequently may be calibrated how many times a year

Several times a year

Liver referral

Shoulder Midthoracic Low back

Pancreas referral

Shoulder Midthoracic Low back

C5 Myotome

Shoulder abduction

C2-C4 Myotome

Shoulder elevationsens

Forequarter (Scapulothoracic) Amputation

Surgical removal of the upper extremity including the shoulder girdle

Transhumeral Amputation

Surgical removal of the upper extremity proximal to the elbow joint

Finkelstein Test

Tenosynovitis in the thumb (de Quervain's disease) The patient is positioned in sitting or standing and is asked to make a fist with the thumb tucked inside the fingers, the therapist stabilizes the patient's forearm and ulnarly deviates the wrist A positive test is indicated by pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist

Ranchos Terminal Stance

Terminal stance begins when the heel of the stance limb rises and ends when the other foot touches the ground (aka initial contact)

Muscle Activity during Terminal Swing

The ankle dorsiflexors continue to contract concentrically to maintain dorsiflexion. The ankle invertors also contract concentrically to prepare the foot for initial contact. The quadriceps contract concentrically to place the knee in extension for initial contact, while the hamstrings act eccentrically to control the rate of knee extension. The hip extensors eccentrically slow the rate of hip flexion and prepare the limb for initial contact.

Muscle Activity during Initial Swing

The ankle dorsiflexors contract concentrically to clear the foot from the ground, while the hamstrings assist with foot clearance by flexing the knee. The hip flexors continue to produce hip flexion to advance the limb forward.

The majority of congenital limb deficiencies are caused by:

The majority of congenital limb deficiencies are idiopathic or genetic in origin. The remaining options represent possible etiologies for congenital limb deficiencies, but they are not as common as genetics.

what structure is assocaited with severe swelling and brusing

The medial inferior genicular artery runs through the anterior cruciate ligament (ACL). As a result, tearing of the ACL often produces hemarthrosis of the knee joint.

Muscle Activity during Pre-Swing

The plantar flexors are at their peak activity as the foot "toes off" from the ground. The hamstrings begin to produce knee flexion to prepare for the swing phase, though the momentum of the body also aids in this motion. The iliopsoas begins to work concentrically to produce hip flexion, along with other hip flexors (i.e. rectus femoris, sartorius, adductor longus)

osseointegration (endoprosthesis)

The process of implanting a prosthetic device directly into the residual limb of a person with limb loss. This process negates the need for a socket component

Dynamometry

The process of measuring forces that are doing work A dynamometer is a device that measures strength through the use of a load cell or spring-loaded gauge

4+/5 MMT

The subject completes range of motion against gravity with moderate-maximal resistance Good Plus

3+/5 MMT

The subject completes range of motion against gravity with only minimal resistance Fair Plus

3/5 MMT

The subject completes range of motion against gravity without manual resistance Fair

Good/Faulty Posture of the Toes

Toes should be straight and extend forward in line with the foot and should not be squeezed together or overlap They should not... Toes bend up at the first joint line and down a the middle joints so that the weight rests on the tops of the toes (hammer toes), this fault is often associated with wearing shoes that are too short Big toe slants inward toward the midline of the foot (hallux valgus) or a bunion, this fault is often associated with wearing shoes that are too narrow and pointed at the toes

Antacid

Tums milk of mag

What to do if distal anterior tib is red

Verify that socks and liners are being worn appropriately prior to contacting a prosthetist Is covered by a thin layer of skin and has little to no adipose tissue to distribute the transmitted forces

rinne test

Vestibulocochlear nerve.. striking tunefork on mastoid process weber goes on the midline of the skull on the patients forehead air conducted sound:bone 2:1

Emetic agents used for

Vomiting after ingesting a toxic substance Apomorphine and ipecac Can cause GI erosion with prolonged use

Foot slap is caused by

Weak dorsiflexors or Dorsiflexor paralysis

Maitland Approach

What we learned in school

Class II Lever

Wheelbarrow

Active Insufficiency

When a two-joint muscle contracts across both joints simultaneously I.E. To flex the knee, the hip flexor must stabilize the hip joint so the hamstring does not extend the hip at the same time, if this does not occur then both the hip will extend and the knee will flex and there will be incomplete ROM at the knee

C6 Myotome

Wrist extension

developmental sequence

a progression of motor skill acquisition, the stages of motor control include mobility, stability, controlled mobility and skill

nonassociative learning

a single repeated stimulus (habituation, sensitizatin)

open motor skill

a skill that is performed under a consistenly changing environment

closed motor skill

a skill that is performed under a stable and unchanging environment

superficial vs deep tendon reflexes, how do you grade them

abdominal reflex, cremasteric reflex, corneal reflex, and normal plantar reflex (BABINSKI) stimulation of skin by stroking or scratching superficial - present or absent (asymmetry should be noted as well bc that indicates pathology) deep tendon 0-4+ ordinal scale

Graphesthesia

ability to "read" a number by having it traced on the skin

two point discrimination

ability to distinguish the separation of two simultaneous pinpricks on the skin

localization test

ability to identify location of light touch using words or gestures

bivalved lower extremity cast

able to be removed easily if find discolored toes, remove so you can inspect the LE

Guillain-Barre Syndrome (GBS) GOLD

aka acute polyneuropathy temporary inflammation and demyelination of the peripheral nerves myelin sheaths potentially resulting in axonal degeneration results in motor weakness in a distal to proximal progression, sensory impiarment, and possible respiratory paralysis autoantibodies of GBS attack segments of the myelin sheath of the peripheral nerves infecting organism is of similar structre to molecules found on the surface of myelin sheath antibodies produced attack botht the organism of the infectin as well as the schwann cells due to the similar strucutre decrease nerve condution velocity and results in weaness or paralysis of the involved muscles demyelinatin that is initiated at ranviers nodes occurs secondary to macrophage response and inflammation and as a result, destriciton of the myelin the body responsds to this and attempts to repair the damage through schwall cell division and myelinzation of the damaged nerves motor fibers are predominantly affected etiiology unknown autoimmune response to aprevious respiratory infection, influenze, immunization or surgery viral infections, epstein-barr syndrome, cytomegalovirus, bacterial infections, surgery, and vaccinatins have been associated with the devleipment of GBS can occur at any age but peaks at young adult and betwen 50th and 80th decade slightly higher in MALES and in CUACASIANS initally present with distal symmetrical motor weakness and will likely expiernce mild distal sensory impairments and transient parestheisas weakness will progress to the upper extremities and head level of disability peaks within 2 to 4 weeks after onset muscle and respiratory paralysis, absence of deep tendon relfexes, inability to speak or swallow may occur can be life threatening with respiratory involvment classic type inlcudes acute onset with symptoms with peak impairment wihtin 4 weeks follow by 2-4 weeks static period and gradual recovery that can takes months to years diagnosed through cerebrospinal fluid sample that contains high protien levels and little to no lymphocytes electromyography will result in abnormal and slowed nerve condution may also experience bladder weakness, deep muscle pain, autonomic nerbous system involvement including arrhythmia, tachycardia, postural hypotension, heart block and absent reflexes up to 30% require mechnical ventilation during the acute stages respiratory assitance can last for up to 50-60 days immunosuppressive and analgesic/narcotic medications corticosteroids are controversial and usually contraindiacted***** during acute stage, PT must avoid overexertion and fatigue to avoid exacerbation of sx IS is really imporant for respiratory involvment PT can assist with recovery but cannot alter the course of the disease PT can last for 3-12 months on an ongoing basis recovery is slow and can last up to 2 years most patients experience a full recovery 20% have remaining neuro deficits 3-5% die from respiratory complications similar to polyneuropathy which is a progressive condition that affects the nerves most common etiology is metabolic conditions such as diabetes this disease develops SLOWLY bilterally and symmetrically first symptoms is SENSORY impairment of the distal LEs pain diminishe drelfexes and motor loss are other sx that is marked by exacerbations and remissions medical managament is focused on stabilization of the underlying metabolic condition

ectopic bone complication of SCI

aka heterotopic ossification spontaneous formation of bone in the soft tissue occurs adjacent to larger joints such as knees and hips theories = tissue hypoxia to abnormal calcium metabolism s/s = edema, decreased ROM, increased temperature of the involved joint tx = pharamacoligcal interventin (diaphosphates that inhibit ectopic bone formation), PT and surgery

Huntington's Disease GOLD

aka huntingtons chorea neuro disorder of the CNS characterized by the degernation and atrophy of the basal ganglia (specif STRIATUM) and cerebral cortex of the brain ventricles become enlaged secondary to atrophy of the basal ganglia and there is extensive loss of small and medium sized neurons decreased in quantity and activity of gamma-aminobutyric acid (GABA) and acetylcholine neuronsthat are produced in ths area the identified neurotransmitters become deficient and are unable to modulate movement loss of neurons creates dysfunction in inhibition that results in the symptoms of chorea, bradykinesia, and rigidty thalamus is also believed to contribute to the movement disorders assocaited with the disease process HD is genetically transmitted as an autosomal DOMINANT trait with the defect linked to chromosome four and to the gene identified as IT-15 perpetuated by a person that has a child prior to the normal onset of symptoms and wihtout knowledge that he/she possessed the defective gene can do genetic testing to determine this 4-8 in 100,000 in north america 25,000 in US average age between 35 and 55 years but sx can develop at any age disease that produces a MOVEMENT disorder, affective dysfunction, and cognitive impairment initally will present with involuntary choreic movements and a mild alteration in personality unintentional facial expressions such as a frimace, protrusion of the tongue, and elevated of the eyebrows are common as the disease progresses, gait will become momre ataxic and a patient experiences choreoathetoid movement of the extremities and the trunk speech distrubances and mental deteriortation are common late stage = decrease in IQ, dementia, depression, dyspahgia, incontinence, inability to ambulate or transfer, and progression from choreiform movements to rigidity MRI or CT for atrphy or abnormalities within the cerebral cortex as well as the basal ganglia PET for blood flow oxygen and metablism in brain DNA marker study to determine if the autosomal dominant trait is present for HD functional ambulation profile tseting for dysdiadochokinesia dementia and other psych changes usually occur after neuroligcal symptoms appear emotional disorder worsens with progression and may require psych help for severe depression/suicide attempts secondary complications inlcude loss of ROM, deformity, pain, communihcation breakdonw, aspirtation and choking, fatigue, and weakness from weight loss anticonvulsants antipsychotics help blockdopamine however have very serious sde effects perphenazine, haloperidol (haldol) and reserpine PT and other disciplines I/M throghout life focus on curret issues focus on motor control including coactivation of msucles, trunk stabilization and use of biofeedback and relaxation PT will NOT prevent further degeneration however it will maximize the patients functional potential and safety OBTAIN FUNCTIONAL OUTCOME WITHIN THE LIMITATIONS OF THE DISEASES PROCESS chronic progresive disorder that is fatal within 15 to 20 years after clinical manifestation late stages of the disease result in total physical and mental incapacitation usually requiring extended care facility due to burden of care similiar to athetoid (dyskinetic) cerebral palsy is a nonprogressive motor disorder caused by central nervous system damage specifically in basal ganglia clinical manifestations include slow and involuntary movement, chroeiform movements, severe dysarrthria, and increased risk of aspiration pneumonia involvetary movements increase with stress and fatigue and subside with sleep PT focus on motor control and mobility to attain highest level of functioning

hip disarticulation/hemipelvectomy considerations

all functions of the hip knee ankle and foot are absent most common cause is malignancy does not allow for activation of the prosthesis through a residual limb prosthetic limb advancement initiated through pelvic motion

undue hardship to an employer

altering the operation of a business NOT hundreds of dollars or larger work space for the employee

oxygen diffuses across the...

alveolar-capillary septum into the RBCs in the lung capillaries where it combines with hemoglobin to be transported back to the heart carbon dioxide diffuses in the opposite direction

cardiac output

amount of blood pumped from the left or right ventricle per minute

transfer of learning

an action cannot be separated from the environment that it is performed in, a patient must be able to transfer the skill or motor task into different environments

Hemiballismus

an involuntary and violent movement of a large body part

low hemoglobin =

anemia or blood loss

decreased hematocrit =

anemia, nutritional deficiency, luekemia

spinal nerves

anterior root carries efferent info AWAY from CNS posterior root carries afferent info TOWARDS the CNS

vertebral artery forsm what arteries that surround the spinal cord

anterior spinal two posterior spinal

T2 sensory testing

apex of axilla

mass to specific

aquire simple movements and progress to complex

pulmonary arteries/veins

arteries carry DEOXYGENATED blood from the right ventricle to the left and right lungs veins carry OXYGENATED blood from the right and left lungs to the left atrium

what can be injuried with improper use of axillary crutches

axillary vessels and nerves

pulmonary artery line

balloon tipped via internal jugular vein or subclavian vein passing through the right atrium, tricuspid valve, right ventricle, pulmonary valve, and into the pulmonary artery used to monitor cardiovascular pressures and to sample mixed venous blood for gas analysis

emphysema primary characteristic

barrel chest air trapped enlarged thorax flaring of the costal margins widening of costochrondral angle

why cant you progress from PWB to FWB when you dont have full knee extension after ACL surgery

bc ambulation on a flexed knee can result in excessive irritation of the patellofemoral joint

hypoglycemia

below 70 headache commonly associated with hypoglycemia bc brain uses glucose as primary source of energy

what is the thorax made of

bones vertebrae, IV discs, ribs, and sternum clavicles and scapulae are not considered part of the thorax

where does a TIA typically occur

carotid and vertebrobasilar arteries

in 6mwt what should the patient alert the therapist of

chest pain or dizziness

dystonia number two

closely related to athetosis howevere there is larger axial muscle involvement rather than appendicular muscles

corset

cnstructed of fabric and may have metal uprights within the materal to provide abdominal compression and support utilized to provide pressure and relieve pain assocaited with mid and low back patholiges

psych impact of ampu

common feel negative thoughts or emotions denial grief anxiety depression or suicidal feelings may be elevated in emergency amputation bc insufficent time to prepare for it

ASIA A

complete no sensory or motor function is preserved in sacral segments S4-S5

median nerve injury caused by

compression in carpal tunnel pronator teres entrapment

ulnar nerve injury caused by

compression in the cubital tunnel, entrapment in guyons canal

radial nerve injury caused by

compression og the nerve in the radial tunnel, fracture of the humerus

external fixation drainage what do you do

continue with PT wipe up with gauze pad very common no need to notify nursing

hyperfunction of adrenal gland

cushings syndrome weight gain not weight loss

hypovolemia refers to

decreased blood volume specifically plasma

wallerian degeneration

degeneration that occurs distally, specifically to the myeline sheath and axon

increased hematocrit =

dehydration, polycythemia and burns

anosognosia

denial or unawareness of ones illness often associated with unilateral neglect

hydrostatic pressure increases as....

depth increases

tetraplegia (quadraplegia)

describe injuries that occur at the level of the cervical spine

reflex inhibiting posture

designated static positions that Bobath found to inhibit abnormal tonal influences and reflexes.

dyspraxia

diffuculty planning a new motor act and is often caused by difficulty interpreting and modulating tactile input

signs that indicate a heart attack

discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back (it can feel like uncomfortable pressure, squeezing, fullness or pain) shortness of breath with out without chest discomfort pain or discomfort in one or both UEs, the back, neck, jaw or stomach breaking out in a cold sweat, nausea or lightheadedness most common sx = chest pain or discomfort in both men and women women are more likely to experience SOB, N/V, and back or jaw pain though patients should not wait more than FIVE minutes to call 911

patent ducuts arteriosus PDA

ductus arteriosus normally shunts blood from the pulmonary artery directly to the descending aorta in utero, pathological if doesnt close after birth risk factors include premature birht, other heart defects, family history, rubella infection or diabetes during prenancy, and exposrure to alcohol drugs chemicals or radiation during pregnancy s/s = small ductus may be asymptomatic, whereas a large ductus may present with tachycardia, respiratory distress, poor eating, weight loss and congestive heart failure tx = non-srgy includes diuretics and indomethacin, surgery if nonsurg fails, if left untreated can cause pulmonary hypertension, HF, and other complications

parameter that is most critical for the therapist to alter for tissue temperatuer

duty cycle intensity between 0.5-2.0 W/cm^2 for thermal CONTINUOUS intensity 0.5-0.75 with 20% for nonthermal effects

TUG what it is used for

dynamic balance and mobility

carl d perkins vocational education act of 1984

each state was required to meet the special needs of inidividuals with handicaps or adults that are disadvanctaged, adults in need of training and retraining, single parents or homemakers, programs designed to eliminate sex bias/stereotyping, and criminal offenders

repeated measure design

each subject acts as their own control because all subjects experience all levels of the indpenednet variable doesnt matter gender age or physical, differences are attributed to treatment aka within-subjects design

what to do when a separate problem comes up during treatment that could be addressed bby PT

educate! do not instruct on exercises if you dont have a referral or havent assessed

C5 key muscle

elbow flexors (bicep and brachialis)

metabolic alkalosis

elevated pH and elevated PaCO2 is considered partially compensated metabolic alkalosis caused by bicarbonate ingestion, vomiting, diruetics, steroids and adrenal disease low pH and low PaCO2 considered partially compensated metabolic acidosis caused by metabolic diseases or disturbances such as diabetes, lactic acid, uremic acidosis, chronic diarrhea

hip strategy

elicited by a greater force, challenge or perturbation around pelvis and hips. hips will move in opposite direction from head in order to maintain balance. muscles contract in a PROXIMAL TO DISTAL fashion in order to counteract the loss of balance

TBI intervention constructs

emphasis on motivation promote independence goal directed and functional focus on orientation and behavior modification activities repetition is typically helpful educate patient in compensatory strategies for success structure is ESSENTIAL avoid overstimulation (calm voice and simple commands) perform activities that are both familiar and enjoyable for the patient family education and support flexibility in treatment is needed based on patients immediate needs and state of mind include cog and orientation training therapeutic exercise positioning sensory integration balance and vestibular training range of motion motor functin training w/c and AD splinting and serial casting mobility training

biotransformation

enzymatic activity that converts the drug to an inactive form and reduces the chance for toxic effects that occur with accumulation or prolonged administration

location for pressure support for coughing in SC

epigastric area like heimlic manuever umbilical is too low

peroneus longus and brevis are strong

evertors

syringomyelia

excess fluid in the SC

double crush syndrome

existence of two separate lesions along the same nerve that create more severe symptoms than if only one lesion existed

osteonecrosis of the knee who does it affect and where

females 60s medial condyle increased pressure caused by the center of gravity being medial to the knee

pressure sensitive areas

fibular head lateral tibial flare tibial crest distal end of fibula distal end of tibia patella anterior tibial tubercle peroneal nerve adductor tubercle greater trochanter pubic tubercle pubic ramus greater trochanter pubic symphysis distal end of femur perineum

FABER is the same as what type of self stretch

figure 4

C8 key muscles

finger flexors (FDP) to the middle finger

Prolonged PR interval

first degree AV block Time between impulses from SA node to Av node >.2 seconds, normally .12-.2

ankle strategy

first strategy to be elicited by a SMALL RANGE and SLOW velocity perturbation when feet are on the ground. muscles contract in a DISTAL TO PROXIMAL fashion to control postural sway from ankle joint

general time rule for US

five min for an area that is two times the size of the transducer face usually 5-8 min

obturator nerve injury caused by

fixatioon of a femur fx THA

neurogenic nonreflexive bladder

flaccid as a result of cauda equina or conus medullaris sacral reflex arc is damaged

tarsal tunnel is associated with

flat feet compresses the nerve

inferior joint capsule of shoulder

flexion and abduction

homolateral synkinesis

flexion pattern of the involved UE facilitates flexion of the involved LE

wenickes aphasia

fluent aphasia lesion to posterior region of superior temporal gyrus "receptive aphasia" comprehension (reading/auditory) is impaired good articulation, use of paraphasias impaired writing poor naming ability motor impairment not typical due to the distance from wernickes area to the motor cortex

suraal nerve injury caused by

fracture of the calcaneus or lateral malleolus

flexion and extension of thumb occur in what plane

frontal plane side to side

gross to fine

general trend for large muscle movement acquisition with progression to small muscle skill

2 years (developmental gross and fine motor skills)

gross motor rides tricycle walks on tiptoe runs on toes walks downstairs alternating feet catches large ball hops on one foot fine motor turns knob opens and closes jar able to button large buttons uses child-size scissors with help does 12-15 piece puzzles folds paper or clothes

12 to 15 months (developmental gross and fine motor skills)

gross motor walks without support fast walking walks sideways bends over to look between legs creeps or hitches upstairs throws ball in sitting fine motor marks paper with crayon builds tower using two cubes turns over small container to obtain contents

talar abduction

happens during inversion

when feeling new side effect of med what do you do

have the patient contact the drs office to make them aware immediately making an appointment would not be as timely

two point

have to only have one AD cane and leg leg two points of floor contact are maintained at any one time closely resembles normal gait

deep vein thrombosis with amputation

heparin is commonly used

allograft is the same as

homograft

common fibular nerve lesion what would you see

inability to actively DF the foo prsence of steppage gait (weak DFs)

agnosia

inability to interpret information

unilateral neglect

inability to interpret stimuli and events on the contralateralside of a hemisphereic lesion, left-sided neglect is most common witha lesion to the right inferior parietal or superior temporal lobes

weakness vs fatigue

inability to maintain the test position vs subjective report

apraxia

inability to perform purposeful learned movements or activities even though there is no sensory or motor impairment that would hinder completion of the task planning issue

Dysdiadochokinesia

inability to perform rapid alternating movements

dysphagia

inability to properly swallow

alexia

inability to read or comprehend written language secondary to a lesion within the dominant lobe of the brain

astereognosis

inability to recognize objects by sense of touch

agraphesthesia

inability to recognize symbols, letters or numbers traced on skin

agraphia

inability to write due to a lesion within the brain and is typically found in combo with aphasia

brown sequard

incomplete lesion typcally caused by a stab wound which produces hemisection of the spinal cord paralysis and loss of vibratory sense and position sense on the same side as the lesion due to the damage of the CS and DC loss of pain and temp on the opposite side of the lesion from damage tothe lateral spinaothalamic tract

lofstrand crutches who could use them

incomplete spinal cord injury

why do teens choose to use steroids

increase body weight, accelerate growth of muscle tissue, reduce recovery time

sensitization

increase in response that will occur as a result of noxious stimuli

bainbridge reflex

increase in venous return stretches receptors in the wall of the right atrium which sends vagal afferent signals to the cardiovascular center within the medulla the signals INHIBIT parasympathetic activity, resulting in an increased HR

monocyte WBC

ingest dead or damaged cells

synergy patterns

inhibition of massive gross motor patterns are no longer controlled

myocyte special ability

intrinsic ability to depolarize and propagte electrical impulses from cell to cell without nerve stimulation

LE nerve injuries caused by

labor delivery or surgery

diffused light

lampshade or blinds to help filter direct light that make provoke glare sensitivity

left hemisphere

language sequence and perform movement understand language produce written and spoken language analytical controlled logical rational mathematical calculations express positive emotions such as love and happiness process verbally coded info in an organized logical and sequential manner

a fibers

large fibers myelinated high condution rate alpha = muscle spindle, golgi tendon, touch beta = touch, kinesthesia, muscle spindle gamma = touch pressure delta = pain touch pressure temp

telencephalon

largest division of the brain includes cerebrum, hippocampus basal ganglia and amygdala

chroeoathetosis side effect of

levodopa can happen 3 months after

hindfoot valgus vs forefoot adduction

like flat foot, over pronator can only see medial toes when looking from the back

pallanesthesia

loss of vibration sensation

AV node

makes the ventricles contract common bundle of His which eventually divides into the purkinje fibers that extend into both ventricular walls

forced expiratory volune (FEV)

max volume of air exhaled in a specific period of time usually the 1st, 2nd, and 3rd second of a forced vital capacity maneuver

expiratory reserve volume (ERV)

max volume of air that can be exhaled after a normal tidal exhalation 15% of total lung volume

inspiratory capacity (IC)

max volume of air that can be inspired after a normal tidal exhalation IC = TV + IRV 60% of total lung volume

inspiratory reserve volume (IRV)

max volume of air that can be inspired after normal tidal volume inspiration 50% of total lung volume

vital capacity

max volume of gas that can be exhaled after a max inhale

total lung capacity

max volume to which the lungs can be expanded sum of vital capacity + residual volume

length of sx central vs peripheral lesion

may be chronic minutes, days, weeks, but finite period of time; recurrent

back height of WC

measured from seat of chair to the floor of the axilla with the patients hsoulder flexed to 90 degrees then subtract 4 inches below inferior angle standad height is 16-16.5 inches

L3 sensory testing

medial femoral condyle

fit issues of prosthesis

most common complaint is regarding the fit manged through sock appliecation, alignment of the liners in the socket, and training the patient how to dynamically adjust the fit to accommodate flucuations if too big may not be wearing their shrinker or medications/diet may be affecting the residual limb volume

myotome

motor areas based on spinal segment innervation

neuro rehab

motor control and motor learning

dysarthria number 2

motor disorder of speech that is caused by an upper motor neuron lesion that affects the muscles that are used to articulate words and sounds speech is often noted as "slurred" and there may also be an effect on respiratory or phonatory systems due to the weakness

ASIA D

motor incomplete motor function is preserved below the neurologic level and most key muscles below the neurologic level have a muscle grade greater than or equal to 3

ASIA C

motor incomplete motor function is preserved below the neurologic level and most key muscles below the neurologic level have a muscle grade less then 3

overflow

muscle activation of an involved extremity due to intense action of an uninvolved muscle or group of muscles

clinical assessment of spasticity

muscle grading DTRs ROM modified ashworth scale UMN lesion exaggerated phasic (tendon jerks) and tonic (spastic) stretch reflexes

megnesium ionto

muscle relaxant and vasodilator

long term goal for child in IEP

one year federal legislation mandates the review of IEP on a one year basis to make sure goals relate to improving the child educational exxperience

operant conditioning vs aversive conditioning vs extinction

operant - learning behavior and its consequences aversive- associating behavior with discomfort extinction - withholding reinforcement for a previously reinforced behavior reduction or loss in the strength of a conditioned reposne when the reinforcment is withheld

Traumatic Brain Injury GOLD

open head injury where there is penetration through the skull or closed where the brain makes contact with the skull secondary to a sudden, violent acceleration or deceleration impact can also occur secondary to anoxia as with cardiac arrest or near drowning primary damage will occur at the site of impact secondary damage occurs as a result of metabolic and physiologic reactions to the trauma brain injury may include swelling, axonal injury, hypoxia, hematoma, hemorrhage and changes in intracranial pressure falls 33% MVA 17% two leading causes of TBI pediatric TBI occurs from a fall MVA account for 32% of deaths from TBI high risk groups include = 0-4 15-19 and >65 MALES are at greater risk in each category 2 million per year 5 milliion living with TBI characteristics of TBI include alterd consciousness (coma, obtundity, delirium), cog and behavioral deficits, changes in personality, motor impairments, alterations in tone, and speech and swallowing issues CT or MRI immediately to rule out hemorrhage, infarction and swelling xray to tule out fracture or sublux EEG electroencephalogram PET and cerebral blood flow mapping CBF may be used for diagnosis and baseline data glasgow coma scale rancho los amigos levels of congitive funcitoning rankin scale rivermead motor assessment intracranial pressure must be monitored bc increased risk for hemorrhage deterotopic ossification, contracures, skin breakodwn, seizures, and DVT may remain in persisent vegetative state in some cases stabilize patient, control intracfranial pressure****, and prevent secondary complications surgery may be necessary to regain homeostasis within the brain secondary to hemorrhage or fracture once medically stable will initiate rehab cerebral vasoconstrictive agents for pharma psychotropic agents hypertensive agenrs antispasticity meds for cognition and attention PT to focus on sensory stimulation and PROM for comatose or pathfinding and high balance for mild may include serial casting and pulmonary inteervention CONSISTENCY IS VITAL IN HOME PROGRAM outcome based on degree of primary and secondary damage 52,000 will due each year ffrom TBI many patients experiience lifelong defciits taht do NOT allow them to return to their preinjury lifestyle similar to meningitis which is a bacterial or viral infection that spreads through the cerebrospinal fluid to the brain meninges of the brain become inflamed as well as the meningeal membraanes pt will have headache and may compain of stiffness in the neck may be confused fatigued and irritible as the virus progresses the patient may experience seizures and may prpgress to a coma medical treatment varies based on the causative strain of the virus/bacteria mortality ranges from 5-25% and 30% have some degree of permanent neuro impairment

education for all handicapped children act 1975

origin of the individuals with disabilities education improvement act protects and improves results for these children

posterior tib tenosynovitis is associated with

over pronation bc supports the foot pain inferior to the medial malleolus

ideal positioning in sidelying

pelvis in line with trunk hips in flexion neutral rotation hips in 10 to 20 degrees abduction straight trunk shoulders in line with hips slight sidebending okay head in neutral facing forward slight cervical flexion both arms supported lower arm forward, not lying on point of shoulders lower arm neutral rotation upper arm may have 0 to 40 degrees medial rotation knees in flexion feet positioned at 90 degrees pillow between knees

ideal positioning in prone

pelvis in line with trunk hip in extension neutral rotation of pelvis hip symmetrically abduction 10 to 20 degrees stright trunk shoulders in line with hips neutral rotation of trunk head in neutral facing to one side slight cervical flexion arms fully supported arms forward of trunk flexion at shoulders flexion at elbows knees extended feet positioned at 90 degrees

LE D2 flexion

pelvis: elevation hip: flexion + abduction + internal rotation knee: flexion or extension ankle and toes: DF + eversion

vibration

perceive vibration or pain through a tuning fork preferrably 128 hz alternating testing with and without vibration to make sure they can recongize when there is not vibration initiate test by tapping fork and placing it on the IP joint of finger or great toe if there is an impairment, test bony prominences proximally including the wrist, elbow spinous process clavicles mediall malleolus patella ASIS etc allow comparisions by asking the pt if the sensation is the same or different

S4-5 sensory testing

perianal area (taken as one level)

integration of a relfex means

period of time when a reflex is no longer present despite an appropriate stimulus

most common etiology of diminished reflexes =

peripheral neuropathy assocaited with diabetes, alcoholism, vitamin deficiencies such as pernicious anemia, cerain cancers and toxins will typically present with sensory motor or mixed impairments and can affect all components of the reflex arc

what to do if pt uncomfortable lying prone

pillows under hips

change position numbers

position every 2 hours weight shift every 15-20 min in sitting

tonic labyrinthine reflex (TLR) (stimulus, response, normal age of response, interferes with...)

position of labyrinth in inner ear, reflected in head position in supine, body and extremities are held in extension in prone, body and extremities are held in flexion birth to 6 mo interferes with... ability to initiate rolling ability to prop on elbows with extended hips when prone ability to flex trunk and hips to come to sitting position from supine position often causes full body extension, which interferes with balance in sitting or standing

SCI intervention constructs

positioning prevention of pressure ulcers pressure relief ROM family/caregiver training bowel and bladder program respiratory training/airway clearance (assisted cough and secretion clearance, breathing exercises, abdominal binders, mechanical ventilation, glossopharyngeal breathing akak "GUP") w/c cushion and orthotics w/ cmob balance and COG training motor function retraining pain management transfers FES, biofeedback and TENS self-care skills gait training use looping of UE, momentum, and gravity to assist in transfers and change of position

anti tip tubes when and why to use

posterior aspect of wheelchair to prevent tipping in patients who have impairments or absence of trunk control can also be used when mastering steep inclines until the aptient gait enough strength and postural control to master the technique

timeline for rehab with prosthetic

preprosthetic phase will last 6 weeks protecitng the limb, prevent contracture, single limb mobility skills, and prep for prosthetic usually fit for prosthetic at 4-6 weeks once healed and sutures are removed then will be sized for a shrinker works with a temproary prosthesis for several months until fit, comfort, and residual limb size has stabilzied then the permanent prosthesis may be made medicare supports a new prosthesis every 5 years

spina bifida cystica

presents with a cyst-like protrusion through the non-fused vertebrae, which results in impairment forms: meningocele and myelomeningocele

digit amp consideration

preserved function is highly variable depending on number of digits involved and levl of amp prosthesis are not typically utilized a long transradial amputaiton may be more functional if multiple digits are involved at priximal levels

primary brain injury vs secondary

primary - sustained by impact (skull penetration, fx, contusions to gray and white matter) coup and countercoup secondary - occurs as a reponse to the initial injury (hemtoma, hypoxia, ischemia, increased IC pressure, post traumatic epilepsy) epidural (btwn skull and dura) and subdural (between dura and arachnoid)

C4 SC injury

primary muscles include the diaphragm and trapezius cannot do slide board transfers

specificity

probability that the test will be negative in someone who does not have the disease true negative

Sensitivity

probability that the test will be positive in someone with the disease true positive

modeling

process of learning by watching others

diaphoresis

profuse perspiration and is often associated with shock or other emergent medical conditions

duchenne muscular dustrophy GOLD

progressive neuromuscular degenerative disorder that manifests symptoms once fat and connective tissue begin to replcae muscle that has been destroued by the disease process, the mutation of the dystrophin gene causes the symptoms of DMD dystrophin gene Xp21 codes for the msucle membrane protein dystrophin found on the x chromosome and since it is a recessivve train, only MALES are affecgted while females are carriers damage within the sarcolemma with contraction of the muscle mutated gene causes weakeneing of cell membranes, destruction or myofibrils, and loss of msucle contractility destroued muscle cells are replaced with fatty deposits mother is silent carrier 20-35 per 100,000 live MALE births diagnosis occurs between 2 and 5 years old first symtpoms include waddling gait, proximal muscle weakness, clumsiness, toe walking, excessive lordosis, psuedohypertrophy of the calf and toher muscle groups, difficulty climbing stairs primarily affects shoulder, pecs, delts, rectus abdominis, gluteals, HS, and calf initially identified when a child begins to have difficulty getting off the floor, needing to use the GOWERS maneuver where the patient uses his hands to stabilize and walk up his legs in order to attain an upright posture 1/3 have some form of learning disabililty secondary to the dystrophin abnormalities usually subtle cognitive or behavioral deficits *rapid progression of this disease with the inability to ambulate by 10 to 12 years of age* electromyography e activity within muscles muscle biopsy to see absence of dystrophin and evalutae the msucle fiber size DNA analysis and high serum creatinine kinase levels in the blood also assist with confirming the diagnosis definitive with clinical findings + EMG and muscle biopsy pulmonary function testing additional findings occur with progression like disuse atrophy, contractures, scoliosis, inabiity to ambulate, weight gain/obesity, cardiac and resp impairments, MSK deformity, GI dysfunction are most common respiratory problems and scoliosis progress once the child is in a w/c at 10-12 glucocorticoids and immunosuppression for pharma PT to assist with progression through the developmental milestones once they have impairments, PT should focus on maintenance of strength, adapting, and promoting family involvemnt respiratory care vital * breathing and postural drainage PT will NOT alter the degenerative process of the disease will affect cardiac muscle in the latera stages death occurs from CP complications by teenage years or less frequently into their 20s similar to facioscapulohumeral dystrophy FSHD also known as landouzy-dejerine dystrophy - a more of MD that is also inherited but origin is unknown, presents later in a childs life usually between 7 and 20 characterisitcs include facial and shoulder weakness, weakness lifting arms over head and difficulty closing eyes disease is more common in males than females females tend to be carriers of the disorder lifespan remains normal

zinc ionto

promote healing esp open lesions and ulcerations

milwaukee orthosis

promote realignment of the spine due to scoliotic curvature custom made and extends from the pelvis to the upper chest corrective padding is applied to the areas of severeity of the curve

antispasticity agents

promote relaxation in a spastic muscle agents bind selectively within the CNS or within the skeletal muscle cells to reduce spasticity indicated with increased tone, spasticity, SCI, CVA, MS side effects include drowsiness, confusion, HA, dizziness, generalized muscle weakness, hepatotoxicity potential with dantrium, toelrance, dependence PTs must balance the need to decrease spastic muscles with the loss of function that a patient may experience with the reduction of hypertonicity once spasticity is reduced, therapists should focus on therapeutic handling techniques, facilitation, and strengthening to promote overall mobility sedation may also alter the schedule of therpay to allow for maximal participation lisresal (baclofen), valium (diazepam), dantrium (dantrolene), zanaflex (tizanidine)

pediatric therapeutic positioning

proper positioning is essential to obtain max function for the pediatric population positioning is used for many purposes including facilitation of desired patterns of movement, inhibition of abnormal reflexes, normalization of tone, midline orientation, enhancement of respiratory capacity, pulmonary hygiene, maintaining skin integrity and prevention of contractures

prevention of pressure ulcers in SCI

proper positioning when sitting and in bed (protect bony prominences, equal weight distribution, use of equipment such as specialized cushions, mattress pads and other pressure relief devices) proper skin care (full cleaning and drying of skin, consistently inspect all skin and monitor any red areas closely; use of skin care products that are recommended by health care professionals proper changing of position (consistently change position every two hours, need to weight shift in sitting at a minimum of every 15-20 min) proper nutrition (attain adequate nutrition and calories each day, drink the recommended amount of water, limit empty calories and alcohol intake) clothing (wear clothing that is not high risk for skin breakdown i.e. zippers, avoid tight clothing, clothing should be breathable with a comfortable fit) mobility (daily activity is recommended and should include a cardiovascular component; however, avoid activities with a high shear or drag component hydration is also important!!

slow reversal hold is what

proprioceptive neuromuscular facilitation technique used primarily to improve stability surrounding a joint

prosthetic and amputee causes of abducted gait

prosthesis is too long high medial wall poorly shaped lateral wall prosthesis positioned in abduction inadequate suspension excessive knee function abduction contracture improper training adductor roll weak hip flexors and adductors pain over lateral residual limb

prosthetic and amputee causes of vaulting

prosthesis too long inadequate suspension excessive alignment stability excessive PF residual limb discomfort improper training fear of stubbing toe short residual limb painful hip/residual limb

prosthetic and amputee causes of lateral bending

prosthesis too short improperly shaped lateral wall high medial wall prosthesis aligned in abduction poor balance abduction contracture improper training short residual limb weak hip abductors on prosthetic side hypersensitive and painful residual limb

K-Level 0

prosthesis will not enhance QOL not eligible for prosthesis

ventricular system in brain

protect and nourish the brain 4 fluid filled cavities contains specialized tissue called choroid plexus that makes CSF excess CSF causes enlargement of ventricles causing hydrocephalus excess fluid within the spinal cord is termed syringomyelia

meninges

protectin from contusion and infection blood vessels and cerebrospinal fluid within the meninges dura mater to SUBDURAL space to arachnoid (impermeable) to SUBARACHNOID space to pia to BRAIN

prosthetic and amputee causes of circumducted gait

prothesis is too long excessive knee friction socket is too small excessive plantar flexion abduction contracture improper training weak hip flexors lacks confidence to flex the knee painful anterior distal residual limb inability to initiate prosthetic knee flexion

functional independence measure (FIM)

provides a level of burden through assessment of mobility and ADL management CVA

duchanne starts as what

proximal weakness

log roll and breathing exercises for

pt following abdominal surgery to increase pt comfort and diminished abdominal pain breathing is also imp since the patients breathing pattern often becomes shallow post op secondary to pain

clearance

rate at which a drug is removed from the body limited clearance = higher risk for toxicity

leukopenia effect on BP

reducion in WBC doesnt typically effect BP

subthalamus/epithalamus

regulating movements produced by skeletal system associated with basal gang and substantia nigra reped by pineal gland secretes melatonin and involved in circadian rhytums assoc with limbic and BG

Non weight bearing rigid removable limb protectors

removable accomodates edema flucuation easily applied presents contracture provides protection not for amb purpses

neurectomy

removal of segment of a nerve in order to decrease spasticity and improve fxn

declarative learning

requires attention, awareness, and reflection in order to attain knowledge that can be consciously recalled (mental practice)

UE D2 Flexion

scapula: elevation + adduction + upward rotation should: flex + abduction + ER forearm: supination Wrist: extension + Radial Dev Thumb: Extension raising your sword in the air

cant see a patient at the time they want what do you do

schedule the patient with another PT at the time they want dont ask another patient to move bc "not respectful"

deep tendon reflexes what position

slight stretch

dysarthria

slurred and impaired speech due to a motor deficits of the tongue or other muscles essential for speech

PNF slow reversal

stability, controlled mobility, skill a technique of slow and resisted concentric contractions of agonists and antagonists around a joint without rest between reversals used to improve control of movement and posture i.e. concentric one way, flip hands, concentric the other way

most valuble info for plan of care

staging of cancer to estimate prognosis and determine approp innerventins

consciousness

state of alertness, awareness, orientation, and memory

most painful burn

superficial partial-thickness burn i..e sunburn with blistering

polymyalgia rheumatica

systemic inflamm condition experienced mainly by older adults, HIGH ESR (erythrocyte sedimentation rate) most common in pelvic and shoulder girdles

current density is calculated by

taking the current amplitude and dividing by the surface area greater current density results in increased risk of an electrochemical burn

tibial injury caused by

tarsal tunnel entrapment popliteal fossua compression

when treating a patient with peripheral nerve damage...

test all areas of face trunk and extremities and each modality of sensation

motor index scoring

testing each key muscle using the 0-5 scoring with total points of 25 per extremity for the total possible score of 100

breathing control is achieved by integrated control of

the central respiratory center in the brainstem and peripheral receptors in the lungs, airways, chest wall, and blood vessels respiratory center integrates the info transmitted from the central and peripheral chemoreceptors and mechanoreceptors in the chest wall to stimulate motor neurons that innervate the respiratory muscles

hypertrophic scarring will occur when the burn extends into ....

the dermis poor comesis and development of contractures

mechanoreceptors inhibit muscle activity aiding in breathing when...

the force of contraction reaches potentially injurious levels

max oxygen uptake calculated by

the greatest amount of oxygen that can be used at the cellular level for the entire body HR and workload

ideational apraxia

the inability to formulate an initial motor plan and sequence tasks where the proprioceptive input necessary for movement is impaired i.e. incorrect orders, buttering toast before putting it in the toaster, putting on shoes before socks, using screwdriver as a pen (the inability to coordinate activities with multiple, sequential movements, such as dressing, eating, and bathing)

learning

the process of aquiring knowledge about the world that leads to relatively PERMANENT change in a person's capability to perform a skilled action

Power

the rate at which work is done i.e. work divided by time

C6 sensory testing

thumb

spinocerebrellar tract (ventral) ascending tract

to cerebellum for ipsilateral subconscious prorioception, tension in msucles, joint sense, and posture of trunk, UE and LEs

why do you put your arm across your lap when practicing a backwards fall in a w/c

to limit the movement of the LEs with the foerarm so that they do not fall into the patients face during a backward fall pt is not likely to remain completely in the chair secondary to limited trunk control and lower extremity paresis

rehabilitation act amendments 1992

transition planning at high school graduation includes coordination of assistive technology services and the rehabilitation system

rotationplasty

treatment for distal femoral osteosarcoma

right AV valve aka

tricuspid valve (controls blood between the right atrium and right ventricle)

corneal "blink" reflex

trigeminal and facial nerves ask the patient to look up and away from you, stroke the cornea using a piece of cotton both eyes will blink with contact to ONE eye

fasciculus gracilis (posterior or dorsal column) ascending tract

trunk and LEproprioception, two point dsicrim, vibration and graphesthesia

how to cue during a transfer

try to utilize your own strength to complete the transfer NOT pretend you were home alone and needed to complete the transfer bc they need assistance at the moment (in the question) and that means they would not follow the correct and safe manner for transferring

K-Level 3

variable cadence ambuator unlimited community ambulator traverse most environmelta barriers prosthetic use beyond simple locomotion hydraulic/pneumatic knee microprocessor vafriable friction mehcnism energy storing dysnmic response foot multiaial foot/ankle

hydraulic knee

variable friction for improved swing and stance phase control

outer third meniscus is avscaul or vascular

vascular inner Avascular

superior vena cava

vein that return venous blood from the head, neck and arms

flaking skin on legs with brownish disoloration is characteristic of

venous insufficiency

AED is used for

ventricular fibrillation or ventricular tachycardia cant od anything about atrial stuff first degree ventricular heart block does not have signifcant changes in cardiac function aka they wouldnt be in cardiac arrest

balance requires what 3 systems

vestibular(movement of head, perturbs) visual somatosensory (proprioception)

vital capacity (VC)

volume change that occurs between maximal inspiration and maximal expiration VC = TV + IRV + ERV 75% of total lung volume

what happens when there is a peripheral nerve lesion...

voluntary muscles first exhibit an altered response to acetylcholine with wasting of the sarcoplasm and loss of fibrils results in total loss of muscle over time with replcaement by fibrous tissue

high guard position

with the scapulae adducted by the rhomboid muscles arms held near shoulder level with retraction of the scapulae

Shoulder Extension ROM

0-60

Wrist Extension ROM

0-70

1st Interphalangeal Flexion ROM

0-80

Forearm Pronation ROM

0-80

Forearm Supination ROM

0-80

Thoracic and Lumbar Flexion ROM

0-80

Wrist Flexion ROM

0-80

Distal Interphalangeal Flexion ROM

0-90

Metacarpophalangeal Flexion ROM

0-90

Shoulder Lateral Rotation ROM

0-90

Waist to Hip Circumferences (Normative Values)

0.9 or less in men 0.85 or less in women >1.0 increased risk

Seven stages of recovery: Brunnstrom

1 - no volitional movement initated 2 - the appearance of basic limb synergies, the beginning of spasticity 3 - synergies are performed voluntarily, spasticity increases 4 - spasticity begins to decrease, movement patterns are not dictated soley by synergies 5 - a further decrease in spasticity is noted with independence from limb synergies 6 - isolated joint movements are performed with coordination 7 - normal motor function is restored

Apley's Compression Test

The patient is positioned in prone with the knee flexed to 90 degrees. The therapist stabilizes the patient's femur using one hand and places the other hand on the patient's heel. The therapist medially and laterally rotates the tibia while applying a compressive force through the tibia. A positive test is indicated by pain or clicking and may be indicative of a meniscal lesion.

Craig's Test

The patient is positioned in prone with the test knee flexed to 90 degrees. The therapist palpates the posterior aspect of the greater trochanter and medially and laterally rotates the hip until the greater trochanter is parallel with the table. The degree of anterversion corresponds to the angle formed by the lower leg with the perpendicular axis of the table. Normal anteversion for an adult is 8 - 15 degrees.

Foraminal Compression Test

The patient is positioned in sitting with the head laterally flexed, the therapist places both hands on top of the subjects head and exerts a downward force, a positive test is indicated by pain radiating into the arm toward the flexed side and may be indicative of nerve root compression

Sitting Flexion Test

The patient is positioned in sitting with the knees flexed to 90 degrees and the feet on the floor. The patient's hips should be abducted to allow the patient to bend forward. The therapist places his/her thumbs on the inferior margin of the posterior superior iliac spines and monitors the movement of the bony structures as the patient bends forward and reaches toward the floor. A positive test is indicated by one posterior superior iliac spine moving further in a cranial direction and may be indicative of an articular restriction.

Tibial Torsion Test

The patient is positioned in sitting with the knees over the edge of a table, the therapist places the thumb and index finger of one hand over the medial and lateral malleolus, the therapist then measures the acute angle formed by the axes of the knee and ankle, normal lateral rotation of the tibia is considered to be 12-18 degrees in an adult

Trendelenburg Test

The patient is positioned in standing and is asked to stand on one leg for approximately ten seconds. A positive test is indicated by a drop of the pelvis on the unsupported side and may be indicative of weakness of the gluteus medius muscle on the supported side.

Lateral Pivot Shift Test

The patient is positioned in supine with the hip flexed and abducted to 30 degrees with slight medial rotation. The therapist grasps the leg with one hand and places the other hand over the lateral surface of the proximal tibia. The therapist medially rotates the tibia and applies a valgus force to the knee while the knee is slowly flexed. A positive test is indicated by a palpable shift or clunk occurring between 20 and 40 degrees of flexion and is indicative of anterolateral rotary instability. The shift or clunk results from the reduction of the tibia on the femur.

Noble Compression Test

The patient is positioned in supine with the hip slightly flexed and the knee in 90 degrees of flexion. The therapist places the thumb of one hand over the lateral epicondyle of the femur and the other hand around the patient's ankle. The therapist maintains pressure over the lateral epicondyle while the patient is asked to slowly extend the knee. A positive test is indicated by pain over the lateral femoral epicondyle at approximately 30 degrees of knee flexion and may be indicative of iliotibial band friction syndrome.

True Leg Length Discrepancy Test

The patient is positioned in supine with the hips and knees extended, the legs 15 to 20 cm apart, and the pelvis in balance with the legs. Using a tape measure, the therapist measures from the distal point of the anterior superior iliac spines to the distal point of the medial malleoli. A positive test is indicated by a bilateral variation of greater than one centimeter and may be indicative of a true leg length discrepancy.

Ortolani's Test

The patient is positioned in supine with the hips flexed to 90 degrees and the knees flexed. The therapist grasps the legs so that the thumbs are placed along the patient's medial thighs and the fingers are placed on the lateral thighs toward the buttocks. The therapist abducts the infant's hips and gentle pressure is applied to the greater trochanters until resistance is felt at approximately 30 degrees. A positive test is indicated by a click or clunk and may be indicative of a dislocation being reduced.

2/5 MMT

The subject completes range of motion in a gravity-eliminated position Poor

0/5 MMT

The subject demonstrates no palpable muscle contraction Zero

2-/5 MMT

The subject does not complete range of motion in a gravity-elimintated position Poor Minus

3-/5 MMT

The subject does not complete the range of motion against gravity but does complete more than half of the range Fair Minus

2+/5 MMT

The subject is able to initiate movement against gravity Poor plus

1/5 MMT

The subject's muscle contraction can be palpated, but there is no joint movement Trace

Acromioclavicular Crossover Test

The therapist moves the patient's shoulder into 90 degrees of flexion, then fully horizontally adducts the shoulder The test is positive for an acromioclavicular joint injury if the patient feels pain over the AC joint, the test can also be done actively by the patient

Anterior Labral Tear Test

The therapist places the patient's hip in full flexion, lateral rotation, and abduction to begin the test, the therapist then moves the hip into extension, medial rotation, and adduction A positive test is indicated by the presence of pain and or a click The test is used for diagnosing an anterior labral tear though it may also be indicative of iliopsoas tendonitis or anterior-superior impingement

End-feel

The type of resistance that is felt when passively moving a joint through the END range of motion Certain tissues and joints have a consistent end-feel and are described as firm, hard or soft. Pathology can be identified through noting the type of abnormal end-feel within a particular joint. Clinical relevance: incorrect end feel, or correct end feel at incorrect ROM indicate pathology

The progression of weakness related to Duchenne muscular dystrophy is most accurately described as:

The typical progression of weakness in Duchenne muscular dystrophy is symmetrical and proximal to distal. Marked weakness of the pelvic and shoulder girdle musculature typically precedes marked weakness in the distal extremity muscles. Bladder and bowel function is typically spared.

forced vital capacity (FVC)

The volume of air expired during a forced maximal expiration after a forced maximal inspiration.

lupus SLE

autoimmune numerious organ and joint tissues butterfly rash and joint pain in smaller joints

Disk Herniation SILVER

Twisting and bending of the spine MOI with added external load Can occur acutely or gradually Nucleus pulposus bulges through the annulus fibrosus Commonly on the posterolateral portion of the disc where the disc is weakest L4-L5 and L5-S1 Often the result of gradual age related changes discs lose water content and they are less flexible and can tear and rupture the outer alyer the annulus risk facotrs are being overweight and a job with lifting and twisting presnts with low back pain followed by unilateral leg pain may also experience numbness tingling and weakness in the distribution of the affected nerve sx are exaggeratted by movement and intraabdominal pressure can happen in cervical spine MRI most common to visual disc hernation Electromyohraphy and nerve conduction test can also be used to determine the extent of the nerve damage avoidance of provocative positions and PT is successful traction and modalities mckenzie extension exercises too can have a cortisone injection if necessary a small % of patients will need surgery Complete resolution will take months Large majority get better with conservative tx if annulus fibrosis is affected determines outcomes better if those fibers are not affected if they are more likely to haver surgery and have reoccurance

each spinal nerve contains

a dorsal root which is sensory afferent fibers and a ventral root which is motor efferent fibers

phenylketonuria

a genetic disorder in which the essential digestive enzyme phenylalanine hydroxylase is missing behavioral and cognitive issues common in caucasians

rigidity

a state of severe hypertonicity where a sustained muscle contraction does not allow for any movement at a specified joint

inhibition

a techniqueused to decrease excessive tone or movement

respiratory alkalosis

elevated arterial blood pH and low PaCO2 which can be caused by alveolar hyperventilation due to dizziness or syncope alkalosis = basic, not acidic

red blood cells

erythrocytes 40% of blood volume contains hemoglobin (a protein that gives blood its red color and enables it to bind with oxygen) when RBCs are low (anemia) the blood carries less oxygen which results in fatigue and weakness if the RBCs are high (polycythemia) the blood is too thick, increasing the risk of stroke or heart attack

hemiplegia therapy considerations

evaluation of strength focuses on patterns of movement rather than straight plane motion at a joint sensory exam required to assist with treating motor deficits initially limb synergies are encouraged as a necessary milestone for recovery encourage overflow to recruit active movement of the weak side repetition of task and positive reinforcement should be emphasized a patient will follow the stages of recovery byt may experience a plateau at any point so that full recovery may not be achieved movement combos that deviate from basic synergies should be introduced in stage 4 of recovery treatment should incorporate only tasks that the patient can master or almost master

K-Level 4

exceeds basic ambulation skills exhibits high impact, stress or energy levels typical child, athlete, or active adult any system any system

prosthetic and amputee causes of medial or lateral whip

excessive rotation of the knee tight socket fit valgus in the prosthetic knee improper alignment of toe break improper training weak hip rotators knee instability

prosthetic and amputee causes of rotation of forefoot at heel strike

excessive toe out built in loose fitting socket inaequate suspension rigid SACH heel cushion poor msucle control improper training weak medial rottaors short residual limb

attention vs construct vs abstract vs orientation

exert a sustained, consistent effort copy or draw interpret, describe similarities/differences person place time

independent variable

experiemental or predictor variable it is the condition, intervention, or characteristic that will predict or cause an outcome in an experiemental study will be MANIPULATED aka noise level to see how it changes the skill performed

lower respiratory tract

extends from the larynx to the alveoli in the lunfs and consists of the conducting airways and the terminal respiratory units between the trachea and the alveoli the airways divide approx 23 times

rubrospinal tract descending

extrapyram motor tract repsonible for motor input of gross postural tone, facilitating activity of flexor msucles, and inhibiting the activity of extensor msucles

vestibulospinal tract descending

extrapyramidal motor tract for ipsilateral gross postural adjustments subsequent to head movements, facilitating activyt of the extensor msucles and inhibting flexor muscles damage to this results in signifncant paralysis, hypertonicity, exaggerated deep tendon relfexes and clasp knife reaction

reticulospinal tract descending

extrapyramidal motor tract responsible for facilitation or inhibitio of voluntary and reflex activity through the inflence on alpha and gamma motor neurons

diplopia from brain damage what do you do to treat it

eye patch

Knee ankle foot orthosis KAFO

fabricated using two metal uprights extending frojm the foot/shoe to the thigh with calf and thigh bands plastic thigh shell is connectd to a plastic ankle foot orthosis thorugh metal uprights lateral and medial to the knee ojint allow for a lock mechanism at the knee that provides stablity ankle is also held in proper alignment

facial vs trigeminal

facial expressions sweet salty chewing facial sensation

contractures with amputations

failure to initate full range of motion early in the post op phase and poor positioning of the residual limb significantly increase the likelihood of a contracture the joint immediately proximal to the amputation site is the most susceptible the most likely contractures based on level of amp are: trasnsmetatarsal and symes (equinus deformity) transtibial (knee flexion) transfemoral (hip flexion and abduction)

lingula

place hand on the left side of the chest below the axilla

strategy

plan used to produce a specific result or outcome that will influence the structure of system

most appropriate orthosis for someone with fair hip and knee strength poor dorsiflexion (2) and even wrose inversion and eversion (1)

plastic articulating ankle-foot orthosis good with intact sensation, and an articulating ankle joint improves biomechanics during gait since there is an ABSENCE of tonal abnormalities

decreased breath sounds and decreased fremitus =

pleural effusion In common medical usage, it usually refers to assessment of the lungs by either the vibration intensity felt on the chest wall (tactile fremitus) and/or heard by a stethoscope on the chest wall with certain spoken words (vocal fremitus), although there are several other types.

decreased fremitus with decreased breath sounds

pleural effusion or pneumothorax (full collapse)

examples of LMN disease

poliomyelitis ALS (both upper and lower) guillain barre syndrome tumors involving the SC trauma progressive muscular atrophy infection bells palsy carpal tunnel MD spinal muscualr atrophy

elevated hemoglobin =

polycythemia or dehydration

venous insufficiency ulcers

poor nutrition to tissues painful, proximal to medial malleolus hyperpigmentation of skin and edema wound bed is shallow, edges are irregular and substantial drainage occurs

hydrocephalus why does ithappen and signs of blocked shunt

poor resorption, obstruction of flow ro excessive production of CSF associated wtih spina bifida, choroid plexus neoplasm, cerebral palsy, tumor, meningitis, or encephalocele will need shunt or third ventriculostomy repeated neurosurgeries often necessary long term health outcomes are unpredicable enlarged head or bulging fontanelles in infacts headache changes in vision large veins noted on scalp behavioral changes seizures alteration in appetite, vomiting sun setting sign or downward deviation of the eyes incontinence failure to act on these sx and seek medical attention can result in coma or death NOTIFY APPROPRIATE MEDICAL PERSONNEL IMMEDIATELY

S2 sensory testing

popliteal fossa in the midline

posterior cerebral artery (PCA) what does it supply and what are the expected impairments

portion of midbrain subthalamic nucleus basal nucleus thalamus inferior temporal lobe occipital and occipitoparietal corticies contralateral pain and temp sensory loss contalateral hemiplegia (central area), mild hemiparesis ataxia, athetosis or choreiform movement quality of movement is impaired thalamic pain syndrome anomia prosopagnosia with occipital infarct hemiballismus visual agnosia homo hemi memory impairment alexia, dyslexia cortical blindness from bilateral involvement two most signficant impairmetns are thalamic pain syndrome and cortical blindeness**** thalamic pain presents with abnormal sensation of pain, temmperature, touch, and proprioception which can be debilitating with corital blindness, the eye is physically normal but there is partial or full blindness the pupil continues to dilate and constrict in repsonse to light since this occurs without infleunce of the brain

primary cause of medial ankle pain in middle aged patients

posterior tib dysfunction occurs due to the inability of the posterior tibial tendon to support the medial longitudinal arch as a result will present with flat foot and may feel lke the ankle tends to roll inward would see hindfoot valgus and forefoot ABDuction

where do the peroneus longus and brevis tendons run

posterior to the lateral malleolus

smooth muscle of the bronchi and pulmonary blood vessels are innervated by

postganglionic sympathetic fibers for sympathetic vagus nerve for parasympathetic the nerves to the lungs reach the pulmonary vessels and lung tissue though the anterior and posterior pulmonary plexuses

variable practice

practice of a given task under differing conditions

whole training

practice of an entire task

part training

practice of an individual component or selected components of a task

massed practice

practice time in a trial is greater than the amount of rest between trials

froments sign tests what nerve

ulnar adductor pollicis longus paper

brainstem CVA

unstable vital signs decreased consciousness decreased ability to swallow weakness on both sides of the body paralysis on both sides of the body

internal intercostals are oriented

up and forward contraction of both internal and external causes elevation of the ribs

base of the heart

upper border of the heart involving the left atrium, part of the right atrium and the proximal portions of the great vessels it lies approx below the second rib at the level of the 2nd intercostal space

Erbs Palsy GOLD

upper brachial plexus injury or palsy that usually results from a difficult birth most common palsy related to the brachial plexus primarily affects the muscles of the shoulder and elbow most common avulsion located at ERBS point (which is he area in the anterolateral neck) nerves supplying the ipsilateral upper limb and shoulder msucles supplied by cervical roots C5-C6 axillary lateral pectoral upper and lower scapular suprascapular partial paralysis of the long thoracic and the MSC nerves result = loss of RC, deltoid, brachialis, coracobrachialis, and biceps brachii function large baby with breech presentation foreceps difficult delivery one side is STRETCHED congential chicken pox or amniotic bands may also produce this condition when it occurs in adults, the cause typcally is an injury that has caused stretching tearing or other trauma to the upper brachial plexus WAITERS TIP DEFORMITY avlusion, ruture, neuroma, neurapraxia loss of shoulder function, loss of elbow function, loss of forearm supination, hand positioned in a pinch grip manner xray or MRI to see if there is damage to the bone or joint of neck EMG or nerve condution study to see if any nerve signals are present in complete injuries, motor and sensory nerve condutin studies of median, ulnar, and radial nerves may be conducted Gilbert shoulder classification pediatric outcomes data collection instrument if amniotic bands were the causes, can exhibit characteristics such as under developed extremity or deforemd area, may also expeirence GH subluxation or dislocation, skeletal deformity, poor bone growth, and a learned pattern of non use chance of getting it is equally distributed by gender and age and race occurs frequently in normal and healthy infants 1 in every 1000 if patient has sponteneous recovery (full active movement) within 3-4 months, the caregivers are usually given a home program if this does not occur, the patient will continue therapy with close monitoring or progress conservative management fails surgery may be indicated but it will not restore normal function will wear a splint for 3-4 weeks avoid traction by teaching parents adaptation of developmental milestones optimal return PT starts at infancy or immediately nerve regeneration remains at a constant speed however PT can assist with overall strength and function during recovery 9 out of 10 recovery with conservaive tx final functional outcome depends on degree of damage and caregivers ability to maintain motion during initial few months of life since nerves grow at a rate of one inch per month, it may take several months or even years for nerves repaired at the cervical spine to reach the muscles of the hand similar to klumpkes palsy brachial plexus palsy where there is an injury from childbirth affecting the spinal nerves C7 C8 T1 it is UNCOMMON and can be contrasted to erbs palsy which affects C5 C6 produces flexion and supination of the elbow and extension of the wrist, hyperextension of the metacarpophalangeal joitns and flexion of the IP joints allowing for CLAWHAND posture traction while in an abducted* position

trachea is the index of the

upper medisatinum check for deviation of the trachea by inserting fingers in the suprasternal notch heart is lower as long as its not enlarged

vertigo

used to describe a sense of movement and rotation of oneself or the surrounding environment typically a sensation of spinning but can also present as linear motion or falling may have a peripheral or central origin

suspensory strategy

used to lower the center of gravity during standing or ambulation in order to better control the COG. examples: knee flexion, crouching or squatting. often used when both mobility and stability are required during a task such as surfing.

three point

used when one limb is affected used for NWB and PWB 2 crutchs + uninvolved crutches to affected to unaffected HOW MANY FULL WEIGHT BEARING POINTS DETERMINES THE NUMBER

autolytic debridement

using body's enzymes to break down tissue through the use of a moisture-retentive dressing promotes rehydration of viable tissue and allows the bodys enzymes to digest necrotic tissue not the same as enzymatic debridement

considerations for rood sensory intervention constructs

utilize sensory stim to achieve motor output during treatment movement is considered autonomic and noncognitive homeostasis of all systems i essential technqiues such as neurtral warmth, maintained pressure, and slow rhythmical stroking can be used to calm a patient tactile stimulation is used to facilitate normal movement environment can influence the eeffects of therapeutic intervention exercise must provide proper sensory feedback in order to be therapeutic belief in technqiues used to stimulate proprioception, exteroceptive, and vestibular channels of the CNS

dix-hallpike test what is it and what is the general procedure

vertiginous position test stimulates the posterior semicircular canal and attempts to determine if otoconia exist within the canal 1 - long sitting and head rotated 45 degrees to one side 2 - patient is rapidly moved to a supine position with the head still in 45 degrees and EXTENDED 30 degrees beyond the horizontal off the end of the table 3 - hold the patients head in the position noted above for 20-30 seconds looking for nystagmus

volumetric vs circumferential measuresments

volume for wrist and hand edema circumferential for impactical joints like knee

2 out of 4 on dyspnea scale

"moderate, bothersome"

Steps for Solving Arthrokinematic Questions

(1) determine concave bone (2) determine convex bone (3) which bone is moving? (4) what direction does it move? (osteokinematics motion) (5) apply rule (6) determine roll (7) determine glide The roll always occurs in the direction of the osteokinematics motion The glide depends on the rule that is applied (concave-convex rule or convex-concave rule)

Moro reflex

falling relfex abduction figners extended to adduction of arms 28 weeks to 5 months

Hip Lateral Rotation ROM

0-45

Hip Medial Rotation ROM

0-45

Metacarpophalangeal Hyperextension ROM

0-45

Thoracic and Lumbar Rotation ROM

0-45

1st Metacarpophalangeal Flexion ROM

0-50

Ankle Plantar Flexion ROM

0-50

Cervical Rotation ROM

0-60

symmetrical tonic labyrinthine reflex

-promotes tendency for ext when pt is in supine and reduced extensor influence when pt in prone -serves to limit child's ability to flex neck when in supine. child should be in sidelying or in supine with hip flexion or knee flexion to decrease influence of reflex

congenital nystagmus

-typically mild and does not change in severity over the person's lifetime; not usually associated with other pathology

Grades of Available Joint Play

0 = Anklylosis, no movement 1 = Considerably decreased movement 2 = Slightly decreased movement 3 = Normal 4 = Slightly increased movement 5 = Considerably increased movement 6 = Complete instability

modified ashworth scale grading

0 = no increase in muscle tone 1 = slight increase in muscle tone, manifested by a slight catch and release or by minimal resistance at end of ROM when the affected part is moved in flexion or extension 1+ = slight increase in muscle tone, manifested by a catch, followed by min resistance throughout remainder of ROM 2 = more marked increase in muscle tone, but affected parts easily moved 3 = considerable increase in muscle tone, passive movement difficult 4 = affected part rigid in flexion or extension (takes a lot of force to move)

Proximal tibiofibular joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

0 degrees plantarflexion Tibia is convex Fibula is concave Same direction

Distal Interphalangeal Hyperextension ROM

0-10

Hip Extension ROM Requirement for Gait

0-10 degrees Max "hyperextension" at terminal stance

Ankle Dorsiflexion ROM Requirement for Gait

0-10 degrees Max dorsiflexion at end of midstance

Proximal Interphalangeal Flexion ROM

0-100

Hip Flexion ROM

0-120

Knee Flexion ROM

0-135

1st Carpometacarpal Flexion ROM

0-15

Ankle Eversion ROM

0-15

Elbow Flexion ROM

0-150

Shoulder Abduction ROM

0-180

Shoulder Flexion ROM

0-180

1st Carpometacarpal Extension ROM

0-20

Ankle Dorsiflexion ROM

0-20

Wrist Radial Deviation ROM

0-20

Ankle Plantarflexion ROM Requirement for Gait

0-20 degrees Max plantarflexion at pre-swing 15 degrees PF during loading respose Midstance starts with 10 degrees PF but moves to 10 degrees DF as the body translates over the ankle Back to neutral with heel off at terminal stance During initial swing it is 10 degrees During midswing and terminal swing and inital contact it is neutral Page 85 in scorebuilders book

Thoracic and Lumbar Extension ROM

0-25

Hip Adduction ROM

0-30

Hip Extension ROM

0-30

Wrist Ulnar Deviation ROM

0-30

Hip Flexion ROM Requirement for Gait

0-30 degrees Max flexion at end of midswing to end of loading response

Ankle Inversion ROM

0-35

Thoracic and Lumbar Lateral Flexion ROM

0-35

Cervical Extension ROM

0-45

Cervical Flexion ROM

0-45

Cervical Lateral Flexion ROM

0-45

Hip Abduction ROM

0-45

Mobilization Technique (Steps)

1. The patient should have a general understanding of the purpose of mobilization 2. The patient should be completely relaxed during treatment 3. The therapist should be in a comfortable position while performing mobilization activities 4. The therapist's position should allow for optimal control of movement. Explain specific mobilization techniques to the patient prior to beginning treatment. Complete a general examination of each patient prior to beginning mobilization activities 5. Use gravity assist with mobilization whenever possible 6. Mobilization activities are usually performed initially with the joint in a loose packed position 7. Maintain contact with the mobilizing hand as close to the joint space as possible 8. Allow one digit to palpate the joint line when possible 9. Mobilize one joint in one direction at a time 10. Use a mobilization belt or wedge to assist with stabilization when necessary 11. Constantly modify mobilization techniques based on individual patient response 12. Compare the quality and quantity of joint play bilaterally 13. Reassess each patient prior to every treatment session

floating ribs

11-12

Average adult cadence

110-120

stand up through quadruped, use a wide array of sittings positions, walk without support, creep up stairs, throw a ball in sitting and mark paper with crayons

12-15 months

At what age would an individual with Duchenne muscular dystrophy typically lose the ability to walk and need to transition to a wheelchair for mobility?

13 A typical child with Duchenne muscular dystrophy will lose the ability to walk at around 12-13 years of age and need to transition to a wheelchair for mobility. Weakness induced changes in gait patterns typically begin to develop at approximately 3-6 years of age.

FIM

18 items on 7 point scale Functional status index also has 18 items but it is not on a 7 point scale Scored on dependence difficulty and pain Physical self maintenance and katz index of ADLs are both only based on the 6 basic adls of bathing, dressing, toileting, transfers, continence and feeding

minute volume ventilation (VE)

volume of air expired in one min VE = TV x respiratory rate

how many segments with pairs of spinal nerves

31

how many spinal nerves

31 pairs 8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal

how many % people with SCI will develop a pressure ulcer

60-80% risk factors of immobility, decreased or absent sensation, prolonged pressure to an area, shearing foces, poor positioning, poor nutrition

% Time Between Right Pre-Swing and Right Initial Contact

40% Left single leg support

% Time Between Left Pre-Swing and Left Heel Initial Contact

40% Right single leg support

HDL high density lipoproteins, high or low for risk for coronary artery disease

40-60 low HDL is associated with coronary artery disease

most commonly used transducer sizes

5 and 10 cm want size to be about half of the treatment area i.e. if 12 cm can use 5cm

how to splint mallet finger

5 degrees hyperextension to ensure optimal length without becoming excessively lengthened (if it is healed in a lengthened position i.e. if the finger is placed in flexion with the splint, full extension cannot be achieved) 6-8 weeks slight hyperextension not to cause ischemia to the skin

Gross Motor Function Classification System GMFCS

5 distinct levels of classification level 1 is MORE functional and less severely involved level 5 (V) are SEVERELY limited in their functional abilities, are unable to maintain antigravity head and trunk positions, and possess minimal control of the upper and lower extremities level 1-2 more likely to ambulate in community with orthoses and/or assistive devices level 3-4 more likely to have some ability to ambulate at home but would use w/c for community level 5 standing fram to allow the child to assume an upright position despite inability to maintain antigravity head and or trunk positioning and to allow weight bearing through the LEs, the position would also serve to prodive a prolonged stretch of the hip flexors and hamstrings, a level 5 would likely use a w/c for both home and community

Open and Closed Pack Position of Glenohumeral

55 degrees abduction and 30 degrees horizontal adduction (anatomical position) Abduction and lateral rotation

how many towels around a hot pack

6-8 layers of towels around the hot pack

normal SV range

60 to 80ml .06 - .08 L

Stance phase is what % of the gait cycle?

60%

normal resting heart rate

60-100 bpm

Stress Fracture

A break in a bone due to repeated forces to a particular portion of the bone

Spiral Fracture

A break in a bone shaped like an S due to torsion and twisting

Nonunion Fracture

A break in a bone that has failed to unite and heel after nine to twelve months

Compound Fracture (Open)

A break in a bone that protrudes through the skin

Greenstick Fracture

A break on one side of a bone that does not damage the periosteum on the opposite side, this type of fracture is often seen in children

key patterns

A developmental sequence designed by Rood that directs patients' mobility recovery from synergy patterns through controlled motion

clasp-knife response

A form of resistance seen during range of motion of a hypertonic joint where there is greatest resistance at the initiation of range that lessens with movement through the range of motion

Circumduction Gait Pattern

A gait pattern characterized by a circular motion to advance the leg during swing phase, this may be used to compensate for insufficient hip or knee flexion or dorsiflexion There are many possible causes, including difficulty with hip flexion, knee flexion, or ankle dorsiflexion.

Equine Gait Pattern

A gait pattern characterized by high steps, usually involves excessive activity of the gastrocnemius I.E. in spastic cerebral palsy

Ataxic Gait Pattern

A gait pattern characterized by staggering and unsteadiness. There is usually a wide base of support and movements are exaggerated. Causes include alcohol abuse, certain medications, stroke, tumor, cerebral palsy, brain degeneration and multiple sclerosis

Double Step Gait Pattern

A gait pattern in which alternate steps are of a different length or at a different rate

Hemiplegic Gait Pattern

A gait pattern in which patients abduct the paralyzed limb, swing it around, and bring it forward so the foot comes to the ground in front of them I.E. with stroke

Steppage Gait Pattern

A gait pattern in which the feet and toes are lifted through hip and knee flexion to excessive heights, usually secondary to dorsiflexor weakness. The foot will slap at initial contact with the ground secondary to the decreased control. I.E. damage to deep peroneal nerve

Scissor Gait Pattern

A gait pattern in which the legs cross midline upon advancement I.E. in spastic cerebral palsy

Trendelenburg Gait Pattern

A gait pattern that denotes gluteus medius weakness; excessive lateral trunk flexion and weight shifting over the stance leg.

what would limit a prosthetic user from walking forward up a hill with a step over pattern

A limitation in dorsiflexion of the prosthesis will result in hyperextension of the knee in order to attain foot flat. This hyperextension may result in damage to the knee in an individual with a transtibial amputation, and provide extreme difficulty for an individual with a transfemoral amputation. For this reason, the safest and most efficient way for an individual with a prosthetic limb to ascend a hill or a ramp is to side step with the sound limb leading the movement and the prosthetic limb trailing.

McGill Pain Questionnaire

A pain assessment tool that is divided into four parts with a total of 70 questions Part 1 - patient marks on drawing of the body to indicate area and type of pain Part 2 - Patient chooses one word that best describes the pain from each of the twenty categories Part 3 - Patient describes pattern of pain, factors that increase and relieve pain Part 4 - Patient rates the intensity of pin on a scale of zero to five This tool can be used to establish a baseline, evaluate particular treatment regimens and monitor progress. It is valid, reliable, and the most widely used pain assessment scale.

Mobilization (Indications and Contraindications)

A passive movement technique designed to improve joint function Indications - restricted joint mobility, restricted accessory motion, desired neurophysiological effects Contra - active disease, infection, advanced osteoporosis, articular hypermobility, fracture, acute inflammation, muscle guarding, joint replacement

Avulsion Fracture

A portion of a bone becomes fragmented at the site of tendon attachment due to a traumatic and sudden stretch of the tendon

Plasticity

A property of soft tissue that allows for tissue elongation even after a stretch is no longer applied

Good/Faulty Posture of the Hips, Pelvis, and Spine Back View

A slight deviation to the left in a right handed individ and opposite for a left handed is not uncommon Also a tendency toward a slightly low right shoulder and slightly high right hip is freq found in right handed people and vice versa Should not see one hip higher than other (lateral pelvic tilt) or rotated

zone of preservation

A term used to describe poor or trace motor or sensory function for up to three levels below the neurologic level of injury.

Thumb Spica Splint

A thumb scipa splint is a rigid splint that covers the radial side of the forearm and hand as well as the thumb may cover thee whole thumb or may stop at the proximal phalanx of the thumb and thus allow IP joint motion used to immobilize wrist and MCP joint of the thumb and is commonly used for treating gamekeepers thumb, scaphoid fractures, first metaarpal fx, de quer, and other thumb injuries when splinting, the wrist should be in 20 dgerees of extension with the MCP in slight flexion

Viscoelasticity

A time-dependent property of soft tissue that results in resistance to stretch when it is initially applied, but allows for tissue elongation as the stretch is held for longer duration. As with elasticity, the tissue will return to its previous length after the stretch is no longer applied

Which abnormal gait pattern is most commonly associated with muscular dystrophy?

A waddling gait is often observed in patients with muscular dystrophy. This gait pattern is characterized by a wide base of support and is often described as duck-like with increased lumbar lordosis and a protruding abdomen. The muscles of the pelvic girdle deteriorate, which causes the patient to use circumduction to compensate for gluteal weakness.

stance control (safety)

A weight-activated mechanism that maintains knee extension during weight bearing even if the knee joint is not fully extended. If the knee is flexed greater than what the control mechanism is designed for, the mechanism will not engage

Triceps Reflex Innervation Level

C7

ACL Sprain Grade III (Complete Tear) GOLD

ACL extends from the anterior intercondular region of the tibia to the medial aspect of the lateral femoral condyle in the intercondylar notch and prevents anterior transplation of the tibia on a fixed femur and posterior translation of the femur on the fixed tibia Permits up to 500 lbs of pressure prior to rupture Poor blood supply and does not have the ability to heal a complete tear Most likley occur with hyperflexion, rapid deceleration, hyperextension, or landing in an unbalanced position Tear occurs at midsubstance Laxity in anteriolateral or anteromedial Agility sports, contact sports, women have higher rates (Q angle and narrow intercondylar notch) Peak incidence occurs between 14-29 years old which corresponds to higher activity level Characterized bgy pain, effusion and edema that sig limits ROM, may be unable to bear weight MRI to confirm Xray to rule out fracture Report of a pop or feeling as though the knee buckled Pain perceotion assessment scale 2/3 of ACL tears also have meniscal tear and mayby collateral ligament injury but not as common ACL + MCL + medial meniscus is called the unhappy triad Patellar tendon used for graft for surgery Protect graft, control edema, improve range closed chain emphasized since open chain causes more anterior translation of the tibia non op need to be aggressive strengthening once acute phase has subsided It is possible with an aggressive strenghtening program and or activity modification patients may be able to participate in light to moderate athletic activites without formal surgical reconstruction, if elect to have surgery then can expect to return to sport in 4-6 mo W/o surgery increase risk for instability and subsequent deteriortaion of joint surfaces Grade III PCL tear can look similar, dashboard injury or forced knee hyperflexion as the foot is PFed Effusion, posterior tenderness, knee extension limited due to effusion and stretching of the posteior capsule and gastroc Will focus on quad strength Less functional performance limitations More opt for non surg Alters arthrokinematircs of the knee joint and as a result a patient will be suscetible to degenerative changes such as arthritis

Transfemoral Amputation

Surgical removal of the lower extremity above the knee joint Can have long and short transfemoral

Transtibial Amputation

Surgical removal of the lower extremity below the knee joint Can have short and long transtibial

Hip Disarticulation Amputation

Surgical removal of the lower extremity from the pelvis

Dynamic Stretching

Actively moving a body segment to the end of range but not beyond this limit, while the antagonist muscle relaxes and stretches Most common warm up Prepares for explosive movements Movement based vs bouncing based (ballistic) End range movement is held only breifly and is performed repeatedly Low intensity, short duration

7 Skin Fold Sites

Abdominal Triceps (most commonly used) Biceps Chest/pectoral Medial calf Midaxillary Subscapular* Suprailiac Thigh

Trapeziometacarpal Joint

Abduction then extension

Patellofemoral Syndrome GOLD

Abnormal tracking between the condyles or pulled too far laterally Damages articuar cartilage of the patella Exact etiology is unknown but very common in adolescence, more prev in females than males and has a direct association with activity level In older pop = associated with OA Assocaited with this dx = patella alta, insufficnet lateral femoral condyle, weak vastus medialis obliquus, excessive pronation, excessive knee valgus, and tightness in lower extrem muscles (IP, ham, gastroc, and vastus lateralis) Gradual onset of anterior knee pain following an increase in physical acitivity Pain located behind the patella and may be exacerbated with PF compressive forces like stair climbing and jumping and with prolonged static postioning (sitting with the knee flexed at 90 degrees as in a car plane or theatre) Point tenderness over lateral border of the patella Quad atrophy (esp vastus medialis obliquus) Burning pain may happen during these activities as well Lab or imaging not commonly used Arthrogram and arthroscopy can be used to examine the cartilage Increased Q angle in these patients usually Strengthen vastus medialis in both NWB and WB Avoid deep squats Return to PLOF 4-6 weeks If primary cause is not addressed will keep happening Similar to patellar tendonitis Anterier pain with jumping or ascend/descend stairs Tenderness at superior pole

Medial glide of the patella would be most effective to increase...

Accessory motion of the patellofemoral joint

Trochanteric Bursitis SILVER

Acute or cumulative trauma to the lateral hip causing irritation to the trochanteric bursa sx typically involve lateral hip pain the actual hip joint is not affected bursa located between the femoral trochanteric process, glut med, and IT band cumulative trauma aka running (friction between the bursa and he IT band) acute aka fall risks include true or functional leg length discrepancy, history of lateral hip surgery, particpation in running or contact sports signicfantly more prevelent in women more common in active but can happen in sedentary individ presents with pain on lateral hip which may radiate to the lateral aspect of the thigh point tenderness and reproductin of pain are typical with palpation exacerbated by weight bearing or direct pressure passive hip movement involing lateral rotation and abductioon or resisted hip flexion and abduction are likely to reproduce sx pain related weakness MRI or ultrasound may differentiate between this and glut med tendinitis xray to rule out bony pathology multiple injections common surgery uncommon emphasize stretching of the ITband, TFL, lateral hip rotators, quads, and hip flexors ionto photo leg length addressed with AD orthortics or heel left or bracing avoidance of excessive unidirectional activiites? respond well to conservative tx return to PLOF and sport with PT and injections very successfu recurrence possible if not compliant

Carpal Bones

All bones between radius/ulna and metacarpals (then moves to phalanges, prox + intermid + distal)

Tarsal Bones

All bones between tibia/fibula and metatarsals

Hip ORIF

Always open procedure TFL glut med and vastus lateralis may be affected Early weight bearing becoming more normal ambulation and ROM early greater troch fx will affect glut med lesser troch fx will affet iliosposas be aware of fixation failure sucha s persistant thigh or groin pain, leg length discrepancy that doesnt present initally, postioning the limb in ER, trendelenburg sign that does not improve with strengthening

tidal volume

Amount of air that moves in and out of the lungs during a normal breath

Resistance Training

An activity that places an additional force against the muscle or muscle group

shrinker

An elastic sleeve that is placed over the end of the residual limb to control edema and encourage limb shaping

PROM Indications and Benefits

Any movement beyond end-range is considered stretching I - patient is unable to physically move the body segment (comatose, paralyzed) cog impaired active movement is contraindicated i.e. post op active is painful therapist is preparing joint for stetching therapist is teaching an active movement to the patient B - improves the mobility of connective tissues and muscles prevents joint contracture formation improves circulation improves synovial fluid movement for cartilage health decreases pain improves the patients awareness of movement

Knee Disarticulation Amputation

Surgical removal of the lower extremity through the knee joint

Shoulder Stabilizeation Surgeres

Anterior capsule most often tightened Labral repairs Bankart = anterior labrum Slap = superior Anterior capsule, normal sling used Avoid positions of external rotation, extension, and horizontal abduction Avoid ressited IR if subscap was detached during surgery posterior capsule, immobilized in hand shake position aka shoulder in neutral the patient should avoid positions of IR, flexion and horiontal adduction AROM can begin son after surgery Should not wait for full range of motion before beginning strengthening exercises and should not be overly aggressive in getting full motion early if SLAP repair has been performed, patient should avoid contracting or stretching the biceps since the biceps is attqached to the superior labrum

Open and Closed Pack Position of Sternoclavicular Joint

Arm resting by side in normal physiological position (anatomical position) Maximum shoulder elevation

Open and Closed Pack Position of Acromioclavicular

Arm resting by side in normal physiological position (anatomical position) Arm abducted to 90 degrees

Good/Faulty Posture of Arms and Shoulders

Arms hang relaxed at the sides with palms of the hands facing toward the body Elbows slightly bent Forearms hang slightly forward Shoulder level Shoulder blades lie flat against the rib cage Separated by 4 inches on average Should not... Arms be stiff Have palms face backward Shoulder blades pulled back too hard Winged

Transfemoral Amptutation due to Osteosarcoma GOLD

Arteriosclerosis obliterans aka peripheral arieral disease PAD vascular disease that produces thickening and narrowing of arteries results in ischemia and subsequent ulceration of the affected tissues affected area becomes necrtoic, gangrenous and requires ampuation 95% of the cases of vascular disease can affected anywhere that gets occluded age diabetes sex hypertension high serum cholestrol low density lipid level smoking impiared glucose tolerance obestiy and sedentary lifestyle males have an overall higher incidence of arteriosclerosis than females typically >45 years that smokes and will presetn with intermittent claudication that produces cramps and pain inthe affected areas I/M claudication will present in the gastroc-soleus complex secondary to its high oxygen demand resting pain decrased pulses ischemia pallor skin and decreased skin temp doppler ultasonography MRI or arteriography examine the dgree of blood flow through the extremities decreased hair ABI can used to assist with diagnosis status post amputation pt may have decrease in CV status depending on the freq of im claud diminished balance poor skin integ and hypersenitivity management - PT immediately focus on not getting knee flexion contracture should be able to return home with support or independenlty 20%will have a MI or CVA after diangosis some time similar to any other amputation

Myasthenia Gravis SILVER

Autoimmune disorder that affects the transmission of neuromuscular signals immune system produces antibodies that attck nerve receptors bc neuromusclar function is decreased, patients with myasthenia gravis have symptoms of weakness and fatigue pathology occurs at neuromuscular junctin normallty there are receptors on the motor end plate that accept acetylcholine which results in the transmission of an action potential in patient with MG there are fewer receptors on the motor end plate, secondary to the immune sysytem attching these receptors which results in inefficient nerve transmission process no known cause abnormalities in thymus function likely plays a role i.e. tumor or hyperplasia though thtat dysfuncton of this gland causes autoimmune reaction within the body women tend to develop the condition in their 20-30s while men develop it in their 50-60s WOMEN are more likely to be affected by this conddition primary feature = muscle weakness within the skeletal mucles muscles faigue rapidly withacitivty and rest quickly improves muscle function muscles commonly affected = ocular muscles and limbs (proximal > distal****) can experience diplopia and ptosis facial expression, chweing, swallowing and speech can also be affected triggers include activity, heat, stress illness certain meds mesntruation and pregnancy myasthenic crisis refers to an episode in which the rsp muscles experience paralysis and the patient need ventilation to asssit with respitation several tests can confirm bloood shows antibodies that attack ach receptors electromyography to demo rapid fatigue with repeated muscle stim edrophonium chloride a drug that blocks the dgradation of acetylcholine can be administered to determine if sx temorarily improve secondary to incfrease ach uptake imaging may show thymus abnormality differentiate between hyperthyroidism and botulism, check pulmoanry fxn meds to inhibit acetylocholinesterase the enzyme that breaks down acetylcholine allows ach to build up which dimishes sx but only helps temporarily corticosteroids can help suppress immunesystem surgery for thymus tumor can help plasma pheresis can be performed to revmove the antibodies from the blood in serious cases with acute worsening of sx PT avoid overexertion can also train breathing techniques PT not primary but can help with strength and endurnace and energy conservation sx are generally most severe within the first few years of diagnosis after sx plateau or improve compelte remission is rare but sx can be wellcontrolled and experience high QOL removal of thymus can also result in complete resmissioon mortality rates are very low

Transmetatarsal Amputation

Surgical removal of the midsection of the metatarsals

Hemicorporectomy Amputation

Surgical removal of the pelvis and both lower extremities

Yergason's Test

Biceps tendon pathology Bicipital tendonitis The patient is positioned in sitting with 90 degrees of elbow flexion and the forearm pronated, the humerus is stabilized against the patient's thorax, the therapist places one hand on the patient's forearm and the other hand over the bicipital groove, the patient is directed to actively supinate and laterally rotate against resistance A positive test is indicated by pain or tenderness in the bicipital groove and may be indicative of bicipital tendonitis

Rancho Initial Contact

Beginning of the stance phase that occurs with the foot touches the ground

Elbow Flexion (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Biceps Brachii Seated with arm supported on table, shoulder abducted to 90 degrees, elbow flexed to 90, full supination of forearm Stabilize over the lateral aspect of the ips arm The dynamometer is placed over the ventral aspect of the distal forearm just proximal to the wrist Resistance is perpendicular to the forearm in the direction of elbow extension

Ludington's Test

Biceps tendon pathology The patient is positioned in sitting and is asked to clasp both hands behind the head with the fingers interlocked, the patient is then asked to alternately contract and relax the biceps muscles A positive test is indicated by absence of movement in the biceps tendon and may be indicated of a rupture of the long head of the biceps

Speeds Test

Biceps tendon pathology Bicipital tendonitis The patient is positioned in sitting or standing with the elbow extended and the forearm supinated, the therapist places one hand over the bicipital groove and the other hand on the volar surface of the forearm, the therapist resists active shoulder flexion A positive test is indicated by pain or tenderness in the bicipital groove region and may be indicated of bicipital tendonitis

BIA Positioning of Electrodes

Bisect wrist Bisect ankle

Kehr's Sign

Blood that accumulates in the abdominal cavity often secondary to rupture of the spleen can cause irritation of the diaphragm and refer pain to the left shoulder, pain is referred to this region due to the innervation of the phrenic nerve (i.e. C3-C5) Kehr's sign is positive when pressure to the upper abdomen or supine positioning results in left shoulder pain

Abnormal Hard End-Feel

Bone to bone I.E. fracture osteoarthritis osteophyte formation

Transradial Amputation

Surgical removal of the upper extremity distal to the elbow joint

Shoulder Disarticulation Amputation

Surgical removal of the upper extremity through the shoulder

flexion injuries of the spine most often affect

C5-C6

Brachioradialis Reflex Innervation Level

C6

Myositis Ossificans BRONZE

Calcification of muscle Caused by neglecting to properly treat a muscle strain or contusion Failing to apply cold therapy after an injury, applying heat after an injury, or having intense therapy or mssage too soon after injury are precipitating factors taht disrupt healing and lead to abnormal bone growth Bone growth in the msucle belly and often occurs in muscles prone to traumatic injury such as the muscles of the arms and legs esp quad bone will begin to grow 2-4 weeks afer the injury and will mature within 3-6 mo Post injury the patient will present with typical symptoms of a contusion Pian with functional activities and stiffness an pain after prolonged rest Swelling, tenderness and bruising may also be presnt Within a few weeks of the injury the development of further symptoms may suggest the presence of myositis ossificans, symptoms include hard lump inthe muscle belly, an increase in pain, and a decrease in range of motion that had previosuly been improving xray to confirm 3 weeks after the injury when the bone has started to grow MRI can also confirm RUle out osteosarcoma

Transfer of Training Principle

Can have transfer from one exercise or task to another but the carryover is far less benefical than the adaptations from more specific training

Abnormal Empty End-Feel

Cannot reach end-feel, usually due to pain I.E. joint inflammation fracture bursitis

Cyriax Approach

Capsular patterns

C1 Myotome

Cervical rotation

Medial Collateral Ligament Sprain Grade II GOLD

Characterized by partial tearing of the ligaments fibers resulting in joint laxity when the ligament is stretched Mechanism is ususally a blow to the outside of the knee joint causing excess force to the medial side of the joint Return to previous functional level should occur within four to eight weeks following the injury Will not be able to fully extend and flex the knee, pain and tenderness along medial side, decrease in strength maybe, loss of porprioception maybe More severe swelling ma indicate of meniscus of cruciate ligament involvement MRI will confirm but it is expensive and not ususally done unless other extenuating circumstances ACL and meniscal damange often accompany this injury RICE, knee imobilizaer, focus on quads PTS SHOULD BE REQUIRED TO DO FUNCTIONAL PROGRESSION PRIOR TO REURENTING TO UNRESTRICTED ACTIVITY Can use crutches until patient can adequately extend the knee joint

Lateral Ankle Reconstruction

Chronic ankle instability Cast for a week non weight bearing Boot for several weeks partial weight bearing to full weight bearing followed by brace therapy does not start immediately will focus on ROM while protecting healing structures caution with inverison bracing may be required forever during return to sport

Laxatives

Citrucel Metamucil

Waist to Hip Circumferences (Anthropometric Measurement)

Compare weight to hip Apple shaped (increased risk for heart disease, type 2 diabetes, and premature death) Not accurate if shorter than 5 feet or BMI more than 35 or with children Two measurements can create error Hard to measure hips

Hip hiking during swing caused by

Compensation for weak dorsiflexors Compensation for weak knee flexors Compensation for extensor synergy pattern

Circumduction during swing caused by

Compensation for weak hip flexors Compensation for weak dorsiflexors Compensation for weak hamstrings

Hyperextension in stance is caused by

Compensation for weak quadriceps Plantar flexor contracture

Genu Valgum

Compression of lateral condyles Tension on medial ligaments Knock kneeed

Temporomandibular Joint Dysfunction GOLD

Condylar, hinge, and synovial joint TMD occurs due to a change in the joint structure that causes multuple sx and lim in fx inflamm and muscle spasm Results from injury, deragnement or incongruence, intraarticular disks or supporting structures Over time the menisuc of the TMJ becomes compressed and torn allowing for the bony portion of the joint (the ball and socket) to deteriorate secondary to the grinding of bone on bone Predisposing factors Triggering Perpetuating/sustaining metabolic conditions and stress can contribute risk facots include chewing on one side, eating touch foot, clenching and grinding Gum chewing and nail biting 20-40 years old with greater incidence in women link between gender specific hormones and risk for TMD 10.8 have TMD 90% are seeking treatment are women n childbearing years presents with pain persistent or recurring, msucle spasm, abnormal or limited jaw motion, headache and tinnitus unilateral or bilateral clicking or popping with motion xray MRI mandicular kinesiography CT and dental exam can be helpful locking of the jaw, restriction of the unaffected side and or pulling of the jaw towards the affected side causes include arthritis, fx, congentical abnorm, dislocations and tension relieving habits management - splinting maybe surgery bite plate occlusal appliance presciption 5% need surgery condylectomy, osteotomy, arthotoomy, arthroscopy, reduction of sublux or joint debrid avoid all foods and activities such as gum chewing that aggravate and stress the TMJ may not have long term affects if complaint PT should improve and decrease sx similar to myofascial pain dysfunction MPD nonarticular disorder that affects the area surrounding the TMJ however symptos are produced secondary to muscle spasm occurs more inf emales and of psychophysiologic orogin grinding and clenching can minim TMD, rule out

What is the most common cause of transfemoral amputations in individuals under 30 years of age? infection trauma tumors vascular disease

Correct Answer: tumors Osteosarcoma (osteogenic sarcoma) is the second most common primary bone tumor. It primarily affects young children and is the most common cause of amputations in younger populations.

Grind Test

Degenerative joint disease in the carpometacarpal joint The patient is positioned in sitting or standing, the therapist stablizes the patient's hand and grasps the patient's thumb on the metacarpal, the therapist applies compression and rotation through the metacarpal

high tetraplegia (C1-C4) functional outcomes for complete lesion

DEPENDENT -bed mobility -transfers -w/c management -ROM/positioning -feeding -grooming -dressing -bathing -bowel/bladder problems -manual weight shift -up/down curb with power w/c SETUP TO MOD I -power weight shifts -wheelchair power mobility with smooth/ramp/rough terrain able to verbally direct!

high tetraplegia (C5) functional outcomes for complete lesion

DEPENDENT -in wheelchair management, ROM/positioning -dressing -bathing -bowel/bladder problems -manual weight shifts MAX ASSIST -level slideboard transfer -manual w/c propulsion in all directions expect forward MAX ASSIST TO MOD -with bed mobility -hair grooming MIN ASSIST -feeding with adaptive equipment -grooming with adaptive equipment SET-UP TO MOD I -power weight shifts MOD I -manual w/c on smooth surface in forward direction (max assist in all other direction) able to verbally direct!

mid-level tetraplegia (C6) functional outcomes for complete lesion

DEPENDENT -w/c loading into car, floor transfers and uprighting wheelchair DEPENDENT TO MAX -up and down curb with power wheelchair MAX TO MODERATE ASSIST -up/down curbs with manual wheelchair MODERATE ASSIST -lower body undressing in bed -lower body bathing and drying -use of equipment for bowel -bladder for female in bed MODERATE TO MIN ASSIST -on ramps and rough terrain with manual wheelchair MIN ASSIST -lower body dressing in bed -upper body bathing and drying -bladder for male in bed or w/c MIN ASSIST TO MOD I -bed mobility -slide board transfers -side to side/forward lean weight shift -wheelchair management MOD I -power recline and tilt weight shift -smooth/ramp/rough terrain with power wheelchair -smooth surfaces with manual w/c -feeding with adaptive equipment -grooming with adaptive equipment -upper body dressing in bed or w/c

low tetraplegia (C7-C8) functional outcomes for complete lesion

DEPENDENT TO MAX ASSIST -assistance up/down curb with power wheelchair -up/down steps with manual w/c MAX TO MOD -floor transfers and uprighting wheelchair MODERATE -bladder for female in w/c MODERATE to MIN ASSIST -up/down curbs with manual MODERATE TO MOD I -car transfer MIN A -lower body dressing/undressing in w/c (C7) -wheelchair management MIN A TO MOD I -rough terrain with manual w/c -ROM/positioning -bowel with equipment MOD I -side to side, forward lean w/c or depression w/c -smooth/ramp/rough terrain with power w/c -smooth surfaces and up/down ramps with manual w/c -feeding with adaptive equipment -grooming -upper/lower body dressing in bed -upper/lower body dressing/undressing in w/c (C8) -bathing using shower or tub chair -bladder for male in bed or w/c -bladder for female in bed MOD I TO I -level surface transfer (slide board) INDEPENDENT -bed mobility

De Quervain's disease is a progressive tenosynovitis of which two tendons?

De Quervain's disease is a pathology that affects the first posterior dorsal compartment, which contains abductor pollicis longus and extensor pollicis brevis. Together, the abductor pollicis longus and extensor pollicis brevis allow the thumb to flex, extend, and grip objects. Overuse of these motions lead to a gradual and insidious onset of de Quervain's disease.

Parkinson's Disease GOLD

Describes a group of disorders within subcoritical gray matter of the basal ganglia that produces a similar disturbance of balance and voluntary movements this syndrome occurs as a secondary effect or disorder from another disease process PD is a primary degenerative disorder and is characterized by a decrease in production of dopamine within the substantia nigra portion of the basal ganglia, this degeneration of the dope pathways causes an imbalance between dopamine and acetylcholine and this produces the sx of PD injury occurs to the subcortical gray matter within the basal ganglia esp in substantia nigra and corpus striatum BG stores the majority of the dope and are responsible for the modulation and control of voluntary movement change in the neurochemical productin damages the complex loop between the basal ganglia and the cerebrum primary PD has unknown etiology and accounts for the majority of parkinsonism contributing factors include genetic defect, toxicity from carbon monoxide, excessive manganese or copper, carbon dissulfide, vascular impairment of the striatum, encephalitis, and other neurodegenerative diseasees such as huntingstons disease or alxhemers 500,000 people with PD 42% are diagnosed specifically with PD risk increases with age 1:100 are affected over the age of 75 majority are between 50 and 79 years old 10% are diagnosed before 40 initally notice a resting tremor in the hands (called pill rolling) or feet that increases with stress and disappears with movement or sleep early in the process people usually attribute the sx to "old age" such as balance disturbances, difficulty rolling over, adn rising from bed, and impairments with fine manipulative movemens seen in writing bathing and dressing a patients symptoms slowly progress and often include hypokinestia, sluggish movement, difficulting initiating (akinesia) and stopping movement, festinating and shuffling gait, bradykinesia, poor posture, dysphagia and cogwheel or lead pipe rigidity of skeletal muscles experience freezing during ambulation, speech, blinking and movements of the arms mask like apperance with no facial expression CT or MRI may be used to rule out other neurodegenerative diseases and obtain a baseline for future comparision difficult to diagnose in early stages, believed to progress slowly over 25 to 30 years prior to the onset of pharma intervention parkinsons disease questionnare PDQ-39 progression of the disease may result in dysphagia, difficult with speech and pulmonary impairment many patients with PD die from complications of bronchopneumonia dopamine replcament therapy (levodopa, sinemet, madopar) is the most effective treatment in reducing the sx of PD bradykinesia rigidity tremor movement disorder antihistamines and anticholinergics can also be utilized I/M PT may need respiratory therapy chest wall mobility PT will NOT prevent further degeneration or cure the momvement disorder but it will asssit the patient to amximize their level of function and QOL PD does not significanly altera a patients lifespan if the pt is diagnosed with a generalized form between 50 and 60 as the diseaes progresses however there will be an exacerbation of all sx and significant loss of mobility inactivity and deconditioning allows for complications and eventual death similar to wilsons disease which is an inherited autosomal recessive trait that causes a defect in the metabolism of copper the accumulation of copper within the erythrocytes, liver, brain, and kidneys produces the associated degenerative changes the patient presnts with hepatic insufficency, tremor, choreoathetoid movements, dysarthria and progressive rigidity

Body Mass Index (Anthropometric Measurement Tools)

Describes relative weight for height and is a measurement used to identify increased risk for mortality and morbidity due to excess weight and obesity May overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older persons and others who have lost muscle

Skin Fold Measurements (Anthropomentric Measurements)

Determines the overall percentage of body fat through the measurement of nine standardized sites The correlation relies on the theory that the amount of subcutaneous fat is proportional to the total fat in the body Limitations of this method include the requisite of an experienced examiner as well as variance from the standards based on gender, age and ethnicity All measurements taken on the R side of the body Multiple measurements at each site Skinfold calipers 1 cm away from examiners fingers when pinching the site Wait 1-2 seconds before reading Maintain pinch during reading

What is the goal of therapeutic intervention associated with developmental dysplasia of the hip?

Developmental dysplasia of the hip is characterized by malalignment of the femoral head in the acetabulum. Enlarging and deepening the acetabulum can allow for a more stable articulation between the two structures. If conservative treatment for this condition is not successful, surgical management may be indicated.

diathermy and TMJ

Diathermy is a deep heating agent that converts high frequency electromagnetic energy into therapeutic heat. Electrical energy produces a molecular vibration within tissue that generates heat and elevates tissue temperature. Diathermy is rarely used around the mouth area since fillings or any other metal compound would be a contraindication.

Open Chain vs Closed Chain

Distal segment moving freely i.e. kicking a ball Moving over a fixed distal segment i.e. squat

Common causes of autonomic dysrelfexia

Distended or full bladder Kink or blockage in catheter Bladder infections Pressure ulcers Extreme temperature changes Tight clothing Ingrown toenail

Paciniform Endings (Location, Sensitivity, Primary Distribution)

Fibrous layer of joint capsule High frequency vibration, acceleration, and high velocity changes in joint position All joints

Ruffini Endings (Location, Sensitivity, Primary Distribution)

Fibrous layer of joint capsule Stretching of joint capsule, amplitude and velocity of joint position Greater density in proximal joints, particularly in capsular regions

Does the tibia move on the fibula or does the fibula move on the tibia?

Fibula on tibia

Subtalar Eversion (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Fibularis Longus & Brevis Supine w/ LE extended, ankle in neutral position, subtalar joint eversion Stabilize the medial aspect of distal leg Dynamometer on lateral aspect of foot just distal to base of fifth metatarsa Resistance perpendicular to lateral aspect of foot in direction of subtalar inversion

Knee Capsular Pattern

Flexion then extension

Metacarpophalangeal and interphalangeal Joints

Flexion then extension

Ulnohumeral Joint Capsular Pattern

Flexion then extension

Radiohumeral Joint Capsular Pattern

Flexion then extension then supination then pronation

Posterior instability of arm how to assess

Flexion to 90 Elbow bent Full IR Axial load Can horizontally add it to further stress the posterior capsule

Wrist Flexion (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Flexor Carpi Radialis Flexor Carpi Ulnaris Seated with forearm in neutral rotation, wrist flexed, arm supported on table Stabilize the radial side of the forearm The dynamometer is placed on the palmar surface of the hand just distal to the wrist Resistance is perpendicular to the hand in the direction of wrist extension

Excessive flexion with swing is caused by

Flexor withdrawal reflex Lower extremity flexor synergy

Standard Foot Flat

Foot flat is the point in which the entire foot makes contact with the ground and should occur directly after heel strike

calcaneovalgus

Foot is abducted and everted (flat feet)

Viscosupplementation

For Oa Injected hyaluronan Restores normal viscosity of the synovial fluid and helps restore the lubricating properties of synovial fluid within that joint

Apprehension Test

For anterior shoulder dislocation The patient is positioned in supine with the arm in 90 degrees of abduction and 90 degrees of elbow flexion, the therapist laterally rotates the patients shoulder A positive test is indicated by a look of apprehension or a facial grimace prior to reaching an end point Can also do for posterior shoulder dislocation by keeping the patient in supine with the arm in 90 degrees flexion and medial rotation and applying a posterior force through the long axis of the humerus A positive test would be the same as above

No toe off is caused by

Forefoot/toe pain Weak plantar flexors Weak toe flexors Insufficient plantar flexion ROM

Muscles with Hip Strategy

Forward - Abs Quads Backward - Paraspinals Hamstrings

Muscles with Ankle Strategy

Forward - Gastrocs Hamstrings Paraspinals Backward - tibialis anterior quads abdominals

Spondyloisthesis GOLD

Forward slippagge of one vertebra on the vertebra below Classification include congential, isthmic, degen, post traumatic and pathologic Caused by weakening of joints that allows for forward slippage due to degeneration changes inldue segmental ligamentous instability and subluxation of the hypertophic facet joints which can result in stenosis of the spinal canal Most common L4-L5 the slippage causes cauda equina symptoms secondary to stenosis ischemia and poor nourishment secondary to the stenosis deprives the assocaited spinal nerves and results in pain L4 nerve root is compressed in an L4-L5 spondyloisthesis the disc, posterior and anterior longitudinal ligaments and vertebral periosteum and bone can also be compromised caused by arthritis and degeneration ususlly, disc loses its ability to resist motion as a result the verebtral facets increase in size and develop bone spurs to compensate this condition can produce spinal stenosis and weaken the spine iteslf resulting in the slippage since all structreus of the spine remain intact the slippage is usually limited due to the secondary bony restraints of the spine >50 years old more common in african americans and women back pain is primary symptom increase with exercise* prolonged standing, walking up stairs or an incline, extension severe pain and radiate dpending on the area of stenosis sensory and motor loss in dermatomal pattern most patients do not have signifcant neuro deficits but some do xrays are adequarte to confirm CT or MRI indicated to rule out other contributing factors or to further assess nerve impingement msy or may not slip more if it slips more it doesnt necessarily mean there will be an increase in symptoms sx may increase even if the slippage doesnt get worse if n=ongoing neuro deficits will require surgery regarless of the amount of slip management = corticosteroids if severe, epidural steroid injections and selective enrve root injections can be indicated if oral meds fail activity mod and rest long term bed rest should be avoided* PT should begin once acute symptoms subside flexion exercises *** williams and abd strength to reduce lordosis *** bracing or wearing a corset may decrease intradiscal pressure surgery - decompression with or without spinal fusion initally take NSAIDs and decrease activity to allow for a reduction in acute sx majority of patients are successful with conservatibe management similar to congential spondylolisthesis slip due to anomaly or defect in the fusion of the neural arch usually occurs in aupper sacral vertebrae arches or at the L5 level usually diangosed during the forwth spurts betwen 12-16 usually pain free until this point and then have back pain and sciatica genetic

Radiohumeral joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

Full extension, full supination Humerus is convex Radius is concave Same direction

Open and Closed Pack Position of Radiohumeral Joint

Full extension, full supination (anatomical position) Elbow flexed 90 degrees, forearm supinated 5 degrees

Occipital Lobe Function/Impairment

Function: Main processing center for visual information, processes visual info regarding colors, light, and shapes, judgement of distance, seeing in three dimensions Impairments: homoymous hemianopsia, impaired extraocular muscle movement and visual deficits, impaired color recongition, reading and writing impairment, cortical blindness with bilteral lobe involvement cortical blindness affects a persons ability to RECIEVE but not to PERCEIVE visual information avoid use of diagrams, written materials, and reading environmental mod is erquied due to field cuts, visual deficits and potential for visual agnosia (a condition in which a person can see but cannot recognize or interpret visual information, due to a disorder in the parietal lobes)

frontal lobe function/impairment

Function: Voluntary movement (primary motor cortex/precentral gyrus), intellect, orientation, Broca's area (typically located in the left hemisphere): speech, concentration, Personality, temper, judgement, reasoning, behavior, self awareness, executive functions Impairment: Contralateral weakness, perseveration/inattention, personality changes, antisocial behavior, broaca's aphasia (expressive defecits), delayed initiation or poor initiation, emotional lability deficits that range from paralysis and apraxia to loss of executive functions and goal directed behaviors modifications to therapy would include response to perseveration, apraxia, and impaired executive function may present with apathy, may be uninibited, distractible and lack judgement

Parietal lobe Function/Impairment

Function: assocaited with sensation of touch, kinesthesia, perception of vibration, and temperature, receives information from other areas of the brain regarding heraing, vision, motor, sensory, and memory, provides meaning for objects, interprets lagnuage and words, spatial and visual perception Impairment: dominant hemisphere (typically located in the left hemi) includes agraphia, alexia, agnosia, nondominant hemisphere (typically the right) includes dressing apraxia, constructional apraxia, anosognosia affect sensory awareness, interpretation, and perception somatosensory deficicts elicit abnormal movement patterns for patients deficits in directional concepts hinder movement planning and require modification of therapy

Gallstones Referred Pain

Gallstones or other gallbladder conditions can refer pain to the right upper abdomen and interscapular region due to the gallbladders innervation from mid-thoracic spinal segments, if an inflamed gallbladder leads to irritation of the diaphragm, pain may also refer to the right shoulder

Ankle Plantarflexion (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Gastrocnemius, Soleus Side-lying on side to be tested, test limb is plantar flexed at ankle Stabilize the medial aspect of distal leg Dynamometer on plantar surface of foot near metatarsal heads Resistance perpendicular to plantar surface of foot in direction of ankle DF

In open chain exercises the joint reaction forces are stronger on the patella when

Getting closer to full extension Closed chain is when getting closer to full flexion

Posterior glide of the humerus on the glenoid would be most effective to increase...

Glenohumeral flexion, medial rotation, and horiz adduction

Glucocorticoid Agents aka Corticosteroids (Purpose, Mechanism, Side Effects, Implications for PT, Examples)

Glucocorticoids provide hormonal, anti-inflammatory, and metabolic effects including suppression of articular and systemic diseases, these agents reduce inflammation in chronic conditions that can damage healthy tissue through a series of reactions, vasoconstriction results from stabilizing lysosomal membranes and enhancing the effects of catecholamines, used for endocrine dysfunction and rheumatic disorders Muscle atrophy, gastrointestinal distress, glaucoma, adrenocortical suppression, drug-induced Cushing syndrome, weakening with breakdown of supporting tissues (bone, ligament, tendon, skin), mood changes, hypertension Wear a mask when working with patients on glucocorticoid therapy since their immune system is weakened, signs of toxicity include moon face, buffalo hump, and personality changes, patients are at risk for osteoporosis and muscle wasting, treatment of an injected joint will require special care due to ligament and tendon laxity or weakening Dermacort (hydrocortisone or cortisol), cordrol (prednisone)

Hip Extension (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Gluteus Maximus Side-lying on side of limb to be tested w/ hip extended & knee flexed to 90* Stabilize the UE of contralateral leg & pelvis The dynamometer is placed on posterior aspect of distal thigh just proximal to knee Resistance perpendicular to thigh in direction of hip flexion

Hip Abduction (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Gluteus Medius & Minimus Supine w/ hip of limb to be tested ABD & in neutral rotation, knee extended Stabilize the anterolateral aspect of ips pelvis The dynamometer placed on lateral aspect of distal thigh just proximal to knee Resistance is perpendicular to thigh in direction of hip ADD

Medial Epicondylitis SILVER

Golfers elbow repetative wrist or elbow motions or gripping seen in golf and racket sports muscles in the anterior forearm which include the pronators wrist flexors and finger flexors common origin at medial epicondyle flexor carpi radialis and pronator teres are most often affected * ulnar nerve can also become irritated as it passes through the cubital tunnel in this region patients who have poor flexiblity, poor strength, poor endurance of the affected msucles are more prone to acquiring medial epicondylitis other risk factors are using a racket grip (equipment) that is the wrong size or excessive top spin in tennis (technique) usually gradual onset though can occur suddenyl after trauma pain with ressited wrist flexion and pronation and with gripping weakness with these movements if the ulnar nerve is affected the patient could epxerience pain and paresthesias into the forearm and 4th and 5th digits imaging not used in diagnosis radiographs will appear normal MRI can help but diagnossi can be made from physical exam alone management - RICE and bracing to control acute symptoms counterforce brace cock up slints to llimit repetitive movement of the wrist ecentric exercises * can do a cortisone injection surgery if conserv doesnt work invoolves debridement of the degenerated tissue Large majority of patients respond well to conservative tx and are able to return to their previous functional level cortisone has no long term effevt so to prevent rcurrence of sx need to maintain good forearm flexibility and strength, use correct technique and equipment and by limiting the volume of repetitive movements

Golgi Tendon Organ

Golgi tendon organs are encapsulated sensory receptors through which the muscle tendons pass immediately beyond their attachment to the muscle fibers. They are very sensitive to tension, especially when produced from an active muscle contraction. They function to transmit information about tension or the rate of change of tension within the muscle. An average of 10-15 muscle fibers are usually connected in series with each Golgi tendon organ. The GT organ is stimulated through the tension produced by muscle fibers. Golgi tendon organs provide the nervous system with instantaneous information on the degree of tension in each small muscle segment.

Ober's Test

Hip contracture/tightness IT band or tensor fasciae latae contracture The patient is positioned in sidelying with the lower leg flexed at the hip and the knee, the therapist moves the test leg into hip extension and abduction and then attempts to slowly lower the test leg A positive test is indicated by an inability of the test leg to adduct and touch the table

Piriformis Test

Hip contracture/tightness Piriformis tightness or compression on the sciatic nerve caused by the piriformis The patient is positioned in sidelying with the test leg positioned toward the ceiling and the hip flexed to 60 degrees, the therapist places one hand on the patient's pelvis and the other hand on the patient's knee, while stabilizing the pelvis, the therapist applies a downward (adduction) force on the knee A positive test is indicated by pain or tightness

Anterior glide of the femur on the acetabulum would be most effective to increase...

Hip extension and lateral rotation

Good/Faulty Head Posture

Head is held erect in a position of good balance Should not... Have chin up too high or head protruding

Lower limb extensor synergY

Hip extension/IR/adduction Knee extension Ankle PF/inversion Toe flexion/adduction

L1-L2 Myotome

Hip flexion

Glenohumeral Dislocation (Anterior) SILVER

Head of the humerus s traumatically separeated from the glenoid fossa Typically involves a forceful blow or loading force when the shoulder is in a posoiton that combines abduction, lateral rotation, and extension 90% are anterior Most common in patients engaged in sporting actiiites between 18-25 years old Notable prevalence among the elderly secondary to a fall Prior to relocation - deformit, severe pain, and sig ROM lims, will be positioned in slight abduction and lateral rotation with the patient unable to touch the opp shoulder Will look square than the unaffected side Once reduced - the most severe pain symptoms will resolve and will have protective limited ROM, a positive apprehension sign Decreased sensation or motor function in axillary, musculocutaneous and radial nerve may also be observed xray done before and after the joint is reduced to assess joint position and rule out additional bony pathology MRI used to assess soft tissue injury electromyography used for nerve injury Management pharmacological management and joint reduction Surgery may be necssary if it cant be reduced conservatively and if it has confounding injuries ie bankart detached labrum etc PT may be initiated immediately for pain management and to prevent loss of function isometrics first * aggressive strengthening program or activity mod will permit a return to athletic activities risk of reinjury is greater in contact sports and further increased depending on damage sustained to other stabilizing strucutres in sed population a return to PLOF is possible Recurrent dislocation can have a substantial impact on peoples lifestyle (outcome) recurrent dislcoations may require surgical intervention and consequently require greater restrictions or compelte avoidance of particpation in high risk activities

Gate Control Theory

Helps explain the regulation of pain (specifically how other stimuli can help to decrease the sensation of pain) A delta and C fibers synapse with a secondary neuron, which sends the pain signal to the brain, however, they also synapse with an inhibitory interneuron at this same junction...a alpha and a beta fibers provide input to these inhibitory interneurons...therefore nerve transmission through the A alpha and A beta fibers can stimulate these interneurons to inhibit pain signals to the brain (closing the gate) the use of estim and massage use this theory by stimulating A alpha and A beta fibers

Osteoarthritis GOLD

Heterogeneous group of conditions resulting in common phys changes Biochemical breakdown of the articular cartilage in the synovial joints Excessive wear and tear or secondary inflamm changes may affect involved joints Excessive loading of a healthy joint or normal loading of an abnormal joint Primary - age related Secondary - young Potential sites = hands DIP and PIP, knees, hips and spine Symmetrical bilateral Exacerbated by prolonged activity Xray >55 prev is higher in women than men Heberdens and bouchards nodes is more common in women Slow progression occurs over years Can become inactive Increased indicende of sprains and strains around joints with OA Glucocorticoid intraaricular injections may also be prescribted but should be used sparingly PT intermittently 80-90% of individuals older than 65 years have evidence of OA OA of the knee is a leading cause of disablity in elderly persons Psoriatic athritis is a rheumatic condition charactered bu nflammaotry arthritis and is often seen in combo with psoriatic skin 20-50 yeras old men and omwen of all races

Stretching Indications and Contraindications

I - decreased joint range of motion or decreased muscle flexibility C - acute inflamm, during soft tissue healing i.e. following tendon repair, range of motion limited by bone on bone, recent fx, hypermobility, hypomobility that allows for improved function i.e. tenodesis, acute pain associated with stretching

AROM Indications and Benefits

I - patient is able to contract a muscle but demonstrates weakness performed prior to initiating resistance training to teach the desired movement B - improves the mobility of connective tissues and muscles prevents joint contracture formation improves circulation improves synovial fluid movement for cartilage health decreases pain improves neuromuscular activity improves kinesthesia and proprioception improves strength in very weak muscles i.e. 3/5 strength i

AAROM Indications and Benefits

I - patient is unable to fully contract a muscle i.e. paresis full activation of a muscle is contraindicated i.e. post op performed prior to initiating active movement B - improves the mobility of connective tissues and muscles prevents joint contracture formation improves circulation improves synovial fluid movement for cartilage health decreases pain improves neuromuscular activity improves kinesthesia and proprioception

oculomotor nerve

III voluntary control of levator of eyelid, superior/medial/inferior recti, inferior oblique autonomic smooth muscle of eyeball upwrad, downwrad and medial gaze reaction to light MOTOR move utensil vertically, horizontally, and diagnonally inspect for tracking deficit, asymmetry or ptosis

trochlear nerve

IV voluntary control of superior oblique muscle of eyeball downward and inward gaze MOTOR move utensil in inferior direction inspect inability to depress the eyes and or complaints of diplopia

PCL Reconstruction

If injuried in isolation may need surgery Same protocol as ACL but progression of weight beraing and exercises is more gradual choose exericses that limit posterior shear forces within the knee repetatie knee flexion should also be avoided

homans sign

In performing this test the patient will need to actively extend his knee. Once the knee is extended the examiner raises the patient's straight leg to 10 degrees, then passively and abruptly dorsiflexes the foot and squeezes the calf with the other hand. Deep calf pain and tenderness may indicate presence of DVT.

Good/Faulty Posture of the Foot

In standing, the longitudinal arch has the shape of a half done When we are barefoot or in shoes without heels, the feet toe out slightly In shoes with heels they are parallel However, during walking with or without shoes, the feet are parallel and weight is transferred through heel to outer border to ball of foot In sprinting, the feet are parallel or toe in slightly, the weight is on the balls of the feet and toes because the heels do not come in contact with the ground They should not... Have a low arch or flat foot Low arch will find calluses under the ball of the foot Weight borne on the inner side of the foot (pronation) ankle rolls in Weight borne on the outside of the foot (supination) ankle rolls out Toeing out while walking or while standing in shoes with heels (slue footed) Toeing in while walking or standing (pigeon-toed)

Kyphosis

Increased curve in posterior direction Common in cervical or lumbar spine Common causes are weak abdominals, pregnancy, excessive weight in abdomin, hip flexion contractures

Edema

Increased volume of fluid in the soft tissue outside of a joint capsule

ADH does what to BP

Increases Due to stimulation of smooth muscle contraction in. Vascular system Can also have an effect on the coronary artistes which can result in angina or MI Promotes water resorption by the kidneys and assists to control osmotic pressure of the ECF Can also cause diarrhea because stimulation to smooth muscle in the GI tract

Free Nerve Endings (Location, Sensitivity, Primary Distribution)

Joint capsule, ligaments, synovium, fat pads One type is sensitive to non-noxious mechanical stress and the other type is sensitive to noxious mechanical or biochemical stimuli All joints

Bicipital Tendonitis GOLD

Inflammatory process of the tendon of the long head of the biceps Impingement or an inflammatory injury can results in symptoms of shoulder pain Repeatd full abduction and lateral rotation of the humeral head can lead to irritaion othat produces inflammation, edema, microscopic tears within the tendon and degereneration of the tendon itself Throw, swim or swing a racquet are at greatest risk Degeneration in a tendon causes a loss of the normal arragement of the collagen fibers that joint together to form the tendon Can be caused secondary to other shoulder pathology including ratotion cufff disease, impingement syndrome, or intraaticular pathology such as labral tears Present with deep ache directly in the front and on top of the shoulder, may spread down into the biceps muscle and is usually made worse with overhead activities or lifting heavy objects, resting the shoulder typically reduces the pain, a catching or slipping sensation of the biceps muscle may indicate a tear of the transverse humeral ligament, bicipital teninopathy, pain to palpation, pain with biceps ressitance test Xrays do not diagnose biciptal tendonitis but may show calcification in the groove or subacromial spurring MRI can view the tendon but is expensive and not usually used unless the pt is not responding to conservative treatment Long term chronic tendonitis may experience shoulder instability and subluxation secondary to biceps degeneration Biceps tendonitis will also frequently accompany impingement syndrome, RC tendonitis, and forms of GH instability Primary goals - relieve pain, reduce inflamm, and regian full ROM Rest and or immobilization using a splint or a removeable brace may be indicated initially for a brief period of time Avoid all overhead movement reachng and lifting PT is not initiated immediately but may be education on restrictions, pendulum, and the use of TENS Heaet or cold can help May benefit from ionto or phono >6 months can consider surgery (decompression and acromioplasty with acromionectomy) HEP warm up before exercise Most patients can return after 6-8 weeks Positive long term outcomes 10% do not acheive pos outcome Labral tear is similar

Rancho Stance Phase includes...

Initial contact Loading response Midstance Terminal stance Preswing

Insufficient hip extension at stance caused by

Insufficient hip extension ROM Hip flexor contracture Lower extremity flexor synergy

Resistance Training Parameters

Intensity Volume Frequency Exercise Sequence Rest Interval Open-Chain Closed-Chain

cerebrovascular accident (CVA) GOLD

Interruption of cerebral circulation that results in cerebral insufficiency, destruction of surrounding brain tissue, and subsequent neurological deficit Stroke in evolution slow progression or completed stroke an abrupt infarct Ischemic - thrombus embolus and lacunar Hemorrhagic - intracerebral subdural subarachnoid Modifiable factors include hypertension, artheroscletosis, heart disease, diabetes, elevated cholesterol, smoking and obesity Non modifiable is age race family history and sex Age is the greatest risk, 73% of patients are >65 years old CT scan can be negative for up to a few days after the event MRI can see it immediately Position emission tomography PET can provide information regarding cerebral perfusion and cell function US can identify areas of diminished blood flow Stroke rehab assessment of movement STREAM Rankin scale NIH stroke scale Left CVA: weakness or paralysis of right side, impaired processing, heightened frustration, aphasia, dysphasia, motor apraxia, right hemianopsia Right CVA: weakness or paralysis of left side, poor attention span, impaired awareness and judgement, spatial deficits, memory deficits, left inattention, emotional lability, impulsive behavior, and left hemianopsia Thrombilytic agents, anticoag (contraind with hemorrhagic), diuretics, antihypertensives, long term use aspirin to prevent clots Treatment approach - bobath neuromuscular developmental (NDT), Brunnstroms movement therapy in hemiplegia, Rood, and Kabat, Knott, and Voss proprioceptive neuromuscular facilitation (PNF) Usually combine 75% of patients return home at various functional levels majority require ongoing home care Can have spontaneous recovery to permanent disability First three months most recovery neurologically Can improve for 2-3 years Similar to TIA but it is transient symptoms only last for a brief period of time Not permanent

Peroneus Longus

O: Lateral surface of the proximal fibula and head of the fibula I: Lateral surface of the base of the first metatarsal and medial cuneiform A: Ankle plantar flexion and eversion N: Superficial peroneal (L5-S1) LATERAL LEG, BRANCH OF COMMON PERONEAL

Insufficient flexion with swing is caused by

Knee effusion Quadriceps extension spasticity Plantar flexor spasticity Insufficient flexion ROM

Exaggerated knee flexion at terminal stance is caused by

Knee flexion contracture Hip flexion contracture

Prosthesis in slight DF allows for what

Knee flexion during early stance Whereas PF will encourage full knee extension during early stance

when does the spinal cord stop

L1-L2

cremasteric reflex

L1-L2 scratch the skin of the pper medial thigh a brisk and brief elevatin of the testicle on the ipsilateral side

LE Dermatomes

L4 great toe L5 dorsum of foot, medial half of sole S1 lateral and plantar aspect of foot S2 not emphasis on foot

Heel walking is a functional test for what innervation level

L4-L5

Straight leg raise is a functional test for what innervation level

L4-S1

plantar reflex

L5-S1 stroke the lateral aspect of the sole of hte foot with the hammer from the heel to the ball of the foot and medially to the base of the great toe flexion of the toes is the normal response abnormal = babinski reflex which indicates CNS lesion toes flare

guillan barre starts in the

LEs and progresses to the trunk sensory loss usually takes form of loss of proprioception and areflexia loss of pain and temp is usually mild

s/s of acute pulmonary edema

LIFE THREATENING CALL 911 extreme shortness of breath or difficulty breathing with profuse sweating a bubbly, wheezing or grasping sound during breathing a cough that produces frothy sputum that may be tinged with blood cyanotic skin color rapid, irregular pulse severe drop in BP "dry drowning"

Grade II

Large amplitude movement performed within the range, but not reaching the limit of the range and not returning to the beginning of the range

Grade III

Large amplitude performed up to the limit of range

Lateral Rotation Stress Test (Kleiger Test)

Ligamentous Instability The patient is seated at the edge of a table with their knee in 90 degrees of flexion, the therapist stabilizes the patient's lower leg with one hand and holds the patient;s foot in neutral with their other hand, the therapist then applies a latearl rotation force to the foot, if the patient experiences pain over the anterior or posterior tibiofibular ligaments and the interosseous membrane then the test is positive for a high ankle sprain (i.e. syndesmosis injury) The test is positive for a deltoid ligament tear is if the patient has pain medially and the therapist can feel the talus shift away from the medial malleolus

Varus Stress Test

Ligamentous Instability at the Elbow Indicates lateral collateral ligament sprain The patient is positioned in sitting with the elbow in 20 to 30 degrees of flexion, the therapist places one hand on the elbow and the other hand proximal to the patient's wrist, the therapist applies a varus force to test the lateral collateral ligament while palpating the lateral joint line A positive test is indicated by increasing laxity in the lateral collateral ligament when compared to the contralateral limb, apprehension or pain

Anterior Deltoid

O: Lateral third of the clavicle I: Deltoid tuberosity of the humerus A: Shoulder flexion, medial rotation, and horizontal adduction N: Axillary (C5-C6)

Scoliosis GOLD

Lateral curvaure of the spine Usually found in the thoracic or lumbar area can be associated with kyphosis or lordosis Can be to the right or left and may be rotated the rotation will typically occur towrads the convex side of the major curve The vertebral column, rib cage, supporting ligaments, and muscles are all affected by a scoliosis of the spine idipathic = 80% of cases 1:10 kids have scoliosis 1:4 requring tx age of onset determines the subset infantile 0-3 juvenile 4-pub adolescent 12 for girls and 14 for boys adult skeletal maturation nonstructural scolisosis is a reversible curve that can change with repositioning non progressive and is usually caused by poor posture or leg length discrepancy structural scoliosis cannot be corrected with movement and cab be cause by congenital, msk, and neuro reasons may have been caused by altered development in utero, neuromuscualr diseases i.e cerebral palsy, and inheritance as an autosomal dominant trait juvenile idiopathic is characterized by a thoracic curve with convexity towards the right curve may develop quickly and develop compensatory cures above and below as the curve progresses there will be a rib hump posterioly over the thoracic region on the convex side of the curve the patient does not typcailly experience pain or other subjective symptoms until the curve has progressed >30 degrees is seen more in females than males 10:1 adult scoliosis 500,000 <20 degrees rarely cause a person to experience significant problems or impairments xrays anterior and lateral in standing and bending over scoliometer can measure rotation of trunk cobb can determine curavture bone scan or MRI can rule out infections neoplasma spondy disc herni or compreession fx Common postural findings = increased spacing between the elbow and trunk during standing, leg length discrepancy, uneven shoulder and hip heights, and prominence on one side of the pelvis or breast (due to the rotation) if progressive scoliosis is untreated the deformity can increase to angle >60 dgerees and cause pulmonary insufficiency, significant pain, impairment in lung capacity and degernative changes in spine early screening to control curve and avoid surgery management = estim for pain and bioifeedback for posture <25 monitor every 3 months breathing exercises 25-40 degrees spinal orthosis and PT intervention >40 surgery spinal stabiliztion kind spinal fusion with harrington rod early intervention has best outccome does not usually progress significantly once bone gorwth is complete if the curve is below 40 degrees at the time of skeletal maturity >50 then will be ongoing similar to toricollis bending of neck towards the affected side and rotation away

Cervical Spine Capsular Pattern

Lateral flexion and rotation are equally limited then Extension

Lumbar Spine

Lateral flexion and rotation equally limited Then extension

Good/Faulty Posture of Knees and Legs

Legs are straight up and down Kneecaps face straight ahead when feet are in good position Looking at the knees from the side, the knees are straight (not flexed or hyperextended) They should not be... Touching when feet are apart (knock knees) Apart when feet touch (bowlegs) Curve slightly backward (hyperextended or back knee) Bent slightly forward (flexed knee) Facing each other (medially rotated femurs) Facing outward (laterally rotated femurs)

Open Packed Position

Less surface area congruency Capsulo-ligamentous tissues are lax Maximum amount of accessory motion Function- mobility

Grade II Sprain

Ligament Moderate pain and swelling, minimal instability of the joint, min to mod tearing of the ligament, decreased ROM

Grade III Sprain

Ligament Severe pain and swelling, substantial joint instability, total tear of the ligament, substantial decrease in range of motion

Grade I Sprain

Ligament mild pain and swelling, to to no tear in the ligament

Talar Tilt Test

Ligamentous Instability The patient is positioned in sidelying with the knee flexed to 90 degrees, the therapist stabilizes the distal tibia with one hand while grasping the talus with the other hand, the foot is maintained in a neutral position, the therapist tilts the talus into abduction and adduction A positive test is indicated by excessive adduction and may be indicative of a calcaneofibular ligament sprain

Valgus Stress Test

Ligamentous Instability at the Elbow Indicates medial collateral ligament sprain Opposite of below The patient is positioned in sitting with the elbow in 20 to 30 degrees of flexion, the therapist places one hand on the elbow and the other hand proximal to the patient's wrist, the therapist applies a varus force to test the lateral collateral ligament while palpating the lateral joint line A positive test is indicated by increasing laxity in the lateral collateral ligament when compared to the contralateral limb, apprehension or pain

Ulnar Collateral Ligament Instability Test

Ligamentous Instability of the Wrist/Hand Tear of the ulnar collateral and accessory collarteral ligaments The patient is positioned in sitting, the therapist holds the patient's thumb in extension and applies a valgus force to the metacaropophalangeal joint of the thumb A positive test is indicated by excessive valgus movement and may be indicative of a tear of the ulnar collateral and accessory collateral ligaments, this type of injury is referred to as gamekeepers or skiers thumb

Anterior Drawer Test of the Ankle

Ligamentous instability The patient is positioned in supine, the therapist stabilizes the distal tibia and fibula with one hand, while the other hand holds the foot in 20 degrees of plantar flexion and draws the talus forward in the ankle mortise A positive test in indicated by excessive anteiror translation of the talus away from the ankle mortise and may be indicative of anterior talofibular ligament sprain

Golgi Ligament Endings (Location, Sensitivity, Primary Distribution)

Ligaments, adjacent to ligaments' bony attachment Tension or stretch on ligaments Majority of joints

Temporomandibular Joint

Limitation of mouth opening

Ranchos Loading Response

Loading response corresponds to the amount of time between initial contact and the beginning of the swing phase for the other leg (aka initial swing)

Grade II Strain

Localized pain, moderate swelling, tenderness, and impaired motor function

Romberg test is indicative of

Loss of proprioception often associated with a posterior column lesion in the spinal cord or a peripheral neuropathy The amount of sway present during the testing period determines whether the test is positive or negative Positive is characterized by a patient being able to stand with no more than minimal sway with eyes open but presents with increased instability or falls with the eyes closed Only administered during 30 second observational periods Does not attempt to quantify how long they hold it look at sway during the testing period

Aerobic Metablism

Low intensity, long duration Oxyfen system yields by far the most ATP but it requires several series of complex chemical reactions Provides energy through oxidation of food, fatty acids + amino acids + glucose with oxygen releases energy that forms ATP This system will provide energy as long as there are nutrients to utilize

Exaggerated hip flexion during swing caused by

Lower extremity flexor synergy Compensation for insufficient ankle dorsiflexion

Paraplegia functional outcomes for complete lesion

MAX TO MOD A -ascend steps with manual w/c MIN ASSIST TO MOD I -up and down 6" curbs with manual w/c MIN A TO INDEPENDENT -floor transfers and uprighting wheelchair MOD I -depression weight shift -descending steps with manual w/c -dressing -bathing with tub bench or tub bottom cushion -bladder for male and female -bowel for male and female INDEPENDENT -bed mobility -level surface and car transfers (depression) -wheelchair management -ROM/positioning -feeding -grooming GAIT range from... -exercise only with KAFOs -household gait with KAFOs -limited community with KAFOs or AFOs -functional community with or without orthoses

Adaptive Postural Control

Modify sensory and motor systems in response to changing task and environmental demands

Biceps Femoris

O: Long head - ischial tuberosity and sacrotuberous ligament (crosses knee and hip) Short head - lateral linea aspera and lateral intermuscular septum (only crosses knee joint) I: Lateral head of the fibula and lateral condyle of the tibia A: Knee flexion, hip extension N: sciatic nerve POSTERIOR THIGH (L5-S2)

Rotator Cuff Tear GOLD

May occur acutely or chronic degeneration such as chronic supraspinatus tendonitis Partial, full, acute, chronic, or degenerative Most commonly supraspinatus with more severe or traumatic being the infraspinatus and subscapularis RC = supra, infra, sub and teres minor Support and mobility demands are the greatest on supra Helps with abduction and depression of the humeral head Infra = lateral rotator but also assists with extension Subscap = depression of the humeral head Teres minor = lateral rotator Older = age related Younger = trauma or repeative tasks Presents with pain and weakenss Generalized apin exacerbated by specific movements or functional tasks is typically reported in the lateral aspect of the shoulder with radiating symptoms into the upper arm and deltoid More acute and specific with traumatic Pain conplaints are greatest with partial tears due to increased tension on the remaining muscle fibers and assocaited neural tissue Partial = retains functional acctivities Full = functional deficits esp with lateral rotation and abduction Other complints = instability or stiffness, sense of GH grinding with mobility, crepitus, night pain, and discomfort when lying on the affected side MRI is used to detect the lcocaiton size and charactersitisc of the tear Xray to find bone spurs In young individ the tear may be accompanie by a small avlusion fx Can have cortisone injectstions Older patients typically suggested conservative management Surgery protocols are variable Patients are typically immobilized using a sling for a period of time to protect the repaired tissue Acute phase = crytherapy, activity modification, ROM and isometrics Scapular stability PT immediately for conservative Surgery maybe immediate or aftera aperiod of immob Pts tend to regain funcitonal use in 4-6 mo However Dynamic overhead activities may be restricted for as long as one year Full return to sport may extend beyond one year Long term effects = if not trated may lead to sig lim activity, additional surgery, adhesive capuslitis, or degenerative changes Since the tendon itself does not heal but rather forms scar tissue there will be an increased risk of rupture or an increase in the size of the original tear, risks are greater in conservatively managed Looks simialr to biceps tendon rupture but will palpate mass in this situation

BMI Procedure

Measure the subjects standing height and body weight Weight (kg) / height (m^2) OR [ Weight (lb) / height (in^2) ] x 703

Hydrostatic Weighing (Densitoetry Measurement Tool)

Measures amount of water that is displaced when person is submerged Body fat is then calculated using Archimedes principle This method determines body density Limitations include taking residual lung volume into consideration as well as the person being able to tolerate being submerged in water

Isometric Dynamometry

Measures the static strength of a muscle group without any movement The extremity is restrained by stabilization straps or stabilized with only verbal instruction Benefits: attains peak and average force data, reaction time, rate of motor recruitment, and maximal exertion data, it is relatively safe, simple to use, easy to interpret data, and it is cost effective Disadvantages: inability to convert data to functional activities, need for caution with patients that have acute orthopedic injury, osteoporosis, and hernia, it is contraindicated for patients with fractures and significant hypertension

Biceps Brachii

O: Long head - supraglenoid tubercle of the scapula Short head - coracoid process of the scapula I: Radial tuberosity and aponeurosis of the biceps brachii A: Elbow flexion, forearm supination, shoulder flexion N: Musculocutaneous (C5-C6) ANTERIOR ARM

baroreceptor reflex

Mechanoreceptors that detect changes in pressure arterial baroreceptors (high pressure receptors located in the carotid sinus, aortic arch, and origin of the right subclavian) cardiopulmonary receptors (low pressure receptors) sympathetic activation leads to increased cardiac contractility, increased heart rate, venoCONSTRICTION, ultimately leading to increased BP via elevation of total peripheral resistance and cardiac output parasympathetic activation leads to decrease in HR and a small decrease in contracility resulting in a decrease in BP

Bioelectric Impedance (Anthropometric Measurement)

Method that uses a small electrical current and measures the resistance or opposition to the current flow. Based on the principle that resistance to electrical current is inversely related to the composition of water within the body height^2 / resistance Limitations include the requisite for the subjects to be properly hydrated as well as following all guidelines for the BIA protocol (including abstaining from eating or drinking for certain times, no vigorous activity, etc.) Therefore, if a person is more muscular there is a high chance that the person will also have more body water, which leads to lower impedance. It is familiar in the consumer market as a simple instrument for estimating body fat. BIA[1] actually determines the electrical impedance, or opposition to the flow of an electric current through body tissues which can then be used to estimate total body water (TBW), which can be used to estimate fat-free body mass and, by difference with body weight, body fat.

light work

Method used to develop controlled movement and skilled function by performing an activity (work) without resistance. Focuses on the extremities.

Scapular Adduction (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Middle Trap Seated with scapula adducted and shoulder abducted to 90 degrees in neutral rotation, elbow flexed, UE is supported Stabilize the superior aspect of the contralateral shoulder to prevent trunk rotation The dynamometer is placed on the lateral aspect of the scapula near the lateral border ? Resistance is perpendicular to the scapula in the direction of scapular abduction

Shoulder Abduction (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Middle deltoid Supraspinatus Supine with shoulder abducted 90 degrees, neutral rotation, elbow extended Stabilize over the superior aspect of the ips shoulder, avoid middle deltoid The dynamometer is placed on the lateral aspect of the distal humerus, proximal to the elbow Resistance is perpendicular to the humerus in the direction of shoulder adduction

Ranchos Midstace

Midstance corresponds to the point in stance phase when the other foot is off the floor until the body is directly over the stance limb

Standard Midstance

Midstance is the point during the stance phase when the entire body weight is directly over the stance limb

Ranchos Midswing

Midswing begins with maximal knee flexion during swing and ends when the tibia is perpendicular with the ground

Standard Midswing

Midswing is the point when the swing limb is directly under the body

Open and Closed Pack Position of Carpometacarpal Joint

Midway between abduction - adduction and flexion - extension ? None listed

Subtalar joint: resting position, convex or concave for anterior/middle and posterior, arthrokinematic/osteo motion

Midway between extremes of ROM Anterior and middle talus are convex Anterior and middle calcaneus are concave Posterior calcaneus is convex Posterior talus is concave Same direction Opposite direction

Intermetatarsal joint: resting position, convex or concave for all movements, arthrokinematic/osteo motion

Midway between extremes of ROM Medial metatarsals are convex Lateral metatarsals are concave Same direction

Open and Closed Pack Position of Midtarsal Joint

Midway between extremes of range of movement (anatomical position) Supination

Open and Closed Pack Position of Subtalar Joint

Midway between extremes of range of movement (anatomical position) Supination

Open and Closed Pack Position of Tarsometatarsal Joint

Midway between extremes of range of movement (anatomical position) Supination

Open and Closed Pack Position of Facet (spine)

Midway between flexion and extension (anatomical position) Extension

Nonfibrous Joints (Synarthroses)

Min to no movement Suture (skull) Syndesmosis (tibia and fibula with interosseous membrane) Gomphosis (tooth in socket)

Convex surface moving on a concave surface, mobilization rules

Mobilization should be applied in the OPPOSITE direction of the bone movement (aka opposite of the osteokinetic movement)

Concave surface moving on a convex surface, mobilization rules

Mobilization should be applied in the SAME direction as the bone movement (aka as the osteokinetic movement)

Torque

Moment arm x load ability to produce rotation around an axis

Ulanr Collateral Ligament Sprain - Thumb BRONZE

Most common ligament injury of the hand secondary to trauma where excessive valgus force is applied to the MCP joint of the thumb gamekeepers thumb or skiiers thumb grad 1 and 2 the ligament is still intact majroity at least and grade 3 sprain involes a compelte tear sx include pain t3enderness ecchymosis and swelling on medial side instability of the jont and weakness with grasp xrays to rule out existence of a fracture or dislocatin US or MRI for ligament if necessary a mvoement of greater than 30-35 degrees indicated a compeltel tear of the UCL

Tempomandibular joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

Mouth slightly open (freeway space) Temporal bone is concave Mandible is convex Opposite direction

Triceps Brachii

O: Long head - infraglenoid tubercle of thee scapula Lateral head - posterior humerus proximal to the radial groove and lateral intermuscular septum Medial head - posteromedial humerus distal to the radial groove and medial intermuscular septum I: Olecranon process of the ulna A: Elbow extension, shoulder extension N: Radial (C6-C8) POSTERIOR ARM

Muscle Spindle

Muscle spindles are distributed throughout the belly of the muscle. They function to send info to the nervous system about muscle length and or the rate of change of its length. The muscle spindle is important in the control of posture, and with the help of the gamma system, involuntary movements.

Spinal Stenosis - Lumbar SILVER

Narrowing of either the lumbar vertebral or intervertebral foramina, symptoms are typically produced as a result of mechanical compression on either the spinal cord or exiting nerve roos and may be further exacerbated by bony degeneration or instability primary - congential and more rare secondary - acquired more common aka degeneration, disc herniation, osteophyte formation and hypertrophy of structrures such as the ligamentum flavum, others would be trauma, compression fx, systemic conditions like tumor or ASpond and iatrogenic i.e. laminectomy or discectomy age is the primary risk factor for the development of seconadry gradual onset and worsening of chronic pain at the midline of the lumbar region unilateral nerve root radiculopathy, apresthesia, weakness and diminished reflexes rare cases may be bilateral including gait and balance issues as well as bowel and bladder and hyperreflexia sx exacerbated with increased lumbar extension like standing upright and lying prone, and are alleviated by rest and activities that increase lumbar flexion i.e. leaning on a grocery card or sitting many patients have stooped posture to functionally reduce their lumbar lordosis and minimize symptoms MRI is the lesat invasive and most conclusive means of diagnosing LSS due to its ability to differentiate soft tissue patholgies such as disc damage or neural compression A CT myelogram utilizes the injection of contract dye into the spinal column to enhance visualizatin of the spinal cord, nerve roots, and areas of compression management = surgery would be a lumbar laminectomy may be necessary if conserv fails TENS unit to improve tolerance to actitivies progressive condition but PT can minimize the effects of the condition and maximize indoendence long term is variable can be asymptomatic or severely disabling

Torticollis - Congential GOLD

Neck to involuntarily and unilaterally contract to one side secondary to contraction of the SCM laterall flexed toward the contracted muscle the chin faces the opposite direction and there may be facial asymm toricollis means twisted enck it is a disease but also a sx of many conditions not usually seen immediataely at birth msucle injury may be due to birth trauma, breech position in utero or other forms of intrauterine malpositioning infants appear healthy at delivery however over daysor weeks they devleop swelling over the injurued SCM exact etiology is unknown however, congential toricollis may be caused by local trauma jsut before or during delivery most common hypoth = bith trauma with resultant hematoma formation results in msucualr contrracture they are usually breech or difficult forceps delivery fibrosis develops and may be due to venous occlusion and pressure on the neck in the brith canal seconadry to skull and neck position antoher theory includes malpositoning in utero resulting in intrauterine comparmtent syndrome presents with intermittent painful spasms of the SCM , trap and other neck msucles neck movements vary from jerky to smooth first sign may be a firm nontender enlargement of the SCM visible at birth or within the infants first few weeks of life usually localized near the clavicular attachment of the SCM enlarges during the first few weeks of life and then decreases in size gradually the mass dissappears by the 6 mo of life and only remaining is the contracture xray for fx CT or MRI for beck mass electromyography useful in defining the dgree of msucle or nerve involvement 20% with torti have congential hip dysplasia also may have facial asymmand plagiocephally or flattening of the skull manangement = non op for first 12-24 mo benzodiapapine (msucle relax) anticholinergics local intramuscualr injections of botox or phenol surgery = unipolar SCM release or selective denervation manual stretching 3x/day for 3-6 mo cerviccal collar may be used for the firs 6-12 weeks after surgery 85-90% patietns with congenetical torti respond to conservative tx withint he first year best outcomes if start prior to 1 years old if have surgery and PT after the outcomes are positive if left untreated = impiarment of normal grrowth and devo but vast majority who recieve tx are expectd to full recover and lived a normal life congential tori can look like acquired, acute wryneck (self limiting occurs overnight without provocation and will subside in one to two weeks) infections torti (retropharyngeal abscess/nasopharyngeal abscess/tonsillitis/sinusitis)

Tinel's Sign

Neurological Dysfunction at the Elbow Ulnar nerve compression or compromise The patient is positioned in sitting with the elbow in slight flexion, the therapist taps with the index finger between the olecrannon process and the medial epicondyle A positive test may be indicative of ulnar nerve compression or compromise

Tinel's Sign for Wrist/Hand

Neurological Dysfunction of the Wrist/Hand Carpal tunnel syndrome due to median nerve compression The patient is positioned in sitting or standing, the therapist taps over the volar aspect of the patient's wrist A positive test is indicated by tingling in the thumb, index finger, middle finger, and lateral half of the ring finger distal to the contact site at the wrist

Phalen's Test

Neurological Dysfunction of the Wrist/Hand Indicates carpal tunnel syndrome due to median nerve compression The patient is positioned in sitting or standing, the therapist flexes the patient's wrists maximally and asks the patient to hold the position for 60 seconds A positive test is indicated by tingling in the thumb, index finger, middle finger, and lateral half of the ring finger

Froment's Sign

Neurological Dysfunction of the Wrist/Hand Ulnar nerve compromise or paralysis The patient is positioned in sitting or standing and is asked to hold a piece of paper between the thumb and index finger, the therapist attempts to pull the paper away from the patient A positive test is indicated by the patient flexing the distal phalanx of the thumb due to adductor pollicis muscle paralysis, if at the same time the patient hyperextends the metacarpophalangeal joint of the thumb, it is termed Jeanne's sign, both objective findings may be indicative of ulnar nerve compromise or paralysis

theories for charcot foot

Neurotrauma: Loss of peripheral sensation and proprioception leads to repetitive microtrauma to the joint in question; this damage goes unnoticed by the neuropathic patient, and the resultant inflammatory resorption of traumatized bone renders that region weak and susceptible to further trauma. In addition, poor fine motor control generates unnatural pressure on certain joints, leading to additional microtrauma. Neurovascular: Neuropathic patients have dysregulated autonomic nervous system reflexes, and de-sensitized joints receive significantly greater blood flow. The resulting hyperemia leads to increased osteoclastic resorption of bone, and this, in concert with mechanical stress, leads to bony destruction.

Metatarsophalangeal joint: resting position, convex or concave for all movements, arthrokinematic/osteo motion

Neutral Metatarsals are convex Phalanges are concave Same direction

Open and Closed Pack Position of Metatarsophalangeal Joint

Neutral (anatomical position) Full extension

Radiocarpal joint: resting position, convex or concave for all motions, arthrokinematic/osteo motion

Neutral with slight ulnar deviation Radius is concave Carpals are convex Opposite direction

Open and Closed Pack Position of Radiocarpal (wrist)

Neutral with slight ulnar deviation (anatomical position) Extension with radial deviation

Isometric Exercise

No change in muscle length Against an immovable object Submax isometric used in rehab

Semimembranosus

O: Ischial tuberosity I: Posteromedial aspect of the medial condyle of the tibia A: Knee flexion, hip extension N: Sciatic (Tibial) (L5-S2) POSTERIOR THIGH

Semitendinosus

O: Ischial tuberosity I: Proximal tibia medial to the tibial tuberosity A: Knee flexion, hip extension N: Sciatic (Tibial) (L5-S2)POSTERIOR THIGH "SEMI" ONLY TIBIAL

Pain Transmission

Nociceptors are free nerve endings present in most types of tissue that are activated by thermal, mechanical or chemical stimuli, they are the terminal portions of two types of afferent neurons (A delta and C fibers) A delta fibers transmit detailed info rapidly from peripheral cutaneous structures C fibers transmit info from deeper tissues like joints and viscera and do so more slowly than A delta fibers Because of this, A delta are more likely to transmit pain signals that are sharp and localized while C fibers transmit pain that are dull, aching, and diffuse These fibers send their impulses to the dorsal horn of the spinal cord where the impulses are then carried to the thalamus via the spinothalamic tracts, the nerve signal is then projected to the sensory cortex to be interpreted and become a conscious pain sensation

global aphasia

Non-fluent lesion: frontal, temportal, parietal lobe impaired naming, writing, repetition may involuntarily verbalize, without correct context may use nonverbal skills for communication

Nonopioid Agents

Nonopioid agents provide analgesia and pain relief, produce anti-inflammatory effects, and initiate anti-pyretic (reduces fever) properties, these drugs promote a reduction of prostaglandin formation that decreases the inflammatory process, decreased uterine contractions, lowers fever, and minimizes impulse formation of pain fibers. includes Aspirin which can reduce risk of an MI Nausea, vomiting, vertigo, abdominal pain, gastrointestinal distress or bleeding, ulcer formation, potential for Reye syndrome in children (aspirin only) Patients are at risk for masked pain that would allow for movement beyond limitation or false understanding of their level of mobility, complaints of stomach pain should be taken seriously with a subsequent referral to an MD Tylenol (acetaminophen), nonsteroidal anti-inflamm (NSAIDs), aspirin (acetylsalicylic acid), aleve (naproxen), advil (ibuprofen)

Extensor Digitorum Communis

O: Lateral epicondyle of the humerus and deep antebrachial fascia I: Dorsal surface of the middle and distal phalanges of digits 2-5 A: Metacarpophalangeal and interphalangeal extension (digits 2-5) N: Radial (C6-C8) POSTERIOR ARM

Tibialis Anterior

O: Lateral proximal tibia, lateral condyle of the tibia, and interosseous membrane I: Medial surface of the medial cuneiform and base of the first metatarsal A: Ankle dorsiflexion and inversion N: Deep peroneal (L4-L5) ANTERIOR LEG

Frequency

Number of times per week Dependent on the intensity, volume, and fitness level of the pt High intensity 2-3x/week Multiple times a day if intensity and volume is kept low i.e. rehab programs Too freq = overtraining and a decline in the patients condition or performance

Brachioradialis

O: Lateral supracondylar ridge of he humerus and lateral intermuscular septum I: Lateral styloid process of the radius A: Elbow flexion N: Radial (C5-C6) "POSTERIOR" ARM

Peroneus Brevis

O: Lateral surface of the distal two-thirds of the fibula and the intermuscular septum I: Tuberosity at the base of the fifth metatarsal A: Ankle plantar flexion and eversion N: Superficial peroneal (L5-S1) LATERAL LEG, BRANCH OF COMMON PERONEAL

Middle Deltoid

O: Acromion I: Deltoid tuberosity of the humerus A: Shoulder abduction N: Axillary (C5-C6)

Internal Oblique

O: Anterior iliac crest, lateral inguinal ligament, and thoracolumbar fascia I: Inferior borders of ribs 9-12, linea alba, and the pubic crest A: Trunk flexion, ipsilateral side bending, and ipsilateral rotation N: Intercostal (T7-T11), subcostal (T12), iliohypogastric, and ilioinguinal

Rectus Femoris

O: Anterior inferior iliac spine and a groove above the acetabular rim I: Proximal patella and the tibial tuberosity via the patellar ligament A: Knee extension; hip flexion N: Femoral (L2-L4) ANTERIOR THIGH

Piriformis

O: Anterior sacrum and superior margin of the greater sciatic foramen I: Superior border of the greater trochanter of the femur A: Hip abduction and lateral rotation N: Sacral plexus (L5-S1) has it owns nerve

Sartorius

O: Anterior superior iliac spine I: Proximal tibia medial to the tibial tuberosity A: Hip flexion and lateral rotation; knee flexion N: Femoral (L2-L3) ANTERIOR THIGH

Pectoralis Major

O: Clavicular head - medial half of the clavicle Sternal head - body of the sternum, costal cartilages of ribs 1-6, and the aponeurosis of the external oblique muscle I: Greater tubercle of the humerus A: Shoulder flexion, adduction, horizontal adduction, and medial rotation; scapula depression N: Lateral pectoral, medial pectoral (C5-T1)

Teres Major

O: Dorsal surface of the inferior angle and lower lateral border of the scapula I: Lesser tubercle of the humerus A: Shoulder extension, adduction, and medial rotation N: Lower subscapular (C5-C7)

Teres Minor

O: Dorsal surface of the upper lateral border of the scapula I: Greater tubercle of the humerus A: Shoulder lateral rotation and horizontal abduction; humeral head stabilization within the glenoid cavity N: Axillary (C5-C6)

Upper Trapezius

O: External occipital protuberance, superior nuchal line, spinous process of C7, and the ligamentum nuchae I: Lateral third of the clavicle A: Scapular elevation and upward rotation; neck extension N: Accessory (cranial nerve XI)

Gluteus Medius

O: External surface of the ilium between the anterior and posterior gluteal lines I: Lateral surface of the greater trochanter of the femur A: Hip abduction, medial rotation, and extension N: Superior gluteal (L4-S1)

External Oblique

O: External surfaces of ribs 5-12 I: Linea alba, pubic tubercle, and anterior half of the iliac crest A: Trunk flexion, ipsilateral side bending, and contralateral rotation N: Intercostal (T7-T11), subcostal (T12)

Vastus Lateralis

O: Greater trochanter of the femur, gluteal tuberosity, lateral linea aspera, and proximal part of the intertrochanteric line I: Proximal patella and the tibial tuberosity via the patellar ligament A: Knee extension N: Femoral (L2-L4) ANTERIOR THIGH

Flexor Carpi Ulnaris

O: Humeral head - medial epicondyle of the humerus Ulnar head - medial border of the olecranon, posterior border of the proximal ulna, and deep antebrachial fascia I: Pisiform, hook of hamate, and base of the fifth metacarpal A: Wrist flexion and ulnar deviation N: Ulnar (C7-T1) exception in anterior arm

Flexor Digitorum Superficialis

O: Humeroulnar head - medial epicondyle of the humerus and deep antebrachial fascia I: Volar surface of the middle phalanges of digits 2-5 A: Metacarpophalangeal and proximal interphalangeal flexion (digits 2-5) N: Median (C7-T1) [medial half is ulnar, expection to anterior forearm]

Latissimus Dorsi

O: Inferior angle of the scapula, ribs 9-12, spinous processes of T7-T12, thoracolumbar fascia, and posterior iliac crest I: Intertubercular groove of the humerus A: Shoulder extension, adduction, and medial rotation; scapula depression N: Thoracodorsal (C6-C8)

Gracilis

O: Inferior pubic ramus and pubic symphysis I: Medial tibia distal to the condyle A: Hip adduction N: Obturator (L2-L4)

Adductor Magnus

O: Inferior ramus of the pubis, ischiopubic ramus, and ischial tuberosity I: Linea aspera and adductor tubercle on the medial femoral condyle A: Hip adduction N: Obturator/tibial (L2-L4)

Infraspinatus

O: Infraspinous fossa of the scapula I: Greater tubercle of the humerus A: Shoulder lateral rotation and horizontal abduction; humeral head stabilization within the glenoid cavity N: Suprascapular (C4-C6)

Transverse Abdominis

O: Inner surfaces of cartilages of ribs 7-12, thoracolumbar fascia, anterior iliac crest, and lateral inguinal ligament I: Linea alba and the pubic crest A: Compression of abdominal contents (trunk stabilization) N: Intercostal (T7-T11), subcostal (T12), iliohypogastric, ilioinguinal

Tibialis Posterior

O: Interosseous membrane and the adjacent posterior borders of the tibia and fibula I: Navicular tuberosity, bases of the second through fourth metatarsals, all three cuneiforms, cuboid, and the sustentaculum tali of the calcaneus A: Ankle plantar flexion and inversion N: Tibial (L5-S2) POSTERIOR LEG

Ankle Sprain (Lateral) Grade II GOLD

Occur due to significant inversion and involve the lateral ligament complex (resists varus stress) and it is comprised of the anterior talofibular ligament, calcaneofibular and posterior talofibular. The ankle is supported medially by the deltoid ligament which is the strongest of the ankle ligaments (superficial and deep components and ressits valgus stress) since is ataches in part to the medial malleolus significant valgus stress typucally causes the medial malleolus to fracture before the deltoid ligaments fails mechanically ATFL most likely to sustain damage ATFL - resists inversion of the talus and calc as well as anterior translation of the talus on the tibia (becomes taut during plantar flexion) CFL - resists inversion within the mjidrange of talocrural motion PTFL - ressists posterior translation of the talus and is the strongest Contrib factors - agility sports, deconditioning, poor proprioception, obesity Recurrent sprains happen because of residual ligament laxity and decreased proprioception Present with pain along the lateral aspect of the ankle esp at the ATFL and will limit strength assessment, AROM should be assessed to rule out achilles tendon rupture Pain elicited with end range inversion and PF Edema, ecchymosis are likely and can persist even as pain resolves and function returns MRI not utilized because of cost Anterior drawer and talar tilt, assess pulses May also have osteochondral or chondral injuries of the talar dome, neurovascular disruption and achilles tendon rupture Management = RICE Target peroneals because they provide the ankle with dynamic stability Once inflammation has subsided, transverse friction massase may be applied to the healing ligmanet to assist in preventing the adherence of scar tissue to adjacent structures Use crutches until the patient can tolerate full weight bearing Generally heals quickly, 2-6 weeks reutrn to PLOF May consider a period of supportive taping or bracing May look like high ankle sprain (snyndesmotic ligaments) usually injuried in conjunction with an ankle fracture and if the ligaments are untreated severe post traumtic arthritis will likely occur and would rewuire surgry which isnt typical for other injuries

Achilles Tendon Rupture GOLD

Occurs within one to two inches above its tendinous insertion on the calcaneus Symptoms will be secondary to the rupture and discontinuity of the achilles tendon Usually due to degenerative changes (bc normally is the largest and strongest tendon in the human body), dengeneration begins with hypovascularity in the area and the impaired blood flow incombo with repetitive microtrauma creates more changes within the tendon and makes it susceptible to injury Occurs most frequently when pushing off a weight bearing extremity with an extended knee, through unexpected dorsiflexion while weight bearing or with a forceful eccentric contaction of the plantar flexors Sports that require quickchanging footwork (i.e. softball, tennis, basketball, and football are high-risk activities) Other contributing factors include poor stretching routine, tight calf muscles, improper shoe wear during high risk activities, and altered biomechanics at the foot during activities (such as a flattened arch) >30 years of age is at a higher risk for ru[ture 2/2 decreased blood flow to the area of the tendon associated with aging, as well as people who have a history of corticosteroid injections to the tendon The highest incidence for rupture is between 30-50 and they usually have no history of calf or heel pain and commonly participate in rec activities Will present with swelling over the distal tendon, a palpable defect in the tendon above the calc tuberosity, and pain/weakness with PF The patient may limp and complain that there was a snap or a pop that was associated with the severe pain, cannot stand on toes and will not demo any passive PF in prone when the calf is squeezed (Thompson test) A complete rupture will have a palpable gap in the tendon prior to the insertion X-ray can help rule out an avulsion fx or bony injury - MRI can be used to location the presence and severity of the tear or rupture Diagnosis = patient history of the event (pop and release from the back of the ankle) + positive Thompson test. Physical exam reveals the discontinuity. The O'Brian needle test may be used by the MD to confirm the rupture Tests/measures - anthropometric, arousal/attention/cognition, sensation, pain perception assessment scale, proprioception/kinesthesia Most common in men that do not consistently exercise but are "weekend warriors" Benefits for op and non-op, determined on a case by case basis Management includes immobilization through casting or a surgical approach for repair or reconstruction, NSAIDs/aceto/narcotics for pain Nonsurg = casting for 10 weeks followed by the use of a heel lift to ensure maximal healing without stress on the tendon for 3-6 mo, PT begins when cast is removed Surgical = cast for 6-8 weeks, although PT is the same for both approaches PT = ROM, stretching, icing, AD training, endurance programming, gait training, strengthening, plyometrics, and skill specific training, modalities - pool therapy - and other CV equipment may assist in the recoery HEP = based on post op impairments and follow protocol, icing and elevation early in the rehab process and HEP for 6-7 mo of rehab Patient will return to PLOF within 6-7 months Higher rate of rerupture if opt for nonsurgical treatment (40%) compared to surgical which is (0-5%) - nonsurg has less likelihood of infection from surgery Surgery = decreased risk for reinjury and higher rate of return to athletic activities Can look like achilles tendonitis where the patient initially feels an aching sensation after activity that progresses to pain with walking, localized tenderness and swelling Acute - use antiimlamm and rest for 2-3 weeks with a heel lift Chronic - symptoms and pain last longer than 6 weeks, exam will reveal a thickened and nodular tendon, surgery may be warranted at this stage

Opioid Agents (Narcotic)

Opioid agents provide analgesia for acute severe pain management, the medication stimulates opioid receptors within the CNS to prevent pain impulses from reaching their destination, certain drugs are also used to assist with dependency and withdrawal symptoms Mood swings, sedation, confusion, vertigo, dulled cognitive function, orthostatic hypotension, constipation, incoordination, physical dependence, tolerance Monitor for side effects esp respiratory depression, painful treatment must occur 2 hours after administration to maximize pain relief benefit but patient will not be able to accurately describe if they are in pain Roxanol (morphine), demerol (meperidine), ozycotin (oxycodone), sublimaze (fentanyl), paveral (codeine)

Convex on concave mobilization rule for GH flexion

Opposite movements Roll = anterior Slide = posterior Mobilizing force should be a posterior glide of the humerus to improve glenohumeral flexion

Transtibial Amputation due to Arterioscerosis Obliterans GOLD

Osteosarcoma is the second most common primary bone tumor and accout for 15-20% of bone tumors Highly malignant and begins in the medullary cavity and leads to the formation of a mass Affects bones with an active growth phase such as the femur or tibia and is often located in the metaphysis Amputation may be necessary to remove the tumor an surrounding tissues to avoid metastatic disease the cancer cells are found in osteoblasts within the primitive mesenchymal cells of the medullary cavity of a bone, the cancer rapidly proliferates, replcaes normal bone and causes tissue destruction, osteosarcoma will also metastasize to the lung very early in the disease process etiology unknown affects young children (esp males), adolescents, and young adults under the age of 30 peak incidence occurs during a growth spurt as an adolescent risk factors are pagets disaes, osteolastoma, giant cell tumor or chronic osteomyselitis distal femur prox tibia prox humerus and pelvis knee region accounts for approx 50% of osteosarcomas will present with a mass found in the tibia or femur usually sx are pain adn swelling within the extremity pain is worse at night or with exercise a lump may develop in the extremity sometime after the onset of pain cancer can weaken the bone and lead to fx fx may be the first sign of osteosarcomaa a metastates pappear in the lungs as early as 90% of cases xray MRI and scintigraphy allow the mD to determine the size location and presence of the tumor Codmans triangle can be seen on xray indicating reactiive bone at the site where the periosteum has been elevated by the neoplasm definitive dx is makde through biopsy after sx may present with fatigue hypersenitivity of the residual limb and psych issues associted sx with chemo such as anemia, abnomral bleeding, infection, kidey impairment PT immediately after desens, residual limb wrapping, tummy time, serial casting if contractured, prosthetic training 5 year survival of 70-80% status post osteosarcoma long term outcome dependent on cancer status similar to Ewings sarcoma a malignnant nonosteogenic primary bone tumor that infilatrates bone marrow and usually affects children and adolescents under 20 present with pain of increasing sevverity, swelling and a fever tumor is not found consistently in a spefici locatioon within the bone and is extrmely malignant with high freq of metastases requires aggressive tx may include amputation and chemo 5 year survival is 70%

total lung capacity (TLC)

volume of air in the lungs after a maximal inspiration the sum of all lung volumes TLC = RV + VC or TLC = FRC + IC

Meniscus Surgeries

Partial - older or part where there is less blood supply aka inner third Repair - younger or when in outer third repair - weight bearing restrictions and bracing, limitations on ROM esp flexion partial - full weight bearing no restrictions no brace

functional residual capacity (FRC)

volume of air in the lungs after normal exhalation FRC = ERV + RV 40% of total lung volume

Primary etiology of lower limb amputations

Peripheral vascular disease with comorbid diabetes

Hip Lateral Rotation (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Piriformis, Gemellus, Obturator Internus & Externus, Quadratus Femoris Supine w/ hips flexed to 90*, knees flexed to 90*, hip in neutral rotation Stabilize the anterolateral aspect of the ips pelvis Dynamometer on medial aspect of distal leg just proximal to ankle Resistance perpendicular to leg in direction of IR of hip

Post-Polio Syndrome SILVER

Poliomyelitis is a neurologic condition characterized by asymmetric weakness and or paralysis caused by a viral infection vaccines for the virus were created in 1950s resulting in eradicagtin of the disease in developing countries however, for patients who had polio and recovered, new neuromuscular sx can appears years after their recovery this new onset of weakness is termed post-polio syndrome origninal injury is viral attack on the nervous system, speficifally on the anterior horn cells within the spinal cord with the deaht of the anterior horn cells, the motor nerves degrade and the msucles experience atrophy recovery was thought to occur through collateral sprouting to help reinnervate denervated muscles i.e. a single nerve innervates a larger proportion of muscle fibers though the collateral sprouting allows for a period of recovery, the increased demand placed on the remaining nerves leads to deterioration of these nerves over time, leading to a new onset of weakness occurs in indivd who had polio 25-50% who had polio will develop post-polio syndrome if they had a more serious onset they are more at risk for post polio i.e. greater motor involvement WOMEN are more likely to develop psot polio sx = muscle weakness, atrophy, fatigue, sometimes msuclar or joint pain can also afect axial musculature and result in difficulties with breathing and swalloing afects the same muscles that were affected during the inital attack though it can affect previously unaffected as well pain and weakness increase with physical activity and exposure to COLD will experience decades of recovery before firts post polio attack weakness progresses slowly over the course of years and is interspersed with periods of stability where there is no progression of sx labs and imaging are used to excluse other condtions EMG can be perfroemd for newly denervated muscles same for muscle biopsy no cure for post polio aim to control sx and improve fxn anticholinesterases, IV immunoglobulin pharma but only have moderate success PT do not overexert can worsen sx exercise every other day to allow for adequate rest and recovery PT can help with function and QOL betteer gait than those who do not do PT not generally a life threatening disease though this may not be treu for patients with resp involvement majority have normal lifespan but can greatly affect QOL

stroke volume

volume of blood ejected by each contraction of the left ventricle

Anterior Compartment Syndrome BRONZE

Pressure in the anterior compartment of the lower leg increases secondary to swelling This increase in pressure results in occlusion of blood flow which may cause ischemia and necrosis of the surrounding nerves and musculature Acute compartment syndrome is a medical emergency, often caused by a traumatic injury, that can lead to irreversible muscle damage Chronic compartment syndrome most often occurs secondary to athletic exertion and is typically not a medical emergency Affects the tibialis anterior, extensor hallucis longus, ext3ensor digitorum longus, and peroneus tertius muscles Because the fascia does not stretch, the increase in pressure causes increased compression on the capillaries, nerves and muscles of the anterior compartment If not relieved, irreversible damange to the nerves and muscles may result secondary to ischemia Presents with swelling that will cause tightness and tenderness over the muscle belly of the tibialis anterior that does not decrease with elevatin or pain medications Pain increases with passive strething or active use of the muscle The patient will also likel experience paresthesias and/or numbness in the distribution of the deep peroneal nerve MDs canuse compartment pressure testing in which a needle or catheter is inserted into the affected compartment to determine the presence of acute compartment syndrome In the case of chronic, measurements can be compared before and after exercise Rule out DVT, fracture and peripheral nerve injury

Documentation of Recorded Measures

Primary way that health care providers keep each other informed of current patient status and other relevant info, failure to meet his standard (document relevant info in a timely manner) potentially results in ineffective medical care and may jeopardize patient safety 10-0-105 (hyperextension) 10-105 (lacking 10 degrees)

ATP-PC System

Provides energy for up to 15 seconds High intensity short duration Lots of PC, not a lot of ATP stored Instantaneous bc it does not depend on a long series of chemical reactions, it does not depending on oxyfen, they are stored directly within the contractile mechanisms of the muscle

Rancho vs Standard Gait

Rancho takes into account pathologic gait Standard is for typical gait

Osteogenesis Imperfecta GOLD

Rare congenital disorder of collagen synthesis that affects all connective tissue in the body, COL1A1 and COL1A2 Can compromise growth, hearing, CP fnction and joint integ Inheritted from parents as either an autosomal dominant or autosomal recessive trait, 25% of the time the genetic defect occufrs by spnteanous mutation of the genes Stats estimate that 30-50 thousand are living with OI Type 1 = mild and near normal growth (freq of fractures ceasing after puberty) mild or mod fragility but most times withut deformity Blue sclera, easy bruise, trianlgular face and possible hearing loss COMMUNITY AMBULATORS Type II = most severe form where a child dies inutero or by early childhood sign fragility, multiple fxs, and soft skull Type III = severe but children present with greater ossification of the skull sig growth retardation, progressive deformity and ongoing fractures severe osteoprorosis traingular face blue sclera and sig limiation with functional moblity 26% HOUSEHOLD AMB Type IV = milder course that involved mild to mod frag and osteopororsit but greater than type I, fx easy before pub but some children wil impreove after that time, may or may not have a shorted stature and will ahev bowing og long bones, barrel shape of their rib cage, possible hearing loss, brittle teeth and will present with near normal sclera, near normal life expectancy MAINLY HOUSEHOLD AMB Skin biopsy Xray bone scan and bone densitomertry Dalyed developmental milestones sesconary to ongoing fxs with immob PT - parent handling techniques, recognzie fxs, positioning and activities taht facilitate safe movement Can undergo "rodding" PT intermittent Ability to sit at 10 months = indicator of future ambualtion Arthrogryposis multiplex congenita (AMC) is a non progressive neuromuscuar disorder that results from multiple conditions that ultimately limit felta movement with an intact skeleton and cause multple congential contracturesa t birth Children are also born with msucle atrphy and weakness and sartiular rigiidyt Primary forms = contracuture syndromes, amyoplasia and distal arthrogryposis, some children will ambulate and others will require wheelchairs for mobility

Rest Interval

Recovery period High intensity = longer rest 3 or more min Low intensity = shorter one or two min Low fitness = longer rest

UE D1 Extension

Scapula: depression + adductin + downward rotation Shoulder: extension + abduction + IR Elbow: flex or extension Forearm: Pronation Wrist: ext + Ulnar Deviation Thumb: Abd Fxtn: push car door open rolling prone to supine

Ulnar gutter splint

Rigid splint that covers the ulnar side of the forearm and hand as well as the fourth and fifth digits immobilize the metacarpals and phalanges and is commonly used following fx to these structures when splinting, the MCP joints are placed in 60-90 degrees of flexion with the IP joints in full extension and the wrist in slight extension

Piriformis Syndrome SILVER

Result of compression or irritation to the proximal sciatic nerve due to piriformis muscle inflammation, spasm or contracture Common etiology of generalized back pain and is sometiems referred to as pseudosciatica because of the similarity of symptoms Piriformis muscle is a flat oblique msucle that functions to abduction and externally rotate the hip, after exiting the greater sciatic foramen, the sciatic nerve passses inferior to the piriformis before continuing distally along the midline of the posterior thigh Trauma, mechnical dysfunction, scarring or entrapment due to soft tissue pathology are among the leading theories 50% of patients diagnosed with piriformis syndrome have a history of local trauma i.e. contusion or total hip arthroplasty abnormal gait mechanics, lumbar lordosis periods of prolonged istting and participating in vigorous physical activity can be contrib factors pain is often imprecise thgou typically presents first in the area of the mid buttock then progresses to radicular complaints in the sciatic nerve distribution hip, coccyx, or groin pain may also be reported sx are exacerbated by prolonged sitting and activities that combine medial rotation and adduction (stretch) pain is reproducible on palpation, with stretch, and weakness with resistance testing during lateral roation and abduction radicular symptoms exacerbated with SLR and alleviated with lower exrtremity traction often misdiagnosed as L5-S1 radic which is due to a herniated disc or stenosis clinical diagnosis of exclusion no specific labs or imaging management piriformis tendon release or sciatic neurolysis are typically successful but last resort strain-counterstrain techniques may further enhance relaxation muscle energy techniques existing SI dysfunction, leg legnth discrepancy, or other biomechanical factors should be addressed may benefit form change in footwaer or an orthotic consultation to improve alignment and overawll risk of recurrance typically respond well and can return to regular actiivty undiagnosed piriformis syndrome often contributes to poor outcomes for patients undergoing surgery for a lumbar disc herniation

DeQuervian's Tenosynovitis BRONZE

Result of the inflammatory process involving the tendons and synovium of the abductor pollicis longus and extensor pollicis brevis at the base of the thumb THe onset of dequer is typicalyl due to repetative activities involving thumb abduction and extension such as racquet ball and rpeatd heavy lifting The associated inflammation results n pain located at the base of the thumb within the anatomical snuff box APL and EPB are coverd by a synovial sheath and pass through the anatomical tunnel that is created by the extensor retinaculum and the radial styloid Inflamm of the tendons and synovium results in impingement of the tendons as they move through the tunnel Direct trauma or structual anomalies in the area can also restrict tendon mobility and cause symtoms of dequar tenosynovitis Patients will report localized pain and tenderness at the snuffbox and may occassionally radiate into the forearm can be gradual or sudden onset degree of reported pain tends to be activity dependent and typcally improves with rest and worsens with activity or resistance testing Edema may be present may have nerve entrapment in the superficial branch of the radial nerve more common is women with higher risk among new mothers due to the repetitive lifting and carrying of the infant No lab or imaging common

Sugar Tong Splint

Rigid splint that covers the wrist and elbow joints and allows for greater immob than a volar or dorsal forearm splint the splint limits supination and prpnation in addition to any wrist motion starts on the dorsum of the hand extends along the dorsal forarm to wrap around the elbow and continues along the volar forearm to end at the palmar aspect of the hand when splinting, the elbow should be in 90 degrees of flexion with the wrist and forearm in neutral, this type of splint is used for carpal fx and distal radius/ulna fxs

Volar/Dorsal Forearm Splint

Rigid splint that extends from the proximal forearm to the metacarpal heads, allowing for full elbow and MCP motion, includes a thenar hole to allow movement of the thumb used to immob the wrist joint and is used for treating fxs of the carpals, distal radius/ulna or soft tissue conditions like a sprain or tendonitis positioning varies can be put in a functional position for improved grasp of people who have significant wekaness of the forearm and hand wrist in 20 degrees of extension the finger flexors are shortened and have improved mechanical advantage for grasping

Supine Impingement Test

Rotator cuff pathology/impingement Impingement The patient lies supine while the therapist passively moves the shoulder into full flexion, the therapist then laterally rotates and adducts the shoulder so that the arm is near the patient's head, from this position the therapist medially rotates the shoulder The test is positive if the patient experiences a significant increase in pain with medial rotation

Lateral Rotation Lag Sign

Rotator cuff pathology/impingement Infra or supra pathology With the patient's elbow bent, the therapist passively moves their shoulder into 20 degrees of scaption and near end-range lateral rotation and asks the patient to hold that position The test is positive for infraspinatus and/or supraspinatus pathology if the patient cannot hold the position (i.e. shoulder moves into more medial rotation) This test can also be performed with the patient's shoulder in varying levels of elevation

Neer Impingement Sign

Rotator cuff pathology/impingement Shoulder impingement The patient is positioned in sitting or standing, the therapist positions one hand on the posterior aspect of the patient's scapula and the other hand stabilizing the elbow, the therapist elevates the patients arm through flexion, arm is fully pronated (thumb down) A positive test is indicated by a facial grimace or pain and may be indicative of shoulder impingement involving the supraspinatus tendon

Drop Arm Test

Rotator cuff pathology/impingement Supraspinatus tear The patient is positioned in sitting or standing with the arm in 90 degrees of abduction, the patient is asked to slowly lower the arm to their side A positive test is indicated by the patient failing to slowly lower the arm to their side of by the presence of severe pain and may indicate a tear in the rotator cuff (supraspinatus)

Supraspinatus Test

Rotator cuff pathology/impingement Tear of the supraspinatus tendon, impingement or suprascapular nerve involvement The patient is positioned with the arm in 90 degrees of abduction followed by 30 degrees of horizontal adduction with the thumb pointing downward. The therapist resists the patient's attempt to abduct the arm. A positive test is indicated by weakness or pain and may be indicative of a tear of the supraspinatus tendon, impingement or suprascapular nerve involvement.

Achilles Reflex Innervation Level

S1

lateral hamstring reflex innervation

S1-S2

most common foot-ankle assembly

SACH

If conCAVE is moving on convex then which ways are the roll and glide?

SAME

accessory muscles of inspiration

SCM, scalenes, pectoralis major (sternocostal portion), pectoralis minor, and serratus anterior

calculate cardiac output

SV x HR

Spinal Cord Injury - Complete L3 Paraplegia GOLD

Same as SCI info for C7 Specifically for complete at L3 - partial innervation of the gracilis, ilipsoas, QL, RF, and sartorius pateints have full use of their upper extremities and have hip flexion, adduction and knee extension routine labs electrolytes and CBC examine rectal tone and perianal sensation cutaneous abdominal reflex, bulbocavernosus relfex and presence of babinski dysesthetic pain (deafferentation pain) additional findings include sexual dysfuncgtion, nonreflexive bladder, the need for a bowel program usually presents with flaccid paralysis below the level of the lesion and are at risk for pain, urinary tract infections, muscle contractures and pressure sores stabilize airway immediately after injury give methyloprednisolone place in TLSO with restriction of activities or surgery then TLSO rehab intitated once stable for 4 to 8 weeks KAFOs or AFOs recommended once patient has gained strength for assit with ambulation using crutches L3 complete should be able to function indpendently from a wheelchair and ambulation level 12,000 sustain SCI each year 5,000 are paraplegia SCI patients are ALWAYS at a greater risk for developing osteoporosis, pressure ulcers, hypertension, and heterotopic ossification the leading cause of death is pneumonia followed by nonischemic heart disease and sepsis**** patients however should be able to live indpendently with education regarding the management of their disability similar to complete conus medullaris which presents with no motor function or sensation below L1 patients with complete damage to the sacral portion of the cord have no control of bowel ad bladder function and sacral motor paralysis

Concave on convex mobilization rule for ulnohumeral (elbow) flexion

Same movements Roll = anterior Slide = anterior Mobilizing force should be a anterior glide of the ulna to improve elbow flexion

upper limb extensor synergy

Scapula depression/protraction Shoulder IR/adduction Elbow extension Forearm pronation Wrist extension Finger flexion/adduction Thumb adduction/flexion

upper limb flexor synergy

Scapula elevation/retraction Shoulder abd/ER Elbow flexion Forearm supination Wrist flexion Finger flexion/adduction Thumb flexion/adduction seen when a patient attempts to lift up their arm or reach for an object*

Total Shoulder Arthroplasty GOLD

Severe pain and impaired shoulder motion due to deterioration of the GH joint Irreparable damange by wear and tear, inflamm or injury or prev surgery OA RA AVN fx or RC arthropathy or bone tumor or patgets idsease or recurrent dislocations unremitting pain is the primary indication for the TSA between 55 and 70 years old for arthritis 40-50 for irreparable damange from dislocation or AVN xray for degeneration MRI or CT for integrity of RC Surgcail complications include mechanical loosening of the prosthesis instability RC tear implant faulure heterotopic ossication and intraoperative fracture Management = in hospital for an average of two to five days CPM may be prescribed PT day 1 post op shoulder immobilized during initial rehab Neer shoulder protocol advocates initiating isometric shoulder exxercises approx 3 weeks after surgery and active shoulder exercises approx 6 weeks after PROM and AAROM indicated but AROM is contraindicated during the first phase no medial rotation or lateral rotation beyond 35 to 40 degrees during the first 2-3 weeks post surgery high success rate longer life expectancy than hip or knee replacement bc non weight bearing patients should avoid activities such as heavy lifting, chopping wood or contact sports since these can increase the risk of fx, loosening of the joint replcament or RC tear similar to shoulder hemiarthroplsaty replaces head andneck of the humerus leaving the glenoid fossa intact indicated when the humeral heda is deteriorated or fxd without healing also performed if pt does not have enough bone density to support the glenoid componene or when there are sig RCC deficiencies that exist

Class III Lever

Shoulder abduction with weight Most common in body Elbow flexion Allows for large movements at rapid speeds Force between the axis and the resistance Effort arm shorter than resistance arm

Upper Limb Tension Test III

Shoulder depression with 10 degrees abduction, elbow extension, forearm pronation, wrist flexion and ulnar deviation, finger and thumb flexion, shoulder medial rotation Contralateral cervical lateral flexion Radial nerve

Upper Limb Tension Test II

Shoulder depression with 10 degrees abduction, elbow extension, forearm supination, wrist extension, fingers and thumb extension, shoulder lateral rotation Contalateral cervical lateral flexion Median nerve, musculocutaneous nerve, axillary nerve

Upper Limb Tension Test IV

Shoulder depression with 10-90 degrees abduction, elbow flexion, forearm supination, wrist extension and radial deviation, finger and thumb extension, shoulder lateral rotation Contralateral cervical lateral flexion Ulnar nerve Start with shoulder move to more distal

Upper Limb Tension Test I (Joint Positioning Sequence, Sensitization, Nerve Bias)

Shoulder depression with 100 degreees abduction, elbow extension, forearm supination, wrist extension, finger and thumb extension Contralateral cervical lateral flexion Median nerve, anterior interosseous nerve

Subacromional Decompression

Shoulder impingement open deltoid detached mini open delt split arthroscopic can remvoe acromion bursae distal clavile if it is degenerated or relaease the coracoacromial ligament rapid recovery from this surgery sling for 1-2 weeks bc typically no repair pain control and gentle rom in early rehab no PROM is deltoid repain was performed tx to focus on interventions to reduce the occurance of impingement ie posture scapular upeard rotator strengthening full recovery is expected

Open and Closed Pack Position of Interphalangeal Joints

Slight flexion (anatomical position) Full extension

Open and Closed Pack Position of Metacarpophalangeal Joint (fingers)

Slight flexion (anatomical position) Full flexion

Cartilaginous Joint (Amphiarthroses)

Slight movement Synchondrosis (sternum and true rib) Symphysis (pubic symph)

Plumb Line

Slightly posterior to coronal suture Through the external auditory meatus Through the axis of the odontoid process Midway through the tip of the shoulder Through the bodies of the lumbar vertebrae Slightly posterior to the hip joint Slightly anterior to the axis of the knee joint Slightly anterior to the lateral malleolus Through the calcaneocuboid joint

Good/Faulty Posture of Chest

Slightly up and back while back is in good aligment Halfway between that of a full inspiration and forced expiration Should not... Depressed or hollow chested Lifted or held too high by arching back Ribs more prom on one side Low ribs flaring out or protruding

Disease Modifiying Antirheumatic Agents (Purpose, Mechanism, Side Effects, Implications for PT, Examples)

Slow or halt the progression of rheumatic disease, they are used early during the disease process to slow the progression prior to widespread damage of the affected joints, they act to induce remission by modifying the pathology and inhibiting the immune response responsible for rheumatic disease Nausea, headache, joint pain and swelling, toxicity, gastrointestinal distress, sore throat, fever, liver dysfunction, hair loss, potential for sepsis, retinal damage Recognize that many of the agents have a high incidence of toxicity Rheumatrex (methotrexate), Arava (leflunomide)

Grade I

Small amplitude movement performed at the beginning of range

Grade IV

Small amplitude movement performed up to the limit of range

Grade V

Small amplitude, high velocity thrust technique performed to snap adhesions at the limit of range

Partial Hand Amputation

Surgical removal of a portion of the hand and/or digits at either the transcarpal, transmetacarpal or transphalangeal level

Hemipelvectomy Amputation

Surgical removal of one half of the pelvis and the lower extremity

Syme's Amputation

Surgical removal of the foot at the ankle joint with removal of the malleoli

Wrist Disarticulation Amputation

Surgical removal of the hand through the wrist joint

Elbow Disarticulation Amputation

Surgical removal of the lower arm and hand through the elbow joint

Osteochondritis Dissecans BRONZE

Subchondral bone and its associated cartilage crack and separate from the end of the bone in severe cases the bone may actually detach from the surrounding area and float freely inside the joint space, there is no definitive etiology though it is thought the condition occurs secondary to a loss of blood flow to the affected area possibly due to repetitive microtrauma detachment leaves thee associated articular cartialge prone to further damage primarily affects knee joint thouhg is also commonly seen in the elbow and ankle presents with pain during functional activities, joint popping or lockong, weakness, swelling and decreased ROM xray can confirm CT and MRI to better visualize the area of cartilage affected

Shoulder Medial Rotation (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Subscapularis, Pec Major, Lat Dorsi, Teres Major Seated w/ shoulder ADD & in neutral rotation, elbow flexed to 90* Stabilize over superior aspect of ips shoulder The dynamometer is placed over the ant. aspect of distal forearm just proximal to wrist Resistance is perpendicular to forearm in direction of lateral rotation

Brush Test

Swelling of the knee The patient is positioned in supine. The therapist places one hand below the joint line on the medial surface of the patella and strokes proximally with the palm and fingers as far as the suprapatellar pouch. The other hand then strokes down the lateral surface of the patella. A positive test is indicated by a wave of fluid just below the medial distal border of the patella and is indicative of effusion in the knee.

lymphocytes WBC

T cells (natural killers, protect against VIRAL infections and some CANCER cells) B cells (produce antibodies)

autonomic dysreflexia common above what level

T6 put in sitting position to reduce BP and examin urianry drainage system

abdominal reflex testing

T8-L1 stroke briskly and lightly with a blunt object (tongue depressor) from each quadrant of the abdomen in a diagnonal manner towards the umbilicus normal = contraction of the abdominals and deviation of the umbilicus in the direction of stumulus

Airborne example

TB Chicken pox Shingles Measles

femoral nerve injury caused by

THA, displcaed acetabular fx, anterior dislocatioon of the femur, hysterectomy, appendectomy

Lateral Epicondylitis GOLD

Tennis elbow (backhand in tennis) can be also with painting, hand tools, gradening, or any activity with forceful wrist extension Inflammation or degenerative changes at the common extensor tendon that attaches to the lateral epicondyle of the elbow, the primary symptom is pain Repeated overuse of the wrist extensors particuarly the extensor carpi radialis brevis (can also include extensor dig, lonus and ulnaris) Repetative wrist action against resistance during extension and supination appear to produce this condition causes inflamm and adhesions Men are more likely to develop lateral epicondylitis and more common in 30-40s secondary to the normal loss of the extensibilty of connective tissue with age unilateral involvement, pain on latearl side can radiate to the dorsum of the hand pain increased with wrist flexion with elbow extension, resisted wrist extension, and resisted radial deviation the patient may also have diffuculty holding or gripping objects and insufficient forearm functional stregnnth ROM is normal, local tenderness and local swelling Pain increases with activity and is noted at night No lab or imaging Management - RICE, avoid aggravating activities, phono with hydrocort or ionto with dex REsting splints may be used during the acute stage to relieve tension of involved muscles PT - all exercises should be pain free, estim and cryotherapy may help Counter force bracing may help A patient should be weaned from the brqace bfeore rehab is compelted Outocmes are favorable Patient should be able to return to all previous functional activities without restrictions Will commonly recur but continued stretching and exercise will decreased the risk If conservative mangaement doesnt work over 2-3 months can consider surgery Medial epicondylitis (golfer or swimmer) is similar Microtrauma to the flexor carpi radilais or the humeral head of the pronator teres during pronation and wrist flexion Complete immobilization is never recommended however counterforce bracin or splinting may be indicated

Hip Medial Rotation (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Tensor Fascia Lata, Gluteus Minimus & Medius Supine w/ hips flexed to 90*, knees flexed to 90*, hip in neutral rotation Stabilize the Anterolateral aspect of the ips pelvis Dynamometer on lateral aspect of distal leg just proximal to ankle Resistance perpendicular to leg in direction of ER of hip

Ranchos Terminal Swing

Terminal swing begins when the tibia is perpendicular to the floor and ends when the foot touches the ground (aka initial contact)

Hoover Test

The Hoover test is performed by the therapist grasping each calcaneus and then asking the patient to perform a straight leg raise. A positive test would result if the therapist was unable to detect pressure from the patient's contralateral heel into their hand as the opposing leg performs the straight leg raise. The test is designed to identify if the patient is malingering.

Muscle Activity at Initial Contact

The ankle dorsiflexors place the ankle in dorsiflexion during heel strike and prepare to lower the foot towards the ground. The quads contract to place the knee in extension while the hamstrings help stabilize the knee and prevent hyperextension. The hip extensors and abductors contract to stabilize the trunk and pelvis over the leg.

The articulating facets of the lumbar vertebrae are oriented:

The articular facets of the lumbar vertebrae are oriented nearly vertical (i.e., 90 degrees) to the transverse plane. The majority of facets (C3-C7) in the cervical spine are oriented at 45 degrees to the transverse plane and 60 degrees to the transverse plane in the thoracic spine.

Strength

The greatest amount of force that can be produced within a muscle during a single contraction which may be assessed clinically by determining a patients 1RM

MI Referred Pain

The heart is innervated by the C3-T4 spinal segments and thus cardiac pathology can result in referred pain to a variety of areas, a patient having a myocardial infarction may experience pain on the left side of the body in the chest, midback, shoulder, arm, neck or jaw

Posterior Drawer Test

The patient is positioned in supine with the knee flexed to 90 degrees and the hip flexed to 45 degrees, the therapist stabilizes the lower leg by sitting on the forefoot, the therapist grasps the patients proximal tibia with two hands, places their thumbs on the tibial plateau, and administers a posterior directed force to the tibia on the femur A positive test is indicated by excessive posterior translation of the tibia on the femur with a diminished or absent end-point and may be indicative of a posterior cruciate ligament injury

Posterior Sag Sign

The patient is positioned in supine with the knee flexed to 90 degrees and the hip flexed to 45 degrees. A positive test is indicated by the tibia sagging back on the femur and may be indicative of a posterior cruciate ligament injury

Clarke's Sign

The patient is positioned in supine with the knees extended. The therapist applies slight pressure with the web space of their hand over the superior pole of the patella. The therapist then asks the patient to contract the quadriceps muscle while maintaining pressure on the patella. A positive test is indicated by failure to complete the contraction without pain and may be indicative of patellofemoral dysfunction.

Patellar Apprehension Test

The patient is positioned in supine with the knees extended. The therapist places both thumbs on the medial border of the patella and applies a laterally directed force. A positive test is indicated by a look of apprehension or an attempt to contract the quadriceps in an effort to avoid subluxation and may be indicative of patella subluxation or dislocation.

Patrick's Test (FABER Test)

The patient is positioned in supine with the test leg flexed, abducted, and laterally rotated on the opposite leg. The therapist slowly lowers the test leg in abduction toward the table. A positive test is indicated by a failure of the test leg to abduct below the level of the opposite leg and may be indicative of iliopsoas, sacroiliac or hip joint abnormalities.

Bounce Home Test

The patient is positioned in supine, the therapist grasps the patient's heel and maximally flexes the knee, the patient's knee is extended passively A positive test is indicated by pain or clicking and may be indicative of a meniscal lesion

Glenoid Labrum Tear Test

The patient is positioned in supine, the therapist places one hand on the posterior aspect of the patient's humeral head while the other hand stabilizes the humerus proximal to the elbow, the therapist passively abducts and laterally rotates the arm over the patient's head and then proceeds to apply an anterior directed force to the humerus A positive test is indicated by a clunk or grinding sound and may be indicative of a glenoid labrum tear

Sacroiliac Joint Stress Test

The patient is positioned in supine. The therapist crosses their arms placing the palms of the hands on the patient's anterior superior iliac spines. The therapist applies a downward and lateal force o the pelvis. A positive test is indicated by unilateral pain in the sacroiliac joint or gluteal area and may be indicative of sacroiliac joint dysfunction.

Hughston's Plica Test

The patient is positioned in supine. The therapist flexes the knee and medially rotates the tibia with one hand while the other hand attempts to move the patella medially and palpate the medial femoral condyle. A positive test is indicated by a popping sound over the medial plica while the knee is passively flexed and extended.

McMurray Test

The patient is positioned in supine. The therapist grasps the distal leg with one hand and palpates the knee joint line with the other. With the knee fully flexed, the therapist medially rotates the tibia and extends the knee. The therapist repeats the same procedure while laterally rotating the tibia. A positive test is indicated by a click or pronounced crepitation felt over the joint line and may be indicative of a posterior meniscal lesion.

Quadrant Scouring Test

The patient is positioned in supine. The therapist passively flexes and adducts the hip with the knee in maximal flexion. The therapist applies a compressive force through the shaft of the femur while continuing to passively move the patient's hip. A positive test is indicated by grinding, catching or crepitation in the hip and may be indicative of pathologies such as arthritis, avascular necrosis or an osteochondral defect.

Vertebral Artery Test

The patient is positioned in supine. The therapist places the patient's head in extension, lateral flexion, and rotation to the ipsilateral side. A positive test is indicated by dizziness, bystagmus, slurred speech or loss of consciousness and may be indicative of compression of the vertebral artery.

Standing Flexion Test

The patient is positoned in standing with the feet 12 inces apart. The therapist places his/her thumbs on the inferior margin of the posterior superior iliac spines and monitors the movement of the nomy structures as the patient bends forward with the knees extended. A positive test is indicated by one posterior superior iliac spine moving further in a cranial direction and may be indicative of an articular restriction.

Jerk Test

The patient is sitting with the shoulder elevated to 90 degrees and in medial rotation with the elbow bent, the therapist provides an axial compression force through the patient's elbow while horizontally adducting the shoulder, A sudden clunk or jerk as the humeral head subluxes posteriorly indicates the presence of posterior instability, a second clunk or jerk may be heard when the shoulder is returned to the starting position as the humeral head reduces, a complaint of pain with this test could indicate the presence of a posterior labral lesion

Gapping Test

The patient lies supine while the therapist crosses their arms and applies pressure in a downward and lateral direction to each anterior superior iliac spine, if the patient experiences pain in the sacroiliac joint, gluteus or posterior leg, the test is positive for a sprain of the anterior sacroiliac ligaments

residual volume (RV)

volume of gas reamining in the lungs at the end of a maximal expiration 25% of total lung volume

Slump Test

The patient sits at the edge of a table and is asked to slump i.e. move into lumbar and thoracici flexion and then bring their chin toward their chest, the therapist uses one hand to maintain the position of full spinal flexion while using the other hand to place the patient's ankle in full DF, the patient is then asked to actively extend the knee (or this can be done passively), if the patient cannot fully extend the knee because of pain, the therapist asks the patient to extend their neck and then try to extend the knee again, if symptoms decrease with knee extension or the patient can extend the knee father the test is positive for neural tension

Active Compression Test (O'Brien's Test)

The patient stands with the shoulder flexed to 90 degrees, horiz adducted 10-15 degrees, and medially rotated so the thumb points downward, the patient resists as the therapist applies a downward force on the arm, the shoulder is then laterally rotated and the same downward force is applied The test is positive for a superior labral tear if the patient experiences pain when the shoulder is in medial rotation but has decreased pain when the shoulder is laterally rotated, the therapist must ensure the pain is not located over the AC joint with this test

Muscle Activity during Terminal Stance

The plantar flexors begin to work concentrically to aid the foot in its propulsion of the body forward. Knee muscle activity remains limited. The hip abductors continue to stabilize the pelvis and the iliopsoas contiunes to slow the rate of hip extension.

Muscle Activity during Midstance

The plantar flexors continue to act eccentrically to control dorsiflexion as the body moves over the stance limb. Activity in the knee musculature is minimal during this phase, though the quads contract concentrically to continue producing closed chain knee extension. The hip abductor muscles stabilize the pelvis and prevent contralateral hip drop. The iliopsoas also begins to contact eccentrically to control hip extension.

Body Composition

The relative percentage of body weight that is comprised of fat and fat-free tissue (bone, water, and muscle)

4-/5 MMT

The subject completes range of motion against gravity with minimal-moderate resistance Good Minus

4/5 MMT

The subject completes range of motion against gravity with moderate resistance Good

endoskeletal shank

This type of shank consists of a rigid pylon covered with a material designed to simulate the contour and color of the contralateral limb.

Roos Test

Thoracic outlet syndrome The patient is positioned in sitting or standing with the arms positioned in 90 degrees of abduction, lateral rotation, and elbow flexion, the patient is asked to open and close their hands for three minutes A positive test is indicated by the inability to maintain the test position, weakness of the arms, sensory loss of ischemic pain

Allen Test

Thoracic outlet syndrome The patient is positioned in sitting or standing with the test arm in 90 degrees of abduction, lateral rotation and elbow flexion, the patient is asked to rotate the head away from the test shoulder while thee therapist monitors the radial pulse A positive test is indicated by an absent or diminished pulse when the head is rotated away from the test shoulder, positive test may indicate thoracic outlet syndrome

Adson Maneuver

Thoracic outlet syndrome The patient is positioned in sitting or standing, the therapist monitors the radial pulse and asks the patient to rotate his/her head to face the test shoulder, the patient is then asked to extend his/her head while the therapist laterally rotates and extends the patient's shoulder A positive test is indicated by an absent or diminished radial pulse and may be indicative of thoracic outlet syndrome

Costoclavicular Syndrome Test

Thoracic outlet syndrome The patient is positioned in sitting, the therapist monitors the patients radial pulse and assists the patient to assume a military posture A positive test is indicated by an absent or dimished radial pulse and may be indicative of thoracic outlet syndrome caused by compression of the subclavian artery between the first rib and the clavicle

Volume

Total amount of work performed Reps x weight (intensity) Reps inversely related to weight

symptoms of diabetes insipidus

Totally different from diabetes mellitus Decreased BP Hypovolemia Constipation

Distraction vs traction

Traction = longitudinal pull Distraction = separation or pulling apart

Osgood-Schlatter Disease SILVER

Traction apophysitis occuring at the tibial tuberosoty Symtpoms are a result of local inflammation at the tibial tub and are exacerbated by running, jumping, and squatting activities Repeated microtrauma Repeated tension at the insertion of the patella tendon can cause a small avulsion at the tuberosity therby producing pain and edema Over time heterotopic bone formation may also produce a visible lumb over the tibial tub Onset occurs most commonly in adolescents following a period of long bone growth during which soft tissue tension may be temporarily increased before accommodating to the change in limb length 20% of adolescents involved in sports that require a lot of running, jumping and agility (soccer/ballet) Onset is during rapid growth esp puberty More prevalent among boys although the gender gap has lessened as more girls engage in competetive athletics Characterized by location pain and edema with point tenderness over the patella tendons insertion on te tibitl tub Sx reproducible with resisted knee extension and alleviated with rest or citivity restriction Generalized tightness in the hip and knee is common esp in the quad, if heterotopic ossicaifcation has occured a firm mass will be palpable xray can confirm conservative management with emphasis on pain management, knee immobilizer may be beneficial to facilitate rest during acute phases while an infrapatellar strap may assist in distributing traction forces once acuity is reduced and activity has resumed surgery is rare but if have ossicles can consider it cross training encouraged exacerbating activities should be modified or avoided until sx resolve limiting sx may last for weeks or months before abating, in some cases discomfort can last for a number of years until the tibial growth plate has closed acute exacebation are common until the long bones have stopped growing PT may help with reducing severity of symptoms but the condition is self limiting Conservative tx is successful 90% of the time Excellent prognosis self limiting bony lump will remain after symtpoms have resolved if sx continue after skeletal maturity may consider surgery

Meniscal Tear SILVER

Typically result of traumatic injury Involves twisting of the knee when it is in a semiflexed position with the foot planted on the ground Can also occur 2/2 to a hyperflexion injury Older patients it is due to degeration when the meniscus has been degenerated a simple pivot or squat can cause a tear Because the medial meniscus is more firmly attached to the tibia it is more comonly affected than the lateral meniscus Cutting spots and pivoting motions patients with instability of the knee secondary to weakness or ligamentous deficiency are also more prone to meniscual tears characterized by joint line pain and tenderness swellling loww of ROM (mechanical block) complaint of catching or locking within the joitn and feelings of instablility xrays will not confirm or deny they rule out other traumatic pathologies MRI is test of choice Conservative tx - rest including limited weight bearing, ice, anti inflamm, PT Reduce swelling, normalize ROM and improve strength at PT Since some meniscus tears can heal on their own, conservaive tx is often attempted before surgery Tear in the outter 1/3 is likely to heal spontaneously since it isvascular inner two thirds surgical intervention may be necessary young and lesion is in vascular portion, a full repair of the torn menisucs is usually performed older and lesion in the avascualr a partial menisectomy will be performed pts who have surgery generally return to PLOF with no issue

Scapular Elevation (Dyna) - Muscles, Pt Position, Stabilization, Dyna Position, Direction of Resistance

Upper trap Levator Scap Patient is prone with arms at their side Shoulder is completely elevated Head in neutral No stabilization necessary The dynamometer is placed over the superior aspect of the acromion process of the scapula Resistance is perpendicular to the acromion in the direction of scapular depression

Viscerogenic Pain vs MSK pain

V doesnt change based on movement or positioning of the body part, it is diffuse and poorly localized (bc organs have innervation from multiple spinal cord levels and a low density of nerve receptors), accompanied by other systemic symptoms such as nausea, vomiting, abnormal vital signs Common sites include shoulder, scapula, back, chest, pelvis, SI joint, groin and hip

Allen Test for the Wrist/Hand

Vascular Insufficiency Indicative of an occlusion in the radial or ulnar artery The patient is positioned in sitting or standing, the patient is asked to open and close the hand several times in succession and then maintain the hand in a closed position, the therapist compresses the radial and ulnar arteries, the patient is then asked to relax the hand and the therapist releases the pressure on one of the arteries while observing the color of the hand and fingers A positive test is indicated by delayed or absent flushing of the radial or ulnar half of the hand

Viscerogenic Pain

Viscerosomatic convergence may be oe method for explaining the phenomenon, the theory states that the afferent inputs for visceral and somatic structures converge as they approach the central nervous system and thus the brain interprets this pain as originating from the MSK system/structure

immunosuppresssive medications what labs should you watch

WBC aka leukopenia nonselective immune system reduction WBC count shows the degree of immunosuppression

Total Hip Arthroplasty GOLD

Warranted seconady to progressive and severe OA or rheymatoid =, developmental dusplasia, tumors, failed reconstruction, trauma, AVN ro nonunion fx arthritis in the acetabulum and the femoral head if only the acetabulum then only the femoral head will be replaced in a hemiarthroplasty repetative microtrauma, nutritional imbalances, falls osteomyelitis, ankylosing spondy preesnts with decreased ROM, impaired mobility, presistent pain that increases with motion and weight bearing >55 consistent pain that is not relieved through conservative measurse and limits functional consistently xray CT MRI view integ of joint contraindications for THA include active infection, severe obesity, arterial insuff, neuromuscular disease, and certain mental illness post surg complications include nerve injury, vasculr damage, dislocation, PE, MI, and CVA prosthesis is at risk for loosening infection, herterotopic ossification and fx management = posterolateral aproach to allow the abductor muscles to remain intact can cause post op instability due to the interruption of the posterior capsule no flexion greater than 90 hip adduction (cross legs) and hip medial rotation (toes in) anteriolateral appraoch should avoid hip flexion and lateral rotation (toe out) a direct lateral approach leaves the posterior portion of the glut med atached to the greater troch and the posterior capsule left intact, this method may be preferred for patients that may be noncomplant in order to avoid posterior dislocation meds will include anticoagulant and pain medication at d/c patient should be able to extend the hip to neutral and flex the hip to 90 degrees a cemented hip replcaemnt allows for PWB initally a noncememeted require TTWB for up to 6 weeks adhere to hip precau for min of three months or until a MD dertermines the hip is stable Pts should increase in fucntion and dimish to no pain within six to eight weeks after srugery prosthesis lifespan is 20 eyars 85-95% indicate pain releif and improved function at 15 to 20 years post THA harris hip scoring system or the special surgery rating system are good to determine the QOL after THA simialr to hemiarthroplasty for eldery that sustain a hip fx or patients who have a shortedn expected lifespan

What are the units associated with maximum voluntary ventilation (MVV)

What are the units associated with maximum voluntary ventilation (MVV)? millimeters liters milliliters per minute liters per minute Correct Answer: liters per minute MVV refers to the maximum amount of air a subject can breathe in 12 seconds. The obtained value is expressed in liters per minute (L/min).

What percentage of the vital capacity is a patient typically able to exhale during the forced expiratory volume in one second (FEV1)?

What percentage of the vital capacity is a patient typically able to exhale during the forced expiratory volume in one second (FEV1)? 25% 50% 75% 100% Correct Answer: 75% FEV1 is the percentage of the vital capacity which is expired in the first second of a maximal expiration. This value is typically greater than 75% of vital capacity, but would not approach 100%. FEV1 is significantly reduced in obstructive lung disease due to increased airway resistance.

Dynamometer Bell Curve, Intrarater Reliability

When doing the test, a bell curve will normally be seen with the greatest strength readings at the middle grip placements (second and third placements) and the weakest readings at the beginning and end. With injury, the bell curve should still be present, but the force exerted will be less. An individual who does not exert maximal force for each test will not show the typical bell curve, nor will the values obtained be consistent. Malingering may be detected by a flat curve in all five dynamometer settings. With a rapid exchange of dynamometer grips between hands, strength normally decreases due to fatigue in normals, but may increase in malingerers, who are confused by the effort. Intra = > .94 Inter = .97 ICC = .99

Contraindications of ROM

When motion is detrimental to the healing of tissues Controlled motion within a pain free range has been shown to be beneficial in the early stages of healing Increased pain or inflammation are signs that range of motion may be too aggressive

Straight Leg Raise Test

With the patient in supine, the therapist flexes the patient's hip while maintaining knee extension and slight medial rotation of the hip, the therapist continues to flex the hip until the patient complains of pain or tightness in the low back or posterior leg, the therapist then lowers the leg until the patient feels no pain or tightness, at this point the therapist dorsiflexes the ankle (or has the patient flex their neck), if the symptoms return, then the test is positive for neural lesion or a lesion within the spinal cord (i.e. disc herniation)

Potential Adverse Reactions to Mobilization

Worsening and/or peripheralization of symptoms, tissue damage, promotion of inflammation leading to chronic pain and/or proliferation of scar tissue, spinal or joint instability, and neurovascular compromise. Failure to properly evaluate responses during the course of examination or intervention could result in adverse responses from the intervention, ranging from increased pain and deformity, to loss of function, to death

accessory nerve

XI 11 voluntary motor of SCM and trapezius ressisted shoulder shrug MOTOR

hypoglossal nerve

XII 12 voluntary motor of msucles of tongue tongue protrusion tongue will deviate to injured side if injured MOTOR

Can you catch pneumonia?

Yes droplet precautions Same for flu

downward pressure on the pelvic floor

increase intra-abdominal pressure increases prolapse and is opposite necessary action for strengthening the pelvic floor

wound infections of ampu

antibiotics

progressive ambulation to tolerance is recommended for what pt with what platelet level

anyone above 20,000

illiolumbar syndrome

aka iliac crest pain syndrome caused by inflammation or a tear of the iliolumbar ligament referred pain in the pelvis or groin

extraneous variable

aka nuisance or intervening variable any factor that is not related to the purpose of the study but that may affect the dependent variable

osthostatic hypotension complication of SCI what are the numbers

aka postural hypotension due to loss of sympathetic control of vasoconstriction in combo with absent or severely reduced muscle tone venous pooling is fairly common during early stages of rehab decrease in systolic >20 after moving from supine to sit decrease in diastolic >10 tx = monitoring vital signs elastic stockings, ace wraps to the LEs, abdominal binders gradual progression to vertical using a tilt table pharma to increase BP

mobility vs stability vs controlled mobility vs skill

ability to initiate movement through a functional range of motion the ability to maintain a position or posture through cocontraction and tonic holding around a joint, unsupported sitting with midline control is an example of stability ability to move within a weight bearing position or rotate around a long axis activities in prone on elbows or weight shifting in quadruped are examples of controlled mobility the ability to consistently perform funcgtional tasks and manipualte the environment with normal postural reflex mechanmisns and balance reactions skill activities include ADLs and community locomotion

plasticity

ability to modify or change at the synapse level either temporarily or permanently in order to perform a particular function

barognosis

ability to perceive differences in weight of two objects

Stereognosis

ability to recognize objects by feeling their form, size, and weight while the eyes are closed

recovery

ability to use previous strategies to return to the same level of functioning

compensation

ability to utilize alternate motor and sensory strategies due to an impairment that limits the normal completion of a task.

hemorrhage 10-15% of CVAs

abnormal bleeding in brain due to rupture in blood supply. the infarct is due to disruption of oxygen to an area of brain and compression from accumulation of blood. hypertension is usually a precipitating factor causing rupture of an aneurysm or arteriovenous malformation. can also happen after trauma (hemorrhage and subsequent CVA) 50% of deaths from hemorrhagic stroke occur within first 48 hours. characteristics = severe headache, vomiting, high blood pressure and an abrupt onset of symptoms usually occurs during the day with sx evolving in relation to the speed of the bleed "CVA" means result in lack of oxygen supply to a specific area of the brain

paradoxical breathing

abnormal breathing that is common in tetraplegia where the abdomen rises and the chest is pulled inward during inspiration expiration the abdomen falls and the chest expands

neuroma

abnormal growth of nerve cells; associated conditions include vasculitis, AIDS, and amyloidosis

restrictive lung dysfunction RLD

abnormal reduction in lung expansion and pulmonary ventilation abnormal lung parenchyma (i.e. atelectasis, pneumonia, PF, pulmonary edema, ARDS), abnormal pleura (i.e. pleural effusion, pleural fibrosis, penumothorax, hemothorax), and disorders affecting ventilatory pump function (i.e. decrease in respiratory drive, neuro and neuromuscular diseases, muscle disease or weakness, thoracic deformity or trauma, connective tissue disorders affecting the thoracic joints, pregnancy, obesity, and ascities) s/s = duspnea on exertion, a persistent non-productive cough, increased respiratory cough, increased respiratory rate, hypoemia, decreased vital capacity, abnormal breath sounds, and reduced exercise tolerance tx = variable depending on the etiology (i.e. antibiotics for pneumonia, tx of edema, reversal of CNS depression), additional supportive measures include mechanical ventilation, supplemental oxygen, nutrition support, and pulmonary rehab (airway clearnce, breathing exercises, respiratory muscle training, endurance and strength training)

aspiration same as

athrocentesis usually sent to a lab for analysis

heart murmur

abnormal swishing or whooshing sounds heard by auscultation sometime during the cardiac cycle innocent herat murmurs occur when blood flows rapidly through the heart due to activity, pregnancy, fever, and anemia abnormal heart murmurs may be caused by turbulent blood flow through a damaged or narrowed heart valve or a hole in one of the hearts walls other causes include rheumatic fever, endocarditis, calcified valves and mitral valve prolapse s/s = innocent no s/s but pathological include cyanosis, limb edema, shortness of breath, enlarged neck veins, weight gain, chest pain, dizziness and fainting tx = innocent doesnt require treatment, pathological includes medication or surgery common meds are digoxin, anticoagulants, diuretics, andother antihypertensive afents surgeries include valve replacement or patching arterial or ventricular septal defects

aphasia

acquired neuro impairment of processing for receptive and/or expressive language result of brain injury, head trauma, CVA, tumor or infection the more sudden the onset, the higher extent of aphasia perseveration of speech, severe auditory comprehension impairments, unreliable yes/no answers, and the use of empty speech without recognition of impairment are associated with poor prognosis

placing

act of moving an extremity into a position that the patient must hold against gravity.

saltatory condution

action potential moving along an axon in a jumping fashion from node to node decreases the use of sodium-potassium pumps and increases speed of conduction

reproduce peroneal tendon subluxation

active dorsiflexion and eversion or plantarflexion or circumduction initial cause may occur during inversin ankle sprain when the peroneals are forcefully stretched, damaging the reinanculum that maintains the tendons in the retromalleolar groove painful snapping or popping senstion a the lateral malleolus lateral ankle effusion and tenderness in the retromalleolar groove

I/M compressin is contraindicated in

acute pulmonary edema because could put excess strain on heart okay with venous statis ulcer, I/M claudication (happens during activivty), and lymphedema

expiratory reserve volume

additional volume of air that can be exhaled beyond the normal tidal exhalation component of vital capacity

inspiratory reserve volume

additional volume that can be inhaled beyond the normal tidal inhalation one component of vital capacity

lengthening the adductors in CP does what

adductor longus, garcilis and iliopsoas in order to reduce hip subluxation can also reduce scissoring gait

enteral

administration of drugs involving the esophagus stomach and small and large intestines aka oral sublingual or rectal

tests for vascular compressionj at the shoulder

adson (rotate towards and extend head while ER and extend shoulder, palpate radial pulse) halstead (palpate radial ppulse and applie downward traction on the symptomatic side, extend head and turn away) weight (hyperabduction while monitoring radial pulse compression in the costoclavicular space)

absence of radial pulse, what tests

adson's test halstead maneuver

swing to pattern

advances the LEs simultaneously to the point of the crutches used for trunk and or bilateral lower extremity weakness, paresis or paralysis inappropriate for a patient with THA

blink reflex and cranial nerves involved

afferent cranial nerve V efferent cranial nerve VII normal response = concurrent blinking of the eyes with contact to the sclera

spinotectal tract ascending

afferent info for the spinovisual reflexes and assists with movement of eyes and head towrads a stimuls

spinoreticular tract ascending

afferent pathway for the retricular formation that influcenes leves of consciousness

visual input and how to challenge it

allow for perceptual acuity regarding verticality, motion of objects and self, environmental orientation, postural sway and movements of the head/neck children rely heavily on this system for maintenance of balance exam of quiet standing with eyes open observe balance strategies to maintain COG with and without visual input assessment of potential visual field cuts, hemianopsia, pursuits, saccades, double vision, gaze control, and acuity is necessary

Rigid Plaster of Paris Adv and Dis Post Op Dressing

allows early amb with pylon promotes circ and healing stimulates proprioception provides protection provides sfot tissue support limits edema ability to utilize an immediate post op prosthesis immediate wound inspection is not possible does not allow for dialy dressing change requires professional application

pull-to wheel lock

allows for closer access to surfaces during transfers, brake extensions on the right side all the patient to reach with the uninvolved upper extremity to lock the wheelchair prior to transferring, the patients ability to use the right hand to lock the brakes is most likely limited due to the right sided hemiparesis

single axis foot

allows for motion in a singular plane imrpvoed knee stability during weight acceptance lacks energy return function if not paired wiwth a dynamic response foot

concepts to remember with NDT

alteration of abnormal ntone and influencing isolated active movement avoid utilization of abnormal reflexes or associated reactions during treatment utilize manual contact for key points of control for faciitation and inhibiation emphasize the use of rotation during tx provide the patient with the senstaion of normal movement by inhibiting abnormal postural reflex activity

venous return

amount of blood that returns to the right atrium each minute, similar in volume to the cardiac output b/c the CV system is a closed loop, venous return must equal CO when averaged over time

half life

amount of time required for fifty percent of the drug remaining in the body to be eliminated elderly do not metabolize medications as quickly as younger patients which creates higher plasma levels and as a result are more at risk for toxicity aleve long half life 10 hours acetaminiphen short half life 2 hours

functional outcome measures for amputees

amputee mobility predictor AMPRO (lower limb prosthetic users, balance-gait-transfers, correlated to K-level, AMnoPRO is for people who dont have a prosthesis) L-test (similar to TUG, 90 degree turn after inital 3 meters, total length is 20 meters not 6 like in tug, four turns are involved, mean times for amp level age and use of AD)

orthotic

an external device that provides support or stabilization, improves function, corrects deformity, and dsitributes pressure from one area to another

hyperpathia

an extreme exaggerated response to pain

knowledge of results feedback

an important form of extrinsic feedback and includes terminal feedback regarding the outcome of a movement that has been performed in relation to the movements goals

retrograde amnesia

an inability to remember prior to the injury may progressively decrease with recovery

mononeuropathy

an isolated nerve lesion; associated conditions include trauma and entrapment

relevant risk factors for coronary artery disease

angina, MI, advanced age, cirgarette smoing, sedentary lifestyle, obesity, hypertensioon, dyslipedema and prediabetes waist hip ratio >0.9 indicates central obesity BMI >30 (18.5-24.9 is normal)

L4 key muscles

ankle DFs (tibialis anterior)

residuum

annother common term for residual limb

remembering muscle innervation

anterior arm - musculocutaneous C5-C6 posterior arm - radial can be between C5-T1 anterior forearm - median nerve can be between C5-T1 small muscles of the hand - 5 are median (abductor pollicus brevis, flexor pollicis brevis, oppoens pollicis, 1st 2 lumbricals), 15 left are ulnar rotator cuff (supra infra) - suprascapular C4-C6 teres minor - axillary along with deltoids teres major - subscap along with subscap C5-C6 (5) rhombaoids and levator scap - dorsal scapular (C4-C5) lats - thoracodorsal (C6-C8) anterior thigh - femoral L2-L4 medial thigh - obturator L2-L4 posterior thigh - sciatic = common peroneal (L4-S2) + tibial (L4-S3) glut max - inferior glut med, min, TFL - superior anterior leg - deep peroneal L4-S2 lateral leg - superficial peroneal L4-S2 posterior leg - tibial foot - medial and lateral plantar nerves

anterior cerebral artery (ACA) what does it supply and what are the expected impairments

anterior frontal lobe medial surface of frontal lobe and parietal lobes contralateral LE motor and sensory involvement loss of BB function loss of behavioral inhibition significant mental changes neglect aphasia apraxia and agraphia perseveration akinetic mutism with signicant bilateral involvement bilateral involvement will produce paraplegia other findings include incontinence, abulic aphasia, frontal lobe sx such as personality changes, and potential akinetic mutisum (conscious unresposniveness)

vestibulospinal reflex (VSR)

attempts to stabilize the body and control movement assists with stability while the head is moving as well as coordination of the trunk during upright postures

coarctation of the aorta

aorta is narrowed near the ductus arteriosus may not be detected until adulthood usually occurs along with other congenital defects inclduing patent ductus arteriosus, ventricular septal defect and bicuspid aortic valve s/s = pale skin, sweating, and shortness of breath noted soon after birth, in older children and adults the common sign is HBP in the arms but LBP in the legs other s/s = SOB during exercise, intermittent claudication, weakness and HA

appendicitis vs diverticulitis

app - right lower quadrant div - left lower, more GI symptoms

apgar score

appearance (skin color), pulse, grimace (reflex irritability), activity (muscle tone), respiration A.P.G.A.R. calculated at 1 min and 5 min good condition = 7-10 <3 means low and requires IMMEDIATE medical attention 0 = blue/pale, absent pulse, no response to stimulation, no movement "floppy", absent respiration 1 = normal body color, below 100 bpm, minimal response to stim, flexing of arms and legs, slow/irregular respiration 2 = normal color "pink", above 100 bpm, pulls away/sneeze/cough to stimuli, active movement, vigorous cry

epidural space

area between the dura matera and th periosteum of the vertebrae

thebesian veins

arise in the myocardium and drain into all chambers of the heart but primarily into the right atrium and right ventricle (makes blood a very small percent less oxygenated)

arterial blood gas (ABG)

arterial blood gases are collected to evaluate acid-base status, ventilation, and oxygenation of arterial blood the partial pressure of oxygen in arterial blood and the percent saturation of hemoglobin provide info on how well the lungs are functioning to oxygenate the blood the partial pressure of carbon dioxide provides info on how well the lungs are able to remove carbon dioxide changes in paco2 directly affect the balance of pH in the body blood pH is tightly regulated as an imbalance in either direction can affect the nervous system and can cause convulsions or coma bicarbonate HCO3- is an important component of the chemcial buffering system that keeps the blood from becoming too acidic or basic and is often part of an ABG test

Total shoulder arthroplasty

arthritis fracture RC arthropathy replaces glenoid and humeral components reverse is when it reverses the concave convex realtionship when the patient has a dysfunctional RC subscap is detached for anterior approach to reach joint movement precautions for 6-8 weeks varies widely avoid extension and ER to protect healing subscap and anterior portion of the capsule resisted IR is also avoided for the same reason may be restrictions on weight bearing and lifting or carrying weight

spinocerebellar tract (dosral) ascending

ascends tothe cerebellum for ipsilateral subconscious proprioception, tension inthe muscles, joint sense, and posture of the trunk and LEs

spino-olivary tract ascending

asecnds to cerebellum and relays info from cutaneous and proprioceptive organs

rhomberg test

assess balance and ataxia unsupported standing, feet together, upper extremities folded, looking at a fixed point straight ahead with eyes open (if mild lesion in vestibular or somatosensory then the patient will typically compensate through the visual sense) normal = 30 seconds with eyes closed if a patient demonsrtaes ataxia and has a positive rhomberg test (vestib or somatosensory prob) this indicates sensory ataxia and not cerebellar ataxia

Tinetti Performance Oriented Mobility Assessment

assess fall risk sit to stand from armless chair immediate standing balance with eyes open and closed turning 360 degrees toelrating slight push max score of 16 initation of gait step leength and height step asym and continutuy path stance trunk motion max score of 12 combined max of 28 with risk of falling increasing as the score decreases <19 indicates high risk for fall

TUG

assess level of mobility and balance walks approx 10 ft with turn and STS transfers x2 patient is scored based on amount of postural sway, excessive movements, reaching out for support, side stepping and other losses of balance 5 point rating scale (ordinal) 1 = normal, 5 = severely abnormal in attempt to increase overall reliability the use of time was implemented independent <10 seconds >20 seconds = limited independence and may have increased risk of falling >30 high risk for fall

berg balance test, cut off score

assess pt risk for FALLING 14 tasks 0-4 scale max score 56 <45 indicates increased risk for falls

functional reach test

assess standing balance and risk for FALLING 3 trials and averaged 20-40 years = 14.5-17 inches 41-69 years = 13.5 - 15 70-87 years = 10.5 - 13.5 high test-retest correlation and intrarater reliability hold out fist

national institute of health (NIH) stroke scale

assessment of an acute CVA relative to impairment

stroke impact scale

assessment of physical and social disability or level of impairment secondary to CVA

embolus 20% of ischemic CVAs

associated with cardiovascular disease, an embolus may be a SOLID LIQUID OR GAS, and can originate in any part of the body. travels thru bloodstream to the cerebral arteries causing occlusion of a blood vessel and a resultant infarct. middle cerebral artery is most commonly affected by an embolus from internal carotid arteries. occurs rapidly with no warning and often presents with a headache. due to the sudden onset, tissues DISTAL to the infarct can sustain higher permanent damage than those of thrombotic infarcts

examples of hyperkinesia

ataxia athetosis chorea tics tremors dysmetria dystonia

thrombus

atherosclerotic plaque develops in an artery and eventually occludes the artery or a branching artery causing an infarct sx can appear in minutes or over several days usually occurs during sleep or upon awakening after an MI or post surgical procedure

stepping strategy

elicited thru unexpected challenges or perturbations during static standing or when the perturbation produces such a movement that the COG is beyond the BOS. LEs step and/or UE reach to regain a new BOS

cauda equina injury vocab

injuries that occur below L1 LMN

neurogenic reflexive bladder

empties reflexively for a patient with an injury above the level of T12 sacral reflex remains intact

biologic reponse modifiers

enbrel humira for rheumatoid arthritis susceptible to infectins cause affect immune system

when does your body use fat vs protein

fats <70% max heart rate greater than an hour carbs >70% <1 hour proteins contribute amino acids in the production of ATP and helps more during prolonged activity or long-term starvation

paraplegia

injury that occurs at the level of the thoracic, lumbar, or sacral spine

bobath: neuromuscular developmental treatment (NDT)

based on hierarchial model of neurophysiologic function abnormal postural reflex activity and abnormal tone are caused by the loss of CNS control at the brainstem and SC concept recognizes that interference of normal function within the brain caused by central nervous system dysfunction leads to a slowing down or cessation of motor development and the inhibition of righting reactions, equilibrium reactions, and automatic movements the patient should learn to control movement through activities that promote normal movement patterns taht integrate function new assumptions in NDT from research includes: postural control can be learned and modified through experience postural control uses both feedback and feedforward mechanisms for execution of tasks postural control is initiated from a patients base of support postural control is required for skill development postural control develops by assuming progressive positions in which there is an increase in the distance between the COG and BOS; the base of support should also decrease

rood

based on sherrington and reflex stimulus model motor output = result of both past and present sensory input tx based on sensorimotor learning takes into account ANS and emotional factores as well as motor ability goal is to obtain homeostasis in motor output and to activate muscles to perform "key patterns" independent of a stimulus exeercise is seen as a treatment technique only if the response is correct and if it provides sensory feedback that enhances the motor learning of that response once a response is obtained during tx, the stimulus should be withdrawn rood introduced the use of sensory stimulation to facililtate or inhibit responses such as icing and brushing in order to elicit desired reflex motor responses

landau reflex what age

begins at 3 months but not fully integrated until 2 respond to prone by aligning their head and extremities in line with the plane of the body

trachea

begins at the larynx (base of the neck) and ending at the carina (4th thoracic vert and sternal angle) horseshoe shaped rings that support anterior and lateral walls posteriorly, the trachea is composed of longitudinal bundles of smooth muscle, fibrous and elastic tissues, and numerous mucous glands

dorsal ganglion cyst

benign cyst located on the back of the wrist or hand would aspirate it due to cosmesis

nerve injury outcomes

better in children generally early repair better distal better bc length is shorter

serial casting how much ROM should you expect to gain

between 5 and 7 degrees

subarachnoid space

between arachnoid and pia contains CSF and the cirulatory system for the cerebral cortex

spinal cord gray and white watter

inner core is gray superficial white

when would you want a w/c to have the wheel axle aligned further posterior than it typically would be in a standard wheelchair

blateral ambutations to increase stability and compensate for the change in the center of gravity or in a recline or tilt wheelchair but it will increase rolling resistance, decrease mechanical efficiency, decreased ability to perform wheelie (want it anterior for that since it will move the axle closer to the pts COG), and increase turning radius (bc distance from the wheel axle to the casters increases), reduced maneuverablity, increased energy required for propulsion

sciatic injurry caused by

blunt force traum to the buttocks, THA, accidental injection into nerve

cataracts vs macular degen vs presbyopia vs glaucoma

blury lines glares danergous at night degenerative changes centrally but can see in the periphery prebyopia farsightedness glaucoma loss of peripheral vision central sparing

aorta

bodys largest artery and central conduit of blood from the heart to the body begins at the upper part of the left ventricle and after ascending for a short distance arches backward and to the left (arch of the aorta) then it descends within the thorax (thoracic aorta) and passes into the abdominal cavity (abdominal aorta)

ANS part of CNS or PNS

both automatic homeostasis vs somatic nervous system which is more voluntary deals with all 5 senses (touch, smell, sight, taste, sound)

computed tomography (CT scan)

brain scan imaging is typically non-invasive and provides cross sections of the area tested with precise two dimensional views of bones, tissues, and organs dyes or contrast are occasionally used to provide the best view of any pathology that may exist within the tissues a CT scan of the brain or spinal cord is required to rule out vascular malformations, tumors, cysts herniated discs, hemorrhage, epilepsy, encephalitis, spinal stenosis, intracranial bleeding and head injury

positron emission tomography PET

brain scan imaging that provides two and three dimensional pictures of brain activity and is used to rule out cerebral circulatory pathology, metabolism dysfunction, tymors, brain changes following injury or drug abuse, blood flo

chorea

brief, irregular contractions that are RAPID but not to the degree of myocloonic jerks chorea is typically secondary to damage of the caudate nucleus chorea is often equated to fidgeting ballism is a form of chorea that incldues choreic jerks of large amplitude - produces flailing movements of the limbs and is typucally secondary to dmange to the subthalamic nucleus i.e. huntingtons disease

neuroma

bundle of nerve endings that group and can produce pain due to scar tissue, pressure from the prothesis or tension on the residual limb

primary complaint of piriformis syndrome

buttock pain that is made worse by sitting, stair climbing, or squatting

closed system model

characterized by transfer of info that incorporates MULTIPLE feedback loops and larger distribution of control. in this model, the NS is seen as an active participant with the ability to enable the initiation of mvt as opposed to solely reacting to stimuli

DTR assess

integrity of afferent and efferent PNS and the ability of the central nervous system to inhibit the reflex

white vs gray matter

gray unmyelinated with dendrites (capillaries, glial cells, cell bodies, and dendrites) white is myelinated without dendrites white matter of the SC is divided into anterior lateral and dorsal columns

dupuytrens contracture

contracture of the palmar fascia of the hand flexion deforimity of the MCP joint and PIP joints 4th and 5th digits characterized by the distal palmar crease in the palm region below the ring finger and little finger is often tender and sensitive to pressure

basilar artery stroke

contralateral hemiplegia and ipsilateral sensory loss of the face

middle cerebral artery stroke

contralateral hemiplegia, aphasia, apraxia, and cognitive deficits

anterior spinal artery

contralateral hemiplegia, deviation of the tongue toward the affected side, dysphagia, and loss of gag reflex arises from vertebral

acetate ionto

calcific deposits

electromyography

can also be used for peripheral nerve injuries but also to differentiate between various neuromuscular disorders invasive and electrical activity of a muscle at rest and with movement

hypertensitivity with amputation

can impede and prevent the appropriate fit and funtional use of a prothesis specific desensitization technqieus and early fitting are KEY weight bearing, massage, tapping, and residual limb wrapping are all commonly utilized

fair balance

can maintain balance without challenges

spasticity as a complication of SCI

can occasionally be useful to a patient enhanced by stress, decubiti (prolonged laying down), UTI, bowel or bladder obstruction, temperature changes or touch dantrium, baclogen, lioresal, myelotomoies, and other surgical interventions PT for positioning, aquatic therapy, weight bearing, FES, ROM and resting splints/inhibitive casting

why do you want to keep a scar covered from the sun

can result in thickening and discoloration cover it with vlothing or a bandage that allows air to circulate scars are considered mature in 12-18 months and will fade in color and become softer, flatter and less sensitive SPF coverage is more appropriate for a mature scar (30-50)

Muscle Performance

capacity of muscle to produce tension and do physical work; encompasses strength, power, and muscular endurance

carpal tunnel syndrome GOLD

carpal tunnel = transverse carpal ligament, scaphoid tuberosity and trapexium, the hook of hamate and pisiform, the volar radiocarpal ligamnet, volar ligamentous extensions between the carpal bones the median nerve, four flexor digitorum profundus tendons, four flexor digitorum superficialis tnedonds, and the flexor pollicis longus pass through it compression as it passes through edema, inflamm, tumor or fibrosis can cause compression and result in ischemia includes repetitive use, RA, pregnancy, diabetes trauma tumor hypothyroidism and wrist sprain or fracture can cause inflammation other etiologies can include a congential narrowing of the tunnel and vitamin B6 deficiency 5 million in US between 35-55 diagnosed greater prev in women presents initialy with sensory changes and parethesia along the median nerve distribution can radiate into the upper extremity soulder and neck sx include night pain, weaness of the hand, muscle atrphy, decreased grip strength, clumsiness and decreased wrist mobility initially muscle atrphy is noticed in the abductor pollicus brevis and progresses to the thenar muscles electromyography and electroneurographic studies MRI for inflammation of the nerve altered tendon or nerve positioning within the tunnel or thickening of the tendon sheath unrelieved compression creates initial neurapraxia (temporary comes back in 6-8 weeks) with some demyelination of the axons eventual axonotmesis (more severe level II) and wallerian degeneration (active process of degeneration, severe) within the enrve ape hand deformity caused by atrphy in the thenar muscles and first two lumbricals 50% have bilateral involvement management = corticosteroid injections, splinting, and PT methylprednisolone splinting, carpal mobs, gentle stretching may require surgery for release of the carpal ligament and decompression of the median nerves newer surgeries allow for smaller incisions and less manipulation of the nerve and have been highly successful post op = moist heat with e stim, ionto, cryo, gentle massage, densensitization of the scar, tendon gliding, AROM initially should avoid wrist flexion and forceful grasp after four weeks a patient can progress with active wrist flexion gentle stretching putty exercises light resistive and continued modified body mechancis radial deviation against resistance should be avoided due to the tendency for irritation and inflammation post op rehab lasts for 6 to 8 weeks PT should improve patients condtion and decrease symtpoms within 4 to 6 weeks possible to have no long term effects is PT is successful but depends on level of involvement others may have permannent impairments similar to compresssion in the tunnel of guyon which occurs with inflamm to the ulnar nerve between the hook of hamate and pisiform condition occurs from leaning during extended handwriting, leaning on bike handles, repetutve gripping or trauma paresthesias along ulnar distribution, weakness and atrophy of hypothenar muscles, decreased mobility of the pisiform and impiared grip strength treated conserv or with surgery

increased size of cathode relative to the anode

cathode - negatively charged electrode anode - positively charged electrode accumulation of positively charged ions in a small area creates an alkaline reaction that is more likely to create tissue damage

hypotonia and cerebellum

causes the patient to have difficulty fixating the limb leading to incoordination with movement

hindbrain

cerebellum, pons, medulla

examples of UNM disease

cerebral palsy hydrocephalus ALS ( both upper and lower) CVA birth inuries MS huntingtons traumatic brain injury psuedobulbar palsy brain tumors

when should you refer back to the physician

change in medial status failure to make anticipated progress

test-retest what source of error

change in subject situation over time because there is an interval of time between tets administrations and a patients function can change during this time and affect reliability score

emotional lability

characteristic of right ehmisphere infarct where there is an inability to control emotins and outbursts of laughing or crying that are inconsistent with the sitaution

UNM disease

characterized by a lesion in the descending tract within the cerebral motor cortex internal capsule brainstem or SC sx = weakness or involved muscles, hypertonicity, hyperreflexia, mild disuse atrophy and abnormal relfexes damaged tracts are in the lateral white column of the SC

spinal muscular atrophy (SMA)

characterized by progressive degeneration of the anterior horn cell causative factor is an autosomal recessive genetic inheritance certain types of this disease involve a mutation on chromosome 5 3 categories: acute infantile SMA (type 1 werdnig-hoffmann disease) - occurs between birth and two months of age motor degeneration progresses quickly and life expectancy is less than 1 year chronic childhood SMA (type 2 chronic werdnig-hoffman disease) - presents after 6 months to one year and has slower progression than infantile SMA, impairment is steady however a child can survive into adulthood juvenile SMA (type 3 kugelberg-welander) - occurs lateral in childhood from 4-17 years of age, children with juvenile SMA typically survive into adulthood s/s = characteristics for all categories of the disease are the same, and vary in onset and speed of progression characteristic include progressive muscle weakness and atrophy, diminished or absent deep tendon reflexes, normal intelligence, intact sensation, and end-stage respiratory compromise tx = positioning, vestibular and visual stimulation, and access to play treatment for the slower progressing categories is primarily supportive including educating caregivers, mobility training, and use of assistive devices and adaptive equipment

found someone unresponsive what do you do

check for unresponsiveness then call 911 then position patient for CPR then monitor airway breathing and cirulation

chemoreceptor reflex

chemosensitive cells located in the carotid bodies and the aortic body respond to changes in the pH status and blood oxygen tension at an arterial partial oxygen pressure of <50 mmHg or in conditions of acidosis, the chemoreceptors stimulate the respiratory centers and increase the depth and rate of ventilation in addition, the ensuing activation of the parasymp system reduces heart rate and myocardial contractility in the case of persistent hypoxia, the CNS will be directly stimulated with a resultant increase in sympathetic activity

contraction of the diaphragm causes

chest to expand longitudinally and the lower ribs to elevate to allow for inspiration

parapodium for

children with thoracic and high level lumbar lesions parallel bars are the most stable assistive device to initiate standing and gait training

Epilepsy BRONZE

chronic central nervous system disorder charqacterized by epileptic seizure due to abnormal neuronal activity within the brain no identifiable etiology inn approx half of the populaion with the conditioon known conditions can cause epilepsy like brain injury, iinfectious disease, genetic infleunce and developmental disorders injury to brain can cause abnormal acitivty in which the electrical discharge of the neurons beocmes hypersynchronos this abnormal actiivyt preciptiates seizure unpredicatable and unprovoked and vary widely in presentation can be simple focal, absence, tonic, or clonic sx include mood distrubances, staring, loss of consciousness, uncontrollable jerking or arms and legs, stiffening of muscles, and loss of muscle control seizure is the hallmark sign of epilepsy though one seizure does not signify that a person has epilepsy electroencephalogram measures electical activity of the rbain and is the most common test used to confirmthe diagnosis common for ppl to have abnormal brain waves even when not having a seizure other imaging can help as well such as MRI CT and blood tests rule out other similar conditons such as syncope metabolic conditions mvoment disorder and migraine

asthma

chronic inflammation of the airways caused by an increase airway hypersensitivity to various stimuli triggers include respiratory infetions, allergens, exposure to cold air or sudden temp change, cigarette smoke, excitement/stress and exercise s/s = range from mild to severe mild - wheezing, chest tightness, and slight SOB severe - dyspnea, flaring nostrils, diminished wheezing, anxiety, cyanosis and the inability to speak, can result in respiratory failure if left untreated tx = reducing exposure to known triggers is CRITICAL for controlling asthma anti inflammatories (interrupt bronchial inflamm and have a preventive action which include inhaled corticosteroids, cromolyn sodium, and leukotriene modifiers) and bronchodilators (dilate the ariways by relaxing bronchial smooth muscle and include beta-adrenergic agonists, methylxanthines and anticholinergics) pt management = caregiver education, airway clearance, breathing exercises, relaxation and edurance and stength training

K level

classifies patients based on functional ability determined with the use of ampu mmobilty predictor or through history and exam determined by the MD, prosthetist and PT

safety during treatment with aphasia

co-treat or consult with the speech pathologist to establish the best means of communication with the patient consider: cueing strategies must avoid verbal input and use tactile and visual cues attempt to have only one person speak to the patient at a time, extra noise and multiple voices will only confuse the patient use concise sentences and yes/no questioning for ease of understanding and response allow the patient adequate time to process and respond allow the patient adequate time to process and respond before progressing with treatment allow for ample time for communication during treatment, if communication is rushed, this can decrease the effectiveness of the therapy session, the patient may also become frustrated with feeling pressure to respond attempt to allow the patient to perform an activity or segment of therapy without repetitive feedback

tetralogy of fallot

combo of 4 heart defects -VSD -pulmonary stenosis -right ventricular hypertrophy -aorta overriding the VSD often diagnosed during infancy but may not be detected until later in life risk factors include poor maternal nutrition, viral illness or genetic disorders s/s = cyanosis of the skin, shortness of breath and rapid breathing esp during feeding, fainting, clubbing of fingers and toes, poor weight gain, tiring easily during play, irritability and prolonged crying, heart murmur tx = surgery is only effective treatment, place patch over the VSD and widen the pulmonary valve and pulmonary arteries, untreated cases usually develop severe complicatons including infective endocarditis, which may result in death or disability by early adulthood

new onset of s/s of infection after surgery what do you do

communicate the info to the referring physician not ER not document not ask patient to make an appintment with the referring

lofstrand crutches + KAFO who is it used for

complete L2-L3 may also use a manual wheelchair for energy conservation and convenience gracilis, iliopsoas, QL, rectus femoris, and sartorius would be the lowest innervated muscles

find blisters from last weeks hot pack on patient , what do you do

complete an incident report factual written summary of an adverse event designed to memorialize specific details of the event and limit future liability of the organization info obtained from the report is often used to guide risk management initiatives

lofstrand + AFO who could use them

complete at L4-L5 extensor digi, medial ham, posterior tib, quads, tibialis anterior, and low back are the lowest innervated

pulmonary fibrosis

condition in which microscopic damage to the alveoli causes irreversible scarring of the interstitial tissue, normally the tissue is highly elastic, expanding and contracting with each breath, scarring makes the interstitial tissue stiff and thick and the alveoli less flexible, making breathing more difficult etiology - mostly unknown but chronic exposure to silica duse, asbestos fibers, grain dust, sugar cane and bird and animal droppings can cause pulmonary fibrosis radiation for lung or breast cancer, chemotherapy (methotrexate, cyclophosphamide), certain antiarrhythmic meds (amiodarone propanolol) and some antibiotics (nitrofurantoin surlfasalazine) can also cause fibrosis s/s = most common sxs are SOB, especially during or after physical activity, and a dry cough, which usually does not appear until the disease is advanced and irreversible lung damage has already occurred other sx = fatigue, unexplained weight loss, and aching muscles and joints tx = lung scarring is irreversible and no current tx has proven effective in stopping the progression of the disease, some treatments may improve sx temporarily and improve QOL combo of corticosteroids and immunosuppressive agents are often prescribed initially lung transplants may be used in advanced cases other tx - supplemental o2 and pulmonary rehab (breathing exercises, nutrition counseling, emotional support)

athetosis number 2

condition that presetns with involuntary movements combined with instability of posture, peripheral movements occur without central stability

ideomotor apraxia

condition where a person plans a movement or task but cannot volitionally perform it, automatic movement may occur, however, a person cannot impose additional movement on command i.e. can explain but cannot act out, may be able to pick up a phone when it rings but not when asked to (the inability to make the proper movement in response to a verbal command)

Spina Bifida - Myelomeningocele GOLD

congential neural tube defect that generally occurs in the lumbar spine but can also occur at the sacral, cervical, and thoracic levels 3 classifications occulta (incomplete fusion of the posterior vert arch with no neural tissue protruding) spina bifida - meningocele (incomplete fusion of the posterior vert arch with neural tissue/meninge protuding outside the neural arch) spina bifida - myelomeningocele (incomplete fusion of the posterior vert arch with both meninges and psinal cord protuding outside the neural arch) characterized by a sac or cyst that protrudes outside the spine and contains a herniation of meninges , CSF, and the spinal cord through the defect in the verterae cyst may or may not be covered by skin results form failure of neural tube to close by day 28 of gesttation when the SC is expcted to form 75% of verrtebral defects are foound in he lumbar/sacral region typically L5-S1 with injury to that structure and below 5 per 10,000 live births in US causative and risk factors include genetic predisposition, environmental influence (certain solvents, lead herbicides, glycol ethers), insulin dependnt diabetes, low levels of maternal folic acid, alcohol ,maternal hyperthermia and certain classifications of drugs i.e. teratogenic exposure and vitamin A toxicity prenatal care including folic acid in the first 6 weeks appears to be the most effective way to prevent neural tube defects impairments are sensory and motor loss below the vertebral defect, hydrocephalus, arnold chiarti type II malformation, clubfoot, scoliosis, BB dysfunction, and learning disabilities the higher the lesionthe worse the prognosis is for survival infant will require surgery to close the lesion and in 90% of cases a shunt is required for hydrocephalus 2/3 of these 90% have normal intelligence and the other third has mild retardation regardless they have difficulties with perceptual abilities, attention, problem solving, and memory US can identify prenatal testing of alphafetoprotein AFP in the blood will show and elevation will show probable defect at week 16 of gestation spinal firms and CT scan will evaluate for the presence of defects and hydrocephalus immediately after birth they have an increased risk of meningitis hemorrhage and hypozia however surgery can reduce these risks ongoing findings include hydrocephalus, clubfoot, neurpathic fracture, visual provlems, osteoporosis, kyphosis, hip dislocatins and latex allergy near normal life expectancy as long as the patient receives consistent and thoroough health care functional outcomes based on level of the lesion similar to anencephaly a condition that is characterized by failed closure of the crfanial end of the neural tube the cerebral hemisphere do not form and some neural tissue may protrude through the defect this type of neural tube defect cannot be reapired and many are stillborn or only survive a shorttime after birth

lasix is for

congestive heart failure lessens the edema

blocked practice

consistent practice of a single task

causalgia

constant, relentless, burning hyperesthesia and hyperalgesia that develops after a peripheral nerve injury

ANS disorders include

constipation erectile dysfunction horners syndrome vasovagal syncope orthostatic hypotension and postural tachycardia

hypercalcemia

constipation pain nausea vomit

A line used for

continuous direct BP readings and to sample arterial blood of arterial blood gases connected to pressure tubing, a transducer, and a monitor RADIAL and BRACHIAL are most common sites for an A line

ventricular systole

contraction of the right and left ventricle pushing blood into the pulmonary arteries and the aorta

pons/medulla

control the bodys vital functions p - regulartin of resp rate and orientation of head in realtin to auditory and visual stimuli CN 5-8 originate here m - autonomic nervous activyt and regulation of respiration ad heart rate relfex center for vomiting coughing and speezing CONTRAlateral impairment if damaged also relays somatic sensory info from internal organs and for the control of arousal and slseep CN 9-12 originate here

PNF agonistic reversals

controlled mobility, skill isotonic contraction performed against resistance followed by alternating concentric and eccentric contractions with resistance slow and sequential manner and may be used in increments throughout the range to attain maximum control i.e. bridge provide resistance on the way up, then "make it hard but not impossible for me to push you back down"

autonomic dysreflexia can lead to what if not treated

convulsions, hemorrage and death s/s HBP, HA, blurred vision, stuffy nose, profuse sweating, goose bumps below the level of the lesion, and vasodilation (flushing) above the level of injury if cannot find the irritating stimuli THE PATIENT NEEDS IMMEDIATE MEDICAL INTERVENTION

max exercise testing offers increased sensitivity for diagnosing what

coronary artery disease in asymptomatic individuals and provide a better estimate of max oxygen uptake than a submax test aka it will test positive if the patient has the disease so can rule out if they test negative

limbic system includes

corpus collosum olfactory tract mammillary bodies fornix thalamic nuclei amygdala hippocampus parahippocampal gyrus cingulate gyrus hypothalamic nuclei invovled in expression and control of mood, memory, olfacgtion, appetite lesions = aggression, extreme fearfulness, altered sexual behavior and changes in motivation

adrenal glands are responsible for the production of what hormones

cortisol and aldosterone decrease in these can result in fatigue and weight loss treated with exogenenous corticol (addison's disease)

chemical burn

could be scattered throughout a large area and be poorly defined could be described as dry, especially if it were caused by an acidic agent

will a person with myasthenia gravis demo good or bad strength during MMT

could demonstate normal since it only requires a single muscle contraction they normally demo weakness with repetitive activity that is restored QUICKLY after a period of rest

parietal pleura

covers the inner surfaces of the chest wall, ribs, vertebrae, diaphragm and mediastinum

schmidt's schema theory

created in response to limitations in the closed loop theory construct relies on open loop control processes and a motor program concept promotes clinical value of feedback and importance of variation in practice

Thoracolumbosacral orthosis TLSO

custom molded prevents all trunk motions and is commonly utilized as a means of post surg stabilizetion rpidig shell is fabricated from plastics in a bivalve style using straps and velcro to secure the orthosis

what do diaphragmatic breathing and PLB do

d - decease resp rate, increase tidal volume, decrease use of accessory muscles p - same as first two + decreased sense of dyspnea

endo or exo more cosmetically pleasing?

endo

endocardium

endothelial tissue that lines the interior of the heatt chambers and valves

simple random sample will do what

ensure every member of the population has an equal opprotunity of being chosen

EMG for muscle at rest (normal)

electrical silence once the insertion acitivity (caused by the trauma of needle insertion) resolves, should be NO action potentials occurring spontaneous electrical potentials like firbtillations and positive sharp waves are seen in ACUTELY denervated muscles polyphasic (>5 phases) are seen in DENERVATED motor unit neurapraxia causes occassional motor unit potentials during minimal effort muscle contractions 2-3 weeks after injury

reciprocating gait orthosis RGO

derivative of the HKAFO incorporates a cable system to assist with the advancement of the lower extremtiies during gait when the patient shifts weight onto a selected lower extremity, the cable system advances the opposite lower extremity used for patients with paraplegia

C7 key muscle

elbow extensors (triceps)

red flags for prosthetic use

d/c use until seen by a physician if wound formatioon

Polyneuropathy BRONZE

damage or disease that affects multiple peripheral nerves most common etiology is diabetes both type 1 and 2 other causes is advacned age, certain drugs i.e. chemotherapy, alcohol abuse, aids, evronemtal toxins and inherited neuro conditions esp effects distal peripheral nerves in the extremities though it can also affect cfranial nerves and nerves of the autonnoic system can affect soley sensory soley motor or both can invole damage to the axon the myelin sheath or the nerves cell body depending on the cause starts in the distal lower extremtieis typically symmetrically and may progress to include the hands and more proximal portions of the limbs sx= numbness, tingling, and pain in a stocking and glove pattern additional sx include loss of position and vibrtation sense as wella s ataxia ifmotor nerves are affected the condition will involve weakness and possibly atrophy autonomic sx include constipation loss of BB control and orthostatis hypotension EMG and nerve condution tests are used to dertmine the lcoation and extent blood tests can determine the cause

valvular heart disease

damage to one or more of the hearts valves results in regurgutation aka insufficiency or incompetence the blood leaks backward through the damaged valve stenosis happens when the leaflets thicken or stiffen or fuse together and do not open wide enough to allow adequate blood flow through the valve caused by congential defects, calcific degeneration, infective endocarditis, coronary artery diseaes, MI, and rheumatic fever s/s = heart palpitatins, shortness or breath, chest pain, coughing, ankle swelling and fatigue tx = medications to reduce the workload on the heart, regulate rhythm and prevent clotting digitalis, diuretics, antiplatelet and anticoagulant agents, beta blockers and calcium channel blockers severe cases may require balloon valvuloplasty or surgery to repair or replace the affected valve

why are there immediate changes in vital signs after a concussion

damage to the reticular activating system

addisons disease includes

dark pigmentation of skin hypotension fatigue hyperkalemia GI disturbances weight loss nausea vomiting arthralgias hypoglecmia

cerebellum CVA

decreased balance, ataxia, decreased coordination, nausea, decreased ability for postural adjustment, NYSTAGMUS

deep sensory receptors vs mechanoreceptors

deep are located in muscles tendons and joints position sense, proprioception, muscle tone and movement mechano respond to mechanical deformation of the area surrounding a receptor sensations of touch, pressure, itch, tickle, vibration, and discriminative touch

sensory stimulation techniques for inhibition

deep pressure prolonged stretch warmth prolonged cold

consequences of steroids

deepened voice for females growth cessation because hormones reach a specific level that signify the conclusion of growth prematurely liver damage testicular atrophy bc inhibit the release of follicle stimulating hormone and lutenizing hormone from the pituitary gland

what is the best method to ensure proper technique and independence

demonstration by the therapist first then the person who is performing the task to ensure competence best probability that the activity will be performed correctly

etiology central vs peripheral lesions

demyelination of nerves, vascular lesion, cancer/tumor menieres disease, vascular disorders, trauma, toxicity, infection of inner ear

what is not necessary during motor relearning as an adult vs a child vs learning for first time

developmental sequence may not be necessary for adults but may include breaking the task into discrete components followed by practice of the task as a whole bobath techniques for handling, facilitation, inhibitive casting, use of therapeutic ball rood techniques for application of ice brushing, tapping for facilitation biofeedback for decreasing hypertonicity self-correction and self-awareness through mirror verbal feedback and biofeedback

evoked potentials helps with vs nerve conduction

diagnosis of MS how fast the signals reach the brain from a stimulus peripheral nerve action potentials in m/s carpal tunnel, peripheral neuropathy, guillain barre

principal muscles of INSPIRATION

diaphragm and external intercostals (angled up and back)

when is hypertension diagnosed

diastolic >90 systolic >140 often goes unrecognized while mild and moderate

anemia effect on BP

diastolic may be lower systolic usually unaffected

where do the major motor and sensory tracts synapse?

diencephalon (beneath the cerebral hemispheres and contqains the thalamus, hypothalamus, subthalamus, and epithalamus) interactive site between the central nervous system and the endocrine system as well as complementing the limbic system

single axis knee

difficult to reciprocate during gait may or may not have knee extension assist and or a weight activated stance phase control constant friction mechanism

polyneuropathy

diffuse nerve dysfunction that is SYMMETRICAL and typically secondary to pathology and not trauma; associated conditions include Guillain-Barre syndrome, peripheral neuropathy, use of neurotoxic drugs, and HIV

hypesthesia

diminished sensation of touch

chest pain during exercise, 20 min rest and the pain is still there what do you do

discontinue tx and call an ambulance IMMEDIATE attention warranted if pain is not relieved by stopping exercise or the use of three sublingual nitroglycerin tablets (1 taken every 5 min)

methotrexate used for

disease-modifying agent in the treatment of rheumatoid arthritis side effects = nausea, GI distress, hemorrhage, cough, shortnesss of breath and LE edema

socket

disperses the pressure experiencd in weight bearing throughout the limb, providing total contract with the surface generalyl speaking muscular areas ar emore tolerant than boney surfaces to pressure ischial containment most common diesign for trasnsfemoral trasntibial common is a total surfcae bearing or patellar tendon bearing socket

dysesthesia

distortion of any of the senses, especially the sense of touch

what happens with a disc herniation nat T1-T2

does not appear to give rise to root weakness weakness of instrinsic muscles of the hand is due to other pathology such as thoracic outlet pressure, neoplasm of lung and ulnar nerve lesion

posterior leaf spring orthosis assists with

dorsiflexion during swing phase but offers minimal medial or lateral ankle support because the trim line is posterior to the malleoli flexible allows for both DF and PF to occur during gait pt should have decent medial lateral control

pericardium

double-walled connective tissue sac that surrounds the outside of the heart and great vessels

the great cardiac vein (along with other small and middle cardiac veins)

drain into the coronary sinus and empty into the right atrium

vestibular input and how to challenge it

feedback regarding the position and mvoement of the head with relation to gravity semicircular canals = respond to movement of fluid with head motion otoliths = measure the effects of gravity and movement with regard to acceleration/deceleration examin balance with movement of head dix hallpike, bithermal caloric testing, assessment for nystagmus, head trust sign, testing of the vestibuloocular reflex

meningitis s/s

fever HA vomit stiff and painful neck nuchal rigidity*** brudzinskis sign (flexion of the neck facilitates flexion of the hips and knees) kernigs sign (pain with hip flexion combined with knee extension) sensitivity to light lumbar puncture is gold standard eraly diagnosis is essential to avoid permanent neuro damage antibiotic antimicrobial and steroid pharma management

autonomous stage of motor learning

final stage of learning or skilled learning where a person improves the efficiency of the activity without a great need for cognitive control the person can also perform the task with interference from a variable environment characterized by automatic resposne mainly error-free regardless of environment patterns of movement are non cogitive and automatic distraction does not impact the activity the person can simultaneously perform more than one task if needed extrinsic feedback should be very limited or should not be provided internal feedback or self-assessment should be dominant

hydraulic/microprocesor foot

finer control over the stability/mkobility of motions improved shock absoprtion not appropriate for all environmeltal conditions and demands

metatarsal bar/pad

flat piece of padding that is paced just posterior to the metatarsal heads either on the outer sole (i.e. bar) or the inner sole (i.e. pad) of the shoe helps relieve presure from the matatarsal heads by transferring it to the metatarsal shafts thus helping relieve pain for patients with metatarsalgia

insert

flexible or soft can accommodate for a space in the prosthetic socket soft = foam cushiioning durin WB flexible = plastic or foam and can improve comfort and fit unlike foam insert whch can offer some shock absoprtion the hard inset relieves pressure through a series of buildups and reliefs molded into the insert

developmental hip dysplasia what motions it is safest in to develop the acetabulum and not dislocated

flexion and abduction (opposite of hip precautions) most likely to dislocate in extension and adduction

conduction aphasia

fluent aphasia Lesion: supramarginal gyrus, arcuate fasiculus Severe impairment with repetition intact fluency, good comprehension speech interrupted by word finding difficulty reading intact writing impaired

fasciculus cuneatus (posterior or dorsal column) ascending tract

for turnk, neck, and UE proprioception, vibration, two point discriminatin and graphestheia

vestibular rehab

for vestibular or central balance system disorders utilize compensation, adaptation, plasticity to increase brains sensitivity, restore symmetry, improve vestibuloocular control, and subsequently increase motor control and movement

afterload

force the left ventricle must generate during systolic phase and is directly related to the resistance in the aorta and peripheral arteries

valsalva maneuver

forcible exhalation against a closed glottis, resulting in increased intrathoracic pressure, increased central venous pressure, and decreased venous return (bc harder to move through veins with increased pressure) the resultant decrease in cardiac output and blood pressure is sensed by baroreceptors which reflexively increases heart rate and myocardial contractility through sympathetic stimulation when the glottis opens, venous return increases and blood pressure and heart contractility increase (bc less resistance), this increase in BP is sensed again by the baroreceptors which reflexively decrease the heart rate through the parasympathetic efferent pathways

charcot foot

form of neuropathic arthropathy invovles bone destruction and absorption leading to an unstable joint sublux is common and results in a rockerbottom foot deformity and can lead to ulceration due to a redistribution of pressure most often seen in patients with diabetes SECONDARY to peripheral neuropathy, loss of SENSATION predisposes the joints of the foot to repetitive trauma and joint destruction diabetes can lead to motor neuropathy and thus muscle weakness and atrophy (diabetic amyotrophy) such as claw toes or flat arches but charcot is more closely realted to altered sensation

later school age 9 to 12 years (developmental gross and fine motor skills)

gross motor mature patterns of movement in throwing, jumping, running competition increases, enjoys competitive games improved balance, coordination, endurance, attention span boys may develop preadolescent fat spurt girls may develop prepubescent and pubescent changes in body shape (hips and breast) fine motor develops greater control in hand usage learns to draw handwriting is developed

fluent vs non-fluent aphasia

frequently involves the temporal lobe, wernickes area or regions of the parietal lobe word output and speech production are functional prosody is acceptable, but empty speech/jargon speech lacks substance, use of paraphasias use of neologisms (sub within a word that is so severe it makes the word unrecognizable) VS frequently the frontal lobe (anterior speech center) of the dominant hemisphere poor word output and dysprosodic speech (impairment in the rhythm and inflection of speech) poor articulation and increased effort for speech content is present but impaired syntactical words

physically active 19 year old pt who had meniscal surgery 8 months ago and now is having ACL surgery should expect to return to what functional level

full PLOF in 6-12 months derotation brace is not supported in research

bounding pulse

full and springlike pulse on palpation as a result of cardiac contraction or excessive volume of circulating blood within the vascular system like a heart palpitation

skin grafts are used in what type of burn

full thickness

axillary nerve injury caused by

fx of neck of humerus, anterior dislocation of the sholder

associative learning

gaining understanding of the relationship between two stimuli, causal relationships or stimulus and consequence (classical conditioning, operant conditioning)

tibial nerve innervates

gastroc soleus plantaris tib posteior flexor hallucis longus flexor digitorum longus aka plantar flexion flexor hallicus brevis aka great toe flexion aka toe flexion

nystagmus in cerebellar lesions

gaze-evoked nystagmus the patient will attempt to look toward and object in the periphery but the eyes will drift involuntarily back to neutral may be unilateral or bilateral

hydrocolloid

gel forming polumers (carbooxymethlcellulose, gelatin, pectin) backed by a strong film or foam adhesive absorb exudate by swelling into a gellike mass and vary in permeability thickness and transparency used with partial and full thickness wounds

prader-willis syndrome

genetic condition that is diagnosed by physical attributes and patterns of behavior rather than genetic testing partial deletion of chromosome 15 is the etiology s/s = physical and behavioral attributes such as small hands, feet, and sex organs, hypotonia, almond shaped eyes, obesity, and a constant desire for food this child will present with coordination impairments and intellectual disability tx = physical therapy includes postural control, exercises and fitness, gross and fine motor skills training

common visual impairment experienced by aging adults

glare sensitivity makes transitioning between bright and dark more difficult color doesnt matter, directness of the light matters so standard bulbs are fine as long as the light is well diffused

gag reflex

glossopharyngeal and vagus lightly stimulate each side of the back of the throat and notes the reaction a gag will occur post stimulation, may be absent in some percent of the normal population

greatest trauma with THA posterolateral appraoch

glut max (piriformis is relesed during a posterolateral THA but is later reattached) anterolateral would affect hip abductors a little more portion are released from the greater trochanter

hyperparathyroid vs hypo

hyper - osteopenia, weight loss hypo - cardiac arrhythmias, muscle spasms

newborn to 1 month (developmental gross and fine motor skills)

gross motor prone - physiological flexion lifts head briefly head to side supine - physiological flexion rolls partly to side sitting - head lag in pull to sit standing - reflex standing and walking fine motor regards objects in direct line of sight follows moving object to midline hands fisted arm movements jerky movement may be purposeful or random

4 to 5 months (developmental gross and fine motor skills)

gross motor prone - bears weight on extended arms pivots in prone to reach toys supine - rolls from supine to side position plays with feet to mouth sitting - head steady in supported sitting position turns head in sitting position sits alone for brief periods standing - bears all weight through legs in supported standing fine motor grasps and releases toys uses ulnar-palmar grasp

8 to 9 months (developmental gross and fine motor skills)

gross motor prone - gets into hands-knees position supine - does not tolerate supine position sitting - moves from sitting to prone position sits without hand support for longer periods pivots in sitting position standing - stands at furnature pulls to stand at furniture lowers to sitting position from supported stand mobility - crawls forward walks along furniture (cruising) fine motor develops active supination radial-digital grasp uses inferior pincer grasp extends wrist actively points with index finger pokes with index finger release of objects is more refined takes objects out of container

2 to 3 months (developmental gross and fine motor skills)

gross motor prone - lifts head 90 degrees briefly chest up in prone position with some weight on the forearms rolls prone to supine supine - ATNR influence is strong legs kick reciprocally prefers head to side sitting - head upright but bobbing variable head lag in pull to sit needs full support to sit standing - poor weight bearing hips in flexion, behind shoulders fine motor can see father distances hands open more visually follows through 180 degrees grasp is reflexive uses palmar grasp

6 to 7 months (developmental gross and fine motor skills)

gross motor prone - rolls from supine to prone position holds weight on one hand to reach for toy supine - lifts head sitting - lifts head and helps when pulled to sitting position gets to sitting position without assistance sits independently mobility - may crawl backward fine motor - approaches objects with one hand arm in neutral when approaching toy radial-palmar grasp "rakes" with fingers to pick up small objects voluntary release to transfer objects between hands

adolescence 13+ years (developmental gross and fine motor skills)

gross motor rapid growht in size and strength, boys more than girls puberty leads to changes in body proportions, center of gravity rises towards shoulders for boys, lower to hips for girls balance and cooridnation skills, hand-eye coordinatioon, endurance may planteau during growth spirt fine motor develops greater dexterity in fingers for fine tasks (knitting, sewing, art, crafts)

early school age 5 to 8 years (developmental gross and fine motor skills)

gross motor skips on alternate feet gallops can play hopscotch balance on one foot controlled hopping squating on one leg jumps with rhythm, control (jump rope) bounces large ball kicks ball with greater control limbs growing faster than trunk allowing greater speed, leverage fine motor hand preference is evident prints well, starting to learn cursive able to button small buttons

16 to 24 months (developmental gross and fine motor skills)

gross motor squats in play walks backward walking upstais and downstairs with one hand held using both feet on step propels ride-on toys kicks ball throws ball throws ball forward picks up toy from floor without falling fine motor folds paper strings beads stacks 6 cubes imitates vertical and horizontal strokes with crayon on paper holds crayon with thumb and fingers

10 to 11 months (developmental gross and fine motor skills)

gross motor standing - stands without support briefly pulls to stand using half-kneel intermediate position picks up object from floor from standing with support mobility - walks with both hands held walks with one hand held creeps on hands and feet (bear walk) fine motor fine pincer grasp puts object into container grasps crayon adaptively

preschool age 3-4 years (developmental gross and fine motor skills)

gross motor throws ball 10 feet walks on a line 10 feet hops 2-10 times on one foot jumps disatnces of up to 2 feet jumps over obstacles up to 12 inches throws and catches small ball runs fast and avoids obstacles fine motor controls crayons more effectively copies a circle or cross matches colors cuts with scissors draws recognizable human figures with head and two extremities draws squares may demonstrate hand preference

autism spectrum disorder

group of complex brain development disorders that are characterized by difficulties with social interaction, communication, and repetitive behaviors children with ASD can vary widely in their functional level since it is an unbrella tuerm that includes four previously isolated disorders (autistic disorder, childhood disintegrative disorder, pervasive developmental disorder and asperger syndrome) etiology is not well understoof, through to be multifactorial with genetic and environemental factors s/s = intial signs and symptoms generally become apparent around the age of two or three, these often include nonpurposeful speech or the complete absence of speech, diminished facial expression, an inability to understand nonverbal cues, limited interest or awkwardness in social interactins, a lack of empathy, defensiveness or indifference towards sensory stimulation, repetitive self-stimulating behaviors, perseverations, preoccupation with routines and rituals, and decreased coordination children that have more severe forms of ASD may be significantly limited in their ability to participate in expected social roles while children with mild ASD (i.e. aspergers) may have relatively few limitations and only be recognized as being socially awkward many children with ASD have exceptional talents in music, art and academic skills tx = multidisciplinary and focus on improving social communication and decreasing nonpurposeful movements and vocalizations sensory integration therapy may also be used for sensory processing difficulties prognosis is directly related to the severity of the conditin

addisons disease and chrons disease

hypofunctioon of the adrenal cortex inflammation of the lining of the digestive tract

when would a step not warrent the use of a sterile technique

if it does not come in direct contact with the wound i.e. a bandage that holds the dressings on

cardiomyopathy

group of conditions that affect the myocardium, impairing the ability of the heart to contract and relax dilated vs hypertophic vs restrictive can be caused by coronary artery disease and valvular heart disease s/s = none during the early stages, as it progresses it includes breathlessness with exertion or even at rest, swelling of the legs, ankles and feet, bloating of the abdomen due to fluid build up, fatigue, irregular heart beat, dizziness, lighteadedness and fainting tx = dilated - ACE inhibitors, beta blockers, digoxin, and diuretics, surgery may include biventricular pacemaker or an implantable cardioverter-defibrillator for patients at risk for serious arrhythmias hypertrophic cardiomyopathy - meds to slow the heart rate and stabilize its rhythm, lopressor and calcium channel blockers, if meds are unsuccessful surgery may include septal myectomy and septal alcohol ablation, pacemaker implantationand implantable cardioverter-defib retrictive - meds that improve symptoms and may include diuretics, antihypertensives, and antiarrhythmics, in severe cases, surgical options include a ventricular assist device or a heart transplant causes arrhythmias bc structure is damaged

metabolic syndrome

group of s/s that are RISK factors for CV disease, diabetes, and stroke screen by using red flags such as BMI greater than 30, elevated BP, increased waist circum, and signs of insulin resistance, dyslipidemia (i.e. elevated triglyceride levels, increased LDL, decreased HDLs) NOT associated with abnormal blood pH

perseveration how to redirect it

guide the patient into an interesting new acitivty and reward successful completion of the task

L1 sensory testing

half the distance between T12 and L2

false negative lachman

hamstring muscle guarding not effusion

body schema

having an understanding of the body as a whole and the relationship of its part to the whole

rules of nines review

head 9% each UE 9% trunk 36% each LE 18% genitals 1%

moro reflex (stimulus, response, normal age of response, interferes with...)

head dropping into extension suddenly for a few inches arms abduct with fingers open, then cross trunk into adduction, cry 28 weeks of gestation to 5 months interferes with... balance reactions in sitting protective responses in sitting eye-hand coordination, visual tracking

vertebral artery test

head in extension lateral flexion and rotation to the ipsilateral side positive test is dizziness, nystagmus, slurred speech or loss of consciousness

grade 1 concussion

head injury where there was no loss of consciousness but typically some transient confusion by the patient, sx typically resolves within 15 min of the event may exhibit full memory of the event, athlete should be removed from the competition and return only if sx free after ONE week of REST

grade 3 concussion

head injury with ANY form of loss of consciousness transport to the EMERGENCY ROOM for full neuro eval hospitalization is warranted if altered consciousness or mental status persists athlete should be withheld from competition after a grade 3 concussion once symptom free for a MINUMUM of ONE MONTH this form of concussion is secondary to diffuse axonal injury and if severe can result in coma

GERD bad position

head lower than the body significantly increases the likelihood of reflux

STNR

head moving in flexion or extension flexion - arms are flexed and legs are extended extension - arms are extended and legs are flexed 6-8 months

symmetrical tonic neck reflex STNR (stimulus, response, normal age of response, interferes with...)

head position, flexion or extension when head is in flexion, arms are flexed, legs extended when head is in extension, arms are extended and legs are flexed 6-8 months interferes with... ability to prop on arms in prone position attaining and maintaining hands-and-knees position crawling reciprocally sitting balance when looking around use of hands when looking at object in hands in sitting

asymmetrical tonic neck reflex ATNR (stimulus, response, normal age of response, interferes with...)

head position, turn to one side arm and leg on face side are extended, are and leg on scalp side are flexed, spine curved with convexity toward face side birth to 6 mo interferes with.. feeding visual tracking midline use of hands bilateral hand use rolling development of crawling can lead to skeletal deformities (ie scoliosis, hip sublux, hip dislocation)

complications after MI

heart failure arrhythmias thrombus formation heart structural damage arrhythmias most common

common fibular vs sciatic lesion

if sciatic is lesioned, will see achilles reflex is absent bc it is characteristic of a tibial or sciatic nerve injury common fibular nerve is not responsible for this reflex

cardiac output calculation

heart rate x stroke volume influenced by oxygen supply to the myocardium, contractility of the myocardium, and conduction of electrical impulses within the ventricles heart rate increases so does CO preload increases so does stroke volume and thus CO (preload = amount of blood in the ventricle at the end of the diastolic phase and is directly related to venous return) afterload increases, stroke volume and thus CO decreases (stroke volume = amount of blood ejected from the heart)

obese people have risk for what during exercise

heat intolerance

polycentric knee

heavier than a single axis reciprocal gait is more fluid may or may not have knee extension assist and or a weight activated stance phase control constant friction mechaism

hyperesthesia

heightened sensation

flooding

help patients heal traumatic memories used to treat people with phobias

buoyancy

helps the patient if they are moving parallel to the floor of the pool or towards the surface of the water, not if they are going towards the floor of the water aka it will resist the movement

spina bifida meningocele

herniation of meninges and cerebrospinal fluid into a sac that protrudes through the vertebral defect, the spinal cord remains within the canal myelomeningocele (meninges, csf, AND spinal cord)

brunnstrom: movement therapy in hemiplegia

hierarchial model created and defined the term synergy and initially encouraged the use of synergy patterns during rehab belief was to immediately practice synergy patterns and subsequently develop combinations of movement patterns outside of the synergy synergies are primitive patterns that occur at a spinal cord level as a result of the heirachy reinforcing synergy patterns is RARELY utilized now as research indicates that reinfoced patterns are very difficult to change developed seven stages of recovery though which are used for evalution and documentation

kabat, knott and voss: proprioceptive neruomuscular facilitation (PNF)

hierarchial model establish gross motor patterns within the CNS stronger parts of the body are utilized to stimulate and strengthen the weaker parts normal movement and posture is based on a balance between control of antagonist and agonist muscle groups development will follow the normal sequence through a component of motor learning greart emphasis on manual contacts and correct handling short and conscise verbal commands are used along with resisitance throughout the full movement pattern promotes or hasten the response of the neuromuscular mechanism through stimulation of the proprioceptors

pes cavus vs pes planus

high arches vs flat foot

is high or low beam more likely to produce undesirable effects in US?

high beam less uniform, decreased comfort and safety

L2 key muscles

hip flexors (ilipsoas)

mass movement pattern

hip, knee, and ankle move into flexion or extension simultaneously

atrial septal defect ASD

hole in the wall separating the right and left atria this is normally open (foramen ovale) until birth and if it persists then blood continues to flow from the left to the right and is called a shunt and severe cases can have the blood flow from right to the left genetics and environmental factors s/s = small to moderate sized defects may produce no symptoms or symptoms that appear after 30 years of age large can cause heart murmur, shortness of breath esp during exercise, fatigue, swelling of the legs, feet or abdomen, heart palpitations, frequent lung infections, stroke, cyanosis of the skin tx = surgical closure or nonsurg by placing a closure device into the heart and across the ASD using a catheter

ventricular septal defect VSD

hole is septum separating the right and left ventricles, if large too much blood will be pumped to the lungs, leading to heart failure risk factors include rubella or diabetes during pregnancy, exposure to alcohol, drugs, chemcial and radiation during pregnancy s/s = no sx if small and may eventaully close as the interventricular wall continues to grow after birth if large, may cause cyanosis of skin, lips, and fingernails, poor eating, failure to thrive, fast breathing or breathlessness, fatigue, swelling of the legs, feet or abdomen, rapid heart rate tx = surgical patching or stitching

gold standard for body composition

hydrostatic weighing antrho, bioelectrical, and skinfold are all inferior

rhomberg measures

impact proprioception on standing balance risk of falls

crackles during inspiration and expiration means

impaired secretion clearance

spina bifida occulta

impairment and non-fusion of the spinous processes of a vertebra, however, the spinal cord and meninges remain intact there is usually no associated disability

dysarthria

impairment of speech that involves the motor component of speech articulation

peripheral neuropathy

impairment or dysfunction of the peripheral nerves; associated conditions include diabetic peripheral neuropathy, trauma, alcoholism

aphasia

inability to communicate or comprehend due to damage to specific areas of the brain

anterograde memory

inability to create new memory, usually the last to recover after a comatose state contributing factors include poor attention, distractibility, and impaired perception to speech

akinesia

inability to initiate movement

constructional apraxia

inability to reproduce geometric figures and designs, often unable to visually analyze how to perform a task

sacral sparing

incomplete lesion where some of the innermost tracts remain innervated characteristics include sensation of the saddle area, movement of the toe flexors, and rectal sphincter contraction

Anterior Cord Syndrome SILVER

incomplete spinal cord lesion in which the anterior two thirds of the spinal cord is damaged dorsal columns NOT affected, it is considered incomplete typcally a cervical flexion injury or through infarction of the anterior spinal artery ** anterior spinal artery supplies blood to the anterior two thirds damage to artery leds to decreases perfusion of the spinal tracts that is supplies including the anterior and lateral CORTICOSPINAL tracts (motor) and SPINOTHALAMIC (pain and temp) usually occurs through a traumatic inciedent that causes compression or damage tothe anteior spinal artery like fx or dislocation but decreased perfusion and vascular insufficiencies can also occur through nontraumatic like atherosclerosis, external compression like a disc or mass and aortic pathology present with complete loss of motor function and loss of pain and temperature bilaterally below the level of the lesion due to the damage of the corticospinal and spinalthalamic tracts dorsal colum i.e. proprioception and vibration remain intact autonomic dysfunction such as a loss of bowel and bladder function and sexual function are both likely though it is dependent on the level of the lesion respiratory funcion may also be affected MRI to determine ext3ent of injury xray to find fx or dislocation CT more senitive than xrays for fxs and stuff imaging can confirm the presence of anterior cord syndrome, neuro exam should be performed esp motor and sensory initial management is immobilization and stabilization of the patient methyprednisolone in high doses orthosis if fx has occured i.e. halo or minerva PT can assist patients to compensate for the injury hohwever only MINOR improvement in motor function is anticipated significant neuro recovery is unusual following spinal cord infarct no cure for SCI some recovery for 1-2 years prognosis is best when recovery is noted within the first 24 hours after the injury othewise the prognosis is poor compared to other spinal cord injury syndromes it is associated with HIGH MORTALITY and poor functional outcomes

Central Cord Syndrome GOLD

incomplete spinal cord lesion that most often results froma cervical hyperextension injury usually occurs from a fall but can also occur from other trauma such as motor vehicle accident sustains bleeding into the central gray matter that causes damage to the centrally located cervical tracts injury is caused by a ligamentum flavum injury or otherwise from anterior compression of the cord due to osteophyte formation axonal disruption in the lateral columns at the level of injury with preservation of the gray matter can also be nontraumatic such as cevical spondylosis, narrowing or congential defect, tumor TA or *syringomyelia* >50 years old higher in men motor loss that is greater in the UE than the LE and is most severe distally in the upper extremities due to damage that occurs within the central location of the spinal cord sensory loss found below the level of the lesion is uaually limited byt can be variable sacral segments are usually unaffected as they are located laterally bowel and bladder resolve in 55-85% of patients after 6 months MRI to assess spinal cord CT for canal compromise xray for fracture or spondy side effects may include autonomic dysrelfexia, spasticity, neurogenic bladder and bowel, allodynia, and pressure ulcers methylprednisolone administed within 8 hours to assist with neuroligc recovery BP meds to avoid autonomic reflexia anticonvulsants for neurogenic pain overall outcome is based on age, motivaion, compliance and extent of injury CCS is the most common incompelte SCI and accounts for 30% of overall incompelte tetraplegia 77% ambulate 53% will gain BB control 42% regain some hand function older patients do not recover as well favorable long term prognostic factors include early hand function, improvement of strength in all extremities during inpatient stay, and little to no lower extremity involvement similar to anterior cord syndrome which affects 2/3 of the spinal cord and can occur from a cervical flexion ninjury or anterior spinal artery embolization compelte loss of motor function as well as pain and temperature below the level of the lesion due to damage of the spinothalamic and corticospinal tracts preservation of the posterior column allow for intact vibrtaion and proprioception ACS has the worst prognosis of all the spinal cord syndromes with only 10-15% of patients achieving functional recovery

hypervolemia

increase blood plasma excess intake of fluids and sodium/fluid retention are causes of this s/s swelling in legs, ascites (fluid in the abdomen), fluid in the legs

polycythemia effect on BP

increase in RBC and concentration of hemoglobin increased blood viscosity, blood volume, and results in elevated blood pressure other s/s include fatigue, dyspnea, headache, dizziness, irritabiity, blurred vision, decreased mental acuity and sensory disturbances

thrombocytosis effect on BP

increase in platelet count, increase in viscosity which increases risk for thrombus but NOT increase in BP

incompetent cervix

increase in pressure can cause the cervix to open prematurely can lead to miscarriage or premature delivery HIGH RISK PREGNANCY causes = cervical surgeries, damage during a previous birth, malformed cervix or diethylstilbestrol (DES) exposure

Osteomyelitis BRONZE

infection that occurs within the bone most commonly secondary to the staph microbe exposure to an infection microbe may occur through direct contamination or seconary to an infeciton elsewhere in the body such as the blodostreeam a wound or nearby soft tissue damage to the bone i.e. during surgery fx or puncture may directly expose the bone to infectious microbes in cases of secondary infection the location of the primary injury is variable in either case, prolonged or severe cases may result in structual damaage to the infected bone which could lead to amputation s/s include same as normal infections, fever and chills, localized pain edema and erythema conclusive diagnosis often delayed because of generalized or vague symptoms patients who have weakened immune systems diabetes sickle cell who are eldery or undergoing hemodyalissys are at greater risk patient who devleop osteomyelitis secondary to a wound infectioon may show signifcant changes in observable wound characterisitcs such as color, exudate, delayed healing as well as slow or stagnent wound healing bone biopsy is the most conclusive procedure for dignapsing osteomyelitis and determining the specific infection microbe present blood tests, xrays mri ultasond ct scan bone scan and PET scan may provide additional info i.e. white blood cell count, microbe, bone damage but are not considered diagnostically conclusive

pseudogout

inflam condition characterized by the deposition of calcium crystals in the articular and periarticular structures most common in knees

gout

inflam condition charaxterized by acute pain due to deposition of urate crystals in the joint which causes hyperuricemia most common at first MTP joint

myocarditis

inflammation and weakness of the myocardium myocarditis can cause the myocardium to become thick and swollen which can lead to sx of heart failure caused by VIRAL (flu, coxsackie, adenovirus) or BACTERIAL (polio, rubella, lyme disease) s/s = arrhythmias, chest pain, SOB, fatigue, and signs of fever (headache, muscle aches, sore throat, diarrhea or rashes) tx = antibiotics, anti inflamm, diuretics, beta blockers, and calcium channel blockers to reduce the workload of the heart severe cases may require surgical implantation of a ventricular assist device or intra-aortic balloon pump

bronchitis

inflammation of the bronchi characterized by hypertrophy of the mucus secreting glands, increased mucus secretions, and insufficient oxygenation due to mucus blockage chronic bronchitis is characterized by a productive cough for 3 months over the course of two consecutive years etiology may be caused by cold viruses and exposure to smoke and other air pollutants cigarette smoking is the primary cause of chronic bronchitis but exposure to poor environment can also contribute s/s = persistent cough with production of thick sputum, increased use of accessory msucles of breathing, wheezing, dyspnea, cyanosis, and increased pulmonary artery pressure patients with chronic bronchitis present with a cough that is worse in the mroning and in damp weather and may experience frequent respiratory infections tx = relieving sx and improving breathing acute - rests, fluids, breathing warm and moist air, cough suppressants and acetaminophen or aspirin chronic - antibiotics, anti-inflamm, bronchodilators, lifestyle changes include smoking cessation, avoiding respiratory irritants, using an air humidifier, using a cold-air face mask, and pulmonary rehabilitation (airway clearance, breathing, exercises and endurance and strength training)

endocarditis

inflammation of the endothelium that lines the heart and cardiac valves if left untreated, endocarditis can damage or destroy heart valves and become life threatening caused by BACTERIA that may enter the blood from catheters or needles, dental procedures, gum disease, sexually transmitted disease or inflammatory bowel disease individuals with a damaged heart valve, artificial heart valve or other heart defects are at the greatest risk s/s = may develop slowly but can include fever, chills, heart murmur, fatigue, shortness or breath, weight loss, blood in urine, and skin petechiae tx = antibiotics are the first line of tx, surgery may be needed to treat persistent infections or replace a damaged heart valve

pneumonia

inflammation of the lungs usually caused by bacterial, viral, fungal, or parasitic infection s/s = fever, cough, SOB, sweating, shaking chills, chest painthat fluctuates with breathing, headache, muscle pain and fatigue tx = antibiotics for bacterial and mycoplasma pneumonais, antiviral for a few viral types, antifunal for fungal, lifestyle remedies include rest and drinking plenty of liquids

rheumatic fever

inflammatory diseases that can develop as a complicaation of untreated or poorly treated strep throat from group A streptococcus bacteria can damage the heart valves and cause heart failure streptococcus pyogenes or group A streptococcus that cause strep throat and scarlet fever s/s = result from the inflammation of the heart, joitns skin or CNS and may include red, swollen, fever, and painful joints, heart palpitations, chest pain, shortness of breath, and skin rash tx = destory group A bacteria, relieve sx, and control inflammation, meds include antibiotics and antiinflam

neutrophil WBC

ingests bacteria and debris

cognitive stage in motor learning

initial stage high conscious processing controlled environment is ideal during this stage and participation has to happen in order to progress characterized by large amount of errors inconsistent attempts repetition of effort allows for improvement in strategies inconsistent performance high degree of cognitive work, listening, observing, and processing feedback

associative stage in motor learning

intermediate stage of learning where the person is able to more independently distinguish correct versus incorrect performance linking the feedback that has been received with the movement that has been performed and the ultimate goal controlled environment is helpful but at this stage, can progress to a less structured or more open environment avoid excessive external feedback as the person should have improved internal or proprioceptivee feedback for the task at hand characterized by decreased errors with new skill performance decreased need for concentration and cognitiion regarding the activity skill refinement increased coordination of movement large amount of practice yields refinement of the motor program surrounding the activity

no pain initially during resistive movements that increases after performing a number of reps

intermittent claudication hypersenstivity pain would be more immediate ligamentous laxity not really to do with pain more with excessive ROM

ANS influences...

internal organs blood vessels pupils muscles of the yee sweat aliva digestive glands BP heart and breathing rates body temp digestion metabolism electrolyte balance production of saliva sweat and tears urination defecation sxual reponse bodily processes may result from outside like diabeteees or alcoholism or primary damage

electromyography (EMG)

invasive assess nerve and msucle dysfunction or SC disease records electrical activity from brain or SC to the peripheral nerve root being tested rule out msucle pathology, nerve pathology, spinal cord disease, denervated muscle and LMN injury

halo vest orthosis

invasive cervical thoracic orthosis that provides full restriction of all cervical motion. a metal ring with four posts that attach to a vest i placed on a patient and secured by inserting four pins thorough the ring into the skull commonly used with cervial spineal cord injuries to prevent further damage or dislocation during the recovery period a patient will wear a halo vest until the spine becomes stable

myelography

invasive of the spinal canal contrast dye and xray high risk for HA following the spinal tap but rules out potential abnormalities surrounding the subarachnoid space, spinal nerve injury, herniated disks, fx, tumors

cerebral angiography

invasive procedure that can determine the narrowing or blockage of an artery within the brain can be used when diagnosing a potential CVA, brain tumor, aneuryssm or vascular malformation the catheter is threaded up through the body into an artery with the neck and contrast dye is released into the bloodstream a series of x-rays is then taken

disography

invasive procedure to evaluate the integrity and pathology of a spinal disc dys injected and CT scanning is performed

associated reaction

involuntary and automatic mvmt of a body part as a result of an intentional active or resistive mvmt in another body part.

tremors

involuntary, rhythmic, oscillatory movement that are classified as resting, postural, or intension resting may or may not disapear with mvoement may increase with mental stress pillrolling in PD during a voluntary contraction to maintain a posture i.e. rapid tremor assocaited with hyperthyroidism, fatigue or anxiety and bnin essential tremor intenstion (kinetic) absent at rest but happen with actiivity and increase as the target approaches likely lesion of cerebellum or its efferent pathways and are typically seen with MS

raimiste's phenomenon

involved LE will abduct/adduct with applied resistance to the uninvolved LE in the same direction

descending tracts

involved with voluntary motor function, muscle tone, reflexes and equilibrium, visceral innervation, and modulation of ascending sensory signals the largest (Corticospinal) originates in the cerebral cortex and smaller originate in the nuclei o fthe brainstem

knowledge of performance feedback

is extrinsic feedback that relates to the actual movement pattern that someone used to achieve their goal of movement

specific test

is when a test is negative in people who do NOT have the disease TRUE NEGATIVE this test will RARELY be positive when a person does NOT have the disease A positive result in a test with high specificity is useful for ruling in disease. The test rarely gives positive results in healthy patients. A test with 100% specificity will read negative, and accurately exclude disease from all healthy patients. A positive result signifies a high probability of the presence of disease.[7]

sensitive test

is when a test is positive in people who DO have the disease TRUE POSITIVE this test will RARELY be negative when a person DOES have the disease A negative result in a test with high sensitivity is useful for ruling out disease.[6] A high sensitivity test is reliable when its result is negative, since it rarely misdiagnoses those who have the disease. A test with 100% sensitivity will recognize all patients with the disease by testing positive. A negative test result would definitively rule out presence of the disease in a patient.

positive stress test means what is going on in the heart

ischemia patient could be experincing angina

somatosensory input and how to challenge it

joints muscles ligment and skin input info on length tension pressure pain and joint position proprioceptive and tactile input from the ankles, knees, hips, and neck provide balance info to the brain changing surface they stand on slopes uneven surfaces standing on foam stress even more make pt close eyes to make it harder on somatosensory system

droplet what do you need

just mask

eosinophils WBC

kills parasites, destroy cancer cells and are involved in ALLERGIC responses

L3 key muscles

knee extensors (quads)

poylcentric knee

knee joint that has multiple axes of rotaiton that allows for a ore natural gait cycle when compared to a single axis knee

superficial peroneal nerve

lateral aspect of the leg and dorsum of the foot sensory

vertebral-basilar artery what does it supply and what are the expected impairments

lateral aspect of the pons and midbrain together with superior surface of cerebellum cerebellum - branches from the basilar artery (posterior inferior cerebellar, anterior inferior cerebellar, and superior cerebellar arteries) medulla - posterior inferior cerebrellar artery, smaller bracnhes from the vertebral arteries pons - branches from the basilar artery midbrain and thalamus - posterior cerebral arteries oxxipital cortex - posterior cerebral artery and abasilar artery loss of consciousness hemiplegia or tetraplegia comatose or vegetative state inability to speak locked in syndrome vertigo nystagmus dysphaga dysarthria syncope ataxia wide variety of sx severe impairment wallenberg syndrome can occur secondary to lateral medullary infarct presents with a varitety of sx including ipsilateral facial pain and temp imapirment, ipsilateal ataxia, vertigo, contralateral pain and temperature impairment of the body

C5 sensory testing

lateral side of antecubital fossa

piriformis weird action

laterally rotates normally but if hip flexed more than 60 degrees then it will medially rotate the femur so to stretch it can put in a flexed and laterally rotated position

circumflex artery

left coronary artery posterior and lateral walls of the left ventricle anterir and inferir walls of the left ventricle

left anterior descending artery LAD

left coronary artery anterior portion of the IV septum

trannsfemoral amputation considerations

length of the residual limb with regard to leverage and energy expenditure knee componentry will determine abiity to functionally reciprocate gait stance control may not activate until weight bearing occurs through the limb donning can be mmore difficult than with a transtib weight bearing through the ischium in an ischial containment socket susceptible to hip flexion cotracture adaption required for balance weight of prosthesis and energy expenditure

transhumeral amp considerations

loss of all elbow and hand function most commonly due to trauma typically 7-10 centimeters proximal to the distal humeral condyles trauma associagted with fx, dislocation or peripheral nerve injury may delay prosthetic interventions second most common level of upper extermity amp

symes amputation considerations

loss of all foot functions residual limb can weight bear through its ends residual limb is bulbous with a noncosmetic apperance dog ears must be resduced for proper prosthetic fit adaptation required for the increased weight of the prosthetic adaption required due to dimished toe off during gait

transradial amp considerations

loss of all hand function must be a min of five centimeters prox to the distal radius typically the result of trauma trauma assocaited with fx dislocation or periph nerve injury may delay prosthetic interventions functionally preferred over wrist disarticulation or selected partial hand amputations most common level of upper extremity amputation

wrist disarticulation consideration

loss of all hand function relativel uncommon level of amp cosmetic and functional prosthetic disadvantages

elbow disartic considerations

loss of allelbow and hand function most commonyl due to trauma allows for self suspending socket an external prosthetic elbow joint is typically required

forequarter (scapulothoracic amp) considerations

loss of allshoulder elbow and hand function most common cause is malignancy functional prosthetic use is common a lightweight cosmetic prothetic is typically well toelrated

shoulder disartic considerations

loss of allshoulder elbow and hand function most common cause is malignancy or severe electrical injuries functional prosthetic use is common an external prosthetic shoulder joint is typically required

transmetatarsal and choparts ampu considerations

loss of forefoot leverage loss of balance loss of weight bearing surface loss of proprioception tendency to develop equinus deformity

femoral anteversion would see what ROM with medial and lateral rotation

lots of medial rotation little lateral rotation

startle reflex (stimulus, response, normal age of response, interferes with...)

loud, sudden noise similar to moro response, but elbows remain flexed and hands closed 28 weeks of gestation to 5 months interferes with... sitting balance protective reponses in sitting eye-hand coordination, visual tracking social interaction, attention

respiratory acidosis

low arterial blood pH and elevated PaCO2 which can be caused by alveolar hypoventilation due to anxiety, confusion and coma

Static Stretching

low-intensity, long-duration muscle elongation; ideally in a supported position that allows the muscle fibers to relax Safest and results in greatest gains in tissue extensibility Less activation of the muscles spindles and thus less resistance to stretch No consensus for the optimal duration of static stretching 30 seconds is a commonly cited value that has been shown to result in significant range of motion gains

C6 tetraplegia

lowest motor innervatin is extensor capri radialis, infraspinatus, latissimus dorsi, pectoralis major, teres, minor, pronator teres and serratus anterior could not self ROM lower extremities

apex of the heart

lowest part of the heart formed by the inferolateral part of the left ventricle it projects anteriorly and to the left at the level of the 5th intercostal space and the left midclavicular line

neurologic level

lowest segment (most caudal) of the spinal cord with intact strength and sensation muscle groups at this level must receive a grade of fair

COPD

lung diseases that block airflow due to narrowing of the bronchial tree emphysema and chronic bronchitis are the two main conditions that make up COPD COPD can also refer to damage caused by chronic asthmatic bronchitis progression of the disease includes alveolar destructin and subsequent air trapping, patients have an increased total lung capacity with a signifncant increased RESIDUAL VOLUME majority of cases are caused by long term smoking or exposure to secondahnd smoke other irritants can cause COPD including air pollution and certain occupational fumes rre cases can result from a genetic disorder that causes low levels of the protien alpha-1-antitrypsin s/s = excessive mucus production, chronic productive cough, whezing, SOB, fatigue and reduced exercise capacity tx = bronchodilators, inhaled steroids, supplemental oxygen and antibiotics (if bacterial infection is present) surgery may include lung volume reduction surgery, bullectomy, and lung transplantation lifestyle modificatins include smoking cessation, influenza shots, avoiding respiratory irritatants, maintaining good nutrition and pulmonary rehab (airway clearance, breathing exercises, and endurance and strength training)

malignant vs benign bone cancers

m - osterosarcoma (long bones) ewings sarcoma (flat bones and long bones) b - osteochondroma (ends of long bones) osteoblastoma (long and sometimes flat) osteoid osteoma (long and sometimes flat)

Work =

magnitude of a load i.e. weight multiplied by the distance the load is moved i.e. range of motion

RC Repair

massive >5cm large 3-5 cm medium 1-3 small <1cm small just debridement all other require repair immobilzied for several weeks abduction pillow protocols vary PROM and AAROM initially precautions include no AROM, lfiting or weight bearing through the arm for several weeks depending on which muscle is repaired there may be ROM precautions for rotation as well if deltoid repair was preformed will acoid passive extension to prevent stress while healing

poor prognosis with guillan barre

mechanical ventilation advanced age long hospital stays poor upper extremity muscle strength bladder dysfunction is seen in more severe cases but is less likely to lead to poor prognosis (i.e. mortality) than would respiratory impairment

extension assist

mechanism that assists the knee joint into extension during the swing phase of gait

anterior trim line helps with

medial lateral stability

L4 sensory testing

medial malleolus

median vs ulnar in power vs precision grips

median - power and precision ulnar - power and minimal precision

anterior interosseous is a branch of what nerve and what does it innervate

median nerve flexor pollicis longus flexor digitorum profundus pronator quadratus can be pinchedbetween the two heads of pronator teres

lungs are located on either side of the...

mediastinum each within its own pleural cavity

b fibers

medium myelinated reasonably fast preganglionic fibers of autonomic

IV is used for

meds and fluids

visceral pleura

membranous serous sac

hippocampus vs amygdala

memory vs emotional and social processing

blood brain barrier

meninges, protective glial cells, and capillary beds of the brain responsible for exchange of nutrients betwen CNS and vascualr system

ankle-foot orthosis AFO

metal that consists of two metl uprights connected proximally to a calf band and distally to a mechanical ankle joint and shoe may have to ability to be locked ankle or set to have some anteiror posterior capablity a plastic one is fabricated by a cast mold plastic is more cosmetic lgihter and requires that if a patients presents with edema it does not significantly fluctuate proper fit requires a patient be casted in a subtalar neutral position a footplate can be incorporated into the AFO to assist with tone reduction solid AFOs control DF and PF and also inversion/eversion with a trim line anterior to the malleoli can be fit so it stays in 90 degrees or it can have an articulating ankle joint which will let the tibia advance over the foot during mid to late stance a posterior leaf spring is a plastic AFO with a trim line posterior to the malleoli and it assists with DF and prevents foot drop requires adequate medial alteral control by the pt AFOs can also influcene knee control a floor reaction AFO assists with knee extension during stance through positioning of the calf band or positioning of the ankle commonly prescribed for patients with peripheral neuropathy, nerve lesions or hemiplegia

brainstem =

midbrain + pons + medulla

lisfranc injury

midfoot injury often misdiagnosed as a lateral ankle sprain but can have serious complications such as joint degeneration or even compartment syndrome if undiagnosed Involves the disruption of the tarsometatarsal joint, with or without an associated fracture caused by a severe twisting injury. The first metatarsal typically is dislocated from the first cuneiform, whereas the other four metatarsals are displaced laterally, usually in combination with a fracture at the base of the second metatarsal.

considerations for myasthenia gravis

mild to severe sx that can fluctuate in severity from hour to hour at times proximal msucle groups are typically more affected difficulty with speech, swallowing and chewing may persist due to weakness of the pharyngeal muscles and muscles of mastication involvement of the cranial nerves may result in eyelid weakness diplopia and ptosis typified by exacerbatins, remissions, and atypically "Crisis" which is life threatening remissions are typically not complete or permanent PT guidelines in tx should include.... acquire baseline for respiratory and neurological status monitor respiratory functin on a regular basis to ensure that the msucles of respiration are not weakening review proper techniques for positioning during meals to prevent aspiration observe for signs of myasthenia crisis i.e. respiratory difficulty, swallowing issues, labored talking or chewing reviews signs of toxicity and side effects of meds educate the patient to plan activity around periods of increased energy conservation techniques avoid strenuous exercise and stress avoid excessive cold or head as it exacerbates sx educate on s/s of osteoporosis for pts that are using long term corticosteroids initiate strengthening for patients with mild to moderate sx using moderate to maximal isometic contractions while avoiding muscle fatigue tx should be based on the current sx, strength and level of fatigue

cholenergic agents

mimic acetylcholine and bind directly to the cholinergic receptor to activate and create a response at the cellular level (direct) increase cholinergic synapse activity through the inhibition of acetylcholinesterase which normally destroys acetylcholine and the increase at the synapse increases cholinergic synaptic transmission (indirect) indicated in glaucoma, dementia due to alzheimers, post op decrease in GI motility, myasthenia gravis, reversal of anticholinergic toxivity side effects include GI distress, imparied visual accommodation, bronchoconstriction, bradycardia, flushing and other parasympathetic effects patients may experience a decrease in HR and dizziness PT should be aware of both sympathetic and parasympathetic systems and notify the physician if a patient begins to exhibit UNEXPECTED side effects increased particpation for alzheimers and MG patients direct - duvoid (bethanechol), pilocar (pilocarpine) indirect - aricept (donepezil), tensilon (edrophonium), prostigmin (neostigmine), cognex (tactrine)

arterial insufficiency ulcers

minimal signs of healing and often gangrenous distal leg where collateral circulation is limited wound bed is deep and the edges are distinct and well-defined

how to calculate the approx percentage of oxygen delivered to a patient receiving supplemental oxygen via nasal cannula

mixed with room at which is 21% increase by 4% for every one liter per minute

hold-relax active movement

mobility a technique to improve initiation of movement to muscle groups tested 1/5 or less. An isometric contraction is performed once the extremity is passively placed into a shortened range within the pattern overflow and facilitation may be used to assist with the contraction. Upon relaxation, the extremity is immediately moved into a lengthened position of the pattern with a quick stretch. The patient is asked to return the extremity to the shortened position through an isotonic contraction

PNF rhythmical rotation

mobility a passive technique used to decrease hypertonia by slowly rotating an extremity around the longitudinal axis, relaxation of the extremity will increase ROM i.e. use the same rotation as the pattern and do that rotation through the pattern rotate move rotate move rotate move movement at the shoulder

PNF rhythmic initiation

mobility a technique used to assist in initiating movement when hypertonia exists, movement progresses from passive, to active assisted, to slight resistive movements must be slow and rhythmical to reduce the hypertonia and allow for full ROM

PNF contract-relax

mobility a technique used to increase ROM, as the extremity reaches the point of limitation, the patient performs a maximal contraction of the ANTAGONIST muscle group, the therapists resists movement for eight to ten seconds with relaxation to follow used until no further gains in range are noted during the session different from hold-relax because the resistance is given to a moving muscle like isokinetic (biodex)

PNF repeated contractions

mobility a technique used to initiate movement and sustain a contraction through the range of motion, RC is used to initate a movement pattern, throughout a weak movement pattern or at a point of weakness within a movement pattern the therapist provides a quick stretch followed by isometric or isotonic contractions push out, stretch back up towards head, push out, stretch back up towards head, repeat until through full ROM

PNF hold-relax

mobility an isometric contraction used to increase range of motion, contraction is facilitated for all muscle groups at the limiting point in the ROM, relaxation occurs and the extremity moves through the newly aquired range to the next point of limitation until no further increases in the range of motion occur often used for patients that present with PAIN

PNF joint distraction

mobility proprioceptive component used to increase range of motion around a joint consistent manual traction is provided slowly and usually in combo with mobilization techniques, it can also be used in combo with quick stretch to initiate movement

PNF rhythmic stabilization

mobility, stability technique used to increase ROM and coordinate isometric contractions, requires isometric contractions of all muscles around a joint against progressive resistance the patient should relax and move into the newly acquired ROM and repeat the technique if stability is the goal, RS should be applied as a progression from alternating isometrics in order to stabilize all muscle groups simultaneously around the specific bony part

what is the last to occur assuming normal development (modified plantigrade, quadruped, ring sitting, bridging)

modifed plantigrade is the answer (requires a patient to be standing on both feet while leaning on to a table or other surface) plantigrade (normal human flat foot stance) quadruped (8 months) ring sitting (6 months) bridging (5 months)

middle cerebral artery (MCA) what does it supply and what are the expected impairments

most of the outer cerebrum basal ganglia posterior and anterior internal capsule putamen pallidum lentiform nucleus most common site of cva !!! wenickes aphasia in dominant hemi homonymous hemianopsia apraxia flat affect with right hemi damage contalateral weakness and sensory loss of face and UE with lesser involvement in the LE impaired spatial relations anosognosia in non dom hemi imapired body schema bilateral at the stem will produce contralateral hemiplegia and sensory impairment, dominant hemi will include global, wernickes or brocas aphasia since this artery supplies the larger portion of the cortex, other imparimetns are lobe dependent

neurotmesis

most severe grade of injury to a perpoheral nerve axon myelin connective tissue components are all damaged or transected irreversible injury, no possibiity of regeneration flaccid paralysis and wasting of muscles occur total loss of sensation to area supplied by the nerve all motor and sensory loss distal to the lesion becomes permanently impaired no spontaneous recovery; with surgical reattachment potential regenerating axons may grow at one millimeter per day with proximal recovery first; sensory recovery occurs sooner than motor fibers complete transection of the nerve trunk

fugl-meyer assessment of physical performance

motor, sensory, and balance impairment; also assesses pain and ROM CVA

athetosis

movement disorder presenting with SLOW, TWISTING and writing movements that are large in amplitude. Primarily seen in face, tongue, trunk and extremities. when the mvoements are breif, they merge with chorea and when sustained they merge with dystonia and it is typicall assocaietd with spasticity Common in CP secondary to basal ganglia pathology.

microprocessor knee

mtiltople programs avail to accommodate the activity level of the user allows for fluid management of descending stairs requires charging variable friction for improved swing and stance phase control

kitchen meal prep best outcome measure

multidirectional reach test (other answers were wrong because they didn't "speficially" address balance during reaching)

upper respiratory tract

nasal cavity pharynx (nasopharynx, oropharynx, laryngopharynx) larynx (voice box, stops food from aspirating) serve as gas conduits, humidifier/cool/warm inspired air, filter foreign matter before it can reach the alveoli hairs in the nostrils filter out many particles while the remaining particles settle on mucous membranes in the nose or near the tonsils and adenoids

posterior leaf spring prescribed for

need good medial lateral stability which the pt didnt have helps with dorsiflexion during termal stance

coronary arteries

network of progessively smaller vessels that carry oxygenated blood to the myocardium right and left coronary arteries arise from the ascending aorta just beyond where the aorta leaves the left ventricle

talar tilt looks at what ligament

neutral - calcaneofibular PF - ATFL DF - posteiror talotibial

can you elevate the foot during water immersion

no

postural drainage is dizziness and mild dysnpea a normal response

no elevate head

would a T12 be a functional ambulator

no because of extreme energy demands utilizes wheelchair as their primary mode of mobility lower abdominals and intercostals would be the lowest innervated muscles

visual fixation central vs peripheral lesion

no inhibition with fixation will inhibit nystagmus and vertigo

can you observe learning

no just performance

electroencephalography EEG

non invasive measure electrical activity using electrodes various stimuli are presented and waves are analyzed EEG used to rule out seizure disorders, brain death, brain tumors, brain damage, and inflammation alcoholism, psychiatric disorders and degeneraative disorders that affect the brain

nerve condutin velocity NCV

non invasive stimulation of a peripheral nerve to determine the nerve action potentials and the nervs ability to send a signal rules out periph neuropathy, carpal tunnel, demyelination, periph nerve compression

arthrogryposis multiple congenita AMC

non progressive neuromuscular disorder that is estimated to occur during the first trimester in utero the restriction in utero allows for fibrosis of muscles and structures within the joints etiology unknown causative factors include poor movment during early development due to myopathic, neuropathic or joint abnormalities can also be genetically inherited (autosomal dominant) in small percent of cases s/s = cylinder-like extremities with minimal definition, significant and multiple contractures, dislocation of joints, muscle atrophy tx = attain the max level of developmental skills through positioning, stretching, strengthening, splinting, and use of adaptive equipment, significant family involvement required for HEP, surgery may be indicated

SACH foot (solid ankle cushion heel)

non-articulating with a rigid keel inexpensive low maintenance cushioning heel for shock absoption lacks energy return cannot accomodate to uneven surfaces

sharpened rhomberg

non-dominant foot in front first with eyes open then eyes closed

verbal apraxia

non-dysarthric and non-aphasic impairment of prosody and articulation of speech verbal expression is impaired secondary to deficits in motor planning a patient is unable to initiate learned movement (articulation of speech) even though they understand the task lesions are usually found in the left frontal lobe adjacent to broca's area

broca's aphasia

non-fluent lesion: 3rd convoluation of frontal lobe also known as "expressive aphasia" most common form of aphasia intact auditory and reading comprehension impaired repetition and naming skills frustration with language skill errors paraphasias are common motor impiarment typical due to proximity of broca's area to the motor cortex

evoked potentials

noninvasive two sets of electrodes records time it takes for an impulse to reach the brain (i.e. auditory, visual, proprioceptive) used to rule out MS, brain tumor, acoustic neuron,a. spinal cord injury

ESR (erythrocyte sedimentation rate)

nonspecific test for inflammatory disorders associated with conditions such as cancer, autoimmune, infection based on how quickly the RBCs sink to the bottom of a test solution containing anticoagulated blood

right hemisphere

nonverbal processing process info in a holistic manner artisitic abilities general concept comprehension hand eye coordination spatial relationships kinesthetic awareness understand music understand nonverbal communciation mathematical reasoning express negative emotions body image awareness

ASIA E

normal sensory and motor functions are normal

sock

normal for individial with limb loss to experience a decrease i nresidual limb volume esp in the first year socks accommodate for this space to maintain a congruent and comfortable fit cotton wool and synthetic common plys = 1, 3 and 5 when the number of ply socks exceeds 12-15 the prosthetisit should be notified as a recasting may be required some socks are split ply distally than proximally socks must be carefully aplied as to eliminate wrinkles otherwise the wearer may experience discomfort or breakdown in the area of increased pressure

visceral and parietal pleura

normally remain in contact through the rspiratory cycle separated only by serous fluid but under abnormal circumstances, the pleural space may contain air (pneumothorax), blood (hemothorax) pus or increased amounts of serous fluid, which compress the lung and cause respiratory distress

does osteogenesis imperfect have tone issues

not really just hypermobility susceptible to fractures during basic activities such as being carried or bathing

how is dermatitis different from cellulitis

not warm to touch can look the same on the outside cellulitis is common post op masitiis painful lumps in breasts usually associated with breast feeding erysipleas form of cellitismuch more raise, sharp and red in color

withdrawn patient how do you engage them

not yes no or short answered questions open ended what are you goals or what do you hope to achieve

positional nystagmus

nystagmus that is induced by a change in head position. The semicircular canals stimulate the nystagmus that typically lasts only a few seconds

AICA (cerebellar) stroke also includes sx of

nystagmus tremor dysmetria incordination and balace deficit and ataxia

pylon

pipelike structure used to connect the socket of the prostheesis to teh foot/ankle components assists with weight bearing and shock absportion

C2 sensory testing

occipital protuberance

Vestibular Disorders GOLD

occur when there is a disruption of the sensory information processed by the inner ear and brain with respect to the bodys control of balance and eye movements disease or injury to these processing areas will result in a vestibular disorder but can also be caused by geneitc environment or idiopathic etiologies as well encompasses many specific diagnoses such as menieres disease, BPPV benign paroxysmal positional vertigo, labyrinthitis, ototoxicity, and acoustic neuroma peripheral - dysfunction of the auditory or vestibular strucutes of the inner ear central - dusfunction of the nervous system in processing spatial and balance info majority of cases are peripheral not all etiologies of dizziness (i.e. due to hyperventilation, dehydration, stress or fatigue) or alteredbalance i.e. peripheral neuropoahty are classified as vestibular disorders ear infection, whiplash, head injury are among the most common causes of vestibular disorders in younger individuals in many individuals esp >50 the onset is idiopathic in many cases sx will dimish or resolve without intervention as the body either heals or compensates for deficits typical characteristics include vertigo, dizziness, nauseas, altered balance, auditory changes, and difficulties with cognition, memory or coordination lesss common include migraine headaches, msucle aches, motion sickness, photosensitivity, auditory sensitivty and fatigue diagnosed through PMH and clincial exam MRI can rule out soft tisssue abnormalities such as tumor acoustic neuroma or CVA blood or allergy tetsing may also be ordrered emphasize assessment of the vestibuloocular reflex aka dix-hallpike test, electronystagmography, videonystagmography and assessment of balance reactions auditory is done by a formal audiologist TUG unipedal stance test limits of stability testing vestibular defciits can become so severe inpatients that functional mobility is imapired patients may expeirnce numerous falls resulting in additional injuries persistent long term sx may cause the atient to experience inicreased irritabiity, a loss of self esteem or depresion benzodiazepines, anticholinergics, antihistamines which are vestibular suppressants prednisone which are steroids long term suppression of sx is not recommended since the body must experience sx in order to develop compensatory strategies antibioic or antiviral may also be used depending on etiology nutriton emphasizes regulation of body fluid to stabilzie the volume and elctrolytes concentrations of the inner ear endolymph fluid may include alterations in diet such as sodium and sugar elimintaign caffeine and alcohol avoiding trigger substances such as nicotine aspirin and nsaids vestib rehab helps patients HABITUATE aka become less sensitive to symptoms through ADAPTATION SUBSTITUTTION cognitive, and symptom prediction strategies facilitate symptom accommodation and habituation vestib rehab recommended to pts whos sx have not resolved within an extended timeframe however risk of falling and incidence of fallng may be reduced if therapy is initated closer to onset vestib exercises have been showen to be effectve is most patients typically bc emphasis on habituation to sx rather than full sx resoluation failure to progress may be attibuted to the etiology or severity of injury or the patietns unwillingness to therapeutically exacervbate sx so that accommodation can be learned spontaneous recovery to permanent disability similar to orthostatic hypotensiojn which may include dizziness, blurred vision, confusion, and loss of balance sx are typically riggered by a change in body position that temporarilty reduces blood flow to the brain i.e. supine to standing though sx mimic some vestibular disorders, they are not vestibular inorigin and typically resolve quickly as blood presssure adapts to the change in position

when does shock occur and what is it characterized by

occurs when blood flow to the organs become diminished causes include sepsis, cardiac problems, injury to central nervous system, hypovolemia, and anaphylaxis characterized by hypotension, tachycardia, hyperventilation, diaphoresis, pallor, confusion and anxiety

gaze-evoked nystagmus

occurs when the eyes shift from a primary position to an alternate position caused by the patients inability to maintain the stable gaze position typically indicative of CNS pathology and is assciated with brain injury and multiple sclerosis

central nystagmus

occurs with a central lesion of the brainstem/cerebellum and is NOT inhibited by visual fixation on an object

peripheral nystagmus

occurs with a peripheral vestibular lesion and is inhibited when the patient fixates their vision on an object

charcoal helps with

odor

tx of DVT

once a DVT is suspected, there should be NO AROM OR PROM performed to the involved lower extremity bed rest and anticoagulant pharma is indicated surgery may be performed if necessary

hygiene of residual limb

once the post surg limb has fully closed and no evidence of exudate is present, washing with warm water and a mild hypoallergenic soap is appropriate if lotion use is advised it should not be petroeum based and it should not be applied prior to donning the prosthesis since it may inhibit suspension

soleus vs gastroc

one joint vs two joint muscle knee flexion puts gastroc on slack

dependent variable

outcome variable response or effect that is presumed to vary with the independent variable physical skill is dependent because it is presumed to vary depending on the noise level aka CRITERION variable

SA node

pacemaker of the heart makes the atriums contract automaticity is intrinsic to the SA node but the heart rate, rhythm and contractility are also influenced by the autonomic nervous system (vagus and sympathetic cardiac nerves converge to form the cardiac plexus at the base of the heart) bachmann bundle conducts the impulse from right to left atrium

trochanteric bursitis

pad like sac that protects the soft tissue structures that cross the posterior portion of the greatertrochanter pt is often extremely sensitive to palpation over the bursa and may experience lateral thigh pain that is exacerbated by activity or periods of prolonged rest

phantom limb

painless sensation where the patient feels that the limb is still present usually subsides with desensitization and prosthetic use

neuropathic ulcer

painless with absent pedal pulses, decreased lower limb temp, shiny skin

epigastic pain

pancreatitis peptic ulcer

patient based outcome measures for amputee

participation beyond physical assessment QOL prosthesis evaluation questionnaire PEQ orthotics prosthetics user survey OPUS trinity amputation and prosthesis experience scales-revised TAPES-R (activity restriction, psychosocial adjustment, satisfaction, factors influencing health)

pressure tolerant areas

patellar ligament lateral fibula shaft medial tibial shaft lateral tibial shaft ischium soft tissues of residual limb

things to consider with PNF

patient learns diagonal pattern of movement techniques must have accurate timing, specific commands and correct hand placement verbal commands must be short and concise resistance given during the movement pattern is greater if the objective is stability, less if the objective is mobility utilize isometric and isotonic developmental sequence used in conjunction with PNF in order to increase the balance between agonists and antagonists PNF techniques are impleneted to progress a patient through the stages of motor control functional patterns of movement are used to increase control techniques should be utilzied that increase or improve relaxation by enhancing overflow froom the stronger to the weaker muscles

KAFO with locked knee who is it appropriate for

patient that had no voluntary knee control keeps knee in extension and avoid genu recurvatum (hyperextended knees) or collapsing of the knee during stance phase

ideal positioning in sitting

pelvis in line with trunk hips at 90 degrees flexion neutral rotation of pelvis hips symmetrically abducted 10 to 20 degrees trunk straight shoulders over hips not rotated head in neutral facing forward head evenly on shoulders arms fully supported elbows in flexion 0 to 45 degrees internally rotated shoulders knees at 90 degrees ankles at 90 degrees feet fully supported thighs fully supported

ideal positioning in supine

pelvis in line with trunk hips in 30-90 degrees of flexion neutral rotation of pelvis hips symmetrically abducted 10 to 20 degrees trunk is straight shoulder in line with hips neutral rotation of trunk head in neutral facing forward slight cervical flexion arms fully supported arms forward of trunk forearms rest on trunk or pillow knees supported in flexion feet positioned at 90 degrees

monitor exercise intensity after cardiac transplatation what do you use

perceived exertion scale since the transplanted heart fails to respond normally to sympathetic nervous stimulation resulting in an abnormal heart rate response to exercise METs are not an objective mean of monitoring exercise intensity but can be useful to select appropriate exercise activities neither is pulmonary fuction tests

phantom pain

perception of some form of painful stimuli as it related to the residual limb can be continuous or intermittent local or general short term or permanent tens US icicng mirror therapy relaxation techniques desentiziation and prosthetic use can help

atrial diastole

period between artrial contractions when the atria are repolarizing

ventricular diastole

period between contractions when the ventricles are repolarizing

ABG results are written as

ph to paco2 to pao2 to hco3- 7.4/40/97/24

organic vs nonorganic causes of back pain means

physical behavioral waddells low back pain with passive shoulder and pelvis rotation occuring simultaneously would mean the back is not moving and the pain is more behavioral does not indicate malingering just indicates behavioral aspect

carbon dioxide can either be...

physically dissolved in the blood (5-10%) or chemically combined with AMINO ACIDS of hemoglobin as carbamino compounds (5-10%) and as bicarbonate ions (80-90%)

oxygen can either be...

physically dissolved in the blood plasma (only 0.3ml dissolved in 100 ml of artieral blood, however, the physically dissolved oxygen comtributes to the PaO2 which determines how much oxygen combines chemically with hemoglobin) OR chemically combined with hemoglobin in RBCs (main way)

spinal shock

physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. spinal shock presents with total flaccid paralysis and loss of all reflexes below the level of injury.

palmar grasp reflex (stimulus, response, normal age of response, interferes with...)

pressure in palm on ulnar side of hand flexion of fingers causing strong grip birth to 4 months interferes with... ability to grasp and release object voluntarily weight bearing on open hand for propping, crawling, protective responses

plantar grasp reflex (stimulus, response, normal age of response, interferes with...)

pressure to base of toes toe flexion 28 weeks of gestation to 9 months interferes with... ability to stand with feet flat on surface balance reactions and weight shifting in standing

educate pts on risk factors for stroke which are

primary - hypertension cardiac disease or arrhythmias diabetes mellitus cigarette smoking transient ischemic attacks secondary - obesity high cholesterol behaviors related to hypertension (stress, excessive salt intake) physical inactivity increased alcohol consumption

primary vs secondary lymphedema

primary - abnormal development of the lymphatic system (milroys disease: inherited disease that presents during infancy and is characterized by lymphedema caused by developmental abnormalities) secondary - result of some other disease or injury that causes damage to the lymphatic system (filariasis which is a parasitic infection, mastectomy) lymphadenitis is infection and inflammation of lymph node, it is not a form a lymphedema

bronchiectasis

progressive obstructive lung disease that produces abnormal dilation of a bronchus, this is an irreversible condition usually associated with chronic infections, aspiration, cystic fibrosis or immune system impairment bronchial walls weaken over time due to infection and allow for permanent dilation of bronchi and bronchioles etiology is from injury to the airways or lung infection (pneumonia, whooping cough, measles, tuberculosis, fungal infections) s/s = consistent with productive cough, hemoptysis, weight loss, anemia, crackles, wheezes and loud breath sounds tx = medications include antibiotics, bronchodilators, expectorants, and mucolytics

muscle relaxant agents

promote relaxation for muscles that presnt with spasm that is a continuous, tonic contraction side effects include sedation, drowsiness, dizziness, nausea, vomiting, HA, tolerance, dependence PTs should maximize potential with relaxation through treatment prevention of reinjury through stretching, posture retraining, and education should assist the patient to achieve desired outcomes valium (diazepam), flexeril (cyclopenzaprine), paraflex (chlorzoxazone)

procedure guideline for superficial reflex testing

pt relaxed and understand the testing procedure position patient properly typically graded as present or absent, although a large difference between sides can also indicate an abnormal response exam should compare sides should assist therapist to recognize a deficit within the nervous system

deep tendon reflexes procedure

pt relaxed and understand the testing procedure position properly and symmetrically with the muscle placed on SLIGHT stretch reflex hammer used to deliver a direct strike on the tendon with an anticipated immediate repsone avoid "pecking" at the tendon, will produce invalid results can be graded as depressed, normal or exaggerated on 0-4 scale (0 = no response ALWAYS ABNORMAL, 1+ = diminished/depressed response, 2+ normal, 3+ = brisk/exaggerated, 4+ very brisk hyperactive ALWAYS ABNORMAL) if difficulty eliciting the reflex use the JENDRASSIK maneuver to distract the patient, locking fingers together and directly pulling against rach other immediately prior to the stimulus exam should provide a comparision and include all deep tendon reflexes compare "normal" ares to suspected areas of inolvement results should assist therapist to identify deficits within the nervous system

procedure for sensory testing

pt relaxed and understands required response exam conducted in efficiet manner so sensory system doesnt fatigue and give unreliable results vision obscured pace should vary so pt does not respond to rhythm therapist should have complete understanding of areas of the skin that hav eheightened or decreased sensitivity exam should be comparison of both sides and should include all extremities and trunk should provide a comparision of normal areas to suspected areas of involvement exam should provide a comparision of distal versus proximal responses for each tested area may examine dermatomes and periphreal nerve distribution results should assist therapist to recognive the deficit as CNS, plexus, or peripheral nerve pateitns with sensory deficits or whoa rea t risk for sensory impairments should be testd suing semmmes weinstein monofilaments for objective data regarding protective sensation

platform attachment is used for

pts who are unable to bear weight through their wrists and hands, who have deformities of the wrists or fingers, who have an amputation distal to the elbow or who are unable to extend the elbow i.e. radial nerve injury would have significant weakness of the triceps and be unable to extend the elbow, would be necessary bc unable to produce elbow extension and would instread need to bear weight through the elbow and forearm

pelvic floor contraction procedure

pull muscles up and in as if attempting to stop the flow of urine 5-10 reps x 3 sets holding for 5-10 seconds 3x/day tightening the abdominal muscles will trigger reflexive contraction of the pelvic floor

what to do if you dont want to exacerbate a patients inflammation with US

pulsed 20% duty cycle because will not cause a measureable net increase in temperature intensity around 1.5 can still exacerbate symtpoms duty cycle and intensity will affect the temperature the most

corticospinal tract (lateral) descending

pyramidal motor tract responsible for contralateral voluntary fine movement damage reuslts in a positive babinski sign, absent superficial abdomnal reflexes and cremasteric reflex, and the loss of fine motor or skilled voluntary movement

technique for low tone patients

quick stretch helps activate muscle spindles and results in enhanced muscular contracture thus helping to increase activity in affected muscles deep pressuer would inhibit tone (making hypotonia worse) same for icing and neutral warmth

muscles of expiration

quiet breathing - passive forceful - rectus abdominis, external oblique, internal oblique, and trasnverse abdominis all depress the lower ribs, compress the abdominal contents THUS pushing UP the diaphragm and assisting with active exhalation

pre-eclampsia

rapidly progressing condition characterized by high blood pressure and protein in the urine swelling, sudden weight gain, headaches, and changes in vision are common sx considered a medical EMERGENCY with HIGH RISK to both the mother and the baby can result in seizures which at that point it is not PRE anymore it is eclampsia

prodromal period post seizure

rare but can occur days or hours prior to a seizure and may include mood changes, lightheadedness, sleep disturbances, irritability and difficulty concentrating aura will briefly occur within minutes before a complex partial or generalized tonic-clonic seizure (aura is actually a simple partial seizure and produces sx that alert the person that something is about to happen, sx can incldue restlessness, nervousness, anxiety, heaviness, and a general feeling that something within the body is not quite right)

perkins vocational and applied technology act 1990

reauthorization and modification of the education for all handicapped children act provides free, appropriate education in the least restrictive environment for individuals with disabilities ranging from 3-21

IDEA (individuals with disabilities education improvement act) amendments 1991

reauthorized early intervention; established federal interagency coordination council

hypothalamus does what

recieves and integrates info from the autonomic nervous system and assists in regaulating hormones controls hunger, thirst sexual behavior and sleeping body temp adrenal and pitutiary glands and other vital activities lesions can produce obestiy sexual disinterest poor temp control and diabetes

SLR emphasizes what muscle

rectus femoris (dynamic hip flexion and isometric contraction of quads), acts on both hip and knee unlike vastus medialis and lateralis resistance from gravity decreases as the lower extremity is elevated

key points of control

specific handling of designated areas of the body (shoulder, pelvis, hand, foot) will influence and facilitate posture, alignment and control.

no child left behind act 2002

redefines the federal role in K-12 education, it requires accountability for all children, including student groups based on poverty, race and ethnicity, disability and limited english proficiency LEP its goal is to close the achievement gap between disadvantaged, disabled and minority students with their peers

antiepileptic agents

reduce or eliminate seizure activity within the brain inhibit the firing of certain cerebral neurons through various effects on the CNS barbiturates, bezodiazepines, carboxylic acids, hydantoions, iminostilbenes, succinimides and second generation drugs side effects include ataxia, skin issues, behavioral changes, GI distress, HA, blurred vision, weight gain PTs must know procedure for seizure response and side effects patients with epilepsy may show greater sensitivity to environmental surroundings such as light or noise level seconal (secobarbital), klonopin (clonazepam), depakote (valproic acid), dilantin (phenytoin), tegretol (carbamazepine), celontin (methsyximide), neurontin (gabapentin)

soft (ace wrap, shrinker)

reduces post op edema provides some protection relatively inexpesnive easily removed for wound inspection allows for active joint range of motion tissue healing is interrupted by freq changes joint range of motion may delay healing of the incision less control of residual limb pain cannot control the amount of tesnion in the bandage risk of tourniquet effect shrinker cannot be applied until sutures are removed

anemia

reduction in circulating red blood cells or reduction in hemoglobin most common disorder of the blood three main categories: excessive blood loss (hemorrhage) excessive blood cell destruction (hemolysis) deficient red blood cell production (hematopoiesis) pallor, cyanosis, cool skin, vertigo, weakness, headache, malaise

if you find a moderate scoliosis curve what should you do

refer for further orthopedic assessment because moderate curves require a spinal orthosis and PT a physician should also evaluate the pateint prior to the development and implementation of an exercise program

dysvascular

refers to the disease of the blood vessels, including peripheral vascular disease, peripheral arterial disease, and complications related to diabetes

afterload

refers to the forces that impede the flow of blood out of the heart, primarily the prssure in the peripheral vasculature, the compliance of the aorta, and the mass/viscosity of blood

preload

refers to the tension in the ventricular wall at the end of diastole, it reflects the venous filling pressure that fills the left ventricle during diastole Preload can be defined as the initial stretching of the cardiac myocytes prior to contraction. Preload, therefore, is related to muscule sarcomere length. Because sarcomere length cannot be determined in the intact heart, other indices of preload are used such as ventricular end-diastolic volume or pressure. When venous return to the heart is increased, the end-diastolic pressure and volume of the ventricles are increased, which stretches the sarcomeres, thereby increasing their preload. In contrast, hypovolemia resulting from a loss of blood volume (e.g., hemorrhage) leads to less ventricular filling and therefore shorter sacromere lengths (reduced preload). Changes in ventricular preload dramatically affect ventricular stroke volume by what is called the Frank-Starling mechanism. Increased preload increases stroke volume, whereas decreased preload decreases stroke volume by altering the force of contraction of the cardiac muscle.

midbrain

relay area for info passing from cerebrum cerebellum and SC REFLEX center for visual auditory and tactile responses

thalamus is what

relay station processing station for info that goes to cortex coordinates sensory with movement recieves sensory from cerebellum basal gang and all sensory except for olfatory damage to the thalmus causes thalamic pain syndrome where there is spontaneous pain on the contralateral side of the body to the thalamic lesion

tenotomy

release of tendon to decrease spasticity and improve function

dopamine replacement agents

relieve sx of parkinsons secondary to the decrease in endogenous dopamine these agents are able to cross the BBB thought active transport and transform to dopamine within the brain side effects include arrhythmias (levodopa), GI distress, orthostatis hypotension, dyskinesias, mood and behavioral changes, tolerance PTs maximize benefit by scheduling therapy one hour after administration of levodope PTs must understand affects of drug holiday (stop taking prescription) and monitor the patients BP freqently due to the potential for orthostatic hypotension sinemet or madopar (levodopa), symmetrel (amantadine)

hypermangesemia

renal failure hypotension and respiratory depression

benign paroxysmal positional vertigo BPPV

repeated episodes of vertigo that occur with changes in head position only lasts a few seconds and is typically first noted while in a recumbent position since it most commonly affects the posterior semiciruclar canal etiology is usually otoconia (canalith) that loosens and travels into the posterior semicircualr canal causing vertigo nystagmus is present and can be noted when assessing a patient using the dix hallpike test pts with BPPV find it self limiting and can be successfully treated with canalith respositioning maneuvers which are passive mvoement used to revmove the otoconia from the canals

intrinsic (inherent) feedback

represents all feedback that comes to the person through sensory systems as a result of the movement including visual, vestibular, proprioceptive, and somatosensory inputs

msk pain can be relieved by

rest, change in position, strethcing, heat and or cold

IDEA amendments 1997

restructuring IDEA into four distinct and individual parts, it defines the responsibilities of school districts in providing services to ensure that children with certain specified disabilities receive free, appropriate education school districts must prepare an individualized education program (IEP) for each eligible child related services most commonly include speech, physical, and occupational therapies and child counseling

phonetics

speech sounds

grade 2 concussion

result from a moderate head injury with transient confusion that will last longer than 15 min exhibit poor concentration, retrograde and anterograde amnesia remove IMMEDIATELY from the competition and receive a medical evaluation CT scan is indicated if sx worsen and return to play should be deferred until the athlete is asymptomatic for TWO weeks at RESET and with exertion

Trigeminal Neuralgia BRONZE

result of abnormal prssure on or irritation of the trigeminal nerve etiologies include tumor or swollen blood vessel irritation is more commonly assocaited with condtions taht cause demyelination such as multiple scerosis in some cases continuous pulsations and consequent friction of a blood vessel in contact with the nerve can cause dmelination and subsequent sx overtime cranial nerve V 5 mixed sensory and motor that originates in the brainstem and branches into ophthalmic, mandibular, and maxillary produces a chronic pain cnodition which may impact the entire nerve dsitribution spending on the location and severity most common location of injyry is the narrow space where the enrve exits the brainstem sx = unilateral and may be episodic or constant episodic sx most commonly present as sudden onset of pain described as sharp, jolting, stabbing or shocklike spasms or tics may also occur episodic sx may be triggered by touch or sounds with attacks that result from ADLS such as shaving, chewing or oral care chronic sx are more commonly described as persisent aching or burnign sensations which may be exacerbated by the same type of ADL that trigger episodic sx can be progressive and can be debilitating in severe cases more common among WOMEN and individauls >50 MR angiography utilzies a colored dye to visualize blood flow near the brainstem and identify vessel pathology that may be causing compression of the trigeminal nerve diagnostic testing is often inconclusive with a dignosis typically made based ont he aptients reported symptoms

dependent edema which type of heart failure

right muscle weakness is for left

posterior descending artery

right coronary artery inferior walls of bothventricles inferior portion of the interventricular septum

cor pulmonale

right sided heart failure from disease in lungs distension of neck veins and shortness of breath elevated central venous pressure ascites (accumulation of fluid in the peritoneal cavity), peripheral edema of the feet and ankles are common fatigue and exercise intolerance

heel cup

rigid insert that covers the plantar surface of the calcaneus and extends upwrads on all three sides help stabilize the calcaneus in a neutral position as well as porovide some shock absorption for the heel used for patients with a calcaneal supor or PFascitis

heel lift

rigid insert which adds extra height to the heel of a shoe used to tak epressure off of the achilles tendon for patietns with tendonitis or recent repair of the tendon also used to help limit the effects of a leg length discrepancy

tinetti measures

risk of falls static and dynamic balance

liner

role in comfort and health of individials using a prosthesis gel liners commonly made from silicone are used for cushioning and hosting a suspension mechanism such as a pin or lanyard some liners are used to maintain suspension through negative pressure such as what is seen with a transfmeoral seal-in liner liners are for the most part, nonbreathable which means perspiration can build up throghout the day and can result in friction issues and cause irriation frequent doffing is required to dry it out along with the residual limb they must be carefully awashed and dried to maintain a hygenic environment gel sheaths can be applied underneath the liner directly on the skin and can serve to relieve irritation

sympathetic and parasympathetic influence on heart

s - achieved by release of epinepherine and norepinephrine, sympathetic nerves stimulate the chambers to beat faster (chronotropic effect) and with greater force (inotropic) (vagus and sympathetic cardiac nerves converge to form the cardiac plexus at the base of the heart) p - achieved via acetylcholine release from the vagus nerve, parasympathetic nerves slow the heart rate (chronotropic) primarily through their influence on the SA node

pain caused by systemic vs msk pathology

s - tends to be more recent and sudden in onset msk - sudden onset or painful intermittently for years

abduction and adduction of thumb occur in what plane

sagittal plane forward and back

a flutter what on ecg

sawtooth P waves regular rhytum very fast 250-350 bpm a flutter and a fib are characterzed by rapid rates of atrial depolaization

UE D2 Extension

scapula: depression + abduction + downward rotation should: ext + add + IR forearm: pronation Wrist: flex + Ulnar Dev digits: flex and Add Thumb: opposition put your sword in your pocket tennis serve

glascow coma scale

scores from 3-15 determine arousal and cerebral cortex function <8 severe and coma in 90% of patients 9-12 moderate 13-15 mild eye opening + best motor response + verbal response eye opening spontaneous eye opening (4) to speech (3) to pain (2) nil aka zero (1) best motor response obeys commands (6) localizes pain (5) withdraws (4) abnormal flexion (3) extensor resposne (2) nil (1) verbal response oriented (5) confused conversation (4) inappropriate words (3) incomprehensible sounds (2) nil (1)

foot orthosis

semirigid or rigid insert worn ninside a shoe that corrects foot alignment and improves function may relieve pain custom molded and designed for specific level of functioning

ascending tracts

sensory ascending in white matter

where do sensory and motor nerves originate

sensory - dorsal root ganglia motor - anterior horn of the spinal cord

dermatome

sensory area based on spinal segement innervation

pathology of neuromuscular junction

sensory component intact motor fatigue is greater than actual weakness normal DTRs myasthenia gravis

pathology of anterior horn cell

sensory component intact motor weakness and atophy fasciculations decreased DTRs ALS, polio

pahology of msucle

sensory component intact motor weakness, fasciculations rare nromal or decreased DTRs MD

pathology of spinal roots and nerves

sensory component will have corresponding dermatomal deficits motor weakness in an innervated pattern, may have fasciculations decreased DTRs herniated disc

pathology of peripheral polyneuropathy

sensory impairments, stocking glove distrbution may have fasciculations diabetic peripheral polyneuropathy

ASIA B

sensory incomplete sensory but not motor is preserved below the neurological level and extends through sacral segments S4-S5

pathology of peripheral nerve (mononeuropathy)

sensory loss along the nerve route motor weakness and atrophy in a peripheral distribution may have fasciculations trauma

spinothalamic tract (anterior) ascending

sensory tract for light touch and pressure

spinothalamic tract (lateral) ascending

sensory tract for pain and temperature

sepsic vs neurogenic vs cardiogenic vs hypovolemic shock

sepsis - infection spread throughout body neurogenic - SCI cardiogenic - heart failure or MI hypovolemic - severe blood loss

critical limb ischemia

serious medical condition that potentially threatens the sustainability of the limb characterized by severe pain in the legs and feet at rest often experiences the pain when in bed and may be able to diminish the intensity of pain by hanging the legs over the edge of the bed or getting up to walk around caused by advanced stages of peripheral ARTERY disease SHINY, smooth, dry skin on legs or feet

epicardium

serous layer of the pericardium the epicardium contains the epicardial coronary arteries and veins, autonomic nerves and lymphatics

T7 sensory testing

seventh intercostal space midway between T6 and T8

neuralgia

severe and multiple shock-like pains that radiate from a specific nerve distribution

myelotomy

severs certain tracts within the spinal cord in order to decrease spasticity and increase function

colostomies

sigmoid solid and regular descending firm but irregular transverse soft or loose infrequent ascending liquid containing digestive enzymes

pusher syndrome

significant lateral deviation TOWARD the hemiplegic side common in pts who sustained a Right CVA tx = mirror therapy, small wedge placed under the left lateral thigh, weight shifting across midline, and facilitation techniques for trunk control

rocker bar

similar to MT bar in placement but it consists f a convex strip instead of a flat strip it assist patients who have difficulty with the terminal stance phase of gait secondary to limited mobility of the foot espeically with the great toe helps releive pressure form the MT heads for patients with pain in this region

open system vs closed

single transfer of information without any feedback loop (reflexive hierarchial theory) where the nervous system is seen as awaiting stimuli in order to react vs multiple feedback looks where the NS is an active participant with the ability to enable the initiation of mvoement as oppsosed to soley reacting to stimuli

friction burn

single well defined not scattered

effective cough after thoracic surgery

sitting (where you can take a max inhalation) standing sidelying and hooklying do not allow this

propped sitting is what

sitting with arms holding babyself up ring sitting would be a progression where the baby can hold himself up with his back extensors

T6 sensory testing

sixth intercostal space at the level of the xiphisternum aka xiphoid process

PNF resisted progression

skill a technique used to emphaisize coordination of proximal components during gait resistance is applied to an area such as the pelvis, hips, or extremity during the gait cycle in order to enhance cooridnation, strength, or endurance i..e if give quick stretch to hip flexors (push back on anterior aspect of pelvis) will encourage hip flexion during gait

PNF normal timing

skill a technique used to improve coordination of all components of a task NT is performed in a distal to proximal sequence, proximal components are restricted until the distal components are activated and initiate movement repetition of the pattern produces a coordinated movement of all components

PNF timing for emphasis

skill used to strengthen the weak component of a motor pattern isotonic and isometric contractions produce overflow to weak muscles i.e. if elbow is weak will stop them at 50% of the motion (up and across) and the shoulder muscles will be doing an isometric contraction against the therapist while doing an isotonic contraction at the elbow (overflow from the strong isometric happening at the shoulder) once she can flex the elbow can allow the patient to move through the the rest of the PNF motion

developmental coordination disorders

slow mvmt times poor motor sequence poor motor memory perceptual problems also associated with learning disabilities, sensory integration disorders, attention deficit hyperactivity

atherosclerosis

slow progressive accumulation of fatty plaques on the inner walls of arteries over time the plaque can restrict BF causing a blood clot exact cause unknown, the process may begin with damage or injury to the inner wall of the artery from hypertension, high cholesterol, smoking or diabetes over time, the fatty plaques made of cholesterol and other cellular waste products build up at the site of injury and harden, narrowing the artery and impeding blood flow s/s = if coronary arteries are effected, may cause angina pectoris, cerebral arteries may cause numbness or weakness of the arms and legs, difficulty speaking or slurred speech, or drooping of the face muscles, peripheral arteries may cause intermittent claudiacation tx = lifestyle changes, medications and surgery smoking cessation, regular exercise, healthy diet, and stress management antihypertensives, antiplatelet, and antilipidemic agents surgeries = angioplasty, endarterectomy and bypass

c fibers

small poorly myelinaed or unmyelinated slowed condution rate postgang fibers of symp nerv system exxteroceptors for pain temp and touch SENSORY

why do old people become incontinent

smaller bladder with decreased sensitivity to urge

prosthetic and amputee causes of excessive knee flexion during stance

socket set forward in relation to foot excessive DF stiff heel prosthetic is too long knee flexion contracture hip flexion contracture pain anteriorly n residual limb decreased quad strenght poor balance

prosthetic and amputee causes of forward trunk flexion

socket too big poor suspension knee instability hip flexion contracture weak hip extensors pain with ischial weight bearing inability to initiate prosthetic knee flexion

heel cushion

soft pad that is palced on the heel of the inner sole to cushion the heel and thus decreased pain in that region may be used for apatient with a calcaneal supor or plantar fascitis

operant conditioning

specific behaviors that receive certain consequences i.e. positive reinforcement, negative reinforcement, extinction and punishment

parapodium

standing frame designed to allow a patient to sit when necessary it is a prefabricated frame and ambulation is achieved by shifting weight and rocking the base across the floor it is used by the pediatric populaton

obtundity

state of consciousness that is characterized by a state of sleep, reduced alertness to arousal, and delayed responses to stimuli

delirium

state of consciousness that is characterized by disorientation, confusion, agitation, and loudness

clouding of consciousness

state of consciousness that is characterized by quiet behavior, confusion, poor attention, and delayed responses

stupor

state of general unresponsiveness with arousal occurring from repeated stimuli

balance

state of physical equilibrium maintenance and control of center of gravity achieving and maintaining an upright posture integrated somatosensory, visual, and vestibular

coma

state of unconsciousness and a level of unreponsiveness to all internal and external stimuli

procedure for seizure

stay calm and prevent injury remove all objects surrounding the person to ensure that there is nothing that could harm the person during the seizure maintain awareness of the length of time of the seizure ensure that the person is as comfortable as possible do not allow other people near the person in an effort to keep the individual isolated consider your safety and do not hold the person down there is no need for restraint if the person is thrashing avoid placing anything into the persons mouth (the person is not capable of swallowing their tongue) avoid providing any water food or medicine until the person is fully alert be prepared to call 911 if the seizure lasts longer than 5 minutes

angle of louis

sternal angle manubrium articulates with the body of the sternum (manubrium is the top of the sternum, then the body then the xiphoid) where the SECOND rib articulates

superficial reflex vs light touch

stroke with noncutting but pointed object vs light feathery object

motor learning

study of the acquisition or modification of movement

where to elicit brachiradialis reflex

styliod process of the radius

muscles innervated by the posterior cord of brachial plexus

subscap teres major latissumus dorsi

Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery

subset of the fugl-meyer physical performance battery and is designed to assess balance specifically for patients with hemiplegia 7 items scored 0-2 max score of 14 (but still may not have normal balance)

ballismus results from lesion in the

subthalamic nucleus of basal ganglia

T3 sensory testing

third intercostal space

hypernatremia

thirst lol

acute respiratory distress syndrome ARDS

sudden respiratory failure due to fluid accumulation in the alveoli, usually occurs in people who are already critically ill or who have significant injuries severe shortness of breath develops within a few horus to a few days after the original disease or trauma fatal in 25-40% of the people who develop it survivors may not regain full lung function for a year or more etiology is fluid leaking from the smallest blood vessels in the lungs into the alveoli normally a protective membrane keeps this fluid in the vessels however inflammation undermines the membranes integrity leading to the fluid leakage, a number of conditions can injure the lungs and lead to inflammation including = severe viral or bacterail pneumonia infection spreading through the blood (sepsis) heart failure multiple or massive blood transfusion a serious head or chest injury fx of long bones which cause a fat embolism prolonged use of large volumes of supplemental o2 accidental inhalation of vomit or chemcials such as ammonia or chlorine smoke inhalation near drowning an adverse reaction to cancer drugs or other medications drug over dose most commonly with heroin shock from any cause s/s = severe SOB, labored and unusually rapid breathing, hypotension, confusion, extreme fatigue, cough and fever tx = first goal is to get oxygen to the lungs and organs most ppl will be treated with supplemental O2 and mechanical ventilation treat underlying condition meds are given to prevent and treat infection, relieve pain, provide sedatin, and prevent blood clot formation

tics

sudden, brief, repetitive coordinated movements that will usually occur at irregular intervals. Tourette vary from myoclonic jerks to jumping movements that may include vocalizatin and repetiion of other tounds

central venous line

superior vena cava or inferior or within the right atrium to measure right atrial pressure may also be used as a route for medication of fluid administration, blood sampling and emergency placement of a pacemaker

pronator teres MMT

supine partial elbow flexion

percussion to the anterior basal segments of the lower lobes happens in what position

supine with the foot of the bed elevated 18 inches

walking (stepping) reflex (stimulus, response, normal age of response, interferes with...)

supported upright position with soles of feet on firm surface reciprocal flexion/extension of legs 38 weeks gestation to 2 months interferes with... standing and walking balance reactions and weight shifting in standing development of smooth, coordinated reciprocal movements of lower extremities

C3 sensory testing

supraclavicular fossa

rhizotomy

surgical resection of the sensory component of a spinal nerve in order to decrease spasticity and improve function

dystonia

sustained muscle contractions that causes twisting, abnormal postures, and repetitive movements all muscles can be affected and the involuntary movements are often accentuated during volitiional movement and with progression can produce overflow i.e. parkinsons CP encephalitis

vestibular input for children with a sensory processing disorder

swings, sit and spin, rocking chair can calm a child who is overaroused the rocking chair can

where do symp and parasymp originate

symp - lateral horn of the thoracic spinal cord para - lateral gray matter of the sacral level

karvonen heart rate reserve method

target heart rate range = [(HR max - HR rest) * 0.60 and 0.80] + HR rest max heart rate - resting heart rate = heart rate reserve bascially this will give you 60-80% of the heart rate reserve which is then added to the resting heart rate

facilitation

technique utilized to elicit voluntary muscular contraction.

pt feels pain with new exercises 2 hours after visit what do you do

tell them to stop the exercises and will reevaluate at next visit

superficial vs deep vs cortical sensation

temperature, light touch, pain proprioception, kinesthesia, vib bilateral simultaneous stimulation, stereognosis, two pt discrimm, barognosis, localization of touch

syncope can be caused by

temporary reduction in blood flow which creates a shortage of oxygen to the brain anemia (low RBC), dehydration, orthostatic hypotension (loss of sympathetic control of vasoconstriction in combo with absent or severely reduced muscle tone, both dehydration and anemia can increase the risk of orthostatic hypotension), and pregnancy (compression of the inferior vena cava by the enlarged uterus)

left chambers collect blood from...

the lungs and pump it to the body

motor level

the most CAUDAL (tail) key muscles that have muscle strength of 3 or greater with the superior segment tested as normal or 5

sensory level

the most CAUDAL dermatome with a normal score of 2/2 for pinprick and light touch

cerebrum

two hemis conjoined by white matter called corpus collosum gray on the outside, white on the inside

taking patient temperature which is highest to lowest

tympanic membrane/rectal oral axillary

what does the diaphragm separate

the thoracic and abdominal cavities dome shaped

post-traumatic amnesia

the time between the injury and when the patient is able to recall recent events, pt is not able to recall the injury or events up until this point of recovery this is usually an indicator of the extent of damage

pistoning

the transplation of the prosthetic limb from the residual limb, it is the result of inadequate suspension and can result in distal residual limb skin issues

inferior vena cava

the vein that returns blood from the lower body and viscera to the right atrium

anatomic dead space volume (VD)

the volume of air that occupies the nonrespiratory conducting airways (internal airways of the upper airways) i.e. nose pharynx trachea bronchi for ventilation not respiration

why would bony obstruction not be a reason for extensor lag

then both AROM and PROM would be limited and extensor lag PROM > AROM

C8-T1 nerve lesion affects what muscles

thenar abductor pollicis bre flexor poll brev opponen poll

who should monitor the hot pack on a pt

therapist with feedback from pt supply with bell to ring if it comes too intense

observer and children for research

they can spend time with the child before they observe to make them feel more comfortable what kind of bullshit is that

person with limb loss

this term describes an individ who has lost a limb due to amputation

taylor brace

thoracolumbarsacral orthosis that limits trunk flexion and extension through a three point control design

blood platelets

thrombocytes assist in blood clotting by clumping together at a bleeding site and forming a plug that helps to seal the blood vessel low platelets (thrombocytopenia) increases the risk for bruising and abnormal bleeding high platelets (thrombocythemia) increases the risk of thrombosis which may result in stroke or heart attack

when to do abdominal thrusts vs finger sweep

thrusts can be used until the object is expelled or the victim becomes unresponsive red cross recommends back blows in combo with thrusts thrusts are not recommended in infants due to increased risk for injury chest thrusts can be used if abdominal thrusts fail rescue breathing for person who is unresponsive aka not breathing but has a palpable pulse finger sweep is recommended if the health care provider can see the solid material obstructing the airway of an UNRESPONSIVE patient

CVA exhibit abnormal what reflexes

tonic reflexes asymmetrical tonic neck relfex ATNR produces extension of the affected upperextremity when the head is turned toward the affected side, the upper extremity on the other side will flex

tidal volume (TV)

total volume inspired and expired with each breath during quiet breathing TV is 10% of total lung volume

rooting reflex (stimulus, response, normal age of response, interferes with...)

touch on cheek turning head to same side with mouth open 28 weeks of gestation to 3 months interferes with... oral motor development development of midline control of head optical righting, visual tracking, and social interaction

galant reflex (stimulus, response, normal age of response, interferes with...)

touch to skin along spine from shoulder to hip lateral flexion of trunk to side of stimulus 30 weeks of gestation to 2 month interferes with... development of sitting balance can lead to scoliosis

dressing as a prophylactic measure to reduce the risk of skin break down

transparent film thin membrane coated with a layer of acrylic adhesive allows for frequent assessment of the wound and offers some level of protection oxygen permeable however or impermeable to microorganism and moisture

elevation of the lower ribs increases the...

transverse diameter (side to side)

K-Level 2

transverse low level barriers: curbs, stairs, uneven surfaces limited community ambulator knee polycentric, constant friction mechanism flexible keel foot multiaxial foot/ankle

UE nerve injuries assocaited with

trauma penetration traction compression

facilitate elbow extension in a patient with hemiplegia after CVA

turn the head to the affected side

positive support reflex (stimulus, response, normal age of response, interferes with...)

weigh placed on balls of feet when upright stiffening of legs and trunk into extension 35 weeks gestation to 2 months interferes with... standing and walking balance reactions and weight shift in standing can lead to contractures of ankles into plantar flexion

when can placebo control be used with humans

when no treatments have been effective or when the purpose is to determine if a particular treatment is not effective IRB always has to review the research proposal before implementation in humans to ensure rights are protected

when can you start AAROM with proximal humerus fracture

when you see callus formation in imaging remodeling is the final step of bone healing would do AAROM before this diminished pain often accompanies the initiation of more dynamic ther act folliwing fx but the finding itself does not provide the necessary info to determine the patients current stage of healing

tender points vs trigger points

wide spread small, localized pain, sensitive to pressure localized to a specific region and will radiate pain

athetosis looks

wormlike with a rotatory component

calcium alginate

wounds that produce moderate to heavy exudate a wound with minimal exudate is unlikely to saturate the alginate to the extent necessary for it to form a beneficial hydrophilic gel

C6 key muscle

wrist extensors (ECRL and ECRB)

heterograft is the same as

xenograft from another species

should you refer to physican if no progress in 3 weeks with variety of treatment tried?

yes

would hemarthosis limit ROM

yes accumualtion of blood in a joint not necessarily associated with patellar tendon rupture

olecranon bursitis aspiration or no

yes relieve the inflammation and prevnt futher accumulation of fluid excessive fluid can inhbit range of motion and functional use of the elbow will analyze fluid to rule out infection or gout