Musculoskeletal and Neuro

Indicatons for Sensory Stimulation Pts who demonstrate absent or disordered (1)______, who would benefit from (2)______ feedback, most useful in early stages of (3) ______

1) motor control 2) augmented 3) motor learning

Complex Regional Pain Syndrome 1) Description 2) Sx do not occur in ______ pattern

1) neurogenic pain and inflammation and activity of SNS 2) peripheral or nerve root pattern

Forefoot varus 1) Involved deviated structures 2) Observed deformity

1) Head and neck of talus 2) inversion of forefoot with subtalar neutral

Pes Cavus 1) aka 2) Deformity Observed (5) 3) Reduces ability to ______ _______ through foot 4) Pt must limit ____-____ activities

1) Hollow Foot 2) increased longitudinal arch height, drop of anterior arch, metatarsal heads lower than hindfoot, PF and splaying of forefoot, claw toes 3) absorb forces 4) high-impact

UE Extensor Tendon Repair 1) First 6-8 weeks 2) When is AROM initiated 3) Active ______ exercises initiated first, followed by ______ 4) Resisted and functional exercise introduced when?

1) Immobilization of interphalangeal joints in neutral for distal repairs 2) at 6 weeks with PIPs in neutral 3) Extension; flexion 4) full AROM achieved

Unhappy Triad 1) Description 2) Causation

1) Injury to MCL, ACL, and medial meniscus 2) Combo of valgum, flexion, and ER on planted LE

Locomotor Training for pts with low lumbar lesions 1) segments 2) AD and Orthosis 3) Level of independence

1) L4-5 2) B AFO and crutches or cane 3) Independent

Localized Lesion to Cortex: Frontal Lobe: Motor Speech (Broca's Area) 1) Function 2) Sx

1) Language Production 2) Nonfluent aphasia

Localized Lesion to Cortex: Temporal Lobe: Wernicke's Speech Area 1) Function 2) Sx

1) Language understanding and formulation 2) Fluent Aphasia

Localized Lesion to Cortex: Parietal Lobe: Postcentral Gyrus/Somatosensory Area 1) Function 2) Sx

1) Somesthetic Sensation 2) Contralateral loss of stimulus location

Normal Metatarsophalangeal angle?

8-20 deg

A hemorrhagic CVA is precipitated by _______ which leads to _______ or _______, causing the the stroke

hypertension; aneurysm or arteriovenous malformation

Elevation in temperature may indicate infection or damage to the ______ or ______

hypothalamus or brainstem

How to screen stereognosis

identifying object without sight

What is the strongest ligament in the body?

iliofemoral ligament

Purpose of a MRI and what does it rule out?

imaging bones, tissues, and organs, and nerves; brain or spinal tumors, MS, and head trauma

Indication of isometrics post THA for cemented and cementless

immediately post-op to pt tolerance

Golfer's elbow typically involves which tendons?

pronator teres and/or flexor carpi radialis

Description and use of HKAFO

pts with hip, knee, ankle and foot weakness. Can control hip rotation and ABD/ADD. pts can only use swing-to or swing-through gait

Indication for soft tissue/myofacial techniques

pts with soft tissue and jt restrictions that result in pain and limit ADLs

(lateral) Corticospinal Tract is responsible for? (1)

pyramidal motor tract: contralateral fine movement

(anterior) Corticospinal Tract is responsible for? (3)

pyramidal motor tract: ipsilateral voluntary, discrete, and skilled movement

Rate of regeneration of axonotmesis injury

regenration distal to site of injury of 1mm/day

Ataxic Gait

staggering and unsteady gait usually with wide BoS and exaggerated movements

Importance of subthalamus

regulating skeletal muscle movement

Description of Elbow Disarticulation (surgery)

removal of lower upper extremity through elbow joint

Description of Transhumeral Amputation

removal of upper extremity proximal to elbow

Description of Shoulder Disarticulation

removal of upper extremity through shoulder

Relationship between femoral rotation and the tibia.

rotate in same direction

Spinal Movement Couplets: Cervical Side-bending and rotation occur in same/opposite (?) direction from C2-C7 regardless of positioning of spine.

same

Homonymous Hemianopsia

same sided blindness of both eyes (i.e. medial left eye and lateral right eye)

Which 3 carpal bones make up the radiocarpal joint with the radius?

scaphoid, lunate and triquetrium

An EEG is used to rule out (5+)

seizure disorders, brain death, brain tumors, brain damage, inflammation, alcoholism, select psychiatric disorders, and brain related degenerative disorders

Osgood-Schlatter Disease description

self-limiting disease from repetitive traction on tibial tuberosity apophysis at patellar tendon insertion

Initial sx of carpal tunnel sundrome?

senosory deficits along median nerve distribution distal to compression, may have radiate up into upper arm, shoulder, and neck

Somatognosia

sense of ones own body (identify own body looking in mirror)

(anterior) Spinothalamic Tract is responsible for? (2)

sensory light touch and pressure

Description and use of Parapodium

standing frame designed to allow for sitting. Use weight shift and lean to progress in gait. Primarily used in pediatrics

PNF: D1 Flexion of upper extremity looks like

start of backhand swing

Spastic Gait

stiff movement, toes catch and drag, legs held together, hips and knees slightly flexed. Common in spastic paraplegia

Common Signs and Symptoms associated with Facet Joint Dysfunction (5) -Common test to help identify?

stiff upon rising but eases within hour, loss of RoM, pain is sharp with certain movements (extension), repetitive movements in pain-free range relieves sx (flexion), prolonged sit/stand increase symptoms -quadrant test

PNS Pathos: Describe Polyneuropathy pathology and give an example (4/1)

stocking glove sensory loss, motor weakness (distal>proximal) and atrophy, possible fasciculation, decreased DTRs; diabetic peripheral neuropathy

Characteristics of CVA in: Brainstem (4)

unstable vitals; decreased consciousness; decreased ability to swallow; bilateral weakness/paralysis;

When the tibia ER, the talus ______ and the foot ______

up glides; supination

Elevators of the scapulae (2)

upper traps, levator scap

Perform ______testing prior to cervical segmental manipulations

vertebrobasilar

Definition of bradykinesia

very slow movement

30-65% of TBI pts exhibit ______ sx

vestibular

Describe post-polio syndrome

viral infection resulting in neuropathy that includes focal and asymmetrical motor impairments. Affects those who have had polio

Function of Frontal Lobe

voluntary movement, (left hemisphere) Broca's:(speech, concentration), personality, judgement, executive functions

Functions of basal ganglia (5)

voluntary movement, autonomic movement regulation, posture, tone, control of motor responses

Causes of hip hiking during swing (2)

weak DF or knee flexors

Causes of circumduction during swing (3)

weak DF, hip flexors, or hamstrings

Common causes of lordosis (4)

weak abs, pregnancy, excessive abdominal weight, hip flexion contractures

Causes of insufficient hip flexion at initial contact (4)

weak or paralyzed hip flexors, hip extensor spasticity, insufficient hip flexor RoM

Causes of excessive knee flexion at contact (4)

weak or paralyzed quads, hamstring spasticity, insufficient extension RoM

Are hereditary ataxias progressive?

yes

Are sx of Guillain-Barre Syndrome symmetrical?

yes

Is the damage done to nerve fibers reversible in axonotmesis?

yes; due to anatomical relationship between fibers

Typical age range of Guillain-Barre?

young adult and those 50s-80s

Pt post-op ACL/PCL reconstruction is typically Non-WB for how long

~1 week

Normal degree of toe-out during free speed walking

~7 degrees

Differential Dx: Tarsal Tunnel Syndrome vs Plantar Fasciitis

+ (TTS) vs - (PF) Tinel sign

Predictable Patterns of Impairment with occlusion to vertebral-basilar artery

-Locked-in syndrome, comatose, vegetative -Wallenberg Syndrome

Two significant symptoms of posterior cerebral artery syndrome

-Most significant: thalamic pain syndrome and cortical blindness

Localized Lesion to Cortex: Frontal Lobe: Middle Frontal Gyrus 1) Function 2) Sx

1) Conjugate Eye Movement 2) Contralateral eye conjugate movement paralysis

Trochanteric Bursitis 1) Causes 2) Typical pt population

1) Direct blow, ITB irritation, repetitive microtrauma from abnormal biomechanics/gait pattern 2) RA

Description of Faber Test (Patrick's Test)

Iliopsoas, SI or hip joint abnormalities: pt in supine with test leg flexed, ABD, and ER onto opposite leg. PT slowly lowers test leg to table. Positive if cannot fall below opposite leg.

Hip flexors (4)

Iliopsoas, sartorius, rectus femoris, pectineus

Ambulation guidelines for cemented TKA post-op

Immediately WBAT with walker, cane 3 weeks post-op, FWB week 4

Ambulation guidelines for cementless WBAT TKA post-op

Immediately post-op WBAT with walker, cane 5-6 week post-op, FWB week 6

Other Conditions Affecting the Spine: Visceral Tumors 1) Esophageal CA signs 2) Pancreatic CA signs

1) pain radiating to back, pain with swallowing, dysphagia, and wt loss 2) deep, gnawing pain that may radiate form chest to back

Myositis Ossificans 1) Description 2) Usually precipitated by ______ that results in ______ and ______ of the muscle 3) May also occur from? 4) Three most common locations 5) Instance for surgery 6) avoid this during treat

1) painful condition with abnormal calcification within muscle body 2) direct trauma; hematoma and calcification 3) aggressive PT following injury (mobilization/stretching 4) Quds, biceps, brachialis 5) in nonhereditary cases where maturation of lesion has occurred (6-24 months), or if lesion impedes movement or pinched nerves 6) aggressive: flexibility exercise, stretching, massage/soft tissue work

Patella Alta 1) Description 2) Positive Camel Back Sign

1) patella tracks superiorly 2) two bumps over anterior knee instead of one. Patella rides high in condyle (superior hump) and tibial tuberosity looks like second hump

Lifespan of THA

15-20 years

High incidence of Bell's Palsy is found in what age range?

15-45

Special Tests for Thoracic Outlet Syndrome (5)

Adson maneuver, Allen test, Costoclavicular syndrome test, Roos test, Wright test

Special Tests for wrist/hand vascular insufficiency (2)

Allen test, capillary refill test

What are zygapophyseal joints?

Also called a facet joint. Joints formed by right and left articular facets of superior vertebrae on an inferior vertebrae's left and right articular facets

Degenerative pathologies that can cause irreversible dementia (3)

Alzheimer's, Huntington's, MS

A heel wedge in a prosthesis that is too short will have what affect on gait after heel strike.

An extension moment is created at the ankle and leads to delayed and limited knee flexion after heel strike.

Left Hemisphere specialization/dominance

Analytical, controlled, logical, rational, Mathematical calculations, Language, Express positive emotions (love & happiness)

What ligament allows the radius to rotate and adhere to the ulna?

Annular ligament

Describe Ipsilateral Anterior Rotation Test

Assess for anterior movement of ilium compared to sacrum. Pt in standing PT one thumb on PSIS other center of sacrum level with other thumb. Have pt extend hip. Positive if PSIS does not move superiorly (anteriorly) with sacrum.

Describe Gillet's Test

Assess for posteriorly movement of ilium compared to sacrum. Pt standing PT places one thumb on testing LE PSIS and other equal with other thumb center of sacrum. Have pt flex hip and knee as if bringing knee to chest. PSIS should move inferiorly. Positive if no movement of PSIS compared to sacrum.

Degeneration of axons and myelin with distal to proximal progression "dying back" of nerves

Axonal Degeneration

Examples of UMN Dz (10)

CP, hydrocephalus, ALS (both), CVA, birth injuries, MS, Huntington's, TBI, pseudobulbar palsy, brain tumors

Immediately post-op ACL or PCL reconstruction use a ______ set at 0-70 deg

CPM

Velocity is calculated by?

Cadence X step length

Talar-Tilt Test tests which ligament?

Calcaneofibular Ligament

Description of Phalen's Sign

Carpal Tunnel secondary to Median nerve compression: pt sitting/standing. PT flexes pt's wrists maximally and asks pt to hold position for 1min. Positive if tingling in thumb/index/middle/lateral half of ring finger.

Description of Tinel's Sign

Carpal Tunnel: pt sitting/standing. PT taps volar aspect of pt's wrist. Positive if tingling over thumb, index finger, middle, or lateral half of middle fingers.

Typical Basal Ganglia damage symptoms and dx (6)

Cause symptoms of ability to control speech, movement, and posture. Dx include: Athetosis, chorea, hemiballismus, hyperkinesia, rigidity, and braykinesia.

Cementles vs cemented fixation for THA

Cementless/hybrid fixation: relies on bone growth. Partial or non-weight bearing. Typically used on developing bone (youth). Cemented fixation: WB as tolerated allowable immediately after procedure.

Characteristics of Central vs Peripheral Nystagmus: Length of Sx

Central: May be chronic Peripheral: Minutes, days, weeks, but finite periodof time; recurrent

Characteristics of Central vs Peripheral Nystagmus: Vertigo

Central: Mild Peripheral: Significant

Characteristics of Central vs Peripheral Nystagmus: Etiology

Central: demyelination of nerves, vascular lesion, CA/tumor Peripheral: Meniere's, vascular disorders, trauma, toxicity, inner ear infection

Capsular Pattern proximal/distal radioulnar joint

supination, pronation

Otoliths measure?

the effects of gravity and movement with regard to acceleration/decceleration

Consider ______ thrusts to attain desired cervical spine result.

thoracic

Description and use of Taylor Brace

thoracolumbosacral orthosis limits trunk flexion/extension

Symptoms of UMN dz (5)

weakness of involved muscles, hypertonicity, hyperreflexia, mild disuse atrophy, abnormal reflexes

Describe Vestibulo-ocular reflex

This reflex supports gaze stabilization through eye movement that counters movements of the head.

Description of Allen Test

Thoracic Outlet Syndrome (Radial/Ulnar Artery Occlusion): pt sitting/standing. test arm ABD, ER, and elbow flexed 90. PT monitors radial and/or pulse and pt rotates head away from test arm. Positive if absent/diminished pulse

Description of Costoclavicular Syndrome Test

Thoracic Outlet Syndrome caused by compression of subclavian artery between 1st rib and clavicle: pt sitting. PT monitors radial pulse and assists pt into military posture. Positive if absent/diminished pulse

Special Tests for neurological dysfunction at the elbow

Tinels Sign

UMN vs LMN: Muscle Bulk

UMN: variable, disuse atrophy LMN: Neurogenic Atrophy: rapid, focal, severe wasting

Misc. Shoulder tests (2)

Upper limb tension tests, glenoid labrum tear test

Sensory only CN affecting equillibrium

Vestibulocochlear

Causes of Foot Slap (2)

Weak or paralyzed DF

Sign and Sx of Achilles Tendonitis

aching/burning posterior heel, tenderness, pain with activity, swelling/thickening of area, weakness secondary to pain, morning stiffness

Define aphasia

acquired neurological impairment of precessing for receptive and/or expressive language

Possible locations of Upper Motor Neuron Dz (4)

cerebral motor cortex, internal capsule, brainstem or spinal cord

Most common complaint in MS pts

fatigue; worse increased activity and later in day

Contraindications to spinal tracton

joint ankylosis, bone malignancy, dz affecting ligamentous integrity (RA/Down's), arterial insufficiency, active inflammation/infection

Example antiepileptic meds

klonopin, dilantin

Gamekeeper's Thumb leads to ______ instability

medial

If a pt has a seizure does that indicate epilepsy?

no

If someone is having a seizure is there possibility to swallow tongue?

no

Description of X-rays (plain films) and uses

noninvasive radiographic test used for identifying and screening lung/heart dz, bone growth, fractures, dislocations, foreign objects

Observational Findings of: Atraumatic instability

normal bone/tissue outlines

If conservative treatment fails for congenital hip dysplagia then?

open reduction with hip spica cast. After cast removal PT

Spinal Movement Couplets: When occiput (C1) side bends, rotation occurs in same/opposite direction?

opposite

Signs and sx of MCL Sprain

pain, swelling, antalgic gait, decreased RoM, instability.

How to screen temperature

perceive warm and cold objects

How to screen Barognosis

perceive weight of different objects in hand

Wernicke's Aphasia is characterized by damage to what structure?

posterior region of superior temporal gyrus

Most common cause of neurapraxia

pressure injuries

Characteristics of strength with myopathies

proximal weakness of extremities

Vertebrobasilar artery strokes may lead to what palsy?

pseudobulbar

Strengthening the lumbricals with a pt with low-metatarsal arch using what?

resisted flexion of metatarsals.

Active Movement Findings: Frozen Shoulder

restricted RoM, shoulder hiking

Functional Scoliosis description

result of abnormal in body that directly impact spine (leg length discrepancy, poor posture, mm imbalance). Referred to as nonstructural scoliosis because it can be corrected with lateral bending

PT focuses on what with Alzheimer's pts?

retaining remaining function

Spino-olivary Tract is responsible for? (2)

sensory from cutaneous (skin) and proprioceptive organs (golgi tendons, mm spindles, etc.)

Anosognosia

severe denial, neglect or lack of awareness of severity of condition

Surgery may be needed for talipes equinovarus if?

severe or failed to properly position foot early on

Describe T1 MRI image

shows fat within tissues and is typically used for viewing bony structures (tissues with little water content)

Describe T2 MRI image

shows tissues with higher water content; muscle tissues, organs, etc

Recovery Stages of Diffuse Axonal Injury: Unresponsive/Vegetative

sleep-wake cycle returns with normalized vegetative function (RR, digestion, BP)

Description and use of Scott-Craig KAFO

specific for paraplegia. allows standing with posterior leaning

Purpose of a myelography

spin tap used to rule out abnormalities of subarachnoid space, spinal nerve injury, herniated disc, fractures, back/leg pathos, and spinal tumors

Purpose of a Nerve Conduction Velocity and used to rule out

stimulates peripheral nerve to test action potentials and ability to send signals; peripheral neuropathy, carpal tunnel, demyelination pathology, peripheral nerve compression

Shoulder IR mm (5)

subscap, teres major, pec major, lats, ant delt

Definition: Contusion

sudden blow to body that can cause mild-severe damage to deep and superficial structures

Definition of Tics and example

sudden, brief, repetitive coordinated movements occurring at irregular intervals; Tourettes

Mandible retrusion mm (3)

temporalis, masseter, digastric

Brudzinski's Sign 1) Test Position 2) Positive Sign; may indicate

1) supine, flex neck to chest 2) causes flexion of hips and knees (drawing up); meningeal irritation

Ape Hand Deformity 1) Characterisitcs 2) Result of?

1) thenar muscle wasting with dorsal alignment of 1st digit with second 2) Median nerve dysfunction

test for nystagmus?

Dix-Hallpike maneuver

Description of Posterior Drawer Test (knee)

PCL Injury: pt is supine knees flexed to 90 and hips flexed to 45. PT stabilizes legs by sitting on forefoot and grasps proximal tibia while palpating tibial plateau with thumbs. Posterior force applied. Positive if excessive displacement of tibia over femur with diminished or absent end feel.

Description of Ober's Test

TFL contracture: pt is sidelying with lower legged flexed at hip and knee. PT moves upper leg into hip extension and ABD attempts to slowly lower. Positive if inability to ADD/touch table

Hip IR mm (5)

TFL, glute med and min

Common mechanism of injury of sciatic nerve

THA, Blunt force trauma to the buttocks, Accidental injection into the nerve

Common mechanism of injury of obturator nerve

THA, Fixation of a femur fracture

Common mechanism of femoral nerve injury

THA, displace acetabular fracture, anterior dislocation of the femur, hysterectomy, appendectomy

Common etiology of femoral nerve injury (5)

THA, displaced acetabular fracture, anterior dislocated femur, hysterectomy, appendectomy

Most common surgery for advanced arthritis of the knee?

TKA

Best test to identify ligamentous instability of Calcaneofibular Ligament

Talar Tilt

Subtalar joint made up of which bones (2)?

Talus and calcaneus

Common mechanism of injury of tibial nerve

Tarsal Tunnel entrapment, or popliteal fossa compression

RoM of hip IR

0-45

RoM of thoracolumbar rotation

0-45

RoM Reqs. for Normal Gait: Knee Flexion

0-60

RoM of wrist extension

0-70

RoM of forearm pronation

0-80

RoM of forearm supination

0-80

Initial treatment of meniscal tear

RICE NSAIDs

Initial Treatment for Achilles Tendonitis (3)

RICE, NSAIDs, analgesics

Initial treatment of ACL sprain?

RICE, NSAIDs, analgesics.

Treatment option for plantar fasciiatis

RICE, NSAIDs, heel cup, massage, medial arch taping, joint mobs.

Most likely reason for a platform for a pt using bilateral axillary crutches is?

Radial nerve injury

Contraindications for MRI

metal implants, pacemakers

Ascending Tracts are sensory or motor?

sensory; afferent

Dorsal roots are sensory or motor?

sensory; afferent

Mobilization for non-irritated neural tissue

(Maitland) Grade III; engage barrier , but not painful

Tendonosis/tendonopathy vs tendonitis

Both are degenerative to tendon, however, only tendonitis is inflamamtory

Protraction of the scapulae (2)

serratus anterior, pec minor

Nonunion Fracture description

break in bone that has failed to unite and heal after 9-12 months

Closed Fracture description

break in bone where skin remains in tact

Definition of Nodes of Ranvier

brief gaps in myelination of axon to speed velocity by jumping node to node

Convex or Concave?: Subtalar movements (navicular and cuneiform)

concave

Convex or Concave?: Talofibular movements of fibula

concave

Hyperventilation could be caused by damage to the lower ______ and ______

midbrain and pons

Signs and sx of PCL sprain

pt reports feeling of femur sliding off tibia. May be asymptomatic

When examining sensation these can be tested superficially

temperature, light touch, pain

Initial LMN signs of ALS (4)

asymmetric muscle weakness, fasciculations, cramping, and atrophy within hands.

Localized Lesion to Cortex: Temporal Lobe: Primary Auditory Cortex 1) Function 2) Sx

1) Hearing 2) Contralateral subtle decrease in hearing and ability to localize sounds

Possible locations of Lower Motor Neuron Dz (2)

at or below level of brainstem, ventral gray column of spinal cord

Definition of causalgia

constant, relentless, burning hyperesthesia and hyperalgesia that develops after peripheral nerve injury

Lesions to the cortex produce ipsilateral or contralateral sx?

contralateral

Treatment of Patellofemoral Syndrome

contributing factors; treat sx

Convex or Concave?: Clavicle during sternoclavicular elevation/depression

convex

Peak Muscle Activity During Gait Cycle: Quads (2)

1.) single limb support during early stance and, 2.) initiating swing just before toe off

Localized Lesion to Cortex: Temporal Lobe: Parahippocampal Region 1) Function 2) Sx

1) Recent memory 2) cannot form new memories

Testing Combined (Cortical) Sensations 1) Stereognosis 2) Tactile Localization 3) Two-Point Discrimination 4) Barognosis 5) Graphesthesia 6) B Simultaneous Stimulation

1) Testing of ability to identify objects by placed in hand by manipulation/touch 2) Testing of ability to identify location of touch sensation by verbally or physically identifying location 3) Testing of ability to identify one or two blunt points stimulating skin simultaneously; Identify minimal distance in mm pt can identify 4) Testing of ability to identify similar size/shaped objects by weight 5) Testing of ability to identify numbers/letters traced on skin (hand) 6) Testing of ability to identify simultaneous touch on two separate segments of the body

Pigeon-Toed 1) common in children who ___ sit

1) W 2) metatarsus ADD, internal tibial torsion, increased femoral anteversion

X-rays typically used to view?

bony anatomy (dysfunction and/or dz

Which is a two-joint muscle: gastroc or soleus?

gastroc

What part of gait doesn't exist during running?

Double limb support

Ankle everters (3)

peroneus longus, brevis, and tertius

Swing phase is what % of gait?

40%

At risk groups for adhesive capsulitis (shoulder) (3)

40-60 years old Women DM

Oligoarticular Juvenile Rheumatoid Arthritis

40-60% of cases. Affects less than 5 joints asmmetrically

Which ribs attach to costal cartilage of other ribs?

8-10

Up to ___% of back pain in undiagnosed

85%

Define Somatagnosia

A lack of awareness of the relationship of one's own body parts or body parts of others.

Higher extent of aphasia seen in insidious or acute onset?

Acute

Passive Movement Findings: Frozen Shoulder

Capsular Pattern

Contraindicated Medication for Avascular Necrosis and why?

Corticosteroids; may be a causative factor.

Special Tests for elbow epicondylitis (4)

Cozens test, lateral and medial epicondylitis test, Mills test

Misc. Hip tests (4)

Craigs test, Patricks test (FABER), quadrant scouring test, Trendelenburg test

Functional Gait Tests List (5)

DGI, FGA, TUG, Gait Velocity, 5xSit-to-Stand

Three Categories of TMJ Conditions

DJD (OA or RA), myofascial pain, internal derangement

Peak Muscle Activity During Gait Cycle: Hamstrings

Decelerating unsupported limb during late swing phase

Special Tests for Rotator Cuff Pathos/Impingement (4)

Drop arm, Hawkins, Neer's, Supraspinatus Test

When does a thrombotic CVA typically occur?

During sleep or upon awakening after an MI or post-surgery

4 Ds of Brainstem Dysfunction

Dysphagia, Dysarthria, Diplopia, Dysmetria

Characteristics of Peripheral vertigo

Episodic/ short duration. Pallor, sweating. Nausea and vomiting. Tinnitus.

Rocker bottom shoe used for

Hallux rigidus; arthritic spurring of 1st MTP

Description of 90-90 SLR

Hamstring Tightness: pt in supine with hips flexed to 90 and knees relaxed. Pt asked to extend one knee at a time. Positive if knee remains flexed 20+.

Description of Tripod Sign

Hamstring tightness: pt in sitting with legs hanging off bed in 90 position. PT passively extends one knee. Positive if felt tightness or trunk extension to compensate

Bell's Palsy may arise secondary to what two conditions?

Herpes and viral infection

Passive Movement Findings: Atraumatic Instability

Normal or excessive

Description of Upper Limb Tension Test for Median, Musculocutaneous, and Axillary Nerves

Sequence: depress shoulder with ABD 10, elbow extended, forearm supination, wrist extension, finger and thumb extension, shoulder ER. Provoke with contralateral cervical lateral flexion

Definition of anesthesia

absence of touch sensation

Description of Upper Limb Tension Test for Median and Anterior Interosseous Nerves

Sequence: shoulder depressed with shoulder ABD 110, elbow extension, forearm supination, wrist extension, finger and thumb extension. Provoke with contralateral cervical lateral flexion

Description of Upper Limb Tension Test for Ulnar Nerve

Sequence: shoulder depression and ABD 10-90, elbow flexion, forearm supination, wrist extension and radial deviation, finger and thumb extension, shoulder ER. Provoke with contralateral cervical lateral flexion

Signs and Sx Possible Peripheral Nerve Involvement: Spinal Accessory Nerve

Inability to ABD arm passed 90; Pain with ABD

Signs and Sx Possible Peripheral Nerve Involvement: Axillary Nerve

Inability to ABD with neutral rotation

Define Ideomotor Apraxia

Inability to imitate a learned motor task or behavior

Define Dysmetria

Inability to judge distances. Seen esp in cerebellar dysfunction

Definition of Intention Tremors and may indicate and example

absent at rest, but observed with activity and typically increase when approaching targeted object; may indicate lesion of cerebellum or it's efferent pathways; MS

Juvenile Rheumatoid Arthritis descitption

Inflammation of joints and connective tissue.

Muscle Strains 1) Description

Inflammation within a muscle due to trauma causing microtears; found in any muscle

Define Reciprocal Inhibition

Inhibition of muscles antagonistic to those being facilitated. Essential for coordinated movement.

Rancho Los Amigos Gait Terminology

Initial Contact, Loading response, midstance, terminal stance, pre-swing, initial swing, midswing, terminal swing

History of: Frozen shoulder onset of sx, age of onset, RoM

Insidious/post trauma/post surgery, age of onset 45+, capsular pattern (ER, ABD, IR)

Describe Reverse Lachman test

Integrity of PCL (knee). Pt in prone testing LE knee flex 30. Stabilize femur and passively glide tibia posteriorly on femur. Positive if lax

tremors absent at rest, but observable with activity and typically increase as the target approaches. Indicate a lesion of the cerebellum or its efferent pathways and also seen with multiple sclerosis

Intention Tremors

Raimiste's Phenomenon

Involved LE ABD/ADD when uninvolved LE ABD/ADD

Cerebellar Lesions tend to produce ipsilateral or contralateral sx?

Ipsilateral

Description of Lateral Epicondylitis

Irritation/inflammation of origin of extensor muscles on lateral epicondyle of humerus.

Originator of PNF

Kabat

Description of Cozen's Test

Lateral epicondylitis of elbow: pt sitting with slight elbow flexion. PT places thumb on lateral epicondyle while stabilizing elbow. pt makes fist, pronates, radially deviates, and extends wrist against resistance. Positive if pain of lateral epicondyle or noted weakness.

Typical point of tenderness in pts with iliotibial band syndrome

Lateral femoral condyle

Depressors of the mandible (3)

Lateral pterygoid, suprahyoid, infrahyoid

Why is decrease in dopamine problematic?

Leads to defects in movement modulation

Temporal lobe impairments: Type of aphasia? Other sx?

Learning deficits, Wernicke's aphasia (receptive), antisocial aggressive behaviors, difficulty with facial recognition, difficulty with memory, inability to categorize objects

Description of True Leg Length Difference Test

Leg Length Discrepancy: pt in supine with hips and knees extended, legs 15-20 cms apart, and pelvis in balance with legs. PT measures from ASIS to medial malleoli. Positive if there is a 1+cm difference between sides.

Passive Movement Findings: Cervical Spondylitis

Limited RoM; may exacerbate sx

Resisted Isometrics Findings: Frozen Shoulder

Normal, when arm at side

Possible consequence of Basilar Artery Syndrome

Locked-In

Description of Congenital Limb Deficiencies Classification? (2)

Longitudinal: absence of substance in long bones, or Transverse: limb develops passed skeletal development

Define Ideational Apraxia

Loss of ability to carry out familiar purposeful movements in the absence of motor/sensory impairment; especially inability to use objects correctly

Description of Adhesive Capsulitis (shoulder)

Loss of active and passive shoulder joint motion due to soft tissue contracture caused by adhesive fibrosis and scarring between capsule, rotator cuff, subacromial bursa, and delt

Characteristics of central vertigo

Loss of consciousness can occur. Presents with neurological symptoms like ataxia, dysarthria, numbness, hemanopsia, diplopia, weakness

Special Tests for Biceps tendonopathy (3)

Ludington's, Speed's, Yergason's

Higher incidence of men or women for ALS and at what age range?

Men; 40-70

Flexing chin to chest causes pain with limitation and guarding due to posterior cervical muscle spasm in supine could indicate? (3)

Meningeal inflammation, arthritis, or neck injury

Etiology of central vertigo

Meningitis. Migraine headache. Trauma/tumor. Cerebellar degeneration (i.e. alcoholism). Multiple sclerosis.

THA Posterolateral approach precautions

Most common method, however has highest dislocation rate; flexion passed 90, ADD, IR

What are the expected impairments of a Middle Cerebral Artery (MCA) dysfunction?

Most common site of a CVA; Wernicke's aphasia if in dominant hemisphere; Homonymous Hemianopsia; Apraxia; Contralateral weakness and sensory loss of face and UE's with lesser involvement of LE'S; Impaired spatial relations

Brown-Sequard's Syndrome: ipsilateral and contralateral sx

Most commonly from stab or bullet wound leading to hemisection of the spinal cord. Ipsilateral paralysis, loss of vibration and position sense from damage to corticospinal and dorsal columns. Contralateral: Loss of pain and temperature on opposite side (lateral spinothalamic tract)

Where does the Middle Cerebral artery (MCA) supply blood?

Most of outer cerebrum; Basal ganglia; Internal capsule; Lentiform nucleus

Anterior Horn of the spinal cord carries ______ information away from CNS

Motor (efferent)

Dysarthria description and treatment

Motor speech disorder from UMN. Treatment focuses on intelligibility of speech by strengthening aspects of speech production using PHONETICS.

Descending tract are sensory or motor?

Motor; efferent

Most common form of TMJ dysfunction

Myofascial pain

Which intervention has the strongest evidence in use for Knee Ligament Sprain

NWB open-chain and WB closed-chain exercises

Description of Upper Limb Tension Test (in general)

Neural provocation test. Test non-involved side first. Any change is documented for each specific step. ULTT recommended for pts with arm, head, neck, or thoracic spine sx.

What is the most severe grade of injury to a peripheral nerve?

Neurotmesis

Modified Ashworth Scale Grade 0

No increased tone

Neurotmesis recovery

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. ex:Complete transection of the nerve trunk

Is surgery typical for MCL damage?

No, it's highly vascularized

Define Broca's Aphasia. Treatment includes? Avoid what? And allow for?

Non-fluent/Expressive Aphasia: speech is awkward, restricted, interrupted, produced with effort; due to lesion of 3rd frontal convolution of L hemisphere. compensatory strategies using a task-oriented approach. Avoid activities requiring substantial verbal output from pt. Allow for ample time for pt to respond verbally.

What is more stressful on the bones: cemented or non-cemented techniques for joint replacement

Noncemented

Palpation Findings: Atraumatic Instability

None

Palpation Findings: Frozen Shoulder

None; unless capsule on stretch

OA vs RA 1) Affected tissue 2) Primary Joints affected 3) Characteristics of sx

OA 1) changes in joint cartilage leading to erosion of subchondral bone 2) Fingers, C/L-spine, hips knees, and toes 3) Joints not affected equally RA 1) primarily synovium then leads to joint cartilage degenration 2) All joints can be affected 3) Morning stiffness, fever, loss of appetite. Bilateral symmetrical joint involvement

Contraindicated thereex for post CVA pt with poor shoulder alignment and decreased function

OH pulleys

What do lateral epicondyle fractures typically require to ensure alignment?

ORIF

CN I 1) Function 2) Test 3) Possible Abnormal Findings

Olfactory 1) Smell 2) Common smells for each nostril 3) Anosmia

PT should occur when, when a pt is taking dopamine replacement meds?

One hour after

Treatment for congenital hip dysplagia for 2+ year olds?

Open reduction under anesthesia--> spica cast 6-12 weeks

CN II 1) Function 2) Test 3) Possible Abnormal Findings

Optic 1) Sight 2) Test Visual Acuity 3) Blindness, myopia, presbyopia, homonymous hemianopsia

Pt with recurrent lateral ankle sprains and a supinated gait, what condition would MOST likely be associated

Peroneal Tenosynovitis: Peroneus Longus/Brevis tendon behind lateral malleolus and see most stress during supinated gait

Most Vascularized portion of medial meniscus

Outer 1/3

Which of these is an atypical presentation of pt s/p R CVA: poor judgement, impulsive, quick, overly cautious

Overly cautious; question like this the other 3 options go hand-in-hand so can deduct the answer

Physical therapy management for Juvenile Rheumatoid Arthritis

P/ARoM, positioning, splinting, strengthening, endurance, WB, posture, mobility.

Description of Posterior Sag Sign

PCL Injury: pt in supine knee flexed to 90 and hip flexed to 45. Positive if tibia sags back on femur.

Treatment for Juvenile Rheumatoid Arthritis

Pharma: corticosteroids, pain killers, anti-inflammatories, antirheumatics, immunosuppresive agents.

Most appropriate communication for Expressive Aphasia

Phrase questions for simple "yes" or "no" responses to avoid confusion & frustration. (Broca's)

Description of Piriformis Test

Piriformis tightness or compression on sciatic nerve: pt sidelying with test leg on top and hip flexed 60. PT places one hand on pt's pelvis and other knee. Stabilize pelvis and ADD knee. Positive if pain/tightness

Description of Hughston's Plica Test

Plica in knee: pt in supine. PT flexes knee and IR tibia with one hand and other attempts to move patella medially while palpating medial femoral condyle. Positive if popping sound over medial plica while knee is passively flexed/extended

Where does the Posterior Cerebral Artery (PCA) supply blood?

Portion of midbrain; Subthalamic nucleus; Basal nucleus; Thalamus; Inferior temporal lobe; Occipitoparietal cortices

Description of McMurray Test

Posterior Meniscal Lesion: pt in supine. PT grasps distal leg with one hand and palpates knee joint line with other. With knee fully flexed PT IR and fully extends knee. Repeat with ER. Positive if click or pronounced crepitation felt over joint line

Final Phase of rehab post TKA (4)

Pre-op ADLs functioning, functional endurance/endurance/proprioceptive

Dx Imaging Findings: Cervical Spondylitis

Radiography: narrowing osteophytes

Dx Imaging Findings: Frozen Shoulder

Radiography: negative: Arthrography: decreased capsule size

Dx Imaging Findings: Rotator Cuff Lesion A radiography will show? Imaging used to dx a RTC lesion

Radiography: upward displacement of humeral head; acromial spurring. MRI: dx RTC

This test examines Cognitive Function

Ranchos Los Amigos Levels of Cognitive Functioning

Progression (?) of initial sx of ____ during an embolic CVA

Rapidly with headache

Posterior Cord Syndrome

Rare incomplete lesion from compression of posterior spinal artery; loss of stereognosis, proprioception, and two-point discrimination below lesion. Motor intact.

Wernicke's Aphasia aka? Broca's?

Receptive; expressive

Description of Ely's Test

Rectus Femoris Contracture: pt in prone. PT passively flexes pt knee. Positive if spontaneous hip flexion during knee flexion

Dorsal root ganglia carry _____ information to the CNS

Sensory (afferent)

Describe symptoms of Neuromuscular junction pathology and example

Sensory component intact Motor fatigue is greater than actual weakness Normal DTR's Ex: Myasthenia gravis

Etiology of Achilles Tendonitis

Repetitive overload.

General Function of Cerebellum

Responsible for fine tuning of movement. Assists with maintain posture and balance. Regulates muscle tone, Controls rapid alternating movements.

Description of Neer Impingement test

Shoulder impingement of supraspinatus: pt sitting/standing. PT places one hand on scapulae and other stabilizing elbow. PT elevates pt's arm into flexion. Positive if painful

Description of Hawkins test

Shoulder impingement of supraspinatus: pt sitting/stanidng. PT flexes pt's arm to 90/90 and IR. Positive if painful

Effects of true leg length discrepancy of the right leg on: Lumbar spine

Side bent right and rotated left

Typical dopamine replacement drug

Sinemet

Characteristics of A Fiber peripheral nerves Size: Myelination: Conduction Rate:

Size: Large Myelination: Myelinated Conduction Rate: High Other: involved with all sensory

Characteristics of B fiber peripheral nerves Size: Myelination: Conduction Rate: Other:

Size: Medium Myelination: myelinated Conduction Rate: medium Other: contain pre-ganglionic fibers of ANS

Characteristics of C-Fiber peripheral sensory nerves Size: Myelination: Conduction Rate: Other:

Size: Small Myelination: poor/no myelination Conduction Rate: slow Other: involved with pain, temperature, and touch

Rule of 3's for Thoracic Spine

Spinous processes of T1-T3: even with same level Spinous Processes of T4-T6: .5 level below transversse process of same vertebrae Spinous Processes of T7-T9: one full level below transverse processes of same level Spinous Process of T10: one full level below Spinous Process of T11: .5 level below Spinous Process of T12: level

Description of Ulnar Collateral Ligament Instability Test

Tear of Ulnar Collateral Ligament and Accessory Collateral Ligaments (Gamekeeper's/Skier's thumb): pt sitting. PT holds thumb in extension and applies valgus force. Positive if excessive valgus movement.

6 Stages of Recovery from CVA

Stage 1: Flaccid; no voluntary movement Stage 2: emergence of spasticity, hyperreflexia, synergies Stage 3: voluntary movement available within synergy; strong spasticity Stage 4: isolated joint voluntary movement; moving out of spasticity and synergies Stage 5: increasing voluntary control out of synergies; coordination deficits present Stage 6: control and coordination near normal

When can active exercise start post THA for cemented and cementless

Start between weeks 1-4 depends on surgeon

The belly compression test is a highly specific test for ______

Subscap lesion

Describe Belly Compression Test

Subscap lesion. Pt sitting or standing. PT places hand on abdomen for eval of pressure during test. Pt instructed to place testing side hand on PT hand and apply pressure into belly while pushing elbow into scapular plane (increasing IR). Test is positive if pt looses pressure in PT hand when pushing elbow out

The Bear Hug test is highly specific for ______

Subscap tear

Describe the Bear Hug Test

Subscap tear. pt sitting or standing with hand placed across body on opposite shoulder. PT applies ER force while pt resists. Positive if cannot hold hand on shoulder.

Ballism is typically secondary to damage to what structure?

Subthalamic nucleus

Common areas of compression in TOS

Superior thoracic outlet, scalene triangle, between clavicle and 1st rib, between pec minor and thoracic wall

Least to most pressure on Lumbar spine: standing in anatomical position, standing with 45 degree hip flexion, sitting in chair slouched forward, sitting in chair with reduced lordotic curve in lumbar, sidelying, and lying in supine

Supine, sidelying, standing in anatomical position, standing with 45 degrees hip flexion, sitting in chair with reduced lordotic curve, sitting slouched

Description of Supraspinatus (empty can) Test

Tear or impingement of supraspinatus or suprascapular nerve involvement: pt arm ABD 90 and horizontally ADD 30 with thumb down. PT resists pt's ABD. Positive is weak or pain

Treatment for Congenital Limb Deficiencies

Symmetrical movements, strengthening, RoM, WB, prosthetics if needed

T/F: Wallerian degeneration may occur in axonotmesis injury?

T

T/F: word output and speech production in fluent aphasia are funtional

T

Paraplegia occurs due to SCI to which spinal segments

T1-L1

The lumbar plexus arises through which vertebrae?

T12-L4 Nerve Roots

Infectious pathologies that can cause irreversible dementia (2)

TB and AIDS

Coup-contracoup Injury

TBI injury to at point of impact and opposite of point of impact

Palpation Findings: Rotator Cuff Lesion

Tender over RTC

Palpation Findings: Cervical Spondylitis

Tender over affected vertebrae or facet

Description of Finkelstein Test

Tenosynovitis in the thumb (DeQuervain's dz): pt sitting/standing. Pt makes fist with thumb tucked. PT stabilizes forearm and ulnarly deviates fist. Positive if pain over ABD pollicis longus and extensor pollicis brevis at the wrist.

Description of Craig's Test

Tests Femoral Antevetsion: pt in prone with test knee flexed to 90. PT palpates posterior greater troch and medially and laterally rotates hip until greater troch is parallel to table. Normal degree of femoral anteversion for adult is 8-15 degrees.

Describe Vestibulo-spinal reflex

This reflex attempts to stabilize the body while the head is moving in order to manage upright posture.

Frontal lobe functions

This lobe is responsible for Intellect, orientation, voluntary movement, Broca's area, executive function.

Temporal lobe function (3)

This lobe is responsible for auditory processing, wernicke's area, and production of meaningful speech.

Parietal lobe receives sensory information associated with (3)

This lobe is responsible for receiving information associated with touch, kinesthesia, and vibration.

Occipital lobe function

This lobe is responsible for visual processing,judgment of distance, and vision in three dimensions.

Right Hemisphere specialization/dominance

This lobes specific responsibilities include: Nonverbal processing, artistic expression, comprehension of general concepts, spatial relationships, kinesthetic awareness, mathematical reasoning, and body image awareness

Contraindications for Joint Mobilizations? (8)

active dz, infection, advanced osteoporosis, articular hypermobility, fracture, acute inflammation, mm guarding, joint replacement

Etiology of Plantar Fasciitis. Most common age range

acute injury form excessive loading of foot, or chronic irritation from over pronation. 40-60 years old

Common Signs and Symptoms associated with vascular claudication

consistent pain no matter spinal position, exacerbated by physical exertion, prompt relief with rest, described as numbness, decreased/absent pulses

RoM guidelines for cemented and cementless TKA

Within 2 weeks: 0-90 deg flexion 3-4 weeks: 0-120 deg

Higher incidence of Alzheimer's in men or women?

Women

Most common gender and age range for Rheumatoid Arthritis

Women 3Xs more likely than men, 40-60 years old

Meniscal injuries diagnosed with what tools? (2)

arthroscopy and MRI

All cranial nerves are distributed to head and neck except CN ______ which goes to thorax and abdomen

X-Vagus

How to screen localization

ability to identify location of light touch by verbal response or gesturing

Definition of Kinesthesia

ability to perceive the direction and extent of movement of joint or body part

Describe motor control

ability to regulate or direct essential movement

Definition of neuroma

abnormal growth of nerve cells; associated conditions include AIDS, vasculitis, and amyloidosis

Visual Analogue Scale description

can be highly sensitive if measured accurately

Definition: Genu Valgum

knees touch while feet are apart. Increases compression on lateral tibial condyle and increases medial structures of the knee (MCL). AKA knocked knees

Mechanism of injury for PCL?

dashboard injury; tibia is struck with knee flexed

Conservative treatment for MCL sprain

decrease inflammation, protecting joint, RoM, strengthening

Spinal Cord C3-C5 (phrenic nerve) supplies?

diaphragm

Sensory Organization Test: Description

examines 6 different sensory conditions using a computerized balance platform and stop watch. Record time standing posture is maintained. Score 1 (min sway) -4 (fall)

Challenging and examining the somatosensory includes

examining pressure and vibration; observe pt changing surface they're standing on

Bouchard's Nodes

excessive bone formation on dorsum of PIP joints typically seen in RA

Hyperhidrosis

excessive sweating

Definition of double crush syndrome

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

Tennis elbow typically involves which extensor tendon?

extensor carpi radialis brevis

Signs and sx of Osteoarthritis 1) onset of pain? 2) Pain exacerbated by? 3) Other features

gradual onset of pain at joint, increases after exercise, increases with weather change, enlarged joints, crepitus, stiffness, decreased RoM, Heberden's/Bouchard's nodes

Bony landmark of supraspinatus insertion

greater tubercle of humerus

If surgery is performed for PCL reconstruction, then avoid ______ exercises for 6 weeks

hamstring

Most commonly involved joints with osteoarthritis?

hands and WB joints (hips and knees)

Testing Form Consistency of Objects

have pt pick out specific object among similar shapes, but different sizes

Examine vestibular input with movement of ?

head

Treatment for Osgood-Schlatter Disease

icing, flexibility, elimination of aggravating activities on patellar tendon-squatting, running, or jumping

How to screen kinesthesia

identify direction and extent of movement of joint/body part

How to screen proprioception

identify static position of extremity or body part

Myopia

impaired far vision

95% of all ligament sprains of the ankle are ______

lateral

Secondary risk factors for CVA? (5)

obesity, high cholesterol, behaviors related to hypertension (stress, high Na intake), physical inactivity, increased alcohol consumption

Definition of Postural Tremors and examples

observed during voluntary contraction to maintain a posture; rapid tremor associated with: hyperthyroidism, fatigue or anxiety, benign essential tremor

Definition of Gaze-evoked Nystagmus and is typically indicative of?

occurs when gaze moves from one object to another. Caused by pt inability to maintain stable gaze position. Typically indicative of CNS pathology and is associated with brain injury and MS.

Definition of Central Nystagmus

occurs with central lesion of brainstem/cerebellum and is not inhibited by visual fixation

Allodynia

pain with light touch

After a seizure do what to prevent what?

place pt on left side to prevent vomit choking them

Osgood-Schlatters dx using

plain film

Signs and sx of Osgood-Schlatter Disease

point tenderness over patellar tendon at insertion on tibial tubercle, antalgic gait, pain with increase in activity

Examples of LMN dz (11)

poliomyelitis, ALS (both), Guillain-Barre Syndrome, spinal cord tumors, trauma, progressive muscular atrophy, infection, Bell's Palsy, carpal tunnel syndrome, muscular dystrophy, spinal muscular atrophy

Avulsion Fracture description

portion of bone detaches with tendon

Positioning for Mechanical Traction for Stenosis of the Cervical Spine, HNP (efficacy under scrutiny), and whiplash

positioned at 15 deg. of flexion

Patellofemoral Syndrome etiology

repetitive overuse

History of: Cervical Spondylosis age of onset, onset of sx

50+, acute or chronic

The vertebral-basilar artery supplies what parts of the brain? (6)

-Pons -Cerebellum -Medulla -Midbrain -Thalamus -Occipital cortex

Characteristics of Central Vertigo

-autonomic symptoms less severe -possible LoC -neurological sx: diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria

Special Tests: Rotator Cuff Lesion

(+) Drop arm and Empty can tests

Function of Occipital Lobe

-primary visual center -judgment of distance -colors

Most PD pts are dx at what age range?

50-79

Normal distinguishable distance difference for two-point sensory testing.

6 mm

Patellofemoral Pain Syndrome 1) Common result of? 2) Type of taping during rehab 3) Type of strengthening not to use in rehab

1) Abnormal tracking causing stress 2) McConnell 3) Isolated quadriceps exercises quad sets

Localized Lesion to Cortex: Frontal Lobe: Supplementary Motor 1) Function 2) Sx

1) B Control of Posture 2) Loss of B control of posture

Rearfoot Varus 1) Structures in varus 2) Observed Deformity

1) Subtalar and Calcaneus in varus 2) rigid inversion of calcaneus when subtalar joint is in neutral

Plagiocephaly (congenital) 1) aka 2) lasting harmful effects?

1) flat head syndrome 2) no

Multilevel Vertebrae Fusion Require ___ weeks in a trunk immobility brace

6 weeks

Order of treatment for glenohumeral instability

1.) 3-6 weeks immobilization, RICE and NSAIDs. 2.) RoM, isometrics. 3.) progressive resistance exercise emphasizing rotators and large capsular muscles

Treatment sequence for Lateral Epicondylitis

1.) Initial: RICE NSAIDs, 2.) increase strength, flexibility and endurance. 3.) strap placed 2-3in. distal to elbow and relieve tension

Order of treatment for impingement syndrome

1.) Initial: RICE, NSAIDs, activity modifications. 2.) once tolerable: rotator cuff strengthening and scapular stability. 3.) cont. strengthening

Waddell's Signs (5)

1.) Widespread tenderness from light touch or extending to unrelated boundaries 2.) Pain with axial loading (pressing on pt's head) or simulated rotation (rotating pelvis and shoulders simultaneously) 3.) Pain with SLR in only supine vs sitting 4.) "Stocking" sensory loss or non-myotomal weakness 5.) Exaggerated response to pain 3/5= (+) Waddell's sign

The Autonomous stage: 1.) ______ response 2.) ______ errors no matter the environment 3.) _____ cognitive work for movement patterns 4.) Distraction impacts or does not impact activity? 5.) multi-tasking? 6.) amount of extrinsic feedback? 7.) amount of intrinsic feedback?

1.) automatic 2.) very little to none 3.) no 4.) does not impact 5.) able to 6.) very little if any 7.) dominant

The associative stage: 1.) _______ errors compared to cognitive stage 2.) _______ need for cognitive work compared to cognitive stage 3.) skills are ______ 4.) ________ coordination of movement 5.) large amounts of practice lead to movement _________

1.) decreased 2.) decreased 3.) refined 4.) increased 5.) refinement of motor programming

How many cervical vertebrae are there?

7

Stages of Parkinson's (5)

1: Min/absent disability, U sx 2: Min B or midline sx, no balance deficits 3: impaired balance, some activity restrictions 4: All sx present and severe; stands and walks with A 5: Bed/WC confined

Age an infant should be able to sit with arm support for extended periods of time

6-7 months

Muscle Grades: Poor

2/5 Completes RoM in gravity eliminated position

What % of ischemic strokes are caused by embolus? Hemorrhage? Thrombotic?

20%, 10-15%, 65-70%

___% of ALS pts may show sensory deficits

20%; due to other etiology

Lachman's Test is performed with pt knee in ____ degrees of flexion

20-30

Stance phase is what % of gait?

60%

Method of double-blind injection for identifying SIJ pathos

1st injection provocative, 2nd is analgesic. If typical pain sx reproduced with 1st shot, then decreased with 2nd--> pathos

Oxford Exercise 3 set pattern

1st set: 10 reps @ 100% of 10RM 2nd set: 10 reps @ 75% of 10RM 3rd set: 10 reps @ 50% of 10RM

DeLorme Exercise 3 set pattern

1st set: 10 reps @ 50% 10RM 2nd set: 10 reps @ 75% 10RM 3rd set: 10 reps @ 100% 10RM

With proper treatment Bell's Palsy may subside after ?

2 weeks

Muscle Grades: Poor Plus

2+/5 able to initiate movement against gravity

Muscle Grades: Poor Minus

2-/5 cannot complete range in gravity eliminated position

When do sx peak in Guillain-Barre Syndrome?

2-4 weeks

Sx of TIA typically resolve in how many hours?

24-48

Approximately what % of those who had polio will develop post-polio and how long after having polio?

25-50%; 25 years

Guidelines for THA are enforced for up to __ months typically

3

Muscle Grades: Fair Plus

3+/5 able to complete RoM with minimal resistance

UMN vs LMN: Disorder examples

UMN: stroke, TBI, SCI LMN: Polio, GBS, PNI, peripheral neuropathy, radiculopathy

Primary risk factors for CVA? (5)

hypertension, cardiac dz/arrhythmia, DM, smoking, TIA

AROM and PROM findings with RTC tear

AROM: ABD significantly limited PROM: normal

Ankylosing Spondylitis vs Spinal Stenosis: Special Tests

AP: None SS: Bicycle test and/or stoop test may be positive

Ankylosing Spondylitis vs Spinal Stenosis: Sensory Deficits

AP: None in early stages SS: Temporary

Ankylosing Spondylitis vs Spinal Stenosis: Reflexes

AP: Normal (in beginning) SS: May be affected after long period with dz

Ankylosing Spondylitis vs Spinal Stenosis: Diagnostic imaging

AP: Plain Films are dx SS: CT are dx

Ankylosing Spondylitis vs Spinal Stenosis: Posture

AP: flexed entirety of spine SS: flexed lumbar spine

Description of Anterior Drawer Test (ankle)

ATFL sprain: pt in supine. PT stabilizes distal tbia and fibula one hand and other hand holds foot in 20 PF and draws talus forward. Positive if excessive anterior displacement of talus away from ankle mortise

Two typical views of x-ray?

Anterior-Posterior (AP view) and lateral

Common cause of death in MS pts

UTI or respiratory infection

Mobilization rules: moving concave surface over a fixed convex surface scenario: increasing knee extension use ____ mobilization (the same direction of movement)

Anterior; since the direction of the concave movement on the convex surface is anterior, the mobilization must also be anterior or the same direction

Which of the following tests would be the least effective in assessing ACL ligament integrity? Lachman's test Anterior drawer test Slocum's test Lateral pivot shift test

Anterior Drawerthom

Motor nerves originate from?

Anterior Horn of spinal cord

Occlusion of anterior spinal artery supplies ____ and may lead to what sx?

Anterior Spinal Cord; contralateral hemiplegia, tongue deviation to affected side, dysphagia, and loss of gag reflex.

Special Tests for knee ligamentous instability (8)

Anterior and Posterior drawer, Lachman test, Lateral Pivot Shift test, Posterior sag sign, Slocum test, valgus and varus test

Shoulder flexors (4)

Anterior delt, coracobrachialis, pec major, biceps

Sensory Function and reflexes Findings: Atraumatic Instability

Anterior or posterior pain

Description of Lateral Pivot Shift Text

Anterolateral Rotary Instability: pt in supine with hip flexed and ABD 30 and slightly IR. PT grasps leg with one hand and other on lateral surface of proximal tibia. PT IR tibia and applies valgus force to knee while knee is slowly flexed. Positive if palpable shift or clunk occurring between 20-40 degrees of flexion.

Description of Slocum Test

Anterolateral/medial Instability: pt in supine knee flexed to 90 and hip flexed to 45. Testing anterolateral stability: PT rotates pt's foot 30 medially. PT stabilizes leg by sitting on forefoot. PT grasps proximal tibia while palpating tibial plateau with thumbs. Anterior force applied. Positive if primary movement of tibia is lateral. To test Anteromedial stability: rotate foot pt's foot 15 degrees laterally and repeat above.

Special Tests for meniscal pathos (3)

Apleys compression test, Bounce home test, McMurray test

Description of Quadrant Scouring Test (hip)

Arthritis, avascular necrosis, or osteochondral defect: pt in supine. PT flexes and ADD hip with knee in max flexion. PT applies compression through femur while 'scouring' leg. Positive if grinding, catching or crepitation in hip.

Gold Standard test for RTC tear? What may also be used, but with less sensitivity?

Arthrogram; MRI

Effects of true leg length discrepancy of the right leg on: Tibia

ER

Vestibular Disorders Activities of Daily Living Scale

assess self-perceived disablement in vestibular pts

Mixed CN involved with Facial Expression

Facial- CN VII

Description of Ludingtons Test

Bicep Rupture: Pt clasps fingers behind head and flexes biceps. Absent contraction indicates possible rupture of long head tendon

Description of Speeds Test and test for?

Bicep tendonitis: pt in sitting/standing with arm supinated and fully extended. PT palpates bicipital groove and other hand at top of wrist. PT resists pt's shoulder flexion. Positive test if pain or tenderness in bicipital groove region

Typical Mechanism of Injury for AC and SC joint disorders?

Fall onto shoulder with ADD UE or direct contact (sports injury)

The cervical plexus arises through which vertebrae?

C1-4 Nerve Roots

Tetraplegia occurs due to SCI to which spinal segmentes

C1-8

Describe how nerve roots exit between vertabrae

C1-C7 exit above respective vertebrae and C8-S5 exit below.

Diaphragm innervated by?

C3-5

Spinal levels most affected by SCI

C5, C7, T12, L1

The brachial plexus arises through which vertebrae?

C5-T1 Nerve Roots

RTC full thickness tear: typical sx

CLASSIC: night pain; ABD and ER weakness, loss of RoM

Misc. Knee tests (4)

Clarkes sign, Hughstons plica test, Noble compression test, Patellar apprehension test

Neurapraxia; recovery; example injury

Class 1 Nerve injury. transient loss of function; nerve regeneration rapid or persists few weeks (compression injury)

Mnemonic for levers: FLE 123

Class 1 lever: Force in the middle Class 2 Lever: Load in the middle Class 3 Lever: Effort in the middle

Neurotmesis; recovery; example injury

Class 3 nerve injury. complete loss of function from complete cut through. Surgery required for regeneration.

Axonotmesis; recovery; example injury

Class two nerve injury. interrupts axon and causes Wallerian degeneration distal to lesion. Recovery possible. Crush injury

Most common mechanism of injury of lumbar SCI

flexion injury

Convex or Concave rule: atlanto-occipital joint? Below second vertebrae?

Convex; Concave

Evidence for use of US for acute ankle sprains

Don't use

Suggested use of CPM machines for uncomplicated post-op TKA

Don't use them

Describe Goldthwait's Test

Differentiates between lumbar and SIJ dysfunction. Pt supine PT fingers between lumbar segments with one hadn and second hand passively SLR. If pain prior to palpation of segments with motion, then dysfunction is SIJ related.

Dysphagia description and treatment

Difficulty swallowing. Treatment includes positioning and compensatory strategies to avoid aspiration.

Objective findings indicating incomplete spinal cord injury

Diminished, not absent sensation/weakness/DTR, weakness in indicated myotome and DIMINISHED findings below level of lesion. Ex: C6 incomplete lesion may find DIMINISHED sensation in C8 dermatome, whereas, a complete lesion would have ABSENT sensation.

Description of Murphy Sign

Dislocated Lunate: pt sitting/standing. Pt makes fist. Positive if 3rd metacarpal remains even with 2nd and 4th

How does weakness progress in ALS?

Distal to proximal

Sensory nerves originate from?

Dorsal Root Ganglia

High grade evidence for treating mid-portion Achille's Tendonopathy

Eccentric loading exercises

Peak Muscle Activity During Gait Cycle: Tib Ant.

Eccentric lowering of foot just after heel strike

Special Tests for Hip contracture/tightness (6)

Elys test, Obers test, Piriformis test, Thomas test, Tripod sign, 90-90 SLR

Emphasize strengthening ___ and ___ for ACL sprains

Emphasize quad and hamstring strength.

THA Anterolateral approach precautions

flexion passed 90, extension, ER, ADD

Most common mechanism of injury of cervical SCI

flexion-rotation injury

Description of glenohumeral instability? Subluxation? Dislocation? ___% dislocations detach glenoid labrum?

Excessive translation of humeral head in glenoid during active motion. Subluxation is 50%+translation without dislocation. Dislocation: complete separation of articular structures from glenoid and humeral head. 85%

T/F: word output and speech production in non-fluent aphasia are funtional

F; poor word output and impaired rhythm and inflection

Humeral neck fractures typically from?

FWOSH (fall with outstretched hand)

Mixed CN involved with salivatory and lacrimal glads

Facial

Pros of Hamstring Grafts for ACL reconstruction (3)

Fewer sx post-op, greater return to pre-construction level, earlier rehab

Talocrural joint is made up of what bones (3)?

Fibula, tibia, and talus

Misc. wrist/hand tests (3)

Finkelstein test, grind test, Murphy sign

Type of strategy used to counter sudden moderate force leading to forward sway will activate what muscles

First abdominals, then quads

Tarsal Tunnel Sx

Flat foot gait.

Define Wernick'e Aphasia

Fluent/Receptive Aphasia; spontaneous speech is preserved, flows smoothly; auditory comprehension is impaired

Capsular pattern knee

flexion>extension

Maitland Description of Joint Oscillation Grades

Grade I: small oscillations beginning range; lubricate joint and decrease pain/mm guarding Grade II: large oscillations to mid-range; lubricate joint and decrease pain/mm guarding Grade III: large oscillations to mid-end range; stretch tight mm, capsules, and ligaments Grade IV: small oscillations at end-range; stretch tight mm, capsules, and ligaments Grade V: LAHVT regain normal joint mechanics and decrease pain/mm guarding

Ambulation guidelines for cementless TTWB TKA post-op

Immediately start post-op. WBAT with walker week 6. Can 8-10 weeks. FWB at week 10

Description of Noble Compression Test

IT Band Friction Syndrome: pt in supine with hips slightly flexed and knee flexed 90. PT places thumb of one hand over lateral epicondyle of femur and other around pt's ankle. PT maintains pressure over lateral epicondyle while pt slowly extend knee. Positive if pain over lateral epicondyle at approx. 30 knee flexion

These levels of Ranchos Los Amigos Levels of Cognitive Functioning represent mid-level recovery

IV-VI

Dz that presents with chorea?

Huntington's

Swan Neck Deformity

Hyperextension of proximal interphalngeal joint and flexion of distal interphalangeal joint

Contraindications to mechanical traction

Hypermobility, pregnancy, RA, Down's, any dz affecting ligamentous integrity

These levels of Ranchos Los Amigos Levels of Cognitive Functioning include sx of decreased response

I-III

Norms for male and female Q angles

Males: 13 degrees Females: 18 degrees

Central nystagmus

Is not inhibited by visual fixation on an object. Can be either bidirectional or unidirectional, symptoms may be chronic. Causes: demyelination of nerves, vascular lesion, cancer/tumor

Description of Patellar Tap Test

Joint Effusion: pt in supine with knee flex or extended to point of discomfort. PT slightly taps patella. Positive if patella appears to be floating

Typical primary goal for arthritic conditions?

Joint protection

Primary reason to use knee immobilizer for a postero-lateral THA.

Keep knee extended to reduce hip flex

Description of Lateral Epicondylitis Test

Lateral Epicondylitis: pt sitting. PT places one hand on elbow and other dorsum of hand distal to PIP. pt extends middle finger against resistance. Positive if pain of lateral epicondyle or noted weakness.

Shoulder ABD mm (2)

Lateral delt, supraspinatus

What are the expected impairments of a Vertebral-basilar artery dysfunction?

Loss of consciousness; hemiplegia or tetraplegia; locked in syndrome; vertigo; nystagmus; dysphagia; dysarthria; syncope; ataxia;

Typical Cerebellar damage symptoms (2) and 5 dx

Loss of motor control (force, extent, and timing of movement) and posture irregularities. Dx include: ataxia, dysarthria, dysdiadochokinesia, nystagmus, dymetria,

Signs and sx of congenital hip dysplagia (2)

assymetrical hip ABD with tightness apparent femoral shortening on involved side

Description of Valgus Stress Test for Elbow

MCL sprain: pt sitting with elbow flexed 20-30. PT places one hand on elbow and other proximal to wrist. Palpates joint line and applies valgus force. Positive if laxity compared to non-involved side, apprehension or pain.

Description of Valgus/Varus Stress Test (knee)

MCL/LCL instability: pt in supine knee flexed 20-30. for MCL (valgus): PT places one hand on medial ankle and other lateral knee applying valgus force. LCL (varus): PT places one hand lateral ankle and other medial aspect of knee and applies varus force. Positive if excessive movement. Positive valgus for MCL, PCL, POL, and posteromedial capsule pathos when test is doen with knee straight. Positive varus, when knee straight, pathos of LCL, PCL, arcuate complex, and posterolateral capsule.

Effective means of identifying labral tears? "Gold Standard" for identifying labral tears?

MRI Arthrograms; Arthroscopic shoulder surgery.

Traumatic Causes of SCI

MVA, jumps and falls, diving, gunshot

Mandible protrusion mm (3)

Masseter, lateral and medial pterygoid

Etiology of Adhesive Capsulitis (shoulder)

May be acute or insidious. Self-limiting typically resolves in 1-2 years.

Three widely used pain scales?

McGill Pain Questionnaire, Numerical Rating System, and Visual Analogue Scale.

Description of Tibial Torsion Test

Measure for normal tibial torsion: pt in sitting with knees over edge of table. One side thumb and index finger placed over medial and lateral malleoli. Then measure acute angle formed by knee to ankle. Norms: 12-18 degrees.

Purpose of Evoked Potentials and what do they rule out?

Measure of time it takes for brain to register an external stimuli's input; MS, brain tumor, acoustic neuroma, and SCI

Description of Medial Epicondylitis Test

Medial Epicondylitis: pt sitting. PT palpates medial epicondyle and supinates pt's forearm, extends wrist, and extends elbow. Positive if pain in medial epicondyle.

Describe a thrombotic CVA

atherosclerotic plaque forms and eventually occludes artery causing an infarct

What is a Bankart Lesion? Require surgery for repair?

avulsion of anteroinferior capsule and ligaments associated with glenoid rim; yes

Moderate severe peripheral nerve injury

axonotmesis

Characteristic of pain with labral tears

Nonlocalized pain in shoulder with increasing pain in OH activities and reaching behind the back

Resisted Isometrics Findings: Atraumatic Instability

Normal

Observational Findings of: Rotator Cuff Lesion

Normal bone/tissue outlines, possible protective shoulder hike

Special Tests for Cervical spine (2)

foraminal compression (Spurling's) test, vertebral artery test

Dopamine Replacement Agents typically used for?

PD

Common pathologies that may present with dystonia? (3)

PD, CP, encephalitis

Dysfunction of basal ganglia may lead to

PD, Huntington's, Tourettes, ADD, OCD, addiction

Causes of toe touch gait (4)

PF spasticity or contracture, weak or paralyzed DF

Capsular Pattern of talocrural joint

PF, DF

Description of Tight Retinacular Ligament Test

PIP held in neutral PT attempts to flex DIP. If PT is unable, retinacular ligaments or capsule is tight. If DIPs flex with PIPs in slight flexion, then retinacular ligaments may be tight without capsular tightness.

Modified Ashworth Scale Grade 3

PROM difficult

Cemented THA WB Guidelines

PWB ~3 weeks, use cane at week 4, FWB week 5

Causes of no toe off (3)

forefoot pain, weak PF, insufficient PF RoM

Resisted Isometrics Findings: Rotator Cuff Lesion

Pain and weak ABD and ER

Signs and Sx Possible Peripheral Nerve Involvement: Long Thoracic Nerve

Pain with flexing fully extended arm; inability to flex extended arm; scapular winging with 90 deg. flexion

Passive Movement Findings: Rotator Cuff Lesion

Painful if impingement present

Active Movement Findings: Cervical Spondylitis

Painful limited RoM

Definition of Ballism

form of chorea includes jerks of large amplitude

Describe 4 parts of McGill Pain Questionnaire

Part 1: pt marks on drawn body where sx are Part 2: pt chooses one word that describes pain from 20 categories Part 3: pt describes pattern of pain including factors that increase or relieve pain Part 4: pt rates pain 0-5

Description of anterior and posterior apprehension tests

Past Shoulder Dislocation test: pt in supine arm ABD 90. PT ER shoulder for anterior, IR for posterior. Positive test if look of apprehension at end point

Description of Patellar Apprehension Test

Patellar Subluxation or Dislocation: pt in supine with knees extended. PT places both thumbs over medial border of patella and applies lateral force. Positive if look of apprehension on pt or flexion of the quad in effort to avoid sublux.

Description of Clarke's Sign

Patellofemoral Dysfunction: pt in supine with knees extended. PT applies slight pressure distally with web space of hand over superior pole of patella. PT has pt contract quad while maintaining pressure. Positive if failure to complete contraction without pain

Multiple Sclerosis causes what that leads to sx

patches of demyelination of nerves within brain and spinal cord

Shoulder ADD mm (3)

Pec major, teres major, lats

Vertebral Artery Test: pt isn't able to complete cervical RoM required to complete correctly...what to do?

Perform test in allowable range

Definition of Chorea.

form of hyperkinesia presents with brief, irregular rapid contractions, but not to degree of tics. More like fidgeting.

Type of wheelchair for a young active individual

Rigid and light weight

Modified Ashworth Scale Grade 4

Rigid flexion or extension

Contraindications for Sensory Stimulation

Pts who would not benefit from hands-on therapy, has sufficient motor control to learn a new motor skill, ability to utilize self-correcting motor skills,

Initial treatment of MCL sprain

RICE NSAIDs

Signs and sx of Osteogenesis Imperfecta

pathological fractures, osteoporosis, hypermobile, leg bowing, weak, scoliosis, impaired respiratory function

Definition of clasp-knife response

form of resistance seen during RoM of hypertonic joint where greater resistance is found at initiation of RoM that lessons as range continues

Potential side-effect of nonopioid agents with children

Reye's Syndrome

Skinfold measurements for BF should all be taken on which side of the body?

Right

Description of Drop arm test

Rotator cuff tear: pt sitting/standing arm ABD 90. pt slowly lowers arm to side. positive if severe pain or cannot slowly lower arm

Cause of Boutonniére Deformity

Rupture of central tendinous slip of extensor hood; typically from trauma or RA

Thompson Test for what?

Ruptured Achilles.

Description of SI Joint Stress Test

SI Joint Dysfunction: pt in supine. PT crosses pt's arms so palms are on ASIS. PT applies downward and lateral force to pelvis. Positive if unilateral pain in SI joint or gluteal area

Special Tests for lumbar and SI region (3)

SI joint stress test, sitting flexion test, standing flexion test

The Biceps Load 2 Test is highly sensitive and specific test for _______

SLAP lesion

What is a tear of the superior labrum from anterior to posterior called?

SLAP lesion

Demyelination without axonal degeneration

Segmental demyelination

Most likely autograft for ACL reconstruction? Other tendons used? (2)

Semitendinosus and Gracilis. Patellar and IT band.

Describe Anterior Horn cell pathology characteristics and example

Sensory component is intact Motor weakness and atrophy Fasciculations Dec. DTR's Ex: Amyotrophic lateral scleorosis and Poliomyelitis

Symptoms of spinal roots and nerve pathology and example

Sensory component will have corresponding dermatomal deficits. Motor weakness in an innervated pattern;May have fasciculations Dec. DTR's Ex: herniated disk

Describe symptoms of peripheral polyneuropathy pathology and example

Sensory impairments in a "stocking glove" distribution Motor weakness and atrophy Weaker distally than proximally May have fasciculations Dec. DTR's Ex: Diabetes

Common etiology of Sural nerve injury

fracture of calcaneus or lateral malleoli

A movement disorder that presents with slow, twisting, and writhing movements that are large in amplitude. Primarily seen in the face, tongue, trunk, and extremities. It is a common finding in several forms of Cerebral palsy due to basal ganglia pathology

athetosis

Cervical vertebrae 1 helps to form what joint?

atlanto-occipital

What structure on cervical vertebrae 2 helps form what join with the anterior arch of the atlas (C1)?

atlantoaxial

Common mechanism of radial nerve injury

fracture of humerus or compression of nerve in the radial tunnel

Meniscus Description (medial and lateral)

attached to proximal tibia. thicker on outside attachments and thinner where not attached. Medial more commonly injured.

Definition of vestibulospinal reflex

attempts to stabilize body and control movement. Assists with stability during head motion as well as coordination of trunk during upright postures

Dysarthria is characterized by damage to what structure?

UMN lesion

Definition of clonus

UMN sx, involuntary alternating spasmodic contraction of muscle from quick stretch reflex

UMN vs LMN: Strength

UMN: Stroke: hemiplegia Corticospinal Lesion: contralateral if above decussation in medulla; ipsilateral if below Spinal Cord Lesion: B loss below lesion LMN: focal

UMN vs LMN dz sx: Fasciculations

UMN: Absent LMN: Present

UMN vs LMN: Location of Lesion

UMN: CNS LMN: PNS

UMN vs LMN: Reflexes

UMN: Hyper LMN: Hypo/absent

UMN vs LMN: Tone

UMN: Hyper LMN: Hypo/absent

UMN vs LMN dz sx: Tone

UMN: Hypertonic LMN: Hypotonic to flaccid

Description of Wright Test

Thoracic Outlet Syndrome secondary to costoclavicular space compression: pt sitting/standing. PT monitors radial pulse while moving pts arms into full ABD. Positive if absent/diminished pulse

Description of Roos Test

Thoracic Outlet Syndrome: pt sitting or standing. Both arms ABD, ER, and elbow flexed 90. Pt opens and closes hands 3 minutes. Positive if unable to hold test position, weakness of arms, or sensory loss or ischemic pain.

Description of Adson Maneuver

Thoracic Outlet Syndrome: pt sitting/standing. PT monitors radial pulse. Pt rotates head to testing side, pt then extends head as PT ER and extends shoulder. Positive if absent or diminished pulse

Dorsiflexors

Tib anterior, extensor hallucis longus and digitorum longus, peroneus tertius

Description of Bunnel-Littler Test

Tightness: pt sitting with MCP joint held in slight extension. PT attempts to move PIP joint into flexion. If unable, then tight intrinsic muscle or capsule. If PIP flexes with slight MCP flexion, then may be intrinsic muscle tightness and not capsule.

UMN vs LMN: Voluntary Movement

UMN: Impaired/absent LMN: Weak/absent

UMN vs LMN: Involuntary Movement

UMN: Spasm LMN: Fasciculations

Spondylolysis

fracture of pars interarticularis with (+) Scotty Dog finding on oblique view plain film

Bones of the hand (starting bottom: left to right, then top: left to right)

Top: Trapezoium, Trapezoid, Capitate, Hamate Bottom: scaphoid, lunate, Triquetrium, Pisiform

Common mechanisms of axonotmesis

Traction, compression, and crush injuries are most common.

Common mechanism of injury of sural nerve

fracture of the calcaneus or lateral malleous

Mixed CN involved with chewing

Trigeminal

Mixed CN involved with sensation of head (3)

Trigeminal, Facial, Glossopharyngeal

True or False: Handheld dynamometers have a high intrarater reliability?

True; >.94

UMN vs LMN: Structures Involved

UMN: cortex, brainstem, corticospinal tracts, SC LMN: SC: anterior horn, spinal roots, peripheral nerves CN: cranial nerves

UMN vs LMN dz sx: Reflexes

UMN: hyper LMN: diminished/absent

UMN vs LMN dz sx: Atrophy

UMN: mild from disuse LMN: present

Most common type of Salter-Harris Fracture?

Type II

Rarest form of Salter-Harris Fracture?

Type III

Gaze-Evoked nystagmus

Typically indicative of CNS pathology and is associated with brain injury and multiple sclerosis. It occurs when the eyes shift from a primary position to an alternate position. It is caused by the patients inability to maintain a stable gaze position.

Homolateral Synkinesis

UE flex involves LE flex on same side

Description of Tinnel's Sign

Ulnar Nerve Compression or Compromise: pt in sitting with elbow slightly flexed. PT taps with index finger between olecranon and medial epicondyle. Positive if tingling sensation in ulnar nerve distribution.

Description of Froment's and Jeann's Sign

Ulnar Nerve Compromise or Paralysis: pt sitting/standing and holds piece of paper between thumb and index finger. PT tries to pull paper away. Positive if pt flexes distal phalanx of thumb due to ADD pollicis muscle paralysis. If at the same time, pt hyperextends MCP of thumb= Jeann's Sign.

Define Ataxia

Uncoordinated movement, especially gait

Congenital Torticollis Description

Unilateral contracture of sternocleidomastoid. Often identified in first two months of life. Laterally flexed to tight SCM and rotation away

Most appropriate communication for Receptive Aphasia

Use word repetition and manual cues to assist in communicating desired actions during rehab (Wernicke's)

These levels of Ranchos Los Amigos Levels of Cognitive Functioning represent High-level recovery

VII-VIII

Mixed CN involved with mm of heart, lung, and bowel

Vagus

Mixed CN involved with vocal sounds

Vagus

Example antispasticity med

Valium

Rearfoot Varus vs Valgus: more problematic

Varus; Valgus leads to more mobility which is favorable over rigidity seen in varus

Coordination Synkinesis

Voluntary contraction of certain muscle groups on involved side, give rise to involuntary contractions of synergistic muscles

Cementless THA WB Guidelines

WBAT/TTWB, PWBx3 weeks, cane week 4, FWB week 6

SCI graded ASIA A and B will typically ambulate with?

WC

An activity to alleviate muscle tightness associated with equinus gait pattern

Walking backwards

What type of degeneration is described as: Degeneration of axon and myelin sheath distal to site of axonal interruption

Wallerian degeneration (neurotmesis)

Describe myasthenia gravis

autoimmune dz resulting in neuromuscular junction pathos. Affects proximal musculature more than distal. Progressive weakness and fatiguability with activity

Two types of fluent aphasia

Wernicke's and Conduction

Absolute contraindications for cardiovascular endurance exercise in SCI

automatic dysreflexia, infected skin on WB surfaces, symptomatic hypotension, UTI, unstable fracture, uncontrolled hot/humid environment, insufficient RoM to perform task

Modified Ashworth scale Widely used qualitative scale for the assessment of spasticity; it measure the amount of resistance to passive stretch. MAS GRADE 0 No increase in muscle tone MAS GRADE 4 Affected part(s) in rigid flexion or extension MAS GRADE 1 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at end of ROM when moved into flexion or extension. MAS GRADE 1+ Slight increase in tone, manifested by a catch, followed by minimal resistance throughout the remained (less than half) of the ROM MAS GRADE 2 Marked increase in muscle tone through most of the ROM, but affected parts(s) easily moved MAS GRADE 3 Considerable increase in muscle tone, passive movement difficult

Widely used qualitative scale for the assessment of spasticity; it measure the amount of resistance to passive stretch.

Definition of Resting Tremors and example

appear at rest and may/may not disappear with movement; may increase with stress. Pill-rolling seen in PD

Special Tests for Shoulder dislocation

apprehension tests

Common forms of hypokinesia (3)

apraxia, rigidity, bradykinesia

Importance of Diencephalon

area where motor and sensory tracts synapse

Signs and sx of rotator cuff tear

arm positioned in IR and ADD, point tenderness of great tubercle and acromion, marked limited flexion and ABD RoM with scapular compensation, increased anterior shoulder tone, night pain

Side effects of Dopamine Replacement Agents?

arrhythmias, GI distress, orthostatic hypotension, dyskinesias, mood/behavioral change

Deceleration definition

as swing limb begins to extend and ends just prior to heel strike

Definition of analgesia

absence of pain while remaining conscious

Definition of vestibuloocular reflex

allows head/eye movement coordination. Supports visual fixation during head movement.

A motor unit consists of ______ motor neurons and the ______ ______ it innervates.

alpha; mm fibers

Signs of increased ICP secondary to Cerebral edema and Brain herniaion

altered LoC, altered vitals (increased BP; widen/slowed pulse, irregular RR with apnea; Cheyne-Stokes; elevated temp), headache, vomit, pupillary change, progressive motor sx, seizure

Double Step Gait

alternating steps are of different length or rate

Effects of nonopiod agents (4)

analgesic, pain relief, anti-inflammatory, anti-pyretic (reduces fever)

When examining sensation these can be tested cortical

bilateral simultaneous stimulation, stereognosis, two-poin discrimination, barognosis, localization of touch

Common etiology of sciatic nerve injury (3)

blunt force trauma to buttocks, THA, accidental injection to nerve

Precautions to improving cardiovascular endurance in SCI Individuals with high paraplegia or tetraplegia

blunted tachycardia and very low VO2 peak, substantial variability in responses

Comminuted Fracture description

bone breaks into fragments

Compound Fracture description

bone breaks through skin

TOS: what comprises the neurovascular bundle?

brachial plexus, subclavian artery and vein, vagus and phrenic nerves, and sympathetic trunk.

Stress Fracture description

break in bone due to repeated stress

Sx of ALS progression include (4)

fatigue, oral motor impairment, motor paralysis, and respiratory paralysis

a form of hyperkinesia that presents with brief, irregular contractions that are rapid, but not to the degree of myoclonic jerks. Is typically secondary to damage to the caudate nucleus. Huntington's disease is an example of a pathology

chorea

Describe ALS

chronic degenerative dz of UMN and LMN

Circumduction Gait

circular motion to advance the leg during swing phase; may be used to compensate for insufficient hip/knee flexion or DF

Weak hip flexors in CVA pts yield what gait deficits

circumduction, ER with ADD, backward trunk lean, or exaggerated flexion synergy

Common etiology of musculocutaneous nerve injury

clavicle fracture

Diagnostical findings confirming Rheumatoid Arthritis

clinical presentation of joints, rheumatoid factor in blood, radiographic changes

Causes of hyperextension of knee in stance (2)

compensation for weak quads, PF contracture

Weak knee extensors (knee is flexed during stance) in CVA pts yield what gait deficits

compensatory knee locking (hyperextension)

Typical uses for CT scan? (4)

complex fractures, facet dysfunction, disc dz, spinal stenosis

Common etiology of Median nerve injury (2)

compression in carpal tunnel, pronator teres entrapment

Common etiology of Ulnar nerve injury (2)

compression in cubital tunnel, entrapment in Guyon's canal

Common etiology of Radial nerve injury (2)

compression of nerve in radial tunnel, humerus fracture

Convex or Concave?: Acromion (on scapula) during acromioclavicular movements

concave

Convex or Concave?: Clavicle during sternoclavicular protraction/retraction

concave

Recovery Stages of Diffuse Axonal Injury: Emerging Independence

confusion clearing, some formation of memories, significant cognitive problems; uninhibited social behavior

Description of Osteogenesis Imperfecta

connective tissue disorder that affects collagen formation during bone formation; easily fractured

Cause of Swan neck deformity

contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons; typically from trauma or RA

Convex or Concave?: Glenohumeral movement

convex

Convex or Concave?: Hip movements of femur

convex

Convex or Concave?: Proximal radius during pronation/supination

convex

Convex or Concave?: Subtalar inversion/eversion (cuboid and calcaneus)

convex

Convex or Concave?: Talocrural DF/PF (talus)

convex

Convex or Concave?: Temporomandibular movement (mandible)

convex

Movement of the atlanto-occipital jopint follows the concave or convex rule?

convex

The largest descending motor tract?

corticospinal tract

Definition of Schwann Cell

cover nerve fibers in PNS and form myelin sheath

When is spinal orthosis used for scoliosis?

curvature between 25-40 degrees

Steppage Gait

feet and toes lifted excessively during hip and knee flexion. Usually from DF weakness. Footslap will occur

At risk pts for Patellofemoral Syndrome (4)

females, growth spurt, runners increasing mileage, overweight

Common etiology of Peroneal nerve injury (2)

femur/tibia/fibula fracture, positioning during surgical procedures

Common etiology of Obturator nerve injury (2)

fixation of femur fracture, THA

Etiology of medial meniscal tear

fixed foot rotation while WB on flexed knee

Initial signs of Alzheimer's Dz?

difficulty learning new information, changes in memory and concentration

Dysphonia

difficulty speaking due to motor dysfuntion: hoarseness denotes vocal cord paralysis; nasal quality denotes palatal weakness

Definition of 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

Definition of Hypesthesia

diminished sensation of touch

Description of Chopart's Amputation

disarticulation at midtarsal joint

Non-traumatic causes of SCI (4)

disc prolapse, vascular insult, CA, infection

Characteristics of strength with neuropathies

distal weakness of extremities

Definition of dysesthesia

distortion of any of the senses, especially touch

Recovery Stages of Diffuse Axonal Injury: Confusional

disturbance of attention mechanisms; no new memories; hypo/hyperarousal

Spinocerebellar ataxias are the main autosomal dominant or recessive?

dominant

Post CVA aphasia indicates lesion to which hemisphere?

dominant (left)

There is no ______ for C1

dorsal root

To palpate tibialis anterior have pt

dorsiflex and invert the foot

Side effects of muscle relaxants

drowsiness, sedation, dizzy,

PTs should be aware of what with pts on dopamine replacement drugs?

drug holidays, monitoring BP due to orthostatic hypotension

What is scapulohumeral rhythm? who and how much moves first? How much does each joint move with full RoM?

during 180 deg of ABD glenohumera joint moves 2:1 to scapulothoracic; first 30-60 is glenohumeral; ST: 60 and GH: 120

Describe discography and use

dye injected into disc to view any disruptions

Describe arthrography and use

dye injected into joint space to observe abnormality; tendon ruptures

Use of diagnostic US

dynamic view of soft tissue in a small area; highly dependent on user skill

Esotropia

eye pulled inward

Non-fluent aphasia typically arises when his structure is damaged

frontal lobe of dominant hemisphere

Global Aphasia is characterized by damage to what structures (3)?

frontal, temporal, or parietal lobes

Type of plain film method used to assess scoliosis

full length Cobb's

Active Movement Findings: Atraumatic Instability

full or excessive RoM

Definition of asthenia and typically secondary to?

generalized weakness; cerebellar pathos

Three Indications for anticholinergic meds

glaucoma, dementia secondary to Alzheimers, myasthenia gravis (helps stop degradation of neuromuscular junction)

Trendelenburg Gait

glute med weakness; opposite hip drop

Why must supracondylar fractures be further examined?

high number of neurological and vascular structures in region (typical radial nerve involvement)

Tabetic Gait

high stepping ataxic gait feet slap ground

Equine Gait

high steps; excessive gastroc activity

Anaerobic Metabolism is used during _____ intensity and _______ duration activities and provides energy for up to ______

high; short; 15 seconds

Definition of dysmetria

inability to control RoM and force of muscular activity

Anosmia

inability to identify smells; common in frontal lobe lesions

Definition of akinesia and commonly seen in?

inability to initiate movement; PD

Definition of ataxia

inability to perform coordinated movement

Define Apraxia

inability to perform mvmnts previously learned even though there is no loss of strength, coordination, sensation or comprehension

Dysdiadochokinesia

inability to perform quick alternating movement

Associative dysfunctions that may lead to myasthenia gravis (4)

lupus, enlarged thymus, RA, DM

Toe off definition

only toe of stance limb is in contact with ground

How to screen superficial pain

perceive noxious stimuli from pen cap, pin, or paper clip

How to screen light touch

perceive touch by light pressure or cotton ball

How to screen vibration

perceive vibration or pain through tuning fork

Ankle Inversion mm (3)

tib post and anterior, flexor digitorum longus

Pavlik Harness 1) Gold Standard for? 2) Keeps body in?

1) congenital hip dysplagia for newborns- 6 months 2) maintains hip flexion and ABD

Toeing Out 1) 3 common causes 2) Excessive angulation if femoral neck to frontal plane is less than ___ deg 3) ______ ______ ______ correction has high complication rate with surgery

1) femoral retroversion, external tibial torsion, flat feet 2) <10 deg 3) external tibial torsion

Pes Planus 1) aka 2) Normal at what age range? 3) Clinical findings for dx (2)

1) flat foot 2) 2-3 years 3) reduced longitudinal arch height and lack of rigidity for propulsion during gate

Mallet Finger 1) Characteristics 2) Caused by?

1) flexion of DIP 2) rupture or avulsion of extensor tendon at insertion into distal phalanx; typically from trauma

Smith's Fracture 1) Description

1) fracture of distal radius that is volarly displaced causing a "garden spade" deformity

Boxer's Fracture 1) Description 2) Casting duration?

1) fracture of neck of 5th metacarpal 2) 2-4 weeks

Osteomyelitis 1) Inflammatory response in bone caused by ______ 2) Typically caused by _______ (bacterium) 3) Prevalence of dz

1) infection 2) Staph A. 3) young children/immunosuppressed, more in males

Describe Elbow Flexion Test

Identifies cubital tunnel syndrome (ulnar nerve entrapment): pt in supine. Pt bilaterally max shoulder ER, and elbow in active max flexion with extended wrist for one minute. Positive if pain medial elbow and nerve signs in ulnar distribution.

Describe Morton's Test

Identifies stress fracture or neuroma in forefoot. pt supine with foot supported. PT grasps metatarsal heads and squeeze. Positive if painful.

Describe Prone Instability Test

Identify lumbar instability. Pt prone legs off table. Spring Lumbar segments until painful segment found. Have pt raise legs and re-test painful segments. Positive if decrease in pain.

Sign of a (+) Roos Test

Inability to maintain testing position for 3 minutes.

Define Astereognosis

Inability to recognize objects by touch alone

Anterior Cord Syndrome

Incomplete lesion caused by compression of anterior spinal cord and anterior spinal artery--> corticospinal and spinalthalamic tract damage. Bilateral loss of motor function and pain and temp sense below level of lesion

Signs and Sx Possible Peripheral Nerve Involvement: Suprascapular Nerve

Increased pain with shoulder flexion, scapular ABD, cervical rotation to opposite side; weakness;

RoM Reqs. for Normal Gait: Hip Flexion

0-30

RoM of hip ADD

0-30

RoM of hip extension

0-30

RoM of wrist ulnar deviation

0-30

RoM of Inversion

0-35

RoM of thoracolumbar lateral flexion

0-35

RoM of cervical spine extension

0-45

RoM of cervical spine flexion

0-45

RoM of cervical spine lateral flexion

0-45

RoM of hip ABD

0-45

RoM of hip ER

0-45

RoM of PF

0-50

RoM of cervical spine roation

0-60

RoM of shoulder extension

0-60

RoM of shoulder IR

0-70

RoM of thoracolumbar flexion

0-80

RoM of wrist flexion

0-80

DTR Testing Scores

0: absent 1+: decreased 2+: Normal 3+: exaggerated 4+: hyperactive

Ranchos Los Amigos Levels of Cognitive Function 1) Levels denoting no response 2) Decreased response 3) Confused Levels 4) Appropriate (automatic, purposeful) Levels

1) 1 2) II and III 3) IV, V, VI 4) VII and VIII

Pediatric Transient Synovitis 1) Age of onset 2) Dx 3) Signs and Sx (4)

1) 3-10 2) exam shows decreased hip ABD and IR. Effusion causing bulging of anterior joint capsule 3) U hip/groin pain, crying at night, antalgic limp, recent hx of upper respiratory tract infection

Complex Regional Pain Syndrome: Early Stage 1) aka 2) Description

1) Acute 2) diffuse, severe or burning pain, increases with stress; allodynia and hyperpathia; vasomotor instability,

Signs of end-stage Alzheimer's

intellectual and physical destruction, incontinence, functional dependence, inability to speak

Increased CSF pressure may be indicative of? (7)

intracranial tumors, abscesses, meningitis, inflammation, subarachnoid hemorrhage, cerebral edema, thrombosis of venous sinuses

somatosensory receptors are located in?

joints, muscles, ligaments, and skin

Causes of exaggerated knee flexion at terminal stance (2)

knee or hip flexion contracture

Etiology of PCL sprain and other involved structures

landing on tibia with flexed knee/dashboard injury. ACL, MCL, LCL, menisci

Scissor Gait

legs cross midline upon advancement

Thalamic Pain Syndrome

lesion to thalamus produces spontaneous pain on contralateral side

Challenging and examining the visual input system

maintaining CoG with eyes open and closed. Assessment of field cuts, hemianopsia, pursuits, saccades, double vision, gaze control, and acuity

Description of Congenital Hip Dysplagia

malalignment of femoral head in acetabulum. Develops during last trimester

The deltoid ligament is located over the lateral/medial ankle?

medial

Lateral deviators of the mandible (4)

medial and lateral pterygoids, masseter, temporalis

Mechanism of injury for LCL?

medial blow to the knee

Hallux Valgus 1) Deformity Observed

medial deviation of head of 1st metatarsal from midline of body, metatarsal and base of proximal first phalanx move medially, while distal phalanx moves laterally

Mechanism of injury for ACL? Often associated with damage to what other structures? (3)

noncontact twist associated with hyperextension and varus/valgus stress. medial capsule, MCL, menisci

Post CVA perceptual deficits indicate lesion to which hemisphere?

nondominant (right)

Special Tests: Frozen Shoulder

none

Acquired ataxia may result from? (3)

nonhereditary neurodegenerative systemic disorder, toxin exposure, or idiopathic

Right Hemisphere Specialization/Dominance

nonverbal processing/understanding, holistic info processing, artistic, hand-eye coordination, spatial relations, kinesthetic awareness, understanding music, math reasoning, negative emotions, body image

Degenerative Scoliosis description

normal aging processes leading to deformity such as osteophytes, bone demineralization, HNP. Structural scoliosis cannot reduce

Observational Findings of: Frozen Shoulder in regards to tissue and bone outlines

normal bone/tissue outlines

Recovery Stages of Diffuse Axonal Injury: Mute/Minimal Responsiveness

not vegetative with fluctuating awareness

Crossed Extension Reflex

noxious stimuli to sole of foot produces flexion of stimulated LE, then extension with ADD of opposite LE. Stretch stimulus from grasping forearm and pulling produces total flexion response of UE

Flexor Withdrawal Reflex

noxious stimuli to sole of foot produces toe extension, DF, L flexion

When the lumbar spine flexes or extends, the ilium rotates in the ______ direction

opposite

Common causes of kyphosis (3)

osteoporosis, compression fractures, poor posture secondary to paralysis

Typical etiology of BPPV?

otoliths dislodging into posterior semicircular canal

What part of the meniscus is more vascularized?

outer edges

When the ilium posteriorly rotates unilaterally (U RDL), it also moves into an ______, causing the acetabulum to ______, and leads to ______ of the hip

outflare; ER, ER

What not to do to a pt with adhesive capsulitis (shoulder)

over stretch or elevate pain

The sacral plexus arises through which vertebrae?

L4-S3 Nerve Roots

Other risk factors for Osteoarthritis (not age/gender)

overweight, fractures/joint injuries, occupational/athletic overuse

Common Signs and Symptoms associated with Degenerative Joint Disease/OA (4)

pain and stiffness upon rising, pain with repetitive flexion, more sore than nagging, eases through day (4-5 hours)

Common Signs and Symptoms associated with spinal stenosis

pain is position dependent, flexed is relieving and extended is painful, pain described as numbing tightness or cramping, walking (lumbar extension) brings on pain, pain may persist for hours once in a resting position

Symptoms of neurapraxia

pain, min. mm atrophy, numbness or greater loss of motor and sensory function, diminished proprioception

Conservative treatment for meniscal tear

palliative and stregnthening

(4) Sx associated with poor aphasia prognosis

perseveration in speech, severe auditory comprehension impairments, unreliable yes/no answers, empty speech without recognition of impairments

Hip ER mm (6) (PGOGOq)

piriformis, gemelli superior, obturator externus, gemeli inferior, obturator internus, quadratus femoris

BPPV mostly affects which semicircular canal?

posterior

Reverse Hill-Sachs fracture associated with

posterior glenohumeral dislocation

Primary focus of treatment for rotator cuff tear

prevent adhesive capsulitis and strengthen upper extremity

Description and use of Thoracolumbosacral Orthosis

prevents trunk motion

Describe PD

primary neuro-degenerative disorder that decrease in serotonin

Describe Alzheimer's Dz

progressive neurodegenerative disorder that results in deterioration and irreversible damage to cerebral cortex and subcortical areas

Description and use of Milwaukee Orthosis

promotes realignment of spine due to scoliotic curvature

Plantar fascitis may arise from a _________ gait

pronated

When examining sensation these can be tested Deep

proprioception, kinesthesia, and vibration

The ventricular system is designed to ______ and _______ the brain

protect and nourish

Function of meninges?

protect brain from contusion and infection

Antalgic Gait

protective gait pattern where involved step length is decreased to decrease weight bearing on involved side

Purpose of a PET and used to rule out

provides 2-D and 3-D imaging of brain activity; cerebral circulatory pathos, metabolism dysfunction, tumors, blood flow, and brain changes following trauma or drug abuse

Challenging and examining the vestibular system

provides CNS feedback in regards to head position and movement with relation to gravity.

Description and use of Corset

provides abdominal pressure and support. provide pressure/support for mi and low back pain and pathos

With myasthenia gravis which muscles are more affected: proximal or distal?

proximal

Why is a "crisis" episode, with a pt with myasthenia gravis, a medical emergency?

respiratory muscle involvement

tremors that are observable at rest and may or may not disappear with movement. An example is the pill-rolling motion associated with Parkinson's disease

resting

Initial sx of PD

resting tremor in hands/feet that increases with stress and stops with movement/sleep

downward rotation of the scapulae (3)

rhomboids, levator scapulae, pec minor

Post CVA pts who impulsive, quick, indifferent; often exhibit poor judgement and safety, overestimating abilities while underestimating problems sustained a lesion to which hemisphere

right (nondominant)

Effects of true leg length discrepancy of the right leg on: Pelvis

right ilium posteriorly rotated

Characteristics of CVA in: Left Hemisphere (8)

right sides weakness/paralysis; frustration; decreased processing; aphasia; dysphagia; motor apraxia; left and right discrimination; right hemianopsia

Definition of allodynia

sensation of pain in response to stimulus that would not typically produce pain

Definition of Vertigo

sense of movement and rotation of oneself or surrounding environment. Has peripheral or central origin.

Hawkin's Test is highly _________ for identifying subacromial impingement

sensitive

Neer's Test is highly ______ for identifying shoulder impingement

sensitive

Speed's Test is highly _________ for identifying bicep tendonopathy

sensitive

The Rent Sign is highly ________ and has moderately high ________ for identifying RTC tear/impingement

sensitivity, specificity

Fasciculus Gracilis is responsible for? (4)

sensory for lower body proprioception, vibration, two-point discrimination, and graphesthesia

Spinoreticular Tract is responsible for? (1)

sensory for reticular formation that influences consciousness

Fasciculus Cuneatus is responsible for? (4)

sensory for upper body proprioception, vibration, two-point discrimination, and graphesthesia

PNS Pathos: Describe Neuromuscular Junction pathology and give an example (3/1)

sensory in tact, motor fatigue > weakness, normal DTR; myasthenia gravis

PNS Pathos: Describe Muscle pathology and give an example (4/1)

sensory intact, motor weak, fasciculations rare, normal/decreased DTRs; muscular atrophy

PNS Pathos: Describe Anterior Horn Cell pathology and give an example (4/2)

sensory intact, motor weak/atrophy, fasciculations, decreased DTR; ALS, poliomyelitis

Signs and sx of shoulder dislocation

severe pain, paresthesias, limited RoM, weakness, shoulder fullness, arm supported by other limb

Description and use of Foot Orthosis

shoe insert that corrects alignment and improves function

Elevated WBC in CSF may indicate?

significant inflammation or infection

Damage to extrapyramidal tracts results in? (4)

significant paralysis, hypertonicity, exaggerated DTRs, and clasp-knife reaction

PNF: D1 Extension of upper extremity looks like

slapping butt of person beside you

Definition of Athetosis

slow, twisting, and writhing movements large in amplitude. Primarily seen in face, tongue, trunk, and extremities. When movements are brief they merge with chorea, sustained merge with dystonia.

Dysarthria

slurred and/or slowed speech that's difficult to understand

Other neuromuscular pathologies that talipes equinovarus may accompany

spina bifida, arthrogryposis

Describe recovery of axonotmesis

spontaneous; ranging from spotty to no recovery

How to screen deep pain

squeeze forearm or calf

Cerebellar Gait

staggering gait seen in cerebellar dz

Initial, conservative treatment, for congenital torticollis. What if conservative treatment fails and child is older than 1?

stretching, ARoM, positioning. Surgical release of SCM.

Describe Motor Learning

study of acquisition or modification of movement

Definition of chorea

sudden, random, and involuntary movements

Supination of foot leads to _______ and ______ glide of fibular head.

superior and anterior

Effects of true leg length discrepancy of the right leg on: ankle/foot

supination, talus rotated externally and glides upwardly

Conduction Aphasia is characterized by damage to what structure?

supramarginal gyrus, arcuate fasciculus

What if scoliosis curvature is 40+ degrees?

surgical intervention

Definition of dystonia

sustained muscle contractions that frequently cause twisting, abnormal postures, and repetitive movements.

Signs and sx of meniscal tear

swelling at joint line, catching or locking sensation,

Vaulting Gait

swing leg advances by elevating pelvis and PF of stance side

Midswing definition

swing limb is under body

Signs and sx of Rheumatoid Arthritis

sx are symmetrical, morning stiffness, warm joints, decreased appetite, malaise, increased fatigue, swan neck deformity, boutonniere deformity, low grade fever

Describe an ischemic stroke by and embolus

sx associated with CVD, an embolus from anywhere in the body dislodges and travels to cerebral artery

Most common forms of diabetic neuropathy (2)

symmetric polyneuropathy and autonomic neuropathy

Typical signs and sx of diabetic neuropathy?

symmetric sensory disturbances and weakness occurring distally. Stocking glove sensory loss

Autonomic neurons are divided into what two categories?

sympathetic and parasympathetic

Semicircular Canals read?

fluid with head motion

Definition of Positional Nystagmus and typically lasts?

induced by change in head position. Typically lasts few seconds

What is a hemorrhagic CVA?

infarct caused by rupture of brain blood supply

Shoulder capsule is least support in what direction?

inferior

Plantar Fasciitis description

inflammation of plantar fascia at proximal insertion on medial tubercle of calcaneus.

Changes in color of CSF may be indicative of? (3)

inflammatory dz, hemorrhage, tumor

Plantar Flexors (7)

tib posterior, gastroc, soleus, peroneus longus and brevis, plantaris, flexor hallucis

More dense objects on an x-ray appear _________ and less dense tissues appear ________

white; black

Damage to pyramidal (corticospinal) tracts results in? (5)

(+) Babinski, absent superficial abdominal reflexes and cremasteric reflex, and loss of fine motor or skilled voluntary movement

Signs of CNS inflammation and meningeal irritation

(+) Kernig's and Brudzinski's, irritability, slowed mental function, headache in head down position, delirium, coma, altered vitals (increased HR/RR or fluctuating BP), generalized weakness

Special Tests: Atraumatic Instability

(+) Load and shift, apprehension, relocation, augmentation tests

Special Tests: Cervical Spondylitis

(+) Spurling's, Distraction, ULTT, Shoulder ABD tests

Mobilization for irritated neural tissue

(Maitland) Grade II; should be non-painful

Spinal cord ends at which vertebral body

L1

Impairments caused by vertebral-basilar artery damage

-LoC -Hemi/Tetraplegia -Comatose/Vegetative -Inability to speak -Locked-in Syndrome -Vertigo -Nystagmus -Dysphagia -Dysarthria -Syncope -Ataxia

Predictable Patterns of Impairment with occlusion to anterior cerebral artery

-Bilateral occlusion--> paraplegia -incontinence -abulic aphasia -frontal lobe sx

List the descending motor tracts (6)

-Corticospinal Tract (anterior and lateral) -Reticulospinal Tract -Rubrospinal Tract -Tectospinal Tract -Vestibulospinal Tract

Signs of impairment to Parietal Lobe

-Dominant (typically left) hemisphere: agraphia, alexia, agnosia -Non-dominant (typically right) hemisphere: dressing/constructional apraxia, anosognosia -contralateral sensory deficits -impaired language comprehension -impaired taste

List ascending sensory tracts (9)

-Fasciculus Cuneatus -Fasciculus Gracilis -Spinocerebellar Tract (dorsal and ventral) -Spino-olivary Tracy -Spinoreticulo Tract -Spinotectal Tract -Spinothalamic Tract (anterior and lateral)

Lateral Patellar Tracking -Possible cause

-Increased Q-angle with a tendency for lateral subluxation/dislocation

Considerations to take whilst pt has a seizure (9)

-Stay calm -Clear surrounding area -Be aware of duration -ensure comfort best as possible -keep isolated; sans medical respondents -Do not restrain -Do not place anything in mouth -Do not provide water/food until fully alert -If duration >5 minutes call 911

Signs of impairment to Temporal Lobe

-learning deficits -Wernicke's Aphasia (receptive) -Antisocial, aggression -Difficulty facial recognition -Memory deficits -Inability to categorize objects -Performing recently learned skills

Impairments caused by middle cerebral artery damage

-Wernicke's aphasia (in dominant hemisphere) -Homonymous Hemianopsia -Apraxia -flat affect with right hemisphere damage -Contralateral motor/sensory loss of face and upper extremity with lesser involvement of lower extremity -Impaired spatial relations -Anosognosia in non-dominant hemisphere -Impaired body schema

Predictable Patterns of Impairment with occlusion to middle cerebral artery

-bilateral occlusion --> contralateral hemiplegia and sensory loss; largely sparing the leg -Dominant hemisphere involvement: global, Wernicke's or Broca's aphasia -homonymous hemianopsia

Impairments caused by anterior cerebral artery damage (simplified)

-contralateral lower extremity motor/sensory deficits

Impairments caused by posterior cerebral artery damage

-contralateral pain and temperature loss -contralateral hemiplegia, mild hemiparesis -ataxia, athetosis, or choreiform movement -impaired quality of movement -thalamic pain syndrome -anomia -prosopagnosia with occipital infarct -Hemiballismus -Visual agnosia -Homonymous Hemianopsia -Memory impairment -alexia, dyslexia -Cortical blindness from bilateral involvement

Characteristics of Peripheral Vertigo

-episodic/short duration -autonomic symptoms present -precipitating factor -pallor, sweating -nausea and vomiting -auditory fullness -tinnitus

Signs of meningitis

-fever, headache, vomiting -nuchal rigidity -lumbar and posterior thigh pain -Brudzinski and Kernig's sign -photosensitivity

Importance of cerebellum

-fine tuning movement -assists with maintaining posture and balance by controlling muscle tone and extremities in space -Ipsilateral impairments

Signs of impairment to Occipital Lobe

-homonymous hemianopsia -impaired extraocular movement and visual deficits -impaired color recognition -reading/writing impaired -if bilateral lobe involvement, then cortical blindness

Damage to hypothalamus may lead to?

-obesity -sexual disinterest -poor temperature control -diabetes insipidus

The middle cerebral artery supplies what parts of the brain?

-outer cerebrum -basal ganglia -posterior and anterior internal capsule -putamen -pallidum -lentiform nucleus

The Posterior Cerebral Artery supplies what parts of the brain?

-part of midbrain -subthalamic nucleus -basal nucleus -thalamus -inferior temporal lobe -occipital and occipitoparietal cortices

Function of Temporal Lobe

-primary auditory/olfactory center -Wernicke's (left hemisphere): understand and produce meaningful speech -interpretation of other's emotions and reactions

Importance of Hypothalamus

-receives and integrates info from ANS -hormonal regulation (homeostasis) -control of sexual behavior, hunger, thirst, and sleep

Importance of Thalamus

-relay/processing center for info to cerebral cortex -coordinates sensory perception and movement with other parts of brain

Function of Parietal Lobe

-sensation of touch, kinesthesia, vibration, temperature, -provides meaning to objects -interprets words/language -spatial/visual perception

RoM Reqs. for Normal Gait: DF

0-10

RoM Reqs. for Normal Gait: Hip Extension

0-10

RoM of hip flexion

0-120

RoM of knee flexion

0-135

RoM of Eversion

0-15

RoM of elbow flexion

0-150

RoM of shoulder ABD

0-180

RoM of shoulder flexion

0-180

RoM Reqs. for Normal Gait: PF

0-20

RoM of DF

0-20

RoM of wrist radial deviation

0-20

RoM of thoracolumbar extension

0-25

Tarsal Tunnel Syndrome 1) Entrapment of what? 2) What may lead to tarsal tunnel syndrome? 3) Sx (3) 4) (+) test

1) posterior tibial nerve 2) over/excessive pronation, overuse tendonitis of long flexor and post tib tendon, and trauma may compromise space 3) pain, numbness, and paresthesias along medial ankle 4) Tinel's

Carr and Shepherd: Motor Re-Learning Approach 1.) identify ___ 2.) inhibit unnecessary ________ 3.) promote proper body ____ 4.) knowledge of ______

1.) goal 2.) movement 3.) alignment 4.) results

Brunnstrom: Movement Therapy in Hemiplegia Terms 1.) Associated Reaction 2.) Homolateral Synkinesis 3.) Limb Synergies 4.) Raimiste's Phenomenon 5.) Souque's Phenomenon 6.) Stages of Recovery

1.) involuntary and automatic movement of body part resulting from intentional active or resistive movement in another body part 2.) flexion pattern of the involved upper extremity facilitates flexion of involved lower extremity 3.) group of muscles that produce predictable pattern of movement in flexion/extension patterns 4.) involved lower extremity will ABD/ADD with applied resistance to uninvolved lower extremity in same direction 5.) raising involved upper extremity above 100 deg with elbow extension will produce extension and ABD of fingers 6.) seven stages of recovery describing tone, reflex activity, and volitional movement

The cognitive stage: 1.) _________ amount of errors 2.) inconsistent or consistent attempts? 3.) Repetition leads to? 4.) consistent or inconsistent performance? 5.) degree of cognitive work?

1.) large 2.) inconsistent 3.) improved strategies 4.) inconsistent 5.) large

Muscle Grades: Fair Minus

3-/5 completes more than half of range against gravity

Normal tissue pressure of carpal tunnel?

3-7 mmHg

Muscle Grades: Fair

3/5 completes RoM without resistance

Carpal Tunnel syndrome may present with tissue pressures exceeding?

30 mmHg

Polyarticular Juvenile Rheumatoid Arthritis

30-40% of cases. Mostly females, significant rheumatoid factor, arthritis 4+ joints symmetrically

How many pairs of spinal nerves exit vertebral column?

31

Sx of Huntington's typically occur at what age range?

35-55

Broca's Aphasia is characterized by damage to what structure?

3rd convolution of frontal lobe

How many small vertebrae form the coccyx?

4

Frequency and duration of BWS treadmill training

4 days/week; 20-30 minutes for 8-12 weeks

Muscle Grades: Good Plus

4+/5 completes RoM against mod-max resitance

Muscle Grades: Good Minus

4-/5 completes RoM against min-mod resistance

Muscle Grades: Good

4/5 completes RoM against mod resistance

50% of deaths from hemorrhagic stroke occur with in?

48 hours

How many fused vertebrae form the sacrum?

5

How many lumbar vertebrae are there?

5

Muscle Grades: Normal

5/5 completes RoM against max resistance

Anaerobic glycolysis is ____ % slower than Anaerobic phosphocreatine metabolism, but provides _______ of energy

50%; 30-40 seconds

How many ribs attach to the sternum?

7

ABCs for Radiograph reading

A: Alignment- size, contour, B: Bone Density- density and texture C: Cartilage Spaces- joint space width, presence of subchondral bone, epiphyseal plates

Piriformis Muscle Actions

ABD and ER

A prosthetic that is too long will?

ABD gait, circumducted gait, vaulting,

Hemiplegic Gait

ABD paralyzed limb, swing it around, and bring it forward

Description of Anterior Drawer Test (knee)

ACL Injury: pt in supine with knee flexed 20-30. PT stabilizes distal femur with one hand and other on proximal tibia. PT applies anterior force through tibia. Positive if excessive displacement with diminished or absent end feel.

What other structures are typically involved with an MCL sprain?

ACL and medial meniscus

Description of ACL sprain Grades I, II, and III

ACL prevents anterior translation of tibia on femur. Grade I: microscopic tears; mild pain and swelling Grade II: moderate pain and swelling, minimal instability, min to mod tearing, decreased RoM Grade III: severe pain and swelling, substantial instability, total tear, substantial loss of RoM

Post reconstruction hinge brace setting for: ACL and PCL

ACL: 20-70 PCL: 0

Effects of true leg length discrepancy of the right leg on: Femur

ADD and ER, relative extension

RoM needed for ADLs and comfortably getting up from sitting in knee?

ADLs: 90 Sit-to-Stand: 105

Ankylosing Spondylitis vs Spinal Stenosis: History AP: (4), SS: (2)

AP: morning stiffness, more in males, sharp pain --> ache, B SI pain may refer to posterior thigh SS: Intermittent aching pain, pain may refer to both legs with walking (neurogenic claudication)

Ankylosing Spondylitis vs Spinal Stenosis: Resisted Isometrics

AP: normal in beginning stages SS: normal

Ankylosing Spondylitis vs Spinal Stenosis: Active Movements

AP: restricted SS: May be normal

Ankylosing Spondylitis vs Spinal Stenosis: Passive Movements

AP: restricted SS: may be normal

Osteogenesis Imperfecta management

ARoM focusing on symmetry, positioning, functional mobility, fracture management, orthotics

Contraindications for Joint Oscillations (absolute and relative)

Absolute: joint ankylosing, bone malignancy, dz affecting ligament integrity (RA and Down's), arterial insufficiency, active inflammation/infection Relative: DJD, metabolic bone dz (osteoporosis, Paget's, TB), hypermobile, total joint replacement, pregnant, spondylolithesis, steroid use, radicular sx

Contraindications for soft tissue/myofacial techniques (absolute and relative)

Absolute: soft tissue breakdown, infection, cellulitis, inflammation, and/or neoplasm Relative: hypermobilit and sensitivity

What (3) ligaments could be involved with an inversion (lateral) ankle sprain?

Anterior talofibular ligament, calcaneofibular ligament, or posterior talofibular ligament

Most (95%) of GH dislocation occur in what direction?

Anterior-Inferior

Description of Sitting Flexion Test and tests for? (Lumbar/SI region)

Articular Restriciton: pt in sitting with knees flexed to 90 and feet on floor. Hips should be ABD to allow forward trunk flexion. PT palpates thumbs over inferior PSIS and monitors as pt bends towards floor. Positive if unilateral difference in movement of PSIS

Stenosis causes U or B Sx? Pts prefer activities in?Avoid ______ activities.

B; flexion; extension

Etiology of Peripheral vertigo (7)

BPPV Meniere's disease. Infection. Trauma/tumor. Metabolic disorders (diabetes). Acute alcohol intoxication

Etiology of Peripheral Vertigo (6)

BPPV, Meniere's, Infection, trauma/tumor, metabolic disorders, acute alcohol intoxication

Special Tests for for pediatric hip pathos (2)

Barlows test, Ortolanis test

Chorea is typically secondary to damage to what structure?

Basal Ganglia

Ganglion Cyst

Benign cyst on back of hand or wrist

List of Postural and Stability Test and Measures (4)

Berg, MiniBest, Rhomberg, Functional Reach

Pros of Patella Grafts for ACL reconstruction (3)

Better maintaining post-op tension, less expensive, faster healing

Description of Yergasons Test

Bicep tendonitis: pt sitting with arm pronated and elbow flexed to 90. Humerus is tabilized and PTs hands over bicipitale groove and one over forearm. PT resists pt's supination and ER. Positive if pain/tenderness at bicipital groove region.

Damage to the optic chiasm will cause...

Bitemporal Hemianopsia; a visual deficit on the outside halves of both eyes

What is responsible for nutrient exchange between CNS and vascular system?

Blood Brain Barrier

Gold Standard for measuring bone mineral density

Bone density scan/DEXA/Bone Densitometry

4 types of non-fluent aphasia

Broca's, Global, Verbal Apraxia, Dysarthria

Description of Trendelenburg

Glute Med Weakness on stance side: pt in standing and asked to stand on one leg. Positive if opposite hip drops

Ambulation guidelines for cementless TTWB THA post-op

By week 6 progress to 1/3 WB, 2/3 by week 8, FWB week 10 with walker. Cane week 12. no AD when safe and absent trendelenburg

Common mechanism of musculocutaenous nerve injury

Clavicular Fracture

Treatment for congenital hip dysplagia for 6 month- 2 year olds

Closed reduction under anesthesia--> spica cast 12 weeks

Ranchos Los Amigos Levels of Cognitive Function assess?

Cognitive recovery from TBI

What are the 3 stages of motor learning?

Cognitive, Associative, and Autonomous

Recovery Stages of Diffuse Axonal Injury (6)

Coma--> Unresponsive--> Mute responsive--> Confused--> Emerging Independence--> Intellectual Competence

Basal Ganglia function and components

Composed of caudate, putamen, globus pallidus, substantia nigra, and subthalamic nuclei. Collectively responsible for voluntary movement, regulation of autonomic movement, posture, muscle tone, and control of motor responses

Common mechanism of median nerve injury

Compression in the carpal tunnel or pronator teres entrapment

Common mechanism of ulnar nerve injury

Compression in the cubital tunnel or entrapment in Guyon's canal

Vertebrae below C-2 follow the convex or concave rule?

Conave

Description of Grind Test for wrist

DJD in carpometacarpal joint: pt sitting/standing. PT stabilizes pt's hand and grasps thumb at metacarpal. Compression with rotation is applied. Positive if painful.

Ligament that is injured after a medial (eversion) ankle sprain?

Deltoid ligament

Sensory Function and reflexes Findings: Cervical Spondylitis

Dermatomes and reflexes affected

Describe Bicycle (van Gelderen's Test)

Differentiates between intermittent claudication and spinal stenosis. Pt rides stationary bike at set pace in an erect position while PT times. Then continues while slumped timed. If can ride longer during slump, then spinal stenosis.

Hip Extensors (4)

Glute max and med, semimemnbranosus/tendinosus, biceps femoris

Gender differences with scoliosis etiology

Equal for mild scoliosis, girls greater risk for 30+ degree scoliosis

Describe alar Ligament Test

Evaluate integrity of Alar Ligament. Pt seated. PT passively slightly flex upper cervical spine and pincer grasp C-2. Palpate movement while side-bending and/or rotating. Positive: inability to palpate C-2 moving in conjunction with C1.

Describe TMJ compression test

Evaluates for pain with compression of retrodiscal tissues. Pt in supine/sitting. PT stabilizes head and other hand superiorly forces mandible to cause compression on disc. Positive finding if painful.

Describe Transverse Ligament Test

Evaluates integrity of transverse ligament. pt supine with head supported. Glide C-1 anteriorly. Should be firm end-feel. Positive if soft end-feel, dizziness, nystagmus, lump sensation in throat, nausea.

Describe Anterior Shear Test

Evaluates upper cervical spine ligaments and capsules. Pt in supine with head supported. PT glides C2-C7. Should be firm end-feel. Positive if lax, dizziness, nystagmus, lump sensation in throat, or nausea.

Hip ABD mm (5)

Glute med and min, piriformis, obturator internus, TFL

Boutonniere Deformity

Extension of metcarpophaangeal joint and distal interphalangeal joint flexion of proximal interphalangeal joint

T/F: there is possibility for regeneration to a neurotmesis peripheral injury

F

Mixed CN involved with taste (3)

Facial, Glossopharyngeal, and Vagus

Common mechanism of injury of peroneal (fibular) nerve

Femur, tibia, or fibula fracture, positioning during surgical procedures

What is a trimalleolar fracture

Fracture of medial and lateral malleoli and posterior tubercle of the tibia

Common mechanism of axillary nerve injury

Fracture of neck of humerus or anterior dislocation of the shoulder

Special Tests for wrist/hand neurological dysfunction (3)

Froments sign, Phalens test, Tinnels Sign

RoM Reqs. for Normal Gait: Knee Extension

Full

Capsular pattern of glenohumeral joint? hip?

GH: ER, ABD, IR Hip: flexion, IR>ABD

SIJ Dysfunction Tests and Measures (5)

Gellet's, Gaenslans, Goldthwait's, Long-Sitting Test, Ipsilateral anterior rotation test

This test examines levels of consciousness

Glasgow Coma Scale

CNS Infection or Meningeal irritation is global or focal?

Global

Mixed CN involved with parotid gland

Glossopharyngeal

Mixed CN involved with alimentary tract, heart, vessels, and lungs (2)

Glossopharyngeal and Vagus

Mixed CN involved with swallowing (2)

Glossopharyngeal and Vagus

Kaltenborn Description of Joint Mobilization Grades (non-thrust)

Grade I: "Loosening". Performed during examination/intervention. Relieves pain and decompresses. Small amplitude beginning of range Grade II: "Tightening". Mobilize after taking up some tissue slack. Alleviates pain, asses joint play, reduce mm guarding. Grade III: "Stretching". Assesses end-feel and increases tissue

Strain Grades Grades: I, II, III

Grade I: localized pain, min swelling and tenderness Grade II: localized pain, mod swelling and tenderness Grade III: palpable defect of muscle, severe pain, poor motor function

Occipital lobe impairments

Homonymous hemianopsia, impaired extraocular muscle movement and visual deficits, impaired color recognition, reading & writing impairment, and cortical blindness with bilateral lobe involvement.

Posterior dislocation of GH occurs with...

Horizontal ADD and IR

What is a compression fracture of the posterior humeral head called?

Hill-Sachs Lesion

A physical therapist notices that a patient with a transfemoral amputation consistently takes a longer step with the prosthetic limb than the contralateral limb. The MOST likely cause of the deviation is:

Hip flexion contracture: this will limit hip extension thus a shorter step is needed on the opposite side

Description of Thomas Test

Hip flexor contracture: pt in supine with legs fully extended. Pt brings one knee to chest to flatten lumbar spine. PT observes opposite hip. Positive if raises from table.

Misc. ankle tests (4)

Homans sign, Thompson test, tibial torsion test, True leg length discrepancy test

Damage to the contralateral optic tract will cause...

Homonymous Hemianopsia; a visual deficit of either the right or left halves of both eyes

Describe Windlass Test

Identifies windlass effect of plantar fascia. Test in WB: Pt stands on step with toes off. PT passively extends 1st MTP Non-WB Test: pt seated foot above floor knee at 90. PT stabilizes foot and extends 1st MTP. Positive if sx are reproduced.

Degrees of motion of ankle through gait cycle starting with ISw

ISw: 10 PF , MSw: neutral , TSw: neutral , IC: neutral , LR: 15 PF , MSt: 10 DF , TSt: neutral , Pre-Swing: 20 PF

Degrees of motion of hip through gait cycle starting with ISw

ISw: 20 flex, MSw: 20-30 flex, TSw: 30 flex, IC: 30 flex, LR: 30 flex, MSt: neutral, TSt: 10 extension, Pre-Swing: neutral

Degrees of motion of knee through gait cycle starting with ISw

ISw: 60 flex , MSw: 30 flex , TSw: 0 , IC: 0 , LR: 15 flex , MSt: moving to neutral , TSt: 0 , Pre-Swing: 35 flex

THA Lateral approach precautions

Ideal for noncompliant pts, flexion passed 90, ER, ADD

Description of Crank Test

Identifie anterior shoulder instability or labral tear. Pt standing. PT holds proximal humerus and elbow. PT elevates pt arm to 160 in scapular plane. Elbow hand applies force through humerus while other IR and ER. Positive with or without click and pt pain response

Describe Horizontal ADD Test

Identifies AC joint dysfunction or subacromial impingement. PT stands behind pt on testing side. PT passively flexes pt shoulder to 90 holding arm just distal to elbow. Then max ADD to other shoulder. Positive if report of pain during movement or local to AC joint.

Description of Brush Test (knee)

Knee Effusion: pt in supine. PT places one hand medial joint line of patella and strokes proximally with palm and fingers to suprapatellar pouch. Other hand strokes down lateral surface of patella. Positive if wave of fluid flow just below medial distal border of patella

Peripheral nystagmus

Is inhibited when the patient fixates their vision on an object. It is unidirectional and presents with significant vertigo. The length of symptoms are finite but recurrent. Causes:Meniere's disease,infection of inner ear

Description of Varus Stress Test for Elbow

LCL sprain: pt sitting with elbow flexed 20-30. PT places one hand on elbow and other proximal to wrist. While palpating joint line varus force is applied. Positive if laxity compared to non-involved side, apprehension or pain.

Dx tests for MS

LP, elevated gamma globulin, CT or MRI, myelogram

Left Hemisphere Specialization/Dominance

Language: (understanding, produce written/spoken), sequencing and performing movement, analytical controlled, logical, math calculations, positive emotions, processing verbal coded information

Description of Mill's Test

Lateral Epicondylitis: pt sitting. PT palpate lateral epicondyle, pronates pt's forearm, flexes wrist, and extends elbow. Positive if painful.

Most common cause of SCI

MVA

Description of Apley's Compression Test

Meniscal Lesion: pt in prone with knee flexed to 90. PT stabilizes femur with one hand and other hand on heel. Apply medial and lateral rotation while applying compressive force. Positive if painful or clicking.c

Description of Bounce House Test

Meniscal Lesion: pt in supine. PT grabs pt heel and max flex knee. Then passively extended. Positive if incomplete extension or rubbery end feel

Etiology of Lateral Epicondylitis

Microtrauma from eccentric loading of extensor muscles; especially extensor carpi radialis. Most common in 30-50 year olds. Tennis elbow

Most common affected artery from CVA?

Middle cerecral

Which cerebral artery is most commonly affected by emboli? and from where?

Middle from the internal carotid

Observational Findings (movement of C-Spine and physical finding) of: Cervical Spondylitis

Minimal/no spine movement, possible torticollis

Sx of a thrombotic CVA may occur when?

Minutes to days

Treatment of adhesive capsulitis (shoulder) (3)

Mobs RoM exercises palliative modalities

Cons of Hamstring Grafts for ACL reconstruction (3)

More expensive, more difficult procedure, rehab more difficult (slower)

Etiology of Osteoarthritis by age and gender.

More in men than women up to age 55, and then more in women than men afterwards

Description/Uses of CT/CAT scan

Noninvasive test provides sectional imaging of bone and most soft tissue. Especially good for chest and abdomen. Also used for bone density (fracture prediction) and tumor identification

Resisted Isometrics Findings: Cervical Spondylitis

Normal; unless nerve root compression. Myotome may be affected

Sensory Function and reflexes Findings: Frozen Shoulder

Not Affected

Sensory Function and reflexes Findings: Rotator Cuff Lesion

Not Affected

What can be observed using the Dix-Hallpike maneuver?

Nystagmus present during BPPV

Gold Standard treatment for congenital hip dysplagia for what age group?

Pavlik Harness; newborn-6 months

6 phases of ACL/PCL reconstruction rehab

Preop, Max Protection, controlled motion, moderate protection, minimum protection, return to activity

treatment of Legg-Calve-Perthes Disease

Primarily relieve pain, positioning, improve RoM,

Basilar Artery Syndrome

Produces brainstem and PCA signs and sx. Locked-in Syndrome

Posterior Tibialis tenosynovitis arises from pronation/supination?

Pronation

Muscle likely to entrap median nerve?

Pronator Teres

Describe Tillaux Fracture

Salter-Harris Type III fracture of distal tibia, that has a poor prognosis

Describe Muscular pathology characteristics and example

Sensory component is intact Motor weakness Rarely fasciculations Normal or Dec. DTR's Ex: Muscular dystrophy

Description of Upper Limb Tension Test for Radial Nerve

Sequence: shoulder depression with ABD 10, elbow extension, forearm pronation, wrist flexion and ulnar deviation, finger and thumb flexion, shoulder IR. Provoke with contralateral cervical lateral flexion

Elevators of the mandible (3)

Temporalis, masseter, medial pterygoid

Define Delirium

Temporary confusion and loss of mental function. Often a result of illness, drug toxicity or lack of oxygen. Often reversible

C1-7 nerve roots exit ______ their respective vertebrae while C8's nerve root exits ______

above; below

Are manipulations appropriate for whiplash pts?

Yes

BPPV typically lasts how long?

a few seconds

NDT inhibits ______ while facilitating _________

abnormal movement; normal movement

Asthenia

abnormal physical weakness or lack of energy

Definition of paresthesia

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

Description and use of KAFO

allow to lock knee if needed. Ankle held in alignment

Describe symptoms of peripheral mononeuropathy pathology and example

an isolated nerve lesion. Sensory loss along the nerve route Motor weakness and atrophy in a peripheral distribution; may have fasciculations Ex: Trauma or entrapment

Special Tests for ankle ligamentous instability (2)

anterior drawer, talar tilt

The anterior cerebral artery supplies what parts of the brain?

anterior frontal lobe and medial surface of frontal and parietal lobes

Where does the Anterior Cerebral Artery (ACA) supply blood?

anterior frontal lobe and medial surface of frontal and parietal lobes

Signs and sx of Patellofemoral Syndrome

anterior knee pain, pain with prolonged sitting, crepitus, pain with up/down stairs

The Crank Test is a highly sensitive and specific test for _____ or ______

anterior shoulder instability or labral tear

3 landmarks of Q-angle is measurement?

anterior superior iliac spine, midpoint of the patella, tibial tubercle

Which ligament would most likely be sprained by inversion+PF?

anterior talofibular ligament

Most common direction of glenohumeral dislocation is ______ and is associated with _______ and ________

anterior; ABD and ER

Common forms of hyperkinesia (7)

ataxia, athetosis, chorea, tics, tremors, dysmetria, dystonia

Signs and sx of Legg-Calve-Perthes Disease

avascular necrosis of femoral head leading to pain, decreased RoM, antalgic gait, Trendelenburg

Type of meningitis that is fatal within hours of onset

bacterial

Early sx of PD

balance disruptions, bed mobility, manual fine motor

Important concept when treating pt on antispasticity meds

balancing treatment between reducing spasticity and loss of function that comes with hypertonicity

Describe Numerical Rating Scale for subjective pain measurement

based off 0-10 or 0-100 scale. easy to administer

Initial Contact definition

beginning of stance phase occurs when foot touches ground

Terminal Stance definition

begins when heel of stance limb rises and ends when other foot touches ground

Pre-Swing definition

begins when other foot touches ground and ends when stance foot reaches toe off

Most affected arteries of TIA?

carotid and vertebrobasilar

Convex or Concave?: Distal radius during pronation/supination

concave

Convex or Concave?: Knee movement of tibia

concave

Convex or Concave?: Radius and ulna during elbow flexion and extension

concave

Convex or Concave?: Toe flexion/extenion (distal phalanx) and ABD/ADD (proximal phalanx)

concave

Convex or Concave?: Trapezoid during wrist flexion/extension

concave

Convex or Concave?: Capitate, scaphoid, lunate triquetrium during wrist flexion/extension

convex

PT implications for anticholinergic meds

decreased HR, dizziness, report concerning sx with MD, pts with myasthenia gravis or Alzheimers should be treated while on anticholinergic meds

Characteristics of CVA in: Cerebellum (6)

decreased balance; ataxia; decreased coordination; nausea; decreased ability for postural adjustment; nystagmus

Characteristics of strength with Myasthenia Gravis

decremental losses

Signs and sx of impingement syndrome

deep discomfort/mild pain, pain with OH activities, painful arc 70-120 ABD, tenderness over greater tuberosity and bicipital groove

Side effects of antispasticity meds

drowsiness, confusion, headache, dizziness, generalized muscle weakness

A Syndrome of sustained muscle contractions that frequently causes twisting, abnormal postures, and reptitive movements. Common diagnoses that may include this disorder are Parkinson's disease, Cerebral palsy, and encephalitis.

dystonia

With tendonopathies (tendonosis/tendonitis/etc), endurance and strengthening exercises typically focus on the ______ phase

eccentric

Causes of insufficient knee flexion during swing phase (4)

effusion, quad extension or PF spasticity, insufficient flexion RoM

Definition of hip stradegy

elicited by large perturbation. Hips move opposite the head. Muscles contract proximal to distal

Main function of amygdala

emotional and social processing

Misc. conditions that may increase risk for dementia (4)

head injury, hydrocephalus, toxins, alcoholism

Prevention for plantar fasciitis

heel cord stretching, appropriate footwear, avoiding sudden change in training intensity

Shoe adjustments for plantar fascitits

heel cup, medial longitudinal arch

Shoe adjustment for Achilles tendonitis

heel lift

Heel off definition

heel of stance limb leaves ground

Standard Terminology for gait (8 terms starting with heel strike)

heel strike, foot flat, midstance, heel off, toe off, acceleration, midswing, deceleration

Definition of Hyperesthesia

heightened sensation

RBC in CSF may indicate?

hemorrhage or traumatic tap

The autonomic nervous system deals with everything that has to do with _____

homeostasis

How to screen graphesthesia

identifying number/letter drawn on skin without visual input

Mechanism of injury for MCL?

lateral blow to knee

Signs and sx of congenital torticollis

lateral cervical flexion to side of contracture and rotation away with facial asymmetries

Description of Scoliosis

lateral curvature of spine. Three classification: functional, neuromuscular, degenerative.

A prosthetic that is too short will? (1)

lateral lean

Post CVA pts who are slow, cautious, hesitant, and insecure sustained a lesion to which hemisphere

left (dominant)

Verbal Apraxia is characterized by damage to what structure?

left frontal lobe adjacent to Broca's Area

Characteristics of CVA in: Right Hemisphere (10)

left sided weakness/paralysis; decreased attention; left hemianopsia; decreased awareness/judgment; memory deficits; left inattention; decreased abstract reasoning; emotional lability; impulsiveness; decreased spatial orientation

LMN sx of ALS are due to damage to what structures and shows as what sx? (2)

loss of anterior horn cells in spinal cord and motor nerves in lower brainstem; atrophy and weakness

Signs of Alzheimer's progression

loss of orientation, word finding difficulties, depression, poor judgement, rigidity, bradykinesia, shuffling gait, impaired ADLs

What is a Ischemic stroke

loss of perfusion of an area causes central portion to irreversibly infarct

Definition of pallenesthesia

loss of vibration sense

Aerobic metabolism is utilized during ____ intensity and ___ duration exercise and provides the _____ ATP of all systems.

low; long; most

Depressors of the scapulae (4)

lower traps, lats, pec major and minor

Gold standard for dx meningitis

lumbar punture

Describe nerve degeneration associated with neurapraxia

nerve fibers not damaged and no evidence of nerve degeneration

Hippocampus is largely involved with ________

memories

Late stage Huntington's sx include (7)

mental decline, IQ decrease, depression, dysphagia, incontinence, immobility, rigidity

Pt has a patellar tendon autograft, which activity would be best post-op

mini-squat

Sx of Anterior Cerebral Artery Syndrome

minimal due to collateral circulation of circle of Willis

Primary reason to alleviate any adherence to a scar post BKA would be?

minimize shear during prosthetic use

First 1-3 weeks following TKA PT goals (5)

mm re-ed, mobilize soft tissue, initiate A/PROM, reduce swelling and lymphedema

Avoid forceful ______ and PROM > ___ deg post TKA

mobilization; 90

Exercise precautions for ALS pts

monitor fatigue, avoid overwork injury, limit positions decreasing pulmonary function

Ventral roots are sensory or motor?

motor; efferent

What information do muscle spindles send to the nervous system?

muscle length and/or rate of change

Examples of somatosensory information

muscle length, tension, pressure, pain, and joint position

An EMG can be used to rule out

muscle pathology, nerve pathology, spinal cord disease, denervated muscle, and LMN

Golgi tendon organs send what information to the nervous system?

muscles tension and/or rate of tension

Describe bone scan and used to identify

radioactive tracers injected; shows metabolic activity of bony anatomy; images for bone CA, fractures, bone dz, RA, infection

What diagnostical test may be helpful in confirming Osteoarthritis?

radiographs; may find decreased joint space or bone spurring

Describe recovery of neurapraxia

rapid and complete and occurs in 4-6 weeks

Goals of treatment for Rheumatoid Arthritis

reduce inflammation and pain, promote joint function, prevent joint destruction and deformity.

Goals for treating osteoarthritis? (3)

reduce pain, promote joint function, protect joint

Sx of Middle Cerebral Artery

reduced consciousness

Sx of Internal Carotid Artery Syndrome

reduced levels of consciousness, massive edema, brain herniation, death

If a pt complains of stomach pains while on non-opioid agents then _______

refer to physician

Pons function -Regulates -Orientates

regulation of respiration orientation of head in relation to visual/auditory stimuli

Modified Ashworth Scale Grade 2

tone throughout, but still easily moveable

What might exaccerbate sx of a pt with myasthenia gravis?

too hot/cold or stress or strenuous exercise

Spinal Shock

transient period of reflex depression and flaccidity; may last hours to 24 weeks

Acts as retinaculum for long head of biceps tendon

transverse humeral ligament

Retractors of the scapulae (2)

traps and rhomboids

Muscles of upward rotation of scapulae (2)

traps serratus anterior

Etiology of Legg-Calve-Perthes Disease

trauma synovitis, infection, vascular compromise

Posterior Leaf spring AFO use

trim line posterior to malleoli. supports DF and prevents foot drop. Need medial/lateral control

Hyperpathia

increased sensitivity to normal stimuli

Definition: Edema

increased volume of fluid in soft tissue outside of joint capsule

Definition: Effusion

increased volume of fluid within joint capsule

Recovery Stages of Diffuse Axonal Injury: Intellectual Competence

increasing independence with residual cognitive/social/behavior difficulties

Rigidity is dependent or independent of velocity?

independent

Metatarsalgia 1) Mechanical Etiology 2) Structural Etiology 3) Common complaint

1) tight tricep surae group and/or Achille's Tendon, collapse of transverse arch, short first ray (toe), forefoot pronation 2) transverse arch changes, possibly leading to: vascular and/or neural compromise in forefoot tissues 3) Pain at first and second metatarsal head after long periods of WB

Sinding-Larsen Johannson's Dz 1) Description 2) Caused by? 3) May occur when?

1) traction apophysitis at patella-patellar tendon junction 2) Overuse injury from repeated stress 3) After significant growth spurt or increase in activity

Myofascial Pain Syndrome 1) characterized by ______ 2) Active vs latent (of above answer)

1) trigger point 2) Active: painful upon palpation with referred pain Latent: palpable taut bands of muscle that are painless, but could convert to active

BPPV 1) Description 2) Duration 3) Etiology

1) vertigo attack and nystagmus occurring with different head positions 2) Brief 3) Degenerative process, mechanical impairment of peripheral vestibular system

Carr and Shepherd: Motor Re-Learning Approach Terminology: 1.) closed motor skill 2.) open motor skill 3.) knowledge of results 4.) Transfer of Learning

1.) skill performed in closed environment 2.) skill performed in changing (open) environment 3.) provide pt with external feedback regarding performance of task 4.) transferring learned skills to new environments

Ankylosing Spondylitis 1.) Etiology 2.) Initially affects? When? 3.) First sx? (3) 4.) Affects on spine with progression?

1.) unknown 2.) axial skeleton before 4th decade 3.) morning stiffness, mid to low back pain, SI inflammation 4.) kyphosis of cervical and thoracic spine and reduction of lordosis in lumbar

Huntington's is caused by?

Autosomal dominant chromosomal disorder

What ASIA grades may be able to utilize Treadmill Training using Body weight support?

B, C, D

Contraindications for joint manipulations (absolute and relative)

Absolute: joint ankylosis, bone malignancy, dz affecting ligamentous integrity (RA/Down's), arterial insufficiency, active inflammation/infection Relative: DJD, metabolic bone dz (osteoporosis, Paget's, TB), hypermobile, total joint replacement, pregnant, spondylolithesis, steroid use, radicular sx

Description of Thompson Test

Achilles Rupture: pt in prone with feet extended over end of table. PT tells pt to relax and then squeezes muscle bellies of gastroc and soleus. Positive if absence of PF

Hip ADD mm (4)

Adductor magnus, longus and brevis, gracilis

List of Special Tests that identify vascular compression of shoulder girdle. (3)

Adson, Halstead, Wright

Normal CSF; Adult and Child 1) Volume 2) Pressure 3) Protein

Adult 1) 90-150mL 2) 90-180 mmH2O 3) 15-45 mg/dL Child 1) 60-100mL 2) 10-100 mmH2O 3) 15-100 mg/dL

Lumbo-pelvic Rhythm

After 60-70 deg. lumbar flexion the pelvis will anteriorly rotate, followed by flexion of hips

Description of Standing Flexion Test (Lumbar/SI region)

Articular Restriction: pt in standing with feet 12in. apart. PT places thumbs over inferior PSISs and monitors movement as pt bends to floor with knees extended. Positive if difference between two PSIS movement.

What are TIAs usually linked to? What does this lead to?

atherosclerotic thrombosis; causes temporary blockage of blood supply to brain

Describe Flexion Rotation Test

Cervicogenic headache. pt in supine. PT max flex neck and rotate fully to each side. Positive if symptom reproduction or if 10 deg. loss from one side

Define Decerebrate Rigidity

Contraction of the extensor muscles of the UEs with contraction of extensor muscles of the LEs

Define Decorticate Rigidity

Contraction of the flexor muscles of the UEs with contraction of the extensor muscles of the LEs

What are the expected impairments of an Anterior Cerebral Artery (ACA) dysfunction?

Contralateral LE motor and sensory involvement; loss of bowel and bladder control; Loss of behavioral inhibition; Neglect, Aphasia, Apraxia and agraphia; perserveration

What are the expected impairments of a Posterior Cerebral artery (PCA) dysfunction?

Contralateral pain and temperature sensory loss; Contralateral hemiplegia(central area), mild hemiparesis; Ataxia, athetosis or choreiform movement; Thalamic pain syndrome; Alexia, dyslexia; visual agnosia; Hemiballismus;

Frontal lobe impairments: contra or ipsi? Type of Aphasia? Other sx?

Contralateral weakness, Perseveration, inattention, Emotional lability, Delayed or poor initiation, Broca's aphasia (expressive), impaired concentration, apathy,Personality changes, and antisocial behavior

Description of Talar Tilt

CFL Sprain: pt in sidelying with knee flexed to 90. PT stabilizes distal tibia with one hand and other grasps talus. Foot is maintained in neutral. PT tilts talus into ABD and ADD. Positive if excessive ADD

What cranial nerves originate from the medulla?

CN IX-XII

Which cranial nerves originate from the pons?

CN V-VIII

Sensory only CN (3)

CN- I (olfactory), II (optic), VIII (Vextibulocochlear)

Motor Only CN (5)

CN- III (oculomotor), IV (Trochlear), VI (Abducens), XI (Accessory), XII (Hypoglossal)

Both sensory and motor CN (4)

CN- V (Trigeminal), VII (Facial), IX (Glossopharyngeal), X (Vagus)

Which Cranial Nerves playa role in vision? What do they do? (7)

CN: II- Optic: visual acuity, visual fields, pupillary constriction III- oculomotor: pupillary size, extraocular movement IV- Trochlear: extraocular movement V- Trigeminal: corneal reflex VI- Abducens: extraocular movement VII- Facial: close eyes tightly (may be absent in Bell'ss Palsy) VIII- Vestibulocochlear: nystagmus in brain dysfunctions

Two areas where antispasticity meds bind to relax spastic muscles

CNS and skeletal muscle

Post-op ACL/PCL reconstruction: By week 6 increase motion of ______ to 0-___ deg

CPM; 0-120

Decreased CSF pressure may be indicative of? (3)

CSF leakage, subarachnoid block circulatory collapse, severe dehydration

Which is better at viewing bony structures: x-ray vs CT?

CT; and it views soft tissues

What is a completed stroke?

CVA that presents with total neurological deficits at onset

What is a Stroke in evolution?

CVA that usually caused by thrombus that gradually progresses; total neurologic deficits don't occur for 1-2 days

Vascular pathologies that can cause irreversible dementia (4)

CVA, anoxia, arteriovenous malformation, multi-infarct dementia

Where does the vertebral-basilar artery supply blood?

Cerebellum; Midbrain; Pons; Medulla; Thalamus; Occipital cortex;

Complication of THA

DVT, infection, pulmonary embolus, heterotopic ossification, femoral fractures, dislocation, neurovascular insult

Anterior Compartment Syndrome typically affects which nerve?

Deep Peroneal

Common sx of internal disc disruptions (nucleus pulpulsa). What might be contraindicated?

Deep achy pain and increased pain with movement; Manipulation

Description of Rent Sign

Identifies RTC tear/impingement: pt seated with arm relaxed. PT stands behind one hand holding flexed elbow other palpating anterior AC joint. Passively extend shoulder while ER and IR. Positive if greater tuberosity is prominent and depression of 1 finger width is felt

Decribe Long Sitting (supine to sit) Test

Identifies SIJ dysfunction secondary to leg length discrepancy. Pt perfectly aligned in supine. Stand at feet and palpate medial malleoli. Pt moves into long sitting. Assess medial malleoli and compare to supine measurements. Abnormal if difference.

Describe Supine Iliac Gapping

Identifies SIJ dysfunction. Pt in supine and baseline sx are taken. PT crosses arms and posteriorly-laterally displaces ASIS; may hold for 30s. Positive if reproduction of pt's chief complaint.

Describe Side-Lying Iliac Compression Test

Identifies SIJ dysfunction. Pt lies side with involved side up. Baseline sx taken. PT places hand on iliac crest and performs downward force; possibly holding for 30s. Positive if reproduces pt's chief complaint.

Describe Gaenslan's Test.

Identifies SIJ dysfunction. Pt sidelying at edge of table with bottom leg in maximal hip and knee flex. PT behind pt passively extending top leg (stresses top SIJ). Positive if pain at SIJ.

Suspensory strategy

This strategy is often used when both mobility and stability are required during a task (such as surfing). It is used to lower COG during standing or ambulation in order to control the COG better.

Mobilization rules: moving a convex surface over fixed concave surface scenario: increasing shoulder extension and external rotation requires _______ mobilization (the opposite direction of the movement)

anterior; since the direction of the convex movement on the concave surface is posterior, the mobilization to increase that movement is opposite (anterior)

In more severe cases of Bell's Palsy what medications may be necessary?

anti-viral and corticosteroids

Floor Reaction AFO use

assists with knee extension during stance by positioning a calf band and/or at ankle

Pathologies associated with cerebellar damage

ataxia nystagmus tremor hypermetria poor coordination postural reflex deficits balance equilibrium

Potential side effects of antiepileptic agents

ataxia, behavior change, GI distress, head ache, blurred vision, weight gain

Initial Swing definition

begins when stance foot lifts from floor and ends with max knee flexion during swing

Terminal swing definition

begins when tibia is perpendicular to floor and ends when foot touches gorund

Acceleration definition

begins when toe off is complete and completes when reference limb is under body

Nerve Roots T1 and down exit ______ their respective vertebral bodies.

below

Definition: Genu Varum

bowing of legs with increased space between knees with feet together. Increases compression on medial tibial condyle and stresses lateral structures of the knee (LCL)

Spiral Fracture description

break in bone shaped like "S" due to torsion/twisitng

Special Tests for knee swelling (2)

brush test, patellar tap test

What is hallux valgus?

bunion. big toe points inward. often from shoes that are too tight

Description and use of AFO

casting for a plastic AFO requires subtalar neutral position. Many uses: peripheral neuropathy, nerve lesions, hemiplegia

Modified Ashworth Scale Grade 1

catch and release or minimal resistance at end of RoM

Modified Ashworth Scale Grade 1+

catch with minimal resistance through remainder (less than half) of RoM

Definition: Bursitis

caused by acute/chronic inflammation of the bursae. May have limited ARoM secondary to pain and swelling

Definition: Tendonitis

caused by acute/chronic inflammation.

Definition of Spontaneous Nystagmus, typically follows?, lasts how long?

caused by imbalance of vestibular signals to oculomotor neurons that cause constant drift in one direction that is countered by quick movement in opposite direction. Follows acute vestibular lesion; typically lasts 24 hours

What specialized tissue makes cerebrospinal fluid?

choroid plexus

Description of Legg-Calve-Perthes Disease

degeneration of femoral head due to disturbance to blood supply (avascular necrosis)

Definition of Wallerian Degeneration

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

Osteoarthritis description

degenerative disease of articularcartilage, primarily with WB. Deformation and thickening of subchondral bone leads to impaired function.

Definition: Q angle

degree of angulation between midpatella to ASIS and tibial tubercle.

UMN sx of ALS are due to damage to what structures (2)

demyelination of corticospinal and corticobulbar tracts

Testing Vertical Disorientation

determine if pt can identify when an object is upright

Testing Topographical Disorientation

determine if pt can navigate familiar routes independently

Testing Depth and Distance Imperceptions

determine pt's ability to judge depth and distance

Neuromuscular Scoliosis 1) Description 2) Often seen in these two pathos 3) Can it be reduced?

developmental pathology resulting in developmental abnormalities in spine. Often seen in CP or Marfan syndrome. Structural scoliosis cannot reduce

Dysphagia

difficulty swallowing

Definition of stepping strategy

elicited through unexpected challenges during static positions or when a perturbation causes CoG do move beyond BoS. Lower extremities step and/or upper extremities reach to regain balance

Definition of ankle strategy 1) Type of perturbation 2) Muscles contract ______ to ______

elicited with small and slow velocity perturbation while feet on the ground. Muscles contract distal to proximal

What is preserved in an axonotmesis acute nerve injury?

endoneurium, epineurium, Schwann cells, and supporting structures

Second phase of rehab post TKA focuses on (3)

endurance, coordination, strength

Midstance definition

entire body weight is over stance limb

Foot Flat definition

entire foot hits ground following heel strike

Tendon affected in de Quervain's

extensor pollicis brevis and ABD pollicis longus

Tectospinal Tract is responsible for? (1)

extrapyramidal motor: contralateral postural tone related to auditory/visual stimuli

Reticulospinal Tract is responsible for? (2)

extrapyramidal motor: facilitation/inhibition of voluntary and reflex activity via alpha/gamma motor neurons

Rubrospinal Tract is responsible for? (3)

extrapyramidal motor: input of gross postural tone, facilitates flexor mm, and inhibiting extensor mm

Vestibulospinal Tract is responsible for? (3)

extrapyramidal motor: ipsilateral gross postural adjustments due to head movements, facilitating extensor mm, and inhibiting flexor mm

Definition of hyperpathia

extreme exaggerated response to pain

Cardinal signs of myasthenia gravis

extreme fatigue, skeletal muscle weakness can fluctuate within minutes or extended period

Contraindications to Neural Tissue Mobs

extreme pain and/or increase in abnormal neuro sx

Strabismus

eye deviates from normal position

Festinating Gait

forward toe walking as if pushed, increases slowly in speed

Common etiology of axillary nerve injury (2)

fractured neck of humerus, anterior shoulder dislocation

Effects of true leg length discrepancy of the right leg on: Fibula

glides cranially and anteriorly

Post-op rotator cuff Treatment Procedure -First 4-6 weeks -Activities until clearance from surgeon -After clearance treatment with these activities lasts 9-12 months

immobilization 4-6 weeks, PRoM slowly to ARoM, once cleared by surgeon- active movement and isometrics, OH activities/functional ADLs 9-12 months

Presbyopia

impaired near vision

Definition of peripheral neuropathy and associated conditions/causes

impairment or dysfunction of peripheral nerves ; associated conditions include diabetic peripheral neuropathy, trauma, alcoholism

Pain in rotator cuff tear vs impingement

impingement is more diffuse pain

Definition of Disdiadochokinesia

inability to perform rapid alternating movements

Apraxia

inability to perform voluntary, learned movements in the absence of sensation, strength, coordination, attention, or comprehension deficits.

Agnosia

inability to recognize familiar objects with one sense while able to identify with other senses

Dyssynergia

incoordinated and abrupt movement

Initial UMN signs of ALS (4)

incoordination, spasticity, clonus, and (+) Babinski

Definition: Lordosis

increased anterior curvature of spine. Typically seen in lumbar and cervical regions.

Parkinsonian Gait

increased forward trunk and knee flexion; shuffling and small steps, may have festinating gait too

Definition: Kyphosis

increased posterior curvature in the spine. Typically in Thoracic region.

Definition of fasciculation

muscular twitch caused by random discharge of LMN and its muscle fibers

Describe White Matter

myelinated axons and contains nerve fibers without dendrites

Purpose of a spinal puncture (lumbar) and used to rule out?

needle inserts below level of L1-L2 and takes CSF sample; hemorrhage, inflammation, infection, meningitis, tumor

What is the mildest form of acute nerve injury?

neurapraxia

Describe Huntington's Dz

neurological degenerative disorder of basal ganglia and cerebral cortex

Common sx of spinocerebellar ataxias include? (4)

neuropathy, pyramidal signs, ataxia, restless leg syndrome

Other sx of carpal tunnel (6)

night pain, hand weakness, muscle atrophy, decreased grip strength, clumsiness, decreased wrist mobility

General list of guidelines following THA

no crossing legs, limit forward bending in sitting, choose firm seating over cushy, stand with feet in neutral, use pillow/splint when in bed, use raised toilet seat, turn with uninvolved side,

Verbal apraxia description and treatment

non-dysarthric (not muscle weakness) and non-aphasic (not word use deficit), but a motor planning issue. Interruption in brain communicating to muscles of word craft

Purpose of a CT Scan

non-invasive; 2-D cross-section view of bones, tissues, and organs.

Are congenital cerebellar malformations progressive or non-progressive?

non-progressive

Signs and sx of ACL (knee) sprain?

pt may report loud pop or feeling of giving way/buckling followed by dizziness, sweating, and swelling.

Testing Figure-ground discrimination

pt picking out an object from an array of objects

Functions of medulla oblongata -Regulates -Reflex Center for (3) -Damage to motor tracts cause contra- or ipsilateral deficits

regulates RR and HR Reflex centers for vomiting, cough and sneeze Damage to motor tracts causes contralateral deficits

Description of Digit Amputation

removal of digit at metacarpophalangeal, PIP, or DIP level

Description of Syme's Amputation

removal of foot at ankle joint with removal of malleoli

Description of Wrist Disarticulation

removal of hand through wrist joint

Description of Transtibial Amputation

removal of lower extremity distal to knee joint

Description of Hip Disarticulation

removal of lower extremity from pelvis

Description of Transfemoral Amputation

removal of lower extremity proximal to knee joint

Description of Knee Disarticulation

removal of lower extremity through knee joint

Description of Transmetatarsal Amputation

removal of midsection of metatarsal

Description of Hemipelvectomy

removal of one half of pelvis and acquainted lower extremity

Description of Hemicorporectomy

removal of pelvis and both lower extremities

Description of Partial Hand Amputation

removal of portion of hand, and/or digits at transcarpal, transmetacarpal or transphalangeal level

Description of Transradial Amputation

removal of upper extremity distal to elbow joint

Description of Forequarter (scapulothracic) Amputation

removal of upper extremity including shoulder girdle

Description of BPPV

repeated episodes of vertigo due to changes in head position

Most often cause of impingement syndrome

repetitive trauma from upper extremity activity above horizontal plane. Humeral head and rotator cuff attachments migrate proximally trapped under acromion and coracoacromial ligaments.

Etiology of Osgood-Schlatter Disease

repetitive trauma to patellar tendon over tibial tuberosity in young athletes. May result in small avulsion of tuberosity and cause swelling

Other Conditions Affecting the Spine: Urological and Gynecological Conditions Kidney, bladder, overy, and uterus disorders refer pain to? (3)

trunk, pelvis, thighs

Elevated proteins in CSF may indicate?

tumors or inflammation

Pt s/p CVA, what action will facilitate elbow extension?

turn head to affected side; ATNR turning head to side facilitates extension of face side

Description and use of Reciprocating Gait Orthosis

type of HKAFO. cable system allows advancement of extremities. weight shift on one lower extremity advances other. Commonly used for paraplegics

Special Tests for wrist/hand ligamentous instability

ulnar collateral ligament instability test

Patellofemoral Syndrome description

umbrella term: pain or discomfort in anterior knee.

Recovery Stages of Diffuse Axonal Injury: Coma

unconsciousness with no arousal/awareness/sleep-wake cycle

Definition of lead pipe rigidity and often associated with lesion to what structure.

uniform and constant resistance to RoM; basal ganglia

Damage to the Optic Nerve will cause...

unilateral blindness

Describe gray matter

unmyelinated, contains glial cells, capillaries, cell bodies, dendrites

Definition of suspensory strategy; often seen during

used to lower CoG during standing or ambulation to increase control over CoG. when mobility and stability needed simultaneously (surfing)

How to screen two-point discrimination

using two-point caliper on skin, identify one or two points without visual input

Greenstick Fracture description

usually in children, one side breaks other side remains in tact

Special Tests for elbow ligamentous instability (2)

valgus and varus test

Allen's Test is highly specific for identifying _____

vascular compromise

CT scan can be used to rule out (5+)

vascular malformations, tumors, cysts, herniated discs, hemorrhage, epilepsy, encephalitis, spinal stenosis, intracranial bleeding, and head injury

Active Movement Findings: Rotator Cuff Lesion

weakness of ABD and/or rotation, crepitus

Signs of impairment to Frontal Lobe

-contralateral weakness -perseveration - personality change -impaired concentration -Broca's aphasia (expressive) -delayed/poor initiation -emotional lability

RoM of shoulder ER

0-90

Nerve tested for Given DTRs 1) Jaw 2) Biceps 3) Triceps 4) Brachioradialis 5) Hamstrings 6) Quads (knee jerk, patellar) 7) Achilles (ankle jerk)

1) CN V 2) C5-6 3) C7-8 4) C5-6 5) L5-S3 6) L2-4 7) S1-2

Sensory Organization Test: 1) Conditions (6) 2) Pts depend on vision become unstable in conditions 3) Pts depend on surface/somatosensory inputs become unstable in conditions 4) Pts with vestibular loss become unstable 5) Pts with sensory selection problems become unstable

1) 1: eyes open, stable surface 2: eyes closed stable surface 3: visual conflict (moving visuals on screen) on stable surface 4: eyes open moving platform 5: eyes closed moving platform 6: visual conflict moving surface 2) 2, 3, 5 3) 4, 5, 6 4) 5 and 6 5) 3-6

Mini-Mental State Examination 1) Max Score 2) Mild Impairment Score 3) Moderate Impairment 4) Severe Impairment

1) 30 2) 21-24 3) 16-20 4) 15 or less

Slipped Capital Femoral Epiphysis (SCFE) 1) Most common what? 2) Deformity Observed 3) Onset in males and females (avg. age). Most prevalent? 4) Dx factors

1) Adolescent hip disorder of unknown etiology 2) Posterior displacement of femoral head and inferior to neck of femur. Within confines of acetabulum 3) Males: 10-17 (~13); Females: 8-15 (~11). More in males 4) restrictions in ABD, flex, and IR AROM, vague knee/thigh/hip pain, (if chronic) Trendelenburg, plain fillm (+) for posterior displacement of upper femoral epiphysis

A patient four weeks status post anterior cruciate ligament reconstruction questions a physical therapist as to why he is still partial weight bearing. An acceptable rationale is: 1. the patient does not have full active knee extension 2. the patient has good quadriceps strength 3. the patient has fair hamstrings strength 4. the patient has diminished superficial cutaneous sensation

1) Ambulation on a flexed knee can result in excessive irritation of PF joint (I had thought 4) However, cutaneous sensation does not affect WB status

Complex Regional Pain Syndrome: Late Stage 1) aka 2) Description

1) Atrophic 2) decreased hypersensitivity; normal vasomotor; skin normalization; severe mm atrophy; pericapsular fibrosis; diffuse osteoporosis; possible claw hand

Pseudobulbar Palsy 1) Description 2) sx 3) examine for

1) B dysfunction of corticobulbar innervation of brainstem, UMN dz 2) similar to bulbar palsy 3) hyperactive refexes

Dupuytren's Fracture 1) Observed as? 2) Gender prevalence 3) Contractures of which joints? Specifically in DM and non-DM populations?

1) Banding on palm, digit flexion contractures from palmar fascia adherence to skin contracture 2) Males 3) Non-DM: MCPs and PIPs of 4th and 5th digits; DM pts: 3rd and 4th

Wheelchair Recommendation for pts with high cervical lesion 1) What segments? 2) Type of chair? 3) Controls?

1) C1-4 2) electric with tilt-in space or reclining back 3) microswitch/puff and sip

Wheelchair Recommendation for pts with shoulder function and elbow flexion 1) Segment 2) Type of chair? 3) Independence with?

1) C5 2) manual with propulsion aids 3) level short distance

Wheelchair Recommendation for pts with radial wrist extensors 1) Segment 2) Type of chair 3) Level of independence

1) C6 2) manual chair with friction surface hand rims 3) Independent

Wheelchair Recommendation for pts with tricep function 1) Segment 2) Type of chair 3) Level of independence

1) C7 2) manual chair with friction surface hand rims; have more propulsion ability than C6 lesion 3) Independent

Wheelchair Recommendation for pts with full hand function 1) Segment 2) Type of chair 3) Level of independence

1) C8 and below 2) manual with standard rims 3) Independent

Sever's Dz 1) aka 2) Most common cause of what? 3) Caused by? 4) B involvement in ___% of cases 5) dx using? 6) Temporary cessation of what activities and what orthoses?

1) Calcaneal Apophysitis 2) cause of heel pain in growing children, occurs before puberty or during growth spurts 3) repetitive microtrauma due to increased traction by Achille's tendon at insertion 4) 60% 5) Plain film 6) jumping, running, heel lifts/cups

Lesion to Cerebellum 1) Example disorder 2) Sensation 3) Tone 4) Reflexes 5) Strength 6) Mm Bulk 7) Involuntary Movements 8) Voluntary Movements 9) Posture 10) Gait

1) Cerebellar Lesion: tumor or stroke 2) Not affected 3) Normal/decreased 4) Normal/decreased 5) Normal/weak 6) Normal 7) none 8) Ataxia, dysdiadochokinesia, dysmetria, dyssynergia nystagmus 9) Impaired: truncal ataxia, dysequilibrium 10) Impaired: ataxic, wide-based, unsteady

Rheumatoid Arthritis 1) Chronic or acute? Etiology? Symmetrical or asymmetrical sx? 2) Dysfunction of synovial and articular tissues of what joints? 3) Affects on MCP joints? 4) Affects on PIP joints? 5) Affects on DIP joints? 6) Predominant gender? 7) Juvenile RA onset age? Complete remission in ______ % of cases 8) Dx Testing (5)

1) Chronic; unknown; symmetrical 2) all UE and LE joints 3) ulnar drift and volar subluxation 4) if severe form- ulnar drift; Bouchard's nodes 5) usually spared 6) Women 2-3x more than men 7) Prior to 16; 75% 8) Plain films show symmetrical involvement, increased WBC and erythrocyte sedimentation rate (inflammation), anemia (+), and elevated rheumatoid factor

Talipes Equinovarus 1) aka 2) Observed Deformity 3) Positioning of joints: talocrural is? Subtalar, talocalcaneal, talonavicular, and calcaneocuboid joints are? Midtarsal joitn is? 4) Course of Treatment for postural and non-postural deformity

1) Clubfoot 2) PF, ADD and inverted foot 3) Talocrural: PF; Midtarsal: supinated; rest: inverted 4) Postural: manipulation--> casting--> Denis-Brown orthosis throughout day 3 months and at night 3 years and stretching Non-postural: surgery--> casting/splinting

Deceberate Posturing 1) Seen in? 2) Description

1) Comatose pt with damage to brainstem between superior colliculus and vestibular nucleus 2) trunk, neck and limbs rigid in extension

Decorticate Posturing 1) Seen in? 2) description

1) Comatose pts with lesion above superior colliculus 2) UE in flexion and LE in extension

Cervical Facet Syndrome Signs and Sx 1) Referred Pain? 2) Pain with hyperextension and rotation of cervical spine? 3) Stiffness? 4) Paresthesia? 5) Reflexes affected? 6) Muscle Guarding? 7) Tension Test Results? 8) Pallor and coolness? 9) Muscle Weakness? 10) Muscle fatigue and cramps?

1) Common 2) Yes; typically localized to joint 3) Yes 4) Not usually, but possible 5) No 6) Yes 7) Typically - 8) No 9) No 10) No

American Spinal Injury Association (ASIA) Impairment Scale 1) A 2) B 3) C 4) D 5) E

1) Complete: no motor/sensory in sacral segments S4-5 2) Incomplete: sensory preserved; no motor below level of insult and includes S4-5 3) Incomplete: motor preserved below insult level, with most grade <3/5 4) Incomplete: motor preserved below level, most mm 3 or more/5 5) normal: motor and sensory is preserved

Equinus 1) Common etiologies (5) 2) Deformity observed 3) Compensation secondary to limited ______ includes ______ or ______ pronation

1) Congenital bone malformation, CP, contracture of gastroc/soleus, trauma, inflammatory dz 2) PF 3) DF; subtalar or midtarsal

Types of Multiple Sclerosis: Primary-Progressive 1) Characteristics 2) Progression

1) Discrete attack do not occur; modest fluctuations in neuro disability 2) Dz progression and deterioration from onset

Localized Lesion to Cortex: Frontal Lobe: Primary Motor Cortex 1) Function 2) Sx

1) Discrete voluntary movement 2) Contralateral paralysis; most pronounced in distal limbs and lower face

Complex Regional Pain Syndrome: Middle Stage 1) aka 2) Description

1) Dystrophic 2) skin changes; cessation of hair and nails; hyperhidrosis; muscle atrophy and osteoporosis

Piriformis Syndrome 1) Piriformis _____ the hip and can be overworked from ______ 2) May lead to? 3) Signs and sx? (5) 4) What first must be ruled out?

1) ER; excessive pronation of foot 2) sciatic nerve compression or SIJ dysfunction 3) restricted IR, pain with palpation, referred pain to posterior thigh, weak ER (+ piriformis test), uneven sacral base 4) Involvement of lumbar spine and SIJ

Salter-Harris Type I 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management

1) Entire epiphysis 2) Shearing, torsion, or avulsion 3) Good; very few complications to bone growth 4) Relocated if needed; immobilized

Salter-Harris Type II 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management

1) Entire epiphysis and portion of metaphysis 2) shear or avulsion with angular force. 3) May cause: minimally decreased bone growth, limited negative impact on function 4) Relocated and immobilized

Charcot-Marie-Tooth Dz 1) Description 2)Progression of dz

1) Genetic dz causing peroneal atrophy that affects motor and sensory nerves 2) Initially affects muscles of lower leg and foot, then progress to hands and forearms

Age variations with Valgum/Varum Angulation 1) Newborns and infants 2) 6-12 months 3) 18-24 months 4) 3-4 years 5) 7-adulthood 6) Norm angulation for males and females

1) Genu Varum normally found 2) maximal varum 3) straighten to 0 deg 4) maximal valgus (~12 deg) 5) Spontaneous correction of valgum 6) Males: 7 deg; Females: 8 deg

Rearfoot Valgus 1) Possible Etiologies 2) Observed Deformity

1) Genu valgum (knee) or tibial valgus 2) eversion of calcaneus with subtalar neutral

Coxa Vera 1) Description 2) Typical cause

1) angle of femoral neck with shaft of femur is <115 deg. 2) defect in ossification of femoral head or necrosis of femoral head from septic arthritis

Tonic-Clonic Seizure 1) aka 2) Signs 3) Duration 4) Post Seizure Sx 5) Time to full recovery

1) Gran mal 2) dramatic loss of consciousness, cry, fall, convulsions of all extremities, tongue biting, arrested breathing, incontinence 3) 2-5 minutes 4) confusion, drowsy, amnesia of event 5) Several hours

Forefoot Valgus 1) Involved deviated structures 2) Observed deformity

1) Head and neck of talus 2) eversion of forefoot with subtalar neutral

Patella Baja 1) Description 2) Leads to restriction with what motion and may cause what?

1) Inferior tracking of patella 2) Extension; DJD

ANS Characteristics: Parasympathetic Division 1) Effects are local or widespread? Long or short acting? 2) Effect on blood vessels to gut 3) Effect on airway 4) Effect on urinary bladder

1) Local; short 2) Dilates 3) Constricts 4) stimulates contraction

Autonomic Dysreflexia 1) What is it 2) Sx 3) what to do?

1) Medical emergency. noxious stimuli causes autonomic reflex 2) paroxysmal HTN, bradycardia, headache, sweating, flushing, diplopia, or convulsions 3) CHECK AND EMPTY CATHETER FIRST, examine for irritant, elevate head

Metatarsus Adductus 1) Fun Fact 2) Mostly seen in ______ and i the ______ foot 3) Most common cause 4) Rigid Type 5) Flexible Type 6) Possible surgical release of what tendon for flexible type? 7) _______% of cases are identified at birth and resolve around year without treatment

1) Most common congenital foot condition 2) females and left foot 3) Intrauterine packing 4) medial subluxation of tarsometatarsal joint; hindfoot in slight valgus with navicular lateral to head of talus 5) Observed as ADD of all metatarsals at tarsometatarsal joint 6) ABD Hallucis 7) 85-90%

Localized Lesion to Cortex: Frontal Lobe: Prefrontal Area 1) Function 2) Sx

1) Motor Association 2) Loss of specific motor plans

Localized Lesion to Cortex: Frontal Lobe: Premotor Area 1) Function 2) Sx

1) Motor Planning 2) Apraxia/motor planning difficulties

Other Conditions Affecting the Spine: Bone Tumors 1) Most common primary bone tumor 2) Typical primary sites of metastatic bone tumors (5) 3) During pt interview always get this info 4) Signs and sx

1) Multiple Myeloma 2) lung, prostate, breast, kidney, thyroid 3) Prior CA hx 4) Pain: unvarying and progressive, not relieved by rest or analgesic, more pronounced at night

Salter-Harris Type V 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management

1) Nothing "broken off" ; compression injury to epiphysis 2) Compression or crush injury of epiphyseal plate, no associated fracture. 3) Growth disturbance at physis. Poor functional prognosis 4) Usually found after the fact; so no immediate intervention. If identified acutely, pt given non-WB protocols

1) Procedure for femoral fracture 2) Non-WB for how long?

1) ORIF 2) 1-2 weeks

Sinemet 1) Primary med for? 2) Common Drug name 3) Drug effects prolonged with low ______ diet 4) Adverse Effects 5) On-Off Phenomenom

1) PD 2) Levodopa 3) protein 4) nausea, vomit, orthostatic hypotension, arrhythmias, dyskinesia, psychoses, abnormal behavior 5) experience of normal function to immobility to severe dyskinesia

Lesion to Basal Ganglia: Subcortial Gray 1) Example disorder 2) Sensation 3) Tone 4) Reflexes 5) Strength 6) Mm Bulk 7) Involuntary Movements 8) Voluntary Movements 9) Posture 10) Gait

1) Parkinsonism 2) Not affected 3) Lead-pipe/cogwheel rigidity 4) Normal/decreased 5) Slowed movement 6) Normal/disuse atrophy 7) Resting tremor 8) Bradykinesia/akinesia 9) Impaired: stooped 10) Impaired: shuffling, festinating

Localized Lesion to Cortex: Parietal Lobe: Parietal Lobe (right hemisphere) 1) Function 2) Sx

1) Perceptual Function 2) Visual-spatial disorders, body scheme disorders, apraxias, tactile and auditory perceptual disorders

Cheyne-Stokes Respiration 1) Description 2) Possible causes (2)

1) Period of apnea lasting 10-60 seconds followed by gradually increasing depth and frequency of respirations 2) Depressed frontal lobe and diencephalon dysfunction

Salter-Harris Type IV 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management

1) Portion of epiphysis and portion of metaphysis 2) Similar to Type III. Mostly seen in distal humerus. 3) May lead to premature focal fusion of involved bone causing deformity to joint; due to growth plate involvement. Dependent on quality of realignment 4) ORIF for alignment.

Salter-Harris Type III 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management

1) Portion of the epiphysis 2) Typically when growth plate is partially fused. Most commonly occurs to distal tibia in adolescents 3) Long-term issues: however, not significant deformity and still favorable. 4) Relocated and immobilized. Occasional need of ORIF.

TOS Signs and Sx 1) Is there referred Pain? 2) Pain with hyperextension and rotation of cervical spine? 3) Stiffness? 4) Paresthesia? 5) Reflexes affected? 6) Muscle Guarding? 7) Tension Test Results? 8) Pallor and coolness? 9) Muscle Weakness? 10) Muscle fatigue and cramps?

1) Possible 2) No 3) Possible; typically form muscle tightness vs joint 4) Possible 5) May be affected 6) Yes 7) May be + 8) Possible in hands 9) Only in later progression in small muscles 10) Possible

Opisthotonos 1) Description 2) Seen in?

1) Prolonged severe spasm of mm--> head, back and neck arched back; arms and hand rigid flexion 2) Severe meningitis, tetanus, epilepsy, strychnine poisoning

Test Proprioception (Deep) Sensation 1) Joint Position 2) Kinesthesia 3) Pallesthesia

1) Pt identifies where limb is in space with PT positioning 2) (movement sense) Pt copies movement of limb done by PT or verbally gives direction 3) (vibration sense) Perceive tuning fork vs sham (deep pressure)

Coxa Valga 1) Description 2) Possible cause?

1) angle of femoral neck with shaft of femur is >125 deg. 2) necrosis of femoral head from septic arthritis

Other Conditions Affecting the Spine: Cardiovascular and Pulmonary Conditions 1) Heart and lung disorders may refer pain to? (5) 2) Abdominal Aortic Aneurysm sx and typically identified during

1) chest, back, neck, jaw, UE 2) nonspecific LBP; pain during abdominal exam

Nerve Tested for given superficial reflex 1) Plantar 2) Abdominal 3) Cremasteric

1) S1-2 (Tibial nerve) 2) T6-L1 3) L1-2

Lesion to Spinal Cord 1) Example disorder 2) Sensation 3) Tone 4) Reflexes 5) Strength 6) Mm Bulk 7) Involuntary Movements 8) Voluntary Movements 9) Posture 10) Gait

1) SCI 2) Impaired/absent below lesion 3) initial flaccidity with spinal shock, hyper/spastic below lesion 4) Hyper 5) Impaired/absent 6) Disuse atrophy 7) spasms 8) Intact: above lesion 9) Impaired below lesion 10) Impaired/absent

Localized Lesion to Cortex: Parietal Lobe: Secondary Somatosensory Area 1) Function 2) Sx

1) Sensory interpretation 2) Tactile agnosia: astereognosia, agraphesthesia, loss of two-point discrimination, extinction

Gout 1) Characterized by increased levels of ______ 2) What affects the joints and other tissues 3) Frequently Affected Joints?

1) Serum Uric Acid (hyperuricemia) 2) uric acid turns to crystals that enter joint spaces and tissues 3) knees and big toe

Superficial Sensory Testing 1) Pain 2) Temperature 3) Touch

1) Sharp/dull using paperclip 2) Hot/cold with test tubes with hot/cold water 3) Response to touch/no touch with cotton ball

Visual Acuity Tests 1) What test focuses on Central vision 2) What test focuses on Visual Fields

1) Snellen eye chart: test each eye separately 20 feet away 2) test peripheral vision by confrontation

Localized Lesion to Cortex: Temporal Lobe: Superior Temporal Gyrus (Left hemisphere) 1) Function 2) Sx

1) Storage of auditory information 2) Impaired Learning and memory

Localized Lesion to Cortex: Temporal Lobe: Temporal Cortex (nondominant hemisphere) 1) Function 2) Sx

1) Storage of visual information 2) Profound loss of memory of recent events

Lesion to Cerebral Cortex: Corticospinal Tracts 1) Example disorder 2) Sensation 3) Tone 4) Reflexes 5) Strength 6) Mm Bulk 7) Involuntary Movements 8) Voluntary Movements 9) Posture 10) Gait

1) Stroke 2) Contralateral loss 3) Hyper; may initially be flaccid with cerebral shock 4) Hyper 5) Contralateral weak 6) Normal with acute, disuse atrophy with chronic 7) Spasms 8) Dyssynergic 9) Impaired/absent 10) impaired

Kernig's Sign 1) Test position 2) Positive Sign; if bilateral may indicate

1) Supine, flex hip and knees to chest, then extend knee 2) pain and increased resistance to extend knee due to hamstring spasm; meningeal irritation

Locomotor Training for pts with high lumbar lesion 1) Segments 2) AD and Orthosis and Gait pattern 3) level of independence

1) T12-L3 2) B KAFO and crutches; swing-through or 4 point. Reciprocating gait orthosis with walker with/out FES 3) can be independent in ambulation on all surfaces and stairs. May use manual WC for community distances

Locomotor Training for pts with midthoracic lesions 1) segments 2) AD and Orthosis and gait pattern 3) level of independence

1) T6-9 2) B KAFO and crutches; swing-to 3) Supervision household ambulation and assistance otherwise

Localized Lesion to Cortex: Parietal Lobe: Gustatory Cortex 1) Function 2) Sx

1) Taste 2) Contralateral taste impairment of tongue

DeQuervain's Dz 1) Description 2) Cause

1) Tenosynovitis of extensor tendons of the radial wrist- ABD Pollicis Longus and Extensor Pollicis Brevis 2) Overuse of thumb, wrist deviation, or arthritis

Psoriatic Arthritis 1) Etiology? Acute or Chronic? Associated with? 2) Typical location of joint erosion? 3) Male or female predominance? 4) Medication that can slow progression 5) Dx test

1) Unknown; Chronic; Psorisis 2) hands and axial skeleton 3) equal 4) dz-modifying antirheumatoid drugs (DMARDs) 5) not helpful, only to rule out RA

Osteomalacia 1) Decalcification of bones secondary to ______ 2) Sx (4)

1) Vitamin D Deficiency 2)severe pain, fractures, weakness, and deformities

WB for TKA 1) Cemented 2) Cementless

1) WBAT 2) 25% weeks 1-7, 50% by week 8, 75% by week 10, 100% by week 12

ANS Characteristics: Sympathetic Division 1) Effects local or widespread? 2) Effect on skeletal mm blood flow 3) Effect on airways 4) Effects on urinary bladder

1) Widespread 2) constricts or dilates 3) relaxes 4) relaxes

Cervical Spinal Nerve Lesion Signs and Sx 1) Referred Pain? 2) Pain with hyperextension and rotation of cervical spine? 3) Stiffness? 4) Paresthesia? 5) Reflexes affected? 6) Muscle Guarding? 7) Tension Test Results? 8) Pallor and coolness? 9) Muscle Weakness? 10) Muscle fatigue and cramps?

1) Yes 2) Yes; typically increases sx 3) Possible 4) Yes 5) May be affected 6) Yes 7) + 8) No 9) Possible 10) No

Apneustic Breathing 1) Description 2) Possible cause

1) abnormal respiration marked by prolong inspiration 2) Damage to upper pons

Vestibular Neuronitis, labyrinthitis 1) Description 2) Duration 3) Etiology

1) acute infection with prolonged attack of sx 2) persisting for several days/weeks 3) viral or bacterial infection

Osteochondritis Dissecans 1) Affects and description? 2) age of onset 3) Mechanism of injury

1) affects central and/or lateral capitellum or radial head (medial condyle). Bone fragment becomes detached and lodges in joint. (loose body) 2) 12- 15 years old 3) repetitive compression of radial head and humeral capitellum

Spondylolithesis 1) Description 2) Grades (4) 3) Two plain film views to view what? 4) Clinical test to identify 5) Contraindication?

1) congenital defective pars interarticularis that may lead to bilateral fracture leading to anterior/posterior slippage of one vertebrae on another 2) I: 25%, II: 50%, III: 75%, IV: 100% slippage 3) Oblique: see fracture, Lateral: see slippage 4) Stork Test 5) Manipulation

Arthrogryposis Multiplex Congenita 1) Description 2) Impact on intelligence 3) Progressive or non-progressive contractures?

1) congenital skeletal and soft tissue deformation characterized by limited joint motion and "sausage like" appearance of limbs 2) none 3) non-progressive

Anterior Cord Syndrome 1) Loss of what tract leads to B loss of motor function and spastic paralysis below level of lesion 2) Loss of what tract leads to B loss of pain and temp sensation 3) What tract is preserved that senses proprioception, kinesthesia, and vibration

1) corticospinal tract 2) spinothalamic tract 3) dorsal columns

Types of Multiple Sclerosis: Relapsing-Remitting 1) Characteristics 2) Progression 3) Prevalence

1) discrete neurological attacks (relapse) with full/partial recovery (remission) in following weeks or months 2) No progression between relapses 3) 85%

TMJ: Internal Derangement of Joint 1) Includes (3) 2) Typical strengthening and flexibility protocol

1) dislocation, displaced articular disc, or condyle injury 2) Rocabado's

UE Flexor Tendon Repair 1) First 3-4 weeks 2) PT initially involves what? 3) What may be introduced after 4 weeks? 4) Resisted and functional exercise introduced when?

1) distal extremity immobilized with wrist and digits flexed (30-50) 2) resisted extension and passive flexion 3) AROM to tolerance 4) full AROM achieved, first extension then flexion

Brown-Sequard Syndrome 1) Ipsilateral loss of what leads to loss of tactile discrimination, pressure, vibration, and proprioception 2) Ipsilateral loss of what leads to motor function and spastic paralysis below level of lesion 3) Contralateral loss of what leads to loss of pain and temperature below level of lesion and at level B loss of pain and temp

1) dorsal columns 2) corticospinal 3) spinothalamic

Stage IV Parkinson's Findings 1) Communication 2) Gait 3) Tone 4) Balance 5) Respiratory Function

1) dysarthia, hypophonia, masklike face, small handwriting 2) poverty of movement, festinating gait 3) Cogwheel rigidity 4) impaired postural reactions including trunk reactions and lack of rotation 5) decreased chest expansion, decreased vital capacity

Scaphoid Fracture 1) Most Common What? 2) Common mechanism of injury? 3) Possible complication? 4) Immobilization time

1) fractured carpal 2) fall on outstretched hand 3) Avascular necrosis of proximal fragment 4) 4-8 weeks

PD Meds Intention 1) Dopamine agonist 2) Anticholinergic 3) Amantadine 4) Selegeline

1) increases Sinemet effect 2) tremor control 3) enhances dopamine release 4) monoamine oxidase inhibitor increases dopamine; slows progression in early stages

Types of Multiple Sclerosis: Secondary-Progressive 1) Characteristics 2) Progression

1) initially relapsing-remission, changes to progressive, with/out acute attacks 2) Changes to progressive steady decline in function

Stages of Primary Shoulder Impingement Stage 1: sx and age of onset Stage 2: sx Stage 3: sx

1) intermittent mild pain with OH activities; 35+ 2) Mild-moderate pain with OH or strenuous activities 3) Pain at rest or with activities. Possible night pain. Scapular or RTC weakness

Complex Regional Pain Syndrome 1) Etiology 2)Dysfunction of? Causing? 3) Types 4) Long-Term Changes (6)

1) largely unknown, but may be due to trauma 2) Sympathetic nervous system: pain, circulation issues, and vasomotor issues 3) Type I: tissue injury without nerve involvement; Type 2: tissue injury with nerve involvement 4) muscle wasting, trophic skin changes, decreased bone density, decreased proprioception, disuse atrophy, and joint contractures

Panner's Dz 1) Description 2) Age of onset

1) localized avascular necrosis of capitellum (distal humerus) leading to loss of subchondral bone 2) 10 years old or younger

Posterior Cord Syndrome 1) What is it 2) what is lost? 3) What is preserved

1) loss of dorsal columns 2) proprioception, kinesthesia, vibration, pressure, two-point discrim, stereognosis 3) motor function, pain, and light touch

Osteoporosis 1) Type of dz? 2) Gender predominance 3) Common sites of fracture? (7) 4) Primary or postmenopasal osteoporosis is directly linked to? 5) Senile osteoporosis due to? 6) Dx tool to assess bone density? 7)

1) metabolic bone mineral wasting 2) women 10x more than men 3) lumbar or thoracic spine, femoral neck, proximal humerus, proximal tibia, pelvis, and distal radius 4) Estrogen decrease 5) genetic or acquired abnormalities 6) CT 7)

Other Conditions Affecting the Spine: GI Conditions 1) Acute Pancreatitis sx 2) Cholecystitis sx

1) mid epigastric pain radiating through back 2) abrupt, severe ab pain and right upper quadrant tenderness, nausea, vomiting, fever

Internal Tibial Torsion 1) Fun Fact 2) high complication rate with ______ of ______ and is associated with ______

1) most common cause of toeing in 2) osteomoty of tibia; W sitting

Spinal Movement Couplets: In the lumbar and thoracic spine- 1) when in neutral/extension side-bending and rotation occur in same/opposite direction? 2) when in flexion side-bending and rotation occur in same/opposite direction?

1) opposite 2) same

Bursitis 1) Inflammation secondary to? (4) 2) Instances of pain 3) RoM limitations

1) overuse, gout, trauma, infection 2) pain at rest and during P/AROM 3) limited due to pain, but not in capsular pattern

Lateral Retinacular Release 1) Typical reason to perform procedure 2) PT ther-ex should emphasize ______ exercises

1) patellofemoral pain syndrome 2) closed kinetic chain

Posterolateral Disc Herniation 1) Mechanical reasons for being most common herniation (3) 2) Resulting sx (4) 3) PT exercise revolves around (2) 4) Positional gapping technique for left posterolateral herniation 5) Possible contraindicated interventio

1) posterior disc is more narrow than anterior disc, posterior longitudinal ligament relatively weak and only centrally located in the lumbar spine, posterior lamellae are thinner 2) Loss of strength, radicular pain, paresthesia, ADL difficulties 3) Stabilization and disc regeneration stimulus 4) pt right sidelying, pillow under hip, flexed hips and knees, rotate trunk left (or pelvis right) 5) Manipulation

Post Spinal Surgery 1) Avoid (2) for 3 months 2) Always avoid 3) Early movement and activation of paraspinals is indicated for which procedures

1) prolonged sitting and heavy lifting 2) repetitive bending and twisting 3) laminectomy/discectomy

Promoting Learning with pts post Left CVA 1) Key to communication 2) Give ______ feedback and support 3) Do not underestimate ability to ______

1) pt understanding 2) frequent 3) learn

Ménièré's Dz 1) Description 2) Duration 3) Etiology 4) Consistent finding

1) recurrent progressive vestibular dz; severe tinnitus, deafness, sensation of ear fullness 2) minutes to hours 3) unknown 4) Membranous Labyrinthe edema

Central Cord Syndrome 1) Loss of what tract leads to loss of pain and temp sensation 2) Loss of what leads to B UE loss of motor function 3) What sensations are preserved

1) spinothalamic 2) Ventral horn 3) proprioception and discriminatory touch

Types of Multiple Sclerosis: Progressive-Relapsing 1) Characteristics 2) Progression

1) steady deterioration like PPMS, but with acute attacks 2) Progression between relapses

Paget's Dz (osteitis deformans) 1) possible etiology (besides unknown) 2) Type of dz characterized by? 3) Results in (3)

1) viral/environmental 2) Metabolic bone dz characterized by osteoclastic/blastic dysfunction 3) Spinal stenosis, facet arthropathy, and possible fracture

Bulbar Palsy 1) Description 2) Etiology 3) Examine for (4)

1) weakness/paralysis of muscle innervated by motor nuclei of lower brainstem, affecting face, tongue, larynx, and pharynx 2) tumor or LMN dz 3) glossopharyngeal and vagus paralysis, changes in voice quality, B involvement, (complication) aspiration PNA

Post Meniscal Arhtroscopy 1) When can a pt PWBAT 2) PT goals (3) 3) Jogging technique to reduce load on knee

1) when full extension is achieved 2) Initial: edema/effusion control, AROM surgery day 1, isotonic/isokinetic strengthening by day 3 3) forefoot/toe jogging

Colle's Fracture 1) Most common what? 2) Mechanism of injury 3) Possible nerve compression? 4) Time immobilized? 5) Most important early intervention?

1) wrist fracture; fracture of distal radius and ulnar styloid posteriorly 2) Fall on outstretched hand 3) Median from excessive edema 4) 5-8 weeks 5) Flexibility

Kabat, Knott, and Voss: PNF Terms 1.) Chopping 2.) Developmental Sequence 3.) Mass Movement Patterns 4.) Overflow

1.) combination of bilateral upper extremity asymmetrical patterns performed as a closed-chain activity 2.) progression of motor skill acquisition: mobility, stability, controlled mobility, skill 3.) hip, knee, and ankle move into flexion/extension simultaneously 4.) muscle activation of involved extremity due to intense action of uninvolved muscle or group of muscles

Bobath: NDT 1.) postural control can be _______ and _______ through experience 2.) Postural control uses both ________ and _________ mechanisms for execution of tasks 3.) Postural control initiates from _____ 4.) Postural control is required for skill _________ 5.) Develop postural control by progressing to positions that increase _________ and decrease ________

1.) learned and modified 2.) feedback and feed-forward 3.) pts BoS 4.) development 5.) distance between CoG and BoS and decrease BoS as well

Dix-Hallpike Maneuver stimulates the (1)_____ ______ ______. If pt experiences (2)_______ and (3)______, then test performed to determine if pt has (4)______ or (5)______.

1.) posterior semicircular canal 2.) nystagmus 3.) vertigo 4.) BPPV 5.) Central lesion

Bobath: NDT Key Terms 1.) Facilitation 2.) Inhibition 3.) Key Points of Control 4.) Placing 5.) Reflex Inhibiting Posture

1.) technique utilized to elicit voluntary muscular contraction 2.) technique to decrease excessive tone or movement 3.) specific handling of designated areas of the body will influence and facilitate posture, alignment, and control 4.) act of moving an extremity into a position that the pt must hold against gravity 5.) designated static positions that inhibit abnormal tonal influences and reflexes

How many ribs articulate with thoracic vertebraes costovertebral and costotransverse joints?

10

Scoliosis typically diagnosed at what age?

10-13

Normal forward angulation of femoral neck in frontal plane If less, then termed? More?

10-15 anteversion retroversion

Normal femoral neck angle to frontal plane. Excessive angulation?

10-15 deg; 25-30 deg

Systemic Juvenile Rheumatoid Arthritis

10-20% of cases. acute onset, high fever, rash, enlarged spleen/liver, inflamed lungs and heart.

History of: Atraumatic Instability age of onset, common complaints

10-35, pain and instability with activity

The windlass test has ______ sensitivity for identifying windlass effect on plantar fascia

100%

What makes ribs 11 and 12 different from 1-10?

11 and 12 only articulate with vertebral bodies of T-11 and T-12 and not the transverse process. AKA floating ribs

Normal Angle of Inclination in hip? If less, then termed? More?

115-125. Coxa vara. Coxa valga

How many pairs of cranial nerves exit the skull through foramina?

12

How many thoracic vertebrae are there?

12

Healthy BF% for males? Females?

12-18%; 18-23%

Stages of ALS (6)

1: asymmetrical mild focal weakness; hand cramping and fasciculations 2: moderate weakness in muscle groups, Mod-I with AD 3: severe weakness of specific muscles, increased fatigue, mild-mod functional limitations 4: severe weakness and wasting of LE, mild weakness of UE, WC 5: progressive weakness with deterioration of mobility and endurance, increased fatigue, mod-severe weakness of limbs and trunk, spastic, hyper reflexes, loss of head control, max-A 6: bedridden, dependent, progressive respiratory distress

History of: Rotator Cuff Lesion Age of onset and common complaint

Age of Onset: 30-50, pain and weakness with eccentric loading

Describe Slump Test

Assesses for dysfunction of neurological structures supplying lower limb. pt sits with head slumped and knees flexed off table (stop progression of steps if symptomatic) --> passively flex neck and head --> extend one knee--> passively DF foot of extended leg --> repeat steps with other extremity. Positive if neurological sx at any step.

Special Tests for wrist/hand contracture/tightness (2)

Bunnel-Littler test, tight retinacular ligament test

Characteristics of Central vs Peripheral Nystagmus: Visual Fixation

Central: No inhibition with visual fixation Peripheral: inhibits nystagmus and vertigo

Characteristics of Central vs Peripheral Nystagmus: Direction

Central: bidirectional or unidirectional Peripheral: Unidirectional (towards opposite side of lesion)

Occlusion of anterior inferior cerebellar artery supplies ____ and may lead to what sx?

Cerebellum; ataxia, nystagmus, tremor, dysmetria, incoordination, and balance deficits

Occlusion of Middle cerebral supplies ____ and artery may lead to wha sx?

Cerebrum; contralateral hemiplegia, aphasia, apraxia, and cognitive decline.

Description of Foraminal Compression (Spurling's) Test

Cervical Nerve Root Compression: pt in sitting with head laterally flexed. PT exerts downward force through head. Positive if radiating pain down arm

Description of Vertebral Artery Test (cervical)

Compression of vertebral artery: pt in supine. PT passively extends pt's head, then lateral flexion, and ipsilateral rotation. Positive if dizziness, nystagmus, slurred speech or LoC.

Convex or Concave?: finger flexion/extension (distal phalanx) and ABD ADD (proximal phalanx)

Concave

Peak Muscle Activity During Gait Cycle: Calves

Concentric raising of heel during toe off during late stance

Parietal lobe impairments: dominant hemisphere sx and non-dominant hemisphere sx.

Dominant hemisphere(typically left): agraphia, alexia, agnosia. Non-dominant hemisphere: dressing apraxia, anosognosia Contralateral sensory deficits Impaired taste Impaired language comprehension

Osteogenesis Imperfecta: Two types are autosomal dominant and two are autosomal recessive

Dominant: I and IV Recessive: II and III

What muscles, first and second, are used to counter a sudden moderate force leading to backward sway

First paraspinals then hamstrings

Common foot tendonopathy in ballet performers

Flexor Hallucis

Describe Biceps Load 2 Test

Identifies SLAP lesion. Pt in supine. PT puts pt shoulder into 120 ABD, max ER, 90 elbow, and forearm supinated. One hand holds wrist other stabilizes elbow. Pt then told to try to flex elbow. Positive if sx increase

Describe FADIR Test

Identifies anterior-superior impingement, iliopsoas tendonopathy, and anterior labral tears. Pt in supine and involved LE taken from full passive flexion, ABD and ER --> flexed ADD and IR. Positive if painful with or without click.

Describe Kleiger Test

Identifies integrity of distal tibiofibular syndesmosis. Pt seated with knee in 90. PT stabilized tibia and ER foot. Positive if symptomatic or noticeable gapping.

Describe Modified Sharp Purser Test.

Identifies integrity of transverse ligament. Pt seated. PT passively slightly flex upper cervical spine and pincer grasp C-2. Apply posterior and extending force through forehead onto C-spine accessing for excessive linear translation or myelopathic sx. Positive if myelopathic sx with upper cervical flexion or a decrease in sx, or excessive translation during posterior/extending motion.

Describe Pronator Teres Syndrome Test

Identifies median nerve entrapment within pronator teres. pt in sitting with elbow supported at 90. PT attempts to pronate and extend elbow. Pt resists. Positive if tingles or paresthesia in median nerve distribution

Describe McKenzie's Side Glide Test

Identifies scoliotic curvature vs side-gliding due to neurological dysfunction. Place shoulders on shifted upper trunk and wrap arms around pelvis. Bring pelvis in alignment with upper trunk. Positive if neurological sx are produced

Describe Stork Test

Identifies spondylolithesis. Pt stands on one leg. Cue pt into extension. Repeat with opposite leg. Positive if ipsilateral low back pain.

Central Cord Syndrome 1) Causal factor 2) Tracts damaged (3) 3) Deficits

Incomplete lesion caused by hyperextension damaging spinothalamic tract, corticospinal tract, and dorsal columns. Motor>sensory deficits. Upper extremities more affected than lower.

Cons of Patella Grafts for ACL reconstruction (3)

Increased risk of: anterior knee pain and patellofemoral OA, increased decreased extension potential, potential delay in rehab due to more atrophy of quads

Describe Lhermitte's Sign

Indicates dysfunction of spinal cord and/or UMN lesion. Pt long sitting. Passively flex head and one hip with knee extended. Repeat on other side. Positive if pain down spine and into upper/lower extremities.

What imaging test is used to dx a mal-tracking patella? Particular strengthening of what muscle is important?

Plain films using Sunrise View; VMO

Loading Response definition

amount of time between initial contact and beginning of swing phase of other leg

Capsular Pattern Humeroulnar/radial

flexion, extension

Signs and sx of shoulder subluxation?

feeling shoulder pop out and back in, pain, paresthesias, sensation of dead arm, + apprehension test, capsular tenderness, swelling

Symptoms of LMN dz (5)

flaccidity or weakness of involved muscles, decreased tone, fasciculations, muscle atrophy, decreased/absent reflexes

Affects on the body due to neurotmesis peripheral injury

flaccidity, mm wasting, total loss of sensation over nerve distribution

Two appropriate times to take corticosteroids for pt with Rheumatoid Arthritis

flare-ups and when NSAIDs aren't working

Definition of mononeuropathy

isolated nerve injury; associated conditions include trauma and entrapment

Signs and sx of adhesive capsulitis (shoulder) (3)

insidious onset pain often extending down arm stiffness (capsular pattern) night pain

Heel Strike definition

instant heel hits ground starting stance phase

Causes of heel lift during midstance (2)

insufficient DF RoM, PF spasticity

Exaggerated hip flexion during swing may be a compensation for?

insufficient DF compensation

Causes of insufficient hip extension at stance (2)

insufficient RoM, hip flexion contracture

Description and use of Halo Vest Orthosis

invasive cervical thoracic orthosis fully restricts cervical motion. Commonly used with cervical SCI. Worn until spine is stable

Purpose of a an EMG

invasive procedure that assesses nerve and muscle dysfuntion or spinal cord dz

Purpose of a Cerebral Angiography

invasive procedure to determine narrowing or blockage of an artery within brain

Purpose of a Discography

invasive procedure to evaluate integrity and pathos of a disc.

To palpate tibialis posterior have pt...

invert and plantarflex

Definition of Hemiballism

involuntary and violent movement of large body part; unilateral

Signs and sx of Huntington's (5)

involuntary choreic movement, mild change in personality, grimace, tongue protrusion, ataxia

Definition of athetosis

involuntary movements combined with instability of posture. Peripheral movement occurs without central stability

Definition of tremors

involuntary, rhythmic, oscillating movements

Souque's Phenomenon

involved UE raised over 100 degrees with elbow extended. Involved fingers will then extend and ABD

What is Wallenberg Syndrome? And what is the usual cause?

ipsilateral: facial pain, ataxia, vertigo Contralateral: pain and thermal impairment Caused by infarct to lateral medullary of vertebral-basilar artery

Definition of Peripheral Nystagmus

occurs with peripheral vestibular lesion and is inhibited when pt fixates vision on an object

Typically, which muscles are first affected by myasthenia gravis?

ocular, then facial and swallowing mm

Motor CN involved with control of smooth mm of inner eye

oculomotor

Common Signs and Symptoms associated with neoplastic dz

pain described as gnawing intense or penetrating, pain not resolved by time of day, positioning, or activity, pain will wake pt

Common Signs and Symptoms associated with Nerve root compromise via disc

painless reclined/semireclined position, pain increases with WB, pain is shooting stabbing or burning, may be reports of altered strength/ADL ability

Definition of Cogwheel Rigidity and often seen in?

phasic resistance to movement; PD

Ideational Apraxia

pt cannot perform task at all

Ideomotor Apraxia

pt cannot perform task on command, but can perform on own

Testing Position in Space

pt demonstrates different limb positions on command

Testing Spatial Relationships

pt duplicates pattern of 2 or 3 blocks

Description of Glenoid Labrum Tear Test (Clunk Test)

pt in supine. PT places one hand posterior on humeral head and other stabilizes humerus proximal to elbow. PT passively ABD and ER pt's arm overhead and applies anterior force to humeral head. Positive if clunk felt or grinding sound

Describe Horner's Syndrome and causes from occlusion of what arteries

ptosis of eyelid, constriction of pupil, sweating of ipsilateral face often accompanying stroke involving anterior inferior or posterior inferior cerebellar arteries

Initial treatment of congenital hip dysplagia

repostitioning using bracing, harness, splinting, traction

Importance of epithalamus

represented by pineal gland which regulates circadian rhythm

PNS Pathos: Describe Mononeuropathy pathology and give an example (3/1)

sensory loss along nerve route, motor weakness and atrophy along nerve route, possible fasciculations; trauma

PNS Pathos: Describe Spinal Roots and Nerves pathology and give an example (4/1)

sensory loss in dermatomal pattern, motor weakness in innervated pattern, possible fasciculations, decreased DTRs; disc herniation

(lateral) Spinothalamic Tract is responsible for? (2)

sensory pain and temp

(Dorsal) Spinocerebellar Tract is responsible for? (4)

sensory: ipsilateral subconscious proprioception, mm tension, joint sense, and posture of trunk and lower extremities

(Ventral) Spinocerebellar Tract is responsible for? (4)

sensory: ipsilateral subconscious proprioception, mm tension, joint sense, and posture of trunk, upper and lower extremities

Spinotectal Tract is responsible for? (2)

sensory: spinovisual reflexes and assists with movement of eyes and head towards stimuli

physical therapist examines the residual limb of a patient following ambulation activities with a patellar tendon bearing prosthesis. The therapist identifies excessive redness over the patella. The MOST likely cause is

settling due to limb shrinkage. Add one-ply socks to more evenly distribute froces

Definition of Neuralgia

severe and multiple shock-like pains that radiate from specific nerve distribution

Complications of Lumbar Puncture

severe headache relieved by laying down (caused by CSF leakage), infection, epidural hematoma, uncal herniation

Signs of hemorrhagic CVA

severe headache, vomiting, high BP, and abrupt sx onset

Definition of rigidity

severe hypertonicity where sustained muscular contraction does not allow for movement of specific joint

3 Components of balance

somatosensory, visual, and vestibular inputs

Spasticity or rigidity is velocity dependent?

spasticity

The Drop Arm Test is highly ______ for identifying RTC tear

specific

Signs and sx of Guillain-Barre syndrome

symmetrical distal to proximal motor weakness, progress form lower to upper extremities, sensory impairments (may have stocking glove), possible respiratory paralysis

Signs & Symptoms of Cerebellar lesions

symptoms are ipsilateral to damaged side Ataxia,nystagmus,Tremor(intention, postural) dysmetria, Hypotonia titubations, dysdiadochokinesia, poor coordination, deficits in postural reflexes, balance, and equilibrium.

Rheumatoid Arthritis Description

systemic autoimmune disorder with periods of exacerbation and remission. Characterized by chronic inflammation of synovial tissues causing erosion of cartilage and other structures in capsule.

Classifications of Juvenile Rheumatoid Arthritis (3)

systemic, polyarticular, oligoarticular

What two joints form the midtarsal joint?

talocalcaneonavicular and calcaneocuboid

Common etiology of Tibial nerve injury (2)

tarsal tunnel entrapment, popliteal fossa compression

Fluent Aphasia typically arises when these structures are damaged (3)

temporal lobe, Wernicke's Area, areas of parietal lobe

What is epilepsy?

temporary dysfunction of brain where hypersynchronous electrical discharge of cortical neurons and seizure activity occur that is unprovoked and unpredictable.

What is Guillain-Barre Syndrome? AKA?

temporary inflammation and demyelination of peripheral nerves' myelin sheath, potentially results in axonal degeneration ; acute polyneuropathy

Describe Bell's Palsy

temporary unilateral facial paralysis secondary to trauma with demyelination and/or axonal degeneration of facial nerve

Signs and sx of plantar fasciiitis

tenderness at insertion, presence of heel spur, AM pain and with activity, difficulty with prolonged standing, pain with barefoot walking

Indication of scaphoid fracture

tenderness in anatomical snuff-box

Shoulder Extensors (3)

teres major, rear delt, lats

Shoulder ER mm (3)

teres minor, infraspinatus, post delt

The elbow flexion test is highly specific to _____

testing ulnar entrapment in cubital tunnel

Factors associated with increased patellofemoral forces: (5)

weak quads, decreased flexibility, patellar instability, increased tibial torsion or femoral anteversion

Describe Active Muscular Insufficiency

when a two joint muscle contracts across both joints

Describe Passive Muscular Insufficiency

when a two joint muscle is lengthened over two joints simutaneously