TO STUDY FROM NPTE READINGS

CO2

PRODUCED AT THE TISSUE LEVEL AS A BY PRODUCT OF METABOLISM, DIFFUSES OUT OF THE WORKING CELLSINTO THE BLOOD IN THE CAPILARIES it is then transported to the venous system and into the right side of the heart once through the R atrium, R ventricle , pulmonary artery, the capillary membrane, interstitial space, into the alveoli where during external respiration is its finally exhaled into the atmosphere

Electrical Conduction Abnormalities Ventricular Ectopy 1. Unifocal PVC 2. Multifocal PVC 3. Ventricular Bigeminy

PVC's are ectopic beats that originate in the ventricle and may present as irregular rhythms two hallmark rhythms to identify PVS on ECG 1. P wave is absent as the impulse originate in the ventricle 2. wide and bizarre QRS complex signifying abnormal electrical conduction through the ventricles PT may be appropriate if appropriate hemodynamic response. if the PVC increase with activity the activity is stopped 1. Unifocal PVC originate from the same irritable site 2. Multifocal PVC originate from different ectopic sites within the ventricles - suggest more irritable ventricles 3. Ventricular Bigeminy - every other beat is a PVC - trigecminey if every third beat is PVC - couplets (2 PVC) and triplet (3 PVC) suggest a high level of ventricular irritability LV function and ischemia are 2 of the common causes for ventricular ectopy

Transtibial 1. What Socket 2. Pressure sensitive areas (4) 3. Pressure tolerant areas (4)

Patellar Tendon Bearing - totally contact socket that allows for moderate loading over the area of the patellar tendon 2. Pressure sensitive areas - anterior tibia - anterior tibial crest - fibular head and neck - fibular nerve 3. Pressure tolerant areas - patellar tendon - medial tibial plateau - tibial and fibular shafts - distal end (rarely may be sensitive)

Lymphedema is divided into two treatment phases. What are they and what do they consist of?

Phase 1 Intensive treatment phase - reduction *MLD * multiple layer compression bandaging *skin and nail care *exercise Phase 2 Maintenance phase - long term management *self MLD by patient *compression therapy - compression garment during the day - multiple layer bandaging in the evening/night *skin and nail care *exercise

Mechanical Debridement 1. What is it? 2. Indications 3. Contraindications

Physical removal of debris by irrigation, hydrotherapy or wet-to-dry dressing application - non selective // may remove healthy tissue - removes foreign material and devitalized or contaminated tissue by physical forces - wet to dry gauze dressings, dextranomers, pulsatile lavage with suction - for wounds with moist necrotic tissue or foreign material present - DO NOT use on clean granulated wounds

Intermittent Mechanical Compression

Pneumatic Applies pressure to limb via inflatable sleeve - lymphedema - traumatic edema - nervous ulcers - residual limb edema - subacute injuries such as ankle sprains

Osteoarthritis (OA), Degenerative Joint Disease (DJD), Spondylosis, Stenosis (Central or lateral), myelopathy, radicuolopathy, radicular pain 1. What bias? (what position do you want them in?) 2. Intervention Summary - Lumbar - Cervical

(spondylosis is thinning of the disc) want them in flexion (flexion bias) interventions - posture education - flexion approach - segmental and global trunk stabilization - mobilization/manipulation as needed - nerve glides if indicated cervical - cervical and scapular stabilization - flexibility to anterior thorax, anterior shoulder girdle, upper cervical spine Lumbopelvic region - flexibility to anterior trunk and hips

Central Cord Syndrome 1. What causes it? 2. What is the clinical presentation?

**most common SCI condition** occurs from hyperextension injuries to the cervical region - associated with congenital or degenerative narrowing of spinal canal - resultant compressive forces give rise to hemorrhage, edema, producing damage to the most central aspects of the cord more severe neurological involvements of UE (cervical more centrally located than the LE's) - lumbar and sacral tracts are located more peripherally complete preservation fo sacral tracts, normal sexual, bowel, bladder function some distal UE weakness and loss of fine motor control remain which result in moderate to severe limitations in the ability to perform functional tasks

Pulmonary Impairment of SCI 1. What are the primary muscles of inspiration (1) / stabilizers 2. decreased what volume?

*DIAPHRAGM* - scalene - intercoastals - SCM - trap - serratus - pec major - pec minor - levator scapulae - abdominals decreased ERV - decreased cough effectiveness and secretion clearance

Total Hip Arthroplasty Precautions ROM + ADL Posterolateral Approaches Anterior/Anterolateral and Direct Lateral Approaches Transgluteal Approach (trochanteric osteotomy)

Posterolateral Approaches - avoid hip flexion >90 - avoid adduction past neutral - avoid IR beyond neutral - do not cross the legs - keeps knees lower than hips when sitting - avoid sitting in low soft chairs - avoid standing activities that involve rotating the body toward the operated extremity - sleep in supine with abduction pillow - avoid sleeping or resting in sidling position Anterior/Anterolateral and Direct Lateral Approaches - avoid hip flexion >90 - avoid hip extension - avoid hip adduction - avoid ER ALL PAST NEUTRL - avoid combination of hip flexion, abduction and ER - if the glue med was incised and repaired DO NOT perform sidling hip ABD for at leaset 6-8 weeks or until approved by the surgeon - do not cross the legs - step to gait pattern so you avoid extension + hyperextension - avoid activities that involve standing on the operated extremity and rotating away from the involved side Transgluteal Approach (trochanteric osteotomy) - avoid hip adduction past neutral - no active antigravity hip abduction for at least 6-8 weeks or until approved by surgeon - no exercises that involve WB on operated leg - sleep in supine position with abduction pillow - do not cross legs - maintain WB restrictions during all ADL's

Associative Stage feedback, practice and environment

Practice on mastering the timing of the skill - Fewer and more consistent errors - practices movements and refines motor programming - decreased visual feedback - increase use for proprioceptive feedback - cognitive monitoring decreases - ask self-evaluation - feedback when errors become consistent avoid excessive augmented feedback - focus on the use of variable feedback - encourage consistency of performance - variable practice (serial or random) - progress toward open, changing environment - prepare the learner for home, community, work environments

Necrotizing Enterocolitis

Pre-term infants have lower immune function, bacteria proliferate in bowel and cause ischemia and air in the bowel. Dx: thin curvilinear lines of lucency

Early Symptoms of MS

*first symptom typically sensory or visual** - minor visual disturbances (episodes of double vision) - paresthesias progressing to numbness, weakness and fatiguability ** diagnosed by LP/CSF, elevated gamma globulin, CT, MRI, myelogram, EEG

drugs to increase contractility

+ ionotropes (digoxin) diuretics - decreased preload - decrease LVEDV Afterload reducers - ACE inhibitors (block vasoconstriction, salt and water retention) results in preload and after load reduced

Functional Independence Measure

- 18 items - physical functional, mobility, basic ADL's, psychological, social functioning

Wrist and Hand Zone I, ii, iii Primary Flexor Tendon Repairs Maximum Protection Phase

- 3-5 weeks - tendon repair is the weakest here Goals 1. pain 2. edema control 3. protection 4. very low level, controlled stresses on tendon to prevent adhesions and maintain tendon gliding. Interventions 1. elevating the hand 2. orthosis use and care 3. wound management and skin care 4. passive and active exercise Exercise Prescription - performed in a static dorsal blocking orthosis - or in a wrist tenodesis orthosis - straps are loose for finger flexion - exercises are performed hourly during the day for the first 4 weeks Exercises - passive MP, PIP, DIP fl and ext - independent motions of the PIP and DIP joints for differential gliding of the FDP and FDS tendons - place and hols exercises: FL and holder 5 seconds (MP joint) then have patient passively flex the digits to passively extend - minimum tension, short arc motion (just enough tension to overcome the resistance of the extensors and cause flexor tendon excursion performed with the wrist in slight extension and the MP joints flexed) it is essential to maintain the MP joints in FL during passive ROM of the iP joints to avoid excessive stretch of repair site

AED PROCESS

- 30 cardiac compressions for every 2 breaths (30:2 ratio) about 100/minute - compression depth 1 and 1/2 inches for adults and children 1/3 to 1/2 the depth of chest for infants - compression landmarks for adults and children are between the nipples and just below the nipple line for infants - 2 hands for adults and 2 hands or 1 for children, use two fingers on infants - check for pulse periodically is no longer recommended - opening the airway is the first priority before restoration of breathing and circulation in infants. if airway obstructed use the hemlock maneuver with abdominal thrust for infants use back slaps and chest thrust with children and adults the sequence priority is CAB (compressions, airway, breathing)

Gait Speed

- 5 meter acceleration - 10 meter timed - 5 minute deceleration 0.05 m/sec

Endurance walk tests? (2)

- 6MWT - 2MWT 2MIN STEP TEST IF CANT DO THESE

Stage 1

- < 3 months - gradual onset - increase w mvt - present at night - loss of ER - intact RTC strength

Upper Lobes Posterior Segments

- Bed or drainage table flat - Patient leans over folded pillow at 30 degree angle - Therapist stands behind and claps over the upper back of both sides

Upper Lobes Apical Segments

- Bed or drainage table flat - Patient leans back on a pillow at 30 degree angle against therapist - Therapist claps with markedly cupped hand over area between clavicle and top of scapular on each side

Upper Lobes Anterior Segments

- Bed or drainage table flat - Patient lies on back with pillow under knees - Therapist claps between clavicle and nipple on each side

Calcium 1. Function 2. Normal Levels 3. Hypocalcemia 4. Hypercalcemia

- Bone and teeth formation - blood clotting - hormone secretion - cell membrane integrity - cardiac conduction - transmission of nerve impulses - muscle contraction 2. Normal Levels 8.4-10.4 3. Hypocalcemia caused by reduced albumin levels, hperphosphatemia, hypoparathyroidism, malabsorption of calcium and vitamin D, alkalosis, acute pancreatitis, vitamin D deficients - observe for muscle cramps, tetany, spasms, paresthesias, anxiety, irritability, twitching, convulsion, arrhythmias, hypotension 4. Hypercalcemia caused by hyperparathyroidism, tumors, hyperthyroidism, vitamin A intoxication - observe for fatigue, depression, mental confusion, nausea/vomiting, increased urination, occasional cardiac arrhythmias

Three Point Gait

- Both crutches and involved leg advance together - Uninvolved leg follows - Uses two canes/crutches or a walker

Precautions for the use of Tredelenburg Position (8)

- CHF - pulmonary edema - SOB made worse with tredelenberf - obesity - abdominal distention - hiatal hernia - nausea - recent food consummating

Deep peroneal

- DF - A branch of the common peroneal - foot drop, yes values

Distal Radioulnar Dorsal Glide Distal Radioulnar Volar Glide

- Dorsal/Distal/ Posterior= supination - Volar/anterior= pronation

Proximal Radioulnar Dorsal Glide Proximal Radioulnar Volar Glide

- Dorsal/Distal/ posterior = pronation - Volar/ anterior= supination

C1, C2, C3, C4 1. Muscles (3) 2. Available Movements 3. Functional Capabilities 4. Equipment and Assistance Required

- Face and neck muscles - cranial nerve innervation - diaphragm (partial innervation at C3, C4) - talking - mastication - sipping - blowing - scapular elevation - dependent in ADL's - dependence in basic ADL - environmental controls - brain computer interfaced - adaptive equipment such a head or mouth stick - full time attendant required - dependent with positioning in WC - dependent in bed mobility - mechanical Lifts - unable to drive and ambulate - independent with power wheelchair with adaptive control such as head, chin, tongue, sip and puff controls, tilt and recline seat - portable ventilator

Humeroulnar Distal Glide

- Increase flexion

Spastic CP

- Increased muscle tone in antigravity muscles - abnormal postures and movements with mass patterns of flexion and extension - imbalance of tone across joints that may cause contractures and deformities, especially of hip flexors, adductors, IR, knee flexors, ankle PF in LE, scapular retractors, GH extensors, adductors, elbow flexors, forearm pronators visual, auditory, cognitive, oral motor deficits crouched gait: walks with hip flexion, hip IR and knee flexion or may also toe walk

upper chest inhibiting technique

- Inhibiting the upper chest can help a patient recruit the diaphragm during inhalation - Used after implementation of other techniques - use only after other techniques have been attempted

Charcot-Marie-Tooth disease

- Involves peripheral nerves - Marked by progressive weakness, primarily inperoneal (fibular) and distal leg muscles - Occurs teenage years or earlier hereditary condition characterized by progressive degeneration of the muscles of the lower leg, specifically those associated with the fibula

Obturator N

- L2-L4 - Adductor muscles and obturator externes - trouble with crossing legs - trouble with ER and adduction

Biological Debridement 1. What is it? 2. Indications 3. Contraindications

- RARELY USED - use of maggots to deride nonviable tissue - produce enzymes and phagocytize necrotic tissue and bacteria - MRSA, strep, pseudomonas - may stimulate granulation formation and epithelization - individuals who cannot tolerate other forms of debridement - all non-healing necrotic wounds in people who are medically stables - psychological stress arises from having living creates in wounds - reports pain increasing

Sodium 1. Function 2. Normal Levels 3. Hyponatremia 4. Hypernatremia

- Regulate Fluid Volume - Help maintain blood volume - Interact with calcium to maintain contraction - Stimulate nerve impulses 2. Normal Levels 135-146 3. Hyponatremia - caused by water intoxication meaning excesses cellular water associated with excess intake or excessADH (tumors, endocrine disorders) - observe for confusion, decreased mental alertness, signs of increased intracerbral pressure, poor motor coordination, sleepiness, anorexia 4. Hypernatremia caused with water deficits not salt excess, with dehydration, insufficient water intake - observe for circulatory congestion (pitting edema, excessive weight gain) pulmonary edema with dyspnea, HTN, tachycardia, agitation, restlessness, convulsions

C1-C2 Inspiratory Muscles (2)

- SCM - Upper trap - no expiratory. expiration is passive - phrenic nerve innervation and spontaneous respiration are lost - ventilator or phrenic nerve stimulator is required to sustain life

Cancer Exercise Recommendations Contraindications To Exercise

- TENS post op pain - isometrics, isotonic light weights - high risk for vertebral compression fractures so light exercise - low to moderate intensity 40-<60% - 11-13/20 on RPE scale - 3-5 days a week - 20-60 minute sessions - warm up and cool down - start slow, progress incrementally - avoid exhaustion - assess fatigue levels 12 hours later Contraindications To Exercise - day of IV chemo or within 24 hours of treatment - severe reaction to radiation - acute infection, temp >100 - unusual extreme fatigue, muscle weakness - chest pain - rapid slow HR - elevated BP - swelling of ankles - severe dyspnea - pain on deep breath - cough, wheezing - dizzy, lightheaded, disorientation, confusion, blurred vision, ataxia patients with neutropenia have decreased neutrophils in blood and are at an increased risk for infection bony metasis= increased risk of fx AVOID -mmt - progressive resistive exercise - high stress activity post mastectomy - shoulder ROM

Cancer 1. Pathophysiology - Tumor or Neoplasm - Benign Tumor (Neoplasm) - Malignant Tumor (Neoplasm) 1. Carcinoma 2. Sarcome 3. Lymphoma 4. Leukemias and Myelomas - Metastasis

- Tumor or Neoplasm abnormal growth of new tissue that is nonfunctional and competes for vital blood supply and nutrients - Benign Tumor (Neoplasm) localized, slow growing, encapsulated, not invasive - Malignant Tumor (Neoplasm) invasive, rapid growth, giving rise to metastasis, can be life threatening 1. Carcinoma malignant tumor originating in epithelial tissues - skin, stomach, colon, breast, rectum 2. Sarcoma malignant tumors originating in CT and mesoderm tissues (muscle, bone, fat) 3. Lymphoma affecting lymphatic system 4. Leukemias and Myelomas affecting the blood (unrestrained growth of leukocytes and blood forming organs (blood marrow) - Metastasis movement of cancer cells from one body part to another - spread via lymphatic system or blood stream

Female response sexual function SCI 1. UMN 2. LMN

- UMN reflex arc remains intact - components of sexual arousal: val lubrication, engorgement of labia, clitorial erection can occur but psychogenic response will be lost LMN - psychogenic response - reflex lost menstrual cycle interrupted for 4-5 months following injury

Facial N

- VII - afferent, efferent (somatic), efferent (visceral) **muscles of facial expression** - taste from anterior tongue - muscles of facial expression - dampens sound (stapedius) - tearing (lacrimal gland) - salivation (submandibular and sublingual glands)

Ape Hand Deformity

- Wasting of thenar eminence - Result of Median N palsy - thumb falls back in line with fingers - result of the pull of extensor muscles ***cant oppose or flex thumb**

Energy Effectiveness Strategies MS 1. What is it? 2. What is activity pacing? 3. What are rest/activity ratios? 4. Weekly review of what? 5. What should be administered on a regular basis?

- activity diary of how sleep, daily activities by hour, how costly activities were - each activity rate the level of fatigue, importance of activity, satisfaction perceived with performance of the activity between 1-10 - modifying task or modifying the environment to ensure successful completed of daily activities - planning, work simplification and developing energy-efficient activities for self care and home management activity pacing - balance of activity with rest periods interspersed throughout the day Rest-activity rations - periods rest periods planned in advance - chronic fatigue - weekly review of activities and recommended modification is sued to evaluate progress to monitor ongoing fatigue status. stress management techniques - in home AC - work modifications - ergonomics

Physical Therapy Management for High Level Recovery of a TBI

- allow for increasing independence - wean patient from structure - closed to open environments - assist patient in behavioral, cognitive, emotional reintegration - provide honest feedback, prepare for community entry - enhance motor learning and promote independence in real-life environments - improve postural control, symmetry and balance - provide emotional support, encourage socialization, behavioral control and motivation - reorient - reassure - provide patient and family education

Physical Therapy Stroke Rehab

- avoid traction to arm - overhead pulleys are contraindicated - directed tasks - organized feedback - improve chest expansion - diaphragmatic breathing - promoter training - isokinetic training to improve velocity and control of movement - EMG/biofeedback -FES - constraint induced movement therapy -

Spasticity MS 1. What 3 medications? 2. What medications make it worse?

- baclofen -gabapentin - tiazidiane **SSRIs make spasticity worse**

Treatment for heart failure (4)

- bed rest - diuretics - sodium restriction - measures to improve myocardial contractility and correction of arrhythmias

Hypoglycemia 1. Depends on what? 2. Clinical Presentation 3. Who is at special risk? 4. interventions

- blood glucose levels - duration and intensity of exercise - blood insulin concentration 2. Clinical Presentation - can still exhibit signs and symptoms when their elevated blood glucose level drops rapidly to a level that is still elevated (400-200_ - the rapidity of drop is the stimulus for sympathetic activity those on beta blockers - inhibits normal physiological response and block appearance of sympathetic manifestations of hypoglycemia immediate sugar - 10-15g of carbs report to physician after

Magnesium 1. Function 2. Normal Levels 3. Hypomagnesemia 4. Hypermagnesemia

- bone health - nerve conduction - muscle contraction/relaxation - numerous enzyme reactions (works with B6 in neurotransmitter metabolism) 2. Normal Levels 1.8-2.4 3. Hypomagnesemia caused by hemodialysis, blood transfusion, chronic renal disease, hepatic cirrhosis, alcoholism, chronic pancreatitis, hypoparathyroidism, malabsorption syndromes, severe burns, excess loss of body fluid - observe for hyper irritability, confusion, leg and foot cramps 4. Hypermagnesemia caused by renal failure, diabetic acidosis, hypothyroidism, Addisons disease, dehydration and use of antacids - observe for hyporeflexia, muscle weakness, drowsiness, lethargy, confusion, bradycardia, hypotension

GH Joint Arthritis Subacute Phase

- capsular tightness - consistent with capsular pattern - ER and ABD most limited - pain at END range

Flattened lordosis

- caused by a posterior pelvic tilt - adaptive shortening of HS - disk protrusion or weakness of hip FL muscles

Enzymatic Debridement 1. What is it? 2. Indications 3. Contraindications

- chemical debridement - applying topical preparation of collagenolytic enzymes to tissues - use for all moist necrotic wounds - eschar after cross hatching - homebound individuals - who cannot tolerate surgical debridement - DO NOT use on ischemic wounds unless adequate vascular status has been determined - dry gangrene - clean granulated wounds

What is the most common airway clearance technique? what technique should be used for those with COPD and why?

- coughing Huffing - high in thoracic pressures of coughing could force the closing of small airways in some patients with COPD. by trapping air behind the closed airway, the forced expulsion of air during a cough becomes ineffective in clearing secretions

Signs of Elevated intracranial pressure

- decrease levels of consciousness (stupor and coma) - widened pulse pressure - increased HR - irregular respirations (cheyne-stokes) - vomiting - unreactive pupils - papilledema

Clinical Signs and Symptoms of Water Intoxication

- decreased mental alertness - sleepiness - anorexia - poor motor coordination - confusion SEVERE - convulsions - sudden weight gain - hyperventilation - warm, moist skin - signs of increased intercererbral pressure (slow pulse, increased systolic and diastolic more than 10) - mild peripheral edema - low serum sodium - low hematocrit

How do you complete huffing?

- does not create high intrathroacic pressures. - patient is asked to take a deep breath and then rapidly contractile abdominal muscles while forcefully saying "HA HA HA" - this allows forced expiration through a stabilized open airway and makes secretion removal more effective

Pursed lip breathing is used for? How do you do it?

- dyspnea - slows RR - decreases airway collapse during expiration inhale through nose for several seconds with mouth closed - then exhale slowly over 4 to 6 seconds through lips held in a whistling or kissing position

Male Response Sexual SCI 1. What has a greater response UMN OR LMN 2. reflexogenic erections 3. psychogenic eretcions 4. higher ability to ejaculate with what lesion?

- erectile capacity greater UMN then LMN. occur in response to external physical stimuli of genitals or perineum intact reflex arc is required through S2, S3, S4 through cognitive activity such as erotic fantasy - meditated through the cerebral cortex either through thoracolumbar or sacral centers higher incidence to ejaculate with LMN then with UMN - vigara - letiva - dualist - injectable to relax penal smooth muscle - topical agents - mechanical devices

What does a bowel program look like?

- establishing a daily or every other day pattern of eliciting a bowel movement - exact time each day either in the morning or night - suppositories - digital stimulation which is a manual stretch of the anal sphincter with a lubricated glove finger or orthotic digital stimulator - fiber - physical acitivity - stool softener - laxatives - bulking agents

Pelvic Crossed Syndrome

- excessive lordosis - erector spina and iliopsoas are shortened - abdominals and glue max are weak **excessive lordosis can indicate spondylolisthesis** - spine lies anterior to sacrum - mid or low lumbar shelf - shortened TFL - lengthened HS and gluten

Cardiac Transplant Patients may present with

- exercise intolerance due to extended inactivity and reconditioning - side affects from immunosuppressive drug therapy are hyperlipidemia, HTn, obseity, diabetes, leg cramps - decreased LE strength - increased fracture risk due to long term corticosteroid use - heart rate alone is not an appropriate measure because the heart is denervated and patients tend to be tachycardia use a combination of HR, BP, RPE, METS, dyspnea scale - use longer warmup and cool down per cause psychological responses to exercises and recovery takes longer

Cardiac Rehabilitations Termination of Exercise

- fatigue, light-headedness, confusion, ataxia, pallor, cyanosis, dyspnea, nausea, onset of angina with exercise - ST displacement 2mm horizontal or downscoping from rest level - ventricular tachycardia or 3 or more consecutive PVCs - drop systolic more than 20 - rise in systolic bP more than 220 or diastolic for than 110

Surgical Debridement 1. What is it? 2. Indications 3. Contraindications

- for deep stage III or IV or complicated pressure ulcer - most efficient method of debridement - selective - performed by physical or surgeon using sterile instruments - one time procedure - may require anesthesia -for advanced cellulitis with sepsis - Immunocompromised individuals - when infection threatens the individuals life - clean wounds as a preliminary procedure to surgical wound closure line - granulation and scar tissue may be excised - DO NOT with cardiac disease, pulmonary disease or diabetes - severe spasticity - cannot tolerate surgery - short life expectancy - quality of life cannot be improved

Spoon Shaped Nails

- fungal infection - anemia - iron deficiency ** - long term diabetes - local injury - developmental abnormality - chemical irritants - psoriasis

Ankylosing Spondylitis Symptoms

- gradual onset before age 40 - marked morning stiffness - persisting limitation of spina movements in all directions - peripheral joint involvement - iritis, skin rashes (psoriasis), colitis, urethral discharge - family history - morning stiffness >1 hour

Metabolic Alkalosis - pH - PaCO2 - HCO3

- high pH - PaO2 WNL - high HCO3 - caused by bicarbonate ingestion, vomiting, diuretics, steroids, adrenal disease Vagus Symptoms - weakness - mental dullness - possible early tetany

Respiratory Alkalosis - pH - PaCO2 - HCO3

- high pH - low PaCO2 - normal HCO3 -caused by alveolar hyperventilation S&S - dizziness - syncope - tingling - numbness - early tetany

Bronchial Breath Sound

- hollow - echowing - right superior anterior thorax - all of inspiration - most of expiration

Clubbed Nails

- hypertrophy of soft tissue - respiratory or cardiac problems - COPD - severe emphysema - congenital heart defects - cor pulmonale

Inspiratory hold technique for who? how do you do it?

- hypoventilation - for ineffective cough (can be used in conjunction with vibration techniques) to aide in airway clearance - improve flow of air into poorly ventilated lungs prolonged holding of the breath at maximum inspiration PT in strutted to hold breath at the height of inspiration for 2-3 seconds followed by a relaxed exhalation

Stacked breathing for who? how?

- hypoventilation - uncoordinated breathing patterns series of deep breaths that build on top of the previous breath without expiration until a maximal volume tolerated by the patient is reached - each inspirited accompanied by a brief inspiratory hold

Unilateral Vestibular Hypofunction

- improved stability of gaze during movement - diminished sensitivity to motion - improved static and dynamic postural stability - I with HEP that includes walking 6-8 weeks Gaze Stability Exercises purpose is to improve the VOR and other systems that are used to assist gaze stability with head motion 1. Vestibular Adaptation X1 - patient moves head horizontally and vertically as quickly as possible while maitaining focus on a stable target - start at arms length away (sticky on wall) X2 - move the head and target in opposite directions - can progress these with using a distracting background, varying distance, move head more rapidly, complete in standing or walking Postural Stability Exercises - challenge visual, vestibular, somatosensory Habituation Exercises (Motion Sensitivity) - use when a patient with UVH has continual complaints of dizziness - habituation is the reduction in response to a repeatedly performed movement - patient should reproduce dizziness

Tredelenburg postion is good for what 2 things? who is it contraindicated for?

- increase BP of hypotensive patients - to clear the lower lobes Contraindicated for - CHF - cardiomyopathy

Humeroradial Dorsal Glide Humeroradial Volar Glide

- increase extension - increase flexion

Forward Head

- increase lower spine lordosis - rounded shoulders - thoracic kyphosis - protracted scapula - tight anterior muscles - stretched posterior muscles - cervicothoracic kyphosis between C4-T1 Result - abnormal strain on joint capsule, ligaments, IVD's, elevator scapulae, upper trap, SCM, scalene and sub occipital muscles Tired neck syndrome - painful fatiguer in levator scap, rhomboids, lower trap AS the head is Brough forward flexing the C-spine, the scalene muscles shorten and lessen the support of the upper ribs COG is slightly anterior to ear ABDduction of the scapulae or protection causes lowering of coracoid process which produces adaptive shortening of the pec which flattens chest wall and alters the motion of the scapula producing a mechanical impairment of the shoulder limits elevation and abduction of shoulders leading to hypermobility or instability of GH joint. May lead to posterior instability and rotary hyper mobility and a biceps tendinitis as this muscle becomes overused in its attempt to stabilize the GH joint

Flattened back

- indicates spinal stenosis, lateral recess stenosis or some lateral shifting of the spinal column

Treatment for bladder dysfunction 1. What technique for UMN? 2. What technique for LMN?

- indwelling cathehter - intermittent cauterization - 2,000mL/day fluid intake - suprapubic tapping directly over the bladder with fingertips cause a reflexive emptying of bladder (ONLY WORKS FOR UMN BLADDER) - VALSALVA MANEUVER which is done by straining

lateral costal breathing? how and for who?

- large incisions from surgery on one side of the thorax - splinting - decreased expansion on one side *most efficient in SL* arm on involved side is in abducted position to the level of the head. the therapist gives a stretch before inspiration and continues giving resistance through the inspiratory phase

Musculocutaneous N

- lateral cord - C5-C6 - biceps, brachialis, coracobrachialis - flexion with supination

Right Hemisphere Lesion 1. Visual- Perceptual Impairments 2. Behavioral Deficits 3. Intellectual Deficits 4. Emotional Deficits 5. Task Performance 6. Deficits of either hemisphere depending on lesion location

- left sided hemiplegia and paresis - left sided- sensory loss 1. Visual- Perceptual Impairments - left sided unilateral neglect - agnosias visuospatial disorders - disturbances of body image and body scheme - difficulty processing visual cues 2. Behavioral Deficits - quick, impulsive behavior style - poor judgement, unrealistic - inability to self-correct - poor insight, awarnesss of impairments, denial of disability - increased safety risk 3. Intellectual Deficits - difficulty with abstract reasoning, problem solving - difficulty synthesizing information and grasping whole idea of task - rigidity of thought - memory impairments, typically related to spatial perceptual information 4. Emotional Deficits - difficulty with ability to perceive emotion - difficulty with expression of negative emotions 5. Task Performance - fluctuations in performance 6. Deficits of either hemisphere depending on lesion location - visual field deficit (homonymous hemianopsia) - emotional abnormalities: lability, apathy, irritability, low frustration levels, anxiety, depression - cognitive: confusion, short attention span loss of memory, executive functions

Kilohertz Ultrasound Debridement 1. What is it? 2. Indications 3. Contraindications 4. Precautions

- long wave low frequency US - typically operates between 20 and 50 KHz - selective - autoclaving of contact probe is usually required - selective removal of necrotic tissue desired - reduces bioburden - increases angiogenesis - wound bed preparation for grafting or flap closure - DO NOT use with vascular abnormalities, DVT, emboli, advanced PVD, irradiated areas, tumors, organs or electrical devices - PRECAUTIONS over nerves, infections, anesthetic areas

Paced breathing used for what? how do you do it?

- low endurance - dyspnear on exertion - fatigue/anxiety - tachypnea breathe in at beginning of activity breathe out during the activity can be combined with pursed lip or diaphragmatic

Exercise prescription MLD

- low intensity resistance exercise - active ROM - stretching - manual drainage techniques - exercises performed wearing a compression garment or bandage

Metabolic Acidosis - pH - PaCO2 - HCO3

- low pH - PaCO2 normal - low HCO3 - caused by diabetic, lactic, or uremic acidosis, prolonged diarrhea S&S - secondary hyperventilation (kussmaul breathing - nausea - lethargy - coma

Respiratory Acidosis - pH - PaCO2 - HCO3

- low pH - high PaCO2 - HCO3 - caused by alveolar hypoventilation S&S Early - anxiety - restlessness - dyspnea - headache Late - confusion - somnolence - coma

Femoral N

- lumboscaral plexus - L2-L4 - hip flexion and knee extension - quads and iliopsoas - symptoms may occur from diabetes mellitus or neuritis

- Amount of fluid transported is called the what? - the amount of fluid the lymphatic system can transport is?

- lymphatic load - transport capacity when imbalanced lymphedema can develop

Physical Therapy Management of Decreased Response Levels after TBI

- maintain rom - prevent contractures - prom - positioning, splinting, serial casting - maintain skin integrity - maintain respiratory status through postural draining, percussion, vibration, suctioning - provide stimulation for arousal and elect movement and function - promote early return to FMS: upright positioning for improved arousal, proper body alignment

Manual Lymphatic Drainage How to do it

- maximize the elasticity available in the superficial tissue. too much pressure can cause vasodilation - each stroke has a working phase and resting phase. working= move fluid into lymphatic system resting= elects a pressure change in tissue and allows the lymph fluid to fill the lymphatic collectors repetition of the strokes is needed to help reduce the high viscosity of the lymphatic system MLD sequences directly lymphatic fluid from an area of congestion, across lymphatic water sheds to an area of no tissue congestion

Wheelchair Seat Width

- measure the width of the hips at the widest part - add 2 inches to patients measurement if excessive width - difficulty reaching the drive wheels and propelling the chair if too narrow - result in pressure/discomfort on the lateral pelvic and thighs

Median N

- medial and lateral cord - C6-C8 - finger flexors - carpal tunnel - pronator teres syndrome

Ulnar N

- medial cord - C8-T1 - FRU, FCR - Cubital tunnel - Guyons canal - Claw hand deformity - hook of hamate and pisiform

Gout

- metabolic, genetic, purine metabolism - elevated serum uric acid (hyperuricemia) - uric acid changes into crystals and deposits int peripheral joints and other tissues - most frequently at knee, foot and great toe - NSAID, COX 2 inhibitors, coaching, corticosteroids, ACTH - DX test are labs to identify monosodium urate crystals in synovial fluid/ connective tissue samples - TX: educate on diet AND CATCH EARLY + INTERVENTION ASAP IS IMPORTANT!

Main Focus of Treatment with Lymphedema

- minimize lymphedema as much as possible - muscle contraction combined with external forces from a bandage or compression garment can be effective in the movement of fluid -

Pacemakers and Automatic Implantable Cardioverter Defibrillators (AICDs)

- most are demand programmed to pace heart rate - most are demand pacemakers so that heart will increase as workload increases - always have a low HR limit set, rarely have an upper limit set - HR will not change with fixed rate pacers, which will impact activity tolerance - AICDS will deliver an electric shock if HR exceeds set limit and or ventricular arrhythmia is detected (should know setting for HR limits or AICD) - ST segment changes may be common - avoid UE aerobic or strengthening exercises 4-6 weeks after implant to allow leads to scar down -

What is predictive of a poor recovery with patients in moderate to severe TBI? (2)

- motor score - pupillary reactivity others - age - race - lower education level

Wheelchair Seat Height

- no measurements - add 2 inches to patient leg length measurement

cardiopulmonary if a child is unresponsive what do you do?//adult?

- open the airway using the head tilt chin lift method and perform 5 cycles (2 mins) of CPR beginning with 2 breaths and see if successful before calling 911 or a code retrieving AED - after lack of response in an adult begin compressions immediately then open airway by head tilt chin life. neck life or jaw thrust is no longer appropriate

Phase 2 of Cardiac Rehabilitation

- outpatient or HEP (subacute) - early at home or outpatient management up to 3 months following discharge begins 1-2 weeks after infarct or surgery - gradual increases of intensity activities within appropriate individual capabilities and medical limitations (angina pectoris, pacemakers) - independent self care at home - return to work or homemaking - modify lifestyle to decrease risk factors - begin low level conditioning - walk, jog, step aerobic program to tolerance - other activities that range between 4 and 9 METS are indicated - 3-4 sessions per week - 30-60 minutes with 5-10 minutes of warm up and cool down - discharge at9 METS functional capacity

Anterolateral Spinothalamic Pathway 1. What is it responsible for? (5) 2. Activated by what? (3) 3. What is the pathway? 4. What are the 3 major tracts? and what are they responsible for?

- pain - temperature - tickle - itch - sexual sensation activated by mechanoreceptors, thermoreceptors, nociceptors originates in the dorsal roots 1. fibers cross and ascend up the spinal cord through the medulla, pons, midbrain to the VPL nucleus of the thalamic 2. axons of VPL project to the somatosensory cortex via the internal capsule 1. Anterior (ventral) Spinothalamic Tract - carries sensations of crudely localized light touch and pressure 2. Lateral Spinothalamic Tract - pain and temperature 3. Spinoreticular Tract - pain sensations - diffuse, deep and chronic

GH Joint Arthritis Acute Phase

- pain - protective muscle guarding - limited ER and ABD - pain radiates into distal elbow - may disturb sleep - tender to palpate at sulcus below edge of acromion process between posterior and middle deltoid

C3-C4 Inspiratory Muscles (3)

- partial diaphragm - levator scapulae - scalenes - no expiratory/passive mechanical ventilation required. with recovery and training will likely be able to breathe on their own. may need part time ventilatory support - need assistance for airway clearance due to no expiratory

General Exercise Guidelines and Precautions Following Repair of a Full-Thickness Rotator Cuff Tear

- passive or assisted shoulder ROM in safe and pain free ranges - only passive ROM for 6-8 weeks after a repair of a massive cuff tear - initially perform passive and assisted shoulder ROM in supine to maintain stability of the scapula - minimize anterior and superior translations and the potential for impingement - position humerus slightly anterior to frontal plane and slight ABDuction - support distal humerus on a folded towel - when imitating passive or assisted shoulder rotation while supine, position the shoulder in slight flexion and 45 degrees ABD - when initiating shoulder extension perform in prone from 90 to short of neutral - restore strength in the RTC especially supraspinatus and infraspinatus before dynamically strengthening the shoulder FL and ABD - do not allow active shoulder flexion or abduction until the patient can lift arm without hiking the shoulder exercise - low exercise loads, resisted motions should not cause pain - non WB closed chain exercises or activities for 6 weeks - delay dynamic strengthening for a minimum of 8 weeks post op small, strong repair and for at least 3 months for large tears - if supra and infra was repaired proceed cautiously when resisting GH ER - if the subs cap was repaired, proceed cautiously with resisted GH joint IR - after an open repair postpone isometric resistance exercises to the repaired deltoid and cuff musculature for at least 6 to 8 weeks unless advised otherwise stretching exercises - avoid vigrous stretching and the use to contract-relax procedures, grade 3 joint mobs for at least 6 weeks and often for 12 weeks post op adl - wait until 6 weeks after a mini open or arthroscopic repair and 12 weeks after a traditional open repair before using the operated arm for fx activities - after the repair of a large or massive cuff tear avoid use of operated arm for functional activities that involve heavy resistance for 6-12 months (push pull left carry)

Inspiratory Muscle Strength test is baed off the patients ability too...

- patients ability to create a negative inspiratory pressure (PImax) - seated with nose clips in place - let out all the air before beginning the test to start the test at residual volume - the person is then asked to "breathe in" against an occluded mouthpiece - negative pressure is recorded after one second of effort - the ability to generate a negative inspiratory pressure reflects the strength of the muscles of inspiration

C6-C8 muscles of inspiration (3)

- pectorals major sternal - pectoralis minor - serratus anterior expiratory pec major clavicular

Kyphotic Lordotic Posture

- pelvis tilts anteriorly - lordosis in lumbar spine increases - kyphosis in thoracic spine increases - lordosis in cervical spine increases head held forward with cervical spine hyperextended - protracted scapular - pelvis anterior - short and strong hip flexors - weak erector spina

Axillary N

- posterior cord - C5-C6 - deltoid and teres minor - abduction and ER

Radial N

- posterior cord - C6, C7, C8, T1 - wrist drop - tennis elbow - past the elbow it becomes just sensory distribution loss. proximal is motor and sensory

Electrolytes and Heart Disease

- potassium - calcium - magnesium allow for normal electrical conduction through the heart hypokalemia : low potassium <3.5 produce arrthymias with flattened T waves and depressed ST segments and bilateral LE cramping or intervened T wave hypocalcemia (low blood serum)

Ankloysing Spondylitis

- progressive inflammatory disorder - low back pain >3 months - morning stiffness - sacroilitis - men > women - kyphotic cervical and lumbar spine - loss of lumbar lordosis - NSAIDS, corticosteroids, cytotoxic drugs to those who dont respond well to corticosteroids// need high dose of sterioids - dx test: HLA-B27 but not diagnostic in itself - flexibility exercises - lengthen muscles especially extensors - aquatic, aerobic programs - relaxation activities to maintain/improve breathing// vital capacity

GH Joint Arthritis Chronic Phase

- progressive restriction of GH capsule - capsular pattern - significant loss of function - inability to reach 1. over head 2. outward 3. behind the back - pain localized to deltoid region

Shank (Prosthetic) Transtibial Exoskeletal Endoskeletal

- provide leg length and shape - connect and transmit weight from socket to foot Exoskeletal: made of wood with plastic laminated finish Endoskeletal: metal shank covered by soft foam and external stocking. components allows for increased ease of prosthetic adjustments

Physical Therapy Management for Mid-Level Recovery of a TBI

- provide structure - prevent overstimulation for confused, agitated patient - closed environment - daily schedules - memory logs - relaxation techniques - be consistent - give clear feedback - written contracts - task specific training - limit activités to familiar, well liked ones - offer options - break down complex tasks into component parts - verbal and physical assistance - control rate of instruction - model calm focused behavior

Left Hemisphere Lesion 1. Speech and Language Impairments 2. Behavioral Deficits 3. Intellectual Deficits 4. Emotional Deficits 5. Task Performance 6. Deficits of either hemisphere depending on lesion location

- right sided hemiplegia/paresis - right sided sensory loss 1. Speech and Language impairment - confluent brocas aphasia - fluent wernickes aphasia - global aphasia - difficulty processing verbal cues and commands 2. Behavioral Deficits - slow, cautious - disorganized - often very aware of impairments, extent of disability 3. Intellectual Deficits - disorganized problem solving - difficulty initient tasks, processing delays - highly distractible - memory impairments, typically related to language - preservation 4. Emotional Deficits - difficulty with expression of positive emotions 5. Task Performance - apraxia common; difficulty planning and sequencing - ideational - ideomotor 6. Deficits of either hemisphere depending on lesion location - visual field deficit (homonymous hemianopsia) - emotional abnormalities: lability, apathy, irritability, low frustration levels, anxiety, depression - cognitive: confusion, short attention span loss of memory, executive functions

Characteristics of Parkinsons

- rigidity (lead pip or cogwheel) - bradykinesia (hypokinesia) - resting tremor - impaired postural reflexes slowly progressive with emergence of secondary impairments and permanent dysfunction

Sciatic N

- sacral plexus - L2, L3, L4, S1, S2, S3 - piriformis syndrome - hamstrings and portion of adductor Magnus - trouble with knee flexion

Tibial/ Posterior Tibial N

- sacral plexus - L4-S3 - PF/ calf muscles - tarsal tunnel syndrome

Cervical Traction 1. Acute Phase/ for what 2. Tx Time 3. Duty Cycle + static traction for who 4. lbs 5. % BW

- seated or supine - cervical halter - cervical gliding device Acute Phase - disc protrusion - elongation of soft tissue - muscle spasm - 10-15lbs - 7&-10% BW - 20-30lbs 5-10 mins for acute and disc protrusion - 15-30 mins for other Duty Cycle static traction is recommend for disc protrusions or when sx are aggravated by motion - 3:1 hold/rest ratio is recommended - ratio 1:1 is recommended when mobility is desired

Interventions and Goals CP

- static positioning, dynamic patterns of movements opposite to habitual abnormal spastic patterns - facilitate symmetry in postures - elongate spastic HS and heel cords - serial casting to increase length or muscle and decrease tone - maximize the gross motor function level - weight bearing and postural challenge to increase muscle tone and strength - orthosis if necessary - AFO rigid or with articulated ankle - submalleolarorthosis for forefoot and mid food alignment (pronated foot) adaptive equipment - seating maintain head din neutral - trunk up right - hips and knees and ankles 90 degrees flexion - hips in ABD if spastic ADD - WC seat may be posterior to decrease extensor tone and maintain hip flexion - parapodium to promote WB through LE and encuraouge bone mineralization - min 5 hours week WB - sidling to decrease effect or TLR - collator walker often use - posterior rollatort to maintain upright position and arm position to decrease extensor tone

Digitalis

- strengthens the contraction of the heart muscle - slows the heart rate - helps eliminate fluid from body tissues

Exercise with MS 1. What exercises should you promote? 2. Aggressive trunk ROM why?

- stretching - ROM exercises (counteract the affects of spasticity) - Tai Chi for relaxation and balance training *Stretching and ROM should be performed daily** - hold at end range for 30-60s - minimum of 2 reps - use of orthotics or dynamic splinting to reverse contractors - aggressive trunk ROM to allow for full function of the core musculature especially quadrates lumborum biofeedback of pelvic floor muscles to combat urgency, improve incontinence and improve quality of life - Aerobic exercise - energy effectiveness strategies to lessen fatigue

Basal Ganglia Function

- substantia nigra - sub thalamic nucleus - complex aspects of movement - postural control - initiation and regulation of gross intentional movement - planning and execution of complex motor responses - facilitating motor response while selectively inhibiting others - automatic movements - postural adjustments - maintain background muscle tone - influence both perceptual and cognition functions (some) somatotropin organization - PMC - supplementary motor area - pre motor area - somatosensory cortex ** indirect and mediated by descending projections form cortical motor areas**

Rearfoot Varus

- subtler varus - calcaneal varus - abnormal mechanical alignment of tibia - shortened rear foot soft tissues or malunion of calcaneous - rigid inversion of calcaneous when subtler joint is in neutral position

Clinical Presentation Lymphedema

- swelling distal to or adjacent to the area where lymph system function has been impaired - swelling usually not relieved by elevation - pitting edema in the early stages, non pitting edema in later states as fibrotic changes occur - feelings of fatigue, heaviness, pressure or tightness in the affected region -numbness and tingling as swelling becomes more severe - discomfort varying from mild to intense - fibrotic changes of the dermis - dermal abnormalities such as cysts, fistulas, lymphorphea, papillomas, hyperkeratosis - increased susceptibility to infection at first local to the affected region but often becoming systemic - loss of mobility and ROM - impaired wound healing

Cancer Pain and Red Flags

- sympathetic signs such as HTN, tachypnea, nausea, vomiting, tachycardia - nerve root compression - cancer related fatigue most common sx - lung, breast, prostate, thyroid and lymphatic cancers commonly metastasize to bone fractures may result or muscle spasm - Cushing syndrome can result form small cell cancer of lung - paraneoplastic syndrome is when signs and sx reproduced at a site distant from the tumor

RA

- systemic autoimmune disorder of unknown etiology. - presents with a chronic inflammatory reaction in synovial tissues of a joint that results in erosion of cartilage and supporting structures within the capsule. - symmetrical pattern - hands, wrist, elbows, shoulders, knees, ankle, feet - MCP and PIP joints affected - DIP joints are spared - ulnar drift - swan neck deformity - boutineere deformity - bouchards nodes (Excessive bone formation on dorsal aspects of PIP joints) - women 2-x than men - DMARDS, NSAIDS, CORTICOSTEROIDS - DX: plain film to show symmetrical involvement of joints, lab testing, positive findings include 1. elevated WBC 2. elevated erythrocyte sedimentation rate 3. elevated rheumatoid factor 4. HCT and HbG show anemia juvinelle - prior to age 16 - 75% make full recovery

Drugs that relieve pain (opiates) antihistamine blockers severe analgesics

- talwin - strudel antihistamine blockers - diphenhydramine severe analgesics - narcotics - codeine - fentanyl - hydrocodone - loratab - hydromorphene - meperidine - methadone

PT Goals With Parkinsons

- teach compensatory strategies to initiate movement and unlock freezing episodes (repetitive auditory stimulation/music) Improve strength, emphasis on improving overall mobility, rotational patterns consider PNF patterns and rhythmic invitation technique teach relaxation skills improve postural control, symmetry, balance, teach compensatory strategies for safety improve gait, locomotortraining promote independence in FMS and ADL's improve cardiovascular endurance teach energy conservation techniques, activity packing

Clinical Presentation of Pressure Injuries

- the first clinical sign is blanch able erythema along with increased skin temperature - progression to a superficial abrasion, blister, shallow crater indicates involvement of dermis - full thickness skin loss is apparent the ulcer appears as a deep crater. bleeding is minimal

Sway Back Deformity 1. What is weak and elongated? 2. What is tight and short?

- thoracolumbar spine exhibits a kyphosis - entire pelvis shifted anteriorly - hips moved into extension 1. What is weak and elongated? - hip flexors - lower abdominals - lower thoracic extensors 2. What is tight and short? - hip extensors - hamstrings - lower lumbar extensors - upper abdominals

Tibial covers what part of sole of foot how about sural?

- tibial medial - sural lateral

Lymphedema 1. sensation 2. ROM 3. infection

- tingling, mild aching, numbness heaviness in the limb - decreased in fingers and wrist or toes and ankle or even in more proximal joints leading to decreased fx mobility of involved segments cellulitis is common

Reverse Tredelenburg is good for what?

- to decrease HTN - facilitate movement of diaphragm by using gravity to decrease weight to abdominal contents

Acute TMJ Disorder

- traumatic origin - direct blow - sudden locking of jaw cause by internal derangement - demonstrates capsular pattern of restriction decrease ipsilateral opening and lateral deviation to the involved side - with pain and tenderness to the same side POLICE - protection, optimal loading, ice, compression, elevation - NSAID, corticosteroids, muscle relaxants analgesis NSAIDS only when pain is the result of inflammatory process such as synovitis or myositis gentle and pain free exercises should be performed every hour to help stimulate mechanoreceptors and modulate pain and improve vascularization - at least 6mm of change has been detectable difference when doing more than one measurement or to determine the affect of treatment following exercises 10x each at a frequency of 3x per day

Phase 1 of cardiac rehabilitation

- usually less than 1 week for uncomplicated cardiac MI - therapist interview patient and assesses tolerance to physical therapy and begins low load activities if medically stable - therapist monitors pulse rate and BP - self-care ADLS REQUIRES 5 METS - selective arm and legs active ROM exercises - very light weights - independent transfers - bedside sitting with progression to supervised ambulation and stairs at discharge - progress from 2-3 METS, initially 3-5 METS by discharge from hospital - exercise 2-3 times a day - ETT may be used to determine functional capacity prior to discharge

Metatarsalphalangeal joint II-V capsular pattern

- variable - more towards flexion

Bishops Hand or Benediction Hand Deformity (Duchene's Sign)

- wasting of hypothenar muscles of hand - interossei + 2 medial lumbricals - result of ulnar N palsy - hyperextension of MCP joint + flexion of IP joints

Clinical Signs and Symptoms of Edema

- weight gain - excess fluid - dependent edema (collection of fluid in lower parts of body) - pitting edema - increased BP - neck vein engorgement - effusion (pulmonary, pericardial, peritoneal - CHF

What is ejection fraction?

-Proportion of end diastolic volume ejected from left ventricle during systole Normal values: 56-78%

Bilateral Vestibular Hypofunction

-Secondary to meningitis, ototoxic drugs, ect -reduction/loss of vestibular function bilaterally Goals - improved stability of gaze during head movement - reduced subjective complaints of gaze stability - demonstrate improved static and dynamic balance Primary Complaints - gaze stability during head motion - disequilibrium - gait ataxia Exercise - Gaze X1, X2 -(pHOTO) - balance exercises - walking program - can last as long as 2 years - exercise in pool - tai chi - limit walking in the dark and night driving habituation exercises do not work for these patients

Zones of Partial Preservation

-Segments partially innervated caudal to the neurological level. -Term used ONLY with complete injuries. -No sacral sparing

Trigeminal N

-V: THREE BRANCHES - missed afferent and efferent **muscles of mastication** - sensation from face - sensation from cornea - sensation from anterior tongue - muscles of mastication - dampens should (tensor tympani)

Potassium 1. Function 2. Normal Levels 3. Hypokalemia 4. Hyperkalemia

-assists in controlling cardiac rate and rhythm -helps in conduction of nerve impulses -skeletal muscle contraction -function of smooth muscle -kidney is primary regulator -sources of K+ from dietary fiber 2. Normal Levels 3.5-5.5 3. Hypokalemia - excessive loss due to diarrhea, vomiting, metabolic acidosis or alkalosis, renal tubular disease - muscle weakness, aches, fatigue, cardia arrhythmias, abdominal distention, nausea, vomiting 4. Hyperkalemia - inadequate secretion with acute renal failure, kidney disease, metabolic acidosis, diabetic ketoacidosis, sickle cell anemia, SLE - symptomless unless very high levels - observe for muscle weakness, arrhythmias, ECG changes TALL T WAVE, prolonged PR interval and QRS duration

Equinus

-from congenital bone deformity, neurological disorder(CP) - contracture of gastroc or soles - trauma -plantar flexed foot - compensation secondary to limited DF includes subtalar or mid tarsal pronation -Tx: flexibility exercise, joint mobilization, orthotic management, strengthen intrinsic muscles

Galveston Orientation and Amnesia Test (GOAT)

-measure of posttraumatic amnesia (PTA) -valid predictor of long-term outcome -series of standardized questions related to orientation and ability to recall events prior to and after the injury -Scores 76-100 are normal -Scores below 76 have PTA predictions functional indolence, employment, good overall recovery and indolence living 1 year after injury

Treatment for Forward Head

-retaining of muscles - contract lengthened muscles - stretch shortened muscles EXERCISE - deep cervical flexor - shoulder retraction strengthening - cervical extensor and pectoral muscle stretching - scapular strengthening and neck strength for those with TMJ disorder SAMPLE - head nods - resisted shoulder retractions using a theraband progressed to shoulder retraction in prone using weights - pec minor stretches - exercises to retrain the occulomotor system

Modified Ashworth Scale

0 No increase in muscle tone 1 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension 1+ Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM 2 More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved 3 Considerable increase in muscle tone, passive movement difficult 4 Affected part(s) rigid in flexion or extension

Angina Scale

0= no angina 1+ light, barely noticeable 2+ moderate, bothersome 3+ severe, very uncomfortable, preinfarction pain 4+ most severe pain ever experienced infarction pain

Dyspnea scale

0= no dyspnea +1: Mild, noticeable +2: Mild, some difficulty +3: Moderate difficulty but can continue +4: Severe difficulty, cannot continue

Methods of Debridement 1 Autolytic 2. Enzymatic 3. Mechanical 4. Sharp 5. Surgical 6. Kilohertz US 7. Biological

1 Autolytic - selective - natural debridement - use for those on anticoagulants - those who cant tolerate other forms of debridement - all necrotic wounds in those who are medically stable - DO NOT USE ON INFECTED WOUNDS, IMMUNOCOMPROMISED, GANGRENE OR DRY ISCHEMIC WOUNDS 2. Enzymatic - chemical debridement - applying topical preparation of collagenolytic enzymes to tissues - use for all mist necrotic wounds - eschar after cross hatching - homebound individuals - who cannot tolerate surgical debridement - DO NOT use on ischemic wounds unless adequate vascular status has been determined - dry gangrene - clean granulated wounds 3. Mechanical - non selective // may remove healthy tissue - removes foreign material and devitalized or contaminated tissue by physical forces - wet to dry gauze dressings, dextranomers, pulsatile lavage with suction - for wounds with moist necrotic tissue or foreign material present - DO NOT use on clean granulated wounds 4. Sharp - selective - uses sterile instruments - removes only necrotic wound tissue - without anesthesia and with little or no bleeding - scoring and/or excision of leathery eschar - excision of moist necrotic tissue - AVOID ON clean wounds, advancing cellulitis with sepsis, when infection threatens an individuals life, anticoagulant therapy or has coagulopathy 5. Surgical - for deep stage III or IV or complicated pressure ulcer - most efficient method of debridement - selective - performed by physical or surgeon using sterile instruments - one time procedure - may require anesthesia for advanced cellulitis with sepsis, immunocompromised individuals, when infection threatens the individuals life, clean wounds as a preliminary procedure to surgical wound closure line, granulation nd scar tissue may be excised - DO NOT with cardiac disease, pulmonary disease or diabetes - severe spasticity - cannot tolerate surgery - short life expectancy - quality of life cannot be improved 6. Kilohertz US - lon g wave low frequency US - typically operates between 20 and 50 KHz - selective - autoclaving of contact probe is usually required - selective removal of necrotic tissue desired - reduces bioburden - increases angiogenesis - wound bed preparation for grafting or flap closure - DO NOT use with vascular abnormalities, DVT, emboli, advanced PVD, irradiated areas, tumors, organs or electrical devices - PRECAUTIONS over nerves, infections, anesthetic areas 7. Biological - RARELY USED - use of maggots to deride nonviable tissue - produce enzymes and phagocytize necrotic tissue and bacteria - MRSA, strep, pseudomonas - may stimulate granulation formation and epithelization - individuals who cannot tolerate other forms of debridement - all non-healing necrotic wounds in people who are medically stables - psychological stress arises from having living creates in wounds - reports pain increasing

Graded Exercise Test Termination Criteria

1) max SOB 2) a fall in PaO2 of > 20 mmHg or a PaO2 < 55 mmHg 3) a rise in PaCO2 of > 10 mmHg or a PaCO2 > 65 mmHg 4) cardiac ischemia or arrhythmias 5) symptoms of fatigue 6) increase in diastolic BP of 20 mmHg, systolic HTN > 250 mmHg, decrease in BP with increasing workloads 7) leg pain 8) total fatigue 9) signs of insufficient cardiac output 10) reaching a ventilatory maximum

Pitting Edema Scale

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

Compression Therapy MLD 1. what compression for phase 1? 2. what for phase 2? 3. what is not recommended?

1. low-stretch bandages - low resting pressure - high working pressure - can wear during the day and at night **suggested to be applied at all times except for bathing** 2. - use compression garment instead of low stretch bandages. - compression garment has a high resting pressure and low working pressure - use of garment is not recommended during long periods of inactivity * wear low stretch bandage at night* 3. high-stretch sport bandages such as ACE wraps are not recommended for treating lymphedema bandages are used for continued limb reduction and a garment keeps the size of extremity stable

Muscle strength outcome test (3)

1. 5 times sit to stand 2. TUG 3. 30s chair rise

Normal Adult Values 1. PaO2 2. PaCO2 3. pH 4. Tidal volume

1. 80-100 mmHg 2. 35-45 mmHg 3. 7.35-7.45 4. 500ml

Pancreas 1. Acute Pancreatitis 2. Chronic Pancreatitis

1. Acute Pancreatitis - caused by gallstones, alcoholism, substance abuse - acute "band-like" pain which can radiate to the back and is worse in supine position - may be accompanied by hypotension, tachycardia, nausea, vomiting - intervention is IV fluids, pain control, NPA and occasionally surgery 2. Chronic Pancreatitis - epigastric and lower quadrant pain - anorexia, nausea, vomiting, constipation, flatulence, weight loss, steatorrhea (greasy stools) - intervention consisted of dietary modification, pain control, supplemental pancreatic enzymes

Types of Grafts 1. Allograft (Homograft) 2. Xenograft (Heterograft) 3. Biosynthetic Graft 4. Cultured Skin 5. Autograft 6. Split Thickness Graft 7. Full Thickness Graft

1. Allograft (Homograft) use of other human skin - temporarily for large burns - used until autograft is available 2. Xenograft (Heterograft) use of skin from other species - pigskin, temporary 3. Biosynthetic Graft combination of collagen and synthetics 4. Cultured Skin laboratory grown from patients own skin 5. Autograft use of patients own skin 6. Split Thickness Graft contains epidermis and upper layers of dermis from donor site. 7. Full Thickness Graft contains epidermis and dermis from donor site

Positioning for Anti-Contracture for Burns 1. Anterior Neck 2. Shoulder 3. Elbow 4. Hand 5. Hip 6. Knee 7. Ankle

1. Anterior Neck common deformity is flexion - stress hyperextension - position with firm plastic cervial orthosis 2. Shoulder common deformity is ADD and IR - stress ABD, FL, EX - position with axillary (airplane splint) 3. Elbow common deformity is flexion and pronation - stress extension and supination - position in extension with posterior arm splint 4. Hand common deformity is claw hand - stress wrist extension (15) - MP flexion (70) - PIP and DIP extension - CMC abduction - intrinsic plus position with resting hand splint 5. Hip common deformity is flexion and adduction - stress hip extension, abduction - position in EXT, ABD, neutral rotation 6. Knee common deformity is flexion - stress EXT - position in extension with posterior knee splint 7. Ankle common deformity is PF - stress DF - position with foot-ankle in neutral with splint or plastic ankle foot orthosis

1. Anti HTN Medication (1) 2. First line Diuretic (1) and side effects

1. Anti HTN Medication **Hydrochlorothiazide **Lasix - decreases the preload and afterload and reduces work load of the heart 2. First line Diuretic Furosemide dizzy, lightheaded, orthostatic hypotension, dehydration, dry mouth, thirst, muscle cramp/weakness upset stomach, ringing in ears, hearing loss, loss of appetite thiazides:hypokalemia, hypercalemia, hyponatremis, increase in LDL levels, hyperurecemia look diuresitcs: hyperurecemia, hypocalcemia, hypokalemia

Upper Limb Prosthetics 1. Below Elbow 2. Above Elbow 3. Conventional System 4. Externally Powered System

1. Below Elbow - terminal device - wrist and forearm socket - harness system 2. Above Elbow - contains elbow and arm socket 3. Conventional System - power of opening hook or hand is transmitted by a cable from a figure 8 shoulder harness - rubber bands are used for closure and prehensile strength - forearm rotation done by manual prepositioning of the TD movement control - Below elbow bilateral scapular abduction or ipsilateral flexion of the humerus is used to pull on the cable and force opening of the hook - above elbow (dual control) same motions can be used to flex the elbow in the AE prosthesis - when the elbow locks by scapular depression and humeral extension - forces then transmitted to operate TD 4. Externally Powered System - microswitches (MYOELECTRIC DEVICES) are activated by same motions of as conventional power systems Small electric motors:battery powered are activated to operate the TS - improves ease of function, prehensile strength - adds weight, increased maintenance cost

Transfemoral Amputation Gait Deviations 1. Circumduction 2. Abducted Gait 3. Vaulting 4. Lateral Trunk Bending During Stance 5. Forward Flexion During Stance 6. Lumbar Lordosis During Stance 7. High Heel Rise 8. Terminal Swing Impact 9. Swing Phase Whips 10. Foot Rotation at Heel Strike 11. Foot Slap 12. Uneven Step Length

1. Circumduction: prosthesis swings out to the side in an arc - long prosthesis - locked knee - small or loose socket - inadequate suspension - floot plantar flexed - abduction contracture - poor knee control 2. Abducted Gait - prosthesis laterally displaced to the side - crotch or medial wall discomfort - long prosthesis - low lateral wall or alignment - tight hip abductors 3. Vaulting: rises onto sound limb to swing the prosthesis through - prosthesis too long - inadequate suspension - socket too small - prosthetic foot set in too much PF - too little knee flexion 4. Lateral Trunk Bending During Stance - BENDS TOWARD PROSTHETIC SIDE - low lateral wall - short prosthesis - high medial wall - weak abductors - abductor contracture - hip pain - short amputation limb 5. Forward Flexion During Stance - trunk bends forward - unstable knee unit - short ambulatory aids - hip flexion contracture 6. Lumbar Lordosis During Stance - exaggeration of the lumbar curve - insufficient support from anterior or posterior walls - painful ischial WB - hip flexion contracture - weak hip extensors or ABD 7. High Heel Rise - during swing the heel raises excessively - inadequate knee friction - too little tension in extension aide 8. Terminal Swing Impact - prosthesis comes to a sudden stop as the knee extends during late swing - insufficient knee friction or too much tension in extension aid - patient fears the knee will buckle - forceful hip flexion 9. Swing Phase Whips - at toe off the heel moves either medially or laterally - socket is rotated - knee bolt is rotated - foot is maligned 10. Foot Rotation at Heel Strike -as the heel contracts the ground the foot rotates laterally sometimes with vibratory motion - foot is maligned - stiff heel cushion - PF bumper 11. Foot Slap - excessive PF at the heel strike - heel cushion or PF number too soft 12. Uneven Step Length - patient favors sound limb and limits WB time on the prosthetic limb - socket discomfort - poor alignment - hip flexion contracture - hip instability

Spasticity 1. Clasp-Knife Response 2. Clonus 3. Babinski

1. Clasp-Knife Response marked resistance to PROM suddenly gives way 2. Clonus maintained stretch stimulus produces a cyclical, spasmodic contraction; common in PF, wrist FL, jaw 3. Babinski DF of great toe with fanning of other toes in response to stroking up the lateral side of the sole of the foot indicative of cortiospinal (pyramidal) tract disruption

Contact Precautions 1. Clinical Syndromes 2. Room Assignment 3. Mask? 4. Gown? 5. Gloves?

1. Clinical Syndromes - MRSA - VISA - VRE - C-DIFF - LICE - SCABIES - IMPETIGO - gram negatives 2. Room Assignment - private room - or patient with same infection - dedicated equipment in room 3. Mask? no 4. Gown? yes, with direct contact with patient, surfaces or items in room 5. Gloves? yes

Airborne plus Contact Precautions 1. Clinical Syndromes 2. Room Assignment 3. Mask? 4. Gown? 5. Gloves?

1. Clinical Syndromes - chickenpox - disseminated herpes zoster in immunocompromised hosts - small pox 2. Room Assignment private room with negative airflow - keep door closed 3. Mask? yes dust/mist mask 4. Gown? yes 5. Gloves? yes

Airborne Precautions 1. Clinical Syndromes 2. Room Assignment 3. Mask? 4. Gown? 5. Gloves?

1. Clinical Syndromes - measles - tuberculosis 2. Room Assignment private room with negative airflow - keep door closed - N-95 respirator 3. Mask? yes, dust/mist mask 4. Gown? no 5. Gloves? no

Droplet Precautions 1. Clinical Syndromes 2. Room Assignment 3. Mask? 4. Gown? 5. Gloves?

1. Clinical Syndromes - mumps - strep A - neisseria meningitis 2. Room Assignment - private room 3. Mask? yes, when working within 3 feet of patient 4. Gown? no 5. Gloves? no

Recovery States From Diffuse Axonal Injury 1. Coma 2. Unresponsive Vigilance/Vegetative State 3. Mute Responsiveness/Minimally Responsive 4. Confusional State 5. Emerging Independence 6. Intellectual/Social Competence

1. Coma - state of unconsciousness in which there is neither arousal, nor awareness, eyes remain closed, no sleep wake cycles 2. Unresponsive Vigilance/Vegetative State - return of sleep wake cycles - normalization of vegetative functions: respiration, digestion, BP control - persistent vegetative state is determined if patient remains in vegetative state >1 year after TBI 3. Mute Responsiveness/Minimally Responsive - in which patient is not vegetative and does show signs, even if intermittent or fluctuating awareness 4. Confusional State - disturbance of attention mechanism - all cognitive operations are effected - patient is unable to form new memories - hyperarousal or hypoarousal 5. Emerging Independence - confusion is clearing and some memory is possible - significant cognitive problems and limited insight remain - frequently inhabited social behaviors 6. Intellectual/Social Competence - increasing independence - cognitive difficulties and problem solving/reasoning persis along with behavioral and social problems (enhancement of premorbid train and mood swings **patient can plateau at any stage or regress under conditions of stress or repetitive brain injury**

Types of Fractures

1. Comminuted: the bone is crushed and/or shattered. 2. Compression: the fractured area of the bone collapses on itself. 3. Colles: the break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his/her fall. 4. Complicated: the bone is broken and pierces an internal organ. 5. Impacted: the bone is broken and the ends are driven into each other. 6. Hairline: a minor fracture appears as a thin line on an x-ray and may not extend completely through the bone. 7. Greenstick: the bone is partially bent and partially broken; common in children because the bones are still soft. 8. Pathologic: any fracture occurring spontaneously as a result of disease. 9. Salter-Harris: a fracture of the epiphyseal plate in children. 10. Sprain: traumatic injury to a joint involving the soft tissue. Includes muscles, tendons, and ligaments. Usually as a result of overuse or overstretching.

Types of Feedback 1. Concurrent 2. Terminal 3. Immediate 4. Delayed 5. Summary 6. Faded 7. Bandwidth- KR Feedback 8. Blocked Feedback 9. Variable (random) feedback 10. Augmented Feedback

1. Concurrent - feedback is presented during the movement 2. Terminal feedback given after the movement 3. Immediate feedback presented immediately after the movement 4. Delayed feedback given after a brief delay allows the learner a brief time for introspection and self-assessment (3 second delay) - feedback after long delays is contraindicated - degrades learning 5. Summary feedback given after a set of number of trials (every 5th, 10th, 17th) 6. Faded feedback given first after every trial, then less frequent (every 1st trail, then every 3rd trial, then every 5th trial) 7. Bandwidth- KR Feedback only when performance deviates outside the boundaries of correct performance - error range is predetermined 8. Blocked Feedback one source of feedback is provided 9. Variable (random) feedback multiple sources of feedback is provided 10. Augmented Feedback verbal cueing

Heat Transmission 1. Conduction 2. Convection 3. Radiation

1. Conduction heat transfer from a warmer object to a cooler object by means of direct interaction of objects in physical contact - EX: hot packs, paraffin 2. Convection heat transfer by movement of air or fluid from a warmer area to a cooler area or moving past a cooler body part - EX: whirlpool, fluidotherapy 3. Radiation transfer of heat from a warmer object to a cooler object by means of transmission of electromagnetic energy without heating of a intervening medium - inferred waves absorbed by cooler body EX: infrared lamp

Pelvic Floor Exercises 1. Contraindicated for who (3) 2. What types of contractions?

1. Contraindicated for who (3) - catheter in place - recent surgery - excessive pelvic pain 2. What two types of contractions? tighten pelvic floor muscles: imagine sitting on a toilet and peeing. then imagine stopping the flow of urine midstream. hold for 5-10 seconds, relax for 10 seconds - repeat 5 times to start and progress to 10x 3x a day - can find these muscles by briefly stopping the flow of urine midstream when urinating - stopping and starting urine while emptying the bladder is not part of Kegel exercises and can be harmful and interfere with urinary reflexes and contribute to bladder infection postural education and musereeducation, pelvic mobilization and stretching of the tight LE muscles

Skin Trauma 1. Contusion 2. Ecchymosis 3. Petechial 4. Abrasion 5. Laceration

1. Contusion a bruise - skin is not broken - pain, swelling, discoloration - cold may limit effects 2. Ecchymosis bluish discoloration of skin caused by extravasation of blood into the subcutaneous tissues - result of trauma to underlying blood vessels or fragile vessel walls 3. Petechial tiny red or purple hemorrhagic spots on the skin 4. Abrasion scraping away of skin due to injury or mechanical abrasion 5. Laceration an irregular tear of skin that produces a torn jagged wound

Spinal Trunk Orthosis 1. Corset 2. Lumbosacral Orthosis (LSO) 3. Plastic Lumbosacral Jacket 4. Thoracolumbarsacral Orthosis (TLSO) 5. Taylor Brace 5. Jewitt 6. Soft Collar 7. Four Posterior Orthosis 8. Halo Orthosis 9. Minerva Orthosis 10. Milwaukee Orthosis 11. Boston Orthosis

1. Corset - provides abdominal compression - increased intrabdominal pressure - assists in respiration in individuals with SCI - pregnancy support 2. Lumbosacral Orthosis (LSO) - controls or limits lumbosacral motions - fl/ext/lateral control - includes pelvic and thoracic bands to anchor the orthosis with two posterior uprights, two lateral uprights and an anterior corset 3. Plastic Lumbosacral Jacket - provides maximum support by spreading forces over a large area - more cosmetic - hotter 4. Thoracolumbarsacral Orthosis (TLSO) - controls or limits thoracic and lumbosacral motions 5. Taylor Brace - FL/EXT control orthosis 5. Jewitt - limits flexion but encourages hyperextension (lordosis) - used for compression fractures of the spine 6. Soft Collar provides minimal levels of control of cervical motions (cervical pain, whip lash) 7. Four Posterior Orthosis - 2 places occipital and thoracic with two anterior and two posterior post to stabilizee the head - used for moderate levels of control in individuals with cervical fracture/spinal cord injury 8. Halo Orthosis - attaches to the skull with screws - halo to thoracic band or plastic jacket - patients with cervical fracture/spinal cord injury - allows for early mobilization out of bed and functional training 9. Minerva Orthosis rigid plastic appliance that provides maximum control of cervical motion - uses a forehead band without screws 10. Milwaukee Orthosis - cervical, thoracic, lumbosacral orthosis - used to control scoliosis - kyphotic or scoliotic cures 40 degrees 11. Boston Orthosis - low specific molded plastic orthosis for scoliosis - can be warn Unser clothing - for mid thoracic or lower scoliosis curves of 40 degrees - used to treat spondylolisthesis and conditions of trunk weakness, muscular dystrophy

Types of Pain. Match with the Structure 1. Cramping, dull, aching 2. Sharp, shooting 3. Sharp, bright, lightning-like 4. Burning, pressure-like, stinging, aching 5. Deep, nagging, dull 6. Sharp, severe, intolerable 7. Throbbing, diffuse

1. Cramping, dull, aching - Muscle 2. Sharp, shooting - Nerve root 3. Sharp, bright, lightning-like - Nerve 4. Burning, pressure-like, stinging, aching - Sympathetic Nerve 5. Deep, nagging, dull - Bone 6. Sharp, severe, intolerable - Fracture 7. Throbbing, diffuse - Vasculature

acquired immunodeficiency syndrome (AIDS) 1. Diagnosis 2. Symptoms

1. Diagnosis - CD4 count drops below 200 or if they develop certain opportunistic illness - high viral load and very infections - ARC (Aids related complex) presence of acute symptoms secondary to immune system deficiency 2. Symptoms some have all or some of symptoms of HIV along with a general failure to thrive - reconditioning, anxiety, depression

Pain referral Patterns 1. Diaphragm 2. Heart 3. Gallbladder

1. Diaphragm - upper trap 2. Heart - L axilla and L pectoral region 3. Gallbladder - tip of shoulder and scapular region

Sacroiliac Dysfunction 1. Due to what? 2. What are symptoms? 3. Physical therapy interventions? / what will aggravate it

1. Due to what? - postural changes - ligamentous laxity 2. What are symptoms? - posterior pelvic pain - pain in buttocks - can radiate into posterior thigh or knee - associated with prolonged sitting, standing or walking 3. Physical therapy interventions? - external stabilization, support belt may help reduce pain - avoid single limb weight bearing, may aggravate

Clinical Signs and Symptoms of Fluid Loss 1. Early Signs 2. As it worsens signs

1. Early Signs - thirst - weight loss 2. As it worsens signs - poor skin tumor - dryness of the mouth, throat, face - absence of sweat - increased body temperature - low urine output - postural hypotension - dizziness when standing - confusion - increased hematocrit

Post- Operative Dressings For Amputation 1. Elastic Wraps 2. Stump Shrinkers 3. Semirigid Dressings 4. Rigid Dressings

1. Elastic Wraps - flexible, soft bandaging - inexpensive - requires frequent application with pressure greatest distal to proximal - if loosen, may have problems with edema control - avoid circular wrapping 2. Stump Shrinkers - flexible, soft, inexpensive - readily available in different sizes 3. Semirigid Dressings - unna paste - applied in operating room - zinc oxide, gelatin, glycerin, calamine 4. Rigid Dressings - applied in operating room - component of immediate post-op fitting - allows for edema reduction and early ambulation with temporary prothesis (pylon and foot) - good for young patients who are a good candidate for permanent prosthesis

Brachial Plexus Injury 1. Erbs Paralysis 2. Klumpkes Paralysis 3. Erb-Klumbkes Paralysis

1. Erbs Paralysis involves C5-C6 upper arm paralysis "waiters tip deformity" 2. Klumpkes Paralysis involves C8-T1 lower arm paralysis 3. Erb-Klumbkes Paralysis total arm paralysis

Venous Ulcer 1. Etiology 2. Clinical Features 3. Examination 4. Compression indicted for ABI < what and what else?

1. Etiology - CVI - valvular incompetence - history of DVT - venous HTN - calf muscle pump failure - arterial insufficiency can co-exist 2. Clinical Features - medial malleolus - normal pulses - aching in dependent position - color is normal, cyanotic in dependent position, dark pigmentation - liposclerosis (thick, tender, indurated, fibrotic tissue) - edema present - pigmentation, statsis dematitis, thickening of skin as scarring develops - wet with large amounts of exudate Examination : DVT assessment - score of 3 or higher is DVT - ultrasonography - cuff test - humans sign COMPRESSION CONTRAINDICATED FOR ABI <7 OR ACTIVE DVT

Arterial Ulcer 1. Etiology 2. Clinical Features

1. Etiology - associated with chronic arterial insufficiency, arteriosclerosis obliterates, atheroembolsism, history of non healing trauma - small toes, feet, bony areas - pulses poor or absent - intermittent claudication - pain is often severe, intermittent, progressing to pain at rest, exacerbated with limb elevation - color is pale on elevation and dusky rumor on dependency - temperature is cool - trophic skin changes, shiny, thin, atrophic - loss of hair on foot and toes - nails thickened - ulceration of toes and feet can be deep - gangrene, black, skin adjacent to ulcer can develop 2. Clinical Features - pulses - ABI - temperature - Segmental BP >20mm Hg drop between segments is significant - capillary refill - TcPO2 - outcome measures (walking impairment questionnaire)

Diabetic Ulcer 1. Etiology 2. Clinical Features 3. Examination 4. What classification tool?

1. Etiology - diabetes is associated with arterial disease and peripheral neuropathy 2. Clinical Features - plantar aspect of foot - typically not painful - sensory loss usually present - absent ankle jerks with neuropathy - sepsis common - gangrene may develop 3. Examination - circulation - sensory integrity - monofilament testing 4. What classification tool? Wagner Classification System - Partial and Full Thickness scheme for Diabetic Foot Ulcer Classification - off load - casting - exercise - foot care guidelines

Transtibial Amputation Gait Deviations 1. Excessive Knee Flexion During Stance 2. Inadequate Knee Flexion During Stance 3. Lateral Thrust at Midstance 4. Medial Thrust at Midstance 5. Drop Off or Premature: Knee Flexion in Late Stance 6. Delayed Knee Flexion During Late Stance

1. Excessive Knee Flexion During Stance - socket too far forward or tilted anteriorly - PF bumper is too hard and limits PF - high heel shoes - knee flexion contracture - weak quads 2. Inadequate Knee Flexion During Stance - socket too far back or tilted posteriorly - PF number of heel cushion too soft - low heel shoes - anterodistal discomfort - weak quads 3. Lateral Thrust at Midstance - foot inset too much 4. Medial Thrust at Midstance - foot outset too much 5. Drop Off or Premature: Knee Flexion in Late Stance - socket is too far forward or excessively flexed - DF bumper too soft - resulting in excess DF of foot - prosthetic foot keel too short - knee flexion contracture 6. Delayed Knee Flexion During Late Stance - "like walking uphill" - socket is too far back or lacks sufficient flexion - DF bumper is too stiff causing excess PF - prosthetic foot too long

Gallbladder 1. Gallstones 2. Cholecystitis

1. Gallstones cholelithiasis or gallstones - often asymptomatic and no intervention needed - if gallstones block the common bile duct, biliary colic can result. - characterized by pain in the right upper quadrant with radiation to the right scapula - can worsen after a fatty meal 2. Cholecystitis partial or complete obstruction of the common of the common bile duct resulting in inflammation of the gallbladder - severe right upper quadrant pain radiating to the right scapula - nausea, vomiting, or low grade fever possible - positive Murphys sign: palpate near right subcostal margin as patient takes a deep breath. pain is elected - surgical or nonsurgical approaches are the options

Ultrasound 1. Goals and Indications 2. Precautions 3. Contraindications 4. Dont use for what?

1. Goals and Indications - modulate pain - increase CT extensibility - reduce or eliminate soft tissue inflammation - accelerate rate of tissue healing - reduce or eliminate muscle spasm 2. Precautions - acute inflammation - breast implants - open epiphyses and over healing fractures 3. Contraindications - impaired circulation - impaired cognitive function - impaired sensation - malignant tumors - over or near an area with thrombus - joint cement - directly over plastic components - over brain, ear, eye, heart, cervical ganglia, carotid sinus, reproductive organs, exposed or unprotected spinal cord, over or in the area of cardiac pacemakers or in the abdomen, low back, uterus, or pelvis during pregnancy 4. Dont use for what? DONT USE to reduce swelling, promote joint healing or achieve long term pain relief for musculoskeletal conditions

Joint Receptors 1. Golgi-Type Endings 2. Free Nerve Endings 3. Ruffini Endings 4. Paciniform Endings

1. Golgi-Type Endings - located in the ligaments - detect the rate of joint movement 2. Free Nerve Endings - found in joint capsule and ligaments - respond to pain and crude awareness or joint motion 3. Ruffini Endings - located in joint capsule and ligaments - responsible for the direction and velocity or joint movement 4. Paciniform Endings - found in joint capsule - monitor rapid joint movements

Rule of Nines Adult Patients 1. Head and Neck 2. Anterior Trunk 3. Posterior Trunk 4. Arms 5. Legs 6. Perineum

1. Head and Neck 9% 2. Anterior Trunk 18% 3. Posterior Trunk 18% 4. Arms 9% 5. Legs 18% 6. Perineum 1%

Viral Infections 1. Herpes 1 (Herpes Simplex) 2. Herpes 2 3. Herpes Zoster (Shingles) 4. Warts

1. Herpes 1 (Herpes Simplex) - itching, soreness followed by vesicular eruption of skin on the face or mouth - cold sore, fever or blister 2. Herpes 2 - common cause of vesicular genital eruption - spread by sexual contract - in newborns may cause meningoencephalitis - may be fatal 3. Herpes Zoster (Shingles) - caused by chickenpox - reaction of virus lying dormant in the cerebral ganglia or ganglia of posterior nerve roots - paina nd tinging affecting spinal or cranial nerve dermatome - fever, chills, malaise, GI disturbances - CN III involvement with eye pain, corneal damage, loss of vision - postherothetic neuralgic pain may be intermittent of constant lasting weeks, months, years - systemic corticosteroids for itching and pain - no curative agent 4. Warts - common benign infection by human papilloma viruses (HPV) - transmission is through direct contact - common on hands and fingers - plantar warts on point of feet - manage with cryotherapy, acids, over the counter medications

Range of Motion Requirements for Normal Gait 1. Hip Flexion 2. Hip Extension 3. Knee Flexion 4. Knee Extension 5. Ankle Dorsiflexion 6. Ankle Plantarflexion

1. Hip Flexion 0-30 2. Hip Extension 0-10 3. Knee Flexion 0-60 4. Knee Extension 0 5. Ankle Dorsiflexion 0-10 6. Ankle Plantarflexion 0-20

Glucose Monitoring Fasting Blood Glucose 1. Hypoglycemic 2. Normal Fasting Glucose 3. Impaired Glucose Tolerance (insulin resistance) 4. Diabetes Mellitus + Red Flag Values Glycosylated Hemoglobin (A1C) Normal Reference Range

1. Hypoglycemic <60 mg/dL for some individuals - a sudden drop in elevated glucose levels can result in symptoms of hypoglycemia for the individual with diabetes 2. Normal Fasting Glucose 60-110 ACSM= 60-99 3. Impaired Glucose Tolerance 100-125 (insulin resistance) 4. Diabetes Mellitus >/=126 - measured on 2 separate days Red Flag Values - <70 or >250 at the start of exercise >300-350 risk of diabetic ketoacidosis Glycosylated Hemoglobin (A1C) Normal Reference Range 4-6% maintain a consistent A1C level below 7%. those above 10% require immediate insulin therapy

Bacterial Infections 1. Impetigo 2. Cellulitis 3. Abscess

1. Impetigo - superficial skin infection caused by staph or strep - inflammation, small pus-filled vesicles, itching - contagious - common in children and the elderly 2. Cellulitis - inflammation of cellular or connective tissue or close to the skin - step and staph infection common - contagious - hot, red, edematous skin - manage with cool, wet dressings and elevation - if untreated lymphangitis gangrene, abscess and sepsis can occur - elderly and individuals with diabetes, wounds, malnutrition or on sterile therapy are at an increased risk 3. Abscess - a cavity containing pus and surrounded by inflamed tissue - result of localized infection - communal a staph infection - healing typically facilitated by draining or incising the abscess

Canes 1. Indications 2. Cane Measurements 3. What hand is it held in? 4. How do you ambulate with it

1. Indications - balance - provide limited stability and unweighting - can unload forces on extremities by 30% - can be used to relieve pain and antalgic gait 2. Cane Measurements - 20-30 of elbow flexion - measure from greater trochanter to a pint 6 inches to side of toe 3. What hand is it held in? opposite to the involved extremity 4. How do you ambulate with it - cane and involved extremity together - followed by uninvolved extremity

Crutches 1. Indications 2. Crutch measurement 3. Axillary Crutches 4. Forearm Loftstrang Crutchtes 5. Forearm Platform Crutches

1. Indications - increase base of support - provides moderate degree of stability - relieve weight bearing in LE 2. Crutch measurement - 20-30 degrees flexion - in standing subtract 16 inches from the patient height - measure 2 point inches below the axilla - 6 inches in front - 2 inches lateral 3. Axillary Crutches - may be difficult in small areas - UE WB over forearm crutches - prolonged leaning can cause vascular or nerve damage in axillary/radial N 4. Forearm Loftstrang Crutchtes - forearm cuff and hand grip - slightly less stability but increase ease of movement - frees hands 5. Forearm Platform Crutches - allow WB on forearm - for PT unable to WB through hands - can attach to walkers

Phases of Dermal Healing 1. Inflammatory Phase 2. Proliferation, Granulation, Fibrotic Phase - Fibroblasts - Myofibroblasts 3. Maturation Phase - hypertrophic scar - keloid scar - hypotrophic scar

1. Inflammatory Phase - redness, edema, warmth, pain, decreased ROM 3-5 days 2. Proliferation, Granulation, Fibrotic Phase 4 primary events - angiogenesis - granulation formation - wound contraction - epithelization 3. Fibroblasts synthesize collagen, elastic and glycosaminoglycans - type III collagen is initially deposited and replaced later with type 1 collagen and scar tissue 4. Myofibroblasts responsible for wound contraction in derma wounds 3. Maturation Phase - tissue remodels for up to 2 years - normal mature scar is soft, white and flat - 6-12 weeks scar is immature (bright pink) - hypertrophic scar may result which is a raised scar that stays within the boundaries or the burn wound and is raised, red, firm - Keloid scare can occur which is a raised scar that extends beyond the boundaries of the original burn wound and is red, raised and firm. more common in young women and those with dark skin - Hypotrophic scar: flat and depressed below surrounding skin

Medical Management of CP (Meds and Surgery)

1. Intrathecal baclofen - overdose can lead to COMA call EMS - GABA b-agonist an inhibitory CNS neurotransmitter - can deliver drug to intrathecal subarachnoid space in the spinal cord, producing muscle relation with less medication - if injected into spine it controls spasticity below tha segment - pump is implanted subcutaneous in abdomen with catheter to spinal cord - programming allow for precise dosage and easily adjusted 2. Peripheral Nerve Block injection of phenol/alcohol into peripheral nervous system from nerve root to motor end plate - last 3-6 months 3. Boxtox injections minute amounts of botox injected into muscle, paralyzing it for 4-6 months Surgery - neurectomy - anterior rhizotomy - selective dorsal rhotomy - crectomy - thalmotomy - deep brain stimulation Selective Dorsal Rhizotomy dorsal sensory nerve rootles are stimulated, those responding abnormally are severed - those responding abnormal are severed - 4-10 years of age usually done - decrease spasticity, improved motor control and not reversible - possible sensory loss, not reversible and its not affection for dystonia/anethesia risk (CONS) Muscle Transfers - muscle attachments move dot change direction of force in order to increase function and decrease spasticity. - most often hip ADD to ABD Osteotomies CUTTING OR MOVING OR REPOSITIONING BONE TO FACILITATE NORMAL ALIGNMENT, PREVENT SUBLUXATION AND DISCLOCATION - most often in LE (femoral, tibial, pelvic)

What are the 3 Deep sensations?

1. Joint Position Sense - test ability to perceive joint position at rest in response to your positioning the patients limb (up/down/in/out) 2. Kinethesia (movement sense) test ability to percieve movement in response to your moving the patient limb - patient can duplicate movement with opposite limb or give a verbal report 3. Vibration Sense (pallesthesia) test proprioceptive pathways by applying vibrating tuning for or pressure only (sham vibration) on bony areas.

Orthotic Gait Deviations 1. Lateral Trunk Bending 2. Circumduction 3. Anterior Trunk Bend 4. Posterior Trunk Bend 5. Hyperextended Knee 6. Knee Instability 7. Foot Slap 8. Toes First 9. Flat Foot 10. Pronation 11. Supination 12. Excessive Stance width

1. Lateral Trunk Bending - leans toward orthotic side during stance - causes: KAFO medial upright too high insufficient shoe lift, hip pain, weak or tight ABD on the orthotic side, short leg, poor balance 2. Circumduction - during swing - caused by lock knee, excessive PF, inadequate PF stop, PF contracture, weak hip FL or DF 3. Anterior Trunk Bend leans forward during stance - causes are inadequate knee lock, weak quads, hip or knee FL contracture 4. Posterior Trunk Bend - patient leans backwards during stance - caused by inadequate hip lock, weak glute max 5. Hyperextended Knee excessive extension during stance - caused by inadequate PF stop, inadequate knee lock, poor fit of calf band, weak quads, loose knee ligaments or extensor spasticity, pes equinus 6. Knee Instability excessive knee flexion during stance - causes inadequate DF stop, inadequate knee lock, knee and or hip flexion contracture, weak quadriceps, insufficient knee lock and knee pain 7. Foot Slap foot hits the ground during early stance - causes are inadequate DF assistance, inadequate PF stop, weak DF 8. Toes First on toes posture during stance - causes are inadequate DF assist, inadequate PF stop, inadequate heel lift, heel pain, extensor spasticity, yes equinus, short leg 9. Flat Foot contact with entire foot - causes inadequate longitudinal arch support, pec planes 10. Pronation excessive medial foor contract during stance, values position of calcaneus - cause transverse plane malalignment, weak investors, pes values, spasciticty, genu valgum 11. Supination excessive lateral foot contact during stance, varus position of the calcaneus - cause: transverse plane malalignment, weak evertors, pes varus, genu varum 12. Excessive Stance width patient stands or walks with a WBS. - causes KAFO height or medical upright too high - HFAKO HIP JOINT ALIGNED IN EXCESSIVE ABD, knee is locked, ABD contracture, poor balance, sound limb too short

Medical record review 1. positive CK-MB or troponin level indicate? 2. electrolytes including potassium, magnesium, calcium indicate? 3. CBC, HgB, HCT 4. BUN and creatinine 5. Elevated lipid values?

1. MI 2. ventricular arrhythmias 3. anemia 4. kidneys and liver function 5. CAD

Types of Practice 1. Massed 2. Distributed 3. Blocked 4. Random 5. Serial 6. Random order 7. Part/Whole 8. Transfer Training 9. Practice of Lead up Activities

1. Massed rest time is much less than the practice time 2. Distributed practice time is equal or less that the rest time 3. Blocked around one tasked, performed repeatedly - uninterrupted 4. Random ordered randomly across trials 5. Serial predictable and repeated order 123123123 6. Random order non repeating and unpredictable order of multiple tasks 123321231 7. Part/Whole part practiced before whole 8. Transfer Training the gain or loss in the capability of task performance as a result of practice or experience on some other test 9. Practice of Lead up Activities simpler task versions of the required complex task are practiced

Clinical Signs and Symptoms of Dehydration 1. Mild 2. Moderate 3. Severe 4. who is most at risk? 5. severe fluid volume deficit can cause what?

1. Mild - thirst - dry mouth - dry lips 2. Moderate - very dry mouth - cracked lips - poor skin tumor - postural hypotension - headache 3. Severe - - very dry mouth - cracked lips - poor skin tumor - postural hypotension - headache - rapid, weak pulse >100 at rest - rapid breathing - confusion, lethargy - irritability - cold hands and feel - unable to cry or urinate - postoperative - aging adult - athletes 5. vascular collapse and shock - burn or trauma patients at risk

Platelet Count 1. Normal Range 2. Exercise Recommendations - 50,000-150,000 - 30,000-50,000 - 20,000-30,000 - <20,000

1. Normal Range 150,000-450,00 2. Exercise Recommendations - 50,000-150,000 some limitations - 30,000-50,000 moderate exercise - 20,000-30,000 light exercise - <20,000 contraindicated - ROM - ADLs - walking with physician approval <10,000 - may experience spontaneous bleeding - SOB, excessive fatigue, possibly angina

White Blood Cells 1. Normal Range 2. Exercise Recommendations >5,000 <5,000 with fever <1000

1. Normal Range 4,800-10,800 2. Exercise Recommendations >5,000 light or regular exercise <5,000 with fever no exercise <1000 no exercise; protective mask required

Core Body Temperature 1. Oral 2. Rectal 3. Tympanic Membrane 4. below 95 degrees is a sign of what? 5. How does body temperature vary throughout the day?? and with lifespan?? 6. what temp indicates a systemic illness? 7. immunosuppressed may have an infection without what?

1. Oral 96.8-99.5 2. Rectal 97.3-100.2 3. Tympanic Membrane 97.2-100 4. hypothermia body temperature is lower in early morning and highest in late afternoon decreases with age due to lower metabolic rate - decreased subcutaneous fat - decreased activity levels - inadequate diet temperature of 100 or higher indicates a systemic illness 7. immunosuppressed may have an infection without elevation of temperature

What are the 3 superficial sensation?

1. Pain - test sharp/dull in response to sharp/dull stimuli with paper clip 2. Temperature - test hot/cold sensation in response to hot/cold stimuli with test tubes filled with hot or cold water 3. Touch - test touch/nontouch in response to slight touch stimulus (cotton ball) or no touch

Midstance 1. Pelvic Rotation 2. Hip: degree and Movement 3. Knee: degree and Movement 4. Ankle: degree and Movement 5. Toe: degree and Movement 6. What muscles are working?/not working?

1. Pelvic Rotation 0 2. Hip: degree and Movement 0 3. Knee: degree and Movement 0 4. Ankle: degree and Movement 5 degrees DF 5. Toe: degree and Movement 0 6. What muscles are working?/not working? - eccentric glute med - eccentric calf

Midswing 1. Pelvic Rotation 2. Hip: degree and Movement 3. Knee: degree and Movement 4. Ankle: degree and Movement 5. Toe: degree and Movement 6. What muscles are working?/not working?

1. Pelvic Rotation 0 2. Hip: degree and Movement 25 FL 3. Knee: degree and Movement 25 FL 4. Ankle: degree and Movement 0 5. Toe: degree and Movement 0 6. What muscles are working?/not working? - concentric iliopsoas - eccentric hamstings - concentric pre-tibial muscles

Initial Swing 1. Pelvic Rotation 2. Hip: degree and Movement 3. Knee: degree and Movement 4. Ankle: degree and Movement 5. Toe: degree and Movement 6. What muscles are working?/not working?

1. Pelvic Rotation 5 backward rotation 2. Hip: degree and Movement 15 flexion 3. Knee: degree and Movement 60 FL 4. Ankle: degree and Movement 10 PF 5. Toe: degree and Movement 0 6. What muscles are working?/not working? - eccentric HS - eccentric quads - concentric pretax muscles

Pre-swing 1. Pelvic Rotation 2. Hip: degree and Movement 3. Knee: degree and Movement 4. Ankle: degree and Movement 5. Toe: degree and Movement 6. What muscles are working?/not working?

1. Pelvic Rotation 5 degrees backward rotation 2. Hip: degree and Movement 0 3. Knee: degree and Movement 40 flexion 4. Ankle: degree and Movement 20 PF 5. Toe: degree and Movement 60 MTP EXT 6. What muscles are working?/not working? - eccentric quads - concentric calfs

Terminal Stance 1. Pelvic Rotation 2. Hip: degree and Movement 3. Knee: degree and Movement 4. Ankle: degree and Movement 5. Toe: degree and Movement 6. What muscles are working?/not working?

1. Pelvic Rotation 5 degrees backwards 2. Hip: degree and Movement 20 hyperextended 3. Knee: degree and Movement 0 degrees extension 4. Ankle: degree and Movement 10 degrees DF 5. Toe: degree and Movement 30 degrees MTP extension 6. What muscles are working?/not working? - eccentric glute - concentric calf

Loading Response 1. Pelvic Rotation 2. Hip: degree and Movement 3. Knee: degree and Movement 4. Ankle: degree and Movement 5. Toe: degree and Movement 6. What muscles are working?/not working?

1. Pelvic Rotation 5 degrees forward rotation 2. Hip: degree and Movement 25 degrees flexion 3. Knee: degree and Movement 15 degrees flexion 4. Ankle: degree and Movement 10 degrees plantar flexion 5. Toe: degree and Movement 0 degrees 6. What muscles are working?/not working? - eccentric glue med - eccentric HS - eccentric quads - eccentric pretibial muscles

Initial Contact 1. Pelvic Rotation 2. Hip: degree and Movement 3. Knee: degree and Movement 4. Ankle: degree and Movement 5. Toe: degree and Movement 6. What muscles are working?/not working?

1. Pelvic Rotation 5 degrees forward rotation 2. Hip: degree and Movement 25 degrees flexion 3. Knee: degree and Movement 0 degrees 4. Ankle: degree and Movement 0 degrees ankle 5. Toe: degree and Movement 0 degrees toe 6. What muscles are working?/not working? - eccentric glute max - eccentric glute med - eccentric HS - eccentric quads - eccentric pretrial muscle

Terminal Swing 1. Pelvic Rotation 2. Hip: degree and Movement 3. Knee: degree and Movement 4. Ankle: degree and Movement 5. Toe: degree and Movement 6. What muscles are working?/not working?

1. Pelvic Rotation 5 forward 2. Hip: degree and Movement 25 flexion 3. Knee: degree and Movement 0 4. Ankle: degree and Movement 0 5. Toe: degree and Movement 0 6. What muscles are working?/not working? - eccentric HS - concentric pretibial muscles

What Drugs to Treat? + Side Effects 1. Peripheral Neuropathy 2. Inhibits vitamin K essential for clotting. used as anti clotting drug for MI, emboli, stroke, prevent venous thrombin 3. Can inhibit thrombin, block clotting factor 10 and can cause anti clotting. given for DVT. given for TKR, THR 6-8 hours after surgery 4. anti platelet function used to prevent CAD, MI

1. Peripheral Neuropathy - Pregabalin (Lyrica) side effects: CHF, lymphedema, greater difficulty walking long distances 2. Inhibits vitamin K essential for clotting. used as anti clotting drug for MI, emboli, stroke, prevent venous thrombin - Warafin (Coumadin) - side effects: increased risk of hemorrhage, bleeding, mjicreoemboli, can lead to lightheadedness due to bleeding. if INR increase greater than 2-3 reduce the dose 3. Can inhibit thrombin, block clotting factor 10 and can cause anti clotting. given for DVT. given for TKR, THR 6-8 hours after surgery - low MWT Heparin 4. anti platelet function used to prevent CAD, MI - aspirin - side effects: not to be sued in acute injury as it will prevent clotting of blood

Severity of Lymphedema Three Categories

1. Pitting 2. Brawny 3. Weeping

Electrical Conduction Abnormalities Ectopic Beats 1. Premature Atrial Contraction 2.Premature Ventricular Contraction

1. Premature Atrial Contraction - originates in the ratio and may present with irregular rhythm - hard to distinguish from a premature junctional contraction - will not compromise CO2 and PT intervention may be appropriate if accompanied by adequate hemodynamic response 2.Premature Ventricular Contraction - by themselves - two PVCs - three PVCs - alternating with sinus beats such as bigeminy (every other PVS) or trigemini (every third beat) - common to have PVC in a normal heart such as with caffeine - do not exercise following smoking or smoke after for at least 2 hours

Transfemoral 1. Pressure Sensitive areas (3) 2. Pressure Tolerant Areas (4)

1. Pressure Sensitive areas (3) - distolateral end of femur - pubic symphysis - perineal area 2. Pressure Tolerant Areas (4) - ischial tuberosity - gluteals - lateral sides of residual limb - distal end rarey sensitive

Transfemoral Knee Stabilization in Extension achieve by: 1. Prosthetic Alignment 2. Manual Lock 3. Friction Break 4. Extension Aid

1. Prosthetic Alignment - knee center is aligned posterior to TKA line, stable, will not flex easily - may be prescribed for short residua limb - unstable knee can occur if anterior to TKA line 2. Manual Lock - who require a constant locked knee - ex: weak hip extensors, difficulty with clearance of leg during swing 3. Friction Break - increases friction at mid stance to prevent knee flexion - but permits smooth knee motion through the rest of the gait cycle 4. Extension Aid - external elastic strap or internal coiled spring that assist in TKE during late swing

Examination of Skin 1. Pruritus 2. Urticaria 3. Xeroderma 4. Hyperhidrosis 5. Hypohidrosis

1. Pruritus itching - common in diabetes, drug hypersensitivity, hyperthyroidism 2. Urticaria smooth, red, elevated patches of skin - hives - indicative of allergic response to drugs or infection 3. Xeroderma - excessive dryness of skin with shedding of epithelium - can indicate deficiency of thyroid function, diabetes 4. Hyperhidrosis - moist skin 5. Hypohidrosis dry skin - can indicate dehydration, hypoparathyroidism

Immune Disorders of The Skin 1. Psoriasis 2. Lupus Erythematosus 3. Discoid Lupus Erythematosus (DLE) 3. Systemic Lupus Erythematosus (SLE) 4. Systemic Sclerosis (Scleroderma) 5. Diffuse Systemic Sclerosis Disease (Scleroderma) 5. Polymyositis

1. Psoriasis - chronic autoimmune disorder of the skin characterized by erythematous plaques covered with a silvery scare - ears, scalp, knees, elbows, genitalia - itching and pain from dry cracked lesions - can be associated with psoriatic arthritis, joint pain of small distal joints - hereditary - triggered by trauma, infection, pregnancy and endocrine changes, cold weather, smoking, anxiety, stress - no cure, topical preparations, immunosuppresive drugs (methotrexate) and corticosteroids 2. Lupus Erythematosus (DLE) - chronic progressive autoimmune inflammatory disorder of the connective tissues - red rash with raised red scaly plaques 3. Discoid Lupus Erythematosus (DLE) - affects only skin - flare ups with sun exposure lesions can resolve or use atrophy - permanent scaring, hypo pigmentation or hyper 3. Systemic Lupus Erythematosus (SLE) - chronic systemic inflammatory disorder affecting multiple organ systems - skin, joints, kidneys, heart, nervous system, mucous membrances - can be fatal - commonly young women - fever, malaise, Butterly rash across bridge of nose skin lesion, chronic fatigue, arthralgia, arthritis, skin rashes, photosensitivity, anemia, hair loss, raynauds phenomenon - no cure - topical treatment of skin lesions - corticosteroid creams 4. Systemic Sclerosis (Scleroderma) chronic autoimmune diffuse disease of connective tissues causing fibrosis of skin, joints, blood vessels and internal organs (GI track, lungs, heart, kidneys) usually accompanied by raynauds phenomenon - taut, firm, edematous skin firmly bound to subcutaneous tissue - symmetrical skin involvement of distal extremities and face - CREST syndrome 5. Diffuse Systemic Sclerosis Disease (Scleroderma) - symmetrical - widespread skin involvement of distal and proximal extremities - face, trunk, rapid progression of skin changes with early appearance of visceral involvement - kidneys, heart and lungs involved - PT: slow development of contracture and deformity - sensitive to pressure, ACUTE HTN may occur 5. Polymyositis disease of connective tissue characterized by edema, inflammation, degeneration of muscles - dermatitis with some forms - sclerodactyl and interstitial lung disease are associated - affects primarily proximal muscles, shoulder, pelvic girdle, neck, pharynx, symmetrical distribution - rapid severe onset may require ventilatory assistance or feeding tubes - degeneration and regeneration, fiber atrophy, inflammatory infiltrates - precautions: too much exercise, contractures, pressure ulcers, inactivity, prolonged bed rest

Transfemoral Prosthesis Friction Devices 1. Purpose 2. Constant Friction 3. Variable Friction 4. hydraulic knee

1. Purpose - control knee motions - provide resistance to pendular motion at the knee 2. Constant Friction - continuous resistance is provided by a clam that acts on the knee mechanism - older individuals who do not vary their gait speeds greatly 3. Variable Friction - resistance can be regulated to the demands of the gait cycle 4. hydraulic knee - fluid controlled or air controlled - adjust resistance dynamically to the individuals walking speed - younger more active indiviauds - heavier - more complicated - increased maintenance and cost

Foot Orthosis 1. Purpose of Soft inserts 2. Metatarsal Pad 3. Cushion Heel 4. Longitudinal arch supports 5. UCBL 6. Thomas heel 7. scaphoid heel

1. Purpose of Soft inserts - plastic or rubber pads - relief cut outs - reduce areas of high loading - restrict forces - protect painful or sensitive areas of the feet 2. Metatarsal Pad - located posterior to the metatarsal head - moves pressure from the metatarsal heads to the shafts - allows more push-pff in weak or flexible feet 3. Cushion Heel - absorb forces at heel contact - used to relieve strain on plantar fascia in plantar fasciitis 4. Longitudinal arch supports - prevent depression of the subtle joint - correct pes planus 5. UCBL: university of California biomechanics library - semirigid plastic molded insert - corrects for flexible yes plans 6. Thomas heel - heel wedge with an extended anterior medial border - support longitudinal arch - correct for flexible per values (pronation) scaphoid pad - used to support the longitudinal arch

Foot Posts (wedge) 1. Rearfoot Wedge 2. Varus Wedge (Medial Wedge) 3. Valgus Wedge (Lateral Wedge) 4. Forefoot Wedge medial wedge for who lateral wedge for who 5. Heel lifts 6. Rocker bar 7. Rocker bottom

1. Rearfoot Wedge - alters position of subtalar joint or rear foot - from heel strike to flat foot 2. Varus Wedge (Medial Wedge) - limits or controls eversion of the calcaneus and internal rotation of the tibia after heel strike// during running *puts in varus* 3. Valgus Wedge (Lateral Wedge) controls the calcaneus and subtalar joint that are excessively inverted and supinated *puts in valgus* 4. Forefoot Wedge - medial wedge for forefoot varus - lateral wedge for forefoot valgus 5. Heel lifts accommodates for leg length discrepancy 6. Rocker bar - located proximal to met heads - improves weight shift onto metatarsals. 7. Rocker bottom - improves push off in weak or inflexible feet

Pelvic Floor Disorders 1. Results in a weakening of what? 2. Cystocele 3. Rectocele 4. Uterine Prolapse 5. Symptoms 6. Where can pain radiate?

1. Results in a weakening of what? pubococcygeal muscles (pelvic floor muscles) 2. Cystocele herniation of the bladder into the vagina 3. Rectocele herniation of the rectum into the vagina 4. Uterine Prolapse bulging of the uterus into the vagina 5. Symptoms - PC muscles can go into spasm - pelvic pain: perivaginal, perirectal, UI pain with sexual intercourse 6. Where can pain radiate? - dow the posterior thigh

Laboratory Test for Liver and Biliary Tract Disease (Adult Values) 1. Serum Bilirubin - Direct (conjugated) - Indirect (unconjugated) - Total 2. Urine Bilirubin 3. Serum Cholesterol 4. Total Protein 5. Serum Albumin 6. Blood Ammonia

1. Serum Bilirubin - Direct (conjugated)= 0.1-0.3 mg/dL - Indirect (unconjugated) = 0.2-0.8 mg/dL - Total = 0.3-1.0 mg/dL 2. Urine Bilirubin 0 3. Serum Cholesterol 150-250 - elevated when its excretion is blocked by bile duct obstruction - reduced when severe liver damage prevents its synthesis 4. Total Protein 6-8 g/dL - decreased then liver is damaged - synthesis is impaired 5. Serum Albumin 3.5-4.8 - decreased in liver damage - decreases with age 6. Blood Ammonia <75 mcg/dL - increased in severe liver damage - liver unable to break down ammonia

Staging of Pressure Ulcers 1. Stage 1 2. Stage 2 3. Stage 3 4. Stage 4 5. Unstagable 6. Deep Tissue Injury

1. Stage 1 - non-blanchable erythema - intact skin - may include changes in skin temp, sensation, tissue consistency 2. Stage 2 - partial thickness skin loss - epidermis, dermis or both - ulcer is superficial - presents clinically as an abrasion, blister or shallow crater 3. Stage 3 - full thickness skin loss - damage to or necrosis of subcutaneous tissue - may extend down to but not through underlying fascia - presents clinically as a deep crater 4. Stage 4 full thickness skin loss - involves extensive destruction - tissue necrosis or damage to muscle, bone or supporting structures - undermining and sinus tracts may be present 5. Unstagable tissue depth obscured due to slough or eschar and extent of damage cannot be determined 6. Deep Tissue Injury discolored area of tissue that is not reversible and will likely progress to full thickness injury

Clinical Signs and Symptoms of Shock 1. Stage 1 (Early Stage) 2. Stage 2

1. Stage 1 (Early Stage) - restlessness, anxiety, hyper alert - tachycardia - increased RR, shallow breathing, frequency sighs - rapid bounding pulse - distended neck veins - skin warm and flushed - thirst, nausea, vomiting 2. Stage 2 - confusion - lack of focused eye contact (vacant look) - abrupt changes in affect or behavior

American College of Cardiology Foundation/American Heart Association Stages 1. Stage A 2. Stage B 3. Stage C 4. Stage D

1. Stage A - risk for CHF - without structural heart disease or symptoms of CHF 2. Stage B - structural heart disease - without signs or symptoms of CHF 3. Stage C - structural heart disease with prior or current symptoms of HF 4. Stage D - refectory HF requiring specialized interventions

What re the 6 cortical sensation?

1. Stereognosis ability to identify familiar objects placed in the hand by manipulation and touch 2. Tactile Locialization test ability to identify location of a touch stimulus o the body by verbal report or pointing 3. Two-Point Discrimination test ability to recognize one or two blunt points applied to the skin simultaneously - determine minimal distance on skin where two points can still be distinguished in mm using aesthesimeter (two tips must be applied simultaneously) 4. Barognosis ability to identify similar size/shaped objects in the hand with different granulations of weight 5. Graphesthesia test ability to identify numbers, letters, symbols traced on skin, typically the hand 6. Bilateral Simultaneous Stimulation test ability to identify simultaneous touch on the two sides/segments of the body

Transfemoral Suspension 1. Suction Suspension 2. Strap Suspension + Silesian Bandage 3. Hinge Suspension

1. Suction Suspension - maximize contact and suspension - air is pumped out through a one way air release valve located at the bottom of the socket - can be total or partial 2. Strap Suspension - adjustable - accommodates volume changes - disadvantage is postponing ALSO Silesian Bandage: - strap that anchors the TKA prosthesis by reaching around the pelvis, below iliac crest - contrals rotatry motions 3. Hinge Suspension - hinged hip joint attached the a metal leather/pelvic band - anchored around the pelvic - aides control of medical/lateral stability of hip (rot, add, abd) - reduces tredelenburg gait - adds extra weight and bulk (not good)

Test of balance and fall risk? (3)

1. TUG 2. berg balance test 3. 10MWT

Spinal Cord Injury 1. Traumatic causes 2. Mechanism of Injury 3. Spinal areas greatest frequency of injury 4. non traumatic causes 5. pathophysiologic 6. Tetraplegia (quadriplegia) 7. Paraplegia 8. Complete vs Incomplete

1. Traumatic causes - MVA, jumps, falls, diving, gunshot wounds 2. Mechanism of Injury - flexion= most common lumbar injury - flexion rotation= most common cervical injury - compression - hyperextension 3. Spinal areas greatest frequency of injury C5, C7, T12, L1 4. non traumatic causes - Disc prolapse, vascular insult, cancer, infection 5. pathophysiologic - primary injury, interruption of blood supply - secondary sequels: ischemia, edema, demyelination, necrosis of axons, progressing to scar tissue formation 6. Tetraplegia (quadriplegia) - occurs between C1-C8 - all 4 extremities and trunk 7. Paraplegia occurs between T1 and T12-L1 - involves both lower extremities and trunk (varying levels) 8. Complete vs Incomplete Complete - no sensory or motor function below the level of lesion incomplete - preservation of sensory or motor function below level of injury - spotty sensation - some muscle function

Bladder Dysfunction SCI 1. what is common? 2. spinal control for micturition originates from what spinal levels? 3. lesions that occur above the conus medullar is and sacral segments have what bladder? 4. lesion sacral segments or conus medullar is is what kind of bladder?

1. UTI 2. S2, S3, S4 3. spastic or hyperreflexive also termed UMN bladder 4. flaccid, areflexive, LMN bladder

What Dressing? 1. Very Mild Exudate? 2. Minimal Exudate? 3. Moderate Exudate? 4. Heavy Exudate? 5. Infected Dressings? 6. Non Infected?

1. Very Mild Exudate? transparent films 2. Minimal Exudate? hydrogel, hydrocolloid 3. Moderate Exudate? foams 4. Heavy Exudate? alginates 5. Infected Dressings? hydrogel, alginate, gauze 6. Non Infected? hydrocolloid, films, gauze

Referred GI Pain Patterns 1. Visceral pain from esophagus refers where? 2. Midthoracic spine pain (nerve root pain) can appear as what? 3. Visceral pain from the gallbladder, stomach, pancreas or small intestine refers where? 4. Viceral pain from the colon, appendix, pelvic viserca can refer where? 5. visercal pain from the liver, diaphragm, or pericardium refers where?

1. Visceral pain from esophagus - midback 2. Midthoracic spine pain (nerve root pain) can appear as what? - appear as esophageal pain 3. Visceral pain from the gallbladder, stomach, pancreas or small intestine - midback and scapular regions 4. Viceral pain from the colon, appendix, pelvic viserca can refer where? - pelvis - Low back - sacrum 5. visercal pain from the liver, diaphragm, or pericardium refers where? - shoulder

Fluid Excess (2)

1. Water Intoxication - resulting from hyponatremia (not enough sodium in blood) - becomes diluted, water must move into cells to equalize solute concentration - potentially lethal situation - usually occurs because excess ADH (tumors, endocrine disorders) or intake of large amounts of only tap water without balanced solute ingestion - athletes who lost a large amount of body fluid during exercise that has been replaced with only water - only drinking water after the flu 2. Edema - excess of fluid

TMJ 1. What bias? (what position do you want them in?) 2. What interventions?

1. What bias? (what position do you want them in?) - postural 2. What interventions? - posture education - JAW posture education - TMJ mobilization/manipulation - suboccipital interventions - mandibular and tongue proprioception

Tension Headaches 1. What bias? (what position do you want them in?)

1. What bias? (what position do you want them in?) - upper cervical = flexion - lower cervical = extension

Compression Fracture from Osteoporosis 1. What bias? (what position do you want them in?) 2. Interventions 3. Contraindications

1. What bias? (what position do you want them in?) extension DO NOT FLEX OR ROTATE THESE PATIENTS 2. Interventions - posture education - extension approach - segmental global and trunk stabilization - scapular stabilization - hip stretching as needed - WB activities and exercises - bed mobility as needed - mobilization/manipulation as needed 3. Contraindications - HVT - aggressive joint manipulation - abdominal crunches (trunk flexion)

Anklysoing Spondylitis 1. What bias? (what position do you want them in?) 2. Interventions 3. Contraindications

1. What bias? (what position do you want them in?) extension DO NOT FLEX OR ROTATE THESE PATIENTS! 2. Interventions - posture education - extension approach - exaggerated lumbar lordosis - segmental and global stabilization - LE and trunk stretching as needed - mobilization and manipulation as needed 3. Contraindications - manipulation as ankloysed segments

Schuermanns Disease 1. What bias? (what position do you want them in?) 2. Interventions 3. Contraindications

1. What bias? (what position do you want them in?) extension bias DO NOT FLEX AND ROTATE THESE PATIENTS 2. Interventions - posture education - extension approach - segmental and global stabilization exercises - LE and trůnk stretching as needed - mobilization/manipulation as needed - nerve glides if indicated 3. Contraindications HVT

Spondylolisthesis 1. What bias? (what position do you want them in?) 2. Interventions 3. Contraindications

1. What bias? (what position do you want them in?) flexion bias 2. Interventions - posture education - flexion approach - segmental and global stabilization - LE trunk and stretching as needed 3. Contraindications - exaggerated extension manipulation and stretching

Postural Pain Syndrome 1. What bias? (what position do you want them in?) 2. Interventions

1. What bias? (what position do you want them in?) postural stain, poor physical condition 2. Interventions - posture education - ergonomic assessment and adaptations as needed - segmental and global stabilization exercises - extremity and trunk stretching as needed - conditioning exercises - relaxation exercises

Herniated Disc, DJD, Stenosis central or lateral, myelopathy, radiculopathy, radicular pain 1. What bias? (what position do you want them in?) 2. Interventions - Lumbar Regions - Cervical Region 3. What is contraindicated?

1. What bias? (what position do you want them in?) put them in extension 2. Interventions - posture education - extension approach - segmental and global stabilization - mobilization/manipulation as needed - nerve glides if indicated Lumbar Regions - side-glide if necessary, - prone press ups - back extensions - LE and trunk stretching as needed Cervical Region - chin tucks - scapular stabilization - UE and cervical stretching 3. What is contraindicated? HVT

Scoliosis 1. What bias? (what position do you want them in?) 2. Severe Cases will have what? 3. Interventions

1. What bias? (what position do you want them in?) variable, depending on region of scoliosis and impairments 2. Severe Cases will have what? will have compromise of cardiorespiratory systems 3. Interventions - posture education - side stretch of concave side - strengthen side of convexity - segmental and global stabilization - scapular stabilization - mobilization/manipulation as needed

Coxa Vara and Coxa Valga 1. What degree is coxa vara? 2. What degree is coxa value? 3. What does coxa vara result from? 4. What does coxa vara and coxa valga result from?

1. What degree is coxa vara? <115 2. What degree is coxa value? >125 3. What does coxa vara result from? defect in ossification of head of femur 4. What does coxa vara and coxa valga result from? - necrosis of femoral head occurring with septic arthritis

Osteoporosis 1. What is it 2. What is diagnosis by? 3. Normal 4. Osteopenia 5. Osteoporosis 6. Primary Osteoporosis 7. Secondary Osteoporosis 8. Prevention of Osteoporosis 9. What kind of exercise?

1. What is it disease of bone that leads to decreased mineral content and weakening of bones 2. What is diagnosis by? determined by the T score of bone mineral density scan - T score is the number of SD above or below a reference value 3. Normal 1.0 or higher 4. Osteopenia -1.0 to -2.4 5. Osteoporosis -2.5 or less 6. Primary Osteoporosis post menopausal, caucasian, asian decent, family history, low body weight, little or no physical activity, diet low in calcium and vitamin D, smoking 7. Secondary Osteoporosis owing to other medical conditions such as GI, hyperthyroidism, chronic renal failure, excessive alcohol consumption, glucosteroids 8. Prevention of Osteoporosis - eating foods good for bone health - maintain balanced diet that is rich in calcium and vitamin D - regular WB exercises - limit alcohol and smoking 9. What kind of exercise? - strengthening and resistance training and WB (mechanical loading) deform bone and stimulate osteoblastic activity that improve BMD Exercise - WB - biking - 5 or more days a week - a day of rest between each bout of exercise - 8-12 reps avoid activities leading to kyphosis, flexion activities, supine curl ups, crunches because it put stress and increase risk of vertebral compression fracture - avoid flexion and rotation of the trunk

Esophagus Gastroesophageal Reflux Disease (GERD) 1. What is it? 2. Red Flags

1. What is it? - caused by reflux or backward movement of gastric contents of the stomach into the esophagus producing heartburn - results from lower esophageal sphincter to regulate flow of food from the esophagus into the smack and increased epigastric pressure - the diaphragm that surrounds the esophagus and oblique muscles also contribute to antireflux function - over time acidic gastric fluids pH(<4) damage the esophagus, producing reflux esophagitis - heartburn commonly occurs 30-30 minutes after eating and at night when laying down 2. Red Flags - atypical pain may present as head and neck pain - chest pain is sometimes mistaken for heart attack - wheezing can occur and chronic cough - hoarseness can also result from chronic inflammation of the vocal cords - complications include strictures and barres esophagus - DO NOT PERFORM A VALSALVA MANEUVER WITH THESE PATIENTS - medications are acid suppressing, proton pump inhibitors, cimetidine, antacids

Diastasis Recti Abdominis 1. What is it? 2. What are PT interventions?/ what to avoid/ when to resume exercise

1. What is it? - lateral seperation or split of the rectus abdomen - seperation from midline (linea alba) - greater than 2cm is significant - associated with loss of abdominal wall support - increase back pain 2. What are PT interventions? - teach protection of abdominal musculature - avoid abdominal exercises - resume exercise when seperation is less than 2cm - teach safe abdominal strengthening exercises such as partial sit ups with knees bent, pelvic tilt, utilize hands to support abdominal wall

CVA (Stroke) 1. What is it? / causes it? 2. What are risk factors? 3. Risk factors? 4. Pathophysiology 5. Neurovascular Clinical Syndromes

1. What is it? - sudden focal neurologica deficit resulting from ischemic or hemorrhagic lesions in the brain - cerebral thrombosis (blood clot) - cerebral embolism (traveling) - cerebral hemorrhage (abnormal breathing) 2. What causes it?/ risk factors - arthersclerosis - HTN - cardiac disease - dabetes/metabolic syndrome - TIA attacks 4. Pathophysiology - cerebral anoxia lack of oxygen supply to the brain . damage begins after 4-6 minutes - cerebral infarction: irreversible cellular damage - cerebral edema: accumulation of fluid increasing inter cranial pressure can result in herniation and death 5. Neurovascular Clinical Syndromes - ICA syndrome

Intestines Irritable Bowel Syndrome (IBS) 1. What is it? 2. Associated with what? 3. Symptoms?

1. What is it? abnormally increased motility of the small and large intestine - spastic, nervous, irritable colon 2. Associated with what? emotional stress and certain food. no. structural or biochemical abnormalities have been identified 3. Symptoms? - persistent or recurrent abdominal pain that is relieved by defamation - constipation - diarrhea - bloating - abdominal cramps - flatulence - nausea - anorexia stress reductions and medications to reduce anxiety or depression and regular physical activity

Hydrocolloids 1. What is it? 2. For what kind of wound staging? 3. For what type of color? 4. For what type of exudate? // absorption 5. Advantages 6. Disadvantages 7. Considerations

1. What is it? adhesive wafers containing hydro active/absorptive particles that interact with wound fluid to form a gelatinous mass over the wound bed - available in paste form that can be used as a filler for shallow cavity wounds 2. For what kind of wound staging? - partial thickness wounds 3. For what type of color? - autolytic debridement of necrosis or slough 4. For what type of exudate? wounds with mild exudate minimal to moderate absorbtion 5. Advantages - maintain a moist wound environment - nonadhesive to healing tissue - comfortable - impermeable to external bacteria contaminants - support autolytic debridement - minimal to mod absorption - waterproof - reduce pain - easy to apply - time saving - thin forms diminish friction 6. Disadvantages - nontransparent - may soften and change shape with heat or friction - not recommended for heavy exudate wounds, sinus tracts, or infections, wounds that exposure bone or tendon or wounds with fragile surrounding skin 7. Considerations - change every 3-7 days

Cancer 1. What is it? 2. Etiology? // factors 3. Early warning signs?

1. What is it? broad group of diseases characterized by rapidly proliferating anapestic cells 2. Etiology? // factors - environment: tobacco, sun exposure, herpes simplex, AIDS, carcinogens, asbestos, smoking, tobacco - Genetic - obesity, high fat diet, diet low in vitamins A,C,E - chronic stress 3. Early warning signs? - unusual bleeding or discharge - lump or thickening of any area - sore throat that does not heal - change in bowel or bladder habits - hoarseness or persistent cough - indigestion or difficulty swallowing - change in size or appearance of a wart or mole - unexplained weight loss

Transparent Film 1. What is it? 2. Permeable? 3. What stage of pressure ulcer? 4. For who? 5. Advantages 6. Disadvantages

1. What is it? clear, adhesive, semipermeable membrane dressings 2. Permeable? - permeable to atmospheric oxygen and moisture - impermeable to water, bacteria, environmental contaminants 3. What stage of pressure ulcer? stage I and II 4. For who? - secondary dressing in certain situations - for autolytic debridement - skin donor sites - cover for hydrophilic power and paste preparations and hydrogels 5. Advantages - visual evaluation of wound without removal - impermeable to external fluids and bacteria - transparent and comfortable - promote autolytic debridement - minimize friction 6. Disadvantages - nonabsorpative - application can be difficult - channeling or wrinkling occurs - not to be used on wounds with fragile surrounding skin or infected wounds

Intestines Malabsorption Syndrome 1. What is it? 2. Caused by? 2. Symptoms 2. Red flags?

1. What is it? complex of disorders characterized by problems in intestinal absorption of nutrients 2. Caused by? - can be caused by gastric or small bowel resection (short guy syndrome) or number of difference diseases including CF, celiac, crowns, chronic pancreatitis, pernicious anemia, NSAID gastroenteritis (drug induced) *deficines of enzymes (pancreatic lipase) and bile salts are contributing factors* Symptoms - anorexia - weight loss - abdominal bloating - pain - cramps - indigestion - steatorrhea (abnormal amount of fat in fece) 2. Red flags? - iron def - easy bruising and bleeding due to lack of vitamin K - muscle weakness and fate - bone loss - neuropathy - muscles spaces - peripheral edema

Intestines Inflammatory Bowel Disease (IBD) 1. What is it? 2. Symptoms? 3. Red Flags 4. What is crohns disease? 5. what is ulcerative colitis?

1. What is it? crohns disease and ulcerative colitis - both result in inflammation of the bowel and are characterized by remissions and exacerbations 2. Symptoms? - abdominal pain - frequent attacks of diarrhea - fecal urgenty - weight loss stunted growth common in pediatric patins 3. Red Flags - joint pain - low bone density - nutritional defmicieis - anxiety and depression 4. What is crohns disease? involves a granulomatous type of inflammation that can occur anywhere in the GI tract. areas of adjacent normal tissue called skip lesions are present 5. what is ulcerative colitis? ulcerative and exudative inflammation of the large intestine and rectum. characterized by varying amounts of bloody diarrhea, mucus and pus - skip lesions are absent

Type 1 Diabetes Mellitus (T1DM) 1. What is it? 2. Usually in who? 3. How do you fix it? 4. Prone to what?

1. What is it? insulin-dependent - juvenile onset - NICK JONAS 2. Usually in who? children and young adults - abrupt onset around the age of puberty - caused by autoimmune abnormalities, genetic or environmental 3. How do you fix it? insulin delivery by injection, insulin pump or inhalation 4. Prone to what? prone to ketoacidosis. which is a presence of ketone bodies in the urine, the byproducts of fat metabolic (ketonuria)

Gauze Dressing 1. What is it? For what type of exudate? // absorption Advantages

1. What is it? made of cotton or synthetic fabric that is absorptive and permeable to water and oxygen - may be used wet, moist, dry or impregnated with petrolatum, antiseptics, or other agents - come in varying weaves and with different size interstices For what type of exudate? // absorption - exudative wounds - wounds with dead space, tunneling, sinus tracts - wounds with combination exudate or necrotic tissue 5. Advantages - readily available - can be used with appropriate solutions such as gels, normal saline, topical antimicrobials to keep wounds moist - can be used on infected wounds - good mechanical debridement if properly used - cost-effective filler for large wounds - effective delivery of topicals if kept moist **requires secondary dressing, avoid direct contacts with granulating tissue - pain on removal - can delay healing is used improperly - pack loosely around woods

Intestines Diverticular Disease Diverticulosis Diverticulitis 1. what is it? 2. symptoms 3. red flags

1. What is it? much like herniations of the musical layer of the colon through the muscular layer diverticulosis rejects to pouch like herniations of the color especially the sigmoid color - rectal bleeding is sx - lack of fiber and lack of physical activity - can lead to diverticulitis Diverticulitis inflammation of one of more diverticula. fecal matter penetrate diverticulitis and causes inflammation and abscess - SX are pain, cramping in lower left quadrant, nausea, vomiting, slight fever and elevated WBC - complications are bowel obstruction, perforation with peritonitis and hemorrhage 3. red flags - back pain - exercise regularly

Myositis Ossificans 1. What is it? 2. What causes it? 3. Frequent locations? 4. When is surgery needed?

1. What is it? painful condition of abnormal calcification within the muscle belly 2. What causes it? - direct trauma that results in hematoma and calcification of the muscle - induced by early mobilization and stretching, with aggressive physical therapy following trauma to a muscle 3. Frequent locations? - quadriceps - brachialis - biceps brachii 4. When is surgery needed? - nonhereditary myositis - after maturation of the lesion 6-24 months - when lesions mechanically interfere with joint movement or impinge nerves

Foams 1. What is it? 2. For what kind of wound staging? 3. For what type of color? 4. For what type of exudate? // absorption 5. Advantages

1. What is it? semipermeable membranes that are either hydrophilic or hydrophobic - vary in thickness, absorptive capacity and adhesive properties 2. For what kind of wound staging? - partial + full thickness with minimal to moderate/heavy exudate 3. For what type of color? secondary dressing for wound with packing to provide additional absorption - provide protection and insulation 4. For what type of exudate? // absorption minimal to moderate exudate 5. Advantages - insulate wounds - provide some padding - most are non adherent - conformable - minimal to heavy exudate - easy to use - some newer products are designed for deep cavities **not for use with dry eschar or wounds with no exudate **change 1-5 days

Alginates 1. What is it? 4. For what type of exudate? // absorption 5. Advantages

1. What is it? soft, absorbent - non woven dressing derived from seaweed that have a fluffy cotton like appearance - react with wound exudate to forma viscous hydrophilic gel mass over the wound area - available in ropes and pads For what type of exudate? // absorption - wounds with moderate to large amounts of exudate - wounds with combination of exudate and necrosis - wounds that require packing and absorption - infected and noninflected exuding wounds 5. Advantages - absorb up to 20x their weight in drainage - fill dead space - support debridement in presence of exudate - easy to apply **not recommended for dry or lightly exuding wounds - change every 8 hours to every 2-3 days

Complex Regional Pain Syndrome (CRPS) 1. What is it? 2. What is the pathophysiology? 3. What are the two types? 4. Medical interventions? 5. Medications? 6. Long Term Changes

1. What is it? thought to be related to trauma or precipitating event 2. What is the pathophysiology? results in dysfunction of sympathetic nervous system to include pain, circulation and vasomotor disturbances 3. What are the two types? - triggered by tissue injury but no underlying nerve injury - clearly associated with a nerve injury 4. Medical interventions? - sympathetic nerve block - surgical sympathhectomy - spinal cord stimulation - intrathecal drug pumps 5. Medications? - topical analgesics - anti seizure drugs - antidepressants - corticosteroids - opiods 6. Long Term Changes - muscle wasting - trophic skin changes - decrease bone density - decreased proprioception - loss of muscle strength from disuse - joint contractures

Illiotibial band tightness/friction disorder 1. What is it? 2. What does it result in? 3. What two special tests are +?

1. What is it? tight ITB - abnormal gait patterns 2. What does it result in? - inflammation of trochanteric bursa 3. What two special tests are +? - noble compression test is positive when pressure with the thumb is introduced over the lateral femoral condyle during knee extension - obers test will demonstrate tightness in ITB **stretch and strengthen IT, hamstrings, quads, hip flexors**

Hydrogels 1. What is it? 2. For what kind of wound staging? 3. For what type of color? 4. For what type of exudate? // absorption 5. Advantages

1. What is it? water or glycerine based gels - insoluble in water - available in solid sheets, amorphous gels, impregnated gauze - absorptive capacity varies 2. For what kind of wound staging? partial + full thickness wounds 3. For what type of color? necrosis + slough - burns and tissue damaged by radiation 4. For what type of exudate? // absorption - necrosis and slough - minimal to moderate absorption 5. Advantages - soothing and cooling - fill dead space - rehydrate dry wound beds - promote autolytic debridement - minimal to moderate absorption - conform to wound bed - transparent to translucent - many are non adherent - amorphous form can be used when infection is present **not used for heavily exuding wounds - change 8-48 hours

Metabolic Syndrome (X) 1. What is it? 2. What is the criteria for diagnosis? 3. Treatment?

1. What is it? a cluster of risk factors that increase the likelihood of developing heart disease, stroke and type 2 diabetes 2. What is the criteria for diagnosis? - >40 inch waste size men - >35 inch was size women - cholesterol: elevated tryglicerides >150mg/dL - low HDL for men <40 women <50 - High BP systolic >135 diastolic >85 - fasting plasma glucose >100 3. Treatment? - lifestyle changes - medications to control levels

Endrometriosis 1. What is it? 2. Symptoms? 3. What will patients complaint of?

1. What is it? ectopic growth and function of endometrial tissue outside of the uterus - entoptic tissue responds to hormonal influences but is not able to be shed as uterine tissue during menstruation - can lead to cyst and rupture producing peritonitis and adhesions and obstructions 2. Symptoms? - pain, dysmenorrhea (pain with menstrual periods) dyspareunia (abnormal pain during intercoarse), infertility 3. What will patients complaint of? - back pain - (psoas, pelvic floor) produce pain with palpation

Trochanteric Bursitis 1. What is it? 2. What causes it? 3. Common in who?

1. What is it? inflammation of deep trochanteria bursa 2. What causes it? - direct blow - irritation by IT band - biomechanics gait abnormalities causing repetitive micro trauma 3. Common in who? patients with RA

Piriformis Syndrome 1. What is the function of the muscle at 60 degrees and 90 degrees? 2. What is the syndrome? 3. What are signs and symptoms? (5) 4. Manual tx?

1. What is the function of the muscle at 60 degrees and 90 degrees? - ER of hip at less tha 60 degrees of hip flexion and can become overworked with excessive pronation of foot, causing abnormal femoral rotation - 90 degrees of hip flexion, the piriformis becomes an IR and ABD *Tonc muscle that is active with motion of SIJ joint* 2. What is the syndrome? tightness or spasm of piriformis muscle resulting in compression of sciatic nerve or SIJ dysfinction 3. What are signs and symptoms? (5) - restriction in IR - pain with palpation of piriformis muscle - referral of pain to posterior thigh - weakness in ER, + piriformis test - uneven sacral base 4. Manual tx? - joint oscillations to hip or pelvis to inhibit pain

Lordosis 1. What is weak and elongated? 2. What is tight and short?

1. What is weak and elongated? - abdominals - hamstrings 2. What is tight and short? - hip flexors - erector spinae - sagging shoulders - scapulae protracted - arms medially rotated - medial rotation of legs - knees hyperextended

Glenohumeral Subluxation and Dislocation 1. What way do most dislocations occur? 2. How does it happen? 3. How do posterior GH joint dislocations occur? 5. What 3 movements do you avoid following surgical repair? 6. What special test are +? Complications include : what are they? - Hill Sachs Lesion - SLAP tear - Bankart lesion

1. What way do most dislocations occur? - anterior-inferior direction 2. How does it happen? - abducted extremity is forcefully externally rotated causing a tear of inferior GH ligament, anterior capsule and occasionally glenoid labrum 3. How do posterior GH joint dislocations occur? - multidirectional laxity - horizontal adduction and IR avoid apprehension positions flexion greater than 90, horizontal abduction 90 and greater, ER to 80 degrees apprehension tests Complications include : what are they? - Hill Sachs Lesion compression fracture of the posterior humeral head - SLAP tear tearing of the superior glenoid labrum from anterior to posterior - Bankart lesion avulsion of anterior inferior capsule and ligaments associated with the glenoid rim and bruising of axillary nerve

Burn Wound Consist of Three Zones 1. Zone of Coagulation 2. Zone of Stasis 3. Zone of Hyperemia

1. Zone of Coagulation - cells irreversibly injured - cell death occurs 2. Zone of Stasis - cells are injured - may die without specialized treatment - usually within 24-48 hours 3. Zone of Hyperemia - minimal cell injury - cells should recover

Somatic sensory information enters the spinal cord through the dorsal roots. Sensory signals are then carried to higher centers via ascending pathways from one of two systems. These are:

1. anterolateral spinothalamic system 2. dorsal column-medial lemniscal system

Precautions for the use of Sidelying position (6)

1. axillofemoral bypass graft 2. arthritis 3. recent rib fracture 4. shoulder bursitis 5. tendonitis 6. any condition that would make appropriate postural drainage positioning uncomfortable

Most Common Oral Medications for Spasticity (4)

1. baclofen 2. diazepam 3. tizanidine 4. dantolene sodium

Major anti ischemic drugs (4)

1. beta blockers - decrease beta sympathetic activity on the heart - decrease HR and contractility - reducing energy demand 2. calcium channel blockers - reduce BP - decrease work of heart 3. nitrates - vasodilators - decrease preload and after load - decrease myocardial work - dilate coronary arteries 4. after load reducers - ACE inhibitors - ARB's used to normalize BP and reduce workload on the heart

Heart sounds 1. S1 2. S2 3. S3 4. S4

1. closure of mitral and tricuspid - beginning of systole 2. closure of aortic and pulmonary - end of systole 3. ventricular gallop - after S2 - acute heart failure decompensation 4. atrial gallop - before S1 - MI or chronic HTN

Special Considerations for Confused and Agitated Patients

1. consistency 2. expect no carryover 3. model calm behavior 4. expect egocentricity (wont see your point of view) 5. Flexibility/options 6. safety 7. environment - closed environment with limited distractions - progress to open

ACL Reconstruction Timeframes 1. Maximum Protection 2. Moderate Protection 3. Minimum Protection

1. day 1 to week 4 2. week 4- week 10 3. Week 11-week 24

SLR test 1. pain 40-70 is indicative of what? 2. after 70 is indicative of what? 3. what are the sciatic nerve roots? 4. pain in posterior leg with pain below the knee?

1. disc 2. facet, joint pain, SIJ 3. L5-S2 4. lateral protrusion

Radiologic findings of CHF

1. enlarged cardiac silhouette 2. Opacites (white areas) 3. blunting of the costophrenic angle

Sudden Signs of a Stroke (FAST)

1. face drooping 2. arm weakness 3. speech difficulty 4. time to call 911

Spatial Relations Disorders 1. figure- ground discrimination 2. form discrimination 3. spatial relations 4. position in space 5. topographical disorientation

1. figure- ground discrimination inability to visually distinguish a figure from the background 2. form discrimination inability to perceive or attend to subtle differences in form and shape - Ex: confuse a pen with a toothbrush, vase as a water pitcher 3. spatial relations inability to perceive the relationship of one object in paces to another object or to oneself - unable to tell time from clock cause cant tell the difference in hands 4. position in space ability to percieve and to interpret spatial concepts such as up, down, under, over, in, out, front or or behind - Ex: raise arm above head, place feet on footrests 5. topographical disorientation difficulty understanding and remembering the relationship of one location to another - Ex: cannot find the way from her room to PT clinic

Brown Squared Syndrome 1. How does it occur? 2. Clinical Features 3. What occurs on the ipsilateral side? 4. What occurs on the contralateral side?

1. hemisection of the spinal cord (damage to one side) - caused by penetration wounds such as a gunshot or stab Asymmetrical same side as the lesion - paralysis and sensory loss - loss of proprioception, light touch and vibratory sense due to damage of dorsal column - paralysis results from damage to the lateral corticospinal tract Contralateral side - damage to the spinothalamic tract results in loss of sense of pain and temperature contralateral (opposite) to the lesion. this begins several dermatome segments below the level of injury its below because the lateral spinothalamic tract asked 2-4 segments on the same side before crossing and the descending motor tract descussating in the medulla. **these pt achieve good functional gains during inpatient rehab**

Avascular Necrosis 1. What is it? 2. What ROM is limited (3) 3. What are symptoms? 4. What is contraindicated with medications?

1. impaired blood supply to the femoral head 2. FL/IR/ABD 3. pain in the groin and/or thigh - tenderness with palpation at the hip joint 4. corticosteroids contraindicated since they may be a causative factor

Recovery Stages of Stroke (6 stages)

1. initial flaccidity no voluntary movement 2. emergence of spasticity, hyperreflexia, synergies (mass patterns of movement) 3. voluntary movement possible, but only in synergies, spasticity strong 4. voluntary control in isolated joint movements emerging, corresponding decline of spasticity and synergies 5. increasing voluntary control out of synergy; coordination deficits present 6. control and coordination near normal

Levels of Traumatic Brain Injury (TBI) Mild 1. level of consciousness time? 2. alteration of consciousness time? 3. Post traumatic amnesia time? 4. Glasgow coma scale score? 5. imaging is normal or abnormal?

1. level of consciousness time? - 0-30 minutes 2. alteration of consciousness time? - brief >24 hours 3. Post traumatic amnesia time? < 1 day 4. Glasgow coma scale score? 13-15 5. imaging is normal or abnormal? normal

Levels of Traumatic Brain Injury (TBI) Moderate 1. level of consciousness time? 2. alteration of consciousness time? 3. Post traumatic amnesia time? 4. Glasgow coma scale score? 5. imaging is normal or abnormal?

1. level of consciousness time? > 30 minutes but < 24 hours 2. alteration of consciousness time? >24 hours 3. Post traumatic amnesia time? > 1 but < 7 days 4. Glasgow coma scale score? 9-12 5. imaging is normal or abnormal? normal or abnormal

Levels of Traumatic Brain Injury (TBI) Severe 1. level of consciousness time? 2. alteration of consciousness time? 3. Post traumatic amnesia time? 4. Glasgow coma scale score? 5. imaging is normal or abnormal?

1. level of consciousness time? >24 hours 2. alteration of consciousness time? >24 hours 3. Post traumatic amnesia time? >7 days 4. Glasgow coma scale score? <9 5. imaging is normal or abnormal? normal or abnormal

Fluid Deficit/Dehydration (2)

1. loss of water without loss of solutes - excess concentration of body solutes within the interstitial and intravascular compartments - to preserve equilibrium, water is forced to shift by osmosis from inside cells to outside compartments - if it persists, large amounts of water will be shifted and excreted (osmotic diuresis) and severe cellular dehydration occurs due to - decreased water intake - prolonged hyperventilation - dude feeding - high glucose levels such as DM 2. loss of both water and solutes - hemorrhage, profuse respiration (marathon runners) and loss of GI secretions (vomiting, diarrhea, draining fistulas, ileostomy can lead to hypovolemic shock

Rancho Los Amigos Levels of Cognitive Functioning (8 levels)

1. no response, 2. generalized response: inconsistent and nonpurposeful 3. localized response: reacts specifically but inconsistently 4. confused-agitated: heightened state of activity. bizarre and nonpurposeful behavior 5. confused-inappropriate: responds to simple commands consistenly but responds randomly or inappropriate with increased complexity of commands 6. confused-appropriate: shows goal-directed behavior, but is depended on external input 7. automatic appropriate: appropriate and purposeful but robot-like 8. purposeful appropriate: able to recall and integrate past and present events, and is aware and responsive to environment.

Arterial Blood Gas Values 1. pH 2. PaO2 3. HCO3 4. PO2 5. O2 Panic values 1. pH 2. PaO2 3. HCO3 4. PO2 5. O2

1. pH 7.35-7.45 2. PaCO2 35-45 3. HCO3 22-26 4. PO2 60-100 5. O2 95%-98% keep above 90% during activity; some exceptions for COPD 1. pH <7.20 or >7.6 2. PaO2 </=20 or >40 3. HCO3 </=10 or >40 4. PO2 </=40 5. O2 </=60

TMJ Therex

1. tongue resting positioning and nasal breathing places tip of tongue on the roof of mouth just behind front teeth. breathe through nose and exhale using diaphragm 2. Controlled opening tongue in resting position and practices opening the mouth without shift or sound to the point where tongue begins to leave roof of mouth 3. Joint mobility with a cork hold cork between teeth. roll cork between the teeth from one side to the other. - to improve articulation patient talks for approximately 2 minutes while holding the cork between his or her teeth - talk with cork removed 4. rhythmic stabilization place tongue is resting position and grasp chin. - apply resistance sideways to R deviation, then left deviation then against mouth opening and closing 5. craniocervical extension place both hands behind the neck and interlace the fingers to stabilize the entire cervical region - perform extension without increased activity of mandible 6. isolated controlled protrusion of the mandible asked to actively protrude the mandible without associated movement of face muscles and craniocervical region 7. shoulder retraction and thoracic extension - eat foods that are soft, avoid those that need a lot of chewing, dont wide yawn, sing, chew gum, any activities that cause excessive jaw movement habit awareness and modification stress avoidance sleeping position, advise to sleep on back with neck support by a cervical pillow - avoid prone bite raising appliances, occlusal splints or bite guards Functional Phase Interventions - postural education - psychotherapy: counseling onlifesyle, relaxation therapy, hypnosis - manual therapy - trigger point therapy - exercises: strengthen cervicothoracic stabilizers, scapular stabilizers, stretching the scalene, trap, pec minor, levator stop, sub occipital extensions - excessive mandibular motion is treated by muscle reeducation with isometrics performed at desired opening range Thermal and Electrotherapeutic Modalities 1. moist heat pack - 15 minutes - soft tissue relax and increase circulation 2. high voltage electrical stimulation - muscle spasm, increase BF 3. ultrasound - relax soft tissues and increase circulation - 3mhz recommended - 0.75-1.0 intensity - tongue depressors during treatment to provide a gentle stretch 4. Iontophoresis - introduce medications such as cortisol, dexamethasone, salicylates, analgesics

Human Immunodeficiency Virus 1. what causes it? 2. pathophysiology 3. stages 4. transmission 5. behaviors that put you at high risk for transmission 7. diagnosis requires 8. HIV symptoms 9. Clinical course 10. Management 11. PT interventions

1. what causes it? by a virus HIV1 or HIV2 that weakens the immune system - important cells that fight disease and infection are destroyed 2. pathophysiology - reduction of CD4 helper T cells resulting in CD4 T lymphocytopenia; a major deficit in the immune system - retroversion will replicate in reverse fashion in the RNA code is transcibred to DNA 3. stages Stage 1= acute HIV infection, flu like illness within 2-4 weeks of infection Stage 2= clinical latency, asymptomatic HIV infection or chronic HIV infection, can last a decade or longer Stage 3= the most severe phase, over time, destroys so many cells that the body cant fight off infection and disease resulting in opportunistic illness 4. transmission - contact with certain body fluids (blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, breast milk) - needle or syringe 5. behaviors that put you at high risk for transmission - unprotected anal or vaginal sex with someone who has HIV - sharing needles or syringes - mother to child during pregnancy, birth or feeding 7. diagnosis requires - CD4 cell count 500-1200 - testing with HIV1/HIV2 antigen/antibody combination immunoassays 8. HIV symptoms - flu like - recurrent fever - night sweats - swollen lymph glands - sore throat - rash - muscle aches - disappear after few weeks Clinical Course - brief, early, nonspecific viral HIV infection and then remain asymptomatic for years - no cure, nearly every person progresses to AIDS Medical Interventions - antiviral drug therapies starting immediately usually give in combination with 3 or more drugs PT Interventions - moderate exercise program - post pone exercises during acute infections - aerobic exercise 20 minutes 3x week up to 45 minutes to an hours 3-4x per week - resistance exercise: moderate levels, weights that can be lifted 8-10 times - avoid exhaustive exercise. immunosuppression can occur with more intense exercise - avoid contact sports due to increased risk of bleeding - activity pacing - energy conservation - stress management and relaxation training

Thyroid Disorder: Hypothyroidism 1. what is it? 2. symptoms? 3. treatment? 4. red flags?

1. what is it? decreased activity of the thyroid gland with deficient thyroid secretion - metabolic processess slowed - decreased thyroid releasing hormone secreted by the hypothalamus or by the pituitary gland; atrophy of the thyroid gland; chronic autoimmune thyroiditis 2. symptoms? - weight gain - mental and physical lethargy - dry skin and hair - low BP - constipation - intolerance to cold - goiter 3. treatment? life long thyroid replacement therapy 4. red flags? - can result in exercise intolerance, weakness, apathy, exercise induced myalgia and reduced CO

Thyroid Disorder: Hypethyroidism 1. what is it? 2. symptoms? 3. treatment? 4. red flags?

1. what is it? hyperactivity of the thyroid gland - thyroid gland is typically enlarged and secretes greater than normal amounts of thyroid hormone - metabolic processes are accelerated 2. symptoms? - nervousness - hyperreflexia - tremor - hunger - weight loss - fatigue - heat intolerance - palpitations - tachycardia - goiter - diahhreah 3. treatment? antithyroid drugs 4. red flags? - can result in exercise intolerance and fatigue

Intestines Peritonitis 1. what is it? 2. results from what? 3. Symptoms

1. what is it? inflammation of the peritoneum, the serous membrane lining walls of the abdominal cavity 2. results from what? - bacterial invasion of peritoneum - ecoli - bacteroides - fusobacterium - streptococci 3. Symptoms - abdominal distention - severe abdominal pain - rigidity for reflux guarding - rebound tenderness - decreased or absent bowel sounds - nausea - vomitying - tachycardia - elevated WBC - fever - electrolyte imbalance - hypotension p

Intestines Appendicits 1. what is it? 2. where is pain?

1. what is it? inflammation of the vermiform appendix 2. where is pain? localized to the epigastric or periumbilical area (R side) rebound tenderness (blumbergs sign) is present in response to depression of the abdominal wall at a site distant from the painful area point tenderness is located and mccburnery point on the side of the appendix locked 1-2 inches above the ASIS on R lower quadrant rovings sign elects pain in the R lower quadrant with pressure on the left lower quadrant pain on the R lower quadrant occurs with hip extension from inflammation of the peritoneum overlying the posts muscle ****immediate medical attention required ****elevations in WBC >20,000 are indicated of perforation and surgery is needed

Adrenal Disorders: Cushing Syndrome 1. what is it? 2. what are signs and symptoms? 3. what are medical interventions?

1. what is it? metabolic disorder resulting form chronic and excessive production of cortisol by the adrenal cortex - from drug toxicity, over administered of glucocorticoids - most common cause is a pituitary tumor with increased secretion of ACTH 2. what are signs and symptoms? - decreased glucose tolerance - round moon face - obesity, rapid development of fat pads on the chest, abdomen, buffalo humo - decreased testosterone levels or decreased menstrual periods - muscular atrophy - edema - hypokalemia - emotional changes 3. what are medical interventions? - goal is to decerase excess ACTH - monitor weight, electrolytes and fluid balance

Post- Cesarean Complications 1. what is it? 2. physical therapy interventions

1. what is it? surgical delivery of the fetus by an incision through the abdominal and uterine walls - indicated in pelvic disproportion - failure of the birth process to progress - fetal or maternal distress 2. physical therapy interventions - postoperative TENS (electrodes placed parallel to the incision) - prevent post surgical pulmonary complications assist patient in breathing, coughing - pelvic floor exercises - postural exercises but be cautious about heavy lifting for 4-6 weeks - prevent incisional adhesions, friction massage

Stomach Peptic Ulcer Disease 1. what is it? 2. caused by what? 3. symptoms? 4. complications? 5. management? 6. red flags

1. what is it? ulcerative lesions that occur in the upper GI tract in areas exposed to acid-pepsin secretions 2. caused by what? - bacterial infection H pylori - aspirin (acetylsalicylic acid) - NSAIDS - excessive secretion of gastric acids - stress - heridatry 3. symptoms? - epigastric pain - gnawing buring - cramp like - pain aggravated by change in position and absence of food - relieved by food or antacids 4. complications? hemorrhage - blood in stool 5. management? - antibiotics for h pylori - acid suppressing drugs (PPI, H2 blockers, antacids) - dietart modifications - surgery for uncontrolled bleeding RED FLAGS - ulcers located on the posterior wall of the stomach can present as radiating back pain - can also radiate into the right shoulder - stress and piety increase gastric secretions and pain

Pregnant Physical Therapy Interventions 1. what to do? 2. Postural Changes with pregnancy 2. positions and things to avoid

1. what to do? - relaxation training - mental imagery - yoga - breathing management with slow, deep, diaphragmatic breathing - postural evaluation - stretch, strengthen and train postural muscles - teach pelvic stabilization exercises (posterior pelvic tilt) - correct body mechanics (sitting, standing, ADL) - exercises to improve and control pelvic floor dysfunction - exercise in moderation with frequent rest, use familiar activities - stress gentle stretching - adequate warm ups and cool downs - teach ankle pump - elevate legs in late stages 2. Postural Changes with pregnancy - kyphosis with scapular protraction - cervical lordosis - forward head - lumbar lordosis - postural stress from lifting and carrying infant - center of gravity shifts forward and upward as fetus develops - wider BOS - difficulty with walking and stair climbing challenges balance - ligamentous laxity - joint hyper mobility - SIJ joint pain - abdominal muscles stretches - pelvic floor muscle weakened - stress incontinence - pressure on bladder causes frequent urination, increased reflux and UTI - respiratory changes with elevation of the diaphragm with widening of thoracic cage, hyperventilation, dyspnea - increased blood volume, increased venous pressure, increased HR and cardiac output - decreased BP due to venous distensibility - altered thermoregulation increase basal metabolic rate, increased heart production 2. positions and things to avoid - avoid valsalva maneuver - limit certain activities in the 3rd trimester AVOID SUPINE POSITION TO AVOID INFERIOR VENA CAVA COMPRESSION, BRIDGING

RPE correlated with % of how hard 12= 13= 14= 17=

12= 40% 13= 60% 14-17= 60-90%

Exercise Guidelines Hemoglobin - normal for male + female <8 g/dL 8-10 g/dL >10 g/dL

14-18 male 12-16 female <8 g/dL essential activities of daily living 8-10 g/dL essential activities of daily living, assistance as needed for safety - light aerobics - lightweights 1-2 lbs >10 g/dL - ambulation - self care as tolerated - resistance and aerobic exercise

Wheelchairs 1. Pressure relief push ups how often? 2. Rigid frame facilitates what? Wheelchair Handrims 1. Caster Wheelchair Tires

15-20 minutes stroke efficiency and increased distance per stroke small front wheels - typically 8 inches in diameter - caster locks can be added pneumatic air filled tires= smoother ride

Gross Motor Classification for CP

1= WALKS WITHOUT RESTRICTIONS 2= WALKS WITHOUT AD 3= WALKS WITH AND MOBILITY DEVICES 4= SELF-MOBILITY WITH LIMITATIONS 5= SELF-MOBILITY IS SEVERLY LIMITED

Wrist and Hand Early Controlled Motion Approaches

2 approaches to the application of early controlled motion 1. maintain tendon gliding 2. prevent tendon adhesions - early passive flexion of IP joints passively Active - minimum tension - active contration first 24-72 hours but no later than 5 days post-op Place and Hold Approach - static muscle contractions to generate active tension of the finger flexors and improve controlled stress on repaired tendon Dynamic Approach - dynamic short art minimum muscle tension exercises to impose initially low intensity stresses on healing tendon Combined Approach - combines place and hold and dynamic approach - 8 progressive levels - warm up with passive finger motions 1. place and hold finger fl 2. active composite finger fl 3. hook and straight fist finger fl 4. isolated finger joint motion 5. continuation of levels 1-4 and discontinuation of protective orthosis with indtroduction of gradually using hand for functional activities 6. resisted composite finger flexion 7. resisted hook and straight fist 8. resisted isolated joint motion

Vertebrobasilar Artery Syndrome

2 verebral arteries arise off the subclavian arteries and supply the ventral surface of the medulla and posterior inferior aspect of the cerebellum before joining to form the basilar artery at the pons-medulla junction; the basilar artery supplies the ventral portion of the pons and terminates in the PCA

What is recommended intensity/ duration/frequency for chronic pulmonary dysfunction?

20-30 minutes 3-5x week high / low intensity =. if cant make it through higher intensity oscillate between high/low or rest periods can be used to accomplish the 2-30 minutes

BMI 1. Overweight 2. Obesity 3. Morbid Obesity Skin Caliper > what inch is indicative of excessive body fat? waste circumference assess what?

25-29.9 >/=30 >40 1 inch distributions of body fat

Percussion 1. how long over each lung segment? 2. contraindications (5)

3-5 minutes - fractured rib - flail chest - osteoporosis - elevated coagulation - decreased platelet count

Chronic Obstructive Pulmonary Disease

4 leading cause of mortality airflow imitation caused by chronic inflammation of the small airways and air paces in response to significant exposure to noxious particles or gases - Mucociliary dysfunction - decrease in BMI - decreased muscle strength - exercise intolerance Risk Factors - smoking - organic and inorganic dust - indoor pollutants - hyperactivity of airways - overall lung growth - exposure to pollutants - genetics Pathophysiology - chronic inflammation, increase in neutrophils, macrophages, t lymphocytes damages the endothelial lining of airways - airway inflammation causes airway narrowing - this leads to a airways remodeling and destruction of lung parenchyma - airway changes most pronounced in the smaller peripheral airways (bronchioles) - lost of elastic recoil properties of lung tissue - endothelial changes in pulmonary vasculature are altered early resulting in thickening of the vessel walls. - advanced stages of the disease there is destruction of the pulmonary capillary bed - decrease in ciliary function and alteration in physiochemical characteristics of bronchial secretions impair airway clearance and contribute to airway obstruction. - damaged and inflamed muscoa shows an increased sensitivity of irritant receptors within the bronchial walls, which in return causes bronchia hyperactivity Breathing - during inspiration the airways are pulled open by thoracic expansion allowing air to enter. - during exhalation the airways already narrowed by inflammation, remodeling, and some cases excessive secretions close prematurely trapping air in the distal airways and air spaces. - this air trapping causes hyperinflation causing increased FRC - ventilation and perfusion in the capillary membrane are no longer well matched resulting in hypoxemia - hypercapnea will then develop with increased in CO2 in the blood - increased pulmonary vascular resistance will result in pulmonary HTN and right ventricular hypertrophy (for pulmonate) - polycythemia occurs to potentially increase the oxygen carrying capacity of the blood Clinical Presentation - history of smoking - dyspnea (1st sx) - dyspneic at rest - chronic cough and expectoration - enlarged thorax due to hyperinflation and loss of lung elastic recoil - anterior posterior diameter of the chest increases and dorsal kyphosis results - barrel chest - assessors muscles recruited for breathing - diaphragm more horizontal then vertical due to fibers being altered - decreased breath sounds with auscultations - may hear wheeze, whistling or crackles - pursed lip breathing - cynosis - digital clubbing - RV and FRC are increased due to air trapping - FEV1 decreased to <70% - ABG= hypoxemia Course and Prognosis - BODE INDEX - 4 domains 1. BMI 2. pulmonary obstruction 3. dyspnea 4. exercise capacity

Blood Values 1. WBC 2. Hematocrit 3. Hemoglobin

4,000-11,000 35%-48% 12-16 g/dL

Exercise Guidelines White Blood Cells - normal <5,000 mm^3 >5,000 mm^3

4,500-11,000 <5,000 mm^3 with fever no exercise permitted >5,000 mm^3 light exercise permitted with progression to resistive exercise

Wrist and Hand Zone I, ii, iii Primary Flexor Tendon Repairs Moderate Protection Phase

4-8 weeks postop - safely increase stress on the repairs tendon and achieving full active FL and EXT of the wrist and digits and differential gliding of tendons - tenodesis orthosis is discontinued at beginning of this phase - static dorsal continues during the day except for exercise until at least 6-8 weeks - night orthosis for protection and prevention of flexion contractures Exercises 1. pace and hold exercises with gradually increase in tension 2. Active ROM 3. tendon gliding and blocking exercises (5-6 weeks initiate) avoid finger extension combined with wrist extension for about 6-8 weeks (places extreme stress on tendon)

Exercise training of HF

40-60% functional capacity -low, level gradually progress aerobic training - gradually increase duration with frequent rest periods - adequate warm up and cool down periods may need longer for more than the typical 5-10 minutes - use caution exercising in prone/supine position due to orthopnea - avoid breath holding and valsalva maneuver

What is a good test for someone with chronic pulmonary dysfunction to assess strength? what about UE function?

5 times sit to stand 6 minute peg-board and ring test

Type 2 Diabetes Mellitus (T2DM) 7. Diagnostic Criteria - plasma glucose - fasting plasma glucose - 2 hour post load glucose 8. Goals and Interventions 10. ACSM Cardiovascular Guidlines 11. ACSM Resistance Guidelines 12. Red Flags with Exercise 13. do not exercise if BGL is what? what should be heavily readily during exercise? and how much is given each hour? 14. do not exercise if BGL exceeded what?

7. Diagnostic Criteria - plasma glucose >/=200 - fasting plasma glucose >/=126 - 2 hour post load glucose 11.1 or 75g? 8. Goals and Interventions - monitor BGL - diet control - hypoglycemia agents - insulin - maintain normal lipid values - control HTN - exercise 10. ACSM Cardiovascular Guidlines - intensity 50-80% of VO2 max and HHR - 12-16 RPE - 3-7 days a week - 20-60 minutes - walking, large muscle activity, biking, treadmill walking, ground walking 11. ACSM Resistance Guidelines - 2-3 days a week - 60-80% of one repetition max 2-3 sets of 8-12 reps - multijoint exercises of major muscle groups - minimize sustained gripping, static work, valsalva maneuver to decrease hypertensive response - flexibility and balance exercise 12. Red Flags with Exercise - monitor glucose prior and following exercise Hypoglycemia is the most common problem for patients with diabetes who exercise - do not exercise if blood glucose level is <70 - provide cards 15g readily available during exercise - 15g for every hour of exercise - may last as long as 48 hours after exercise Hyperglycemia - do not exercise when blood glucose levels are high >300 fasting glucose or poorly controlled ketosis is present - do not exercise without eating at least 2 hours before exercise - do not exercise without adequate hydration and maintain hydration during exercise session other parameters - do not exercise alone - inject insulin into ABDOMINAL - do not exercise in extreme environmental temperatures. very hot or very cold due to thermoregulation issues

Laboratory Test for Liver and Biliary Tract Disease (Adult Values) 7. Prothrombin Time 8. Platelets 9. INR

7. Prothrombin Time 12-15 seconds - prolonged with liver damage - double for individuals taking anticoagulant 8. Platelets 150,000-400,000 - may drop when spleen is enlarged from portal hypertension 9. INR 0.9-1.1 for health adult not on coagulant for individuals on anticoagulant medication >/=2.5= guard against falls >3.0 risk for hemarthrosis >4.0 evaluation, therapy, or increase in routine exercise may be contraindicated or modified. consult with physician >6.0 may require bed rest until corrected

Rancho Los Amigos Levels of Cognitive Function 1. what is it?

8 general cognitive and behavioral levels

Wrist and Hand Zone I, ii, iii Primary Flexor Tendon Repairs Minimum Protection Phase

8 weeks post op - gradually progress resistance exercises to improve strength and endurance - dexterity exercises - 1-2lb functional activities intermittent use of orthosis if patient has persistent extensor lag or flexion contracture full activity by 12 weeks

Inspiratory muscle weakness is denied as a PImax of what?

<60 mmHg

ABI Scale

>1.2 falsely elevated, arterial disease, diabetes 1.19-0.95 NORMAL 0.94-0.75 mild arterial disease, + intermittent claudication 0.74-0.50 moderate arterial disease, + rest pain <0.50 severe arterial disease

Multiple Sclerosis

A chronic disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech - Relapse- Remitting Disease (RRMS) - Primary- Progressive (PPMS) - Secondary-Progressive (SPMS) - Progressive-Relapsing (PRMS)

Duchenne Muscular Dystrophy

A human genetic disease caused by a sex-linked recessive allele; characterized by progressive weakening and a loss of muscle tissue. x- linked recessive - inherited by boys - carried by recessive gene of mother - diagnosis by clinical exam, EMG, muscle biopsy, DNA analysis, blood enzyme levels - dystrophin gene missing results in increased permeability of sarcolemma and destruction of muscle cells - collagen adipose laid down in muscle leading to pasudohypertrophic calf muscles impairments - progressive weakness from PROXIMAL TO DISTAL beginning at 3 year of age to death in late adolesnces or early adult hood - postive GOWERS sign due to weak quadriceps and gluteal muscles. child must use UE to "walk up legs" and rise from prone to standing - cardiac tissue involved - contractures and deformities develop especially of heel cord and TFL as well as lumbar lordosis and kyphoscoliosis PT goals - maintain mobility as long as possible - maintain ROM - E stim to icnrease contractile ability - do not exercise and maximum level - leads to respiratory insufficiency and death in wound adult hood medications - palliative and supportive care - steroids (prednisone) - muscle lengthening surgeries beckers muscular dystrophy is a slower variant of DMD emerging in late childhood or adolescence. cease walking around 27 years of age and death at approximately 42 years of age

What is a spastic bladder?

A hyperreflexic detrusor muscle that leads to uncontrolled voiding and the inability to store urine because of the spasms. Bladder emptying becomes reflexive and lesions appear superior to the sacral spinal cord. Spinal cord control becomes segmental due to absent higher CNS control - dyssynergia is a lack of coordination between the detrouser and splinter

Standard Precautions

A strict form of infection control that is based on the assumption that all blood and other body fluids are infectious.

Continuous Passive Motion (CPM) - for who - precautions - contraindications

A therapy that prevents stiffness and improves circulation by delivering a form of passive range-of-motion exercise so that the joint is moved without the patient's muscles being used. Exercises that are performed by motorized exercise machinery that keeps a joint in constant slow motion for who - post immobilization fracture - tendon or ligament repair esp ACL precautions - intracompartmental hematoma from anticoagulant use contraindications - increases pain, edema, inflammation following treatment

Braden Scale

A tool for predicting pressure ulcer risk

Plagiocephaly (Flat Head Syndrome)

A type of cranial deformation that is classified based on severity. Described as a parellelogram-shaped skull with ipsilateral occipital flattening and contralateral bulging - develops due to congenital muscular torticollis or supine positioning that results in excessive pressure son the malleable skull with "floating plates" cranial remodeling - helmet made of thermo plastic material lined with high density foam - worn 20-23 hours per day for 2-7 months - child 18 months the sutures of plates in the skull fuse and the helmet is no longer useful - surgery in only very severe cases

Phlebolymphedema

A venous—lymphatic dysfunction; mixture of • Low protein edema from the venous system and • High protein edema from the lymphatic system Differ from venous in which this - skin changes - hyperpigmentation

Orthostatic hypotension is significant in what level? how should you treat it?/Pharm mgmt

ABOVE T6 - fainting - blurred vision - ringing in ears - light headed TX - evaluation of head of bed - compressive stockings - ace wraps on LE - abdominal binder Pharm - ephedrine to increase BP or low dose diuretics to relieve persistent edema of legs, ankles or feet

Inhibits biosynthesis of Angiotensin II and inhibits the increased BP, lowers the BP, decreases fluid retention and peripheral resistance used in CHF Diuresis

ACE: angiotensin converting enzyme inhibitor - captopril, miso-til - ENDS IN PRIL side effects: headache, dizzy, postural hypotension, HYPERKALEMIA DRY HACKING COUGH THIAZIDE loop diuretics: furosemide, bumetanide, torasemide - the salt balance in the blood stream sometimes being upset which can cause a low blood volume of potassium, sodium and magnesium and a high level of calcium - can cause weakness, confusion

Unhappy Triad 1. What ligaments? 2. How does it happen? // what movement

ACL, MCL, medial meniscus resulting from a combination of valium, flexion, ER forces applied to the knee when the foot is planted

Reverse lordosis

AKA SWAY BACK - thoracic kyphosis - posterior pelvic tilt - stretching of anterior hip ligaments, back extensiors and hip flexors, - hip hyperextension and compression of the vertebrae posteriorly ** kyphosis of lumbar spine may indicate damage to the SSL complex

ARBS Agents Loop Diuretic

ARBS Agents blocks angiotensin II receptor site rather than enzymatic production of angiotensin like ACE inhibitor - reduces BP - angiotensin receptor blockers (ARB) - losartan side effects: HYPERKALEMIA Loop Diuretic - treats CHF - furosemide, thiazide - excessive leptons of K+ HYPOKALEMIA

ankylosing spondylitis vs. lumbar stenosis

AS - morning stiffness - male - sharp pain --> ache - bilateral sacroiliac pain that may refer to posterior thigh - restricted active and passive movement - flexed posture of entire spine - normal sensory and reflexes in beginning of disorder - plain films are diagnostic LS - intermittent aching pain - may refer to both legs when walking - flexed posture of lumbar spine - temporary sensory deficits - arom and prom may be normal - bicycle test + stoop test - CT scabs are diagnostic

Positive Expiratory Pressure Device

Acapella Assists client to remove airway secretions Clients inhales deeply and exhales through device While exhaling a ball moves (that is inside the device) causing a vibration that results in loosening the clients secretions - tx is 10-20 minutes

Extensor Plus Deformity

Adhesions or shortening of extensor communist tendon proximal to MCP joint - inability for patient to simultaneously flex the MCP and PIP joints but may be flexed individually

Residual Volume

Amount of air remaining in the lungs after a forced exhalation

Expiratory Reserve Volume

Amount of air that can be forcefully exhaled after a normal tidal volume exhalation

Inspiratory Reserve Volume

Amount of air that can be forcefully inhaled after a normal tidal volume inhalation

Psoriatic Arthritis

An inflammatory arthritis associated with psoriasis of the skin - chronic, erosive - joints of digits and axial skeleton - NSAIDS, corticosteroids, DMARDS, BRMS - DX: not useful except to rule out RA

Ankle Foot Orthosis 1. Foot Plate 2. Stirrup Ankle Control's 1. Free Motion 2. Solid Ankle 3. Limited Motion - Bichannel Adjustable Ankle Lock - Anterior Stop (DF stop) - Posterior Stop (PF stop) 4. Solid AFO Dorsiflexion Assistance 1. Spring Assist 2. Posterior Leaf Spring (PLS) Molded AFO 1. Posterior Leaf Spring (PLS) 2. Modified AFO 3. Solid Ankle AFO 4. Spiral AFO Specialized AFO 1. Patellar-Tendon Bearing Brim 2. Tone Reducing Orthosis

Ankle Foot Orthosis 1. Foot Plate molded plastic shoe insert 2. Stirrup - metal attachment riveted into the sole of the shoe. allow for shoe interchanges Ankle Control's 1. Free Motion mediolateral stability that allows for free motion in DF and PF 2. Solid Ankle allows NO movement - severe pain or instability 3. Limited Motion - Bichannel Adjustable Ankle Lock ankle joint with anterior and posterior channels - can be fit with pins to reduce motion or springs to assist motion - Anterior Stop (DF stop) - limits ankle DF - set to allow 5 degrees DF - knee flexion results - can be used to control hyperextension - if set too much, knee buckling occurs - Posterior Stop (PF stop) - limits PF - set to allow slight PF 5 degrees - knee extension results - control knee that buckles - too much PF knee hyperextension can result 4. Solid AFO limits all foot and ankle motion Dorsiflexion Assistance 1. Spring Assist double upright metal AFO with a single anterior channel for spring assist to aide in DF 2. Posterior Leaf Spring (PLS) a plastic AFO that inserts in the shoe widely used to prevent foot drop Molded AFO made of molded plastic and are lighten in weight, cosmetically more appealing, contraindicated for those with changes in leg volume 1. Posterior Leaf Spring (PLS) - flexible narrow posterior shell - shell functions as DF assist - holds foot at 90 degree angle during swing - displaced during stance - provides no medial/lateral stability 2. Modified AFO - wider posterior shell - provides more medial/lateral stability - control for calcanea forefoot and eversion 3. Solid Ankle AFO - wide posterior shell - prevents DF, PF, inversion and eversion 4. Spiral AFO spirals around calf - provides limited control of motion in all planes Specialized AFO 1. Patellar-Tendon Bearing Brim allows for weight distribution on the patellar shelf - reduce WB forces through the foot 2. Tone Reducing Orthosis applies constant pressure to spastic or hypertonic muscles

Anti Diuretics (2) and side effects

Antidiuretics retain water, constricts blood vessels Vasopressin - contains arginine - HTN, CHF, edema Aldosterone - raises BP or during hypotension - adrenal grands secrete aldosterone and cortisol - stimulates adrenal glands to release cortisol - HTN, CHF, EDEMA

Auscultation Points

Aortic - 2nd intercostal space just right of sternum Pulmonary - 2nd intercostal space just left of sternum Tricuspid - 5th/6th intercostal space generally left of sternum Mitral Apex at 4th/5th midclavicular line (mammary line)

Superficial Thermotherapy 1. What is it? 2. Indications 3. Precautions 4. Contraindications 5. Hot Packs 7. Hydrotherapy

Application of modalities to body surface 1) hot packs 2) warm water baths 3) fluidotherapy 4) infrared lamp 5) paraffin 2. Indications - modulate pain - increase CT tissue extensibility - reduce or eliminate soft tissue inflammation and swelling - accelerate rate of tissue healing - reduce or eliminate soft tissue and joint restriction and muscle spasm 3. Precautions - cardiac insufficiency - edema - impaired circulation - impaired thermal regulation - metal in treatment site - pregnancy - where topical counteriirants have recently been applied - demyelinated nerves - open wounds 4. Contraindications - acute and early subacute traumatic and inflammatory conditions - decreased circulation - decreased sensation - DVT - impaired cognitive function - malignant tumors - hemorrhage or edema - very young and very old patients good cognitive function a call bell or other signaling device can be given to the patient to alert personnel of any untoward effects of treatment 5. Hot Packs - 165F-170F - reach peak heat within 5 minutes/greatest risk of a burn - check skin within first 5 minutes then periodically after - tx time: 20-30 minutes 7. Hydrotherapy partial or total immersion baths in which the water is agitated and mixed with air to be directed against or around the affected part - can move extremities easily because of buoyancy and therapeutic effect of the water - convection - indicated for subacute and chronic MSK conditions - precautions are decreased temp, sensation, impaired cognition, recent skin graft, confusion/disorientation, reconditioned state - contraindicated for WOUND MANAGEMENT - irrigation PLWS

Apraxia Ideomotor Apraxia Ideational Apraxia

Apraxia inability to perform voluntary, learned movements in the absence of loss of sensation, strength, coordination, attention, or comprehension, represents a breakdown in the conceptual system or motor production system or both Ideomotor Apraxia patient cannot perform the task on command but can do the task then left on own Ideational Apraxia patient cannot perform the task at all, either on command or on own

Venous Vs. Arterial Ulcers 1. Etiology 2. Appearance 3. Location 4. Pedal Pulses 5. Pain 6. Drainage 7. Associated Gangrene 8. Associated Signs

Arterial 1. Etiology arteriosclerosis obliterates, atheroembolism 2. Appearance - irregular smooth edges - minumum to no granulation - usually deep 3. Location - distal lower leg - toes - feet - lateral malleolus - anterior tibial areas 4. Pedal Pulses decreased or absent 5. Pain painful, especially if legs elevated 6. Drainage not present 7. Associated Gangrene may be present 8. Associated Signs trophic changes, pallor on foot elevation, dusky rubor on dependency Venous 1. Etiology - valvular incompetence - venous HTN 2. Appearance - irregular - dark pigmentation - sometimes fibrotic - good granulation - usually shallow 3. Location - distal lower leg - medial malleolus 4. Pedal Pulses usually present 5. Pain little pain, comfortable with legs elevated 6. Drainage moderate to large amounts of exudate 7. Associated Gangrene absent 8. Associated Signs edema, stasis dermatitsis, possible cyanosis on dependency

VOR Gain VOR Phase Semicircular canals

As the head moves in one direction, the eyes move in the opposite direction with equal velocity represents the amplitude relationship between the eye and head - if the head moves 10 degrees to the right the eyes should move 10 degrees to the left - when the head and eyes are equally positioned but oppositely directed this is a 0 phase shift ipsilateral anterior and contralateral posterior work in pairs left anterior cancel is paired with right posterior canal

Ascending Ramp with Wheelchair Descending Ramp with Wheelchair

Ascending Ramp with Wheelchair - forward lean of head and trunk - use shorter strokes - move hands quickly for propulsion Descending Ramp with Wheelchair - grip hand rims - loosely control chair decent or descend in wheelie position

Ascending Stairs 1. What way do you walk? 2. What way to do guard the patient? Descending Stair 1. What way do you walk? 2. What way to do guard the patient?

Ascending Stairs 1. What way do you walk? - up with the good - followed by the crutches/cane 2. What way to do guard the patient? - behind - slightly to the involved side Descending Stair 1. What way do you walk? - down with the bad - crutches go down first with them 2. What way to do guard the patient? - anterior - slightly to the involved side

ABCDEs of melanoma

Asymmetry - uneven edges - lopsided Border - irregular - poorly defined edges - notching Color - variations - mixture of black, blue, red Diameter - larger than 6cm Elevation (for evolving) - usually elevated - may be flat - moles that changed over time

Rheumatoid Arthritis - what is it? 1. Age of Onset 2. Progression 3. Manifestations 4.Joint Involvement 5. Joint Signs and Symptoms 6. Systemic Signs and Symptoms 7. Treatment

Autoimmune chronic inflammatory systemic disease primarily of unknown etiology affecting the synovial lining of joints. characterized by a fluctuating course with periods of active disease and remission. mild joint symptoms, aching, stiffness, swelling, and progressive deformity. need >/=6 out of 10 score - symmetric, erosive synovitis with periods of exacerbation (flare) and remission. early inflammatory changes in the synovial membrane, peripheral portions of articular cartilage and subchondral marrow spaces. in response granulation tissue (panes) forms, covers and erodes the articular cartilage, bone, and ligaments in the joint capsule. adhesions form and restrict joint mobility. - with progression of the disease cancellous bone becomes exposed and fibrosis/ossific ankylosis or subluxation may eventually cause deformity and disability 1. Age of Onset usually begins between age 15 and 50 2. Progression may develop suddenly, within weeks or months 3. Manifestations inflammatory synovitis and irreversible structural damage to cartilage and bone 4.Joint Involvement - usually affects may joints - usually bilateral - MCP, PIP - wrist - elbows - shoulders - cervical spine - MTP - talonavicular - ankle 5. Joint Signs and Symptoms - redness - warmth - swelling - prolonged morning stiffness - increased joint pain with activity 6. Systemic Signs and Symptoms generally feeling of sickness and fatigue - weight loss and fever - may develop RA nodules - may have ocular, respiratory, hematological and cardiac symptoms Treatment: - energy conservation - joint mobility grade I and II - do not stretch swollen joints (contraindication) - high velocity thrust techniques (contraindication) - immobilize in orthosis - gentle isometrics progress to ROM when tolerated - exercise that does not cause joint stress - chronic stage = nonimpact or low impact such as aquatic, cycling, aerobic dancing, walking, running - avoid prolonged static positioning. change positions every 20-30 minutes - steroids may cause osteoporosis and ligamentous laxity - loss of joint function is irreversible and often surgery is needed to decrease pain and improve function

Autonomic Dysreflexia 1. What is it? 2. Occurs in lesions?? 3. How does it happen? 4. What is the cause? 5. What are symptoms? - rise is what BP is diagnostic? 6. What are interventions

Autonomic hyper-reflexia that can be life threatening. - acute onset of autonomic activity from noxious stimuli below the level of the lesion. - afferent input from these stimuli reach the lower spinal cord and initiate a mass reflex response resulting in elevation of blood pressure. - impulses from the vasomotor center cannot pass the site of the lesion to counteract hypertension. - HTN can result in seizures, cardiac arrest, subarachnoid hemorrhage, stroke, death - occurs in lesion above T6 - common in the chronic stages of recover common cause is BLADDER AND BOWEL DISTENTION/IRRITATION - distended bladder, blocked catheter, UTI, kidney stones, irritation of bladder or urethan during cauterization or other procedures. - can also occur from pressure injuries, noxious cutaneous stimuli kidney malfunction, ESTIM, sexual activity, labor, skeletal fracture Symptoms - HTN - bradycardia - headache (severe and pounding) - profuse sweating - increased spasticity - restlessness - vasoconstriction below level of lesion - constricted pupils - nasal congestion - pilorection - blurred vision - rise in systolic BP of 20-30 mmHg IS DIAGNOSTIC OF AD WITH SCI BP - resting 90-110 with neurological level about T6 - BP with AD may rise to 250-300 and diastolic 200-220 Interventions - brought upright - loosen tight clothing or restricted devices - examine bladder and drainage systems and remove immediately if blocked - abdominal binders check - Antihypetensive medications to lower BP - CLONIDINE in recurrent cases

Fibromyalgia vs Myofascial Pain syndrome

BOTH - pain in muscles - decreased ROM - postural stresses Fibromyalgia - tender points at specific cites - no referred patterns of pain - no tight band of muscles - fatigue and waking unrefreshed - need 11/18 tender points MPS - trigger points in muscle - referred patterns of pain - tight band of muscle - no related fatigue complaints

Bowel for SCI 1. UMN 2. LMN

Because parasympathetic and internal sphincter connection of S2-S4 are in tact reflex defection can occur when the rectum fills with stool S2-S4 are not intact so the bowel will not refelxively empty. this can cause feces to become impacted and incontinence can occur

Periventricular-Intraventricular Hemorrhage

Bleeding around and into the ventricles of the brain. - bleeds graded I-IV - grade II-IV may result in CP

Somatognosia

Body Scheme disorder Have patient identify body parts or their relationship to each other

Bone Patellar Bone vs. Patella Tendon Graft

Bone Patellar Bone - more rapid progression of exercises due to healing being faster Patella Tendon Graft - be cautious with knee extensor strengthening **HS tendon graft be careful with knee flexion strengthening **tendon graft goes through a necrotizing process for the first 2-3 weeks post-op before revascularization commences

OA Most common in what joint

C5-C6 C6-C7

Respiratory Acidosis 1. Causes 2. Observe for 3. May lead to

CO2 retention, impaired alveolar ventilation 1. Causes hypoventilation, drugs/oversedation, chronic pulmonary disease, hypermetabolism (sepsis, burns) 2. Observe for dyspnea, hyperventilation, cyanosis, restlessness, headache 3. May lead to disorientation, stupor and coma / death

Calcium Antagonist (2) Anti-Arrhythmic Drug (1) Increase force/ strength of contractility of the ventricles of the heart (1) and side effects

Calcium Antagonist (2) decreases the force of contraction of heart muscles causing vasodilation - anginal pain, anti HTN, decreases arrhythmia drugs: verapamil, amlodipine, nifedipine ending with PINE AND ZEM side effects: lightheaded, constipation, face flushing, headache, nausea, vomiting, sexual problems, weakness, tiredness, orthostatic hypotension Anti-Arrhythmic Drug (1) used in treatment of abnormal heart rhythms such as atrial fibrillation, atrial flutter, ventricular arrhythmias such as paroxysmal ventricular tachycardia - Quinidine - side effects : vomiting, heart burn, rash, fever, dizziness, fatigue, weakness, headache Increase force/ strength of contractility of the ventricles of the heart (1) increases SV, decreasing the duration of contraction of ventricles - ECG depressed ST segment, QT shortens, flat T waves. used in CHF Side effects: ARRHYTHMIA, palpitations, fatigue, weakness due to increased strength of contraction - digoxin toxicity is very common: GI disturbances, loss of appetite, confusion, blurred vision, irregular pulse - hypokalemia: excessive potassium depletion

Cardiovascular Impairments of SCI

Cardiovascular function is regulated by the brainstem and hypothalamus via the sympathetic and parasympathetic nervous system of the autonomic nervous systems. Parasympathetic signals to the heart arise from the vagus nerve, decreasing heart rate and contractility. - sympathetic outflow comes from spinal segments T1-L2 through the sympathetic trunk increasing HR and heart contractility and peripheral vasoconstriction - sympathetic outflow to the heart and blood vessels of the upper body comes from above T6 - while sympathetic outflow to blood vessels of the lower body come from below T5 (T6-T12) - THUS a higher SCI above T6 will result in loss of sympathetic control to the heart and blood vessels below the level of the inrush and intact parasympathetic to the heart. - T6 and below has intact sympathetic and para to the heart but loss of sympathetic control to the blood vessels below level of injury - this imbalance can cause a variety of CV impairments 1. neurogenic shock 2. bradyarrhythmias 3. hypotension 4. orthostatic hypotension 5. impaired cardiovascular reflexes above T6 - neurogenic shock because sympathetic output to the hear is lacking and lags (para) input is unopposed.

Skin Color 1. Cherry Red 2. Cynaosis 3. Pallor 4. Yellow 5. Liver Spots

Cherry Red palmar erythema could indicate liver or renal issues Cynaosis - slightly bluish, grayish, slate-colored discoloration - indicates lack of oxygen (hemoglobin) Pallor - indicates anemia, internal hemorrhage - arterial insufficiency Yellow - jaundice, liver disease Liver Spots brownish, yellow spots may be due to aging, uterine and liver malignancies, pregnancy Brown - CVI - hemosiderin

Parkinsons Cognitive Status Communication Oral Motor Control Cardiorespiratory function ROM Sensation/Perceptual Function Vision Skin Integrity and Condition Autonomic Changes Muscle Tone Muscle Strength Motor Function Involuntary Movements Blance Gait Functional Status Psychosocial Function Patients on Levodopa Medical Management Physical Therapy Goals

Cognitive Status - intellectual impairments - examine memory deficits - dementia in advanced stages - bradyphrenia (slowing of thought process) - depression Communication - dysarthria - hypophonia (decreased volume) - mask like face with infrequent blinking and expression - writing becomes progressively smaller Oral Motor Control - dysphagia - problems chewing and swallowing Cardiorespiratory function - examine reduced endurance - altered breathing patterns and chest mobility - decreased thoracic expansion, RR - orthostatic hypotension is common ROM - deformity associated with diseases and inactivity - contractors common in flexors, adductors - persistent posturing in kyphosis with forward head - many patients osteoporotic with high risk for fracture Sensation/Perceptual Function - examine for aching, stiffness, abnormal sensations - problems in spatial organization - perception of vertical - extreme restlessness (akathisia Vision - examine for blurring - cog wheeling eye pursuit - eye irritation from decreased blinking - decreased pupillary reflexes Skin Integrity and Condition - edema - circulatory changes in LE Autonomic Changes - excessive drooling (salivation) - sweating - greasy skin - abnormalities in thermal regulation Muscle Tone - examine for rigidity - examine symmetry between two sides of body Muscle Strength - weakness is associated with disuse atrophy - assess torque output at varying speeds (isokinetic) Motor Function - examine bradykinesia (slowed movement) or akinesia (absence movement) - ability to initiate movement (# of freezing episodes - assess reaction time versus movement time - overall poverty of movement Involuntary Movements - tremor - resting tremor common especially in pill rolling of hands - tremors during movement may occur in advanced stages - postural tremors Balance - impaired postural reactions are common; worse with sever rigid of trunk, lack of trunk rotation) Gait - poverty of movements with generalized lack of extension - destination common (abnormal voluntary increase in the speed of walking often with forward acceleration but may occur with backward progression - examine freezing gait Functional Status - functional mobility skills - dexterity/ hand function Psychosocial Function - levels of depression, stress, anxiety, available coping strategies Patients on Levodopa - examine for fluctuations in symptoms - long term use 2-3 years Medical Management - sinemet (LEVODOPS/CARBIDOPA) Decreses the affect of the disease. adverts effects are vomiting, orthostatic hypotension, cardiac arrhythmias, involuntary movements, psychos, abnormal behaviors, hallucinations common . off phase experience sudden changes from normal function to immobility to severe dyskinetic movements - dopamine agonist drugs (enhance carv/lev) - anticholinergic drugsL enhance dopamine release - amantadine: enhance dopamine release - selegilince: increase dopamine early to slow progression - deep brain stimulation in thalamic or sub thalamic nucleus

Ulnar Drift

Commonly seen in patients with RA - due to weakening of the capsuloligamentous structures of the MCP joints and accompanying "bowstring" effect of the extensor communist tendons

Full- Thickness Burn (Third Degree) 1. Characteristics 2. Healing when? 3. Scarring?

Complete destruction of epidermis, dermis and subcutaneous tissues and may extend into muscles - white ischemic, charred tan or black appearance - no blanching - poor distal circulation - parchment like, dry leathery surface - depressed area - little pain - nerve endings are destroyed - removal of eschar and skin grafting are necessary due to destruction of dermal and epidermal tissue - risk of infection is increased - hypertrophic scarring and wound contracture are likely to develop without preventive measures

Locked in Syndrome (complete basal artery syndrome) 1. what is it? 2. what causes it? 3. Symptoms

Condition in which a patient is aware and awake but cannot move or communicate verbally because of complete paralysis of nearly all voluntary muscles except the eyes. due to basilar artery thrombosis and bilateral infarction of ventral pons - tetraplegia (quadriplegia) - bilateral cranial nerve palsy - upward gaze is spared - coma - cognition is spared

Drugs that Soothe the GI Tract Constipation DTC Antacids A DM type II patient on metformin asks PT if OTC antacids or herbals can be taken?

Constipation - Psyllium, fibers, laxatives - side effects gas, stomach cramps DTC Antacids ranitidine, Zantac, nizatdine, pepside, famotidine A DM type II patient on metformin asks PT if OTC antacids or herbals can be taken? herbal antacids are not significantly beneficial - the OTC acids can be taken above but not in excess because cemetedine interferes with metformin

Dupuytren Contracture

Contracture of the palmar fascia - fixed flexion deformity of the MCP and PIP - **usually seen in the ring or little finger - men > women - 50-70 year old age group

Adventitious (Extra) sounds (2)

Crackles - also termed rales/crepitations - crackling sound heard usually during inspiration that indicates pathology atelectasis fibrosis pulmonary edema Wheezes - musically pitched sound - usually heard during expiration - caused by airway obstruction asthma COPD Foreign body aspiration

Classification of % of Body Burned 1. Critical 2. Moderate 3. Minor

Critical - 10% with 3rd degree - 30% or more with second degree Moderate - <10% 3rd degree - 15%-30% with second degree Minor - <2% with 3rd degree - 15% with second degree

Ulnar Variance

Difference in lengths of radius & ulna -Interosseous membrane tension changes

Medications for heart failure (2)

Digitalis (Digoxin) - increases cardiac output - decreases HR Diuretics (Lasix) - decreases vascular fluid volume - decrease preload and afterload - control HTN

Ultrasound Procedures 1. Direct Contact

Direct Contact - transducer/skin interface - moving sound head in contact with relatively flat body surface - apply coupling medium - select sound head that is half the size of the treatment area - place sound head at right angle to skin surface - move sound head slowly 1.5 inches/sec in overlapping circles or longitudinal strokes - DO NOT cover an area greater than 2-3x the size of effective radiating area per 5 mins of tx - to cover an area greater than twice the ERA apply US in 2 or more sections - tx intensity 0.5-2.5w/cm2 - lower intensity for acute conditions or thin tissue (wrist joint) - chronic conditions or thick tissue (low back) higher intensities - if there is perosteal pain its because the high intensity. if occurs, stop treatment and readjust US intensity or add more coupling agent - tx time 3-10 minutes

Discrete Motor Skills Serial Motor Skills

Discrete Motor Skills skills that have a recognizable beginning and end point (sit to stand) Serial Motor Skills skills that combine a series of discrete skills with a specific order of actions (transfers)

DCMLP

Dorsal column - synapse w dorsal column nuclei Nuclei gracilis and cutaneous Cross to opposite side Pass up to thalamic through bilateral pathway (medial leminscus) Termiantes at ventral posterolateral thalamic To thalamus 3rd order neurons project to somatosensory cortex

Drugs to lower high cholesterol Drugs to lower blood cholesterol

Drugs to lower high cholesterol - statins (most effective class of drugs for lowering serum low-density lipoprotein cholesterol concentrations) - lipitor - pravachol - zocor - livalo - Crestor side effects rnhabdomylosis: dark colored Drugs to lower blood cholesterol - niacin - requires lab test to check LFT

Signs of Hypoglycemia + treatment

EARLY SIGNS - pallor - shakiness/trembling - sweating - excessive hunger - tachycardia - palpitations - fainting or feeling faint - dizziness - fatigue and weakness - poor coordination and unsteady gait LATE SIGNS - nervousness - irritability - headache - blurred or double vision - slurred speech - drowsiness - inability to concentrate - confusion - delusions - loss of consciousness and coma <70 mg or a rapid drop in glucose - onset is rapid provide sugar if unresponsive IV glucose

Electrical Conduction Abnormalities Ventricular Tachycardia

EMERGENCY a run of 4 or more PVS in a row is V-Tach - sustained - non sustained sustained - HR of at least 100bpm and last for at least 30s - patient may not have a palpable pulse - if present pulse is weak - severe decrease in CO and rapid hemodynamic deterioration this is an EMERGENY - no PT is appropriate except stabilization, initiating CPR - may turn into V-Fib quickly non sustained - groups of 3-5 PVC known as salvos or a run of six or more PVC lasting for up to 30s - high risk indicator of potential lethal arrhythmias - do not do PT interventions

Shoulder capsular pattern

ER/ ABD/ IR

Lab Values Enzyme elevation: kinase SaO2 less than what requires supplemental O2 PaO2 < than what indicates mild hypoxia? PO2< what indicates severe hypoxia and requires O2? Elevated totally cholesterol and LDL associated with what?

Enzyme elevation: kinase - diagnostic of MI in which creatine kinase is elevated due to MI damage SaO2 less than what requires supplemental O2= <88% - NORMAL IS >/=95% <80 <60 CAD

Superficial Partial Thickness Burn (Second Degree) 1. Characteristics 2. Healing when? 3. Scarring?

Epidermis and upper layers of Dermis are damaged - bright pink or red appearance - blanching with brisk capillary refill - blisters - moist surface - weeping - moderate edema - painful - sensitive to tough - temperature changes - 7-21 days - minimal or no scarring - discoloration

Forearm capsular pattern

Equal loss of supination and pronation

Classification of Knee Injuries 1. First degree 2. Second degree 3. Third degree

First - little or no instability Second - minimal to moderate instability Third - extreme instability

Oral Airway Oscillation Devices

Flutter **helps removal of secretions from airways** - patient inhales a normal breath - during exhalation through the device the exhaled air causes an intermittent backward air pressure that oscillates the airways usual procedure - exhale 10 or so breaths followed by 2 large exhaled volumes through the device and finally a huff or cough to clear mobilized secretions - repeat until all secretions are cleared from the lungs

Shaking Technique 1. How do you do it? 2. How many breaths? 3. Commonly used following what? 4. Contraindications?

Following a deep inhalation a bouncing maneuver is applied with the therapists open hands to the rib cage throughout the expiratory phase of breathing 5-7 deep breaths with shaking on exhalation to hasten the removal of secretions via the mucociliary transport system commonly used following percussion - fractured rib - flail chest - osteoporosis - elevated coagulation - decreased platelet count

Transtibial Prosthesis Foot Ankle Assembly Solid Ankle Cushion Heel SACH Foot Solid Ankle Flexible Endoskeleton Flexed Foot Single Axis foot

Foot Ankle Assembly - absorb shock at heel strike - PF in early stance - permit MTP ext in late stance Solid Ankle Cushion Heel SACH Foot - most common - non articulated - limits sagittal plane motion - very very small frontal and transverse plan motion - assist in hyperextension of knee (knee stability) in stance Solid Ankle Flexible Endoskeleton - flexible - non articulated similar to SACH - permits more nonsagittal plane motion - more active individuals Flexed Foot - leaf spring shank (not a foot) - used with endoskeleton prosthesis - stores energy in early stance for later during push off - more active individuals Single Axis foot - articulated foot with lower shank - motion is controlled by ant/post rubber bumps that limit DF and PF - permits only sagittal plane motion - more stable - more for bilateral transferal amputation

Lower Lobes Posterior Basal Segments

Foot of bed elevated 20 in Patient lies on abdomen, head down, with pillow under hips. Therapist claps over lower ribs close to spine on each side

Left Upper Lobe Singular Segments

Foot of table or bed elevated 16 inches. Patient lies head down on right side and rotates 1/4 turn backward. Pillow may be placed behind from shoulder to hip. Knees should be flexed. Therapist claps with moderately cupped hand over left nipple area. In females with breast development or tenderness use cupped hand with heel of hand under armpit and fingers extending forward beneath the breast.

Stage 2

Freezing - 3-9 months - persistent pain even at rest - limited motion in all directions - cant be restored with injection

Conventional Postoperative Management After Achilles Tendon Repair or Reconstruction With Graft - Postoperative Time Period - Type and Position of Ankle Immobilization - Weight Bearing Guidelines - From 0-2 Weeks - From 2-4 Weeks - From 4-6 Weeks - From 6-8 Weeks - Beyond 8 Weeks

From 0-2 Weeks - compression dressing and posterior orthosis OR walking boot set at 20 degrees equines OR CAM orthosis that allows free PF but restricts DF to -20 - partial WB with bilateral axillary crutches From 2-4 Weeks - CAM orthosis that allows free PF but restricts DF -20 - WB as tolerated in walking boot or CAM orthosis - crutches as needed From 4-6 Weeks - CAM orthosis that allows free PF but restricts DF -10 (week 4) and 0 degrees (week 5) - Full WB in walking boot or brace, wean from crutches From 6-8 Weeks - CAM orthosis that allows free PF but restricts DF to 10 degrees (week 6) - Wean from CAM orthosis to shoes with 1- to 1.5- bilateral heel lift (weeks 7) - Full WB in functional brace or shoe with heel lift Beyond 8 Weeks - Wean from heel lifts by 10 weeks - Full WB in regular shoe without lifts by 10 weeks

Stage 3

Frozen - 9-15 months - pain only with movement - significant adhesions - limited GH motions - excessive scapulothoracic movement typical compensation - atrophy of deltoid, RTC, biceps, triceps

Fungal Infections 1. Ringworm 2. Athletes Foot

Fungal Infections 1. Ringworm - fungal infection involving the hair skin or nails - forms rink shaped patches with vesicles or scale - itchy - through direct contact - treated with topical or oral anti fungal drugs 2. Athletes Foot - fungal infection of the foot typically between the toes - causes erythema, inflammation, pruritus, itching and pain - treated with anti fungal creams - can progress to bacterial infections, cellulitis if untreated

Global Initiative for Obstructive Lung Disease (GOLD)

GOLD 1 >/= 80 GOLD 2 50-79 GOLD 3 30-49 GOLD 4 <30

Precautions and Guidelines for Exercise and Functional Activities Following Achilles Tendon Repair General Precautions Stretching to Increase Ankle DF Resistance Exercises Advanced Training (Plyometric, Agility, Sport-Specific Training)

General Precautions - progress all exercises very cautiously that place resistance or a stretch on the gastric soleus muscle - postpone all unilateral WB exercises on the operated side until full WB without pain is possible Stretching to Increase Ankle DF - initiate active ROM DF within the protected range by week 3 following surgery - begin stretching program in non-WB exercises (towel stretch with slight knee flexion) - limit DF to no more that 10 degrees beyond neutral until 8 weeks after surgery. progress to full ankle DF (bilateral symmetry) by 12 weeks - initiate WB stretches in sitting with feet on the floor, a low incline wedge (<10 degrees) or a rocker board - begin standing stretches in bilateral stance with knees bent only if pain free. this can be accomplished with a modified runners wall stretch or low incline (<10 degrees) wedge - postpone unilateral standing stretches or bilateral standing stretches with heels over the edge of a step until advanced postoperative activities are permitted (Approximately 12 weeks) Resistance Exercises - begin strengthening exercises for ankle and foot musculature in non WB positions against low load (light grade elastic resistance) before progressing to closed chain exercises against BW - initiate heel raises in a seated position with gradual addition of exerternal resistance before progressing to bilateral heel raises in standing - progress heel raising/lowering exercises from bilateral to unilateral only if performed pain free - unilateral heel raising/lowering shoulder be postponed until approximately 10-12 weeks postoperatively. Advanced Training (Plyometric, Agility, Sport-Specific Training) - pool training chest deep to waist deep - running and plyometrics after 12 weeks and individual meets criteria 1. ambulates pain free with normal gait and no AD 2. normal DF ROM 3. completes 5 unilateral heel raises at >/=90% of the limbs maximum heel rise height - begin with bilateral land based plyometric activity, teaching landing techniques - advance to unilateral activities when proper joint alignment and controlled deceleration on the operative limb is achieved - wear a prescribed functional AFO or tape the ankle during high impact, high velocity activities to minimize the risk of tendon re-rupture.

Endocrine System

Glands secrete hormones that regulate processes such as growth, reproduction, and nutrient use (metabolism) by body cells.

Maximum Protection ALCR Key Points Goals and Exercises

Goals - ROM 0-110 - WB 75% to WBAT Interventions - PRICE - gait training - PROM/AAROM - patella mobs (I and II) - muscle setting (iso) all ranges w estim - assisted SLR - ankle pumps - heel raises - toe raises - trunk/pelvis stabilization - stationary cycle

Minimum Protection ALCR Key Points Goals and Exercises

Goals - 75% strength Interventions - initiate plyometrics (EX: boudning, jumping, double leg, single leg, box jumps) - skill specific patterns - advance closed chain exercises - work or sport specific - transition to full speed, jogging, sprinting, running and cutting

Moderate Protection ALCR Key Points Goals and Exercises

Goals - full or near full knee ROM - fair plus to good muscle strength (3+/5 to 4/5) Interventions - multiple angle isometrics - closed chain strengthening - bike, pool, elliptical - LE stretching - proprioceptive training: single leg stance, balance board, bosu - elastic band stabilization exercises - endurance and flexibility - initiate walk/jog at the end of phase - high speed stepping, unstable surface drills, balance beam

Intermittent Mechanical Spinal Traction Goals and Indications Precautions Contraindications

Goals and Indications - decrease joint stiffness - decrease meniscoidal blocking muscle spasm - degernative disc - disc protrusion - joint disease - modulation discogenic pain - modulate subacute or chronic joint pain - reduce N root impingement not effective for treating acute or chronic non-specific LBP. activity/exercise is recommended although mechanical lumbar traction is neither non detrimental no beneficial Precautions - claustrophobia - hiatal hernia - vascular compromise - pregnancy - impaired cognition - any disease or condition that can compromise the structure of spine, such as osteoporosis, tumor, infection, RA, protracted steroid use - TMJ problems - disc extrusion - medial disc protrusion - complete resolution or severe pain with traction Contraindications - acute strains - sprains and inflammation - spondylolisthesis fractures - post spinal surgery - spinal joint instability or hyper mobility - spinal cord compression - HTN - increased peripheralization of pain - numbness or tingling - decreased myotomal strength - decreased reflex response

Cancer Grades Grade 1 Grade 2 Grade 3 Grade 4

Grade 1 - low grade - cancer cells resemble normal cells - slow growing - well differentiated Grade 2 - intermediate grade - cancer cells look more abnormal - slightly faster growing - moderately differentiated Grade 3 - high grade - cancer cells are abnormal - grow or spread more aggressively - poorly differentiated Grade 4 - cancer cells are abnormal - indifferent

Adrenal Disorders: Addisons Disease 1. what is it? 2. what are signs and symptoms? 3. what are medical interventions? 4. secondary adrenal insufficiency

Hypofunctioning of adrenals Results in decreased production of cortisol and aldosterone Etiology: Autoimmune proceses, infection, neoplasm, hemorrhage S&S: Metabolic dysfunction (cortisol), fluid and electrolyte imbalances (aldosterone) - Increased bronz pigmentation of the skin - Weakness, decreased endurance, - Anorexia, dehydration, weight loss, GI disturbances - Anxiety, depression, - Decreased cold and stress tolerance. - If left untreated can lead to shock and death. Medical interventions: - Replacement of glucocorticoids, adrenal corticoids - Adequate fluids, control of Na and K - Diet high in complex carbs and protein secondary adrenal insufficiency can result from prolonged steroid (ATCH) rapid withdrawal of drugs and hypothalamic or pituitary tumors

Parkinson Stages Hoehn and Yahr Classification I II III IV V

I Minimal or absent disability, unilateral symptoms II Minimal bilateral or midline involvement, no balance involvement III impaired balance, some restrictions in activity IV all symptoms present and severe; stand and walks only with assistance V confinement to bed or wheelchair

Heart Disease Classification

I - No limitation of physical activity, ordinary activity does not cause undue fatigue, palpitations, and dyspnea 6.5 METS MAX II - Slight limitation of physical activity, Comfortable at rest but activity causes undue fatigue, palpitations, and dyspnea 4.5 METS MAX III - Marked limitation of physical activity, Comfortable at rest but LESS THAN ORDINARY activity causes undue fatigue, palpitations, and dyspnea 3.0 METS MAX IV - Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased 1.5 METS MAX

List the Cranial Nerves

I. Olfactory II. Optic III. Oculomotor IV. Trochlear V. Trigeminal VI. Abducens VII. Facial VIII. Vestibulocochlear IX. Glossopharyngeal X. Vagus XI. Accessory XII. Hypoglossal

Salter Harris Fracture Classification

I: Straight across the plate - causing separation. II: Across plate and metaphysis. III: Across plate and epiphysis. IV: Through the metaphysis, plate, and epiphysis. V: Compression fracture along plate. early PROM TO PREVENT CAPSULAR ADHESIONS

Hip capsular pattern

IR/ FL/ ABD minimal loss of extension

Vital Capacity

IRV + TV + ERV all the possible volume of air within the lungs that is under volitional control. measure by achieving maximal inspiration, then forcible exhale as hard and fast as possible into a measuring device until ERC has been exhausted.

Traumatic Lesion of the Wrist and Hand 1. Immobilization time 2. What type of orthosis for flexor tendon repairs? (3)

Immobilization time - 5 days after surgery What type of orthosis 1. static dorsal blocking orthosis - covers the dorsal surface of the entire hand and two thirds of the forearm (thumb is free) - wrist and MP flexion and IP extension to avoid excessive tension on the repaired flexor tendon - restricts wrist and MP extension - worn during early phases of rehab - can wear as a protective night orthosis 2. dorsal blocking orthosis with dynamic traction - allows active extension of involved finger and the elastic band passively returns the finger to a flexed position - allows early motion of the operated joint while had is in the orthosis - at rest elastic band provides dynamic traction that hold the operated finger in flexion - allows active extension of the IP joints to the surface of the dorsal orthosis - when PIP and DIP extensors relax, tension from the elastic band pulls on the finger, causing passive flexion 3. a dorsal tenodesis orthosis with a wrist hinge - worn exclusively for exercise sessions - no dynamic traction - allow fulls wrist flexion and limited approximately 30 degrees wrist extension but maintain the MP joints at least 60 degrees of flexion and the IP joints in full tension when the straps are secured

Counterrotation

Increases tidal volume and decreases respiratory rate by reducing neuromuscular tone and increasing thoracic mobility - for impaired cognition - young children - increase in neuromuscular tone

Infection Control 1. Topical Antimicrobial Agents 2. Anti-Inflammatory Agents 3. Topical Anesthetics and Alangesics Cleansing Topical Agents

Infection Control 1. Topical Antimicrobial Agents - silver nitrate - silver sulfadiazine - erythromycin - gentamicin - neomycin - triple antibiotic 2. Anti-Inflammatory Agents - corticosteroids - hydrocortisone - ibuprofen - indomethacin 3. Topical Anesthetics and Alangesics - lidocaine - lignocaine Cleansing Topical Agents - povidone-iodine solution - sodium hypochlorite solution - Dakins solution acetic acid solution - hydrogen peroxide

T6-T10 muscles of inspiration (1) EXPIRATORY (2)

Inspiratory - abdominals expiratory - abdominals - serratus posterior inferior

Physical Therapy + Treatment for Prematurity

Interventions -play activities and positioning to facilitate shoulder protraction and adduction such as supported side lying while doing visual (use black and white and red objects 9 inches away) and auditory tracking and reaching midline positioning of head encourage reaching for toys, parents face if infan over 32 weeks conceptional age supervised side-lying and prone positioning for periods during the day - supine sleeping to decrease SIDS AVOID ACTIVITES THAT MAY INCREASE EXTENSOR TONE, SUCH AS USE OF INFANT JUMPERS AND WALKERS

Autonomic Dysreflexia Intiating stimuli Signs and Symptoms

Intiating stimuli - bladder distension/irritation - bowel distention/irritation - stimuli that would normally be painful below level of lesion - gastrointestinal irritation - sexual activity - labor - skeletal fracture below level of lesion ESTIM below level of lesion signs and symptoms - HTP rise in systolic BP 20-30 - bradycardia - severe headache - feeling of anxiety - constricted pupils - blurred vision - flashing and piloerection above level of lesion - dry, pale skin below level of lesion due to vasconstriction - nasal congestion - increased spasticity - may be asymptomatic

Swan Neck Deformity

Involves only the fingers. Result of contracture of intrinsic muscles or tearing of the volar plate. - often seen in RA or following trauma - MCP flex - DIP flex - PIP ext

KAFO's Knee Controls 1. Hinge Joint 2. Offset Locks 1. Drop Ring Lock 2. Paw lock with bail release Knee Stability 1. Sagittal Stability 2. Frontal Plane Stability Specialized KAFO 1. Craig Scott 2. Oregon Orthotic System 3. Fracture Braces 4. FES Standing Frames 1. Parapodium Specialized Knee Orthosis 1. Articulated KO 2. Sweedish Knee Cage 3. Patellar Stabilizing Brace 4. Neoprene Sleeve

Knee Controls 1. Hinge Joint - provides mediolateral and hyperextension control while allowing flexion and extension 2. Offset - hinge placed posterior to WB line/TKA line - assist in extension, stabilizes knee during early stances - may have difficulty on ramps where knee may flex inadvertently Locks 1. Drop Ring Lock - ring drops over joint when knee is in full extension to provide maximum stability - retention button may be added to hold ring lock up - gait train with knee unlocked 2. Paw lock with bail release lever ring - allows patient to unlock by pulling up or hooking the pawl on the back of chair pushing it, or with posterior knee pressure Knee Stability 1. Sagittal Stability by bands or straps to provide posteriorly directed force - anterior band or strap 2. Frontal Plane Stability control of valgum and vacuum - posterior plastic shell - medial or lateral correction straps Specialized KAFO 1. Craig Scott - for individuals with paraplegia - shoe attachments with reinforced foot plats - ankle joints in slight DF 2. Oregon Orthotic System - combination of plastic and metal components allows for control in all 3 planes of motion (sagittal, frontal, transverse) 3. Fracture Braces calf and thigh support that encompasses fracture and provides support 4. FES E-Stim - paraplegia - drop foot - scoliosis Standing Frames allows for standing without crutch support, may be stationary frames or attached to a wheeled mobility base (SCI) 1. Parapodium - allows standing without crutch support - allows for ease in sitting with addition of hip and knee joints that can be unlocked Specialized Knee Orthosis 1. Articulated KO controls knee motion - post surgery 2. Sweedish Knee Cage provides mild control for excess hypertext of the knee 3. Patellar Stabilizing Brace - improve patellar tracking - maintain alignment - laterally buttress can position knee medially - central patellar cut may help positioning and minimize compression 4. Neoprene Sleeve - nylon coated rubber materia - provides compression, protection, proprioceptive feedback

Knee Disarticulation Prosthesis Hip Disarticulation Prosthesis

Knee Disarticulation Prosthesis - functional - allows WB on the distal end of femur - lower shank is shortened to balance leg length in standing - adds thigh length / cosmoses Hip Disarticulation Prosthesis - socket is molded to accommodate the pelvis - WB occur on ischial seat and iliac crests - endoskeletal components decrease weight of prosthesis - stability achieved with hip extension aid - posterior placement of knee joint with anterior placement of hip joint to the WB line

ABI 1. what is it? // how is it calculated?

LE pressure divided by the UE pressure

Spasticity Management 1. Stronger in LE or UE? 2. At risk for what? (3) 3. optimize PT through what? what in terms to medication? 4. What can be used for temporarily relief? 5. What should be started early? (2) 6. Strech how long? 7. What modality? 8. Relaxation (3)? 9. functional activities aimed at reducing tone should concentrate on what segments? (2)

LE's contractures, postural deformity, decubitus ulcers with dosing cycle - baclofen will respond better to stretching techniques if they are applied in the middle of the dosing cycle rather than at the end or beginning topical cold ice packs or wraps or hydrotherapy cool bath can temporality reduce spasticity by decreasing tendon reflex excitability and clonus and by slowing conduction of impulses in nerves and muscles *some may react to the unpleasant sensation of cold with fight or flight (autonomic nervous system) responses, such as increased HR, increased RR, nausea CRYOTHERAPY CONTRAINDICATED in these patients stretching and ROM exercises - combining stretching with movements using rhythmic rotation (Gentle rotation of the limb) or PNF techniques (hold relax, contract relax) maintained stretch - held for 30 minutes to 3 hours low load weights applied using skin traction or serial casts **ballistic stretching movements are contraindicated because spasticity is velocity sensitive** contracting the antagonist muscles can assist through mechanism of reciprocal inhibition Electrical stimulation of muscles antagonist to the spastic muscles Relaxation Techniques - tai-chi - yoga - aquatic exercise with cool water temperatures - trunk - proximal segments (for example lower trunk rotation in hook lying can be effective in reducing proximal extensor tone position the patient in hook-lying with a therapy ball under the flexed legs and gently rock the ball back and forth - quadruped to side-sitting can also be effective in reducing extensors tone in some patients as the activity combines LTR with prolonged inhibitory pressure on the quadriceps prolonged or static positioning in any fixed posture can be deleterious to the patient with strong spasticity and should be avoided mechanical position devices (splints, toe spreader, finger spreader, ankle splint to prevent positioning and preserve joint structures

Claw fingers

Loss of intrinsic muscle action and the overreaction of the extrinsic (long) extensor muscles on the proximal phalanx of the fingers - MCP hyperextended - PIP and DIP flexed **normal cupping of the hand is lost, both longitudinal and transverse arches** often caused by combined median and ulnar nerve palsy Masse sign: hand appears flattened. result of hypothenar muscle paralysis

Epiphyseal Plate Fracture

MOI is weight bearing torsional stress

Prominent Ulnar Head

May indicate Distal Radioulnar Joint pathology (posterior dislocation) , ulnar side carpal pathology, TFCC pathology - In RA this is ulnar caput syndrome

Femoral Condyle Fracture

Medial Femoral Most common - trauma - shearing - impacting - avulsion forces common mechanism is a fall with knee subjected to a shearing force

Exercise Guidelines Hematocrit - normal value M + F <25% 25%-35% >35%

Men: 40-54% Women: 38-47% <25% essential ADL; assistance as needed for safety 25%-35% essential ADL's - assistance as needed for safety - light aerobics - light weights 1-2 lbs >35% ambulation and self care as tolerated - resistance and aerobic exercise

ASIA C

Motor Incomplete - motor function is preserved at the most caudal sacral segments for voluntary anal contraction OR - the patient meets the criteria for sensory incomplete status (sensory function is preserved for most caudal sacral segments (S4-S5) by LT, PP, DAP. and has some sparing of motor function more than three levels below the ipsilateral motor level on either side of the body this includes key or non-key muscle functions to determine motor incomplete status for AIS C less than half of key muscle functions below the single NLI have a muscle grade >/= 3

ASIA D

Motor Incomplete at least half (half or more) of key muscle functions below the single NLI having a muscle grade >/=3

Muscle Receptors 1. Muscle Spindles 2. Golgi Tendon Organs 3. Free Nerve Endings 4. Pacinian Corpuscles

Muscle Spindles - monitor changes in muscle length and velocity - muscle spindle fibers (intramural fibers) lie in parallel arrangement to the muscle fibers (extrafusal) - play a vital role in position and movement sense and in motor learning Golgi Tendon Organs - monitor tension in the muscle - protect and prevent structural damage to the muscle in situations of extreme tension by inhibiting the agonist and facilitating the antagonist - located at the proximal and distal tendinous insertions of the muscle Free Nerve Endings - in fascia respond to pain and pressure Pacinian Corpuscles in fascia respond to vibratory stimuli and deep pressure

Periventricular Leukomalacia

Necrosis of white matter adjacent to ventricles of the brain due to systemic hypotension or ischemia May result in CP

Negative Pressure Wound Therapy Hyperbaric Oxygen Therapy (HBO) Mechanical Delivery Systems Irrigation Pulsed Lavage Electrical Stimulation

Negative Pressure Wound Therapy - Vacuum assisted closure - an open cell foam dressing placed into the wound - controlled aubatlmospheric pressure - 125mmHg below ambient pressure is applied via device - helps to maintain a moist wound environment, control edema, increased localized blood flow and reduces infectious material Hyperbaric Oxygen Therapy (HBO) - patient breathes 100% oxygen in a sealed, full body chamber with elevated atmospheric pressure - between 2.0-2.5 atmospheres absolute ATA - hyper oxygenation reverses tissue hypoxia and facilitates wound healing due to enhanced solubility of oxygen in the blood **contraindicated in untreated pneumothorax and some antineoplastic medications** Mechanical Delivery Systems minimal mechanical forces ceasing with gauze, cloth or sponge Irrigation - 4-15 psi - squeeze bottle, bulb syringe or piston syringe Pulsed Lavage - delivery of irrigating solution under pressure that is produced by an electrically powered device - pulsed lavage with vacuum assists in removal of wound debris electrical stimulation for wound healing is used to improve circulating, facilitate debridement and enhance tissue repair - continuous waveform application - direct current - high voltage pulsed current - pulsed biphasic current

Nitrates Vasodilators

Nitrates angina pectoris, decreases preload through the peripheral vasodilation, coronary artery vasodilation by inhibiting smooth muscle contraction of CA, reduces myocardial oxygen demand - nitrobid, nitrostat, NTG, given in supine - dizziness, lightheadedness, flushing, headache, reflex tachycardia Vasodilators used to treat HTN, along with beta blockers - also used to treat CHF with ACE inhibitors - minoxidil, hydrazine - side effects: headache, flushing, GI disturbances, reflex tachycardia, myalgia, arthralgia

Nitrates

Nitroglycerin - angina - CHF

Vesicular Breath Sound

Normal - soft rustling - head throughout all inspiration and beginning of expiration

Vocal Sounds (2)

Normal Transmission of Vocal Sounds - loudest near traces and main-stem bronchi - words should be intelligible though softer and less clear at the more distal areas of the lungs Abnormal Transmission of vocal sounds may be heard through fluid-filled areas of consolidation, cavitation lesions or pleural effusions 1. Egophony - nasal or bleating sound heard doing auscultation "E" sounds are transmitted to sound like "A" 2. Bronchophony - intense, clear sound during auscultation even at the lung bases 3. Whispered Pectoriloquy - when whispered sound are heard clearly during auscultation

Hemoglobin Normal Value Men Women 2. Exercise Recommendations >10 <8-10 <8

Normal Value Men : 13-18 Women : 12-16 2. Exercise Recommendations >10 regular exercise <8-10 light exercise <8 no exercise

Hematocrit Normal Value Men Women 2. Exercise Recommendations - >25% - <25%

Normal Value Men : 45-52% Women : 37-48* 2. Exercise Recommendations - >25% light or regular exercise - <25% no exercise

ASIA E

Normal; motor and sensory function is normal

Exercise Guidelines Platelet Count - normal value <10,000 or temp >100.5 10,000-20,000 >20,000

Normal= 150,000-400,000 <10,000 or temp >100.5 no therapeutic exercise/hold therapy 10,000-20,000 therapeutic exercise/bike without resistance >20,000 therapeutic exercise bike with or without resistance

Clinical Manifestations of Vertebrobasilar Artery Syndrome Medial Midpontine Syndrome

Occlusion of paramedian branch of the mid basilar artery - ataxia of limbs and gait - paralysis of face UE, LE - deviation of eyes

Clinical Manifestations of Vertebrobasilar Artery Syndrome Lateral Midpontine Syndrome 1. what is it 2. symptoms

Occlusion of short circumferential artery - ataxia of limbs - paralysis of muscles of mastication - impaired sensation over side of face - medial superior pontine syndrome - cerebellar ataxia - internuclear ophthalmoplegia - paralysis of face UE and le

Clinical Manifestations of Vertebrobasilar Artery Syndrome Medial Inferior Pontine Syndrome 1. What are symptoms ipsilateral to lesion? 2. Contralateral to lesion?

Occlusion of the paramedian branch of basilar artery; - paralysis of conjugate gaze to side of lesion (preservation of convergence) - nystagmus - ataxia of limbs and gait - diplopia on lateral gaze - paresis of face, UE, LE - impaired tactile and proprioceptive sense over 50% of the body

Clinical Manifestations of Vertebrobasilar Artery Syndrome Medial Medullary Syndrome 1. what is it? 2. ipsilateral to lesion? 3. contralateral to lesion?

Occlusion to the vertebral artery, medullary branch 2. ipsilateral to lesion - paralysis with atrophy of half the tongue with deviation to the paralyzed side when tongue is protruded ( facial and hypoglossal N effected) - decreased pain and temperature sensation in face (trigeminal) - cerebellar ataxia/gait and limb ataxia - vertigo, nausea, vomiting, nystagmus 3. contralateral to lesion - paralysis of UE and LE - impaired tactile and proprioceptive sense - laterally medullary (wallenburgs) syndrome

Shine light in eye for what CN?

Oculomotor (pupillary refill, constricts)

Two Point Gait

One crutch and opposite extremity move together followed by opposite crutch and extremity

Snellen eye chart for what CN?

Optic

Lateral Ankle Sprain + Grades

PF with inversion Grade 1 - no loss of function - minimal tearing of ATFL Grade 2 - some loss of function - partial disruption of ATLF and CFL Grade 3 - complete loss of function - complete tearing of ATFL , CFL with partial tear of the PTFL **ANTERIOR DRAWER** **TALAR TILT TEST**

what is after load?

Pressure/resistance in aorta and peripheral arteries that left ventricle has to pump against to get blood out.

Traumatic Brain Injury (TBI) Primary vs. Secondary brain damage?

Primary brain damage - diffuse axonal injury with disruption and tearing of axons and small blood vessels from shear strain of angular acceleration resulting in neuronal death and petechial hemorrhages - focal injury: contusions, lacerations, mass effect from hemorrhage, and edema - coup-contracoup injury: point of impact and opposite point of impact - closed or open injury with fracture of skull Secondary Brain Image hypoxic ischemic injury: results from systemic problems (respiratory or cardiovascular) that compromise cerebral circulation Swelling/edema - can result in mass effect, with increased intracranial pressures, brain herniation (uncal, central, tonsillar) and death electrolyte imbalance and mass release of damaging neurotransmitters

Frontal Lobe Lesion

Primary motor cortex and brocas area Functions - discrete volitional movements - motor planning or praxis - bilateral control of posture - conjugate eye movements - language production - motivation - problem solving - emotions - behavior Impairments - contralateral paralysis and paresis of distal part of limbs - apraxia or motor planning difficulties - non fluent aphasia - unpredictable behaviors

What is the most common pulse for assessing HR?

RADIAL

ABCD assessment tool

Recommended by GOLD to assess a patient newly diagnosed with COPD and we are trying to assess which therapy to administer initially.

Rectum Rectal Fissure Hemorrhoids

Rectal Fissure a tear or ulceration of the lining of the anal canal - constipation and large hard stools are contributing factors Hemorrhoids (piles) - varicosisties in the lower rectum or anus caused by congestion or the veins in the hemorrhoidal plexus - can be internal or external - local irritation - pain - rectal itching - prolonged bleeding results in anemia - stringing with defacation, constipation and prolonged sitting can contribute to discomfort - pregnancy increases risk - topical medications to treat, dietary changes, hot and cold compress

Dorsal (Posterior) Column Medial Leminscus Pathway

Regulation of movement dependent on - sensory afferent information Peripheral Somatosensory Receptors - provide information about the status of environment, status of body and status of body related to the environment --> encode and conveyed too various parts of the CNS --> data processed based on peripheral feedback and memory --> leads to election and modification of MA strategy Functions - coordinated movement response for the afferent transmission of discriminative sensations 1. discriminative touch 2. sterogenesis 3. tactile pressure 4. barogenesis 5. graphesthesia 6. recognition of texture 7. kinethesis 8. 2 pt discrimination 9. proprioception 10. vibration

Restrictive vs. Obstructive

Restrictive Lung all fields decreased (IRV,VT,ERV,RV,VC,IC,FRC & TLC) (Restrictive diseases: Inflammatory diseases, Cardiac disease, Neurological/neuromuscular, Pleural diseases, Thoraic deformities, Post-surgical patients, Fibrotic diseases & all others) Obstructive Lung only (IRV, ERV, VC & IC) are decreased. (Obstructive diseases: Cystic fibrosis, Bronchitis, Asthma, Bronchiectasis & Emphysema; only one that will give low DLco)

Drop Wrist Deformity

Result of Radial N Palsy - wrist extensor muscles are paralyzed - wrist and fingers cannot be actively extended by the patient

Sympathetic Storming

Result of hypothalamic stimulation of the SNS with an increase in circulating corticoids and catecholamines (stress response) - patients generally exhibit minimal alertness, minimal awareness and reflexive motor response to stimulation - examine for alteration in level of consciousness, increased posturing, dystonia, HTN, hyperthermia, tachycardia, tachypnea, diaphoresis and agitation

Immediate Postoperative Prosthesis is what? 1. what are the advantages? 2. what are the limitations? 3. contraindicated for who?

Rigid Dressing Advantages - plaster of Paris socket is fabricated in the operating room with the capability to attach a foot and pylon - allows early limited WB and ambulation within days of surgery - limits post-op sequel: edema, post-operative pain - enhances wound healing - allows for easier fit of permanent prosthesis Limitations - skilled application requires - requires close monitoring - does not allow for daily wound inspection Contraindicated older patients with cardiovascular compromise and increased risk for wound

Cardinal Motor Symptoms of PD

Rigidity - increased resistance to passive motion - cog wheel + lead pipe - asymmetrical - early stage affects proximal muscles first especially in the shoulders, neck, face, extremities - lack of reciprocal arm swing - mental concentration, emotional stress can increase it Bradykinesia - slowness of movement - insufficient recruitment of muscle force during intuition of movement - external cues, vision, sound help this - bradyphrenia= slowness of though - akinesia= spontaneous movement - hypomimia= masked facial expression - hypokinesia= slowed movements - mircographia= writing becomes smaller Tremor - aggravated by emotional stress and excitement Postural Instability - contractures develop in the hip, knee flexors, hip rotators, adductors, plantar flexors Fatigue*** - olfactory dysfunction - paresthesias, numbness, tingling, cold, aching pain, burning, hyperalgesia - visual perception disturbances - dysphagia (impaired swallowing) - pain most common in the low back, legs, shoulders due to abnormal modulation of pain caused by dopaminergic deficiceny in the basal ganglia - hypokinets dysarthria: decreased voice volume, distorted articulation - uncontrolled speech rate - hoarse, breathy, harsh voice - reduced vital capacity, reduced air expended during phonation - deficits in cognitive processing - dementia - hallucinations, delusion and psychosis and common complications of levodopa toxicity - hypomimia: reduce facial expressivementss - chronic depression - dysphoric mood - low energy - apathy: decreased motivation - hyperhidrosis: excessive sweating or uncomfortable/abnormal sensations of warmth and coldness - slow pupillary response to light - constipation common - blunted cardiovascular and metabolic responses to peak exercise meaning lower HR, lower VO2 and SBP - excessive daytime sleepiness - at night insomnia diagnosis is mad based on history and clinical examination look for the 4 golden sx!!! symptoms often - loss of smell - sleep disturbance - vivid dreams - foot dystonia - foot cramping - restless leg syndrome - orthostatic hypotension - constipation -5-25 years - most common cause of death are cardiovascular disease and pneumonia Unified Parkinson's Disease Rating Scale (UPDRS) GOLD STANDARD***

Rule of Nines Child 1. Head 2. Arms (each arm) 3. Trunk 4. Leg (each leg) 5. Perineum Rule of Nines Adults 1. Head 2. Arm (each arm) 3. Trunk 4. Leg (each leg) 5. Perineum **just included front, the back of body is not included**

Rule of Nines Child 1. Head 8.5% 2. Arms (each arm) 4.5% 3. Trunk 18% 4. Leg (each leg) 6.5% 5. Perineum 1% Rule of Nines Adults 1. Head 4.5% 2. Arm (each arm) 4.5% 3. Trunk 18% 4. Leg (each leg) 9% 5. Perineum 1%

Boutonniere Deformity

Rupture of the central tendinous slip of the extensor hood - most common after trauma or RA - DIP ext - PIP flx - MCP ext

Mallet Finger

Rupture or avulsion of the extensor tendon where it inserts into the distal phalanx of the finger - distal phalanx rests in a flexed position

Spastic Hypertonia 1. What is it? 2. What influences it? 3. What 3 interventions? 4. What medications? (3)

SCI, CNS disorders, TBI, MS, stroke - common in cervical level injuries - part of UMN - spasticity - muscle spasms - high muscle tone - hyperactive stretch reflexes - clonus - velocity dependent - gradual increase in first 6 months plateaus usually 1 year after injury positional changes, cutaneous stimuli, environmental temperatures, tight clothing , bladder, kidney stones, fecal impactions, catheter blockage, UTI, ulcers, emotional stress may trigger an increase in spasticity and muscle spams Interventions - stretch - modalities - medications Medications - muscle relaxants - spasmodic agents: baclofen, tizanidine, diazepam, dantrolene sodium - intramuscular injection of botulinum neutron can be used to manage focal spasticity - intrathecal baclofen where its implanted pump delivers small amounts of baclofen directly at the spinal cord level to minimize side affects can be used in severe cases when indiduvals dont response to oral medications

Dinner Form Deformity

Seen with malunion distal radius fracture. - Distal radial fragment angulated posteriorly **Colles Fracture**

Symptoms of MS

Sensory - paresthesias - numbness - hypesthesia Pain - paroxysmal limb pain - headache - optic or trigeminal neuritis - lhermittes sign - hyperpathia - chronic neuropathic pain Visual Symptoms - blurred or double vision - diminished acuity/loss of vision - scotoma - nystagmus - lateral gaze palsy Cognitive Symptoms - short term memory deficits - difficulty performing multiple tasks - diminished attention, concentration - diminished executive functions - diminished information processing - diminished visual-spatial abilities Affective Symptoms - depression, anxiety, psuedobulbar affect Motor Symptoms - paresis or paralysis - fatigue - spasticity, spasms - ataxia incoordination/intention tremor - postural tremor - impaired balance and gait -UMN PRESENTATION Speech and Swallowing - dysarthia - diminished verbal fluency - dysphonia - dysphagia Bladder and Bowel Symptome - spastic bladder - flaccid bladder - dyssynergic bladder (problem with coordination between the bladder contraction and sphincter relaxation) - constipation is most common bladder complaint - diarrhea and incontinence Sexual Symptoms - impotence - decreased libido - impaired ability to achieve organsm Fatigue Coordination - ataxia - postural tremor - intention tremors (with mvt) - hypotonia - truncal weakness Emotional - euphoria (sense of optimism) - apathy (lack of motivation) - pseudo bulbar (sudden unpredictable episodes of crying or laughing)

Deep Partial thickness (Second Degree) 1. Characteristics 2. Healing when? 3. Scarring?

Severe damage to epidermis, dermis with injury to nerve endings, hair follicles, sweat glands - mixed red or wavy white appearance - bleaching with slow capillary refill - broken blisters - wet surface - marked edema - sensitive to pressure but insensitive to light touch or soft pin prink - healing is slow and occurs through scar formation and reepithelization - excessive scarring without preventive treatment

Thoracic mobilization techniques

Simple thoracic mobilization techniques to increase the ability of the thorax to expand during breathing

Transfemoral Prosthesis Axis Single Axis Polycentric Systems (multiple axis)

Single Axis - permits knee motions to occur around a fixed axis Polycentric Systems (multiple axis) - changing axis motion allows for adjustments to be the center of knee rotation. - more stable then single axis - complex - not widely used

Skin Cancer Benign Tumors 1. Seborrheic Keratosis 2. Actinic Keratosis 3. Common Mole Malignant Tumors 1. Basal Cell Carcinoma 2. Squamous Cell Carcinoma (SCC) 3. Malignant Melanoma 4. Kaposi Sarcoma (KS)

Skin Cancer Benign Tumors 1. Seborrheic Keratosis - proliferation of basal cells - raised lesions - multiple lesions on trunk of older individuals - untreated unless causing pain and removed with cryotherapy 2. Actinic Keratosis - flat, round, irregular - covered by dry scale on sun exposed skin - precancerous - can lead to SCC 3. Common Mole - proliferation of melanocytes - round or oval shape - sharply defined borders - changing into melanoma if redness, scaling, oozing, bleeding Malignant Tumors 1. Basal Cell Carcinoma - slow growing epithelial basal cell tumor - raised patch - ivory appearance/redened area of eczema - rolled border with indented center or presents as a thickened area of skin - rarely metastasize - common on face of fair skin individuals - with prolonged sun exposure 2. Squamous Cell Carcinoma (SCC) poorly defined margins - flat red area - ulcer or nodule - grows quickly - common on sun exposed areas, face, neck, back of hand - higher risk to metastasize - mucosal and lingual are related to alcohol and tobacco use 3. Malignant Melanoma tumor arising from melanocytes - superficial spreading melanoma is most common type - risk factors are family history, intense year round sun exposure, fair skin, freckles, >50 - lesions may have swelling, redness beyond border, oozing, bleeding, itching, burning sensation 4. Kaposi Sarcoma (KS) - lesions of endothelial cell origin due to human herpes virus 8 with red or dark purple/blue macule that progress to nodules or ulcers associated with itching and pain - common in LE - may involves lymphatic obstectuon

Relationships between the size of the rotator cuff tear with the type and duration of immobilization after arthroscopic and mini open repair Size of Tear and Type and Duration of Immobilization Small Tear Medium Tear Massive Tear

Small Tear </=1 - sling for 1-2 weeks - removal for exercise the day of surgery or 1 day post op Medium Tear 1-5cm - sling or abduction orthosis/pillow 3-6 weeks - removal for exercise 1-2 days post op Massive Tear >5cm - sling or abduction orthosis/pillow for 4-8 weeks - removal for exercise 1-3 days post op

Ultrasound Spatial Average Intensity Beam Nonuniformity Ratio Pulsed US applied when Duty Cycle Temporal Peak intensity 3MHz vs 1MHz

Spatial Average Intensity total power (watts) / area (cm2) of the transducer head Beam Nonuniformity Ratio ratio of spatial peak intensity to spatial average intensity - the lower the more uniform the energy distribution and less risk of tissue damage - 2:1-6:1 Pulsed US applied when non thermal effects are desired (acute soft tissue injuries) Duty Cycle - fraction of time the US energy is on over one pulsed period (time on /time off) - 20% duty cycle could have an on time of 2msec and off time of 8 msec - </= 50% is pulsed UE - 51%-99% produces less acoustic energy and less hear than continuous US at 100% duty cycle Temporal Peak intensity peak intensity of US during the on time phase of the pulse period 3MHz vs 1MHz 3= greater heat production in superficial layers caused by greater scatter of sound waves 1= heat production in deep layers caused by a lesser scatter in superficial tissues thus more US energy is able to penetrate to deeper tissues

Cancer Staging Stage 0 Stage 1 Stage 2 Stage 3 Stage 4

Stage 0 carcinoma in situ (premalignant neoplasm that has not invaded the basement membrane) Stage 1 tumor is localized - <2cm - not spread to lymph nodes Stage 2 - tumor is locally advanced - 2 to 5 cm - with out without lymph node involvement Stage 3 - tumor is locally more advanced - spread to lymph nodes - designated stage 2 or 3 depending upon type Stage 4 - tumor has metastasized or spread to other organs throughout the body

Stages of Lymphedema

Stage I Latency Stage - no outward swelling noted - asymptomatic with occasional reports of heaviness in the limb - body can still accommodate lymphatic load Stage I Reversible Stage - elevation reduces swelling - no tissue fibrosis - swelling is soft or pitting Stage II Spontaneously Irreversible - fibrosis of tissue - brawny, hard, swelling - swelling is no longer pitting - + Stemmer sign - frequent infections may occur Stage III - + stemmer sign - significant increases in limb volume - typical skin changes (hyperkeratosis, papillomas, deep skin folds) - bacterial and fungal infections of the skin and nails more common

Lacunar Stroke 1. what is it? whats the cause?

Stroke caused by the occlusion of a small branch of a larger blood vessel - associated with HTN, diabetes

Anterior Cerebral Artery Syndrome (ACA) 1. What does it supply? 2. Signs and Symptoms?

Supplies the frontal and parietal lobes - contralateral hemiparesis and sensory loss with greater involvement of the LE - contralateral hemiparesis LE - contralateral hemisensory loss of LE - urinary incontinence - problems with imitation and bimanual tasks - apraxia - abulia akinetic mutism - slowness, delay, lack of spontaneity, motor inaction - contralateral grasp reflex, sucking reflex

Transtibial Suspensions Supracondylar Leather Cuff Suspension Supracondylar Socket Suspension Supracondylar/suprapatella Socket Suspension Thigh Corset Suspension

Supracondylar Leather Cuff Suspension - buckles over femoral condyles - widely used - easily adjusted Supracondylar Socket Suspension - medial and lateral walls of socket extend up and over the femoral condyles - provides increased media-lateral stability Supracondylar/suprapatella Socket Suspension - high anterior wall - assist ni suspension of short residual limbs - similar to one above Thigh Corset Suspension - provide larger surface areas for WB - for those with sensitive skin - knee joint allows for knee control (locks_ - poisoning may be a problem

Complications Following Primary Repair of a Ruptured Achilles Tendon

Sural nerve injury leading to altered sensitivity of the lateral border of the foot difficulty ascending and descending stairs due to limited DF strength and muscular endurance deficits, typically of the PF

Total Lung Capacity (TLC)

TV + IRV + ERV + RV

Semmes Weinstein Monofilament Test - normal sensation what monofilament can be felt? - protective sensation what monofilament can be felt?

Tests for protective sensation in foot, especially people with diabetic foot; plantar aspects of 3rd and 5th metatarsal heads is best place to test 4.17 (1g force) 5.07 (10g force)

Stage 4

Thawing - 15-24 months - minimal pain - no synovitis - significant capsular restrictions from adhesions - motion may gradually improve in this stage - some patients never regain ROM

Spinal Cord 1. What is the neurological level? 2. What is the motor level? 3. What is the sensory level? 4. What is the ordinal scale?

The most caudal level of the spinal cord with normal motor and sensory function on both the left and right sides of the body testing the strength of the 10 key muscles on R and L side of the body the lowest myotome with a key muscle that has a grade of at least 3 determined by testing the patients sensitivity to light touch and pin prick on L and R side the most caudal level with normal light touch and pin prick sensation 0= absent 1= impaired 2= normal

Thermal Vs. Non-Thermal US

Thermal - produced by continuous sound energy of sufficient intensity - range 0.5-3 w/cm2 - excessively high temperatures may produce a sudden, strong ache caused by overheating of periosteal tissue (periosteal pain) reduce the intensity or increase surface area of tx if periosteal pain is expressed by patients - insufficient coupling agent may produce discomfort caused by a "hot spot" which is uneven distribution of the acoustical energy through the sound head Non-Thermal - very low intensity or pulsed intermittent treatment - typical duty cycles are 20%-50% - cavitation is alternating compression (condensation phase) and expansion (rarefaction phase) of small gas bubbles in tissue fluids caused by mechanical pressure or waves - stable cavitation: gas bubbles resonate without tissue damage. stable cavitation may be responsible for diffusional changes in cell membrane - unstable cavitation: sever collapse of gas bubbles during compression resulting in local tissue destruction due to high temperatures

Trigger Finger

Thickening of the flexor tendon sheath (nottas nodule) which causes sticking of the tendon when the patient attempts to flex the finger. - more in middle aged women - usually occurs in the 3rd or 4th finger - often associated with RA - worse in the morning Trigger thumb - with flexion deformity of the IP joint is more common in young children.

Zig-zag deformity of thumb

Thumb is flexed at the CMC joint and hyperextended at the MCP joint - associated with RA - due to hyper mobility

Strengthening for Transtibial Transfemoral

Transtibial - knee extensors Transfemoral - hip extensors - hib abductors for stance phase pelvic stability

Positioning for Contractures Transtibial Transfemoral

Transtibial - prolonged FL and ER - knee FL counteract with posterior board to keep knee straight in WC and prone lying Transfemoral - FL, ABD, ER counteract with prone lying time

Types of Drainage - Transudate - Serosanguineous - Exudate - Pus - Infected pus

Transudate - clear - thin - watery Serosanguineous - clear or tinge of red/brown - thin, water Exudate - creamy, yellowish - moderate to very thick - autolytic debridement Pus - yellow, brown - moderate to very thick Infected pus - hued of yellow, blue, green - thick, usually indicates infection

Restrctive Lung Disease

Two groups 1. know cause 2. idiopathic rheumatic disease, oxygen, drug induced toxicity, inhalation of organic and inorganic dust, radiation exposure, asbestos exposure cause cause damage to pulmonary parenchyma, pleura and result in restrictive lung disease most common is idiopathic pulmonary fibrosis termed unusual interstitial pneumonia Pathophysiology - chronic inflammation and thickening of the alveoli and interstitial - distal air spaces become fibroses, making them more resistant to expansion - lung volumes reduced - hypoxemia and cor pulmonale Clinical Presentation - dyspnea with activity - persistent non productive cough - rapid shallow breathing - limited chest expansion - inspiratory crackles - clubbing - cyanosis - honeycombing - reduced VC, FRC, RV, TLC - expiatory flow rate may be somewhat normal - FEV1 may be normal or increased

UMN vs LMN

UMN - stroke - TBI - SCI - MS LMN - polio - GB - peripheral N. injury - peripheral neuropathy - radiculopathy

imaging used for CHF

Ultrasound technology Echocardiogram - examine wall motion integrity, valvular status, wall thickness, chamber size and LV function echo - stress echo - compare LV function and wall motion between rest and exercise while an increased V02 resumed in an increased MVO2 - + test indicates a worsening of LV function as activity increase - (-) the LV has adequately adapted to the increase in energy demand nuclear imaging - compares coronary perfusion between rest and exercise. - if there is no decrease in perfusion with increasing work loads, the test is negative - if there is decrease in perfusion and workload the test is negative

Upper vs. Lower UTI

Upper = fever, flank pain, chills, malaise, systemic, tender over kidneys - inflammation and infection of one of both kidneys Low = urgency, frequency, dysuria, urning, cloudy, smell fowling urine - inflammation and infection of the bladder or urethritis (inflammation and infection of the urethera

Head Shaking Induced Nystagmus Test

Use: for the detection of latent spontaneous vestibular nystagmus - patients closes eyes - flexes head 30 degrees - oscillate horizontally - patient then opens eyes - check for nystagmus if nystagmus present, there is an asymmetry between the peripheral vestibular inputs to central vestibular nuclei

Diaphragmatic Controlled Breathing

Used to manage dyspnea, reduce atelectasis, increase oxygenation Facilitating outward motion of abdominal wall while reducing upper rib cage motion during inspiration Sniffing can be added to engage the diaphragm Scoop technique supine --> sit -->stand

Conus Medullaris Syndrome

Very distal portion of the spinal cord is damaged - resulting in LE motor and sensory loss - a reflexic bowel and bladder ** results in mixture of LMN and UMN damage**

Occipital Lobe Lesions

Vision -visual understanding - integrates sensory information - somatosensory, visual, auditory impairments - contralateral homonymous hemianopsia - impairment of vision - visual agnosia - perceptual impairment

what is cardiac output?

Volume of blood ejected by the heart in one minute: cardiac output = heart rate x stroke volumne

Cancer Hematologic Disruptions 1. WBC? 2. Platelets 3. RBC

WBC - Suppressed - leukopenia - increased infection susceptibility Platelets - suppressed - thrombocytopenia - increased bleeding RBC - suppressed - anemia - diminished aerobic capacity

Features of Early Weight Bearing and Remobilization Programs After Repair of Acute Achilles Tendon Rupture Weight Bearing Guidelines ROM Guidelines

Weight Bearing Guidelines - ankle immobilized in PF or possibly neutral - progress gradually to full WB status between 3-6 weeks post-op - orthosis worn during all WB for 6-8 weeks after surgery - full WB without the functional orthosis but wearing regular shoes with bilateral heel lifts 1- or 1.5-cm when orthosis discontinued beginning at about 6-8 weeks post-op ROM Guidelines - immediately or by 1-2 weeks after surgery active PF and DF of the operated ankle initiated while wearing a functional brace or orthosis to prevent DF beyond 15-20 degrees of equines or to no more than neutral position - during the first 4-6 weeks and with the orthosis removed, ankle inversion, eversion while maintaining the ankle in PF - by 6-8 weeks, DF to 10 degrees beyond neutral permitted in the orthosis and inversion/eversion out of the orthosis

Type 2 Diabetes Mellitus (T2DM) 1. What is it? 2. What is the onset like? 3. Prone to ketoacidosis? 4. Risk factors? 5. Classic Signs and Symptoms 6. Complications of DM

What is it? results from inadequate utilization of insulin (insulin resistance) and progressive beta cell dysfunction also known as non-insulin dependent or adult- onset diabetes - insulin resistance in muscle and adipose tissue - progressive decline in pancreatic insulin production - excessive hepatic glucose production - inappropriate glucagon secretion Onset - gradual - usually not insulin dependent - progressive not prone to ketoacidosis Risk Factors - over age 45 - obesity - family history - unhealthy eating - lack of physical factitive classic signs and symptoms - elevated blood sugar (hyperglycemia) - elevated sugar in urine (glycosuria) - excessive excretion of urine (polyuria) - excessive thirst (polydipsia) dry mouth - excessive hunger (polyphasic) especially after eating - unexplained weight loss - fatigue - blurred vision, headache 6. Complications of DM - retinopathy - renal disease - polyneuropathy - CVA/ stroke - MI - PAD - slow healing of cuts, increased risk of ulcers - joint stiffness - increased risk of contractures - increased risk of frozen shoulder, tenosynovitis, plantar fascistis - increased risk of osteoporosis - diabetic autonomic neuropathy: resting tachycardia, exercise intolerance, abnormal HR, BP, cardiac output, exercise induced hypoglycemia, postural hypotension - anhidrosis, abnormal sweating, dry skin, heart intolerance - GERD, diarrhea, constipation - metabolic hypoglycemia - mononeuropathies: focal nerve damage resulting from vasculitis with ischemia and infarction - enragement neuropathies: resulting from repetitive trauma to superficial nerves - kidney failure - diabetic retinopathy - diabetic macular edema - fatty liver disease

Pitres-Testus Sign

When the patient cannot do a cylinder grasps because of loss of hypothenar muscles due to **ulnar N neuropathy**

Pagets Disease 1. What is it? 2. What is the cause? 3. What does it result in? 4. Medical interventions? 5. Diagnostic tests?

a bone disease of unknown cause characterized by the excessive breakdown of bone tissue, followed by abnormal bone formation 1. What is it? type of viral infection along with environmental factors 2. What is the cause? metabolic bone disease involving abnormal osteoclastic and osteoblastic activity 3. What does it result in? - spinal stenosis - facet arthropathy - possible spinal fracture 4. Medical interventions? - calcitonin and etidonate they limit osteoclast activity 5. Diagnostic tests? - plain film - increased serum, alkaline phosphate and urinary hydroxyproline on labs

Heart failure/CHF - pathophysiology

a chronic condition in which the heart is unable to pump out all of the blood that it receives cause by: - HTN, infections, arteriosclerosis, constrictive pericarditis, atherosclerosis, hyperthyroidism, congenital defects CAD, valvular disease patho - decreased cardiac output - elevated end diastolic pressures (preload) - tachycardia - contractile deficient (Decreased stroke volume and contractile force) - impaired ventricular function

Myofascial Pain Syndrome 1. What is it? 2. What are the characteristics? 3. What is a trigger point? 4. What are causes of trigger points? 5. Treatment

a chronic pain disorder that affects muscles and fascia throughout the body - trigger points in muscle - referred patterns of pain - tight band of muscle - no related fatigue complaints - increased pain with muscle stretching - produces a classic pain pattern hyper irritable area in a tight band of muscle pain is dull, aching, deep - chronic overload of muscle with repetitive activities or that maintain the muscle in a shortened position - acute overload of muscle such as slipping and catching onself - poorly conditioned muscles - postural stresses (Sitting prolonged periods) - poor body mechanics with lifting and other activities. Treatment - correct chronic overload such a faulty posture, repetitive activity, poor lifting techniques - eliminate trigger points by doing -contract relax passive stretch done repeatedly until the muscle lengthens - contract relax active stretch done in repetition - trigger point release - spray and stretch - modalities - dry needling or injection - strengthen muscle, endurance protocol typically indicated for core and scapular stabilizing muscle groups - eliminate the contributing factor prior to addressing the trigger point

Parkinson's Disease 1. What is it? 2. Causes?

a chronic progressive disease of the CNS with degenerating of dopaminergic substantial nigra neurons and nigrostriatal pathways infectious/postencephalitic, artherosclerosis, idiopathic, toxic, drug induced - deficiency of dopamine within the basal ganglia corpus striatum with degeneration of substantial nigra - loss of inhibitory dopamine results in excessive excitatory output from cholinergic system (Acetycholine) of basal ganglia

Common sites of lumbar strain

a common site for injury in the lumbar region is along the iliac crest. - this is where many forces converge around the attachment of the lateral raphe of the lumbodorsal fascia, erector spina, iliolumbar ligament - injury to this region frequently occurs with falls and with repeated loading of the region during lifting or twisting motions

Diabetes Mellitus

a complex disorder of carb, fat, protein metabolism caused by a deficiency or absence of insulin secretion by the beta cells of the pancreas of by defect of the insulin receptors causing an abnormally high level of sugar or glucose in the blood

Standard Deviation

a computed measure of how much scores vary around the mean score probability or level of confidence as to whether or not the results of the experiment happened by chance P=.05 there is a probability that the results obtained would occur by chance 5% of the time and would occur from the treatment or procedure performed 95% of the time P=.01 is a higher statistical significance because there is only a 1% probability that the results of the study occurred by chance

Failure to Thrive

a condition in which infants become malnourished and fail to grow or gain weight for no obvious medical reason - lacks nutritional intake - infant can present with developmental delays - increased fragility of skin - thermoregulation problems - feeding problems - interaction/attachment problems with caregivers

Acquired Immunodeficiency Syndrome (AIDS) 1. what is it 2. what causes it? 3. what is the treatment?

a disease in which the immune system is weakened - dementia like symptoms with memory loss to disorientation - ataxia, weakness, tremor, loss or fine motor coordination, peripheral neuropathy, hypersensitivity, pain, sensory loss treat with anti HIV drugs - provide palliative and supportive therapy

Autism Spectrum Disorder

a disorder that appears in childhood and is marked by significant deficiencies in communication and social interaction, and by rigidly fixated interests and repetitive behaviors - linked to abnormal biology and chemistry in the brain - difficulties with verbal and non verbal communication, social interaction, atypical play - sensory integration issues either hypo or hypersensitive - boys > girls impairments - decreased coordination - high level of balance impairments - occasional strength and ROM deficits - sensory impairments - difficulty with new people and situations - aggressive or passive behaviors are seen

Phantom Limb Sensation

a feeling of pressure or paresthesia as if coming from the amputated limb. - sensations are normal, not painful - may last for a lifetime patients who have had a limb amputated may still experience sensations such as itching, pressure, tingling, or pain as if the limb were still there

Cerebral Palsy 1. What is it? 2. Classifications of CP 3. Most Obvious Impairments - Spastic - Athetosis - Ataxia - Dystonia - Hypotonia - Mixed 4. Impairments for all Classifications of CP

a group of disorders that are prenatal, perinatal or postnatal in origin - non progressive encephalopathy: major causes included hemorrhage below the lining of ventricles, hypoxic encephalopathy, malformations and trauma of CNS - preterm birth associated with CP Classifications - one limb= monoplegia - two lower limbs= diplegia - hemiplegia - quadriplegia - trunk can be involved in all types Most Obvious Impairments mixed is that it can be present with a multiple/mixture of movement disorders Impairments for all classifications - insufficient force generation - tone abnormality - poor selective control of muscle activity - poor regulation of muscle activity in anticipation of postural changes - decreased ability to learn unique movements - abnormal patterns of movement in totally flexion and extension - persistence of primitive reflex that may interfere with normal posture and movement and may cause contracture sand deformities

Dialysis

a procedure to remove waste products from the blood of patients whose kidneys no longer function

Double Blind Test

a research design in which neither the experimenter nor the patient knows who is getting the research treatment

Secondary Diabetes Gestational Diabetes Mellitus Prediabetes

a type of diabetes caused by another disease or certain drugs or chemicals. glucose intolerance (high blood sugar) associated with pregnancy. most likely in the 3rd trimester impaired glucose tolerance (IGT) with abnormal response to oral glucose test 10%-15% of individuals will convert to type 2 diabetes within 10 years

Ischemic Stroke

a type of stroke that occurs when the flow of blood to the brain is blocked - produces cerebral edema - accumulation of fluid in the brain - begins within minutes and reaches a maximum by 3 to 4 days - result of tissue necrosis and widespread rupture of cell membranes with movement of fluid from the blood into brain tissues - disappears by 2-3 weeks - edema elevates intracranial pressures leading to intracranial hypertension and neurological deterioration **cerebral edema most frequent cause of death in acute stroke**

Meconium Aspiration Syndrome

abnormal inhalation of meconium (first stool) produced by a fetus or newborn - some with developmental delays - some up until 3 years of age

Rearfoot Valgus

abnormal mechanical alignment of knee (genu valium) or tibial values deformity observed is eversion of calcareous with neutral subtalar joint due to increased mobility of hind foot

Myocardial Infarction

abrupt reduction in coronary blood to the heart muscle causes - atherosclerotic heart disease with thrombus formation - coronary vasospasm - embolism - cocainetoxicity signs and symptoms - deep visceral pain - aching or pressure - radiates into the jaw and left arm - similar to angina pectoris but more severe and not improve with nitroglycerin - restless, pale, diaphoretic, cool (Excessive sweating) treatment - relieve distress - reduce cardiac work and treatment complications

Renal Failure Acute Renal Failure - whats elevated? (2) Chronic Renal Failure Uremia

acute renal failure - sudden loss of kidney function with resulting elevation in serum urea and creatinine Chronic Renal Failure progressive loss of kidney function leading to end stance failure - may result from prolonged acute urinary tract obstruction and infection, diabetes, SLE, uncontrolled HTN Uremia end stance toxic condition resulting from renal insufficiency and retention of nitrogenous waste in blood - anorexia, nausea, mental confusion

once the secretions have been mobilized with postural drainage, percussion and shaking the task of removing the secretions from the airways is undertaken using what technique?

airway clearance

T11 and below muscles of inspiration EXPIRATORY (1)

all the above listed all the above listed and quadrates lumborum

Metabolic System - glucose control - insulin - glucagon - amylin - somatostatic

allows our bodies to utilize food and convert it to energy - glucose control: nutrient, neural and hormonal regulation - insulin allows uptake of glucose from the blood stream lowering blood plasma glucose levels - glucagon stimulates hepatic glucose production to raise glucose levels in a fasting state - amylin modulates rate of nutrient delivery - somatostatin depresses secretions of both insulin and glycogen

Calcium Channel Blockers

amlodipine, isradipine, nicardipine, nifedipine, nimodipine, diltiazem, verapamil agents that inhibit the entry of calcium ions into heart muscle cells - slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation - used to prevent or treat angina pectoris, some arrhythmias, and hypertension

Forced Expiratory Volume in 1 Second (FEV1) - what is normal for healthy individuals?

amount of air expelled in I second after maximal inspiration 70% or more

Metabolic Alkalosis 1. Causes 2. Observe for

an increase in bases or a reduction of acids; blood pH rises above 7.45 1. Causes excessing vomiting, excess diuretics, hypokalemia, peptic ulcer, excessive intake of antacids 2. Observe for hypoventilation, depressed respirations, dysrhythmias, prolonged vomiting, diarrhea, weakness, muscle twitching, irritability, agitation, convulsions and coma (death)

Phantom Limb Pain

an intense burning or cramping pain - disabling

Spondylolisthesis - what is it? - seen in who? - interventions

anterior slippage of one vertebra on the one directly below it - graded according to the amount the superior vertebra moves in relation directly below it Grade 1= up to 25% slippage Grade 2= 26%-50% Grade 3= 51%-75% Grade 4= more than 75% can occur at any age and is accosted with instability at the involved segment can be the result of either a congenital malformation in pars interarticularis, a traumatic fracture of the vertebral arch, or degenerative changes associated with age or obesity Interventions - avoid trunk flexion activities and exercises, such as bending forward to lift heavy objects and performing toe touch and sit up (crunch) exercises - stabilization exercises including both segmental and global - stretch hip flexors - gentle grade I and II for pain modulation - avoid HVT techniques as they can exacerbate symptoms

arrhythmias

are any alteration in the electrical conduction of the heart from the normal beat caused by a disturbance in the electrical activity of the heart reusing in impaired electrical impulse formation or conduction. Ex; V TACH or A-FIB

Electrical Conduction Abnormalities - what is an arrythmia - what is considered malignant? - what is considered benign?

arrhythmias are any alteration in the electric conduction of the heart from the normal beat - they are cause by a disturbance in the electrical activity of the heart resulting in impaired electrical impulse formation or conduction malignant are sustained ventricular tachycardia (V TACH) and ventricular fibrillation ( V FIB) benign is atrial fibrillation (A-FIB) with a controlled ventricular response

6 Minute Walk Test

as much distance as possible in 6 minutes. - can use an AD - can rest as needed - 25-35 meters

Background Questions

ask applicants about their work experience, education, and other qualifications ("Tell me about the training you received at . . ."). Questions focusing on basic or general knowledge about a condition and/or disorder

Decreased Breath Sound

associated with obstructive lung disease

Total Lung Capacity

at full inspiration the lungs contain their maximum amount of air divided into 4 separate parts 1. tidal volume 2. inspiratory reserve volume 3. expiratory volume 4. residual volume

Coronary Artery Disease

atherosclerotic disease process that narrows the lumen of coronary arteries resulting in ischemia to the myocardium - leading cause of death in the US - main clinical symptoms are angina pectoris, MI and heart failure

Body Scheme /Body Image/ Body Awareness

awareness of body parts and the position of the body and its parts in relation to themselves and the environment

Pathology of the Vertebrae: Compression Fracture Secondary to Osteoporosis - how do vertebral compression fractures occur? // most common where? - sx? - commonly where? - interventions? - contraindications?

axial overload (compression) of the spine may cause end-plate damage or vertebral body fracture. compression fracture is a complication of osteoporosis vertebral compression fractures are most common in the thoracolumbar region as the result of a fall or trauma or from performing basic ADL's. that require forward bending and flexion of the trunk during the 6th or 7th decade in the anterior vertebral body - pain can be referred to the low back or ABD region with or without LE radiculopathy - increased thoracic kyphosis (dowagers hump) - lumbar lordosis secondary to instability, bone changes (wedging) and muscle weakness - exercise prescription is based on pain tolerance - vertebroplasty in severe cases common in the thoracolumbar region as a result of axial loading and trunk flexion, symptoms are provoked with flexion activities Interventions - stabilization exercises to promote a neutral thoracolumbar junction and developing spina stability - scapular stabilization exercises to assist with correct posture, decrease progression of the thoracic kyphosis - stretch the antagonist muscles (shoulder horizontal adductors, IR, hip flexors, IR) - instruct in correct lifting techniques, advise to avoid extreme and prolonged trunk flexion when possible avoid trunk flexion activities and exercises such as bending forward to lift heavy objects and performing toe touch and sit up exercises

Positioning to relive pressure 1. In bed how long? 2. In WC how long?

bed every 2 hours WC every 15 minutes

Lower Lobes Superior Segments

bed flat patient prone with 2 pillows under hips claps over middle of back at tip of scap on either side of spine

What is neurogenic shock? 1. What level? 2. What is systolic BP? HR? 3. Symptoms? 4. more likely in what part of spine?

blood vessels don't get signals from sympathetic nervous system (above T6) systolic below 100mmHg - HR below 80 bpm bradyarrhythmias, atrioventricular conduction block, hypotension - acute patients experience bradycardia - more likely with cervical and upper thoracic level injuries

Swing Through Gait

both crutches are advanced then the legs swing past the crutches

Swing to Gait

both crutches are advanced together and then both legs are lifted and placed down again on a spot behind the crutches. * the feet and crutches form a tripod*

Combinations of two or more lung volumes are called what?

capacities

Beta Blockers

carveilol + labetalol - decreased HR - decreased BP - decreased ischemia

Pes anserine bursitis

caused by overuse or contusion

Electrical Conduction Abnormalities Conduction Delays and Blocks 1. First, second and third degree heart blocks 1. First Degree Heart Block 2. Second Degree Heart Block - Mobitz Type 1 - Mobitz Type 2 (dropped beats) 3. 3rd degree heart block 4. Conduction delays through the bundle of His 1. Right Bundle Branch Block (RBBB) 2. Left Bundle Branch Block (LBBB)

changes in length of PR interval, width of QRS complex and length of QT are indicative of conduction abnormalities 1. First, second and third degree heart blocks - conduction delays through the AV node 1. First Degree Heart Block - AV node is prolonged - increased PR interval - no exercise limitation 2. Second Degree Heart Block - Mobitz Type 1 Wenckeback - gradual increase in PR interval length in the preceding beats and then an eventual dropped beat - Mobitz Type 2 normal PR interval in all the beats preceding the dropped beat - medical clearance before exercise 3. third degree heart block - mismatch of atrial and ventricular conduction - no consistency between the atrial and ventricular contracting (no relation between P and QRS waves) - medical clearance before exercise 4. Conduction delays through the bundle of His 1. Right Bundle Branch Block (RBBB) - may occur from variety of reasons - may be a permanent change due to underlying disease - may be benign - can occur transiently 2. Left Bundle Branch Block (LBBB) - permanent and indicates a pathological condition - usually indicates the presence of more significant disease then R - should be medically evaluated before beginning or progressing an exercise program. following medical clearance there is usually no contraindication to exercise - NOT true arrthymias because there is no change in the actual rhythm just in the timing of conduction through th bundle of His. - distortion of the QRS complex with increased widening/duration.

Drugs Used in Chemotherapy

chemotherapy - liver damage - decreased platelets - bone marrow suppression - decreased RBC's - decreased WBC's - GIT problems cancer patient undergoing chemotherapy must be warned, the use of NSAIDS that may worsen GI tract symptoms (severe diarrhea) any other drugs/like psyllium, hypnotics, anxiolytics are fine

Down syndrome

chromosomal abnormality caused by a breakdown and translocation of a piece of chromosome onto normal chromosome - standard and translocation - brain and brainstem lighter than normal Impairments - hypotonia - decreased force generation of muscles - congenital heart defects especially septal defects - visual and hearing losses - antlantoaxial subluxation (dislocation could be due to laxity of transfers odontoid ligament) - decreased strength - decreased ROM - hyporeflexic DTR - decreased sensation in extremities - persistent head tilt and increase in muscle tone - cognitive deficits Functional limitations - gross motor development delay - difficulty eating dn speech development due to low tone - forceful neck flexion and rotation activites should be limited due to atlantoaxial ligament laxity - cognitive and perceptual deficits Goals for PT - minimize gross motor delay - encourage orla motor function (facilitate lip closure and tongue recursion, short frequent feeding sessions for energy conservation) - avoid hyperextension of elbows and knees during WB - avoid all traction on extremities or spine due to ligamentous laxity and low muscle tone

Fibromyalgia 1. What is it? 2. What are the characteristics? 3. What kind of exercise?

chronic condition with widespread aching and pain in the muscles and fibrous soft tissue - pain in muscles - decreased ROM - postural stresses - tender points at specific sites - no referred patterns of pain - no tight band of muscles - fatigue and walking unrefreshed - affects multiple body regions (right or left side, upper or lower half) - last for more than 3 months - 11 out of 18 tender points - nonrestorative sleeps - morning stiffness - fatigue with subsequent diminished exercise tolerance - women>men - appears early to middle adulthood - symptoms develop after physical trauma such as an MVA or viral infection - muscular origin predominantly reported in the scapula, head, neck and low back - fluctuation in symptoms - have higher incidence of tendonitis, headaches, irritable bowel, TMJ, restless leg syndrome, mitral valve prolapse, anxiety, depression, memory problems - aggravated by stressors (environment, physical, emotional) - changes in barometric pressure, cold, dampness, fog and rain - repeptivie activities bother it **pace activities throughout the day** - aerobic exercise - strengthening - low intensity exercise - flexibility training - prescription medication - CBT - avoidance of stress factors - decreasing alcohol and caffeine - diet modification - manual therapy

Osteoarthritis what is it? 1. Age of Onset 2. Progression 3. Manifestations 4.Joint Involvement 5. Joint Signs and Symptoms 6. Systemic Signs and Symptoms 7. Treatment

chronic degenerative disorder primarily affects the articular cartilage of synovial joints with eventually bony remodeling and overgrowth at the margins of joints (spurs and lipping) - progression of synovial and capsular thickening and joint effusion - contractures eventually develop in portions of the capsule and overlying muscle, so as the disease progresses motion becomes more limited - cartilage splits and thins out losing its ability to withstand stress as a result crepitation or loose bodies may occur in the joint - increased density of bone along the joint line with cystic bone loss and osteoporosis - due to major stress of repeated minor stresses, weak quads Herberdens node (enlarged DIP) Bouchards Nodes (enlarged PIP) 1. Age of Onset - usually after age 40 2. Progression usually develops slowly over many years in response to mechanical stress 3. Manifestations - cartilage degradation - altered joint architecture - osteophyte formation 4.Joint Involvement - asymmetrical typically - DIP, PIP, 1 CMC - Cervical and Lumbar Spine - Hips, Knees, 1st MTP 5. Joint Signs and Symptoms - morning stiffness usually <30 minutes - increased joint pain with WB and strenuous activity - crepitus and loss of ROM 6. Systemic Signs and Symptoms NONE 7. Treatment - active ROM - joint mobs - orthoses - stretch muscle, joint, soft tissues restriction - low intensity resistance exercise and muscle repetitions - balance training - non impact or low impact aerobic exercise - multiple angle isometrics in pain free positions - aquatic to decrease WB stresses and improve strength and function - tai chi - walking, biking, swimming - avoid repetitive intensive loading such as running and jumping - can be stiff after exercise - late stages = pain at rest - spine bony growth can cause radicular pain

Cystic Fibrosis

chronic disease that effects the excretory glands of the body - thicker, viscous secretions effecting a number of systems in the body including - pulmonary - pancreatic - hepatic - sinus - reproductive systems May have - failure to thrive - diabetes - sinusitis - biliary disorders -infertility Etiology - autosomal recessive genetically transmitted disorder - CFTR gene functions to transport electrolytes and water in and out of the epithelial cells of many organs such as pancreas, digestive, potassium, reproduction - defection transport of sodium and potassium and water leaves the muscus thickened and difficult to move and disrupts the lumen of excretory gland Pathophysiology - muscus impairs the function of the mucociliary transport system - altered secretions result in airway obstruction and hyperinflation - ventilation and perfusion are not matched - fibrotic changes in lung parenchyma Diagnosis - family history - recurrent pulmonary infections from staph - malnutrition - failure to thrive - sweet test - genotyping Clinical Presentation - barrel chest - ant/post increase - dorsal kyphosis - crackles/wheezes - pursed lip breathing - cyanosis - digital clubbing - decreased FEV1, PEF, FVC - increased RV, FRC - hypoxemia and hypercapnea respiratory failure is cause of death TX - proper diet - vitamin supplementation - replace panreatic enemies - habitual exercise nutrition status is a predictor of prognosis

Plantar Fasciitis

chronic irritation of the plantar fascia from excessive pronation - limit ROM of first MTP and talocrural joint - tight triceps surae - acute injury from excessive loading of foot - rigid caves foot reels in micro tears at attachment of plantar fascia - modalities - joint mobilizations - night splints - strengthen inverters of the foot

Parkinsons Disease 1. What is it?

chronic progressive disease of the CNS with degeneration of dopaminergic substantial nigra neurons and nigrostratial pathway Deficiency of dopamine within the basal ganglia corpus striatum with degeneration of substantial nigra loss of inhibitory dopamine results in excessive excitatory output from cholinergic system (acetylcholine) of basal ganglia - rigidity - bradykinesia - hypokinesia - resting tremor - impaired postural reflexes

Clinical Manifestations of Vertebrobasilar Artery Syndrome Horners Syndrome 1. What is it? 2. Symptoms 3. Symptoms contralateral to lesion

collection of signs relating to injury of the cervical sympathetic innervation to the eye 2. Symptoms - mitosis - ptosis - decreased sweating - dysphagia and dysphonia - paralysis of palatal and laryngeal muscles - diminished gag reflex - sensory impairment of ipsilateral UE, trunk, LE 3. Symptoms contralateral to lesion - impaired pain and thermal sense over 50% of body, sometimes face

Meniscal Injury 1. How does it happen? 2. Symptoms Include? (6) 3. Clinical Tests (2)

combination of forces - tibialfemoral joint flexion, compression, rotation - places abnormal shear stresses on the meniscus Symptoms - lateral and/or medial joint pain - effusion - joint popping - knee giving way during walking - limitation in flexibility of knee joint - joint locking Clinical Tests - Aplys - McMurrays

Functional Residual Capacity

combination of residual volume and expiratory reserve volume the volume of air that remains in the lungs at the end of a tidal exhalation

Asthma

common chronic pulmonary disease - expiratory airflow limitation - wheezing - SOB - chest tightness - cough chronic airway inflammation associated with airway hyperresponsivemess (bronchospasm) to direct or indirect s timely Diagnosis - based on episodic wheezing, SOB, chest tightness - coughing - may be worse at night, early morning - FEVI <80% with exacerbation - inhaled short acting beta 2 agonist is used - improvement of at least 12% with this (200ml in fev1) indicates reversibility of the airway limitation consistent with the diagnosis of asthma Etiology 1. allergic asthma - most common - trigger to dust mites, pollen, mold, animal dander 2. non allergic asthma - less common - result from exposure to an irritant such as smoke, fumes, infections, cold air - viral infections play a role in development and exacerbation Pathophysiology -inflammation of the bronchial musocsa leading to narrowing of the airways, bronchospasm and increased bronchial secretions all in response to a trigger -the narrowed airway increases resistance to airflow and cause air trapping on exhalation leading to hyperinflation Clinical Presentation - cough - dyspnea on exertion or at rest - wheezing - crackles may be present - decreased FEV1 - RV and FRC increase because of air trapping - VC AND IRV are reduced - hypoxemia

Tibial Plateau

common mechanism of injury is a combination of valium and compression forces to knee when knee is in a flexed position often occurs in conjunction with a MCL injury

Tendonosis/Tendonopathy 1. What is it? 2. Common where? 3. Medications? 4. PT Goals

common tendon dysfunction whose cause and pathogenesis are poorly understood but likely related to degenerative collagen changes within the tendon referred to as tendonitis however there is no inflammatory response noted - loosening of collagen fibrils - supraspinatus, extensors of elbow, patella tendon, achilles, flute med NSAIDS, Steroid injection PT Goals - manual therapy - flexibility - ECCENTRICS endurance and strengthening

Phase 3 of Cardiac Rehabilitation

community program (post-acute) - usually behind 3-6 months after the incident and may last 12 weeks or longer - cardiac team supervises the program that increases the exercise capacity and improves various psychological values, BP, HRR, cholesterol, angina threshold - continued psychological recovery - individualized exercise training - promote long term fitness - life long commitment to risk factor modification - patient must function at 5 METS to begin program - consist of aerobic exercises involving large muscle groups (walking, jogging, stepping, biking, swimming, rowing) - low level resistive exercise may also be included - relaxation training - progress from supervised to self-regulation of exercise - progress to 50%-85% of functional capacity, 3-4 times a week, 45 minutes or move per session -

ASIA A

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

Subdermal Burn (Fourth Degree) 1. Characteristics 2. Healing when? 3. Scarring?

complete destruction of epidermis, dermis with involvement of subcutaneous tissues and muscle - charred appearance - destruction of vascular system may lead to additional necrosis - from electrical burns, prolonged contact with flame - additional complications likely with electrical burns - ventricular fibrillation - acute kidney damage - spinal cord damage - heals with skin grafting and scarring - requires extensive surgery - amputation may be necessary

Internal Carotid Artery Syndrome

complete occulsion of internal carotid artery causes massive infarction in MCA & ACA regions of the brain; - leads to extensive cerebral edema, frequently coma, and death

Systolic dysfunction (heart failure with reduced EF)

compromised contractile function of the ventricles causing reductions in stroke volume, cardiac output and ejection fraction ejection fraction <40%

Forefoot Valgus

congenital abnormal development of head and neck of talus deformity observed is eversion of forefoot when the subtalar joint is in neutral

Forefoot Varus

congenital abnormal deviation of head and neck of talus inversion of forefoot when subtalar joint is in neutral

Hip Knee Ankle Foot Orthosis what is it? Denis Brown Splint Frejka Pillow Toronto Hip Abduction Orthosis

contains hip joint and pelvic band added to a KAFO - controls abduction, adduction, rotation - controls hip flexion when locked Denis Brown Splint - bar connecting two shoes that can swivel - used in correction of club for or equinovarus in young children Frejka Pillow - keeps hips ABD - used for hip dysplasia - tight adductors Toronto Hip Abduction Orthosis ABD the hip - leg calve perthes

Central Vestibular System

cranial nerve VIII, brainstem, brain - the cerebellar connections help maintain calibration of the VOR

Epidermal Burn (First Degree) 1. Characteristics 2. Healing when? 3. Scarring?

damage to epidermis only - pink or red appearance - no blisters - dry surface - minimal edema - tenderness - delayed pain - 3-7 days - no scars ****SUNBURN**

Temperature as a Result of SCI 1. what is lost? 2. what is lost initially after injury? 3. hyperthermia is likely due to what?

damage to the spinal cord, hypothalamus can no longer control cutaneous blood flow or level of sweating - autonomic dysfunction results in the loss of internal thermoregulatory responses. - the ability to shiver below the level of injury is lost - cervical injuries and complete is worse - initially after injury hypothermia may occur due to peripheral vasodilation hyperthermia is more likely due to the lack of sympathetic control of sweat glands patients with tetraplegia typically exerpience long-term impairment of body temperature regulation

Osteomalacia 1. what is it? 2. what are symptoms? 3. medications? 4. diagnostic tests?

decalcification of bones due to vitamin D deficiency severe pain fractures weakness deformities calcium vitamin D - plain fils - lab test (urinalysis and blood work) - bone scan - bone biopsy if warranted

What does a thoracolumbar SCI do to SV and CO?

decreased - lower peak HR - post exercise hypotension - abnormal CVD responses to exercise

Anosognosia

defined as a lack of awareness, denial or a paretic extremity as belonging to the person or lack of insight concerning or denial of paralysis and disability Ex: patient thinks there is nothing wrong and may disown the paralyzed limbs and refuse to accept responsibility for them - the patient may claim that the limb has a mind of its own or that it was left at home in a closet

Achilles Tendonosis/Tendonpathy

degenerative achilles tendon - + Thompsons test

Patellar tendonosis/tendonopath (jumpers knee)

degenerative condition of the patellar tendon - may be related to overload and/or jumping related acitivty/sports

Metabolic Acidosis 1. Causes 2. Observe for 3. May lead to

depletion of bases or an accumulation of acids - blood pH below 7.35 1. Causes diabetes, renal insufficiency or failure, diarrhea 2. Observe for hypoventilation, deep respirations, weakness, muscular twitching, malaise, nausea, vomiting, diarrhea, headache, dry skin, mucus membranes, poor ski tutor 3. May lead to stupor and coma (death)

Exercise Tolerance Test

determines the physiological responses during measured and graded exercise stress of increasing workloads - determines the exercise capacity of the individual - establishes an exercise prescription - screens patients for possible CAD - assist in the diagnosis of CVD disease - may be submaxial or maximal depending upon the patients history and current symptoms - submaxial is used to evaluate the early recovery of patients after MI, coronary bypass, coronary angioplasty

Idiopathic Frozen Shoulder

development of dense adhesions, capsular thickening and capsular restrictions - insidious - 40-65 years old - diabetes and thyroid disease are at an increased risk - primary: pathogenesis may provoke chronic inflammation in musculotendinous or synovial tissue such as RTC, biceps tendon or joint capsule - period of pain, restricted motion, such as RA, OA, trauma, immobilization may lead to secondary frozen shoulder

Respiratory Alkalosis 1. Causes 2. Observe for

diminished CO2, alveolar hyperventilation 1. Causes anxiety attack with hyperventilation, hypoxia, impaired lung expansion, CHF, pulmonary embolism, disuse liver or CNS disease, salicylate poisoning, extreme stress, stimulation of respiratory center 2. Observe for tachypnea, dizziness, anxiety, difficulty concentrating, numbness and tingling, blurred vision, diaphoresis, muscle cramps, twitching, tetany, weakness, arrhythmias convulsions

Relapsing-Remitting MS (RRMS)

discrete attacks or relapses followed by remission the most common disease course - is characterized by clearly defined attacks of new or increasing neurologic symptoms. These attacks - also called relapses or exacerbations - are followed by periods of partial or complete recovery (remissions). During remissions, all symptoms may disappear, or some symptoms may continue and become permanent. However, there is no apparent progression of the disease during the periods of remission.

Osteoporosis 1. What is it? 2. What is used to diagnosis it? 3. What is normal? 4. What is osteopenia? 5. What is osteoporosis? 6. risk factors (8)

disease of bone that leads to decreased mineral content and weakening of the bone - may lead to fractures especially in the spine, hip and wrist T-Score of a Bone Mineral Density Scan 1.0 or higher -1.0-2.4 -2.5 or less postmenopausal, Caucasian, asian descent, family history, low body weight, little or no physical activity, diet low in calcium and vitamin D primary or postmenopausal is directly related to a decrease in estrogen

Intermittent Mechanical Spinal Traction Joint Distraction 1. what is it? 2. what % force for lumbar spine? / lbs 3. what % of force for cervical? /lbs 4. Reduces Disc Protrusion 5. Soft Tissue Stretching

distraction force applied to the spine to separate articular surfaces between vertebral bodies and elongate spinal structures Joint Distraction seperation of the facets joints occur with sufficient force opening the intervertebral foramen, relieves pressure on the N root and decreases compression on the facets 2. what % force for lumbar spine? / lbs - 50% of patients body weight - 30-40lbs 3. what % of force for cervical? /lbs - 7% of BW - 8-10lbs - reduces disc protrusion by separation of vertebral bodies occurs at higher forces, causing a decrease in intradiscal pressure that creates a suction like effect on the nucleus drawing it back in centrally. the surrounding ligaments are stretched taut which also helps to push the disc in centrally 60-120lbs or up to 50% of patients bodied weight and for cervical 12-15lbs 5. Soft Tissue Stretching the surrounding spinal muscles, ligaments, tendons, and discs can be stretched dressing the pressure on the facet joints, nerve roots and vertebral bodies and discs without achieving joint seperation - lumbar 25% BW - cervical 12-15lbs muscle relation both intermittent and static traction can decrease muscle tone. traction interrupts the pain muscle spasm cycle by stimulating mechanoreceptors through the motion caused by interrupted traction and by inhibiting motor neuron firing with static traction.

Midtarsal capsular pattern

dorsiflexion, plantar flexion, adduction, medial rotation

Where is lymphedema located?

dorsum of the foot or hand can manifest more centrally such as axilla, groin or trunk

Respiratory Distress Syndrome

due to atelectasis caused by insufficient in surfactant in premature lungs - may lead to acute respiratory failure and death - treatment includes oxygen supplementation, assisted ventilation, and surfactant administration - chronic RDS may lead to bronchopulmonary dysplasia

Retinopathy of Prematurity

due to combination of low birth weight and high oxygen levels - sequel may range from nonsignificant to detachment of retinas and blindness

irregularity of pulses is called?

dysrhythmias

Hemoglobin and Hematocrit

each gram of hemoglobin carries approximately 1.34mL of oxygen within arterial blood - a normal hemoglobin level is 12-14 in males and 14-16 in females - hemoglobin 15g/100mL the oxygen carrying capacity is 20 if someone has a hemoglobin of 7.5/100mL the oxygen scarring capacity is reduced by half and is 10mL of O2/100mL of blood with reduced oxygen carrying capacity the heart must work harder to compensate for low oxygen levels to provide sufficient oxygen to the peripheral tissues

Shortwave Diathermy 1. what is it? 2. continuous 3. pulsed 3. inductive coil 4. capacitive plates 5. thermal and non thermal effects 6. Indications of thermal and non thermal ****not really on NPTE**

electromagnetic energy produces deep heating within tissues - radio frequency range of up to 300MHz and a short wavelength of no more than 200m 2. continuous will increase tissue temperature in deeper structures 3. pulsed allows dissipation of heat during the off cycle and can result in other physiological and therapeutic benefits 3. inductive coil alternating current in a coil produces a magnetic field - results in electric eddy currents in tissues which causes charged particles in the tissues to vibrate - the vibration and oscillation causes the temperatures to rise capacitive plates carbon rubber or metal plates covered by felt pads and encased in plastic - placed on opposite sides of the patient - high frequency AC current flows from one plate to another through the patient - the patin is part of the circuit - charged particles oscillate and tissue temp increases (heating by electric field method) 5. thermal - continuous more - increased tissue temp both deep and superficial - increased soft tissue extensibility - increased n conduction - increased pain threshold - vasodilation Use for: - increased joint ROM - pain management - increased tissue healing non thermal effects - pulsed mode - increased microvascular perfusion - increased local tissue oxygenation - increased cell growth - phagocytosis - healing wounds and diabetic ulcers Used for: - pain control - decreased edema - resolution of acute and chronic infections - wound control and soft tissue healing

Carpometacarpal joint II-V capsular pattern

equally restricted in all directions

Glasgow Coma Scale 1. what does it examine? 2. whats a mild score? 3. whats a moderate score? 4. whats a severe score?

examines - eye - verbal - motor responses mild 13-15 moderate 9-12 severe <8

National Institute of Stoke (NIH) Stroke Scale

examines levels of - consciousness - visual function - face palsy - motor arm - motor leg - limb ataxia - sensory function - best language - dysarthria - extinction - inattention uses ordinal scales with specific criteria for each section

Lymphedema

excessive and persistent accumulation of extravascular and extracellular fluid and proteins in tissue space - lymph volume exceeds the capacity of the lymph transport system - associated with a disturbance of the water and protein balance across the capillary membrane - increased concentration of proteins draws large amount of water into interstitial spaces, leading to lymphedema

Cerebellum Function and 3 Anatomic Divisions (midline, hemispheres, posterior)

execute smooth, accurate, coordinated movement Midline - vermis - paleocerebellum fx: titration, truncal ataxia, orthostatic tremor, gait imbalance Hemispheres - neocerebellum (R control R side, L control L side) fx: limb ataxia, dysdiadochokinesis, dysmetria, kinetic tremor, dysarthria, hypotonia Posterior - flocculondular lobe - archicerebellum fx: posture, gait, eye movement disorders (nystagmus, VOR disruption) compares internal and external feedback feedforward control to reduce errors/generate corrective signals lack of this = lack of coordination

Carpometacarpal joint I capsular pattern

extension and abduction

Metatarsalphalangeal joint 1 capsular pattern

extension loss greater than flexion

1. Smooth Pursuits (Gaze Stability) 2. Head Impulse Test

eye movements that follow a moving object examines semicircular canal function - cervical ROM determined before - patient first fixates on a near target (nose of PT) - head is manually rotated in a small amp, mod velocity, high acceleration - VOR is normal the eyes will move in direction opposite of the head movement with gaze on the target - if impaired the patients eyes will not more as quickly, eyes move off the target and a corrective saccade indicating vestibular hypofunction - if central the patient will not be able to maintain gaze with the head rotated quickly - bilateral loss will make corrective saccades this tests is a sensitive indication of vestibular hypofunction

What nerve for taste of anterior 2/3 of tongue?

facial

Clinically Isolated Syndrome

first episode of inflammatory demyelination in the CNS that could become mS if additional activity occurs - can progress to RRMS

Wrist capsular pattern

flexion and extension equally limited

Knee capsular pattern

flexion greater than extension

Anterior Cord Syndrome 1. Caused by what? 2. What is the clinical presentation?

flexion injuries of the cervical region with resultant damage to the anterior portion of the cord and/or its vascular supply from the anterior spinal artery. - compression of the anterior cord from fracture, disclocation, cervical disc protrusion Loss of motor function - (corticospinal tract damage) Loss of sense of pain and temperature - (spinothalamic tract damage) below level of lesion **proprioception, light touch, sensation and vibratory sense are generally preserved because the dorsal column are ok**

Elbow capsular pattern

flexion loss greater than extension

Finger interphalanlgeal capsular pattern

flexion loss greater than extension

Biventricular Failure

fluid from the left ventricle backs up into the lungs, increasing PA pressure and causing fluid to back up into the right side of the heart and the systemic venous vasculature - presents with both pulmonary and systemic signs of HF

Autonomous Stage feedback, practice and environment

foability to automatically execute the skill - the learner practices movements - continues to refine motor responses - movements are error free - minimal level of cognitive monitoring - learner demonstrates appropriate self-evaluation - occasional feedback when errors are evident - variable, open environments - high levels of practice (Massed Practice) - vary environments to challenge learner - ready the learner for home, community, work environment - focus on competitive aspects of skill as appropriate

Gastrointestinal Tract 1. Upper GI 2. Middle GI 3. Lower GI 4. what nerve controls motility of GI tract? 5. major GI hormones (3) 6. Symptoms and Signs common to many types of GI disorders

foods and fluids are broken down into molecules that are absorbed and used by the body while waste products are eliminated 1. Upper GI - mouth - esophagus - stomach function for digestion and initial digestion of food 2. Middle GI - small intestine (duodenum, jejunum, ileum) major digestive and absorption processes occur here 3. Lower GI large intestine (Cecum, colon, rectum) primary functions that include absorption of water and electrolytes, storage and elimination of waste products - accessory organs aid in digestion by producing digestive secretions and include the salivary glands, liver and pancreas - GI motility propels food and fluids through the GI system and is provided by rhythmic intermitted contractions of smooth muscle - the vagus nerve reflex controls the secretions and motility of the GI tract hormones are cholecystokinin, gastrin, secretin Signs and Symptoms - nausea - vomiting - diarrhea - constipation (obstipation is the inability to pass gas, also common sx) - anorexia (anoxrexia nerve is prolonged loss of appetite and inability to eat) - dysphagia (difficulty swallowing) - achalasia (lower esophageal sphincter fails to relax and food is trapped in esophagus) - heartburn - abdominal pain prolonged vomiting can produce fluid and electrolyte imbalance and can result in pulmonary aspiration and mucosal or GI damage

Right Middle Lobe

foot of table or bed elevated 16 inches, patient lies head down on left side and rotates 1/4 turn backward, pillow may be placed behind from shoulder to hip. Knees should be flexed. Therapist claps over right nipple area. In females with breast development or tenderness, use cupped hand with heel of hand under armpit and fingers extending forward beneath the breast.

Bronchopulmonary Dysplasia

free radical damage to lung early in life before lungs are mature enough to handle pure oxygen - chronic lung disease as a result of damage to lungs from mechanical ventilation, oxygen administration, chronic RDS - predisposes child to frequent respiratory infections and developmental disability - treatment includes respiratory support, infection control, bronchodilators administration

Reactive Hypoglycemia 1. what is it?

functional hypoglycemia occurs after the intake of a meal and usually results from stomach or duodenal surgery - rapid stomach emptying with rapid rise in glucose levels, glucose then rapidly falls below normal levels and exaggerated response of insulin secretion develops - avoid fasting and simple sugars

Athetoid Cerebral Palsy

generalized decreased muscle tone, floppy baby syndrome - poor functional stability especially in proximal joints ataxia and incoorindation when child assumes upright position with decreased BOS and muscle tone fluctuations poor visual tracking, speech delay and oral motor problems tonic reflexes such as ATNR, STNR, and TLR may be persistent blocking functional postures and movements

Impairment w/ cerebellar pathologies 1. Asthenia 2. Asynergia 3. Rebound Phenomenon

generalized mm weakness loss of ability to associate muscles together for complex movements inability to stop a motion quickly to avoid striking something????

What CN for gag reflex?

glossopharyngeal

What CN for sensory of posterior one-third of tongue?

glossopharyngeal

Signs of Hyperglycemia

glucose is high >300 - gradual onset seek immediate medical tx - weakness - increased thirst - dry mouth - frequent scant urination - decreased appetite - nausea/vomiting - abdominal tenderness - dull sense - confusion - diminished reflexes - paresthesias - flushed signs of dehydration - deep rapid respirations - rapid, weak pulses - fruity odor to the break - hyperglycemia coma

Temporal Lobe Lesions

hearing - language and understanding and formulation - recent memory Impairments - fluent aphasia - impairment of learning and memory - profound memory loss of recent events, no new learning

Diastolic Dysfunction

heart failure with preserved ejection fraction - compromised diastolic function of the ventricles - ventricles cannot relax and fill appropriately during the relaxation (diastolic) phase of the cardiac cycle - impaired ability to fill the ventricles with blood reduces the volume of blood ejected with each contraction (SV) and the overall blood ejected per minute (CO)

Rate Pressure Product

heart rate X systolic blood pressure; a measure of myocardial work - activity that increase HR or BP will increase Myocardial oxygen demand

Ectopic beats

heartbeats that occur outside of a normal rhythm 1. premature atrial contractions (PAC) - 2. premature ventricular contractions (PVC) 3. bigeminy - every other bear a PVC 4. trigeminy - every 3rd beat PVC

Pes Cavus

high arch - contracture of soft tissues - neurological disorders increased height of longitudinal arches, dropping of anterior arches, metatarsal heads lower than hind foot, plantar flexion and spaying of forefoot, and claw toes

Cancer Medical Interventions + Red Flags with Each 1. Cured when? 2. Radiation Therapy 3. Chemotherapy 4. Immunotherapy

if patient does not have recurrence within 5 years after treatment 2. Radiation Therapy - destroys cancer cells - inhibits cell growth and division 3. Chemotherapy - drugs can be given orally, subcutaneously, intramuscular, intravenously, intrathecally in spinal canal - usually intermitted doses to allow for bone marrow recovery 4. Immunotherapy - strengthens host ability to fight cancer cells - agents include interferons, interleukin-2 and cytokines - bone marrow (stem cell) transplant follows high doses of chemo and radiation that destroys cancer and bone marrow cells - monoclonal antibodies - hormonal therapy RED FLAGS 2. Radiation Therapy pain, fatigue, sickness, immunosuppression, fibrosis, burns, delayed wound healing, edema, hair loss, CNS effects 3. Chemotherapy fatigue, GI symptoms, nausea, vomiting, diarrhea, ulcers, hemorrhage, bone marrow suppression, anemia, leukopenia, thrombocytopenia, fatigue, skin rashes, neuropathies, phlebitis, hair loss 4. Immunotherapy fatigue, weight loss, flu like symptoms, fever, shills, nausea, vomiting, anorexia, fluid Rene tons Hormone therapy - GI sam HTN, steroid induced diabetes and myopathy, weight gain, hot flashes and sweating, altered mental status, impotence

Hypoglossal deviates to what side?

impaired movements with deviation of tongue to weak side UMN LESION - deviates away from side of the lesion

Apraxia 1. Ideational 2. Ideomotor

impairment of voluntary skilled learned movement - inability to perform purposeful movements 1. Ideational breakdown between concept and performance - can carry out habitual tasks automatically and decribe how they are done but are unable to imitate gestures or perform command Ex: the patient is unable to blow on command, but if presented with a bubble they can blow bubbles 2. Ideomotor failure on ceptualization of the task - either automatically or on command Ex: toothbrush and toothpaste, told to brush teeth and patient may put the tube of toothpaste in the mouth

Right/Left Discrimination

inability to identify the right and left sides of ones or body EX: Patient cannot tell the therapist which is the right arm and which is the left

Impairment w/basal ganglia 1. Akinesia 2. Dystonia 3. Hemiballismum

inability to initiate movement - late stage PD - "freezing episodes" sustained involuntary contractions of agonist and antagonist muscles large amplitude sudden, violent, flailing motions of arm + leg of one side of body - lesion of contralateral sub thalamic nucleus

Agnosia

inability to recognize familiar objects with one sensory modality while retaining ability to recognize same object with other sensory modalities - subject doesnt recognize an object (clock) by sight, but can recognize it by sound (ticking)

Tactile Agnosia or Asterognosis

inability to recognize forms by handling them although tactile, proprioceptive and thermal sensations may be intact Ex: if a patient is handed a familiar object such as a key or safety pin with vision occluded they will not be able to recognize it

Unilateral Neglect

inability to register and integrate stimuli and perceptions from one side of the body (body neglect) and the environment (spatial neglect) *forgets to shave half of face*

Urinary Incontinence Stress Incontinence Urge Incontinence Overflow Incontinence Functional Incontinence Management PT goals

inability to retain urine - result of loss of sphincter control - may be acute or persistent Stress Incontinence sudden release of urine due to 1. increase in intra-abdominal pressure - coughing, laughing, exercise, straining, obesity 2. weakness and laxity of pelvic floor muscles, sphincter weakness, postpartum incontinence, menopause, damage to PUDENDAL NERVE Urge Incontinence bladder begins contracting and urine is leaked after sensation of bladder fullness is perceived. inability to delay voiding to reach toilet due to 1. detrousur muscle instability or hyperreflexia 2. sensory instability: hypersensitive bladder Overflow Incontinence bladder continuously leaks secondary to urinary retention. overdistedned bladder or incomplete emptying of bladder due to 1. anatomical obstruction such as prostate enlargement 2. contractile bladder: SCI, diabetes 3. neurogenic bladder" MS, suprasacral spinal lesion Functional Incontinence leakage associated with inability or unwillingness to toilet due to 1. impaired cognition 2. depression 3. impaired physical function (stroke) 4. environmental Barries Management - food, beverages that aggrivate the bladder (chocolate, fruit juices, citrus juices, caffeine) - control fluid intake - drug therapy - control medications that may aggrivate such as diuretics - cauterization used for overflow - surgery - bladder training prompted voiding to restore a pattern of voiding involving a toilet schedule on regular intervals or intermitted cathetizationfor patients with over distention, persistent retention PT Goals Pelvic floor muscle exercises - pubococcygeus muscle to treat stress incontinence 1. Kegels - active strengthening - type 1: holding contraction, progressing to 10 second holds, rest 10 seconds between contractions - type 2: quick contraction to shut off flow of urine 10-80 reps a day - avoid squeezing buttocks or contracting abdominals (bearing down) 2. FES - muscle re-education if patient is unable to initiate active contractions 3. biofeedback - use pressure recordings to reinforce active contractions, relax bladder 4. progressive strengthening - weighted vaginal cones for home exercises or pelvic floor exercises 5. incorporate keels into every day life with lifting, coughing, changing positions 6. behavioral training - voiding diary - education on valsalva maneuver 7. FX Mobility - sit to stands - ambulation - toilet transfers 8. environmental mod - commode - raised toilet seat

ASIA B

incomplete sensory but no motor Sensory Incomplete - sensory - no motor function is preserved below the neurological level - includes sacral segments S4-S5 (light touch or pin prick at S4-S5 or deep anal pressure) - no motor function is preserved more than 3 levels below the motor level on either side of the body

Right Sided Heart Failure

increased PA pressure increases the after load placing greater demands on the RV and causing it to go into failure - blood is not effectively ejected from the right ventricle and backs up into the right atrium and venous vasculature producing two hallmark signs of JVD AND PERIPHERAL EDEMA reduces venous return to the heart from systemic circulation due to failure of the right ventricle - increased PAP with peripheral edema (ankle swelling) - venous HTN and stasis - weight gain - fullness in the abdomen - fatigue

Anterior Compartment Syndrome

increased compartmental pressure resulting in a local ischemic condition - direct trauma - fracture - overuse - muscle hypertrophy symptoms are chronic or exertional produced by exercise or exertion and described as a deep, cramping feeling symptoms of acute ACS are produced by sudden trauma causing swelling within the compartment ACUTE ACS is considered a medical emergency and requires immediate surgical intervention with fasciotomy

Rigidity

increased resistance to PROM that is independent of the velocity of movement

Active Cycle of Breathing Technique

independent breathing technique consisting of 3 phases 1. breathing control phase 2. thoracic expansion phase 3. forced expiratory technique if secretions need to be loosed - 4 thoracic expansion exercises defined as 3-5 deep inhalation's with a 3 second hold following by a passive exhalation Forced expiratory technique used if secretions are ready to be moved proximally - 1-2 huffs from tidal volume down to low lung volumes to move secretions into the larger more proximal airways - followed by a period of breathing control for rest and reassessment

Stemmer Sign 1. WHAT STAGES?

indication of stage II or III + if the skin on the dorsal surface of the fingers or toes cannot be pinched or is difficult to pin compared with uninvolved limb - can be indicative of a worsening condition

Brain Abscess 1. what is it 2. what causes it? 3. what is the treatment?

infectious process in which there are a collection of pyogenic material in the brain parenchyma extension of infection or post TBI treat infective organism

Bursitis 1. What causes it? 2. What are symptoms?

inflammation of bursae - overuse - trauma - gout - infection pain with rest - PROM/AROM limited - not in a capsular pattern

Hepatobiliary System Liver 1. Hepatitis - Hepatitis A Virus (HAV) - Hepatitis B Virus (HBV) - Hepatitis C Virus (HCV) - Hepatitis D Virus (HDV) 2. Signs and Symptoms 3. Medical Magement

inflammation of the liver may be caused by viral or bacterial infection. chemical agents: alcohol, drugs, toxin, herbals, autoimmune h epatitis, biliary cirrhosis and metabolic disorders such as Wilsons disease Hepatitis A Virus (HAV) acute infectious hepatitis - transmission through fecal oral route - contaminated food or water or person to person - acute illness - prevent w hand washing and good hygiene or vaccine Hepatitis B Virus (HBV) transmission from blood, body fluids, body tissues, sexual contact, contaimined needles, blood transfusion - can be life long - educate on disposable needles, screen blood donors, precautions of health care worker with immunization Hepatitis C Virus (HCV) transmission is same as for HBV (post transfusion or needed sharing are the most common routes) - can be acute or chronic Hepatitis D Virus (HDV) dependent upon having hep B - the prognosis is poor and patients often present with fulminant liver failure 2. Signs and Symptoms - low grade fever - anorexia - nausea - vomiting - diarrhea - fatigue - malaise - headache - abdominal tenderness - myalgia - arthralgia - jaundice icteria phase (fever, jaundice, enlarged liver with tenderness, abatement of earlier sx. amber colored dark urine) - elevated lab values: hepatic transaminases and bilirubin - HBC and HCV may lead to chronic liver infection, including necrosis, cirrhosis, liver failure 3. Medical Magement - IV fluids - analgesis FOR ACUTE CHRONIC - direct acting antivirals VIRAL - the leading cause of liver cancer and common reason for liver transplantation

Meningitis 1. what is it? 2. what causes it? 3. treatment?

inflammation of the membranes of the spinal cord or brain bacterial or viral infection treat the infected organs with antibiotics, fluid, maintain electrolyte

Stomach Gastritis 1. What is it? 2. Symptoms? 3. Red Flags

inflammation of the stomach musosa. can be acute or chronic 1. What is it? acute is caused by severe burns, aspirin or other NSAIDS, corticosteroids, food allergies or viral or bacterial infections - hemorrhage bleeding can occur CHRONIC - occurs with certain disease such as peptic ulcer, bacterial infection caused by HELICOBACTER PYLORI , stomach cancer, pernicious anemia or with autoimmune disorder (thyroid disease, Addisons disease) 2. Symptoms? - anorexia - nausea - vomiting - pain 3. Red Flags - patients taking NSAIDS - avoid irritating substances such as caffeine, nicotine, alcohol, dietary modification medications - acid suppressing PPI - H2 blockers - antacids

Dermatitis (Eczema) + Precautions/Contraindications + treatment

inflammation, itching, redness, skin lesions - some PT modalities - avoid use of alcohol tx - hydration - lubrication of skin

Muscle Strain

inflammatory response within a muscle following a traumatic event that cause micro tearing of the musculotendinous fibers - pain and tenderness within that muscle

Osteomyelitis 1. what is it?/ 2. caused by what 3. medications? 4. diagnostic tests?

inflammatory response within bone caused by an infection // staph A antibiotics and proper nutrition - surgery may be indicated if it spreads to joints lab tests for infection and possible a bone biopsy

Primary Lymphedema Secondary Lymphedema

inhere problem with thee structures of the lymphatic system - insufficient development (dysplasia) and congenital malformation - Milroys Disease - Praecox (early) prior to 35 years of age - Tarda: after 35 F>M LE>UE injury to the lymphatic structure - surgery - radiation - trauma - infection and inflammation - CVI - obstruction or fibrosis MOST COMMON cause is related to cancers of the breast, pelvis and abdomen

Cauda Equina Injuries 1. What is it? 2. Clinical Presentation?

injury below L1 spinal level where long nerve roots transcend. - usually incomplete due to large number of nerve roots in area. - considered a peripheral nerve injury (LMN) - flexic bowel and bladder - saddle anesthesia

ACL, PCL, MCL, LCL instabilities injury to the ligaments may result in a single plane or rotary instability

injury to the ligaments may result in a single plane or rotary instability - ACL and MCL can result in an anteriomedial rotary instability - ACL and LCL can result in a anterolateral rotary instability - PCL and MCL laxity may result in posteromedial rotary instability - PCL and LCL laxity may result in posterolateral rotary instability

CS muscles of inspiration and expiration (2)

inspiratory - diaphragm expiratory - pectorals major CLAVICULAR

T1-T5 muscles of inspiration (2) EXPIRATORY (1)

inspiratory - intercostals - serratus posterior superior expiratory - intercostals

Pulses 1. irregular 2. weak 3. bounding 4. bruit what do all of these mean?

irregular - arrhythmias or myocarditis weak, thready - low stroke volume bounding - shortened ventricular systole and decreased peripheral pressure bruit - abnormal sound or murmur or arterial or venous origin indicating arteriosclerosis

Cirrhosis 1. Clinical Manifestations 2. Pharmacotherapy 3. Late complications may be what?

irreversible chronic injury of the hepatic parenchyma as a result of chronic hepatitis 1. Clinical Manifestations - jaundice - peripheral edema - angiomas - hepatomegaly - splenomegaly - ascites (accumulation of fluid in the peritoneal cavity) 2. Pharmacotherapy - furosemide (lasIX) - spironolactone (potassium sparing diuretic) *paracentesis drainage can be used to remove peritoneal fluid* 3. Late complications may be what? - hepatic encephalopathy - neuropsychiatric abnormalities with personality changes, intellectual impairment, depressed levels of consciousness, slurred speech, slowed movement - asterisks (Liver Flap) myoclonus of the hand with the wrist in extension. a result of the liver unable to convert ammonia to urea. it is a characteristic of hepatic encephalopathy as well as other disorders such as drug overdose and Wilsons disease - lactulose can be used to increase bowel movements and exert ammonia in stool

Hallus Valgus

lateral or outward deviation of the great toe - excessive pronation - ligament laxity - heredity - weak muscles - foot wear is too tight medical deviation of head of first metatarsal from midline of body - metatarsal and base of proximal first phalanx move medially, while distal phalanx then moves laterally normal MTP angle is 8-20 degrees

Left Heart Failure

left ventricle reduces the cardiac output leading to a back up of fluid in the left atrium and lungs. - the two hallmark pulmonary signs are SHORTNESS OF BREATH AND COUGH The heart does not adequately circulate blood to systemic system. Due to pressure overload or volume overload forward--> inability of left ventricle to pump - undue tachycardia - intolerance to cold - increased PAP and pulmonary edema with dyspnea on exertion - orthopnea - fatigue

Post traumatic amnesia

length of time between the injury and the time at which the patient is able to consistently remember ongoing events - important factor in predicting recovery - <48.5 days will have a higher FIM

Bipolar Disorder medication

lithium - side effects ataxia, tremors, increased DTR, confusion, seizures levodopa/carbidopa - off phase side effects - dizziness - involuntary movements - dyskinesia - arrhythmia - hallucination - orthostatic hypotension NOT bradycardia

Agnosia - visual agnosia - simultanagnosia - prosopagnosia - color agnosia - auditory agnosia

loss of ability to recognize importance of sensory impressions - visual agnosia most common - inability to recognize familiar objects despite normal function of eyes and optic tracts Ex: may not recognize people, possessions and common objects - simultanagnosia inability to perceive a visual stimulus as a whole - prosopagnosia inability to recognize familiar faces - color agnosia inability to recognize colors auditory agnosia inability to recognize non speech sounds to to discriminate between them - Ex: differences between the ring of a doorbell and that of a telephone or between a dog barking and thunder

Concussion

loss of consciousness, either temporary or permananent, resulting from injury or blow to head with impaired functioning of the brainstem, reticular activating system - may see changes in HR, RR, BP

Testing for Homonymous Hemianopsia

loss of half of visual field in each eye - contralateral to the side of cerebral hemisphere lesion Test slowly bring two fingers from behind head into the patients visual field while asking the patient to gaze straight ahead - the patient indicates when and where the fingers first appear

Bioimpedance Measurement

low level alternating electrical current to measure the resistance to the flow through the extracellular fluid in the UE - the higher resistance to flow the more extracellular fluid

Patella baja

malalignment in which patella tracks inferiorly in inercondylar notch results in restricted knee extension with abnormal cartilage wearing, resulting in DJD

Patella Alta

malalignment in which the patella tracks superiorly - may result in chronic patella subluxation - + camel back sign. two bumps over anterior knee region instead of typical one - two bumps since patella rides high within femoral condyles creating a superior bump with tibial tuberosity forming second bump inferably

Patellofemoral Pain Syndrome (PEFS)

may be caused by trauma, congenital/devleopmental dysfunction - can be interrelated with chondromalacia patella and or patella tendonitis common result is abnormal patellofemoral tracking leading to abnormal patellofemoral stress paellofemoral (mcconnl) taping is helpful to inhibit pain during REHAB DO NOT USE QUAD SETS, SINGLE LEG RAISE FLEXION AND ISOLATED QUAD EXERCISES FOR PFPS

Wheelchair Back Height

measure from seat platform to the loweringly of the scapula, mid scapula, top of shoulder, based on the degree of support desired added back height may increase difficulty in getting chair into a car or van - prevent patient from hooking onto the push handle for pressure relief or stabilization

Wheelchair Leg Length/Seat to Footplate Length

measure from the bottom of the shoe to just below the thigh in the popliteal fossa - when a seat cushion is used the height needs to be subtracted excessive length - sacral sitting - sliding forward in chair too short - uneven wt distribution on which and excessive weight on the ischial seat

Flow Rates

measure the volume of air moved in a period of time

Peak Expiratory Flow Rate

measurement of how fast a person can exhale using a small handheld device to monitor treatment in asthma or COPD the greatest flow rate generated during a maximal forced expiratory maneuver lung disease usually measure PEF on a daily basis with a handheld peak flow meter to track pulmonary states a drop in this indicates airway narrowing and may indicate the need for a physician visit

Dynamic Visual Acuity Test

measurement of visual acuity during horizontal motion of the head static visual acuity is determined first 1. read the lowest line you can see 2. read the chart while PT horizontally oscillates the patients head at 2mhz with vestibular function the eyes will not be stable in space during head movements - if cant read 3 line or more during head movement suggest vestibular hypofunction

Expiratory Flow Rates

measurements of exhaled gas volume divided by amount of time required for the volume to be exhaled

Volumetric Measurements

measures girth by amount of liquid displaced - hand - full arm - foot - full lower leg

Tilt Table 1. what is it 2. what is it used for 3. indicated for who 4. how does it work 5. how often?

mechanical or electrical table designed to elevate patient from horizontal to vertical position in a controlled, incremental manner (0-90 degrees) 2. what is it used for - stimulate postural reflexes to counteract orthostatic hypotension - facilitate postural drainage - gradual loading of one or both LE - begin active head or trunk control - provide positioning for stretch or hip flexors, knee flexors, ankle PF 3. indicated for who - prolonged bed rest - immobolization - spinal cord injury - TBI - orthostatic hypotension - spasticity how does it work - take baseline vitals - gradually increase in increments by degrees 30, 45, 60, 80, 85 or as tolerated - position can be maintained for as long as 30-60 minutes vital signs need to be monitored to assess the patients tolerance to treatment cyanotic lips or fingernail beds may indicate compromised circulation. treatment should not exceed 45 minutes once or twice daily

Vasodilators

medications that cause dilation of blood vessels - ACE inhibitors - angiotensin blockers - alpha-adrenergic blockers - antiadrenegic agents without selective blockade

Interventions for Benign Paroxysmal Positional Vertigo

most common peripheral vestibular pathology Techniques Canalith repositioning maneuver - free floating debris in the SSS - the patients head is moved into different positions in a sequence that will more the debris out of the involved SCC and into the vestibule - once in vestibule S and S should resolve at home: maintain upright for 1-2 nights, avoid sleeping on the involved side for 5 nights Liberty (Semont) maneuver - posterior BPPC based on cupulolithiasis theory - rapidly moving patient through positions to dislodge the debris from the cupula - alternative tx for canalithiasis difficult for pt to tolerate Brandy-Daroff exercises - habituate the CNS to the provoking position - 5-10 reps - 3x day until vertigo is gone for 2 consecutive days

Transfemoral Sockets 1. Quadrilateral Socket what is a scarpas bulge?

most commonly prescribed - broad horizontal posterior shelf for seating of ischial tuberosity and gluteals - medial wall is the same height as the posterior wall - the anterior and lateral wall and 2 1/2-3 inches higher - a posterior directed force is provided by the anterior and lateral walls to ensure proper seating what is a scarpas bulge? - an area built up on the anterior wall to distribute forces across the femoral triangle - reliefs are provided for the adductor longus tendon, hamstring tendon, sciatic nerve, gluteus maximum and rectus femurs

ventilation

movement of air in and out of the lungs

Anterior Tibial Periostitis (Shin Splints)

musculotendious overuse condition 3 common etiologies - abnormal biomechanics alignment - poor conditioning - improper training methods muscles - ant tib - extensorhaullis longus pain with palpation of lateral tibia and anterior compartment stretch anterior compartment muscles

Myelodysplasia/Spina Bifida - spina bifida occulta - spina bifida cystic (meningocele and myelomeningocele)

neural tube defect resulting in vertebral and/or spinal cord malformation - elevated serum and amniotic alpha fetoprotein - spina bifida occulta no spinal cord involvements may be indicated by a tuft of hair, dimple or sinus - spina bifida cystic (meningocele and myelomeningocele) meningocele= cyst includes cerebrospinal fluid; cord intact myelo=cyst includes CSF and herniated cord tissue - linked to maternal decreased folic acid, infection, hot tub soaks, exposure to tetraogens such as alchol and valporic acid - hydrocephalus related; shunting relieves pressure but may develop Arnold charier malformation type 2 (cerebellum and brain stem are pushed through foramen magnum) - meningitis common - foot deformities such as talipes equinovarus (club foot) especially with L4-L5 level - tethered cord may lead to increased severity of problems as child grows - kyphoscoliosis - shortened hip FL and ADD - flexed knees - pronated feet -L4/L5 lesions results in bowel and bladder dysfunction - sensory loss - dev delays - cognitive impairments - abnormal tone - osteoporosis

What is a areflexive bladder?

no reflex action of detrusor muscle. failure to empty urine

Cardias Dysrhythmias

normal electrical conduction though the heart allows for normal mechanical centurion of the ventricles. altered electrical conduction alters the mechanical activity of the ventricles exacerbating heart failure

Clinical Manifestations of Vertebrobasilar Artery Syndrome Lateral Inferior pontine Syndrome 1. ipsilateral to lesion 2. contralateral

occlusion of the anterior inferior cerebellar artery; - horizontal vertical nystagmus, vertigo nausea, vomiting - facial paralysis - paralysis of conjugate gaze to side of lesion -deafness - tinnitus - ataxia - impaired sensation over face - impaired pain and thermal sense over half of the body (may include face)

Clinical Manifestations of Vertebrobasilar Artery Syndrome Lateral Superior Pontine Syndrome 1. what is it? 2. symptoms?

occlusions of superior cerebellar artery Symptoms: - Ipsilateral limb and trunk ataxia (middle and inferior cerebellar peduncles) - ataxia, dysmetria, and intention tremor (part of cerebellum) - contralateral loss of pain and temperature of the body (spinothalamic and spinotrigeminal tracts) - ipsilateral pain and temperature sense of head - ipsilateral Horner's syndrome (descending sympathetic tract) - contralateral loss of proprioception, vibration and discriminative touch from lower extremities and trunk (lateral portion of medial lemniscus) Results from occlusion of the superior cerebellar artery

Carpal (Carpometacarpal) Bossing

overgrowth of hard bone on the posterior aspect of the hand - where the index/middle finger meets the trapezoid and capitate bones **indicates arthritis** **can be see on X-Ray** **unless pain is caused= usually left alone**

Stress Fractures

overuse injury resulting most often in micro fracture of the tibia or fibular - tibia more common 3 common etiologies - abnormal biomechanics alignment - poor conditioning - improper training methods

Medial Tibial Stress Syndrome

overuse of the posterior tibias and medial soles resulting in periosteal inflammation at the muscular attachment - excessive pronation - pain elicited with palpation of the distal posteromedial border of tibia stretch anterior compartment

Metatarsalgia

pain in the bones of the foot

Sacroiliac Joint Dysfunction

pain localized to the SI joint region with or without radiculopathy - relieved with rest and/or by unweighting the joint - unresolved inflammation or a traumatic etiology may yield a hypo mobile SI joint 4 common impairments 1. pubic symphysis hypomobility 2. anterior rotated innominate 3. posterior rotated innominate 4. unclipped innominate

Patent Ductus Arteriosus

passageway between the aorta and the pulmonary artery remains open after birth failure of the ductus arteriosus to close after birth, resulting in an abnormal opening between the pulmonary artery and the aorta non oxygenated blood is circulated pt should monitor O2 saturation, signs of cyanosis, SOB and RR

Superficial peroneal

peroneus longus, peroneus brevis - branch of common perineal - will effect eversion - equinovarus can develop

Spinal Shock 1. What is it? 2. What is clinical presentation?

physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. - believed to result from the very abrupt withdrawal of connections between higher centers and the spinal cord - absent of all reflex activity - impairment of autonomic regulation - hypotension - loss of control of sweating and piloerection (goose bumps) - loss of bulbocavernosus reflex, cremasteric refelx, babinski response and delayed plantar response - evolves over time the initial period of total areflexia lasts approximately 24 hours - gradual return of refelexes 1-3 days after injury - period of increasing hyperreflexia lasting 1-4 weeks

Ankle talocrural capsular pattern

plantar flexion loss

Wheelchair Seat Depth

posterior buttock to the posterior aspect of the lower leg in popliteal fossa - subtract 2-3 inches from the patients measurement potential problems - too short fails to support thighs - too long compromise posterior knee circulation, kyphotic posture, posterior tilting of pelvic and sacral sitting

Kyphosis 1. What is weak and elongated? 2. What is tight and short? 1. flat back 2. hump back 3. round back 4. dowagers hump

posterior curvature of the spine 1. flat back 2. hump back 3. round back 4. dowagers hump Round Back - long rounded curve - decreased pelvic inclination - trunk flexed forward - decreased lumbar curve - high hip extensors, trunk flexors - weak hip flexors and lumbar extensors Hump Back - localized - sharp posterior angulation in the thoracic spine Flat Back decreased pelvic inflation to 20 degrees and a mobile lumbar spine Dowagers Hump - osteoporosis - older patients - women

Preeclampsia 1. what is it? 2. what should you initiate?

pregnancy induced acute HTN after the 24th week of gestation - may be mild or severe - evaluate for symptoms of HTN, edema, sudden excessive weight gain, headache, visual disturbances, hyperreflexia initiate prompt physician referral

Severity of Lymphedema 1. Pitting Edema 2. Brawny Edema 3. Weeping Edema

pressure on the edematous tissues with the fingertips causes an indentation of the skin - persist for several seconds after pressure removed - short duration edema - little or no fibrotic changes in skin or subcutaneous tissue Pressure on the edematous areas feels hard with palpation - progressive fibrotic changes to subcutaneous tissues Weeping - most severe and long-duration form of lymphedema - fluids leak from custom sores - wound healing impaired

Secondary-Progressive MS

progressive accumulation of disability after initial relapsing course, with or without occasional relapses and minor remissions

Progressive Relapsing MS

progressive with relapses progressively getting worse progressive accumulation of disability from onset, but clear acute clinical attacks, with or without full recovery

Aquatic Exercise 1. Intense Training, whats the water temp? 2. Rehabilitation exercises what water temp? 3. Bouyancy 4. as the water gets deeper, what increases happens to hydrostatic pressure? 5. what does viscosity do? 6. what happens to stroke volume? 7. what happens to HR? 8. what happens to cardiac output? 9. what does hydrostatic pressure do to chest expansion? what decreases? 10. FITT parameters? 11. contraindications (8) and precautions (3)

promotes relaxation, ambulation, weight bearing and exercise 27- 28 celsius/ 81-83 Fahrenheit 33-34 celsius/ 91-93 Fahrenheit can be used as assistance to move a limb toward the surface of the water, support to hold a limb on the surface with flotation devices or resistance when moving a limb toward the bottom of a pool hydrostatic pressure increases on the body part and can be used to reduce effusion or allow the patient to exercise an injured extremity without increasing effusion causes resistance to flow so that increasing the speed of an exercise or movement will increase resistance stroke volume increases HR remains the same or slightly decreases cardiac output increases 9. hydrostatic pressure on the chest challenges chest expansion - FVC and IRV are reduced - this may be a problem for those with reduced lung capacity or breathing difficulties 10. - 3-5x per week - fewer than 3 session per week does not produce adequate changes in aerobic capacity or body composition - changing intensity is most effective way to improve aerobic fitness - 15-60 minutes each session either continuous or intermittently - multiple sessions of short durations are indicated when intensity if limited by environmental conditions, hot and humid or by medical conditions such as intermittent claudication contraindications - bowel or bladder incontinence - severe kidney disease - severe epilepsy - severe cardiac or respiratory dysfunction - cardiac failure - unstable angina - Beverly reduced vital capacity - unstable blood pressure - severe peripheral vascular disease - large open wounds - skin infections - colostomy - bleeding or hemorrhage - water and airborne infection - influenza - gastrointestional infection precautions - fear of water - inability to swim - patients with heat intolerances (MS) - use waterproof dressing on small open wounds

Esophagus Hiatal Hernia

protrusion of the stomach upward through the diaphragm (rolling hiatal hernia) or displacement of both the stomach and gastroesophageal junction upward into the thorax (sliding hiatal hernia) - may be congenital or acquired - symptoms include heartburn from GERD - conservative or symptomatic treatment is the same as for GERD (upright)

What breathing exercise for those with COPD?

pursed lip - delay or prevent airway collapse allowing for better gas exchange little evidence on diaphragmatic for chronic pulmonary dysfunction - strengthening accessory muscles of ventilation may be more effective Those with flattened diaphragms, focusing on diaphragmatic breathing may even be detrimental

Electrical Conduction Abnormalities Atrial Fibrillation

quivering of the atria due to inadequate electrical stimulation - results in a low atrial kick and compromised CO - PT can be appropriate if the patient has a good ventricular rate at rest and appropriate hemodynamic and HR increase with exercise - if a rapid ventricular rate of 120bpm at rest, exercise intensity must be lowered and monitor hemodynamics - the ventricular rhythm is "irregularly irregular

Electrical Conduction Abnormalities Ventricular Fibrillation

quivering of the ventricles resulting from inadequate electrical stimulation when the ventricles do not contract but rather quiver there is ineffective CO the patient will arrest and expire if this rhythm is not altered immediately treatment - activate ACLS - electrical defibrillation - medications if they go through defibrillator they are candidates for indwelling defibrillator (automatic implantable cardiac defibrillator (AICD) - for those with life threatening V TACH OR V FIB - will deliver an electrical shock if it detect a HR higher than normal HR limit

Electrical Conduction Abnormalities Supraventricular Ectopy

rapid firing of an ectopic focus that originate in any location above the ventricles - atrial or junctional area examples 1. Paroxysmal Atrial Tachycardia 2. a run of PAC or PJC at a rate of 150-250bpm = supra ventricular tachycardia - treat with carotid massage to produce a parasympathetic response - coughing and breath holding techniques achieved through the valsalva maneuver

Scheuermanns Disease - what. is it? - most common where? - caused how? - interventions

rare congentital and/or degenerative weakening of the vertebral end plates - T10-L2 similar to HNP except the nucleus pulpous migrates either superior or inferior versus posterior or posterolateral results of a weakened vertebral end plate. this weakness causes a crack and breakdown in the weight bearing ability in the vertebrae. the nucleus travels the path of least resistance - typically do not have any radicular symptoms the nucleus pulpous can protrude vertically into the vertebral end plate, which can lead to a bony necrosis or schmorls nodes can also be causes by insufficient blood supply to the growing bone. usually in the second decade of life and are "growing pains" interventions should be related to presenting signs with the caution to minimize compressive forces on the vertebrae - segmental and global stabilization exercises - stretch tight muscles - posture education - joint manipulation for pain modulation - use caution with high velocity tenchiques

Surfactant Production importance

reduced post-op making patients at risk for serious pulmonary complications such as pneumonia and respiratory failure. - surfactants role is to reduce surface tension and prevent alveolar collapse (atelectasis) - by expanding the alveoli and stretching type II pneumocytes with deep breaths surfactant production is stimulated - DEEP BREATHING IS THE MOST EFFECTIVE WAY TO PREVENT ALVEOLAR COLLAPSE

What do flow rates represent?

reflex the ease with which the lungs can be ventilated, the state of the airways and the elasticity of the parenchyma tissue

Drugs that Effect Blood Glucose hypoglycemic agent

regulates blood sugar, helps insulin transport glucose into cells - chromium hypoglycemia agent - metformin - thiazolidinediones increas insulin receptors inject insulin in abdomen during exercise and NOT BEFORE THE EXERCISE

Function of the Kidneys 1. What are normal creatine levels? 2. What is glomerular filtration rate (GFR)? 3. what is blood urea nitrogen (BUN)?

regulates pH of body fluids through absorption and elimination creatine= 115-125 controls minerals - sodium - potassium - hydrogen - chloride - bicarbonate ions - water balance eliminates metabolic wastes - urea, uric acid, creatine, drugs, drug metabolites assists in blood pressure regulation through rennin-angiotensin-adolesterone mechanism and salt and water elimination contributes to bone metabolic function by activating vitamin D and regulating calcium and phosphate conservation and elimination controls the production of red blood cells in bone marrow through the production of erythropoietin the glomerular filtration rate (GFR) is the amount of filtrate that is formed each minute as blood moves through the glomeruli and serves as an important gauge of renal function - regulated by arterial blood pressure and renal blood flow - measured clinically by attaining creatine levels Blood urea nitrogen (BUN) - urea produced in the liver as a by product of protein metabolism that es eliminated by the kidneys - elevated with increased protein, GI bleeding and dehydration

Foreground Question

relates to specific information that will guide management of the patient, typically addressing diagnosis or intervention ask about a particular patient status with the discover

Selective Debridement 1. Sharp Debridement 2. Enzymatic Debridement 3. Autolytic Debridements Non-Selective Debridement 1. Wet to Dry 2. Wound Irrigation 3. Hydrotherapy

removes only nonviable tissues from a wound Sharp debridement - using scalpel, scissors, forceps Enzymatic debridement - use of a topical application Autolytic debridement - use of the body's own mechanism to remove nonviable tissue removal of both nonviable and viable tissues from wound Wet-to-dry dressings- application of a moistened gauze over area of necrotic tissue to be completely dried and removed Wound irrigation- moves necrotic tissue from wound bed using pressurized fluid Hydrotherapy- using a whirlpool with agitation directed toward a wound requiring debridement

Renal Cystic Disease

renal cysts are fluid filled cavities that form along the nephron and can lead to renal degeneration or obstruction - polycystic, medullary sponge, acquired and simple renal cysts - sx are pain, hematuria, hypertension, fever w infection - cysts can rupture producing hematuria - simple cyst asymptomatic

Sharp Debridement 1. What is it? 2. Indications 3. Contraindications

requires use of scalpel, scissors, and/or forceps to selectively remove devitalized tissues, foreign materials or debris from a wound. - selective - uses sterile instruments - removes only necrotic wound tissue - without anesthesia and with little or no bleeding - scoring and/or excision of leathery eschar - excision of moist necrotic tissue AVOID ON - clean wounds - advancing cellulitis with sepsis, when infection threatens an individuals life - anticoagulant therapy - has coagulopathy

Function of the Lymphatic System

responsible for pulling the fluid into the lymphatic circulation - once inside the lymphatic vessels, the fluid is transported from lymph nodes to lymphatic trunks - end result is collection of fluid at the venous angles - largest group of lymph nodes found in head, beck, around intestines, axilla and groin

GH Joint Arthritis

restricted mobility of the GH joint may occur as a result of pathology such as RA, OA or prolonged immobilization or from unknown causes (idiopathic frozen shoulder)

Subtalar capsular pattern

restricted varus motion

Lateral Patella Tracking

result if there is an increase in Q Angle with a tendency for lateral subluxation or dislocation **VMO strength , regain flexibility of ITB, hamstrings, patellar bracing/taping

Ankylosing Spondylitis - what is it? - seen in what age? - pain where? - what is the 4 diagnostic criteria? - interventions?

rheumatic disorder that results in the eventual ossification of both anterior and posterior longitudinal spinal ligaments and the facet joints first appears in adolescents and "peaks" in the mid 20's complain of pain in the bilateral SI joints, thoracic or lumbar spine, shoulder, foot regions - stiffness >30 minutes in duration - back pain that improves with exercises but NOT AS REST - back pain that wakes a person up only during the second half of the night - alternating buttock pain - 3/4 + interventions - education on the proper or functional posture before the spine segment becomes ankylosed - an exaggerated lumbar lordosis is required to facilitate a functional thoracic kyphosis and print the person from fusing in a posture in which the entire spine is in a kyphotic posture ( encourage sleeping in a prone position or use a pillow or towel roll behind their lumbar spine during all sitting activities) - gentle manipulation grade I and II for pain modulation at the non-ankylosed segments - segmental and global trunk stabilization and scapular stabilization exercises are mandatory to strengthening the muscle surrounding the spine - stretch to maintain hip extension, shoulder flexion, lumbar and thoracic extension

Rib Subluxation - how does it happen? - interventions?

ribs articulate with the thoracic spine and. move with all arm and thoracic activities the place/location where the rib articulates with the thoracic spine is called a costovertebral joint - the joints becomes sprained, displaced during twisting activities such as unloading a trunk or swinging a golf club or trauma of MVA OR fall, or period of prolonged sickness with repetitive coughing radicular pain (intercostal nerve) may or may not be involved interventions - MET - resist horizontal adduction to correct a posterior direction - resist horizontal abduction to correct a anterior position

Cor Pulmonale

right ventricular hypertrophy and heart failure due to pulmonary hypertension - ex chronic bronchitis or emphysema produces pulmonary artery hypertension that creates a problem for the R ventricle

Fugl-Meyer Assessment of Physical Performance

scores 0= cannot perform score 2= fully performed subtests for - UE function - LE function - balance - sensation - ROM - Pain

Wheelchair Arm Rest Height

seated platform to just below the elbow held at 90 degrees with the shoulder in neutral position - chair measurement add 1 inch to the patients handing elbow measurement too high - cause shoulder elevation too low - encourage leaning forward

Parietal Lobe Lesion

sensory interpretation, tasta, perceptual function - loss of contralateral stimulus location, intensity - tactile agnosia: asterognosis, agraphesthesia, low of two point discrimination, extinction - impairment of taste in contralateral side of tongue - visual-spatial disorders, body scheme disorders, apraxia, tactile and auditory perceptual disorders

Anosognosia

severe denial, neglect or lack of awareness of condition

Encephalitis 1. what is it 2. what causes it? 3. what is the treatment?

severe infection and inflammation of the brain arbovirus, chronic and recurrent sinuses, otitis, other infections treat infection organism

Drugs for Asthma Attacks

short acting beta agonists that relax the airways - albuterol - salbutamol - prednisone (corticosteroid) that decreases body immune response to various disease - fluticasone (inhaled nasally) - salmeterol (long acting beta agonist)

Dynamic postural control

stability is maintained while parts of the body (UE or LE) are moving

Primary-Progressive MS

steady increase in disability without attacks Disease progression from onset, without plateaus or remissions or with occasional plateaus and tempory minor improvments

Shoulder Sign of the Thumb

subluxation of the CMC joint - if subluxation is more that 2-3mm there will be slight step at the joint

Lumbar Traction 1. How is the patient laying? 2. BW %/ lbs

supine, pillow under knees or small bench under lower leg Prone preferable in the case of a posterior herniated lumbar disc L5 TO S1 up to 45-60 degrees of hip flexion or at L3 to L4 up to 75-90 degrees Acute phase - 30-40lbs - disc protrusion - spasm - elongation of soft tissues 25% BW - joint distraction 50lbs or 50% of BW tx time - 5-10 minutes for herniated disc - 10-30 minutes for other conditions

Posterior Cerebral Artery Syndrome 1. What does it affect? 2. What are signs and symptoms? of peripheral terrority 3. signs and symptoms of central territory

supplies occipital lobe and medial/inferior temporal lobe - contralateral homonymous hemianopsia - bilateral homonymous hemianopsia with some degree of macular sparing - visual agnosia - prosopagnosia (difficulty naming people on sight) - dyslexia (difficultly reading) without agraphia (difficulty writing) - color naming (anomia) - color discrimination problems - memory defect - topographic disorientation - central post stoke thalamic pain - involuntary movements - choreoathetosis - intention tremor - hemiballismum - contralateral hemiplegia - webers syndrome - occulomotor nerve palsy and contralateral hemiplegia - paresis of vertical eye movements, slight mitosis and ptosis and sluggish pupillary light response

Middle Cerebral Artery Syndrome (MCA) 1. What does it supply? 2. Signs and Symptoms

supplies the entire lateral aspect of the cerebral hemisphere (frontal, temporal, parietal lobes) **most common site of occlusion - contralateral spastic hemiparesis and sensory loss of the face, UE - aphasia - contralateral hemiparesis involving UE and face - contralateral hemisensory loss involving LE and face - motor speech impairment (Brocas) or non fluent aphasia with limited vocabulary and slow resistant speech - repetitive speech impairment (wernickes) or fluent aphasia with impaired auditory comprehension and fluent speech with normal rate and melody - global aphasia: non fluent speech with poor comprehension - perceptual deficits, unilateral neglect, depth perception, spatial relations, agnosia - limb kinetic apraxia - contralateral homonymous hemianopsia - loss of conjugate gaze to opposite side - ataxia or contralateral limb (sensory ataxia) - pure motor hemiplegia

Internal Respiration

takes place at the tissue capillary level between the tissues and the surrounding capillaries. begins when the arterial blood reaches the tissue level. oxygen diffuses from the gas carrying sites of hemoglobin, out of the red blood cell, out of the capillary, through the cell membranes and into the mitochondria of the working cells

Transient Ischemic Attack (TIA) 1. how long are symptoms? 2. Why does it happen?

temporary interruption in the blood supply to the brain - last for a few minutes or for several hours but no longer than 24 hours - occlusive episodes, emboli, reduced cerebral profusion, arrhythmias, decreased cardia output, hypotension, overmedication with antihypertensive medication, subclavian steal syndrome, cerebrovascular spasm

Interphalangeal joints

tend toward extension restriction

Rotational Chair Test

test for dizziness by recording nystagmus while chair moves - stimulates each horizontal SCC by rotating subjects in the dark - normal vestibular function nystagmus should be generated by the rotation

Tidal Volume

the amount of air inspired or expired during normal resting ventilation - 500 mL

What is stroke volume?

the amount of blood ejected by the heart in any one contraction

External Respiration

the exchange of gas that occurs at the alveolar capillary membrane between the atmosphere air and pulmonary capillaries to take place there must be an inhalation of air form the environment through the conducting airways and into the respiratory bronchioles and alveoli. oxygen diffuses through the walls of the respiratory unit, interstitial space, through the pulmonary capillary wall to the blood plasma to the RBC where it occupies HGB. a small portion of dissolved oxygen is carried in the plasma the now oxygenated blood in the pulmonary capillaries travels to the left side of the heart via the pulmonary veins. from there is its pumped into the aorta then through a netweork of connecting arteries, arterioles, capillaries until its destination the tissue is reached

Respiration

the gas exchange within the body

Maximum Inspiratory Pressure

the greatest static inspiratory effort that can be generated from residual volume reflects the strength of the muscles of inspiration the max pressure is defined as the highest negative pressure that the patient can sustain for 1 second during the testing procedure

Finger Agnosia

the inability to identify the fingers or ones own hands or of the hands of th examiner Ex: difficulty naming the fingers on command, identifying which finger was touched, and by some definitions, mimicking finger movements

Cognitive Stage feedback, practice and environment

the learner develops an understanding of the task - highlight the purpose of the task - demonstrate ideal performance of the task - have patient verbalize task components and requirements Feedback - intrinsic - carefully pair with extrinsic - knowledge of performance: focus on errors as they become consistent do not cue on large number of random errors - knowledge of results: focus on success of movement outcome - feedback after every trial improves performance with early learning - variable feedback can improve retention but may decrease performance initially - high dependence on vision Practice - distributed practice, rest longer than work time - part training - blocked practice - closed environment

Forced Vital Capacity

the maximum amount of air that can be removed from the lungs during forced expiration

Inspiratory Reserve Capacity

tidal volume + inspiratory reserve volume the volume of air that can be inspired beginning from a tidal exhalation

Dorsal Column Medial Lemniscal Pathway 1. What is it responsible for? 2. Whats the pathway?

transmission of discriminative sensations received from specialized mechanoreceptors - discriminative touch - sterogenesis - tactile pressure - barognosis - graphesthesia - recognition of texture - kinesthesia - 2 point discrimination - proprioception - vibration Pathway 1. enters dorsal column 2. fibers ascend to the medulla and synapse with the dorsal column nuclei (gracilis/cutaneous) 3. cross to the opposite side and pass up to the thalamic through bilateral pathways called the medial leminscus 4. each medial lemniscus terminates in the ventral posterolateral thalamic 5. 3rd order neurons project to the somatic sensory cortex

Two Types of GH Shoulder Instability 1. What are signs? 2. What surgery? // sling for how long?

traumatic (common in young athletes) atraumatic (congenitally lost CT around the shoulder) 1. What are signs? - popping - clicking - dislocations - subluxation 2. What surgery? unstable injuries require surgery to reattach the labrum to the glenoid. Bankart lesions require surgery - 3-4 weeks - after 6 weeks more sport specific training

Corneal reflex CN?

trigeminal

Butterfly

upright version the counterrotation technique - patient is doing it in sitting

Phonophoresis 1. what is it 2. goals 3. mode 4. tx time

use of ultrasound waves to introduce medication across the skin and into the subcutaneous tissues - local analgesics (lidocaine) and anti-inflammatory drugs (dexamethasone, salicylates) - mode= pulsed - tx time 5-10 minutes - 0.5w/cm2 - avoid paste and creams Goals/indications - pain modulation - decrease inflammation in subacute and chronic MSK conditions

Inspiratory Muscle Training

used for patients that exhibit decreased chest expansion, SOB, bradypnea, and decreased breath sounds. - hypoventiation (Decreased O2 INCREASED CO2) - attempts to increase ventilating capacity and decrease dyspnea through strengthening of diaphragm and intercostal muscles. Pt inhale through Inspiratory muscle trainer orifice. this orifice can decrease in size progressively. Exhalation is performed without resistance. Tx is performed 1-2 times a day for 15-30 mins. if pt can tolerate 30 mins increase the intensity by varying the orifice size and later increase duration to improve on duration.

Four Point Gait

used when both legs can bear some weight; right foot, left crutch, left crutch, right foot

Autolytic Debridement 1. What is it? 2. Indications 3. Contraindications

using body's own mechanisms to remove nonviable tissue. - selective - natural debridement - use for those on anticoagulants - those who cant tolerate other forms of debridement - all necrotic wounds in those who are medically stable - DO NOT USE ON - INFECTED WOUNDS - IMMUNOCOMPROMISED - GANGRENE OR DRY ISCHEMIC WOUNDS

Cryotherapy 1. What form of heat transfer? (2) 2. Modalities 3. Cold Urticaria 4. Goals 5. Precautions 6. Contraindications 7. Ice massage + ice packs + vaporcoolant spray + contrast baths

vasoconstriction of skin capillaries that results in blanching of skin in center of contact area and hyperemia due to decreased rate in oxyhemoglobin dissociation around the edge of contact area in normal tissue Conduction - transfer of heat from warmed too cooler object with physical contact (ice packs, ice massage) Evaporation - highly volatile liquids that evaporate rapidly on contact with warm object 2. Modalities - cold pack - ice pack - ice massage - cold bath 3. Cold Urticaria erythema of skin with wheal formation associated with severe itching due to histamine reaction 4. Goals - modulate pain - reduce or elimate soft tissue inflammation or swelling - reduce muscle spasm - reduce spasticity - cryokinetics - cryostretch - management of sx in MS 5. Precautions - HTN - impaired temp sensation - open wound - over superficial N - very old or young - cognitive changes 6. Contraindications - cold hypersensitivity (urticaria) - cold intolerance - cryoglublinememia - peripheral vascular disease - impaired temp sensation - raynauds disease - paroxysmal cold hemoglobinuria - over regneration peripheral nerves Ice Packs - folded in moist towel - conduction - 10-20 minutes Ice Massage - cold, burning, aching, numbness - conduction - no larger area that 4x6 inches in slow 2 inch/second - do not massage over bony area or superficial N (perineal, fibular) - continue tx until anesthesia is achieved - 5-10 mintes or till analgesia occurs vaporcoolant spray - rapid cooling spray - evaporation - 30 angle spraying - be passively stretched before and during application - 10-15 minutes - indicated for myofascial referred pain, trigger points contrast baths - warm water 4 minutes - cold water 1 minute - 20-30 mins - indicated for any condition requiring stimulation of peripheral circulation in limbs, PVD, sprains, strings, trauma - contraindicated for advanced arteriosclerosis, arterial insufficiceny, loss of sensation to heat and cold

Blood Flow with PaCO2 and pH vasodilate or constrict? 1. increase PaCO2? 2. decreases in PaO2? 3.Fall in pH 4. Rise in pH

vasodilation vasodilation vasodilation decreased blood flow

with scoliosis how do the vertebrae rotate? muscles on the convex side are strong or weak? muscles on the concave side strong or weak?

vertebral bodies rotate to the convexity of the curve - rib hump on convexity side - spinous process deviate toward the concave side muscles on the convex side are strong or weak? - weak and long muscles on the concave side strong or weak? strong and short concave side hip ABD is weak

Manual Lymphatic Drainage

very light repetitive stroking and circular massage movement - proximal is cleared first to make room for fluid from the more distal areas - distal to proximal stroking first clear proximal portion and then in the distal portion **teach MLD asap to patients**

Lung auscultation 1. normal is what?

vesicular - soft, low pitched

what is preload?

volume of blood in ventricles at end of diastole the degree of stretch on the heart before it contracts

Indirect Contact US

water immersion - use with irregular body parts - fill container with water high enough to cover tx area - plastic container preferred - place body part and sound head in water, keeping it 1cm from skin surface and at right angle to body part

Drugs That Relax Muscles Skeleteal muscle relaxants CNS + PNS acting skeletal muscle relaxants only PNS muscle relaxants

weakens the muscles but does not paralyze the muscle (botulin paralyzes the muscle) - taper off gradually - side effects are that they may interfere with the patients balance who use spasticity to maintain balance/gait imbalances 1. Flexeril 2. Soma 3. Robin 4. Norflex key side affect is sedation CNS + PNS acting skeletal muscle relaxants - diazepam - valium - baclofen - lioresol - flexural side affects are weakness only PNS muscle relaxants dantrolene + tantrum

Positional Testing

whether crystals are displaced from SCC causing BPPV - Dix-Hallpike is the most common positional test used to examine for BPPV - patient is moved from long sitting with head rotated 45 degrees to one side, to a supine position with head extended 30 degrees beyond horizontal, head still rotated 45 degrees - places each SCC in a gravity dependent position and observes for nystagmus if horizontal SCC BPPV the roll test can be used instead - patient in supine with head flexed 20 degrees

Facet Joint Impingement (Blocking, Fixation, Entrapment) - what is it - whats the sx

with a sudden or unusual movement the meniscoidal of a facet capsule may be entrapped, impinged or stressed causing pain and muscle guarding - sudden onset - usually involves forward bending and rotation (golfing) Symptoms - loss of specific motions and attempted movement induces pain - no pain at rest - no true neurological signs - may be referred pain in the related dermatome - over time stress is placed on the contralateral joint and on the disc leading to problems in these structures

MS Related Fatigue looks like? How is it treated with exercise?

with exercise often associated with thermal stress which can be offset with adequate rest and the use of cooling and precooking treatments during exercise

Why can a person breathe better leaned forward?

with the arms supported the accessory muscles can act on the rib cage and the thorax allowing more expansion for inspiration - SCM, elevators, scalene, pec major when the patient leans forward on supported hands, in intrabdominal pressure rises and thus pushes the diaphragm up in a lengthened position. the diagrams then has an increased strength of contraction

Pressure Injury

wound caused by unrelieved pressure to the dermis and underlying vascular structures, usually between bone and support surface Decreased blood flow --> leads to cell death --> tissue necrosis --> visible wound Superficial dermis can tolerate ischemia for 2-8 hours before breakdown occurs Deeper muscle, connective and fat tissues tolerate pressures for 2 hours or less - presence of low albumin levels - confusion -DNR = **increased PI risk**

Lower Lobes Anterior Basal Segments

• Foot of bed or table elevated 20" • Pt lies on unaffected side, head down, pillow under knees • Therapist claps with lightly cupped hands over lower ribs position shown is for drainage of left anterior basal segment. to drain the right anterior basal segment patient should be on the left side in the same posture.

Lower Lobes Lateral Basal Segments

• Foot of bed or table elevated 20" • Pt lies on abdomen, head down, and then rotates ¼ turn upward affected side now exposed. Upper leg is flexed over pillow for support • Therapist claps over uppermost portion of lower ribs (position shown is for drainage of right lateral basal segment. to drain the left lateral basal segment patient should lie on the right side in the same posture