Capdiopulmary/lympahtic, boards exam review from questions, THERAPY ED Nero section essential info
patellar tendon reflex
L3-L4
Extended Erb's Paralysis
Lateral Cord (C5-C7)-
Total Brachial Plexus Paralysis
Posterior Cord (C5-T1)
12 lead EKG
Rate, rhythm, conduction, areas of ischemia, infarct, hypertrophy and electrolyte imbalances
c4 dermatome
Shoulder area, clavicular area, upper scapular area
Pain associated with appendicitis
appendicitis is constant and may shift within 12 hours to the right lower quadrant at the McBurney point.
pleural effusion
buildup of fluid in the pleural space between the lungs and chest cavity
fibromyalgia
widespread aching and pain in muscles and soft tissue nonarticular thematic disease of unknown origin
3.5 years
Hops on 1 foot, kicks a ball
components of motor learning
feedback, practice, transfer
sliding board transfers need to happen with
finger flexion or wrist in neutral to avoid stretching tight flexor tendons
ankle strategy
first strategy to be elicited by a small range and slow velocity perturbation when feet are on the ground. muscles contract in a distal to proximal fashion to control postural sway from ankle joint
cremaster reflex
l1-l2 scratch skin of upper medial thigh brisk and brief elevation of testicle on insular side
Examination of a patient's right lower extremity reveals weakness in great toe extension and decreased sensation along the lateral leg and dorsum of the foot. Which of the following nerve roots is MOST likely contributing to these findings?
l5
first phase of complete decognestive therapy
Multilayered compression bandaging or "lymphedema bandaging" is a technique used to provide compression therapy during the first phase of complete decongestive therapy
what do isometrics do post injury?
Muscle setting isometric exercises are begun immediately to prevent adhesions of the tendon to the sheath or surrounding tissues and to promote alignment of healing tissue.
global aphasia
NON-FLUENT reduced speech and comprehension. Reading and writing are impaired as well. CAUSED BY BLOCKAGE of the main stem of the Middle cerebral artery
c3 dermatome
Neck, Posterior cheek, Temporal area, prolongation forward under mandible
hammer toe
PIP is flexed and DIP is extended
INTRAVASCULAR STENTS
PREVENTS responses and occlusion
akinesia
inability to initiate movement (major impairment in Parkinson's patients)
astereognosis
inability to judge the form of an object by touch
asynergia
inability to move muscles together in a coordinated manner
posterior root carry information
(afferent) sensory information to the CNS
middle lobe lung excursion
. Hands are placed over the lower ribs
INR time
.9-1.1
PROTHROMBINE TIME NORMAL
11-15 seconds
PTT time
25-40 seconds
treatment for HF
A. BED REST b. diurectics c. sodium restriction d. measures to improve myocardial contractile and correction of arrhythmias
ETT FUNCTIONS TO
A. determine exercise capactiy 2. establish exercise persciption 3. screens for possible CAD 4. assist in Dx
t8-t12 dermatome
Abdomen and lumbar region
c6 myotome
Biceps, supinator, wrist extensors
bicep DTR
C5-C6
Which of the following factors MOST contributes to adverse reactions to medications in aging adults?
Decrease in total body water A decrease in lean body mass and an increase in the proportion of body fat results in a decrease in body water. As a result, water-soluble drugs have a lower volume of distribution, which speeds up onset of action and raises peak concentration.
beta-adrenergic blocking agents
Decreased HR, bp and contractility and SV decreased oxygen demands on th heart ENDING IN OLOL- infernal , propranolol (infernal), atenolol, metropolis (oppressor, toprol) USE PRE
c8 dermatome
Medial arm and forearm to long, ring, and little fingers
lymphedema stage 1
Stage 1 (Spontaneously Reversible) Puffy appearance of the hand or foot (distally). There may be pitting edema. It may be more difficult to see veins on the top of the hand or foot. It is not unusual for swelling to improve at night but return during the day. Similarly, elevation may temporarily reduce the edema. Lymphedema hasn't been present long enough to result in fibrosis.
vestibular input challenge
balance with head movement (halpike dix, bithermal caloric testing, testing for nystagmus, head trust
stages of recovery following stroke
Stage 1: Flaccid - no limb movement Stage 2: spasticity, hyperreflexia, synergies emerge Stage 3: Severe Spasticity. some voluntary control Stage 4: Some independent movement, voluntary control. spasticity decrease Stage 5: Synergies decrease, movement more complex Stage 6: Spasticity gone, coordination and movement near normal
stage 3 lymphedema
Stage 3 (Lymphostatic Elephantiasis) Skin typically becomes dry and scaly and the limb or other affected body region becomes very large. There may be fluid leaking from the limb and skin infections are common. The weight of the limb can be debilitating. Excess skin projections (including blisters) can form to attempt to contain the fluid, and these projections pose an even greater infection risk.
protective extension reaction
Stimulus: displace the center of gravity outside the base of support Response: arms or legs extend and abduct to support and to protect the body against falling ---proective extension downward (parachute reaction) develops first, following by FW, SW, and BW) Onset: arms 4-6 mos, legs 6-9 mos, persists
Symmetrical Tonic Neck Reflex (STNR)
Stimulus: flexion or extension of the head Response: head flexion: flexion of the arms and extension of the legs Head extension: extension of the arms and flexion of the legs ***can strongly influence the ability to assume a quadruped position and the ability to crawl onset- 4-6 months integrated 8-12 months
hemoptysis
blood in sputum
hypotnesion
blood pressure not enough for perfusion of tissues
traction reflex
Stimulus: grasp forearm and pull up from supine into sitting position Response: grasp and total flexion of the upper extremity and the head will lag behind Onset: 28 weeks gestation Integrated: 2-5 months
landau's reflex
Stimulus: lift the child under the thorax in a prone position Response: extension of the head and legs. if head is then pushed into flexion, extensor tone will disappear. onset: 3 months integrated- 2 years *** absent in babies with strong flexor spasticity
Tonic Labyrinthine Reflex
Stimulus: prone or supine position Response: Prone: increased flexor tone Supine: Increased extensor tone ***hard to position supine to sidelying due to increased extensor tone will limit onset- birht integrated- 6 months
A 12-year-old patient who has spastic diplegic cerebral palsy has full passive range of motion of the lower extremities, but demonstrates crouching with hip and knee flexion angles of 20° each in standing position. Which of the following interventions is BEST to achieve sustained improvements in lower extremity alignment during walking
Strength training has been shown to improve gait and muscle performance in patients who have cerebral palsy. The physical therapist should seek to create a balance of muscle activity across a joint. In this case, addressing quadriceps and gluteal muscles will be beneficial for improving knee and hip extension by counteracting the forces potentiating flexion.
Gastrointestinal complications post SCI
Stress ulcers occur in the stomach or duodenum in 5-22% of cord injured patients during the acute phase of recovery -other GI complications include bowel obstruction, fecal impaction, or gastric dilation. bowel programs aim for regular evacuation ---can be achieved by diet, stool softeners, fluid intake, digit stimulation, suppositories and manual stretch of sphincters with evacuation.
bone density scores
T-scores of -2.5 and lower indicate osteoporosis. T-scores falling in the range -1.0 to -2.5 indicate low bone mass, which is osteopenia. T-scores of -1.0 and higher indicate normal bone mass.
thoracic SCI
T12-L1 most common flexion or vert compression can cause wedge compression or burst fractures of the vertebral bodies damaging the spinal cord
restrictive diseases
TLC,FRC,RV,VC,PACOS-DECREASES FEV1-normal DECREASED VC WITH NORMAL EXPIRATORY FLOWS
hindfoot valgus
Talus slides forward and down on front of calcaneus -> flat foot
what muscle should be relaxed with urge incontinence
The detrusor muscle should be relaxed or inhibited
cholesterol goals
Total Chol <200 mg/dL LDL <100 mg/dL HDL >40 mg/dL Triglyceride <150 mg/dL
what is needed to rule out pneumothorax prior to mobilization of a patient?
The device shown in the photograph is a chest tube collection device. Removal of a chest tube may result in pneumothorax. A radiograph of the chest is needed to rule out pneumothorax prior to mobilization of the patient
SC lesion at s3 and below lead to
Spinal cord lesions at the level of S3 and below lead to bladder areflexia and dysfunction of the external sphincter S2-S4 innervate muscles in the perineum and external sphincter; therefore, complete loss of innervation would lead to paralysis of the respective musculature
A patient has sustained a moderate ankle sprain with significant swelling greater than 1 inch (2.5 cm) throughout the ankle and into the foot. Which of the following wrapping techniques is MOST appropriate to control the edema?
Spiral compression wrap with more pressure on the limb distally than proximally When applying compression wraps to control edema, a spiral wrap is used with more pressure applied distally than proximally. In no case should a wrap be applied with the proximal pressure greater than the distal pressure.
Stages of Lymphedema stage 0
Stage 0 (Non-Visible, Latency) Lymphedema can develop very slowly—early changes within the tissues without obvious noticeable swelling or symptoms. Protein molecules can accumulate beneath the skin and"pull" extra water into the affected area, occasionally resulting in sensations of heaviness or fatigue in the limb or region. Despite a "normal" measurement of tissue or limb sizes inthat area, the early changes leading to lymphedema have begun and generally respond to treatment. This stage should not be ignored— instead, prompt treatment will reduce the risk of worsening edema.
D1 flexion LE
Start - IR, Ext, ABD End - ER, Flex, Add
prehypertension
Systolic: 120-129 Diastolic: <80
c2 dermatome
Temple, forehead, occiput
gluteal reflex
Tensing of the skin in the gluteal area is due to the gluteal reflex, which is evoked by stroking the back. The gluteal reflex comes from nerve roots of L4-L5, S1-S3.
Rubor of dependency test
Tests of peripheral arterial circulation: STEPS: Pt. in supine and note color of plantar aspect. Elevate to 45 deg for 1 min. Note color, return to original position Normal: Return normal red/pink color in 15-20 sec Insufficiency: pallor within 30 sec of elevation With insufficiency - Pallor develops in elevation; reactive hyperemia (rubor of dependency) develops in dependent position. over 30 seconds is indicative of arterial insufficiency
foul sputum
anaerobic infection
tricep dtr
c7
stance phase knee problems
flexion during FW progression from a flexor contracture combined with weak knee extensions b) hyperextension during FW progression can be due to plantar flexion contraction past 90 or severe spasticity in quadriceps or weak knee extensors (compensatory locking)
s3 dermatome
groin, posteromedial thigh to knee
wheezes
high pitch, and muscle asthma
agnosia
inability to recognize familiar objects with one form of sensation
hyperkalemia
increased concentration of potassium ions decrease rate and force of contraction
when is traction contraindicated?
instability
seoncdary risk factors for lymphedema
insult to the lymphatic system 1. cancer patents (most common breast and cervical) -lymph node removal -chemo -venous disease -trauma -cardiac disease -dependent edema -filariasis
SWING PHASE: Trunk/Pelvis
insufficient forward pelvic rotation from weak abdominals inclination to sound side for foot clearance due to weak hip flexors
myelogpraphy
look at subarachnoid space, spinal nerves, herniated disk, fractures, back or leg pathology and spinal tumors
SA node
located at junction of SVC and RA pacemaker of the heart initiates 60-100 bpm has sympathetic and parasympathetic
Pallanesthesia
loss of vibration sensation
L4 dermatome and myotome
medial butt, lateral thigh, medial leg, dorm of foot and big toe myotome- tibialis anterior, Extensor hallcuis SLR limited, neck flexion pain, weak or absent knee jerk
heart attack refereed pain
medial left arm and jaw pain referred
EEG TEST
measures the electrical activity of the brain HELP FOR SERIZURES, BRAIN TUMOR, BRAIN DAMAG,E ALCHOLISM
locomotor training
motor TM with partial body support provides early and safe training while freeing up the PT's hands to provide cueing and observe body movement progress from support to no support allows for massed practice progress from TM to overground support or device to no device
calculate target heart rate
multiple age predicted max HR by 60-90% .65-.90 (220-age)-resting hr) + resting HR= THR
ST elevation shows
new infarct or injury or pericarditis
vibaration
performed an isometric coocntraction of the arms appleid to thorax used in conduction with other techniques
lymphadenitis
redness/ tenderness
c5 myotome
supraspinatus, infraspinatus, deltoid, biceps
forced vital capacity
the maximum amount of air that can be formally removed from the lungs during forced expiration IRV+TV+ERV
increased expiratory force or cough
train the inspiratory muscles during resistance
t3-t6 dermatome
upper thorax
bioimpedance
used for bilateral diseases and distisguiding between lipodema and lymphedema
occipital lobe
visual information
Forced expiration technique
1. one or two forced expirations with relatively low lung volumes and the glottis not closed COPD patients
As a child ages from 1 to 7 years, which of the following factors indicate maturing gait?
2. Velocity increases and cadence decreases.
forced expiratory volume
(FEV1) how much air comes out in the first second of ehalation. normally- at least 75% of FVC is exhaled in the first second
lymphedema stage 2
(Spontaneously Irreversible) Swelling takes on a spongy consistency and "non-pitting" and does NOT respond to elevation. This tissue consistency change is caused by the formation of fibrosis, or scar tissue, with gradual thickening of the tissues on the limb as it increases in size POSTIVE STEMMERS
RIGHT HEART FAILURE
(backward) reduced venous return to the heart from the systemic circulation due to the failure of the right ventricle HALLMARK- jugular vein distention and peripheral edema increase pulmonary artery pressures with peripheral edema (ankle swelling) venous hypertension and swelling weight gain, fullness in abdomen, fatigue
Third-degree AV block
(complete block of conduction) Fatigue, dizziness, and light-headedness are common and, with concomitant structural heart disease, heart failure, weakness, chest pain, confusion and syncope may occur Associated with profound bradycardia unless the site of the block is located in the AV node Can cause asystole leading to cardiac arrest and/or death
total lung capacity
) is the amount of air the lung can contain at the height of maximum inspiratory effort.
If the ATNR remains active in a child at a later age, it can affect:
- Hand-eye coordination - difficulties such as ability to control the arm and hand when writing - Ability to cross the vertical midline.
spinal shock
- Temporary loss below the lesion the spinal reflexes, voluntary motor control, sensory function and autonomic control are absent below the level of lesion usually resolves within 24 hours with return to the anal and bulbocavernous reflexed sparing of sensation or voluntary motor function below the lesion indicated that the lesion is incomplete
head or mouth stick
- wooden or metal- 12-18 inches lesions C3-C4, sometimes c5
Lambert-Eaton myasthenic syndrome
-*Presynaptic neuromuscular disease, autoimmune disease caused by antibodies blocking the calcium channels, leading to reduced acetylcholine release into the synoptic cleft. patients with LEMS RARELY have ocular symptoms but may have distal extremity sensory loss and polyneuropathy secondary to small cell lung cancer and paraneoplastic syndrome
pulmonary edema
-Excessive seepage of fluid from the pulmonary vascular system into the interstitial space --can be due to left ventricle failure, aortic valvular disease, mitral valvular dies, inahaltion of toxic fume or narcotic overdose sign and symptoms 1. dyspnea on exertion or paroxysmal nocturnal dyspnea 2. faituge 3. frothy pink sputum 4. positive chest x-ray 5. crackers treatment 1. med (oxygen and direutics) 2. reduction fo salt intake 3. bed rest (head elevated)
normal cardiac cycle
-P wave is depolarization of the atria -QRS complex is depolarization of ventricles -ST is beginning of ventricular repolarization -T wave is repolarization of ventricles QT- time for electrical systole PR interval- time to travel from atria to purkinje fibers
flexor synergy UE
-Scapular - Elevation and Rectrac -Shld - ABD and ER -Elbow - Flex (strongest part) -Forearm - Sup -Wrist - Flex -Fingers - Flex with ADD -Thumb - Flex and ADD
equilibrium reaction
-Stimulus: displace the center of gravity by tilting or moving the support surface -Response: curvature of the trunk toward upward side, with extension/abduction of extremities on that side, protective extension on downward side -reaction will be absent if there is marked spasticity -Onset: develops sequentially after 6 mos, (prone) supine (7-8), sitting (7-8) kneeling (9-12) and standing (12-21)
crossed extension reflex
-Stimulus: noxious stimuli to ball of foot of extremity fixed in extension, tested in supine Response -Opposite lower extremity flexes then adducts and extends -In pts with hemiplegia, lifting the uninvolved leg during ambulation results in increased extensor tone in involved leg -can result in knee hyperextension when coupled with Positive supporting reaction -Onset 28 weeks gestation, Integrated 1-2 months
posterior inferior cerebellar artery
-Wallenberg's syndrome (vertigo, nausea, hoarseness, dysphagia, ptosis, decreased sensation of ipsilateral face and contralateral torso/limbs horners syndrome may appear as well
c1-c3 SCI
-capable of talking, mastication, sipping, blowing key muscles: face and neck muscles dpndt for self care requires portable ventilator or phrenic nerve stimulator, power tilt in space w/c with mouth control and seatbelt for trunk control a person with c3 lesion can attain w/c independence with this equippinment on smooth level surface
Dysmetria
-inability to judge distances -seen in cerebellar dysfunction
A partial-thickness wound that has been treated for 10 days is currently debrided of all devitalized tissue, but granulation tissue is still not apparent. The wound is draining a minimal amount of serous fluid. Which of the following interventions would be MOST appropriate?
. Hydrocolloids are indicated for wounds that have low to moderate amounts of drainage and that need protection from bacteria or other contaminants
normal diastolic pulmonary arterial pressure
. Normal diastolic pulmonary arterial pressure ranges from 5 to 15 mm Hg A measure of 3 mm Hg is pathologically low and may indicate unstable hemodynamic status, which is a relative contraindication for percussion
Patients who have sustained a complete C5 spinal cord injury should be able to achieve
. Patients who have sustained a complete C5 spinal cord injury should be able to achieve transfers and bed mobility with assistance, or at maximum are dependent for transfers and bed mobility. Power wheelchair mobility is the recommended mode of mobility, with modified independence as the highest level.
liver disease pain pattern
. Right shoulder pain, bruising, palmar erythema, and confusion
A 62-year-old patient has ascites and bilateral pedal edema. The patient's pulse rhythm is regular. The patient's history is negative for any liver, kidney, or metabolic disease. Which of the following conditions isMOST likely present?
. Right ventricular failure results in backup of blood into the systemic venous circulation, manifested by edema systemically, including jugular venous distention, ascites, and bilateral pedal edema
stage 1 wound
. Stage 1 pressure injuries are characterized by nonblanchable erythema of intact skin.
Calcaneovalgus
. The ankle is in excessive dorsiflexion, the forefoot is curved out laterally, and the hindfoot is in valgus.
Pulse grading
0 absent 1+ weak 2+ normal 3+ increased 4+ bounding
modified asworhth scale
0- no increase in muscle tone 1- slight increase in tone, by a catch and release or min resistance at end range 1+- increase in tone with a catch and min resistance through remained of less than 1/2 ROM 2- MORE INCREASED TONE but can still easily move 3- passive movement is diffciutly 4- affected parts rigid in flexion or extension
pediatric BP
1 month old- 80/45 6 year old 105-125/60-80
thermoregulation problems post SCI
1) cord injury that interrupts communication with the hypothalamus can cause hypothermia due to peripheral vasodilation 2) reflexive tone returns in the peripheral vasculature, resolving this problem 3) later, hyperthermia occurs due to a loss in sympathetic control of the sweat glands. 4) below the level of the lesion sweating does not occur. To compensate diaphoresis occurs above the lesions.
changes to CV system post SCI
1) with an injury to the cord blocks communication between the brainstem and the t/l cord, sympathetic input to the heart is lost and parasympathetic input remains, resulting in bradycardia, peripheral vasodilation and hypotension 2) orthostatic hypotension occurs due to a drop in bP when the pt moves from horizontal to upright 3) problems are usually significant with lesions above T6 and often resolve within a few weeks of injury
edema scale
1+ mild, <1/4 2+ mod-returns to norma Lin 15 seconds 3+- 15-30 to rebound 4- >30 seconds
A patient has a lesion in the right middle cerebral artery. During examination, a physical therapist should expect to find:
1. impaired spatial perception.
COPD signs and symptoms
1. increased resistance to airflow 2. hx of smoking 3. abnormal breath sounds 4. use of accessory muscles 5. increased chest size 6. dry or productive cough
Phase one of cardiac rehab
1. less than 1 week from an uncomplicated 2. PT interview, assess tolerance and begins Low-level activities if indicated c. monitors pulse rate and BP
COMPLETE DECONGESTIVE THERAPY
1. manual lymphatic drainage (proximal segments first at the right lymphic duct for the RUE and thoracic duct for the LUE, LE, and torso 2. compresison bandages/ garments ----short stretch compression worn 24hr/day ---low resting and high working pressure 3. exercise 4. skin care, hygiene, nail care 5. patient education
neurodevelopment treatment
1. motor learning can be facilitated by rep or experience in the environment 2. INHIBITION OF UNWANTED ACTIVITY precedes practice of normal movement patterns 3. guided movement 4. NORMALIZE TONE and abnormal patterns 5. normalize sensory/perceptual experiences
New York heart classification 1
1- No symptoms with ordinary physical activity. (max mets and activities allowed-6.5Moderate shoveling, push mower, square dancing , singles tennis, walking at 4.5 mph)
New York Heart Association Classification of Heart Failure
1- No symptoms with ordinary physical activity. (max mets and activities allowed-6.5Moderate shoveling, push mower, square dancing , singles tennis, walking at 4.5 mph) 2- Slight limitations of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitations, or dyspnea.4.5Painting, scrubbing floors, carrying golf clubs, foxtrot dancing, walking at 3.5 mph 3. Marked limitation of physical activities. Comfortable at rest, but minimal activity results in fatigue, palpitations, or dyspnea.3.0Riding lawn mower, light wood working, walking at 2 mph 4. Unable to do physical activity without discomfort. Cardiac insufficiency symptoms at rest. Angina may be present at rest. 1.5Desk work, driving, walking <1mph, sewing
grade of murmur
1-6
tests for arterial circulate ion
1. ABI 2. rubor depednecy 3. examine intermittent claudication
history for lyumphadema
1. observe swelling 2. sensation of tightness, heaviness, fullness 3. tight fit of clothing or jewelry 4. aching sensation
ventricular tachycardia
1. 3 or more PVCs occurring sequentially 2. ECG will show WIDE QRS 3. no p waves
A patient had a central line peripherally inserted via the cephalic vein. Proper placement has been confirmed. Which of the following activities of the ipsilateral arm should be AVOIDED?
1. Blood pressure should not be taken on the ipsilateral side. This is a precaution for patients who have a peripherally inserted central line, as well as for patients who have some other lines
Wide QRS bundle
1. occurs with bundle brach heart blocks (abnormal delays or failure to conduct the electrical signal from the atria to the ventricles) 2. slowed ventricular rate decreases CO and 3 degree/complete heart block is life treating. REQUIRES ATROPINE (ANTI-CHOLINERGIC)
cross sectional research
1. Cross-sectional research involves studying a group at one point in time and generalizing the results to a population
sign and symptoms of mI
1. DEEP visceral pain, jaw. left arm pain (doesn't improve with nitroglycerin) 2. pt restless, pale, diaphoretic and excessive sweating
foam dressings
1. Foam dressings are highly absorbent and are appropriate for a granular wound that is draining (p. 191).
A patient who has decreased tactile sensation due to diabetes mellitus is being treated for a mild Achilles tendon strain. Which of the following interventions is MOST appropriate to restore normal alignment of the healing collagen?
1. Gastrocnemius stretching-Stretching is a stimulus in the early healing stages for the proper alignment of healing collagen. Gentle stretching is performed to provide a stimulus for fiber orientation without disruption of the immature collagen.
A patient who has a spinal cord injury reports having spastic (reflex) bowel function. Which of the following descriptions BEST characterizes the patient's neurologic injury?
1. In spastic bowel dysfunction, the level of cord injury occurs above S2-S4, leaving the spinal defecation reflexes intact.
Which of the following descriptions BEST represents the highest potential of function for a patient who sustained a C4 spinal cord injury (ASIA Impairment Scale A)?
1. Level transfers with total assistance, bed mobility with total assistance, power wheelchair mobility
A patient who had a medial meniscus repair 1 week ago has limited knee flexion. Which of the following interventions is MOST appropriate for the patient at this time?
1. Limit knee flexion to 90°. . Limiting the knee flexion to 90° for the first 4 to 6 weeks is recommended to limit the shear stress to the healing meniscus.
deep partial-thickness burns color
1. Mixed red-white coloring is evident with deep partial-thickness burns because the dermis is almost completely destroyed. Marked edema is present with deep partial-thickness burns because of broken blisters and leakage of plasma fluid. Capillary destruction is marked.
treatment for DMD
1. Mtn mobility 2. encourage strength and CVS function 3. positing and avoid contracture 4. pt education 5. no MAX EXERCISE CAN DAMGE MUSCLE
Following a total knee arthroplasty, a patient has been receiving moist heat to the knee prior to exercise and gait training. During the current visit, the physical therapist notes new redness, swelling, and increasing warmth surrounding the knee. Which of the following actions should the therapist take?
1. Notify the orthopedic surgeon of the changes. New symptoms of redness, swelling, and increasing warmth following a surgical procedure are indicators of a possible infection. The surgeon should be notified.
Pain associated with urinary calculi MOST often occurs because of blockage of which of the following structures?
1. Pain from urinary calculi results from the ureter contracting in the attempt to dislodge the calculi.
A patient who has a long-term history of nonsteroidal antiinflammatory drug use reports back pain from the mid thoracic region to the right upper quadrant, including the posterior right shoulder. The patient also reports weight loss, loss of appetite, dark-colored stools, and episodes of epigastric pain within 3 hours of eating a meal. The patient reports an episode of vomiting material with a coffee-ground appearance prior to arriving for physical therapy. Which of the following gastrointestinal conditions is MOST likely responsible for these symptoms?
1. Peptic ulcer disease Patients who have a history of long-term nonsteroidal antiinflammatory drug use should be monitored for signs and symptoms of bleeding. Pain occurring within 1-3 hours of eating is typical in duodenal ulcers. T he pain occasionally radiates to the mid thoracic back and right upper quadrant, including the right shoulder. Right shoulder pain alone may occur as a result of blood within the peritoneal cavity. Melena (dark, tarry stools) and coffee-ground vomitus are indicative of bleeding. Referral to a physician is warranted.
treatment for mI
1. RELIEVE distress 2. reduce cardiac work and treat complications
Which of the following definitions BEST describes a systematic literature review?
1. Secondary analysis of individual studies with similar characteristics . A systematic review of literature entails a secondary analysis of individual studies with similar characteristics in order to generate a combined conclusion
Asymmetrical Tonic Neck Reflex (ATNR)
1. Stimulus - Head position, turned to one side 2. Responses - Arm and leg on face side extended, arm and leg on scalp side are flexed flexed, 3. strongest influence- supine or sitting 4. prolonged influence can cause scoliosis or even hip subluxation is marked hypertonia 5. if reflex is severe, grasping of objects with the extended arm is only possible if pt looks away 6. onset: birth 7. integrated 4-6 months
Which of the following methods is MOST appropriate for evaluation of chest excursion in a patient with an incomplete spinal cord injury at the C7 level who is in supine position?
1. Use a tape measure circumferentially at the levels of the axillae and the xiphoid process.
Raynauds phenomen
1. abnormal vasoconstrictor reflex 2. exacerbated by exposure to cold or emotional stress 3. mostly affects females 3. pallor/cyanosis of finger tips 5. numb, tingling and burning during attacks
cardiopulmonary resuscitation
1. adult unresponsive, call 911 or code blue. GET AN AED 2. if child- try to pen the airway, perform 5 cycles of cpp begin with 2 breaths and see if successful before calling 911 or a code and retrieving an AED after lack of responsive in adult begin compressions immediately and then open airway by head tilt 4. resort breathing and circulation. USE AED. checking for pulse is no longer recommended,
serum enzymes
1. appear in circulation following death of cardiac muscle cells 1. examples 1. creatine phospate (cpk) 2. LACTACT DEHYDROGENASE (LDH) 3. Serum glutamic oxaloacetic transaminase (SGOT)
left hemisphere problems
1. apraxia 2. diffx starting and sequencing tasks 3. easily frustrated 4. inability to communicate verbally 5. cautious and slow
physical exam for lymphedema
1. assess swlling 2. volumetric measurement (if 10% INCREASE compared to unaffected side) --water displacement, girth measurement, bioimpedance 3. pitting edeam 4. skin assessment 5. stemmers sign 6. vasclaulr assessment (ABI, pulse oximitery, arterial and venous insuficcieny) 7. lymph node palpation 8.diagnositc imaging 9.lab testing MOST lymphedema diagnoses are based on medical history and physical exam.
ventricular fibrillation
1. chaotic activity of the ventricle originating from multiple foci 2. unable to determine rate 3. ECG erratic activity without QRS complex
prone pulmonary
1. decreased AP expansion of abdomen 2. lateral diameter INCREASED COMPARED TO SITTING 3. decreased FRC compared to sitting 4. pt with pathology in superior and posterior segments of Lower lobes may have increased oxygen 5. head down position is limited or avoid with increase intracranial pressure
treatment for trisomy 21
1. facilitate gross and fine motor 2. increase strength and stability 3.avoid hyperextnion 4. energy conservation
cor pulmonale
1. failure or hypertrophy of the right ventricle resulting from disorders of lungs, pulmonary vessels or chest wall 2. the lung pathology (ex: C.B or emphysema) produces pulmonary after hypertension that creates a problem in RV 3. usually chronic but can be acute and reversible
STOP INPATIENT EXERCISE INDICATIONS
1. fatigue, light headiness, confusion, ataxia, pallor/cyanosis, nausea, angian 2. ST displacement 2 mm horizontal or downward from resting level 3. ventricular tachycardia or 3 or more PVC's 4. drop of systolic BP of 10 mmh or more 5. rise is systolic bp to more than 220 mmh or diastolic more than 110 mmhg
treatment for cerebral palsy
1. goal develop max I 2. motor leaning and control 3. adaptive quipemtn and orthotic use
lower extremity lymph nodes
1. iliac 2. inguinal 3. popliteal
angina pectoris
1. pain in chest, jaw or left arm secondary to temporary, localized ischemia (usually from atherosclerosis) 2. other symptoms include ( dyspnea, indigestion, dizziness, syncope and anxiety 3. caused by increased physical or emotional stress/ weather 4. ischemia changes cause depressed LV function 5. can be merged with medications and rest 6. use angina scale
tests for peripheral venous circulation
1. percussion test 2. tredelenberg test 3. venous filling time 4. doppler US 5. air plethysmography
Measures of motor learning
1. performance 2. retention 3. generalizability 4. resistance to contextual change
phase 1 cardiac rehab exercise guidelines
1. progress from 2-3 METS to 3-5 by discharge 2. short exercise session 2-3x a day 3. ETT may be used to determine functional capacity prior to d/c
exercise guidelines for phase 3 cardiac rehab
1. progress to I 2. PROGRESS TO 50-85% of functional capactiy, 3-4x a week, at 45 minutes or more
inhibition techniques
1. prolonged icing 2. neutral warmth (towel wrapping) 3. prolonged stretch 4. low frequency (5-50hz) 5. pressure on tendons
treatment for myelomeningocele
1. proper positioning 2. orthotic devices 3. standing frames 4. parapodia 5. swivel and rollator walkers for lower thoracic lesion 6. reciprocal gait walker or orthotics for upper lumbar lesion 7. adaptive w/c for upper thoracic lesion
venous filling time
1. pt supine, passively elevate LE to approximately 45 degrees fro 1 minute then place in dependent position 2. delayed filling of >15 indicated venous insufficiency
PHASE 1 cardiac rehab goals and activities
1. pt/family education 2. support 3. progress to self care I 4. provide medical surveillance and prevent deconditioning activities 1. self care (adl require 5 mETS) 2. selected arm and leg AROM 3. very light weights 4. I transfers 5. bedside sitting progressed to supervised ambulation and stair training.
Facilitation Techniques
1. rep brushing 3. quick icing 3. quick stretch/taping 4. high freq vibration (50-300 hz)
atelectasis
1. shrunken and airless state of part of the lung (acute or chronic, complete/partial_ 2. associated with infection 3. presents with pain on the affected side, dyspnea, cyanosis, drop in BP, tachycardia, diminished or absent breath sounds, dull or flat to percussion, fever, and reduced chest excursion on the affected side.
right hemisphere problems
1. spatial awareness/ hand-eye coordination 2. irritability, short attnention span 3. can't retain info, differ learning individual steps 4. diminished body image with left sided neglect 5. quick and impulsive
upper extremity lymph nodes
1. suprsclaviuclar 2. axillary 3. cubital
Constrained induced movement therapy
1. unaffected limb is retrained 2. pt needs minimum movement/strength criteria
upright. sitting pulmonary
1. vertical lung height and AP expansion greatest 2. mechanical compression of lungs is minimal 3. most comfortable for pulmonary complications
normal BP
120/80. range of 110-120 and 60-80
Hypertension Stage 1
130-139/80-89
normal platelet count
150,000-400,000 <20,000 AROM, ADL only 20-30- light ex 30-50 moderate ex
hypertensive crisis
180/110
1 month
1month: lift head, follows a moving object, exhibits reflex stepping, positive supporting reflexion ,decreased flexion and hands fisted with indwelling thumb most of the time, reciprocal and symmetrical kicking and neonatal reaching
juvenile RA and flexibility
2. Children who have juvenile rheumatoid arthritis lose a substantial amount of flexibility. A stretching program to improve flexibility is important for children who have juvenile rheumatoid arthritis. (p. 146)
collagen dressing
2. Collagen dressings are highly absorbent and are appropriate for a granular wound that is draining
A patient who has chronic obstructive pulmonary disease is participating in a mild graded exercise program at a level of 2 metabolic equivalents (METs). The patient's heart rate at rest is 80 bpm. During an incremental increase in exercise up to 4 metabolic equivalents (METs), the patient experiences an elevation in heart rate to 120 bpm. Which of the following actions is MOST appropriate?
2. Continue the exercise session while monitoring vital signs.
flail chest
2 or more fractures in 2 or more adjacent ribs- trauma signs and symptoms 1. shallow breathing 2. crepitation during ventialtion 3. paradoxical breathing- inhaled- in exhale-flail section moves out treatment 1. gentle breathing x 2. splinting 3. pain management 4. proper positioning
New York heart classification 2
2- Slight limitations of physical activity . Comfortable at rest, but ordinary physical activity results in fatigue, palpitations, or dyspnea. 4.5-Painting, scrubbing floors, carrying golf clubs, foxtrot dancing, walking at 3.5 mph
If treatment time and surface area are kept constant, which of the following ultrasound parameters would MOST likely deliver the GREATEST amount of energy through tissues?
2. 0.8 W/cm2 in continuous mode at 3 MHz Continuous mode (or 100% duty cycle) produces thermal effects, compared to pulsed mode Research indicates that a frequency of 3 MHz results in a higher maximal temperature than 1 MHz despite delivering a lesser depth of penetration (p. 175). Furthermore, higher intensities produce higher temperature increases in tissues
A patient who is overweight reports pain and tenderness in the right lower quadrant of the abdomen that worsens upon coughing or sneezing. Which of the following actions should a physical therapist perform FIRST?
2. Measure the patient's body temperature and check for rebound tenderness. the therapist should screen for appendicitis by checking for the presence of a low fever as well as palpating the abdomen for tenderness
Which of the following exercise guidelines is MOST appropriate for a patient who has diabetes?
2. Patients who have diabetes should exercise regularly and consistently (Goodman; Porcari).
A patient who fell while running 3 days ago reports diffuse lateral ankle pain with active movement. The patient exhibits localized swelling distal and anterior to the lateral malleolus. Minimal laxity is noted with an anterior drawer test. Which of the following interventions would be MOST appropriate for the patient at this time?
2. Posterior talocrural joint mobilizations The patient has signs and symptoms consistent with a diagnosis of a lateral ankle (inversion) sprain. A grade 2 lateral ankle sprain is characterized by localized swelling and more diffuse lateral tenderness Gentle posterior talocrural joint mobilizations should be performed in the acute stage of healing to maintain mobility and inhibit pain
In a patient who has weak oblique, rectus abdominis, and transversus abdominis muscles, which of the following interventions is MOST likely to improve the mechanical efficiency of the diaphragm?
2. Use of an abdominal binder A corset is recommended over a rigid orthosis when the goal is compression and not movement restriction
age predicted maximal heart rate
220 - patient's age
pulmonic valve location
2nd left intercostal space at the sternal border
aortic valve located
2nd right intercostal space at the sternal border
The physical therapy plan of care for a patient with low back pain includes posterior pelvic tilts performed in the supine position. Modification of the plan of care would be MOST needed if the patient were found to have which of the following conditions?
3. Hiatal hernia
A patient with hypertension has been referred for aquatic physical therapy following a total hip arthroplasty. Which of the following statements is the BEST reason for altering this plan of care?
3. Increased hydrostatic pressure centralizes peripheral blood flow and increases venous return
meninges
3 layers of specialized membranes surrounding the brain and spinal cord. 1. dura mater 2. arachnoid mater 3. pia mater
sepsis signs
3. Clinical signs of sepsis include fever, tachycardia, and tachypnea (Goodman, Pathology).
A patient has an ankle-brachial index (ABI) of 1.5. Which of the following conditions affecting the lower extremity should a physical therapist suspect?
3. Arterial calcification Ankle-brachial index is a ratio of the systolic blood pressure at the ankle and the brachial systolic pressure. The normal value of the ankle-brachial index is 1.0, indicating similar blood flow in the ankle and brachial arteries. An ankle-brachial index greater than 1.1 relates to arterial calcification in the leg. With arterial calcification, the artery cannot be fully compressed for valid measurement of arterial pressure at the ankle. An ankle-brachial index greater than 1.1 is mostly found in patients who have diabetes
calcium alginate dressing
3. Calcium alginate dressings are highly absorbent and are appropriate for a granular wound that is draining
Exercises to improve flexibility would be LEAST appropriate to include in a physical fitness program for children with which of the following diagnoses?
3. Children who have Down syndrome are extremely flexible (p. 433).
A physical therapist is teaching a patient pursed-lip breathing. This intervention will MOST likely result in which of the following changes?
3. Decreased respiratory rate 3. The increase in exhalation time creates a decrease in respiratory rate.
New York heart classification 3
3. Marked limitation of physical activities. Comfortable at rest, but minimal activity results in fatigue, palpitations, or dyspnea. 3.0Riding lawn mower, light wood working, walking at 2 mph
A patient who had an atrial septal defect repair continues to have mild pulmonary hypertension. Which of the following activity-level recommendations is MOST appropriate?
3. Participation is limited to low-intensity sports.
A patient has thin, bloody drainage from an abdominal surgical wound. This finding should be classified as which of the following types of drainage?
3. Sanguinous
A patient has medial ankle pain, a pronated foot with a calcaneal valgus deformity, pain with passive ankle eversion, and weakness of the great toe flexors. The patient MOST likely has which of the following conditions?
3. Tarsal tunnel syndrome
Uncompensated lateral (external) rotation of the tibia would result
3. Uncompensated lateral (external) rotation of the tibia would result in excessive foot supination.
CPR
30 compressions for very 2 breaths. about 100-120/minute adult and child- compress 2 inches between nipple 2 hands-adult 1 hand- child two fingers-infant infact- at least 1/3, just below nipple line
WBC normal range
4300-10,800 use mask with <1000-2000
normal WBC COUNT
4500-11,000/mm3,
tricuspid
4th left intercostal space at the sternal border
massive rc tear cm
5 cm
A patient is practicing moving from seated to standing position. Which of the following transfers to standing position would BEST facilitate motor learning of the task?
4. From a variety of chairs at a variety of speeds, with minimal feedback of results Motor learning principles suggest that psychomotor skills are best learned when practice conditions allow errors to occur, when performers are encouraged to engage in active sensory encoding and retrieval processes and when knowledge of results is used minimally. Such practice typically involves varying the task, varying the environment in which the task occurs, and providing minimal feedback of results.
When using electrical stimulation to treat a patient's nonhealing, infected wound, which of the following waveforms and parameters will be MOST helpful in facilitating wound closure?
4. High-voltage pulsed current waveform, negative electrode in wound, 100 pps
Which of the following actions should be done FIRST when teaching a new motor skill?
4. Identify and utilize learning preferences.
An 18-year-old patient who has a traumatic brain injury exhibits mild cognitive deficits, poor head and trunk control, and slowly healing pressure injuries on the ischial tuberosities. The patient has good voluntary movement and motor control in the right arm but has significantly increased tone and poor functional use of the left arm. Which of the following methods of wheelchair pressure relief is BEST for the patient?
4. Power tilt-in-space manual tilt-in-space requires assistance from another person for pressure relief.
Which of the following modalities is MOST appropriate to administer to a patient who has hip joint pain secondary to a labral tear that occurred 6 months ago?
4. Sensory-level electrical stimulation can cover a large area and is effective for treating chronic pain
Which of the following substitution patterns should be prevented when measuring active forearm supination?
4. Shoulder lateral (external) rotation and shoulder adduction past 0°
New York heart classification 4
4. Unable to do physical activity without discomfort. Cardiac insufficiency symptoms at rest. Angina may be present at rest. 1.5Desk work, driving, walking <1mph, sewing
Uncompensated pes cavus would result
4. Uncompensated pes cavus would result in excessive foot supination.
mitral
5th left intercostal space at the midclavicle area
obesity measures goals
<40 inch waist men and 35 for woman vmi between 18.5 and 24.9
hypertension stage 2
>140 and at least 90
normal SA02
>95%
ground reaction orthosis
A floor (ground) reaction orthosis has an anterior shell that provides a posteriorly directed force to resist knee flexion during stance phase
foam dressing
A foam dressing is absorptive but also creates an occlusive environment for moist wound healing. In the case of infection, a less occlusive dressing would be a better choice
Clasp-knife response
A form of resistance seen during range of motion of a hypertonic joint where there is greatest resistance at the initiation of range that lessens with movement through the range of motion
A compensated forefoot valgus deformity would result in
A compensated forefoot valgus deformity would result in excessive foot supination.
cerebral palsy
A group of non-progressive neurological disorders that are the result from gestation, perinatal, for postal CNS dame characterize by VOLUNTARY MOVEMENT DISORDERS MAJOR causes 1. hemorrhage below lining of ventricles 2. hypo encephalopathy 3. malformations 4. trauma of the CNS spastic diplegia most common after premature birth 1. spastic 2. athetoid 3. ataxi 4. mixed
hyperactive thyroid symptoms
A hyperactive thyroid will elevate the body's metabolism, causing an elevated heart rate, fatigue, weight loss, heat intolerance, and muscle atrophy, among other symptoms
autonomic dysreflexia post SCI
A medical emergency characterized by a sudden increase in BP, bradycardia, a pounding headache, flushing profuse sweating and anxiety occurs in lesions above t6. (most prevalent in the first 3 years post SCI) -most common cause of this is bladder distention other stimuli- rectal distention, pressure sores, urinary stones, bladder infx, noxious cutaneous stimuli, kidney malfunction, temp changes the bladder drainage system should be check immediately and opened if necessary if lying flat the pt should be Brough to a sitting position to the lower BP
metatarsal bar
A metatarsal bar is placed posterior to the metatarsal heads on the sole of a shoe to assist in transferring stress from the metatarsophalangeal joints to the metatarsal shafts during late stance
metatarsal pad
A metatarsal pad transfers stress from the metatarsal heads to the metatarsal shafts, reducing plantar pressure
A patient exhibits a steppage gait pattern. Which of the following muscles is MOST likely weak?
A patient who has weakness of the tibialis anterior muscle would have a steppage gait due to the decrease in ankle dorsiflexion. The patient would exhibit high steppage to allow clearing of the ankle and foot during gait and to avoid tripping over the foot.
PT and DVT
A physician's order for a Doppler study indicates possible deep vein thrombosis. A complete physical therapy evaluation and treatment should be deferred until a deep vein thrombosis has been ruled out or therapeutic levels of a prescribed anticoagulant to treat a deep vein thrombosis have been reached. DONT TAKE FROM NURSE Transfer from bed to chair is contraindicated due to possible deep vein thrombosis.
second degree prolapsed
A second-degree prolapse is marked by the cervix as part of the uterus having descended through the introitus, or vaginal opening. Pelvic floor rehabilitation has become the recommended first course of treatment and should include a discussion of alternative positions for sexual intercourse. Additional functional questions should include those related to bladder and bowel habits. Questions about usual sitting patterns would not be most important to ask.
WBC OF 16,000
A white blood cell count of 16,000/mm3 exceeds the normal range of 4,500 to 11,000/mm3 This elevated count suggests infection, which may compromise exercise tolerances
bowel and bladder issues following SCI
A) voluntary control of urination and defecation is lost after an injury to the sacral cord S2-S4 b) Following spinal shock, 2 types of bladder conditions can occur. 1_ reflex (UMN) bladders- empty in response to certain level of filling pressure 2) autonomous or nonreflex (LMN) bladders are flaccid and can be emptied by increasing intraabominal pressure or by manually compressing the lower abdomen
compression therapy contraindicated if
ABI<.8 active cellulitis or infection systemic arterial pressure <80mmh advanced peripheral neuropathy uncontrolled heart failure
unilateral peripheral vesitubular hyopofunction
A. trauma b. BPPV C. VESTIBULAR neuronitis/labyrinthitis d. tumor e. Mendieres disease sign/symptoms 1. dizziness 2. vertigo 3. postural instability/falls d. visual changes: nystagmus, blurred vision treatment a. habituation b. gaze stability exercises c. balance/ mobility training d. BPPV positioning techniques
asia scale
A: complete (no m or s in sacral segments s4/s5) B: sensory incomplete (sensory preserved below level) no motor below nuro level C: motor incomplete (motor preserved below level) most key muscles below NL have a muscle grade less than 3 D: motor incomplete (preserved below level and >3 key muscles) E: normal ( m and s normal)
amyotrophic lateral sclerosis
ALS- degenerative disease that involves both UMN and LMN (cranial nerves can also be affected) signs and symptoms 1. weakness is progressive 2. weakness is asymmetric and presents in distal extremities first 3. dysarthria and dysphagia- presenting sign in 1/3 of ALS its 4. amyotrophic (anterior horn cell or LMN damage) signs include muscle atrophy, weakness, and fascinations. 5. lateral sclerosis (corticopsinal and corticobulbar tracts- UMN) include spasticity, clonus, hypperreflexia and babinski 6. little to no sensory symptoms DTR- INCREASED m>w, 40-70 meds- riluzole( diluted)
side lying pulmonary
AP increased, lateral decreased FRC falls between upright and supine and is greater in nondependent lung rolling a throactomy or in unilateral lung condition (ateclasis, pnuemonaia) AFFECTED SIDE UPPERMOST to improve ventilation/perfusion ratio DECREASED EXPANSITION OF DEPDENDENT LUNG bronchopleural fistula- AVOID PROLONGED periods with the affect lung UP if the pt on positive pressure .COULD LEAK THE FISTULA
S4 heart
ASSOCIATD WITH MI or chronic hypertension
LDL is associated with
ASSOCIATED WITH arterial damage
A physical therapist is using exercise as an intervention for a patient with advanced ankylosing spondylitis. Which of the following types of exercise would be MOST important for the patient?
Advanced ankylosing spondylitis would cause loss of chest wall excursion, which compromises breathing. Aerobic exercise done consistently would be most important in order to optimize efficiency of oxygen transport and maintain cardiopulmonary function.
walking post heart surgery
After open-heart surgery, such as coronary artery bypass surgery, patients are encouraged to gradually increase walking, with a goal of 30 minutes of ambulation 1-2 times/day by 4-6 weeks post-surgery
After the 20th week of gestation, the weight of the fetus can
After the 20th week of gestation, the weight of the fetus can impair blood flow through the inferior vena cava when the woman is in supine position.
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
Which of the following dressings is MOST appropriate to use with an infected wound that also requires hemostasis?
An alginate dressing is best to use in this case because this type of dressing provides both hemostasis and is appropriate for use over an infected wound
increased.Adrenocorticotropic hormone symptoms
An increase in the secretion of adrenocorticotropic hormone causes Cushing disease, associated with hypertension, mental changes, weight gain, and increased hair growth
hemoglobin
An iron-containing protein in red blood cells that reversibly binds oxygen. 12-16
c6 dermatome
Anterior arm, radial side of hand to thumb and index finger
non traumatic SCI
Approx 10%. most likely to occur in narrowing spinal canal
arterial wounds
Arterial wounds are typically on the dorsum of the foot, lateral leg, or toes and have minimal edema initially. Typically edema is only present if the limb is held in a dependent position. There is minimal exudate but severe pain. These wounds can be quite deep, involving even tendon and bone.
arthrogyposis
Arthrogryposis comprises nonprogressive conditions characterized by multiple joint contractures found throughout the body at birth.
post ab surgery complications and treatments
Atelectasis is present in up to 95% of patient who undergo abdominal surgery (p. 180). Deep breathing (diaphragmatic breathing) is used to resolve atelectasis and increase oxygenation
A child who has athetoid cerebral palsy is MOST likely to exhibit which of the following characteristics?
Athetoid cerebral palsy is characterized by slow, involuntary, writhing, twisting, "wormlike" movements. Some muscles demonstrate tone that is too high, and others demonstrate tone that is too low
rhonchi
Coarse, low-pitched breath sounds- EXPIRATION could be result of air passing thru airways narrowed by inflammation, bronchospasm or secretions freq in patients with asthma or chronic bronchitis
blood glucose levels and exercise
Below 100 mg/dL (5.6 mmol/L) is the cautionary range for exercise (Goodman; Porcari). Above 250 mg/dL (13.9 mmol/L) is the cautionary range for exercise
cervical arhtorkinemeatics
Cervical rotation follows the same arthrokinematic motions as side bending; therefore, side bending to the right would be limited. Side bending mechanics include a superoanterior glide of the left superior facet and a posteroinferior glide of the right facet, which would be restricted with decreased cervical motion and translation of the mid cervical spine to the left.
"Coffee-ground" vomitus indicates
BLLEEDING
L2 Dermatome/Myotome
Back, front of thigh to knee psoas, adductors
Athetoid CP
Basal Ganglia involved. slow, writhing, involuntary movements -decrease muscle tone, poor functional stability in proximal joints, poor visual tracking, speech delay and oral-motor problems tonic reflex may be persistent blocking functional positions
Which of the following tests or measurements is BEST to assess risk for skin ulceration in a patient who has diabetes?
Because peripheral neuropathy is a common secondary complication of diabetes, it is imperative for a physical therapist to assess a patient's ability to detect light touch and presence of protective sensation to determine risk of skin ulceration
expressive aphasia
Broca's aphasia- severe difficulty with verbal expression with impairments in object naming and writing abilities. INTACT AUDITORY AND READING MOST FOUND WITH RIGHT hemiplegia frontal lobe of the dominant hemisphere, usually the left
L5 dermatome
Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes EHL, fib longus/brevis, glutei medius, dorsiflexors, hamstrings, plantera flexors
cough with SCI
C1-T3- WEAK/ non functional cough t4-t8- weak cough t10 and below- functional cough c6 and below pt can provide manual cough
Brachioradialis dtr
C5-C6
elevated total cholesterol and LDL associated with
CAD
s3
CHF
glossopharyngeal nerve
CN IX touch, pain: posterior tongue, pharynx taste-posteiroe tongue 1/3 voluntary- pharynx autonomic- parotid gland taste- gag reflex and swallow
facial nerve
CN VII taste- anterior tongue voluntary motor: facial muscles close eyes tight, side/show teeth, whistle and puff tastes,
hypoglossal nerve
CN XII tongue muscles tongue protrusioni (if injured, TONGUE DEVIATES TOWARD INJURED SIDE)
olfactory nerve
CN1 smell test with identify familiar odors
optic
CN2 vision test visual fields and acuity
oculomotor
CN3 voliuntary motor: levato of eyelid, superior, medial and inferior recti: inferior oblique autonomic- smooth muscle of eyeball test- up, down, medial gaze and reaction to light (testing with foollowing utensil)
trochlear
CN4 motor- superior oblique muscle of eyeball test- downard and inward gaze
trigeminal nerve
CN5 touch- skin of face, nose, mouth, and anterior tongue motor- muscle of mastication test( close eyes) pin and cotton over pt face (sharp or dull) cornea reflex, face sensation test mandibular protraction, recursion, and lateral deviation, clench teeth
abducens nerve
CN6 lateral rectus of eyeball test lateral gaze
CRPS
CRPS 1- tissue injury without nerve damage CRPS 2- nerve injury pain by sympathetic NS, char by burning pain (Causalgia), hypersensitivity to touch, coldness and sweating b. usually with trauma injury
Second-degree AV block
Can be asymptomatic Palpitations, weakness, lightheadedness, or syncope Manifests on physical examination as bradycardia and/or irregularity of heart rate
c7 SCI
Capable of elbow extension, wrist flexion, finger extesnion key muscles: triceps, EPL/EPB, extrinsic finger extensors, FCR I IN lower extremity self ROM exercises can use manual w/c with friction hand rims for community button hook may be required for I DRESSING able to get in w/c and out car
chronic bronchitis, sputum and bronchodilator?
Chronic bronchitis is associated with sputum that is predominantly neutrophilic, and bronchodilators improve the spirometry scores of patients who have chronic bronchitis
A physical therapist is evaluating an infant who has bilateral ankle equinus, hindfoot varus, and forefoot adductus. The infant MOST likely has which of the following deformities?
Clubfoot (talipes equinovarus) is a congenital deformity (environmental and genetic) that includes components of forefoot adductus, hindfoot varus, and ankle equinus. The primary distinguishing factor is the equinus component.
platelet counts
Coagulopathy is a precaution for percussion Percussion, like mechanical compression or soft tissue mobilization, increases the risk of injury for patients who have a low platelet count and should not be performed without the approval of the physician Although a platelet count of 30,000/mm3 is a precaution, a platelet count below 20,000/mm3 is a relative contraindication
A patient walks with excessive foot pronation during midstance through toe off (preswing). What is the MOST likely cause of the patient's gait deviation?
Compensated rearfoot varus deformity Excessive foot pronation during midstance to toe off is the result of a compensated rearfoot (or forefoot) varus deformity.
During lung auscultation, a physical therapist asks a patient to continuously say "E." Transmission of an "A" sound is heard over the right lower lobe when the patient says "E." Which of the following conditions is MOST likely present in the right lower lobe?
Consolidation When a patient has consolidated lung tissue or increased secretions, egophony will be present. Egophony is a voice sounds test and is the transmission of an "A" sound when the patient says "E." Voice sounds will increase in patients who have consolidation .
construct validity
Construct validity is based on abstract concepts and is not observable or measurable.
content validity
Content validity of a test is measured to determine the extent of coverage of a concept. It is not determined by comparison with a reliable/valid (gold) standard.
tricuspid valve
valve between the right atrium and the right ventricle
face validity
Face validity is based on the validation of a test without comparison to an already validated test.
Criterion-related validity
Criterion-related validity of a new tool is tested by using practical and objective comparisons to a reliable/valid (gold) standard measure already in use.
contractures post SCI
DEVELOP secondary to prolonged shortening of structures around a joint, which results in decreased ROM -muscle strength, imbalance, gravity, spasticity, or habitual postures can cause joint immobility -BEST PREVENTION- by periodic, AROM of joints through ROM, PROM is second best
Debris in the left superior semicircular canal
Debris in the left superior semicircular canal produces symptoms of persistent downbeating nystagmus and/or left ocular torsion.
Debris in the right superior semicircular canal
Debris in the right superior semicircular canal produces symptoms of persistent downbeating nystagmus and/or right ocular torsion.
A patient has diabetes with peripheral neuropathy. The patient's shoe on the involved side shows scuffing and wear on the outside of the shoe over the toe box. Which of the following gait deviations is MOST likely contributing to the wear on the shoe?
Decreased dorsiflexion would cause increased wear to the anterior portion of the toe box secondary to poor clearance and toe drag
c5 dermatome
Deltoid area, anterior aspect of entire arm to base of thumb
victal capacity with SCI
Diaphgram- c3,c4,c5 inetrcostals- t1-t12 abdominals t5-t12 trapezieus- c1-c4 sci c1-c3 levator scapula c3-c5 scalenes- c3-c5 usually less than 15% for its on ventilators with c1-c3 lesions at c3-c4, VC is around 15% below c4- VC is around 58% c6-c8- initially may be 30% then rise to 50-70 high thoracic lesion- 73% VC t10-12 can increase to 100% at d/c
improve gas exchange and increase lung volume
Diaphragmatic breathing, Segmental Breathing, Maximal Inspiratory effort
medications for CHF/HF
Digitalis (digoxin) -increased cardiac pump and decreased HR diuretics (lasix) 1. decrease vascular fluid volume, decrease preload/afterload, control hypertension
Peripheral Lesion Nystagmus
Direction: Uni with fast segment of movement indicating the opposite direction of lesion. Visual fixation: will inhibit nystagmus and veritgo Vertigo: significant Length of symptoms: minutes, days, weeks, but finite period of time Etiology: Meniere's disease, vascular disorders, trauma, toxicity, infection in ear
trisomy 21
Down syndrome congenital chromosomal abnormality, resulting an an extra chromosome 21 babies may present with hypotonia, decreased muscle force, congenital heart defects, visual and hearing losses, laxity of ligaments and cognitive deficits gross motor development delay and didxx speech and eating may have AO ligament laxity- AVOID FLEXION AND ROATITION FORCE
Which of the following parameters of electrical stimulation control the recruitment of peripheral axons during therapeutic electrical stimulation?
Duration of stimulus The process by which increasing numbers of nerve fibers are activated by increasing the amplitude or the duration of the stimulus is called fiber recruitment.
Edema associated with chronic venous insufficiency usually presents
Edema associated with chronic venous insufficiency usually presents in a gaiter distribution creating the appearance of an inverted bottle at the calf. Acute onset of swelling at the dorsum of the foot
A patient has higher than normal residual volume, absent or mucoid sputum, and spirometry measures that are unimproved with bronchodilators. The patient MOST likely has which of the following conditions?
Emphysema has the features of higher than normal residual volume (because of destroyed alveolar walls and enlarged air spaces), absent or mucoid sputum (as opposed to sputum with a lot of neutrophils), and spirometry measures that are unimproved with bronchodilators (unlike asthma, which improves with bronchodilators)
eschar
Eschar is evident with full-thickness burns. It is a hard, devitalized tissue consisting of coagulated plasma and necrotic cells. Full-thickness burns destroy all of the epidermal and dermal layers and possibly the subcutaneous fat layer.
Exercise and Angina
Exercise is beneficial with stable angina because of its effect on many of the contributing factors, including high BP and cholesterol, diabetes and obesity. Aerobic exercise, in particular, increases blood and oxygen flow to the heart. 1+- Light, barely noticeable 2+ Moderate, bothersome 3+Severe, very uncomfortable 4+Most severe pain
HF/ CHF pathophysiology
FAIULRE of the heart the maintain adequate coruscation of the blood to meet the demands of the body pathophsyicology 1. decreased CO 2. elevated end diastolic pressure (preload) 3. tahcycardia 4. contractile defiicney (decreased SV) 5. impaired ventricular function
exercise perception includes
FREQUENCY INTENSITY TIME TYPE
Adhesive Capsulitis (Frozen Shoulder) characteristics
Factors associated with development of adhesive capsulitis include age older than 40 years, history of diabetes, and female gender. Stage II adhesive capsulitis, which is present for 3-9 months, is associated with decreased lateral (external) rotation and abduction and with pain that disrupts sleep
First-degree AV block
First-degree AV block(slowed conduction) Generally asymptomatic Excessive delay causes dyspnea, weakness, or dizziness
Lower Lobes Lateral Basal Segments postural drainage
Foot of bed elevated 20 in; pt lies on abdomen, head down and then rotates 1/4 up drain left- pt lie on right drain right- lay on elft
lower lobe (anterior basal segments)
Foot of bed elevated 20 in; patient lies on side, head down, pillows under knees. right- pt lie on left left-pt lies on right
cremaster reflex
For the cremasteric reflex text, the patient lies in supine position while the examiner strokes the inner side of the upper thigh with a pointed object. The test result is negative if the scrotal sac on the tested side pulls up. Unilateral absence of this response indicates a lower motor neuron lesion between L1 and L2.
heterotrophic bone formation post SCI
Formation of new bone within muscle or other C.T under the lesion different from myosistis ossificans which results from trauma to the muscle and presents within the bony deposits within the muscle occurs in 16-33% of all its with SCI, usually in 1-4 months after injury TREATMENT- drug therapy and regular exercise during early stage can be effective
Glove and Stocking Anesthesia
Generalized peripheral neuropathy in the distal portions of nerves that degenerate resulting in anesthesia of the distal extremities as if patient wearing long gloves and stockings
phase 2 cardiac rehab goals and activities
Goals 1. I self care 2. improve functional capactiy 3. return to work or homemaking 4. modify lifestyle to decrease risk factors 5. begin low level conditioning activities 1. I self care 2. walk-jog or step aerobics program to tolerance 3. other activities that range between 4-9 METS
graves disease
Graves disease is a hyperthyroid condition causing proximal muscle weakness and a generalized elevation of body metabolism. It has been linked to periarthritis and calcific tendinitis in the shoulder, and sometimes the wrist, but not the knee. It does not cause local joint inflammation.
palpation of the diaphragm
Hands are placed over the anterior chest with the thumbs over the costal margin so the tips of fingers almost meet at the xiphoid process.
Brown-Sequard Syndrome
Hemisection of spinal cord (INCOMPLETE) ipsilateral weakness, motor paralysis, loss of proprioception, vibration, and 2 pt discrimination, decreased reflexes, clonus and spasticity. Contralateral pain and temp loss (spinothalamic tract) below lesion
One day after lumbar laminectomy surgery, a patient refuses to wear a thoracolumbosacral orthosis because of a painful and itching rash that extends in a narrow path from the central low back along the iliac crest to the right lateral trunk. Which of the following conditions is MOST likely present?
Herpes zoster (shingles) is a painful, blistering skin rash caused by the varicella-zoster virus. The first symptom is usually one-sided pain, tingling, or burning followed by development of a rash that usually involves a narrow area from the spine around to the front of the chest or abdomen. A typical location for occurrence of shingles rash is the T11-T12 dermatome along the iliac crest. The location of the rash, postsurgical onset, and symptoms of pain all suggest herpes zoster.
inverted T wave equals
ISCHEMIA
immunnosuppression
Immunosuppression causes leukopenia, which is a white blood cell count less than 4000/mm3.
In sitting, the abdominals
In sitting position, the abdominal contents shift inferiorly and anteriorly in patients who have weak abdominals. This causes the diaphragm to be pulled into a more horizontal position, where its mechanical function is at an extreme disadvantage
genital function post SCI
Injury to the t-l or sacral cord can alter genital and sexual responses. female fertility is unchanged but men are likely to become infertile
increase/excessive toe off would have what effect on shoe observation
Increased/excessive toe off (preswing) would be associated with increased time weight-bearing on the front portion of the sole of the sho
C7 paresthesias
Index, long, and ring fingers
ataxic CP
Indicates lesion involving the cerebellum Weakness, poor coordination, intention tremor may produce unsteadiness, wide base gait and difficulty with rapid or fine movement
lumbar SCI
L1/L2. below these levels the caudal equina is less likely to sustain a complete injury
A patient has a superficial partial-thickness burn. Which of the following signs would MOST likely be observed in the burned area?
Intact blisters are the most common sign of superficial partial-thickness burns. Damage is through the epidermis and into the papillary layer of the dermis.
nystagmus
Involuntary rapid eye movements in horizontal, vertical or rotational directions associated with vestibular, visual and cerebellar disorders.
7-10 METS
Jogging to rapid running, bball, heavy shoveling, viogoriius skiing or cycling.
approximation
Joint compression Indications: stimulate afferent nerve endings and facilitate postural extensors promoting stability
left ventricle receives blood from
LA and pumps blood to the aorta throughout the entire systemic circulation
upper motor neuron lesion as infant or toddler often results in
LE flexor synergy (scissoring gait)
anterior cerebral artery
LE has greater sensorimotor deficits than UE urianry incontience, bowel bladder can result in mental impairments such as confusion, amnesia, apathy or short attention Span
For a patient who is undergoing postural drainage for secretions in the right lateral segment, which of the following positions would be MOST appropriate?
Left sidelying with the lower extremities raised 18 inches (45.7 cm)
Leukocytosis range
Leukocytosis is a total white blood cell count of greater than 11,000-15,000/mm3 (above normal range).
c2 myotome
Longus colli, sternocleidomastoid, rectus capitis
angiotensin 2 receptor blockers
Losartan (Cozaar) block binder of angiotensison 2 at tissue/ smooth muscle to decrease BP
Osteoporosis post SCI
Loss of calcium from bones below the level of the lesion results in increased risk of fractures -treatment- dietary management and early mobility activities to place stress on skeletal system (wolfs law)
lower chest wall excursion measured
Lower chest wall excursion measurements should be taken circumferentially at the midpoint between the xiphoid process and the umbilicus
A patient reports an insidious onset of swelling of 1 month's duration on the dorsum of the left foot. Which of the following conditions is the MOST likely cause?
Lymphedema is usually unilateral with typical presentation distally on the extremity (dorsum of the foot or hand)
spastic CP
MOST COMMON affects UMN with spasticity affex both limbs on side (hemiplegia) both legs, all 4 or intermediate affecting mostly legs (Diplegia) affected limbs have increased DTR, increase muscle tone, abd postures and movements with mass patterns of flexion or extension, weakness and a tendencyy to contraction SCISSORING GAIT/TOE WALKING visual, auditory or cog, or oral-motor deficitds
respiratory complications post SCI
MOST COMMON CAUSE OF DEATH FOLLOWING SCI -inability to cough effectively allows secretions to build in the lungs (decreased forced expiration) -inaequate inhalation and exhalation can reduce the ventilation of the lungs, leading to atelectasis, pneumonia and respiratory insufficiency
Manual lymphatic drainage is CONTRAINDICATED for a patient who has which of the following conditions?
Manual lymph drainage facilitates the removal of fluid from the extremities back into the circulatory system . If the patient has heart failure, the heart will not be able to handle the additional fluid and the heart failure will worsen.
A physical therapist is conducting a research project that synthesizes the results of several studies in a quantitative process. This process represents which of the following research methods?
Meta-analytical research is a process by which the results of several studies are synthesized in a quantitative way (pp. 357-358). This is consistent with the stem.
methodological research
Methodological research is conducted to determine the reliability and validity of clinical and research measurements
spinal puncture
Most commonly performed at l3-l4
neuropathic ulcers
Neuropathic ulcers are typically located in the forefoot area, specifically on the metatarsal heads, toes, or over an area of increased weight-bearing that may be present because of a foot deformity.
non weight bearing with CRPS
Non-weight-bearing gait would promote more swelling due to disuse of the muscle pump
normal diaphragm excursion
Normal excursion of the diaphragm is 1.2 to 2 inches (3 to 5 cm);
abdominal reflex
Normal response is the ipsilateral contraction of the abdominal muscles with an observed deviation of the umbilicus towards the stroke.
obstructive disease
Obstructive=hard to exhale air Asthma Bronchitis COPD CF Dry Cough (sometimes) Emphysema TLC, FRC,RV, PaCO2- increases VC- decreases FEV1-sharp decrease
Erb's palsy
Occurs when C5 and C6 nerve roots are stretched during the birth process The patient has weakness in GH abduction and external rotation, elbow flexion, and supination Classically, the shoulder is adducted and IR, with waiters tip deformity Neutral positioning of arm with gentle ROM exercises may be done early Functionally, in severe cases the child will not be able to use the involved side to hug a doll, drink from a cup, zip up a coat, etc.
rocker bar
Rocker bars affix to the sole of the shoe proximal to the metatarsal heads to reduce the distance the patient travels during stance phase and to shift the load from the metatarsophalangeal joints to the metatarsal shaft
Characteristics of a PVC
PREMATURE BEATING FROM THE VENTRICLE. •There is no P wave prior to the QRS complex •The QRS complex is prolonged and bizarrely-shaped •The T wave is abnormal (if depolarization doesn't follow the normal pathway, repolarization does not).•There is a compensatory pause after the PVC.
lab values for oxygen
PaO2= 75-100 PaCO2= 35-45 FEV1:FVC= 70-80%** **<60% indicates an obstructive disease **>90% indicates a restrictive disease ph- 7.35-7.45 co2 content (bicarbonate) 23-29
Paget disease
Paget disease is a chronic bone condition characterized by disorder of the normal bone remodeling process. The bone that is formed is abnormal, enlarged, brittle, and prone to breakage.
A 13-year-old patient reports moderate knee pain persisting more than 3 weeks, with no trauma noted. The patient exhibits an out-toeing gait pattern, leg length discrepancy, and restriction in medial (internal) rotation of the involved leg. Which of the following test findings would MOST likely be present?
Pain in the groin region with hips flexed 80° to 90° and then medially (internally) rotated with adduction This describes a SCFE
Tarsal Tunnel Syndrome S/S
Pain only with passive ankle eversion, a pronated foot, valgus deformity, and weak toe flexion strength are associated with tarsal tunnel syndrom
Which of the following activities is CONTRAINDICATED for a patient who is 2 weeks post coronary artery bypass surgery?
Patients who are at risk for sternal instability (e.g. following open-heart surgery) demonstrate the greatest separation when pushing up from a chair
Patients who have sustained a complete C7-C8 spinal cord injury should be able to perform transfers
Patients who have sustained a complete C7-C8 spinal cord injury should be able to perform transfers with modified independence and may not need a transfer board. They will be able to perform bed mobility without assistance and wheelchair mobility over most surfaces, including ramps and rough terrain.
pt with glute max weakness would have what gait deviation
Patients who have weakness in the gluteus maximus exhibit a posterior thrust of the trunk at heel strike (initial contact) to help obtain hip extension of the stance leg. They also exhibit an anterior tilt of the pelvis to help maintain posture.
Right Torticollis
Positional contracture in L rotation and R sidebending Treatment: Facilitate R rotation and L sidebending. Caregiver holds the child in R sidelying using their arm to pull upward and give the infants neck a stretch into L lateral flexion. The caregiver can gently bounce the child and walk around with the child. This is a very effective way to facilitate a stretch.
barognosis
Perceive the weight of different objects in the hand
S4 Dermatome
Perineum, genitals, lower sacrum mytome- rectum paresthesia-saddle area, genitals, anus, impotence
lower lobe postural drainage
Prone with the lower extremities raised 18 inches
RLA 8
Purposeful, Appropriate pt acts appropriately though not perfectly. may have some problems in a stressful or unusual environment
purulent drainage
Purulent drainage is thick, often odiferous drainage that contains large amounts of bacteria.
Right ventricle receives blood from the
RA and pumps blood from the PA to the lungs for oxygen
Wernicke's aphasia
RECEPTIVE, fluent- severe disturbance in auditory comprehension. Reading, writing and word recognition are also impaired. good articulation temporal lobe on the left side of the brain
ABi
Ratio of LE pressure divided by the UE 1. pt supine for 5 minutes 2. BP cuff inflated to occlude BF, then deflated (LISTEN FOR RETURN) 3. peroffmred in UE brachial artery and LE posterior tibialis and dorsalis pedis arteries ABI <.50- RISK FOR PROGRESSION TO SEVERE OR critical limb ischemia in 1 year <.90= 2-4x risk for CV events >.15 or significant or >.10 in sympomatic patients
Repeated Contractions (RC)
Repeated isotonic contractions induced by quick stretches and enhanced by resistance performed through the range or part of range at a point of weakness. Indications: weakness, incoordination, muscle imbalances, lack of endurance.
Mesothelioma
Restrictive pattern of impairment with Obstructive features due to small airways diseas
CRPS massage
Retrograde massage is recommended in complex regional pain syndrome; deep friction massage may increase edema
rheumatoid arthritis
Rheumatoid arthritis often presents with general fatigue, weakness, and bilateral symptomatic joints, most often presenting first in the hands and wrists
Which of the following orthoses would be MOST appropriate for a child who has a history of myelomeningocele at the S1 level and has Poor (2/5) gastrocnemius strength?
S1 myelomeningocele would cause weakness in the muscles of the posterior lower leg and tibia, without affecting muscle strength in the hips and knees. Solid ankle-foot orthoses would provide the appropriate support at the foot and ankle
Achilles tendon DTR
S1-S2
mean arterial pressure
SBP and 2x diastolic divided by 3 70-110 normal
accessory nerve
SCM AND traps
digitalis
SLOW heart rate and increase contractility digoxin
RED ZONE FOR HEART FAILURE AND PT
SOB at rests unrelieved chest pain wheezing or chest tight at rest must sleep in chair weight gain or loss of 5 pounds in 3 days IMMEDAITE EMGERGENCY
homonymous hemianopsia
The loss of the right or left half of the field of vision in both eyes. caused by damage to the contalateral optic tract
Which of the following interventions would be MOST appropriate for a child who has Sever disease?
Sever disease is a calcaneal apophysitis and will benefit from stretching to improve flexibility of the gastrocnemius and soleus and use of a heel wedge to decrease the stress and traction of the Achilles insertion.
1st Degree Heart Block
Signal blocked from SA to AV. PR interval is lengthened. Can be caused by a MI or medication. Relatively benign. Typically no medical treatment required at this time.
SCFE signs and symptoms
Signs and symptoms are typically found in adolescent patients (10-16 years old) and include leg shortness, knee pain, and pain when the hip is medially (internally) rotated. Groin pain will be triggered with the anterior impingement test (hips flexed to 80° to 90° and medially [internally] rotated with adduction) if slipped capital femoral epiphysis exists.
Rhythmic Stabilization (RS)
Simultaneous isometric contractions of both agonist and antagonist muscles (co-contraction) performed without relaxation using carful grading of resistance; RS emphasizes rotational stability control. Indications: - Decreased stability in weight bearing and holding - Poor antigravity control - Weakness - Ataxia - Limitations in ROM caused by muscle tightness, painful muscle splinting.
athetosis
Slow, involuntary, writhing, twisting movements usually seen with cerebral palsy
D2 flexion LE
Start - ER, Add, Ext End - IR, Abd, Flex "Lift your foot up, turn and lift your leg up and out"
D2 flexion UE
Start - IR, Add, Ext End - ER, Abd, Flex "Open your hand, turn and lift your arm up and out"
Postural or orthostatic hypotension post SCI
Sudden drop in BP when going from lying to sitting or standing. Dizziness/fainting, falls. (stood up too fast) -lack of muscle tone and loss of sympathetic vasoconstriction causes venous pooling in the periphery due to immobilization of 6-8 weeks, SCI patients commonly have postural hypotension symptoms- dizziness, faintness, imprinting blackout TREATMENT- slow progress to vertical, compressive stockings, abdominal binder
right middle lobe drainage
Supine position with the lower extremities raised 12 inches (30.5 cm) is the preferred position for postural drainage of right middle lobe secretions.
anterior secretions postural drainage
Supine with the lower extremities raised 18 inches (45.7 cm) is the preferred position for postural drainage of anterior segment secretions.
When treating a patient who has transient upbeating nystagmus and left ocular torsion, canalith repositioning maneuvers should be targeted to which of the following structures?
The canalith repositioning maneuver for the left posterior semicircular canal is performed to move free-floating debris in the posterior semicircular canal back into the vestibule, thus resolving the signs and symptoms of nystagmus and dizziness. Debris in the left posterior semicircular canal produces symptoms of transient upbeating nystagmus and/or left ocular torsion.
superficial abdominal reflex.
The examiner uses a pointed object to stroke each quadrant of the abdomen of the supine patient in a triangular fashion around the umbilicus. Absence of the reflex (movement of the skin) indicates an upper motor neuron lesion; unilateral absence indicates a lower motor neuron lesion from T7-L2, depending on where the absence in noted, as a result of segmental innervation.
Which of the following structures provide active compression of the urethra?
The levator ani muscles consist of the pubococcygeus, iliococcygeus, and puborectalis, which actively compress the urethra, vagina, and rectum, thus maintaining continence.
A physical therapist is examining a patient who has a whiplash injury and a mid-cervical spine sprain. To determine the function of the patient's longus colli and longus capitis, which of the following assessments should be included in the examination?
The longus colli and longus capitis are deep neck flexors. The craniocervical flexion test or the deep neck flexor endurance test is included in the examination of these muscles.
A patient exhibits swelling and pain in the medial aspect of the ankle. During examination, the patient demonstrates rearfoot pronation in standing position and inability to perform a heel raise on the affected side. The patient demonstrates forefoot abduction when observed from behind. Which of the following conditions is MOST likely present?
The main function of the tibialis posterior is to plantar flex and invert the foot as well as support the medial arch. The tendon courses under the medial malleolus, causing pain and inflammation in this area when the tendon is dysfunctional. With a heel raise, the tendon becomes stressed due to its actions of plantar flexion and inversion. Finally, a finding of the "too many toes sign," which is the hallmark sign of this diagnosis, is due to forefoot abduction and hindfoot valgus.
mobilizing post ce-sextion
The mobilization described in the stem traces the location of the ascending, transverse, and descending colon and can address intestinal gas pain by promoting motility
s1 dermatome/myotome
The myotome associated with S1 is ankle plantar flexion. The dermatome associated with S1 is along the posterior thigh and lateral foot.
s2 dermatome/myotome
The myotome associated with S2 is knee flexion, and the dermatome associated with S2 is the posterior thigh and medial ankle.
intracranial pressure norm
The normal range of intracranial pressure is 0 to 10 mm Hg for adults and 0 to 5 mm Hg for children younger than age 6 years. High intracranial pressure correlates with low cerebral perfusion pressure. Percussion would be likely to further increase this value.
A patient reports incontinence and a sensation of urgency to urinate with little output. Which of the following interventions is BEST to include in the therapeutic program?
The patient is describing signs of urge incontinence with possible detrusor contractions. Relaxation training is helpful to decrease bladder contractions.
murphy percussion test
The presence of costovertebral tenderness during the Murphy percussion test is a positive sign of renal involvement; however, the test is performed on the back, not the abdomen
wound healing with e-stim
The principle behind wound healing with electrical stimulation is galvanotaxis. he current's polarity introduced into the wound attracts cells that promote healing. Thus, a generator that has polarity must be used. High-voltage pulsed currents are polar currents. The other stimulators are not polar because they have a counter-pulse in the opposite direction that cancels out any polar effects. The negative electrode will attract neutrophils and is used in infected wounds. The positive electrode attracts macrophages and epidermal cells and is used in treating noninfected wound states. The frequency of 100 pps provides a continuous, comfortable current and has been demonstrated to promote healing.
A 43-year-old male patient reports the recent appearance of silver and scaly-appearing plaques on the scalp, elbows, and knees. If left unaddressed, which of the following complications is MOST likely to develop?
The stem describes a patient who recently developed psoriasis, a systemic disease hallmarked by silver scaled papules and plaques in the scalp, elbows, knees, back, and buttocks. It is a systemic disease that can result in erosive arthritis, particularly in the DIP joints of the hands.
Which of the following examination activities is used in testing of the vestibuloocular reflex?
The vestibuloocular reflex keeps the visual environment in focus during rapid head movements The vestibuloocular reflex is essential for gaze stabilization during high-frequency, high-velocity, and high-acceleration head movements.
Which of the following descriptions BEST depicts the Cheyne-Stokes respiratory pattern?
This is a typical Cheyne-Strokes respiratory pattern, which is an irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth and frequency of respirations his breathing pattern is often observed with depression of the cerebral hemisphere (e.g., coma), in basal ganglia disease, and occasionally with congestive heart failure.
Arterial thrombosis ABI score
Thrombosis is an occlusive disease of the arteries. With occlusive diseases, the blood flow to the lower extremity decreases. Decreased blood flow to the lower extremities will result in an ankle-brachial index of less than 1.0.
pulmonary emboli
Thrombus from peripheral venous circulation (usually from LE) lodges into pulmonary artery with subsequent obstruction of blood flow to the lungs signs and symptoms 1. without infarction: tachypnea, anxiety, rales (CackleS) wheezing, and decreased breath sound with infarction- chest pain, hemoptysis, pleural fiction rub, fever, positive chest x ray treatment -low dose heparin analgesics -pulmonary vasodilateral
c8 myotome
Thumb extension and ulnar deviation, finger flexors
Which of the following ankle-foot orthoses is MOST appropriate for a patient who exhibits Trace (1/5) strength of the tibialis anterior muscle?
Trace (1/5) strength in the anterior tibialis indicates the ankle is unable to move into dorsiflexion, resulting in foot drop The posterior leaf spring is designed to help lift the foot for adequate clearance during the swing phase of gait
c3 myotome
Trapezius, splenius capitis
parkinsons treatment
Tx depends if pt is on levodopa or off a.gait training to increase width and length b. breathing ex. c. relaxation tech d. mobility e. PNf (Rhythmic initiation to overcome bradykinesia) f. ROM (contract relax) g. visual or auditory cueing h. dopamine agonist medications to decrease bradykineisa (long term levodopa use sometimes loses effectiveness and or increase dyskenesia)
submaximal ETT
USED TO EVALUATE THE EARLY RECOVERY of patients after MI, coronary bypass or coronary angioplasty
A patient has diplopia, dysphagia, and bilateral weakness of the lower extremities. The patient also has loss of vibratory sense, two-point discrimination, and position sense. There are no signs of personality changes or aphasia. Which of the following arteries is MOST likely affected?
Vertebral (basilar) arteries supply the brainstem and cerebellum. Lesions of these arteries usually manifest as unilateral or bilateral weakness of extremities and loss of vibratory sense, two-point discrimination, and position sense. Diplopia, homonymous hemianopsia, dysphagia, dysarthria, nausea, and confusion may also occur.
Rhythmic Initiation (RI)
Voluntary relaxation followed by passive movement through increasing ROM, followed by active-assisted contractions progressing to resisted isotonic contractions. - Indications: spasticity, rigidity, hypertonicity, inability to initiate motion (apraxia), motor learning deficits, communication deficits (aphasia)
what to use to dx DVT
WELLLLLLLLS CRITERIA
w/c width for door
Wheelchairs require a minimum of 32 to 34 inches (81 to 86 cm) in doorway width and would be unable to go through a door 28 inches
motor plan
an overall strategy for movement; an action sequence requiring the coordination of a number of motor programs
arterial occlusion ABI score
With severe arterial occlusion, the ankle-brachial index will be less than 1.0. An ankle-brachial index of 1.1 or higher is not an indication of arterial occlusion.
BLOOD FLOW AND AGE
With advanced age, functional liver tissue diminishes and hepatic blood flow decreases, not increases.
arterial aneurysm ABI
With arterial aneurysm in the lower extremity, the affected artery is dilated and there is decreased blood flow and ischemia in the limbs. In this case, the ankle-brachial index should be less than 1.0.
weak hip extensors, the trunk would be
With weak hip extensors, the trunk would be displaced posteriorly relative to the lower extremities
A patient receiving physical therapy due to a history of lumbar and thoracic pain reports a new onset of night pain, urinary incontinence, and severe abdominal pain after a recent fall from a roof. Which of the following courses of action is BEST for the physical therapist?
Withholding physical therapy, referring the patient to an emergency department, and contacting the referring physician is the best course of action. The patient's new symptoms of night pain, urinary incontinence, and abdominal pain may indicate the presence of cauda equina syndrome and require medical assessment.
multiple sclerosis
a demyelinating disease of the CNS. signs and symptoms a. sensory disturbances b. coordination problems/spasticity c. fatigue (esp afternoon) d. visual impairments to include diplopia and visual acuity e. bowel and bladder f. communication disorder g. phsychosocial h. adverse reacting to heat treatment a. prevention of secondary problems b. breathing exercise c. exercise to tolerance d. ambulatory or w/c mobility e. regular tone f. manage fatigue DTR INCREASED
aneurysm
a localized abnormal dilation of a blood vessel, usually an artery, caused by weakness of the vessel wall; may eventually burst
motor program
a set of restructured commands, that when initiated results in production of coordinated movement
pt eduction for premature infant
a. teach parents play with shoulders forward b. toys in front encourage reaching c. position of head in midline d. tilt child to encourage balance and head righting e. position prone or side lying f. minimize the use of infant jumpers or walkers, which increase extensor tone
Static Wrist-Hand Orthosis
c1-c5- NO WRIST EXTENSORS MAINTAIN FUNCTIONAL HAND POSITON- THUMB IN ABDUCTIon and supports palm
designation of spinal level
a. Defined as the most caudal level of the spinal cord that exhibits intact sensory and motor functioning b. Muscles must have a grade of at least 3+/5 strength to demonstrate intact innervation c. Sensory areas are well demarcated and are innervated by a single spinal cord segment. d. Complete lesions. Total and permanent functional (sensory and motor) disruption of the spinal cord more than three segments below the level of the lesion.
goals and IV for pain syndromes
a. assist pt in identifying pain behaviors b. teach coping skills c. provide relaxation techniques d. provide direct pain/symptom control e.establish a realist daily exercise program.
phase 3 management of lymphadema
a. continue with CDT b. skin care c. compression, may use bandaging at night d. exercise with compression e. pneumatic compression pumps with caution ----high pressure can damage lymph and may move water instead of proteins
Cause of polyneuropahty
a. endocrine/metabolic b. nutrition (b vitamin deficits) c. GI d. autoimmune e. infexions (HIX, hepatitis b/c) f. heridaty (Charcot marie tooth) g. neoplastic conditions (multiple myeloma) h. medication (Chemo) I: exposure to toxins
sign and symptoms of polyneuropathy
a. glove and stocking sensory loss or pain b. distal extremity weakness/ foot atrophy c. problems with balance and/or falls d. ataxic gait e. fear of falling/mobility f. GI discomfort
Postural profile of Premature Neonate and normal
a. normal neonate symmetrical flexed and abducted posture of UE and LE. b. premature- hyperextended neck and trunk, elevated shoulders, scap retraction, shoulders/hips abducted/extended, APT, decreased midline arm, and decreased WB on toes when place in upright position
treatment for polyneuropathy
a. pain control b. check bottom of feet daily c. exercise d. PT for gait/balance
task specific training
a. practice and repetition of actives toward independence b. promote functional independnece d. tasks that are varied improve motor control e. VC and manual cues provided as needed f. promote problem solving
treatment positions for premature infant
a. stress sidelying and prone with chin tuck, trunk flexed, shoulder protracted ,PPT and flexion of leg (these decrease tonic labyrinthine reflex-enhance flexion now) b. gentle flexion of hips and knees in supine and semisttigin can be used
sputum
a. substance expelled by coughing or clearing the throat b. contain variety of materials form the respiratory tract ( cellular debris, mucus, blood, pus and microorganisms) c. amount, color and conditions can be used for differential dx
myocardial infarction
an ischemic myocardial necrosis usually resulting from abrupt reduction in coronary blood to the heart muscle causes range from atherosclerotic hear t disease from thrombus formation., coronary vasospasm or embolism or cocain toxicity
adventitious breath sends
abdnormal
pulsating mass in supine over abdomen indicated
abdominal aneurysm.
Distention on the costal margin indicates
abnormal finding for the spleen, which is palpated typically below the left costal margin. A positive finding occurs in conditions such as mononucleosis and trauma. This warrants immediate medical attention.
bruit
abnormal sound or murmur of arterial or venous origin- indicating ATHEROSCLEROSIS
metabolic acidosis
acidosis
Neuromuscular junction disorder
acquired or inherited and present with common feature of weakness and fatigue -myastehnia gravis and lambert-eaton myasthenia syndrome are acquired NMJD PT FOCUS ON not over fatiguing the patient
acte Mi and activities
activirty can be increased once the acute MI has stopped (troponin levels peaked) LLIMTIED TO 5 METS or 70% hr MAX FOR 4-6 FOLLOWING
polio and post-polio syndrome
actue poliomyelitis caused by a virus that attacks alpha motor neurons and results in rapid and severe weakness postpolio syndrome typically occurs 1.5 or more after recovery from polio and resulting in a new bout of weakness, muscle fatigue and pain sign/symptoms 1. myalgia b. joint pain. c. variable asymmetrical muscle atrophy with decreased strength d. excessvie fatigue and decreased endurance contribute to loss of function treatment 1. low intensity exercise, NEVER TO FATIGUE 2. use of orthotic devices to improve function 3. work on endurance and energy conservation techniques.
Guillain-Barre Syndrome (GBS)
acute autoimmune polyneuropathic condition that results in rapid loss of myelin in peripheral nerves. signs and symptoms include: LMN affecting cranial and peripheral nerves with predominate feature of acute weakness. b. sensory less (glove/stocking) and paresthesias c. muscle weakness progressed so rapidly that it may not follow distal to proximal pattern d. may produce to full tetraplgia with respiratory failure. e. tachycardia, abdnormalities in cardio function and BP f. recovery is slow ( up to 1 year) with some mild weakness persisting and a 3% mortality rate usually peaks with in 2-4 weeks after onset treatment A. initial tx includes respiratory function, pROM, position to reduce contractures and skin care to prevent breakdown B. when the pt stabilizes ,prevent injury to denervated muscles, avoid overuse and fatigue, begin gentle stretching and initiate movement in a controlled environmnet c. in the lateral recovery phase provide muscle re-education with a moderate ex program and improve CV fitness and teach energy conservation DTR DECREASED
lymphangitis
acute bacterial (often streptococcus) or viral infection that spreads throughout the lymphatic system red streaks are often seen in the skin proximal to the infection site
gout symptoms
acute monoarticular arthritis with redness and swelling. The knee is one of the commonly affected joints. The peak incidence is in the 40-50-year age group, and it predominantly affects men
spasticity from SCI
after spinal shock resolves, reflexes return and progressively become stronger, resulting in spasticity. b) more prevalent with higher lesions and with incomplete lesions c) due to hypertonicity and hyperreflexia, quick stretching of muscles elects exaggerated reflexive responses
pneumothorax
air enters the pleural space, causing the lung to collapse due to loss of negative pressure signs and symptoms 1. decreased or absent breath sounds 2. dry cough 3. local or referred pain 4. tracheal devotion AWAY from affected side 5. hypperesonant and timpani percussion sound treatment 1. chest tube ---pulls air fluid out of the pleural space, resonated negative pressure to fill lung chest PT is a precaution in affected area
COUGH
air forcefully expelled following a deep inhalation and closing of the glottis STIMULATE- compress the trachea just above the sterna notch or HUFF
infant CPR
airway breathing compressions.
antiarthythmic drugs
alter conductivity, restore HR, control arrhythmias and improve CO (lidocaine, dilantin, nor pace, and quinidine, procainamide )
restrictive diseases
alterations in pleura- fibrotic changes within the pulmonary pleura associated with idiopathic pulmaonr y fibrosis, asbestosis, radiation pneumonitis, and oxygen toxicity alterations in chest wall- restriction motion of bony thorax - A.S, arthritis, scoliosis, precuts excavated and chest wall skin burns/ scleroderma alteration in NMS- (decreased muscular strength to expand rib cage (ms, md, Parkinson, SCI, stroke)
slow reversal
alternating isotonic contractions of agonist then antagonist patterns using careful grading of resistance and optimal facilitation in srh, isometric hold is added at the end ROM of weakness.. indications: inability to reverse directions, muscle weakness/imbalance, incoordination, lack of endurance.
tidal volume
amount of air inhaled or exhaled with each breath under resting conditions
residual volume
amount of air that remain in lungs after ERV t
Current density
amount of current per unit of contact area, which is inversely proportional to electrode contact area.
bells palsy
an inflammatory response affecting the facial nerve (CN VII), results in paralysis of the muscles of the facial expression. The branch of CN VII will dictate the symptoms. (15-45 age) maybe secondary to herpes zoster virus -pts may have difficulty in wrinkling forehead, closing eyes tightly and smiling. (can have pt whistle, wink, smile and wrinkle forehead to test) signs and symptoms : loss of control of salivation, one sided muscle weakness, or paralysis, normal sensation. mouth droops and decreased taste to anterior 2/3 of the tongue. treatment: artificial tears or temporary patching to protect cornea b. e-stim to maintain tone and support function of facial muscles c. teach facial muscle exercises d. provide function retraining
infarction
area of necrotic tissue that results from a loss of blood supply to that area
irregular pulse maybe due to
arrhtymias or myocarditis
fugl meyer
assess balance for patents wit hemiplegia max score is 14
ecg
assess cardiac function at rest, during exercise and following exercise
discography
assess damage IV disk
electromyography
assess motor neuron integrity and provides analysis of resting and active contraction of muscle dx and prognosis of Lower motor neuron injury, disease or myopathy
parietal lobe
associated with sensation of touch, kinesthesia, vibration and temperature meaning for objectd
coronary artery disease
atherosclerosis of the coronary arteries that results in ischemia to the myocardium risk factors- age, sex, race, family hx, smoking, HBP, high cholesterol, obesity, inactivity and stress clinical manifestations- ischemia, infarction, sudden death and heart faiulure CLINICAL syndrome- angina pectoris, MI, and heart failure
p wave
atrial depolarization
anti-cholingeric drugs
atropine 1. used with IV for heart block or Brady cardia 2. inhibit acetylcholine at the parasympathetic nerves blocking vagal effects on SA AND AV nodes side effects: palpitations, headaches, restlessness, ataxia, dry mouth, blurred vision
valsalvas maneuver
attempt to forcibly exhale with the glottis, nose, and mouth closed, producing an increased intrathoracic pressure causes intrathoracis pressure and decreased return of blood to the heart
RLA 7
automatic, appropriate can perform auto and appropriately in strutted environments. judgment remains impaired
central vertigo
autonomic symptoms less severe loss of consciousness can occur neurlogical symptoms present: diploia, hem ianposia, weakness, numbness, ataxia, dysarthria Causes: meningitis, migraine, complications of neurologic origin post eat infection, trauma/tumor, cerebeller degeneration, MS
L3 dermatome and myotome
back, upper butt, anterior thigh and knee, medial lower leg PSOAS and quadriceps knee jerk sluggish, full SLR pain medial calf and ankle pareatehsia
5-6 METS
shoveling light soil, walking at 4mph, ice skating , stars or step aerobics, horseback riding, ADLS REQUIRE 5 METS
l1 dermatome
back, over trochanter and groin
Left ventricular failure results
backup of blood into the pulmonary system and decreased cardiac output. Clinical manifestations include dry cough or wheezing, tachycardia, light-headedness, pallor, or cyanosis.
Chorea-type movements are noted during an initial gait assessment of a patient referred to physical therapy following a stroke. This clinical finding is indicative of a lesion in the:
basal ganglia
left upper lob (lingular segments)
bed elevated 16 inches pt on right side and quarter turned left nipple area
right middle lobe
bed elevated 16 inches pt quarter turned with head down on left side right nipple are
upper lobes apical segments
bed flat- pillows at 30 degrees clavicle and top of scapula
st wave
beginning ventricular repolarization
8-9 months
belly crawling, quad creeping side sitting pulls to stand cruises sideways can stand alone printer grasps transfers objects from hand to hand
epidural space
between skull and outer dura mater
CT scan for neuro test
brain or SC looks for vascular maformations, tumor, cyst, herniated disk, hemmorrhag
frontal lobe
brocas area (left) voluntary movement judgment, reasoning
causalgia
burning sensations, which are painful often associated with Complex regional pain syndrome
s2 dermatome
butt, thigh and posterior leg same as s1 except personals
how does SCI occur
can be from physical impingement on the cord or interruption of cords vascular supply
elevation of epinephrine symptoms
can cause an increase in blood pressure, tachycardia, and hyperglycemia. It causes an increase in the sympathetic response ("fight or flight").
3 months
can prop self into POE, coos, chuckles, takes weight with toes curled in supported standing and head elevation to 90 degrees
4 months old
can prop up head and chest for long time (pivot prone) no more head lag with traction LOL rolls prone to side, rolls supine to side optical and labrytthine head righting and ulnar palmar grasp
18-20 months
can walk up and down stairs with assistance ascends stairs with step-to pattern, sits on a small chair, begins to run in a more coordinated way, jumps off bottom step, plays make-believe
c8 SCI
capable of all UE muscles except intrinsics of hand key muscles: extrinsic finger flexors, FCU, FPL/FPB I in living at home may be able to I go up/down with manual w/c may need tubseat, grab bars able to work in a building free of architectural barriers
c5
capable of elbow flexion and supination, shoulder ER, and abduction to 90, limited shoulder flexion key muscles: biceps, brachilia, brachioradilias, deltoid, infraspinatus, rhomboids, and supinator mobile arm supports to assist UE function moderate to min A needed for LE dressing and rolling power W.C with hand controls for community integration and manual w/c with rim projects 200-300 feet indoors driving possible may achieve ischial pressure relief with FW lean but usually dependent need assistance for manual cough technique
t1-t5 SCI
capable of full use of UE, improved trunk control, increase respiratory reserve -key muscle- top intercostals, long muscle of back, intrinsic finger flexors I in all transfers standing table for physiologic standing able to go up curb using wheele w/c sports
t6-t8 SCI
capable of improved trunk control. increased respiratory reserve key muscles: long muscles of back including sacropsinalis and semispinalis I in swing to gait in // bars with B KAFO for short distances supervision with walker and KAFO in home w/c for community
t9-t12 SCI
capable of increased endurance and trunk control key muscles: lower abs, and all intercostals
c4 SCI
capable of respiration and scapular elevation key muscles: diaphragm and trapezius ventilator not need. glossopharyngeal breathing used to cough chin control to adjust w/c limited feeding and ADL may be possible with use of mobile arm support, environment controls, adapted eating equipment, head or mouth stick and other adaptive equipment
c6 SCI
capable of shoulder flexion, extension, IR, and adduction. scapular abduction and upward rotation, forearm pronation, and wrist extension (tenodesis grip) key muscles: ECR, infraspinatus, lats, pec major, S.A, and T.MINOR I with self care with equipemnt I with rolling and unsupported sitting can be a LTG use of manual w/c with projection or friction hand rims for household mobility. may require a power W/C for community locks on casters positioned sideways provide stability in transfers manual cough I can drive with hand controls
anterior root spinal neves
carry motor information away from the CNS (EFFERENT)
Swan-Ganz catheter
catheter inserted into the right side of the heart MEASURE CENTRAL VENOUS PRESSURE, pulmonary artery pressure, and pulmonary capillary wedge pressure.
increase in insulin symptoms
cause a decrease in blood glucose levels, resulting in a hypoglycemic reaction, which includes pallor, increased perspiration, tachycardia, weakness, shakiness, and blurred vision. Fatigue and weight loss are not symptoms of hyperglycemia.
friction rub
caused by rubbing of the pleural surfaces against on another, usually result of inflammation or neoplastic processes may be accompanied by pain during inspiration.
princzmetal angina
caused by vasospasm of coronary arteries in the absence of occlusive disease (variant)
stance phase ankle/foot problems
equinos gait ( heel does not touch ground) spastic or contractures of gastroc-soleus unequal step length due to hammer toes caused by spastic toe flexors
cerebellar disorders
causes: a. stroke b. chronic alcholohism c. hereditary ataxia/frederichs ataxia d. trauma e. developmental: ataxic cerebral palsy signs and symptoms a. impairments in coordination b. weakness/fatigue c/ intention tremor d. ataxic gait e. postural instability/falls tx: a. hand eye coordination b. balance training c. functional strength/stability d. locomotor training e. therapeutic pool f. motor learning strategies/activities
peripheral vertigo
causes: BPPV, meniers, infection, trauma/tumor, metabolic disorders, acute alcohol intoxication - episodic and short duration - autonomic symptoms present - precipitating factor - pallor, sweating - nausea and vomiting - auditory fullness (fullness within the ears) - tinnitus
telencephalpn
cerebrum, hippocampus, basal ganglia and amygdala
challenging somatosensory input
challenging the surface they are standing on
polyneuropathy
char. by demyelination and/or axonal loss of multiple peripheral nerves and corresponding impairments in sensory, motor and autonomic nervous function with the exception of gBs, POLYNERUOPATIC conditions present with distal to proximal progression.
Huntington disease
characterized by degenertion and atrophy of basial ganglia in cerebral cortex movement disorder choleric movements
stage 3 wound
characterized by full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia (deep crater with or without undermining).
atherosclerosis
characterized by thickening of the blood vessel wall from focal accumulation of lipids, platelets, monocytes, plaque and other debris b. part of CAD that results in ischemia to myocardium that can progress to injury and/or death
hypolipidemic drugs
cholestyramine (qeustran) colestipol simvastin (zocor) lovastatin (menacer)
Changes in the level of which hormone are MOST likely to contribute to development of chondromalacia patella in a pregnant woman?
chondromalacia cartilage behind the kneecap, and relaxin causes an increase in tendon and ligament laxity, exacerbating any friction between the patella and the femur
bronchitis
chronic inflammation of the tracheobronchial tree with cough and sputum production lasting at least 3 months for 2 consecutive years signs and sympomts 1. wheezing or rhonici 2. productive mucoid or purulent sputum 3. may have fever treatment 1. bronco pulmonary hygeine 2. positions of relaxation 3. paced breathing 4. endurance exercise 5. patient eeducation about disease and relation to smoking
3-4 METS
cleaning windows, 3MPH, cycling 6mph, archery, golf, fishing, slow stairs, balance and mat actives with mild resistance
serous drainage
clear, watery
mucoid
clear,thick indicative of cystic fibrosis or conditions with a chronic cough
DVT
clot formtation and acute inflammation in a deep vein USE WELLS CRITERIA (>=2- DVT likely . <2 not likely) tender calf tender swelling warmth red
vesibulocochlear nerve
cn8 hearing and balance balance testing hear ticking watch (18-24 inches) weber and rinne test- 512 hz tuning fork
stages of motor learning
cognitive, associative, autonomous
Papillomas and hyperkeratosis
common dermal abnormalities that occur in the presence of chronic lymphedema These dermal changes do not prohibit the use of multilayered compression bandaging.
phase 3 cardiac rehab
community based exercise programs 1. usually at 3-6 months post incident and may last 12 weeks or longer 3. cardiac team supervises the program
adult/CHILDREN CPR
compressions, airway, breathing
expressive aphasia IV
confluent, brocas- phrase questions for simple yes or no responses to avoid confusion
RLA 6
confused, appropriate pt dependent upon external input but can perform consistently. memory improved
RLA 5
confused, inappropriate, non-agitated pt responds to simple commands but not to complex tasks. memory impaired, verbalization is inappropiate
RLA 4
confused-agitated pt in heightened state of activity. behavior is bizarre and nonpurposeful relative to immediate environment. recall and attention span are poor.
primary risk factors for lymphedema
congenital abnormality-hypoplasia, hyperplasia, aplasia
parasympathetic division
conserving energy acetylcholine neurotransmitter
stridor
continuous adventitious sound of inspiration associated with upper airway obstruction
thalamic pain
continuous, intense pain occurring in the contralateral hemiplegic side result of a stroke involving the POSTERIOR CEREBRAL ARTERY
decorticate rigidity
contraction of the flexor muscles of the uE with contraction of the extensor muscles of the LE damage to motor tracts above the red nucleus (midbrain)
limbic system
control of moor and emotion, processing and storage of memory, olfaction, control of appetite and emotional responses to food
vestibuloocular reflex
coordinates head and eye movement to support gaze stabilization
t5-t7
cotal margin
how to calculate heart rate
count QRS complexes in a 6 second strip and multiple by 10. 30 large squares = 6 seconds
dopamine replacement agents
cross the bBB to transport and transform dopamine side effects: arrhtymias, GI distress, orthostatic hypotension, dyskinesias, mood and behavior changes SCHULE PT ONE HOUR AFTER ADMINSTERATION examples: SINEMET or Madopar (Levodopa), symmetry (amantadine)
percussion secretion removal
cupped hands rhythmically to the thorax
ESR
erythrocyte sedimentation rate males <15 females <20 increased inflammation, rhemuatic or pelvic inflammatory disease (RA, SLE, Hodgkins)
metabolic equivalent
estimate the metabolic cost of physical activity 1 met = 3.5 mL of oxygen per KG of body weight per minute at rest- body consumes 200-250 ml of oxygen per minute. EQUALS 1 MET.
Apgar scale
evaluates status of newborn assesses heart rate, respiration, muscle tone, color, and reflex irritably ( 0-2 at birth scale and measure at 1,5,10 and 15 minutes post birth score- 7 or more-normal 5-6- some care (ventilation, stimulation or resuscitation) 4 or less- immediate care
anti spasticity agents
side effects: drowsiness, confusion, headache loresal (baclofen) valium (diazepam)tantrum (dantrolene) zanaflex (tizanidine)
bronchodilators
examples: epinephrine, alupent, ventolin, Proventil relax smooth muscle and open airway lumen to assist in breathing often used prior to exercise to reduce negative effects of asthma
Anticoagulants
examples: heparin and Coumadin (warfarin) increase blood clotting time could result in hemoptysis during percussion and shaking administered to patients with DVT
conduction or associative aphasia
damage to the arcuate fasiciculus (association neural fibers) that connects wernicks and brocas areas. severe impairment with repetition reading intact
aspirin
decrease plater alt aggregation
ischemia
decreased blood flow to the trauma area may be due to chemicals in the body that cause vasoconstriction or thromboses, metabolic dsiturabcnes or elevated pressure due to edema
hypokalemia
decreased concentrations of potassium, may cause arrthymias
corticosteroids
examples: prednison and cortisol decrease edema and inflammation associated with COPD side effects: osteoporosis, muscle wasting, and slow wound healing
Bitemporal hemianopsia
deficit of the temporal or peripheral visual fields caused by injury at the optic chiasm. Tunnel vision
external validity
degree to which the results of a study can be generalized to another situation. In this option, the only change in the procedure is the model of the electrical stimulation machine. External validity should be maximized in this situation.
Ranchos Los Amigos
descriptive scale of responses to stimuli that is useful for communicating or documenting general cognitive and/or behavioral status
patellar-tendon bearing orthosis
designed to lessen the load on the foo
cerebral angiography test for
determine the narrowing or blockage of an artery within the brain
trendelenburg for peripheral vascular circulation
determines competence of communicating veins and saphenous system 1. pt position in supine with legs elevated to 60 (empties venous) 2. tourniquet over proximal thgih to occlude venous flow 3. pt then asked to stand 4. examiner notes whether veins fill in normal pattern should take about 3 0seconds
percussion test
determines competence of greater saphenous vein A. In stadning, palpate one segment of vein while percussing vein approximately 20 cm higher b. if pulse wave is felt by lower hand, then intervening valves are incompetent
exercise tolerance test
determines the physiological responses during measured and graded exercise stress of increasing workloads
nerve conduction studies
determines the speed and amplitude of an action potential along a nerve or muscle fiber nerve compression or damge- velocity and size of the AP will be diminished test- determine if damage has impacted the myelin and/or axons of a peripheral nerve
enzyme elevations
diagnostic of MI in which creatine kinases is elevated due to myocardial damage
respiratory changes after SCI
diaphragm- C3-C5- may need artificial ventilator or phrenic nerve stimulator if damaged b) disruption to intercostals and ab muscles can impair respiration c) following sci, TV and VC are rescued secondary due to respiration muscles
obtunded
difficult to arouse from a somnolent state and is frequently confused when awake.
orthopnea
difficulty breathing except in sitting or standing
dysphagia
difficulty swallowing
percutaneous transluminal coronary angioplasty (PTCA)
dilation of blood vessel using a small ballon receives obstructed BF in acute angina or MI
loss of sensation after SCI can lead to
disco ordination of body movements, vulnerability to trauma and impaired body awareness
alzheimer disease
disease of structural changes in the brain resulting in an irreversible deterioration that progresses from forgetfulness and disorientation to loss of all intellectual functions, total disability, and death
edema in spinal cord
disruption of cell membranes results in abdnormal concentrations of sodium and potassium in the extracellular tissue. this ions causes an increase in osmotic pressure in the damaged area of the spinal cord and creates excessive edema in the area
Stemmer's sign
dorsal skin folds of the toes or fingers are resistant to lifting; indicative of fibrotic changes and lymphedema
ST depression may indicate ischemia if
downsloping 2-3 mm
horners syndrome
drooping of the eyelid (ptosis), constriction of the pupil (mitosis) and lack of sweating of ipsilateral face (anhidrosis) occurs secondary to damage sympathetic tract (ex: cervical sympathetic chain ganglion or associated track in the brain stem)
orthostatic hypotension
drop >20 mmh or if diastolic drops more than 10
nitrates
drugs that primarily dilate blood vessels 1. reduce BP and preload 2. reduce oxygen demand NITROGLYCERIN
Calcium Channel Blockers
drugs that vasodilator and relieve the coronary artery spasm. Could reduce blood flow to the heart muscle creating an ischemic response. dilitazem (cardine, procaccia) , amlopidipine (norvasc)
s2
dub-normal closure of aortic and pulmonary valves, end of systole decreased in arctic stenosis
signs of heart failure
dyspnea and LE edema
descending tracts
efferent motor commands
c7 myotome
elbow extension, wrist flexion
hip strategy
elicited by a greater force, challenge or perturbation thru pelvis and hips. hips will move in opposite direction from head in order to maintain balance. muscles contract in a proximal to distal fashion in order to counteract the loss of balance
stepping strategy
elicited thru unexpected challenges or perturbations during static standing or when the perturbation produces such a movement that the COG is beyond the BOS. LEs step and/or UE reach to regain a new BOS
lymphadenopathy
enlargement of the lymph nodes with or without tenderness typically caused by an infection
partial pressure of oxygen (PAO2)-mild hypoxia if
less than 80mmhg. <60- sever hypoxia
lymphedema
excessive accumulation of fluid due to obstruction of lymphatics, which causes swelling of the soft tissues in arms and legs lymph fluid exceeds the transport capabilities of the vessels
functional residual capacity
expiratory reserve volume + residual volume
best position to palpate the supraspinatus tendon
extension and medial (internal) rotation
crackles (rales)
extra breath sounds discontinuous sounds heard during inspiration could be result of air bubbles in secretion or movement of fibrotic tissues basilar rales often accompany left ventricular CHF
shaking
follows inspiration with a bouncing
lower lobes (posterior basal segments)
foot or table elevated 20 inches pt lies on abdomen head down with pillow under ribs
BALLISMS
form of chorea that includes choleric jerks of large amplitudes
lead pipe rigidity
form of rigidity where there is uniform and constant resistance to ROM, often associated with lesions of basal ganglia
tilting child backward will facilitate
forward righting reaction and abdominals increase extensor tone- use a tilt in space w/c to maintain hip flexion at 90 degrees
stance phase trunk/pelvic problems (forward trunk)
forward trunk from weak hip extension or flexor contractors
phase 2 cardiac Exercise guidelines
frequency 3-4 sessions a week duration 30-60 minutes with 5-10 cool down/warm up discharge at 9 METS functional capacity
Film Dressings: Indications
friction reduction
stage 4 pressure injuries
full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon or joint capsule).
Frederic's ataxia
gene mutation gait unsteadiness followed by UE ataxia, dysarthria and paresis reflexes, vibration and proprioception impaired
RLA 2
generalized response, pt reacts inconsistently and nonspecifically to stimuli
right coronary artery blockage
generally supplies the RA/RV/AV/SA/ interventricula septum and inferior wall of LV blockage could result in arrhythmia
Duchenne muscular dystrophy
genetic disease that affects males and causes destruction of muscle cells progressive weakness PROXIMAL TO DISTAL presenting in boys 3-7 waddling gait, toe walking, lordosis, frequent falls, gowers sign, problems with stair climbing contracutres in heel cords and tfl KYPHOSCOLOIOS AFTER AGE 111
diabetes goals
less than HGA1C 7%
cystic fibrosis
genetic inherited, thickening of secretions of all exocrine glands, leading to obstruction may be obstructive, restrictive or both signs and symptoms 1. frequent respiratory infection, escpially staphylococcus aureus and pseudomonas aeruginosa 2. inability ot gain weight 3. positive sweat electrolyte test 4. rales, wheezing 5. productive large amount of mucoid or purlurent sputum 6. may have hemoptysis treatment 1. percussion, vibration, shaking, postural drainage 2. suction if severe 3. endurance exercise
conduction or associative aphasia IV
give pt time to correct or repeat a phrase. allowing them to write down words or sentences they hear often helps with repetition.
Insulin promotes
glucose uptake by target cells; glucose storage; protein synthesis
phase 3 cardiac goals and activities
goals 1. continued recovery 2. individual exercise training 3. promote long term fitness 4. life long commitment to decrease rf activities 1. MUST FUNCTION AT 5 METS TO BEGIN 2. aerobic exercises involving large muscle groups 3. low level resistance exercise
donning order
gown then face mask or respirator then goggles or face shield then gloves.
Which of the following automatic postural responses will a patient MOST likely use to maintain equilibrium following a small perturbation on a stable surface from a posterior to anterior direction?
he ankle strategy is appropriate for small perturbations on a stable surface (Umphred). Small perturbations forward (posterior to anterior) would create a backward weight-shift, then a return to midline in response
recommended ramp size for w/c
he recommended ramp length is 12 inches (30 cm) for each inch (2.5 cm) of rise (p. 324).
Postural drainage for the posterior segments of the lower lobes would be CONTRAINDICATED for which of the following patients?
head trauma
heart failure
heart unable to adequately pump blood to maintain circulation
flexor synergy LE
hip flexion(STRONGEST) /abduction/external rotation knee flexion ankle dorsiflexion/inversion toe extension
4 years
hops on one foot several times, climbs, throws a ball overhead, stand on tiptoes, and realtes to friends
4-5 mets
house painting, walking at 3.5, cycle at 8mph, raking leave, dancing lightly, seated with 10-15 pounds
A patient has a granular ulcer that is non-draining. Which of the following types of dressing would be MOSTappropriate for the patient?
hydrogel- Hydrogel dressings provide hydration to dry wound beds and are appropriate for a granular wound that is not draining
what are some common adverse effects that patients taking nitrates, directs, beta-blockers of calcium antagonists might experience
hypotension and dizziness ALL THESE MEDCIATIONS LOWER BLOOD PRESSURE
psoriasis hallmark
silver scaled papules and plaques in the scalp, elbows, knees, back, and buttocks. It is a systemic disease that can result in erosive arthritis, particularly in the DIP joints of the hands.
kinesthesia
identify direction and extent of movement
A Stemmer sign is positive
if the skin on the dorsum of the toes and fingers cannot be lifted, or is difficult to lift, compared to the opposite side. Presence of a Stemmer sign is considered to accurately diagnose the presence of lymphedema Therefore, presence of a Stemmer sign, in the absence of peripheral arterial disease, would indicate that multilayered compression bandaging may be beneficial
aphasia
impairments of language that results in errors in word choice, comprehension or syntax
apraxia
inability to perform movements previously learned even though these is no loss of strength, coordination, sensation or comprehension.
Dysdiadochokinesia
inability to perform rapid alternating movements ASSOCIATED WITH CEREBELLAR DISORDERS
Prosopagnosia
inability to recognize faces
hip swing phase problems
inadequate flexion from weak hip flexors, poor proprioception ,spastic quads, hip abductor weakness of opposite side exaggerated hip flexion due to flexor synergy
knee problems during swing phase
inadequate knee flexion- spastic quads or reduced hip flexion inadequate knee extension at weight acceptance due to spastic hamsstinrg or flexor pattern
sacral sparing
incomplete lesion where most centrally located sacral tracts are spared perianal sensation, rectal sphincter contraction ,cutaneous innervervation in the saddle area and active contractions on of the sacrally innerverated toe flexors are intact
hydrocephalus
increase in CSF within the brain due to poor resorption or obscruption of flow or excessive CSF. production signs - enlarged head, bulging fontanelle, headache, change in vision, large veins, seizures,
hyperventialtion
increased inspiration and expiration of air as a result of an increase in rate and/ordepth of respiration results in respiratory alkalosis (carbon dioxide depletion)- symptoms (fall in bP, vasoconstriction, anxiety and wrist cramping) treatment- have patient breathe into a paper bag until the CO2 content of the blood returns to normal calm and reassure the patient
hypermagnesemia
increased magnesium is a calcium channel blocker which can lead to arrhythmias or cardiac arrest
asthma
increased reactivity of the trachea and bronchi to various stimuli causing widespread narrowing of the airways due to inflammation, smooth muscle constriction and increased secretions 1. wheezing cough 2. dry or productive mucoid sputum 3. anxiety with severe bronchospasm may restrict airflow that no wheezing is heard 4. chest wall symmetrically decreased treatmnet 1. use bronchodialtores 2. decreased activity in bad environments 3. oral or IV steroids, neubilizar or inhaler
premature infant defined as
infant born before completing 37 weeks of gestation categorized by birth weight
tuberculosis
infection spread by aerosolized droplets from an untreated infected host. After 2 weeks, medications renders the host noninfectious. increased incited of TB in population of HIV WEAK A MASK s and s 1- slight non p cough 2. hemptoysis 3. low grade fever 4. dyspnea 5. chest wall pain 6. possible x ray changes treatment eliminate infection isiolation to reduce spread
meningitis
inflammation of the meningitis acute- medical emergency -fever, he ache, vomitting stiff and painfulneck pain in lumbar area and posterior thigh brudzinski sign (flexion neck=flexion of hip and knees) kernigs sign( pain with hip flexion combined with knee extensiion) gold standard- lumbar puncture
myopathy
inherited or acquired -inherited myopathies are like muscular dystrophies acquired- inflammatory (dermatomyositis,polymyosistis), infection myopathy (HIV), toxic, and system disease (ex: thyroid and parathyroid) MYOPATHY PRESENT WITH PROXIMAL WEAKENSS TX- don't overwork involved muscles
ACE inhibitor
inhibirors angiotnesion 1-2 decrease NA rentention and peripheral vasoconstriction- DECREASE BP examples- captopil (Capoten) enalopril (vasotec), lisinopril (zestril)
diuretics
inhibits chloride and sodium reabsorption in the kidney, which in turn reduces water reabsorption and increases urine volume- DECREASES VASCULAR RESISTANCE furosemide(lasix) and hydrocaholorothiazide (esdirix), digoxin, posassium sparing direutics (aldactone, dyrenium and midamor)
Cauda equina injury
injuries that occur below the L1 level of the spine. A cauda equina injury is considered to be a lower motor neuron lesion. sensory loss, paralys, loss of bowel and bladder damage to peripheral nerve roots, regeneration may be possible
metatarsus adducts
intrauterine "packaging" deformity. The hindfoot is in valgus, and the forefoot is in varus.
Decerabrate rigidity
involuntary contractions to the extensor muscles of the upper and lower extremities. INJURY in the brainstem above the vestibular nucleus and below the red nucleus
hold-relax
isometric contraction of the antagonistic pattern against slowly increasing resistance, followed by voluntary relaxation and passive movement into the newly gained range of the agonist pattern; indications: limitation in ROM due to muscle tightness, spasm, or pain
contract-relax
isotonic movement in rotation followed by an isometric hold of the range limiting muscles in the antagonist pattern against slowly increasing resistance, then passive motion and active contraction of the agonistic pattern; Indications: limited ROM caused by muscle tightness or spasticity
2-3 METS
keyboarding, level walking at 2 mph, bicycling at 5 mph, light woodworking, instrument, active exercises standing or light mat activities, light weights 2-3 pounds
somatagnosia
lack of awareness of the relationship of one's own body parts or the body parts of others
S1 Dermatome, myotome, reflex
lateral and plantar foot hamstring, gluteals, peroneals, plantar relfex
c7 dermatome
lateral arm and forearm to index, long, and ring fingers
supine pulmonary
lateral diameter INCREASE diaphragm moves toward head, increasing abdominal pressure FRC is less than upright or prone
varus foot
lateral side makes contact first, weak peroneals or spastic anterior tib
arotic valve prevents
left back flow
spleen referrall
left upper quadrant or shoulder
lower motor neuron lesion
lesion affects nerves or their axons at or below the level of brainstem fascinations, weakness, atrophy, decreased DTR
upper motor diseases
lesion found in the descending motor tracts within the CNS. 1. hyperactive reflexes 2. spastiity 3. clonus/babinski
2 months
lift head 45 in prone, head lags on traction reflex, begin prone on elbow with elbows behind shoulders, head bobs in supported sitting.
. Patients who have sustained a complete C6 spinal cord injury should be able to perform
likely to be able to perform bed mobility independently with assistance needed only for leg management at times. Manual wheelchair mobility will be possible over level surfaces, but assistance will be required over unlevel surfaces such as rough terrain and curbs.
ascultation
listening to the respiration fro breath sounds using a stethoscope
C8 paresthesias
little finger alone or with two adjacent fingers; not ring or long fingers, alone or together (C7)
A patient who has right shoulder pain exhibits bruising, palmar erythema, and signs of confusion. Which of the following organs is MOST likely involved?
liver
RLA 3
localized response, pt reacts inconsistently but specifically to stimuli
dementia
loss of memory or intellectual functioning -may be reversible if caused by toxins, drugs, metabolic or physchiartic disorders -often slowly progressive and non reversible with alcoholism, alheizmers, infarction and Parkinson's disease
low stroke volume pulse
low stroke volume weak, thready pulse
hypotonicity
low tone (risk of sublux/dislocation) must protect joints with spinting/ positioing hypoactive reflexes and shallow breathing patterns treatment- avoid joint hyperextension, work for joint compression and facilitation to help normalize tone use resistance of function muscles and isometric holding to increase activation of inactive muscles facilitation techniques- quick stretch, tapping, high frequency vibration, light touch, quick icing, fast spinning, joint approximation
suspensory statergy
lower COG during standing or balance to control COG
S1
lub- normal closure of mitral and tricuspid valve, beginning of systole decreased in first degree heart block
lymph travels from
lymphatic capillaries to lympahtic vessels to large lymphatic ducts to the subclavian veins
7 months
maintain quadruped, pivots on belly pivot prone assumes sitting from quadruped trunk rotation I sitting recognizes voices
DGI (Dynamic Gait Index)
max score - 24 risk for falls- <19
Tinetti Falls Efficacy Scale
max score- 0-100 (higher the score, less balance confidence risk for fall >80
Functional Gait Assessment
max score- 30 risk for falls <20
Tinetti Performance Oriented Mobility Assessment
max score- 32 risk for falls- <20
berg scores
max score- 56 risk for falls- 45 or less
ABC (Activities-Specific Balance Confidence Scale)
max- 100 risk for falls- < 67
t1 dermatome and myotome
medial side of the forearm to base of the little finger
t2 dermatome
medial side of upper arm to medial elbow, pectoral and midscapular areas
chylous drainage
milky, white drainage that occurs after abdominal surgeries where there is trauma to the cisterna chyli or adjacent lymphatic trunks.
contraindicated lymphadema exercise
strenough activités, jogging, ballistic movements and rotational movements
cholinergic acids
mimic acetytlocholine and bind directly to the cholinergic receptor to active and create a response at the cellular level indications: glaucoma, démenta, myasthenia graves side effects: impaired vision, GI distraction, bronchoconstriction, parasympathetic responses cognex, tension, prostigmin, pilocarpine, duvoid
contraindicated modalities for lymphadema
modalities that cause vasodilation or increase lymph load (NO ICE, HEAT, HYDROTHERAPY,SAUNA, PARAFIIN) NO E MODALITIES OVER 30 Hx
mixed form cp
more likely spastic and athetosis
Pancreatic Referred Pain
more likely to refer to left not right shoulder
filariasis
mosquito borne illness and most common outside US
myasthenia gravis
most common NMJD and impairs post synaptic transmission secondary to antibodies blocking and ultimately destroying nicotinic acetylcholine receptors (prevents muscle contraction) signs/symptoms- ocular is affected first ptosis and dipoplia secondary to ocular muscle weakness, difficulty swallowing and phonation (bulbar weakness), EXTREME fatigue and proximal greater than distal weakness. DTR- NORMAL CN Eyes Proximal Respiratory
middle cerebral artery stroke
most common involved in stroke contralateral hemiplegia with sensory and motor deficits in the face and UE >LE contralateral homonymous hemianopsia infarfaction in the left hemisphere will often produce aphasia right ( non dominant) hemi- perceptual deficits occlusion of the main stem of the MCA- global aphasia
BPPV- most common canal
most commonly affects the POSTERIOR SEMICIRCULAR CANAL
central cord
most commonly from hyperextension injuries with minor trauma to c-spine results in damage to the central aspect of the spinal cord affecting the UE sensation and motor functioning with normal LE functioning bilateral loss of pain.temp, and UE motor loss below level of lesion
a wound that is deep, regularly shaped and dry
most likely an arterial wound Compression therapy is contraindicated for management of edema in the presence of peripheral arterial disease
cervical SCI
most often to c5/c7 flexion, vertical load, extension, accompanied by rotation or lateral flexion are motions most likely to cause cervical spine injuries
diabetic neuropathy
nerve damage from microvascular disease with effects of hyperglycemia on neurons symmetrical neuropahty signs and symptoms 1. weakness and sensory in symmetrical pattern 2. numb, tingling and pain GLOE ADN STOCKING o.h, URIANRY IMPRIAMENTS
neuropathic pain syndrome
results of lesions in some part of nervous system --usually with some degrees of sensory deficiit -thalmci pain -CRPS -neuralgia (nerve pain) -radiculaglia (nerve root causing pain) -heperes zoster (shingles) -phantom limb
RLA 1
no response, completely unresponsive to stimuli
DETERMINE PULSE RATE
normal heart rate adults- 70bpm (60-100) pediartic-120 bpm tachycardia >100 bradycardia <60
VC, FEV1, FEV1/FVC
normal- vc- >80%, FEV1 >80% FEV1/FVC >70 mild 66-80, 66-80, 60-70 moderate 50-65, 50-65, 45-59 severe <50 and <45
central nystagmus
not inhibited by visual fixation on a n object bidirecitonal or unidriectional mild vertigo can be chronic demyelination of nerves, vascular lesion, cancer/tumor
incomplete lesions
not totally disrupted at the level of injury 1. preservation of some sensory or motor function more than 3 segments below the lesion 2. ascending and descending tracts are undamaged and resulting function is called sparing
Glasgow Coma Scale
objective way to describe pt level of consciousness a. eye opening, spontaneous to none (4) b. best motor response. (follows commands to abnormal response to no response) (6) c. verbal response. oriented to inappropriate to no response (5) 8 or less is indicative of a severe brain injury
ischemia
obstruction of circulation that results in temporary deficiency of blood to supplied to certain area of heart usually with angina
Klumpke's palsy
occurs when c8 and T1 are stretched during birth results- weakness of wrist flexors, finger flexors, hand/thumb, and finger intrinsic muscle claw hand- commom
decubitus ulcers post SCI
often at sacrum, heels, greater trochanter, and ischium other areas include scapula, elbows, ASIS, knees and malleoli pressure relief should take place 3-4x per hour or every 15-20 minutes
vertebral-basil artery
often results in death from edema if patient survives and lesion impacts the pons, then could cause quadripareiss and bulbar palsy or locked in syndrome (patient can only communicate with eye blinking) often vertebral artery sympotoms- vertigo, diplopia, nausea, dysphagia, ataxia and cranial nerve impairments locked in,
huffing
open glottis cough quick exhalation occur after max inspiration
Clonus
rhythmic involuntary oscillations of a muscle and joint in response to a sudden stretch in its with UPPER MOTOR NEURON DISEASE tested at ankles, wrists, jaw
phase 2 cardiac rehab
outpatient or HEP (subacute) 1. early at home or outpatient management for up to 3 months following d/c. ---begins 1-2 weeks after infarct or surgery 2. gradual increases of Intensity of activities
arteries transfer
oxygenated blood from high pressure areas to lower pressure areas
left atrium receives
oxygenated blood from the lungs and the four pulmonary veins
Which of the following clinical manifestations MOST indicates the onset of hypoglycemia?
pallor also, tachycardia shallow breathing
peripheral pulses
palpated peripheral pulses for 30 seconds with regular rhythm and 1-2 minutes with irregular rhythm RADIAL PULSE MOST COMMON FOR HR
primary effects of SCI
paralysis of voluntary motor control occurs from damage to the descending motor tracts, anterior horn cells, or spinal nerves
cardiac catherization
passage of a tiny tube from brachial or femoral artery through aorta into the blood vessels asses EF, anatomy of heart and function
ejection fraction
percentage of blood emptied from the ventricle during systole CLINICALLY SUEFUL TO MEASURE lv
Hematocrit
percentage of blood volume occupied by red blood cells male- 40-54% female 37-47% newborn 50-62%
carpal tunnel cydnrome
peripheral entrapment of the median nerve normal pressure 2-10 mmhg, with CTS can have >30mmhg which can promote ischemia
emphysema
permeant abnormal enlargement and destruction of air spaces distal to terminal bronchioles (may happen after smoking with chronic cough and sputum production) signs and sympomts 1. barrel chest 2. use of accessory msucles 3. decreased breath sounds 4. dyspnea treatment 1. pursed lip breathing during expiration 2. education 3. endurance exercise
Charcot marie tooth
peroneal muscular atrophy heredity disorder of the fibular and distal leg muscles. 1.- loss of myelin 2- loss of axons foot drop and stork leg- problems orthotic devices to help the equinovarus can be helpful.
ankle foot during swing phase
persistent equinovarus from PF contracture, weak DF,delayed contraction on of DF varus position of foot due to spastic T.A, weak peroneals and toe extensors exaggerated DF- flexor synergy
myofasicla pain syndrome
persistent, deep aching pains in muscle nonarticular in origin char by well-defined, highly snesitive tender spots
ideomotor apraxia
person can't do a task on command but can do it spontaneously
ideational apraxia
person no longer gets the idea how to do a routine task ( wash hands/brush teeth)
respiratory acidosis
ph decreased tacos increased
metabolic alkalosis
ph increased
respiratory alkalosis
ph increased co2- decreased
hammer toe
pip is flexed and DIP extended using a high toe box to relieve pressure
AV node
right atrium and right ventricle intrinsic firing of 40-60 beats
pulmonary valve prevents
right back flow
pleural effusion asculataion sound
pleural effusion, voice sounds will not be present over the effusion since the lung tissue is deflated. Voice sounds may be increased immediately above the line of the fluid of the effusion,
pneumothorax auscultation sound
pneumothorax, voice sounds will decrease since the lung is collapsed and will not allow transmission of sounds.
damage to cotricipsianl tract results in
positive babinski , abnormal reflex ,creamsteric reflex, and loss of motor or skilled voluntary movements
Kidney referred pain
posterior subcostal region Associated symptoms include blood in the urine and fever/chills
premature ventricular contractions
premature beat arising from the ventricle if during exercise, SERIOUS WHEN THERE ARE 3-5 CONSECUTIVE PVC per minute, PVC in pairs or PVS are multifocal
sympathetic nervous system
prepares the body for emergency response: norepinephrine neurotransmitter
Diverticulosis
presents with diverticula in the wall of the colon or small intestine, but no infection or inflammation.
stage 2 wound
pressure injuries are characterized by partial-thickness skin loss involving the epidermis, dermis, or both (e.g., abrasion, blister, or shallow crater).
wheel chair cushion pressure relief
pressure relief needs to occur 3-4x an hour
temporal lobe
primary auditory processing and olfaction wernickes area
parkinsons disease
progressive disease affecting the substantial nigra of the basal ganglia resulting in a decrease in dopamine production and/or receptors. signs and sensory 1.resting tremor 2. akinesia/bradykinesia 3. rigidity 4. postural instability festinating or slow shuffling gait flexed posture masked like face decreased postural reflexes behavior changes (memory loss, apathy, decubitus ulcers, atrophy, contractures, decreased VC, and falls)
HDL
promote the removal of cholesterol by liver 1. mod exercise- increase HDL 2. LDL/HDL- important for reducing risk of heart disease
lipoproteins
proteins that carry fat in blood for delivery to the cells
coma
pt can't be aroused
stupor
pt only responds to strong, noxious stimuli and returns to unconscious state when stimulation is stopped
Lower Lobes Superior Segments
pt prone, 2 pillows under hips
upper lobe posterior
pt sitting leaning over pillow at 30 degrees upper back
upper lobes anterior
pt supine with pillow under knees over clavicle and nipples
high frequency chest wall oscillation
pt wears a vest that fills with air and then rapidly increases or decreases pressure frequency is set to 12-16 hertz.
levator ani muscles
pubococcygeus, iliococcygeus, puborectalis
fothy sputum
pulmonary edema
Decrease Dyspnea and increase efficiency
pursed lip breathing, pace of breathing and diaphgramn breathing
herpes zoster
shingles painful inflammation of the posterior root ganglion caused by a virus, resulting in formation of vesicles (fluid filled sacs) along the course of the nerve (dermatome)
arterial oxygen saturation
ratio of amount of oxygen present in a known volume of blood to the amount of oxygen that could be carried by that volume of blood measure with pulse oximeter if under 88% then indicative of poor gas exchange and need supplemental o2 corresponded to PAO2 of 58 mmh, assuming the arterial ph is normal supplemental oxygen needs a MD PERSCRIPTION
Duty cycle refers
ratio of on time to the sum of on time plus off time, expressed as a percentage. It characterizes the interrupted cycle of stimulation; this allows for relaxation between stimulation and assists with comfort during stimulation.
3 years
reciprocally down rides tricycle catch ball jumps 2 feet
evoked potentials
records the time it takes for impulse to reach brain
Antiepileptic drugs
reduce or eliminate seizure activity within the brain barbiturates, benzodiazepines, carboxylic acids, hyantoinds, side effects: ataxia, skin issues, behaviors, GI distress, headache blurred vision klonopin, dilantin, tegretol, neuron tin
LEFT HEART FAILURE
reduced CO with blood not being adequate pumped into the systemic circulation due to the inability to the left ventricle to pump undue tachycardia, intolerance to cold, increased pulmonary artery pressure and pulmonary edema with doe, orthopnea, fatigue
ventilation
refers to the movement of air exchanged in the pulmonary system .
orthoptopic
removing diseasd heart and replacing it with donor
anterior cord
results from trauma to anterior cord or damage to the anterior spinal artery usually related to flexion injuries in the cervical region char. by loss of motor function and loss of pain/temperature below the level of the lesion
Tracheal deviation
results from unequal intrathoracic pressure within the chest cavity. Most commonly associated with traumatic pneumothorax. shifts away- Spontaneous Pneumothorax Pleural effusion Large mass ** If pressure increases on one side of chest cavity, the mediastinum will shift towards the opposite side.
superior cerebellar
results in severe ataxia, dysarthria, dysmetria, and contralateral pain/temperature
manterior inferior cerebrellar
results in unilateral deafness, loss of pain and temperature on the contralateral side, paresis of lateral gaze, unilateral horners syndrome (ptosis, constriction of pupil and loss of sweating of ipsilateral face) plus ataxia, vertigo and nystagmus
bounding, full pulse
shortened ventricular systole and decreased peripheral pressure
gallbladder referrall
right sub scapular pain
liver referral
right upper quadrant
congestive heart failure
right- peripheral edema left- pulmonary edema SEVERE- widespread edema
primary measure of mI on labs
rise and fall of troponin elevated CPK CK-mb(PEAKS BETWEEN 12-24)
Functional Reach score
risk for falls <18 cm
5 Times Sit to Stand Test
risk for falls >12
10 Meter Walk Test
risk for falls- < 0.4 m/s lhousehold ambulators 0.4 - 0.8 m/s limited community
Four Step Square Test
risk for falls- >12-15
tug scores
risk of falls- >12-15
5 month old
roll from prone to supine, head control in supported sitting and wieghtshifntin from one arm to other in prone
6 months
rolls supine to prone I in sitting pulls to standing POE with elbows extending with WS
2 years
runs well, reciprocal stairs up
A meta-analysis
s an aggregation of raw data from multiple studies to increase the sample size and generate a conclusion based on a larger subject population
dependent edema
s one of the early signs of right-sided heart failure. The edema is usually symmetric and occurs in the feet and ankles
hypermetria
seen in cerebellar dysfunction in which individuals past point or move beyond a specific target (past pointing)
Feedforward
sending of afferent signals in advance of movement to ready the system; anticipatory responses in postural activity
anterior horn cell pathology
sensory component intact motor weakness and atrophy fasiculations decreased DTRs Examples: ALS, poliomyelitis
traction
separation of joint surfaces indication: facilitates flexor muscles, mobilizing patterns
A patient has a Foley catheter, diabetes mellitus, a decline in appetite and fluid intake, confusion, and an oral temperature of 101°F (38.3°C). The signs and symptoms are MOST consistent with which of the following diagnoses?
sepsis
A patient with a medical diagnosis of second-degree uterine prolapse is referred to a physical therapist for exercise. For the therapist to evaluate this case fully, questions about which of the following patient functional activities are MOST important to ask?
sexual activity
visual acuity
sharpness of vision can occur with diabetes
6-7 mets
shoveling 10 pounds, cycling 11 mph,
1-2 MET activities
sitting, self feeding, reaching , AROM or AAROM of limbs exercise in supine, standing, walking at 1mph
Metabolic Equivalencies (METs) for ADLs
sitting- about 1.5-2 Food and drink prep, presentation, and clean-up- 2.32 walking to/from house and worksite 2.50 walking 3.0mph- 3 Playing a Sport 5.10 aerobics- 6.83
5 years
skips, kicks a ball well, dresses and undresses self
agonist reversals
slow isotonic shortening contraction through the range followed by eccentric lengthening contraction with the same muscle group; indications: weak postural muscles, inability to eccentrically control body weight during movement transitions(sitting down)
lymph node palpation types
soft mvoemeblae and non tender-normal soft,tender lymph, move easily- inflammation or infection hard, immobile lymph nodes- metazoic cancer
upper motor neuron signs
spastic paralysis with hyperreflexia, increased muscle tone, positive Babinski sign, clonus
hypertonicity
spastic, high tone with hyperactive reflexes and decreased thoracic mobility risk of contractors and deformity treatment- work to inhibit (prolonged muscle stretching, casting, slow rocking/rolling, very low frequency vibration, reflex inhibtigin postures, rotation, slow stroke, warmth, prolonged icing, deep pressure) Reciprocal inhibitor
myelomeningocele
spina bifida a defect in the vertebrae resulting in protrusion of the spinal cord and meninges -after surgical closure, hydrocephalus may become a problem and require shunting of the cerebrospinal fluid to decrease Intracranial pressure functional problems: strength, hip flexor, adductor tightness, club foot or talipes equinovaus, bowel/bladder, sensory loss, low tone, poor head control, developmental dlay
Pneumococcal pneumonia
sputum that is most often pinkish, blood-flecked, or rusty and will show evidence of bacteria when cultured. Treatment is centered on antibiotics. Oxygen can be administered, but bronchodilators are not a treatment of choice.
10-15 months
stands and begins to walk unassisted, begins self-feeding, searches for hidden toys, plays patty-cake and peek-a boo, imitates, reaches with supination, neat pincer grasp with release
refereed pain
starts in deep visceral tissues and is felt in a body region remote from the side of the pathology
D1 Flexion UE
starts with GH IR, abduction and extension and ends up GH ER, adduction and flexion
dix hallpike test
stimulates the posterior semicuicular canal
grasp reflex
stimulus - pressure to palm of hand or ball of the foot under toes response - finger flexion or toes onset: palmar at birth, plantar at 28 weeks of gestation integrated: palmar 4-6 months, plantar 9 months
optical and labyrinth righting reflexes
stimulus: alter body position by tipping body in all directions. For labyrinthine, vision is occluded. response: head orients to vertical posit and mouth horixzontal onset- birth-2 months integrated- persists
postive supporting reaction
stimulus: contact to the ball of the foot in an upright standing position response: rigid extension (cocontraction) of the LE with ankle PF and invention, toe clawing and hip IR variations a. pt with cp, ADDUCTOR SPASM B. hemiplegia- may have hip abduction c. ambulation will be disrupted by inability to DF foot or properly move the leg joints onset- birth integrated- 6 months
rooting reflex
stimulus: side of face is stimulated with light touch response: infant turns head toward side of stimulation and opens the mouth onset: present in premature infants integrated: 3 months
moro reflex
stimulus: sudden change in position of the head in relation to the trunk (drop pt BW) response: extension and abd of UE with hand opening and crying. Followed by flex, add and arms across chest onset: 28 weeks gestation integrated 5-6 months
diastasic rectus treatment
strengthening exercises, not soft tissue mobilization
chorea
sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face seen in HUNTINGTONS DISEASE
venous ulcer presentation
superficial, irregularly shaped, highly exudative wound . Compression therapy is considered one of the most important therapeutic measures for prevention and treatment of venous leg ulcers
coronary circulation
supplied blood to the heart
left coronary artery supples and blockage leads to
supplies anterior, super, lateral walls of the LV and interventricular septum blockage causes LVF which leads to pulmonary edema
Lipedema presentation
symmetrical swelling of both legs, extending from hips to ankles. Lipedema onset is primarily proximal to distal.
Debris in the left posterior semicircular canal
symptoms of transient upbeating nystagmus and/or left ocular torsion.
right atrium receives blood from
systemic circulation from the SVC and IVC
Reiter syndrome
systemic disease that can cause pain in multiple joints; however, it is usually asymmetric, occurs after an infection, and presents over several weeks (
Glossopharyngeal breasting
technique used with high level quadriplegia in which there is an aggressive use of the tongue, pharyngeal and laryngeal structures as a respiratory pump to gulp air and increase vital capacity
delerium
temporary confusion and loss of mental function often reversible often with illness, drug toxicity, or lack of oxygen
epilepsy
temporary dysfunction of the brain that results in hyper synchronous electrical discharge of neurons and seizure activity SEIZURE- hallmark sign of epilepsy
wrist-driven orthosis
tenodesis splint (assist with grasp) ---transfer of force produced by wrist extensors to provide finger flexion action and more functional pretension with a c6/c7 lesion
motor control
the ability to regulate or direct the mechanisms essential to movement
Dysarthria
the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system
perfusion
the volume of blood that circulates through the lungs, it is gravity dependent. if pt has a perfusion problem, treatment should occur with the involved side down
kidney referaall
thoracic or flank
DVT post SCI
thrombus forms within a blood vessel -loss of muscle pumping action to move blood through the veins contributes to the thrombus formation - DVTS occur most frequently within the first 3 months following a SCI and can be prevented with a regular turning program, PROM exercises, elastic stockings and proper positioning of lower extremities.
C6 paresthesias
thumb and index finger
The role of calcitonin
to decrease plasma calcium concentration. Calcitonin should not alter the way muscles and bones interact in a way that would cause chondromalacia, because any calcium changes in the muscle will occur in every muscle, so no imbalance should occur.
standers can be used
to reduce influence of primitive reflex, promote WB and bowel/bladder function
debris in the right posterior semicircular canal produce
transient upbeating nystagmus and/or right ocular torsion.
veins
transport blood back to the heart unoxygenated
c4 myotome
trapezius, levator scapulae
testing for intermittent claudatication
treadmill test- 1 mph examine for cold, numb, pallor or loss of hair over anterior tibial area LEG CRAMPS CAN BE FROM DIURETIC USE WITH HYPOKALEMIA
stance phase hip
trendelenberg (weakness in contralateral hip abd) scissoring gait (spastic adductors)
blink reflex (which nerves)
trigeminal and facial nerves
double crush injury
two separate lesions along the same nerve
froment test
ulnar nerve
imaging for lymphadema
ultrasound: assess soft tissue for thickening and fibrosis doppler- rule out dvt LYMPHOSCINTIGRAPHY- identifies lymphatic insufficiency and performed at rest and with exercise MRI/CT- skin thickening and traditional honey patterns in soft tissue. (differs between lipedema and lymphatic obstruction)
percussions
use of fingertips to tap the body lightly but sharply to dim position, size and consistently of an underlying structure and presence of fluid/pus b. the pitch, vibration and resistance is evaluated 3. also can be used in pulmonary treamtn ----cupping can be performed to lung segment ----used to increase amount of secretions clear from the tracheobronchial tree
global phasia IV
use symbolic gestures to reduce the chance of overestimating the patients ability to understand speech
mobile arm support
used by patients with weak proximal UE musculature to improve function candidates- shoulder flexors, ER, and elbow flexors between 1-3+
coronary artery bypass graft
using saphenous vein
muscle relaxants
valium (diazepam) flexural paraflex
mitral valve
valve between the left atrium and the left ventricle; bicuspid valve
posterior cerebral artery
various visual deficits (blindness) aphasia and thalamic pain syndrome (abnormal pain, temp, touch, vibration INCREASED PAIN ) can have semi if cerebral peduncle fo midbrain involved
chronic venous stasis
venous valvular insufficiency from degeneration and valve dilation 1- mild aching, min edema, dilated supervficial veins 2- increased edema, changes in skin pigmentation 3- venous claudication severe edema, cutaneous ulceration The aching pain, especially worsened with the limb in the dependent position, is a classic sign for venous wounds. The dependent position causes increased pressure in the venous system.
qrs
ventricular depolarization
t wave
ventricular repolarization
c1 dermatome
vertex of skull
posterior cord injury
very rare with deficits of kinesthesia and proprioception ataxic gait with wide BOS
normal breath sounds
vesicular- soft rustling sound heard throughout all of inspiration and at the beginning of expiration
standing on foam with eyes open challenges what systems most
visual and vestibular
yellow zone for heart failure
weight gain of 2-3 pounds in 24 hours increased cough peripheral edeam increase sob ORTHOPENIA ADJUST MEDS AND COMMUNICATE WITH DOCTOR
fluent aphasia intervention
wernickes- use word repetition and manual cues
heart block
when spread of the electrical excitation to the heart muscle is interrupted or slowed ATROPINE- often given to patient with block
demyelination and destruction in spinal cord
when the cells of the SC are traumatized, calcium ions accumulate in the injured cells. this abnormal concentration of calcium disrupts functioning and causes demeylination and destruction of the cell membrane and axonal cytoskeleton the necrosis of axons progresses to scar tissue formation
ateleclasis ascultation sound
whereas in a patient who has atelectasis, voice sounds will decrease since the lung tissue is deflated and will not transmit sounds.
ascending tracts
whit ematter sensory feedback to cerebrum and cerebellum
vagus nerve
x touch, pain: pharynx, larynx, and brocnhi taste- tongue and epiglottis say ahhh lack of gagging or inability to feel tongue depressior gag reflex absent then assess soft palate and uvula
purulent sputum
yellow or green (infection)
can you perform manual lymphatic drainage for venous insufficiency
yes
Management by Noninvasive Complex Lymphedema Therapy
• Hygiene and Topical Skin Care• Aim is to eliminate bacterial and fungal growth. Low pH, lanolin-based skin lotions are used twice a day with meticulous skin and nail care. • Manual Lymphatic Drainage (MLD)• This massage follows the course of the lymphatic system and should empty and decompress the obstructed lymphvessels.- Contraindications for MLD are: malignant tumor, thrombosis, acute bacteriological or viral infection, cardiovascular insufficiency, or malfunction of the kidneys. • Bandaging and Compression• When the patient's limb size reaches a plateau, a custom garment is fit. The pressure of the garment is generally 20-30 mmHg for the UE and 30-40 mmHg for the LE. Garments need replacement every three to six months • Exercise and Elevation. no bP, loose fitting NO TEMPERATURE ABOVE 102 DEGRESS NO EXTREME COLD
Goals & Positioning Neonates (hospital or home):
•facilitate physiologic flexion (the fetal position), •provide "barriers" (end of crib, firm bumpers, sleep sacks, etc.) to push against, •help the child self-regulate (e.g., at least one hand by their mouth to help self-regulate) ,•prevent skin breakdown,•prevent musculoskeletal issues (plagiocephaly, torticollis, etc), •assist with normal development (midline orientation, strength, motor skills, etc).