rehab: final

Motion and weight bearing can produce

"Extra noise" that interferes with pulse ox signal

indications to terminate exercise or physical activity for other signs such as..

-cyanosis -diaphoresis -bilateral edema in pt with CHF -pallor -abnormal change in breath sounds or heart sounds -ataxia (impaired coordination)

sx's of CHF: STAGE 1

-feel tired easily -SOB when more active -palpitations -feel weak, tired or dizzy (sx's can come & go in this stage)

indications to terminate exercise or physical activity pertaining to SBP

-greater than 200mmHg -decreases to less than 90 mmHg -drop greater than 10 mmHg from resting or with increasing exercise

sx's of COPD - early stage

-have a cough that produces mucous or lasts a long time -SOB easily (esp with activity) -have a tight feeling in the chest -have 'wheezing' , 'rattling' , or 'whistle' in chest when you breathe

indications to terminate exercise or physical activity pertaining to symptoms such as..

-SOB -angina -dizziness -severe headache -sudden onset of numbness or weakness

sx's of CHF: STAGE 2

-SOB, even @ rest -swelling (esp in legs, ankles, feet) -weight gain (may happen in 1-2 days or more slowly) -cough or wheeze (esp when lying down) -need to urinate more @ night -feel bloated or sick to stomach

two disease-specific measures have been developed to assess QOL in pts with heart failure

-minnesota living with heart failure questionnaire (LHFQ) & -kansas city cardiomyopathy questionnaire (KCCQ)

ADVANCED STAGE of sx's of COPD

-mms do not work as well as they previously did -weight loss -difficulty catching breath w/ any activity (even just walking) -lips & nail beds turn grey or blue in color -experience swelling in your legs, feet, or ankles -HB is fast -frequently experience colds &/or flu

new york heart association (NYHA) classifies patients with heart failure into

-one of four classes according to their degree of sx's @ rest & with activity -4 classifications based on their self-report of sx's in response to activity

indications to terminate exercise or physical activity pertaining to HR

-sudden drop less than 15 bpm -change from regular to irregular rhythm -or excess HR maximum (200)

heart failure is generally classified by whether it most affects

-systolic (ejection of blood from heart) heart function or -diastolic (filling of the heart with blood) heart function

Balance Evaluation Systems Test (BESTest) categories

36 item assessment across 6 postural control contexts Biomechanical constraints Stability limits Anticipatory postural adjustments Postural responses Sensory orientation Stability in gait

RA affects how many

2.1M Americans

Consequences of falls for elderly

20% who fall and sustain a medical injury are admitted to hospital 1% die as a result of the injury Most serious fall injuries -- head trauma and/or fractures (wrist, vertebrae, and hip) Women (especially over 80yo) are more likely to be injured Falls are the most common cause of accidental death (48.8% within age 60-69 and 65.9% above 70yo) **EXCEPTION: patient fell while putting away TENS unit, reports back felt "better" after fall, assuming back was stiff and she was afraid to move it and the fall helped loosen things up

RA occurs between the ages

20-40yo

BKA saves ___ of tibial length

20-50%

dilated cardiomyopathy affects

20-60 YO males>females

RBCs stay in circulation for

120 days

Left upper lobe lingular segment

16in table, sidelying on right and turned 1/4 backwards onto pillow Percussion over left nipple area (for females -- heel of hand under armpit and fingers beneath breast)

Do NOT exercise body part of insulin injection

60-90min following injection **Because metabolizes more quickly

General goal for 30sec Sit to Stand

9-10 reps (varies depending on age and gender)

Thigh corset suspension is commonly used in

1950s NOT common today

Wearing schedule for orthosis

1st day -- 30min on/30min off 2nd day -- 60min on/60min off 3rd day -- increase incrementally After 1 week -- should be tolerating 1/2 day to full day

Sustained maximal breathing exercises AKA rhythmic breathing

A maximal inspiration is sustained for about 3sec, then air is exhaled Associated with improved oxygenation and slowing breathing rate

Pulse ox values are critical to assess and determine

A patient's oxygen needs at rest and with activity

A in CAUTION stands for

A sore that does not heal

OA affects how many

20.7M Americans

Lower lobe posterior basal segment

20in table, prone with pillow under hips Percussion over lower ribs (below scapula) fingers pointed towards spine

Lower lobe lateral basal segment

20in table, sidelying and turned 1/4 frontwards onto pillow with bottom leg straight and top arm extended over head Percussion over upmost portion of lower ribs (on side, next to breast) fingers of hand are pointed towards pt's toes

Lower lobe anterior basal segment

20in table, sidelying with pillow between knees and top arm extended over head Percussion over lower ribs (beneath breast) hand is diagonal; fingers pointing towards toes

Other diabetic medications

22-31% of people with diabetes use dietary supplements Certain ethnic groups use supplements more than others

Troponin T (Trop T) usually peaks

24-36hrs after MI then starts to fall

to be dx with chronic bronchitis (blue bloater) you must have a productive cough lasting

3 months out of a year for 2 consecutive years

Time needed for Oswetry Disability Index (ODI)

3-6min

cardiopulmonary test & measures: abnormal heart rhythms (arrhythmias) cause approximately

50% of deaths in patients with heart failure therefore it is important for therapists to monitor vitals, on telemetry if available, at baseline, as well as during & after interventions

MHR intensity for diabetic patient exercise

50-75%

Age of onset for FTD

57-63yo (average is 57yo)

Fibromyalgia syndrome affects how many

3.7M Americans

Alignment of knee joint

3/4in above medial tibial plateau Weight line falls anterior to offset joint, hinge is placed posterior to midline of leg which helps in ambulation

Polyarticular arthritis affects how many

30-40% of all JRA patients Most common

AKA saves ___ of femoral length

30-60%

Time to complete for 30sec Sit to Stand

30-60sec

JRA affects how many

300,000 children nationally 6,000 in Minnesota

Duration and frequency of exercise for diabetic exercise prescription

30min 5x/week (150min total) **May need to start at a deconditioning level

If AKA, actively ___ residual limb

ADDuct

Dealing with hip replacement precautions

ADDuction wedge Knee immobilizer Spaced retrieval memory training Memory notebook or cues

Example of orthosis that increase function

AFO to address toe drag

Orthosis that reduce tone

AFOs Wrist brace where thrumb is ABDucted (key to breaking tone is getting thumb out, then hand relaxes)

Clinical Test of Sensory Integration and Balance (CTSIB)

AKA "foam and dome" Similar to SOT but requires less equipment

platelet count of less than 20,000/mm3

AROM, maybe walking

Bony landmarks of pelvis

ASIS PSIS Ischial tuberosity Iliac crests Pubic symphysis

Sternal precautions

AVOID pushing, pulling, or lifting over 5lbs (or 10lbs for some facilities) for 6-8wks Some facilities restrict shoulder flexion and ABDuction to 90', others include full shoulder AROM as part of rehab Little evidence to base sternal precautions on

Arterial line AKA A-line precautions

AVOID tension and AROM at catheter insertion site Apply pressure immediately at insertion site if catheter is pulled out and notify nurse If a LE artery is used, check facility policy regarding mobilizing patient

Balance Evaluation Systems Test

Abbreviated to BESTest Shortened to mini-BESTest and brief BESTest 69% differentiated fallers from nonfallers in the general population

Balance (def.)

Ability to locate and maintain one's center of gravity (CoG) within or over one's base of support (BoS)

Hammer toe

Abnormal bend in the middle joint of the toe

Scoliosis (def.)

Abnormal lateral s-curve of spine

Systolic BP should not be ___ during exercise

Above 180mmHg

Blood glucose ___ is a contraindication to exercise

Above 240-300mg/dL (ESPECIALLY if fasting)

AKA or AK (abbrev.)

Above knee amputee

BPPV symptoms onset ___ and ___

Abrupt Frightening

Apnea (def.)

Absence of ventilation

Atrial fibrillation

Absent P waves

4 progressive stages of pharmacokinetics

Absorption Disruption Biotransformation Excretion

Alpha-glucosidase inhibitor medications

Acarbose (Precose) Miglitol (Glyset)

Adaptive reconciliation

Acceptance

Advantages of multi-axis foot

Accommodates to uneven ground

Cancer patients canNOT take herbal home remedies because can

Affect absorption of vitamins and minerals Contains cancer causing agents Increase tumor growth Increase risk of bleeding Cause depression Decreased efficacy Decrease effectiveness of chemo

Claw toe AKA mallet toe

Affects joint nearest the toenail **Usually occurs to 2nd toe

Results of great toe transphalangeal amputations

Affects push off, running and walking quickly

Charcot's joint/charcot foot

Affects small joints of foot Degeneration of bone

Postural awareness training

Allows body to maintain upright alignment Permits efficient movement patterns Allows joints to be loaded smmetrically Decreases/distributes load on ligaments, muscle, cartilage, and bone

Joints in orthosis provide

An axis for movement to occur

Clinical notes on factors that influence SpO2 including

Anemia, and low perfusion Errors including wrong probe, wrong position, and "noise" interference

Foot complications with diabetes

Angiopathy (macrovascular and microvascular disease) Neuropathy (autonomic, sensory, motor) End result is amputation

If cardiac patient is on vent and PT is not on hold, treatment consists of

Ankle pumps Heel slides Hugs (bilateral D1 flexion) Cheer (bilateral D2 extension) -- unless Swan-Ganz then only go to 90'

GI side effects of chemotherapy include

Anorexia Nausea/vomiting (N/V) Diarrhea Ulcers Hemorrhage

Weight relief surfaces with PTB socket

Anterior tibial crest Head and distal end of fibula Lateral tibial condyle Anterior distal end of tibia

2nd course of JRA medical treatment

Anti-rheumatics Gold salts, anti-malarial drugs

Choice of socket depends on patient's

Anticipated activity level Co-morbidities Residual limb condition

Medical treatment for labyrinthitis

Antiviral medications or anti-inflammatory medications or cortisone-like drugs Symptomatic medications for vertigo or nausea such as Meclizine or Antivert Sedative medications are best avoided

Initial shock felt after amputation

Anxiety, fear, anger

Disability (def.) in WHO 1980 disablement model

Any limitation or function loss deriving from impairment that prevents the performance of an activity in the time-lapse considered normal for a human being

Abnormal GHb AKA Hgb A1C

Anything over 6% warrants intervention via diet and exercise

Blood vessel changes as pregnancy progresses

Aorta partially obstructed in supine Vena cava compression in supine

Coronary Artery Bypass Graft (CABG) is AKA

AortoCoronary Bypass (ACB)

Disadvantages of IPOP

Application Does NOT allow for daily wound inspection and dressing changes If patient can NOT control weight bearing then early ambulation is a detriment

Rocker feet

Arch disappears and becomes the primary weight bearing surface of foot

Old terminology for foot orthotics

Arch supports

HypOmagnesemia (low magnesium) can cause

Arrhythmias

Surgical management for severe JRA

Arthroplasty Arthroscopy Carpel tunnel release Fusion Synovectomy

Hip/ankle/stepping strategies

Arutomatic Occur 85-90msec after the perception of instability is realized

Alzhemier's disease (AD) was first identified

As early as 1907 as a distinct clinical and pathological entity

If AKA, get up and ambulate

As soon as possible

Assisted joints

Assist in motion in one direction via spring load mechanism

Basis of geriatric rehab

Assist the disabled aged in recovering lost physical, psycholocal, or social skills, so that they may become more independent, live personally satisfyinng environments, and maintain meaningful social interactions

Gait training with/without prosthesis

Assistive device used Ability to donn/doff prosthesis Functionality of the joint just proximal to amputation (if maintaining a position that causes gait abnormality) Weight shift/weightbearing Gait pattern Wheelchair mobility and adaptations Management of architectural barriers

Adapting the environemnt to lessen the likelihood of falls

Assistive walking devices -- correct choices Adaptive ADL equipment Handrails in bathroom/bedside commode Opportunities to enhance communication (i.e. LifeAlert, keeping phone on person) Increased illumination Large pattern design and bright contrasting colors in upholstry and textiles Higher, reasonably firm, supportive and comfortable chairs with high backs and wide arms rests Reduce clutter and excessive furniture Omit or clearly define stairs and more unsafe areas

In constrast with unilateral loss of labyrinthine function, bilateral loss of labyrinthine function patients have no

Asymmetry of activity from the labyrinthines with the head still They do not have symptoms until they move Some patients who lose vestibular function, for example from the toxic effects of some antibiotics that must be used to treat severe infections are so sick and are not moving anyway so until they get better and start moving around they are unaware of deficits

P wave

Atrial contraction (depolarization) (systole) Rounded deflection before QRS complex

Saw toothed

Atrial flutter

Characteristics of Menieres disease

Attacks last a few hours to a few days Patients usually return to normal between attacks Usually only affects one ear initially In about 1/3 of patients, both ears eventually become involved In more chronic cases, drop in hearing may not recover between attacks and becomes permanent

Acetylcholine purpose

Autonomic nervous system regulation Nerve to muscle transmission Memory formation

Waist belt suspension is indicated for

Auxiliary suspension

Disability of the Arm, Shoulder, and Hand (DASH)

Available in short form known as the QuickDASH

Thiazolidinedione medications

Avandia Actos

Goal of phase 1 (inpatient) cardiac rehab

Avoid deleterious (damaging) effects of bed rest Maintain ROM and muscle strength

Precautions for postural drainage (if side-lying position) **From handout provided

Axillofemoral bypass graft Arthritis Recent rib fracture Shoulder bursitis or tendinitis Any condition that would make postural drainage positioning uncomfortable

Warning signs of cancer

CAUTION acronym

PTB socket is more common with

BKAs

Plaques and tangles in AD brain

BOTH are present in brains that display symptoms Overproduction/overabundance of these in AD brains

Women lose bone density from which location

BOTH femoral neck and vertebra Lose at faster rate than men, starting at 25yo

Regardless of mode of exercise, need to monitor

BP and HR in diabetic patients with cardiovascular problems

How to treat and improve gait

Backwards gait Gait with saccades Gait with head turn Gait with head movement up and down Gait with mental exercises such as counting backwards Reaching, weight shifting activities such as tossing a ball Sudden turns Head circles seated and standing Walking in circles Sudden change in direction with gait

Intrinisic factors contributing to fall risks

Balance and strength problems: Dizziness Protective sensation

Task-specific training (locomotion) with falls

Balance during gait can be made more challenging by increasing its speed, number of stops and starts, variation of surfaces, and closing the eyes

Vestibular therapy interventions include

Balance retraining Oculor motor exercises Repositioning/redistribution techniques

Trunk strengthening after amputation

Balance, isometric, isotonic Functional activities

Standardized testing

Balance/gait LE strength/endurance Low back pain UE disability

Insulin pump mimics pancreas by offering insulin delivery in two ways

Basal dose: helps control blood sugar between meals and during sleep Bolus dose: controls blood sugar from meals (released in a burst)

Treatment for Menieres disease

Based upon both treating symptoms AND preventing the attacks Medications that ease nausea and vomiting or mild sedatives Modify diet AVOID foods that trigger symptoms (MSGs or caffeine) AVOID nicotine Use of a diuretic to excrete excess endolymph fluid Diamox or Acetazolamide to decrease production of endolymph fluid and reduce inner ear pressure Gentamicin injections through the ear drum into the middle ear for recurrent, incapacitating attacks of vertigo which partially destroys labyrinthine function so decreases severity Removing the labrinthine when hearing is already lost Cutting the vestibualr nerve to the part of the labyrinth that relays vestibular sensation to the brain

Three levels of ADLs

Basic Instrumental Mobility

Basic ADLs include

Bathing Dressing Toileting Continence Feeding

Education for prevention and early diagnosis

Be familiar with American Caner Society warning signs of cancer Encourage patients to seek further medical care if signs and symptoms present

ADLs to learn after amputation

Bed mobility, transfer Dressing (including donning/doffing prosthesis) Eating/food prep Cleaning Toileting Overall ability to function throughout the patient's day Care of shrinkers and ace wraps Donn/doff shrinkers and ace wraps

Treatment during bedrest

Bedrest with bathroom privileges after contractions are under control Sometimes placed in trendelenberg (upsidedown position) Tocolytic therapy given to decrease uterine contractions Modalities for pain, positioning, bed mobility,and exercise to prevent muscle atrophy

Environmental fall risk factors

Bedroom (i.e. stepstool needed for high bed, bedside commode) Available devices Bathroom (i.e. shower chair, long handed reacher) Outside (i.e. ramps and stairs, yard hazards) Lighting (i.e. brightness, keeping a light on)

Insulin pump

Beeper-sized device that delivers insulin through a flexible plastic tube attached to the body

Although dementia is viewed as a disorder of cognition, non-cognitive symptoms include

Behavioral symptoms that may precede any clinical evidence of changes in cognition Include changes in mood, manifestations of agitation, and psychotic symptoms

Patient behavior warranting a mental health consultation

Behaviors produce clinically significant distress and/or significant impairment to personal and interpersonal functioning Regression Disorientation Delusional thinking Inaccurate interpretation of environment Inappropriate affect Hypo- or hyhper-vigilance Mood swings Self-destructive behavior Normal behaviors taken to extreme

BKA or BK (abbrev.)

Below knee amputee

Peripheral vestibular dysfunctions

Benign Paroxysmal Positional Vertigo (BPPV) Bilateral Loss of Labyrinthine Function (AKA Disequilibrium of Aging) Unilateral Loss of Labyrinthine Function (AKA Labyrinthinitis) Menieres Migraines

PT management in chest care

Breathing techniques Cough facilitation (ABCT) Postures to increase breathing Relaxation techniques Functional training Bronchial drainage Percussion/vibration

Exercises that put too much pressure on chest and ribcage

Bridge and partial sit-ups (do NOT perform these exercises)

What to do when patient continues to wander from session

Bring session to them and set up stations along wandering path

Amyloid (def.)

Bunch of proteins that fold into abnormal shape (fibrils) disrupting normal healthy tissue function

Glucagon is released by pancreas as a response to

Decreased blood sugar

Changes in GI tract contributing to more medication being absorbed

Decreased intestinal blood flow Increased time to empty gastric contents Increased time for mucosal cell absorption

Prognosis of transmetatarsal (mid foot/Chopart's) amputation

Decreased morbidity rate compared to AKA or BKA

Results of knee disarticulation

Decreased morbidity than amputation that transects a bone

Neuronal changes with age

Decreased myelin sheath and axon diameter

Impaired wound healing in diabetics is due to

Decreased oxygen in tissues Catabolism of proteins Growth of microorganisms

Age-related changes in vision

Decreased peripheral vision Changes in accuracy to judge horizontal and vertical orientation

Advantages of una boot dressing

Decreased post-op edema Self suspension Changes easily if needed Conforms to shape of residual limb Light weight

Average cancer survival rate with weight loss is decreased by 30% and show

Decreased response to chemotherapy

Symptoms of ANS neuropathy with diabetes

Decreased temperature regulation Decreased ability to sweat Cardiac neuropathy Gastroparesis

Age-related changes to muscle

Decreased torque Decreased cross-section area Decreased muscle fibers (fast phasic) Decreased muscle size Muscle is replaced with fat cells

Age-related intrinsic fall risk factors

Decreased type II (fast twitch) muscle fiber function Loss of tissue extensibility (decreased ROM, esp. ankle DF) Loss of function in spine and LEs due to strength/ROM changed Decreased capillary function) increased risk of orthostatic hypertension

Prognosis for hip disarticulation

Decreased use of prosthesis Wound healing problems can occur Many are functional even with driving with/without prosthesis

Advantages of CET

Decreases edema Decreases pain (subjective) Increases wound healing environment Allows active exercise secondary to flexibility (need 60' knee flexion) Allows observation of wound

Foot orthotics (FO)

Decreases pain because transfers weightbearing strsses to pressure tolerant sites Protects painful areas from contact with show Improve foot balance

Advantages of waist belt suspension

Decreases pistoning (which decreases friction)

Pads are used to control ___ and provide ___

Deformity Support

Sarcopenia

Degenerative loss of muscle mass 0.5-1% loss each year after 25yo Increases with each decade Increases to 1-2% each year after menopause in women

Residual limb pain causes

Delayed healing, ulceration, gangrene

PPD will see deterioration on tasks of

Delayed recall Semantic knowledge Frontal-executive functions Speech and language Visuospatial functions

Memory loss is not always the first sign of ___ and is not always a progressive condition

Dementia

Normal pressure hydrocephalus is seen with clinical triad of

Dementia Slow shuffling gait Urinary incontinence

Grieving

Denial or problem/severity Obsession with past or pre-loss state Obsession with guilt related to loss Regression Difficulty concentrating Loss of interest in activities and events Liability of mood Inability to discuss loss Fear of being left alone Acting out (i.e. tantrums, promiscuity, suicidal behaviors) Angry stance

Prognosis of transphalangeal (toe) amputations

Depends if 1 toe or multiple toes amputated and if both feet are affected

Prognosis of knee disarticulation

Depends on patient Requires increased O2 demand Depends on the scar free padding left for weight bearing

Atherosclerosis (def.)

Deposits of plaques of fatty material on the inner walls of the arteries

Dementia may not be the culprit of memory loss, other diagnoses could be

Depression Anxiety Delirium Medication-induced problems

Hightened possibility of suicide

Depression Giving away possessions Hoarding or hiding medication or potential weapons Writing suicide note Updating will Verbalizing loneliness or hopelessness Statements regarding benefit of release of pain, absence, etc. Intrusiveness of such thoughts

Grief reaction

Depression Mourning Self-blame Needs to be resolved before the patient can move on

Acknowledgement after amputation includes

Depression, mourning, hostility

Imbalance can occur when a patient is

Deprived of other sensory cues such as vision or the sense of touch that are typically used o compensate for loss of labyrinthine function Walking in the dark can become treacherous Walking in sand or even a soft surface such as well padded carpet can be difficult because sensations from the feet cannot be used to determine exactly where one's are relative to the stable ground For this reason, one should not swim alone on a dark day because one can't rely on vision or other sensory cues to know up from down

Reciprocating gait orthosis (RGO)

Derivative of the HKAFO but incorporated a cable system to assist with advancement of lower extremities during gait When patient shifts weight on right extremity cable system will advance left extremity

Craig Scott KAFO

Designed for paraplegics Design allows a person to stand with a posterior lean of the trunk

Dementia (def.)

Deterioration in cognitive functioning that renders a person unable to meet the diverse intellectual demands of everyday life

Distribution (def.)

Determines the concentration of a drug at its target site Nature of drug has an affinity for certain body components (H2O, fat, protein)

Characteristics of type II (NIDDM) diabetes

Develops over 35yo (called "adult onset") Gradual onset 90% of all diabetes cases Ketoacidosis is unlikely Usually obese Managed by diet, exercise, oral medication, and insulin Obesity-related or hereditary etiology

Characteristics of type I (IDDM) diabetes

Develops under 30yo (called "juvenile onset") Abrupt onset 10% of all diabetes cases Ketoacidosis may occur Normal body weight Managed by diet/exercise and insulin Viral, autoimmune, or hereditary etiology

Microvascular changes result in

Diabetic neuropathy Retinopathy

Performing active cycle of breathing technique (ACBT)

Diaphragmatic breathing then thoracic expansion then FES/huff

Chest excursion (def.)

Difference in chest circumference from maximal expiration to maximal inspiration

Work balance tasks in increasing ___

Difficulty (i.e. seated to standing to walking, moving to narrower base of support)

Orthopnea (def.)

Difficulty breathing in postures other than erect

DRE (abbrev.)

Digital rectal exam

Normal pressure hydrocephalus (def.)

Dilation of ventricles affects surrounding brain tissue that controls lower extremity movement and bladder function

How ankylating agents work

Directly damage DNA to keep the cell from reproducing

DMARDs

Disease modifying medications Include GOLD, methotrexate, leflunomide Arthritis patients can also take azathioprine or cyclosporine (immumosuppressants), or hydroxychloroquine (anti-malarial drugs)

Pre-op patient education

Disease process Benefits of exercise Extremity hygiene Methods of edema control Information on phantom limb pain/sensation, donning/doffing prosthesis, gait training

Heart blocks (def.)

Disease where electrical system of heart does not work

Immunotherapy is given to people with cancer to

Encourage their own cells to attack the cancer cells Example: approved vaccine for advanced prostate cancer

Diabetic neuropathy may affect what nerves

CNS (including cranial nerves), PNS (most common), or ANS

Deep thermal modalities (US, diathermy, etc.) with cancer

CONTRAINDICATED over or near a malignancy

Deep heat for arthritis

CONTRAINDICATED with RA Stimulates collagenase activity in the joint furthering its destruction It may effect viscoelastic properties of collagen and increase the plastic stretch of ligaments Include ultrasound

Symes amputation

Calcaneous is dissected from talus Tibia/fibula malleoli are shaved or removed Flap made from preserved heel fat pad

Examples of topoisomerase inhibitors

Camptothecin alkaloids, pododphyllotoxin derivatives, anthracycline antibiotics and anthracenediones

Ventricular tachycardia

Can be very dangerous (leads to v-fib and death) If sustained, then crash cart and staff will be in room If recent episode of unsustained (shorter than 30sec), defer PT until after cardiology assessement

Main concern of anti-tumor antibiotics

Can cause permanent damage to heart if given in high doses

Goals of breathing exercises

Can decrease the risk of lung complications following surgery Get more O2 to body's cells Can also be beneficial to individuals who are susceptible to pulmonary or respiratory problems Work to clear muscus and allow moist air to enter the airways

Cause of Menieres disease

Can follow other diseases of the inner ear including: Head trauma Inner ear infections of them in the distant past Auto-immunity Allergy Viral infections

Disadvantages of una boot dressing

Can loosen up allowing edema Frequently changing Does not protect residual limb well

Advantages of ENDOskeletal shanks

Can make adjustments Components can be exchanged Improved cosmetic appearance

Denial

Can mask depression or anxiety

When you can change supplemental oxygen orders

Can only change in urgent need and must contact PT PT will need to get order to modify O2 prescription during therapy

Exercise based on stage of arthritis

Can only do PROM and gentle isometrics in acute stage Must do PROM/stretching regardless of flare up or not When NOT in acute phase, movement and strengthening are key to recovery Energy conservation (differs from joint protection) -- sitting v. standing to perform a task

Treatment after Four Square Step Test (FSST)

Can perform FSST multiple times Forward/backward and lateral stepping

Results of symes amputation

Can provide durable end-bearing stump Can ambulate short distances without prosthetic or AD

Testing for protective sensation

Can their feet touch the floor? More common problems in diabetics Test with 5.07 monofilament (great toe, 4th toe, 1/3/5 metatarsal heads)

Differentiating agents attack

Cancer cells and help them mature into normal cells

Abnormal potassium (K+) levels can cause

Cardiac arrhythmias

Beta blockers (Metoprolol) is used with

Cardiac arrhythmias Cardiac protection after MI HypERtension (HTN) Congestive heart failure (CHF)

Troponin (Trop T) shows evidence of

Cardiac muscle injury

Exercise physiology educated patients on

Cardiac rehab phase II (outpatient) before discharge

Other problems that futher affect pharmacokinetics

Cardiac, kidney and liver disease

Common musculoskeletal complications during pregnancy

Carpal tunnel syndome (CTS) Thoracic outlet syndome (TOS) Femoral nerve compression Diastasis recti

Multiple gestation (def.)

Carrying more than one baby (i.e. twins, triplets, quadruplets, etc.)

Osteoarthritis (OA)

Cartilage degenerates Loss of joint integrity

Ethnicity and bone density changes

Caucasian and Asian are more at risk than African Americans

Meglitinides are unlike sulfonylureas because they do NOT

Cause an increase in insulin release regardless of glucose levels Can lead to hypOglycemia

Age-related GI system changes

Changes begin before 50 Increased tooth decay Decreased taste buds and smell Decrease in gastric motility (proteins, fats, and minerals are absorbed more slowly) Decreased gastric acid Decreased absorption of iron and vitamin B12 Bowel and bladder function is decreased

Age-related changes in vestibular system

Changes in neurotransmission with overall decrease

Crisis points in the rehabilitative process

Changes in the phases of heath care (i.e. acute care vs IP vs OP clinic) Changing status of other patients (i.e death, discharge, or new admittance) Patients discharge or termination form service raises awareness of loss of security and safe environment Patient must confront physical and social differences in a non-hospitalized or non-injured population

Results of all age-related changes on pharmacokinetics

Changes make the elderly more susceptible to toxicity and more prone to side effects

Parkinson's disease (PD)

Characterized by tremors, rigidity, flexed or forward posture, slowing of movements, or bradykinesia

Temporary pacemaker

Check with ICU nurse before seeing patient Not unusual to see post-CABG Do NOT change setting accidentally when mobilizing patient AVOID tension on wires NO restrictions to mobilizing patient if he/she is stable

High PT/INR (above 5)

Check with PT to see if high risk of bleeding Fall precautions

If troponin T (Trop T) levels are still rising

Check with PT, consider holding exercise If exercise, keep patient on telemetry

Percussion

Chest clapping (manual v. mechanical) Both loosen secretions Increased pulmonary function with manual

Chest wall mobility can be measured by

Chest excursion

Pulse ox errors due to machine maintenance

Clean with minimal amount of alcohol, harsh chemicals cause corrosion or damage to the unit Use bleach solution or alcohol with slightly wet cloth (water only) to minimize corrosion Put monitor in clear glove or baggie for use in isolation areas If rubber boot available, use it to prevent damage if dropped Wrapping cable/wire around unit causes wire to break and cable quit working

Postural draininge (def.)

Clears airway of seretions by placing patient in position where gravity can assist with removing secretions

CBE (abbrev.)

Clinical breast exam

Gastroparesis (def.)

Condition that reduces the ability of the stomach to empty its contents **Stomach muscle doesn't function normally but NOT due to blockage

Geriatric perspectives with amputation

Confusion/disorientation Agitation Forgetfulness Becomes fearful Feelings of isolation Concentration difficulties Withdrawl Depression

Brain natriuretic peptide (BNP) AKA B-type natriuretic peptide or GC-B is elevated with which diagnosis

Congestive heart failure (CHF)

Precautions for postural drainage (if Trendelenburg position) **From handout provided

Congestive heart failure (CHF) HypERtension Pulmonary edema Shortness of breath (SOB) made worse with Trendelenberg Obesity Abdominal distention Hiatal hernia Nausea Recent food consumption

Troponin T (Trop T) levels can be elevated with which diagnoses

Congestive heart failure (CHF) Post heart surgery Chronic ischemia

If awaiting bolus of potassium (K+) to correct low levels

Consider deferring PT

Guidelines when looking at common labs for cardiac rehab

Consider the numbers as one piece of the whole clinical puzzle Treat the patient, NOT the numbers No exercise does not necessarily equal complete bed rest

Medical treatment of JRA

Consists of 4 courses Keep MD informed of what's working and what's not

Many patients have a mild degree of ___ during periods where they are having the recurrent attacks of BPPV

Constant unsteadiness

Purpose of socket

Contain support and residual limb

Types of supplemental oxygen

Continuous flow Pulsed flow Resevoir

P wave on EKG

Contraction of atria by electrical current from SA node Depolarization occurs here

CET (abbrev.)

Controlled environment treatment

Cardiac rehab should consist of

Coordinated, multifaceted interventions designed to optimize a cardiac patient's physical, psychological, and social functioning. In addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality.

Emotional adjustment following amputation

Coping with loss and grief dependent on pre-amputation behavior and personality - Initial shock - Defensive retreat - Acknowledgement - Adaptation

Purpose of heel spur cushions

Corrects abnormal functioning (i.e. forefoot ABDuction)

3rd course of JRA medical treatment

Corticosteroids Prednisone

Non-prosthetic management

Cost of prosthesis prohibitive Energy cost is too high for patient NOT ambulatory before surgery Poor balance, strength, paralysis, coordination Severe contractures Chemotherapy or radiation (b/c may complicate wound healing) Bilateral amputations (especially AKAs)

Hemotysis (def.)

Coughing up blood

Primary benefits of pulmonary strength training

Counteract systemic effects of COPD resulting in peripheral and ventilatory muscle weakness Strength of both UEs and LEs improve

If AKA, want to strengthen ADDuctors to

Counteract typical contracture formation

Two PVCs together

Couplet Arrhymia

Rhonchi breath sound

Course rattles or popping sounds the sound like snoring usually heard on expiration Indicate congestion in proximal (large) airways that typically clear with an effective cough

Nagi disablement model

Created in early 1980s Similar to WHO's 1980 model but includes functional limitations

Otoconia with BPPV

Crystals become disloged from the utricle If formed, a clump can migrate to the lowest part of the inner ear, the posterior semicircular canal Once in the semicircular canal, they may still move whe the head changes position, leading to false sense that head and body are spinning

Lifestyle factors that influence health

Cultural influences (i.e. generational demographics, socioeconomic status, adverse childhood experience, etc.) Physical activity Nutrition Obesity Smoking/tobacco use/alcohol/other drugs Domestic violence

Nurture

Cultural, ethnic, and social adaptations to adjustments

Sick role

Culture supports helplessness and dependency Secondary gains from being ill

Disadvantages of waist belt suspension

Cumbersome Poor cosmetic appearance Hygiene problems

How to treat and improve balance

Cushion drills Open eyes and closed eyes Perturbations Head turns Sacaddes and vestibular occular reflex (VOR) exercises (i.e. gaze stabilization) from seated static to bouncing on an exercise ball CTSIB (foam and dome) Head motions

Purpose of metatarsal pad

Cushions

BPPV in anterior canal

Exceedingly rare because debris in the canal is located at the top of the inner ear easily falls out on its own

Prognosis of oligoarticular JRA with early diagnosis in kids

Excellent

Polyphagia (def.)

Excessive hunger

Polydipsia (def.)

Excessive thirst **Initial symptom of diabetes

Polyuria (def.)

Excessive urination

Second degree heart block: Mobitz type II (AV block)

Excitation completely fails to pass to AV node so you get repeated P waves

How to establish correct vestibular migrane diagnosis

Exclude other conditions that can cause similar symptoms: BPPV Menieres disease TIAs (mini strokes) Fluid leaks in the inner ear Vestibular nerve irritation

Weakness/debility

Exercises in early stage Cueing each repetition or after 5 or 6 reps, may be needed Group volleyball beneficial (parachute game, balloon volleyball) Use activities as a modality Can grade the activity with weight cuffs or number of minutes standing or required reaching

Typical cardiac patient

Expect multiple diagnoses (i.e. MI with CHF that is S?P CABG) PT may not be ordered for all cardiac cases, more MDs recognize early mobility after surgery is important

Physiological symptoms that dementia patient may exhibit

Experiencing pain Distracted by basic urges (hunger, thirst, bathroom urge) Refusing to participate in therapy Drifting off task NOT sustaining a behavior

If AKA, work on ___ while flexing other leg

Extension of residual limb

Orthosis (def.)

External device work on the body to improve mobility, increase stability, increase function, restrict motion, enhance motion, reduce load

Oscillopsia (def.)

FIRST major symptom of bilateral loss of labyrinthine function is the illusion that the environment is moving when we move our heads Characteristic visual symptom when vestibular function is lost

Step strategy is used to prevent a

Fall

Patient history in typical examination findings

Fall history, including number, time, and circumstances of any falls Type and overall number of medications Number of targeted, standardized, self-report questionnaires concerning balance and fall history Complaints of imbalance, dizziness, vertigo, oscillopsia, nausea and/or vomiting, diminished strength, sensation changes, hearing loss, tinnitus, or vision changes

Listen to ___ because they can tell you key information

Family members

Procedure for fasting plasma glucose test

Fast for at least 8hrs One sample of blood is drawn for glucose levels

Prolonged expiration (def.)

Fast inspiration, slow and prolonged expiration yet normal rate, depth, regular rhythm Associated with obstructive lung disease

Hip strategy is used when perturbation is

Fast or large amplitude

Hyperventilation (def.)

Fast rate, increased depth, regular rhythm Results in decreased arterial carbon dioxide and tension Associated with CNS disorders such as encephalitis

Tachypnea (def.)

Fast rate, shallow depth, regular rhythm Associated with restrictive lung disease

Types of intensive conventional insulin treatment

Fast-acting (regular) Intermediate (LPH, Lente) Prolonged (Ultralente)

Ways to monitor blood sugar

Fasting blood sugar Glycosylated hemoglobin (GHb) AKA Hgb A1C

Diagnostic tests for diabetes

Fasting plasma glucose Random plasma glucose (AKA "non-fasting") Oral glucose tolerance test

Presyncope

Feeling faint More cardiovascular

Diabetic patients are prone to injury during exercise, especially on the

Feet

Men lose bone density from which location

Femoral neck > vertebra

Hip disarticulation excises the ___ but saves the ___

Femur Pelvis

Side effects of biotherapy (interferons) cancer treatment

Fever Chills Nausea/vomiting (N/V) Anorexia Fatigue Fluid retention CNS effects

Clinical features of JRA

Fever (if systemic) Rash Symmetrical joint inflammation Swelling Malaise ROM limitations Pain with palpation or movement Same as adult RA Cold will aggravate symptoms Heat relieves symptoms Exacerbations and remissions

Rales AKA crackes breath sound

Fine crackling sounds, usually high pitched Sounds like hair rubbing between fingers or rustling of cellophane

Placement of pulse ox probe

Fingertip (transmission) sensor Forehead (reflectance) sensor Nasal sensory Earlobe sensor Foot style sensors

Contact surface with ankle strategy

Firm, wide and longer than foot

Timeframe for phase 1 (inpatient) cardiac rehab

First 3-5 days after MI

Depression

Flat affect Low energy levels Manic energy or behavior Psychomotor retardation -- slow movements Ruminating about negative thoughts Change in eating/sleeping patterns Regression Social withdrawl Self-destructive behaviors Loss of interest in environment, people, and events Self blame and criticism

Upper lobe posterior segment

Flat table or backless chair, sitting leaned forward/over on pillows 30' Percussion over upper back (on top of scapula)

Lower lobe superior segment

Flat table, prone with superior segment Percussion over middle of back at top of scapula fingers pointed towards spine or head

Upper lobe apical segment

Flat table, sitting leaned back 30' on pillows with therapist leaning on wedge Percussion between clavicle and top of scapula

Upper lobe anterior segment

Flat table, supine with pillow under knees Percussion between clavicle and nipple fingers pointed towards toes

PT intervention for falls

Flexibility exercises Strength training Sensory training or retraining Perceptual training Postural awareness training Task-specific training (locomotion) Vestibular rehabilitation Progression of gaze stabilization exercises Multidimensional or multifactoral training Patient or client related instruction (education and safety) Injury prevention or reduction

Other dizziness

Floating, lightheaded, feelings of nausea May be lots of other things

Perceptual training with falls

Focuses on integrating all sensory information relevant to certain environmental conditions, particularly vertical orientation relative to gravity and surface orientation relative to the base of support

Diabetic foot ulcer stats

Foot ulcers are key cause to morbidity in diabetes mellitus 45% of all non-traumatic amputations

Frequent dependence of compliance

For asthmatics and COPD patients who have compromised airway resistance, the slower you breathe, the better you breathe

Microtubules

Form skeleton of nerve cell Function as a conduit for materials to flow within the cell **If microtubules tanged up then cell cannot get its needed nutrition and dies **If skeleton is tangled, cell structure collapses

Purpose of tau

Forms microtubules

Glycosylated hemoglobin (GHb) AKA Hgb A1C

Forms when glucose in the blood attaches to hemoglobin

Center of gravity is shifted ___ creating balance issues

Forward

Two types of joints

Free Assisted

Q wave

Frist deflection downward of EKG Beginning of QRS complex

Berg balance test

Functionally oriented balance, transfer and gait assessment Detailed test that requires more time

Soft dressings

Gauze and an ace wrap Oldest method

Polyneuropathy (def.)

General degeneration of peripheral nerves that spreads toward the center of the body

Allow for as much self pacing as possible

General tip for working with the elderly

Assist older persons in organizing information learned

General tip for working with the elderly

Concentrate on one task at a time, succeed then move on

General tip for working with the elderly

Emphasize new knowledge that will be consistent with previous learning

General tip for working with the elderly

Expect the intellectual ranges to be varied

General tip for working with the elderly

Make learning experiences concrete, set very specific and attainable goals

General tip for working with the elderly

Poor performance may not mean poor learning

General tip for working with the elderly

Present the information in the mode in which it will be used

General tip for working with the elderly

Provide as much feedback as possible

General tip for working with the elderly

Recognize limitations of vision/hearing

General tip for working with the elderly

Reduce potential for distraction

General tip for working with the elderly

Space learning experiences sufficiently

General tip for working with the elderly

Use sensorimotor techniques

General tip for working with the elderly

Hemoglobin (Hgb) less than 8.0

Generally patients are dizzy in bed or sitting, and lack activity tolerance

Patients with an acute MI prior to surgery

Generally slower to progress

One week of post-partum physical therapy

Gentle LE/UE exercises AVOID intrabdominal pressure

RELATIVE precautions to exercise

Gestational diabetes Severe anemia Systemic infection Extreme fatigue Musculoskeletal issues/pain Obesity OR underweight/eating disorder Diastasis recti

JRA affects which gender more

Girls

Diabetic urine tests measure ___ in urine

Glucose and ketones

Muscles to strengthen after amputation

Gluteus maximus Hip internal rotators Hip ADDuctors Pelvic and trunk rotators Abdominals Shoulder depressors and elbow extensors Quads (if BKA)

Second generation sulfonylurea medications

Glyburide Glypizzide **Used today

Diabetes evaluation

Glycosylated hemoglobin (GHb) AKA Hgb A1C Opthalmoscopic exam Neurologic exam Nephrologic exam Nutritional status

Physical rehabilitation

Goal-oriented treatment process Addresses the sequelae of pathology rather than the pathology itself Uses interventions that are noninvasive and physical in nature to promote progress toward functional goals Focuses on improving impairments and functional limitations Not directed at curing disease

Advantages of air splint dressing

Good post-op edema control Aids in ambulation More effective in BKs than AKs Incision available for inspection Bipedal support in upright position

Advantages of thigh corset suspension

Good when stability is paramount

No pulse ox reading is a substitute for

Good, quality clinical assessment and observation of patient's status

Usual course of BPPV is ___ over a period of weeks to months, occasionally symptoms last years

Gradual lessening of symptoms

To help disloge the stones, a ___ is applid to the bone behind the bad ear

Hand-held vibrator

Testing instructions for One Leg Stance Test (OLST)

Hands on counter, look straight ahead Lift up one leg, fold arms Balance as long as able

Pulse ox errors due to an incorrectly positioned sensor

Happens more in disposable probes if not applied in proper alignment

Sit to stand with sternal precautions

Have patient hold onto cardiac pillow Scoot buttocks forward using slouching technique or else moving one butt cheek at a time Place feet back as far as possible, lean "nose over toes" and push up with leg muscles NO pushing with arms on chair and NO reaching out to pull up on anything

Ankylating agents are dose dependent, larger doses

Have worse effects **Seen 5-10yrs later

Vestibular migrane

Headache can be minor or not even occur Association between migrane inner ear and brain mechanisms that influence hearing and balance

Post-surgical general goals for amputation

Healing residual limb Protect remaining limb (if dyvascular) Independent in transfers and mobility Demonstrate proper positioning Begin psychological adjustment Understand the process of prosthetic rehabilitation

Called labyrinthitis when

Hearing is affected

Diagnostic tests for Menieres disease

Hearing test Electrocochleography (ECOG) Tumarkin's otolithic crises

GI changes during pregnancy

Heartburn and indigestion

RA PT management

Heat to decrease pain and stiffness (heated pool is great) Cold can be used to reduce swelling (if tolerated) Splinting (resting)/joint protection to prevent or decrease joint contractures Stretching to prevent contractures and decrease stiffness Strengthening to regain function

Variations in client populations

Heath status (i.e. chronic disease, disability, etc.) Race and ethnicity Age and aging Gender Socioeconomic status

External foot orthotics include

Heel wedge Cushion heel Sole wedges Metatarsal bar Shoe lift

Myoplasty

Helps distal muscle stabilization Muscles are sutured together then placed over end of bone to create weight bearing pad Recommended if ischemic

Level 2 of phase 1 (inpatient) cardiac rehab

Hemodynamically stable and/or have been stable for 24hrs Basic exercises (i.e. sitting up, getting to chair, etc.)

Contraindications for postural drainage **From powerpoint

Hemorrhage or hemoptysis Untreated acute conditions (i.e. PE, pneumothorax, CHF) Cardiovascular instabiity (recent MI, arrhythmias, hypO- or hypERtension) Recent neurosurgery (do NOT place in head down positions) Low vital capacities

Contraindications of postural drainage

Hemorrhage or hemoptysis Untreated acute conditions (i.e. PE, pneumothorax, CHF) Cardiovascular instabiity (recent MI, arrhythmias, hypO- or hypERtension) Recent neurosurgery (do NOT place in head down positions) Low vital capacities

When people fall, 20-30% sustain moderate to severe injuries such as

Hip fractures or head trauma that reduce their mobility and independence and increase their risk for premature death

BKA positioning in prone

Hip/knee extension

BKA positioning in supine

Hip/knee extension ABDuction/ADDuction neutral

NO prolonged ___ with BKA

Hip/knee flexion

Why should you get a good AD diagnosis

If actually FTD, medications may worsen the disinhibition and compulsive behaviors

Dealing with ORIF precautions

If cannot follow, mobilize without restrictions Limit mobility to transfers only for 1mo Automated feedback on weight bearing Knee immobilizer to prevent standing Use weight bearing to assist device

VCI may progress and result in VaD

If detected and its underlying causes are treated, VaD can be prevented

Bilateral amputation

If unilateral prosthesis -- limited ambulation and transfers Fitting with temporary prosthesis advisable Higher level of amputation, and age less likelihood of ambulation Requires wheel chair for permanent basis Requires mat activities to regain sense of body position and balance Transfers ROM to prevent contractures May move about on knees, residual limbs or buttocks (need protectors form rubber foam, or felt) Bilateral AKAs can be fitted with stubbies (walk on residual limbs like peg leg)

Muscles to stretch after amputation

Iliopsoas Hip external rotators Gluteus medius Hamstrings (if BKA)

IPOP (abbrev.)

Immediate Post-Op Prosthesis

Symptoms of labyrinthitis

Immediate onset Severe vertigo Imbalance Nausea and vomiting Loss of hearing in high frequency range Tinnitus (ringing in ears)99 Symptoms reach maximum intensity quickly, may be constant and incapacitating for several days After a few days, symptoms subside then they are triggered by sudden head movements

Traumatic reaction period

Immediately following injury or disablement Physiologic defenses (i.e. shock, numb) Waiting Support is strong

4th course of JRA medical treatment

Immunosuppressive Cyclosporin

Positioning following amputation

Important to prevent contracture to be able to fit prosthesis and biomechanics of gait

General goal for Disability of the Arm, Shoulder, and Hand (DASH)

Improve by 10 points

General goal for Oswestry Disability Index (ODI)

Improve by 10-12 points

Goal of phase 2 (outpatient) cardiac rehab

Improve cardiorespiratory fitness

How thiazolidinedione medications work

Improve insulin's effectiveness (improves insulin resistance) in muscle and in fat tissue Lower the amount of sugar released by the liver Make fat cells more sensitive to the effects of insulin

General goal for Funcitonal reach test

Improve reach to farther than or equal to 9in

General goal for One Leg Stance Test (OLST)

Improve time to greater than 5sec

General goal of Timed Up and Go (TUG)

Improve time to less than 13.5sec

General goal for Four Square Step Test (FSST)

Improve time to less than 15sec

Advantages of sleeves

Improved cosmetic appearance Simple Minimal pistoning

Pursed lip breathing is suggested for

Improving ventilation and oxygenation and relieving respiratory symptoms in individuals with airway clearance dysfunction

Action of insulin

In liver, reduces the production of glucose through decreased gluconeogenesis and glycogenolysis In muscle, increases uptake of glucose by the muscle cell

Ankle strategy

In which all joints except for the ankle are fixed and torque about the ankle is used to compensate for perturbation

Hip strategy

In which torque about the hip joint is used to accelerate the torso and move the center of mass

Ankle strategy head movements

In-phase with hips

I in SERIOUS stands for

Inability to move a joint normally

ABSOLUTE precautions to exercise

Incompetent cervix Vaginal bleeding (especially in 1st trimester) Placenta previa Multiple gestation nd high risk pregnancies Preeclampsia Rupture of membranes Maternal heart disease, thyroid disease, or serious respiratory disease Intrauterine growth retardation

Dynamic response foot (AKA energy storing foot)

Incorporate shock absorption in a flexible heel to be used in toe off Transverse rotation permitted to small degree Seattle Foot, SAFE, Carbon Copy, College Park, Flex Foot, or Springlite Indicated for athletic patients

Kidneys ___ in length by 1cm or 1/2in

Increase

Tidal volume and minute ventilation ___ during pregnancy

Increase

___ in blood volume by 35-50%, and returns to normal 6-8 weeks after delivery

Increase

___ in chest circumference during pregnancy

Increase

___ in depth of breathing during pregnancy

Increase

___ in heart rate by 10-20bpm by full term, returns to normal within 6 weeks of delivery

Increase

___ in pre-existing musculoskeletal problems

Increase

Meneires disease has an ___ in pressure and amount of endolymph

Increase Endolymph bathes the inner ear sensory organs within the labyrinth Similar to glaucoma of eyes

Goals of arthritis PT in subacute stage

Increase ROM Increase strength Increase endurance Regain independence in ADLs

Main purpose of daily foot care

Increase circulation Prevent injury Prevent infection

General goal of Tinetti balance and gait

Increase score above 19/28

Goal/purpose of bracing

Increase the patient's ability to function and improve their quality of life with minimal restictions

Levels 4-6 of phase 1 (inpatient) cardiac rehab

Increase time of ambulation Add stairs with reciprocal gait Educate patient about their fatigue Give adequate rest breaks

Disadvantages of single axis foot

Increase weight Less cosmetic appearance (b/c visible joint line at ankle) May squeak (may be able to address at home)

Exercise may cause vitreous hemorrhages, especially if eye pressure is

Increased

Insulin is released by pancreas as a response to

Increased blood sugar

Compensatory mechanisms with age

Increased branching of dendrites with slowing of membrane potential and CNS fatigue

Postural pregnancy changes

Increased lordosis and weakened abdominals Increased scapular retraction/shoulder IR due to enlarged breasts creating tight pectoral muscles and weak scapular stabilizers May have forward head, suboccipital muscles shorten to keep eyeline level and may become overworked

If taking four medications or more daily

Increased risk of injury from fall

Age-related changes in balance system

Increased sway Decreased area of control in sway

Ace inhibitors (Lisinopril) ___ fall risk

Increases

Beta blockers (Metoprolol) ___ fall risk

Increases

Diuretics (Lasix) ___ fall risk

Increases

Encourage use of pelvic tilt because

Increases balance (strengthens abdominals) Keeps posture in alignment

Activity or exacerbation of disease increases respiratory rate causes trapped air in COPD/asthma patients

Increases work of breathing which causes a steadily increasing struggle to breathe and panic can easily ensue Inefficient breathing patterns and use of accessory muscles of respiration can further develop into a disastrous situation

Cheyne-Stokes respiration (def.)

Increasing then decreasing depth, periods of apnea interspersed with somewhat regular rhythm Associated with critically ill patients

Pre-prosthetic general goals

Independent in residual limb care Bandaging or shrinker application Skin care Positioning Independent in mobility, transfers and functional activities Partial weightbearing crutch walking if fitted with IPOP or EPOP Full weightbearing when tolerated (and permitted by surgeon) Single leg ambulation with crutches/walker if fitted with soft dressing Demonstrate HEP accurately ROM graduating to resistive exercises for all parts of residual limb ROM/strengthening exercises for unamputated LE PRN Care of the remaining LE if amputated for vascular reasons

Hip knee ankle foot orthosis (HKAFO)

Indicated for patients with hip, knee, and ankle weakness (patients with spina bifida, SCI, or other disorders that result in paraplegia) Consists of bilateral KAFOs with an extension to the hip joints and a pelvic band Can control rotation, ABDuction, and ADDuction of hip Heavy -- restricts patient to only use swing to/through gait pattern

Damaged self-esteem

Isolation Self-destructive behaviors Inability to maintain eye contact Inability to accept praise Judgmental attitude Self-deprecating and self-critical Unwarranted pessimism Unconcern for appearance Unconcern for personal safety

UE strengthening after amputation

Isotonic, manual resistance, weights, theraband

Nystagmus (def.)

Jerking of the eyes that accompny sever vertigo patients

Rheumatoid arthritis (RA)

Joint lining thickens Inflammation Loss of joint and soft tissue integrity Systemic Symmetrical

Mitotic inhibitors can damage cells in all phases by

Keeping enzymes from making proteins needed for cell reproduction

Day one/two of post-partum physical therapy

Kegal Isometrics Pelvic tilt Lay prone

Joint protection with arthritis

Key is to use large joints to do the work of small joints Education is the key factor in treating arthritis Joint protection is one of the most effective ways to avoid or relieve pain and prevent further joint damage

Examples of orthosis that decreases pain

Knee brace for OA reduces pressure at knees Insoles increase alignment which decrease pain

Example of orthosis that protect

Knee brace that protects ACL

BKA positioning in sitting

Knee extension

Chest deformities

Kyphosis Scoliosis Pigeon breast Pectus excavatum Barrel chest

Dopamine treatment/medications

L-Dopa (Dopamine) Olanzapine (Zyprexia) Haloperidol (Haldol)

Dysmetria (def.)

Lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye Form of ataxia Sometimes described as an inability to judge distance or scale

Clinical features of FTD

Lack of social tact Failure to demonstrate acceptable manners Violate others' interpersonal space Touches others' inappropriately Neglect or loss of interest in maintaining personal hygiene

Barrel chest (def.)

Large, rounded chest due to accessory muscle use

___ seen in joints and pelvic floor during pregnancy

Laxity

Cerebellar degeneration

Leads to ataxia and dysmetria Decreases the effectiveness of balance strategies and impair oculomotor control

Plantar ulcers could be from claw toes because it

Leaves metatarsal head exposed which shifts weight bearing surface to small areas of bone and leads to thinning of normal fat pad

Cardiac output is increased most significantly in what position

Left sidelying

Sequelaes of oligoarticular JRA

Leg length discrepancies Joint destruction Inflammation of eye which can lead to blindness

As type II (NIDDM) diabetes worsens, the pancreases produces

Less insulin and become "insulin deficient"

Disadvantages of dynamic foot response (AKA energy storing foot)

Less stability Heel cushion may be too soft Separation of components has occurred Heavier than SACH

Normal fasting plasma glucose levels

Less than 110mg/dL

Fall risk value for Tinetti

Less than 19/28

Oligoarticular JRA affects how many joints

Less than 4

Fall risk value for Berg balance scale

Less than 45

Time needed for 5x Sit to Stand

Less than or equal to 3min

Fall risk value for Functional reach

Less than or equal to 9in

Anti-metabolites are used to treat

Leukemia Breast cancer Ovarian cancer Cancer of intestinal tract

Ankylating agents are used to treat

Leukemia Lymphoma Hodgkin disease Multiple myeloma Sarcoma Lung cancer Breast cancer Ovarian cancer

Endolymph with Menieres disease

Endolymph fluid is contained within a thin membrane called the membranous labyrinth Normally, endolymph is continuously made and then reabsorbed so that the pressure remains relatively constant When the fluid is not adequately reabsorbed, pressure inside the mamranous labyrinth increases This can lead to a balooning of the membranous labyrinth, which interferes with the normal functioning of hair cells that relay information used for hearing and balance Thin membrane that holds the endolymph may also rupture, causing the fluid to leak out and further interfere with the function of the hair cells Breaks in membrane are usually experienced as sudden and secere attacks of vertigo and imbalance that can be incapacitating

Menieres disease is AKA

Endolymphatic hydrops

Vibration

Enhances mucociliary activity Studies show higher secretion clearance with both vibration and percussion

Breast changes during pregnancy

Enlargement and sensitivity is common

Set up for Four Square Step Test (FSST)

Equipment -- 4 canes or PVC pipes Arrange in 4 squares Patient begins in upper left square Have patient practice first

Set up for Timed Up and Go (TUG)

Equipment -- chair, assistive device PRN May use assistive device, document it Chair with approx 18-20in seat height and arm rests Clear and straight pathway

Set up for One Leg Stance Test (OLST)

Equipment -- none needed Patient can stand in front of countertop (if home health) Consider using gait belt for safety

Set up for Functional reach test

Equipment -- tape, ruler (or large goni), gait belt PRN Tape ruler to the wall

Hematocrit (Hct) less than 25%

Essential ADLs

Hemoglobin (Hgb) less than 8

Essential ADLs

Sensory exam

Evaluates the patients ability or lack thereof to percieve and identify specific sensations with her eyes closed Might check for sharp/dull sensation, temperature sensation, proprioception

With TSB socket, weight is distributed

Evenly over all surfaces

If weak in one area of balance

Take away another area or both to challenge the weak one

89% of people over 65yo

Take medications on a daily basis

Internal metatarsal bars

Take more pressure off the MTP joints than a standard external metatarsal bar Relieve metatarsal pain Relieve problems caused by limited ankle motion Shorten stride Assist dorsiflexion Relieve hallux rigidus

Fall prevention tips

Take patient to bathroom when they are with you in therapy Voice alarms, bed alarms Anticipate needs and meet them Patient who need to move should move Rocking chairs, locking glider chairs may work for some patients who attempt to stand up from their wheelchair Walking or standing someone up on a regular basis Keep patient engaged in meaningful activities

Stump sensitization and hygiene

Tapping, patting, rubbing with different textures Visualization, relaxation Stump wrapping (helps to desensitize) TENS Skin care (inspections, powders, lotions)

Other types of cancer drugs

Targeted therapies Differentiating agents Hormone therapy Immunotherapy

Old terminology for thoracolumbar orthosis

Taylor Brace

Patient or client related instruction (education and safety) with falls

Teach patients to stop, hold onto a stable surface, and refocus if they feel dizzy or unbalanced

Physical therapy treatment for Menieres disease

Teaching compensatory strategies Teaching balance strategies Performing habituation exercises Sharpening the vestibular occular reflex (VOR) Improving patient's core strength to help with balance

Significance of diastasis recti

Technically becomes hernia if does not resolve after pregnancy

If patient has low magnesium (Mag) levels, keep patient on

Telemetry

If patient has abnormal potassium (K+) levels, keep patient on

Telemetry during activity

Instrumental ADLs include

Telephone Driving Shopping Housekeeping Cooking Laundry Management of money and medication

Dermatologic changes during pregnancy

Temporary or permanent changes to skin color due to hormonal stimulation of melanin

Low hemoglobin (Hgb) and/or blood transfusion

Tend to defer PT until after transfusion, especially if patient is very weak/dizzy Not absolute contraindication to PT

Remission (def.)

Term used to describe the period of time when the symptoms of a disease improve or even disappear completely

Flare up (def.)

Term used to describe the period when symptoms of discomfort are at its worst

Handicap (def.) in WHO 1980 disablement model

The disadvantaged condition deriving from impairment or disability limiting a person performing a role considered normal in respect of their age, sex, and social and cultural factors

Goal of drug administration

To reach therapeutic administration Rate and efficacy of the pharmacokinetics stages is influential Controversial -- aging v. effect of disease which truly affects absorption of drugs

Aspects of diabetic foot assessment

Toe color Intrinsic foot muscle atrophy Loss of toe nails/thickness of nails Capillary refill Temperature Loss of hair, shiny appearance Toe deformity

Factors affecting pain

Tolerance Cultural differences Cultural differences in expression of pain Pain

Step strategy is used when perturbation is

Too large to stop the fall with the other strategies Fast or large amplitude OR when other strategies fail

Ankle foot orthosis (AFO)

Two metal uprights with band proximal and distally to mechanical ankle joint or molded of plastic

Hemoglobin (Hgb) less than 9.0

Typically transfused, especially if symptomatic

Semi-rigid dressings

Una boot or air splint

___ respiratory rate during pregnancy

Unchanged

Total lung capacity during pregnancy

Unchanged or may see slight decrease

More proximal amputations are

Uncommon

Ataxia (def.)

Uncoordinated movement due to a muscle control problem Leads to jerky, unsteady, to-and-fro motion of the middle of the body (trunk) and unsteady gait (walking style)

Pillows with AKA positioning

Under hips is forbidden

U in SERIOUS stands for

Unexpected weight loss, fever or weakness with joint pain

Indications for gaze stabilization

Unilateral vestibular disturbances (i.e. vestibular neuritis, or tumors on 8th nerve) Central vestibular disorders

Labyrinthitis is AKA

Unilateral vestibular loss Vestibular neuritis Vestibular neuronitis Neurolabyrinthitis

Fall (def.)

Unintentionally coming to the ground or some other lower level Unexpected event in which the participants come to rest on the ground, floor, or lower level

Estrogen

Uniquely responsible for the growth anf development of female sexual characteristics and reproduction

Cause of Alzheimer's disease

Unknown

Cause of fibromyaglia syndrome

Unknown

Cause of RA

Unknown Autoimmune

Cause of AS

Unknown Genetic predisposition with gene HLA-B27

Cause of AD

Unknown Increased risk if serious head injuries with loss of consciousness Genetic link (possibly trisomy 21)

Superficial heat with cancer

Unknown determination Can increase metabolism of tissues

Contact surface with hip strategy

Unstable or shorter than feet

U in CAUTION stands for

Unusual bleeding or discharge

Pistoning (def.)

Up/down movement of limb inside socket or up/down movement of socket around leg

Stages of Dementia

Use Reisberg's Global Deterioration Scale Much variability

Weightbearing is a very critical factor to consider when determining

Use of prosthesis and for prosthetic training for gait (i.e. can the patient accept the weight of the body on each LE?)

Set up for Tinetti balance and gait

Use standard chair height for sit-to-stand (no recliners, try to use chair with 18-20in seat height) Testing surface (linoleum v. carpet, document it) Device used (may use AD, document it)

Substitute with incompatible behavior

Use this if patient engages in a persistent, repetitive behavior that interferes with treatment Have the patient engage in behavior that occurs at the same time as the target and substitutes for it

Corticosteroids are considered chemotherapy drugs when

Used as part of cancer treatment

SI joint during pregnancy

Ligaments soften and become more mobile Widens with pubic separation

How pulse ox works

Light emitter and a photodetector directly opposite and facing each other Light emitter produces red infrared light which is absorbed by the hemoglobin on RBCs, and the photodetector measures the light on the hemoglobin to estimate oxygen saturation levels

Hemoglobin (Hgb) between 8-10

Light exercise (as tolerated)

If not exercising at all, recommend starting with

Light walking and mat strengthening/stretching exercises Recommend 15-30min most days of week

Sleeve

Light weight May be used as auxiliary suspension

Symptoms of heart block

Lightheadedness Syncope Possible palpitations

Advantages of SACH

Lightweight Durable NO moving components Less maintenance Shock absorption

Stops

Limit motion (usually ankle/knee) Usually internal device built into orthotic Same type of device can also be made to assist with motions

Impairment (def.) in WHO 1980 disablement model

Loss or abnormality of physical body structure or function, of logic-psychic origin, or physiological or anatomical origin

Low sodium (Na+) levels cause

Weakness

Decreased risk of bone density loss

Weight bearing activity and resisted muscle contractions because increases osteoblastic activity

Femoral nerve compression occurs due to

Weight of belly compressing nerve while sitting

Best time to exercise if diabetic

When blood sugar is on rise (about 30min after eating) At same time every day, if possible (because helps to more efficiently manage blood sugar)

Topoisomerase inhibitors are grouped into Type I and Type II according to

Which type of enzyme they affect

Epley Maneuver

While longistting, the patients head is turned aout 45' to the *AFFECTED* side Patient is quickly laid down backwards with their head just over the edge of the exam table, position usually provokes strong vertigo and nystagmus Head is kept in that position, then turn head 90' to opposite side The hand and the body are turned together in he same direction so that the body is pointing towards the side and head is turned down toward the ground at a 45' angle Patient is brought upright again This maneuver is repeated 5 or 6 times until neither vertigo nor nystagmus are elicited when the head is brought into the bad ear down position *Each position is held until symptoms subside PLUS 30sec*

Vestibular rehabilitation with falls

Widely used in the management of patients with disequilibrium, dizziness, a history of loss of balance or falls, and gait instability caused by peripheral or central vestibular dysfunction

Symphysis pubis during pregnancy

Widens by 5mm Usually returns to normal in 1 month but could be up to 3-6 months

Hearing test for Menieres disease

Will show low pitch sounds are hardest to hear

Fibromyaliga syndrome mostly affects which gender

Women

Gender affected more by bone density changes

Women

RA is more common in which gender

Women

If patient's fail a clinical test of sensory interaction and balance (CTSIB)

Work on it until they pass

Treatment after Timed Up and Go (TUG)

Work to improve sit-to-stand, gait, and turning

Level 3 of phase 1 (inpatient) cardiac rehab

Working on increasing gait (measure in time, not distance, or can do both because insurance wants feet and PT wants time -- i.e. 500ft in 6min)

Methods of edema control of residual limb

Wrapping with elastic bandage (ACE) -- most common, greatest distal pressure Shrinkers -- give conical shape but can NOT mimic pressure of ACE wrap Elevation and compression Intermittent compression pump (temporary use ONLY)

Example of orthosis that stabilizes

Wrist splint

Results of transmetatarsal (mid foot/Chopart's) amputation

Yield a better mobilization percentage outside the home

Exercise for patients on bedrest

Low resistance exercise AVOID excessive increase in intrabdominal pressure AVOID isometrics (because might hold breath and increases intrabdominal pressure) AVOID abdominal exercises AVOID pelvic flor exercises with a very irritable uterus

Heightened possibility for violence

Low threshold for anger Depression High anxiety state Motoric agitation Self-mutilation Oversensitive Argumentative Inability to express feelings Fears of abandonment Disassociative states

Children with JRA can also be diagnosed with

Lupus, fibromyalgia, and other conditions

Occasional PVCs

Normal Related to caffeine **Continue PT

Dementia is NOT an inevitable part of

Normal aging

Pathophysiology of type II (NIDDM) diabetes

Normal level of insulin production Defect in the ability of insulin to act on its target cell (called "insulin resistant")

Hypernea (def.)

Normal rate, increased depth, regular rhythm

Eupnea (def.)

Normal rate, normal depth, regular rhythm

Most likely your rhythm

Normal sinus Tachycardia Occasional PVCs

Multidimensional or multifactoral training for gait

Normally include gait training, strengthening programs, balance training, training in appropriate assistive device use, review of health management Normally include environmental assessment or modification, including a home safety evaluation and patient and/or caregiver education regarding fall

Disadvantages of ENDOskeletal shanks

Not as durable Easily soiled/torn NOT as strong structurally More expensive May be heavier

Diagnosis of BPPV

Made by characteristic symptoms and also by observing the nystagmus when position of head is changed

Plaques in brain

Made up of beta-amyloid proteins that form solid aggregates Exist between the nerve cells

Ankle foot orthoses (AFOs) are used for

Mainly foot drop (seen with hemiplegia) Often used in pediatric population to prevent plantarflexion contractures Control plantarflexion/dorsiflexion, inversion/eversion Alter knee motion Foot plate can be used to assist with tone reduction

Goals of PT with RA

Maintain ROM Maintain strength Ambulation/gait training ADLs (OT eval to address function and possible need for adaptive equipment) Home program Deformity prevention (i.e. splinting) Pain management

Sort term goals following amputation

Maintain ROM and prevent contractures Decrease edema and shape limb for prosthesis Increase strength in extremities and trunk Bed mobility, transfers, and gait training without prosthesis Residual limb healing/hygiene Assist with adjustment of loss of body part

Goals of arthritis treatment

Maintain flexibility Maintain ROM Reduce pain Reduce stiffness Decrease edema Maintain or improve function

Goal of phase 3 (maintenance program) cardiac rehab

Maintain/improve cardiorespiratory fitness

Glutamate purpose

Major excitatory neurotransmitter Potentiates other neurotransmitters ("brain workhorse")

Fall statistics

Major health concern of the elderly Over 1/3 of older adults fall annually Fall rates increase with advancing age Falls are the leading cause of injury deaths (1 death/hour) Falls are the most common cause of non-fatal injuries Falls are the most common reason for hospital admission due to adult trauma More than 95% of hip fractures result from falls

Disadvantages of sleeves

Not durable Hot (increases perspiration) Hygiene problems Does NOT control knee instability Need good hand function to donn/doff

Relaxation exercise tenchiques

Often administered to decrease unnecessary muscle contraction (of accessory muscles) throughout body

Cardiac post-op days 5-7 (when discharge occurs)

Often ambulating 400-600ft twice a day

Maintenance of moving parts in orthosis

Oil them Keep clean

Gait belts with sternal precautions

Ok to use when ambulating May want to place cardiac pillow between patient and belt for comfort Place belt above the level of the chest tube

Peak age and gender affected with ERA

Older than 8yo Boys

Three types of JRA

Oligoarticular JRA (pauciarticular) Polyarticular JRA Systemic JRA

Disadvantages of air splint

Once applied pressure is constant (does NOT conform to stump Plastic environment is hot and humid (requires frequent cleaning) Fullness of walls leads to hip ABDuction

Prompting and cueing

Manual guidance Gesturing Vocal instructions Written instructions/photos Cueing (i.e. use of alarm watch, notebook, cue cards) Situational cues

Diabetic screening tests

One drop of blood used to determine blood sugar level Used for persons that do not have symptoms but may be at risk Used at health fairs for wide populations Must be followed up with physical exam and more tests

Impact of poor balance and limited postural control on gait

Many older adults use hip strategies rather than ankle strategies and walk more slowly to improve accuracy during gait Walking slower means stance phase is longer (more time spent on one leg) which contributes to a false sense of security and are actually more prone to falls

Labyrinthitis epidemics

Many people in one area can be affected with an attack of vertigo because can be caused by virus

Instructions for Oswestry Disability Index (ODI)

May be administered as a questionairre Or as a survey

Arthritis statistics

One in three adults has arthritis or chronic joint pain, 24.3% of women and 18.3% of men have arthritis Nearly 40-60% of people over 65 Arthritis is the number one cause of disability in adults Arthritis and related diseases costs our society $82.6B in medical costs, lost wages and support services

Gentamicin and bilateral loss of vestibular function

One of the most common causes Small percentange of patients poisoning of inner ear cells occurs and lead to loss of vestibular function May be genetically predisposed Only rarely effects hearing making toxicity difficult to detect

Adaptation

Ongoing process equally encompassing physiological, physical, psychological, and social

Manual guidance

May need to use fading of manual guidance or placing hand over hand and then fade the contact Depending on person's cognitive functioning level, they may need repeated manual guidance to complete a task

Tumarkin's otolithic crises with Menieres disease

May occur early in the course of the disease Subside on their own

Arterial line AKA A-line (def.)

Measures arterial pressure and/or used to draw arterial blood samples Usually at radial artery with wrist splint to hold in palce

Hallux valgus

Medial deviation of great toe

Ventricular fibrillation

Medical emergency because not getting blood to body efficiently

Aspects to review in medical chart

Medical history History of present illness (type of operation or intervention) Labs Medications (especially cardiac meds) Prior functional status Home environment/home support Funding

Methods of arthritis pain management

Medication Splinting/joint protection Thermal modalities Rest Exercise Energy conservation Relaxation techniques TENS

Glutamate treatment/medications

Memantine (Namenda)

First sign of AD

Memory loss

Dementia (def. from DSM-IV-TR)

Memory loss and other cognitive advancements (aphasia, apraxia, or disturbance of executive functioning) and a decline in occupational or social functioning

Involve ___ in balance drills

Mental tasks Gaze stabilization

Purpose of wrapping/edema control

Minimize post-op edema Shape residual limb for prosthetic fit Aid in desensitization of residual limb

Role of psychological factors

Mitigate the extent of disability Length of treatment Treatment outcome

Intensity of exercise for diabetic exercise prescription

Moderate

Stage 4 of Global Deterioration Scale

Moderate decline (late confusion) Clear deficits on clinical examination Decreased knowledge of personal and/or current events Often trouble with travel and finances

RH - polyarticular arthritis

Onset at adolescence Poorer prognosis than RH +

Stage 5 of Global Deterioration Scale

Moderately severe cognitive decline Can NO longer survive independently in the community without some assistance Difficulty with recall of some important details (i.e. address, names of one or more important schools attended) May require cueing for ADLs

First degree heart block AKA isolated heart block

PR interval is delayed (time for SA node to fire to AV node increases) Commonly asymptomatic NO dancer of increasing to other heart block types NO increase in morbidity

Early detection for prostate cancer

PSA and DRE yearly after 50yo **If high risk (family history or African American ethnicity) then begin at 45yo

Socket

PTB is more common than TSB Provides intimate total contact with entire surface of residual limb Posterior wall lower than anterior Contains a soft liner

Bigeminy

PVC every other beat **Hold PT

Trigeminy

PVC every third beat **Hold PT if greater than 6/min, unless normal for patient then continue exercise

Principles of energy conservation

Pacing Planning Prioritize Reduce effort

Residual limb pain (def.)

Pain arising in residual limb from a specific anatomical structure that can be identified Can be vascular or neurogenic pain

Dyspareunia (def.)

Pain during sex

Reasons to STOP exercise

Pain in chest, pelvis, back Leakage of amniotic fluid Uterine contractions Vaginal bleeding Decreased fetal movements Shortness of breath Irregular heartbeat Tachycardia Dizziness/swelling Swelling/pain in calf Difficulty walking

Phantom limb pain (def.)

Painful sensation experienced within the residual limb Common, unpredictable in terms of predisposing factors Unpredictable in severity, frequency, duration or character Usually stable or resolved in period of months Decreases with weight bearing

Early detection for breast cancer

Monthly SBE starting in 20s CBE at least every 3yrs starting in 20s Mammograms yearly after 40yo (30yo if high risk) -- some recommendations are now involving MRI

Early detection for testicular cancer

Monthly testicular self exams after puberty

Disadvantages of pin/shuttle suspension

More expensive than sleeve NOT durable Increase perspiration Hygiene problems Does NOT control knee instability

Multi-infarct dementia

More rapid onset progressing in a step wise fashion with abrupt worsening and subsequent plateau of function Associated with neurological deficits as paresis and paralysis Treat the underlying cause and prevent further insult Any superimposed illness can cause rapid prolonged decline in mental status

Early detection for cervical cancer

Pap smear yearly after puberty

Reciprocating gait orthosis (RGO) are used primarily with

Paraplegic patients

Dopamine is used to treat which diagnosis

Parkinson's Lewy Body Dementia

Neurological disorders that affect balance

Parkinson's disease (PD) Cerebellar degeneration

Core features of DBL

Parkinsonism Cognitive fluctuations with prominent deficits in attention Cognitive disorder precedes movement disorder Recurrent, well-formed and detailed visual hallucinations

Cancer patients are at increased risk of falls because

Pathologic fractures Weakness Fatigue Neuropathies Pain Decreased flexibility

Juvenile rheumatoid arthritis (JRA)

Most common rheumatic disease in childhood Characterized by inflammation of connective tissue (usually one or more joints) Can occur in other systems of body (i.e. heart, liver, spleen, and lymph nodes)

Benign Paroxysmal Positional Vertigo (BPPV)

Most common vestibular disorder Most easily treated "Cured" with a simple physical therapy maneuver called Epley maneuver Most common in population over age of 60 years old

Intrinsic fall risk factors in order of DECREASING relative risk

Muscle weakness (ankle DF/PF and hip and knee) History of falls (esp. if multiple or injurious)/fear of falling Gait deviations Balance deficit Use of assistice device Visual deficit Arthritis Impaired ADLs Depression Cognitive Impairment Cardiac arrhythmias Older than 80yrs

Fibromyalgia syndrome

Musculoskeletal pain, stiffness and fatigue Accompanied by sleep distubances and prolonged muscle contraction

Education on diabetes

Must be performed by ALL members of the healthcare team Must be continuous throughout lifetime, not just at diagnosis Must be reinforced Empowers patients to make informed choices

Procedure for oral glucose tolerance test

Must fast for at least 8hrs but no more than 16hrs, tests performed in AM only First plasma glucose is taken Drink a sugary drink (75-100g) given by your physician After drinking this drink, blood samples are taken up to 4x

Swan-Ganz catheter precautions

NO ABDuction or flexion above 90'

platelet count of less than 5,000/mm3

NO activity

Stage 1 of Global Deterioration Scale

NO cognitive decline NO subjective memory deficit NO problems with activities of daily living

Fever above 100.5

NO exercise

Platelets less than 10,000

NO exercise

Prothrombin (PT) time more than 2-3x reference range

NO exercise

hematocrit less than 24% or hemoglobin less than 8 g/dL

NO exercise

hematocrit% less than 24%

NO exercise

hemoglobin less than 8 g/dL

NO exercise

WBC less than 1,000/mm3

NO exercise; wear protective mask

Pillows with BKA positioning

NO pillows under knee If you need a pillow to elevate leg, put distal to knee

Bed mobility with sternal precautions

NO pulling on bedrails For supine to sit, have patient swing legs off bed and then use abdominals for sitting up OR can use log roll (roll onto side, drop legs off bed, and come up to sitting using trunk muscles) Some facilities allow patient to push a little with elbow if elbow is kept at side

General recommendations regarding exercise after amputation

NO pulling or stretching of incision Focus on functional tasks Endurance training (patient now needs to work 2x as hard) Do NOT exercise in ace wrap or shrinker (b/c creates friction and moisture rich environment)

Third degree (AKA Total) heart block

NO relationship between P waves and QRS segment Medical emergency and patient likely needs pacemaker

platelet count of less than 60,000/mm3

NO resistive exercise

Free joints

NO stops in anterior/posterior direction Provide medial/lateral stability **Might prevent hyperextension when have ligamental laxity -- but still free joint because preventing NOT assisting flexion or extension

Exercise for postpartum exercises

NO strenuous exercise for at lease 6 weeks, prevents hemorrhage and increased uterine contractions

Methods of preventing cancer

NO tobacco NO sun Nutritional diet low in fat

If low brain natriuretic peptide (BNP) AKA B-type natriuretic peptide or GC-B

NOT a contraindication for PT May give you an idea of how bad your patient is (i.e. dyspneic at rest)

Low magnesium (Mag) levels

NOT an absolute contraindication to PT

Low sodium (Na+) levels

NOT an absolute contraindication to PT, unless too weak or confused to participate

Abnormal potassium (K+) levels

NOT an absolute contraindication, but consider altering plan to gentle mobilization to beside rather than long distance walking

Disadvantages of supracondylar cuff suspension

NOT recommended for vascular problems NOT for use with short residual limbs High forces result with knee flexion in sitting

Medications to decrease arthritis pain

NSAIDs DMARDs Combination therapy

1st course of JRA medical treatment

NSAIDs Try not to use aspirin because Reye's syndrome risk

Multifocal

No pattern to PVCs, life-threatening **Discontinue PT

Cause of BPPV in elderly

No specific inciting event Otoconia are probably more easily sheared off from their normal positions as patients age We all have a few of these microscopic stones floating around in our semicircular canals, but not enough to clump and cause symptoms

Phantom limb sensation (def.)

Non-painful sensation or awareness experienced that gives form to the body part with specific dimensions, weight, and ROM Example: touch, pressure, cold, wetness, itching, movement

NSAIDs

Non-steroidal anti-inflammatory drugs Used with arthritis to decrease inflammation/pain

Improve communication

Non-verbal communication (eye's focus, tone of voice, inflection, volume, posture) Use physical gestures and go slow (allow 5sec for processing time) "No" may instead mean "I'm afraid"

NIDDM (abbrev.)

Noninsulin-dependent diabetes mellitus (AKA type II)

Phases of cardiac rehab

Phase 1: inpatient Phase 1.5: gentle home rehab Phase 2: outpatient, monitored Phase 3: maintenance program

Delirium

Physical cause of hypER- or hypOactive behavior, sudden onset (days)

Intervention for diastasis recti

Physical therapy If severe enough, may require surgery

TSB sockets are primarily used with ___ suspension

Pin/shuttle

Prosthesis fit while walking

Piston action is minimal Stairs, curbs, inclines (note knee stability and toe clearance) Should be able to kneel Prosthesis should be quiet (possible hissing, squeaking from hydraulics) Residual limb free of abrasions (discolorations in areas of weightbearing for no more than 10min, can use clay for determining distal contact

Placenta previa (def.)

Placenta covers cervix/cervical opening Can fix itself during pregnancy Can be life threatening due to loss of blood

Advantages of single axis foot

Plantarflexion provides knee stability at heel strike and foot flat (eases difficulty with descending inclines) Improves sensory feedback as foot hits floor

New orthotic components

Plastic Velcro Snaps

Subcostal angle

Point under sternum where ribs meet

Symptoms of hypERglycemia

Polydipsia Polyphagia Polyuria Fatigue/lethargy Nausea/vomiting Fruity breath

Prognosis of systemic JRA

Poor 25-50% will develop joint destruction with significant disability

Disadvantages of soft dressings

Poor control of edema without shrinker Can slip to become tourniquet

Disadvantages of thigh corset suspension

Poor cosmetic appearance Excessive weight Possible quad atrophy

Pre-op factors that affect success/failure of BKA

Poor pre-op mobility Over 70yo Dementia Severe kidney or heart disease

Disadvantages of knee disarticulations

Poor prosthetic fit and bulbous shape of residual limb

Conditions where gaze stabilization is not helpful

Positional vertigo Cervical vertigo Migrane associated vertigo Meniere's disease

Principles of joint protection

Positioning Adaptive aids

General plan on interventions following amputation

Positioning to AVOID contractures Standing balance and transfer activities Mobility training with crutches/walker Residual limb care and protection, bandaging if appropriate Care of the remaining LE (if circulation compromised) Education on amputation and prosthetics

CET dressing (def.)

Positive pressure around residual limb to reduce edema, increases vascular pumping, and increases venous return Includes bacterial filter for air being blown in Old techology

Social support, networks, and roles that influence the effects of illness

Positive social support Access to resources and material goods Close family ties Help seeking behaviors

Biotransformation (def.)

Process of metabolizing drug to inactive metabolites (neutralize chemicals) -- responsibility of the liver

Variability of the aged

Young old v. old old Chronologic age is poor indicator of physical or cognitive function

Results of hip disarticulation

Younger patients can be functional with "Canadian" type prosthesis Older patients typically have more difficulties

Relaxin

Produced by the ovary and placenta with important effects in the female reproductive system and during pregnancy In preparation for childbirth, it relaxes the ligaments in the pelvis and softens and widens the cervix

Progesterone

Produced in the ovaries, placenta (when a women gets pregnant) and adrenal glands Helps prepare the body for conception and pregnancy and regulates the monthy menstrual cycle

Superficial heat for arthritis

Produces local analgesia, improves circulation, promotes muscle relaxation Includes MHP, paraffin, hydrotherapy or aquatics

Supine hypOtension

Profound hypOtension causing fainting in 3-11% of women

Natural course of Menieres disease

Progression but with extended periods of regression or no symptoms at all Broken membranes are repaired rapidly naturally so that patients usually recover within a day or two

What symptom of DBL is not present in early stages but becomes apparent as the disorder progresses

Prominent or persistent memory impairment

PSA (abbrev.)

Prostate-specific antigen Blood test that measures for prostate cancer

Problems of symes amputation

Prosthetic difficulties Blood supply can be affected (posterior tibial artery)

Senile plaques (def.)

Protein deposits found in normal aging and AD

Hemoglobin (def.)

Protein found on RBCs that is responsible for transporting oxygen to tissues

High frequency chest wall oscillation (HFCWO)

Provided by a device that uses an air compressor and a vest with inflatable bladders attached to the compressor by large, flexible tubing

Knee ankle foot orthosis (KAFO)

Provides support to knee and ankle Metal uprights extending from foot/shoe to thigh with calf and thigh bands or plastic KAFOs are fabricated by a plastic thigh shell connected to a plastic AFO through metal uprights Both types have a knee joint (allow for lock or stop mechanism)

Muscle recruitment with hip strategy

Proximal to distal

Uprights are longitudinal supports that run

Proximal to distal

Warning signs of PTSD (patient can display MORE THAN ONE of these)

Psychic numbing (i.e. lack of interest or lowered participation in social/physical activities, or unable to feel emotions) Disturbed sleep patterns Hyper-vigilance Exaggerated startle response Ongoing level of irritability Difficulty concentrating

Ways to monitor pulm patients

Pulse oximeter Visual signs of distress

General guidelines for instruction

Quiet area Explain rationale Position of comfort Loosen restrictive clothing Observe patients' naural way of breathing

Rest with arthritis

RA is a systemic disease and patient my have constitutional symptoms Must also rest joints (only inflammed) with joint protection and energy conservation

Aspects of PT evaluation for arthritis

ROM Strength Joint stability Endurance Functional assessment Mobility and gait Sensory integrity Psychological status Pain management Environmental barriers

Pre-prosthetic assessment

ROM (looking for hip flexor, ABDuctor, and knee contracture) MMT (patient need to have good extensors, ABDuctors, flexors and knee flexors/extensors with BKA) Circumferential measurements Transfers and bed mobility Shape of residual limb Phantom limb pain/sensation Residual limb condition Balance/coordination Home environment/discharge status Vascular status of both LEs (i.e. ABI) ADLs Pre-surgical activity level Emotional status

Musculoskeletal tests and measures

ROM and MMT See "weakness and stiffness in balance stabilizing muscles"

Side effects of radiation include

Radiation sickness Immunosuppression Fibrosis Burns Diarrhea Edema Hair loss Delayed wound healing CNS effects Malignancy

Random plasma glucose test

Random blood samples taken after eating or drinking May be used when symptoms are present Must be reconfirmed on another day with a fasting plasma glucose or oral glucose tolerance test

Normal pulse ox values

Range from 95-100%

Dyspnea (def.)

Rapid rate, shallow depth, regular rhythm Associated with accessory muscle activity

Demonstrated outcomes from cardiac rehab

Reduced symptoms (angina, dyspnea, fatigue) Increased exercise performance Increased knowledge about cardiac disease and its management Enhanced ability to perform ADLs Enhanced health-related quality of life (QOL) Improved psychosocial symptoms (reversal of anxiety and depression, increased self-efficacy) Reduced hospitalizations and use of medical resources Return to work leisure acticvities

Pathophysiology of type I (IDDM) diabetes

Reduction in number of beta cells in pancreas Inadequate amount or total lack of insulin produced

Locus of control

Refers to patients perception held by an individual of the level of influence they have regarding the events of life, or a specific event Patient's perception of their role in the outcome of the disability can be influenced by the therapist in rehab (therapist can empower the patient through education and clarification of the nature of the situation)

Early detection for colon cancer

Regular testing after 50yo (every 3 years for women)

Post-traumatic adjustment period

Rehabilitative intervention All psychological defense reactions of the first phase diminish Creates perception, fears, anxiety, and behaviors that healthcare team must deal with Psychological impact felt most here, and can be as debilitating as physical injury Emergence of post-traumatic stress disorder (PTSD)

Psychological complications of amputation

Rejections of rehab, or prosthesis (AKA non-compliance)

BPPV in lateral canal

Requires slightly different maneuver Sometimes lying with the bad ear up for 12 hours allows the stones to fall out of the canal and cures the condition

Autogenic drainage (AD)

Requires the patient to know when bronchial secretions are present in the smaller, medium, or larger airways Patient then learns to breathe at low, medium, and high lung volumes to mobilize secretions in those airways

Hemoglobin (Hgb) above 10

Resistive exercise (as tolerated)

Treatment for carpal tunnel syndrome (CTS)

Resting night splints for wrist(s) Education on elevating wrists while sleeping and supporting wrists on the job

Symptoms of autonomic neuropathy

Resting tachycardia Exercise intolerance Orthostatic hypOtension Constipation Gastroparesis Erectile dysfunction Sudomotor dysfunction Impaired neurovascular funciton HypOglycemic autonomic failure

Goals for geriatric patients in chronic setting

Restoring lost function Maximizing current functional level

Barriers to health care (related to disability)

Restricted social activity Not knowing where or how to obtain disability resource information Needing home modifications but having no way to obtain them Having difficulty accessing a heath care provider's office because of physical layout or location Being treated unfairly at a heath care provider's office

Goals of arthritis PT in chronic stage

Resume previous level of ADLs Resume all previous functions (work, sports)

Tension on nerve is created prior to cutting it so that it will

Retract

Uterine ___ can contribute to pelvic pain

Retrodisplacement

T wave on EKG

Return of ventricular wave back to resting Repolarization occurs here

Standard PT protocol for cardiac patients

Review chart Check with nurse Record vital signs (BP, HR, SpO2) prior to and following treatment

Fibromyaglia syndrome may be secondary to

Rheumatoid arthritis

Shaking

Rib springing Concurrent pressure to chest wall wih bibration

Oscillopsia often occurs when

Riding in a car on a bumpy road making reading road signs difficult, running or walking quickly making faces unrecognizable, with quick head movements, or scanning across a computer screen

Drop locks

Rings and with to make easier to reach

Instructions for30sec Sit to Stand

Rise in standing positions as many times as you can in 30sec without using arms

Instructions for 5x Sit to Stand

Rise to standing position 5x without using arms Record time

BPPV symptoms occur when there is a large change in orientation of the head with respect to gravity such as

Rolling over in bed Putting head back in the shower or looking above head for items on shelf Getting in and out of bed Bending over to pick up items from floor

Lewy bodies

Round neurofilament inclusion bodies that contain damaged nerve cell deposits

Feet/ankle assembly

SACH Single axis foot Multiaxis foot Dynamic response foot

Imbalance

SECOND major symptom of bilateral labyrinthine function Patient is susceptible to fall when rapid readjustments in posture are required such as making quick turns

Precautions with all breathing exercises

SOB doesn't always mean you should stop altogether, ask MD about when you should stop exercising and rest Heavy lifting or pushing Chores such as shoveling, mowing, or raking Pushups, sit-ups, or isometric exercises, which involve pushing against immovable objects Outdoor exercises when the weather is very cold, hot, or humid Walking up steep hills

Progression of Alzheimer's disease

STM loses first Progressing to inability to learn or remember new tasks Loss of ability to perform ADLs

Maintenance of leather orthosis

Saddle soap Look for flexibility, replace before they break Soap and water for plastic

Multi-axis foot

Same as single axis but inversion and eversion are added Foot provides increased accommodation to uneven ground Foot may be less stable because of greater motion

Low pulse ox values

Seen in patients with pulmonary and cardiac processes American Thoracic Society suggests oxygen supplementation for patients presenting with long-term chronic respiratory failure

Mild cognitive impairment

Seen with aging NOT dementia Does NOT always transition into dementia ADLs are NOT impaired

SBE (abbrev.)

Self breast exam

Dysequilibrium

Sensation of falling Proprioception or balance disorders

Dynamic equilibrium theory

Sensory and motor systems interact to control equilibrium

AD and VaD

Separate diseases with different clinical presentations, different neuropathical basis and different risk factor profiles Patient could have both, AKA "mixed" dementia

Effective cough (def.)

Sequence of deep inspiration, glotis closes, build up of intra-thoracic and intra-abdominal pressure followed by forced expiration and strong abdominal muscle contraction

Situational cues

Set up a situation so that the elements of the situational environment automatically cue the desired behavior

Stage 6 of Global Deterioration Scale

Severe cognitive decline Largely unable to verbalize recent events in their life May forget name of spouse Incontinence develops as this stage progresses Requires increasing assistance with ADLs Increased behavioral problems (i.e. agitation, delusions)

Causes of bilateral loss of vestibular function

Severe head injury Certain infections such as meningitis in children or a viral infection that may affect one ear and years later infect the other ear Hereditary conditions such as migranes, Menieres syndrome, inflammatory conditions, or autoimmune diseases Severe reaction to antibiotics No apparent causs Gentamicin antibiotic

Symptoms of unilateral loss of labyrinthine function

Severe sense of spinning or falling and nausea and vomiting Not felt by patients affected by bilateral loss of labyrinthine function Such severe symptoms arise because even when the head is still, there is an imbalance in the normally equal and even flow of sensory signals that come to the brain from each labyrinthine

Symptoms of hypOglycemia

Shaking Trembling Irritable Impatient Cold sweat Dizzy Racing pulse Hungry

Description of ischemic residual limb pain

Sharp and stabbing, impaired circulation which can lead to hypoxia

Description of neuroma residual limb pain

Sharp, shooting pain evoked by tapping (or touch)

Bone beveling (def.)

Shaving bone down to a narrow point Allows for a more conical shape to help prosthetic fit

Purpose of cushion heel (also some heel wedge)

Shock absorption at heel strike

Stages of adjustment

Shock and anxiety Denial Grief reaction Anger and hostility Adaptive reconciliation (acceptance)

SACH can be used with or without

Shoes

Old terminology for AFO

Short leg brace

Memory issues with PPD

Short-term memory Effortful memory Incidental learning Retrieval of information Temporal ordering of learned information Procedural memory

Alignment of ankle joint

Should fall 1/4in proximal/distal to joint, want some plantarflexion/dorsiflexion

Percussors and vibrators

Shown to produce similar changes in patients with cystic fibrosis (CF) in both pulmonary function and secretion production as unassisted manual airway clearance techniques alone but with less effort

Result of liver changes in elderly affecting biotransformation

Slows down metabolism Drug may build up in body More prone to toxicity

Increased risk of bone density loss

Small body build

Otoconia (def.)

Small microsized calcium crystals

AKA positioning in sidelying

Small or large pillow between legs for comfort, remove to stretch

Polyarticular arthritis distribution

Smaller joints first (fingers, toes), ankles, elbows, wrists, hands, then hips, knees, and shoulders involved

Maintenance of plastic orthosis

Soap and water Watch for stress fractures

Basic BKA prosthetic components

Socket Liner Suspension Shank Foot/ankle assembly

Corsets are made of

Soft canvas/cotton

Old terminology for cervical orthosis

Soft collar Philadelphia (AKA "Philly") collar

Cervical orthosis

Soft collar, posterior collar, custom callar (orthoplast) All restrict motion, decrease axial load on cervical spine by decreasing the weight on cervical spine (collar takes some of the weight)

SACH (abbrev.)

Solid ankle, cushion heel

For our balance we rely on

Somatosensory function Visual function Vestibular function

Ambulation ADs with sternal precautions

Some facilities prohibit all ADs (because will push/lean on it) Some facilities allow use of wheeled walkers (especially 4-wheeled walkers) Most facilities prohibit unilateral devices (i.e. canes)

Monitoring and documentation for cardiac patients when resting

SpO2 should stay above 90% HR should stay under 120bpm Generally like to see BP less than 160/100 to start (if high, check to see if BP meds are given)

Bradycardia

Spaces between continuous QRS complexes are larger than in NSR

Tachycardia

Spaces between continuous QRS complexes are smaller than in NSR

PPD patients will develop problems with

Specific aspects of memory Changes in executive functioning are evident

Biotherapy (interferon) treatment is targeted for

Specific cancer cell types

Monofilament testing

Specific spots of foot are poked by strings of different diameter Assesses risk of pressure ulcers by amount of pressure given and sensation felt

Locks provide ___ and are located on ___

Stability Uprights

Readiness for prosthetic wearing

Stabilization of bodyweight Edema control Scar healing/mobility Desensitization of limb Insurance reimbursement Time frame varies (1-3mo, some longer)

Purpose of uprights

Stabilize/support body part

Goals for geriatric patients in acute setting

Stabilizing the primary problem Preventing secondary complications Restoring lost function

Functions of orthosis

Stablize Decrease pain Decrease deformity Increase function Protection Reduce tone

Treatment after One Leg Stance Test (OLST)

Standing LE exercises (i.e. march in place and hip ABDuction because patient balances on one leg) Toe touching (progressive height) UE counter tapping while standing on one leg

Treatment after Functional reach test

Standing dynamic reaching activities

Parapodium

Standing frame -- allows patient when needed Prefabricated frame -- ambulation by shifting weight and rocking base or frame across the floor (used primarily by pediatric population)

Progression of gaze stabilization with falls

Start with simple target, patient moves head in direction that is easiest to focus Using two targets patient focuses on one eith eyes and head aligned then moves eyes to other without moving head Habituation exercises involve repeated exposure to a symptom-causing stimulus or movement to reduce the pathological response to that movement

Work on both ___ and ___ balance

Static Dynamic

Pectus excavatum (def.)

Sternum caves in

Pigeon breast (def.)

Sternum protrudes outward

Phase 1.5 (gentle home rehab) of cardiac rehab

Still very monitored -can't handle being outside of home very long so will more than likely be homebound

Systemic JRA is AKA

Still's disease

Single axis foot

Stimulates plantarflexion/dorsiflexion Inversion/eversion can be simulated with the use fo flexible toes Toe break at MTP

How mitotic inhibitors work

Stop mitosis in *M phase*

Goal of redirection

Stop the current behavior from occurring and redirect the patient to another stream of behavior

Advantages of dynamic response foot (AKA energy storing foot)

Stores and releases energy Smoother gait pattern Provides degree of motion to that of multi-axis Flexible (can negotiate uneven terrain) Can be waterproof Available in symes foot

Treatment after 30sec Sit to Stand

Strengthen LEs Improve LE power Improve LE endurance

Treatment after 5x Sit to Stand

Strengthen LEs Improve LE power Improve LE endurance

Treatments to prevent falls

Strengthening exercises (for UEs, LEs, and trunk) Balance and coordination Good shoes and othotics Gait training Environmental safety checks Allow time for activities

Stretching after amputation

Stretch joint area just proximal to amputation due to possible contracture formation **Very important to maintain functionality

Sharpen ___ to aid in compensating for poor vestibular function

Strong aspects of balance

Energy conservation with arthritis

Structuring and simplifying of work and daily tasks to decrease fatigue and maximize energy

Enthesis related arthritis (ERA)

Subtype of JRA Swelling or inflammation with tendons/ligaments that attach to bones causing pain, swelling, and loss of ROM

If in doubt, give a diabetic patient

Sugar

Types of oral meds for diabetes

Sulfonylureas Biguanides Thiazolidinediones Alpha-glucosidase inhibitors Meglitinides Dipeptidyl peptidase IV (DPP-IV) inhibitors

If cardiac patient is extubated, treatment consists of

Supine to sit without the use of UEs Sitting at EOB and letting legs dangle Ankle pumps Long arc quads Hugs (bilateral D1 flexion) Cheer (bilateral D2 extension) Will progress to ambulate 500ft before discharge

AD medications work where

Synapse of neuron Help improves the stimulation of the dendrite

Surgical interventions

Synovectomy Arthroscopic surgery Arthroplasty Joint fusion/tenodesis Tendon transfer Nerve entrapment release Tendon repair Spinal surgery Osteotomy

Gluconeogenesis (def.)

Synthesis of glucose from non-carb molecules (i.e. amino acids, fatty acids) Occurs in liver and kidneys when not enough carbs

Corticosteroid

Synthetic hormones that are used to prevent or reduce inflammation

characteristics of heart failure contributing to exercise intolerance: ___________ contributes to exercise intolerance

abnormal pressures within the heart, reduced L ventricular EF, reduced cardiac output, & increased pulmonary capillary wedge pressure

intervention - exercise program for pts w/ heart failure: exercise prescription in all patients always includes

activity pacing & energy conservation techniques

appropriately selected aerobic exercise can be helpful for pts with

all classes of heart failure as long as their heart failure is not decompensated

emphysema (aka pink puffer) affects the ___ where the O2 & CO2 trade places

alveoli

intervention - exercise program for pts w/ heart failure: brisk walking can elicit

an adequate training effect in many pts with heart failure

hypertrophic cardiomyopathy (HCM) affects

an aged individual

cardiopulmonary test & measures: BP is used to

assess systemic perfusion & must be measured @ least @ baseline & after each intervention & if there are any s/s of decompensation

cardiopulmonary test & measures: heart sounds are heard by

auscultation of the heart through the chest wall with a stethoscope

test & measures - neuromuscular: cognitive deficits in pts with heart failure are thought to be caused by

cerebral infarction &/or cerebral hypoperfusion

potassium less than or equal to 3.2 mEq/L OR greater than or equal to 5.1 mEq/L

check with PT & physician (arythmias)

COPD

chronic obstructive pulmonary disease

intervention: exercise training is recommended as part of a

comprehensive post-transplant management plan that includes proper nutrition, drug therapy, & frequent medical & surgical follow-up

aerobic exercise is any

continuous activity that involves rhythmic contraction of large mm groups & increases the rate of aerobic metabolism

-cyanosis -diaphoresis -bilateral edema in pt w/ CHF -pallor -fever -weight gain greater than 4-6 lbs/day -abnormal change in breath sounds or heart sounds

contraindications for exercise or physical activity

Resting DBP greater than 110 mmHg

contraindications for exercise or physical activity

Resting HR greater than 100 bpm or less than 50 bpm

contraindications for exercise or physical activity

Resting SBP greater than 200 mmHg or less than 90 mmHg

contraindications for exercise or physical activity

symptoms of -SOB -angina -dizziness -several headache -sudden onset of numbness or weakness -painful calf suggestive of DVT

contraindications for exercise or physical activity

with chronic bronchitis (blue bloater) what decreases the air that is able to flow to & from the lungs?

could be scarring or swelling of the bronchial tubes

with emphysema (aka pink puffer) permanent "holes" are left in the bottom of the lungs which

damage the air sacs causing the lungs to be less able to keep airways open

intervention - exercise program for pts w/ heart failure: exercise mode

depends on pt

intervention: mechanical assist devices are

devices that can be used to provide either temporary or permanent support for a failing heart

your lungs @ work: which mms are mms of respiration?

diaphragm intercostal mms

pathology of CHF: structural causes of heart failure include

disorders of the myocardium, pericardium, endocardium, or great vessels

test & measures - neuromuscular: dyspnea can be rated on the

dyspnea index, which is rated on a 0-4 scale

what has been show to improve outcomes in pts w L VADs (LVADs)

early progressive mobilization

cardiopulmonary test & measures: jugular venous pressure (JVP) will be

elevated in pts with heart failure when they cannot pump blood out of the heart adequately, causing blood to accumulate in the venous system

typical examination findings: patient hx includes information regarding the pt's

employment hx, home environment, equipment the pt is using, health, & social habits

diastolic heart failure is usually detected after

exclusion of other possible reasons for heart failure

indications to terminate exercise or physical activity pertaining to DBP

greater than 110 mmHg

characteristics of heart failure contributing to exercise intolerance: patients with heart failure may only acheive

half the normal increase in cardiac output during exercise

sodium normal values 135-145 mEq/L

hold intervention when: less than 125 mEq/L or greater than 155 mEq/L

eval, dx, & prognosis: preferred practice pattern 6D

impaired aerobic capacity/endurance associated w/ cardiovascular pump dysfunction or failure (guide is available online)

___ in cardiac output by 30-60%

increase

mechanical assist devices include

intra-aortic balloon pumps (iABPs) ventricular assist devices (VADs) cardiopulmonary bypass machines (CPBs)

systolic dysfunction can be further categorized as

ischemic or nonischemic

with CHF, your heart does not stop working..

it has to work harder to pump the blood throughout your body

chronic bronchitis aka

blue bloater

chronic bronchitis (blue bloater) affects the

bronchial tubes that carry the O2 to the air sacs

what may occur with chronic bronchitis (blue bloater)

bronchiectasis

blood glucose 100-250 mg/dL

less than 100 or greater than 250 =LIMITED activity

indications to terminate exercise or physical activity pertaining to O2sat

less than 90%

WBC greater than 5,000/mm3

light exercise: progress to resistive exercise as tol.

eating healthy: COPD

make sure to eat from all food groups •if you are finding it hard to breath while you are eating, try the following •eat slowly and stop often between bites •take small bites, chewing with your mouth closed •eat 6 small meals instead of 3 large meals •try to breath evenly when you chew. Take a few deep breaths PRN. •eat less salt. Food high in salt causes fluid retention •avoid gas forming foods (may cause your stomach to bloat & make it hard to breath). •you may be asked to increase fluid intake to help keep the secretions in your lungs from getting thick.

hematocrit between 24-30% or hemoglobin between 8-10 g/dL

markedly reduced exercise capacity

hematocrit% between 24-30%

markedly reduced exercise capacity

hemoglobin between 8-10 g/dL

markedly reduced exercise capacity

Myocardium

middle layer of the heart -aka muscular layer- contracts to push blood through

new york heart association (NYHA) classification system is the system

most commonly used by physicians to prognosticate & monitor the effectiveness of tx interventions in heart failure

the 3 most important factors affecting the risk of exercise in pts with heart failure were that

multiple systems were affected, as well as, peripheral mms & arteries

Myocardial Infarction (MI) is an interruption of blood supply to an area of the

myocardium for 20min or more

WBC less than 5,000/mm3 or 10,000/mm3 WITH fever

no exercise permitted

WBC between 4,800-10,800/mm2

normal reference range; no activity restriction in healthy adults but some modifications may be needed in clients who are ill or during recovery after chemotherapy

restrictive cardiomyopathy affects..

older adults

unfractionated heparin (normal range 25-35)

partial thromboblastin time (PTT) GREATER than 3x normal range value =NO exercise

Pericarditis occurs when

pericardium becomes inflamed Audible auscultations called pericardial friction rub

emphysema aka

pink puffer

intervention: heart transplantation may be indicated in pts with

poor pumping capability or problems w electrical components that is refractory to optimal pharmacological support

cardiopulmonary test & measures: HR, BP, pulse oximetry, RR & rhythm are often monitored & may

predict the pts tolerance for activity-based interventions

practical (this is what I'm going to do, you can choose to do your tx however you want lol)

prior to tx: 30 second relaxation technique -percussion/vibration must be 3-5 mins 1. percussion: 1 min 2. vibration while exhaling: total 30 secs repeat steps 1-2 3x -ask pt to cough after tx before getting up from table -teach pt huff cough after getting up from table while sitting in a chair

coumadin

protime (PT) greater than 3 or INR greater than 3 =NO exercise

intervention - exercise program for pts w/ heart failure: exercise progression

pts with a low initial exercise capacity will generally make faster initial progress than those who start @ a high functional capacity

musculoskeletal tests & measures include

quantification of ROM, flexibility, postural alignment, joint integrity & mobility

isometric resistance exercise should be avoided in patients with heart failure bc

raises BP

hematocrit =30% or hemoglobin =10 g/dL

reduced exercise capacity

hematocrit% =30%

reduced exercise capacity

hemoglobin =10 g/dL

reduced exercise capacity

the term "cardiomyopathy" is a general term that refers to

the abnormality of the heart mm itself

your lungs @ work: take in O2 from

the air

your lungs @ work: gas exchange occurs in

the alveoli

your lungs @ work: remove CO2 from

the body

with restrictive cardiomyopathy the pumping or systolic function of the ventricle may be normal but

the diastolic function (the ability of the heart to fill with blood) is ABNORMAL. therefore, it is harder for the ventricles to fill with blood, & with time, the heart loses the ability to pump blood properly which leads to heart failure

what will you see with chronic bronchitis (blue bloater)

thick mucous being coughed up

markedly

to an extent which is clearly noticeable

with CHF, you may not experience sx's @ first due to

your heart compensating for the decreased function but over time, the heart will fatigue & you will start experiencing sx's

chapter objectives

•Define congestive heart failure and identify implications for rehabilitation interventions •Understand the etiology and pathology of heart failure •Describe classification systems for heart failure •Identify typical examination procedures used to diagnose heart failure •Provide effective rehabilitation interventions for patients with heart failure •Modify a patient's program, as needed, based on the patient with heart failure's response to exercise •Identify methods to measure outcomes of treatment of patients with heart failure, including exercise testing and self-report measures

intervention: risks

•The three most important factors affecting the risk of exercise in patients with heart failure were that multiple systems were affected, as well as, peripheral muscles & arteries. •Exercise should be closely monitored & adjusted PRN during periods of heart failure decompensation •Isometric resistance exercise should be avoided in patients with heart failure because raises BP •Any other Exercise contraindications •Cardiac arrhythmias

other things to consider with COPD

•make sure to get enough rest & sleep •control stress •energy conservation •practice good posture •cough to clear your lungs of mucous •pursed lip breathing to help catch your breath •diaphragmatic breathing •avoid too hot or too cold temperature •get regular exercise

medications: COPD

•make sure you take all medications as prescribed by your doctor •keep a running list of ALL medications (OTC, prescribed, Vitamins, Herbs to report to your physician because some of these may work against each other) •make sure if you are prescribed O2 to use as prescribed by your physician & keep the nasal cannula donned correctly •nebulizer or Inhaler may be prescribed

managing COPD: also avoid

•strong smells (perfumes) •exhaust from cars •stay in doors when the air pollution warnings are in effect •second-hand smoke •dusts and pollens (especially on windy days) •very hot & very cold temperatures •paint & bug spray fumes •try to avoid crowds during flu & cold seasons

your lungs @ work

•take in O2 from the air •remove CO2 from the body •mms of respiration: * diaphragm * intercostal mms •gas exchange then occurs in the alveoli •O2 IS CARRIED BACK TO THE LEFT SIDE OF THE HEART VIA PULMONARY VEIN WHERE THE HEART PUMPS THE O2 TO THE REST OF THE BODY •CO2 has come back to the lungs via the right side of heart in the pulmonary artery •& removes CO2 from the body •the cycle repeats itself every minute of every day •for the cycle to continue, you must have O2 come into the body from inhalation (12-20bpm)

Activity v. inactivity

"Use it or lose it" is true Have to look at causes of immobility or inactivity Immobilization may be due to disease process or environmental barriers

What you don't know about arthritis can hurt you

*S*welling in one or more joints *E*arly morning stiffness *R*ecurring pain and tenderness in any joint *I*nability to move a joint normally *O*bvious redness or warmth in a joint *U*nexpected weight loss, fever, or weakness with joint pain *S*ymptoms like these persisting for more than two weeks

test & measures - neuromuscular: perceived pain or breathlessness can be measure on a

0-10 scale

test & measures - neuromuscular: angina can be rated on a

1-4 scale

Peak age of oligoarticular JRA

1-5yo

Tips for successful caregiver/patient interactions across cultures

1. Don't treat patients in the same way you want to be treated 2. Begin by being more formal with patients who were born in another culture 3. Don't be "put off" if the patient fails to look you in the eye or ask questions about the treatment 4. Don't make any assumptions regarding the patient's concepts about the ways to maintain health, causes of illness, or means to prevent/cure illness 5. Allow the patient to be open and honest with you by not discounting or laughing at beliefs that are not held by our Western biomedical tradition 6. Don't discount the possible effect of the belief in the supernatural on the patient's health and well-being 7. Make your questioning indirect concerning the patient's belief in the supernatural or use of nontraditional forms of care 8. Try to ascertain the value of involving the entire family in the treatment 9. Be very restrained in relating bad news or in explaining in detail the many complications that may result from a particular course of action 10. Whenever possible, try to incorporate into your treatment plan the elements of the patient's folk medication and folk beliefs that are not specifically contraindicated

Minimal detectable change

10 point improvement in the Disability of the Arm, Shoulder, and Hand (DASH)

Minimum clinical important difference

10-12 point improvement in Oswestry disability index (ODI)

General goal for 5x Sit to Stand

10sec (varies depending on age)

Right middle lobe

16in table, sidelying on left and turned 1/4 backwards onto pillow Percussion over right nipple area (for females -- heel of hand under armpit and fingers beneath breast)

Positive expiratory pressure (PEP)

Breathing employs a device that tries to maintain airway patency by applying positive pressure during expiration

Stats of diabetic neuropathy

15% will develop ulcer 40x more likely to undergo amputation (because non-healing wound)

AS is most common in men aged

15-40yo

If AKA, lie on stomach to stretch hip flexors how long

15min 3x/day

Cardiac patient typically spend ___ in ICU

2 days

Diastasis recti begins in

2nd trimester, continues into early postpartum Improves in 6 weeks to 3 months

Abnormal results showing Impaired Glucose Tolerance (IGT)

2hrs after, glucose is 140-199mg/dL

Normal results of oral glucose tolerance test

2hrs after, glucose should be at or below 110mg/dL

Contracture formation with BKA

Hip flexion External rotation Knee flexion (possible in 1-2 weeks post-op)

Normal GHb AKA Hgb A1C

4-6%

Spondylarthropathies (SA) affect how many

412,000 Americans

Number of joints affected in polyarticular arthritis

5 or more

Time needed for Disability of the Arm, Shoulder, and Hand (DASH)

5-30min

Biggest drug users in coutry are aged

65+

Average length of stay in hospital is ___ for cardiac patients

7 days

IPOPs are worn how long

7-14 days

Risk factors for VaD

Advancing age Male gender Known history of cerebrovascular accident (CVA)/stroke Other vascular risk factors (i.e. hypertension (HTN))

Why should you get a good DBL diagnosis

Adverse reaction if take certain anti-psychotics

Typical diagnoses seen for cardiac rehab

Acute coronary syndrome Myocardial Infarction (MI) Congestive Heart Failure (CHF) S/P cardiac stent Percutaneous Transluminal Coronary Angioplasty (PCTA) Coronary Artery Bypass Graft (CABG) Valve replacement

Type II topoisomerase can increase risk of a second cancer

Acute myelogenous leukemia (AML) seen as early as 2-3yrs after treatment drug is administered

Indications for breathing exercises

Acute or chronic lung disease Thoracic or abdominal pain (from trauma or surgery) Airway obstruction CNS disorder with muscle weakness (SCI, GBS) Kyphosis/scoliosis Stress management Cardiac patients

Stages of arthritis

Acute phase Subacute phase Chronic phase Degenerative phase

Anxiety disorders

Acute stress disorder Post-traumatic stress disorder (PTSD) Chronic PTSD

Liner provides

Added comfort and protection of residual limb

Treatment after Oswestry Disability Index (ODI)

Address low back pain and core strengthening

Treatment after Disability of the Arm, Shoulder, and Hand (DASH)

Address upper extremity dysfunction

Purpose of shoe lift

Addresses leg length discrepancy

Cultural diversity

Addresses things such as greeting, time, eye contact, gestures, volume, gender, conflict, role of family, etc.

Orthotic check out

Adherence to prescription (including stops and locks) Smooth edges, good workmanship Conformity of mechanical joints to anatomic joints Clearance from bony prominance and superficial nerves Comfort of bands, straps, pads Fit and function during sitting, standing, and walking Ability to don and doff orthosis

Advantages of supracondylar cuff suspension

Adjustable Easy application Easy to replace

Instructions for the Disability of the Arm, Shoulder, and Hand (DASH)

Administered as a questionaire

Troponin T (Trop T) is usually checked upon

Admission to ER and every 6hrs for next 2 days

Mode of exercise for diabetic exercise prescription

Aerobic/cardiovascular Strength training

Risk factors for OA

Aging (over 40yrs) Obesity Repetitive stress (from sports, occupation) Previous injury Genetic (joint may be misaligned)

HypERactive delirium

Agitation, hallucinations, inappropriate behavior

Exercise may cause proteinuria, specifically

Albuminuria

Disadvantages of EXOskeletal shanks

Alignment NOT adjustable without major re-fabrication Sockets can NOT be replaced Less cosmetic appearance Heavier than ENDOskeletal

Dopamine purpose

Concentration Socializing Food seeking Sexual desire Motor neuron control

Glucagon is a hormone produced by

Alpha Islet of Lagerhans cells in pancreas

How anti-tumor antibiotics work

Alter DNA inside caner cells to keep them from growing and multiplying

Purpose of sole wedges

Alter mediolateral/metatarsal alignment

Terminology in WHO 2001 disablement model

Altered language and words show a marked change in emphasis form talking in terms of disease or impairment, to talking in terms of levels of health and functioning This change is consistent with widespread acceptance of the social model of disabilities

Age-related changes to integumentary system

Altered skin permeability Vulnerability to injury Decreased sensory perception Decreased vascularity Decreased ability to sweat Decreased inflammatory responsiveness Decreased wound healing Decreased vitamin D production Decreased elasticity

Purpose of heel wedge

Alters alignment of calcaneus Can be internal or external

Material of uprights

Aluminum/steel/plastics

Acetylcholine is used to treat which diagnosis

Alzheimer's disease

Glutamate is used to treat which diagnosis

Alzheimer's disease

Types of dementia

Alzheimer's disease (AD) Lewy Body Dementia (DBL) Frontotemporal dementia (FTD) Vascular dementia (VaD) Parkinson's Disease with Dementia (PDD)

Cardiac post-op day 2

Ambulate

DBL patients typically have ___ and ___, similar to AD

Amyloid pathology Senile plaques

Insulin is a hormone produced by

Beta Islet of Lagerhans cells in pancreas

Advantages of pin/shuttle suspension

Better cosmetic appearance Simple/easier to donn/doff than sleeve Minimal pistoning

Location of falls

Between 20-55% of falls in adults over 60yo occur inside the home Most falls occur at ground level Approximately 16% of falls occur on stairs 4% of falls occur in bathroom 2-5% of falls occur during hazardous activities (i.e. ladders, etc.) 23% of falls occur outside 75% of nursing home residents fall annually

Multiple diagnosis

Biggest problem facing the elderly Have to deal with each problem as it presents itself Rehab will focus on functional levels

Age-related neurologic changes

Brain decreases in size and weight Synapses slower

Glycogenolysis (def.)

Breakdown of glycogen to glucose

Mitotic inhibitors are used to treat

Breast cancer Lung cancer Myelomas Lymphomas Leukemias

Hormone therapy is used slow growth of which cancers

Breast, prostate, and endometrial (uterine) cancers ** These normally grow in response to natural sex hormones in the body

Cough assistance

Breath stacking Manually assisted cough Chest wall mobilization

How alpha-glucosidase inhibitors work

Block enzymes that help digest starches (slow the rise of blood sugar) Concerns with hypOglycemia

Uprights are made to conform to

Body image

Pregnant women should be educated on proper ___

Body mechanics

Anatomy of joint

Bone Articular cartilage (shock absorber) Joint cavity Synovium (weeps fluid) Joint capsule (girdle) Tendons (attach muscle to bone) Muscles (flex/straighten joint) Ligament (connect bones, give stability and support)

Surgical processes of amputation

Bone beveling Myodesis Myoplasty Myofascial

Because ankylating agents damage DNA, can can cause long term damage to

Bone marrow

Other side effects of chemotherapy include

Bone marrow suppression Skin rashes Neuropathies Hair loss Sterilization (fertility) Phlebitis

Older term for orthotics

Brace

Atherosclerosis results in

Decreased blood lumen (opening) size Compromised blood flow Resultant tissue ischemia

Retinopathy (def.)

Caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina)

Cardiac neuropathy (def.)

Causes abnormalities in HR control and central and peripheral vascular dynamics

Results of 2nd toe transphalangeal amputations

Causes hallux valgus

Results of 3rd, 4th, or 5th toe transphalangeal amputation

Causes little disability

Targeted therapies attack

Cells with mutant (altered) versions of certain genes, or cells that express too many copies of a certain gene

Central sensory impairments

Central nervous system is needed because information from a single system does not distinguish specific movements and positions Central processing is important when there are sensory conflicts within or between sensory systems Sensory conflict can be triggered by walking on stairs, escalators, uneven ground, dimly lit, or overly bright areas CNS disease, such as stroke, multiple sclerosis, cerebral palsy or brain tumors, as well as trauma, can adversely affect central sensory processing

Neuromuscular tests and measures

Cerebellar screening and equilibrium testing Specific tests of sensory integration or sensory organization Peripheral nerve integrity Motor function -- control and learning

VaD is a result of ___ damage

Cerebral vascular

Central vestibular dysfunctions

Cerebrovascular accident (CVA) Traumatic brain injury (TBI) Vertebrobasilar insufficiency Multiple sclerosis (MS)

Topoisomerase inhibitors are used to treat

Certain leukemias Lung cancer Ovarian cancer Gastrointestinal cancer

Set up for 30sec Sit to Stand

Chair without arm rests and a stopwatch

Examples of compensatory strategies

Change how task is performed Change task expectations or demands Change elements of the physical task environment Change elements of the social task environment

C in CAUTION stands for

Change in bowel or bladder habits

Neuroleptics

Class of antipsychotics that can cause an adverse reaction to those with DBL

Stabilization period

Clinical team is phased out Acceptance of the quality of life Life can be meaningful or meaningless

Treatment after Tinetti balance and gait

Clinician should work on functional activities where there is a deficit on the Tinetti

Pre-gait activities

CoG/BoS Lateral and anterior/posterior weight shift Step up with sound limb Stool step with sound limb

Grading

Cognitively and motoric complex or challenging could be one Patient must follow instruction or multiple step task and complete an infamiliar task Example: using theraband during an activity

Prosthesis fit while standing

Comfortable Midline of heels 6in apart Anterior portion of heel and ball should be flat on floor Should be able to place a piece of paper no more than 1/2in under heel and ball of new shoe Prosthetic length (at iliac crests, greater trochanter, ASIS)

Incidence of diastasis recti

Common

Diabetes and increased susceptibility to infection

Common belief that is not supported by strong evidence Several aspects of immunity are altered in patients with diabetes Evidence that improving glycemic control in patients improves immune functions

Treatment of Alzheimer's disease

Communication strategies Must relate therapy to functional, fun tasks Example: work on dance moves to improve balance Functional reach -- clean counters and reach for objects

Therapeutic activities

Complex to simple continuum (grading the activity) Match targeted muscle groups with activity Meaningful to patient You may need to continue prompting and provide guidance If you identify something that works, pass on the information

Bradypnea (def.)

Slow rate, shallow or normal depth, regular rhythm Associated with drug overdose

Bradrykinesia (def.)

Slowness of movement

Nephropathy (def.)

Damage to or disease of the kidneys **Usually manifests in 15-25yrs after diagnosis **Affects 25-35% of patients under 30yo

Complications of BKA

Death Wounds Contractures DVT Further amputation due to poor wound healing and breakdown

___ in mechanical advantage of abdominals (because of change in center of gravity) during pregnancy

Decrease

Goals of management (what to do when arthritis is stabilized)

Decrease edema Decrease pain Maintain/improve ROM Prevent/correct deformities Psychological support Patient self management Appropriate modification of activities

When cancer patient is overworked, could be due to treatment affecting immune system including

Decrease in WBCs, RBCs, or platelets

Changes that can affect the concentration of a drug

Decrease in lean body mass Decrease in total body water

Liver changes in elderly affecting biotransformation

Decrease in size of liver Decrease blood flow Decreased hepatic liver enzyme activity

Goals of splinting

Decrease pain Decrease inflammation Decrease symptoms of nerve entrapment Support ligaments/capsule Correct or minimize deformity Stabilize for function

Overall goals of arthritis PT

Decrease pain Improve or maintain ROM Increase or maintain joint function Increase endurance for all activities Promote independence in ADLs Improve gait Establish regular exercise program to facilitate strengthening and cardiovascular fitness Educate on joint protection/pain control

Age-related changes in proprioception

Decreased Especially in lower extremities

Changes to kidneys affecting excretion in elderly

Decreased blood flow Decreased glomerular filtration Decreased tubular excretion

Potential benefits of exercise

Decreased blood glucose levels Decreased exogenous insulin dosages Increased insulin receptor sensitivity of target cells Weight loss Increased peripheral circulation

Side effects of surgical oncology treatment include

Disfigurement Loss of function Infection Increased pain Deformity

Central motor impairments

Disorders that affect areas of the CNS that control motor output can cause difficulties with motor control Static, anticipatory, adaptive, and reactive postural control and balance are affected

Dementia -- slow onset of increasing intellectual impairment including

Disorientation Memory loss Diminished ability to make sound judgements Loss of social skills Development of regressed antisocial behavior

Knee disarticulation preserves

Distal femur and patella

Muscle recruitment for ankle strategy

Distal to proximal

Diagnostic test for BPPV

Dix Hallpike test

Caution with chest tubes

Do NOT knock over

___ correct "pregnant posture"

Do not

General contraindications with pregnancy

Do not immerse in heated pool/sauna/hot tub Do not use any modality over throacic/lumbar spine, pelvis, abdomen with exception of hot packs with extra layers of passing to lumbar area Do not lay patient supine after 20 weeks gestation, reclines if okay (5 minute limit in supine after 13 weeks) HypERtension and significant swelling is a red flag and should be reported to MD

Disadvantages of multi-axis foot

Does NOT allow rotation Increased weight Increased cost Increased maintenance Accommodation period and training

Maximizing optimal health

Don't sell aged population short Rehab should focus on activities to maintain or increase functional mobility and capability The more that is done for a person the less they do for themselves

Acetylcholine treatment/medications

Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne)

Orthotic training

Donning and doffing orthosis Working various components/locks Wearing schedule Skin inspection for breakdown Maintenance of orthosis

Absorption of drugs in elderly

Drug passes from GI tract to blood stream

Absent or diminished breath sounds

Due to air or fluid around the lungs (i.e. pneumonia, heart failure, or pleural effusion) Increased thickness of the chest wall Reduced air flow to parts of the lungs Over inflation of parts of the lungs (from ephysema)

Components of cough assessment

Duration Type Severity Irritants/aids

Causes of balance dysfunction

Dynamic equilibrium theory Muscle weakness, skeletal asymmetry, or joint dysfunction can impair balance and increase the risk of falling

LE strengthening after amputation

Dynamic residual limb exercises, isometric/isotonic (AKA PRE)/manual resistance

Hallmark cognitive impairment for *both* VCI and VaD

Dysexutive syndrome

At 20 weeks of pregnancy, mom may experience ___ with mild exercise

Dyspnea

Cardiovascular tests that may be ordered for diabetic patients

EKG/ECG Echocardiogram Exercise stress test Coronary angiogram Thallium stress test

Shank

ENDOskeletal (support is underneath) EXOkeletal (support is seen)

Incompetent cervix (def.)

Early dilation

E in SERIOUS stands for

Early morning stiffness

EPOP (abbrev.)

Early post-op prosthesis

Cardiac patient discharge planning

Educate on sternal precautions Home walking program Referral to cardiac rehab phase II (Medicare pays for post-MI and post-CABG, does not pay for CHF if only diagnosis) Educate on medications Educate on nutrition Smoking cessation IF patient has CHF, they should weigh daily to monitor fluid build-up Healthy lifestyle education (with referral for diabetes education, if appropriate)

Management of diabetes

Education Monitor blood sugar Diet Medications Exercise Foot care

Implications for PT

Education for prevention and early detection Risk of falls Use of modalities Exercise precautions in chemotherapy

Coughing and huffing

Effective means of removing secretions and is critically important for the individual with airway clearance dysfunction Huffing has been recommended in lieu of coughing because it is thought to reduce the physical work of the activity but research has not shown huffing to be any more energy efficient than coughing

Straps are made of ___ to secure orthosis

Elastic Leather Velcro

EKG or ECG (abbrev.)

Electrocardiogram

Diaphragm during pregnancy

Elevated Decreased excursion

Excretion (def.)

Elimination of drug through kidneys

Plaques are condensed in the area of the brain that focuses on

Emotional behavior Feelings of confusion

Early indication of FTD

Emotionally blunted

Forced expiratory clearance (FET) AKA huff cough

Employs a forced expiration or huff after a medium sized breath

Pulmonary hygiene with cardiac patients

Encourage sitting out of bed and upright when in bed Encourage deep breathing and use of incentive spirometer Encourage coughing, use cardiac pillow to splint for pain

Fall risk value for Four Square Step Test (FSST)

Greater than 15sec

Monitoring and documenting for cardiac patients when exercising

HR and SpO2 with exertion BP, HR, and SpO2 with exertion Pain (0-10 scale) Exertion level (either 6-20 or 1-10 Borg scale depending on facility)

Bradycardia (def.)

HR dropping more than 10bpm with no change in work load **Discontinue PT if bradycardia happens without explanation (i.e. new meds, etc.)

Tachycardia (def.)

HR increases to above 120bpm **Discontinue PT

Preeclampsia

High blood pressure **Eclampsia is severe, high blood pressure

Manual devices for airway clearance

High frequency chest wall oscillation (HFCWO) Positive expiratory pressure (PEP) Flutter and Acapella Percussors and vibrators

Dynamic gait index

High level gait assessment

Wheezing breath sound

High pitched musical noise Usually on expiration (can be on inspiration) due to narrowing of lumen High pitched course or high pitched whistling sound like stretching neck of inflated balloon

Acute onset of systemic JRA

High spiking fever 2x/day, generally in morning and night

Prognosis of AKA

Highest healing rate for PVD

Results of AKA

Highest percent of patients are NOT ambulating after amputation with prosthesis

Lack or dysfunction of any type or component of postural control

Hinder a person's ability to meet particular task demands and increase the risk of falling

AKA positioning in supine

Hip extension Neutral rotation Neutral ABDuction/ADDuction

AKA positioning in prone

Hip extension (with pillow under residual limb to promote extension)

Contracture formation with AKA

Hip flexion ABDuction External rotation

If cardiac patient is on ventilator

Hold PT until after weaning -- but that does not mean you hold for all mechanical vent patients **If patient has stable hemodynamics, they can be mobilized out of bed even on a vent

Bail locks

Horseshoe shaped Located on posterior aspect of knee Posterior pressure unlocks it

Assist family in identifying what tangible supports they need and how they might elicit assistance from other family members, friends, neighbors, and available community resources

How health professionals can support families

Clarify how the diagnosis will affect the individual's occupational and social functioning

How health professionals can support families

Help make care decisions in which they consider both their own needs and the needs of the desires of the person with dementia

How health professionals can support families

Provide resources that will enable them to support the occupational functioning, well-being, and overall quality of life of their family members with dementia

How health professionals can support families

Share information about community resources (i.e. Meals on Wheels, transportation assistance, housekeeping or chore services, adult day care, senior citizens' center actvities, friendly visitors, respite programs)

How health professionals can support families

Share practical strategies for dealing with behavioral problems and other challenges

How health professionals can support families

Support family to take steps when the person with dementa is still able to make decisions related to financial planning (i.e. making a will), care preferences, and end-of-life decisions (advanced directives)

How health professionals can support families

Validate family members' feelings and experience as caregivers

How health professionals can support families

Kyphosis (def.)

Hunchback

Ace inhibitors (Lisinopril) is used with

HypERtension (HTN) Congestive heart failure (CHF)

Diuretics (Lasix) is used with

HypERtension (HTN) Congestive heart failure (CHF)

Natural state of ___ occurs during pregnancy because mom needs to meet the oxygen needs of her and baby

HypERventilation

Ace inhibitors (Lisinopril) can cause

HypOtension Dizziness Persistent dry cough

Diuretics (Lasix) can cause

HypOtension Electrolyte imbalances

Beta blockers (Metoprolol) can cause

HypOtension and bradycardia

Redirection

Hypothesize why person is doing what they are doing Give the patient something new to do Engage patient in a meaningful way

I in CAUTION stands for

Indigestion or difficulty swallowing

Dysexutive syndome (def.)

Individual will demonstrate particular impairments in attention, working memory, planning, sequencing, abstraction, and speed of mental processing rather than memory

Cognitive impairments

Individuals who have had a stroke, head injury, multi-focal cerebral infarcts, tumors, or dementia may have significant changes in cognition that can increase their risk of falling

Advantages of soft dressings

Inexpensive Light weight Readily available Can be laundered Dressing of choice with infection because readily available and easy to replace

Arthritis (def.)

Inflammation of a joint

Ankylosing spondylitis (AS)

Inflammation of spinal ligaments Progressive stiffness in the spine

Nature

Inherit genetic traits that affect adjustment

Shock and anxiety

Initial reaction Initiates body's defense mechanisms

Causes of labyrinthitis

Inner ear virus Flu-like symptoms Stomach virus with GI symptoms Occasionally, herpes virus Bacterial or infectious organisms for example the organism that causes lyme disease

Endocardium

Innermost layer of the heart

Swan-Ganz catheter (def.)

Inserted into jugular or subclavian veins to measure pulmonary arterial and R ventricular pressures

Alzheimer's disease is a slow progression with

Insidious onset

Pre-op management on exercise/functional mobility

Instruct in post-op exercise Positioning (prone, supine, sitting) Instruct in transfers and wheelchair mobility Access stress and coping mechanisms

Normal sugar metabolism is regulated by two hormones

Insulin Glucagon

Continuous stimulus insulin infusion

Insulin pumps (Betatron II, Autosyringe) **Commonly used with type I (IDDM)

IDDM (abbrev.)

Insulin-dependent diabetes mellitus (AKA type I)

Age-related changes to cognition

Intellegence generally unchanged until 80s Timing and speed decreases significantly Age-related slowing Memory primarily in short term memory

Sensory training or retraining with falls

Intended to optimize the function of the visual, vestibular, and proprioceptive sensory systems to enhance delivery of information to the CNS where it can be integrated and precessed, and then used to control balance

Disability (def.) in WHO 2001 disablement model

Interaction between individuals with a health condition (i.e. cerebral palsy, Down's syndrome, depression), and personal and environmental factors (i.e. negative attitudes, inaccessible transportation/public buildings, and limited social supports)

How anti-metabolites work

Interfere with DNA and RNA growth by substituting for normal building blocks

How topoisomerase inhibitors work

Interfere with enzymes called topoisomerases Inhibits separation of DNA strands during *S phase*

2001 WHO disablement model

International Classification of Functional Disability, and Health (ICF)

1980 WHO Disablement model

International Classification of Impairments, Handicap and Disability (ICIDH) Used terms "impairment", "disability", and "handicap"

Mitotic inhibitors can also cause nerve damage which will

Limit the number of drugs which can be given

90% of people 75-84 yo can manage without help to perform basic ADLs but 50% of the same people have

Limitations in transfers and ambulation without assistance

Disadvantages of SACH

Limited dorsiflexion/plantarflexion Heel cushion loses elasticity over time Rubber heel corrodes over time

Advantages of IPOP

Limits edema (because rigid form puts pressure when WB) Earlier ambulation Earlier prosthetic fit (not always better fit) Overall shorter rehab time

Age-related changes to hepatic system

Liver decreases in size and weight Liver more fibrotic Function is moderately affected

Mobility ADLs include

Locomotion Use of public transportation

Old terminology for KAFO

Long leg brace

Diabetic neuropathy is the most common complication of

Long term diabetes mellitus

Fall risk value for Timed Up and Go (TUG)

Longer than 13.5sec

Fall risk value for One Leg Stance Test (OLST)

Longer than 5sec, eyes open

Internal foot orthotics include

Longitudinal arch support Metatarsal pad

Skin inspection for breakdown from orthosis

Look at bony landmarks to see if blister is forming Redness going away in less than 30min is good, if stays longer than 30min then thats bad and need to notify PT **Putting something between skin and orthosis is only a temporary solution because actually creates more pressure

Rupture of membranes

Loss of amniotic fluid ("water breaking")

Old orthotic components

Metal Leather

Bands are more rigid and are made of

Metal or plastic in leather or neoprene

Biguanide medications

Metformin (Glucophage) is most common Riomet Fortamet

Age-related changes in musculoskeletal system

Microfibrinous adhesions not broken down Decreased elastic properties of collagen (prone to contracture formation) Decreased cartilage lubricating abilities leading to osteoarthritic changes in the joints Greater friction and more heat in joint

Transmetatarsal (mid foot/Chopart's) amputation is through the

Mid section of metatarsals

Diasis recti (def.)

Midline separation of rectus abdominis at linea alba Results from stress/hormones Not all spontaneously close

Stage 3 of Global Deterioration Scale

Mild cognitive decline (early confusion) Earliest clear deficits Difficulties often noted at work May have gotten lost May have misplaced a valuable object

Specific causes of BPPV

Mild to moderate head trauma Head in same position for a long time Bike riding rough trails High intensity aerobics

Psychological adjustment

Occurs in three phases: - Traumatic reaction period - Post-traumatic adjustment period - Stabilization period

Prognosis of BKA

Most functional Better mobility Increased success with IPOP Minimal phantom limb pain

Injury prevention or reduction with falls

Most important considerations in making home modifications to reduce falls are modifications of surfaces, lighting, obstacles, and activity in the home

Role of cognition

Most significant factor in determining the way of dealing with the world Perception of the event and subjective value assigned to the factors Individuals beliefs and value systems help determine adjustment

BPPV patients are occasionally quite ill with nausea, vomiting, and other ___ like symptoms

Motion sickness

Clinical notes on assessing pulse ox accuracy

Motion, acrylic nails, dirt on finger, etc.

Guidelines for prosthetic candidate

Motivation Strength Residual limb status Cognition Function Ability to problem solve

Foot deformities associated with diabetes

Motor nephropathy (hammer and claw toe)

Purpose of diaphragmatic breathing

Move diaphragm, done by using abdominal muscles not accessory chest muscles When diaphragm is pulled down, lungs expand and when diaphragm is pushed up, air is expelled

Parkinsonism (def.)

Movement disorder characterized by rigidity and bradykinesia

Hearing symptoms with vestibular migrane

Muffled hearing Ear fullness Tinnitus (ringing in ear)

Drug use in elderly is influenced by

Multiple diagnoses

Myofascial

Muscle from behind is attached to fascia on other side, usually attach graft to mobile muscle bed (but subcutaneous grafts are not as durable because no fat layer) NOT as effective for muscle stabilization Used if severe ischemia and thus cannot do other procedures

N in CAUTION stands for

Nagging cough or hoarseness

Guide to Physical Therapist Practice uses ___ disablement model

Nagi's The Guide's preferred practice patterns are based on the pathologies of four systems and their related impairments

Menieres disease

Named after the 19th century physician who described condition Disease of adults often beginning in 30s or 40s, rarely occurs in children

Disablement models in 1993

National Center for Medical Rehabilitation Research (NCMRR) combined Nagi and ICIDH models

Cortiosteriods

Natural hormones and hormone-like drugs that are useful in the treatment of many types of cancer, as well as other illnesses

Mitotic inhibitors are derived from

Natural products, often plant alkaloids and other compounds

Side effects of hormonal cancer treatment

Nausea/vomiting Hypertension (HTN) Steroid-induced diabetes Myopathy Weight gain Altered mental status Hot flashes Sweating Impotence Decreased libido

Fluid and electrolyte imbalance is common in cancer patients due to

Nausea/vomiting (N/V)

Cortiocosteroids are commonly used to help prevent

Nausea/vomiting caused by chemotherapy Severe allergic reactions (when taken before chemotherapy)

Indications for thigh corset suspension

Need for knee stability Short residual limbs

Pulse ox errors from low perfusion/dysrhythmia

Need good perfusion for machine to read signal correctly Patients with poor perfusion (i.e. atrial fibrillation) machine has difficulty distinguishing weak signal from "noise," like patient movement "Probe off" false reading happens when probe has fallen off earlobe but value is given due to excessive ambient light

ENDOskeletal shanks are used when

Need to change components Can make post-fabrication adjustments

Clinical notes of proper pulse ox documentation

Need to include all vital signs and S/S of hypoxia

Pre-gait exercises with prosthesis

Need to reteach BoS and bipedal balance Important not to skip these basic exercises prior to gait with prosthesis

Hemovac unit is a

Negative pressure vacuum drain system used to pull fluid out of residual limb

Sleeves are made of

Neoprene, silicone

Complications associated with diabetes

Nephropathy Retinopathy Atherosclerosis Peripheral vascular disease (PVD) Coronary artery disease (CAD) impaired wound healing Peripheral neuropathy

Structural problem in physiology of AD

Neurofibrillary tangles from an over accumulation of tau protein

Manual assisted cough is used with

Neuromuscular damage with weak respiratory muscles (i.e. SCI)

Why stops preventing plantarflexion create a function position

Neutral for swing phase (or else toe will drag) End up rolling off neutral foot (because NO plantarflexion for toe pushoff) Neutral foot clears floor but get foot slap in initial strike

What to look when observing cough

Note if weak or not

Once you identify the behavioral manifestations of a physiological process

Note it in the chart and tell others what you found

Pin/shuttle suspension

Now commonly used Achieved by rolling a closed end line of silicone or urethane directly on limbs Often used with TSB socket Prosthesis is suspended by pin Prosthetic socks are worn over liner (so friction is between sock and liner)

with COPD sometimes the lungs become damaged & dont work as they should, the lungs stop the exchange of ___ & ___ correctly through the ___ ___

O2 CO2 air sacs

Mild cognitive impairment shows evidence of cognitive decline based on

Objective measurement

O in CAUTION stands for

Obvious change in wart or mole

Red flags for urgent re-evaluation for arthritis

Obvious changes in condition including: -Increased redness -Decreased ROM -Increased pain -Decreased strength noted -Decreased/inability to ambulate -Increased difficulty with ADLs

O in SERIOUS stands for

Obvious redness and warmth in a joint

Orthotist (def.)

Person who designs, fabricates, and fits orthosis

Recommendations for treating these patients

Optimize patient involvement Maintain optimistic but realistic outlook Limit use of jargon and labels Enforce independence and self-reliance

Role of vestibular system

Orient the head and body to vertical Activate anti-gravity muscles and automatic postural responses to control the stability of the head and the body's center of mass

Borg scale (rate of perceived exertion or RPE)

Original scale ranges from 6-20 Modified scale goes from 1-10

First generation sulfonylurea medications

Orinase Diabinese Dymelor Tolinese

Examples of orthosis that decrease deformity

Orthosis to address ulnar drift and hammer toe caused by RA

Osteopenia

Osteoclasts outnumber osteoblasts Bone density is lower than normal peak density but not low enough to qualify for osteoporosis

What needs to be ruled out to refine labyrinthinitis diagnosis

Other conditions such as BPPV, Menieres syndrome, vestibular migrane, damage to arteries in neck (i.e. vertebrobasilar artery insufficiency), small stroke, generalized inflammation or infections or hemorrhage in labyrinth or brain Particularly if patient has risk factors for stroke, such as smoking, high cholesterol, obesiy, heart disease, HBP, or strong family history or heart disease or stroke

PPD and DBL

Other than the time sequence (movement disorder precedes cognitive disorder in PPD) in which symptoms appear, there are no distinguishing features that can discriminate

Hip strategy head movements

Out of phase with hips

Pericardium

Outer covering of the heart

Transport problem in physiology of AD

Overproduction of plaques

Hemoglobin is red pigment in RBCs that carry

Oxygen

Boutonniere deformity

PIP flexion DIP hyperextension

Swan neck deformity

PIP hyperextension DIP flexion

After amputation, defensive retreat occurs to

Past events

Weight bearing surfaces with PTB socket

Patellar tendon Medial tibial flare and anteromedial aspect of tibial shaft Mid-shaft of fibula Pre-tibial muscle group

PTB (abbrev.)

Patellar tendon bearing

FTD has a slow onset, will see prominent changes in

Personality Behavior disturbances Changes in social awareness These are the early and most obvious impairments

Primary feature of FTD

Personality changes

Core components of cardiac rehab according to AHA

Patient assessment Nutritional counseling Weight management Blood pressure management Lipid management Diabetes management Tobacco cessation Psychosocial management Physical activity counseling Exercise training

Do NOT perform One Leg Stance Test (OLST) if

Patient cannot balance with both feet together, they will fall

Vertigo

Patient complains of spinning or that the world is spinning Usually indicates inner ear issues

Performing segmental breathing

Patient in sitting or hooklying Place firm downward and inward stretch of chest just before inspiration, then apply gentle manual resistance to increase sensory awareness

Vertebral Artery test

Patient lays supine Neck is passively extended and rotated while talking to patient Look for nystagmus, slurred speech, or confusion **If unable to lay supine, patient can be seated leaning on forearms looking backwards

Instructions for Functional reach test

Patient makes fist Line up MCP joints with 0in marker Therapist positions self to prevent fall Patient to reach forward as far as able without losing balance NO trunk rotation permitted Document ditance reached

Anger and hostility

Patient may project blame, anger, and hostility Negativism Rebelliousness Opposition Non-compliance Resolution needed before acceptance phase

After Epley maneuver

Patient should sit still with head upright for 10-20min Begin walking with caution AVOID provoking behaviors for remainder of the day AVOID sleeping on the affected side for 24hrs

INVALID Four Square Step Test (FSST)

Patient touches canes or loses balance

Level 1 of phase 1 (inpatient) cardiac rehab

Patients don't receive PT in first 24hrs after cardiac event

Acute coronary syndrome is used to describe

Patients who present to the ER with either acute MI or unstable angina

When NOT to exercise if diabetic

Peak insulin times Late at night **May cause hypOglycemia

Adaptation after amputation includes

Peer respect, independence, social activity

Liner is commonly made of

Pelite, silicon gel

Hemipelvectomy removes the

Pelvis

What pulse ox measures

Percent of hemoglobin saturated with oxygen

Three layers of heart wall

Pericardium Myocardium Endocardium

Peripheral motor impairments

Peripheral motor system executes all of the movements required for postural control Ankle strategy Hip strategy Stepping strategy

Neuromas are formed from

Peripheral nerves

Ureters enter the bladder at a ___ angle because of uterine enlargement

Perpendicular

Examples of cortiosteroids

Prednisone Methylprednisolone (Solumedrol) Dexamethasone (Decadron)

Fasting plasma glucose test is the ___ method of diabetes diagnosis

Preferred

Goals following amputation are dependent on

Premorbid functional level Rate of healing Motivation and compliance Emotional adjustment Condition of intact limbs Abilities and limitations

Diagnoses we treat

Prenatal and postpartum care Incontinence Voiding dysfunctions Pelvic pain Dyspareunia

Supplemental oxygen

Prescription required Order may include flow rate or FlO2 (inspired oxygen concentration)

DBL is named by the

Presence of Lewy bodies in the brain

Clinical features of VaD

Preservative behaviors Difficulties with verbal fluency on neurophychological tests

Segmental breathing

Presumes that inspired air can be actively directed to a specific area of lung by emphasizing and increasing movement of the thorax overlying that lung area Questionable if patient can actually improve a segment of lung

Bedrest ordered with

Preterm labor (PTL) or premature onset of labor (POL) Premature rupture of membranes Placenta previa (placenta covering cervix) Uterine activity resulting in cervical effacement and dilation prior to 37 weeks

Goals of postural drainage

Prevent accumulation of secretions in patients at risk for pulmonary complications Remove accumulated secretions from the lungs

Goals of chest PT

Prevent airway obstruction Improve airflow Improve respiratory tolerance to exercise Decrease energy costs of breathing Prevent, reduce, or correct dysfunctional postures Encourage relaxation Improve chest mobility Teach effective ways to cough

Purpose of longitudinal arch supports

Prevent depression of subtalar joint

Contracture management

Prevention through PROM, standing De-cerebrate posturing in late stages Skilled therapy for orthotics, ultrasound/heat and stretch, establishing ROM programs Will meds or splinting be needed

RH + polyarticular arthritis

Primarily in females after 8yo 50% of polyarticular arthritis patients

Global Deterioration Scale is used for the assessment of

Primary degenerative dementia and delineation of its stages

Pulse ox errors due to dirt, fingernail polish, acrylic nails or anything blocking sensor light path

Probes are calibrated for the amount of tissue and bone/cartilage expected (finger vs earlobe) Assumes nothing else is blocking light

Pharmacokinetics (def.)

Process by which body handles drugs

Surgery for BPPV

Rare cases where the posterior canal is plugged Caries risk of hearing loss

Clinical features of systemic JRA

Rash over trunk and proximal extremities common Possibly enlarged liver or spleen Swollen lymph nodes Inflammation of heart or pericardium Joint pain and myalgia

Factors in recovery

Rate function is lost, brain can adapt better to a more gradual loss Age of patient when function is lost Young people adapt more easily, patients after age 50 have more difficulty compensating

General goals of vestibular rehab

Re-orient source of vertigo (i.e. otoconia) via Epley maneuver Reduce gaze stabilization problems (visual ocular reflex -- VOR, exercises, saccades) Reduce vertigo via habituation exercises (i.e. brandt Daraff) Balance retraining Facilitate compensation of any part of the system that cannot function

Patients with unilateral loss of labyrinthine function are initially quite sick but

Recover more rapidly than bilateral patients

Treatment for labyrinthinitis

Recovery may be slow taking several weeks or months Positional vertigo syndrome may occur after a few weeks or months which can be treated with physical therapy Exercise activities are encouraged to help the body compensate for any loss of function and adapt to its new balance requirements Specialized vestibular physical therapy programs are sometimes used to speed up recovery

Warning signs of PTSD (patient can display any ONE of these)

Recurrent, intrusive recollection of traumatic event Intrusive and distressing dreams of event Disassociative states (behaving as if relieving event) that can last seconds to minutes Amnesia of events

R in SERIOUS stands for

Recurring pain and tenderness in any joint

A treatment session may consist of constant

Redirection That is okay and may be what is needed

Signs and symptoms of joint inflammation

Redness Joint swelling Joint pain Joint stiffness Loss of joint function Heat

Goals of arthritis PT in acute stage

Reduce pain and inflammation Maintain ROM Maintain strength and endurance of associated areas Assist in ADLs Protect joints involved (splinting and bracing) Patient education

Ankle strategy is used when perturbation is

Slow and low amplitude

Solution to increased respiration rate from activity or exacerbation in COPD/asthma patients

Relaxation/control breathing Using purse lips breathing and efficient accessory muscle activity along with diaphragmatic breathing to slow respirations helps to "spiral out" of the crisis/improve breathing

Effects of pursed lip breathing

Releases trapped air in lungs Keeps airways open longer Prolongs exhalation to slow breathing rate Improves breathing pattern by removing old air Decreases work of breathing improves ventilation Relieves shortness of breath General relaxation

Meglitinide medications

Repaglinide (Prandin) Nateglinide (Starlix)

Clinical diagnosis of DBL is strengthened by

Repeated falls Non-visual hallucinations (can be auditory or sensory) Delusions Syncope or transient losses of consciousness Hypersensitivity to neuroleptics

Atrial flutter

Repeated rapid P waves

Atrial flutter/fibrillation

Repeated rapid P waves (flutter) to rapid chaotic atrial arrhythmia (fibrillation) which is noted by absent P waves Most common arrhythmia Common in elderly

T wave

Repolarization of ventricles (diastole) Rounded deflection after QRS complex

Systemic JRA

Reported in childhood Can be found in adults (Aged 20) but still considered juvenile diagnosis Least common form (only in 10-20% of JRA)

Activity analysis

Required component skills Proprioceptive, kinesthetic, vestibular, muscular, tactile, smell, cognitive (sequencing, memory, problem solving, recognition, etc)

Set up for 5x Sit to Stand

Requires chair without armrests and a stopwatch

Result of kidney changes affecting excretion

Slow excretion of drug

Second degree heart block: Mobitz type I (Wenkebach)

Similar to first degree heart block but PR interval delay gets wider **Hold PT until clarification is received because it may be an emergency and patient may need pacemaker

Discovery of Epley Maneuver for BPPV

Simple treatment is one of the most gratifying advances in the evaluation of the dizzy patient BPPV can be diagnosed and treated successfully with no invasive tests, no pills, no surgery and no special equipment

Prosthesis fit while sitting

Sit comfortably Minimal bunching of sift tissue in popliteal area Knees can flex 90' (if unable, popliteal brim may be too high) Lean forward (if unable, transfemoral anterior brim maybe too high) Knees should be level

Performing breath stacking

Sit on EOB or in chair in upright position with shoulders relaxed Take in a small breath and hold for 1sec Take in a larger breath and hold for 1sec Take in an even larger breath to completley fill lungs Hold breath for 3-10sec Slowly exhale through pursed lips Repeat 2-4x/day Can teach this technique prior to cough to increase lung expansion

Gait training starting in parallel bars or tilt table

Sit to stand (two hand support --> one hand --> no support), do NOT let patient get dependent on parallel bars Progress to assistive device (if young with good balance use crutches, if old and poor balance use walker) Teach gait with and without prosthesis All surfaces (curbs, ramps, stairs)

EZ stander

Sit-to-stand standing frame for all ages Glider also available

Recommended position for coughing

Sitting with trunk flexed and hands/arms supported

Disadvantages of CET

Size of equipment keeps patient in room Bag interferes with laying prone Patient spends more time in bed (skin care concerns -- i.e. bed sores)

HypOactive delirium

Sleepy, lethargy, depression-like symptoms More common type

Blood pressure during pregnancy

Slighly decreases in 1st trimester Lowest midway through pregnancy Gradually increases through end of pregnancy

Age-related changes to cardiovascular system

Slight increase in BP Slight decrease in HR and O2sat Decreased stretch of myocardium Decreased cardiac output

Alignment of hip joint

Slightly forward and anterior to greater trochanter Prevents ABDuction/ADDuction Drop ring lock can be added for flexion control (locked into hip extension for standing/walking at 90' of hip flexion for standing)

Methods of suspension

Supracondylar cuff Thigh corset Waist belt Sleeve Pin/shuttle

Treatment of normal pressure hydrocephalus

Surgical management with shunt frequently clears symptoms

Criteria for successful activity

Sustaining of the activity Does patient appear to be engaged by scanning the environment, looking in the right direction and staying on task

Myodesis

Suturing of muscle or tendon to bone Helps to stabilize divided muscles Inadequate surgical techniques can result in weak muscle or skin that cannot tolerate weight bearing Better stabilization than myoplasty NOT recommended if ischemic

Equipment seen in patient on first day of cardiac rehab

Swan-Ganz Multiple IV sites Foley catheter TED hose Chest tubes

Visual cues can be improperly interpreted with bilateral loss of labyrinthine function

Swaying of the trees is an example Patient will adjust their body which is not needed We all have experienced abnormal sensations even with normal labyrinthine function such as hitting our breaks when still because the car next to us goes in the opposite direction Usually the use of visual cues is a good thing but considerable movement from other people or objects can become quite uncomfortable or disconcerning

(First) S in SERIOUS stands for

Swelling in one or more joints

Post-traumatic stress disorder (PTSD)

Symptoms last less than 3 months

Chronic PTSD

Symptoms last over 3 months

(Second) S in SERIOUS stands for

Symptoms like these persisting for more than two weeks

Acute stress disorder

Symptoms occur 2 days-weeks after incident

T in CAUTION stands for

Thickening or lump in breast or elsewhere

Dix Hallpike Test

Tilting a person's head way back at the end of an examination table to provoke the symptoms to see the nystagmus for a through diagnosis

PR interval

Time impulse travels from SA to excite AV node Interval between end of P wave and beginning of QRS complex

Considerations for standardized balance/gait testing

Time required to complete test (including documentation time) Appropriateness of test Set up/available equipment Intra-rater reliability (you doing it the same way) Inter-rater reliability (others doing the same way)

Instructions for Four Square Step Test (FSST)

Time starts with R foot touches upper R quadrant Proceed clockwise Then reverse counterclockwise from upper left quadrant End in upper left quadrant

PR interval on EKG

Time taken for excitation to spread from SA node to AV node

ST segment on EKG

Time taken for ventricles to stop firing

Common balance and gait standardized tests

Tinetti Timed Up and Go (TUG) One Leg Stance Test (OLST) Functional reach Four Square Step Test (FSST) Berg Balance Scale Dynamic Gait

Symptoms of Menieres disease

Tinnitus (ringing in ears) Fluctuating hearing loss Pain Pressure or fullness in ear Bouts of vertigo with nausea and vomiting

Cause of rales AKA crackles breath sound

Tissue fibrosis and secretions in airway (specifically at alveoli)

TSB (abbrev.)

Total surface bearing

Cerebellar screening

Touch nose with bilateral index fingets and alternate with eyes open and closed

Purpose of metatarsal bar

Transfer stress from MTPs to shafts

Cardiac post-op day 1

Transfer to bedside chair

Factors involved in amputation level

Trauma Malignancy Elective stump length AKA or BKA Allow for wound healing and prosthetic fit

Strategies to manage behavioral challenges

Treat/manage physiological symptoms Improve communication (ask closed questions) Redirection/distraction (better to use with angry patients than reason) Behavior maintenance strategies Substitute with an incompatible behavior Develop/implement therapeutic activities

Many dementia patients do NOT respond to

Treatment

In adult guardianship cases, the Global Deterioration Scale is a

Useful and frequent tool of medical evidence

Electrocochleography (ECOG) for Menieres disease

Useful diagnostic technique to test inner ear pressure which is commonly elevated in Menieres disease

Vascular Cognitive Impairment (VCI) reflects cognitive changes that can be attributed to

Vascular changes Most often due to cerebral vascular insufficiency Do NOT meet criteria for dementia

Cognitive decline and nature of course of cognition decline with VCI

Vary depending on subtype (number, size, and location of infarction)

Progression for cardiac patient

Usually "as tolerated"

Lasting effects of Epley maneuver

Usually NO medications are required unless for severe nausea or vomiting Cure is immediate in about 70-80% of patients, may have residual unsteadiness 20-30% symptoms recur within the first week nd the patient is treated again Over the long term, BPPV recurs about half of the time Exercise programs can be prescribed so the patients can treat themselves (i.e. Brandt Daroff exercises or Semont maneuver)

Gradual onset of AD

Usually after 65yo Uncommon among those younger than 60yo but the risks of developing dementia increase considerably with age

Strength training with falls

Usually focus on the lower extremities, particularly the ankle and hip muscles

Laxity of pelvic floor and supporting ligaments can contribute to ___

Uterine prolapse

Sensory Organization Test (SOT)

Utilizes and expensive machine to take away senses one at a time

Active cycle of breathing technique (ACBT)

Utilizes several individual breathing strategies in sequential combination to accomplish the goals of mobilizing and evacuating bronchial secretions

Three principles of geriatric rehab

Variability of the aged Activity v. inactivity Optimum health

Weight gain during pregnancy

Varies from person to person

Anti-tumor antibiotics are used to treat

Various cancers

QRS complex on EKG

Ventricular contraction

QRS complex

Ventricular contraction (depolarization (systole) Largest deflection

Medical emergency

Ventricular fibrillation

3 or more PVCs together

Ventricular tachycardia

BEFORE administering the Dix Hallpike or Supine Roll, you must perform

Vertebral Artery test

Vestibular symptoms with vestibular migrane

Vertigo Imbalance Dizziness Unsteadiness Extreme sensitivity to motion

Premature ventricular contraction (PVC)

Very common arrhthmia Ventricles contract before atria have relaxed (QRS complex starts before P wave finishes)

Tinetti balance and gait

Very common test for balance and gait

Stage 2 of Global Deterioration Scale

Very mild cognitive decline Subjective memory complaints Complaints of being forgetful, such as complaints of trouble with recall of names Complaints of misplacing objects

Stage 7 of Global Deterioration Scale

Very severe cognitive decline Few intelligible words or no verbal abilities Loses the ability to walk as this stage evolves

Onset of PPD

Very slow and insidious Apparent about 10yrs after initial diagnosis of Parkinson's

Advantages of EXOskeletal shanks

Very strong More durable Fabricated for light or heavy use Less expensive Easy to keep clean

Treatment for vestibular migrane

Vestibular migrane is treated similarly to other types of migranes For attacks of dizziness that include nausea, drugs such as Meclizine In the majority of patients who have vestibular migrane, the vestibular symptoms and headaches do NOT occur at the same time, this is why the onset of dizziness by itself makes a correct diagnosis difficult

Flutter and Acapella

Vibratory positive expiratory pressure devices that add oscillation during the expiratory cycle of PEP breathing

Examples of mitotic inhibitors

Vinca alkaloids, taxane alkaloids

Bilateral loss of labyrinthine function leads to characteristic disturbances in

Vision and balance reflecting how crucial or labyrinth senses are in generating proper reflexes so we can see clearly when our head is moving and so we don't lose our balance when walking or standing

Oscillopsia (def.)

Visual disturbance in which objects in the visual field appear to oscillate Severity of th effect may range from a mild blurring to a rapid and periodic jumping Incapacitating condition experienced by many patients with neurological disorders

Peripheral sensory impairments

Visual pathologies such as glaucoma, macular degeneration or diplopia can increase risk of falls and impair balance Problems with oculomotor functions can interfere with orientation to the environment Central components of the vestibular system receive information from the peripheral components and send information to the reticular formation, which facilitates arousal and motor responses

If you need a wandering person to change direction 180'

Walk them in a circle instead of making them turn around

Common behavioral challenges during therapy session

Wandering, inattention, restlessness CanNOT follow written or verbal instructions Does NOT remember the exercise between sets Does NOT sustain the exercise (starts but then stops or drifts off)

restrictive cardiomyopathy (def)

a condition in which the walls of the ventricles are abnormally rigid & lack the flexibility to expand as the ventricles fill with blood

hypertrophic cardiomyopathy (HCM)

a disease in which the heart mm (myocardium) becomes abnormally THICK(hypertrophied). the thickened heart mm can make it harder for the heart to pump blood. typically goes undiagnosed with few sx's-in a small number of cases the thickened walls cause SOB with problems with electrical systems causing life threatening abnormal heart rhythms (arrhythmias)

dilated cardiomyopathy

a disease of the heart mm, usually starting in your hearts main pumping chamber(left ventricle). the ventricle stretches & overly thins (dilates) & can't pump blood as well as a healthy heart can. this might not cause sx's but can be life threatening. this is a common cause of heart failure - the heart's inability to supply the body with enough blood

heart catheterization

a medical test for pts with heart failure that can be used to measure pressures @ various sites in the heart & blood vessels

echocardiography

a medical test for pts with heart failure that provides info about the size of the heart chambers, the thickness of the heart walls, valve form & function, & other info

during periods of heart failure decompensation

exercise should be closely monitored & adjusted PRN

cardiopulmonary test & measures: metabolic equivalent (MET) levels can be determinded by

exercise testing

cardiopulmonary test & measures: standard clinical method for assessing functional aerobic capacity & endurance is

exercise testing

cardiopulmonary test & measures: ventilatory gas exchange can be measured during

exercise testing to provide additional information about functional capacity

emphysema (aka pink puffer) you will have difficulty..

exhaling the CO2 - comes on gradually

which phase of breathing takes longer with chronic bronchitis (blue bloater)

expiration phase

typical examination findings: what will be assessed pertaining to pt hx

fatigue, SOB, reduced exercise & activity tolerance, & peripheral edema

cardiopulmonary test & measures examination will include tests & measures of

fluid accumulation, jugular venous distention, HR & BP, & lung & heart sounds

cardiopulmonary test & measures: heart failure decompensation can cause

fluid retention that presents symmetrically in the distal LE edema & weight gain of 3 or more lbs. in one day

intervention: heart transplantation is the last resort for pts w heart failure bc although it can produce good outcomes, it is

fraught w complications & the availability of hearts for transplantation is far less than the demand

intervention - exercise program for pts w/ heart failure: exercise intensity

generally, pts w heart failure can tolerate an initial intensity ranging from 40-70% of peak VO2 (max HR)

which form of cardiomyopathy is the rarest?

restrictive cardiomyopathy

Time needed for Functional reach test

risk if cant reach farther than or equal to 9"

risk for Timed Up and Go (TUG)

risk if greater than 13.5 seconds

Risk for Tinetti balance and gait

risk if less than 19/28

risk for One Leg Stance test (OLST)

risk if less than 5secs with eyes open

risk for Four Square Step Test (FSST)

risk if time is greater than 15 secs

intervention - exercise program for pts w/ heart failure: exercise frequency & duration

severely compromised pts may require a longer rest interval between exercise sessions, with gradual progression

cardiopulmonary test & measures: six-minute walk test (6MWT) is a

simple clinical tool that can be used by clinicians to assess submaximal exercise capacity; easily performed in corridors or gyms & does not require any special equipment other than a stopwatch (if shorter than 300 meters they have a poorer short term survival rate)

characteristics of heart failure contributing to exercise intolerance: many patients with significant heart failure fatigues with very low levels of exertion such as

simply brushing their teeth or walking to the bathroom

managing COPD: avoid

smoking & air borne pollutions

Electrical conduction of the heart starts @

starts at sinoatrial (SA) node then travels to atrioventricular (AV) node

managing COPD: if you smoke

stop smoking

COPD is actually referred to __ diseases that interfere with __ __ within the lungs such as __ __ & __

two air flow chronic bronchitis emphysema

prognosis for patients with ischemic heart failure is

worse than for those with nonischemic heart failure

emphysema (aka pink puffer) is causes by

years of exposure to something that irritates the lungs