NPTE Mega Review

Bainbridge Reflex

(also, called atrial reflex) autonomic reflex that responds to stretch receptors in the atria that send impulses to the cardioaccelerator area to increase HR when venous flow into the atria increases

Bone mineral regulating agents

- Prevent bone loss - Examples: calcium (calcium carbonate Tums, Calderol), calcitonin (Cibacalcin), biphosphonate (Fosamax), anabolic agents (Premarin) - Indications: Paget's disease, osteoporosis, hyperparathyroidism, rickets, hypoparathyroidism, cardiac arrhythmias - Implications for PTs: Risk for fractures and side effects

Meralgia Paresthetica

-compression of the *lateral femoral cutaneous nerve * -pain & tingling sensation in latearal thigh but *no motor loss* -cause: obesity, postural changes, tight clothing, pregnancy

Borg Dyspnea Scale

0 - no breathlessness at all 0.5 - very, very slight 1 - very slight 2 - slight breathlessness 3 - moderate 4 - somewhat severe 5 - severe breathlessness 6 - 7 - very severe breathlessness 8 - 9 - very, very severe breathlessness 10 - maximal

Normal Basophil Count

0-2%

Cervical Spine Degrees of flexion for Traction

0-5 degrees flexion: Upper Cervical Spine 10-20 degrees flexion: Midcervical spine 25-35 degrees flexion: Lower cervical spine

Stages of Kidney Disease

1 - Kidney damage with normal GFR (>90) 2 - Mild decrease in GFR (60-89) 3 - Moderate decrease in GFR (30-59) 4 - Severe reduction in GFR (15-29) 5 - Kidney failure (GFR <15)

EMG fasciculations

-Indicative of irritation or degeneration of anteiro hor cell -Nerve root compression -Muscle spasms

Cauda Equina Syndrome

-Injury at the L1 level and below resulting in a LMN lesion -Can be complete, often are incomplete due to large number of nerve roots in area. Considered peripheral nerve injury. -Flaccid paralysis w/no spinal reflex activity, loss of bowel and bladder function Above L1 acts like UMN lesion. Can use suprapubic tapping to help void Below L1, will present as LMN

Articulated AFO

Allows for free, unrestricted sagittal plane motion. -Good when solid AFO is too rigid -for spastic cerebral palsy, knee hyperext, correctable ankle equinus -For medial/lateral stability at ankle

-zosin

Alpha blocker to treat BPH and HTN Doxasoin, Prazosin

Hypothermia/Frostbite: Response

Assess verbal and motor responses. Warm the patient, starting with core, using towels, blankets, or skin-to-skin. If patient drops below 95 deg F, call EMS If frostbite, submerge area in warm water or warm uing body heat. Do not use massage, may increase tissue damage

Alternate forms reliability (parallel forms)

Assesses consistency or agreement of measurements obtained with different forms of a test (Each SAT is considered an equivalent measure)

International Normalized Ratio

Assesses risk of bleeding or coagulation. High means risk of bleeding. Normal is 0.9-1.1. Over 2.5: Caution, guard for falls Over 3: At risk for hemarthrosis 4:

Hepatitis B

B= blood and body fluids (hep c is the same) Transmitted via blood and bodily fluids (sharing of needles, intercourse, exposure to blood, semen, or maternal-fetal exposure) 10% of cases progress to chronic Hep Tx: Hepatitis B Immunoglobulin, then vaccination series.

Electrical Burn

Caused by electrical current passing through body. -Entrance and exit wound -Can include cardiac arrhythmias, respiratory arrest, renal failure, neurological damage, and fractures

Hypercalcemia

Caused by hyperparathyroidism, malignant tumors, thiazide diuretics, or acute kidney failure Sxs: WEAK Weakness of muscles EKG changes Absent/diminished reflexes Kidney stone formation

Hyperactive DTRs

Caused by upper motor neuron injury.

Development happens:

Cephalic to Caudal (head and UE before trunk and LE) Gross to Fine (Large muscle skill acquisition before small) Mass to specific (Simple to complex) Proximal to Distal (Trunk control is acquired before extremity control

Telencephalon

Cerebrum Hippocampus Basal Ganglia Amygdala

Joints falling posterior to Line of Gravity

Cervical Joint (Anterior Scalene, Deep neck flexors) Lumbar Joint (Abdominals) Hip Joint (Iliopsoas)

C1 Resistive Test

Cervical Rotation

Power

Chance or percentage that a researcher will find a significant result in a sample if it exists. Usually set to 0.8 Low = low chance of finding significant result when one is present (Type II error)

Obstructed Airway: Response

Check mouth for foreign object, then position behind patient to give forceful, inward/upward thrust on abdomen using closed fists until object is dislodged. If LOC, place in supine and perform rescue breathing and abdominal thrusts, using a finger to sweep mouth

Ankle-Brachial Index

Compares Systolic BP at ankle and arm. Calculated by dividing ankle measurement by arm measurement. Normal is 1.0 to 1.3. Greater than 1.3: Rigid arteries, should check for PAD using ultrasound 0.8-0.99: Mild blockage, beginnings of PAD 0.4-0.79: Moderate blockage, may be associated with intermittent claudication Less than 0.4: Severe blockage, severe PAD, may have claudication at rest

Two way ANOVA

Compares two or more groups of data with two or more independent variables

Irritable Bowel Syndrome

Colon or large intestine are sensitive to certain foods or stress. Symptoms may be triggered by anxiety, caffeine, smoking, alcohol, or fat intake. Sxs: Abdominal pain/bloating/distension, nausea, vomiting, changes in form/frequency of stool, passing of mucus in stool Tx: Diagnosis of exclusion from other GI diagnoses. Change in lifestyle, nutrition, stress, adequate sleep and exercise. Avoid milk, wheat, rye, barley, alcohol, and caffeine.

T test

Comparing two means when population is not normally distributed

Hip hiking during swing

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

Circumduction in swing

Compensation for weak hip flexors Compensation for weak DF Compensation for weak hamstrings

Hyperextension in stance

Compensation for weak quads PF contracture

ASIA impairment scale Category A

Complete No motor or sensory function in the sacral segments (S4-S5).

3rd degree AV Block

Complete heart block. All impulses blocked at AV node, none transmitted to ventricles. Atria and ventricles paced independently. Considered medical emergency, pacemaker required. If ventricular rate is too slow, CO drops and patient may faint.

Pes anserine

Common insertion point of gracilis, semitendinosus, and sartorius on medial tibia.

Anterior Interosseous Nerve Syndrome (AIN

Compression to the anterior interosseous nerve ONLY Motor deficits, no sensory loss Results in a motor loss involving the flexor digitorum longus, flexor profundus to the index finger, and pronator quadratus Tested using "OK sign" test

Pressure Ulcers

Compromised circulation secondary to pressure, friction, or shearing. Most common areas: -Coccyx -Sacrum -Ischium -Trochanters -Elbows -Buttocks -Malleoli -Scapulae -Prominent Vertebrae Symptoms: Reddened area that persists or open area of skin Treatment: Prevention is greatest importance. Change position frequently, proper skin care, appropriate cushion, consistent weight shift, proper nutrition and hydration.

Agonistic Reversals (AR)

Concentric contraction against resistance followed by alternating concentric/eccentric contractions w/resistance. Slow, sequential, used throughout range. Devt. Sequence: Controlled mobilty, skill

Medulla Oblongata

Connects to pons superiorly and spinal cord inferiorly. Influences autonomic nervous activity and regulation of RR and HR. Reflex centers for vomiting, coughing, and sneezing. Damage produces contralateral impairment. Cranial nerves IX-XII originate from this structure.

Reliability

Consistency, reproducibility, or repeatability of a measurement

Blocked Practice

Consistent practice of a single task

Epithalamus

Contains pineal gland, which secretes melatonin and regulates internal clock.

Forebrain (Prosencephalon)

Contains: Telencephalon -Cerebrum -Hippocampus -Basal Ganglia -Amygdala Diencephalon: -Thalamus -Hypothalamus -Subthalamus -Epithalamus

100% Ultrasound Duty Cycle

Continuous thermal ultrasound -Increase blood flow -Deform scar tissue -Heat contractile tissue Typically chronic conditions

Flouroscopy

Continuous x ray shows heart and lungs using contrast medium. Has been replaced with ECG due to high radiation doses

Systole

Contraction

Volkmann Ischemic Contracture

Contraction of the fingers and sometimes, the wrist, with loss of muscular power with death and resultant contracture of the forearm musculature, that sets in rapidly after severe injury around the elbow joint.

Frontal Lobe Impairment

Contralateral weakness Perseveration/inattention Personality changes/antisocial behavior Broca's Aphasia (expressive deficits) Delayed/Poor intiation Emotional Lability

Thyroid Gland

Controls body's metabolism. Produces thyroxine and triiodothyronine to control the rate at which cells burn fuel from food. Increased thyroid hormones increases rate of chemical reactions in body.

Valsalva Manuever

Forced expiration against closed glottis increases intrathoracic pressure +central venous pressure, decreasing venous return, CO, and BP, causing a reflexive increase of HR and contractility.

Brain Divisions

Forebrain (prosencephalon) Midbrain (mesencephalon) Hindbrain (Rhombencephalon)

Upper Extremity Amputations

Forequarter (scapulothoracic) Shoulder disarticulation Transhumeral Elbow Disarticulation Transradial Wrist Disarticulation Partial Hand Digital

Prescriptive Validity

Form of criterion-related validity in which the measurement suggests the form of treatment a person needs. Validity is judged on how accurate that prediction is.

Bathing (drying off, upper/lower body) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Dependent Mid Tet (C6): Min Asst for Upper body, Mod Asst for lower body. Use shower/tub chair Low Tet (C7-8): ModI with all using shower/tub chair Para: ModI with all on tub bench or tub bottom cushion

Ribs

12 pairs that form the wall of the thorax and attach to vertebrae 1-7: attached to sternum through costal cartilage 8-10: Join with costal cartilage of 1-7 11-12: articulate only with bodies of T11-12, classified as "floating"

Nasal cannula

A device that delivers low concentrations of oxygen through two prongs that rest in the patient's nostrils. Can deliver 6 L per minute

Egophony

A form of bronchophony in which the spoken long "E" sound changes to a long, nasal-sounding "A"

Concurrent Validity

A form of criterion-related validity where a measurement is compared to the gold standard at the same time.

Knowledge of Results (KR)

A form of extrinsic feedback, includes terminal feedback regarding the outcome of a movement

Clasp-knife response

A form of resistance seen during range of motion of a hypertonic joint where there is greatest resistance at the initiation of range that lessens with movement through the range of motion Results from damage to cortex or brainstem

Glucagon

A hormone secreted by the pancreatic alpha cells that increases blood glucose concentration, and is released into bloodstream when blood glucose is low.

Coefficient of Variation

A measure of relative variability computed by dividing the standard deviation by the mean and multiplying by 100. CV = sd/mean x 100

Internal Consistency

A measure of reliability; the degree to which a test yields similar scores across its different parts. Does the functional assessment scale include only items that relate to patient's physical function?

Odds Ratio

A measure of the odds of an event happening in one group compared to the odds of the same event happening in another group OR of 1 = Exposure does not increase risk of outcome OR more than 1: Greater odds of association between exposure and outcome OR less than 1 = Lower odds of association between exposure and outcome

Trousseau's sign

A sign of hypocalcemia and early stages of tetany. Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

Rhythmic Auditory Stimulation

A technique used to facilitate rhythmic movement, especially gait in Parkinsonian population Improve cadence, stride length, and gait speed (should be 25% faster than pts current gait speed)

Capillary Refill

A test that evaluates distal circulatory system function by squeezing (blanching) blood from an area such as a nail bed and watching the speed of its return after releasing the pressure. Normal: 2 seconds to full color return Abnormal: Greater than 2 seconds

Vaulting gait

Active PF of stance limb to clear contralateral limb in swing phase Causes: -LLD -Contralateral prosthesis too long -Contralateral foot stuck in PF

Spinotectal tract

Afferent info for spinovisual reflexes, movement of eyes and head towards stimulus

Spinoreticular tract

Afferent pathway for reticular formation, influences level of consciousness.

Convection

Air or water moving in constant motion over body causes gain or loss of heat. Ex: Whirlpool, fluidotherapy

Cerebrovascular Accident

Ischemia or hemorrhage causes lack of blood supply to a specific area of the brain.

Mononeuropathy

Isolated nerve lesion to a single peripheral nerve(trauma, entrapment) Example: CTS

Hold-Relax (HR)

Isometric contraction to increase ROM at limiting point. Devt. Sequence: Mobility

Alternating Isometrics (AI)

Isometric contractions performed alternating from muscles on one side of the joint to the other side without rest. Devt. Sequence: Stability

Pubic symphysis

Joiint formed between each end of the pubis bone. Covered in hyaline cartialge with a fibrocartilage disk in between.

Atlantoaxial joint

Joint between C1 and C2 that permits majorty of cervical rotation

Intermittent lumbar traction

Joint mobilization forthose who cannot tolerate static traction. Max force during hold period, then min force (50% of max) is used during hold. Little evidence to guide.

zygapophyseal joints

Joints between the superior and inferior articular processes of vertebrae

Cremasteric Reflex

L1-2 Stroke skin of upper medial thigh. Testicle should elevate ipsilaterally

Posterior glide of talus

Improves DF

Anterior glide of talus

Improves PF

2nd Degree AV Block Mobitz type 1 (Wenckebach)

Impulses between atria and ventricles fail intermittently. Longer delays between P wave and QRS until one QRS complex is missed. -Benign if asymptomatic -If symptomatic refer to physician -May require pacemaker

Early Heel Off

Inability to achieve DF in midstance Causes: -Limited posterior talocrural capsular mobility -Tight/Spastic PF -Heel pain

Anterograde amnesia

Inability to form new memories

Arterial Insufficiency

Inadequate arterial blood flow. Common in DM, HTN, obese, smokers. Stop smoking, then exercise and weight control PALLOR Pallor Abnormal Nail Growth Little leg hair (gone) Lateral Malleolar Wounds Overly dry/shiny skin Rest pain, intermittent claudication

Anuria

Inadequate urine output in 24 hour period (less than 100 ml)

Oliguria

Inadequate urine output in 24 hour period, less than 400 ml, due to acute renal failure or DM

ASIA Impairment Scale Category D

Incomplete Motor function below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more.

ASIA impairment Scale Category C

Incomplete Motor function below the neurological level, and more than half of key muscles below the neurological level have a muscle grade of less than 3.

Sacral sparing

Incomplete lesion where some of innermost tracts remain innervated. Sensation in saddle area is present, rectal sphincter can contract, and toe flexor movement is retained.

Ulnar glide of proximal carpal row

Increase Radial deviation

Radial glide of proximal carpal row

Increase Ulnar Deviation

Diuretic Agents

Increase excretion of sodium and urine, causing a reduction in plasma volume, decreasing BP. Classifications include thiazide, loop, and potassium sparing agents. Used for HTN, edema associated with heart failure, pulmonary edema, glaucoma Thiazide: Chlorothiazide (Diuril) Loop: Lasix (Furosemide) Potassium sparing: Triamterene (Dyrenium)

Positive Inotropic Agents

Increase force and velocity of myocardial contraction, slow HR, decrease conduction velocity through AV, decrease sympathetic activation. Used for heart failure and A-Fib Digoxin (Lanoxin)

Metabolic Alkalosis

Increase in bicarbonate accumulation or abnormal loss of acids, leading to pH rising above 7.45. Can be a result of vomiting too much, taking too many antacids, or diuretic therapy. Sxs: Nausea, diarrhea, vomiting, confusion, fasciculations, muscle cramping, hypoventilation. Can result in coma, seizures, and respiratory paralysis

Cellulitis

Inflammation that occurs as a result of bacterial infection of the skin and connective tissues. Develops anywhere under skin but typically extremities. Caused by streptococci or staphylococci. Can lead to sepsis or gangrene. Sxs: Localized redness that spreads quickly, skin that is warm or hot to touch, local abscess or ulceration, ttp, chills, fever. Tx: Systemic antibiotics.

Phases of Wound Healing

Inflammatory (1-10 days) Proliferative (3 to 21 days) Maturation/Remodeling (7 days to 2 years)

Rheumatic Fever

Inflammatry disease that develops as a complication of untreated or poorly treated strep throat from streptococcus bacteria. Can damage heart valves and cause heart failure. Sxs: Fever, painful joints, CHF symptoms Tx: Destroy bacteria, relieve symptoms, control inflammation

High Frequency Chest Wall Oscillation Vest

Inflatable vest attached to air pulse generator machine that vibrates at high frequencies Who: Cystic fibrosis with Mucus plugs, or ALS Why: Mobilize solidified mucus in airways, relieve dyspnea, improve activity tolerance, improve oxygenation, and reduce wheezing.

Intra-Aortic Balloon Counterpulsation (IABP)

Inflation and deflation of balloon in aorta provides circulatory assistance for patients after infarction or with cardiogenic shock

Monocytes

Ingests dead/damagedcells and defends against infectious organisms

Laxatives

Metamucil (Psyllium) Colace (Docusate) Glycerin Suppository Milk of Magnesia Correctol (Bisacodyl) Senokot (Senna) Citrucel (Methylcellulose)

Mitochondrial disorders

LHON (Leber Optic Atrophy), MELAS, Leigh syndrome Caused by mutations in DNA that lead to impaired mitochondrial protein function, resulting in loss of muscle coordination or strength, visual/hearing problems, learning disabilities, heart/liver/kidney disease, respiratory, neuro and GI disorders, dementia

Delayed Heel Off Gait

Lack of PF resulting in inability to transfer weight onto forefoot Causes: -Weak PF -Excessive DF -Tibial Nerve palsy -Anterior foot pain

Sensory level for SCI

Most caudal dermatome with a normal score of 2/2 for light pinprick. 0 is absent, 1 is impaired, 2 is intact

Motor Level of SCI

Most caudal muscles that have an MMT of 3 or greater with superior segment tested as 5

SACH Foot System

Non-articulating, rigid keel. Inexpensive, low maintenance, cushioned heel for shock absorption. No energy return or accommodation for uneven surfaces.

Contamination

Non-replicating bacteria on wound surface. No additional tissue injury, does not stimulate inflammatory immune response

Magnetic Resonance Imaging

Nuclear magnetic resonance to visualize tissues. Does NOT use ionizing radiation -Rotator Cuff tears and muscular disorders -Labral and meniscal abnormalities -Disc herniations -Neurologic conditions (entrapment, compression) -Bone marrow variations (bone marrow, tumor, avascular necrosis)

Number Needed to Treat (NNT)

Numbe of patients that need to be treated to prevent one bad outcome or result in one additional good outcome. Ideal NNT is 1, everyone improves. Higher NNT = less effective treatment

E-Stim Frequency

Number of pulses through each channel per second. High frequency causes more rapid fiber recruitment

Quantitative Data

Numbers that represent counts or measurements

Discrete data

Numerical data values that can be COUNTED. No inbetween -Patients diagnosed with cancer -Number of visits to clinic

K Level 2

Patient is able to traverse low-level barriers (curbs, stairs, uneven surfaces) and is a limited community ambulator Knee: Polycentric, constant friction Ankle/Foot: Flexible-keel or multi-axial foot

Dependent

Patient is unable to participate and therapist must provide all effort to perform task

Non-weight Bearing (NWB)

Patient is unable to place any weight through involved extremity, and not permitted to touch ground or any surface. AD is required

Toe-touch Weight bearing (TTWB)

Patient is unable to place any weight through involved extremity, but may place toes on the ground to assist with balance. AD required

Spinal Cord Injury

Permanent damage to spinal cord, resulting in neurological deficits. MVA is largest cause, then stabbing, falls, sports injuries, high risk behaviors, axial loading, rotational injuries. Flexion injuries occur most often at C5-6, Extension injuries occur most at C4-5.

Creep

Permanent deformation of tissue through application of low magnitude load over a long period of time. Example: Dynamic splinting

Eversion

Peroneus Longus, Brevis, Tertius

Muscles innervated by Sacral Plexus

Piriformis Superior and inferior gemelli Obturator Internus Quadratus Femoris

Seizures: Response

Place patient in safe location and position without constraining movements. Monitor RR, ensure airway stays open. Turn pt on left side if vomiting occurs

Heat Illness: Response

Place patient in shaded or covered area, monitor vital signs Remove outer clothing and use ice bag or cold compress on forehead, neck, or groin. Administer water or electrolytes.

Ankle Burn

Plantar flexion deformity Posterior foot drop splint, posterior ankle conforming splint, anterior ankle conforming splint

Parietal Pleura

Pleural layer covering the thorax walls, ribs vertebrae, diaphragm, and mediastinum. Separated by serous fluid from other pleural layer.

Zone of Preservation

Poor or trace motor/sensory function up to three levels below neurologic level of injury.

Lung Volume Reduction Surgery

Portion of lung tissue damaged by emphysema is removed, creating extra space in chest so remaining lung tissue and diaphragm can work more efficiently

Lidocaine-iontophoresis

Positive Used for Analgesia and inflammation

Magnesium Sulfate-iontophoresis

Positive Used for Muscle Spasms and ischemia

Copper Sulfate-iontophoresis

Positive Used for fungal infection

Zinc Oxide - iontophoresis

Positive Used for healing, dermal ulcers, and wounds

Anterior chest and axilla burn

Possible shoulder ADD, EXT and IR deformity Use axillary or airplane splint, or shoulder abduction brace

Infection

Presence of replicating bateria that invades tissue beyond wound surface. Visible inflammatory immune response. Will significantly delay wound healing, can progress to sepsis, osteomyelitis, and gangrene

Shock: Response

Presents with moist, cool skin, diaphoresis (excessive sweating), shallow/irregular breathing, low body temp, weakness, syncope Remove source of shock, monitor BP, HR, and RR. CPr if necessary. Place pt in supine with feet elevated above level of head, assuming no injury to head, spine, trunk or legs.

Plantar Grasp Reflex

Pressure to base of toes causes toe flexion. Normal Age: 28 weeks of gestation to 9 months

H2 Receptor Blockers

Prevents the release of stomach acid to promote ulcer healing Pepcid (famotidine) Zantac (ranitidine) Tagamet (cimetidine)

ACE Inhibitors

Prils Decrease BP by suppressing enzyme that converts Angiotensin I to Angiotensin II. Change the o on Indications: HTN, CHF Captopril, Enalapril, Lisinopril, Ramipril

Parkinson's Disease

Primary degenerative disorder. Production of dopamine decreases in substantia nigra of basal ganglia, resulting in inability to modulate and control voluntary movement. Etiology: Primary--unknown. Contributing factors--genetics, CO toxicity, manganese or copper excess, vascular impairment of striatum, encephalitis, or other neurodegen disease (Alzheimer's, Huntington's) Sxs: Resting tremor in hands or feet increasing with stress and disappearing with sleep. Early--balance disturbances, impairment with fine manipulative movts (writing, dressing). Progression--Hypokinesia, sluggish movement, shuffling gait, bradykinesia, rigidity, freezing during gait. Tx: Dopamine replacement therapy. PT for strength, endurance, and functional mobility.

Male Hypogonadism

Primary hypogonadism: deficiency of testosterone secondary to failure of testes to respond to FSH and LH. Most common cause is Klinefelter's Secondary hypogonadism: Failure of hypothalamus or pituitary to produce hormones to stimulate testosterone production. Sxs: Pre-puberty--sparse body hair, underdeveloped msk, long arms/legs secondary to no growth plate closure Adult-onset--decreased libido, ED, infertility, decreased cognitive skills, mood changes, sleep disturbances.

Beta value

Probability of accepting a false null hypothesis.

Alpha level

Probability of rejecting the null hypothesis when it is true Often 0.05 or 0.01.

p value

Probability that a statistical result could happen by chance. If p value is smaller than alpha, null hypothesis is rejected (P< 0.05). If p value is larger than alpha, null hypothesis is not rejected

Cervical Spine Motions: -Loose-packed position -Close-Packed Position -Capsular Pattern

Seven vertebrae, including atlantooccipital joint and the atlantoaxial joint Motions: Flexion, extension, lateral flexion (sidebending), rotation -Loose-packed position: Midway between flexion and extension -Close-Packed Position: Extension -Capsular Pattern: Lateral flexion and rotation equally limited, extension

3.3 MHz Ultrasound

Shallow regions -Superficial tendonitis -Finger joints

-oprazole

Proton Pump Inhibitor for GERD, peptic ulcers, and H. Pylori Omeprazole (prilosec)

Rectocele

Protrusion of rectum into vagina

Lumbar Plexus (FL)

QL Psoas

Metabolic Alkalosis

Quad T's Tetany Tachycardia Tremors Tingling

Muscles innervated by Femoral Nerve

Quads (RF, VL, VM, VI) Iliacus Sartorius Pectineus

Burn: Response

Remove source of burn, dilute if chemical, brush off if powder. Don't use cold water if large area bc of hypothermia If electrical, assess HR and RR, monitor for cardiac arrest Don't remove clothing if part of burn

Extrinsic feedback

Represents info that can be provided while a task or movement is in progress, or after. Can be verbal or tactile.

Two point gait pattern

Requires bilateral ambulation aids. "Left crutch and right foot, right crutch and left foot."

Cogwheel rigidity

Resistance to movement has phasic quality. Seen in Parkinson's, and basal ganglia lesions

Ischiofemoral ligament

Resists posterior displacement of femoral head

Turgor

Speed at which distended skin resumes natural appearance after being lightly pinched. Indication of skin elasticity

Sternocleidomastoid

Spinal accessory Cr11, C2, C3

Trapezius

Spinal accessory nerve XI and branches of C3, C4

Sitting Bony Prominences (Pressure Injury)

Spine of scapula -Vertebral Spinous Processes -Ischial tuberosities

Lymphedema Stage 2

Spontaneously Irreversible Stage Non-pitting, does not change with elevation or rest. Skin begins to demonstrate fibrotic changes and risk for infection increases. Stemmer's Sign positive at this stage.

Glenohumeral Ligaments

Superior: Limits adduction and ER in 0-45 deg ABD Middle: Limits ER in 45 deg ABD Inferior: Limits inferior translation. Above 90 deg ABD--> -Anterior band limits ER -Inferior band limits IR

Lymphocytes

T lymphocytes and Natural killer cells protect against infections and cancer, and B lymphocytes produce antibodies

Abdominal Superficial Reflex

T8-L1 Stroke each quadrant of abdomen diagonally towards umbilicus. Umbilicus deviates towards stimulus

Face validity

The degree to which a measurement appears to test what it is supposed to. Important to patients who may not be compliant with repeated testing if they don't see how its measurements relate to their problem

Construct Validity

The degree to which a test actually measures what it claims to measure

Validity

The degree to which a useful or meaningful interpretation can be inferred from a measurement

Postural Drainage: Posterior basal segments left and right lower lobes

The patient is in prone with the foot of the bed elevated 18 inches. Percussion and vibration are performed over lower ribs on left and right side of chest.

Postural Drainage: Anterior Segments right and left upper lobes

The patient is in supine with the bed horizontal. Percussion and vibration are performed below the clavicles.

Postural Drainage: Anterior basal segments left and right lower lobes

The patient is in supine with the foot of the bed elevated 18 inches. Percussion and vibration are performed over the lower ribs on the left and right side

Postural Drainage: Posterior Segment Right upper lobe

The patient is turned 1/4 from prone on the left side with the bed horizontal and the head and shoulders raised on a pillow. Percussion and vibration are performed around the medial border of the right scapula.

Postural Drainage: Posterior segment left upper lobe

The patient is turned 1/4 from prone on the right side with the head of the bed elevated 45 degrees and the head and shoulders raised on a pillow. Percussion and vibration are performed around the medial border of the left scapula.

Quadrant/Scour Test

Therapist flexes and adduts patient's hip with knee in ful flexion, applying compressive force through shaft of femur while passively moving hip. Positive for grinding, catching, crepitation in hip, may be indicative of arthritis, avascular necrosis, or an osteochondral defect

Plantar fascia

Thick layer of tissue on plantar aspect of foot that originates on calcaneal tuberosity and inserts onto the plantar forefoot. Helps support weight of body and support arches of foot for improved propulsion during gait

Hyperkeratosis

Thickening of the skin caused by a mass of keratinocytes, occurs in stage 3 lymphedema

Transparent Film Dressing

Thin membrane made from transparent polyurethane. Permeable to vapor and oxygen, impermeable to bacteria and water. Used for superficial or partial thickness wounds with minimal drainage -Allows for easy visual inspection -Provides moist environment for wound healing -Allows for autolytic debridement

Hyperglycemia: Response

Thirst, frequent urination, glucose in urine. Can progress to ketoacidosis (fruity breath, deep labored breathing, nausea and vomiting) Call EMS if ketoacidosis, pt will need to be injected with insulin

Ottawa Foot Rules

X ray only required if pain in midfoot AND ANY ONE of following are present 1. Bone tenderness at base of 5th MT 2. Bone tenderness at navicular 3. Inability to WB immediately and in ER for four steps

Cerebral Angiography

X-ray imaging of the arterial blood vessels in the brain after injection of contrast material to determine narrowing or blockage of brain arteries. Used to diagnose CVA, brain tumor, aneurysm, or vascular malformation.

Thalamic Pain Syndrome

a condition caused by damage to the thalamus resulting in burning or tingling sensations and possibly hypersensitivity to things that would not normally be painful such as light touch or temperature change. Contralateral to thalamic lesion

Trigeminal Neuralgia

a condition characterized by sudden, intense, severe lightning-like pain due to an inflammation of the fifth cranial nerve

Puncture wound

a deep hole made by a sharp object such as a nail. Typically little tissue damage beyond wound tract, but risk of contamination and infection are high

Tracheostomy Mask

a device designed to be placed over a stoma or tracheostomy tube to provide supplemental oxygen

Electromyography

a diagnostic test that measures the electrical activity within muscle fibers in response to nerve stimulation

Test-retest Reliability

a method for determining the reliability of a test by comparing a test taker's scores on the same test taken on separate occasions

Positron Emission Tomography (PET)

a method of brain imaging that assesses metabolic activity by using a radioactive substance injected into the bloodstream. Rules out cerebral circulatory pathology, metabolism dysfunction, tumors, brain changes following injury or drug abuse

Post-Polio Syndrome (PPS)

a neurologic disorder marked by increased weakness and/or abnormal muscle fatigue in persons who had paralytic polio many years earlier -Slow, progressive weakness, muscle atrophy, swallowing issues.

Myelography

a radiographic study of the spinal cord after the injection of a contrast medium through a lumbar puncture High risk for headache following spinal tap. Rules out subarachnoid space abnormalities, spinal nerve injury, herniated disks, fractures

Type II Diabetes Mellitus

Typically occurs over age of 45. Resistance to insulin action at receptor site, inadequate insulin secretion, and hyperglycemia when body cannot properly respond to insulin. Exacerbated by obesity. Sxs: Polyphagia, polydipsia, polyuria, dehydration, fatigue, no ketoacidosis. Tx: Blood glucose control through diet, exercise, and medications.

Wrist Ligamentous Instability Tests

Ulnar Collateral Ligament Instability Test: Therapist holds patient's thumb in extension and applies valgus force to MCP joint of thumb. Positive for excessive valgus movement and may be indicative of tear in UCL. May indicate presence of "gamekeeper's thumb"

Abductor digiti minimi (hand)

Ulnar nerve C8, T1

Lead pipe rigidity

Uniform and constant resistance as limb is moved

Brainstem CVA symptoms

Unstable vital signs Decreased LOC Decreased ability to swallow Weakness on both sides of the body Paralysis on both sides of the body

Posterior canal BPPV

Up-beat, torsional nystagmus towards affected side. Most common.

Scapula Elevation

Upper Trap Levator Scap

Subscapularis

Upper and lower subscap nerve C5, C6

-mustine

alkylating agent (antineoplastic) Carmustine, estramustine, lomustine

Dysarthria

Upper motor neuron lesion affects muscles used in articulation, resulting in slurred speech.

Referred pain from Diaphragm

Upper trap and shoulder, or costal margins/lumbar area MOI: pneumonia, infection, compression

Scapular Upward Rotation

Upper/Lower Trap Serratus Anterior

Pectoralis major

Upper: lateral pec nerve C5-C7 Lower: medial pec nerve C8, T1

Modified Plantigrade

Upright position with UE support

K Level 3

Variable cadence and unlimited community ambulator, can traverse most environmental barriers, and uses prosthetic beyond simple locomotion. Knee: Hydraulic/pneumatic, microprocessor, variable friction mechanism Ankle/Foot: Energy storing, dynamic response, multiaxial

Hydraulic Knee Prosthetic

Variable friction for improved swing and stance phase control

Canalithiasis

Variant of BPPV where otoconia are free floating within the semicircular canal. More common. Brief duration of symptoms while in position that disappear while patient is in the position.

Bayley III

assesses children birth to 3-4 in cognitive, language, motor, adaptive behavior, and social-emotional development.

CN VIII

Vestibulocochlear Sensory: Hearing and balance Test: Hear watch ticking, hearing tests, balance and coordination test

Floor Markers

Visual aid to improve attention and reduce freezing of gait and hypokinesia in Parkinsonian Gait

Occipital Function

Visual processing--colors, light, shapes, 3D, judging distance

Total Lung Capacity (TLC)

Volume of air after maximum inhalation. Sum of all lung volumes. Residual Volume (RV) + Vital Capacity (VC) OR Functional Residual Capacity (FRC) + Inspiratory Capacity (IC)

Forced Vital Capacity (FVC)

Volume of air expired during max expiration after a forced inspiration

Stroke Volume

Volume of blood ejected from the LV with each heartbeat. Normal is 60-80 mL

Corticospinal tract

Voluntary refined movements of distal extremities. Pyramidal. Damage to this tract results in positive Babinski sign, absent cremasteric reflex, and loss of fine motor skills

Normal breath sounds

Trachial and bronchial sounds: Loud, tubular sounds heard over trachea Vesicular: High pitched breezy sounds over distal airways

Mechanical Insufficiency

Transport capacity of lymphatic system is reduced due to damage to lymph system, resulting in non-pitting edema

CN V

Trigeminal Sensory: Touch/pain on face, membranes of nose, sinuses, mouth and tongue Motor: Mastication Test: Corneal reflex, facial sensation, push down on chin Common Pathologies: ALS, Trigeminal Neuralgia

CN IV

Trochlear Motor: Superior oblique Test: Visual tracking (down and in)

Decorticate rigidity

Trunk and lower extremities flexed. upper extremities in flexion. Result of corticospinal lesion at level of diencephalon.

Fasciculus Gracilis

Trunk, LE: Proprioception, 2 pt disc, vibration, graphesthesia Gracilis like the leg muscle

Fasciculus cuneatus

Trunk, neck, and UE: Proprioception, 2 pt disc, graphesthesia

Gastric Tube (G tube)

Tube inserted through abdomen to stomach Used for long term feeding in presence of difficulty with swallowing, or to avoid risk of aspiration

Weber's Test

Tuning fork struck and placed on top of head. Pt reports which ear sound is heard louder in. Conductive: Louder on affected side Sensorineural: Louder on unaffected side

D1 Extension LE

extension, abduction, internal rotation

Dysmetria

inability to control the ROM and force of muscular activity

Dysdiadochokinesia

inability to perform rapid alternating movements

Foley catheter

indwelling catheter inserted through the urethra and into the bladder that includes a collection system allowing urine to be drained into a bag; the catheter can remain in place for an extended period

Hemiballism

involuntary and violent movement of a large body part. Form of chorea.

Decreased/diminished Breath sounds

less audible sound may indicate severe congestion, emphysema or hypoventilation

Compound Fracture

bone breaks through the skin

Three stages of Motor Learning

cognitive stage, associative stage, autonomous stage

One-way ANOVA

compares multiple groups on a single independent variable

Radial nerve injury can be caused by

compression of nerve in radial tunnel or humeral fracture,

Rhonchi

continuous low pitched, rattling lung sounds that often resemble snoring. Caused by air passing through an airway which is obstructed by inflammatory secretions or liquid, or neoplasm.

Pleural Friction Rub

continuous, dry grating sound caused by inflammation of pleural surfaces and loss of lubricating pleural fluid. Indication: Inflamed visceral or parietal pleura

Craig-Scott KAFO

designed specifically for persons with paraplegia. allows a person to stand with a posterior lean of trunk.

Milwaukee Orthosis

designed to promote realignment of spine due to scoliotic curvature.

Stemmer's Sign

dorsal skin folds of the toes or fingers are resistant to lifting; indicative of fibrotic changes and lymphedema

Posterior Leaf Spring AFO

dorsiflexion assistance and foot clearance during swing phase (foot drop) -Pt has mild spastic CP, or isolated DF weakness -Little to no medial/lateral ankle support -Minimal restriction of sagittal ankle motion

Soft End Feel (abnormal)

edema, synovitis, ligament instability/tear

Enzymatic Debridement

topical application of enzymes to surface of necrotic tissue -can be used on infected and non-infected wounds with necrotic tissue -may be used in wounds that have not responded to autolytic debridement or in conjunction with other debridement techniques -can be slow to establish a clean wound bed and should be discontinued after removal of devitalized tissues in order to avoid damage

-pramine

tricyclic antidepressant (TCA) Clomipramine

Neuroma

tumor composed of nerve (benign) Associated with vasculitis, AIDS, and amyloidosis

BMI Classifications

underweight: <18.5 normal: 18.5-24.9 overweight: 25-29.9 obese: >30 Class 1 Obesity: 30-34.9 Class 2 Obesity: 35.0-39.9 Class 3 Obesity: 40+

Pacinian Corpuscles

respond to deep pressure and vibration

Cardioversion

restoration of a normal heart rhythm by electric shock

Stridor

strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx (upper airway)

Chorea

sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face. Often equated to fidgeting. Ballism is a form of this that involves large amplitude, flailing movements. Those that suffer from Huntington's disease often present with this.

Tics

sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations

Interrater reliability

the amount of agreement in the observations of different raters who witness the same behavior

Endocrine System

the body's "slow" chemical communication system; a set of ductless glands that secrete hormones directly into the bloodstream. Hormones travel through the body to target organs, where they selectively bind to receptor cells. Hormones travel to virtually every area of the body. Key Glands: -Hypothalamus -Pituitary Gland -Thyroid Gland -Parathyroid Gland -Adrenal Gland -Pancreas -Ovaries -Testes

Content Validity

the extent to which a test samples the behavior that is of interest. Does the test measure all aspects of the thing being tested?

Semi Fowler's Position

the head of the bed is raised 30 degrees; or the head of the bed is raised 30 degrees and the knee portion is raised 15 degrees

Null hypothesis

the hypothesis that there is no significant difference between specified populations, any observed difference being due to sampling or experimental error.

Agnosia

the inability to recognize familiar objects.

Inspiratory Reserve Volume (IRV)

the maximal amount of additional air that can be drawn into the lungs by determined effort after normal inspiration. Approx 50% of total lung volume

Median

the middle score in a distribution; half the scores are above it and half are below it

Sample size

the number of times a measurement is replicated in data collection. Directly proportional to power.

Postural Drainage: Lateral basal segments lower lobes

the patient is in sidelying with the foot of bed elevated 18 inches. percussion and vibration performed over the lower ribs. L sidelying for R lobe and R sidelying for L lobe.

Peripheral Nervous System

the sensory and motor neurons that connect the central nervous system to the rest of the body. Made up of Autonomic Nervous System and the Somatic Nervous System -12 Cranial Nerves and Ganglia -31 pairs of spinal nerves exit vertebral column through intervertebral foramina: 8 Cervical 12 Thoracic 5 lumbar 5 Sacral 1 Coccygeal

Detrusor

the smooth muscle that forms most of the bladder wall and aids in expelling urine

Bronchophony

the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue (999)

Intrarater Reliability

the stability of repeated measures by the same examiner

Cardiomyopathy

the term used to describe all diseases of the heart muscle (myocardium). Broken into three types: -Dilated (Expanded ventricles -Hypertrophic (thickened ventricular walls) -Restrictive (Stiff but not thickened) Sxs: None in early stages, As condition progresses sxs include breathlessness with exertion or rest, swelling of LE, bloating of abdomen, dizziness, fainting

Ureters

the tubes connecting the kidneys to the bladder

Peak Expiratory Flow

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

Absent Breath Sounds

may indicate pneumothorax or lung collapse

Fasting Plasma Glucose

measures circulating glucose level in a patient who has fasted at least 8 hours. Positive for DM if blood glucose level is over 125 mg/dL (normal is 100)

Forced Vital Capacity (FVC) Test

measures the amount of gas expelled when a subject takes a deep breath and then forcefully exhales maximally and as rapidly as possible

Head/Hips Relationship

mechanics used during mobility training with UE WB used as fulcrum for activity, head moves in opposite direction from hips

Pronator Teres Syndrome

median nerve compression, like CTS Unlike CTS: -aching in forearm -No night symptoms -positive tinel's sign OT: elbow splint at 90, avoid repetition post op OT: AROM, gliding, strengthen (2 wks), sensory re-ed, work mod

-nacin

muscarinic antagonist (anticholinergic) darifenacin, solifenacin

Taylor Brace

thoracolumbosacral orthosis that limits trunk flexion and extension through a 3 point control design.

Inspiratory Muscle Training

used for patients that exhibit decreased chest expansion, SOB, bradypnea, and decreased breath sounds. attempts to increase ventilating capacity and decrease dyspnea through strengthening of diaphragm and intercostal muscles. Threshold or PFLEX.

Epley's Maneuver

used to TX Benign paroxysmal positional vertigo Head rotates to affected ear first, then rotated 45 deg to each side.

Segmental Breathing

used to prevent accumulation of fluid and to increase chest mobility by directing inspired air to predetermined areas. Posterior low ribs: Posetrior basal segment of ower lobes Lower lateral costal area: lateral basal segments of lower lobes Anterior midchest: Anterior segments of upper lobes Anterior low ribs: Anterior basal segments of lower lobes

Hemiparesis

weakness on one side of the body

Reverse Muscle Action

when distal bone is stabilized and proximal bone moves. (Closed Chain Exercise OKC: Middle delt abducts shoulder. CKC (iso on wall): Middle delt brings origin (scap spine) to insertion (distal tuberosity), causing scapular downward rotation

Venous Insufficiency Ulcers

occur secondary to inadequate functioning of the venous system resulting in inadequate circulation and eventual tissue damage and ulceration Presentation: -Located proximal to medial malleolus -Irregular, shallow shape, with moderate to heavy exudate -Normal pedal pulse and skin temp -Leg elevation decreases pain, dependent position increases pain

Minimal Assist

patient requires 25% assist from therapist to complete task

Curved Headrest

patient tends to maintain backward listing and/or lateral head and neck position in sitting side panels may be indicated for more aggressive support

Swing-to gait

patient with bilateral trunk and or LE weakness uses crutches or a walker and advances LEs at the same time only to point of AD.

Legg-Calve-Perthes Disease Condition: Etiology: S/Sx: Testing: Tx:

Condition: Avascular necrosis of femoral head leading to degeneration. Stages: Condensation, Fragmentation, Re-ossification, and Remodeling Etiology: Trauma, genetic predisposition, vascular abnormalities, infection S/Sx: Pain, decreased ROM, antalgic gait, positive Trendelenburg Tx: Scottish Rite brace to hold hips in ABD.

Chronic pain E-stim parameters

Higher pulse duration (250ms-1ms) Lower pulse frequency (1-10pps) Max sensory amplitude

Amine hormones (catecholamines)

Epinephrine Norepinephrine Dopamine Synthesized from chromaffin cells in adrenal medulla, and released into the bloodstream after sympathetic nervous system stimulation to activate glycogen breakdown for fuel, block insulin, increase metabolic rate, and dilate lung airways.

Osteoarthritis Condition: Etiology: S/Sx: Testing: Tx:

Condition: Chronic disease that causes degeneration of articular cartilage, primarily in weight bearing joints, resultin in deformity and thickening of subchondral bone that impairs functional status. Most common sites are hands, hips, and knees. Etiology: Occurs during middle age. More common in men before 55, more common in women after 55. Risk factors include weight, fractures/joint injuries, occupational/athletic overuse S/Sx: Gradual onset of pain present at affected joint, increased pain post exercise, pain with weather changes, enlarged joints, crepitus, stiffness, limited ROM, Heberden's (DIP) and Bouchard's (PIP) nodes. Testing: Tx: PROM, AROM, strengthening, weight loss, bracing, arthroscopic surgery, joint arthroplasty. Some knee OA patients benefit from hyaluronic acid injections.

Osteogenesis imperfecta (brittle bone disease) Condition: Etiology: S/Sx: Testing: Tx:

Condition: Connective tissue disorder that affects formation of collagen during bone development, resulting in poor bone strength. Etiology: Genetic inheritance. Types I and IV are autosomal dominant, Types II and III are autosomal recessive. S/Sx: Pathological fractures, osteoporosis, hypermobile joints, bowing of long bones, weakness, scoliosis, impaired respiratory function Tx: Education on proper handling and facilitation of movement and fracture management. Wheelchair prescription in severe cases where ambulation is not realistic.

Thoracic/Lumbar Extension

Erector spinae QL Multifidus

Cervical Radiculopathy Clinical Prediction Rule

Highly likely if all four are present 1. Positive ULTTA 2. Involved-side Cervical rotation ROM less than 60 deg 3. Positive Distraction 4. Positive Spurling's A

Carpal Tunnel Syndrome Clinical Prediction Rule

Highly likely if at least 4/5 is present 1. Shaking hands 2. Wrist ratio over 0.67 3. Symptom Severity Scale over 1.9 4. Diminished sensation in thumb 5. Age over 45

Tonic Labyrinthine Reflex

In supine: body and extremities in extension In prone: body and extremities in flexion Normal Age: Birth to 6 months

Peripheral Nerve Injuries

Etiology: -Mechanical (compression) -Crush/Percussion (fracture/compartment syndrome) -Laceration -Penetrating trauma (stab wound) -Stretch (traction) -High velocity trauma (MCA) -Cold (Frostbite) Sxs: Total loss of muscle over time, replacement by fibrous tissue

Erectile Dysfunction

Inability of adult male to achieve or maintain an erection. Caused mainly by diabetes, CHD, HTN, hypothyroidism, hypopituitarism, MS, excess alcohol, hormonal imbalances

Computerized Tomography (CT)

Ionizing electromagnetic radiation at different angles to produce cross-sectional slices -Subtle or complex fractures -Central Spinal Stenosis -First imaging choice in serious trauma involving multiple injuries to bone/soft tissue

X ray Radiographic Imaging

Ionizing electromagnetic radiation passes through tissues -Best Initial Study for MSK -Best initial assessment for joint, spine, and cardiopulmonary disease

Spinocerebellar tract

Ipsilateral subconcious proprioception

Lower Quarter Functional Testing

L4-L5: Heel walking S1: Toe walking L4-S1: Straight leg raise

Lower Quarter Reflex Testing

L4: Patellar Tendon S1: Achilles Tendon

Plantar reflex

L5-S1 Stroke lateral aspect of the sole from heel to ball of foot and medial to base of great toe. Normal response is flexion. If extension, positive Babinksi sign.

Anemia

Lack of RBCs, causing decrease in oxygen and overall fatigue and weakness

Conduction Aphasia

Lack of ability to conduct between listening and speech, can't repeat words or phrases. Reading intact, writing impaired.

Maturation Phase of Wound Healing

7 days to 2 years Initiated when granulation tissue and epithelial differentiation appear in wound bed.

Normal Adult pH Acidemia Alkalemia

7.35-7.45 Acidemia: lower than 7.35 Alkalemia: Higher than 7.45

Level of SpO2 to stop at

90% for acutely ill patients, 85% for patients with chronic lung disease.

Ischemic Stroke

Loss of perfusion to portion of the brain, causing irreversible infarction. Caused by Embolus (20%), or Thrombus

Salicylates

(Negative) Used for muscle/joint pain, plantar warts

Ultrasound Frequency

High frequency is absorbed more rapidly and affects superficial tissues (3.3 MHz reaches 1-2 cm below skin) Low Frequency is absorbed deeper and is used for deeper tissues (1 MHz reaches 3-5 cm below skin)

Talipes Equinovarus (Clubfoot) Condition: Etiology: S/Sx: Testing: Tx:

Condition: Deformity where heel points downward and forefoot turns in. Etiology: Often accompanies other neuromuscular abnormalities (spina bifida, arthrogryposis). S/Sx: Adduction of forefoot, varus positioning of hindfoot, equinus of ankle. Tx: Splinting and serial casting. Restore proper positioning of ankle and foot.

Serous Exudate

Clear, light color Thin watery consistency Normal in healthy healing wound through inflammatory and proliferative stages of healing

Curved back insert

Clinical indications: -requires moderate trunk support due to tone -strength or deformity related postural concerns

D1 Flexion UE

Close your hand and pull up and across your body.. putting on earring

Levels of Consciousness (LOC)

Coma: Unconscious and unresponsive to internal/external stimuli Stupor: Unresponsive with arousal from repeated stimuli Obtundity: Sleep, reduced alertness to arousal, delayed response to stimuli Delirium: Disorientation, confusion, agitation, loudness Clouding of consciousness: Quiet behavior, confusion, poor attention, delayed response Consciousness: Alertness, awareness, orientation, memory

Tetralogy of Fallot

Combination of 4 heart defects: 1. VSD 2. Pulmonary STenosis 3. R Ventricular Hyprertrophy 4. Aorta overriding VSD Sxs: Cyanosis, SOB during feeding, fainting, finger/toe clubbing, poor weight gain, tiring easily, heart murmur Tx: Surgery placing patch over VSD and widening pulmonary valve and arteries. Untreated casesdevelop infective endocarditis, resulting in death or disability by early adulthood

Seropurulent Exudate

Cloudy/Opaque, yellow or tan color Thin, watery consistency Early warning sign of impending infection, always considered abnormal

Seminiferous Tubules

Coiled tubes found in each lobe of the testes where spermatogenesis takes place

Schedule V Drugs

Lowest potential for abuse and addiction, may be available without prescription -Cough and cold medicines with low doses of opioids

Atelectasis

Complete or partial collapse of a section of a lung due to blockage of bronchioles or due to pressure on the lung. Can be caused by pleural effusion, tumor, ARDS, asthma, COPD, cystic fibrosis. Sxs: Cyanosis, SOB, increased RR and HR. Tx: Deep breathing, changing positions, airway clearance techniques, supplemental oxygen, Positive End-Expiratory pressure (PEEP) or CPAP to keep airways and alveoli open. Bronchoscopy to remove foreign objects.

Autonomic Dysreflexia: Recognition and Response

Complete spinal cord injury above T6 when exposed to noxious stimuli (tight clothes, full bladder). Sxs: HTN, bradycardia, sweating, HA, nausea, red blotchy skin Pt in upright position (sitting/semirecumbent), then identify and remove noxious stimuli

Median nerve injury can be caused by

Compression in the carpal tunnel, pronator teres entrapment

Thrombocythemia

High platelet count increases risk of thrombosis, may result in a stroke or heart attack

Schedule II Drugs

High potential for abuse and high risk for addiction Allowed for medical use, but no auto refills -Opioids, amphetamines, barbiturates

Schedule I drugs

High potential for abuse, high risk for addiction Only used for research and not medical treatment -Heroin, LSD

Muscle re-education E-stim

High pulse duration Medium pulse frequency (50 pps) Motoric with timeon/off ratio and ramp

Tabetic gait pattern

High stepping ataxic gait pattern where the feet slap ground

Equine gait pattern

High steps, excessive gastroc activity

Gout

Monoarticular inflammatry process in first MTP that develops in those with high uric acid in the blood, causing needlelike crystals to form and cause pain, redness, warmth, and swelling Etiology: Mainly males over 30 with a purine rich diet (fish, seafood, bacon) and/or alcoholism. Sxs: -Elevated Uric acid (over 7 mg/DL -Pain starts at night GOUT TOE Great toe pain One joint in most cases-1st MTP Uric acid elevated over 7 Tachycardia Tophi (uric acid crystal chunks) Overly sensitive Erythema and feever Colchicine, Alopurinol. and NSAIDS

Axonotmesis

More severe form of acute nerve injury. Reversible injury to damaged nerve fibers. Damage occurs to axons, but endoneurium is preserved. Distal Wallerian degeneration can occur. Pt complains of pain in distribution Nerve can regen distal to site of lesion at 1 mm per day, with spontaneous and spotty to no recovery. Traction, compression, crush injuries most common

Friedrich's Ataxia

Most common autosomal recessive ataxia. Gait unsteadiness early in life, followed by UE ataxia, dysarthria, and paresis. Mental function declines and tremors may be seen. Impaired reflexes vibration, and position senses.

Central Cord Syndrome

Most common type of SCI. Incomplete lesion from compression/damage to central portion of spinal cord, MOI is usually cervical hyperextension, but can be caused by spinal stenosis. -Spinothalamic, corticospinal, and dorsal column tracts are damaged -Greater UE involvement than lower extremities -Greater motor than sensory deficits -Minimal bowel/bladder loss -Should regain ability to ambulate

Radiation Burn

Most common with exposure beam radiation therapy. Ischemic injury may be irreversible due to altered DNA in exposed tissues. -Severe blistering -Desquamation -Non-healing wounds -Tissue fibrosis -Permanent discoloration

Autonomic Dysreflexia

Most dangerous complication of SCI, can occur in T6 and above. Noxious stimuli below level of lesion triggers autonomic nervous system causing sudden elevation in BP. Can lead to convulsions, hemorrhage, or death. Cause: Full bladder, kink or blockage in catheter, bladder infections, pressure ulcers, extreme temp changes, tight clothing, ingrown toenails. Sxs: High BP, severe headache, blurred vision, stuffy nose, profuse sweating, goosebumps above lesionand flushing below level of injury. Tx: Do not lie patient down, will only elevate BP. Patient should be examined for irritating stimuli and bowel impaction.

Incisional wound

Most often associated with surgery and is created intentionally by means of a sharp object such as a scalpel or scissors

Visual Action Therapy (VAT)

Most often used with global aphasia. Pt traces objects, then matches objects to tracing. Progress to pantomiming tasks, using gestures to identify visible objects and to symbolize absent objects. Non-verbal treatment

Neurotmesis

Most severe form of acute nerve injury Axon, myelin, connective tissue are all damaged irreversibly with no possibility of regeneration. Flaccid paralysis and waisting of muscles occur, total loss of sensation to nerve area. No pain. Complete neural loss. Muscle wasting. All motor/sensory loss distal to lesion is permanently.

Connective Tissue Cancers (muscle, blood vessel, cartilage, fat)

Sarcoma Fibrosarcoma Liposarcoma Chondrosarcoma Osteosarcoma Hemangiosarcoma Leiomyosarcoma Rhabdomyosarcoma

Atrial Flutter

Saw tooth P waves are characteristic. Rapid but regular atrial tachycardia Often occurs with valvular disease, HTN, MI, obstructive lung disease, pulmonary emboli. Sxs: Palpitations, lightheadedness, angina. Stagnation of blood may predispose to thrombi in atria

Open System Model

Single transfer of information without any feedback loop. Nervous system is awaiting stimuli in order to react. (Reflexive hierarchical theory)

Sinus Arrest

Sinus Rhythm with intermittent failure of SA node or AV node ECG: Occasional complete absence of P or QRS wave

Sinus Bradycardia

Sinus rhythm with HR less than 60 BPM

Sinus Tachycardi

Sinus rhythm with HR more than 100 BPM

Sinus Arrhythmia

Sinus rhythm with quickening and slowing of impulse formation, slight beat-to-beat variation of rate

Alginate Dressing

Soft, absorbent, cotton like, for wounds with exudate, require packing and absorption, absorb a TON Highly absorptive, highly permeable -used on infected wounds for excessive drainage -May require frequent changes and requires secondary dressing. -Can be used to stop blood flow -Enables autolytic debridement

Pulmonary artery catheter (Swan-Ganz)

Soft, flexible catheter inserted through vein into pulmonary artery to provide continuous measures of PA pressure. -Can also diagnose RHF -PA HTN -Heart function post-MI -Cardiomyopathy

Normal Voice Sounds

Soft, muffled, and indistinct syllables. Increases in loudness or distictness indicate consolidation, atelectasis or fibrosis, all of which improve vibrations through lung tissue.

Iliofemoral Joint Motions: -Loose-packed position -Close-Packed Position -Capsular Pattern

Motions: Flex/Ext. Abd/Add, Internal/External rotation -Loose-packed position: 30 deg flex, 30 deg abd, slight external rot -Close-Packed Position: Full ext, internal rotation -Capsular Pattern: flexion, abduction, internal rotation

Tibiofemoral Joint Motions: -Loose-packed position -Close-Packed Position -Capsular Pattern

Motions: Flexion, extension, internal/external rotation -Loose-packed position: 25 deg flex -Close-Packed Position: Full ext, ext rotation of tibia, flexion/extension -Capsular Pattern: Flex, ext

Proximal Radioulnar Joint Motions: -Loose-packed position -Close-Packed Position -Capsular Pattern

Motions: Pronation, Supination -Loose-packed position: 70 deg elbow flex, 35 deg supination -Close-Packed Position: 5 deg supination -Capsular Pattern: Supination, Pronation

Upper GI function

Mouth, Esophagus, and Stomach mechanically and chemically digest food. Stomach uses HCl acid and digestive enzymes from liver, pancreas, and gallbladder to assist digestion

Cerebral Palsy

Movement disorder caused by brain damage. Non-progressive, acquired in utero, birth, or infancy due to lack of oxygen, maternal infection, substance abuse, toxemia, prematurity. Can be acquired through meningitis, CVA, seizures, or brain injury. Sxs: Mild to severe loss of control, profound intellectual disability. Abnormal muscle tone, abnormal reflexes Can be Spastic: Lesion in motor cortex of cerebrum, UMN damage or Athetoid: Lesion involved basal ganglia Monoplegia: one extremity Diplegia: Bilateral lower extremity with some UE involveent Hemiplegia: Unilateral UE and LE Quadriplegia: Whole body

Microprocessor Knee Prosthetic

Multiple programs available, allows for fluid management of stair descent. Requires charging, variable friction.

High voltage pulsed stimulation

Muscle contractions, pain control

Biceps brachii

Musculocutaneous nerve C5, C6

Brachialis

Musculocutaneous nerve C5, C6

Coracobrachialis

Musculocutaneous nerve C5-C7

White matter

Myelinated axons, nerve fibers without dendrites

ST segment elevation

Myocardial infarction (STEMI) Greater than 1 mm is indicative -True STEMI = terminate exercise and alert EMS -If STEMI is observed on monitor without symptoms, check the lead

EMG repetitive Discharge

Myopathies, lesion of anterior horn cells and peripheral nerves

EMG Polyphasic potentials (Voluntary)

Myopathies, muscle or peripheral nerve involvement

CVA Tests and Measures

NIH Stroke Scale: Assessment of acute CVA relative to impairment Functional Independence Measure: Assesses level of burden by measuring mobility and ADL management Stroke Impact Scale: Assessment of physical and social disability or level of impairment secondary to CVA Fugl-Meyer Assessment of Physical Performance: Motor, sensory, balance impairment, pain, ROM

Functional Electrical Stimulation (FES)

NMES during a functional activity -Reducing shoulder subluxation (posterior delt and supraspinatus, 3 sec ramp up/down) -Foot drop during gait (Tibialis anterior + peroneals to prevent inversion sprain, 0-1 ramp up/down) -Impaired hand/finger function -Exercise to maintain mobility

Respiratory Alkalosis

NO CARDS Numbness/Tingling Orthostatic Hypotension Confusion Anxiety Rapid Breathing (Hyperventilation) Dizziness Seizures

-profen

NSAID Ibuprofen

-fenac

NSAID Diclofenac, bromenac

Aspirin

NSAID for pain, fever, HA, inflammation Sides: Bloody/tarry stools, nausea, vomiting, peptic ulcers

Procedural Learning

Task is learned by forming movement habits through repetitive practice.

Gluteus minimus

Superior gluteal nerve L4, L5, S1

Tensor fasciae latae

Superior gluteal nerve L4, L5, S1

Transient Ischemic Attack (TIA)

Temporary interruption of blood supply, symptoms resolve in 24-48 hours. Most often at carotid and vertebrobasilar arteries.

Allograft

Temporary skin graft taken from a cadaver to cover a burned area

GH External (Lateral) Rotation

Teres Minor Infraspinatus Posterior Delt

Post-traumatic Amnesia

Time between injury and when patient is able to recall recent events.

Friable

Tissue that is easily torn, fragmented, or bleeding when gently palpated

Jejunostomy Tube (J-tube)

Tube inserted through endoscopy into jejunum via abdominal wall Used for long term feeding for patients unable to receive food by mouth

Hypothalamus Dysfunction

Tumors (ependyomas), inflammatory process (sarcoidois), surgical transection, trauma (skull fracture)

Effect Size

Measure of magnitude of the difference between two treatments, or the magnitude of relatioship between two variable. Larger ES=statistically significant

Standard Deviation

Measurement of spread or dispersion of data. Valid in normal distribution

Therapeutic Index

Measurement of the safety of a drug. Calculated as a ratio, compares effectiveness of a drug against lethal effects. Median Toxic Dose/Median Effective Dose Low TI indicates that a drug is less safe, and will result in more adverse effects

Erb's Palsy

Upper brachial plexus injury that results from difficult birth. Most common avulsion is at Erb's point in anterolateral neck, damaging C5-C6 (axillary, lateral pectoral, upper/lower subscap, suprascapular, long thoracic, musculocutaneous). Loss of RC, delt, brachilais,coracobrachialis, and biceps function. Sxs: Waiter's tip deformity (loss of shoulder function, elbow flexion, supination, and hand positioned in pinch grip). May have GH subluxation/dislocation, skeletal deformity, poor bone growth, learned pattern of non-use.

Neutrophils

WBC that ingest bacteria and debris

Slipped Capital Femoral Epiphysis

Weak femoral epiphyseal growth plates cause excessive mechanical stress -Traumatic onset (LCP is insidious) -May have trendelenburg gait -Capsular pattern present (NOT present in LCP) -Usually surgery is required

Chronic Venous Insufficiency (CVI)

Weak or damaged valves in veins can't keep blood flowing to the heart, causing veins to remain filled with blood. Risk factors: female, obese, pregnant, prolonged sitting/standing Sxs: Leg swelling, varicose veins, aching, heaviness, cramping, itching, redness or skin ulcers of legs/ankles Tx: Compression stockings, elevation of legs to decrease chronic swelling. Varicose vein stripping for persistent leg pain or skin ulcers.

Exaggerated Knee flexion at contact

Weak quads Quad paralysis Hamstrings spasticity Insufficient EXT ROM Too much PF at foot Too soft of heel (tibia travels forward in front of femur, causing ext)

Hyperkeratosis

White/gray in color, can vary in texture from firm to soggy. Also called callus.

Cerebellar gait

Wide based, uncoordinated arms, staggering. Associated with cerebellar disease.

Wheelchair Seat Width

Widest aspect of hips Add 2 inches

Discography

radiological examination of the intervertebral disk structures with injection of a contrast medium Evaluates integrity and pathology of spinal disk

Relative Risk

ratio of incidence/prevalence of a disease in an exposed group to the incidence/prevalence of a disease in an unexposed group RR of 1 = Equally likely in both groups RR more than 1 = Exposure means more risk RR less than 1 = Exposure means less risk

Modified Trendelenburg position

used in the treatment of shock; the patient is positioned lying flat on the back with the legs elevated 12-16 inches above the head in an effort to improve the blood flow to the brain

Pearson product moment correlation (r)

Measures the magnitude of the linear relationship between two variables on the inverval scale. Positive r = values increase or decrease together Negative r = values increase or decrease away from each other 0 = no relationship

Airway Suctioning

Mechanical aspiration of secretions from the nasopharynx, oropharynx, or trachea using a suction catheter.

Endotrachial Suctioning

Mechanical removal of pulmonary secretions from pt who is on a vent Who: Severely involved pt with trach on mechanical vent (ALS, GB, high SCI). Pt with audible lung secretions, sesat, and/or signs of ARD

Baroreceptor Reflex

Mechanoreceptors that detect changes in pressure. Arterial baroreceptors (carotid, aortic arch, R subclavian) are high pressure receptors Cardiopulmonary receptors are low pressure receptors Sympathetic activation leads to increased HR, vasoconstriction, increased BP and CO. Parasympathetic activation leads to decreased HR and contractility, and decreased BP

Antiemetics

Meclizine Scopolamine Dolasetron Phenergan

Pec minor

Medial pectoral nerve C8-T1

Abductor hallucis

Medial plantar nerve L4, L5

Flexor digitorum brevis

Medial plantar nerve L4, L5

Flexor hallucis brevis

Medial plantar nerve L4, L5, S1

Abductor pollicis brevis

Median nerve C6, C7

Flexor carpi radialis

Median nerve C6, C7

Opponens pollicis

Median nerve C6, C7

Palmaris longus

Median nerve C6, C7

Pronator Quadratus

Median nerve C6, C7

Pronator Teres

Median nerve C6, C7

Flexor digitorum superficialis

Median nerve C7, C8, T1

Flexor digitorum profundus

Median nerve C8, T1 to 2nd and 3rd fingers; ulnar nerve C8, T1 to 4th and 5th fingers

Flexor pollicis longus

Median nerve palmar interosseous branch C8, T1

Hindbrain (Rhombencephalon)

Metencephalon -Cerebellum, Pons Myelencephalon -Medulla Oblongata

Surgeries to fix Articular Cartilage Defects

Microfracture Procedure: Awl penetrates subchonral bown, causing an ingrowth of fibrocartilage. Osteochondral Autograft Transplantation: Cartilage is harvested from NWB surfaces to form a plug to fill chondral defect Autologous Chondrocyte Implantation: Healthy cartilage is harvested and cultured so it will grow, then implanted. Rehab Considerations: Weight bearing restrictions, depending on size and location of lesion. Adherence to weight bearing restrictions is critical.

Pulmonary Fibrosis

Microscopic damage to alveoli causes irreversible scarring of interstitial tissue, decreasing tissue elasticity and increases difficulty of breathing. Cause is unknown (idiopathic) or can be from exposure to toxic elements (dust, silica, asbestos, grain, animal droppings), radiation to lungs, chemo drugs, antiarrhythmic medications, ad some antibiotics. Sxs: SOB, especially during/afer physical activity and dry cough. Fatigue, weight loss, aching muscles/joints Tx: Scarring is irreversible, but corticosteroids and immunosuppressives can help, Lung transplantation may be required.

Schedule IV Drugs

Mild risk for physical or psychological dependence Some limitations set on auto refills -Anti-anxiety drugs, some barbiturates (phenobarbital)

Lymphedema Classification

Mild: Less than 3 cm between affected and unaffected limbs Moderate: 3-5 cm difference between affected and unaffected limb Severe: Greater than 5 cm difference between affected and unaffected limb

Neurapraxia

Mildest form of acute nerve injury Conduction blocked due to myelin dysfunction, with axonal continuity preserved. Nerve conduction preserved proximal and distal to lesion. Nerve fibers not damaged, with no evidence of nerve degeneration. Pt complains of pain in distribution Pressure injuries Sxs: Pain, minimal muscle atrophy, numbness or loss of motor/sensory function. Rapid recovery, will occur within 4-6 weeks.

Direct Cholinergic Agents

Mimic the action of the parasympathetic nervous system, induce the rest-and-digest response by binding directly to cholinergic receptors and mimicking ACh. Used for dementia, decrease in GI motility, glaucoma, Myasthenia Gravis May increase HR and dizziness, cause GI distress, or other parasympathetic effects. -Duvoid/Bethanechol -Pilocar/Pilocarpine

Cane

Min stability and support. Straight cane provides least support, should not be utilized with PWB. Small base and large base quad canes have larger BOS, can better liit WB on uninvolved LE. 20-25 deg of elbow flexion while grasping handgrip

Type I Diabetes Mellitus

Pancreas fails to produce enough insulin due to genetic disposition and/or exposure to trigger causing an immune reaction. Also called insulin-dependent or juvenile diabetes. Sxs: Rapid onset, weight loss, ketoacidosis, polyuria (urination), polydipsia (thirst), polyphagia (hunger), blurred vision, dehydration, fatigue Tx: Insulin injections to maintain glucose blood levels.

ADA Doorway width Requirements

Minimum 32 inch width

Anterior neck burn

Possible flexion and lateral flexion deformity Use soft, molded, or Philadelphia collar

Minimal Detectable Difference

Minimum change in patient's condition beyond threshold of measurement error. Smallest chnge that would be statistically significant.

Title V of ADA

Miscellaneous: includes insurance issues, congressional inclusion and amendments to Rehab Act of 1973

Referred pain from Large Intestine

Pain in lower mid-abdomen with referral to sacrum when rectum is stimulated by passing gas or defecation MOI: diverticulitis, IBS, Chron's

Referred pain from Heart

Pain in substernal region, referral to mid-thoracic, jaw, L upper trap, L shoulder, and down L arm In women, can present as epigastric pain, R shoulder pain, indigestion. MOI: MI, pericarditis

Grade 2 Concussion

Moderate head injury causing transient confusion lasting longer than 15 minutes. Poor concentration, retrograde, and anterograde amnesia. CT scan indicated if symptoms worsen. RTP deferred until athlete is symptom free for 2 weeks with exertion and rest.

Schedule III Drugs

Moderate risk for physical dependence, high risk for psychological dependence Auto refills allowed with limitations -Opioids combined with non opioids and anabolic steroids

Multi-Layered Bandages

Moderate to high resting pressure -several bandages with elastic and inelastic layers -providing protection, absorption, compression Most commonly used for venous stasis ulcers

Sacrotuberous ligament

Sacrum to ischial tuberosity. Resists sacral anterior rotationa dn prevents superior translation of sacrum.

Pigmented Cell Cancers

Melanoma

Broca's Aphasia

"Expressive aphasia", a type of non-fluent aphasia, and most common form. Can understand, but unable to express speech. MCA causing lesion in premotor area of L Frontal Lobe Slow, hesitant speech with limited vocab and difficulty with sentences. Auditory and reading comprehension are intact, but speak in short phrases with great effort due to motor impairment. BEN has Broca's Broca's Expressive Deficits Nonfluent

Type II Muscle Fibers

"Fast Twitch" Anaerobic, white, phasic, fast-glycolytic High fatigability, low capillary density, myoglobin, mitochondria, blood supply. Larger fibers. High Jump, sprinting

Glossopharyngeal Breathing

"Frog breathing" Use tongue to push air into airway - swallow air. USED FOR: High SC injury (if ventilator fails)

Type I Muscle Fibers

"Slow Twitch" Aerobic, red, tonic, slow-oxidative Low fatigability, high capillary density and myoglobin content, extensive blood supply and mitochondria Marathon, swimming

Aldosterone

"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure

Ectopic bone

(or heterotopic ossification): spontaneous formation of bone in the soft tissue/muscle. occurs adjacent to larger joints such as knees or hips. Possibly due to tissue hypoxia or abnormal calcium metabolism. Early symptoms: Edema, decreased ROM, increased temp of involved joint. Tx: Diphosphates that inhibit etopic bone formation, focus on maintaining ROM and keeping pt independent

Noxious TENS

*Amplitude*: highest tolerated stimulus *Pulse freq*: high or low *Pulse duration*: long (250 usec up to 1sec) *Tx time*: 30-60sec for each point *Used for*: trigger points

Ulnar nerve muscles

*Flexor carpi ulnaris *1/2 flexor digitorum profundus *Palmaris Brevis *Abductor digiti minimi *Opponens digiti minimi *Flexor digiti minimi *Interossei *Lumbricales *Adductor pollicis

Frontal Lobe Functions

*Voluntary movement (primary cortex/precentral gyrus) *Intellect *Orientation *Broca's area: Speech and concentration *Personality, temper, judgment, reasoning, behavior, self-awareness, executive functions

Long stretch bandages

- Can apply 60-70 mmHG - Most often used for patients who are immobile because it provides little working pressure High resting pressure Low working pressure

Anterior Innominate Rotation

- With Supine to sit test, goes Long to Short (ALS) Treatment: MET on hamstrings (opposite anterior)

Ostomy device

- provides a method for collection of waste from a surgically produced opening in the abdomen. -The removal of the waste occurs through a stoma extending into the small intestine. - The waste is collected in a plastic bag or pouch covering the stoma.

ADA Ramp guidelines

-12 inches of horizontal run for every inch of vertical rise -1 foot/1 inch. Example: If ramp rises 21 inches, must be at least 21 feet long -equivalent to 8.3% grade -Max rise for run is 30 inches (max run is 30 ft) -Ramp must be 36 inches wide -Level landing at top and bottom -If changing direction, landing area must be 5 ft by 5 ft (60 in by 60 in)

Iontophoresis Dosage

-40-80 mA-min -Amplitudes range from 1.0-4.0 mA -Current amplitude x time -4.0 mA over 10 min = 40 mA-min -Lower amplitude and longer duration = less burns or irritation -Decrease likelihood of burns by decreasing current density, increasing size of cathode, and increasing space between electrodes.

Thoracic Outlet Syndrome Tests

-Adson Maneuver: Palpating radial pulse, therapist asks patient to rotate head to face test shoulder and extend head while therapist passively ER and EXT patient's shoulder. Positive for Absent/Diminished radial pulse. -Allen Test: 90 deg ABD, ER, and Elbow Flex. Radial pulse palpated, patient's head turns away from test shoulder. Positive for Absent/Diminished radial pulse -Costoclavicular Syndrome Test: Palpating radial pulse, patient lifts chest in "military posture". Positive for absent/diminished radial pulse may indicate subclavian artery compression between first rib and clavicle. -Roos Test: 90 deg ABD, ER, Elbow flexion (field goal). Patient opens and closes hands for three minutes. positive for inability to maintain position, weakness of arms, sensory loss, or ischemic pain. -Wright Test (Hyperabduction Test): Passive ABD while monitoring radial pulse. Positive for absent/diminished raidal pulse, may be indicative of costoclavicular compression

Tunnel of Guyon

-Anatomic region formed by the hook of the hamate bone and the pisiform bone -the ulnar nerve and artery pass into the hand through this region

Shoulder dislocation special tests

-Apprehension test for anterior shoulder dislocation (90 90 with supine ER) -Apprehension test for posterior shoulder dislocation (90 flex and IR, posterior directed force) -Sulcus sign (Greater than 2 cm = 3+, 1-2 cm = 2+, less than 1 cm = 1+

Lymphedema

-Chronic, incurable condition -Accumulation of lymph in the body, causing edema that presents typically in extremities, but can occur anywhere on body (face, neck, abdomen, trunk, genitalia) -Fluid buildup occurs secondary to damage to lymph structures -Categorized as Primary or Secondary -Patients complain of achiness, fullness, and heaviness of affected limb, which eventually becomes fobrotic, resulting in further chronic inflammation and increased risk for infection

Metabolic System Functions

-Conversion of food to energy to run cellular processes -Conversion of food to fuel for proteins, lipids, nucleic acids, and carbs -Elimination of metabolic waste Catabolism breaks down organic processes Anabolism combines simple molecules for tissue growth

Epicondylitis Tests

-Cozen's Test: Resisted wrist pronation, radial deviation, and extension with palpation at latereal epicondyle. Positive for weakness or pain on lat epicondyle. Indicative of lateral epicondylitis. -Lateral Epicondylitis Test: Patient extends third digit against resistance. Positive for pain or muscle weakness -Medial Epicondylitis Test: Therapist passively supinates the forearm, extends the wrist and elbow. Positive for pain in medial epicondyle. -Mill's Test: Therapist pronates forearm, flexes wrist, extends elbow. Positive for pain in lateral epicondyle.

Basal Ganglia Dysfunction

-Difficulty starting, stopping or sustaining movement -Uncontrollable, repeated movements (shaking) -Muscle spasms and muscle rigidity -Parkinson's/Huntington's, Tourette's, ADD, OCD, addiction

Exercise Stress Test Absolute Indications for stopping

-Drop in SBP greater than 10 despite increase in workload WTIH evidence of ischemia -3/4 angina -Nervous system symptoms (ataxia, dizziness) -Poor perfusion (cyanosis, pallor) -Sustained V-tach -1.0 mm ST elevation without diagnostic Q waves

SLAP tear

-Lesion of superior labrum that extends anterior to posterior -Type 2 is most common (detachment of superior labrum from glenoid along with LHB tendon) Proceed with caution if biceps tendon is detached -Direction of instability most likely to be anterior Post-op rehab: -elevation PROM limited 30 deg per week (90 deg by week 3-4) -ONLY passive IR and ER -AVOID active elbow flex/supination for 6 wks -AVOID shoulder EXT with elbow EXT for 6 wks -Avoid resisted biceps contraction for 8 wks -Avoid ABD/ER combo for 12+wks

SC Joint: -Motions -Loose-packed position -Close-Packed Position -Capsular Pattern

-Motions: Elevation, Depression, Proctraction/Retraction, Ext/Internal Rotation -Loose-packed position: Arm at side -Close-Packed Position: Max shoulder elevation -Capsular Pattern: Pain at end range of motion

Medial Collateral Ligament

-Runs from medial femoral epicondyle to medial aspect of shaft of the tibia. Deep capsular fibers are attached to the medial meniscus -Prevents excessive valgus displacement of tibia relative to femur Injured through: -Pure valgus load at knee without rotation (lateral blow to knee in football) -Often involves injury to ACL or medial meniscus Special test: Valgus stress test

Posterior Cruciate Ligament

-Runs from the posterior intercondylar tibia to the anterolateral surface of the femoral medial condyle. -Prevents posterior displacement of tibia on femur Injured through: -"Dashboard Injury" where tibia is driven posteriorly on femur as well as femur driven anteriorly on tibia -Severe knee hyperflexion (falling on bent knees) Special tests: Posterior Drawer, Posterior sag

Angiotensin II Receptor Blockers (ARBs)

-Sartans Block Angiotensin II receptors which limit vasoconstriction and stimulation of vascular tissue Indications: HTN, CHF Losartan, Candesartan, Valsartan

Relative contraindications to Exercise during Pregnancy

-Severe Anemia -Unevaluated maternal cardiac dysrhythmia -Chronic bronchitis -Poorly controlled Type I diabetes -Extreme morbid obesity or underweight (BMI less than 12) -History of extremely sedentary lifestyle -Intrauterine growth restriction in current pregnancy -Poorly controlled hypertension -Orthopedic limitations -Poorly controlled seizure disorder -Poorly controlled hyperthyroidism -Heavy smoker

Biceps Tendon Pathology special tests

-Speed's Test: Resisted active shoulder flexion with palpation of bicipital groove, positive for pain -Yergason's Test: Resisted forearm supination and ER -Ludington's Test: Hands behind head, alternately contract/relax biceps muscles. Absence of movement is positive for long head of biceps rupture

Levels of Evidence

-Systematic Review: best option -Randomized Control Trials: double blind -Cohort studies: longitudinal, not randomized or controlled, writing down observations, retrospective -Case Control: Individuals w/ disease are compared to invidiuals without -Cross-sectional: Observations are only made at one point in time, all subjects tested at same time -case study: one patient results -expert opinions: least valuable

Central Vestibular Disorders

-TIA/Stroke -Acoustic Neuroma -Cerebellar Tumor -Vertebrobasilar insuficciency -Concussion/Head Injury -Vestibular migraine -Multiple Sclerosis

Posterior Innominate Rotation

-With supine to sit, test leg goes short to long (SLP) Treatment: MET on hip flexors (opposite posterior)

Ulnar Gutter Splint

-aka ulnar FA based static wrist orthosis -provides rigid support for fxs, inflammatory conditions of soft tissue/nerve injuries; reduces pain and inflammation; protects against joint damage; immobilization to promote healing -Population: Boxer's fx of 5th metacarpal, skin graft, wrist sprain/fracture, sports, work related injuries, arthritis, congenital hand deformities -Wear at all times except when bathing

Antibiotics (Cancer)

-cins Adriamycin (doxorubicin) Mithracin (plicamycin) Cosmegen (Dactinomycin

Positions to Relieve Dyspnea

-forward leaning with arm support optimized length tension of diaphragm and allows piece minor and major muscles to assist with elevating rib cage during inspiration. -reverse trendelenburg (supine with head above trunk and LE) -semi fowlers - supine head of bed evaluated 45 degrees.

Occipital Impairment

-homonymous hemianopsia -impaired extra ocular mvmt -reading and writing impairment -cortical blindness with bilat lobe involvement

Antihistamine Agents

-ines Block effects of histamine to decrease nasal congestion, mucosal irritation and symptoms of cold, sinusitis, conjunctivitis, allergies. Can also be used for seasonal allergies, motion sickness, and Parkinson's. Benadryl (Dipenhydramine), Allegra (Fexofenadine), Zyrtec (Cetirizine HCL), Claritin (Loratadine)

Hickman Catheter

-inserted through cephalic or internal jugular vein -threaded into SVC and R atrium -used for long-term administration of substances into venous system (chemotherapeutic agents, total parenteral nutrition, and antibiotics)

Anterior Cruciate Ligament

-runs from anterior intercondylar area of tibia to medial aspect of lateral femoral condyle in intercondylar notch ( -Prevents anterior displacement of tibia on femur Injured through: -noncontact twisting injury associated with hyperext and varus/valgus stress to knee. -severe knee hyperextension -Tibia being driven anteriorly on femur, or femur driven posteriorly on tibia Special tests: Anterior drawer, Lachman, lateral pivot shift, Slocum

Thumb Spica Splint

-stabilizes and supports CMC joint, IP joint free, includes wrist -provides rest to pt who has pain or edema in thumb 2/2: RA, sprains, wrist instabilities and surgical repair, DeQuervain's tenosynovitis, Skier's/Gamekeeper's thumb -splint should be worn: during activs that may require extra support; activs that include repetitive movts; at night to provide a functional resting splint

Central Venous Pressure Catheter

-used for measuring pressures in right atrium or SVC -indwelling venous catheter + pressure manometer -evaluates right ventricular function, right atrial filling pressure, and circulating blood volume -reduces need for repeated venipuncture

Repeated Contractions (RC)

-used when multiple muscle groups are weak -concentric until point of weakness then resist isometrically -apply a quick stretch then have patient continue actively into pattern -hold an isometric at end of range then concentrically contract antagonists with an isometric at the end of that range -mobility

Inflammatory Phase of Wound Healing

1-10 days Initial response to wound, Platelet activation, clotting cascade. WBCs kill bacteria. Re-epithelializationin 24 hours

High Altitude

1,500-3500 m (5000 ft to 11,500 feet) Atmospheric pressure is low, partial pressure of O2 is high (PaO2) Increased HR, CO, BP, RR Decreased performance, SV, Arterial PaCO2 Altitude sickness: HA, nausea, vomiting, edema, dyspnea

Arterial Blood Gas Analysis

1. *pH over 7.40 = alkalosis *pH under 7.4 = acidosis 2. *CO2 = 35-45 means no respiratory problem and no respiratory compensation for metabolic problem. *CO2 over 50 mmHg = alveolar hypoventilation/failure to get rid of CO2 *CO2 under 30 mmHg = alveolar hyperventilation (getting rid of too much CO2) 3. Rule: if pH and CO2 are outside norms in same direction, it's a compensation for metabolic OPPOSITE of what pH says it is (high pH = compensated acidosis). If outside norms in opposite direction, CO2 is causation (Acidosis/Alkalosis) *Low pH and High CO2 = Respiratory Acidosis *High pH and High CO2 = Retention of CO2 to compensate for metabolic alkalosis *High pH and Low CO2 = Respiratory Alkalosis *Low pH and Low CO2 = Elimination of CO2 to compensate for metabolic acidosis 4. HCO3 22-26 = no metabolic problem or compensation. Rule: If HCO3 and pH are outside norms in same direction, HCO3 is causation. If outside norms in opposite direction, it's a compensation for respiratory OPPOSITE of what pH actually is (low pH = Compensated Alkalosis, etc). *Low pH and Low HCO3 = Metabolic Acidosis *Low pH and High HCO3 = Renal compensation for respiratory alkalosis *High pH and High HCO3- = Metabolic Alkalosis *High pH and Low HCO3- = Renal Compensation for Respiratory Acidosis

Moisture Retentive Dressings from Most to Least Moisture Retentive

1. Alginates 2. Semipermeable Foams 3. Hydrocolloids 4. Hydrogels 5. Semipermeable Film

Gait: Standard Terminology

1. Heel strike 2. Foot Flat 3. Midstance 4. Heel off 5. Toe Off 6. Acceleration 7. Midswing 8. Deceleration

Occlusive Dressings from Most to Least Occlusive

1. Hydrocolloids 2. Hydrogels 3. Semipermeable foam 4. Semipermeable Film 5. Impregnated Gauze 6. Alginates 7. Traditional Gauze

Gait: Rancho Los Amigos Terminology

1. Initial Contact 2. Loading Response 3 Midstance 4. Terminal Stance 5. Pre-swing 6. Initial Swing 7. Mid-swing 8. Terminal Swing

Characteristics of Synovial Joints

1. Joint cavity 2. Articular cartilage 3. Synovial membrane 4. Synovial fluid 5. Fibrous capsule

Brunnstrom's Seven Stages of Recovery

1. No volitional movement 2. Appearance of basic limb synergies, beginning of spasticity 3. Voluntary synergies, spasticity increases 4. Spasticity decreases, movement patterns not dictated solely by synergies 5. Further decrease in spasticity, independence from limb synergy patterns. 6. Isolated joint movements with coordination 7. Normal motor function

Central vs Peripheral vertigo

1. Nystagmus - bidirectional in central - only vertical in peripheral. Fast segment of movement indicates opposite direction of lesion. 2. Peripheral is episodic/Short duration 3. Tinnitus, hearing loss only in peripheral, vertigo is more significant 4. Refractoriness only present in peripheral (tilt test, ex) 5. Brainstem sx / focal neur. deficits only in central (diplopia, weakness, numbness, LOC)

Misc PT responsibilties

1. Reporting drug tolerance or adverse effects to physician immediately if placing pt at risk for harm 2. Students are an extension of PT and when under direct supervision, can perform all functions of PT 3. Are responsible for acting in best interests of patients and minimizing risk of pt harm and pt inconvenience

Misc PTA responsibilities

1. Shall not determine appropriate electrical modality parameters 2. Should report suspected cases of abuse involving children or vulnerable adults to supervising therapist AND to appropriate authority 3. Modify interventions only when within POC set up by PT 4. PTAs and SPTAs can train pts with an AD once pt has been assessed and correct AD identified by PT

ADA carpet surface max. pile

1/2 inch

Russian Stim (Muscle Re-ed)

10 ms PD 50 PPS Frequency (high) Motoric amplitude, 1/3 ratio with 1.5 sec ramp time

CPR compression rate

100-120 bpm

Normal infant HR and RR

100-130 BPM, 33-45 RR newborn, 25-35 RR 1 yr

Thoracolumbar spine Motions: -Loose-packed position -Close-Packed Position -Capsular Pattern

12 thoracic vertebrae, 5 Lumbar vertebrae. First 10 T spine vertebrae have articular facets on each transverse process where ribs articulate. Motions: Flexion, extension, lateral flexion, rotation -Loose-packed position: Midway between flexion and extension -Close-Packed Position: Extension -Capsular Pattern: Lateral Flexion and rotation equally limited, extension

Normal Hemoglobin Level

12-18 gm/dL 8 is cutoff point for exercise

ADA Bathroom toilet requirements

17-19 inches from floor to top of toilet

Surgery for meniscus injuries

1: Partial meniscectomy, torn piece of meniscus is removed. Chosen when tear is in avascular inner third of meniscus or for older individuals. No weight bearing restriction. 2: Meniscal Repair. Tear is sutured together. Chosen for younger patients or when tear is on the outer third. Weight bearing restriction.

Angina Pain Scales

1: mild, barely noticeable 2: moderate, bothersome 3: moderately severe, very uncomfortable 4: most severe or intense pain ever experienced

Lumbricals (hand)

1st and 2nd: median nerve C6, C7 3rd and 4th: ulnar nerve C8, T1

Zone of coagulation

Area of burn receiving most severe injury with irreversible cell damage

Infarction

Area of dead tissue (necrosis) caused by ischemia

INR (International Normalized Ratio) value:

2.0-3.0. if on warfarin. Target of 2.5. Higher the number bleeding disorder. Lower the number clotting disorder.

Embolus ischemic Stroke

20% of CVAs - associated with CVD, embolus may be solid, liquid or gas and can originate in any part of body. Embolus travels through the bloodstream to cerebral arteries causing occlusion of blood vessel and a resultant infarct. MCA most commonly affected by embolus from internal carotid arteries. Tissues distal to the infarct can sustain higher permanent damage. Often presents with HA.

Normal Lymphocyte Range

20-50%

Total Cholesterol (TC)

200 mg/dL is desirable Borderline: 200-239 High: over 240

Normal Adult HCO3-

22-26 mEq/L

zone of stasis

Area of less severe injury that possesses reversible damage surrounding zone of coagulation

Proliferative Phase of Wound Healing

3-21 days Formation of new tissue Capillary buds and granulation tissue fill the wound bed

Embolus

A clot that breaks lose and travels through the bloodstream.

Normal Leukocyte Count

4,500-11,000 per mm3 Lower than 5,000 with fever or 1,000 with no fever is CUTOFF

CPR Compression to ventilation ratio

30:2

Normal Hematocrit Level

35-55% 25% is cutoff point for exercise

ADA Hallway Clearance width

36 inch width

Glasgow Coma Scale: Eye Opening.

4 spontaneous 3 to speech 2 to pain 1 none

Normal monocyte count

4-8%

Normal Adult HR

60-100 BPM 12-20 RR

Thermal Burn

Caused by conduction or convection -Hot liquid, fire, or steam

Glasgow Coma Scale: Verbal Response

5 - Alert and Oriented 4 - Confused, yet coherent, speech 3 - Inappropriate words and jumbled phrases consisting of words 2 - Incomprehensible sounds 1 - No sounds

Gross Motor Function Classification System

5 level standardized assessment tool classifying a child with a motor disability (like CP). Based on "usual performance" eg what child does regularly rather than what they are capable of 1. Walks without limitations -Independent, climbs steps w/out railing, runs and jumps 2. Walks with limitations -Climbs steps with railing, requires AD for challenging environment -Wheeled mobility for long distance 3. Walks using Hand-held mobility device -Walking AD in most settings, wheeled mobility for long distances 4. Self-mobility with limitations, may use power -May ambulate with walking AD for short distance with assistance 5. Dependent--Transported in manual wheelchair.

Normal Erythrocyte count

4.0-5.6 million per mL

Normal HDL levels

40-60 High is good

Junctional Rhythm

40-60 Regular! -impulse from AV node w/ retro/antegrade transmission - P wave often inverted/buried/follow QRS - slow rate - narrow QRS (not wide like ventricular)

Normal Neutrophil Range

40-70%

ADA Wheelchair Turning Radius (U-turn)

60 inch width 78 inch length

ADA Parking space Requirements

8 foot width 20 foot length 2% of spaces must be accessible

Normal Child HR and RR

80-100 BPM 15-20 RR

Normal Adult PaO2 Mild Hypoxemia Moderate Hypoxemia Severe Hypoxemia

80-100 mmHg Mild Hypoxemia: 60-79 mmHg Moderate Hypoxemia: 40-59 mmHg Severe Hypoxemia: Under 40 mmHg

Acute Pain IFC

80-120 pps, sensory intensity

Normal Adult SaO2

95-98%

Completed Stroke

A CVA that presents with total neurological deficits at the onset.

Ectopic

Implantation of fertilized ovum outside uterus, most common site being fallopian tube

Hematoma

Mass of clotted blood confined to a tissue or organ caused by a break in a blood vessel

AC Joint test

AC Crossover Test: 90 deg shoulder flexion, then passive full Horiz ADD. Positive for pain on AC.

Enalapril (Vasotec)

ACE Inhibitor for HTN and CHF Sides: Dry cough, swelling, confusion, tachycardi

-pril

ACE inhibitor to lower BP Lisinopril, Enalapril

U Walker with laser

AD to improve stability and upright positioning while reducing FOG and hypokinesi

Myocardial Perfusion Imaging (MPI)

AKA Radionuclide Stress Test or Nuclear Stress test. Shows how well heart is perfused at res adn under exercise stress by injecting radionuclide agent into blood at rest and at max exercise. Images reveal areas of reduced blood supply due to coronary artery narrowing.

ANS Dysfunction

ANS influences all internal organs, blood vessels, and glands, controlling BP, HR, RR, Temp, metabolism, etc. Constipation, erectile dysfunction, Horner's syndrome, vasovagal syncope, orthostatic hypotension, and postural tachycardia are all ANS dysfunctions that can be caused by outside pathology or primary damage. Treated with pharmacological interventions.

Heart murmur

Abnormal swishing or swooshing sound by auscultation in cardiac cycle. May be "innocent" due to blood flowing rapidly through heart from activity, or due to turbulent blood flow through a damaged or narrowed heart valve or hole in heart walls. May also be caused by rheumatic fever, endocarditis, mitral valve prolapse. Sxs: Cyanosis, limb edema, SOB, distended neck veins, weight gain, chest pain, dizziness, fainting. Tx: Digoxin, anticoagulants, diuretics, antihypertensives.

Crackles

Abnormal, discontinuous high pitched popping sound heard in inspiration. Indication: Restrictive or obstructive respiratory disorders (Pulmonary edema, atelectasis, pneumonia, bronchiectasis, pleural effusion)

Leukocytosis

Abnormally high WBC count, can indicate infection or leukemia. Higher than 11,000 per mL

Premature Ventricular Complex (PVC)

Absent P wave with wide and bizarre QRS complex. Couplet: Two consecutive PVCs Triplet: Three consecutive PVCs Bigeminy: Every other QRS is a PVC Trigeminy: Every third QRS is a PVC Commonly occurs in healthy and diseased hearts. -If one in isolation, continue exercise and monitor vitals -If 6 in one strip, call EMS -3 consecutive in a row is V-tach, call EMS -PVC that lands on a T wave impairs heart's ability to fill with blood, call EMS

Areas of Heart Auscultation

All People Enjoy Time Magazine Aortic Area (2nd intercostal space at right sternal border) Pulmonic Area (2nd intercostal space, L sternal border Erb's Point (3rd intercostal space, L sternal border Mitral Area (5th intercostal space, medial to L midclavicular line) Tricuspid area (4th intercostal space at L sternal border)

Split thickness graft

All epidermis and some dermis

Axillary Crutches

All levels of WB, but require higher coordination Fit: Crutches 6 in in front and 2 in lateral to pt Height: no greater than 3 finger widths from axilla Handgrip: allows for 20-25 deg of elbow flexion Two-point, three point, four point, swing to, swing through

Loftstrand Crutches

All levels of WB, but require highest level of coordination for proper use. Less stable than axillary, not used often with geriatrics Fit: 20-25 deg of elbow flexion while holding handgrip with crutches 6in in front and 2 in lateral -Selected over axillary when pt has injury to axillary nerves and blood vessels Two point, three point, four point, swing to, swing through

Tibial Nerve (FL)

All posterior calf muscles All muscles on plantar side of foot

Lateral Medullary Syndrome

Also called Wallenberg Syndrome of PICA syndrome. Caused by blockage of VA or PICA leading to infarct of lateral medulla oblongata, which houses CN 9-12 Loss of pain and temp on contralateral side Lateral Medullary Syndrome is a BIG HANDFUL Bradycardia Ipsilateral Facial Loss Gag reflex dinimished Horner's sign (ptosis, meiosis, anhydrosis) Ataxia Nystagmus Double Vision (Diplopia) Faulty Speech (Dysphonia) Unable to swallow (Dysphagia) Loss of contralateral limb sensation

Guillain-Barre Syndrome

Also called acute polyneuropathy. Autoimmune response to previous respiratory infection, flu, immunization, or surgery causing a temporary inflammation and demyelination of PNS myelin sheaths, sometimes resulting in axonal degeneration. Sxs: Motor weakness in distal to proximal progression, NO LOSS OF SENSATION, and possible respiratory paralysis. Initially presents with symmetrical distal motor weakness that peaks 2-4 weeks post onset. Muscle/respiratory paralysis, DTR absence, and inability to speak/swallow may occur. Can be life threatening. Tx: Immunosuppressive and analgesics, PT for pulmonary rehab, strengthening, mobility training, WC or orthotic scrip, or asst device training.

Minute Volume Ventilation (VE)

Amount of air expelled in one minute, equal to Tidal Volume x Respiration Rate

Parenteral administration of drugs

Any form of administration not involving GI tract (intramuscular, intravenous, subcutaneous, inhalation, transdermal)

Grade 3 Concussion

Any head injury with LOC. Transport to emergency room for full neurological evaluation. Hospitalization for persistent symptoms. Held out of competition for a minimum of one month once symptom free. This type causes diffuse axonal injury and if severe, can result in a coma.

Emetics

Apomorphine, Ipecac

Blood platelets (Thrombocytes)

Assist in blood clotting by dumping at bleeding site to form a plug to seal the blood vessel. Normal level is 150,000-400,000 platelets per mL of blood

Deltoid

Axillary nerve C5, C6

Teres minor

Axillary nerve C5, C6

Visceral Pleura

Membranous sac that covers each lung. Separated by serous fluid from other pleural layer.

Hepatitis C

Blood, semen, or bodily fluid transmission. 90% of post-transfusion hep cases. Often asymptomatic, acute infection can be mild Increased frequency of hashimoto's, DM, and corneal ulceration. No vaccine available. Chronic hep occurs in 50% of cases, 20% of those progress to liver cirrhosis

Palmar Grasp Reflex

Baby will flex fingers and grab something with pressure in palm. Normal Age: Birth to 4 months

Invasive Hemodynamic Monitoring

Balloon catheter (Swan-Ganz) is placed in pulmonary artery to obtain pulmonary artery pressure and L Atrial pressure, a CVP line measures pressure in vena cava or R atrium, and thermodilution catheter measures CO. Measures pressure, volume, and temp continuously.

Aneurysm

Ballooning of weakened portion of arterial wall due to congenital defect, chronic hypertension, trauma, infection, or connective tissue disease (Marfan) Sxs: Aortic can be asymptomatic or ab or low back pain. Abdominal aortic will cause pulsations near navel. Cerebral will cause sudden/severe headache, nausea, vomiting, stiff neck, seizure, LOC, double vision Tx: Antihypertensives, surgery to replace large aneurysms with synthetic graft.

Antacids for GERD, peptic ulcer, gastric indigestion

Basaljel (Aluminum carbonate) Tums (Calcium carbonate) Milk of magnesia (magnesium hydroxide) Bromo Seltzer (sodium bicarbonate)

Greenstick Fracture

Bending and incomplete break of a bone; most often seen in children

Sciatic nerve injury can be caused by

Blunt force trauma to buttocks, THA, injection to nerve

-dronate

Bone resorption inhibitor for osteoporosis Alendronate, risedronate

Osteomalacia

Bones become soft secondary to calcium (decreased intestinal absorption) or phosphorous deficiency (increased renal excretion) or deficiency in vitamin D. Bone matrix is adequate, insufficient calcification of matrix. Sxs: Vague presentation of aching, fatigue, weight loss. Myopathy and sensory polyneuropathy with periarticular tenderness and pain, thoracic kyphosis and bowing of lower extremities. Tx: Fix underlying etiology.

Femoral Triangle

Bordered by inguinal ligament, sartorius, and adductor longus Structures (from medial to lateral): Femoral vein, artery, and nerve (VAN)

Interosseus Sacroiliac Ligament

Connects sacrum and ilium and is deep to posterior sacroiliac ligament. Resists anterior and inferior sacral movements

Gray Matter

Brain and spinal cord tissue that appears gray with the naked eye; consists mainly of neuronal cell bodies (nuclei) and lacks myelinated axons.

dynamic response foot

Can be articulating or non-articulating. Keel can store and return some energy, may have split keel to allow for improved surface accomodation

Injection

Can be intravenous (IV), intramuscular, subcutaneous, intra-arterial, or intra-thecal

Peripheral Neuropathy

Can cause absent reflexes. Can be caused by diabetes, alcoholism, vitamin deficiencies, cancers, and toxins.

Associative Stage of Motor Learning

Can distinguish errors in performance, and errors decrease with performance. Decreased need for conscious concentration, and increased movt coordination.

Sacrospinous ligament

Connects ischial spine to lateral sacrum and coccyx. Limits anterior sacral rotation.

Longus capitis

C1-C3

Rectus capitis anterior

C1-C3

Rectus capitis lateralis

C1-C3

Age-appropriate activities for 2-3 year old

Catching ball, riding tricicyle, running short distances

Qualitative Data

Categorical data. Represents categories distinguished by non-numeric characteristic (eye color, blood type, hand dominance)

Upper Quarter Dermatomal Testing

C2: Posterior Head C3: Posterolateral Neck C4: AC Joint C5: Lateral Arm C6: Lateral Forearm and Thumb C7: Middle Finger C8: Little finger and ulnar border of hand T1: Medial Forearm

Moist Hot Packs

Can heat tissues 1-3 cm deep. If goal is to heat deeper tissues (knee joint capsule, muscle belly of quads), use a deep heat modality (diathermy, continuous ultrasound) Tissue temp should be elevated to 104-113 degrees F 6-8 Terry Towels to ensure adequate insulation from hot pack Check patient's subjective temp response and skin temp at 5 and 10 min checkpoints Pt should not lay on moist heat pack, have them lay prone Total treatment time no longer than 20 min

Asthma

Chronic inflammation of airways due to airway hypersensitivity from allergens (pollen, mold, dust), exposure to cold air or temp change, smoke, exercise, stress. Sxs: Mild presents as wheezing, chest tightness, SOB. Severe presents as dyspnea, flaring nostrils, diminished wheezing, anxiety, cyanosis, inability to speak. Can result in respiratory failure Tx: Anti-inflammatories (inhaled corticosteroids, leukotriene mods) and bronchodilators (Anticholinergics, methylxanthines, beta-adrenergicagnoists)

Urinary Anti-infective Agents

Cinobac (Cinoxacin) Furadantin (Nitrofurantoin)

Circumduction Gait pattern

Circular movement of limb during swing phase to compensate for insufficient hip/knee flexion or dorsiflexion.

Antibiotics for H. Pylori

Clarithromycin Amoxicillin Tetracycline Metronidazole

Nephrolithiasis

Condition of developing kidney stones

Osgood-Schlatter Disease Condition: Etiology: S/Sx: Testing: Tx:

Condition: Also known as traction apophysitis. Etiology: Repetitive tension to patellar tendon over tibial tuberosity in young athletes, causing a small avulsion of tibial tuberosity and mild swelling S/Sx: Point tenderness over tibial tuberosity, antalgic gait, pain with increasing activity

Iliolumbar ligament

Connects posterior portion of ilium to the transverse process of L5, and limits all motions between L5 and S1

Heat Transfer

Conduction Convection Conversion Evaporation Radiation

cort

Corticosteroid Cortisone, hydrocortisone

Pred

Corticosteroid Prednisone

-asone

Corticosteroid (dexamethasone, flucatisone)

Methylprednisone (Medrol)

Corticosteroid for inflammation, severe allergies, or flare-ups of chronic illnesses. Sides: Mood changes, visual changes, rapid weight gain

-olone

Corticosteroid or anabolic steroid Triamcinolone; Nandrolone

Anti-inflammatory agents for bronchospasm and asthma

Corticosteroid: Qvar (beclomethasone dipropionate), Pulmicort (Budesonide), AeroBid (Flunisolide) Leukotrine Modifier: Zyflo (Zileuton) Mast-cell stabilizer: Nasalcrom (Cromolyn Sodium)

Neurogenic Bladder

Damage to cerebral control of bladder from diabetes, CVA, or nerve damage, and allows for urinary dysfunction that can increase UTIs and kidney damage. Sxs: Frequent UTIs, urine leakage, inability to empty or los of urge to urinate with full bladder. Urodynamics to diagnose.`

Ventricular Arrhythmias

PVC V tach V fib Ventricular Asystole

C2 dermatome Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Temple/forehead/occiput Muscles innervated: Longus colli, SCM, rectus capitis Reflexes (if any): None Paresthesias: None

C1 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Vertex of skull Muscles innervated: None Reflexes (if any): None Paresthesias: None

Rubrospinal tract

Extrapyramidal motor tract responsible for motor input of gross postural tone, facilitating activity of flexor muscles, and inhibiting the activity of extensor muscles

Continuous Data

Data that can take on any value, covers a range of values without gaps or interruptions. ROM, meters, kg, time

Gangrene

Death of tissue caused by loss of blood supply. Most commonly affects extremities

Axillary Nerve (EX)

Deltoid Teres Minor

Uterine Prolapse

Descent of uterus and cervix into vagina due to genetics, denervation, or muscular trauma from labor and delivery. -Classified using Baden-Walker system using 5 point grading scale (0 = no prolapse, 5 = max descent of tissue outside body) Sxs: Pelvic pressure with exertion, urgency/frequency, urinary incontinence, incomplete bladder emptying, discomfort, vaginal dryness, dyspareunia, lower back pain relieved by lying down Tx: Pessary for severe cases. Positioning and pelvic floor training

Glasgow Coma Scale

Determines arousal and cerebral cortex function. Total of 4 for Eye opening, 6 for Motor Response, and 5 for Verbal response E+M+V=3-15 8 or less: Severe brain injury and coma. 9-12: is moderate brain injuries. 13-15: Mild brain injuries

Endometriosis

Development of endometrial tissue normally lining the uterus in extrauterine locations in abdomen and pelvis, most commonly the uterosacral ligaments. Each menstrual cycle the tissue bleeds, causing scarring and adhesions. Sxs: Mod to severe abdominal, pelvic, or LBP before/during menstruation, irregular cycles, PM spotting, dyspareunia, pain during defecation, infertility Tx: Manual therapy to break up scar tissue/adhesions, mobility to sustain elongation of tissues, surgery to remove endometrial tissue or total hysterectomy

Airway Adjuncts

Devices that aid in maintaining an open airway in mechanical ventilation Oral Pharyngeal Airway: Holds tongue away from back of throat Nasal Pharyngeal Airway: Tube through nose Endotracheal tube: Tube inserted in trachea from mouth or nose Tracheostomy Tube: Artificial airway in trachea from incision in neck below vocal cords for patients needing prolonged vent

Types of Synovial Joints

Diarthrosis Uniaxial, Biaxial, Multiaxial

Range

Difference between maximum and minimum values

Autonomic Nervous System

Division of PNS that controls glands and muscles of internal organs. Largely automatic responses that don't reach consciousness and emphasize homeostasis and stress response. Contains two divisions: Sympathetic: Emergency response, Norepinephrine transmission, stimulating response. "Fight or flight" Parasympathetic: Conserving/restoring energy, ACh transmittion, inhibitory response. "Feed and breed"

Somatic Nervous System

Division of PNS that controls muscles. Voluntary movements, ability to touch, smell, see, taste, and hear.

Left Cerebral Hemisphere

Dominates in speech sounds & in understanding sequential, rational & analytical concepts

D1 Flexion LE

ER, Flex, Add "Bring your foot up, turn and pull your leg up and across your body"

Hand and wrist burn

EXT or hyperEXT of MCP, FLEX of IP, ADD and FLEX of thumb, Flexion of wrist Use wrist splint, thumb spica splint, palmar or dorsal extension splint

NCI Stage 0

Early malignancy, present only in layer of cells in which it began (in situ). Not all cancers have stage 0

Female Athlete Triad

Eating disorder Osteoporosis (depleted estrogen) Amenorrhea (changes in hypothalamus)

C7 Resistive Test

Elbow Extension, Wrist Flexion

C5-6 Resistive Test

Elbow Flexion

Elbow Neurological Dysfunction Tests

Elbow Flexion Test: Patient fully flexes both elbows while extending wrists, holding the position for 3-5 minutes. Positive for cubital tunnel syndrome if tingling or paresthesia is noted in ulnar nerve distribution Pinch Grip Test: Patient pinches tips of index fingers and thumbs together. If unable to pinch tip to tip and goes pad to pad, positive for anterior interosseus nerve dysfunction. -Tinel's Sign: Therapist taps between olecranon process and medial epicondyle. Positive for tingling in ulnar nerve distribution, may indicate ulnar nerve compression

Superficial Reflexes

Elicited by gentle cutaneous stimulation

Amygdala

Emotional and social processing. Processing of memory and formation of emotional memeory.

Normal adult PaCO2 Eucapnia Hypercapnia Hypocapnia

Eucapnia: 35-45 Hypercapnia: Over 45 mmHg Hypocapnia: Under 35 mmHg

Summary Feedback

Feedback after a set number of trials, shown to dramatically improve skill retention while significantly delaying acquisition of the skill. Cognitive and associative learning stages

Intrinsic feedback

Feedback that comes to the person through sensory systems as a result of the movement.

Nasogastric Tube (NG Tube)

Feeding tube goes through the nose, pharynx, ad into the stomach. Used for short term liquid feeding, med admin, or remove gas from stomach. Tube in nostril/back of throat can inhibit cough and be irritating

Steppage Gait

Feet and toes are lifted through hip and knee flexion to excessive heights, usually secondary to DF weakness. Foot slaps at initial contact with ground secondary to decreased control

Sartorius

Femoral nerve L2, L3

Pectineus

Femoral nerve L2-L4

Rectus femoris

Femoral nerve L2-L4

Vastus intermedius

Femoral nerve L2-L4

Vastus lateralis

Femoral nerve L2-L4

Allergic Reaction: Response

First: Remove source of allergic reaction Then: check airway to assess if compromised and begin CPR if necessary

Obturator nerve injury can be caused by

Fixation of femur fracture, THA

Chronic pain IFC

Fixed PD 1-10 pps Max sensory

Median Nerve (FL)

Fl. digit. superf. Fl. carpi radialis Palmaris longus

Ulnar Nerve (FL)

Fl.carpi uln. Fl. prof. dig.

Hip burn

Flexion and adduction deformity Anterior hip spica, abduction splint

Elbow burn

Flexion and pronation deformity Use a gutter splint, conforming splint, three point splint, or an air splint

Knee burn

Flexion deformity Conforming splint, three point splint, air splint

Posterolateral Approach Contraindications

Flexion, Adduction, IR (FADIR)

Thumb Mechanics

Flexion/Extension: Concave on convex, Roll/Glide same direction. (medial/ulnar roll and medial glide to improve flexion) Abduction/Adduction: Convex on concave, Roll glide in opposite directions (Volar/Palmar Roll and Dorsal glide for ABduction)

Lymph

Fluid transported by lymphatic system, originates as interstitial fluid and is made up of water, proteins, fatty acids, and cellular componens

Lobes of the brain

Frontal, Parietal, Occipital, Temporal

Stage 4 Pressure Injury

Full thickness skin and tissue loss, WITH exposed or directly palpated fascia, muscle, tendon, ligament, cartilage, or bone in ulcer. Slough or eschar may be visible. Unstageable if slough or eschar obscures tissue loss

Unstageable Pressure Injury

Full thickness skin and tissue loss, extent of tissue damage within ulcer cannot be confirmed by slough or eschar. Stable eschar (dry/intact, without erythema) should not be removed.

Shoulder Joints

GH SC AC S

Inhalation administration

Gaseous or aerosol. Lungs have large surface area, and can enter systemic circulation rapidly. Used when treating pulmonary pathologies

LUQ pain

Gastric Ulcer Pancreatitis Perforated Colon Spleen injury or rupture Pneumonia Aortic Aneurysm

Muscles innervated by Tibial Nerve

Gastroc Soleus Popliteus Tibialis Posterior Plantaris FHL FDL

Concurrent feedback

Given during task performance about quality of movement, usually during associative and autonomous stages

CN IX

Glossopharyngeal Sensory: Posterior tongue sensation and taste, pharynx Motor: Pharynx Test: Gag reflex, swallowing Common Pathologies: ALS, GB , Medullary Stroke

Muscle innervated by Inferior Gluteal Nerve

Glute Max

Dose-response curve

Graphic representation of relationship between dosage of a drug and the body's response. As the dosage increases, more receptors become activated, increasing the body's response to the drug, but the body's response will plateau at a certain dosage. Can compare potency of two drugs.

L5 Resistive Test

Great Toe Extension

Cardiac Output

Heart rate x stroke volume. Amount of blood pumped from ventricles per minute. Normal is 4.5-5 and can increase up to 25 L/min during exercise

Glutocorticoids (Corticosteroids)

Hormonal, anti-inflammatory, metabolic effects (suppression of articular/systemic diseases) to treat endocrine dysfunction, rheumatic or respiratory disorders. Results in weakened immune system (PT must wear mask). Toxicity: moon face, buffalo hump, personality changes. At risk for osteoporosis and muscle wasting. Examples: Hydrocortisone/Cortisol, Prednisone, Prednisolone, Methylprednisone, Dexamethasone, Nasonex

Pancreas

Housed in upper left quadrant of abdominal cavity. -Functions mostly as endocrine organ but also an exocrine gland, secreting bicarbonate and enzymatic pancreatic juice to neutralize stomach acid in intestines and break down food. -Islets of Langerhans are the hormone-producing cells of pancreas, containing Alpha cells to produce glucagon and Beta cells tp produce insulin -Those two hormones regulate glucose in bloodstream

Hyperparathyroidism

Hyperfunction of the parathyroid gland Sxs: Renal stones, kidney damage, depression, memory loss, muscle wasting, bone deformities and vertebral compression fractures Tx: Lowering serum calcium with diuretics or antiresorptive meds

Coccydynia

Hypermobility between coccyx and sacrum during or after childbirth causes a subluxation or tissue damage to soft tissue around coccyx. Sxs: Difficulty sitting on hard surfaces, referred pain to LBP, hip, SI, buttock, groin, or rectum, pain with bowel movements, dyspareunia, hemorrhoids

Epilepsy

Hypersynchronous electrical discharge of cortical neurons, typically unprovoked and unpredictable. Seizures are transient events that are hallmark signs of epilepsy but one seizure does not equal epilepsy. Etiology: Most are idiopathic, but may include genetics, head trauma, dementia, CVA, CP, down's, and autism. Sxs: LO awareness or LOC, disturbances in movt, sensation, modd, or mental function.

Cor Pulmonale

Hypertrophy of R ventricle due to pulmonary hypertension. R ventricle hypertrophies due to increased force needed to overcome resistance in pulmonary circulation. Sxs: Progressive SOB with exertion, fatigue, palpitations, LE swelling, dizziness, syncope Tx: Supplemental oxygen to maintain O2 sat over 90 or PaO2 over 60 mmHg.

Hypoparathyroidism

Hypofunction of parathyroid gland Sxs: Hypocalcemia, seizures, cognitive deficits, tetany, cramps, muscle pain, cardiac arrhythmias. May see Trousseau's Sign Tx: Intravenous calcium

CN XII

Hypoglossal Motor: Muscles of tongue Test: Tongue protrusion (if injured, tongue deviates towards injured side)

Hypocalcemia

Hypoparathyroidism, decreased intake, post parathyroidectomy, Vitamin D deficiency Sxs: CRAMP Confusion Reflexes are hyperactive Arrhythmias Muscle spasms Positive Trousseau sign (hand spasm with inflated BP cuff)

Heart Attack: Response

If unresponsive, call EMS and locate AED. Initiate CPR until AED arrives. 5 cycles of CPR, then AED.

Femoral Nerve (EX)

Iliacus Pectineus Sartorius Quadriceps

Positron Emission Tomography (PET)

Imaging test where a small amt of radioactive material is swallowed, injected, or inhaled. Used to evaluate for heart disease or cancer.

Aphasia

Impairment of processing for understanding (receptive) or speaking (expressive) language. Caused by TBI, CVA, tumor, infection. 95% of R handed persons and 66% of L handed persons are L hemisphere dominant for language. More sudden onset = higher extent of aphasia. Can be Fluent (Wernicke's, Conduction) or Non-Fluent (Broca's, Global)

Combined Insufficiency

Increase in lymph fluid and decrease in transport capacity

Gluteus maximus

Inferior gluteal nerve L5, S1, S2

Myocarditis

Inflammation and weakness of myocardium, due to virus (flu, coxsackie virus, adenovirus), or bacterial (polio, rubella, Lyme disease). Myocardium becomes thick and swollen, leading to sxs of heart failure. Sxs: Arrhythmias, chest pain, SOB, fatigue, fever (headache, muscle aches, sore throat, diarrhea, rashes). Tx: Antibiotics, antiinflammatories, diruetics, beta blockers, calcium channel blockers. Severe may need VAD or intra-aortic balloon pump.

Diverticulitis

Inflammation in diverticula (pouch-like protrusions in colon). 80% of diverticulosis is asymptomatic, but 20% may progress to diverticulitis. May be a result of low fiber diet. Sxs: Abdominal pain, with tenderness over left side of lower abdomen. Cramping, constipation/diarrhea, nausea, fever, chills, vomiting. Tx: Diet modification, lower internal colonic pressure through increased fiber. Nasogastric tube for severe cases.

Bronchitis

Inflammation of bronchi, characterized by larger and more active mucus glands, decreasing oxygenation. Acute caused by cold viruses, exposure to smoke, air pollutants. Cigarettes or air pollutants in workplace contribute to chronic. Sxs: Persistent cough with production of thick sputum, accessory muscles in breathing, increased pulmonary artery pressure. Chronic--cough worse in morning, in damp weather, and have frequent respiratory infections Tx: Rest, fluids, cough suppressants, lifestyle changes.

Gastritis

Inflammation of gastric mucosa (stomach lining) with similar symptoms to GERD but greater intensity. Can be erosive (acute) or non-erosive (chronic type B). Patients should avoid all aspirin containing compounds. If blood in stool, initiate physician referral.

Non-erosive Gastritis

Inflammation of gastric mucosa as a result of H.Pylori bacterial infection. Sxs: May be asymptomatic, but will show symptoms in progression. Tx: H. Pylori is a carcinogen and should be treated with aggressive pharmacological intervention, including proton pump inhibitor and antibiotics

Endocarditis

Inflammation of inner lining of heart and cardiac valves due to bacteria that enters the blood rom catheters, needles, dental procedures, gum disease, STDs, or IBS. Individuals with damaged or artificial heart valves are at greatest risk Sxs: Develop slowly. Fever, chills, heart murmur, fatigue, SOB, weight loss, blood in urine, skin petechiae. Tx: Antibiotics.

Pericarditis

Inflammation of pericardium due to viral infections (HIV, coxsackie, flu), bacterial infections, fungal infections, MI, chest trauma, immunosuppressive meds, or chest radiation. The inflammation causes pericardial effusion which can disrupt heart's normal rhythm. Sxs: Chest pain, SOB, dry cough, anxiety, fatigue, fever. Tx: Analgesics,antiinflammatories, antibiotics if it was for a bacterial infection. Most cases are mild and clear up on their own.

Indirect Cholinergic Agonists

Inhibit Acetylcholinesterase to keep ACh bioavailable, increasing cholinergic synaptic transmission. -Aricept/Donepezil -Tensilon/Edrophonium -Prostigmin/Neostigmin -Cognex/Tacrine

Paraplegia

Injury at Thoracic, Lumbar, or Sacral spine

Complex Regional Pain Syndrome

Intense, chronic, burning pain in affected extremity that spreads proximally after trauma, surgery, CVA, TBI, or peripheral nerve injuries. Stage I (Acute): Edema, thermal changes, discoloration, stiffness, dryness Stage II (Dystrophic): Worsening and constantpain, continued edema, and Stage III (Atrophic): Hardened edema, decreased limb temp, atrophic changes to fingertips or toes

Rectus abdominis

Intercostal nerves T7-T12

Lower Motor Neuron Disease

Lesion to nerves or their axons at or below level of brainstem. Ventral gray column of spinal cord may also be affected. Sxs: flaccidity or weakness of muscles, decreased tone, fasciculations, muscle atrophy, and decreased or absent reflexes. Examples: -Poliomyelitis -ALS -Guillain-Barre -Spinal Cord tumors -Trauma -Progressive muscular atrophy -Infection -Bell's Palsy -CTS -Muscular Dystrophy -Spinal Muscular Atrophy

Normal LDL levels

Less than 100 mg/dL is optimal. 100-129: Near optimal 139-159: Borderline 160-189: High Over 190: Very high

Normal Triglyceride Level

Less than 150

ADA Threshold Height Requirements

Less than 3/4 inch for sliding Less than 1/2 inch for other doors

Hematopoietic Cancers (Bone marrow, Plasma Cells)

Leukemia Myelodysplasia Myeloproliferative Syndromes Multiple Myeloma

-caine

Local anesthetic Lidocaine, bupivicaine

Pubofemoral ligament

Located anteromedially & inferiorly, limits excessive hip extension & abduction

Pituitary Gland

Located at base of brain below hypothalamus, and is controlled by the hypothalamus. Consists of two glands (adenohypophysis anterior, and neurohypophysis in posterior). Considered the "master gland" and releases hormones that regulate other endocrine glands, and is influenced by seasonal changes or emotional stress. Creates sex hormones, controls ovulation

Ovaries

Located in pelvic cavity on each side of uterus, providing estrogen and progesterone that contribute to regulation of menstrual cycle and pregnancy. Ovarian follicles secrete estrogen, responsible for female sex characteristics Corpus Luteum secretes progesterone, which maintains uterus lining

Testes

Located in scrotum. Secrete androgens such as testosterone that regulate body changes associated with sexual development and support sperm production

Basilar Artery Stroke

Locked in syndrome

Acupunture-Like TENS

Long Duration (100-300usec) Low Frequency (2-4 pps) Moderate Amplitude (Motoric) Several hours of pain relief (endogenous opioids) after 25-45 minute treatment Do not use during ADLs

Brief Intense TENS

Long Duration (150-500 usec) High Frequency (60-200 pps) Moderate Amplitude (paresthesia or motor response) Intended to minimize pain during painful activities (painful manualtherapy, dressing changes, debridement) via endogenous opioid pathway 15 min treatment time

Serratus anterior

Long thoracic nerve C5-C7

Overflow Urinary Incontinence

Loss of urine when intra-bladder pressure exceeds the urethra's capacity to remain closed due to urinary retention. Caused by outflow obstruction secondary to narrow/obstructed urethra from prolapsed pelvic organ, stricture, enlarged prostate, chronic constipation, or neurological disease. Sxs: Difficulty initiating urine stream, weak stream with post-void dribble when initiated. Tx: Double voiding for patients with weak detrusor. Surgical intervention for obstruction

Brainstem Sections

Midbrain Pons Medulla Oblongata

Scapular Retraction

Middle Trap Rhomboids

Unilateral vestibular hypofunction

Nausea, vomiting, nystagmus, vertigo, postural instability. Habituation exercises are indicated (neural adaptation) Romberg will be POSITIVE As well as Gaze stability training

Iodine-iontophoresis

Negative Used for Scars and adhesive capsulitis

Acetic Acid-iontophoresis

Negative Used for calcific deposits, myositis ossificans

Gracilis

Obturator nerve L2-L4

Adductor brevis

Obturator nerve L3, L4

Three point gait pattern

One injured LE with decreased WB. AD advances, followed by injured LE then uninjured LE

Bullectomy

One or more Bullae (large air spaces formed when alveoli are destroyed from emphysema) are removed to improve breathing

alveolar capillary membrane

Oxygen diffuses across alveolar-capillary septum into RBCs in lung capillaries, where it combines with hemoglobin to be transported back to the heart. CO goes opposite direction.

Premature Atrial Contraction (PAC)

P wave is premature, abnormal configuration Can occur in normal heart (caffeine, stress, smoking, alcohol), or any type of heart disease.

Waveforms of ECG

P wave: Atrial Depolarization PR Interval: Conduction from SA to AV. QRS: Ventricular depolarization, atrial repolarization QT: Time for both ventricular depolarization and repolarixation ST segment: both ventricles are depolarized T wave: Ventricular depolarization

Toe down instead of heel strike

PF Spasticity PF contracture Weak DF DF paralysis LLD Hindfoot pain

Hypoglycemia: Response

Pale, moist skin, rapid HR, shallow breathing, HA, altered vision, confusion, seizure, LOC. Administer sugar (orange juice). If not conscious, intravenous glucose injection by medical professional

Finger Adduction

Palmar Interossei (PAD)

Stage 2 Pressure Ulcer

Partial thickness skin loss with exposed dermis. Wound bed is pink or red, no exposed adipose, no granulation tissue, slough or eschar.

GH Adduction

Pec major Lat Teres Major

Erector spinae: Iliocostalis

Posterior branches of the spinal nerves

Erector spinae: Longissimus

Posterior branches of the spinal nerves

Erector spinae: Spinalis

Posterior branches of the spinal nerves

Wheelchair Seat Depth

Posterior buttock to popliteal fold Subtract 2 inches

Quadrangular Space

Posterior circumflex humeral artery and Axillary nerve PAs play in the quad

Kim Test

Posterior inferior labrum tear test

Splenius capitis

Posterior lateral branches of cervical nerves four through eight C4-C8

Splenius cervicis

Posterior lateral branches of cervical nerves four through eight C4-C8

Semispinalis capitis

Posterior primary divisions on spinal nerves

Lung Auscultation

Procedure - 7 POINTS Listen to the breath sounds with the diaphragm of the stethoscope Positive Findings and Indications (+) Decreased breath sounds; Indication: Obstructed lung disease, pleural effusion, pneumothorax, or COPD (+) Crackles; Indication: pneumonia, fibrosis, CHF, bronchiectasis. (+) Wheezes; Indication: asthma, COPD, bronchitis. (+) Rhonchi; Indication: secretion in large airways. (+) Stridor; Indication: bronchial obstruction.

Escharotomy

Procedure to open or remove eschar from burn site to reduce tension on surrounding structures, relieve edema pressure, and enhance circulation

Liver

Produces bile which emulsifies fat, produces RBCs and vitamin K, regulates serum level of carbs, proteins, and fats

Basophils

Produces histamine and is involved in allergic response

Atherosclerosis

Progressive accumulation of fatty plaque on inner walls of arteries, due to damage or injury to inner wall of artery (HTN, high cholesterol, smoking, diabetes), causing plaque made of waste products to build up at the site of injury. This narrows blood flow and causes a blood clot. Sxs: Angina if coronary arteries are affected. Numbness or weakness of arms/legs, slurred speech, drooping face for cerebral arteries. Intermittent claudication for peripheral arteries. Tx: Lifestyle changes, meds, (antihypertensives, antiplatelets, antilipidemics), surgery (angioplasty, endarterectomy, bypass surgery)

Congestive Heart Failure

Progressive condition where heart is unable to maintain CO to meet demands for blood/oxygen due to damage from other conditions (CAD, HTN, DM, MI, cardiomyopathy). Ventricles weaken and dilate, heart can't pump efficiently. Blood "backs up" into liver, abdomen, LE, and lungs. Sxs: Tachycardia, SOB, fatigue, weakness, swelling in legs, feet, and abdomen, rapid/irregular heartbeat with S3 or S4 heart sound, persistent cough or wheeze Tx: Sometimes treating underlying cause can correct heart failure, most tx is balance of meds, devices, and lifestyle change

Spinal Muscular Atrophy

Progressive degeneration of anterior horn cell, caused by genetic inheritance. Categories: -Acute Infantile SMA Type 1: Wernig-Hoffman Disease (birth-2 months, motor degeneration is quick and life expectancy is >1year) -Chronic Childhood SMA Type 2 Wernig-Hoffman Disease (6 months-1 year, slower progression than type 1. Child can survive into adulthood.) -Juvenile SMA Type 3: Kugelberg-Welander (4-17yrs. Will survive to adulthood) Sxs: Progressive muscle weakness, atrophy, diminished DTRs, normal intelligence, intact sensation, end-stage respiratory compromise PEAT Note: If unable to develop sitting ability, pt is unlikely to walk and will need power mobility.

Chronic Renal Failure

Progressive deterioration in renal function due to DM, severe HTN, glomerulopathies, obstructive uropathy, interstitial nephritis, or polycystic kidney disease

Duchenne Muscular Dystrophy

Progressive disorder caused by absence of gene required to produce dystrophin and nebulin, causing muscle fiber membranes to weaken, become destroyed, and lose contractility. Fat and connective tissue replace muscle, death occurs from cardiopulmonary failure before 25. Sxs: First signs at 2-5. Progressive weakness, disinterest in running, toe walking, excessive lordosis, pseudohypertrophy of muscle. ADL usage begins around 5, inability to ambulate follows. Gower's sign usually present.

Nonopioid Agents

Provide analgesic and anti-inflammatory effects and anti-pyretic effects. Reduce prostaglandins, decreasing inflammation. Used for mild/moderate pain, fever, muscle ache, inflammation Sides: nausea, ulcers, GI distress Implication for PT: patients are at risk for masked pain allowing for movement beyond limitation. Examples: Acetaminophen, NSAIDS (Aspirin, Naproxen, ibuprofen, Celebrex/Celexocib)

Brachioradialis

Radial nerve C5, C6

Supinator

Radial nerve C6

Abductor pollicis longus

Radial nerve C6, C7

Extensor carpi radialis brevis

Radial nerve C6, C7

Extensor carpi radialis longus

Radial nerve C6, C7

Extensor pollicis brevis

Radial nerve C6, C7

Extensor carpi ulnaris

Radial nerve C6, C7, C8

Extensor digiti minimi

Radial nerve C6, C7, C8

Extensor digitorum

Radial nerve C6, C7, C8

Extensor indicis

Radial nerve C6, C7, C8

Extensor pollicis longus

Radial nerve C6, C7, C8

Anconeus

Radial nerve C7, C8

Triceps brachii

Radial nerve C7, C8

Pons

Regulates RR and associated with orientation of head in relation to auditory/visual stimuli. Cranial nerves V-VIII originate from pons.

Diastole

Relaxation

Hippocampus

Responsible for forming/storing new memories and important to learning language. Embedded in lower temporal lobe.

Distributed practice

Rest time in trials is equal or greater than practice time for each trial

Nerve root entrapments

Result from closure or narrowing of intervertebral foramen due to arthritic changes, spurring, or narrowing of intervertebral disks.

Pressure ulcers

Result from sustained pressure on tissues at levels greater than capillary pressure. Skin over bony prominences are very susceptible to ischemia and necrosis. May initially present as bruising or blisters under intact skin to deeper tissues before opening to reveal full thickness damage.

Symphysis Pubis Pain

Results from effects of relaxin and progesterone. Joint widens by 4 to 10mm. Sxs: Severe pain in symphysis pubic and SI joints as well as urine in the blood due to injury to urethra or bladder neck

Superior Vena Cava

Returns venous blood from head, neck, and arms to R atrium.

Inferior Vena Cava

Returns venous blood from lower body and viscera to R atrium

Lymphedema Stage 1

Reversible Stage Pitting edema present, increases with activity or heat, but diminishes with activity and rest

Femoral Torsion

Rotation between femur's shaft and neck 8-15 deg anterior anteversion is normal Less than 8 deg is femoral retroversion

Cardiac Conduction System

SA node, AV Node, Bundle of His, Purkinje fibers 60 bpm-->40 bpm-->20 or less

Metabolic Acidosis

SHAMED Stupor Hyperkalemia Arrhythmias Muscle twitching Emesis Decreased CO Kussmaul Respirations (compensatory hyperventilation)

O'Brien Test

SLAP tear Full internal rotation of shoulder and elbow pronation while therapist applies downard force

Sural Nerve Tension Test

SLR with DF and INV

Tibial Nerve Tension test

SLR with DF, EV

Common Peroneal Nerve Tension Test

SLR with PF and INV

Wheelchair Back Height

Seat of chair to floor of axilla with shoulder flexed to 90 deg Subtract 4 inches Should be below inferior angles of scapulae

Wheelchair Armrest Height

Seat to olecranon process with user's elbow flexed to 90 deg Add 1 inch

S2

Second heart sound, closure of aortic and pulmonic valves at onset of ventricular diastole Higher pitch and shorter duration "Dub"

Oswestry Disability Index

Self report questionnaire that measures the degree to which back or leg pain impacts functional activities. -assess the level of pain and interference with physical activities such as sleeping, self-care, sex life,social life and traveling. -6 items rated 0-5 100 = 100% disabled 0% = 0% disabled

Muscles innervated by tibial division of Sciatic Nerve

Semitendinosus Semimembranosus Biceps Femoris (long head)

Contraindications to Thermotherapy

Sensation, Circulation, Mentation!!! -Areas with lack of intact thermal sensation -Vascular insufficiency, vascular disease -Liniment or heat rub applied recently -Patient's subjective response to modality is unreliable (altered mentation) -Hemorrhage (recent or potential) -Malignancy -Acute inflammation or infection

Golgi Tendon Organs

Sense change in muscular tension

Parietal Function

Sensory Touch, kinesthesia, vibration, temp Receives info from other areas of brain regarding senses and memory Provides meaning or objects, interprets language and words, spatial/visual perception

Diastasis Recti

Separation of rectus Abdominis along linea alba during pregnancy. Sxs: Separation greater than width of two fingers when woman lifts head and shoulders off plinth

Conventional TENS

Short Duration (50-100 usec) High Frequency (30-150 pps) Sensory amplitude (Low, no muscular contraction) Brief pain relief, only when current is generated (gate theory) Used to relieve pain during ADLs

C5 Resistive Test

Shoulder Abduction

Contact Precautions

Skin-to-skin, contaminated intermediate object in patient's environment -Private room, may share with other pt with same microorganism -Gloves must change post direct contact with infectious material, and gloves come off prior to leaving room -Gown if substantial close contact with patient, remove gown prior to leaving room -Dedicate non-critical pt care equip to 1 patient, do not share between patients Examples: -GI, RR, skin/wound infections, drug-resistant bacteria, C-diff, E-coli, Hep A (incontinence), diphtheria, herpes, impetigo, scabies, zoster, Ebola

Slow Reversal Holds (SRH)

Slow reversal with the addition of isometric contraction at the end of each movement

National Cancer Institute Staging

Stages 0-IV, with 0 being early malignancy and IV being most malignant

Ataxic gait

Staggering, unsteadiness, wide BOS and exaggerated movements

Pathologic staging of cancer

Staging based on pathology findings of tissue samples obtained during surgery. This may differ from clinical stage (may reveal cancer has spread more than expeted) and gives more precise information to predict treatment responses and prognosis

Guarding during ambulation

Stand to affected side and behind patient, avoid grasping arm

Type I error (alpha)

Stating that there is an effect when none exists (accepting an experimental hypothesis when the null is true)

Type II Error (Beta)

Stating there is not an effect when one exists (failure to reject null hypothesis when it's false)

Antihyperlipidemia Agents

Statins Inhibit enzyme action in cholesterol synthesis (stops cholesterol formation), breaks down LDLs, decrease triglycerides, increase HDLs. Aerobic exercise can increase HDLs and maximize effects of drug therapy Indications: Hyperlipidemia, atherosclerosis, prevent coronary events in pts with existing DM, PVD, or coronary disease Atorvastatin (Lipitor), Simvistatin (Zocor), Fenofibrate (Tricor)

Intravenous System (IV)

Sterile fluid source, pump, clamp, and catheter to insert into a vein Used to infuse fluids, electrolytes, nutrients, and meds Most commonly inserted into superficial veins (basilic, cephalic, antecubital) Permits nutrients to be introduced when GI tract is not able to digest or absorb food

Spastic gait

Stiff movement, toes catch and drag, legs held together, hip and knee joints flexed. Common in spastic paraplegia.

Acute Renal Failure

Sudden decline in kidney function increase in BUN and creatine, oliguria, hyperkalemia, and sodium retention -Prerenal--Shock, hemorrhage, burn, or PE -Postrenal--Neoplasm, kidney stone, prostate hypertrophy -Intrarenal--Toxins, intrarenal ischemia, vascular disorders

Acute Respiratory Distress Syndrome (ARDS)

Sudden respiratory failure due to fluid accumulation in alveoli, usually in people who are already ill. Etiology is fluid leaking from blood vessels in lungs into alveoli due to inflammation compromising membrane integrity. This inflammation can be caused by: -Pneumonia -Infection spreading through blood (sepsis) -Heart failure -Blood transfusions -Smoke inhalation or chemical (ammonia/chlorine) inhalation) -head/chest injury, or fracture of long bones -Near drowning -Drug overdose, shock, or adverse reaction to medication Sxs: Severe SOB, labored breathing, hypotension, confusion, fatigue, cough, fever Tx: Supplemental O2, vent. Fatal in 25-40% of those who develop it, survivors may not regain full lung function for 1+ yrs

Tinea Pedis (Athlete's Foot)

Superficial fungal infection causing epidermal thickening due to warm and moist environment. Happens due to closed toed shoes with no airflow, prolonged moisture or sweating, small nail or skin abrasions. Infectious. Sxs: Itching, redness, peeling skin, pain, odor, breaks in skin continuity Tx: Topical or oral antibiotics

Flexor pollicis brevis

Superficial head: median nerve C6, C7 Deep head: ulnar nerve C8, T1

Contact Dermatitis

Superficial irritation of skin from local irritation (poison ivy, latex, soap, jewelry). Can be acute or chronic. Sxs: Intense itching, burning, and red skin Tx: Identifying and removing the source of the irritation.

Peroneus brevis

Superficial peroneal nerve L4, L5, S1

Peroneus longus

Superficial peroneal nerve L4, L5, S1

Gluteus medius

Superior gluteal nerve L4, L5, S1

Vertebral-Basilar Artery

Supplies Cerebellum, medulla, pons, occipital cortex, and midbrain. Occlusion results in: -Locked-in syndrome, coma, vegetative state -Wallenberg syndrome (secondary to lat medullary infarct) results in ataxia, verigo, ipsilateral facial pain/temp impairment and contralateral pain/temp impairment -vertigo, nystagmus -Dysphagia, Dysarthria, Syncope

Posterior Cerebral Artery (PCA)

Supplies Occipital and inferior temporal lobes, subthalamic and basal nucleus, thalamus, and portion of midbrain. Occlusion results in: -Thalamic Pain syndrome -Hemiballismus, ataxia, athetosis, choreiform movement -Homonymous Hemianopsia -Visual agnosia -Cortical blindness -Memory impairment

Vertebrobasilar Artery Insufficiency

Supplies cerebellum, brainstem, occipital lobes 5 D's: Drop attacks Dysphagia Dysarthria Diplopia Dizziness 3 N's: Nystagmus, Nausea, Numbness Testing: Quadrant Vertebral Artery test -Pt extends, side bends and rotates to same side for 30 sec. If pt's sxs reproduced, contralateral artery is impaired. Cervical Extension+Rotation tests CONTRALATERAL ARTERY Cervical Flexion/Rotation Tests BOTH

Anterior Cerebral Artery

Supplies frontal lobe, and medial surface of frontal and parietal lobes. Occlusion results in: -Paraplegia -Incontinence -Personality changes -Aphasia, Apraxia, Agraphia -Perseveration -Akinetic Mutism (mimicks catatonia)

Supraspinatus

Suprascapular nerve C5

Tenotomy

Surgical release of tendon to decrease spasticity and improve function

Femoral nerve injury can be caused by

THA, displaced acetabular fracture, anterior femoral dislocation, hysterectomy, appendectomy

Bell's Palsy

Temporary unilateral facial paralysis secondary to trauma w/demyelination or degen of facial nerve. Common between 15-45. Etiology: Secondary to viral infection, especially herpes simplex/zoster Sxs: Asymmetrical facial drooping of eyelid and mouth, drooling, dryness of eye, inability to close eyelid due to weakness Tx: Anti-viral meds and high dose steroids. PT for stimulation of facial nerve, facial massage/exercise

Preload

Tension in ventricular wall at end of diastole

Negative Predictive Value

The probability that a person with a negative test result is truly disease free

Roots of Sacral plexus

The sacral plexus begins as the anterior fibres of the spinal nerves S1, S2, S3, and S4. They are joined by the 4th and 5th lumbar roots, which combine to form the lumbosacral trunk

Pharmacotherapeutics

The treatment of pathologic conditions through the use of drugs

Latissimus dorsi

Thoracodorsal C6-C8

Active Cycle of Breathing (ACB)

Three phases: 1. Breathing control (Gentle relaxed breathing for 5-10 sec) 2. Thoracic Expansion (3-4 slow deep inhalations) 3. Forced Expiration (1-2 huffs) Assists with secretion clearance in patients with asthma

C8 Resistive Test

Thumb Extension

Flexor digitorum longus

Tibial nerve L5, S1

Popliteus

Tibial nerve L5, S1

Tibialis posterior

Tibial nerve L5, S1

Flexor hallicus longus

Tibial nerve L5, S1, S2

Gastrocnemius

Tibial nerve S1, S2

Modified Ashworth Scale

To test for spasticity; apply quick stretch to muscle so it is lengthened quickly 0= no inc. in tone 1= slight inc. in tone, catch and release or minimal resistance at end of ROM when affected part moved in flex or ext 1+= slight inc. in tone, catch, followed by min. resistance t/o remainder (< half) of ROM 2= more marked inc. in tone through most of ROM, but affected parts easily moved 3= considerable inc. in tone, passive mvmt diff. 4= affected parts rigid in flex or ext

Clawing of toes

Toe flexor spasticity Positive support reflex (contraction of extensors and flexors in infant)

TMJ Dysfunction: Bite Down/Cotton Roll Test

Tongue depressor or cotton roll is placed on one side of the patient's mouth in between the teeth. Patient is asked to bite down onto the object. Pain reproduced on SAME side of cotton roll: MUSCLE on same side is causing pain Pain reproduced on OPPOSITE side of cotton roll: JOINT on the opposite side is causing pain. "Biting down on one side stresses the TMJ on the opposite side"

Complete spinal cord lesion

Total loss of sensation and voluntary muscle control below level of lesion

Sharp Debridement

Use of scalpel, scissors, or forceps to remove devitalized tissue, foreign material, or debris from wound Used for wounds with large amounts of necrotic tissue, or in presence of cellulitis or sepsis Most expedient form of removing necrotic tissue

Foot slap

Weak dorsiflexors, dorsiflexor paralysis

Insufficient Hip flexion at initial contact

Weak hip flexors Hip flexor paralysis Hip extensor spasticity Insufficient hip flexion range of motion

Aquatic Therapy

When submerged below xiphoid process, hydrostatic pressure increases difficulty of breathing, leading to increased RR. Pts with dyspnea should avoid submersion above Xiphoid MS should avoid water temp above 84 degrees Water temp above 95.9 deg causes peripheral vasodilation + increase HR, and decrease BP Water temp below 80.6 degrees will cause peripheral vasoconstriction + decrease HR and CO to reduce oxygen demand and preserve organs. BP increases bc of vasoconstriction

Stepping Reflex

When supported upright and feet flat, baby will reciprocally flex and extend legs. Normal age: 38 weeks to 2 months

Positive Support Reflex

When weight is placed on balls of feet in upright, baby stiffens its legs and trunk into extension. Normal Age: 35 weeks gestation to 2 months Interferes with standing, walking, and balance, and can cause contractures of ankles into PF

Angiography

X ray imaging of blood vessels after injection of contrast material to show location of plaque in coronary arteries and extent of occlusion

Hydrotherapy wound care

Whirlpool tank with agitation toward wound requiring debridement softens and loosens adherent necrotic tissue. -May cause maceration of viable tissue, edema from dependent LE positioning, Hypotension

MMT Grades

Zero (0/5): No palpable muscle contraction Trace (1/5): Palpable muscle contraction but no joint movement Poor Minus (2-/5): No complete ROM in gravity eliminated position Poor (2/5): Complete ROM only in gravity eliminated position Poor Plus (2+/5): Able to initiate movement against gravity Fair Minus (3-/5): Can't complete ROM against gravity but can complete more than half range Fair (3/5): Completes ROM against gravity without resistance Fair Plus (3+/5): Completes ROM against gravity with only minimal resistance Good Minus (4-/5): Completes ROM against gravity with min/mod resistance Good (4/5): Completes ROM against gravity with mod resistance Good Plus (4+/5): Completes ROM against gravity with mod/max resistance Normal (5/5): Completes ROM with max resistance

Oxygen Tent

a canopy that surrounds the patient, providing oxygen, humidification, and a cool environment to help control body temperature

Foot Orthosis

a removable appliance placed within a shoe that applies forces to the foot either to relieve pain or to improve balance and function in standing and walking.

APGAR Score

a scale of 1-10 to evaluate a newborn infant's physical status at 1 and 5 minutes after birth. Considered good condition if 7-10. 3 or below requires immediate medical attention. Each score is 0-2. Appearance: Blue/Normal except for blue extremities/Pink Pulse: Absent/Below 100 bpm/Over Grimace: No response/Min response/Pulls away, sneeze Activity: Floppy/Flexing arms or legs/Active movement Respiration: Absent/Slow/Vigorous cry

Interval Scale

a scale of measurement in which the intervals between numbers on the scale are all equal in size. No true zero point Temperature (F or C)

CT scan

a series of x-ray photographs taken from different angles and combined by computer into a composite representation of a slice through the body to view bones, tissues, and organs. Rules out vascular malformations, tumors, cysts, herniated disks, hemorrhage, epilepsy.

Sheet graft

a skin graft that is transferred directly from the unburned donor site to the prepared recipient site

Motions in frontal plane

abduction and adduction

Positive Predictive Value

ability of a diagnostic test to correctly determine the proportion of patients with the disease from all the patients with positive test results

Graphesthesia

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

Stereognosis

ability to recognize objects by feeling their form, size, and weight while the eyes are closed

Scoliosis

abnormal lateral curvature of the spine Named by the Convexity. LEFT curve will have a C open on the right RIGHT curve will have C open on the left Cobb angles: 10 degrees or higher with axial rotation to confirm diagnosis

Forced Expiratory Volume (FEV)

amount of air exhaled in the 1st, 2nd, and 3rd second of a forced vital capacity test

Patent Ductus Arteriosus (PDA)

an abnormal opening between the pulmonary artery and the aorta caused by failure of the fetal ductus arteriosus to close after birth Sxs: Small may be asymptomatic. Large causes tachycardia, respiratory distress, poor eating, weight loss, and congestive heart failure Tx: Diuretics, indomethacin, surgical repair. Left untreated, can cause pulmonary HTN or heart failure

Juvenile Rheumatoid Arthritis

an autoimmune disorder that affects children aged 16 years or less with symptoms that include stiffness, pain, joint swelling, skin rash, fever, slowed growth, and fatigue Diagnosed based on presence of RF or ANA and systemic involvement.

Fowler position

an inclined position in which the head of the bed is raised

Alar ligaments

attach dens of axis (C2) to occipital condyles. Resist flexion, contralateral side bending, contralateral rotation. Also limit sagittal plane translation between axis and occiput

Echocardiography

an ultrasonic diagnostic procedure used to evaluate the structures and motion of the heart Transthoracic Echocardiography (TTE) uses a handheld transducer. Transesophageal (TEE) uses a transducer passed into esophagus to give more detailed image of heart

-mycin

antibiotic/antibacterial Erythromycin

sulfa-

antibiotic; anti-infective; anti-inflammatory Sulfadiazine, sulfasalazine

-nazole

antifungal Miconazole, terconazole

Cancer

any malignant growth or tumor caused by abnormal and uncontrolled cell division. Malignant cells can grow uncontrollably, invade other tissues, remain undifferetiated, initiate growth at distant sites. Most common cancer is carcinoma

Cardiac Cycle

atrial systole/ventricular diastole, ventricular systole/atrial diastole, brief complete diastole

-bital

barbiturate (sedative) Phenobarbital

Ordinal Measurement Scale

being of a specified position or order in a numbered series. "Ranking scale" Levels of assistance, pain, joint laxity grades, manual muscle test grades

Cardiac Enzyme studies

battery of blood tests performed to determine the presence of cardiac damage Creatine Phosphokinase (CK-MB) appears in blood 4 hours post infarction, peaks at 24 hours, declines over 72 hours Cardiac Troponin-I remains elevated for 5-7 days. (Over 0.10) Brain Natriuretic Peptide (BNP): Peptide hormone released with heart stress. Indicates HEART FAILURE

Athetosis

bizarre, slow, twisting, writhing movement, resembling a snake or worm. When brief, they merge with chorea (Choreoathetosis) and when sustained, they merge with dystonia. Common in several forms of CP secondary to BG pathology

Neurogenic Nonreflexive bladder

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

Thrombus

blood clot

Swing Through Gait

both crutches are advanced then the legs swing past the crutches

Ankle Foot Orthosis (AFO)

brace that is worn on the lower leg and foot to support the ankle and correct foot drop. Requires medial/lateral control by patient.

Sural nerve injury can be caused by

calcaneal fracture, lateral malleolus fracture

Lymph vessel

carrier of lymph throughout the body; lymphatic vessels empty lymph into veins in the upper part of the chest

Ulcerative Colitis

chronic inflammation of the colon with presence of ulcers. Diarrhea and rectal bleeding.

Sarcoidosis

chronic inflammatory disease in which small nodules (granulomas) develop in lungs, lymph nodes, and other organs

Ankylosing Spondylitis

chronic, progressive arthritis with stiffening (ankylosis) of joints, primarily of the spine and hip, but ossification can happen in all affected joints. Sxs: Recurrent and insidious episodes of LBP, morning stiffness, impaired spinal extension, limited ROM. Progresses to severe, consistent and extending to midback and neck. Natural lumbar curve flattens, thoracic kyphosis increases. On x-ray, may see SI fusion, ossification of outside of intervertebral disks (syndesmophyte)

Musculocutaneous nerve injury can be caused by

clavicular fracture

Metabolic Equivalent (MET)

concept expressing the energy cost of physical activity; for example, 3 METs means three times the amount of energy expended at rest Moderate risk for mortality if capacity is less than 5-6 METs

Hyperpigmentation

darkened areas of skin caused by excessive amounts of melanin

Hypesthesia

decreased sensitivity to touch

Anosognosia

denial of illness

Filariasis

disease caused by parasitic roundworm that occurs in tropic and subtropic regions that can lead to elephantiasis

FEV1/FVC ratio

dividing of value for FEV1 by value for FVC; useful in differentiation obstructive and restrictive pulmonary dysfunction.

Cold Pack application

do not apply direct to skin -wetting towel will conduct better -check skin after 5 minutes Application time of 20 min, extend to 30 for spasticity reduction 5-10 min for ice massage

Ketoacidosis

excessive production of ketones, making the blood acidic

Double crush syndrome

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

Delayed Feedback

feedback provided several seconds or more following movement completion Provides brief period of introspection and self-assessment, improving retention

-trel

female hormone (progestin) Desogestrel, etonogestrel

Atlantooccipital Joint

first joint formed by occipital condyles of skull sitting on articular fossa of the 1st vertebra allows capital flexion & extension ("Yes")

Motions in the sagittal plane

flexion and extension

D2 Flexion UE

flexion, abduction, external rotation Pulling a sword out.

D2 Flexion LE

flexion, abduction, internal rotation

Comminuted Fracture

fracture in which the bone is splintered or crushed

Axillary nerve injury can be caused by

fracture of humeral neck, anterior dislocation of shoulder

Tympany

high-pitched, musical, drumlike percussion note heard when percussing over the stomach and intestine. If heard over lungs, almost exclusively signals large pneumothorax

Ultralight Wheelchair frame

highly active, no need for postural supports, used for sports

Extensor synergy LE

hip abduction/extension/internal rotation knee extension ankle plantar flexion/inversion toe flexion

Flexor Synergy LE

hip flexion/abduction/external rotation knee flexion ankle dorsiflexion/inversion toe extension

Apraxia

impaired ability to carry out motor activities despite intact motor function

Reciprocating Gait Orthosis (RGO)

incorporates a cable system to assist with advancement of lower extremities during gait. when patient shifts weight onto a selected lower extremity, the cable system advances the opposite LE. Used primarily for paraplegia.

Ataxia

lack of muscle coordination

Associative Learning

learning that certain events occur together. The events may be two stimuli (as in classical conditioning) or a response and its consequences (as in operant conditioning).

Pallanesthesia

loss of vibration sensation

Klumpke's Palsy

lower brachial plexus injury resulting in claw hand deformity; usually improves btwn 3-6 months. Affects C7-T1

Urea

major nitrogenous waste excreted in urine

Neuroblastoma

malignant tumor composed mainly of cells resembling neuroblasts that occurs most commonly in infants and children. Most common malignant tumor in children. Abdominal mass, change in personality, anemia, sweating, pain, diarrhea

Urinary Tract Infection

microbial infection of any part of the urinary tract due to infiltration of bacteria into urethra or bladder. If untreated, can spread to kidneys and cause pyelonephritis. Sxs: Increased frequency of urination, pain/burning with urination, cloudy urine, pressure above pubic bone in women, shakiness, fever, back pain, fatigue. Confusion in elderly population. Tx: Drink an excess of fluid, bacteria-specific antibiotics

Arterial line

monitoring device consisting of a catheter that is inserted into an artery and attached to an electronic monitoring system. used to measure blood pressure or obtain blood samples. considered more accurate than traditional measures of blood pressure and does not require repeated needle punctures Used for: -Critically ill -HTN crisis -Uncontrolled HTN -Post MI

Granulation Tissue

new tissue that is pink/red in color and composed of fibroblasts and small blood vessels that fill an open wound when it starts to heal

Arterial Insufficiency Ulcers

occur secondary to ischemia from inadequate circulation of oxygenated blood (ischemia) and typically linked to PAD. often due to complicating factors such as atherosclerosis Presentation: -Located usually on distal third of leg, toes, webbed spaces, and lateral malleolus. -Severely painful, and more painful with limb elevation. -Pedal pulses are diminished or absent, decreased skin temp -ABI of 0.79 or less is indicative of moderate blockage -Deep wound, smooth and well defined edges

ABG results

pH-->PaCO2-->PaO2-->HCO3- 7.4/40/97/24

Spinothalamic tract

pain and temperature

Hemiplegia

paralysis of one side of the body

Massed practice

practice performed all at once, practice time is greater than amount of rest.

Electroencephalography (EEG)

process of recording the electrical activity of the brain. Rules out seizure disorders, brain death, brain tumors, degenerative disorders.

Electromyography (EMG)

recording the strength of muscle contraction as a result of electrical stimulation. Measures activity from brain or spinal cord to peripheral nerve root. Used to rule out muscle pathology, nerve pathology, denervated muscle, lower motor neuron injury

Carpal bones

scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate Some Lovers TRI Positions (lateral) That They Can't Handle

Startle Reflex

similar to Moro but arms are flexed rather than extended and fingers are closed. Happens in response to loud sudden movement, integrated by 5 months

Metabolic rate

speed at which an organism carries out its metabolic process

Parapodium

standing frame designed to allow a patient to sit when necessary. primarily used in peds.

Myelotomy

surgical procedure that severs certain tracts within the spinal cord in order to decrease spasticity and improve function

Neuroectomy

surgical removal of a nerve to decrease spasticity and improve function

Atherectomy

surgical removal of plaque buildup from the interior of an artery

Alkylating agents (cancer)

synthetic chemicals containing alkyl groups that attack DNA, causing strand breaks. Indicated for malignancies Mustargen (Mechlorethamine) Busulfex (Busulfan) Leukeran (Chlorambucil)

High Frequency airway oscillation

• *Acapella and Flutter* are handheld devices that combine *positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in airways* • W/ device in mouth, inhale slowly to 75% full breath; hold breath 2-3 seconds; exhale through device 3-4 seconds, repeat 10-20 breaths • Remove device and perform 2-3 coughs or huffs to raise secretions

Ambulatory ECG

• AKA Holter monitoring • Recorded for 24-48 hours or longer to evaluate cardiac rhythm, efficiency of meds, and pacemaker function; then correlated w/ diary of pt's symptoms/activities

Phonocardiography

• Diagnostic test that creates a graphic record of sounds produced by heart/great vessels • Phonocardiogram supplements auscultation and *improves detection of S3/S4 heart sounds* in diagnosis of heart failure

Chest Radiograph

• Visualizes location/size/shape of heart,lungs, blood vessels, ribs, bones of spine • Can also reveal fluid in lungs/pleural space, pneumonia, cancer

-sartan

Angiotensin II Receptor Antagonist to lower BP Valsartan, Losartan

L4-5 Resistive Test

Ankle Dorsiflexion

S1 Resistive Test

Ankle Plantar Flexion

GH Horizontal Adduction

Anterior Delt Pec major

Nerve Tissue Cancers (Brain, nerves, spinal cord, retina)

Astrocytoma Glioma Neurilemma Neuroblastoma Retinoblastoma

Cerebellum CVA Symptoms

Decreased balance Ataxia Decreased coordination Nausea Decreased ability for postural adjustment Nystagmus

Hypovolemia

Decreased blood volume due to bleeding, dehydration from vomiting, diarrhea, sweating, burns, and diuretics to treat hypertension. Sxs: Orthostatic hypotension, tachycardia, elevated body temp

Glucose

Ideal Range: 100-250 Below 70: Give 15g snack 70-100 with syptoms, give 15g carb snack, recheck in 15. If no symptoms, continue ex and give snack, recheck in 15 250-300 WITH ketones: No ex, call EMS 250-300 without ketones: Ex with caution, retest in 15 Over 300: No ex, call EMS

Knee Thrust Gait

Rapid knee hyperextension in midstance. Most often occurs to move COM anterior to knee, producing knee extensor movement Causes: -Weak/Spastic Quads -PF Contracture

Septic Arthritis

Rapid onset, over hours or days, of monoarthritis with swollen, tender, adn warm joint, with limited ROM due to pain.

Atrial Fibrillation

Rapid, irregular EXG without discrete P waves. Sxs: Palpitations, fatigue, dyspnea, lightheadedness, syncope, chest pain -New onset should be reported to physician -Pts should be taking blood thinners to reduce stroke risk -Not medical emergency unless life threatening sxs arise (LOC, confusion)

Half-life

Rate of elimination of a drug, or how long it takes to eliminate half of an administration.

Large Intestine Function

Reabsorbs water and stores and eliminates undigested food as feces Ascending colon Transverse Colon Descending colon Sigmoid Colon Rectum Anus

Balanced suspension

Realigns fractures of the femur; uses pulley to create balanced suspension by countertraction to the top of the thigh splint. Thomas splint (positioned under anterior thigh) with Pearson attachment (supports leg from knee down) frequently used. Requires prolonged immobilization and increases incidence of secondary complications (contractures, skin breakdown)

Electrocardiogram

Record of heart's electrical activity. Used to asses cardiac rhythm, diagnose location, extent, and acuteness of ischemia and infarction.

Thoracic/Lumbar Flexion

Rectus Abdominus Internal/External oblique

Knee Extension

Rectus Femoris Vastus Lateralis, Medialis, Intermedius

Sanguineous Exudate

Red color Thin, watery consistency May be indicative of new blood vessel growth or disruption of blood vessels.

Semimembranosus

Sciatic nerve-tibial division L5, S1, S2

Semitendinosus

Sciatic nerve-tibial division L5, S1, S2

Alexia

inability to read

Agraphesthesia

inability to recognize symbols, letters or numbers traced on the skin

Agraphia

inability to write

Toe Adduction

Adductor Hallucis Plantar Interossei (PAD)

Thumb Adduction

Adductor Pollicis

Muscles innervated by Obturator Nerve

Adductor longus, brevis, magnus Obturator Externus Gracilis

Hip Adduction

Adductor magnus, longus, brevis Gracilis

Obturator Nerve (FL)

Adductors (except for Pectineus and long tendinous portion of Add Magn) Obturator externus

Wrist Vascular Insufficiency Test

Allen Test: Patient opens and closes hand several times and maintains hand in closed position. Therapist compresses radial and ulnar arteries and patient relaxes hand. Therapist releases pressure on one artery and observes color of hand and fingers. Positive for delayed or absent flushing of radial or ulnar half of hand. May indicate occlusion of radial/ulnar artery

Pediatric Hip Tests

Barlow's Test: Patient in supine with hips flexed to 90 deg and knees flexed. Therapist moves test leg into ADD while applying forward pressure to greater trochanter. Positive for click or clunk, and may dislocate hip. "Going out to the BAR" Ortolani's Test: Patient is supine with hips flexed to 90 deg and knees flexed. Therapist abducts hips and applies Anterior pressure to greater trochanters until resistance is felt at approx 30 deg. Positive for click or clunk and may be indicative of dislocation being reduced "If you are out, you need to go home

Lymph Nodes

Bean-shaped filters that cluster along the lymphatic vessels of the body. They function as a cleanser of lymph as wells as a site of T and B cell activation

Rule of Nines

Head and Neck= 9% Each upper ext= 9% Each lower ext= 18% Front trunk= 18% Back trunk= 18% Genitalia= 1%

Deep Tissue Pressure Injury

Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. If necrotic tissue, subcutaneous tissu, granulation tissue, fascia, or muscle are visible, indicates full-thickness pressure injury.

Stage 1 Pressure Ulcer

Intact skin, non-blanchable redness.

Transversus abdominis

Intercostal nerves T7-T12, iliohypogastric nerve T12, L1, and ilioinguinal nerve L1

External oblique abdominal

Intercostal nerves T8-T12, iliohypogastric nerve T12, L1, and ilioinguinal nerve L1

Internal oblique abdominal

Intercostal nerves T8-T12, iliohypogastric nerve T12, L1, and ilioinguinal nerve L1

2nd Degree AV Block Mobitz II

Intermittent skipping of QRS complex. -All pts with this will have pacemaker -If abnormality is found without pacemaker, with symptoms present, CALL EMS -If abnormality is found without symptoms, stop exercise and call physician -Can become Third Degree if not handled

Normal Platelet Count

150,000-450,000 50k-100k: You can exercise, stop if signs of bleeding 20k-50k: Weights are ok but no breath holding 10k-20k: Strength training with NO WEIGHTS OR STRAIN Below 10k is NO EXERCISE Clotting Factor

Glasgow Come Scale: Motor Response

6: Obeys comands 5: Localizes pain 4: Withdraws 3: Abnormal flexion 2: Extensor response 1: Nil

Moderate Assist

Patient requires 50% assist from therapist to complete task

Maximal Assist

Patient requires 75% assist from therapist to complete task

Subthalamus

Regulates movements by skeletal muscles, associated with basal ganglia and substantia nigra.

Adductor magnus

Anterior: obturator nerve L2-L4 Posterior: sciatic nerve L4, L5, S1-S3

Alkaline Reaction to Iontophoresis

Sodium Hydroxideforming under cathode (negative electrode)

Class I Antiarrhythmic Agents

Sodium channel blockers Quinidine, Lidocaine

Stroke in Evolution

CVA usually caused by a thrombus that gradually progresses. deficits are not seen for one to two days after onset.

Firm End feel (abnormal)

Increased tone, tightening of capsule, ligament shortening Frozen shoulder, TMJ capsular fibrosis

Muscles innervated by Deep Peroneal Nerve

Tibialis Anterior EHL EDL, EDB Peroneus Tertius

Transcutaneous Electrical Stimulation (TENS)

Increases sensory stimulation at site, blocking pain transmission (gate control, endogenous opioid)

Risk factors for cancer

Increasing age, poor diet, stress, alcohol/tobacco use, environmental exposure

Insufficient Hip Extension in Stance

Insufficient hip EXT ROM Hip Flexion contracture Lower extremity flexor synergy

Dorsiflexion Stop

Velcro strap on posterior aspect of AFO that limits DF

Eosinophils

Kill parasites, destroy cancer cells, involved in allergic response

Metabolic Bone Disease

- Disruption in normal skeletal metabolism - Results in deformity, bone loss, fx's, softening of the bones, arthritis, and pain. -Skeletal system uses calcium and phosphorous to balance remodeling of cortical and trabecular bone to optimize skeletal structure -Osteomalacia -Osteoporosis -Paget's Disease

Lingula of left lung

- Flat, medially-pointing projection of the inferior lobe, forming the base of the cardiac notch; Latin for "little tongue" - Believed to be homologous to a middle lobe (as in the right lung)

Spinal Shock Syndrome

- occurs after major damage to the spinal cord - loss/depressed cord functions below the lesion for less the 24 hours to several weeks - subsequent recovery as shock wears off below the transection/damage, resulting in spasticity, exaggerated reflexes, etc.

Anatomic snuffbox

-Bordered by Abductor Pollicis Longus, Extensor Pollicis Brevis, and Extensor Pollicis Longus (Brevis sandwich) -Scaphoid may be palpated through this structure when there is concern for a fracture.

Adrenal Glands

-Adrenal Cortex: Corticosteroids that regulate water/sodium balance, stress response, immune system, sexual development, and metabolism -Adrenal Medulla: Epinephrine that increases HR and BP in response to stress

Peripheral Vestibular Disorders

-BPPV -Vestibular -Hypofunction (vestibular neuritis, labyrinthitis) -Bilateral Vestibular Hypofunction (BVL, usually ototoxicity) -Meniere's Disease -Mal de Debarquement -Perilymphatic Fistula -Motion Sensitivity

Knee Patellar Tests

-Brush/Sweep Test: Therapist places on hand below joint line of medial surface of patella, sweeps upward towards suprapatellar bursa. The other hand then strokes down lateral surface of patela. Positive for wave of fluid below medial distal border of patella, indicates knee effusion -Patellar Tap Test: Therapist taps patella. Positive if patella seems to be floating -Clarke's Sign: Therapist applies pressure with hand to superior pole of patella, patient contracts quadriceps muscle. Positive for pain, indicative of PFP -Hughston's Plica Test: Therapist flexes knee and medially rotates tibia with one hand while other hand moves patella medially. Positive for popping over medial plica with knee passively flexed or extended -Noble Compression Test: Therapist maintains pressure over lateral epicondyle of knee while patient extends. Positive for pain over lateral femoral condyle at 30 deg of knee flexion, indicative of IT band friction syndrome -Patellar Apprehension Test:Therapist places thumbs on medial border of patella and pushes it laterally. Positive for apprehension or attempt to contract quads to avoid subluxation.

Peptic Ulcer

-Burning, gnawing, cramping stomach pain especially when empty, between meals, and in early AM. -Coffee Ground Emesis -Pain is midline, in epigastrum, may radiate to costal margins, into the back and rarely to right shoulder -Pain is usually relieved by food and/or antacids

Wrist Neurological Dysfunction Tests

-Carpal Compression Test (Median Nerve Compression Test): Therapist applies pressure to median nerve in carpal tunnel for 30 seconds. Positive for CTS for pain or paresthesia in median nerve distribution -Froment's sign: Therapist attempts to pull piece of paper away from patient's thumb and index finger. Positive for patient flexing distal phalanx of thumb due to adductor pollicis paralysis. If patient hyperextends MCP joint, termed Jeanne's Sign. May be indicative of ulnar nerve compromise or paralysis -Phalen's Test: Patient holds flexed wrist position (reverse prayer) for 60 seconds, positive for ingling in median -Tinel's sign: Therapist taps over patient's anterior wrist, positive for tingling in thumb, index/middle finger, and lateral half of ring finger. May indiccate CTS due to median nerve compression

Triangular Fibrocartilage Complex

-Cartilaginous disc that sits between ulna, lunate and triquetrum -Provides stability to wrist joint and connects radius and ulna together -Distributes force across wrist

Cervical Spine Tests

-Cervical Flexion/Rotation Test: Patient in supine, therapist fully flexes C spine and rotates in each direction while maintaining flexion. Should have 45 deg each. If limited, dysfunction is occurring at AA joint. Can be provocative for cervicogenic headache. -Distraction Test: Used for patients with radicular symptoms. Therapist places one hand under patient's chin and other under occiput, providing a upward distraction force. Positive for cervical nerve root compression if pain is decreased with distraction force -Foraminal Compression Test: Therapist places both hands on top of patient's head while sidebending and presses down. Positive for pain radiating into arm toward flexed sign, indicates nerve root compression -Vertebral Artery Test: Therapist places patient's head into extension, sidebending, and rotation to ipsilateral side. Positive for dizziness, nystagmus, slurred speech, or LOC, may indicate vertebral artery compression.

Imaging techniques for lymphedema

-Direct Lympography: injection of contrast medium into lymph vessel to visualize entire system. Not often used -Indirect lymphography: injection of contrast medium just under skin to observe superficial lymph vessels -Lymphoscintigraphy: Injection of contrast material for visualization of lymphatic system through nuclear medicine injury. Fewer complications than Direct -MRI and CT scan to identify tumors

Rotator Cuff Pathology Special Tests

-Drop Arm: Patient slowly lowers arm from 90 deg abd. Positive = failure to slowly lower arm or presence of severe pain, may indicate rotator cuff tear -Hawkins-Kennedy Impingement Test: 90 deg flexion, Passive IR, positive for reproduction of pain. May indicate supraspinatus impingement -Infraspinatus Test: 90 deg elbow flexion, shoulder in 45 deg ER. Patient resists ER force to forearm. Positive = infraspinatus strain/tear -ER Lag Sign: Bent elbow, 20 deg scap, end range ER, ask patient to hold position. If patient cannot hold position, positive for infra/supraspinatus pathology -Lift off sign: Full IR patient is asked to raise hand off small of back. If unable to complete, subscap lesion may be present -Neer Impingment: Elevate patient's arm through flexion, positive test = pain, indicates supraspinatus impingement -Supine Impingment Test: Passive full flexion, then ER and adducts shoulder so arm is near patient's head. From this position, IR shoulder. Positive for pain -Supraspinatus Test (Empty Can): 90 deg abduction, 30 deg horiz ADD, thumb pointing down, resisted ABD. Positive for weakness.

Exercise Stress test Relative Indications for Stopping

-Drop in SBP greater than 10 despite increase in workload WITHOUT evidence of ischemia -greater than 2 mm ST segment depression -Arrhythmias OTHER THAN sustained V-tach, including multifocal PVCs, SVTs, heart block, bradyarrhythmias -Fatigue, SOB, claudication -Increasing chest pain -Hypertensive response (over 250 SBP or DBP over 115)

Medial Meniscal Injury

-Firmly attached to joint capsule, MCL, ACL, PCL, and semimembranosus -Tears in outer 1/3 have better chance of healing, while inner 2/3 (avascular) often require surgery MOI: Pivot on planted foot, during sports or stepping in a hole Sxs: Mild to severe pain with clicking and popping. Catching at certain parts of range. Clear OA as option. Tests: Apley's, Mcmurray's

Lumbar traction force

-Force of 25% of patient's BW is needed to overcome friction force -50% is required to separate vertebrae -Maximum of 30 lbs for first trial to assess pt response -In acute phase, keep duration to 15 for intermittent and 10 for sustained -Max duration is 30 min

Prone Bony Prominences (Pressure Injury)

-Forehead -Anterior acromion process -anterior head of humerus -Sternum -ASIS -Patella -Dorsum of foot

Temporal Function

-Hearing and smell -Wernicke's area (ability to understand/produce meaningful speech, verbal and general memory)

Supine Bony Prominences (Pressure Injury)

-Occiput -Spine of scap -Inferior angle of scap -Vertebral spinous processes -Medial epicondyle of humerus -Post iliac crest -Sacrum -Coccyx -Heel

Dorsal Radiocarpal ligament

-Only major ligament on dorsal surface of wrist. -Limits wrist flexion. -Runs from posterior distal radius to lunate/triquetrum.

Lymphatic System

-Primary functions: Immune system defense, maintenance of fluid balance in body, collection and transportation of fluids not reabsorbed by venous system. -Lymphatic system collects 10-20% of interstitial fluid, venous system collects other 80-90% -Under control of autonomic nervous system, contractions of smooth muscle in vessel walls move lymph along -Skeletal muscle contractions compress vessels and move lymph along its one way valves

Airborne Precautions

-Private room, monitored negative air pressure -6 to 12 air changes in room per hour -Room door closed with patient remaining in room -Mask and gloves Examples: Measles, Tuberculosis, Varicella (Chicken pox)

Parathyroid Glands

-Produce parathyroid hormone, which is an antagonist to calcitonin and helps maintain normal blood levels of calcium and phosphate -Increased PTH increases reabsorption of calcium and phosphate from bones to blood. -Low blood calcium stimulates PTH, high blood calcium inhibits it. -Calcium levels control clotting, neuromuscular excitability, and cell membrane permeability.

Iliofemoral ligament

-Resists anterior displacement of hip and prevents hyperextension -Strongest ligament in the body

Lateral Collateral Ligament

-Runs from lateral femoral epicondyle to fibular head -Prevents excessive varus displacement of tibia relative to femur Injured through: -Pure varus load at knee without rotation, often sustained via medial blow to the knee. -Rarely torn without concurrent injury to ACL or PCL Special Tests: Varus stress test

Anticoagulant Agents

-arins Inhibit platelet aggregation and thrombus formation Indications: s/p coronary angioplasly or Coronary Artery Bypass Graft, preventing thromboembolism in patients with A-fib and prosthetic heart valves Sides: Hemorrhage, increased risk of bleeding, GI distress with orals Heparin, Warfarin (Coumadin), Enoxaparin (Lovenox)

Foam Dressings

-composed from a hydrophilic polyurethane base. -hydrophilic at wound contact surface -hydrophobic on the outer surface -allows exudates to be absorbed into the foam through the hydrophilic layer -most commonly available in sheets or pads with varying degrees of thickness. -Encourages autolytic debridement

Oronasal mask

-consists of facepiece designed to cover nose and mouth with small vent holes to expel exhaled air along with a breathing tube and connector -used most for oxygen therapy -can be used to administer medications, mucolytic detergents, or humidit, by use of an accessory nebulizer -delivers 6-15 L/min

Pulse Amplitude Scale

0 = absent 1 = small or reduced 2+ = Normal or average 3+ = large or bounding

Reflex Grading

0 = no reflex, always abnormal 1+ = diminished response 2+ = normal 3+ brisk/exaggerated response 4+ - hyperactive, always abnormal response

Normal Eosinophil Count

0-6%

Clinical staging of cancer

1- Localized to tissue of origin. 2- Limited local spread. 3- Extensive local or regional spread 4- Metastasis. Estimated extent of malignancy based on examination, lab values, imaging, and biopsy.

Hoehn and Yahr Scale (1-5)

1-Unilateral disease with minimal dysfunction 2-Bilateral or midline impairment without balance dysfunction 3-Bilateral, mild to moderate postural dysfunction 4-Severely disabled but still able to stand and walk 5-Confined to bed and wheelchair

Scissor gait

Legs cross midline upon advancement

Lumbricals

1st lumbricals: medial plantar nerve L4, L5 2nd, 3rd, 4th lumbricals: lateral plantar nerve S1, S2

Glomerular Filtration Rate

125 mL/min is normal Estimate of filtering capacity of kidneys, volume of filtrate produced per minute by kidneys

Patient that is dependent must be repositioned in bed every ___ hours and must be lifted when changing positions to avoid ____

2, shearing

Limbic System

A doughnut-shaped system of neural structures at the border of the brainstem and cerebral hemispheres; involved in control/expression of moddoand emotion, processing recent memory, olfaction, appetite, and emotional responses to food. Lesions here can result in aggression, fearfulness, altered sexual behavior, or motivation

Normal Distribution

A function that represents the distribution of variables as a symmetrical bell-shaped graph. Mean, median, and mode are the same -68% of values fall in one Std. deviation (+-1) 34% each way -95% of values fall in two std. deviations (+-2) 13.6% -99% of values fall in three standard deviations (+-3) another 2.14% way

Festinating gait

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

Hypothalamus

A neural structure lying below the thalamus; it directs autonomic nervous system, the feed & breed (hunger, thirst, sexual behavior, body temperature), helps govern the endocrine system via the pituitary gland

Benign Prostatic Hypertrophy

A non-cancerous enlargement of the prostate gland that is progressive. Common in males over 60 and can interfere with normal voiding.

Enhanced Extracorporeal Counterpulsation (EECP)

A noninvasive procedure in which inflation of pressure cuffs on the lower extremities compresses the veins and assists with venous return to the heart.

Antalgic gait

A protective gait pattern where the involved step length is decreased in order to avoid weight bearing on the involved side usually secondary to pain. Rapid and short swing phase on uninvolved limb

Insulin

A protein hormone synthesized in the pancreas that regulates blood sugar levels by facilitating the uptake of glucose into tissues. High blood glucose levels increase this hormone's activity to achieve homeostasis.

Ventricular Tachycardia

A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest. 3 or more consecutive PVCs at greater than 150 bpm. Causes: MI, cardiomyopathy, valvular disease

Neuropathic ulcers

A secondary complication usually associated with a combination of ischemia and neuropathy. Often associated with diabetes mellitus, or any form of peripheral neuropathy. Presentation: -Located on areas of foot susceptible to pressure during weight bearing -Looks like an oval with a callused rim -Loss of protective sensation

Mesh graft

A skin graft that is altered to create a mesh-like pattern in order to cover a larger surface area

Alternate hypothesis

A statement that is accepted if the sample data provide sufficient evidence that the null hypothesis is false.

Athetoid Cerebral Palsy

A type of cerebral palsy in which movements are contorted, abnormal, and purposeless. Less likely to have contractures. PT emphasis is on cocontractures and voluntary control

Gauze Dressing

A woven, flexible absorbent cloth applied to a wound Can be "impregnated" with petroleum, zinc, or antimicrobials Used for infected or non-infected wounds -Has tendency to adhere to wound bed -Increased infection rate compared to occlusive dressing

Paradoxical Breathing

Abdomen rises, chest is pulled inward during inspiration, and opposite on expiration. Common in tetraplegia.

CN VI

Abducens Motor: Lateral rectus of eyeball Test: Lateral gaze

Muscles innervated by Medial Plantar Nerve

Abductor Hallucis 1st Lumbrical FDB FHB

Toe Abduction

Abductor Hallucis Abductor Digiti Minimi Dorsal interossei (DAB)

Thumb Abduction

Abductor Pollicis Longus/Brevis

Muscles innervated by Lateral Plantar Nerve

Abductor, flexor, opponens digiti minimi 2nd-4th lumbricals Dorsal/Plantar Interossei Quadratus Plantae Adductor Hallucis

Skill

Ability to consistently perform functional tasks with normal posture and balance reactions. Examples: ADLs and community locomotion.

Mobility

Ability to initiate movement through functional ROM

Stability

Ability to maintain position or posture through cocontraction and tonic holding around a joint. Ex: Unsupported sitting.

Controlled Mobility

Ability to move within a weight bearing position or rotate around a long axis. Example: Activities on POE or weight shifting in quadruped.

Hemorrhagic CVA

Abnormal bleeding of brain from rupture. Accumulation of blood causes compression and disrupts oxygen flow to an area of the brain, causing infarction. HTN is a precipitating factor, causing rupture of an aneurysm or arteriovenous malformation. 50% of deaths occurin first 48 hrs. Sxs: Severe headache, vomiting, high BP, abrupt onset of symptoms.

Restrictive Lung Dysfunction (RLD)

Abnormal reduction in lung expansion and pulmonary ventilation caused by abnormal lung parenchyma (atelectasis, pneumonia, pulmonary fibrosis, pulmonary edema), abnormal pleura, (pleural effusion/fibrosis) and disorders affecting pulmonary lung function (neuromuscular diseases, connective tissue disorders) Sxs: Dyspnea on exertion, non-productive cough, increased RR, hypoxemia, vital capacity, abnormal breath sounds, reduced ex tolerance PFT: Impaired VC, FVC, and TLC. Normal RV, decreased ERV and FRC. Tx: depending on etiology.

Keloid Scar

Abnormal scar made up of irregularly distributed collagen bands Red, thick, firm, and raised

Small Intestine Function

Absorbs most nutrients; Main absorption organ of the digestive tract Duodenum: Neutralizes stomach acid Jejunum: Absorbs water, electrolytes, nutrients Ileum: Absorbs bile and intrinsic factors to be recycled

THA Anterolateral Approach and Precautions

Access to hip joint between TFL and glute med. Some hip abductors are released from GT and hip is dislocated anteriorly. Precautions: Hip flexion beyond 90, hip EXT, ER and ADD

CN XI

Accessory Motor: SCM and Trap Test: Resisted Shoulder shrug

Metabolic Acidosis

Accumulation of acids or deficit in bicarbonate results in pH dropping below 7.35. Can be a result of renal failure, lactic acidosis, diabetic/alcoholic ketoacidosis, diarrhea, or poison. Sxs: Compensatory hyperventilation (to blow off excess CO2), vomiting, diarrhea, headache, weakness, hyperkalemia, cardiac arrhythmias. Can lead to coma and death.

Ligaments of Shoulder

Acromioclavicular Coracoacromial forms a roof over humeral head to limit superior translation of humeral head and prevent AC separation Coracoclavicular limits superior clavicle translation(conoid, trapezoid) Coracohumeral limits inferior humeral translation Costoclavicular is the primary supporting ligament for SC joint Glenohumeral (Superior, Middle, Inferior) Transverse Humeral attaches between greater and lesser tubercles of humerus, spanning bicpital groove to maintain tendon of LHB

Enteral Administration of drugs

Administration of drugs using the gastrointestinal tract (rectal, oral, sublingual)

Cushing's Syndrome

Adrenal Hyperfunction. Excessive amounts of cortisol production. Sxs: Moon Face, buffalo hump, hyperglycemia, truncal obesity, acne, hypertension, depression, memory loss

Addison's Disease

Adrenal Hypofunction. Occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone Sxs: Hyperpigmentation, GI pain, nausea, hypotension, weakness, fluid/electrolyte imbalance secondary to aldosterone dysfunction, metabolic dysfunction secondary to cortisol deficiency

Single Axis foot

Allows PF/DF, improved knee stability in weight acceptance, lacks energy return if not paired with dynamic response foot

Ground Reaction AFO

Allows for control at ankle and knee, prevents collapse into flexion during stance phase by restricting DF at ankle -Used for knee buckling during stance phase or crouched gait -SCI, CVA, MS, GB, or other Neuro condition for weak quads -Must have at least 3/5 mmt at quads and hip stability

Wernicke's Aphasia

Also known as "receptive aphasia", unable to "receive" comprehension. Also fluent aphasia, sensory aphasia. Typically caused by MCA stroke with lesion in auditory association cortex of L Lateral Temporal Lobe Reading and auditory comprehension impaired, writing impaired, but muscular ability to speak is not. Will talk in complete sentences that have no meaning with made up words.

Residual Volume (RV)

Amount of air remaining in lungs after max exhalation. Approx 25% of lung volume

Tidal Volume (TV)

Amount of air that moves in and out of the lungs during a normal breath. Approximately 10% of total volume

Venous Return

Amount of blood returned to the R atrium each minute. Must equal CO when averaged over time.

Types of Cartilaginous joints

Amphiarthrosis Hyaline cartilage or fibrocartilage that connects bones. Slightly moveable Synchondroses: Hyaline cartilage completely joins two bones (sternum and true rib articulation) Symphysis: Fibrocartilage connects two bones (pubic symphysis)

Opioid Agents (Narcotics)

Analgesia for severe pain management by stimulatig opioid receptors in CNS to prevent pain signals from reaching destination. Used for severe pain, sedation, managing opioid dependence, relief of severe and persistent cough (codeine) Sides: Mood swings, sedation, confusion, vertigo, dulled cognitive function, orthostatic hypotension Treatment should be scheduled two hours post administration to maximize analgesic benefit. Examples: Morphine, Meperidine, Oxycodone, Fentanyl, Codeine

Ankle Special Tests

Anterior Drawer Test: Positive for excess anterior translation of the talus from the mortise, indicates ATF sprain Lateral Rotation Stress Test (Kleiger Test): With patient seated at end of table w/knees bent, therapist ERs foot. If patient reports pain over ATF or PTF and interosseus membrane, positive for high ankle sprain. If patient reports pain medially and therapist can feel talus shift from medial malleolus, positive for deltoid ligament tear Talar Tilt Test: Patient in sidelying, knee flexed to 90 deg. Therpist stabilizes distal tibia, tilts talus into ABD and ADD. Positive for excess ADD, may be indicative of CCF sprain -Thompson Test: Squeeze gastroc. If no passive PF, achilles tendon may be ruptured -Tibial Torsion Test: Patient in sitting with knees over edge of table. Therapist places thumb and index finger of one hand over medial/lateral malleoli, then measures angle formed by axes of knee and ankle. Normal ER of tibia is 12-18 deg in an adult -True leg length Discrepancy Test: Patient in supine, hips and knees extended. Measure from distal point of ASIS to distal point of medial malleolus. Positive for bilateral variation of greater than 1 cm.

Knee Ligamentous Tests

Anterior Drawer, Lachman, Lateral Pivot Shift -Posterior Drawer, Posterior Sag -Slocum Test: Patient with knee at 90 and hip at 45, foot rotated to provide 30 deg of internal rotation. Therapist sits on patient's foot and provides anterior force to tibia on femur. Positive for movement primarily on lateral side. Indications: Anterolateral laxity. Can also assess anteromedial instability with 15 deg external rotation of tibia -Valgus/Varus stress test

GH Flexion

Anterior deltoid Coracobrachialis Pec Major (clavicular head) Biceps brachii

-Cycline

Antibiotic Tetracycline, doxycycline

Bronchodilators for asthma/COPD

Anticholinergic: Atrovent (Ipratropium), Spiriva (Tiotropium) Sympathomimetics: Ventolin (Albuterol), Primatene mist (Epinephrine), Serevent (Salmeterol) Xanthine Derivative: Theo-Dur (Theophylline), Aminophylline

-Parin

Anticoagulant (blood thinner) Heparin, Warfarin, dalteparin

-zodone

Antidepressant Ex: nefazodone, trazodone, vilazodone

-tadine

Antihistamine Loratadine

-Statin

Antilipidemic to reduce cholesterol Atorvastatin, pravastatin, pitavastatin, simvastatin

-triptan

Antimigraine Sumatriptan

-vir

Antiviral Acyclovir

Coarctation of the aorta

Aorta is narrowed near ductus arteriosus, ranging from mild to severe and may not be detected until adulthood. Usually occurs with PDA, ventricular septal defect, bicuspid aortic valve. Sxs: Severe--SOB, pale skin, sweating soon after birth. Most common sign in adults/older children is high BP in arms, low BP in legs. other sxs are SOB in exercise, intermittent claudication, weakness, headache. Tx: Surgical repair of aorta or balloon angioplasty.

Meniscal Pathology Tests

Apley's Compression Test: Prone with knee at 90, compressive force through tibia with IR and ER. Positive for pain or clicking. Bounce Home Test: Maximal knee flexion in supine, passive knee extension. Positive for rubbery end feel or incomplete extension McMurray Test: Patient in supine, knee fully flexed. Therapist provides IR and EXT, then ER and EXT to knee. Positive for click or crepitus over joint line, may be indicative of posterior meniscal lesion Thessaly Test: One leg stance, 5 deg flexion of knee. Patient rotates femur on tibia 3 times, then repeats with 20 deg knee bend. Positive for joint line discomfort, catching or locking in knee.

RLQ pain

Appendicitis Kidney stone/Ureteral Stone Meckel Diverticulum Cholecystitis Intestinal Obstruction

Topical administration

Application of drug directly to skin or mucous membrane (nasal mucosa). Poorly absorbed, so reserved for localized epithelial disorders.

Transdermal administration

Application of drug in patch form, where it absorbs through the skin and enters systemic circulation. Allows for slow, controlled release of drug into circulation over long period of time. Fentanyl, iontophoresis and phonophoresis

Wet-to-dry Dressings

Application of moistened gauze dressing over necrotic tissue. Dressing is allowed to dry and then removed with any necrotic tissue still adhered. - Used for wounds with mod amounts of exudate and necrotic tissue - Viable tissue can removed as well in the process, so use sparingly - Can cause bleeding and can be very painful

External catheter

Applied over shaft of penis, held in place by padded strap or adhesive tape

Arcuate ligament complex

Arcuate ligament Oblique Popliteal Ligament Lateral Collateral Ligament Popliteus Tendon Lateral Head of gastroc Assists cruciate ligaments in controlling posterolatearl rotatory instability of knee and provides support to posterolateral joint capsule

Cerebrum

Area of the brain responsible for all voluntary activities of the body. Two hemispheres joined by corpus callosum.

Effective Radiating Area (ERA)

Area of transducer that transmits ultrasound energy

Zone of hyperemia

Area surrounding zone of stasis that presents with inflammation but will fully recover without intervention

Mean

Arithmetic average - sum of all values divided by number of values

Coccyx

Articulates with sacrum and consists of four small fused vertebral bodies

Fracture: Response

Assess peripheral pulses and sensation distal to injury to determine extent of injury to nerves/blood vessels Support site with firm object to stabilize Avoid movement

Six Minute Walk Test

Assesses walking endurance and aerobic capacity 100 feet long hallway, floor markers every 3 feet Pt must walk as far as possible for 6 min, and can slow down and rest as necessary. Notes: -Can use AD but must be least restrictive w/out jeaporizing safety -Alerted after each min how much time is left (you have 5 min left) -Accepted verbal encouragement "Keep up the good work" -Therapist should walk a half step behind the patient and not beside or in front

Rhythmic Initiation (RI)

Assists in initiating movement when hypertonia exists. Progresses from passive (let me move you) to active assistive (help me move you) to slightly resistive (move against the resistance). Movements must be slow and rhythmical and allow for full ROM Mobility/Stability

Parametric Statistics

Assumes that samples come from normally distributed populations

Thrombus Ischemic Stroke

Atherosclerotic plaque occludes an artery or branch causing an infarct. Sxs can appear in minutes or over several days. Usually occurs during sleep or waking up after myocardial infarction or surgical procedure.

Joints falling anterior to Line of Gravity

Atlanto-Occipital Joint (cervical extensors and suboccipitals) CT Joint (Thoracic erector spinae) SI joint (TA) Knee joint (Hamstrings, gastroc) Ankle joint (PFs)

Menisci

Attached to proximal surface of tibia and serve to deepen the articular surfaces of the tibia where they articulate with femoral condyles, and function as shock absorbers. Thicker w/ better blood supply on the outside, thinner with less blood supply on inside./

Declarative Learning

Attention, awareness, and reflection to attain knowledge that can be consciously recalled (mental practice)

Myasthenia Gravis

Autoimmune disease resulting in poor nerve transmission at neuromuscular junction. Antibodies block/destroy receptors for ACh uptake, preventing muscle contraction. Sxs: -Dysarthria -Dysphagia -Dysphonia -Diplopia -Daily fluctuations in fatigue -Proximal MSK weakness -Ptosis and facial weakness "Crisis" may include respiratory muscles, requiring vent. -75% of people with MG have thymus abormalities (hyperthyroidism, thyrotoxicosis, thymic tumor, overactive thymic gland) Tx: ACh drug therapy, plaspaheresis, immunosuppressive therapy. PT for pulmonary rehab, preventing secondary osteoporosis. AVOID HOT/COLD, as well as strenuous exercise. No eccentrics. Commonly confused with MS. Differentiate w/ fatigue as day progresses + improvement in strength post rest.

Multiple Sclerosis

Autoimmune disorder that attacks the proteins in the myelin sheath, decreasing efficiency of nerve impulse transmission. Sxs: Initial symptoms--visual problems, sensory changes, clumsiness,weakness, ataxia, balance dysfunction, fatigue. Disease has exacerbation and remissions, with frequency and intensity indicating course of disease process. Tx: Lessen length of exacerbations and maximize health of pt. Regulate activity level, relaxation, energy conservation techniques, normalization of tone, adaptive/assistive device training.

Huntington's Disease

Autosomally dominant condition, characterized by degen and atrophy of basal ganglia ad cerebral cortex, causing neurotransmitters to be deficient and unable to modulate movement. Sxs: Involuntary choreic movements, alteration in personality, grimacing, protrusion of tongue, and ataxia w/choreoathetoid movements. Late stage--mental deterioration, IQ drop, depression, immobility Tx: Maximize endurance, strength, balance, postural control, and functional mobility.

Legg-Calve-Perthes Disease

Avascular necrosis of femoral head -Atraumatic onset, ages 3-12 (SCFE is 12-15) -May have trendelenburg gait -No capsular pattern -Disease lasts 2-5 yrs and pts recover w/consiervative treatment

-olol

Beta Blocker (reduces HR) atenolol, metoprolol, propanolol

Class II Antiarrhythmic Agents

Beta Blockers inhibit sympathetic activity by blocking beta adrenergic receptors. Atenolol (Tenormin)

-terol

Beta antagonist, bronchodilator Albuterol, Formeterol

-Zola

Benzodiazepine Alprazolam, midazolam

-zepam

Benzodiazepine Clonazepam, diazepam, flurazepam

Metoprolol (Lopressor)

Beta blocker for chest pain, HTN, CHF or arrhythmia. Sides: Dizziness, depression, dry mouth

ADA bathroom sink requirements

Between 29 inches and 40 inches from floor to bottom of mirror 17 inch minimum depth under sink to back wall

Mediate Percussion: Hyper-resonant

Between resonant and tympany. Suggests pulmonary emphysema or pneumothorax.

Elbow Flexion

Biceps Brachii Brachialis Brachioradialis

Radioulnar Supination

Biceps Brachii Supinator

Knee Flexion

Biceps Femoris Semitendinosus, Semimembranosus Sartorius

Muscles innervated by Common Peroneal division of Sciatic Nerve

Biceps Femoris (short head)

Musculocutaneous Nerve (FL)

Biceps br. Brachialis Coracobrach. Pronator Quad. Fl. dig. Prof., Fl. Poll. Long

Forefoot Valgus

Big toe down. Pronation of forefoot. Often associated with Pes Planus Can be "Rigid", so bring the ground up to the foot! Add a lateral wedge Can be "Flexible", so assist the foot to the ground! Add a medial wedge

Forefoot Varus

Big toe up. Supination of forefoot Compensated by forcing medial forefoot to ground Can be "Rigid varus", so bring the ground up to the food! Add medial wedge Can be "Flexible varus", so assist the foot the ground! Add lateral wedge

Peabody Developmental Scale

Birth to 72 months (6 years)

Eschar Tissue

Black or brown, thick, hard and leathery necrotic tissue that tends to be firmly adhered to the wound bed

Deep Vein Thrombosis (DVT)

Blood clot formed in deep veins of lower extremities caused by any condition that impairs normal circulation or clotting. Risk factors: prolonged sitting/bed rest, inherited blood clotting disorders, venous injury or surgery, pregnancy, cancer, birth control, obesity, smoking Sxs: Mostly asymptomatic, but can present with swelling, pain, redness, warmth. Confirmed with Homan's sign. Tx: Prevent blood clot from getting bigger or breaking loose to cause PE. Anticoagulants, thrombolytics. Compression Stockings.

Myocardial Infarction (MI)

Blood flow through one or more coronary arteries is reduced or cut off completely by a plaque or blood clot, or by spasm. This causes irreversible necrosis to the portion of myocardium supplied by the artery. Sxs: Chest discomfort, SOB, discomfort in upper body (arms, shoulder, neck, back), nausea, vomiting, dizziness, sweating, palpitations. Labs: Elevated creatine phosphokinase, aspartate transferase. EKG: Inverted T wave = myocardial ischemia, elevated ST segment = acute infarction, depressed ST segment - pending subendocardial infarction. Treatment: Meds (anticoagulants, thrombolytics, antihypertensives, cholesterol lowering meds), Coronary angioplasty, coronary bypass, lifestyle changes.

Hypoglycemia

Blood glucose less than 70 mg/dL Sweating, shaking, dizziness, clumsiness, headache. May lose consciousness. Counteracted with glucose or carb rich substace (sugar, honey, crackers, juice)

Hyperglycemia

Blood glucose over 180-200 mg/dL. Increased thirst and frequent urination, dyspnea, fruity breath odor, dry mouth, nausea, confusion, LOC.

Hematuria

Blood in urine (cancer, faulty catheterization, serious disease)

A1C Testing

Blood test based on attachment of blood glucose to hemoglobin, measuring patient's glucose level over 2-3 months. Positive if A1C level is 6.5% or higher (normal is below 5.7%)

Serosanguineous Exudate

Light red or pink Thin, water consistency Normal in healthy healing wound through inflammatory and proliferative stages

Secondary Injury (TBI)

Brain damage that occurs as a response to initial injury. Hematoma, hypoxia, ischemia, increased intracranial pressure, post-traumatic epilepsy

Closed TBI

Brain injury without penetration. Concussion, contusion, hematoma, injury to extracranial blood vessels, hypoxia, drug overdose, accel/decel injuries

Central Nervous System

Brain, Brainstem, Spinal Cord

Quadratus femoris

Branches from sacral plexus L4, L5, S1

Gemellus inferior

Branches from sacral plexus L4, L5, S1, S2

Obturator internus

Branches from sacral plexus L4, L5, S1, S2

Quadratus lumborum

Branches of T12, L1 nerves

Contusion

Bruise. Injury caused by blow that does not disrupt skin integrity. Pain, edema, discoloration from blood seepage under skin

Pleural Effusion

Buildup of fluid in pleural space between lungs and chest cavity, due to viral infection, pneumonia, PE, or autoimmune disease (lupus, RA). Excess fluid pushes pleura against lungs, and may cause atelectasis. Fluid may be infected, turning into abscess (empyema) Sxs: SOB. Empyma presents as dry cough, chills, and fever. Tx: Underlying condition. May need chest tube to drain fluid.

Cystocele

Bulging of bladder into vagina

Wrist Contracture/Tightness Tests

Bunnell-Littler Test: Patient holds MCP in slight EXT. Therapist moves PIP into flexion. If PIP does not flex with MCP joint extended, may be tight intrinsic muscles or capsular tightness. If PIP fully flexes with MCP in slight flexion, there may be intrinsic muscle tightness without capsular tightness. -Tight Retinacular Ligament Test: PIP is held in neutral position, therapist attempts to flex DIP. if unable to flex DIP, retinacular ligaments or capsule may be tight. If therapist flexes DIP with PIP in flexion, retinacular ligaments may be tight with normal capsule

Retrocalcaneal Bursa

Bursa between Achilles tendon and calcaneus, acting as a cushion between the tendon and bone.

Dehiscence

Bursting open of a wound closed by primary intention

Respiratory Acidosis

CARBS Confusion Agitation Restlessness Blurred Vision Seizures

Sensory Testing in SCI

C2: Occipital Protuberance C3: Supraclavicular Fossa C4: Top of AC joint C5: Lateral antecubital fossa C6: Thumb C7: Middle Finger C8: Little Finger T1: Medial Antecubital Fossa T2: Apex of axilla T3: 3rd IS space T4: Fourth IS space @ nipple line T5: Fifth IS T6: Sixth IS T7: Seventh IS T8: Eighth IS T9: Ninth IS T10: Umbilicus T11: 11th IS T12: Midpoint of inguinal ligament L1: Half distance between T12 and L2 L2: Midanterior thigh L3: Medial Femoral Condyle L4: Medial Malleolus L5: Dorsum of foot at 3rd MTP joint S1: Lateral heel S2: Popliteal fossa S3: Ischial Tuberosity S4-5: Perianal area

Upper Quarter Reflex Testing

C5: Biceps C6: Brachioradialis C7: Triceps

Muscles tested in SCI

C5: Elbow flexors C6: Wrist Extensors (ECRL and ECRB) C7: Elbow Extensors C8: Finger flexors (FDP) to middle finger T1: Small finger abductors (ADM) L2: Hip Flexors L3: Knee extensors L4: Ankle Dorsiflexors (TA) L5: Long toe extensors (EHL) S1: Ankle PF

General signs and symptoms of Cancer

CAUTION Change in bowel/bladder routine A sore that will not heal Unusual bleeding or discharge Thickening or lump develops Indigestion, or difficulty swallowing Obvious change in wart or mole Nagging cough, hoarseness Other sxs are unexplained weight loss, fatigue, anemia, pain or weakness

Cranial Nerves

CN I: Olfactory (Sensory) CN II: Optic (Sensory) CN III: Oculomotor (Motor) CN IV: Trochlear (Motor) CN V: Trigeminal (Both) CN VI: Abducens (Motor) CN VII: Facial (Both) CN VIII: Vestibulocochlear (Sensory) CN IX: Glossopharyngeal (Both) CN X: Vagus (Both) CN XI: Accessory (Motor) CN XII: Hypoglossal (Motor) OOOTTAFVGVAH "Oh oh oh, to touch and feel" SSMMBMBSBBMM "Some say marry money..."

Gag reflex

CN IX (Glossopharyngeal) and CN X (Vagus) Stimulate back of throat. Gag will occur, may be absent in % of normal population

Corneal "blink" Reflex

CN V (Trigeminal) feels the pain CN VII (Facial) closes the eyelid Ask the patient to look away, stroke the cornea using piece of cotton. Both eyes should blink with contact to one eye.

Baclofen (Kemstro)

CNS-acting muscle relaxant used for muscle spasms. Sides: Drowsiness, dizziness, weakness

-Dipine

Calcium Channel Blocker (nifedipine, amlodipine) Therapeutic Use: Angina, HTN. Dilates blood vessels

Diltiazem (Cardizem)

Calcium Channel blocker for HTN, chest pain, arrhythmia Sides: Dizziness, drowziness, mood changes, SOB, swelling

Indications for Ultrasound

Calcium deposits Chronic inflammation Delayed soft tissue healing Dermal ulcers Joint contracture Muscle spasm Myofascial trigger points Pain plantar warts Scar tissue

Exercise for Lymphedema

Can help improve lymph flow by: -increasing lymph vessel contractions -increasing fluid uptake in initial lymph -Improving muscle pump to stimulate lymph flow Low impact, aerobic activities recommended for onset. Start with trunk exercises, work proximal to distal. Deep breathing eercises to enhance lymphatic flow Wear compression bandages/garments while exercising

Ideomotor Apraxia

Can plan a movement or task, but can't volitionally perform it.

Glomerulus

Capillaries needed for filtration of fluid as blood passes through arterioles of the kidneys

Epithelial Cancers

Carcinomas

Digitalis/Digoxin (Lanoxen/Digox)

Cardiac Glycosides for CHF Sides: Bradycardia, bloody/tarry stools, Halos

Pharmacologic Stress Test

Cardiovascular stress induced by meds when routine stress test is contrindicated or if pt is unable to complete due to injury. Used in combo with MPI and ECG. Agents used: adenosine, dipyridamole, dobutamine

Pulmonary arteries

Carry deoxygenated blood from R ventricle to lungs

Efferent Fibers

Carry motor signals from CNS to effectors

Afferent Fibers

Carry sensory signals from receptors to CNS

Control of Breathing

Central control in brainstem, peripheral receptors in lungs, airways, chest walls and blood vessels. - medulla - CO2 ^ --> medulla --> impulse to diaphragm & chest muscles --> breathing rate ^

Chemoreceptor Reflex

Chemosensitive cells in carotid bodies and aortic body respond to changes in pH status and blood oxygen tension. Acidosis (>50mmHg spO2) causes respiratory center stimulation to increase depth and rate of ventilation Activation of parasympathetic system reduces HR and contractility. Hypoxia stimulates CNS to increase sympathetic activity (epinephrine)

Paradoxical Breathing

Chest contracts with inhalation, and expands during expiration Normal in some infants, pathological in children and adults -Fall, sports injury, car accident, damage to lungs or rib cage -Sleep apnea, upper airway blockage, electrolyte imbalance, diaphragmatic neuro issue.

Angina Pectoris

Chest pain from myocardial ischemia due to inadequate blood flow usually from coronary artery disease. Can be Stable: Predictable level of exertion, exercise, or stress brings it on, responds to stress or nitroglycerin. Unstable: More intense, lasts longer, precipitated by less exertion, occurs spontaneously at rest, is progressive Prinzmetal: Occurs due to coronary artery spasm. Sxs: Pressure, heaviness, fullness, burning, or aching behind sternum or neck, back, jaw, shoulders, arms. Can be associated with breathing issuee, fear, anxiety. Tx: Oxygen, nitroglycerin, rest for acute. Long acting nitrates, beta blockers, and calcium channel blockers for chronic.

RUQ pain

Cholecystitis Hepatitis Duodenal Ulcer Biliary Stones

Plaque Psoriasis

Chronic autoimmune disease of skin from genetics, injury, sunlight (insufficient or excess), stress, alcohol, HIV, smoking. Sxs: Red raised blotches bilaterally. Complications include arthritis, pain, itching, secondary skin infections Tx: Control symptoms, prevent secondary infection. Life long, can only be managed through exacerbations

Systemic Lupus Erythematosus

Chronic autoimmune inflammatory disease due to genetics, environmental (UV exposure, infection, antibiotics, stress), viral, or hormonal factors. Sxs: Butterfly rash across cheeks and nose, arthralgias, kidney involvement, malaise, seizures

Beta Blocker Agents

Class II antiarrhythmic agents. the -olols Decrease myocardial oxygen demand by increaseing HR and contractility by blocking beta-adrenergic receptors. Used for HTN, angina, arrhythmias, heart failure, migraines. If on these, HR and BP will be diminished, use RPE to monitor exercise intensity. Atenolol (Tenormin), Metoprolol (Lopressor), Inderal (Propanolol)

Calcium Channel Blocker Agents

Class IV antiarrhythmics. Decrease entry of calcium into vascular smooth muscle, decreasing contraction, vasodilation, and oxygen demand of the heart. Used for HTN, angina, arrhythmias, CHF. Norvasc (amlodipine), Procardia (nifedipine), Calan (Verapamil), Cardizem (diltiazem)

Nominal Measurement Scale

Classification scale. Values are mutually exclusive, each person can only be assigned one category like: Race, gender, types of schools, hair colors (e.g., public, private, parochial)

Inherited Metabolic Disorders

Classified by particular building block that is affected. -Enzyme deficiency leads to accumulation of substrate and deficiency in the product of the enzyme Diagnosis: Amniocentesis in utero, or chorionic villus sampling -Phenylketonuria -Tay-Sachs disease -Mitochondrial disorders -Wilson's Disease Must have awareness of dietary restrictions

Glenohumeral Instability Condition: Etiology: S/Sx: Testing: Tx:

Condition: Excessive translation of humeral head during active rotation. Can include Subluxation (joint laxity where more than 50% of humeral head translates over glenoid rim w/out dislocation) or Dislocation (complete separation of articular surfaces of glenoid and humeral head). 85% of dislocations detach glenoid labrum (Bankart lesion) Etiology: Most common is anterior dislocation associated with excessive ER and ABD S/Sx: Subluxation--popping in and out of place), pain, paresthesias, dead arm feeling, positive apprehension test. Dislocation: Severe pain, paresthesias, limited ROM, Shoulder fullness, shoulder supported by contralateral limb Tx: Immobilization, ROM, isometric strengthening, PRE.

Lateral Epidondylitis Condition: Etiology: S/Sx: Testing: Tx:

Condition: Inflammation of common extensor muscles at origin on lateral epicondyle of humerus. Etiology: Eccentric loading of the wrist extensor muscles (usually ECRB). Poor mechanics, tennis racquet with handle that is too small or strings with too much tension. Common in racquet sports and throwing sports. S/Sx: Pain anterior or distal at lateral epicondyle. Pain worsens with repetition and resisted EXT. Tx: Strength, flexibility and endurance of wrist extensors. Epicondylitis strap can reduce tension on epicondyle.

Plantar Fasciitis Condition: Etiology: S/Sx: Testing: Tx:

Condition: Inflammation of plantar fascia at the proximal insertion on medial tubercle of calcaneus. Excessive tension over time creates chronic inflammation and microtears at proximal insertion of plantar fascia Etiology: Acute injury from excessive loading of foot or chronic irritation from excessive pronation or prolonged duration of pronation. Most common in patients 40-60 years old. S/Sx: Tenderness at insertion of plantar fascia on medial calcaneal tubercle, heel spur, pain in morning or after periods of prolonged inactivity, difficulty with prolonged standing, pain when walking barefoot. Tx: Heel cup, tennis ball/rolling pin massage, medial longitudinal arch taping, achilles stretching, soft soled footwear, orthotics to minimize hyperpronation

Scoliosis Condition: Etiology: S/Sx: Testing: Tx:

Condition: Lateral curvature of the spine, classified as functional (LL discrep, muscle imbalance, posture), neuromuscular (developmental pathology such as CP or Marfan) or degenerative (normal aging process, facilitated by disk herniation, bone demineralization, osteophyte formation). Neuromuscular and Degenerative scoliosis are structural rather than functional Etiology: Typically idiopathic S/Sx: Shoulder level asymmetry w/ or w/out rib hump. Pain not typically associated with spinal curvature, usually a result of abnormal forces on other tissues from curvature. Tx: Orthosis warranted at 25-40 degrees, surgery required over 40 deg. Mild curve = 10 deg or less. Less than 20 deg is usually asymptomatic.

Congenital Limb Deficiencies Condition: Etiology: S/Sx: Tx:

Condition: Longitudinal (reduction/absence of elements within long axis of bone) or transverse (developed to a level beyond which no skeletal elements exist) Etiology: Poor blood supply, infection, drug exposure in utero, genetic. S/Sx: Limb abnormality Tx: Symmetrical movements, strengthening, weight bearing activities, prosthetic training when appropriate

Congenital Hip Dysplasia Condition: Etiology: S/Sx: Testing: Tx:

Condition: Malalignment of femoral head within acetabulum, develops during last trimester in utero Etiology: Malposition in utero S/Sx: Asymmetric hip ABD with tightness and femoral shortening of involved side. Testing: Ortolani's, Barlow's, diagnostic ultrasound Tx: Harness, bracing, splinting, traction. Open reduction with application of cast required if conservative treatment fails.

Juvenile Rheumatoid Arthritis (JRA) Condition: Etiology: S/Sx: Testing: Tx:

Condition: Most common chronic rheumatic disease in children. Can be Systemic, Polyarticular, or Oligoarticular. Etiology: Virus, infection, or trauma triggers an autoimmune response producing JRA in a child with a genetic predisposition S/Sx: --Systemic: 10-20% of cases. Acute onset, fevers, rashes, enlargement of spleen/liver, inflammation of lungs and heart. --Polyarticular: 30-40% of cases. High female incidence, significant rheumatic factor, arthritis in more than 4 joints with symmetrical joint involvement --Oligoarticular: 40-60% of cases. Affects less than 5 joints with asymmetrical joint involvement. Testing: Tx: Pharmacological management (NSAIDs, corticosteroids, antirheumatics, immunosuppressives). PROM, AROM, positioning, splinting, pain management. Surgery may be indicated secondary to contractures or irreversible joint destruction NOTE: In gait-- -Decreased cadence -Decreased PF at toe off -Decreased Hip EXT at terminal stance -Increased anterior pelvic tilt

Patellofemoral Syndrome Condition: Etiology: S/Sx: Testing: Tx:

Condition: Pain or discomfort at anterior knee, also called chondromalacia patella (softening of articular cartilage of patella) Etiology: Repetitive overuse disorder from increased force at PF joint (deceased quad strength, decreased LE flexibility, increased tibial torsion, femoral anteversion. Females, individuals in a growth spurt, runners who increase mileage recently, and overweight individuals more at risk S/Sx: Anterior knee pain, pain with prolonged sitting, pain with ascending/descending stairs, swelling, crepitus. Testing: Tx: Depends on contributing factors. LE flexibility, patellar taping, quad strengthening.

Total Hip Arthroplasty (THA)

Condition: Removal of hip joint surfaces (femoral head and acetabulum) and replacement by implants. Can utilize anterolateral, direct lateral, or posterolateral approach. Indications: OA, RA, Osteomyelitis, Avascular Necrosis Fixation can be cemented (allows WBAT immediately) or cementless (relies on bone growth, may be PWB or NWB initially, more for young active individuals). Average lifespan of implant is 15-20 years. Complications: DVT, infection, PE, femoral fractures, dislocation.

Rheumatoid Arthritis Condition: Etiology: S/Sx: Testing: Tx:

Condition: Systemic autoimmune disorder that presents as a chronic inflammatory reaction in synovial tissues of a joint with periods of exacerbation and remission. Etiology: Unknown. Women affected more than men, most common age of onset is 40-60 years old. S/Sx: Symmetrical joint involvement. Tenderness, warmth, morning stiffness, decreased appetite, fatigue, Swan neck (DIP flexion, PIP ext) or Boutonniere (DIP ext, PIP flexion), low grade fever Testing: Diagnosed based on presentation of involved joints, presence of blood rheumatoid factor, and radiography. Tx: DMARDs can slow progression of joint destruction/deformity. PROM, AROM, Joint protection, body mechanics, education.

Rotator Cuff Tear Condition: Etiology: S/Sx: Testing: Tx:

Condition: Tear in Supraspinatus, Infraspinatus, Teres Minor, or Subscapularis muscle due to acute trauma or chronic degenerative pathology. Can be partial-thickness (portion of tendon) to full-thickness, and can range from small (1cm or less) to large (5 cm or greater) Etiology: Impaired blood supply to tendon resulting in degeneration (particularly in patients over 50), repetitive microtrauma, macrotrauma, postural abnormalities. S/Sx: Arm in IR and ADD, tenderness at GT and acromion, limitation in flexion, ABD with upper trap recruitment, increased tone Tx: Prevent Adhesive Capulitis. Surgery can be arthroscopic, mini open or traditional open approach. Immobilization with sling, with 4-6 wks required for large tears. PROM-->AAROM-->AROM+RROM. Return to dynamic overhead motionin 9-12 months

Biaxial joints

Condyloid: MCP joint of finger Saddle: CMC of thumb

Milroy's Disease

Congenital Lymphedema that presents in infancy. Bilateral LE edema is most common symptom

Atrial Septal Defect

Congenital defect in wall dividing R and L atria, foramen ovale does not close at birth, causing blood to shunt from L to R atrium or R to L in severe cases. Sxs: Small/moderate defects have no sxs or appear after 30. Large defects cause heart murmur, SOB, fatigue, LE and abdomen swelling, heart palpitations, lung infections, stroke, cyanosisof skin. Tx: Surgical closure if defect is large.

Spina Bifida

Congenital defect occurring in early pregnancy due to insufficient closure of neural tube by day 28 of gestation. Occurs in spine and affects CNS, MSK, and urinary systems. Classified as: Occulta: Non-fusion of spinous processes of vertebrae, with intact spinal cord and meninges. No associated disability Cystica: Cyst-like protrusion through non-fused vertebrae, resulting in impairment. Can be meningocele (herniation of meninges/CSF into sac that protrudes through defect) or myelomeningocele (severe, with spinal cord extending through defect in vertebrae. Cyst may/may not be covered by skin. Sxs: Motor loss below level of deficit, sensory deficits, hydrocephalus, Arnold-Chiari Type II malformation, osteoporosis, clubfoot, scoliosis, tethered cord syndrome, latex allergy, bowel/bladder dysfunction, learning disabilities PEAT NOTE: Hydrocephalus occurs in 25% or more of children with myelomeningocele, additional 60% post closure. Most will require a shunt.

Thoraculumbar fascia

Connected to spinous processes of lumbar vertebrae, PSIS, and iliac crest. Three layers separate lumbar muscles into compartments and provide spinal stability, transmit forces, resist lumbar flexion, and provide muscular attachment site.

Posterior Sacroiliac ligament

Connects PSIS to 3rd and 4th sacral segments. Strong, with fibers running in multiple directions and combining with sacrotuberous ligament fibers. Limits all sacral motions, especially posterior sacral rotation

Anterior sacroiliac ligament

Connects anterior ilium to anterior sacrum. Considered the weakest sacroiliac ligament.

Ligamentum Flavum

Connects lamina of adjacent vertebrae and limits flexion and rotation of spine

Cerebellum

Control of finely coordinated movements. Coordination center, voluntary movement and balance. "Small brain." Rapid alternating movements. Damage to one side of cerebellum will produce ipsilateral impairment. Lesions produce ataxia, nystagmus, tremors, hypermetria, poor coordination, and deficits in postural reflexes.

Autogenic Drainage

Controlled breathing to remove secretions without using postural drainage positions or coughing. Can be performed anywhere. Sitting upright in chair w/ back support 1. Unsticking Phase: Slow breath in through nose, 2-3 sec hold, exhale down to ERV. 2. Collecting Phase: Breathe at tidal, interspersed with 2-3 sec holds 3. Evacuating Phase: Deep inspiration from low-mid IRV, breath hold followed by huff

Right Cerebral Hemisphere

Controls left body, Creative, Visual, facial recognition, visual, and musical traits, nonverbal communication, negative emotions, and concept comprehension

Directed Cough and Huffing

Cough compensates for physical limitations to elicit max exhalation. Huffing is forved expiratory maneuver with glottis open, similar to fogging glasses. Lower potential for airway collapse. "Ha ha ha"

Radial Gutter Splint

Covers Radial side of forearm and second/third digits. Immobilizes metacarpals and phalanges, used following fractures.

Extensor Retinaculum

Crosses dorsal aspect of wrist and covers extensor tendons. Prevents "bowstringing" with wrist extension

Flexor Retinaculum

Crosses palmar aspect of wrist, covering flexor tendons. Prevents flexor tendons from "bowstringing" with wrist flexion. Attachment site for thenar/hypothenar muscles

Ulnar nerve injury can be caused by

Cubital tunnel compression, tunnel of Guyon entrapment

Bones of the foot

Cuboid is lateral Navicular is medial 1st cuneiform is medial

Mucolytic Agents

Decrease viscosity of mucus secretions by altering composition and consistency, making them easier to secrete. Administered with a nebulizer. Perform airway clearance within one hour after drug admin. Pulmozyme (Dornase Alpha), Mucosil or Mucomyst (Acetylcysteine)

Valvular Heart Disease

Damage to heart valve resulting in regurgitation (insufficiency), where blood leaks backward through damaged valve, or or stenosis of blood flow where valves do not open wide enough to allow adequate blood flow through the valve. Caused by congenital defects, calcific degeneration, MI, rheumatic fever. Sxs: Palpitations, SOB, chest pain, coughing, ankle swelling, fatigue Tx: Moderate cases require digitalis, diuretics, antiplatelet/anticoagulants, beta blockers, calcium channel blockers.

Necrotic Tissue

Dead tissue from localized enzymatic changes associated with cell death. -Eschar -Gangrene -Hyperkeratosis -Slough

Orthostatic Hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions. In SCI patients loss of sympathetic control of vasoconstriction in combo with absent muscle tone. Decrease of systolic 20mmHg after moving from lying to sitting or decrase in diastolic BP greater than 10 mmHg. Sxs: Complaints of dizziness, lightheadedness, nausea, blacking out when going from horizontal to vertical. Tx: Elastic stockings/ace wraps to LE, Gradual progression to vertical position.

Osteoporosis

Decrease in trabecular and cortical bone mass leading to increased risk of fracture. Can be idiopathic, post-menopausal, or involutional (senile) osteoporosis. Declining osteoblast function coupled with loss of calcium and bone salts will cause bones to be brittle Sxs: Compression and other bone fractures, low thoracic/lumbar pain, loss of lumbar lordosis, kyphotic deformity, decrease in height, dowager's hump, postural changes Tx: Vitamin and pharmacological intervention

Nitrate Agents

Decrease ischemia by relaxing smooth muscle and dilating peripheral vessels. Used for angina pectoris. Administer sublingually. Nitroglycerin (Nitrostat), Isordil (Isosorbide dinitrate), Amyl nitrate solution for inhalation

Obstructive Ventilatory Impairment

Decreased expiratory flows. Primary indicator is PEV1/FVC less than 70%. Asthma, Emphysema, Chronic Bronchitis 100%: Possible normal 70%: Mild Obstruction 60%: Moderate Obstruction 50%: Moderate to severe Obstruction Less than 50%: Severe Obstruction

Hypothyroidism

Decreased thyroid hormon secretion, slowing metabolic processes in the body. Hashimoto's or underdeveloped thyroid gland. Sxs: Fatigue, weight gain, decreased HR, constipation, slowed growth PT implications: Risk of rhabdomyolsysis

Hypopituitarism

Decreased/absent secretion from anterior pituitary gland, causing dwarfism, delayed growth/puberty, diabetes insipidus. Often caused by pituitary adenoma (usually benign tumor) or a pituitary infarction

Extensor digitorum longus

Deep peroneal nerve L4, L5, S1

Extensor hallucis longus

Deep peroneal nerve L4, L5, S1

Peroneus tertius

Deep peroneal nerve L4, L5, S1

Tibialis anterior

Deep peroneal nerve L4, L5, S1

Extensor digitorum brevis (incl. extensor hallucis brevis)

Deep peroneal nerve L5, S1

1 MHz Ultrasound

Deep regions -Capsule -Deep muscle -Arthritis in larger joints

Growth Factors

Derived from naturally occurring protein factors to stimulate specific cells in a topical wound healing application. Increases growth rate of new tissues, promotes cell division.

Wallerian Degeneration

Degeneration of a nerve distal to injury

Amyotrophic Lateral Sclerosis (ALS)

Degenerative disease producing UMN and LMN impairments, no sensory deficits. Loss of anterior horn cells in spinal cord and motor nuclei in lower brainstem causes weakness and atrophy. Corticospinal and corticobulbar tracts demyelinate, causing UMN deficits. LMN Sxs: Asymmetric msk weakness (distal to prox), fasciculations, cramping, and atrophy of hands UMN Sxs: Lack of coordination, spasticity, clonus, Positive Babinski Global Sxs: Fatigue, oral motor impairment, motor paralysis, respiratory paralysis Tx: Riluzole/Rilutek

Variance

Degree of difference in a data set. As it increases, power decreases.

1st Degree AV Block

Delayed contraction of ventricles caused by impaired AV node. Can be normal in athletes. prolonged PR interval, but constant beat to beat. No symptoms. Benign if no symptoms.

Pulmonary Veins

Deliver oxygen rich blood from lungs to L atrium

EMG positive sharp wave

Denerved muscle disorders at rest (primary muscle disease like muscular dystrophy)

Class IV Antiarrhythmics

Depress depolarization to slow conduction through AV node. Diltiazem (Cardizem)

T3-T-12 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: -T3-6: upper thorax -T5-7: Costal margin -T8-T12: Abdomen and lumbar region Muscles innervated: None Reflexes (if any): None Paresthesias: None

C6 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Anterior arm, radial side of hand to thumb and index finger Muscles innervated: Biceps, supinator, wrist extensors Reflexes (if any): Biceps, brachioradialis Paresthesias: Thumb and index finger

L1 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Back, over trochanter and groin Muscles innervated: None Reflexes (if any): None Paresthesias: Groin

L3 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Back, upper buttock, anterior thigh/knee, medial lower leg Muscles innervated: Psoas, quads, thighs Reflexes (if any): Knee jerk, prone knebend positive, pain on full SLR Paresthesias: Medial knee, anterior lower leg

L5 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Buttock, posterior/lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes Muscles innervated: Extensor hallucis, peroneals, glute med, DFs Reflexes (if any): SLR limited one side, neck flexion painful Paresthesias:

S2 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Buttock, thigh, posterior leg Muscles innervated: Same as S1 +peroneals Reflexes (if any): Achilles Paresthesias: Lateral leg, knee, and heel

C5 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Delt, Anterior arm to base of thumb Muscles innervated: Supraspinatus, infraspinatus, delt, biceps Reflexes (if any): Biceps, brachioradialis Paresthesias: None

L2 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Front of thigh and knee Muscles innervated: Psoas, hip adductors Reflexes (if any): None Paresthesias: Anterior thigh

S3 dermatome

Dermatome: Groin, medial thigh to knee

S1 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Lateral and plantar aspect of foot Muscles innervated: Calf and hamstrings, glute wasting, PFs Reflexes (if any): Achilles reflex wek or absent Paresthesias:

C7 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Lateral arm/forearm to index, long and ring fingers Muscles innervated: Triceps, wrist flexors Reflexes (if any): Triceps Paresthesias: Index, long, and ring fingers

C8 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Medial arm and forearm to long, ring, and middle fingers Muscles innervated: Ulnar deviators, thumb EXT, thumb adductors Reflexes (if any): None Paresthesias: Little finger

L4 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Medial buttock, lateral thigh, medial leg, dorsum of foot, big toe Muscles innervated: Tibialis anterior, extensor hallucis Reflexes (if any): Weak or absent knee jerk, SLR limited, side flexion limited Paresthesias: Medial aspect of calf and ankle

T1 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Medial side of forearm to base of little finger Muscles innervated: Finger abductors Reflexes (if any): None Paresthesias: None

T2 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Medial upper arm to medial elbow, pec and midscap areas

C3 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Neck, posterior cheek, temporal area, mandible Muscles innervated: Trap, Splenius capitis Reflexes (if any): None Paresthesias: Cheek, side of neck

S4 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Perineum, genitals, lower sacrum Muscles innervated: Bladder, rectum Reflexes (if any): None Paresthesias: Saddle area, genitals, anus, impotence, posterior herniation

C4 Dermatome: Muscles innervated: Reflexes (if any): Paresthesias:

Dermatome: Shoulder, clavicle, upper scap Muscles innervated: Trap, Levator Scap Reflexes (if any): None Paresthesias: Clavicle and upper scap

Desiccated

Dried up or dehydrated wound from dressing selection that does not control for evaporation of wound bed moisture

Temporomandibular Joint Dysfunction

Diagnosis: Injury or derangement of TMJ, intra-articular disks, or supporting structures. Over time meniscus of TMJ becomes compressed and torn, allowing ball and socket of joint to deteriorate w/ bone on bone grinding. Risk factors: Chewing on one side of mouth, eating tough food, clenching/grinding teeth, nail biting. Symptoms: Unilateral or bilateral pain, muscle spasm, abnormal/limited jaw motion, headache, tinnitus. May complain of clicking or popping.

Transtibial Amputation due to Arteriosclerosis Obliterans (PAD)

Diagnosis: Peripheral vascular disease that produces thickening, hardening, and narrowing/occlusion of arteries. Results in ischemia and ulceration of affected tissues, leading to necrosis, gangrene, and amputation. Clinical Presentation: Intermittent claudication producing cramps and pain in gastroc/soleus, decreased pulse, ischemia, pallor, and decreased temperature. Ankle Brachial Index, Segmental Limb Pressure, Pulse volume recordings

Single Axis Knee Prosthetic

Difficult to reciprocate during gait, may or may not have knee EXT assist or weight activated stance control. Has a constant friction mechanism.

Polyneuropathy

Diffuse Nerve dysfunction, symmetrical and secondary to pathology, not trauma. Sensory impairments in stocking glove distribution, motor weakness/atrophy, weaker distally than proximally. Associated with Guillain-Barre, peripheral neuropathy, neurotoxic drugs, and HIV

Conduction

Direct contact between two materials at different temps--high heat transfers to low heat. Ex: Hot pack, cold pack

Open TBI

Direct penetration through skull to brain (gunshot wound, knife, sharp object, skull fragments)

Laceration: Response

Direct pressure over site until bleeding ceases. If arterial bleeding, intermittent pressure to artery just proximal to site of injury Excessive blood flow = elevate above heart, sparingly use a tourniquet. Call EMS if blood is spurting or does not stop after 10 min of steady pressure

Radiation

Direct transfer of heat from radiation energy source. Ex: Laser, UV light, infrared lamp

Bronchoscopy

Direct visualization of bronchial tree for diagnostic purposes using a fiber optic video camera. Can identify tumors, bronchitis, foreign bodies, and bleeding. Can remove specimens for biopsy.

Dichotomous Data

Discrete data limited to only two values Example: Male and female, smoker and non-smoker

Methotrexate (Folex/Trexall)

Disease Modifying Anti-Rheumatic Drug (DMARD). for cancer, auto-immune conditions Sides: Mouth sores, anemia, bloody or tarry stools

Peptic Ulcer Disease

Disruption or erosion in GI mucosa due to imbalance between protective mechanisms of stomach and secretion of acids in stomach. Causes include H pylori, chronic NSAId use, stress, alcohol, some meds and food, smoking Sxs: Dependent on location and severity. Can include epigastric pain, burning or heart burn, nausea, vomiting, bleeding, bloody stools, pain in waves that is relieved by eating. Specific to H. Pylori: halitosis, rosacea, and flushing. HR increase or BP decrease may be signs of bleeding Perforated ulcer on posterior wall of stomach may present as back pain! Midthoracic to Right upper quadrant and shoulder may signify blood in peritoneal cavity secondary to perforated ulcer

Overactive Bladder Agents

Ditropan (oxybutynin Chloride) Detrol (Tolterodine Tartrate)

-Thiazide

Diuretic Chlorothiazide, hydrochlorothiazide

Furosemide (Lasix)

Diuretic for swelling (edema), CHF, liver or kidney disease, HTN Sides: Tinnitus, jaundice, severe pain in upper stomach

THA Direct Lateral Approach and Precautions

Divides TFL and vastus lateralis longitudinally to access hip joint, leaves posterior glute med attached to GT. Posterior tissues and capsule are left intact, minimizing dislocation probability, ideal for noncompliant patients. Precautions: Hip flexion beyond 90, EXT, ER, ADD

Steroid Hormones (prostaglandins)

Do not circulate in blood, just exert effects where they are produced. All cells create prostaglandins from phospholipids of cell membrane Can produce wide variety of effects: inflammation, pain, vasodilation/constriction, nutrient metabolism, blood clotting

Parietal Impairment

Dominant hemisphere (usually left): Agraphia, alexia, agnosia Non-dominant hemisphere: Dressing apraxia, contstructional apraxia, anosognosia (unaware of deficit) Contralateral sensory deficits Impaired language comprehension and impaired taste

Rhomboids major and minor

Dorsal scapular nerve C5

Levator scap

Dorsal scapular nerve C5 and branches of C3 and C4

Superior canal BPPV

Down beat, torsional nystagmus toward affected side. Straight downbeat with no torsion or bidirectional means CNS

Stroke: Response

Drooping or numbness on one side of face. numbness or weakness of one arm, altered vision, headache, dizziness, lack of coordination, confusion, LOC Call EMS immediately, noting time initial sxs appeared. If symptoms go away after a few minutes, insist that patient seeks care for their TIA

Oral Administration

Drugs by mouth. Most common and easiest. Absorption by GI allows for gradual increase in drug lvels throughout the body, but must be lipid soluble so intestines can absorb it. Gastric irritation, metabolism of liver before reaching target tissue are downsides

Moisture and Occlusion

Dry wound bed = slow wound healing, risk for cracks or fissures Excessive moisture = maceration damage or erosion of tissue Occlusion = ability of dressing to transmit moisture between wound bed and atmosphere. Fully occlusive would be impermeable (latex gloves), non-occlusive substance is completely permeable (gauze pad)

Sidelying Bony Prominences (Pressure Injury)

Ears Lateral Acromion Process -Lateral head of humerus -Lateral humeral epicodyle -GT -fibular head -Lateral malleolus -Medial Malleolus

Direct Current

Electric current flowing from Anode (positive) to Cathode (negative electrode) continuously -Polarity is constant 1 mA/sq inch 40-80 mA*min

EMG of normal, relaxed muscle

Electrical silence. Spontaneous potentials are abnormal and ay indicate nerve/muscle damage

Hip Contracture/Tightness Tests

Ely's Test: Patient passively flexes patient's knee in prone. Positive for spontaneous hip flexion, indicative of rectus femoris tightness Ober's Test: Patient sidelying with lower leg flexed. Therapist moves test leg into EXT and ABD, then slowly lowers test leg. Positive for inabilty of test leg to adduct and touch the table. May indicate IT band or TFL contracture Piriformis Test: Patient in sidelying, test leg up, hip flexed and knee bent. Therapist presses down on knee, positive for pain or tightness, may be indicative of piriformis tightness or compression on sciatic caused by piroformis Thomas Test: Patient lies supine, bends one knee to chest. If patient's straight leg rises from table, may be indicative of hip flexion contracture Tripod Sign: Patient sits with knees flexed to 90 over edge of table. Therapist passively exgends one knee. Positive for hamstring tightness of trunk extends. 90/90 SLR: Patient extends knees from 90/90 in supine. Positive if knee remains in 20 deg or more of flexion.

Resisted Progression (RP)

Emphasizes coordinationof proximal components during gait. Resistance applied to pelvis, hips, or extremity during gait cycle to enhance coordination. Skill

Title I of the ADA

Employment. - Prohibits discrim. in all aspects of employment - Reasonable accommodations

Types of Abnormal End Feels

Empty Firm Hard Soft

Hepatitis A

Ends in a vowel, comes from the bowel. Transmission is by close personal contact with someone who has the infection or through fecal-oral route (contaminated water or food source). Flu like symptoms, usually does not progress to chronic disease or liver cirrhosis. Pts recover in 6-10 weeks

Lymphadenomegaly

Enlargement of lymph nodes, commonly occurs secondary to cancer, infections, or allergic reactions

Pleuroscopy

Examination of lung surfaces, pleura, and plural space using a small video camera inserted between ribs into pleura space

Regression Analysis

Examines relationship between between dependent variable and one or more independent variables

Polyuria

Excesive production of urine

Hyperpituitarism

Excess secretion of growth hormone, causing gigantism, acromegaly, hirsutism (excess hair growth), galactorrhea (abnormal lactation), amenorrhea, infertility, or impotence.

Hyperthyroidism

Excess thyroid hormones in bloodstream. Most specific cause is Grave's disease, an autoimmune disorder. Sxs: Increase in nervousness, excess sweating, exophthalmos weight loss, increased BP, myopathy chronic periarthritis, enlarged thyroid gland PT implications: Avoid treatments that exacerbate, avoid hot settings, avoid cardiovascular stress

Trendelenburg Gait Pattern

Excessive lateral trunk flexion and weight shifting over stance leg that indicates gluteus medius weakness

Full-thickness wound

Extends through dermis into deeper structures such as subcutaneous fat. Deeper than 4 mm = full-thickness, healing by secondary intention.

Partial Thickness Wound

Extends through epidermis and possibly into dermis (but not through). Will heal by re-epithelialization or epidermal resurfacing. -Abrasions -Blisters -Skin tears

Subcutaneous Wound

Extends through integumentary tissues and involves subcutaneous fat, muscle, tendon, or bone. Requires healing by secondary intention.

Decerebrate rigidity

Extension of trunk and all four extremities. Result of corticospinal lesion at brainstem level.

Plicae

Extensions of synovial membrane sometimes found in anterior knee, usually medial to patella. Can be source of anterior knee pain.

Wrist Extension

Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Extensor Carpi Ulnaris

Radial Deviation

Extensor Carpi Radialis Longus/Brevis Extensor Pollicis Longus/Brevis Flexor Carpi Radialis

Ulnar Deviation

Extensor Carpi Ulnaris Flexor Carpi Ulnaris

Toe Extension

Extensor Digitorum Longus and Brevis Extensor Hallucis Longus and Brevis Lumbricals

Thumb Extension

Extensor Pollicis Longus/Brevis Abductor Pollicis Longus

Ankle retinacula

Extensor retinacula is anterior to ankle, contains tendons on extensor musculature and prevents them from "bowstringing" as ankle dorsiflexes. Flexor retinaculum and peroneal retinaculum are also present.

Evoked Potentials

External stimuli (auditory, visual, proprioceptive) are used to evoke electric potentials in brain, and electrodes record the amount of time it takes for the impulse to reach the brain. Rules out MS, brain tumor, acoustic neuroma, SCI

Vestibulospinal tract

Extrapyramidal tract for ipsilateral postural adjustments after head movements, extensor activation and flexor inhibition. Damage to extrapyramidal tracts results in paralysis, hypertonicity, exaggerated DTRs, and clasp-knife reaction

CN VII

Facial Sensory: Taste on anterior tongue Motor: Facial muscles, lacrimal and sublingual glands Test: Facial expressions, taste Common Pathologies: ALS, Bell's Palsy, GB

Thrombolytic Agents

Facilitate clot dissolution through conversion of plasminogen to plasmin, which breaksdown clots and allows occluded vessels to reopen. Used for acute MI, PE, ischemic stroke, arterial/venous thrombosis Kinlytic (urokinase), Activase (Alteplase)

Heart Transplant

Failing, diseased heart is replaced with healthy, donor heart. Reserved for patients with end-stage heart failure that fail other more conservative measures. (cardiomyopathy, coronary artery disease, valvular disease, congenital heart disease)

Closed system model

MULTIPLE feedback loops Nervous system actively initates movement (doesnt react to stimuli)

Vastus medialis

Femoral nerve L2-L4

Peroneal nerve injury can be caused by

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

Interosseus Membrane

Fibrous connective tissue that runs obliquely from radius to ulna. -Spans from proximal to distal radioulnar joint and serves as a stabilizer against axial forces to wrist

Arcade of Frohse

Fibrous ridge at the proximal aspect of the supinator muscle that may compress the radial nerve. Near the radiocapitellar joint, the radial nerve branches into the deep, motor, posterior interosseous nerve and the superficial sensory branch. It is the deep branch that passes beneath the arcade of Frohse which is the most common site of compression of the radial nerve

Kidneys

Filter water, salt, and metabolic waste from blood through urine excretion Contributes to homeostasis--acid/base balance, regulation of electrolytes, blood volume control, BP control via hormone

Hemodialysis

Filters waste products from patient's blood due to Renal Disease robbing kidneys of that ability -Exercise is best on non-dialysis days -RPE is best measure, stay between 9-13 -Weight/pressure should never be placed on ateriovenous fistula arm -BP should never be taken in the arm with arteriovenous fistula -LE exercises can be performed in 1st 1/2 of dialysis but nothing last 1/2. NO EX immediately post dialysis

Autonomous Stage of Motor Learning

Final stage of learning, little need for cognitive control. Can perform task with interference from variable environment. Automatic response, error-free, can multi-task. Internal feedback dominant.

Hydraulic Microprocessor for Foot

Finer control over stability/mobility, improved shock absorption, non appropriate for all environments.

T1 Resistive Test

Finger Adduction

De Quervain's Tenosynovitis Test

Finkelstein Test: Patient makes fist with thumb tucked inside fingers, therapist ulnarly deviates wrist. Positive for pain over AbPL and EPB at wrist, indicative of tenosynovitis in thumb

Types of Normal End Feels

Firm (Stretch): ankle DF, finger EXT, Hip IR, Forearm supination Hard (bone to bone): Elbow EXT Soft (tissue approximation): Elbow/Knee flexion

Piriformis

First and second sacral nerves S1, S2

S1

First heart sound, closure of atrioventricular valves at onset of ventricular systole High frequency sound, low pitch and longer duration than S2 "Lub"

Uncovertebral joints

Formed betweenn lateral projections on adjacent vertebrae between C3 and T1. Guide motio in sagittal plane and limit motion in other two planes

Intervertebral disks

Formed by Annulus Fibrosis (dense layer of collagen fibers and fibrocartilage that firmly attaches to adjacent vertebrae to provide tensile strength during movement) and the Nucleus Pulposus (Gelatinous mass in center of disc that provides shock absorption)

Talocrural Joint Motions: -Loose-packed position -Close-Packed Position -Capsular Pattern

Formed by articulations of distal tibia, talus, and fibula. Stable in DF, more mobile in PF. Motions: Dorsiflexion, plantarflexion -Loose-packed position: 10 deg PF, midway between max INV and EV -Close-Packed Position: Max DF -Capsular Pattern: PF, DF Mobilization: Anterior for PF Posterior for DF

Knee Ankle Foot Orthosis (KAFO)

For patients with more extensive paralysis or limb deformity -knee control provides medial-lateral hyperextension restriction while allowing flexion

Planar posterior headrest

For reclining or tilt in space frame, or PT tends to maintain hyper EXT head/neck position in upright

Afterload

Force that impedes blood flow out of heart

No toe off

Forefoot/toe pain Weak PF Weak toe flexors Insufficient PF ROM

Deep Vein Thrombosis

Formation of blood clot that becomes dislodged (embolus). Patients w/ SCI are at greater risk of developing DVT due to decrease in normal pumping action from muscular contraction in LE. Homan's Sign to confirm presence of DVT. Prevention should include anticoagulants, positioning schedule, ROM, and elastic stockings. S/Sx: Swelling, pain, sensitivity over area of clot, warmth in area. Tx: Bed rest and anticoagulants. Avoid active or passive movement to avoid dislodging clot.

Lumbar Plexus

Formed by nerve roots of T12-L4, innvervates anterior and medial muscles of the theigh and dermatomes of the medial leg and foot. Largest and most important branches of the plexus are the obturator and femoral nerves

Midtarsal joint Motions: -Loose-packed position -Close-Packed Position -Capsular Pattern

Formed by the talocacanealnavicular joint and the calcaneocuboid joint. Motions: Inversion, eversion -Loose-packed position: Midway between extremes of ROM -Close-Packed Position: Supination -Capsular Pattern: DF, PF, add, medial rotation

Subtalar Joint Motions: -Loose-packed position -Close-Packed Position -Capsular Pattern

Formed by three articulations between talus and calcaneus (anterior, middle, posterior). Anterior and middle articulations are formed by two convex facets on the talus and two concave facets on the calcaneus. Posterior articulation is a concave facet on inferior talus and a convex facet on the calcaneus Motions: Inversion, eversion -Loose-packed position: Midway between extremes of ROM -Close-Packed Position: Supination -Capsular Pattern: Limited varus ROm Medial glide increases eversion Lateral glide increases inversion

Spondylolisthesis (Degenerative Spondylolisthesis)

Forward slippage of one vertebra on the vertebra below it. Can be congenital, degenerative, post traumatic, or pathologic. Most common site is L4-5. Over 50 is most common, more common w/ AA and women. Degenerative is caused by arthritis and bone spurs that develop to resist motion when disc cannot. Symptoms: Back pain that is worse with exercise, lifting overhead, standing, getting out of bed or a car, walking up stairs/incline, and positioning in EXT. Will have "step off sign" If L4 is anteriorly displaced relative to L5, it's L5-S1 spondolysthesis. "The level of the slip is one level below the step off deformity) Meyerding scale: Grade 1-5, with Grade 1 at less than 25% and Grade 5 at 100% slippage

Alanine Amino-Transferase (ALT)

Found within liver cells. Damage to liver cells releases this into blood stream. Can be caused by alcoholism, celiac, Cirrhosis, hepatitis, and liver cancer.

S4

Fourth heart sound. Atrial Gallop. Sound of vibration of ventricular wall with ventricular filling and atrial contraction. May be associated with HTN, stenosis, hypertensive heart disease, MI

Nonunion Fracture

Fracture that fails to heal after 9-12 months

Hard End Feel (abnormal)

Fracture, osteoarthritis, osteophyte formation

Abrasion

Friction and shear forces over a rough surface, scraping away at the skin's layers

Stage 3 Pressure Ulcer

Full thickness skin loss, with visible adipose and granulation tissue present, often with visible slough or eschar. Possible undermining and tunneling. Fascia, muscle, ligament, tendon, bone NOT exposed. If slough or eschar obscures tissue loss, it is unstageable.

Onychomycosis

Fungal infection of nail. Happens at manicures or pedicures with unsterile utensils, excess skin moisture, closed toed shoes, ipaired immune response Sxs: Yellow or brown nail discoloration, hyperkeratosis and hypertrophy of nail causing it to partially detach from nailbed Tx: Manual debridement of nail and topical antifungal

Double step

Gait pattern where alternate steps are a different length or different rate

Lumbar/SI Special Tests

Gapping Test: Patient lies supine, therapist applies downward and lateral pressure to ASISs. If pain experienced in SI, glute, or posterior leg, positive for sprain of anterior SI ligaments SI Joint Stress Test: Patient positioned in supine, Therapist applies downward and lateral force to ASIS. Positive for pain in SI or glutes, may indicate SI joint dysfunction -Sitting Flexion Test: Patient sitting with knees flexed to 90 and feet on floor. Hips adducted to allow patient to bend forward, Therapist palpates PSIS and monitors while flexing. Positive if one PSIS moves farther cranially. May indicate articular restriction. -Slump Test: Patient sits at edge of table, moves into lumbar and thoracic flexion. Then extends knee and DFs ankle. If patient can't extend knee without pain, patient can raise head and try again. If symptoms decrease of if patient can bend knee farther, positive for neural tension. -Standing flexion test: Positive for one PSIS moving farther in cranial direction. -Straight leg raise Test: With patient in supine, therapist flexes patient's hip while maintaining knee extension until patient complains of pain or tightness in low back or posterior leg. Therapist lower leg until patient feels no pain. Then therapist dorsiflexes ankle. If symptoms return, postive for neural tension

Plantarflexion

Gastroc Soleus Tibialis Posterior Peroneus Longus/Brevis Plantaris Flexor Hallucis

Hydrogel Dressing

Gel used to regulate fluid exchange and relieve pain during wound healing -Minimally adheres to wounds -Enables autolytic debridement -Moisture retentive -Commonly used on superficial/partial thickness wounds (abrasions, blisters) with minimal drainage

Hydrocolloids

Gel-forming polymers (gelatin, pectin, carboxymethylcellulose) backed by a strong film or adhesive. Dressing does not attach to wound, but attaches to intact surrounding skin and absorbs exudate by swelling into gel-like mass. Used for partial or full thickness wounds -Enables autolytic debridement -Protects from contamination -Can't be used on infected wounds.

Asthenia

Generalized weakness secondary to cerebellar pathology

Down Syndrome

Genetic abnormality, extra 21st chromosome (trisomy 21). Sxs: Intellectual disability, hypotonia, joint hypermobility, flattened nasal bridge, narrow eyelids, feeding impairment, heart disease. Tx: Exercise, fitness, stability, respiratory function

Prader-Willi Syndrome

Genetic condition diagnosed by physical attributes and patterns of behavior. Small hands feet, and sex organs, hypotonia, obesity, constant desire for food. Presents with coordination impairments and intellectual disability.

Oral glucose tolerance test

Glucose testing after two hours post injection of sugary drink. positive for DM if level is 200 mg/Dl or higher (normal is less than 140)

Hip External (Lateral) Rotation

Glute Max Obturator Externus/Internus Piriformus Gemelli Sartorius

Hip Extension

Glute Max and med Semitendinosus/Semimembranosus (medially) Biceps Femoris (laterally)

Backward Trunk lean

Glute avoidance! Flores walk! -Causes: Weak glute, inferior gluteal nerve palsy

Muscles innervated by Superior Gluteal Nerve

Glute med, min TFL

Hip Abduction

Glute med/min Piriformis TFL Obturator internus

Gluteal Nerves (EX)

Gluteals (maj, med, min) Tensor fasciae latae

Drop Arm Test

Grade 3 Supraspinatus tear Pts arm passively abducted to 90, patient is asked to slowly lower arm down to side. Positive if arm drops and pt cannot control it.

Basal Ganglia

Gray matter masses in the white matter of cerebrum: -Caudate -Putamen -Globus Pallidus -Substantia Nigra -Subthalamic Nuclei Responsible for voluntary movement, regulation of autonomic movement, posture, tone, and motor responses.

Prone lumbar traction (Extended position of spine)

Greater separation of anterior structures (disk spaces) Beneficial for posterolateral disk herniations

Supine lumbar traction (Flexed position of spine)

Greater separation of posterior structures (facet joints, intervertebral foramen) Useful for spinal stenosis

Autism Spectrum Disorder (ASD)

Group of brain disorders characterized by difficulties w/ social interaction, communication, and repetitive behavior. Sxs: Apparent around 2 or 3. Nonpurposeful or absent speech/facial expressions, inability to understand nonverbal, lack of empathy, preoccupation with rituals. Treatment: Multidisciplinary, focusing on improving social comm and decreasing nonpurposeful movts and vocalizations. Sensory integration therapy

Eczema

Group of disorders taht cause chronic skin inflammation due to an immune system abnormality, allergic reaction, or external irritant. Sxs: Red or brown-gray itchy, lichenified skin plaues exacerbated by some topical agents like soaps or lotions. Younger population will experience oozing and crusting. Tx: Topical/oral steroids, oral antibiotics and histamines.

Chronic Obstructive Pulmonary Disease (COPD)

Group of lung diseases that block airflow due to narrowing of bronchial tree (emphysema and chronic bronchitis are main). Disease can progress to alveolar destruction Sxs: Excessive mucus, chronic cough, wheezing, SOB, fatigue Tx: Bronchodilators, inhaled steroids, antibiotics, supplemental oxygen.

Malabsorption Syndrome

Group of pathologies where intestinal absorption and nutrition are inadequate. Occurs secondary to defects in digestion, or inability of intestinal mucosa to absorb nutrients -Celiac -CF -Pancreatic Carcinoma -Pernicious Anemia -AIDS -Crohn's -Addison's Disease Risk for osteoporosis and fractures, and swelling/spasms secondary to electrolyte imbalances and protein depletion.

Normal Sinus Rhythm

HR 60-100 bpm

Vital Response to Exercise

HR and RR increase with workload SBP increase 10 per MET DBP can change +/- 10 UE exercise causes 30-40% less O2 demand than LE at same workload

Tibial Portion of Sciatic Nerve (FL)

Hamstrings (except for the short head of Biceps Fem) Long tendinous portion of Add Magn

Cirrhosis of the Liver

Healthy tissue of liver replaced with scar tissue which blocks blood flow through liver and prevents liver from properly functioning. Etiology: Alcoholism (over a decade), hep C, B, D, certain drugs, infections, toxins, heredity, steatohepatitis, blocked bile ducts. Alcohol blocks normal metabolism of protein fats and carbs. Cirrhosis occurs after >a decade of alcoholism. Hep C causes inflammation - results in cirrhosis after > 2 decades. Sxs: Fatigue, decreased appetite, abdominal pain, spider angiomas, weight loss. Ascites, LE edema, jaundice, gallstones, bleeding, immune system dysfunction, varices.

Sensorineural Hearing Loss

Hearing loss caused by damage to inner ear, cochlea, or vestibulocochlear nerve (CN VIII) Ototoxicity, aging, TBI, acoustic neuroma, Meniere's Sxs: Soft sounds are difficult to hear, loud sounds are muffled, high frequency is inaudible

Polycentric Knee Prosthetic

Heavier than single axis, reciprocal gait is more fluid, but may or may not have knee EXT assist or stance control. Has constant friction mechanism.

Wheelchair Seat Height

Heel to popliteal fold Add 2 inches

Shoe modifications

Heel wedge: Prevents hindfoot eversion/inversion, or treat pes planus/cavus Heel Lift: Used for LLD or achilles tendonitis/repair Heel Cushion: Calcaneal spur or Plantar Fasciitis Heel Cup: Provides shock absorption for heel, used for calcaneal spur or PF Metatarsal Bar/Pad: Relieves pressure from met heads by transferring to met shafts, used for metatarsalgia Rocker Bar: Similar to met bar, but assists patients with terminal stance, specifically toe off.

Paget's Disease

Heightened osteoclast activity, causing excess bone formation that lacks true structural integrity. Bone is large but lacks strength. Sxs: MSK pain, bony deformities at skull, clavicle, pelvis, femur, spine, and tibia. Progresses to HA, vertigo, hearing loss, mental deterioration, fatigue, increased CO and heart failure Tx: Biphosphonates to limit bone resorption and improve quality of involved bone.

Brown-Sequard Syndrome

Hemi-section of the cord - ipsilateral (same side) spastic paralysis and loss of position sense - contralateral (opposite side) loss of pain and thermal sense

Lower Extremity Amputations

Hemicorporectomy (Pelvis and both lower extremities) Hemipelvectomy (1/2 of pelvis and LE) Hip Disarticulation Transfemoral Knee Disarticulation Transtibial Syme's: Removal of foot at ankle joint with removal of malleoli) Transverse Tarsal (Chopart): Amputation through talonavicular and calcaneocuboid joints, preserving plantarflexors and sacrifices dorsiflexors, often resulting in equinus contracture Tarsometatarsal (Lisfranc): Removal of metatarsals, preserving DFs and PFs.

Absolute Contraindications to Exercise During pregnancy

Hemodynamically significant heart disease Restrictive Lung disease Incompetent Cervix/Cerclage Multiple gestation at risk for premature labor Persistent 2nd or 3rd trimester bleeding Placenta previa after 26 weeks Premature labor during current pregnancy Ruptured membranes Preeclampsia/pregnancy-induced hypertension

Primary Lymphedema

Hereditary abnormal development of lymphatic system -Absence of lymph vessels, decrease in number or size of lymph vessels, or increased size of lymph vessels making them incompetent -Occurs more frequently in females, typically in LE

Polycythemia

High RBCs causing thick blood and increasing risk of stroke or heart attack

Bowel/Bladder High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Dep Mid Tet (C6): Min Asst male,Mod Asst female for bladder. Mod Asst with equip for bowel Low Tet (C7-8): ModI for male in bed or WC, ModI for female in bed and ModAsst for WC. Bowel: MinAsst to ModI with equip Para: ModI

ROM/Positioning (PROM to trunk, legs, arms, bed positioning) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Dependent Mid Tet (C6): ModAsst to ModI Low Tet (C7-8): MinAsst to ModI Para: Independent

Dressing (and undressing in bed or WC, upper body/lower body) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Dependent Mid Tet (C6): ModI for upper in bed or WC, MinAsst with lower in bed. ModAsst with lower undressingin bed Low Tet (C7-8): ModI for upper/lower dressing in bed, MinAsst with lower body dressing/undressing in WC (C7), ModI for (C8) Para: ModI

Transfers (bed, car, toilet, bath, WC) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Dependent (C1-4), Max w/ sliding board (C5) Mid Tet (C6): Min asst to mod I for slidingboard, dependent with WC>car, dependent w/ floor transfers Low Tet (C7-8): ModI to I with sliding board, ModAsst to ModI with car, Max to mod with floor transfers Para: Independent with level surfaces/car transfers, min asst to independent w/ floor transfers and uprighting WC

Feeding (Drinking, finger and utensil feeding) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Dependent (C1-4), Min Asst with adaptive equipment (C5) Mid Tet (C6): ModI with adapt equip Low Tet (C7-8): ModI with Adapt equip (C7) Para: Independent

Bed Mobility SCI (rolling, supine/sit, scooting) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Dependent (C1-4), Mod to max asst (C5). Mid Tet (C6): Min asst to mod independent w/equip Low Tet (C7-8): Independent Para: Independent

Grooming (Face, teeth, hair, makeup, shaving face) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Dependent (C1-4). Min Asst w/ adaptive equip for all but hair, with Max-mod asst for hair (C5). Mid Tet (C6): Mod I with adapt equip Low Tet (C7-8): Mod I Para: Independent

Wheelchair Mgmt (wheel locks, armrests, safety straps, cushion adjustment) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Dependent with all Mid Tet (C6): Some asst required Low Tet (C7-8): May require asst with cushion adj and WC maint Para: Independent with all

Weight Shifts (Pressure relief, repositioning) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): ModI with power recline tilt weight shift, dependent with manual recline/tilt/lean weight shift Mid Tet (C6): ModI with power recline weight shift, Min Asst to Mod I with side/side/forward lean weight shift Low Tet (C7-8): ModI with side to side/forward/depression weight shift Para: ModI with depression weight shift

Wheelchair Mobility (Smooth surfaces, up/down ramps/curbs, rough terrain, up/down steps) High Tet (C1-C5): Mid Tet (C6): Low Tet (C7-8): Para:

High Tet (C1-C5): Sup/ to modI with power WC on terrain. ModI with manual on smooth going forward, max Asst to dep with manual in all others (C5) Mid Tet (C6): ModI with terrain, Dep to max Asst up/down curb with pwr, max/mod asst with manual. Mod tomin asst on ramps with manual Low Tet (C7-8): ModI on terrain with power, Dep to Max Asst up/down curb with power, Mod/Min Asst with manual. Min asst on rough terrain. Dep/Max asst up/down steps on manual Para: ModI with curbs in manual WC, ModI with descending steps, Max to Min asst asending steps with WC

Hypertension

High blood pressure. Can be primary (idiopathic) or secondary (identifiable cause, usually renal disease). Elevated: 120-129/80+ Stage 1: 130-139 OR diastolic 80-89 Stage 2: At least 140 Systolic OR at least 90 Diastolic Hypertensive Crisis: 180/120 Sxs: Asymptomatic until complications develop. S4 heart sound is early sign. Severe (DBP 120+) can cause CNS symtpoms, CV symptoms, and renal involvement Tx: Activity, smoking cessation, low sodium diet. Meds: Diuretics, beta blockers, calcium channel blockers, ACE inhibitors, AII receptor blockers, direct vasodilators.

Transfemoral Amputation due to Osteosarcoma

Highly malignant cancer begins in the medullary cavity of a bone (long bones most affected) and leads to formation of a mass. Amputation may be necessary to remove tumor. Clinical Presentation: Pain and swelling, weakness of extremity leading to fracture (may be first sign of osteosarcoma). Early metastases of lungs in 90% of cases. Fatigue, loss of balance, phantom pain, residual limb hypersensitivity, psychological issues Lying in prone position is beneficial to decrease the incidence of a hip flexion contracture

Uniaxial joints

Hinge elbow joint Pivot Atlantoaxial

L1-2 Resistive Test

Hip Flexion

THA Posterolateral Approach and Precautions

Hip joint accessed by splitting glute max in line with muscle fibers. Short ERs are released and hip ABDs retracted anteriorly, and femur is dislocated posteriorly.. This maintains glute med and vastus lateralis. Most common approach but highest dislocation rate. Precautions: Hip flexion beyond 90, ADD, IR

Ventricular Septal Defect

Hole in septum separating R and L ventricles. If hole is too large, too much blood is pumped to lungs, leading to heart failure. Sxs: Large defect can cause cyanosis of skin/lips/fingernails, poor eating, failure to thrive, fast breathing, fatigue, swelling of legs, feet or abdomen, and rapid HR

Pharmacodynamics

How a drug exerts therapeutic effect on the body at a cellular level

Acidic Reaction to Iontophoresis

Hydrochloric acid forming under anode (positive electrode)

Rancho Los Amigos Scale of Cognitive Functioning

I. No response II. Generalized Response (Same response regardless of stimulus) III. Localized Response (Responses directly related to type of stimulus, still inconsistent) IV. Confused-Agitated (Bizarre behavior, uncooperative, incoherent responses) V. Confused-Inappropriate (Can respond to commands, non-purposeful/random/fragmented responses) VI. Confused-Appropriate (Goal-directed behavior dependent on external stimuli. Can follow directions. May respond incorrectly.) VII. Automatic-Appropriate ("Robot-like", minimal to no confusion, but little recall of activities) VIII. Purposeful-Appropriate (Can recall and integrate past and recent events, aware/responsive with learning carryover)

Moro Reflex

If dropped into extension a few inches, baby will splay out with arms and fingers, then cross trunk into adduction and cry. Normal Age: 28 weeks of gestation to 5 months Interferes with balance reactions in sitting, eye-hand coordination

Normal Timing (NT)

Improve coordination in all components of a task. Distal-->proximal sequence, with prox components restricted until distal components activated and initiate movt.

Hold-Relax Active Movement (HRAM)

Improves initiation of muscles at 1/5 or less. Isometric contraction once extremity is placed into shortened ROM. Upon relaxation, moved to lengthened with quick stretch, and patient returns extremity to shortened position with active contraction. Mobility

Akinesia

Inability to initiate movement

Unilateral neglect

Inability to interpret stimuli and events on contralateral side of hemispheric lesion. L sided neglect most common with lesion to R inferior parietal.

Retrograde amnesia

Inability to remember events prior to injury

gastroesohageal reflux disease (GERD)

Incompetent lower esophageal sphincter allows gastric contents to move backward, causing esophageal tissue injury over time. Occurs in 20-30% of adults and some newborns or infants Sxs: Heartburn, belching, chest pain, coughing, esophagitis, hematemesis. If untreated, may develop esophageal strictures, esopaghitis, aspiration pneumonia, asthma, and esophageal adenocarcinoma PT Rehab Considerations: Avoid certain exercises, recumbency will induce symptoms. Head/neck discomfort secondary to perception of lump in throat and subsequent compensation. Tight clothing, exercise, and constipation may precipitate it. Chronic bronchitis, asthma, and pulmonary fibrosis may present with GERD. Have them sleep in left sidelying with pillows elevated (lower esophagus bends to left, so reflux is minimized)

ASIA impairment scale Category B

Incomplete Sensory but NO MOTOR function below the neurological level and includes S4-S5.

Anterior Cord Syndrome

Incomplete lesion from compression and damage to anterior spinal cord. MOI is usually cervical flexion. Usually whiplash Loss of motor function and pain/temp sense due to damage of corticospinal and spinothalamic tracts. Everything but DCML, but no pain or motor. UE more than LE

Gestational diabetes

Increase in insulin resistance and blood glucose levels during pregnancy, usually last trimester. Babies born to women with gestational diabetes have increased levels and are usually big, increasing difficulty of delivery. Baby will have breathing difficulties, jaundice, or hypoglycemia following birth In childhood, will be more likely to have insulin resistance, obesity, behavioral healthy disorders, delays in fine/gross motor skills

Anterior glide of tibia on femur

Increase knee EXT (heel off, terminal stance)

Hydrocephalus

Increase of CSF in ventricles of brain due to poor resorption, obstructed flow, or excessive CSF production. Can be congen, acquired, or idiopathic. Can be caused by spina bifida, choroid plexus neoplasm, cerebral palsy, tumor, meningitis, or encephalocele. Sxs: -Enlarged head or bulging fontanelles in infants -Headache -Vision and behavioral changes -Seizures, altered appetite or vomiting -Downward deviation of eyes ("sun-setting") -Incontinence

Expectorant Agents

Increase respiratory secretions to loosen mucus, and reducing viscosity of secretions. Improves efficiency of cough reflex. Used for cough associated with respiratory tract infections and related (sinusitis, pharyngitis, bronchitis) Mucinex (Guafinesin), Terpin Hydrate

Hypervolemia

Increased blood volume due to increased blood plasma. Caused by excess intake of fluids (IV or blood transfusion) or sodium/fluid retention (heart disease, kidney disease). Sxs: Swelling in legs, Ascites, fluid in lungs

Parkinsonian Gait pattern

Increased forward flexion of trunk and knees, shuffling gait. Festinating may occur.

Hypergranulation

Increased thickness of granular layer of epidermis exceeding the surface height of the skin

C-Reactive Protein

Indication of acute inflammation if over 3 Arthritis, Lupus, rheumatic conditions, vasculitis, meningitis,

Lymphangitis

Infection and inflammation of the lymphatic system pathways

Droplet Precautions

Infectious agent transmission through mucous membranes of nose and mouth, contact with conjunctivae, through coughing, sneezing, laughing, or talking. -Requires close contact (infectious agents don't suspend in air past three feet) -Private room, may sharewith pt that has active infect of same microorganism -3 ft at least between pt and any contact (staff, visitor) -Room door can remain open -Wear a mask when working within 3 feet of patient -Limit transport outside room, pt must wear mask Examples: Bacterial--Haemophilus Influenzae (meningitis, pneumonia, sepsis), Neisseria Meningitidis, diptheria, mycoplasma pneumonia, pertussis, streptococcal A Viral--Adenovirus, influenza, mumps, rubella, Parvovirus B19

Analysis of Variance (ANOVA)

Inferential statistical procedure used to compare two or more populations by analyzing variances

Upper rib Mobilization

Inferior glides Improve Inhalation III Superior glides Improve Exhalation SIE When I do upper rib mobilizations, III SIE

Erosive Gastritis

Inflammation and bleeding of gastric mucosa due to stress, NSAIDs, alcohol, viral infection, or direct trauma. Sxs: Dyspepsia, nausea, vomiting, and hematemesis. Pt may be asymptomatic. May progress to gastric ulcer

Prostatitis

Inflammation of prostate gland due to bacterial infection, or back up of prostate secretions in the gland. I. Acute Bacterial II. Chronic Bacterial III. Chronic Pelvic Pain Syndrome IV. Asymptomatic Inflammatory Prostatitis Sxs: Urgency, frequency, discomfort with urination and pain with ejaculation. -Chronic pelvic pain syndrome--pain in perineum, rectum, prostate, penis, testicles, abdomen. -Asymptomatic inflammatory prostatitis--prostate inflammation in absence of genitourinary tract symptoms

Cholecystitis

Inflammation of the gallbladder, usually associated with cholelithiasis (gallstones). Sxs: Can be asymptomatic, but most common symptom is RUQ pain. If gallstone is lodged in cystic duct, patient can have severe pain that radiates to interscapular region. Tx: Low fat diet to decrease gallbladder stimulation. Lithotripsy if symptomatic to break up stones. Can use laparoscopic cholecystectomy to completely remove gallbladder. Acute cholecystitis resolves in a week.

Pneumonia

Inflammation of the lungs -Bacterial -Fungal -Viral -Aspiration Presents with: -Tachypnea, fever, fatigue, chest discomfort -Tachycardia, dull percussion -Crackles, Ronhchi, Bronchial sounds over consolidation -Dry cough progressing to productive Tx: Antibiotics for bacterial/mycoplasma pneumonia, Antivirals/antifungals PT: Incentive Spirometer, Bronchopulmonary Hygiene

Meningitis

Inflammation of the meninges. Bacterial meningitis is fatal in hours. Sxs: -Fever, headache, vomiting -Complaints of stiff/painful neck -Pain in lumbar area and posterior thigh -Brudzinski's sign: flexion of neck facilitates flexion of hips and knees -Kernig's sign: Pain with hip flexion combined with knee extension -Sensitivity to light Treatment with antibiotics and steroids, lumbar puncture for diagnosis

Hyperbaric Oxygen

Inhalation of 100% oxygen at pressure over 1 atm to reduce edema and hyperoxygenate tissues. Has antibiotic effects and stimulates fibroblast production and collagen synthesis -Used for osteomyelitis, diabetic wounds, thermal burns, radiation necrosis, compromised flaps/grafts -Do not use for active malignancy

Phenylketonuria (PKU), amino acid metabolic disorder

Inherited deficiency in phenylalanine hydroxylase, which normally converts phenylalanine to tyrosine. Excess buildup of phenylalanine leads to brain damage resulting in behavioral and cognitive deficits Sxs: Intellectual disability, hyperactivity, psychoses, abnormal body order, lighter features than family members. Tx: Dietary restriction of phenylalanine (diet drinks, anything with aspartame, breast milk, eggs, chicken, beef, liver, milk.)

Tay-Sachs Disease (Lysosomal storage disorder)

Inherited deficiency of Hexosaminidase A, producing an accumulation of gangliosides (GM2) in the brain, typically in Eastern European (Ashkenazi) Jewish population Sxs: At 6 months of age, child will start to miss developmental milestones and continue to deteriorate in motor and cognitive skills. Patient will develop significant intellectual disability and paralysis, dying by age 5 Tx: No effective treatment. Genetic testing in high risk pops.

Wilson's disease (hepatolenticular degeneration)

Inherited disorder most common in eastern Europeans, Sicilians, and southern Italians that appears in people under 40, usually between 4 and 6 years old. Inherited defect in body's ability to metabolize copper, which accumulates in brain, liver, cornea, and kidney. Sxs: Kayser-Fleischer rings surrounding iris of eye, degenerative changes in basal ganglia, hepatitis, cirrhosis of liver, athetoid movements, ataxic gait patterns, emotional/behavioral changes as copper accumulates. Over time, deformities in msk system, fractures, osteomalacia, contractures Tx: Vitamin B6 and D-Penicillamine, and treatment of hepatic disease

Antithrombotic (Antiplatelet) Agents

Inhibit platelet aggregation and clot formation post MI or a-Fib, and prevent arterial thrombus formation. Aspirin, Plavix (clopidogrel), Persantine (Dipyridamole)

Proton Pump Inhibitors

Inhibit the action of the gastric proton pump, thereby reducing gastric acid production. They usually have the suffix "PRAZOLE". Used for dyspepsia and GERD Nexium (Esomeprazole) Prilosec (Omeprazole) Protonix (Pantoprazole) Prevacid (Lansoprazole) AcipHex (Rabeprazole)

Primary Injury (TBI)

Initial injury to brain sustained by impact (skull penetration, fracture, contusions to gray/white matter) Can be Coup: Direct lesion under point of impact with local brain damage or Contrecoup: Injury on opposite side of impact due to rebound effect of brain after impact

Cognitive Stage of Motor Learning

Initial stage of learning. Conscious processing of information, problem solving. Many errors, inconsistent attempts/performance.

Subcutaneous administration

Injection of a drug directly under the skin into the subcutaneous fat or connective tissue. Useful when slow release is required (insulin). Pts can self-administer

Intramuscular Administration

Injection of drug into skeletal muscle, used to treat local muscular problems (botulinim toxin for spasticity). More rapid absorption than subcutaneous, while still allowing for steady release of drug into systemic circulation. Tend to cause soreness and pain at injection site

Intrathecal

Injection of drugs into a sheath, like subarachnoid space of spinal meninges. Advantageous because it allows for introduction of drugs into CNS without having to pass blood brain barrier.

Intra-arterial administration

Injection of medication into an artery. Difficult to perform, but may be necessary where drug is intended to act at a specific site without affecting other tissues. (chemotherapy)

Intravenous administration

Injection of medication into peripheral vein to enter bloodstream. Drug enters circulation rapidly. 100% bioavailable

Tetraplegia

Injury at cervical spinal cord.

Peripherally Inserted Central Catheter (PICC line)

Inserted into peripheral vein and advanced to superior vena cava. Can stay in for weeks and deliver proteins, electrolytes, carbs, vitamins and minerals when pt is unable to use a feeding tube. Used for: -chemo drug admin -Antibiotic therapy -Parenteral Nutrition -Drugs that can't be injected peripherally Pts: -critically ill -Cancer -Require frequent blood draws

Rectal administration

Insertion of suppository into rectum and absorption of drug within rectal cavity. Advantageous for patients that cannot take drugs orally (unconscious, vomiting) Bypasses the liver, but not absorbed as well

Skin Care for Lymphedema

Inspection and cleansed thoroughly each day, with frequent application of moisturizer with low or neutral pH

Heel lift in midstance

Insufficient DF range PF spasticity

Ratio scale

Intervals between values are equal, there is a true zero point ROM (degrees), distance walked (m), time to complete activity(s)

Iontophoresis

Introducing ions into body through the skin using continuous direct current. Positively charged ions are carried into tissue from positive anode, negatively charged ions carried into body from negative cathode. "Active" Electrode carries the ion solution

HALO vest orthosis

Invasive cervical thoracic orthosis that provides full restriction of all cervical motion. Commonly used with spinal injuries to prevent damage during recovery until spine is stable

Urinary Incontinence

Involuntary loss of urine great enough to be problematic for the person, typically when bladder pressure exceeds sphincter resistance. Classified as: Stress Urinary Incontinence Urge Urinary Incontinence Overflow Urinary Incontinence Functional Urinary Incontinence

Tremors

Involuntary, rhythmic, oscillatory movements that are classified into: Resting--Observable at rest, don't disappear w/ rest and increase with stress (pill rolling w/PKsons) Postural--Observable during voluntary contraction to maintain posture. Ex: rapid tremor w/ hypothyroidism, fatigue, or anxiety Intention (kinetic)--Absent at rest, observable with activity and increase as target approaches, indicating lesion of cerebellum. Seen in MS.

Age-appropriate Activities 4 year old

Kicking a rolling ball, catching a small ball, hopping on one foot

LLQ pain

Kidney stone, ureteral stone Intestinal Obstruction Sigmoid Diverticulitis Perforated Colon

Renal Failure

Kidneys experience a decrease in glomerular filtration rate, and fail to adequately filter toxins and waste from blood. Occurs due to DM or HTN, or from poison, trauma, and genetics, damaging nephrons so they cannot filter blood. Can be: Acute Chronic End-stage Sxs: Nausea, vomiting, lethargy, pruritus, GI ulcers, sleep disorder, anemia, PE, seizure, coma

L3-4 Resistive Test

Knee Extension

Insufficient flexion with swing

Knee effusion Quad EXT spasticity PF Spasticity Insufficient flexor ROM

Exaggerated Knee flexion at terminal stance

Knee flexion contracture Hip flexion contracture

Lower Quarter Dermatomal Testing

L2: Anterior Thigh L3: Middle third of anterior thigh L4: Patella and medial malleolus L5: Fibular head and dorsum of foot S1: Lateral and plantar aspect of foot S2: Medial Aspect of posterior thigh S3-S5: Perianal area

Diabetes Insipidus

Large amounts (almost 20 L per day) of urine, excessive thirst. Variety of causes Central: lack of anti-diuretic hormone Nephrogenic: Kidneys don't respond to ADH Dispogenic: Hypothalmic thirst mechanism is damaged from trauma or meds

Dystonia

Larger axial muscle involvement rather than appendicular muscles. Sustained muscle contraction that causes twisting, abnormal postures. Can have sustained agonist/antagonist, repeated contractions of one group, voluntary movements creating involuntary movts, torsion spasms. Common diagnoses: Parkinson's, CP, encephalitis.

Lower Respiratory Tract

Larynx, Trachea, Bronchi, Lungs. Trachia divides at carina into R and L main bronchi.

Lymphedema Stage 0

Latent (pre-clinical) stage No visible edema, but transport capacity of lymph system has been affected

Intervertebral foramina

Lateral openings between adjacent vertebrae for spinal nerves and blood vessels. Increased size with flexion and contralateral side bending, decreased size with extension and ipsilateral sidebending.

Abductor digiti minimi

Lateral plantar nerve S1, S2

Adductor hallucis

Lateral plantar nerve S1, S2

Dorsal interossei

Lateral plantar nerve S1, S2

Plantar interossei

Lateral plantar nerve S1, S2

Quadratus planae

Lateral plantar nerve S1, S2

Flexor digiti minimi brevis

Lateral plantar nerve S2, S3

Scapular Depression

Latissimus Dorsi Pectoralis Major/Minor Lower Trap

Temporal Dysfunction

Learning deficits Wernicke's Aphasia (receptive deficits) Antisocial/aggressive behavior Difficulty with facial recognition, memory loss, inability to categorize

Referred pain from Spleen

Left upper quadrant, Left shoulder MOI: left side impact (usually MVA)

Non-fluent Aphasia

Lesion is typically in frontal lobe of dominant (often left) hemisphere Poor word output, dysprodosic speech (bad rhythm and inflection) Poor articulation, and words are hard to come by. Broca's and Global are examples

Fluent Aphasia

Lesion often in temporal or parietal lobe or Wernicke's area. Speech output is functional, prosody is fine, but speech makes no sense and lacks substance. Use of paraphasias and neologisms (substitutions in a word making it unrecognizable) Wernicke's and Conduction are examples

Upper Motor Neuron Disease

Lesion to cerebral motor cortex, internal capsule, brainstem or spinal cord. Sxs: weakness of involved muscles, hypertonicity, hyperreflexia, mild disuse atrophy, and abnormal reflexes. Damaged tracts are in lateral white column of spinal cord. Examples: -CP -Hydrocephalus -ALS (upper/lower) -CVA -Birth injuries -MS -Huntington's -TBI -Psuedobulbar Palsy -Brain tumors

Antimetabolite Agents (Cancer)

Leustatin (Cladribine), Adrucil (Fluorouracil), Fludara (Fluradabine), Trexall (Methotrexate)

Deltoid ligament

Ligament in ankle formed by: -Anterior tibiotalar ligament, posterior tibiotalar ligament -Tibiocalcaneal ligament -Tibionavicular ligament This ligament resists eversion of the talus

Anterior talofibular ligament

Ligament in ankle that is taut in PF and resists inversion of calcaneus and talus. Also resists anterior translation of talus on tibia.

Calcaneneofibular ligament

Ligament in ankle that resists inversion of talus within midrange of talocrural motion

Posterior talofibular ligament

Ligament in ankle that resists posterior displacement of talus on tibia.

Knee retinaculum (Lateral and medial)

Ligamentous structures that attach to femur, tibia, and menisci. Lateral is stronger than medial, and plays a large role in patellar positioning.

Promoting Aphasics' Communicative Effectiveness (PACE)

Like Charades! Goal is to improve pt convo skills. Pt gets pic prompt and must use diff communication modalities to convey message

ECG Leads

Limb Leads: RA, LA, LL, RL

Posterior Stop

Limits amount of PF, if displays an increase in PF • Used to limit foot slap at heel strike!!

Ligamentum Nuchae

Limits flexion in cervical spine

Posterior Longitudinal Ligament

Limits flexion in spine and reinforces posterior aspect of intervertebral disks

Anterior longitudinal ligament

Limits spinal extension and reinforces anterior portion of intervertebral disks

Evaporation

Liquid absorbs energy and changes into vapor. Ex: Vapocoolant spray

Plasma

Liquid component of blood, contains blood cells and platelets. Accounts for more than half of total blood volume and important in regulating BP and temp

Oxygen Therapy

Liquid or gaseous oxygen for treatment of acute and chronic hypoxemia in pts with PaO2 less than 55 mmHg, or SaO2 less than 88% at rest. Nasal cannula, face mask, partial rebreathing mask, nonrebreathing mask, aerosol face ask, venturi mask, transtracheal catheter

Biceps femoris

Long head: sciatic nerve-- tibial devision S1-S3 Short head: sciatic nerve-- peroneal division L5, S1, S2

Semide

Loop diuretic Furosemide

Posterior Cord Syndrome

Loss of dorsal columns bilaterally, bilateral loss of proprioception, vibration, pressure, stereognosis, 2 point discrimination; preservation of motor function, pain and light touch; very rare!

Stress Urinary Incontinence

Loss of urine due to activities that increase intra-abdominal pressure, such as sneezing, coughing, laughing, running, and jumping.

Functional Urinary Incontinence

Loss of urine due to inability or unwillingness of a person to use the bathroom prior to involuntary bladder release Cause: decreased level of mental awareness or decrease in mobility. Rarely seen without another bladder issue or neuro involvement. Sxs: Impaired cognition or mobility Tx: Modify mobility, clothing, independence with ambulation

Gangrene (Dry)

Loss of vascular supply resulting in local tissue death, usually from DM or atherosclerosis. Fingers, toes, limbs most often affected. May result in auto-amputation. -Infection not present Sxs: Dark brown or black nonviable tissue that eventually becomes hardened mass. Cold or numb skin Tx: Pharmacologic intervention, surgery, hyperbaric oxygen therapy

Beam Nonuniformity Ratio (BNR)

Low BNR = less likely to experience hot spots and discomfort High BNR = need to move transducer more quickly. Between 2:1 to 8:1, but most devices are 5:1 to 6:1

Leukopenia

Low number of WBCs, increasing risk of infection. Less than 4,000 per mL

Thrombocytopenia

Low platelet count increases risk for bruising and abnormal bleeding.

Acute pain E-stim parameters

Low pulse duration (50ish) High Pulse frequency (100-120 pps) Sensory amplitude

Short stretch bandages

Low resting pressure High working pressure Effective when patient is active, used during exercise. Pt must have functional calf muscle and gait patternt o benefit in LE. Not effective on flaccid/inactive limb

Exaggerated Hip Flexion during swing

Lower Extremity flexor synergy Compensation for insufficient ankle dorsiflexion

EMG Fibrillation potentials

Lower motor neuron disease

Teres major

Lower subscap nerve C5, C6

Illiacus

Lumbar nerve and femoral nerve L2-L4

Psoas major and minor

Lumbar nerve and femoral nerve L2-L4

Dynamic insufficiency

Lymph in system exceeds transport capacity, resulting in pitting edema -Most common type of insufficiency

Secondary Lymphedema

Lymphedema caused by disease or injury causing damage to lymph vessels -Trauma, surgery, radiation, tumor growth, chronic venous insufficiency, infection. -Breast cancer surgery and treatment is most common cause in USA (higher risk with axillary lymph node dissection or radiation therapy

Lymphoid cancers

Lymphoma

Lymphedema Stage 3

Lymphostatic Elephantiasis Stage -Extensive, non-pitting edema, significant fibrotic changes to skin, presence of papillomas, deep skinfolds, and hyperkeratosis -Infection is common at this stage -Stemmer's sign remains positive at this stage

Knee Joint Overview Bones, articulations, type of joint

Made up of femur, tibia, and patella, with tibiofemoral and patellofemoral articulations. Hinge joint formed by articulation of tibia and femur

Spinocerebellar Ataxias

Main autosomal dominant ataxias. Many manifestations affecting CNS and PNS, often presenting with neuropathy, pyramidal signs (loss of fine motor, Babinski), ataxia, and RLS

Olecranon bursa

Main bursa of the elbow, located posterior to olecranon process. Most easily injured, and becomes inflamed with direct trauma to elbow due to superficial position

Compression Therapy for Lymphedema

Maintains reduction in edema achieved with MLD, and reduces limb size by improving reabsorptive ability of capillaries and reduces filtration of fluids into interstitium. Can also soften fibrotic tissue, Phase I: Compression bandages, usually short stretch for low resting pressure (not long-stretch, they constrict lymph flow) Phase II: Combo of compression garments in the day and bandages during the night. -Compression garments should only be fitted once edema levels have plateaued. -Bandages/garments should have higher pressure in distal regions (graded compression)

Red blood cells (Erythrocytes)

Make up 40% of blood volume and contain hemoglobin, which gives blood its red color and allows it to bind to oxygen. Normal count: 12-17 gm/dL Low RBCs = Anemia High RBCs = Polycythemia

Congenital Heart Defects

Malformation of interior walls or valves of heart or major arteries/veins near heart that are present at birth, causing blood flow through heart to be slowed, blocked, or misdirected. Atrial Septal Defect Coarctation of the Aorta Patent Ductus Areteriosus Ventricular Septal Defect Tetralogy of Fallot

NCI Stage I

Malignancy limited to tissue of origin with no lymph node involvement or metastasis.

NCI Stage II

Malignancy spreading into adjacent tissues, possible lymph nodes show micrometastases

NCI Stage III

Malignancy spreading to adjacent tissues showing fixation to deep structures. High likelihood of lymph node metastatic involvement

NCI Stage IV

Malignancy that has metastasized beyond the primary site, for example, bone to another organ

Osteogenic Sarcoma

Malignant tumor in epiphyses of long bones. Most common form of bone cancer with peak incidence between ages 10-20

Trendelenburg Gait

Marked lateral lean towards weak LE in midstance to decrease load on ipsilateral hip abductors Causes: -Glute med/min weakness -Same-side hip adductor tightness -Superior gluteal nerve palsy

Q wave

Marker of infarction, signifies loss of positive voltage due to necrosis. Longer than 0.04 or larger than 1/3 amplitude of R wave

TMJ Protrusion

Masseter Lateral Pterygoid Medial Pterygoid

Expiratory Reserve Volume (ERV)

Max volume of air that can be exhaled after normal inhalation. Approx 15% of lung volume

Inspiratory Capacity (IC)

Max volume of air that can be inhaled after normal tidal exhalation. Approximately 60% of lung volume. Tidal Volume (TV) + Inspiratory Reserve Capacity (IRV

Fetal Alcohol Syndrome

Maxillary hypoplasia, elongated midface, short upturned nose, short attention span, poor growth. Deficits in: -fine motor -Visuomotor -Balance -Grasp

Effect size index

Mean of treatment - mean of control group/standard deviation of one group Less than 0.1 = trivial effect 0.1-0.3 = small effect 0.3-0.5 = Moderate effect Greater than 0.5 = Large effect

Coronary Artery Disease

Narrowing or blockage of coronary arteries due to plaque, resulting in diminished blood flow. Damaged inner wall of coronary artery (HTN, trauma, smoking, etc) gains accumulation of fatty plaque at site of injury, and if plaque ruptures, platelets clump at the site to repair the artery, blocking it and causing an MI. Risk factors: High LDL, low HDL, Type 2 DM, smoking, obesity, inactivity, HTN. Sxs: Angina, SOB. Complete blockage causes MI Tx: Aggressive modification of risk factors to slow progression and induce regression of plaques. ACE inhibiters, Aspirin for antiplatelet, statins.

Dexamethasone-iontophoresis

Negative Used for inflammation

Calcium Chloride-iontophoresis

Negative Used for scar tissue, keloids, muscle spasms

Mediate Percussion: Dull

Neoplasm, atelectasis, or consolidation of lung if heard over upper lung

Subclavius

Nerve fibers from C5 and C6

Brachial plexus

Network of nerves formed by C5-T1 nerve roots that combine to form trunks, divide to form divisions, cords, and then peripheral nerves. These nerves innnervate muscles of upper quarter

Alzheimer's Disease

Neurodegenerative disorder that results in deterioration and irreversible damage to cortex and subcortical areas. S/Sx: Changes in higher cortical functions (new learning, memory, concentration), progressing to loss of orientation, depression, rigidity, bradykinesia, and impaired self-care. End-stage is severe intellectual/physical disability, incontinence, dependence, and inability to speak. Tx: Cholinergic agents (Cognex, Donepezil and Rivastigmine) can alleviate some sxs and control behavior with substantial sides.

Epinephrine

Neurotransmitter secreted by the adrenal medulla in response to stress. Also known as adrenaline. Targets cardiovascular and metabolic systems.

Grade 1 Concussion

No LOC, some transient confusion. Symptoms resolve 15 min of event, with full memory of event. Return if symptom free after one week.

Independent

No assistance required

Free Nerve Endings

Nociception. Sensitive to noxious biochemical and mechanical stimuli

Hormones for cancer treatment

Nolvadex (tamoxifen citrate) Lupron (leuprolide acetate) Casodex (bicalutmide)

Arthrogryposis Multiplex Congenita

Non-Progressive neuromuscular disorder that occurs during 1st trimester, causing fibrosis of muscles and joints. Possibly caused by poor movement during early development. Can be genetic. Sxs: Cylinder-like extremities with little definition, contractures, joint dislocation, muscle atrophy Treatment: Attain max level of devt. skills through positioning, stretching, splinting, adaptive equipment

Verbal Apraxia

Non-dysarthric and non-aphasic impairment of speech articulation. Verbal expression impaired secondary to deficits in motor planning. Patient can understand, but unable to initiate speech.

Acquired Ataxias

Nonhereditary, from neurogenerative disorders (alcoholism, hypothyroidism, vitamin E deficiency), or toxin exposure (Carbon Monoxide, heavy metals, lithium).

Conversion

Nonthermal energy like mechanical or electrical is absorbed into tissue and transformed into heat. Ex: Ultrasound

ASIA Impairment Scale Category E

Normal Motor and sensory function are normal.

Infant Head Lag

Normal until infant is in sitting (3 months)

Intracanial Pressure

Normal: 5-15 mmHg Abnormal: Above 20 Avoid cervical flexion, percusion/vibration, coughing, or trendelenburg

Normal Respiration rhythm vs COPD

Normal: Inspiration is half as long as Expiration (1:2) COPD: Longer Expiration phase (1:3, 1:4)

Buckling during IC-Loading with Transtibial Prosthesis

Normal: Knee flexes between 8-10 deg Deviation: Buckles into knee flexion, or avoids by shortening stance time. C/O: Knee buckling, instability, fear of falling Causes: 1. Too hard cushioned heel. Does not allow for PF, stuck in DF, so pt loses shock absorption and compensates with knee flexion to get foot on ground. (DF = Knee Flexion, PF = Knee extension 2. Anteriorly Displaced Socket or Posteriorly Set Prosthetic Foot -Sets knee anterior to foot during IC, causing LOG to be behind knee, causing flexor moment

Wide BOS in midstance (Transtibial Prosthesis)

Normal: Prosthesis in EXT, body weight is supported in single limb stance with level pelvis and neutral trunk Deviation: BOS moves laterally, prosthetic limb moves more laterally, prosthetic hip abducts C/O: Pain at proximal lateral brim of socket, pain at medial distal end of residual limb Causes: 1. Outset foot. Loss of medial support causes wide base to compensate 2. Medially leaning pylon (part that connects foot to socket). Top of pylon is more medial than bottom, causing pt to lose medial support in midstance.

Upper Respiratory Tract

Nose, Pharynx (nasopharynx, oropharynx, laryngopharynx), Larynx Humidify, cool/warm inspired air, filter out foreing matter. Hair in nostrils filters particles, the remaining settles on mucous membranes

Cupolithiasis

Not as common. As long as patient is in provoking position, they will experience symptoms

Bone Scintigraphy (Bone scan)

Nuclear imaging test using ionizing radiation and a radioactive nucleotide to assess for bone disease -Bone tumors -Skeletal Metastasis -Stress Fractures

Labral Tests

O'Brien's (Active Compression Test): 90 deg shoulder flexion, 10-15 deg horiz ADD, empty can position (IR). Therapist applies downward force, then ER (thumb up) and retests. Positive for superior labral tear if patient experiences pain in IR but not ER. -Glenoid Labrum Tear (Clunk) Test: Therapist places one hadn on posterior humeral head, and other hand stabilizes humerus proximal to elbow. Passive aDD and ER over patient's head, then applies anterior force to humerus. Positive = Clunk or grinding sound, may be indicative of Glenoid Labral tear -Jerk Test: 90 deg shoulder flexion, IR with elbow bend. Therapist provides axial compression force through elbow w/ horiz add. Clunk or jerk as humeral head subluxes posteriorly may indicate posterior instability, and pain could indicate posterior labral lesion

Restrictive vs Obstructive lung disease

Obstructive (impaired expiration) : COPD, Asthma, Emphysema, Cystic Fibrosis -TLC, RV up (can't blow out air) -FEV1 down, VC Down -FEV1/FVC below 70% affects FEV1 Restrictive (reduced volumes and limited inspiration) : Musculoskeletal disorders, Tumors, Lung resection, ILD, pneumonia, pulmonary fibrosis, pneumothorax, pulmonary edema, thoracic trauma -TLC and RV down (lungs can't expand) -Normal FEV1

Adductor longus

Obturator nerve L3, L4

Obturator externus

Obturator nerve L3, L4

T wave inversion

Occurs hours or days after MI as a result of delay in repolarization produced by injury

Non-associative Learning

Occurs when an organism is repeatedly exposed to one type of stimulus (haituation, sensitization)

Chemical Burn

Occurs when chemical contacts skin and will continue until compound is diluted at site of contact -Sulfuric acid -Lye -Hydrochloric Acid -Gasoline

CN III

Oculomotor Motor: Levator of eyelid, superior/inferior/medial recti, inferior oblique Test: Visual tracking (up, down, and medial gaze), and reaction to light Common Pathologies: MS and Horner's

CN I

Olfactory Sensory: Smel Test: Familiar odors (chocolate, coffee)

Pulmonary Embolism (PE)

One or more arteries in lung blocked by blood clots from lower extremities. Sxs: Vary greatly depending on size of clot. Sudden onset of SOB, chest pain that becomes worse with deep breathing, coughing, eating or bending; coughing up bloody sputum. Can include LE swelling, irregular heartbeat. Tx: Anticoagulants, thrombolytic agents. Preventing clot formation in deep leg veins reduces risk of PE.

Types of TBI

Open Closed Primary Secondary

Fentanyl (Sublimaze)

Opioid Analgesic for mod to severe pain. Sides: Bradycardia, RR depression, low BP

Thumb Opposition

Opponens Pollicis Opponens Digiti Minimi Flexor Pollicis Brevis Abductor Pollicis Brevis

CN II

Optic Sensory: Vision (central and peripheral vision) Test: Visual fields Common pathologies: Multiple sclerosis, Posterior CVA

Hip-Knee-Ankle-Foot Orthosis (HKAFO)

Orthosis controls rotation and ab/adduction at the hip, and restricts patients to swing-to or swing-through gait pattern.

Amputee Mobility Predictor (AMPPRO)

Outcome measure designed to measure ambulatory potential of lower limb prosthesis users, correlated to K level.

L-Test

Outcome measure of amputee mobility, similar to the TUG, except a 90 deg turn is performed after initial 3 m, total length is 20 m, and 4 turns are involved.

Epidermis

Outer layer of skin

Sublingual administration

Passage of drug through sublingual or buccal mucosa, where it travels from venous circulation directly to heart to enter venous circulation. Faster introduction of drug in cases of acute pain (angina) and bypasses liver so as not to be overly metabolized before reaching target

Conduction Hearing Loss

Passage of sound is blocked in ear canal or middle ear -Ear wax -Otitis media -Otosclerosis -Cholesteatoma Sxs: Soft sounds hard to hear regardless of pitch, loud sounds are muffled

Homan's Sign

Passive dorsiflexion of foot at ankle. Positive for DVT if maneuver produces deep pain in calf or popliteal space.

Rhythmic Rotation (RS)

Passive technique used to decrease hypertonia by slowly rotating extremity around longitudinal axis.

Muscles of Exhalation

Passive unless forceful, then is rectus abdominis (T7-L1), external oblique, internal oblique, and transverse abdominis. These depress lower ribs and compress abdominal contents, pushing diaphragm up

Planar back insert

Patient requires mild to moderate trunk support due to tone, strength, or deformity related postural concerns

Contact Guard

Patient requires therapist to maintain contact with the patient to complete the task. Usually needed if LOB

Supervision

Patient requires therapist to observe through completion of task

Emphysema

Pathologic accumulation of air in the lungs found with chronic obstructive pulmonary disease. Alveolar walls are gradually destroyed due to smoking, can be partially genetic. Alveoli are turned into large pockets with gaping holes. Elastic fibers holding bronchioles open are destroyed, so they collapse during exhalation, so air cannot escape from lungs, causing alveoli to be permanently overinflated. Sxs: Barrel chest, wheezing, coughing, SOB, accessory muscle use, fatigue PFT: Obstructive, so-- Tx: Lung volume reduction surgery, bullectomy, lung transplant. Pulmonary rehab (airway clearance, breathing exercises, endurance/strength training)

Bilateral Vestibular Hypofunction

Pathology affecting both sides of vestibular symptom. Disequilibrium, gait ataxia. Vertigo and Nystagmus NOT expected, so habituation NOT indicated Gaze stability training indicated Postural stability training indicated

Hemiplegic gait pattern

Patient abducts paralyzed limb, swings it around, then brings it forward so the foot comes to the ground in front.

Hemi Frame Wheelchair

Patient able to self propel using LE

Partial Weight Bearing (PWB)

Patient allowed to put some weight through involved extremity, expressed as a % of total weight. AD required

Full Weight bearing

Patient can place full weight on involved extremity. Assistive device is not required, but may be used to assist with balance.

One hand drive Frame wheelchair

Patient can self propel with one UE

K-Level 1

Patient can transfer, ambulate on level surface with fixed cadence, and is a limited/unlimited household ambulator Knee: Single axis, constant friction Ankle/Foot: SACH, single axis

Weight bearing as tolerated (WBAT)

Patient determines amount of WB based on comfort, AD may not be required.

Four point gait pattern

Patient does not move LE simultaneously with device. AD advances first, then opposite LE. May be used with coordination, balance, or strength deficits.

K Level 4

Patient exceeds basic ambulation skills, exhibits high impact, stress, or energy levels. Child, athlete, or active adult. Can use any system for knee or foot/ankle.

Craig's Test

Patient in prone with knee flexed to 90, therapist palpates greater trochantera nd internally and externally rotates hip until GT is parallel with table. Degree of femoral anteversion corresponds to angle formed by lower leg with perpendicular axis of table. Normal anteversion for adults: 8-15 degrees

Murphy Sign

Patient makes fist. If third and fourth CMP are level with first and second, may be indicative of dislocated lunate

Power wheelchair

Patient not able to self propel but can safely operate a power mobility devices. May have transfer, sitting, or UE functional limitations

Pusher Syndrome

Patient pushes with stronger extremities towards weaker hemiparetic side. Most often caused by posterolateral thalamus damage Use visual cues, vertical makings, cane in uninvolved side Guard involved side Have pt assess self (what direction are you tilted?)

FABER test

Patient supine, cross one ankle above other knee. Stabilize opposite hip, while pressing crossed knee down + pain at the hip: inflammation or trauma of the hip joint May be indicative of SI or hip joint abnormalities

Backward tilt-in-space frame

Patient unable to sit upright or perform weight shifts, also has issues with sliding or extensor tone

Claudication Test

Patient walks on flat track at max speed or tread mill at 2.0 mph at constant grade between 0-12% Initial Claudication Distance: Pain-free walking distance Absolute Claudication Distance: Max distance walked when test is terminated due to pain. Location of symptoms corresponds to the site of most proximal stenosis (tibial/peroneal arteries, femoral/popliteal arteries, aortic/iliac arteries) Grade 1: Initial or modest disfomfort of pain Grade 2: Moderate discomfort or pain, patient can be distracted Grade 3: Intense pain, patients attention cannot be diverted Grade 4: Excruciating, unbrearable pain

PICO Question

Patient, Intervention, Comparison, Outcome

Tenodesis Grasp

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

Astrocytoma

Pediatric brain tumor, usually either cerebellar (clumsiness, ataxic gait, change in personality, vomiting) or Supratentorial (headache, seizures, change in personality, visual impairments, vomiting) Accounts for 50% of pediatric brain tumors

Desquamation

Peeling or shedding of outer layers of epidermis Usually occurs in small scales

Pediatric Therapeutic Positioning: Sitting

Pelvis/Hips: Pelvis in line with trunk, hips at 90 deg flexion, neutral rotation of pelvis, hips abd 10-20 deg Trunk: Straight, shoulders over hips, not rotated Head/Neck: Head neutral, facing forward Shoulders/Arms: Arms supported, elbows in FLEX, 0-45 deg IR Legs/Feet: Knees at 90, Ankles at 90, feet and thighs supported

Pediatric Therapeutic Positioning: Prone

Pelvis/Hips: Pelvis in line with trunk, hips in EXT, hips symmetrically abducted 10-20 deg Trunk: Straight, shoulders in line with hips Head: Neck: Head in neutral position, facing one side w/ slight cervical flexion Shoulders/Arms: Arms fully supported, forward of trunk flexed Legs/Feet: Knees extended, feet at 90

Pediatric Therapeutic Positioning: Sidelying

Pelvis/Hips: Pelvis in line with trunk, hips in FLEX, 10-20 deg ABD Trunk: Straight, shoulders in line with hips, slight sidebending Head/Neck: Head in neutral position, facing forward, slight cervical flexion Shoulders/Arms: Both arms supported, lower arm forward, not lying on point, in neutral. Upper arm 0-40 deg IR Legs/Feet: Knees in Flexion, Feet at 90, pillow between knees

Pediatric Therapeutic Positioning: Supine

Pelvis/Hips: Pelvis in line with trunk, hips symmetrically abducted 10-20 deg Trunk: Straight, Shoulders in line with hips Head/Neck: Neutral, slight cervical flexion Shoulders/Arms: Fully supported, forward of trunk, forearms resting on pillow Legs/Feet: Knees supported in flexion, feet at 90

-cilin

Penicillin antibiotic Amoxicillin, ampicillin

Antidiarrheals

Pepto Bismol (bismuth subsalicylate) Motofen (difenoxin) Imodium (loperamide) Donnagel (attapulgite) Kapectolin (Kaolin)

Barognosis

Perceive the weight of different objects in the hand

Bioavailability

Percentage of drug that makes it into systemic circulation from site of original administration.

Specificity

Percentage of people who test negative for a specific disease among a group of people who do not have the disease. If someone tests positive to a specific test, you can rule them in. SpIN

Sensitivity

Percentage of people who test positive for a disease among a group of people who have the disease If someone tests negative to a sensitive test, you can rule them out. SnOUT

Mediate Percussion: Resonance

Percussion sound from normal lung

Achilles Tendon Repair

Performed arthroscopically if done within days, and tendon is sutured together. If done after a delay, surgery may need to be open and may require augmentation with a graft (flexor hallucis longus, peroneus brevis, plantaris) instead of suturing. Research shows that ankle casted in neutral and PWB leads to less restricted ROM over long term, which is more aggressive than traditional NWB for several weeks.

C fibers

Peripheral Nerve Fibers Small diameter, unmyelinated, slow conduction rate. Postganglionic fibers.

Carpal Tunnel Syndrome

Peripheral nerve entrapment due to compression of median nerve passing through carpal tunnel, increasing pressure in carpal tunnel from normal 2-10 mmHg to 30 mmHg, causing sensory and motor disturbances in median nerve distribution Etiology: Repetitive use, RA, Pregnancy, diabetes, trauma, Tumors, hypothyroidism Sxs: Sensory changes and paresthesia in median nerve distribution. Radiation into UE, shoulder, neck. Night pain, hand weakness, muscle atrophy, decreased grip strength, clumsiness, decreased wrist mobility. Tx: splinting, ergonomics, corticosteroid injections, surgical release.

B Fibers

Peripheral nerve fiber Medium diameter, myelinated, reasonably fast Preganglionic fibers of autonomic nervous system

A fibers

Peripheral nerve fibers. Large size, myelinated with high conduction rates. Sensory components: -Primary muscle spindle endings (low threshold stretch) -Secondary muscle spindle endings (change in length facilitates muscle contraction) -GTOs: (interrupt muscle contractions on stretch of tendon) Alpha: alpha motor neurons, muscle spindle primary endings, GTOs, touch Beta: Touch, kinesthesia, muscle spindle secondary endings Gamma: Touch, pressure, gamma motor neurons Delta: Pain, Touch, pressure, temp

Ape Hand

Peripheral nerve injury to median nerve, resulting in weakness with thumb flexion/opposition, and thumb may fall in line with other digits since thumb extensors overpower. Thenar atrophy.

Autograft

Permanent skin graft taken from donor site on patient's own body

Muscles innervated by Superficial Peroneal Nerve

Peroneus Longus Peroneus Brevis

Complete Decongestive Therapy (CDT)

Phase I: Intensive acute treatment phase, outpatient setting by certified lymphedema therapist or 4-6 weeks Phase II: Self-management phase, long-term management of symptoms utilizing various components of CDT. May return to phase 1 if significant change in symptoms is noted Four parts of Treatment: -Manual Lymphatic Drainage -Compression Therapy -Exercise -Skin Care

Spinal shock

Physiologic response that occurs between 30-60 min after trauma and can last up to several weeks, presenting as total flaccid paralysis and loss of all reflexes below level of injury

Sacral Plexus (FL)

Piriformis Obturator internus Gemelli sup.&inf Quad. femoris Levator ani

Obliquus capitis inferior

Posterior rami of C1

Rectus capitis posterior major

Posterior rami of C1

Rectus capitis posterior minor

Posterior rami of C1

Obliquus capitis superior

Posterior rami of Cq

Ultrasound intensity

Power (Watts)/ERA (Cm2) Watts/Cm2 Ranges from 0.5-2.0 W/Cm2 Acute conditions: Decreased intensity (0.5-1.25 W/cm2) Subacute: 0.75-1.5 W/cm2 Chronic: 1.5-2.0 W/Cm2

Bursae of Knee

Prepatellar: lies over patella and allows for greater movt of skin covering anterior patella Superficial Infrapatellar: Lies between patellar tendon and skin Deep Infrapatellar: lies between patellar tendon and tibia

Variable practice

Practice of a given task under differing conditions

Constant Practice

Practice of a given task under uniform condition

Whole training

Practice of an entire task

Part training

Practice of an individual component or select components

Drug Development Stages

Preclinical Testing: Cellular, organ, animal testing Phase 1: Safety. First stage of human testing, small number of patients. Toxicity and safe dosing range established Phase 2: Effectiveness. Small number of patients, determines effective dosing level and adverse effects Phase 3: Same as Phase 3, but larger sample size Phase 4: Real life scenarios (post-marketing surveillance)

Atrial dysrhythmias include:

Premature Atrial Contractions Atrial Flutter Atrial Fibrillation

chorionic villus sampling (CVS)

Prenatal diagnostic technique that involves taking a sample of tissue from the chorion (outermost membrane of embryo)

Female Hypogonadism

Primary: Gonads do not produce the amount of sex steroid sufficient to supress secretion of LH and FSH at normal levels. Most common cause is Turner's (X). Secondary: Failure of hypothalamus or pit to produce the hormones which will subsequently stimulate estrogen production. If this happens before puberty symptoms will include gonadal dysgenesis, short stature, failure to progress through puberty or primary amenorrhea and premature gonadal failure. The main post-puberty symptom is secondary amenorrhea.

Bronchiectasis

Progressive lung disease that produces abnormal dilation of bronchus due to infection, aspiration, cystic fibrosis, or immune system impairment. Sxs: Consistent productive cough, hemoptysis, weight loss, anemia, crackles, wheezes, loud breath sounds Tx: Antibiotics, bronchodilators, expectorants, mucolytics

Class III Antiarrhythmic Agents

Prolong repolarization by inhibiting both potassium and sodium channels, considered to be the most effective antiarrhythmic Amiodarone (Cordarone)

Diabetic Neuropathy

Prolonged exposure to high blood glucose results in nerve ischemia, impairing nerve function. Sxs: Weakness/sensory deficits dystally in symmetrical pattern, with c/o tingling, numbness and pain typically in feet. Can include wasting of muscles in feet/hands, stocking glove sensory distribution impairments, and orthostatic hypotension.

Antispasticity agents

Promote relaxation in spastic muscles by selectively binding in CNS or skeletal muscle to reduce spasticity. -Baclofen -Valium/Diazepam -Dantrolene -Zanaflex/Tizanidine

Radioulnar Pronation

Pronator Teres Pronator Quadratus

Joint Distraction

Proprioceptive component to increase ROM around a joint.

Genitourinary Differential

Prostatitis: Inflammation of prostate in men over 40, typically from bacterial infection. -Perineal pain, burning during urination and fever BPH: Increase in size of prostate gland in men over 50 -dribbling at end of urine, weak stream, incomplete emptying -Non-systemic so fever/chills/malaise uncommon Prostate Cancer: Presents similar to BPH, but with sudden moderate to high fever, sciatica, and changes in bowel/bladder function.

K-Level 0

Prosthesis does not enhance quality of life or mobility, patient is ineligible for knee or foot/ankle prosthesis.

Forward Trunk Flexion (Prosthetic/Amputee Causes)

Prosthetic Causes: -Socket too big -Poor suspension -Knee instability Amputee Causes: -Hip Flexion contracture -Weak hip extensors -Pain with ischial weight bearing -Inability to initiate prosthetic knee flexion

Vaulting (Prosthetic/Amputee causes)

Prosthetic Causes: -Too long prosthesis -Inadequate socket suspension -Excessive alignment stability -Excessive plantarflexion Amputee Causes: -Residual limb discomfort -Improper training -Fear of stubbing toe -Short residual limb -Painful hip/residual limb

Lateral Bending in prosthetic/amputee

Prosthetic causes: -Prosthesis too short -Improperly shaped lateral wall -High medial wall -Prosthesis aligned in abduction Amputee causes: -Poor balance -Abduction contracture -Improper training -Weak hip abductors on prosthetic side -Hypersensitive and painful residual limb

Valve replacement

Prosthetic valve replaces narrowed or leaky valve. May be mechanical (ball in cage, tilting disc, bileaflet) or tissue grafts from the same patient, a cadaver, or a pig

Medial or lateral whip (prosthetic/amputee causes)

Prosthetic: -Excessive rotation of knee -Tight socket fit -Valgus in prosthetic knee -Improper alignment of toe break Amputee Causes -Improper Trainig -Weak hip rotators -Knee instability

Rotation of forefoot at heel strike (prosthetic/amputee causes)

Prosthetic: -Excessive toe-out built in -Loose fitting socket -Inadequate suspension -Rigid SACH heel cushion Amputee causes: -Poor muscle control -Improper training -Weak medial rotators -Short residual limb

Circumducted gait (prosthetic/amputee causes)

Prosthetic: -Prosthesis too long -Excessive knee friction -Socket too small -Excessive PF Amputee: -Abduction contracture -Improper training -Weak hip flexors -Lacks confidence to flex the knee -Painful anterior distal residual limb -Inability to initiate prosthetic knee flexion

Excessive Knee Flexion during stance (amputee/prosthetic causes)

Prosthetic: -Socket set forward in relation to foot -Excessive dorsiflexion -Stiff heel -Prosthesis too long Amputee Causes: -Knee flexion contracture -Hip flexion contracture -Pain anteriorly in residual limb -Decrease in quad strength -Poor balance

Abducted Gait with prosthetic/amputee

Prosthetic: -Too long prosthesis -High medial wall -Poorly shaped lateral wall -Prosthesis positioned in abduction -Inadequate suspension -Excessive knee friction Amputee: -Abduction Contracture -Improper training -Adductor roll -Weak hip flexors and adductors -Pain over residual limb

White blood cells (Leukocytes)

Protect against infection. Normal count: 4,000-11,000 per microliter of blood

Parallel Bars

Provide max stability and security or patient during beginning stages of ambulation or standing. Bar height allows 20-25 deg of elbow flex with hands 4-6inches in front of body Pt must progress out of parallel bars ASAP

Faded feedback

Provided after every trial, then less frequently. Every trial-->every 3rd-->every 5th etc Used in early stages of motor learning to transition from acquisition to retention

Bandwidth Feedback

Provided only when patient's performance deviates outside boundaries of what is considered "correct", pre-determined at start of task. Prevents bad habit formation and keeps patient from safety risks.

Sacrum

Provides an attachment for iliac bones and protects pelvic organs. Attached to pelvis by sacroiliac ligaments

Ligamentum Teres

Provides physical attachment between head of femur and inferior rim of the acetabulum -Provides limited stability but blood vessels and nerves that supply femoral head run through this sheath

Muscle innervated by Lumbar Plexus

Psoas major, minor Quadratus Lumborum

Standard/Lightweight wheelchair frame

Pt able to self propel with both UEs, adequate LE ROM

Amputee Wheelchair frame

Pt able to self propel, COG shifted posteriorly due to amputation

Sling back insert

Pt requires no postural support, no neuro deficits. Not intended for longterm use

Reclining Frame

Pt unable to perform weight shifting tasks, unable to sit upright for extended periods

Title III of ADA

Public Accommodations and Services operated by public entities. - Places of accommodation (hospitals, hc providers' offices, schools, etc.) may not discrim. against persons w/disabil.

Title II of the ADA

Public Services. - No discrim. persons w/disabil. to participate in or benefit from svcs, programs, activ. of public entities: transporation, public edu., employment, recreation, social svcs, hc, courts, voting, etc.

Russian Stim (Chronic Pain)

Pulse Duration: 10 ms (long) Pulse Frequency: 1-10 pps (Low) Amplitude: Max sensory

Biphasic Current (Edema Control)

Pulse Duration: 50 usec acute, 200 Subacute, 250 chronic Pulse Frequency: 100 pps acute, 1-10 subacute, 50 pps chronic Amplitude: Sensory for acute, motoric sub-acute, and motoric 1/1 with 1.5 sec ramp for chronic

Biphasic Current (Muscle Re-ed)

Pulse Duration: Long, greater than 250 usec *Longer pulse duration needed to depolarize motor nerves* Pulse Frequency: Mod High, 50 pps Amplitude: Motoric, 1/3 ratio with 1.5 sec Ramp

Biphasic Current (Chronic Pain)

Pulse Duration: Long, greater than 250 usec Pulse Frequency: Low, 1-10 pps Amplitude: Max sensory

Biphasic Current (acute pain)

Pulse duration: Short, 50 usec Pulse Frequency: High, 100 pps Amplitude: Sensory

20% Ultrasound Duty Cycle

Pulsed Non-thermal ultrasound -Improving fluid dynamics and resolving swelling Acute conditions

50% Ultrasound Duty Cycle

Pulsed, non-thermal ultrasound -Tissue healing -Improving fluid dynamics -Pain modulation Acute to subacute conditions

Ventricular Assist Device (VAD)

Pump implanted in chest to provide mechanical support to the ventricle. RVAD attaches to R atrium and pulmonary artery, bypassing R ventricle. LVAD attaches to L atrium, bypassing L ventricle. BiVAD bypasses both ventricles. Commonly used as a temp treatment for those waiting for heart transplant or permanent treatment for heart failure.

Fat pads of knee

Quadriceps, prefemoral, and intrapatellar. Infrapatellar is most commonly affected, can be source of anterior knee pain when impinged (Hoffa's syndrome)

RA vs OA

RA is usually bilateral, systemic complaints, exacerbations and remissions, painful warm joints (esp fingers and wrist - "sausage joints"). Swan's neck deformity (flexion of the DIP with hyperextension of the PIP joint). OA: Morning stiffness, asymmetrical, degenerative wear and tear, increased pain w/WB, crepitus/clicking

Erythema

Redness of skin from capillary dilation or inflammation

Restrictive Ventilatory Impairment

Reduced Lung Volumes (TLC, FEV1, FVC) and normal expiratory flow rates. Tumor, interstitial lung disease, pleural disease, chest wall deformities, obesity, pregnancy, neuromuscular disease Spirometry: Reduced FVC, normal FEV1/FVC

Pursed Lip Breathing

Reduces respiratory rate, reduces dyspnea, and maintains positive pressure on bronchioles to prevent airway collapse in patients with emphysema. "Inhale through your mouth and exhale through tightly pressed lips" Who: Obstructive Lung condition (FEV1/FVC less than 70%) who has dyspnea at rest or with exertion/wheezing Why: to relieve dyspnea, improve activity tolerance, and reduce wheezing.

Hypothalamus

Regulates homeostasis using hormones, controlling hunger, thirst, sexual behavior, sleeping, body temp. Lesions produce impairments based on area of damage (obesity, sexual disinterest, poor temp control, diabetes insipidus)

Dopamine Replacement Agents

Relieve symptoms of PD secondary to decrease of endogenous dopamine. Can cross blood brain barrier to transform into dopamine in the brain. Sides: Arrhythmias, GI distress, dyskinesias, orthostatic hypotension, tolerance Max benefit from scheduling therapy 1 hour after admin of levodopa. -Sinemet/Madopar/Levodopa -Symmetrel/Amantadine

Muscle Relaxant Agents

Relieve tonic/continuous spasm occurring secondary to MSK or PN injury rather than CNS injury. Sides: Sedation, drowsiness, nausea, dependence -Valium/Diazepam -Flexeril/Cyclobenzaprine -Paraflex/Chlorzoxazone

Non-selective (Mechanical) Debridement

Removal of both viable and non-viable tissues from a wound. -Wet-to-dry -Wound Irrigation -Hydrotherapy (whirlpool)

Thoracentesis

Removal of fluid from pleural space with a needle

Wound Irrigation

Removal of necrotic tissue using pressurized fluid. Ideal for infected wounds or wounds with loose debris. -Pulsed lavage uses pressurized stream of irrigation solution

Selective Debridement

Removal of only nonviable tissue from a wound -Sharp -Enzymatic -Autolytic

Total Knee Arthroplasty (TKA) -Compartments -Degree of Constraint -Fixation methods

Removal of proximal and distal knee surfaces and replacing them with an implant. Lifespan of 15-20 years. Compartments: -Unicompartmental (only medial or lateral joint surface replaced) -Bicompartmental (entire surface of femur and tibia were replaced) -Tricompartmental (replacement of femur and tibia along with patella) Can also be classified by degree of constraint: -Unconstrained: No inherent stability, relies on soft tissue for stability (unicompartmental) -Semiconstrained: Some degree of stability without compromising mobility, most common TKA. -Fully Constrained: Most stability, restricts one or more planes of motion, causing greater implant stress and higher likelihood of implant failure. Fixation methods: Cemented, uncemented, and hybrid

Colonization

Replicating bacteria on wound surface that does not invade or injure tissue, does not stimulate inflammatory immune response. May delay wound dealing, may benefit wound healing by preventing worse organisms from proliferating in wound bed

Human Immunodeficiency Virus

Retrovirus that invades and destroys immune system cells (CD4+ T lymphocytes). Transmitted through blood, semen, vaginal secretions, and breast milk (sexual, perinatal, bodily fluid contact). Stage 1: Acute HIV infection -2-4 weeks post transmission, asymptomatic to flu like symptoms. Pt at highest risk of transmission Stage 2: Clinical Latency -10 years of asymptomatic living until progressing to AIDS, several decades for those on Antiviral RetroTherapy or ART Stage 3: AIDS -3 year survival rate, less if contracting an opportunistic ilness. Can lead to malignancies, infections, neuro dysfunction, cognitive decline, and cardiopulmonary pathologies

Scapular Downward Rotation

Rhomboids Levator Scap Pec Minor

Heart Chambers and Valves

Right Atrium and Left Atrium separated by atrial septum Right Ventricle and Left Ventricle separated by ventricular septum Tricuspid Valve (Tri to be Right) separates R atrium and Ventricle Bicuspid Valve (Bi people are usually Left) separates L Atrium from L ventricle

Pulmonary Embolism: Response

SOB, cough, chest pain worsening with deep breathing, lightheadedness, rapid/irregular heart rate, fever, diaphoresis, clammy skin, leg pain/swelling Call EMS

Gemellus superior

Sacral nerve L5, S1, S2

Incomplete spinal cord lesion

Scattered motor function, sensory function, or both below level of lesion.

Peritoneal Irritation

Set of abdominal examination findings that indicate inflammation of the visceral or parietal peritoneum Low back pain with rebound tenderness during palpation of abdomen

Shin Pain Differential Diagnosis

Shin Splints: Repetitive overuse causing dull pain that is non-focal, extending over 5 cm. Present at start of workout, improves during ex, then returns Stress Fracture: Repetitive overuse causing deep pain that is focal with point tenderness less than 5 cm in length, and present at rest (and with activity). Use vibration and percussion (tuning fork) to provoke symptoms. Compartment Syndrome: Severe trauma to anterior compartment, causing severe pain with fullness, numbness, burning, or tingling. Worse with stretching, present during rest and activity. May not have dorsal pedal pulse

Common Peroneal Nerve (EX)

Short head of Biceps femurs Tib.ant., Ext.dig.long., Ext.hal.long Ext.dig.brev., Ext.hal.brev. Peroneus l. & b.

Lumbar Manipulation CPR

Should be considered if 4/5 are present 1. Pain less than 16 days 2. No symptoms below nkee 3. FABQ less than 19 4. IR of more than 35 deg for one hip 5. Hypomobility of at least one level of L-Spine

ULTT3

Shoulder = Depression and Abduction to 10° Elbow = extension Forearm = pronation Wrist = flexion and ulnar deviation Finger & Thumb = flexion Shoulder = medial rotation Cervical spine = Contralateral side flexion Nerve Bias: Radial nerve

ULTT2

Shoulder = Depression and Abduction to 10° Elbow = extension Forearm = supination Wrist = extension Finger & Thumb = extension Shoulder = lateral rotation Cervical spine = Contralateral side flexion Nerve bias: Median nerve, Musculocutaneous nerve, Axillary Nerve

ULTT4

Shoulder = Depression and Abduction to 10° - 90° Elbow = flexion Forearm = supination Wrist = extension and radial deviation Finger & Thumb = extension Shoulder = lateral rotation Cervical Spine = Contralateral side flexion Nerve Bias: Ulnar Nerve

ULTT1

Shoulder = Depression and Abduction to 110° Elbow = extension Forearm = supination Wrist = extension Finger & Thumb = extension Cervical spine = Contralateral side flexion Nerve bias: Median nerve, Anterior Interosseus Nerve

C2-4 Resistive Test

Shoulder Elevation

ST segment Depression

Sign of myocardial ischemia, can be due to digitalis toxicity or hypokalemia. -2mm ST depression is significant. Stop exercise and monitor vitals. (True for exercise, not for exercise TEST) -Use clinical judgement (signs, symptoms, vitals)

Walker

Significant base of support, offers good stability. Should allow for 20-25 deg of elbow flexion. Three-point gait pattern

Avulsion (degloving)

Skin becomes detached from underlying structures

Full thickness graft

Skin graft containing dermis and epidermis

Maceration

Skin softening and degeneration from prolonged exposure to water or other fluids

Heterograft

Skin transplant taken from another species (usually pig)

Slow Reversal (SR)

Slow and resisted concentric contractions of agonist and antagonists around a joint w/out rest between reversals. Used to improve control of movement and posture.

Disease Modifying Antirheumatic Drugs (DMARDs)

Slow/stop rheumatic disease progression, used mostly in early stages. High incidence of drug toxicity. Sides: nausea, headache, toxicity, sepsis, retinal damage Examples: Methotrexate, leflunomide, chloroquine, TNF inhibitors, Enabrel, Humira

Obturator Nerve Tension Test

Slump with Hip ABD +FLEX, knee ext and ankle DF

Minimal Clinically Important Difference (MCID)

Smallest difference in a patient's condition that the patient or clinician considers worthwhile and would warrant a change in patient's management.

Cubital Tunnel

Space formed by UCL, FCU, medial head of triceps, and medial epicondyle. Space becomes smallest with elbow in full flexion Contains: Ulnar nerve

Geri Chair

Special chair that assists in positioning a resident to increase body alignment and comfort

Peripheral Artery Disease

Stenotic, occlusive, and aneurysmal diseases of aorta and peripheral arteries caused by atherosclerosis and thromboembolicprocesses Sxs: Fatigue, aching, numbness, pain in LE at rest or when walking, poorly healing wounds of legs or feet, distal hair loss, trophic skin changes, hypertrophic nails Tx: Lifestyle changes, lipid lowering meds, control of diabetes and HTN. Disabling intermittent claudication, revascularization procedures (angioplasty, stent, atherectomy), and surgery (aortobifemoral bypass, iliofemoral bypass)

Mechanical Insufflation-Exsufflation Device (CoughAssist)

Stimulates natural cough by delivering large positive pressure followed by a sucking negative pressure that pulls air out of the lungs. Who: Severely involved pt with impaired ab function that can't produce effective cough to clear secretions (ALS, MS, PD, MD, GB, SCI). Can be used with Trach.

Empty End Feel

Stoppage of range of motion due to trauma to an effected muscle or joint.. -Joint inflammation, fracture, bursitis

Gallbladder

Stores and releases bile into duodenum to assist digestion

Ventricular Asystole

Straight line pattern, no rhythm. Requires immediate CPR. MI, ventricular rupture, cocaine use, lightning, electrical shock.

Ruffini Ending

Stretching of skin, joint capsule, velocity of joint position

Pharmacokinetics

Study of how drugs are absorbed, distributed, and metabolized and eliminated by the body. Four major parameters: 1. Absorption 2. Distribution 3. Metabolism 4. Excretion *Note, in geriatric population, drugs are not excreted as quickly due to low GFR, so meds act on body for longer

GH Internal (Medial) rotation

Subscap Teres Major Pec Major Lat Anterior Delt

Subscapular Nerve (EX)

Subscapularis Latissimus Dorsi & Teres Major

Neologism

Substitution in a word so severe it makes the word unrecognizable.

Middle Cerebral Artery

Supplies most of outer cerebrum, basal ganglia Most common site of CVA Occlusion results in: -Contralateral hemiplegia -Global, Wernicke's, or Broca's Aphasia -Homonymous Hemianopsia -Apraxia -Contralateral weakness and sensory loss of face/lower extremity

Referred Pain from Urinary Tract

Suprapubic region or diffuse LBP (bladder/urethra) LBP, pelvis, sacrum, perineum, inner thighs, testes (prostate) MOI: Bacterial infection, renal calculi

Infraspinatus

Suprascapular nerve C5, C6

Empty Can Test

Supraspinatus Tear (1 or 2) Passive abduction to 90, then resistance (full can) Internal rotaiton and abduction to 90 (empty can)

Oncology treatment options

Surgery (resection) Radiation (ionizing or particle) Chemotherapy Biotherapy (immunotherapy to strengthen host's biological response to malignant cells, using bone marrow or stem cell transplant Antiangiogenic therapy (thalidomide, treats multiple myeloma)

Types of Fibrous joints

Synarthrosis Non-synovial, limited movement Sutures: union of two bones by ligament or membrane (sagittal suture of skull) Syndesmoses: Bone connected to bone by dense fibrous membrane (tibia-fibular interosseous membrane) Gomphosis: peg in a hole. Teeth and sockets in mandible

Anterior Cruciate Ligament Reconstruction

Surgical Considerations: Arthroscopic surgery, preferred autograft over allograft. Bone-patellar tendon-bone graft is gold standard, due to bone-to-bone healing. Gracilis or semitendinosus grafts are common but fixation is not as strong. Rehab Considerations: Period of immobilization in hinged brace. ROM emphasis on full EXT early. Exercise focus on iso quads/hamstrings and closed chain early. Patellar Tendon graft patients should be cautions with quad strengthening early, opposite for gracilis/semi grafts. Graft tissue most vulnerable 6-8 wks pos surgery, failure happening secondary to poor compliance. 100% graft maturation 12-16 months post.

Rotator Cuff Repair

Surgical Considerations: Graded according to depth (partial vs full) and according to width (small = 1 cm or less, medium 1-3, large 3-5, massive greater than 5 cm). Small requires only debridement, all others require repair (sutures, anchors, staples). Generally arthroscopic, possibly open or mini open if large. Rehab Considerations: Sling at discretion of surgeon. Precautions are no AROM, lifting, or WB through arm for some weeks.

Spinal Fusion

Surgical Considerations: Indicated with unstable spinal segments, advanced arthritis, or uncontrolled peripheral pain. Pedicle screws immobilize segments while bony callus forms between segments. Lumbar fusion uses posterior approach, cervical uses anterior approach typically. Rehab Considerations: Lifting restrictions, restrictions on active motion (bending/twisting). Bracing (cervical collar, TLSO) may be used to help compliance. Rehab usually begins 6 weeks post op, with instrumentation it can be less.

Laminectomy

Surgical Considerations: Performed for disc protrusion or spinal stenosis. Complete: removal of entire lamina, spinous process, and Rehab Considerations: Weight restrictions, restrictions on active motion (often extension)

Lateral Ankle Reconstruction

Surgical Considerations: Performed secondary to complete tear of ATF or CCF, or secondary to chronic ankle instability. Two methods both using an open approach that may include arthroscopy or subchondral drilling: 1. Repair of torn ligaments, suturing them back together 2. Harvesting an autograft (usually peroneus brevis) to replace torn ligaments. This option is chosen when original ligaments have deteriorated and cannot be repaired.

Subacromial Decompression

Surgical Considerations: Performed when impingement does not respond to conservative treatment. Can be open (deltoid detached), mini open (split deltoid) or arthroscopic. Could also involve acromioplasty, bursectomy, or removal of degenerative distal clavicle. Rehab Considerations: Rapid recovery--sling used for 1-2 wks and early rehab for pain and ROM. Passive EXT limited in deltoid repairs to limit stress.

Hip ORIF (Open Reduction - Internal Fixation)

Surgical Considerations: Surgical repair to proximal hip fractures in femoral neck and intertrochanteric region. Nonunion and osteonecrosis are common with fem neck fractures (intracapsular, can lead to loss of blood supply). Intertrochanteric are extracapsular. Fixation occurs with plates and screws, or an intramedullary nail. If patient has poor healing capacity, THA is considered. Always open procedure. Capsulotomy is performed if fem neck is involved. Rehab Considerations: Early weight bearing, ambulation, ROM. Fixation failure--persistent thigh or groin pain, LL discrep not present initially, non-improving Trendelenburg, or ER positioning.

Capsular Shift Procedure (Shoulder Stabilization)

Surgical considerations: Performed for chronic shoulder instability. Joint capsule tightened by cutting capsule and overlapping ends to reduce capsular redundancy. Portion of capsule tightened depends on direction of instability (anterior is most common so anterior capsule is most often tightened). Labral repairs may be performed since labral injuries often accompany dislocations. Bankart (anterior labrum) or SLAP (superior labrum). Usually arthroscopic Rehab Considerations: Anterior capsule repair gets normal sling, should avoid ER, EXT and HOR ABD, and IR if subscap is detached. Posterior capsule repair gets neutral rotation sling (handshake), avoiding IR, FLEX, and HOR ADD. AROM asap after surgery, don't wait for full motion for strength. Avoid contracting biceps with SLAP.

Total Shoulder Arthroplasty (TSA)

Surgical considerations: Performed when joint components are arthritic, or secondary to fracture or rotator cuff arthropathy. Glenoid and humeral head areboth replaced in TSA, while a shoulder hemiarthoplasty replaces only one. Reverse Total Shoulder reverses concave/convex relationship, used for dysfunctional RTC. All use an anterior approach where subscap is detached for easy access. Rehab Considerations: Immobilization for several weeks, longer if repair performed on tendon. Movement precautions for 6-8 weeks.

Tracheostomy

Surgical hole through neck into trachea below level of vocal cords. Indications: Airway obstruction at or above level of larynx, or respiratory failure requiring prolonged mechanical vent.

Thoracotamy

Surgical incision cutting chest wall to access heart, lungs, esophagus, and diapragm. May be: Axillary thoracotomy Median Sternotomy Posterolateral Thoracotomy Anterolateral Thoracotomy

Lobectomy

Surgical removal of a lobe of a lung

Rhizotomy

Surgical resection of sensory component of spinal nerve to decrease spasticity and improve function

Automatic Implantable Cardioverter-Defibrillator (AICD)

Surgically implanted device similar to pacemaker that monitors HR and delivers shocks to restore normal HR when necessary

Cardiac Pacemaker

Surgically implanted, battery powered device placed under the skin in L anterior chest wall to treat slow HR and arrhythmias. By preventing slow HR, pacemakers can treat fatigue, lightheadedness, and fainting.

Annular ligament

Surrounds the head of radius and allows head of radius to rotate and maintain contact with the radial notch of the ulna

Gangrene (Wet)

Swelling from bacterial infection causes a sudden stoppage of blood flow, resulting in loss of vascular supply to local tissue. Bacterial infection can develop after a burn, frostbite, or injury. Spreads quickly and can be fatal. Sxs: Swelling and pain at site of infection, change in skin color from red to brown to black, blisters that produce pus, fever, general malaise

Vaulting Gait Pattern

Swing leg advances by elevating pelvis and PF of stance leg

Heart innervation

Sympathetic: Release of Epinephrine and Norepinephrine to speed up contractions (chronotropic) and increase force (inotropic) Parasympathetic: ACh via Vagus nerve to slow HR

Femoral Anteversion

TOE IN during ambulation W-sitting Excessive hip IR, restricted hip ER Increased Q angle Genu Vaglum Femoral torsion OVER 15 deg

Femoral Retroversion

TOE OUT during ambulation Excess Hip ER, restricted IR Genu Varum, medial compartmental pain Tibial IR compensation Femoral torsion less than 8 deg Relatively uncommon

Contract Relax (CR)

Technique to increase ROM. When muscle reaches point of limitation, patient performs maximal contraction of antagonistic muscle group. Therapist resists movement for 8-10 seconds, then lets patient relax. Dev. Sequence: Mobility

Midbrain (Mesencephalon)

Tectum: -Superior and inferior Colliculi Tegmentum: -Cerebral Aquedut -Periaqueductal Gray -Reticular Formation -Substantia Nigra -Red Nucleus

Title IV of ADA

Telecommunications. - All televisions must have closed captioning - Relay svcs 24 hr/day, 7 days/wk

TMJ Elevation (closing)

Temporalis Masseter Medial Pterygoid

Transient Ischemic Attack

Temporary interruption of blood supply, symptoms resolve in 24-48 hours. Most often at carotid and vertebrobasilar arteries.

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)

Test of motor function for kids 4 to 21 years old. Assesses motor coordination and balance

Nerve Conduction Velocity

Test that measures how fast an impulse travels along a nerve. Can pinpoint an area of nerve damage. Rules out peripheral neuropathies, CTS, demyelination, and peripheral nerve compression Compromise: Latency increases, velocity decreases. NOTE: will only test distal component of peripheral nerve. Cannot detect abnormalities in lesions proximal to dorsal root ganglion

Motor Index Scoring for SCI

Testing each muscle using 0-5 scoring, total of 25 points per extremity for total possible score of 100

Anterior Labral Tear Test (FADDIR)

Tests anterior-superior impingement syndrome, anterior labial tear, & iliopsoas tendinitis. Patient supine. Examiner takes the hip to full flexion, lateral rotation and full Abduction as a starting position. Examiner then extends hip combined with medial rotation and adduction. (+) pain or the production of the patient's symptoms with or without a click. Note: (FADDIR) = flexion adduction internal rotation.

Neurogenic Reflexive Bladder

The bladder empties reflexively for a patient with an injury above the level of T12. The sacral reflex arc remains intact.

homonymous hemianopsia

The loss of the right or left half of the field of vision in both eyes.

Independent variable

The experimental factor that is manipulated; the variable whose effect is being studied.

Dependent variable

The outcome factor; the variable that may change in response to manipulations of the independent variable.

Ultrasound Duty Cycle

The fraction of time the US is on over one pulse period time on/time on+time off

Constructional Apraxia

The inability to reproduce geometric figures and designs. A person is often unable to visually analyze how to perform a task

Aorta

The large arterial trunk that carries blood from the heart to be distributed by branch arteries through the body. Begins at L Ventricle, descends within thorax, and passes into abdominal cavity

Postural Drainage: Apical segments right and left upper lobes

The patient is in a sitting position, leaning back 30-40 degrees. Percussion and vibration are performed above the clavicles.

Postural Drainage: Superior segments left and right lower lobes

The patient is prone with the bed horizontal. Percussion and vibration are performed below the inferior border of the left and right scapulae.

Postural Drainage: Right middle lobe

The patient is turned 1/4 from supine on the left side with the foot of the bed elevated 12 inches. Percussion and vibration are performed over the right chest between the axilla and the right nipple.

Postural Drainage: Lingula Left upper lobe

The patient is turned 1/4 from supine on the right side with the foot of the bed elevated 12 inches. Percussion and vibration are performed over the left chest between the axilla and the left nipple.

Sinus tarsi

The superior portion of the calcaneus contains a groove called the calcaneal sulcus. The inferior portion of the talus contains a matching groove called the sulcus tali. Collectively, these two sulci form the:

Vital Capacity (VC)

The total volume of air that can be exhaled after maximal inhalation. Approximately 75% of total lung volume. Tidal Volume (TV) + Inspiratory Reserve Volume (IRV) + Expiratory Reserve Capacity (ERV)

Grind test (thumb)

Therapist applies compression and rotation through first metacarpal. Positive for pain and may be indicative of DJD in CMC joint

S3

Third heart sound, also called "ventricular gallop". Vibrations from distended ventricle walls due to passive flow of blood from atria during filling phase of diastole. Normal in healthy young children, called "physiologic". May be associated with heart failure in adults.

Soleus

Tibial nerve S1, S2

Rooting Reflex

Touch on cheek causes baby to turn head to same side with mouth open. Normal Age: 28 weeks of gestation to 3 months Interferes with oral motor devt, visual tracking, devt of midline control of head

Superficial Wound

Trauma to the skin, epidermis remains intact. Will heal with inflammatory process -non-blistering sunburn

Semirigid Bandages

Treated gauze applied to distal extremity, usually applied wet and dries hard. Used to treat venous stasis ulcers. Unna boot is example, made of zinc oxide impregnated gauze 35-40 mmHg

Hemodialysis

Treatment process for patients with advanced and permanent kidney failure. This process removes blood from the body, cleanses the blood, and returns it to the body. Patient must attend 3x/week for 3-5 hours at a time. Side effects may include anemia, pruritus, sleep disorders, and amyloidosis (amyloid deposits in organs and tissue)

Lobes of the lung

Tri to be Right: 3 for the right, 2 for the left R has Upper, Middle and Lower L has Upper and Lower

Cubital Fossa

Triangular space at anterior elbow bordered by brachioradialis, pronator teres, brachialis, and humeral epicondyles. Contains: Biceps brachii tendon, median nerve, radial nerve, brachial artery, median cubital vein

Elbow Extension

Triceps Brachii Anconeus

Radial Nerve (EX)

Triceps brachii Anconeus Ext.carpi rad. br. & long. Brachioradialis Ext.dig., Ext.dig.min., Ext.carpi uln. Supinator Abd.poll.long& br Ext.poll.long., Ext. indices

Rinne's Test

Tuning fork struck and placed on mastoid bone of suspected side, while asking patient to report when sound is no longer heard. Then, tuning fork is placed 2 cm from auditory canal. Conductive: If pt is not able to hear tuning fork when moved from mastoid to outside ear Sensorineural: Patient is able to hear tuning fork outside ear longer than when held against mastoid, and reports sound has stopped before tuning fork stops vibrating

Interferential current

Two alternating biphasic waveforms, producing an alternating higher/lower amplitude at their intersection. Comfy for patients, low amps to skin and higher amps to deeper tissues -Uses: pain relief, increased circulation, muscle stimulation

Passive insufficiency

Two joint muscle is lengthened over both joints simultaneously

Adductor pollicis

Ulnar nerve C8, T1

Flexor carpi ulnaris

Ulnar nerve C8, T1

Flexor digiti minimi brevis (hand)

Ulnar nerve C8, T1

Opponens digiti minimi

Ulnar nerve C8, T1

Palmar interossei

Ulnar nerve C8, T1

Palmaris brevis

Ulnar nerve C8, T1

Dorsal interossei (hand)

Ulnar nerve, palmar branch C8, T1

Ventricular Fibrillation

Uncoordinated contraction of ventricles, asynchronous and ineffective. No cardiac output, patient becomes unconscious. This arrhythmia is lethal and requires immediate defib.

Static lumbar traction

Used if patient's symptoms are exaggerated by movement.

Quick Stretch

Used to activate muscles that have difficulty initiating contraction

Neuromuscular Electrical Stimulation (NMES)

Used to facilitate skeletal muscle activity. Therapist aligns electrodes over muscle belly in parallel, separated by minimum of two inches. PPS: 35-50 Duty Cycle: 1/5 on/off ratio (10 seconds, on, 50 seconds off) Ramp: 1-4 seconds Treatment: 10-20 contractions

Manual Resistance

Used to facilitate weak muscles, or facilitate desired motion

Thoracolumbosacral Orthotic Brace (TLSO)

Used to prevent all trunk motions, post-surgical stabilization.

Timing for Emphasis

Used to strengthen weak component of a motor pattern. Isotonic and isometric contractions produce overflow to weak muscles.

Types of Precision Grips

Used when accurate and precies hand movements are needed. -Digital Prehension (Three finger pinch): Pad to Pad contact between thumb, index finger, and middle finger. Pencil -Lateral Prehension: Contact between thumb and lateral side of index finger. Key -Tip Prehension: Thumb opposition (tip to tip). Needle

Types of Power Grips

Used when strong grip is needed, involves stabilization of the object against the palm of the hand. Fingers in flexion, wrist is in ulnar deviation and slight extension -Cylindrical: Entire hand wraps around object. Soda can -Fist: Thumb and fingers overlap. Hammer -Spherical: Fingers are separated from one another. Baseball -Hook: Second and third IP joints create a "hook". Pail handle

Balloon Valvuloplasty

Uses balloon tipped catheter to open narrow valve and increase blood flow

Magnetic Resonance Imaging (MRI)

Uses magnetic field and radio waves to create 3D images of heart and blood vessels to assess size and function of chambers, thickness and movement of walls, extent of damage from MI, structural problems, presence of plaques.

Cardiac Ablation

Uses radio frequencies or chemicals to destroy areas of myocardium identified by electrophysiologic testing to be causing cardiac arrhythmia. Is an optino for pts with tachyarrhythmias that cannot be controlled by meds, or Wolff-Parkinson-White syndrome

Carotid Ultrasound

Uses soundwaves to examine carotid arteries to screen for blockages, evaluate stent placement, or function of artery post endarterectomy

Negative Pressure Wound Therapy (Vacuum Assisted Closure) or Wound VAC

Uses suction to remove drainage and speed wound healing. -Used for wounds that can't be closed by primary intention (dehisced surgical incisions, full-thickness wounds, heavily draining granular wounds, ulcers) -Don't use over areas of malignancy, insufficient vascularity, large amounts of eschar, or fistulas.

Mechanical Ventilation

Using a machine to move air into and out of the lungs, using positive pressure to increase intrathoracic pressure.

Autolytic Debridement

Using the body's own enzymes to remove nonviable tissue. Establishes moist wound environment that rehydrates necrotic tissue and eschar, facilitating enzymatic digestion. -Transparent films -Hydrocolloids -Hydrogels -Alginates Requires longer healing period, should not be performed on infected wounds

CN X

Vagus Sensory: Pharynx, larynx, bronchi, taste in tongue/epiglottus Motor: Muscles of palate, pharynx, larynx. Thoracic and ab viscera Test: Gag reflex, ability to swallow, "Say ahhhhh"

Innervation of Lungs

Vagus nerve for Parasymatpethc innervation, Postganglionic sympathetic fibers for sympathetic

Criterion-related Validity

Validity of a measurement established by comparing it to the gold-standard

Percentiles

Value below which a certain percent of observations will fall. 20th percentile is the value or score below which 20% of scores will fall

Mode

Value that occurs most frequently

Elbow Ligamentous Instability Tests

Varus Stress Test: Tests LCL. Positive for increased laxity compared to opposite side, apprehension, or pain. Positive test may indicate LCL sprain Valgus Stress Test: Tests MCL. Positive for increased laxity compared to contralateral limb, apprension, or pain. Positive tests may be indicative of MCL sprain

Random Practice

Varying practice amongst different tasks

Heart blood flow

Vena Cava Right Atria Tricuspid Valve Right Ventricle Semilunar Pulmonary Valve Pulmonary Artery Pulmonary Vein Left Atria Bicuspid Valve Left Ventricle Semilunar Aortic Valve Aorta

Right Hemisphere CVA Symptoms

Weakness, paralysis of contralateral side Hemianopsia on contralateral side Decreased attention span Decreased awareness and judgement Memory deficits Inattention to contralateral side Decreased abstract reasoning Emotional lability Impulsive behavior Decreased spatial orientation

Left Hemisphere CVA Symptoms

Weakness, paralysis of contralateral side Hemianopsia on contralateral side Increased frustration Decreased processing Possible aphasia (expressive, receptive, global) Possible dysphagia Possible motor apraxia Decreased discrimination between L and R

Excessive Knee extension during IC-Loading response (Transtibial prosthesis)

What should happen: knee flexes between 8-10 deg to allow for weight acceptance Deviation: Pt keeps knee extended on prosthetic side, making the limb longer and reducing shock absorption C/O: Walking uphill and distal anterior stump pain CAUSES: 1. Too soft cushioned heel, allowing for too much PF too quickly. PF = Knee EXT, DF = Knee flex 2. Posteriorly Displaced Socket or Anteriorly set Prosthetic Foot, setting knee posterior to foot in IC, causing LOG to be in front of knee, and causing extensor moment

active insufficiency

When a 2 joint muscle contracts (shortens) across both joints simultaneously

Galant Reflex

When baby's trunk is touched from shoulder to hip, baby's trunk will laterally flex to side of stimulus. Normal age: 30 weeks of gestation to 2 months

Global Aphasia

When both production and understanding of language is damaged. Combination of Broca's and Wernicke's. typically MCA with lesion in frontal and temporal lobes

Asymmetrical Tonic Neck Reflex (ATNR)

When face is turned to one side, arm and leg on face side are extended, arm and leg on scalp side are flexed. Normal Age: 0-6 months Interferes with feeding, visual tracking, bilateral hand use, rolling

Symmetrical Tonic Neck Reflex (STNR)

When head is in flexion, arms are flexed and legs are extended. When head is in extension, arms extended and legs flexed. term-369 Normal Age: 6-8 months Arms follow the head, Legs go opposite.

Bronchial breath sound

When heard NOT over trachea, can indicate pneumonia

Laceration

Wound or irregular tear of tissue associated with trauma. Can result from shear, tension, or high force compression

Tertiary Intention (Delayed Primary Intention) Healing

Wound remains open, and when risk factors for complications have been alleviated, wound is closed with primary intention. Risk factors for complications like sepsis or dehiscence: wounds with significant edema, debris contamination, high risk for infection, questionable vascular integrity.

Penetrating wound

Wound that enters interior of organ or cavity

Secondary Intention Healing

Wounds close on their own without superficial closure, edges are not approximated. Usually significant tissue loss or necrosis, irregular or nonviable wound margins. Require ongoing wound care and have larger scars. Neuropathic, arterial, venous, pressure ulcers Most Full-thickness wounds Chronically inflamed wounds

C6 Resistive Test

Wrist Extension

Ottawa Ankle Rules

X-ray is only required if pain in malleolar Zone AND ANY ONE of following 1. Bone tenderness along distal 6 cm of posterior edge of tibia or tip of medial malleolus 2. Bone tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus 3. Inability to WB immediately and in ER for four steps

Slough Tissue

Yellow green, or grey necrotic tissue described as moist, stringy, or mucinous. Tends to be loosely attached in clumps to wound bed

Purulent Exudate

Yellow/Green color Thick, viscous consistency Indicator of wound infection, always considered abnormal

Alpha Adrenergic Antagonist Agents

Zosins Reduce peripheral vascular tone by blocking Alpha-1-adrenergic receptors, causing dilation of arterioles and decreasing BP Indications: HTN, BPP PT: Caution when rising from sitting or lying bc of dizziness/orthostatic hypotension. Examples: Cardura/doxazosin, Minipress (prazosin), Hytrin (Terazosin)

Traumatic Brain Injury

a blow to the head or a penetrating head injury that damages the brain. Leading risk factor is MVA, then falls, high risk behaviors, and gunshot wounds

Lipedema

a chronic abnormal condition that is characterized by the accumulation of fat and fluid in the tissues just under the skin of the hips and legs Normally functioning lymphatic system!!! -Female Dominant -Bilateral/Symmetrical (lymphedema is unilateral) -Often due to hormonal imbalance -Negative Stemmer's sign -Swelling stops at wrists/ankles

Benign Paroxysmal Positional Vertigo

a common cause of vertigo that occurs when there is a shift in the location of small crystals in the semicircular canals 2 types: Canalithiasis and cupolithiasis. Canalithiasis is more common. Assessed using Dix-Hallpike test and treated with canalith repositioning techniques. Will not have positive Romberg

Cheyne-Stokes Breathing

a distinct pattern of breathing characterized by quickening and deepening respirations followed by a period of apnea. -Crescendo and decrescendo -end-of-life transitioning -stroke, TBI, CHF, brainstem, opioid.

Predictive Validity

a form of criterion-related in which validity is measured by how predictive it is of a future event. (use of GPA as admission criteria based on presumed ability to predict future academic success)

Internal Fixation

a fracture treatment in which a plate or pins are placed directly into the bone to hold the broken pieces in place

External Fixation

a fracture treatment procedure in which pins are placed through the soft tissues and bone so that an external appliance can be used to hold the pieces of bone firmly in place during healing Allows for stability and earlier mobility

Cystic Fibrosis

a genetic disease that causes the body to produce unusually thick, sticky mucus that leads to life threatening lung infections, obstructs pancreas, and inhibits normal digestion/absorption of food. Most common complication is exacerbation of obstructive pulmonary disease Sxs: Salty tasting skin, persitent/productive cough, frequent lung infections, failure to thrive, frequent greasy/bulky stools PFT: Decreased FEV1 and PVC, increased FRC and RV. Tx: Antibiotics, muculytics, bronchodilators, airway clearance, breathing techniques, ventilatory msucle training.

Carcinoma

a malignant tumor that occurs in epithelial tissue. More specifically named by characteristics (large cell carcinoma, adenocarcinoma, squamous cell carcinoma are all lung carcinomas) 80% of all cancer in the USA is carcinoma

CT Scan

a series of x-ray photographs taken from different angles and combined by computer into a composite representation of a slice through the body. *Allows for pictures of coronary arteries to be taken without need for catheterization

Z plasty

a surgical procedure to eliminate a scar contracture, an incision in the shape of a z allows the contracture to change configuration and lengthen the scar

MRI

a technique that uses magnetic fields and radio waves to produce computer-generated images that distinguish among different types of soft tissue; allows us to see structures within the brain Rules out tumors, MS, and had trauma.

Whispered Pectoriloquy

a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue

Antiepileptic agents

also known as anticonvulsants, they are used to reduce the frequency of seizures by inhibition of cerebral neurons. -Seconal/Secobarbital -Clonazepam/Klonopin -Valproic Acid -Phenytoin/Dilantin -Carbamazepine -Gabapentin -Methsuximide

Diaphragmatic Breathing

breathing with the use of the diaphragm to achieve maximum inhalation and slow respiratory rate. Cue: "Breathe into your belly" Who: Restrictive lung condition, Hypoxemia, Tachypnea, Atelectasis, Anxiety, Excess Pulmonary Secretions When: To improve O2 sats, resolve atelectasis, decrease anxiety, mobilize secretions

-phylline

bronchodilators asthma or colds dilate large air passages Aminophylline, theophylline

Suprapubic Catheter

catheter inserted into the bladder through a small abdominal incision above the pubic area, performed under general anesthesia

Ganglia

clusters of cell bodies in the PNS. They give rise to peripheral and central nerve fibers.

Muscles of inspiration

diaphragm (C3-C5), external intercostals (T2-T12), pectoralis minor, scalenes (C3-C7), sternocleidomastoid, serratus Diaphragm expands chest longitudinally and elevates lower ribs to allow for inspiration

Ideational Apraxia

difficulty conceptualizing planned, multistep movements

D1 Extension UE

extension, abduction, internal rotation

D2 Extension LE

extension, adduction, external rotation

D2 Extension UE

extension, adduction, internal rotation. Sheathing the sword.

Tectospinal tract

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

Reticulospinal tract

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

Knowledge of Performance (KP)

extrinsic feedback given by clinicians to patients about performance variables such as ROM, muscular force, coordination of extremity's movement in space. Most effective KP is info about critical components of the actions and provides prescriptive info about how to correct errors.

Pulmonary Edema

fluid accumulation in the alveoli and bronchioles, most often seen with L Ventricular heart failure. Pressure increases in L atrium, then into pulmonary veins and capillaries, causing fluid to be pushed through capillary walls into alveoli. Can be noncardiac due to increased capillary permeabilityfrom pneumonia, toxins, meds, RDS. Acute pulmonary edema is life threatening. Sxs: SOB, feeling of suffocating, wheezing, coughing w/blood tinged sputum, chest pain and irregular pulse Tx: Supplemental O2 and meds

Manual Lymphatic Drainage (MLD)

gentle manual treatment which improves the activity of the lymph vascular system; re-routes lymph flow around blocked areas into more centrally located healthy lymph vessels. Treatment first directed at uninvolved areas to prepare for new lymph flow, then towards involved areas.

Urge Urinary Incontinence

loss of urine after a sudden, intense urge to void due to the detrusor muscle of the bladder involuntarily contracting during bladder filling. Common in geriatric population and among residents in long-term care facilities Sxs: Urination triggered due to conditioned reflex, i.e. "key in lock" syndrome or running water Tx: Behavior modification, biofeedback, pelvic floor strengthening, and bladder retraining via scheduled voiding

Trendelenburg position

lying on back with body tilted so that the head is lower than the feet

Components of Lymphatic System

lymph, lymphatic vessels, lymphatic tissue, lymphatic organs (thymus, bone marrow, spleen, tonsils, Peyer patches in small intestine)

Intracranial pressure monitor

measures the pressure exerted against the skull using pressure sensing devices placed inside the skull Used for closed head injury, cerebral hemorrhage, overproduction of CSF or brain tumor

Cuneiforms

medial, intermediate, lateral

Viscerogenic pain:

pain that originates from the kidneys, sacroiliac, pelvic lesions, and retroperitoneal tumors pain is neither aggravated by activity nor relieved by rest Examples: Kehr's Sign: Positive when pressure to upper abdomen or supine position reproduces L shoulder pain. Blood accumulates in abdominal cavity, often due to spleen rupture, causing irritation of diaphragm and phrenic nerve (C3-5) that refers pain to L shoulder. Gallstones: Gallbladder's innervation from mid-thoracic spinal segments leads to right upper abdonem or interscapular pain. May refer to R shoulder if diaphragm is irritated. Myocardial Infarction: Heart is innervated with C3-T4 spinal segments, and patients may experience pain on L side of body in chest, midback, shoulder, arm, neck, or jaw.

Causalgia

persistent, severe burning pain that usually follows an injury to a sensory nerve

-afil

phosphodiesterase inhibitor (PDE inhibitor) ex. sildenafil (Viagra) -Tx of erectile dysfunction **do not give with other vasodilating agents

Ventilation-Perfusion Scan (Lung Scan or VQ scan)

radioactive substance is injected IV; scan views blood flow to lungs (perfusion) OR radioactive substance is inhaled showing how well O2 is distributed in lungs

Venography

radiography of a vein after injection of a contrast medium to detect incomplete filling of a vein, indicating an obstruction

Main lymphatic ducts

right lymphatic duct: drains lymph from right side of arm and head thoracic duct: drains lymph from rest of body These vessels dump directly into venous system via subclavian veins

Extensor Synergy UE

scapular Protraction/depression shoulder adduction/internal rotation elbow extension, forearm pronation wrist and finer flexion/extension

Flexor synergy UE

scapular Retraction & elevation shoulder abduction & external rotation elbow flexion, forearm supination wrist flexion, and finger flexion

Paced Breathing and exhale with effort.

strategy to decrease work of breathing and prevent dyspnea during activity. Allows those who experience SOB during activity to participate. EWE is a breathing strategy to prevent patients from holding their breath.

Coronary Artery Bypass Graft (CABG)

surgical technique to bring a new blood supply to heart muscle by detouring around blocked arteries. Procedure joins patient's own saphenous vein, internal thoracic/mammary artery or radial artery to connect the affected artery above and below occlusion

Tibial nerve injury can be caused by

tarsal tunnel entrapment, popliteal fossa compression

Thalamus

the brain's sensory switchboard, located on top of the brainstem; it directs messages to the sensory receiving areas in the cortex and transmits replies to the cerebellum and medulla and appropriate association cortex. Coordinates sensory perception and movement.

Cardiac Catheterization

thin, flexible tube is guided into the heart via a vein or an artery. Can evaluate occlusion of coronary arteries and measure heart BP and oxygenation. Coronary Angioplasty is performed using cardiac catheterization.

Erythrocyte Sedimentation Rate (ESR)

timed test that measures the rate at which red blood cells settle through a volume of plasma Increased in presence of rheumatics, HIV, infections, and collagen vascular disease

Primary Intention Healing

tissue surfaces are approximated (closed) using staples, sutures, or adhesive, and there is minimal or no tissue loss, formation of minimal granulation tissue and scarring Common in acute wounds with minimal tissue loss. -Superficial partial thickness wounds (blisters, abrasions) -Punctures -Surgical Incisions -Lacerations

Cruciform ligament

transverse ligament of atlas and vertical ligament from skull; holds body of C2 and dens to the inside of the skull. Limits upper cervical flexion and atlantoaxial translation

Wheeze

whistling or sighing sound heard on auscultation that results from narrowing of the lumen of the respiratory passageway. Indication: Bronchospasm, edema, collapse, secretions, foreign body, neoplasm

Lumbar Spinal Puncture

withdrawal of cerebrospinal fluid from between two lumbar vertebrae. Most commonly at L-3-4. Used to rule out meningitis, tumor, infection, and hemorrhage

Electrophysiologic Testing

• Evaluates rhythm or electrical conduction abnormalities of heart using 3-5 catheters inserted into a blood vessel and threaded to the heart • Help to locate abnormal tissue that causes cardiac arrhythmias

TMJ Depression (opening)

-Lateral Pterygoid -Suprahyoid -Infrahyoid

Finger Extension

Extensor digitorum Extensor Indicis Extensor Digiti Minimi

Thumb Flexion

Flexor pollicis Longus and Brevis Opponens Pollicis

TMJ Side to side

Medial/Lateral pterygoid Masseter Temporalis

GH Horizontal Abduction

Posterior delt Infraspinatus Teres Minor

Cervical Flexion

SCM Longus Colli Scalenes

Glenohumeral Joint: -Motions -Loose-packed position -Close-Packed Position -Capsular Pattern

-Motions: Flex, Ext, AB/ADD, Ext/Internal Rotation -Loose-packed position: 55 degrees abduction, 30 degrees horizontal adduction (scaption) -Close-Packed Position: ABD and Ext Rotation -Capsular Pattern: External Rotation, Abduction, Internal Rotation

Radiocarpal joint Motions: -Loose-packed position -Close-Packed Position -Capsular Pattern

-Motions: Flexion, extension, radial/ulnar deviation -Loose-packed position: Neutral with slight ulnar deviation -Close-Packed Position: Extension with radial deviation -Capsular Pattern: Flex/ext equal

Finger Abduction

Dorsal Interossei (DAB) Abductor Digiti Minimi

Wrist Flexion

Flexor Carpi Radialis Flexor Carpi Ulnaris Palmaris Longus

Toe Flexion

Flexor Digitorum Longus/Brevis Flexor Hallucis Longus, Brevis Flexor Digiti Minimi Longus Quadratus Plantae Lumbricals

Finger Flexion

Flexor Digitorum Superficialis/Profundus Flexor Digiti Minimi Interossei Lumbricals

GH Extension

Latissimus dorsi Teres major Posterior deltoid Triceps brachii (long head)

Motions in the transverse plane

internal and external rotation

AC Joint -Motions -Loose-packed position -Close-Packed Position -Capsular Pattern

-Motions: Anterior/Posterior Tilting, Upward/Downward Rotation, Protraction/Retraction -Loose-packed position: Arm at side -Close-Packed Position: Arm abducted to 90 degrees -Capsular Pattern: Pain at extremes of range of movement

Humeroradial Joint -Motions -Loose-packed position -Close-Packed Position -Capsular Pattern

-Motions: Flexion, extension, supination, pronation -Loose-packed position: Full ext, supination -Close-Packed Position: 90 deg flex, 5 deg supination -Capsular Pattern: Flex, Ext, Supination, Pronation

Humeroulnar Joint -Motions -Loose-packed position -Close-Packed Position -Capsular Pattern

-Motions: Flexion/extension -Loose-packed position: 70 deg elbow ext, 10 deg supination -Close-Packed Position: Ext -Capsular Pattern: Flex, ext

Carpal Tunnel

-Space between carpal bones and flexor retinaculum, and the median nerve runs through this structure. -Tenosynovitis, inflammation of retinaculum, or anything that decreases the space may result in compression of the median nerve.

Cervical Extension

Cervical erector spinae (Iliocostalis, Longissimus, Semispinalis cervicis) Splenius Cervicis Multifidus Trapezius

Elbow Joints

Humeroradial Humeroulnar Proximal Radioulnar

Hip Flexion

Iliopsoas Sartorius Rectus Femoris Pectineus

Hip Bursae

Iliopsoas: between anterior joint capsule and iliopsoas tendon Trochanteric: between greater trochanter and different glute muscles Ischiogluteal: between ischium and glute max

GH Abduction

Middle delt Supraspinatus

Multi-axial joint

Plane: carpal joints Ball and socket: hip joint, GH

Thoracic/Lumbar Rotation/Lateral Bending

Psoas major Quadratus lumborum External oblique Internal oblique Multifidus Longissimus thoracis Iliocostalis thoracis Rotatores

Cervical Rotation and Sidebending

SCM Scalenes Splenius, Longissimus, Iliocostalis Cervicis Levator Scap Multifidus

Scapula Protraction

Serratus anterior Pec minor

Hip Internal (Medial) Rotation

TFL Glute Med/Min Pectineus Adductor Longus

TMJ Retrusion

Temporalis Masseter Digastric

Dorsiflexion

Tibialis Anterior Extensor Hallucis Longus Extensor Digitorum Longus Peroneus Tertius

Inversion

Tibialis Posterior/Anterior Flexor Digitorum Longus