Review 2018 Set #12
Common vertebral levels of cervical disc herniations
C6-7 (60%) C5-6 (30%)
Where are the electrodes placed in HVPC for dermal wound therapy?
*anode* should be at or near the site
What are some potential causes of neuropathy?
-*DIABETES* -tumor -trauma -autoimmune disease -vitamin B, E or niacin deficiency -exposure to toxins -infection
What is an LVAD used to treat?
-*advanced heart failure* -non-reversible L heart failure, CHF, cardiomyopathy -imminent risk of death -candidate for heart transplant -destination therapy often used as a bridge to a transplant
Risk Factors: thrombotic CVA Risk Factors: embolic CVA
-HTN -DM -cardiac/vascular disease -A-fib -DVT -infection -& all of thrombotic risk factors
MES is also known as: (read)
-LIS: low intensity stimulation -formerly known as MENS: microcurrent electrical nerve stimulators
STTT: dura matter
-Slump Test
What are common comorbidities of acromegaly? (3)
-diabetes -high BP -CV disease
What are some symptoms of Cushing's syndrome? (not congenital)
-enlarged abdomen w/ purple stretch marks that may look like ascites -*poor wound healing* -thin skin -muscle weakness -*osteoporosis*, made worse by excess loss of calcium in urine
If someone is performing a prone hip extension, why would it be bad if their HS activated initially and glute max activation was delayed?
-glute max should be the main hip extensor: bc it attaches close to the point of rotation it allows more precise control of the femoral head in the acetabulum -delayed glute max activation could result in losing control of the femoral head-- more susceptible to ant shearing (ideally want to see them activate at the beginning of the motion together)
3 aspects of cognitive development that Piaget examined:
-goal of cognitive development -cognitive development as biological adaptation -knowledge originates from the environment Note: he examined how children knew what they knew and not so much what they knew
Two requirements for successful grasp
-hand must be adapted to shape, size and use of object -finger movements must be timed in relation to transport
Symptoms of autonomic dysreflexia
-headache -sweating -nasal congestion -sustained penile erection -hyperhydrosis (excessive sweating) above level of lesion -paresthesias
List some equipment that can be used as life support: (read- overview)
-hemodynamic monitoring & life support, arterial pressures -ventilatory monitoring & life support -mechanical ventilation -mechanical percussors -manual resuscutators
What are side effects of decongestants?
-high BP -insomnia -irritability -difficulty urinating
What roles do higher brain centers and the cerebellum play in reach/grasp?
-higher brain centers in cortex make a movement plan for the movement goal -cerebellum receives and updates movement plan with sensory information
Most common site(s) for HO
-hip -may also occur in knee, shoulder and elbow
If you MMT a pt's hip abduction in sidelying, and their leg drops w/ any pressure until it is a few inches off of the table and then holds strong, what does this tell you? What modifications would you teach them in standing, sitting & sidelying?
-hip abductors may be lengthened -a truly weak muscle would give throughout the entire ROM -stand: equal weight on each LE -sit: don't cross legs -sidelying: pillow b/w knees
Causes: chronic nerve root
-hx of disc pathologies -NR injury -degenerative changes -spinal surgery/scarring
How is a stroke diagnosis made?
-hx of recent events (timing) -PMH & risk factors -confirmed w/ CT or MRI of brain (CT is good at seeing fluid)
Traumatic causes of SCI
-hyperflexion -hyperextension -axial loading -bruising -severing (rare) -w/ or w/o spinal cord fracture or dislocation
When first seeing a patient after they've had a stroke, what should you be looking for/thinking about when screening them for rehab services?
-identify problems that need treatment to determine if they will benefit from therapy (Ex: functional limitations) -determine appropriate setting for rehab after discharge from acute care
When should emergency activation be called upon?
-if anginal pain is not relieved in 20 mins -if the client has nausea, vomiting or profuse sweating -throbbing chest, back or abdominal pain that increases with exertion, accompanied by a sensation of a heartbeat when lying down, and palpable pulsating abdominal mass (may be aneurysm) -sudden worsening of intermittent claudication (may be due to thromboembolism)
Should we train pts w/ hemiparesis using bilateral activities? (read)
-if the goal is smooth, coordinated movement, there is some evidence that bilateral activities can help the affected arm -however, gains from bilateral conditions may not transfer to unilateral conditions -if the goal is to increase the speed of movement of the affected arm, bilateral movements are probably not a good idea
When might a modified 4-point gait pattern be chosen for a pt?
-if the pt has a functional deficit in an UE -if the pt is using a quad or pyramid cane
Examples of sensorineural hearing loss
-illness -drugs -genetics -presbycusis -TBI -malformation of the inner ear -exposure to loud noise
Things that exacerbate MS sx
-illness -infection -stress -heat -fatigue -dehydration -malnutrition -sleep deprivation
List some medications transplant patients may be on:
-immunosuppressive -anti-inflammatory -anti-viral -anti-biotic -mycostatins -gastric motility agents initiated in ICU & continued life-long
Why would a patient be put on a ventilator?
-impending or established respiratory failure -airway protection -inadequate ventilation or oxygenation more specifically: -respiratory depression d/t drug OD -inspiratory mm fatigue d/t COPD -inspiratory mm weakness d/t neuro condition -severe hypoxemia d/t lung parenchymal disease and more things on a later slide: -pulmonary atelectasis -inability to clear secretions -ST support for those who are hypoventilating
Even though we don't have a lot of answers about variability in practice, what should we remember? (3)
-important to consider whether you are providing variable practice situations for your client -should examine responses to variable practice (not all pts will benefit) -examinations that include unpracticed conditions should be included
Side effects of methylxanthines include:
-inc myocardial work load -heightened susceptibility to ventricular and supraventricular dysrhythmas CNS -stimulation -confusion -irritability -restlessness
Somatosensory contributions to *reaching*?
-incoordination w/ complex tasks results when visual input removed -muscle spindles have an important role in position sense -cutaneous afferents also important for position sense
What are signs and symptoms of peripheral vascular disease and atherosclerosis?
-increasing fatigue and weakness in legs -intermittent claudication (leg pain associated with exercise due to muscle ischemia) -sensory impairment (parestesias, tingling burning etc.) -peripheral pulses distal to the occlusion become weak or absent -skin on feet and legs change (cyanosis when elevated, redness when dangling, skin dry & hairless, toenails are thick and hard)
Motor components required for successful reach and grasp?
-intact primary motor cortex (precision grip), cerebellum (coordination and postural control), midbrain and brainstem (prox. mm in reach) -appropriate muscle tone -ROM in hand, arm and trunk -mm strength -synergistic control of components of movement
Pain Description: acute & chronic cervical nerve root
-intense pain -radiating sx -muscle spasms (Body Chart Example: P1- stiff on L side of neck, P2- deep ache at inf angle of scap, P3- deep ache w/ intermittent sharp & shooting pain down L arm
3 groups of sources of sensory information from the environment:
-interoceptors -exteroceptors -proprioceptors
What exits the triangular space?
Circumflex scapular artery
How do you compress a lumbar facet joint?
-ipsilateral lateral flexion -contralateral rotation
What do the clavicular and sternocostal heads of the pectoralis major muscle do?
Clavicular Head: flexes Sternocostal Head: extends (flexed arm) both act on the humerus
List some contraindications for heart & lung transplants: (14)
-irreversible renal function -psychosocial or cognitive instability -absence of support -active infection -history of non-compliance -active substance use -morbid obesity -lack of adequate financial coverage -cancer w/in last 5 years -age inappropriateness (70+) -active smoker -HIV -severe neurological deficits -major systemic disease
STTT: ligaments
-joint distraction -passive special tests (Ex: ant drawer)
Pain Description: spinal stenosis
-leg & back pain -N/T in legs -weakness & cramping of calf muscles (neurogenic claudication)
How is the strength of a lengthened muscle altered?
-lengthened mm is stronger at a longer length -same muscle in a shortened position is weaker than a normal muscle in a normal position
What does fat secrete? (5)
-leptin -angiotensinogen -resistin -adiponectin -CRP
What should we consider when choosing massed vs. distributed practice for discrete task training?
-less is known about which is better for discrete tasks -there may be a slight benefit to massed practice for both acquisition and learning for discrete tasks -more importantly: consider the environment the pt will have to perform the task in once learned, and use training schedule based on what's more applicable (if task will be done in massed condition, practice in same condition)
What are the levels of organ recipient classification and what are they based on?
-levels: 1A, 1B and 2 -based on: disease level, need for mechanical support & medications this determines how quickly a patient gets a transplant
How is brain volume affected over the course of MS? -preclinical phase -relapsing-remitting phase -secondary-progressive phase
-little change: due to re-myelination -decrease: due to axonal degeneration -more decrease: due to axonal loss
Anterior cord syndrome -structures damaged -functions preserved -functions lost
-loss of function of the ventral pathway and the conservation of the dorsal column -preservation of light touch, proprioception and deep pressure -absence of pain and motor function
What can triceps tendinosis lead to? (3)
-lost reaction time -increased work related disability claims -dec quality of life
Demographics info for SCI (read):
-males account for 81% of all pts with SCI -average age at injury went from 29 y.o. in the 70s to 42 y.o. since 2010 -MVA leading cause of injury followed by falls, violence and sports
Which treatments for LBP have strong evidence to support them? (read)
-manual therapy -trunk coordination, strengthening & endurance -centralization procedures -progressive endurance exercises & fitness activities
Describe Home Care Rehab for a stroke patient:
-may be a simple check out for safety & function -rehab service provided if needed -typically 2-3x per week, 30-45 min -limited equipment -focus on functional training in a relevant setting
Pain Description: cervical central or lateral stenosis
-may be absent initially -then starts w/ more distal sx -then neck & arm pain
ROM: acute facet dysfunction
-may be limitation in SB & ext -can usually go through full flex/ext ROM, but have to go very slow
ROM: chronic nerve root
-may report pain w/ OP -mvmt impairment -don't see extreme limitation like you do in acute nerve root injuries
MOI: cervical central or lateral stenosis (3)
-mechanical compression -degenerative instabilities -congenital condition
Describe the deficits someone may have from an ACA stroke:
-medial portion of frontal & parietal lobes -stronger LE impairments -may be in a wheelchair -UE is spared
What criteria must an IABP patient meet in order to participate in PT?
-medically stable -alert & able to participate in PT :)
What should the PT response be for a patient with peripheral vascular disease and atherosclerosis?
-monitor and educate regarding foot care -modify exercise/activity as needed
What nutrition education should a patient with neuropathy be given? What should their glucose levels be before and after a meal?
-monitor their BMI -encourage stable weight loss -fresh fruits & vegetables > frozen > canned -glucose levels before a meal should be 90-130 mg/dL -glucose levels after a meal should be less than 180 mg/dL
What are our top priorities in acute care specific to hemorrhagic strokes?
-monitor/dec ICP -prevent seizures -surgery for large, progressing bleeds
24 Hours: chronic facet dysfunction
-morning stiffness -sx ease w/ mvmt throughout the day -if they do too much, they will have pain again
MS definition
-most prevalent -non-traumatic -chronic disabling -neurological disease among young adults in the U.S.
If someone has a movement impairment, our job is to think of all the possible contributing factors to the problem. What are some general factors you should always keep in mind?
-muscle length -muscle strength -muscle recruitment -muscle stiffness -structural faults
Two basic kinds of reflexive closed loop control:
-myotatic -long-loop
STTT: peripheral nerves
-myotomes & dermatomes -neurodynamics -palpation, stretch & tapping -Slump Test
When might a patient be intubated?
-need to deliver positive pressure ventilation -protect resp tract from *aspiration* of gastric contents -in almost all situations involving *neuromuscular paralysis* -surgical procedures involving the cranium, thorax or abdomen
How is clinical disability affected over the course of MS? -preclinical phase -relapsing-remitting phase -secondary-progressive phase
-no disability -initial attacks are followed by complete remission, but then only partial remission -steady inc in disability
What fasting plasma glucose levels correspond to normal, insulin resistance syndrome (IRS) and diabetes? (tests should be done on 2 different days prior to diagnosis)
-normal: below 100 mg/dL -IRS: 100-125 mg/dL -*diabetes: above 126 mg/dL*
Objective: general neck pain (read)
-observation/posture -AROM & OP (dec w/ degenerative changes) -PROM -repeated motions -sustained motions -neuro testing (only if radiating sx) -muscle testing
Describe the deficits someone may have from a PCA stroke:
-occipital lobe -vision impairments
What are signs and symptoms of thrombophlebitis?
-often unnoticed until a pulmonary embolus occurs (severe chest pain and shock) -presence in superficial veins may present with aching or burning and tenderness in the affected leg. The leg may be warm and red in the affected area of the inflamed vein -presence in deep veins may present with aching pain and tenderness, and edema in affected leg (positive Homan's sign) -systemic signs: fever, malaise
Invariant features of a GMP:
-order of events -relative timing of components of movement -relative force of the components
What causes acute hypoglycemia? (7)
-overtreatment w/ insulin -late or missed meal -more than normal amt of activity -exercising when insulin action is peaking -stress -drinking alcohol without food after insulin injection -delayed gastric emptying
Body Chart: cervical DDD
-pain is spread out & involves multiple levels -Cloward Signs (deep ache)
What are signs/symptoms of a radial head fracture?
-pain on outside of elbow -swelling in elbow -difficulty with flexion/extension -inability or difficulty with pronation/supination
ROM: spinal stenosis
-pain w/ SB to side of stenosis -pain/limited extension -altered end-feel -(limited in all directions)
What are some signs of chronic thyroiditis?
-painless, enlargement of the gland (*goiter*) -irregular surface, which occasionally causes pressure on surrounding structures. This pressure may cause *dysphagia* or respiratory distress
What should the PT response be for a patient suspected to have shock?
-place patient in supine position -cover and keep warm -call 911/EMS
3 times that sensory info is used during a motor program
-prior to movement -during a movement -after a movement
Pressure ulcers in pts with SCI are usually due to:
-prolonged immobilization -poor handling during transfers and bed mobility activities -prolonged compression b/w bony prominence and support surface (causing dec tissue perfusion)
What are possible MOI for olecranon bursitis?
-prolonged pressure (leaning on elbow against hard surface) -trauma (direct blow to olecranon) -infection -other medical conditions (gout, RA)
What are some foot deformities that may develop in a patient with neuropathy?
-prominent metatarsal heads -hammer/claw toes -bunions -Charcot foot
How do you assess foot alignment & function in an evaluation for a LE orthotic?
-pronation -supination -skeletal deviations: hallux valgus
Examples of trim lines: (read)
-proximal -anterior -ankle -foot -metatarsal (picture of a posterior leaf spring)
Subjective: chronic cervical nerve root (symptoms, agg factors, 24 hrs, history)
-proximal sx > distal sx in dermatomal pattern -"patchy" distribution -usually intermittent pain -*Agg*: sustained flexion, mvmt that narrow foramen -*24 hrs*: nagging pain, but able to sleep at night -*Hx*: long hx of neck pain, or post-surgical
Different things the brain might care more/less about that may be useful to guide interventions in therapy (read)
-quality of movement vs outcome of movement (how gait looks from point A to B vs. doing whatever motion we need to do to get to point B) -completion of 'functional goals' such as eating (don't care how it's done, just that it gets done) -control of movement changes from birth to adulthood, and how we move as children shapes our movement as adults
Clinical signs of a DVT for a patient with SCI (hint: different than non SCI)
-rapid onset of swelling -inc temp of limb
Key features of movement under open loop control (2):
-rapidly occurring (<150 ms) -pre-programmed motor response
If someone has a very kyphotic-lordotic posture, you are likely not going to be able to completely reverse this. What are your goals instead?
-recognize the structural issues you aren't able to change and take a preventative role -educate pt on activity modifications & strengthening to prevent further curvature development -teach them how to be in charge of the condition
What should you work on in addition to strengthening muscles to develop motor control?
-recruitment -timing of activation
Are reflexes under closed or open loop control?
-reflexes can influence movement and do this much faster than 250 ms -reflexes are sensory influenced -*some consider these influences on movement as part of closed loop control*
STTT: facet joints
-repeated movements (extension) -unilateral PA -side bend + rotation to close foramen
What is a CPG? What is required for them to work?
-rhythmical movements of the limbs produced by alternating flexor/extensor muscle group activation -can be produced without a connection to the brain and therefore no sensory feedback from the periphery -must have some kind of stimulation (electrically or chemically) to the SC to initiate movement
Things that must be "controlled" in order to have skilled, purposeful movement (6)
-safety -force -direction -timing -functional goal -energy conservation (likely a lot more than this, but these are a start)
How can dynamical systems be used in PT? (read)
-search for rate limiters or constraints in the subsystems -manipulate control parameters during intervention -set up therapeutic environment to practice in a meaningful context -promote a variety of movement patterns -create an environment that supports strengths or compensates for weaknesses
Name Piaget's cognitive development stages and what age ranges they cover (4):
-sensorimotor (birth - 2 y.o.) -Preoperational (2-7 y.o.) -concrete operational (7-11 y.o.) -formal operational (adolescence - adulthood)
STTT: nerve roots
-side bend + rotation to close foramen -myotomes & dermatomes -SLR Test & neurodynamics -Slump Test
When would you use an assistive device on the same side as the affected limb? (exceptions to the general rule)
-side of comfort/habit -to improve balance or endurance -to improve gait deviations -weak grip strength in contralateral hand -strong handedness -general safety
Objective (not subjective) sx of vascular claudication
-skin color changes -temperature changes -hair loss
How does reaching coordination change with increased age?
-slowed target approach and deceleration phase -more movement adjustments -decreasing hand steadiness
What conditions is serious spinal pathologies referring to? (4)
-spinal tumor -infection -fracture -cauda equina syndrome
What are some long term complications of organ transplants?
-steroid myopathy -osteoporosis -CAD -cancer -wound healing -infection exercise can mitigate or prevent a lot of these things
Agg Factors: chronic facet dysfunction
-stretch to joint capsule -prolonged activity
Where does pericarditis pain present?
-substernal or over the sternum, sometimes to left of midline toward the cardiac apex
Describe the PT mobility protocol for IABP patients: (hint: the order in which you progress from one mobility activity to another)
-supine ther-ex -cardiac position in bed (sitting- like in a chair) -dangle (sitting at EOB) -transfers (sit to stand) & standing trials -up to chair -pre-gait & standing exercises -gait often need more than one staff member to help them stand
What is a meniscoid? What is it's function?
-synovial folds that project to sup/inf aspects of the facet joints -limits excessive motion & provides a gliding motion
What are 3 compensations for CHF that occur?
-tachycardia -pallor (pale skin) -daytime oliguria (not urinating during the day)
Reminders of things we've heard a million times: (read)
-take VS before & after treatments -important to do some sort of warm-up activity before transfers or gait training to get blood moving -use RPE scale in addition to VS
Steps that take place after SCI (7):
-traumatic blow to spine -changes in blood flow cause ongoing damage -excessive release of neurotransmitters kills nerve cells -invasion of immune system cells creates inflammation -free radicals attack nerve cells -nerve cells self-destruct -secondary damage takes a cumulative toll
If someone has weak plantarflexors, what will their gait pattern look like?
-trouble w/ toe off in pre-swing, may result in toe drag during swing if uncompensated -compensations: hip hike, vaulting, circumduction, etc. to clear the foot
Pain Description: chronic facet dysfunction
-unilateral, less sharp -localized over facet, but can refer to broader area -TTP, *stiff & thick facets* -*no leg/nerve sx* -morning stiffness/pain -intermittent deep ache -ocassional sharp twinges (behaves like arthritis)
Pain Description: acute facet dysfunction
-unilateral, sharp pain -localized over facet -TTP over facet -somewhat debilitating -*no leg sx*
What is a vibratory sensation test?
-use a 128 Hz tuning fork to apply vibration sensation at various points on pt's foot -if they can't feel the vibration for more than 10 sec, this suggests sensory loss
Pituitary adenoma: -malignant or benign -effect of mass -what happens if untreated -affects ages:
-usually benign -mass can cause pressure in skull -effects tumor secretion -if untreated, will eventually destroy all types of cells -people ages 30-50 yo
Atraumatic causes of SCI:
-vascular -neoplastic -inflammatory -degenerative -other
What alternatives exist if a patient does not qualify for a heart transplant or is waiting for one?
-ventricular assistive devices or system -pharmacologic management -cardiomyoplasty
ROM: acute nerve root
-very limited motion -severely limits activity
How do you monitor a transplant patient's exercise tolerance?
-vital signs -RPE scale
What are some symptoms of congenital Cushing's syndrome?
-weight gain, esp in face -bruising -excess hair growth -weakness, fatigue -*loss of muscle mass* -*dec fertility* -*high BP* -high blood glucose
When a patient has any of the following symptoms they should get a medical referral: (read)
-when a client has any combination of systemic signs and symptoms of cardiac problems -women with chest or breast pain who have a positive family history of breast cancer -palpitation in any person with history of unexplained sudden death in the family. More than 6 episodes of palpitations in 1 minute or palpitations lasting for hours, shortness of breath, fainting, severe lightheadedness -fainting w/o warning period of lightheadedness, dizziness, nausea, unexplained syncope with risk factors for heart attack
How do the following affect wound assessment: -white/fair skin -black/darker skin -poor nutrition -muscle atrophy -overweight
-white: may be more sensitive -black: may be more difficult to identify stage I PU (higher incidence of SCI in this pop) -Poor nut: skin more susceptible to ulcers -atrophy: bony prominences more pronounced -overweight: moisture control and hygiene issues inc risk
What are characteristics of a shoe that Brittany likes for someone using a LE orthotic?
-wide -stable -solid on bottom brands: NewBalance & Sketchers recently
Rxn to Central/Unilateral PA: spinal stenosis
-will have pain -may have excessive motion -some can't even get into prone position -may or may not want to perform this -won't necessarily help give you additional info
When at rest, the sum of all forces is __________ ?
0
When at rest, the sum of all torques is. _________ ? What is this called?
0 Moment equilibrium
Anything below an ABI score of ____ is concerning because circulation is considered impaired at this point
0.9
What is the MA of a fixed pulley?
1
How many channels are used with MES?
1 or 2
What does it mean to say each movable pulley provides a MA of 2?
1 pulley requires 1/2 the force 2 pulleys requires 1/4 the force 3 pulleys requires 1/6 the force
What are the 2 types of joints that a locked knee KAFO can have? How does each work?
1. *bail lock*: works based on a cabling system, use depends on if the pt is able to reach down and undo the lock 2. *drop lock*: can push on a little ball to lift the lock up & allow knee motion, and push it back down if you want to lock the knee again
What types of bone injuries can MES (LIS) be used to help heal?
1. *fractures*: clavicle, humerus, radius, ulna, MCs, femur, tibia, fibula, MTs (long bones) 2. *s/p spinal fusion* 3. *wounds*: skin ulcers
What beneficial effects does HVPC have? (6)
1. *inc circulation* 2. *inc wound healing* (inc current at injury, maintain + polarity w/ anode to attract - cells to clean things up, similar to MES) 3. *dec pain* (Gate Control, pain-spasm cycle?) 4. *dec muscle spasm* (little evidence) 5. *dec muscle weakness* (little evidence) 6. *dec edema* (muscle pump due to greater contraction, dec histamine levels w/ cathode over injury site?)
What are contraindications for HVPC? (11)
1. *osteomyelitis* 2. heavy scarring 3. thick adipose tissue 4. extreme edema 5. electronic implants 6. over transcranial area 7. over ant. cervical area 8. over transthoracic area 9. over neoplastic area 10. over hemorrhagic area 11. over pregnant abdomen/lumbar
Intervention Strategies for CS patents: (read) 1. education 2. ergonomics 3. TherEx 4. adaptive equipment 5. modalities 6. manual therapy
1. *posture re-education* 2. head straight forward, head set instead of phone, elbows at 90 deg, wrists in slight ext, chair w/ lumbar support, take frequent breaks-- avoid being in one posture for too long 3. specific strengthening & stretching, scapular mm exercises 4. cervical collars, head sets 5. -- 6. mobilization, soft tissue, TS manipulation
What is the MOI of posterolateral rotatory instability of the elbow?
1. *trauma or dislocation* usually from a FOOSH 2. LCL instability 3. iatrogenic causes
What are the most common diagnoses that lead to lung transplants? (3)
1. COPD- emphysema (44%) 2. idiopathic pulmonary fibrosis 3. cystic fibrosis 4. other: idiopathic pulm HTN, sarcoidosis, etc.
Prosthetic causes of "medial whip" gait deviations in a transfemoral amputee: (5)
1. ER of knee 2. tight socket 3. incorrect foot rotation 4. cylindrical socket shape vs. anatomical 5. heel too stiff (1-2 are exact opposite, 3-5 are the same as lateral whip)
Prosthetic causes of "lateral whip" gait deviations in a transfemoral amputee: (5)
1. IR of knee 2. loose socket 3. incorrect foot rotation 4. cylindrical socket shape vs. anatomical 5. heel too stiff (1-2 are exact opposite, 3-5 are the same as medial whip)
2 main reasons for medical management of MS:
1. Steroids: helpful in acute relapses to shorten the length & improve the outcome 2. Disease Modifying Treatment: help to dec # & severity of relapses (Ex: interferons, Natalizumab) (3. Symptomatic Treatment)
What should you look for in bench alignment in the A/P view of a transfemoral prosthesis? (2)
1. TKA should travel from the trochanter down to the front of the heel 2. initial 5-10 deg of socket flexion (if 0 deg contracture)
Amputee causes of "abducted gait" deviations in a transfemoral amputee: (2)
1. abduction contracture 2. poor gait habit due to insecurity- widen base to inc stability (same as wide gait)
Amputee causes of "wide gait" deviations in a transfemoral amputee: (2)
1. abduction contracture 2. poor gait habit- pt insecure & widens base to inc stability (same as abducted gait)
2 types of lumbar facet (zygoapophysial) joint issues
1. acute 2. chronic
Describe the pattern of a modified 4-point gait pattern:
1. assistive device 2. affected LE to step-length parallel to the device 3. unaffected LE to/past the device
Describe the pattern of a modified 2-point gait pattern:
1. assistive device and affected LE 2. unaffected LE to/past device
Pain patterns can help you determine if a pt has an upper or lower CS issue. What are the pain patterns of the following regions of the CS: 1. upper CS 2. C4-5 3. C5-7
1. base of neck, head & face 2. base of neck & top of shoulder 3. scapula, shoulder, post/lat upper arm
What are our top priorities in acute care of a stroke patient? (5)
1. control life-threatening problems 2. prevent recurrent stroke (initial bed rest, monitor vitals) 3. prevent complications (DVT, aspiration, falls, pressure ulcers) 4. manage general health (DM) 5. mobilize & resume self-care when medically stable
List the steps to solving a pulley problem
1. convert mass to F 2. count movable pulleys to find MA 3. MA = FA/RA 4. F(FA) = R(RA) solve for whatever is missing
How does cervical DDD affect the following: 1. disc height 2. cervical lordosis 3. segmental mobility
1. dec 2. dec (greater dec = greater pain) 3. initial hypomobility, but all degenerative changes will eventually result in *hypermobility & instability*
Amputee causes of "uneven pelvic rotation" gait deviations in a transfemoral amputee: (4)
1. dec pelvic rotation 2. fear of falling 3. weak abductors, excessive adductors 4. habit
Describe the pattern of a modified 3-point gait pattern:
1. device 2. affected LE 3. unaffected LE to/past device
Describe the pattern of a 3-point gait pattern:
1. device and affected LE 2. unaffected LE to/past device
Therapy goals for "lateral whip" gait deviations in a transfemoral amputee: (3)
1. encourage proper donning 2. strengthen hip ERs 3. stretch hip flexors & adductors
Therapy goals for amputees with "medial whip" gait deviations: (2)
1. encourage proper donning 2. strengthen internal hip rotators & extensors
Physical Therapy Interventions for MS
1. energy conservation techniques 2. spasticity management 3. skin care 4. gait/functional training 5. CV fitness 6. home/work adaptations 7. education 8. balance training
Prosthetic causes of "knee instability" gait deviations in a transfemoral amputee: (5)
1. excessive dorsiflexion 2. knee aligned in unstable position- need to move it more posterior to fix it 3. insufficient socket flexion- esp. w/ contractures 4. poor foot alignment 5. incorrect knee settings (upon IC, knee flexes the user had to forcefully extend it back which results in a jerky motion in MS)
Amputee causes of "heel rise" gait deviations in a transfemoral amputee: (1)
1. excessive use of hip flexors to initiate swing, overpowering knee unit
What should you look for in static alignment of a transfemoral prosthesis? (5)
1. height of prosthesis 2. verify knee center matches sound side 3. pylon is vertical 4. trim lines & comfort of socket 5. knee is stable, foot is flat, & back has a normal lordotic curve
Therapy goals for "lateral trunk bend" gait deviations in a transfemoral amputee: (2)
1. improve balance 2. strengthen core
What do glucocorticoids do to control asthma long term? (6)
1. inhibit the migration of leukocytes and mast cells 2. reduce tissue stores of histamine and other mediators 3. stabilize mast cell membranes 4. supress kinin activity 5. potentiate catecholamine activity 6. reduce activity of phophodiesterase (enzyme that inactivates cAMP)
3 neural mechanisms for eye-hand coordination
1. locating targets in periphery - primarily eye movements 2. locate objects further in periphery - eye and head movements 3. locate objects even further in periphery - eye, head and trunk move
What are the different types of knee ankle foot orthoses (KAFOs) we learned about?
1. locked knee 2. posterior offset 3. stance control
Prosthetic causes of "circumducted gait" deviations in a transfemoral amputee: (3)
1. long prosthesis 2. excessive knee friction 3. excessive knee stability (2 & 3: can't flex knee, doesn't allow heel rise)
Prosthetic causes of "toe drag" gait deviations in a transfemoral amputee: (3)
1. long prosthesis 2. excessive plantarflexion 3. excessive knee friction
Prosthetic causes of "wide gait" deviations in a transfemoral amputee: (3)
1. long prosthesis 2. high medial wall 3. insufficient femoral stability (basically the same as abducted gait in function, in this case they prefer the wide gait, in abducted they can't always control it) (same as abducted gait answers)
Prosthetic causes of "abducted gait" deviations in a transfemoral amputee: (3)
1. long prosthesis 2. high medial wall 3. insufficient femoral stability, may cause distal-lateral femoral pressure, not able to keep femur in its natural adduction angle -induces medial whip- (same as wide gait)
Prosthetic causes of "vaulting" gait deviations in a transfemoral amputee: (5)
1. long prosthesis 2. poor suspension 3. excessive plantarflexion (easy to fix) 4. excessive knee resistance/stability* 5. inadequate knee extension assist
MS disease process
1. lymphocytes & macrophages destroy myelin in CNS 2. intermittent bursts of focal inflam in CNS (plaques) 3. demyelination 4. axonal degeneration
How can people "learn" under a massed practice condition when the data from their performance during acquisition is so compromised?
1. massed practice may result in more variability during performance which can be a good thing for learning 2. massed practice may require more effort for learning which can be a good thing
Vascular or Neurogenic Claudications: 1. take away the pressure, the sx go away 2. take away the workload, the sx go away
1. neuro 2. vascular
What are the 2 different types of heart transplants?
1. orthotopic heart transplant: donor heart replaces original heart (more common) 2. heterotopic heart transplant: donor heart attached to original heart
What are the 4 types of neuropathy?
1. peripheral 2. autonomic 3. proximal 4. focal
What are the 3 types of recurrent elbow instability?
1. posterolateral rotatory instability 2. valgus instability 3. varus posteromedial rotatory instability
What are contraindications for using a KAFO? (5)
1. spasticity 2. poor balance or ataxia 3. knee flexion contracture >10 deg 4. uncorrectable valgus/varus >15 deg 5. hip flexion strength <3/5
Therapy goals for "uneven pelvic rotation" gait deviations in a transfemoral amputee: (3)
1. strengthen aBductors 2. stretch aDductors 3. gait training
Therapy goals for "knee instability" gait deviations in a transfemoral amputee: (2)
1. strengthen hip extensors 2. stretch hip flexors
Therapy goals for "toe drag" gait deviations in a transfemoral amputee: (2)
1. strengthen hip extensors (of sound leg) & abductors 2. encourage pelvic motion to initiate enough knee flexion for swing phase
Therapy goals for "uneven timing" gait deviations in a transfemoral amputee: (2)
1. strengthen hip flexors & extensors 2. improve balance
Therapy goals for "wide gait" deviations in a transfemoral amputee: (2)
1. stretch abductors 2. strengthen core, RL & sound limb (same as abducted gait)
Therapy goals for "abducted gait" deviations in a transfemoral amputee: (2)
1. stretch abductors 2. strengthen core, residual limb & sound leg (same as wide gait)
What is happening when people say their back "locked up"?
1. sudden motions, such as flexion & rotation, can cause too much tension on joint capsule 2. causes displacement & entrapment of meniscoid in facet joint 3. causes reflexive hyperactivation of superficial muscles
What are the different types of foot orthoses we learned about?
1. supramalleolar: SMO / DAFO
Amputee causes of "toe drag" gait deviations in a transfemoral amputee: (4)
1. weak hip extensors on sound side (or residual limb hip flexors) 2. weak hip abductors on sound side (hip drop on residual limb) 3. poor posture 4. poor gait habits
Therapy goals for "external foot rotation" gait deviations in a transfemoral amputee: (1)
1. work on donning correctly
Therapy goals for "internal foot rotation" gait deviations in a transfemoral amputee: (2)
1. work on donning correctly 2. more upright position during ambulation
If a patient survives their first stroke, how likely is it that they will have a second stroke?
10-20% have a 2nd stroke
Response type: reaction time -time -modified by instructions? -affected by the # of choices?
120-180 yes yes
When does the deltoid kick in for shoulder abduction?
15 degrees
When did we start doing heart & lung transplants? (read)
1968- heart transplant 1981- heart & lung transplant 1983- lung transplant
Define: assimilation (Piaget's)
1st step of learning a new thing -understanding an object based on knowledge of existing structures
How many points of floor contact are maintained throughout a 2-point gait pattern?
2
If ___ of 3 P's are present, an _____ is very unlikely
2 of 3 MI
If a pt is only partially able to assist, do not lift over ______ lbs
200
How many points of floor contact are maintained throughout a 4-point gait pattern?
3
Most orthotics revolve around a ___________ pressure system
3-point orthotic designs are based on this
Which type of gait pattern uses an alternate, reciprocal pattern?
4-point pattern
Mortality rates after an amputation increase by ___ % at one year, and by ___ % at 5 years ****
40% one year 80% five years
Angina has a lag time of ______ to _______ minutes, why is this an important characteristic?
5-10 musculoskeletal pain can occur immediately after physical activity, helps determine origin of pain
What % of diabetic patients will develop neuropathy?
50%
Response type: long-loop reflexes -time -modified by instructions? -affected by the # of choices?
50-80 ms yes no
Central & lateral cervical stenosis are most common in adults > ___ years of age
55 (also can affect high contact sport athletes)
If head movement is required for location of a target, typically the head only moves ______% to _____% of the distance to the target
60-75%
How long does outpatient PT typically last for a transplant patient after hospital discharge? What are the goals of outpatient rehab?
8-12 weeks Similar to inpatient: -strength -aerobic conditioning -independence w/ HEP -education on self-monitoring -education on posture again -MSK problem solving
**Reminder: go back and review ASIA practice charts from lecture**
:)
**re-listen to Central Auditory Pathways slide**
:)
What is Newton's first law?
A body at rest will remain at rest unless acted on by a resultant force (law of intertia/equilibrium)
What is Newton's second law?
A body subjected to a resultant force will accelerate in the direction of the force & the magnitude of acceleration will be proportional to the force magnitude F=ma or Weight=mg
What is treatment for vaginismus like?
A comination of education, counseling & behavioral sciences. Vaginal dilation exercises under the direction of a PT or sex therapist.
What is vaginismus?
A condition involving involuntary spasms of the muscles surrounding the vagina which close the vagina and makes intercourse difficult or even impossible
What is the perineal body?
A thick connective tissue mass that serves as the site of insertion of many urogenital muscles
GOGOQ muscles' common function:
ER hip
What is the function of infraspinatus?
ER the arm
How often should a patient with neuropathy have their feet visualized at medical visits?
EVERY medical visit
What does the superficial perineal space contain?
Erectile tissue & muscles of the external genitalia
What is the function of the pelvic diaphragm?
Essential for maintaining the proper positioning of the pelvic organs Essential for maintaining abdominal & thoracic pressure during micturation, defecation, child birth, and heavy lifting
Racial distribution of MS
European & Caucasians are at a higher risk
Nervous system maturation can be categorized into 2 categories. Name them:
Experience-dependent Experience-expectant
Where is the lesser/true pelvis located?
Extends from pelvic brim to the pelvic floor/diaphragm
Which anal sphincter muscle is under voluntary control?
External anal sphincter
What structures does the urogenital triangle include in both males and females?
External genitalia and urethra of both sexes
Internal Intercostal (only F)
F: -interchondral portion: raise ribs -*lateral fibers: depress ribs*
In HVPC for pain therapy, what parameters are used? -frequency -mode -amplitude -length of treatment
F: arbitrary M: *continuous* A: arbitrary LOT: arbitrary *there isn't great evidence for this*
Levator Costarum (only F)
F: elevate ribs during inspiration
External Intercostal (only F)
F: raise ribs during inspiration
What is the equation for force? What unit is it in?
F=ma (N or lbs)
What is a first class lever?
FAR Ex: neck
FYI: Beta receptors are activated (by a drug) and they stimulate adenyl cyclase which starts a signal cascade that acts on the contractile proteins of smooth muscle cells to induce relaxation
FYI
FYI: Leukotrine blockers can be used to treat mild, persistent asthma, or can be combined with corticosteroids to treat moderate to severe asthma
FYI
FYI: Once the anti-leukotrines are bound, the receptor cannot be activated
FYI
FYI: PT's are among the top 10 professions with greatest risk of back injury
FYI
FYI: Some reports state that methylxanthines enhance diaphragmatic contractility, reduce patient complaints of dyspnea, and improve exercise tolerance and gas exchange
FYI
FYI: all bronchodilators for this module are listed under asthma treatment, but can also be used to treat other respiratory conditions such as COPD abd other infections
FYI
FYI: an inhaler should be sprayed two times before use to "prime" it
FYI
FYI: antitussive drugs have different names when packaged for respiratory problems than when packaged for pain control but are also use for treatmetn of musculoskeletal conditions
FYI
FYI: approximately 38% of nurses and 42% of radiation techs have suffered injuries due to moving, lifting or repositioning patients
FYI
FYI: basically all of the drugs talked about for treatment of asthma can apparently be used for treatment of allergies as well...and for other obstructive diseases like COPD
FYI
FYI: health professions are more dangerous than construction work or farming due to prevalence of back injuries incurred while lifting obese patients
FYI
FYI: sudafed is a common expectorant, but it also contains pseudoephedrine, which is a sympathomimetic, meaning that it activates the sympathetic nervous system
FYI because I don't know what this means but feel like it might be important...
T/F: ECMO patients are still typically mobilized
False-- don't typically mobilize them bc it's a temporary thing and would be v difficult to do
T/F: people w/ chronic facet joint dysfunction only have localized pain over the facet joints
False-- the most intense pain is likely right over the facet, but the pain pattern can refer more broadly
T/F: patients who are intubated can not be treated
False-- they can be, but depends on alertness, often medicated or sedated bc intubation is uncomfortable
T/F: it is normal for an LVAD patient to have an INR of 2.5 or higher
False-- they normally have an elevated INR of 1.5-2.5, but over 2.5 is considered high for them
What does most of the anal triangle contiain? What is this space called?
Fat to allow expansion of the anus during defecation Ischioanal/Ischiorectal fossa
What are signs and symptoms of CHF?
Fatigue and weakness Dyspnea (breathlessness) Shortness of breath expecially with exertion exercise intolerance cold intolerance dizziness
Is the female or male true pelvis more wide & shallow?
Female
What is the subpubic angle of males and females? ****
Female: 90 degrees Male: 60 degrees
Is the pelvic outlet larger in females or males?
Females
Gender distribution of MS
Females are at a higher risk (3:1 ratio)
What type of joint is the pubic symphysis?
Fibrocartilaginous joint with an interpubic disc between the pubic bones
What are the 2 types of pulleys?
Fixed or movable
What is Newton's third law?
For every action, there is an equal and opposite reaction
What does a dynamometer measure?
Force
Define work What unit is it measured in?
Force applied over a distance W=F/d (measured in joules or Nm)
Define pressure
Force applied within an area (P = F/A)
What is the name of the instrument that is a rigid platform used to amplify and transduce forces?
Force plate
Ground/Joint reaction forces are equal and opposite to what?
Forces produced by humans
What are some advantages and disadvantages of an articulated AFO?
A: addresses multiple biomechanical functions, varying levels of adjustability D: size, weight & cosmesis
What are the advantages and disadvantages of a metal upright AFO?
A: easily adjustable, max stabilization, allows for fluctuating volume of LEs (lymphedema) D: major concerns for weight & cosmesis (Forrest Gump), only attached to 1 pair of shoes
What are some advantages & disadvantages of a locked knee KAFO?
A: maximal stability D: inc energy expenditure, creates functional leg length discrepancy
What is a second class lever?
ARF Ex: gastroc/soleus complex
Where does the inguinal ligament attach?
ASIS
What lymphatics are responsible for the area of the rectum above and below the pectinate line?
Above: internal iliac nodes Below: inguinal nodes
What does an accelerometer measure?
Acceleration forces including both static & dynamic forces -can determine angle of a device -can determine movement of a device
B/w acute & chronic nerve root injuries, which one has a greater limitation of activity?
Acute: big limitation Chronic: minimal limitation
B/w acute & chronic nerve root injuries, which one has more prominent distal sx and which one has more prominent proximal sx?
Acute: distal sx Chronic: proximal sx
MOI: acute vs chronic cervical facet syndrome
Acute: sudden neck mvmt that results in impingement of meniscoid w/in facet joint Chronic: chronic inflam leading to degeneration of the facet joint due to arthritis or injury
How should you adjust a transfemoral prosthesis if the user has a hip flexion contracture? ********
Add socket flexion to the point where there is 5 deg more socket flexion than the flexion contracture, this is essentially giving them back 5 deg of hip extension
What is the function of teres minor?
Adducts and ER arm
What are the new standards for determining if someone has hypertension and at a level where medical management would be needed?
Ages < 60 = 140/90 equates medical management Ages > 60 = 150/90 equates medical management *BP < 80/40 is considered hemodynamic compromise
Agg/Ease Factors: general neck pain
Agg: arm mvmts Ease: placing their hand on the top of their head relieves neck sx
With a spinal stenosis patients, their leg symptoms are aggravated by ____________ posture and decreased with ______________ posture options: flexion, extension
Aggravating: extension Relieved: flexed
What is the lateral boundary of the greater pelvis?
Ala of ilium, iliacus muscle
What motions does a SMO allow/restrict?
Allows: full dorsiflexion & plantarflexion Restricts: pronation & supination
What motions does a semi-solid AFO allow/restrict?
Allows: some dorsiflexion *in late stance* Restricts: provides some M-L stability
Define SCI
An injury to the spinal cord resulting in a change - either temporary or permanent - in its normal sensory, motor or autonomic function
What does an inclinometer measure?
Angles
What is the sacral promontory normally covered with?
Anterior longitudinal ligament
Where is the perineum located?
Area between thighs that extends from the coccyx to the pubic symphysis It is the outlet of the pelvis
What test can be done to test for a rotator cuff tear?
Arm drop test
What is the blood supply (artery & vein) to the part of the rectum above the pectinate line provided by?
Artery: IMA Vein: portal venous system
What is the blood supply (artery & vein) to the part of the rectum below the pectinate line provided by?
Artery: internal iliac A Vein: IVC
Painful Arc Syndrome
Ask pt to abduct arm and see if they have pain with the motion
Where is the greater/false pelvis located?
From the iliac crests to the pelvic brim/inlet
What is the function of the puborectal sling and what is it formed by?
Function: maintain fecal continence, relieves pressure on anal sphincters Formed by: puborectalis portion of levator ani muscle
Which hyperthyroid condition is an autoimmune disorder?
Grave's disease (Hashimoto's thyroiditis is also an autoimmune disorder but it is a hypothyroid condition)
Which direction do the following forces act: gravity, shear, tensile and compressive? Are they coplanar or colinear?
Gravity: always vertically down Shear: coplanar, in opp direction Tensile: colinear, in opp direction Compressive: colinear, in similar directions to push together
How are pelvic fractures treated that do not involve significant displacement?
Bed rest, external stabilization is not needed
Drugs that can be used to treat asthma (read)
Beta-agonists Glucocorticoids Parasympathetic blockers Methylxanthines Mediator-release inhibitors Leukotrine blockers
Where is the subacromial bursa located?
Between the tendon of the supraspinatus and the acromain, coracoacromial ligament, and deltoid
Iliocostalis, Longissimus & Spinalis: only F
Bilateral: -extends back -compresses each segment -eccentric: controls first few deg of trunk flexion -ant tilt of pelvis via TLF Unilateral: -lateral flexion -rotation
What is an example of a good abdominal exercise for a MSI lumbar flexion or rotation patient?
Bird Dog -position w/out kyphosis -work abdominals as well as back extensors -teach them to control rotation while lifting extremities
What are the different classifications of pelvic outlets? (4)
Gynecoid: typical female Android: typical male Anthropoid: elongated pelvis Platypelloid: flat pelvis
What endocrine disorder is associated with other autoimmune diseases such as lupus, type 1 diabetes mellitus, pernicious anemia, myasthenia gravis or rheumatoid arthritis?
Hashimoto's thyroiditis
Arm Drop Test
Have pt abduct arm, on the way down, about parallel to floor, their arm will drop if its a positive test
What is an example of a good abdominal exercise for a MSI extension or rotation patient?
Heel Slides -supine w/ knees bent is a comfortable position for these people, eventually want them to be able to lay flat w/out pain or pelvic rotation -work abdominals and also stretches stiff hip flexors
What are a stroke patients options for PT after they have been discharged from a rehab hospital or sub-acute care? (2) Which patients are candidates for these options?
Home Care: -functionally homebound patients Outpatient: -pts live at home & mobile in community
How is DIS (dissemination in space) demonstrated in a potential MS patient?
DIS demonstrated by 2 of: -MRI brain -MRI cord -CSF oligoclonal bands
What do straddle injuries result in?
Damage to external genitalia may bleed into the superficial perineal space The area the blood/urine can spread to is limited by the superficial perineal membrane and where it attaches Does not extend into thighs or around anus, does not go above arcuate line in abdomen
What fascia is the perineal membrane a part of?
Deep fascia
What are the 3 parts of the external anal sphincter muscle?
Deep, superficial, and subcutaneous external sphincters
What does the axillary nerve innervate?
Deltoid and teres minor
What can be estimated by transvaginal palpation? Why is this information helpful?
Diagonal conjugate Used to estimate the true & obstetrical conjugate which is the pathway of the baby
What is the perineum shaped like?
Diamond, can be separated into 2 triangles
How would the pain description differ between ventral and dorsal spinal nerve stimulation?
Dorsal: myotome & dermatome-like symptoms Ventral: deep, dull ache, associated w/ muscle spasms (Cloward Signs)
What is the difference b/w an ischemic & hemorrhagic stroke?
I: clot blocks blood flow to an area of the brain H: bleeding leads to less blood flow to the brain
How may glucocorticoids be administered?
IV (ER) inhalers oral medication
What is the purpose of producing hormones to relax pelvic joints during pregnancy?
Increase the birth canal size, especially the lateral dimension
What is the function of supraspinatus?
Initiate abduction of arm
Which anal sphincter muscle is tonically contracted but relaxes to release gas and fecal material?
Internal anal sphincter
What is used to determine joint forces?
Inverse dynamics- obtain kinematic data using video analysis system & force plates. Similar to FBD - JRF
What bony structure causes the transverse diameter of the pelvic inlet to be smaller?
Ischial spines
What is the lateral border of the perineum?
Ischial tuberosities
What is the function of the subacromial bursa?
It attempts to reduce friction that supraspinatus experiences
What causes an injury to the thoracodorsal nerve?
It can be injured in surgery
As the moment arm increases, what happens to the magnitude of torque?
It increases
Why is the sacral hiatus clinically important?
It is a site of injection into the caudal epidural space
With an AFO, are you more likely to see skin issues up high around the proximal tibia or down low around the ankle or foot?
Jason said he rarely sees issues up high, but he often sees skin issues around the malleoli or MT heads also on toes if they are gripping the bottom of the AFO (neuro pt's)
What kind of accidents may lead to displacement of the head of the femur through the head of the acetabulum?
Jumping accidents (parachuting)
Inverse dynamics, work, power, pressure, and friction are all associated with what branch of dynamics?
Kinetics
Is neck or low back pain more prevalent?
LBP (LBP affects 80% of world population, neck pain affects 20-30% of world population)
Which muscles forms part of the posterior wall of the axilla?
Latissimus dorsi, teres major, subscapularis
Which muscles form the pelvic diaphragm/floor?
Levator ani Coccygeus
What does the dorsal scapular nerve innervate?
Levator scapulae and rhomboids
Pathophysiology: lumbar vs cervical DDD
Lumbar: -NP dries out (loss of proteoglycans) -AF is less organized (type 1 --> type 2 collagen & fibers start to fray) Cervical: -degeneration starts at sides (near U joints) of disc & migrates towards the middle -eventually the disc splits in two
What is the equation for mechanical advantage?
MA = df / dr force arm / resistance arm
Which type of e-stim is "similar to the body's current"?
MES (b/c the amplitude is low)
Is the female or male greater pelvis more narrow?
Male
Bronfenbrenner's Bio-Ecological Modal covers 5 components. What are they?
Microsystem: activities and interaction in immediate surroundings Mesosystem: relationships among people involved in child's microsystem Exosystem: social institutions which affect children indirectly (parent's work) Macrosystem: broad cultural value and governmental resource Chronosystem: changes that occur in child's life (i.e. birth of sibling or war in the world)
List some modifiable & non-modifiable stroke risk factors:
Modifiable: -smoking -diet -exercise -stress -non-compliance w/ meds -comorbidities: DM, HTN, etc. Non-Modifiable: -age -gender -race -genetics -hx of previous strokes
Define kinetics
Motion, forces that create motion
Define kinematics
Motion, relationship b/w displacement, velocity & acceleration
ASIA class D
Motor incomplete - motor function is preserved below the neurological level and at least half of key muscle functions below the NLI have a muscle grade of >3 (3-5)
What is the pelvic diaphragm/floor? What does it attach to?
Muscular funnel that surrounds the anal canal Stretches from pubic symphysis anteriorly to the coccyx posteriorly, and is attached to the obturator internus muscle on each side (laterally)
Leukotrine blockers are all categorized into the broader group of ________
NSAIDs
If the force passes through the axis, is there torque/moment?
No
Is the subclavius an important muscle?
No, we do not use it anymore. It is more important for animals on all fours.
Does the sacroiliac joint permit much movement?
Not normally, but during pregnancy it does due to hormones produced to relax the ligaments to allow the birth canal to be more flexible
Transversus Abdominis (no N)
O/I: pubic symphysis, iliac crest, lower rib cage, thoracolumbar fascia, spine F: stabilizes trunk before limb & trunk mvmt, minimizes ant shearing (when you contract TA you are also contracting MTF due to TLF connection)
Longus Coli
O/I: segmental attach. (TVP to V body) in TS to occiput F: posture, B flexion, U rot/SB, eccentrically controls extension
Diaphragm (N & F)
O/I: xiphoid process, int surface of lower ribs, LS & arcuate lig N: phrenic N (C3-5) F: principle muscle of inspiration, trunk control, resting tone inc before extremity mvmt -inhale: diaphragm inc, TA & PFM dec -exhale: diaphragm dec, TA & PFM inc
Palmar Interossei
O: I: extensor expansion, base of prox. phalanx N: ulnar N F: adduct digits
Vastus Lateralis, Medialis & Intermedius
O: -Lat: greater trochanter, lat. linea aspera -Med: intertrochanteric line, med. linea aspera -Inter: shaft of femur I: quad tendon N: femoral N F: extend knee
Biceps Brachii
O: -SH: coracoid process -LH: supraglenoid tubercle I: radial tuberosity N: musculocutaneous N F: flexes shoulder & elbow, supinates forearm when elbow is flexed to 90 deg
Dorsal Interossei
O: I: extensor expansion, base of prox. phalanx N: ulnar N F: abducts digits
Triceps Brachii
O: -LH: infraglenoid tubercle -SH: post. surface of humerus -LatH: post. surface of humerus I: olecranon of ulna N: radial N F: extends elbow, LH extends & adducts shoulder
Biceps Femoris
O: LH: ischial tuberosity SH: linea aspera, supracondylar ridge of femur I: fibular head (& lateral condyle of tibia) N: sciatic N F: extend hip, flex knee
Subclavius (no N)
O: 1st rib I: inferior surface of mid 1/3 of clavicle F: anchors & depresses clavicle
What is the O, I, N, F of subclavius?
O: 1st rib and its cartilage I: middle 1/3 of clavicle on inferior surface N: subclavius nerve F: anchors and depresses clavicle
Rectus Femoris
O: AIIS I: quad tendon N: femoral N F: flex hip, extend knee
What is the O, I, N, F of rhomboid minor?
O: SP of C7-T1 I: medial border of scapula N: dorsal scapular nerve F: retracts scapula
Rhomboid Major
O: SP of T2-5 I: medial border of scapula N: dorsal scap N, C5 F: adduct & downward rotation of scapula
What is the O, I, N, F of rhomboid major?
O: SP of T2-T5 I: medial border of scapula N: dorsal scapular nerve F: retracts scapula
Latissimus Dorsi
O: SP of T5-12, thoracolumbar fascia, iliac crest, ribs 9-12 I: bicipital groove of humerus N: thoracodorsal N F: adduct, extend, & IR arm
Rotatores (only O & I)
O: TVP I: SP 1-2 levels up
Deltoid
O: acromion, clavicle, spine of scapula I: deltoid tuberosity N: axillary N F: ant- flex, mid- abduct, post- extend, keeps head in socket during movement (esp. when carrying things)
Flexor Pollicis Longus
O: ant. radius, interosseous membrane I: base of 1st distal phalanx N: median N F: flexes IP joint of thumb**, 1st MCP joint & wrist
Piriformis
O: ant. surface of sacrum, sacrotuberous lig I: greater trochanter N: L5, S1-2 F: abducts hip (ortho- ER below 60 deg of hip flexion, IR above 90 deg hip flexion)
Extensor Hallucis Brevis
O: dorsal calcaneus I: dorsal aponeurosis & base of proximal phalanx of big toe N: deep fibular N F: extend MTP of big toe
Extensor Digitorum Brevis (of foot)
O: dorsal calcaneus I: dorsal aponeurosis & bases of middle phalanges of 2-4 N: deep fibular N F: extend MTP and PIP of digits 2-4
Opponens Pollicis
O: flexor retinaculum, scaphoid & trapezium I: 1st metacarpal N: median N F: opposes thumb
Adductor Magnus: Adductor Part
O: inf. pubic ramus, ischial ramus I: gluteal tuberosity, linea aspera, med. supracondylar line N: obturator N F: adduct & flex hip
What is the O, I, N, F of teres major?
O: inferior angle of scapula I: medial lip of intertubercular groove N: lower subscapular N F: adduct, IR arm
Infraspinatus
O: infraspinous fossa I: greater tubercle of humerus N: suprascapular N F: ER arm
Transverse Thorasis (focus on F)
O: inner surface of sternum I: inner, anterior surface of ribs 2-6 F: *depress ribs during heavy exercise
Tibialis Posterior
O: interosseous membrane, borders of tibia & fibula I: navicular tuberosity, all 3 cuneiforms, bases of 2-4 MTs N: Tibial N F: plantarflexion, inversion
Semimembranosus
O: ischial tuberosity I: medial condyle of tibia N: sciatic N F: extend hip, flex knee
Semitendinosus
O: ischial tuberosity I: pes anserinus N: sciatic N F: extend hip, flex knee
Extensor Carpi Ulnaris
O: lat. epicondyle I: base of 5th metacarpal N: radial N F: extends & adducts/UD wrist
Teres Minor
O: lateral border of scapula I: greater tubercle of humerus N: axillary N F: adduct & ER arm
Trapezius
O: lig. nuchae, SP of C7-T12 I: spine of scapula, acromian, lateral 1/3 of clavicle N: CN XI, C3-4 F: elevate, retract/adduct, depress & rotate scapula
Serratus Posterior Superior
O: lig. nuchae, supraspinoug lig, SP of C7-T3 I: upper border of ribs 2-5 N: 1st 4 intercostal NN F: elevates ribs (focus on N & F)
Opponens Digiti Minimi (of foot)
O: long plantar lig I: 5th MT N: lateral plantar N F: pulls 5th MT in plantar & medial direction slightly
Flexor Hallucis Brevis
O: med & inter cuneiform I: prox. phalanx of big toe N: -MH: medial plantar N -LH: lateral plantar N F: flex 1st MTP joint
Gastrocnemius
O: med & lat epicondyles of femur I: calcaneal tuberosity N: tibial N F: plantarflexion, inversion, knee flexion
Lumbricals 1-4 (of foot)
O: med border of FDL tendons I: dorsal aponeurosis of digits 2-5 N: -1-2: medial plantar N -3-4: lateral plantar N F: flex MTP, extend IP of digits 2-5, also adducts digits 2-5
Abductor Hallucis
O: med calcaneal tuberosity I: prox. phalanx of big toe N: medial plantar N F: flex & med abduction of big toe
Flexor Digitorum Brevis (of foot)
O: med calcaneus I: middle phalanges of digits 2-5 N: medial plantar N F: flex MTP & PIP of digits 2-5
Flexor Carpi Radialis
O: med. epicondyle I: 2nd metacarpal N: median N F: flex & abduct wrist
Palmaris Longus
O: med. epicondyle I: flexor retinaculum & palmar aponeurosis N: median N F: flexes wrist used to be used to protract nails, ~15% of Caucasians don't have it anymore
Pectoralis Minor
O: outer surface of ribs 3-5 I: coracoid process N: med pectoral N F: depress scapula or elevate ribs if scap is fixed (double check O & I, shoulder lecture had them flipped)
Abductor Digiti Minimi
O: pisiform I: base of proximal phalanx of 5th digit N: ulnar N F: abducts (& helps flex) proximal phalanx of 5th digit
Soleus
O: post fibular head, soleal line of tibia I: calcaneal tuberosity N: tibial N F: plantarflexion, inversion
Flexor Hallucis Longus
O: post fibular shaft I: base of distal phalanx of big toe N: Tibial N F: plantarflexion, inversion, flex MTP & IP joints of digit 1
Gluteus Medius & Minimus
O: post. surface of ilium I: greater trochanter N: sup. gluteal N F: -hip: abduct & IR -trunk (glute med): pelvic stabilization
Abductor Pollicis Longus
O: post. surface of ulna, radius & interosseous membrane I: base of 1st metacarpal* N: radial N F: abducts & extends the thumb at CMC joint
What is the O, I, N, F of serratus anterior?
O: ribs 1-8 external lateral surface I: medial border of scapula N: long thoracic nerve F: hold scapula against thoracic wall, protracts and abducts scapula (rotates inferior angle)
What is the O, I, N, F of pectoralis minor?
O: ribs 3-5 I: coracoid process N: medial pectoral nerve F: elevates ribs, protracts scapula, and fixes scapula to thoracic wall
Extensor Carpi Radialis Longus
O: supracondylar ridge of humerus I: base of 2nd metacarpal N: radial N F: extends & abducts/RD the wrist
Brachioradialis
O: supracondylar ridge of humerus I: lat. surface of radius N: radial N F: flexes elbow, supinates forearm & wrist (doesn't work in anatomical position bc elbow doesn't bend laterally)
Supraspinatus
O: supraspinous fossa I: greater tubercle of humerus N: suprascapular N F: initial 15 deg of abduction
What is the lateral boundary of the true pelvis?
Obturator internus muscle***
What do pelvic fractures from car accidents usually look like?
Often involve displacement of the pubic symphysis posteriorly, breaking the superior and/or inferior rami The pelvis rarely breaks in one place (like a pretzel) ***
Which bones make up the bony pelvis?
Os coxae (2) Sacrum Coccyx
Is a female pelvic brim oval or heart shaped?
Oval shaped Male is heart shaped
What are symptoms of a rotator cuff tear?
Pain in the anterosuperior part of the shoulder
Two categories of SCI 4 types of SCI
Paraplegia -complete -incomplete Tetraplegia -complete -incomplete
What are the consequences of an injury to the thoracodorsal nerve?
Patient is unable to use an axillary crutch because there will be no counter force. They also will not be able to climb or do monkey bars
Who is at risk for autonomic dysreflexia?
Patients with SCI of T6 or higher
What muscle forms the anterior wall of the axilla?
Pectoralis Major
What are the muscles in the anterior group of the shoulder?
Pectoralis major & minor, subclavius, and serratus anterior
What area of the body is the inferioposterior portion of the abdomen?
Pelvis
What are the external genitalia and urethra built up on for support?
Perineal membrane
What are the "Three Ps"? What is their purpose?
Pleuritic pain Pain on palpation pain with changes in position they help to determine if the origin of pain is due to musculoskeletal or cardiac involvement
What is the cause of vaginismus?
Possible causes include religious upbringing, psychological factors, past sexual trauma, or history of discomfort with sexual intercourse
What exits the quadrangular space?
Posterior circumflex humeral artery and axillary nerve
What covers the sacral hiatus?
Posterior sacrococcygeal ligament
Type of MS: steady increase in disability without attacks
Primary Progressive
What hormones are produced during pregnancy that are responsible for making the pelvic joints more mobile, especially the pubic symphysis?
Progesterone Relaxin
Type of MS: steady decline since onset with superimposed attacks
Progressive-Relapsing Notes: little improvement in sx b/w relapses
External & Internal Oblique: only F
Proximal Attach Moving: -B: trunk flexion -U: trunk rotation Distal Attach Moving: -B: EO- ant pelvic tilt, IO- post pelvic tilt -U: rotate pelvis (B contraction of IO separates the linea alba whereas EO's fiber direction is towards the linea alba)
When standing, the ASIS is in the same vertical plane as what other bony landmark?
Pubic symphysis
What exits the triceps hiatus/ triangular interval?
Radial nerve, and profunda brachii artery (deep artery of arm)
Which LE orthotic provides the highest level of foot control with no restriction to ankle function?
SMO / DAFO
What is the anterosuperior most portion of the sacrum, just below the junction of the sacrum with L5 vertebra, called?
Sacral promontory
What is the posterior boundary of the pelvic wall?
Sacrum, coccyx, and part of ilium/sacroiliac joint
What joint handles a lot of force coupling?
Scapula
What is the superficial fascia called in females? (2 names)
Scarpa's fascia Colles' fascia
What is the superficial fascia called in males? (3 names)
Scarpa's fascia Darto's fascia (penis & scrotum) Colles' fascia (behind scrotum)
Type of MS: initial relapsing-remitting MS that suddenly begins to decline without periods of remission
Secondary Progressive
Which muscle forms the medial wall of the axilla?
Serratus anterior
What causes deltoid paralysis? (what are common ways to injure the axillary nerve?)
Shoulder dislocation, humeral surgical neck fracture, & intramuscular injection of medication
In a U joint, the superior vertebra has __________ to it and the inferior vertebra has __________ to it options: convexity, concavity
Sup: concavity Inf: convexity
Which muscle initiates abduction?
Supraspinatus
What does the suprascapular nerve innervate?
Supraspinatus and infraspinatus
What is the difference b/w a thrombotic & embolic CVA?
T: plaque builds up in cerebral AA over time in 1st major branchings E: clot suddenly travels to brain from the body, typically from carotid sinus, int carotid or heart, & lodge in medium-sized bv Notes: we won't really know if a person is having a thrombotic or embolic stroke while it's happening
What is the "white line" of the pelvic floor also known as?
Tendinous arch of the levator ani muscle Epimysium of obturator internus
In the torque equation, what distance does d represent?
The distance that is perpendicular to the axis line Unit: pound-foot or Newton-meter
How should "mental fatigue" play into our decision of using massed vs. distributed practice?
The first stage of motor learning has a high cognitive component -distributed or massed practice may be better for different types of patients that have trouble paying attention/focusing/staying entertained
Where does the superficial membranous fascia (Colle's fascia) attach to?
The free edge of the perineal membrane just anterior to the anus
What forms the anterior axillary fold?
The inferior border of the pectoralis major muscle
What does a winged scapula look like?
The medial border and inferior angle are pulled away from the thoracic wall, particularly when the arm is raised or pushing anteriorly. The arm cannot abduct above the horizontal position
What muscles is the levator scapulae deep to?
The superior 1/3 is deep to SCM, the inferior 1/3 is deep to trapezius
Why do surgeons care a lot more about making sure they don't cut a nerve versus a blood vessel?
There is usually one nerve per muscle, but that is not the case for blood supply
Impulse is a type of force produced over _______________ ?
Time
What are the muscles in the posterior group of the shoulder?
Trapezius, latissimus dorsi, levator scapulae, and rhomboids
How do you determine if a pt is experiencing neurogenic or vascular claudications?
Treadmill/Bike Test: -Neuro: worse w/ decline or level surface, better w/ incline or bike (flexed position) -Vasc: worse w/ incline or inc effort Peripheral Pulses: -Neuro: present -Vasc: absent (during claudication) Back Symptoms: -Neuro: present -Vasc: rare
Name the exercise classification system: -created by Delitto -classified according to cluster of s/sx -named based on the treatment they thought the pt would respond best to (manipulation, stabilization, specific exercises, traction)
Treatment Based Classification
T/F: transplant patients need a long warm-up and cool down
True
T/F: TIA's are a warning sign of a stroke
True-- RED FLAG! they are probs a walking time bomb, really work on modifiable risk factors
What are the 2 triangles of the diamond shaped perineum called?
Urogenital triangle Anal triangle
Define biomechanics
Use principles of physics to study how forces interact w/ a living body
Define power What unit is it measure in?
Work divided by time P=W/t (measured in watts or J/s)
Should PT's treat the "non-specific LBP" category of LBP patients?
YES-- PT is considered the first line of defense for these patients, they do well w/ conservative treatment
Do solid ankle AFO's have the potential to become articulated AFO's?
Yes, they can cut the orthotic and add in a hinge to make it articulated. This would save the pt money by not having to pay for an orthotic twice.
Is there research to support that having a stroke patient get acute rehab on a specialized stroke unit improves their outcome?
Yes-- evidence for dec mortality & inc functional outcomes
Define a radial head fracture
a break in the proximal portion of the radius (these make up 1/3 all elbow fractures)
What should be the PT response for a patient believed to have a dissecting aortic aneurysm?
a change in symptoms is what should be alarming -if you believe that an aortic dissection is occurring, this is a medical emergency -if someone has an aortic aneurysm that is being followed and monitored by other healthcare providers, contact the healthcare providers regarding any changes
Does a posterior leaf spring AFO provide M-L stability?
a little bit
Define elbow instability:
a looseness in the elbow joint that may cause it to catch, pop or slide out of place during certain motions
Most cases of sexual misconduct involve:
a male PT and female patient, usually in an OP setting
Acute pain related to a facet joint is from:
a mechanical block w/in the facet due to intra-articular entrapment of the meniscoid
If a pt is only partially able to assist, and they are between 100-200 lbs, use ________________
a sliding board and 2 people
What are "triggered reactions"?
an intermediate response for error correction
In what location does the pain manifest for a dissecting aortic aneurysm?
anterior chest (thoracic aneurism), abdomen, thoracic area of back
Lung infections such as TB can be treated with either _________ or _________ depending on the offending organism
antibiotics or antiviral drugs
Decongestants are often given together with what other drug?
antihistamines
Agg Factors: spinal stenosis
anything that narrows the lateral foramina or causes loading of the structures in the posterior column -trunk extension -prolonged standing/walking -walking downhill -lying flat
Easing Factors: spinal stenosis
anything that opens the lateral foramina -trunk flexion -sitting/squatting -walking uphill -bike riding
Describe the usual presentation of thyroid cancer:
appearance of a hard, painless nodule on the thyroid gland (most palpable nodules are benign adenomas)
What does it mean if your ABI is less than 0.9?
arterial disease is present
When can a transplant patient resume normal activities? When can they resume vigorous activities?
as soon as the patient feels well enough & has consulted with their doctor vigorous activities should be avoided
Describe the cephalocaudal principle of development
as we develop we first gain control of the head before the arms, before the trunk and before the LE etc. (top down)
Describe the proximodistal principle of development
as we develop we gain control of the body from the center outwards (start from SC and trunk, then shoulders and hips, then elbows and knees etc. all the way to fingers and toes)
Hierarchial levels of control
ask what the take away from this slide is
What are the 2 steps that children use to gain knowledge from their environment based on Piaget's theory of cognitive development?
assimilation accommodation
Antihistamines can be used for treatment of what two conditions?
asthma and allergies
What conditions is sciatica referring to?
back-related LE symptoms Notes: an umbrella term used to describe leg sx in the back of the legs due to compression on nerve tissue
HVPC can be battery operated or a plug-in device. Which option has less voltage output?
battery operated
Why is it inappropriate to treat PF weakness with a posterior leaf spring that has a *sulcus trim line*?
bc sulcus trim lines provide a shorter lever arm, this would make toe off more difficult (we want a longer lever arm to give them a more rigid surface for push off)
Why don't we move the knee center on every prosthetic user back 2 inches so that their knees never buckle?
bc they would have a very difficult time initiating swing or knee flexion in late stance
KU Spine precautions for cervical pt whose spine is unstable
bed rest
Does a 2-point gait pattern use bilateral, unilateral or both kinds of devices?
bilateral
Does a 4-point gait pattern use bilateral, unilateral or both kinds of devices?
bilateral
Does a 3-point gait pattern use bilateral, unilateral or both kinds of devices?
bilateral (walker or axillary crutches)
Does a modified 3-point gait pattern use bilateral, unilateral or both kinds of devices?
bilateral (walker or axillary crutches)
According to Piaget, what is the goal of cognitive development?
biological survival
The neural-maturationists theory is an example of what type of theory?
biological theory
Autonomic Dysreflexia primary cause -other causes
bladder distention (most likely from blocked urinary catheter) -bowel distension -rectal stimulation and bowel program -cutaneous lesions -fractures -intra-abdominal injury -body positioning
What is a down side of parasympathetic blockers?
body will develop tolerance over time
In MES (LIS) for (bone/wound) healing, the electrode can be implanted or external
bone
Are facet joint injections & medial branch N blocks used to diagnose chronic facet dysfunction or treat it?
both
PPIVM: acute vs chronic facet dysfunction
both will have hypomobility
What is an intra-aortic balloon pump used to treat?
bridge to heart transplant
What are the generic names for the antihistamines? (7)
brompheniramine cetirizine chlorpheniramine desloratadine diphenhydramine fexofenadine loratadine
Airway obstruction can be caused by what conditions? (5)
bronchial astma emphysema chronic bronchitis lung infections lung cancer
_________ are the most common treatment of respiratory disease
bronchodilators
What is the description of pain with a MI? How intense is the pain?
burning, stabbing, viselike pressure, squeezing, heaviness (specifically on their chest) severe pain
Do the majority of people who survive a stroke recover a) almost completely b) w/ minor impairments c) w/ mod-severe impairments d) require nursing home care
c) 40% have mod/severe impairments
What compound facilitates smooth muscle cell relaxation and inhibits mast cell degranulation in respiratory smooth muscle?
cAMP
Adrenergic bronchodilators work through what two compounds?
cAMP and cGMP
______ facilitates smooth muscle contraction and may enhance mast cell release of histamine and other mediators resulting in bronchoconstriction
cGMP
If an exercise causes symptoms of angina that the patient previously could do without issues, what should the PT do?
call the Dr immediately
If a patient has notable _______________ on their feet, they may not be able to feel the vibrations in a vibratory sensation test, which does not indicate sensory loss
calluses may need to adjust locations on the foot for the test to avoid calluses
What is the equation for velocity?
change in d / change in t
Define: childhood development
change in the child that occurs over time -changes follow an orderly pattern that moves toward greater complexity and enhances survival
Failed romantic relationships in the employment setting are troubling and frequent causes of:
charges of sexual misconduct in court
What are general signs and symptoms of a cardiovascular disease that affect the musculoskeletal system?
chest, shoulder, neck, jaw, or arm pain; myalgias, muscular fatigue, muscle atrophy, edema, claudication (leg cramping)
Are acute or chronic nerve root injuries more common?
chronic
Define vascular claudication
circulatory system compromise due to PVD (plaque build up along arterial walls causing a decrease in circulation-- system is unable to meet the inc demands of muscle activity)
Defamation
civil wrongs that harm a reputation, decrease respect, induce disparaging, are hostile, or disagreeable feelings against a person or entity (fine line b/w this and disparagement)
Which foot deformity involves hyperextension of the MTP with PIP and DIP flexion
claw toe
What is ABI (ankle brachial index)?
compares the BP in your ankle to the BP in your arm normal is considered 1.0 - 1.2, meaning the BP in the ankles should be equal to or slightly higher than the BP in the arms
The more proximal a trim line is, the more ___________ you will have
control of a joint the closer the trim line is to a joint, the more it can stabilize the joint
Articulated orthotics often use springs to:
control the amt of motion available the looser the spring the more motion available at that joint
Antitussive drugs are given to supress a _____ by acting on what part of the nervous system?
cough act on the cough center of the brain in the CNS
What is the primary concern with someone with foot deformities?
development of callus/corn which may turn into a wound
The dynamical systems theory is an example of what type of theory?
developmental systems theory
When is the onset of gigantism?
develops in kids before the age when the epiphyses of the bones close
_________ in low doses is the form of drug typically sold in non-prescription inhalers
epinephrine
When the cortex develops (in the hierarchial neural-maturationist model), what postural reflex development will emerge? At this stage of development, we are considered ________ in function
equillibrium reactions bipedal (ambulatory)
What does error in program selection refer to in the carrying out of motor programs?
error resulting from a misperception of the environment or an error in the selection of the goal
What does error in program execution refer to in the carrying out of motor programs?
error resulting from unexpected difference or alteration in the environment
If a patient has had 1 attack and evidence of 2 lesions in the CNS, what additional info is needed to diagnose them with MS?
evidence of DIT (dissemination in time)
If a patient has had 1 attack and evidence of 1 lesion in the CNS, what additional info is needed to diagnose them with MS?
evidence of both DIS & DIT
Cause: TIA
evolving thrombus or small emboli
Prognosis: acute facet dysfunction
excellent-- resolves over time
What are aggravating factors for Angina Pectoris?
exercise or physical exertion cold weather or wind heavy meals emotional stress
Which type of nervous system maturation? a continuing process of the creation and organization of neuron connections that occurs as a result of a person's life experiences
experience-dependent
Which type of nervous system maturation? normal, generalized development of neuron connections that occur as a result of common experiences that all humans are exposed to in a normal environment. These early universal experiences are visual stimulation, sound, and bodily movement
experience-expectant
Are custom fabricated LE orthoses better for short or long term use?
extended or permanent use
If you are ambulating a transplant patient and you think they are ready to leave their room and walk down the hallway for the first time, what piece of equipment is important for you to grab that is unique to these patients?
face mask-- transplant patients need to wear a mask when they leave their room and will continue to wear it for 2-3 mo after they leave the hospital in the community HCP's also need to use good hand hygiene to protect the patients from getting an infection
__________ joints of the lumbar spine are essential for spinal mobility & stability
facet
What structure of the lumbar spine provides a bony locking mechanism that protects the IV disc by dec segmental rotation to dec shearing?
facet joints
What structure distributes forces evenly across the lumbar spine?
facet joints ("load sharing")
T/F: open loop control means that sensory info is completely unnecessary and disregarded
false
T/F: when performing a task bimanually, the hemiparetic limb gets faster to match the pace of the non-hemiparetic limb
false
T/F: definitions of SCI are clear cut and standardized among all practices
false "there are differences between physician definitions of SCI [and] specialists in neurology and physical medicine and rehabilitation may document the level differently"
T/F: HO may occur cranially or caudally to level of SCI
false only occurs caudal to LOI
T/F: malignant tumors of the thyroid are common
false tumors are common, but malignant thyroid tumors are very rare
T/F: there is some evidence to support high-dose steroid administration for treatment of a SCI
false no evidence for that
T/F: with a ground reaction AFO, the strut goes up the lateral side of the ankle
false, it can go up either side people are more bony on the lateral malleolus and medial struts better allow for shoe inserts
T/F: all motor movements are either under closed *or* open loop control
false, some movements may be broken down from open loop to closed loop to either work on them, or even learning a new skill can start as closed loop then eventually as the skill is mastered may switch to being under open loop control
T/F: sexual relations b/w a patient & HCP are permissible if they are mutual
false, they are NOT permissible whether they are mutual or not
T/F: locked knee KAFO's are well liked by patients
false, they are really disliked, they're not fun to wear
T/F: the locking mechanism of stance control KAFO's is always the same
false, they vary (Ex: bail lock, drop lock, etc.)
T/F: it is a bad sign if a patient with neuropathy has hair on their feet
false, this is a good sign, hair can't grow unless there is good circulation
T/F: sexual relations b/w a patient & HCP are permissible after the therapeutic relationship is terminated
false, this is not an ethical basis for progressing the relationship to sexual relations -emotions developed during therapeutic relationship can be manipulated -can obscure clinical objectivity of HCP -hurt well-being of patient -- violates trust
T/F: regulation by the state regulatory & licensing agencies of sexual harassment is strong
false, weak regulation
T/F: you only need to be concerned about checking a diabetic patient's feet if they have type 2 diabetes
false, you should check their feet regardless of the type of diabetes that they have
T/F: the LS is easier to palpate than the CS
false-- the CS is the easiest part of the spine to palpate & can be very helpful in an objective exam
T/F: there is no evidence to support that TS manipulations are helpful for CS issues
false-- there is some evidence that TS manips are safe & helpful for CS issues
Is a 2-point pattern faster or slower than a 4-point pattern?
faster
What is the largest endocrine organ in the body?
fat
What is morbid obesity?
fat as a disease
When performing an action, you often use ___________ about the movement that is being performed to help control or adjust the action
feedback
How is sensory information used *after* a movement for a motor program?
feedback from the outcome may be used for subsequent movements
Define: chronic facet dysfunction
fibrotic changes & adhesions of the joint capsule
Define: power grip
finger and thumb pads direct force towards palm
Define: precision grip
finger and thumb pads direct forces towards each other
Grip size in response to intrinsic properties changes primarily by movement of what part of the hand?
fingers (not thumb)
Easing Factors: chronic facet dysfunction
flexed posture-- takes the pressure off of the joint capsule
2 characteristics of sound
frequency amplitude
If a patient does not have a known history of angina and the first dose of nitroglycerin does not relieve symptoms, what should the PT do?
get emergency medical aid
Are the following global or local muscles of the CS: SCM, scalenes & paraspinals
global
What is the preferred category of drug for controling mild to moderate asthma long term?
glucocorticoids
In Addison's disease, a deficiency of what substance decreases the person's ability to withstand emotional or physical stress?
glucocorticoids (Ex: cortisol- manages stress response)
Prognosis: cervical DDD
good w/ conservative treatment (hardly ever requires surgery unless degeneration is so severe that it's led to instability)
How does grip size change as a hand reaches closer to the target?
grip size is larger than width of target and scaled down just before contact w/ object
If a pt says they're knees feel like they are going to buckle or give way, which type of ground reaction AFO would be most helpful to them?
ground reaction with anterior shell this would reduce the flexion moment they are experiencing and give them more of a knee extension moment
_________ (listed as an expecorant) also has cough supressing abilities and is sold under the name Robitussin for either purpose
guaifenesin
What are the two generic names for expecorants?
guaifenesin guaifenesin and pseudoephedrine
Which foot deformity involves hyperextension of the MTP and DIP joints?
hammer toe
When might fractures happen in patients with SCI?
happen with mechanical stress and strain during transfers
Why is hip strength so important for someone who uses a KAFO?
have to be able to compensate for lack of knee motion during gait with a hip hike to clear the foot
Which AFO is best to treat quad weakness?
have to find a happy medium based on the way they walk by working w/ an orthotist Example: -ground reaction w/ anterior shell: give them an extension moment, but they may not be able to control the extension eccentrically -ground reaction w/ posterior shell: give them a flexion moment, but they may not be able to prevent their knee from buckling concentrically
What are general signs and symptoms of a cardiovascular disease that affect the CNS?
headaches, impaired vision, dizziness or syncope
Expectorants help to treat obstructive lung diseases how?
help to move the mucous so that it can be removed from the lungs (by lubricating the lining of the airway)
Do ischemic or hemorrhagic strokes lead to more global problems?
hemorrhagic -mechanical injury from blood, edema to distant neurons -ischemic injury to area supplied by vessel
What is HVPC also known as?
high voltage *galvanic stimulator*
What does HVPC stand for?
high voltage pulsed current
Geographic distribution of MS
higher risk in areas further away from the equator -thought to be linked to vit D intake -but little evidence to support vit D supplements improving MS
If a patient has an LVAD, where should you place the gait belt?
higher up-- just under their arm pits so we don't pull on any of the wires
Define *neurological level* of injury
highest of the motor or sensory levels on either side
What hip flex/ext ROM do you want all patients to have before compensating w/ their spine?
hip flex: 90 deg hip ext: 0 deg
When you lock out the knee in a locked knee KAFO, what gait compensation will you see?
hip hike during swing phase
When examining a person's movement, what is more important to look at than how far someone moves?
how they move Ex: when bending fwd, a pt may get all their motion from their thoracic spine and none from their hips
Which part of an AFO determines how much talocrural motion the user will have?
how thick/thin the orthotic is right above the heel thinner = more motion
History: acute facet dysfunction
hx of sudden unguarded mvmt ex: flexion, return from flexion, rotation
Is Grave's disease a hyperthyroid or hypothyroid condition?
hyperthyroid
Neuromuscular irritability, such as muscle twitching in the face and hands (tetany), is a symptom of what endocrine disorder?
hypoparathyroidism (hypocalcemia)
Is Hashimoto's thyroiditis a hyperthyroid or hypothyroid condition?
hypothyroid
What is an endemic goiter?
hypothyroid condition that affects large groups of people in a specific geographical region (endemic) with low iodine levels in the soil or food
When is PT contraindicated for a cardiac patient in terms of IABPs?
if they have a femoral IABP-- can still do bed level ROM except for the affected extremity
Why are MD's reluctant to give T-PA to a patient having a stroke?
if they're wrong about it being an ischemic stroke, and it's actually a hemorrhagic stroke, then giving them T-PA will kill them
Beta-agonists can alleviate the ________ symptoms of asthma
immediate
What are the MSI Classifications for LS conditions?
in order of prevalence: -lumbar rotation w/ ext -lumbar ext -lumbar rotation -lumbar rotation w/ flex -lumbar flex
What counts as an impaired colleague?
inability to care for patients w/ reasonable skill or safety anything that prevents the HCP from safely meeting current standards of practice behavioral or skill difficulties Ex: substance abuse, mental illness, dementia, effects of aging, physical disability, inappropriate sexual behavior, burnout, poor general health, etc.
What is the #1 cause of "medial whip" or "lateral whip" gait deviations?
incorrectly donning the prosthesis amputees don't have a mark to let them know exactly how to align the prosthesis when they put it on, brand new patients have a hard time getting a sense of the correct amount of rotation they should have
Over the last 15 years, the percentage of persons with incomplete tetraplegia has ________ slightly, while complete paraplegia has ________ slightly
increased decreased
Why is autonomic dysreflexia dangerous?
increased BP and risk for cerebral hemorrhage or possible heart failure
The prevalence of neck pain (inc/dec) with age
increases-- usually affects ages 50 and up
In the auditory processing pathway, what is the function of the inferior and superior colliculus?
inferior: integrates the information from both ears superior: movement of the eyes and head towards the sound
Remember that beta agonists do not depress ______, they only ______ airways
inflammation dilate
Glucocorticoids reduce airway ________ and ________ thus decreasing the chances of having an asthma attack
inflammation and swelling
What is thyroiditis?
inflammation of the thyroid
HO is a(n) _________ process following trauma to soft tissue
inflammatory
How should we consider massed vs. distributed practice effects on learning when it comes to the musculoskeletal system?
injury and safety are very important to consider (increased fatigue has an impact on both), also the risk this may have on the cardiovascular system should be considered (if they have CV disease they may be at inc risk for stroke or MI with excessive bouts of massed practice)
Someone with a history of angina who becomes weak or short of breath with arms overhead could have a likely _________ or __________
ischemia or infarction
Is an ischemic or hemorrhagic stroke more common?
ischemic (70%)
Would you potentially want to promote high BP for an ischemic or hemorrhagic stroke?
ischemic-- to perfuse ischemic tissue & essentially push the clots out But, if BP is >220 systolic or >120 diastolic, there is other organ damage or tPA was used, you want to decrease their BP
Disc degeneration, in both the lumbar & cervical spine, is a normal process, but it becomes pathological when:
it becomes painful
In MES for *wound healing*, if there is an infection present, how should you adjust your treatment?
keep the cathode in the wound until 3 days after the infection clears
What feature of a PRAFO prevents hip IR and ER while the pt is in bed?
kick-stand
What HbA1c level should a patient aim to have?
less than 6.5 to 7
A competitive agonist is competitive because if you add more _______ you will compete the drug off the receptor and _______ will bind more than the drug, and the opposite is true
leukotrine (for both blanks)
_________ will not stop an attack or even reduce symptoms once an asthma attack has started
leukotrine blockers
What is the only way to decrease lifting load on a PT's back?
lifting devices
Articulated orthotics often use pins to:
limit one motion and allow another or just restrict all motion
Strategies for teaching eye-hand coordination skills in older adults (read)
little work has been done in this area but in general it seems that extensive practice can be helpful
Fat near the ______________ (organ) is more dangerous
liver
A posterior leaf spring stores energy during _________ and releases energy to facilitate ___________
loading swing helps them clear their foot
Are the following global or local muscles of the CS: multifidus, longus coli and deep segmental paraspinals
local
Pain Description: acute cervical facet syndrome
localized pain w/wo muscle spasms
Where is the main location of pain and the location of referred pain with a MI?
location: substernal, anterior chest referral: may radiate like angina, frequently down both arms
History: spinal stenosis
long hx of intermittent back pain
Does diabetes insipidus involve excess retention or loss of water? What condition can this lead to?
loss, leads to severe dehydration
Define *sensory level* of injury
lowest NORMAL dermatome
Are lumbar or cervical disc herniations more common?
lumbar
Where do emboli lodge to cause an embolic stroke?
medium-sized vessels (MCA, vertebral or basilar branches, basilar has a higher mortality rate)
What causes acute cervical torticollis?
meniscoid entrapment in cervical facet joints
If a pt has high risk feet or fluctuating edema, which AFO would be indicated?
metal upright
Caffeine and theophylline are two drugs that fall under the category of _________?
methylxanthines
What does MES stand for?
microcurrent electrical stimulation
Are pre-fabricated LE orthoses better for mild, moderate or severe involvement?
mild
Are custom-fit LE orthotics better for mild, moderate or severe involvement?
mild to moderate
How intense is pain from angina pectoris?
mild to moderate, builds up gradually or may be sudden
What are side effects of expectorants?
minimal and rare... but include: -rash -urinary retention -insomnia -hallucinations (very rare)
Are custom fabricated LE orthoses better for mild, moderate or severe involvement?
moderate to severe
Which type of gait pattern allows functional use of an affected LE within a WB restriction?
modified 3-point and 3-point
How do antihistamines work?
modulate the neural activity within the CNA and regulate gastric secretions by means of two types of histamine receptors, H1 and H2
A 3-point gait pattern allows for controlled _______________ of gait rather than "swing gait"
momentum
What are the 3 leukotrine blockers by generic name?
montelukast zafirlukast zileuton
Which leukotrine blockers work by competing with the leukotrines at the receptor (competitive agonists)?
montelukast and zafirlukast
Pressure ulcers are a significant source of ______ in patients with SCI
morbidity
Radial head fractures are more frequent in __________ (women/men) and is more likely to occur in people between _____ and ______ years of age
more common in women 30-40
What would pericarditis pain be described like? What is the intensity associated with it?
more localized than pain of MI, sharp, stabbing, knifelike Intensity: moderate to severe
A recent study found that when looking at patients' hip rotation in prone, people w/ back pain had (more/less) rotation than people w/out pain
more rotation-- also occurred earlier in the motion
ASIA class C
motor incomplete - motor function is preserved below the neurological level and more than half of key muscle functions below the neurological level of injury (NLI) have a muscle grade less than 3 (0-2)
What does MSI stand for?
movement system impairment
What does it indicate if pain changes with re-positioning?
musculoskeletal or pulmonary origin (pain worse when lying down and better when sitting up or leaning forward = pleuritic in origin)
How may mediator-release inhibitors be administered?
nasal spray (not available in oral form)
How may decongestants be administered?
nasal spray, eye drops, syrup or pill (usually over-the-counter)
What are general signs and symptoms of a cardiovascular disease that affect the gastrointestinal system?
nausea and vomiting, ascites (abdominal distension)
When thyroid cancer does metastasize (rare) where does it go?
nearby lymph nodes, and then to bone
With Angina Pectoris, where is pain usually referred to?
neck, jaw, back, shoulder or arms, may only have a toothache, occasionally to the abdomen
On admission to the hospital, a suspected stroke patient will receive a __________ exam performed by an acute care MD, nursing staff & maybe rehab consultants. What are the 3 purposes of this?
neuro exam -rule in/out CVA -determine etiology of CVA -assess comorbidities
If a patient with spinal stenosis experiences heaviness, tightness, pain & weakness in their calf muscles while walking on a downhill slope, what do you think might be going on?
neurogenic claudication
What is the leading cause of diabetic hospitalization?
neuropathy
Can a PT refer a patient back to the Dr w/o providing an evaluation?
no
Do bronchodilators often require a prescription?
no
Does taking armrests off a wheelchair help reduce the lifting load?
no
Is there much difference in the efficacy of different asthma medications?
no
Which type of HVPC should produce a muscle contraction? Which type should not? options: dermal wounds, pain, edema/spasm/weakness
no contraction: dermal wounds & pain contraction: edema, spasm or weakness
Will the patient feel tingling with MES?
no, it doesn't activate sensory nerve fibers
Is an asthma attack the same for all people?
no, it is completely individual meaning that there are different triggers and the reactions are unique as well
With congenital heart defects, do all defects cause symptoms?
no, small defects are asymptomatic other than the presence of a heart murmur
Do modified 4-point and modified 2-point gait patterns allow for WBing restrictions?
no, they just provide an increased BOS
2 types of pain
nociceptive neuropathic
Which category of LBP patient do lumbar facet joint issues fall under?
non-specific LBP
Neuropathy is implicated in 50-75% of ______________ amputations
non-traumatic
What are relieving factors for a dissecting aortic aneurysm?
none
Which type of gait pattern is used with bilateral PWB of LEs?
none of them, this would dictate non-ambulatory status
What are aggravating factors?
not necessarily anything, may occur at rest or follow emotional stress or physical exertion
You're performing a quick action plan, and after completion of the action you get sensory feedback to let your brain know how the execution of the plan went, then based on that feedback you can make adjustments for the next time you execute that action plan ^ this is an example of a _________ (closed/open) loop control of motor movement
open
What are the main risk factors for patients taking glucocorticoids long term to control asthma?
osteoporosis, slow healing wounds and muscle wasting (because these drugs have catabolic effects) other long term effects include: immunosupression, GI disturbance, emotionally labile, insomnia, retardation of growth, hyperglyceremia, and sodium and water retention
Auditory disorders that affect peripheral structures
otitis media tinnitus presbycusis acoustic neuroma
Where does pain refer to for a dissecting aortic aneurysm?
pain may move in the chest as dissection progresses, pain may exten to the neck, shoulders, interscapular area or lower back
Neuropathic pain
pain or sensory disturbance due to abnormal processing of afferent input
Define tetraplegia
paralysis caused by illness that results in the partial or total loss of use of all limbs and torso
What class of respiratory drug does ipratropium (Atrovent) fall under?
parasympathetic blocker
If a patient's MAP isn't high enough, they are at risk of:
passing out
If a pt has pretty severe deformities (ex: Charcot deformity) but is not eligible for an amputation, which AFO would be the most helpful?
patellar tendon bearing
Which AFO looks kind of like a socket and offers more control than a ground reaction AFO?
patellar tendon bearing
Which AFO limits weight bearing? How does it do this?
patellar tendon bearing reduces force on *midfoot & heel* via a "rocker sole"
KU spine precautions if cervical spine is pending clearance but no fracture/dislocation identified
patient may be up with use of collar
What population are decongestants contraindicated for?
people with high BP (because decongestants can raise blood pressure, glaucoma is especially a concern)
What might cause more movement adjustments in reaching coordination as we age?
perhaps due to less online and feedforward processing (rely on feedback instead)
Sound travels through the perilymph in the cochlea, how is it transferred to an electrical impulse after this?
perilymph is displaced, causing the first membrane (Reissner's) to move, displacing endolymph and then the basillar membrane to move and stimulate the organ of Corti. -the hair cells fixed between the Basillar and tectorial membranes are moved/bent when the organ of corti is stimulated and the basillar membrane moves upwards (tectorial does not move) -hair cells bending causes mechanically gated potassium channels to open changing electrical potential within the cell -voltage gated Ca++ channels then open, causing vesicles to fuse and release neurotransmitters causing the AP to be sent down the vestibulocochlear nerve to the brain
Is the output polarity in MES constant or reversing during stimulation?
periodic reversal of polarity (could be days b/w reversals)
Define: distributed practice
periods of work are interspersed with periods of rest; the length of time spent in work is equal to or less than the amount of time spent in rest
Define: massed practice
periods of work without rest; the length of time spent in work is greater than the amount of time spent in rest
Which type of neuropathy affects UEs and LEs?
peripheral
Auditory system disorders can affect ______ or _______ structures
peripheral central
In the signal cascade that results in the relaxation of respiratory smooth muscle, the final step is ________ of one of the contractile proteins. This inhibits what?
phosphorylation inhibits the interaction with actin
Which domain? -body size -body proportion -appearance -brain development -motor development -perception capacities -physical health
physical domain
What are 2 characteristics that might be searched for in an X-ray of someone suspected to have a non-displaced radial head fracture?
posterior fat pad sign (elbow effusion) anterior fat pad (sail sign)
Which type of AFO stores & releases energy during gait?
posterior leaf spring
The U joints of the CS are located at the ____________ aspect of the vertebral column options: anterolateral, posterolateral
posterolateral
Which type of elbow instability involves an injury of the LCL that causes the proximal radius & ulna to ER together as a unit?
posterolateral rotatory instability
Which type of LE orthotic is used for someone who is limited financially? -pre-fabricated -custom fit -custom fabricated
pre-fabricated
Which type of LE orthoses provide limited fit and function? -pre-fabricated -custom fit -custom fabricated
pre-fabricated and custom fit
Which type of LE orthotic can be used for diagnostic procedures? -pre-fabricated -custom fit -custom fabricated
pre-fabricated and custom-fit
Antihistamines are available either over-the-counter or as a _______
prescription
Why can those with traumatic SCI be more complicated patients?
presence of co-morbidities such as: -brain injury -fractures -pneumothorax -peripheral nerve injury -other trauma (abdominal etc.)
Sound is created by ________ waves in the air that usually have fixed spacing
pressure
What does PRAFO stand for?
pressure relieving ankle foot orthosis
_________ are lesions of the skin and underlying tissue
pressure ulcers
What are general signs and symptoms of a cardiovascular disease that affect the integumentary system?
pressure ulcers, loss of body hair, cyanosis (lips and nail beds turn blue)
How does cromolyn sodium work?
prevents the influx if calcium ions into the mast cells, blocks the degranulation process of these cells and inhibits further release of mediators that cause bronchoconstruction
3 areas in the cortex auditory impulses are sent for processing
primary auditory cortex auditory association cortex Wernicke's area
What is a Charcot Arthropathy (Foot)?
progressive bone destruction and ligament damage leading to arch collapse and impaired skin integrity
Mediator-release inhibitors can be given _______ in cases of chronic asthma to prevent immediate hypersensitivity due to mast cell release of specific mediators that produce bronchoconstriction
prophylactically
What are proprioceptors? Examples?
provide information about our own movement -vision -audition -vestibular system -muscle receptors -joint receptors -cutaneous receptors
Cloward Sign: anterior IV disc stimulation
referred pain locally over the SP of spinal segments b/w the scapulae
Why is a lung volume reduction surgery (LVRS) done as an alternative to a lung transplant?
remove selected parts of lung tissue d/t disease-- allows expansion of remaining, more functional tissue
What maneuver creates the most load on a PT?
repositioning a person in bed
What is deep vein thrombosis?
result of coagulation of blood resulting in a thrombus in the venous system
When the midbrain develops (in the hierarchial neural-maturationist model), what postural reflex development will emerge? At this stage of development, we are considered _______ in function
righting reactions quadrupedal (can use UE and LE to creep)
What type of joint is a U joint?
saddle-shaped, diarthrodial
In the CS, side bend & rotation are coupled in the ___________ (same/opp) direction regardless of if the person is in a neutral, flexed or extended position
same (this is different than the LS which follows Fryette's Law)
Which objective measure do you *need* to perform on a patient with spinal stenosis?
segmental neuro exam-- need to determine which levels are involved
What is this an example of? If a child exhibits an earlier than normal stepping reflex, they likely will then walk at an earlier age and exhibit a more mature looking gait at a younger age
sensitive periods
ASIA class B
sensory incomplete - sensory, but not motor function is preserved below the neurological level. Sacral segments S4 & S5 are intact
Which AFO offers maximum motion control in all planes (plantarflexion, dorsiflexion, pronation, supination)?
solid ankle
How does variability play a role depending on the population you're working with? -children -women -those w/ brain damage
some populations are affected differently by variability in practice than the populations included in most studies (i.e. healthy young adults) 1. children may particularly benefit from variability in practice 2. (limited evidence) women benefit from variability in practice more than men 3. mixed results from studies on variability and AD
What is another name for DDD?
spondylosis
Which type of KAFO only controls knee motion during the stance phase of gait and not the swing phase?
stance control locks during stance, unlocks during swing
"Hemi" gait is usually performed as:
step to
What are symptoms of hyperparathyroidism in the early stages?
subtle: depression or anxiety
If a patient cannot feel a 10g monofilament, that means that if the person stepped on a __________ they wouldn't be able to feel it
tack
What can significantly reduce the side effects of glucocorticoids?
taking via inhalation
Cervical DDD begins in the __________ years and by the age of 40, almost all of the __________ is gone. Why is this important to know?
teenage NP almost impossible to have a true cervical HNP after age 40-45
What positioning suggestion could you make to a spinal stenosis pt if they have a job where they're required to stand a lot?
tell them to put one leg up on a step-stool to help them maintain a posterior pelvic tilt to dec their sx
What is involved with a *complete* distal biceps tendon rupture?
tendon is completely detached from its attachment point
FYI: before administering emergency care, it is always best to try to determine whether the person is having an episode of hyperglycemia or hypoglycemia
thank you, stacia
What does it mean if your ABI is 0.90-0.99?
the BP in your arms is slightly greater than in your ankles, still *acceptable* at this point
What is different about the patient initiating sexual behavior toward the PT?
the PT is responsible for the patient-therapist relationship this may result in ignoring or under-reporting a problem
What does convergence refer to with SCI?
the idea that, after DC a patient who was originally assigned one ASIA class may have a change in function and later on be considered a different class on the AISA scale
Define amplitude
the intensity of sound, measured in decibels
How should variability of practice be considered when structuring a therapy session?
the learning of a motor program may be enhanced by practicing various parameters of a skill. (ex: walking with a cane - practice at varied speeds)
Define *motor level* of injury
the lowest key muscle with a grade of at least 3/5 provided ALL key muscles above it are grade 5/5
How do proprioceptors play a role in CPG?
the proprioceptors pick up on the stretch input from periphery to initiate the contraction of muscles
Define "reminiscence" as it relates to motor learning
the recovery phenomenon where their performance on the first transfer trial was better than the last practice trial (1st attempt on day 2 is better than last attempt on day 1)
What allows the stapes to displace the fluid within the bony labyrinth?
the round window is a membrane that gives flexibility to the structure and allows displacement of the fluid
In HVPC, the *interval* between waves, a.k.a. twin spikes, can be adjusted. What happens as the time between the waves decreases?
the spikes overlap more and the stimulation is perceived as stronger
What is auditory transduction
the transfer of sound from a mechanical energy to an electrical impulse
Zealous Advocacy Trap
there is a difference b/w advocating for your pt and disparagement
Pain Description: chronic cervical facet syndrome
there is localized pain over the facet joints (away from midline), but can additionally be spread over a larger area
If you see a runner w/ a lot of cross-over in their LE when they advance a limb, what might this indicate?
they lack hip extension
Why do people with neuropathy often have dry, calloused skin on their feet?
they often lose their ability to sweat which results in this
Mucolytics are helpful for people with extremely _____, sticky mucous secretions such as with what condition?
thick... ew cystic fibrosis
Which type of goiter could be secondary to excessive stimulation by TSH?
toxic goiter (hyperthyroid condition)
Are hip flexion contractures more common in transtibial or transfemoral amputees?
transfemoral **** (almost every amputee)
Injury to the spinal cord can be categorized into ______ or ______
traumatic atraumatic
T/F: Piagetian theory had little effect on pediatric PT from the perspective of planning the motor aspects of therapeutic programming
true
T/F: convergence may happen between an AISA class C/D but NOT between a A/B
true
T/F: eye and hand movements interact with and influence each other
true
T/F: locked knee KAFO's are not very common
true
T/F: olecranon bursitis can be treated either surgically or non-surgically
true
T/F: reaching/grasping skills can be improved in aging adults
true
T/F: neuropathy is common after chemo
true, this is an example of exposure to toxins causing neuropathy
T/F: people often don't need to be cued to transition from a 4-point to a 2-point gait pattern
true, this often naturally happens when the pt is ready
Rectus Abdominis: only F
trunk flexion
What should you do right after the MSI exam?
try to place the pt into a MSI Classification
________ quadrant pain that is reproduced by __________quadrant activity is usually ________ in origin
upper; lower; cardiac
What are side effects of leukotrine blockers?
upset stomach, fatigue, dizziness, headache and rash (similar to those taking a placebo)
Prognosis: acute cervical facet syndrome
very good-- often gets better on its w/in a few weeks
Is a high or low amplitude current used with MES? What action potential amplitude is MES capable of generating in the body?
very low- most units are <1 mA above 1000 micro-A
What does pain with Angina Pectoris feel like?
viselike pressure, squeezing, heaviness, burning indigestion
What is the most important source of feedback (sense - exteroceptor) for much of what we do?
vision
After a transplant patient is no longer on sternal precautions, why do you need to work on posture?
w/ sternal precautions they are often bent forward & after the precautions are removed they sometimes maintain this posture-- teach them to sit upright to improve their breathing
What are the main symptoms of asthma?
wheezing when breathing, coughing, tight feeling in the chest and trouble breathing especially at night or early in the morning
Sexual Harassment
when sexual relations aren't mutual abuse of power includes criminal acts of rape, assault, or battery
What makes the presence of bimanual influence more pronounced?
when the nondominant hand has to do the complex task
Are men or women more commonly affected by hyperparathyroidism?
women (2:1) usually after age 60
Does thyroid cancer affect men or women more?
women, ages 40-60
Does a 3-point gait pattern allow for WB restrictions?
yes
If a patient has neuropathy due to a vitamin B deficiency, will supplementing vitamin B fix this?
yes
Is a ground reaction AFO capable of tri-planar motion?
yes
How long does it take for the final Volkmann's contracture deformity to develop when compartment syndrome is neglected?
~6 months
Components of hearing aids and their function:
*microphone*: receives sound and converts it into electrical impulses *amplifier*: intensifies electrical impulses *receiver*: translates those electrical impulses into louder sounds *battery*: power source *earmolds*: direct flow of sound into ear and enhance sound quality
Chronic cervical nerve root injuries usually occur in ___________ patients options: younger, middle-aged, older
*middle-age & older* w/ established degenerative changes and long hx of neck pain or post-surgical
What does it mean if your ABI is 1.0-1.2?
*normal*, BP in ankles is equal to or slightly greater than BP in arms
Acute cervical nerve root injuries usually occur in ___________ patients options: younger, middle-aged, older
*older* pt's w/ degenerative changes or viral infections, may occur in younger pt's if trauma induced
Which type of KAFO would be indicated for a patient who significantly hyper-extends at the knee? Why?
*posterior offset*- it moves the mechanical axis posteriorly relative to the knee joint as soon as the joint moves anterior to the weight line (a.k.a., the weight line moves posterior to the joint) they will move into knee flexion
MS cause
*unknown*, possible ideas: -viral infection -genetic component -auto-immune
Factors associated with improved neurologic outcomes:
-*completeness of injury* -zones of partial preservation -when an incomplete cervical spinal cord lesion exists, younger patients and those with a central cord or brown sequard syndrome have a more favorable prognosis
What is the anterior boundary of the pelvic wall?
Body and ramus of pubic bone, pubic symphysis
What treatment should a low risk patient for developing foot wounds receive?
-annual foot exam -education -good footwear educate them about checking their feet, talk about diabetic shoes w/ a wider toe box, they should never be barefoot even within the home, should have a rubber sole on their shoe
Types of incomplete lesions:
-anterior cord syndrome -central cord syndrome -brown sequard syndrome -cauda equina injury
What is included in a general PT evaluation of a post-transplant patient? (read)
-appearance -edema -*VS* -pain -posture -ROM -strength -bed mobility/tranfers/gait/ADL
Hypothyroidism puts one at risk for what conditions?
-arteriosclerosis -coronary heart disease
What is an intra-aortic balloon pump (IABP)?
-assists heart in pumping blood-- L heart fxn -dec workload on heart -inserted into aorta -2 types: axillary & femoral IABP
Define: thrombus
-atherosclerotic plaques in 1st major branchings of large cerebral AA -progressively narrows bv over time
Secondary conditions associated with SCI
-autonomic dysreflexia -deep vein thrombosis -pressure uclers -heterotrophic ossification -UTI and renal complications -bone fracture -syringomyelia -spasticity -pain
STTT: cervical discs
-axial compression -sagittal plane motion (flex/ext) -segmental translation Note: rotation is a bad choice bc rotation is permitted in the CS due to U joints & wouldn't stress the discs
Describe a fixed pulley
-axis is anchored -pulley wheel only rotates -provides change in direction of F application only -mechanical advantage = 1 -Ex: lat malleolus & fibularis mm
Describe a movable pulley
-axis is the attachment point for F but is not fixed -pulley wheel rotates and translates -provides a change in direction of F -each movable pulley provides a MA of 2
What are the components of a lever?
-axis/fulcrum (A) -force (F) -resistance (R)
What are some things you should work on in PT with a patient who just got an LVAD?
-bed mobility -transfers -gait training -endurance (RPE 3-4) -balance & safety -breathing exercises (strengthen resp mm) -education on precautions (sternal & bleed risk)
What are some KU Hospital spine precautions for thoracic and lumbar spine?
-bedrest -limit extremity movement -do not elevate HOB -pt position in reverse trendelenburg (30 deg) to prevent aspiration -log roll w/ 2 person assist
Pain Description: acute nerve root
-begins as a proximal ache, then more distal sx -distal sx > proximal sx (example of shingles gives you an idea of the intensity of the pain)
When might a lung transplant be recommended? At what ages are you eligibile for a bilateral and unilateral lung transplant?
-bilateral transplant: <60 y.o. -unilateral transplant: <65 y.o. -recommended if poor prognosis-- survival less than 18-24 months
What are associated signs and symptoms for angina pectoris?
-extreme fatigue -lethargy -weakness (women) -shortness of breath -nausea -diaphoresis -anxiety/apprehension -belching and heartburn -UNRELIEVED BY ANTACIDS (women) -feels like inhaling cold air (women) -prolonged and repeated palpitations w/o chest pain (women...of course)
Causes: chronic facet dysfunction
-facet joint degeneration or hypertrophy -osteophytes -inflammation -micro-fracture
What are some *early* symptoms of hypothyroidism?
-fatigue -mild sensitivity to cold -mild weight gain -forgetfulness -depression -*upper eyelid droop* -thick, brittle nails -dry skin -sparse hair -*myxedema* often vague & unnoticed
Large congenital heart defects can lead to these:
-pallor and cyanosis (blue skin) -tachycardia (w/ rapid sleeping pulse) -dyspnea and tachypnea -a squatting position (modifies blood flow and to be more comfortable - children) -clubbed fingers -marked intolerance for exercise and cold -delayed growth and development
Symptoms of MS
-paresthesia -paresis -visual deficits -apathy -*cognitive* (slow processing) -bowel & bladder -ataxic gait (uncoordinated) -sleep disturbances -*fatigue* -tremors -sexual dysfunction -hyperreflexia -spasticity -pain
Important aspects of auditory rehabilitation
-patient and family education -hearing aid and hearing AD -speech -using visual/verbal clues -communication (background noise, handling coversation, home arrangement)
Example of "open loop" motor movements (read):
-tennis serve -golf swing -regaining balance after slipping on ice -getting up from sitting to answer doorbell -grasping a falling object
What do the presence of CPGs suggest about the CNS? (2)
-the CNS is wired to support functional goals even without the brain -SC is capable of more than just transmitting signals (integrates sensory and motor info)
What does the Ecological Systems Theory (bioecological theory) state?
-the varied systems of the environment and the interrelationships among the systems shape a child's development -both the environment and biology influence development -environment affects child and child affects environment
If someone walks w/ excessive pelvic rotation, what might this indicate?
-they lack hip extension -also puts inc shear forces on LS
Under the PT Practice Act, what is a PT required to do if they have knowledge of a colleague being impaired for some reason?
-they shall encourage them to seek counseling -they shall report them to the appropriate authority
Types: ischemic CVA (2)
-thrombotic infarction -embolic infarction
What does it mean to say "repeated movements & sustained postures alter tissue characteristics"? (language of MSI)
-too little stress: muscle atrophy, osteoporosis -right amt of stress: hypertrophy -too much stress: muscle damage, tendinitis, etc.
What are some ways to offload areas of the body to prevent pressure sores?
-total contact casts -orthotics/walking boots -surgical shoes -dressings (foam/felt) -cutouts (dec pressure points in shoe) -assistive devices -elevate heels w/ a pillow under calves
Since there are so many things pointing to distributed practice being better than massed practice (for a continuous task), why would we ever even consider this as a method?
-total practice time (massed practice more efficient) -massed practice may also be more beneficial with cortical remapping of the brain (being investigated)
What is the MOI for a Volkmann's contracture?
-trauma (most common- fracture, crush injury, supracondylar fracture compromising brachial artery) trauma causes acute compartment syndrome which cuts off O2 supply to wrist flexors and other mm which results in a Volkmann's contracture
If a spine patient is really into an exercise trend, such as CrossFit, that you don't think is the best choice for them, what education might you provide them with?
-try not to tell them to just not do it, they may not come back -try to figure out how to modify the exercises based on the pt condition -spend time educating them why you chose or modified certain exercises for them so they can make educated decisions in the future
How does a thrombotic CVA progress?
-uneven progression -"wake rise fall": these pts often stroke when they first get up in the morning due to the drop in BP & RBC's no longer being able to push through the narrowed bv -"thrombus in evolution": clot may develop over min/hours so sx progressively get worse
What is a Semmes Weinstein Monofilament test?
-use a 10g monofilament to apply pressure to about 10 locations on a patient's feet -if the pt can't feel any of them, this indicates decreased sensation -dec sensation puts them at risk for injury and eventual amputation
Characteristics of reflexive closed loop control (3)
-very rapid (changes occur in as little as 30 ms) -may not require our conscious attention -are mediated at the spinal level
What happens to bimanual skills when compared with unimanual skills in healthy controls? How does this compare with individuals who have hemiparesis?
-when performing a task unimanually the non-dominant hand was slower than the dominant hand -when performing a task bimanually, the dominant hand slowed down to meet the pace of the non-dominant hand and was slower than both unimanual tasks performed similar results in people w/ hemiparesis
Possible causes of neck pain: (read)
-whiplash/MVA -spondylosis -*poor posture* -collisions -improper CS, scapular or shoulder mechanics -infection, tumor or disease process (rare)
What are the 3 different modes of a mechanical ventilator?
1. Assist Control: set TV, extra breaths given if triggered by pt 2. Synchronized Intermittent Mandatory Ventilation: mandatory bpm, extra breaths aren't supported 3. Pressure Support: helps provide pressure support to overcome inc WOB, pt controls RR & duration of inspiration
What structures does the perineum include in men? (3)
Anus Penis Scrotum
What structures does the perineum include in women? (2)
Anus Vulva (external genitalia)
Spondylosis in CS can be caused by degeneration of the discs, facet joints or U joints. When do these structures begin to degenerate?
Disc: 30-55 yo (later said begins in teen years & NP is gone by age 40) Facets: >55 yo U joints: >55 yo
Which endocrine disorder leads to pathologic fractures, wedging of the vertebrae, kyphosis, osteonecrosis, bone pain & back pain? How does it do this?
Cushing's syndrome in severe cases, muscle weakness & demineralization of bone may lead to these conditions
What are "Selective Tissue Tension Techniques" (STTT) created by Cyriax?
Cyriax believed that every pain has an anatomical source & if you stress each tissue you will be able to figure out which tissue is the source through reproduction of pain
What type of histamine receptor is blocked by antihistamines in the treatment of respiratory disease?
H1
How is the relationship b/w HCP and patient unequal?
HCP: position of power & knowledge Patient: position of great vulnerability
What does deltoid paralysis/axillary nerve damage look like?
Loss of sensation of lateral side of proximal arm, loss of shoulder contour due to muscle atrophy
Name the exercise classification system: -created by Sahrmann -not limited to LB -addresses acute through chronic conditions
Movement System Impairment Syndromes
What does the deep perineal space contain?
Muscle of the urethra and a deep transverse perineal muscle that supports the free edge of the perineal membrane. Nerves and arteries are also in this space
Lumbricals
O: FDP tendons (follows FDP's innervation) I: lat. sides of extensor expansion N: -1-2: median N -3-4: ulnar N F: flex MCP, extend PIP & DIP joints
Rhomboid Minor
O: SP of C7-T1 I: spine & medial border of scapula N: dorsal scap N, C5 F: adduct scapula
Levator Scapulae
O: TVP of C1-4 I: medial border of scapula N: dorsal scap N, C3-4 F: elevate scapula
What is the O, I, N, F of levator scapulae?
O: TVP of C1-C4 I: superior angle of scapula N: dorsal scapular nerve F: elevate scapula
Middle Scalene (no N)
O: TVP of C2-7 I: 1st rib, post. to subclavian A. groove F: elevate ribs during heavy exercise, lateral flexion of neck
Anterior Scalene (no N)
O: TVP of C3-6 I: scalene tubercle of 1st rib F: elevate ribs during heavy exercise, lateral flexion of neck
Semispinalis (only O & I)
O: TVP of C4-T12 I: SP 4-6 levels up F: (bil: extension, uni: lateral flexion & rotation - Google)
Posterior Scalene (no N)
O: TVP of C5-7 I: upper surface of 2nd rib F: elevate ribs during heavy exercise, lateral flexion of neck
What is the O, I, N, F of deltoid?
O: acromian, clavicle, and spine of scapula I: deltoid tuberosity of humerus N: axillary nerve F: shoulder flexion, extension, and abduction after 15 degrees, also stabilizes shoulder joint by holding the head of the humerus in the glenoid cavity during movement
Flexor Digiti Minimi Brevis (of foot)
O: base of 5th MT I: base of prox. phalanx of pinky toe N: lateral plantar N F: flex MTP of pinky toe
Gracilis
O: body & inf pubic ramus I: sup/med surface of tibia N: obturator N F: adduct hip, flex & IR knee
Adductor Brevis
O: body & inf. ramus of pubis I: pectineal line, prox. linea aspera N: obturator N F: adduct & flex hip
Adductor Longus
O: body of pubis I: mid 1/3 of linea aspera N: obturator N F: adduct hip
Adductor Pollicis
O: capitate, 2-3 metacarpals (transverse & oblique heads) I: med. side of proximal phalanx base N: ulnar N F: adduct thumb
What is the O, I, N, F of pectoralis major?
O: clavicle, sternum, costal cartilages I: lateral lip of intertubercular groove of humerus N: medial and lateral pectoral nerves F: adduct, IR humerus, and flex clavicle
Coracobrachialis
O: coracoid process I: mid 1/3 of shaft of humerus N: musculocutaneous N F: flexes & adducts shoulder (musculocutaneous N pierces this muscle)
Pectoralis Major
O: costal margin, sternum, & medial clavicle I: bicipital groove of humerus N: med & lat pectoral NN F: flex, adduct & IR arm
Pronator Quadratus
O: distal 1/4 of anterior ulna I: distal 1/4 of anterior radius N: median N F: pronate forearm
Fibularis Brevis (focus on N & F)
O: distal, lat fibular shaft I: 5th MT tuberosity N: superficial fibular N F: plantarflexion, eversion
Fibularis Longus (focus on N & F)
O: fibular head, proximal, lat fibular shaft I: plantar side of med cuneiform, *base of 1st MT* N: superficial fibular N F: plantarflexion, eversion
Flexor Pollicis Brevis
O: flexor retinaculum, scaphoid & trapezium I: base of 1st phalanx N: -*sup head: median N* -deep head: ulnar N F: flexes CMC & MC joints of thumb, assists w/ opposition
Abductor Pollicis Brevis
O: flexor retinaculum, scaphoid & trapezium I: base of 1st phalanx N: median N F: abduct CMC joint of thumb, assists w/ opposition
Opponens Digiti Minimi
O: hook of hamate & flexor retinaculum I: medial border of 5th MC N: ulnar N F: flexes & ER 5th MC bone for opposition action
Flexor Digiti Minimi Brevis
O: hook of hamate, flexor retinaculum I: base of proximal phalanx of 5th digit N: ulnar N F: flexes 5th digit at MC joint
What is the O, I, N, F of latissimus dorsi?
O: iliac crest, thoracolumbar fascia, and SP of T7-L3ish I: intertubercular groove N: thoracodorsal F: extend, adduct, and IR humerus
Multifidus (no N)
O: inf sacrum & ilium, TVP more cranially I: SP 2-4 levels up F: controls trunk flexion & *ant shear forces*, segmental stability
Teres Major
O: inf. angle of scapula I: med lip of bicipital groove N: lower subscapular N F: adduct & IR arm
Adductor Magnus: Hamstring Part
O: ischial tuberostiy I: adductor tubercle of femur N: tibial N (sciatic N) F: extends hip
Extensor Digitorum Longus (focus on N & F)
O: lat tibial condyle, fibular head, ant fibular border I: dorsal aponeuroses & bases of digits 2-5 N: deep fibular N F: dorsiflexion, eversion, extend 2-5 MTP & IP joints
Extensor Carpi Radialis Brevis
O: lat. epicondyle I: base of 3rd metacarpal N: radial N F: extends & abducts/RD the wrist
Extensor Digiti Minimi
O: lat. epicondyle I: extensor expansion N: radial N F: extends 5th DIP, PIP, MCP* and wrist joints
Extensor Digitorum
O: lat. epicondyle I: extensor expansion N: radial N F: extends DIP, PIP, MCP & wrist joints
Supinator
O: lat. epicondyle, RCL & annular lig. I: lat, ant & post surface of radius N: radial N F: supinates forearm
Abductor Digiti Minimi (of foot)
O: lat/inf calcaneus I: prox phalanx of pinky toe, tuberosity of 5th MT N: lateral plantar N F: flex MTP of pinky toe, abduct pinky toe
Flexor Carpi Ulnaris
O: med. epicondyle I: pisiform N: ulnar N F: flexes & adducts wrist
Extensor Hallucis Longus (focus on N & F)
O: med. surface of fibula I: dorsal aponeurosis & base of distal phalanx of big toe N: deep fibular N F: dorsiflexion, inv & ev, extends 1st MTP & IP joints
Obturator Externus
O: obturator foramen & membrane I: trochanteric fossa of femur N: obturator N F: ER hip
Serratus Anterior
O: outer surface of ribs 1-8 I: medial border of scapula N: long thoracic N (SALT) F: abduct & protract scapula, rotates inf angle of scap, holds scap against thoracic wall
Flexor Digitorum Longus (of foot)
O: post tibial shaft I: base of 2-5 distal phalanxes N: Tibial N F: plantarflexion, inversion, flex MTP & IP joints of digits 2-5
Gluteus Maximus
O: post. ilium, sacrum, coccyx, sacrotuberous lig. I: IT band, gluteal tuberosity of femur N: inf. gluteal N F: -hip: ext, ER & abduction -trunk: return from flexed position to prevent arching of back
Extensor Pollicis Longus
O: post. radius & interosseous membrane I: base of 1st distal phalanx N: radial N F: extends IP, MCP & wrist
Extensor Pollicis Brevis
O: post. radius & interosseous membrane I: base of 1st proximal phalanx N: radial N F: extends MCP, and extends & abducts the wrist
Brachialis
O: shaft of humerus I: coronoid process & tuberosity of ulna N: musculocutaneous N F: flexes elbow
Subscapularis
O: subscapular fossa I: lesser tubercle of humerus N: upper & some lower subscapular N F: adduct & IR arm
Pectineus
O: sup. ramus of pubis I: pectineal line of femur N: both femoral & obturator NN F: adduct, flex & IR hip
Tibialis Anterior
O: sup/lat. tibia, interosseous membrane I: med/plantar surface of med cuneiform, base of 1st MT N: deep fibular N F: dorsiflexion & inversion
What is the O, I, N, F of trapezius?
O: superior nuchal line, SP of C7-T12 I: acromian, spine of scapula, and lateral clavicle N: spinal accessory F: elevates, retracts, depresses, and rotates scapula
Serratus Posterior Inferior
O: supraspinous lig, SP T11-L3 I: lower border of ribs 9-12 N: last 4 intercostal NN F: depresses ribs (focus on N & F)
Flexor Digitorum Profundus
O: ulna & interosseous membrane I: distal phalanges 1-4 N: digits 2-3 median N, digits 4-5 ulnar N F: flexes DIP, PIP, MCP & wrist joints
Extensor Indicis
O: ulna, interosseous membrane I: 2nd extensor expansion N: radial N F: extends index finger at PIP & DIP independently, some wrist extension
T/F: OT is a first-line of treatment in transplant patients
False--OT is consulted if they are having trouble with bathing or dressing usually
When doing a foot exam of a patient with neuropathy, what characteristics of the skin and toenails should you look for?
Skin: thin? shiny? brawny/muscular? frail? dry? callused? hair present? Toenails: thickened? deformed? ingrown?
What is the MOI usually for a distal biceps tendon rupture?
sudden injury -usually when the elbow is forced straight against resistance and results in greater arm weakness than injuries to the biceps tendon at the shoulder
What is claudication? Why does it happen?
sudden severe pain in calves that goes away if the pt sits down this happens b/c the vasculature can no longer support the muscle activity evidence shows the pt will develop collateral circulation if you force them to push through the pain
What are aggravating factors for a dissecting aortic aneurysm?
supine position accentuates symptoms
If someone has *long* upper trap muscles, what modification could you teach them to get their muscles back to a normal resting length?
support under their elbow when sitting
What are the two main treatment options for a distal biceps tendon rupture?
surgical non-surgical
What can result if a Volkmann's contracture is not treated?
swelling can lead to ischemia and cause involvement of forearm flexors
Beta-blockers inhibit what part of the nervous system? Therefore, beta-agonists have what role in the respiratory system?
sympathetic they will stimulate the respiratory portion of the sympathetic system
What are symptoms of hyperparathyroidism later on? What are symptoms related to?
symptoms are related to release of bone calcium into blood excess PTH leads to: *bone damage, hypercalcemia & kideny damage* -bones may become so fragile that pathologic fractures or deformities can occur -compression fractures of vertebral bodies -kidney stones
Proximal neuropathy affects which parts of the body?
thigh, hip and core muscles
How do mucolytics work to treat obstructive lung diseases?
thin the mucous of the lungs, but do not assist in removal (cough reflex usually takes care of this)
What additional joint does the CS have that the LS does not?
U-joints also called: -unconvertebral joints -joints of von Luschka
Which vertebral levels refer to the upper & lower cervical spine?
U: C1-3 L: C3-7
What is the MOI of valgus instability of the elbow?
UCL tear or sprain (valgus OH stress or repetitive OH activities cause lateral compression, medial tension and posterior shear)
Large residual urine volumes after voiding increases risk of _______
UTI
Name the exercise classification system: emphasis on reducing lordosis
Williams Flexion
When does equilibrium occur with levers?
When the forces on one side of the axis equal the forces on the other side of the axis F (df) = R (dr)
What are typical causes of rotator cuff injuries?
When trying to avoid crushing into an object, throwing a ball hard, or shoulder dislocation
What does the pectinate line mark the location of?
Where the columnar mucous membrane transitions to stratified squamous epithelium
In the sensorimotor stage of Piaget's cognitive development theory, how does a child learn?
use senses to explore and learn
How long does pain last with a MI?
usually at least 30 mins, may last 1-2 hrs, residual soreness for 1-2 days
When might a modified 2-point gait pattern be chosen for a pt?
usually for a pt with mild balance deficit using a single point cane
How long does pain with angina pectoris normally last?
usually less than 10 mins, never more than 30 mins, averaging 3-5 mins
What are associated signs and symptoms of pericarditis?
usually medically determined associated symptoms
Parasympathetic stimulation through the _____ nerve causes bronchoconstriction. Therefore parasympathetic ________ can be used to reduce asthma symptoms.
vagus blockers
Which type of elbow instability involves an injury of the ulnar collateral ligament (MCL)?
valgus instability
What material is an articulated AFO made out of?
various materials
Which type of elbow instability involves an injury of the lateral collateral complex in addition to a fracture of the coronoid process?
varus posteromedial rotatory instability
Which gait deviation is very common in transfemoral amputees?
vaulting
Sexual Misconduct
verbalization, touch, behavior, expression, gesture or innuendo that is sexual in nature
Which specific devices can be used in a 3-point pattern?
walker or axillary crutches (canes or forearm crutches do not provide enough support for use with a WB restriction)
How do we control movements that happen very quickly?
we have pre-programmed, stereotypical responses for those movement patterns
What are general signs and symptoms of a cardiovascular disease?
weakness, fatigue, weight change, poor exercise tolerance
Long acting asthma medications must be taken for _____ before the effects will be noticed
weeks
What are side effects of corticosteroids?
weight gain, fluid retention, high BP. diabetes, cataracts and osteoporosis
When is MES (LIS) used for aiding in *bone healing* for conditions such as fractures, spinal fusion or wounds?
when healing is delayed -Medicare criteria: 90 days w/out progress on a series of x-rays -CIGNA criteria: 1 cm gap or less
Do you need a prescription for MES (LIS) for *bone healing*?
yes, care is prescribed & monitored by a physician
Age Population: acute nerve root
young or old
Age Population: meniscoid entrapment in facet joint
young/middle aged
Why does an embolic CVA have a more immediate impact than a thrombotic CVA?
there's no time to form collateral blood flow in a thrombotic stroke the plaque forms over time so collateral circulation can form
In the formal operational stage of Piaget's cognitive development theory, how does a child learn and/or how do they see their world?
they are able to use critical thinking and logical operations in systematic fashion
Where are the trim lines around the ankle in a semi-solid ankle AFO?
they bisect the malleoli
How do leukotrine blockers work?
they block the formation of leukotrines
How do methylxanthines work?
they cause reversible airway dilation by inhibiting phosphodiesterase that causes degradation of cAMP (basically it inhibits the degredation of cAMP which is a compound that promotes bronchodilation)
Where are the trim lines around the ankle in a solid ankle AFO?
they encompass the malleoli
Why are methylxanthines considered more dangerous?
they have a small therapeutic range (10-20 mg/ml) so they can quickly become toxic
Do HCP's have the right to abuse drugs or alcohol in their private life, without penalty from their employer or interference from their colleagues, if they are able to do their job?
arguments for each side: -Yes: they aren't harming anyone & have a right to autonomy -No: it increases the risk of doing harm to patients
Describe the maturation principle of development
as we develop, the sequence of vertical changes in children depend on changes in the brain and NS, and all these changes help to improve thinking and motor skills (quote from lecture but seems like word mush)
How often should a patient with neuropathy have a comprehensive foot exam done?
at least annually, more often if complications exist
Quick acting asthma medications should be taken when?
at the first signs of an asthma outbreak, they will relieve symptoms within minutes
When should the assistive device come in contact with the ground during ambulation?
at the same time that the affected limb heel strikes to provide support while it is in stance
What is the most common parasympathetic blocker?
atropine (Saltropine)
Auditory disorders that affect central structures
auditory processing disorder
Outer ear structures
auricle/pinna auditory canal tympanic membrane
Which type of neuropathy affects the cardiopulmonary system, temp regulation, bowel, bladder and sexual function?
autonomic
How does Hashimoto's thyroiditis cause destruction of the thyroid gland?
because it is an autoimmune disease so the gland is infiltrated by lymphocytes & antithyroidantibodies
In a study about massed vs. distributed practice, the subjects performed a continuous task. There were groups with 60 sec of rest, 30 sec of rest, and 0 rest between trials. The 60 sec rest group had the most improvement in % time on target, whereas the 0 sec rest group did not have any improvement. Why might this be?
because the 0 sec rest group did not give their muscles a chance to relax and recover
Why is it common to see that pt with Cushing's disease can not rise out of a chair without help?
because the condition causes marked muscle weakness, and in this case the pt would have quad weakness
Define: biological theories
belief that heredity and innate biological processes govern growth
Define: cognitive theories
beliefs that describe how children learn
If someone has *short* hamstring muscles, how would you teach them to squat to prevent back compensations?
bend at the knees right away
How does zileuton work?
blocks the action of the enzyme, lipoxygenase, which blocks leukotrines from ever being formed (helps inhibit future asthma attacks)
Diabetes mellitus can cause mortality over a long period of time, but immediate death can occur if:
blood glucose levels become acutely high or low *this is a medical emergency*
If a patient has a KNOWN history of angina and the first dose does not relieve symptoms, what should the PT do?
can administer another dose of nitroglycerin, but you should not suggest it, wait for the patient to bring it up
What should the PT response be for a patient believed to have pericarditis?
can be acute or chronic **if symptoms are acute and progressing quickly, immediate medical attention would be warranted
How does variability affect the following? -acquisition of motor skill -retention of motor skill -transfer of motor skill
can be beneficial or harmful... -variability is *good* for the retention and transfer of a motor skill -variability is *bad* for the acquisition of a motor skill (variable practice leads to greater generalizability)
Are the symptoms of spinal stenosis usually bilateral or unilateral?
can be either, but usually bilateral (affects both lateral foramina)
How can a SMO be used to manage tone?
can raise the toes to give them a little bit more of a stretch
Which direction do cervical discs usually herniate?
central or paramedian (just off central)
What is the equation for acceleration?
change in v / change in t
You're performing an action plan and you get sensory information about how the execution of the plan is going and make adjustments to that action plan as it is happening ^ this is an example of a ________ (closed/open) loop control of motor movement
closed
"... the system can receive and process feedback information" ^ this defines _________ (open/closed) loop control
closed loop
Define: Spurling Test
closes a cervical vertebral foramina by extension, compression, SB & rotation to same side (look for reproduction of sx in arm)
Inner ear structures
cochlea semicircular canals
There are a lot of over-the-counter drugs that contain a small amount of antitussive (opioid) drug, but in general, any drug that contains ________ for a respiratory problem would have an antitussive drug in it
codeine
Piaget's development theory is an example of what type of theory?
cognitive
Which domain? thought processes and intellectual abilities including: -attention -memory -problem solving -imagination -creativity -academic and everyday knowledge -metacognition -language
cognitive domain
Auditory association cortex function
compares sounds with memories of other sounds (language/music/sounds)
Most biceps tendon ruptures are _________ (partial/complete)
complete
ASIA class A
complete - no motor or sensory function is preserved in sacral segments S4-S5
Wernicke's area is responsible for __________
comprehension of sound
Possible neoplastic causes of injury to the SC
compression on cord from meningiomas or gliomas
There is a (direct/inverse) relationship between brain volume loss and disease burden in MS
inverse
What can result from prolonged use of the nasal spray or eye drop form of decongestants?
irritation of the eye or nasal passageway (exacerbate symptoms)
Define: acute nerve root dysfunction
irritation/inflam, compression or tension to a nerve root
In distribution of practice we can either organize it to be _______ or _______
massed distributed
What is one theory for why reminiscence occurs?
may be due to the dissipation of temporary effects like fatigue (will also learn about a neurophysiological reason for reminiscence later in semester)
What are two means for determining if someone has hypertension?
measuring BP reading assess jugular vein for distension
Innervation of lumbar facet joints
medial branch of the dorsal primary ramus of that spinal level and 1-2 levels above & below
Disparagement
making unflattering statements against someone or something a problem w/ a particular HCP diff values, principles or philosophies doesn't mean they can't present a legit problem, it means the manner in which it was presented wasn't professional
Middle ear structures
malleus incus stapes
*Cromolyn sodium* was first discovered in 1960 in Britan in a plant and is part of the _____________ inhibitor family
mediator-release inhibitor
What type of drug is cromolyn sodium?
mediator-release inhibitor
What category of asthma drugs can be used either prophylactically or in response to acute asthma attacks?
mediator-release inhibitors
Autonomic dysreflexia is a __________. What should be done if AD is suspected?
medical emergency -get assistance -check catheter -elevate head -if catheter not the cause, check other sources -activate EMS
Mediator-release inhibitors are most commonly used to treat persistent _____ asthma
mild
The medial branch of the dorsal primary ramus that innervates the facet joints also innervates which structure at each segmental level?
multifidus-- there is a connection b/w facet joints & multifidus
What are aggravating factors of pericarditis?
muscle movement associated with deep breathing , left lateral bending of the trunk, trunk rotation, supine position
What does the presence of pain on palpation indicate?
musculoskeletal origin of symptoms
How is sensory information used *prior* to a movement for a motor program?
must know initial position of your body and limbs to complete a movement
Is a medical diagnosis sufficient to guide your PT treatment typically?
nah-- talked about how PT diagnoses (MSI classifications) are very different from medical diagnoses Ex: -PT diagnosis: lumbar rotation w/ extension -Med diagnosis: facet syndrome, spinal stenosis, spondylolisthesis, spinal instability, DDD, OA, herniated disc
Where does pericarditis pain get referred to?
neck, upper back, upper trap muscle, left subclavicular area, down left arm, costal margins
Define neurogenic claudication
neural compromise due to obstruction of blood flow to the nerve or dural sleeve (very common w/ spinal stenosis)
What are relieving factors for MI?
none, unrelieved by rest or nitroglycerin taken every 5 minutes for 20 minutes
Life expectancy of someone w/ MS
normal
Modified 4-point and 2-point gait patterns attempt to train toward:
normalized gait patterns and midline COG
Most people who only have chronic thyroiditis will have a _________________ functioning thyroid
normally -20% will be hypothyroid -less than 5% will be hyperthyroid
Are there many side effects of quick-acting asthma medications?
not many but notable points are: -too much albuterol can increase asthma symptoms -side effects vary from person to person -should not be used in people taking beta blockers
If more repetitions would theoretically mean more learning, should we just have patients do massed practice and perform as many repetitions as they can in a therapy session?
not necessarily results from a study looking at a high energy task showed that very long rests, and very short rests were both detrimental to performance results from a different study looking at a low energy task showed that still, the shortest possible rest period was not indicative of the best performance, but still shorter rest periods in general did seem to be better than long rest periods
What is somatosensory input *not* involved with during reach?
not required for fast, simple, or nonrepetitive arm movement initiation or execution
Does having 2 people repositioning or lifting reduce the load?
not significantly
If a patient has had 2 attacks and evidence of 2 lesions in the CNS, what additional info is needed to diagnose them with MS?
nothing-- this is the most obvious & typical MS diagnosis
______________ is a condition that involves a high amount of body fat in relation to lean body mass or a BMI greater than 30 (fat is not supported by the person's frame)
obesity
Expectorants, Mucolytics and antitussive drugs are used to treat what kind of respiratory disorder?
obstructive lung diseases
What is a bursa?
Small fluid-filled sac lined by a synovial membrane
How should nitroglycerin be administered?
sublingual, the PT should NEVER TOUCH the nitroglycerin pill because it may be absorbed through the skin very easily
What is the collective function of the rotator cuff muscles?
To hold the head of the humerus against the glenoid fossa
T/F: Charcot foot is caused by neurotrauma
*false*, it's unclear if the etiology is neurotraumatic, neurovascular or both
What happens to reaching duration with increased age? What causes this?
*increased reaching movement time* due to changes in: -sensory and perceptual systems -central processing systems -motor systems -arousal and motivational systems
What is a good cue to get someone to activate their transversus abdominis?
"think about bringing your belly button to your spine" or abdominal bracing
Which arteries are the most common locations of a stroke?
#1: MCA #2: ACA PCA is less common
The treatment for neuropathy costs as much as _________ per year
$13.7 billion amputations cost $1 billion per year
FYI: thyroiditis is often seen first as an acute inflammatory response to autoimmunity in an autoimmune disease
(I think her point is that thyroiditis often happens secondary or in conjunction with autoimmune diseases)
Example of a reflex-reversal phenomenon:
(idea that reflexes are not stereotyped in CPG) -if sensory stimulus is applied to the top of a feline's foot during gait, the foot will flex higher in swing phase, but in stance, the limb will not flex or extend slightly during stance phase of gait
The goals of all respiratory drugs can be classified under what 4 goals? Which two goals does the majority of drugs in this module fall under? (bold)
*1. promotion of bronchodilation for relief of bronchoconstriction* *2. Facilitation of the removal of secretion from the lungs* 3. improvement of alveolar ventilation or oxygenation 4. optimization of the breathing pattern
Define: ischemic core & penumbra
*Core*: dead tissue that can't be saved *Penumbra*: injured tissue that can be saved w/in a certain time frame
In MES for *wound healing*, where are the cathode and anode placed?
*First 3 days*: -cathode: in the wound area -anode: within 25 cm of wound *After 3 days*: -reverse polarity and place anode in the wound area
MSI Exam for every Lower Quarter patient: (read)
*Standing*: --alignment --mvmt testing --SLS --gait analysis *Sitting*: --positioning effects (see how sx change) --mvmt testing --MMT/ROM *Supine*: --positioning effects --mvmt testing/relative flexibility --lower abdominals *Sidelying*: --positioning effects --mvmt testing/relative flexibility --MMT (glute med) *Prone*: --mvmt testing --structural variation *Quadruped* --preferred position --rocking back *Functional tasks* (pt specific to daily demands) --sit to stand --stairs
What is the only precaution for MES and HVPC? What causes this?
*chemical burns* can result from excessive electrical density due to: -intensity too high for size of active electrode -direct metal contact
What is a PRAFO indicated for?
*contracture prevention & pressure relief* -neuro involvement: CVA, SCI, TBI, etc. -orthopedic: hip fx, amputation -LT immobility: ICU
How does grasping change with age? What may cause this?
*decreased manual dexterity* -longer time needed to manipulate small objects -larger grip forces w/ less ability to adapt to changes in surface, and greater variability may be due to: -decreased tactile sensation -motor deficits -programming deficits
What population should be screened for type 2 diabetes mellitus (what are risk factors for DM?)
*everyone over 45 yo* every 3 years younger if: --*overweight* --high BP --*triglyceride level* > 250 mg/dl --*low HDL cholesterol* --1st degree relative w/ DM --*high risk ethnic group* --*delivered baby > 9 lbs* --impaired glucose tolerance --impaired glucose fasting --autoantibodies
Interventions: cervical central or lateral stenosis (education, TherEx, manual therapy, AD)
-*Education*: activity modifications, discourage participation in sports -*TherEx*: isometric strength for posture, mobility ex but avoid end ROM -*MT*: specific level traction, unilateral PA (lateral stenosis) -*AD*: cervical collar Notes: definitely try conservative treatment first, but if that fails then surgery is done, CS cord compression raises diff concerns than in LS & that's why you should discourage sports
Intervention: cervical DDD (education, manual therapy, TherEx)
-*Education*: posture, ergonomics -*MT*: mobs of UCS, CT jxn & TS, TS manip -*TherEx*: scap stabilization, thoracic extension, neck flexor activation Notes: hardly ever mobilize mid-low CS bc there's already a lot of shear forces there and don't forget TS & scap mm for exercises bc this is how you correct posture
Interventions: chronic cervical nerve root (manual therapy, education, TherEx)
-*MT*: joint mobs, traction -*Education*: ergonomics, modification of activities -*TherEx*: neurodynamics- tensioners bc chronic
Intervention: cervical disc herniation (manual therapy, assistive device, education, McKenzie)
-*MT*: manual traction (unload disc)*** -*AD*: cervical collar when indicated -*Education*: posture, ergonomics, body mechanics -*McKenzie*: repeated motions
PT Interventions: chronic facet dysfunction
-*MT*: rotation, unilateral PAIVM, traction, manipulation -*TherEx*: stretch, muscle re-education -*Education*: address faulty mvmts Other: facet joint injections or nerve blocks
Intervention: acute & chronic cervical facet syndrome (manual therapy, education)
-*MT*: unilateral PA, hold-relax, joint specific traction -*Education*: posture --think of specific techniques rather than global approaches--
PT Interventions: acute facet dysfunction
-*MT*: unilateral PA, traction, manipulation -*TherEx*: mobility ex usually see these people for 2-3 visits and then tell them it should go away on its own, but come back if it still persists after 3 weeks if you do treat it, choose unilateral MT techniques
PT Interventions: chronic nerve root
-*MT*: unilateral PAIVM, rotation, traction, soft tissue mobilization -*TherEx*: mobility ex, segmental muscle re-education -*Education*: faulty mvmts, treat neurodynamic findings
Interventions: acute cervical nerve root (modalities, manual therapy, TherEx)
-*Modalities*: can try ice -*MT*: manual traction, joint mobs only when dec severity & irritability, nerve sliders? -*TherEx*: TS exercises Notes: there's not a whole lot you can do for these people, you can try these things, but hopefully they are on medications to manage nerve pain like Gabapentin
PT Interventions: acute nerve root dysfunction
-*Modalities*: manual traction in supine or SL -*TherEx*: gentle N glides, later ex program when pain decreases -*MT*: lumbar rotation Other: epidural steroid injection (respond well to this)
Subjective: cervical DDD (pain description, hx, agg)
-*Pain*: Cloward Signs, diffuse, radiculopathy -*Hx*: long hx of neck pain, possible MVA/trauma -*Agg*: sustained flex, quick mvmt, end ROM mvmt
Subjective: cervical disc herniation (pain description, agg factors, behavior, history)
-*Pain*: deep ache & stiffness in center of back, occasional sharp pain, may have distal sx, may have radiculopathy or myelopathy, Cloward Signs -*Agg*: look down, turn head, sitting, driving, work -*Behavior*: limited ADL's, *slow speed of movement* -*Hx*: no clear hx, may be associated w/ MVA or trauma, may have slow onset or wake w/ pain, may be related to sustained posture Notes: usually just have pain or radicular sx at 1 segment, not multiple segments
Objective: chronic cervical nerve root (posture, neuro signs, neurodynamics, ROM, PAIVM, special tests, x-ray)
-*Posture*: "changes" -*Neuro Signs*: +/- -*Neurodynamics*: positive findings -*ROM*: limited in "closing" mvmts, stretch can reproduce their sx so SB toward or away -*PAIVM*: possible GHJ limitations -*ST*: positive Spurling Test -*X-ray*: possible degenerative changes of facets or foraminal encroachment
Objective: cervical DDD (posture, ROM, PAIVM, PPIVM, segmental exam, neural tension tests, palpation, diagnostics)
-*Posture*: flexed CS -*ROM*: may be limited w/ pain -*PAIVM*: central/uni PA-- hyper or hypo depends on where they are in degeneration process -*PPIVM*: sensitive test to determine segmental motion, can determine the "age" of pt's CS -*Segmental Exam*: check for sensory or motor loss and presence of hyporeflexia -*UE Neural Tension Tests*: if indicated for median, radial or ulnar NN -*Palpation*: soft tissue & bony alignment in back, feel for overgrowth of bone in ant neck -*Diagnostics*: x-ray would show degenerative changes
Objective: acute cervical nerve root (posture, ROM, palpation, neuro exam, x-ray)
-*Posture*: looks uncomfortable, attempt to correct deformity inc sx -*ROM*: limited in all planes***, only able to test 1-2 motions -*Palpation*: may not be able to do this -*Neuro*: positive -*X-ray*: degenerative changes, NR compression
Objective: cervical disc herniation (posture, ROM, PAIVM, special tests)
-*Posture*: may be flexed or head tilt -*ROM*: *large limitation in flex/ext*, painful ipsilateral SB + rotation -*PAIVM*: painful central PA > unilateral PA -*ST*: positive Spurling Test Notes: may only have a few degrees of flex/ext which is very indicative of a herniation or a fx causing instability
Objective: acute & chronic cervical facet syndrome (ROM, PPIVM, PAVIM, segmental neuro, palpation)
-*ROM*: limited w/wo muscle guarding, SB limited to both sides (but not as extreme as a disc herniation) -*PPIVM*: limited segmental motion -*PAIVM*: limited, painful -*Neuro*: lack of neuro sx*** -*Palpation*: point tenderness, muscle spasm, changes in soft tissue
Objective: cervical central or lateral stenosis (ROM, neuro exam, observation, diagnostics)
-*ROM*: painful & restricted -*Neuro*: sensory & motor deficits, radiculopathy & myelopathy due to mixture of cord & NR compression -*Obervation*: wasting of intrinsic hand mm resulting in loss of dexterity, difficulty writing & visible atrophy of thenar & hypothenar eminences -*Diagnostics*: x-ray or MRI must be used to determine the extent of the problem
What are some symptoms of Addison's disease?
-*bronzed/tanned appearance* -*inc pigmentation of scars* formed after onset of disease -people of darker skin may develop *gray color* -weight loss -dizziness -low BP -abdominal pain -nausea
Define the following as it relates to the dynamical systems theory: -control parameters -rate limiters -attractors
-*control parameters*: variables that regulate the change in behavior (movement) of the child (may induce transition to a new attractor state ex: increasing speed on treadmill can be control parameter that causes the phase shift from walking to running) -*rate limiters*: factors that limit the ability of the child to move (control parameters can also inhibit movement thus being referred to as a rate limiter (example of child who has a ball thrown at them will likely close eyes in fear, inhibiting the ability to catch a ball) -*attractors*: stable movement patterns (movement patterns that are chosen due to preference and may be the most fitting at the time (example of tennis player that injury hand but then retains the altered hand position for hitting because it improves playing), also example of PT teaching to walk without a limp because we don't want an attractor to develop of walking with a limp)
Pain Description: Cloward Sign d/t cervical IV disc stimulation
-*deep, dull ache* -intense, but not sharp -lasts 10-15 min -*muscle spasms* Notes: Cloward thought the deep ache was from stimulating the *ventral* nerve roots (all motor) and as a response you get reflex muscle spasms & pain in the thoracic area that's innervated by the cervical region-- scapular mm are innervated by cervical spinal NN
What are some symptoms of Grave's disease?
-*exopthalmos* -nervous, *anxious*, emotional -heat intolerance -weight loss despite inc appetite -sweating -diarrhea -tremors -fatigue -palpitations
Body Chart: general neck pain
-*headache* -neck -shoulder -upper back -radiates to UE Note: HA is almost always an upper CS issue or intra-cranial issue
With any potential spine conditions, you need to assess the hip as well. What structural considerations at the hip do you need to keep in mind?
-*hip anteversion/retroversion*: example of anteverted person never being able to get their legs to the ground w/ a butterfly stretch, or a retroverted person using their spine for all their motion in a back swing in golf -*wide pelvis*: sidelying will put the spine in a bad position, use pillow for proper alignment -*femoral acetabular impingement*: CAM vs Pincer
What are *early* (rapid) signs of hypoglycemia?
-*hunger* -headache -dizziness -sweating -shakiness -*tingling sensation around mouth* -pale skin color -high HR
Interspinalis & Intertransversarii: only F
-*proprioception* -fine tune segmental motion
Subjective: general neck pain (read)
-*screen CS first* -check for central & peripheral nerve and vascular sx (indicate it's not a MSK issue) -r/o: fx, instability, & cervical myelopathy
Which of the 3 categories of LBP patients would benefit from having imaging done?
-*serious spinal pathologies* -sciatica if they are a surgery candidate or monitoring disease progression
According to McGill, what are some good abdominal exercises that place minimal compression loads on the spine?
-*side plank*: high activity of obliques w/ low compressive loads -*bird dog*: high level of contraction w/ low compressive loads
What are *late* signs of hypoglycemia?
-*slurred speech* -difficulty paying attention -confused -pale skin color -*sudden moodiness* -behavior changes such as crying for no apparent reason -clumsy or jerky movements -seizures -pass out
PT Interventions: spinal stenosis
-*traction/distraction*: if they have compression -*joint mobs*: rotation technique- open lat foramen -*education*: how to move w/ a neutral (not extended) spine, positioning to encourage flexion -*exercise*: (more on diff flashcard) Non-PT Interventions: -*medications*: should be on meds to control nerve pain, may get injections -*laminectomy/fusion*: if everything else fails
How prevalent is MS? -worldwide -U.S.
-2.5 million worldwide -400K in U.S.
How many stages of degeneration are there? What is the last stage?
-4 stages -last stage: hypomobility
In MES for *wound healing*, what parameters are used for: -amplitude -pulse duration -pulse frequency -waveform -treatment duration -treatments/day
-A: higher for denervated skin vs. normal skin -PD: long or continuous -PF: maximum -Wave: monophasic or biphasic -TD: 2 hrs w/ 4 hr rest time -#: 2-3 times per day
What characteristics make a good organ donor?
-ABO blood compatible -histocompatability -cause of death: brain death -age: <35-40 -relatively healthy -weight & thoracic dimensions match
Boundaries: lateral foramen
-Ant: post aspect of disc & v body -Post: ligamentum flavum -Sup/Inf: facet joints & articular processes Notes: hypertrophy of facet joints or pedicles from excessive loading can narrow the lateral foramen
What are our top priorities in acute care specific to ischemic strokes?
-Anticoagulants: heparin or coumadin -Antiplatelets: aspirin -Thrombolytic Agents -T-PA: 3 hour window -Prourokinase: 6 hour window, given via microcatheter by neurovascular surgeon
When might a heart transplant be recommended?
-CAD -cardiomyopathy -heart valve disease w/ CHF -severe congenital heart disease -poor quality of life-- intractable angina & life threatening arrhythmias
What are potential complications of DM?
-CV disease -peripheral vascular disease -diabetic neuropathy -diabetic retinopathy -diabetic nephropathy -skin problems
What alternatives exist if a patient does not qualify for a lung transplant or is waiting for one?
-ECMO -lung volume reduction surgery (LVRS) -pressure release ventilation or biphasic positive airway pressure (BiPAP) (more alternative options for heart issues)
Medial Pterygoid: only F
-B elevation -B protrusion -U contralateral lat deviation
Masseter: only F
-B elevation -B protrusion (sup fibers) -B retrusion (deep fibers) -U ipsilateral lat deviation
Temporalis: only F
-B elevation -B retrusion -U ipsilateral lat deviation
Lateral Pterygoid: only F
-B protrusion -B *inf head*: depression -U contralateral lat deviation
What are some things that might impact a patient's outcome with a lung transplant? (read)
-BMI -air flow obstruction -dyspnea -exercise capacity -evaluation of cardiac function -previous abominal/thoracic surgery
Auditory function in CNS (3)
-activating effect of sound -orients head and eyes toward the sound -recognition of sound
Rehab in a rehab hospital is ideal for most patients except for: (2)
-Comorbidities: adv COPD, low EF, or cardiac dysfunctions mean a pt will need a 2 hr nap after therapy so they'll never be able to do 3-6 hrs of therapy due to lack of endurance -Cognition Impaired: can't follow directions
Possible vascular causes of injury to the SC
-epidural hemorrhage -cardiac arrest -severe hypotension -atherosclerosis -embolism
What are the parameters for HVPC *in general*? -current -voltage -pulse duration
-DC and PC -high voltage/electromotive force -PD: phase duration of both spikes (*short*, usually fixed)
2 possible sources of error in the carrying out of motor programs:
-error in program selection -error in program execution
What is the MOI for a radial head fracture?
-FOOSH (most common - causes radius to hit capitulum) -direct blow
When might a 4-point gait pattern be chosen for a pt?
-FWB progressive gait and balance training -post-surgical patient transitioning to WBAT -early prosthetic training
What are the settings on a mechanical ventilator?
-FiO2: room air or 21% oxygen -Flow Rate: max flow delivered during inspiration -Resp Rate: 12-16 breaths/min -Tidal Volume: volume delivered/breath -PEEP: how much pressure during exhalation -I:E time ratio
What are the goals of a foot exam?
-establish history -identify their risk of foot injury -intervene -pt education *early involvement is key!*
Features of a GMP (2):
-GMP has certain invariant features (features that are fixed and identify actions as coming from that motor program -GMP can be "parameterized" (certain features of the template can be adjusted to meet demands of task at hand)
Nociceptive pain
-everyone can experience -in people w/ spastic paresis or paralysis of the reflex is often exaggerated (reflex spasm)
What is a pulmonary artery catheter and IABC-- intra-aortic balloon counter pulsation? (read)
-IABC rapidly shuttles helium in/out of balloon which is in the descending aorta -inflated: onset of diastole -deflated: onset of systole
Describe the deficits of a stroke that occurred in the *right* hemisphere:
-L hemiparesis -L visual-perceptual deficits -poor judgement -cognitive & behavioral issues
Cauda Equina Injury
-LBP, radicular pain, LE paresis or paralysis -sensory deficit in perineal area, bowel/bladder dysfunction -diminished/absent patellar and achilles reflexes
What does it mean to say that an LVAD can be used as destination therapy?
-LT support for patients who are not candidates for heart transplants with end stage heart failure -they will have this device until they pass away -common if they have "aged out" of receiving a transplant -can extend life 5-10 years
What is the MOI for triceps tendinosis?
-activities or sports with repetitive, forceful elbow extension -will continue to progress when adequate time is not allowed for tendon healing -instability of shoulder and scap may contribute
What are 3 common ankle alignment & function problems to check for when assessing a pt for a LE orthotic?
-M-L stability -*foot drop* -PF contracture: likely to occur w/ foot drop
STTT: muscles
-MMT -put a muscle on stretch & add resistance
The first rib serves as an attachment site for some neck muscles. What are 3 common MOI's for issues with the first rib?
-MVA -posture -poor breathing pattern (not thoracic spine rotation)
Breakdown of traumatic causes of injury to SC
-MVA: 39% -Falls: 30% -GSW/violence: 14% -sports: 9% Other: 8%
History: chronic facet dysfunction
-acute facet dysfunction -trauma -degeneration -LBP
What is the NIOSH standard in Newtons for safe repetitive loading on the spine? Anything above this is linked to an inc risk of injury __________ N of compression begins to cause damage in weak spines
-NIOSH Standard: 3300 N (670 lbs) = risk of injury -7000 N (1568 lbs) = damage
What objective measures should you perform if you suspect a chronic nerve root injury?
-Neuro exam: likely positive -Soft tissue: localized thickness in tissue, stiff at segment of injury -Neurodynamic tests (SLR): could be positive
What are cams, how are they different from pulleys?
-Non-uniform ellipses used to improve the mechanical advantage of a system -Allows for variable resistance throughout the ROM to match the length-tension relationship of the muscle
How does an LVAD affect the validity of a patient's VS and how should you measure them? (HR, O2, BP)
-O2: unreliable d/t dec pulse pressure -HR: manual auscultation or doppler US -BP: manual auscultation or doppler US, MAP should be ~80 mmHg, taken by nurse usually we do still check VS, but we are relying more on their symptoms since an LVAD makes VS less reliable-- monitor for s/sx of dizziness or SOB
Possible degenerative causes of injury to the SC
-OA -RA -spondylosis -osteoporosis
Stabilization mechanisms after SCI:
-ORIF w/ spinal instrumentation and fusion -bracing -traction (Halo) -cervical collar (Aspen, Miami J, Philadelphia) -CTLSO -TLSO
Examples of joint types for articulated AFOs: (read)
-Oklahoma -Gillette -Camber axis hinge -Metal upright
Why are LVAD patients at an increased risk of bleeding?
-often on blood thinners -INR is elevated (*1.5-2.5*)
Describe Outpatient Rehab for a stroke patient:
-PT most common -OT & SLP also available -2-3x per week, 30-45 min -strength & endurance training
What should you do if a patient initiates sexual behavior towards you?
-address them directly rather than ignore them -veracity is important to maintain your dignity -maintain work performance -look at alternatives -reach out to co-workers to vent & generate solutions
Describe the deficits of a stroke that occurred in the *left* hemisphere:
-R hemiparesis -language deficits -apraxia -delays in processing -perseveration Notes: -apraxia: motor planning deficit -perseveration: repetition of words or phrases w/out a stimulus
How many hours of rehab do patients complete per day/week in a rehab hospital, sub-acute care & long-term care setting?
-RH: 3-6 hrs per day -SA: variable -LTC: 2-3 hrs per week
Which patients are good candidates for a rehab hospital, sub-acute care & long-term care setting?
-RH: medically stable, adequate endurance, cognition intact, but have functional disability -SA: cognition intact, less endurance & more serious disability -LTC: 24 hr care needed LT due to cognition, comorbidities or lack of home support
What is the difference between a rehab hospital, sub-acute care, & long term care?
-RH: rehab unit of hospital or rehab center (inpatient) -SA: SNF -LTC: nursing home
Factors that correspond to a more favorable outcome in MS (4)
-RRMS (rather than PRMS) -older onset -disease begins w/ 1 sx -no pyramidal or cerebellar sx w/in 5 years of onset
What should a PT do if they think a patient is suffering from angina pectoris?
-Rest, stop activity -seat patient in upright position -administer nitroglycerin (sublingual) -check pulse and respiration -administer O2 if necessary (PT will not do)
What are side effects of antihistamines?
-allergic reaction resulting in difficulty breathing and a closing feeling in the throat -dizziness, drowsiness, nausea, dry mouth and muscle aches
What are s/sx of *lung* transplant rejection?
-SOB -desaturation-- problems maintaining their O2 sat level (should have a baseline measurement to compare O2 sat level to)
Visual and somatosensory contributions to *anticipatory* (feedforward) control of reaching?
-allows for correct direction of initial reach -update proprioceptive and visual body maps to allow reaching
Are we able to make improvements in ROM in a short or stiff muscle?
-Short: no, would need serial casting to add sarcomeres in length & really see a change -Stiff: yes w/ repetitions
Difference b/w soft & hard disc herniations
-Soft: migration of NP -Hard: bulging of AF fibers
Static & Dynamic Posture: spinal stenosis
-Static: flat lumbar posture, post pelvic tilt, flexed hips & knees -Dynamic: ant pelvic tilt (due to poor control) w/ excessive segmental translation
What modifications would you teach an extension patient in supine, sidelying, sitting, fwd bending, walking & prone?
-Supine: bend knees to turn off hip flexors -Sidelying: pillow b/w knees (rot), "curl up" (ext) -Sitting: back of chair, okay to slouch, raise hips -Fwd Bend: work on hip motion in return instead of all of it coming from spine, can't fix curve reversal right away -Walking: shorten stride -Prone: careful w/ ant pelvic tilt, pillows under them, work on inc hip ext ROM, work on glute strength
Cause: hemorrhagic CVA
-aneurysm -HTN -AV malformation leads to abnormal bleeding in brain
What is torque/moment? (3)
-The application of force at a distance from the point of pivot -Causes rotation around a stationary point T = F x d -Has magnitude & direction
Rectus Capitis Posterior Major
O: C2 SP I: lat nuchal line F: B head ext, U same SB & rot
What should you do if someone who is hypoglycemic loses consciousness?
-act quickly, they need immediate treatment -injection of glucose or emergency treatment in a hospital is ideal
Once the AP is sent down the cochlear nerve, how does it get to the primary auditory cortex?
-Vestibulocochlear nerve (cochlear nerve) travels to brainstem and synapses in the inferior pons on the cochlear nucleus (some info travels to reticular formation) -travels to inferior colliculus and superior colliculus then up to the medial geniculate body in the thalamus which relays info to the primary auditory cortex
Most common type of MS
Relapsing-Remitting
What are symptoms of *early* acute hyperglycemia?
-blood sugar > 180 mg/dL -blurred vision -thirsty -*ketones in urine* -dry skin -inc urination -tired (same as DM becoming a medical emergency)
What are symptoms of *late* acute hyperglycemia?
-blood sugar > 240 g/dL -nausea, vomiting -deep rapid breathing -large ketones in urine -fruity breath (same as DM becmoing a medical emergency with further decline)
What are the symptoms of DM becoming a medical emergency due to acute hyperglycemia?
-blood sugar is above 180 mg/dL -blurred vision -thirst -ketones in urine -dry skin -inc urination -extreme fatigue *with further decline:* -blood sugar is above 240 mg/dL -nausea, vomiting -deep rapid breathing -large ketones in urine -fruity breath
The 3 tiers of the hierarchial model of NS development involve sections of the CNS in what order?
-brainstem and SC -midbrain -cortex
What is included in a PT cardiopulmonary assessment on a post-transplant patient?
-breathing & ventilatory function -airway clearance -auscultation -exercise tolerance: 6-MWT, NuSTEP, submax test
How are custom fabricated LE orthoses made?
-casting -measurement -negative mold -positive mold -fabrication -modification
Central cord syndrome -structures damaged -functions lost -functions preserved
-central area of injury which affects the medially located motor fibers that control distal UE function -UE weakness > LE weakness -sacral sensory sparing
What are the 4 *principles* of development?
-cephalocaudal principle -proximodistal principle -maturation -spiraling pattern of development
Common locations for MS plaques to form
-cerebrum (ventricular area) -optic N -brain stem -cerebellum -spinal cord
Which 3 cervical conditions may have Cloward Signs?
-cervical DDD -cervical disc herniation -acute or chronic cervical nerve root issues
Factors contributing to bone demineralization after SCI:
-change in hormonal regulation -neural and vascular changes -reduction of mechanical stimuli to bone from muscle contraction
What education should be provided for a patient with neuropathy specific to foot care?
-check feet daily -*always* wear shoes -don't apply lotion b/w toes -have nails clipped by health care professional -manage calluses w/ emery board/ped-egg -Vick's Vaporub or tea tree oil for onychomycosis -immediately report changes
Define: chronic nerve root
-chronic irritation of a nerve root -fibrotic changes in the joint capsule are pulling on the nerve root -- tethering issue
What is Piaget referring to when saying cognitive development is a biological adaptation?
-cognitive development occurs as the result of adaptation of mental constructs gained from experiences -children learn like 'the little scientist'
How do you treat Charcot foot?
-complete immobilization in a total contact cast -protected WB
What treatment should a high risk patient for developing foot wounds receive?
-comprehensive assessment every 6 months - 1 year -education -certification for diabetic shoes (documentation is critical to get them these shoes)
What should you be sure to look at in an objective exam of patient with neuropathy?
-condition of skin, hair & toenails -deformities -pulses -sensation -shoe wear
Causes of hearing loss (2)
-congenital (genetic/non-genetic) -acquired
Should PT's treat the "sciatica" category of LBP patients?
-conservative treatments (like PT) are always tried first -if they fail, they are a candidate for surgery
Define: motor program
restructured set of central commands capable of carrying out movement (without sensory feedback)
What topics should you be sure to ask about in a subjective exam of patient with neuropathy? (6)
-contributing diagnoses to neuropathy (DM, HIV, etc) -PMH and social factors -complications (neuropathy, nephropathy, retinopathy, vascular disease) -history of LE surgery, ulcers, or amputations -current or past smoking -HbA1c (tells you how well their blood sugar has been controlled if diabetic)
Somatosensory contributions to *grasping*?
-cutaneous afferents essential for control of grip forces -somatosensory cortex critical for control of grasp
When a patient with neuropathy checks their feet at home, what should you tell them to look for?
-cuts -blisters -infection (anything that is red, swollen or weeping) -use a mirror if needed -enlist help of family
Brown sequard syndrome -structures damaged -functions lost -functions preserved
-damage that affects 1/2 of the spinal cord significantly greater than the other 1/2 -spastic paresis -loss of light touch and vibration sensation (damaged side) -loss of pain/temp on contralateral side
What interventions should be provided to a patient with (diabetic?) ulcers?
-debulk calluses -control moisture -dec infection risk (silver products & antibiotics) -edema management
What is the "muscle dysfunction" associated with neck pain?
-dec force production & endurance of neck flexors -altered postural muscle tone
If most people experience LBP at some point, and most people get better on their own, what is PT's role in treating these people?
-dec frequency of recurrences -prevent progression to a chronic condition Kurt's ideas: -slow degeneration -dec loads on already damaged spine -assess hip joint for adequate motion
What may tightness of the scalene muscle that attaches to the first rib result in? (3)
-dec mobility of the ribs -elevation of the ribs -puts neck in extended position
What is the purpose of kinesiology?
-develop rational evaluation -develop precise PT diagnosis -develop effective treatment of disorders that affect musculoskeletal system
What does the dynamical systems theory state? (3)
-development of motor pattern depends on a *combination* of mechanical, neurologic, cognitive, and perceptual factors in addition to environmental contributions -neural maturation is *equal* to other structures and processes that influence motor development -*Environment is as important as the organism*
What is mechanical ventilation?
-device that delivers a stream of compressed air via face mask & hose -keeps airway open (splinting it) under air pressure -ventilators can take sole charge of pt's ventilation or assist them w/ their own breaths
Pelvic Floor Muscles: only F
-direct connection w/ obturator internus via tendons -contributes to local hip control -stabilizes hip via global mm -anchors deep hip rotators -provides good hip joint mechanics -allows optimal power for larger mm
Causes: acute nerve root dysfunction
-disc pathology -degenerative changes -other medical conditions (ex: shingles)
General treatment guidelines for elbow instability: (read)
-discourage a "no pain, no gain" attitude -avoid lifting, pushing or pulling -gradually reintroduce activities as long as they are pain-free
Subjective: acute cervical nerve root (symptoms, agg factors, 24 hrs, onset, history)
-distal sx > proximal sx in dermatomal pattern -possible Cloward Signs -constant or intermittent -*Agg*: any neck mvmt (esp. those that close foramina), arm mvmts, sustained flexion -*24 hrs*: awakes at night -*Onset*: insidious, then spreads out, may start w/ neck stiffness or from scapular area -*Hx*: prior episodes of neck stiffness
What does it mean to say a patient is able to achieve "community ambulation" in terms of: -distance -speed -ambient conditions -physical load -terrain
-distance: 1000 feet -speed: traffic lights, busy sidewalks -ambient conditions: rain, temp, light -physical load: packages, doors -terrain: stairs, curbs, slopes, obstacles -attention demands
What are some associated signs and symptoms of a MI?
-dizziness/vomiting -feeling faint/fatigued/sudden weakness -nausea -indigestion -pallor -diaphoresis (sweating) -apprehension -severe anxiety -dyspnea -followed by painful shoulder-hand syndrome
Examples of genetic congenital causes of hearing loss:
-down syndrome -usher syndrome
Features of a GMP that can be "parameterized"
-duration of movement -overall force required -selection of muscles to complete movement
What are some things that should be considered when designing an orthotic? (read)
-dx -px -comorbidities -height -weight -cost -cosmesis -degree of deformity -degree of correction -musculoskeletal factors -mobility & stability requirements -anticipated functional level
Causes of hearing loss (acquired)
-ear infections -medications -meningitis -measles -encephalitis -chicken pox -flu -mumps -TBI -noise exposure
How can PT's raise awareness about strokes in general? (read)
-educate pts if they've had a stroke that they're at risk of having another -educate pts about warning signs -provide health fairs to screen people for stroke risk factors
What are the post-operative treatment goals in acute inpatient PT for a transplant patient? (read)
-education (precautions) -functional abilities in self-care -mobility -transfers -ambulation -pulmonary hygiene -chest wall mechanics -exercises: ADLs, MET levels 1-3, breathing
Describe the physical appearance of acromegaly: (7)
-enlarged hands & feet -thick skull -changes in facial features -can lead to carpal tunnel and arthritis -protruding jaw -large tongue -large shoe or glove size
Possible inflammatory causes of injury to the SC
-epidural abscess -granuloma -transverse myelitis (most common)
What has provided some evidence that motor programs exist? (3)
-feedback is too slow (movements can be performed faster than feedback can be processed) -time to react to a stimulus (reaction time (RT)) is longer for complex movements compared to simple movements -individuals who cannot receive sensory info (de-afferentiation) can still perform skilled movements)
What are signs and symptoms of shock?
-first signs (often missed) are thirst and agitation or restlessness -next, sign of compensation: cool, moist, pale skin; tachycardia; oliguria (dec. urine output) -septic shock: patient may experience "warm shock" (fever, warm, dry, flushed skin), rapid, strong pulse, hyperventilation -progressive signs: lethargy, weakness, dizziness, weak, thready pulse
How do you assess knee alignment & function in an evaluation for a LE orthotic?
-flexion -genu recurvatum -genu varum -genu valgum
What are s/sx of *heart* transplant rejection?
-flu-like symptoms -fever -muscle aches -dysarrhythmias
Examples of conductive hearing loss
-fluid in middle ear -otitis media -allergies -poor eustachian tube function -performated tympanic membrane -benign tumors -impacted cerumen (ear wax) -otitis externa -presence of foreign body -absence or malformation of the outer ear, ear canal or middle ear
What are goitrogens?
-foods that block elements of synthesis of T3 and T4, but increase TSH secretion -can cause hypothyroid goiters when consumed in large quantities Ex: cabbage, turnips, lithium, fluoride
At which anatomical locations does a SMO provide stability?
-forefoot -midfoot -subtalar joint
Suprahyoids: only F
-form floor of mouth -elevate & move hyoid anteriorly to widen pharynx & close trachea when swallowing -when hyoid is fixed, depress & retrude mandible (digastric, mylohyoid, geniohyoid, stylohyoid)
What education should be provided for a patient with neuropathy in general?
-general diabetes self-care -foot & skin care -daily skin checks -proper footwear: breathable & adjustable, wide toe box, good support
Why do patients temporarily get removed from the heart transplant list when they get an LVAD?
-getting an LVAD is a surgical procedure, so they don't want to have surgery immediately again -removed from list for 4-6 weeks
How may the thermostat example be described that acts as though it is under closed loop control?
-if the real temp doesn't match the desired temp, the "executive" creates and issues instructions on what to do. -instructions are put into action and the furnace turns on -thermostat relies on feedback, monitoring air until goal temp is reached
How do we know if massed or distributed practice is better?
-in general, longer rest periods are more beneficial to performance during practice -however, we have to consider the overall time that we have to spend working with the pt
How do you treat acute hypoglycemia? After treating, you wait ______ minutes and test their blood sugar again, if its less than ______ you should repeat the treatment, it its greater than ______ you should _______________
-inc blood sugar with 15 g fast acting sugar (3 glucose tablets, 1/2 cup fruit juice, or 5-6 pieces of hard candy) -wait 15 min and test blood sugar again, if its less than *70 mg/dL* then repeat the steps, it its greater than 70 then have them eat a meal or snack
Pregrasp hand shaping is affected by:
-intrinsic properties of an object (shape, size, texture) -extrinsic (contextual) properties of an object (location in respect to body)
If someone has weak dorsiflexors, what will their gait pattern look like?
-lack of pick up of toes during swing, drop foot -compensate w/ hip & knee flexion in the swing phase to clear the foot
Describe the deficits someone may have from a MCA stroke:
-large amt of frontal, parietal & temporal lobes -stronger facial & UE impairments -language & speech -LE is spared
Should PT's treat the "serious spinal pathologies" category of LBP patients?
-learn the conditions -recognize the sx -refer them to MD & let them do the rest
What is an LVAD?
-left ventricular assist device -receives blood from LV & delivers it to the aorta -implanted below the heart & attaches at apex -have to wear a vest to carry the battery assists to pump blood through the body
What are the signs & symptoms of elbow instability?
-locking, catching or clicking of the elbow -sliding or shifting -feeling like your elbow might pop out of place (usually when pushing off from a chair) -athletes might have pain when throwing OH or have loss in throwing velocity
How does obesity effect acute hospital care?
-longer hospitalizations -poorer outcomes at discharge -more re-hospitalization and re-injury -higher mortality
Significance of CPG in PT: -populations it may be important for -focus with training in gait -who may benefit most from utilizing presence of CPG -other things that still interfere with functional gait and possible use of CPG
-lots of research in pt with SC injury -training in foot placement and WB -taking advantage of preserved rhythmicity of limb movement at SC level --> promise for regaining locomotion -pt w/ incomplete SC injury likely to make greatest gains -lack of postural stability and inability to initiate gate continue to interfere w/ functional gait
What are signs and symptoms of a distal biceps tendon rupture?
-often a "pop" at the elbow -pain (severe at first but subsides after a week or two) -swelling -bruising -weakness in elbow flexion and supination -"popeye" deformity -gap in soft tissue at the anterior elbow
What are symptoms of hypothyroidism later on?
-low HR -dec GI motility -slow neurologic functioning -dec body heat production -achlorhydria: absence of HCl from gastric juice -*symptom complex like fibromyalgia* (muscle aches & tender points) but is resolved with replacement therapy so it is not true fibromyalgia -*inflammatory arthritis* that is indistinguishable from rheumatoid arthritis
TherEx: spinal stenosis
-lumbar flexion exercises -spinal stabilization exercises -no lumbar extension ex: strengthen glute mm in a spine neutral position (quadruped) -no typical abdominal ex: bc they will have excessive ant pelvic tilt -stretch HS & HF: want enough hip flexibility to reduce amt of spine extension needed -watch for back compensations
What are the components of a vector? (4)
-magnitude -direction -point of application -line of application
Examples of non-genetic congenital causes of hearing loss:
-maternal infections, such as rubella, or herpes simplex virus -prematurity -low birth weight -birth injuries -toxins including drugs and alcohol consumed by the mother during pregnancy -complications associated with the Rh factor in the blood -maternal diabetes -lack of O2
How does grip size change based on context of surroundings?
-may be smaller or larger based on what is surrounding the target object (study found that grip size was smaller when cherries were placed next to target object of an apple than presence of larger fruit or no fruit)
What are some risk factors for a distal biceps tendon rupture?
-men 30+ y.o. -smoking -corticosteroid medication use
What are side effects of parasympathetic blockers?
-mental depression (w/ low doses) with high doses: -delirium -hallucinations -decreased GI activity
What objective measures should you perform if you suspect an acute nerve root injury?
-neuro exam (level specific) -neurodynamic tests (SLR, slump)
Cardiac clients should be set back to physicians if: (read)
-nitroglycerin tablets do not relieve anginal pain -pattern of angina changes -abnormally severe chest pain w/ nausea and vomiting -anginal pain radiates to jaw or L arm -anginal pain not relieved by rest -upper back feels abnormally cool, sweaty or moist to touch -client develops progressively worse dyspnea -client has any doubt about his/her present condition
24 hours: spinal stenosis
-nocturnal pain & cramping -sx get worse as the day goes on
What are 3 different classifications for radial head fractures according to Mason?
-nondisplaced -displaced w/o comminution -comminuted
Dwarfism: how does it affect... -body proportions -intelligence -skeletal maturation & puberty
-normal body proportions -normal intelligence -delayed skeletal maturation & puberty
What is an Addisonian crisis? -who does it occur in -due to dec in ______________ -symptoms
-occurs in someone who has previously been diagnosed with Addison's disease -involves a *serious decrease in the production of cortisol and aldosterone* (gluco- & mineralo- corticoids) -symptoms: weakness, low BP, anorexia, nausea, emotional disturbances, etc.
How would you recommend a spinal stenosis pt stretch their hip flexors?
-perform heel slides in a hooklying position -as they slide their heel out, they are stretching their HF while having to maintain their trunk in a neutral position -as soon as their pelvis begins to tilt, they begin sliding their heel back towards them -stretches HF and works on trunk control
How do older adults try to adapt when presented with unpredictable conditions for reaching and grasping?
-pick the most conservative approach -take longer approach time -use standard coordination pattern
How do you perform an endurance test to see if someone with neck pain has associated muscle dysfunction?
-place pressure cuff under neck -inflate to 20 mmHg -ask pt to chin tuck -pressure will inc 10 mmHg -if they can do this 10x w/ 10 sec hold = 100% performance (examines tonic capacity & endurance of neck flexors)
What are signs and symptoms of triceps tendinosis?
-point tenderness at the olecranon process -inc symptoms with resisted elbow extension (X-ray can be performed to rule out other conditions)
What are some symptoms of diabetes insipidus?
-polydipsia (excess thirst) -nocturia -*dehydration* -constipation -muscle weakness -dizziness -low BP
What do neural-maturationists believe regarding development? (4)
-predetermined biological timetable -hierarchial nature of nervous system maturation -normal motor devevlopment to increasing corticalization of the CNS -development is built upon reflexes
Define the following time frames: -conception to birth -infancy to toddlerhood -early childhood -middle childhood -adolescence
-prenatal period -birth - 2 yrs -2-6 yrs -6-12 yrs -12-19 yrs
What classifies a patient with neuropathy as a low risk for developing foot wounds?
-preserved sensation -no foot deformities -intact circulation
In acute care rehab of a stroke, what are the benefits of early mobilization? What are precautions to early mobilization?
-prevent DVT, pressure ulcers, contractures, pneumonia, atrophy -start recovery process -functional mobility assessment -coma/stupor -progressing neuro signs -unstable vitals -severe orthostasis
What are the functions of U joints?
-prevent disc herniations -take tension off vertebral AA
When is ECMO used?
-recover from heart or lung failure -recover from heart surgery -really sick flu patients -bridge option to further treatment or assess the state of other organs (kidneys, brain) before performing heart or lung surgery -bridge to a heart assist device (LVAD) -bridge for lung transplant, also makes them a better transplant candidate d/t tissue oxygenation -support during high risk procedures in cardiac cath lab allows pt lungs to rest, helps them recover and then go off of it when they don't need it anymore
Ways to prevent SCI:
-seat belts/air bags -safety restraints for children -never drive/ride with someone impaired -wear helmets w/ sports -check water depth before diving -use spotters for gymnasts -keep firearms secured
What classifies a patient with neuropathy as a high risk for developing foot wounds?
-sensory loss -foot deformities -vascular disease -callus formation -hx of ulcers -amputation
What terms should we use to describe muscle length instead of tight?
-short -stiff -lengthened
What are some risk factors for type 1 diabetes?
-siblings have type 1 DM -parents have type 1 DM
Key features of closed loop control (2):
-slow or continuous movements -use feedback to monitor
Characteristics of "triggered reactions"? -speed -location -purpose -influenced by what -mediated by? -level of consciousness
-slower than reflexes but faster than reaction time -does not have to occur in stimulated muscles but can involve a # of muscles and joints, resulting in a smooth, coordinated response -seems to relate to a purpose or the completion of some predetermined action -influenced by practice -mediated by some stage of information processing (not simply at spinal level) -probably remains at non-conscious level
What type of waveform is used with MES?
-square waveform -either monophasic w/ periodic reversal of polarity or biphasic
Quadratus Lumborum: only F
-stabilizer in sustained posture & heavy lifting -controls lumbopelvic rotation -lateral trunk flexion (mainly eccentric)
What are the 4 possible gait sequences?
-step to -step through -swing to -swing through *to*: to the point of the assistive device *through*: past the assistive device
After an LVAD is placed, what precautions do we need to keep in mind during PT?
-sternal precautions for 6 weeks+ -watch for battery & power cables -check battery charge -*no chest compressions* -alarms -gait belt placement -watch trunk rotation -*fall risk w/ inc risk of bleeding*
What are signs/symptoms of olecranon bursitis?
-swelling (first) -pain (with stretching of bursa) over olecranon, which worsens with pressure -redness/warmth (if due to infection)
What is the Treatment Based Classification for LBP? (what treatments are you supposed to provide for LBP patients according to the Treatment Based Classification developed by Delitto)
-sx modulation -movement control -functional optimization (fxn optimization is directed toward pts w/ a chronic high pain level)
Stacia's "creative steps" to avoid being fat:
-take the stairs -park as far away as possible from the building -walk when you're on the phone -deliver a message in person -instead of a lunch meeting, have a walking meeting
When is a tracheostomy performed?
-temporarily during some operations to protect the airway from inspiration & swelling -permanently after laryngectomy -to provide airway access for some pts on ventilators more permanently -after facial trauma
Define: TIA
-temporary interruption of brain's blood flow -basically a stroke that resolves itself & induces minor sx -neuro sx last <24 hours
What should you look for in bench alignment in the M/L view of a transfemoral prosthesis? (3)
1. 5-7 deg socket adduction 2. 5 deg ER of tibia 3. heel falls just under the ischial tuberosity in the socket (transtibial socket adduction is only 2-5 deg, it also doesn't have the tibia ER setting)
What is a normal value for the following arterial pressures: 1. SBP 2. DBP 3. MAP (mean arterial pressure) RAP (R arterial pressure), pulmonary artery pressure & SV are also arterial pressures
1. 90-140 mmHg 2. 60-80 mmHg 3. 70-110 mmHg also helpful to look at pt chart to see where the MD wants their VS at
What are the 2 general MSI Classifications for hip conditions?
1. Accessory Motion (femoral ant glide, femoral hypermobility, etc.) 2. Physiological Motion (hip adduction w/ IR, hip extension w/ knee extension, etc.)
Important concepts about CPGs from experiments (5):
1. CPGs prewired in SC 2. can be turned on in various ways and continue until stopped by some other input 3. patterns modifiable (ex: muscle stretch input can change gait speed if treadmill is moving faster) 4. basic reflexes are still active and can influence output of CPG in spinalized animals (reflexes can influence CPG if SC intact) 5. reflexes are not stereotyped (ex: stimulus to top of foot causes limb to flex higher during swing phase but no response or slight extension if stimulus applied during stance phase)
If we locate a target in our periphery, what has to happen before we reach for the target?
1. Neck mm activated 2. Eye mm activated 3. Eyes move first (less intertia than head) 4. Head moves. Eyes reach target before head stops moving.
What are indications for HVPC? (4)
1. Pain 2. Edema 3. muscle Weakness 4. Wound management PEWW
The visual system provides imputs to 2 parallel pathways. What do these help with in target acquisition? What is each pathway called and where does each pathway travel to from the visual cortex?
1. Ventral stream pathway (visual cortex to temporal): -conscious visual perceptual experience -perceptual identification of objects a.k.a. perception and object recognition 2. Dorsal stream pathway (visual cortex to parietal): -object position, structure and orientation (action-relevant info for reaching) a.k.a. localization -mediates sensorimotor transformations
What hormone deficiency causes diabetes insipidus?
ADH deficiency
Type of MS: unpredictable attacks which may or may not leave permanent deficits followed by periods of remission
Relapsing-Remitting
In order for someone to be able to use a KAFO orthosis, what requirements must they meet? (2)
1. adequate cognitive function 2. hip flexion & extension strength at least 3/5
What beneficial effects does MES have? (6)
1. aids in wound healing 2. inc cell proliferation & motility 3. inc growth factor receptor levels 4. enhances electrical potential gradients of stimulated cells 5. collagen synthesis 6. DNA synthesis
3 things the study comparing 0 sec rest, 30 sec rest and 60 sec rest suggest about the effects of massed vs. distributed practice has on learning
1. differences between groups persisted 2. differences between groups were smaller at the beginning of the transfer phase compared to the end of practice 3. performance during transfer gets worse (these trials were massed - no rest provided)
What are the 2 pulses you should check on a pt with neuropathy's foot?
1. dorsal pedal 2. posterior tibial
Prosthetic causes of "lateral trunk bend" gait deviations in a transfemoral amputee: (3)
1. foot too far outset 2. high medial wall 3. aligned in abduction
Amputee causes of "medial whip" gait deviations in a transfemoral amputee: (3)
1. gait habit 2. *socket not donned properly* 3. ER of hip at toe off/hip flexion (1-2 are same, 3 is exact opposite, compared to lateral whip)
Amputee causes of "lateral whip" gait deviations in a transfemoral amputee: (4)
1. gait habit 2. *socket not donned properly* 3. IR of hip at toe off/hip flexion 4. tight adductors, IRs or flexors (1-2 are same, 3 is exact opposite, 4 is new compared to medial whip)
Amputee causes of "vaulting" gait deviations in a transfemoral amputee: (3)
1. gait habit- fear of catching toe*, hard to break 2. weak hip flexors on residual limb 3. improper initiation of hip flexors on residual limb
What are the different types of ankle foot orthoses (AFOs) we learned about?
1. ground reaction 2. patellar tendon bearing 3. solid ankle 4. semi-solid ankle 5. posterior leaf spring 6. articulated (7. metal upright)
Two concerns with the concept of a motor program, thus leading to the development of the idea for *generalized* motor programs (GMP)?
1. how does our brain store all of these programs? 2. how do we produce movements that we have never done before?
Amputee causes of "external foot rotation" gait deviations in a transfemoral amputee: (1)
1. improperly donning socket
Amputee causes of "internal foot rotation" gait deviations in a transfemoral amputee: (2)
1. improperly donning socket 2. flexed at hip during gait, typically w/ walker or crutches, looking down at the ground
Amputee causes of "lateral trunk bend" gait deviations in a transfemoral amputee: (3)
1. inadequate balance 2. short residual limb (lack of adductors to prevent the lean) 3. habit
Prosthetic causes of "heel rise" gait deviations in a transfemoral amputee: (3)
1. inadequate extension aid 2. insufficient knee friction 3. improper knee selection
PT's are responsible for making a recommendation on where a stroke patient should be discharged to from the hospital. What are the options for this?
1. inpatient rehab 2. SNF/ extended care 3. outpatient 4. home care 1 or 2 is ideal bc they will get the most intensive & skilled rehab, but this is really expensive
Prosthetic causes of "uneven pelvic rotation" gait deviations in a transfemoral amputee: (3)
1. instability of prosthesis 2. poor suspension 3. proximal trim line too high or tight
Prosthetic causes of "external foot rotation" gait deviations in a transfemoral amputee: (4)
1. knee ER 2. foot ER 3. socket design issues 4. tight adductor channel in socket -results in a medial whip-
Prosthetic causes of "internal foot rotation" gait deviations in a transfemoral amputee: (4)
1. knee IR 2. foot IR 3. socket design issues 4. excessive quad pressure
Amputee causes of "circumducted gait" deviations in a transfemoral amputee: (4)
1. lack of confidence in flexing knee 2. abduction contracture 3. weak hip flexors 4. habit- using entire hip & pelvis to initiate gait
Describe the pattern of a 4-point gait pattern:
1. left crutch/cane 2. right LE 3. right crutch/cane 4. left LE
Describe the pattern of a 2-point gait pattern:
1. left crutch/cane with right LE 2. right crutch/cane with left LE
What are the 3 functions of the CS in order of most to least important?
1. mobility 2. load bearing 3. stability (stability is more important in LS, mobility is more important in CS)
What are the 4 factors of gait?
1. patient 2. socket fit 3. prosthetic alignment 4. physical therapy
Amputee causes of "uneven timing" gait deviations in a transfemoral amputee: (3)
1. pt insecurity 2. weak hip muscles 3. poor balance
According to McGill, what are the "Big 3 for Abdominals" exercises?
1. quad reciprocals 2. plank 3. side plank can add a lot of variability w/ these
What steps should you take if your PT colleague is impaired?
1. recognize there's a problem 2. obligated to document & report impaired behavior to appropriate supervisor 3. once reported, administrator addresses the colleague & comes up w/ a plan 4. if using EDM, then you should follow up w/ supervisor
What are the 3 categories to sort LBP patients into?
1. serious spinal patholgies (10%) 2. sciatica (40%) 3. non-specific LBP (50-85%)
Prosthetic causes of "uneven timing" gait deviations in a transfemoral amputee: (5)
1. socket pain 2. weak extension aid 3. unstable knee 4. leg length discrepancy 5. poor suspension (unsure what this looks like)
What should you look for in bench alignment in the transverse view of a transfemoral prosthesis? (3)
1. socket rotation 2. knee rotation: 3-5 deg ER 3. foot rotation: 5-7 deg ER
Therapy goals for "vaulting" gait deviations in a transfemoral amputee: (2)
1. strengthen hip flexors 2. work on timing & symmetrical pelvic rotation
Therapy goals for "circumducted gait" deviations in a transfemoral amputee: (3)
1. stretch abductors 2. strengthen hip flexors 3. gait training
Amputee causes of "knee instability" gait deviations in a transfemoral amputee: (2)
1. weak hip extensors 2. hip flexion contracture (things that would make your knee buckle)
Therapy goals for "heel rise" gait deviations in a transfemoral amputee: (2)
1. work on coordination & encourage symmetrical motion of the femurs 2. work on timing of flexor firing
According to McGill, you need ___ - ___ % of a max isometric contraction for stability of the spine
10-25% -important to note you don't always need a full out contraction -we want to match the demands of their daily activities (low level of activity, but maintained over a long period of time -- endurance training)
Long acting asthma medications require about ____hours to have an effect and should be taken twice a day
12
If someone has weak quads, what will their gait pattern look like?
2 Possibilities: -knee buckles, results in crouch gait in stance, compensated w/ dec step length -excessive knee extension to avoid position of instability (knee flexion)
Which type of gait pattern approximates normal gait?
2-point pattern
Which type of gait pattern is used to progress a 4-point pattern?
2-point pattern
If someone has weak dorsiflexors, which orthosis would you consider treating with?
AFO such as: posterior leaf spring or an articulated AFO (dorsi-assist or PF stop), the best choice should be based on the pt's case. be careful of post. leaf spring & dorsi-assist if they have tone though
Define: accommodation (Piaget's)
2nd step of learning: -expanding of understanding based on new information gained
Development is described in ____ domains, but growth in one domain influences the other domains. What are the *domain* names?
3 -physical -cognitive -social/emotional
Typically, there are _____ years from onset to the point where the pt needs to use a cane
30
What type of exercise should a patient with neuropathy engage in?
30 min or more epr day, ideally both aerobic and resistance exercises consider foot integrity
At what age are U joints fully developed?
30 years old
Age Population: cervical disc herniation
30-35 y.o. (but always younger than 40)
Response type: myotatic reflexes -time -modified by instructions? -affected by the # of choices?
30-50 ms no no
What is a third class lever?
AFR Ex: bicep muscle
What differences do you have to keep in mind between the 2 types (axillary & femoral) of IABPs during PT?
A: pt able to mobilize w/ PT or nursing staff F: limited mobility, can't get out of bed bc they could kink the line
Response type: triggered reactions -time -modified by instructions? -affected by the # of choices?
80-120 ms yes yes
Re-listen to screening and testing blue speech banana slide
:)
The spinal canal in a normal person is usually around 17 mm in diameter in the cervical spine. What does less than 13 mm indicate? Less than 10 mm?
<13: predisposes pt for cervical stenosis or cord compression <10: will definitely have some cervical cord compression
Only after the constricted airways are _______ can mucociliary transport and removal of secretions begin
dilated
What is a free body diagram?
A drawing that consists of all the forces acting on a system or body in correct proportion -identify F's & parameters for each -parallel F's can be add/subtract -concurrent F's determined w/ math
What is a lever?
A simple machine used to inc/dec a mechanical advantage, often a rigid bar
What are some of the advantages & disadvantages of a stance control KAFO?
A: provides stability during stance, allows knee flexion during swing D: larger, more expensive
What ligaments are above and below the pubic symphysis?
Above: superior pubic ligament Below: inferior pubic ligament
Pedometers and air bags in vehicles are examples of what type of instrument?
Accelerometer
Which endocrine disorder can take place after surgery, pregnancy, accident, injury, trauma, infection, salt loss (strenuous exercise), or failure to take steroid therapy if the person has chronic adrenal insufficiency?
Addison's disease
What is it called when someone has previously been diagnosed with Addison's disease?
Addisonian crisis
What is the function of subscapularis?
Adducts and IR arm
What does it mean if your ABI is 0.5-0.8?
intermittent claudications present
Define center of mass
Body mass is equally distributed around this point
What innervates the internal anal sphincter muscle?
Both sympathetic and parasympathetic Parasympathetic is from pelvic splanchnic NN
Key muscle groups for following SC levels: C1-4 C5 C6 C7 C8 T1 T2-L1 L2 L3 L4 L5 S1 S2-5
C1-4: diaphragm and sensory C5: biceps C6: wrist extension C7: triceps C8: finger flexors T1: small finger abductors T2-L1: sensory L2: hip flexors L3: knee extensors L4: ankle dorsiflexors L5: long toe extensors S1: ankle plantarflexors S2-S5: sensory level and sphincter tone
Which vertebral levels have U joints?
C3-T1 (lower cervical spine)
Common vertebral levels of cervical DDD (3)
C4-5 C5-6 C6-7
Chest pain, shoulder pain, neck pain or temporaomandibular pain occurring in the presence of ____________ or history of MI may be ________ in origin
CAD (coronary artery disease) cardiac
What is paralysis of serratus anterior caused by and what does it look like?
Cause: injury to long thoracic nerve or a nerve above this spinal level Appearance: winged scapula
Define center of pressure
Center point of weight of a body Point of application of the GRF
With bradycardia, how does the conduction change, and what is the effect of this?
Conduction change: rate regular, slower than 60 bpm Effect: stroke volume increased, possibly reduced cardiac output
Which muscles of the shoulder are considered intrinsic shoulder muscles?
Deltoid, teres major, and 4 rotator cuff muscles (SITS)
What is the distance between the inferior* surface of the pubic symphysis and the sacral promontory called?
Diagonal conjugate
How often should a diabetic patient check their feet at home?
EVERY day
In HVPC for dermal wound therapy, what parameters are used? -frequency -mode -amplitude -length of treatment
F: arbitrary M: *continuous* A: arbitrary (*submotor*) LOT: arbitrary
In HVPC for edema/spasm/weakness, what parameters are used? -frequency -mode -amplitude -length of treatment
F: arbitrary (30-60 pps) M: *pulsed* on/off 1-5 or 1-3 A: arbitrary (produce tetanic contraction) LOT: arbitrary
Subcostal MM (only F)
F: depress ribs (small slips of muscle on inner surface of lower ribs)
Innermost Intercostal (only F)
F: depress ribs during heavy exercise
H2 receptor blockers are used for the treatment of what kind of disorders?
GI and stomach
Which type of e-stim is known for having twin spikes in the wave?
HVPC
Are there different types of electrodes for MES or HVPC? What coupling agents are used for these?
HVPC- rubber carbon, electromesh glove/sock gel or saline soaked sponge
Stages of pressure ulcers (wound assessment):
I: *intact skin, non-blanchable redness* of a localized area, usually over bony prominence II: a *superficial ulceration* that extends into the *dermis* III: ulcer that extends into subcutaneous tissue but not into muscle IV: deep ulceration that extends through muscle tissue down to the underlying bony prominence Unstagable: full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough and/or eschar
In MES for *wound healing* if the process of the wound size decreasing plateuas, what should you do?
return the cathode to the wound for 3 days
What are some examples of subjective questions? (just read)
If you climb a few flights of stairs fairly rapidly, do you have tightness or pressing pain in your chest? Do you ever have bouts of rapid heart action, irregular heartbeats, or palpations of your heart? Do you get short of breath during activity that doesn't make other people short of breath? Do you ever feel dizzy or have fainting spells?
What innervates the external anal sphincter muscle?
Inferior rectal nerve (branch of pudendal nerve, somatic NS)
Where are internal vs external hemorrhoids?
Internal: above pectinate line External: below pectinate line
Where is the pelvic brim/inlet located?
It is a plane marked by the: sacral promontory** pubic crest** arcuate line pectineal line
What population is vaginismus most often seen in?
It is an uncommon condition, but when it is seen it is frequently present in certain religious groups
What type of joint is the sacroiliac joint?
It is both fibrous and synovial
What is the innervation of the rectum below the pectinate line like?
It is completely somatic below the line Above the line is somatic and visceral
Why is the puborectalis muscle less likely to be injured during child birth?
It is only attached anteriorly and is used to being stretched (defecation) If it is injured though it may result in fecal incontinence
What is the deltopectoral groove and what forms it?
It is the groove for the cephalic vein formed by pectoralis major and deltoid
What happens to the interpubic disc during pregnancy?
It may increase in size and laxity which is a source of pelvic pain in pregnant women. This change may be permanent after pregnancy which causes an increase in lateral pelvic dimension
What is an example of a fixed pulley in the body?
Lateral malleolus and fibularis muscles
What are options for post-rehab care (post 6 months) of a stroke patient?
Limited Options -HEP -community fitness centers -American Stroke Foundation: locations in KCMO & mission, KS, wellness center, speech group, art classes, caregiver support, etc.
What can kinetics be used to calculate? (4)
Linear force Rotational force Momentum/impulse- F applied over t Work/energy- F applied over d
Which arteries are the MCA, ACA & PCA derived from?
MCA: int carotid A ACA: int carotid A PCA: basilar A
_______ (type of e-stim) is approved by the FDA to treat chronic pain, but there is no evidence to support the effectiveness of it
MES
How long does a MES treatment last? What about HVPC?
MES: 2 hrs, rest 4 hrs (2-3x/day) HVPC: 15-50 min
The parameters for MES and HVPC can vary based on different conditions that they are treating. What conditions are they?
MES: wound or bone healing HVPC: dermal wound, pain or edema/spasm/weakness
Patient Case Ex: what MSI classification do you suspect? -P1: pain inc w/ standing tasks -Posture: inc lordosis, ant pelvic tilt -Mvmt: limited curve reversal w/ fwd bend, inc lumbar ext vs hip ext w/ return -Contributing Factors: wide infrasternal angle, poor recruitment of abdominals, stiff hip flexors- spine more flexible than hips -Functional Tasks: inc pelvic rotation w/ walking
MSI Classification: extension patient
What nerve root(s) is the levator ani muscle mostly innervated by?
Mainly S4
What nerve root(s) is the coccygeus muscle innervated by?
Mainly S4, but some S3 and S5
Is a male or female pelvis heavier?
Male pelvis is heavier, female is lighter
What passes through the pelvic diaphragm in males and females?
Male: urethra and anus Female: urethra, vagina, and anus
Name the exercise classification system: extension based treatment
McKenzie
Inferior Oblique (UCS)
O: C2 SP I: C1 TVP F: ipsi rotation & stabiize AA joint
ASIA class E
Normal - used in follow up of patients with SCI who initially had deficits. If on follow up testing sensation and motor function is now graded as normal in all segments, then the AIS grade is E. Someone without an initial SCI does not receive an AIS grade
Does the transverse diameter of the pelvic inlet limit vaginal delivery?
Not usually because ischial spines are not usually large enough to cause a problem
Does the pelvic outlet limit vaginal delivery?
Not usually because the coccyx is moveable
Thoracolumbar Fascia (no N)
O/I: many muscles, SP T12 to iliac crests, PSIS, TA F: trunk & pelvic stability- when TA contracts it pulls on the fascia & transmits forces up/down which results in compression forces & approximation of SP like a corset
Adductor Hallucis
O: -OH: 2-4 MTs, cuboid, lat cuneiform -TH: 3-5 MTs I: 1st prox phalanx N: lateral plantar N F: flex 1st MTP, adduct big toe
Flexor Digitorum Superficialis
O: -humeral head: med. epicondyle -ulnar head: prox, med ulna -radial head: ant shaft of radius I: middle phalanges 1-4 N: median N F: flexes PIP, MCP & wrist joints
Pronator Teres
O: -humeral head: med. epicondyle -ulnar head: prox, medial ulna I: lateral surface of radius N: median N F: pronate forearm
Iliopsoas (separate origins for psoas major & iliacus)
O: -psoas major: V bodies & TVP of T12-L5, IV discs -iliacus: iliac fossa I: lesser trochanter N: lumbar NN, femoral N F: depends on if proximal or distal attachment is moving -distal: hip flexion -proximal: trunk flexion, ant segmental shearing or segmental rotation if unilateral
Tensor Fascia Lata
O: ASIS I: ITB, lat. condyle of tibia N: sup. gluteal N F: flex & abduct hip
Sartorius
O: ASIS I: med. surface of tibia (pes anserinus) N: femoral N F: flex, abduct & ER hip, flex knee
Rectus Capitis Posterior Minor
O: C1 I: med nuchal line F: extends head
Rectus Capitis Lateralis
O: C1 TVP I: jugular process F: ipsi SB of head
Superior Oblique (UCS)
O: C1 TVP I: lat nuchal line F: B ext head, U same SB & opp rot (can think of fxn like SCM)
Rectus Capitis Anterior
O: C1 lat mass I: base of occiput F: flex head
What is the anteroposterior distance between the inner* surface of the pubic symphysis and the sacral promontory?
Obstetrical conjugate
Is there a spring you can add into an orthotic, like an AFO, that can help with dorsiflexor or plantarflexor weakness?
PF: no- there isn't a spring large enough to be able to push your entire body weight forward DF: yes- the spring only has to be able to push your foot up, this is called a DF assist orthotic
What creates dimples on the back side near the sacrum?
PSIS
PT Goals: spinal stenosis
PT can't change their stenosis, but our goals are to: -dec pain -inc trunk stability & mvmt pattern -inc muscle flexibility & fix imbalances -inc aerobic fitness -keep them functional
What are the symptoms of subacromial bursitis and calcific supraspinatus tendon?
Pain during abduction of the arm (painful arc syndrome) pain is around 50-130 degree range
What is the deltopectoral triangle formed by?
Pectoralis major, deltoid, and clavicle
____________ signals from eye muscles contribute to the ability to localize targets in extrapersonal space
Proprioceptive
Which muscle is most likely to be compromised during child birth? What might this result in?
Pubococcygeus Urinary stress incontinence & may contribute to uterine prolapse
Relaxation of what muscle is essential during defecation?
Puborectalis along with external anal sphincter muscles
What are the parts of the levator ani muscle called?
Puborectalis muscle Pubococcygeus muscle Iliococcygeus muscle
What named nerve innervates external genitalia in both males and females?
Pudendal nerve
What is the function of the puborectalis muscle?
Pulls anorectal junction anteirorly creating an anorectal angle which aids in maintaining fecal continence **
What are pyramidal symptoms?
Pyramidal tract is a synonym for corticospinal tract -paresis -spasticity (UMN) -hyperreflexia -loss of fine motor skills
What is another name for TIA?
RIND = reversible ischemic neurologic disorder
HO may result in a sudden limitation of _____
ROM
During an evaluation in which someone is being considered for a LE orthotic, functional ROM and muscle strength should be assessed at which locations?
ROM: midtarsal, subtalar, talocrural, knee & hip Strength: focus on general LE muscle groups (problems in one area may be stemming from problems in another area)
What joint handles a lot of compressive forces?
Spine
When do the bones of the os coxae start to fuse? When do they finish fusing?
Start: around puberty (12 girls, 14 boys) Finish: age 20-25
Define statics
Study bodies at rest
Define dynamics
Study bodies in motion
Define kinesiology
Study of human movement
Are trapezius and latissimus dorsi superficial or deep?
Superficial
What anatomical space fills with fluid in a straddle injury?
Superficial perineal space
What 2 spaces are created by the presence of the perineal membrane?
Superficial perineal space Deep perineal space
What is superior, attached to, and inferior to the ischial spines?
Superior: greater sciatic notch Attached: sacrospinous ligament Inferior: inferior sciatic notch
Agg Factors: acute facet dysfunction
stretch or compression of joint
What forms the inferior border of the posterior wall of the axilla?
Teres major
Which muscles of the shoulder are considered extrinsic shoulder muscles?
The anterior and posterior muscles groups
Define friction
The resistance created as a result of 2 bodies being in contact with each other
What is a joint reaction force?
The resultant of all forces acting on a joint (muscle, gravity, load). It will be equal & opposite to the sum of all x and y vectors.
Where do the superior fibers of the latissimus dorsi insert onto the humerus?
They insert inferiorly on the humerus, he wants us to know that the muscle twists as it inserts
What do kegel exercises involve and why are they used?
They involve isometric contractions of the pubococcygeus muscle and pelvic diaphragm in general Helps prevent urinary stress incontinence during/after pregnancy, also helps prevent injuries during child birth
What is the leading cause of disability & 3rd leading cause of death?
stroke
Patient Case Ex: what muscles are working too well? What muscles aren't working enough? -P1: pain inc w/ standing tasks -Posture: inc lordosis, ant pelvic tilt -Mvmt: limited curve reversal w/ fwd bend, inc lumbar ext vs hip ext w/ return -Contributing Factors: wide infrasternal angle, poor recruitment of abdominals, stiff hip flexors- spine more flexible than hips -Functional Tasks: inc pelvic rotation w/ walking
Too Much: hip flexors & back extensors Too Little: abdominals
What space(s) are formed by the intercept of the long head of triceps with teres major?
Triangular space and Quadrangular space
What does the radial nerve innervate in the arm?
Triceps brachii
What does TKA stand for and what is it in terms of prosthetics? (Hint: not total knee arthroplasty)
Trochanter Knee Ankle refers to stationary alignment line to identify the relative alignment b/w the center of the socket weight line (trochanter), the rotation point of the knee & the functional rotation point of the foot/ankle
T/F: heart & lung transplants extend a patient's life
True-- orthotonic heart transplants have a median survival of 10 years
T/F: in general, transplant patients should be performing low intensity exercise
True-- when acute
List of abdominal exercises that placed forces on the spine that were under the NIOSH Standard: (read)
Under 3300 N: -curl-up feet anchored & feet free -quarter sit-up -straight leg raise -bent-leg raise -cross-knee curl-up -hanging, straight leg -isometric side bridge -quad reciprocals Over 3300 N: -straight-leg sit-up -bent-leg sit-up -hanging, bent leg -super man -prone trunk extensions
When is a pulley used?
Used to improve a line of pull or the mechanical advantage of a system
What is the difference between VA and VV ECMO?
VA: connected to vein & artery, used when there's a problem w/ both heart & lungs VV: connected to 1+ veins, usually near the heart, used when there's a problem w/ only the lungs
What is syringomyelia?
a tapered, fluid-filled cavity within the SC that may extend for multiple spinal levels -cause considerable reduction in functional capacity as well as pain *be alert to sudden change in level of function after injury - dec in motor function sign of new pathology*
Define: sensitive periods
a time in development when children vary selection of a movement strategy in response to a particular task (ex: holding a ball in front of an infant they may decide to crawl or walk to get it)
What is the main cause of degeneration in general?
accessory hypermobility at the joint
In which endocrine disorder do bones become heavier and broader?
acromegaly
In overweight people, fat is the most ________________ endocrine organ in the body
active
Is acute hyperglycemia or hypoglycemia much more of a life-threatening condition?
acue hypoglycemia
Which CS pathology results in an acute torticollis?
acute facet syndrome (pt's head is stuck in a SB & rotated position)
What is immunotherapy?
administration of allergy shots to iinduce tolerance in the body. They gradually increase the level of allergen in the body so that an allergic reaction is not mounted when it is seen from an exogenous source
Beta-agonists are often called _______ bronchodilators
adrenergic
Normal bronchomotor tone is a balance between what two influences?
adrenergic and cholinergic (sympathetic and parasympathetic)
Respiratory smooth muscle cells contain what type of receptors?
adrenergic beta-2 receptors
What can a modified 3-point gait pattern be progressed to?
advancing the device with the affected LE, then unaffected LE pts typically do this on their own as stability improves
How prevalent is Charcot foot in people w/ diabetes?
affects 9% of people with diabetes
What is the purpose of MES overall?
aids in healing at the cellular level
What are the 5 different quick acting asthma medications by generic name?
albuterol epinephrine isoproterenol metaproterenol terbutaline
Corticosteroids can be used to treat what two conditions?
allergies and asthma *note: for treatment of allergies, corticosteroids must be taken over a period of a few weeks to notice an effect*
Define paraplegia
an impairment in motor or sensory function of the lower extremities (may also involve some of the trunk)
What does it mean if your ABI is greater than 1.2?
ankle blood vessels are *incompressible* and toe brachial indexes should be considered
With atrial flutter, how does the conduction change, and what is the effect of this?
conduction change: rate 160-350 bpm Effect: less filling time, often reduced cardiac output
With tachycardia, how does the conduction change, and what is the effect of this?
conduction change: rate regular, fast, 100-160 bpm Effect: possibly reduced cardiac output
Types of auditory impairments (3)
conductive hearing loss sensorineural mixed
Decongestants are specifically given to relieve __________. Do they treat the problem?
congestion no, they treat symptoms
Primary auditory cortex function
conscious awareness of timing frequency and amplitude of the sounds
Is the output polarity during HVPC constant or reversing during stimulation?
constant
Bronchial ___________ can result from abnormal bronchomotor tone, inflammation and mechanical obstruction?
constriction
What is the purpose of the following types of hemodynamic monitoring & life-support: (same answer for all) -sphygmomanometer -pressure transducer -pressure transmitter -monitor or recorder
continuous monitoring of blood pressure-- a lot of these devices are pretty automated and take BP every 30 min or so and records it so you can look at it later
How long does pericarditis pain last?
continuous, may last hours or days with residual soreness following
Which type of HVPC uses continuous modes and which use pulsed modes? options: dermal wounds, pain, edema/spasm/weakness
continuous: dermal wounds & pain pulsed: edema, spasm or weakness
What is a bronchospasm?
contraction of the respiratory smooth muscle cells
Generally, which side of the body do you use an assistive device on?
contralateral to affected side
The pattern of clinical presentation is directly related to the _________ anatomy of the spinal cord
cross-sectional
Which type of LE orthoses provide individualized fit for maximal function? -pre-fabricated -custom fit -custom fabricated
custom fabricated
Which type of LE orthosis does Brittany rarely use? -pre-fabricated -custom fit -custom fabricated
custom-fit they're difficult to fit bc everyone's bony anatomy is very different
Exercise selection should be specific and it should address their ________ activities
daily
Long acting asthma medications should be taken when?
daily, no matter if there are asthma symptoms present or not
What is involved with a *partial* distal biceps tendon rupture?
damage to the soft tissue but the tendon is not severed
Allegra-D, Claritin-D, Zyrtec-D, Benadryl Allergy and Sinus, and Tylenol Allergy and Sinus These are all examples of what combination of drugs?
decongestants and antihistamines
The blocking of the H1 receptor has what effects?
decrease mucosal congestion, irritation and discharge caused by inhaled allergens, they may also reduce coughing and sneezing associated with common colds
How do decongestants work?
decrease swelling normally experienced with inflammation by shrinking the blood vessels and making them less leaky, thus reducing fluid in the area
When testing key sacral sensory points you should also test for ______ ______ pressure
deep anal
Once acute compartment syndrome has developed in the forearm, which group of mm is most commonly affected?
deep tissue flexors (muscle fibrosis and tissue shortening can occur)
What is Volkmann's contracture?
deformity of the hand, wrist, and fingers resulting from an acute compartment syndrome in forearm (wrist flexion & MCP extension)
What is often the first thing Brittany looks at in a LE orthotic evaluation?
degree of pronation or supination can lead to a lot of other problems
Movement strategy selections within 'sensitive periods' may be the result of experience-________ maturation
dependent (production, strengthening, and pruning of synapses based on experiences) within the 'sensitive periods' if a child chooses to walk instead of crawl this is likely due to past experiences they've had (i.e. if they've walked before, their brain has been making neural synapses for walking, so they're more likely to choose the movement strategy of walking in the sensitive period to further strengthen those new neural connections)
Urie Bronfenbrenner's Ecological Systems Theory or bioecological theory is an example of what *type* of theory?
developmental systems theory
Acute & chronic nerve root issues are not a _________________ , they are a secondary problem of another condition
diagnosis
What criteria must a patient meet in order to have diabetic shoes covered by Medicare?
diagnosis of DM and 1 of the following: -hx of ulcers -pre-ulcerative callus -peripheral neuropathy w/ callus formation -foot deformity -poor circulation -partial or complete foot amputation
How does sound move through the cochlea?
displacement of the perilymph via the stapes on the oval window vibration sent through ascending cochlea (scala vestibuli) sound waves in perilymph also are transferred through endolymph in the cochlear duct to meet the basillar membrane vibration returns through descending cochlea (scala tympani)
What is critical to get a patient diabetic shoes?
documentation of the symptoms they have that meet the criteria for insurance to pay for diabetic shoes
What are side effects of mediator-release inhibitors?
dry mouth and throat, airway irritation and possible bronchospasm
When is DVT more likely after a SCI?
during acute flaccidity phase (initial 2 wks after injury)
When does hand shaping begin for grasping? Reach and grasp are _____
during the transport phase of reach coupled
What conditions is non-specific LBP referring to?
dysfunctions of MSK tissues Notes: everyone that doesn't fit into one of the first 2 categories
In Cushing's syndrome, muscle wasting can be so extensive that the condition stimulates muscular ___________________
dystrophy (tissue wastes away) this literally makes no sense...that's a genetic disease...
What is an important aspect about diagnosing Volkmann's contractures?
early detection is key (tools to measure intercompartmental pressure)
What is HO?
ectopic bone formation in soft tissue surrounding a joint
What is the most important PT intervention for a patient with neuropathy?
education!
How is mild genu recurvatum often treated?
either a shoe insert or AFO to give them a little bit more of a flexion moment this isn't enough if they have extreme genu recurvatum
What is the MOI of posteromedial varus rotatory instability of the elbow?
elbow subluxation AND fracture of the coronoid process AND avulsion or rupture of the LCL usually from a FOOSH
What happens if you don't set the tibia in 5 deg of ER during bench alignment of a transfemoral prosthesis?
end up w/ a lateral whip (ER the tibia to account for pelvis rotation)
How is sensory information used *during* a movement for a motor program?
errors may be monitored during a movement -errors and feedback of outcome are used to modify future movement
Agg Factors: acute nerve root
everything hurts & nothing helps
If a patient has had 2 attacks and evidence of 1 lesion in the CNS, what additional info is needed to diagnose them with MS?
evidence of DIS (dissemination in space)
What does a wide infrasternal angle indicate?
external oblique muscles are lengthened (want a 90 deg angle)
What does ECMO stand for? What is it's function?
extracorporeal membrane oxygenation device located outside the patient's body that has the same function as your lungs-- takes off CO2 and adds O2
T/F: custom-fit LE orthoses are considered "off the shelf"
false, they are pre-fabricated devices that are *modified* to fit a specific patient
Which type of neuropathy involves a sudden loss of function in one nerve or group of nerves?
focal
How long does a transplant patient need to take immunosuppressive drugs?
for the rest of their life
Whistleblowing
formally reporting unethical or impaired behavior of a person or organization takes moral courage
What does kinesiopathology mean?
idea that movement induces pathology (certain postures & repeated mvmts lead to cumulative microtrauma that builds up & becomes a painful episode)
When should you not stretch a painful muscle?
if it is lengthened-- Ex: UT
Why might olecranon bursitis be treated non-surgically?
if it is suspected that the bursitis is due to infection they may try aspiration with a needle first to remove fluid.
What is an indication that someone is not correctly using their inhaler?
if mist is coming back out of their nose or mouth
When might surgery be used to treat olecranon bursitis?
if non-surgical treatments do not work
When might non-surgical treatment for a distal biceps tendon be used?
if pt is older or less active. Treatment is focused on pain relief and maintaining function (rest, anti-inflammatory meds, PT to strengthen other mm)
If you are treating someone with a posterior offset KAFO for significant hyper-extension, at what degree of knee motion should you stop them with knee extension?
if the pt has been hyper-extending their whole life you can't all of a sudden put them into neutral can position them to allow enough hyper-extension for them to feel stable and gradually progress from there
How may the thermostat example be described that acts as though it is under open loop control?
if you have a furnace with no thermostat, just a on/off switch, you have no way to control the temperature other than turning it on or off. You will get feedback once you turn it on/off it it is too hot or cold but the furnace will always just either be on and the temperature it puts out will be the same whether it needs to be warmed up 2 degrees or 20 degrees
If chest pain is due to a musculoskeletal origin, it is likely to be caused by the ________ muscles, or trauma from vigorous _________
intercostal coughing
A UTI is common for patients who have a SCI and use __________
intermittent catheterization
You should encourage a cardiac pt in the hospital to use an inspirometer because:
it decreases their risk of getting pneumonia, especially after surgery
Ipratropium has fewer side effects than atropine because?
it is more poorly absorbed into the system
What does "direction susceptible to movement (DSM)" mean? (language of MSI)
it is referring to whichever direction is susceptible to hypermobile accessory motion in a joint hypermobility creates wear & tear which starts an early degenerative process
Why is it important to know that the lumbar facet joints are highly innervated?
it's a common source of LBP
In TKA alignment of a transfemoral prosthesis, which of the 3 points is slightly off-set?
knee center is slightly posterior to the TKA line
In a ground reaction AFO with an anterior shell, the pre-tibial cuff facilitates what motion?
knee extension (which results in hip extension)
In a ground reaction AFO with a posterior shell, the tibial cuff facilitates what motion? (not in lecture, from lab notes)
knee flexion (which results in hip flexion)
What would the description of pain be like for a dissecting aortic aneurysm?
knifelike, tearing, dull ache in lower back or L flank
What are general signs and symptoms of a cardiovascular disease that affect the Respiratory system?
labored breathing, productive cough
How are the electrodes arranged for HVPC?
large dispersive electrode with: -1, 2 or 4 active electrodes -handheld electrode electrodes are of equal size
Level of injury determined by?
last intact muscle group and dermatome, not by spinal fracture (ex: a pt w/ fx of C5 & C6 vertebrae that has intact musculature of 3/5 or greater at the key muscle group triceps (C7) would have a level of injury of C7)
Would a posterior disc herniation cause central or lateral (spinal) stenosis?
lateral stenosis
In the concrete operational stage of Piaget's cognitive development theory, how does a child learn and/or how do they see their world?
learn to think logically, expected to have ability to reverse operations, understand others point of view
In HVPC, the high voltage component means the device will have less capacitance than others. (less ability to store an electric charge). Based on this, will HVPC have more or less tissue impendence? Will it be more or less comfortable for the patient?
less impedance more comfortable C (capacitance) = Q (charge) / V (voltage)
Is a 2-point pattern more or less stable than a 4-point pattern?
less stable
Relieving factors for angina pectoris
rest or nitroglycerin antacids (contradiction)
Define: closing restriction of CS
restriction of cervical extension, SB, & rotation to the same side as their pain
What is conductive hearing loss?
occurs when sound is not conducted efficiently through the outer ear canal to the tympanic membrane and the ossicles of the middle ear
What is sensorineural hearing loss?
occurs when there is damage to the cochlea, or to the nerve pathways from the inner ear to the brain
What is triceps tendonosis?
occurs when there is degeneration of the collagen in the tendon from repeated overuse
How long does it take acute facet dysfunction patients to recover?
often have a spontaneous recovery in 1-2 weeks (many people don't know this)
What is olecranon bursitis?
olecranon bursa which lies b/w skin and olecranon becomes inflamed/irritated
What happens with a bimanual skill?
one hand performs a simple task and the other performs a complex task, the pattern of movement of the hand doing the simple task has some elements of the complex task
"the instructions are structured in advance and are executed without regard to the effects that they may have on the environment" ^ this defines _________ (open/closed) loop control
open
A Central Pattern Generator (CPG) is an example of movement that is under _________ (closed/open) loop control
open
What the brain cares about may depend on the type of control being used. All motor movements for humans can be split into two categories of movement control, which are:
open loop control closed loop control
All ________ drugs are antitussive because they all have the side effect of suppressing cough
opioid
How are leukotrine blockers administered?
orally
Define: theory
orderly set of ideas which describe, explain, and predict behavior
What is the most obvious risk factor for thyroid cancer?
past radiation to head, neck or chest
When the brainstem and SC develop (in the hierarchial neural-maturationist model), what postural reflex development will emerge? At this stage of development, we are considered _______ in function
primitive reflexes apedal (cannot use UE or LE or ambulate)
Define: opening restriction of CS
restriction of cervical flexion, SB & rotation to the opposite side of their pain
KU spine precautions if cervical spine is post fixation
pt may be up typically with use of collar
How often is MES (LIS) used when helping with *bone healing*?
pts use it for extended, multiple, daily periods of time
What does the presence of pleuritic pain indicate?
pulmonary or cardiac source of symptoms *symptoms will improve with breath holding
What are associated signs and symptoms of a dissecting aortic aneurysm?
pulses absent, person senses "heartbeat" when lying down, palpable, pulsating abdominal mass, lower blood pressure in one arm
Deep tissue injury
purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear
In a ground reaction AFO with an anterior shell, the rigid foot plate facilitates:
push off
Drugs given to treat asthma symptoms are categorized according to their ___ acting or ____ acting mode of action
quick or long
Research has shown that atrophy of multifidus occurs in chronic LBP patients. Failure to regain normal morphology & endurance of multifidus & ES is a risk factor for:
recurrence of LBP
What is the goal of pharmacological treatment with asthma?
reduce the frequency and severity of asthma attacks
Cloward Sign: posterolateral IV disc stimulation
referred pain shifted out to the vertebral border again, but is also spread to the posterior aspect of the upper arm
Cloward Sign: anterolateral IV disc stimulation
referred pain shifted out to the vertebral border of spinal segments b/w the scapulae
Cloward Sign: posterior VI disc stimulation
referred pain was still intra-scapular, but more spread out (unlike anterior)
What are Cloward Signs?
refers to the pain referral pattern of cervical IV discs (not a nerve root) Notes: in the article, Cloward showed that pain in the scapular region is often referred from the cervical spine & not the thoracic spine
What does "completeness" of injury refer to?
relates to presence or absence of rectal tone or sensation takes into consideration if any sensation or motor function is present below the level of injury
Beta-2 receptors induce _______ in smooth muscle cells by activating __________ to produce ________
relaxation adenyl cyclase cAMP
Role Fidelity (again)
responsibility & faithfulness
What are exteroceptors? What are 3 senses that may provide the body with information here?
sensory information for movement that comes from objects within the environment -vision -auditory -smell
What are interoceptors?
sensory information for movement that comes from within the person (ex: hunger - has little relation to movement)
If a transfemoral amputee has a 10 deg hip flexion contracture, how should the prosthesis be adjusted?
set to 15 deg of socket flexion
What does it mean if your ABI is less than 0.5?
severe arterial disease is present and some sort of bypass should be done
What intensity of pain is associated with a dissecting aortic aneurysm? How long does the pain last?
severe, excruciating pain lasts for hours
What is the foundation of any LE orthotic?
shoes
When a pt gets a new LE orthotic, they also need to get new:
shoes this is bc the sole of their current shoes will have worn a certain way that promotes their mal-alignment
HVPC has (short/long) stimulation periods and an interpulse time that is ____ times as long as the stimulation time
short periods 50 times
Are custom-fit LE orthoses better for short or long term use?
short term / temporary
Are pre-fabricated LE orthoses better for short or long term use?
short-term / temorary
When treating the CS, you should also address the muscles of which other joints?
shoulder girdle joints
What are relieving factors of pericarditis?
sitting upright or leaning forward
Which domain? -self-knowledge (self-esteem, metacognition, sexual identity, ethnic identity) -moral reasoning -understanding and expression of emotions -self-regulation -temperament -understanding (relating to) others -interpersonal skills -friendships
social/emotional domain
How may variability in practice influence the outcomes seen?
some schedules of variability in practice may interfere with the benefits one would otherwise expect to see
The result of CPG being studied in felines was the discovery that they produced movement resembling what?
some semblance of locomotion
According to Sahrmann's MSI system, we should put more emphasis on treating the mvmt pattern rather than ________________
source of pain (means focus on the movement that results in tissue irritation rather than the tissue that is symptomatic) Ex: instead of focusing on greater trochanter bursitis, focus on the mvmts that cause pain such as hip adduction w/ IR
Define frequency
spacing between waves or period, can also be thought of in terms of how many wave cycles pass by in one second (Hz = cycles/sec)
__________ is a complex phenomenon that is thought to be due by an aberrant processing of incoming sensory information by the SC
spasticity
What is tonotopic arrangement?
spatial arrangement of where sounds of different frequency are processed in the cochlea and sent to different areas of the brain (low frequencies go further toward apex and higher frequencies are further away from apex)
A 4-point gait pattern approximates normal gait with decreased:
speed slow speed imposed by sequence promotes safety
How do you treat hallux valgus?
splint & bunionectomy
Infrahyoids: only F
stabilize hyoid to form firm base for suprahyoid mm (sternohyoid, sternothyroid, thyrohyoid, omohyoid)
If a pt has quad weakness that results in crouch gait, which type of KAFO would help the most?
stance control prevents knee flexion during stance, but when they dorsiflex, right before swing, it unlocks so they have the full swing motion
With Angina Pectoris, where is the source of pain located?
sub-sternal/retrosternal, left chest pain in the absence of substernal chest pain (women), isolated midthoracic back pain (women), aching in the right biceps muscle (women)
How is triceps tendinosis different from tendinitis?
tendinitis occurs with inflammation of the tendon resulting from micro-tears when overloaded (tendinosis definition on prev. slide)
What happens during an allergy attack?
the allergen will trigger the immune system, activating mast cells to release histamine into the blood. Histamine binds to receptors on the walls of blood vessels causing local inflammation and swelling, followed by leakage along the wall
What does Piaget's cognitive development theory state?
the behavior of children and the development of their thinking can only be explained by the interaction of nature (intrinsic development) and nurture (extrinsic environmental factors)
Define: developmental systems theory
the belief that development can't be explained by a single concept, but rather by a complex system
What does "relative flexibility" in terms of the "path of least resistance" and "springs in series" mean? (language of MSI)
the body is going to find the mvmt that will create the least resistance (sorry this flashcard sucks)
The sx of an embolic stroke can change if:
the clot moves
What does "loop" refer to in open/closed loop control?
the cycle or "circuit" of action and evaluation and consideration of feedback mechanisms
How does massed vs. distributed practice effect learning for a continuous task?
the higher rest periods resulted in the most learning, but we should also keep in mind how much total time you have to spend with the pt
Describe the spiraling pattern of development
the idea that as we develop our progression of motor control does not follow a linear pattern (we may develop a skill then regress to an earlier version of that skill, then eventually we gain more mature looking patterns of movement)
Who is ultimately responsible for deciding where a stroke patient will go when they discharge from the hospital?
the patient (or family member if power of attorney)
Why is it important, as clinicians, to consider the question: what does the brain care about?
this question was posed with the suggestion that if we knew what the brain cared about, we may better be able to guide our interventions in therapy
In hypoparathyroidism, if hypocalcemia becomes severe, what symptoms will this cause?
tingling spreads & intensifies producing painful muscle tension, spasms, grimacing, laryngospasms & heart arrhythmias
What is the overall treatment goal of elbow instability
to avoid an elbow flexion contracture and minimize elbow stiffness while maintaining elbow stability
What is the purpose of the MSI classification system?
to develop a classification system that guides intervention (get you started when you don't know what to do with a pt)
What is the goal of pre-operative PT for a transplant patient?
to improve or prevent deterioration of physical conditions before surgery-- the better you are doing before surgery, the better you will be doing after surgery also: -patient/family education -strength & flexibility training -breathing training
Professional Gatekeeping
to protect the profession from those who would misuse the appropriate functions of certain activities responsible for self & other practitioners thru self-regulation based on standards of education & practice and the fiduciary responsibility for those we serve Ex: impaired colleagues, sexual misconduct
Why might surgical intervention for a distal biceps tendon rupture be needed?
to regain full strength
T/F: the osteo- and arthro- kinematics of the CS are very similar to the LS
true
T/F: the primary auditory cortex has areas like the cochlea does that process different frequencies of sound
true
T/F: there is mixed evidence on early surgical intervention of SCI
true
T/F: there is no relationship between the incidence of DVT and the level of injury
true
T/F: the same structures that can cause LS pain can cause CS pain
true -disc -dura, NR or nerves -facet joints -U joints -muscles -ligaments
T/F: our hands can produce separate spatial-temporal patterns but it takes a lot of practice
true this is how pianists end up being able to run two different motor programs
T/F: pre-fabricated LE orthoses are considered "off the shelf"
true this is technically true bc an orthotist doesn't need to modify them, but they need to be "fit" by a licensed orthotist to make sure it's working for them well
T/F: sometimes a conductive hearing loss occurs in combination with a sensorineural hearing loss
true (a.k.a. "mixed" type) (in other words, there may be damage in the outer or middle ear and in the cochlea or auditory nerve)
T/F: neuropathy may develop during or after a shingles flare up
true, this is an example of infection causing neuropathy
What types of treatment interventions are offered for type I, II and III radial head fractures?
type I - non-operative type II - non-operative or surgical depending on severity type III - surgical intervention
Age distribution of MS
typical onset: ages 20-40
A U joint is formed between the ______________ processes
uncinate
Does a modified 2-point gait pattern use bilateral, unilateral or both kinds of devices?
unilateral
Does a modified 4-point gait pattern use bilateral, unilateral or both kinds of devices?
unilateral
What are general signs and symptoms of a cardiovascular disease that affect the genitourinary system?
urinary frequency, nocturia, concentrated urine, decreased urinary output
In MES for *wound healing*, how does the amplitude setting change for normal skin compared to denervated skin?
use a higher amplitude for denervated skin compared to normal skin normal: 200-400 micro-A denervated: 400-800 micro-A
How do older adults' reaching/grasping change in the workplace?
use compensatory strategies to preserve reaching (changes are unconscious or automatic)
In the preoperational stage of Piaget's cognitive development theory, how does a child learn/ see their world?
use imagination, mental representation of object, thinks others see the world as they do
What does it mean to say a gait pattern is modified? (with the exception of 3-point modified)
use of a unilateral device
