Review 2018 Set #15

The arthrokinematics of the humeroradial joint involve the _______ (convex/concave) head of the proximal radius moving on the _________ (convex/concave) capitulum of the humerus. This means the roll and glide happen in the __________ (same/opposite) direction

*concave* head of radius *convex* capitulum *same* direction

2nd heart sound: -what makes the sound -occur during systole or diastole? -where is it the loudest?

"Dub"/ S2 -happens when semilunar valves close (and AV valves open) -happens at end of systole -loudest at aortic and pulmonic areas

T/F: gout usually causes constant, dull, aching pain

*false* gout occurs in intermittent attacks and causes severe pain

T/F: gout typically affects multiple joints

*false* typically affects a single joint, usually the big toe

What are general guidelines for dosing of plyometric exercise?

*follow guidelines for higher performance activities* -1-2 types of exercise -1-3x/wk for 6-12 weeks -2 sets of 10 or 4 sets of 8 reps, depend on pt. condition, exercise, and objective: power or strength -give 48-72 hrs rest per body part -give ample rest between sets (3-5 min)

In what situation would you want to use a single axis ankle over a SACH?

*for someone with quad weakness* Why? -you can set the posterior bumper to the softest setting to cause them to go to immediate foot flat so that the quads do not have to eccentrically control knee flexion What's the difference? SACH & single axis prosthetics pretty much do the same thing, single axis is just more adjustable

What color is slough? What color is eschar?

*slough*: yellow, tan, gray, green or brown *eschar*: tan, brown or black

Which *ligaments* help stabilize the medial ankle? Which is the most commonly injured (bold)?

-*superficial deltoid ligament* -plantar calcaneonavicular -deep plantar

Spontaneous Pneumothorax: what causes it?

Cause: rupture of a cyst on the surface of a lung creating a hole

What segments does the esophagus have?

Cervical, thoracic, and abdominal segments

Subdivisions of the Parietal Pleura

Cervical- superior to 1st rib. Costal- contact w/ ribs. Diaphragmatic- contact w/ upper surface of diaphragm. Mediastinal- contact w/ mediastinal structures

In general, the main defining systems for postural control are ______ and _______

-Musculoskeletal -Neural

Systems that impact postural control: (read)

-Musculoskeletal -Neuromuscular synergies -Individual sensory systems -Sensory strategies -Anticipatory mechanisms -Adaptive mechanisms -Internal representations

What type of symptoms might someone complain of if they have AIGS (abnormal impulse generating sites) causing nerve pain?

-N/T -temperature -pressure

Describe cognition & object exploration in a 12 month old:

-begins to use objects correctly -imitates gestures

When might a calcaneal fracture be treated conservatively?

-depending on severity -extra-articular fracture -treatment of choice for patients 50+ (esp w/ comorbidities)

How does anesthesia and supplemental O2 affect cardiopulmonary function?

-depressed breathing -significantly dec resp. excursion -altered tone & pattern of resp. muscle contractions -diaphragm ascends in chest ~2 cm -significantly dec TLC -inc WOB -airway closure -intrapulmonary shunting -compression atelectasis -inc airway resistance -may have obstructed airways-- blood, fluid, bronchospasm

What structures do thoracoabdominal incisions allow to be operate on?

-diaphragm -esophagus -biliary tract -R lobe of liver -kidneys

Damage to the nondominant Wernicke's area results in what characteristics?

-difficulty understanding intonations -neglect

Name the association cortices:

-dorsolateral prefrontal association -parietotemporal association -ventral and medial dorsal prefrontal association

When a patient has a contagious disease, pt confidentiality and HCP's duty to warn are placed at odds. What is the argument to maintain pt confidentiality based on?

-duty to control pt privacy as a personal right -if breached, pt would avoid seeking medical treatment -relationship calls for trust -potential discrimination against pt could be a safety issue

Define: -full term/ term -preterm

-full term: 40 wks GA -Preterm: infant born before 37 wks GA

Describe an unstageable pressure ulcer

-full thickness tissue loss -*base of ulcer is covered in slough and/or eschar* in the wound bed

Describe a stage 4 pressure ulcer:

-full thickness tissue loss -*bone, tendon, muscle* are visible -*slough or eschar* may be present on some parts of wound bed -often include undermining and tunneling

Describe grasping skills in a 12-13 month old infant?

-grasp is initiated earlier in the reach -timing is similar to adults -pincer grasp is well-developed

What are some symptoms of a dislocation? (6)

-history of trauma -severe pain -swelling -tenderness -deformity -limited ROM

How do disorders of the cerebral cortex present in general?

-impair ability to discriminate intensity and quality of a stimuli -interfere with ability to use that sensation

If a complete lesion was made in an animal at the decerebrate level, what would we still see with movement?

-improved coordination of activation patterns compared with spinal level -weight support -some active propulsion

Function: ventral and medial dorsal prefrontal association

-impulse control: regulates mood, emotion, and reaction to emotion -personality -affect

What should the general exercise structure for the sub-acute phase be?

-inc AROM repititions -strengthening progression (isometric -> isotonic) -begin small resistance for involved areas (GE to gravity resisted, manual and mechanical resistance) -proprioceptive exercises -include other joints/muscles that may be affecting condition

What happens during compensation of forefoot equinas? (3)

-increased DF at ankle with weight bearing -increased pronation -knee hyperextension

What are causes/MOI for FAI?

-increased joint flexibility/stiffness -muscular weakness -proprioceptive impairments -balance control impairments -delayed peroneal activation time

When does the inflammation phase of healing occur?

0-4 days post injury

In the normal human gait cycle, there is a phase lag of _____. What does this mean?

0.5 one limb initiates its step cycle as the other limb reaches the midpoint of its own cycle

Spinothalamic Pathway: 1. pain & temp info from limbs enters SC via _____________ and synapses in dorsal horn 2. crosses to contralateral SC 3. ascends in spinothalamic tract 4. synapses in ________________ 5. ascends to _________________

1. A-delta or C fibers 4. VPL nucleus of thalamus 5. primary somatosensory cortex

What does the ulnar nerve innervate?

1.5 muscles of forearm: flexor carpi ulnaris, and medial portion of flexor digitorum profundus. Also innervates almost all of the hand except 3.5 muscles

Why can pain from the heart, lungs and esophagus refer to the T1-5 dermatomes?

Because the visceral afferent nerves from these regions come back to the spinal cord at these levels

How many extensor retinaculums are at the ankle? How many flexor retinaculums are at the ankle?

Extensor: 2, superior & inferior Flexor: 1

What do the posterior divisions mainly innervate?

Extensors (muscles in posterior region)

30-50% of patients who suffer an ankle sprain for the first time may later develop _________?

FAI (mey reach up to 80% in basketball players)

FYI: neuropathic pressure ulcers is referring to pressure ulcers that form in diabetic conditions, if a flashcard just says pressure ulcer, it is not the same thing bc it doesn't form due to diabetes

FYI

Where is the descending aorta?

It begins at the sternal angle and descends just anterior to the vertebral bodies

Where is the ascending aorta?

It begins within the pericardial sac with the aortic valve and ascends behind the sternum to the sternal angle

3 strategies that people might use to maintain postural control (hint: not ankle, hip, step)

-sensory -sensorimotor -attentional

What is a thoracotomy in general?

-typically an incision for a lung resection -direction of approach for ^^ depends on surgeon preferences (lateral or thoracoabdominal incision for diaphragmatic procedures)

What characteristics indicate a *doubtful* CRPS diagnosis? (2)

-unexplained pain and tenderness in an extremity -diagnostic blocks can indicate sympathetic involvement

Where can you palpate the median N?

-upper arm -medial to biceps tendon -indirectly @ carpal tunnel

How are coronary artery revascularization procedures done in general?

-use an inflatable, balloon-type device to inc the lumen size -contrast dye to assess blood flow -risk assoc. w/ these procedures

Temporal and distance factors commonly measured with gait:

-velocity -step length -step frequency (cadence) -stride length

Perception

-what we think we see -shaped by attitudes, beliefs & values

What is a *reverse double crush* injury?

-when a nerve injury results in symptoms proximal to the location of injury Ex: injury to nerve at elbow leads to nerve sx in the shoulder

What color is fascia and where is it located?

-white -covers muscles, nerves, bv, and fascia layers

What is a typical MOI for a repetitive strain injury? (2)

-work-related activity -repetitive activity

PTs are responsible for monitoring pts following fractures and immobilization for possible development of ___________

CRPS should create a checklist of signs & symptoms to asses it

What is compartment syndrome of the leg?

Can occur with significant hypertrophy of leg muscles. when the compartments become stretched, diagnose by feeling distal pulse, treated with a fasciotomy

Is this an acute or chronic wound: -*failure or delay of healing component* -doesn't respond to regulatory growth signals -associated with repeated trauma, poor perfusion, excess inflam., concomitant disorders -dormant, senescent cells

chronic wound

Function: secondary auditory area

classification of sound

Function: secondary auditory cortical area

classification of sounds

What happens to the clavicle during abduction of the shoulder between 0 and 60 degrees?

clavicle elevates ~30 degrees at the SC joint (rolls superiorly, glides inferiorly)

What are two accessory motions that happen with shoulder abduction? (read)

clavicle rotates and retracts 30 degrees, thoracic spine extends slightly

What causes venous valves to close?

close when pressure gradient is reversed <0.5 second delay is normal

What are some MOI for plantar fasciitis?

common in: -runners -people who are overweight -those who wear shoes w/ inadequate support -overload from physical activity -excessive running and jumping -inc in difficulty or intensity of exercise too quickly -arthritis that result in inflammation in tendons (elderly) -diabetes can cause additional heel pain -walking or exercise in improper shoes

Describe cognition & object exploration in a 3 year old:

completes 3-4 piece puzzle

Reflex sympathetic dystrophy is another name for what condition?

complex regional pain syndrome (CRPS)

Function: Wernicke's area (L hemisphere)

comprehension of spoken language

Where are A-beta fibers located that detect pain & temperature (instead of proprioception)? What are the names of these 5 types of receptors?

cutaneous & subcutaneous tissue -Meissner's (touch, vibration) -Pacinian (touch, vibration) -Ruffini's (skin stretch) -Merkel's (pressure) -Hair Follicle (pressure)

Meissner's corpuscles, Pacinian corpuscles, Ruffini endings, Merkel's disks & free nerve endings are all types of _________________ receptors.

cutaneous receptors of the somatosensory system

To facilitate wrist flexion, would you perform a dorsal or volar glide

dorsal

Do the suprascapular artery and nerve go above or below the superior transverse scapular ligament?

The artery goes above and the nerve goes below it

What is a potential complication of a postfixed brachial plexus?

The inferior trunk may be compressed by the 1st rib producing neurovascular symptoms

What do communicating rami communicate between?

The intercostal nerve and the sympathetic chain

Which brachiocephalic vein is longer?

The left

What primary bronchus does the aortic arch arch over?

The left main bronchus

What are all of the great vessels behind?

The manubrium, and the heart is behind the body of the sternum

Where does the vagus nerve originate?

The medulla

Costodiaphragmatic Recess

The most dependent (low) when a person is standing so it is most likely to collect excess fluid in the pleural space. Space beneath the lungs but superior to the end of the pleural cavity.

When the diaphragm, pericardium, or mediastinal pleura is irritated, where can afferents within the phrenic nerve transmit referred pain to?

The neck: dermatomes C3-5

T/F: typically the MD will want a patient post-thoracic surgery up and moving pretty quickly

True-- but it varies, just look at your orders

T/F: PT's should be involved at all stages of peri-operative care

True-- get pts ready for surgery Ex: strength, endurance, crutch training ahead of time, transfers, what to expect, etc.

Utilitarian vs Duty vs Beneficence approach to chronic care

U: several unknowns about consequences in this case D: do no harm includes not causing harm directly, removing & preventing it B: consider wellbeing of the family

How is gestational age calculated? How is the expected delivery date determined?

a.k.a. post menstrual age - day 1 of mother's LMP (age from conception) expected delivery is when the fetus will be 40 wks gestational age (40 days since day 1 of LMP)

In lumbar traction, the top web belt of the pelvic belt should be above the ____________ and the web belt's top edge should cross the ___________ line in the front

above iliac crests crosses umbilical line

What is the esophagus between posteriorly and anteriorly?

It is behind the trachea and in front of the vertebral column

What happens as a result of an injury to the common fibular nerve? Is this injury common?

It is easy to injure because it is so superficial Results in foot drop due to paralysis of anterior and lateral muscle groups which results in a "waddling gait"

What type of nerve fibers are in the brachial plexus?

Motor, sensory, and autonomic (sympathetic)

What is the approximate O, I, N, F of flexor digitorum longus?

O: posterior tibia I: base of 2-5 distal phalanges N: tibial nerve F: plantar flexion, inversion, flexion of MTP and IP joints

What is the approximate O, I, N, F of tibialis anterior?

O: upper 2/3 of tibia I: medial cuneiform & base of 1st metatarsal N: deep fibular nerve F: dorsiflexion, inversion

What is a gastrocnemius strain caused by?

Overstretching the muscle

Function of the lungs

Oxygenation of blood and removal of CO2

Who determines a person's K level? Can a person's K level change over time?

Physician w/ input from prosthetist yes

What is the general function of the posterior compartment muscles of the leg?

Plantar flexion

What motion does the calcaneal tendon reflex cause?

Plantar flexion

At the mid-axillary line (lateral), what rib level are the pleura and lungs at?

Pleura: 10th rib Lungs: 8th rib

At the medial edge of the scapula (posterior), what rib level are the pleura and lungs at?

Pleura: 12th rib Lungs: 10th rib

What kind of blood do pulmonary arteries and veins carry?

Pulmonary arteries carry oxygen poor blood. Pulmonary veins carry oxygen rich blood.

Stage 1 of CRPS is ______ and lasts several weeks to several months

acute

Determinants of a Resistance Exercise Program (read)

alignment and stabilization intensity volume frequency rest interval mode velocity periodization integration of exercises to functional activity

Which sensory strategies do healthy young adults use during quiet stance? options: somatosensory, vision, vestibular

all 3 of them

What does activation of A-delta or C fibers result in?

an action potential that travels down the nerve to the dorsal root ganglion and then to the spinal cord

Why would a wound get stuck in a chronic remodeling phase of healing?

an imbalance in collagen synthesis and lysis, dehiscence, keloids

Function: secondary visual cortical area

analysis of motion, color; control of visual fixation

Function: secondary visual area

analysys of motion, color; control of visual fixation

What does the popliteal A turn into when it reaches the leg?

anterior and posterior tibial arteries

If a patient has anterior ankle pain, what are they *most likely* to have?

anterior ankle impingement

With the SC joint, clavicular protraction involves a(n) ________ roll and a(n) _________ glide

anterior roll anterior glide

Which directions are the roll and glide for dorsiflexion of the talocrural joint?

anterior roll posterior glide

What is pain behavior referring to?

the observed (potentially measurable) consequence of a painful experience that can be considered as a "distress" response

What is pain quality referring to?

the perception of nociception that is not directly measurable (self-reporting)

Define: Center of Mass (COM)

the point at the center of the total body mass (located somewhere within the body itself)

In a endoskeletal transfemoral prosthesis, considerable attention is given to the relative position of: Why is this?

the prosthetic knee over the prosthetic foot knee instability will be induced if the alignment is too far forward or backward

Does Paget's involve thickening or thinning of long bones?

thickening

T;F: the calcaneus is the largest bone in the foot

true

How long does stage III CRPS last?

unlimited amount of time

Define: percentile score

used to indicate number of children of same age expected to score lower than the child

In lumbar traction, you want to secure the thoracic belt so that both web belts (pelvic & thoracic) are below the:

xiphoid process

Are J-shaped prosthetic feet energy storing & releasing?

yes absorb during loading, release during toe off

Do heel height adjustable prosthetic feet exist?

yes, it is a specialty foot where the pt can change the heel height to accommodate various shoes without changing overall prosthetic alignment

What populations are calcaneal fractures more common in?

young to middle age males and industrial workers

Initiating gait has the appearance of what?

falling forward

Osteoarthritis puts one at risk for:

falls

T/F: standardized assessments can replace a large part of our PT examination

false does not replace it, but rather enhances our normal PT exam with another objective measure

T/F: more pain = more dysfunction

false talked a long time about how you can have lots of pain but no dysfunction etc...

T/F: there are multiple modalities that can help with FAI

false, not many that can help because it is a chronic condition

CRPS is more common in what gender?

females

Which type of cell synthesizes collagen and other ECM substances and also uses growth factors?

fibroblast ***

What cells are involved in the remodeling phase of healing?

fibroblasts

How do you determine the best prosthetic foot for an individual?

functional abilities & associated needs keep in mind, this may change over time

Ankylosing spondylitis involves inflammation that leads to:

fusion

Varicosities mainly occur in which veins?

great and short saphenous veins

If a wound is red, blue or purple (erythema), swelling (turgor), pain and heat are present, which phase of healing is the wound in?

inflammatory phase

If you're going to exercise several times a day, both _______ and volume need to be low

intensity

The greater the ________ and ___________ of exercises, the more time is needed between sessions to recover (reduced frequency)

intensity and volume

Is the adult or juvenile form rheumatoid arthritis usually more acute?

juvenile

Which type of cell is an epidermal cell that synthesizes keratin and other proteins?

keratinocytes

What is the close packed position for the talocrural joint?

maximum dorsiflexion

The affected limb may have what appearance with stage 1 CRPS?

may be warm and red or dry and cool, pale

What is the most common incision used in cardiothoracic surgery?

median sternotomy (Ex: MI, bypass)

What are the two types of achilles tendinopathy?

midsubstance insertional

What 2 things does the axoplasm of nerves depend on in order to function properly?

movement & blood circulation

The PT should be able to recognize signs and symptims of non-___________ pain to help with a differential diagnosis

musculoskeletal

Which type of cell is found at wound periphery and is responsible for contraction?

myofibroblasts (modified fibroblast)

What can constant, long term stimulation of nociceptors result in? What may cause the constant stimulation of these nociceptors?

nerve damage/changes chronic inflammation causes the constant stimulation of the nociceptors

Do visceral organs have pain receptors? How do we feel visceral pain?

no there are pain receptors present in the walls of the arteries serving these organs allowing us the sensation of visceral pain

Strategic Requirements of Gait:

normal gait will be energy-efficient and effective in minimizing stress to the body

Stage 1 CRPS usually manifests after a ________ event or immobilization

noxious event

Define achilles tendinopathy

occurs when the tendon degenerates and becomes inflamed. The tendon may swell and cause pain

Reactive equilibrium control is used in response to ________ during gait and involves what systems?

perturbation -vision -somatosensory -vestibular

Define: traction

pulling or drawing

If a patient has pain along their lateral leg, which nerve would you screen to see if it's involved? If you find that it's involved, how would you treat this?

sciatic N perform nerve glides instead of static stretches bc stretching for a long time will compress the nerve in the piriformis muscle

What is a lateral curvature of the spine called?

scoliosis

Standardized Assessments may be used for ________, assessment, ______ and evaluation

screening assessment testing evaluation

Which sensations have secondary sensory areas in the brain?

secondary somatosensory secondary visual secondary auditory (vestibular does not have a secondary area)

What is the MOI for cuboid syndrome?

secondary to overuse, increasing body weight, training on uneven surfaces or lateral ankle sprain

Pain and _______ changes are present with stage III CRPS

sensory

What is the most common type of diabetic neuropathy?

sensory neuropathy

Which type of diabetic neuropathy causes pain or loss of feeling in the toes, feet, legs, hands and arms?

sensory neuropathy

What are 2 theories of plyometric exercise?

series elastic component neurophysiological model theories as to what helps produce movement in plyometric exercise

Which type of forces are *rotational torque adapters* for prosthetic feet good at reducing?

shear forces

Do patient's typically have a longer or shorter length of stay in the hospital for coronary artery revascularization procedures?

short LOS-- often go home the next day

If a patient has a K level of 1 and has weak quads, what might be a good foot prosthesis for them?

single axis foot or SACH

Free weights are safe and effective in _____ and ________ velocities?

slow and medium

Describe how eye-head-hand coordination changes between the age of 2-4 months old

during these months, head and arm movements begin uncoupling, allowing for more flexibility

What are 3 modes of resistance exercise?

dynamic (eccentric/concentric) isometric isokinetic

With wrist glides for radial and ulnar deviation, the radiocarpal joint involves what bones moving against each other?

scaphoid, lunate and triquetrum move on radius

Reticular veins and telangiectasis both indicate:

early stages of chronic venous insufficiency

The key for successfully descending stairs is ___________ contractions

eccentric

Which type of cell lines blood vessels (esp capillaries) and migrate and form new vessels in wound healing?

endothelial cells

Which layer of the skin prevents water loss?

epidermis

Which layer of the skin protects you from toxic irritants?

epidermis

Which layer of the skin provides pigmentation?

epidermis

Which layer of the skin synthesizes vitamin D?

epidermis

What 2 membranes must both be reestablished to maintain an impermeable barrier (closed wound)?

epidermis and basement membrane

Shoulder abduction is coupled with shoulder ___________ (motion) above 60 degrees to prevent shoulder impingement

external rotation

When does a posterior roll and anterior glide happen with shoulder motions?

external rotation extension horizontal abduction

Receptive fields: -size vs. location -density vs. location

smaller distally larger proximally more dense distally less dense proximally

Which body position during surgery has the greatest impact on the resting position of the diaphragm

supine-- allows the diaphragm to creep higher up

In the ankle, which joint is mainly responsible for DF/PF? Which is primarily responsible for inversion/eversion?

talocrural = DF/PF subtalar = inversion/eversion

Postural control requirements vary with the ______ and ______

task and environment specific orientation and stability requirements vary according to the task and the environment strategies used to accomplish postural control must adapt to varying tasks & environments

GTO's relay info about ___________ via Ib afferents

tendons

The primary sensory areas in the cortex (Ex: primary somatosensory, auditory, visual, vestibular) receive sensory info from the ___________

thalamus

Define: postural stability

the ability to control the COM in relationship to the BOS

Define: postural orientation

the ability to maintain appropriate relationships between body segments and between the body and the environment for successful task completion Ex: slouching vs. sitting upright

Extrinsic factors influencing reaching in infancy (3):

-task demands -vision -coordination

If a patient has medial ankle pain, what are they *most likely* to have?

-tibial posterior tendinitis -ligamentous injury (deltoid) -medial tibial stress syndrome (shin splints)

How are endothelial stents placed? (type of CV revascularization procedure)

-tiny, spring-like device place into a stenotic lesion -inflated & remains in place to inc luminal diameter to restore blood flow (40% reduction in coronary bypass surgery within 1 yr follow up)

Where are diabetic wounds usually located? (4)

-tips of toes -lateral aspect or dorsum of foot -metatarsal heads (esp 1st & 5th) -heel, midfoot, or location of orthopedic deformity

What is acute compartment syndrome?

-tissue pressure becomes greater than the venous pressure, resulting in impaired blood flow -tissue ischemia -rapid development over hours or days -medical emergency

Describe newborn's ability to locate a target (3)

-track object using saccadic eye movements -move attn from one object to another -have limited smooth pursuit at birth (infants are born with obligatory looking, but have the ability to disengage with an object by 4 mo of age)

What are the 3 main arches of the foot?

-transverse arch -lateral longitudinal arch -medial longitudinal arch

People with infectious (septic) arthritis may have a history of: (4)

-trauma -surgery -nearby infection -Lyme disease

What are the MOI for acute compartment syndrome?

-trauma (fracture, crush injury, burns) -casts and bandages -blood vessel surgery or clot -vigorous eccentric exercise -taking anabolic steroids

Where are good anatomical locations to palpate nerves?

-tunnels (Ex: carpal tunnel, post. tarsal tunnel) -branches (Ex: radial N splits at elbow, sciatic N splits in post thigh) -hard surfaces (Ex: radial N on radius, sup peroneal N on bones of foot)

What are the 4 different types of precision grip or pinch? Which is the most precise? Which is also known as 3-jaw chuck?

-two-point tip to tip (most precise) -three-point tip to tips -two-point pad to pad -three-point pad to pads (3-jaw chuck)

What are 3 goals in rehabilitation when the object is to treat pain?

-unload the area/joint -change in posture/position -ROM within pain free range

How do you use the Holton curve to figure out dosing? example...

1. patient can do 10 lbs for 16 reps (75% on scale) 2. divide 10/.75 = 13.3 3. 1 RM = 13 lbs 4. 10 RM on curve is ~81% of 1 RM 5. (13.3 x 81)/100 = 10.77 lbs 6. 10RM is ~11lbs

The lymphatic system plays a role in the balance of what fluid?

ISF

What does the thoracodorsal nerve innervate?

Latissimus dorsi

Once you find the arch of the aorta, which vagus nerve will you find?

The left vagus nerve

Pulmonary Emboli

The lungs are a natural filter for venous clots from the systemic circulation. Symptoms: sudden dyspnea, light headedness, and tachycardia.

What population is calcaneal tendonitis common in?

Runners

Sympathetic pain is a type of nerve pain due to the abnormality of the function of the ________

SNS see peripheral changes in somatic tissues

Does venous or arterial insufficiency result in absent or diminished pulses?

arterial insufficiency

What is the WHO ICF- Children and Youth (ICF-CY) version? What does it add?

builds on ICF framework captures growth and development even when dx doesn't change -addresses infancy, childhood and adolescence and relevant environmental associate with these age groups (coding also expanded)

Step _______ is typically measured as the # of steps per minute

frequency

Kyphosis is also known as:

hunchback

Edema is caused by an increased intravascular _________________ pressure

hydrostatic

Which layer of the skin contains deep blood vessels and nerve endings?

hypodermis

Which layer of the skin is considered superficial fascia?

hypodermis

Periodization helps maximize _____ in a minimum ______

max results min time

Do the following increase or decrease during the remodeling phase of wound healing: -tensile strength -cellularity -vascularity

increase decrease decrease

What is the definition of compartment syndrome?

increased intracompartmental pressure in a confined fascial space due to bleeding, swelling or another cause that decreases blood flow and can deprive the compartment contents of oxygen, nutrients and waste removal which can result in ischemia or pain

With normal, healthy young adults, how does slower speeds in gait effect variability?

increases it

Describe eye-head-hand coordination in a 4 month old

infants gain trunk postural stability, providing a stable base for the emergence of reaching

What does it mean to say a wound was closed by primary intentions?

means it was closed surgically which is the fastest way to close a wound

What does it mean to say a wound was closed by secondary intentions?

means it was left to heal by itself (granulation/epithelialization), this is often done if there was a concern for infection

Define: discriminative measure What's their purpose?

measures used to determine if child displays deviations from the normal standard purpose: identify children with delays and determine program eligibility

Mechanoreceptors respond to:

mechanical deformation of the receptor by touch, pressure, stretch or vibration

What is Saunders' Cervical Traction Device?

mechanical traction we did in lab

Types of somatosensory receptors

mechanoreceptors chemoreceptors thermoreceptors

Loss of thumb opposition is a clinical sign of damage to which nerve?

medial nerve

According to Loudon's, describe the arthrokinematics at the subtalar joint during supination/inversion?

medial roll medial glide

Which type of cell produces melanin in the stratum basale?

melanocytes

What population is typically affected by gout?

men, 40+ yo

Which type of cell is a touch receptor attached to keratinocytes through desmosomes in the stratum basale?

merkel cells

What would the origin of pain and the quality of pain be for a muscular injury?

origin: muscle quality: deep aching, poorly localized, dull or sharp

What would the origin of pain and the quality of pain be for a neuropathic injury?

origin: nerve quality: shooting, sharp, burning pain *electric shock type sensation with acute injury*

What would the origin of pain and the quality of pain be for a cutaneous injury?

origin: skin quality: sharp, superficial

What would the origin of pain and the quality of pain be for a visceral injury?

origin: visceral organs quality: deep aching, pressing, boring, stabbing *very poorly localized*

What AD may be used for a foot condition caused by a deformity?

orthotic

If a diabetic ulcer is down to the bone, 90% of them will have:

osteomyelitis

Where are the cell bodies of most peripheral sensory neurons located?

outside SC in dorsal root ganglia, or outside brain in cranial NN ganglia

What are some symptoms that patients might be feeling in the acute phase of healing?

pain swelling loss of ROM/strength functional limitations high tissue and patient reactivity

In acute pain, pain ______ is more important whereas in chronic pain, pain ______ is more important

pain quality (intensity, pt description) pain behavior (observation, questionnaires, objective measures)

Difficulty with sensory integration and inability to handle new information effectively are indications of damage to which association cortex?

parietotemporal association

Wernicke's aphasia indicates damage to which association cortex?

parietotemporal association (L hemisphere)

Neglect and/or difficulty understanding nonverbal communication indicates damage to which association cortex?

parietotemporal association (R hemisphere)

What does transmission mean in reference to first order neurons?

passage of the resulting sensory input from peripheral terminals to spinal cord

What is a common side effect of Paget's disease?

pathologic fractures

Do you secure the thoracic or pelvic belt first in mechanical lumbar traction?

pelvic

Define: age-equivalence

performance of a child is compared w/ the mean age when 50% of children would have mastered those skills

___________ involves the systematic variation in the exercise intensity and repetitions, sets and frequency at regular intervals over a specific period of time

periodization

What is the order of the vagus nerve, phrenic nerve, sympathetic chain, and hilar region from anterior to posterior?

phrenic nerve - hilar region - vagus nerve - sympathetic chain

What is chronological age? How is it determined?

postnatal age time elapsed after birth (described in days, weeks, months or years

Plyometric exercises are good for _______ training, especially when combined with ________

power strengthening

Initiating gait begins with the ________ (relaxation/contraction) of muscles from quiet stance What muscles in particular?

relaxation gastrocnemius and soleus

Which phase of healing begins as granulation tissue is formed?

remodeling phase (can last 1-2 years; until wound matures)

What info do divergent somatosensory pathways carry? Where does this pathway terminate? (divergent: spinoreticular, spinolimbic & spinomesencephalic)

slow, aching pain terminate: -SR: reticular formation -SL: amygdala, BG, many areas of cortex -SM: midbrain

How do muscle spindles maintain their correct length?

small efferent fibers (gamma MN) adjust spindle length via specialized (intrafusal) muscle fibers so the spindle is responsive through a physiologic range of muscle length

What is a simple explanation for why we feel somatic pain for visceral structures?

somatic and visceral pathways run parallel to each other and have intersections in the spinal cord (Dr. Sharma)

Through a subjective and objective exam, you can use differential diagnosis steps to determine if pain is ______ or ______ in nature

somatic or visceral

How is volume defined in relation to exercise dosing?

summation of total reps performed x resistance

What are the 3 layers of the venous system?

superficial, deep and perforator

With the SC joint, clavicular elevation involves a superior ______ (roll/glide) and an inferior ______ (roll/glide)

superior roll inferior glide

What is the close packed position for the subtalar joint?

supination

Supination of the foot is a combination of what three motions? Pronation?

supination - PF, inversion and IR pronation - DF, eversion and ER

Supination of the foot is produced by ________ of the tibia. The rear foot and midfoot ________ and the forefoot ______ on the midfoot

supination of the foot is produced by external rotation of the tibia. The rear foot and midfoot supinated and the forefoot pronates on the midfoot

True CECS is best relieved with _______

surgery

According to Stacia, lordosis is also known as:

swayback

A normal human gait cycle can be described as using a __________ alternating gait pattern

symmetrical (this is chosen b/c it provides the greatest dynamic stability with minimal control demands)

The primary sensory areas receive information directly from the ___________ and function to discriminate among different ________ and qualities of one type of input

thalamus intensities

What is rest interval in relation to exercise?

the amount of time in between sets

Somatosensory receptors are located at:

the distal end of peripheral neurons

Define: ceiling level

the item representing the most difficult item

How is power defined?

the strength and speed of movement (force x distance) produced by the muscle per unit of time (f x d/ t)

What is adjusted working weight used to determine?

the weight for the next session

What is the purpose of the 4 screws in an endoskeletal prosthesis?

they act against an inverted pyramid and enables angular alignment changes which affect the relative "length" of the "toe" and "heel" of the foot

What accounts for 1/3 - almost 1/2 of falls in older adults? What accounts for another (almost) 1/3 percentage of falls in older adults?

trips slips

In older adults, perturbations during locomotion can result in either ____ or ____

trips or slips

Stage 1 CRPS is associated with beginning signs of ______ changes

trophic

T/F: Paget's disease is often asymptomatic

true

T/F: during lung auscultation you should listen both on the chest and back

true

T/F: training velocities of resistance exercise should be generated to match or approach the demands of patient's functional activity

true

T/F: the strategies for regaining anteroposterior stability (ankle, hip, stepping) are hierarchical in nature and each requires a greater amount of perterbance to initiate the next strategy

true-ish generally it takes more of a perturbation to get a hip strategy vs an ankle strategy, but they are not discrete and are actually on a continuum, there is also some variability from person to person

Loss of thumb adduction (Froment's sign) is a clinical sign of damage to which nerve?

ulnar nerve

Define: evaluative measures What's their purpose?

used to measure progress and determine a child's performance against previous performance on the *same measures* purpose: used for program planning or to track change over time

When trying to maintain postural control by using the hip strategy after a perturbation, what happens to the COM?

we lower it closer to the ground and try to bring it backwards or forwards to the BOS

What is cuboid syndrome?

when the calcaneocuboid joint temporarily subluxes laterally and posteriorly, caused by a strong external force (aka locked cuboid, calcaneocuboid fault syndrome or subluxed buboid)

How does the relationship of tissue damage to pain intensity change with acute vs. chronic pain?

-with acute pain there is a linear relationship -with chronic pain there is a nonlinear relationship (may not need a lot (or any) injury to feel chronic pain)

How does friction cause ulcers? Which layers of the skin can friction forces damage?

-works w/ gravity to cause shear -alone, causes damage to epidermis and upper dermis -mildest form, abrades similar to a burn

According to the DeLORME dosing for resistance exercise, when is 1 RM appropriate, and when is 10 RM appropriate?

1 RM - for helthy, young athletes and active older adults 10 RM - safer than 1 RM for patients and is used for exercise baseline

What are some factors that affect pain from person to person? (7)

injury (previous injury changes pain threshold) fatigue age (older people tolerate more pain) gender (women tolerate pain better) fear and apprehension racial and cultural characteristics emotional status

Stasis eczema is associated with chronic ______________ changes with ___________ and ___________ deposition and edema

inflammatory changes with fibrin and hemosiderin deposition and edema

In which phase of healing do WBC migrate between endothelial cells out of capillaries and migrating monocytes transform into macrophages to initiate debridement?

inflammatory phase

In which phase of healing does phagocytosis occur?

inflammatory phase

In which phase of healing should you clean the wound site for tissue restoration?

inflammatory phase

The proliferation phase of healing overlaps with the _____________ phase this begins ____ to ____ days post-injury and continues for ____ weeks

inflammatory phase 3-5 days post-injury and continues for 3 weeks

Function: sensory association area

info from all sensations gets dumped here so that your brain can integrate the info & make sense of your environment

Describe how the control of the trapezius muscle changes with increasing shoulder elevation?

initiation: upper trap predominates at 90 deg: middle trap peaks later phases: lower trap predominates

What should the following be for endurance exercise? -intensity -sets -repetition -rest

intensity: low sets: 2-3 reps: 15+ Rest: short (less than 1 min)

What should the following be for strength focused exercise? -intensity -sets -repetition -rest

intensity: moderate/high sets: 2-3 reps: 6-12 rest: 2-3 min

What should the following be for power exercises? -intensity -sets -repetition -rest

intensity: moderate/high sets: 2-4 reps: 3 to 6 rest: 3-5 min

What types of joints are affected by juvenile rheumatoid arthritis? (large or small)

large joints

What is a tophus in terms of gout?

large, hard nodule that consists of urate crystals

According to Loudon's, describe the arthrokinematics at the subtalar joint during pronation/eversion?

lateral roll lateral glide

Muscle spindles respond to changes in the _________ and ____________ of muscles, this concept is often referred to as "muscle stretch"

length & velocity

What is defined as a grade 1 ankle sprain? Can the pt WB? How long off activity?

less than 25% tear, mild pain and swelling w/o instability. Patient may be able to weight-bear. 7-14 days off from activity

What may cause rhonchi?

may occur when there is mucus in bronchi (sound may be changed w/ coughing)

What does the treatment outlook for stage 1 CRPS look like?

may resolve spontaneously or should respond rapidly to appropriate treatments

Based on the acute phase symptoms that patient's may be experiencing, what should some goals be for therapy?

minimize/control pain reduce swelling promote healing educate on ADLs protect against further loss of function

Which blood cell differentiates into a macrophage during the inflammatory process?

monocytes (large WBC)

What are the 2 best signs to rule in achilles tendinopathy?

morning stiffness and tenderness with palpation

What are some symptoms of bone tumors?

most are asymptomatic -local swelling -local pain -other systemic symptoms of cancer

Which type of diabetic neuropathy results in muscle atrophy and weakness?

motor neuropathy

Function: Broca's area

motor programming of speech (usually in L hemisphere only)

In the ankle & hip strategies, the subject moves the _______ and keeps the ______ the same. options: BOS, COM

move COM same BOS in the stepping strategy, the BOS is also changed

The nervous system must __________ to the system it's contained in

move, stretch & adapt during it's adaptation, it must be performing complex, electrochemical processes

What may improve nerve pain caused by AIGS (abnormal impulse generating sites)?

movement (will encourage turnover of ion channels)

Define: thixotropic

movement dependent (relates to axoplasm being thixotropic)

What causes the sound of pleural friction rub?

movement of inflammed pleural surfaces rubbing together

What info do unconscious relay somatosensory pathways carry? Where does this pathway terminate? (unconscious relay: spinocerebellar)

movement-related info terminate: cerebellum

Which type of prosthetic foot is preferred for uneven terrain?

multi-axial foot

Are rheumatoid nodules present in juvenile rheumatoid arthritis?

no, they are absent

As long as the chemical mediators of inflammation are present, the _________ will be stimulated and you will feel pain

nociceptors

A subset of each type of somatosensory receptor (mechano-, chemo-, thermo- receptors) is classified as ________

nociceptors (if you have a sensation that's over threshold, it can be detected as painful which stimulates the sub-type nociceptors--- Ex: too much pressure or too much heat)

Which principles conflict if a patient asks you to keep their intent to commit suicide a secret?

non-maleficence & beneficence with fidelity

What causes compression atelectasis during thoracic surgery?

occurs when lung tissue & surrounding structures are being physically manipulated

Where is instability the greatest with ascending stairs?

occurs with contralateral toe-off, when the ipsilateral leg takes all the body weight and that limb is flexed

What is the open packed position for the subtalar joint?

pronation

Where can medial nerve entrapment occur?

pronator teres, FDS, carpal tunnel

If the belts/pads for lumbar traction were set up for a supine position and a posterior pull, what other position would these belts work for?

prone w/ anterior pull

If the belts/pads for lumbar traction were set up for a supine position and an anterior pull, what other position would these belts work for?

prone w/ posterior pull

The spinocerebellar pathway transmits ________ info to the cerebellum. This is critical for adjusting _______ and ____________

proprioceptive (unconscious proprioception) adjusts movement and posture

Granulation tissue is delicate and needs to be:

protected

What does P.R.I.C.E. stand for?

protection rest ice compression elevation

What are the 5 motions of the clavicle?

protraction retraction elevation depression posterior rotation

What are the 5 functions of the dermis?

provides: -structure (collagen) -elasticity (elastin) -insulation -reserve of energy -serves as a cushion (fatty layer)

Two types of equilibrium control

reactive proactive

What is a classic symptom of FAI?

recurrent ankle sprain and sensation of ankle instability

What is the main muscle group responsible for controling shoulder elevation?

rotator cuff

Grasp development is split into what 3 phases? What time frame is covered in each phase?

rudimentary grasp (pre-grasp): birth - 3 months Infant grasp: 4 months - 13 months Childhood: 13 months - adults

What activities are J-shaped prosthetic feet used or not used for?

running not for general walking (too stiff & no heel)

The thumb CMC and the SC joint are both ________ joints

saddle

Muscle spindles are sensory receptors within: What 3 things does a muscle spindle consist of?

skeletal (extrafusal) muscle consists of: -muscle fibers -sensory endings -motor endings (GMN)

The somatosensory systems carry info from which 2 body systems?

skin musculoskeletal

A pressure ulcer is a localized injury to the:

skin and/or underlying tissue, usually over a bony prominence

Describe a category III skin tear:

skin tears w/ complete tissue loss

Describe a category II skin tear:

skin tears w/ partial tissue loss

What types of joints are affected by adult rheumatoid arthritis? (large or small) Is it usually unilateral or bilateral?

small joints bilateral

Which system is the *most important* for maintaining postural control in a healthy young adult?

somatosensory

Infanib AIMS BSID-III PDMS-2 GMFM PEDI BOT-2 SFA These are all examples of what?

standardized assessments that can be used with children

Define: Norm-Referenced Assessments

standardized on groups of "normal" children -child is compared to the group in a sample based on skill level -compares child's performance against known group performance -deviations from normal distribution are determined

Function: secondary somatosensory cortical area

stereognosis and memory of the tactile and spatial environment

Function: secondary somatosensory area

stereognosis and memory of the tactile and spatial environment (Ex: stereognosis- if you put an apple in someone's hand w/ their eyes closed, they can figure out what it is relying on their senses of touch & proprioception)

What stimulates GTO's?

stimulated by tension: active contraction of muscle, passive stretch of muscle, resting position or even gravity pulling on it

Nociceptors respond to:

stimuli that damage, or threaten to damage, tissue (results in pain sensation)

What is the series elastic component theory?

stored energy created with rapid stretching, energy released immediately with concentric contraction

What are some characteristics of a patient's pain in a subjective exam that may indicate chronic pain? (7)

-patient focused on the pain -pain persists beyond healing time frame -pain is poorly localized/referred -vague description of pain -severely limited function -high anxiety and fear -work history (related to job)

How is a patient's breathing affected post-thoracic surgery?

-normal pattern disrupted -shallow tidal ventilation -dec normal occasional deep breaths -can cause alveolar collapse w/in 1 hour -tachypnea w/ gross atelectasis d/t hypoventilation -dec breath sounds at bases, coarse wheezes w/ mucus obstructing airflow -left lower lobe atelectasis is common after cardiac surgery

What are signs/symptoms of chronic exertional compartment syndrome?

-numbness and tingling -limited ROM -visible bulge in the muscle -weakness -aching, burning, cramping

Describe cognition & object exploration in an 8 month old:

-object permanence & separation anxiety

In pediatrics, what are standardized assessments used for?

-objectively measure (motor) skills and knowledge -determine child's level of development and functioning -identify impairments, activity and functional limitations -helps establish diagnosis, prognosis, plan of care -select appropriate interventions and services -support goals, interventions and outcomes -determine/document progress, revise interventions -determine eligibility for services

What are some components of an OE for foot/ankle?

-observation (WB or NWB, moving sit to stand, walking, gait) -palpation -active and passive ROM -muscle length and strength -special tests

How can pain be documented objectively? (4)

-observation (skin/temp) -edema -ROM -function

How might we go about assessing/screening developmental skills other than working directly with/interviewing the child?

-observation of child at informal or structured play and of parent-child interactions -parental interview to elicit their concerns, obtain a history of the child's early development, and gather information about the child's current level of function -review of the child's records (including health, education, daycare etc.) -parent/caregiver checklist(s)

Stereotyping

-observing something & then automatically classifying it & judging -distorted belief or truth about a person/group -generalization that allows for no wiggle room -could be positive or negative

How does initiation of gait change in an older individual?

-older adults may try to keep COP and COG more closely aligned (less sway of COP) to minimize unsteadiness -especially true for those w/ disability

How can a lack of *blood flow* generate nerve pain?

-only minor compression is needed to stop blood flow & create a hypoxic situation -the nerve will swell if the restriction is held too long

Describe grasping skills in a 3 month old?

-open hand when infant is visually fixated on target

Describe grasping skills in a 8-9 month old infant?

-opening of hand during reaching is related to size of object -pincer grasp emerges

Implicit Bias

-operates on an unintentional or even unconscious basis -may or may not relate to clinical judgment

If a patient has *lateral* ankle pain, what are some conditions that should be considered? (10)

-osteochondral fracture of talus -distal fibular fracture -avulsion fracture (5th MT) -peroneal tendon injury/subluxation -*ligamentous injury* -high sprain of the tibiofibular ligament -fibular or sural nerve irritation -*cuboid subluxation* -achilles tendon injury -subtalar joint ligament injury

In a differential diagnosis for children and adolescents, what are some conditions of the foot/ankle that you might consider? (3)

-osteochondritis dissecans of the talus -juvenile RA -epiphyseal fractures

What should you ask about for a patient's current/past history to help determine what might be the issue for foot/ankle pain?

-insidious onset (duration, stability, prev treatments) -trauma (when, how, direction of force, swelling, able to walk?)

When does a person have pain from heel spurs?

-intermittent or chronic -knife-like or pin sticking into the bottom of the foot at first steps in the morning, dull ache later in the day -sharp pain after sitting for prolonged periods of time -pain w/ activity

Why are thoracic & CV surgery hard on cardiopulmonary function?

-invasive & lengthy -heavy & prolonged anesthesia -typically performed on older adults -generally assoc. w/ inc risk

What are the MOI for an ankle sprain?

-inversion (85%): excessive load on a supinated ankle, rolling foot inward -eversion: less common, excessive load on a pronated ankle, rolling foot outward

As we walk at our "normal" speed, what causes us to settle around an average cadence?

-our own cadence is likely related to trying to minimize energy output (metabolic cost) with gait

What are some MOI for achilles tendinopathy?

-overuse -bone spur -sudden inc in activity -altered lower limb biomechanics -footwear -posture/leg length -impaired mm performance -trauma

What are some common symptoms for a foot/ankle injury? (3)

-pain -instability -hypomobility

What are signs/symptoms of acute compartment syndrome?

-pain above what the injury would indicate -muscle feeling tight/full -tissue discoloration -numbness or paralysis indicate permanent tissue injury

What characteristics must be present for a *definite* CRPS diagnosis? (4)

-pain and tenderness in distal extremity (disproportionate to injury) -signs/symptoms of vasomotor instability -swelling in extremity -dystrophic skin changes usually present

What are some symptoms of Rickets? (lots)

-pain in extremities, pelvis, spine ---deep pain, worse w/ palpation -slow growth -short stature -inc bone fractures/deformities -poor teeth -muscle cramps -waddling gait other picture: -soft spot on baby's head slow to close -"bony necklace" -curved bones -big, lumpy joints -bowed legs

What are some symptoms of a repetitive strain injury? (3)

-pain that interrupts sleep -weakness -numbness

What are some symptoms that patients may be feeling in the sub-acute phase of healing?

-pain w/ movement or specific movements -dec patient/tissue reactivity -pain characteristics changing

What are some diagnostic tests for compartment syndrome?

-palpation -imaging (MRI or NIRS) -compartment pressure testing

2 ways to assess if nerve pain is contributing to a patient's symptoms:

-palpation -neural tension testing

Describe a stage 2 pressure ulcer:

-partial thickness loss of dermis -presents as *shallow open ulcer* -red-pink wound bed w/out slough -may also present as an intact or ruptured serum-filled *blister*

How can a *double crush* injury generate nerve pain?

-nervous system is a closed system, so injury in one area can lead to pathology at another site on a nerve Ex: injury to median N at elbow can lead to carpal tunnel sx (distal sx)

What are some symptoms a patient may have in the chronic/remodeling phase of healing?

-no pain unless w/ repetitive activity or at end ROM -nearly normal function -pain reproduction w/ certain activities -patient do well w/ activity modifications

What are some changes in limitation/injury that you should see before progressing from the sub-acute phase?

-no pain w/ ADLs -nearly normal AROM -improved tissue healing -tolerance of resisted motion w/ no or min pain

T/F: FAI may be a limiting factor in sports and ADL

True

T/F: in a hip strategy for postural control, there is a larger movement when reacting to the perturbation compared to an ankle strategy

True

T/F: when you're resting one muscle group you can work another muscle group

True patients have 48 hr interval for recovery (every other day)

What does DAPRE stand for?

Daily Adjustable Progressive Resistive Exercise

DeLorm is based on ______ resistance whereas Oxford is based on ______

DeLorm: inc Oxford: dec

Where do thromboemoboli usually originate from?

Deep leg veins caused by bed rest, trauma, or coagulation disorders

What does DOMS stand for?

Delayed Onset Muscle Soreness

What does the axillary nerve innervate?

Deltoid and teres minor

Barrel Chest

Develops as a result of emphysema

What do the anterior divisions mainly innervate?

Flexors (muscles in anterior region)

Where does the left brachiocephalic vein run?

From behind the medial end of the left clavicle and then it passes obliquely behind the manubrium to the right side and joins with the right brachiocephalic vein

Where does the right brachiocephalic vein run?

From behind the medial end of the right clavicle and then it joins with the left brachiocephalic vein

In a patellar tendon reflex, you have a quick stretch of the muscle which results in you contracting your quad. Now you're quad is short and your muscle spindles in the quad are longer than normal. What will happen next in a healthy person?

GMN will co-contract the muscle spindles (alongside the AMN contracting the quads) so that both the muscle & muscle spindles shorten together and the spindles are able to detect another quick stretch if they need to ("you want the to shrink together & lengthen together")

What are the superficial muscles of the posterior compartment of the leg?

Gastrocnemius Soleus Plantaris

Which superficial muscles of the posterior compartment cross the knee?

Gastrocnemius and plantaris (not soleus)

Which is the only splanchnic nerve type you can see on a cadaver?

Greater splachnic nerve

What are the 3 types of splanchnic nerves?

Greater thoracic, Lesser thoracic, and least thoracic

Groove of the Left Lung

Groove for the arch of the aorta and cardiac impression

Grooves of the Right Lung

Groove for the superior vena cava and arch of the azygos vein

Where does the common fibular N always split distal to?

Head of fibula

What type of neuron are the splanchnic nerves?

Sympathetic preganglionic neurons

Function: primary somatosensory area

discriminates shape, texture, or size of objects

T/F: heavy-duty, non-slip harnesses are necessary for traction

true

T/F: norm-referenced assessments are discriminative measures

true

When would you screen for femoral N involvement in a patient's condition? (3)

-*inguinal hernia* -pinch or hyperextension at inguinal ligament -L2-3 N root syndrome

What are some associated illnesses with arterial insufficiency? (7)

-CAD -CHF -COPD -HTN -DM -ESRD -hypercholesterolemia

What's the main takeaway we should understand about the maintenance of postural control and the use of ankle/hip/stepping strategies?

"muscle synergies are flexible and alter in a task-dependent manner" a.k.a.: -some people may react differently to the same perturbation -some people with a certain type of injury may always revert to stepping strategy -the same person can even react differently if the environment is changed

Contraindications for neural tension testing

"same as the contraindications for any mvmt of the spine" -tethered cord syndrome -SCI -cauda equina lesion -recent neuro changes -malignancy -instability of the vertebral column -unstable disc lesion (more of a precaution)

Function of association cortices (5):

(complex behavior organized) -integration and interpretation of sensations (PT) -processing of memory (PT) -emotions (VM) -personality (VM) -executive functions (DL)

How do you use Dutton's to figure out 1 RM?

(weight lifted x # reps x .03) + weight lifted if patient can do 10 lbs for 16 reps (10 x 16 x .03) + 10 = 14.8 lbs 1 RM = ~15 lbs

Fact or Myth: About 80-90% of patients return to work; the other 10% of people are never pain free no matter what is done

*Fact* most patients do want to get better and return to work/normal activities, some people are never pain-free and it is not known why

Fact or Myth: 6 months after an injury, 50% of the people that are still not back to work will never go back to work

*Fact* 6 months is a big landmark for PT goals to get patients back to work

Fact or myth: Within 2 months following an injury, the majority of patients get better regardless of intervention type or no intervention provided

*Fact* body will heal itself with time (to a certain extent), but some conditions can be recurrent in nature without treatment in acute state (LBP can become chronic and recurrent if not treated appropriately in the acute phase)

How can the PT change the volume of exercise? (3)

-# of reps per set -# of sets per exercise -# of exercises per session

What are the 3 causes of scoliosis?

-*15% congenital*: due to problems with formation of spine or fused ribs -*10% neuromuscular*: poor muscle control, muscle weakness or paralysis -*60% idiopathic*: most common in adolescents

If a patient has *anterior* ankle pain, what are some conditions that should be considered? (3)

-*anterior ankle impingement* -acute/chronic compartment syndrome -deep fibular nerve lesion talar dome injuries

Which *ligaments* help stabilize the lateral ankle? (6)

-*anterior tibiofibular* -*anterior talofibular* -*calcaneofibular* -lateral talocalcaneal -interosseous talocalcaneal -cervical talocalcaneal

When would you screen for median N involvement in a patient's condition? (3)

-*carpal tunnel* -post Colles' fx -C5-6 nerve root

What are positive findings from neural tension testing (NTT)?

-*comparable sign* (produce sx in test that are comparable to their P1) -asymmetrical ROM -change of sensation in the distrubution of nerve being tested

What are some PT interventions for venous insufficiency? (4)

-*compression* to promote venous return: 4 layer bandages, short stretch bandages, compression stockings -*non-adherent dressings* to protect delicate skin -*gentle debridement* -*exercise*: promote venous return

What are some PT interventions for arterial ulcers? (4)

-*debridement*: sharp, mechanical- whirlpool, dull -*wound management*: appropriate dressing choice for exudate control and moisture level -*identify & treat strength, ROM or gait impairments* leading to functional deficits -*education* of nutrition and dressing

How do you determine the *cervical* traction force?

-5-20 lbs -assess results of lighter force before increasing -monitor symptoms

2 major features in development of fine motor control:

-control of the hand as the terminal device for reaching and grasping -object manipulation and release

ASQ-3 -What does it stand for? -what ages is it valid for? -is it criterion or norm referenced? -how is info collected? -what does it assess?

-Ages and Stages Questionnaire - 3rd ed -1-66 mo -Norm referenced -standardized parent report -assesses communication, GM, FM, problem solving and personal social development

AIMS: -what does it stand for? -what is assessed? -what age child is appropriate? -purpose? -is it criterion or norm referenced?

-Alberta Infant Motor Scales and Motor Assessment of the Developing Infant -observation of GM skills in prone, supine, sitting and standing -Birth - 18 mo -ID infants and toddlers w/ GM delay and evaluates GM maturation -Norm referenced

Describe the general path for the COP when getting ready to initiate gait:

-COP moves posteriolateral *towards swing limb* -COP then moves laterally towards the stance limb -COP lastly moves anteriorly towards the toes on what will be the stance limb

What strategies/mechanisms might one use to maintain postural control during perturbed stance?

-controlling forward and backward sway (and lateral) -feedback control -feedforward (anticipatory) control

What are common tension points, or places where the nerve doesn't move very well, in the body?

-C6 -*T6* (consistently reported in text) -L4 -Posterior knee -Anterior elbow

Bayley (BSID) - III: -what does it stand for? -what is assessed? -ages valid for? -purpose? -is it criterion or norm referenced? -when is this commonly used?

-Bayley Scales of Infant and Toddler Development, 3rd ed. -assesses adaptive behavior, cognitive language, GM and FM fxn, and socio-emotional development -1-42 mo (3.5 yr) -ID developmental delay -Norm -commonly used in early intervention and research

BOT-2: -what does it stand for? -ages valid for? -is it criterion or norm referenced? -what does it test? -subscales? -purpose?

-Bruininks-Oseretsky Test of Motor Proficiency 2nd ed -4-21 yrs -Norm -test of FM and GM skills -subscales for running, speed & agility, balance, BL coordination, strength, UE coordination, response speed, visual-motor control, and UE speed and dexterity -Measure higher-level motor skills and evaluate motor training programs

When would you screen for radial N involvement in a patient's condition? (4)

-DeQuervain's tenosynovitis -*supinator mm (tennis elbow)* -post humerus fx -C5-6 nerve root

"Callahan" style treatment for neural tension: intensity, duration, repetitions

-Educate first-- pt need to know what you're doing -Low Intensity-- want to inc axoplasm flow & dec pain, high force won't do that, stop at first sensation -Low Duration-- need constant blood, stretch squeezes blood away, only 1 sec duration -High Reps--the more the nerve is moved, the more fluid mvmt created, the better, 25-50 reps 3x/day

What would be found during an examination of a patient with cuboid syndrome?

-FF valgus and pronated foot -unstable midtarsal joint due to pronated foot -tight fibularis longus -pain reproduced during terminal stance at onset of heel rise -decreased ROM

In which direction is the superior/dorsal aspect of the talus convex and concave?

-convex anterolateral -concave mediolateral

Large myelinated type 1b have _________(2) receptors and respond to _________(2) stimulus

-GTO/ ligament receptors -tendon/ligament tension stimulus

GMFM: -What does it stand for? -ages valid for? -populations used for? -criterion/norm referenced? -purpose? -commonly used to determine what?

-Gross Motor Function Measure -5mo - 16 yrs -children w/ CP (66 & 88) and DS (88) -criterion -assess GM function -commonly used to determine quality of movement in children w/ CP

When would you screen for ulnar N involvement in a patient's condition? (2)

-Guyon's canal -cubital tunnel

Which neural structures contribute to postural control? (hint: not vision, vestibular, somatosensory)

-Higher Level Planning-- frontal and motor cortices -Coordination-- brain stem, spinal networks coordinating muscle response synergies -Generation-- motor neurons and muscles

Describe infant reaching in a *8-9 month* old

-coordinated/complementary bimanual reaching (transfers objects) -controlled release

What would happen if a K1 pt used a prosthetic foot with a rigid ankle & stiff heel? How would these forces be resisted within the prosthetic socket?

-Inc knee flexion moment -Could be unstable, esp w/ weak knee extensors -Residual tibia extends into the socket & creates *localized* pressures

What are some signs of ankylosing spondylitis? What are some systemic signs of it?

-LB pain -morning stiffness -pain lying down -rigid spine -systemic signs: fatigue, fever, weight loss, iritis (inflamm of eye)

Define: longitudinal mobilization

-MT term -manual traction

How do you differentiate a SLR test to test the following nerves: -peroneal N -sural N -tibial N

-P: PF + inversion -S: DF + inversion -T: DF + eversion

What conditions should be included in a differential diagnosis for calcaneal fracture?

-PF -retrocalcaneal bursitis -tarsal tunnel syndrome -calcaneal spur

Which specific movements does a multi-axial prosthetic foot allow?

-PF & DF -inversion & eversion -IR and ER

What kind of therapeutic exercises should be utilized during the acute phase of healing?

-PROM -AAROM (low reps) -GE positions -exercises for joints "above and below" -single joint, single plane exercises -isometrics

When would you screen for tibial N involvement in a patient's condition? (4)

-plantar fasciitis -heel spurs -recurrent HS injury -piriformis (bc splits off sciatic N)

PDMS-2: -What does it stand for? -ages valid for? -is it criterion or norm referenced? -what is assessed? -subtests? -purpose? -when is this commonly used?

-Peabody Developmental Motor Scales, 2nd ed -Birth - 6 yrs -Norm -Assessment of GM and FM skills -subtests: reflexes, stationary, locomotion, object manip, grasping and visual-motor integration -Estimate motor competence -Commonly used in early intervention services to determine eligibility for services

PEDI: -what does it stand for? -ages valid for? -is it criterion or norm referenced? -how is info collected/ what is collected?

-Pediatric Evaluation of Disability Inventory -6 mo - 7.5 yrs -Norm -parent interview to determine self-care (grooming, dressing, bathing and toileting), mobility (including transfers), social function (communication, social interaction, household and community tasks) and need for modifications and assistance

What are the 6 types of therapeutic exercise?

-ROM -flexibility/stretching -resistance exercise -coordination -balance/neuromuscular control -functional/specific activities

DDD/DJD & Traction: -Rationale -Treatment Time (static or intermittent) -Position during Treatment

-Rationale: dec intradiscal pressure may benefit nutritional state of nucleus pulposus -Time: shorter hold-rest periods of intermittent -Position: either prone or supine for lumbar

Muscle Spasm & Traction: -Rationale

-Rationale: decompress painful joint structures, if pain is relieved by traction, spasm will be relieved as a result of relaxation of nociceptive reflexes

Joint Hypomobility & Traction: -Rationale -Treatment Time -Position

-Rationale: form of mobilization that involves passive mvmt of joints -Time: short hold-rest periods of intermittent -Position: either prone or supine for lumbar

Facet Impingement & Traction: -Rationale

-Rationale: release restriction of facet joints (another option besides manual mobilization & manipulation techniques)

HNP & Traction: -Rationale -HNP-Protrusion Static or Intermittent -Treatment Time

-Rationale: separates vertebra & leads to dec pressure at disc space w/ resulting suction force -HNP-Protrusion: sustained traction or w/ longer hold-rest periods, 60 sec hold, 20 sec rest, are more effective -Time: short, 5-10 min

What are characteristics of a total valgus foot in NWB?

-STJ neutral -all metatarsal heads are everted -may be due to plantarflexed 1st ray

What are characteristics of calcaneal varus in a NWB position? (3)

-STJ neutral -inverted calcaneus -may/not be combined with tibial varum

What are characteristics of forefoot varus in a NWB position? (3)

-STJ neutral -vertical calcaneus -forefoot inverted

What happens to the foot positioning of calcaneal varus when in weight-bearing? (2)

-STJ pronated -calcaneus vertical

What are characteristics of forefoot varus when in weight-bearing? (3)

-STJ pronated -everted calcaneus -forefoot flat on surface

What are characteristics of a total valgus foot in WB?

-STJ supinated -inverted calcaneus -forefoot stable (but not necessarily totally flat)

SFA: -What does it stand for? -what population? -is it criterion or norm referenced? -what does it assess? -how is info collected and about what?

-School Function Assessment -children w/ disabilities K-6 -criterion -assess activity and function in school setting -judgement-based interview to determine child's participation in all aspects of school environment

How do you decide b/w static & intermittent traction treatments for *lumbar & cervical* spine?

-Static: ---sustained pull ---consider w/ mod severe & irritable conditions Intermittent: ---rest time & hold time ---consider w/ less severe & irritable conditions

Infanib: -what does it stand for? -who might it be used for? ages? -What does it test? -is it criterion or norm referenced?

-The infant neurological international battery -1-18 mo; at risk infants including premies -Tests spasticity, vestibular fxn, head and trunk control, french angles, and legs (determines normal/abnormal neuromotor fxn) -Criterion

What are the MOI for chronic exertional compartment syndrome?

-consistent vigorous exercise -unknown

How is endurance defined?

-ability of muscle to contract repeatedly against a load, generate and sustain tension and resist *fatigue* over an extended period of time

What are 3 theories for the cause of CRPS?

-abnormal activity of the SNS -gate control theory (imbalance between normal receptors and nociceptors) -reflex muscle spasm *all deal with abnormalities in the sympathetic NS*

What are some other conditions that should be included in a differential diagnosis for achilles tendinopathy?

-achilles bursitis -ankle OA -partial achilles rupture -gastrocnemius strain

In a differential diagnosis for an adult, what are some conditions of the foot/ankle that you might consider? (5)

-achilles tendonitis/tendinosis -plantar fascitis -ligament sprains -RA -gout

What are some symptoms of osteoarthritis? (5) (1 notable symptom)

-aching pain w/ weight-bearing -limited ROM -pain limited recreational activities -difficulty walking -*bony enlargement of DIP joints*

Precautions: traction

-acute strains & sprains -inflam conditions that may be aggravated -joint instability -pregnancy -osteoporosis -hiatal hernia -claustrophobia

What are the 3 main functions of the ankle?

-adapt to ground surface -shock absorbing (pronation) -a rigid lever to propel the body (supination late in gait cycle)

When will we use neurodynamics in the clinic?

-adhesive capsulitis -severe IVD injury -hamstring strain -PF -whiplash -immobilized post-op shoulder -hip flexor tendon strain -leg compartment syndrome -medial epicondylitis -acute facet syndrome -CMC joint arthritis -poor sleeping position

What are some trophic skin changes that take place in stage II CRPS?

-affected limb is edematous and cool -hair loss -cracked, brittle nails -motor changes

When tissues are damaged, the chemicals released into tissues have what effects? -bind to? -activate? -release? -result?

-binding of substance to specific receptor -activation of ion channels for depolarization -activation of other receptors and intracellular messenger systems -release of neuropeptides from neurons -vasodilation of vessels and edema

What are some treatment techniques that can be used in PT for CRPS?

-biofeedback -imagery? -behavioral modification -desensitization -edema control -TENS -soft tissue mobilization -thoracic mobilization (sympathetic input) -exercises for ROM and activity (not for strengthening) -mirror therapy (trick your brain)

What are reticular veins?

-bluish discoloration -1-3 mm diameter -dilation of surface vein

How can pain be documented subjectively? (3)

-body chart (location and description) -intensity of pain -behavior of pain (over 24 hr period)

What should be included in a differential diagnosis for plantar fasciitis?

-bone spurs (rule in/out w/ X-Ray) -achilles tendinitis (if pain behind heel more likely than PF)

Which neural systems/structures semi-automatically control muscle responses and coordination for postural control?

-brainstem -spinal networks (coordinate muscle response synergies)

What is the purpose of the inflammatory phase of healing? (3)

-bring inflam. cells to wound site -control bacteria -control debris

What is a head halter?

-cervical traction -hangs from ceiling -pad under pt chin

Describe grasping skills in a 4 year old child?

-children begin to use an anticipatory control strategy for grasp (grip and load force become positively correlated, less overshooting)

Considerations for the elderly in PT treatment of pain (read):

-chronic pain common in older persons -1/5 of all elderly take analgesics regularly -45% of elderly that take pain meds have been seen by 3+ Drs in past 5 yrs -45-80% of nursing home patients have substantial pain that is undertreated -follow Americal Geriatrics Society Clinical Practice Guidelines for management of chronic pain in elderly

Describe grasping skills in a 4-5 month old infant?

-infants begin to use vision to correct hand trajectory, palmar grasp emerges

How is a percutaneous transluminal coronary angioplasty (PTCA) performed? (type of CV revascularization procedure)

-lesion penetrated -balloon placed at distal aspect of catheter & inflated -press central portion of lesion outward against wall of artery -if needed, can start w/ smaller catheters & progress to larger ones to increase the lumen size

In a differential diagnosis for athletes, what are some conditions of the foot/ankle that you might consider? (3)

-ligament sprains -stress fractures -muscle strains

If a patient has lateral ankle pain, what are they *most likely* to have? (2)

-ligamentous injury (ATFL, CFL) -cuboid subluxation

What are 3 qualities of endurance exercise?

-low intensity contractions -large # of reps -prolonged time period

What might you do to help heal after DOMS?

-low load and high reps will assist in healing -proper hydration and nutrition

What do rhonchi sound like? When in the breathing pattern are they heard?

-low-pitched, coarse, rattling sounds -produced during expiration

Based on symptoms that patients may be feeling in the sub-acute phase of healing, what should goals of therapy include?

-maintain/improve mobility/ROM -gradually strengthen -improve proprioception -improve functional capabilities -attention to "flare ups"

Varicosities present in what percent of males and females in Western populations?

-males: 10-15% -females: 20-25%

What are signs/symptoms of a heel spur?

-may have no symptoms (50% of ppl don't) -pain

Large myelinated type 1a fibers have ________ receptors and respond to _________ stimulus

-muscle spindle receptors -muscle stretch stimulus

Medium myelinated type II fibers have ________ receptors and respond to ________ stimulus

-muscle spindle receptors -muscle stretch stimulus

Describe a 3rd degree muscle tear:

-muscle unable to contract -great deal of internal bleeding

Which neural systems help with the generation of forces to maintain postural control?

-muscles -motor neurons

What is wound contracture?

-myofibroblasts are at the wound edges -> -epithelialization begins immediately -> -basal cells at wound edge elongate and migrate across the wound surface -> -MMP expresses integrins secrete proteolytic enzymes -> -remodeling occurs

What causes excessive lordosis? (3)

-obesity -discitis (rare, inflamm of IV discs) -slipping forward of vertebrae

Some American Geriatrics Society Clinical Practice Guideline points (read):

-on initial presentation, older persons should be assessed for pain -persistent pain should be recognized as significant problem -variety of terms should be used to screen older adults for pain -for those w/ cognitive or language impairments, nonverbal pain behavior and information from a caregiver should be sought -thorough analgesic medication history should be collected -physical exam should include functional tests -pain reassessed frequently -patient education is important part of the intervention -when treating a geriatric patient, the PT should first assume that the pain has a physiological basis until they are sure otherwise

What does the skin around a wound due to arterial insufficiency look like? (3)

-thin, dry, shiny, smooth skin -absence of hair -cool to touch

When initiating gait, a steady velocity is typically reached within ______ steps

1-3 steps

What are the functions of the following cortical structures: 1. primary sensory cortex 2. secondary sensory cortex 3. sensory association cortex

1. *registers* receptor activation ('maps') 2. *processes* information from that sensory system alone 3. *integrates* related activity of different sensory systems

In a posterolateral thoracotomy... 1. what position is the patient in? 2. where is the incision? 3. nerve to avoid? 4. potential shoulder injuries?

1. 1/4 turn from prone to elevate operative side, uppermost arm elevated forward, flexed at elbow & behind head 2. downward b/w T4 & scapula, serratus anterior divided close to origin to preserve function 3. avoid long thoracic N, if it is nicked, may notice scapular winging after surgery that wasn't there before 4. may have pain or early frozen shoulder sx afterwards

What are some specific examples of energy storage & return prosthetic feet for K3 users? (5)

1. Energy Storing foot (looks like a SACH w/ hardware in it) 2. Dynamic Response w/ multi-axial ankle unit 3. "Flex Foot" (long spring) 4. "Flex Walk" (short spring) 5. Shank Foot (powerful)

Which nerve fibers w/in a muscle spindle detect 1. quick & tonic stretches of spindles and 2. tonic stretches of spindles? ***

1. Ia fibers 2. II fibers allows us to detect if something is happening, fast, slow or not moving at all

How does an energy storage & return prosthetic foot work?

1. PF on initial contact 2. Internal keel structure absorbs energy during mid & terminal stance 3. Releases energy at pre-swing to provide smoother gait

Which muscles are activated and in what order in a hip strategy to maintain postural control when the body sways forward in response to a perturbation?

1. abdominals fire (produce trunk flexion) 2. quads fire 3. paraspinals fire MUCH later (200 ms)

Which types of forces are *vertical shock absorbers* for prosthetic feet good at reducing? Which forces are they good at improving?

1. impact forces during stance 2. sheer forces w/in the socket 3. improves prosthetic rotational forces at heel strike

Which muscles are activated and in what order in an ankle strategy to maintain postural control when the body sways backward in response to a perturbation?

1. anterior tib fires (produce DF motion & slow backwards movement) 2. quads fire 3. abdominals fire (keep hips flexed to keep trunk upright)

What are the 4 major locations for heart auscultation? (name what you're auscultating)

1. aortic 2. pulmonary 3. tricuspid 4. mitral

Nerve pain generators: (read)

1. blood flow 2. axoplasmic flow 3. double crush injury 4. connective tissue 5. abnormal impulse generating sites (AIGS) 6. substance P 7. surrounding tissue injury

What are the functions of a *ankle* rocker in a prosthetic foot? (2)

1. to provide a "stable tripod foot flat" posture- heel, 1st & 5th MT 2. maintain forward progression

What are the 3 types of somatosensory pathways? Give examples of each type

1. conscious relay (dorsal column & spinothalamic) 2. divergent (spinoreticular, spinolimbic & spinomesencephalic) 3. unconscious relay (spinocerebellar)

What are the functions of a *heel* rocker in a prosthetic foot? (4)

1. control PF 2. shock absorption 3. dec knee flexion moment 4. maintain forward progression

What do each of the 2 axons of peripheral sensory neurons do?

1. distal axon: carries info from receptor to cell body 2. proximal axon: carries info from cell body to SC or brainstem

List the 5 D's for when to stop traction:

1. drop attack 2. dizziness 3. diplopia 4. dysarthria 5. dysphagia

What are the main functions of the foot & ankle joints? (3) (what does a prosthetic foot/ankle need to be able to do?)

1. force attenuation 2. ground accomodation 3. rigid lever arm absorbs shock on heel strike, adapts to ground surface in mid-stance and acts as a rigid lever for push off

What are the functions of a *forefoot* rocker in a prosthetic foot? (3)

1. forefoot locks & becomes rigid 2. heel rise against a rigid forefoot lever 3. energy storage in the PF

Which muscles are activated and in what order in an ankle strategy to maintain postural control when the body sways forward in response to a perturbation?

1. gastroc/soleus complex fires (produce PF motion & slow forward movement) 2. hamstrings contract 3. paraspinals contract (keep knees & hips extended to keep trunk upright)

What are the 4 phases of healing?

1. hemostasis 2. inflammatory 3. proliferation 4. remodeling

Distributive Justice issues w/ terminal diseases (read)

1. how much *resources* should be invested in a terminally ill person? 2. how much *access to technology* should terminally ill pts have? 3. should experimental treatments be used on them?

What are the 3 steps to the Cobb Method of angle measurement in scoliosis x-rays?

1. identify upper and lower ends of vertebrae 2. draw lines extending along vertebral borders 3. measure Cobb Angle directly or geometrically

What are some possible explanations of suicide from an outsider's perspective? (4)

1. insane act: psych perspective 2. evil act: religious perspective 3. socially disgraceful act 4. autonomous act

What are the 3 layers of the venous wall?

1. intima: excretes anti-thrombogenics 2. media: smooth muscle 3. adventitia: thick outer layer

Describe the physical findings for pain with all 3 grades of ankle sprain?

1. minimal 2. moderate 3. severe

Describe the physical findings for swelling with all 3 grades of ankle sprain?

1. minimal 2. moderate 3. severe

Describe the physical findings for loss of function with all 3 grades of ankle sprain?

1. minimal 2. some 3. great

Describe physical findings for difficulty bearing weight with all 3 grades of ankle sprain?

1. no 2. usually 3. almost always

What are two ways of measuring pain quality?

1. pain intensity (numeric scale or quantitative threshold measure) 2. pain description (sharp/dull, constant/intermittent)

Somatosensory info from skin:

1. touch (pressure and vibration) 2. pain 3. temperature

What nerve might have problems if a person sleeps in the following positions: 1. hands behind head 2. arm around sleeping partner 3. prone w/ head turned to side 4. palms resting on ASIS

1. ulnar N 2. median N 3. radial N 4. ulnar N

Describe the physical findings for ecchymosis (discoloration under the skin from bleeding... a.k.a. bruising) with all 3 grades of ankle sprain?

1. usually not 2. frequently 3. yes

Averages for a *normal* young adult: Velocity Step cadence/frequency Step length

1.46 m/sec (3.26 mph) 1.9 steps/sec (112.5 steps/min) 76.3 cm (30.05 in)

Somatosensory info from MSK:

1. proprioception: -(stretch of muscles, tension on tendons, position of joints, and deep vibration) -(static joint position and kinesthetic sense) 2. pain

Effects of Spinal Traction (6)

1. separates v. bodies 2. distracts & glides facet joints 3. widens intervertebral foramen 4. tenses ligaments 5. straightens spinal curves 6. stretches spinal musculature

What are the 5 layers of the epidermis?

1. stratum corneum 2. stratum lucidem 3. stratum granulosum 4. stratum spinosum 5. stratum basale "cows like good sleep blankets"

In what order of activities do you mobilize a patient post-thoracic surgery?

1. supine to turning in bed 2. sitting over the bed 3. standing 4. sitting in chair 5. walking monitor VS during each transition

What is the open packed position for the talocrural joint?

10 deg plantar flexion, midway between inversion and eversion

How often do we typically visually sample our terrain during locomotion? When might this change? And by how much?

10% of the time increases to about 30% of the time with uneven surfaces

How many intercostal nerves do we have?

11, the subcostal nerve goes under the 12th rib

When we bend forward, the spinal canal lengthens ______ cm. Why doesn't this cause spinal cord injuries in all of us?

7-10 cm bc the nerves are able to accommodate (move & stretch) in response to the lengthening of the spinal canal

When a wound closes, the tissue will have tensile strength equal to ____ % of normal

15%

How much fluid and white blood cells does the thoracic duct return to the circulatory system every day?

About 2 liters

How far inferiorly does the diaphragm move during heavy breathing?

About 7 cm (5L of air), at rest the diaphragm is only moving 1-2 cm

Hemothorax

Accumulation of blood in the pleural space, usually caused by an injury to an intercostal, or internal thoracic vessel

If a scoliotic curve is less than _____ degrees in an adolescent, it won't be treated

20 check every 6 months

An example of nerve accommodation is how the median N has to become ____ % longer from the position of wrist & elbow flexion to wrist & elbow extension

20%

Describe the physical findings for ligaments with all 3 grades of ankle sprain?

1: no tear 2: partial tear 3: complete tear

Peripheral sensory neurons have _____ (#) axons

2

There have been ____ identified "turning strategies" that people use. What determines which one is used? Name them.

2 depends on which foot was forward and the direction of the turn Spin-turn Step-turn

How many arteries and nerves does the thigh have?

2 arteries 3 nerves

At what age does a child develop the following object manipulation skill? -rotation of held objects -translation of grasped objects -vibration (shaking) of held objects -bilateral hold of 2 objects -2-handed hold of single object -hand-to-hand transfer of object -coordinated action w/ single object when one hand holds the object while the other manipulates (bangs) it -coordinated action w/ 2 blocks (striking both blocks together) -deformation of objects -instrumental sequential actions

2 months 3 months 4 months 4.5 months 4.5 months 4.5 - 6 months 5 - 6.5 months 6 - 8.5 months 7 - 8.5 months 7.5 - 9.5 months

What is a "usual" or normal frequency?

2-3 times per week highly trained individuals may have up to 6 times per week

How does an infant's ability to track an object change at 3 months? 5 months?

3 months: tract objects well 5 months: use head and eyes together

How many arteries and nerves does the leg have?

3 nerves: superficial fibular, deep fibular, and tibial 3 arteries: anterior tibial, posterior tibial, and fibular

Is axoplasm thinner or thicker than water?

3-5x thicker

The nervous system makes up 7% of your total body weight, yet demands ____ % of your cardiac output (blood)

25%

What is defined as a grade 2 ankle sprain? Can the pt WB? How long off activity?

26-75% tearing, moderate pain and swelling, loss of ROM and slight instability. Patient may only manage partial WB w/ crutches. 2-6 wks off from activity

With shoulder abduction above 60 degrees, how does the scapula move?

2:1 ratio humerus to scapula AC joint upwardly rotates 30 degrees

How many grades are there for an ankle sprain?

3

When referring to DAPRE, the adjusted working weight is based on the max # of reps possible in set _____

3

How many stages of CRPS are there? Is this condition progressive from one stage to another?

3 no

Traditionally, pain is considered a _____ (#) neuron system

3 1st, 2nd and 3rd order neurons

At what angle is a scoliotic curve braced in an adolescent?

30 deg

What does the median nerve innervate?

Anterior forearm and a little bit of the hand (8 muscles): flexors, pronators, palmaris longus, some thenar and lumbricals

How does immobilization affect the nerve after: -3 weeks -6 weeks -6-16 weeks

3: degenerative changes in myelin 6: collagen deposits in the endoneurium 6-16: dec fiber diameter of myelinated fibers

How many cords are in the brachial plexus?

3: lateral, posterior, and medial

How many trunks are in the brachial plexus?

3: superior, inferior, middle

Reaching skills that appear in the second phase of development (infants) show up between what ages?

4 months to 9months

When does the proliferation phase of healing occur?

4-21 days post injury

How many divisions are in the brachial plexus?

6: each trunk divides into anterior and posterior

The epidermis regenerates completely every ___ to ___ days

45 to 75

What compartments do the anterior and posterior tibial arteries run in?

Anterior tibial A: anterior Posterior tibial A: posterior

When does DOMS occur?

48-72 hrs after exercise

What are the following Brodmann's areas? 4 5,7 6 3, 1, 2 17 39, 40 40 18, 19 41 42/22

4: M1 5,7: 2nd somatosensory 6: PMA 3, 1, 2: primary somatosensory 17: primary visual 39, 40: somatosensory association area 40: vestibular 18, 19: 2nd visual 41: primary auditory 42, 22: 2nd auditory

How many terminal branches do you end up with in the brachial plexus?

5

What are the 3 aspects of resting position of the scapulothoracic joint? (upward rotation, IR and anterior tilt)

5-10 degrees upward rotation 35 degrees internal rotation 10 degrees anterior tilt

How many roots make up the brachial plexus?

5: C5, C6, C7, C8, T1 (when he says roots he does not mean spinal roots, they are ventral rami)

What is DAPRE based on?

6 RM

Ischemia for ___ hours can produce contractures

6 hours

The veins store ___ % of the total blood volume

60%

Normal human gait: ______% of a cycle is spent in stance ______% of a cycle is spent in swing Of the _____% of a cycle spent in stance, _______% of that time is spent in double limb stance

60% in stance 40% in swing of the 60% in stance -> 20% in double stance

What percent of calcanues fractures are displaced and intra-articular?

60-75%

With wrist extension, what is the normal ROM? How much of this motion comes from the radiocarpal vs. midcarpal joints?

70 is normal 45 from RC 25 from MC

During the remodeling phase of healing, the tissue will not exceed ___ to ___ % tensile strength of the original.

70-80%

Nerves have only so much accommodation before they reach their critical value, then they can go an extra ___ % of their normal length before:

8% blood flow is cut off to the nerve

With wrist flexion, what is the normal ROM? How much of this motion comes from the radiocarpal vs. midcarpal joints?

80 is normal 30 from RC 50 from MC

What are the results of Erb's Palsy? What do you lose function of?

Appearance: "waiter's tip position" injured limb hangs by the side in medial rotation, loss of sensation on lateral aspect of upper limb, also causes muscle paralysis of deltoid, bicep, brachialis, and brachioradialis

Reaching in childhood (3rd phase of development for reaching) spans what time frame of a child's life?

9 months - 11 years

The hand is involved in _______% of UE activities. What percent of UE activities are the following structures involved in? -thumb -index finger -long finger -ring finger -little finger

90% thumb = 50% index = 20% long finger = 20% ring finger = 10% little finger = 5%

Implantable cardioverter defibrillators are beneficial for patient's with a left ventricle ejection fraction of:

</= 30%

Which artery does the left recurrent laryngeal nerve run under?

Arch of the aorta just lateral to the ligamentum arteriosus

At what vertebral level does the trachea branch off into the right and left primary bronchus?

Around T4-T5

What nerves/arteries are in the anterior compartment of the leg?

Artery: anterior tibial Nerve: deep fibular

What are the 3 parts of the thoracic aorta?

Ascending aorta, arch of the aorta, and descending aorta

Where did the lungs develop from?

At 4 weeks the respiratory diverticulum (lung bud) develops off of the ventral wall of the foregut.

If you damage the surgical neck of the humerus, what nerve are you also likely to damage?

Axillary Nerve

What vessel do the cords of the brachial plexus wrap around?

Axillary artery

For a K1 pt, why is a SACH prosthesis helpful?

A compressive heel dec the knee flexion moment by shifting the GRF anteriorly

What are the two types of nociceptors?

A-delta C fibers the different types help to distinguish between different types of pain (burning, stabbing, sharp, dull etc.)

Which type of nerve fibers are free nerve endings? What do they detect?

A-delta & C fibers detect pain, tissue damage & coarse touch

What are K levels?

A method of rating functional abilities & potential to ambulate

What is acute brachial plexus neuritis? What trunk of the brachial plexus does it involve? Is it a superior or inferior BP injury?

A neurological disorder of unknown cause, involves the superior trunk and severe pain around the shoulder. It is a superior brachial plexus injury

What is a footshell?

A plastic cover of a prosthetic foot, comes in different skin tones, comes with split toe options and is worn over a blade-style foot

For which contagious disease is it mandatory to report it to public authorities in every state?

AIDS

Carina of Trachea

A ridge that subdivides the trachea into right and left bronchi

For a K1 pt, why is a single axis foot prosthesis helpful?

A single axis foot has bumpers that add resistance to DF & PF It would dec the knee flexion moment by shifting the GRF anteriorly quicker

What pressure is the pleural fluid at and why is this important?

A slightly lower pressure than atmospheric pressure. This allows the lungs to remain "filled" within the pleural cavity

What do alpha motor neurons (AMN) innervate? What do gamma motor neurons (GMN) innervate?

AMN: skeletal muscles GMN: muscle fibers of the muscle spindles

The _____valves close when the pressure in the ventricles exceeds pressure in the atria The ______ valves close when the pressure in the aorta/pulmonary trunk exceeds pressure in respective ventricles

AV SL

Lingula

Adjacent to the costomediastinal recess, it is the caudal portion of the superior lobe of the left lung

What is her "adjusted age"? Anna DOB: 1/23/17 Assessment date: 1/25/18 Born at 36 wks GA Chronological age: 1 yr 2 days

Adjusted age: 11 months and 2 days

Where does the femoral A turn into the poplieal A?

After it passes through the adductor canal

Forced Respiration: muscles used for inspiration and expiration

All of the muscles from quiet respiration plus... Inspiration: SCM, scalene, levator costarum, serratus posterior superior Expiration: rectus abdominis, obliques, int intercostal, serratus posterior inferior, transversus thoracis

What is a tibialis anterior strain?

Also called shin splints It is microtrauma to tibialis anterior (small tears), which causes pain in ant compartment, edema, inflammation, and increased pressure

What is Klumpke's Palsy?

An injury to the inferior part of the brachial plexus, that results in a "clawhand": you can only flex the 1st and 2nd digit and the rest just partially

What is Backpacker's Palsy and what causes it?

An injury to the superior part of brachial plexus. A micro injury of the superior trunk due to carrying a heavy backpack.

In a single axis foot, which muscles do the anterior & posterior bumpers take the place of?

Ant: eccentric PF Post: eccentric DF

Do the phrenic nerves run anterior or posterior to the root of the lungs to reach the diaphragm?***

Anterior

What are the compartments of the leg?

Anterior Posterior Lateral

Where are pulmonary veins located on the hilum?

Anterior and inferior

Which scalene muscles does the brachial plexus travel between?

Anterior and middle

What forms the medial cord?

Anterior division of the inferior trunk

What forms the lateral cord?

Anterior divisions of the superior and middle trunks

Bronchopulmonary Segments

There are 10 in each lung and include bronchi and pulmonary arteries. Pulmonary veins drain a segment near by.

Where is the bursa located that is involved in calcaneal bursitis?

Between the cancaneal tendon and calcaneus

Does the phrenic nerve carry sensory or motor fibers?

Both

Fissures of the lungs

Both have an oblique fissure, only the right lung has a horizontal fissure

Where does the thoracic duct receive lymph from?

Both sides of the thoracic cavity and abdomen

Which nerve(s) innervate the voice box?

Both the right and left recurrent laryngeal nerves

95% of cases of ________ occur in the anterior and lateral lower leg compartments

CECS

Vagus Nerve: what is the main type of fiber it contains and what areas does it supply?

CN X, major parasympathetic nerve supply to thorax and upper abdomen.

What are protective layers for the CNS? PNS?

CNS - dura, arachnoid, pia PNS - mesoneurium, epineurium, perineurium, endoneurium

Postural *stability* is obtained when the ______ is over the BOS

COM (because if the COM is over the BOS then the COP is somewhere in the middle of the BOS resulting in stability)

The relationship between the ______ and the _______ provides better insight into stability than either one of these terms alone

COM COP

What roots have fibers in the phrenic nerve?

C3-5

What spinal nerves does the phrenic nerve arise from?

C3-5

What roots have fibers in the upper subscapular nerve?

C5-6

What roots have fibers in the lateral cord?

C5-7

What roots have fibers in the lateral pectoral nerve?

C5-7

What roots have fibers in the long thoracic nerve?

C5-7

What roots have fibers in the posterior cord?

C5-T1

What roots have fibers in the lower subscapular nerve?

C6-7

What roots have fibers in the thoracodorsal nerve?

C6-7

What roots have fibers in the medial cord?

C8-T1

What roots have fibers in the medial cutaneous nerve of the arm?

C8-T1

What roots have fibers in the medial cutaneous nerve of the forearm?

C8-T1

What roots have fibers in the medial pectoral nerve?

C8-T1

Empyema

Condition where pus/fluid from infected tissue collects in a body cavity, most often in the pleural cavity (empyema thoracis), subcategory of hydrothorax

What does the musculocutaneous nerve innervate?

Coracobrachialis, biceps, brachialis

3 Surfaces of the Lungs

Costal Surface: contacts ribs, costal cartilage, and sternum. Mediastinal surface: mediastinal structures including V. bodies. Diaphragmatic Surface: convex dome to diaphragm

What does a mixed spinal nerve split into?

Dorsal and ventral rami

What do the anterior tibial artery and vein become in the foot?

Dorsalis pedis artery and vein

What is the function of the anterior compartment?

Dorsiflexion (extension) of foot

What area does the superficial fibular nerve supply sensation to?

Dorsum of foot

What happens if fluid or air is allowed in the pleural cavity?

Due to the negative pressure, the air/fluid will be drawn in and cause the lung to collapse towards the hilum = pneumothorax

Serous Fluid: how much fluid is there in the pleural cavity and what produces it?

There is a thin film of fluid (20 mL) produced by the mesothelium

How does excessive pronation affect gait?

ER of the tibia causes the rear foot and midfoot to pronate, this causes the forefoot to supinate which locks the bones to propel you forward during toe off

What is the general function of the muscles of the lateral compartment of the leg?

Eversion of foot

If popliteal lymph nodes are swollen, what do you need to check?

Examination of distal structures must be done to check for evidence of inflammation or disease

Hydrothorax/Pleural Effusion

Excessive accumulation of serous fluid in the pleural space, usually caused by congestive heart failure or infection

What is the saphenous nerve a continuation of?

Femoral N

What branches off of the posterior tibial artery?

Fibular artery

What muscles are in the lateral compartment of the leg?

Fibularis longus Fibularis brevis Fibularis tertius (only in some) These start lateral and insert medial = eversion

What 2 muscles run between the lateral malleolus and calcaneus and under the superior fibular retinaculum?

Fibularis longus and brevis

What is the difference b/w fine & coarse touch?

Fine: discriminative touch, what we typically think of Coarse: sensations like tickling or itching

What is the 2x2 rule for exercise progression?

If the patient can do 2 or more repetitions over the assigned repetitions for an exercise over 2 consecutive workouts: *increase load* *load increase* 5-10% current load

What are benefits of resistance exercise? (9)

Improvement/enhacement of: -*muscle performance* (strength, power, endurance) -connective tissue strength -*bone mineral density* -tissue remodeling (capacity of repair and healing) -*balance* -physical performance during ADL and recreational activities -changes in body comp (inc lean mass, dec fat) -*feeling of well-being* -*perception of disability and quality of life*

Thoracotomy

Incision into the chest

What happens with deep fibular nerve entrapment?

Increased pressure in the anterior compartment compresses this nerve (ski boot syndrome)

Postural control emerges from an interaction between what 3 things? Example of how each can impact postural control.

Individual -muscle strength, pain, ROM, spasticity and confidence Task -standing w/ a nearly empty cup of coffee vs. with a full cup of coffee Environment -walking outside on sunny day vs. windy and rainy day

Which lobe creates almost all of the posterior surface of the lungs?

Inferior Lobe

Pleurisy/Pleuritis: what is it, what causes it and what are the symptoms?

Inflammation of the pleural membrane which can lead to a pleural rub and adhesions of the visceral and parietal layers to each other. Causes can be bacterial, viral, or cancer. Symptoms include sharp stabbing pain upon deep inhalation & increased respiration rate

What is a brachial plexus block?

Injection of anesthesia between the SCM and clavicle. This is done during an upper limb operation. Have to be careful not to cause a pneumothorax or injecting into the vessels instead of the axillary sheath

Where is the aortic arch?

It lies behind the manubrium and in front of the trachea. It arches over the right pulmonary artery and left main bronchus. It also gives off 3 branches.

Where do the cords start in the brachial plexus?

Just below the clavicle

Where should the left vagus nerve be in relation to the arch of the aorta?

Just lateral to the aortic arch

What type of foot prosthesis would be recommended for a pt with a K level of 0?

K0 will be bed or chair restricted a prosthesis is *not* medically necessary

What type of foot prosthesis would be recommended for a pt with a K level of 1?

K1 will need a prosthesis for transfers & level, household ambulation *SACH or single axis*

What type of foot prosthesis would be recommended for a pt with a K level of 2?

K2 will be a limited, single speed community ambulator *flexible keel or multi-axial ankle/foot*

What type of foot prosthesis would be recommended for a pt with a K level of 3?

K3 will be a variable speed, community ambulator *energy storing, multi-axial/dynamic response, flexfoot, flexwalk*

Which K level do most children, active adults or athletes w/ an amputation fall under?

K4

Which K level has no movement limitations?

K4

Which hemisphere is dominant in communication for 94% of people?

L hemisphere

How does auditory agnosia vary depending on hemisphere damaged?

L: unable to distinguish language vs other sounds R: interferes with interpretation of environmental sounds

Describe a K level of 0:

Lack of ability or potential to ambulate or transfer safely w/ or w/out assistance A prosthesis does *not* enhance quality of life or mobility

What branches off of the lateral cord?

Lateral pectoral nerve

What are the 2 types of supplemental oxygen delivery?

Low-Flow Oxygen Delivery -delivered via nasal cannula -dec hypoxemia -dec intrapulmonary shunting High-Flow Oxygen Delivery -delivered via oxygen mask

What are the 5 terminal branches?

MARMU: musculocutaneous, axillary, radial, median, ulnar

What happens when you lock your knees?

Many of your LE muscles are at rest, so when you unlock your knees, they tend to buckle for a few seconds until the muscles recontract

What branches off of the medial cord?

Medial pectoral, medial cutaneous nerve of the arm, medial cutaneous nerve of the forearm

Which nerves wrap around the medial and lateral malleoli?

Medial: saphenous N Lateral: sural N

If you damage the distal end of the humerus, what nerve are you also likely to damage?

Median nerve

Which of the receptors for the A-beta fibers are primarily responsible for *superficial fine touch*? options: Meissner's, Pacinian, Ruffini's, Merkel's or hair follicles

Meissner's & Merkel's disks

Which scalene muscles does the long thoracic nerve travel between?

Middle and posterior

What branches does the popliteal A give off?

Multiple genicular branches

What roots have fibers in each of the terminal braches of the brachial plexus?

Musculocutaneous: C5-7 Axillary: C5-6 Radial: C5-T1 Median: C5-T1 Ulnar: C8-T1

What branches come off of the 6 divisions of the brachial plexus?

None

Pros & Cons of mandatory testing for contagious diseases

P: catch the disease early C: medical costs of testing & enforcing rules, discrimination for those who test positive

Pros & Cons of providing experimental treatments to terminally ill patients

P: freedom of choice (or is it desperation due to lack of options?) C: potentially dangerous, haven't been approved, lack of compliance Other: no legal obligation to provide these drugs to people outside of the study

What are some pros & cons of a single axis foot?

P: rapid foot flat C: inc maintenance, inc weight

Because of the included axis of the talocrural joint, plantarflexion is combined with __________ and dorsiflexion is combined with __________

PF = inversion DF = eversion

What are the AROM norms for the talocrural joint?

PF: 0-50 deg DF: 0-20 deg

What domains do we as PTs have a big role in assessing in pediatric clients? What other domains are important to assess that may be covered with an interprofessional team treating the pt?

PT domain: -motor/physical skills (fine/gross motor) Interprofessional domains: -cognitive ability -communication/language -adaptive skills (self-help/sufficiency) -social, emotional, and behavioral functioning -sensory processing -hearing

15-20% of diabetic ulcers are from:

PVD- peripheral vascular disease another 15-20% are from mixed causes

What does the lateral pectoral nerve innervate?

Pectoralis major

What does the medial pectoral nerve innervate?

Pectoralis major and minor

In a single axis foot, what compensation would you see if the posterior bumper was too stiff? What if the anterior bumper was too soft?

Post: knee flexion Ant: "drop off"- hip & knee flexion

What does the radial nerve innervate?

Posterior arm (tricep) and forearm (11 muscles: all the extensors, supinator

Which compartment of the leg has 2 supcompartments?

Posterior compartment has deep and superficial muscle groups

What does the popliteal artery turn into in the leg?

Posterior tibial artery

Disorders of nonverbal communication involve damage to which hemisphere?

R hemisphere (where non-dominant Broca's and Wernicke's areas are located)

The R lung has ___ lobes and the L lung has ___ lobes

R: 3 L: 2

Which blood cell is a major element of circulating blood that contains hemoglobin and transports oxygen?

RBC

What is a common method of determining resistance for exercise? What are 2 scales that can be used for this?

RM (rep max) DeLORME HOLTEN

If you damage the radial groove, what structures are you also likely to damage?

Radial nerve and deep arm vessels

Define: Raw Score and Percentage

Raw score: # of test items correct Percentage: passed items out of total measured

Pulmonary Plexus: what kind of innervation does it receive?

Receives both sympathetic (T1-5) and parasympathetic (vagus) innervation

What does cutaneous mean?

Sensation

What are the results of Backpacker's Palsy? (Which nerves are affected?)

Sensory deficits in the musculocutaneous and radial nerves. It may also cause muscle spasms

What effect do the sympathetic and parasympathetic NS have on the bronchi?

Sympathetic: bronchial dilation, reduced mucous secretion. Parasympathetic: bronchial constriction, increased mucous secretion, and bronchial vasodilation

Which type of energy storage & return prosthetic for a K3 user would be useful for a construction workerer or someone lifting a lot of weight?

Shank Foot also apparently good for a diabetic pt

What does the medial cutaneous nerve of the arm innervate?

Skin on medial side of arm and superior part of forearm

What does the medial cutaneous nerve of the forearm innervate?

Skin on medial side of forearm

What does SACH stand for?

Solid Ankle Cushion Heel

Do hemiazygos and accessory hemiazygos veins connect to the azygos vein?

Sometimes, if they do they would cross the midline on top of the V body to the azygos vein

Sub-phases: Stance Swing

Stance: -initial contact -loading -mid-stance -terminal stance (pre-swing) Swing: -initial swing -mid-swing -terminal swing

What divides the superior mediastinum from the rest of the mediastinum?

Sternal angle of Lewis

Name the 4 articulations that occur in the shoulder

Sternoclavicular Acromioclavicular Glenohumeral Scapulothoracic

What nerves does the superior trunk give off?

Subclavius and suprascapular nerve

What does the subclavius nerve innervate?

Subclavius muscle

What does the upper subscapular nerve innervate?

Subscapularis

What are common injuries to the inferior part of the brachial plexus? (C8-T1)

Sudden pull of the arm superiorly such as grasping a tree to stop a fall or during child birth resulting in Klumpske's palsy

What does the fibular nerve branch into?

Superficial fibular N Deep fibular N

What compartments do the superficial and deep fibular nerves run in?

Superficial fibular N: lateral Deep fibular N: anterior

Lobes of the Left Lung

Superior and inferior lobe

What does increased pressure in the compartments of the leg result in?

The compartments have limited space due to tight CT boundaries, so an increase in pressure due to infection, edema, etc. causes tissue and nerve injuries = compartment syndrome

Elastic Recoil of Lungs

The elastic fibers of the lungs are stretched during inhalation and the elastic recoil causes them to return to normal during exhalation. If the chest wall and muscles did not counter balance this elastic recoil, the lungs would naturally want to collapse.

What population commonly fractures the surgical neck of the humerus and how do they do it?

The elderly, caused by fall on to hand

Where is the esophagus in relation to the trachea?

The esophagus is immediately posterior to the trachea

After you pick your foot up off the ground, what muscle group makes sure your foot is level when you put it back down?

The everter muscles (fibularis longus and tertius)

Can a patient move their arm if they fracture the surgical neck of the humerus?

The fracture is stable due to surrounding ligaments, so the patient can still move the injured arm passively with little pain

What blood vessel(s) runs along with the phrenic nerve?

The pericardioaphrenic artery and vein

What does the esophagus connect?

The pharynx with the stomach

When you bend your knee, why do you not cut off blood flow in the popliteal A?

The popliteal fossa is fat filled so it cushions the artery, the genicular arteries also offer an alternative pathway

What forms the posterior cord?

The posterior division of all 3 trunks

Bucket Handle Effect

The ribs are raised to increase the lateral dimension of the thoracic cavity and slightly increase it ant/posteriorly, esp if SCM and scalene mm contract

Which bronchi are you more likely to aspirate something into? What part of that bronchus would a foreign body end up in?

The right bronchi because it is more aligned with the trachea. It would end up in the right inferior lobe bronchus.

Which main bronchus is larger?

The right main bronchus

Which posterior intercostal veins always drain into the azygos vein?

The right posterior intercostal veins, it sometimes gets the left as well

What do the right and left brachiocephalic veins form when the join?

The superior vena cava

Where does the azygos vein dump into?

The superior vena cava

What will never vary about the brachial plexus?

The terminal branches

Do ventral or dorsal rami make up the brachial plexus?

The ventral (anterior) rami of C5-T1 spinal nerves

What is a prefixed and postfixed brachial plexus?

These are both variations of what spinal nerves contribute to the brachial plexus. Prefixed: C4-C8 Postfixed: C6-T2

Why is it important to note that there are 2 different crossing points between the 3 muscles of the deep layer of the posterior compartment of the leg?

These spots may result in the muscles rubbing together and creating friction/problems

What kind of nerves are in the cardiac, pulmonary, and esophageal plexuses?

They are all mixed plexuses that have sympathetic and parasympathetic fibers

Are the phrenic nerves inside or outside of the fibrous pericardium?

They are external to the fibrous pericardium

Where are the pulmonary arteries?

They arise off of the pulmonary trunk which sits on top of the right ventricle

Pleura

Thin serous membrane (mesothelium) that forms a sack that surrounds each lung.

What does the sciatic nerve branch into?

Tibial N Common fibular N

What nerve runs in the posterior compartment of the leg?

Tibial nerve

What nerves run through the popliteal fosa?

Tibial, common fibular, and sural (cutaneous) NN

If you damage the medial epicondyle of the humerus, what nerve are you also likely to damage?

Ulnar nerve

Where is the brachial plexus in relation to the clavicle?

Underneath it

What branches off of the posterior cord?

Upper subscapular, thoracodorsal, and lower subscapular nerves

Standardized assessments should be both reliable and valid. Define each of these

Valid: measure what test is supposed to measure Reliable: produce consistent and repeatable results

Hemizygos Vein

Vein on the inferior aspects along the left side of the thoracic vertebrae

Accessory Hemiazygos Vein

Vein on the superior aspect of the left side of the thoracic vertebrae

What are the 2 covering surrounding the lungs?

Visceral and parietal pleura

Function: primary somatosensory cortical area

discriminates shape, texture or size of objects

How do the following sensory systems influence postural control? Visual Somatosensory Vestibular

Visual: important but not essential (may give us wrong info) Somatosensory: proprioceptive, cutaneous and joint receptors, very helpful in normal situations like standing on a foam pad instead of hard floor Vestibular: by itself it cannot provide a true picture of how the body is moving in space *Take away*: no single sense is always helpful, esp in isolation, but they work together to maintain postural control

Receptive, sensory, fluent aphasia all refer to different names for which condition?

Wernicke's aphasia

Pneumothorax: what is it, what causes it, and what are the symptoms?

When air/fluid is let into the pleural cavity and causes the lung to collapse. Cause: trauma or infection. Symptoms:chest pain, respiratory distress, and tachycardia

Chylothorax

When lymph suddenly appears in the pleural cavity, can be reintroduced to the body so you don't lose all the WBCs

What is the goal of chronic care & long term interventions?

a caring response & improve QOL (not a cure)

When is a tophus formed?

a few years after the first attack of gout

Stigma

a mark of disgrace associated w/ a particular circumstance, quality or person (Google, missed it in lecture)

What is a nociceptor?

a nerve fiber that responds to noxious stimuli

How does pressure cause ulcers?

a perpendicular force is exerted on a specific area which causes ischemia & hypoxia which leads to an ulcer

What are the most effective categories of therapeutic exercise for FAI?

balance training, proprioception and strengthening exercises

5 year olds use _______ reaching strategies

ballistic (lots of feedforward)

What are some other options for determining baseline for strength training? (read)

based on BW or intial exercise isokinetic hand dynamometry

What is the role of perioperative PT?

baseline.... -*hemodynamic response & VS* -*CP fitness* -cardiac/lung dysfunction -smoking history -neuromuscular dysfunction -effects of age, obesity, DM & compromised systems -body position, transfers, bed mobility, TherEx

Why is it important to know that the protective layers of the CNS & PNS are innervated?

bc inflam & ischemia in these connective tissues can cause symptoms (such as pain)

Why do neuropathic (diabetic) pressure ulcers often go unnoticed?

bc peripheral neuropathy alters sensation so pressure related trauma goes unnoticed as an ulcer forms

Why is it a good thing that both Ia and II nerve fibers have muscle spindle receptors?

bc we have different stimuli (quick stretch, slow stretch and static stretch) that we need to be able to detect from muscle spindles to know the position of our muscles

What are tests that can be performed to check for forefoot equinas?

calcaneus alignment and navicular drop

What is a heel spur?

calcium deposits on the calcaneus

How is velocity typically measured with gait?

calculated from a 10 meter walk

What is the most efficient venous pump in the body?

calf pump

Neuropathic (diabetic) pressure ulcers have _________________ edges

calloused

Define: auditory agnosia

cannot recognize sounds

With wrist glides for flexion and extension, the midcarpal joint involves what two bones against each other?

capitate moves on lunate

With wrist glides for radial and unlar deviation, the midcarpal joint involves what bones moving against each other?

capitate moves on lunate

Function: primary vestibular area

discriminates among head positions and head movements

Function: primary vestibular cortical area

discriminates among head positions and head movements

What is conduction aphasia?

damage to neurons that connect Wernicke's and Broca's areas

What are the 3 sources of pain in inflammation?

damaged cells secondary plasma leakage and lymphocyte migration nociceptors

As a task is learned there is a decrease in the relative importance of __________ input for postural control and an increase in reliance on _____________ input options: somatosensory, vision, vestibular

dec vision inc somatosensory

Venous valves ensure flow from superficial to __________ and from caudal to ___________

deep cranial

If you have a patient with a neuro pathology that caused them to lose their continuum of strategies to maintain postural control and makes them always revert to a stepping strategy, how can you have them work on this?

have them work on this beyond the typical perturbations: -reaching/stepping outside BOS -sit to stand transition -walking -walking on variable surfaces

Describe eye-head-hand coordination in a 2 month old:

head and arm movements are strongly coupled

Thermoreceptors respond to:

heat or cold

What gait deviations are associated with a rearfoot varus abnormality?

heel strike and weight acceptance with excessive pronation -inc tibial internal rotation/delayed tibial external rotation

Why is frequency an important part of exercise dosing?

helps avoid large microtraumas to the tissue

What is the purpose for understanding how complete lesions in animal brains effect their movement patterns and walking?

helps us understand the dysfunction we might see in our patients with varying lesions (remembering roles of higher centers in control of locomotion)

In which phase of healing does fibrin deposit and clot formation occur?

hemostasis phase

In which phase of healing does platelet aggregation occur?

hemostasis phase

Do blood vessels vasoconstrict or vasodilate during the hemostasis phase? What about the inflammatory phase?

hemostasis: vasoconstrict inflammatory: vasodilate

When would a calcaneal fracture be treated surgically?

ideal for intra articular fracrture (via ORIF) however, there is no gold standard for surgical approach for this

Why is step length measured with gait?

identifies asymmetry in gait which is not identified by many other measurements in gait

When does the hemostasis phase of healing occur?

immediately

Define: Broca's aphasia

impairments in speaking and writing

Where is the 1st order neuron located in a pain neuron system?

in the PNS- in the peripheral and visceral tissues

Where is the 2nd order neuron located in a pain neuron system?

in the SC- they then travel to the thalamus

Where is the 3rd order neuron located in a pain neuron system?

in the brain- they travel from the thalamus to various parts of the brain

Define: astereognosis

inability to identify objects by touch and manipulation

Define: apraxia

inability to perform a movement or sequence of movements despite intact sensation, motor output and cognition

Define: agnosia

inability to recognize objects using a specific sense (even though discriminative ability intact)

What is global aphasia?

inability to use language in any form cannot produce understandable speech, comprehend spoken language, speak fluently, read or write

Define: prosopagnosia

inability to visually identify people's faces (identify people through voice or mannerisms instead)

Define: visual agnosia

inability to visually recognize objects despite having intact vision

The causes of FAI are ________ and ____________

individual and multifactorial

When does an anterior roll and posterior glide happen with shoulder motions?

internal rotation flexion < 90 degrees horizontal adduction

AC joint motion may be involved with fine tuning of what shoulder motions?

internal/external rotation anterior/posterior tilting

Function: Wernicke's area (R hemisphere)

interpreting nonverbal signals (comprehension of spatial relationships - body schema/image - mental representation of how the body is anatomically arranged)

What are the two different classifications for calcaneal fractures? Which is more difficult to recover from?

intra-articular (more difficult to recover) extra-articular

What are the norm values for AROM of the subtalar joint?

inversion = 0-30 eversion = 0-10

What is plantar fasciitis?

involves inflammation of the plantar fascia (a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes) -tears in the tissue result in pain and inflammation

When does the remodeling phase of healing end?

it can continue for 1-2 years after injury until the wound reaches maturation

Criteria used to determine whether the decision to treat a patient with a contagious disease is a duty or an option:

it is a moral duty if the answer is yes to all of the following: -significant harm to pt if not assisted -intervention is directly related to preventing harm -care will probs prevent harm to pt -benefit to pt outweighs harm to provider -doesn't pose more than a minimal risk to HCP the principle of beneficence drives this duty

What is an abnormally rounded upper back called?

kyphosis

Which type of cell is derived from bone marrow and recognizes foreign invaders and rejects skin grafts?

langerhans cells (stratum spinosum)

Aphasia, alexia and agraphia are all types of _________ disorders

language

Ia, Ib and II nerve fibers are _____________, ___________ fibers. A-delta and C nerve fibers are ___________, _____________ fibers. options 1: large, medium, small options 2: myelinated, non-myelinated

large (1's), medium (II) myelinated small, myelinated (A-delta), non-myelinated (C)

Stability _______ change according to the task and individual characteristics The ______ and _______ of the COM influence stance

limits position and velocity

In which phase of healing does wound contraction occur?

listed under proliferation and remodeling phases

Function: secondary vestibular cortical area

lol doesn't exist silly

Is the team approach especially favorable in short or long term cases?

long term/chronic (2 camps: believers & doubters: to treat or not to treat?)

What is a significant inward curve at the low back called?

lordosis

What causes a Volkmann's Ischemic Contracture?

loss of blood supply to the forearm

What rest interval should you have for low, moderate and high intensity exercises?

low - less than 1 min moderate 2-3min high 4-5 min

What is the most common location of hemosiderin staining?

lower medial 1/3 of the leg

With wrist glides for flexion and extension, the radiocarpal joint involves the movement of what two bones against each other?

lunate moving on the radius

Which blood cell produces MMP's, functions best at low O2 tension and acidic pH tension?

macrophages (idk what that means)

What cells are involved in the proliferation phase of healing?

macrophages fibroblasts endothelial cells epithelial cells

Is osteomyelitis more common in males or females?

males

What population does ankylosing spondylitis usually affect?

males 20-40 yo runs in families

What do older adults commonly struggle with, or use adaptations for when climbing stairs when compared to young healthy adults?

older adults may not have HF strength required to clear step, also they may need to use vision for an extended period of time when climbing stairs to know if they're clearing the step safely (younger people may not look or may only look once and then their brain knows how high they need to step)

With SC elevation and depression, roll and glide happen in the _______ (same/opposite) direction

opposite

What would the origin of pain and the quality of pain be for a neurovascular injury?

origin: blood vessels quality: throbbing, pulsing, pounding *can migrate to different locations*

If you think you hear S3/S4 heart sounds, but aren't sure, what could you try to accentuate these sounds?

place pt in left lateral decubitus position

The acromioclavicular joint is a _______ joint. Describe the arthrokinematics of this joint.

plane joint no arthrokinematics

Function: area analogous to Broca's in opposite hemisphere

planning nonverbal commnication (emotional gestures, tone of voice; usually in the R hemisphere)

Heel spurs are often associated with what?

plantar fasciitis (spurs on sole/plantar area of heel achilles tendinitis (spurs on back of heel)

What cells are involved in the hemostasis phase of healing?

platelets

What is the smallest cell in the blood?

platelets

Drop-land jumping, lateral step ups, and diagonals are examples of what?

plyometric exercise

How do you monitor a CP patient's vital signs while performing gait activities?

portable telemetry unit to monitor BP, EKG & O2 sat

Which directions are the roll and glide for plantarflexion of the talocrural joint?

posterior roll anterior glide

With the SC joint, clavicular retraction involves a(n) _______ roll and a(n) ________ glide

posterior roll posterior glide

When initiating gait, the *first* movement of the center of pressure (COP) is in what direction?

posterior to lateral *toward* the swing limb

What may cause wheezes?

produced by constricted or partially obstructed airways

What is the current gold standard for 4 layer bandages?

profore

3 types of subcortcial white matter Function of each?

projection fibers -to/from cortex and subcortical structures and SC commissural fibers -connect homologous areas of R and L hemisphere association fibers -connect cortical regions within one hemisphere

In which phase of healing do capillary buds extend into the wound bed (angiogenesis)?

proliferation phase

In which phase of healing do endothelial cells fill the wound space creating capillaries with loose junctions and gaps causing an edematous look so capillaries look like small granules (granulation)?

proliferation phase

In which phase of healing does a wound defect fill with new tissue and the skin integrity is restored?

proliferation phase

How do you perform neural tension testing?

put the nerve on stretch and monitor pt response to see if sx are reproduced

In order for an older adult to *successfully* use reactive adaptation in response to a trip, what is needed?

quick reaction of HF of the swing leg and PF of the stance leg (often older adults don't have this required response reactively which is why this accounts for a lot of falls)

Wrist drop is a clinical sign of damage to which nerve?

radial nerve

Define: developmental quotient

ratio bw child's actual score based on developmental age achieved on the test and child's chronological age

Define: dysarthria

speech disorder due to paralysis, incoordination, or spasticity of muscles used for speaking

What are the three types of power grips?

spherical cylindrical hook

What areas of the body are typically affected by ankylosing spondylitis?

spine or spine & pelvis

An intact or ruptured serum-filled blister would be which stage of pressure ulcer?

stage 2

Chemoreceptors respond to:

substance released by cells

Does scoliosis affect the cervical, thoracic or lumbar areas?

thoracic & lumbar

When listening to S1 and S2, how do you know which sound is which?

time it w/ carotid pulse S1, pulse, S2

Why would a cardiac pacemaker be used for a patient?

to eliminate hemodynamic compromise d/t inadequate cardiac output Notes: it's a way to maintain Q so the brain doesn't have any loss of blood flow

What is the goal of immediate treatment of a Volkmann's Ischemic Contracture?

to re-establish circulation

A multi-axial prosthetic foot absorbs gait ___________ to reduce ___________ forces on the residual limb ***

torque shear

What is defined as a grade 3 ankle sprain? Can the pt WB? How long off activity?

total disruption of the ligament, severe pain and swelling, loss of ROM and instability present. Patient typically cannot WB. anywhere from 4-26 weeks off from full acitivity

What are the two main functions of the first order neurons?

transduction and transmission

How does stage II CRPS respond to treatment?

treatments can be effective but not as responsive as stage I CRPS

How should velocity of exercise be modified based on stage of healing?

velocity of contraction depends on the phase of the treatment, usually from slow to fast velocities

The lymphatic system returns fluid to the ___________ system from the LE's

venous

Difficulty with self-control characterized by impulsiveness indicates damage to which association cortex?

ventral and medial dorsal prefrontal association

Impaired emotional responses including empathy, embarrassment, guilt and regret, as well as inappropriate and risky behavior are indications of damage to which association cortex?

ventral and medial dorsal prefrontal association

How well does stage III CRPS respond to treatment?

very resistant to treatment

Diffuse, poorly localized pain are characteristics of _______ pain

visceral

What chart is a helpful tool for a PT to determine if pain location may be due to a visceral origin?

visceral referred pain pattern table

It is thought that our pts who are recovering from brain pathology rely more on _________ during early stages of recovery options: somatosensory, vision, vestibular

vision

In an infant <3 months old, reaching movements are ______ triggered

visually

To assist with MCP flexion of joints 2-5, you would perform what kind of glide?

volar

Describe a category I skin tear:

skin tears w/out tissue loss

Why do 30% of extrapulmonary malignant tumors metastasize to the lungs?

Because the lung capillary bed is the next capillary bed into which cells that leave the primary tumor will travel to via blood

T/F: post-thoracic surgery, patients are encouraged to reduce the amount of time they need to rest during exercise

False-- rest during this period is prescribed judiciously to help healing & recovery

What passes under the flexor retinaculum of the ankle?

Tom, Dick, artery, nerve, Harry each has its own synovial sheath

Pain that has a recent onset of less than 3 months, close link with the pain generator, not a learned response, objective findings that coincide with pain generator, high anxiety levels and pain that is protective and necessary are all characteristics of what type of pain?

acute

What are the two types of compartment syndrome?

acute compartment syndrome chronic exertional compartment syndrome

Is this an acute or chronic wound: -healing sequence is continuous and within the expected time frame -little to no complications -*can get overreaction in healing* such as hypertrophic or keloid scars

acute wound

If a lesion occurred somewhere in the brain that left an intact system in an animal, what would we still see with movement?

adaptable locomotor control system to meet goals of the animal in any environment

When in the stages of rehabilitation does periodization become relevant?

advanced stages of rehabilitation (used as limited base for injured athletes)

Finding & using appropriate long term care services is difficult for chronic patients. What can we do about this as HCPs?

advocate for the patient

What are risk factors for CECS?

age type of activity/exercise overtraining

What is the purpose of having more receptive fields in the periphery?

assists w/ fine motor skills Ex: writing w/ pen or manipulating small objects w/ hands

How do you relieve pain from venous dysfunction?

compression, rest and limb elevation

Funcion: primary auditory area

conscious discrimination of loudness and pitch of sounds

Where on the hand can you test for sensation loss resulting from damage to the medial nerve?

distal tip of 2nd finger

Where on the hand can you test for sensation loss resulting from damage to the ulnar nerve?

distal tip of 5th finger

What may bring DOMS on?

eccentric exercise or lack of preparation

What gait deviations are associated with a forefoot varus abnormality?

excessive mobility in midstance and propulsion (dec supination)

Define: standard scores

expressed in terms of deviations, used to express deviation or variations from the mean score of a group

How does the thoracic spine react with shoulder abduction between 60 and 180 degrees?

extends slightly

T/F: in normal gait, swing phase requires more energy than stance phase

false "swing phase doesn't require much energy expenditure"

T/F: 4/5 falls occur during stair ascent

false 4/5 occur during stair descent

T/F: both lungs have a horizontal and oblique fissure

false both lungs have an oblique fissure, only the R lung has a hortizontal fissure

T/F: criterion-referenced assessments are discriminative measures

false criterion-referenced assessments are evaluative measures

T/F: changes continue to be made between the ages of 9 months to 7 years

false, reaching changes very little in that time period

T/F: there is a single best prosthetic foot overall

false, there are only best prosthetics for an individual's needs

How do perceptual systems influence postural control?

gives the CNS an accurate picture of where the body is in space, and if we are stationary or moving, to know when and how to apply restoring forces can't make adjustments if we don't know where we are in space

What manual therapy might be included in the treatment of FAI?

grade III and IV mobilization when any hypomobility is detected

Which blood cell is a WBC with granules?

granulocyte (eosinophils, neutrophils, basophils)

How is strength defined?

greatest measurable force that can be exerted by a muscle or group of muscles to overcome resistance during a *single max effort*

What stimulates epithelial cell migration from dermal appendages and wound edges starting in the inflam. phase and continuing into the proliferative stage?

growth factors (released by macrophages, neutrophils and site of injury)

The inflammatory phase of healing provides:

hemostasis: vasoconstriction, platelet aggregatioon, thromboplastin, makes clot (confused, hemostasis comes before inflam. phase)

What would happen to a transfemoral amputee's gait if they were using an endoskeletal prosthesis and they got new shoes with a higher heel?

it would induce knee instability

Define: basal level

item preceding the first failed item

What are some symptoms of gout (gouty arthritis)?

joint: red, swollen & painful

Are the systemic effects more marked in the adult or juvenile form of rheumatoid arthritis?

juvenile

What happens in mild and severe forms of conduction aphasia?

mild: paraphrasia occurs (incoherence in arrangement of words) severe: speech and writing meaningless

CRPS is often _________ and attributed to psychological problems

misdiagnosed

Is traction alone likely to be successful?

nah

Where can you palpate the femoral N?

near inguinal ligament (Pro Tip: stay away from palpation w/ this nerve bc it's deep & a sensitive area, stick to nerve tension testing instead)

If you have decreased supination during gait, what will this affect?

need supination to create forward propulsion during gait, if foot is over pronated this will not happen correctly

Stage II CRPS follows what type of injury?

nerve injury

60-70% of diabetic ulcers are what specific type of ulcer?

neuropathic foot ulcers

What cells are involved in the inflammation phase of healing?

neutrophils macrophages

Rudimentary (pre-reaching) skills develop in children between what ages?

newborn (birth) to 3 months

What type of sleep is more helpful, or biologically restorative, to a patient who is trying to recover from thoracic surgery?

night sleep-- bc patient is often interrupted during the day, if you can avoid waking them up you should do this bc they are recovering

Do reticular veins and telangiectasis need to be treated?

not for health reasons, can be treated for cosmesis

What does it mean to say a wound was closed by tertiary intentions?

not very common, essentially a delayed primary intention. means it was left to heal by itself for a while and then eventually surgically closed

How is frequency defined in relation to exercise dosing?

number of exercise sessions per day or per week

What may cause rales (crackles)?

presence of fluid in the alveoli and the bronchioles

As we move, the __________ on the nerves increases and it slides along the adjacent tissue

pressure

Why would a carotid endarterectomy be done on a patient?

prevent a stroke d/t plaques (incision along ant border of SCM, scar left on lateral neck)

What is another name for the 1st order neuron in a pain neuron system?

primary afferent neuron

What are the different primary sensory areas? (4)

primary somatosensory primary auditory primary visual primary vestibular (have a primary area in the cortex for every sense except olfaction)

What are potential risks of auscultating a patient's lungs?

pt discomfort including: light-headedness, faintness from hyperventillation

Is the need for PT based on the patient's condition or needs?

pt needs-- dec mobility, strength, balance, etc.

____________ depends on the intensity/volume and it is critical to recuperate the acute effects of exercise?

rest interval

What causes arterial insufficiency which leads to wounds?

result of complete or partial arterial blockage limiting perfusion causing tissue necrosis/ulceration

What arthrokinematic motions happen at the metatarsal and interphalangeal joints during open chain extension?

roll: dorsal glide: dorsal

What arthrokinematic motions happen at the talonavicular joint during pronation?

roll: dorsal and lateral glide: dorsal and lateral

What arthrokinematic motions happen at the metatarsal and interphalangeal joints during open chain flexion?

roll: plantar glide: plantar (movement of phalanges)

What arthrokinematic motions happen at the talonavicular joint during supination?

roll: plantar and medial glide: plantar and medial (movement of navicular in open chain)

Rotational torque adapters for prosthetic feet provide ______________ mobility

rotation for standing & twisting movements

At the SC joint, rotation of the joint occurs with what two shoulder motions? Can this rotation happen independent of other shoulder motions?

rotation occurs with *flexion and abduction* of the shoulder *no* SC rotation cannot occur without another shoulder motion

What kind of tumors commonly metastasize to the lungs?

salivary gland, thyroid, breast, kidney, colon, uterine, bladder, ovarian, and prostate

With SC retraction and protraction, the roll and glide happen in the ______ (same/opposite) direction

same

What happens to the scapula during abduction of the shoulder between 0 and 60 degrees?

scapula is fixed until 30 degrees of shoulder motion at 30 degrees the scapula upwardly rotates at a 2:1 ratio (also causes AC joint rotation)

Motion at the acromioclavicular joint are pertinent with what motion?

scapular motions (upward/downward rotation) require AC joint motion to happen

How is scoliosis most often identified?

school screenings (observe alignment of SP's in standing and look for rib hump while they bend forward)

Stage II CRPS generally lasts about how long?

several months (3-6 mo)

Where are nociceptors located?

skin deep tissues blood vessels (all in peripheral nervous system) (not in visceral organs)

________ accounts for the largest percentage of falls in public places

stair-walking

During gait we have both ______ and _______ phases in which various forces are needed to continue with locomotion

stance swing

What are two ways to assess pain behavior?

standard questionnaires objective observation/measures

The _____ (step/spin)-turn is a more stable means of turning

step-turn

What does the lymphatic system transport?

fat, cells, protein, water, waste products, and other foreign substances

Is scoliosis more common in males or females?

females

In which phase of healing does collagen synthesis by __________ occur?

fibroblasts proliferation phase

Which patient population is more sensitive to pain secondary to abnormal pain processing?

fibromyalgia patients

What may be the cause of egophony, bronchophony and whispering pectoriloquy?

fluid in the lungs carrying the sound into the lung tissue

Ethical social policy in regards to contagious diseases is aimed at:

-dec susceptibility of hosts -eliminating source of organism -interrupting mode of transmission

What are the venous valves formed by?

folds of vein endothelium

What is involved with "executive function" (goal-oriented behavior)?

-deciding on a goal -planning how to accomplish the goal -executing a plan -monitoring the execution of the plan

How does subtalar joint supination affect gait? (2)

-decreases the shock absorbing function (no or less pronation during gait) -increase the risk of ankle sprain

How should a pt be taught to breathe during lung auscultation?

-deeper and more forcefully than normal -through the mouth -have them turn head away from you in case they cough

What puts an individual with diabetes at an increased risk for neuropathic pressure ulcers?

foot deformities- due to abnormal pressure Examples: hammer toe, claw toe, charcot foot

Which neural systems are involved if a person is cognitively thinking about how to control postural movements?

frontal cortex motor cortex (higher level planning)

What are some risk factors for heel spurs?

gait abnormalities that place excessive stress on the calcaneus, ligaments and nerves

The chances of developing scoliosis drop dramatically after age _____ in girls and age ____ in boys

girls: 15 boys: 17

A patient _________ can help in a differential diagnosis to determine if pain is somatic or visceral

history

What are Saunders' Cervical Hometrac Deluxe and Lumbar Hometrac Deluxe?

home cervical & lumbar traction devices we used in lab

With shoulder abduction above 60 degrees, how does the humerus move?

humeral head glides inferiorly and anteriorly while rolling superiorly and posteriorly

What happens to the humerus during abduction of the shoulder between 0 and 60 degrees?

humeral head glides inferiorly while rolling superiorly

What causes hematogenous osteomyelitis?

infection from other place that travels through blood to bone

What causes osteomyelitis?

infection in bone, usually bacterial

What is exogenous osteomyelitis?

infection in deep wound

With the SC joint, clavicular depression involves a superior ________ (roll/glide) and an inferior ________ (roll/glide)

inferior roll superior glide

Where can you palpate the saphenous N?

-infrapatellar branches: proximal, medial tibia -main saphenous N: b/w gracilis & sartorious at the knee joint (can try to find it in the pes anserine)

What are some reasons our stability may be altered/challenged? 1. voluntary 2. external perturbation 3. structural

*Voluntary* -initiating a step -leaning forward -reaching to pick up item *External perturbation* -getting pushed in a crowded hall -movement when a bus starts/stops *Structural (slow or sudden)* -age-related kyphosis -long leg cast -BKA amputation

For a K2 pt, what are the goals of the prosthetic foot they select for this pt?

*adapt to uneven terrain* for limited community ambulation

1st heart sound: -what makes the sound -occur during systole or diastole? -where is it the loudest?

"Lub"/ S1 -happens when AV valves close (and semilunar valves open) -happens at start of systole -loudest @ Mitral area

What is functional ankle instability defined as?

"a condition in which patients experience recurrent sprains and/or a feeling of their ankle "giving way"

What would happen to a transtibial amputee's gait if they were using an endoskeletal prosthesis and they got new shoes with a higher heel?

"drop off" gait hip flexion & knee flexion

Precautions for neural tension testing

"just general therapy precautions" -irritable and severe dysfunction: be wary of acute nerve root disorders -unstable condition -elderly patient -test which causes dizziness -pathologies that affect NS -circulatory disturbances -pregnancy

Describe the appearance of a wound due to arterial insufficiency: Describe the associated symptoms:

*appearance:* -dry gangrene -"punched out" smooth edges -erythematous halo -black/gray necrotic tissue *symptoms*: -painful -**in depedent position: dec pain and inc skin redness -in elevation: inc pain and skin pallor (paleness) -claudication

Describe the appearance of stasis eczema:

-swollen, red, itchy skin -dry and scaly or vesicular and weeping

When is an instance where a PT might have some treatment plan for visceral pain? What is this type of pain called?

*centrally mediated pain* when visceral pain leads to chronic pain, this is something a PT can help treat

Define: criterion-referenced assessments

*compares child to himself* based on child's performance on specific test items

How do you determine the *lumbar & cervical* traction duration?

-consider SINS of pt -variety of recommendations -safe: start at 3-5 min

What are the most common symptoms of inflammation? (6)

-constant pain -redness -heat -edema -tenderness of the affected area -limitation in function

How can substance P generate nerve pain?

*Normal Pain Processing*: -release of ntm substance P -signal to the brain -descending control to handle the situation & dec attention to the stimulus -glia cells are quiet *Abnormal Pain Processing*: -starts the same way -no descending control to dampen pain response -excessive release of substance P & excitatory AA -glia cells are activated & release nitric oxide, inflam cells, & prostaglandins -this inc substance P further & results in more pain

How do you do nerve tension testing on the median N? (hint: 2 options)

*Option 1:* -Position: pt supine, arm supported at 90 deg elbow flexion & 90 deg shoulder abduction 1. depress scapula 2. supinate forearm 3. wrist & finger extension 4. slowly extend elbow 5. cervical SB away *Option 2:* -Position: pt supine, arm at side 1. depress scapula w/ thigh 2. extend elbow 3. ER shoulder 4. supinate forearm 5. extend wrist & fingers 6. slowly abduct shoulder 7. cervical SB away

How does a cardiac pacemaker work?

-creates an artificial action potential -voltage difference b/w 2 electrodes -controls some arrhythmias (2nd or 3rd deg heart block, tachycardia, bradycardia)

For the thumb, flexion and extension of the CMC joint involve the _________ (convex/concave) base of MCP in frontal plane moving on the ________ (concave/convex) surface of the trapezium. This means that the roll and glide happen in the ________ (same/opposite) direction

*concave* MCP *convex* trapezium *same* direction

For the prox and distal IP joints of digits 1-5, the ________ (convex/concave) base of the distal phalanx moves on the ________ (convex/concave) head of the proximal phalanx. This means that the roll and glide happen in the ________ (same/opposite) direction

*concave* base of distal *convex* head of prox *same* direction

For MCP joints 2-5, the ________ (convex/concave) base of the proximal phalanx moves on the _________ (convex/concave) head of the metacarpal. This means that the roll and glide happen in the _______ (same/opposite) direction

*concave* base of phalanx *convex* head of the metacarpal *same* direction

At the SC joint. retraction and protraction involve the __________ (convex/concave) clavicle moving on the __________ (convex/concave) sternum

*concave* clavicle moving on the *convex* sternum (manubrium)

The arthrokinematics of the humeroulnar joint involve the _______ (convex/concave) ulna moving on the _______ (convex/concave) trochlea of the humerus. This means the roll and glide happen in the _________ (same/opposite) direction

*concave* prox ulna *convex* trochlea *same* direction

For the thumb, abduction and adduction of the CMC joint involve the _________ (convex/concave) base of MCP in sagittal plane moving on the ________ (convex/concave) surface of the trapezium. This means that the roll and glide happen in the ________ (same/opposite) direction

*convex* MCP *concave* trapezium *opposite* direction

At the SC joint, elevation and depression involve the ________ (convex/convace) clavicle moving on the _________ (convex/concave) sternum

*convex* clavicle moving on the *concave* sternum (manubrium)

Since the glenohumeral joint involves the _________ (convex/concave) humeral head moving on the __________ (convex/concave) glenoid fossa, the roll and glide happen in the ____________ (same/opposite direction.

*convex* humeral head moving on *concave* glenoid fossa, roll and glide in *opposite* directions

For the radiocarpal joints, the _______ (convex/concave) proximal carpal bones move on the _________ (convex/concave) distal radius. This means that the roll and glide happen in the __________ (same/opposite) direction

*convex* proximal carpals *concave* distal radius *opposite* direction

The infraspinatus, teres minor and subscapularis muscles all _______ (elevate/depress) the humeral head

*depress* humeral head (inferior glide)

For a K1 pt, what are the goals of the prosthetic foot they select for this pt?

*enable safety & early stance* for transfers and level surfaces

For a K3 or K4 pt, what are the goals of the prosthetic foot they select for this pt?

*energy storage & return* for variable speeds

The infraspinatus and teres minor _______ (internally/externally) rotate the humerus

*externally* rotate

In the stance phase of gait, what forces do we need to generate and why?

*horizontal* - so we can keep moving the body forward *vertical* - so we can support the body against gravity

Visceral organ pain is often "________" to or felt in another _________ structure distant or near the source of visceral pain

*referred* to or felt in another *somatic* structure

What system(s) help us recover from a perturbation? How do they help with this?

*somatosensory*:main piece that gives us all the sensory info from periphery and helps us know where our body is in space vestibular: control of gaze during head movement, stabilizing the head (done with precision), top-down organization visual: visual flow contributes to control of velocity and maintaining vertical alignment

The supraspinatus muscle controls the ______ (superior/inferior) roll of the humerus, seats the head of the humerus in the ______ fossa, and prevents excessive __________ (superior/inferior) translation

*superior* roll of the humerus *glenoid fossa* *superior* translation

Like in any joint, the roll and glide must happen at the same ________ to keep the joint articulated

*time* roll and glide happen simultaneously

How might a history of falls change the gait pattern in an older adult?

*walking patterns*: dec stride length and walking speed *stride time*: increased variability *step width*: increased (+ inc variability)

Describe a stage 3 pressure ulcer:

-*full thickness* tissue loss -*subcutaneous fat* may be visible -bone, tendon, muscle not visible -*slough* may be present, but *does not obscure the depth* of tissue loss -may include undermining and tunneling

Describe a stage 1 pressure ulcer:

-*intact skin* -non-blanchable *redness* of localized area, usually over bony prominence (darkly pigmented skin may not have visible blanching, it's color may differ from surrounding area)

When would you screen for peroneal N involvement in a patient's condition? (5)

-*lower lumbar spine* -piriformis (bc splits off sciatic N) -superior tibiofibular joint -lower limb compartments -ankle extensor retinaculum

What are 4 characteristics of a wound due to venous dysfunction/insufficiency:

-*pain* -*pruritus* -*stasis eczema/dermatitis* -*hemosiderin staining* -lipodermatosclerosis -atrophie blanche -thrombophlebitis -telangiectasis/varicosities -perforator insufficiency -post thrombotic syndrome -edema -ulceration

What are signs/symptoms of achilles tendinopathy?

-*palpatory tenderness* -morning pain and stiffness -pain along tendon or back of heel that worsens with activity -severe pain the day after exercising -thickening of tendon -swelling that is always present and gets worse throughout the day and w/ activity

If a patient has *plantar heel pain*, what are some conditions that should be considered? (7)

-*plantar faciitis* -neuropathy -*heel spur* -stress fracture -tarsal tunnel syndrome -radiculopathy - S1 -systemic problems (Reiter's, RA, gout)

If a patient has *posterior* ankle pain, what are some conditions that should be considered? (6)

-*retrocalcaneal bursitis* -Haglund's deformity -*Achilles tendinitis/tendinosis* -Calcification within the Achilles Tendon -Referred pain from soleus trigger point -radiculopathy - S1

How do you treat arterial ulcers medically?

-*surgical*: amputation, revascularization via angioplasty, endarterectomy, arterial bypass graft -*minimally invasive*: thrombolysis, stents, anti-coagulation therapy (blood thinners)

How do older adults proactively adapt to their environment during locomotion?

-*visual sampling*: visually monitor terrain more -*implementation time*: they have difficulty monitoring step length, slower velocity -*obstacle avoidance*: use slower approach speed, slower crossing speed and shorter step length

In an anterolateral thoracotomy what position is the patient in?

-1/4 turn from supine to elevate operative side -uppermost arm elevated forward & placed beneath the back -retract latissimus dorsi

What are the 5 points of the "functional position of the hand"?

-20-30 degrees of extension -slight ulnar deviation -35-45 degrees of MCP flexion -15 to 30 degrees of PIP and DIP flexion -35-45 degrees CMC abduction

In the swing phase of gait, what forces/things do we need to generate/accomplish and why?

-advance the swing limb -position the swing limb so that it's ready to accept weight (so we don't collapse) -avoid contact with the ground and obstacles (so we don't trip)

What are some symptoms of adult rheumatoid arthritis? What are some systemic signs of RA? (1 notable symptom)

-affected joints are: extremely painful, stiff, red and swollen -limited ROM -*eventually joint becomes fixed & deformed* -systemic signs: fatigue, anorexia, mild fever, generalized aching

When would you screen for saphenous N involvement in a patient's condition? (2)

-after a medial knee arthroscopy -MCL injury

Intrinsic factors influencing reaching in infancy (4):

-age -experience -postural control -developmental delay

What are some risk factors for pressure ulcers? (5)

-age (dec ability of soft tissue to distribute mechanical load) -nutrition -smoking -low BP -poor oxygen perfusion

What are some risk factors for osteoporosis? (8)

-age 50+ yo -dec mobility -sedentary lifestyle -deficit of Ca++, vitamin D, protein -smoking -low BMI -asian or european ancestry -excessive caffeine intake

What is adjusted (corrected) age in peds? Why is it used?

-age adjustment for preterm babies -only done for children 24 mo or less in chronological age Purpose: gives more accurate assessment of developmental abilities

What does alignment and stabilization cover as a determinant of exercise?

-alignment and muscle action -alignment and gravity -stabilization (stabilize proximally)

What contributes to the motor control of quiet stance?

-alignment-- COM w/in BOS -muscle tone-- must maintain some m tone to maintain alignment -postural tone

How does moisture cause ulcers?

-alters the resiliency of epidermis to external forces -shear & friction are increased in the presence of *mild to moderate* moisture (shear & friction actually decrease in the presence of diffuse moisture)

Strategies to regain anteroposterior stability (3)

-ankle strategy -hip strategy -stepping strategy these are roughly hierarchical in terms of amount of perturbance to initiate one of these

What are the 3 most commonly injured ligaments of the lateral ankle? (the most common in bold)

-anterior tibiofibular -*anterior talofibular* -calcaneofibular

What aspects help to maintain the arches of the foot? (4)

-architechture of the tarsal bones -the orientation of the bones and supporting ligaments -the force produced by contracting muscles -the structurally strong plantar ligaments

Documentation of NTT

-area/sequence of response -restriction of movement -symptom characteristics (this can get lengthy & difficult bc there are so many ways to do NTT)

What are 4 reasons why good skin goes bad? (results in wounds)

-arterial insufficiency -venous insufficiency -diabetic/neuropathic -pressure ulcers

Which type of turning technique should you practice with your patient?

-as clinicians we will have to decide if we should practice both or one -does the pt need the flexibility to perform both safely?

How do you determine the *lumbar* traction force?

-assess results of lighter force before increasing ---consider 25-50% of BW -monitor pt symptoms -inc if no change at next visit, dec if worse, STOP if dramatic change

How can a lack of *axoplasmic flow* generate nerve pain?

-axoplasm flow has to have mvmt of the body for it to be going back & forth -if it's not moving (Ex: immobilization), then we will have dec transport of ions & ntm in the nerve which nourish it -this somehow causes pain

Where are wounds from arterial insufficiency usually located? (4)

-b/w toes and distal tips of toes -dorsal aspect of foot and over phalangeal heads -*lateral malleolus* -tibia

What are some symptoms of scoliosis? (3)

-back pain -fatigue -uneven shoulders or hips

What is the primary contributor to stable walking in older adults? What is the major factor affecting loss of independent mobility in older adults?

-balance control -decreased balance control

What precautions does a post-pacemaker implantation patient have?

-based on surgeon preference -in PT, may have 1-2 days where they can't do arm motions -just follow precautions in chart

How does pain progress in CECS?

-begins during exercise -inc throughout activity -subside 10-20 mins after activity -recovery period will inc over time

In which direction is the inferior surface of the tibia concave and convex?

-concave anterolateral -convex mediolateral

Why would an implantable cardioverter defibrillator (shock box) be used for a patient?

-designed to correct life-threatening arrhythmias -detects & corrects all tachycardias, bradycardias & ventricular fibrillation -dec risk of sudden death d/t arrhythmias (similar to pacemaker)

Lumbar Traction Technique (read)

-determine traction force -determine duration -determine static vs intermittent -determine position -harnesses -split table

Cervical Traction Technique (read)

-determine traction force -determine duration -determine static vs intermittent -position

How is maintaining postural control in the mediolateral direction different than anteroposterior?

-different strategies are used to recover stability -stepping strategy will certainly still work -hip strategy may help a little bit -ankle strategy not used as much -muscle patterns are organized in a *proximal to distal* direction starting with the head

Characteristics of Broca's aphasia (7):

-difficulty expressing oneself using language -able to understand language and control muscles for other purposes -may be able to produce emotional speech when upset -usually aware of language difficulties -frustrated -usually writing impaired also -reading spared

What are some signs of muscle fatigue?

-discomfort in the mm, pain or cramping -trembling in contracting mm -active movements are jerky -inability to complete movement pattern through full ROM during dynamic ex against same level of resistance -compensations -inability to continue low-intensity physical activity -dec of peak torque during isokinetic testing

What info do conscious relay somatosensory pathways carry? Where does this pathway terminate? (conscious relay: dorsal column & medial lemniscus & spinothalamic)

-discriminative touch & conscious proprioception -discriminative pain & temp terminate: primary sensory area in cortex

What 3 bones make up the talocrural joint?

-distal tibia -distal fibula -talus

Who are the moral agents in a chronic care case?

-doctor -team members -patient -caregivers

If a complete lesion was made in an animal at the decorticate level, what would we still see with movement?

-dynamic stability -initiates reasonably normal goal-directed behavior in neonatally decorticate animal

How do you reduce the risk of a contagious disease from a patient spreading to others?

-education -use standard precautions -infected workers remove themselves from procedures

What are the 3 main layers of the skin?

-epidermis -dermis -hypodermis

Describe the appearance of a venous ulcer: -color -exudate -depth -edges -location

-eschar, wet, yellow, fibrous -moderate to heavy exudate -shallow -irregular edges -usually superior to malleoli (usually medial malleoli)

How can exercise effect gait function in older adults?

-evidence that exercise programs for older adults can be effective in improving gait -programs have included intense PT, high intensity strengthening and aerobics -greatest changes are seen in those with the slowest velocities prior to training

Function: dorsolateral prefrontal association cortex

-executive function -self-awareness (avoid socially inappropriate behavior)

How does shear cause ulcers?

-exerts force parallel to skin -shear forces stretch/tear bv and dec the amt of pressure needed to occlude them -changes angle of blood flow -vascular occlusion is enhanced if shear & pressure are together

Where is a tophus typically located? (3)

-extensor surfaces of forearm -joint bursae -pinnae of the ear

What are some complications that occur due to ankylosing spondylitis? (3)

-eye inflammation -hip/shoulder pain, stiffness -restrictive respiratory impairment

What might happen if someone's COM moves outside of their BOS?

-fall (not ideal) -grab onto something -enact a "movement strategy" to regain balance last bullet is what most healthy people do

Why do diabetic wounds have delayed healing? (4) -inhibited activity of: -dec _________ deposition -delayed _____________ -dec ______________ of micro-arterial anastomoses

-fibroblast & endothelial cells -collagen -re-epithelialeization -re-endothelialization

Describe cognition & object exploration in a 6-7 month old:

-find partially hidden objects -explores objects with hands and mouth

What abnormalities of the foot can place someone at an increased risk for developing plantar fasciitis?

-flat feet -high arches -pronation -abnormal gait (can all result in fascial tissue to become overworked or stretched resulting in tears and inflammation)

What are sliders in terms of neurodynamics? When are they used most often?

-floss the N through the surrounding tissue w/o tensioning the entire length of the nerve -acute issues & sx that are very irritable

When climbing a set of stairs we are unfamiliar with, what are some adaptations that are required for successful completion of the task?

-foot clearance and placement (HF strength required to clear) -using visual input (if needed) to know how high the step is

How is ascending stairs different from level walking regarding requirements of forces generated?

-forces needed are 2x greater than level walking -knee extesors generate most of energy to move forward

What should be included in a differential diagnosis for cuboid syndrome?

-fracture or dislocation of the cuboid, calcaneus or forth/fifth metatarsals -peroneal or extensor digitorun brevis tendinopathy -plantar fasciitis -gout

Describe reaching skills in a *2 month* old:

-frequency of reaching decreases -hand fisted

Describe reaching skills in a *3 month* old

-frequency of reaching increases -hand open -infants acquire skill in aiming movements and become realistic in their reaching

Describe the pain from venous dysfunction/insufficiency: (6) -exacerbated by? -location? -4 other things

-fullness or heaviness -aching/throbbing -exacerbated by standing -progressive throughout the day -typically felt in calf or thigh -night cramps after a long period of standing without exercise

When examining a pt in a differential diagnosis screen, the PT should ask what questions relating to associated signs and symptoms if they suspect visceral referred pain?

-general health questions -questions unique to each organ system (endocrine, pulmonary etc.) to locate the pain

What are signs/symptoms of cuboid syndrome?

-gradual onset of lateral foot pain -sensation of walking on a small rock -discomfort w/ palpation on the fibular groove on the plantar surface -occasionally the hook of the bone under cuboid breaks or a tear of the plantar ligament produces pain

How is a coronary artery bypass graft procedure performed?

-grafts come from either a vein or artery (if venous-- saphenous VV) -median sternotomy performed -pt put on heart/lung machine -graft placed above and below lesion site -chest wall closed & recovery begins

Describe grasping skills in a 2 year old child?

-grip and load force are negatively correlated -tendency to over-shoot target (lots of feedforward)

Describe grasping skills in an adult?

-grip and load forces are programmed in parallel to prevent slips and avoid squeezing too hard -integration of feedback and feedforward strategies

Describe grasping skills in a 2 month old?

-hand fisted during reaching

More PT treatment considerations for CRPS (read)

-have patient make a plan and write it down -start with low baseline and build up tolerance -do small amounts often rather than all at once -avoid prolonged activity and prolonged rest -motivation; hurt does not equal harm -movement is the key - general exercises, aerobic activity -weight bearing exercises -aquatic therapy -patient must participate

How should you respond to finding out a patient is suicidal?

-have the mindset of believing the person would rather alter an aspect of their life than end it -trust your instincts that they may be in trouble -talk w/ them about your concerns -communication should include listening -ask direct questions w/out being judgmental -determine if the person has a plan, more details = greater risk -get professional help, even if they resist -don't leave them alone -don't swear to secrecy***** -don't act shocked or judgmental -don't counsel them yourself

Describe vesicular breath sounds: -location heard -length during inhale/exhale -pitch/volume

-heard over lung tissue (except inf to manubrium and b/w scapula) -longer on inhale, shorter on exhale -lower pitch and quieter than bronchial sounds

Describe bronchial (tubular) breath sounds: -location heard -length during inhale/exhale -pitch/volume

-heard over the trachea -shorter on inhale, longer on exhale -higher pitched and louder than vesicular breath sounds

What organs may be compressed due to scoliosis? (2)

-heart -lungs

What are 3 characteristics of strength exercises?

-heavy loads -low # of reps -short period of time

What are risk factors for vein dysfunction? (8)

-hereditary -gender -pregnancy -age -obesity -extended sitting & standing -height -history of vein problems including varicosities, thrombophlebitis and DVT

Indications for Spinal Traction:

-herniated nucleus pulposus (HNP) -DDD or DJD -joint hypomobility -facet impingement -muscle spasm

What do wheezes sound like? When in the breathing pattern are they heard?

-high-pitched musical sounds -may sound like high notes on clarinet -heard upon exhalation

What do rales (crackles) sound like? When in the breathing pattern are they heard?

-high-pitched, fine, rattling/crackling sounds -non-continuous -sounds like a carbonated beverage or rubbing hair together -usually heard on inspiration (and sometimes beginning of exhalation)

How can you increase the overall load of a SLR test?

-hip IR -hip adduction -lumbothoracic contralateral SB -cervical flexion

What are some chemicals that are released into tissues after tissue damage that cause pain? (6)

-histamine -serotonin -bradykinin -acetylcholine -prostaglandins -cytokines

How is a heel spur diagnosed?

-history of pain and tenderness localized to area of bony involvement -X-ray to identify bony protrusion on calcaneus

What are some characteristics of a fracture? (read)

-history of trauma -obvious deformity -swelling -tenderness -altered sensation -inability to move broken limb -crepitus -pain (can cause shock)

What are some theories for CECS?

-inc blood flow goes to the muscles during exercise (mm size can inc up to 20%) -if the fascia does not simultaneously expand, the inc pressure will cut off the blood supply in the particular compartment -may be because of biomechanical movement, hypertrophied muscles, thick fascia with dec elasticity or high BP

What should the general exercise structure in the chronic phase of healing be?

-inc resistance -reps/sets determined by pt needs -proper body mechanics and movement patterns -dec reps/inc load (gradually) -multi-joint exercises -multi-planar exercises -functional/sport related exercises

In a median sternotomy, how is the incision made & closed?

-incision extends below xiphoid process -sternum is divided along its midline -sternal retractor holds incision open -sternum closed with stainless steel sutures -incision closed in layers

Describe grasping skills in a 5-6 month old infant?

-infants look at the hand & performance is disturbed if vision of hand is blocked -visual information is used to adjust grip configuration, radial palmar grasp

What are some symptoms of osteomyelitis? (8)

-inflammation -edema -fever -fatigue -weakness -aching pain -guarding behavior -*inc pain w/ weight bearing*

What are some symptoms of sprains & strains? (4)

-inflammation -marked swelling -discoloration (hematoma) -limited strength or ROM

How can *abnormal impulse generating sites* generate nerve pain?

-ion channels only live a few days -need a lot of axoplasmic flow to help get the old channels out & new ones in -if the flow stops (due to a vascular injury), the ion channels can get stuck open or closed -if the channels are stuck open, Na+ is leaking in and eventually creates an AP -NN receiving these impulses don't know what to do and backfire causing an inflam chemical release at their distal ends -abnormal & excessive impulses results in the brain getting confused and interprets this as pain

Where are common locations of pressure ulcers?

-ischial tuberosities -greater trochanters -sacrum/coccyx -lateral malleoli -heels -olecranons -medial femoral condyles -occiput

How can *connective tissue* generate nerve pain?

-it's highly innervated (free N endings & Pacinian corpuscles) & can generate pain if it's injured -it's also surrounded by umyelinated fibers containing pain neuropeptides Ex: ~50% of nerve diameter is CT

What are some symptoms of infectious (septic) arthritis?

-joints are red, swollen & painful -limited ROM

Why is it important to test the uninvolved side first in neurodynamics?

-just bc you have a tight neural system doesn't mean that is the cause of the pt's condition -need to check the uninvolved side to know if they are just a tight person or if it is the cause of a problem -when testing the involved side, you can also ask, "is this the pain that you're here to treat?"

Where can you palpate the ulnar N?

-just medial to pisiform -b/w olecranon process & medial epicondyle

What are the keystone and pillars of the lateral longitudinal arch?

-keystone: cuboid -pillars: calcaneus and 4th and 5th metatarsal heads

What are the keystone and pillars of the transverse arch?

-keystone: middle cuneiform -pillars: cuboid and medial cuneiform

What are the keystone and pillars of the medial longitudinal arch?

-keystone: talar head -pillars: calcaneus and great toe and the head of 1st, 2nd and 3rd metatarsals

What are some potential causes of Rickets? (4)

-lack of sun exposure -lack of being outside -lactose intolerant -genetic: kidney disorder

Characteristics of Wernicke's aphasia (4):

-language comprehension impaired -easily produce sounds, but output meaningless -have alexia (inability to read) and unable to write meaningful words -often unaware of disorder

Where can you palpate the sural N?

-lateral to achilles tendon -distal to fibula (small & hard to find)

*Patho of venous ulceration:* -venous hypertension causes: -edema and blood products cause: -^^^^^ leads to:

-leakage into ISF -inflammation -(inflam. leads to) skin failure ulceration is a response to a complex inflam. rxn

Mechanical traction is effective for a subgroup of patients who are characterized by the presence of __________ symptoms, signs of __________ compression, and either __________ w/ extension mvmts or crossed SLR

-leg -nerve root -peripheralization

What are some general things that could be included in manual therapy for a foot condition caused by a deformity?

-massage -mobilization -manipulation (cuboid subluxation)

What are the goals of PT with post-thoracic surgery patients?

-maximize pt's ability to perform ADLs -inc general strength & endurance -maximize muscle & soft tissue length & ligament integrity -achieve normal arousal & neurological function -assess skin integrity -prescribe secondary prevention -know precautions assoc. w/ procedure -early mobilization is beneficial with s/p stroke patients -cardiac revascularization procedures are most common-- short LOS & outpatient cardiac rehab

Where can you palpate the peroneal N?

-medial to biceps femoris tendon -end of fibula -dorsum of foot

What are 3 general treatment strategies for pain?

-medication -PRICE -rehabilitation

Where can you palpate the radial N?

-mid humerus -radial sensory N: lateral aspect of forearm (hard to find)

Describe a 1st degree muscle tear:

-mild pain -no significant loss of strength or ROM

Which veins are involved in mild, moderate and severe edema?

-mild: associated w/ uncomplicated varicose veins -moderate: perforator involvement -severe: associated w/ acute deep system blockage

What are some changes you should see in the injury/limitation before exercises are progressed from the acute phase?

-minimal/no tenderness -pain reduced significantly -ROM nearly restored (better if PROM and AAROM are pain free) -min-no swelling -improved functional ability -dec tissue/patient reactivity

Threatening suicide is a _________, __________, ___________, ___________, and __________ issue

-moral -psychological -sociological -religious -legal

What are some easing factors you should examine to see what helps relieve a patient's pain?

-movement vs. rest -bracing or supports -medication -modalities

Describe reaching skills in a *newborn*

-moves arm when visually fixated on an object -open hand

What are different aspects of treatment for CRPS? (6)

-multidisciplinary management -patient education -medications -rehabilitation -sympathetic block -peripheral nerve block *early diagnosis is crucial to a good outcome*

If a complete lesion was made in an animal at the spinal level, what would we still see with movement?

-near normal inter/intra limb rhythmic activation patterns -functionally modulates reflex action -executes other rhythmic movements concurrently

How can *surrounding tissue* generate nerve pain?

-nerves travel through stuff, so injuries to the surrounding tissue can cause compression on the nerve and pain -Ex: muscle strain, ligament damage, swelling of any kind, immobilization

How quickly do post-thoracic surgery patients typically progress through the stages of mobility?

-patients progress at diff rates -some may pass through all stages quickly while others need more time -encourage body positioning, otherwise pts will assume supine for extended periods of time -educate them to change positions while lying in bed for a while

Which *tendons* run along the lateral side of the ankle?

-peroneus longus -peroneus brevis -extensor digitorum brevis -extensor digitorum longus

How might stage II CRPS affect the following clinical features: -pain -joints -muscle -bone -skin

-persistent pain exacerbated with any stimulus -edema spreads and joints stiffen -muscle wasting begins -osteoporosis begins -cutaneous and trophic (change in soft tissue due to dec nerve supply) present

Effects of contagious diseases (read)

-personal: medical costs -research: provide cures & vaccinations -indirect costs for screening, education & loss of productivity -overburdened health care system

What are some possible orthopedic conditions that could result from fore or rearfoot varus? (6)

-plantar fasciitis -metatarsalgia -hallux valgus -callus formation (2nd or 3rd met head) -overuse symptoms - tibial posterior muscle (decelerate STJ pronation) -increase tibial medial rotation

Research to Support Traction (read)

-poor evidence for traction alone -alone or combined, little to no impact on pain intensity, function, global improvement & return to work -combined w/ other modalities: improvement in Oswestry & VAS -no changes after 5 weeks -mechanical effects are effective short-term, less than 5 weeks -most likely benefits acute radicular pain w/ concomimtant neuro deficits -low doses are probably sufficient to achieve benefit -intermittent, cervical traction is beneficial for pain reduction when compared w/ control or placebo for chronic mechanical neck disorders, neck disorders w/ radicular findings & degenerative changes

What causes excessive kyphosis? (5)

-poor posture -spina bifida -congenital defects -spinal tumors or infections -Scheuermann's disease

*Patho of venous edema:* -inc venous pressure inc the volume of blood within: -inc diameter of larger venules and veins bulge into the extravascular compartment raising: -venous bulging stiffens: -results in abnormal:

-post capillary venules -tissue pressure -ECM -microcirculation

Which *tendons* run along the medial side of the ankle?

-posterior tibialis -flexor digitorum longus -flexor Halux longus

Where can you palpate the tibial N?

-posterior to knee b/w HS tendons -medial ankle

Prejudice

-pre-judgment about a person/group -often accompanied by ignorance, fear or hatred -discrimination is the resultant behavior based on group membership

What are the three types of prehension?

-precision grip or pinch (when control or delicate action is needed - variations) -power pinch (lateral pinch) -power grip (large forces w/ no need for precision)

What are the 4 major contributing causes of pressure ulcers?

-pressure -shear -friction -moisture

What are the different ways you can palpate nerves?

-pressure -tapping -"twanging"

Communication pathway (anatomical pathway):

-primary auditory cortex -secondary auditory cortex -Wernicke's area -subcortical connections (links Wernicke's & Broca's) -Broca's area -oral and throat region of sensorimotor cortex

How does stage III CRPS affect the tissues?

-progressive atrophy of the skin, subcutaneous tissue, muscle and bone -skin is thin and shiny

When a patient has a contagious disease, pt confidentiality and HCP's duty to warn are placed at odds. What is the argument for duty to warn based on?

-protect the healthy population -vulnerable people should be warned

General Traction Guidelines (read)

-pt must relax to allow traction to occur -observe the effect of the set up -continually monitor pt symptoms -don't leave pt unattended during 1st treatment -always give pt safety button -always consider SINS -always establish * before & after treatment -special questions

What are patients post-CABG at risk for?

-pulmonary infection -chest wall soreness -leg discomfort/infection Notes: -have to really make sure they are keeping incisions clean -encourage them to take deep breaths, they won't want to do this d/t chest soreness

Describe a deep tissue injury:

-purple or maroon localized area of intact skin or blood-filled blister due to damage of underlying soft tissue from pressure or shear -area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue

Things to consider when choosing an assessment

-purpose -what the test measures -child's age -developmental or functional areas to be examined -standardization sample -setting -reliability -validity -ICF level/classification

Describe infant reaching in a *6 month* old

-reaching becomes smoother (fewer "steps" and straighter approach) -unilateral reaching may begin -elbow is used

Describe infant reaching in a *4-5 month* old

-reaching occurs in several "steps" -bimanual reaching may dominate -elbow may be locked -final approach crooked/awkward -reaching becomes *visually guided* instead of triggered

When would you screen for sural N involvement in a patient's condition? (2)

-recurrent ankle problems -*Achilles tendonitis*

What is chronic exertional compartment syndrome?

-recurrent syndrome characterized by pain/disability during exercise or work, but relieved when the activity is stopped -develops over days or weeks -usually not dangerous

Describe grasping skills from birth to 2 months?

-reflexive grasp -hand open during reaching

Define: distraction

-relates to joint surfaces -move perpendicular to one another

What are some general things that could be included in education for a foot condition caused by a deformity?

-rest -activity modification -use proper tennis shoes

Based on symptoms that a patient may be experiencing in the chronic/remodeling phase of healing, what should goals of therapy include?

-restore pain free, full ROM and endurance/strength/power -lifestyle changes (if needed) -return to functional/occupational/sport/activity -maintenance programs

What are the MOI for calcaneal fractures?

-result of trauma and high-impact situation (axial trauma - falls from height, MVA) -may occur in workplace -also possible with ankle sprain or stress fracture

If a patient has posterior ankle pain, what are they *most likely* to have?

-retrocalcaneal bursitis -Achilles tendinitis/tendinosis

How is the success of a CV surgery measured other than technical success?

-return to full participation in life -capacity to perform activities -avoid recurrence of problem -dec hospital care & re-admissions in future

Lung sounds that are *always* considered abnormal:

-rhonchi -rhales (Crackles) -wheezes -pleural friction rub -egophany

With shoulder abduction above 60 degrees, how does the clavicle move?

-rotates posteriorly 30 degrees at SC joint around longitudinal axis -retracts 30 degrees at SC joint (rolls and glides posteriorly)

What is telangiectasis?

-same thing as spider veins -0.5 to 1 mm diameter -dilation of surface vein

What does pleural friction rub sound like?

-scratchy -may sound like walking on fresh snow

While there may be CPG present in humans, what seems to be required for normal gait that is not included in the function of CPG?

-sensory info from periphery -descending control

Function: parietotemporal association cortex

-sensory integration -understanding language and spatial relationships

What are the 3 different types of diabetic neuropathies?

-sensory neuropathy -autonomic neuropathy -motor neuropathy

Describe a 2nd degree muscle tear:

-severe pain -muscle partially contracted -substantial loss of strength and ROM

In stage III CRPS, how might the following be affected: -trophic changes -mobility -swelling/edema -cutaneous tissues -bones

-severe trophic changes -severe immobility of affected limb -edema often has resolved -cutaneous tissues atrophied and changes in nails -X-rays show osteoporosis

What types of forces does the epidermis protect you from?

-shear -friction

Define: dermatome Define: peripheral N

-skin innervated by axons from single dorsal root -axons from dorsal root innervating specific parts of the limbs regrouped to form peripheral nerve (dorsal root (1/2 of spinal N) > peripheral N (Ex: ulnar) > afferent N)

Treatment options for positive findings from NTT

-sliders -tensioners (the test becomes the treatment, and the treatment becomes the re-test)

Which sensory strategies do healthy young adults use during perturbed stance? options: somatosensory, vision, vestibular

-somatosensory: most important -vestibular: minor role -vision: not critical

Damage to the nondominant Broca's area results in what characteristics?

-speak in monotone (difficulty producing intonations) -lack of emotional facial expressions and gestures -flat affect

What is autotraction?

-special table w/ 2 sections -sections can be individually angled & rotated -pt can set it up & progress treatment -popular in 70's and 80's

What are some components of a functional evaluation of the ankle/foot?

-squatting (DF) -heel raise (PF) -squatting and jump -ascending and descending stairs -tip toe walking -running straight -running changing directions -star excursion balance test -balance single leg stance?

What are signs/symptoms of plantar fasciitis?

-stabbing pain that usually occurs with your first steps in the morning, with movement the pain normally decreases but can return after long periods of standing or rising after sitting -located close to where the fascia attaches to the calcaneus -burning, stabbing or aching pain in the heel of the foot

Describe cognition & object exploration in a 13-15 month old:

-stacks 2 blocks -adapts reaching to the weight of the object

Describe cognition & object exploration in an 18 month old:

-stacks 3 blocks -understands objects go together (cup and saucer)

Describe cognition & object exploration in a 2 year old:

-stacks 6 blocks -sorts by shape/color -begins to pretend play

When considering if you should implement resistance exercises into a patient's rehab program, what are some things you should consider before moving forward?

-stage of healing -patient goals -medical or injury hx -psychological consideration (WC or pressure from parent/coach) -contraindications/precautions

What impairments could be contributors in age-related gait changes?

-standing balance -cognition -increased fear of falling -sensory impairments -muscle weakness

What are some MOI for heel spurs?

-strains of foot muscles and ligaments -stretching of the plantar fascia -running, jumping, impact injuries (common in athletes) -repetitive overuse -other inflammatory diseases

What are some general things that could be included in therapeutic exercises for a foot condition caused by a deformity?

-stretching -strengthening -proprioception (to modify biomechanics according to the condition)

Contraindications: traction

-structural disease secondary to tumor or infection -vascular compromise -condition where mvmt is contraindicated -osteoporosis (usually precaution) -RA -TMD

What are signs/symptoms of a calcaneal fracture?

-sudden pressure pain in heel of foot -swelling, bruising -hematoma and edema -difficulty walking or WB -inability to move foot (can use X-ray or CT to diagnose)

What are the 3 functions of the hand?

-support (to brace or stabilize, serve as a platform) -manipulation -prehension (grip and pinch)

Which patients would make a good candidate for a carotid endarterectomy?

-symptomatic w/ carotid stenosis >/= 70% of largest benefit -symptomatic w/ carotid stenosis 50-69% of moderate benefit -asymptomatic w/ stenosis of >/= 60% (can't do these on a completely blocked artery)

During an objective exam in a differential diagnosis screen, the PT should pay attention to these 3 things:

-symptoms change with testing -selectively stress MSK tissues -recognize common MSK pain patterns

Lumbar traction Reminders: (read)

-take up slack in ropes before starting -be mindful of the rope angle -remember to split the table after 1 minute

If a patient has *medial* ankle pain, what are some conditions that should be considered? (7)

-tarsal tunnel syndrome -*tibial posterior tendinitis* -*ligamentous injury* (deltoid) -subtalar joint arthropathy -accessory navicular syndrome -*medial tibial stress syndrome (shin splints)* -maleolar fractures

General technique rules for neural tension testing

-tell pt what you're doing & why -tell them to expect strange feels -estimate approx end point/ have idea of AROM -*be consistent w/ how you load the system* -test uninvolved side first -note onset of resistance or changes in dynamics -symptoms (location, nature, intensity, duration, *comparable sign*) -advanced testing: change order of movement to tease out area of impingement

How is a STS transfer changed in older adults generally?

-tend to inc trunk flexion & have a higher movement velocity -forces used are lower -overall time to rise is longer

What are characteristics of "neglect"?

-tendency to behave as if one side of the body does not exist -fail to report or respond to stimuli present on contralesional side -usually affect left side of the body

What are tensioners in terms of neurodynamics? When are they used most often?

-tensioning entire length of the nerve -chronic issues & sx w/ low irritability

What are general characteristics of nociceptors? (4) -what do they require to be activated? -threshold -acute vs chronic pain -adaptation?

-they require tissue damage or painful stimulus to be activated -their threshold is intensity driven and is different from person to person -the relationship of tissue damage and pain intensity changes from acute to chronic pain -there is no adaptation that occurs to a painful stimulus

Notes about test administration for standardized assessments (read)

-thorough understanding of test, administration, scoring and interpretation must be present -test must be administered exactly as specified to remain valid -no need to memorize assessment, use manuals as directed -use info from PT exam and info from assessment to support decision making for intervention and services

Describe the typical deformity that takes place in the hands in adult rheumatoid arthritis:

-thumb: boutonniere deformity -digits: *ulnar drift* and ankylosis of the joints

What are the 4 normalcies of the foot/ankle?

-tibia vertical -calcaneus in line with tibia -metatarsals in a plane perpendicular to the calcaneus -metatarsals in same plane with each other

List some factors that contribute to the increased cardiopulmonary risk associated with CV and thoracic surgery:

-type of surgery/procedure -anesthetics -duration -incision -*body positioning* -lines, leads, tubes, catheters -monitoring devices -peri-operative anxiety or pain -peri-operative fluid balance, blood & plasma transfusions

What are some symptoms of a Volkmann's Ischemic Contracture? (7)

-vasoconstriction -inc sympathetic stimulation -muscle swelling- compartment syndrome -muscle necrosis -sudden onset of pain -*cyanosis* of fingers -*absent radial pulse*

What characteristics must be present for a *possible/probable* CRPS diagnosis? (3)

-vasomotor instability and/or swelling -pain and mild to moderate tenderness -dystrophic skin changes present

What happens physiologically when a varicose vein is formed? -vein walls lose ____________ -___________ thickens -_____________ is disrupted -location of distension -results in _______________

-vein walls lose elastin -collagen thickens -muscle layer innervation becomes disrupted -distension usually occurs distal to the valves -the weakened vein walls cause valve failure resulting in reflux

What causes hemosiderin staining?

-venous dilation allows RBCs through the endothelium into the ISF where they breakdown -then hemoglobin is converted to hemosiderin which results in a brown pigment stain that darkens over time

Basic Warning Signs of a Suicidal Patient***** (80% of people will give some sign of intention)

-verbal suicidal threats ("you'd be better off w/out me") -guilt, hopeless, helpless -sad, anxious -trouble eating or sleeping -withdrawn from friends or social activities -loss of interest in hobbies, work, school or future plans -inc alcohol or drug use -previous suicide attempts -daring or risk-taking behavior -personality changes -depression -giving away prized possessions**

What are some characteristics of *pain behavior* that you can examine on a patient with chronic pain? -verbal -vocal -facial expression -physical actions -function -social actions

-verbal: patient constantly complains of being in pain -vocal but not verbal: screams, sighs -facial expressions -phycical actions: guarding, bracing, rubbing, limping -function: change/limitation in activity, use of medications -social actions: nor going to work or social events

how is proactive equilibrium control used during locomotion?

-vision used to identify and avoid or accommodate for obstacles -predictions, based on past experiences, helps us proactively adapt

What happens with reaching skills at the end of the first year of life?

-visually guided reaching diminishes -young infants initiate reaching using a ballistic strategy to aim the hand at the target and then switch to a feedback strategy to make corrective movements for grasping

What should guide exercise order? (3)

-warm up -large mm groups before single joint mm -most fatiguing first

What are some aggravating factors that you should ask about to see what bothers a patient?

-weight bearing -hopping -walking -stairs -twisting -squatting -standing

Dorsal Column Pathway: 1. touch & prop info from limbs enter SC via ___________________ 2. ascends in dorsal column to ipsilateral lower medulla 3. synpases in ________________ 4. crosses SC & ascends in medial lemniscus to contralateral thalamus 5. synapses in _______________ 6. ascends to ________________

1. A-beta or I/II afferents 3. nucleus cuneatus (UE) or gracilis (trunk/LE) of medulla 5. VPL of thalamus 6. primary somatosensory cortex

Which muscles are activated and in what order in a hip strategy to maintain postural control when the body sways backward in response to a perturbation?

1. paraspinals fire (produce trunk extension) 2. hamstrings fire 3. abdominals fire MUCH later (200 ms)

What are the 5 functions of the skin?

1. thermoregulation 2. sensation 3. metabolism of vitamin D 4. protection from shear 5. protection from water loss

How thick is the dermis in cm?

2-4 cm

What is the pressure of the fluid in the pleural cavity?

2-6 mmHg less than atmospheric pressure which keeps the lungs filling the pleural cavity.

Clinical Prediction Rule: Lumbar Traction

4 of the following suggested inc probability of successful response to mechanical lumbar traction: 1. low level of fear-avoidance behavior 2. no neuro deficit involvement 3. >30 yrs old 4. non-involvement of manual work

Wound contracture occurs __ to __ days after injury for up to ___ to ___ weeks

4-6 days after injury for up to 2-3 weeks

What degrees of motion are considered "functional" ROM of the wrist needed to complete ADLs?

40 degrees flexion/extension 10 degrees radial deviation 30 degrees ulnar deviation

4th heart sound: -when does it happen? -during systole or diastole? -what causes this?

S4 -happens at time of atrial contraction -occurs late in diastole -due to accelerated rush of blood in ventricles (blood hitting stiff ventricular wall)

Left vagus nerve: where does it enter the superior mediastinum? How does it reach the abdominal cavity?

It enters the superior mediastinum on the left of the aortic arch, it also stays posterior to the hilar region as it also descends along the esophagus to the abdominal cavity

Once vasodilation of vessels and edema occur in the process of inflammation, what are the next 2 steps?

inflammation reaction rapidly proceeds to remove and repair the damaged tissue and pain develops as a protective mechanism

Which lobe of the cortex are the following functions primarily located? SAA Visual perception Hearing Declarative memory formation Emotions

SAA: parietal cortex Visual perception: occipital lobe Hearing: temporal declarative memory: temporal emotions: limbic

Right vagus nerve: where does it enter the superior mediastinum? How does it reach the abdominal cavity?

It enters the superior mediastinum on the right side of the trachea, passes behind the right brachiocephalic vein and inferior vena cava and remains behind the hilar region and descends along the esophagus to abdominal cavity

What forms the middle trunk?

It is a continuation of the C7 root

What does the sural nerve supply?

It is a cutaneous nerve that runs along the posterior aspect of leg and ends up on the lateral malleolus

What motion causes compression of cords of the brachial plexus if done repeatedly?

It is a superior injury caused by hyperabduction of the arm (i.e. painting a ceiling) symptoms include pain running down the arm, numbness, tingling

Where is the thoracic duct in relation to the vertebral bodies?

It is just anterior to the V. bodies

What is the only bony articulation that the shoulder has with the axial skeleton?

SC joint

Where do the left and right pulmonary arteries attach?

Left: attached to the aorta by the ligamentum arteriosum. Right: crosses under aortic arch to the right lung.

Parietal Pleura

Lines the wall of the pleural cavities that surround the lungs

Stage II CRPS is thought to be caused by an over reactive ______

SNS

What is the approximate O, I, N, F of fibularis brevis?

O: distal surface of fibula I: base of 5th metatarpal N: superficial fibular nerve F: plantar flexion, eversion

What is the approximate O, I, N, F of fibularis longus?

O: head of fibula I: medial cuneiform N: superficial fibular nerve F: plantar flexion, eversion

What is the approximate O, I, N, F of extensor digitorum longus?

O: lateral tibial condyle, head of fibula I: distal phalanges of toes 2-5 N: deep fibular nerve F: dorsiflexion, eversion, extends digits 2-5

What is the approximate O, I, N, F of extensor hallucis longus?

O: middle surface of fibula I: distal phalanx of big toe N: deep fibular nerve F: dorsiflexion, eversion, and inversion

What is the approximate O, I, N, F of soleus?

O: post surface of tibia & fibula I: calcaneal tuberosity via achilles N: tibial nerve F: plantar flexion

What is the approximate O, I, N, F of flexor hallucis longus?

O: posterior fibula I: base of distal phalanx of big toe N: tibial nerve F: MTP, IP plantar flexion

In lumbar traction, the pelvic belt provides ___________ while the thoracic belt provides ____________

Pelvic: traction force Thoracic: counter traction force

At the mid-clavicular line (anterior), what rib level are the pleura and lungs at?

Pleura: 8th rib Lungs: 6th rib

What nerve runs in the lateral compartment of the leg?

Superficial fibular nerve

When do S1 and S2 occur when looking at an EKG?

S1: occurs immediately after QRS wave (depol of ventricles) S2: occurs immediately after T wave (repol of ventricles)

What structures protect the brain, SC and PNS?

Brain - skull SC - spinal column PNS - muscles, ligaments, fascia, bones, joints, bursa etc. Take Home: PNS is not protected like the CNS is

Motor, expressive, non-fluent aphasia all refer to different names for which condition?

Broca's aphasia

How did the lungs develop?

By growing into a body (pleural) cavity resulting in a double layer of pleural membranes.

What causes injuries of the brachial plexus and what are the results of an injury?

Cause: disease or injury Result: paraylsis or anesthesia

3rd heart sound: -when does it happen? -during systole or diastole? -what causes this? -usually associated w/ what?

S3 -happens during ventricular filling -during early diastole -produced by vibrations of the ventricular walls -associated w/ CHF due to volume overload

Where does the thoracic duct empty?

Into the junction of the left subclavian vein and the left internal jugular vein

Thoracentesis/Pleural Tap

Invasive procedure to remove fluid/air from the pleural space

What fixes the muscles/tendons of the anterior leg muscles to the ankle?

Superior and inferior extensor retinaculum

Visceral Pleura

Covers each lung directly

What standardized assessments did we learn about that are criterion referenced? Norm referenced?

Criterion: -Infanib -GMFM -SFA Norm: -AIMS -BSID-III -PDMS-2 -PEDI -BOT-2 -ASQ-3

What fascia forms intermuscular septa in the leg?

Crural fascia

Lobes of the Right Lung

Superior, middle, and inferior

Hiccups: what are they, and what causes them?

Involuntary, spasmodic contractions of the diaphragm interrupted by closure of the glottis. This can be caused by diaphragmatic irritation or consumption of certain things. It is normal and looked for in infants in utero.

What is the function of the serous fluid in the pleural cavity?

It allows for movement of the thoracic cage and diaphragm without producing friction with the lungs

What happens to the brachial plexus if an individual has hypertrophied scalenes?

It can impinge on the brachial plexus

Foot pronation is produced by ______ of the tibia. The rear foot and midfoot ________ and the forefoot _________

IR of tibia rear and midfoot pronates forefoot supinates

Which type of axons are involved with proprioception?

Ia Ib II

Order the following sensory nerve afferents from largest to smallest in diameter: -II (A beta) -Ia -A delta -C -Ib

Ia Ib II (A-beta) A delta C

What is Erb's Palsy and what causes it?

Injury to superior part of brachial plexus caused by excessive separation of the head & neck such as falling with shoulder on ground or during child birth

Quiet Respiration: muscles used for inspiration and expiration

Inspiration: mainly diaphragm (a little ext intercostal, interchondral in intercostal) Expiration: passive elastic recoil (a little abdominal mm)

What 2 veins come together to form the brachiocephalic vein on each side?

Internal jugular vein and subclavian vein

Pulmonary Ligament

NOT a true ligament. It's an extra reflection of pleural membranes onto each other inferior to each hilar region

Do the lungs have pain receptors? How is pain perceived from that area?

No, the visceral pleura and lungs have no pain fibers. The parietal pleura does have pain fibers which can be local or referred. The diaphragm is innervated by C3-5 so parietal pleura pain may be referred to the neck/shoulder area.

What artery runs in the lateral compartment of the leg?

None (fibular A is posterior compartment)

Which muscles of the anterior leg share a synovial sheath under the extensor retinaculum?

None, they each have their own

When auscultating the heart, which heart sounds are normal? Which are abnormal? (options: 1st, 2nd, 3rd, 4th)

Normal: 1st and 2nd Abnormal: 3rd and 4th

What is the approximate O, I, N, F of gastrocnemius?

O: MH: medial epicondyle of femur LH: lateral epicondyle of femur I: calcaneal tuberosity via achilles N: tibial nerve F: plantar flexion, inversion, knee flexion

What is the approximate O, I, N, F of tibialis posterior?

O: Tibia, fibula and interosseous membrane I: navicular, cuneiforms, bases of 2-4 metatarsals N: tibial nerve F: plantar flexion, inversion

What is the approximate O, I, N, F of plantaris?

O: above LH of gastroc I: calcaneal tuberosity via achilles N: tibial nerve F: negligible (might prevent compression of post leg during knee flexion)

What is the approximate O, I, N, F of fibularis tertius?

O: distal surface of fibula I: base of 5th metacarpal (dorsal aspect) N: deep fibular nerve F: dorsiflexion, eversion

Where does the small saphenous vein terminate?

Popliteal Fossa

What do the anterior and posterior tibial arteries come off of?

Popliteal artery

What blood vessels run through the popliteal fossa?

Popliteal artery and vein (artery is deep to vein)

What pulse is particulary clinically important when no pulse is found in the foot?

Popliteal pulse

How do you do nerve tension testing on the ulnar N?

Position: pt supine, arm at side 1. depress scapula 2. abduct shoulder 3. ER shoulder 4. flex elbow 5. pronate forearm 6. extend wrist & fingers 7. cervical SB away

How do you do nerve tension testing on the radial N?

Position: pt supine, arm at side 1. depress scapula w/ thigh 2. extend elbow 3. IR shoulder 4. pronate forearm 5. flex wrist & fingers 6. slowly abduct shoulder 7. cervical SB away

In lumbar traction, perform a posterior pull if __________ (flex/ext) is desired. Perform an anterior pull if __________ (flex/ext) is desired.

Posterior: flexion Anterior: extension

What are common variations of the brachial plexus?

Prefixed/postfixed brachial plexuses, formation of trunks, divisions, cords may be different, the median nerve might be formed from 2 branches of the medial cord

Difference between a primary and secondary spontaneous pneumothorax

Primary: occurs in someone with no history of lung disease (most often happens in tall young men) Secondary: occurs in someone who has lung disease

Essential requirements for successful locomotion:

Progression: the need to initiate and terminate locomotion and move the body in the desired direction Postural control (stability): maintain the body upright and stable in a dynamic environment Adaptation: alter gait in response to a dynamic environment and changing goals

Summary (read):

Prosthetic foot type is selected based on a patient's ability & potential -indoor vs outdoor walking -environmental obstacles -single vs. variable speed

Describe a K level of 3: What is their ambulation status?

Pt has ability or potential for ambulation w/ *variable* cadence. Likely to achieve *community* ambulation, w/ ability to traverse *most* environmental barriers, & may have activity that demands prosthetic use *beyond* simple locomotion for work or TherEx

Describe a K level of 2: What is their ambulation status?

Pt has ability or potential for ambulation, including lower-level environmental barriers such as curbs or stairs. (still fixed cadence) W/ a prosthesis, pt achieves a *limited community* ambulation status

Describe a K level of 4: What is their ambulation status?

Pt has ability or potential for prosthetic ambulation that *exceeds* basic ambulatory skills, exhibiting high impact, stress, or energy levels during activity.

Describe a K level of 1: What is their ambulation status?

Pt has ability or potential to use a prosthesis for transfers or ambulation on *level* surfaces at a *fixed* cadence W/ a prosthesis, pt achieves limited or unlimited *household* ambulation status

What condition is common in children that live in a climate with little sun exposure?

Rickets

Is the azygos vein on the right or left side of the vertebral bodies?

Right side

When auscultating the (R/L) lung, you will need to place the stethoscope more anteriorly for the 3rd landmark on that side.

Right side

Which artery does the right recurrent laryngeal nerve run under?

Right subclavian artery at about T1

Differences between right and left bronchi

Right: wider, shorter, more aligned w/ trachea. Left: narrower, more horizontal

What is the roof, floor, superior and inferior borders of the popliteal fossa?

Roof: popliteal fascia Floor: knee joint capsule and popliteus muscle Superior: hamstrings Inferior: gastrocnemius & plantaris

What are the 5 regions of the brachial plexus?

Roots, trunks, divisions, cords, terminal branches (nerves)

Reaching development is split into what 3 phases? What time frame is covered in each phase?

Rudimentary reaching (pre-reaching): birth - 3 months Infant: 4 months - 9 months Childhood: 9 months - 11 years

How can you teach a pt to unload the spine in supine, sitting & standing?

Supine: lay on floor, legs supported at 90/90 Sitting: pt attempts to use UE's on arms of chair to unload the spine Standing: place one LE up on a step or push up on table w/ UE's

What does the suprascapular nerve innervate?

Supraspinatus, infraspinatus, and glenoid joint

Which nerve in the leg can be used for nerve grafts?

Sural (cutaneous) N

The right recurrent laryngeal nerve branches from the right vagus at what level?

T1 (subclavian artery)

Where are the sympathetic nerves that supply the 3 plexuses from?

T1-T5

At what vertebral level does the esophagus pass through the diaphragm?

T10 along with the vagus nerve

What vertebral levels are the lesser splanchnic nerves found at?

T10-11

What vertebral levels are the least splanchnic nerves found at?

T12

The left recurrent laryngeal nerve branches from the left vagus at what level?

T4-T5 (The ductus arteriosus or 6th aortic arch)

What vertebral levels are the greater splanchnic nerves found at?***

T5-9

What does the lower subscapular nerve innervate?

Teres major, and inferior part of subscapularis

What is immediately in front of, to the left, and right of the thoracic duct?

The azygos vein is to the right, the aorta is to the left, and the esophagus is in front of it

Which muscles are in the anterior compartment of the leg?

Tibialis anterior Extensor digitorum longus Extensor hallucis longus

What are the deep muscles of the posterior compartment?

Tibialis posterior Flexor digitorum longus Flexor hallucis longus

What muscles pass between the medial malleolus and the calcaneus under the flexor retinaculum?

Tibialis posterior Flexor digitorum longus Flexor hallucis longus (Tom, Dick, Harry)

The thoracic duct is originally on the right side of the vertebral bodies and then shifts to the left, why is this?

To drain into the junction of the left subclavian and left internal thoracic veins

T/F: the gastroc & anterior tib are relatively quiet during a hip strategy for postural control

True-- more quads/HS & abdomen/PS

T/F: prolonged periods of rest can be deleterious/harmful

True-- rest during the day & b/w PT sessions is recommended, but if they are not wanting to do anything and are sleeping for days, this is harmful to their health

Hilum

Where the bronchus and pulmonary vessels enter/leave the lung

Costomediastinal Recess

Where the costal and mediastinal pleura meet anterior to the heart on the left.

Can bodies have more than one type of azygos vein?

Yes, they can only have an azygos vein, they can have that plus a hemiazygos or any combination

What general motions are available at the scapulothoracic joint?

elevation/depression abduction (protraction)/adduction (retraction) upward/downward rotation

When during the course of therapy might the implementation of power exercises be appropriate?

end of treatment before discharge

How does the control of the serratus anterior change with increasing shoulder elevation?

activity increases throughout

Pain is an unpleasant sensory & emotional experience associated with _______ or _______ damage

actual or potential-- pain not always due to injury

What does intensity refer to as a determinant of resistance exercise? What are 2 options to inc/dec intensity?

amount of resistance imposed on the muscles during each repetition of an exercise -using sub-maximal load -using near/maximal load

What is forefoot equinas?

an abnormality in which the lower leg is 10 degrees forward of vertical

When performing a complete auscultation of the lungs, how many points would you listen to: -anteriorly? -posteriorly? -R side? -L side?

anterior: 10 posterior: 12 R side: 4 L side: 4

For the subtalar joint, describe the surfaces of the talus and calcaneus at the anterior and posterior aspects?

anteriorly: -convex talus -concave calcaneus posteriorly: -concave talus -convex calcaneus Cal Vex Post

What is resistance exercise?

any form of active exercise in which a static or dynamic muscle contraction is resisted by an outside force manually or mechanically applied

What causes increased airway resistance during thoracic surgery?

anytime you have tubes/valves shoved down the trachea, it inc airway resistance making it harder to get air in

Define: aphasia alexia agraphia

aphasia: spoken language alexia: comprehension of written language agraphia: ability to write

Define: receptive field

area of skin innervated by a single afferent neuron

The benefits of an energy storage & return prosthetic foot are more apparent in what situation?

at faster speeds -smoother dynamics during gait -dec impact on sound side at heel strike

What populations is achilles tendinopathy common in?

athletes runners patients w/ calf tightness

How do symptoms of CRPS manifest in different systems (autonomic, psychological, inflammatory, motor and sensory)?

autonomic (skin color change, sweating, swelling) psychological (fear, anxiety, anger) inflammatory (nail growth, hair growth) motor (weakness, tremor) sensory (allodynia, hyperalgesia)

Which type of diabetic neuropathy can affect the nerves that serve the heart and control BP, as well as nerves in the lungs and eyes?

autonomic neuropathy

Which type of diabetic neuropathy causes changes in digestion, bowel & bladder function, sexual response and perspiration?

autonomic neuropathy

In which type of prosthetic construction can you adjust the relative position of the foot underneath the prosthesis? exoskeletal or endoskeletal

endoskeletal

Which type of prosthetic construction allows the feet to be interchangeable? exoskeletal or endoskeletal

endoskeletal

Which type of prosthetic construction can facilitate multiple alignment options? exoskeletal or endoskeletal

endoskeletal

Proliferation & ________________ are both a part of phase 3 of wound healing.

epithelialization

In which phase of healing does wound closure occur?

epithelialization phase

Culture

behaviors, values & beliefs shared by a group of people

Over which ribs does the scapula cover in resting position?

between ribs 2-7

Attitudes & beliefs are based on experience but create a _________

bias

LE veins contain __________________ to aid in venous return

bicuspid valves

Structure involved with prosopagnosia

bilateral damage to visual secondary sensory area

Which artery is typically affected in a Volkmann's Ischemic Contracture?

brachial A- usually after humerus fracture

What body structures might be affected in preterm babies?

brain and neurological system may not have been developed compared to if born full term

Describe the appearance of granulation tissue: (2)

bright red budding tissue

The ______________ phase of healing occurs concurrently with other phases of healing, primarily the proliferation phase

epithelialization phase

T/F: the heel height of an endoskeletal prosthesis can be adjusted

false, they are aligned to one heel height, so shoes can dramatically affect overall alignment

Function: axoplasm

carries cell components to/from cell body and terminal endings (cytoplasm of nerves)

What AD may be utilized after an ankle sprain?

cast, tapping and crutches

What is the main education component for patients with FAI?

changing activity

What happens to reaching skills in a child between 9-11 years old?

children combine strategies to improve efficiency and reduce the amount of attention required

Pain that has a longer onset of 3+ months, loose link with pain generator, is a learned behavior, has no clinical findings, not broken by force and pain that serves no biological purpose are all characteristics of what type of pain?

chronic

When should you design treatment programs with the caregiver in mind?

chronic cases this is different than normal plans of care, don't normally have to consider practicality and financial aspects for a caregiver

Complex regional pain syndrome, fibromyalgia, neuropathic pain, headaches, TMJ, and chronic LBP are all examples of what type of condition?

chronic pain syndromes

7 year olds constantly monitor and control their reaches with a ________ strategy

closed-loop (lots of visual feedback)

The remodeling phase of healing is a balance between what 2 things?

collagen synthesis and lysis

Function: primary auditory cortical area

conscious discrimination of loudness and pitch of sounds

What are bronchial sounds a result of?

consolidation or compression of the pulmonary tissue that assists in transmission of sound from the bronchial tree

Define: postural control

controlling the body's position in space

With stage III CRPS, _____ skin is associated with a poor prognosis

cool

What does the skin surrounding a diabetic wound look like?

cracking callous formation

The calf pump uses __________ fascia and extensive valves to generate a _____ % ejection fraction

crural fascia 65%

Where can ulnar nerve entrapment occur?

cubital tunnel, Guyon's canal

T/F: periodization is an important aspect of everyone's exercise routine

false, usually only athletes

T/F: in pediatrics we likely will only use one objective measure

false, we will use a combination of tools (ROM, strength etc.) in addition to standardized assessments

In PT with a post-thoracic surgery patient, you should coordinate mobilization & body position with:

deep breathing & supported coughing maneuvers

Edema increases with legs in a ______________ position

dependent

How do you determine how long you should wait before implementing resistance exercise?

depends on cause of impairment (hamstring pulling 2-4 wks and ACL reconstruction 6 to 12 months)

Pruritis (chronic itchiness) is a result from a _____________ problem and a symptom of systemic changes from ___________ insufficiency

dermatologic venous

Which layer of the skin houses sensory organs and vasculature?

dermis

What does transduction mean in reference to first order neurons?

detection of noxious or damaging stimuli

More than 60% of non-traumatic LE amputations occur in people with:

diabetes

Which type of wound (venous, arterial, diabetic, pressure ulcer) involves delayed healing?

diabetic wound

For auscultation of the lungs, you listen with the (diaphragm/bell) of the stethescope

diaphragm

As a PT, we need to learn to differentiate ______ pain from _______ pain, both of which are part of the peripheral nervous system

differentiate between *somatic* pain and *visceral* pain

What is the diameter of a varicose vein?

dilated >4mm in diameter

Recovery from balance threats take place in a ______ to _______ sequence during slips

distal to proximal

Two-point discrimination is more sensitive ________ (distally/proximally)

distally Ex: hands & feet have small receptive fields that are densely packed together

Are there more venous valves located proximally or distally?

distally, lessen toward the hip

Stride length is defined as:

distance from one heel strike (or foot contact with the ground) to ground contact with the same foot -a.k.a. right heel strike to right heel strike

Function: primary visual area

distinguishes intensity of light, shape, size and location of objects

Function: primary visual cortical area

distinguishes intensity of light, shape, size and location of objects

What is the purpose of fascia surrounding muscles?

divides muscles, nerves and blood vessels into specific compartments -holds these systems in place -collagen make up does not allow for easy stretch or expansion

To assist with MCP extension of joints 2-5, you would perform what kind of glide?

dorsal

Since the wrists aren't in the anatomical position when performing glides, what direction are the glides referred to as?

dorsal (towards back of hand) volar (towards palm of hand)

Where on the hand can you test for sensation loss resulting from damage to the radial nerve?

dorsal web spaces

Loss of executive functions, lack of initiative and apathy are indications of damage to which association cortex?

dorsolateral prefrontal association

What are some special tests that can be done on the ankle for the talocrural joint?

drawer test talar tilt

What are some benefits of a SACH prosthetic foot? (3)

durable, simple, inexpensive

Describe how the shock absorbtion of the foot happens during gait? (detailed description starting with the tibia)

during the weight bearing part of the gait cycle, the tibia internally rotates, causing the IR of the talus and pronation of the calcaneus. This stretches the ligaments on the arch of the foot to absorb shock

What therapeutic exercise might you include in the early, late and functional stages after an ankle sprain?

early: limit eversion/inversion and weight bearing exercises; DF/PF ROM exercises, towel toe curls, gastro and soleus stretching, isometrics late: progress to isotonic, isokinetic and WB exercises, total ROM including eversion/inversion (no pain), balance w/ double and single leg stance and unstable surfaces functional: running, jumping, stairs, balance exercises

Describe the education, modalities and manual therapy parts of a treatment plan for an ankle sprain?

education: rest, no WB modalities: RICE, intermittent air compression device, cryo cuff manual therapy: gentle massage and grade I and II mobilization for acute phase. Grade III and IV mobilization when pain decreases and healing takes place

How are rotational torque adapters AND vertical shock absorbers incorporated into a prosthetic foot?

either built into the prosthetic foot or attached as a separate component

When does a superior roll and inferior glide happen with shoulder motions?

elevation (flexion > 90 degrees, abduction)

How does our somatosensory system help us recover our balance after a perturbation?

strategy depends on the time of the perturbation - if a trip occurs early in swing: elevating strategy of swing limb by increased flexion and early heel rise of stance limb -if a trip occurs late in swing: lowering strategy with plantarflexion of swing foot to reach for ground

In which layer of the skin (specific) is melanin produced?

stratum basale

What are 3 aspects of resistance exercise?

strengthening power endurance

What is the neurophysiological model theory?

stretch reflex occurs as a response to overstretching. Reaction is to recoil spring into concentric contraction

What is an ankle sprain defined as?

stretching or tearing of lateral or medial ligaments of the ankle joint

Where can radial nerve entrapment occur?

supinator muscle

In a median sternotomy, what position is the patient in?

supine

For auscultation of the lungs, the pt can be positioned how?

supine or sitting

What treatment is provided usually after growth has stopped in a scoliotic curve greater than 30 deg?

surgery

What needs to be done to treat acute compartment syndrome?

surgical intervention is necessary (fasciotomy or fasciectomy)

Define: Center of Pressure (COP)

the center of distribution of total force applied to the supporting surface (located on the ground when standing) also can be thought of as the vertical projection (towards the ground) of the COM

Define: Neurodynamics

the study & relationship of the nervous system's mechanics and physiology

When attempting recovery from a slip, older adults may end up tripping. Why is this?

they have delayed and weaker muscle responses of the rectus, abdominals and tibialis anterior (muscles required for recovery from trips)

T/F: there are specialty prosthetic feet for certain activities such as skiing or swimming

true

What is a step-turn?

turning to the left with the right foot forward. Weight is shifted to the right foot so that the left hip can externally rotate. Weight then transfers to the left foot

What is a spin-turn?

turning to the right with right foot forward. The body spins around the right foot

The dermis contains the most of which type of collagen?

type 1: 75-85% type 3: 15%

When does the remodeling phase of healing occur?

up to 2 years

What are features of plyometric exercise?

using max force in a short period of time eccentric to concentric

To facilitate wrist extension, would you perform a dorsal or volar glide?

volar

How does stair walking change in older adults?

walk with larger foot clearance in descending stairs compared to young adults

Why is it important to be able to recognize visceral pain as a PT?

we must be able to distinguish this type of main from musculoskeletal pain to know when to refer back to MD or advise patient to seek another treatment route

Where are neuropathic (diabetic) pressure ulcers usually located?

weight bearing surfaces

When is a coronary artery bypass graft procedure performed?

when a coronary artery becomes completely occluded

What does egophony sound like?

when patient says "E" but you hear "A" during lung auscultation

When is a percutaneous transluminal coronary angioplasty (PTCA) performed? (type of CV revascularization procedure)

when the lesion doesn't completely occlude the lumen of a coronary A

When are vesicular/bronchial sounds considered abnormal?

when they occur in a different anatomical location (ex: when bronchial sounds occur over normal lung tissue)

What does bronchophony sound like?

when you can hear a pt clearly say "99" (normally sounds muffled)

What does whispering pectoriloquy sound like?

when you can hear a pt talk very softly (normally shouldn't hear anything)

Global aphasia may happen when?

with a large lesion in lateral L cerebrum

With stage 1 CRPS, movement affects pain how?

worsens it immobility of the limb serves as a protective position