Things to Study

iontophoresis

-continuous direct current to transport medicinal agents through the skin -like charges repel like charges (+) ions move towards (-) pole (cathode), where secondary alkaline rxn occurs (-) ions move toward (+) pole, where an acid rxn occurs -max intensity is 4-5 mA

Metabolic Acidosis

-decrease in bicarb, increased acids, pH < 7.35 -caused: renal failure, lactic acidosis, starvation, diabetic, alcohol ketoacidosis, severe diarrhea remember Acidotic A: aspiration toxicity (increase in acid in body) C: Carbohydrates not metabolized I: insufficiency of kidneys acids increase) D: diarrhea (body breaks down ketones) O: ostomy drainage fisTula: I: intake of high fat diet C: carbonic anhydrase inhibitors: diuretic which reduces reabsorption of bicarb -sx: HA, fatigue, muscular twitching, compensatory hyperventilation(kussmaul breathing), nausea, lethargy, coma, vomitting, diarrhea, malaise, hyperkalemia, cardiac arrythmias tx: correct electrolytes, administer sodium bicarb

Athetoid Cerebral Palsy

-decreased muscle tone, floppy baby -poor functional stability in prox joints -ataxia, incoordination -poor visual tracking, speech delays

Hallux rigidis

-degenerative arthritis and stiffness -due to bone spurs that affects the MTP at base of hallux -will likely be prescribed a rocker bottom shoe

Gross Motor Functional Measure (GMFM-88)

-developed to measure change in children with CP and Down Syndrome -all items should be accomplished by a 5 year old w/ typical normal motor development -voluntary movements in prone, supine, sitting, crawling, kneeling, standing, walking, jumping

Bruininks-Oserestky Test of Motor Preficiency (BOT-2)

-developed to measure gross and fine motor in children 4.5- 21 years old -norm referenced on typical children

limitation to diagnostic ultrasound

-difficulty penetrating bone and therefore visualizing internal structures of bones -poor contrast resolution -small viewing field -can't penetrate deep good for: soft tissue dysfunction, real time dynamic imaging, diagnosing tears, muscle abnormalities, fluid collections, benign and malignant soft tissue tumors, early RA changes, lumps, soft tissue masses (children)

obese patient and wheelchair prescription

-displace the rear axle forward for more efficient arm push -adjustable backrest to accomodate excessive posterior bulk -reclining WC to accomodate excessive anterior bulk; cardio compromised -power application to accomodate excessive fatigue

ovaries in the endocrine system

-either side of uterus -provide estrogen and progesterone to regulate menstruation and pregnancy -estrogen secreted by ovarian follicles, development and maintenance of female sex -progesterone: produced by corpus luteum and maintains lining of uterus for pregnancy

cirrhosis of liver

-healthy tissue is replaced by scar tissue and blocks blood flow etiology: hep C, alcoholism, toxins, drugs sx: decreased appetite, nausea, weakness, abdominal pain, weight loss, spider angioma tx: liver transplant

ACE inhibitor side effects

-hypotension, dizziness, dry cough, hyperkalemia, hyponatremia -avoid sudden changes in posture -CHF: avoid rapid progression/increase in activity

contraindications to US

-impaired circulation -impaired cognitive fxn -impaired sensation -malignant tumors -over or near thrombophlebitis -joint cement -directly over plastic -over ear, brain, eye, heart, cervical ganglia, carotid sinus, reproductive organs -exposed or unprotected SC -over top pace makers -over the abdomen, low back, uterus or pelvis during pregnancy

posterior walker

-improves upright posture, trunk ext, shoulder depression, elbow ext, neutral wrist -decrease LE scissoring -energy efficiency -velocity *typically used with CP children

abnormal oculomotor nerve

-lateral strabismus (stuck laterally, cant go medial) - pupillary dilation (CN 3 does constriction) - ptosis (loss of innervation to the levator palpebrae superioris muscle, which elevates the eyelid) - double vision ( inability to move the eyeball normally, because four of the six ocular muscles) -abnormal pupillary light reflex

pituitary gland in the endocrine system

-located beneath hypothalamus -adenohypophysis (anterior) and neurohypophysis (posterior) -releases hormones that regulate other endocrine glands -influenced by season changes/emotional stress secretes endorphins, reduce sensitivity to pain

testes in the endocrine system

-located in scrotum between upper thighs -secrete androgens(testosterone) to regulate body changes and support production of sperm

pancreas in the endocrine system

-located in upper L quadrant -both endocrine and exocrine -islet of langerhan--> alpha and beta alpha: produce glucose beta: produce insulin

Ataxic Cerebral Palsy

-low postural tone w/ poor balance -stance and gait are wide based -intention tremors of hands -uncoordinated movement -ataxia -poor visual tracking

Parameters to e-stim (amplitude)

-magnitude of the current -average amp: average amount of current supplied over a period of time, while peak amp is the max (+) or (-) point from zero where the pulse is maintained amplitude controls are labeled intensity or voltage and expressed as volts, microvolts, millivolts...the higher the amplitude, the greater the peak amp

internal carotid artery stroke

-massive infarct in the areas of the brain that controls MCA and ACA -significant edema -possible uncal herniation, coma and death

considerations with alginates

-may use dry gauze or transparent film for secondary dressing -change schedule varies from every 8 hours to 2-3 days

School Functional Assessment (SFA)

-measures participation, task supports, activitiy performance, physical tasks and cognitive/behavioral tasks in school setting -K-6 (5-12 y/o) -criterion referenced

Phenylketanuria Syndrome

-mental retardation, behavioral/cognitive issues due to elevation of serum phenylalanine (missing enzyme) -autosomal recessive inherited trait -sx: gait disturbances, hyperactivity, psychoses, abnormal body odor, lighter skin tx: dietary restrictions of phenylalaine

Paget's Disease

-metabolic condition, heightened osteoclast activity -bone is enlarged but no strength -caused: genetics, > 50 y/o * spinal stenosis, facet arthropathy, spine fx sx: MS pain, kyphosis, coxa vara, bowing of long bones, vertebral compressions, pain, headache, vertigo, hearing loss, mental deterioration tx: pharm, biphosphanates, exercise, weight control, cardiac fitness, joint/bone protection, implement aerobic endurance (acquatic)

complications associated with DM

-microvascular disease (retinopathy, renal disease, polyneuropathy) -macrovascular (CVA, MI, PAD) -integ changes (decreased healing) -joint stiffness/contractures, increased osteoporosis -neuromuscular impairments (diabetic polyneuropathy, diabetic autonomic neuropathy) -kidney, vision and liver impairments

Duchenne's MD impairments

-muscle wasting and atrophy (prox--> distal) -look for gowers sign -protuberant abdomen -increased lumbar lordosis (causes weak hip extensors), weak knee extensors -pseudohypertrophy of calves tx: do not exercise or strengthen (this causes further atrophy)...low repetition AROM is safe contractures of hips, knees, plantarflexors and IT band

precautions with diabetes and exercise

-need to eat at least 2 hours before exercise -dont inject short acting insulin in exercising muscles(absorbed more quickly) *abdominal site is preferred

Prolifertive Phase of healing

-new tissue -granulation tissue fills bed -collagen matrix formed -wound closure occurs through wound contraction and epitheliazation -angiogenesis, granulation formation, wound contraction, epitheliazation 3-21 days

doppler ultrasonography

-non invasive -evaluates blood flow into major veins, arteries and cerebrovascular system -relies on transmission and reflection of high freq sound waves to produce cross sectional images -safer, less expensive and shorter time period

disadvantages to foams

-nontransparent -nonadherent foams require secondary dressing, tape, or net -some newer foams have tape on edges -poor conformability to deep wounds -not for use w/ dry eschar or wounds w/ no exudate

Denver Developmental Screening II Test

-norm referenced, standardized -personal social, fine motor adaptive, language, gross motor and behavioral categories -age range: 1 week to 6.5 years

sarcoidosis

-occurs between 20-40 in women -4 times more prevalent in AA -systemic pathology of unknown etiology -tiny clumps of abnormal tissue (granulomas) that form on certain organs or face

impetigo

-superficial skin infection caused by strep or staph -inflammation, small pus filled vesicles, itching -CONTAGIOUS

modified ashworth scale

0- no increase in muscle tone 1- slight increase in muscle tone, min resistance at end of ROM (catch and release or minimal resistance at end of ROM) 1+ - slight increase in muscle tone, catch followed by min resistance through less than 1/2 of ROM 2- marked increase in muscle tone through most of ROM, affected parts moved easily 3- considerable increase in tone, passive movement difficult 4- affected parts rigid in flexion/extension

reflex grading

0-absent 1+ - depressed, hypoactive 2+ normal 3+ increased, brisker than average 4 + very brisk, hyperactive

correlation statistics

0.26-0.49 - low 0.5-0.75= moderate 0.75-1.0 = high

Compression therapy is contraindicated when the ankle-brachial index is less than

0.8

malpractice comes from

1 ) a duty to act in a particular manner 2) conduct that breaches that particular duty 3) damage that occurs from that conduct 4) conduct that is substandard, causing injury

what ultrasound parameters are necessary to treat acute bursitis of the hip?

1 MHZ and 1.5 watts/cm2

Terminate Cardiac Rehab Phase 1 if...

HR > 130 or > 30 bpm above resting DBP > 110 SBP decreases more than 10 significant ventricular or atrial dysryhtmias 2nd or 3rd degree heart block ECG changes of ischemia DBP > 110 SBP > 210 SBP increases > 20 from resting HR > 20 above resting

Chronic Adaptations To Aerobic Exercise (submax)

HR: decrease AVO2 difference: no change SBP/DBP: no change or slight decrease Blood Lactate: decreased Skeletal Muscle Blood Flow: no change

obesity is associated with....

HTN dyslipedemia hyperinsulinemia (type 2 DM) hyperglycemia CV disease stroke glucose intolerance gallbladder disease menstrual irregularities cancer

developmental age of bridging

5-7 months

developmental age of ring sitting

5-7 months

Most patients are considered to have the physical capacity to return to work if the average demand of their job is less than or equal to ____ of the peak METs achieved on an exercise test.

50%

exercise prescription with DM

50-80 % of MVO2 or HRR (12-16 on Borg) 3-7 days/week 20-60 min resistance: 60-80% of 1 RM, 2-3 sets of 8-12 reps

Aerobic Prescription Intensity (normal healthy population)

55-90% of Target Heart rate (HR max x ____) 40-85% of Heart Rate reserve (karnovens formula) Karnoven's formua: ((HRrest - HRmax) x ____ %) + HRrest

where should crutches and cane be measured in terms of the body?

6 inches in front and 2 inches lateral to the body

glasgow coma scale motor response

6- obeys commands 5- moves to localized pain 4- flexion withdrawl from pain 3- abnormal flexion 2- abnormal extension 1- no movement

rotator cuff repair rehab...

6-8 weeks: strength, endurance, NM control 12-14 weeks: task specific strengthening 24-28 weeks: return to rec sports (golf/tennis) 36-40 weeks: return to previous lifestyle 6-8 weeks: begin strengthening

exercise prescription in healthy elderly

60-90% of HRmax and 50-85% VO2 max

skin fold measurement

9 standard sites: abdominal, triceps, biceps, chest/pectoral, medial calf, midaxillary, subscapular, suprailiac, thigh *take on right side of body *perpendicular to skin

accessibilty requirements for parking spaces

96 in width 240 in length approx 2% of total spaces must be accessible

do not exercise if blood glucose is ....

<70 mg/dL or... > 300 or poorly controlled

ABI Values

> 1.4 = rigid 1-1.39= normal .8-.99 = mild blockage .4-.79 = moderate blockage < .4 = severe blockage *dont use compression if ABI is < .8

Antihyperlipedemia Drug Names

Lipitor (Atorvastatin) Zocor (simvastatin) Tricor (Fenobibrate) Choledstryramine: Questrain Colestipol: Colestid Lovastatin: Mevacor (ending in -OR or -statin)

Braden Scale vs Wagner Scale

Braden: 6 item pressure sore risk assessment (scores 6-23, scores <18 indicate progressive risk) Wagner: designed to assess the depth and tissue involvement of diabetic foot ulcers or dysvascular ulcers (i.e., any ulcer which results from the inadequacy of vascular structures).

Cardiac Rehab Phase 2

Intensity: 55-90 % THR OR 40-85% using Karnoven METS: 40-85% RPE: 12-16 (40-85% of max capacity) RPE: 11-13 is upper limit RPE : 14-16 high intensity training at end of rehab duration: 15-20 min continuous (1st month), 25-30 min (3-4 months) and > 40 min (after 6 months) 2:2 ratio for exercise/interval

Pulmonary Rehab

Intensity: REP 4-6 (on 10 scale) or 12-16 (on 6-20 scale) Duration: min of 30 min accumulated Frequency: 3-5 days/week

hamstrings need to be fully ranged in what position?

110 degrees in supine

hot packs

12 in by 12 in, 24 in x 24 x or cervical (6 x 18) stored in water 158-167 degrees NEED 6-8 LAYERS (covers are typically 2-3 layers) max temp reached in 6-8 min, check every 10 min and give bell treatment time: 15-20 min 2 hours to initially heat, 30 min in between pt's

Berg Balance Scale

14 tasks of everyday life activities, scored on 5 point ordinal scale (0-4) max score is 56 <45 = high risk of falls

mm Hg pressure for patients?

16-18 - typically off the shelf stockings to prevent DVT 20-30 - control scar tissue formation 30-40= control edema in ambulatory patients

accessibilty requirements for bathroom toilet

17-19 in from floor to top of toilet not less than 36 in grab bar length grab bars 1 1/4 - 1 1/2 in in diameter 1 1/2 in spacing b/w grab bars and wall grab bar placement 33-36 in up from floor level

Herpes 1 and 2

1: itching and soreness, cold sore or fever blister 2: genital eruption

Rancho Los Amigos Brain injury

1: no response 2: generalized response 3: localized response 4: confused agitated 5: confused inappropriate 6: confused appropriate 7: automatic appropriate 8: purposeful appropriate

maitland grades

1: small amplitude at beginning of range 2: large amplitude at beginning to midrange 3: large amplitude at end of range 4: small amplitude at end range 5: small amplitude, quick thrust

electrodes with e-stim

2 electrodes of opposing charges w/ direct or monophasic pulsed= 1 (+) and 1 (-)...in alternating, the cathode and anode switch current density: size of the electrodes and distance...current is more under smaller electrode closer electrodes= current is more dense in superficial tissues vs further away electrodes= current is more dense in deep tissues

highest grip strength at five-position grip strength ?

2 or 3 *uses the FDS and FDP (in position 4 and 5, they are max stretched and in 1, they are max shortened)

2 pt vs 3 pt vs 4 pt gait used with?

2 point: 2 crutches or 2 canes 3 point: walker or crutches 4 pt: 2 crutches or 2 canes (for those w/ impaired balance, coordination or strength deficits)

Productive analysis Quality Assurance Utilization Review Accreditation Review

Productive Analysis: measure of financial efficacy of labor costs Quality Assurance: peer review of pt care notes Utilization Review: external review of necessity of pt care, not a review of the quality of patient notes Accreditation Review: voluntary process of quality measurement against an external set of standards

homogeneity study

SR free of variations (heterogenity) in the directions and degree of results between individual studies

medial cutaneous nerve of arm

T1 supplies inner portion of antebrachial near armpit comes off of medial cord

what occurs in open chain knee extension? closed chain knee extension?

OKC: anterior glide of tibia and ER of tibia CKC: medial rotation of femur on tibia

American with Disabilities Act (titles)

Title 1: employment Title 2: public services Title 3: public accomodations Title 4: telecommunications Title 5: Miscellaneous

Type 1 vs Type 2 Error

Type 1 error: null hypothesis is rejected by the researcher when it is true; the scores are concluded to be different when the differences are actually due by chance *false positive= saying there is a difference when there truly is not a difference Type 2 error: null hypothesis is not rejected by the researcher when it is false; the means of scores are concluded to be due to chance when the means are truly different *false negative= saying there is not a difference when there truly is one reduce the errors by increasing the sample size, using random selection and having valid measures reduce the chance of errors

UMN vs LMN bladder

UMN: above T12-L1 they have to use suprapubic stroking or tapping, kneading (reflex is intact and can be emptied reflexively) LMN: below T12...use crede maneuver, valsalva manuever, timed voiding program

UMN vs LMN disease

UMN: damage in the brain, SC, brainstem sx: hyperreflexia, hypertonia, spasticity, muscle spasms, + babinski, dyssynnergia and timing deficits ex: cerebral palsy, hydrocephalus, CVA, birth injuries, multiple sclerosis, and brain tumors, SCI LMN: lesion in nerves from the anterior horn cell going out to the muscle sx: hypotonia, hyporeflexia, atrophy, fasciculations ex: poliomyelitis, tumors involving the spinal cord, trauma, infection, and muscular dystrophy, SCI at L1 and below *in SCI, this is L1 and below

VOR vs VSR vs optical righting reaction

VOR: coordinates head and eye movement to support gaze stabilization. VSR: The vestibulospinal reflex acts to stabilize the body and control movements while the head is moving. optical righting reaction: acts to keep the eyes in a horizontal plane through alterations in cervical spine positioning. This reflex activates the muscles of the posterior neck to prevent the head from falling forward as the shoulders become more rounded.

heterotopic ossification

abnormal growth of bone in the non-skeletal tissues including muscle, tendons, or other soft tissue. When HO develops, new bone grows at 3 times the normal rate resulting in jagged, painful joints seen commonly after brain injury, typically in large joints such as knee and hip...due to tissue hypoxia or maybe abnormal calcium metabolism sx: edema, decreased ROM, increased temp of involved joint tx: Maintaining available range of motion, avoiding "vigorous" stretching, and achieving and maintaining "optimal wheelchair positioning" are the recommended therapeutic interventions

What are the 7 core values?

accountability altruism compassion/caring excellence integrity professional duty social responsibility

gout

accumulation of excessive uric acid in the blood that results in the formation of crystals within the joints, which triggers a painful inflammatory process * usually 1st toe or peripheral joints of LE * can occur with hyperparathyrodism

acidic and alkaline reactions from ionto

acidic: result of hydrochloric acic forming under the (+) electrode (anode) alkaline: sodium hydroxide forming under the negative electrode (cathode)

thromobolytic drug actions

activate the body's fibrinolytic system dissolve the clot and restore coronary blood flow used for: acute MI, PE, ischemic stroke, arterial/venous thrombosis

vestibular ocular reflex

activation of the vestibular system causes eye movement. This reflex functions to stabilize images on the retinas during head movement by producing eye movements in the direction opposite to head movement, thus preserving the image on the center of the visual field(s). ex: when the head moves to the right, the eyes move to the left, and vice versa.

s/p flexor tendon reattachment, what ROM do you perform 72 hours after surgery?

active extension and passive flexion of the IP joints can perform AROM typically at 4 weeks

superficial thermotherapy contraindications

acute MS trauma arterial disease bleeding or hemorrhage over compromised circulation over malignancy peripheral vascular disease thrombophlebitis

Transcutaneous electrical stimulation (TENS)

acute and chronic pain management pain relief through gate control theory types: conventional, acupuncture like, brief tens, noxious tens

ultrasound contraindications

acute and post acute(thermal) areas of active bleeding decreased temp sensation DVT infection malignancy over breast implants over carotid sinus/cervical ganglia epiphyseal areas in children eyes, heart, genitalia cement or plastic pelvic, lumbar or abdominal areas in pregnant over area of pacemaker thromboplebitis vascular insufficiency

diathermy contraindications

acute infection acute inflammation cardiac pacemaker hemophilia inter/ext metal objects intrauterine device ischemic tissue low back, abdomen or pelvis of pregnant malignant area moist wound dressing hemorrhagic region over eyes, testes pain and temp sensory deficits

unilateral neuritis/labrinthitis

acute infection w/ prolonged attack of symptoms, persisting for several days or weeks, caused by virus or bacteria

traction contraindications

acute inflammation acute sprains/strains aortic aneurysm bone diseases cardiac/pulm problems condition where movement increases sx's dislocation fracture hiatal hernia increased pain or radicular sx's w/ traction infection in bones/joints meningitis osteoperosis peripheralization of sx's postiive alar ligament test positive vertebral test pregnancy RA-advanced subluxation TMJ trauma tumors vascular conditions vertebral joint instability

intermittent compression contraindications

acute inflammation, trauma, fx, acute DVT, thrombopletibis, obstructed lymph or venous return, arterial disease insufficiency, arterial revascularization, acute pulmonary edema, diminished sensation, cancer, edema w/ cardiac and renal impairment, impaired cognition, infection in tx area, hypoproteinemia, very old or young patients

cervical traction

acute phase: (8-10 lbs for initial).. 10-15 lbs or 7-10% of body weight for disc protrustion, soft tissue elongation, msucle spasm joint distraction: 20-30 pounds 5- 10 min for acute or disc protrustion, 15-30 min for others

Guillan barre

acute, ascending symmetrical polyneuropathy..progressive muscular weakness, perhaps due to autoimmune attack. Causes acute deymelination of both cranial and peripheral nerves (distal to proximal) sensory loss, motor paresis, dysarthria, dysphagia, diplopia, decreased DTR's worse motor > sensory corticosteroids are usually CI check CN 7, 9, 10, 11 and 12

Addisons Disease

adrenal insufficiency (hypo fxn adrenals and decrease cortisol and aldosterone produced) sx: *asthenia*, dark pigmentation of skins, hypotension, fatigue, hyponatremia, hyperkalemia, GI disturbances, weight loss, nausea, vomitting, arthralgias, hypoglycemia tx: replacement therapy, fluid intake, diet high in carbs/protein

hydrotherapy contraindications

advanced CV or pulm disease active bleeding diminished sensation gangrene impaired circulation incontinence maceration peripheral vascular disease renal infection severe infection severe mental disorders

double product or rate pulse pressure

assesses myocardial oxygen demand correlates to the onset of angina or the development of ECG abnormalities SBP x HR *keep the intensity of exercise below the RPP value will reduce the risk of developing angina

assisted cough, trach stimulation, endotracheal suctioning

assisted cough: aka manual costophrenic stimulation...therapists' hands or fist become the force behind the cough when their ab muscles cannot generate enough force (in SCI). Supine w/ HOB flat or in trendelenberg psition, or sitting w/ wheelchair against the wall..place hand at subcostal angle, inhale deeply, push in and up Trach stimulation: unable to cough on command, such as infants or patients with brain injury or stroke. Place thumb or finger at substernal notch, quick in an downward push on the trachea elicits a cough Endotracheal suctioning: used only when all other methods have FAILED. Apply suction intermittently so you dont damage the trachea

anticoagulation SE and PT implication

at risk for bleeding prevent alls, monitor for signs of bleeding, educate pt about risks

cerebellar deficits result in these symptoms....

ataxia (wide BOS due to irregular foot placement) dysarthria hypotonia dysdiadokinesia nystagmus tremor hypermetria (dysmetria) poor coordination posture deficits decrease initiation of movement *deficits are on IPSILATERAL side of lesion

atrial fibrillation

atria are depolarized between 350-600 times/min irregular undulations without discrete P waves can occur in healthy or pts with CAD, HTN and valve disease sx: palpitations, dyspnea, lightheadedness, syncope, chest pain

Social cognitive Theory

attempts to explain how patients acquire and continue with particular behavior patterns as well as providing a basis for intervention strategies behavior capability emotional coping responses environment expectancies expectations observational learning reinforcement reciprocal determinism self control self efficacy situation

Temporal Lobe

auditory and memory processing, Wernicke's area, interpret other people's emotions impairment: learning deficts, Wernickes aphasia, difficulty w/ facial recognition, difficulty w/ memory and memory loss, *hippocampus

Grave's Disease

autoimmune disease in which antibodies hyperstimulate thyroid gland sx: fatigue, weight loss via elevation of body's metabolism, enlarged thyroid (goiter), heat intolerance, nervousness, weight loss, tremor, palpitations

contraindications to exercise with SCI

autonomic dysreflexia severe or infected skin on WBing surfaces symptomatic hypotension UTI unstable fx uncontrolled hot/humid environment insufficient ROM to perform task

characteristics of central vertigo

autonomic sx's less severe loss of consciousness maybe diploplia hemianopsia weakness numbness ataxia dysarthria *fixation will NOT inhibit nystagmus

osteogenesis imperfecta

autosomal disorder of collagen synthesis that affects bone metabolism. often have developmental delays secondary to ongoing fractures that result in immobilization, hypermobility of joints and poorly developed muscles *does not affect muscle tone * DO NOT GIVE STEROIDS (already have low bone mass and lax ligaments)

Laxatives

bowel evacuation SE: nausea, abdominal discomfort, cramping, electrolyte imbalance, dehydration, dependence ex: Cirtucel (methylcellulose), Metamucil (psyllium), Colace (docusate), Fleet Glycerin suppository (glycerin), Phillips Milk of Magnesia (magnesium hydroxide), Correctol (bisacodyl), Senokot (senna)

contraindications to acquatic therapy

bowel/bladder incontinence severe kidney disease severe epilepsy severe cardiac dysfxn, failure, unstable angina, unstable BP large open wounds, infections, colostomy bleeding or hemorrhage water and airborne infections (flu, GI infections)

Skin Color Changes

cherry red: liver or renal issues, CO poisoning cyanosis: CHF, heart disease, venous obstruction pallor: anemia, internal hemorrhage, syncope yellow: jaundice, liver disease liver spots: aging, liver/uterine malignancy, pregnancy

medulla

influences ANS and regulates respiration and HR, reflex centers for vomitting, coughing, sneezing, relay somatic sensory info from organs for control of arousal and sleep impairments will cause contralateral impairment (DCML and corticospinal cross here so that's why it's contralateral) CN IX, X, XI, XII (glossopharyngeal) vagus, spinal accessory, hypoglossal)

anti-inflammatory agents (airway and lung)

inhaled corticosteroids, leukotriene modifiers and mast cell stabilizers prevent inflammatory mediated bronchoconstriction by inhibiting production of inflammatory cells, suppress release of inflammatory mediators and reverse capillary permeability SE: skin breakdown, osteoporosis, break down of tissue, glaucoma, delayed growth, check for liver dysfunction exM; Qvar, Pulmicort, Zyflo, Nasalcrom

Proton Pump Inhibitors

inhibit the H+/K+ ATPase enzyme that blocks secretions of acids from gastric cells. Prevent erosion and protect against H pylori indications: dyspepsia, GERD SE: acid rebound after discontinued use ex: Prilosec (omeprazole), Prevacid (lansoprazole), Nexium (esomeprazole), Protonix (pantoprazole), AcipHex (rabaprazole)

secondary progressive MS

initial onset of the relapsing remitting followed by progresion of the disease

lateral pectoral nerve

innervates pec major C5, C6, C7 comes off of lateral cord

Brown Sequard Syndrome

ipsilateral loss of DCML (proprio, 2 pt discrimination, pressure, vibration) ipsilateral loss of corticospinal tract w/ loss of motor function below level of lesion contralateral loss of spinothalamic tract w/ loss of pain and temp below level of lesion, at level....bilateral loss of pain and temp

acupuncture like TENS

long duration, low frequency w/ moderate current amplitude should generate muscle twitching (similar to motor TENS) pt's report uncomfortable burning produced through stimulation evoked production of endogenous opiates pain relief lasts hours, about 1 hour used for chronic pain tx time usually 20-45 min

when should someone use mental practice vs. serial practice vs. performance in variable environments?

mental- early cognitive stage serial practice- middle, associative practice in variable environment- autonomous

diathermy capacitive plate method

metal encased in a plastic housing produces an electric field from one plate to the other field radiation consists of a strong electrical field and a weak magnetic field heating pattern is SUPERFICIAL w/ majority of energy absorbed in skin application over areas of low fat content

foot orthosis

metatarsal pad: located posterior to the met heads, moves pressure from met heads to shafts; allows more push off in weak or inflexible feet cushion heel: cushions and absorbs forces at heel contact; used to relieve strain on plantar fascia in plantar fasciitis longitudinal arch support: prevent depression of subtalar joint and correct for pes planus

when is a heel cup prescribed? metatarsal pad? midsole cushion? Longitudinal arch support?

metatarsal pad: metatarsalgia or a neuroma heel cup: similar to a heel lift, good for shock absorption midsole cushion: used on a stiff foot (pes cavus) longitudinal arch support/strapping: limit excessive pronation (pes planus)

accessibilty requirements for doorway

min 32 in width max 24 in depth

accessibilty requirements for ramps

min of 36 in wide and handrails if ramp rise greater than 6 in horizontal run should be 72 in (6 in rise = 12 in x 6 = 72 in) landing area should be 5 ft by 5 ft if ramp changes direction 12 in of horizontal run for every inch of vertical rise (8.3% grade)...1:12 (rise: run)

monopolar vs bipolar electrode placement

monopolar: active electrode is placed over the target area, second electrode is placed far away...used w/ wounds, ionto, tx of edema bipolar: 2 active electrodes of same size, used for muscle weakness, NM facilitation, spasms and ROM

relapsing remitting MS

most common period of exacerbations followed by remissions, periods w/o sx's and w/o further progression

hydrogel disadvantages

most require a second dressing not used for heavily exudating wounds may dry out and then adhere to wound bed may macerate surrounding tissue

pulsatile current

non-continuous flow of direct or alternating current pulse: discrete electrical event separated from other pulses by a period of time where there is no electrical activity either mono or biphasic

transparent film disadvantages

nonabsorptive appplication can be difficult channeling or wrinkling not used on wounds w/ fragile surrounding skin or infected wounds

shin splints symptoms

nonfocal tenderness(diffiuse along tibia) lack of edema

chi square test

nonparametric test of significance used to compare data in the form of FREQUENCIES counts occuring in 2 or more mutually exclusive categories ex: subjects are asked to rate tx preferences

Mechanical Debridement

nonselective debridement using physical forces such as pulsatile lavage, wet to dry gauze or whirlpool contra: clean, granulated wounds

Achilles Tendon rupture

nonsurgical tx: immobilized for 10 weeks, heel lift for 3-6 months and therapy needs to be until 6-7 months (with HEP) tx: ROM, stretching, icing, AD training, endurance, programming, gait training, strengthening, plyometrics

Bayley Scales of Infant Development

norm referenced motor and mental scales birth to 42 months

Blood pressure norms in children 3-17

normal: < 90th percentile pre HTN: SBP and DBP 90-95th percentile stage 1 HTN: > 95th percentile plus 5 mm Hg Stage 2 HTN: > 99th percentile plus 5 mm Hg

end feels

normal: firm, hard or soft firm: ankle DF, finger extension (stretch) hard: elbow extension soft: elbow flexion, knee flexion abnormal: empty, firm, hard, soft empty: due to pain, joint inflammation, fx, bursitis firm: increased tone, capsule tightness, ligament shortening hard: fx, OA, osteophytes soft: edema, synovitis, ligament instability/tear

objectivity vs subjectivity

objectivity: agreement among expert judges on what is observed or done; scoring of a perceptible sign or sx is the same, regardless of who is observing the phenomenon (licensure test) subjectivity: refers to testing format that may differ depending upon the person grading the test (figure skating judge)

cohort study

observation studies in which subjects are classified according to presence or absence of a particular risk factor *determine risk ratio(ratio of the incidence rate of exposed to that of the control) do not evaluate effect of therapy lacks randomization may or may not have a control group

cross sectional study

observational study where the data and observations are made at one point in time and subjects are tested at relatively the same time *describes the prevalance of disease or conditions and demonstrates associations -cannot distinguish between newly occuring and long-established conditions - cannot identify causal relationshos

autonomic portions of cranial nerves

oculomotor: smooth muscle of eyeball (eye dilation) facial: lacrimal, submandibular, sublingual glands glossopharyngeal: parotid gland vagus: thoracic and abdominal viscera

pulmonary edema is caused by?

often L sided heart failure because the heart isnt pumping blood out to the periphery and causing it to back up into the lungs fluid collects in the alveoli, making it hard to breath sx: difficulty breathing, bubbly, wheezing or gasping sound, frothy sputum, cyanotic skin color, rapid irregular pulse

Atelectasis

one or more areas of the lungs collapse or do not inflate properly restrictive disease sx: cyanosis, SOB, increased breathing and RR

t test for independent samples

one tailed: based on a directional hypothesis; you can rule out one of 2 non-null directions ...ex: 15 sec stretch vs 30,..this is 1 tailed because we know that 30 seconds will always be more beneficial 2 tailed: when both non-null directions are plausible (either method A or method B could work)

indications for foams

partial and full thickness wounds w/ min-mod exudate secondary dressing for wounds with packing to provide additional support provide protection and insulation

partial thickness wound

partial thickness skin loss involving epidermis and into but not through dermis ex: abrasians, blisters and skin tears -healing occurs by reepitheliazation or epidermal resurfacing

lowest muscle innervation at L3

partial: gracilis, iliopsoas, quadratus lumborum, rectus femoris, sartorious full use of UE, hip flexion, adduction, knee extension

Terminate Cardiac Rehab Phase 2 if...

plateau or decrease in HR with increase work SBP plateuas or increases > 250 or DBP > 115 ST depression > 1 mm 2nd or 3rd degree heart block ventricular dysrythmias angina

what 2 conditions are associated with decreased breath sounds and decreased fremitus?

pleural effusion pneumothorax

Stutter test

plica condition knee flexed to 90 degrees sitting over edge of table, the examiner places their finger over the patella and passively extends the knee + = patella jumps/stuters between 60 and 45 degrees of knee flexion

point biserial correlation vs rank biserial correlation

point biserial: one variable is dichotomous(nominal) and the other is ratio or interval ex: relationship b/w elbow flexion spasticity and side of stroke rank biserial: one variable is dichotmous (nominal) and the other is ordinal ex: relationship b/w gender and functional ability

squamous cell carcinoma

poorly defined margins flat, red area high risk of metastasizing common in alcohol and tobacco use

large intestine and colon pain (IBS) symptoms

poorly localized to midabdominal area pain can be referred to sacrum

risk factors for osteoporosis

post menopausal age low body weight loss of height sedentary lifestyle tobacco use hyperthyroidism (graves disease)

Premature Ventricular Complex

premature depolarization of ventricles unifocal, multifocal, bigeminy, trigeminy sx: may be asymptomatic or palpitations causes: anxiety, caffeine, stress, smoking, all forms of heart disease more than 6 in a minute is unstable, less than 6 is fine

primary vs secondary risk factors for atherosclerosis

primary: smoking, high blood pressure, hyperlipedemia secondary: stress, obesity, low activity level, age, gender, race,

modeling

process of learning by watching others learning occurs through observation alone w/o any verbal direction from the therapist

operant conditioning

process where learning occurs when an individual engages in a specific behavior in order to receive certain consequences ex: (+) or (-) reinforcement

what does the liver do ?

produces bile makes RBC makes Vit K regulates serum carbs, proteins, fats

vapocoolant spray

produces counter-irritant stimulus to cutaneous thermal afferent nerves that overlay muscle reduces motor neuron activity treat trigger points -spray 3-4 sweeps in same direction as muscle (30 degree angle, distance 12-18 in away from skin) stretch the whole time when spray is applied

progressive relapsing

progression of the disease from the initial onset, as well as acute relapses in b/w relapses, the disease continues to progress

HIV (AIDS)

progressive destruction of cell mediated (t-cell) immunity and changes in humoral immunity because of the central role of CD4+ T lymphocyte in immune reactions...susceptible to opportunitistic infections such as cancer, TB early sx: fatigue, fever, chills, night sweats, swollen lymph glands, decreased appetite, thrush sx: alterations in memory, confusion and disorientation, ataxia, paresis w/ gait disturbances, loss of fine motor coordination, develop peripheral neuropathy w/ distal pain and sensory loss

bronchiectasis

progressive obstructive lung disease that produces abnormal dilation of a bronchus sx: productive cough, hemoptysis, weight loss, anemia, crackles, wheezes, loud breath sounds tx: antibiotics, bronchodilators, expectorants, mucolytics

Follicle Stimulating Hormone

promotes follicular development and creation of estrogen in females; promotes spermatogenesis in males target: ovaries and tests regulation: hypothalamus *made in pituitary

Luteinizing Hormone

promotes ovulation along with estrogen/progesterone synthesis from the corpus luteum; promotes testosterone synthesis in males target: ovaries and testes reguated: hypothalamus *made in pituitary

pronation of NWB foot and supination of NWB foot

pronation: abduction, dorsiflexion and eversion supination: forefoot adduction, plantarflexion of subtalar and midtarsal joint, inversion

which position will cause the most patellafemoral joint compressive forces?

prone and flexing the knee to 110 degrees with the hip extended

what conditions are associated with decreased breath sound and increased fremitus?

pulmonary edema consolidation atelectasis

signs and symptoms of infection

pus, redness, pain, swelling generalized: fever, chills, increased pulse increased erythrocite sedimentation rate and WBC count

visceral referral patterns

pyelonephritiis: thoracic or lumbar areas pancreatic cancer: thoracic or lumbar pain colon cancer: lumbar or sacral areas MI: nonspecific neck pain gallbladder: midback and scapular region eosphageal pain: mid back, head and neck appendix: LBP, pelvis or sacrum

corticospinal tract

pyramidal tract, ipsilateral voluntary, discrete and skilled movements (anterior is ipsi, lateral is contra) damage here: + babinski, absent superficial, cremasteric and abdominal reflexes, loss of fine motor or skilled motor

measures of variability

range (highest-lowest) standard deviation: subtract each score from the mean, square each difference, add all the squared differences and divide by the # of scores *appropriate w/ interval or ratio

diathermy inductive coil method

rapid metal encases coil produces a magnetic field perpendicular to the coil, charged particles in the tissue vibrate--> increase tissue temp field radiation consists of a strong magnetic field and a weak electrical field heating pattern DEEP with the majority of energy absorbed w/i deeper structures application over high water content

Wilson's Disease

rare inherited disorder, typically 4-6 y/o autosomal recesive, body cant metabolize copper sx: Kayser Fleischer rings in eyes, changes in basal ganglia, hepatitis, cirrhosis liver, athetoid movements, ataxia tx: vitamin B6 and D-penicillamine to excrete copper

waist to hip ratio

ratio of the circumference of waist to hips > .9- central obesity and risk factor for CAD

accessibilty requirements for side reach in chair

reach over obstruction 24 in

advantages to gauze dressings

readily available can be used w/ gels, saline, or topical antimicrobials can be used on infected wounds good mechanical debridement cost effective for large wounds effective delivery of topicals if moist

posting (foot orthosis)

rearfoot: varus post (medial wedge): limits eversion of calcaneus and IR of tibia after heelstrike valgus post(lateral wedge): controls the calcaneus that are inverted and supinated at heel strike forefoot: medial wedge: supports forefoot varus lateral wedge: supports forefoot valgus

Beta Blocker Actions

reduce HR and contractility; control arrythmias and chest pain (angina); reduce BP

antiepileptic agents

reduce or eliminate seizures, inhibit firing of CNS aka barbituates, benzodiapepines, carboxlyic agents, SE: ataxia, skin issues, behavioral changes, GI distress, HA, blurred vision, weight gain ex: seconal (secobarbital), Klonopin (chlonazepam), Dilantin (phenytoin), Neurontin (gabapentin)

Diuretic Actions

reduce preload and afterload; reduce myocardial work excretion of sodium in urine CH edema, pulmonary edema, glaucoma, HTN

Airborne Precautions

reduce risk of airborne transmission of infectious agents through evaporated droplets in air or dust -private room w/ negative air pressure - 6- 12 air changes w/in room per hour -room door always closed, pt in room -respiratory protection worn when entering -limit pt transport outside of room, pt has to wear a mask ex: measles, varicella, TB

Calcium Channel Blocker Action

reduce the calcium; reduce the contractility and HR, reduce the BP; control arrythmias and chest pain; dilate the coronary arteries used for angina, HTN, CHF, arrhymias

ACE Inhibitor Actions

reduce the conversion of Ang 1--> 2 peripheral VD reduce Na retention

droplet precautions

reduce the risk of droplet transmissions of infectious agents through contact of the mucous membranes of the nose, mouth, contact w/ conjunctivae and through coughing, sneezing, talking or suctioning. It requires close contact, particles only travel about 3 ft or less -private room, may share room w/ same diseased pt -maintain at least 3 ft b/w pt and personnel -room door may remain open -wear mask -limit transport outside of room, pt should wear a mask MASK ex: meningitis, PNA, sepsis, strep, pertussis, adenovirus, influezna, mumps, rubella

contact precautions

reduce the risk of transmission of infectious agents through direct or nondirect contact. Skin to skin or with contaminated object -private room, may share room w/ pt with same disease -use of gloves when entering room -change gloves after direct contact -take off gloves prior to leaving room, wash hands -wear a gown if you have substantially close contact -limit pt transport outside of room unless essential -dedicate non critical pt care equipment to one pt, don't share -gloves, gown ex: GI, respiratory, skin, wound infection, multi drug resistant bacteria, C-diff, E coli, shigella, Hep A, enterovirus, herpes simplex virus, impetigo, scabies, zoster, Ebola

hypolipedemic Action

reduce the serum lipid levels (when diet and exercise are not working) used for: hyperlipedemia, CAD, reduce cardiac events in those with CAD, PVC

intraclass correlations

reliability coefficient based on the analysis of variance + correlations= 0 - 1.0 as X increases, so does Y - correlations= -1.0 - 0 as X increases, Y decreases high correlation: >.76-1.0 moderate: -.51-0.75 fair: 0.26- 0.50 low: 0.00-0.25

reliability vs. validity

reliability: extent to which a test is consistent or yields the same result on repeated trials (reproducability of tests) validity: degree to which a test or measurement accurately reflects or assesses the specific concept the clinician is trying to measure (does it measure what its supposed to measure)

bronchodilators

relieve bronchospasm by stimulating receptors that cause bronchial smooth msucle relaxation include anticholinergics, sympathomimetics, xanthine derivatives SE: paradoxical bronchospasm, dry mouth, GI distress, chest pain, tremor, palpitations examples: Atrovent, Albuterol, Primatene, Theo Dur

wound irrigation

removes nonviable tissue from wound bed using pressurized fluid which serves as an externally applied force ex: pulsatile lavage

cardiac transplant exercise prescription

require longer warm up/cool down periods 4-6 x/week duration from 15-60 minutes have resting tachycardia HR will not increase linearly w/ exercise (base it on RPE)

disadvantages to alginates

require secondary dressing not recommended for dry or light exudate can dry wound bed

accessibilty requirements for carpet

requires 1/2 in pile or less

enzymatic debridement

requires application of commericially prepared enzyme to the surface of nonviable tissue contraindicated: clean, granulated tissue

sharp debridement

requires scalpel, scissors and forceps to selectively remove nonviable tissue contra: clean wounds, advanced cellulitis w/ sepsis, anticoagulation therapy

what is the most important factor to consider in an elderly with a transfemoral amputation?

residual limb healing

tectospinal tract

responsible for visual info related to spatial awareness. The tract ends at the cervical spine and controls the musculature of the neck as well as head position -arises from the superior colliculus(midbrain) and descends to ventral gray; assist w/ head turning to visual stimuli *damage to the extrapyramidal: paralysis, hypertonicity, exagerrated DTR's, clasp knife reflex

restrictive vs obstructive lung diseases examples

restrictive: atelectasis, PNA, SCI, pulmonary fibrosis, pulmonary edema, ARDS, (will likely have dry cough) obstructive: COPD, asthma, emphysema, bronchiectasis, CF, bronchitis (will likely have productive cough)

hyperparathyroidism

results in demineralization of bones due to increased secretion of pTH and loss of bone density and strength (osteopenia).. increases blood calcium levels sx: muscle weakness, loss of appetite, weight loss, nausea, vomitting, personality changes, kidney stones, memory loss, myopathy tx: pharm, surgery, diuretics or antiresorptive meds

Why would someone get a reverse TSA compared to normal TSA?

reverse: if rotator cuff is irreparable/completely torn

3 years development

rides tricycle stands on one foot briefly jumps off step hops on one foot kicks ball sharing

appendix pain

right LQ, pain can be referred to periumbilical or right hip area over Mcburneys point, 1/2 way between ASIS and belly button

Sinus node artery supplies:

right atrium (comes off of right coronary artery)

right scoliosis would have....

right rip hump high right shoulder prominent right scapula left hip protrudes

Right marginal artery supplies

right ventricle

right vs left hemisphere damage

right: difficulty grasping whole idea or task, difficulty w/ reasoning, poor judgement, impulsive, over estimate their abilities, quick, indifferent, difficulty with spatial perceptual tasks (tx: empahsize verbal cues since their visuospatial perception is messed up) left: cautious, anxious, disorganized, difficulty w/ communication, slow, hesitant, insecure, apraxia, aphasia

Fungal Infections (ringworm and athlete's foot)

ring worm: tinea corporis -involves hair, skin, nails, ring shaped tx: topical and antifungal athlete's foot: tinea pedis -fungal infection of foot, erythema, inflammation, pruritis, itching, pain tx: fungal creams

4 month development

rolls prone to side, supine to side sits w/ support no head lag bilateral reaching with pronation ulnar-palmar grip laughs out loud

ASIS apophysitis

runner coming out of blocks origin of sartorious

ischial tuberosity apophysitis

runner completing hurdles hamstrings affected

2 years development

runs well upstairs reciprocally active, restless jumps w/ 2 feet catches large ball

interval data

same rank order characteristic as ordinal, but also demonstrates known and equal distances between the units NO true zero point ex: celsius and fahrenheit

autonomic dysreflexia

seen in SCI above T6 severe HA (above) increase in BP (above) deceased pulse (above) sweating, pale, cool below lesion flushed appearance *DO NOT LAY THEM DOWN

malabsorption syndrome

seen with CF, celiac disease, Crohns, Addisons, AIDS etiology: defects w/ digestion sx: weight, loss, chronic diarrhea, oil covered stools, cramps, indigestion tx: probiotics, vitamins, diet

what are foam dressings?

semipermeable membranes that are either hydrophilic or hydrophobic. Vary in thickness, absorptive capacity and adhesive properties

sciatic nerve innervates

semitendinosus semimembranosus biceps femoris (long head) short head is (scaitis common peroneal division)

what 2 muscles are typically used with ACL surgery?

semitendinosus and gracilis *limits in early knee flexion but allows for decreased post op patellofemoral knee pain

Parietal Lobe

sensation of touch, kinestesia, perception of vibration, temp, receives info from other areas of brain, interprets language, spatial and visual perception impairment: L hemsiphere(agraphia, alexia, agnosia), R hemsiphere (dressing apraxia, constructional apraxia, anosognosia), contralateral sensory deficits, impaired language comprehension, impaired taste

shoe prescription for sesamoiditis, hallux valgus, pes cavus, metatarsalagia

sesamoiditis: transverse metatarsal bar and rocker sole hallux valgus: high and wide toe box, medial arch support, foot pronation pes cavus: cushion sole to absorb shock, metatarsal bar to shift weight from met heads, lateral flare to increase stability metatarsalgia: transverse metatarsal bar, rocker sole

redness over the patella in PTB prosthetic caused by?

settling due to limb shrinkage (need to add additional socks)

relative contraindications to exercise in pregnancy

severe anemia unevaluated cardiac arrythmias chronic bronchitis poorly controlled type 1 DM BMI < 12 poorly controlled HTN orthopedic limitations

pancreatitis pain

severe epigastric or abdominal pain to the middle of the back and may worsen when lying supine often to the left of the epigastric region, just below the xiphoid process

Flexor withdrawl

sharp, quick pressure stimulus to sole of foot or palm of hand causes withdrawl of stimulated extremity 0-2 months, but may persist throughout life

Crossed Extension

sharp, quick pressure stimulus to sole of foot or palm of hand causes withdrawl of stimulated extremity and extension of opposite leg 0-2 months

what muscles do you need for crutch training?

shoulder depressors and extensors ex: lower trap, latissimus dorsi and pec major

how to position a CVA UE in supine?

shoulder protracted slightly abducted and ER elbow extension wrist neutral finger extension

extensor synergy UE

shoulder protraction shoulder adduction shoulder IR elbow extension forearm pronation wrist and finger flexion

how would a C6 SCI transfer?

shoulders ER forearms supination wrists extended fingers flexed *need to maintain tenodesis so the fingers need to be flexed if wrist is extended they will use anterior deltoid, shoulder ER, clavicular portion of the pec major..causing elbows to extend

antihyperlipedemia SE and PT implications

side effects: HA, GI distress, myalgia, rash exercise can increase HDL's and maximize the medication usefulness

Disease modifying Antirheumatic Agents

side effects: HA, joint pain and swelling, toxicity, GI distress, sore throat, liver dysfunction hair loss, retinal damage ex: Rheumatrex (methotrexate), Enbrel (etanercept), Aralen (chloroquine), Humira (adalimumab)

dopamine replacement agents

side effects: arrythmias(levodopa), GI distress, OH, dyskinesias, tolerance, behavior disorders ex: Sinemet or Madopar (levodopa), Symmetral (amantadine)

muscle relaxer agents

side effects: sedation, drowsiness, dizziness, vomitting, HA ex: Valium (diazepam), Flexeril (cyclobenzaprine), Paraflex (chlorzoxazone)

Hoffman sign

sign of UMN lesion tapping the nail or flicking the terminal phalanx of the middle or ring finger. A positive response is seen with flexion of the terminal phalanx of the thumb.

Treatment with burns

silver nitrate and nitrofurazone- superficial agent attacks surface organsisms panafil- keratolytic enzyme used for selective debridement...will look yellow on dressing but this is normal sulfamylon-penetrates through eschar and provides antibacterial control

single blind research design vs double blind

single: only the subject is kept unaware of the identity of the treatment group double: protection against bias -both the subject and investigators are not aware of the identity of the tx group

Froment's sign

sitting or standing and asked to hold a piece of paper b/w the thumb and index finger. The therapist attempts to pull the paper away from the pt. (+) test= flexing the DIP, indicates adductor pollicis longus paralysis if pt also hyperextends the MCP joint of the thumb...this is Jeanne's sign

radiation

direct transfer of heat from a radiation energy source of higher temp to cooler temp need to have difference of temps, but must exist w/o direct contact rate of heat transfer will be influenced by intensity and size of energy source, target area and angle of radiation, distance ex: infrared lamp, laser, UV light

compensations for fixed forefoot

excessive subtalar pronation plantarflexed 1st ray hallux valgus excessive tibial, femoral or pelvis internal rotation contralateral lumbar spine rotation

full thickness wound

extends through dermis into deeper structures such as sub q fat -wounds deeper than 4 mm -heal by secondary intention

types of hydrotherapy tanks

extremity tank lowboy tank (extremities, long sit to mid thoracic) highboy tank (chest high water, hips knees flexed *dont exceed 100 degrees hubbard tank (full body immersion) therapeutic pool (79-97 degrees)

indications for gauze dressings

exudate wounds wounds w/ dead space, tunneling or sinus tracts wounds w/ exudate AND necrotic tissue wet to dry, continuous dry and continuous moist

what muscles get denervated with anterior interosseus syndrome?

flexor pollicis longus lateral half of the flexor digitorum profundus pronator quadratus *difficulty w/ pinching and pronating

ARDS is caused by?

fluid accumulation in the alveoli, causing severe SOB, increased RR, hypotension, confusion, fatigue

lateral thrust at midstance with prosthetics

foot inset aka varus thrust pain will be at proximal medial and distal lateral knee

causes of foot rotation at heel strike with prosthetics

foot is malaligned stiff heel cushion plantar flexion bumper

reasons for excessive knee flexion during stance with amputee

foot is set in too much DF socket aligned too far anterior prosthesis too long socket aligned in excessive flexion

medial thrust at midstance with prosthetics

foot outset aka valgus thrust pain will be at proximal lateral and distal medial knee

Surgical Debridement

for deep stage 3 and 4 ulcers used: advancing cellulitis w/ sepsis, immunocompromised, when infection threatens their life CI: cardiac/pulm/ DM disease, severe spasticity, cannot tolerate surgery, quality of life poor or death soon

ultraviolet light

form of energy that is used therapeutically and absorbed 1-2 mm into skin...used to treat skin disorders suberythemal dose minimal erythema dose first degree dose second degree eythemal dose third degree erythemal dose must determine MED *must wear glasses

charcot's foot

form of neuropathic arthropathy that involves bone destruction and absorption leading to an ulcer will see erythema, edema, warmer than other foot (no trauma or pain) subluxation of joints common--> rocker bottom foot

convection

gain or loss of heat resulting from air or water moving in a constant motion across the body transfers large amounts of heat ex: fluidotherapy, hot and cold whirlpool

conduction

gain or loss of heat resulting from direct contact b/w 2 materials at diff temps rate of heat transfer accelerated when there is a large temp difference materials w/ high thermal conductivity will transfer faster (water transfers > than air) ex: hot pack, cold pack, ice massage, cry cuff

Causes for LUQ pain

gastric ulcer perforated colon PNA spleen injury/rupture aortic aneurysm

Functions of the hippocampus, basal ganglia and amygdala

hippocampus: forming and storing new memories, "memory indexer" basal ganglia: consists of the caudate, putamen, globus pallidus, substantia nigra, subthalamic nuclei. Responsible for voluntary movement, regulation of autonomic movement, posture, tone, control of motor responses amygdala: emotional and social processing, involved w/ fear and pleasure, arousal, memory processing, formation of emotional memories

Hold relax vs contract relax

hold relax: isometric contraction contract relax: max contraction

what position can patients with COPD get in to help with breathing?

holding onto table with bilateral UE, facilitates reverse action of the latissimus dorsi to maximize ventilation can also put elbows on knees to allow serratus and pec minor to work more efficiently

4 years development

hops on one foot several times stands on tiptoes relates to friends

Huff cough vs cough

huff: inhale through open mouth, keep glottis open, contract abs w/ glottis open and say ha ha ha cough: inhale maximally, close the glottis, hold breath 2-3 seconds, contract expiratory muscles and cough against closed glottis *closed glottis= at risk of collapse

chronic fatigue syndrome

hx of > 6 months of unexplained. prolonged, severe fatigue not relieved by rest 4/8 sx: recurrent sore throat, memory/concetration deficits, painful/enlarged lymph nodes, unexplained muscle pain, migrating joint pain, malaise lasting > 24 hours HA

hydrostatic weighing vs plethysmography

hydrostatic weighing: density of body by immersing a person in water and using archimedes principle to determine amount of water displaced plethysmography: density of body by using air chamber and measuring change of pressure

classic signs of DM

hyperglycemia elevated sugar in urine (glycosuria) excessive secretion of urine (polyuria) excessive thirst (polydipsia) excessive hunger after eating (polyphagia) unexplained weight loss fatigue blurred vision, HA

corticosteroids side effects

hyperglycemia hypertension increased risk of infection calcium loss, osteoporosis

hyperglycemia (lab value) and hypoglycemia lab value

hyperglycemia: blood glucose > 180-200 normal: 70-110 (same to exercise at 70 and 250 mg/dL for patient safety) hypoglycemia: < 70 mg/dL

hidrosis issues

hyperhidrosis: fevers, pneuomonic crisis, drugs, exercise hypohidrosis: dehydration, hypothyroidism, DM cold sweats: fear, anxiety, depression, AIDS hirsutism: male pattern hair growth on women...Cushing's syndrome, tumor, inherited

renal failure lab tests will show....

hypocalcemia hyperkalemia elevated blood urea nitrogen, creatine, magnesium and uric acid

Addison's Disease

hypofunction of adrenal glands, decreased cortisol (glucocorticoid) and aldosterone sx: hypotension, weakness, anorexia, weight loss, altered pigmentation, can lead to shock and death tx: synthethic corticosteroids and minderalocorticoids

What metabolic symptoms will you see with someone with adrenal insufficiency?

hyponatremia hyperkalemia hypoglycemia may have acidosis * do not produce enough cortisol--> addisons disease

EMG sensitivity

high sensitivity will detect small amounts of electrical activity low sensitivity will detect only large amounts of electrical activity

What is the reason for taking a longer prosthetic step?

hip flexion contracture

hip OA classification

hip pain hip IR less than 15 hip flexion less than 115 age > 50 duration of hip stiffness > 60 min *anterior hip pain is most common hip pain can be referred to the knee, pain relieved with distraction *test using hip scour test

hip and ankle strategy

hip: proximal to distal, forward sway (PA push)--> hip flexion (Abs and quads) backward sway (AP push)--> trunk extensors, glutes, hamstrings ankle: forward sway--> ankle PF backward sway--> ankle DF

hypoparathyroidism

hyposecretion or low levels of parathyroid hormone low blood calcium levels leads to altered function of tissues, usually muscle spasms sx: hypocalcemia, neuro sx such as seizures, cog deficits, short stature, tetany, muscle pain, cramps tx: rapid elevation in serum calcium levels through IV calcium, dietary modifications

fluent aphasia

impaired auditory comprehension , impaired writing and reading, poor naming ability aka wernicke's, lesion on posterior first temporal gyrus of left hemisphere tx: emphasize demonstration and gesture (since they cant process verbal cues)

DeQuervains tenosynovitis

inflammation at the abductur pollicis longus, extensor pollicis brevis at the first dorsal compartment, due to repetitive trauma or pregnancy sx: pain in anatomical snuffbox, swelling, decreased grip and pinch strength, + Finkelsteins test tx: acetaminophen, NSAIDS, correct biomechanical faults, soft tissue techniques

Hepatitis

inflammation of liver etiology:chemical or drug rxn, viruses sx: fever, flu like symptoms, anorexia, fatigue, dark urine, light stool, jaundice tx: liver transplant A: viral, close contact with people, self limiting and resolves in 6-12 weeks B: caused by sex, maternal/fetus, sharing needles C: caused by sex, maternal/fetus, sharing needles..often need liver transplant

pancreatitis

inflammation of pancreas sx: epigastric pain, nausea, vomitting, diarrhea, fever, tachycardia, malaise, jaundice pain will be worse when walking or lying supine

gastritis

inflammation of stomach etiology: bleeding, stress, NSAIDS, alcohol, virus sx: dyspepsia, nausea, vomitting, hematemesis tx: pharm, surgery

Bronchitis

inflammation of the bronchi, hypertrophy of the mucous secreting glands *productive cough for 3 months over the course of 2 consecutive years sx: cough, thick sputum, increased accessory muscle use, cyanosis, increased PAP

endocarditis

inflammation of the endothelium of the heart, caused by bacteria sx: fever, chills, heart murmur, fatigue, SOB, weight loss, blood in urine, skin petechiae tx: antibiotics

cholecystitis/cholelithiasis

inflammation of the gallbladder etioloy: gallstones, hypomobile gallbladder, supersaturation of bile sx: RUQ pain, muscle guarding, tenderness, jaundice, fever, nausea, vomitting, anorexia tx: low fat diet, lithotripsy to break apart stones or laparoscopic cholecystectome to remove gall bladder

pericarditis

inflammation of the pericardium, amount of fluid b/w the 2 layers increases (pericardial effusion) sx: chest pain, SOB, dry cough, anxiety, fatigue, fever tx: analgesics, anti-inflammatory agents, cardiac tamponade

prostatitis

inflammation of the prostate gland etiology: bacteria or build up of prostate secretions sx: watery urethral discharge, urgency, frequency, discomfort w/ urination, pain w/ ejaculation, pain in perineum/penis/scrotum tx: lifestyle modifications, biofeedback, stretching, myofascial techniques, antibiotics, alpha blockers, NSAIDS

carpal tunnel syndrome

inflammation, edema, tumor or fibrosis in carpal tunnel, compressing the median nerve sensry changes and paresthesias, night pain, weakness of hand, decreases grip strength, clumsiness, decreased wrist mobility, tx: heat, e-stim, ionto, cryo, active ROM, tendon glides, AVOID WRIST FLEXION after 4 weeks post surgery...begin light AROM flexion AVOID RADIAL DEVIATION

rheumatic fever

inflammatory process due to untreated strep bacteria sx: inflammation of the heart, joints, skin, CNS, red swollen, fever and joint pain, heart palpitation, chest pain, SOB, skin rash tx: antibiotics and anti-inflammatory agents

MRI

uses magnetic fields, not radiation T1-fat in tissues T2-suppresses fat and shows high water content *gold standard for diagnosing MS

autolytic debridement

using the body's own mechanisms to remove nonviable tissue ex: transparent films, hydrocolloids, hydrogels and alginates contraindicated: infected wounds, immunosuppressed people, dry gangrene or dry ischemic wounds

what type of ultrasound can you use for wounds? What type of stim can you use?

utrasound: low intensity pulsed US e-stim: high volt pulsed galvanic current or low intensity, low volt continuous direct current

norepinephrine

vasoconstricts in skin, viscera and skeletal muscles target: CV and metabolic systems regulated: sympathetic impulses from the hypothalamus in stressful situations *made in adrenal medulla

Raynaud's Disease

vasospastic disorder characterized by intermittent episodes of small artery constriction of the digits of fingers, causing temporary pallor and cyanosis, numbness, tingling mostly females not caused by occlusive disease

femoral nerve innervates

vastus lateralis vastus medialis rectus femoris vastus intermedius iliacus sartorious pectineus L2-L4

ventricular asystole

ventricle standstill with no rhythm requires immediate CPR, acute MI, ventricular rupture, cocaine, lightening strike, shocked

transparent films advantages

visual evaluation of wound w/o removal impermeable to fluids and bacteria comfortable promote autolytic debridement minimize friction

posterior cerebral artery

supplies: portion of midbrain, subthalamic nuclei, basal nucleus, thalamus, inferior temporal lobe, occipital lobe damange: central post-stroke pain, contralateral pain and temp sensory loss, contralatearl hemiplegia, ataxia, athetosis, choreiform, thalamic pain syndrome, anomia, hemiballismus, visual agnosia, homonymous hemianopsia, alexia, dyslexia, cortical blindness, involuntary movements can occur

stroke in the internal capsule results in....

supranuclear palsy, so only lower half of face muscles on opposite side are affected (UMN sign) bells palsy is a LMN disease, so this would affect all the muscles on the ipsi side of the lesion

e-stim placement for shoulder subluxation

supraspinatus and posterior deltoid *supraspinatus probably keeps it from going inferiorly and posterior delt prevents anterior subluxation

Juvenile RA symptoms

swollen, stiff, painful joints fatigue fever swollen lymph nodes poor weight gain/slow growth

right sided heart failure

sx: elevated central venous pressure, distension of neck veins, ascites, edema of LE (systemic edema)

what is a criterion variable?

synomymous with dependent variable (outcome variable)

level of evidence hierarchy

systematic review and meta analysis RCT cohort case control cross sectional case series case report ideas, opinions

meta-analysis

systematic review that uses a statistical technique to derive an estimate of the effect size by combining the results of several RCT's to determine the overall effectiveness of a treatment

ankylosing spondylitis

systemic inflammation of spine and large peripheral joints men > women .... 20-40 y/o acute: LBP, morning stiffness, impaired spinal extension, limited ROM for 3 months *exagerated thoracic curve, flattened lumbar curve chronic: severe pain going to the midback and neck, loss of lumbar curve, spinal kyphosis, fatigue, weight loss, impaired chest mobility, compromised breathing, decreased VC tx: extension exercises, gentle AROM and exercise, swimming, posture retraining

role playing

take the place of another participant, so they can learn from acting out a particular situation compared to just discusing it

Mallet finger

tear in the extensor sheath with flexion injury results in flexion of DIP (cannot extend)

flooding

technique to help patients heal their traumatic memories..goal is to expose pt's with the goal of reintegrating their repressed emotions with their current awareness. ex: phobias

iliac crest aophysitis

tennis player changing directions traction of iliac crest due to contraction abs, glute med, TFL

prone knee bend test

tests femoral nerve prone, flex knee ...and can increase it by going into more hip extension (+) femoral nerve involvement = L3

Kerneg's Sign

tests meningeal irritation in supine, the LE is flexed at the hip and knee, the knee is then straightened...resistance to knee extension = + test

tibial nerve innervates

tib posterior abductor and adductor hallucis flexor hallucis longus and brevis flexor digitorum longus and brevis quadratus plantae soleus gastroc plantaris popliteus L4-S3

deep peroneal nerve innervates

tibialis anterior extensor hallucis longus extensor digitorum longus peroneus tertius cutaneous: between 1st and 2nd toes L4-S2

lower crossed syndrome

tight hip flexors weak hamstrings weak abs tight erector spinae * you need to strengthen the elongated muscles (not the tight ones)

evaporation

transfer of heat that occurs as a liquid absorbs energy and changes form into vapor ex: vapocoolant spray is heated by the warmer skin of the body, causing liquid to change into a vapor ex: vapocoolant spray and sweating

Antibiotics for GI

treat H pylori, rapid healing of gastric ulcers indications: H pylori bacteria SE: Hypersensitivity, diarrhea, nausea ex: metronidazole, tetracycline, clarithromycin, amoxicillan

malignant melanoma

tumor arising from melanocytes family history, light skinned, freckles, > 50 y/o lesions are oozing, bleeding, sensations of burning, itching pain

whirpool

turbine effect of water agitation tx: 10-30 min can perform exercise at same time *don't use whirlpool for wound management

stratifed random sample

type of probability sample in which elements of the population are chosen at random from homogenous groups based on some characteristic ex: by height, weight or gender organizing into homogenous groups before selection decreases sampling error

simple random sample

type of probability sample where every element of the population has an equal chance of being selected for the sample

systematic sample

type of probabilty sample where elements are chosen from the lists of population members using specified intervals, such as every 4th element

ASIA LEVELS

A: COMPLETE...no sensory or motor preserved in the sacral segments B: SENSORY INCOMPLETE...sensory is preserved int eh sacral segments but no motor preserved below the level of the lesion C: MOTOR INCOMPLETE...motor and sensory preserved in the sacral segments, but more than half the muscles below the injury have muscle grades of < 3/5 D: MOTOR INCOMPLETE...motor and sensory preserved in the sacral segments, but more than half the muscles below the injury have > 3/5

neck position for AA, C3-C4, C5-7 cervical traction

AA: neutral C3-C4: 10-20 flexion C5-C7: 25-30 degrees flexion

PNF chop vs lift

Chop: start in D1 flexion and end in D1 extension Reverse Chop: start in D1 extension and ending in D1 flexion Lift: start with D2 extension, ends in D2 flexion Reverse Lift: start with D2 flexion, ends with D2 extension

5 types of joint receptors

Free nerve endings (noxious and non noxious) Golgi Ligament Endings (tension or stretch) Golgi Mazzoni Corpuscles(compression) Pacinian (vibration, acceleration, high velocity changes) Ruffini (stretch, velocity and amplitude)

Differentiate hiatal hernia vs femoral hernia vs inguinal hernia vs umbilical hernia referral patterns

Hiatal: shoulder pain femoral: level pelvic wall pain inguinal: groin pain umbilical: umbilical ring in the mid to lower abdomen pain

Stage 2 Pressure Ulcer

-partial thickness skin loss; involves epidermis, dermis or both -shallow open ulcer w/ red or pink wound bed -ulcer is superficial -presents as abrasian, blister or shallow crater

S3 heart sound

vibrations of distended ventricle walls due to passive flow of blood from the atria during the rapid filling phase of diastole "ventricular gallop" lub-dub-lub; heard in early diastole associated with heart failure (can be normal in children)

order of putting on sterile PPE?

wash hands (first) put on mask put on gown put on gloves (last)

how do you reduce lumbar spine compression forces at a desk?

add armrests to the chair increase chair-backrest seat angle to 90-110 degrees add lumbar support

talipes equinovarus

adduction of forefoot varus hindfood (calcaneal varus) plantarflexion at ankle stretch it with DF and eversion

obturator nerve innervates

adductor longus adductor magnus adductor brevis obturator externus gracilis L2-L4

hydroccoloids dressings

adhesive wafers containing hydroactive/absorptive particles that interact with wound fluid to form a gel. May be occusive/semi occlusive. changed every 3-5 days or when drainage leaks out odor or yellow color is expected

considerations to using foams

change schedule varies 1-5 days or as needed protect intact surroduing skin w/ skin sealant to prevent maceration

what does nitroglycerin do?

decreases myocardial demand by dilating eins to decrease venous return (preload), dilates arteries to decrease afterload, and relaxes coronary artery smooth muscle to increase coronary blood supply

TMJ condition where pt has difficulty opening mouth wide and performing functional jaw movements such as chewing?

disc displacement without reduction

symptoms of HTN

dizziness headache blurred vision

internal consistency

form of reliability of a measurement, assessing the degree to which a st of items in an instrument all measure the same trait

causes of lumbar lordosis during stance with prosthesis

insufficient support from anterior or posterior walls painful ischial WBing hip flexion contracture weak hip abductors or abdominals

advantages to foams

insulate wounds provide padding most are nonadherent conformable manage min-heavy exudate easy to use some newer products for deep cavities

tethered cord

neuro disease (often in spina bifida) where there is abnormal stretching of the tissue attachments that limit the movement of the spinal cord within the spinal column. sx: bowel and bladder function changes, increased spasticity, back pain

which type of ulcer do you lose protective sensation? How do you test it?

neuropathic (not venous, arterial or pressure related) test with a 10- g (5.07) monofilament: place perpendicular to skin and press it until it bends

peripheral nerve injury grading

neuropraxia: injury to nerve that causes a transient loss of function; nerve dysfunction may be rapidly reserved or persist a few weeks ex: compression axonmetsis: injury to nerve interrupting the axon and causing loss of function and wallerian degeneration distal to the lesion; no disruption of endoneurium, regeneration is possible neurotmesis: cutting of the nerve, loss of all function, reinnervation typically fails w/o surgical intervention b/c of aberrant regeneration

Moro Reflex

stimulus: head dropping into extension suddenly for a few inches response: arms abduct w/ fingers open, then cross trunk into adduction; cry normal: 28 weeks of gestation to 5 months interferes: balance reactions in sitting, protective responses in sitting, eye hand coordination, visual tracking

vertebral artery test

passively move head and neck into extension and side flexion, then rotation to the same and holding for 30 seconds *assesses the opposite side artery is being compressed

what 3 arteries supply cerebellum?

superior cerebellar artery anterior inferior cerebellar artery posterior inferior cerebellar artery

tibial torsion

supination and lateral tibial torsion pronation and medial tibial torsion

anterior cerebral artery

supplies: anterior frontal lobe and medial surface of frontal and parietal lobes damage: contralateral LE motor and sensory, loss of bowel and bladder control, loss of behavioral initiation, significant mental changes, neglect, aphasia, apraxia and agraphia, perseveration

PT interventions after c-section

post op TENS for incision pain (parallel 2 inc) breathing, coughing, pelvic floor exercises postural exercises(precautions for 4-6 weeks)

Difference between power tilt wheelchair and reclining?

power tilt can can provide pressure relief and is less likely than reclining wheelchairs to elicit spasticity * in power chair, the entire chair tilts backwards so you stay in 90 degrees hip flexion and knee flexion...preventing you from just going into trunk extension which will elicit extensor tone)

swallowing issues

to help swallow: chin tuck warm foods easier to swallow than cold liquids aspirated more than solid food (which is why we thicken liquids)

sling seat

too much sling and not enough support will cause a posterior pelvic tilt, hip medial rotation and hip adduction

silver sulfadiazine, what can it cause?

topical agent avoid at term pregnancy, on infants less than 2 months, and those with sulfa drug allergies it can cause: leukopenia

transfemoral amputee and transtiibal amputee contracture risk

transfemoral: hip flexion, abduction and ER *place them in hip extension, adduction and IR transtibial: knee flexion, hip flexor and ER *place them in knee extension, hip extension and IR

protein, carbs, fats are used during....

protein: long duration activity or starvation carbs: > 70% max o2 consumption, greater than 1 hour fats: < 70% max O2 consumption, less than 1 hour

SC joint osteokinematics

protraction/retraction: concave on convex elevation/depression: convex on concave

Nonopiods Agents

provide analgesia and pain relief, produce anti inflammatory effects, initiate anti pyretic properties SE: nausea, vomitting, vertigo, ab pain, GI distress or bleeding, ulcer formation ex: Tylenol (acetaminophen), NSAIDS, Aspirin (acetylsalicyclic acid), Aleve (naproxen), Advil (ibuprofen), celebrex (celecoxib)

bandage size used w/ transfemoral and transitibial

transfemoral:6 inch wraps transtibial: 4 in wraps

3 person carry lift

transfer a pt from a stetcher to a bed or plinth supine position, roll pt then lift them one at head (in control), one at stomach, one at LE

diagnostic ultrasound

soft tissue dysfunction real time dynamic imaging diagnosing tears muscle abnormalities fluid collections benign and malignant soft tissue tumors early RA changes lumps soft tissue masses (children)

myositis ossificans

soft tissue that was injured in a traumatic event and develops a hematoma, then develops into this disease. It is a benign, ossifying soft tissue lesion in skeletal muscle. -may take 2-4 weeks to develop, have decreased ROM and palpable mass -pts are male, young -pain and tenderness in soft tissue with a mass -mass starts in the periphery and moves centrally

Swan Ganz (pulmonary artery pressure)

soft, flexible catheter inserted through a vein to the pulmonary artery continuous measurements of PAP

maceration

softening of CT fibers due to excessive moisture loss of pigmentation and highly susceptible to breakdown/enlargement

antihyperlipedemia actions

statins: inhibit enzyme action in cholesterol synthesis, break down LDL, increase HDL, decrease trigylcerides indicated: hyperlipedemia, atherosclerosis, prevent coronary events, diabetes, PVD

walking velocity is calculated by

step length and step cadence

beta adrenergic agonists

stimulate the beta receptors of the lungs, causing bronchodilation and relaxing smooth muscle bronchial constriction *indicated for asthma, breathing issues *may cause increase HR and BP though due to beta receptors on the heart

Lyrica (pregabalin)

treats diabetic neuropathy (nerve pain) SE: heart failure, greater difficulty walking long distances and lymphedema

lowest muscle innervation at C7 SCI

triceps extensor pollicis longus and brevis extrinsic finger extensors flexor carpi radialis

true/false: there is decreased heat dissipation through sweating with immersion?

true: this is why patients with heat intolerance should be careful in water such as MS

scoliosis presents with this spine deformity...

-posterior thoracic rib hump on convexity -lateral curvature of the spine with fixed rotation of the vertebrae -vertebral bodies rotate to convex side -spinous process rotate to opposite side -decreased aeration on contra side -decreased breath sounds on contra side -decreased thoracic rib elevation on contra side -shortened int/ ext intercostals on contra side -protruding hip/breast on contra side of convex -prominent shoulder blade on curved side scoliosis seen in 10-13 y/o females: 11-13 y/o males: 13-14 y/o

bronchophony vs egophony vs whispered pectoriloquiy

bronchophony: increased vocal resonance with greater clarity and loudness of spoken words ()ex: 99 egophony: form of bronchophony in which a long E sounds like a nasal sounding A whispered pectoriluquy: recognition of whispered words at 1, 2 and 3

Rhonchi

continunous low pitched sounds "snoring" or gurgling heard during both inspiration and expiration causes: inflammatory secretions or liquids, neoplasms

lymphedema

stage 1: pitting edema, reduces w/ elevation overnight and does not exhibit fibrotic changes stage 2: fibrotic changes, increasing in nonpitting edema, does not reduce w/ elevation stage 3: skin changes, frequent infections, severe edema, non-pititng and fibrotic tissue mild: < 3 cm difference mod: 3-5 cm difference severe: > 5 cm difference early stages: pitting edema late stage: non pitting edema

ventricular fibrillation

ventricles do not beat in coordinated manner no CO, pt becomes unconscious requires immediately defibrillation caused by: MI, cocaine or any heart disease

Pulse grading

0- absent 1+ small or reduced 2+ normal or average pulse 3+ large or bounding

how slow should you move US sound head?

1.5 inches/sec

exercise and pregnancy (guidelines)

50-60% of max HR for 30 minutes, at least 3 times a week pelvic floor strengthening (80-100 contractions a day) strength: 3 x 10, 2 sec hold, 4 sec relax endurance: 3 x 5, 5 sec hold, 10 sec relax

accessibilty requirements for wheelchair turning radius

60 in width 78 in length

coupled motion in the cervical spine, thoracic and lumbar spine?

C0-C1= contra C2-C7= ipsilateral thoracic: contra lumbar: contra

what nerve roots cause cervical spine lateral flexion?

C3-C4 and CN 11

Angiotensin II Receptor Blocker Drug Names

Losartan: Cozar Atacand: Candesartan Diovan: Valsartan -end in TAN

1st degree heart block

PR interval is longer than 0.2 seconds no symptoms

Red Yellow Black System

Red: pink granulation tissue protect wound; maintain moist environment Yellow: moist, yellow slough remove exudate an debris, absorb drainage Black: black, thick eschar firmly adhered debride necrotic tissue

what do the following sounds sound like? (S3, S4, heart murmur, pericardial friction rub)

S3: heard during early diastole, low freq turbulence S4: low freq turbulence heard during late diastole heart murmurs: swishing hearing during systole, diastole or both pericardial rub: heard as leathery sound during diastole

who would benefit from anti tip tubes?

Someone with trunk impairments of absence of control. It is used when mastering wheelchair mobility on steep inclines .

Thromobolytic Therapy Names

Streptokinase TPA: tissue plasminogen activator Urokinase: Linlytic Activase: alteplase (ending in -ase)

normal amounts for CO and SV

Stroke volume: 80 mL CO: 4.5-5.0 L/min

normal ROM values for wrist: UD/RD, flex and ext

UD: 30 degrees RD: 20 degrees ext: 70 flex: 80

Domains of Learning

affective: attitudes, values, emotions cognitive: knowledge and understanding psychomotor: physical action or motor skill

Power

amount of work / time *the larger the number, the more the power

ataxia is a side effect of....

antidepressants opioid analgesics anticonvulsants (antiepileptics)

which medication decreases platelet aggregation?

antiplatelets

ABCDE of malignant melanoma

asymmetry border color diameter elevation/evolving

ideal goal setting should include

audience (who), behavior (what will be done), condition (under what circumstances), and degree (amount of change)

What is the max aerobic capacity for men and women? (in terms of METS)

between 8-12 METS

what is a normal hemodynamic response to exercise in overweight/obese individuals??

blood pressure will rise during exercise and fall below resting levels after exercise ceases

UMN/spastic/reflexive bladder

can void by using suprapubic stroking or tapping manual stimulation (stroking, kneading, tapping)

lupus erythematosus

chronic, progressive autoimmune disorder of CT, red rash with raised, red, scaly patches

Kaposi's sarcoma

common in human herpes virus 8 and AIDS red or dark blue/purple macules, itching, pain

1 month Development

decreased flexion momentary head elevation tracks moving ojbect head to side neonatal reaching

causes of high hematocrit

dehydration or polycythemia vera

what way will the jaw deviate with ipsilateral capsular restriction of opening?

deviation to the side of the restriction

reliability coefficient grading

good= > 0.75 moderate 0.5-0.75 poor < .50

accessibilty requirements for forward reach in chair

low reach 15 in high reach 48 in

rythmic rotation improves

mobility

t-test

parametric test used to compare 2 independent groups created by a random sample and identify a difference at a selected probability...used to compare mean in a normal distribution independent samples: 2 independent groups paired samples; 2 matches samples (same group performed at 2 different times)

anemia

reduction of the number of circulating RBC or reduction in hemoglobin. caused: excessive blood loss, excessive RBC destruction (hemolysis) or deficient red blood cell production (hematopoiesis) pallor, cyanosis, cool skin, vertigo, weakness, HA, malaise

pons

regulation of respiratory rate and associated with head in relation to visual and auditory stimuli CN V- VIII (trigeminal, abducens, facial, vestibulocochlear)

long thoracic nerve

serratus anterior C5-C7 (comes off of roots)

Hiatal hernia pain

sharp and localized to lower esophagus/upper stomach pain

what are alginates?

soft, absorbent, nonwoven dressings derived from seeaweed that have a fluffy, cotton like apperance. React w/ wound exudate to form a viscous hydrophilic gel mass over wound, available in ropes and pads

lower subscapular nerve

subscapularis and teres major C5-C6 comes off of posterior cord

testicular cancer symptoms

supraclavicular adenopathy + iliopsoas sign (resisted hip flexion or passive hip extension) back pain unchanged by position

how much should SBP rise with exercise? how much should DBP maintain or decrease w/ exercise?

systolic rises 5-10 mm Hg per MET diastolic maintains or drops between 0-10 mm Hg

Symptoms of Patent Ductus Arteriosis

tachycardia respiratory distress poor eating weight loss CHF *hole b/w pulmonary artery and aorta remains open (L --> R shunt)

wheel chair measurements (width, height, depth)

width: lateral hip to hip + 2 inches back height: butt to axilla - 4 inches (add seat cushion height) depth: butt to popliteal fold - 2 inches seat height: need 2 inches to clear the floor armrest height: seat of chair to olecranon process w/ elbow flexed to 90 degrees and then add 1 in leg length/seat to footplate length: from bottom of shoe to just below thigh in the popliteal fossa (if seat cushion is used height must be subtracted)

internal carotid artery stroke...

will have combined result of anterior and middle cerebral artery strokes

Secondary intention

wounds close on their own associated w/ DM, ischemia, pressure damage granulation will fill wound bed require wound care

indications for alginates

wounds w/ mod- large exudate wounds w/ exudate and necrosis wounds that require packing and absoprtion infected and noninfected exuding wounds

urticaria vs pruritis vs xeroderma

xeroderma: excessive dryness, shedding of skin urticaria: hives (allergic rxn to something) pruritis: itching

3 zones of injury (burns)

zone of coagulation: area of the burn that received the most severe injury w/ irreversible injury zone of stasis: area of less severe injury that possesses reversible damage and surrounds zone of coag zone of hyperemia: area surrounding zone of stasis that presents w/ inflammation, but will fully recover w/o any intervention or permanent damage

Cardiac Rehab Phase 1

Mode: walking (2-3 METS) or steps/treadmill (3-4 METS) intensity: < 13 RPE, Post infarct: HR < 120 or < 20 above resting HR...post surgery: < 30 bpm Duration: intermittent 3-5 min bout progressing to 10-15 min continuous 1:1 ratio for exercise/interval

CPR steps

1) check for unresponsiveness 2) call 911 3) check breathing, (CAB) (ABC in infants) 4) 30:2 ...15:2 for 2 rescuer child and infant (always 30:2 for adults) Adults: 2 inches (5 cm) Children: 1/3 AP depth, about 2 in (5 cm) Infant: 1/3 AP depth, about 1.5 in (4 cm) * 1 breath every 6-8 seconds (8-10 breaths/min)

ventricular tachycardia

3 or more consecutive PVC's at a ventricular rate > 150 p waves are absent and QRS is wide/abherrant cannot maintain blood supply--> hypotension serious if longer than 30 seconds causes: MI, cardiomyopathy, valvular disease

symptoms of hypoglycemia

confusion heart palpitations dizziness glucose < 70 pallor shakiness sweating excessive hunger tachycardia fainting nervousness and irritability HA blurred vision *caused by too much insulin or low carbs/intake

Stridor

continuous, high pitched wheeze heard with both inspiration and expiration causes: bronchospasm, edema, collapse, neoplasms

cystocele vs urocele vs rectocele vs enterocele

cystocele: bladder prolapse urocele: uterine prolapse rectocele: rectum prolapse enterocele: small bowel prolapse

Mucolytic Agents

decrease viscosity of mucus by altering secretions, making them easier to expectorate (inhaled) SE: pharyngitis, oral mucosa inflammation, rhinitis, chest pain ex: Mucosil, Mucomyst, Pulmozyme

absolute indications to stop exercise test

drop in SBP > 10 mm from baseline despite increased in work load with other evidence of ischemia moderately severe angina (3/4) signs of poor perfusion (cyanosis, pallor) ataxia, dizziness sustained ventricular tachycardia 1.0 mm ST segment elevation w/o Q waves

relative indications to stop exercise test

drop in SBP > 10 mm without evidence of ischemia > 2 mm ST segment depression arythymias other than v-tach, including multifocal PVC, supraventricular tachycardia, heart block or bradyarhythmia fatigue, SOB, wheezing, leg cramps, claudication development of bundle branch block or intraventrivular conduction delay increasing chest pain HTN SBP > 250 and/or DBP > 115

Atrial Flutter

ectopic, rapid atrial tachycardia rate 250-350 bpm, ventricular rate dependent upon AV node conduction saw tooth pattern sx: palpitations, lightheadedness and angina

COPD in terms of pulmonary function tests

increased residual volume increased TLC decreased ERV (can't blow off as much air)

specificity vs sensitivity

specificity: SPIN testing negative in a group of people that do NOT have the disease TRUE negative sensitivity: SNOUT testing positive in a group of people that do indeed have the disease TRUE POSITIVE

BMI classification

< 18.5 = underweight 18.4-24.9 = normal 25-29.9 = overweight 30-34.9 = class 1 obese 35-39.9 - class 2 obese > 40 = class 4 obese calculate: weight (kg) / height (m) (squared) weight (lb) / height (squared) x 703

accessibility requirements for door threshold

< 3/4 inch for sliding doors < 1/2 in for other doors

pulmonary fibrosis PFT's

decreases in TLC, VC, FRC and RV

Pediatric Standardized motor tests

Movement Assessment of Infants PeaBody Gross Motor Function Measure (GMFM) Bruiinks-Oseretsky Test (BOT-2)

associative stage of learning

"how to do" continue to provide KP and KR encourage self assessment serial or random practice progress towards open environment *KP and proprio most important

cognitive stage of learning

"what to do" provide KP and KR feedback after every trial *KR and visual feedback is MOST IMPORTANT controlled environment to minimize errors break down complex tasks blocked practice, mental imagery

4 major complications after MI (what is most likely to occur, too?)

#1 arrythmias thrombi heart failure heart structure damage

Symptoms of Atrial Septal Defect

(patent foramen ovale)--> LA to RA shunt *blood is not being pumped out of left side heart murmur shortness of breath fatigue swelling of legs, feet, abdomen heart palpitations frequent lung infections stroke cyanosis of skin

within subject design

(repeated measures) subjects serve as their own controls randomly assigned to treat or not treatment blocks

skinfold measurments

*RIGHT SIDE of body use VERTICAL folds *caliper is PERPENDICULAR to skin fold common sites: abdominal, triceps, biceps, chest, medial calf, midaxillary, subscapular, suprailiac, thigh

Growth Hormone

-promotes growth and development; increases rate of protein synthesis target: bone and muscle regulation: hypothalamus *made in pituitary

Suspected Deep tissue injury

-purple or maroon, intact skin, blood filled blister -painful, firm, mushy, warmer/cooler -will likely progress to full thickness injury

electroencephalography

-recording of electrical activity of the brain -collected by examining the difference b/w the electrical potential of 2 electrodes placed at different locations on the scalp. -assess seizures, metabolic disorders and cerebellar lesions

nerve conduction velocity

-refers to the speed by which an action potential travels down a peripheral nerve. The measure is recorded in meters per second. Nerve conduction velocity can be used to diagnose conditions such as CTS, peripheral neuropathy and GB.

Korotkoff Sounds

1- clear tapping, palpable pulse, SBP 2- sounds are softer and longer 3- sounds are crisper and louder 4- sounds disappear, DBP * release BP cuff 2-3 mmHg /sec dont go above 15-20 mm Hg of their systolic

Angina Pain scale

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

Waddells Signs

1. Superficial skin tenderness to light pinch over wide area of lumbar spine 2. Deep tenderness over wide area, often extending to thoracic spine, sacrum, or pelvis 3. Low back pain on axial loading of spine in standing 4. Straight leg raising test positive when specifically tested, but not when patient is seated with knee extended to test Babinski reflex 5. Abnormal neurological (motor or sensory) patterns 6. Overreaction

what is the minimum recommended work interval duration for nondeconditioned pateint?

10 minute spouts

developmental age of modified plantigrade

10-12 months

Brunstrum Stages

1. no voluntary movement 2. appearance of basic limb synergies, beginning of spasticity 3. synergies are performed voluntarily, spasticity increased 4. spasticity begins to decrease, movement patterns are not dictated solely by limb synergies 5. further decrease in spasticity is noted w/ independence from limb synergies 6. isolated joint movements are performed in coordination 7. normal motor function

barthel Index

10 ADL's and often used as screening tool in long term care or home care score: 0-100, increments of 5 score of 100= independent

outpatient dialysis duration/frequency

3 times a week for 4 hours

APGAR score

5 items (HR, respiration, reflex irritability, muscle tone, color) --> score 0, 1, or 2 score of 7 or above is good *HR: (2) = HR over 100, less than 100, absent *respiration: vigorous cry, slow and irregular, absent *color: pink, pink body and blue extrem, blue color *grimace: prompt response to stimuli, min response to stimuli, floppy *activity: active, flexed arms and legs, absent

Glasgow Coma scale verbal response

5- oriented to time, place, person 4- confused, disoriented 3- inappropriate words 2- incomprehensible sounds 1- no response

2nd degree heart block (mobitz type 2)

AV conduction disturbance consecutive PR segments are the same or normal followed by nonconduction of 1 or more impulses

2nd degree heart block (mobitz type 1)

AV conduction disturbance progressive elongation of PR interval until impulse is not conducted aka wenckebach

Types of Grafts

Allograft: use of other donor skin Xenograft: from other species such as pig Biosynthetic: combo of collagen and synthetics Cultured: grown from lab of own skin Autograft: from own body Split thickness: epidermis and some dermis Full thickness: epidermis and all dermis

Bouchards and Heberdens vs swan neck and bouteniers

Bouchards: excessive bone in the DIP Heberdens: excess bone in the PIP * both seen in OA Swan neck: DIP flexion, PIP extension Boutteneiers: DIP ext, PIP flexion *seen in RA

Active cycle of breathing

Breathing control: gentle, relaxed breathing for 5- 10 sec Thoracic expansion: 3-4 slow, deep breaths (can use chest percussion, vibration, shaking) Forced Expiratory Technique: 1-2 huff cuffs

Bronchial Breath Sounds vs Vesicular Breath Sounds

Bronchial: loud, tubular sounds normally heard over trachea Vesicular: high pitched, breezy sounds normally heard over distal airways in healthy lung tissue

Upper Quarter Screen Resistive Testing

C1: cervical rotation C2-C4: shoulder elevation C5: shoulder abduction C5-C6: elbow flexion C6: wrist extension C7: elbow extension and wrist flexion C8: thumb extension T1: finger adduction

Upper Quarter Screen Dermatome Testing

C2: posterior head C3: posterior lateral neck C4: AC joint C5: lateral arm C6: lateral forearm and thumb C7: palmar distal phalanx-middle finger C8: little finger and ulnar border of hand T1: medial forearm

controlled cold compression unit and cryocuff

CCCU: circulates cooled water through sleeve applied in extremity...temp 50-77 degrees, compression applied intermittently cryocuff: water fills contain via gravity (keep 15-18 in above sleeve)...can provide hours of mild cooling at levels far below other cold agents.

ACE Inhibitor Drug Names

Caprtopril: Capoten Enalopril: Vasotec Lisinopril: Zestril Rampirpril: Altace end in -prils

Alpha Adrenergic Antagonist Drug Names

Cardura (doxazosin) Minipress (Prazosin) Hytrin (terazosin) (ending in -sin)

stages of grief

DABDA denial anger bargaining depression acceptance

Causes of Diarrhea and constipation

Diarrhea: IBS, hyperthyroidism, electrolyle imbalance, endocrine disorder, divertculitis, caffeine, diet, malabsorption Constipation: MS, SC tumor, IBS, DMD, endocrine disorders, diverticulitis, inactivity, bowel obstruction, pregnancy, CVA, meds

Digitalis Drug Names

Digoxins: Lanoxin

Calcium Channel Blocker Drug Names

Diltazerm: Cardizem and Procardia Amlodipine: Norvasc Verapmil (Calan) -pine or zem

Joint classifications

Fibrous- suture, syndesmosis(tibia/fibula), gomphosis(tooth and socket) Cartilagenous(Ampiarthrosis): synchondrosis (sternum and ribs), Symphysis Synovial (Diarthrosis): Uniaxial (hinge, pivot), Biaxial (condyloid, saddle), Multiaxial (plane, ball and socket)

Claudication Test Grading

Grade 1 : definite discomfort or pain Grade 2: mod discomfort and pain, attention diverted Grade 3: intense pain, attention cant be diverted Grade 4: excruciating and unbearable pain

Ca channel blocker SE and PT implications

HA, dizziness, peripheral edema, orthostatic hypotension BP and HR response will reduce--> use RPE monitor for CHF (dyspnea, edema, weight gain)

how can you differentiate intermittent claudication vs peripheral vascular disease vs nerve root compression vs peripheral neuropathy?

IC: vascular problem causes pain, but no sensory or motor loss (may have absent pulses) peripheral vascular disease: would not cause sensory changes or altered reflexes nerve root compression: would cause sensory impairments in a dermatomal pattern peripheral neuropathy: sensory impairment and distal/peripheral loss of motor function in a stocking glove pattern

Contraindications/Precautions to Postural Drainage

ICP > 20 mm Hg head and neck injury until stable recent spinal surgery active hemoptysis empyma Pulmonary edema PE large pleural effusion rib fx surgical wound/healing wound

Lumbar Plexus (interested in getting laid on fridays?)

Iliohypogastric [L1] Ilioinguinal [L1] Genitofemoral [L1, L2] Lateral femoral cutaneous [L2, L3] Obturator [L2, L3, L4] Femoral [L2, L3, L4] • Alternatively: "I twice Get Laid On Fridays". • Alternatively: "Interested In Getting Laid On Fridays?"

Levels of supervision

Independent supervision contact guard min A- pt needs < 25% help mod A- pt needs 25-50% help max A- pt needs 50-75% help dependent- pt needs 75-100% help

Angiotensin 2 Receptor Blockers Action

Inhibit the binding of angiotensin 2 on smooth muscle; reduce BP

ratios to remember:

Inspiration: expiration 1:2 COPD: 1:3 or 1:4 Quad/Hamstring: 3:2 or 1.5:1 Pursed Lip Breathing: 2:4 contrast bath 4:1 (warm to cool) compression: 3:1 ratio for edema, 4:1 for shaping limb

Lower Quarter Screen Resistive Testing

L1-L2: hip flexion L3-L4: knee extension L4-L5: ankle dorsiflexion L5: great toe extension S1: ankle plantarflexion

LE nerve root testing for EMG

L2, 3, 4: vastus medialis L4-5: tibialis anterior L4-5, S1: tensor fascia latae L5-S1: peroneus longus L5, S1-S2: glute max L5, S1-2: hamstrings S1-2: gastrocnemius

Lower Quarter Screen Dermatome Testing

L2: anterior thigh L3: middle 1/3 of anterior thigh L4: patella and medial malleolus L5: fibular head and dorsum of foot S1: lateral and plantar aspect of foot S2: medial aspect of posterior thigh S3-S5: perineal area

ECG Leads

Lead 1: left arm, right arm Lead 2: left leg, right arm Lead 3: left leg, left arm * count the L's

Examples of Peripheral Vertigo

Meineir's BPPV Infection trauma/tumor metabolic disorders (DM) acute alcohol intoxication

NG Tube vs G tube V J tube

NG tube: in through the nostril that extends into the stomach. Short term feeding, medicine administration or removing gas G tube: inserted through small incision in abdomen into stomach, used long term w/ presence of difficulty swallowing or risk of aspiration J tube: inserted through endoscopy into jejunum via abomdinal wall, long term feeding for those that cant receive food by mouth

myasthenia gravis

NM junction disorder characterized by progressive muscle weakness and fatiguability on exertion. Autoimmune anti body mediated attack on acetylcholine receptors at NM junction affects cranial nerves, proximal muscle strength > distal, respirator function

TMJ OA

NO clicking joint pain, stiffness, crepitus

Respiratory Rate norms/ HR norms

Newborn: 35-45 breaths/min 1 year: 25-35 breaths/min 10 years: 15-20 breaths/min adult: 12-20 breaths/min Newborn: 100-130 bpm Normal child: 80-100 bpm Normal Adult: 60-100 bpm Bradycardia < 60 Tachycardia > 100

TMJ muscles involved with opening, closing, protrusion, retrusion

Opening: Lateral pterygoid, suprahyoid, infrahyoid (25-35 mm functional and 35-50 normal) lateral Closing: Temporalis, Masseter, Medial Pterygoid Protrusion: Masseter, Lateral Pterygoid, Medial Pterygoid (3-6 mm) Retrusion: Temporalis, Masseter, Digastric

bone tumors

Osteosarcoma: malignant and affects long bones Ewing's: malignant and affects both long and flat bones Osteochondroma: benign, near end of long bones

PICO question

P- patient or problem I- intervention C- comparison O- outcome

Swan Neck Deformity

PIP Extension DIP Flexion contracture of intrinsics muscles w/ dorsal subluxation of lateral extensor tendons

Bouteneier Deformity

PIP flexion DIP Extension caused by rupture of volar slippage of lateral bands

what PNF technique is good for PD patients to initiate rolling?

PNF UE lift, reverse lift and using rhythmic initiation

Pediatric Functional Assessments

Pediatric Evaluation of Disability Inventory (PEDI) Functional Independentce Measure (weeFIM) School Functional Assessmnet (SFA)

Health Belief Model

Perceived susceptibilty Perceived severity Perceived benefit Perceived barriers Cues to action self-efficacy why patient's make

Trans Theoretical Model

Precontemplation contemplation preparation action maintenace

Rood vs Bobath vs Brunnstum vs Kabat

Rood: based on sherrington, believed motor output was result of past and present sensory input. Sensory stim to either inhibit or facilitate movement Bobath: interference of a normal brain caused by CNS damage, leads to slowing of motor development, inhibition of righting reactions...normal movement and rotational patterns Kabatt: stronger parts stimulate and strengthen the weaker parts. Balance b/w control of antagonist and agonist. Brunsstum: defined synergy and encouraged synergy

Thoracic Outlet Syndrome Tests

Roos: sitting or standing w/ arms abd and flexed to 90, open and close hands for at least 3 minutes Adson: sitting or standing, pt rotates his head to test side, extendes head and PT laterally rotates and extends shoulder (look for absent radial pulse) Allen test: sitting or standing w/ arm in 90 degrees ABD, ER, elbow flex. Rotate head away from test shoulder, monitor radial pulse Costoclavicular test: sitting, monitor radial pulse, ask pt to assume military position (indicates compression of subclavian artery in b/w 1st rib and clavicle) Wright (Hyperabduction test)-pt sitting or supine, therapist moves arm into full ABD, monitoring radial pulse

what joint is typically affected in pregnancy due to increased hormone relaxin?

SI joint

sensitivity vs specificity vs responsiveness vs linearity of change

Sensitivity is a measure of validity of a diagnostic or screening test based on the probability that someone with a disease will test positive on the test. Specificity is a measure of validity of a diagnostic or screening test based on the probability that someone who does not have a disease will test negative on the test. Responsiveness: ability of the instrument to detect change over time. This is an essential attribute when the goal is to assess changes in quality of life before and after participating in cardiac rehabilitation. If the questionnaire is being used to assess the effectiveness of an intervention, the score should change as the patient's status changes and stay the same if the patient is unchanged. Linearity of change refers to the magnitude of the change with respect to the starting score. The extent to which a score changes is a function of the starting score. For example, patients may experience substantial changes in joint ROM if their initial ROM is limited because there is more to be gained.

Nitrate Drug Names

Sublingual Nitroglycerin--> acute MI Nitrostat: nitroglycerin Isodril (isosorbide dinitrate) Amyl nitrate solution for inhalation

Superficial Cutaneous Reflexes, Primitive/Spinal Reflexes/ Tonic/Brainstem Reflexes

Superficial: Plantar Reflex (babinski)= S1-S2 Abdominal: T6- L1 Cremasteric: L1-L2 Primitive/Spinal Reflexes Flexor Withdrawl, Crossed Extension Traction Grasp Tonic/Brainstem Reflexes ATNR STNR Positive Support Associated Reactions

spinal cord injury ambulation predictions

T6-T9: supervised ambulation for short distances, requires bilateral KAFO and crutches T12-L3: independent in ambulation on surfaces and stairs, bilateral KAFOs; independent household ambulation, wheelchair use for community ambulation L2 or L3: ambulate w/ crutches and bilateral KAFOS L4-L5: bilateral AFO's and crutches or canes, independent community ambulators

Sections of the brain

Telencephalon: cerebrum, hippocampus, basal ganglia, amygdala Diencephalon: thalamus, hypothalamus, subthalamus, epithalamus Tectum: superior and inferior colliculi Tegmentum: cerebral aqueduct, periaqueductal gray, reticular formation, substantia nigra, red nucleus Metencephalon: cerebellum, pons Myelecephalon: medulla oblongata

Teleological theory vs Deontologism

Teleological (consequentialism): outcome or consequence of a particular action should come from answering "what should I do.". Person will choose the action that brings the most good and least harm, supports paternailistic behavior Deontologism: focuses on the action itself and if the action follows moral principles. Person's obligations determine the ethical course of action

Bakody Sign

The test described in the stem evaluates for radicular symptoms and involves the C4 or C5 nerve roots. If resting the arm on the head relieves the patient's symptoms, a cervical compression problem or nerve root compression should be suspected. Lateral shoulder pain occurs in the location of the C4 dermatome

Nitrate Actions

VD the coronary arteries to improve blood flow; reduce the myocardial O2 demand; reduce chest pain/discomfort

Chronic Adaptations To Aerobic Exercise (Max)

VO2 max: increased HR: no change or decrease AVO2 difference: increased SBP/DBP: no change or slight increase blood lactate: increased Skeletal Muscle blood flow: increase

Vitamins

Vit A: essential to eyes, epithelial tissue normal growth and development, reproduction Vit C: combat infections and facilitate wound healing. Development and maintenance of bones, cartilage, CT and blood vessels Vit D: calcium absorption, synthesis, transport and bone decalcification, increases blood flow levels of minerals(calcium and phosphorous) Vit E: antioxidant in cell membranes and is important for cell integrity that are exposed to high levels of O2 such as lungs and RBC Vit K: synthesis of at least 2 of the proteins involved in blood clotting

can you perform percussion/vibration on a patient with a chest tube?

YES no contraindications

standard deviation

a symmetrical bell shaped curve indicates distribution of scores; the mean, median and mode will be similar 1 SD above and below the mean: 68% (34% of either side of mean) 2 SD: 95% 3 SD: 99%

Restrictive Lung Disease

abnormal reduction in lung expansion and pulmonary ventilation. Abnormal lung parenchyma decreased TLC, VC, IRV, ERV, IC sx: DOE, persistent non productive cough, increased RR, hypoxemia, increased RR, decreased vital capacity, abnormal breath sounds, reduced exercise tolerance, decreased chest mobility, increased accessory muscles

loss of function of hamstrings during swing will result in....

abrupt knee extension and increased hip flexion

ratio data

absolute zero point classifies and ranks variables or scores based on equal intervals and a true zero point ex: goniometry, scales for height, weight ex: length, height, weight,

advantages to alginates

absorb up to 20 times their weight in drainage fill dead space support debridement in presence of exudate easy to apply

massage contraindications

acute injury arteriosclerosis cancer cellulitis embolus infection thrombosis

standard wheelchair dimensions

adult: 18 seat width, 16 seat depth, 20 seat height narrow adult: 16 seat width, 16 seat depth, 20 seat height slim adult: 14 seat width, 16 seat depth, 20 seat height hemi low seat: 17.5 in junior: 16 seat width, 16 depth, 18.5 seat height child: 14 seat width, 11.5 depth, 18.75 height tiny tot: 12 seat width, 11.5 depth, 19.5 seat height

negative pressure wound advantages/disadvantages

adv: provides wound drainage and moisture decreases edema decreases bacteria increases capillary blood flow increases granular tissue formation enhances epithelial cell migration disadv: require special supplies treatment can be painful not reimbursed in acute or long term care

discoid lupus erythematous (DLE)

affects only the skin flare ups w/ the sun lesions can resolve or cause atrophy, permanent scarring, hypopigmentation, hyperpigmentation

transparent films considerations

allow 1-2 inch wound margin around bed shave surrounding hair secondary dressing not required dresing change varies avoid in infected wounds, copious drainage or tracts

Prolactin

allows for process of lactation target: mammary glands regulated: hypothalamus *made in pituitary

emphysema

alveolar walls are destroyed and turned into air pockets sx: SOB, wheezing, chronic coughing, orthopnea, barrel chest, increased subcostal angle, rosy skin coloring increased RV, FRC decreased FEV, VC, FVC

20 months development

ascends stairs step to jumps off bottom step throws ball overhead a few feet

PeaBody Developmental Motor Scales

assess gross and fine motor from birth-42 months includes spontaneous, elicited reflexes and automatic reactions

arterial line

attached to transducer (monitoring system) measure BP or obtain blood samples

polarity with bacteriocidal and non infected wound?

bacteriocidal = negative, so put it with cathode culture free wound= + so put with anode (still in the wound)

bsal cell carcinoma, squamous carcinoma, malignant melaonma, nevi

basal cell carcinoma: occur on hair bearing areas exposed to the sun, such as face, neck, head, ears or hands. Grow slowly 1-2 cm a year squamous cell carcinoma: on ear, face, lips, mouth and dorsum of hands, small red hard nodules nevi: irregular borders and colors, smaller than 6 mm and have uniform pigmentation (mole) malignant melanoma: appear anywhere in body, asymmetric, irregular borders, colors are black, brown red or white. Larger than a pencil erase and evolves in shape

8-9 months development

belly crawls quadruped creeping side sitting pulls to stand w/ furniture cruises sideways radial digital grasp, radial palmar 3 pt chuck, inferior pincer grasp transfer object from hand to hand manipulate toys in sitting raise from supine to sit

anterior cord syndrome

bilateral loss of motor function and pain and temp sense below the level of the lesion (corticospinal and spinothalamic tract)

Arnold Chiari Malformation

brainstem and cerebellum extend into the foramen magnum. sx: weakness, pain, sensory changes, vertigo, diplopia, ataxia

basal ganglia deficits result in these symptoms....

choreaoathetosis hyperkinesias rigidity bradykinesia

hepatitis

chronic inflammation of liver sx: jaundice, RUQ pain

normal sensations with cold application?

cold--> burning--> aching--> analgesia

conduction aphasia vs global aphasia

conduction: lesion to the arcuate fasciculus, impairment w/ repetition, intact fluency and comprehension but word finding difficulties global: comprehension impaired, impaired naming, writing, repetition, may verbalize w/o context ...they need to use nonverbal for communiaction

what treatments can be used to decrease sympathetic activity?

connective tissue massage rotating trunk while in hooklying gentle manual pressure over abdomen

primary progressive MS

continuous worsening of sx's from the onset w/o distant relapses or remissions

medial plantar nerve innervates

cutaneous branches to the medial 3 and a half digits abductor hallucis flexor digitorum brevis flexor hallucis brevis medial lumbricals

lateral plantar nerve innervates

cutaneous lateral one and a half toes lateral lumbricals interossei abductor digiti minimi

manual lymph drainage

decongest proximal portions first and work distally proximal before distal, trunk segments before limb segments and directing the flow centrally towards the lymph ducts

emphysema PFT's

decreased VC increased TLC, FRC, RV

Huntingtons

degeneration and atrophy of basal ganglia (striatum) and cerebral cortex decrease in GABA and acetylchoine causes loss of inhibition, therefore you have chorea, bradykinesia, rigidtity autosomal dominant, linked to chromosome 4 and IT-15 gene sx: movement disorder, affective disorder, cog impairment, altered personality, unintentional facial movements

trimgeminal neuralgia

degeneration/compression of CN 5 sx: stabbing/shooting pain in face, exacerbated by stress, cold, relieved by relaxation trigger points: light touch to face, lips, gums, extremes of heat/cold, chewing, talking, jaw pain, movement across face tx: anticonvulsants, B12, alcohol injections, nerve resection

disadvantages to gauze dressings

delayed healing if used improperly pain on removal (wet to dry) labor intensive require secondary dressing avoid direct contact w/ granulating tissue

tertiary intention

delayed wound healing at risk for sepsis or dehiscence, may be left open wound will be closed via primary once ready

how to prevent delayed vs rapid onset hypoglycema

delayed: crackers or bread rapid: candy, juice

delirium vs dementia

delirium: fluctuating attention state, confusion that alternates w/ lucid intervals, sleep wake cycles disrupted and confusion worst at night, periods of disorientation dementia: personality changes, hallucinations throughout the day, level of arousal is significantly depressed, constant disorientation

Horner's Syndrome

droopy eye lid (ptosis) miosis (pupillary constriction) anhydrosis (lack of sweating) due to lesion of the SNS pathway to the head, often caused by trauma, interruption of blood supply, tumors or cluster headaches skin vasodilation is often seen, it is all on the same side of the face and ipsilateral to the lesion

orthostatic hypotension defined as

drop of SBP > 20 drop of DBP > 10

Alpha Adrenergic Antagonist Agent SE and PT implications

drowsiness, dizziness, orthostatic hypotension, palpitations watch changing positions and monitor

left sided heart failure

dyspnea, orthopnea, hypotension, tachycardia, fatigue, weakness, dry cough (lung issues)

hyperthyroidism

excessive levels of thyroid hormones in the bloodstream sx: extreme sweating, nervousness, heat intolerance, increased DTR's, weight loss, increased BP, exopthalamus, myopathy, chronic periarthritis, enlarged thyroid gland , fatigue, tachycardia, arrythmia Grave's Disease tx: radioactive iodine, surgery, pharm

intermittent compression

general ranges 30-80 mm Hg, should not exceed DBP arterial capillary pressure is 30 mm Hg, so needs to be above this inflation pressure that is greater than the SBP may restrict blood flow and create a medical emergency 3:1 ratio for edema, 4:1 for shaping limb *LE= typically 40-80 and UE usually 30-60 tx duration: 30 min to 4 hours

how to help a festinating gait in parkinsons?

give them a toe wedge to displace COG posterior

what do you have to wear if someone has contact precautions"?

gloves, gown

hemiballism vs athetosis vs chorea vs intention tremor

hemiballism: sudden, jerky, forceful and flailing involuntary movements on one side of the body (primarily in the axial and prox joint muscles) athetosis: slow, writhing, twisting involuntary movements chorea: rapid, irregular and jerky involuntary movements intention tremor: involuntary oscillation movements that occur during voluntary movements *all basal ganglia signs

absolute contraindications to exercise in pregnancy

hemodynamically heart disease restrictive lung disease incomptetent cervix multiple gestation pregnancy at risk for early labor 2nd or 3rd trimester bleeding ruptured membranes preeclampsia/ pregnancy induced HTN

thrombolytics agents SE and PT implications

hemorrage (intracranial), allergic reaction, cardiac arrythmias avoid activities that may cause trauma due to altered clotting

chronic venous insufficiency

hemosiderin changes increased LE edema typically medial malleoli wet, irregular shallow borders minimal pain flaky skin

causes for RUQ pain

hepatomegaly duodenal ulcer cholycystitis PNA hepatitis biliary stones

new children learning to walk...

high guard(scapular retraction): rhomboids-->they help to adduct and provide assistance to the trunk extensors when in an upright position bowed legs (genu varum) flexion at the hips wide BOS

extensor synergy LE

hip extension hip adduction hip IR knee extension ankle PF ankle inversion

Cushing's

hyperfunction of adrenal gland results in increased secretions of cortisol cause: pituitary tumor sx: moon face, buffalo hump HTN, hyperglycemia deceased glucose tolerance obesity muscular atrophy edema hypokalemia weight gain

massage friction

incorporates small circular motions over a trigger point or muscle spasm penetrates deep in muscle to reduce edema, loosen adhesions, relieve muscle spasm used w/ chronic inflammation or overuse injuries

glucagon

increase blood glucose by stimulating the conversion of glycogen to glucose target: liver regulated: hypoglycemia *made in pancreas

hickman catheter

indwelling right atrial catheter removal of blood samples administer medications(chemo, TPN, antibiotics) monitoring central venous pressure complications: sepsis and blood clots

which muscle is most active during FORCED expiration?

internal intercostals

types of validity

internal validity: degree to which the observed differences on the dependent variable are the direct result of manipulation of the independent variable and not some other variable external validity: degree to which the results are generalizable to individuals (general pop) or settings outside of the study face validity: assumption of validity based on the appearance of an instrument as a reasonable measure content validity: degree to which an instrument measures an intended content area; reflects a meaningful element of a construct and the items in a test adequately reflect the content domain of interest ex: mcgill pain questionaire includes pain but also location, quality, etc concurrent validity: degree to which the scores on one test are related to the scores on another criterion test with both tests being given at relatively similar times; usually a comparison to a gold standard predictive validity: degree to which a test is able to predict future performance construct validity: degree to which a test measures an intended hypothetical abstract content ex: MMT would have construct validity as indicators of innervation of muscles

transfemoral pressure tolerant socket

isch tube glutes lateral side of residual limb distal end

TMJ subluxation

jaw locks in an open position and pt cannot close the mouth

5 classifications that make up a synovial joint

joint cavity articular cartilage fibrous capsule synovial membrane synovial fluid

keratitis vs folliculitis

keratitis: corenal inflammation (white patch in eye) folliculitis: bacterial infection of hair follicles that produces individual pustules, each pierced by a ahir

causes for RLQ pain

kidney stone uretal stone meckel diverticulitis appendicitis cholecystitis intestinal obstruction

renal failure

kidneys have a decrease gllomerular filtration rate and cant filter toxins/waste etiology: DM and HTN, poison, trauma sx: nausea, vomitting, lethargy, weakness, hiccups, anorexia, ulcers, HA, peripheral neuropathy will have decreased urine output and anemia (kidneys make erythropoitein) tx: pharm, diuretics, dialysis, hydration

massage petrissage

kneading, muscle is squeezed and rolled under the hands loosen adhesions, improve lymphatic flow, remove waste distal to proximal

Lyme's disease affects what body parts?

large joints, especially the knee

lunate dislocation, capitate instability, scaphoid subluxation, lunotriquetral tear

lunate dislocation: murphys sign-make a fist and the head of the 3rd MCP is level with the 2nd and 4th meaning dislocated lunate (should be lower) capitate instability: apprehension, sx's and pain during dorsal capitate displacement scaphoid subluxation: scaphoid subluxation during watson (scaphoid shift test) lunotriquetral ligament tear: pain, crepitus or abnormal movements during the lunotriquetral shear test

what are gauze dressings?

made of cotton or synthetic fabric that is absorptive and permeable to water and oxygen. May be used with wet, moist, dry or impregnated w pretrlatium, antiseptics or other agents. Come in different sizes and weaves

Occipital Lobe

main processing center for visual info, process visual info regarding colors, lights and shapes, judgement for distance impairment: homonymous hemianopsia, impaired color recognition, reading and writing impairment, cortical blindness

advantages of hydrocolloids dressings

maintain moist wound environment nonadhesive to healing tissue conformable impermeable to bacteria/contaminents support autolytic debridement min-mod absoprtion waterproof reduce pain easy to apply time saving thin forms diminish friction

7 months development

maintain quadruped pivots on belly pivot prone assumes sitting from quadruped recognizes tone of voice may show fear of strangers

hyperfunction agent drugs

manage a hyperactive endocrine gland, inhibition of hormone function indicated: hyperactive or excessive endocrine fxn

The code of ethics is built upon these 4 roles of PT

management of pt/clinet consultation education research administration

treatment for lupus

no cure topical management for skin lesions (corticosteroids) salicylates indomethacin w/ fever and joint side effects: edema, weight gain, HTN, acne, purple stretch marks, osteoperosis, myopathy, diabetes, GI irritation, low potassium, infection

Primary intention

occurs in acute wounds w/ minimal tissue loss closed w/ sutures, staples, adhesives minimal scarring and heal quickly

definition of preload, afterload, ejection fraction

preload: amount of blood left in the ventricle at the end of diastole afterload: the force the LV must generate during systole to overcome aortic pressure to open the aortic valve ejection fraction: % of blood emptied from the ventricle during systole; clinically useful term to determine LV function.... SV/LVEDV (normal should be > 55%)

epitheliazation

process of epidermal resurfacing and appears as pink or red skin

Alpha Adrenergic Antagonist Actions

reduce peripheral tone by blocking alpha 1 adrenergic receptors. It causes VD of arteries and veins in the periphery to decrease BP used for: HTN, BPH

5 month development

rolls from prone to supine weight shifting in prone head control in supported sitting

5 years development

skips kicks ball well dresses self

Symmetrical Tonic Neck Reflex (STNR)

stimulus: head position, flexion or extension response: when head is in flexion, arms are flexed, legs extended...when head is in extension, arms are extended and head is flexed normal: 6-8 months interferes with: ability to prone on arms in prone, attaining and maintaining hands and knees, crawling reciprocally, sitting balance when looking around, use of hands when looking at object in hands in sitting position

Asymmetrical Tonic Neck Reflex (ATNR)

stimulus: head position, turned to one side response: arm and leg on face side extend, arm and leg on scalp side are flexed, spine curved w/ convexity toward face side normal age: birth to 6 months Interferes with: feeding, visual tracking, midline use of hands, bilateral hand use, rolling, crawling

Startle Reflex

stimulus: loud, sudden noise response: similar to moro, but elbows remain flexed and hands closed normal: 28 weeks of gestation to 5 months interferes with: sitting balance, protective responses in sitting, eye hand coordination, visual tracking, social interaction, attention

palmar grasp reflex

stimulus: pressure in palm on ulnar side of hand response: flexion of fingers causing strong grip normal age: birth to 4 months intereferes with: ability to grasp and release objects, WBing on open hand for propping, crawling, protective response

functions of the thalamus, hypothalamus, subthalamus and epithalamus

thalamus: relay or processing center, coordinates sensory and motor info and sends it to the appropriate cortex...damage will cause thalamic pain syndrome (contralateral side pain of the lesion) hypothalamus: receives and integrates info from the ANS, regulates hormones, hunger, thirst, sexual behavior, sleeping, body temp subthalamus: regulates movements produced by skeletal muscles, associated w/ basal ganglia and substantia nigra epithalamus: pineal gland, secretets melatonin, circadian rhythm, internal clock, selected regulation of motor pathways and emotions

effective radiating area (ERA)

the area of the transducer that transmits ultrasound energy. more relevant when considering the size of the transducer to utilize and the duration of treatment.

ultrasound duty cycle

the fraction of time the US energy is on over one pulse period (time on: time off) ex: 20% duty cycle means its on for 2 seconds and off for 8 seconds on time/ on + off time x 100 duty cycle <50% is considered pulsed

how do the adrenal glands work?

the hypothalamus sends releasing hormones to the pituitary gland to release ACTH, a hormone that stimulates the adrenal glands. When the adrenal glands receive the signal, they produce cortisol. Aldolsterone is also produced and helps to maintain BP, water and salt balance by helping the kidneys RETAIN sodium and excrete potassium. If the signals aren't sent and there is LOW cortisol--> you get LOW sodium(hyponatremia) and HIGH potassium(hyperkalemia)

effect size

the size (quantity, magnitude) of the differences between sample means; allows a statistical test to find a difference when one really does exist the larger the ES, the more likely it will be statistically significant

apehand deformity

thenar muscle wasting, first digit moves dorsally in line with second digit results from median nerve dysfunction

ultrasound thermal vs non thermal effects

thermal: increases metabolic rate modulate pain reduce muscle spasm decrease joint stiffness alter NCV increase circulation increase soft tissue extensibility nonthermal: increase cell/skin membrane permeability increase intracellular calcium levels faciliate tissue repair promote normal cell function

ultrasound thermal vs nonthermal effects

thermal: increase tissue temp, increase pain threshold, increase collagen extensibility, alters NCV, increased enzyme activity, increased tissue perfusion nonthermal: alters cell membrane activity, increased cell wall permeability, increased macrophage response, increase protein synthesis, accelerate tissue healing

clubbing nails

thickened and round edges indicates; chrohns, cardiac/cyanosis, UC, cirrhosis, neoplasm, GI involvement, hypoexmia, lung cancer

myelomeningocele ambulation differences

thoracic: standing in parapodium L1-L2: walk short distances in the home with KAFO L2: ambulation with KAFO in home (or RGO and lofstrand) L3-4: community ambulation using KAFO L4-5: walking in the home and community using only AFO

throbbing vs aching vs agonizing vs burning pain

throbbing: vascular aching: MS agonizing: emotional burning: neurogenic

antithrombotics SE and PT implications

thrombocytopenia, hemorrhage, GI distress and liver toxicity (aspirin)

Symmetrical Tonic Neck Reflex

when the head is flexed, the UE are flexed and LE are extended when the head is extended, the UE are extended and LE are flexed 6-8 months

when do you used pulsed ultrasound?

when you want non thermal effects ex: acute soft tissue injuries

CPM usage

-2 cycles per minute improve ROM that has been impaired secondary to surgery *help regain knee flexion ROM, does not prevent knee flexion contracture can prevent loss of motion, inhibit the formation of adhesions and contractures and edema formation

precautions to US

-acute inflammation(use nonthermal) -breast implants -open epiphyseal plates -US over healing fractures

structural scoliosis ex: on the right

-convexity is named towards side of scoliosis (right thoracic scoliosis) -decreased breath sounds on contra side (left) -decreased thoracic rib elevation on the contra (left) -shortened internal and external intercostals on the contra (left) -increased lateral costal expansion on ipsi (right)

what occurs in muscles when using electromyography?

normal: electrical silence (after insertional activity resolves) spontaneous potentials: like fibrillations and positive sharp waves, seen in acutely denervated muscle. polyphasic potentials: electrical potentials from a denervated motor unit. It exhibits 5 or more phases which is referred to as polyphasic. occasional motor unit potentials: likely to occur with neuropraxia, minimal effort muscle contractions 2-3 weeks after injury

how far away should sound head be in US in water?

1 cm

Borg scale correlations with max HR

11-12 (fairly light) = 60% of max HR 13-14 (somewhat hard) = 70% of max HR 16 (very hard) = 85% of max HR

what amount of elbow flexion is required for walker, crutches, cane?

20-25 degrees of elbow flexion

traction duration to stretch soft tissue or reduce muscle spasm? traction pounds?

20-30 minutes cervical: 12-15 lbs lumbar: 25% of body weight

normal physiological changes with pregnancy

25-35 lb weight gain diaphram ascends 4 inches uterus ascends increases O2 consumption, CO and blood volume joints become hypermobile

developmental age of quadruped

7-9 months

target heart rate calculations (according to ACSM)

70-85% of max HR 50-70% of VO2 max

accessibilty requirements for bathroom sink

not less than 29 in height not greater than 40 in from floor to bottom of mirror or paper dispenser 17 in min depth under sink to back wall

extraneous variable

nuisance or intervening variable any factor that is not related to the purpose of the study, but that may affect the dependent variable

who is more at risk of heat illness?

obese.... they are more suspectible because their cooling system cannot work quickly enough

erectile dysfunction

aka impotence etiology: DM, heart disease, HTN, hypopituitarism, MS, alcohol tx: pharm, surgery, injections, kegels

What two hormones are not produced in adrenal insuffiency?

aldosterone cortisol

biofeedback contraindications

conditions where muscle contraction is detrimental skin irritation at electrode site

5 types of heat transfer

conduction convection conversion evaporation radiation

Hypothalamus in the endocrine system

connects to the pituitary gland regulation of the ANS ex: body temp, appetite, sweating, thirst, sexual behavior, rage, fear, BP, sleep)

direct current

constant flow of electrons from anode (+) to cathode (-) for a period of > 1 sec w/o interruption polarity is constant used with iontophoresis or bells palsy

neurogenic bladder

damage to the cerebral contol that controls urinary dysfunction etiology: DM, diminshed bladder capacity, hyperactive destrusor muscle, CVA, SCI sx: frequent UTI's, leakage, inability to empty the bladder or loss of urge to urinate when bladder is full tx: prevent UTI's, patient education, bladder techniques, catherization, pharm

Osteoporosis

decrease in bone mass, increases risk of fx, increased osteoclast > osteoblast cause: idopathic or secondary to other condition or drugs sx: low thoracic or lumbar pain, loss of lumbar lordosis, kyphosis, decrease height, dowagers hump, posture changes tx: vit/pharm therapy, proper nutrition, assist and AD devices, patient education, aquatic programs, joint/bone protection, maintain joint mechanics *avoid excess flexion, heavy resistance, ballistic movements

what do calcium channel blockers do?

decrease myocardial oxygen demand and increase myocardial oxygen supply, they prevent arterial vasospasm and increase the cellular metabolic rate

hypopituitarism

decreased or absent hormonal secretion from anterior pituitary gland sx: short stature (dwarf), delayed growth and puberty, sexual and reproductive disorders, diabetes insipidus bilateral hemianopsia is common

chronic arterial insufficiency

decreased/absent pulses dependent rubor trophic changes (nails, loss of hair, pale or shiny skin) typically lateral malleoli punched out appearance well defined borders, granulation tissue HURTS pale

acquatic therapy effects

decreases BP decreases HR increased CO decreased VO2 max increased venous circulation increased muscle circulation decreases VC increase work of breathing

insulin

decreases blood glucose and increases the storage of fat, protein and carbs target: all body systems regulated: hyperglycemia *made in pancreas

massage vibration

places the hands or fingers firmly over an area and utilizes a rapid, shaking motion that causes vibration to the treatment area initiate from forearm while maintaining firm contact on the treatment area used for relaxation

diagnosing DM

plasma glucose concentration > 200 mg/dL fasting plasma glucose > 126 mg/dL

cluster sample

probabilty sample in which large subgroups (clusters) are randomly selected first, and then smaller units are selected from the clusters *it requires 2 or more samples to be drawn, each sample is subject to sampling error *greatest degree of sampling error

hydroccoloids dressings indications

protection of partial thickness wounds autolytic debridement of necrosis or slogh wounds w/ mild exudate

lumbar plexus innervates

psoas major psoas minor quadratus lumborum T12-L4

parasitic infections

scabies (mites) -burrow in skin, caused inflammation, itching, tx: scabicide lice (pediculosis) -affects, head, body, pubic hair -bite marks, redness, nits

what does the pancreas do?

secretes bicarb into duodenum secretes insulin and glucagon

supine to long sit test

short --> long posterior innominate long --> short anterior innominate

ALS

degenerative disease affecting both UMN and LMN, degeneration of anterior horn cells and corticobulbar and corticospinal tracts bulbar onset, muscle weakness that starts in the hands. WONT SEE SENSORY CHANGES *sensation, eye movement and bowel and bladder are NORMAL check CN 7, 9, 10, 11 and 12 men, usually 40-70 y/o tx: mild resistance exercises, dont overwork them, aerobics in the pool, FUNCTIONAL TRAINING

reasons why blood urea nitrogen would be high....

dehydration renal failure heart failure blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passed out of your body in the urine. A BUN test is done to see how well your kidneys are working.

x-ray

demonstrate bony tissue the more dense, the white the image( bone) inexpensive, readily available con: exposure to radiation

how to calculate ionto current density?

density (mA/cm^2) = amplitude (mA) / surface area (cm)

T4 and T10 nerve root

dermatome of T4: nipple dermatome of T10: umbilicus

C4 nerve root

dermatome: shoulder area, clavicular area, upper scapular area myotome: trap, levator scap reflexes: none

C2 nerve root

dermatome: temple, forehead, occiput myotome: longus colli, SCM, rectus capitus reflexes: none

C1 nerve root

dermatome: vertex of skull

transfemoral pressure sensitive socket

distolateral end of femur pubic symphysis perineal area

minimum width of doorway? hallway?

doorway: 32 inches hallway: 36 inches

what will help with delivering insulin? prohibit it ?

help: aerobic exercise prohibit: cold, eating, excess body fat

flexor synergy LE

hip flexion hip abduction hip ER knee flexion ankle DF ankle inversion

female hypogonadism

if gonad does not produce sex steroids to suppress secretion of LH and FSH caused: turners syndrome, faiure of hypothalamus or pituitary gland to produce estrogen sx: gonadal dysgenesis, short stature, lack of puberty, primary amennorhea, premature gonadal failure adults: secondary amenohrrea tx: hormone replacement therapy

baroreceptor reflex

if you have an increase in BP--> causes peripheral vasodilation and bradycardia...therefore leading to decreased CO if you have a decrease in BP--> causes vasoconstriction of periphery, increased HR(tachycardia) --> resulting in increased CO *baroreceptor reflex does not control respiration rate

cold bath

immersion of distal LE allows circumferential contact be careful of dependent position w/ edema 15-20 min

PT with Erbs/Klumpke Palsy

immobilization across stomach for 1-2 weeks gentle ROM proper positioning elicit muscle strengthening

side effects of diazepam

impaired balance decreased neuromuscular function decreased central processing

Autogenic Drainage

improve airflow in the smaller airway w/o using postural draining positions or coughing Unsticking: slowly breath in through nose followed by 2-3 second hold, then exhale Collecting: breath at tidal volume interdespersed 2-3 sec breath holds Evacuating phase: deeper inspirations, breath holding followed by huff cuff * requires motivation and concentration to learn

subtalar mobilization for supination/pronation

improve supination: lateral glide of calcaneus (calc inversion, PF and adduction/lateral tilt) improve pronation: medial glide of calcaneus (calc eversion, DF and abduction) convex on concave

case report

in depth description of an interesting condition or response to treatment (case series--> collection of observations of similar cases) cannot test hypothesies or establish cause and effect least rigorous form, lack of control and generalizability

when is high kneeling used?

in those with pronounced ataxia and decreased postural control (lowers COM, DOF are reduced)

causes of early heel rise with prosthetics

inadequate knee friction too little tension in the extension aide

expectorants agents

increase respiratory secretions which help to loosen mucus, reduce the viscosity of secretions and increase sputum volume to increase cough reflex SE: GI distress, drowsiness ex: Mucinex

prosthesis causes for circumduction

long prosthesis locked knee unit loose knee friction inadequate suspension small or loose socket plantarflexed foot

Parkinsons

loss of dopamine neurons due to degeneration of the basal ganglia, specifically the substantia nigra and corpus striateum causes slow movements, hypokinesia or bradykinesia, festinating, rigidity, freezing, mask like appearance tx: Levadopa, Sinemet, Madopar

posterior cord syndrome

loss of proprio, stereognosis, 2 pt discrimination below the level of the lesion

central cord syndrome

loss of spinothalamic tracts with bilateral loss of pain and temperature loss of ventral horn w/ bilateral motor function loss, worse in UE

urge urinary incontinence

loss of urine after a sudden, intense urge to void due to the detrusor muscle involuntarily contracting...most common in old people etiology: smooth msucle changes, increased afferent activity, increased sensitivity to acetycholine, sx: "key in lock", running wter tx: biofeedback, pelvic floor strengthening, bladder retraining

stress urinary incontinence

loss of urine due to activities that increase intraabdominal pressure, such as sneezing, laughing, running, jumping

functional urinary incontinence

loss of urine due to inability or unwillingness to use bathroom or not mobile etiology: decreased mental awareness, decreased mobility tx: improve mobility, increase independence with ambulation

order of lowest load to greatest total load of the lumbar spine?

lying supine sidelying standing in anatomic position standing w/ 45 degrees hip flexion sitting in chair w/ reduced lumbar lordosis sitting in a chair with slouched posture

rhythmic stabilization improves

mobility, stability

symptoms of nerve root, muscle, bone, and vascular pain

nerve root: sharp, shooting, burning muscle: cramping, dull, aching bone: deep, intolerable, boring, highly localized vascular: diffuse, throbbing, aching, poorly localized

CABG exercise prescription

no pushing, pulling, lifting for 4-6 weeks resistance training avoided for first 3 months once cleared: initial loads of UE is 30-40% of 1 rep max and 50-60% for hips and legs

hydroccoloids disadvantages

nontransparent may soften and change shape w/ heat/friction odor and yellow draiing on removal not recommended for heavy exudate, infections dressing edges may curl avoid in wounds with infections

what does the gallbladder do?

stores and release bile into duodenum

suprascapular nerve

supraspinatus and infraspinatus C5-C6 comes off of superior trunk

Beta Adrenergic Blocker Drug Names (beta blockers)

Metoprolol: Lopressor and Toprol Atenolol: Tenormin Propranolol: Inderal (-lols)

Spastic Cerebral Palsy

-increased muscle tone in antigravity muscles -contractures of hip flexors, adductors, IR, knee flexors, ankle PF -crouched gait

Stage 1 Pressure Ulcer

-nonblanchable erythema of intact skin -may have changes in temp, tissue consistency or sensation (pain/itching)

circle of willis

2 internal carotids and 2 vertebral arteries

normal pH of skin

3-4

Amount of pounds to initiate lumbar traction?

30-45 pounds

accessibilty requirements for hallway

36 in width

how do you test peroneal subluxation?

ACTIVE dorsiflexion and eversion subluxation must be active, not passive

reciprocating gait orthosis

HKAFO w/ molded body jacket used in children w/ thoracic level spina bifida or SCI

ultrasound indications

acute and post acute conditions calcium deposits chronic inflammation delayed soft tissue healing dermal ulcers joint contracture muscle spasm myofascial trigger points pain plantar warts scar tissue tissue regeneration

3rd degree heart block

all impulses are blocked at the AV node, none transmitted to ventricles atrial rate > ventricular rate emergency! cause: digitalis, heart surgery, acute MI

causes of low hematocrit

anemia blood loss vitamin or mineral deficiences

causes of circumduction w/ prosthesis

long prosthesis locked knee unit loose knee friction inadequate suspension small or loose socket plantarflexed foot

male hypogonadism

deficiency of testosterone, failure of test to respond to FSH and LH caused: Klinefelters syndrome or failure of hypothalamus or pituitary to produce hormones that produce testosterone sx: sparse body hair, underdeveloped skeletal muscles, long arms and legs (no closure of epi plates) adult sx: decreased libido, erectile dysfunction, infertility, decreased cog skills, mood changes, sleep disturbances tx: hormone replacement therapy

C6 nerve root

dermatome: anterior arm, radial side of hand to thumb and index finger myotome: biceps, supinator, wrist extensors reflexes: biceps, brachioradialis

C7 nerve root

dermatome: lateral arm and forearm to index, long and ring fingers myotome: triceps, wrist flexors reflexes: triceps

Peptic Ulcer Disease

disruption of the GI mucosa causing imbalance b/w protective mechanism of stomach and acids etiology: H pylori, NSAIDS, alcohol, stress sx: epigastric pain, heart burn, nausea, vomitting, bloody stools, pain relieved by eating tx: pharm or surgery

CRPS

disturbance in the functioning of the SNS, causes increase of norepi and vasoconstriction of blood vessles. Will see hyperhydrosis, trophic changes, , thermal changes, vasomotor instability, pain out of proportion to the injury, limited ROM Stage 1: hyperalgesia(increased pain to pain) hyperpathia (increase intensity) allodynia(everything painful) Stage 2: increased pain w/ edema atrophic skin and nail changes Stage 3: spreading pain hardening of edema cool, dry and cyanotic skin osteoperosis and ankylosis

tarsal tunnel syndrome

entrapment of the posterior tibial nerve or one of its branches in the tarsal tunnel caused: excessive pronation, overuse, trauma sx: pain in the distal medial lower leg, numbness, paresthesias along the medial ankle to the plantar surface of the foot

threats to reliability

errors of measurement: random errors or systematic errors (repeat of BP may cause anxiety, fear)

Symphysis Pubis Pain

etiology: becomes hypermobile during pregnancy sx: severe pain in pubic symphysis, SI joint pain, blood in urine tx: pharms, surgery, ice/heat, manual techniques, MET, education

diastasis recti

etiology: separation of rectus abdominis from the linea alba, occurs during pregnancy sx: > 2 fingers width in linea alba tx: stabilization exercises, abdominal strengthening exercises w/ support, postural awareness, body mechanics

Coccydynia

etiology: subluxation of coccyx, and sacrum, adherence to scar tissue sx: difficulty sitting on hard surfaces, LBP, SI joint pain, pain w/ bowel movements, dysparenueia tx: heat, external joint mobilization, myofascial release, MET, biofeedback for pelvic floor postural training

compensatory action of weak hip flexors during swing...

excessive compensatory hip extension on the sound side

hyperpituitarism

excessive secretions of one or more hormones ex: gigantism or acromegaly, hirsutism, glactorrhea, amenorrhea, infertility, impotence bilateral carpal tunnel, arthritis, osteophyte formatipn are common

subcutaneous wound

extend through integ tissues and involves deeper structures such as sub q fat, muscle, tendon or bone -healing by secondary intention

inferior gluteal nerve

glute max

Maturation phase of healing

granulation tissue appears fiber reorganization scar tissue strengthening *7 days to 2 weeks (up to 2 years O sullivans)

moving wheel axle posteriorly will...

increase the amount of rolling resistance (decrease mechanical efficiency) decreases the ability to perform a wheelie (moving axle away from person's COG) increases the turning radius (distance from axle to caster increases) increases energy expenditure for propulsion

how to minimize burns during ionto?

increase the space between electrodes increase moisture of electrodes increase size of cathode relative to anode decrease current intensity

physiological effects of heat

increased CO increased metabolic rate increase pulse rate increased RR increased vasodilation decreased BP decrease muscle activity decreased blood flow to organs decreased blood flow to resting muscles decrease stroke volume

myocarditis

inflammation of the myocardium of the heart, caused by bacteria or virus sx: arrythmias, chest pain, SOB, fatigue, fever tx: antibiotics, anti-inflammatory agents, diuretics, B-blockers, Ca Channel Blockers

Diverticulitis

inflammed or infected diverticuli, causing pouches sx: bloating, diarrhea, constipation, LLQ pain, nausea, fever, chills, vomitting tx: increased fiber diet

cortisol

influences metabolism of food molecules; anti-inflammatory effect in large amounts target: GI system regulated: adrenocorticotropic hormone *made in adrenal cortex

pearsons product coefficient vs spearmans rank coefficient

pearsons: used to correlate continuous data w/ underlying normal distribution on interval or ratio scales ex: relationship between prox and distal development in infants... + sign= both variables increase or decrease together or - sign...one variable increases and the other decreases spearmans: nonparametric test used to correlate ordinal data ex: relationship of verbal and reading comprehension scores

medial pectoral nerve

pec major and pec minor C8-T1 comes off of medial cord

LE spasticity position

pelvis retraction hip adduction hip IR Hip Extension Knee extension Plantarflexion Inversion Equinovarus Toes Claw

Sulfamylon

penetrates through eschar avoid with sulfa drug allergies

causes for LLQ pain

perforated colon ileitis sigmoid diverticulitis kidney stones uretal stones intestinal obstruction

feedback given after every trial improves? variable feedback improves?

performance learning and retention

balance grades (absent)

pt unable to maintain balance

venography

radiograph that visualizes injected radioopaque dye in a vein invasive, gold standard

Arteriography

radiograph that visualizes injected radioopaque dye into an artery identify artherosclerosis, tumors or blockages

Tranquilizers Actions

reduce anxiety and sympathetic effect

single subject experimental design

sample of one w/ repeated measurements and design phases A-B: 2 phases, a pre-tx or baseline followed by an intervention or tx phase A-B-A: (multiple baseline): baseline phase, followed by tx phase, followed by a second baseline phase A-B-A-B: (multiple baseline, multiple tx): includes baseline, tx, and an additional baseline and tx phase

threats to validity

sampling bias failure to exert rigid control over subjects/conditions administration of pretest influences scores on post test (learning effect) measurement instrument isnt accurate pretest-tx interaction multiple tx interference (more than 1 tx given, carry over effects) experimental bias hawthorne effect: subject knows participation of study placebo effect: responding to sham tx

UE spasticity position

scapular retraction and downward rotation shoulder adduction and IR elbow flexion forearm pronation wrist flexion and adduction finger flexion thumb adduction

flexor synergy components UE

scapular retraction/elevation shoulder abduction shoulder ER elbow flexion forearm supination wrist and finger flexion

selective vs. non selective debridement

selective: sharp, enzymatic and autolytic non-selective: wet to dry, wound, hydrotherapy

what is the order of balance testing?

sensory--> static balance--> dynamic balance--> locomotor

sensory stim vs motor stim

sensory: higher frequency, shorter phase duration, lower amplitude motor: lower frequency, longer phase duration, higher amplitude

antispasticity agents

side effects: drowsiness, confusion, HA, dizzy, muscle weakness ex: Lioresal (baclofen), Valium (diazepam), Dantrium (dantrolene), zanaflex (tizanidine)

ice massage

small, overlapping circles area 10 cm by 15 cm will need 5-10 min maintain skin temp above 59 degrees cools tissue more rapidly

causes of uneven step length with prosthesis

socket discomfort poor socket alignment hip flexion contracture hip instability

causes of inadequate knee flexion during stance with prosthetics

socket too far posterior or tilted posterior foot set too far anterior PF bumper or heel too soft low heel shoes anteriordistal pain weak quads

excessive knee flexion vs excessive knee extension w/ prosthetics

soft heel cushion-->excessive knee extension PF bumper that is too soft--> excessive knee extension stiff heel --> excessive knee flexion DF bumper that is too soft--> excessive knee flexion PF bumper too hard-->excessive knee flexion

Adam's forward bend test

used to assess scoliosis child bends forward, feet together, knees straight and assess rib humps

low vs high intensity ultrasounds

low intensity: acute conditions or thin tissue high intensity: thick tissue, chronic conditions intensity is normally 0.5-2.5 w/cm^2

metal vs plastic AFO

metal: good if they dont have tone, good for changing edema plastic: good for tone, not good for fluctuating edema

axillary nerve

C5-C6 supplies deltoid, teres minor

oxygen concentration is increased by how much per Liter with supplemental oxygen?

4 % a 3 L flow rate has 33% O2 (21% + 12% )

glasgow coma scale eye response

4- spontaneous 3- to speech 2- to pain 1- no response

Balance tests and scores

Berg: risk of falling (no gait), < 45/56 increased risk of falls Fugl-Meyer: used w/ stroke, max score is 14 Functional Reach: use 3rd MCP to reach, < 10.5 in is increased risk of fall in elderly Dynamic Gait Index: (speed, head turns, obstacles, stairs): < 19/24 Tinetti (POMA): (balance, gait) < 19/28 increased risk of falls TUG: walk 10 ft (3 meteres), > 30 seconds=increased risk of falls and poor balance

what do you have to wear if someone has airborne precautions?

mask

radial nerve

C5-T1 Triceps Anconeus Brachioradialis ext. Carpi radialis longus ext. Carpi radialis brevis Supinator ext. Digitorum ext.Digiti minimi ext. Carpi ulnaris Abductor poll. longus ext. Poll. brevis ext. P poll. longus ext. Indicis

median nerve

C5-T1 pronator teres and quadratus flexor digitorum superficialis flexor digitorum profundus (2nd and 3rd digits) abductor pollicis brevis opponens pollicis flexor pollicis brevis aka flexor muscles in the forearm (except FCU), Lumbricals 1 & 2 (lateral)

ASIA Muscles Tested

C5: elbow flexors (biceps, brachialis) C6: wrist extensors (ECRL and ECRB) C7: Elbow Extensors (triceps) C8: Finger flexors (FDP) to middle finger T1: Small finger abductors (ADM) L2: Hip flexors (iliopsoas) L3: Knee extensors (quads) L4: Ankle Dorsiflexors (tibialis anterior) L5: Long toe extensors (EHL) S1: Ankle plantarflexors (gastroc, soleus)

medial cutaneous nerve of forearm

C8 supplies inner portion forearm to elbow comes off of medial cord

ulnar nerve

C8-T1 flexor carpi ulnaris flexor digitorum profundus 2 medial lumbricals muscles opponens digiti minimi flexor digiti minimi abductor digiti minimi interossei (PADS and DABS) adductor pollicis

Klumpke Palsy

C8-T1 lower hand paralysis involves intrinsics of hands, flexors and extensors or wrist and fingers can also produce flexion and supination of elbow, wrist extension, hyperextension of MCP, flexion of IP and claw hand

calculating C and F

C= (F - 32) x 5/9 F= (C x 9/5) + 32 0 C= 32 F = 273 K (freezing) 100 C = 212 F (boiling)

what do you have to wear if someone has droplet precautions?

mask

measures of central tendancy

mean, median and mode mean: appropriate for interval and ratio median: appropriate for ordinal mode: appropriate for nominal

Functional Independence Measure (FIM)

measure of 18 items of physical, psychological and social functioning. Used in rehab, (NOT OP) 1- Dependent ( < 25%) 2- Max A (25-49%) 3- Mod A (50-74%) 4 -min A (75-99%) 5 - supervision 6- Mod I 7- Independent

Outcome and Assessment Information Set (OASIS)

measure of function in the home care setting 79 items sociodemographic, environmental factors, social support, health status, functional status

odds ratio

measure of the odds of an event happening in one group compared to the odds of the same event happening in another group used in case control (looking backwards)

relative risk (RR)

measure of the risk of a certain event happening in one group compared to the risk of the same event happening in another group RR = 1 --> probable in both groups RR > 1 exposure increases the risk RR < 1 exposure decreases the risk

Tinetti Performance Oriented Mobility Assessment

measures balance and gait ordinal scale of 0-2 total score= 28 <19= high risk of falls

plantar fascitis

mechanical problem causes: chronic irritation of plantar fascia from excessive pronation, limited ROM of first MTP and talocrural joint, tight triceps surae, acute injury from excessive loading of foot, rigid cavus floor sx: (will have a negative tinel sign), pain in the medial calcaneal tubercle pain in morning, typically at first few steps and will then resolve

medial cord of brachial plexus

medial pectoral nerve medial cutaneous nerve of arm medial cutaneous nerve of forearm

medial vs lateral strabissimus

medial strabissimus: the eye is stuck medially and cannot laterally deviate (damage to the abducens) lateral strabissimus: the eye is stuck laterally, cannot medially deviate (damage to the ocuomotor)

medial and lateral hamstring reflex

medial: L5-S1 lateral: S1-S2

what does the popliteus do?

medially rotates the tibia on femur and flexes knee in NWB laterally rotates femur on tibia and flexes knee in WBing

what is contained in the carpal tunnel?

median nerve 4 tendons of flexor digitorum superficialis 4 tendons of flexor digitorum profundus flexor pollicis longus

Examples of Central Vertigo

meningitis migraine complications of ear infection trauma/tumor cerebellar disorders (alcoholism) MS

Pediatric Evaluation of Disability Inventory (PEDI)

interview or questionnaire scale of ADLs, w/ or w/o modification completed by caregivers

Meniers Disease

overaccumulation of endolymph due to lack of absorption *peripheral vertigo hearing loss tinnitus approx 30 min of vertigo

pneumonia

tachycardia signs of lung infection abnormal breath sounds dullness to percussion fever, chills sputum w/ coughing hypoxemia

autonomous stage of learning

"how to succeed" only KR and KP when errors evident variable, open practice massed practice

Crutch Measurement

-20-30 degrees elbow flexion -subtract 16 inches from height or 2 inches from below axilla to a point 6 inches in front and 2 inches lateral to the foot -supine: measure from axilla to 6-8 in lateral to the heel lofstrand: cuff should be proximal 1/3 of forearm, 1-1.5 inches away below the elbow

polymyositis (PM)

-CT disease causing edema, inflammation and muscle degeneration -affects prox muscles -rapid, severe, may affect cardiac tx: corticosteroids and immunosuppressives tx: avoid high intensity exercise, fatigue management, energy conservation

Tay Sachs Disease

-absence or deficiency of hexosamididase A (accumulation of gangliosides) in brain -autosomal recessive inherited trait in Jews -sx: miss developmental milestones, deteriorate motor and cog skills..leads to death tx: none

considerations when using gauze dressings

-change schedule varies -pack loosely -use continuous roll of gauze for large wounds -if too wet, dressings will macerate skin -use wide mesh for debridement and fine mesh for protection -protect surrounding tissues w/ moisture barrier or skin sealant

psoriasis

-chronic autoimmune disease -red plaques with silvery scales on ears, elbows, knees -may have arthritis, joint pain, small distal joints -hereditary, associated immune disorders, drugs tx: topic ointments, corticosteroids, immunosuppressive drugs, UV light PT

Functional Independence Measure for Children (WeeFIM)

-comprehensive, criterion referenced -18 items in 6 subscales -self care, sphincter control transfers, locomotion and cognitive function -determines amount of caregiver support needed -age range: 6 months to 8 years

Unstageable Wound

-full thickness tissue loss but the base is covered in slough or eschar -need to remove this to actually stage -stable slough on heels is normal though*

Stage 3 Pressure Ulcer

-full thickness tissue loss; involves damage to or necrosis of sub Q tissue -may extend down to but not through underlying fascia -presents as deep crater -sub Q fat may be visible but tendon, bone, muscle not exposed -slough

Stage 4 Pressure Ulcer

-full thickness tissue loss; involves extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures -undermining and sinus tracts may be present

Metabolic Alkalosis

-increase in bicarb, loss of acids, pH > 7.45 -caused by vomitting, ingestion of antiacids, alkalkine substances remember: Alkali A: aldosterone production (keep sodium and bicarb) L: loop diuretics, increases bi carb alKali ingestion of food: baking soda, milk, antacids A: anticoagulant citrate: increasing bicarb L: loss of fluids: lose hydrogen ions I: increase sodium bicarb administration sx: confused mental state, wekakness, nausea, mental dullness, tetany, nausea, vomitting, diarrhea, confusion, muscle fasciculations, hyperexcitability, convulsions, hypoventilation, bradypnea tx: correct electrolytes, give potassium chloride

CPM contraindications

-increase in pain after use -particular anticoagulants may cause intracompartmental hematoma -unwanted translation of opposing bones

cellulitis

-inflammation of cellular or CT -poorly defined, widespread -strep or staph -skin is HOT, red, edamatous, red streaking tx: antibiotics, eleveation, cool, wet dressing

contraindications to e-stim

-insulin pump -unstable arrythmias -suspected epilepsy, seizure disorder -over eyes, thoracic region, phrenic nerve, low back during pregnancy -presence of active bleed or infection -metal implants -pharyngeal muscles -motor should not be applied in conditions that prohibit motion

ultrasound intensity parameters

-intensity measures the quantity of energy delivered per unit area -effective radiating area (ERA) -spatial average intensity: intensity of beam averaged over area of transducer (power/ERA) --> labeled w/cm^2 beam nonuniformity ratio (BNR) ratio b/w spatial peak intensity and spatial average intensity lower BNR more favorable (less hot spots) BNR b/w 2:1 and 8:1 the higher the BNR, need to move transducer more rapidly

2 person lift

-one person behind patient, other at floor -place R arm on pt's L forearm, L arm on pt's R forearm -2nd PT with one arm under mid to distal thigh and other to support LE

contraindications to iontophoresis

-pacemaker -impaired skin sensation -allergy/sensitivity to medicine or direct current -insulin pump -unstable arrythmias -suspected epilepsy, seizure disorder -over eyes, thoracic region, phrenic nerve, low back during pregnancy -presence of active bleed or infection -metal implants -pharyngeal muscles

Inflammatory Phase of healing

-platelet activation and clotting cascade -debris/necrosis removed -clean wound bed -reepitheliazation begins in 24 hours -characterized by redness, edema, warmth pain, decreased ROM *1-10 days (3-5 days O sullivans)

contraindications to percussion/airway clearance techniques

-platelets below 50,000 -pain made worse by technique -aneurysm precautions - hemoptysis -increased PTT time -fractured rib -flail chest -DJD -bone metastases

paraythyroid gland in the endocrine system

-posterior surface of thyroid lateral lobes -produce parathyroid hormone(antagonist to calcitonin and maintains blood levels of Ca and phosphate) -increases reabsoprtion of calcium and phosphase from bones to the blood -stimulated by hypocalcemia and inhibited by hypercalcemia

electromyography

-records the electrical activity of selected muscles at rest and during voluntary contraction. -inserting the needle electrode percutaneously into a muscle or through the use of surface electrodes. -assesses peripheral nerves injuries or to differentiate b/w various NM disorders

mini mental state exam

-screen for cog dysfunction or dementia -11 questionnaire, assess 5 areas -orientation, registration, attention/calculation, recall and language 0-30.... 30 is perfect score < 24= cog impairment

hydrogel considerations

-sheet forms works well w/ partial thickness -dont use sheet form on infected wounds -sheet form can promote yeast and pseudomonas -dressing changes every 8-48 hours -use skin barrier wipe on surrounding intact skin to decrease risk of maceration

Osteomalacia

-soft bones due to calcium or phosphorous deficiency -inadequate intestinal absorption, increase renal excretion, Vit D deficiency sx: aching, fatigue, weight loss, myopathy, sensory polyneuropathy, tenderness and pain, thoracic kyphosis tx: increased nutrition, vit D or phosphorous supplements, aquatic programs, joint/bone protection, maintain joint mechanics

adrenal glands in the endocrine system

-top of each kidney -adrenal cortex (outer), medulla (outer) -adrenal cortex secretes corticosteroids to regulate water and sodium balance -medulla: produces epinephrine and norepi to increase HR and BP when there is stress

superficial wound

-trauma to skin w/ epidermis intact, such as non blistering sunburn -healing: inflammatory process

Stemmer's sign

-used to assess lymphedema -pulling up on the skin of the base of the 2nd toe. -If the skin is unable to be pulled up, sign of lymphedema

negative pressure wound therapy indications and CI

-vacuum assisted chronic or acute wounds that cannot be closed by primary intentention -ex: dehiscence, full thickness, flaps, grafts CI: malignancy, insufficient vascularity, large necrosis, osteomyelitis, exposed arteries/veins

Herpes Zoster (shingles)

-varicella zoster virus, rxn of dormant disease -pain and tingling in dermatomal pattern -fever, chills, malaise, GI upset -ocular involvement of CN 3 -post-herpetic nerve pain -mononeuropathy tx: NO CURE, antivirals can slow down progression CI: heat or ultrasound

men/women are at risk for metabolic syndrome if....

-waist circumference > 40 inches (men) > 35 (women) -elevated triglycerides (>150 mg/dL) - < 40 HDL in men, < 50 in women - fasting plasma glucose level > 110 mg/dL -high blood pressure: > 135/85 * need 3 or more to be diagnosed with metabolic syndrome

CT-SIB

1) EOSS 2) ECSS 3) visual conflict dome, stable support 4) EOMS (on foam) 5) ECMS (on foam) 6) visual conflict, moving support (on foam, visual conflict dome) Patients who are surface dependent (somatosensory) have difficulty w/ 4, 5, and 6 patients who are visually dependent have difficulty w/ 2, 3, and 6 sensory selection problems are evident w/ loss of balance on conditions 3-6 Patients who show an increased amount of sway when blindfolded and standing on a firm surface, when wearing a dome and standing on a firm surface, when blindfolded and standing on a foam surface, and when wearing a dome and standing on a foam surface, are thought to be highly dependent upon vision for balance. 2. Patients who have increased sway when standing on foam while wearing a dome or blindfolded are thought to have the inability to select vestibular input for balance. 3. Patients who have increased sway during all conditions standing on foam are thought to be dependent upon somatosensory information.

Tetralogy of Fallot (4 things), symptoms?

1) VSD 2) overriding aorta 3) RV hypertrophy 4) pulmonary stenosis sx: cyanosis SOB and rapid breathing fainting clubbing of fingers poor weight gain tiring easily during play prolonged crying heart murmur

sexual harrassment

1) behavior is unwelcomed or unwanted 2) behavior is sexual in nature or related to gender 3) behavior must occur in a relationship where the person is being harrassed by a superior or a peer; someone has power over the other sexual harrassment case: 1) submission or rejection of the conduct is used as a factor in obtaining employment 2) submission or rejection used to determine the status of the persons' employment 3) conduct must substantially interfere with the persons' employment 4) conduct creates a hostile work environment

symptoms of hyperglycemia

3 P's polydyspiea polyuria polyphagia Dry, crusty mucous membranes glucose > 300 decreased appetite, nausea/vomitting flushed, signs of dehydration pulse: weak, rapid fruity breath

Glasgow Coma Scale

3-15 motor response eye response verbal response <8- severe 9-12- moderate > 12 - minor

exercise prescription for AIDS

3-4 x/ week 40-60% of VO2 or HRR 30-60 min of activity

1 MET

3.5 mL O2 per kg of body weight

superficial reflexes

Abdominal: T8-L1, stroke lightly from each quadrant towards belly button..causes ab contraction and umbilicus deviation towards stimulus Corneal Blink reflex: trigeminal and facial nerve, stroke cornea and should see both eyes blink Cremasteric reflex: L1-2, scratch skin of upper medial thigh and will cause brisk elevation of testicle towards ipsi side Gag Reflex: glosspharyngeal and vagus, stimulate back of throat and will have gag response (maybe) Plantar Reflex (L5-S1) perform babinski, should see flexion of toes..abnormal is Big toe extension and splaying of other toes *damage to the corticospinal tract

A physical therapist would like to minimize the likelihood of a burn when using iontophoresis. Which action would be the MOST consistent with the therapist's objective? a. increase the size of the cathode relative to the anode b. decrease the space between the electrodes c. increase the current intensity d. decrease the moisture of the electrodes

Answer: a Rationale: Current density (mA/cm2) is calculated by taking the current amplitude (mA) and dividing by the surface area (cm2). Greater current density will result in an increased risk of an electrochemical burn. Increasing the size of the cathode relative to the anode serves to decrease current density and therefore reduces the probability of a burn when using iontophoresis. The cathode refers to the negatively charged electrode in a direct current system and the anode refers to the positively charged electrode. The accumulation of positively charged ions in a small area creates an alkaline reaction that is more likely to create tissue damage. As a result, it is desirable to increase the size of the cathode * if you increase the surface area (increase electrode size), it has an inverse relationship with current density due to the equation

acquired autoimmune deficiency (AIDS)

Asymptomatic Stage = CD4 count of > 500 cells *start to see fatigue early symptomatic stage= CD4 count between 200-500 HIV Advanced Disease (ADIS)= CD4 < 200

definition of autonomy, beneficence, justice and nonmaleficence

Autonomy: refers to the PT respecting the rights, decisions, and dignity of patients. This scenario best represents the ethical principle of autonomy since the therapist must respect the decision of the patient not to receive physical therapy services. Beneficence: PT doing what is in the best interest of the patient. Justice: PT maintaining fairness in the allocation of good and harm. Nonmaleficence: PT avoiding doing harm to others.

treating BPPV, unilateral peripheral vestibular loss, impaired VOR

BPPV: dix hallpike- EVALUATION tool (not tx) canialith repositioning: TX for BPPV unilateral peripheral vestibular loss: habituation exercises. People w/ vestibular loss tend to rotate their head to one side and report vertigo, dizzines, falls toward the nonfunctioning side when marching in place w/ eyes closed impaired VOR: gaze stabilization exercises

Erb's Palsy

C5-6 involves rhomboids, levator, serratus anterior, delotid, supraspinatius, infraspinatus, biceps, brachioradialis, brachialis, supinator, long extensors of wrist, fingers and thumb waiters tip position (shoulder adduction, internal rotation w/ elbow extension, forearm pronation, flexion of wrist)

UE nerve roots testing for EMG

C5-6: lateral deltoid C5-C6: biceps brachii C6-C7: triceps C6-C7: flexor carpi radialis C7-C8: extensor indicis proprius C8-T1: abductor pollicis brevis C8-T1: first dorsal interossei

ASIA Dermatomes

C2: occipital protuberance C3: supraclavicular fossa C4: top of AC joint C5: lateral side of antecubital fossa C6: thumb C7: middle finger C8: little finger T1: medial side of antecubital fossa T2: Apex of axilla T3: 3rd IS T4: 4th IS, nipple T5: 5th IS T6: 6th IS, xiphisternum T7: 7th IS T8: 8th IS T9: 9th IS T10: 10th IS, belly button T11: 11th IS T12: midpoint of inguinal ligament L1: half distance b/w T12-L2 L2: midanterior thigh L3: medial femoral condyle L4: medial malleolus L5: dorsum of foot at 3rd MTP S1: lateral heel S2: popliteal fossa in the midline S3: ischial tuberosity S4-5: perianal area

how to test C4, C5, C6, C7 myotomes?

C4: shoulder elevation or diaphragm C5: shoulder abduction and ER C6: elbow flexors or shoulder IR C7: elbow extension or wrist flexion

C4, C5, C6, C7 and C8 wheelchair set up

C4: sip and puff (head controls) C5: handrim projections (or power joint stick) C6 and C7: friction surface handrims C8: standard handrims

musculocutaneous nerve

C5, C6, C7 supplies coracobrachialis, biceps brachii and brachialis

mechanoreceptors vs deep sensory receptors

Deep sensory receptors: are sensory receptors that are located in the muscle, tendon and bone and joints. They include GTO, Pacinian corpuslces, muscle spindle and ruffini's endings, free nerve endings and joint receptors. They evaluate position sense, proprio, muscle tone and movement. Mechanorecetpros are sensory receptors that respond to mechanical deformation of the area surrounding a receptor. They are responsible for touch, pressure, itch, tickle, vibration and discriminative touch.

Diuretic Drug Names

Loop--> Furosemide: Lasix Thiaside: diurel (chlorthiazide) K Sparing: Dyrenium (triamterene) Hydrochlorothiazide: Esidrix

MCID vs MDD

MCID: smallest difference in a pt's condition that the pt or clinician considers worthwhile MDD: minimum detectable change in a pt's condition beyond the threshold of measurement error (smallest difference or change that would be statistically significant)

Cranial Nerves

Olfactory: smell...test w/ familiar odors Optic: vision..test visual fields Oculomotor: levator of eyelid, superior, medial and inferior recti; inferior oblique muscle.. Elevates the eye (if there's damage, ptosis)..Autonomic: smooth muscle of eye lid..pupillary constriction and accomodation. test upward, downward and medial gaze, reaction to light Trochlear: superior oblique muscle of eye...test down and inward gaze Trigeminal: touch, pain of face, mucus membranes of nose, sinus, mouth, anteriro tongue. Muscles of mastication. Test corneal reflex, face sensation, clench teeth Abducens: Lateral rectus of eye, test lateral gaze Facial: taste on anterior tongue, motor facial muscles, Autonomic: lacrimal, sublingal glands, submandibular glands. Test, closing eyes tight, smile, show teeth, whistle and puff cheeks, identify taste on 2/3 tongue Vestibulocochlear: Hearing and balance of ear, test with watch ticking, hearing test, balance and coordination Glossohpharyngeal: touch and pain on posterior tongue and pharynx, voluntary muscles of pharynx, autonomic: parotid gland. Test with gag reflex and ability to swallow Vagus: touch, pain on pharynx, larynx, bronchi. Taste on tongue, epiglottis. Muscles of palate, pharynx, larynx, autonomic: thoracic and abodminal viscera. Test w/ gag reflex, ability to swallow, say AHHH Accessory: SCM and trap, test with resisted shoulder shrug Hypoglossal: muscles of tongue, test w/ tongue protrusion (deviate towards injured side)

Antiarrythmia Drug names

Quinidine and Procadinamide Na Channel Blockers Xylocaine: Lidocane Beta Blockers: Tenormin (atenolol) Prolong the depolarization: Cordarone (amiodaron) Ca Ch Blockers: Cardizem (diltiazem)

homonymous hemianopsia

R homonymous: losing the R temporal and L nasal field...due to damage in the L occipital lobe

cor pulmonale

R sided heart failure, consequence of chronic COPD sustained hypoxia causes increased PAP--> R ventricular hypertrophy--> R heart failure does not have an S3 heart sound

case control study

RETROSPECTIVE (backward in time) study of a group of individuals with a similar condition compared with a group that does not have the condition determines the odds ratio (ratio of odds of exposure in diseased subjects to the odds of exposure in non-diseased subjects)

electricity of the heart

SA node: 60-100 bpm at the R atria and SVC AV node: b/w RA and RV, 40-60 bpm purkinje: R and L bundle branches of the AV node on either side of the IV septum, 20-40 bpm

Prosthetic Feet

SACH: energy absorbing cushion heel and internal wooden keep that limits sagittal plane motion, permits a very small amount of mediolateral (frontal) and transverse plane motion SAFE: permits more nonsagittal plane motion; prescribed for more active individuals flex foot: leaf spring shank(not a foot), long carbon fiber band stores energy in early stance for late used during push off; single axis foot: articulated foot w/ lower shank; motion controlled by anterior and posterior rubber bumpers that limit DF and PF, can be used w/ those w/ bilateral amputations

Legg Calve Perthes vs SCFE

SCFE: Onset in males is 10-17 and females is 8-15. Common in obese males. Pain is left hip and ground w/ WBing (more often L hip than R) Present with slight hip flexion, adduction and ER (can't go into hip ABD or IR or hip flexion). EMERGENCY Legg calve Perthes: age 3-12 y/o males, degeneration and avascular necrosis of femoral head. The disease is self limiting and has 4 stages: condensation, fragmentation, re-ossification and remodeling. 2-13 y/o, typically males. stuck in ER, flexion and adduction Sx: hip pain, groin pain, antalgic gait, limited hip ROM, + trendelenberg sign, disuse atrophy of hip and thigh muscles, painful limitation of ABD and IR tx: relieve pain, crutch training, splinting, traction, stretching...AVOID CORTICOSTEROIDS (might have caused it)

Diuretics SE and PT implications

SE: hyotension, electrolyte balance, dehydration, polyuria, increased LDL, arrythmias, hypokalemia tx: watch for postural changes, watch for dehydration, muscle cramping

acute pulmonary edema treatment? (pink, frothy sputum, SOB, coughing)

The presence of dyspnea and the pink, frothy sputum would suggest the presence of heart failure and resultant pulmonary edema. Heart failure can occur from poor cardiac muscle function as a result of myocardial infarction. Pulmonary edema occurs from the backflow of blood from the heart into the pulmonary vessels, increasing pulmonary capillary pressure. The increase in pulmonary capillary pressure increases fluid movement into the alveoli, which are normally dry. This leads to the presence of pink, frothy sputum that can be expectorated along with shortness of breath (dyspnea). Positions that increase blood flow to the heart, such as lying flat, will increase the signs and symptoms. Therefore, the patient should be positioned with the head up or should be placed in a sitting position to help alleviate the symptoms.

mobilization to improve down gliding/closure of T7-8 joints

Transverse process of T8 or spinous process of T7 axis of rotation for mid thoracic vertebrae is above the SP and below the TP

osteosarcoma

affects long bones, begins in the medullary cavity sx: sign of mass in femur, tibia, fx may be first sign typically males, young children during growth spurt, pain at night, swelling *normally metastasizes to lungs tissue biopsy is confirmation diagnosis

nonfluent aphasia

aka broca's -speech that is slow, hesitant, awkward, interrupted and produced w/ effort -lesion is on 3rd convolution on frontal lobe -will likely have motor impairments due to prox to motor area -intact comprehension, impaired repetition, paraphasias tx: verbal cues

calcaneocuboid joint subluxation

aka cuboid syndrome minor disruption or subluxation of the structural conguity of the calcaneocuboid portion of the midtarsal joint * will have pain with PROM tibia ER due to compression of joint

brief intense TENS

aka inter-electrode analgesia long duration, high frequency w/ moderate current amplitude application is shorter and current amplitude is higher should generate strong paresthesias or a motor response used to minimize pain during ther activities that may be painful, wound debridement, deep friction massage, joint mobs, passive stretching tx time: typically 15 min

Lisfranc Injury

aka midtarsal or tarsometarasal injury occurs when foot is PF and person lands on heel or in a crush injury pain near shoe laces increased pain when stressing the foot with plantarflexion and rotation

systemic sclerosis

aka scerloderma autoimmune disorder affecting CT that results in fibrosis of skin, blood vessels, joints and internal organs sx: bilateral non pitting edema--> replaced by hard, fibrotic skin

short acting beta 2 agonists

aka sympathomimetics Albuterol mimic SNS by producing bronchodilation; reduces airway resistance by reducing bronchospasm SE: look for tremor, anxiety, nervousness, weakness and can unintentionally cause increased HR and BP because beta 1 on the heart causes vasoconstriction but beta 2 on lungs cause dilation

Crackle

aka: rales abnormal discontinuous, high pitched popping heard more over inspiration ( can be heard during both though) heard: pulmonary edema, interstital lung disease, PNA, bronchiectasis, pulmonary edema, atelectasis, fibrosis

Nutritional Concerns with Wounds

albumin: normal (3.5-5.5 ) < 3.5 = malnutrition BMI < 21 risk of pressure ulcers 3 or more L of water air fluidized bed: 40-60 ml/kg a day of water high calorie, high protein diet

Dermatitis (eczema)

allergic or contact dermatitis (soaps, poison ivy) acute: red, oozing, crusting rash, exudate subacute: erythematous skin, scaling ,plaques chronic: thick skin, increased marking, fibrosis, nodules actinic: rxn to sunlight, UV light atopic: unknown etiology CI: avoid alcohol, some modalities are CI

contrast bath

alternating heat/cold in order to decrease edema in a distal extremity alternate vasodilation and vasoconstriction to decrease pain, improve flexibility, avoid risk of increased edema good for irregular shaped areas, allows for movement during tx, assists w/ pain management start in hot water (104-106 degrees) for 3-4 minutes...then in cold bath (50-60 degrees). Repeat for 25-30 min

FIM Ambulation and stairs

ambulation: > 150 ft is graded as performed 50-149 feet= 2 < 50 feet is graded as 1 stairs: First determine the number of stairs 12 stairs: grade performance 4-6(11) stairs: grade a "2" < 4 stairs: grade a "1" Use of a rail is always MOD I (6)

parameters to e-stim (phase duration)

amount of time it takes for one phase of a pulse phase begins when the current departs from the zero line and ends when it returns to zero line pulse duration: amount of time it takes for 2 phases of a pulse w/ biphasic current monophasic: phase and pulse duration are same measured in microseconds

Opioid Agents (narcotics)

analgesia for acute severe pain management, stimultes opioid receptors in CNS to prevent pain impusles from reaching destination SE: mood swings, sedation, confusion, vertigo, dulled cog function, OH, constipation, incoordination, dependence, tolerance ex: Roxanol (morphine), Oxycontin (oxycodone), Sublimaze (fentanyl), Demerol (meperidine), Paveral (codeine)

what is the diagnosis if someone has pallor (lack of skin color/paleness)?

anemia internal hemorrage lack of sun exposure

first time anterior dislocation tears?

anterior capsule anterior labrum subscapularis

what manual mobilization would you perform to improve flexion and ER?

anterior glide (ER of humerus occurs at late flexion)

sitting on a therapy ball with pertubations?

anterior movement of ball: posterior pelvic tilt and ab contraction posterior movement of the ball: anterior pelvic tilt and hip flexors?

left anterior descending artery supplies...

anterior portion of the IV septum

anterior spinal artery supplies?

anterior portion of the SC and arises from the vertebral artery near medulla obloganta sx: contralateral hemiplegia, deviation of tongue towards affected side, dysphagia, loss of gag reflex

pressure sensitive areas in patellar tendon socket

anterior tibia anterior tibial crest fibular head and neck fibular nerve

what ligaments make up the deltoid ligament?

anterior tibiotalar ligament posterior tibiotalar ligament tibiocalcaneal ligament tibionavicular ligament *resists eversion of talus at the ankle joint

Anterolateral Spinothalamic Tract (anterior vs lateral) controls?

anterior: crude touch lateral: pain and temp damage in the SC: contralateral damage in the brain: contralateral

anterograde vs retrograde vs post traumatic amnesia vs dissociative amnesia

anterograde: pt cannot form new memories after the accident; typically the last recovered retrograde: pt cannot remember anything before the accident; may progressively decrease w/ injury post traumatic amnesia: inability to recall the specific details associated with the event that caused a TBI, and those occurring soon after the injury dissociative amnesia: results from a psychological cause rather than physical injury. Forms of dissociative amnesia include repressed memories, dissociative fugue, and post-hypnotic amnesia.

steps to controlling bleed

apply gauze (dont remove pads if they are soaked, add to them) elevate the part apply pressure bandage (roller gauze) apply pressure over pressure points

accessibilty requirements for hotels

approx 2% of rooms must be accessible

ultraviolet contraindications

areas receiving radiation DM herpex simplex pellegra photosensitive meds skin cancer systemic lupus erythematosus tuberculosis

Arterial Wound Treatments vs venous wound treatment

arterial: avoid elevation, avoid heat packs/soaking in warm water venous: compression to control edema elevate legs above heart

aspiration is also referred to as what?

arthrocentesis sterile needle removes the fluid from a joint

Cystic Fibrosis

autosomal recessive disease, chromosome 7 defective gene produces unusually thick, sticky mucus that leads to infections, decreased absorption of food, obstructs pancreas sx: salty tasting skin, persistent and productive cough, frequent lung infections, wheezing, SOB, poor growth/weight gain elevated sodium chloride and pancreatic enzyme insufficiency..sweat test is primary indicator (> 60) OBSTRUCTIVE disease decreased FEV1, FVC...increased RV, FRC

treating a patient with mental retardation

avoid cervical motions (check AA laxity) -visual feedback is better compared to verbal -retain info presented w/ multiple modalities -require repetition and overlearning -practice whole complete functional tasks compared to portions

proper precautions taken when treating a patient with Hep B?

avoid direct contact with pt's blood or blood contaminated equipment by wearing GLOVES

nerve root levels for reflexes and reflex grading

biceps: C5-6 brachioradialis: C5-6 triceps: C7-C8 patellar: L3-4 achilles: S1-S2 0- no response 1+ - diminished/depressed 2+ - normal 3+ brisk, exaggerated 4+ very brisk, hyperactive

different types of PVC's

bigeminy: PVC every other heart beat w/ no regular heart beat in between trigeminy: every 3rd is PVC couplet: 2 PVC's in a row w/ no normal heart beat in between

H2 Receptor Blockers

bind to histamine receptors to prevent histamine activaed release of gastric acid during food intake indications: dyspepsia, acute and long term peptic ulcers, GERD SE: headache, dizziness, mild GI distress, arthralgias, acid rebound ex: Tagamet (cimetidine), Zantac (ranitide), Pepcid (famotidine)

interferential bipolar delivery vs. quadripolar delivery vs quadripolar w/ automatic vector scan

bipolar delivery: uses 2 electrodes connected to a single channel w/ 2 medium sinusoidal currents. Creates a beat frequency (net diff b/w 2 currents)..it allows for current to be modulated prior to delivery (creates oval field) quadripolar: 4 electrodes w/ each pair connected to a single channel. Interference b/w them at 90 degrees creates max resultant amplitude halfway b/w the 2 lines of current. Creates a 4 leaf clover quadripolar w/ vector scan: when there is need to increase size of the field current. One circuit varies in amplitude and creates field pattern to rotate b/w 2 lines of current...creates circular pattern.

causes of hypovolemia? symptoms of hypovolemia?

bleeding dehydration from vomitting, diarrhea sweating severe burns diuretics sx: OH, tachycardia, elevated body temp

Anticholinergics for GI

block effects of Acetylcholine on parietal cells in stomach and decrease release of gastric acid indicated: gastric ulcers SE: Dry mouth, confusion, constipation, urinary retention Ex: Gastrozepin (pirenzepine), muscarinic cholingerbic antagonist

antihistamine action

block the effects of histamine resulting in decreased nasal congestion, mucousal irritation, and sx's of common cold, sinusitis, conjuctivitis and allergies SE: arrythmias, postural hypotension, GI distress, dizziness, drowsiness, HA, blurred vision, fatigue, nausea, thickening of bronchial secretions examples: Benadryl(diphenhydramine), Allegra (fexofenadine), Zyrtec (cetirizine HCL), Claritin (loratadine)

bar graph, box and whisker, forest plot, histogram, line graph, scatter plot, stem and leaf plot

bra graph: show the magnitude or frequency of categories of data box and whisker: shows minimal score, lower quartile, median, upper quartile, max score forest plot: used in meta-analyssis, shows individual studies, measure of effect size, vertical line is the null hypothesis histogram: frequency distributions (how many people on the y axis had a RHR value on x axis)..counts on y axis line graphs: relationship b/w 2 or more quantitiative variables.. IV on x axis and DV on y axis scatter plot: relationship b/w 2 quantitiatve variables; each paired value is plotted as a single point and line of best fit is determined stem and leaf plots: graphical display which enables readers to observe entire distribution of data w/o losing info (one digit on left side of line, others on right side of line)

spondylolisthesis

break in the pars interarticularis causes forward slippage of upper vertebrae on lower..causes increased lumbar lordosis, tight hamstrings, knee flexion (due to hamstring tightness) *avoid lumbar extension exercises with them *use bilateral oblique radiographs

biofeedback

bring specific events to conscious awareness doesnt measure muscle contraction, measures electrical activity 2 active electrodes placed parallel to muscle fibers and close to each other, ground electrode placed anywhere

reasons for a firm end feel with dorsiflexion ROM

calcaneofibular tension posterior joint capsule soleus and achilles tension posterior portion of deltoid ligament posterior talofibular

dependent squat pivot transfer

cannot stand (I) but can bear some weight through trunk and LE position themselves at 45 degree angle to destination place arm around PT's neck block pt's knees

what is the diagnosis if someone has cherry-red discoloration?

carbon dioxide poisoning liver or renal failure/issues

electrotherapy contraindications

cardiac arrythmias cardiac pacemaker malignancy osteomyelitis over a pregnant uterus over carotid sinus pt with bladder simulator phlebitis seizure disorder

glaucoma vs cataracts

cataracts: clouding of the lens, gradual vision loss with central vision loss first, then peripheral *think Cataracts starts w/ C, central vision loss first glaucoma: loss of peripheral vision first, then central, progressing to total blindness

massage direction

centrifuge: moving from center of body out centripetal: moving in from extremities toward the center of the body

middle cerebral artery supplies?

cerebrum sx: contralateral hemiplegia (worse in UE), aphasia, apraxia, cognitive deficits

Rheumatoid Arthritis

chronic systemic disorder of unknown etiology, symmetrical tissues and articular cartilage of joints of hands, wrists, elbows, shoulders, knees, ankles and feet affects MCP and PIP, may see ulnar drift, volar subluxation at MCP, swan neck deformity, bouteinier, bouchards nodes (excessive bone on dorsal PIP) sx: pain, tenderness, morning stiffness, warm joints, decreased appetite, malaise, fatigue, low grade fever, vasculitis *avoid resistive exercises, deep heat and active stretching in acute phase= exacerbates arthritis women > men *check for vasculitis + findings= increased WBC, erythrocyte sedimentation rate, decreased RBC, hemoglobin and hematocrit show anemia, RF elevated

scleroderma

chronic, autoimmune disease affecting CT, causing fibrosis of skin, joints, blood, vessels and internal organs *presence of raynaud phenomenon limited systemic: symmetrical skin, distal extremities and face (CREST syndrome) diffuse: widepsread tx: corticosteroids, vasodilators, immunosuppressive agents *AROM, walking in therapeutic pool *monitor BP, vital signs

systemic lupus erythematosus

chronic, autoimmune systemic inflammatory disorder affecting skin, joints, kidneys, heart, NS and mucous membranes affects young women, 15-40 y/o fever, malaise, butterfly rash, fatigue, arthralgia, arthritis, photosensitivity, hair loss, anemia, raynauds tx: salicylates, indomethacin, NSAIDS (avoid UV light)

Lupus Erythematosus

chronic, progressive, autoimmune inflammatory disorder of CT red, raised scale plaques DLE: affects only skin, caused by sunlight SLE: involves joints, organs (butterfly rash) tx: ointments, corticosteroids, immunosuppressive drugs

compression contraindications

circulatory obstruction DVT heart failure infection of treated areas malignancy of treated area unstable or acute fracture pulmonary edema

what are transparent films?

clear, adhesive semipermeable membrane permeable to O2, moisture vapor but impermeable to water, bacteria and contaminents

cryotherapy contraindications

cold intolerance cold urtcaria cryoglubolinemia infection over area of compromised circulation over regenerating nerves paroxysmal cold hemoglobinuria peripheral vascular disease raynauds phenomonon skin anesthesia

cold pack

cold pack conforms to contour of body cooled at least 30 min b/w uses and 2 or more hours prior to initial use applied over a moist, cold towel approx 20 min application (30 min for spasticity) penetrates 2 cm down

interferential current

combines 2 medium frequency alternating wave forms that are biphasic ..when currents intersect, they produce a higher amplitude (can penetrate deeper)

AIIS apophysitis

commonly seen in kicking injuries, rectus femoris torn

rubrospinal tract

communicates with the hypothalamus and cerebellum and plays a rode in coordination of movement -arises in contralateral red nucleus and descends in lateral white columns to spinal gray *damage to the extrapyramidal: paralysis, hypertonicity, exagerrated DTR's, clasp knife reflex

Rinne test

compare bone conduction hearing with air conduction place vibrating tuning fork on mastoid process and then place it next to the ear air should be twice as long as bone conducted sound if bone is > air, conductive deafness if air > bone, sensorineural deafness

between subject design

comparisons made between groups of subjects

deep partial thickness burn (2nd degree)

complete destruction of epidermis and most dermis discolored, broken blisters and edema hypertrophic scars and keloid scars nonblanchable redness typically not painful due to nerve ending involved healing is slow and has scar formation, 21-35 days

Subdermal Burn

complete destruction of epidermis, dermis and subcutaneous tissue..charred appearance(electrical burns) may involve muscle and bone require surgeries and extensive healing amputation may be necessary

definition of confidentiality, duty, fidelity, paternalism, rights, veracity

confidentiality: holding of professional secrets or discussions. Keeping client information within appropriate limits Duty: obligations that individuals have to others in society Fidelity: related to confidentiality and is defined as the moral duty to keep committments that have been promised Paternalism: someone fails to recognize another individuals' rights and autonomy Rights: ability to take advantage of a moral entitlement to do something or not to do something Veracity: obligation of a health care provider to tell the truth

wheeze

continuous "musical" or whistling sound heard during both inspiration and expiration causes: bronchospasm, edema, collapse, secretions

continuous, discrete, dichotomous date

continuous: assume any value along a continuous scale that covers a range of values without gaps or interruptions ex: ROM, distance, weight discrete: measured in whole units ex: stages of cancer, heart rate, # of PT visits dichotomous: discrete data limited to only 2 values ex: gender, smoker vs non smoker

TMJ lateral deviation muscles

contralateral medial and lateral pterygoids and ipsilateral temporalis muscle (scorebuilders also has masseter) 10-15 mm

antiarrythmias actions

control arrythmias; restore normal rhythm, and improve the cardiac output 1) NA channel blockers: control cardiac excitation 2) beta blockers: decrease sympathetic input 3) K+ and NA+ inhibitors: prolong repolarization 4) Ca channel blockers: control contractility

compression effects and indications

control of peripheral edema management of scar formation prevent DVT promote lymphatic and venous return shape residual limb indications: edema hypertrophic scarring lymphedema new residual limb risk for DVT stasis ulcers

alternating current

contuinuously changes from (+) to (-) with the change in direction of current measured in cycles per second or hertz cathode and anode are always switching

water temp thermodynamic effects

cooler temp: high intensity exercise warm temps: enhance mobility, flexibility, relaxation (ex: arthritis)

glenohumeral ligaments

coracohumeral ligaments: base of coracoid to lesser tubercle. Reinforce biceps tendon, reinforce superior capsule, prevent CAUDAL dislocation of humerus. Taut with ER coracoacromial ligament: runs from coracoid to acromion, not a true ligament because it connects same bone superior middle and inferior GH ligaments (inferior resists anterior inferior translation )

how do you determine HR on an EKG strip?

count the number of RR intervals in a 6 second strip and multiply by 10 *one big box is .2 seconds you need 5 of the big boxes to equal 1 second (30 big boxes total) you can also: count the number of large boxes (5 mm or 0.2 seconds in length) between two R waves. The number of large boxes is then divided into 300 to obtain an estimate of the heart rate. In the example, the number of large boxes is approximately 2.5. so the HR is 300/2.5 = 120

LMN/areflexive bladder

crede maneuver (manually compress lower abdomen) Valsalva (increase intra thoracic pressure) timed voiding program

Movement Assessment of Infants (MAI)

criterion referenced, standardized test muscle tone, reflexes, automatic reactions, volitional movement age range: birth to 12 months

critical vs moderate vs. minor burn

critical: 10% of body w/ 3rd degree or > 30% of 2nd degree moderate: < 10% of body w/ 3rd degree or 15-30% of 2nd degree minor: < 2% of body with 3rd degree or 15% or less with 2nd degree

contact with a cupped hand is used for? flattened palmar hand? distal phalanx of 1/3 finger? ulnar border of hand?

cupped hand: percussion flattened palmar hand: vibration distal phalanx of 1/3 finger: mediate percussion to determine lung density ulnar border of hand: tactile fremitus (vibration of spoken words felt through chest wall)

how do you determine ionto dosage?

current amplitude x time dosages range from 40-80 mA- min ex: dosage of 40 mA- min can be delivered in 10 minutes w/ a current amplitude of 4.0 mA

NMES parameters

current: want stronger current w/ muscle strengthening pulse duration: should be high enough to overcome low capacitance of motor nerve fibers... shorter pulse durations are more comfy when targeting smaller muscles and longer pulses more comfy w/ larger muscles frequency: want tetanic contraction, usually 35-50 pps...the higher the freq will produce more fatigue (not stronger contraction) duty cycle: on time should be 6-10 sec and off should be 5 times longer ramp time: usually 1-4 seconds for 6-10 sec on time tx time: 10 - 20 contractions (max)...10 contractions will take about 10 minutes (want 3x/week)

Symptoms of Ventricular Septal Defect

cyanosis poor eating, failure to thrive fast breathing fatigue swelling rapid heart rate

what do beta blockers do?

decrease myocardial oxygen demand by inhibiting the binding of epinephrine and norepinephrine to beta blockers. This results in a decrease in HR, contractility, CO, and blood pressure

CPM effects and indications

decrease post op pain improve rate of recovery increase ROM lessen effects of immobilization reduce edema by assisting venous return stimulate tissue healing indications: pain, limited ROM, edema, susceptibility of contractures or adhesions, muscle or joint stiffness

Antiemetic Agents

decrease symptoms of nausea and vomitting SE: sedation, dysrhythmias, pain ex: scopolamine (anticholinergic agent), Meclizine (antihistamine), Dolasestron (5-HT3 receptor receptor antagonist agent), Phenergan (promethazine hydrochloride)

what effects does bed rest cause?

decreased CO from decreases in blood volume and decreases in SV decreased resting SBP from decreases in blood volume and excessive diuresis decreased blood volume due to profound diuresis increased resting and submax HR, resulting in lower cardiac efficiency

spinal cord injury on PFT's

decreased TLC, vital capacity and inspiratory capacity

TMJ condition where there is left face pain with limited active and passive mouth opening, but PROM lateral deviation is full...caused by?

decreased flexibility in the muscles of mastication on the left *mouth opening requires lengthening of the muscles of mastication as the mandible moves away from the upper palate, but lateral deviation does not require significant lengthening(which is why PROM is not limited)

weak hip flexors and weak knee extensors during terminal swing will result in....

decreased hip flexion followed by increased knee flexion on the weak side

hypothyroidism

decreased levels of thyroid hormones in the bloodstream (hashimoto's) sx: fatigue, weakness, decreased HR, weight gain, constipation, delayed puberty, retarded growth tx: oral thyroid hormone replacement therapy

physiological effects to cold

decreased metabolic rate decreased pulse rate decrease RR decrease venous blood pressure increase blood flow to organs decrease CO decrease stroke volume decrease arterial blood pressure

TMJ capsular fibrosis

decreased mouth opening and chewing, NO clicking on opening/closing

lateral medullary (walleberg) syndrome

decreased pain and temp on ipsi face nysgatmus, vertigo, nausea, dysphagia, ipsilateral horners syndrome, contralateral loss of pain and temp on the body occlusion of the PICA (branch of the vertebral)

skin changes seen in the elderly

decreased sensitivity to touch decreased perception of pain and temp increased risk of injury due to impaired sensory integrity inflammatory responses are attenuated decreased scarring decreased eccrine sweating decreased vascular responses *decreased flexibility due to decrease in collagen, increased wrinkles and dryness, decreased turgor

diathermy

deep heating agent that converts high freq electromagnetic energy into therapeutic heat produces a molecular vibration within tissue that generates heat and elevates tissue temp pulsed or continuous most frequency is 27.12 MHz can use capacitive plate or inductive coils tx duration: 30-60 min (can heat up to 25 x normal heat modalities)

symptoms of compartment syndrome

deep, cramping, pain decreased pulses pallor paralysis

L2 nerve root

dermatome: back, front of thigh to knee myotome: psoas, hip adductors

L3 nerve root

dermatome: back, upper buttock, anterior thigh and knee, medial lower leg myotome: psoas, quadriceps, thigh atrophy reflexes: (+) prone knee bend, knee jerk sluggish, pain on full SLR

L5 nerve root

dermatome: buttock, posterior and lateral thigh, lateral aspect of leg, lateral knee, dorsum of foot, medial half of sole, first, second and third toes myotome: extensor hallucis, peroneals, glute med, dorsiflexors, hamstrings, plantar flexors reflexes: medial hamstrings, posterior tib

S2 nerve root

dermatome: buttock, thigh, posterior leg(more medial buttock) myotome: hamstrings, plantar flexors reflexes: achilles

C5 nerve root

dermatome: deltoid area, anterior aspect of arm to base of thumb myotome: supraspinatus, infraspinatus, deltoid, biceps (shoulder abd and shoulder ER) reflexes: biceps, brachioradialis

C3 nerve root

dermatome: entire neck, posterior cheek, temporal area, under mandible myotome: trap, splenius capitis reflexes: none

S1 nerve root

dermatome: lateral and plantar aspect of foot myotome: hamstrings, peroneals, plantar flexors *ankle eversion is S1 reflexes: achilles

C8 nerve root

dermatome: medial arm and forearm to long, ring and little fingers myotome: ulnar deviators, thumb extensors, thumb adductors reflexes: none

L4 nerve root

dermatome: medial buttock, lateral thigh, medial leg, dorsum of foot, great toe myotome: tibialis anterior, extensor hallucis reflexes: patellar, SLR limited, neck flexion pain, weak or absent knee jerk, side flexion limited

T1 nerve root

dermatome: medial side of forearm to base of little finger

T2 nerve root

dermatome: medial side of upper arm to medial elbow, pectoral and midscapular area

uterine prolapse

descent of uterus and cervix into the vagina etiology: genetics, denervation, trauma(birth) sx: pelvic pressure that increases w/ exertion, urgency, frequency, urinary incontinence, back an perineal pain w/ prolonged standing, incomplete bladder emptying, LBP relieved with lying down tx: biofeedback, kegels, strengthening, body mechanics, symptom modification

full thickness burn (3rd degree)

destruction of the epidermis and dermis with partial damage of the subcutaneous fat eschar formation and NO PAIN require grafts, removal of eschar hypertrophic scars and contractures months to heal wound care, pulm exercises, splinting and immobilization for the first 3-5 days

ultrasound frequency

determined by depth of penetration tissues high in water, low absorption rate higher freq--> absorb more rapidly and used superficially 3= superficial (1-2 cm) 1= deep (2-5 cm))

parameters to e-stim (frequency)

determines the # of pulses delivered through each channel per second labeled as rate, expressed in pulses per second or Hertz higher freq causes them to fire at a more rapid rate

effect size index

difference b/w the 2 groups (mean experimental - mean control) / standard deviation of one of the groups < .1= trivial effect 0.1-0.3 = small effect 0.3-0.5 = moderate effect > 0.5 = large effect

Bicyle Gelderens test

differentiate b/w spinal stenosis and IC sit and ride bike in erect position, measure time sit and ride bike in slumped position...should be able to ride longer in slumped position if it's stenosis (in flexed position)

angiotensin 2 blocker side effects and indications

dizziness, back pain, leg pain, angina pectoralis

Digitalis SE and PT implications

dizziness, blurred vision, arrythmias, GI issues monitor HR; make sure b/w 60-100

antiarrythmias side effects and PT implications

dizziness, hypotension, cardiac arrythmias make sure pt's are on a regular schedule and report sx's immediately

spinocerebellar tract

dorsal and ventral sensory tract that ascends to the cerebellum for ipsilateral subconscious proprio, tension in muscles, joint sense, posture of trunk and LE

dysmetria vs dysdiadochokinesia vs dyssynergia

dysmetria: inability to judge the distance or range of movement dysdiadochokinesia: impaired ability to perform rapidly alternating movements dyssynergia: impairment in movement composition, usually performed in component parts rather than a single smooth activity

dysphonia vs dysarthria vs dysphasia

dysphonia: disorder of vocalization characterized by an abnormal production of sounds from the larynx...hoarseness is biggest complaint dysarthria: deficits in articulation, extraneural, rhythm of speech. Usually due to oral structures, poor fitting dentures and impairments of musculature. Slurring, slow speech, indistinct speech, breaks in normal ryhthm dysphasia: inability to use and understand written and spoken words as a result of disorders involving the cortical centers of speech or their interconnections in the dominant cerebral hemisphere

evoked potentials

electrical activity recorded from the presentation of a stimulus. Signals can be recorded from the cerebral cortex, brain stem, SC and peripheral nerves. Evoked potentials can determine how quickly and completely nerve signals reach the brain and can be used to assist with diagnosing things such as MS

congestive heart failure

early sx: tachycardia late: venous congestion, high catecolamines, impaired CO L sided: pulmonary edema R sided: systemic edema sx: pulmonary edema, noctural dyspnea, orthopnea, S3, dry cough, exertinoal dyspnea, weight gain, cyanosis, urinalysis, CBC, chest x-ray, electrocardiogram, echocardiogram

Premature Atrial contractions

ectopic focus in the atrium initiates an impulse before the SA node P wave is premature with abnormal configuration

massage effects and indications

effects: altered pain transmission, decreased anxiety and tension, decreased muscle atrophy, decreased muscle spasms, facilitate healing, improve circulation, increased lymphatic circulation, loosen adhesions, reduce edema, relaxation, remove metabolic waste, stimulate reflexive effects indications: adhesions, bursitis, decreased ROM, edema, intermittent claudication, lactic acid excess, migraine/headache, muscle spasms/cramps, pain, Raynauds, scar tissue, tendonitis, trigger point

hydrotherapy effects and indications

effects: decrease abnormal tone, increase blood flow, increase core temp, pain relief, relaxation, vasodilation, wound debridement indications: arthritis, burn care, edema, decrease ROM, desensitization, joint stiffnes, muscle spasm/spasticity, muscle strain, pain, sprain, wound care

traction effects and indications

effects: decreased disc protrusion, decrease pain, increase joint mobility, increase muscle relaxation, increase soft tissue elasticity, promote arterial/venous and lymphatic flow indications: disc herniation, joint hypomobility, muscle guarding, muscle spasm, narrowing of IVF, nerve root impingement, osteophyte formation, spinal ligament and other CT contactures, subacute joint inflammation, subacute pain

electrotherapy effects and indications

effects: decreased edema, decreased pain, eliminate disuse atrophy, facilitate bone repair, facilitate wound healing, improved ROM, increased local circulation, muscle re-education, muscle strengthening, relax muscle spasms indications: bells palsy, decreased ROM, facial neuropathy, fx, idiopathic scoliosis, joint effusion, labor and delivery, muscle atrophy or spasm, muscle weakness, open wound/ulcer, pain, stress incontinence, shoulder subluxation

ultraviolet light effects and indications

effects: bacteriocidal effects, exfoliation, facilitate healing, increased pigmentation, thickening of epidermis, vitamin D production indications: acne, chronic ulcer/wound, osteomalacia, psoriasis, sinusitis, Vit D deficiency

biofeedback effects and indications

effects: decreased accessory muscle use, decreased muscle spasms, decrease pain improve muscle strength, muscle relaxation, NM control indications: bowel incontinence, CP, hemiplegia, impaired motor control, muscle spasms, muscle weakness, pain, SCI, urinary incontinence

diathermy effects and indications

effects: alter cell membrane function, increase collagen extensibility, increase edema, increase metabolic rate, increase muscle elasticity, increase NCV, increase pain threshold, increase temp, vasodilation indications: bursitis, chronic inflammation, chronic inflammatory pelvic disease, decrease collagen extensibility, DJD, increase metabolism, joint stiffness, muscle guarding, myofascial trigger points, pain, peripheral nerve regeneration, tissue healing

superficial thermotherapy effects and indications

effects: decrease muscle spasm, decrease tone, increase blood flow(vasodilation), increase capillary permeability, increase collagen extensibility, increase local temp, increase metabolic rate, increase muscle elasticity, increase NCV, increase pain threshold indications: abnormal tone, decreased ROM, muscle guarding or spasm, myofascial trigger points, subacute/chronic pain, subacute/chronic conditions

Cryotherapy effects and indications

effects: decreased blood flow to area, decrease edema, decrease local temp, decrease metabolic rate, decrease NCV, decrease tone, increased pain threshold indications: abnormal tone, acute/chronic pain, acute/subacute inflammation, bursitis, muscle spasm, MS trauma, myofascial trigger points, tendonitis, tenosynovitis

conventional (high rate) TENS

electrical pulses have short duration and high frequency w/ low current amplitude should have sensory, NOT MOTOR effect electrodes placed over painful area pain relief is brief, often used during ADLs used during acute or chronic phase of pain variable tx time modulation of pain is due to inhibition of pain fibers by large diameter fiber activation(gate mechanism) *pt not responsible for altering pulse width and rate

nominal data

elements are assigned to categories based on some criterion, such as coded by names, number or symbol ex: gender, blood type, diagnosis

endometriosis

endometrial tissue turns into scarring in the uterus and outside the uterus etiology: unknown sx: mod to severe low abdominal pain, irregulary menstruation, spotting, dyspareunia, pain w/ defecation tx: myofascial release, soft tissue massage, relaxation exercises, pharm, TENS, surgery, hysterectomy

bone mineral regulating agents

enhance bone mass while preventing bone loss or rate of bone reabsoprtion agents: estrogen, calcium, vit D, biphosphonates, calcitonin, anabolic agents indicated: paget's, osteoporosis, hyperparathyroidism, rickets, hypoparathyroid, bone pain, arrythmias

scapula vertebral levels

entire length: T2-T7 T3: scapular spine

Epibole, Keloid scarring, lichenification, Hypertrophic scarring

epibole: wound edges are rolled under and the wound bed remains open keloid scarring: excessive scar tissue outside of the original margins of the wound lichenification: skin becomes hard and leathery, similar to lichens hypertrophic scarring: healed wound w/ thick fibrous tissue that remains w/i the original wound borders

superficial burn (epidermal/1st degree)

epidermis only red with slight edema minimal scarring heals in 3-7 days healing occurs w/o peeling

characteristics of peripheral vertigo

episodic and short duration autonomic sx's present precipitating factor pallow, sweating nausea, vomitting auditory fullness tinnitus

Landeau reflex

equilibrium response that occurs when a child responds to prone suspension by aligning their head and extremities in line with the plane of the body 3 months- 2 years

erythrocyte sedimentation rate, c-reactive protein, rheumatoid factors, CBC

erythrocyte sedimentation rate (ESR): is typically measured to assist in confirming or monitoring the progress of an inflammatory process. ESR measures how quickly an erythrocyte (red blood cell) sample settles to the bottom of a test tube by measuring the distance cells have descended in one hour. Inflammation causes cells to clump and descend faster, therefore, a higher ESR is suggestive of inflammation. C-reactive protein (CRP) is a protein found in the blood plasma that appears in increased quantities during an acute inflammatory response. CRP levels may also be utilized to determine a patient's risk of developing heart disease. Rheumatoid factors (RF) are antibodies which may be quantified by a specific blood test referred to as a rheumatoid factor assay. High levels of RF are typically associated with autoimmune diseases such as rheumatoid arthritis, scleroderma, and systemic lupus erythematosus. Complete blood count refers to a grouping of blood tests which quantifies numerous blood components including white blood cells, red blood cells, platelets, hematocrit, and hemoglobin. Abnormalities in the white blood cell count are most closely related to inflammatory, infectious, and autoimmune conditions.

linear regression

establish the relationship b/w 2 variables as a basis for prediction X is the IV, Y is the DV ex: if given X , can Y be predicted...can SBP predict age?

positive predictive value

estimates the probability that a person who tests positive on the screening test actually has the condition the screening test is intended to detect provides a strong estimate of the actual number of patients who have the condition

IBS

etiology: unknown, food sensitivity sx: abdominal pain, bloating, nausea, vomitting, anorexia, stool changes, mucous in stool tx: avoid stress, alcohol, greasy foods, large meals, milk, caffeine

How often do you perform pressure relief with wheelchairs? bed?

every 15-20 minutes for 10-15 seconds in chair every 2 hours need position change in bed

what is the reasoning for pressure garnments to reduce edema?

exceeds the internal tissue hydrostatic pressure

Rood Facilitation vs inhibition

facilitation: approximation, joint compression, icing, light touch, quick stretch, resistance, tapping, traction inhibition: deep pressure, prolonged stretch, warm, prolonged cold, vibration?

what is the best indicator that a patient has exerted a max effort during a graded exercise program?

failure of the heart rate to increase with further increases in intensity

abnormal potentials with EMG

fibrillation potentials: indicative of LMN disease positive sharp waves: denervated muscle disorders at rest, primary muscle disease such as MD fasciculations: irritation/degeneration of anterior horn cell, nerve root compression of muscle spasms repetitive discharges: myopathies, lesions of anterior horn cell and peripheral nerves

lymph node abnormalities

firm or hard, mobile or nonmobile tender or nontender

prone instability test

first palpate prone segmental palpation, then ask the pt to stabilize the upper body off the plinth and lift the legs up off the ground . + test= tenderness initially encountered in prone can be reduced upon activation of the segmental stabilizers of the spine, which contract when the LE ar raised off the ground. Reduction in palpable tenderness is indicative of a + test, not a reduction in pain

Dupuytren's contracture

flexion contractures of 4th and 5th digits of the hand, MP and PIP joints

1st carpometacarpal joint osteo and arthro

flexion/extension: concave/convex (med/lat) abduction/adduction: convex on concave (ant/post)

superior gluteal nerve

glute med glute min TFL L4-S1

what can help with retention?

gradually reducing the feedback (fading schedule) forces the pt to use internal processes of error detection *The best time to evaluate retention is after a rest or at the beginning of the session, to minimize the temporary effects of variables on performance.

how to do a wheelie?

grasp the handrims posteriroly and then pull them forward abruptly and forcefully

skin turgor

grasp the skin between the 2 fingers on the dorsum of hand and see how long the skin remains elevated--> check for skin hydration if it takes a while for the skin to go back to normal: poor turgor and seen in eldery (dehydrated)

residual limb wrapping

greatest pressure distal to proximal 2 rolled bandages for transtibial diagonal turns overlap each wrap by 1/2 inch

vestibulospinal tract

gross postural adjustment subsequent to head movements and acceleration. Muscle tone, antigravity muscles and voluntary motor control. (descends to lateral SC which is uncrossed) and medial (crossed and uncrossed) *damage to the extrapyramidal: paralysis, hypertonicity, exagerrated DTR's, clasp knife reflex

hormones in the hypothalamus (7)

growth hormone releasing hormone growth hormone inhibiting horone gonadotropin releasing hormone thyrotropin releasing hormone corticotropin releasing hormone prolactin releasing hormone prolactin inhibibitory factor; dopamine

Rule of 9's

head and neck- 9% anterior trunk: 18% posterior trunk: 18% R arm: 9% L arm: 9% R leg: 18% L leg: 18% perineum: 1%

2 month development

head elevation to 45 in prone head bobs in supported sitting responds to friendly handling

how to determine "clock" on person with wound?

head is always 12 o clock undermining: tissue destruction that occurs under intact skin around the wound perimenter tunneling: channeling that extends from any part of the wound through sub Q tissue

scars: healing vs keloid vs delayed/retarded vs scar inflammation

healed: soft, raised to palpation, pink w/ silvery white appearance..heals at 6 weeks, pink or pale, flexible, less than 2 mm in height and within borders of the wound retarded healing: at 6 weeks still no sign of approximation, not fully granulated or epithelizaed, scar hasn't achieved maturation inflammation: red color, warmth, induration (firm, inflexible) keloids: firm of inflexible, highly raised, outside the wound borders

conversion

heating that occurs when nontheral energy (mechanical or electrical) is absorbed into tissue and transformed into heat rate of heat transfer determined by power not affected by temp of the thermal agent does not require direct contact, but does require a medium ex: diathermy and ultrasound

causes of foot slap with prosthesis

heel cushion too soft plantarflexion bumper too soft

anthropometric measures....

height, weight BMI, waist to hip ratio, % of body composition

noxious TENS

high density current that is painful/uncomfortable small probe type applicator or electrode 30-60 second intervals to motor, acupuncture or trigger points waveforms: mono, pulsatile current or biphasic pulsaltile w/ spiked, square, rectangular or sine wave can be placed on nerve roots, trigger points, acupuncture sites or key pts of pain and sensitivity net polarity is near zero (dont want charge b/c then it will cause irritation under electorides)

Digitalis Action

increase the contractility of the heart and decrease HR, decrease sympathetic action, decrease conduction through AV node Inotrop: the force and velocity CHF and a-fib

patients with burns are at risk of these symptoms....

increased O2 consumption and minute ventilation hyponatremia: increased cellular permeability decreased intravascular fluid increased core temp: due to higher metabolic responses (keep them warm so they dont expend more energy then needed) Intravascular volume: decreases fluid from the blood goes into the interstitial spaces (Decrease cardiac output: from increased blood viscosity, decreased volume in the blood and increased peripheral vascular resistance (increased PVR from increased viscosity) Hyperkalemia

causes of hypervolemia? symptoms of hypervolemia?

increased fluid intake, sodium or fluid retention (kidney or heart failure) sx: swelling in legs, ascites, fluid in lungs

symptoms of bone tumor

increased night pain pain with WBing

gait deviations seen with long limb (LLD)

increased plantarflexion with short limb during stance increased DF with long limb during swing vaulting or circumduction

cardiac transplant

increased resting heart rate due to lack of sympathetic and parasymp innervtion decreased HR response w/ exercise decreased peak HR during exercise USE RPE

what occurs with chest immersion in water?

increased work of breathing due to increased hydrostatic pressure

epinephrine

increases HR and force of contraction; increases energy production; vasodilation in skeletal muscle target: CV and metabolic systems regulated: sympathetic impulses from the hypothalamus in stressful situations *made in adrenal medulla

parathyroid hormone

increases blood calcium target: bone, kidneys, intestinal mucosa regulated: hypocalcemia *made in parathyroids

calcitonin hormone

increases calcium storage in bone; decreases blood calcium levels target: plasma regulated: hypercalcemia *made in thyroid

Oxytocin

increases contraction of uterine muscles; promotes release of milk from mammary glands target: uterus and mammary glands regulated: nerve impulse from hypothalamus; stretching of cervix; nipple stimulation *made in pituitary

Adrenocorticotropic Hormone

increases cortisol synthesis (adrenal steroids) target: adrenal cortex (of kidney) regulated: hypothalamus *made in pituitary

Androgen

increases mascularization; promotes pubic hair growth in males and females target: ovaries and testes Regulated: influence by the hypothalamic production and release of GnRH and LH *made in adrenal cortex

Aldosterone (mineralocorticoid)

increases reabsoprtion of sodium ions by the kidneys to the blood; increases excretion of K ions by the kidney into the urine target: kidneys regulated: low blood sodium levels, high K levels *made in adrenal cortex

Thyroid Stimulating Hormone

increases the synthesis of thyroid hormones T3 and T4 target: thyroid gland regulated: hypothalamus *made in pituitary

Antidiuretic Hormone

increases water reabsorption; conserves water; increases BP through stimulating contraction of muscles in small arteries target: kidneys regulated: decreased water content *made in pituitary

Emetic Agents

induce vomitting SE: dehydration, electrolyte imbalance, upper GI erosion ex: Apomorphine, ipecac

induration vs maceration vs ecchymosis vs hyperkeratosis

induration: due to local edema in the tissue, causing firmness ecchymosis: darkish discolored skin maceration: excessive amounts of moisture causing white and wrinkled appearance hyperkeratosis: thickening of the skin

Symptoms of Coarction of the Aorta

infants: pale, sweating, SOB Adults: High BP in arms, low BP in children later stages may see shortness of breath w/ exercise, intermittent claudication, weakness, headache

cholycystitis

infection/inflammation of gallbladder can refer it's pain to interscapular area sx: jaundice, fever, nausea, vomitting, RUQ pain, GI symptoms

posterior descending artery supplies...

inferior walls of both ventricles inferior portion of IV septum Comes off of right coronary artery

ulcerative cholitis

inflammation and ulceration of inner lining of colon and rectum sx: rectal bleeding, diarrhea, nausea, vomitting, weight loss, fever

types of reliability

interrater reliability: degree to which 2 or more independent raters can obtain the same rating for a given variable intrarater reliability: degree to which 1 rater obtains the same rating for a given variable test-retest reliability: degree to which the scores on a test are stable or consistent over time; measure of instrument stability split-half reliability: degree of agreement when a test is split in half and reliabily of 1st half is compared to second half; measure of internal consistency alternate forms of reliability: consistency or agreement of measurements obtained w/ different forms of a test ex: SAT, GRE internal consistency: extent to which elements that contribute to a measurement reflect one basic phenomenom or dimension ex: a functional scale should only include items related to function

intra vs interrater reliability

intra: b/w same person inter: b/w multiple people

overflow urinary incontinence

intrabladder pressure exceeds the urethra's capacity to remain closed due to urinary retention *often caused by LMN disease, that disrupts the activity of the detrusor muscle etiology: obstructed or narrowed urethra sx: difficulty initiating urine stream, weak flow, dribbling tx: surgery if obstruction, double voiding, catherization

discography

invasive technique that involves injecting a radioopaque dye into the nucleus pulposus of an IV disc using radiographic guidance can identify disruptions of annulus fibrosis

myelography

invasive test that utilizes fluroscopy and radiography to evaluate spinal subarachnoid space...contract medium is injected into SC and epidural space identifies bone displacemnt, disk herniation, SC compression or tumors

arthrography

invasive test utilizing a contrast medium to provide visualization of joint structrues through radiographs, soft tissue disruption identified by leakage

Raimiste's phenomenon

involved LE abducts or adducts w/ applied resistance to the uninvolved LE in the same direction

testosterone hormone

involved in the process of spermatogensis and male sexual characteristics target: pituitary gland regulated: influenced by pituitary release of LH *made in testes

estrogen/progesterone

involved in the regulation of the female reproductive system and female sexual characteristics target: uterus and mammary glands regulated: cyclic rise and fall of hormone levels *made in ovaries

thyroxine (T4) and triiodothyronine (T3)

involved with the normal development; increases cellular level metabolism target: all tisues regulated: thyroid stimulating hormone *made in thyroid

subdermal burn

involves complete destruction of epidermis, dermis and subcutaneous tissue may involve muscle and bone requires multiple surgeries and extensive healing time

superficial partial thickness burn (2nd degree)

involves epidermis and upper dermis min to no scarring in 2 weeks BLISTERING blanchable redness (capillary refill OK) nerve endings intact (painful!) moderate edema spontaneous healing in 5-21 days

Ottawa ankle, knee and foot ruls

knee rules: inability to bear weight/walk for more than 4 steps, > 55 y/o, tenderness to the fibular head or patella, inability to flex the knee greater than 90 degrees ankle rules: inability to bear weight on both immediately and in ER (4 steps) or bone tenderness at the posterior edge or tip of either malleoli foot rules: inability to bear weight both immediately and in ER (4 steps) or one tenderness at the navicular or the base of the 5th metatarsal

alpha peripheral nerves

large, myelinated, high conduction rate alpha: alpha MN, muscle spindle, GTO, touch Beta: touch, kinesethseia, muscle spindle secondary endings Gamma: touch, pressure, gamma MN Delta: pain, touch, pressure, temp

medial or lateral buttress with patellofemoral brace with excessive Q angle?

lateral (strap pulls the patella medially)

lateral cord of brachial plexus

lateral pectoral nerve C5, C6, C7

causes of abducted gait with prosthetics

laterally displaced prosthetics high medial wall long prosthesis low lateral wall tight hip abductors

thoracodorsal nerve

latissimus dorsi C6, C7, C8 comes off of posterior cord

circumflex artery supplies...

left atrium posterior and lateral walls of L ventricles anterior and inferior walls of the L ventricle

hypokalemia

leg cramps hyporeflexia postural hypotension dizziness flat T wave, proonged QT interval and depressed ST segment

digitalis has what affect of EKG?

lengthens PR may have ST segment sagging

dorsal scapular nerve

levator and rhomboids C5 - C6 comes off of roots

massage effluerage

light stroke that produces a reflexive response performed at beginning and end strokes directed towards heart

lung auscultation

listen to one breath per segment take breath w/ open mouth to increase turbulence (allows sounds to be heard) -tubular sounding lungs sounds, or bronchial breath sounds, are normally found over the trachea. -Vesicular breath sounds, (i.e., soft, low-pitched sounds), are normally found over the distal portions of the lung in a person without lung disease.

neuropathic ulcers

located: plantar foot (met heads), heels, toes dry, well defined borders, callous rim doesnt hurt dry, cracked skin tx: total contact cast, footwear assessment to allow wound to heal

types of compression bandages

long stretch: 60-70 mm Hg, little working pressure when muscles activated (those who are immobile) short stretch: low pressure at rest, high in mobility--> must have fxnl gait and calf muscle multi layered bandage: high resting pressured, protection, absorption, compression (treat venous stasis ulcers) semirigid bandages: gauze to distal extremity...initially wet and then dries. similar to unna boot. 35-40 mm Hg

Ultrasound Debridement

long wave low frequency between 20-50 kHz selective removal of necrosis reduces bioburden increases angiogenesis wound bed prep or flap/graft prep CI: DVT, irradiated areas, tumors, electrical devices precautions: over nerves, infections, anesthetic areas

causes of lateral trunk bending with prosthesis

low lateral wall high medial wall short prosthesis weak abductors abductor contracture hip pain short amputation limb

anticoagulation therapy names

low molecular weight heparin: CI for high risk bleed unfractioned heparain: for those at high risk of bleeding *at risk for heparin induced thrombocytopenia: not enough platelets *check for hematuria and ecchymosis heparin coumadin (warfarin) Lovenox (enoxaparin)

reasons why hemoglobin would be low? high?

low: anemia high: dehydration, diarrhea, vomitting, excessive sweating, severe burns, use of diuretics

GERD

lower esphageal sphincter weak etiology: weak LES, alcohol, smoking, trauma sx: heartburn, regurgitation, belching, chest pain, persistent burning pain in the esophagus, throat or chest tx: pharm

UTI

lower: urinary freq, burning, cloudy, foul smelling urine, suprapubic/lower abs/ or groin pain upper(in kidneys): fevers, chill, malaise, HA, tenderness over costovertebral angle (murphy's sign) sx in the elderly: fever, lethargic, nausea, painful urination

amount of pounds for mechanical separation of lumbar spine? cervical spine?

lumbar: 50% of body weight cervical: 7% of body weight (20-30 lbs)

what two ways can you reduce ultrasound hot spot?

move the ultrasound head used pulsed current

what population may require a posterior vs. anterior wheel axle alignment change?

moving anterior: obese patients (decreases their work and reduces energy cost) moving posterior: used for bilateral amputees to increase stability and compensate for change in gravity

false negative with ACL tear

muscle guarding of hamstrings

e-stim on/off time for muscle re-education? muscle spasm?

muscle re-ed 1:5 muscle spasm: 1:1

close spaced electrode and low sensitivity?

muscle relaxation when the patient progresses, you want to increase the space b/w the electrodes and use high sensitivity

EMG muscle re-ed and muscle relaxation

muscle relaxation: low sensitivity (moving to high) w/ active electrodes placed close to each other muscle re-ed: (start high...progress to low). high sensitivity(progress to low), contract muscles for 6-10 seconds. Electrodes spaced wide (moving to close together)

Mitochondrial Disorders

mutations in DNA sx: loss of muscle coordination, muscle weakness, visual and hearing problems, heart/liver/kidney disease

homolateral synkinesis

mutual dependancy b/w the involved upper and lower extremities. ex: Right elbow flexion will cause mass flexion of the R LE

side effect of statins

myalgia stiffness spasms weakness affecting exercise tolerance liver dysfunction

stress fracture symptoms

nagging, localized pain pain present consistently at night pain increases with activity and causes swelling

nystagmus

named for the fast component direction of slow component indicates side of unilateral hypofunction

growth factor treatment

naturally occuring protein substances limited # approved by FDA -used for neuropathic ulcers in the sub Q CI: wounds closed, hypersensitivity, neoplasm

SI joint special tests

need 3/5 to be positive SI gapping, SI compression, thigh thrust (p4 test), sacral thrust, gaenslen's test *can also use FABERS

negative and positive skew data

negative skew: mean and median are to the left of the mode positive skew: mean and median are to the right of the mode

antacid agents

neutralize gastic acid and increase pH aluminum containing, calcium carbonate containing, magnesium containing or sodium bicarb containing indicated: GERD, heart burn, peptic ulcer SE: Acid rebound, constipation or diarrhea, electrolye imbalances Aluminum Containing: Basaljel (aluminum carbonate gel) Calcium Carbonate containing : TUMS (calcium carbonate) Magnesium containing: Milk of magnesia (magnesium hydroxide) Sodium Bicarb: Bromo Seltxer (sodium bicarb)

null hypothesis

no relationship exists b/w variables any relationship found is the result of change or sampling error Ho rejected: sig difference was observed Ho accepted: no difference

ordinal data

order matters, exhibit a greater than-less than value *intervals b/w ranks are NOT equal ex: scales of sensation, balance, MMT, pain, joint laxity *a 4 on MMT is not twice as much as 2 on MMT scale

Oronasal mask vs tent vs tracheostomy mark

oronasal: facepiece covers nose and mask w/ small vent holes to expel exhaled air along w/breathing tube and connector. Can give O2, administer meds, mucolytic detergents, humidity, accessory nebulizer tent: canopy placed over the head and shoulders or the entire body for the purpose of delivering O2 at a higher level than normal tracheostomy mask: placed over stoma or tracheostomy for the purpose of administering supplemental O2

beta blocker SE and PT implications

orthostatic HTN, dizziness, depression, bradycardia, blurred vision, cardiac arythmias use the RPE to determine workload, monitor closely

posterior tibial tendonitis

pain in the distal medial lower leg typically due to overpronation (post tib controls pronation), pain is prevalent in the morning, eases after a few hours and then returns at the end of the day

small bowel obstruction symptoms

pain near umbilicus, pain referred to back if intense

ANCOVA

parametric test used to compare 2 or more treatment groups or conditions while also controlling for the effects of intervening variables (covariates) ex: 2 groups of subjects are compared on the basis of gait parameters using 2 different types of AD's; subjects in one group are taller than the 2nd group; height then becomes the covariate that must be controlled during statistical analysis

ANOVA

parametric test used to compare 3 or more independent treatment groups or conditions at a selected probability level 1 way ANOVA: multiple groups on 1 single independent variable (ex: balance scores in young, old and elderly group) factorial ANOVA: compares multiple groups on 2 or more IV (ex: 2 groups of uninjured patients and a control group are compared for muscle activation and sensory perception of each limb)

parametric statistics vs nonparametric statistics

parametric: t-test, ANOVA, ANCOVA *includes tests of significance based on interval or ratio data....*normally distributed, variance is equal, random sampling is performed nonparametric: testing on ordinal or nominal data, when the data is skewed

hydrogel indications

partial and full thickness wounds wounds w/ necrosis and slough burns and tissue damage by radiation

pressure tolerant areas in patellar tendon socket

patellar tendon medial tibial plateau tibial and fibular shafts distal end

Souques phenomenon

patient raises the involved UE above 100 degrees w/ elbow extended, causes extension and abduction of involved fingers

head jolt test

patient turns their head frequently 2-3 times a second + test= worsening headache and caused by meningeal irritation

correlational statistics

pearson product-moment coefficient (r) spearmans' rank correlation (Rss or spearmans rho) point biserial correlation rank biserial correlation intraclass correlation coefficient (ICC)

granulation

perfused, fibrous CT that replaces a fibrin clot in a healing wound tissue is highly vascularized and fills the defects of a full thickness wound

neural tension test for peroneal(fibular) nerve, tibial and sural nerves

peroneal: plantarflexion and inversion tibial: dorsiflexion and eversion sural: dorsiflexion and inversion

superficial peroneal nerve innervates

peroneus longus peroneus brevis cutaneous: antero-lateral aspect of the leg along with the greater part of the dorsum of the foot (not b/w 1st and second toes) L4-S2

posture of a newborn/NICU baby?

physiological flexion

hypothenar eminence

pinky side contains: abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi innervated by the ulnar nerve

sacral plexus innervates

piriformis superior gemelli inferior gemelli obturator internus quadratus femoris L4-S4

High Frequency airway oscillation (acapella and flutter)

place device in mouth--> inhale to 75%--> hold for 2-3 seconds--> exhale 3-4 seconds--> repeat 10-20 breaths....then perform 2-3 coughs or huffs to raise secretions

CT scans

plain film radiograph, multiplanar assess complex fx, disc disease, SCI better visualization of bone than plain films con: fairly expensive, exposed to radiation the more dense, the white the image (bones) the less dense, the blacker the image (CSF)

neck, chest and shoulder burns....position the patient with this device?

plastic cervical orthosis and axillary splints in an airplane position

central venous pressure catheter

plastic intravenous tube used to measure pressure in the right atrium or the superior vena cava can also measure right ventricle function, right atrial filling, circulating blood volume also can measure filling of the right atrium (diastolic BP)

3 month development

prone on elbows, WB on forearm head in midline in supine increased back ext and scap add in sitting coos, chuckles

6 months development

prone on hands w/ elbows extended rolls supine to prone independent sitting pulls to stand w/ hands held

DCML

proprio light touch vibration 2 pt discrimination stereognosis barognosis graphesthesia damage in the SC: ipsi damage damage in the brain (above medulla): contra *decussates in the medulla

Proprioceptive placing reaction, traction response

proprioception placing reaction: exhibited by the LE when the shin is rubbed against a surface resulting in flexion of the hip and knee traction response: traction applied to the arm results in UE flexion

causes of terminal swing impact with prosthetics

prosthesis comes to sudden stop as the knee extends during late swing insufficient knee friction too much tension in extension aide fears that knee will buckle forceful hip flexion

causes of vaulting with prosthesis

prosthesis too long inadequate suspension socket too small prosthetic foot set in too much PF too little knee flexion

Glucocorticoids Agents (corticosteroids)

provide hormonal, anti inflammatory and metabolic effects to suppress articular systemic disease. Vasoconstrict, reduce inflammation decrease fibroblast proliferation, inhibit inflammatory proteins, preserve cell bodies at the inflammation site, decrease production of prostaglandins SE: muscle atrophy, GI distress, adrenocortical suppression, glaucoma, HTN, weakening of tissues, drug induced Cushings, calcium loss, osteoporosis ex: Dermacort (hydrocortisone or cortisol), Cordrol (prednisone), Pediapred (prednisolone), Medrol (methyprednisolone), Decadrol (dexamethasone), Nasonex (mometasone)

Vest Airway Clearance System

provides high frequency chest wall compression allows for control of inspiratory and expiratory flow rates can be used in any position regardless of cognition

massage tapotment

provides stimulation through rapid alternating movements such as tapping, hacking, cupping and slapping enhance circulation and stimulate peripheral nerve endings

hypothyroidism symptoms

proximal muscle weakness(myalgia and weakness) joint stiffness prolonged DTR's (decreased DTR's) fatigue weakness dyspnea decreased CO sinus bradycardia (decreased HR) weight gain constipation delayed puberty retarded growth and development *slowing of metabolic processes

what complication is also seen with psoroartic arthritis?

psoriatic skin and nail changes conjunctivitis and iritis

hyperbaric oxygen therapy

pt breaths in 100% O2 in sealed, body chamber usually 2-2.5 atmopsheres hyperoxygenation reverses hypoxia and facilitates wound healing contra: terminal illness, pneuomthorax, malignancy, pregnancy, emphysema

Balance grades (good)

pt maintain balance w/o hand held support, limited postural sway pt accepts mod challenge, maintain balance while picking object up off of floor able to sit unsupported, move in and out of BOS, accept some challenge without loss of balance

Balance grades (fair)

pt maintain balance without hand held support, may require min assistance (static) pt accepts min challenge, able to maintain balance while turning head/trunk able to sit unsupported, cannot accept any challenge or go outside their BOS w/o losing balance

Balance grades (normal)

pt maintains steady balance w/o hand held support pt accepts max challenge and can weight shift at full ROM in all directions able to sit unsupported, move in and out of BOS, accept max challenge w/o loss of balance

Balance grades (poor)

pt requires hand held support and mod-max A to maintain position pt unable to accept challenge or move without loss of balance unable to maintain their balance in sitting w/o external support or assistance

position of arm for supraspinatus US

slight abduction and IR

to prevent contractures in a newly admitted patient with anterior neck burns, it would be best to position the neck in?

slight extension

functional position of the hand with splints

slight wrist extension slight ulnar deviation fingers flexed at the MCP, PIP, and DIP joints thumb slightly abducted.

what color will someone's skin be if they have CHF?

slightly blue-ish, slate colored discoloration

ideal plumb line

slightly posterior to coronal suture through axis of odontoid process through external auditory meatus midway through tip of shoulder through lumbar vertebrae slightly posterior to hip slightly anterior to the knee slightly anterior to the lateral malleolus through calcaneocuboid joint

Antidiarrheal Meds

slow debilitating effects of dehydration SE: constipation, abdominal discomfort ex: Donnagel (attapulgite), Kapectolin (kaolin), Pepto Bismol (bismuth subsalicyclate), Motofen (difenoxin), Imodium (loperamide)

Basal Cell carcinoma

slow growing epitheliial tumor raised patch, ivory apperance rarely metastasizes in fair skinned individuals

causes of swing phase whips with prosthetics

socket is rotating knee bolt rotated foot is malaligned

causes of drop off gait with prostetics

socket too far forward excessive knee flexion DF bumper too soft excessive DF of foot prosthetic foot too short foot too far posterior knee flexion contracture

causes of excessive knee flexion during stance

socket too far forward socket too far anteriorly tilted (too much flex) PF bumper too hard high heel shoes knee flexion contracture weak quads

causes of delayed knee flexion during stance with prosthetics

socket too far posterior lacks sufficient flexion DF too stiff causes PF prosthetic foot keel too long foot too far anterior plantar flexion bumper heel cushion too soft

somatoagnosia vs anosognosia vs prosopagnosia

somatoagnosia: impairment of body schema where there is lack of awareness of a body structure and its relationship to other body parts, or oneselves to others anosognosia: severe denial or awareness of presence of severity of one's neuro deficits or illness in general prosopagnosia: inability to recognize faces in person or in photos. The person may be identified by the patient, however, by voice or other mannerisms.

hydrogel advantages

soothing and cooling fill dead space rehydrate dry wound beds promote autolytic debridement provide minimal to mod absoprtion conform to wound bed transparent --> translucent many are nonadherent amorphous form can be used when infection is present

S4 heart sound

sound of vibration of the ventricular wall with ventricular filling and atrial contraction "atrial gallop"; la lub dub..heard in late diastole HTN, stenosis, heart disease, MI

spinolivary vs spinoreticular vs spinotectal

spinolivary: ascends to the cerebellum and relays info from cutaneous and proprio organs spinoreticular: afferent pathway for the reticular formation that influences level of consciousness spinotectal: sensory info that provides afferent info for spinovisual reflexes and assists w/ movement of eyes and head toward a stimulus

spondylolysis vs. spondylolithesis

spondylolysis: break in vertebra at pars inerarticularis spondylolisthesis: forward slippage of upper vertebrae on lower vertebrae

Turf Toe

sprain of the 1st MTP joint due to hyperextension, such as when pushing off into a sprint

transparent films indications

stage 1 and 2 ulcers secondary dressing in certain situations for autolytic debridement skin donor sites cover for hydrophilic powder and paste preps and hydrogels

Tonic Labryintine Reflex (TLR)

stimulus: position of labryinthine in inner ear-reflected in head position response: in the supine position, body and extremities are held in extension, in the prone position, body and extremities are held in flexion normal: birth to 6 months interferes with: ability to initiate rolling, ability to prop on elbows with extended hips when in prone, ability to flex trunk and hips to come to sitting position from supine

Plantar grasp reflex

stimulus: pressure to base of toes response: toe flexion normal: 28 weeks-9 months interferes with: ability to stand with feet flat on surface, balance reactions and weight shifting in standing

walking(stepping) reflex

stimulus: supported upright position with soles of feet on firm surface response: reciprocal/extension of legs normal age: 38 weeks of gestation to 2 months interferes with: standing and walking, balance reactions and weight shifting in standing, development of smooth, coordinated reciprocal movements of LE

Rooting reflex

stimulus: touch on cheek response: turning head to same side w/ mouth open normal: 28 weeks of gestation to 3 months interferes with: oral -motor development, development of midline control of head, optical righting, visual tracking and social interaction

Galant Reflex

stimulus: touch the skin along spine from shoulder to hip response: lateral flexion of trunk to side of stimulus normal age: 30 weeks of gestation to 2 months interferes with: development of sitting balance, can lead to scoliosis

Positive support reflex

stimulus: weight placed on balls of feet when upright response: stiffening of legs and trunk into extension normal: 35 weeks of gestation to 2 months interferes with: standing and walking, balance reactions and weight shifting in standing, can lead to contractures of ankles in plantarflexion

antithrombotics (antiplatelets)

stop platelet aggregation and CLOT formation; prevent MI ex: Aspirin (bayer); Plavix (Clopidogrel); Persantine (dipyridamole)

Anticoagulation Therapy Action

stop platelet aggregation and thrombus formation used for: post CABG, PTCA, prosthetic valve, prevention of emboli, venous thromboembolism

forward head rounded shoulders posture

strengthen the rhomboids strengthening the deep neck flexors stretch pecs stretch traps

Cyriax Contractile Tissue

strong and painfree= no pathology strong and painful= minor lesion of muscle-tendon weak and painful= serious problem, fracture weak and painless=complete tear of muscle-tendon or nerve involvement

upper subscapular nerve

subscapularis C5-C6 comes off of posterior cord

Lhermitte's sign

sudden, transient electric like shocks spreading down the body when the head is flexed forward occurs with MS

systematic review

summaries of (RCT's) medical literature that uses explicit methods during lit search, critical appraisal and statistical techniques HIGHEST level of evidence

Testing sensation

superficial--> deep--> cortical superficial: pain, light touch, temp deep: proprio, kinesesthia, vibration cortical: sterognosis, 2 pt discrimination, barognosis, localization of touch, tactile localization, double simultaneous stimulation, graphesthesia, texture recognition, and barognosis.

superficial vs deep peroneal nerve

superficial: sensory of lateral aspect of leg and dorsum of foot...innervates peroneus longus and brevis deep: between 1st and 2nd toes..innervates EHL, tibi anterior, peroneus tertius, EDL, EDB, EHB

vertebral basilar artery supplies?

supplies: lateral aspect of pons and midbrain, cerebellum, medulla, pons, midbrain and thalamus, occipital cortex damage: loss of consciousness, hemiplegia or tetraplegia, comatose/vegetative state, inability to speak, locked in syndrome, vertigo, nystagmus, dysphagia, dysarthria, syncope, ataxia basilar artery specifically: contralateral hemiplegia and ipsilateral sensory loss of face

middle cerebral artery

supplies: most of outer cerebrum, basal ganglia, posterior and anterior internal capsule, putamen, pallidum, lentiform nucleus damage: contralateral hemiplegia with UE > LE, most common site of CVA, Wernickes aphasia, homonymous hemianopsia, apraxia, flat affect (R damage), contralaterl weakness and sensory loss of face and UE, impaired spatial relations, anosognosia (R damage), impaired body schem

breast cancer

typically found in women > 50 painless mass behind areola or upper quadrant metastasize: brain, lungs, bones, adrenals, liver risk: gender, age, estrogen, young menarche, late menopause, high fat diet sx: painful breast, changes shape, bleed from nipple, dimple over mass

what happens with diastolic BP with exercise?

typically increases or decreases by 10 mmHG

high volt pulsed current

typically monophasic, twin peaked pulses of short duration used for wound healing and pain relief...don't want a muscle response clean and debride wound, place active electrode over gauze in wound promote granulation, reduce size, stimulate proliferation and capillary growth can only adjust amplitude

Wheelchair frames

ultralight: highly active, no postural supports; sports hemi: propel using LE geri: pt not able to self propel or safely operate a power mobility device reclining frame: unable to perform (I) weight shifts, cant sit upright for long periods of time; mod to severe trunk impairment backward tilt in space: unable to sit upright or perform weight shifts; issues w/ sliding or EXTENSOR tone

general ultrasound safety rules

ultrasound rule: 5 minutes for an area that is 2-3 times times the size of the transducer head dont treat area that is 4 times size of ERA (+) response should be in 3 visits...if not, discontinue

phonophoresis

ultrasound to deliver medication pulsed or continuous ultrasound limited efficacy typically pulsed 20%, 5-10 min

abnormal skin response to thermotherapy

uneven, blotchy, red and white skin in a light skinned pt, or darker and lighter areas in a darker skin pt is sign of overheating

Contraindications to Cardiac Rehab

unstable angina resting SBP > 200 or resting DBP > 110 orthostatic BP > 20 drop aortic stenosis acute illness/fever 3rd degree heart block w/o pacemaker recent embolism resting ST depression/elevation > 2 mm resting ventricular arythmias

causes of forward flexion during stance with prosthesis

unstable knee unit short ambulatory aids hip flexion contracture

posterior cord of brachial plexus

upper subscapular nerve thoracodorsal nerve lower subscapular nerve

upper mid and lower trap action

upper: upward rotation, scapula elevation, scapular abduction middle: scapular retraction, adduction lower: upward rotation of scapula, scapula depression, scapular adduction

upslip vs inflare

upslip: PSIS and ASIS would be high infare: the left PSIS would be more lateral and ASIS would be medial

Archmimedes principle of buoyance

upward force on the body when immersed in water equal to the amount of water that has been displaced by the body buoyant force works in opposition to gravitational force *allows joint unloading and enhances ease of active movement *largest force would be at the feet if immersed in a pool

hyperstimulation (point stimulation) TENS aka noxious TENS

use a small probe to locate and noxious stimulate acupuncture or trigger points duration: 15-30 sec increments long lasting pain relief

Modified Fatigue Impact Scale

used for MS assesses fatigue on physical, cognitive and psychosocial function

large spaced electrode and high sensitivity?

used for muscle re-education when the patient can then begin activitating their muscle, you want to decrease the space b/w electrodes and progress to low sensitivity

what is the purpose of continuous ultrasound?

used for thermal effects, also used to decrease tissue stiffness of collagen the higher the intensity, the greater the chance of causing a tissue temp rise that will increase metabolic rate

who would benefit from a platform attachment?

used for those who are unable to bear weight through their wrist and hands(or shoulder), who have deformities of wrists or fingers or who have an amputation distance to the elbow or who are unable to extend the elbow

paraffin

used on distal extremities low melting point, even distribution of heat mixture kept at 113-122 degrees dip wrap, dip reimmersion, paint application dip- harden- repeat 6-8 times (wrap, reimmersion or paint on) tx duration: 20 min (10-15 for wrap)

Frontal Lobe

voluntary movement(primary motor cortex), Broca's Area, personality, temper, judgement, reasoning, self awareness, executive function impairments: contralateral weakness, perseveration, inattention, personality changes, impaired concentration, Broca's Aphasa, delayed initiation, emotional lability

10-15 months development

walk unassisted creeps up/down steps transitions from floor to stand self feeding reaching w/ supination build tower of 2 cubes suspicious of strangers imitates

what are hydrogels?

water or glycerine based gels, insoluble in water. Available in solid sheets, gels or impregnanted gauze.

disciminant validity

way to assess the constructional validity of a measurement when measurements that are believed to assess different characteristics are shown to be different, or have a low correlation, then the one measurement is said to have discriminant validity with respect to the second measurement

steppage gait is due to ?

weak dorsiflexors and knee flexors...have to lift the entire hip and LE off the floor to clear toe from dragging *apply e-stim to DF

excessive winging and abduction of scapula is caused by?

weak rhomboids

bulbar palsy vs psuedobulbar palsy

weakness or paralysis of the motor nuclei of the lower brainstem, affecting the face, tongue, larynx and pharynx check for: CN 9 and 10 paralysis, dysphonia pseudobulbar palsy: bilateral dysfunction of corticobulbar innervation of the brainstem nuclei; a central or UMN lesion analogous to corticospinal lesions disrupting function of the anterior horn cells...examine for hyperactive reflexes such as snout and jaw reflex

incident report should include?

what occurred, where it occurred and witness statement * you don't want to mention that there was a cause or corrective, there is no presumption that someone was injured