Musculoskeletal and Neuro
Indicatons for Sensory Stimulation Pts who demonstrate absent or disordered (1)______, who would benefit from (2)______ feedback, most useful in early stages of (3) ______
1) motor control 2) augmented 3) motor learning
Complex Regional Pain Syndrome 1) Description 2) Sx do not occur in ______ pattern
1) neurogenic pain and inflammation and activity of SNS 2) peripheral or nerve root pattern
Forefoot varus 1) Involved deviated structures 2) Observed deformity
1) Head and neck of talus 2) inversion of forefoot with subtalar neutral
Pes Cavus 1) aka 2) Deformity Observed (5) 3) Reduces ability to ______ _______ through foot 4) Pt must limit ____-____ activities
1) Hollow Foot 2) increased longitudinal arch height, drop of anterior arch, metatarsal heads lower than hindfoot, PF and splaying of forefoot, claw toes 3) absorb forces 4) high-impact
UE Extensor Tendon Repair 1) First 6-8 weeks 2) When is AROM initiated 3) Active ______ exercises initiated first, followed by ______ 4) Resisted and functional exercise introduced when?
1) Immobilization of interphalangeal joints in neutral for distal repairs 2) at 6 weeks with PIPs in neutral 3) Extension; flexion 4) full AROM achieved
Unhappy Triad 1) Description 2) Causation
1) Injury to MCL, ACL, and medial meniscus 2) Combo of valgum, flexion, and ER on planted LE
Locomotor Training for pts with low lumbar lesions 1) segments 2) AD and Orthosis 3) Level of independence
1) L4-5 2) B AFO and crutches or cane 3) Independent
Localized Lesion to Cortex: Frontal Lobe: Motor Speech (Broca's Area) 1) Function 2) Sx
1) Language Production 2) Nonfluent aphasia
Localized Lesion to Cortex: Temporal Lobe: Wernicke's Speech Area 1) Function 2) Sx
1) Language understanding and formulation 2) Fluent Aphasia
Localized Lesion to Cortex: Parietal Lobe: Postcentral Gyrus/Somatosensory Area 1) Function 2) Sx
1) Somesthetic Sensation 2) Contralateral loss of stimulus location
Normal Metatarsophalangeal angle?
8-20 deg
A hemorrhagic CVA is precipitated by _______ which leads to _______ or _______, causing the the stroke
hypertension; aneurysm or arteriovenous malformation
Elevation in temperature may indicate infection or damage to the ______ or ______
hypothalamus or brainstem
How to screen stereognosis
identifying object without sight
What is the strongest ligament in the body?
iliofemoral ligament
Purpose of a MRI and what does it rule out?
imaging bones, tissues, and organs, and nerves; brain or spinal tumors, MS, and head trauma
Indication of isometrics post THA for cemented and cementless
immediately post-op to pt tolerance
Golfer's elbow typically involves which tendons?
pronator teres and/or flexor carpi radialis
Description and use of HKAFO
pts with hip, knee, ankle and foot weakness. Can control hip rotation and ABD/ADD. pts can only use swing-to or swing-through gait
Indication for soft tissue/myofacial techniques
pts with soft tissue and jt restrictions that result in pain and limit ADLs
(lateral) Corticospinal Tract is responsible for? (1)
pyramidal motor tract: contralateral fine movement
(anterior) Corticospinal Tract is responsible for? (3)
pyramidal motor tract: ipsilateral voluntary, discrete, and skilled movement
Rate of regeneration of axonotmesis injury
regenration distal to site of injury of 1mm/day
Ataxic Gait
staggering and unsteady gait usually with wide BoS and exaggerated movements
Importance of subthalamus
regulating skeletal muscle movement
Description of Elbow Disarticulation (surgery)
removal of lower upper extremity through elbow joint
Description of Transhumeral Amputation
removal of upper extremity proximal to elbow
Description of Shoulder Disarticulation
removal of upper extremity through shoulder
Relationship between femoral rotation and the tibia.
rotate in same direction
Spinal Movement Couplets: Cervical Side-bending and rotation occur in same/opposite (?) direction from C2-C7 regardless of positioning of spine.
same
Homonymous Hemianopsia
same sided blindness of both eyes (i.e. medial left eye and lateral right eye)
Which 3 carpal bones make up the radiocarpal joint with the radius?
scaphoid, lunate and triquetrium
An EEG is used to rule out (5+)
seizure disorders, brain death, brain tumors, brain damage, inflammation, alcoholism, select psychiatric disorders, and brain related degenerative disorders
Osgood-Schlatter Disease description
self-limiting disease from repetitive traction on tibial tuberosity apophysis at patellar tendon insertion
Initial sx of carpal tunnel sundrome?
senosory deficits along median nerve distribution distal to compression, may have radiate up into upper arm, shoulder, and neck
Somatognosia
sense of ones own body (identify own body looking in mirror)
(anterior) Spinothalamic Tract is responsible for? (2)
sensory light touch and pressure
Description and use of Parapodium
standing frame designed to allow for sitting. Use weight shift and lean to progress in gait. Primarily used in pediatrics
PNF: D1 Flexion of upper extremity looks like
start of backhand swing
Spastic Gait
stiff movement, toes catch and drag, legs held together, hips and knees slightly flexed. Common in spastic paraplegia
Common Signs and Symptoms associated with Facet Joint Dysfunction (5) -Common test to help identify?
stiff upon rising but eases within hour, loss of RoM, pain is sharp with certain movements (extension), repetitive movements in pain-free range relieves sx (flexion), prolonged sit/stand increase symptoms -quadrant test
PNS Pathos: Describe Polyneuropathy pathology and give an example (4/1)
stocking glove sensory loss, motor weakness (distal>proximal) and atrophy, possible fasciculation, decreased DTRs; diabetic peripheral neuropathy
Characteristics of CVA in: Brainstem (4)
unstable vitals; decreased consciousness; decreased ability to swallow; bilateral weakness/paralysis;
When the tibia ER, the talus ______ and the foot ______
up glides; supination
Elevators of the scapulae (2)
upper traps, levator scap
Perform ______testing prior to cervical segmental manipulations
vertebrobasilar
Definition of bradykinesia
very slow movement
30-65% of TBI pts exhibit ______ sx
vestibular
Describe post-polio syndrome
viral infection resulting in neuropathy that includes focal and asymmetrical motor impairments. Affects those who have had polio
Function of Frontal Lobe
voluntary movement, (left hemisphere) Broca's:(speech, concentration), personality, judgement, executive functions
Functions of basal ganglia (5)
voluntary movement, autonomic movement regulation, posture, tone, control of motor responses
Causes of hip hiking during swing (2)
weak DF or knee flexors
Causes of circumduction during swing (3)
weak DF, hip flexors, or hamstrings
Common causes of lordosis (4)
weak abs, pregnancy, excessive abdominal weight, hip flexion contractures
Causes of insufficient hip flexion at initial contact (4)
weak or paralyzed hip flexors, hip extensor spasticity, insufficient hip flexor RoM
Causes of excessive knee flexion at contact (4)
weak or paralyzed quads, hamstring spasticity, insufficient extension RoM
Are hereditary ataxias progressive?
yes
Are sx of Guillain-Barre Syndrome symmetrical?
yes
Is the damage done to nerve fibers reversible in axonotmesis?
yes; due to anatomical relationship between fibers
Typical age range of Guillain-Barre?
young adult and those 50s-80s
Pt post-op ACL/PCL reconstruction is typically Non-WB for how long
~1 week
Normal degree of toe-out during free speed walking
~7 degrees
Differential Dx: Tarsal Tunnel Syndrome vs Plantar Fasciitis
+ (TTS) vs - (PF) Tinel sign
Predictable Patterns of Impairment with occlusion to vertebral-basilar artery
-Locked-in syndrome, comatose, vegetative -Wallenberg Syndrome
Two significant symptoms of posterior cerebral artery syndrome
-Most significant: thalamic pain syndrome and cortical blindness
Localized Lesion to Cortex: Frontal Lobe: Middle Frontal Gyrus 1) Function 2) Sx
1) Conjugate Eye Movement 2) Contralateral eye conjugate movement paralysis
Trochanteric Bursitis 1) Causes 2) Typical pt population
1) Direct blow, ITB irritation, repetitive microtrauma from abnormal biomechanics/gait pattern 2) RA
Description of Faber Test (Patrick's Test)
Iliopsoas, SI or hip joint abnormalities: pt in supine with test leg flexed, ABD, and ER onto opposite leg. PT slowly lowers test leg to table. Positive if cannot fall below opposite leg.
Hip flexors (4)
Iliopsoas, sartorius, rectus femoris, pectineus
Ambulation guidelines for cemented TKA post-op
Immediately WBAT with walker, cane 3 weeks post-op, FWB week 4
Ambulation guidelines for cementless WBAT TKA post-op
Immediately post-op WBAT with walker, cane 5-6 week post-op, FWB week 6
Other Conditions Affecting the Spine: Visceral Tumors 1) Esophageal CA signs 2) Pancreatic CA signs
1) pain radiating to back, pain with swallowing, dysphagia, and wt loss 2) deep, gnawing pain that may radiate form chest to back
Myositis Ossificans 1) Description 2) Usually precipitated by ______ that results in ______ and ______ of the muscle 3) May also occur from? 4) Three most common locations 5) Instance for surgery 6) avoid this during treat
1) painful condition with abnormal calcification within muscle body 2) direct trauma; hematoma and calcification 3) aggressive PT following injury (mobilization/stretching 4) Quds, biceps, brachialis 5) in nonhereditary cases where maturation of lesion has occurred (6-24 months), or if lesion impedes movement or pinched nerves 6) aggressive: flexibility exercise, stretching, massage/soft tissue work
Patella Alta 1) Description 2) Positive Camel Back Sign
1) patella tracks superiorly 2) two bumps over anterior knee instead of one. Patella rides high in condyle (superior hump) and tibial tuberosity looks like second hump
Lifespan of THA
15-20 years
High incidence of Bell's Palsy is found in what age range?
15-45
Special Tests for Thoracic Outlet Syndrome (5)
Adson maneuver, Allen test, Costoclavicular syndrome test, Roos test, Wright test
Special Tests for wrist/hand vascular insufficiency (2)
Allen test, capillary refill test
What are zygapophyseal joints?
Also called a facet joint. Joints formed by right and left articular facets of superior vertebrae on an inferior vertebrae's left and right articular facets
Degenerative pathologies that can cause irreversible dementia (3)
Alzheimer's, Huntington's, MS
A heel wedge in a prosthesis that is too short will have what affect on gait after heel strike.
An extension moment is created at the ankle and leads to delayed and limited knee flexion after heel strike.
Left Hemisphere specialization/dominance
Analytical, controlled, logical, rational, Mathematical calculations, Language, Express positive emotions (love & happiness)
What ligament allows the radius to rotate and adhere to the ulna?
Annular ligament
Describe Ipsilateral Anterior Rotation Test
Assess for anterior movement of ilium compared to sacrum. Pt in standing PT one thumb on PSIS other center of sacrum level with other thumb. Have pt extend hip. Positive if PSIS does not move superiorly (anteriorly) with sacrum.
Describe Gillet's Test
Assess for posteriorly movement of ilium compared to sacrum. Pt standing PT places one thumb on testing LE PSIS and other equal with other thumb center of sacrum. Have pt flex hip and knee as if bringing knee to chest. PSIS should move inferiorly. Positive if no movement of PSIS compared to sacrum.
Degeneration of axons and myelin with distal to proximal progression "dying back" of nerves
Axonal Degeneration
Examples of UMN Dz (10)
CP, hydrocephalus, ALS (both), CVA, birth injuries, MS, Huntington's, TBI, pseudobulbar palsy, brain tumors
Immediately post-op ACL or PCL reconstruction use a ______ set at 0-70 deg
CPM
Velocity is calculated by?
Cadence X step length
Talar-Tilt Test tests which ligament?
Calcaneofibular Ligament
Description of Phalen's Sign
Carpal Tunnel secondary to Median nerve compression: pt sitting/standing. PT flexes pt's wrists maximally and asks pt to hold position for 1min. Positive if tingling in thumb/index/middle/lateral half of ring finger.
Description of Tinel's Sign
Carpal Tunnel: pt sitting/standing. PT taps volar aspect of pt's wrist. Positive if tingling over thumb, index finger, middle, or lateral half of middle fingers.
Typical Basal Ganglia damage symptoms and dx (6)
Cause symptoms of ability to control speech, movement, and posture. Dx include: Athetosis, chorea, hemiballismus, hyperkinesia, rigidity, and braykinesia.
Cementles vs cemented fixation for THA
Cementless/hybrid fixation: relies on bone growth. Partial or non-weight bearing. Typically used on developing bone (youth). Cemented fixation: WB as tolerated allowable immediately after procedure.
Characteristics of Central vs Peripheral Nystagmus: Length of Sx
Central: May be chronic Peripheral: Minutes, days, weeks, but finite periodof time; recurrent
Characteristics of Central vs Peripheral Nystagmus: Vertigo
Central: Mild Peripheral: Significant
Characteristics of Central vs Peripheral Nystagmus: Etiology
Central: demyelination of nerves, vascular lesion, CA/tumor Peripheral: Meniere's, vascular disorders, trauma, toxicity, inner ear infection
Capsular Pattern proximal/distal radioulnar joint
supination, pronation
Otoliths measure?
the effects of gravity and movement with regard to acceleration/decceleration
Consider ______ thrusts to attain desired cervical spine result.
thoracic
Description and use of Taylor Brace
thoracolumbosacral orthosis limits trunk flexion/extension
Symptoms of UMN dz (5)
weakness of involved muscles, hypertonicity, hyperreflexia, mild disuse atrophy, abnormal reflexes
Describe Vestibulo-ocular reflex
This reflex supports gaze stabilization through eye movement that counters movements of the head.
Description of Allen Test
Thoracic Outlet Syndrome (Radial/Ulnar Artery Occlusion): pt sitting/standing. test arm ABD, ER, and elbow flexed 90. PT monitors radial and/or pulse and pt rotates head away from test arm. Positive if absent/diminished pulse
Description of Costoclavicular Syndrome Test
Thoracic Outlet Syndrome caused by compression of subclavian artery between 1st rib and clavicle: pt sitting. PT monitors radial pulse and assists pt into military posture. Positive if absent/diminished pulse
Special Tests for neurological dysfunction at the elbow
Tinels Sign
UMN vs LMN: Muscle Bulk
UMN: variable, disuse atrophy LMN: Neurogenic Atrophy: rapid, focal, severe wasting
Misc. Shoulder tests (2)
Upper limb tension tests, glenoid labrum tear test
Sensory only CN affecting equillibrium
Vestibulocochlear
Causes of Foot Slap (2)
Weak or paralyzed DF
Sign and Sx of Achilles Tendonitis
aching/burning posterior heel, tenderness, pain with activity, swelling/thickening of area, weakness secondary to pain, morning stiffness
Define aphasia
acquired neurological impairment of precessing for receptive and/or expressive language
Possible locations of Upper Motor Neuron Dz (4)
cerebral motor cortex, internal capsule, brainstem or spinal cord
Most common complaint in MS pts
fatigue; worse increased activity and later in day
Contraindications to spinal tracton
joint ankylosis, bone malignancy, dz affecting ligamentous integrity (RA/Down's), arterial insufficiency, active inflammation/infection
Example antiepileptic meds
klonopin, dilantin
Gamekeeper's Thumb leads to ______ instability
medial
If a pt has a seizure does that indicate epilepsy?
no
If someone is having a seizure is there possibility to swallow tongue?
no
Description of X-rays (plain films) and uses
noninvasive radiographic test used for identifying and screening lung/heart dz, bone growth, fractures, dislocations, foreign objects
Observational Findings of: Atraumatic instability
normal bone/tissue outlines
If conservative treatment fails for congenital hip dysplagia then?
open reduction with hip spica cast. After cast removal PT
Spinal Movement Couplets: When occiput (C1) side bends, rotation occurs in same/opposite direction?
opposite
Signs and sx of MCL Sprain
pain, swelling, antalgic gait, decreased RoM, instability.
How to screen temperature
perceive warm and cold objects
How to screen Barognosis
perceive weight of different objects in hand
Wernicke's Aphasia is characterized by damage to what structure?
posterior region of superior temporal gyrus
Most common cause of neurapraxia
pressure injuries
Characteristics of strength with myopathies
proximal weakness of extremities
Vertebrobasilar artery strokes may lead to what palsy?
pseudobulbar
Strengthening the lumbricals with a pt with low-metatarsal arch using what?
resisted flexion of metatarsals.
Active Movement Findings: Frozen Shoulder
restricted RoM, shoulder hiking
Functional Scoliosis description
result of abnormal in body that directly impact spine (leg length discrepancy, poor posture, mm imbalance). Referred to as nonstructural scoliosis because it can be corrected with lateral bending
PT focuses on what with Alzheimer's pts?
retaining remaining function
Spino-olivary Tract is responsible for? (2)
sensory from cutaneous (skin) and proprioceptive organs (golgi tendons, mm spindles, etc.)
Anosognosia
severe denial, neglect or lack of awareness of severity of condition
Surgery may be needed for talipes equinovarus if?
severe or failed to properly position foot early on
Describe T1 MRI image
shows fat within tissues and is typically used for viewing bony structures (tissues with little water content)
Describe T2 MRI image
shows tissues with higher water content; muscle tissues, organs, etc
Recovery Stages of Diffuse Axonal Injury: Unresponsive/Vegetative
sleep-wake cycle returns with normalized vegetative function (RR, digestion, BP)
Description and use of Scott-Craig KAFO
specific for paraplegia. allows standing with posterior leaning
Purpose of a myelography
spin tap used to rule out abnormalities of subarachnoid space, spinal nerve injury, herniated disc, fractures, back/leg pathos, and spinal tumors
Purpose of a Nerve Conduction Velocity and used to rule out
stimulates peripheral nerve to test action potentials and ability to send signals; peripheral neuropathy, carpal tunnel, demyelination pathology, peripheral nerve compression
Shoulder IR mm (5)
subscap, teres major, pec major, lats, ant delt
Definition: Contusion
sudden blow to body that can cause mild-severe damage to deep and superficial structures
Definition of Tics and example
sudden, brief, repetitive coordinated movements occurring at irregular intervals; Tourettes
Mandible retrusion mm (3)
temporalis, masseter, digastric
Brudzinski's Sign 1) Test Position 2) Positive Sign; may indicate
1) supine, flex neck to chest 2) causes flexion of hips and knees (drawing up); meningeal irritation
Ape Hand Deformity 1) Characterisitcs 2) Result of?
1) thenar muscle wasting with dorsal alignment of 1st digit with second 2) Median nerve dysfunction
test for nystagmus?
Dix-Hallpike maneuver
Description of Posterior Drawer Test (knee)
PCL Injury: pt is supine knees flexed to 90 and hips flexed to 45. PT stabilizes legs by sitting on forefoot and grasps proximal tibia while palpating tibial plateau with thumbs. Posterior force applied. Positive if excessive displacement of tibia over femur with diminished or absent end feel.
Description of Ober's Test
TFL contracture: pt is sidelying with lower legged flexed at hip and knee. PT moves upper leg into hip extension and ABD attempts to slowly lower. Positive if inability to ADD/touch table
Hip IR mm (5)
TFL, glute med and min
Common mechanism of injury of sciatic nerve
THA, Blunt force trauma to the buttocks, Accidental injection into the nerve
Common mechanism of injury of obturator nerve
THA, Fixation of a femur fracture
Common mechanism of femoral nerve injury
THA, displace acetabular fracture, anterior dislocation of the femur, hysterectomy, appendectomy
Common etiology of femoral nerve injury (5)
THA, displaced acetabular fracture, anterior dislocated femur, hysterectomy, appendectomy
Most common surgery for advanced arthritis of the knee?
TKA
Best test to identify ligamentous instability of Calcaneofibular Ligament
Talar Tilt
Subtalar joint made up of which bones (2)?
Talus and calcaneus
Common mechanism of injury of tibial nerve
Tarsal Tunnel entrapment, or popliteal fossa compression
RoM of hip IR
0-45
RoM of thoracolumbar rotation
0-45
RoM Reqs. for Normal Gait: Knee Flexion
0-60
RoM of wrist extension
0-70
RoM of forearm pronation
0-80
RoM of forearm supination
0-80
Initial treatment of meniscal tear
RICE NSAIDs
Initial Treatment for Achilles Tendonitis (3)
RICE, NSAIDs, analgesics
Initial treatment of ACL sprain?
RICE, NSAIDs, analgesics.
Treatment option for plantar fasciiatis
RICE, NSAIDs, heel cup, massage, medial arch taping, joint mobs.
Most likely reason for a platform for a pt using bilateral axillary crutches is?
Radial nerve injury
Contraindications for MRI
metal implants, pacemakers
Ascending Tracts are sensory or motor?
sensory; afferent
Dorsal roots are sensory or motor?
sensory; afferent
Mobilization for non-irritated neural tissue
(Maitland) Grade III; engage barrier , but not painful
Tendonosis/tendonopathy vs tendonitis
Both are degenerative to tendon, however, only tendonitis is inflamamtory
Protraction of the scapulae (2)
serratus anterior, pec minor
Nonunion Fracture description
break in bone that has failed to unite and heal after 9-12 months
Closed Fracture description
break in bone where skin remains in tact
Definition of Nodes of Ranvier
brief gaps in myelination of axon to speed velocity by jumping node to node
Convex or Concave?: Subtalar movements (navicular and cuneiform)
concave
Convex or Concave?: Talofibular movements of fibula
concave
Hyperventilation could be caused by damage to the lower ______ and ______
midbrain and pons
Signs and sx of PCL sprain
pt reports feeling of femur sliding off tibia. May be asymptomatic
When examining sensation these can be tested superficially
temperature, light touch, pain
Initial LMN signs of ALS (4)
asymmetric muscle weakness, fasciculations, cramping, and atrophy within hands.
Localized Lesion to Cortex: Temporal Lobe: Primary Auditory Cortex 1) Function 2) Sx
1) Hearing 2) Contralateral subtle decrease in hearing and ability to localize sounds
Possible locations of Lower Motor Neuron Dz (2)
at or below level of brainstem, ventral gray column of spinal cord
Definition of causalgia
constant, relentless, burning hyperesthesia and hyperalgesia that develops after peripheral nerve injury
Lesions to the cortex produce ipsilateral or contralateral sx?
contralateral
Treatment of Patellofemoral Syndrome
contributing factors; treat sx
Convex or Concave?: Clavicle during sternoclavicular elevation/depression
convex
Peak Muscle Activity During Gait Cycle: Quads (2)
1.) single limb support during early stance and, 2.) initiating swing just before toe off
Localized Lesion to Cortex: Temporal Lobe: Parahippocampal Region 1) Function 2) Sx
1) Recent memory 2) cannot form new memories
Testing Combined (Cortical) Sensations 1) Stereognosis 2) Tactile Localization 3) Two-Point Discrimination 4) Barognosis 5) Graphesthesia 6) B Simultaneous Stimulation
1) Testing of ability to identify objects by placed in hand by manipulation/touch 2) Testing of ability to identify location of touch sensation by verbally or physically identifying location 3) Testing of ability to identify one or two blunt points stimulating skin simultaneously; Identify minimal distance in mm pt can identify 4) Testing of ability to identify similar size/shaped objects by weight 5) Testing of ability to identify numbers/letters traced on skin (hand) 6) Testing of ability to identify simultaneous touch on two separate segments of the body
Pigeon-Toed 1) common in children who ___ sit
1) W 2) metatarsus ADD, internal tibial torsion, increased femoral anteversion
X-rays typically used to view?
bony anatomy (dysfunction and/or dz
Which is a two-joint muscle: gastroc or soleus?
gastroc
What part of gait doesn't exist during running?
Double limb support
Ankle everters (3)
peroneus longus, brevis, and tertius
Swing phase is what % of gait?
40%
At risk groups for adhesive capsulitis (shoulder) (3)
40-60 years old Women DM
Oligoarticular Juvenile Rheumatoid Arthritis
40-60% of cases. Affects less than 5 joints asmmetrically
Which ribs attach to costal cartilage of other ribs?
8-10
Up to ___% of back pain in undiagnosed
85%
Define Somatagnosia
A lack of awareness of the relationship of one's own body parts or body parts of others.
Higher extent of aphasia seen in insidious or acute onset?
Acute
Passive Movement Findings: Frozen Shoulder
Capsular Pattern
Contraindicated Medication for Avascular Necrosis and why?
Corticosteroids; may be a causative factor.
Special Tests for elbow epicondylitis (4)
Cozens test, lateral and medial epicondylitis test, Mills test
Misc. Hip tests (4)
Craigs test, Patricks test (FABER), quadrant scouring test, Trendelenburg test
Functional Gait Tests List (5)
DGI, FGA, TUG, Gait Velocity, 5xSit-to-Stand
Three Categories of TMJ Conditions
DJD (OA or RA), myofascial pain, internal derangement
Peak Muscle Activity During Gait Cycle: Hamstrings
Decelerating unsupported limb during late swing phase
Special Tests for Rotator Cuff Pathos/Impingement (4)
Drop arm, Hawkins, Neer's, Supraspinatus Test
When does a thrombotic CVA typically occur?
During sleep or upon awakening after an MI or post-surgery
4 Ds of Brainstem Dysfunction
Dysphagia, Dysarthria, Diplopia, Dysmetria
Characteristics of Peripheral vertigo
Episodic/ short duration. Pallor, sweating. Nausea and vomiting. Tinnitus.
Rocker bottom shoe used for
Hallux rigidus; arthritic spurring of 1st MTP
Description of 90-90 SLR
Hamstring Tightness: pt in supine with hips flexed to 90 and knees relaxed. Pt asked to extend one knee at a time. Positive if knee remains flexed 20+.
Description of Tripod Sign
Hamstring tightness: pt in sitting with legs hanging off bed in 90 position. PT passively extends one knee. Positive if felt tightness or trunk extension to compensate
Bell's Palsy may arise secondary to what two conditions?
Herpes and viral infection
Passive Movement Findings: Atraumatic Instability
Normal or excessive
Description of Upper Limb Tension Test for Median, Musculocutaneous, and Axillary Nerves
Sequence: depress shoulder with ABD 10, elbow extended, forearm supination, wrist extension, finger and thumb extension, shoulder ER. Provoke with contralateral cervical lateral flexion
Definition of anesthesia
absence of touch sensation
Description of Upper Limb Tension Test for Median and Anterior Interosseous Nerves
Sequence: shoulder depressed with shoulder ABD 110, elbow extension, forearm supination, wrist extension, finger and thumb extension. Provoke with contralateral cervical lateral flexion
Description of Upper Limb Tension Test for Ulnar Nerve
Sequence: shoulder depression and ABD 10-90, elbow flexion, forearm supination, wrist extension and radial deviation, finger and thumb extension, shoulder ER. Provoke with contralateral cervical lateral flexion
Signs and Sx Possible Peripheral Nerve Involvement: Spinal Accessory Nerve
Inability to ABD arm passed 90; Pain with ABD
Signs and Sx Possible Peripheral Nerve Involvement: Axillary Nerve
Inability to ABD with neutral rotation
Define Ideomotor Apraxia
Inability to imitate a learned motor task or behavior
Define Dysmetria
Inability to judge distances. Seen esp in cerebellar dysfunction
Definition of Intention Tremors and may indicate and example
absent at rest, but observed with activity and typically increase when approaching targeted object; may indicate lesion of cerebellum or it's efferent pathways; MS
Juvenile Rheumatoid Arthritis descitption
Inflammation of joints and connective tissue.
Muscle Strains 1) Description
Inflammation within a muscle due to trauma causing microtears; found in any muscle
Define Reciprocal Inhibition
Inhibition of muscles antagonistic to those being facilitated. Essential for coordinated movement.
Rancho Los Amigos Gait Terminology
Initial Contact, Loading response, midstance, terminal stance, pre-swing, initial swing, midswing, terminal swing
History of: Frozen shoulder onset of sx, age of onset, RoM
Insidious/post trauma/post surgery, age of onset 45+, capsular pattern (ER, ABD, IR)
Describe Reverse Lachman test
Integrity of PCL (knee). Pt in prone testing LE knee flex 30. Stabilize femur and passively glide tibia posteriorly on femur. Positive if lax
tremors absent at rest, but observable with activity and typically increase as the target approaches. Indicate a lesion of the cerebellum or its efferent pathways and also seen with multiple sclerosis
Intention Tremors
Raimiste's Phenomenon
Involved LE ABD/ADD when uninvolved LE ABD/ADD
Cerebellar Lesions tend to produce ipsilateral or contralateral sx?
Ipsilateral
Description of Lateral Epicondylitis
Irritation/inflammation of origin of extensor muscles on lateral epicondyle of humerus.
Originator of PNF
Kabat
Description of Cozen's Test
Lateral epicondylitis of elbow: pt sitting with slight elbow flexion. PT places thumb on lateral epicondyle while stabilizing elbow. pt makes fist, pronates, radially deviates, and extends wrist against resistance. Positive if pain of lateral epicondyle or noted weakness.
Typical point of tenderness in pts with iliotibial band syndrome
Lateral femoral condyle
Depressors of the mandible (3)
Lateral pterygoid, suprahyoid, infrahyoid
Why is decrease in dopamine problematic?
Leads to defects in movement modulation
Temporal lobe impairments: Type of aphasia? Other sx?
Learning deficits, Wernicke's aphasia (receptive), antisocial aggressive behaviors, difficulty with facial recognition, difficulty with memory, inability to categorize objects
Description of True Leg Length Difference Test
Leg Length Discrepancy: pt in supine with hips and knees extended, legs 15-20 cms apart, and pelvis in balance with legs. PT measures from ASIS to medial malleoli. Positive if there is a 1+cm difference between sides.
Passive Movement Findings: Cervical Spondylitis
Limited RoM; may exacerbate sx
Resisted Isometrics Findings: Frozen Shoulder
Normal, when arm at side
Possible consequence of Basilar Artery Syndrome
Locked-In
Description of Congenital Limb Deficiencies Classification? (2)
Longitudinal: absence of substance in long bones, or Transverse: limb develops passed skeletal development
Define Ideational Apraxia
Loss of ability to carry out familiar purposeful movements in the absence of motor/sensory impairment; especially inability to use objects correctly
Description of Adhesive Capsulitis (shoulder)
Loss of active and passive shoulder joint motion due to soft tissue contracture caused by adhesive fibrosis and scarring between capsule, rotator cuff, subacromial bursa, and delt
Characteristics of central vertigo
Loss of consciousness can occur. Presents with neurological symptoms like ataxia, dysarthria, numbness, hemanopsia, diplopia, weakness
Special Tests for Biceps tendonopathy (3)
Ludington's, Speed's, Yergason's
Higher incidence of men or women for ALS and at what age range?
Men; 40-70
Flexing chin to chest causes pain with limitation and guarding due to posterior cervical muscle spasm in supine could indicate? (3)
Meningeal inflammation, arthritis, or neck injury
Etiology of central vertigo
Meningitis. Migraine headache. Trauma/tumor. Cerebellar degeneration (i.e. alcoholism). Multiple sclerosis.
THA Posterolateral approach precautions
Most common method, however has highest dislocation rate; flexion passed 90, ADD, IR
What are the expected impairments of a Middle Cerebral Artery (MCA) dysfunction?
Most common site of a CVA; Wernicke's aphasia if in dominant hemisphere; Homonymous Hemianopsia; Apraxia; Contralateral weakness and sensory loss of face and UE's with lesser involvement of LE'S; Impaired spatial relations
Brown-Sequard's Syndrome: ipsilateral and contralateral sx
Most commonly from stab or bullet wound leading to hemisection of the spinal cord. Ipsilateral paralysis, loss of vibration and position sense from damage to corticospinal and dorsal columns. Contralateral: Loss of pain and temperature on opposite side (lateral spinothalamic tract)
Where does the Middle Cerebral artery (MCA) supply blood?
Most of outer cerebrum; Basal ganglia; Internal capsule; Lentiform nucleus
Anterior Horn of the spinal cord carries ______ information away from CNS
Motor (efferent)
Dysarthria description and treatment
Motor speech disorder from UMN. Treatment focuses on intelligibility of speech by strengthening aspects of speech production using PHONETICS.
Descending tract are sensory or motor?
Motor; efferent
Most common form of TMJ dysfunction
Myofascial pain
Which intervention has the strongest evidence in use for Knee Ligament Sprain
NWB open-chain and WB closed-chain exercises
Description of Upper Limb Tension Test (in general)
Neural provocation test. Test non-involved side first. Any change is documented for each specific step. ULTT recommended for pts with arm, head, neck, or thoracic spine sx.
What is the most severe grade of injury to a peripheral nerve?
Neurotmesis
Modified Ashworth Scale Grade 0
No increased tone
Neurotmesis recovery
No spontaneous recovery; with surgical reattachment, potential regenerating axons may grow at one millimeter per day with proximal recovery first. Sensory recovery occurs sooner than motor fibers. ex:Complete transection of the nerve trunk
Is surgery typical for MCL damage?
No, it's highly vascularized
Define Broca's Aphasia. Treatment includes? Avoid what? And allow for?
Non-fluent/Expressive Aphasia: speech is awkward, restricted, interrupted, produced with effort; due to lesion of 3rd frontal convolution of L hemisphere. compensatory strategies using a task-oriented approach. Avoid activities requiring substantial verbal output from pt. Allow for ample time for pt to respond verbally.
What is more stressful on the bones: cemented or non-cemented techniques for joint replacement
Noncemented
Palpation Findings: Atraumatic Instability
None
Palpation Findings: Frozen Shoulder
None; unless capsule on stretch
OA vs RA 1) Affected tissue 2) Primary Joints affected 3) Characteristics of sx
OA 1) changes in joint cartilage leading to erosion of subchondral bone 2) Fingers, C/L-spine, hips knees, and toes 3) Joints not affected equally RA 1) primarily synovium then leads to joint cartilage degenration 2) All joints can be affected 3) Morning stiffness, fever, loss of appetite. Bilateral symmetrical joint involvement
Contraindicated thereex for post CVA pt with poor shoulder alignment and decreased function
OH pulleys
What do lateral epicondyle fractures typically require to ensure alignment?
ORIF
CN I 1) Function 2) Test 3) Possible Abnormal Findings
Olfactory 1) Smell 2) Common smells for each nostril 3) Anosmia
PT should occur when, when a pt is taking dopamine replacement meds?
One hour after
Treatment for congenital hip dysplagia for 2+ year olds?
Open reduction under anesthesia--> spica cast 6-12 weeks
CN II 1) Function 2) Test 3) Possible Abnormal Findings
Optic 1) Sight 2) Test Visual Acuity 3) Blindness, myopia, presbyopia, homonymous hemianopsia
Pt with recurrent lateral ankle sprains and a supinated gait, what condition would MOST likely be associated
Peroneal Tenosynovitis: Peroneus Longus/Brevis tendon behind lateral malleolus and see most stress during supinated gait
Most Vascularized portion of medial meniscus
Outer 1/3
Which of these is an atypical presentation of pt s/p R CVA: poor judgement, impulsive, quick, overly cautious
Overly cautious; question like this the other 3 options go hand-in-hand so can deduct the answer
Physical therapy management for Juvenile Rheumatoid Arthritis
P/ARoM, positioning, splinting, strengthening, endurance, WB, posture, mobility.
Description of Posterior Sag Sign
PCL Injury: pt in supine knee flexed to 90 and hip flexed to 45. Positive if tibia sags back on femur.
Treatment for Juvenile Rheumatoid Arthritis
Pharma: corticosteroids, pain killers, anti-inflammatories, antirheumatics, immunosuppresive agents.
Most appropriate communication for Expressive Aphasia
Phrase questions for simple "yes" or "no" responses to avoid confusion & frustration. (Broca's)
Description of Piriformis Test
Piriformis tightness or compression on sciatic nerve: pt sidelying with test leg on top and hip flexed 60. PT places one hand on pt's pelvis and other knee. Stabilize pelvis and ADD knee. Positive if pain/tightness
Description of Hughston's Plica Test
Plica in knee: pt in supine. PT flexes knee and IR tibia with one hand and other attempts to move patella medially while palpating medial femoral condyle. Positive if popping sound over medial plica while knee is passively flexed/extended
Where does the Posterior Cerebral Artery (PCA) supply blood?
Portion of midbrain; Subthalamic nucleus; Basal nucleus; Thalamus; Inferior temporal lobe; Occipitoparietal cortices
Description of McMurray Test
Posterior Meniscal Lesion: pt in supine. PT grasps distal leg with one hand and palpates knee joint line with other. With knee fully flexed PT IR and fully extends knee. Repeat with ER. Positive if click or pronounced crepitation felt over joint line
Final Phase of rehab post TKA (4)
Pre-op ADLs functioning, functional endurance/endurance/proprioceptive
Dx Imaging Findings: Cervical Spondylitis
Radiography: narrowing osteophytes
Dx Imaging Findings: Frozen Shoulder
Radiography: negative: Arthrography: decreased capsule size
Dx Imaging Findings: Rotator Cuff Lesion A radiography will show? Imaging used to dx a RTC lesion
Radiography: upward displacement of humeral head; acromial spurring. MRI: dx RTC
This test examines Cognitive Function
Ranchos Los Amigos Levels of Cognitive Functioning
Progression (?) of initial sx of ____ during an embolic CVA
Rapidly with headache
Posterior Cord Syndrome
Rare incomplete lesion from compression of posterior spinal artery; loss of stereognosis, proprioception, and two-point discrimination below lesion. Motor intact.
Wernicke's Aphasia aka? Broca's?
Receptive; expressive
Description of Ely's Test
Rectus Femoris Contracture: pt in prone. PT passively flexes pt knee. Positive if spontaneous hip flexion during knee flexion
Dorsal root ganglia carry _____ information to the CNS
Sensory (afferent)
Describe symptoms of Neuromuscular junction pathology and example
Sensory component intact Motor fatigue is greater than actual weakness Normal DTR's Ex: Myasthenia gravis
Etiology of Achilles Tendonitis
Repetitive overload.
General Function of Cerebellum
Responsible for fine tuning of movement. Assists with maintain posture and balance. Regulates muscle tone, Controls rapid alternating movements.
Description of Neer Impingement test
Shoulder impingement of supraspinatus: pt sitting/standing. PT places one hand on scapulae and other stabilizing elbow. PT elevates pt's arm into flexion. Positive if painful
Description of Hawkins test
Shoulder impingement of supraspinatus: pt sitting/stanidng. PT flexes pt's arm to 90/90 and IR. Positive if painful
Effects of true leg length discrepancy of the right leg on: Lumbar spine
Side bent right and rotated left
Typical dopamine replacement drug
Sinemet
Characteristics of A Fiber peripheral nerves Size: Myelination: Conduction Rate:
Size: Large Myelination: Myelinated Conduction Rate: High Other: involved with all sensory
Characteristics of B fiber peripheral nerves Size: Myelination: Conduction Rate: Other:
Size: Medium Myelination: myelinated Conduction Rate: medium Other: contain pre-ganglionic fibers of ANS
Characteristics of C-Fiber peripheral sensory nerves Size: Myelination: Conduction Rate: Other:
Size: Small Myelination: poor/no myelination Conduction Rate: slow Other: involved with pain, temperature, and touch
Rule of 3's for Thoracic Spine
Spinous processes of T1-T3: even with same level Spinous Processes of T4-T6: .5 level below transversse process of same vertebrae Spinous Processes of T7-T9: one full level below transverse processes of same level Spinous Process of T10: one full level below Spinous Process of T11: .5 level below Spinous Process of T12: level
Description of Ulnar Collateral Ligament Instability Test
Tear of Ulnar Collateral Ligament and Accessory Collateral Ligaments (Gamekeeper's/Skier's thumb): pt sitting. PT holds thumb in extension and applies valgus force. Positive if excessive valgus movement.
6 Stages of Recovery from CVA
Stage 1: Flaccid; no voluntary movement Stage 2: emergence of spasticity, hyperreflexia, synergies Stage 3: voluntary movement available within synergy; strong spasticity Stage 4: isolated joint voluntary movement; moving out of spasticity and synergies Stage 5: increasing voluntary control out of synergies; coordination deficits present Stage 6: control and coordination near normal
When can active exercise start post THA for cemented and cementless
Start between weeks 1-4 depends on surgeon
The belly compression test is a highly specific test for ______
Subscap lesion
Describe Belly Compression Test
Subscap lesion. Pt sitting or standing. PT places hand on abdomen for eval of pressure during test. Pt instructed to place testing side hand on PT hand and apply pressure into belly while pushing elbow into scapular plane (increasing IR). Test is positive if pt looses pressure in PT hand when pushing elbow out
The Bear Hug test is highly specific for ______
Subscap tear
Describe the Bear Hug Test
Subscap tear. pt sitting or standing with hand placed across body on opposite shoulder. PT applies ER force while pt resists. Positive if cannot hold hand on shoulder.
Ballism is typically secondary to damage to what structure?
Subthalamic nucleus
Common areas of compression in TOS
Superior thoracic outlet, scalene triangle, between clavicle and 1st rib, between pec minor and thoracic wall
Least to most pressure on Lumbar spine: standing in anatomical position, standing with 45 degree hip flexion, sitting in chair slouched forward, sitting in chair with reduced lordotic curve in lumbar, sidelying, and lying in supine
Supine, sidelying, standing in anatomical position, standing with 45 degrees hip flexion, sitting in chair with reduced lordotic curve, sitting slouched
Description of Supraspinatus (empty can) Test
Tear or impingement of supraspinatus or suprascapular nerve involvement: pt arm ABD 90 and horizontally ADD 30 with thumb down. PT resists pt's ABD. Positive is weak or pain
Treatment for Congenital Limb Deficiencies
Symmetrical movements, strengthening, RoM, WB, prosthetics if needed
T/F: Wallerian degeneration may occur in axonotmesis injury?
T
T/F: word output and speech production in fluent aphasia are funtional
T
Paraplegia occurs due to SCI to which spinal segments
T1-L1
The lumbar plexus arises through which vertebrae?
T12-L4 Nerve Roots
Infectious pathologies that can cause irreversible dementia (2)
TB and AIDS
Coup-contracoup Injury
TBI injury to at point of impact and opposite of point of impact
Palpation Findings: Rotator Cuff Lesion
Tender over RTC
Palpation Findings: Cervical Spondylitis
Tender over affected vertebrae or facet
Description of Finkelstein Test
Tenosynovitis in the thumb (DeQuervain's dz): pt sitting/standing. Pt makes fist with thumb tucked. PT stabilizes forearm and ulnarly deviates fist. Positive if pain over ABD pollicis longus and extensor pollicis brevis at the wrist.
Description of Craig's Test
Tests Femoral Antevetsion: pt in prone with test knee flexed to 90. PT palpates posterior greater troch and medially and laterally rotates hip until greater troch is parallel to table. Normal degree of femoral anteversion for adult is 8-15 degrees.
Describe Vestibulo-spinal reflex
This reflex attempts to stabilize the body while the head is moving in order to manage upright posture.
Frontal lobe functions
This lobe is responsible for Intellect, orientation, voluntary movement, Broca's area, executive function.
Temporal lobe function (3)
This lobe is responsible for auditory processing, wernicke's area, and production of meaningful speech.
Parietal lobe receives sensory information associated with (3)
This lobe is responsible for receiving information associated with touch, kinesthesia, and vibration.
Occipital lobe function
This lobe is responsible for visual processing,judgment of distance, and vision in three dimensions.
Right Hemisphere specialization/dominance
This lobes specific responsibilities include: Nonverbal processing, artistic expression, comprehension of general concepts, spatial relationships, kinesthetic awareness, mathematical reasoning, and body image awareness
Contraindications for Joint Mobilizations? (8)
active dz, infection, advanced osteoporosis, articular hypermobility, fracture, acute inflammation, mm guarding, joint replacement
Etiology of Plantar Fasciitis. Most common age range
acute injury form excessive loading of foot, or chronic irritation from over pronation. 40-60 years old
Common Signs and Symptoms associated with vascular claudication
consistent pain no matter spinal position, exacerbated by physical exertion, prompt relief with rest, described as numbness, decreased/absent pulses
RoM guidelines for cemented and cementless TKA
Within 2 weeks: 0-90 deg flexion 3-4 weeks: 0-120 deg
Higher incidence of Alzheimer's in men or women?
Women
Most common gender and age range for Rheumatoid Arthritis
Women 3Xs more likely than men, 40-60 years old
Meniscal injuries diagnosed with what tools? (2)
arthroscopy and MRI
All cranial nerves are distributed to head and neck except CN ______ which goes to thorax and abdomen
X-Vagus
How to screen localization
ability to identify location of light touch by verbal response or gesturing
Definition of Kinesthesia
ability to perceive the direction and extent of movement of joint or body part
Describe motor control
ability to regulate or direct essential movement
Definition of neuroma
abnormal growth of nerve cells; associated conditions include AIDS, vasculitis, and amyloidosis
Visual Analogue Scale description
can be highly sensitive if measured accurately
Definition: Genu Valgum
knees touch while feet are apart. Increases compression on lateral tibial condyle and increases medial structures of the knee (MCL). AKA knocked knees
Mechanism of injury for PCL?
dashboard injury; tibia is struck with knee flexed
Conservative treatment for MCL sprain
decrease inflammation, protecting joint, RoM, strengthening
Spinal Cord C3-C5 (phrenic nerve) supplies?
diaphragm
Sensory Organization Test: Description
examines 6 different sensory conditions using a computerized balance platform and stop watch. Record time standing posture is maintained. Score 1 (min sway) -4 (fall)
Challenging and examining the somatosensory includes
examining pressure and vibration; observe pt changing surface they're standing on
Bouchard's Nodes
excessive bone formation on dorsum of PIP joints typically seen in RA
Hyperhidrosis
excessive sweating
Definition of double crush syndrome
existence of two separate lesions along the same nerve that create more severe symptoms than if only one lesion existed
Tennis elbow typically involves which extensor tendon?
extensor carpi radialis brevis
Signs and sx of Osteoarthritis 1) onset of pain? 2) Pain exacerbated by? 3) Other features
gradual onset of pain at joint, increases after exercise, increases with weather change, enlarged joints, crepitus, stiffness, decreased RoM, Heberden's/Bouchard's nodes
Bony landmark of supraspinatus insertion
greater tubercle of humerus
If surgery is performed for PCL reconstruction, then avoid ______ exercises for 6 weeks
hamstring
Most commonly involved joints with osteoarthritis?
hands and WB joints (hips and knees)
Testing Form Consistency of Objects
have pt pick out specific object among similar shapes, but different sizes
Examine vestibular input with movement of ?
head
Treatment for Osgood-Schlatter Disease
icing, flexibility, elimination of aggravating activities on patellar tendon-squatting, running, or jumping
How to screen kinesthesia
identify direction and extent of movement of joint/body part
How to screen proprioception
identify static position of extremity or body part
Myopia
impaired far vision
95% of all ligament sprains of the ankle are ______
lateral
Secondary risk factors for CVA? (5)
obesity, high cholesterol, behaviors related to hypertension (stress, high Na intake), physical inactivity, increased alcohol consumption
Definition of Postural Tremors and examples
observed during voluntary contraction to maintain a posture; rapid tremor associated with: hyperthyroidism, fatigue or anxiety, benign essential tremor
Definition of Gaze-evoked Nystagmus and is typically indicative of?
occurs when gaze moves from one object to another. Caused by pt inability to maintain stable gaze position. Typically indicative of CNS pathology and is associated with brain injury and MS.
Definition of Central Nystagmus
occurs with central lesion of brainstem/cerebellum and is not inhibited by visual fixation
Allodynia
pain with light touch
After a seizure do what to prevent what?
place pt on left side to prevent vomit choking them
Osgood-Schlatters dx using
plain film
Signs and sx of Osgood-Schlatter Disease
point tenderness over patellar tendon at insertion on tibial tubercle, antalgic gait, pain with increase in activity
Examples of LMN dz (11)
poliomyelitis, ALS (both), Guillain-Barre Syndrome, spinal cord tumors, trauma, progressive muscular atrophy, infection, Bell's Palsy, carpal tunnel syndrome, muscular dystrophy, spinal muscular atrophy
Avulsion Fracture description
portion of bone detaches with tendon
Positioning for Mechanical Traction for Stenosis of the Cervical Spine, HNP (efficacy under scrutiny), and whiplash
positioned at 15 deg. of flexion
Patellofemoral Syndrome etiology
repetitive overuse
History of: Cervical Spondylosis age of onset, onset of sx
50+, acute or chronic
The vertebral-basilar artery supplies what parts of the brain? (6)
-Pons -Cerebellum -Medulla -Midbrain -Thalamus -Occipital cortex
Characteristics of Central Vertigo
-autonomic symptoms less severe -possible LoC -neurological sx: diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria
Special Tests: Rotator Cuff Lesion
(+) Drop arm and Empty can tests
Function of Occipital Lobe
-primary visual center -judgment of distance -colors
Most PD pts are dx at what age range?
50-79
Normal distinguishable distance difference for two-point sensory testing.
6 mm
Patellofemoral Pain Syndrome 1) Common result of? 2) Type of taping during rehab 3) Type of strengthening not to use in rehab
1) Abnormal tracking causing stress 2) McConnell 3) Isolated quadriceps exercises quad sets
Localized Lesion to Cortex: Frontal Lobe: Supplementary Motor 1) Function 2) Sx
1) B Control of Posture 2) Loss of B control of posture
Rearfoot Varus 1) Structures in varus 2) Observed Deformity
1) Subtalar and Calcaneus in varus 2) rigid inversion of calcaneus when subtalar joint is in neutral
Plagiocephaly (congenital) 1) aka 2) lasting harmful effects?
1) flat head syndrome 2) no
Multilevel Vertebrae Fusion Require ___ weeks in a trunk immobility brace
6 weeks
Order of treatment for glenohumeral instability
1.) 3-6 weeks immobilization, RICE and NSAIDs. 2.) RoM, isometrics. 3.) progressive resistance exercise emphasizing rotators and large capsular muscles
Treatment sequence for Lateral Epicondylitis
1.) Initial: RICE NSAIDs, 2.) increase strength, flexibility and endurance. 3.) strap placed 2-3in. distal to elbow and relieve tension
Order of treatment for impingement syndrome
1.) Initial: RICE, NSAIDs, activity modifications. 2.) once tolerable: rotator cuff strengthening and scapular stability. 3.) cont. strengthening
Waddell's Signs (5)
1.) Widespread tenderness from light touch or extending to unrelated boundaries 2.) Pain with axial loading (pressing on pt's head) or simulated rotation (rotating pelvis and shoulders simultaneously) 3.) Pain with SLR in only supine vs sitting 4.) "Stocking" sensory loss or non-myotomal weakness 5.) Exaggerated response to pain 3/5= (+) Waddell's sign
The Autonomous stage: 1.) ______ response 2.) ______ errors no matter the environment 3.) _____ cognitive work for movement patterns 4.) Distraction impacts or does not impact activity? 5.) multi-tasking? 6.) amount of extrinsic feedback? 7.) amount of intrinsic feedback?
1.) automatic 2.) very little to none 3.) no 4.) does not impact 5.) able to 6.) very little if any 7.) dominant
The associative stage: 1.) _______ errors compared to cognitive stage 2.) _______ need for cognitive work compared to cognitive stage 3.) skills are ______ 4.) ________ coordination of movement 5.) large amounts of practice lead to movement _________
1.) decreased 2.) decreased 3.) refined 4.) increased 5.) refinement of motor programming
How many cervical vertebrae are there?
7
Stages of Parkinson's (5)
1: Min/absent disability, U sx 2: Min B or midline sx, no balance deficits 3: impaired balance, some activity restrictions 4: All sx present and severe; stands and walks with A 5: Bed/WC confined
Age an infant should be able to sit with arm support for extended periods of time
6-7 months
Muscle Grades: Poor
2/5 Completes RoM in gravity eliminated position
What % of ischemic strokes are caused by embolus? Hemorrhage? Thrombotic?
20%, 10-15%, 65-70%
___% of ALS pts may show sensory deficits
20%; due to other etiology
Lachman's Test is performed with pt knee in ____ degrees of flexion
20-30
Stance phase is what % of gait?
60%
Method of double-blind injection for identifying SIJ pathos
1st injection provocative, 2nd is analgesic. If typical pain sx reproduced with 1st shot, then decreased with 2nd--> pathos
Oxford Exercise 3 set pattern
1st set: 10 reps @ 100% of 10RM 2nd set: 10 reps @ 75% of 10RM 3rd set: 10 reps @ 50% of 10RM
DeLorme Exercise 3 set pattern
1st set: 10 reps @ 50% 10RM 2nd set: 10 reps @ 75% 10RM 3rd set: 10 reps @ 100% 10RM
With proper treatment Bell's Palsy may subside after ?
2 weeks
Muscle Grades: Poor Plus
2+/5 able to initiate movement against gravity
Muscle Grades: Poor Minus
2-/5 cannot complete range in gravity eliminated position
When do sx peak in Guillain-Barre Syndrome?
2-4 weeks
Sx of TIA typically resolve in how many hours?
24-48
Approximately what % of those who had polio will develop post-polio and how long after having polio?
25-50%; 25 years
Guidelines for THA are enforced for up to __ months typically
3
Muscle Grades: Fair Plus
3+/5 able to complete RoM with minimal resistance
UMN vs LMN: Disorder examples
UMN: stroke, TBI, SCI LMN: Polio, GBS, PNI, peripheral neuropathy, radiculopathy
Primary risk factors for CVA? (5)
hypertension, cardiac dz/arrhythmia, DM, smoking, TIA
AROM and PROM findings with RTC tear
AROM: ABD significantly limited PROM: normal
Ankylosing Spondylitis vs Spinal Stenosis: Special Tests
AP: None SS: Bicycle test and/or stoop test may be positive
Ankylosing Spondylitis vs Spinal Stenosis: Sensory Deficits
AP: None in early stages SS: Temporary
Ankylosing Spondylitis vs Spinal Stenosis: Reflexes
AP: Normal (in beginning) SS: May be affected after long period with dz
Ankylosing Spondylitis vs Spinal Stenosis: Diagnostic imaging
AP: Plain Films are dx SS: CT are dx
Ankylosing Spondylitis vs Spinal Stenosis: Posture
AP: flexed entirety of spine SS: flexed lumbar spine
Description of Anterior Drawer Test (ankle)
ATFL sprain: pt in supine. PT stabilizes distal tbia and fibula one hand and other hand holds foot in 20 PF and draws talus forward. Positive if excessive anterior displacement of talus away from ankle mortise
Two typical views of x-ray?
Anterior-Posterior (AP view) and lateral
Common cause of death in MS pts
UTI or respiratory infection
Mobilization rules: moving concave surface over a fixed convex surface scenario: increasing knee extension use ____ mobilization (the same direction of movement)
Anterior; since the direction of the concave movement on the convex surface is anterior, the mobilization must also be anterior or the same direction
Which of the following tests would be the least effective in assessing ACL ligament integrity? Lachman's test Anterior drawer test Slocum's test Lateral pivot shift test
Anterior Drawerthom
Motor nerves originate from?
Anterior Horn of spinal cord
Occlusion of anterior spinal artery supplies ____ and may lead to what sx?
Anterior Spinal Cord; contralateral hemiplegia, tongue deviation to affected side, dysphagia, and loss of gag reflex.
Special Tests for knee ligamentous instability (8)
Anterior and Posterior drawer, Lachman test, Lateral Pivot Shift test, Posterior sag sign, Slocum test, valgus and varus test
Shoulder flexors (4)
Anterior delt, coracobrachialis, pec major, biceps
Sensory Function and reflexes Findings: Atraumatic Instability
Anterior or posterior pain
Description of Lateral Pivot Shift Text
Anterolateral Rotary Instability: pt in supine with hip flexed and ABD 30 and slightly IR. PT grasps leg with one hand and other on lateral surface of proximal tibia. PT IR tibia and applies valgus force to knee while knee is slowly flexed. Positive if palpable shift or clunk occurring between 20-40 degrees of flexion.
Description of Slocum Test
Anterolateral/medial Instability: pt in supine knee flexed to 90 and hip flexed to 45. Testing anterolateral stability: PT rotates pt's foot 30 medially. PT stabilizes leg by sitting on forefoot. PT grasps proximal tibia while palpating tibial plateau with thumbs. Anterior force applied. Positive if primary movement of tibia is lateral. To test Anteromedial stability: rotate foot pt's foot 15 degrees laterally and repeat above.
Special Tests for meniscal pathos (3)
Apleys compression test, Bounce home test, McMurray test
Description of Quadrant Scouring Test (hip)
Arthritis, avascular necrosis, or osteochondral defect: pt in supine. PT flexes and ADD hip with knee in max flexion. PT applies compression through femur while 'scouring' leg. Positive if grinding, catching or crepitation in hip.
Gold Standard test for RTC tear? What may also be used, but with less sensitivity?
Arthrogram; MRI
Effects of true leg length discrepancy of the right leg on: Tibia
ER
Vestibular Disorders Activities of Daily Living Scale
assess self-perceived disablement in vestibular pts
Mixed CN involved with Facial Expression
Facial- CN VII
Description of Ludingtons Test
Bicep Rupture: Pt clasps fingers behind head and flexes biceps. Absent contraction indicates possible rupture of long head tendon
Description of Speeds Test and test for?
Bicep tendonitis: pt in sitting/standing with arm supinated and fully extended. PT palpates bicipital groove and other hand at top of wrist. PT resists pt's shoulder flexion. Positive test if pain or tenderness in bicipital groove region
Typical Mechanism of Injury for AC and SC joint disorders?
Fall onto shoulder with ADD UE or direct contact (sports injury)
The cervical plexus arises through which vertebrae?
C1-4 Nerve Roots
Tetraplegia occurs due to SCI to which spinal segmentes
C1-8
Describe how nerve roots exit between vertabrae
C1-C7 exit above respective vertebrae and C8-S5 exit below.
Diaphragm innervated by?
C3-5
Spinal levels most affected by SCI
C5, C7, T12, L1
The brachial plexus arises through which vertebrae?
C5-T1 Nerve Roots
RTC full thickness tear: typical sx
CLASSIC: night pain; ABD and ER weakness, loss of RoM
Misc. Knee tests (4)
Clarkes sign, Hughstons plica test, Noble compression test, Patellar apprehension test
Neurapraxia; recovery; example injury
Class 1 Nerve injury. transient loss of function; nerve regeneration rapid or persists few weeks (compression injury)
Mnemonic for levers: FLE 123
Class 1 lever: Force in the middle Class 2 Lever: Load in the middle Class 3 Lever: Effort in the middle
Neurotmesis; recovery; example injury
Class 3 nerve injury. complete loss of function from complete cut through. Surgery required for regeneration.
Axonotmesis; recovery; example injury
Class two nerve injury. interrupts axon and causes Wallerian degeneration distal to lesion. Recovery possible. Crush injury
Most common mechanism of injury of lumbar SCI
flexion injury
Convex or Concave rule: atlanto-occipital joint? Below second vertebrae?
Convex; Concave
Evidence for use of US for acute ankle sprains
Don't use
Suggested use of CPM machines for uncomplicated post-op TKA
Don't use them
Describe Goldthwait's Test
Differentiates between lumbar and SIJ dysfunction. Pt supine PT fingers between lumbar segments with one hadn and second hand passively SLR. If pain prior to palpation of segments with motion, then dysfunction is SIJ related.
Dysphagia description and treatment
Difficulty swallowing. Treatment includes positioning and compensatory strategies to avoid aspiration.
Objective findings indicating incomplete spinal cord injury
Diminished, not absent sensation/weakness/DTR, weakness in indicated myotome and DIMINISHED findings below level of lesion. Ex: C6 incomplete lesion may find DIMINISHED sensation in C8 dermatome, whereas, a complete lesion would have ABSENT sensation.
Description of Murphy Sign
Dislocated Lunate: pt sitting/standing. Pt makes fist. Positive if 3rd metacarpal remains even with 2nd and 4th
How does weakness progress in ALS?
Distal to proximal
Sensory nerves originate from?
Dorsal Root Ganglia
High grade evidence for treating mid-portion Achille's Tendonopathy
Eccentric loading exercises
Peak Muscle Activity During Gait Cycle: Tib Ant.
Eccentric lowering of foot just after heel strike
Special Tests for Hip contracture/tightness (6)
Elys test, Obers test, Piriformis test, Thomas test, Tripod sign, 90-90 SLR
Emphasize strengthening ___ and ___ for ACL sprains
Emphasize quad and hamstring strength.
THA Anterolateral approach precautions
flexion passed 90, extension, ER, ADD
Most common mechanism of injury of cervical SCI
flexion-rotation injury
Description of glenohumeral instability? Subluxation? Dislocation? ___% dislocations detach glenoid labrum?
Excessive translation of humeral head in glenoid during active motion. Subluxation is 50%+translation without dislocation. Dislocation: complete separation of articular structures from glenoid and humeral head. 85%
T/F: word output and speech production in non-fluent aphasia are funtional
F; poor word output and impaired rhythm and inflection
Humeral neck fractures typically from?
FWOSH (fall with outstretched hand)
Mixed CN involved with salivatory and lacrimal glads
Facial
Pros of Hamstring Grafts for ACL reconstruction (3)
Fewer sx post-op, greater return to pre-construction level, earlier rehab
Talocrural joint is made up of what bones (3)?
Fibula, tibia, and talus
Misc. wrist/hand tests (3)
Finkelstein test, grind test, Murphy sign
Type of strategy used to counter sudden moderate force leading to forward sway will activate what muscles
First abdominals, then quads
Tarsal Tunnel Sx
Flat foot gait.
Define Wernick'e Aphasia
Fluent/Receptive Aphasia; spontaneous speech is preserved, flows smoothly; auditory comprehension is impaired
Capsular pattern knee
flexion>extension
Maitland Description of Joint Oscillation Grades
Grade I: small oscillations beginning range; lubricate joint and decrease pain/mm guarding Grade II: large oscillations to mid-range; lubricate joint and decrease pain/mm guarding Grade III: large oscillations to mid-end range; stretch tight mm, capsules, and ligaments Grade IV: small oscillations at end-range; stretch tight mm, capsules, and ligaments Grade V: LAHVT regain normal joint mechanics and decrease pain/mm guarding
Ambulation guidelines for cementless TTWB TKA post-op
Immediately start post-op. WBAT with walker week 6. Can 8-10 weeks. FWB at week 10
Description of Noble Compression Test
IT Band Friction Syndrome: pt in supine with hips slightly flexed and knee flexed 90. PT places thumb of one hand over lateral epicondyle of femur and other around pt's ankle. PT maintains pressure over lateral epicondyle while pt slowly extend knee. Positive if pain over lateral epicondyle at approx. 30 knee flexion
These levels of Ranchos Los Amigos Levels of Cognitive Functioning represent mid-level recovery
IV-VI
Dz that presents with chorea?
Huntington's
Swan Neck Deformity
Hyperextension of proximal interphalngeal joint and flexion of distal interphalangeal joint
Contraindications to mechanical traction
Hypermobility, pregnancy, RA, Down's, any dz affecting ligamentous integrity
These levels of Ranchos Los Amigos Levels of Cognitive Functioning include sx of decreased response
I-III
Norms for male and female Q angles
Males: 13 degrees Females: 18 degrees
Central nystagmus
Is not inhibited by visual fixation on an object. Can be either bidirectional or unidirectional, symptoms may be chronic. Causes: demyelination of nerves, vascular lesion, cancer/tumor
Description of Patellar Tap Test
Joint Effusion: pt in supine with knee flex or extended to point of discomfort. PT slightly taps patella. Positive if patella appears to be floating
Typical primary goal for arthritic conditions?
Joint protection
Primary reason to use knee immobilizer for a postero-lateral THA.
Keep knee extended to reduce hip flex
Description of Lateral Epicondylitis Test
Lateral Epicondylitis: pt sitting. PT places one hand on elbow and other dorsum of hand distal to PIP. pt extends middle finger against resistance. Positive if pain of lateral epicondyle or noted weakness.
Shoulder ABD mm (2)
Lateral delt, supraspinatus
What are the expected impairments of a Vertebral-basilar artery dysfunction?
Loss of consciousness; hemiplegia or tetraplegia; locked in syndrome; vertigo; nystagmus; dysphagia; dysarthria; syncope; ataxia;
Typical Cerebellar damage symptoms (2) and 5 dx
Loss of motor control (force, extent, and timing of movement) and posture irregularities. Dx include: ataxia, dysarthria, dysdiadochokinesia, nystagmus, dymetria,
Signs and sx of congenital hip dysplagia (2)
assymetrical hip ABD with tightness apparent femoral shortening on involved side
Description of Valgus Stress Test for Elbow
MCL sprain: pt sitting with elbow flexed 20-30. PT places one hand on elbow and other proximal to wrist. Palpates joint line and applies valgus force. Positive if laxity compared to non-involved side, apprehension or pain.
Description of Valgus/Varus Stress Test (knee)
MCL/LCL instability: pt in supine knee flexed 20-30. for MCL (valgus): PT places one hand on medial ankle and other lateral knee applying valgus force. LCL (varus): PT places one hand lateral ankle and other medial aspect of knee and applies varus force. Positive if excessive movement. Positive valgus for MCL, PCL, POL, and posteromedial capsule pathos when test is doen with knee straight. Positive varus, when knee straight, pathos of LCL, PCL, arcuate complex, and posterolateral capsule.
Effective means of identifying labral tears? "Gold Standard" for identifying labral tears?
MRI Arthrograms; Arthroscopic shoulder surgery.
Traumatic Causes of SCI
MVA, jumps and falls, diving, gunshot
Mandible protrusion mm (3)
Masseter, lateral and medial pterygoid
Etiology of Adhesive Capsulitis (shoulder)
May be acute or insidious. Self-limiting typically resolves in 1-2 years.
Three widely used pain scales?
McGill Pain Questionnaire, Numerical Rating System, and Visual Analogue Scale.
Description of Tibial Torsion Test
Measure for normal tibial torsion: pt in sitting with knees over edge of table. One side thumb and index finger placed over medial and lateral malleoli. Then measure acute angle formed by knee to ankle. Norms: 12-18 degrees.
Purpose of Evoked Potentials and what do they rule out?
Measure of time it takes for brain to register an external stimuli's input; MS, brain tumor, acoustic neuroma, and SCI
Description of Medial Epicondylitis Test
Medial Epicondylitis: pt sitting. PT palpates medial epicondyle and supinates pt's forearm, extends wrist, and extends elbow. Positive if pain in medial epicondyle.
Describe a thrombotic CVA
atherosclerotic plaque forms and eventually occludes artery causing an infarct
What is a Bankart Lesion? Require surgery for repair?
avulsion of anteroinferior capsule and ligaments associated with glenoid rim; yes
Moderate severe peripheral nerve injury
axonotmesis
Characteristic of pain with labral tears
Nonlocalized pain in shoulder with increasing pain in OH activities and reaching behind the back
Resisted Isometrics Findings: Atraumatic Instability
Normal
Observational Findings of: Rotator Cuff Lesion
Normal bone/tissue outlines, possible protective shoulder hike
Special Tests for Cervical spine (2)
foraminal compression (Spurling's) test, vertebral artery test
Dopamine Replacement Agents typically used for?
PD
Common pathologies that may present with dystonia? (3)
PD, CP, encephalitis
Dysfunction of basal ganglia may lead to
PD, Huntington's, Tourettes, ADD, OCD, addiction
Causes of toe touch gait (4)
PF spasticity or contracture, weak or paralyzed DF
Capsular Pattern of talocrural joint
PF, DF
Description of Tight Retinacular Ligament Test
PIP held in neutral PT attempts to flex DIP. If PT is unable, retinacular ligaments or capsule is tight. If DIPs flex with PIPs in slight flexion, then retinacular ligaments may be tight without capsular tightness.
Modified Ashworth Scale Grade 3
PROM difficult
Cemented THA WB Guidelines
PWB ~3 weeks, use cane at week 4, FWB week 5
Causes of no toe off (3)
forefoot pain, weak PF, insufficient PF RoM
Resisted Isometrics Findings: Rotator Cuff Lesion
Pain and weak ABD and ER
Signs and Sx Possible Peripheral Nerve Involvement: Long Thoracic Nerve
Pain with flexing fully extended arm; inability to flex extended arm; scapular winging with 90 deg. flexion
Passive Movement Findings: Rotator Cuff Lesion
Painful if impingement present
Active Movement Findings: Cervical Spondylitis
Painful limited RoM
Definition of Ballism
form of chorea includes jerks of large amplitude
Describe 4 parts of McGill Pain Questionnaire
Part 1: pt marks on drawn body where sx are Part 2: pt chooses one word that describes pain from 20 categories Part 3: pt describes pattern of pain including factors that increase or relieve pain Part 4: pt rates pain 0-5
Description of anterior and posterior apprehension tests
Past Shoulder Dislocation test: pt in supine arm ABD 90. PT ER shoulder for anterior, IR for posterior. Positive test if look of apprehension at end point
Description of Patellar Apprehension Test
Patellar Subluxation or Dislocation: pt in supine with knees extended. PT places both thumbs over medial border of patella and applies lateral force. Positive if look of apprehension on pt or flexion of the quad in effort to avoid sublux.
Description of Clarke's Sign
Patellofemoral Dysfunction: pt in supine with knees extended. PT applies slight pressure distally with web space of hand over superior pole of patella. PT has pt contract quad while maintaining pressure. Positive if failure to complete contraction without pain
Multiple Sclerosis causes what that leads to sx
patches of demyelination of nerves within brain and spinal cord
Shoulder ADD mm (3)
Pec major, teres major, lats
Vertebral Artery Test: pt isn't able to complete cervical RoM required to complete correctly...what to do?
Perform test in allowable range
Definition of Chorea.
form of hyperkinesia presents with brief, irregular rapid contractions, but not to degree of tics. More like fidgeting.
Type of wheelchair for a young active individual
Rigid and light weight
Modified Ashworth Scale Grade 4
Rigid flexion or extension
Contraindications for Sensory Stimulation
Pts who would not benefit from hands-on therapy, has sufficient motor control to learn a new motor skill, ability to utilize self-correcting motor skills,
Initial treatment of MCL sprain
RICE NSAIDs
Signs and sx of Osteogenesis Imperfecta
pathological fractures, osteoporosis, hypermobile, leg bowing, weak, scoliosis, impaired respiratory function
Definition of clasp-knife response
form of resistance seen during RoM of hypertonic joint where greater resistance is found at initiation of RoM that lessons as range continues
Potential side-effect of nonopioid agents with children
Reye's Syndrome
Skinfold measurements for BF should all be taken on which side of the body?
Right
Description of Drop arm test
Rotator cuff tear: pt sitting/standing arm ABD 90. pt slowly lowers arm to side. positive if severe pain or cannot slowly lower arm
Cause of Boutonniére Deformity
Rupture of central tendinous slip of extensor hood; typically from trauma or RA
Thompson Test for what?
Ruptured Achilles.
Description of SI Joint Stress Test
SI Joint Dysfunction: pt in supine. PT crosses pt's arms so palms are on ASIS. PT applies downward and lateral force to pelvis. Positive if unilateral pain in SI joint or gluteal area
Special Tests for lumbar and SI region (3)
SI joint stress test, sitting flexion test, standing flexion test
The Biceps Load 2 Test is highly sensitive and specific test for _______
SLAP lesion
What is a tear of the superior labrum from anterior to posterior called?
SLAP lesion
Demyelination without axonal degeneration
Segmental demyelination
Most likely autograft for ACL reconstruction? Other tendons used? (2)
Semitendinosus and Gracilis. Patellar and IT band.
Describe Anterior Horn cell pathology characteristics and example
Sensory component is intact Motor weakness and atrophy Fasciculations Dec. DTR's Ex: Amyotrophic lateral scleorosis and Poliomyelitis
Symptoms of spinal roots and nerve pathology and example
Sensory component will have corresponding dermatomal deficits. Motor weakness in an innervated pattern;May have fasciculations Dec. DTR's Ex: herniated disk
Describe symptoms of peripheral polyneuropathy pathology and example
Sensory impairments in a "stocking glove" distribution Motor weakness and atrophy Weaker distally than proximally May have fasciculations Dec. DTR's Ex: Diabetes
Common etiology of Sural nerve injury
fracture of calcaneus or lateral malleoli
A movement disorder that presents with slow, twisting, and writhing movements that are large in amplitude. Primarily seen in the face, tongue, trunk, and extremities. It is a common finding in several forms of Cerebral palsy due to basal ganglia pathology
athetosis
Cervical vertebrae 1 helps to form what joint?
atlanto-occipital
What structure on cervical vertebrae 2 helps form what join with the anterior arch of the atlas (C1)?
atlantoaxial
Common mechanism of radial nerve injury
fracture of humerus or compression of nerve in the radial tunnel
Meniscus Description (medial and lateral)
attached to proximal tibia. thicker on outside attachments and thinner where not attached. Medial more commonly injured.
Definition of vestibulospinal reflex
attempts to stabilize body and control movement. Assists with stability during head motion as well as coordination of trunk during upright postures
Dysarthria is characterized by damage to what structure?
UMN lesion
Definition of clonus
UMN sx, involuntary alternating spasmodic contraction of muscle from quick stretch reflex
UMN vs LMN: Strength
UMN: Stroke: hemiplegia Corticospinal Lesion: contralateral if above decussation in medulla; ipsilateral if below Spinal Cord Lesion: B loss below lesion LMN: focal
UMN vs LMN dz sx: Fasciculations
UMN: Absent LMN: Present
UMN vs LMN: Location of Lesion
UMN: CNS LMN: PNS
UMN vs LMN: Reflexes
UMN: Hyper LMN: Hypo/absent
UMN vs LMN: Tone
UMN: Hyper LMN: Hypo/absent
UMN vs LMN dz sx: Tone
UMN: Hypertonic LMN: Hypotonic to flaccid
Description of Wright Test
Thoracic Outlet Syndrome secondary to costoclavicular space compression: pt sitting/standing. PT monitors radial pulse while moving pts arms into full ABD. Positive if absent/diminished pulse
Description of Roos Test
Thoracic Outlet Syndrome: pt sitting or standing. Both arms ABD, ER, and elbow flexed 90. Pt opens and closes hands 3 minutes. Positive if unable to hold test position, weakness of arms, or sensory loss or ischemic pain.
Description of Adson Maneuver
Thoracic Outlet Syndrome: pt sitting/standing. PT monitors radial pulse. Pt rotates head to testing side, pt then extends head as PT ER and extends shoulder. Positive if absent or diminished pulse
Dorsiflexors
Tib anterior, extensor hallucis longus and digitorum longus, peroneus tertius
Description of Bunnel-Littler Test
Tightness: pt sitting with MCP joint held in slight extension. PT attempts to move PIP joint into flexion. If unable, then tight intrinsic muscle or capsule. If PIP flexes with slight MCP flexion, then may be intrinsic muscle tightness and not capsule.
UMN vs LMN: Voluntary Movement
UMN: Impaired/absent LMN: Weak/absent
UMN vs LMN: Involuntary Movement
UMN: Spasm LMN: Fasciculations
Spondylolysis
fracture of pars interarticularis with (+) Scotty Dog finding on oblique view plain film
Bones of the hand (starting bottom: left to right, then top: left to right)
Top: Trapezoium, Trapezoid, Capitate, Hamate Bottom: scaphoid, lunate, Triquetrium, Pisiform
Common mechanisms of axonotmesis
Traction, compression, and crush injuries are most common.
Common mechanism of injury of sural nerve
fracture of the calcaneus or lateral malleous
Mixed CN involved with chewing
Trigeminal
Mixed CN involved with sensation of head (3)
Trigeminal, Facial, Glossopharyngeal
True or False: Handheld dynamometers have a high intrarater reliability?
True; >.94
UMN vs LMN: Structures Involved
UMN: cortex, brainstem, corticospinal tracts, SC LMN: SC: anterior horn, spinal roots, peripheral nerves CN: cranial nerves
UMN vs LMN dz sx: Reflexes
UMN: hyper LMN: diminished/absent
UMN vs LMN dz sx: Atrophy
UMN: mild from disuse LMN: present
Most common type of Salter-Harris Fracture?
Type II
Rarest form of Salter-Harris Fracture?
Type III
Gaze-Evoked nystagmus
Typically indicative of CNS pathology and is associated with brain injury and multiple sclerosis. It occurs when the eyes shift from a primary position to an alternate position. It is caused by the patients inability to maintain a stable gaze position.
Homolateral Synkinesis
UE flex involves LE flex on same side
Description of Tinnel's Sign
Ulnar Nerve Compression or Compromise: pt in sitting with elbow slightly flexed. PT taps with index finger between olecranon and medial epicondyle. Positive if tingling sensation in ulnar nerve distribution.
Description of Froment's and Jeann's Sign
Ulnar Nerve Compromise or Paralysis: pt sitting/standing and holds piece of paper between thumb and index finger. PT tries to pull paper away. Positive if pt flexes distal phalanx of thumb due to ADD pollicis muscle paralysis. If at the same time, pt hyperextends MCP of thumb= Jeann's Sign.
Define Ataxia
Uncoordinated movement, especially gait
Congenital Torticollis Description
Unilateral contracture of sternocleidomastoid. Often identified in first two months of life. Laterally flexed to tight SCM and rotation away
Most appropriate communication for Receptive Aphasia
Use word repetition and manual cues to assist in communicating desired actions during rehab (Wernicke's)
These levels of Ranchos Los Amigos Levels of Cognitive Functioning represent High-level recovery
VII-VIII
Mixed CN involved with mm of heart, lung, and bowel
Vagus
Mixed CN involved with vocal sounds
Vagus
Example antispasticity med
Valium
Rearfoot Varus vs Valgus: more problematic
Varus; Valgus leads to more mobility which is favorable over rigidity seen in varus
Coordination Synkinesis
Voluntary contraction of certain muscle groups on involved side, give rise to involuntary contractions of synergistic muscles
Cementless THA WB Guidelines
WBAT/TTWB, PWBx3 weeks, cane week 4, FWB week 6
SCI graded ASIA A and B will typically ambulate with?
WC
An activity to alleviate muscle tightness associated with equinus gait pattern
Walking backwards
What type of degeneration is described as: Degeneration of axon and myelin sheath distal to site of axonal interruption
Wallerian degeneration (neurotmesis)
Describe myasthenia gravis
autoimmune dz resulting in neuromuscular junction pathos. Affects proximal musculature more than distal. Progressive weakness and fatiguability with activity
Two types of fluent aphasia
Wernicke's and Conduction
Absolute contraindications for cardiovascular endurance exercise in SCI
automatic dysreflexia, infected skin on WB surfaces, symptomatic hypotension, UTI, unstable fracture, uncontrolled hot/humid environment, insufficient RoM to perform task
Modified Ashworth scale Widely used qualitative scale for the assessment of spasticity; it measure the amount of resistance to passive stretch. MAS GRADE 0 No increase in muscle tone MAS GRADE 4 Affected part(s) in rigid flexion or extension MAS GRADE 1 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at end of ROM when moved into flexion or extension. MAS GRADE 1+ Slight increase in tone, manifested by a catch, followed by minimal resistance throughout the remained (less than half) of the ROM MAS GRADE 2 Marked increase in muscle tone through most of the ROM, but affected parts(s) easily moved MAS GRADE 3 Considerable increase in muscle tone, passive movement difficult
Widely used qualitative scale for the assessment of spasticity; it measure the amount of resistance to passive stretch.
Definition of Resting Tremors and example
appear at rest and may/may not disappear with movement; may increase with stress. Pill-rolling seen in PD
Special Tests for Shoulder dislocation
apprehension tests
Common forms of hypokinesia (3)
apraxia, rigidity, bradykinesia
Importance of Diencephalon
area where motor and sensory tracts synapse
Signs and sx of rotator cuff tear
arm positioned in IR and ADD, point tenderness of great tubercle and acromion, marked limited flexion and ABD RoM with scapular compensation, increased anterior shoulder tone, night pain
Side effects of Dopamine Replacement Agents?
arrhythmias, GI distress, orthostatic hypotension, dyskinesias, mood/behavioral change
Deceleration definition
as swing limb begins to extend and ends just prior to heel strike
Definition of analgesia
absence of pain while remaining conscious
Definition of vestibuloocular reflex
allows head/eye movement coordination. Supports visual fixation during head movement.
A motor unit consists of ______ motor neurons and the ______ ______ it innervates.
alpha; mm fibers
Signs of increased ICP secondary to Cerebral edema and Brain herniaion
altered LoC, altered vitals (increased BP; widen/slowed pulse, irregular RR with apnea; Cheyne-Stokes; elevated temp), headache, vomit, pupillary change, progressive motor sx, seizure
Double Step Gait
alternating steps are of different length or rate
Effects of nonopiod agents (4)
analgesic, pain relief, anti-inflammatory, anti-pyretic (reduces fever)
When examining sensation these can be tested cortical
bilateral simultaneous stimulation, stereognosis, two-poin discrimination, barognosis, localization of touch
Common etiology of sciatic nerve injury (3)
blunt force trauma to buttocks, THA, accidental injection to nerve
Precautions to improving cardiovascular endurance in SCI Individuals with high paraplegia or tetraplegia
blunted tachycardia and very low VO2 peak, substantial variability in responses
Comminuted Fracture description
bone breaks into fragments
Compound Fracture description
bone breaks through skin
TOS: what comprises the neurovascular bundle?
brachial plexus, subclavian artery and vein, vagus and phrenic nerves, and sympathetic trunk.
Stress Fracture description
break in bone due to repeated stress
Sx of ALS progression include (4)
fatigue, oral motor impairment, motor paralysis, and respiratory paralysis
a form of hyperkinesia that presents with brief, irregular contractions that are rapid, but not to the degree of myoclonic jerks. Is typically secondary to damage to the caudate nucleus. Huntington's disease is an example of a pathology
chorea
Describe ALS
chronic degenerative dz of UMN and LMN
Circumduction Gait
circular motion to advance the leg during swing phase; may be used to compensate for insufficient hip/knee flexion or DF
Weak hip flexors in CVA pts yield what gait deficits
circumduction, ER with ADD, backward trunk lean, or exaggerated flexion synergy
Common etiology of musculocutaneous nerve injury
clavicle fracture
Diagnostical findings confirming Rheumatoid Arthritis
clinical presentation of joints, rheumatoid factor in blood, radiographic changes
Causes of hyperextension of knee in stance (2)
compensation for weak quads, PF contracture
Weak knee extensors (knee is flexed during stance) in CVA pts yield what gait deficits
compensatory knee locking (hyperextension)
Typical uses for CT scan? (4)
complex fractures, facet dysfunction, disc dz, spinal stenosis
Common etiology of Median nerve injury (2)
compression in carpal tunnel, pronator teres entrapment
Common etiology of Ulnar nerve injury (2)
compression in cubital tunnel, entrapment in Guyon's canal
Common etiology of Radial nerve injury (2)
compression of nerve in radial tunnel, humerus fracture
Convex or Concave?: Acromion (on scapula) during acromioclavicular movements
concave
Convex or Concave?: Clavicle during sternoclavicular protraction/retraction
concave
Recovery Stages of Diffuse Axonal Injury: Emerging Independence
confusion clearing, some formation of memories, significant cognitive problems; uninhibited social behavior
Description of Osteogenesis Imperfecta
connective tissue disorder that affects collagen formation during bone formation; easily fractured
Cause of Swan neck deformity
contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons; typically from trauma or RA
Convex or Concave?: Glenohumeral movement
convex
Convex or Concave?: Hip movements of femur
convex
Convex or Concave?: Proximal radius during pronation/supination
convex
Convex or Concave?: Subtalar inversion/eversion (cuboid and calcaneus)
convex
Convex or Concave?: Talocrural DF/PF (talus)
convex
Convex or Concave?: Temporomandibular movement (mandible)
convex
Movement of the atlanto-occipital jopint follows the concave or convex rule?
convex
The largest descending motor tract?
corticospinal tract
Definition of Schwann Cell
cover nerve fibers in PNS and form myelin sheath
When is spinal orthosis used for scoliosis?
curvature between 25-40 degrees
Steppage Gait
feet and toes lifted excessively during hip and knee flexion. Usually from DF weakness. Footslap will occur
At risk pts for Patellofemoral Syndrome (4)
females, growth spurt, runners increasing mileage, overweight
Common etiology of Peroneal nerve injury (2)
femur/tibia/fibula fracture, positioning during surgical procedures
Common etiology of Obturator nerve injury (2)
fixation of femur fracture, THA
Etiology of medial meniscal tear
fixed foot rotation while WB on flexed knee
Initial signs of Alzheimer's Dz?
difficulty learning new information, changes in memory and concentration
Dysphonia
difficulty speaking due to motor dysfuntion: hoarseness denotes vocal cord paralysis; nasal quality denotes palatal weakness
Definition of polyneuropathy
diffuse nerve dysfunction that is symmetrical and typically secondary to pathology and not trauma; associated conditions include Guillain-Barre syndrome, peripheral neuropathy, use of neurotoxic drugs, and HIV
Definition of Hypesthesia
diminished sensation of touch
Description of Chopart's Amputation
disarticulation at midtarsal joint
Non-traumatic causes of SCI (4)
disc prolapse, vascular insult, CA, infection
Characteristics of strength with neuropathies
distal weakness of extremities
Definition of dysesthesia
distortion of any of the senses, especially touch
Recovery Stages of Diffuse Axonal Injury: Confusional
disturbance of attention mechanisms; no new memories; hypo/hyperarousal
Spinocerebellar ataxias are the main autosomal dominant or recessive?
dominant
Post CVA aphasia indicates lesion to which hemisphere?
dominant (left)
There is no ______ for C1
dorsal root
To palpate tibialis anterior have pt
dorsiflex and invert the foot
Side effects of muscle relaxants
drowsiness, sedation, dizzy,
PTs should be aware of what with pts on dopamine replacement drugs?
drug holidays, monitoring BP due to orthostatic hypotension
What is scapulohumeral rhythm? who and how much moves first? How much does each joint move with full RoM?
during 180 deg of ABD glenohumera joint moves 2:1 to scapulothoracic; first 30-60 is glenohumeral; ST: 60 and GH: 120
Describe discography and use
dye injected into disc to view any disruptions
Describe arthrography and use
dye injected into joint space to observe abnormality; tendon ruptures
Use of diagnostic US
dynamic view of soft tissue in a small area; highly dependent on user skill
Esotropia
eye pulled inward
Non-fluent aphasia typically arises when his structure is damaged
frontal lobe of dominant hemisphere
Global Aphasia is characterized by damage to what structures (3)?
frontal, temporal, or parietal lobes
Type of plain film method used to assess scoliosis
full length Cobb's
Active Movement Findings: Atraumatic Instability
full or excessive RoM
Definition of asthenia and typically secondary to?
generalized weakness; cerebellar pathos
Three Indications for anticholinergic meds
glaucoma, dementia secondary to Alzheimers, myasthenia gravis (helps stop degradation of neuromuscular junction)
Trendelenburg Gait
glute med weakness; opposite hip drop
Why must supracondylar fractures be further examined?
high number of neurological and vascular structures in region (typical radial nerve involvement)
Tabetic Gait
high stepping ataxic gait feet slap ground
Equine Gait
high steps; excessive gastroc activity
Anaerobic Metabolism is used during _____ intensity and _______ duration activities and provides energy for up to ______
high; short; 15 seconds
Definition of dysmetria
inability to control RoM and force of muscular activity
Anosmia
inability to identify smells; common in frontal lobe lesions
Definition of akinesia and commonly seen in?
inability to initiate movement; PD
Definition of ataxia
inability to perform coordinated movement
Define Apraxia
inability to perform mvmnts previously learned even though there is no loss of strength, coordination, sensation or comprehension
Dysdiadochokinesia
inability to perform quick alternating movement
Associative dysfunctions that may lead to myasthenia gravis (4)
lupus, enlarged thymus, RA, DM
Toe off definition
only toe of stance limb is in contact with ground
How to screen superficial pain
perceive noxious stimuli from pen cap, pin, or paper clip
How to screen light touch
perceive touch by light pressure or cotton ball
How to screen vibration
perceive vibration or pain through tuning fork
Ankle Inversion mm (3)
tib post and anterior, flexor digitorum longus
Pavlik Harness 1) Gold Standard for? 2) Keeps body in?
1) congenital hip dysplagia for newborns- 6 months 2) maintains hip flexion and ABD
Toeing Out 1) 3 common causes 2) Excessive angulation if femoral neck to frontal plane is less than ___ deg 3) ______ ______ ______ correction has high complication rate with surgery
1) femoral retroversion, external tibial torsion, flat feet 2) <10 deg 3) external tibial torsion
Pes Planus 1) aka 2) Normal at what age range? 3) Clinical findings for dx (2)
1) flat foot 2) 2-3 years 3) reduced longitudinal arch height and lack of rigidity for propulsion during gate
Mallet Finger 1) Characteristics 2) Caused by?
1) flexion of DIP 2) rupture or avulsion of extensor tendon at insertion into distal phalanx; typically from trauma
Smith's Fracture 1) Description
1) fracture of distal radius that is volarly displaced causing a "garden spade" deformity
Boxer's Fracture 1) Description 2) Casting duration?
1) fracture of neck of 5th metacarpal 2) 2-4 weeks
Osteomyelitis 1) Inflammatory response in bone caused by ______ 2) Typically caused by _______ (bacterium) 3) Prevalence of dz
1) infection 2) Staph A. 3) young children/immunosuppressed, more in males
Describe Elbow Flexion Test
Identifies cubital tunnel syndrome (ulnar nerve entrapment): pt in supine. Pt bilaterally max shoulder ER, and elbow in active max flexion with extended wrist for one minute. Positive if pain medial elbow and nerve signs in ulnar distribution.
Describe Morton's Test
Identifies stress fracture or neuroma in forefoot. pt supine with foot supported. PT grasps metatarsal heads and squeeze. Positive if painful.
Describe Prone Instability Test
Identify lumbar instability. Pt prone legs off table. Spring Lumbar segments until painful segment found. Have pt raise legs and re-test painful segments. Positive if decrease in pain.
Sign of a (+) Roos Test
Inability to maintain testing position for 3 minutes.
Define Astereognosis
Inability to recognize objects by touch alone
Anterior Cord Syndrome
Incomplete lesion caused by compression of anterior spinal cord and anterior spinal artery--> corticospinal and spinalthalamic tract damage. Bilateral loss of motor function and pain and temp sense below level of lesion
Signs and Sx Possible Peripheral Nerve Involvement: Suprascapular Nerve
Increased pain with shoulder flexion, scapular ABD, cervical rotation to opposite side; weakness;
RoM Reqs. for Normal Gait: Hip Flexion
0-30
RoM of hip ADD
0-30
RoM of hip extension
0-30
RoM of wrist ulnar deviation
0-30
RoM of Inversion
0-35
RoM of thoracolumbar lateral flexion
0-35
RoM of cervical spine extension
0-45
RoM of cervical spine flexion
0-45
RoM of cervical spine lateral flexion
0-45
RoM of hip ABD
0-45
RoM of hip ER
0-45
RoM of PF
0-50
RoM of cervical spine roation
0-60
RoM of shoulder extension
0-60
RoM of shoulder IR
0-70
RoM of thoracolumbar flexion
0-80
RoM of wrist flexion
0-80
DTR Testing Scores
0: absent 1+: decreased 2+: Normal 3+: exaggerated 4+: hyperactive
Ranchos Los Amigos Levels of Cognitive Function 1) Levels denoting no response 2) Decreased response 3) Confused Levels 4) Appropriate (automatic, purposeful) Levels
1) 1 2) II and III 3) IV, V, VI 4) VII and VIII
Pediatric Transient Synovitis 1) Age of onset 2) Dx 3) Signs and Sx (4)
1) 3-10 2) exam shows decreased hip ABD and IR. Effusion causing bulging of anterior joint capsule 3) U hip/groin pain, crying at night, antalgic limp, recent hx of upper respiratory tract infection
Complex Regional Pain Syndrome: Early Stage 1) aka 2) Description
1) Acute 2) diffuse, severe or burning pain, increases with stress; allodynia and hyperpathia; vasomotor instability,
Signs of end-stage Alzheimer's
intellectual and physical destruction, incontinence, functional dependence, inability to speak
Increased CSF pressure may be indicative of? (7)
intracranial tumors, abscesses, meningitis, inflammation, subarachnoid hemorrhage, cerebral edema, thrombosis of venous sinuses
somatosensory receptors are located in?
joints, muscles, ligaments, and skin
Causes of exaggerated knee flexion at terminal stance (2)
knee or hip flexion contracture
Etiology of PCL sprain and other involved structures
landing on tibia with flexed knee/dashboard injury. ACL, MCL, LCL, menisci
Scissor Gait
legs cross midline upon advancement
Thalamic Pain Syndrome
lesion to thalamus produces spontaneous pain on contralateral side
Challenging and examining the visual input system
maintaining CoG with eyes open and closed. Assessment of field cuts, hemianopsia, pursuits, saccades, double vision, gaze control, and acuity
Description of Congenital Hip Dysplagia
malalignment of femoral head in acetabulum. Develops during last trimester
The deltoid ligament is located over the lateral/medial ankle?
medial
Lateral deviators of the mandible (4)
medial and lateral pterygoids, masseter, temporalis
Mechanism of injury for LCL?
medial blow to the knee
Hallux Valgus 1) Deformity Observed
medial deviation of head of 1st metatarsal from midline of body, metatarsal and base of proximal first phalanx move medially, while distal phalanx moves laterally
Mechanism of injury for ACL? Often associated with damage to what other structures? (3)
noncontact twist associated with hyperextension and varus/valgus stress. medial capsule, MCL, menisci
Post CVA perceptual deficits indicate lesion to which hemisphere?
nondominant (right)
Special Tests: Frozen Shoulder
none
Acquired ataxia may result from? (3)
nonhereditary neurodegenerative systemic disorder, toxin exposure, or idiopathic
Right Hemisphere Specialization/Dominance
nonverbal processing/understanding, holistic info processing, artistic, hand-eye coordination, spatial relations, kinesthetic awareness, understanding music, math reasoning, negative emotions, body image
Degenerative Scoliosis description
normal aging processes leading to deformity such as osteophytes, bone demineralization, HNP. Structural scoliosis cannot reduce
Observational Findings of: Frozen Shoulder in regards to tissue and bone outlines
normal bone/tissue outlines
Recovery Stages of Diffuse Axonal Injury: Mute/Minimal Responsiveness
not vegetative with fluctuating awareness
Crossed Extension Reflex
noxious stimuli to sole of foot produces flexion of stimulated LE, then extension with ADD of opposite LE. Stretch stimulus from grasping forearm and pulling produces total flexion response of UE
Flexor Withdrawal Reflex
noxious stimuli to sole of foot produces toe extension, DF, L flexion
When the lumbar spine flexes or extends, the ilium rotates in the ______ direction
opposite
Common causes of kyphosis (3)
osteoporosis, compression fractures, poor posture secondary to paralysis
Typical etiology of BPPV?
otoliths dislodging into posterior semicircular canal
What part of the meniscus is more vascularized?
outer edges
When the ilium posteriorly rotates unilaterally (U RDL), it also moves into an ______, causing the acetabulum to ______, and leads to ______ of the hip
outflare; ER, ER
What not to do to a pt with adhesive capsulitis (shoulder)
over stretch or elevate pain
The sacral plexus arises through which vertebrae?
L4-S3 Nerve Roots
Other risk factors for Osteoarthritis (not age/gender)
overweight, fractures/joint injuries, occupational/athletic overuse
Common Signs and Symptoms associated with Degenerative Joint Disease/OA (4)
pain and stiffness upon rising, pain with repetitive flexion, more sore than nagging, eases through day (4-5 hours)
Common Signs and Symptoms associated with spinal stenosis
pain is position dependent, flexed is relieving and extended is painful, pain described as numbing tightness or cramping, walking (lumbar extension) brings on pain, pain may persist for hours once in a resting position
Symptoms of neurapraxia
pain, min. mm atrophy, numbness or greater loss of motor and sensory function, diminished proprioception
Conservative treatment for meniscal tear
palliative and stregnthening
(4) Sx associated with poor aphasia prognosis
perseveration in speech, severe auditory comprehension impairments, unreliable yes/no answers, empty speech without recognition of impairments
Hip ER mm (6) (PGOGOq)
piriformis, gemelli superior, obturator externus, gemeli inferior, obturator internus, quadratus femoris
BPPV mostly affects which semicircular canal?
posterior
Reverse Hill-Sachs fracture associated with
posterior glenohumeral dislocation
Primary focus of treatment for rotator cuff tear
prevent adhesive capsulitis and strengthen upper extremity
Description and use of Thoracolumbosacral Orthosis
prevents trunk motion
Describe PD
primary neuro-degenerative disorder that decrease in serotonin
Describe Alzheimer's Dz
progressive neurodegenerative disorder that results in deterioration and irreversible damage to cerebral cortex and subcortical areas
Description and use of Milwaukee Orthosis
promotes realignment of spine due to scoliotic curvature
Plantar fascitis may arise from a _________ gait
pronated
When examining sensation these can be tested Deep
proprioception, kinesthesia, and vibration
The ventricular system is designed to ______ and _______ the brain
protect and nourish
Function of meninges?
protect brain from contusion and infection
Antalgic Gait
protective gait pattern where involved step length is decreased to decrease weight bearing on involved side
Purpose of a PET and used to rule out
provides 2-D and 3-D imaging of brain activity; cerebral circulatory pathos, metabolism dysfunction, tumors, blood flow, and brain changes following trauma or drug abuse
Challenging and examining the vestibular system
provides CNS feedback in regards to head position and movement with relation to gravity.
Description and use of Corset
provides abdominal pressure and support. provide pressure/support for mi and low back pain and pathos
With myasthenia gravis which muscles are more affected: proximal or distal?
proximal
Why is a "crisis" episode, with a pt with myasthenia gravis, a medical emergency?
respiratory muscle involvement
tremors that are observable at rest and may or may not disappear with movement. An example is the pill-rolling motion associated with Parkinson's disease
resting
Initial sx of PD
resting tremor in hands/feet that increases with stress and stops with movement/sleep
downward rotation of the scapulae (3)
rhomboids, levator scapulae, pec minor
Post CVA pts who impulsive, quick, indifferent; often exhibit poor judgement and safety, overestimating abilities while underestimating problems sustained a lesion to which hemisphere
right (nondominant)
Effects of true leg length discrepancy of the right leg on: Pelvis
right ilium posteriorly rotated
Characteristics of CVA in: Left Hemisphere (8)
right sides weakness/paralysis; frustration; decreased processing; aphasia; dysphagia; motor apraxia; left and right discrimination; right hemianopsia
Definition of allodynia
sensation of pain in response to stimulus that would not typically produce pain
Definition of Vertigo
sense of movement and rotation of oneself or surrounding environment. Has peripheral or central origin.
Hawkin's Test is highly _________ for identifying subacromial impingement
sensitive
Neer's Test is highly ______ for identifying shoulder impingement
sensitive
Speed's Test is highly _________ for identifying bicep tendonopathy
sensitive
The Rent Sign is highly ________ and has moderately high ________ for identifying RTC tear/impingement
sensitivity, specificity
Fasciculus Gracilis is responsible for? (4)
sensory for lower body proprioception, vibration, two-point discrimination, and graphesthesia
Spinoreticular Tract is responsible for? (1)
sensory for reticular formation that influences consciousness
Fasciculus Cuneatus is responsible for? (4)
sensory for upper body proprioception, vibration, two-point discrimination, and graphesthesia
PNS Pathos: Describe Neuromuscular Junction pathology and give an example (3/1)
sensory in tact, motor fatigue > weakness, normal DTR; myasthenia gravis
PNS Pathos: Describe Muscle pathology and give an example (4/1)
sensory intact, motor weak, fasciculations rare, normal/decreased DTRs; muscular atrophy
PNS Pathos: Describe Anterior Horn Cell pathology and give an example (4/2)
sensory intact, motor weak/atrophy, fasciculations, decreased DTR; ALS, poliomyelitis
Signs and sx of shoulder dislocation
severe pain, paresthesias, limited RoM, weakness, shoulder fullness, arm supported by other limb
Description and use of Foot Orthosis
shoe insert that corrects alignment and improves function
Elevated WBC in CSF may indicate?
significant inflammation or infection
Damage to extrapyramidal tracts results in? (4)
significant paralysis, hypertonicity, exaggerated DTRs, and clasp-knife reaction
PNF: D1 Extension of upper extremity looks like
slapping butt of person beside you
Definition of Athetosis
slow, twisting, and writhing movements large in amplitude. Primarily seen in face, tongue, trunk, and extremities. When movements are brief they merge with chorea, sustained merge with dystonia.
Dysarthria
slurred and/or slowed speech that's difficult to understand
Other neuromuscular pathologies that talipes equinovarus may accompany
spina bifida, arthrogryposis
Describe recovery of axonotmesis
spontaneous; ranging from spotty to no recovery
How to screen deep pain
squeeze forearm or calf
Cerebellar Gait
staggering gait seen in cerebellar dz
Initial, conservative treatment, for congenital torticollis. What if conservative treatment fails and child is older than 1?
stretching, ARoM, positioning. Surgical release of SCM.
Describe Motor Learning
study of acquisition or modification of movement
Definition of chorea
sudden, random, and involuntary movements
Supination of foot leads to _______ and ______ glide of fibular head.
superior and anterior
Effects of true leg length discrepancy of the right leg on: ankle/foot
supination, talus rotated externally and glides upwardly
Conduction Aphasia is characterized by damage to what structure?
supramarginal gyrus, arcuate fasciculus
What if scoliosis curvature is 40+ degrees?
surgical intervention
Definition of dystonia
sustained muscle contractions that frequently cause twisting, abnormal postures, and repetitive movements.
Signs and sx of meniscal tear
swelling at joint line, catching or locking sensation,
Vaulting Gait
swing leg advances by elevating pelvis and PF of stance side
Midswing definition
swing limb is under body
Signs and sx of Rheumatoid Arthritis
sx are symmetrical, morning stiffness, warm joints, decreased appetite, malaise, increased fatigue, swan neck deformity, boutonniere deformity, low grade fever
Describe an ischemic stroke by and embolus
sx associated with CVD, an embolus from anywhere in the body dislodges and travels to cerebral artery
Most common forms of diabetic neuropathy (2)
symmetric polyneuropathy and autonomic neuropathy
Typical signs and sx of diabetic neuropathy?
symmetric sensory disturbances and weakness occurring distally. Stocking glove sensory loss
Autonomic neurons are divided into what two categories?
sympathetic and parasympathetic
Semicircular Canals read?
fluid with head motion
Definition of Positional Nystagmus and typically lasts?
induced by change in head position. Typically lasts few seconds
What is a hemorrhagic CVA?
infarct caused by rupture of brain blood supply
Shoulder capsule is least support in what direction?
inferior
Plantar Fasciitis description
inflammation of plantar fascia at proximal insertion on medial tubercle of calcaneus.
Changes in color of CSF may be indicative of? (3)
inflammatory dz, hemorrhage, tumor
Plantar Flexors (7)
tib posterior, gastroc, soleus, peroneus longus and brevis, plantaris, flexor hallucis
More dense objects on an x-ray appear _________ and less dense tissues appear ________
white; black
Damage to pyramidal (corticospinal) tracts results in? (5)
(+) Babinski, absent superficial abdominal reflexes and cremasteric reflex, and loss of fine motor or skilled voluntary movement
Signs of CNS inflammation and meningeal irritation
(+) Kernig's and Brudzinski's, irritability, slowed mental function, headache in head down position, delirium, coma, altered vitals (increased HR/RR or fluctuating BP), generalized weakness
Special Tests: Atraumatic Instability
(+) Load and shift, apprehension, relocation, augmentation tests
Special Tests: Cervical Spondylitis
(+) Spurling's, Distraction, ULTT, Shoulder ABD tests
Mobilization for irritated neural tissue
(Maitland) Grade II; should be non-painful
Spinal cord ends at which vertebral body
L1
Impairments caused by vertebral-basilar artery damage
-LoC -Hemi/Tetraplegia -Comatose/Vegetative -Inability to speak -Locked-in Syndrome -Vertigo -Nystagmus -Dysphagia -Dysarthria -Syncope -Ataxia
Predictable Patterns of Impairment with occlusion to anterior cerebral artery
-Bilateral occlusion--> paraplegia -incontinence -abulic aphasia -frontal lobe sx
List the descending motor tracts (6)
-Corticospinal Tract (anterior and lateral) -Reticulospinal Tract -Rubrospinal Tract -Tectospinal Tract -Vestibulospinal Tract
Signs of impairment to Parietal Lobe
-Dominant (typically left) hemisphere: agraphia, alexia, agnosia -Non-dominant (typically right) hemisphere: dressing/constructional apraxia, anosognosia -contralateral sensory deficits -impaired language comprehension -impaired taste
List ascending sensory tracts (9)
-Fasciculus Cuneatus -Fasciculus Gracilis -Spinocerebellar Tract (dorsal and ventral) -Spino-olivary Tracy -Spinoreticulo Tract -Spinotectal Tract -Spinothalamic Tract (anterior and lateral)
Lateral Patellar Tracking -Possible cause
-Increased Q-angle with a tendency for lateral subluxation/dislocation
Considerations to take whilst pt has a seizure (9)
-Stay calm -Clear surrounding area -Be aware of duration -ensure comfort best as possible -keep isolated; sans medical respondents -Do not restrain -Do not place anything in mouth -Do not provide water/food until fully alert -If duration >5 minutes call 911
Signs of impairment to Temporal Lobe
-learning deficits -Wernicke's Aphasia (receptive) -Antisocial, aggression -Difficulty facial recognition -Memory deficits -Inability to categorize objects -Performing recently learned skills
Impairments caused by middle cerebral artery damage
-Wernicke's aphasia (in dominant hemisphere) -Homonymous Hemianopsia -Apraxia -flat affect with right hemisphere damage -Contralateral motor/sensory loss of face and upper extremity with lesser involvement of lower extremity -Impaired spatial relations -Anosognosia in non-dominant hemisphere -Impaired body schema
Predictable Patterns of Impairment with occlusion to middle cerebral artery
-bilateral occlusion --> contralateral hemiplegia and sensory loss; largely sparing the leg -Dominant hemisphere involvement: global, Wernicke's or Broca's aphasia -homonymous hemianopsia
Impairments caused by anterior cerebral artery damage (simplified)
-contralateral lower extremity motor/sensory deficits
Impairments caused by posterior cerebral artery damage
-contralateral pain and temperature loss -contralateral hemiplegia, mild hemiparesis -ataxia, athetosis, or choreiform movement -impaired quality of movement -thalamic pain syndrome -anomia -prosopagnosia with occipital infarct -Hemiballismus -Visual agnosia -Homonymous Hemianopsia -Memory impairment -alexia, dyslexia -Cortical blindness from bilateral involvement
Characteristics of Peripheral Vertigo
-episodic/short duration -autonomic symptoms present -precipitating factor -pallor, sweating -nausea and vomiting -auditory fullness -tinnitus
Signs of meningitis
-fever, headache, vomiting -nuchal rigidity -lumbar and posterior thigh pain -Brudzinski and Kernig's sign -photosensitivity
Importance of cerebellum
-fine tuning movement -assists with maintaining posture and balance by controlling muscle tone and extremities in space -Ipsilateral impairments
Signs of impairment to Occipital Lobe
-homonymous hemianopsia -impaired extraocular movement and visual deficits -impaired color recognition -reading/writing impaired -if bilateral lobe involvement, then cortical blindness
Damage to hypothalamus may lead to?
-obesity -sexual disinterest -poor temperature control -diabetes insipidus
The middle cerebral artery supplies what parts of the brain?
-outer cerebrum -basal ganglia -posterior and anterior internal capsule -putamen -pallidum -lentiform nucleus
The Posterior Cerebral Artery supplies what parts of the brain?
-part of midbrain -subthalamic nucleus -basal nucleus -thalamus -inferior temporal lobe -occipital and occipitoparietal cortices
Function of Temporal Lobe
-primary auditory/olfactory center -Wernicke's (left hemisphere): understand and produce meaningful speech -interpretation of other's emotions and reactions
Importance of Hypothalamus
-receives and integrates info from ANS -hormonal regulation (homeostasis) -control of sexual behavior, hunger, thirst, and sleep
Importance of Thalamus
-relay/processing center for info to cerebral cortex -coordinates sensory perception and movement with other parts of brain
Function of Parietal Lobe
-sensation of touch, kinesthesia, vibration, temperature, -provides meaning to objects -interprets words/language -spatial/visual perception
RoM Reqs. for Normal Gait: DF
0-10
RoM Reqs. for Normal Gait: Hip Extension
0-10
RoM of hip flexion
0-120
RoM of knee flexion
0-135
RoM of Eversion
0-15
RoM of elbow flexion
0-150
RoM of shoulder ABD
0-180
RoM of shoulder flexion
0-180
RoM Reqs. for Normal Gait: PF
0-20
RoM of DF
0-20
RoM of wrist radial deviation
0-20
RoM of thoracolumbar extension
0-25
Tarsal Tunnel Syndrome 1) Entrapment of what? 2) What may lead to tarsal tunnel syndrome? 3) Sx (3) 4) (+) test
1) posterior tibial nerve 2) over/excessive pronation, overuse tendonitis of long flexor and post tib tendon, and trauma may compromise space 3) pain, numbness, and paresthesias along medial ankle 4) Tinel's
Carr and Shepherd: Motor Re-Learning Approach 1.) identify ___ 2.) inhibit unnecessary ________ 3.) promote proper body ____ 4.) knowledge of ______
1.) goal 2.) movement 3.) alignment 4.) results
Brunnstrom: Movement Therapy in Hemiplegia Terms 1.) Associated Reaction 2.) Homolateral Synkinesis 3.) Limb Synergies 4.) Raimiste's Phenomenon 5.) Souque's Phenomenon 6.) Stages of Recovery
1.) involuntary and automatic movement of body part resulting from intentional active or resistive movement in another body part 2.) flexion pattern of the involved upper extremity facilitates flexion of involved lower extremity 3.) group of muscles that produce predictable pattern of movement in flexion/extension patterns 4.) involved lower extremity will ABD/ADD with applied resistance to uninvolved lower extremity in same direction 5.) raising involved upper extremity above 100 deg with elbow extension will produce extension and ABD of fingers 6.) seven stages of recovery describing tone, reflex activity, and volitional movement
The cognitive stage: 1.) _________ amount of errors 2.) inconsistent or consistent attempts? 3.) Repetition leads to? 4.) consistent or inconsistent performance? 5.) degree of cognitive work?
1.) large 2.) inconsistent 3.) improved strategies 4.) inconsistent 5.) large
Muscle Grades: Fair Minus
3-/5 completes more than half of range against gravity
Normal tissue pressure of carpal tunnel?
3-7 mmHg
Muscle Grades: Fair
3/5 completes RoM without resistance
Carpal Tunnel syndrome may present with tissue pressures exceeding?
30 mmHg
Polyarticular Juvenile Rheumatoid Arthritis
30-40% of cases. Mostly females, significant rheumatoid factor, arthritis 4+ joints symmetrically
How many pairs of spinal nerves exit vertebral column?
31
Sx of Huntington's typically occur at what age range?
35-55
Broca's Aphasia is characterized by damage to what structure?
3rd convolution of frontal lobe
How many small vertebrae form the coccyx?
4
Frequency and duration of BWS treadmill training
4 days/week; 20-30 minutes for 8-12 weeks
Muscle Grades: Good Plus
4+/5 completes RoM against mod-max resitance
Muscle Grades: Good Minus
4-/5 completes RoM against min-mod resistance
Muscle Grades: Good
4/5 completes RoM against mod resistance
50% of deaths from hemorrhagic stroke occur with in?
48 hours
How many fused vertebrae form the sacrum?
5
How many lumbar vertebrae are there?
5
Muscle Grades: Normal
5/5 completes RoM against max resistance
Anaerobic glycolysis is ____ % slower than Anaerobic phosphocreatine metabolism, but provides _______ of energy
50%; 30-40 seconds
How many ribs attach to the sternum?
7
ABCs for Radiograph reading
A: Alignment- size, contour, B: Bone Density- density and texture C: Cartilage Spaces- joint space width, presence of subchondral bone, epiphyseal plates
Piriformis Muscle Actions
ABD and ER
A prosthetic that is too long will?
ABD gait, circumducted gait, vaulting,
Hemiplegic Gait
ABD paralyzed limb, swing it around, and bring it forward
Description of Anterior Drawer Test (knee)
ACL Injury: pt in supine with knee flexed 20-30. PT stabilizes distal femur with one hand and other on proximal tibia. PT applies anterior force through tibia. Positive if excessive displacement with diminished or absent end feel.
What other structures are typically involved with an MCL sprain?
ACL and medial meniscus
Description of ACL sprain Grades I, II, and III
ACL prevents anterior translation of tibia on femur. Grade I: microscopic tears; mild pain and swelling Grade II: moderate pain and swelling, minimal instability, min to mod tearing, decreased RoM Grade III: severe pain and swelling, substantial instability, total tear, substantial loss of RoM
Post reconstruction hinge brace setting for: ACL and PCL
ACL: 20-70 PCL: 0
Effects of true leg length discrepancy of the right leg on: Femur
ADD and ER, relative extension
RoM needed for ADLs and comfortably getting up from sitting in knee?
ADLs: 90 Sit-to-Stand: 105
Ankylosing Spondylitis vs Spinal Stenosis: History AP: (4), SS: (2)
AP: morning stiffness, more in males, sharp pain --> ache, B SI pain may refer to posterior thigh SS: Intermittent aching pain, pain may refer to both legs with walking (neurogenic claudication)
Ankylosing Spondylitis vs Spinal Stenosis: Resisted Isometrics
AP: normal in beginning stages SS: normal
Ankylosing Spondylitis vs Spinal Stenosis: Active Movements
AP: restricted SS: May be normal
Ankylosing Spondylitis vs Spinal Stenosis: Passive Movements
AP: restricted SS: may be normal
Osteogenesis Imperfecta management
ARoM focusing on symmetry, positioning, functional mobility, fracture management, orthotics
Contraindications for Joint Oscillations (absolute and relative)
Absolute: joint ankylosing, bone malignancy, dz affecting ligament integrity (RA and Down's), arterial insufficiency, active inflammation/infection Relative: DJD, metabolic bone dz (osteoporosis, Paget's, TB), hypermobile, total joint replacement, pregnant, spondylolithesis, steroid use, radicular sx
Contraindications for soft tissue/myofacial techniques (absolute and relative)
Absolute: soft tissue breakdown, infection, cellulitis, inflammation, and/or neoplasm Relative: hypermobilit and sensitivity
What (3) ligaments could be involved with an inversion (lateral) ankle sprain?
Anterior talofibular ligament, calcaneofibular ligament, or posterior talofibular ligament
Most (95%) of GH dislocation occur in what direction?
Anterior-Inferior
Description of Sitting Flexion Test and tests for? (Lumbar/SI region)
Articular Restriciton: pt in sitting with knees flexed to 90 and feet on floor. Hips should be ABD to allow forward trunk flexion. PT palpates thumbs over inferior PSIS and monitors as pt bends towards floor. Positive if unilateral difference in movement of PSIS
Stenosis causes U or B Sx? Pts prefer activities in?Avoid ______ activities.
B; flexion; extension
Etiology of Peripheral vertigo (7)
BPPV Meniere's disease. Infection. Trauma/tumor. Metabolic disorders (diabetes). Acute alcohol intoxication
Etiology of Peripheral Vertigo (6)
BPPV, Meniere's, Infection, trauma/tumor, metabolic disorders, acute alcohol intoxication
Special Tests for for pediatric hip pathos (2)
Barlows test, Ortolanis test
Chorea is typically secondary to damage to what structure?
Basal Ganglia
Ganglion Cyst
Benign cyst on back of hand or wrist
List of Postural and Stability Test and Measures (4)
Berg, MiniBest, Rhomberg, Functional Reach
Pros of Patella Grafts for ACL reconstruction (3)
Better maintaining post-op tension, less expensive, faster healing
Description of Yergasons Test
Bicep tendonitis: pt sitting with arm pronated and elbow flexed to 90. Humerus is tabilized and PTs hands over bicipitale groove and one over forearm. PT resists pt's supination and ER. Positive if pain/tenderness at bicipital groove region.
Damage to the optic chiasm will cause...
Bitemporal Hemianopsia; a visual deficit on the outside halves of both eyes
What is responsible for nutrient exchange between CNS and vascular system?
Blood Brain Barrier
Gold Standard for measuring bone mineral density
Bone density scan/DEXA/Bone Densitometry
4 types of non-fluent aphasia
Broca's, Global, Verbal Apraxia, Dysarthria
Description of Trendelenburg
Glute Med Weakness on stance side: pt in standing and asked to stand on one leg. Positive if opposite hip drops
Ambulation guidelines for cementless TTWB THA post-op
By week 6 progress to 1/3 WB, 2/3 by week 8, FWB week 10 with walker. Cane week 12. no AD when safe and absent trendelenburg
Common mechanism of musculocutaenous nerve injury
Clavicular Fracture
Treatment for congenital hip dysplagia for 6 month- 2 year olds
Closed reduction under anesthesia--> spica cast 12 weeks
Ranchos Los Amigos Levels of Cognitive Function assess?
Cognitive recovery from TBI
What are the 3 stages of motor learning?
Cognitive, Associative, and Autonomous
Recovery Stages of Diffuse Axonal Injury (6)
Coma--> Unresponsive--> Mute responsive--> Confused--> Emerging Independence--> Intellectual Competence
Basal Ganglia function and components
Composed of caudate, putamen, globus pallidus, substantia nigra, and subthalamic nuclei. Collectively responsible for voluntary movement, regulation of autonomic movement, posture, muscle tone, and control of motor responses
Common mechanism of median nerve injury
Compression in the carpal tunnel or pronator teres entrapment
Common mechanism of ulnar nerve injury
Compression in the cubital tunnel or entrapment in Guyon's canal
Vertebrae below C-2 follow the convex or concave rule?
Conave
Description of Grind Test for wrist
DJD in carpometacarpal joint: pt sitting/standing. PT stabilizes pt's hand and grasps thumb at metacarpal. Compression with rotation is applied. Positive if painful.
Ligament that is injured after a medial (eversion) ankle sprain?
Deltoid ligament
Sensory Function and reflexes Findings: Cervical Spondylitis
Dermatomes and reflexes affected
Describe Bicycle (van Gelderen's Test)
Differentiates between intermittent claudication and spinal stenosis. Pt rides stationary bike at set pace in an erect position while PT times. Then continues while slumped timed. If can ride longer during slump, then spinal stenosis.
Hip Extensors (4)
Glute max and med, semimemnbranosus/tendinosus, biceps femoris
Gender differences with scoliosis etiology
Equal for mild scoliosis, girls greater risk for 30+ degree scoliosis
Describe alar Ligament Test
Evaluate integrity of Alar Ligament. Pt seated. PT passively slightly flex upper cervical spine and pincer grasp C-2. Palpate movement while side-bending and/or rotating. Positive: inability to palpate C-2 moving in conjunction with C1.
Describe TMJ compression test
Evaluates for pain with compression of retrodiscal tissues. Pt in supine/sitting. PT stabilizes head and other hand superiorly forces mandible to cause compression on disc. Positive finding if painful.
Describe Transverse Ligament Test
Evaluates integrity of transverse ligament. pt supine with head supported. Glide C-1 anteriorly. Should be firm end-feel. Positive if soft end-feel, dizziness, nystagmus, lump sensation in throat, nausea.
Describe Anterior Shear Test
Evaluates upper cervical spine ligaments and capsules. Pt in supine with head supported. PT glides C2-C7. Should be firm end-feel. Positive if lax, dizziness, nystagmus, lump sensation in throat, or nausea.
Hip ABD mm (5)
Glute med and min, piriformis, obturator internus, TFL
Boutonniere Deformity
Extension of metcarpophaangeal joint and distal interphalangeal joint flexion of proximal interphalangeal joint
T/F: there is possibility for regeneration to a neurotmesis peripheral injury
F
Mixed CN involved with taste (3)
Facial, Glossopharyngeal, and Vagus
Common mechanism of injury of peroneal (fibular) nerve
Femur, tibia, or fibula fracture, positioning during surgical procedures
What is a trimalleolar fracture
Fracture of medial and lateral malleoli and posterior tubercle of the tibia
Common mechanism of axillary nerve injury
Fracture of neck of humerus or anterior dislocation of the shoulder
Special Tests for wrist/hand neurological dysfunction (3)
Froments sign, Phalens test, Tinnels Sign
RoM Reqs. for Normal Gait: Knee Extension
Full
Capsular pattern of glenohumeral joint? hip?
GH: ER, ABD, IR Hip: flexion, IR>ABD
SIJ Dysfunction Tests and Measures (5)
Gellet's, Gaenslans, Goldthwait's, Long-Sitting Test, Ipsilateral anterior rotation test
This test examines levels of consciousness
Glasgow Coma Scale
CNS Infection or Meningeal irritation is global or focal?
Global
Mixed CN involved with parotid gland
Glossopharyngeal
Mixed CN involved with alimentary tract, heart, vessels, and lungs (2)
Glossopharyngeal and Vagus
Mixed CN involved with swallowing (2)
Glossopharyngeal and Vagus
Kaltenborn Description of Joint Mobilization Grades (non-thrust)
Grade I: "Loosening". Performed during examination/intervention. Relieves pain and decompresses. Small amplitude beginning of range Grade II: "Tightening". Mobilize after taking up some tissue slack. Alleviates pain, asses joint play, reduce mm guarding. Grade III: "Stretching". Assesses end-feel and increases tissue
Strain Grades Grades: I, II, III
Grade I: localized pain, min swelling and tenderness Grade II: localized pain, mod swelling and tenderness Grade III: palpable defect of muscle, severe pain, poor motor function
Occipital lobe impairments
Homonymous hemianopsia, impaired extraocular muscle movement and visual deficits, impaired color recognition, reading & writing impairment, and cortical blindness with bilateral lobe involvement.
Posterior dislocation of GH occurs with...
Horizontal ADD and IR
What is a compression fracture of the posterior humeral head called?
Hill-Sachs Lesion
A physical therapist notices that a patient with a transfemoral amputation consistently takes a longer step with the prosthetic limb than the contralateral limb. The MOST likely cause of the deviation is:
Hip flexion contracture: this will limit hip extension thus a shorter step is needed on the opposite side
Description of Thomas Test
Hip flexor contracture: pt in supine with legs fully extended. Pt brings one knee to chest to flatten lumbar spine. PT observes opposite hip. Positive if raises from table.
Misc. ankle tests (4)
Homans sign, Thompson test, tibial torsion test, True leg length discrepancy test
Damage to the contralateral optic tract will cause...
Homonymous Hemianopsia; a visual deficit of either the right or left halves of both eyes
Describe Windlass Test
Identifies windlass effect of plantar fascia. Test in WB: Pt stands on step with toes off. PT passively extends 1st MTP Non-WB Test: pt seated foot above floor knee at 90. PT stabilizes foot and extends 1st MTP. Positive if sx are reproduced.
Degrees of motion of ankle through gait cycle starting with ISw
ISw: 10 PF , MSw: neutral , TSw: neutral , IC: neutral , LR: 15 PF , MSt: 10 DF , TSt: neutral , Pre-Swing: 20 PF
Degrees of motion of hip through gait cycle starting with ISw
ISw: 20 flex, MSw: 20-30 flex, TSw: 30 flex, IC: 30 flex, LR: 30 flex, MSt: neutral, TSt: 10 extension, Pre-Swing: neutral
Degrees of motion of knee through gait cycle starting with ISw
ISw: 60 flex , MSw: 30 flex , TSw: 0 , IC: 0 , LR: 15 flex , MSt: moving to neutral , TSt: 0 , Pre-Swing: 35 flex
THA Lateral approach precautions
Ideal for noncompliant pts, flexion passed 90, ER, ADD
Description of Crank Test
Identifie anterior shoulder instability or labral tear. Pt standing. PT holds proximal humerus and elbow. PT elevates pt arm to 160 in scapular plane. Elbow hand applies force through humerus while other IR and ER. Positive with or without click and pt pain response
Describe Horizontal ADD Test
Identifies AC joint dysfunction or subacromial impingement. PT stands behind pt on testing side. PT passively flexes pt shoulder to 90 holding arm just distal to elbow. Then max ADD to other shoulder. Positive if report of pain during movement or local to AC joint.
Description of Brush Test (knee)
Knee Effusion: pt in supine. PT places one hand medial joint line of patella and strokes proximally with palm and fingers to suprapatellar pouch. Other hand strokes down lateral surface of patella. Positive if wave of fluid flow just below medial distal border of patella
Peripheral nystagmus
Is inhibited when the patient fixates their vision on an object. It is unidirectional and presents with significant vertigo. The length of symptoms are finite but recurrent. Causes:Meniere's disease,infection of inner ear
Description of Varus Stress Test for Elbow
LCL sprain: pt sitting with elbow flexed 20-30. PT places one hand on elbow and other proximal to wrist. While palpating joint line varus force is applied. Positive if laxity compared to non-involved side, apprehension or pain.
Dx tests for MS
LP, elevated gamma globulin, CT or MRI, myelogram
Left Hemisphere Specialization/Dominance
Language: (understanding, produce written/spoken), sequencing and performing movement, analytical controlled, logical, math calculations, positive emotions, processing verbal coded information
Description of Mill's Test
Lateral Epicondylitis: pt sitting. PT palpate lateral epicondyle, pronates pt's forearm, flexes wrist, and extends elbow. Positive if painful.
Most common cause of SCI
MVA
Description of Apley's Compression Test
Meniscal Lesion: pt in prone with knee flexed to 90. PT stabilizes femur with one hand and other hand on heel. Apply medial and lateral rotation while applying compressive force. Positive if painful or clicking.c
Description of Bounce House Test
Meniscal Lesion: pt in supine. PT grabs pt heel and max flex knee. Then passively extended. Positive if incomplete extension or rubbery end feel
Etiology of Lateral Epicondylitis
Microtrauma from eccentric loading of extensor muscles; especially extensor carpi radialis. Most common in 30-50 year olds. Tennis elbow
Most common affected artery from CVA?
Middle cerecral
Which cerebral artery is most commonly affected by emboli? and from where?
Middle from the internal carotid
Observational Findings (movement of C-Spine and physical finding) of: Cervical Spondylitis
Minimal/no spine movement, possible torticollis
Sx of a thrombotic CVA may occur when?
Minutes to days
Treatment of adhesive capsulitis (shoulder) (3)
Mobs RoM exercises palliative modalities
Cons of Hamstring Grafts for ACL reconstruction (3)
More expensive, more difficult procedure, rehab more difficult (slower)
Etiology of Osteoarthritis by age and gender.
More in men than women up to age 55, and then more in women than men afterwards
Description/Uses of CT/CAT scan
Noninvasive test provides sectional imaging of bone and most soft tissue. Especially good for chest and abdomen. Also used for bone density (fracture prediction) and tumor identification
Resisted Isometrics Findings: Cervical Spondylitis
Normal; unless nerve root compression. Myotome may be affected
Sensory Function and reflexes Findings: Frozen Shoulder
Not Affected
Sensory Function and reflexes Findings: Rotator Cuff Lesion
Not Affected
What can be observed using the Dix-Hallpike maneuver?
Nystagmus present during BPPV
Gold Standard treatment for congenital hip dysplagia for what age group?
Pavlik Harness; newborn-6 months
6 phases of ACL/PCL reconstruction rehab
Preop, Max Protection, controlled motion, moderate protection, minimum protection, return to activity
treatment of Legg-Calve-Perthes Disease
Primarily relieve pain, positioning, improve RoM,
Basilar Artery Syndrome
Produces brainstem and PCA signs and sx. Locked-in Syndrome
Posterior Tibialis tenosynovitis arises from pronation/supination?
Pronation
Muscle likely to entrap median nerve?
Pronator Teres
Describe Tillaux Fracture
Salter-Harris Type III fracture of distal tibia, that has a poor prognosis
Describe Muscular pathology characteristics and example
Sensory component is intact Motor weakness Rarely fasciculations Normal or Dec. DTR's Ex: Muscular dystrophy
Description of Upper Limb Tension Test for Radial Nerve
Sequence: shoulder depression with ABD 10, elbow extension, forearm pronation, wrist flexion and ulnar deviation, finger and thumb flexion, shoulder IR. Provoke with contralateral cervical lateral flexion
Elevators of the mandible (3)
Temporalis, masseter, medial pterygoid
Define Delirium
Temporary confusion and loss of mental function. Often a result of illness, drug toxicity or lack of oxygen. Often reversible
C1-7 nerve roots exit ______ their respective vertebrae while C8's nerve root exits ______
above; below
Are manipulations appropriate for whiplash pts?
Yes
BPPV typically lasts how long?
a few seconds
NDT inhibits ______ while facilitating _________
abnormal movement; normal movement
Asthenia
abnormal physical weakness or lack of energy
Definition of paresthesia
abnormal sensations such as tingling, pins and needles or burning sensations
Description and use of KAFO
allow to lock knee if needed. Ankle held in alignment
Describe symptoms of peripheral mononeuropathy pathology and example
an isolated nerve lesion. Sensory loss along the nerve route Motor weakness and atrophy in a peripheral distribution; may have fasciculations Ex: Trauma or entrapment
Special Tests for ankle ligamentous instability (2)
anterior drawer, talar tilt
The anterior cerebral artery supplies what parts of the brain?
anterior frontal lobe and medial surface of frontal and parietal lobes
Where does the Anterior Cerebral Artery (ACA) supply blood?
anterior frontal lobe and medial surface of frontal and parietal lobes
Signs and sx of Patellofemoral Syndrome
anterior knee pain, pain with prolonged sitting, crepitus, pain with up/down stairs
The Crank Test is a highly sensitive and specific test for _____ or ______
anterior shoulder instability or labral tear
3 landmarks of Q-angle is measurement?
anterior superior iliac spine, midpoint of the patella, tibial tubercle
Which ligament would most likely be sprained by inversion+PF?
anterior talofibular ligament
Most common direction of glenohumeral dislocation is ______ and is associated with _______ and ________
anterior; ABD and ER
Common forms of hyperkinesia (7)
ataxia, athetosis, chorea, tics, tremors, dysmetria, dystonia
Signs and sx of Legg-Calve-Perthes Disease
avascular necrosis of femoral head leading to pain, decreased RoM, antalgic gait, Trendelenburg
Type of meningitis that is fatal within hours of onset
bacterial
Early sx of PD
balance disruptions, bed mobility, manual fine motor
Important concept when treating pt on antispasticity meds
balancing treatment between reducing spasticity and loss of function that comes with hypertonicity
Describe Numerical Rating Scale for subjective pain measurement
based off 0-10 or 0-100 scale. easy to administer
Initial Contact definition
beginning of stance phase occurs when foot touches ground
Terminal Stance definition
begins when heel of stance limb rises and ends when other foot touches ground
Pre-Swing definition
begins when other foot touches ground and ends when stance foot reaches toe off
Most affected arteries of TIA?
carotid and vertebrobasilar
Convex or Concave?: Distal radius during pronation/supination
concave
Convex or Concave?: Knee movement of tibia
concave
Convex or Concave?: Radius and ulna during elbow flexion and extension
concave
Convex or Concave?: Toe flexion/extenion (distal phalanx) and ABD/ADD (proximal phalanx)
concave
Convex or Concave?: Trapezoid during wrist flexion/extension
concave
Convex or Concave?: Capitate, scaphoid, lunate triquetrium during wrist flexion/extension
convex
PT implications for anticholinergic meds
decreased HR, dizziness, report concerning sx with MD, pts with myasthenia gravis or Alzheimers should be treated while on anticholinergic meds
Characteristics of CVA in: Cerebellum (6)
decreased balance; ataxia; decreased coordination; nausea; decreased ability for postural adjustment; nystagmus
Characteristics of strength with Myasthenia Gravis
decremental losses
Signs and sx of impingement syndrome
deep discomfort/mild pain, pain with OH activities, painful arc 70-120 ABD, tenderness over greater tuberosity and bicipital groove
Side effects of antispasticity meds
drowsiness, confusion, headache, dizziness, generalized muscle weakness
A Syndrome of sustained muscle contractions that frequently causes twisting, abnormal postures, and reptitive movements. Common diagnoses that may include this disorder are Parkinson's disease, Cerebral palsy, and encephalitis.
dystonia
With tendonopathies (tendonosis/tendonitis/etc), endurance and strengthening exercises typically focus on the ______ phase
eccentric
Causes of insufficient knee flexion during swing phase (4)
effusion, quad extension or PF spasticity, insufficient flexion RoM
Definition of hip stradegy
elicited by large perturbation. Hips move opposite the head. Muscles contract proximal to distal
Main function of amygdala
emotional and social processing
Misc. conditions that may increase risk for dementia (4)
head injury, hydrocephalus, toxins, alcoholism
Prevention for plantar fasciitis
heel cord stretching, appropriate footwear, avoiding sudden change in training intensity
Shoe adjustments for plantar fascitits
heel cup, medial longitudinal arch
Shoe adjustment for Achilles tendonitis
heel lift
Heel off definition
heel of stance limb leaves ground
Standard Terminology for gait (8 terms starting with heel strike)
heel strike, foot flat, midstance, heel off, toe off, acceleration, midswing, deceleration
Definition of Hyperesthesia
heightened sensation
RBC in CSF may indicate?
hemorrhage or traumatic tap
The autonomic nervous system deals with everything that has to do with _____
homeostasis
How to screen graphesthesia
identifying number/letter drawn on skin without visual input
Mechanism of injury for MCL?
lateral blow to knee
Signs and sx of congenital torticollis
lateral cervical flexion to side of contracture and rotation away with facial asymmetries
Description of Scoliosis
lateral curvature of spine. Three classification: functional, neuromuscular, degenerative.
A prosthetic that is too short will? (1)
lateral lean
Post CVA pts who are slow, cautious, hesitant, and insecure sustained a lesion to which hemisphere
left (dominant)
Verbal Apraxia is characterized by damage to what structure?
left frontal lobe adjacent to Broca's Area
Characteristics of CVA in: Right Hemisphere (10)
left sided weakness/paralysis; decreased attention; left hemianopsia; decreased awareness/judgment; memory deficits; left inattention; decreased abstract reasoning; emotional lability; impulsiveness; decreased spatial orientation
LMN sx of ALS are due to damage to what structures and shows as what sx? (2)
loss of anterior horn cells in spinal cord and motor nerves in lower brainstem; atrophy and weakness
Signs of Alzheimer's progression
loss of orientation, word finding difficulties, depression, poor judgement, rigidity, bradykinesia, shuffling gait, impaired ADLs
What is a Ischemic stroke
loss of perfusion of an area causes central portion to irreversibly infarct
Definition of pallenesthesia
loss of vibration sense
Aerobic metabolism is utilized during ____ intensity and ___ duration exercise and provides the _____ ATP of all systems.
low; long; most
Depressors of the scapulae (4)
lower traps, lats, pec major and minor
Gold standard for dx meningitis
lumbar punture
Describe nerve degeneration associated with neurapraxia
nerve fibers not damaged and no evidence of nerve degeneration
Hippocampus is largely involved with ________
memories
Late stage Huntington's sx include (7)
mental decline, IQ decrease, depression, dysphagia, incontinence, immobility, rigidity
Pt has a patellar tendon autograft, which activity would be best post-op
mini-squat
Sx of Anterior Cerebral Artery Syndrome
minimal due to collateral circulation of circle of Willis
Primary reason to alleviate any adherence to a scar post BKA would be?
minimize shear during prosthetic use
First 1-3 weeks following TKA PT goals (5)
mm re-ed, mobilize soft tissue, initiate A/PROM, reduce swelling and lymphedema
Avoid forceful ______ and PROM > ___ deg post TKA
mobilization; 90
Exercise precautions for ALS pts
monitor fatigue, avoid overwork injury, limit positions decreasing pulmonary function
Ventral roots are sensory or motor?
motor; efferent
What information do muscle spindles send to the nervous system?
muscle length and/or rate of change
Examples of somatosensory information
muscle length, tension, pressure, pain, and joint position
An EMG can be used to rule out
muscle pathology, nerve pathology, spinal cord disease, denervated muscle, and LMN
Golgi tendon organs send what information to the nervous system?
muscles tension and/or rate of tension
Describe bone scan and used to identify
radioactive tracers injected; shows metabolic activity of bony anatomy; images for bone CA, fractures, bone dz, RA, infection
What diagnostical test may be helpful in confirming Osteoarthritis?
radiographs; may find decreased joint space or bone spurring
Describe recovery of neurapraxia
rapid and complete and occurs in 4-6 weeks
Goals of treatment for Rheumatoid Arthritis
reduce inflammation and pain, promote joint function, prevent joint destruction and deformity.
Goals for treating osteoarthritis? (3)
reduce pain, promote joint function, protect joint
Sx of Middle Cerebral Artery
reduced consciousness
Sx of Internal Carotid Artery Syndrome
reduced levels of consciousness, massive edema, brain herniation, death
If a pt complains of stomach pains while on non-opioid agents then _______
refer to physician
Pons function -Regulates -Orientates
regulation of respiration orientation of head in relation to visual/auditory stimuli
Modified Ashworth Scale Grade 2
tone throughout, but still easily moveable
What might exaccerbate sx of a pt with myasthenia gravis?
too hot/cold or stress or strenuous exercise
Spinal Shock
transient period of reflex depression and flaccidity; may last hours to 24 weeks
Acts as retinaculum for long head of biceps tendon
transverse humeral ligament
Retractors of the scapulae (2)
traps and rhomboids
Muscles of upward rotation of scapulae (2)
traps serratus anterior
Etiology of Legg-Calve-Perthes Disease
trauma synovitis, infection, vascular compromise
Posterior Leaf spring AFO use
trim line posterior to malleoli. supports DF and prevents foot drop. Need medial/lateral control
Hyperpathia
increased sensitivity to normal stimuli
Definition: Edema
increased volume of fluid in soft tissue outside of joint capsule
Definition: Effusion
increased volume of fluid within joint capsule
Recovery Stages of Diffuse Axonal Injury: Intellectual Competence
increasing independence with residual cognitive/social/behavior difficulties
Rigidity is dependent or independent of velocity?
independent
Metatarsalgia 1) Mechanical Etiology 2) Structural Etiology 3) Common complaint
1) tight tricep surae group and/or Achille's Tendon, collapse of transverse arch, short first ray (toe), forefoot pronation 2) transverse arch changes, possibly leading to: vascular and/or neural compromise in forefoot tissues 3) Pain at first and second metatarsal head after long periods of WB
Sinding-Larsen Johannson's Dz 1) Description 2) Caused by? 3) May occur when?
1) traction apophysitis at patella-patellar tendon junction 2) Overuse injury from repeated stress 3) After significant growth spurt or increase in activity
Myofascial Pain Syndrome 1) characterized by ______ 2) Active vs latent (of above answer)
1) trigger point 2) Active: painful upon palpation with referred pain Latent: palpable taut bands of muscle that are painless, but could convert to active
BPPV 1) Description 2) Duration 3) Etiology
1) vertigo attack and nystagmus occurring with different head positions 2) Brief 3) Degenerative process, mechanical impairment of peripheral vestibular system
Carr and Shepherd: Motor Re-Learning Approach Terminology: 1.) closed motor skill 2.) open motor skill 3.) knowledge of results 4.) Transfer of Learning
1.) skill performed in closed environment 2.) skill performed in changing (open) environment 3.) provide pt with external feedback regarding performance of task 4.) transferring learned skills to new environments
Ankylosing Spondylitis 1.) Etiology 2.) Initially affects? When? 3.) First sx? (3) 4.) Affects on spine with progression?
1.) unknown 2.) axial skeleton before 4th decade 3.) morning stiffness, mid to low back pain, SI inflammation 4.) kyphosis of cervical and thoracic spine and reduction of lordosis in lumbar
Huntington's is caused by?
Autosomal dominant chromosomal disorder
What ASIA grades may be able to utilize Treadmill Training using Body weight support?
B, C, D
Contraindications for joint manipulations (absolute and relative)
Absolute: joint ankylosis, bone malignancy, dz affecting ligamentous integrity (RA/Down's), arterial insufficiency, active inflammation/infection Relative: DJD, metabolic bone dz (osteoporosis, Paget's, TB), hypermobile, total joint replacement, pregnant, spondylolithesis, steroid use, radicular sx
Description of Thompson Test
Achilles Rupture: pt in prone with feet extended over end of table. PT tells pt to relax and then squeezes muscle bellies of gastroc and soleus. Positive if absence of PF
Hip ADD mm (4)
Adductor magnus, longus and brevis, gracilis
List of Special Tests that identify vascular compression of shoulder girdle. (3)
Adson, Halstead, Wright
Normal CSF; Adult and Child 1) Volume 2) Pressure 3) Protein
Adult 1) 90-150mL 2) 90-180 mmH2O 3) 15-45 mg/dL Child 1) 60-100mL 2) 10-100 mmH2O 3) 15-100 mg/dL
Lumbo-pelvic Rhythm
After 60-70 deg. lumbar flexion the pelvis will anteriorly rotate, followed by flexion of hips
Description of Standing Flexion Test (Lumbar/SI region)
Articular Restriction: pt in standing with feet 12in. apart. PT places thumbs over inferior PSISs and monitors movement as pt bends to floor with knees extended. Positive if difference between two PSIS movement.
What are TIAs usually linked to? What does this lead to?
atherosclerotic thrombosis; causes temporary blockage of blood supply to brain
Describe Flexion Rotation Test
Cervicogenic headache. pt in supine. PT max flex neck and rotate fully to each side. Positive if symptom reproduction or if 10 deg. loss from one side
Define Decerebrate Rigidity
Contraction of the extensor muscles of the UEs with contraction of extensor muscles of the LEs
Define Decorticate Rigidity
Contraction of the flexor muscles of the UEs with contraction of the extensor muscles of the LEs
What are the expected impairments of an Anterior Cerebral Artery (ACA) dysfunction?
Contralateral LE motor and sensory involvement; loss of bowel and bladder control; Loss of behavioral inhibition; Neglect, Aphasia, Apraxia and agraphia; perserveration
What are the expected impairments of a Posterior Cerebral artery (PCA) dysfunction?
Contralateral pain and temperature sensory loss; Contralateral hemiplegia(central area), mild hemiparesis; Ataxia, athetosis or choreiform movement; Thalamic pain syndrome; Alexia, dyslexia; visual agnosia; Hemiballismus;
Frontal lobe impairments: contra or ipsi? Type of Aphasia? Other sx?
Contralateral weakness, Perseveration, inattention, Emotional lability, Delayed or poor initiation, Broca's aphasia (expressive), impaired concentration, apathy,Personality changes, and antisocial behavior
Description of Talar Tilt
CFL Sprain: pt in sidelying with knee flexed to 90. PT stabilizes distal tibia with one hand and other grasps talus. Foot is maintained in neutral. PT tilts talus into ABD and ADD. Positive if excessive ADD
What cranial nerves originate from the medulla?
CN IX-XII
Which cranial nerves originate from the pons?
CN V-VIII
Sensory only CN (3)
CN- I (olfactory), II (optic), VIII (Vextibulocochlear)
Motor Only CN (5)
CN- III (oculomotor), IV (Trochlear), VI (Abducens), XI (Accessory), XII (Hypoglossal)
Both sensory and motor CN (4)
CN- V (Trigeminal), VII (Facial), IX (Glossopharyngeal), X (Vagus)
Which Cranial Nerves playa role in vision? What do they do? (7)
CN: II- Optic: visual acuity, visual fields, pupillary constriction III- oculomotor: pupillary size, extraocular movement IV- Trochlear: extraocular movement V- Trigeminal: corneal reflex VI- Abducens: extraocular movement VII- Facial: close eyes tightly (may be absent in Bell'ss Palsy) VIII- Vestibulocochlear: nystagmus in brain dysfunctions
Two areas where antispasticity meds bind to relax spastic muscles
CNS and skeletal muscle
Post-op ACL/PCL reconstruction: By week 6 increase motion of ______ to 0-___ deg
CPM; 0-120
Decreased CSF pressure may be indicative of? (3)
CSF leakage, subarachnoid block circulatory collapse, severe dehydration
Which is better at viewing bony structures: x-ray vs CT?
CT; and it views soft tissues
What is a completed stroke?
CVA that presents with total neurological deficits at onset
What is a Stroke in evolution?
CVA that usually caused by thrombus that gradually progresses; total neurologic deficits don't occur for 1-2 days
Vascular pathologies that can cause irreversible dementia (4)
CVA, anoxia, arteriovenous malformation, multi-infarct dementia
Where does the vertebral-basilar artery supply blood?
Cerebellum; Midbrain; Pons; Medulla; Thalamus; Occipital cortex;
Complication of THA
DVT, infection, pulmonary embolus, heterotopic ossification, femoral fractures, dislocation, neurovascular insult
Anterior Compartment Syndrome typically affects which nerve?
Deep Peroneal
Common sx of internal disc disruptions (nucleus pulpulsa). What might be contraindicated?
Deep achy pain and increased pain with movement; Manipulation
Description of Rent Sign
Identifies RTC tear/impingement: pt seated with arm relaxed. PT stands behind one hand holding flexed elbow other palpating anterior AC joint. Passively extend shoulder while ER and IR. Positive if greater tuberosity is prominent and depression of 1 finger width is felt
Decribe Long Sitting (supine to sit) Test
Identifies SIJ dysfunction secondary to leg length discrepancy. Pt perfectly aligned in supine. Stand at feet and palpate medial malleoli. Pt moves into long sitting. Assess medial malleoli and compare to supine measurements. Abnormal if difference.
Describe Supine Iliac Gapping
Identifies SIJ dysfunction. Pt in supine and baseline sx are taken. PT crosses arms and posteriorly-laterally displaces ASIS; may hold for 30s. Positive if reproduction of pt's chief complaint.
Describe Side-Lying Iliac Compression Test
Identifies SIJ dysfunction. Pt lies side with involved side up. Baseline sx taken. PT places hand on iliac crest and performs downward force; possibly holding for 30s. Positive if reproduces pt's chief complaint.
Describe Gaenslan's Test.
Identifies SIJ dysfunction. Pt sidelying at edge of table with bottom leg in maximal hip and knee flex. PT behind pt passively extending top leg (stresses top SIJ). Positive if pain at SIJ.
Suspensory strategy
This strategy is often used when both mobility and stability are required during a task (such as surfing). It is used to lower COG during standing or ambulation in order to control the COG better.
Mobilization rules: moving a convex surface over fixed concave surface scenario: increasing shoulder extension and external rotation requires _______ mobilization (the opposite direction of the movement)
anterior; since the direction of the convex movement on the concave surface is posterior, the mobilization to increase that movement is opposite (anterior)
In more severe cases of Bell's Palsy what medications may be necessary?
anti-viral and corticosteroids
Floor Reaction AFO use
assists with knee extension during stance by positioning a calf band and/or at ankle
Pathologies associated with cerebellar damage
ataxia nystagmus tremor hypermetria poor coordination postural reflex deficits balance equilibrium
Potential side effects of antiepileptic agents
ataxia, behavior change, GI distress, head ache, blurred vision, weight gain
Initial Swing definition
begins when stance foot lifts from floor and ends with max knee flexion during swing
Terminal swing definition
begins when tibia is perpendicular to floor and ends when foot touches gorund
Acceleration definition
begins when toe off is complete and completes when reference limb is under body
Nerve Roots T1 and down exit ______ their respective vertebral bodies.
below
Definition: Genu Varum
bowing of legs with increased space between knees with feet together. Increases compression on medial tibial condyle and stresses lateral structures of the knee (LCL)
Spiral Fracture description
break in bone shaped like "S" due to torsion/twisitng
Special Tests for knee swelling (2)
brush test, patellar tap test
What is hallux valgus?
bunion. big toe points inward. often from shoes that are too tight
Description and use of AFO
casting for a plastic AFO requires subtalar neutral position. Many uses: peripheral neuropathy, nerve lesions, hemiplegia
Modified Ashworth Scale Grade 1
catch and release or minimal resistance at end of RoM
Modified Ashworth Scale Grade 1+
catch with minimal resistance through remainder (less than half) of RoM
Definition: Bursitis
caused by acute/chronic inflammation of the bursae. May have limited ARoM secondary to pain and swelling
Definition: Tendonitis
caused by acute/chronic inflammation.
Definition of Spontaneous Nystagmus, typically follows?, lasts how long?
caused by imbalance of vestibular signals to oculomotor neurons that cause constant drift in one direction that is countered by quick movement in opposite direction. Follows acute vestibular lesion; typically lasts 24 hours
What specialized tissue makes cerebrospinal fluid?
choroid plexus
Description of Legg-Calve-Perthes Disease
degeneration of femoral head due to disturbance to blood supply (avascular necrosis)
Definition of Wallerian Degeneration
degeneration that occurs distally, specifically to the myelin sheath and axon
Osteoarthritis description
degenerative disease of articularcartilage, primarily with WB. Deformation and thickening of subchondral bone leads to impaired function.
Definition: Q angle
degree of angulation between midpatella to ASIS and tibial tubercle.
UMN sx of ALS are due to damage to what structures (2)
demyelination of corticospinal and corticobulbar tracts
Testing Vertical Disorientation
determine if pt can identify when an object is upright
Testing Topographical Disorientation
determine if pt can navigate familiar routes independently
Testing Depth and Distance Imperceptions
determine pt's ability to judge depth and distance
Neuromuscular Scoliosis 1) Description 2) Often seen in these two pathos 3) Can it be reduced?
developmental pathology resulting in developmental abnormalities in spine. Often seen in CP or Marfan syndrome. Structural scoliosis cannot reduce
Dysphagia
difficulty swallowing
Definition of stepping strategy
elicited through unexpected challenges during static positions or when a perturbation causes CoG do move beyond BoS. Lower extremities step and/or upper extremities reach to regain balance
Definition of ankle strategy 1) Type of perturbation 2) Muscles contract ______ to ______
elicited with small and slow velocity perturbation while feet on the ground. Muscles contract distal to proximal
What is preserved in an axonotmesis acute nerve injury?
endoneurium, epineurium, Schwann cells, and supporting structures
Second phase of rehab post TKA focuses on (3)
endurance, coordination, strength
Midstance definition
entire body weight is over stance limb
Foot Flat definition
entire foot hits ground following heel strike
Tendon affected in de Quervain's
extensor pollicis brevis and ABD pollicis longus
Tectospinal Tract is responsible for? (1)
extrapyramidal motor: contralateral postural tone related to auditory/visual stimuli
Reticulospinal Tract is responsible for? (2)
extrapyramidal motor: facilitation/inhibition of voluntary and reflex activity via alpha/gamma motor neurons
Rubrospinal Tract is responsible for? (3)
extrapyramidal motor: input of gross postural tone, facilitates flexor mm, and inhibiting extensor mm
Vestibulospinal Tract is responsible for? (3)
extrapyramidal motor: ipsilateral gross postural adjustments due to head movements, facilitating extensor mm, and inhibiting flexor mm
Definition of hyperpathia
extreme exaggerated response to pain
Cardinal signs of myasthenia gravis
extreme fatigue, skeletal muscle weakness can fluctuate within minutes or extended period
Contraindications to Neural Tissue Mobs
extreme pain and/or increase in abnormal neuro sx
Strabismus
eye deviates from normal position
Festinating Gait
forward toe walking as if pushed, increases slowly in speed
Common etiology of axillary nerve injury (2)
fractured neck of humerus, anterior shoulder dislocation
Effects of true leg length discrepancy of the right leg on: Fibula
glides cranially and anteriorly
Post-op rotator cuff Treatment Procedure -First 4-6 weeks -Activities until clearance from surgeon -After clearance treatment with these activities lasts 9-12 months
immobilization 4-6 weeks, PRoM slowly to ARoM, once cleared by surgeon- active movement and isometrics, OH activities/functional ADLs 9-12 months
Presbyopia
impaired near vision
Definition of peripheral neuropathy and associated conditions/causes
impairment or dysfunction of peripheral nerves ; associated conditions include diabetic peripheral neuropathy, trauma, alcoholism
Pain in rotator cuff tear vs impingement
impingement is more diffuse pain
Definition of Disdiadochokinesia
inability to perform rapid alternating movements
Apraxia
inability to perform voluntary, learned movements in the absence of sensation, strength, coordination, attention, or comprehension deficits.
Agnosia
inability to recognize familiar objects with one sense while able to identify with other senses
Dyssynergia
incoordinated and abrupt movement
Initial UMN signs of ALS (4)
incoordination, spasticity, clonus, and (+) Babinski
Definition: Lordosis
increased anterior curvature of spine. Typically seen in lumbar and cervical regions.
Parkinsonian Gait
increased forward trunk and knee flexion; shuffling and small steps, may have festinating gait too
Definition: Kyphosis
increased posterior curvature in the spine. Typically in Thoracic region.
Definition of fasciculation
muscular twitch caused by random discharge of LMN and its muscle fibers
Describe White Matter
myelinated axons and contains nerve fibers without dendrites
Purpose of a spinal puncture (lumbar) and used to rule out?
needle inserts below level of L1-L2 and takes CSF sample; hemorrhage, inflammation, infection, meningitis, tumor
What is the mildest form of acute nerve injury?
neurapraxia
Describe Huntington's Dz
neurological degenerative disorder of basal ganglia and cerebral cortex
Common sx of spinocerebellar ataxias include? (4)
neuropathy, pyramidal signs, ataxia, restless leg syndrome
Other sx of carpal tunnel (6)
night pain, hand weakness, muscle atrophy, decreased grip strength, clumsiness, decreased wrist mobility
General list of guidelines following THA
no crossing legs, limit forward bending in sitting, choose firm seating over cushy, stand with feet in neutral, use pillow/splint when in bed, use raised toilet seat, turn with uninvolved side,
Verbal apraxia description and treatment
non-dysarthric (not muscle weakness) and non-aphasic (not word use deficit), but a motor planning issue. Interruption in brain communicating to muscles of word craft
Purpose of a CT Scan
non-invasive; 2-D cross-section view of bones, tissues, and organs.
Are congenital cerebellar malformations progressive or non-progressive?
non-progressive
Signs and sx of ACL (knee) sprain?
pt may report loud pop or feeling of giving way/buckling followed by dizziness, sweating, and swelling.
Testing Figure-ground discrimination
pt picking out an object from an array of objects
Functions of medulla oblongata -Regulates -Reflex Center for (3) -Damage to motor tracts cause contra- or ipsilateral deficits
regulates RR and HR Reflex centers for vomiting, cough and sneeze Damage to motor tracts causes contralateral deficits
Description of Digit Amputation
removal of digit at metacarpophalangeal, PIP, or DIP level
Description of Syme's Amputation
removal of foot at ankle joint with removal of malleoli
Description of Wrist Disarticulation
removal of hand through wrist joint
Description of Transtibial Amputation
removal of lower extremity distal to knee joint
Description of Hip Disarticulation
removal of lower extremity from pelvis
Description of Transfemoral Amputation
removal of lower extremity proximal to knee joint
Description of Knee Disarticulation
removal of lower extremity through knee joint
Description of Transmetatarsal Amputation
removal of midsection of metatarsal
Description of Hemipelvectomy
removal of one half of pelvis and acquainted lower extremity
Description of Hemicorporectomy
removal of pelvis and both lower extremities
Description of Partial Hand Amputation
removal of portion of hand, and/or digits at transcarpal, transmetacarpal or transphalangeal level
Description of Transradial Amputation
removal of upper extremity distal to elbow joint
Description of Forequarter (scapulothracic) Amputation
removal of upper extremity including shoulder girdle
Description of BPPV
repeated episodes of vertigo due to changes in head position
Most often cause of impingement syndrome
repetitive trauma from upper extremity activity above horizontal plane. Humeral head and rotator cuff attachments migrate proximally trapped under acromion and coracoacromial ligaments.
Etiology of Osgood-Schlatter Disease
repetitive trauma to patellar tendon over tibial tuberosity in young athletes. May result in small avulsion of tuberosity and cause swelling
Other Conditions Affecting the Spine: Urological and Gynecological Conditions Kidney, bladder, overy, and uterus disorders refer pain to? (3)
trunk, pelvis, thighs
Elevated proteins in CSF may indicate?
tumors or inflammation
Pt s/p CVA, what action will facilitate elbow extension?
turn head to affected side; ATNR turning head to side facilitates extension of face side
Description and use of Reciprocating Gait Orthosis
type of HKAFO. cable system allows advancement of extremities. weight shift on one lower extremity advances other. Commonly used for paraplegics
Special Tests for wrist/hand ligamentous instability
ulnar collateral ligament instability test
Patellofemoral Syndrome description
umbrella term: pain or discomfort in anterior knee.
Recovery Stages of Diffuse Axonal Injury: Coma
unconsciousness with no arousal/awareness/sleep-wake cycle
Definition of lead pipe rigidity and often associated with lesion to what structure.
uniform and constant resistance to RoM; basal ganglia
Damage to the Optic Nerve will cause...
unilateral blindness
Describe gray matter
unmyelinated, contains glial cells, capillaries, cell bodies, dendrites
Definition of suspensory strategy; often seen during
used to lower CoG during standing or ambulation to increase control over CoG. when mobility and stability needed simultaneously (surfing)
How to screen two-point discrimination
using two-point caliper on skin, identify one or two points without visual input
Greenstick Fracture description
usually in children, one side breaks other side remains in tact
Special Tests for elbow ligamentous instability (2)
valgus and varus test
Allen's Test is highly specific for identifying _____
vascular compromise
CT scan can be used to rule out (5+)
vascular malformations, tumors, cysts, herniated discs, hemorrhage, epilepsy, encephalitis, spinal stenosis, intracranial bleeding, and head injury
Active Movement Findings: Rotator Cuff Lesion
weakness of ABD and/or rotation, crepitus
Signs of impairment to Frontal Lobe
-contralateral weakness -perseveration - personality change -impaired concentration -Broca's aphasia (expressive) -delayed/poor initiation -emotional lability
RoM of shoulder ER
0-90
Nerve tested for Given DTRs 1) Jaw 2) Biceps 3) Triceps 4) Brachioradialis 5) Hamstrings 6) Quads (knee jerk, patellar) 7) Achilles (ankle jerk)
1) CN V 2) C5-6 3) C7-8 4) C5-6 5) L5-S3 6) L2-4 7) S1-2
Sensory Organization Test: 1) Conditions (6) 2) Pts depend on vision become unstable in conditions 3) Pts depend on surface/somatosensory inputs become unstable in conditions 4) Pts with vestibular loss become unstable 5) Pts with sensory selection problems become unstable
1) 1: eyes open, stable surface 2: eyes closed stable surface 3: visual conflict (moving visuals on screen) on stable surface 4: eyes open moving platform 5: eyes closed moving platform 6: visual conflict moving surface 2) 2, 3, 5 3) 4, 5, 6 4) 5 and 6 5) 3-6
Mini-Mental State Examination 1) Max Score 2) Mild Impairment Score 3) Moderate Impairment 4) Severe Impairment
1) 30 2) 21-24 3) 16-20 4) 15 or less
Slipped Capital Femoral Epiphysis (SCFE) 1) Most common what? 2) Deformity Observed 3) Onset in males and females (avg. age). Most prevalent? 4) Dx factors
1) Adolescent hip disorder of unknown etiology 2) Posterior displacement of femoral head and inferior to neck of femur. Within confines of acetabulum 3) Males: 10-17 (~13); Females: 8-15 (~11). More in males 4) restrictions in ABD, flex, and IR AROM, vague knee/thigh/hip pain, (if chronic) Trendelenburg, plain fillm (+) for posterior displacement of upper femoral epiphysis
A patient four weeks status post anterior cruciate ligament reconstruction questions a physical therapist as to why he is still partial weight bearing. An acceptable rationale is: 1. the patient does not have full active knee extension 2. the patient has good quadriceps strength 3. the patient has fair hamstrings strength 4. the patient has diminished superficial cutaneous sensation
1) Ambulation on a flexed knee can result in excessive irritation of PF joint (I had thought 4) However, cutaneous sensation does not affect WB status
Complex Regional Pain Syndrome: Late Stage 1) aka 2) Description
1) Atrophic 2) decreased hypersensitivity; normal vasomotor; skin normalization; severe mm atrophy; pericapsular fibrosis; diffuse osteoporosis; possible claw hand
Pseudobulbar Palsy 1) Description 2) sx 3) examine for
1) B dysfunction of corticobulbar innervation of brainstem, UMN dz 2) similar to bulbar palsy 3) hyperactive refexes
Dupuytren's Fracture 1) Observed as? 2) Gender prevalence 3) Contractures of which joints? Specifically in DM and non-DM populations?
1) Banding on palm, digit flexion contractures from palmar fascia adherence to skin contracture 2) Males 3) Non-DM: MCPs and PIPs of 4th and 5th digits; DM pts: 3rd and 4th
Wheelchair Recommendation for pts with high cervical lesion 1) What segments? 2) Type of chair? 3) Controls?
1) C1-4 2) electric with tilt-in space or reclining back 3) microswitch/puff and sip
Wheelchair Recommendation for pts with shoulder function and elbow flexion 1) Segment 2) Type of chair? 3) Independence with?
1) C5 2) manual with propulsion aids 3) level short distance
Wheelchair Recommendation for pts with radial wrist extensors 1) Segment 2) Type of chair 3) Level of independence
1) C6 2) manual chair with friction surface hand rims 3) Independent
Wheelchair Recommendation for pts with tricep function 1) Segment 2) Type of chair 3) Level of independence
1) C7 2) manual chair with friction surface hand rims; have more propulsion ability than C6 lesion 3) Independent
Wheelchair Recommendation for pts with full hand function 1) Segment 2) Type of chair 3) Level of independence
1) C8 and below 2) manual with standard rims 3) Independent
Sever's Dz 1) aka 2) Most common cause of what? 3) Caused by? 4) B involvement in ___% of cases 5) dx using? 6) Temporary cessation of what activities and what orthoses?
1) Calcaneal Apophysitis 2) cause of heel pain in growing children, occurs before puberty or during growth spurts 3) repetitive microtrauma due to increased traction by Achille's tendon at insertion 4) 60% 5) Plain film 6) jumping, running, heel lifts/cups
Lesion to Cerebellum 1) Example disorder 2) Sensation 3) Tone 4) Reflexes 5) Strength 6) Mm Bulk 7) Involuntary Movements 8) Voluntary Movements 9) Posture 10) Gait
1) Cerebellar Lesion: tumor or stroke 2) Not affected 3) Normal/decreased 4) Normal/decreased 5) Normal/weak 6) Normal 7) none 8) Ataxia, dysdiadochokinesia, dysmetria, dyssynergia nystagmus 9) Impaired: truncal ataxia, dysequilibrium 10) Impaired: ataxic, wide-based, unsteady
Rheumatoid Arthritis 1) Chronic or acute? Etiology? Symmetrical or asymmetrical sx? 2) Dysfunction of synovial and articular tissues of what joints? 3) Affects on MCP joints? 4) Affects on PIP joints? 5) Affects on DIP joints? 6) Predominant gender? 7) Juvenile RA onset age? Complete remission in ______ % of cases 8) Dx Testing (5)
1) Chronic; unknown; symmetrical 2) all UE and LE joints 3) ulnar drift and volar subluxation 4) if severe form- ulnar drift; Bouchard's nodes 5) usually spared 6) Women 2-3x more than men 7) Prior to 16; 75% 8) Plain films show symmetrical involvement, increased WBC and erythrocyte sedimentation rate (inflammation), anemia (+), and elevated rheumatoid factor
Talipes Equinovarus 1) aka 2) Observed Deformity 3) Positioning of joints: talocrural is? Subtalar, talocalcaneal, talonavicular, and calcaneocuboid joints are? Midtarsal joitn is? 4) Course of Treatment for postural and non-postural deformity
1) Clubfoot 2) PF, ADD and inverted foot 3) Talocrural: PF; Midtarsal: supinated; rest: inverted 4) Postural: manipulation--> casting--> Denis-Brown orthosis throughout day 3 months and at night 3 years and stretching Non-postural: surgery--> casting/splinting
Deceberate Posturing 1) Seen in? 2) Description
1) Comatose pt with damage to brainstem between superior colliculus and vestibular nucleus 2) trunk, neck and limbs rigid in extension
Decorticate Posturing 1) Seen in? 2) description
1) Comatose pts with lesion above superior colliculus 2) UE in flexion and LE in extension
Cervical Facet Syndrome Signs and Sx 1) Referred Pain? 2) Pain with hyperextension and rotation of cervical spine? 3) Stiffness? 4) Paresthesia? 5) Reflexes affected? 6) Muscle Guarding? 7) Tension Test Results? 8) Pallor and coolness? 9) Muscle Weakness? 10) Muscle fatigue and cramps?
1) Common 2) Yes; typically localized to joint 3) Yes 4) Not usually, but possible 5) No 6) Yes 7) Typically - 8) No 9) No 10) No
American Spinal Injury Association (ASIA) Impairment Scale 1) A 2) B 3) C 4) D 5) E
1) Complete: no motor/sensory in sacral segments S4-5 2) Incomplete: sensory preserved; no motor below level of insult and includes S4-5 3) Incomplete: motor preserved below insult level, with most grade <3/5 4) Incomplete: motor preserved below level, most mm 3 or more/5 5) normal: motor and sensory is preserved
Equinus 1) Common etiologies (5) 2) Deformity observed 3) Compensation secondary to limited ______ includes ______ or ______ pronation
1) Congenital bone malformation, CP, contracture of gastroc/soleus, trauma, inflammatory dz 2) PF 3) DF; subtalar or midtarsal
Types of Multiple Sclerosis: Primary-Progressive 1) Characteristics 2) Progression
1) Discrete attack do not occur; modest fluctuations in neuro disability 2) Dz progression and deterioration from onset
Localized Lesion to Cortex: Frontal Lobe: Primary Motor Cortex 1) Function 2) Sx
1) Discrete voluntary movement 2) Contralateral paralysis; most pronounced in distal limbs and lower face
Complex Regional Pain Syndrome: Middle Stage 1) aka 2) Description
1) Dystrophic 2) skin changes; cessation of hair and nails; hyperhidrosis; muscle atrophy and osteoporosis
Piriformis Syndrome 1) Piriformis _____ the hip and can be overworked from ______ 2) May lead to? 3) Signs and sx? (5) 4) What first must be ruled out?
1) ER; excessive pronation of foot 2) sciatic nerve compression or SIJ dysfunction 3) restricted IR, pain with palpation, referred pain to posterior thigh, weak ER (+ piriformis test), uneven sacral base 4) Involvement of lumbar spine and SIJ
Salter-Harris Type I 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management
1) Entire epiphysis 2) Shearing, torsion, or avulsion 3) Good; very few complications to bone growth 4) Relocated if needed; immobilized
Salter-Harris Type II 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management
1) Entire epiphysis and portion of metaphysis 2) shear or avulsion with angular force. 3) May cause: minimally decreased bone growth, limited negative impact on function 4) Relocated and immobilized
Charcot-Marie-Tooth Dz 1) Description 2)Progression of dz
1) Genetic dz causing peroneal atrophy that affects motor and sensory nerves 2) Initially affects muscles of lower leg and foot, then progress to hands and forearms
Age variations with Valgum/Varum Angulation 1) Newborns and infants 2) 6-12 months 3) 18-24 months 4) 3-4 years 5) 7-adulthood 6) Norm angulation for males and females
1) Genu Varum normally found 2) maximal varum 3) straighten to 0 deg 4) maximal valgus (~12 deg) 5) Spontaneous correction of valgum 6) Males: 7 deg; Females: 8 deg
Rearfoot Valgus 1) Possible Etiologies 2) Observed Deformity
1) Genu valgum (knee) or tibial valgus 2) eversion of calcaneus with subtalar neutral
Coxa Vera 1) Description 2) Typical cause
1) angle of femoral neck with shaft of femur is <115 deg. 2) defect in ossification of femoral head or necrosis of femoral head from septic arthritis
Tonic-Clonic Seizure 1) aka 2) Signs 3) Duration 4) Post Seizure Sx 5) Time to full recovery
1) Gran mal 2) dramatic loss of consciousness, cry, fall, convulsions of all extremities, tongue biting, arrested breathing, incontinence 3) 2-5 minutes 4) confusion, drowsy, amnesia of event 5) Several hours
Forefoot Valgus 1) Involved deviated structures 2) Observed deformity
1) Head and neck of talus 2) eversion of forefoot with subtalar neutral
Patella Baja 1) Description 2) Leads to restriction with what motion and may cause what?
1) Inferior tracking of patella 2) Extension; DJD
ANS Characteristics: Parasympathetic Division 1) Effects are local or widespread? Long or short acting? 2) Effect on blood vessels to gut 3) Effect on airway 4) Effect on urinary bladder
1) Local; short 2) Dilates 3) Constricts 4) stimulates contraction
Autonomic Dysreflexia 1) What is it 2) Sx 3) what to do?
1) Medical emergency. noxious stimuli causes autonomic reflex 2) paroxysmal HTN, bradycardia, headache, sweating, flushing, diplopia, or convulsions 3) CHECK AND EMPTY CATHETER FIRST, examine for irritant, elevate head
Metatarsus Adductus 1) Fun Fact 2) Mostly seen in ______ and i the ______ foot 3) Most common cause 4) Rigid Type 5) Flexible Type 6) Possible surgical release of what tendon for flexible type? 7) _______% of cases are identified at birth and resolve around year without treatment
1) Most common congenital foot condition 2) females and left foot 3) Intrauterine packing 4) medial subluxation of tarsometatarsal joint; hindfoot in slight valgus with navicular lateral to head of talus 5) Observed as ADD of all metatarsals at tarsometatarsal joint 6) ABD Hallucis 7) 85-90%
Localized Lesion to Cortex: Frontal Lobe: Prefrontal Area 1) Function 2) Sx
1) Motor Association 2) Loss of specific motor plans
Localized Lesion to Cortex: Frontal Lobe: Premotor Area 1) Function 2) Sx
1) Motor Planning 2) Apraxia/motor planning difficulties
Other Conditions Affecting the Spine: Bone Tumors 1) Most common primary bone tumor 2) Typical primary sites of metastatic bone tumors (5) 3) During pt interview always get this info 4) Signs and sx
1) Multiple Myeloma 2) lung, prostate, breast, kidney, thyroid 3) Prior CA hx 4) Pain: unvarying and progressive, not relieved by rest or analgesic, more pronounced at night
Salter-Harris Type V 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management
1) Nothing "broken off" ; compression injury to epiphysis 2) Compression or crush injury of epiphyseal plate, no associated fracture. 3) Growth disturbance at physis. Poor functional prognosis 4) Usually found after the fact; so no immediate intervention. If identified acutely, pt given non-WB protocols
1) Procedure for femoral fracture 2) Non-WB for how long?
1) ORIF 2) 1-2 weeks
Sinemet 1) Primary med for? 2) Common Drug name 3) Drug effects prolonged with low ______ diet 4) Adverse Effects 5) On-Off Phenomenom
1) PD 2) Levodopa 3) protein 4) nausea, vomit, orthostatic hypotension, arrhythmias, dyskinesia, psychoses, abnormal behavior 5) experience of normal function to immobility to severe dyskinesia
Lesion to Basal Ganglia: Subcortial Gray 1) Example disorder 2) Sensation 3) Tone 4) Reflexes 5) Strength 6) Mm Bulk 7) Involuntary Movements 8) Voluntary Movements 9) Posture 10) Gait
1) Parkinsonism 2) Not affected 3) Lead-pipe/cogwheel rigidity 4) Normal/decreased 5) Slowed movement 6) Normal/disuse atrophy 7) Resting tremor 8) Bradykinesia/akinesia 9) Impaired: stooped 10) Impaired: shuffling, festinating
Localized Lesion to Cortex: Parietal Lobe: Parietal Lobe (right hemisphere) 1) Function 2) Sx
1) Perceptual Function 2) Visual-spatial disorders, body scheme disorders, apraxias, tactile and auditory perceptual disorders
Cheyne-Stokes Respiration 1) Description 2) Possible causes (2)
1) Period of apnea lasting 10-60 seconds followed by gradually increasing depth and frequency of respirations 2) Depressed frontal lobe and diencephalon dysfunction
Salter-Harris Type IV 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management
1) Portion of epiphysis and portion of metaphysis 2) Similar to Type III. Mostly seen in distal humerus. 3) May lead to premature focal fusion of involved bone causing deformity to joint; due to growth plate involvement. Dependent on quality of realignment 4) ORIF for alignment.
Salter-Harris Type III 1) Anatomical Deformity 2) Common Cause 3) General Prognosis 4) Medical Management
1) Portion of the epiphysis 2) Typically when growth plate is partially fused. Most commonly occurs to distal tibia in adolescents 3) Long-term issues: however, not significant deformity and still favorable. 4) Relocated and immobilized. Occasional need of ORIF.
TOS Signs and Sx 1) Is there referred Pain? 2) Pain with hyperextension and rotation of cervical spine? 3) Stiffness? 4) Paresthesia? 5) Reflexes affected? 6) Muscle Guarding? 7) Tension Test Results? 8) Pallor and coolness? 9) Muscle Weakness? 10) Muscle fatigue and cramps?
1) Possible 2) No 3) Possible; typically form muscle tightness vs joint 4) Possible 5) May be affected 6) Yes 7) May be + 8) Possible in hands 9) Only in later progression in small muscles 10) Possible
Opisthotonos 1) Description 2) Seen in?
1) Prolonged severe spasm of mm--> head, back and neck arched back; arms and hand rigid flexion 2) Severe meningitis, tetanus, epilepsy, strychnine poisoning
Test Proprioception (Deep) Sensation 1) Joint Position 2) Kinesthesia 3) Pallesthesia
1) Pt identifies where limb is in space with PT positioning 2) (movement sense) Pt copies movement of limb done by PT or verbally gives direction 3) (vibration sense) Perceive tuning fork vs sham (deep pressure)
Coxa Valga 1) Description 2) Possible cause?
1) angle of femoral neck with shaft of femur is >125 deg. 2) necrosis of femoral head from septic arthritis
Other Conditions Affecting the Spine: Cardiovascular and Pulmonary Conditions 1) Heart and lung disorders may refer pain to? (5) 2) Abdominal Aortic Aneurysm sx and typically identified during
1) chest, back, neck, jaw, UE 2) nonspecific LBP; pain during abdominal exam
Nerve Tested for given superficial reflex 1) Plantar 2) Abdominal 3) Cremasteric
1) S1-2 (Tibial nerve) 2) T6-L1 3) L1-2
Lesion to Spinal Cord 1) Example disorder 2) Sensation 3) Tone 4) Reflexes 5) Strength 6) Mm Bulk 7) Involuntary Movements 8) Voluntary Movements 9) Posture 10) Gait
1) SCI 2) Impaired/absent below lesion 3) initial flaccidity with spinal shock, hyper/spastic below lesion 4) Hyper 5) Impaired/absent 6) Disuse atrophy 7) spasms 8) Intact: above lesion 9) Impaired below lesion 10) Impaired/absent
Localized Lesion to Cortex: Parietal Lobe: Secondary Somatosensory Area 1) Function 2) Sx
1) Sensory interpretation 2) Tactile agnosia: astereognosia, agraphesthesia, loss of two-point discrimination, extinction
Gout 1) Characterized by increased levels of ______ 2) What affects the joints and other tissues 3) Frequently Affected Joints?
1) Serum Uric Acid (hyperuricemia) 2) uric acid turns to crystals that enter joint spaces and tissues 3) knees and big toe
Superficial Sensory Testing 1) Pain 2) Temperature 3) Touch
1) Sharp/dull using paperclip 2) Hot/cold with test tubes with hot/cold water 3) Response to touch/no touch with cotton ball
Visual Acuity Tests 1) What test focuses on Central vision 2) What test focuses on Visual Fields
1) Snellen eye chart: test each eye separately 20 feet away 2) test peripheral vision by confrontation
Localized Lesion to Cortex: Temporal Lobe: Superior Temporal Gyrus (Left hemisphere) 1) Function 2) Sx
1) Storage of auditory information 2) Impaired Learning and memory
Localized Lesion to Cortex: Temporal Lobe: Temporal Cortex (nondominant hemisphere) 1) Function 2) Sx
1) Storage of visual information 2) Profound loss of memory of recent events
Lesion to Cerebral Cortex: Corticospinal Tracts 1) Example disorder 2) Sensation 3) Tone 4) Reflexes 5) Strength 6) Mm Bulk 7) Involuntary Movements 8) Voluntary Movements 9) Posture 10) Gait
1) Stroke 2) Contralateral loss 3) Hyper; may initially be flaccid with cerebral shock 4) Hyper 5) Contralateral weak 6) Normal with acute, disuse atrophy with chronic 7) Spasms 8) Dyssynergic 9) Impaired/absent 10) impaired
Kernig's Sign 1) Test position 2) Positive Sign; if bilateral may indicate
1) Supine, flex hip and knees to chest, then extend knee 2) pain and increased resistance to extend knee due to hamstring spasm; meningeal irritation
Locomotor Training for pts with high lumbar lesion 1) Segments 2) AD and Orthosis and Gait pattern 3) level of independence
1) T12-L3 2) B KAFO and crutches; swing-through or 4 point. Reciprocating gait orthosis with walker with/out FES 3) can be independent in ambulation on all surfaces and stairs. May use manual WC for community distances
Locomotor Training for pts with midthoracic lesions 1) segments 2) AD and Orthosis and gait pattern 3) level of independence
1) T6-9 2) B KAFO and crutches; swing-to 3) Supervision household ambulation and assistance otherwise
Localized Lesion to Cortex: Parietal Lobe: Gustatory Cortex 1) Function 2) Sx
1) Taste 2) Contralateral taste impairment of tongue
DeQuervain's Dz 1) Description 2) Cause
1) Tenosynovitis of extensor tendons of the radial wrist- ABD Pollicis Longus and Extensor Pollicis Brevis 2) Overuse of thumb, wrist deviation, or arthritis
Psoriatic Arthritis 1) Etiology? Acute or Chronic? Associated with? 2) Typical location of joint erosion? 3) Male or female predominance? 4) Medication that can slow progression 5) Dx test
1) Unknown; Chronic; Psorisis 2) hands and axial skeleton 3) equal 4) dz-modifying antirheumatoid drugs (DMARDs) 5) not helpful, only to rule out RA
Osteomalacia 1) Decalcification of bones secondary to ______ 2) Sx (4)
1) Vitamin D Deficiency 2)severe pain, fractures, weakness, and deformities
WB for TKA 1) Cemented 2) Cementless
1) WBAT 2) 25% weeks 1-7, 50% by week 8, 75% by week 10, 100% by week 12
ANS Characteristics: Sympathetic Division 1) Effects local or widespread? 2) Effect on skeletal mm blood flow 3) Effect on airways 4) Effects on urinary bladder
1) Widespread 2) constricts or dilates 3) relaxes 4) relaxes
Cervical Spinal Nerve Lesion Signs and Sx 1) Referred Pain? 2) Pain with hyperextension and rotation of cervical spine? 3) Stiffness? 4) Paresthesia? 5) Reflexes affected? 6) Muscle Guarding? 7) Tension Test Results? 8) Pallor and coolness? 9) Muscle Weakness? 10) Muscle fatigue and cramps?
1) Yes 2) Yes; typically increases sx 3) Possible 4) Yes 5) May be affected 6) Yes 7) + 8) No 9) Possible 10) No
Apneustic Breathing 1) Description 2) Possible cause
1) abnormal respiration marked by prolong inspiration 2) Damage to upper pons
Vestibular Neuronitis, labyrinthitis 1) Description 2) Duration 3) Etiology
1) acute infection with prolonged attack of sx 2) persisting for several days/weeks 3) viral or bacterial infection
Osteochondritis Dissecans 1) Affects and description? 2) age of onset 3) Mechanism of injury
1) affects central and/or lateral capitellum or radial head (medial condyle). Bone fragment becomes detached and lodges in joint. (loose body) 2) 12- 15 years old 3) repetitive compression of radial head and humeral capitellum
Spondylolithesis 1) Description 2) Grades (4) 3) Two plain film views to view what? 4) Clinical test to identify 5) Contraindication?
1) congenital defective pars interarticularis that may lead to bilateral fracture leading to anterior/posterior slippage of one vertebrae on another 2) I: 25%, II: 50%, III: 75%, IV: 100% slippage 3) Oblique: see fracture, Lateral: see slippage 4) Stork Test 5) Manipulation
Arthrogryposis Multiplex Congenita 1) Description 2) Impact on intelligence 3) Progressive or non-progressive contractures?
1) congenital skeletal and soft tissue deformation characterized by limited joint motion and "sausage like" appearance of limbs 2) none 3) non-progressive
Anterior Cord Syndrome 1) Loss of what tract leads to B loss of motor function and spastic paralysis below level of lesion 2) Loss of what tract leads to B loss of pain and temp sensation 3) What tract is preserved that senses proprioception, kinesthesia, and vibration
1) corticospinal tract 2) spinothalamic tract 3) dorsal columns
Types of Multiple Sclerosis: Relapsing-Remitting 1) Characteristics 2) Progression 3) Prevalence
1) discrete neurological attacks (relapse) with full/partial recovery (remission) in following weeks or months 2) No progression between relapses 3) 85%
TMJ: Internal Derangement of Joint 1) Includes (3) 2) Typical strengthening and flexibility protocol
1) dislocation, displaced articular disc, or condyle injury 2) Rocabado's
UE Flexor Tendon Repair 1) First 3-4 weeks 2) PT initially involves what? 3) What may be introduced after 4 weeks? 4) Resisted and functional exercise introduced when?
1) distal extremity immobilized with wrist and digits flexed (30-50) 2) resisted extension and passive flexion 3) AROM to tolerance 4) full AROM achieved, first extension then flexion
Brown-Sequard Syndrome 1) Ipsilateral loss of what leads to loss of tactile discrimination, pressure, vibration, and proprioception 2) Ipsilateral loss of what leads to motor function and spastic paralysis below level of lesion 3) Contralateral loss of what leads to loss of pain and temperature below level of lesion and at level B loss of pain and temp
1) dorsal columns 2) corticospinal 3) spinothalamic
Stage IV Parkinson's Findings 1) Communication 2) Gait 3) Tone 4) Balance 5) Respiratory Function
1) dysarthia, hypophonia, masklike face, small handwriting 2) poverty of movement, festinating gait 3) Cogwheel rigidity 4) impaired postural reactions including trunk reactions and lack of rotation 5) decreased chest expansion, decreased vital capacity
Scaphoid Fracture 1) Most Common What? 2) Common mechanism of injury? 3) Possible complication? 4) Immobilization time
1) fractured carpal 2) fall on outstretched hand 3) Avascular necrosis of proximal fragment 4) 4-8 weeks
PD Meds Intention 1) Dopamine agonist 2) Anticholinergic 3) Amantadine 4) Selegeline
1) increases Sinemet effect 2) tremor control 3) enhances dopamine release 4) monoamine oxidase inhibitor increases dopamine; slows progression in early stages
Types of Multiple Sclerosis: Secondary-Progressive 1) Characteristics 2) Progression
1) initially relapsing-remission, changes to progressive, with/out acute attacks 2) Changes to progressive steady decline in function
Stages of Primary Shoulder Impingement Stage 1: sx and age of onset Stage 2: sx Stage 3: sx
1) intermittent mild pain with OH activities; 35+ 2) Mild-moderate pain with OH or strenuous activities 3) Pain at rest or with activities. Possible night pain. Scapular or RTC weakness
Complex Regional Pain Syndrome 1) Etiology 2)Dysfunction of? Causing? 3) Types 4) Long-Term Changes (6)
1) largely unknown, but may be due to trauma 2) Sympathetic nervous system: pain, circulation issues, and vasomotor issues 3) Type I: tissue injury without nerve involvement; Type 2: tissue injury with nerve involvement 4) muscle wasting, trophic skin changes, decreased bone density, decreased proprioception, disuse atrophy, and joint contractures
Panner's Dz 1) Description 2) Age of onset
1) localized avascular necrosis of capitellum (distal humerus) leading to loss of subchondral bone 2) 10 years old or younger
Posterior Cord Syndrome 1) What is it 2) what is lost? 3) What is preserved
1) loss of dorsal columns 2) proprioception, kinesthesia, vibration, pressure, two-point discrim, stereognosis 3) motor function, pain, and light touch
Osteoporosis 1) Type of dz? 2) Gender predominance 3) Common sites of fracture? (7) 4) Primary or postmenopasal osteoporosis is directly linked to? 5) Senile osteoporosis due to? 6) Dx tool to assess bone density? 7)
1) metabolic bone mineral wasting 2) women 10x more than men 3) lumbar or thoracic spine, femoral neck, proximal humerus, proximal tibia, pelvis, and distal radius 4) Estrogen decrease 5) genetic or acquired abnormalities 6) CT 7)
Other Conditions Affecting the Spine: GI Conditions 1) Acute Pancreatitis sx 2) Cholecystitis sx
1) mid epigastric pain radiating through back 2) abrupt, severe ab pain and right upper quadrant tenderness, nausea, vomiting, fever
Internal Tibial Torsion 1) Fun Fact 2) high complication rate with ______ of ______ and is associated with ______
1) most common cause of toeing in 2) osteomoty of tibia; W sitting
Spinal Movement Couplets: In the lumbar and thoracic spine- 1) when in neutral/extension side-bending and rotation occur in same/opposite direction? 2) when in flexion side-bending and rotation occur in same/opposite direction?
1) opposite 2) same
Bursitis 1) Inflammation secondary to? (4) 2) Instances of pain 3) RoM limitations
1) overuse, gout, trauma, infection 2) pain at rest and during P/AROM 3) limited due to pain, but not in capsular pattern
Lateral Retinacular Release 1) Typical reason to perform procedure 2) PT ther-ex should emphasize ______ exercises
1) patellofemoral pain syndrome 2) closed kinetic chain
Posterolateral Disc Herniation 1) Mechanical reasons for being most common herniation (3) 2) Resulting sx (4) 3) PT exercise revolves around (2) 4) Positional gapping technique for left posterolateral herniation 5) Possible contraindicated interventio
1) posterior disc is more narrow than anterior disc, posterior longitudinal ligament relatively weak and only centrally located in the lumbar spine, posterior lamellae are thinner 2) Loss of strength, radicular pain, paresthesia, ADL difficulties 3) Stabilization and disc regeneration stimulus 4) pt right sidelying, pillow under hip, flexed hips and knees, rotate trunk left (or pelvis right) 5) Manipulation
Post Spinal Surgery 1) Avoid (2) for 3 months 2) Always avoid 3) Early movement and activation of paraspinals is indicated for which procedures
1) prolonged sitting and heavy lifting 2) repetitive bending and twisting 3) laminectomy/discectomy
Promoting Learning with pts post Left CVA 1) Key to communication 2) Give ______ feedback and support 3) Do not underestimate ability to ______
1) pt understanding 2) frequent 3) learn
Ménièré's Dz 1) Description 2) Duration 3) Etiology 4) Consistent finding
1) recurrent progressive vestibular dz; severe tinnitus, deafness, sensation of ear fullness 2) minutes to hours 3) unknown 4) Membranous Labyrinthe edema
Central Cord Syndrome 1) Loss of what tract leads to loss of pain and temp sensation 2) Loss of what leads to B UE loss of motor function 3) What sensations are preserved
1) spinothalamic 2) Ventral horn 3) proprioception and discriminatory touch
Types of Multiple Sclerosis: Progressive-Relapsing 1) Characteristics 2) Progression
1) steady deterioration like PPMS, but with acute attacks 2) Progression between relapses
Paget's Dz (osteitis deformans) 1) possible etiology (besides unknown) 2) Type of dz characterized by? 3) Results in (3)
1) viral/environmental 2) Metabolic bone dz characterized by osteoclastic/blastic dysfunction 3) Spinal stenosis, facet arthropathy, and possible fracture
Bulbar Palsy 1) Description 2) Etiology 3) Examine for (4)
1) weakness/paralysis of muscle innervated by motor nuclei of lower brainstem, affecting face, tongue, larynx, and pharynx 2) tumor or LMN dz 3) glossopharyngeal and vagus paralysis, changes in voice quality, B involvement, (complication) aspiration PNA
Post Meniscal Arhtroscopy 1) When can a pt PWBAT 2) PT goals (3) 3) Jogging technique to reduce load on knee
1) when full extension is achieved 2) Initial: edema/effusion control, AROM surgery day 1, isotonic/isokinetic strengthening by day 3 3) forefoot/toe jogging
Colle's Fracture 1) Most common what? 2) Mechanism of injury 3) Possible nerve compression? 4) Time immobilized? 5) Most important early intervention?
1) wrist fracture; fracture of distal radius and ulnar styloid posteriorly 2) Fall on outstretched hand 3) Median from excessive edema 4) 5-8 weeks 5) Flexibility
Kabat, Knott, and Voss: PNF Terms 1.) Chopping 2.) Developmental Sequence 3.) Mass Movement Patterns 4.) Overflow
1.) combination of bilateral upper extremity asymmetrical patterns performed as a closed-chain activity 2.) progression of motor skill acquisition: mobility, stability, controlled mobility, skill 3.) hip, knee, and ankle move into flexion/extension simultaneously 4.) muscle activation of involved extremity due to intense action of uninvolved muscle or group of muscles
Bobath: NDT 1.) postural control can be _______ and _______ through experience 2.) Postural control uses both ________ and _________ mechanisms for execution of tasks 3.) Postural control initiates from _____ 4.) Postural control is required for skill _________ 5.) Develop postural control by progressing to positions that increase _________ and decrease ________
1.) learned and modified 2.) feedback and feed-forward 3.) pts BoS 4.) development 5.) distance between CoG and BoS and decrease BoS as well
Dix-Hallpike Maneuver stimulates the (1)_____ ______ ______. If pt experiences (2)_______ and (3)______, then test performed to determine if pt has (4)______ or (5)______.
1.) posterior semicircular canal 2.) nystagmus 3.) vertigo 4.) BPPV 5.) Central lesion
Bobath: NDT Key Terms 1.) Facilitation 2.) Inhibition 3.) Key Points of Control 4.) Placing 5.) Reflex Inhibiting Posture
1.) technique utilized to elicit voluntary muscular contraction 2.) technique to decrease excessive tone or movement 3.) specific handling of designated areas of the body will influence and facilitate posture, alignment, and control 4.) act of moving an extremity into a position that the pt must hold against gravity 5.) designated static positions that inhibit abnormal tonal influences and reflexes
How many ribs articulate with thoracic vertebraes costovertebral and costotransverse joints?
10
Scoliosis typically diagnosed at what age?
10-13
Normal forward angulation of femoral neck in frontal plane If less, then termed? More?
10-15 anteversion retroversion
Normal femoral neck angle to frontal plane. Excessive angulation?
10-15 deg; 25-30 deg
Systemic Juvenile Rheumatoid Arthritis
10-20% of cases. acute onset, high fever, rash, enlarged spleen/liver, inflamed lungs and heart.
History of: Atraumatic Instability age of onset, common complaints
10-35, pain and instability with activity
The windlass test has ______ sensitivity for identifying windlass effect on plantar fascia
100%
What makes ribs 11 and 12 different from 1-10?
11 and 12 only articulate with vertebral bodies of T-11 and T-12 and not the transverse process. AKA floating ribs
Normal Angle of Inclination in hip? If less, then termed? More?
115-125. Coxa vara. Coxa valga
How many pairs of cranial nerves exit the skull through foramina?
12
How many thoracic vertebrae are there?
12
Healthy BF% for males? Females?
12-18%; 18-23%
Stages of ALS (6)
1: asymmetrical mild focal weakness; hand cramping and fasciculations 2: moderate weakness in muscle groups, Mod-I with AD 3: severe weakness of specific muscles, increased fatigue, mild-mod functional limitations 4: severe weakness and wasting of LE, mild weakness of UE, WC 5: progressive weakness with deterioration of mobility and endurance, increased fatigue, mod-severe weakness of limbs and trunk, spastic, hyper reflexes, loss of head control, max-A 6: bedridden, dependent, progressive respiratory distress
History of: Rotator Cuff Lesion Age of onset and common complaint
Age of Onset: 30-50, pain and weakness with eccentric loading
Describe Slump Test
Assesses for dysfunction of neurological structures supplying lower limb. pt sits with head slumped and knees flexed off table (stop progression of steps if symptomatic) --> passively flex neck and head --> extend one knee--> passively DF foot of extended leg --> repeat steps with other extremity. Positive if neurological sx at any step.
Special Tests for wrist/hand contracture/tightness (2)
Bunnel-Littler test, tight retinacular ligament test
Characteristics of Central vs Peripheral Nystagmus: Visual Fixation
Central: No inhibition with visual fixation Peripheral: inhibits nystagmus and vertigo
Characteristics of Central vs Peripheral Nystagmus: Direction
Central: bidirectional or unidirectional Peripheral: Unidirectional (towards opposite side of lesion)
Occlusion of anterior inferior cerebellar artery supplies ____ and may lead to what sx?
Cerebellum; ataxia, nystagmus, tremor, dysmetria, incoordination, and balance deficits
Occlusion of Middle cerebral supplies ____ and artery may lead to wha sx?
Cerebrum; contralateral hemiplegia, aphasia, apraxia, and cognitive decline.
Description of Foraminal Compression (Spurling's) Test
Cervical Nerve Root Compression: pt in sitting with head laterally flexed. PT exerts downward force through head. Positive if radiating pain down arm
Description of Vertebral Artery Test (cervical)
Compression of vertebral artery: pt in supine. PT passively extends pt's head, then lateral flexion, and ipsilateral rotation. Positive if dizziness, nystagmus, slurred speech or LoC.
Convex or Concave?: finger flexion/extension (distal phalanx) and ABD ADD (proximal phalanx)
Concave
Peak Muscle Activity During Gait Cycle: Calves
Concentric raising of heel during toe off during late stance
Parietal lobe impairments: dominant hemisphere sx and non-dominant hemisphere sx.
Dominant hemisphere(typically left): agraphia, alexia, agnosia. Non-dominant hemisphere: dressing apraxia, anosognosia Contralateral sensory deficits Impaired taste Impaired language comprehension
Osteogenesis Imperfecta: Two types are autosomal dominant and two are autosomal recessive
Dominant: I and IV Recessive: II and III
What muscles, first and second, are used to counter a sudden moderate force leading to backward sway
First paraspinals then hamstrings
Common foot tendonopathy in ballet performers
Flexor Hallucis
Describe Biceps Load 2 Test
Identifies SLAP lesion. Pt in supine. PT puts pt shoulder into 120 ABD, max ER, 90 elbow, and forearm supinated. One hand holds wrist other stabilizes elbow. Pt then told to try to flex elbow. Positive if sx increase
Describe FADIR Test
Identifies anterior-superior impingement, iliopsoas tendonopathy, and anterior labral tears. Pt in supine and involved LE taken from full passive flexion, ABD and ER --> flexed ADD and IR. Positive if painful with or without click.
Describe Kleiger Test
Identifies integrity of distal tibiofibular syndesmosis. Pt seated with knee in 90. PT stabilized tibia and ER foot. Positive if symptomatic or noticeable gapping.
Describe Modified Sharp Purser Test.
Identifies integrity of transverse ligament. Pt seated. PT passively slightly flex upper cervical spine and pincer grasp C-2. Apply posterior and extending force through forehead onto C-spine accessing for excessive linear translation or myelopathic sx. Positive if myelopathic sx with upper cervical flexion or a decrease in sx, or excessive translation during posterior/extending motion.
Describe Pronator Teres Syndrome Test
Identifies median nerve entrapment within pronator teres. pt in sitting with elbow supported at 90. PT attempts to pronate and extend elbow. Pt resists. Positive if tingles or paresthesia in median nerve distribution
Describe McKenzie's Side Glide Test
Identifies scoliotic curvature vs side-gliding due to neurological dysfunction. Place shoulders on shifted upper trunk and wrap arms around pelvis. Bring pelvis in alignment with upper trunk. Positive if neurological sx are produced
Describe Stork Test
Identifies spondylolithesis. Pt stands on one leg. Cue pt into extension. Repeat with opposite leg. Positive if ipsilateral low back pain.
Central Cord Syndrome 1) Causal factor 2) Tracts damaged (3) 3) Deficits
Incomplete lesion caused by hyperextension damaging spinothalamic tract, corticospinal tract, and dorsal columns. Motor>sensory deficits. Upper extremities more affected than lower.
Cons of Patella Grafts for ACL reconstruction (3)
Increased risk of: anterior knee pain and patellofemoral OA, increased decreased extension potential, potential delay in rehab due to more atrophy of quads
Describe Lhermitte's Sign
Indicates dysfunction of spinal cord and/or UMN lesion. Pt long sitting. Passively flex head and one hip with knee extended. Repeat on other side. Positive if pain down spine and into upper/lower extremities.
What imaging test is used to dx a mal-tracking patella? Particular strengthening of what muscle is important?
Plain films using Sunrise View; VMO
Loading Response definition
amount of time between initial contact and beginning of swing phase of other leg
Capsular Pattern Humeroulnar/radial
flexion, extension
Signs and sx of shoulder subluxation?
feeling shoulder pop out and back in, pain, paresthesias, sensation of dead arm, + apprehension test, capsular tenderness, swelling
Symptoms of LMN dz (5)
flaccidity or weakness of involved muscles, decreased tone, fasciculations, muscle atrophy, decreased/absent reflexes
Affects on the body due to neurotmesis peripheral injury
flaccidity, mm wasting, total loss of sensation over nerve distribution
Two appropriate times to take corticosteroids for pt with Rheumatoid Arthritis
flare-ups and when NSAIDs aren't working
Definition of mononeuropathy
isolated nerve injury; associated conditions include trauma and entrapment
Signs and sx of adhesive capsulitis (shoulder) (3)
insidious onset pain often extending down arm stiffness (capsular pattern) night pain
Heel Strike definition
instant heel hits ground starting stance phase
Causes of heel lift during midstance (2)
insufficient DF RoM, PF spasticity
Exaggerated hip flexion during swing may be a compensation for?
insufficient DF compensation
Causes of insufficient hip extension at stance (2)
insufficient RoM, hip flexion contracture
Description and use of Halo Vest Orthosis
invasive cervical thoracic orthosis fully restricts cervical motion. Commonly used with cervical SCI. Worn until spine is stable
Purpose of a an EMG
invasive procedure that assesses nerve and muscle dysfuntion or spinal cord dz
Purpose of a Cerebral Angiography
invasive procedure to determine narrowing or blockage of an artery within brain
Purpose of a Discography
invasive procedure to evaluate integrity and pathos of a disc.
To palpate tibialis posterior have pt...
invert and plantarflex
Definition of Hemiballism
involuntary and violent movement of large body part; unilateral
Signs and sx of Huntington's (5)
involuntary choreic movement, mild change in personality, grimace, tongue protrusion, ataxia
Definition of athetosis
involuntary movements combined with instability of posture. Peripheral movement occurs without central stability
Definition of tremors
involuntary, rhythmic, oscillating movements
Souque's Phenomenon
involved UE raised over 100 degrees with elbow extended. Involved fingers will then extend and ABD
What is Wallenberg Syndrome? And what is the usual cause?
ipsilateral: facial pain, ataxia, vertigo Contralateral: pain and thermal impairment Caused by infarct to lateral medullary of vertebral-basilar artery
Definition of Peripheral Nystagmus
occurs with peripheral vestibular lesion and is inhibited when pt fixates vision on an object
Typically, which muscles are first affected by myasthenia gravis?
ocular, then facial and swallowing mm
Motor CN involved with control of smooth mm of inner eye
oculomotor
Common Signs and Symptoms associated with neoplastic dz
pain described as gnawing intense or penetrating, pain not resolved by time of day, positioning, or activity, pain will wake pt
Common Signs and Symptoms associated with Nerve root compromise via disc
painless reclined/semireclined position, pain increases with WB, pain is shooting stabbing or burning, may be reports of altered strength/ADL ability
Definition of Cogwheel Rigidity and often seen in?
phasic resistance to movement; PD
Ideational Apraxia
pt cannot perform task at all
Ideomotor Apraxia
pt cannot perform task on command, but can perform on own
Testing Position in Space
pt demonstrates different limb positions on command
Testing Spatial Relationships
pt duplicates pattern of 2 or 3 blocks
Description of Glenoid Labrum Tear Test (Clunk Test)
pt in supine. PT places one hand posterior on humeral head and other stabilizes humerus proximal to elbow. PT passively ABD and ER pt's arm overhead and applies anterior force to humeral head. Positive if clunk felt or grinding sound
Describe Horner's Syndrome and causes from occlusion of what arteries
ptosis of eyelid, constriction of pupil, sweating of ipsilateral face often accompanying stroke involving anterior inferior or posterior inferior cerebellar arteries
Initial treatment of congenital hip dysplagia
repostitioning using bracing, harness, splinting, traction
Importance of epithalamus
represented by pineal gland which regulates circadian rhythm
PNS Pathos: Describe Mononeuropathy pathology and give an example (3/1)
sensory loss along nerve route, motor weakness and atrophy along nerve route, possible fasciculations; trauma
PNS Pathos: Describe Spinal Roots and Nerves pathology and give an example (4/1)
sensory loss in dermatomal pattern, motor weakness in innervated pattern, possible fasciculations, decreased DTRs; disc herniation
(lateral) Spinothalamic Tract is responsible for? (2)
sensory pain and temp
(Dorsal) Spinocerebellar Tract is responsible for? (4)
sensory: ipsilateral subconscious proprioception, mm tension, joint sense, and posture of trunk and lower extremities
(Ventral) Spinocerebellar Tract is responsible for? (4)
sensory: ipsilateral subconscious proprioception, mm tension, joint sense, and posture of trunk, upper and lower extremities
Spinotectal Tract is responsible for? (2)
sensory: spinovisual reflexes and assists with movement of eyes and head towards stimuli
physical therapist examines the residual limb of a patient following ambulation activities with a patellar tendon bearing prosthesis. The therapist identifies excessive redness over the patella. The MOST likely cause is
settling due to limb shrinkage. Add one-ply socks to more evenly distribute froces
Definition of Neuralgia
severe and multiple shock-like pains that radiate from specific nerve distribution
Complications of Lumbar Puncture
severe headache relieved by laying down (caused by CSF leakage), infection, epidural hematoma, uncal herniation
Signs of hemorrhagic CVA
severe headache, vomiting, high BP, and abrupt sx onset
Definition of rigidity
severe hypertonicity where sustained muscular contraction does not allow for movement of specific joint
3 Components of balance
somatosensory, visual, and vestibular inputs
Spasticity or rigidity is velocity dependent?
spasticity
The Drop Arm Test is highly ______ for identifying RTC tear
specific
Signs and sx of Guillain-Barre syndrome
symmetrical distal to proximal motor weakness, progress form lower to upper extremities, sensory impairments (may have stocking glove), possible respiratory paralysis
Signs & Symptoms of Cerebellar lesions
symptoms are ipsilateral to damaged side Ataxia,nystagmus,Tremor(intention, postural) dysmetria, Hypotonia titubations, dysdiadochokinesia, poor coordination, deficits in postural reflexes, balance, and equilibrium.
Rheumatoid Arthritis Description
systemic autoimmune disorder with periods of exacerbation and remission. Characterized by chronic inflammation of synovial tissues causing erosion of cartilage and other structures in capsule.
Classifications of Juvenile Rheumatoid Arthritis (3)
systemic, polyarticular, oligoarticular
What two joints form the midtarsal joint?
talocalcaneonavicular and calcaneocuboid
Common etiology of Tibial nerve injury (2)
tarsal tunnel entrapment, popliteal fossa compression
Fluent Aphasia typically arises when these structures are damaged (3)
temporal lobe, Wernicke's Area, areas of parietal lobe
What is epilepsy?
temporary dysfunction of brain where hypersynchronous electrical discharge of cortical neurons and seizure activity occur that is unprovoked and unpredictable.
What is Guillain-Barre Syndrome? AKA?
temporary inflammation and demyelination of peripheral nerves' myelin sheath, potentially results in axonal degeneration ; acute polyneuropathy
Describe Bell's Palsy
temporary unilateral facial paralysis secondary to trauma with demyelination and/or axonal degeneration of facial nerve
Signs and sx of plantar fasciiitis
tenderness at insertion, presence of heel spur, AM pain and with activity, difficulty with prolonged standing, pain with barefoot walking
Indication of scaphoid fracture
tenderness in anatomical snuff-box
Shoulder Extensors (3)
teres major, rear delt, lats
Shoulder ER mm (3)
teres minor, infraspinatus, post delt
The elbow flexion test is highly specific to _____
testing ulnar entrapment in cubital tunnel
Factors associated with increased patellofemoral forces: (5)
weak quads, decreased flexibility, patellar instability, increased tibial torsion or femoral anteversion
Describe Active Muscular Insufficiency
when a two joint muscle contracts across both joints
Describe Passive Muscular Insufficiency
when a two joint muscle is lengthened over two joints simutaneously
