(1) Principles of NM PT Flashcards
What are the 5 benefits to using the ICF framework?
- non-discipline specific
- all inclusive
- incorporates contextual factors
- used with any health condition
- broaden our perspective
“to determine the significance, worth or condition of, usually by careful appraisal and study”
evaluate
“a label encompassing a cluster of signs and symptoms, syndromes or categories”
diagnosis
“the determination of the optimal level of improvement that might be attained and the amt of time required to reach that level”
prognosis
what does alert and oriented x 4 mean
person, place, date, and reason for being admitted
what 4 things might you check when determining pts level of communication and language
- command following
- gesturing
- identifying objects
- yes/no accuracy
what are 2 important questions to ask the pt during the exam
- what is their perception of their biggest problem
- goals
describe the tone scale
hypotonicity < normal < hypertonicity < rigidity
shoulder subluxation occurs as a result of what type of tone
hypotonicity
serial casting and meds, such as baclofen, are used to treat what level of tone?
hypertonia
what treatment methods are often used for rigidity
surgery - tendon lengthening
what is “and increased, velocity dependent resistance to passive stretch”
spasticity
spasticity is an indication of what type of injury
CNS
what type of reflexes do you see with spasticity
hyperactive
what does the modified ashworth scale measure
spasticity
Modified Ashworth Scale: 0
no increase in tone - no spasticity
modified Ashworth scale: 1
- slight increase in tone
- manifested by a catch AND release OR
- minimal resistance at end of ROM
Modified Ashworth scale: 1+
-slight increase in tone
- manifested by a catch
- followed by minimal resistance throughout remainder (< 1/2) ROM
Modified Ashworth Scale: 2
- more marked increase in tone thru most ROM
- BUT affected parts easily moved
Modified Ashworth score: 3
- considerable increase in m tone
- passive mvmt is difficult
Modified ashworth scale: 4
- affected parts rigid in flex/ext
- possible clonus
how is ashworth and mod ashworth scale different?
regular one does not have 1+ category
what do you document for clonus
- strength and # of beats
what is a positive babinski result
- up mvmt of great toe
- flair of toes 2-4
- flexor withdrawal (if severe)
what is the reflex scale?
0 = none
1+ = hypo
2+ = normal
3+ = hyper reflexive
4+ = marked reflex/clonus
what is a positive Hoffman’s sign
- flexion/approximation of thumb and 2nd finger
describe the UE flexion synergy
- scapular retraction and elevation
- shoulder ABD/ER
- elbow flexion
- forearm supination
- wrist and finger flexion
describe the UE extension synergy
- scapular protraction
- shoulder ADD/IR
- elbow extension
- forearm pronation
- wrist and finger flexion
what is the main mvmt seen in UE flexion synergy
- elbow flexion
what is the hallmark of the UE ext synergy
- shoulder ADD
- forearm pronation
escribe the LE flexion synergy
- hip flexion/ER/ABD
- knee flexion
- ankle DF/IV
- toe DF
what is the hallmark of the LE flexion synergy
hip flexion
escribe the LE extension synergy
- hip ext/IR/ADD
- knee ext
- ankle PF/IV
- toe PF
what is the hallmark of LE ext synergy
hip ADD
knee ext
ankle PF
when does synergy mvmt show up?
when a pt tries to perform voluntary mvmts
What are the 6 stages of recovery according to Brunnstrom
- flaccidity
- spasticity/associated mvmt
- synergy
- mvmt deviating from basic synergies
- relative independence of basic synergies
- indep, isolated mvmt
which 2 stages of recovery have no voluntary mvmt?
stage 1 - flaccidity
stage 2 - associated reactions/spasticity
what is a key characteristic of stage 3 recovery
- spasticity becomes pronounced
- pt gains voluntary control thru synergy pattern but limited range
describe 4 UE mvmts to demonstrate that a pt is in stage 4 recovery (mvmts deviating from synergy)
- hand to sacrum
- raise arm horizontal
- pronation/supination with elbow flexed
Describe 4 LE mvmts to demonstrate that a pt is moving into stage 4 (mvmts deviating from synergy)
- supine unilateral hip ABD
- sitting hip flexion or knee flexion
- ankle DF
- knee ext
describe 4 UE mvmts that indicate a pt is in stage 5 recovery (relative indep of basic synergy)
- raise arm to side - horizontal
- supination (shoulder 90 deg flex/elbow ext)
- forward reach from horizontal (serratus)
- raise arm overhead
escribe 3 LE mvmts to indicate a pt is in stage 5 recovery
- ankle DF/PF with knee extended
- ankle IV/EV (heel on floor)
- standing isolated knee flexion w/o hip flexion
what 3 things indicate a pt has reached stage 6 - indep, isolated mvmt
- fractionated mvmt
- spasticity is no longer apparent
- normal to near normal mvmt
you notice a pt is demonstrating pronator drift. What does this look like and what does it indicate
- slow downward drift of arm from shoulder flexion, elbow ext, forearm supination –> forearm pronation and elbow ext
- sign of UMN involvement –> mild hemiparetic weakness
what term is used to describe rapid alternating mvmts when testing for coordination
dysdiadochokinesia
what term is used to describe impaired distance judgement when testing for coordination
dysmetria
what is hypermetria
overshooting a distance
what is hypometria
undershooting a distance
give some examples of how you might test for dysdiadochokinesia
- pronation/supination
- hand to knee to opposite shoulder
- knee flex/ext
- hand or toe tapping
give some examples of how you would test for dysmetria
- finger to nose
- finger to therapist finger
- heel on shin
- indiv finger touch
anytime you see perceptual or sensory issues, what part of the brain is most likely affected
parietal lobe
you notice a pt is demonstrating neglect/inattention to the L side, what area of the brain is affected?
where will you see physical symptoms?
- R hemisphere lesion in the inferior-posterior parietal lobe
- L hemi symptoms
what is denial or lack of awareness of a paretic limb
anosognosia
you notice a pt demonstrating signs of anosognosia, where is the most likely location of the lesion
R (non-dominant) parietal lobe
you notice a pt is demonstrating issues with R/L discrimination, where is the lesion
parietal lobe of either side
if a pt has spatial relations deficit, what might you see?
- inability to perceive relationship in space of one object to another or oneself
- may have issues with layout of numbers
inability to perform purposeful mvmts not attributable to loss of strength, coordination, sensation, tone or poor comprehension
apraxia - a perceptual disorder
when is the ability to motor plan worse for pts with apraxia?
when they have to motor plan on command
ex: when someone askes them to do something such as pick up a cup
you notice a pt with apraxia, and your CI asks you to tell them where the lesion is
L hemisphere (dominant) of the frontal/parietal lobe
what are the 2 types of apraxia
ideomotor and ideational
what is the breakdown b/w concept and performance
ideomotor apraxia
you notice a pt is unable to imitate gestures or follow commands when you ask them to do something although they have full strength and control. what condition do you suspect?
ideomotor apraxia
what is the inability to grasp the concept of a task
ideational apraxia
you give your pt a button up shirt without any instruction and they are:
- unable to describe the process or function of the shirt
- unable to use it appropriately
ideational apraxia
where is the lesion of a pt with ideational apraxia
L parietal lobe
you give a pt a toothbrush and toothpaste and they do not use it correctly. What condition might they have?
ideational apraxia
what is a resistance to upright vertical correction by active pushing with non-paretic extremities to the side C/L to the brain lesion
contraversive pushing
what are 2 other names for contraversive pushing
lateropulsion or pusher syndrome
where is the lesion if the pt demonstrates contraversive pushing
- inferior parietal lobe at junction of post central gyrus
- L or R posterolateral thalamus
what scale is used to assess contraversive pushing
Burke LAteropulsion scale
what is the cutoff score for BLS
> / = 3 means a pt has CP
what is the max score/range for severe lateropulsion
13-17
