(1) Principles of NM PT Flashcards
1
Q
What are the 5 benefits to using the ICF framework?
A
- non-discipline specific
- all inclusive
- incorporates contextual factors
- used with any health condition
- broaden our perspective
2
Q
“to determine the significance, worth or condition of, usually by careful appraisal and study”
A
evaluate
3
Q
“a label encompassing a cluster of signs and symptoms, syndromes or categories”
A
diagnosis
4
Q
“the determination of the optimal level of improvement that might be attained and the amt of time required to reach that level”
A
prognosis
5
Q
what does alert and oriented x 4 mean
A
person, place, date, and reason for being admitted
6
Q
what 4 things might you check when determining pts level of communication and language
A
- command following
- gesturing
- identifying objects
- yes/no accuracy
7
Q
what are 2 important questions to ask the pt during the exam
A
- what is their perception of their biggest problem
- goals
8
Q
describe the tone scale
A
hypotonicity < normal < hypertonicity < rigidity
9
Q
shoulder subluxation occurs as a result of what type of tone
A
hypotonicity
10
Q
serial casting and meds, such as baclofen, are used to treat what level of tone?
A
hypertonia
11
Q
what treatment methods are often used for rigidity
A
surgery - tendon lengthening
12
Q
what is “and increased, velocity dependent resistance to passive stretch”
A
spasticity
13
Q
spasticity is an indication of what type of injury
A
CNS
14
Q
what type of reflexes do you see with spasticity
A
hyperactive
15
Q
what does the modified ashworth scale measure
A
spasticity
16
Q
Modified Ashworth Scale: 0
A
no increase in tone - no spasticity
17
Q
modified Ashworth scale: 1
A
- slight increase in tone
- manifested by a catch AND release OR
- minimal resistance at end of ROM
18
Q
Modified Ashworth scale: 1+
A
-slight increase in tone
- manifested by a catch
- followed by minimal resistance throughout remainder (< 1/2) ROM
19
Q
Modified Ashworth Scale: 2
A
- more marked increase in tone thru most ROM
- BUT affected parts easily moved
20
Q
Modified Ashworth score: 3
A
- considerable increase in m tone
- passive mvmt is difficult
21
Q
Modified ashworth scale: 4
A
- affected parts rigid in flex/ext
- possible clonus
22
Q
how is ashworth and mod ashworth scale different?
A
regular one does not have 1+ category
23
Q
what do you document for clonus
A
- strength and # of beats
24
Q
what is a positive babinski result
A
- up mvmt of great toe
- flair of toes 2-4
- flexor withdrawal (if severe)
25
what is the reflex scale?
0 = none
1+ = hypo
2+ = normal
3+ = hyper reflexive
4+ = marked reflex/clonus
26
what is a positive Hoffman's sign
- flexion/approximation of thumb and 2nd finger
27
describe the UE flexion synergy
- scapular retraction and elevation
- shoulder ABD/ER
- elbow flexion
- forearm supination
- wrist and finger flexion
28
describe the UE extension synergy
- scapular protraction
- shoulder ADD/IR
- elbow extension
- forearm pronation
- wrist and finger flexion
29
what is the main mvmt seen in UE flexion synergy
- elbow flexion
30
what is the hallmark of the UE ext synergy
- shoulder ADD
- forearm pronation
31
escribe the LE flexion synergy
- hip flexion/ER/ABD
- knee flexion
- ankle DF/IV
- toe DF
32
what is the hallmark of the LE flexion synergy
hip flexion
33
escribe the LE extension synergy
- hip ext/IR/ADD
- knee ext
- ankle PF/IV
- toe PF
34
what is the hallmark of LE ext synergy
hip ADD
knee ext
ankle PF
35
when does synergy mvmt show up?
when a pt tries to perform voluntary mvmts
36
What are the 6 stages of recovery according to Brunnstrom
1. flaccidity
2. spasticity/associated mvmt
3. synergy
4. mvmt deviating from basic synergies
5. relative independence of basic synergies
6. indep, isolated mvmt
37
which 2 stages of recovery have no voluntary mvmt?
stage 1 - flaccidity
stage 2 - associated reactions/spasticity
38
what is a key characteristic of stage 3 recovery
- spasticity becomes pronounced
- pt gains voluntary control thru synergy pattern but limited range
39
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
40
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
41
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
42
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
43
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
44
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
45
what term is used to describe rapid alternating mvmts when testing for coordination
dysdiadochokinesia
46
what term is used to describe impaired distance judgement when testing for coordination
dysmetria
47
what is hypermetria
overshooting a distance
48
what is hypometria
undershooting a distance
49
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
50
give some examples of how you would test for dysmetria
- finger to nose
- finger to therapist finger
- heel on shin
- indiv finger touch
51
anytime you see perceptual or sensory issues, what part of the brain is most likely affected
parietal lobe
52
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
53
what is denial or lack of awareness of a paretic limb
anosognosia
54
you notice a pt demonstrating signs of anosognosia, where is the most likely location of the lesion
R (non-dominant) parietal lobe
55
you notice a pt is demonstrating issues with R/L discrimination, where is the lesion
parietal lobe of either side
56
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
57
inability to perform purposeful mvmts not attributable to loss of strength, coordination, sensation, tone or poor comprehension
apraxia - a perceptual disorder
58
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
59
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
60
what are the 2 types of apraxia
ideomotor and ideational
61
what is the breakdown b/w concept and performance
ideomotor apraxia
62
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
63
what is the inability to grasp the concept of a task
ideational apraxia
64
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
65
where is the lesion of a pt with ideational apraxia
L parietal lobe
66
you give a pt a toothbrush and toothpaste and they do not use it correctly. What condition might they have?
ideational apraxia
67
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
68
what are 2 other names for contraversive pushing
lateropulsion or pusher syndrome
69
where is the lesion if the pt demonstrates contraversive pushing
- inferior parietal lobe at junction of post central gyrus
- L or R posterolateral thalamus
70
what scale is used to assess contraversive pushing
Burke LAteropulsion scale
71
what is the cutoff score for BLS
> / = 3 means a pt has CP
72
what is the max score/range for severe lateropulsion
13-17
