14 Special Topics Flashcards
Goals of wheelchair evaluation
Assess pelvic alignment
Identify possible ROM limitations
Determine visual field available
Note anatomical deformities
Seat depth of wheelchair
Subtract 2 inches
Proper wheelchair fitting
Start at pelvis
Use 3 points of control
Increase surface area to disperse pressures
Accommodate to fixed deformities and correct flexible deformities
Flexible posterior pelvic tilt
Pommel
Lumbar support
Anterior/posterior trunk supports
Fixed posterior pelvic tilt
Open seat to back angle to match pelvis angle
Contoured back
Tilt in space to allow upright head
Flexible pelvic obliquity
Firm foam on low side and soft foam on high side
Build up low side and grid/waffle on high side
Fixed pelvic obliquity
Build up to meet high side, cut down to match low side
Flexible windswept legs
Proper width seat Contoured seat Pommel Lateral pelvic/thigh supports Leg harness or troughs Foot straps
Fixed windswept legs
Foot plate that fits both feet
Ensure contact of back and seat with cushion
Measure true point of maximum for seat width
Flexible kyphosis
Anterior chest/shoulder support
Mid-thoracic/lumbosacral support
Tilt in space frame
Fixed kyphosis
Custom molded back
Grid seating
Open back seating
Tilt frame
Flexible scoliosis
Generic contoured back
Lateral trunk supports (3-point pad system)
Anterior trunk supports
Fixed scoliosis
Custom molded seating
Grid back
Lateral tilt under seat to fix head position
Insurance coverage for manual wheelchairs
Must be used inside home
Sufficient UE and cognitive function
Caregiver available to provide assistance when necessary
Insurance coverage for power wheelchairs
Unable to self-propel manual wheelchair
Home has adequate space
Positioning seat cushion
For postural deformities
Trunk weakness
Spasticity
Orthopedic deformities
Stage I pressure injury
Non-blanchable erythema
Intact skin
Usually over bony prominence
Stage II pressure injury
Partial thickness
Shallow open wound with red/pink wound bed
No slough present
Stage III pressure injury
Full thickness skin loss Bone, tendon, muscle NOT visible Subcutaneous fat may be visible Slough may be present May have undermining and/or tunneling
Stage IV pressure injury
Full thickness skin loss
Exposed bone, tendon, or muscle
Slough or eschar present
Often includes tunneling and undermining
Unstageable pressure injury
Full thickness skin loss- depth unknown
Depth obscured by slough or eschar
Dry, intact eschar should not be removed
Suspected deep tissue injury
Depth unknown
Discolored, intact skin or blood-filled blister from pressure or shear
Gait speed for ADL independence
>= 1.0 m/s independent <= 0.6 m/s dependent
Gait speed more likely to be hospitalized
<= 0.6 m/s more likely >= 1.0 m/s less likely
Gait speed necessity of fall risk intervention
<=1.0 m/s
Gait speed for discharge location
<=0.1 m/s for SNF
>=0.1 m/s home more likely
Gait speed ambulation status
<=0.4 m/s household walker
0.4-0.8 m/s limited community ambulator
0.8-1.2 m/s community ambulator
>= 1.2 m/s cross street and normal walking speed
Most common primary brain tumor in adults
Meningiomas (36%)
Most common malignant brain tumors in adults
Gliomas (80%)
Most common pediatric CNS tumors
Pilocytic astrocytoma Malignant glioma Medulloblastoma Neuronal and mixed neuronal-glial tumors Ependymoma
Meningiomas
Benign from meninges
Grow slow, large size before affecting function
Astrocytoma
Glioma
Low grade- slow, likely in children
High grade- fast, likely in adults
Glioblastoma multiforme- most common and deadliest primary brain tumor
Oligodendrocytoma
Glioma
Slow growing- years before symptoms
Ependymomas
Glioma
Rare in adults
Grade I tumor
Benign
Slow-growing
Usually associated with long-term survival
Rare in adults
Grade II tumor
Relatively slow growing
May spread to nearby healthy tissue
May be recurring as grade II or higher grade tumor
Grade III tumor
Malignant
Actively reproduces abnormal cells
Spreads to nearby tissues
Often returns as higher grade tumor
Grade IV tumor
Most malignant
Fast growing
Easily spreads to normal tissue
Tumor forms new blood vessels to maintain rapid growth
Tumor has areas of dead cells in the center
Signs of increased intracranial pressure
Headache Nausea/vomiting Blurred vision Balance problems Personality changes Seizures Drowsiness
Spinal cord tumor presentation
UMN and LMN signs
Nerve root pain
Bowel/bladder changes
Birth to 3 month milestones
Alternate kicking legs on back
Hold head 45 degrees in prone by 2 months
Begins to hold head midline and track objects with eyes
Reflexes- step, moro, Babinski, ATNR, flexor posture, grasp, root, suck
Cooing sounds and develops smile/imitates faces
4 to 6 month milestones
Able to lift and hold head in all positions Plays with hands near face and chest Palmar grasp 4 months, raking 6 months Roll to side and tummy to back 4-5 months Roll back to tummy 6 months Bears weight on elbows/hands on tummy Sit without arms for brief periods Postural reflexes develop
7 to 9 month milestones
Able to sit independently Begins to creep Pull to stand with arms, uncontrolled drop stand to sit Drop objects on purpose Inferior pincer grasp, thumb more active Cruise along furniture 9 months
10 to 12 month milestones
Lower self from standing with legs Play in squat position May take first steps with wide base Kneels independently Use objects appropriately Fine pincer grasp, finger-feeds self
13 to 15 month milestones
Begins walking
Can stack 2 objects
Begins using spoon
Scribbles
16 to 19 month milestones
Walks up steps with HHA and 2 feet Walks backwards Stacks 4 objects Kick stationary ball Hold toys while walking Removed clothing, drink from cup
20 to 23 month milestones
Walk down steps with HHA and 2 feet
Jump in place
Imitates domestic tasks, shows independence
Stacks 6 objects
2 year milestones
Jumps on 2 feet Handedness established Uses fork Follows 2-step commands 2-word phrases
3 year milestones
Ascends stairs alternating feet
Pedals tricycle
Turns pages of books
Toilet trained
4 year milestones
Hops on one foot
Descends stairs alternating feet
Able to do buttons
Tells stories
5 year milestones
Skips Balance on one foot 10 seconds Draw person Tripod pencil grasp Independent ADLs
Down syndrome complications
Deafness Visual impairments Heart defects Sleep apnea Ear infections
Norm-referenced outcome measure
Compares performance of and individual to a representative group
Criterion-referenced outcome measure
Document performance in relation to domain of information or specific skill set
Measures changes in performances of individual
PDMS-2
Assesses fine and gross motor skills
Birth to 7 years
Norm and criterion referenced
GMFM
Assess gross motor skills 5 months to 16 years Change over time in CP Also validated for Down syndrome Criterion-referenced
BOT
Assess fine and gross motor skills
4.5-14.5 years
Norm-referenced
ICP monitor
Measures ICP, some allow CSF drainage
Most need to stay at level of external auditory meatus
If therapy performed, device needs to be recalibrated by RN after
NG tubes, Gastrostomy, J tubes
HOB should not be below 30 degrees after feeding
