3 - Physical Medicine Flashcards
What is the main focus of a Rehabilitation Physician?
Specializes in FUNCTION, with regard to ADLs
Describe what a FIM score is used for?
A system used to measure progress of functional skills. Can be used as an outcome predictor that objectively measures of functional gains enabling physician to predict: Length of stay, Prognosis, Discharge Destination
not necessarily one’s potential for recovery, outcomes are dependent on many various factors that aren’t measurable
List the most important ADLs that a rehab medicine physician must assess.
Dressing Eating Ambulating Toileting/Transfers Hygeine
Any loss or abnormality of physiologic, psychological, or anatomic structure or function. Usually, a manifestation of a disease or injury.
Impairment
A restriction due to an impairment in the ability to perform an activity within the range of what is considered “able-bodied”
Disability
A disadvantage resulting from an impairment or disability, that limits or prevents the fulfillment of a role that is “normal” for the individual.
Handicap
What are the requirements for inpatient rehabilitation?
- 60/40 rule: 60% of patients admitted must have one of the medicare 13 impairments
- Functional Deficits - 2/2 pain, immobility, congenitive dysfunction, communication disorder
- Medical Necessity - sometimes controversial
- Anticipate significant improvement in <3wks
- D/C setting: Home/AL/PCH (not SNF in general)
What is the physiatrists position in the rehabilitative care team?
Provides primary medical care, while coordinating interdisciplinary team and medical specialties
Differentiate between step length and stride length
Step Length: Distance between both heels
Stride Length: Distance between heel of same foot after 2 steps
Define cadence
Number of steps per unit time
Define Speed
Length per unit time (most comfortable/efficient is 3mph)
speed slows by reducing 1. cadence or 2. step length
Where is the center of gravity?
typically 5cm anterior to S2 vertebra
displaced 5cm horizontally and 5cm vertically during an average adult male step
Describe a persons base of support
Space outlined by feet and any assistive device in contact with the ground (normally 5-10cm between heels
Describe the phases of gait in the stance phase?
Initial Contact Loading Response Midstance Terminal Stance Pre-swing
“I Like My Tea Presweetened”
Describe the steps of gait in the swing phase?
Initial Swing
Mid Swing
Terminal Swing
“In My Teapot”
Stance phase is abnormally shortened relative to the swing phase, a good indication of pain with weight-bearing. What is the dysfunction?
Antalgic Gait
Describe Uncompensated and Compensated Trendelenburg Gait.
Uncompensated: during stance phase, the weakened gluteus medius allows the pelvis to tilt down on the opposite side. Bilateral weakness causes “waddling gait”
Compensated: During stance phase, the trunk lurches to weak side to maintain a level pelvis throughout the gait cycle. (Gait pattern also seen with hip OA 2/2 pain)
Describe foot slap
Milder form of foot drop resulting in a slapping sound at initial contact. (3/5 - 4/5 strength)
Describe steppage (Hip Hiking)
Swing leg excessively hip flexes so that the toes of swing leg can clear the ground
Describe vaulting
Stance leg excessively plantarflexes to allow toes of swing leg to clear the ground
Describe circumduction
Swing leg excessively hip abducts so that the toes of swing leg can clear the ground
Genu Recurvatum
Backbending of knee causing excessive extension at the tibiofemoral joint due to weak quads of limited ankle dorsiflexion/ excessive plantar flexion.
(Gastrochnemius crosses two joints)
Dorsiflexion stretched gastrochnemius causing knee flexion movement at knee.
Describe Ataxic Gait
Unsteady, uncoordinated walk, employing a wide base and the feet thrown out.
Commonly seen with cerebellar pathology, classic drunken appearance.
Describe Festinating Gait
Involuntary advancement of legs with short, accelerating steps, often on tiptoes (shuffling). Seen in PARKINSONS
Describe the levels noted on the Manual Muscle Testing grading scale.
5/5 - complete ROM against full resistance
4/5 - complete ROM against some resistance
3/5 - complete ROm against gravity
2/5 - complete ROM with gravity eliminated
1/5 - evidence of slight contractility with no movement
0/5 - no evidence of contractility (visual or tactile)
*don’ confuse with PIF - pain inhibition of function
Describe the MMT nerve levels for the upper limb
C5 - biceps C6 - extensor carpi radialis C7 - triceps C8 - FDP D3 T1 - Abductor Digtiti Minimi (5th digit abduction)
Describe the MMT nerve levels for the lower limb
L2 - Iliopsoas L3 - Quads L4 - Tib Anterior L5 - Ext. Halliucus L. S1 - Gastroch
Describe the Muscle Stretch Reflex Scale.
0 - absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus
What is clonus?
Rapid alternating contractions and relaxations of muscle after forced stretch
Describe the certain points and nerve levels of DTRs/MSRs
C5 - Biceps
C6 - Brachioradialis
C7 - Triceps
L4 - Patellar Tendon
S1 - Achilles tendon
Define: Hyperesthetic, Hypoesthetic, Dyesthetic, Paresthetic, Anesthetic, with regard to sensation
Hyper - Increased sensation Hypo - Decreased sensation Dys - unpleasantly altered sensation Pares - not unpleasantly altered sensation Anes - absent sensation
Describe the babinski test for pathologic reflexes
lateral plantar aspect of foot is stroked with blunt object causing dorsiflexion of great toe and fanning of other toes
Describe the oppenheim test for patholocgic reflexes
downward pressure on tibia causing great toe dorsiflexion
Describe the chaddock test for pathologic reflexes
stroking lateral foot causing great toe dorsiflexion
Describe the hoffman test for pathologic reflexes
hand pronated with passive D3 MCP hyperextension. The DIP is passively flexed and suddenly released, causing thumb flexion/adduction, and flexion of other fingers. Assesses increased tone of FDP D3 (UMN sign). Can be normal, but absent in mots. Most meaningful when correlated with history and MMT
