3 - Physical Medicine

Question 1

What is the main focus of a Rehabilitation Physician?

Answer 1

Specializes in FUNCTION, with regard to ADLs

Question 2

Describe what a FIM score is used for?

Answer 2

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

Question 3

List the most important ADLs that a rehab medicine physician must assess.

Answer 3

Dressing 
Eating
Ambulating
Toileting/Transfers 
Hygeine

Question 4

Any loss or abnormality of physiologic, psychological, or anatomic structure or function. Usually, a manifestation of a disease or injury.

Answer 4

Impairment

Question 5

A restriction due to an impairment in the ability to perform an activity within the range of what is considered “able-bodied”

Answer 5

Disability

Question 6

A disadvantage resulting from an impairment or disability, that limits or prevents the fulfillment of a role that is “normal” for the individual.

Answer 6

Handicap

Question 7

What are the requirements for inpatient rehabilitation?

Answer 7

1. 60/40 rule: 60% of patients admitted must have one of the medicare 13 impairments
2. Functional Deficits - 2/2 pain, immobility, congenitive dysfunction, communication disorder
3. Medical Necessity - sometimes controversial
4. Anticipate significant improvement in <3wks
5. D/C setting: Home/AL/PCH (not SNF in general)

Question 8

What is the physiatrists position in the rehabilitative care team?

Answer 8

Provides primary medical care, while coordinating interdisciplinary team and medical specialties

Question 9

Differentiate between step length and stride length

Answer 9

Step Length: Distance between both heels

Stride Length: Distance between heel of same foot after 2 steps

Question 10

Define cadence

Answer 10

Number of steps per unit time

Question 11

Define Speed

Answer 11

Length per unit time (most comfortable/efficient is 3mph)

speed slows by reducing 1. cadence or 2. step length

Question 12

Where is the center of gravity?

Answer 12

typically 5cm anterior to S2 vertebra

displaced 5cm horizontally and 5cm vertically during an average adult male step

Question 13

Describe a persons base of support

Answer 13

Space outlined by feet and any assistive device in contact with the ground (normally 5-10cm between heels

Question 14

Describe the phases of gait in the stance phase?

Answer 14

Initial Contact 
Loading Response
Midstance
Terminal Stance
Pre-swing

“I Like My Tea Presweetened”

Question 15

Describe the steps of gait in the swing phase?

Answer 15

Initial Swing
Mid Swing
Terminal Swing

“In My Teapot”

Question 16

Stance phase is abnormally shortened relative to the swing phase, a good indication of pain with weight-bearing. What is the dysfunction?

Answer 16

Antalgic Gait

Question 17

Describe Uncompensated and Compensated Trendelenburg Gait.

Answer 17

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)

Question 18

Describe foot slap

Answer 18

Milder form of foot drop resulting in a slapping sound at initial contact. (3/5 - 4/5 strength)

Question 19

Describe steppage (Hip Hiking)

Answer 19

Swing leg excessively hip flexes so that the toes of swing leg can clear the ground

Question 20

Describe vaulting

Answer 20

Stance leg excessively plantarflexes to allow toes of swing leg to clear the ground

Question 21

Describe circumduction

Answer 21

Swing leg excessively hip abducts so that the toes of swing leg can clear the ground

Question 22

Genu Recurvatum

Answer 22

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.

Question 23

Describe Ataxic Gait

Answer 23

Unsteady, uncoordinated walk, employing a wide base and the feet thrown out.

Commonly seen with cerebellar pathology, classic drunken appearance.

Question 24

Describe Festinating Gait

Answer 24

Involuntary advancement of legs with short, accelerating steps, often on tiptoes (shuffling). Seen in PARKINSONS

Question 25

Describe the levels noted on the Manual Muscle Testing grading scale.

Answer 25

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

Question 26

Describe the MMT nerve levels for the upper limb

Answer 26

C5 - biceps
C6 - extensor carpi radialis
C7 - triceps
C8 - FDP D3
T1 - Abductor Digtiti Minimi (5th digit abduction)

Question 27

Describe the MMT nerve levels for the lower limb

Answer 27

L2 - Iliopsoas
L3 - Quads
L4 - Tib Anterior
L5 - Ext. Halliucus L. 
S1 - Gastroch

Question 28

Describe the Muscle Stretch Reflex Scale.

Answer 28

0 - absent
1+ Hypoactive
2+ Normal
3+ Hyperactive without clonus
4+ Hyperactive with clonus

Question 29

What is clonus?

Answer 29

Rapid alternating contractions and relaxations of muscle after forced stretch

Question 30

Describe the certain points and nerve levels of DTRs/MSRs

Answer 30

C5 - Biceps
C6 - Brachioradialis
C7 - Triceps

L4 - Patellar Tendon
S1 - Achilles tendon

Question 31

Define: Hyperesthetic, Hypoesthetic, Dyesthetic, Paresthetic, Anesthetic, with regard to sensation

Answer 31

Hyper - Increased sensation
Hypo - Decreased sensation
Dys - unpleasantly altered sensation
Pares - not unpleasantly altered sensation
Anes - absent sensation

Question 32

Describe the babinski test for pathologic reflexes

Answer 32

lateral plantar aspect of foot is stroked with blunt object causing dorsiflexion of great toe and fanning of other toes

Question 33

Describe the oppenheim test for patholocgic reflexes

Answer 33

downward pressure on tibia causing great toe dorsiflexion

Question 34

Describe the chaddock test for pathologic reflexes

Answer 34

stroking lateral foot causing great toe dorsiflexion

Question 35

Describe the hoffman test for pathologic reflexes

Answer 35

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