Confused/agitated: maximal assistance - Non-purposeful movement - Can perform motor activities (sitting, reaching, walking) - Hitting, foul behavior, yelling, restlessness, decreased attention span - No short-term memory Use familiar, simple tasks the patient enjoys doing - washing hands - catching object Redirect if agitated Ignore inappropriate commentary Do not force pt. to do activities Low stimulation

Confused, inappropriate non-agitated: maximal assistance - Impaired recent memory - Unable to learn new information - Able to follow simple commands with external cues/assistance - May get stuck on basic needs (going home, going to sleep, etc.) - May be able to perform previously learned tasks when structured. External cues and structure! Keep conversations brief, correct misinformation and move on Change subject if patient becomes argumentative.

Confused appropriate: moderate assistance - Emergence from PTA - Memory is improving but still requires assist - Focal deficits become apparent (L vs R sided weaknesses) - decreased problem-solving ability - can perform familiar tasks in non-distracting environment w/ modA-SUP - unaware of safety risks Consistently follows simple directions Rapid, exaggerated changes in mood with strong emotions/feelings

Automatic, appropriate: minimal assistance for ADLs - A&Ox4 - Able to perform familiar tasks w/ minA - Initiates routine w/ decreased recall - Minimal supervision for safety w/in routine activities - Unable to think about consequences of decision - overestimates abilities - MinA w/ carry over of new learning

Purposeful, appropriate: SBA - completes familiar tasks in distracting environment - uses of assistive memory devices w/ SBA - IND w/ learned activities - Overestimates or underestimates abilities - Understands consequences of actions w/ minA - improved organization Depressed, irritable, easily frustrated, argumentative

Purposeful, appropriate: SBA on request - initiates and carries out familiar tasks SBA on request - SBA to adjust to task demands Depressed, easily irritable, easily frustrated

Purposeful, appropriate: modified independent - can handle multiple tasks simultaneously - initiates and completes tasks however may require increased time

CAPE 2 Flashcards by Lauren Wolfe

RLA Level 1

No response: total assistance

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RLA Level 2

Generalized response: total assistance

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RLA Level 3

Localized response: total assistance

Responds to painful, auditory, visual stimuli.
Responds inconsistently to simple commands.

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RLA Level 4

Confused/agitated: maximal assistance

Non-purposeful movement
Can perform motor activities (sitting, reaching, walking)
Hitting, foul behavior, yelling, restlessness, decreased attention span
No short-term memory

Use familiar, simple tasks the patient enjoys doing
- washing hands
- catching object

Redirect if agitated
Ignore inappropriate commentary
Do not force pt. to do activities
Low stimulation

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RLA Level 5

Confused, inappropriate non-agitated: maximal assistance

Impaired recent memory
Unable to learn new information
Able to follow simple commands with external cues/assistance
May get stuck on basic needs (going home, going to sleep, etc.)
May be able to perform previously learned tasks when structured.

External cues and structure!

Keep conversations brief, correct misinformation and move on

Change subject if patient becomes argumentative.

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RLA Level 6

Confused appropriate: moderate assistance

Emergence from PTA
Memory is improving but still requires assist
Focal deficits become apparent (L vs R sided weaknesses)
decreased problem-solving ability
can perform familiar tasks in non-distracting environment w/ modA-SUP
unaware of safety risks

Consistently follows simple directions

Rapid, exaggerated changes in mood with strong emotions/feelings

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RLA Level 7

Automatic, appropriate: minimal assistance for ADLs

A&Ox4
Able to perform familiar tasks w/ minA
Initiates routine w/ decreased recall
Minimal supervision for safety w/in routine activities
Unable to think about consequences of decision
overestimates abilities
MinA w/ carry over of new learning

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RLA Level 8

Purposeful, appropriate: SBA

completes familiar tasks in distracting environment
uses of assistive memory devices w/ SBA
IND w/ learned activities
Overestimates or underestimates abilities
Understands consequences of actions w/ minA
improved organization

Depressed, irritable, easily frustrated, argumentative

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RLA Level 9

Purposeful, appropriate: SBA on request

initiates and carries out familiar tasks SBA on request
SBA to adjust to task demands

Depressed, easily irritable, easily frustrated

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RLA Level 10

Purposeful, appropriate: modified independent

can handle multiple tasks simultaneously
initiates and completes tasks however may require increased time

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Main goal for RLA 2-3

Stimulation

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Main goal for RLA 4-5

Allowing
Encouraging patient to be a more active participant in therapy

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Main goal for RLA 7-10

Initiation
More structure
New learning
Gaining independence
Return to optimal level of function and participation

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TBI exam considerations

Communication
Cognition
Ability to follow commands
Level of assistance

MMT/ROM
Skin breakdown
Hypertonia
UMN signs
Functional mobility
Balance

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TBI intervention considerations

ROM/stretching/contracture prev.
Skin protection/bed mobility
Balance/weight shifting
Functional mobility
Challenge cognition/memory simultaneously if appropriate

Could speak out loud in CAPE about how you may educate caregivers or about prescription of adaptive equipment

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Glasgow coma scale: verbal response

5 - oriented
4- confused orientation
3- inappropriate words
2- incomprehensible sounds
1- nil

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Glasgow coma scale: eye opening

4 - spontaneous
3 - to speech
2 - to pain
1 - nil

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Glasgow coma scale: motor response

6 - obeys
5 - localizes (pushes away from painful stimuli)
4 - withdraws
3 - abnormal flexion
2 - extensor response
1 - nil

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UMN signs

hyperreflexia
spasticity
positive babinski

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LMN signs

hyporeflexia
flaccid paralysis
atrophy

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Clavicle fx MOI

FOOSH
Fall onto shoulder
Direct blow to shoulder

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Clavicle fx examination considerations

Signs:
- drooping shoulder
- snapping/cracking sound
- swelling, bruising, tenderness

DDx:
SC or AC joint injury
Rib fx
Shoulder dislocation
RTC

Complications:
- pneumothorax, subclavian a./v. injury, brachial plexus injury

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Subacromial pain syndrome test cluster

Arc of pain
Neer’s
Hawkin’s
Resisted ER at side

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Rotator cuff pathology/partial tear test cluster

Empty can
Full can
Champagne toast
Resisted ER at 45

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Extra-articular long head of biceps test cluster

Speed's Yergason's

Intra-articular long head of biceps test cluster

Active compression Throwers Palpation

Full thickness tear test cluster

Drop arm (supraspinatus) Belly press (subscapularis) Internal rotation lag sign (subscapularis) External rotation lag sign (infraspinatus)

SLAP tear test cluster

Active compression Modified dynamic sheer Biceps load 2 Resisted supination w/ ER (in supine)

MDI test cluster

Load and shift Sulcus sign Hyperabduction

Anterior labral tear test cluster (bankart)

Load and shift Sulcus sign Anterior apprehension

Posterior labral tear test cluster

Kim Jerk

AC joint test cluster

Cross-body adduction AC resisted abduction Active compression

Cubital tunnel test cluster

Elbow flexion test Shoulder IR test Tinnel's Froment's Wartenberg

Lateral epicondylalgia test cluster

Palpation Resisted wrist ext (cozen's) Passive wrist flexion/elbow ext/UD (Mill's) Third finger sign

Radial tunnel syndrome test cluster

Palpation Third finger sign

Medial epicondylalgia test cluster

Resisted wrist flexion Passive wrist extension

Median nerve test cluster

Pronator teres syndrome test OK sign (anterior interosseous nerve)

UCL injury test cluster

Valgus stress test (0 & 30) Moving valgus stress test

RCL injury test cluster

Varum stress test (0 & 30)

Biceps rupture test cluster

Hook test Biceps squeeze test

PPPD

chronic; peripheral - Head impulse test - Dynamic visual acuity - Balance subjectively poor but actually has great balance - Sensation of motion - Visual motion

BPPV

acute; peripheral HiNTs - CNS red flag screen Head impulse test (peripheral) Nystagmus Test of skew Dynamic visual acuity Dix hall-pike Roll test

Vestibular hypofunction

VOR Balance Head impulse test Dynamic visual acuity Gaze stability w/ head turns (aka VOR) Rotary chair test Sensation of motion

Heart referred pain pattern

Left chest, left arm

Stomach referred pain pattern

Mid thoracic spine, xyphoid process

Gallbladder referred pain pattern

RUQ, RLQ

Kidney referred pain pattern

Low back, pelvis, medial thigh, groin

Lung referral pain pattern

anterior/posterior neck and upper trapezius

liver and gallbladder referred pain pattern

R neck/shoulder, R low back

Auscultation

auscultate 4 quadrants before palpation listen for bowel sounds

Percussion

all 4 quadrants identify presence of fluid or solid masses dull vs resonant

Rebound tenderness (blumberg's sign)

Palpate deeply and slowly away from suspected or painful area, remove quickly + for peritonitis if pain experienced in area of inflammation

McBurney's point

Palpate deeply halfway between umbilicus and R ASIS Severe pain is + for appendix

Iliopsoas sign

Patient raises each leg w/ or w/o resistance + for appendicitis if ipsilateral lower quadrant pain

Murphy's sign

Place fingers below R costal margin at mid-clavicular line as pt. exhales Ask pt. to inhale while pressing tips of fingers upward; gall bladder descends + sign for gall bladder inflammation if abrupt cessation of inspiration

Murphy's percussion

Place one hand flat over kidney, percuss w/ ulnar surface of opposite fist + if intense pain

Opioids

Taken for pain SE: drowsiness dizziness constipation respiratory depression

Beta blockers

Lowers BP, causes heart to beat slower and with less force SE: fatigue dizziness SOB hypotension

ACE inhibitor

high BP, heart failure SE: fatigue headache hypotension cough

Hallmark features of pulmonary embolism

Tachypnea: 16 breaths per minute or greater Tachycardia: >100 bpm Sudden onset dyspnea Chest pain (acute in onset) Hypotension Oxygen desaturation Cough