Clinical pearls

Question 1

Pressure areas

Answer 1

Stage I pressure injury: non-blanchable erythema.
Stage II pressure injury: break in skin with partial thickness skin loss.
Stage III pressure injury: full thickness skin loss and exposure of subcutaneous fat.
Stage IV pressure injury: full thickness tissue loss down to muscle or bone.

Question 2

Gross motor milestones

Answer 2

Rolling: 4-5 months
Sitting independently: 6 months
Walking: 12 months
Running: 2 years
Stand on one foot: 3 years
Stairs (alternative stepping): 4 years
Skipping: 5 years

Question 3

Fine motor milestones

Answer 3

Grasping items: 4-5 months
Hand-to-hand transfer: 6 months
Pincer grip: 10-11 months
Feeding with spoon: 18 months
Scribbling: 18 months
Circle: 3 years
Cross: 4 years
Triangle: 5 years

Question 4

Language milestones

Answer 4

Babbling: 7-8 months
Single word: 12 months, “mama, dada” 
10 words and body parts: 18 months
Short sentences: 2 years
Full sentences: 3 years
Paragraphs: 4 years
Knowing colours: 5 years

Question 5

Social milestones

Answer 5

Interactive (pat-a-cake): 9 months 
Take shoes off: 15 months
Feeds self: 18 months
Parallel play: 3 years
Social interaction: 4 years

Question 6

Key dermatomes

Answer 6

C1 - nil sensory distribution 
C2 - skull cap
C3 - collar around neck
C4 - cape of shoulders
C6 - thumb sucker
T5 - nipple
T10 - umbilicus
L1 - inguinal ligament
L4 - knee jerk
S1 - ankle jerk

Question 7

Autonomic nervous system

Answer 7

Sympathetic nerves, which originate from spinal cord segments T1-L2
Parasympathetics nerves, which originate from S2-S4
Four cranial nerves (which follow the path of CN5): CN3 (pupil & ciliary body), CN7 (salivary glands), CN9 (parotid gland), CN10 (vagus to heart, lungs, GI)

Question 8

Quality of life

WHO - individuals perception of their position in life in context of the culture and value system in which they live in relation to their goals, standards expectations and concerns

Answer 8

Multifaceted subjective interpretation covering domains of life including physical, psychological health but also Social coherence and safety allow people to be productive. It’s subjective relative to people around you

Question 9

The aims of hospital rehabilitation are

Answer 9

Optimising the medical care required
Supporting with personal care while healing occurs
Restoring strength
Improving the level of dependency
Educating in compensatory mechanisms for lost organs or limbs

Question 10

Characteristics of FIM

Answer 10

Clinically appropriate validity (eg hours of therapy) and interrater reliability
- Ceiling effect -not sensitive to subtle changes expected after acute inpatient rehabilitation discharge

Question 11

Goals essential for discharge

Answer 11

Funding
Accommodation
Care
Equipment

Mobility, ADLs, community reintegration, education, health maintenance, psychological wellbeing

Question 12

PLISSIT model for discussing sexuality

Answer 12

Permission
Limited Information
Specific Suggestions
Intensive Therapy

Question 13

Describe FIM levels

Answer 13

7. Complete independence
8. Modified independence (requiring assistive device, taking more time)
9. Non-contact supervision/set up
10. Minimal contact assist (>75% effort)
11. Moderate assist (50-75% effort)
12. Maximal assist
13. Total assistance (<25% effort)

Question 14

Types of fluent aphasia

Answer 14

Transcortical sensory - good ability to repeat
Wernicke - poor repetition skills
Conductive - good comprehension poor repetition
Anomia - can’t find the words

*broca = non fluent expressive

Question 15

Neuroplasticity

Answer 15

Refers to the physical changes in the brain that result from thoughts, environment, emotions and things that are done - predominately in the connections between neurons

Question 16

Ranchos Los Amigos

Answer 16

I - no response
II - generalised response 
III - localised response
IV - confused and agitated
V - confused, inappropriate (non-agitated)
VI - confused, appropriate 
VII - automatic and appropriate 
VIII - purposeful