exam 1 Flashcards
AD most to least supportive
parallel bars
walkers
crutches
canes
Walkers
Standard
Wheeled: 2-wheeled vs. 4-wheeled
Folding vs. fixed
Hemi walkers (Walkane)
Platform attachments
Crutches
Axillary crutches
Forearm/Lofstrand crutches, triceps/Canadian crutches
Platform attachment aka gutter crutch
Leg support crutches: knee scooter or iWalk
Cane
Handles: J, T, pistol grip
Offset shaft
Wide base/narrow base, 3- footed, 4-footed “quad cane” “or “hemi cane”
Pain
Antalgic gait
limping gait
short stance on the painful side
Muscle Weakness- Lower Motor Neuron lesions
Trendelenburg gait -Gluteus Medius lurch gait
foot slap- Ankle dorsiflexion weakness
Foot drop, steppage gait aka Neuropathic gait
lack of push-off- Plantar flexion weakness
Waddling gait/Myopathic gait- shoulders behind hips, use trunk movement to advance legs aka
Neurologic Involvement- Upper motor neuron lesion
Hemiplegic gait
Ataxic gait
Parkinsonian gait - festinating
Parkinsonian gait -freezing
Parkinsonian gait -Shuffling feet
Scissoring gait
Crouch gait aka Spastic Dypelgic gait
Common Deviations
Hip hiking
Circumduction
Vaulting-decreased hip and knee flexion, ankle plantar flexion
Weak Quadriceps
Weak Hamstrings
Deviations with Prosthesis
Hip circumduction
Lateral Whip
Lateral lean
Vaulting
Foot slap
Hyperextension of the knee
Initial contact – weight acceptance
Hip
Flexion 30°
Glut max, Hamstrings, Add. Mag.
Isometric
Knee
Flexion 5°
Quadriceps
Eccentric
Ankle
Neutral
Dorsiflexors
Isometric
Loading response – shock absorption
Hip
Flexion 30°-25°
Gluteus maximus, Hamstrings
Isometric to slightly concentric
Knee
Up to 15 flexion
Quadriceps
Eccentric
Ankle
15° plantarflexion
Dorsiflexion
eccentric
Midstance -The Center of gravity is at its highest point
Hip
Extension 30-10°
Gluteus maximus
Minimal concentric activation
Gluteus medius
Eccentric or isometric
Knee
flexion 15° - neutral
Quadriceps
Concentric
Ankle
From 10° plantarflexion to 5° dorsiflexion
Plantarflexors
Eccentric
Terminal stance
Hip
20° Extension
Hip flexors, adductor longus in late heel-off, TFL
ant. Fibers
Eccentric
Knee
Moves into full extension
Quads
Eccentric
Ankle
Dorsiflexion 10°
Plantarflexors
Eccentric —concentric
Pre-swing
Hip
10° extension
Hip flexors, hip adductors
Concentric
Knee
40° flexion
Quads
Eccentric
Ankle
20° plantarflexion
Plantarflexors
Concentric moving to eccentric
Initial Swing
Hip
To 20° flexion
Iliopsoas
Concentric
Knee
Flexion - 40°-60°
Hamstrings, sartorius, gracilis
Concentric
Ankle
Moving from plantarflexion to dorsiflexion
Dorsiflexors
Concentric
Midswing
Hip
Flexion - 30°
Iliopsoas
Concentric
Knee
60°- 30° flexion
Hamstrings
Eccentric
Ankle
Neutral
Dorsiflexors
Concentric
Terminal Swing
Hip
30° flexion
Hamstrings, Gluteus max
Eccentric
Knee
Moving into extension 0 °
Quadriceps
Concentric
Ankle
Neutral/Dorsiflexion
Dorsiflexors
Isometric/concentric
Anthropometric
– Body circumference measurements – chart for determining
– Height and weight – chart for determining
genu valgum/valgus
knee in
genu varum/varus
knee out
Girth Measurements
Can be used to predict the percentage of body fat
Can be used to monitor edema
Volumeter
used to assess edema, lymphedema, or swelling
Apparent
Measure from umbilical to medial malleolus
Real
Measure from ASIS to medial malleolus
What affects BP readings
Pt should be seated at least 5 min. and refrained from smoking or ingesting caffeine during 30 minutes before measurement
Systolic over diastolic
Absolute indications to stop exercise
– Drop in systolic BP of >10 from baseline despite an increase in workload when accompanied by other evidence of ischemia
– Moderately severe angina (defined as 3 on a pain scale)
– Increasing nervous system symptoms (ataxia, dizziness, near syncope)
– Signs of poor perfusion
– Technical difficulties monitoring
– Subject’s desire to stop
Relative indications to stop exercise or modify
– Drop in systolic BP of >10 from baseline despite an increase in workload in the absence of other evidence of ischemia
– Fatigue, SOB, wheezing, leg cramps, Claudication
– Increasing chest pain
– Hypertensive response (SBP >250 and/or DBP >115)
– Resting HR >130 bpm or < 40 bpm
Medicare
Over 65 or permanent disability or end-stage renal disease or ALS
Part A
Insurance for hospital and skilled nursing facilities (SNF)
Part B
Coverage requires payment of premiums
Covers physician visits, outpatient therapy, other services not covered by A
Part C (Medicare Advantage Plan)
Must be enrolled in A and B
Allows private companies to offer Medicare plans like HMOs and PPOs
Often includes vision, dental, hearing, wellness, and prescription services.
Sometimes even gym memberships and transportation.
Part D
Prescription drug coverage
Requires a monthly premium
Must be enrolled in A and B
Covers brand name and generic
2 types
Prescription Drug Plan (PDP)
Medicare Advantage and Prescription Drug Plan
(MA-PD)
Drug and medical coverage
Medigap insurance
Must have Medicare A and B. Not used with Medicare Advantage plans
Supplemental insurance through private insurances or agencies. Sometimes through an employer you
retired from.
Meant to cover the difference in what Medicare doesn’t cover.
Monthly premiums
Medicaid
Low income, some elderly, disabled, children, pregnant women
Based on financial need. Must apply
Federally mandated, but state administered and funded
States receive some federal funding
Coverage is mandatory for hospital services, physicians, labs, and x-rays, home health services.
Workers’ Compensation Insurance
Provided by an employer
Must include:
Medical care
Temporary disability benefits
Permanent disability benefits
Supplemental job displacement benefits
Vocational rehabilitation
Death benefits
Time sensitive
Allows employers to monitor progress
Cap on expenses
Physician assigned by employer
PTAs
Direct vs General supervision
Different settings
Medicare changes
Students
Reimbursement of student services has become limited (pg. 52)
In some cases, nursing homes in Missouri, PT must be on-site. Refer to each facilities guidelines.
Student and CI can’t be treating different patients at the same time for Part B but can for Part A. - Only therapist services can be billed under Part B
APTA recommends documentation be done by therapist for Part B
Medical setting
Plan of Care (POC) is developed by PT
Treatment must be “reasonable and necessary”
Goals are to return to highest functional level possible, reflecting medical necessity
Time period is determined by third party payers
Medical necessity
Diagnosis should include the medical need for therapy
Requires documentation reflecting need for skilled therapy
Educational setting
Individualized Education Plan (IEP) developed by team with PT input
Goals must reflect educational necessity – can’t move about the educational
environment, can’t ambulate independently, balance or coordination problems
Adaptive PE
Treatment can continue until age 21
Educational necessity
Not based on diagnosis
Need for treatment is based on problems noted meeting educational goals
Incident reporting
Anything out of the ordinary
Anything inconsistent with the facility’s usual routine or treatment procedure
An accident or situation that could cause an accident
Side view
through lobe of ear
through bodies of cervical vertebrae
midway through trunk
through greater Trochanter
slightly anterior to a midline through knee
slightly anterior to lateral malleolus
Frontal view
symmetry
bisects sternum
level nipples
level pelvic crests
level ASIS
level patella
level malleoli
bisects base of support
8-10 degrees of forefoot abduction
Posterior view
Bisect head
bisects spinal column
level pelvic crests
level PSIS
LEs straight
popliteal creases even
feet parallel or toeing out slightly
Heelcords are vertical
Antalgic
Not wanting to spend time on one of the legs, decreased stance phase on the affected leg, and accelerated swing phase on affected side
Crouch
Hips and knees flexed, ankles extended and internally rotated, tight hip adductors
ankle plantar flexor weakness, lever arm dysfunction, knee and hip flexion contractures, and hamstrings
contractures
Swinging gait on both sides, low/mid guard
Festinating
Parkinson’s during ‘off phase’
Reduced arm swing, turning is difficult, shuffling feet
Ataxic
Incoordination of lower limbs, foot placement and step length change constantly with foot crossing midline. Poor balance
Steppage
an exaggerated lifting of the foot during each step
Ms, stroke, drop foot, Damage to the peroneal nerve (which controls foot dorsiflexion muscles)
Circumduction
Compensation for being unable to go through the swing phase
Poor hip flexion, knee flexion, or ankle dorsiflexion
Drop foot/neuropathic
Weak dorsiflexors, damage peroneal nerve
Trendelenburg
Weak gluteus medias
Waddling/myopathic
Weak hip abductors
Scissoring gait
Tight hip adductors, weak abductors
interrater reliability
2+ people measuring the same thing
intrarater reliability
1 person measuring the same thing
fraud
crime punishable by law, billing for services that were never provided, or billing higher reimbursement that service provided:
INTENTIONAL
abuse
result of an error, billing/copayment errors, unaware of proper procedures, claims for services not medically necessary:
UNINTENTIONAL
Hip hike
weak knee flexors, quads
