EXAM 1 COMBINED LECTURES Flashcards
1
Q
in the PNF task classification, what is stability
A
Maintaining a position or posture (statically)
Often refers to stability of proximal muscle groups (requires core activation for posture)
2
Q
In PNF task classification, what is controlled mobility
A
Ability to shift COG over stable BOS (dynamic) Distal segments (UE or LE) fixed; proximal segments move (ex: wt shifting)
3
Q
IN PNF task classification, what is skill
A
A goal-oriented action
Requires coordinated movement sequences
Characterized by fluency, consistency, precise timing, and efficiency (open chain ex: pnf patterns)
4
Q
what is MDC
A
minimally detectable change
MDC is real change without error
5
Q
what is MCID
A
MCID (minimally clinically important difference)
The smallest change in an OM that is perceived as beneficial by the patient, and that would lead to a change in the patient’s medical management
MCID is patient notices improvement)
6
Q
what things do predictive OM focus on
A
sensitivity and specificity, predictive values and likelihood
7
Q
main domains of OM
A
motor function, balance, transfers, cognition
8
Q
purposes of OMs (they either aim to ___, __ or ___)
A
discriminate, predict, evaluate
9
Q
types of OMs
A
generic vs disease specific
self reported vs performance
10
Q
feasibility components of OMs
A
cost equipment training space time
11
Q
fallers vs non fallers is an ex of what type of OM
A
discriminative (its this or it’s that)
12
Q
fall risk, or DC desination are what type of OM
A
predictive
13
Q
type of OM that is useful in determining the effect of the intervention
A
evaluative
14
Q
Consistency when one person takes repeated measures over time
A
intra-rater reliabilty
15
Q
Consistency of repeated measures across time
A
test retest reliability
16
Q
Consistency between >1 persons
A
inter rater reliability
17
Q
The assumption of validity based on appearance as a reasonable measure of the given construct
A
face validity
18
Q
A comparison of one measure to another, previously validated, measure
A
concurrent validity
19
Q
Ability of the measure to indicate some future event
A
predictive validity
20
Q
The conceptual /theoretical basis for using a measurement to make an inferred interpretation
A
construct validity
21
Q
The degree to which the measure’s items reflect the domain being measured.
A
content validity
22
Q
Minimal Detectable Change
Minimally Clinically Important Change
these are most important with what types of OMs
A
evaluative
23
Q
sensitivity or specificity are more important with what type of OMs
A
disc or predictive
24
Q
true +
Proportion of people w/ a + test result who have the condition
A
sensitivity
25
true –
| Proportion of people w/ a negative test result who do not have the condition
specificity
26
Majority of true non-fallers correctly identified
| is an ex of (sens or spec)
ruled out so sensitivity
27
true fallers correctly identified is an ex of (sens or spec)
ruled in so specificity
28
what is responsiveness
ability of the test to measure change
Minimal detectable change (MDC)
Minimally important difference (MID) or minimal clinically important difference (MIDC)
29
explain MDC
due to actual change and not just error (smallest amt of change that is not due to error) is based off of test/retest reliability.
The more reliable the test, the smaller the MDC
30
explain MCID
Minimally clinical important diff
The smallest change in an OM that is perceived as beneficial by the patient, and that would lead to a change in the patient’s medical management
31
the likelyhood of a ceiling or floor effect depends on
Patient capability
Instrument used
(20% have either the highest or lowest score -its too easy or too hard)
32
EDSS normal is
0-3.5
6-8 is max
33
acute care settings, do they usually do team meets
no
34
acute care uses a ___ disciplinary approach
multi (very distinct and separate roles)
35
when does screening for rehab begin (where to place them)
as soon as pt is stable
36
for an in pt rehab, pt must be able to do what 2 things and require what things
must be able to learn and sit for 1 hour, must require at least 2 services
37
long term goals for in pt would be what time frame
2-3 weeks (dc)
38
short term goals for in pt rehab are done
week to week
39
what is worst/best FIM scores
18 worst best 126
40
what determines length of stay in rehab (what test)
FIM score
41
what setting typically does have weekly meetings ofr grand rounds
in pt rehab
42
DC occurs when
goals are met or pt platues
43
requirements for home care
```
under care of a Doc
cannot leave the house dt med cond
leaving is too taxing on pt
home env (ex: too many stairs)
illness progression
family at home
```
44
STroke triage scale is based on
FIM score
45
mild, mod, severe stroke triage scales
mild :126-80 FIM
mod: 40-60 FIM
severe: 18-40 FIM
46
what team approach is best
InterDisciplinary (overlapping roles)
47
what is a multi disciplinary approach
separate functions/roles
48
what is a transdisciplinary approach
no set roles, every health care provider does same jobs
49
walking ___ft is necessary for full independence
1000
50
every pt assessment should always include what 4 things
env at home
goals
chief CO
prior LOF
51
mini mental eval of scores is influenced by what 2 things
age, education
52
dev Hx is important with children, but what 2 pathos are also included for adults
downs, CP
53
what can sinemet for PD do
cause ortho hypotension
54
we need to know if PD pts are on what meds
antispastic (sinemet)
55
what 2 things are need to knows in regards to pts with swallowing issues
hydration, nutrition
56
endurance/aerobic test best for neuro pts
2mwt
57
stroke pts get edema where
UE
58
what factors effect functional reach
age, ht
59
when testing/assessing integration status, look at what 3 things
community social and civic involvement
60
the DGI identifies what
identifies ability to modify gait in response to changes
61
DGI is only for what pts
high functioning
62
mini mental reliablity and validity relies on
pt pop
63
injury to frontal lobe would cause what sx
lack of judgement
64
PASS stands for
posture assessment of stroke scale
65
PASS is best performed when
early - within 90 days of stroke
66
what does PASS test for
balance and position change ability
67
STREAM stands for
stroke rehab assemeent of movement
68
STREAM tests what
measurement of motor function and mobility (tests initiation, modification, and control of movement)
69
if pts dont show normal motor control/strength, what HAS to be assessed
PROM (Muscle length, soft tissue extensibility, and flexibility - Important given musculoskeletal contributions to spasticity)
70
what is tone
R to passive stretch
71
modified ashworth scale tests what
spacticity only (not rigidity or flaccidity)
72
shopping, family roles are considered ADL or IADL
IADL
73
FIM is about what
level of assistance needed for all constructs
74
peak age of MS onset
30 (15-50)
75
farther away from the ___ it increases your chance of MS
equator (however, if you move before you are 15 you assume that geographical locations risk)
76
virus possibly linked to MS
Epstein Barr
77
an immune response that produces T lymphocytes and macrphages which cause antigens to activate. Creating cytotoxic responses to the CNS and T lymp cells attack myelin. is what type of MS
Relapsing remitting
78
invovlement of the oligodentrocyte cells is what type of MS
secondary progressive
79
main difference btwn relapsing remitting and secondary progressive MS
SP they don't improve after an exacerbation
80
most common 1st sx of MS
optic neuritis
81
____matter is effected by MS
white
82
what tracts carry sensory info to brain
corticospinal
83
what is CIS
clinically isolated syndrome- it's like an MS precursor- it's the first episode they've ever had and it goes away. typically monofocal. Imaging doesn't always show
84
to diagnose MS you have to have dissemination of __ and __
time and space (time meaning you have to have episodes happen at diff times - over a month apart) space meaning have to have 2 lesions in different spots)
85
4 types of MS
relapsing remitting
secondary progressive
primary progressive
progressive relapsing
86
EDSS
expanded disability status scale (#1 OM for MS)
87
downfall of EDSS
doesn't respond to changes in intervention
88
sensitivity to heat with MS is known as
Uthoff sx
89
biggest c/o for MS pts
fatigue
90
which type of MS has more severe fatigue early on,
PPMS (it decreases over time though bc they stop being active)
91
2 types of fatige with MS
peripheral and central (muscular vs true exhaustion)
92
cause of fatigue for MS
BG or widespread axonal damage. overactivation of frontal cortical areas.
bottom line: motor planning takes alot out of them
93
weakness in MS is more common in the ___extremeties
Lower
94
MS weakness effects both ___ and __
muscle contraction/performance and endurance
95
incoordination of mvmt dt sensory or cerebellar issues
ataxia
96
ataxia is a prob with ___ control
anticipatory
97
co contractures and decompensation are compensatory methods for
ataxia
98
timing, scaling, accuracy, (coordination) are done by what part of brain
cerebellum
99
pts with cerebellar issues have a hard time ___ and ___ movement
predicting and adapting
100
does life exp with MS decrease
no
101
5 main issues of MS
fatigue, weakness, spacticity, ataxia, posture
102
prognositc indicators of MS
sphinctor control, cognition
103
is higher or lower EDSS better
higher is worse
104
primary dx tool for MS
MRI (can also do CSF draw to test for antibodies)
105
drugs for MS
interferons (decrease the inflammatory process)
106
```
Betaseron
Avonex
Rebif
Copaxone
Novantrone
these are all what types fo drugs
```
interferons
107
drug that improves gait speed
K channel blocker (AMpyra - or dalfampridine)
108
what is a pseudo exacerbation
happens after exercise, tell pts it will go away (they have an increase in their sensory sx)
109
PD is a disease of the ___NS
CNS
110
tell tell signs of PD
rididity, bradykinesia, tremors (resting), posture probs
111
what anatomical location is the issue with PD
BG (basal ganglia) specifically the substansia nigra
112
3 types of PD
ideopathic (most pts have this kind)
identifiable (secondary)
Parkinsons plus
113
identifiable AKA secondary PD is dt
drugs or tumors or illness (virus)
114
would reflexes for PD be normal
yes
115
what would be good walking tests for PD
TUG or DGI
116
dopamine comes from the
subs nigra
117
2 tracts/loops of the basal ganglia
direct -exitation
indirect -inhibition
direct: excitatory -excited by dopamine
decrease production decreases movement
indirect: inhibitory -inhibited by dopamine
decreased production decreases excitation and decreases movement
118
what happens with PD (what causes it)
decreased dopamine, decreases excitation, which decreases movement
119
rigidity of PD happens more
proximal
120
with PD, there is a(n) ____ in tone
increase (they are rigid)
121
2 subgroups of PD
posture/gait
| tremor
122
highest form of increased resistance to a passive stretch
rigidity (rigidity is the highest form of tone)
123
rigidity is vel ___
independent
124
shuffling gate of PD is aka
festination
125
sudden stopping with PD is aka
freezing
126
why are toppling falls common with PD
bc festinated gate changes their COM as they shuffle
127
micrographia
poor control of handwritting
128
PD #1 assessment
Hoen and Yar
129
how is PD dx
if they have 2/3 sx (there is no imaging)
130
another tx for PD
deep brain stimulation
131
list the 3 models of motor control
| list the 3 models of neuro rehab
models of motor control: Reflex, heirarchial, systems
| models of neuro rehab: muscle re-ed, neuro therapeutic facilitation, task oriented
132
ATNR is an ex of what model of motor control
heriarchial
133
downfall of reflex theory and heirarchial
they dont' include how human mvmt is variable
134
sx theory use what model of neuro rehab
task oriented approach only
135
what are the 3 models of neuro rehab
muscle re-education (no one uses)
Neuro therapeutic facilitation
Task oriented rehab
136
goal of neurotherapeutic facilitation is
to get pts out of a synergy pattern and to normalize mvmt
137
plus of task oriented
variability and adaptability, there is no 1 right way, pts are the prob solvers, we dont always normalize
Emphasizes high repetition intensive task practice
138
neurotherapeutic facilitation utilizes
PNF, NDT, Brunnstrom
139
what is Brunnstrom stages
only use this when there is absolutely no mvtmt, she has stages of recovery that she progresses pts through. not good for goal writing, uses associateive movement
140
NDT
neuro develpmental tx
141
goal of NDT
enhance normal movement or normalize tone
142
NDT uses
handling (sensory feedback)
143
downfalls to NDT
takes a lot of time, and typically doesnt progress until pt has mastered a skill
144
what is PNF task classification scale, and list the progression
it is a progression we are supposed to follow when doing PNF (mobility, stability, controlled mob, and skill)
145
downfall with PNF task classification scale
not all pts can follow that progression (ex: PD dont need to work on stability, ataxic pts dont need mobility)
146
3 components of task or approach
effects that pt, env, and task have on mvmt
147
all movement is comprised of 3 things
progression, stability, adaptability
148
which type of therapist always tries to correct abnormal mvmt
NDT
149
2 ways to retrain mvmt
force control or momentum
150
force control requires
strenght
151
momentum requires __ and __
strenght and coordination
152
which is best for ataxic pts, force control or momentum
force control
153
restorative vs compensate
one you improve the issue back to normal,the other uses adaptive techniquies
154
constraint induced therapy is _____ oriented
task
155
clear start and finish is a ___ task
discrete
156
no clear start and finish is a ___ task
continuous
157
3 essential tasks of mobility
Progression
Stability
Adaptability
158
stages of motor learning
cog
associative
autonomous
159
progression part of mobility task is what (describe)
its all the movement of the body (ex: in sit to stand it's hip flexion, trunk flexion, knee ext)
160
explain stability as an essential task of mobility
controlling balance, maintaining COM
161
what are the 3 steps to using a task orientied approach in mobility
1. initial considerations
2. movement analysis
3. plan the intervention
162
what does initial considerations mean in task oriented approach (with mobility)
you have to consider the task itself and the env
ex: Task complexity, Task characteristics, Cognitive demands of task, In what environments are the movement typically performed? Environmental characteristics?
163
adaptation of movement is hardest for what type of pts
ones stuck in a synergy pattern
164
in step 3 of task oriented approach of mobility (plan the intervention) what may you have to do be for actual movement
tx underlying impairments (ex: stretch plantar flexors)
165
what is different about STS vs supine to stand or rolling in bed
STS is not really variable (you stand up)
| supine to stand and rolling both have variable ways to do it
166
2 months post stroke, would you work on more compensatory or restorative
restorative (still acute)
167
is it better to do random or blocked practice in associative stage
do random
168
4 steps to assessment part of soap note
Brief intro to the patient Male/female, age dx, admitted to,_
Summarize exam data
Explains impairments and relates to activity and participation
Identify prognostic indicators (pos or neg)
Explain the need for PT… make it clear that the patient will benefit from PT
169
A label to describe the dimensions of the patient
diagnosis
170
diagnosis directs what
plan of care
171
ataxia dismetria-celebellar
| are what PT diagnosis
movement pattern coordination deficit
172
weakness is what PT diagnosis
force production deficit
173
force production deficit PT dx has 2 components (list them)
1. improvment expected
| 2. no improvement expected
174
lack of ROM or diminished ROM is what PT dx
biomechanical deficit
175
one thing is off so they “weigh” one sensation over the other (what PT dx)
sensory selection deficit
176
severe Hypokinesia PT dx would be related to
PD
177
SCI (cannot sit upright) would be what PT dx
monitored mobility
178
left neglect would be what PT dx
perceptual deficit
179
proprioceptive issues would be what PT dx
sensory detection deficit
180
decreased muscle tone with inability to initiate movement is what PT dx
Paresis
181
Significant signs of hyperexcitability with associated inability to initiate movement is what PT dx
spacticity without mvmt
182
significant signs of hyperexcitability with associated inability to fractionate movement against gravity is what PT dx
spacticity with mvmt
183
if pt simply cannot participate in mobility training, their PT dx is
mobility consult
184
how to word a prognosis for a SCI pt who will not return motor function, but is motivated
pt has poor prognosis for motor return, but good prognosis for learning compensatory strategies for functional activity
185
what is neuroplasciticy
brain remodels and adapts after a stroke (can take months), at about 6 months it stops
186
what strokes have best prognosis
lacunar
187
what is best predictor of prognosis post stroke
initial recovery of motor function
188
most motor recovery occurs when (post stroke)
1st month -6 months
189
what does research say about UE vs LE prognosis of motor function post stroke
less UE involvment (better prognosis for UE)
190
what is a good predictor for prognosis of stroke for UE
shoulder shrug ability
191
what is orpington scale
stroke prognostic scale
Measures UE motor function, proprioception, balance, and cognition (highly recommended by EDGE website)
under 3.2 they usually go home, over 5 they are dependent
192
goal time frame for OP setting (long term is how long, short term is how long)
LTG reflect DC, short term are 3-4 weeks
193
SMART goals
```
specific
measurable
acheivable
relavent
time
```
194
when formulating prognosis, we must consider both ___ and ___ factors
pos and neg
195
walking and talking is an ex of a ____type of task
cognitive dual
196
walking and lifting something is a ___ type of task
motor dual
197
considerations when setting gait related goals
```
distance variables
Amount of assistance needed
Use of assistive device
Ability to ambulate in various environments
Safety
Cognition
```
198
what test would you do to determine gait speed
10m walk
199
community ambulatory would need to walk at what pace
community: over .8m/sec
moderate limited: .4m/s - .8 m/sec
Severe limited: if they walked under .4m/s that is severe impairment or household ambulator
200
5 main impairments constraining gait
```
Weakness
Spasticity
Loss of ROM
Dyscoordination/Ataxia
Rigidity/bradykinesia
```
201
#1 muscle group needed for progression, that gives power for push off in walking progression.
gastroc soleus (decreased plantarflexors lessons push off and even their speed and power)
202
how does weakness effect stabilty in walking
if glut med is weak, their single leg stance is poor
203
how does weakness effect adaptabilty in walking
if quads are weak, they cannot change directions or alter gait well
204
weakness can impact what tasks of mobility
all (progression, stability, and adaptabilty)
205
post stroke, these muscles are most weak on pts
pts will have the most problem with dorsiflexion, hip flexion, knee flexion
206
post stroke, pts have more probs with what tasks of mobility
pts have More difficulty with progression, decreased push off, and adaptability (stepping over things in the env
207
weak quads post stroke, what compensations might you see
Knee hyperextension
| Forward trunk lean
208
spacticity can effect what tasks of mobility
all
209
how can spacticity specifically effect gastroc/soleus during gait
If gastrocs are tight, in mid to late stance gastrocs cannot do stride position very well bc they feel very unsteady (in order to get into terminal stance, the gastroc needs full extension – they cannot do this) = instablity
210
which type of walker is better for ataxic pts
rolling (standard they would have to pick up, increasing their chance of fall)
211
Tx options for ataxic pts with gait
```
Weighting
Balanced Based Torso Weighting
assistive device
Exercises to increase stability (pnf)
Balance-retraining
Compensatory strategies
```
212
tx options for PD with gait
```
Balance and gait retraining
Use of visual and auditory cues
Lee Silverman Voice Treatment (LSVT) BIG program
Assistive device
Stretching/flexibility exercises
```
213
key ingredients to locomotive training
```
high reps
speed
salience-meaningful to them
make it challenging
incorporate paretic side
task specific-walking improves walking
whole task
know env
```
214
what does speed offer as a key ingredient to locmotive training
taps into CPG
215
gait is a ___task
whole
216
2 main types of body supported treatmill devices
harness
| robotic
217
BWSTT (harness) is as effective as __
a task oriented training program (robotics not so much)
218
in regards to the big chart she keeps showing, what does cog demands mean
is it dual task vs single (walking and talking or just walking)
219
difference btwn blocked and random tasks
random-all in random order
blocked-practicing each task in a block before progressing to a new task.
220
explain the MDC results (how do you know if it's reliable test)
The more reliable the test, the smaller the MDC
221
the goal of this model of rehab is to alter CNS,
Reduce stereotypical movement patterns and reflexes
Facilitate normal movement
neuro therapeutic facilitation
222
ave age onset of PD
Average age at onset 50-60 years
223
one of the most prevalent issues with PD (decreases their QOL)
postural instabilty that causes falls
224
```
Emphasizes sensory feedback
HANDLING!
Therapist guides therapeutic process
Tendency to focus on one way of moving
Tendency to aim for mastery of one skill before moving on to another
```
This describes what type of rehab approach
NDT
225
surgical txs for parkinsons
Thalamotomy- takes out ventral intermediate nucleus —> decreases sx
Pallidotomy -Decreases sx but can cause speech/swallow problems
Deep brain stimulations -estim implantion that doesn't damage the brain
226
models used by NTF (neuro therapeutic facilitation)
Proprioceptive Neuromuscular Facilitation (PNF)
Neurodevelopmental Treatment (NDT)
Brunnstrom
227
This tx approach progresses pts through phases of synergistic patterns to hopefully get them to normal movement
Brunnstrom
228
what are the 4 PNF task classifications (the progression that you are supposed to follow)
mobiliy
stability
controlled mobility
skill
