Exam 2 Flashcards
1
Q
The science of Healing
A
- the charge to DPT faculty is always create “evidence based”
- always practice using evidence based tools, interventions, and sound clinical decision making
2
Q
The art of caring
A
- interpersonal relationship between therapist and patient
- ability to listen to patient (what is being said, how it is being said, what is not being said)
- developing rapport, good communication skills, taking time to reassure and explain
- compassion, professionalism, empathy, understanding
- making decisions not on a clinical prediction rule, but on theory/experience/creativity/sensitivity
3
Q
Caring for yourself
A
- come to class rested
- exercise to get or stay fit
- do everything can to stay focused in class
- wear appropriate clothes (tennis shoes and name tag)
- use good body mechanics in lab
- care for areas of body with previous or current injury
- ask for feedback from peers and instructors and respond appropriately
4
Q
Caring for patient/partner in lab
A
- know their name
- ask if any body parts hurt and permission to touch
- patients: act appropriately to encourage correct practicing
- use good body mechanics so partner feels secure
- use open or closed hands so touch is comfy
- use good communication/interpersonal skillls
- smooth out clothes/wrinkles, assist with removing and putting on shoes
- come prepared
- arrange days outside of class to meet
5
Q
Caring for instructor
A
- come prepared and on time
- wear name tag
- pay attention and watch demonstrations of skills
- ask for feedback
- if need extra help, make appointment
- instructors may have differences in skill performance. understand and respect that
- laugh at their jokes
- be respectful at all times
6
Q
Documentation
A
- document any complications (dizziness, lightheadedness, BP, HR, respiration, pain (when and where) intensity, abrasions/wounds, falls or near falls, balance and coordination)
- record: description of movement patterns, time took, level of assistance (PA, adaptive aids/devices)
7
Q
Safe patient handling first step
A
- assess the situation and patient’s level of assistance, cooperation, comprehension
- plan ahead if patient ins unable to assist with bed/mat mobility or if patient is large and needs assistive devices
8
Q
Matched physical assistance
A
- as much or as little physical assistance that the patient needs at this moment in time
9
Q
FIM levels overview
A
- scale 1-7
- 1 = total assistance
- 7 = total independent
10
Q
FIM level 1
A
- total assistance
- patient performs less than 25% of activity
11
Q
FIM level 2
A
- maximal assistance
- patient performs 25-49% of activity
12
Q
FIM level 3
A
- moderate assistance
- patient performs 50-74% of activity
13
Q
FIM level 4
A
- minimum assistance
- patient performs 75%+ of activity
14
Q
FIM level 5
A
- supervision setup
- cueing, setup, coaxing
15
Q
FIM level 6
A
- modified independent
- device, safety, extra time
16
Q
FIM level 7
A
- completely independent
- timely, safetly
17
Q
FIM helper complete dependence
A
- FIM levels 1&2
18
Q
FIM modified dependence
A
- FIM levels 3-5
19
Q
FIM no helper
A
- FIM levels 6&7
20
Q
Body Mechanics and safe handling
A
- position yourself optimally
- be aware of pressure points (skin checks)
- minimize shearing forces (skin checks)
- may need to use protective padding or gloves
- move slow if need to control movement and minimize pain
- move fast for momentum
- facilitate typical movement patterns
- engage the patient
21
Q
Sit to stand key joint movements
A
- neck: flexion to extension
- trunk: flexion to extension
- pelvis: flexion to extension
- hip: flexion to extension
- knee: extension throughout
- ankle: dorsiflexion to plantar flexion
22
Q
Pelvis sit to stand breakdown
A
- 0% = 26 deg behind vertical (post pelvic tilt…move into flexion or ant tilt)
- 50% = 12 deg forward of vertical (move into extension or post tilt)
- 100% = 1 deg forward of vertical
23
Q
Momentum strategy sit to stand
A
- requires generation of acceleration forces forward and upward
- requires generation of eccentric forces to decelerate body
- requires certain amt of speed and no true breaks in motion
24
Q
Safety issues with momentum sit to stand strategy
A
- can result in backwards fall, especially if patient tries to transfer momentum from trunk to legs for vertical lift before COM is sufficiently forward over feet
- can result in forward fall, especially if unable to control the horizontal forces at end of movement
- continued forward eccentric posterior trunk, HS and GS muscles
25
Q
Force strategy sit to stand
A
- characterized by at least one stop
- trunk generates force to bring COM over BOS (trunk and hip flexion over knees)
- break
- then LE forces lift the body to vertical position
26
Q
Work injuries
A
- lost work time injuries and illnesses: days away from work
- 2nd group with greatest injuries: nurses’ aids, orderlies, attendants (79,000)
- typically strains and sprains to trunk/back due to over exertion during lifting/moving patients
- mean days away from work = 8 days
27
Q
pre-transfer considerations
A
- obesity
- fragility
- amputation
- paralysis
- extra equipment needs
- altered level of consciousness
- language barriers
- hearing/vision loss
28
Q
Facilitation vs. Man-handling during transfers
A
- goal: promote independence and mobility
- every movement and activity is chance to allow patient to help
- facilitation: “the increasing of ease”. Engage and promote recovery via verbal cuing, demos, physical cuing, alignment of patient in biomechanics advantage, set up environment promoting engagement
- *if we chose to do it all for dependent person = no active participation and therefore no motor recovery
29
Q
Slide board transfer
A
- handling is similar to squat-pivot but allows to be done in steps
- used with amputees, SCI, dependent patients
- assisted slide board transfer for patient with quadriplegia or paraplegia
30
Q
Squat pivot transfer
A
- more dependent (FIM 1-4)
- CVA, SCI, TBI
- contact post hip, post shoulder, ant knee
31
Q
Stand pivot and step pivot transfer
A
- deconditioned patients, patients who can weight bear (WB), fearful, PT alone
- contact post hip and ant knee
32
Q
special circumstances supine to short sit
A
- total hip arthroplastry = pillows to prevent adduction and internal rotation
- hemiplegia = initially stronger side down so push with stronger, then as progress can try weaker side. Must stabilize GH joint through scap to prevent GH sublux
- spinal instability = log rolling, keep spine neutral, no valsalva
33
Q
Special circumstances for rolling
A
- total hip arthroplasty = no hip flexion past 90 deg, no adduction, no internal rot
- hemiplegia = at 1st use stronger side and work way to weaker side. consider painful and involved shoulder
- s/p back surgery = log rolling, keep back and neck aligned
34
Q
Prone on elbows pointers
A
- encourage maintaining static 1st
- encourage dynamic and weight bearing through shoulder and scap
- discourage hyperextended neck
- progress to mobility weight shift
- progress to off-loading and moving extremity
- progress to assuming POE position last
35
Q
Pregait»_space; Crawling
A
- overhead suspension system
- progress from partial to full BWS
- crawling harness
36
Q
Bariatrics considerations
A
- proper body mechanics are even greater to prevent injury
- all equipment must be rated for higher maximum weight
- typically labeled EC (extended capacity) or XL
- look for capacity over 250 lbs
- transfers and repositioning usually require assistance of more than one individual
37
Q
Dependent (FIM 1/2) transfer with sliding board
A
- contact anterior chest, post hips, ant knees
- make sure to really hug patient and pull their hips forward on knees
- stagger your feet and rock back onto foot/heels
38
Q
Dependent 2 person transfer WC to bed
A
- one PT behind patient (they call the shots)
- patient crosses arms, PT behind is under shoulders and grabs forearms, hugging patient to chest
- one PT in front with arms under thighs
39
Q
Mechanical lifts
A
- arjo-maxi move
- traditional hoyer
- ceiling suspension
- etc
40
Q
LMN
A
- letters of medical necessity
- needed to justify choice of WC and defend patient
- why they need those specific choices
41
Q
Wheelchair types
A
- standard adult
- heavy duty adult
- pediatric
- hemiplegic
- reclining/tilt in space
- custom/light-weight
- power chair
- all terrain
- standing
42
Q
Standard WC
A
- basic WC found in hospitals, nursing homes, etc
- 250 lbs capacity
- no frills, chroms WV
- durable, low maintenance
- often non-adjustable
- weighs ~36 lbs
- seat widths: 16, 18, 20”
- seat depth: 16”
- back height: 18”
- front riggings swing away or swing away elevating
- 1 year warranty
43
Q
Heavy duty WC
A
- usually covered by insurance if patient is over 250 lbs
- 350 lbs capacity
- weighs ~38 lbs
- more options for everything
- 16-22” width and 16-20” depth
- urethane casters = better ride and lighter weight
44
Q
Hemi WC
A
- adjustable seat heights and are lower than traditional WCs = allows to use feet to help propel
- for post-stroke, arm amputees
45
Q
Custom/light-weight WC
A
- aka quickie
- lightweight frame (titanium)
- often rigid frame (non-collapsable)
- low profile back (depends on SCI level and sport)
- may/may not use tubular arm rests
- narrow, angled camber 0-90 deg wheels
- always add premiere cushion
46
Q
Ultra light-weight WC
A
- provide manual WC users with high strength, fully customizable manual WC made of lightest possible material
- lighter = less to propel, adjustable, made with better components, costs less, shown to last 13.2 times longer
