Exam 2 Flashcards
When applying an UE PNF technique to a patient, what is the pt asked to watch?
- Follow and watch hand
What is the highest LOI to use a manual wheelchair with projections on the rim?
C5
The average length of rehabilitation stay is 2 months. T or F
False (Acute: 12 days, Inpatient: 37 days)
What are the treatment times that are most beneficial for PD pt on L-Dopa? * Provide informative nutritional info about medication.
- At peak dosage time of medication.
- DECREASE protein consumption at and around dosage times.
- Decrease Calories. Increase water, vegetables, and fruits “fiber”
Which spinal cord syndrome features sensory impairments that are usually less severe than the motor impairments and result from hyperextension injuries (UE > LE)?
Central Cord
________ occurs during the first day after spinal injury with the patient unable to perform motor or sensory assessment.
Spinal Shock
Avascular malformations occur in the spinal cord tissue. T or F
True
To assess the L2 myotome on the ASIA Scale, the person will have hip flexion assessed. T or F
True
What needs to be promoted with our treatment for PD patients to improve functional mobility?
- increased cervical extension
- increased thoracic extension
- Increased lumbar extension
- increased anterior pelvic tilt
What are 4 pt education examples of Autonomic Dysreflexia?
- Checking drainage system of catheter first
- Headache
- Sweating above level of injury
- High blood pressure monitoring
What Neurodegenerative Disease has a sub max exercise level of 20-70% of HR Max?
Multiple Sclerosis
You must work (lightly or hard) on a patient with PD?
Aggressive-Hard
In PD patients, what are strategies to enhance locomotor?
- walking with vertical poles (like 2 canes)
- verbal instructions: walk tall, walk fast, large steps, swing both arms
- transverse visual cues
- braiding (trunk rotation)
Which LE pattern can facilitate hackysack play?
D1 Flexion
What pattern of return (recovery) does a C4 incomplete SCI have?
- Proximal to Distal “Most distal doesn’t improve”.
What type of motor learning do patients of PD work well in?
Blocked practice, same task, high reps, and closed environment
When rhythmical initiation is performed 8-12 times by a patient with PD, what other relaxation benefit will the patient have?
Decreased muscle tone, increased chest expansion and aerobic capacity
Which diagnosis is most likely to have impaired sensory?
- MS>GB>ALS
A pt with a clinical syndrome produces an acute onset of unwanted activity from noxious stimuli below the level of the lesion. What is this term? What is the most common cause?
Autonomic Dysreflexia; Bladder and Bowel Distention
What PD medicine is the best in crossing the blood brain barrier but only benefit a decade?
- Carbidopa “Cinamed”
Which spinal cord syndrome features preservation of motor function, a sense of pain and light touch, and loss of 2 point discrimination?
Posterior Cord
A patient that presents with motor function below the neurological level with more than half the key muscle groups having a grade < 3 will be scored as a(n) ______ on the ASIA Impairment Scale.
C
Which patient treatment stategies will encourage an increase ROM, increase respiratory function, and increase in pulmonary capacity?
- Bilateral symmetrical D2 flexion
When a patient with SCI level C5 with biceps intact attempts to long sit, can they perform the task?
No, can’t wrist or triceps extend. Need at least C7
Which UE can facilitate strengthening for functional carryover to increase pt ability to clean the back of their neck and scapula in shower?
D1 Flexion
How often should a person perform pressure relief, and how long of a hold?
- Every 15min for 2min hold***
What level of the spine must be intact to perform seated push-ups?
C7
Which diagnosis reviewed is most likely to have spasticity?
- Multiple Sclerosis
A patient with a complete C3 injury is most likely to have a ventilator. T or F
True (C1-C3)
What is generally contraindicated for PD patients in resistance training?
Isometrics
Which 2 PNF techniques facilitate increased ROM in a pt?Which is best for PD?
- Contract Relax (pt moves to new range) (*best for PD)
- Hold Relax (PTA moves to new range)
Which muscles groups should not be stretched with a pt with SCI?
- Long finger flexor (wanted tenodesis)
- Lower trunk (wanted sitting stability)
To increase ROM, what PNF technique should be applied at the end ROM?
- Contract-relax (best, pt performs) and hold-relax
What are some relaxation exercises for PD?
Yoga, Tai Chi, rocking, rhythmic initiation, diaphragmatic breathing
What are the cardinal signs and symptoms of PD?
- Tremor
- Rigidity
- Akinesia (bradycardia)
- Postural Instability
What is the highest LOI to independently transfer to most surfaces including uneven?
C8
Which LOI would need a ventilator or phrenic stimulator?
C1 to C3
What is the highest LOI able to perform outdoor mobility on uneven surfaces and cubs independently?
T1-T12
What area can have weight relief with forward lean, hands down to the floor?
Sacral
How does Carpidopa benefit patient’s with PD?
- Controls bradykinesia and rigidity
What are the principle steps of the application of Rhythmic Initiation?
PROM, AAROM, AROM, ARROM
What is the most common spinal cord syndrome?
Central Cord Syndrome
What are motor learning strategies of PD?
- Large number of repetitions
- Structured instructional sets
- Closed environment; less clutter
- Avoid dual tasking; Do single tasks
- Blocked practice order
- External cues
Why are SCI pts prone to developing DVT’s?
- Lack of movement
- Loss of nerve control for BP
What level of the spine must be intact to perform weight relief with lateral lean?
C7 ???
What is known to present osteogenesis within the joints of SCI below the level of the lesion and usually occurs adjacent to large joints (hips/knees)?
Heterotropic Ossification
In MS, If a lesion and scar formation happens in the sensory or motor cortex, what will the patients symptoms be?
- Bladder, Bowel, and sexual dysfunction
- Motor and/or Sensory loss, typically LE>UE (ones sided at times but not considered hemiplegia)
What types of verbal cues will benefit a patient with PD the most?
BIGGER” “Left, right, left right” - rhythmic and simple verbal cues
What level of the spine must be intact to perform seated push-ups?
Triceps
With chopping and symmetrical overhead reaching, what verbal and tactile cues are necessary to encourage maximal irradiation and AROM? Which region of the body does the therapist facilitate?
“Watch and follow your hand” “in and out”; scapula and hand
Brown-Sequard Syndrome is the least common spinal cord injury presentation. T or F
False (Posterior Cord Syndrome)
The majority of spinal cord injuries are caused by non-traumatic events. T or F
False (Traumatic Events)
Which diagnosis has UMN symptoms and LMN symptoms?
- MS
- ALS
What causes of PD?
Unknown - Idiopathic
What Neurodegenerative Disease presents with many people having heat sensitivity? What’s the best time to exercise them?
- MS; A.M. In the morning
What pathological issue that typically occurs in lesions above T6 presents from the onset of noxious stimuli below the level of a SCI lesion?How long does it last and when does it resolve?
- Autonomic Dysreflexia “Increases BP. Inability to communicate with phrenic area to decrease HTN”
Which UE pattern can facilitate strengthening for functional carryover over to increase pt ability to scoot?
D1 Extension
What is the complete paralysis of all four extremities and trunk, including respiratory muscles, and results from lesions in the cervical cord?
Tetraplegia
In MS, If a lesion and scar formation happens in the cerebellum, what will the patients symptoms be?
- Loss of balance and coordination
- Ataxia
What additional benefits will patients receive with Tai chi sequencing and braided resistance?
- Decrease muscle tone (rigidity), decrease muscle instability, and increase big motions
What are aerobic exercise recommendations for PD patient?
- 50%-85% max HR (220-age)
What muscles are being strengthened when performing seated push-ups?
Triceps
What are ways to progress functional training?
- changing surface or height
- narrowing BOS
- reaching activities
________ cord syndrome presents from flexion of the cervical spine with the loss of ________ and _______ sensory function below the level of injury.
Anterior; motor; pain and temperature
Which diagnosis reviewed is the most likely to have bulbar involvement?
- GB
- ALS
Patients with SCI are not at risk of orthostatic hypotension. T or F
False
What is contraindicated for PD patients to do in bed mobility?
-Log Rolling “because it encourages trunk rigidity”
How much hamstring length must be gained to long sit?
- 100° for long sitting (90° for short sitting)
Which spinal cord syndrome features loss of motor function (corticospinal) and loss of the sense of pain and temperature (spinothalamic ) below the level of the lesion ?
Anterior Cord
Which PNF techniques facilitate strengthening for a pt?
- Rhythmic Stabilization (Choppy)
- Stabilizing Reversals (Smooth Co-contractions)
What should be done and checked with Autonomic Dysreflexia?
- 1st Sit pt up
- Check for noxious stimuli “Check for Bowel/Bladder distention, blocked catheters, UTI’s, kidney stones, pressure sores”
What 2 techniques in GB/MS were discussed to address ataxia?
- Frankel Exercises (Unilateral Shin Slides) “Helps improve trunk control”
- Weighted or WB exercises
Is Guillian Barre an UMN or LMN disease?
LMN (Peripheral)
A bony prominence which is most likely to form at the hip and knee joint is a(n) _______.
Heterotropic Ossification
What is the frequency and duration for flexibility exercises? How hard?
- 4 reps with 15-60 second holds
- 2-3 days per a week (minimum)
- 5-7 days per a week (ideally)
What area can have weight relief with lateral lean over side of the chair?
- Ischial Tuberosity
- Gluteus
Which spinal cord syndrome features paralysis (lateral corticospinal) and sensory loss (dorsal column) on the same side, with sensory loss (spinothalalmic) on the opposite side 2 segments below the level of injury?
Brown-Sequard
What is the most common sex and age for PD?
- Male and 55 and up
What is defined as a period of areflexia (hyporeflexia, flaccidity) below the level of lesion that usually results in 24 hours?
Spinal Shock
Which LE pattern can facilitate skin checks to the bottom of pt foot?
D1 Flexion
What types of external internal cues benefit the patient with PD the most?
- Auditory (music, metronome, “saying take BIG Steps”)
- Visual (Parallel Visual lines, 2-2.5 ft space between lines, Color of lines)
- Tactile (Touching patient for cueing to facilitate a beneficial movement)
How should pt with spastic and flaccid bladder be educated in a bladder training program?
- Spastic, empty with manual techniques
- Flaccid, empty with valsalva maneuver
What types of internal cues benefit the patient with PD the most?
- Mental Music (keep patient from freezing and BIG step promotion)
- Remembering (recalling external cues to discourage freezing and promote BIG steps)
A patient with a complete C7 injury is most likely to have a spastic bladder. T or F
True (UMN Lesion)
What is the highest LOI able to walk with AFOs and canes?
L4-L5
What PNF pattern can also be used with the ROM maintenance of the Iliopsoas?
D1 Flexion
What SCI level must be intact for biceps use?
C5
If a PD patient was retropulsive, where does their balance need to be improved for sit to stand?
Anterior
Paralysis of intercostals results in decreased chest expansion and lower capacity. What is the name for this type of respiration? What is the range of spinal segments most likely involved?
- Paradoxical breathing “chest flattens, and there is dominant epigastric rise”
- C1 to C3 (will require a ventilator)
What is the difference between Cogwheel rigidity and Lead-pipe rigidity?
Cogwheel - jerky, resistance to PROM (tremor + rigidity)
Leadpipe - sustained resistance without fluctuations
What other neuromuscular diagnosis can these (GB/MS) techniques be used with?
- GB/MS/ALS declined
How many sets and reps do patients with PD need to do to gain ROM?
- 4 reps with 15-60 second holds; 2-3 days/week
When the hypothalamus can no longer control cutaneous blood flow or level of sweating in a pt, they will not be able to sweat below the level of the lesion, but may demonstrate diaphoresis above the level of the lesion due to what?
- Loss of temperature control “external environment control, especially tetrapalegia”
A neurodegenerative disease that produces intentional tremors is called?
Multiple Sclerosis
What ND Disease produces involuntary emotional expression disorder or emotional incontinence, and is characterized by sudden and unpredictable episodes of crying, laughing, or other emotional displays? What is it called?
MS; Pseudobulbar Syndrome
Exercise sessions should be scheduled on alternate (non-endurance) days and during optimal times, such as in the morning, when body core temperatures tend to be lowest and before fatigue sets in MS. T or F
True
Precautions should be taken to prevent the deleterious effects of overwork. Exercising to the point of fatigue is contraindicated and can result in worsening of symptoms, most notably increased weakness in what Neurodegenerative Disease?
Multiple Sclerosis
What’s an appropriate option for prevention and in some cases reversal of contractures? (Ex. MS)
- Orthosis and Dynamic Splinting
Which ND diseases recommends training frequency at 3 to 5 days/week, on alternate days. Daily exercise at lower levels of intensity is recommended for individuals with more limited exercise capacities
Multiple Sclerosis
LMN, UMN, Bulbar, and Respiratory impairments are characteristics of ?
ALS
Sensory pathways are spared, for the most part, in people with this dx
ALS
EMG, nerve conduction velocity (NCV) studies, muscle and nerve biopsies, and neuroimaging studies are used to support the diagnosis of?
ALS
Glutamate inhibitors such as Rilutek are used to treat?
ALS
Respiratory management of _______ consist of (1) pneumococcal and yearly in-fluenza vaccinations (2) prevention of aspiration; (3) effective oral and pulmonary secretion management. ***Supplemental oxygen must be used with caution because it can suppress respiratory drive, exacerbate hypoventilation, and ultimately lead to hypercarbia and respiratory arrest.
ALS
To determine the extent of bulbar involvement, the nerves that we should test in ALS are?
V, VII, IX, X, and XII
Physical therapist can play a role in managing dysarthria and dysphagia by addressing the patient’s? (Ex. ALS)
- Head trunk control
- Position in sitting
What Disease presents these symptoms?
- 50% chance of passing to offspring
- Clumsiness, tremor, balance problems, jerkiness, rigidity, ataxia, dystonia (Basal Ganglia sx)
- Atrophy to BG and corpus Callosum common
- Weight loss, mental impairment/depression/behavior issues
- Diagnosis through PMH, fam history, genetic testing
- No cure, medications can help chorea which include dopamine blockers
Huntington’s Disease
What are the most common tumors that metastasize to brain?
PT Barnum Loves Kids
- Prostate
- Testis
- Breast
- Lungs
- Kidneys
What condition has these characteristics?
- Most in cerebrum, but can be in cerebellum→ most have multiple lesions.
Grade 1 Astrocytoma- slow growing, defined borders. Sx= standard w/chemo (2%)
Grade II - Rarely spreads to other parts of CNS. Borders not well defined.
Grade III- Anaplastic Astrocytoma; grows faster and more aggressively. Tumor cells not uniform in appearance. Invades neighboring tissues. (4%)
Grade IV- Glioblastoma Multiforme - Most invasive. Commonly spreads to other tissues rapidly. May be composed of several types of cells. 23% of all tumors
Metatastic Brain Tumor
