Exam 4 Flashcards
what are some other things that need to be in the exam for acute care
Coordination
Balance
***only if needed or time
what is the set up for Spontaneous Nystagmus
Patient is arm’s length from PT, head stationary, looking straight ahead with PT standing off to side.
what are the directions for VOR – slow
“Look at my nose the entire time I’m moving your head.” or “Look at thumbs the entire time.”
what should glucose levels be like
70-110 mg/dl
what are postoperative complications renal
Acute renal failure
Decreased urine output
Fluid/electrolyte imbalance
what are some things to keep in mind (femoral line )
able to perform hip rom (check for md precautions)
what is a evd (external ventricular drain)
this is to let out pressure and the swelling of the lateral ventricle
what are some precautions for arterial line
try not to do BP but if you have to it is okay
what is the vascular supply of the inner ear
- labyrinthine artery
- anterior vestibular artery
- common cochlear artery
what is substitution
using other strategies to replace the lost function.
what is the hematorit rates in females
37-47%
what is the lab values for WBC males
5,000-10,000
what is low hematocrit
Low? Anemia, acute of chronic blood loss, trauma
why are lab values important
Daily Chart Reviews
Communication is KEY with healthcare team
Guidelines and general norms
Condensations depending on facility, patient and location
Therapy Considerations will drive your treatment
what is the problem with dizziness
vestibular system
what are the directions for Smooth-Pursuit
“Follow the visual target with your eyes, keep head stationary”. PT observes for any saccadic eye movements.
what is diplopia
The perception of two images of a single object seen adjacent to each other (horizontally, vertically, or obliquely) or overlapping
what is the BBQ position 5
Choose how to sit up
Keep head level - pitched down (cervical flex 30°)
what is other vascualr supply info for inner ear
The labyrinth has no collateral anastomotic network and is highly susceptible to ischemia. Only 15 seconds of selective blood flow cessation is needed to abolish auditory nerve excitability
what are the postoperative complications cardiovascular
High or low blood pressure
Dysrhythmia
Mytrial Infarction (MI)
Deep Vein Thrombosis (DVT)
Plumonary Emboli (PE)
Look at slide on vestibule (picture)
8
what is Leukopenia
<4,000
what is a + test for Spontaneous Nystagmus
Probable CNS problem, make sure referral source is aware of finding may be acute unilateral periheral vestibular hypofunction. Subjective complaints often include difficulty with reading and watching TV.
what happens with the disorders that affect spinal fluid
Disorders that affect spinal fluid pressure can also affect inner ear function.
Ex: Lumbar Puncture
what is position 1 for the side lying test
Patient short sits on the side of the treatment table
Turn Head 45° Horizontal away from side (ear) being tested
May modify to whole body movement - rotate body and head together.
what is the measurement for Ocular Alignment
+ if skew deviation observed, one eye is elevated in orbit (classified R/L hypertropia based on side elevated)
what are some therapy considerations for o2 saturation
<90% stop activity
reading is affected by nail polish, poor circulation, movement; make sure has good signal or may have false low reading
what is a + test for Gaze-Holding Nystagmus
Probable CNS problem or VOR involvement. End-point nystagmus is normal, pay increase with age. Problems w/ downgaze is NOT vestibular deficit, may be progressive supranuclear palsy.
what is habituation
reduction in symptoms produced through repetitive exposure.
what is the motor output
vestibular reflexes
what si the central vestibular system
Vestibular Nuclear Complexes (pons, medulla) Reticular Formation Thalamus Cerebral Cortex / Vestibular Cortex Cerebellum
Additional diagnostic testing needed to identify central deficits.
Team up with Neurologist.
what is the vascualr supply for the central vestibular system
vertebral basilar arterial system
what is the theory of Canalolithiasis
Theory: Otoconia are free floating in semicircular canal
what is the BBQ position 3
Roll head to the unaffected side
Affected ear is now up
what are the therpay considerations for hypoglycemia
Therapy considerations: low activity tolerance
Headache, shakiness, weakness, irritability, cold sweats, psychosis
pacemaker precaution
watch UE rom
no head above 90
no blood pressure on that side
what is teh duration of symptoms for Cupulolithiasis
Duration of symptoms > 60 seconds
what is the plan
Plan of care
Goals
what is a precaution of chest tube
below the heart level keep the drain and dont knock over
what are the postoperative complication for neurologic
Delayed arousal Agitation altered consciousness cerebral edema Seizure stroke peripheral muscle weakness altered sensation
what is the BBQ position 4
Roll head and body in the same direction until patient is prone
Face floor, nose in midline
Pt should be asymptomatic
(if they have symtoms you did the wrong side)
what is a chest tube
drain infection and blood out of the lungs
what is position 2 for the side lying test
Patient quickly lies down to the side being tested
Maintaining head turned 45° horizontal
Maintain this position #2 for 30-60 seconds
what is the measurement forVOR – rapid “Head-Thrust” or “Head Impulse” Test
+ if patient unable to maintain visual fixation, demonstrates corrective saccade. If + repeat with patient looking at a distant target >2m to reduce false +. Ability to accommodate to near target decreases with aging.
how do you monitor tolerance in therapy
- vitals
- observation (visual)
- response
what is the adaptation of vestibular nerve impairment
intact CNS, visual information, recalibration is approximately 2 weeks
what is high hematorit
High? Severe lung disease, heart defects, high altitude, history of smoking, polycythemia
what ar ethe symptoms of Mal de Debarquement
persistent rocking vertigo at rest
dizziness and imbalance
what is a must and do not with assessment problmes list
MUST have problem to justify need for treatment.
DO NOT treat or charge for “vestibular rehab” without documenting vestibular problem.
what is the physical therapy roles in the acute care setting
Examination
Assessment
Treatment
Discharge Planning
what needs to be looked at for chart review
Orders
**Precautions/ Tests/ Cleared for therapy
History of Present Illness (HPI)
Past Medical History (PMH)
Current Tests and Appointments Scheduled
what si the statistics of phobic postural vertigo
Individuals with psychiatric disorders report more disability with dizziness than individuals without.
what is the orientation of the semicirular canals of the
3 planes, 90* to each
structure is elevated 30* from horizontal
what is vestibular gain
Vestibular Gain = Eye Velocity / Head Velocity
Normal Gain = 1.0
what is the normal range for INR
1 (0.8-1.2) seconds
what is BPPV
most common cause of vertigo
what is bppv canalith re positioning
Maintain position until nystagmus stops
If no nystagmus, approximately 20 seconds in position
what is external fixation
this holds the bones together after injury
what are some things to keep in mind (femoral sheath )
NO ROM
what are some symptoms of motion sickness
Dizziness
Nausea or Emesis
Malaise after motion
what is the first step of transfers in acute care
this is the first step to mobility
what is intracranial pressure monitoring normal pressure range
5-15 mmHG
what make migraine different from meiere disease
Tinnitus: high-pitched
May have ear fullness (ache), phonophobia and photophobia
True spontaneous vertigo is rare, can occur for minutes
Short nap usually helps
Visual Auras are common
Motion Sickness is common
what are some things to keep in mind (fOther )
know diet restrictions
know swallow precautions
what is the precautions for evd
this HAS to be clamped
what is some other info about phobic postural vertigo
Anxiety and Panic => Natural Avoidance => Heightened Arousal => Conditioned Autonomic Response
why used the ICD 9 codes
Establish an evidence based connection between rehab therapy treatment and patient progress
Evaluation the effectiveness of the therapy treatment
Medicare reimbursement
what is the set up for Ocular Alignment
Patient is arm’s length from PT, head stationary, looking straight ahead.
what are the symptoms of phobic postural vertigo
Self-limit or exaggerate movements/imbalance
Loss of balance with simple tasks
No imbalance with complex tasks
is oxygen a med
yes
what are the therapy considerations for hemoglobin
decrease activity tolerance
<7: Hold therapy
8-10 g/dl, light exercise permitted; modify treatment
> 10 g/dl, resistive exercise permitted; monitor low levels for dizziness
what is thrombocytompenia and what causes it
<
Causes: disorders, viral/bacterial infection, drugs, Chemo/Radiation, HIV, heart valve disorders
what are some medications for clot combat
- heparin- is used for acute anticoagulation
- warfarin - is used for long term us
what is the info about migraines
Migraines can cause symptoms of dizziness and imbalance when no peripheral or central vestibular deficit is present.
Migraines may be comorbid with peripheral vestibular lesion.
Migraines w/ aura (classic migraine), increased occurrence of vertigo w/ headache.
what are some alternative interventions before restraint use
Family at beside, move patient closer to nursing station, medication review, physiologic assessment, orientation, verbal intervention, diversions, environmental modification
what are some activity and exercise guidelines when dealing with HR
Pulse: HR should increase with increased workload intensity
A deconditioned person has a higher resting HR, and the HR increases more rapidly for the same workload as in a healthy individual.
what is functional mobility
Transfers, Ambulation, Stairs, Curb/Ramp
what are the examination components of an acute care
Chart Review
History/Patient Interview Neuro: Cognition Sensory Motor Balance Functional Mobility Discharge
what are the high levels for INR
> 3.5 = longer for the blood to clot
Increased risk for bleeding, activity modification recommended
> 5 = hold therapy, bedrest, check with MD
what is position 1 of hallpike
Position #1
Patient is long sitting on treatment table
Turn Head 45° Horizontal towards side (ear) being tested
what are some thearpy considerations for thrombocytompenia
minor trauma can cause bleeding (nose, GI tract, uterus, respiratory tract), bruising
what is the most common virus for Viral Infection
Upper respiratory tract infection Gastritis Herpes Zoster Bacterial Meningitis Syphyllis
what are some things to keep in mind (oxygen )
need order form md
if patient is on high flow ox ( green tube) use portable ox tank
what is the central processing itmes
brain
what are some other ICP info
Brief elevations will occur normally – continue therapy
Sustained elevations (alarm will sound) should be reported and therapy temporarily held to allow decrease in pressure.
what si remove or change periphearl input
Eyes
Fogged Glasses, Dark Glasses, Dark Room, Eyes Closed
Ears
Head Position Changes, Ear Plugs
Muscles / Joints
Compliant or Unstable Surfaces
—-foam, balance board, dynadisc, trampoline, bosu ball
Changing base of support
Look at slide of the exam pp
18
what is the position 2 of hallpike
Patient quickly lies down
Maintaining head turned 45° horizontal
Head hanging approximately 30° below horizontal
Maintain this position #2 for 30-60 seconds
why are the effect of immobiliazation are scary
“Muscle wasting occurs early and rapidly in the critical care setting with up to 30% of muscle mass lost within the first 10days of an ICU admission”
“Stroke volume has been shown to be reduced by 30% within the first month of bed rest”
“Increase in resting heart rate, and signs of orthostatic intolerance can develop within 72h of inactivity “
“atrophy of the anti-gravity muscle groups such as soleus, back extensors and quadriceps musculature “
what is a + test for VOR – suppression or cancellation
CNS problem; parietal lobe.
what ar the special test for rom and strength
Cervical if c/c is dizziness
LE’s if suspicious of imbalance
UE’s if using an assistive device for imbalance
what are some therapy considerations for sodium
Therapy Considerations: mental status changes, confusion, hemorrhage
Hyperkalemia
Hypokalemia
what is the onset of Viral Infection
Dysfunction up to 2 weeks after illness
what are the symptoms of TBI
dizziness and imbalance
peripheral vestibular hypofunction
BPPV due to intense acceleration of utricular otolith membrane
what is position 3 for the toll test
Slowly return to Position #1, head in midline
Maintain 20° cervical flexion
what are the highest level of restraints
1 0n 1 sitters,
enclosure bed,
what is the FIM score of 5
.supervision (subject =100%)
what is the cardiovascular considerations with anesthesia
anesthetic agents create potential for arrhythmia, decrease B/P, decrease heart contractility, decrease peripheral vascular resistance
what is the vertebral basilar arterial system
Posterior-Inferior Cerebellar Arteries (PICAs)
Basilar Artery
Anterior Inferior Cerebellar Artery (AICA)
Superior Cerebellar Artery (SCA)
Posterior Cerebellar Artery (PCA)
what is the precautions for central line
dont dislodge this
what is the theory of Cupulolithiasis
Theory: Otoconia are adhearing to and/or affecting ampula / cupula
what are some precaution for external fixation
no wb and has ↑ infection rate
what is oscillopsia
Visual instability with head movement, images appear to move or bounce; may have blurring or diplopia
what is a + test for Saccadic Eye Movements
1-2 saccades with eye movement is normal, > 2 saccadic eye movements is abnormal. Probable CNS problem.
look at slide of documentation
8 and 9
what are vestibular reflexes
VOR
VSR
VCR
what is the RBC count for males
4.5-5.5
what is the assessment
Prognosis
Summary of barriers and impairments
what is vestibular rehabilitation
An exercise approach to decrease or alleviate symptoms of dizziness, imbalance or nausea. Includes the facilitation of the central nervous system to compensate for vestibular deficits.
what is the objective
Patient history, systems reviews
Tests & Measures
Results of examination
what i the normal range for PT and PTT
PT 10-12.5 seconds (adults)
PTT 40-60 seconds
what are the precautions of the PICC
no BP
what is position 3 for the side lying test
Patient is assisted to sitting on side of treatment table (position #1)
Maintain head turned 45° horizontal away from side (ear) being tested
Tip: Patient may use arms on side of treatment table to help achieve position #3
what are some differential diagnosis mimicking bppv
Migraine CNS Issues Perilymphatic Fistula Hypermobile Stapes Labyrinthine Hypofunction Orthostatic Intolerance
what is statistics for menieres disease
Frequency: Men = Women
Onset: usually between 40-60 years of age
Genetics: 15% familial connection
what is increased in endolymphatic fluid pressure
Endolymphatic sac dysfunction or blockage
Dehydration
Temporal bone lesions
Infiltrates w/ leukemia
what does the internal auditory canal contain
Vestibular Nerve
Cochlear Nerve (hearing)
Facial Nerve
Labyrinthine Artery
Travels through the petrous portion of the temporal bone.
what is fluid problem in the endolymphatic hydrops
Change in sodium/potassium concentration
what are the directions for Optokinetic Nystagmus
“Look at each and every line as I move this cloth”.
what are the therapy considerations for hyperglycemia
Therapy considerations: At risk for diabetic ketoacidosis
dehydrations, weak/rapid pulse, coma
what are some s/s of increased ICP
Headache. Nausea, Vomiting, ocular palsy, altered mental status and conscious
what are some red flag
Numbness Tingling Weakness Slurred Speech Progressive Hearing Loss Tremors Poor Coordination Babinski Sign / Spasticity / Clonus Loss of consciousness Rigidity Visual Field Loss Memory Loss Cranial Nerve Dysfunction Spontaneous Nystagmus (room light after 2 weeks) Vertical Nystagmus w/o torsional component (not BPPV)
what is our assessment problem list for vesti
Subjective Complaints Problems Observed Comorbidities BPPV Somatosensory Deficits Vestibular Deficits Ocular Motor Deficits VOR Deficit CNS Deficits Decreased Balance Decreased Gait Decreased Function
how do the canals working
Canals work in pairs Left/Right using push/pull mechanism.
what causes leukoctosis
Causes: Infection, trauma, tissue injury
what are the symptoms of menieres disease
attacks of dizziness, loss of balance, fluctuating hearing loss and tinitus
what is PE
Pulmonary Thrombosis
Increased Heart Rate
what are the types od dialysis
- hemodialysis
- peritoneal dialysis
what are some examples of restraints
1 0n 1 sitters, enclosure bed, full side rails, hand mitt, poesy vest, soft wrist /ankle, belt
what is position 2 for the toll test
Patient’s head is quickly rolled to one side, maintaining 20° cervical flexion
Maintain Position #2 for 30-60 seconds
what should O2 saturation
98%-100%
what is the canaith repositioning technique position 4
Roll to Side-lying position with head turned 45° down (toward the floor)
Tip: “ Look at your shoulder” or “Look at my shoe”
Frequently patient symptoms increase with moving to Position #4
what is pacemaker
this is something that helps pace the heart
what is a central line
long term apparatus
this is an access point for
iv meds
draw blood
fluids
what are the directions for Ocular Alignment
PT observes for any skew deviation or eyes “not level” in obit.
what is dysequilibrium
Sensation of being off balance
what are the directions for Saccadic Eye Movements
Have patient quickly change gaze from PT nose to visual target. “Follow my instruction to look at the object (nose/target) when I tell you too.” Pt needs to follow PT instructions and not anticipate or increase tempo.
what is the FIM score of 1
total assistance (subject less than 25%)
what is the inner ear responsible
Responsible for Balance + Hearing
what is the fistula
An opening allowing fluid to pass between structures
what are some general guidelines for documentations
Chart must match charge
Avoid extraneous verbiage
Avoid using abbreviations not understood university be all providers
Patient stated goals related to prior level of function
what, why, how , when
how to use the ICD 9 codes
Initial Evaluation, 10 days after initial evaluation, discharge
what is helper- modified dependence FIM
5
4
3
what is coagulation profiles
Determines ability to initiate clotting sequence
Used to diagnosis clotting disorder
Used to monitor anticoagulant therapy
what are the icd 10 codes
slide 92
what is the measurement for Dynamic Visual Acuity
Note number of errors in line read. If greater than 2 errors when reading must go to larger print type. If difference between baseline (line#) and movement (line#) is greater than 2 test is (+).
what are some tumors of the ear
Glomus Tumors Schwann Cell Tumors Meningiomas Medulloblastomas Metastatic neoplasms Gliomas Acoustic Neuroma
what type of movment is the smooth pursuti
Smooth Pursuit are “slow” movements
when head velocity is < 60 degrees/second, <1Hz
what is hypoglycemia
<60 Hold therapy
why are we are skilled therapist
Services require complex and
sophisticated therapy procedures.
We provide:
- *Professional expertise
- *Knowledge
- *Clinical judgment
- *Decision-making
We have the skill set of a qualified professional to assure safety and effectiveness of the service
how is teamwork is essential
Teamwork is ESSENTIAL for Maximum, Efficient Outcomes:
Correct Diagnosing Pharmacological Interventions Surgical Interventions Comprehensive Vestibular Rehabilitation Treatment Modifications for Home/Work
what is non invasive vent
Positive airway pressure (CPAP)
what is statistics ofOtotoxicity
Onset: within 2-4 weeks of medication delivery
what is BPPV
bign postural ….
what is invasive vent
Assist-Control Ventilation (ACV)
Synchronized Intermittent – Mandatory Ventilation (SIMV)
what are some things to keep in mind (EVD )
must be clamped prior to mobilization as it goes right into the brain
what is a + test for VOR – slow
Could be a unilateral or bilateral VOR problem.
what is the set up for VOR – suppression or cancellation
PT holds pt’s head with aprox. 30* cervical flex. Slowly rotate pt’s head from 30* R to 30L with PT moving in same direction. If cervical problems, pt can clasp hands, extend arms, rotate entire trunk with 30 cervical flex.
what do you need to do also with roll test
Repeat to Opposite Side
Patient’s head is quickly rolled to opposite side, maintaining 20° cervical flexion
Maintain Position #2 for 30-60 seconds
what is the VOR and what kind of movements do they have
Eye movements opposite head movement direction
VOR are “fast” movements
when head velocity is > 60 degrees/second, >2Hz
what are the scores
score range 1-7
what is 80,000-150,000 platelet level
moderate resistance exercise, ambulation and ADLs
what are some contingent vestibular loss
Intrauterine Infection Cytomegalovirus (CMV) Intoxication Anoxia Rubella Thalidomide
what can play a role in altering baseline O2
PMH can play a role with altered baseline 02 saturations
what are the directions for Gaze-Holding Nystagmus
“Look at visual target”. PT observes for any nystagmus (eye movement).
what is something that is important to remember wth ocular motor testing
O HEAD SHAKING if patient has a DETACHED RETINA
what is the diuretics
@ risk for orthostatic hypotension
what is the labyrinthine artery for inner ear
Originates from the Anterior-Inferior Cerebellar Artery (AICA) or the Basilar Artery
what are the type of documentation
- narrative (handwritten, typed)
- template (handwritten, typed, electronic health records)
- acronym (soap)
what are the fx outcome measure for vest.
Dizziness Handicap Index (DHI)
Motion Sensitivity Quotient (MSQ)
Activities Specific Balance Confidence (ABC)
Positive and Negative Affective Scale (PANAS)
Disability Scale (0-5)
what are some response with the monitoring tolerance in therapy
diaphoresis, cyanosis, nasal flaring, increase accessory muscle use, weakness, fatigue, dizziness, lightheadedness, angina, palpitations, dyspnea
what is hemodialysis
vascular access is usually through AV fistula located in the forearm.
blood is mechanically circulated thru semipermeable tubing that is surrounded by a dialysate solution in the artificial kidney
what ar ethe otolith organs
The Utricle
The Saccule
Detect linear motion, acceleration and static tilt.
what is the lab values for WBC females
5,000-10,000
keep in mind high INR with medication to treat
Afib, DVT, post MI
Check with MD about appropriate range
what are the BPPV treatments
Canalith Repositioning Technique
also called the Epley Maneuver (since 1992)
Horizontal Canal Repositioning
also called Bar-B-Que Roll
what is the membranous labyrinth
Portion of 3 Semicircular Canals
The Utricle
The Saccule
Membranous labyrinth is suspended inside the bony labyrinth by perilymphatic fluid and connective tissue.
what are some acute care precautions
- lines
- tubes
- mointors
what are the IDC 9 codes
Quality data codes to fulfill requirements for Functional Limitation Reporting (FLR)
what is vor deficit
Try to increase reflex with x1 and x2 viewing activities
Rest breaks to allow symptoms to return to baseline
No Head Shaking if patient has a detached retina
what are the references for documentations
Medicare publications
APTA
Guide to PT practice
PT practice act
Code of professional Conduct
what are some precautions that are preceeed with cautions
Sternal
Weight bearing precautions (%)
Hip precautions ( is might not be in the chart)
Spinal Precautions
Clavicle Fractures
what is the bony labyrinth
3 Semicircular Canals
The Cochlea
The Vestibule
what makes meniere disease different from migraines
Tinnitus: low-pitched, roar
Usually ear fullness or hearing loss
True spontaneous vertigo is common, can occur for hours
Short naps usually do not help
Visual Auras are uncommon
Motion Sickness is uncommon
what are some other things to help with clot combat
- sequential compression devices (scd)
- best prevention: early mobility and medication administration
what is the perilymphatic fluid
Concentration Ratio
High Potassium : Low Sodium
Similar to Cerebrospinal Fluid
The cochlear aqueduct allows perilymphatic fluid to communicate with cerebrospinal fluid.
what may be experienced with fistula
May experience fluctuating hearing loss, episodic vertigo, gait/balance deficits.
what are the jackson pratt drain precautions
dont dislodge
what happens in BPPV
Calcium Carbonate Crystals from Otolith Organs break off and travel into a semicircular canal.
Calcium Carbonate Crystals = Otoconia = Ear Rocks
C/C: Short, episodic “spinning” with change in head position
what are the priority of the examination components
functional mobility
discharge
what happens with changes in intracranial pressure and fistual and their causes
Changes in Intracranial Pressure
Potential Causes: Valsalva’s Maneuver, barotrauma, violent exercise, heavy lifting, sneezing, prior ear surgery and congenital malformations.
what is the hematorit rates in males
42%-52
what is high hemoglobin
Chronic hypoxemia, high altitude
what is a + test for Ocular Alignment
Acute Unilateral Vestibular Loss with decreased tonic firing rate, eye “drops” in orbit on side of lesion. Usually resolves 3-7 days after onset. Subjective complaints often include vertical diplopia.
what is some in of the roll test
Patient’s with debris in the Horizontal Canal usually experience symptoms with testing to both R and L sides.
Subjective symptoms, nystagmus, duration and slow-phase eye velocity are usually worse when head is turned towards affected ear
what are the mode of mechanical vent
- invasive
- non invasive
what can go wrong with muscles/ joints (somatosensroy)
Any interference with proprioception/kinesthetic sense?
Ex: Peripheral Neuropathy, Crush Injury, Bone Fracture
how do you document bppv treatment
Document side treated, number of repetitions, patient response to treatment and if home instructions/precautions were given.
Should wait 24-48 hours before repeating special tests or treatment.
what is a halo
this is for cervical spinal surgeries
what is orthostatic hypotension
Supine x 10 mins, check BP
(+) if systolic BP drops by at least 20mmHg within 3 mins of standing up and symptomatic
what are some postoperative complications OTHER
Hypothermia Pain Infection Nausea/vomiting hyperglycemia
what is INR
calculated from the PT, used to monitor how well anticoagulant treatment is working to prevent clots
what is high H/H
polycythemia
what is motion insensitivty
Habituation or Adaptation with Motion Activities
Rest breaks to allow symptoms to return to baseline
how does everyone help in the ICU
MD: cleared for therapy, orders, sedation adjustments
RN: Pre medicated, advocate for PT referral, monitor
Respiratory therapy: 02 saturations, Vent adjustments
Therapy Team: PT,OT, SLP: early mobilization
Family Education
what is differential diagnosis of Ototoxicity
High doses of antibiotics (aminoglycosides)
Examples: Streptomycin and Gentamicin
what are statistics for BPPV
Frequency: increased for Women (ratio 1.6 :1.0)
Bilateral occurrence approximately 10%
Reoccurrence is common
what is the tip for position 1 of the hallpike
Have patient reach back so hands touch corners of treatment table to estimate where body will be when supine, then have patient return to sitting position and cross arms over chest.
what are some postoperative complications respiratory
airway obstruction
respiratory depression
hypoxia
aspiration
pulmonary edema
pneumothorax
what is a test for the BPPV
dix hallpike
what is ocular motor eye testing deficits
Focal Point, Visual Tracking, Saccades, Targets
what is DVT
Deep Vein Thrombosis
Signs/Symptoms: Redness, Swelling, painful
what doe shte HEP look like for vesti
HEP should emphasize:
=Safety
=Compliance
=Accountability
Look for reinforcement opportunities and ways to progress difficulty of HEP.
Permanent changes in vestibular system typically take 3 months or more.
what is the set up for Dynamic Visual Acuity
Pt’s wear glasses if needed for distance. Sit appropriate distance from chart; 4m ETDS chart with SLOAN letters is preferred to Snellen Eye Chart. Baseline: No movement by PT. Movement: PT stands behind pt, cervical flex 30, hold head firmly with both hands and rotate 10R/10L for horizontal test or 10up/10*down at 2Hz, 1-2” movement either side of midline.
what structures are involved in Ototoxicity
Hair cells of inner ear
what is the vitals for the acute care exam
Baseline
During
Post Activity
what does is measure
burden of care
what is a + test for Dynamic Visual Acuity
Problem with VOR and CNS.
what are some barriers for the examination
Note Barriers that are impeding discharge home
Impairments
Cognition
Response to Session
what are some other ways to release pressure
Burr hold→ cranidectomy → craniopasty
what is the neurological considerations with anesthesia
anesthetic agents decrease cortical and autonomic function
what is low hemoglobin
Anemia, cancer, blood loss, hemolysis
what is a craniectomy
this is where they take a out part of the head
what is the measurement for VOR – suppression or cancellation
+ if saccadic eye movements
what is balance retraining
Focus on musculoskeletal coordination w/ postural control
What is VSR
Vestibular-Spinal Reflex
Balance strategies
what is the therapeutic range for PT and PTT
1.5-2.9 X normal reference range
what structures involved in Mal de Debarquement
dysfunction in otoliths, do not recalibrate to baseline
may be associated with psychological disorders
what is the 3rd thing you do with vesti eval
special test/ screenings
Proprioception / Sensation
ROM / Strength
Ocular Motor Testing
Orthostatic Hypo tension
bppv semiciruclar canal frequencys
Canal Involvement in BPPV in 200 consecutive patients seen at Dizziness and Balance Center, Johns Hopkins University and University of Miami.
Semicircular Canal % of Patients Posterior 76 Anterior 13 Horizontal 5 Posterior or Anterior SCC? 6
what are some considerations with abnormal H+H if it is LOW
Weakness Fatigue Dyspnea on Exertion (DOE) Heart Palpations Tachycardia
Decreased tolerance to exercise
Monitor vitals close
what structures are involved with menieres disease
Membranous Inner Ear
what is some active vor training
X1 Viewing Exercise NO HEAD SHAKING
X2 Viewing Exercise if patient has a DETACHED RETINA
Progression:
Static sitting w/ support > sitting w/o support > standing
Sitting on complaint surface > standing on compliant surface or with change in base of support > dynamic gait/movement
Distracting visual backgrounds: checkerboard, stripes, mirror
what is the peripheral input items
eyes
inner ear
muscles /joints
what is the canaith repositioning technique position 3
Maintain cervical extension
Turn Head 45° Horizontal towards unaffected side (ear)
what is in the inner ear
Labyrinthine structures - 3 semicirccular canals
- Anterior = Superior
- Posterior = Inferior
- Horizontal = Lateral
what is early mobility in the ICU
Multidisciplinary Approach
what is the measurement for Smooth-Pursuit
+ if saccadic eye movements, note direction of saccadic movement
what is the measurement forSaccadic Eye Movements
+ if overshooting or undershooting, note direction.
what are some things that need to be done with leukopenia
Hold: neutropenic precautions, masks (high risk for infection)
what are some barriers to early mobility
Over-Sedation
Delirium/ Cognitive Deficits
Equipment
Limited Staff
General knowledge
what is the respiratory considerations with anesthesia
multiple effects on lung including O2 sat and respiratory pattern
what should you do with leukoctosis as a caution
Use caution while exercising
what are some considerations for therapy wit dialysis
Fatigue
***Provide rest breaks frequently
Schedule
AV Fistula – no BP on the arm of insertion
Need to monitor vital signs and symptoms during therapy
****fluid and electrolyte imbalance can alter the hemodynamic response to activity
Activity Intolerance
Chronic Renal Failure: @ risk for Renal osteodystrophy
what is endolymphatic fluid
High concentration of Sodium
Low concentration of Potassium
how is coagulation profiles measured
Prothrombin Time (PT)
Partial Thromboplastin Time (PTT)
International Normalized Ratio (INR
what do the semicircular canacl widen to form
Each semicircular canal widens to form an ampulla.
what does the roll test for BPPV assess
Assesses Horizontal Canal
what is the FIM score of 4
minimal assistance (subject =75%)
what is a + test for Smooth-Pursuit
Probable CNS problem. Typically horizontal results are better than vertical. Pt’s w/ strabismus or “lazy eye” may have difficulty w/ smooth-pursuit.
what are the CRT post treatment instructions
Bend Over Lie Back Move Head Up / Down Tilt Head to Either Side Lie on effected side
Duration: at least 20 min
Cervical Collar- optional
what is motion sickness caused by
Visual-vestibular conflict
Conflict between actual and anticipated sensory input
what is lightneadedness
Feeling as if about to faint
what are the expectations of an acute care pt
Critical Thinking
Flexible
Broad knowledge of various diagnoses
Efficient / productive
Team member
First Responder
what is perilymphatics fistula
Perilymphatic Fistula common at round and oval windows of middle ear.
what is >150,000 platelet level
cleared for all activity without restrictions
what are the symptoms of Ototoxicity
partial up to complete loss of vestibular function
what is hemoglobin
Supplies the tissue with oxygen
what are the 3 basics things when working with a pt on a vent
- mode of ventilation
- fiO2
- PEEP
what is the set up for Smooth-Pursuit
Patient is arm’s length from PT, head stationary, PT standing in front of pt. Visual Target 18-24” from pt. Move visual target (finger or pen) slowly 30* to R, L, Up, Down, diagonals.
what is the set up for VOR – slow
Same set-up as VOR suppression, this time PT or hands stationary.
what can go wrong with the eyes in the peripheral input
Is anything prohibiting good vision?
Ex: Glaucoma, Macular Degeneration, Detached Retina
Suggest annual eye exams
how is treatment a team approach
Physicians & Staff Nursing and Patient Care Staff Speech Therapy Occupational Therapy Social Work or Case Management Neurology Ear Nose and Throat Surgery Audiology Podiatry Dentistry
what is a arterial line
short term access point that monitors BP
- this is thin
what is the Soap
subjective
objective
assessment
plan
what is the measurement for VOR – slow
+ if patient unable to maintain visual fixation
how do you document your treatment
Action / Activity Somatosensory (Eyes, Ears, Muscles/Joints) Position Surface Level of Assistance / Support Resistance / Weight Limitations in ROM Duration Patient Response to Treatment
what is <50,000 platelet level
no resistance but ambulation and ADLs OK
what are platelet roles
clotting
what are functional activities
Transfers Bed Mobility Gait Pattern / Quality Curbs / Stairs Reaching / Lifting / Carrying Simulated Home or Work Tasks Postural Strategies Used Coordination Deficits Noted
what are some activity and exercise guidelines when dealing with BP for normal adults
20 mmHg for min to moderate exercise,
40 to 50 mmHg with intensive exercise
what are some acute care areas are there
Cardiac Post-surgical Oncology Orthopedic Pediatric Geriatric Neurology General debilitation Wound care Same day surgery Emergency Room Intensive Care Units Trauma
what is the subjective
Patient reported information
what are the postoperatvie complications
Patients are at an increased risk of complications if they have one or more of the following:
baseline pulmonary disease incisional pain smoking history Obesity increased age large IV fluid need intraoperatively prolonged operative time
general anesthesia consideration systemic effect
- neurologicla
- cardiovascular
- respiratory
what are some activity and exercise guidelines when dealing with BP- systolic
Systolic B/P normally rises with increased activity/exercise, in proportion to the workload (~7 to 10 mmHg per MET)
what are some other abnormal bp issues responses
Little change in SBP with excessive workload in an unfit or deconditioned person
progressive rise of DBP
what is a jackson pratt drain
.this drains other fluid from a source
what is the neuro screen of the acute care exam
Cognition Cranial Nerves (if needed)
what is mode of ventilation
Assist-Control Ventilation (ACV)
Synchronized Intermittent – Mandatory Ventilation (SIMV)
Positive airway pressure (CPAP)
what is the set up for Gaze-Holding Nystagmus
Patient is arm’s length from PT, head stationary, PT standing in front of pt. Visual Target 18-24” from pt. Move visual target (finger or pen) stopping at positions 30* to R, L, Up, Down, Diagonals.
what is peritoneal dialysis
Dialysate fluid is usually instilled and drained manually into the peritoneum
what are some other treatment maneuvers for vest treatment
Liberatory Maneuver by Semont
Liberatory Maneuver by Brisk
Brand-Daroff Habituation Exercises
what is the endolymphatic fluid
Concentration Ratio
High Sodium : Low Potassium
Similar to Intracellular Fluid
Usually there is no direct communication between the endolymph and perilymph compartments.
what is VCR
Vestibulocollic Reflex
Use of cervical muscles for head stabilization
what is the critical stage for PT and PTT
3x and greater= Critical
Risk for hemorrhage
May hold therapy
what is the sensory/ motor of the acute care exam
Screen depending on time
More detail if needed (specific diagnoses)
what is the FIM score of 2
maximal assistance (subject =25%)
how do hair cell communicate
Hair cells use vestibular afferents to notify vestibular nuclei (brainstem) and cerebellum.
what is teh duration of symptoms for Canalolithiasis
Duration of symptoms < 60 seconds
what structures involved in vestibular nerve impairment
afferent signals from labyrinth, internal auditory canal, pontomedullary junction
what is <10,000 platelet level
hold therapy per MD guidelines
what is differential diagnosis for menieres disease
endolymphatic hydrops + low level hearing loss
what is the canaith repositioning technique position 2
Patient quickly lies down, maintaining head turned 45° horizontal
Head hanging approximately 30° below horizontal
what is the set up for Optokinetic Nystagmus
Use optokinetic drum or striped cloth. Pt sits comfortably while PT moves cloth through horizontal path 1x. Cloth should be 10-12” away from pt.
what is the set up forHead-Shaking Nystagmus
PT holds pt’s head with aprox. 30* cervical flex. Pt closes eyes, while PT quickly moves head 20x in horizontal plane, stop movement, open eyes and observe for immediate nystagmus. Repeat with vertical head movements 10x. May use Frenzel or IR goggles.
what are some type sof BPPV
cupuloithiasis
canalolithiasis
what are the swan gaze cath precautions
dont dislodge this
what cant we fix with vesti
Habituation and Adaptation
“temporary” problem, recalibrate sensory system
Substitution
“permanent” problem, reorganization of neural strategies
what are some precautions for the halo
no px
↑ infection rate with these and common in trauma
what are the benefits of the early mobility
Reduce risk for comorbities
Preserves musculoskeletal integrity
Improve Cardiovascular function
Decrease risk for DVT/PE
Cognition/Attention
Decreased Hospital Length of Stay
Improve Quality of Life
what is the effective bppv sefl treatment
Radtke and associates compared the success of using two different home self-treatments, Brandt-Daroff habituation exercises, and CRT. They found CRT to be much more successful.”
what is hyperglycemia
> 250 Hold therapy
what is a pen rose drain
little tube that let infection out
what are some compensation for treatment
- habituation
- adaptation
- substitution
what is the measurement for Optokinetic Nystagmus
Nystagmus is NORMAL response. + if no nystagmus.
what is the FIM
Functional Independence Measure
what are some Proprioception / Sensation
Great Toe Light Touch Vibration
what is thrombocytosis and what causes it
>
Causes: Iron Deficiency, neoplasm, inflammation, renal failure, acute infection
what is dizziness
Sensation from the disruption of information in the vestibular, visual and somatosensory systems.
what is the 1st thing you do with vesti eval
observe
Type of vision correction
Hearing Aides or Hard of Hearing
Assistive Devices
Function
how does the direction of fluid move in the inner ear
Direction of fluid movement is opposite head movement.
Fluid deflects hair cells in cupula which excites vestibular nerve.
what is the measurement forHead-Shaking Nystagmus
+ if nystagmus
what is hemoglobin in females
12.0-15.0
what is hemoglobin in males
13.5-16.5
what is PEEP
Positive End Expiratory Pressure
the pressure in the lungs (alveolar pressure) above atmospheric pressure (the pressure outside of the body) that exists at the end of expiration.
what is documentation
We as a profession must justify our services through effective documentation
Commination Patient care planning Evaluating quality of care Identifying deficiencies Database for Utilization and Reimbursement Research and education Legal Document
how do hair cell move
Hair cells are distorted by movement of calcium carbonate (limestone) crystals (aka Otoconia) in a gelatinous matrix.
Hair cells use vestibular afferents to notify vestibular nuclei (brainstem) and cerebellum.
vest PP look at
slide 84
what are the directions for Head-Shaking Nystagmus
“Close your eyes. I’m going to shake your head side to side. When I stop, I will ask you to open your eyes”.
what needs to be done with the examination for interview
Prior Level of Function
Assistive Devices
Family support
”normal” day
Home setup
Pain Levels
Goals
what is safety education
Focus on safe ADLs with adaptive equipment
Home Set-up to decrease trip and fall hazards
Lighting Changes to increase visual input, decrease glare
Plan in case a patient does fall or is unable to transfer
Reasons to seek immediate medical attention
what is dialysis
- kidney function - bypass an unproductive kidney
- treatment to remove waste, salt and extra water to prevent build up
- maintain safe hemostasis
what is peripheral or central deficits resulting in imalance
Practice Functional Activities “Use it or loose it”
Obstacle Course Curbs Stairs Head Turns with Dual Tasking (reaching, ironing, washing dishes, pushing grocery cart) Gait Speed!
what is the subjective part ot evaluation of vesti.
Specific Complaint Duration Frequency Severity Circumstances Other Medical Issues *Orthostatic Hypotension *Hypoglycemia *Anxiety *Medications
what is a + test for Head-Shaking Nystagmus
Vestibular Imbalance, peripheral or central unilateral vestibular lesion.
what is vertigo
The illusion of movement (rotation, tilt or linear displacement).
what is a cranioplasty
this putting the head back together again
what is orthostatic hypotension with HR
Increase in pulse rate of >15 bpm
what is adaptation
ability to make long-term changes in the neuronal response to input. Important in development and maturation. Can be induced with brief (1-2 mins) of stimulation.
what is the canaith repositioning technique position 5
Patient slowly returns to short sitting on edge of treatment table
Maintain Head Turn to Unaffected Side and Cervical Flex
Tip: “Look at your elbow”
what are some treatment charges for vesti
Therapeutic Exercise Therapeutic Activities Neuromuscular ReEducation Gait Training Manual Therapy Self Care/Home Mangement Canalith Repositioning
what is H+H
In the chart: H&H (hemoglobin/Hematocrit)
what structures are involved for Viral Infection
Unilateral Vestibular Nerve
Vestibular Ganglion
how fast does the bppv resolve
BPPV Should improve quickly, 1-2 visits
what is 20,000-50,000 platelet level
AROM and functional activity are OK, caution with ambulation and ADLs
what is the measurement for Spontaneous Nystagmus
+ if nystagmus is present, record direction and pace of nystagmus
what are some addition mechanisms of recovery for vesti
Cellular Recovery
Receptors or neurons may recover
Spontaneous reestablishment of tonic firing rate
what is the BBQ position 2
Roll head slowly to midline
Nose pointed up
what is the canaith repositioning technique position 1
Position #1
Patient is long sitting on treatment table
Turn Head 45° Horizontal towards side (ear) being treated
what are some things you need to watch out for during transfers
Invasive lines, O2
Safety Recommendations
what are some therapy considerations
<21% Hold therapy
25-30%: modified therapy
what kind of movements do the semicirular canals
Angular Head Movement
Coordinate the Vestibular Ocular Reflex (VOR)
what is the increased attention to peripheral input
Eyes – Visual Focal Points
Patient Selects Focal Points and Pace
Therapist Commands, Pace Varies
Ears – Identify Location of Sounds
Muscles / Joints –
Ankle Weights
NDT Compression at Lower Extremity
Weighted Vest worn at trunk
what are some vascuar disease
- vertebrobasilar insufficiency (atherosclerosis of vert. and basilar arteries)
- labyrinthineartery ischemia
- vascular loop compression of cranial nerve VIII
- spontaneous haemorrhage into inner ear (bledding disorder, leukemia)
- mirgraine headaches
what is the evaluation objective portion of vest.
Observations
Selective Special Testing
(including cervical clearing and BPPV tests)
Ocular Motor Testing
Functional Tests
Gait and Balance Testing
how long do you work on vestibular system
12-20 min
“Work” for fatigue and carryover. Short rest breaks as needed to return to baseline symptoms.
Find communication tool for patient to express “work”?
Symptom scale 0-10
Easy, Medium, Hard
Ask patient “Why do you need to stop activity/exercise”?
what is the FIM score of 7
complete independence (timely, safely)
what are some potential causes for free floating otoconia
Middle Age Head Trauma Viral Neurolabyrinthitis Meniere's Disease Prolonged Inactivity of Head
what is anti thrombotics (aspirins)
inhibit platelet aggregation and platelet-induced clotting; used mainly to prevent arterial thrombus formation
what is orthostatic hypotension with BP
drop of >10 DPB
drop in SBP(or both SBP and DBP) of 10 to 20 mmHg or more
what are some health precautions
Contact- cant touch Droplet- airbone Airborne- need a special mask Chemo- double glove and gown Sternal- no push/pull, 5 lbs, overhead
what are restraints
straints are used by healthcare providers when the restraint will improve the patient’s well being or there is an imminent risk of a patient physically harming themselves, staff, or others
what is the 2nd thing you do with vesti eval
functional activites
Balance and Gait Tests
what are serum electrolytes
- sodium
- potassium
what can eye head dyscoordination can result form in TBI
Damage to the vestibular system that disrupts VOR function
Deficits within the visual system, including loss of ocular motility, visual acuity/field deficits and visual perceptual deficits
Orthopedic injuries that limit cervical motion
Damage to cerebellar structures resulting in loss of visual suppression of the VOR.
what are some recommendations for the exam
Recommendations Therapy Recommendations Projected Equipment needed at home Days per week Discharge
what shoudl potassium level be like
3.5-5/5 (mEq/l)
what are the Balance and Gait Tests
Gait Deviations 10 meter walk test Timed up & go Modified CTSIB Functional Reach Test Functional Gait Assessment Dynamic Gait Index Tinetti Balance Exam Berg Balance Test Single leg stance Rhomberg (feet together) Sharpened Rhomberg (heel to toe) Fukuda Step Test
what is the what, why, how , when of documentation
What: all procedures, education, equipment/supplies
Why: accurate diagnosis, medical necessity, goals related to prior level of function
How: pts response to treatment and progress towards goals
When: date of service, frequency and duration
what is the RBC count for females
4.0-4.9
what is the position 3 of hallpike
Patient is assisted to long sitting (position #1)
Maintain head turned 45° horizontal towards side (ear) being tested
Tip: Patient may use arms on side of treatment table to help achieve position #3
what is a swan gaze cath
in ICU settings and it measure the r heart for the blood flow
what is the set up for VOR – rapid “Head-Thrust” or “Head Impulse” Test
Same set-up as VOR -slow this time with increasing speed 3000-4000/sec2, within a small range aprox 5-10 R/L with a sudden stop 10* R or 10* L. Painfree ROM.
what is the common cochlear artery for inner ear
Main branch
Main cochlear artery supplies the cochlear, the ampulla of the posterior semicircular canal and the saccule.
Vestibulocochlear artery
what is vestibular rehabilitation
Focus on sensory system re-integration
what are the directions for Dynamic Visual Acuity
Baseline: “Please read aloud the bottom line you can see clearly. Movement: “I’m going to move your head for quick, small movements. Please read aloud the bottom line you can see clearly.”
what are the directions for Spontaneous Nystagmus
PT observes for any nystagmus (eye movement).
what is a + test for VOR – rapid “Head-Thrust” or “Head Impulse” Test
Could be a unilateral or bilateral VOR problem.
what are some ocular motor tests
Optokinetic Nystagmus Gaze Nystagmus Smooth Pursuits Gaze Holding Nystagmus Saccadic Eye Movements VOR – suppression VOR – slow VOR – rapid Head Thrust Head – Shaking Nystagmus Dynamic Visual Acuity *Baseline *Horizontal Movement *Vertical Movement
what is 50,000-80,000 platelet level
minimal resistance TE, amb, ADLs
what is the FIM score of 6
modified independence (device)
what is the beta blockers
Normal Response a 20-30 beat increase from resting value
Maybe blunted
why are CRT effective
“..sudden jerks of the head or maneuvers that incorporate eccentric moments (such as the Semont maneuver) are unlikely to have a substantial additional effect in comparison with maneuvers that rely on gravity to accomplish canalith repositioning.”
what is the measurement for Gaze-Holding Nystagmus
+ if nystagmus is present, record direction and pace of nystagmus
what are some activity and exercise guidelines when dealing with BP- diastolic
Diastolic B/P should remain the same or change slightly
<5mmHg increase or decrease normal
what are the statistics of Mal de Debarquement
Occurrence usually after prolonged motion
Ex: long boat cruise, train trip
what si the anterior vestibular artery for inner ear
Anterior Vestibular Artery supplies vestibular nerve, utricle, ampullae of the lateral and anterior semicircular canals.
what is the cervicogeeni dizziness
Symptoms of dizziness (including vertigo, disequilibrium and lightheadedness) arising from the cervical spine.”
“Lack of a concrete test that is sensitive and specific to this entity.”
Need to isolate cervical symptoms vs movement symptoms.
what is the BBQ position 1
Lie Supine
Affected Ear Down
what are some considerations with abnormal H+H if it is high
Headache Dizziness Blurred Vision Decreased mental acuity Distal Sensory changes
Increased risk for stoke and thrombosis
Follow MD guidelines
what is the 2nd most common cause of vertigo
vestibular nerve impairment
what is anticoagulants
inhibit synthesis and function of clotting factors; used mainly to prevent and treat venous thromboembolism
what is the motor ouput items
reflexes
volitonal responses
what is no help FIM scores
7
6
what is position 1 for the toll test
Patient is Supine with 20° cervical flexion
what is PT and PTT used for
Test to screen for bleeding disorders – screens for the presence of multiple clotting factors found in the blood stream
what is the 4th thing you do with vesti eval
clear cervical spine
H/O cervical surgery Spondylolithesis / spondylolisis Recent neck trauma Severe rheumatoid arthritis Atlantoaxia and occipitoatlantal instability (ex: Down’s Syndrome) Cervical myelopathy or radiculopathy Carotid sinus syncope Chiari Malformation Vascular dissection syndromes Vertebral Artery Screening Other Tests
where are some places you can discharge a patient to
- inpatient rehab
- long term assistive care
- skilled nursing facility
- home health services
- outpatient services
**look at my last slide for detailed info
what is hematocrit
measures the percentage of total blood volume
what is differential diagnosis of vestibular nerve impairment
Loss of tonic firing rate
what does immobility cause
High Incidence of Clots with ICU and acute patients
- DVT
- PE
Both 911 and we are the first responders
what is done during the egress test
3 reps of Sit to Stand Transfers
- *First “clearing test” – 1-2 inches off bed
- *Two complete sit to stands
- **Perform marching in place/ and weight shifts in standing
Static stance for 60 seconds – record symptoms and vitals is needed
**patient demonstrates difficulty or need for physical assistance beyond cues and/or guarding techniques, that patient is indicated for mechanical conveyance.
what are some rules of restraints
look at slide 30 at all the rules
what are soem surgical interventions for vestibular
The development of surgical interventions for vertigo is fascinating and challenging branch of nuerotology. Unfortunately at the moment, most of the procedures used are ablative rather than restorative.
what is the med for PT
warafin
how would allergies affect vestibular
Adverse reactions to foods and chemicals
Ex: seafood, chlorine
Clinical evidence; however, pathophysiology is unclear
what is the FIM score of 3
moderate assistance (subject=50%)
what is the set up for Saccadic Eye Movements
Patient is arm’s length from PT, head stationary, PT standing in front of pt. Visual Target 18-24” from pt. Move visual target (finger or pen) to location 15* to R, L, Up, Down.
what is the therapeutic level for coagulation profiles
Level at when the blood has been sufficiently anticoagulated given the current medical condition of the patient
what causes leukopenia
Causes: Bone marrow failure, autoimmune disease. Rx/Cx
what is the egress test
Quick screen to determine the ability to transfer and ambulate safety
what are some other presciption info
Make immediate adjustments to exercise/activity based on your observations and patient comments.
Stop repeating same verbal cues over and over. If it’s not working try something else!
Internal Focus – concentrate on body moving this way
External Focus – look at end goal
Reactive Balance – encourage patient error
what are some therapy considerations for potassium
Therapy considerations * minor changes can have HUGE consequences*
Hyperkalemia: EKG changes, nausea, diarrhea
Hypokalemia: dangerous ventricular arrhythmias, cardiac irritability, ST segment depression, dizziness, hypotension
what can we fix with vesti
BPPV – Address Otoconia with Canalith Repositioning Technique or Bar-B-Que Roll
Endolymphatic Fluid – Education (salt, caffeine, alcohol, tobacco)
what are some complications of ↑ ICP
Headache. Nausea, Vomiting, ocular palsy, altered mental status and conscious
what is some other vascular supply info for the central vestibular system
Recognizable clinical syndromes with vestibular components may appear after occlusions of the basilar artery, labyrinthine artery, AICA and PICA.”
what is the basics anatomy of how the processing of information in the inner ear
- peripheral input
- central processing
- motor ouput
what are other treatment options
- vestibular rehabilitation
- balance retraining
- safety education
- motion insensitivity
- ocular motor eye testing
- vor deficits
- remove or change peripheral input
- change multiple condition s
what are the directions for VOR – suppression or cancellation
“Look at my nose the entire time I’m moving your head.” or “Look at thumbs the entire time.”
what are the directions for VOR – rapid “Head-Thrust” or “Head Impulse” Test
“I’m going to move your head faster and without warming I’m going to stop. Look at my nose the entire time.”
what should sodium levels be like
135-145 (mE q/l)
what is 10,000-20,000 platelet level
light functional activity only
what are some things to keep in mind (chest tube )
do not remove tube from suction uless have a MD order to do so
what are structures involved in TBI
temporal bone fracture tearing of tympanic membrane tearing of membranous labyrinth vestibular and cochlear nerve damage inner ear concussion – VIIIth cranial nerve or labyrinthine injury
what should you keep in mind with transfers in acute care
Tolerance level
remember that a transfer TO a chair, also means a transfer BACK TO bed
what is collected for the fim
first three days after admission
Each day during therapy
3 days before discharge
what is change multiple conditions
Eyes + Ears
Eyes + Muscles/Joints
Ears + Muscles/Joints
Eyes + Ears + Muscles/Joints
what is leukoctosis
> 11,000
how do you asses functional mobility
Level of assist (FIM) Distance Assistive Device Response Gait Quality Response to mobility
what is the evaluation plan
- Limited ability to “fix” problems
- If you can’t “fix” it – Learn to Compensate
what is FiO2
Fraction of inspired oxygen
Fraction or percentage of oxygen in the space being measured
what is helper complete dependence
2
1
what is VOR
Vestibular-Ocular Reflex
Gaze stability with rapid head movements
what are some the functional goals
Amb on uneven surface 100ft w/ functional head turns and least restrictive A.D.
Independent with HEP and symptom management.
Able to verbalize and demonstrate good safety awareness.
Improved functional balance and decrease fall potential with increase in Dynamic Gait Score to 20/24 or better.
what is a + test for Optokinetic Nystagmus
If nystagmus is not observed, validity of other nystagmus testing is questionable.
what shoudl platelet levels be
100,000-450,000 cells/mCL
what is the med for PTT
heprin
what is the PICC
access point in the arm and this is thick
