Final Flashcards
Muscle Grade Definitions
0-No palpable muscle contraction 1-Trace muscle contraction 1+-GE through 1/2 ROM 2-GE through full ROM 2+-AG through 1/2 ROM 3-Full ROM AG No R 3+-AG Min R 4-AG Mod R 5-AG Max R
Medical Complications of SCI AH, OH, etc
Spinal shock may last 24 hrs – 8 weeks Spasticity- below level of injury Heterotrophic ossification Osteoporosis Autonomic dysreflexia Orthostatic hypertension Decubitus ulcer/pressure sore Deep vein thrombosis/DVT Posttraumatic syringomelia/syrinx Limits/total deficits in respiratory function, sexual functioning/response, bowel and bladder functioning depending on level of injury
Hetetrotrophic Ossification
abnormal bone development in soft tissue in or around a joint
Autonomic Dysreflexia
sudden and significant increase in blood pressure in response to noxious stimuli
Ramp specifications (1:12)
Maximum slope of a ramp in new construction should be 1:12 — meaning that every 1 inch of vertical rise requires at least 12” of ramp.
W/C access specifications for doorways
Minimum clear width for a wheelchair is 36 inches for a hall and 32 inches for a door. and radius of 5’x5’
Rheumatoid arthritis
Autoimmune: acute and non acute stages. Thickened synovial membranes, cartilage erosion leading to joint weakness, misalignment and pain. Fatigue, loss of appetite, fever, overall achiness or stiffness, weight loss.
Osteoarthritis
pain, stiffness, swelling, and crepitus, due to the breakdown of cartilage in the joints. NOT inflammatory or systemic.
Gout
metabolic disease cause by urate deposits, causing recurrent acute episodes of arthritis (diet/crash-dieting related, often men 40-50 yrs of age).
Impact of RA on the hands (types of deformities) and splinting options
Swan-neck Boutonniere Ulnar drift Subluxation Fusiform swelling Trigger finger In the acute stages RA can cause hypermobility so avoiding exercise can be helpful. Splinting options include the silver ring splints to help correct finger deformities in a functional and attractive way.
Swan-Neck Deformity
PIP hyperextension and DIP flexion
Fusiform Swelling
swelling which narrows towards the distal end
Boutonniere Deformity
tendonal misalignment leading to DIP hyperextension and PIP flexion
Trigger Finger
swollen flexor tendon/sheath limiting flow of synovial fluid
Treatment precautions for arthritis
Avoid fatigue Respect pain Avoid static/stressful/resistive activities Limit application of heat to 20 mins Use resistive exercises with caution and never with unstable joints Be aware of sensory impairments
Focus of treatment for patients with arthritis
Reengagement of meaningful activity—ADLs but also IADLs of significance.
Principles of joint protections
• use strongest/largest joints available; • use each joint in its most stable anatomical and functional plane; • avoid holding or staying in one position for prolonged periods of time; • avoid activities that cannot be stopped immediately if they become stressful; • do use assistive equipment and splinting
Equipment modifications/adapted equipment for individuals with arthritis
Consider before the presence of deformity Equipment needs vary over course of the day and may affect other joints Activities and equipment involving strong grasp are contraindicated for patients with MCP involvement Some patients with wrist or hand involvement are unable to grip standard transfer assist equipment “Convenience” appliances are not always convenient for patients with arthritis A change in ambulation aids requires instruction in ADL include built up utensils and crochet needles
Considerations for exercise and activities
Consider how joint disease affects ROM Type of exercise to use Min # of reps necessary to maintain or increase mobility Time of day to exercise Post-treatment or post-discharge followthrough on pts behalf
Test for assessing regeneration of nerve Tinel’s Sign
performed to produce a reaction Tapping along nerve to elicit pins and needles/tingling sensation, to determine whether a peripheral nerve has regenerated.
Test for assessing regeneration of nerve Phalen’s Sign
produce the nerve paresthesis present in compression of the median nerve. The pt is asked to hold the wrist in a fully flexed position for 60 seconds and the test is considered positive if tingling occurs within this time
Sensory distribution of Radial nerves
strip of posterior upper arm and forearm, dorsum of thumb, index and middle fingers and radial half of ring finger to PIP joints. Sensory loss typically not disabling to functional hand use.
Sensory distribution of Ulnar nerves
dorsal and volar surfaces of little finger; ulnar half of the dorsal and volar surface of the ring finger. Sensory loss results in frequent injury, especially burns, to ulnar side of hand and small finger.
Sensory distribution of Median nerves
volar surface of the thumb, index, and middle fingers; dorsal surface of index and middle; and radial half of ring finger distal to PIP joints. Sensory loss affects all pinch patterns due to inability to judge force required.
