Final Exam Flashcards
1
Q
Where would bradykinesia be placed in the ICF model
A
Structure and function impairment
2
Q
Where is the PDQ-39 in the ICF model
A
Participation
3
Q
What are some PD body structure and function outcome measures
A
MDS-UPDRS part 1 and part 3
4
Q
What are some PD activity limitations outcome measures
A
MDS part 2
Parkinson’s fatigue scale
5
Q
What are some PD participation outcome measures
A
PDQ - 8, 39
Nonmotor symptoms questionnaire
6
Q
What is the general model of PD care
A
Prevention is better than reaction
Do PT as soon as their is a diagnosis and don’t wait until their is an event
7
Q
What are some intervention strategies for HY stage 1-2
A
Increase physical activity
Large body movements
Prevention of inactivity
8
Q
What are some intervention ideas for HY stage 3-4
A
Train for gait balance and transfers
Reach and grasp
Sensory queuing
9
Q
What are some intervention ideas for HY stage 5
A
Supportive care
Prevention of contractures, pressure sores, pneumonia
Hospital bed as needed
Family training
10
Q
What are some PD associated motor and nonmotor impairments
A
Postural hypotension
Bladder infrequency
Sleep disturbances
Depression, anxiety, apathy
11
Q
Describe shuffling gait
A
Short step length, decreased foot clearance, flexed knees and hips
rigid trunk, asymmetrical arm swing
bradykinesia that worsens with dual tasking
12
Q
Describe anteropulsion
A
COM too far forward, starts to run
Caused by forced through a freeze or walkers without wheels
13
Q
Describe retropulsion
A
COM if to far posterior
Cause by backing up, reaching overhead, opening doors, carrying items too close to by body
14
Q
What are some triggers for freezing gait
A
Narrow spaces
Stress
Turning
Change in walking surface
15
Q
What are the 4 S’s to fight festinating a freezing
A
Stop
Stand tall
Sway
Step long
16
Q
What AD may help most for freezing
A
Laser pointers useful for visual que
Ustep walker
17
Q
What are some ways to implement visual ques
A
rail road tracks, 24-48 inches apart, 150% longer than normal step length
18
Q
What are some ways to implement auditory ques
A
Music while walking
Metronome, 100-125 BPM
19
Q
Why does cueing work for PD
A
It bypasses the damaged basal ganglia and brings gait to the conscious level
20
Q
What is Camptocormia
A
Extreme involuntary flexion in standing but relieved in supine
21
Q
What is pisa syndrome
A
increased lateral flexion
subsides with passive correction in recumbent positions
22
Q
What muscles need to stretched with PD
A
Pecs
Extensor muscles
23
Q
What intensity of cardiovascular exercise is ideal for individuals with PD
A
150 mins a week of moderate intensity
This can slow or reverse neurodegeneration
24
Q
What are some ways to manage PD tremors
A
Stress management
Promote relaxation
Weighted utensils
Large buttons
25
What is a common PD medication
Levodopa
26
What is an example of reactive balance training
Perturbation training
| Abrupt stops and starts, ball catches
27
What are some anticipatory balance training activities
Self initiated movements
Gait with head turns
Dual tasking
28
What are some characteristics of successful PD activities
High repetition, high intensity
Dynamic
Patient enjoys
29
What is the underlying pathophysiology of PD
Degeneration of dopaminergic neurons in the BG, the pars compacta of substantia nigra no longer produce dopamine
30
How is DP acquired
Genetics
Exposure to certain environmental toxins
Certain drugs
31
What underlies hypokinesia in PD
Inhibition of the thalamus by the basal ganglia
32
Where is dopamine produced specifically in the brain
in the pars compacta of the substancia nigra of the BG
33
What are the 4 cardinal symptoms of PD
Rigidity
Bradykinesia
Tremor
Postural instability
34
Do PD patients suffer from primary sensory loss
No
| 60-80% deal with paresthesia and pain as early symptoms
35
What are some impairments in PD that may warrant a speech language pathologist
Hypokinetic dysarthria
Degraded vocal quality
Mutism
36
What are some autonomic symptoms of PD
Hyperhidrosis
Seborrhea
Gi disorders
37
Describe the HY stage 1
Minimal or absent disability
| Unilateral if present
38
Describe the HY stage 2
Minimal bilateral or midline involvement, balance not impaired
39
Describe the HY stage 3
impaired righting reflexes, some activities restricted
40
Describe the HY stage 4
All symptoms present and severe, standing and walking only with assistance
41
Describe the HY stage 5
bed or char bound
42
What can chronic dopamine replacement cause
dyskinesias and akinesias
43
Explain deep brain stimulation
Brain stimulation with implanted device that can eliminate symptoms of PD
44
What are some specific MS outcome measures
```
12 item MS walking scale
Timed 25 foot walk
MS quality of life -54 instrument
Expanded disability status scale
Fatigue severity scale
```
45
Subtypes of MS
Progressive relapsing
Secondary progressive
Primary progressive
Relapse remitting
Relapse remitting
Primary progressive
46
What are some MS exacerbating symptoms
```
Stress
Affective disorders
Disease of major organ systems
Viral or bacterial infection
Pseudoexacerbation
```
47
What is uthoff's symptom
Adverse reaction to heat
48
What are some clinical considerations for MS
Avoid overheating
Exercise and activity should be a challenge, but never a struggle
Progression is generally slower
49
What are some exercise contraindications for MS
Do not exercise them to the point of fatigue
| Do not exercise RRMS during an exacerbation
50
Describe fatigue as it relates to MS
sudden severe sleepiness, excessive tiredness, sense of weakness
51
What are some energy effectiveness strategies for MS patients
Activity diary
Energy conservation techniques
Activity pacing
52
What is the underlying cause of MS
Inherited susceptibility to immune system dysfunction
| These people are then exposed to a viral agent and MS may develop
53
What is the pathophysiology of MS
an abnormal immune response attacks oligodendrocytes and the nerve root fibers themselves in the CNS
54
Describe relapse remitting
Most common form of MS
| Attacks followed by remission
55
Describe primary progressive
continued worsening of the disease
56
Describe progressive relapsing
Progressive decline with attack
57
What is considered a MS relapse
Symptoms longer than 24 hours
58
What are some secondary deficits with MS
numbness
| paresthesia
59
What are some cognitive issues associated with MS
Short term memory loss
Dual tasking issues
Lower attention
Lower executive function
60
What are some eye movement defecits with MS
Nystagmus
| Diplopia
61
What cerebellar symptoms may be present in MS
Ataxia
Tremors
Hypotonia
Truncal weakness
62
What is cognitive motor interference
Impairments with gait due to inability to dual task
63
What is dysarthria
Poorly articulated speech
64
What is pseudo bulbar affect
Sudden laughing or crying when it is inappropriate
65
Describe Dawson's fingers
Seen in coronal MRI
| Indicated MS
66
What medications can manage spasticity
Oral baclofen
| Botulin toxin
67
What interventions are bets for early / mid MS stages
Regular exercise
Community classes for socialization
Education
Determine need for assistive device
68
What are some fatigue based OM for MS
MFIS
| FSMC
69
What is the MSWS-12
Self assessment on walking function
70
What is the ideal exercise frequency for MS patients
3-5 days per week
71
Describe the activity diary for MS patients
Document how they sleep
Daily activities by the hour
How costly those activities were
72
What are 2 ways to limit ataxic movements
Proprioceptive loading
| Light resistance
73
Define ataxia
Loss of muscle coordination
74
What does the midline of the cerebellum control
Titubation
Truncal ataxia
Orthostatic tremor
Gait imbalance
75
What does the hemispheres of the cerebellum control
Limb ataxia
Dysarthria
Hypotonia
76
What does the posterior of the cerebellum control
Posture
Gait
Eye movement disorders
77
What side of the body does the cerebellum control
ipsilateral side
78
Define dyssynergia
impaired synergistic actions with decomposition of movement
79
How does stroke affect eccentric and concentric strength
Affects concentric more
| 40-60% less torque
80
What are some characteristics of post stroke exercise
Prevent stiffness
Strengthen muscles over short lengths
Eccentric strength preservation
81
What is the exercise dosing post stroke
1 set of 10-15 reps
40-50% 1RM
2-3 days per week
48 hour rest
82
What type of power training should be conducted post-stroke
Emphasis on fast concentric and slow eccentric
| This helps with fall prevention and reactionary balance
83
Describe CIMT, who made it
Technique of treatment intended to increase the use of the affected limb in post stroke patients
Taub
84
What are the 4 main components of CIMT
repetitive and intense training
Shaping
Transfer package
Physical restraint of uninvolved limb
85
What is the dosing of CIMT
3 hours per day
5 days per week
2-3 weeks
86
How do you shape tasks
Slowly make the task harder
87
What is the main goal of CIMT
reverse learned nonuse and increase the use of the patients affected limb
88
What is the goal of the transfer package
Transfer what the patient has learned into the real world
89
What are the minimum ROM requirements to begin CIMT
45 shoulder abduction
20 elbow extension
10 wrist extension
10 finger flexion
90
What are the major OM used in CIMT
Wolf motor function test
| Motor activity log
91
What are the most consistent predictors of adherence to physical activity in older adults.
Self efficacy
| Perceived barriers
92
How do you break down objective and subjective obstacles
Objective - environment and task adaptation
| Subjective - confidence building, problem solving, refuting beliefs that hinder activity
93
What is use-dependent neural reorganization
Happens after overuse is overcome use of that extremity is learned
94
What activities may require "mit off both hands"`
Dressing
| Bathing
95
What is the difference between home skills and home practice
Home skill - encourage patients to try ADL’s that they may not have tried with the more involved limb
Home practice - Patients performing 15-30 mins of specific UE tasks
96
What side to "pushers" push toward
Weak side
| Opposite the lesion
97
What OM can be used to determine if the patient is a pusher
Scale for contraversive pushing - SCP
| Burkle Lateropulsion scale - BLS (more sensitive)
98
What is the hallmark sign that someone has Pusher’s syndrome
resistance to passive coercion
99
What characteristics mark a higher incidence of pusher syndrome?
Severe hemiparesis / plegia
Severe sensory loss
Neglect
Right CVA compared to left
100
What system is affected with pusher syndrome?
impaired gaviception
101
What is the prognosis of individuals with Pusher syndrome?
Good prognosis
Most resolve in 3 weeks
Generally 80% resolve in 3 months
Rare presence by 6 months
102
Which hemisphere is push most evident in
Right
103
What area of the brain will most likely underlie contraversive pusher
Posteriolateral thalmus
| Parietal lobe
104
What is a lacunar stroke
Caused by small vessel disease deep in the cerebral white matter
105
Why is dysphagia a worry among stroke patients
happens to 1/3
| Can lead to aspiration, pneumonia and death
106
Where is short term memory stored
Limbic system in the temporal lobes
107
Damage to which hemisphere is associated with a more cautious, anxious, disorganized behavior?
left
108
Perceptual deficits are frequently the result of lesions to what area(s) of the brain?
Right hemisphere
109
What are the SS for PE
```
Chest pain
Tachypnea
Tachycardia
Anxiety
Restlessness
Apprehension
Persistent cough
```
110
What is central post-stroke pain?
Pain arising as a direct consequence of a lesion or disease affecting the central somatosensory system, happens in about 10% of strokes
111
What is selective capacity
Ability to isolate movement
112
A selective loss in what type of fibers is present post-stroke?
type 2 fast twitch
113
When performing rolling during bed mobility with an individual with hemiparesis, which direction would be the most difficult?
Onto the good side will be more difficult
114
What should early sitting balance training focus on in the acute/sub-acute stages post-stroke?
symmetric posture with proper spine and pelvic alignment
115
In a patient with hemiparesis which direction is lateral flexion more prominent
Lateral flexion to the affected side
116
Define TBI
Alteration of brain function by an external force
117
What is the leading cause of TBI
Falls
| Then MVA
118
What population is most affected by TBI
Elderly
119
What is a Primary TBI
The brain contacting another object or rapid acceleration and deceleration of the brain
120
What is the most predominant mechanism of injury in most individuals with moderate to severe TBI
Diffuse axonal injury
| Caused by acceleration and deceleration shear forces
121
What is Blast TBI
When the shockwave from a black causes compression to the brain
122
Describe secondary TBI injury
```
The subsequent events after an initial trauma
Hypoxemia
Ischemia
Edema
Elevated ICP
```
123
Define a vegetative state
awake
non powerful movements
withdrawal from noxious stimulus
124
Define minimally conscious state.
Inconsistent ability to mediate behaviors
| some evidence of self and environmental awareness
125
What is dysautonomia?
Pathologically increased sympathetic nervous system activity
126
Which outcome measure is most often used for TBI severity? Provide the value corresponding with a severe TBI.
GCS
| <8 = severe
127
The duration of what predicts TBI recovery
Post traumatic amnesia
PTA
Length of time from injury to when patient can remember events
128
What is normal intracranial pressure
5-20 mmHG
129
What are some methods used to treat elevated ICP
```
Moderate head up position
Osmotherapy
Hypothermia
Surgical decompression
Barbiturates
```
130
What are contraindications for early mobilization with TBI patients
Unstable spine
| Increased ICP
131
Describe the Community Balance and Mobility Scale
Activity
Ambulation
High level patients
132
Describe the Community Integration Questionnaire
Participation
Home integration, social activities, productive activities
For home health and outpatient settings
133
What kind of practice shedule is good for TBI
Distributed
