FLASH Flashcards
1
Q
agnosia
A
inability to interpret information
2
Q
agraphesthesia
A
inability to recognize symbols
3
Q
agraphia
A
inability to WRITE due to lesion on brain
4
Q
akinesia
A
inability to INITIATE MOVEMENT
5
Q
aphasia
A
inability to communicate or comprehend due to damage to the brain
6
Q
apraxia
A
inability to perform PURPOSEFUL learned mvmts although there is no sensory or motor impairment
7
Q
astereognosis
A
inability to recognize objects by sense of TOUCH
8
Q
asymmetrical tonic neck reflex (ATNR)
A
with head turned to one side, arm and leg on face side are extended and arm and leg on scalp side are flexed. this reflex could interfere with an infant’s ability to roll from prone to supine.
9
Q
ATNR normal age of response
A
6 months
10
Q
ataxia
A
inability to perform COORDINATED mvmts
11
Q
athetosis
A
INVOLUNTARY mvmts and INSTABILITY of POSTURE. usually due to damage to basal ganglia.
12
Q
bradykinesia
A
slow movements
13
Q
chorea
A
movements that are SUDDEN
14
Q
clonus
A
INVOLUNTARY ALTERNATING SPASMODIC CONTRACTION of a muscle precipitated by a QUICK STRETCH REFLEX. characteristic of an upper motor neuron lesion
15
Q
diplopia
A
double vision
16
Q
dysarthria
A
slurred and impaired speech due to MOTOR deficits of tongue or other muscles
17
Q
dysmetria
A
INABILITY to CONTROL range of movement and the FORCE of MUSCLE ACTIVITY
18
Q
dysphagia
A
INABILITY to SWALLOW
19
Q
hemiparesis
A
WEAKNESS on one side of body
20
Q
hemiplegia
A
PARALYSIS on one side of body
21
Q
kinesthesia
A
ability to PERCEIVE the DIRECTION and EXTENT OF MOVEMENT of a joint or body part
22
Q
symmetrical tonic neck reflex (STNR)
A
head positioned in flexion or extension
23
Q
STNR normal age of response
A
6-8 months
24
Q
STNR with head positioned in extension
A
arms are extended
25
STNR with head positioned in flexion
arms are flexed
26
postural drainage
techniques for therapists to help dislodge mucous from lungs
27
upper lobes anterior segment
supine with pillow under knees. claps btwn clavicle and nipple on each side
28
upper lobes apical segment
leans back on pillow at 30 degree angle against therapist
29
upper lobes posterior sgmt
pt leans over pillow at 30 degree angle. claps over upper back on each side.
30
left upper lobe lingular
foot of bed elevated 16 inches. lies prone on rt side and rotates 1/4 turn backward. claps over left nipple area
31
right middle lobe
foot of bed elevated 16 inches. prone on left side and rotates 1/4 turn backward. claps over right nipple area
32
lower lobe anterior basal
foot of bed elevated 20 inches. sidelying
33
lower lobe lateral basal
foot of bed elevated 20 inches. prone
34
lower lobes posterior basal
foot of bed elevated 20 inches. prone
35
lower lobes superior segments
bed flat. patient prone with 2 pillows under hips. claps over middle of back at tip of scap on either side of spine
36
arterial insufficiency
usually caused by arteriosclerosis. acute stage: acute arterial obstruction, distal pain, sudden onset. vascular: decreased or absent pulses, pallor of forefoot on elevation, dependent rubor. risk factors: smoking, diabetes, hypertension
37
arterial insufficiency: skin
dry skin
38
arterial insufficiency
arterial insufficiency severe muscle ischemia, intermittent claudication, worse with exercise, relieved by rest. rest pain means severe involvement. will present with muscle fatigue, cramping, numbness, paresthesia overtime
39
chronic venous insufficiency
acute stage: dvt, calf pain, aching, EDEMA, muscle tenderness. caused by vein obstruction
40
chronic venous insufficiency: skin
ulcers: sides of ankles, mostly MEDIAL MALLEOLUS. will be DARK, BROWN, MAY LEAD TO STASIS DERMATITIS, CELLULITIS, skin thick
41
venous insufficiency
vascular: venous dilation. edema: moderate to severe. risk factors: venous hypertension, varicose veins. pain: minimal to moderate steady pain. aching pain with prolonged standing or sitting
42
w/c for C1-C4 lesions
electric w/c with tilt in space or reclining back
43
w/c for C5
can use manual w/c with projections. C5's have shoulder function and elbow function.
44
w/c for C6
manual w/c w/friction surface and hand rims independently. ability to drive a car independently. use of radial wrist extensors
45
w/c for C7
manual w/c w/friction surface hand rims independently. has use of triceps (elbow extension - can push up on arm rests)
46
w/c for C8-T1
may use manual w/c with standard hand rims. use of hands.
47
ERV-expiratory reserve volume
max amt of air expired after a normal expiration. 1000 mL
48
FVC-forced vital capacity
amount of air forcefully expired after maximal inspiration
49
FRC-functional residual capacity
amount of air in lungs after a normal exhalation. ERV+RV
50
RV-residual volume
volume of air remaining in airways and lungs after max expiration
51
tidal volume
volume of air inspired OR expired in one breath. 500 mL
52
TLC-total lung capacity
total amt of air lungs can hold. total amount after a max inspiration. IRV+TV+ERV+RC
53
vital capacity
max volume of air that can be forcefully expired after a max inspiration. 4000-5000 mL
54
moro reflex
when head drops into extension for a few inches the arms abduct with fingers open
55
palmar grasp reflex
pressure in palm will produce reflex of flexion/strong grip. birth to 4 months
56
plantar grasp reflex
pressure to base of toes will produce reflex of toe flexion. 28 weeks of gestation to 9 months
57
positive support reflex
weight placed on balls of feet will produce stiffening or legs and trunk into extension. 35 weeks of gestation to 2 months
58
cold therapy/cryotherapy contraindications
cold therapy/cryotherapy contraindications infection, ischemic tissue, peripheral vascular disease, hypertension
59
hot therapy/superficial heat contraindications
arterial disease, bleeding, circulation issues, malignancy, thrombophlebitis
60
ultrasound contraindications
epiphyseal areas in children, pain/temp/sensory deficits
61
traction contraindications
tumor, pregnancy, acute sprain or fracture, osteoporosis
62
compression contraindications
heart failure
63
estim contraindications
pacemaker, arrythmia, heart failure, malignancy, broken skin
64
cervical traction guidelines
supine, force between 10-15 lbs and progress to 7% of body weight
65
lumbar traction guidelines
supine or prone. force of less than half of body weight for initial treatment, 25 to 50% of body weight required for actual separation. for muscle spasm, 25% of body weight should be used.
66
intermittent compression
used primarily to reduce chronic or post traumatic edema. can use for venous insufficiency
67
e-stim
increasing size of one of 2 electrodes will decrease current density
68
estim pulsed/alternating/biphasic
muscle retraining
69
estim direct current/monopolar
used with iontophoresis
70
ultrasound for muscle/deep tissue
frequency: 1 MHz
71
ultrasound for superficial/bony
frequency: 3 MHz
72
pulsed u/s
produces nonthermal effects
73
continuous u/s
produces thermal effects
74
u/s BNR
5:1 or 6:1
75
u/s ERA transducer head
ERA=1/2 size of transducer head
76
standard manual w/c dimensions
supine or prone. force of less than half of body weight for initial treatment, 25 to 50% of body weight required for actual separation. for muscle spasm, 25% of body weight should be used.
77
doorway width for w/c
32"
78
hallway width for w/c
36"
79
ramp dimensions for w/c
12:1 rise/run
80
u/s for stroke
upper motor neuron lesion
81
estim for pressure ulcer
enhances healing. use monophasic pulsed current
82
what muscles should be stimulated for Bell's Palsy?
frontalis
83
arterial insufficiency will cause
reactive delayed hyperemia (increase of blood flow to tissues)
84
Parkinsons-what exercises for preventing falls?
postural exercises
85
tight hip flexors will cause
anterior pelvic tilt and increased lumbar lordosis
86
hyperthyroidism often presents with
RA
87
diagnostic procedures to confirm disc herniation
MRI
88
intervention exercises for lumbar stenosis
pts will tolerate flexion exercises
89
lumbar stenosis
involves multilevel impingement in spine ligaments. pain is worse when ambulating or extending spine.
90
best exercises for ankylosing spondylitis
pts tend to assume flexed postures, so back extension exercises would be most important. ankylosing spondylitis is a form of rheumatic disease w/inflammation of spine. will exhibit posture such as forward head, increased kyphosis, loss of lumbar curvature.
91
which nerve is compressed - carpal tunnel syndrome
median. causes atrophy and weakness of thenar muscles and lateral lumbricals. positive tinel's and phalens
92
regular exercise for diabetics will
lower blood glucose levels and decrease amount of insulin required
93
compensations of shoulder motions
flexion: extension of spine. abduction: lateral flexion. scap protraction: IR. scap elevation: shoulder hyperextension
94
orthostatic hypotension after bed rest
most likely result of inadequate ventricular filling during diastole - decreased venous tone
95
most appropriate exercise for new dx of hyperthyroidism
decrease intensity
96
traumatic brain injury - tonic reflexes
tonic reflexes are released. TL supine reflex results in flexor stimulation when in prone
97
bicipital tendonitis
inflammation of long head. impingement of proximal tendon btwn anterior acromion and bicipital groove. speed's test
98
colles fracture
most common fracture caused by FOOSH. immobilized for 5-8 weeks
99
idiopathic scoliosis
2 types: structural: irreversible lateral curve with rotation. nonstructural: reversible lateral curve w/o rotation which straightens with flexion. over 45 degrees would require surgery
100
piriformis syndrome
piriformis overworked with overpronation (due to hip IR).
101
plantar fasciitis
chronic irritation of fascia from overpronation
102
spondylolysis
fracture of par interarticularis
103
spondylolysthesis
anterior/posterior slippage of one vertebra on another following bilateral spondylolysis. avoid extension, Lf, ROT
104
thoracic outlet syndrome (TOS)
compression of neurovascular bundle
105
tibial plateau fracture
valgus and compressive forces to knee with knee in flexion. often in conjunction with MCL injury
106
torticollis
spasm/tightness of SCM. laterally flex towards affected side, rotation away from affected side.
107
ulnar collateral ligament injury
due to repetitive valgus strain (overhead throw). pain at medial elbow at distal insertion, sometimes parasthesia in ulnar nerve distribution with positive tinel's sign.
108
end feels
firm (stretch) ex: ankle dorsiflexion. hard (bone to bone) ex: elbow extension. soft (soft tissue approximation) ex: elbow flexion
109
abnormal end feels
empty: cannot reach end feel due to pain, ex: joint inflammation, fracture. firm: increased tone, tightening of capsule. hard: fracture, osteoarthritis. soft: edema, synovitis.
110
ROM requirements for normal gait
hip flexion: 0-30, hip extension: 0-15, knee flexion: 0-60, knee extension: 0, ankle DF: 0-10, ankle PF: 0-20
111
trendelenburg gait
glute medius weakness
112
RA pathologies
boutonniere deformity: DIP extension. Swan neck deformity: DIP flexion
113
effusion
increased volume of fluid within a joint capsule
114
Q angle
degree of angulation when measuring from midpatella to ASIS, and tibial tubercle. measured in supine with knee straight: 13 degrees average for male, 18 degrees average for female. excessive Q angle can lead to pathology and abnormal tracking.
115
dermatome
see page 70
116
Brunnstrom's 7 stages of recovery (spasticity and tone)
1=no volitional mvmt
117
UE: D1 Flexion
starts in shoulder flexion
118
UE: D1 Extension
starts in shoulder extension
119
UE: D2 Flexion
...
120
UE: D2 Extension
...
121
LE: D1 Flexion
...
122
LE: D1 Extension
...
123
LE: D2 Flexion
...
124
LE: D2 Extension
...
125
Ranchos Los Amigos Levels of Cognitive Functioning (TBI)
p 101
126
carpal bones mnemonic
Some Lovers Try Positions That They Can't Handle: Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate (proximal row, then distal row)
127
PNF technique "repeated contractions" should be applied when
at the point where the desired muscular response begins to diminish
128
To increase pt's ambulation distance (w/chronic arteriosclerotic vascular disease) with INTERMITTENT CLAUDICATION
short duration, frequent intervals
129
to stretch hip flexors (could be in Parkinson's patient)
prone lying would be best choice. increased flexibility in hip flexors will improve standing posture
130
blood pressure response to exercise
systolic pressure increases
131
when ascending a curb with axillary crutches using 3 pt gait
should lead with
132
action that would place greatest stress on achilles tendon
eccentric contraction of gastroc and soleus
133
a quad cane should be used in the UE that is
opposite from affected LE. the longer legs should be positioned away from patient
134
how much pressure for compression garment to control LE edema?
30-40 mmHg
135
which stage of bone healing is associated with the termination of external fixation?
clinical union
136
most appropriate method to selectively train VMO is
quad setting exercises and biofeedback
137
muscles
go over origins and insertions.
138
when working with a Parkinson's patient on controlled mobility, what would be best intervention? when working with same patient on motor control, which technique should be utilized?
promote weight shifting and rotational trunk control for controlled mobility. for motor control, should use rhythmic initiation.
139
which component of the vertebral artery test is most likely to assess patency of intervertebral foramen?
extension to assess intervertebral foramen; lateral flexion and rotation have a greater effect on vertebral artery
140
how to address a patient with diplopia during interventions
place a patch over one of the eyes
141
movements in frontal plane occur as
side to side movements
142
most appropriate rate to release pressure when obtaining bp measurement?
rate of 2-3 mm Hg per second.
143
most significant differences between heat exhaustion and heat stroke:
mental status and skin temp. heat stroke: altered mental status and elevated skin temp.
144
primary purpose of "anterior control" TLSO
prevent thoracic flexion
145
to avoid burning a pt during iontophoresis
pta should
146
post polio syndrome
symptoms that occur years after onset of poliomyelitis. remaining motor units become more dysfunctional. (sensation not affected.)
147
conventional TENS parameters
50-100 pps
148
lab values
...
149
pronation of foot consists of:
eversion of heel
150
confused-agitated patients (rancho los amigos) would benefit from:
numerous activities since they have a short attention span.
151
what determines the depth of u/s penetration?
frequency
152
mean angle of anteversion in an adult
8-15 degrees. patients with excessive anteversion of hip typically present with excessive medial rotation and limited lateral rotation of hip
153
most important value to check when giving exercises to diabetic patient
blood glucose value.
154
dysmetria
cerebellar
155
most common site for ulnar nerve injury
medial epicondyle of humerus
156
how to calculate heart rate by QRS complexes
if there are eight QRS complexes in a six second interval
157
guillain barre syndrome symptoms
rapid
158
decorticate and decerebrate posturing
decorticate: UE flexion and LE extension. decerebrate: UE and LE extension
159
positive support reflex
promotes extension of LE and trunk w/weight bearing through balls of the feet. reflex normally integrates at 2 months of age
160
Grade I & II mobilization
used mainly for pain
161
age predicted maximal heart rate
220 - patient's age
162
length of treatment when using u/s?
5 minutes for area that is 2-3 times the size of the transducer face
163
lateral trunk bending towards affected side of transfemoral amputee would indicate what problem with prosthesis?
too short
164
mechanoreceptors
generate info related to discriminative sensations. (2 point discrimination
165
acute burn produces hypermetabolism and results in:
increased oxygen consumption
166
genu recurvatum patient would benefit from increasing
plantar flexion stop of ankle foot orthosis. this would prevent PF after heel strike and inhibit full extension of knee during midstance
167
normal hemoglobin value for male
14-18 gm/dL
168
a lesion affecting the sensory cortex often results in impairments including loss of:
perception
169
corticospinal tract
carries info from cerebral cortex to spinal nerves. the tract's projections are primarily contralateral
170
level or urea in the blood provides a gross estimate of what?
kidney function. increased blood urea nitrogen level can be indicative of dehydration
171
MS
progressive CNS disease marked by intermittent damage to myelin sheath. patients tend to fatigue later in day
172
failure to stabilize scapula while measuring glenohumeral abduction will lead to:
upward rotation and elevation of scapula
173
humeral head slides posteriorly on glenoid fossa during shoulder medial rotation and as a result places pressure on the:
posterior capsule
174
dorsal scapular nerve innervates
levator scapulae and rhomboids
175
passive insufficiency occurs when
a 2 joint muscle is stretched across two joints at the same time. when performing passive knee flexion
176
infant's pulse is often assess at the ___ artery
brachial. an older child's pulse is often assessed at the radial artery.
177
patient slightly vaults and has early toe off due to what gait deviation?
pt has limited DF.
178
RR _____ a intensity of exercise plateaus
decreases. patient will accommodate to level of exercise and RR will tend to decrease.
179
shoulder: medial rotators and adductors provide support for the
anterior joint capsule. these muscles should be strengthened after anterior shoulder dislocation
180
C2
dermatome: temple
181
C3
dermatome: entire neck
182
C4
dermatome: shoulder area
183
C5
dermatome: deltoid area
184
C6
dermatome: anterior arm
185
C7
dermatome: lateral arm and forearm to index
186
C8
dermatome: medial arm and forearm to long
187
L1
dermatome: back
188
L2
dermatome: back
189
L3
dermatome: back
190
L4
dermatome: medial buttock
191
L5
dermatome: buttock
192
S1
dermatome: buttock
193
S2
dermatome: buttock
194
S3
dermatome: groin
195
S4
dermatome: perineum
196
T1
dermatome: medial forearm to base of little finger. myotome: elbow flexion and arm horizontal
197
T2
dermatomes: medial upper arm to medial elbow
198
T3-T12
dermatomes: upper thorax
199
diabetes mellitus
sx: polydipsia
200
hip joint consists of
convex femoral head within a concave acetabulum. hip flexion requires a posterior and inferior translation of the femoral head within the acetabulum
201
a minor lesion of a muscle or tendon will yield
mild to mod pain with resistance
202
special tests
go over
203
plumb line measurements
normal posture: thru lobe of ear
204
e-stim: when measuring phase charge
unit of measure is
205
duchenne muscular dystrophy
proximal muscle weakness first
206
heterotopic ossification
abnormal bone growth in tissue. sx include decreased ROM
207
bp cuff
width of bladder should be 40% circumference of midpoint of limb. average size adult=5-6 inches
208
stages of ulcers
...
209
which muscles of respiration are the most active during forced expiration
internal intercostals. depress ribs during forceful expiration
210
emphysema will present with
hyperinflated lungs and chest wall becomes fixed in hyperinflated position. total lung capacity and dead space in lungs significantly increase
211
extensor lag
lack of full knee extension with full contraction of the quads. pts with extension lag have greater passive extension than active extension.
212
shortening of latissimus dorsi presents as
limitation of shoulder flexion or abduction due to muscles origin on external lip of iliac crest and its insertion on intertubercular groove of humerus
213
burn thicknesses
...
214
best predictor of altered sensation after burn
depth of burn injury
215
ideational apraxia
deals with errors in concepts and sequencing of tasks. most commonly due to a lesion in patient's dominant parietal lobe of cerebrum
216
residual limb wrapping
6 inch ace wrap most appropriate for transfemoral amputation. 4-5 inch most appropriate for transtibial amputation
217
homolateral synkinesis
flexion patter of involved UE facilitates flexion of involved LE
218
raimiste's phenomenon
involved LE will abd/adduct with applied resistance to the uninvolved LE in the same direction
219
souque's phenomenon
raising the involved UE above 100 degrees with elbow extension will produce extension and abduction of fingers
220
akinesia
inability to initiate movement
221
apraxia
inability to perform purposeful learned movements
222
chorea
movements that are sudden
223
dysdiadochokinesia
inability to perform rapidly alternating mvmts
224
dysmetria
inability to control range of a mvmt and force of muscular activity
225
dysphagia
inability to properly swallow
226
hemiballism
involuntary and violent movement of a large body part
227
hemiparesis and hemiplegia
paresis: weakness on one side of body
228
ideational and ideomotor apraxia
ideational: inability to formulate an initial motor plan and sequence tasks where proprioceptive input necessary for mvmt is impaired....ideomotor: person plans a movement or task
229
complete/incomplete lesion
complete: no preserved motor or sensory function below level of lesion. incomplete: may be scattered motor function
230
anterior cord syndrome
incomplete lesion from compression and damage to anterior part of cord. injury is usually cervical flexion. loss of motor function
231
brown-sequard's syndrome
incomplete lesion caused by stab wound
232
cauda equina injuries
injury below L1 spinal level where long nerve roots transcend. usually incomplete due to large number of nerve roots in area. considered a peripheral nerve injury. flaccidity
233
central cord syndrome
incomplete lesion from compression and damage to central portion of sc. usually cervical hyperextension that damages spinothalamic tract
234
posterior cord syndrome
compression of posterior spinal artery. loss of pain perception
235
ectopic bone
or heterotopic ossification
236
sacral sparing
incomplete lesion where some of innermost tracts remain innervated. sensation of saddle area
237
myelotomy
surgical procedure that severs certain tracts within sc in order to decrease spasticity and improve function
238
neurogenic bladder
bladder empties reflexively for a pt with an injury above level of S2. sacral reflex arc remains intact
239
nonreflexive bladder
bladder is flaccid as a result of cauda equina or conus medullaris lesion. sacral reflex arc is damaged
240
rhizotomy
surgical resection of sensory component of a spinal nerve in order to decrease spasticity and improve function
241
neurectomy
surgical removal of a segment of a nerve in order to decrease spasticity and improve function
242
spinal shock
occurs physiologically 30 to 60 mins after trauma to sc and can last up to several weeks. presents with total flaccid paralysis and loss of all reflexes below level of injury
243
tenotomy
surgical release of a tendon in order to decrease spasticity and improve function
244
zone of preservation
poor or trace motor or sensory function for up to 3 levels below neurologic level of injury
245
glasgow coma scale
total score of 8 or less indicate coma in 90% of pts. score of 9-12 indicate moderate brain injuries
246
osteomalacia
softening of the bone
247
osteopenia
low bone mass; deprivation of bone
248
osteopetrosis
increased bone density
249
osteoporosis
decreased bone density
250
paget's disease
metabolic condition characterized by heightened osteoclast activity. excessive bone formation lacks true structural integrity. bone appears large but lacks strength. medication for treatment
251
endocrine system
hormones...glands of system include: hypothalamus
252
endocrine system dysfunction: signs and symptoms
neuromuscular: muscle weakness
253
adrenal dysfunction:
addison's disease or cushing's syndrome
254
addison's disease
hypofunctioning of adrenal cortex. electrolyte imbalance. weakness
255
cushing's
excessive amount of cortisol. persistent hyperglycemia
256
thyroid dyfunction:
hypothyroidism
257
hypothyroidism
decreased levels of thyroid hormones in bloodstream. fatigue
258
hyperthyroidism
excessive levels of thyroid hormones in blood. nervousness
259
type 1 diabetes mellitus
pancreas fails to produce adequate insulin. rapid onset of sx
260
type 2 diabetes mellitus
when body cannot properly respond to insulin. sx: ketoacidosis does not occur since insulin is still produced.
261
rehab considerations for pts with diabetes
peripheral neuropathies
262
phases of tissue healing
inflammation: 1-6 days
263
hydrotherapy tanks
extremity tank: used for distal upper or lower extremity
264
qualitative vs quantitative research
qualitative: derives data from observation
265
types of clinical evidence
systematic: comprehensive survey of topic which all primary studies have been identified
266
berg balance
test designed to assess a patient's risk for falling. 14 tasks
267
tinetti
another tool assessing risk for falling. patients with a total score of less than 19 indicates a high risk for a fall. tool has combined max total of 28.
268
mini mental state exam
screening patients for cognitive impairments. one point for correct answer and 0 for incorrect answer. max score of 30
269
short portable mental status questionnaire
10 item screening tool mainly used in geriatrics. orientation and memory, practical skills and math skills are assessed. max score of 10, with a score below 8 indicating cognitive impairment. lower score below 8 the more significant the cognitive impairment.
270
borg rating of perceived exertion scale (endurance)
tool designated to measure perceived exertion, dyspnea, and exercise intensity. original scale measures 6-20 points and revised scale measures 0-10 points. score of 20 (original) or 10 (new) indicates high intensity exercise that cannot be completed due to exhaustion.
271
six minute walk test
tool used to determine a patient's functional exercise capacity. allows for observation of heart rate and oxygen consumption during activity.
272
fugl-meyer assessment (motor recovery)
used to measure recovery after CVA.
273
functional independence measure (FIM)
used in rehab hospitals in order to determine a patient's level of disability and burden of care.
274
barthel index
tool designed to measure the amount of assistance needed to perform 10 different activities with a total max score of 100.
275
special tests: shoulder
dislocation (apprehension test), biceps tendon pathology: lundington's, speed's, yergason's; rotator cuff/impingement: drop arm, hawkins-kennedy impingement, neer impingement, supraspinatus; thoracic outlet syndrome: adson, allen, costoclavicular syndrome, roos, wright (hyperabduction), miscellaneous: glenoid labrum tear
276
special tests: elbow
ligamentous instability (varus stress
277
special tests: wrist/hand
ligamentous instability: ulnar collateral ligament instability test. vascular insufficiency: allen test, capillary refill test. contracture/tightness: bunnel-littler test, tight retinacular ligament test. neuro dysfunction: froment's sign, phalen's test, tinel's sign. miscellaneous: finkelstein test, grind test, murphy sign
278
special tests: hip
special tests: hip contracture/tightness: ely's, ober's, piriformis, thomas, tripod sign, 90-90 slr test. pediatric: barlow's, ortolani's. miscellaneous: craig's, patrick's (faber), quadrant scouring test, trendelenburg test.
279
special tests: knee
ligamentous instability: anterior drawer, lachman, lateral pivot shift, posterior drawer, posterior sag, slocum test, valgus stress, varus stress. meniscal pathology: apley's compression, bounce home, McMurray. swelling: brush, patellar tap. miscellaneous: clarke's sign, hughston's plica, noble compression, patellar apprehension
280
special tests: ankle
ligamentous instability: anterior drawer, talar tilt. miscellaneous: homan's sign, thompson, tibial torsion, true leg length discrepancy
281
special tests: spine
cervical: foraminal compression
282
special tests: spine
lumbar/si region: sacroiliac joint stress
283
nerves of the brachial plexus
nerves of the brachial plexus somatic network of nerves that originate near the neck and shoulder. These nerves begin at the spinal cord in the neck and control the hand, wrist, elbow, and shoulder
284
brachial plexus: dorsal scapular nerve
originates from rami of plexus. innervates rhomboids
285
bp: long thoracic
originates from rami of plexus. innervates serratus anterior
286
bp: nerve to subclavius
originates from trunk of plexus: innervates the subclavius
287
bp: suprascapular
originates from trunk of plexus: innervates infraspinatus and supraspinatus
288
bp: lateral pectoral
originates from lateral cord of plexus: innervates pec major and pec minor
289
bp: musculocutaneous
originates from lateral cord of plexus: innervates coracobrachialis
290
bp: lateral root of the median
originates from the lateral root of plexus: innervates flexor muscles in forearm, except flexor carpi ulnaris and five muscles in hand.
291
bp: medial pectoral
originates from medial cord of the plexus: innervates pec major and minor.
292
bp: ulnar
originates from medial cord of plexus: innervates 1 1/2 muscles of forearm and most small muscles of hand
293
bp: medial root of median
originates from medial cord of plexus: innervates flexor muscles in forearm
294
bp: upper scapular
originates from posterior cord of plexus: innervates subscapularis.
295
bp: thoracodorsal
originates from posterior cord of plexus: innervates latissimus dorsi.
296
bp: lower subscapular
originates from posterior cord of plexus: innervates subscapularis
297
bp: axillary
originates from posterior cord of plexus: innervates deltoid
298
bp: radial
originates from posterior cord of plexus: innervates brachioradialis
299
muscle spindle
receptors that respond to change in length
300
golgi tendon organ
responds to tension/stretch of a tendon
301
achilles tendon rupture
impaired blood flow along with degeneration will make tendon more susceptible to injury. occurs most frequently when pushing off a weight bearing extremity with an extended knee. patient will present with swelling over distal tendon, palpable over calcaneal tuberosity, and pain & weakness with plantar flexion. special tests: thompson's and possible O'brien needle test by physician
302
adhesive capsulitis
nflammation and fibrotic thickening of anterior joint capsule. primary is spontaneous, secondary is from an underlying condition. associated with diabetes. acute: pain radiates below elbow. arthrogram can assist with diagnosis by detecting a decreased volume of fluid within joint capsule. should avoid abduction. pain with lateral rotation. interventions may include u/s, grade 3 and 4 mobs, pnf techniques, stretching. can take up to 12-24 months to recover
303
ALS (amyotrophic lateral sclerosis)
degenerative disease producing upper and lower motor neuron impairments. demyelination, axon swelling and atrophy. unknown cause. tests: electromyography, muscle biopsy, spinal tap. medication: reluzole (Rilutek).
304
ankylosing spondylitis
systemic condition of inflammation of spine and larger peripheral joints. leads to fibrosis and ossification. usually affects SI joint, intervertebral disks, spine, and other joints. special test: wright-schober. low impact aerobic exercise with emphasis on extension and rotation are appropriate. high impact and flexion exercises are contraindicated.
305
ACL Grade III sprain
ACL Grade III sprain injuries usually occur during hyperflexion, rapid deceleration, hyperextension or landing in an unbalanced position. grade III acl sprain is considered a complete tear of ligament with excessive laxity. laxity is often classified as anterolateral or anteromedial. MRI is preferred imaging tool. special tests: lachman, anterior drawer, pivot shift. for surgery, the patellar tendon is the most commonly utilized graft for intraarticular reconstruction. closed chain are more desirable than open chain since they minimize anterior translation of the tibia.
306
bicipital tendonitis
inflammation in long head of biceps. repeated full abduction and lateral rotation of humeral head leads to inflammation. years of shoulder wear and tear
307
carpal tunnel syndrome
median nerve passes through the carpal tunnel, along with four flexor digitorum profundus tendons, 4 flexor digitorum superficialis tendons, and flexor pollicis longus tendon. occurs as a result of compression of the median nerve. normal tissue pressure within the carpal tunnel is 7-88mmHg, but CTS can result in pressure above 30mmHg. increase in pressure produces ischemia in nerve. special tests: positive tinel's, positive phalen's, positive tethered median nerve stress test. treatment can include corticosteroid injections, splinting, and PT. PT includes carpal mobilization and gentle stretching.
308
cerebral palsy
broad term used to describe a group of nonprogressive movement disorders that result from brain damage. 2-4 out of 1,000 births. most common cause of permanent disability in children. spastic CP involves upper motor neuron damage. athetoid CP involves damage to cerebellum. CP is classified as monoplegia (one involved extremity), hemiplegia (unilateral involvment of upper and lower extremities), and quadriplegia (involvement of all extremities). special tests: barthel index, bayley scale of infant development, bruininks-oseretsky test of motor proficiency, alberta infant motor scale, pediatric evaluation of disability inventory.
309
CVA
interruption of cerebral circulation resulting in cerebral insufficiency. results from prolonged ischemia to an artery in the brain. CT can confirm
310
cystic fibrosis
inherited disease that affects ion transport of exocrine glands resulting in impairment of hepatic, digestive, respiratory and reproductive systems. causes the exocrine glands to overproduce thick mucus. creates an elevation of sodium chloride and pancreatic enzyme insufficiency. chromosome 7. 1:2,500 births for caucasians, 1:17,000 births for african americans. most consistent symptom is finding of high sodium and chloride in sweat. symptoms are cough, salty skin, sputum production, wheezing, poor weight gain, recurrent infections. testing: neonates' meconium as screening tool for increased albumin. most common complication is exacerbation of obstructive pulmonary disease. PF testing results in decreased forced expiratory volume, forced vital capacity. functional residual capacity and residual volume become increased. hypoxemia and hypercapnia develop due to alteration in perfusion. treatment: chest PT and medications
311
down syndrome
trisomy 21. error in cell devision and cell nucleus results in 47 chromosomes. pair of 21st chromosomes is responsible for downs. 1 in every 800-1000 births. increased incidence of celiac disease
312
duchenne muscular dystrophy
progressive neuromuscular degenerative disorder tat manifests symptoms once fat and connective tissue begin to replace muscle that has been destroyed by disease. dystrophin gene xp21. 20-35:100
313
emphysema
emphysema results from long history of chronic bronchitis. results from a non-reversible injury and destruction of elastin protein within the alveolar walls. causes permanent enlargement of air spaces distal to terminal bronchioles within the lungs. causes pockets of air to form between alveolar spaces and within the lung parenchyma. pulmonary function: impaired forced expiratory volume, vital capacity, and forced vital capacity. will caused increases in: total lung capacity, residual volume, and functional residual capacity. cor pulmonale can result with advanced emphysema. PT includes breathing exercises such as pursed lip breathing, ventilatory muscle strengthening, chest wall exercises, patient education on posture, airway secretion clearance, and energy conservation techniques.
314
fibromyalgia
rheumatology syndrome or a nonarticular rheumatic condition. widespread history of pain in all four quadrants of body.
315
guillain-barre syndrome
acute polyneuropathy is a temporary inflammation and demyelination of the peripheral nerves' myelin sheaths, potentially resulting in axonal degeneration. results in motor weakness in a distal to proximal progression, sensory impairment, and possible respiratory paralysis. weakness will progress towards upper extremities and head. level of disability usually peaks within 2 to 4 weeks after onset. gradual recovery can take months to years. can be diagnosed through a CSF sample containing high protein levels and little to no lymphocytes.
316
HIV
retrovirus that invades and destroys cells within the immune system. transmitted through contact with blood
317
huntington's disease
neuro disorder of CNS and is characterized by degeneration and atrophy of basal ganglia and cerebral cortex of brain. loss of neurons creates dysfunction in inhibition that results in the symptoms of chorea
318
juvenile RA
in children less than 16. inflammation and stiffness to multiple joints for a period of greater than 6 weeks. medication, PT including ROM, exercise, pain control, functional mobility, strengthening, endurance, aerobic training.
319
lateral epicondylitis
tennis elbow. inflammation or degenerative changes at common extensor tendon that attaches to the lateral epicondyle of the elbow. repeated overuse of wrist extensors
320
medical collateral ligament sprain - grade II
MCL is primary stabilizer of medial side of knee against valgus force and lateral rotation of tibia especially during knee flexion. common mechanism of injury is direct blow against the lateral surface of knee causing valgus stress and damage to medial aspect of knee. grade II injury is partial tearing of ligament's fibers resulting in joint laxity when ligament is stretched. patient will present with inability to fully extend and flex knee
321
multiple sclerosis
produces patches of demyelination that decreases the efficiency of nerve impulse transmission. presents with visual problems, parasthesias and sensory changes, clumsiness, weakness, ataxia, balance dysfunction and fatigue. PT interventions include regulation of activity level, relaxation and energy conservation techniques, normalization of tone, balance activities, gait training, core stabilization and control, adaptive/AD training.
322
MI: myocardial infarction
poor coronary artery perfusion, ischemia, and subsequent necrosis of cardiac tissue. 12 lead ekg: elevated ST segment indicates acute infarction, inverted T wave indicates myocardial ischemia, depressed ST segment indicates pending subendocardial or transmural infarction. blood serum analysis can be utilized to determine the level of selected cardiac enzymes. PT intervention is a multi phase cardiac rehab program
323
patellofemoral syndrome
damage to articular cartilage of patella ranging from softening to complete cartilage destruction resulting in exposure of subchondral bone. common during adolescence. management includes controlling edema
324
peripheral vascular disease
usually secondary to atherosclerosis (hardening of arteries). narrowing of lumen of blood vessels, causing a reduction of circulation. patient education important: protecting limbs, foot and skin care, risk factor reduction
325
plantar fasciitis
chronic overuse secondary to repetitive stretching of plantar fascia through excessive foot pronation during loading phase of gait. interventions: ice massage, deep friction massage, heel insert, orthotics, gentle stretching of achilles tendon and plantar fascia
326
reflex sympathetic dystrophy
increase in sympathetic activity causing a release of norepinephrine in periphery and subsequent vasoconstriction of blood vessels resulting in pain and increase in sensitivity to peripheral stimulation. intense burning and pain in affected extremity
327
restrictive lung disease
decrease in lung and chest wall compliance, decrease in lung volumes, increase in work of breathing.
328
rheumatoid arthritis
systemic autoimmune disorder of connective tissue - chronic inflammation within synovial membranes, tendon sheaths, and articular cartilage. 3 times greater in females, dx'd more frequently between 30-50. blood work assists in diagnosis thru elevation of rheumatoid factor, wbc count, erythrocyte sedimentation rate, hemoglobin and hematocrit values
329
rotator cuff tendonitis
inability of a weak supraspinatus to depress head of humerus into glenoid fossa during arm elevation. caused by excessive overhead activity. weakness and painful arc of motion most occurring between 60-120 degrees of active abduction
330
sciatica (secondary to herniated disk)
sciatic nerve inflamed - damage secondary to compression from herniated disk. low back and gluteal pain radiating down back of thigh. pain will increase in sitting
331
spina bifida - myelomeningocele
occulta (incomplete fusion of posterior vertebral arch with no neural tissue protruding) meningocele (incomplete fusion of posterior vertebral arch with neural tissue/meninges protruding outside neural arch) myelomeningocele (incomplete fusion of posterior vertebral arch with both meninges and sc protruding outside neural arch). approx 75% of vertebral defects are found in lumbar/sacral region most often at L5-S1. prenatal testing of AFP in blood will show elevated levels
332
systemic lupus erythematosus
connective tissue disorder caused by autoimmune reaction in body. females greater risk, most common age group is 15-40. pt will present with red butterfly rash across cheeks and nose, red rash over light exposed areas, arthralgias, alopecia, pleurisy, kidney involvement, seizures, and depression
333
temporomandibular joint dysfunction
females greater risk, 20-40 yrs, limited jaw motion, headache, tinnitus. treatment: moist heat, ice, biofeedback, u/s, electrostimulation, TENS and massage
334
thoracic outlet syndrome
compression and damage to brachial plexus nerve trunks, subclavian vascular supply, and/or axillary artery. contributing factors in development of condition include presence of a cervical rib, abnormal first rib, postural deviations, hypertrophy or spasms of scalene muscles, and elongated cervical transverse process. females greater risk than males. 30-40
335
total hip arthroplasty
posterolateral approach allows abductor muscles to remain intact, but there may be higher incidence of post-op joint instability due to interruption of posterior capsule. cemented=PWB initially. noncemented=toe touch WB for up to 6 weeks
336
total knee arthroplasty
destruction of articular cartilage secondary to OA. post-op care includes knee immobilizer, limb elevation, CPM, knee protocol exercises. avoid squatting, quick pivoting
337
transfemoral abduction due to osteosarcoma
may present with fatigue, LOB, phantom pain or sensation, hypersensitivity of residual limb, psycho issues regarding loss of limb. lying in prone position is beneficial to decrease hip flexion contraction
338
transtibial amputation due to arteriosclerosis obliterans (closing of arteries
results in ischemia and subsequent ulceration of affected tissues. may have a decrease in cardiovascular status depending on frequency of intermittent claudication prior to amputation
339
TLR (tonic layrinthine reflex)
position of labyrinth in inner ear-reflected in head position. in supine, body and extremities are held in extension; i prone, body and extremities are held in flexion. birth to 6 months. often causes full body extension, which interferes with balance in sitting or standing
340
galant reflex
touch to skin along spine from shoulder to hip. response: lateral flexion of trunk to side of stimulus. 30 weeks of gestation to 2 months. can interfere with development of sitting balance. can lead to scoliosis.
341
positive support reflex
weight place on balls of feet when upright will produce stiffening of legs and trunk into extension. 35 weeks of gestation to 2 months. interferes with standing and walking
342
arthrogryposis multiplex congenita (peds)
non-progressive neuromuscular disorder. restriction in utero allows for fibrosis of muscles and structures within the joints. cylinder-like extremities with minimal definition, contractions, joint dislocations, muscle atrophy. tx: attain max level of developmental skills through positioning, stretching, strengthening, splinting, use of adaptive equipment.
343
prader-willi syndrome
genetic condition diagnosed by physical attributes and patterns of behavior. partial deletion of chromosome 15. constant desire for food.
344
spinal muscle atrophy
condition of progressive degeneration of anterior horn cell.
345
baroreceptor reflex
produced by mechanoreceptors that are found within walls of heart, vessels, large arteries. activated when pressure rises within large arteries above 60 mmHg. mechanoreceptors are sensitive to stretch and pressure peak in activity at approx 180 mmHg. activation results in vasodilation secondary to inhibition of vasomotor centers within medulla as well as a decrease in heart rate and strength of contraction secondary to vagal stimulation.
346
bainbridge reflex
occurs when mechanoreceptors embedded within right atrial myocardium respond to increase in pressure and stretch. stimulates vasomotor centers of medulla, and results in increased sympathetic input and heart rate. can also influence a decrease in heart rate when heart is beating too fast.
347
chemoreceptor reflex
responds to need for increased depth and rate of ventilation. located on carotid and aortic bodies and detect lack of oxygen, responding to an increase in arterial CO2 levels.
348
low hematocrit
feeling of weakness
349
high hematocrit
increased risk of thombus
350
low hemoglobin
anemia or recent hemorrhage
351
high hemoglobin
hemoconcentration caused by polycythemia or dehydration
352
high platelets
increased risk of thrombosis. low platelet count increases risk of bruising and bleeding.
353
WBC count
increase will occur after hemorrhage, surgery, coronary occlusion or malignancy. decrease will indicate infection
354
blood volume
average in adult is 7-8% of body weight. blood is pumped through body at 30 cm/sec with a total circulation time of 20 seconds.
355
systolic pressure measures
force exerted against arteries during ejection cycle
356
diastolic pressure measures
force exerted against arteries during rest
357
bp is directly related to
cardiac output and peripheral vascular resistance.
358
pulse pressure
generally increases in direct proportion to intensity of exercise since systolic pressure increases with exercise
359
systolic bp is legs is 10-20%
higher than pressure in arms. this is why ankle -brachial index value of greater than 1.0 is still considered be normal.
360
bp that fails to increase or decrease with increasing workloads may signal a
plateau or decrease in cardiac output
361
systolic bp normally decreases promptly with
cessation of exercise. 3 minute post exercise systolic bp should be less than the 90% of systolic bp at peak exercise.
362
intracranial monitoring
isometric exercise and valsalva maneuver should be avoided. avoid neck and hip flexion greater than 90 degrees and lying down in prone position.
363
hypovolaemic shock
caused by insufficient circulating blood volume. primary cause is hemorrhage or severe burn. clinical presentation: hypotension due to lack of circulating volume, anxiety, altered mental state, cool and clammy skin, rapid and thready pulse, thirst and fatigue. activate emergency medical system. lie patient in supine with legs elevated approx 12" in situations where tolerated.
364
memory/amnesia
anterograde memory: inability to create new memory. post-traumatic amnesia: does not recall injury or events up until point of recovery. retrograde: inability to remember events prior to the injury.
365
rancho los amigos: levels of cognitive functioning
1. no response, 2. generalized response: inconsistent and nonpurposeful, 3. localized response: reacts specifically but inconsistently, 4. confused-agitated: heightened state of activity. bizarre and nonpurposeful behavior, 5. confused-inappropriate: responds to simple commands consistenly but responds randomly or inappropriate with increased complexity of commands, 6. confused-appropriate: shows goal-directed behavior, but is depended on external input, 7. automatic appropriate: appropriate and purposeful but robot-like, 8. purposeful appropriate: able to recall and integrate past and present events, and is aware and responsive to environment.
366
CPR Adult Flow Chart
CPR Adult Flow Chart No movement or response-phone 911, emergency response-open airway; check breathing-if no breathing, administer 2 breaths that make chest rise-if no response, check pulse. if pulse-rescue breathing only at 10-12 breaths/min-if no pulse, begin CPR with 30 compressions and 2 breaths. push hard and fast (100/min) and release completely. minimize interruptions during compressions. continue to perform CPR until medical assistance arrives, breathing, coughing or other signs of circulation return, the patient begins to move or you cannot physically continue due to exhaustion.
367
CHF: congestive heart failure
usually results from coronary artery disease when heart is unable to maintain adequate cardiac output. characterized by abnormal retention of fluid and results in diminished blood flow to the tissue and congestion of the pulmonary and/or systemic circulation. symptoms: pulmonary edema, dyspnea when lying down, S3 gallop, exertional hypotension, weight gain within hours, increased resting heart rate
368
CAD: coronary artery disease
narrowing or blockage of coronary arteries that may produce ischemia and necrosis of the myocardium. inability for vasodilation and arteries cannot meet the metabolic demands. this will produce ischemia and ultimately necrosis. significant blockage is present over 75%
369
typical lung volumes and capacities
tidal volume=500mL, expiratory reserve volume=1000mL, vital capacity=4000-5000mL, inspiratory capacity=3000-4000mL, 75-80% vital capacity, 55-60% of total lung capacity
370
forced expiratory volumes
FEV1 (in one second): 83% of VC, FEV2: 94% of FC, FEV3: 97% of VC
371
PaO2 (partial pressure of oxygen)
95-100mmHg.
372
pursed lip breathing
improves ventilation by decreasing RR and increasing tidal volume
373
segmental breathing
used to prevent accumulation of fluid by directing inspired air to predetermined areas. applying pressure downward and inward during exhalation.
374
cor pulmonale
medical emergency. sudden dilation of right ventricle of heart secondary to a pulmonary embolus. rt sided heart failure will occur if not treated. chronic cough, chest pain, distal swelling, dyspnea, fatigue and weakness
375
most occlusive to non-occlusive
hydrocolloids, hydrogels, semi-permeable foam, semi-permeable film, impregnated gauze, alginates, and traditional gauze
376
hydrocolloids
hydrocolloids used for partial to full thickness wounds, can be used with granular or necrotic wounds. provides moist environment for wound healing. enables autolytic debridement. good for wounds that have moderate exudate. cannot be used on infected wounds. (hydrogels similar but used for wounds with less exudate)
377
foam dressings - hydrophilic polyurethane base
allow exudates to be absorbed into foam. provide protection over partial and full thickness wounds
378
alginates
calcium salt of alganic acid that is extracted from seaweed. highly permeable and non-occlusive. require a secondary dressing. used on partial and full thickness draining wounds such as pressure wounds or venous insufficiency ulcers. often used on infected wounds due to likelihood of excessive drainage
379
selective debridement
removes only nonviable tissues from a wound. often performed by sharp debridement, enzymatic debridement, and autolytic debridement. (nonselective debridement removes both viable and nonviable tissue. often termed mechanical and is most commonly performed by wet-to-dry dressings, wound irritation and hydrotherapy-whirlpool)
380
pressure ulcer staging
Stage I: intact skin, change in skin color, temp, stiffness or sensation, Stage II: partial thickness skin loss that involves epidermis and/or dermis. superficial and presents as an abrasion, blister or shallow crater. Stage III: full thickness skin loss involving damage or necrosis of subcutaneous tissue that may go down to underlying fascia. Stage IV: full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures.
381
zones of injury (burns)
zone of coagulation: area of burn that received most severe injury along with irreversible cell damage. zone of stasis: area of less severe injury that possesses reversible damage and surrounds the zone of coagulation. zone of hyperemia: area surrounding the zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage
382
burn classification
superficial burn: involves outer epidermis only. red with possible slight edema. healing occurs w/o scarring. Superficial partial-thickness: involves epidermis and upper portion of dermis. extremely painful w/blisters. minimal to no scarring. Deep partial thickness burn: complete destruction of epidermis and majority of dermis. discolored with broken blisters and edema. damage to nerve endings may result only in moderate levels of pain. healing occurs with hypertrophic scars and keloids. Full thickness: complete destruction of epidermis and dermis along with partial damage of subcutaneous fat layer. presents with eschar formation and minimal pain. requires grafting and may be susceptible to infection. Subdermal burn: complete destruction of epidermis, dermis and subcutaneous layer. may involve muscle and bone.
383
skin grafts
allograft: from another human or cadaver. autograft: taken from patient's own body. heterograft (or xenograft): taken from another species. mesh: altered to create a mesh like pattern to cover larger area.
384
HeatStroke
may develop following heat exhaustion if the condition is not treated. It occurs when the body’s temperature rises and the cooling system stops working. This potentially life-threatening condition is characterized by nausea, vomiting, headache, dizziness, fatigue, rapid heart rate, hot and dry skin, shortness of breath and decreased urination.
385
Heat exhaustion
is usually accompanied by a fever no higher than 104 degrees Fahrenheit, excessive thirst, nausea, fainting, cool and clammy skin, weakness, muscle aches, heavy sweating, slow heartbeat and dizziness.
