Focus Topics Lecture Flashcards
Integu– Dressings
Exudate types + Dressing Types
- Very MILD exudate= Transparent**
- Minimal exudate= HYDROgel, HYDROcolloid
- Moderate exudate= Foams
- **Heavy exudate “Heavy Algae”= Alginates, Hydrofiber
Wound Debridement (think of gardening): 2 types
- Selective– removal of only NONviable tissues
- NONselective– removal of both NONviable AND viable tissues
Wound Debridement
Selective: removal of ONLY nonviable tissues: 3 types
- Sharp (exactly what it sounds like)– scalpel, scissors, forceps– “Getting weeds out”
- Enyzmatic (use something else)– Use topical application– “something to kill weeds w/”
- AUTOlytic (self)– Use of bodys own mechanism to remove nonviable tissues– “plants remove weeds themselves”
Wound Debridement
NONSelective: removal of BOTH NONviable and viable tissues: 3 types
“EVERYTHING GOES”
- Wet to Dry Dressings– application of moistened gauze over area of necrotic tissue to be comp. dried and removed
- Wound Irrigation (pressure spray)– moves necrotic tissue from wound bed using pressurized fluid (irrigation)
- Hydrotherapy– Using a whirlpool w/ agitation directed toward a wound requiring debridement
NOTE: If 50% or more of wound== Necrosis–> NONselective!!!
Burn Types
See chart
Rule of 9’s– Burns
9x11– 11 body areas, 9x11=99% 1% perineum=100%
Adult
- Head x1 (ant 4.5, post 4.5)
- Chest x2 (18)
- Back x2 (18)
- L Arm x1 (Ant 4.5% & Post 4.5%)
- R Arm x1 (Ant 4.5% & Post 4.5%)
- L Leg x2 (ant 9, post 9)
- R Leg x2 (ant 9, post 9)
- Perineum 1%
Child– Legs always > arms, trunk stays 18, adult head 4.5 child head 8.5
Lab Values + Exercise Guidelines
See chart
More Lab Values
see pics
Motor Learning Stages:
Cognitive- WHAT to do
WHAT TO DO– bc your so new to it your like “what do I do?”
- Extrinsic feedback > Intrinisc fb
- KR FIRST then KP
- Feedback after EVERY trial
Motor Learning Stages:
Associative- HOW to do
HOW TO DO– “How do I associate these skills to task?
- Intrinsic fb (let them “feel” it)
- Feedback–> summed (after sum of attempts), bandwidth, fading (fading away, further and further from immediate)
- Variable practice
Motor Learning Stages:
Automatic- How to SUCCEED
Totally autonomous (automatic)
Lab Values are above, but these are NO EXERCISE values
See chart
Lab Vals
Platelets
150,000-450,000
Lab Vals
WBCs
4,800-10,800
Lab Vals
Hemoglobin (HGb)
Women: 12-16
Men: 13-18
Lab Vals
Hematocrit
Women: 37-48%
Men: 45-52%
Lab Vals
BUN
10-20
Lab Vals
Creatinine
.5-1.2
Lab Vals
Potassium
3.5-5
“Dont buy more than 3-5 bananas”
Sodium
“kinda like pH”
135-145
Lab Vals
Calcium
“911”
9-11
HypOcal= QT cries== prolonged QT
Magnesium (Mg)
1.5-2.5
Lab Vals
hba1c %
4-6%
Lab Vals
INR
“again 911 but w/ decimals”
.9-1.1
PreTest-PostTest Group Design
Ex. LBP
see pics
P-value= 0.05 or 5% chance of error
IF < 0.05== Significant
NOTE: I for I==> Ind variable is the Intervention**
Ex. Group of PT students compiling injury prevention program for adolescent soccer players. P-value set at 0.05. **Critical value for rejecting null hypothesis **is 1.45, and statistical test result is 1.85.
Make sense of these #’s
- If you exceed/pass critical value (bare minimum)==Statistically significant– Critical value is MIN value to prove research is significant, so we want the statistical value to EXCEED this (> critical value= sig.)
- P-value should always be LESS THAN Alpha value
- P < 0.05== Significant
- Null hypothesis says NO DIFFERENCE; so REJECTING THIS we say there IS A DIFFERENCE (alternate hypothesis)
Lvls of research evidence
see pyramid
Top 3:
1. Meta analysis
2. Systematic Review
3. RCTs
Reliability– consistency of instrument/measure
“Does it give me the same results over and over?”
- InTRArater== 1 person performs test several times (1 PT)
- IntERrater== bw 2 or more== test performed by 2 or more indivs on diff subjs testing 1 variable (ex goni)
- Test-Retest== Same test to same indivs on 2 occasions (its in the name)
Validity– consistency again
“Does this measure what I want it to measure?
- Content== test should measure specifically what the pt problem is (ex. balance/falls-BERG, TUG)
- Construct (think TOOLS)== test should measure what its SUPPOSED to measure (ex. Goni for ROM)
- Concurrent (think GOLD standard)== test performed and compared to GOLD STND. and results matched
Type I Error (False Pos)
incorrectly reject a true null hyp
think “theres an I in P”
Type II Error (False Neg)
failing to reject a false null
think “II can be converted to N”
Hallways and Ramps for WC
- Hallway– 36in width w/ turning NOT reqd; Turning reqd= 60in
- Ramps– every inch of threshold ht there is 12in of ramp Slop of 1:12 and 1 step= 7in– see ex. but essentially if 2 steps = 7 (1 step) x 12 = 84 and 2 steps so 84x2= 168 inches
W/C Measurements
see pics
UNcompensated Forefoot valgus
Rearfoot will be…
Neutral
CRPS main sx
Impaired sensation
White color finger while applying Cryo
Raynauds
US Freq
Deep vs Superf
Superf= 3 MHz (3 is backwards S)
Deep= 1 MHz
Uncompensated Forefoot valgus
Explain
Heel or rearfoot is either gonna stay where it is and NOT help (UNcompd) OR its gonna move the OPP way so that forefoot can go to neutral (COMPENSATED)
Calcaneus is gonna decide Comp vs UNcomp
- UNcomp= Heels gonna stay down or wherever it is, “not gonna help you”
- OR it will do the OPP motion to HELP you and COMPENSATE
Ex.
- If heel in neutral and forefoot in varus (big toe OFF ground, small toe ON ground– UNcompensated forefoot varus
Ex.
- If heel is in varus and forefoot in neutral– Compensated forefoot valgus (bc heel did the OPP motion to compensate)
Forefoot Valgus= big toe down, little toe UP; Forefoot Varus= big toe up, little toe down
Aquatic Tx CONTRAindications
DO NOT DO!
- Cardiac failure and unstable angina (nitrates)
- Resp dysfunction, Vital capacity < 1L– hydrostatic pressure FURTHER DECs VC (already goes down w/ aquatic tx)
- Severe PVD
- Danger of bleed or hemorrhage
- Severe kidney disease (bc fluid imbalances already and water inc’s this)
- Open wounds W/OUT occlusive dressings, colostomy and skin infx’s
Modified Ashworth
0: NO inc in mm tone
1: SLIGHT inc in mm tone, manifested by catch and release OR by min resist @ end ROM when affected part moved
1+: Slight inc in mm tone, manifested by catch, f/b MIN resist t/o remainder (LESS than half) of ROM
2: More marked inc in mm tone thru MOST of ROM, but affected part EASILY moved
3: CONSIDERABLE inc in mm tone, passive mvmt is DIFFICULT
4: Affected part rigid in flex/ext
Tibial N. think…
Gastrocs
Ankle Control AFOs
Anterior Stop: Limits DF, helps w/ paralyzed PFs to achieve propulsion in late stance
Plastic Solid AFO: Limits all motion
Hinged AFO: permits sag plane
BICAAL: Consists of anterior and posterior spring
Solid AFO: provides M/L stability
Spiral AFO: controls, but does NOT eliminate motion
ALL DF ASSIST
Bi-axial Klenzac jt
AFO w/ DF assist
Posterior leaf spring AFO
NOTE: ** BICAAL has a spot for both Anterior stop or Post stop— IF BICAAL w/ peg in ANT chamber== ANT (DF) STOP– helps to improve propulsion (PFs)** during late stance
Benign Prostatic Hyperplasia
BPH
- Hypertrophy of prostate glands (surrounds urethra)
- ==> Narrowing of urethra lumen which inc’s Urinary Retention and dilation of urinary bladder
Pt recently underwent radical lymph node dissection 2ndary to prostate cx. According to hx, most important to educate on?
Routinely monitor for changes in fitting of socks OR indentations left by socks=== bc swelling/lymphedema
TALOfib vs TIBIOfib lig
Anterior TALOfib== Lateral ankle sprain (MOI is PF+INV) == Anterior Drawer (can also do for Deltoid (medial) ligs
Calcaneofibular lig== Talar Tilt
Tibiofibular lig== High Ankle Sprain== Syndesmotic squeeze or Kleigers ER/DF (MOI of high ankle sprain)
MS and dysmetria intervention?
PNF using Dynamic Reversals w/ carefully graded resistance
ASIA Scale
see pics
Normal Toe Out==
5-7 degs
FYI
Inferior glenohumeral ligament is taut/ stretched with 90 degrees of shoulder abduction. Middle glenohumeral ligament is taut between 45-60 degrees of abduction.
Special tests AC jt
Horiz ADDuction Test
Adhesive Capsulitis mob
Capsular pattern of restriction is present in adhesive capsulitis i.e. lateral rotation> abduction> medial rotation. Clinical studies have demonstrated that posterior glide is more effective than an anterior glide to increase glenohumeral external rotation range of motion (exception to the convex- concave rule) in adhesive capsulitis. Patient’s external rotation can be treated with posterior glide and inferior glide are used to resolve abduction. So, posterior inferior glides should be given in this patient.
Hand deformities
Boutonniere Deformity: Rupture of the central band (central slip) of the extensor hood results in the lateral bands of the extensor apparatus (extensor hood) slipping in a volar direction to the PIP joint, causing PIP flexion and DIP extension.
Swan Neck Deformity: Laxity of the PIP joint with an over- stretched palmar plate and bowstringing of the lateral bands of the extensor hood result in hyperextension of the PIP and flexion of the DIP joints.
Ulnar drift: Ulnar deviation of the digits because of weakening of the capsuloligamentous structures of the metacarpophalangeal joints and the accompanying “bowstring” effect of the extensor communis tendons.
Mallet finger: It is the result of a rupture or avulsion of the extensor tendon where it inserts into the distal phalanx of the finger. The distal phalanx rests in a flexed position.
Major association w/ Radial N injury
Weak grip
Wrist drop
Bowstring injury
Annular pulleys along with other flexor pulleys share a similar function of holding the underlying tendons at a relatively close distance to the joints. With injury to these structures, the force of a strong contraction of the extrinsic finger flexors causes the tendon to pull away from the joint’s axis of rotation, a phenomenon referred to as “bowstringing” of the tendon.
29) During exams week, the physical therapist observes the posture of a 29-year-old female patient. The PT notices that she has a forward head posture. Which of the following characterizes forward head posture?
With a forward head posture, the patient has his lower cervical spine flexed along with upper cervical extension. This causes the head to translate anteriorly and the load of the weight of the head (load arm) on the long cervical extensors increases resulting in an increase in the external moment arm (resistance arm). (The external moment arm is the perpendicular distance between the axis of rotation and the external force.)
