home assessment parameters Flashcards
garages and driveways
24 feet
porches
5x5 feet
doorway width
32-34 inches
doorway threshold
no more than 1/2 in
doorway kick plate
12 feet
steps
not greater than 7 inches hight, 11 inches deep
lip of step
1/2 inch
handrail height
34-38 inches
at least one should allow for modificiations
handrail should extend a minimum of
12 inches beyond foot and top of stairs
ramp grade
1:12 (feet)
outdoor ramps exposed to rain and slow
1:20 (feet)
rise for ramps for power WC
1.5 inch first for every foot
if ramp more than 5% grade (power WC)
hand rails should be 32 inches from rap surface and extend an inch beyond top and bottom of ramp
minimum ramp width
36 inches inside rails, 48 is ideal
top of ramp
5x5feet
bottom of ramp
5 foot straight away
indoor doorways
consistent with outdoors 32-34 inches
indoor stairs
handrails extend minimum 12 inches
kitchen aisle
5x5 feet floor space
32 inch doorway
36 inch walk way
stoves
32 inches adequate height for sitting
consider raising dishwasher 6 inches
kitchen cabinets
12-15 inches
counter tops
36 in standard
30 inch for WC/LBP, child
bedroom windows
18-20 inches from floor, 30 inches from ground
bathroom door
32 in standard 36 recommended
toilets
15 inches above floor with grab bars,
bathroom sinks
30 inches
bathroom grab bars height
1.23-2 inch CSdiameter
33-36 inches next to toilet
bathroom grab bar length
42-54 inches on side wall
24-36 on back wall
mcconnel taping worn for up to
18 hours
acute phase kinesio tape
fingers with no tension, skin stretched, insertion to origin
kinesio tape for weak muscles
tension on tape, origin to insertion
paper off tension
0-15% for acute conditions
light tension
15-25%
moderate tension
25-50%
sever tension
50-75%
full tension
75-100%
tension on anchors
0% because they are meant to disperse energy
tape tension >50%
for corrective techniques only
mcconnel tape worn for
1-2 days
kinesio tape worn for
3-5 days
little league shoulder
widening of proximal humerus epiphysis
decreased ER and ABD strength
min 6 weeks no throwing, gentle post shoulder stretch, core strength
after pain free ROM begin RC strength, scap strength and control
little league elbow
medial eipcondyle apophysitis or avulsion fx
rest 6-8 weeks; rc and scap strength, dynamic shoulder stabilization
return to throw at 6 weeks if pain free ROM
throwing phases
wind up cocking acceleration deceleration follow through
phase with most stress on passive shoulder structures
cocking due to ER
phase with most stress on shoulder musculature
deceleration
phase with most elbow stress
acceleration phase
most important aspect of wind up
winding up lower extremity to generate force
phase with greatest elbow valgus stress
late cocking
phase with peak RC activation
late cocking
stride length
87% of height
most harmful phase of pitch
decelleration
increased risk for injury with limited hip ROM
limited flexion in lead
limited IR in lead
limited extension in train
limited ER in both
good predictors of UE injury and pitching performance
SLS control and SEBT
trunk rotation timing/control decreases
shoulder and elbow forces
trunk rotational strength related to
ball velocity
trunk lean affects
UE forces
CKCUEST
21 taps in 15 seconds predictor for injury risk
core strength
prone plank side plank Sorensen's DL bridges SL bridge
decreased stride length and push off correlates to
decreased ball velocity
pitches need more trunk rotation to
the non-throwing side - more time to wind up and more time to deceleration in follow through
glenohumeral internal rotation deficit
GIRD - loss of 18 degrees or greater of IR in the throwing shoulder compared to non throwing shoulder
bigger difference in Max ER compared to passive ER
higher risk of injury
SA important during cokcing
eccentrically and isometrically to resist retraction
concentrically to cause protraction and upward rotation
middle and lower trap
fire concentrically to resist protraction
create stable surface for rotator cuff to work
difference in protractor/retractor ratio increased risk of shoulder pain
> 20%
greatest lower-upper trap ratio
B/L ER at 0 deg ABD
teenage pitcher guidelines
75 pitches / game
1000 per competitive season
3000 per calendar year
key guidelines for pitching
don’t pitch w/ elbow or should pain, or on consecutive days
don’t play year round - rest is best
age appropriate skills
pitching emphasize
control, accuracy, good mechanics
pitch type progression
fasteball
change up
then consider breaking pitches
softball pitch guidelines
2 days rest for pitchers
<12 yo - only 2 days consecutive pitching
>13 yo - only 3 days consecutive pitching
plyometric prerequisites
pull pain free AROM
80% strength vs opposite side
good quality movement
no swelling
plyo frequency
2x / week
6-8 weeks
48-72 hours recovery time
plyo volume
5-10 reps/set, 1-3 sets per motion with 6 different motions
60 throws low, 120 high
plyo intensity
80-100 MVC
2 arms to one arm
5-10% progression each week
injuries 2x more likely to occur in ____ thank backswing
down swing
due to amount of force and velocity required
1 in 4 gold injuries occur during
follow through
walking an 18 hole course
5-6 niles
total joint precautions with golf
avoid wet conditions
use small or no spikes
use cart or caddy
limit backswing and follow through - decrease mechanical stress
golf ROM
subtler joint rotates 5-8
hips 30-40 IR
40-60 ER
thoracic spine 40
economical runners
shorter stride, faster caidence (180/min) knee joint flexion maintained ball heel ball toe foot lands under COM (hip extension) decreased vertical displacement of COM
running - forward lean
from foot to shoulders not at trunk so steps fall directly under COM
rearfoot running
impact nearly 3X BW
most of vertical momentum is absorbed by vertical components of collision - slows down momentum
forefoot running
7 times lower impact at IC
vertical momentum converted to rotational momentum
as cushioning in shoes is lost
foot control improves
plan for runners
flexibility
strenth
retrain of running gait
pelvic floor muscle functions
supportive
sphincteric
sexual
second leading cause of CA death in men
prostate cancer
PSA
prostate specific antigen test
detects blood levels of a protein made only by the prostate cells
below 4 normal
4-10 slightly elevated
above 10 highly elevated and cancer likely
Gleason score
rating deformity of prostate cells after biopsy has been taken
higher score - increased speed of cancer growth
prostate CA stage T1
cannot be felt, confined w/in capsule, usually found by chance (PSA)
prostate CA stage T2
can be felt with digital exam
still confined
no symptoms
prostate CA stage T3
spread beyond capsule
varied symptoms
frequent, bloody or painful urination
prostate CA stage T4
metastasis
sudden weight loss
difficult, painful urination
low back pain
possible etiology of incontinence
sphincter deficiency
decreased bladder compliance
detrusor instability
most widely recommended non invasive conservative tx for continence post RP
supervised pelvic floor muscle training
first line option in curing incontinence post RP
pelvic floor reeducation
effective tx for intontience from RP persisting more than 1 year
behavioral therapy
PFMT offers no further benefit…
4-6 months after initiation of program
neobladder- bladder emptying education
no muscle to push urine out no sense of filling/fullness larger capacity than true bladder normal cycle disrupted voiding on the clock (2-4 hrs) evacuation strategies
possible sensitivity to certain fluids (bladder)
caffeine
citric acid
carbonated drinks
alcohol
pelvic floor physical therapy focuses on
behavioral modification
improving pelvic floor muscle strength, endurance, coordination
neuro muscular re-ed
common errors with pelvic floor awareness training
holding breath
bearing down
active abdominals
active gluteals
pelvic floor exercise dosage
2-10 sec hold
15-30 reps
2-5 exercises per session
twice daily
pelvic floor hypertonia
inadequate sphincter closure
voiding/defecation dysfunction
pelvic pain impaired coordination and ROM
pelvic floor hypotone
inadequate sphincter closure
urinary/fecal or flatus incontinence
pelvic organ prolapse
poor pelvic floor/core muscle performance strength, endurance and coordination
stress urinary incontinence
leakage upon increased load on the pelvic floor accompanied by lack of adequate urethral closure
urge urinary incontinence
overactive detrusor
behavior management and coordination training
pelvic floor strength
3/5 lift and squeeze against gravity
5/5 difficultly pulling finger out
safe exercise during pregnancy
avoid supine > 3 mins post 1st trimester (30 degree angle)
left sidelying
avoid prone
avoid strong abdominal compression during 2nd/3rd trimester
avoid rapid bouncing or swinging
avoid overheating and stay hydrated
benefits of exercise during pregnancy
lower incidence gestational diabetes
shorter 1st stage of labor
increase in APGAR scores at 1 min mark
help with fast recovery post delivery
pregnancy exercise intensity guidelines
RPE moderate 13-14
talk test
150 mins/week 30 mins 5days/week
lower extremity ROM required for dancers
90 PF
90 LE ER
90-100 1st MTP DF
Your patient started CAR T-cell therapy for treatment of Multiple Myeloma. She presents with
the following symptoms: fever, nausea, headache, rash, rapid heartbeat, low blow pressure, and
trouble breathing. You are concerned about which condition?
Cytokines Release Syndrome
T or F?
One benefit of Autologous stem cell transplant versus allogenic stream cell is autologous stem
cell transplant has less risk of graft versus host disease (GVHD).
true
Your patient is a 43 year old male who presents with bilateral acute hypertonic lumbar
paraspinals. You choose kinesiotape as your intervention. What application would be best for
this patient’s condition?
From insertion to origin bilaterally
You are treating a 19 year old male baseball pitcher with excessive anterior capsule instability.
He reports reduced pain with manual posterior glide. His anterior numeral position does not
change with activation of scapular stabilizers. Which taping method would be best for this
patient?
Leukotape to position the humerus more posteriorly and provide optimal alignment
within the acetabulum
What phase of the baseball pitching motion would be most
likely to cause the most strain on the labrum of the shoulder?
Cocking phase
What phase of the upper extremity athlete require is the maximum deceleration control?
follow through
t or f?
When running your center or mass is at its lowest point during mid stance, and when walking
your center of mass is at its highest point during mid stance.
true
Your patient is a 38 year old triathlete who is complaining of right knee pain during running. You
have diagnosed him with IT band syndrome. This patient most likely feels the moment knee
pain with running on which type of surfaces?
decline/downhill
What phase of the golf swing creates the most spinal compression?
backswing
Your patient is a 67 year old female recreational golfer who comes to you with complaints of
right knee pain with golfing. The pain is most significant during her back swing. The patient
reports that she is right handed. Which of the following equipment medications would you
recommend for this patient?
wear spineless shoes
what dictates type of cancer treatment needed?
type of cancer and specific genetic mutation
types of cancer treatment
chemotherapy radiation immunotherapy surgery stem cell transplant
immunotherapy
boosts body’s natural defenses to fight cancery
- optimize immune system (increase role of agents that fight cancer cells, down regulate agents to decrease fight to cancer cells)
- compliment immune system
- may be dynamic with modified cells replicating in the body or reacting to cancer cells as they develop
immunotherapy can distinguish between
healthy and unhealthy cells
tumor lysis syndrome
electrolyte and metabolic disturbance caused by excessive calcium, potassium, phosphate, uric acid n the blood
dx of tumor lysis syndrome
2 or more metabolic abnormalities that occur 3 days before or 7 days after initiation of therapy
major risks of tumor lysis syndrome
renal insufficiency
seizures
cardiac dysrhythmia
death
childhood acute lymphoblastic leukemia
75% of childhood leukemia
involves lympobasts (starts in bone marrow)
male, white/hispanic, exposure to radiation/chemo, hx of genetic disorder
s/s of childhood acute lymphoblastic leukemia
night sweats discomfort in bones or joints enlarged spleen, liver or lymph nodes pain or feeling of fullness below ribs unexplained weight loss or loss of appetite
diffuse large B cell lymphoma
most common subtype of non Hodgkin
very aggressive
over 64, male, non asian or African American, immunocompormised, hx exposure to radiation/chemo
first sign of diffuse large B cell lymphoma
lump in groin, armpit or neck
mutiple myeloma
blood cancer involving plasma cells that create antibodies
over 60, men, African Americans, fam hx, hx of plasma dz
s/s of multiple myeloma
bone pain weakness/fatigue weight loss infection pathological fx
complications of all blood disorders
anemia
thrombocytopenia
leukopenia
tx for blood disorders
chemo
myeloablative conditioning
stem cell transplantation
types of stem cell transplant
autologous
allogenic (increase risk for GVHD) matched by HLA
non-myeloablative transplant
graft vs host disease
donor’s t lymphocytes do not recognize patent’s cells and attacks them
occurs in about 50% of allogenic SCT pts
car T cell therapy
T cells removed, reprogrammed to find and kill cancer cells, re-entered in the body
most common use in liquid tumors
t cells
specifically target cells that express peptides
long clonal life
potentially significant expansion/replication in vivo
car T lymphodelepting phase
currently inpatient 3-5 days
CAR T administration phase
day 0
similar to transfersion
monitor for fever and neurotoxicity
car T recovery phase
2-3 weeks
blood cell recovery
bone marrow aspiration day 30
hallmark sign of cytokine release syndrome
fever
first sign of neurotoxicity
tremor
confusion, attention deficits, handwriting, apraxia, ataxia
car t chart review - vitals
hypotension fever > 38 c arrhythmias tachycardia SaO2 and O2
provokes anterior labral tear
faber to extension, IR, ADD
promotes posterior labral tear
ext abd ER into flex ADD IR
number one cause of injury in modern dancers
faulty technique due to fatigue or decrease in power
main force generator during pitching
legs and trunk
hip extension deficits in trail leg leads to
increased shoulder external rotation
hip IR deficits in lead leg
increased risk for injury
hip flexion deficits on lead leg
increased risk for elbow pain
hip ER deficits
increased shoulder horizontal ADD ROM
increased shoulder ER torque
trunk most active (pitching)
during late cocking through acceleration
pitching pelvic rotation
prior to thoracic rotation
late = increased max shoulder ER and force
pitchingif upper torso rotates before stride foot contact
sig increase in elbow valgus torque
