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Intro to PT > Intro to PT chapter 10 > Flashcards

Intro to PT chapter 10 Flashcards

1
Q

Parkinson Disease and Lou Gehrig disease (amyotrophic lateral scerosis) ALS

A

Onset ages 30-60

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2
Q

Cerebrovascular accident CVA

A

leading cause of long term disability.
Caused by a clot or a hemorage.

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3
Q

hemiparesis

A

contralateral to the side of the brain the CVA is on
paralysis or partial weakness on the side of the body

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4
Q

Other possible CVA symptoms

A

possible sensory impairments
speaking or understanding language
swallowing deficits
cognitive imparements
neglect of the involved side

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5
Q

clot busting

A

plasminogen activator (tPA)

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6
Q

Recovery from stroke

A

Most rapidly during first 3 months.
Continues at a slower pace after that.

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7
Q

Essential components of CVA rehabilitation program

A
  1. patient education to address stroke risk factors that may predispose an indivicual to a stroke.
  2. assessment and management of fall risk factors to prevent future injury.
  3. compensatory strategies including equipment use/
  4. Recovery of task related functions and resolve impairments.
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8
Q

Traumatic brain injury (TBI)

A

alteration in brain function, or other evidence of brain pathology, caused by an external force.
Clinical evidence:
* altered state of consciousness
* loss of memory before or after injury
* confusion or other mental status changes.
* Neurologic deficits such as weakness, visual abnormalities, sensory deficits, communication impairments, or loss of balance.
* Abnormal findings from imaging techniques.

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9
Q

Leading cause of TBI

A

Falls

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10
Q

Other common causes of TBI

A

blunt trauma, motor vehicle accidents, sports, and assaults.

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11
Q

TBI

Focal Injury

A

develop when head hits a stationary object.

Contusions or hematoma formation at the site of injury

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12
Q

TBI

Diffuse axonal injury

A

Rapid acceleration or decceleration forces.

Wide spread breakage of the long nerve axons in the brain.

Mild to severe

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13
Q

TBI

Accute care

A

Focused on life preservation and minimizing secondary mechanisms of injury such as increased intracranial pressure and hypoxia.

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14
Q

TBI Imparements

Cognitive impairments

A

Disordered level of consiousness, confusion, decreased memory storate and retrieval, impaired concentration, slowness of thinking, limited attention span, impairments of perception, communication, planning, writing, reading, and judgemnt.

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15
Q

TBI Imparements

Physical impairments

A

paresis or paralysis, dyscordination, balance deficits, spasticity, loss of joint flexibility, swallowing deficits, fatigue, reduced cardiopulmonary endurance, visual deficits, speach impairments, headaches

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16
Q

TBI Imparements

Emotional/behavioral impairments

A

depression, mood switngs, celf-centeredness, anxiety, lowered self-esteem, sexual dysfunction, restlessness, lack of motivation, and difficulty controling emotions

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17
Q

PT plan for TBI

A

focus on recovery of function within meaningful environmental contexts.

Reinforce the cognitive and behavioral strategies that are most appropriate to each individual

Impairment reduction and strength/endurance.

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18
Q

SCI Spinal Cord Injury

A

damage to the spinal cord or nerve roots resulting in temporary or permanent loss of sensation, strength and body function below the level of injury.

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19
Q

Leading cause of SCI

A

Motorcycle accidents. - second is falls. - next is acts of violence or sports

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20
Q

SCI

Tetrapelegia

A

all limbs affected

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21
Q

SCI

paraplegia

A

lower part of trunk and legs.

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22
Q

SCI

paresis

A

incomplete lesion in which some distal motor and sensory functions may be preserved.

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23
Q

SCI

Accute management

A
  • preservation of life and prevention of further damage to neural tissue
  • spinal cord decompression and spinal column stabilization.
  • Medications to control inflammation
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24
Q

SCI

accute PT

A
  • maintaining flexability and ROM
  • strengthening unaffected muscles.
  • Cardio capacity and endurance
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25
Q

SCI

immediatly after initial accute phase PT

A
  • More vigourous functional training in a rehabilitation setting
  • Transfer and wheelchair skills.
  • Environmental adaptations/modifications
  • Home evaluation
  • other assistive technology
  • family education
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26
Q

Vestibular Disorders

A

Dizziness - sensations may include feelings of lightheadedness, unsteadiness, or spinning (virtigo)

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27
Q

Vestibular Disorders

virtigo

A

spinning

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28
Q

Vestibular Disorders

semicircular canals

A

detect rotational movments

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29
Q

Vestibular Disorders

otolith organs

A

detect linear movements.

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30
Q

Vestibular Disorders

Vestibular nerve

A

send via CNS to vestibular nuclei, and cerebellum

Vestibular ganglion.

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31
Q

Vestibular Disorders

PT examination

A

history. Onset and timing. circumstances in which symptoms are provoked.

tests to see how well eyes can cordinate movements with one another and with movement of the head.

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32
Q

Vestibular Disorders

benign paroxysmal positional vertigo

A

(BPPV) Crystals of the otolith organs break free and fall into the semicircular canals, causing the sensation of spinning.

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33
Q

Vestibular Disorders

Other causes of peripheral vestibular pathology

A

viral infections, eighth cranial nerve seath tumors. toxicity from specific antibiotics, and fluctuations in flud pressures in the inner ear.

Central cerebellar strokes, and TBI can also lead to this.

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34
Q

Vestibular Disorders

PT focus

A

specific eye and head movement exercises
engasging the patient in a balance retraining program
BPPV - “Repositioning maneuver”

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35
Q

MS

A

Anormal immune attack of myelin sheath of nerves.
disturbences of the conduction of messages along the nerves.
diagnosed between ages 20 and 50 years
Occurs more frequently in areas farther from equator.

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36
Q

MS symptoms

A
  • visual deficits
  • tingling and numbness,
  • weakness,
  • fatigue,
  • problems with balance
  • disniness and vertigo
  • bladder dysfunction
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37
Q

MS ebb and flow

A

exacerbations followed by remissions.

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38
Q

PT focus for MS

A
  • primary disease impairments and functional limitations as well as secondary impairments that may have arisen because of reduced function and immobility.
  • Equipment assesments
  • Home or work modifications.
  • care giver education
  • fatigue management.
  • Regular exercise - evidence for strength and endurance
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39
Q

Parkinson Disease PD

A

Neurodegenerative disease. - seen with advancing age.
tremor rigidity and bradykinesia

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40
Q

Parkinson Disease PD

Tremor

A

alternating contractions of opposing muscle groups
affects hands and feet most.
Mostly at rest.

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41
Q

Parkinson Disease PD

Rigidity

A

Disturbance in muscle tone.
Resistence when limbs or trunk are passively moved regardless of speed.

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42
Q

Parkinson Disease PD

Bradykinesia

A

slowness of movement. Most common feature and cause of disability.

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43
Q

Parkinson Disease PD

Other motor symtoms

A

Pustural instability occurs later in the disease

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44
Q

Parkinson Disease PD

non motor symptoms

A

apathy, anxiety, depression, sleep disorders, cognitive issues and constipation.

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45
Q

Parkinson Disease PD

treatments

A

Medications that restore neurochemical balance and deep brain stimulation

46
Q

Parkinson Disease PD

disabilities

A

functional activities: moving from supine to sit, rising from a chair, walking, climbing stairs and reaching.
stooped posture

47
Q

Parkinson Disease PD

PT treatments

A

specific movement and compensatory strategies.
target secondary problems such as weakness, decreased ROM and decreased aerobic capacity.
exercise and phisical therapy have a impact ont he brain of PD patients.
exercise helps with release of dopamine.

48
Q

Guillain-Barre Syndrome

A

GBS - acquired neuromuscular condition that results from an inflammatory process affecting peripheral nerve.

Presents following viral infection.

symmetric progressive weakness, often beginning in the lower extremities.

49
Q

Guillain-Barre Syndrome GBS

weakness in respiratory muscles requiring ventilator support

A

10 to 30% of individuals.

50
Q

Guillain-Barre Syndrome GBS

Time frame of progression

A

rappidly over a period of 2 weeks, reaching a plateau after 4 weeks.

51
Q

Guillain-Barre Syndrome GBS

treatments

A

plasmapheresis or immunoglobulin.

recovery over weeks or months.

Majority of individuals regain ability to walk within a year of onset.

52
Q

Guillain-Barre Syndrome GBS

Pt focus

A
  • Begins in hospital.
  • functional training
  • maintaining proper limb position and posture
  • protecting weakend muscles
  • protecting weakened muscles
  • regaining sitting and standing postural control
  • Strengthening exercises.
53
Q

ALS - Lou Gehrig disease

A

Amyotrophic Lateral Sclerosis

54
Q

Amyotrophic Lateral Sclerosis ALS - Lou Gehrig disease

cause and onset

A

Median age is 50s.
progressive neurologic disorder
degeneration of motor neurons.

55
Q

Amyotrophic Lateral Sclerosis ALS - Lou Gehrig disease

symptoms/signs

A

weakness, atrophy, fasciculations (muscle twitches) and spasticity.

Weakness initially in limbs. - functional activities
bulbar muscles - speach swollowing and breathing

56
Q

Amyotrophic Lateral Sclerosis ALS - Lou Gehrig disease

Needs

A

assistence with activities of daily living and use of powered mobility equipment and respiratory support.

survival time is 3 to 5 years.

57
Q

Amyotrophic Lateral Sclerosis ALS - Lou Gehrig disease

medications

A

Riluzole (Rilutek - slow progression and extend life by about 3 months

edaravone - slow functional decline in some individuals.

58
Q

Amyotrophic Lateral Sclerosis ALS - Lou Gehrig disease

role of physical therapy

A
  • maximize functional abilities
  • minimize secondary complications
  • low intensity exercse program - energy conservation
  • bracing and orthotic needs
  • adaptive and assistive equipment.
59
Q

neuromuscular examination

A

which movement system components remain functional and which may need to be addressed

60
Q

neuromuscular examination

History

A

review of all medical records.
comorbid conditions
past health history
results of tests.

61
Q

neuromuscular examination History tests

computed tomography CT

A

detects bony abnormalities in skill or spine, hemorrhages, brain atrophy and hydrocephalus

62
Q

neuromuscular examination History tests

Magnetic resonance imaging MRI

A

provides detail of CNS tumors and pathologic lesions seen in MS

63
Q

neuromuscular examination History tests

Angiography

A

identifies narrowing or abnormalities in blood vessels supplying the brain or spinal cord

64
Q

neuromuscular examination History tests

lumbar puncture LP

A

assists with measuring intracranial pressure; also used to collect cerebrospinal fluid to identify pathogens or abnormal chemical/cellular content

65
Q

neuromuscular examination History tests

Electroencephalography EEG

A

assists with diagnosis of seizures

66
Q

neuromuscular examination History tests

Nerve conduction velocity test NCV

A

identifies peripheral nerve pathology

67
Q

neuromuscular examination History tests

Electromyography EMG

A

identifies muscle pathology

68
Q

neuromuscular examination History

Interview

A

hear firsthahd the sequence of events that brought the patient to therapy.

it provides insights into societal roles and functional activities that are important to the patient.

ascertain patient’s understanding of their condition and their goals.

69
Q

neuromuscular examination

Systems Review

A

cardiovascular, pulmonary, integumentary, musculoskeletal and neuromuscular systms. affect, cognition, communication, learning style and behavioral emotional resonses.

70
Q

neuromuscular examination Systems Review

patient data

A
  1. height, weight, vital signs.
  2. determine what body systems need further physical therapy assessment
  3. guide desision making regarding appropriate tests and measures
  4. determine whether a patient needs a referal.
71
Q

neuromuscular examination

Tests and measures.

A

process allows clinicians to establish an initial examination baseline.

72
Q

neuromuscular examination Tests and measures.

Berg balance scale

A

static and dynamic sitting and standing balance

73
Q

neuromuscular examination Tests and measures.

Functional gait assessment

A

dynamic walking balance

74
Q

neuromuscular examination Tests and measures.

Activities-specific balance confidence scale

A

self-reported balance confidence in upright tasks

75
Q

neuromuscular examination Tests and measures.

10 meter walk test

A

walking speed

76
Q

neuromuscular examination Tests and measures.

6-minute walk test

A

walking distance/endurance

77
Q

neuromuscular examination Tests and measures.

5 times sit to stand

A

transfer skill and lower extremity function strength.

78
Q

neuromuscular examination

Examination of Specific Impairments

A

testing for specific impairments

79
Q

neuromuscular examination of Specific Impairments

Cognition

A
  • Montreal Cognitive Assessment.
  • impact design of therapeutic program, and the level of physical assistance or supervision.
  • neuropsychologist is a valuable resource.
  • asses changes in level of cognitive functioning.
80
Q

neuromuscular examination of Specific Impairments

Communication

A

Receptive aphasia - can’t recieve or interpret written or verbal information

Expressive aphasia - impaired ability to communicate their needs in some manner.

81
Q

neuromuscular examination of Specific Impairments

Range of Motion

A

ROM deficits can affect, limbs truck or neck.

measured using a goniometer.

82
Q

neuromuscular examination of Specific Impairments

Motor control

A

capable of performing voluntary movement.
isolate and control specific muscle actions
assesed by ability to start stop reverse change speed change direction and regulate force
strength
involuntary movements can soometimes interfere with functional limb use

83
Q

neuromuscular examination of Specific Impairments

Muscle Tone

A

Hypotonia -too low
Hypertonia - too high
- spasticity - velocity-dependent hypertonia
- Rgidity - another example of hypertonia

84
Q

neuromuscular examination of Specific Impairments

Sensation and Perception

A

Sensation - ability to recieve sensory input from within and outside the body -essential for movement.

Perception - ability to integrate sensory information and interpret it in a meaningful manner

Perceptial deficit example- Unilateral spacial neglect - can’t integrate sensory information from one side of body.

85
Q

Evaluation, Diagnosis, and Prognosis

Key elements of clinical decision-making

A

 Synthesize data from all sources of information
(evaluation)
 Classify the nature of the patient’s deficits (diagnosis)
 Determine the patient’s potential for enhanced
movement and function, set appropriate goals, and
determine time needed to achieve them (prognosis)

86
Q

neuromuscular

Principles of intervention goals:

A
  • Enhancing function in meaningful tasks
  • Adapting functional mobility strategies to changing task and environmental conditions
  • empowering patients to solve their own motor problems when faced with novel situations
  • Resolving Reducing and preventing impairments
  • Promoting and supporting patient behaviors that address long term health and wellness.
87
Q

neuromuscular

Principles of intervention - guiding:

A
  • A consideration of whether the program will emphasize recovery versus compesnsatory strategies
  • The influence of prevailing motor control theories
  • A current understanding of neuroplasticity
  • How motor learning concepts might shape the structure of the practice environment
  • Motivational and attentional aspects of training
88
Q

neuromuscular Principles of intervention

Recovery v Compensatory

A
  • Functuional recovery - implies intervention that will be facilitate the patient’s ability to accomplish a task in a manor prior to neurologic injury
  • Compensation - successfull task completion using alternative movement strategies or substitutions.
  • Blended strategy - encouraging a patient to practice ambulating without an assistive device in therapy, while simultaneously having them compensate for a dynamic balance deficit by using a straight cane when walking outside of therapy.
89
Q

neuromuscular Principles of intervention

Motor control

A

how movement is organized and coordinated.

90
Q

neuromuscular Principles of intervention

Motor control early approaches

A
  • ( PNF )- proprioceptive neuromuscular facilitation, Brunnstrom approach to hemiplegia, aad the neurodevelopmental treatment (NDT)
  • Theory is no longer supported by research.
  • Contribution of sensation to the movement system - still important
  • multijoint extremity muscle activity and proximal control in normal movement - still important.
91
Q

neuromuscular Principles of intervention

Motor control Current theories

A
  • nervous system assumes an active role in movement control, but does not work in isolation.
  • Theory now relies on a systms approach.
  • Many different body systems work together.
  • external forces play a role - gravity - momentum
  • environment may affect task
92
Q

neuromuscular Principles of intervention

Neuropalasticity

A

The brain and spinal cord’s ability to adapt and remodel themselves and the learn new behaviors and skills.

Learn new task more quickly if they engage their lesser involved extremity to the majority of the task.

importance of using impared body structures through priciples of task repitition and practice.

93
Q

Principles that drive neuroplastic changes

A

 Repetition
 Specificity of action
 Training intensity
 Goal-directed movement

94
Q

neuromuscular Principles of intervention

Motor learning

A

implies there has been a relatively permament change in ability to perform some type of skill

Importance of practice and feedback

95
Q

Stages of motor learning

A
  • Cognitive stage: learn what to do
  • Associative stage: refine movement
  • Autonomous stage: develop skill
96
Q

PTs manipulate motor learning training variables; for
example:

A
  • Practice variability (single or multiple tasks)
  • Modification of the order of task practice
  • Whole task vs. part task training
  • Feedback variables
97
Q

neuromuscular Principles of intervention Motor learning

blocked practice

A

practice of one task for a block of trials with low practice variability

98
Q

neuromuscular Principles of intervention Motor learning

Random practice

A

practice of several different tasks in a random order

99
Q

neuromuscular Principles of intervention Motor learning

Whole versus part-task training

A

practice of a complete continous task versus breaking down a task into its component parts and having the patient learn these first before tackling the entire task

100
Q

neuromuscular Principles of intervention Motor learning feedback

Intrinsic feedback

A

sensory input about the movement process that the patient recieves from their own soensory organs

101
Q

neuromuscular Principles of intervention Motor learning feedback

extrinsic feedback

A

movement information that comes from sources outside of the patient’s internal sensory systems (auditory or tactile cueing provided by the therapist)

102
Q

neuromuscular Principles of intervention Motor learning feedback

Feedback schedule

A

frequency and timing of feedback

103
Q

neuromuscular Principles of intervention Motor learning feedback

Nature of feedback

A

positive feedback - movement success
Negative feedback - movement errors

104
Q

Wulf and Lewthwaite theory on motor learning

A

includes social cognitive factors including motivational and attentional influences.
PT - must support:
* autonomy or self-determination
* Expectation enhancement
* self-efficacy
* Use of an external focus of attention

105
Q

Activity-based training Paradigms

Constraint induced movement therapy

A

(CIMT)
regaining use of more involved upper extremity by:

constraining use of the patient’s lesser involved arm while engaging the involved arm in intensive training and practice.

106
Q

`

locomotor training with body weight support

A

fouses on key limb movements in walking

Straps and harness and overhead suspension support body weight while the patient practices walkingl.

107
Q

neuromuscular

Maanagement of imparements

A

Stretching and strengthening programs are frequently needed.

108
Q

Maanagement of imparements

Neuromuscular electrical stimulation or functional electrical stimulation

A

adjuct treatments to facilitate motor control, timing of a muscle contraction, assist in ROM, or provide an orthotic assist to an extermity joint.

109
Q

Maanagement of imparements

Assistive device and Bracing

A

assist with balance, safety and function

110
Q

Promotion of physical Activity

A

cronic nature of neuromuscular impairments can cause disuse weakness, deconditioning, and sedentary lifestyle.

Aerobic trainiing - positive impact on health outcomes, like aerobic capacity, gait endurance, and walking speed.

111
Q

Patient Related Instruction

A

Educate patients about their disease and comorbidities.

patients and families need health-related education to help them optimize their capacity to function and to prevent future emergencies.

112
Q

Causes of neuromuscular conditions

A

 Pathology of vascular system

 Trauma

 Infection

 Metabolic disturbances

 Tumors

 Degenerative disorders

Intro to PT (12 decks)

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