Mega Review Flashcards
What main muscles do the musculocutaneous nerve innervate?
Biceps brachii
Brachialis
Coracobrachialis
What nerve supplies sensory innervation to the lateral forearm?
Musculocutaneous
What nerve innervates the latissimus dorsi?
Thoracodorsal
What nerve innervates the serratus anterior?
Long thoracic
What muscles do the Median nerve innervate?
MeaT LOAF
Median nerve
Pronator teres
Lumbricals (1,2)
Opponens pollicis
Flexors (wrist + fingers) EXCEPT flexor carpi ulnaris and ulnar side of flexor digitorum profundus
What muscles do the Ulnar nerve innervate?
MAFIA
Medial lumbricals (4+5)
Adductor pollicis
FCU/FCP ulnar side
Interossei (dorsal)
Abductor digiti minimi
What muscles do the Radial nerve innervate?
Rudolph is a BEAST
Brachioradialis
Extensors
Anconeus/APL
Supinator
Triceps
What key muscles does the Axillary nerve innervate?
Teres minor
Deltoid
What muscles does the Femoral nerve (L2-L4) innervate?
F-QuIPS
Iliopsoas
Sartorius
Pectineus
Quadriceps femoris
What muscles does the Obturator nerve (L2-L4) innervate?
Adductor longus/brevis
Gracilis
Adductor magnus
Obturator externus
The Gluteus Maximus is innervated by what nerve?
Inferior gluteal nerve (L5-S2)
What muscles does the Superior gluteal nerve (L4-S1) innervate?
Gluteus medius
Gluteus minimus
TFL
The Tibial nerve (L4-S3) innervates which muscles?
Gastrocnemius
Soleus
Popliteus
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
The common peroneal nerve branches into what two nerves?
Superficial peroneal
Deep peroneal
What two muscles does the Superficial peroneal nerve innervate?
Fibularis longus
Fibularis brevis
What muscles do the deep peroneal nerve innervate?
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Tarsal Tunnel Syndrome affects what nerve?
Posterior tibial nerve
Where would a patient with Tarsal Tunnel Syndrome have pain? Weakness?
Pain: medial heel, medial arch, worse with standing/walking
Weakness: foot intrinsics
For a patient with adhesive capsulitis, what joint mobilization would be most effective?
Posterior (second best is inferior)
Purpose of Long Sitting (Supine to Sit) Test
Identifies SI joint dysfunction that may be cause of leg length discrepancy
What joint mobilization increases Glenohumeral ER?
Anterior
What joint mobilization increases Glenohumeral IR?
Posterior
What hip mobilization will increase IR?
Posterior
What hip mobilization will increase ER?
Anterior
What patellar glide will encourage knee extension?
Superior
What talocrural mobilization increases DF?
Posterior
What talocrural mobilization increases PF?
Anterior
With UMN disorders, you expect to see:
hypotonia/hypertonia
hyporeflexia/hyperreflexia
HYPER
What is anosognosia?
A lack of awareness, or denial, of a paretic extremity as belonging to the person. Could also be lack of awareness/denial of paralysis and disability.
Neglect is most commonly a symptom of a CVA in what lobe (and what side)?
Right parietal lobe
What is prosopagnosia?
Inability to recognize familiar faces
What is ideomotor apraxia?
There is a disconnection between the idea of a movement and its motor execution.
SO, a patient may be able to carry out habitual tasks automatically and describe how they are done, but is unable to imitate gestures or perform on command.
What is ideational apraxia?
The inability to perform a purposeful motor act, either intentionally or on command.
What are risk factors of diabetic neuropathy?
Duration and severity of DM
Elevated triglycerides
High BMI
History of smoking or HTN
When the anterior cerebral artery is affected, there is contralateral hemiparesis which mostly affects (LEs/UEs)
LEs, since the ACA supplies mostly the medial part of the brain (homunculus)
Aphasia is a result of a CVA involving which cerebral artery?
Middle Cerebral Artery
Broca’s, Wernicke’s, and global aphasia
Signs and symptoms of CVA involving ACA
Contralateral hemiparesis and hemisensory loss (LE)
ACA = ABCD = kids/babies
Urinary incontinence
Problems with imitation, bimanual tasks, apraxia
Slowness, delay, motor inaction
Contralateral grasp reflex, sucking reflex
What is Apraxia?
Difficulty with previously known tasks
What is the main difference in Left and Right MCA infarcts?
Left = language
Right = perceptual disorders/neglect
(UEs/LEs) are more involved in MCA infarcts?
Upper extremities
Homonymous hemianopsia is seen with which artery?
MCA
What are the symptoms of a Middle Cerebral Artery infarct?
Contralateral hemiparesis and hemisensory loss (UE + face)
MCA mnemonic = MPH
Mouth = aphasia
Perceptual disorders = neglect
Homonymous hemianopsia
What is global aphasia?
When both Broca’s and Wernicke’s areas are damaged.
Patient cannot understand or communicate.
Wernicke’s area is in the (parietal/temporal) lobe.
Patient’s with Wernicke’s aphasia would benefit most from what form of communication?
Temporal
Gestures
Broca’s area is in the (frontal/temporal) lobe.
Patients with this type of aphasia would benefit from what form of communication?
Frontal
Yes/no questions
Unilateral neglect is most common in (R/L) (MCA/PCA)
Right MCA stroke
Is vision affected in unilateral neglect?
No, perception is affected
Someone with a R MCA would neglect their (R/L) side.
Left
For a patient with left unilateral neglect, what side should you initially start interventions on?
Left/Right
Right: you have to start on their right side (the side they can perceive) or else they’ll just ignore you.
What is Homonymous Hemianopsia?
When the same half of your visual field is affected in both eyes. Common with MCA and PCA CVA.
Left Homonymous Hemianopsia means the (left/right) visual field is affected?
Left: it’s named for the side that’s affected
A Right MCA would lead to (left/right) homonymous hemianopsia.
Left
After a patient had a PCA infarct, they complain that they can feel the clothes on their skin and that it hurts. What is this a case of?
Thalamic Pain Syndrome, which happens in Central Territory
Your patient has to be driven to therapy due to him being unable to understand the directions on the roads.
What is this called and what cerebral artery damage would cause this?
Topographical disorientation, which is caused by the peripheral territory of PCA being damaged.
Your patient’s caregiver reports the patient keeps trying to use the TV remote as a phone after their stroke.
What is this called and what artery was affected?
Visual agnosia: patient can see, but they cannot understand what they’re seeing.
Common in peripheral territory of PCA.
The TV in the clinic is showing a movie with Tom Cruise and Tom Hanks in it. Your post-stroke patient has no clue who those people are.
What is this and what artery was affected to cause this?
Prosopagnosia: difficulty naming familiar faces.
Common in peripheral territory of PCA.
T/F: homonymous hemianopsia occurs only in the left hemisphere
F: HH can occur in both the left and right hemispheres
A patient with neglect would have the most difficulty with (visual/verbal) cues
Visual
Describe the behavior, intellect, and emotion of a left hemisphere CVA.
Left = oLd
Behavior: slow, cautious
Intellect: highly distractible
Emotion: difficulty with positive emotions
Describe the behavior, intellect, and emotion of a right hemisphere CVA.
Right = child/baby
Behavior: quick, impulsive, safety risk
Intellect: rigidity of thought
Emotion: difficulty with negative emotions
Spasticity is assessed with (PROM/AROM)
Passive: you can’t spell Spastic without “pas”
Muscle synergies are assessed with (PROM/AROM)
Active: synergies are patterned movements so you need to have the patient move to see them
Brunnstrom Stages of Stroke Recovery
Remember that it’s like a bell curve in terms of spasticity.
Stage 1: flaccidity
Stage 2: beginning of minimal voluntary movement
Stage 3: voluntary control of movement synergy (spasticity peak)
Stage 4: movement outside of synergy
Stage 5: greater independence from limb synergies
Stage 6: individual and coordinated movements
Stage 7: normal
What is the UE spasticity pattern?
Chicken Dance
Scapula: retracted and downwardly rotated
Shoulder: ADD, IR, depression
Elbow: flexion
Forearm: pronation
Wrist: flexion, ADD
Hand: finger flexion, clenched fist with thumb ADD in palm
What is the LE spasticity pattern?
Ballerina
Pelvis: hip hike
Hip: ADD, IR, extension
Knee: extension
Foot/Ankle: PF, INV, equinovarus, toes claw/curl
When positioning a patient with an UE spasticity pattern, you want their shoulder (protracted/retracted) and arm (abducted/adducted).
Always opposite of synergy:
Protracted
Abducted
The LE spasticity pattern is the same as which synergy pattern?
LE Extension synergy: ballerina
Describe the LE flexion synergy pattern.
“Hot guy crossing his legs putting on a sock.”
Hip flexion, ABD, ER
Knee flexion
Ankle DF, INV
Toe DF
The UE (flexion/extension) synergy pattern looks like you are trying to show off your biceps
Flexion
The UE (flexion/extension) synergy pattern looks like you are being handcuffed behind your back.
Extension
T/F: you can have both a flexion and extension synergy pattern.
True
Which stroke is more serious: ischemic or hemorrhagic?
Hemorrhagic
What are the 2 purposes of the lymphatic system?
1- immune system
2- drain lymph
What is the flow of lymph in the body?
“CV NoTeD”
Capillaries
Vessels
Nodes
Trunks
Ducts
The face and RUE drains to which duct?
RULE
Face + RUE = lymphatic duct
Everywhere else drains to the thoracic duct.
Name some of the causes of secondary lymphedema
Venous insufficiency
Lymph node removal
> Lymphatic load
> Transport capacity
What are the 3 causes of primary lymphedema?
Milroy disease
Lymphedema Praecox (Meige disease)
Lymphedema Tarda
At what age are people diagnosed with Milroy’s disease?
0-2 yrs, it’s congenital
At what age are people diagnosed with Meige disease (Lymphedema praecox)?
10-20yrs
At what age are people diagnosed with Lymphedema Tarda?
> 35 years, tarda = late
What condition is the Stemmer Sign testing for?
Lymphedema (stage II or III)
What are the stages of lymphedema?
2 mnemonics: Lymph 0-3 dema and SPIT
Subclinical: 0 latency
Pitting edema: 1 reversible stage
Irreversible: 2 spontaneously irreversible
Trunk-like: 3 lymphostatic elephantiasis
At what stage of lymphedema does elevation reverse the symptoms?
Stage 1: reversible stage
At what stage of lymphedema do you get a positive Stemmer sign?
Stage 2: spontaneously irreversible
At what stage of lymphedema do you see pitting edema?
Stage 1: reversible stage
At what stage of lymphedema is hyperkeratosis and papillomas common?
Stage 3: lymphostatic elephantiasis
Your patient presents with 1/4 inch pitting edema that returns to normal in 10s. What stage is this?
2+
Pitting Edema Grades
1+: <1/4 inch
2+: 1/4-1/2inch, <15s
3+: 1/2-1inch, 15-30s
4+: >1in, >30s
Lipedema is (BL/UL)
“You have 2 lips”
Bilateral
In (lymphedema/lipedema), patients will bruise easily and their skin will be more sensitive to pressure + touch.
Lipedema
Lipedema (does/does not) occur in the feet.
Does NOT
T/F: in lymphedema, distal edema in the foot is present
True
(Volumetric/girth) measurements are more appropriate for distal limbs.
Volumetric
(Volumetric/girth) measurements are more appropriate for proximal limbs.
Girth
When are bioimpedance measurements taken?
On a lymphedema patient pre and post surgery.
What does a Lymphoscintigraphy identify?
Lymphatic insufficiency
What do lymph nodes usually feel like on palpation?
Soft, non-tender, non-palpable
Pea sized (<1cm)
You are palpating your patient’s lymph nodes and notice they are hard. The patient reports slight pain with palpation. Your patient has not been sick for a while now. What should you do?
Refer to PCP
What tool is used to assess lymphedema pre/post surgery?
bioelectric impedence
During manual lymphatic drainage, you should clear (proximal/distal) areas first.
Traffic jam!
Proximal
During manual lymphatic drainage, stroking should be done towards more (distal/proximal) proximal
Proximal, AKA stroke distal to proximal
During phase I of compression therapy, the patient wears (low/high) stretch bandages (at night/at all times).
Low stretch
At all times
During phase II of compression therapy, patients wear (low stretch bandages/compression garments) during the day.
Compression garments during the day.
They still wear low stretch bandages during the night.
Low stretch bandages have a (high/low) working pressure and (high/low) resting pressure.
High working pressure: applies resistance so when you move, your muscles need to work against the resistance
Low resting pressure: no increased resistance at rest
When does a patient begin the maintenance phase of lymphedema therapy?
When their symptoms plateau.
What are the two things patients do when they go into the maintenance phase of lymphedema therapy?
1.) patient performs self-manual lymphatic drainage
2.) graduates to compression garments during the day, while they still bandage at night
What exercise should lymphedema patients NOT do?
High intensity exercises
T/F: Lymphedema patient’s should not wear their bandages during workouts to reduce risk of skin breakdown.
FALSE: you want to wear bandages during workouts to increase lymphatic drainage
You are giving your lymphedema patient an HEP. You order the exercises so that you are working the (distal/proximal) muscles first.
Proximal, so start with cervical/chest exercises and then move distal.
T/F: swimming is not recommended for patients with lymphedema
False: the increased pressure aids in lymphatic drainage
T/F: Compression garments are wrapped with more pressure proximally.
False: more pressure distally and less pressure proximally
What is Rate Product Pressure?
HR x SBP: tells us about the myocardial oxygen demand on the heart
What 3 vital signs are supposed to increase linearly during exercise?
HR, CO, and MAP
(Systolic/Diastolic) BP increases during exercise.
Systolic
Stage 1 HTN values
Systolic between 130-139
OR
Diastolic between 80-89
What are the names of the blood pressure categories?
Normal
Elevated
Stage 1
Stage 2
Hypertensive crisis
Hypertensive crisis values
Systolic >180
AND/OR
Diastolic >120
What is normal blood pressure?
Less than 120/80 mmHg
What values fall under “elevated” blood pressure?
Systolic 120-129
AND
Diastolic <80
Stage 2 HTN values
Systolic at least 140
OR
Diastolic at least 90
When VO2 reaches a steady state, what does that tell you?
The ATP demand is being met aerobically.
What are the INITIAL changes you see in vital signs in a higher altitude environment?
HR increases
BP increases
CO increases
SV no change
What are the changes you see in vital signs in a higher altitude environment once you acclimatize?
HR increases
BP normal
CO normal
SV decreases
What are the cardiovascular effects of aquatic therapy?
“Going into the water is relaxing.”
HR decreases
BP decreases
Vo2 decreases
CO increases
SV increases
When you are standing in water that is up to your ASIS, what percentage weight bearing are you?
50%
When you are standing in water that is up to your Xiphoid process, what percentage weight bearing are you?
33%
When you are standing in water that is up to C7, what percentage weight bearing are you?
10%
How do you calculate cardiac output?
HR x SV = CO
What is a great measure to assess change in fitness from pre and post fitness training?
The time it takes for the heart rate to return to baseline.
What 4 valves do we auscultate?
Aortic, Pulmonic, Tricuspid, and Mitral (Bicuspid)
S4, also known as atrial gallop, is associated with what?
Ventricular filling and atrial contraction
HTN
S3, also known as ventricular gallop, is associated with what?
Ventricular filling
Heart failure but also seen in some athletes.
S1 is (lub/dub) and marks the onset of (systole/diastole)
Lub
Systole
S2 is (lub/dub) and marks the onset of (systole/diastole)
Dub
Diastole
Closure of the mitral and tricuspid valves are associated with what heart sound?
S1
Closure of the aortic and pulmonic valves are associated with what heart sound?
S2
Where does the S2 sound the loudest?
Base of heart
Where does S1 sound the loudest?
Apex of heart (bottom)
When your patient presents with abnormal smooth pursuit and saccades, what should you do?
Refer out, this is pointing to a central vestibular pathology which we can’t treat.
Peripheral vestibular pathology presents with (pendular/jerk) nystagmus.
Jerk, where there are slow and fast phases
In peripheral vestibular pathology, does a visual fixation help improve nystagmus?
Yes
(Central/peripheral) vestibular pathology can present with hearing loss.
Peripheral
When you are asking a patient to follow your moving finger with their eyes, what are you testing?
Smooth pursuit
When you are asking a patient to look from your finger to your nose, what are you testing?
Saccades
When performing a Head Impulse/Thrust Test to the left, your patient’s eyes jump back to yours. What does this tell you?
Left sided peripheral vestibular pathology
Left sided VOR issues
What is Charcot’s Triad? What condition would it point to?
SIN
Scanning speech
Intention tremor
Nystagmus
Points to MS
T/F: Nystagmus with Canalithiasis will last <1min
True
When performing the Dix-Hallpike Test, your patient exhibits upbeating nystagmus. What canal is affected?
Posterior Canal “PUP”
When performing the Dix-Hallpike test, your patient’s head is turned to the Left and exhibits downbeating nystagmus. What does this tell you?
Left Anterior Canal is affected.
Which canal presents with upbeating nystagmus?
Posterior Canal
Which canal presents with downbeating nystagmus?
Anterior Canal
Your patient has posterior canal BPPV Canalithiasis. What maneuver should you perform?
Epley
The Semont or Liberatory Maneuver is for what type of BPPV?
Cupulolithiasis
Your patient gets extremely nauseated every time you attempt an Epley maneuver. What intervention can you do instead?
Brandt Daroff Exercise
What tests the horizontal canals for BPPV?
Roll Test/Horizontal Canal Test
You do the roll test and find that the patient had ageotrophic nystagmus on both sides, but the patient reported increased symptoms on the Left side. What’s the Dx?
HC R cupulolithiasis
Ageo = cupulo
>Sx on L = R side affected
When a patient has horizontal canal cupulolithiasis, the side on the roll test with the (more/less) intense symptoms is affected.
Less intense
When a patient has horizontal canal canalithiasis, the side on the roll test with the (more/less) intense symptoms is affected.
More intense
Horizontal Canalithiasis presents with (a/geotropic) nystagmus.
Canals are in the ground
Geotrophic
Horizontal Cupulolithiasis presents with (a/geotrophic) nystagmus.
Ageotrophic
What is the treatment for Horizontal Canal Canalithiasis?
BBQ Roll/Maneuver
List the steps of the BBQ Maneuver.
Patient starts supine with head on pillow for ~20 degrees of cervical flexion.
1- Turn head towards affected side
2- Turn back to midline
3- Turn away from affected side
4- Go prone
During the Roll Test, your patient has geotrophic nystagmus, which is more intense on the right side. What is the diagnosis and intervention?
Dx: Horizontal Canal R sided Canalithiasis
Treatment: BBQ Maneuver going to the R side initially
What is one unique symptom of Labrynthitis?
Labrynthitis = Loss of hearing
L and L
What is one symptom a patient will describe if they have Meniere’s Disease?
Aural fullness, AKA feeling like they have water stuck in their ears.
What type of cerebral palsy has movements that are described as “worm-like?”
Athetoid cerebral palsy due to mixed muscle tone.
What does the “too many toes” sign correlate with?
Tib posterior tendon dysfunction
Pain from urinary caculi most often occurs because of blockage of which structure?
Ureter
Which muscles actively compress the urethra, vagina, and rectum, thus maintaining continence?
Levator ani muscles: pubococcygeus, iliococcygeus, and puborectalis
Which respiratory pattern is seen in coma and near death?
Cheyne-Stokes respiratory pattern: period of apnea followed by gradually increasing depth and frequency of respirations.
In gaze stability, when both the patient’s head and the target are moving, this is (VORx1/VORx2)
VORx2
In gaze stability, when your patient is looking at a static target while moving their head, this is (VORx1/VORx2)
VORx1
For unilateral vestibular hypofunction, you (should/shouldn’t) do actions that bring a patient’s symptoms on.
SHOULD: habituation training
What are the risk factors for Metabolic Syndrome?
WEIGHHT
Waist Expanded: waist circumference
Impaired Glucose: fasting plasma glucose
HDL
HTN
Triglycerides
How many positive criteria do you need in order to diagnose Metabolic Syndrome?
3 or more
What is the criteria for Metabolic Syndrome?
Waist circumference: >40in M, >35in F
Triglycerides: 150mg/dL or higher
HDL: <40 M, <50 F
Blood Pressure: 130 or higher SBP and/or 85 or higher DBP
Fasting Plasma Glucose: >100 mg/dL
What are some symptoms of Addison’s Disease?
“Mrs. Addison: a petite brown old lady who walks with a stick.”
Adrenal insufficiency: decreased cortisol and aldosterone
Decreased BP, dehydration.
Hyperkalemia
Decreased glucose
Bronze pigmented skin
Weight loss, anorexia, GI disturbances
Intolerance to cold and stress
Generalized weakness
What is a disease of adrenal insufficiency?
Addison’s Disease
What’s the difference between Cushing’s Disease vs Syndrome?
Disease: increased ACTH released by pituitary
Syndrome: increased cortisol released by adrenal
What are the symptoms of Cushing’s Disease?
“Mr. Cushings: white chubby boy who loves chugging beer.”
Elevated cortisol + aldosterone
Increased BP, water retention
Hypokalemia
Increased glucose
Ruddy/red appearance
Weight gain, centripetal obesity, moon face
Proximal muscle weakness and atrophy
Frozen shoulder is very common with which endocrine disorders?
Thyroid disorders (both hyper and hypo)
Graves’ disease is what type of endocrine disorder?
Hyperthyroidism
How does hyperthyroidism affect a person’s MSK system?
Decreased bone mineral density
Increased risk of osteoporosis
Hyperreflexia
Hashimoto’s disease is what type of endocrine disorder?
Hypothyroidism
(Hypo/hyper)thyroidism increases the risk of DM2
Hypothyroidism
What are the symptoms of hypothyroidism?
“A lazy person laying on the couch watching TV, cozy under a comforter.”
Decreased HR
Low BMR
Cold intolerance
Decreased glucose absorption (increased blood glucose)
Sleepiness, tiredness, proximal muscle weakness
Constipation
Weight gain and decreased appetite
Prolonged deep tendon reflexes
What are the symptoms of Hyperthyroidism?
“David! Super hyper, doesn’t gain weight with all the mango lassis he drinks, and has silky hair.”
Increased HR (decreased BP)
High BMR
Heat intolerance
Increased glucose absorption (decreased blood glucose)
Restlessness, insomnia
Diarrhea
Weight loss and increased appetite
Increased perspiration
Hyperreflexia
What is the job of the parathyroid gland?
Controlling calcium and phosphate.
Parathyroid Hormone (PTH) is (directly/inversely) related to calcium levels.
PTH is directly related to calcium, inversely to phosphate.
Hyperparathyroidism is (+/-) calcium and (+/-) phosphate
Increased calcium
Decreased phosphate
Remember that parathyroid hormone is directly related to calcium levels, and inversely related to phosphate levels.
What are the symptoms of Hyperparathyroidism?
Bones: osteopenia
Stones: kidney stones
Groans: peptic ulcers
Moans: fatigue, depression, confusion, drowsiness
Sensory: glove/stocking sensory loss
Hypercalcemia, as seen in Hyperparathyroidism, leads to increased (bone/blood) calcium levels.
Blood calcium: this is why osteopenia is a side effect of hyperparathyroidism
Symptoms of Hypoparathyroidism
CATS are Numb
Convulsions
Arrhythmias
Twitching/tetany
Spasms
Numb: paresthesia of fingers and mouth, fatigue
The pancreas does not produce enough insulin in (Type 1/Type 2) DM.
Type 1: also called hypoinsulinemia
What are the symptoms of T1DM?
3Ps:
Polyphagia (increased hunger)
Polyuria (increased urination)
Polydipsia (increased thirst)
Ketoacidosis is much more common in which type of Diabetes?
T1DM
Symptoms of Hypoglycemia
TIRED
Tachycardia
Irritable
Restless
Excessive hunger
Dizzy
“If they’re cold and clammy, give them a candy.”
Symptoms of Hyperglycemia
HOT + DRY = SUGAR HIGH
Dry mouth, polyuria, excessive thirst, etc.
At what blood glucose levels should you NEVER exercise?
<70
>300
Exercise (increases/decreases) insulin sensitivity, which in turn decreases blood glucose.
Increases insulin sensitivity
Rules for Diabetic Foot Care
- Look for diabetic neuropathy
- Screen feet regularly
- Wash (do not soak) feet in warm water daily
- Keep toenails trimmed
- Clean white socks should be worn
- Alternate shoes, snug fit
- Shop for shoes in the afternoon
What type of incontinence is the involuntary leakage of urine during coughing, sneezing, or exercising?
Stress Incontinence: pelvic floor weakness
- can be seen postpartum
What type of incontinence is the involuntary contraction of the detrusor muscle with a strong desire to void?
Urge Incontinence: overactive bladder
- can be seen with infections, PD, UMN lesions
What type of incontinence is caused by the acontractile or underactive detrusor muscle? Bladder is overdistended, cannot empty completely, and urine dribbles or leaks out.
Overflow Incontinence: underactive bladder
- can be seen with DM
What type of incontinence is due to mobility, dexterity, or cognitive deficits?
Functional Incontinence
- can be seen with dementia, LE weakness
What is the treatment for Overflow Incontinence?
Behavioral modification like double voiding, medication, and catheterization.
What is the treatment for Urge Incontinence?
Treat infections, voiding schedule, and relaxation.
What is the treatment for Stress incontinence?
Strengthen pelvic floor muscles
What is the treatment for Functional Incontinence?
Clear clutter, improve accessibility, and prompted voiding
How would you describe what your patient should expect with cryotherapy?
CBAN
Cold
Burning
Aching
Numb
For heat:
What is the ideal temperature of storage?
Treatment time?
Layers of toweling?
Temp: 158-167 deg F
Time: 20-39min
Layers: 6-8
For cold:
What is the ideal temperature of storage?
Treatment time?
How often can you apply?
Temp: 25 deg F
Time: 10-20min
Can be applied every 1-2 hours.
NMES Parameters
Pulse Fq: 35-88 pps
Pulse Duration: 150-200 for small muscles, 200-350 for large muscles
Amplitude: >10% MVIC in injured, >50% MVIC in uninjured
On:Off Time: 1:5
Ramp Time: 2sec or more
High-Voltage Pulsed Current is used for what?
Promoting wound healing
For inflamed or infected wounds, you’d want to use (positive/negative) electrodes.
Negative
For wounds without inflammation and/or in the proliferation phase, you would use (positive/negative) electrode.
Positive
For High-Voltage Pulsed Current, the pulse frequency is always at ___.
100-105 pps
What are the negative ions used in Iontophoresis?
I SAD
Iodine
Salicylate
Acetate
Dexamethasone
For acute wounds, you would use a (pulsed/continuous) duty cycle for US.
Pulsed
For chronic wounds, you would use a (pulsed/continuous) duty cycle for US.
Continuous
For Ultrasound, a frequency of 1MHz is (deep/superficial).
Deep
For Ultrasound, a frequency of 3MHz is (deep/superficial), but also hotter than the 1MHz.
Superficial
When performing EMG Biofeedback on a patient with spasticity, you want the sensitivity to be (low/high) and electrodes to be (close/far).
“She Loves and Fancies Him”
Spasticity = Low = Close
When performing EMG Biofeedback on a patient with flaccidity, you want the sensitivity to be (low/high) and the electrodes to be (close/far).
“She Loves and Fancies Him”
Flaccidity = High = Far
How would you position a patient with a posterior disc herniation for lumbar traction?
Prone
When aiming to get a full joint distraction, how much weight should be applied during traction?
50lbs or 50% of body weight
When treating a disc protrusion with traction, how much weight would you use?
25% of body weight
What are the contraindications to mechanical traction?
Immobilization
Acute injury or inflammation
Joint hypermobility or instability
Peripheralization of Sx with traction
Uncontrolled HTN
What is a positive Babinski sign?
Toes point UP when you stroke the side of the foot.
UMN = UP
What is Dysdiadochokinesia?
Inability to perform rapid alternating movements
When the Basal Ganglia is affected, how does a patient’s tone change?
Increased: Rigidity (not velocity dependent)
Ataxia, intention tremor, dysdiadochokinesia, dysmetria, and nystagmus are all symptoms of what type of lesion?
Cerebellar lesion
When the Basal Ganglia is affected, how do voluntary movements change?
They are decreased and slowed.
Bradykinesia, akinesia
How do voluntary movements change with UMN dysfunction?
They move in synergic patterns.
What are the cardinal signs of PD?
TRAP
Tremor
Rigidity
Akinesia
Postural instability
Micrographia, mask-like face, hypophonia, and loss of smell are all symptoms of what disease?
Parkinson’s
What does Parkinson’s gait look like?
Freezing: sudden inability to initiate movement
Festinating: short stride, shuffling, increased speed
Festinating gait happens due to patient’s posture, so what can be added to shoes to help?
Toe wedge or declined heel: because PD patients are very kyphotic, their COM is moved anterior. You can add these things to bring it back more.
Hoehn and Yahr Classification of Disability
I: unilateral
II: bilateral
III: balance
IV: rolling walker
V: wheelchair
Your patient is taking Sinemet for PD. When should you tell them to take their medication in relation to your PT appointment?
PT should be scheduled 1 hour after dose
What type of diet should patients taking Sinemet avoid?
High protein
What are the signs and symptoms of Multiple Sclerosis?
All common UMN symptoms
Optic Neuritis
Trigeminal Neuralgia
Pseudobulbar affect (inappropriate laughing or crying)
What is Lhermitte’s Sign?
In MS, when patients feel a shock-like sensation down their spine with neck flexion.
What is Uhthoff’s Phenomenon?
Uhthoff sounds like Utah
Heat gives a pseudoexacerbation or temporary worsening of symptoms.
What temperature should the pool be for Multiple Sclerosis patients?
<85 deg F
What are the 4 MS Types
Relapse-Remitting
Primary Progressive
Secondary Progressive
Clinically Isolated Syndrome
What is Clinically Isolated Syndrome (CIS)?
The first episode of inflammatory demyelination of the CNS (first episode of MS symptoms).
When should you schedule your PT session with your patient with MS?
In the morning to avoid fatigue.
Amyotrophic Lateral Sclerosis presents as UMN or LMN?
Both
T/F: ALS presents with motor and sensory loss
False: ALS is death of motor neurons, sensory is intact
What is a key muscle group that is commonly weak in people with ALS?
Cervical extensors
Guillain-Barre Syndrome presents as a (LMN/UMN) disorder.
LMN
Demyelination of the nerves in the brain occur in (MS/GBS)
MS
Demyelination of nerve roots, peripheral nerves, and cranial nerves happens in (MS/GBS)
GBS
Guillain-Barre Syndrome symptoms
GBS
Glove and stocking paresthesia as well as motor loss.
Bilateral
Symmetrical
What condition is a painful rash with clusters of fluid filled vesicles that present in a dermatomal pattern?
Herpes Zoster
Which cranial nerve is most often affected in Herpes Zoster?
Trigeminal (V)
