MEGA REVIEW DAY 2 Flashcards
Types of MS: 4 (Its IN the NAMES!)
ON TEST– DRAW THE GRAPH!!!!
- Relapsing Remitting– Unpredictable attacks which may or may not leave perm deficits f/b pds of remission
- Progressive Relapsing– Steady decline since onset w/ superimposed attacks
- Primary (Chronic) Progressive– Steady INC in disability w/out attacks
- Secondary Progressive– STARTS as relapse-remitting PROGRESSES to primary progressive
What VOLUMES ALWAYS INCS in COPD?
INC RV, FRC, TLC
GOLD CLASSIFICATION- COPD
REMEMBER Start @ 30%- VERY Severe
Mild–> Very Severe; all stages have FEV1/FVC < 70% (remember COPD lOwer than 70%)
I: Mild– FEV1 >/= 80%, w/ or w/out sx’s of cough/sputum
II: Mod– FEV1 50-79%; SOB w/ exertion, w/ or w/out cough/sputum
III: Severe– FEV1 30-49%; greater SOB w/ ex, decd ex cap, fatigue and repd exacerbation of COPD
IV: Very Severe– FEV1 < 30% (Start here!); chronic resp failure
ULTT Tests
ULTT1= MAIN
ULTT2= MAM
ULTT3= R
ULTT4= U
ALL are CS lateral flexion C/L side
Helpful tips for P. nerves
See hand deformities/P. nerve lesions in notes!!!
P nerve maps!!!
- Median/Ulnar or any major P. nerve– Sensory AND Motor loss
- Interosseus– think ONLY MOTOR
- Cutaneous– think ONLY SENSORY
SCI Syndromes
What MUST you draw for each????
- DCML sxs– same side
- Corticospinal sxs– same side
- Lateral (pain/temp) + Ant (crude touch) Spinothalamic sxs– OPP side
Anterior Cord
- HyperFLEX injury
- Motor function loss B/L, Spastic paralysis below lvl of injury, Loss of pain/temp B/L lvl of injury
Posterior Cord
- Sensory loss (DMCL–Val got GBS twice) (lose proprio, vibration, stereog)
Central Cord (sm or lg–“Walking Quads”)– MUD-E (Motor, UEs, Distal)
- HyperEXT inj
- Loss pain/temp
- Motor loss B/L UEs only
Brown-Sequard
- Brown POT – pain/temp OPP
- I/L sx’s–> motor and sensory loss
Pressure Ulcers— See bonus material for pics
Stages 1-Unstageable
Over bony areas–stage related to depth of wound bed
Stage 1: intact skin w/ non-blanchable redness
Stage 2: Partial thickness (Pink) wound. Superf in nature w/ pink/red wound bed (SHALLOW crater)
Stage 3 (FAT is 3 letters): Full thick (Fat). Subq tissue visible but no bone, tendon and mm. DEEP crater
Stage 4 (BONE is 4 letters): Full thick w/ bone exposed, tendon and mm. Undermining and tunneling w/ slough/eschar present
Unstageable: wound bed covered w/ slough/eschar– unable to ID depth
Deep tissue injury– Intact skin w/ purple/maroon appearance
Venous vs Arterial Insufficiency (Wounds)
Venous– “My (medial mall) Victory (venous) Elevates Me (elevate the leg)”
- prox to med mall
- Irreg, shallow
- Flaking, brownish–hemosiderin stain
- mild-mod pain (bc still blood there)
- Elevation DECs pain (bc gravity assists bloodflow)
Arterial– All (arterial) Losers (lat mall) stays down (NO elevation of LE)
- lower 1/3 of leg, toe, LAT mall
- smoothe edges, well-defined
- thin and shiny, hair loss, yellow nails (trophic changes–PAD)
- SEVERE pain (bc no bloodflow!)
- Elevation INCs pain (bc already NO blood there, now theres REALLY no blood if you elevate it!)
Burns!!!
Review!!!
REVIEW Sx PROTOCOLS!!!!
!!!!!!!!
THA Precautions:
Ant vs Post Approach
AVOID!
Posterior – ESP first 6wks
- hip flex >90degs (knees lower than hips)
- ADD past midline (bed pos’ing w/ ADD wedge
- IR
- No FADDIR
Anterior
- hip flex >90degs
- Individual: hip EXT, ADD, ER past neutral
- Combined: FABER
Parametric Tests: 2
- Paired T-Test (2a: 1-tail 2b: 2-tail)
- ANOVA (3 or more ind groups compared on 1 intervention)
Parametric Tests
Paired T-Test
T-test think TWO groups
Compares diffs bw 2 matched samples
- 2a: 1-tailed= 1 end of distribution, EITHER (+) or (-)
- 2b: 2-tailed= 2 ends of distribution, BOTH (+) and (-)
Ex. Dist covered by M/F on 6MWT
1-tail= Females cover longer dist
2-tail= Looks @ BOTH males or females
Parametric Tests
ANOVA (3 groups) and ANCOVA
One way ANOVA: 3 or more ind groups compared on 1 intervention
ANCOVA: Compare 2 ore more Tx groups while controlling effects of variables (COvariates) Ex. time
Parametric Tests (Paired T-test and ANOVA)
Gen Details
Research Question
- 2 groups== IND or unpaired T-tests
- 2 Tests
Criteria/Assumptions
- EQUAL samples
- NORMAL distribution (Bell curve)
- CONTINUOUS scale= Ratio/Interval= ROM, Temp, Ht/Wt, Distance, Infinite #’s
ORDINAL== rank/scale—DIFFERENT
NONparametric Tests
Kruskal Wallis test- NONparametric equivalent to ANOVA– needs 3 groups
Chi-Square- 2 groups but NOMINAL (Y/N) data– Association study (asking is this ASSOCIATED w/ that? Y/N?= Nominal (Nominal think Nonparametric)
Long Sitting (Supine to Sit) Test
Rotated inominate
- If leg on PFL side appears LONGER in SUPINE, then SHORTER in Long-Sit==> Anteriorly rotated inom on that side
- If leg on PFL side appears SHORTER in SUPINE, then LENGTHENS in Long-Sit==> Posteriorly rotated inom on that side
- MM Energy Techniques**–> Stretch BEFORE strengthen, OR isometric to opp side to pull inominate back
Postural Drainage: KEY POS’s
BAD lung UP
Key Pos’s
- SUP segs, LOWER lobes==> prone w/ 2 pillows under pelvis
- ANT apical segs, UPPER lobes==> recliner leaning slightyly backwards
- POST apical segs, UPPER lobes==> sitting on chair leaned forward
- ANT segs, UPPER lobes==> supine w/ pillows under knees
Postural Drainage: Tips to remember
BAD lung ALWAYS UP
Ex. R middle lobe= R. lung UP; L lingular= L lung UP (Both raise feet 12 in. (middle lobes raise feet 12in); LOWER lobes= raise feet 18in
Position help:
- Ant segs= Supine
- Lateral segs= S/L
- Posterior segs= Prone
- Apical= Sitting (Ant apical= recline back; Post apical= sit & lean forward
Contraindications to Postural Drainage
**Precautions vs Relative Contraindications (IHRRR, make sound)
Precautions:
- Pulm edema, Hemoptysis, Massive obesity, Lg pleural effusion, Massive ascites
Relative Contraindications: “IHRRR”
- Incd ICP, Hemodynamically UNstable, Recent esophageal anastomosis, Recent spinal fusion or injury, Recent head trauma
SCI Chart
See chart—KNOW IT!!!
SCI Chart Broken Down
C1, 2, 3/C4= High lvl injury– DEPENDENT
C5/C6– Modified DEP/IND
C7-L4/5, S1/2– IND w/ MOST
SCI MM’s spared
C1, 2, 3= Face/Neck
C4= Diaphragm (partial), Trpz (bc they are CN XI)
C5= 3BIRDS- Biceps, Brachialis, Brachioradialis, Infrasp, Rhomboids, Deltoids, Supinators
C6 (SLIP rhymes w/ 6)= PET-SLIP- P.major, ECR, T.minor, SA, LD, Infrasp, Pronator
C7= FEET- FCR, EPB/EPL, Extrinsic finger EXTs, Triceps (easy C7 one to remember)
C8= FCU, FPL/FPB & Intrinsic finger FLEXors
T1-T12= Intercostals, long mms of back (sacrospinalis and semispinalis), Abs ~T7 and below
L1, 2, 3= Gracilis, Iliopsoas, QL, RF, Sartorius
L4= TA, L5= ED, S1= PFs, S2= HS’s
What lvl of RLA scale do you HAVE to know?????
TBI- RLA Lvl IV: Confused & Agitated
TBI- RLA Lvl IV: Confused & Agitated
Motor vs Behavioral Probs
Motor probs:
- Goals: Inc endurance, Maint jt mob, Dec risk secondary impairs
- Intervention: Prepare MULT acts, Give pt CHOICES (make them feel they are in charge)
Behavioral probs:
- Goals: Dec outbursts, Dec agitation
- Interventions: Be CALM, Be CONSISTENT (same tx time, same PT, same location), Provide orientation, Know when to STOP or CHANGE act.
NPTE questions—
READ STEM FIRST!!!
LOOK FOR KEYWORDS AND WORDS LIKE “MOST, LEAST, ETC”
!!!!!!!!
More on RLA Lvl IV: Confused & Agitated
- ALWAYS orient the pt!!!
- use the SAME people, Introduce yourself!!
- Be calm, composed
- Give OPTIONS (This OR That)
- More– daily routine, orient pt, chart/white board to doc progress
NEVER use Y/N questions OR open-ended questions!!!!
TBI-RLA Scale
Broken down
1-3= Response; 4-6= Confused; 7-8= Appropriate
1: No response
2: General response
3: Localized response
4: Confused-Agitated
5: Confused-INappropriate
6: Confused- Appropriate
7: Automatic-Appropriate
8: Purposeful-Appropriate
Balance Strategies
2 types:
Corrective (Ankle strategy & Hip strategy)
Protective (Stepping strategy & Reach/Grasp strategy)
Balance Strategies
Corrective: Ankle (small) vs Hip (large)
- Bring us back to neutral
Ankle strategy: OA (Opp Ankle)
- Sway/Perturb= Small, slow, near midline
- MM’s activation= Dist–> Prox
- w/ FORWARD sway= Gastroc–> HS’s–> Paraspinals (Forward sway think POST mm’s bc its OPP
- w/ BACKWARD sway= Tib ant–>Quads–>Abs (Backward sway think ANT mm’s bc opp
Hip strategy
- Sway/Perturb= Lg, (bc Lg jt), fast
- MM’s activation= Prox–> Dist (do it and you’ll feel it, same w/ ankle)
- w/ FORWARD sway= Abs–>Quads (same side mm’s)
- w/ BACKWARD sway= Paraspinals–>HS’s
Balance Strategies
**Protective: Stepping vs Reach/Grasp **
- EXTRA strategy to help out
Stepping strategy:
- Sway/Perturbs= Fast and Lg
- COM exceeds BOS
Reaching/Grasp strategy:
- UEs
- Extend BOS to stabilize posture
Suspension think Lowering BOS closer to floor, bend knees/lower BOS
ROODS Approach
What do you IMMEDIATELY think of?
Facilitory vs Inhibitory
ROODS Approach
Facilitatory Tech’s
Think ACTIVATE
LOOK @ the words used!!!
Ex. Flaccid mm’s
- Approx
- Lt manual resist, Manual contact
- Quick icing
- Lt touch
- Tapping, brushing, hacking
- High freq vibration
- Quick stretch
- Fast spinning or rolling
ROODS Approach
Inhibitory Tech’s
Think PREVENT Activation or Inhibit
Look @ Words used!!!
Ex. Spasticity
- DEEP pressure
- Prolooonged stretch
- Neutral warmth or prolonged cold
- Maintained touch– myofascial release–hold it there to RELAX mm’s
- Rhythmic swinging
- LOW freq vibration
- Slow-stroking
- Slow rocking or rolling
Mod. Ashworth for Grading Spasticity
0= NO inc in mm tone
1= Slight inc in mm tone, manifested by catch and release OR by min resist @ end of ROM when affected part moved into flex/ext
1+= Slight inc in mm tone, manifested by catch f/b MIN resist t/o remainder (less than 1/2) of ROM
2= More marked inc in mm tone t/o MOST of ROM, but affected part easily moved
3= Considerable inc in mm tone, passive mvmt is diff
4= Affected part(s) rigid in flex or ext
Putting ROODs Approach into practice
Pt w/ R. CVA (perceptual defs). Biceps grade 2 on MAS. Most effective intervention?
Think SPASTIC…think INHIBIT (slow words)
A: Proloooonged cyro to L. biceps bc this will inhibit the mm
Lymphedema Mgmt UE exercises
**What should you remember about this? **
PROXIMAL muscles FIRST!!!!
When it comes to Ex’s for lymph03dema…. Start PROXIMAL!!!
Techniques for Lymphedema and Direction:
Technique: Stroking/Massage Direction: Dist–> Prox
Technique: Decongestion Direction: Prox–> Dist (think traffic jam, have to clear the congestion proximally BEFORE the distal can come through!!!)
Technique: Exercise Direction: Prox–> Dist
Iontophoresis
At least remember the NEGATIVE (ISAD) ions
ISAD (Ions)
- Iodine (-): Sclerotic scars
- Salicylate (-): Analgesic (Sal has pain, analgesic)
- Acetate (-): CAlcium deposits
- Dexamethasone (-): Msk inflammation
Rest are all (+)– some to easy remember
- Zinc (+): WoundZ– Dermal ulcers
- LidoCAINE/XyloCAINE (+): Analgesic
- Copper (think old fungal penny on ground) (+): Fungal infx
- Magnesium (think “spastic maggy”) (+): Muscle spasm
Iontophoresis
At least remember the NEGATIVE (ISAD) ions
ISAD (Ions)
- Iodine (-): Sclerotic scars
- Salicylate (-): Analgesic (Sal has pain, analgesic)
- Acetate (-): CAlcium deposits
- Dexamethasone (-): Msk inflammation
Rest are all (+)– some to easy remember
- Zinc (+): WoundZ– Dermal ulcers
- LidoCAINE/XyloCAINE (+): Analgesic
- Copper (think old fungal penny on ground) (+): Fungal infx
- Magnesium (think “spastic maggy”) (+): Muscle spasm
Iontophoresis
At least remember the NEGATIVE (ISAD) ions
ISAD (Ions)
- Iodine (-): Sclerotic scars
- Salicylate (-): Analgesic (Sal has pain, analgesic)
- Acetate (-): CAlcium deposits
- Dexamethasone (-): Msk inflammation
Rest are all (+)– some to easy remember
- Zinc (+): WoundZ– Dermal ulcers
- LidoCAINE/XyloCAINE (+): Analgesic
- Copper (think old fungal penny on ground) (+): Fungal infx
- Magnesium (think “spastic maggy”) (+): Muscle spasm
E-stim parameters for MM Contractions
Pulse Freq: 35-80 pps
Pulse Duration: Sm mm’s= 150-200 Lg mm’s= 200-250 (larger #)
Amplitude: Injured= >10% MVIC UNinjured= >50% MVIC
On:Off Times/Ratio: JUST REMEMBER 1:5 INITIALLY— can then progres “On” time
Ramp Time: @ least 2s (1-4)
Tx Time: 10-20 mins to produce 10-20 reps
X/Day: Every 2-3hrs when awake
Common GAIT abnorms: 4
- Step LENGTH devs
- Trunk bending devs (Magnet Theory in STance)
- LLD devs
- Inad mm control devs
Practice + tips
Pt w/ weak tib ant (DFs), PT uses FES to improve ambulation. Stimulation initiated for weak mms during which phase of gait cycle?
Initial Swing to Mid Swing
Bc FOOT CLEARANCE, functionally this is THE MOST IMPORTANT and functional answer.
TIP: ALWAYS pick MOST functional mvmt
If they cannot clear the foot== higher risk of falls
Lumbar spine mobilizations
CLOSING and GAPPING
Remember… “Bar OPENS= Pop the Top, Cheers” “Bar CLOSES= Bottoms UP (finish your drinks)
ALWAYS DRAW THE “C”
Flexion: OPENS or INCs gap
Extension: CLOSES or DECs gap
- Imagine vertebrae as letter “C”– DRAW IT!
- Always PA mob
- If it says U/L– mob TP, or it will say facet joints
- If it says B/L– mob SP
Ex. PT det’s manual therapy to improve closing (Bottoms UP) of T4-T5 facets (think TPs). Hand/finger placements for PA mob?
MAKE THE C!!!
Mobilize TP of T5 to move T5 (bottom) UP to improve CLOSING
Burns and Contracture Predisposition Pos’s
If you know where they are at most risk for contracture, just put them in the OPP position!!!
Most common contracture pos’s:
Neck= flexion
Shoulder= ADD/IR
Elbow= flexion
Forearm= PRO
Wrist/Hand= Claw hand (intrinsic minus) w/ MCP ext, IP flex, thumb ADD
Hip= flex/add
Knee= flex
Ankle= PF
SO THEN PREVENTATIVE POSITIONING IS JUST THE OPPOSITE– see chart
Garment Compression Classification for Lymph03dema
NOTE: Compression MUST ALWAYS BE LOWER than DBP
Class I (Least) to Class IV (Most)– things to remember + see chart
Class I 20-30: Least compression– think MILD lymphedema, Stage I, elderly
Class II 30-40: ALWAYS UE lymphedema (most common for UE lymph)
Class III 40-50: think LE lymphedema, Stage II (high-int acts)
Class IV 50-60 (really high, rare): usually only thru recommendation
What type of STRETCH bandage for lymph03dema?
SHORT (LOW) stretch w/ more layers DISTALLY than proximally– easy to remember bc short person is LOW to ground
NO BP on lymph arm ever!!!!
No heat!! bc will inc swelling
Diastasis Recti
Split of rectus abdominis @ linea alba
Test: Pt in Hooklying– raise head/shoulders OFF floor–reach hands towards knee until scap leaves floor–> PT places one finger of one hand horiz. across midline of abdomen @ umbilicus
Interpret: If split is >2cm= Concern
Treat: First protect (binding/bracing) abd musculature then progress to head lifts THEN head lifts w/ PPTs
Supraventricular arrhythmias aka
Atrial arrhythmias
SUPRAvent arrhythmias Types: 4
Atrial arrhythmias are NEVER an emergency bc Vents are still FINE
- PAC
- Atrial Tachy (Rate= 100-250bpm)
- Atrial Flutter; F-waves (Rate= 250-350bpm)
- Atrial Fibrillation; quivering (Rate= 400-600bpm)
Atrial probs are NEVER 911–> Insuff CO though, blood pooling–> clot risk (if A-fib)
Incremental Exercise
What should you think of?
HR & BP
- SHOULD Inc linearly w/ inc’ing work rate
Incremental Exercise
HR and CO (HR * SV)
Incs linearly w/ inc work rate
Reaches plateau @ 100% VO2 max
Incremental Exercise
BP (MAP)
MAP incs linearly
- SBP Incs
- DBP remains fairly constant (+/- 10)
Cardinal Signs L. vs R. sided HF
L. Sided HF:
1. DOE
2. Cough
3. will also see Pulm edema (pump failure)
R. Sided HF
1. JVD
2. Peripheral edema
Lumbar Traction
Key stuff
Supine (Flex bias) w/ pillows under knees–> IVJs, Facet jts, MM elongation
Prone (Ext bias)–> Posterior disc herniation
To Inc IV space of:
- L5-S1 (Lower=Little bit): 45-60degs hip flexion (obv supine)
- L3-4 (higher): 75-90deg hip flexion
Lumbar Traction
% BW Parameters
Disc protrusion/herniation, spasm, elongation= 25% BW
Jt distraction= 50lbs OR 50% BW (obv more bc need to distract)
NO >50% BW
NOTE: CS traction= 5-7% BW or 25lbs
Above Knee Prosthesis: Above Knee Amp; Transfemoral
LOW (Weak) walls vs HIGH (High and Tight) walls
LOW walls (think loW=Weak)
- Think WEAK mm’s
- Ex. LOW ant thigh wall= weak quads
- Ex. LOW lateral wall= weak abd’s
High walls (think High and TIGHT)
- Think TIGHT mms
- Ex. HIGH ant thigh wall= tight hip flexors- pulls pelvis ANTERIORLY
