Mobility Flashcards
How far away should a patient place their lead hand away from the sliding board?
4-6 inches
Patients with unilateral weight-bearing restrictions or hemiplegia may utilize what transfer and lead with what foot?
Stand pivot transfer leading with their
Uninvolved side
This transfer may also be used therapeutically, leading with the involved side for a patient post CVA
What w/c frame - pt is able to self propel using LE
Hemi frame
What w/c frame - pt is able to self propel using one UE
One hand drive frame
What w/c frame - pt is unable to self propel or safely operate a power w/c
Geri chair
A back insert for a patient requiring no postural support and has no neuromuscular deficits; not typically intended for long-term use
Sling back
The back insert for a patient requiring mild to moderate trunk support due to Tone strength or deformity related postural concerns
Planar ( flat) back insert
A back insert for patients requiring moderate trunk support due to tone strength or deformity related postural concerns
Curved back insert
Seat insert for a pt with no seated deformity
Planar flat seat
A seat insert for a patient requiring mild to aggressive supportive curvature to provide increased contact between the lower body and the seat
Curved seat
A seat insert for a patient requiring correction of pelvic obliquity or fixed asymmetrical deformity
Custom molded seat
A seat insert for patient whom self propels using LEs
Bevel ( undercut) front edge of seat
Trunk support for a pt requiring mild to mod lateral support due to listing or scoliosis
Planar lateral supports
Trunk support for a pt requiring total constant lateral support due to significant listing or scoliosis
Contoured or curved lateral supports
Trunk support for a pt requiring support to correct for anterior listing
Chest strap
Trunk support for pt requiring both trunk and shoulder support to correct for anterior listing
Chest harness
What are full length armrest good for
Pt perform sts transfers, additional support, pt need for lap board
Pt needs minimal support for the UE; pt requires easy access to wheels for propulsion, pt requires easy removal of arms
Tubular or single posted arms
Large diameter handrims for?
Some degree of weakness
Pt has grip deficits or hand deformities which limits the ability to functionally grip rims
Rim projections
Pt requires assistance with adequate grasp or friction when hands are in contact with wheel rims
Covered rims
Footrest required for a pt with a lower extremity that is not aligned with body midline as with a windswept deformity
Custom foot box
Light weight cushions but can produce high shear forces
Soiled foam cushions
Cushions which are heavier but serve to limited shear forces
Liquid cushions
Proper height of parallel bars and walker
Allows for 20-25 degrees of elbow flexion - grasp the parallel bars approximately 4-6 inches in front of the body
Crutches parameters
6 inches in front
2 inches lateral
Crutch height no more than 3 finger width from the axilla
Handgrip adjusted to ulnar styloid process
What AD requires the highest level of coordination
Loftstrand crutches
What AD shouldn’t be utilized for pt’s that are partial wb
Straight cane
The pt ambulates moving the left crutch forward while simultaneously advancing the right LE
Two point gait
The AD, following by involved LE, and lastly the uninvolved LE
Three point LE
What gait pattern is prescribed when a pt exhibits impaired coordination
Four point gait
Similar to the two point gait but the pt does not move the LE simultaneously with the device, but rather waits and advances the opposite leg once the crutch or cane has been advanced
Descending stairs stairs with crutches sequence
Involved leg and crutch to the lower step; followed by uninvolved leg
A device is commonly used for a short term liquid feeding, medication administration, or to remove gas from the stomach
nasogastric tube
A tube used for pt’s with diff with swallowing due to an anatomic or neurologic disorder or to avoid the risk of aspiration
Gastric tube or jejunostomy tube
Used for long term feeding
If a a line is displaced what should PT do
Apply direct pressure and call for assistance
What monitoring device is used for measuring BP or to obtain blood samples
Arterial line
What monitoring device is used to evaluate the right ventricle function, right atrial filling pressure, and circulating blood volume.
Central venous pressure catheter
Measures pressure in the r atrium or superior vena cava
What monitoring device is used for long term administration of substances into the venous system such as chemotherapeutic agents, total parenteral nutrition, and antibiotics
Indwelling right atrial catheter (Hickman)
What device is used to determine oxygen saturation of blood
Oximeter
What monitoring device is used to provide continuous measurements of pulmonary artery pressure.
Swan ganz Cather aka pulmonary artery Catheter
Pt should avoid excessive movement of the head neck and extremities to avoid disrupting the line at the insertion site
Applying a traction force using an externally applied weight most commonly used for femur fractures
Balanced suspension
Requires prolonged immobilization
What type of skeletal fixation allows for earlier mobility while maintaining the desired alignment
External fixation
Internal too
Ostomy device
Poop bag attached to small intestine with stoma exit
Diagnostic test used to identify arteriosclerosis, rumors, or blockages
Arteriography
Invasive test providing visualization of joint structures through radiographs
Arthrography
A test which relies on the transmission and reflection of high-frequency sound waves to produce cross-sectional images in a variety of planes. It can evaluate blood flow in the major veins arteries and cerebrovascular system
Doppler ultrasonography
What diagnostic test is used to assess seizure activity metabolic disorders and cerebral lesions
Electroencephalography
Which diagnostic test is used to identify bone displacement, disk herniation. Spinal cord compression or tumors
Myelography
Which diagnostic test produced planar images
X-ray
The gain or loss of heat resulting form direct contact between two materials at different temperatures ie cold pack, paraffin, ice massage
Conduction
Metal has an extremely high thermal conductivity thus all Jewelry must be removed prior to initiating treatment
Gain or loss of heat resulting from air or water moving in constant motion across the body ie hot whirlpool
Convection
Hearing that occurs when non thermal energy is absorbed into the tissue and transformed into heat. Heat transfer does not require direct contact but does need a median that allows transmission
I e ultrasound or diathermy
Conversion
Refers to the transfer of heat that occurs as a liquid absorbs energy and changes into a vapor
Evaporation
Vapocoolant spray
Refers to the direct transfer of heat from a radiation energy source of higher temperature to one cooler temperature
Radiation
Infrared lamp
Laser
Uv light
5 contraindications to cryotherapy
Cold intolerance Infection Decrease circulation Over regenerating nerves Raynaud's phenomena
When should one stop ice massage?
Ice massage should continue until the pt reports analgesia aka inability to feel pain
Intense cold > burning > aching > analgesia
Following ice massage what is the normal skin response ?
Dark Pink or red
Abnormal is wheals
What strategy should be used to inc the initial cooling heating effects of hot/cold pack?
Moist towel to minimize the influence of air as a poor conductor of temperature
Parameters for ice pack application
Applied for 20-30 mins
30 mins is for spasticity reduction
Reapplied 1 to 2 hours for reduction of inflammation and pain control
Spray and stretch technique for trigger points
Make three to four sweeps with the spray in the direction of the muscle fibers
Applied at a 30 degree angel at a distance of 12-18 inches from the skin
Stretched during the spraying and after
Reapplication during same treatment is saga as long as the skin is rewarmed
Vapocoolant spray for non-trigger point application
From proximal to distal
Torticollis, neck, or low back pain caused by muscle spasm, acute bursitis, and hamstring tightness
How many layers of towels should be between the skin and the hot pack?
6-8
Commercial hot pack is equivalent to 2-3 towel layers
If pt can’t tolerate from for hot pack treatment ?
Pt should be positioned in SL with the HP strapped to body
Skin checks for hot pack how often
After first 5 min
After 6-8 minutes max surface temp is reached, making it critical to perform frequent skin checks during the first ten mins
How long do hot packs require to achieve the desired effects?
15-20 min
If the hot pack is not hot enough what should the PT do?
Towels should be removed the next treatment session
A container circulating warm air and small cellulose particles, creating superficial heating thought forced convection
Fluidotherapy
What is the main therapeutic effect of infrared lamp
Enhancement of soft tissue healing
Benefits of paraffin
Low melting point- more even distribution of heat
Low specific heat- enhances a pt’s ability to tolerate heat
A paraffin technique where the pt maintains a static position as the distal extremity is dipped into the paraffin bath and is removed. After it hardens it is dipped back in for 6-10 times then placed into a plastic bag and towel wrapped
Dip- wrap
What are non-thermal effects of ultrasound
Increased cell and skin membrane permeability, increased intracellular calcium levels, facilitation of tissue repairs, and promotion of normal cell function
What decreases the acoustic impedance by eliminating as much air as possible between the transducer and the target area.
Coupling agents
When using indirect coupling agents such as water immersion the transducer should be moved parallel to the treatment surface at a distance of
0.5-3.0 centimeters away from the skin
What is the beam non uniformity ratio (BNR)
The ratio between the special peak intensity and the spatial averaged intensity
Usually is 5:1 or 6:1
The Lower the BNR the better since less hotspots
What frequency of ultrasound is absorbed more rapidly?
Higher frequency is absorbed more rapidly than ultrasound delivered at a lower frequency.
A setting of 3 MHz is used for?
More superficial tissues (1 to 2 cm) since it’s a higher frequency which is absorbed more rapidly
A frequency of 1MHz is for
Deeper tissues (up to 5 cm)
Pulsed ultrasound is primarily used for generating ?
Non thermal effects and should be done at 20% or lower duty cycle
An area of _______ times the size of the transducer typically requires a duration of _____ minutes.
2-3 times
5 minutes
Ultrasound should not be used to treat Areas larger than 4 times the effective radiating area of the transducer
Ultrasound using thermal effects usually is applied when in the healing process?
Later
2-3 x a week
Vs for nonthermal effects is usually applied earlier in the healing process, as frequently as once a day
Benefits of diathermy over ultrasound
Can heat surfaces effectively of up to 25x the size of a typical ultrasound transducer
Heat is applied to the target area In a more uniform fashion with diathermy since the application is performed statically
The rate of tissue cooling is slower with diathermy thus the PT has additional time to perform interventions that are enhanced by the increased tissue temp
A tank used for full body immersion
Hubbard tank- temp should not exceed 100 degrees Fahrenheit
Contraindications for full body immersion
Unstable BP and incontinence
Treatment temperature guidelines - acute inflammation of distal extremities
32-79 degrees
Treatment temperature guidelines - exercise
79-92
Treatment temperature guidelines - wound care, spasticity
92-96
Treatment temperature guidelines - cardiopulmonary compromise, treatment of burns
96-98
Treatment temperature guidelines - pain management
99-104
Treatment temperature guidelines- chronic rheumatoid arthritis, inc ROM
104-110
A contrast utilizes alternating heat and cold in order to?
Dec edema in distal extremity
Treatment should begin with extremity immersed in hot bath with a temp between 104-106 for 3-4 minutes»_space;» the pt should then place the distal extremity into the cold bath with temp between 50-60 for one min»> pt should repeat this hot cold process for 25-30 min
How much force is indicated for cervical traction to treat muscle spasm or disk protrusion ?
7–10 percent of body weight or 11-15 lbs
Should not exceed 10 lbs the initial treatment session
How much force is indicated for cervical traction to create joint distraction?
13-20% of a pt’s body weight or 20-30 lbs
Should not exceed 30 lbs
What compression bandages should be applied for pt’s who are immobile?
Long-term bandages
Which compression bandages we most commonly used during exercise?
Short-stretch bandages
Pt’s must have functional calf muscle and gait pattern
Which compression bandages are most often used for venous stasis ulcers?
Multi-layered bandages
Provide protection absorption and and compression
Unna boot is a example of what kind of compression bandage
Semirigid made of zinc oxide impregnated gauze
Off shelf compression garments used to prevent DVT
16-18 mm Hg
Compression garments offering 20-30 mmhg for?
Scar tissue control
Compression garments providing 30-40 mm Hg is typically required for
Edema control
Intermittent pneumatic compression pump pressure should not exceed the pt’s diastolic pressure
Ranges from 30-80 mmhg
Inflation pressure greater than the pt’s systolic blood pressure may restrict arterial blood flow and create a medical emergency
Primary indication of the CPM is to ?
Improve ROM that may have been impaired secondary to a surgical procedure.
A direct current is most often used with ?
Iontophoresis and is characterized by a constant flow of electrons from the anode to the cathode
The amount of time it takes for one phase of a pulse. It begins at when the current departs from the zero line and ends as the current returns to the zero line
Phase duration
The phase duration and pulse duration are the same in?
Monophasic current
Alignment of electrodes for NMES
Parallel and a minimum of 2 inches apart
Shorter pulse duration are more comfortable when targeting ?
Smaller muscles
Frequency for NMES
Should be sufficient to produce a tetanic contraction. Usually produced at a frequency of 35-50 pulses per second. Higher frequency will not produce a stronger contraction but will instead rapidly fatigue the muscle
The ON and OFF time for NMES
On time should be 6-10 seconds
Off time should be 5x longer
Pt should complete 10-20 contractions
Min of 3x per week
Conventional TENS- amplitude, pulse frequency, pulse duration, treatment time
Amp- Sufficient for a sensory response
Frequency- high 30-150 pulse per second
Pulse duration- short 50-10 msec
Treatment time- varied based of the duration of ADL
Acupuncture-like TENS- amplitude, pulse frequency, pulse duration, treatment time
Amp- Sufficient for muscle twitch
Frequency- low 2-4 pulse per second
Pulse duration- long 100-300 msec
Treatment time- 20-45 minutes
Brief intense TENS- amplitude, pulse frequency, pulse duration, treatment time
Amp- Sufficient for a strong paresthesias or a motor response
Frequency- low 60-200 pulse per second
Pulse duration- long 150-500 msec
Treatment time- 15 min
Noxious TENS- amplitude, pulse frequency, pulse duration, treatment time
Amp- Highest tolerated stim
Frequency- low or high
Pulse duration- long 250 msec up to 1 sec
Treatment time- 30-60 secs for each point
The rate of ion delivery is determined by what four factors
The rate of ion delivery, he pH of the solution, the current density, and the duration of treatment
Negatively charged ions are carried into the body’s tissue from the ?
Negative pole (cathode)
The amount of electricity used when performing iontophoresis
Dosage- determined by multiplying current amplitude and time
A current of 40 mA-min could be delivered in 10 mins with a current of 4.0 mA
A longer duration and a lower current amplitude will be less likely to cause skin irritation or burns.
Ranges from 40-80 mA-min
What is the recommended spacing between the active and dispersive electrode for iontophoresis?
Minimally equivalent to the diameter of the active electrode
One way to decrease the risk of iontophoresis burns?
As the spacing btw the electrodes inc, the current density in the superficial tissues decreases, resulting in a diminished risk for burns
Also decreasing the current density and inc the size of the cathode relative to the anode
Smaller electrodes have a higher _____ and are used to treat a specific lesion
Current density
Additional treatment time may be required if the intensity is less than ______?
Four milliamperes
What results from sodium hydroxide forming under the negative electrode (cathode)
Alkaline reaction
What results from iontophoresis treatment as hydrochloride acid forms under positive electrode (anode)
Acidic reaction
Acetic acid- indications and polarity
Calcification deposits and myositis ossificans
Negative
Calcium chloride - indications and polarity
Scar tissue, keloids, muscle spasm
Negative
Copper sulfate - indications and polarity
Fungal infection
Positive
Dexamethasone - indications and polarity
Inflammation
Negative
Iodine- indications and polarity
Scars and adhesive capsulitis
Negative
Lidocaine- indications and polarity
Analgesia and inflammation
Positive
Magnesium sulfate- indications and polarity
Muscle spasms and ischemia
POSITIVE
Salicylates - indications and polarity
Muscle and joint pain and plantar warts
Negative
Zinc oxide - indications and polarity
Healing and dermal ulcers and wounds
Positive
Spontaneous potentials during _____ are abnormal findings and may indicate nerve or muscle damage
Rest
Fibrillation potentials, positive sharp wave, fasciculations, repetitive discharges
Biofeedback for muscle relaxation requires a _______ sensitivity setting with the active electrodes initially placed _______
Muscle relaxation required a high sensitivity setting with the active electrodes initially placed close to each other. As the pt improves with relaxation, the electrodes should be placed further apart and the sensitivity setting should be increased
The treatment for biofeedback for muscle reeducation should begin with?
Pt performing a max muscle contraction, the sensitivity of the biofeedback unit should be set to a low sensitivity setting and adjusted so pt can perform reps at a ration of 2/3 of max muscle contraction. Isometric holds should last 6-10 secs. An inc in audio or visual feedback is a positive sign
Technique performed in the beginning and end of a massage treatment characterized by light stokes directed towards the heart
Effleurage
Massage technique that incorporates small circular motions over a trigger point or muscle spasm. Used frequently with chronic inflammation or with overuse injuries. Primary exception to using lub
Friction massage
Massage characterized by kneading where the muscle is squeezed and rolled under the therapist’s hands. The goal is to loose. Adhesions, improve lymphatic return, and facilitate removal of metabolic waste
Petrissage
Massage technique used to enhance circulation and stimulate peripheral nerve endings by tapping, hacking, cupping, and slapping motions.
Tapotement
Technique used primarily for relaxation
Vibration
What is the final arm rest height measurement which is 7 inches from the seat of the chair to the olecranon process with the elbow flexed to 90 degrees
8
What is the final seat depth measurement that is 18 inches from the posterior butt along the lateral thigh to the popliteal fold
16
What are the measurements of a standard W/C?
18” width, 16” depth, and 20” height
Cold urticaria and Raynaud’s phenomenon are contraindications for what
Cryotherapy
Arterial disease, pvd, thrombophlebitis are contraindications for what ?
Superficial thermotherapy
What temp should be maintained for paraffin bath?
113-122
What is the primary therapeutic effect of of an infrared lamp
Enhances superficial tissue healing
How deep does the healing occur for ultraviolet light?
1-2 mm into the skin
A measure of the electromotive force or the electrical potential difference
Voltage
The directed flow of charge from one place to another
Current
A pt that is dependent should be repositioned in bed at least every ____ hours
Two
