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MT2 Flashcards

1
Q

What is the difference between impairment and disability?

A

Impairment relates to physiological deficit (neurological exams, etc)

disability relates to functional deficit (functional independance measures, etc)

subjects may have the same IMPAIRMENT but have differing extents of DISABILITY

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2
Q

What are functional measures used for?

A

select appropriate therapy/assistive systems

assess progress during rehab

predict long term outcomes

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3
Q

What is the neurological examination for sensory impairment

A

testing key points in each of 28 dermatomes by examining sensitivity to pin prick/light touch (3 point scale, 0=absent, 1= impaired 2=normal)

test points go from C2 to S4/5

scores are summed for left and right sides, with a max score of 112

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4
Q

What is the neurological examination for motor impairment

A

testing key muscles in 10 paired myotomes (elbow flexors (C5) /extensors (C7), wrist extensors (C6), finger flexors (C8), pinky abductor (T1), hip flexor (L2), knee extensors (L3), ankle dorsiflexion (L4), long toe extensors (L5), ankle plantarflexors (S1))

6 point ASIA scale:
0=paralysis
1 - palpable or visible contraction
2 - active movement, full ROM with gravity eliminated
3 - active movement, full ROM against gravity, POINT AT WHICH MUSCLE INNERVATION IS INTACT
4 - active movement, full ROM against moderate resistance
5 - normal active movement, full ROM against full resistance, most rostral key muscle to the motor level must have this score (ex if C7 is 0, and C6 is 3, and C5 is 5, then motor level is C6)

external anal sphincter also tested for presence/absense of tonic contraction (S4/5)

score is summed, with a max score of 100

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5
Q

How does the ASIA scale grade degrees of impairment

A

asia A = complete, no voluntary anal contraction

asia B = incomplete, sensory but not motor function is preserved below neurological level

asia C = incomplete, motor function is preserved below neurological level, and more than half key muscles have muscle grade of less than 3

asia D = incomplete, same as C but muscle grade of more than 3

asia E = normal

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6
Q

What is the functional independance measure of disability

A

6 areas of functioning measured on a 7 point scale (1-7)

self-care,
sphincter control,
mobility,
locomotion,
communication
social cognition.

developed for disabled groups

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7
Q

WHat is the scale for FIM

A

7 - Complete independence
6 - Modified independence (assistive device)
5 - Supervision or setup
4 - Minimal contact assistance (subject does over 75% of work)
3 - Moderate assistance (subject does 50-75% of work)
2 - Maximal assistance (subject does 25-50% of work)
1 - Total assistance (subject does 0-25% of work)

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8
Q

What is the QIF

A

quadriplegia index of function

9 categories on a 5 point scale

4 - subject completely independent, needs no assistive device.
3 - subject independent with assistive device, needs no supervision.
2 - same as 3, yet supervision is required.
1 - subject requires physical contact and assistance to perform task.
0 - subject is completely dependent, unable to do activity at all.

also has questionaire portion assessing other physical conditions, and a part that deals with human services availible

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9
Q

What are the 9 categories for the QIF

A

transfers (max 16)
grooming (max 12)
bathing (max 8)
feeding (max 24)
dressing (max 20)
wheelchair mobility (max 28)
bed activites (max 20)
bladder care (max 28)
bowel care (max 24)

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10
Q

What is the blood supply to the brain

A

mainly from the carotid canal, supplying the MCA and ACA, with the vertebral arteries supplying PCA and PICA/AICA after connecting to the basilar artery

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11
Q

What is the blood brain barrier

A

membrane that regulates movement of molecules from blood into the CNS

capillary endothelial cells connected by tight junctions to form physical barrier

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12
Q

What is a stroke

A

loss of blood to vascular territories of the brain, leading to cell death and irreversible brain damage (after about 4 min)

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13
Q

What are the types of strokes

A

thrombotic - closure of a vessel due to atherosclerosis

embolic - blocked vessel due to movement of clot

hemorrhagic - ruptured blood vessel

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14
Q

What happens if theres a stroke in the MCA

A

most common stroke site due to largest branches, supplies parietal lobes and temporal lobes (lateral brain)

upper body motor/sensory control

damage to speech if in left brain

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15
Q

What happens if theres a stroke in the ACA

A

loss of sensation for lower limbs and damage to areas for planning/voluntary movement

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16
Q

what happens if theres a stroke in the PCA

A

usually in the basilar arteries, supplies temporal and occipital lobes

damages vision, and can cause hypersensitivity to pain, nerve paralysis, and visual deficits like colour blindness, hallucinations, etc

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17
Q

Howcan you spot a stroke?

A

FAST

face drooping
arm weakness
speech difficulty
time to call 911

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18
Q

What is a spinal cord stroke

A

stroke in spinal cord, does not disrupt brain supply, very rare

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19
Q

What is a transient ischemic attack

A

mini stroke that blocks artery for short time, is TEMPORARY

no permanent injury to brain

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20
Q

how do you assess for stroke

A

CT scan is first line imaging modality for assessment of strokes

MRI can detect brain injury earlier

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21
Q

WHat is a hemorrhagic stroke

A

30% of all strokes, pts appear more ill with signs of increased intracranial pressure

appears as hyperdense area in the brain, usually caused by trauma or leakage from smaller intracerebral arteries (hypertensive damage)

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22
Q

What is an angiography

A

catheter threaded for direct visualization of blood vessels under xray during injection of contrast medium

used to detect abnormalities in vessels like narrowing or blockages

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23
Q

What is penumbra

A

window of opportunity for reversing ischemic symptoms

area of brain around the main blockage, it has reduced blood flow but can survive

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24
Q

how do you manage an ischemic stroke

A

tPA used to breakdown clots, used within 3 hours

mechanical thrombectomy can also be used to widen or stent arteries to allow blood flow

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25
What is a cerebral aneurysm
bulge of artery that can rupture, leading to a hemorrhage rupture causes stroke
26
what is a subarachnoid hemorrhage
increased pressure in subarachnoid space, leading to higher pressure on brain due to excess blood, region that was supposed to get blood has an ischemic stroke a sign of ruptured aneursym
27
what is spastic hemiplegic walking?
slow asymmetric labourous walking that can cause the paralyzed foot to stumble
28
What is spasticity?
neurological condition that causes large increases in muscle tone when muscle is stretched, resists stretching and remains abnormally contracted
29
how is spasticity triggered?
rapid muscle stretch or other sensory stimulation
30
What are some problems associated with spasticity?
dynamic contracture - increased stiffness when stretching fixed contracture - progression of dynamic contracture, a permanent shortening and hardening of muscles/tendons, leading to permanent deformity of joints
31
how do exaggerated reflexes support oscillations for spasticity
1a fibers make monosynaptic excitatory xonnections with alpha motorneurons, and they also connect with inhibitory interneurons that project to alpha motorneurons of antagonist muscles. reciprocal inhibition occurs
32
What are some complications associated with spasticity
inability to perform ADLs poor hygene due to inability to reach poor mobility poor comfort
33
how is spasticity assessed
identifying overactive muscles and determining effect of spasticity on aspects of patient function
34
WHat is the definition of a spasm
jumping or twitching of a muscle or limb without control
35
What is the spasm frequency scale
tracks how many spasms a pt has had in the last 24hrs 0 = No spasms 1 = 1 spasm 2 = 1-5 spasms 3 = 5-9 spasms 4 = 10 or more spasms per day
36
what is the modified ashworth scale
checks for muscletone increase, 0-4
37
What are the positive and negative signs of upper motor neuron syndrome
positive spasticity and released flexor reflexes, babinski positive negative loss of dexterity and weakness, paresis negative signs are more important to function of pt than positive
38
What are rheological changes in muscles
changes in plasticity and visco-elasticity interact with pathologic regulatory mechanisms to prevent normal limb control resistance in recent spasticity is reflex induced, while chronic usually involves rheological changes
39
WHat are the key points for spasticity of cerebral origin
enhanced excitability of spinal reflex pathways and rapid reflex activity bias towards antigravity muscle overactvity
40
WHat are the key points for spasticity of spinal origin
removal of inhibition on polysynaptic pathways slow rise of excitatory state overexcited flexors/extensors
41
WHo is a part of the spasticity management team
neurologist physiatrist PT OT neurosurgeon Orthopedic surgeon goal is to regain ADL and IADL
42
WHat are the ADLs and IADLs
ADLS (death) Dressing Eating Ambulation Toilet Hygene IADLs (shaft) Shopping Housekeeping Accountng Food prep Transportation
43
How do physical therapists treat spasticity
reduce muscle tone maintain and improve ROM/mobility increase strength/coodination improve comfort - minimize types of stimuli that trigger it they also : 1. Stretching – Prevention of contracture 2. Strengthening of muscles 3. Casts and braces – Maintain physiologic position and adjust with serial casting 4. Cold packs – Effect on muscle tone 5. Electrical Stimulation – Strengthening and transient spasticity reduction 6. Biofeedback
44
What is chemodenervation
use of chemicals injected to interrupt nerve impulses to spastic muscles alcohol/phenol - nerve/muscle destruction, cheap but worse side effects and painful BOTOX - disruption of nerve-muscle communication, causes excess weakness Lidocaine -short term local anesthetic to assess muscles
45
What are benzodiazepines
improve ROM by acting on CNS, can casue drowsiness and low bp
46
what is baclofen
works on CNS to reduce stretch reflexes and increase ROM causes drowsiness and weakness
47
what is dantrolene sodium
acts on muscle and interferes with contraction, increasing passive ROM causes generalized weakness of the whole body
48
what is tizanidine
reduces spasticity by acting on CNS sedation side effect
49
What is intrathecal Baclofen
delivers baclofen directly to fluid around spinal cord via an implanted pump does not cause drowsiness side effects and reaches target nerve cells better for severe spasticity
50
what are the options for managing spasticity in increasing order from mild to severe
prevention of nocieception stretching/splinting and oral meds electrical stim and botox intrathecal baclofen surgery
51
What is cerebral palsy and how does it relate to spasticity
brain damage that affects movement and posture, producing lifelong disabilities 80% of kids w CP have spasticity treated with meds,PT, or surgery
52
WHat is selective dorsal rhizotomy
not for acute CNS injury, reduces input from sensory fibers to brain by cutting abnormal rootlets, after rootlets are tested with EMG kids who get it must be 2 or older with no significant brain damage, with muscle strength to weightbear/crawl and a history of delayed motor development. must be diagnosed with spastic diplegia adults who get it must be diagnosed with spastic diplegia and walk without assistive device can resume independant walking after a few weeks, improvements continue upto age 10 for kids and for 2 years for adults, can improve speech due to less distraction from spasticity
53
how is a fractured femur repaired
with a medullary rod to allow weight bearing
54
What are the tendon transfer principles
1. Joints must be supple prior to transfer 2. Soft tissue must be at equilibrium (local tissue should be healthy) 3. Donor muscle must have adequate excursion (should have the right length) 4. Donor muscle must have adequate strength 5. Expendable donor muscle 6. Straight line of pull 7. Synergy 8. Replace a single function per transfer
55
What is the GMFCS
gross motor function classification scale level 1- kids walk indoors/outdoors and climb stairs, speed/balance/coordination are impaired level 2 - limitations with walking on inclines level 3- need mobility device to walk or self propelled wheelchair for long distance level 4 - need walker or wheelchair level 5 - cant maintain antigravity postures and cannot move independantly
56
What are the goals for orthopaedic surgery
reduce spasticity increase ROM improve ADLs reduce pain
57
what are the types of orthopaedic surgery
1. Contracture release 2. Tendon transfer 3. Osteotomy 4. Arthrodesis
57
WHat are the clinical presentations of cerebral palsy
foot deformities (bunions, plantarflexion contracture, high arches, flatfeet) hip subluxation/dislocation (spastic hip adductors/flexors) upper extremity deformities spinal deformaties (scoliosis, kyphosis, lordosis) - usually need surgery
58
what is split tibialis posterior tendon transfer
tendon is divided in two in order to balance the forces around the ankle
59
What is achillies Z lengthening
takes 6-8 weeks to heal, involves lengthening the achillies to improve dorsiflexion with knee extension, for combating spasticity of calf
60
How can you manage osteoarthritis
definitive - replacement of knee temporary - pain meds, bracing, physical therapy, injections
61
What happens when the posterosuperior cuff fails
irreparable head of humerous translates superiorly and the deltoid doesnt rotate humerus around center of rotation, leading to pseudoparalysis (cant elevate arm, but have full pROM)
62
WHat is the solution to posterosuperior cuff failure
inferiorize and medialize the Center of rotation, as this increases the deltoid moment arm length with optimized fulcrum
63

BPK 448 (3 decks)

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