NPTE Review Flashcards
Neurapraxia
mildest form of acute nerve injury; axon/nerve fibers intact; rapid recovery usually in 4-6 weeks
Axonotmesis
more severe than neurapraxia; reversible damage to nerve fibers with possible Wallerian degeneration; recovery is spotty and surgery may be required for repair
Neurotmesis
most severe peripheral nerve injury; axon, myelin and connective tissue damaged; complete motor and sensory loss distal to injury; no spontaneous recovery
Ape Hand Deformity
atrophy of thenar musculature and first 2 lumbricals
Spondylitis
inflammation of the joints in the spine
Spondylosis
painful condition of the spine resulting from the degeneration of the intervertebral disks
Spondylolysis
crack or stress fracture develops through the pars interarticularis; most commonly in the fifth vertebra of the lumbar spine; sometimes occurs in the fourth lumbar vertebra (scotty dog fracture)
Spondylolisthesis
spondylolysis can weaken the vertebra so much that it is unable to maintain its proper position in the spine. This condition is called spondylolisthesis; fractured pars interarticularis separates, allowing the injured vertebra to shift or slip forward on the vertebra directly below it
Central Cord Syndrome (CCS)
incomplete SCI (compression/damage to central SC); MOI most often cervical hyperextension; motor loss greater in UE than LE and most severe distally in the UE; sensory loss below level of lesion limited (motor loss greater than sensory); damage can occur to spinothalamic, corticospinal and dorsal columns; most common incomplete SCI
Characteristics of Left CVA
right side weakness/paralysis; impaired processing; heightened frustration; aphasia; dysphagia; motor apraxia (ideational/ideomotor); right hemianopsia
Characteristics of Right CVA
left side weakness/paralysis; poor attention span; impaired awareness and judgement; spatial deficits; memory deficits; left inattention; emotional lability; impulsive behavior; left hemianopsia; (pusher syndrome maybe more common)
Chorea
jerky, involuntary movements; choreiform movements are repetitive and rapid, jerky, involuntary movement that appears to be well-coordinated
Athetoid
slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue
Relapse-remitting MS; RRMS
(85% of cases); characterized by clearly defined attacks of new or increasing neurologic symptoms. These attacks – also called relapses or exacerbations – are followed by periods of partial or complete recovery (remissions)
Secondary-progressive MS; SPMS
SPMS follows an initial relapsing-remitting course. Most people who are diagnosed with RRMS will eventually transition to a secondary progressive course in which there is a progressive worsening of neurologic function (accumulation of disability) over time. SPMS can be further characterized at different points in time as either active (with relapses and/or evidence of new MRI activity) or not active, as well as with progression (evidence of disease worsening on an objective measure of change over time, with or without relapses) or without progression.
Primary-progressive MS; PPMS
characterized by worsening neurologic function (accumulation of disability) from the onset of symptoms, without early relapses or remissions
Progressive-relapsing MS; PRMS
rare form of MS (5%), PRMS is characterized by a steadily worsening disease state from the beginning, with acute relapses but no remissions, with or without recovery
Anterior Cord Syndrome
incomplete SCI in which anterior 2/3 of SC is damaged; compression/damage to anterior spinal artery (most often via cervical flexion or fracture/dislocation); complete loss of motor function and loss of pain and temperature sensation bilaterally below the level of lesion due to damage to corticospinal and spinothalamic tracts; intact vibration and proprioception; worst prognosis of SC syndromes
S1 (heart sound)
closing of the mitral and tricuspid valves; onset of ventricular systole
S2 (heart sound)
closing of the aortic and pulmonary valves; onset of ventricular diastole
S3 (heart sound)
Ventricular gallop; may occur in healthy children and young adults; indicates a loss of ventricular compliance in the presence of heart disease or heart failure
S4 (heart sound)
Atrial gallop; associated with atrial contraction and an increased resistance to ventricular filling; common in pts. with HTN, history of MI, or coronary bypass surgery
Digitalis (digoxin)
Rx given to increase force of myocontractility, often prescribed for heart failure; increased cardiac output and decreased preload, cardiac workload, and myocardial oxygen demand; prolongs PR interval on ECG, may shorten QT interval or produce sagging in ST segment
Atrial flutter
abnormal heart rhythm characterized by rapid atrial tachycardia (250-350 bpm); fast but regular rhythm producing sawtooth P waves on ECG
Atrial fibrillation
arrhythmia characterized by erratic electrical conductivity of the atria; fast and irregular atrial rhythm
Vital Capacity (VC)
maximum volume of air that can be exhaled after a maximum inhalation; VC = IRV + TV + ERV
Expiratory Reserve Volume (ERV)
additional volume of air that can be exhaled beyond the normal tidal exhalation; component of VC
Inspiratory Reserve Volume (IRV)
additional volume of air that can be inhaled beyond normal tidal inhalation
Tidal Volume (TV)
volume of air inspired and expired with each breath during quiet breathing
Hypercalcemia
excessive level of calcium in blood; normal serum calcium is 8.4-10.2 mg/dL; increases heart actions (hypocalcemia depresses heart actions)
Hyperkalemia
excessive level of potassium in blood; normal serum potassium is 3.5-5.0 mEq/L (higher than 7 mEq/L cause hemodynamic and neurologic effects); higher than 8.5 mEq/L can cause respiratory paralysis and cardiac arrest); decreases rate and force of contraction, produces widened PR interval and QRS, tall T waves on ECG
Inspiratory Reserve Volume (IRV)
additional volume of air that can be inhaled beyond normal tidal inhalation; 55-60% of total lung capacity
Tidal Volume (TV)
volume of air inspired and expired with each breath during quiet breathing; 10% of total lung capacity (500 mL)
Specificity/SpPin
percentage of people who test negative for a specific disease among a group of people who do not have the disease (true negative); SpPin - in a test with high SPECIFICITY, a POSITIVE diagnostic test rules IN the diagnosis
Asymmetrical Tonic Neck Reflex (ATNR)
stimulated when head is turned to one side - response is arm/leg on face side are extended, and arm/leg on scalp side are flexed; birth to 6 months
Moro Reflex
stimulated when infant’s head is suddenly dropped into extension - response is arms abduct and finger open, then cross the trunk into adduction (often with crying); 28 weeks gestation to 5 months
Landau Reflex
equilibrium response that occurs when a child responds to prone suspension by aligning their head and extremities in line with the plane of the body; begins around 3 months and integrates around second year
Symmetrical Tonic Neck Reflex (STNR)
stimulated by the head moving into flexion or extension; flexion causes arm to flex and legs to extend, extension causes arms to extend and legs to flex; 6-8 months
Plantar Grasp Reflex
stimulated by placing pressure on ball of the foot - response is flexion and curling of the toes; 28 weeks gestation to 9 months
Galant Reflex
stimulated by touching the skin along the spine from the shoulder to the hip - response is lateral flexion of the trunk to the side of the stimulus; 30 weeks gestation to 2 months
Residual Volume (RV)
volume of air remaining in the lungs after a forced expiratory effort; usually 1,000 mL, 25% of total lung capacity
Functional Residual Capacity (FRC)
amount of air remaining in the lungs at the end of normal tidal exhalation; 40% of total lung capacity
Total Lung Capacity (TLC)
maximum volume of air to which the lungs can be expanded; typically 4,000-6,000 mL
Tonic Labyrinthine Reflex (TLR)
in supine, body and extremities are held in extension; in prone, body and extremities are held in flexion (lie in sidling or supine with hips and knees in flexion in order to decrease influence of the reflex); birth to 6 months
Ottawa Knee Rules
Referral for knee X-ray is required for patients with knee injury with one or more of the following:
- Age 55 years or older
- Isolated patellar tenderness without other bone tenderness
- Tenderness of fibular head
- Inability to flex knee to 90 degrees
- Inability to bear weight immediately after injury or in ED
Ottawa Ankle Rules
Ankle x-ray only required if there is any pain in the malleolar zone and any of these findings:
- bone tenderness from posterior edge to tip of the lateral malleolus extending 6 cm proximally
- bone tenderness from posterior edge to tip of the medial malleolus extending 6 cm proximally
- Inability to take 4 steps immediately or in the ED
Ottawa Foot Rules
Foot x-ray only required if there is any pain in the midfoot zone and any of these findings:
- Bone tenderness at base of 5th metatarsal
- Bone tenderness of the navicular
- Inability to take 4 steps immediately or in the ED
Canadian C Spine Rule
- Any High risk factor for X-ray:
- Age 65 or older
- dangerous mechanism
- paresthesia in the extremities - Any Low Risk factor that allows safe assessment of ROM: (none refer to x-ray)
- Rear end MVA
- sitting position in the ED
- ambulatory at any time
- delayed onset of neck pain
- absence of midline c-spine tenderness - able to actively rotate neck 45 degrees bilaterally?
- unable = x-ray
Kehr’s sign
+ when pressure to the upper abdomen or supine positioning results in L shoulder pain.
Indicative of blood that accumulates in the abdominal cavity secondary to a ruptured spleen and cause irritation to the diaphragm. (Phrenic nerve: C3-C5)
SCI: ASIA A
Complete; No motor or sensory function is preserved in the sacral segments S4–S5.
SCI: ASIA B
Incomplete; Sensory function preserved but not motor function is preserved below the neurological level and includes the sacral segments S4–S5.
SCI: ASIA C
Incomplete; Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.
COPD: GOLD Classification Stages
GOLD I: Mild - FEV1 ≥ 80% predicted; FEV1/FVC < 70%; with or without symptoms of cough and sputum production
GOLD II: Moderate - 50% ≤ FEV1 < 80% predicted; FEV1/FVC < 70%; SOB with exertion; with or without symptoms of cough and sputum production
GOLD III: Severe - 30% ≤ FEV1 < 50% predicted; FEV1/FVC < 70%; greater SOB with exercise, decreased exercise capacity, fatigue, and repeated exacerbations of their disease
GOLD IV: Very Severe - FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure
Blood pH
7.35 - 7.45
Blood bicarbonate (HCO3-)
24 mEq/L (22-26 mEq/L)
PaO2
80-100 mm Hg
PaCO2
35-45 mm Hg
Horner’s Syndrome
miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face). It is caused by damage to the sympathetic nerves of the face.
Wallenberg’s Syndrome
lateral medullary syndrome; caused by a stroke in the vertebral or posterior inferior cerebellar artery of the brain stem. Symptoms include difficulties with swallowing, hoarseness, dizziness, nausea and vomiting, rapid involuntary movements of the eyes (nystagmus), and problems with balance and gait coordination. Some individuals will experience a lack of pain and temperature sensation on only one side of the face, or a pattern of symptoms on opposite sides of the body – such as paralysis or numbness in the right side of the face, with weak or numb limbs on the left side.
E-Stim: Hi-Volt pulsed monophasic current (used for what)
reduction of infection, promotion of granulation & epithelialization; the anode (+) is used over a silver dressing in the wound if infection is present; the current should pass through the wound for the greatest effect
Meningitis tests
Kernig’s sign: pain with hip flexion and knee extension
Brudzinski’s sign: stiffness of neck; flexion of neck facilitates flexion of hip and knees
Head-jolt test: turn head 2-3x per second, positive test is worsening of baseline headache
Bunnell-Littler Test
evaluates the source of PIP flexion motion limitation by differentiating between intrinsic muscle or capsular tightness in the affected digit; The MCP joint is held in an extended position and the therapist passively flexes the PIP making note of the available range. The test is then repeated with the MCP joint flexed. If no change in motion is detected between the two tests, then capsular restriction at the PIP joint is implicated. If the motion increases when the MCP joint is flexed, then lumbrical muscle tightness is implicated.
Stroke Volume (SV)
amount of blood ejected with each myocardial contraction; 55-100 mL/beat
Afterload
force the LV must generate during systole to overcome aortic pressure to open aortic valve; influences SV
Cardiac Output (CO)
amount of blood discharged from the L or R ventricle per minute; average adult, 4-5 L/min; CO = HR x SV
Ejection Fraction (EF)
percentage of blood emptied from the ventricle during systole; clinically useful measure of LV function; EF = SV/LV end diastolic volume
Myocardial Oxygen Demand (MVO2)
represents energy cost to the myocardium; measured by product of HR and SBP, known as Rate Pressure Product (RPP); MVO2 increases with activity and with HR and/or BP
Hypokalemia
decreased concentrations of blood potassium ions; produces flattened T waves, prolonged PR and QT intervals; arrhythmias, may progress to ventricular fibrillation
Hypermagnesium
increased magnesium is a calcium blocker which can lead to arrhythmias or cardiac arrest
Hypomagnesium
decreased magnesium causes ventricular arrhythmias, coronary artery vasospasm, and sudden death
P wave
atrial depolarization
P-R interval
time required for impulse to travel from atria through conduction system to Purkinje fibers
QRS wave
ventricular depolarization
ST segment
beginning of ventricular repolarization
T wave
ventricular repolarization
QT interval
time for electrical systole
Quinidine
Class 1 antiarrhythmic agent; QT lengthens, T wave flattens (or inverts), QRS lengthens
Ankle Brachial Index (ABI)
SBP at ankle divided by SBP at arm > 1.40, indicates non-compliant arteries 1.00-1.40, normal 0.91-0.99, borderline < or = 0.90, abnormal < or = 0.50, severe arterial disease, risk for critical ischemia, may have pain at rest
Partial Prothrombin Time (PPT) and Prothrombin Time (PT)
PPT = 25-40 sec; PT = 11-15 sec
International Normalized Ratio (INR)
0.9 - 1.1
White Blood Cells (WBCs)
3.54-9.06 x10^3/mm^3 (scorebuilders); 4,300-10,800 cells/mm^3 (therapy ed)
Red Blood Cells (RBCs)
Male: 4.3-5.6 x10^6/mL (therapy ed; 4.6-6.2 x10^6/uL)
Female: 4.0-5.2 x10^6/mL (therapy ed; 4.2-5.9 x10^6/uL)
Hematocrit
percent of RBC to total volume of blood
Male: 38.8-46.6% (therapy ed; 45-52%)
Female: 35.4-44.4% (therapy ed; 37-48%)
Hemoglobin
protein in blood that binds/holds oxygen
Male: 13.3-16.2 g/dL (therapy ed; 13-18 g/dL)
Female: 12.0-15.8 g/dL (therapy ed; 12-16 g/dL)
Erythrocyte Sedimentation Rate (ESR)
nonspecific measure of inflammation
Male < 15 mm/hr
Female < 20 mm/hr
Platelets
Scorebuilders: 165,000 - 415,000 cells/mm^3
Therapy Ed: 150,000 - 450,000 cells/mm^3
Cholesterol
Total: < 200 mg/dL (> 240 mg/dL = high)
LDL (bad): < 100 mg/dL (> 160 mg/dL = high)
HDL (good): < 40 mg/dL (> 60 mg/dL = high)
Triglyceride: < 150 mg/dL (> 200 mg/dL = high)
ACE Inhibitors
inhibit conversion of angiotensin I to angiotensin II, decreased Na retention and peripheral vasoconstriction in order to decrease blood pressure (e.g., captopril [capoten], enalopril [vasotec], lisinopril [zestril])
Angiotensin II Receptor Blockers (ARBs)
blocks binder of angiotensin II at the tissue/smooth muscle level, decreasing blood pressure (e.g., losartan [cozaar])
Nitrates
decrease preload through peripheral vasodilation, reduce myocardial oxygen demand, reduce angina; may also dilate coronary arteries, improve coronary blood flow (e.g., nitroglycerin); used to treat angina (CAD); increased HR; SE include hypotension, vertigo, dizziness, weakness, headache, palpitation, postural hypotension
Beta-adrenergic Blocking Agents (Beta Blockers)
reduce myocardial demand by reducing HR and contractility; control arrhythmias, chest pain, reduce blood pressure (e.g., atenolol [tenormin], metoprolol [lopressor, torprol XL], propranolol [inderal]); blunts HR response to exercise; used for HBP, arrhythmia, heart failure, chest pain
Calcium Channel Blocking Agents
inhibit flow of calcium ions, decrease HR, decrease contractility, dilate coronary arteries, reduce BP, control arrhythmias, chest pain (e.g., diltiazem [cardizem, procardia], amlodipine [norvasc])
Antiarrhythmic’s (4 Classes)
alter conductivity, restore normal heart rhythm, control arrhythmia, improve cardiac output (e.g., quinidine, procainamide)
Diuretics
decrease myocardial work (reduce preload and after load), control HTN (e.g., furosemide [lasix], hydrochlorothiazide [esidrix])
Hypolipidemic Agents (6 major cholesterol lowering drugs)
redue serum lipid levels when diet and weight reduction are not effective (e.g., cholestyramine [questran], colestipol [colestid], simvastatin [zocor], lovastatin [mevacor])
Wells Criteria Score for DVT
-2 to 0: low probability of DVT
1 to 2: moderate probability of DVT
3 or higher: high probability of DVT
C5 (dermatome/myotome)
Myotome (functional group): biceps brachii, brachialis (elbow flexors)
Dermatome: lateral shoulder
C6 (dermatome/myotome)
Myotome (functional group): ECR Longus and Brevis (wrist extensors)
Dermatome: lateral forearm, dorsum of thumb and index finger
C7 (dermatome/myotome)
Myotome (functional group): Triceps brachii (elbow extensors)
Dermatome: dorsum of middle finger
C8 (dermatome/myotome)
Myotome (functional group): flexor digitorum profundus (finger flexors)
Dermatome: dorsum of ring and little finger
T1 (dermatome/myotome)
Myotome (functional group): abductor digiti minimi (finger abductors)
Dermatome: medial forearm
L2 (dermatome/myotome)
Myotome (functional group): iliopsoas (hip flexors)
Dermatome: anterior mid thigh
L3 (dermatome/myotome)
Myotome (functional group): quadriceps (knee extensors)
Dermatome: anterior knee
L4 (dermatome/myotome)
Myotome (functional group): tibialis anterior (ankle dorsiflexors)
Dermatome: medial leg and medial malleolus
L5 (dermatome/myotome)
Myotome (functional group): extensor halluces longes (long toe extensors)
Dermatome: lateral leg, medial dorsum foot
S1 (dermatome/myotome)
Myotome (functional group): gastrocsoleus complex (ankle plantar flexors)
Dermatome: distal calf, lateral plantar foot
Q Angle (Quadriceps Angle)
Overall lateral line of pull of the quadriceps relative to the patella; measured by extending a line through the center of the patella to the anterior superior iliac spine and another line from the tibial tubercle through the center of the patella; 13.5 ± 4.5° is considered as normal Q angle for healthy subjects between the ages of 18 and 35 years.
The Q angle for women is 4.6° greater than that for men due to the presence of a wider pelvis, increased femoral anteversion, and a relative knee valgus angle.
Joint Mobs: Anterior GH glide
To restore GH external rotation and extension
Joint Mobs: Posterior GH glide
To restore GH flexion and internal rotation
Joint Mobs: Inferior GH glide
To restore GH abduction
Glenohumeral Capsular Pattern
ER, ABD (and flexion), IR
Hip Capsular Pattern
Flex, ABD, IR (sometimes IR is most limited)
Knee Capsular Pattern
Flex, Ext
Talocrural Capsular Pattern
Plantar flexion, Dorsiflexion
Wrist (radiocarpal) Capsular Pattern
Flex and Ext equally limited
Elbow (ulnohumeral) Capsular Pattern
Flex, Ext
Cervical Spine Capsular Pattern
Lateral Flex and Rotation equally limited, Ext
Thoracic Spine Capsular Pattern
Lateral Flex and Rotation equally limited, Ext
Lumbar Spine Capsular Pattern
Lateral Flex and Rotation equally limited, Ext
Supraspinatous
Origin: supraspinous fossa
Insertion: greater tubercle of humerus (superior part)
Action: ABD humerus (1st 15 deg alone, then with deltoid)
Innervation: suprascapular nerve (C5, C6)
Infraspinatous
Origin: infraspinatous fossa
Insertion: greater tubercle of humerus (posterior)
Action: ER of humerus
Innervation: suprascapular nerve (C5, C6)
Teres Minor
Origin: middle of lateral border of scapula
Insertion: greater tubercle of humerus (posterior)
Action: ER of humerus
Innervation: axillary nerve (C5, C6)
Subscapularis
Origin: subscapular fossa of scapula
Insertion: lesser tubercle of humerus
Action: IR of humerus, ADD of humerus
Innervation: upper and lower subscapular nerves (C5, C6)
Semimembranous
Origin: ischial tuberosity
Insertion: posterior medial condyle tibia
Action: Ext thigh, Flex knee, IR leg when flexed
Innervation: tibial nerve of sciatic (L4-S3)
Semitendinous
Origin: ischial tuberosity
Insertion: superomedial tibia (pes anserinus)
Action: Ext thigh, Flex knee, IR leg when flexed
Innervation: tibial nerve of sciatic (L4-S3)
Biceps Femoris
Origin: long head, ischial tuberosity; short head, linea aspera and lat supracondylar line femur
Insertion: lateral fibular head (lat tibial condyle/collateral lig.)
Action: Ext thigh, Flex knee, ER flexed leg
Innervation: long, tibial nerve (L4-S3); short, common fibular nerve of sciatic (L4-S2)
Gluteus Medius
Origin: between anterior and posterior gluteal lines of illium
Insertion: greater trochanter of femur (lateral)
Action: ABD and IR of femur
Innervation: superior gluteal nerve (L4-S1)
Gluteus Maximus
Origin: posterior ilium, sacrum, coccyx, sacrotuberous lig.
Insertion: IT tract and gluteal tuberosity of femur
Action: Ext at hip, assists with ER of femur
Innervation: inferior gluteal nerve (L5-S2)
Gluteus Minimus
Origin: between anterior and inferior gluteal lines of illium
Insertion: greater trochanter of femur (anterior)
Action: ABD and IR of femur
Innervation: superior gluteal nerve (L4-S1)
Teres Major
Origin: inferolateral scapular border (posterior)
Insertion: medial lip intertubercular groove of humerus (posterior to Lat)
Action: Ext, ADD, IR of humerus
Innervation: lower subscapular nerve (C5, C6)
Osteogenesis Imperfects
Type I: mildest form, near normal growth (blue sclera, easy bruising, triangular face, possible hearing loss)
Type II: most severe, dies in utero or early childhood (extreme deformity, multiple fractures, soft skull)
Type III: severe, greater ossification of skull (growth retardation, progressive deformities, ongoing fractures, severe osteoporosis, triangular face, blue sclera, functional limitations)
Type IV: mild but greater than type I, mild to moderate fragility/osteoporosis (shorter stature, bowing of long bones, barrel shaped rib cage, possible hearing loss, brittle teeth, near normal sclera)
Spinothalamic Tract (Ascending)
major afferent pathway for pain and temperature localization (some crude touch and pressure); afferent info crosses over immediately upon entering SC
Anterior: light touch and pressure
Lateral: pain and temperature
Spinocerebellar Tract (Ascending)
unconscious proprioceptive and movement information (spine to cerebellum)
Dorsal: ipsilateral subconscious proprioception, tension in muscles, joint sense, posture of trunk and LE
Ventral: ipsilateral subconscious proprioception, tension in muscles, joint sense, posture of trunk UE and LE (some fibers cross at pons with subsequent recrossing)
Dorsal Column-Medial Lemniscal (DCML)
Ascending
pathways for discriminative touch (two-point discrimination, vibration, and graphesthesia) and conscious proprioception
Upper: travels up fasiculus cuneatus and crosses in caudal medulla at nucleus cuneatus
Lower: travels up fasiculus gracilis and crosses in caudal medulla at nucleus gracilis
Spinotectal Tract (Ascending)
afferent info for spinovisual reflexes and assists with movement of eyes and head toward a stimulus (spine to tectum [tectum is made of sup/inf colliculi])
Corticospinal Tract (Descending)
Anterior: pyramidal; ipsilateral voluntary, discrete and skilled movements
Lateral: pyramidal; contralateral voluntary fine movement
Reticulospinal Tract (Descending)
extrapyramidal; responsible for facilitation or inhibition of voluntary and reflex activity through the influence on alpha and gamma motor neurons
Rubrospinal Tract (Descending)
extrapyramidal; responsible for motor input of gross postural tone, facilitating activity of flexor muscles, and inhibiting activity of extensor muscles
Tectospinal Tract (Descending)
extrapyramidal; motor tract responsible for contralateral postural muscle tone associated with auditory/visual stimuli
Vestibulospineal Tract (Descending)
extrapyramidal; motor tract responsible for ipsilateral gross postural adjustments subsequent to head movements, facilitating activity of the extensor muscles, and inhibiting activity of the flexor muscles
Damage to corticospinal (pyramidal) tracts
positive babinski, absent superficial abdominal reflexes and cremasteric reflex, and the loss of fine motor or skilled voluntary movement
Damage to extrapyramidal tracts
significant paralysis, hypertonicity, exaggerated deep tendon reflexes, and clasp-knife reaction
SLR bias: Tibial, Sural, Peroneal
TED: Tibial nerve - Eversion and Dorsiflexion
SID: Sural nerve - Inversion and Dorsiflexion
PIP: Peroneal nerve - Inversion and Plantarflexion
Rubor on Dependency (arterial insufficiency)
Pallor on Elevation: passively elevate pt’s legs and hold them for 15-30 seconds; mild pallor on elevation is normal; marked pallor may signify arterial insufficiency
Rubor on Dependency: after being held in the elevated position as described above, lower pt’s legs and swing them over the side of the bed; color should return in < 10 seconds; superficial veins usually fill in < l5 seconds
Rubor on Dependency: With severe arterial insufficiency, the dependent limb often becomes very red after a period of elevation
Preload
venous filling pressure that fills the left ventricle during diastole; tension in the ventricular wall at the end of diastole
Joint Mobilization (Grade I-V)
Grade I: oscillations; small amplitude, before beginning of tissue resistance (joint lubrication, decrease pain and guarding)
Grade II: oscillations; large amplitude, before beginning of tissue resistance (joint lubrication, decrease pain and guarding)
Grade III: oscillations; large amplitude into tissue resistance (stretch tight muscles, capsules, ligaments)
Grade IV: oscillations; small amplitude into tissue resistance (stretch tight muscles, capsules, ligaments)
Grade V: high-velocity, low-amplitude thrust at end of joint movement (regain normal joint mechanics, as well as decrease pain and guarding)
Absolute/Relative Contraindications for Joint Mobilization/Manipulation/Traction
Absolute: joint ankyloses, malignancy, diseases affecting ligament integrity (RA, Down Syn.), arterial insufficiency, active inflammation or infection
Relative: arthritis, metabolic bone disease (osteoporosis, Pagets, tuberculosis), hyper mobility, total joint replacement, pregnancy, spondylolisthesis, use of steroids, radicular symptoms
UE Flexor Synergy
scapular elevation and retraction; shoulder ABDuction and ER; elbow flexion; forearm supination; wrist flexion; finger and thumb flexion with adduction
UE Extensor Synergy
scapular depression and protraction; shoulder ADDuction and IR; elbow extension; forearm pronation; wrist extension; finger and thumb flexion with adduction
LE Flexor Synergy
hip ABDuction and ER; knee flexion; ankle DF with supination; toe extension
LE Extensor Synergy
hip extension, IR, and ADDuction; knee extension; ankle PF with inversion; toe flexion and ADDuction
Brunnstrom’s Stages of Recovery (1-7)
Stage 1: no volitional movement initiated
Stage 2: appearance of basic limb synergies; beginning of spasticity
Stage 3: synergies are performed voluntarily; spasticity increases
Stage 4: spasticity begins to decrease; movement patterns are not dictated solely by limb synergies
Stage 5: further decrease in spasticity is noted with independence from limb synergy patterns
Stage 6: isolated joint movements are performed with coordination
Stage 7: normal motor function is restored
Sign of the Buttock
To be (+), Sign of the Buttock must have all present: restriction of SLR concurrently with limited hip flexion and a non-capsular pattern of restriction of hip joint ROM.
7 Signs:
-Buttock large and swollen and tender to touch
-Straight Leg Raise (SLR) limited and painful
-Limited trunk flexion
-Hip flexion with knee flexion limited and painful
-Empty end feel on hip flexion
-Non capsular pattern of restriction at hip (flex,abd,IR)
-Resisted hip movements painful and weak esp hip extension
Knowledge of Results/Performance
Knowledge of results and a random practice pattern improve long-term retention and task transfer to novel conditions.
Knowledge of performance may result in a faster acquisition of a skill; however, it is not associated with long-term retention.
Prosthetic Gait Deviations (transfemoral amputation)
- A prosthesis that is too short causes a patient to laterally bend toward the prosthetic side during stance phase
- A prosthetic socket that is too small would likely functionally lengthen the prosthetic side and also cause vaulting
- Inadequate suspension causes vaulting
- Inadequate knee flexion causes vaulting
Wound Border descriptors
Epibole is used to describe a condition in which the wound edges are rolled under and the wound bed remains open.
Keloid scarring is a condition in which excessive scar tissue grows outside of the original margins of the wound.
Lichenification is a term used to describe skin that becomes hard and leathery. Its texture is similar in appearance to lichens.
Hypertrophic scarring would describe a healed wound with thick fibrous tissue that remains within the original wound border
Constructional apraxia
cognitive dysfunction in which a patient has difficulty initiating and performing a sequence of movements (assemble blocks)
Astereognosis
inability to recognize an object by handling the object without looking at the object.
Activity Termination in Phase I (inpatient) Cardiac Rehab
- diastolic blood pressure of 110 mm Hg or greater
- systolic blood pressure above 210 mm Hg or an increase greater than 20 mm Hg from resting
- heart rate that increases beyond 20 bpm above resting.
Functional position for splinting/immobilizing hand
wrist EXT, phalangeal FLEX, and ABD of the thumb
Anterior rotation of ilium
anterior rotation of the ilium would result in the involved leg appearing long in supine position and shortening in long-sitting position.
Posterior rotation of ilium
posterior rotation of the ilium would result in a shorter involved leg in supine that lengthens in long-sitting position.
Signs of Hyperglycemia
- fruity smelling breath
- thirst, nausea, vomiting
- dry, crusty mucus membranes
Signs of hypoglycemia
- difficulty speaking and concentrating
- confusion, difficulty completing tasks
- visual disturbances, blurred vision
Phase I (inpatient) Cardiac Rehab: parameters with activity that warrant termination are…
diastolic blood pressure of 110 mm Hg or greater, systolic blood pressure above 210 mm Hg or an increase greater than 20 mm Hg from resting, and a heart rate that increases beyond 20 bpm above resting.
Salter-Harris Fractures (types I-V)
SALTR S: slipped (type I) A: above or away from joint (type II) L: lower (type III) T: through or transverse or together (type IV) R: ruined or rammed (type V)
Brown-Sequard’s Syndrome (Hemisection of SC)
MOI causes hemisection (stab, gunshot); paralysis and loss of vibratory and position sense on ipsilateral side as the lesion due to damage to the corticospinal tract and dorsal columns; loss of pain and temperature sense on the contralateral side of the lesion from damage to the lateral spinothalamic tract; rare form of incomplete SCI
Cauda Equina Injuries
injury that occurs below the L1 spinal level where long nerve roots transcend; can be complete or incomplete; characteristics include flaccidity, areflexia, and impairment of bowel and bladder function; full recovery not typical; considered peripheral nerve injury;
Posterior Cord Syndrome
caused by compression of posterior spinal artery and is characterized by loss of proprioception, 2-point discrimination, and stereognosis; motor function is preserved; relatively rare
Anterior Cerebral Artery (ACA) - impairment
- anterior frontal lobe
- medial surface of frontal and parietal lobes
- C/L LE motor and sensory involvement
- loss of bowel and bladder control
- loss of behavioral inhibition
- significant mental changes
- neglect
- aphasia
- apraxia and agraphia
- perseveration
- akinetic mutism with significant bilateral involvement
Middle Cerebral Artery (MCA) - impairment
- most of outer cerebrum
- basal ganglia
- posterior and anterior internal capsule
- putamen
- pallidum
- lentiform nucleus
- most common site of CVA
- Wernicke’s aphasia in dominant hemisphere
- homonymous hemianopsia
- apraxia
- flat affect with right hemisphere damage
- C/L weakness and sensory loss of face and UE with lesser involvement in the LE
- impaired spatial relations
- anosognosia in non-dominant hemisphere
- impaired body schema
Posterior Cerebral Artery (PCA) - impairment
- portion of midbrain
- subthalamic nucleus
- basal nucleus
- thalamus
- inferior temporal lobe
- occipital and occipitoparietal cortices
- C/L pain and temperature sensory loss
- C/L hemiplegia (central area), mild hemiparesis
- ataxia, athetosis or chloroform movement
- quality of movement impaired
- thalamic pain syndrome
- anomia
- prosopagnosia with occipital infarct
- hemiballismus
- visual agnosia
- homonymous hemianopsia
- memory impairment
- alexia, dyslexia
- cortical blindness from bilateral involvement
Vertebral-basilar Artery (VBA) - impairment
- lateral pons and midbrain together with superior surface cerebellum
- cerebellum (branches of vertebral-basilar; PICA, AICA, SCA)
- medulla; PICA and smaller branches from VBA
- pons; branches from VBA
- midbrain and thalamus; posterior cerebral artery
- occipital cortex; posterior cerebral artery, basilar artery
- loss of consciousness
- hemiplegia or tetraplegia
- comatose or vegetative state
- inability to speak
- locked-in syndrome
- vertigo
- nystagmus
- dysphagia
- dysarthria
- syncope
- ataxia
Supine to Long Sit Test
If there is a posterior innominate, the leg that appeared shorter will lengthen with the sit up. If there is an anterior innominate, the leg that appeared longer will shorten with the sit up.
The reason a posterior innominate appears to lengthen following the situp is because activation of the hip flexors anteriorly rotates the innominate to return it to its normal position. A posterior innominate makes a leg appear shorter than the opposite side due to the altered position of the acetabulum. The opposite applies to the anterior innominate due to the restrictions (and in this case mobilizing nature) of the posterior tissues.
