Physical Conditions Flashcards
Arthrodesis
Surgical procedure used to fuse a joint
Compression fx
Vertebral collapse typically associated with:
- decreased bone density
- trauma from vertical force
- spinal tumors
- infection
Lordosis
Excessive anterior curvature of the spine
Kyphosis
Excessive posterior curvature of the spine
Spondylosis
Degenerative process in the spine and typically associated with OA
Symptoms may include:
- pain
- neurological changes
- motor impairment
Spinal stenosis
Narrowing of intervertebral foramen often compressing the nerve as it exits the spinal column
Symptoms may include:
- pain
- parethesia
- muscle weakness
- sensory changes
Claw-hand deformity
Hand deformity secondary to an ulnar nerve injury
Presents with atrophy of the hypothenar eminence and hyperextension of the MCP joints and flexion of the IP joints of the 4th and 5th digits
Intervention includes orthotic positioning to prevent overstretching of the intrinsic muscles by restricting MCP joint hyperextension
Torticollis
Dystonic disorder that can be congenital or acquired
Defined by abnormal, asymmetrical head or neck position
Intervention includes: ROM, positioning, environmental adaptations
Macular degeneration
Progressive age-related visual condition characterized by:
- atrophy of the macula (posterior retina)
- decrease in central visual acuity
- blurry, distorted, or low vision
Intervention may include:
- magnification devices
- lighting recommendations
- color and contrast enhancements
- visual skills training
Myasthenia gravis
Autoimmune motor unit disorder characterized by:
- ptosis and double vision
- possible difficulty with chewing, swallowing, and speech
- weakness and fatigue that increases throughout the day
Intervention may include:
- energy conservation and work simplification education
- sleep hygiene strategies
- recommendation of adapted and assistive devices
- activity modification
Chronic obstructive pulmonary disease (COPD)
Pulmonary condition associated with limited airflow from the lungs, characterized by:
- difficulty breathing
- shortness of breath during activities
- dyspnea and fatigue that influence occupational performance
- persistent cough
- includes emphysema and chronic bronchitits
Dyspnea
Shortness of breath due to impaired breathing in response to activity or at rest, may require:
- medical attention
- modification to activity demands
- instruction in breathing techniques
- dyspnea control postures
Orthopnea
SOB due to impaired breathing when lying supine
Cerebral palsy (CP)
Neurological condition caused by a brain injury or malformation that occurs while the brain is developing.
Characterized by:
- body movements and GM skills
- muscle control and tone
- muscle coordination and FM skills
- reflexes, posture, and balance
- oral motor functioning
Myocardial infarction
Emergency medical condition characterized by blocked flow of blood to the heart
Expected functional outcome of SCI level C1-C3
Ventilator dependent
Total physical assistance for BADL and ADL
Able to direct care needs
Expected functional outcome of SCI level C4
Initially vent dependent; progress to breathing independently with reduced vital capacity
Total physical assistance for BADL and ADL
Able to direct care needs
Power chair with adaptations for independence in mobility
Total assistance for bed mobility and tranfers
Expected functional outcome of SCI level C5
Independent respiratory function with reduced vital capacity; may need assistance for a productive cough
Total assistance for bowel and bladder management
Independent self-feeding with adaptive devices
Assistance for grooming with adaptive devices
Total assistance for bathing
Expected functional outcome of SCI level C6
Independent respiratory function with reduced vital capacity; may need assistance for a productive cough
Minimal to total assistance for bowel and bladder management with adaptive devices
Some assistance for BADLs
May need some assistance for outdoor w/c propulsion in manual w/c
May need assistance with t/f and bed mobility with adaptive devices
Total assistance for standing
Expected functional outcome of SCI level C7-T1
Independent respiratory function
Assistance for bowel management
Modified independence for BADLs
Some assistance for standing
Modified independence for bed mobility and t/f
Independent driving with modifications
Expected functional outcome of SCI level T2-T12
Ind - mod I for BADLs
Mod I for bowel/bladder management
Mod I for bed mobility, t/f, and standing
Ind w/c mobility
Pulmonary embolism
Potentially fatal condition resulting when a blood clot travels to the lungs and blocks arterial circulations
May be asymptomatic or experience:
- sudden dyspnea
- sharp chest pain
- tachycardia
- tachypnea
- profuse sweating
- anxiety
Expected functional outcome of SCI level L1-L5
Ind ADLs and bed mobility
Ambulate with assistive devices
May use w/c for distance; Ind with loading/unloading from vehicle
Ind driving with hand controls
Stage 2 pressure ulcer
Characterized by:
- partial thickness skin loss
- exposed dermis
- open wound that looks like a scrape, blister, or tear
- client reports pain and tenderness
- warm to touch
- localized edema
Stage 3 pressure ulcer
Characterized by:
- full thickness skin loss
- open wound that looks like a crater
- wound extends into the fat layer but not to the tendon, muscle, or bone
Stage 4 pressure ulcer
Characterized by:
- full thickness tissue and skin loss
- open wound with visible muscle, tendon, or bone
- tunneling or undermining may both be present
Unstageable pressure ulcer
Characterized by:
- full thickness skin and tissue loss
- wound is completely covered by eschar or slough
Stage 1 pressure ulcer
Characterized by:
- no wound or tears in the skin
- skin reddens but does not blanch
- warm to the touch
- surrounding area may feel firmer or osofter
- client may report pain
Deep vein thrombosis (DVT)
Potentially fatal formation of a blood clot most often occurring in the calf area with high risk for pulmonary embolism, symptoms include:
- pain with dorsiflexion of the foot
- tenderness of the calf
- swelling of the leg
- warmth to touch
Gravitational insecurity
Inability of CNS to regulate vestibular input resulting in overreation to changes in head position and movement during ordinary activities
Ape hand deformity
Hand deformity secondary to a median nerve injury in the proximal forearm or at the wrist
Presents with atrophy of the thenar eminence and inability to abduct and oppose thumb
Intervention includes orthotic positioning to maintain palmar abduction and opposition
Duchenne muscular dystrophy
Inherited genetic disorder resulting in muscular weakness and atrophy of the proximal musculature of the pelvis and shoulder girdle
Symptoms more common in males and detected around 3 y/o
Results in gradual loss of independent ambulation and progressive deterioration of musculature of the trunk, neck, and distal extremities
Swan neck deformity
Joint deformity consisting of PIP hyperextension and DIP flexion commonly associated with RA and tendon trauma
Lateral bands of the extensor mechanism slip above the PIP, thereby hyperextending the PIP joint and flexing of the DIP
Intervention may include a tri-point ring orthosis to prevent PIP hyperextension
Boutonnière deformity
Joint deformity consisting of PIP flexion and DIP hyperextension, commonly associated with rheumatoid arthritis and PIP joint trauma
occurs when synovitis weakens, lengthens, or disrupts the dorsal capsule and central slip of the extensor mechanism; the lateral bands displace volarly below PIP
Intervention may include fabrication of orthosis to support the PIP in extension while allowing movement at the DIP
Rheumatoid arthritis (RA)
An autoimmune, chronic inflammatory disease associated with synovitis of the joints, characterized by:
- acute pain, erythema, and swelling during disease exacerbation
- symmetrical joint involvement
- chronic pain secondary to progressive joint damage
- prolonged morning stiffness lasting 1-2 hours
- swan neck and boutonnière deformity
- wrist radial deviation and MP ulnar deviation
Clonus
Reflexive abnormal motor movements in response to a tendon stretch, indicative or a cortical lesion
Characterized by a series of involuntary rhythmic contraction and relaxation of the muscle
Lead pipe rigidity
Motor dysfunction secondary to a lesion of the basal ganglia where during slow passive ROM, constant resistance is felt
Common symptom of Parkinson’s
Clasp-knife rigidity
Reflexive abnormal motor response due to a cortical lesion in which a spastic muscle suddenly releases tension and gives way in response to passive stretch
Mallet finger
Inability to extend DIP joint due to rupture of the distal end of the extensor tendon
Intervention may include static orthosis to maintain DIP in extension
Cog-wheel rigidity
Motor dysfunction secondary to a lesion of the basal ganglia in which the muscles respond in a jerky motion when force is applied during flexion of a joint
Common symptom of Parkinson’s
Decorticate rigidity
Characteristic of abnormal reflexive posturing secondary to severe brain injury, typically in patients with a score of 3 on motor section on GCS
Includes:
- flexion of the elbows across the chest
- adduction and flexion of wrists
- flexion of fingers
- extension and internal rotation of the legs
- plantarflexion of the feet
Web space contracture
Loss of tissue elasticity between fingers or toes impacting function, commonly associated with soft tissue trauma such as a burn
Decereberate rigidity
Characteristic of abnormal reflexive posturing secondary to severe brain injury, typically in patients with a score of 2 on motor section on GCS
Includes:
- adduction and extension of the arms next to the body
- pronation of the forearms
- flexion of wrists and fingers
- extension and internal rotation of the legs
- plantarflexion of the feet
Full thickness burn
Associated with:
- damage to nerve endings, dermis, and epidermis
- pale
- decreased sensation
- high risk of hypertrophic scar or contractures, may require surgery to promote wound healing
Ulnar drift
Hand deformity where MCP joints deviate to the ulnar side, commonly associated with RA
Intensified by functional activities requiring power grasp and lateral pinch
Carpal tunnel syndrome
Pain, numbness, and paresthesia in thumb, index, and middle fingers associated with median nerve compression
deQuervain’s tenosynovitis
Inflammation of the abductor pollicis longus and extensor pollicis brevis, resulting in pain, crepitation, and swelling over the radial styloid
Complex regional pain syndrome: stage III
Atrophic stage of CRPS that lasts sever years after injury or trauma, characterized by:
- decrease in pain intensity
- persistent edema
- irreversible changes in skin and joints
- bony demineralization
- severe muscle atrophy
- joint contractures
Complex regional pain syndrome: stage II
Dystrophic stage of CRPS that typically last from 6-9m after injury or trauma, characterized by:
- extreme pain
- hypersensitivity to light touch or deep pressure
- brawny edema
- skin redness and warmth to touch
- bony demineralization
- muscle atrophy
- joint contractures
Complex regional pain syndrome: stage I
Traumatic stage of CRPS that typically lasts up to 3m, characterized by:
- extreme pain
- decreased AROM
- hypersensitivity to light touch or deep pressure
- pitting edema
- blotchy looking skin discoloration
- hyperhidrosis
- skin temperature fluctuation
- changes in extremity hair and nail growth patterns
Complex regional pain syndrome (CRPS)
Disorder of the sympathetic nervous system typically triggered by sx or trauma, resulting in pseudomotor and vasomotor changes and disproportionate pain beyond the region of sx or injury
Divided into 3 stages: traumatic, dystrophic, atrophic
Neurotmesis
Seddon’s classification of a completely severed nerve where recovery will not occur unless sx repaired
Intervention may include:
- pain relief
- orthotic positioning
- controlled motion ex
- neural gliding ex
- scar and edema management
- compensatory techniques
- pt education
Trigger finger
Catching or locking of the digit due to inflammation or a thickening of the flexor tendon sheath during grasping activities
Axonotmesis
Seddon’s classification of a nerve compression that recovers spontaneously but is more severe compared to a neuropraxia
Characterized by:
- axon and myelin sheath disruption
- endoneurium remains intact
Classification of peripheral nerve injuries
Neurapraxia (1st degree)
Axonotmesis (2nd degree)
Neurotmesis (3rd degree)
Long thoracic nerve injury
Peripheral nerve injury characterized by weakness in the serratus anterior and winging of scapula
Axillary nerve injury
Peripheral nerve injury characterized by hyperesthesia on the lateral aspect of the shoulder and weakness of the deltoid and teres minor
Brachial plexus injury
UE nerve injury where the signs and symptoms may impact the arm, hand, or wrist depending on the severity, mechanism, and anatomical location of the injury and may include:
- loss of sensation or numbness
- decreased shoulder ROM
- weakness or paralysis
- pain
Lateral epicondylitis
Also called tennis elbow; term used to describe pain and tenderness at the supracondylar ridge of the elbow, most often associated with irritation at the origin of the extensor carpi radialis brevis tendon
Cubital tunnel syndrome
Pain, numbness, and paresthesia in the ring and small fingers due to ulnar nerve compression at the elbow
Symptoms are associated with direct compression of the nerve or repetitive or sustained flexing the elbow beyond 90º
Neurapraxia
Seddon’s classification of a nerve compression where there is disruption of the myelin and spontaneous recovery is expected
Deep partial thickness burn
Associated with:
- direct contact or lengthy exposure to a heat source
- complete destruction of epidermis and most of dermis
- redness and large blisters
- high risk or hypertrophic scar or contractures
Superficial partial thickness burn
Associated with:
- severe sunburn, lengthy exposure to a heat source
- damage to upper dermis and epidermis
- blistering and redness
- reports of significant discomfort
- low risk of hypertrophic scar formation
Superficial burn
Also referred to as a first-degree burn
Associated with:
- mild sunburn or short exposure to heat source, chemical or hot liquid
- dry, superficial redness, blister free
- reports of mild to moderate discomfort
- no risk of scar formation or contracture
Parkinson’s disease (PD)
Neurodegenerative condition associated with the deterioration in the substania nigra characterized by:
- rigidity
- bradykinesia
- resting tremor
- festinating gait
Multiple sclerosis (MS)
Neurodegenerative condition associated with white matter lesions in the CNS and demyelination process, characterized by fluctuant changes in:
- energy level
- vision
- sensation
- mobility
- weakness
- cognition
Guillian-Barré syndrome
Acute demyelinating condition characterized by:
- symmetrical and progressive paralysis
- ascending weakness starting at the fet
- possible involvement of cranial nerves and muscles of respiration
Typical course includes:
- acute phase (2-4wks): progressive increase in symptoms
- plateau phase (few days-weeks): no change occurs
- progressive recovery phase (up to 2y): gradual improvement
Amyotrophic lateral sclerosis (ALS)
Neurodegenerative condition associated with progressive death of upper and lower motor neurons, characterized by:
- muscle weakness in one or more extremity
- difficulties with speech, swallowing, and/or breathing
Huntington’s disease
Genetically-inherited degenerative neurological disease typically beginning between 30-50y/0, characterized by choreiform movements, decline in thinking and reasoning skills, and alterations in mood
Hypertrophic scar
Type of scar formation caused by an overproduction of collagen and increased vascularity, characterized by:
- initially appearing as raised, thick, erythematous, possibly in a circular or spiral pattern
- progressively becomes flatter and more pliable as the wound matures and collagen fibers relax
Systemic lupus erythematosus
Autoimmune inflammatory disease affecting joints, skin, blood cells, and vital organs
Characterized by a distinct butterfly-shaped facial rash that crosses both cheeks
Symptoms may be acute, chronic, or episodic and may include:
- joint pain and swelling
- skin lesions
- fatigue
- Raynaud’s phenomenon
- dyspnea
- alterations in cognition
Usher syndrome
A medical condition that involves partial or complete hearing loss, gradual vision loss due to retinitis pigmentosa, and difficulties with balance
Motor coordination
Function of the cerebellum that includes ability for different muscle groups to work smoothly together to allow for desired rate and rhythm of movement
Ataxia
Abnormal movement pattern secondary to cerebellar lesion, resulting in a lack of smooth-coordinated muscle movements, behavioral manifestations include:
- slurred speech (dysarthria)
- difficulty with alternating movements (dysdiadochokinesia)
- staggering gait (ataxic gait)
- swallowing difficulties (dysphagia)
- over/undershooting during reach (dysmetria)
Atelectasis
Partial or fully collapsed lung
Signs and symptoms include:
- rapid and shallow breathing
- dyspnea
- low oxygen saturation
- increased HR
Heterotrophic ossification
Abnormal extraskeletal bone formation, high risk dx include:
- SCI
- TBI
- burns
- direct contusion
Bradykinesia
Decreased or slowed movement with difficulties switching motor patterns, characterized by:
- lack of facial expression
- monotone speech
- slow eye movement
- shuffling gait
- muscles freezing
Wrist drop
Radial nerve damage that causes loss of wrist extension
Benediction sign
Result of median nerve compression
Clinical sign in which the 4th and 5th digits will flex but the thumb, 2nd, and 3rd digits will remain extended when attempting to make a fist
Hemiballismus
A subtype of chorea in which involuntary, sudden, aggressive movements occur in the affected extremities
Due to dysfunction in the CNS on contralateral side
Athetosis
Involuntary, slow, writhing movements caused by damage to the caudate and putamen observed in pt with CP
Chorea
Involuntary, unpredictable, rapid, jerky movements commonly observed in clients with Huntington’s disease
Signs include:
- shoulder shrugs
- hip movements
- crossing/uncrossing legs
- facial grimacing
- tongue protrusions
Peripheral vertigo
Sudden dizziness, vomiting, and nausea due to lesions of the vestibulocochlear nerve, Ménière’s disease, or vestibular neuritis
Neuroma
Regenerated nerve tissue found at the site of a prior nerve injury that may cause pain or numbness within the body
Hyperglycemia
High blood sugar level that requires the following actions:
- assess the situation and call for medical assistance as needed
- encourage client to measure blood glucose level
- if client is unable to assist or it unconscious, call for immediate medical assistance
Autonomic dysreflexia
Potentially life-threatening acute medical condition caused by overreaction of autonomic nervous system to stimulation, commonly associated with a SCI above T6 level, characteristic symptoms include:
- pounding headache
- chills and flushed skin
- anxiety
- excessively high BP
- perspiration
- bradycardia
Orthostatic hypotension
Condition resulting from a sudden decrease in BP associated with changing position from supine to sitting or standing, often associated with prolonged bed rest or side effects from medication
Hypotension
Low BP associated with:
- feeling faint
- syncope
- change in mental status
- drowsy or decreased wakefulness
- weakness and light-headedness
Hypoglycemia
Physiological condition resulting in low blood sugar, may be caused by:
- excessive insulin levels
- physical activity
- decreased intake of food or sugar
Primary lymphedema
Condition caused during development of the lymphatic system that results in an abnormal accumulation of fluid in tissues
Secondary lymphedema
Condition caused by damage to the lymphatic system as a result of a trauma, illness, disease, or surgery that results in an abnormal accumulation of fluid in tissues
Compartment syndrome
A condition that occurs due to an increase in muscle pressure that causes a restriction in blood flow to nerves and muscle cells
Degloving injuries
A traumatic injury resulting from skin and tissue tearing from a bone surface, muscle, or deep fascia
Typically requires limited movement to the affected region during recovery
Open reduction and internal fixation (ORIF)
Sx intervention for displaced fx requiring screws, metal plates, or rods to stabilize and align the fx bone
Sepsis
A life-threatening, systemic inflammatory response that occurs when an infection triggers a response throughout the body
Results in a compromised blood flow, damage to tissues and organs, and in severe cases, death
Tracheostomy
An artificial airway created by cutting the trachea and inserting a tube that avoids the mouth and nose to provide oxygen to the lungs
Aortic aneurysm
A weakened and enlarged section of the aorta that may lead to rupture or dissection, which can fatal if left untreated
Precautions may include limited pushing, pulling, lifting, or straining during activities
Electrocardiogram
Noninvasice imaging that records the heart’s electrical conduction cycle to assess cardiac function
Used to diagnos cardiac function
Neutropenia
A condition that causes a person to be at a higher risk of infection due to a low count of neurtophils, a type of white blood cell
Post-invasive care syndrome
The onset or progression of impairments following a critical illness in the ICU
Characterized by:
- decreased physical function
- impaired cognitive function
- changes in thoughts and feelings
Chemotherapy-induced peripheral neuropathy
A side effect of some cancer treatments that involves severe numbness, pain, and ataxia due to sensory and motor nerve damage
Tardive dyskinesia
A neurological condition characterized by involuntary and repetitive movement or oral musculature
Mean arterial pressure
Measured via centralized monitoring to determine average arterial pressure during a cardiac cycle
Normal range: 70-110 mmHg
What is the normal range for intracranial pressure?
below 20 mmHg
Osteoarthritis
Gradual wearing away of a joint
Occurs mostly in aging population
Typically unilateral
Stiff less than 30 minutes in the morning
Joints feel bony but no soft swelling
Bouchard’s nodes
PIP joint
Herbeden’s nodes
DIP joint
Mallet (jersey) finger
DIP in flexion
Rupture of distal terminal tendon
Often turns into swan neck
Straight finger orthotic for 6-8 weeks
Osteoporosis
A bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes.
This can lead to a decrease in bone strength that can increase the risk of broken bones (fractures).
Types of fx
Greenstick: incomplete fracture. A portion of the bone is broken, causing the other side to bend.
Transverse: break is in a straight line across the bone.
Spiral: break spirals around the bone; common in a twisting injury.
Oblique: break is diagonal across the bone
Compression: bone is crushed. This causes the broken bone to be wider or flatter in appearance.
Comminuted: bone has broken into three or more pieces and fragments are present at the fracture site.
Segmental. The same bone is fractured in two places, so there is a “floating” piece of bone.
Spondylolisthesis
Vertebrae shift due to disc degeneration
Can result in paralysis in extreme cases
Coronary artery disease (CAD)
Heart attack
Most common in those 65+
Attributed to atherosclerosis (collection of plaque in arteries as we age)
Causes: angina pectoralis (stable or unstable), heart failure, death
- angina pectoralis: if it’s stable we know what causes it and it’s not as serious, lasts less than 3 minutes; unstable always has to be treated as a potential MI
Diagnosed with echocardiogram or angiogram (may put balloon or stent in)
Treated with:
Nitroglycerin
- if nitroglycerin helps = no ambulance
Beta blockers
Ace inhibitors
CABG (coronary artery bypass graft)
PCI (pericutaneous coronary intervention)
Congestive heart failure
Common in pt with a history of HBP
Can result from MI or CAD
Can be unilateral or bilateral
Heart is not able to pump enough blood, causing a back of blood in the lungs and heart, causing the heart to enlarge
Stage 1: breathlessness or tiredness (with brisk walk, jog, or stairs)
Stage 2: comfortable when resting; heart races or breathlessness when walking a block or taking stairs
Stage 3: palpitation or tiredness with simple tasks like standing or walking short distances
Stage 4: heart and breath go faster even at rest; tiredness even while sitting; anxiety and palpitations almost all the time
Acute respiratory distress syndrome
A reaction to an illness such as flu, COVID, pneumonia, sepsis, or trauma.
Can be treated with medication and therapy.
Interstitial lung disease
Usually chronic and has a poor outcome.
Anyone can get ILD including children.
Increased risk:
- smoking
- genetic predisposition
- exposure to hazardous materials
- exposure to certain meds or therapies (chemo, radiation)
- some autoimmune diseases such as scleroderma, sarcoidosis, RA
Sarcoma
Connective tissue (bone, muscle, tendon)
Myeloma
Plasma and bone marrow
Leukemia
Blood forming tissue
Lymphoma
Cancer of the lymphatic system
Inflammation
Natural response to tissue damage necessary for the healing process
- changes pressure to slow internal bleeding
- causes pain to tell the body to stop
May or may not come with infection
Lack of inflammatory response can indicate a disease such as AIDS
Occurs with trauma, allergy, heat, and bacteria
Acute or chronic
For the most part, if you are hurting the patient, you are doing more harm than good.
Classic signs:
- redness, edema, heat, pain
Infection
An invasion of a pathogenic microorganism that disturbs homeostasis
A foreign substance has invaded and is attacking. Infection is always a problem.
What is sickle cell disease?
A group of inherited (genetic) disorders that impact red blood cells
- abnormal hemoglobin (carries O2)
- normal RBCs live 120 days, are round, soft, and flexible; but with SCD they life 20 days, are sticky, brittle, and crescent shaped which leads to O2 loss, pain, and stoke
Slowing or blockage of blood to any part of the body
If an area doesn’t receive enough blood it will rot
What is sensory integration?
The ability to select (automatically) a useful input, organize it, and accomplish a goal (in a split second); thuse, leading to an adaptive response (new skill) and competent praxis (coordinated movement).
Interoceptive sense
The awareness of your own body
The ability to calm down or get loud even if you don’t want to
Emotional and attentional regulation
Sensory processing effects…
Development - you know how to walk and climb stairs based on sensory integration from walking and crawling
Learning - you either learn by focusing on input or by ignoring it
Emotional/ Behavioral - if your underwear is in a ball how does that affect you?
Sensory processing disorders
Usually not one, but a group
CNS not PNS
- sensory reception is normal, the interpretation and organization is flawed
Sensation is one of the basis for cognitive learning.
- kids with learning disabilities have more postural, vestibular, and proprioceptive problems
- many kids with ADHD have tactile processing disorders as well
What is cerebral palsy?
Diverse group of non-progressive (and permanent) syndromes that affect the brain and cause motor or cognitive defects beginning in early infancy
CNS disorder
If the TBI happens before 24 months, it is called CP
Spastic CP
Increased muscle tone
Prolonged primitive reflexes - walking, sitting, suck reflex
Rigidity of extremities
Contractures - a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints
Dyskinetic/ Athetoid (extrapyramidal) CP
Extreme difficulty with fine motor and purposeful movement
- Dystonia: muscles contract involuntarily
Jerky, uncontrolled movement
Tone fluctuates
Injury to basal ganglia or extrapyramidal tracts
Ataxic CP
Gait disturbances and instability
Nystagmus - a condition in which your eyes make rapid, repetitive, uncontrolled movements
Hypotonic at birth but develop stiffness of trunk in late infancy
Types of plegia
Monoplegia – one limb
Paraplegia – 2 extremities, usually both lower
Diplegia – 2 extremities, usually both upper limbs
hemiplegia – 2 limbs, usually leg and arm on same side (ipsilateral)
Quadriplegia – effects 4 limbs
Plegia – means effects not paralyze
Becker’s muscular dystrophy
- almost identical to Duchenne’s, but less severe and progresses slower
- survival into middle age
Duchenne’s muscular dystrophy
- general muscle weakness and wasting
- affects pelvis, upper arms, and upper legs
- eventually involves all voluntary muscles
- survival beyond 20s is rare
Facioscapulohumeral muscular dystrophy
- facial muscle weakness
- weakness and wasting of shoulders and upper arms
- progression is slow with periods of rapid deterioration
- lifespan may be many decades after onset
Limb-girdle muscular dystrophy
- weakness and wasting of shoulder girdle and pelvic girdle
- progression is slow
- death is usually due to cardiopulmonary complications
Hydrocephalus
Excessive CSF in the ventricles of the brain
Skull can expand
Spina bifida often leads to hydrocephalus
Spina bifida occulta
defect in bone
comes with a tuft of dark, curly hair that grows right over the spot of the defect
Spina bifida meningocele
defect in bone and sac but no nerve involvement
most don’t have severe issues
Spina bifida myelomeningocele
meninges and nerves are involved
whatever level the defect is at, typically person will have paralysis in inferior levels
Reye’s syndrome
Cause is not known
Almost always follows some type of illness (strep), usually viral
Link to aspirin and aspirin products
- No longer given to children under 12
- Pepto has aspirin
Butterfly shaped rash
Development in reverse: stop developing and begin to regress
Erb’s palsy
C5-c6, shoulder but no hand
Waiter’s tip: internal rotation
Klumpke’s palsy
C8-t1 more hand impact and less shoulder
Cystic fibrosis
Inherited
Chromosome 7
All mucous producing parts of the body over produce
OT Role:
Education/genetic issues
Postural drainage: percussions to loosen phlegm collected in lungs so they can cough it up
Developmental delay: not a component like in down syndrome; miss school and opportunities which can lead to these delays
School issues-energy conservation
Chest expansion
Grades of ligament sprains
Grade I: stretch the ligament causing mild swelling and pain with stress testing, but no laxity
Grade II: partial tear resulting in more moderate swelling and pain along with some laxity on stress testing; have definitive endpoint with stress testing
Grade III: complete tear with a lot of pain, swelling, and gross laxity on stress testing without any definitive endpoint
Grade IV: not really a sprain; avulsion fracture
Types of muscle movement
Isotonic
- eccentric: lengthening of muscle
- concentric: shortening of muscle
Isometric
- muscle contraction, not shortening or lengthening
- happens with co-contraction of flexors and extensors
Muscle contracture
Muscle shortening from being stationary
Rickets (Osteomalacia)
bad bones
due to vitamin D and E deficiency
common in children outside the US
bowing is caused by bodyweight
Acute care of arthritis
Move it, calm it, support it
- education
- ROM with no pain
- modalities
- gentle stretching
- functional tasks
- orthotics
- assistive devices
Stages of osteoarthritis
Stage 0: asymptomatic
Stage 1: mild joint pain, no serious symptoms
Stage 2: pain with activity, difficulty straightening and bending joints, stiffness
Stage 3: frequent pain with movement, stiffness in the morning or after sitting, visible swelling of possible joints
Stage 4: high pain with joint usage, difficulty with daily activities, intense stiffness, severe swelling and inflammation
Rule of nines
Pruritus
Itching due to nerve regeneration
- may be other sensory sensations
- teach them to apply lots of moisturizer, pat instead of scratch, compression garment and pressure can override the itching sensation
Treatment of burns
Acute phase (ICU) –> rehab phase (inpatient then outpatient)
Acute phase:
- skin integrity and sheer prevention
- protect grafts,
- pain
- positioning (antideformity)
- ADLs
- orthotics
- adaptive function
Rehab phase:
- aggressive ROM
- splinting to increase ROM and function (functional and dynamic orthotics)
- scar management
- functional tasks (crafts work well)
- ADLs
Psychosocial
Components of motor control
Reciprocal innervation
- If the agonist is contracting/the antagonist is relaxing
> Heavy flexion = relaxed extension
> Spasticity (elbow flexed up to chest) – resist against flexion – better extension
Co-Contraction
- Agonist and antagonist = stability
- Necessary for postural control
Heavy Work
- Mobility to be superimposed on stability
- Proximal stability = distal controlled mobility
- Proximal instability = distal loss of control and mobility
Skill
- Proximal stability = functional distal motion
- Painting on an upright vs. floor
- Writing board vs paper
Critical concepts of PNF
Resistance - improves muscle contraction
Stretch - use of quick stretch
Irradiation - also called overflow
Traction or approximation - the lengthening or compressing of a limb
Body position - the therapist finds the body position that is most stable for the client
PNF patterns
Combination of stretch/resistance and motion in 4 distinct FUNCTIONAL patterns
D2 – swords
D1 – pledge of allegiance
