Random Flashcards
volt
the electrical force capable of moving charged particles through a conductor between two regions or points.
hertz
a unit of measure which describes the number of cycles per second when using an alternating current
coulomb
amount of electrical charge transported in one second by a steady current of one ampere.
Pulses per second
utilized to describe the frequency of pulsed current
anemia
heart palpations , shortness of breath
coagulant disorder
susceptibility to bruising
stage 1 ulcer
characterized by an observable pressure related alteration of intact skin whose indicators, as compared to an adjacent or opposite area of the body, may include changes in skin color, temp, stiffness, or sensation.
stage 2 ulcer
partial thickness skinloss that involves the epidermis and/or dermis. Superficial and presents as a clinical abrasion, a blister or a shallow crate.
stage 3 ulcer
full thickness skin loss that involves damage or necrosis of subcutaneous tissue that may extend down to but not through, the underlying fascia. Presents as a deep crater with or without undermining adjacent tissue.
stage 4 ulcer
full thickness loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures.
Inspiration muscles
Diaphragm (main)
Upper trapezius
External interostals (Secondary)
Expiration muscles
Internal intercostals (main)
superficial burn
involves only the outer epidermis .
red with slight edema
No scar healing in 2-5 days
super ficial partial thickness burn
involves the epidermis and the upper portion of the dermis.
Painful with blisters
Healing occurs in minimal to no scaring in 5-21 days
a deep partial thickness burn
complete destruction of the epidermis and upper portion of the dermis
discolored with broken blisters/edema
Damage to the nerve endings may result in only moderate pain
Healing for hypertrophic scars and keloids in 21-35 days
full thickness burn
complete damage of epidermis and dermis and partial damage to subcutaneous fat layer
eschar formation
no pain
require grafts and susceptible to infection
Compression garments:
10mmHg: not adequate edema control
- 16-18mmHg: off the shelf stockings used to prevent DVT in bed ridden patients.
- 20-30mmHg: used to control scar tissue formation.
- 30-40mmHg: used to control edema in ambulatory patients.
Best indicator that the pt. exerted maximal effort
failure of the heart rate to increase with further increases in intensity
acceleration
rate of change in velocity with no respect to time
cadence
number of steps taken by a person per unit in time
110 steps typical in male
115 steps typical in female
velocity
rate of linear forward motion in the body
measured in cm per sec
= distance dived by time
Grade 1 Joint mob
small movement performed at beginning of range
Grade 2 Joint mob
II large amplitude movement performed within the range, but not reaching limit of range and not returning to beginning of range
Grade 3 Joint mob
large amplitude movement performed to limit of range
Grade 4 Joint mob
small amplitude movement performed at limit of range
Direct current
uninterupted flow of electrons toward the positive pole. This type of current is necessary to move the charged ions across the dermal barrier. Polarity remains constant and is determined based on treatment goals and the polarity of the chosen ion.
Alternating current
biderictional, constantly changing continous flow of electrons. negative to posisitve
Pulsatile Current
3 or more pulses grouped together.
interferential current
combines 2 high freq alternating waveforms that are biphasic. delivered through 2 different electrode in2 different channels.
Intermittent claudication
An aching, crampy, tired, and sometimes burningpain in the legs that comes and goes – it typically occurs with walking and goes away with rest – due to poor circulation of blood in the arteries of the legs. In very severe claudication the pain is also felt ar rest.
Nerve pain
sharp shooting burning
M.m pain
cramping dull achy
worse when mm stretches
Bone pain
deep intolerable and highly locolized
Vascular pain
diffuse, throbbing aching, and poorly locolized
Glossopharyngeal breathing
used to increase vital capacity and clear upper airway in
patients with paralysis of some of the respiratory muscles
The pedal pulse
The pedal pulse is the anterior tibial artery that supplies the musculature of the anterior compartment of the shin. Obstruction of this artery is anterior compartment syndrome
Electrocardiogram lead I?
The negative lead is on the right arm and the positive lead is on the left arm
Electrocardiogram lead 2?
The negative lead is on the right arm and the positive lead is on the left foot
Electrocardiogram lead 3?
The positive lead is on the foot and the negative lead is on the left arm
Hydrostatic pressure
affects the chest expansion, decreasing it. This decreases
inspiratory capacity, thus the vital capacity.
the best pulmonary pattern to monitor to indicate the significance of
the patient’s disability:
Inspiratory reserve volume, tidal volume, vital capacity, total volume
Reason: The tidal volume and vital capacity indicate the patient’s ventilatory function.
insidious onset
should lead the therapist to explore disease as an etiology for this
problem. The most common are metastatic cancer, idiopathic frozen shoulder, and
arthritis.
edema compression
has shown that two hours of intermittent compression will achieve the best
edema reduction.
galvanic simulation
is characterized by high voltage, pulsed
stimulation and is recommended primarily for local edema reduction through pumping
and polarity effect. The galvanic stimulation thereby applies an electrical potential which
disperses the negatively charged proteins away from the edematous site and helping to
reduce the edema. 50Hz is chosen over 30Hz as this is sufficient for muscle
contraction
Contrast bath
Hot 5 min, cold 1 min, hot 5 min.
Ratio of 3:1 or 4:1(hot: cold) for 19-20 minutes is fairly well
accepted.
Traction of lumbar spine:
traction of lumbar spine: typically 25% of patients body weight is generally recommended when the goal of treatment is to decrease muscle spasm or stretch soft tissue.
50%: required for mechanical separation of lumbar spine.
mechanical agent: traction
modality that applies mechanical forces to body to separate joint surfaces and decrease pressure. force can be applied manually by therapist or mechanically by a machine.
therapeutic effects of traction
joint distraction, soft tissue stretching, muscle relaxation, reduction of disk protrusion, joint mobility
indications for traction
nerve impingement, herniated or protruding disc, subacute joint inflammation, spondylolisthesis, joint hypomobility, paraspinal muscle spasm, degenerative joint disease, osteophyte formation
contraindications for traction
when motion is contraindicated, joint instability, tumor, pregnancy, acute inflammatory response, acute sprain, osteoporosis, fracture
treatment parameters for traction
treatment time is 5-20 mins. cervical: pt supine with approx 25-35 degrees of neck flexion, should start with a force btwn 10-15 lbs and progress to 7% of pt’s body weight as tolerated for separation of vertebrae. lumbar can be supine or prone, and should be set with a force of less than half body weight for initial treatment. traction force of 25-50 lbs is recommended when initiating mechanical lumbar traction. force of up to 50% of body weight is required for actual separation of the vertebrae.
extremity tanks:
used for distal UE or LE.
Depth: 18-24 in
Length: 28-32 in
Width: 15 in
highboy tank:
used for larger parts of the extremities and the trunk. This tank permits sitting in chest high water with hips and knees flexed.
Depth: 28 in
Length: 36-48 in
Width: 20-24 in
hubbard tank:
used for fully body immersion. Depth: 4 feet Length: 8 feet Width: 6 feet Contraindications: unstable BP, incontinence. Temperature shouldn't exceed 100 degrees F.
Hydrotherapy tanks:
transfers heat through water (wound care, edema control).
lowboy tank:
used for larger parts of the extremities and permits long sitting with water up to the midthoracic level.
Depth: 18 in
Length: 52-65 in
Width: 25 in
pursed lip breathing
improves ventilation by decreasing RR and increasing tidal volume
segmental breathing
used to prevent accumulation of fluid by directing inspired air to predetermined areas. applying pressure downward and inward during exhalation.
reverse trendelenburg
places a patient in supine with head raised above their trunk and LEs. may be used with patients diagnosed with hypertension or other cardiac conditions. also decreases the weight of the abdominal contents on the diaphragm providing it with less resistance to mvmt during breathing
guidelines for chest PT
treatment should be before eating, or at least one hour after meals, percuss and vibrate over each segment to be treated for at least 3-5 mins, cough after each segment is treated, allow for a rest period after each segment is treated, review breathing exercises in each drainage position, not to exceed 45-60 mins secondary to patient fatigue
goals for chest PT
mobilize secretions, expel secretions, improve breathing patterns, improve ventilation throughout all lobes, improve overall function
percussion
using cupped hands to strike over a particular lung segment in alternating fashion during inspiration and expiration in order to mobilize secretions. should last for several minutes and should not be painful
vibration
technique using both hands (one on top of the other) directly over the chest wall to provide pressure and manual vibration during exhalation. should be used in conjunction with percussion and only during expiration. pressure should be applied in same direction as chest wall mvmt during expiration
semi-fowler’s position
places patient supine with head of bed elevated to 45% and pillows under patient’s knees for support and maintenance of a proper lumbar curve. used quite often for patients with CHF or other cardiac conditions
trendelenburg position
patient in head down position with bottom of bed inclined to approx 45%. ideal to assist with secretion drainage from lower lobes of lungs. can also assist with increasing blood pressure in case of hypotension. do not use with patients with CHF, pulm edema, hypertension, SOB or other circulatory problems
diaphragmatic breathing
attempts to enhance movement of diaphragm upon inspiration and expiration and diminish accessory muscle use. position patient in bed with head and trunk elevated 45 degrees. place dominant hand over rectus abdominis. place non dominant hand over sternum. direct patient to inspire slowly and feel dominant hand rise. instruct patient to control both inspiration and expiration. non dominant hand should only have minimal movement.
low frequency breathing
slow deep breathing designed to improve alveolar ventilation and oxygenation.
Brunnstrom’s 7 stages of recovery
Stage 1:
no volitional mvmt initiated.
Brunnstrom’s 7 stages of recovery
Stage: 2
beginning of spasticity.
Brunnstrom’s 7 stages of recovery
Stage: 3
voluntary synergies. spasticity increases.
Brunnstrom’s 7 stages of recovery
Stage: 4
spasticity begins to DEcrease.
Brunnstrom’s 7 stages of recovery
Stage: 5
decrease in spasticity.
Brunnstrom’s 7 stages of recovery
Stage: 6
jt mvmts are performed with coordination.
Brunnstrom’s 7 stages of recovery
Stage: 7
normal motor function is restored
Babinski sign
an extensor plantar response that consists of flexion of the great toe and fanning of the other toes in the presence of a stimulus applied to the sole of the foot.[biggrin]
Innervation S1 - 2
Achilles Tendon
Innervation L5 - S1
Medial Hamstring
Innervation L3-4
Patellar Tendon
Innervation C5-6
Biceps Tendon
Innervation C5-6
Brachioradialis Tendon
Innervation C6-7
Triceps Tendon
infant development 6-7 months
sitting for prolonged period of time
infant development 8-9 months
months: manipulate toys in sit, supine–sit
infant development 10-11 months
stand briefly w/o support, pincer grasp, sit–stand
infant development 11-12 months
months: stand–quadruped, walk, creep up stairs, throw a ball, mark paper with crayons.
posterior cord syndrome:
refers to a relatively rare incomplete lesion caused by compression of the posterior spinal artery.
S&S: loss of pain perception, proprioception, two point discrimination and stereognosis. Motor function is preserved.
Cauda Equina
occurs BELOW the L1 spinal level where the long nerve roots transcend. can be complete, however, are frequently incomplete due to the large number of nerve roots in the area.
S&S: flaccidity, areflexia and impairment of bowel and bladder function. Full recovery isn’t typical.
Guillain-Barre Syndrome:
BODY’S IMMUNE SYSTEM ATTACKS YOUR NERVES.
S&S: weakness and tingling in extremities are usually first signs. weakness, unsteady/inability to walk, difficulty with eye & face movement, chewing, rapid HR, low BP.
In most cases it stems from an infection in the lungs, or digestive tract. Also, recent immunization, surgery & pregnancy.
Ankylosis Spondylitis
aka Marie Strumpell disease.
A systemic condition that is characterized by inflammation of the spine and larger peripheral joints.
PT: focus on extension and general ROM. pain mgmt. and energy conservation techniques.
blood urea nitrogen:
used to assess kidney function.
increased level: indicative of dehydration, renal or heart failure.
decreased level: indicative of malnourishment, hepatic failure or pregnancy.
Inspiratory muscle trainer
handheld device used to increase strength and endurance
Mechanical precurssors
subsitution for manual percusiion
Incentive spirometers
provide visual feedback while pt. performs inspirations
Used after thoracic surgery
Synergies
pg 161
tuberculosis
bacterial infection that is transmitted by airborne fashion (coughing, sneezing, speaking). lungs are primarily involved, however TB can occur in kidneys, lymph nodes, and meninges. lesions in the lungs can be seen with x ray. symptoms: fatigue, weight loss, loss of appetite, low grade fever, productive cough, chest discomfort, and dyspnea. treatment includes anti-tb drug therapy. prevention of TB through immunization is recommended for children.
Modified plantigrade
allows for postural stability and dynamic control of the trunk and all 4 extremities. Weight bearing through lower ext. will elicit proprioceptive feedback.
Isometric
do not change the length of a mm or produce movement
Isokenetic
contractions occur when muscle is lengthened and shortened at a constant speed
ankle pronation
abduction
DF
Eversion
ankle bones:
navicular-medial border between talus & cuneiforms
cuboid-most lateral bonie
cuneiforms-medial, intermediate, and lateral (1st, 2nd, 3rd).
Evidence based practice steps 1-4 of a well built clinical question:
PICO- (P) 1: patient/problem of interest (I) 2: intervention (C) 3: comparison intervention(s), if relevant (O) 4: clinical outcomes of interest
Degree of toe out:
3 degrees: may be associated with walking at a relative fast rate of speed
7 degrees: during free speed walking
14 degrees: is greater than normal and may be associated with a wide range of orthopedic or neurologic abnormalities.
21 degrees: is excessive and may be associated with more severe ortho or neuro abnormalities.
Standard wheelchair measurements:
(for adults) seat width: 18 inches seat height (back): 16-16.5 inches seat depth: 16 inches
Balance grades:
Balance grades: Normal: can weight shift all directions and accept max perturbations while maintaining their balance.
Good: maintain balance w/o support and accept moderate perturbations.
Fair: maintain balance w/o support but can’t weight shift w/o losing balance.
Poor: needs assistance to maintain balance.
Firm end feels:
muscular stretch- “rubbery”
capsular stretch- “leathery”
ligamentous stretch- no give or creep
Drug administration: oral
swallow
Drug administration: buccal-
drugs placed between cheeks and gums
Drug administration: sublingual
drugs under tongue
Drug administration: topical
on surface of skin
the distal row of carpals from lateral to medial:
trapezium, trapezoid, capitate, hamate.
wheelchair measurement: back of chair:
measure from seat of the chair to base of the axilla and subtract 4.
Add seat cushion in if applicable.
lumbar spine pressure positions from lowest load to greatest load:
- lying in supine
- sidelying
- standing in anatomical position
- standing with 45 degrees hip flexion
- sitting in a chair with reduced lumbar lordosis
- sitting in a chair with slouching forward
wheelchair measurements;
32 inches: minimum required width of a doorway
60 inches: minimum required width to turn 180 degrees in standard wheelchair
Four rules of asepsis:
- know which items are sterile
- know which items aren’t sterile
- separate sterile and non sterile items
- if a sterile item becomes contaminated, the situation must be remedied immediately..
TENS (transcutaneous nerve stimulation):
frequency is significantly greater with sensory level stim than with motor level stim.
sensory level requires lower amp than motor; phase duration is shorter with sensory stim than motor level stim.
concurrent validity:
is demonstrated when the measurement to be validated and “gold standard” are measured at relatively the same time so that they both reflect the same incident or behavior.
ex of “gold standard”-blood measured by sphygmomanometer and pressure transducer inserted in the artery.
Vertebrae and finding points.
L4-L5: same level as top of iliac crest
S2: same level as PSIS
T2-T7: lines with scapula medial border
T3: the vertebral end of the spine of scapula
the Red-Yellow-Black system:
uses a wounds surface color to direct treatment
RED: granulation
YELLOW: slough
BLACK: eschar
venous statis ulcer:
occur secondary to inadequate functioning of the venous system resulting in inadequate circulation and eventual tissue damage and ulceration. Intermittent compression improves venous circulation and facilitates the healing of previously formed ulcers.
lymphedema:
refers to an abnormal accumulation of tissue fluid in the interstitial spaces. Stagnation of the tissue fluid promotes the inflammatory response and increases the probability of infection. Common tx: intermittent compression.
TENS units:
specific pulse rates and widths are selected by the therapist based on the TENS technique selected. Ex: conventional, acupuncture-like, brief-intense, and noxious-TENS. Pulse rate and width should not be altered by the patient throughout the duration of tx, unless specified by the therapist.
Autonomic nervous system:
maintains homeostasis.
sympathetic-“fight or flight” stressful situations.
parasympathetic: “rest and digest” ordinary situations
proximal row of carpal bones: (lateral to medial)
scaphoid, lunate, triquetrium, pisiform
dermatomes:
L5: medial portion of the dorsum of the foot
S1: lateral portion of the dorsum of the foot
L2 L3: anterior thigh
S3: groin and medial thigh
S4: perineum, genitals, lower sacrum
L5: lateral calf
GH Joint ligaments/capsules and end feels: anterior joint capsule:
firm end feel caused by ER of GH joint flex and abd of GH joint
GH Joint ligaments/capsules and end feels: posterior joint capsule:
firm end feel caused by IR of GH joint
GH Joint ligaments/capsules and end feels: inferior joint capsule:
superior joint capsule: ext and add of GH joint
all firm end feels
GH Movement of humeral head:
flex: posteriorly & inferiorly
ABD: inferiorly
ADD: superiorly
ext: anteriorly & superiorly
wheelchair measurements:
seat width: measuring widest aspect of users butt, thighs, or hips and ADDING two inches.
seat depth: measured from the users posterior butt, along lateral thigh to popliteal fold then SUBTRACTING two inches.
wrist and finger muscles: flexor carpi radialis tendon:
flex & abducts wrist.
flexor digitorum superficialis:
flex the proximal IP joints of the 2-5th digits
flexor digitorum profundus:
acts to flex the distal IP joints of the index, middle, ring and little finger
extensor digitorum communis:
extends the MCP joints and in conjunction w. the lumbricals and interossei, extends the IP joints of the 2-5 digits.
lung volumes:
tidal volume: 4,000-6,000 mL 10% total lung capacity.
inspiratory reserve volume: should represent 50% TLC.
residual volume: 1,000 mL 25% TLC.
functional residual capacity: 40% total lung capacity (TLC).
