Recordings Flashcards
rate pressure product =
RPP = HR x BP
used to determine myocardial O2 demand of the pt at the onset of chest symptoms
blood pressure norms
normal: 120/80
elevated: 120-129/80
stage 1: 130-139/80-89
stage 2: 140+/90+
initial changes of exercises in altitude and in pool
what happens to HR, BP, CO, SV after being acclimized to altitude
explain the respiratory effects of aquatic therapy
pressure of water on the chest wall will give it more resistance and it will be harder to expand, making the vital capacity smaller (decrease) AND work of breathing harder (increase)
heart sounds:
where is S1 and S2
S1: apex of heart (mital valve and tricuspid)
S2: base of hear (pulmonary and aortic)
erb’s point
S1 and S2 sounds equally heard
located in the third intercostal space close to the sternum.
describe fwd head posture
lower c/s = flexed
upper c/s = extended
janda’s cross syndrome
screw home mechanism
IN OPEN CHAIN:
to achieve terminal knee extension - the tibia has to laterally rotate
“TOLL”
Tibia Open chain Lateral Lock. EXTENSION
FLEXION: need to unlock, therefore, tibia medially rotates
CLOSED CHAIN:
femur moves on tibia.
extension: MEDIAL rotation
flexion: LATERAL rotation
mm of the scapula
active insuffiency
inability of a two joint mm to SHORTEN stimultaneously at both joints
“simply the function of the mm”
passive insuffiency
the inability of a two joint mm to LENGTHEN simultaneously at both joints
“opposite of the mm function” or the stretch of the mm
kinematic chain of a pronated foot
ankle: pronation
knee: internal roation, knee valgum
hip: internal rotation and pelvis tilts fwd
malalignment of:
excessive anterversion
- toe in
- subtalar pronation
- lateral patellar subluxation
- medial tibial torsion
- medial femoral torsion
malalignment of:
excessive retroversion
- toe out
- subtalar supination
- lateral tibial torsion
- lateral femoral torsion
malalignment of:
coxa vara
- pronated subtalar joint
- medial rotation of leg
- short ipsilateral leg
- anterior pelvic tilt
malalignment of:
coxa valga
- supinated subtalar joint
- lateral roation of leg
- long ipsilateral leg
- posterior pelvic tilt
think vara and valga - vara is smaller/less letters, so the knees come closer together
open chain: supination of ankle
‘IPAD is Superior”
Supination: Inversion, Plantarflexion, Adduction
open chain: pronation of ankle
eversion + DF + Abduction
what glide to perform for adhesive capsulitis?
posterior-inferior glides
capsular pattern: ER - ABd- IR
for shoulder extension and ER, name the mechanisms (roll and glide)
posterior roll
anterior glide
f
for shoulder flex and IR, whats the mechanisms (roll and glide)
anterior roll
posterior glide
what glide is used for limited wrist extension
volar glide
joint mobilization grades
if you want to improve supination at the proximal radioulnar joint, what glide do you perform?
anterior glide
prox. RUJ move in oppisitie direction when thinking about convex on concave rull.
think anatomical postion, when you supinate, arm moves posteriorly and with pronation, it moves anteriorly. therefore oppisite = anterior for supination,
also:
pronation = “PPP”
pronattion proximal RUJ, posterior
stage 0 lymphedema
latency stage
- no clincal edema, occasional reports of heaviness
- stemmer sign negative
- tissue and skin appear normal
stage 1 lymphedema
reversible stage
- edema present (soft and pitting); can go back to normal
- edema increases with standing and activity but REDUCES ON ELEVATION
- stemmer sign negative
stage 2 lymphedema
spontaneoulsy irrversible
- hard swelling present
- progresses to non pitting “brawny” edema
- stemmer sign positive
- tissue appears fibrosclerotic; proliferation of adipose tissue
stage 3 lymphedema
lymphostatic elephantiasis
- edema is present; severe “brawny” non pitting edema
- stemmer sign positive
- skin changes (papillomas, deep skin folds, warty protrusions, hyperkeratosis, mycotic infections, etc)
- bacterial and viral infections are common
grading scale of edema
difference between lymphedema and lidedema
lymphedema
proximal =
distal =
pre/post surgery =
lymphatic insufficiency =
bandages vs compression garments for lymphedema
phase 1- short stretch/low stretch and to be worn 23 hours
phase 2 - compression garments during the day and short stretch at night
what can cause toe drag in swing phase
weak DF
PF spasticity
pes equines
weak hip flexors
prosthetic:
- knee lock
- inadequate DF assist
- inadequate PF asisst
what causes circumduction in swing phase
weak hip flexors
extensor energy
knee and/or ankle ankylosis
weak DF
pes equines
prosthetic:
- knee lock
- inadequate DF assist
- inadequate PF asisst
what causes hip hiking in swing phase
anatomical:
- short contralateral LE
- contralateral knee and or hip flexion contracture
- weak hip flexors
- extensory energy
- knee and or ankle ankylosis
- pes equines
prosthetic:
- knee lock
- inadequate DF assist
- inadequate PF asisst
what causes vaulting in swing phase
anatomical
- weak hip flexors
extensor spasticity
pes equines
short contralateral LE
contralateral knee and/or hip flexion contracture
knee and/or ankle ankylosis
weak DF
prosthetic:
- knee lock
- inadequate DF assist
- inadequate PF asisst
too soft heel cushion (soft plantar flexion) =
causes hyperextnesion of the knee joint
(think david in high heels)
too hard heel cushion (hard plantar flexion) =
excessive knee flexion
what causes lateral heel whip
internal rotation of the prostethic knee
what causes medial heel whip
external rotation of prosthetic knee
- meissner corpuscles=
- krause end bulbs=
- golgi tendon organs=
- ruffini endings=
- meissner corpuscles= fin touch/vibration
- krause end bulbs= kold = cold
- golgi tendon organs= contractions
- ruffini endings= hot
clinical presentation:
arterial vs venous insuffiency
diabetic ulcers
generally located on weight bearing surface of the foot
venous insufficiency ulcers
frequently are proximal to the medial malleoli. they are edematous
VENMO: venous medial malleoli
arterial ulcers
generally located on the lateral malleoli, distal toes or areas of trauma
ALMA - arterial lateral mall
pressure ulcers
result of unrelieved external pressure on an area
heel whips
LIME
lateral - internal
medial - external
pressure tolerant areas
patellar tendon
medial tibial plateau
tibial and fibualr shafts
distal end
who assures min standards are met in a hospital to maintain accredidaton and safety of patients
jahco
who assures min standards are met by rehabiliation centers to maintain accredidaton and safety of patients
CARF
paraffin bath
temp: 125-127 F
time: 15-20min
used on wrist and hands or feet, irregular body areas, distal extremities
- dip 6-8 times
ultrasound contraindications
ergonomic requirments
isolation precautions
parametric vs nonparametric data
parametric= quantitative
interval: temperatue (no true zero)
ratio: ROM (has true zero)
non-parametric: qualitative
nominal: gender
ordinal: MMT
seat height
heel to popliteal fold + 2 inches
seat depth
posterior buttock along lateral thigh to popliteal fold - 2 inches
seat width
widest aspect of buttock or thighs + 2 inches
back height
chair seat to axilla - 4 inches (consider any seat cushion and ADD the thickness to final value)
back has 4 lettters, subtract 4
armrest height
seat of chair to olecranon + 1 inch (consider cushion)
wheelchair axle position:
- normal axle position
in line with shoulder or slightly posterior
wheelchair axle position:
- bariatric patient
move the rear wheel axle FWD
think bariatric = fat= fwd
wheelchair axle position:
- B transfemoral amputation
move the rear wheel axle behind the patients shoulder
bilateral, B, behing
describe an UMN lesion
structures: cortex, brainstem, spinal cord
tone: hypertonia, spasticity
reflexes: hyperreflexia, abdnormal reflexes (babinski, clonus,hoffmans)
sensation: decreased
involuntary movements: mm spasms
voluntary movements: movements in synergic patters
describe LMN lesions
structures: peripheral nerves, nerve roots, cranial nerves
tone: hypotonia
reflexes: hyporeflexia or absent
sensation: decreased
involuntary movements: denervation - fasiculations
voluntary movements: weak or absent
describe basal ganglia lesion
structures: basal ganglia
tone: rigidity (only associayed with basal ganglia)
reflexes: decreased or normal
sensation: normal
involuntary movements: resting tremor
voluntary movements: bradykinesia, akinesia
describe a cerebellum lesion
structures: cerebellum
tone: decreased or normal
reflexes: decreased or normal
sensation: normal
involuntary movements: none
voluntary movements: ataxia: intention tremor, dysdiadochonkinesia, dysmetria, nystagmus
t
types of rigidity
- cogwheel
- lead-pipe
Hoehn and Yahr classification 1
minimal or absent
unilateral if present
unilateral = 1
Hoehn and Yahr classification 2
minimal bilateral or midline involvement
balance is NOT impaired
bilateral - 2
Hoehn and Yahr classification 3
impaired righting reflexes (balance is affected)
unsteadiness when turning or rising from chair
some activities are restricted, but patient can live independently and continue some forms of employment
B has a backwards 3, b=balance
Hoehn and Yahr classification 4
all symptoms present and severe
standing and walking possible only with assistance
walker has 4 legs 4th stage
Hoehn and Yahr classification 5
confined to bed or wheelchair
early signs and symptoms of PD
- loss of smell
- constipation
- sleep disorders
motor: hypophonia (mono voice); mask like face; micrographia
cardio: orthostatic hypotension, abnormal response to exercises fatigue, weakness
respiratory: restrictive lung diseasse due to decreased chest expansion
cognition/behaivor: difficulty with dual tasking, depresion, dementia
compare dyskinesia and dystonia
effects of medication- levedopa and carbidopa
- on/off phenomenon: random fluctuations in motor performance and responses
dyskinesia - snake skin - smooth
dystonia - theres already an ‘on’ therefore we want off
- scheudle PT 1 hour after dose
gait in PD
- freezing gait: sudden inability to initiate movement
- festinating gait: short stride, shuffling, increases speed, anteropulsive; (trying to catcht their BOS so they are usually leaning fwd)
- decreased step width and length
- decreased trunk rotation and arm swing
- en bloc turning
unique signs and symptoms with MS
1.** lhermitte’s sign:** neck flexion causes electric shock sensation from spine to leg
her-mitt-ee’s
“hair messy” when you perform neck flexion
-
Uhthoff’s phenomenon: when there’s heat present - pseudo (false) exacerbation < 24 hrs
U-turn-off
treat the pt in cold or AM -
Charcot’s triad: brain, spinal cord, cerebellum
“SIN”
scanning speech
intention tremor
nystagmus -
Cranial nerve 2
normally, the pupillary light reflex will constrict when light is infront of the eye. With those with MS, it would cause paradoxically dilate = Marcus Gun Pupil
other things, optic neuritis: inflammation of optic nerve. causes pain and can lead to blindness.
other nerves, CN 2-6 are affected
CN 5= trigeminal neuralgia
signs and symptoms of MS
spasticity
numbness and paresthesia
nystagmus, coordination, balance, ataxia, intention tremor
scissoring, extenstor spasticity in LE, ataxia, uneven steps
spastic and flaccid bladder
dysphagia and dysphonia (CN 7.9,10)
pseudobulbar affect (abnormal emotional resposne)
diminished attnetion, concentration
fatigue
optic nueritis
trigeminal neuralgia
MS types
1. relapsing remitting, RR:short duration attacks with full or partial recovery, may or maynot leave lasting symptoms/deficits; MOST COMMON
2. primary progressive: steady increase in disability without attacks/exacerbations
3. secondary progressive: initially RR, then symptoms increase without periods of remission
4. progressive relapsing: steady increase in disability with superimposed attacks
MS interventions
low intensity- 3-5METS
50-70% VO2max
30min sessions
signs and symptoms of ALS
UMN and LMN presentation without sensory loss
- mm atrophy, fasiculations (LMN)
- spasticity, hyperreflexia (UMN)
- dysphagia, dysarthria (bulbar) ((LMN))
only motor neurons will be affected
dementia, attn deficits
pseudobulbar affect - emotional lability
c/s extensor weakness
respiratory mm weakness
signs and symptoms of GBS
AKA acute inflammatory demyelinating polyradiculoneurpathy
LMN
distal to proximal weakness
sensory: glove and stocking; burning, tingling, numbess
decreased reflexes/areflexia
respiratory and cranial nerve involvement: 7, 9,10, 11, 12
fatigue
difference between cushings disease and cushings sydrome
cushings disease= comes from PITUITARY
cushings syndrome = comes from ADRENAL GLAND
addisons disease
insuffiency of aldosterone and cortisol
Mrs. Addison - thin brown old lady walking with a stick
cushings disease
Mr. Cushing’s: white chubby man that is lying in bed/lazy and loves chugging beer
elevated cortisol and aldosterone
- increased BP, water retention
- hyokalemia
- increased glucose
- ruddy appearance, straie on skin
- weight gain
- centripetal obesity
- round moon face
- proximal mm weakness and atrophy
- increased susceptibility to infection
- osteoporosos (buffalo hump)
- poor wound healing
think Mr. Cushings - white chubby man that loves chugging beer
Ruddy appearance- that their face is a reddish colour, usually because they are healthy or have been working hard, or because they are angry or embarrassed.
hashimoto’s disease
autoimmune disease of hypothyroid
hyperthyroidism
hypothyroidism
examples of hypo/hyper thyroidism
hypo: hashimoto’s, myxedema
hyper: graves, exophthalmos
hyperparathyroidism
elevated calcium and decreased serum phosphate
calcium and phosphate are inversly related
- can demineralize bone making bones weak and decreasing its density
symptmosm:
- osteopenia
- gout
- arthalgia
- kidney stones
- renal insufficiency
- peptic ulcers
- proximal mm weakness
- fatigue
- depression
- cofusion
- drowsiness
- glove/socking sensory loss
BONES: osteopenia, brittle, arthralgia, uric acid
STONES: kidney. renal insuffiency
GROANS: peptic ulcers
MOANS: fatigiue, depression, mm weakness
SENSORY LOSS: hands and feet
hypoparathyroidism
low calcium and high phosphorus
symptoms:
- convulsions
- cardiac arrythmias
- mm twitching
- tetany
- mm cramps
- mm spasms
- paresthesia of fingertips and mouth
- fatigue
- weakness
“CATS are Numb”
convulsions
arrythmias
twitches/tetany
spasms
numbness of fingertips
how to diagnose DM
fasting glucose > 126+
random blood glucose 200+
HbA1c >6%
hypoglycemia
cold and clamy give them candy
hyperglycemia
hot and dry - sugar is high
DM and exercise
what are changes with CVS with pregnany
blood pressure is low in the 1st-2nd trimester and increases in the 3rd
no supine after 1st trimester
resting HR increases by 10-20bmp
HRmax will decrease
lest sidelying is considered the bets as it decreases compression IVC, maximizes CO, decreases GERD as internal organs are relaxed and improves maternal and fetal circulation
supine hypotensive syndrome
symptoms: dizziness
nausea
fainting
supine lyinng can cause decompression of inferior vena cava (after month 4). this declines CO
what happens with respiration and pregnany
respiration depth increases but the rate remains the same
typical pain pattern in the RUQ
peptic ulcers
gall bladder
head of pancreas
typical pain pattern in the RLQ
appendix
crohns disease
typical pain pattern in the LLQ
diverticulitis
ulcerative colitis
IBS
LLQ, Lou DUI, lou is short so lower quadrant
whats seen in the LUQ
tail on pancreas
spleen
cholecystitis
blockage or impaction of gallstone in the cystic duct resulting in inflammation of gallbladder
- pain in RUQ, radiaitng to R scapula
- n/v
- low grade fever
- pain icnreases with ingestioin of fatty food
special tests: murphys sign
palpate near R subcostal margin as pt takes deep breath- if pin and tenderness is elicited during inspiration, test is +
elaborate the levels of evidence
strong to weak
meta analysis
systemic review
RCT
cohort study
case control study
cross sectional study
case report/series
type 1 error
false positive
type 2 errors
false negative
example of face validity
survey
weak form; does not consider gold standard
“what does the test appear to be”
strongest form of validity
concurrent
its compared to the gold standard
cross sectional studies look at what
diagnostic
RTC are good for what
interventions
dependent v independent variable v covariate
dependent: the outcome or variable of interest in the study
independent: variable that is manipulated or chnaged by the researcher to observe its effect on the dependent variable
ex: the effect of the intervention on step length
intervention = independent
ROM= dependent
covariate = heights height (can influence step length)
compare parametric and non-parametric
parametric:
- more powerful
- bell shaped, normal curve
- equal distribution
- quantitative data
non parametric
- unequal distribution
- non-normal distribution
- qualitative
- less powerful
at what level is near normal respiratory function at
T11 and below
spastic bladder
above t12
intervention: suprapubic tapping
flaccid bladder
below t12
valsava or crede manever
mm associated with different levels of SCI
c5
elbow flexors
mm associated with different levels of SCI
c6
wrist extensors
mm associated with different levels of SCI
c7
elbow extensors
mm associated with different levels of SCI
c8
finger flexors
mm associated with different levels of SCI
t1
finger abductors
mm associated with different levels of SCI
L2
hip flexors
mm associated with different levels of SCI
l3
knee extensors
mm associated with different levels of SCI
l4
ankle df
mm associated with different levels of SCI
l5
bigtoe ext
mm associated with different levels of SCI
s1
ankle pf
what levels of SCI would be considerd
- dependent
- mod. dependent
- independent
- dependent = c1-4
- mod. dependent= c5-6
- independent= c7 and below
what level of SCI can independently transfer with slideboard on even surface?
c6
what level of SCI can dependently transfer with slideboard on even surface?
c5
what level of SCI can independently transfer with slideboard on uneven surface?
c7-c8
what level of injury may be able to transfer from floor to wc?
c8
for sure t1
what level of injury can independently propel with wc on even surfaces
c7
what level of injury can independently propel with wc on uneven surfaces
c8
ASIA A
complete
no motor or sensory function at S4-5
ASIA B
sensory but no motor present below level and s4-5 present
ASIA C
they have sensory and motor
majority below the lesion are <3/5 (more than half)
ASIA D
both sensory and motor
majority of the mm below are greater than 3/5 (half or more)
symptoms of AD
increase BP (20-30)
decrease HR
severe HA
anxiety
constricted pupils
blurred vision
flushing, piloerection (goosebumps) above level of lesion
dry pale skin below lesion
increased spasticity
symptoms of pre-eclampsia
- increase in protein in urine
- hyperreflexia
- edema
- HA
- sudden weight gain
- BP in excess of 140/90
second BP reading 4 hours later, confirms dx
treatment for diastasis recti
head lift
head lift with pelic tilt
greater than 2cm = diastasis recti
when does BP change with pregnancy
decrease 1-2 trimester
increase on 3rd
GERD
- heartburn 30min after eating and at night lying down
- dysphagia (difficulty swallowing)
- sour taste
- hoarness in voice
- atypical pain of the head and neck
lower esophagueal sphincter
referral pattern to midback and scapula
esophagus
gall bladder
stomach
pancreas
referral pattern to shoulder
R: gall bladder, liver, head of pancreaus
L: heart, diaphragnm splee, tail of pancreas
what tumor mimics TOS
pancoast tumor (upper lung tumor)
RUQ pain
peptic ulcers
gall bladder pathology
head of pancreas
LUQ pain
tail of pancreas
spleen pathology
RLQ pain
appendix
chrons
LLQ
DUI
diverticulitis
ulcerative colitis
IBS
what kind of hernia occurs when the diaphragm is weak
hiatal
which can cause shoudler pain and symptoms are similar to GERD
types of peptic ulcers
- gastric ulcer
- duodenal ulcer
what are characteristics of peptic ulcers
coffee ground emisis (vomit) and melena tarry stools
when do you notice gastric ulcers
pain icnreases with the presence of food due to acid secretion
pain after eating
pain relieved by anatcid and/or clearing infection
duodenal ulcers
pain increases with the absence of food, early mornings and in between meals
ulcerative colitis
only in large intestine and rectum
- rectal bleeding/pain
- bloody diarrhea with mucus and pus
- fecal urgency
- weight loss
- lbp
chrons disease
can occur anywhere in GI tract
- pain relieveed by farting/pooping
- abdominal pain
- weight loss
- joint arthritis
reiters syndrome
AKA reactive arthritis
“cant see. cant pee. cant climb a tree”
conjunctivitis
urethritis
knee OA
irritable bowel syndrome
spastic, nervouse or irritable colon
causes: emotional stress, anxiety, high fat, lactose foods
- pain is relieved by defecation
*- sharp cramps in the AM or after eating * - n/v
- bloating
- foul breath
- diarrhea
- ribbon like stools
appenicitis
- pain in RLQ
- comes in waves
- progressing to steady
- anorexia
- n/v
- elevated temps
- leukocytosis
- fever
special tests:
mcburneys
rovsings
blumbergs
in what phase do the plantar flexors work concentrically
pre swing only
what phases does the ankle move into DF?
and what phases does it work concentrically?
move:
mid stance 5deg
terminal stance 10-15deg
concentrically:
mid stance 5deg
terminal stance 10-15deg
inital swing
mid swing
