Rehab Exam 4 Review

Question 1

Life expectancy of someone with MS

Answer 1

• No change in life expectancy with proper maintenance

Question 2

Pathophysiology of MS

Answer 2

• T-lymphocytes attach to and destroy myelin sheath
• Disruption causes demyelination
• Neural transmission is slowed or stopped; nerves fatigue rapidly
• Inflammation, edema, infiltrates surround acute lesion and interfere with nerve conductivity
• Most susceptible areas: Optic nerves, periventricular white matter, spinal cord, cerebellar peduncles

Question 3

Exacerbation (regarding MS patient)

Answer 3

• Significant decline in functional capability, sudden increase in clinical signs (8 manifestations - sensory, pain, visual, motor, speech and swallowing, cognitive, affective, autonomic)

Question 4

2 factors that can contribute to an exacerbation

Answer 4

• Heat

- Stress

Question 5

Strategies that can be used during interventions involving strengthening and conditioning exercises

Answer 5

• Start interventions early
• Alternate days and during times of lower core temps (am) to prevent rapid fatigue (outpatient)
• Balance exercise with rest periods
• Incorporate resistance/circuit training
• Manage core temp and prevent overheating
• Consider cog deficits when implementing program
• Integrate functional training and closed chain
• Incorporate group exercise

Question 6

Most likely cause of pain in MS patient

Answer 6

• Demyelination (demyelinating lesions) of pain tracts (most common in spinothalamic tracts)
• 80% pts Chronic neuropathic pain

Question 7

Causes of depression in MS patient

Answer 7

• Loss of function
• Disease itself (related directly to MS)
• Side effect of medication
• Lesion located - whatever affect is controlled can lead to depression

Question 8

Which affect characteristic is more common in later stages of MS?

Answer 8

• Euphoria

Question 9

Focus of PT interventions for MS patients

Answer 9

• Education (increase awareness of sensory deficits)
• Compensation (for sensory loss)
• Neuroplasticity
• Depends if pt is exacerbated or not

Question 10

More appropriate for MS pt that has declined significantly in function - power of manual w/c

Answer 10

• Power w/c: Need to conserve energy, pt fatigues faster

Question 11

Pathology of Parkinson’s Disease

Answer 11

• Abnormality of basal ganglia

Question 12

PD is due to a decline in the production of dopamine - true or false?

Answer 12

• True. Degeneration of neurons producing dopamine.

Question 13

Impairments characteristic of PD

Answer 13

• Rigidity
• Pill-rolling tremor
• Difficulty initiating movement (bradykinesia)
• Postural instability

Question 14

“On-Off” State in PD

Answer 14

• Refers to medication (Levodopa) - when on, it causes increase in dopamine and a return to normal function, eventually shuts off when L-Dopa wears off)

Question 15

Posture of PD pt

Answer 15

• Presents with flexed, stooped posture; increased kyphosis; COM forward to limits of stability
• Narrow BOS
• Increased sway

Question 16

Clinical presentation of sensation in PD patient

Answer 16

• No primary sensory loss (ex: light touch)
• Restlessness
• Impaired proprioception

Question 17

Ortolani’s Sign

Answer 17

• Attempts to reduce hip dislocation by relocating the hip
• Postiive sign: Positive for hip dysplasia - hip is subluxed or dislocated and can be reduced - palpate hip moving over acetabular ridge
• Negative sign: Hip cannot be relocated (hip dislocation)

Question 18

Barlow Maneuver

Answer 18

• PTA flex, adduct hip
• Attempts to dislocate/sublux the hip
• Femoral head exits acetabulum; Positive is click with flex/add, also with abd as hip clicks back in

Question 19

Causes of hydroencephalus

Answer 19

• Overproduction of CSF
• Failure of absorption of CSF
• Obstruction of the CSF flow

Question 20

Arnold Chiari Malformation

Answer 20

• Posterior cerebellum herniates through the foramen magnum
• Brainstem displaced caudally
• Obstructs CSF flow in the 4th ventricle
• Traction on lower CN

Question 21

Most severe type of Spina Bifida

Answer 21

• Myelomeningocele

Question 22

Syringomyelia (Hydromyelia)

Answer 22

• CSF collects in pockets along SC and creates areas of pressure
• Signs include rapidly progressing scoliosis, progressive UE weakness, hypertonia
• Can occur with SB or in isolation

Question 23

Post-conceptual age of newborn (5 wks old) who was birthed at 28 weeks

Answer 23

• AA prior to achieving term age
• GA + CA
• 33 PCA

Question 24

Adjusted Term Age of Newborn in prior example

Answer 24

• CA - #wks missed in utero

- 5 - 14 = -9 TAA

Question 25

NICU Levels

Answer 25

• Level 1: Minimal observation or care; small community hospital; “Well-baby nursery”
• Level 2: Step down from Level III; continued care from Level III, IV meds or alimentation, tube feedings, O2; regional or community hospitals
• Level 3: Highly specialized services for sickest and most fragile infants - complex, medical interventions, advanced diagnostic testing, surgery, resp. support; Teaching hospitals and affiliated with medical schools
• Level 4: Level III plus ECMO (extracorporeal membrane oxygenation)

Question 26

Reasons pre-term baby might not feed

Answer 26

• Learned oral aversion resulting from NICU care
• Lack of flex/ext balance and chin tuck to assist with sucking, swallowing, breathing
• Residual lung disease may cause tachynea; interferes with sucking and swallowing
• Lack of self-regulation; unable to calm self with environmental stressors
• Apnea
• Bradycardia
• Unable to coordinate sucking, swallowing, breathing, and becomes physiologically unstable
• Immature GI Tract

Question 27

Importance of surfactant

Answer 27

• Lowers the surface tension in lungs and allows alveoli to maintain its shape
• Prevents respiratory distress syndrome (RDS)

Question 28

Osteopenia

Answer 28

• Decrease in bone density
• Occurs because of immature bone development
• 80% of bone formed between 24 and 40 weeks; 3rd semester essential for bone formation

Question 29

Meconium Aspiration Syndrome

Answer 29

• During delivery, fetus may pass BM into amniotic fluid; as infant gasps for first breath, may aspirate meconium-tainted fluid
• Meconium particles obstruct airway, interfere with gas exchange; leads to respiratory distress

Question 30

Brachial Plexus Injury - Position of baby’s arm

Answer 30

• Baby’s arm in “waiter tip” position
• Shoulder ADD, IR, elbow ext, pronation, wrist and finger flexion
• UE limp at infant’s side