Review Flashcards
What are the indicators of emergence from minimally conscious state
functional object use
functionally accurate communication
What is the key phase of gait
hip extension during mid stance to heel off
three key inputs to CPG
stretch of hip flexors
unweighting triceps surae
WBing to facilitate extensor tone in stance
what comes first for unilateral scooting: shortening or lengthening
shortening
How does stroke cause increased diabetes
greater degree of impairment -> less slow twitch muscle fibers -> more insulin resistance
Decreasing the duration of an illness is what kind of prevention
Secondary
How much Physical activity does the WHO recommend
150-300 mins of moderate intensity
or 75-150 of vigorous
Disadvantage of folding wheelchair:
Less durable
Heavier
Disadvantage of soft upholstery backrest compared to solid backrest on wheelchair
soft upholstery will stretch overtime
Solid wheelchair seat vs Soft upholstery seat
solid seat- will not stretch, also will not fold
soft seat- will fold, will stretch overtime
Do you want a patient in a wheelchair in slight anterior pelvic tilt, or posterior pelvic tilt
anterior pelvic tilt
Cambered vs vertical wheel alignment advantages/disadvantages
cambered wheels- quicker turning
vertical- more narrow
High vs low mount breaks
Low mount- more difficult to reach for lower functioning pts
High mount- Might injure users thumb while pushing wheelchair
MAG wheel vs spokes
MAG - more durable, heavier
spokes- lighter less durable
Pneumatic vs solid wheelchair tires
Pneumatic = more cushion but also more maintenance
Caster wheel larger vs smaller advantages
Caster wheels are the front wheels (smaller)
Smaller = easier to maneuver on level ground inside, less forward stability
Larger = easier to maneuver over uneven ground, heavier
how to measure wheelchair seat width
Less than 1.25inch width wider than the greater trochanter or the widest portion of their thigh
How to measure wheelchair seat depth
What are the 2 landmarks?
Less than 1-2inches than the measurement between the posterior buttocks and popliteal fossa
Should we measure backrest height with the wheelchair cushion present or absent?
present!
How to measure backrest width
backrest width should be 3/4 inches wider than the widest part of the torso at the top of the back rest
When measuring foot-rest to seat distance what do we need to keep in mind? What should be absent or present
Cushion in wheelchair
pt wearing their normal shoes
How much clearance should there be between the footplates and the floor
atleast 2 inches
how to measure arm rest height:
Elbows flexed to 90 degrees
cushion in place
Axel alignment for wheelchair:
As anterior as possible without compromising stability
Having a more anterior axle makes it easier to do wheelies, propel the chair, but it increases risk of tipping
If a patient has a curb of 8 inches to get to their front door, how long does the ramp need to be?
8 feet
What has the best evidence for dealing with hemiparetic shoulders
FES/NMES
But only good for handling subluxation acutely, does not improve long term benefits
What device for shoulders has the highest chance of overcorrections:
- Lap Trays
- Arm Troughs
According to the study shown to us by da silva what had the best results for flaccid shoulder
Sling
What is the disadvantaged of the laptray/arm trough
They come in standard sizes so your patient may be too small and this leads to an overcorrection or maybe theyre too big and its an undercorrection
What medication is used to treat HO
Biphosphonates
example: Etidronate/ Didronel
When does shoulder-hand syndrome first appear
1-3 months after CVA
What are the first signs of shoulder-hand syndrome
Swelling at the MCP and PIP
Shoulder hand syndrome can lead to what sympathetic NS dysfunction
What are the first signs
Complex regional pain syndrome
skin pigment changes, sweating, nail changes
Another disadvantage of lap board/arm trough
They cant take it with them when they start walking, its attached to the chair
What is the disadvantage of using a shoulder sling
Holds the pt in flexion synergy
Pts with shoulder hand syndrome will be unable to do what motion at the hand
flexion
Preventing an illness from ever taking place
Primary prevention
Reducing the duration of an illness or using tests to detect it early
Secondary prevention
Rehab, and preventing additional disability
Tertiary prevention
Risk factor reduction targeted towards an entire population through a focus on social and environmental conditions
Typically get promoted through laws and national policy.
Primordial
Brunstrom Stage 1:
Brunstrom Stage 2:
Flaccidity
minimum voluntary movement, developing spasticity
Brunstrom 3:
Brunstrom 4:
Max spasticity, Voluntary movement within synnergy
decreasing spasticity, 1 joint out of synnergy
Brunstrom 5:
Brunstrom 6:
Brunstrom 7:
2 joints out of synnergy
No more spasticity, movements are slowed
Normal
Sequence of inhibiting the hand:
Spread the metacarpals
Extend IP
Extend MCP
Extend Wrist
Sequence of mobilizing hand
Mobilizing metacarpals (one at a time) ->
Mobilizing carpals (flexion/ext of wrist) ->
Mobilizing Distal forearm (pronation/supination)
What area of the brain is damaged w pusher syndrome
Posterolateral thalamus
What syndromes are most common w/ pusher syndrome
Aphasia and neglect
At what age do you use the Child SCAT6 instead of the SCAT6
12 and under
What is the difference between the SCAT6 and the CRT6
SCAT6 - medical professionals
CRT6- meant for non-medical professionals
T or F: Training postural control has carry over to balance
F
Pt has eye closed and we put their feet on foam, what sensory system are we focusing on
Vestib
How to work on hip strategy for patients
Do balance activities with restricted ankle motion/ put feet in line w/ eachother
Pt cannot interact with world around them
example: pt cannot eat dinner with family
Participation restriction
Pt cannot participation in certain activities
example: cannot climb stairs
Activity restriction
What exercises are for temporarily decreasing dysmetria
Frenkel exercises:
-Starts with doing heel slides on mat
(Progression: Supine -> Sitting -> Standing)
What can help patients with dysmetria in LE (to walk)
Using therabands to apply compression/approximation from their legs to their body
NOT USING ANKLE WEIGHTS
note: Pt might not be able to wear it all day as they cant go to the bathroom
6 stages of the transtheoretical model
Pre-contemplation- you don’t think there’s a problem
contemplation- acknowledge problem
preparation- want to change within 30 days
action
maintenances- Made behavior modifications for over 6 months
relapse
Tardieu Scale R1 vs R2
R1: ROM Up to their first catch
R2: Full PROM
HO can only affect where?
BELOW level of lesion
for TBI it can be anywhere
for SCI it has to be below the level
Example T5 Spinal cord injury will not have HO in arms
Neurotomies vs nerve blocks
Neurotomies are permanent
Nerve blocks - temporary
Rhizotomy- only sensory fibers cut
Botox contraindications
Pregnancy
Children under 2
Neuromuscular transmission disease (example: Myasthenia Gravis)
Inflammation at site of injection
What are the most common places to get a tendon release
disadvantage?
Achilles and hamstring
Does not change the original factor that made the tendon tight
Split anterior tibial tendon transfer (SPLATT)
Typically done with an achilles tendon release
they split the Tibialis anterior tendon and attach it to the cuboid to correct foot varus/inversion
Pt needs help bringing food to mouth, what PNF pattern helps with this
D1 Flexion
If pt needs help reaching for a high shelf, what PNF pattern might help with that
D2 flexion
pt needs help reaching cross-body to put on seatbelt, what pnf pattern might help with this?
D1 Flexion
Balance training progression
eye head coordination
Orientation to midline
System training
Sitting balance
sit to stand/ transfer
Strategy training
Gait training
HEP
What is the #1 social determinant of health
economic stability
how much will medicare pay for DME under part B?
80%
What will medicare not pay for
anything in the bathroom
a automatic hi-lo bed
Wheelchair decision making process
Can they propel a manual wheelchair
Can they propel a light weight wheelchair
Can they use a scooter?
Can they use an automatic wheelchair
What device is appropriate for someone that can walk short distances but needs a motorized device for longer distances
scooter
Difference between scooter and automatic wheelchair
You can tell the difference by looking at how the seat is connected to the device (if its connected by 1 pole its a scooter)
Also you cannot drive an automobile w/ a scooter
who is more likely to have multiple concussions: athletes or military
military
Is the SCAT diagnositc for concussions?
no
SCAT6 vs SCOAT6 vs CRT6
CRT- sideline assessment by non-medical pro
SCAT- sideline assessment by medical professional
SCOAT- reassessment by medical professional at office visit typically 3+ days later
SCAT6/SCOAT6 vs Child SCAT6/SCOAT6
Child SCAT/SCOAT is for ages 5-12
Who is more vulnerable to concussions
females
children
elderly
Does a concussion require a loss of consciousness
no
Mild TBI:
Loss of consciousness:
Alteration of consciousness:
PTA:
GCS:
Mild TBI:
Loss of consciousness: 0-30 mins
Alteration of consciousness: 24 hours
PTA: 24 hours
GCS: 13-15
With a concussion imaging is typically ____
normal
What is the most common concussion symptom
headache
What is the slogan for managing concussions
if in doubt, sit them out
player has neck pain after concussion, what do you do?
Spinal precautions and arrange trip to emergency room, that is red flag
Player has double vision after concussion, what do you do?
Spinal precautions and arrange trip to emergency room, that is red flag
Concussion red flags that indicate you take spinal precautions and send them to ER
Neck pain/tenderness
Double Vision
Weakness/tingling/burning in more than one arm or in the legs
Seizure or increasing Headache
Seizure or convulsion
Loss of consciousness
Deteriorating consciousness
vomiting
increasing restlessness, agitation, aggression
GCS of less than 15
with all unconscious athletes it must be assumed that
they have cervical injury
Initial advice for concussion
not to be left home alone
no driving
monitored to sleep the first night
no medication
return to sport progression for concussion
symptom limited activity -> aerobic exercise -> individual sport specific practice -> noncontact training -> full contact training -> RTS
persistent post concussion syndrome is anything over
____ in adults
_______ in children
10-14 days
4 weeks
In what order do you typically treat PPCS
Visual -> Cervical -> vestib
but usually start with the main symptom generator
contemplation stage: no plan to change within __________
6 months
maintenance stage: theyve been consistent for __________
6 months
What is considered the primary sign of cerebellar damage
Ataxia
Movement decomposition definition
breaking down of a movement sequence or a multijoint movement into a series of separate movements, each simpler than the combined
note: is a compensation strategy for cerebellar problems
Ataxia definition
Refers generally to disordered or noncoordinated movements
Dysmetria definition
The inability to properly scale movements leading to hypermetria or hypometria
Dyssynergia definition
impairment of multijoint
movements, wherein movements of specific segments are not properly sequenced or of the proper range or direction, resulting in uncoordinated multijoint movement
Lack of Check definition
inability to rapidly and sufficiently
halt movement of a body part after a strong isometric force, previously resisting movement of the body part, is suddenly released.
Cerebellar patients usually have _______ extensor tone for holding themselves up against gravity AKA: ____________
decreased
hypotonia
What is the classic cerebellar tremor
Kinetic tremor w/ intention tremor
T or F: Cerebellar patients have increased postural sway
T, also refered to as imbalance
paragraph describing one of the charts da silva said we need to look at
it has been shown that clients with cerebellar damage and significant balance deficits also typically demonstrate
nearly all the classic features of gait ataxia (i.e., reduced stride lengths, increased stride widths, reduced joint excursions, abnormal swing foot trajectories, increased variability in foot placement, and joint-joint decomposition). In contrast, clients with cerebellar damage and significant leg coordination deficits but minimal or no balance deficits typically have very few walking abnormalities (Figure 21-7).101,102
Therefore during typical conditions of level walking, balance deficits contribute much more strongly to cerebellar gait ataxia than do leg coordination deficits.
occulomotor deficits for cerebellar patients
Saccades are often slowed and dysmetric
Smooth pursuit maybe “choppy,” referred to as saccadic pursuit, wherein the smooth tracking of a target is degraded into a series of
shorter saccadic movements following behind the target.
The ability to cancel, or suppress, the VOR may be impaired or absent Finally, abnormal nystagmus may also
be present
cerebellar patients have what kind of speech impairment
scanning speech
For all cerebellar coordination tests we need to:
repeat multiple times
compare slow vs fast
compare w/ and without vision
compare both sides
What is the most important activity limitation to observe for cerebellar patients
gait
can motor learning be measured directly?
no
What is best for motor learning:
Massed/blocked vs Distributed
Constant vs Variable
Contextual interference?
Physical Guidance?
Mental Practice?
Distributed
Variable
Contextual interference = good
Physical guidance = bad
Mental practice = good
Recovery vs Compensation
Compensation is using an alternative strategy to accomplish a task
What are the 2 regulatory conditions of a task in motor learning:
Stationary - your environment
Motion- Supporting surfaces, objects, or people that are in motion
So if the ground is in motion that is a motion regulatory condition
What are the categories by which we organize tasks in motor learning?
Body Stability vs Body Transport
Intertrial variability vs not
Motion vs Stationary
Manipulation vs No Manipulation
Types of feedback:
Interval:
Ratio:
Bandwidth:
Faded:
Types of feedback:
Interval: Every X mins
Ratio: every X reps
Bandwidth: only if they make a mistake
Faded: less feedback over time
Sedentary activity is anything below ____
1.5 METS while sitting, reclining, or lying
Contemplation stage means you’re thinking of changing behavior within ____
6 months
Precontemplation stage means you have no desire to change behavior within _____
6 months
Should health promotion for the disabled focus on their weaknesses or their pre existing strengths
Strength based
When does discharge planning start?
At the initial chart review before you even see the patient
When measuring the height of an entrance for a wheelchair ramp, do you include the height of the threshold?
Yes
Flaccidity in ______ causes downward rotation of scapula
Spasticity in _________ causes downward rotation of scapula
supraspinatus
lats/upper trap
What is the diff between PNF d1/d2 Contract relax and hold relax
Contract/relax involves a rotational component (they dont move their arm they just IR/ER their arm at the end range)
Is it easier for patients to manipulate bigger or smaller objects
bigger are easier
Exception: Those w/ contractions may need to start w/ smaller
Whats the minimum brunstrom for liftoffs
brunstrom 2
Whats the minimum brunstrom for reaching activities
4
What are the 3 stages of shoulder/hand syndrome
Acute- Diffuse swelling/pain
Dystrophic- no more swelling/pain, muscle atrophy
Atrophic- Deformities of hand/limited articular function
Can a patient skip brunnstrom stages?
No
You cannot superimpose efficient movement on abnormal postural alignment
You cannot superimpose efficient movement on abnormal postural alignment
You cannot superimpose efficient movement on abnormal postural alignment
You cannot superimpose efficient movement on abnormal postural alignment
You cannot superimpose efficient movement on abnormal postural alignment
You cannot superimpose efficient movement on abnormal postural alignment
Principles of neuroplasticity:
Use it or lose it
Use it and improve it
Specificity
Repetition
Intensity
Salience/meaningfulness
Time since onset
Age
Transference
Interference
Chronic stroke speeds:
unlimited household ambulation
limited community ambulation
unlimited community ambulation
how fast to cross a busy street?
.27
.58
.8
2.0
What kind of footwear should patient wear
As little as possible!
What are the 4 things stored in a motor schema
Initial conditions
Parameters of movement pattern
knowledge of results
Sensory consequences of movement
A patient has an orthotic that is rubbing their heel, is this likely because the therapist measured them at R1 or R2 by mistake?
They measured at R1 when they were suppose to measure at R2
Your patient has the circulation cut off to their legs, what wheelchair measurement did the PT get wrong
Wheelchair depth too long
Your patient is developing pressure injuries on the bottom of their legs, what wheelchair measurement did the PT get wrong?
Wheelchair depth too short
What percent of the US is living with a disability
25%
Socioecological model:
Personal:
Interpersonal:
Institutional:
Community:
Societal:
Personal: the self
Interpersonal: friends, family
Institutional: School, church, work
Community: neighborhood, community
Societal: all of these as a whole
What amount of people dont have health insurance in the US
1 in 10
Whats generally the biggest obstacle for accessibility in homes?
bathroom!
If a person needs a wheelchair just to get to dr appointments and go to the store and be out in their community, do they qualify for a wheelchair under medicare
No, has to be a need WITHIN the home
What chair is easier to push, the rigid frame chair or the folding frame chair
rigid
will medicare pay for quick release wheels?
No
what is the advantage of vinyl coating for a hand rim on a wheelchair
makes it easier to grip
What is a desk length arm rest
shorter arm rest so that you can pull up under a desk
Measurement of patient dimensions takes place in what position
seated position
A patient who needs to propel their wheelchair with their feet needs what wheelchair measurement adjusted
Shortened seat depth
If medicare covers a patients wheelchair but they also want a power assist device added on that medicare wont cover, can they get secondary insurance to pay for it?
No, secondary insurance will only pay for expenses covered under medicare
