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Neuromuscular Phys > Review > Flashcards

Review Flashcards

1
Q

What are the indicators of emergence from minimally conscious state

A

functional object use

functionally accurate communication

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2
Q

What is the key phase of gait

A

hip extension during mid stance to heel off

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3
Q

three key inputs to CPG

A

stretch of hip flexors

unweighting triceps surae

WBing to facilitate extensor tone in stance

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4
Q

what comes first for unilateral scooting: shortening or lengthening

A

shortening

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5
Q

How does stroke cause increased diabetes

A

greater degree of impairment -> less slow twitch muscle fibers -> more insulin resistance

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6
Q

Decreasing the duration of an illness is what kind of prevention

A

Secondary

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7
Q

How much Physical activity does the WHO recommend

A

150-300 mins of moderate intensity

or 75-150 of vigorous

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8
Q

Disadvantage of folding wheelchair:

A

Less durable

Heavier

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9
Q

Disadvantage of soft upholstery backrest compared to solid backrest on wheelchair

A

soft upholstery will stretch overtime

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10
Q

Solid wheelchair seat vs Soft upholstery seat

A

solid seat- will not stretch, also will not fold

soft seat- will fold, will stretch overtime

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11
Q

Do you want a patient in a wheelchair in slight anterior pelvic tilt, or posterior pelvic tilt

A

anterior pelvic tilt

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12
Q

Cambered vs vertical wheel alignment advantages/disadvantages

A

cambered wheels- quicker turning

vertical- more narrow

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13
Q

High vs low mount breaks

A

Low mount- more difficult to reach for lower functioning pts

High mount- Might injure users thumb while pushing wheelchair

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14
Q

MAG wheel vs spokes

A

MAG - more durable, heavier

spokes- lighter less durable

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15
Q

Pneumatic vs solid wheelchair tires

A

Pneumatic = more cushion but also more maintenance

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16
Q

Caster wheel larger vs smaller advantages

A

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

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17
Q

how to measure wheelchair seat width

A

Less than 1.25inch width wider than the greater trochanter or the widest portion of their thigh

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18
Q

How to measure wheelchair seat depth

What are the 2 landmarks?

A

Less than 1-2inches than the measurement between the posterior buttocks and popliteal fossa

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19
Q

Should we measure backrest height with the wheelchair cushion present or absent?

A

present!

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20
Q

How to measure backrest width

A

backrest width should be 3/4 inches wider than the widest part of the torso at the top of the back rest

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21
Q

When measuring foot-rest to seat distance what do we need to keep in mind? What should be absent or present

A

Cushion in wheelchair

pt wearing their normal shoes

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22
Q

How much clearance should there be between the footplates and the floor

A

atleast 2 inches

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23
Q

how to measure arm rest height:

A

Elbows flexed to 90 degrees

cushion in place

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24
Q

Axel alignment for wheelchair:

A

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

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25
Q

If a patient has a curb of 8 inches to get to their front door, how long does the ramp need to be?

A

8 feet

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26
Q

What has the best evidence for dealing with hemiparetic shoulders

A

FES/NMES

But only good for handling subluxation acutely, does not improve long term benefits

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27
Q

What device for shoulders has the highest chance of overcorrections:

A
  1. Lap Trays
  2. Arm Troughs
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28
Q

According to the study shown to us by da silva what had the best results for flaccid shoulder

A

Sling

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29
Q

What is the disadvantaged of the laptray/arm trough

A

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

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30
Q

What medication is used to treat HO

A

Biphosphonates

example: Etidronate/ Didronel

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31
Q

When does shoulder-hand syndrome first appear

A

1-3 months after CVA

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32
Q

What are the first signs of shoulder-hand syndrome

A

Swelling at the MCP and PIP

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33
Q

Shoulder hand syndrome can lead to what sympathetic NS dysfunction

What are the first signs

A

Complex regional pain syndrome

skin pigment changes, sweating, nail changes

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34
Q

Another disadvantage of lap board/arm trough

A

They cant take it with them when they start walking, its attached to the chair

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35
Q

What is the disadvantage of using a shoulder sling

A

Holds the pt in flexion synergy

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36
Q

Pts with shoulder hand syndrome will be unable to do what motion at the hand

A

flexion

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37
Q

Preventing an illness from ever taking place

A

Primary prevention

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38
Q

Reducing the duration of an illness or using tests to detect it early

A

Secondary prevention

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39
Q

Rehab, and preventing additional disability

A

Tertiary prevention

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40
Q

Risk factor reduction targeted towards an entire population through a focus on social and environmental conditions

Typically get promoted through laws and national policy.

A

Primordial

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41
Q

Brunstrom Stage 1:

Brunstrom Stage 2:

A

Flaccidity

minimum voluntary movement, developing spasticity

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42
Q

Brunstrom 3:

Brunstrom 4:

A

Max spasticity, Voluntary movement within synnergy

decreasing spasticity, 1 joint out of synnergy

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43
Q

Brunstrom 5:

Brunstrom 6:

Brunstrom 7:

A

2 joints out of synnergy

No more spasticity, movements are slowed

Normal

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44
Q

Sequence of inhibiting the hand:

A

Spread the metacarpals

Extend IP

Extend MCP

Extend Wrist

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45
Q

Sequence of mobilizing hand

A

Mobilizing metacarpals (one at a time) ->

Mobilizing carpals (flexion/ext of wrist) ->

Mobilizing Distal forearm (pronation/supination)

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46
Q

What area of the brain is damaged w pusher syndrome

A

Posterolateral thalamus

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47
Q

What syndromes are most common w/ pusher syndrome

A

Aphasia and neglect

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48
Q

At what age do you use the Child SCAT6 instead of the SCAT6

A

12 and under

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49
Q

What is the difference between the SCAT6 and the CRT6

A

SCAT6 - medical professionals

CRT6- meant for non-medical professionals

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50
Q

T or F: Training postural control has carry over to balance

A

F

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51
Q

Pt has eye closed and we put their feet on foam, what sensory system are we focusing on

A

Vestib

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52
Q

How to work on hip strategy for patients

A

Do balance activities with restricted ankle motion/ put feet in line w/ eachother

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53
Q

Pt cannot interact with world around them

example: pt cannot eat dinner with family

A

Participation restriction

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54
Q

Pt cannot participation in certain activities

example: cannot climb stairs

A

Activity restriction

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55
Q

What exercises are for temporarily decreasing dysmetria

A

Frenkel exercises:

-Starts with doing heel slides on mat

(Progression: Supine -> Sitting -> Standing)

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56
Q

What can help patients with dysmetria in LE (to walk)

A

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

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57
Q

6 stages of the transtheoretical model

A

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

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58
Q

Tardieu Scale R1 vs R2

A

R1: ROM Up to their first catch

R2: Full PROM

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59
Q

HO can only affect where?

A

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

60
Q

Neurotomies vs nerve blocks

A

Neurotomies are permanent

Nerve blocks - temporary

Rhizotomy- only sensory fibers cut

61
Q

Botox contraindications

A

Pregnancy

Children under 2

Neuromuscular transmission disease (example: Myasthenia Gravis)

Inflammation at site of injection

62
Q

What are the most common places to get a tendon release

disadvantage?

A

Achilles and hamstring

Does not change the original factor that made the tendon tight

63
Q

Split anterior tibial tendon transfer (SPLATT)

A

Typically done with an achilles tendon release

they split the Tibialis anterior tendon and attach it to the cuboid to correct foot varus/inversion

64
Q

Pt needs help bringing food to mouth, what PNF pattern helps with this

A

D1 Flexion

65
Q

If pt needs help reaching for a high shelf, what PNF pattern might help with that

A

D2 flexion

66
Q

pt needs help reaching cross-body to put on seatbelt, what pnf pattern might help with this?

A

D1 Flexion

67
Q

Balance training progression

A

eye head coordination

Orientation to midline

System training

Sitting balance

sit to stand/ transfer

Strategy training

Gait training

HEP

68
Q

What is the #1 social determinant of health

A

economic stability

69
Q

how much will medicare pay for DME under part B?

A

80%

70
Q

What will medicare not pay for

A

anything in the bathroom

a automatic hi-lo bed

71
Q

Wheelchair decision making process

A

Can they propel a manual wheelchair

Can they propel a light weight wheelchair

Can they use a scooter?

Can they use an automatic wheelchair

72
Q

What device is appropriate for someone that can walk short distances but needs a motorized device for longer distances

A

scooter

73
Q

Difference between scooter and automatic wheelchair

A

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

74
Q

who is more likely to have multiple concussions: athletes or military

A

military

75
Q

Is the SCAT diagnositc for concussions?

A

no

76
Q

SCAT6 vs SCOAT6 vs CRT6

A

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

77
Q

SCAT6/SCOAT6 vs Child SCAT6/SCOAT6

A

Child SCAT/SCOAT is for ages 5-12

78
Q

Who is more vulnerable to concussions

A

females

children

elderly

79
Q

Does a concussion require a loss of consciousness

A

no

80
Q

Mild TBI:

Loss of consciousness:

Alteration of consciousness:

PTA:

GCS:

A

Mild TBI:

Loss of consciousness: 0-30 mins

Alteration of consciousness: 24 hours

PTA: 24 hours

GCS: 13-15

81
Q

With a concussion imaging is typically ____

A

normal

82
Q

What is the most common concussion symptom

A

headache

83
Q

What is the slogan for managing concussions

A

if in doubt, sit them out

84
Q

player has neck pain after concussion, what do you do?

A

Spinal precautions and arrange trip to emergency room, that is red flag

84
Q

Player has double vision after concussion, what do you do?

A

Spinal precautions and arrange trip to emergency room, that is red flag

85
Q

Concussion red flags that indicate you take spinal precautions and send them to ER

A

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

86
Q

with all unconscious athletes it must be assumed that

A

they have cervical injury

87
Q

Initial advice for concussion

A

not to be left home alone

no driving

monitored to sleep the first night

no medication

88
Q

return to sport progression for concussion

A

symptom limited activity -> aerobic exercise -> individual sport specific practice -> noncontact training -> full contact training -> RTS

89
Q

persistent post concussion syndrome is anything over

____ in adults

_______ in children

A

10-14 days

4 weeks

90
Q

In what order do you typically treat PPCS

A

Visual -> Cervical -> vestib

but usually start with the main symptom generator

91
Q

contemplation stage: no plan to change within __________

A

6 months

92
Q

maintenance stage: theyve been consistent for __________

A

6 months

93
Q

What is considered the primary sign of cerebellar damage

A

Ataxia

94
Q

Movement decomposition definition

A

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

94
Q

Ataxia definition

A

Refers generally to disordered or noncoordinated movements

95
Q

Dysmetria definition

A

The inability to properly scale movements leading to hypermetria or hypometria

96
Q

Dyssynergia definition

A

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

97
Q

Lack of Check definition

A

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.

98
Q

Cerebellar patients usually have _______ extensor tone for holding themselves up against gravity AKA: ____________

A

decreased

hypotonia

99
Q

What is the classic cerebellar tremor

A

Kinetic tremor w/ intention tremor

100
Q

T or F: Cerebellar patients have increased postural sway

A

T, also refered to as imbalance

101
Q

paragraph describing one of the charts da silva said we need to look at

A

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.

102
Q

occulomotor deficits for cerebellar patients

A

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

103
Q

cerebellar patients have what kind of speech impairment

A

scanning speech

104
Q

For all cerebellar coordination tests we need to:

A

repeat multiple times

compare slow vs fast

compare w/ and without vision

compare both sides

105
Q

What is the most important activity limitation to observe for cerebellar patients

A

gait

106
Q

can motor learning be measured directly?

A

no

107
Q

What is best for motor learning:

Massed/blocked vs Distributed

Constant vs Variable

Contextual interference?

Physical Guidance?

Mental Practice?

A

Distributed

Variable

Contextual interference = good

Physical guidance = bad

Mental practice = good

108
Q

Recovery vs Compensation

A

Compensation is using an alternative strategy to accomplish a task

109
Q

What are the 2 regulatory conditions of a task in motor learning:

A

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

110
Q

What are the categories by which we organize tasks in motor learning?

A

Body Stability vs Body Transport

Intertrial variability vs not

Motion vs Stationary

Manipulation vs No Manipulation

111
Q

Types of feedback:

Interval:

Ratio:

Bandwidth:

Faded:

A

Types of feedback:

Interval: Every X mins

Ratio: every X reps

Bandwidth: only if they make a mistake

Faded: less feedback over time

112
Q

Sedentary activity is anything below ____

A

1.5 METS while sitting, reclining, or lying

113
Q

Contemplation stage means you’re thinking of changing behavior within ____

A

6 months

114
Q

Precontemplation stage means you have no desire to change behavior within _____

A

6 months

115
Q

Should health promotion for the disabled focus on their weaknesses or their pre existing strengths

A

Strength based

116
Q

When does discharge planning start?

A

At the initial chart review before you even see the patient

117
Q

When measuring the height of an entrance for a wheelchair ramp, do you include the height of the threshold?

A

Yes

118
Q

Flaccidity in ______ causes downward rotation of scapula

Spasticity in _________ causes downward rotation of scapula

A

supraspinatus

lats/upper trap

119
Q

What is the diff between PNF d1/d2 Contract relax and hold relax

A

Contract/relax involves a rotational component (they dont move their arm they just IR/ER their arm at the end range)

120
Q

Is it easier for patients to manipulate bigger or smaller objects

A

bigger are easier

Exception: Those w/ contractions may need to start w/ smaller

121
Q

Whats the minimum brunstrom for liftoffs

A

brunstrom 2

122
Q

Whats the minimum brunstrom for reaching activities

A

4

123
Q

What are the 3 stages of shoulder/hand syndrome

A

Acute- Diffuse swelling/pain

Dystrophic- no more swelling/pain, muscle atrophy

Atrophic- Deformities of hand/limited articular function

124
Q

Can a patient skip brunnstrom stages?

A

No

125
Q

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

A

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

126
Q

Principles of neuroplasticity:

A

Use it or lose it
Use it and improve it
Specificity
Repetition
Intensity
Salience/meaningfulness
Time since onset
Age
Transference
Interference

127
Q

Chronic stroke speeds:

unlimited household ambulation

limited community ambulation

unlimited community ambulation

how fast to cross a busy street?

A

.27

.58

.8

2.0

128
Q

What kind of footwear should patient wear

A

As little as possible!

129
Q

What are the 4 things stored in a motor schema

A

Initial conditions

Parameters of movement pattern

knowledge of results

Sensory consequences of movement

130
Q

A patient has an orthotic that is rubbing their heel, is this likely because the therapist measured them at R1 or R2 by mistake?

A

They measured at R1 when they were suppose to measure at R2

131
Q

Your patient has the circulation cut off to their legs, what wheelchair measurement did the PT get wrong

A

Wheelchair depth too long

132
Q

Your patient is developing pressure injuries on the bottom of their legs, what wheelchair measurement did the PT get wrong?

A

Wheelchair depth too short

133
Q

What percent of the US is living with a disability

A

25%

134
Q

Socioecological model:

Personal:

Interpersonal:

Institutional:

Community:

Societal:

A

Personal: the self

Interpersonal: friends, family

Institutional: School, church, work

Community: neighborhood, community

Societal: all of these as a whole

135
Q

What amount of people dont have health insurance in the US

A

1 in 10

136
Q

Whats generally the biggest obstacle for accessibility in homes?

A

bathroom!

137
Q

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

A

No, has to be a need WITHIN the home

138
Q

What chair is easier to push, the rigid frame chair or the folding frame chair

A

rigid

139
Q

will medicare pay for quick release wheels?

A

No

140
Q

what is the advantage of vinyl coating for a hand rim on a wheelchair

A

makes it easier to grip

141
Q

What is a desk length arm rest

A

shorter arm rest so that you can pull up under a desk

142
Q

Measurement of patient dimensions takes place in what position

A

seated position

143
Q

A patient who needs to propel their wheelchair with their feet needs what wheelchair measurement adjusted

A

Shortened seat depth

144
Q

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?

A

No, secondary insurance will only pay for expenses covered under medicare

Neuromuscular Phys (26 decks)

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