Scales and Assessment Tools Flashcards
Grading of Pulse Quality (Strength)
0
Absent
No perceptible pulse even with maximum pressure
Grading of Pulse Quality (Strength)
1+
Thready
Barely perceptible
Easily obliterated with slight pressure
Fades in and out
Grading of Pulse Quality (Strength)
Obliterated with LIGHT pressure
2+ (Weak)
Difficult to palpate
Slightly stronger than Thready
Grading of Pulse Quality (Strength)
Obliterated with MODERATE pressure
3+ (Normal)
Easy to palpate
Grading of Pulse Quality (Strength)
Very strong
4+ (Bounding)
Hyperactive
Not obliterated with moderate pressure
Types of Fever
Intermittent
Body temperature alternates at regular intervals between periods of FEVER and NORMAL temperature
Types of Fever
Remittent
Elevated body temperature that fluctuates MORE THAN 3.6F (2C) within a 24-hour period, but REMAINS ABOVE NORMAL
Types of Fever
Periods of fever are interspersed with normal temperatures, each last AT LEAST ONE DAY
Other name?
Relapsing Fever (Recurrent Fever)
Types of Fever
Body temperature may fluctuate SLIGHTLY, but is CONSTANTLY ELEVATED ABOVE NORMAL
Constant Fever
Modified Ashworth Scale (MAS)
0
No increase in muscle tone
Modified Ashworth Scale (MAS)
Slight increase in muscle tone
Catch and release or minimal resistance at the end of the ROM
1
Modified Ashworth Scale (MAS)
Slight increase in muscle tone
Catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
1+
Modified Ashworth Scale (MAS)
2
More marked increase in muscle tone through the ROM
Affected part still easily moved
Modified Ashworth Scale (MAS)
Considerable increase in muscle tone
Passive movement becomes difficult
3
Modified Ashworth Scale (MAS)
4
Affected part in rigid flexion or extension
Abnormal pulses
Decreased pulse pressure with a slow upstroke and prolonged peak
Small, Weak pulse
Causes: Increased peripheral vascular resistance such as occurs in cold weather or severe congestive heart failure; decreased stroke volume such as occurs in hypovolemia or aortic stenosis
Abnormal pulses
Causes are: Increased stroke volume, as in aortic regurgitation; increased stiffness of arterial walls, as in atherosclerosis or normal aging; exercise; anxiety; fever; hypertension
Describe the pulse.
Large, Bounding pulse
Bounding pulse in which a great surge precedes a sudden absence of force or fullness
Abnormal pulses
Corrigan’s pulse
Describe the pulse.
Other name? Causes?
Water-Hammer pulse
Increased pulse pressure with a rapid upstroke and downstroke and a shortened peaks
Causes: Aortic regurgitation, patent ductus arteriosus, systemic arteriosclerosis
Abnormal pulses
Only cause is left ventricular failure
Describe the pulse.
Pulsus Alterans
Regular pulse rhythm with alternation of weak and strong beats (amplitude or volume)
Abnormal pulses
Due to Premature ventricular beats caused by heart failure, hypoxia, or other conditions
Describe the pulse.
Pulsus Bigeminus
Irregular pulse rhythm in which premature beats alternate with sinus beats
Abnormal pulses
Pulsus Bisferiens
Causes?
A strong upstroke, downstroke, and second upstroke during systole
Causes are: aortic insufficiency, aortic regurgitation, aortic stenosis
Abnormal pulses
Pulse with a markedly decreased amplitude during inspiration
Causes?
Pulsus paradoxus
Causes: constrictive pericarditis, pericardial tamponade, advanced heart failure, severe lung disease
Respiratory patterns
Eupnea is described as?
Normal respirations
Equal rate and depth
12-20 breaths per minute
Respiratory patterns
Bradypnea is described as?
Rate?
Slow respiratons
<10 breaths per minute
Respiratory patterns
Tachypnea is described as? Usual depth of respiration?
Rate?
Fast respirations
Usually shallow
>24 breaths per minute
Respiratory patterns
Respirations that are regular but abnormally deep and increased in rate
Kussmaul’s respirations
Respiratory patterns
Irregular respirations of variable depth (usually shallow), alternating with periods of apnea (absence of breathing)
Biot’s respirations
Respiratory patterns
Gradual increase in depth of respirations
followed by gradual decrease and then a
period of apnea
Cheyne-Strokes respirations
Respiratory patterns
Absence of breathing
Apnea
Common sensory impairments
Inability to recognize weight
Abarognosis
Common sensory impairments
Difference of Allesthesia and Pallanesthesia
Allesthesia: Sensation experienced at a site remote from point of stimulation
Pallanesthesia: Loss or absence of sensibility to vibration
They are not related!
Hint: In allesthesia, “All-“ is derived from Gr. “Allos” meaning “other”
Common sensory impairments
Difference of Allodynia and Hyperalgesia
Allodynia: Pain produced by a non-noxious stimulus
Hyperalgesia: Increased sensitivity to pain
Common sensory impairments
Difference of Analgesia and Hypalgesia
Analgesia: Complete loss of pain sensitivity
Hypalgesia: Decreased sensitivity to pain
Common sensory impairments
Difference of Dysesthesia and Allesthesia
Allesthesia: Sensation experienced at a site remote from point of stimulation
Dysesthesia: Touch sensation experienced as pain
Common sensory impairments
Difference of Atopognosia and Allesthesia
Atopognosia: Inability to localize a sensation
Allesthesia: Sensation experienced at a site remote from point of stimulation
Common sensory impairments
Synonymous with Tactile agnosia
Describe.
Astereognosis: Inability to recognize the form and shape of objects by touch
Common sensory impairments
Causalgia
Painful, burning sensations, usually along the distribution of a nerve
Common sensory impairments
Difference of Hypesthesia and Hyperesthesia
Hyperesthesia: Increased sensitivity to sensory stimuli
Hypesthesia: Decreased sensitivity to sensory stimuli
Common sensory impairments
Difference of Dysesthesia and Paresthesia
Dysesthesia: Touch sensation experienced as pain
Paresthesia: Abnormal sensation such as numbness, prickling, or tingling, without apparent cause
Common sensory impairments
Describle Thalamic (Pain) Syndrome
Vascular lesion of the thalamus
Results in: Sensory disturbances and partial or complete paralysis of one side of the body, associated with severe, boring-type pain; sensory stimuli may produce an exaggerated, prolonged, or painful response
Common sensory impairments
Type of pain experience in Thalamic (Pain) Syndrome
Boring-type pain
Common sensory impairments
True or false: In Thalamic (Pain) Syndrome, paralysis does not occur.
False.
Partial or complete paralysis on one side of the body may occur.
Common sensory impairments
Difference of Thermanalgesia and Thermanesthesia
Thermanalgesia: Inability to perceive heat
Thermanesthesia: Inability to perceive sensations of heat and cold
Common sensory impairments
Increased sensitivity to temperature
Thermhyperesthesia
Common sensory impairments
Decreased temperature sensibility
Thermhypesthesia
Common sensory impairments
Thigmanesthesia
Loss of light touch sensibility
Grading of ligamentous instability
I
0-5 mm
Grading of ligamentous instability
6-10 mm
II
Grading of ligamentous instability
11-15 mm
III
Grading of ligamentous instability
IV
> 15 mm
Typical Patterns of Spasticity in UMNLs
Scapula
Action and muscle/s responsible
Retraction and downward rotation
Rhomboids
Typical Patterns of Spasticity in UMNLs
Shoulder
Action and muscle/s responsible
Adduction and internal rotation, depression
Pectoralis major, latissimus dorsi,
teres major, subscapularis
Typical Patterns of Spasticity in UMNLs
Elbow
Action and muscle/s responsible
Flexion
Biceps, brachialis, brachioradialis
Typical Patterns of Spasticity in UMNLs
Forearm
Action and muscle/s responsible
Pronation
Pronator teres, Pronator quadratus
Typical Patterns of Spasticity in UMNLs
Wrist
Action and muscle/s responsible
Flexion, adduction
Flexor carpi radialis
Typical Patterns of Spasticity in UMNLs
Hand
Action and muscle/s responsible
Finger flexion, clenched fist, thumb adducted in palm
Flexor digitorum profundus / sublimis, adductor pollicis brevis, flexor pollicis brevis
Typical Patterns of Spasticity in UMNLs
Pelvis
Action and muscle/s responsible
Retraction (hip hiking)
Quadratus lumborum
Typical Patterns of Spasticity in UMNLs
Hip
Action and muscle/s responsible
Hip Adduction (scissoring): Adductor longus/brevis
Internal rotation: Adductor magnus, gracilis
Extension: Gluteus maximus
Typical Patterns of Spasticity in UMNLs
Knee
Action and muscle/s responsible
Extension
Quadriceps
Typical Patterns of Spasticity in UMNLs
Foot and ankle
Action and muscle/s responsible
Plantarflexion: Gastrocnemius/soleus
Inversion, Equinovarus: Tibialis posterior
Claw toes (TMT extension + MTP flexion), Curling of toes (TMT and MTP flexion): Long toe flexors, Extensor hallucis longus, Peroneus longus
Typical Patterns of Spasticity in UMNLs
Hip and knee in prolonged sitting
Action and muscle/s responsible
Flexion: Iliopsoas
If sacral sitting: Rectus femoris, pectineus, hamstrings
Typical Patterns of Spasticity in UMNLs
Trunk
Action and muscle/s responsible
Lateral flexion with concavity: Rotators
Rotation: Internal / External obliques
Typical Patterns of Spasticity in UMNLs
Forward posture in prolonged sitting
Action and muscle/s responsible
Excessive forward flexion and forward head
Rectus abdominis, External obliques, Psoas minor
Examination of DTRs
Nerve mediating the Jaw Reflex
Describe the procedure and response.
CN 5
Patient is sitting, with jaw relaxed and slightly open. Place finger on top of chin; tap downward on top of finger in a direction that causes the jaw to open.
Jaw rebounds and closes
Examination of DTRs
Nerve mediating the Biceps Reflex
Describe the procedure and response.
Musculocutaneous nerve (C5, C6)
Patient is sitting with arm flexed and supported. Place thumb over the biceps tendon in the cubital fossa, stretching
it slightly. Tap thumb or directly on tendon.
Slight contraction of elbow flexors
Examination of DTRs
Nerve mediating the Bracioradialis (supinator) Reflex
Describe the procedure and response.
Radial nerve (C5, C6)
Patient is sitting with arm flexed onto the abdomen. Place finger on the radial tuberosity and tap finger with hammer.
Slight contraction of elbow
flexors, slight wrist extension
or radial deviation
Examination of DTRs
Nerve mediating the Triceps Reflex
Describe the procedure and response.
Radial nerve (C6, C7)
Patient is sitting with arm supported in abduction, elbow flexed. Palpate triceps tendon just above olecranon. Tap directly on tendon.
Slight contraction of elbow extensors
Examination of DTRs
Nerve mediating the Finger Flexor Reflex
Describe the procedure and response.
Median nerve (C6-T1)
Hold hand in neutral position. Place finger across palmar surface of distal phalanges of four fingers and tap.
Slight contraction of finger flexors
Examination of DTRs
Nerve mediating the Hamstrings Reflex
Describe the procedure and response.
Tibial branch of the Sciatic nerve (L5, S1, S2)
Patient is prone with knee semiflexed and supported. Palpate tendon at the knee. Tap on finger or directly on tendon.
Slight contraction of knee flexors
Examination of DTRs
Nerve mediating the Quadriceps Reflex
Other names of this reflex?
Describe the procedure and response.
Femoral nerve (L2, L3, L4)
Knee Jerk or Patellar Reflex
Patient is sitting with knee flexed, foot unsupported. Tap tendon of quadriceps muscle between the patella and tibial tuberosity.
Slight contraction of knee extensors
Examination of DTRs
Nerve mediating the Achilles Reflex
Other names of this reflex?
Describe the procedure and response.
Tibial nerve (S1, S2)
Ankle Jerk
Patient is prone with foot over the end of the plinth or sitting with knee flexed and foot held in slight dorsiflexion. Tap tendon just above its insertion on the calcaneus. Maintaining slight tension on the gastrocnemius-soleus group improves the response.
Slight contraction of plantarflexors
Examination of Superficial Cutaneous Reflexes
Roots of the Plantar reflex
Describe the procedure and response.
S1, S2
With blunt object (key or wooden end of applicator stick), stroke the lateral aspect of the sole, moving from the heel to the ball of the foot, curving medially across the ball of the foot.
Normal response is flexion (plantarflexion)
of the great toe, and sometimes the other toes (negative Babinski sign).
Examination of Superficial Cutaneous Reflexes
Describe the abnormal response to the Plantar reflex. What is this response called? What does this sign generally indicate?
Positive Babinski sign
Extension (dorsiflexion) of the great toe
with fanning of the four other toes (indicates UMN lesions).
Examination of Superficial Cutaneous Reflexes
How is the Plantar reflex tested if the patient has sensitive feet? Where should the examiner stroke, and what are these tests called?
Describe the response.
Chaddock: stroke lateral ankle and lateral aspect of foot
Oppenheim: stroke down tibial crest
Responses are similar to the Negative Babinski sign if normal, and Positive Babinski sign if abnormal.
Examination of Superficial Cutaneous Reflexes
Describe the procedure and response of Abdominal reflexes.
Position patient in supine, relaxed. Make brisk, light stroke over each quadrant of the abdominals from the periphery to the umbilicus.
Localized contraction under the stimulus, causing the umbilicus to move toward the stimulus.
Examination of Superficial Cutaneous Reflexes
What are the roots of the abdominal reflex above the umbilicus?
If it is tested, the response is masked if the patient is?
T8-T10
Obesity
Examination of Superficial Cutaneous Reflexes
What are the roots of the abdominal reflex below the umbilicus?
In which can it be absent, UMNLs or LMNLs?
T10-T12
Both
Primitive and Tonic Reflexes
What are the Primitive Reflexes? These are also called ______ reflexes.
Primitive reflexes are also called Spinal Reflexes because the integration center is at the Spinal Cord
Flexor Withdrawal Crossed Extension Traction Moro Grasp (Plantar and Palmar) Startle Rooting
Mnemonic (lecture): FaCe The Morayta GroupS + Rooting
Primitive and Tonic Reflexes
What are the Tonic Reflexes? These are also called ______ reflexes.
Tonic reflexes are also called Brainstem Reflexes because the integration center is at the Brainstem
STNR ATNR Positive Supporting TLR Associated Reactions
Mnemonic (lecture): SAPTA
Primitive and Tonic Reflexes
The Flexor withdrawal reflex starts and integrates when?
Onset: 28 weeks of gestation
Integration: 1-2 months
Primitive and Tonic Reflexes
The Crossed extension reflex starts and integrates when?
Onset: 28 weeks of gestation
Integration: 1-2 months
Primitive and Tonic Reflexes
The Traction reflex starts and integrates when?
Onset: 28 weeks of gestation
Integration: 2-5 months
Primitive and Tonic Reflexes
The Moro reflex starts and integrates when?
Onset: 28 weeks of gestation
Integration: 5-6 months
Primitive and Tonic Reflexes
The Plantar Grasp reflex starts and integrates when?
Onset: 28 weeks of gestation
Integration: 9 months
Primitive and Tonic Reflexes
The Palmar Grasp reflex starts and integrates when?
Onset: birth
Integration: 4-6 months
Primitive and Tonic Reflexes
The Rooting reflex starts and integrates when?
Onset: birth
Integration: 3 months
Primitive and Tonic Reflexes
The STNR starts and integrates when?
Onset: 4-6 months
Integration: 8-12 months
Primitive and Tonic Reflexes
The ATNR starts and integrates when?
Onset: birth
Integration: 4-6 months
Primitive and Tonic Reflexes
The Startle reflex starts and integrates when?
Onset: birth
Integration: persists throughout life
Primitive and Tonic Reflexes
The Positive supporting reflex starts and integrates when?
Onset: birth
Integration: 6 months
Primitive and Tonic Reflexes
The TLR starts and integrates when?
Onset: birth
Integration: 6 months
Primitive and Tonic Reflexes
Associated Reactions start and integrate when?
Onset: birth - 3 months
Integration: 8-9 years
Primitive and Tonic Reflexes
Response is grasping and total flexion of the UE
Traction
Primitive and Tonic Reflexes
Stimulus is grasping the forearm and pulling up from supine into sitting
Traction
Primitive and Tonic Reflexes
Stimulus and response of the flexor withdrawal reflex
Noxious stimulus (pinprick) to the sole of the foot. Tested in supine or sitting.
Toes extend, foot dorsiflexes, entire LE flexes uncontrollably.
Primitive and Tonic Reflexes
Stimulus and response of the crossed extension reflex
Noxious stimulus to ball of foot of LE fixed in extension; tested in supine position
Opposite LE flexes, then adducts and extends.
Primitive and Tonic Reflexes
Noxious stimulus presented at the SOLE of the foot
Flexor withdrawal
Mnemonic: Flex-Sole; Ball-Ex
Primitive and Tonic Reflexes
Noxious stimulus presented at the BALL of the foot
Crossed extension
Mnemonic: Flex-Sole; Ball-Ex
Primitive and Tonic Reflexes
Stimulus and response of the Moro reflex
Sudden change in position of head in relation to trunk; drop patient backward from sitting position.
Extension, abduction of UEs, hand opening, and crying followed by flexion, adduction of arms across chest.
Primitive and Tonic Reflexes
In the response of Moro reflex, which occurs first?
UE abduction or UE adduction?
UE flexion or UE extension?
Crying or hand opening?
Crying or UE flexion?
UE abduction
UE extension
At the same time
Crying
Sequence:
UE extension + UE abduction + Hand opening + Crying; then
UE flexion + UE adduction across the chest
Primitive and Tonic Reflexes
The only reflex that persists throughout life.
Startle
Primitive and Tonic Reflexes
The response is sudden extension or abduction of the UEs and crying ONLY.
Name the reflex. What is its stimulus?
Startle
Sudden loud or harsh noise.
Primitive and Tonic Reflexes
The stimulus is rotating the head to one side.
Name the reflex. What is its response? The posturing assumed is/are called what?
This reflex, when not integrated, interferes with what activity?
Asymmetric Tonic Neck Reflex (ATNR)
Flexion of skull limbs, extension of the jaw limbs.
Bow and arrow or Fencing posture.
Rolling, Eating
Primitive and Tonic Reflexes
Stimulus is maintained pressure to either the palm of the hand or the ball of the foot under the toes.
Name the reflex. What is the response?
Grasp reflex (Palmar if at the hand, or Plantar if at the foot)
Maintained flexion of the fingers (Palmar) or toes (Plantar)
Primitive and Tonic Reflexes
True or False: In Grasp reflex, after a brief application of pressure to the palm of the hand, there is maintained flexion of the fingers.
False.
Pressure is maintained, not briefly applied.
Primitive and Tonic Reflexes
True or False: In Grasp reflex, maintained pressure to the ball of the foot causes the toes to flex briefly.
False.
The toes are maintained in flexion as long as pressure is maintained.
Primitive and Tonic Reflexes
If not integrated, this reflex interferes with the assumption of the Quadruped position.
Name the reflex. Describe the stimulus and response.
Symmetric Tonic Neck Reflex (STNR)
Flexion or extension of the head.
Flexion: flexion of UEs, extension of LEs;
Extension: extension of UEs, flexion
of LEs
Primitive and Tonic Reflexes
If not integrated, this reflex interferes with walking and stair negotiation.
Name the reflex. Describe the stimulus and response.
Positive supporting
Contact to the ball of the foot in upright standing position
Rigid extension (co-contraction) of the LEs.
Primitive and Tonic Reflexes
The Tonic Labyrinthine Reflex (TLR) is also called?
Symmetric Tonic Labyrinthine Reflex (STLR)
Primitive and Tonic Reflexes
If not integrated, this reflex interferes with activities that involve moving from supine to sitting
Name the reflex. Describe the stimulus and response.
Symmetric Tonic Labyrinthine Reflex (STLR or TLR)
Prone or supine position
Prone: increased flexor tone (flexion of all limbs)
Supine: increased extensor tone (extension of all limbs)
Primitive and Tonic Reflexes
Involuntary movements at the resting extremity occur when a voluntary movement in any part of the body is resisted.
This is due to what reflex?
Associated reactions
Historical Disablement Frameworks
ICIDH defines _____ as the intrinsic pathology or disorder.
Disease
Historical Disablement Frameworks
Nagi defines _____ as an interruption or interference with normal processes, and efforts of the organism to regain normal state.
Active pathology
Historical Disablement Frameworks
True or False: ICIDH and Nagi define Disability as any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.
False.
This is the ICIDH definition of Disability.
Nagi describes disability as: Limitation in performance of socially defined roles and tasks within a sociocultural and physical environment.
Historical Disablement Frameworks
The ICIDH definition of Impairment is similar to that of Nagi’s.
True.
ICIDH: Impairments are any loss or abnormality of physchological, physiological, or anatomical structure or function.
Nagi: Impairments are anatomical, physiological, mental, or emotional abnormalities or loss.
Historical Disablement Frameworks
Functional Limitations is used by which framework?
Nagi
Historical Disablement Frameworks
The description of Functional Limitation by Nagi is synonymous to which among those used by ICIDH?
Disability.
Functional Limitation: Limitation in performance at the level of the whole organism or person.
Disability (ICIDH): Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being
Historical Disablement Frameworks
ICIDH’s definition of a Handicap is synonymous to which term used by Nagi?
Disability.
Handicap: A disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the
fulfillment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual
Disability (Nagi): Limitation in performance of socially defined roles and tasks within a sociocultural and physical environment
Descriptors of Weight-Bearing Status
100%
Full weight-bearing (FWB)
There are no restrictions on weight-bearing
Descriptors of Weight-Bearing Status
Limited by patient tolerance
Weight-bearing as tolerated (WBAT)
Descriptors of Weight-Bearing Status
Partial weight-bearing (PWB)
Only a portion of weight can be borne on the extremity
Sometimes expressed as a percentage of body weight
Descriptors of Weight-Bearing Status
The LE is non-weight-bearing, but is allowed to contact the floor
What is the other name for this WB status?
What part of the LE is allowed to contact the floor?
Toe-touch weight-bearing (TTWB)
Touch-down weight-bearing (TDWB)
Only the toes of the affected extremity contact the floor to improve balance, and not to support body weight.
Descriptors of Weight-Bearing Status
The foot is not allowed to contact the floor; hence, no weight is borne on the extremity.
Non-weight bearing (NWB)
GOLD Classification
FEV1/FVC < 70% is one of the prerequisites of which stage?
All stages (I, II, III, IV)
GOLD Classification
Mild COPD is characterized by?
I
FEV1/FVC < 70%
FEV1 ≥ 80% predicted
With or without symptoms of cough and sputum production
GOLD Classification
Moderate COPD is characterized by?
II
FEV1/FVC < 70%
FEV1 is 50-79% predicted
Shortness of breath with exertion
With or without symptoms of cough and sputum production
GOLD Classification
Severe COPD is characterized by?
III
FEV1/FVC < 70%
FEV1 is 30-49% predicted
Greater shortness of breath with exercise,
Decreased exercise capacity
Fatigue and repeated exacerbations of the disease
GOLD Classification
Very Severe COPD is characterized by?
IV
FEV1/FVC < 70%
FEV1 is < 30% predicted OR FEV1 is < 50% predicted plus chronic respiratory failure
GOLD Classification
True or False: The patient’s FEV1 is at 32% and presents with chronic respiratory failure. The patient is classified as at stage III.
False.
The patient is at stage IV (very severe).
FEV1/FVC < 70%
FEV1 is < 30% predicted OR FEV1 is < 50% predicted plus chronic respiratory failure
GOLD Classification
True or False: The patient’s FEV1 is at 32% and presents with chronic respiratory failure. The patient is classified as at stage III.
False.
The patient is at stage IV (very severe).
FEV1/FVC < 70%
FEV1 is < 30% predicted OR FEV1 is < 50% predicted plus chronic respiratory failure
GOLD Classification
The patient experiences shortness of breath with exertion.
II (Moderate) or III
GOLD Classification
True or False: To be classified as stage II (Moderate), the patient has to demonstrate symptoms of cough and has to produce moderate amounts of sputum.
False.
In stage I (mild) and II (moderate), symptoms of cough and sputum production MAY OR MAY NOT be present.
Glasgow Coma Scale (GCS)
3 domains assessed?
Eye Opening
Verbal Response
Best Motor Response
Glasgow Coma Scale (GCS)
Highest possible score
15
Glasgow Coma Scale (GCS)
Lowest possible score
3
Glasgow Coma Scale (GCS)
Maximum score for each domain
Eye opening: 4
Verbal response: 5
Motor response: 6
Glasgow Coma Scale (GCS)
Spontaneous eye opening
4
Glasgow Coma Scale (GCS)
Eye opening to pain
2
Glasgow Coma Scale (GCS)
Eye opening to speech
3
Glasgow Coma Scale (GCS)
Does not open eyes (no response)
1
Glasgow Coma Scale (GCS)
Follows motor commands
6
Glasgow Coma Scale (GCS)
Localizes pain
5
Glasgow Coma Scale (GCS)
Withdraws from pain
4
Glasgow Coma Scale (GCS)
Abnormal flexion
3
Glasgow Coma Scale (GCS)
Extensor response
2
Glasgow Coma Scale (GCS)
No motor response
1
Glasgow Coma Scale (GCS)
Oriented speech
5
Glasgow Coma Scale (GCS)
Confused conversation
4
Glasgow Coma Scale (GCS)
Inappropriate words
3
Glasgow Coma Scale (GCS)
Incomprehensible sounds
2
Glasgow Coma Scale (GCS)
No verbal response
1
Glasgow Coma Scale (GCS)
The patient demonstrates decorticate posturing and opens his eyes once his name is called. The patient says random words in response to your questions.
GCS score
Motor: 3
Verbal: 3
Eye: 3
9
Glasgow Coma Scale (GCS)
Upon entering the room, the patient is awake. The patient demonstrates decerebrate posturing. When asked what year it is, the patient responds “2055.”
GCS score
Motor: 2
Verbal: 4
Eye: 4
10
Severity of TBI
Mild TBI is characterized by:
LOC: 0-30 mins AOC: brief >24 hours PTA: 0-1 day GCS: 13-15 Normal findings in neuroimaging
Severity of TBI
Moderate TBI is characterized by:
LOC: >30 mins - <24 hours AOC: >24 hours PTA: >1 - <7 days GCS: 9-12 Normal or abnormal findings in neuroimaging
Severity of TBI
Severe TBI is characterized by:
LOC: >24 hours AOC: >24 hours PTA: >7 days GCS: <9 Normal or abnormal findings in neuroimaging
Salter Harris Classification for Growth Plate Fractures
I
Straight
Fracture across the physis only
Salter Harris Classification for Growth Plate Fractures
II
Above
Fracture involves the physis and the metaphysis
Salter Harris Classification for Growth Plate Fractures
III
Lower
Fracture involves the physis and the epiphysis
Salter Harris Classification for Growth Plate Fractures
IV
Through
Fracture involves the physis, metaphysis, and epiphysis
Salter Harris Classification for Growth Plate Fractures
V
Erased
Fracture involves crushing of the growth plate
Salter Harris Classification for Growth Plate Fractures
VI
Ring
Fracture involves the peripheral physis develops into a ridge and can cause angular deformities
Salter Harris Classification for Growth Plate Fractures
VIII
Fractures involves the metaphysis only
Salter Harris Classification for Growth Plate Fractures
IX
Fracture involves the periosteum only
Garden Classification of Femoral Neck Fractures
I
Incomplete
Garden Classification of Femoral Neck Fractures
II
Complete, undisplaced
Garden Classification of Femoral Neck Fractures
III
Complete, partially displaced (<50%)
Garden Classification of Femoral Neck Fractures
IV
Complete, full displacement (>50%)
LeFort Classification of Facial Fractures
I
Upper tooth segment moves and separates from the superior maxilla; a sulcus above the lips appears
Diplopia and cheek anesthesia may develop
LeFort Classification of Facial Fractures
II
Upper tooth segment moves with the midportion of the face, the nasal bone moves; a sulcus appears at the side of the nose
Diplopia and cheek anesthesia may develop
LeFort Classification of Facial Fractures
III
This grade is indicative of?
Upper tooth segment moves with the middle 1/3 of the face and the nasal bone; a sulcus does not appear because the face is already moving.
Diplopia and cheek anesthesia may develop
Indicates Craniofacial separation
Grading of DTRs
Absent
0
Grading of DTRs
1+
Depressed, hyporeflexive
Grading of DTRs
Normal
2+
Grading of DTRs
3+
Increased, but not necessarily abnormal
Grading of DTRs
Hyperreflexive
4+
Abnormal compared to grade 3+
ABI
<0.5
Severe arterial disease
ABI
0.74-0.5
Moderate arterial disease with rest pain
ABI
Mild arterial disease with intermittent claudication
0.75-0.94
ABI
Normal
0.95-1.19
ABI
> 1.2
Falsely elevated, arterial disease, diabetes
Scoring mechanics in FIM
7 point scale
18 areas
Scoring mechanics in Tinetti POMA
2 sections
Maximum score of 28
Less than 19 indicates high risk for falls
Scoring mechanics in Fugl-Meyer
Ordinal scale
5 areas of assessment
Maximum score of 100; may be used as a percentage of motor recovery
Scoring mechanics in Barthel Index
10 different ADLs assessed
Maximum score of 100
Does not account for cognitive or safety issues, and is not sensitive to higher level patients regarding their level of disability.
Korotkoff sound 1
2 consecutive beats: SBP reading
Korotkoff sound 2
Murmuring or swishing sound after a momentary disappearance following sound 1
Korotkoff sound 3
Sharper and louder sounds
Korotkoff sound 4
Sound becomes muffled
Korotkoff sound 5
Silence; the point at which sounds disappear: DBP reading
Mini-Mental State Examination scoring mechanics
11 questions assessing 5 areas of cognitive function
5-10 minutes to complete
Scores can range from 0-13
Minimum score for cognitive impairment: 23
Dementia, delirium, schizophrenia, affective disorder: 20
