Ultimate Review Pt. 1 Flashcards
fibrous joints
(synarthroses) minimal movement. ex: sutures, syndesmosis, gomphosis
cartilaginous joints
(amphiarthroses) has cartilage to connect one bone to another. slightly moveable joints. ex: syndchondrosis, symphysis
synovial joints
(diarthroses) provide free mvmt btwn bones they join. have five characteristics: joint cavity, articular cartilage, synovial membrane and fluid, and fibrous capsule. ex: uniaxial joint (elbow), biaxial (condyloid: finger, saddle: thumb), multi-axial (plane: carpal jts, ball & socket: hip)
shoulder complex articulations
sternoclavicular, acromioclavicular, glenhumeral, scapulothoracic articulation
elbow
hinge joint, reinforced by ulnar collateral and radial collateral ligaments
wrist and hand
radiocarpal and midcarpal joints. mcp joints, prox and distal interphalangeal joints, and cmc joints
hip
ball and socket joint. stability provided at joint by: acetabulum, iliofemoral ligament, pubofemoral ligament, and ischiofemoral ligament
knee
hinge joint. stability by these ligaments: anterior cruciate, posterior cruciate, medial collateral, lateral collateral, ad deep medial capsular
ankle
hinge joint formed by articulation of tibia and fibula w/talus. medial ligaments: deltoid. lateral ligaments: anterior tibiofibular, anterior talofibular, calcaneofibular, lateral talocalcaneal, and posterior talofibular
joint receptors
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frontal plane
divides body into anterior and posterior. motions are abduction and adduction, occur around an anterior-posterior axis.
sagittal plane
divides body into right and left sections. flexion and extension occur around a medial=lateral axis.
transverse plane
divides body into upper and lower sections. rotation occurs around vertical axis.
class 1 lever
very few class 1 levers in body. one example is triceps force on olectranon with an external counter force pushing on forearm. (seesaw). axis of rotation is btwn effort (force) and resistance (load).
class 2 lever
resistance (load is btwn axis of rotation and effort (force). length of effort arm is always longer than resistance arm. most instances, gravity is effort and muscle activity is resistance. ex: wheelbarrow
class 3 lever
effort (force) btwn axis of rotation and resistance (load). shoulder abduction with weight at wrist is a class 3 lever example. most common type of lever in body.
ATP-PC system
energy system producing ATP during high intensity, short duration exercise. Phosphocreatine decomposes and releases large amount of energy used to construct ATP. provides energy for muscle contraction for up to 15 seconds.
anaerobic clycolysis
major supplier of ATP during high intensity, short duration activities. 50% slower than ATP-PC system and can provide a person with 30-40 secs of muscle contraction
aerobic metabolism
used predominantly during low intensity, long duration exercises. yields by far the most atp, but requires chemical reactions.
Type 1 Muscle Fibers
Aerobic, Red, Tonic, Slow twitch, Slow-oxidative: low fatigability, high capillary density, high myoglobin content, smaller fibers, extensive blood supply, large amt of mitochondria (ex: marathon, swimming)
Type 2 Muscle Fibers
Anaerobic, White, Phasic, Fast twitch, Fast-glycolytic: high fatigability, low capillary density, low myoglobin content, larger fibers, less blood supply, fewer mitochondria (ex: high jump, sprinting)
muscle receptors: muscle spindle
throughout belly of muscle. send info to nervous system about muscle LENGTH and or RATE of change of LENGTH. important in control of posture and involuntary mvmts.
golgi tendon organ
sensory receptors through which muscle tendons pass immediately beyond attachment to muscle fibers. very sensitive to TENSION when produced from an active muscle contraction. average of 10-15 muscle fibers are connected in series with each golgi tendon organ. stimulated through the tension produced by muscle fibers.
concentric contraction
when muscle shortens while developing tension
eccentric contraction
occurs when muscle lengthens while developing tension
isometric contraction
occurs when tension develops but no change in length of muscle
isotonic
occurs when muscle shortens or lengthens while resisting a constant load
isokinetic contraction
occurs when tension developed by muscle is maximal over full range of motion while shortening or lengthening at a constant speed.
open-chain activity
involve distal segment, usually hand or foot, moving freely in space. example: kicking a ball with LE
closed-chain activity
involve body moving over a fixed distal segment. example: squat lift
densitometry: hydrostatic weighing
method of calculating density of body by immersing in water and measuring amt of water that becomes displaced.
densitometry: plethysmography
method of calculating body density utilizing amt of air displacement during testing within a closed chamber.
anthropometry: skinfold msrmt
determines overall % of body fat thru msrmt of 9 standardized sites.
end feel
type of resistance that is felt when passively moving a joint thru end range of motion.
firm end feel
(stretch) ex: ankle DF, finger extension, hip medial rotation, forearm supination
hard end feel
(bone to bone) ex: elbow extension
soft end feel
(soft tissue approximation) ex: elbow flexion, knee flexion
abnormal end feel: empty
cannot reach end feel due to PAIN, ex: joint inflammation, fracture or bursitis
abnormal end feel: firm
ex: increased tone, tightening of capsule, ligament shortening
abnormal end feel: hard
ex: fracture, OA, osteophyte formation
abnormal end feel: soft
ex: edema, synovitis, ligament instability/tear
MMT 0/5
no muscle contraction felt
5-Jan
no movement, but can feel muscle contraction
2-/5
does not complete ROM in gravity eliminated position
5-Feb
completes ROM with gravity eliminated
2+/5
able to initiate mvmt against gravity
3-/5
does not complete ROM against gravity, but completes more than half the range
5-Mar
completes ROM against gravity w/o manual resistance
3+/5
completes ROM against gravity with only minimal resistance
4-/5
completes ROM against gravity with min/mod resistance
5-Apr
completes ROM against gravity with mod resistance
4+/5
completes ROM against gravity with mod/max resistance
5-May
completes ROM against gravity with max resistance
Gait: Standard - Stance Phase (60% of gait cycle)
Heel strike: instant heel touches ground to begin stance phase
standard - foot flat
point in which entire foot makes contact with ground and should occur directly after heel strike
standard - midstance
point during stance phase when entire body weight is over the stance limb
standard - heel off
point in which heel of the stance limb leaves ground
standard - toe off
point in which only toe of stance limb remains on ground
standard - swing phase (40% of gait cycle)
acceleration: begins when toe off is complete and reference limb swings until positioned directly under body
standard - midswing
point when swing limb is directly under body
standard - deceleration
begins directly after midswing as swing limb begins to extend and ends just prior to heel strike
rancho los amigos terminology
initial contact, loading response, midstance, terminal stance, pre-swing; initial swing, midswing, and terminal swing
ROM requirements for normal gait
hip flexion: 0-30, hip extension: 0-15, knee flexion: 0-60, knee extension: 0, ankle DF: 0-10, ankle PF: 0-20
Gait muscles: tibialis anterior
activity just after heel strike. eccentric lowering of foot into PF.
gait muscles: gastroc/soleus
activity during late stance phase. concentric raising of heel during toe off.
gait muscles: quads
single support during early stance phase, and just before toe off to initiate swing phase.
gait muscles: hams
activity during late swing phase. decelerating unsupported limb.
base of support
distance msrd btwn left and right foot during progression of gait. average BOS is 2-4 inches
cadence
of steps an individual will walk over a period of time. average value for an adult is 110-120 steps per minute
double support phase
refers to the two times during a gait cycle where both feet are on the ground. does not exist when running
gait cycle
sequence of motions that occur from one initial contact of the heel to the next initial contact of the same heel.
single support phase
occurs when only one foot is on the ground and occurs 2ce during a single gait cycle
step length
distance measured btwn right heel strike and left heel strike. average step length for adult is 13-16 inches
stride
distance measured btwn right heel strike and the following right heel strike. average stride length for an adult is 26-32 inches.
antalgic gait
involved step length is decreased in order to avoid weight bearing due to pain
ataxic gait
gait characterized by staggering and unsteadiness, wide BOS and movements are exaggerated.
cerebellar gait
staggering gait
circumduction
circular motion to advance leg during swing phase
double step
alternate steps are of a different length or different rate
equine
gait pattern with high steps, excessive use of gastrocs
festinating
patient walks on toes as though pushed. starts slowly, increases and may continue until patient grabs an object in order to stop
hemiplegic
abducts paralyzed limb, swings it around and brings forward so that foot comes to ground in front of them
parkinsonian
increased forward flexion of trunk and knees, shuffling with quick and small steps.
scissor gait pattern
legs cross midline upon advancement
spastic
stiff mvmt, toes catch and drag, legs held together, hip and knee joints slightly flexed
steppage
gait pattern in which feet and toes are lifted thru hip and knee flexion to excessive heights; usually secondary to DF weakness.
tabetic
high stepping ataxic gait pattern where feet slap ground
trendelenburg
glute medius weakness; excessive lateral trunk flexion and weight shifting over stance leg
vaulting
swing leg advances by compensating thru combination of elevation of pelvis and PF of stance leg
muscle insufficiency
muscle contraction that is less than optimal due to an extremely lengthened, or extremely shortened position of the muscle.
active insufficiency
when a 2 joint muscle contracts (shortens) across both joints simultaneously
passive insufficiency
when a 2 joint muscle is lengthened over both joints simultaneously
dynamometer
measures strength through use of a load cell or spring loaded gauge. (ex: grip strength-pounds)
dynamometry: make test
eval procedure where a patient is asked to apply a force against the dynamometer.
dynamometry: break test:
eval procedure where patient is asked to hold a contraction against pressure that is applied in opposite direction to contraction.
joint mobilization
passive movement technique designed to improve joint function
indications for joint mobs
restricted joint mobility, restricted accessory motion, desire neuro effects
contraindications for joint mobs
active disease, infection, advanced osteoporosis, articular hypermobility, fracture, acute inflammation, muscle guarding, muscle guarding, joint replacement
grade I
small movement performed at beginning of range
grade II
large amplitude movement performed within the range, but not reaching limit of range and not returning to beginning of range
grade III
large amplitude movement performed to limit of range
grade IV
small amplitude movement performed at limit of range
rheumatism
condition found in a number of disorders characterized by inflammation, degeneration or metabolic derangement of connective tissue, soreness, joint pain and stiffness of muscles. different conditions present with rheumatism. goals are to alleviate pain, decrease inflammation, maintain strength and functional mobility
osteoarthritis
chronic disease that primarily involves weight bearing joints. causes a degeneration of articular cartilage. risk factors include trauma, repetitive microtrauma, and obesity. cartilage becomes soft and damaged, bone thickens.
RA
systemic autoimmune disorder of unknown etiology. presents with a chronic inflammatory reaction in synovial tissues of a joint that results in erosion of cartilage and supporting structures within the capsule.
avulsion fracture
portion of bone becomes fragmented at site of tendon attachment from a traumatic and sudden stretch of tendon
closed fracture
break in a bone where skin over site remains intact
comminuted fracture
bone that breaks into fragments at the site of injury
compound fracture
break in a bone that protrudes thru skin
greenstick fracture
break on one side of a bone that does not damage periosteum on opposite side. often seen in children.
nonunion fracture
break in a bone that has failed to unite and heal after 9-12 months
stress fracture
break in a bone due to repeated forces to a particular portion of the bone
spiral fracture
break in a bone shaped as an S due to torsion and twisting
bursitis
condition caused by acute or chronic inflammation of bursae. pain and swelling limits range.
contusion
sudden blow to part of body that can result in mild to severe damage to superficial and deep structures. ROM, ice, compression are treatments
edema
increased volume of fluid in soft tissue outside of a joint capsule
effusion
increased volume of fluid within a joint capsule
genu valgum
knees touch while standing with feet separated. will increase compression of lateral condyle and increase stress to medial structures. also called knock-knee.
genu varum
bowing of knees. will increase compression of medial tibial condyle and increase stress to lateral structures. also called bowleg.
kyphosis
excessive curvature of spine in posterior direction usually in thoracic spine.
lordosis
excessive curvature of spine in anterior direction usually in cervical and lumbar spine.
myositis ossificans
condition of heterotopic bone formation that occurs 3 to 4 wks after a contusion or trauma within the soft tissue
osteoporosis
thinning of bone matrix with eventual bone loss and increased risk for fracture. usually found in postmenopausal women
q angle
degree of angle when measureing from midpatella to ASIS and tibial tubercle. normal q angle is 13 degrees for man and 18 degrees for a woman.
scoliosis
lateral curvature of spine.
shoulder dislocation
true separation of humerus from glenoid fossa
shoulder separation
disruption in stability of acromioclavicular joint
sprain
acute injury of ligament. grade I: mild pain and swelling, little or no tear of ligament. grade II: mod pain and swelling, minimal instability of joint, min to mod tearing of ligament resulting in decreased ROM. grade III: severe pain and swelling, substantial joint instability, total tear of ligament, substantial decrease in ROM
strain
acute injury of tendon, muscle. grade I: localized pain, min swelling and tenderness. grade II: localized pain, mod swelling, tenderness and impaired motor function. grade III: palpable defect of muscle, severe pain and poor motor function
tendonitis
acute or chronic inflammation of a tendon.
(start of peds) congenital hip dysplasia
malalignment of femoral head with acetabulum. develops during last trimester in utero. asymmetrical hip abdution with tightness and apparent femoral shortening of involved side. testing includes ortolani test, barlow maneuver, and u/s. treatment initially attempts to reposition femoral head within the acetabulum thru constant use of a harness, brace, splint or traction. PT may be indicated after cast removal for stretching, strengthening, and caregiver education.
congenital limb deficiencies
malformation that occurs in utero secondary to impaired developmental course. classified longitudinal or transverse. causative factor is an abnormality present at conception when a bone lacks potential to form. primary characteristic is a missing long bone suce as the radius. treatment may focus on symmetrical mvmts, strengthening, ROM, weight bearing and prosthetic training.
congenital torticollis
characterized by a unilateral contracture of the SCM muscle. causative factors include malposition in utero, breech position and birth trauma. usually dx’d within first three weeks of life. lateral flexion to same side as contracture, rotation toward opposite side. treatment conservative for the first year with emphasis on stretching, active ROM, position and caregiver education. possible surgery.
legg-calve-perthes disease
degeneration of femoral head due to avascular necrosis. disease is self limiting and has 4 phases: condensation, fragmentation, re-ossification and remodeling. presents with pain, decreased ROM, antalgic gait, positive Trendelenburg sign. primary treatment focus is to relieve pain and maintain femoral head in proper psition.
osgood-schlatter disease
also known as traction apophysis that results from repetitive traction on the tibial tuberosity apophysis. caused by repeated tension to the patella tendon over the tibial tuberosity in young athletes which results in a small avulsion of the tuberosity and swelling. self limiting condition includes point tenderness over patella tendon at insertion on tibial tubercle, antalgic gait and pain with increasing activity. treatment is conservative with focus on education, icing, and eliminating placing strain on the patella tendon.
osteogenesis imperfecta
connective tissue disorder that affects formation of collagen during bone development. 4 classifications of osteogenesis imperfecta vary in levels of severity. caused by genetic inheritance with type I and IV considered autosomal dominant traits, and types II and III considered autosomal recessive traits. characteristics: brittle bones, weakness, impaired respiratory function. treatment begins at birth with education on proper handling and facilitation of movement.
scoliosis
lateral curvature of spine that can be classified as infantile, juvenile, adolescent or adult. structural curve cannot be corrected with active or passive mvmt and there is rotation of vertebrae towards the convexity of the curve. results in a rib hump over thoracic region. primary causative factor for a non structural curve is a leg length discrepancy. treatment is based on type and severity, generally curves that are less than 25 degrees require monitoring, btwn 25 and 40 degrees are treated with orthotic management, and beyond 40 degrees require surgery.
talipes equinovarus
deformity of ankle/foot known as clubfoot.
juvenile rhematoid arthritis
most common chronic rheumatic disease in children and presents with inflammation of joints and connective tissues. systemic juvenile RA occurs in 10-20% of children with JRA and presents with acute onset and other symptoms. polyarticular JRA accounts for 30-40% of children with JRA and presents with high femal incidence, RF+ majority and arthritis in more than 5 joints. oligoarticular (pauciarticular) JRA accounts for 40-60% of children with JRA and affects less than 5 joints. treatment includes medication to relieve inflammation and pain and PT.
Foot orthotics
semirigid or rigid insert worn inside a shoe that corrects foot alignment and improves function.
AFO
primary purpose is to assist with dorsiflexion and prevent foot drop, can also influence knee control. commonly described for patients with peripheral neuropathy, nerve lesions or hemiplegia
KAFO
provide support and stability to knee and ankle. allow for a lock mechanism at the knee that provides stability. ankle is also held at proper alignment.
craig-scott KAFO
designed specifically for persons with paraplegia. allows a person to stand with a posterior lean of trunk.
HKAFO
indicated for patients with hip, foot, knee, and ankle weakness. can control rotation at hip and abduction/adduction. heavy and restricts patients to a swing to or swing thru gait pattern.
reciprocating gait orthosis (RGO)
incorporates a cable system to assist with advancement of lower extremities during gait. when patient shifts weight onto a selected lower extremity, the cable system advances the opposite LE.
parapodium
standing frame designed to allow a patient to sit when necessary. primarily used in peds.
corset
constructed of fabric to provide abdominal compression and support.
halo vest orthosis
invasive cervical thoracic orthosis that provides full restriction of all cervical motion. commonly used with cervical spinal cord injuries to prevent further damage or dislocation.
milwaukee orthosis
designed to promote realignment of spine due to scoliotic curvature.
taylor brace
thoracolumbosacral orthosis that limits trunk flexion and extension through a 3 point control design.
thoracolumbosaral orthosis (TLSO)
utilized to prevent all trunk motions and is commonly utilized as a means of post surgical stabilization.
factors that influence vascular disease
hypertension, aging, diabetes, infection, poor nutrition, cigarette smoking
risk factors for amputation
vascular disease (atherosclerosis, arteriosclerosis), venous insufficiency, buerger’s disease, diabetes. malignancy/tumor (osteosarcoma), congenital deformities, infection, and trauma
types of LE amputations
hemicorporectomy (surgical removal of pelvis and both LEs), hemipelvectomy (surgical removal of one half of the pelvis and LE), hip disarticulation (surgical removal of lower extremity from pelvis), transfemoral (surgical removal of LE above knee joint) knee disarticulation: thru knee joint, transtibial: below knee joint, syme’s foot at ankle joint with removal of malleoli, chopart’s: disarticulation at midtarsal joint, transmetatarsal: midsection of metatarsals
prosthetic training for transfemoral amputation
length of residual limb with regard to leverage and energy expenditure, no ability to weight bear thru the end of the residual limb, susceptible to hip flexion contracture, adaptation required for balance, weight of prosthesis, and energy expenditure
prosthetic training for transtibial amputation
loss of ankle and foot functions, residual limb does not allow for weight bearing at its end, WB in prosthesis should be distributed over the total residual limb, patella tendon should be the area of primary weight bearing, adaptations required for balance, and susceptible to knee flexion contracture.
possible complications with amputations
neuroma: bundle of nerve endings that group together an d produce pain due to scar tissue. phantom limb: refers to a painless sensation where patient feels that limb is still present. phantom pain: refers to patient’s perception of some form of painful stimuli.
wrapping guidelines for amputees
elastic wrap should not have wrinkles, diagonal and angular patterns should be used and should not be wrapped in circular patterns, provide pressure distally to enhance shaping, anchor wrap above knee for transtibial amputations, anchor wrap around pelvis for transfemoral amputations, promote full knee extension for transtibial amputations, promote full hip extension for transfemoral amputations. secure wrap with tape, do not use clips, use 3-4 inch wrap for transtibial and 6 inch wrap for transfemoral, rewrap frequently to maintain proper pressure.
components of a prosthesis
socket, suspension, knee, shank, foot
gait deviations of amputee: lateral bending
causes: prosthesis too short, improperly shaped lateral wall, high medial wall, prosthesis aligned in abduction, poor balance, abduction contracture, improper training, short residual limb, weak hip abductors on prosthetic side, hypersensitive and painful residual limb
gait deviations of amputee: abducted gait
causes: prosthesis may be too long, high medial wall, poorly shaped lateral wall, prosthesis position in abduction, inadequate suspension, abduction contracture, improper training, adductor roll, weak HF and adductors, pain over lateral residual limb
gait deviations of amputee: circumducted gait
causes: prosthesis may be too long, too much friction in knee, socket too small, excessive PF of prosthetic foot, abduction contracture, improper training, weak HF, inability to initiate prosthetic knee flexion
gait deviations of amputee: excessive knee flexion during stance
socket set forward in relation to foot, foot set in excessive DF, stiff heel, prosthesis too long, knee flexion contracture, hip flexion contracture, poor balance, decrease in quad strength
gait deviations of amputee: vaulting
causes: prosthesis may be too long, inadequate socket suspension, excessive alignment stability, foot in excess PF, residual limb discomfort, improper training, short residual limb
gait deviations of amputee: rotation of forefoot at heel strike
causes: excessive toe-out built in, loose fitting socket, inadequate suspension, rigid SACH heel cushion, poor muscle control, weak medial rotators, short residual limb
gait deviations of amputee: forward trunk flexion
causes: socket too big, poor suspension, knee instability, hip flexion contracture, weak hip extensors
gait deviations of amputee: medial or lateral whip
causes: excessive rotation of the knee, tight socket fit, valgus in prosthetic knee, improper alignment of toe break, improper training, weak hip rotators, knee instability
Start of Neuro
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CNS
Brain & Spinal Cord
PNS (Peripheral)
cranial nerves and their ganglia, spinal nerves and their glania and plexuses, efferent and afferent somatic nerves outside the CNS, ANS (autonomic nervous system) including sympathetic (fight or flight) and parasympathetic (activated during time of rest)
Brain (encephalon)
Parts include brainstem, cerebellum, diencephalon, cerebral hemispheres, fissures, sulci, meninges, ventricular system and dural spaces
brainstem
midbrain, pons, medulla oblongata
diencephalon
hypothalamus, infundibulum, optic chiasm
cerebral hemispheres
cortex, white matter, basal nuclei. 2 hemispheres: deep white matter, basal ganglia, and lateral ventricles
fissures
interhemispheric fissure: separates the two cerebral hemispheres. Sylvian or lateral fissure: (anterior portion) separates the temporal from frontal lobes; (posterior portion): separates temporal from parietal lobes
sulci
central sulcus: separates frontal and parietal lobes laterally. parietal-occipital sulcus: separates the parietal and occipital lobes medially. calcarine sulcus: separates the occipital lobe into superior and inferior halves
meninges
term to describe the three layers of connective tissue covering brain and spinal cord
meninges: dura mater
outermost meninge, has 4 folds, lines periosteum of skull.
meninges: arachnoid
middle meninge, surrounds brain in a loose manner
meninges: pia mater
innermost meninge, covers contours of brain, forms choroid plexus in the ventricular system
ventricular system
designed to protect and nourish brain. comprised for 4 ventricles and multiple foramen that allow passages of CSF. CSF acts as a cushion around brain and spinal cord, and is produced by the choroid plexus of each ventricle.
dural spaces: epidural space
space occupied between the skull and outer dura mater
dural spaces: subdural space
space occupied btwn the dura and arachnoid meninges
dural spaces: subarachnoid space
space occupied btwn the arachnoid and pia mater that contains CSF and the circulatory system for the cortex
ascending and descending tracts
…
corticospinal tract (anterior)
pyramidal motor tract responsible for ipsilateral voluntary mvmt
corticospinal tract (lateral)
pyramidal motor tract responsible or contralateral voluntary fine mvmt
fasciculus gracilis
sensory tract for trunk and LE proprioception, 2 pt discrimination, vibration and graphesthesia
fasciculus cuneatus
sensory tract for trunk, neck and UE proprioception, vibration, 2 pt discrimination, graphesthesia
rubrospinal tract
extrapyramidal motor tract for motor input of gross postural tone
spinocerebellar tract (dorsal)
sensory tract for ipsilateral and contralateral subconscious proprioception
spinocerebellar tract (ventral)
sensory tract for ipsilateral subconscious proprioception
spinothalamic tract (lateral)
sensory tract for pain, light touch, and temperature
tectospinal tract
extrapyramidal motor tract for contralateral posture muscle tone associated with auditory/visual stimuli
vestibulospinal tract
extrapyramidal motor tract for ipsilateral gross postural adjustments subsequent to head movements
Nerve Root Dermatomes
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C1
vertex of skull.
C2
temple, forehead, occiput. myotome: longus colli, SCM, rectus capitis
C3
entire neck, posterior cheek, temporal area, prolongation forward under mandible. myotome: trap, splenius capitis
C4
shoulder area, clavicular and upper scap area. myotome: trap, levator scapulae
C5
deltoid area, anterior aspect of entire arm to base of thumb. myotome: supraspinatus, deltoid, biceps
C6
anterior arm, radial side of hand to thumb and index finger. myotome: biceps, supinator, wrist extensors.
C7
lateral arm and forearm to index, long and ring fingers. myotome: triceps, wrist flexors
C8
medial arm and forearm to long, ring and little fingers. myotome: ulnar deviators, thumb extensors, thumb adductors
T1
medial side of forearm to base of little finger.
T2
medial side of upper arm to medial elbow, pectoral and midscapular areas
T3-T6
upper thorax
T5-T7
cotal margin
T8-T12
abs and lumbar region
L1
back, over trochanter and groin
L2
back, front of thigh to knee. myotome: psoas, hip adductors
L3
back, upper buttock, anterior thigh and knee, medial lower leg. myotome: psoas ,quads, thigh atrophy
L4
medial buttock, lateral thigh, medial leg, dorsum of foot, big toe. myotome: tib anterior, extensor hallicus
L5
buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first second and third toes. myotome: extensor hallucis, peroneals, gluteus medius, dorsiflexors, hamstring and calf atrophy
S1
buttock, thigh and posterior leg. myotome: calf and hamstring, wasting of gluteals, peorneals, PFs
S2
same as S1. mytome: same as S1 except peroneals
S3
groin and medial thigh to knee.
S4
perineum, genitals, lower sacrum. myotome: bladder, rectum
LE: Sciatic nerve innervates:
semitendinosous, soleus, popliteus, semimembranosous, plantaris, tib posterior, gastroc, biceps femoris, flexor hallucis lonus, flexor digitorum longus.
LE: lumbar plexus innervates:
psoas minor, psoas major
LE: sacral plexus innervates:
piriformis, superior gemelli, obturator internus, inferior gemelli, quadratus femoris
LE: inferior gluteal nerve innervates:
gluteus maximus
LE: deep peroneal nerve innervates:
extensor digitorum longus and tib anterior
LE: superior gluteal nerve innervates:
gluteus medius, gluteus minimus, tensor fasciae latae
LE: superficial peroneal nerve innervates:
peroneals (longus and brevis)
LE: femoral nerve innervates:
iliacus, vastus lateralis, intermedius and medialis; recturs femoris, sartorious, pectineus
LE: medial plantar nerve innervates:
abductor hallucis, lumbricale I, flexor digitorum brevis, flexor hallucis longis
LE: obturator nerve innervates:
adductor longus, gracilis, adductor brevis, obturator externus, and adductor magnus
LE: lateral plantar nerve innervates:
abductor digiti minimi, dorsal interossei, quadratus plantae, adductor hallucis, lumbricale II, III, IV, plantar interossei, flexor digiti minimi brevis
UE: dorsal scapular nerve innervates:
rhomboids, levator scapulae
UE: long thoracic nerve innervates:
serratus anterior
UE: nerve to subclavius innervates
subclavius
UE: suprascapular nerve innervates
infraspinatus, supraspinatus
UE: lateral pectoral nerve innervates
pect major, pect minor
UE: musculocutaneous nerve innervates
coracobrachialis, biceps brachii, brachialis
UE: lateral root of the median nerve innervates
flexor muscles in forearm, 5 muscles in hand
UE: medial pectoral nerve innervates:
pect major and minor
UE: ulnar nerve innervates
1 1/2 muscles of forearm and most small muscles of hand
UE: medial root of the median nerve innervates
flexor muscles in forearm, 5 muscles of hand
UE: upper subscapular nerve innervates
subscapularis
UE: thoracodorsal nerve innervates
latissimus dorsi
UE: lower subscapular nerve innervates
subscapularis, teres major
UE: axillary nerve innervates
deltoid, teres minor
UE: radial nerve innervates
brachioradialis, extensor muscles of forearm
AFFERENT NERVES
SENSORY
EFFERENT NERVES
MOTOR
Cranial Nerves
olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal
olfactory
smell
optic
sight
oculomotor
voluntary movement of eye
trochlear
voluntary motor movement of eye
trigeminal
touch, pain: skin of face, chewing
abducens
voluntary motor: muscle of eyeball, lateral
facial
taste: anterior tongue, voluntary motor: facial muscles. autonomic: lacrimal, submandibular, sublingual glands
vestibulocochlear (acoustic nerve)
hearing/balance: ear
glossopharyngeal
touch, pain: posterior tongue, taste: tongue. swallowing
vagus
touch, pain: pharynx, larynx, bronchi. taste: tongue, epiglottis.
accessory
voluntary motor: SCM and trapezius muscle
hypoglossal
voluntary motor: muscles of tongue
types of sensory testing
light touch, deep pain, superficial pain, vibration, proprioception, kinesthesia, temperature, stereognosis, graphesthesia, 2 point discrimination
light touch
light pressure with cotton ball
deep pain
squeeze forearm or calf muscle
superficial pain
pen cap, paper clip end, pin
vibration
tuning fork
proprioception
identify a static position of an extremity/part
kinesthesia
identify direction and extent of mvmt of a joint or body part
temperature
hot and cold test tubes
stereognosis
identify an object without sight
graphesthesia
draw a number or letter on skin with finger, identify without sight
2 pt discrimination
2 point caliper on skin, identify one or two points without sight
DTR: deep tendon reflexes
reflex is a motor response to a sensory stimulation that is used in an assessment to observe the integrity of the nervous system. DTRs elicit a muscle contraction when the muscle’s tendon is stimulated.
DTR grades
0=no response. 1+=diminished/depressed response. 2+=active normal response. 3+=brisk/exaggerated response. 4+=very brisk/hyperactive, abnormal response.
DTR normal responses:
biceps tendon: flexion/contraction of biceps. brachioradialis tendon: elbow flexion and/or forearm pronation. triceps tendon: elbow extension or contraction of triceps muscle. patellar tendon: knee extension. tibialis posterior tendon: PF/inversion of foot. achilles tendon: PF of foot.
PNS: peripheral nervous system
nervous system outside of brain and spinal cord. consists of motor, sensory, and autonomic neurons. neurons are located in cranial, spinal, and peripheral nerves. PNS consists of 12 pairs of cranial nerves, 31 prs of spinal nerves, and associated ganglia and sensory receptors. most peripheral nerves contain motor (efferent) and sensory (afferent) components.
A fibers
large, myelinated, high conduction rate. contained in alpha and gamma motor systems. sensory components in muscle spindles, golgi tendon organs, bare nerve endings, mechanoreceptors
B fibers
medium, myelinated, reasonably fast conduction rate. pre ganglionic fibers of ANS.
C fibers
small nerve fibers, poorly myelinated or unmyelinated. slow conduction rate. post ganglionic fibers of sympathetic system. exteroceptors for pain, temp, and touch.
types of nerve injury
mechanical (compression), crush and percussion (fracture, compartment syndrome), laceration, penetrating trauma (stab wound), stretch (traction injury), high velocity trauma (MVA), and cold (frostbite).
neurapraxia
mildest form of injury. conduction block usually due to myelin dysfunction. axonal continuity conserved. nerve conduction is preserved proximal and distal to lesion. nerve fibers are not damaged. recovery will occur within 4/6 weeks.
axonotmesis
a more severe grade of injury to a peripheral nerve. is reversible injury to damaged fibers. damage occurs to the axons with preservation to endoneurium. nerve can regenerate distal to the site of lesion by one millimeter per day.
neurotmesis
most severe grade of injury to a peripheral nerve. all components are damaged and irreversible. all motor and sensory loss is permanently impaired.
upper motor neuron disease
characterized by a lesion found in descending motor tracts within the cerebral motor cortex, internal capsule, brainstem or spinal cord. symptoms include weakness of involved muscles, hypertonicity, hyperreflexia, mild disuse atrophy, and abnormal reflexes. damaged tracts are in lateral white column of spinal cord.
lower motor neuron disease
characterized by a lesion that affects nerves or their axons at or below level of brainstem, usually within the “final common pathway.” ventral gray column of spinal cord may also be affected. symptoms include flaccidity or weakness of muscles, decreased tone, fasciculations, muscle atrophy, and decreased or absent reflexes.
upper motor neuron lesions
CP, hydrocephalus, CVA, birth injuries, MS, brain tumors.
lower motor neuron lesions
poliomyelitis, tumors involving spinal cord, trauma, infection, muscular dystrophy.
blood supply to brain
PCA: posterior cerebral artery, MCA: middle cerebral artery, and vertebrobasilar artery.
PCA
portion of midbrain, subthalamic nucleus, basal nucleus, thalamus, inferior temporal lobe, occipital and occipitoparietal cortices
MCA
most of outer cerebrum, basal ganglia, posterior and anterior internal capsule, putamen, pallidum, lentiform nucleus
vertebrobasila artery
medulla, cerebellum, pons, middle occipital cortex
CEREBRAL HEMISPHERE FUNCTION
…
frontal lobe
responsible for: voluntary motor function, advanced motor planning, initiation of action, cranial nerves 3, 4, 6, 9, 10, 12; emotion interpretation, personality, judgment, planning, motivation, bladder & bowel inhibition, broca’s motor speech center, appreciation of intonation, understanding gestures.
frontal lob impairments
contralateral weakness, contralateral head and eye paralysis, personality changes, antisocial behavior, ataxia, primitive reflexes, broca’s aphasia, delayed or poor initiation
parietal lobe
responsible for: processing perceptual and sensory info, body schema, contralateral pain, posture, touch, proprioception (to arm, trunk and leg), perform calculations, spatial awareness, sensory: speech comprehension, visual tract, taste perception
parietal lobe impairments
agraphia, finger agnosia, constructional apraxia, dressing apraxia, anosognosia, wernicke’s aphasia (receptive), homonymous visual deficits, impaired language comprehension, impairment in taste
temporal lobe
responsible for: auditory and limbic processing, appreciation of language, music and sound, memory, learning, affective mood centers (primitive behaviors), short term memory
temporal lobe impairments
auditory and hearing, impaired appreciation of music, memory deficits, learning deficits, wernicke’s aphasia, antisocial behaviors
occipital lobe
responsible for: primary processing area of visual info, visual tract, perception of vision
occipital lobe impairments
homonymous hemianopsia (only seeing half of one visual field), impaired extraocular muscle movement
cerebellum
responsible for: coordination of motor skills, postural tone, sensory/motor input for trunk and extremities, coordination of gait
cerebellum impairments
ataxia, discoordination of trunk and extremities, intention tremor, balance deficits, ipsilateral facial sensory loss, dysdiadochokinesia (inability to perform rapidly alternating movements)
hemisphere specialization/dominance
left: language, sequence and perform movements, understanding language, produce written and spoken language, analytical, controlled. right: nonverbal processing, processing information in a holistic manner, artistic abilities, general concept comprehension, hand-eye coordination, spatial relationships
balance
state of physical equilibrium needing input from these three systems: somatosensory, visual and vestibular.
somatosensory input
receptors located in joints, muscles, ligaments, and skin to provide proprioceptive info regarding length, tension, pressure, pain, joint position.
visual input
visual receptors allow for perceptual acuity regarding verticality, motion of objects and self, environmental orientation, postural sway, and movements of the head/neck. children rely heavily on this system for maintenance of balance.
vestibular input
provides CNS with feedback regarding position and movement of the head with relation to gravity.
Balance Reflexes: Vestibuloocular reflex (VOR):
allows for head/eye movement coordination. reflex supports gaze stabilization where eyes can move while head is fixed; visual tracking can also occur when both eyes and head are moving.
Balance Reflexes: Vestibulospinal reflex (VSR):
attempts to stabilize body and control movement. reflex assists with stability while head is moving as well as coordination of trunk during upright postures.
automatic postural strategies
automatic motor responses that are used to maintain center of gravity over base of support.
ankle strategy
first strategy to be elicited by a small range and slow velocity perturbation when feet are on the ground. muscles contract in a distal to proximal fashion to control postural sway from ankle joint
hip strategy
elicited by a greater force, challenge or perturbation thru pelvis and hips. hips will move in opposite direction from head in order to maintain balance. muscles contract in a proximal to distal fashion in order to counteract the loss of balance
suspensory strategy
used to lower the center of gravity during standing or ambulation in order to better control the COG. examples: knee flexion, crouching or squatting. often used when both mobility and stability are required during a task such as surfing.
stepping strategy
elicited thru unexpected challenges or perturbations during static standing or when the perturbation produces such a movement that the COG is beyond the BOS. LEs step and/or UE reach to regain a new BOS
vertigo
unbalance due to ear disease
nystagmus
abnormal eye mvmt that entails nonvolitional, rhythmic oscillation of eyes. spontaneous, peripheral, and central
vestibular rehabilitation
intervention that can be successful for pts with vestibular or balance disorders. utilizes compensation, adaptation, and plasticity to increase brain’s sensitivity, restore symmetry
goals for vestibular rehab:
improve balance and stability, increase strength and ROM, decrease falls, minimize dizziness
balance tests (types)
romberg, one legged stance test, tinetti, berg balance, get up and go test, timed get up and go test
pharmacological intervention for managing vestibular disorders
antihistamine treats vertigo, anticholinergic agents decrease conduction in vestibular-cerebellar pathways. benzodiazepine (valium) treats vertigo and emesis. phenothiazine (phenergan) treats emesis. monoaminergic (ephedrine) treats vertigo
COMMUNICATION DISORDERS
…
aphasia
acquired neuro impairment of processing for receptive and/or expressive language. result of brain injury, head trauma, CVA, tumor or infection.
fluent aphasia
lesion often in temporoparietal lobe of dominant hemisphere. word output is functional. empty speech or jargon. speech lacks any substance. uses of paraphasias (substitution of incorrect words)
wernicke’s aphasia
lesion found at posterior region of superior temporal gyrus. major fluent aphasia. also known as “receptive” aphasia. comprehension is impaired, but good articulation
broca’s aphasia
major non-fluent aphasia. also known as “expressive” aphasia. most common form. lesions in frontal lobe.
non-fluent aphasia
poor word output, increased effort for producing speech. poor articulation.
global aphasia
major non-fluent aphasia. lesion of frontal, temporal, and parietal lobes. comprehension (reading and auditory) is severely impaired.
dysarthria
motor disorder of speech that is caused by an upper motor neuron lesion that affects muscles that are used to articulate words and sounds. speech is often slurred.
CVA
cerebrovascular accident
completed stroke
cva that presents with total neuro deficits at onset.
stroke in evolution
cva usually caused by a thrombus that gradually progresses. deficits are not seen for one to two days after onset.
ischemic stroke
when there is a loss of perfusion to a portion of the brain within just seconds, there is a central area of irreversible infarction surrounded by an area of potential ischemia.
embolus (20% of ischemic CVAs)
associated with cardiovascular disease, an embolus may be a solid, liquid or gas, and con originate in any part of the body. travels thru bloodstream to the cerebral arteries causing occlusion of a blood vessel and a resultant infarct. middle cerebral artery is most commonly affected by an embolus from internal carotid arteries. often presents with a headache.
thrombus
artherosclerotic plaque develops in an artery and eventually occludes the artery or a branching artery causing an infarct. usually occurs during sleep or upon awakening, after a MI or post surgical procedure
hemorrhage (10-15% of CVAs)
abnormal bleeding in brain due to rupture in blood supply. due to disruption of oxygen to an area of brain and compression from accumulation of blood. hypertension is usually a precipitating factor causing rupture of an aneurysm or arteriovenous malformation. 50% of deaths from hemorrhagic stroke occur within first 48 hours.
TIA
transient ischemic attack
TIA
usually linked to an atherosclerotic thrombosis. temporary interruption of blood supply to an area. effects may be similar to a CVA, by symptoms resolve quickly. often occurs in the carotid and vertebrobasilar arteries, and may indicate future CVA.
CVA risk factors
hypertension, heart disease, DM, smoking, TIAs, obesity, high cholesterol, behaviors related to hypertension, physical inactivity, increased alcohol consumption
If CVA is in anterior cerebral artery:
impairments include LE involvement, loss of bowel/bladder control, loss of behavioral inhibition, mental changes, may see neglect, may see aphasia, apraxia and agraphia, perseveration
If CVA is in vertebral-basilar artery
impairments include loss of consciousness, hemi or tetraplegia, comatose or vegetative state, inability to speak, locked in syndrome, vertigo, nystagmus, dysphagia, dysarthria, syncope, ataxia
if CVA is in posterior cerebral artery
impairments include pain and temp sensory loss, contralateral hemiplegia, ataxia, athetosis or coreiform mvmt, quality of mvmt is impaired, thalamic pain syndrome, anomia, prosopagnosia with occipital infarct, hemiballismus, visual agnosia, homonymous hemianopsia, mild hemiparesis, memory impairment, dyschromatopsia, palinopsia, micropsia, macropsia, alexia, dyslexia, achromatopsia
if CVA is in middle cerebral artery (most common area)
impairments include wernicke’s aphasia, homonymous hemianopsia, apraxia, flat affect in rt hemisphere, impaired body schema
characteristics of a CVA in RIGHT hemisphere
weakness, paralysis of LEFT side, decreased attention span, left hemianopsia, decreased awareness and judgment, memory deficits, left inattention, decreased abstract reasoning, emotional lability, impulsive behaviors, decreased spatial orientation
characteristics of a CVA in LEFT hemisphere
weakness, paralysis of RIGHT side, increased frustration, decreased processing, possible aphasia, dysphagia, motor apraxia, decreased discrimination btwn left and right, right hemianopsia
characteristics of a brainstem CVA
unstable vital signs, decreased consciousness, ability to swallow, weakness and paralysis on both sides
characteristics of a cerebellum CVA
decreased balance, ataxia, decreased coordination, nausea, decreased ability for postural adjustment, nystagmus
synergy patterns
result when higher centers of the brain lose control and the uncontrolled or partially controlled stereotyped patterns of the middle and lower centers emerge.
flexor synergy pattern
seen when patient attempts to lift up their arm or reach for an object. characterized by great toe extension and flexion of the remaining toes secondary to spasticity.
NDT
neuromuscular developmental treatment: concept recognizes that interference of normal function of the brain caused by CNS dysfunction leads to a slowing down or cessation of motor development and the inhibition of righting reactions, equilibrium reactions, and automatic movements. patient should learn to control mvmt thru activities that promote normal mvmt patterns that integrate function.
NDT: facilitation
technique utilized to elicit voluntary muscular contraction.
NDT: inhibition
technique utilized to decrease excessive tone or movement.
NDT: key points of control
specific handling of designated areas of the body (shoulder, pelvis, hand, foot) will influence and facilitate posture, alignment and control.
NDT: placing
act of moving an extremity into a position that the patient must hold against gravity.
NDT: reflex inhibiting posture
designated static positions that Bobath found to inhibit abnormal tonal influences and reflexes.
Brunnstrom’s 7 stages of recovery
stage 1: no volitional mvmt initiated. stage 2: beginning of spasticity. stage 3: voluntary synergies. spasticity increases. stage 4: spasticity begins to DEcrease. stage 5: decrease in spasticity. stage 6: jt mvmts are performed with coordination. stage 7: normal motor function is restored
associated reaction
involuntary and automatic mvmt of a body part as a result of an intentional active or resistive mvmt in another body part.
homolateral synkinesis
flexion pattern of the involved UE facilitates flexion of the involved LE
limb synergies
group of muscles that produce a predictable pattern of mvmt in flexion or extension patterns
raimiste’s phenomenon
involved LE will abduct/adduct with applied resistance to the uninvolved LE in the same direction
souque’s phenomenon
raising the involved UE above 100 degrees with elbow extension with produce extension and abduction of the fingers
PNF
proprioceptive neuromuscular facilitation
PNF
approach is based on the premise that stronger parts of the body are utilized to stimulate and strengthen the weaker parts. development will follow normal sequence thru a component of motor learning. PNF places great emphasis on manual contacts and correct handling. movement patterns follow diagonals or spirals that each possess a flexion, extension, and rotary component and are directed toward or away from midline.
chopping (PNF):
combination of bilateral UE asymmetrical extensor patterns performed as a closed chain activity
developmental sequence (PNF):
progression of motor skill acquisition. stages of motor control include mobility, stability, controlled mobility, and skill.
mass mvmt patterns (PNF):
hip, knee, and ankle move into flexion or extension simultaneously
overflow (PNF):
muscle activation of an involved extremity due to intense action of an uninvolved muscle or group of muscles
levels of motor control
mobility, stability, controlled mobility, skill
agonist reversals
isotonic concentric contraction performed against resistance followed by alternating concentric and eccentric contractions with resistance. (controlled mobility, skill)
alternating isometrics
isometric contractions performed alternating from muscles on one side of joint to the other side w/o rest (stability)
contract-relax
technique used to increase ROM. as extremity reaches point of limitation the pt performs a maximal contraction of the antagonistic muscle group. therapist resists mvmt for 8-10 secs with relaxation following. technique is repeated until no further gains in ROM are noted during session (mobility)
hold-relax
isometric contraction used to increase ROM. contraction is facilitated for all muscle groups at the limiting point in the ROM. relaxation occurs and extremity moves thru the newly acquired range to the next point of limitation until no further increases in ROM occur. used for patients that present with pain usually. (mobility)
hold-relax active
technique to improve initiation of mvmt to muscle groups tested at 1/5 or less. (mobility)
joint distraction
proprioceptive component used to increase ROM around a joint. manual traction is provided slowly and usually in combo with mobilization techniques. (mobility)
normal timing
used to improve coordination of all components of a task. performed distal to proximal sequence. (skill)
repeated contractions
used to initiate mvmt and sustain a contraction through the ROM. therapist provides a quick stretch followed by isometric or isotonic contractions (mobility)
resisted progression
used to emphasize coordination of proximal components during gait. resistance is applied to an area such as the pelvis, hips, or extremity during the gait cycle in order to enhance coordination, strength or endurance (skill)
rhythmic initiation
used to assist initiating movement when hypertonia exists. mvmt progresses from passive to active assist, to slightly resistive. (mobility)
rhythmic rotation
passive technique used to decrease hypertonia by slowing rotating an extremity around the axis. relaxation of extremity will increase ROM. (mobility)
rhythmic stabilization
used to increase ROM and coordinate isometric contractions. requires isometric contractions of all muscles around a joint against progressive resistance. pt should relax and move into newly acquired range and repeat. (mobility, stability)
slow reversal
technique of slow and resisted concentric contractions of agonists and antagonists around a joint w/o rest btwn reversals. used to improve control of movement and posture. (stability, controlled mobility, skill)
slow reversal hold
using slow reversal with the addition of an isometric contraction that is performed at the end of each mvmt in order to gain stability. (stability, controlled mobility, skill)
compensation
ability to utilize alternate motor and sensory strategies due to an impairment that limits the normal completion of a task.
motor learning
ability to perform a mvmt as a result of internal processes that interact with the environment and produce a consistent strategy to generate the correct mvmt
plasticity
ability to modify or change at the synapse level either temporarily or permanently in order to perform a particular function
postural control
ability of the motor and sensory systems to stabilize position and control mvmt.
recovery
ability to utilize previous strategies to return to the same level of functioning
strategy
plan used to produce a specific result or outcome that will influence the structure or system
task oriented approach
to motor control: utilizes a systems theory of motor control that views the entire body as a mechanical system with many interacting subsystems that all work cooperatively in managing internal and environmental influences. (compensation, motor learning, plasticity, postural control, recovery and strategy are all keys to this approach)
Rood theory
says that all motor output was the result of both past and present sensory input. treatment is based on sensorimotor learning. takes into account the autonomic nervous system and emotional factors as well as motor ability. goal is to obtain homeostasis in motor output and to activate muscles and perform a task independently of a stimulus. examples: icing and brushing in order to elicit desired reflex motor responses.
sensory stimulation techniques (facilitation)
approximation, joint compression, icing, light touch, quick stretch, resistance, tapping, traction
sensory stimulation techniques (inhibition)
deep pressure, prolonged stretch, warmth, prolonged cold, carotid reflex
pharmacological interventions for CVA management
include thrombolytic agents, antiplatelet agents, cholesterol-lowering agents, antiarrhythmic agents, neuroprotective agents, antihypertensive agents
thrombolytic agents (heparin, activase, coumadin
produces anticoagulation effects, destroys thrombus or emboli
antiplatelet agents (aspirin, plavix, ascriptin)
reduces atherosclerotic events and decrease the risk for CVA
cholesterol-lowering agents (lipitor, zocor, pravachol)
decreases the triglycerides and low-density lipoproteins in the bloodstream
neuroprotective agents (N-methyl-D-aspartate: NMDA)
administered only within the acute stage of CVA (within 3 hrs)
antiarrhythmic agents: prevention of arrhythmias, ischemia and hypertension
sodium channel blockers: norpace, Xylocaine. beta-blockers: tenormin, lopressor, inderal. Refractory period alterations: cordarone, corvert. Calcium channel blockers: norvasc, cardizem, verapamil.
antihypertensive agents: assists to lower blood pressure; decreases tension within circulation system
diuretics: lasix, bumex, thiazide. beta-blockers: sectral, inderal, lopressor. calcium channel blockers: cardizem, calan. alpha-blockers: cardura, minipress
agnosia
inability to interpret information
agraphesthesia
inability to recognize symbols, letters or numbers traced on the skin
agraphia
inability to write due to a lesion within the brain
akinesia
inability to initiate mvmt; commonly seen with parkinson’s
aphasia
inability to communicate or comprehend due to damage to specific areas of brain
apraxia
inability to perform purposeful learned mvmts, although there is no sensory or motor impairment
astereognosis
inability to recognize objects by sense of touch
ataxia
inability to perform coordinated movements
athetosis
condition that presents with involuntary mvmts combined with instability of posture. peripheral mvmts occur without central stability
bradykinesia
mvmt that is very slow
chorea
mvmts that are sudden, random and involuntary
clonus
characteristic of an upper motor neuron lesion; involuntary alternating spasmodic contraction of a muscle precipitated by a quick stretch reflex
constructional apraxia
inability to reproduce geometric figures
decerebrate rigidity
characteristic of a corticospinal lesion at level of brainstem that results in extension of trunk and all extremities
decorticate rigidity
characteristic of a corticoapinal lesion at level of diencephalon where the trunk and LEs are positioned in extension, and the UEs are positioned in flexion
diplopia
double vision
dysarthria
slurred and impaired speech due to a motor deficit of the tongue or other muscles essential for speech.
dysdiadochokinesia
inability to perform rapidly alternating mvmts
dsymetria
inability to control the range of a mvmt and the force of muscular activity
dysphagia
inability to properly swallow
dystonia
closely related to athetosis; however there is larger axial muscle involvement rather than appendicular muscles
emotional lability
characteristic of a right hemisphere infarct where there is an inability to control emotions and outbursts of laughing or crying that are inconsistent with the situation
hemiballism
involuntary and violent mvmt of a large body part
hemiparesis
condition of weakness on one side of body
hemiplegia
condition of paralysis on one side of the body
homonymous hemianopsia
loss of right or left half of vision in both eyes
ideational apraxia
inability to formulate an initial motor plan and sequence tasks where the proprioceptive input necessary for mvmt is impaired
ideomotor apraxia
condition where a person plans a mvmt or task, but cannot volitionally perform it. automatic mvmt may occur, but a person cannot impose additional mvmt on command.
kinesthesia
ability to perceive the direction and extent of mvmt of a joint or body part
neglect
inability to interpret stimuli on the left side of the body due to a lesion of the rt frontal lob of brain
perseveration
state of repeatedly performing the same segment of a task or repeatedly saying the same word/phrase without purpose
proprioception
ability to perceive the static position of a joint or body part
rigidity
state of severe hypertonicity where a sustained muscle contraction does not allow for any mvmt at a specified joint
synergy
result of brain damage that presents with mass mvmt patterns that are primitive in nature and coupled with spasticity
SCI
spinal cord injury
complete lesion
lesion to SC where there is no preserved motor or sensory function below the level of lesion
incomplete lesion
lesion to the SC with incomplete damage to the cord. there may be scattered motor function, sensory function or both below the level of injury/lesion.
incomplete: anterior cord syndrome
results from compression and damage to the anterior part of SC or anterior spinal artery. usually cervical flexion is mechanism of injury. loss of motor function and pain and temp sense below lesion due to damage of the corticospinal and spinothalamic tracts
incomplete: brown-sequard’s syndrome
usually caused by a stab wound, which produces a hemisection of the sc. paralysis and loss of vibratory and position sense on same side as lesion due to damage to corticospinal tract and dorsal columns. loss of pain and temp sense on opposite side of lesion from damage to lateral spinothalamic tract. rare since most spinal cord lesions are atypical.
incomplete: cauda equina injuries
injury that occurs below L1 spinal level where long nerve roots transcend. mostly incomplete but rarely can be complete as well. considered a peripheral nerve injury. flaccidity, areflexia, impairment of bowel/bladder function. full recovery not typical due to distance needed for axonal regeneration.
incomplete: central cord syndrome
results from compression and damage to the central portion of sc. injury is usually cervical hyperextension that damages spinothalamic tract, corticospinal tract, and dorsal columns. UEs present with greater involvement than LEs, and greater motor deficits than sensory deficits.
incomplete: posterior cord syndrome
rare syndrome that is caused by compression of posterior spinal artery and is characterized by loss of pain perception, proprioception, 2 pt discrimination, and stereognosis. motor function is preserved.
autonomic dysreflexia
dangerious complication of sci. can occur in pts with lesions above T6. noxious stimuls below lesion level triggers autonomic nervous system, causing a sudden elevation in blood pressure. common causes include distended or full bladder, kink or blockage in catheter, bladder infections, pressure ulcers, tight clothing.
symptoms of autonomic dysreflexia
high bp, severe headache, blurred vision, stuffy nose, profuse sweating, goose bumps below level of lesion, and vasodilation (flushing) above level of injury.
treatment of autonomic dysreflexia
check catheter for blockage first. bowel should also be checked for impaction. pt should remain in a sitting position. lying a patient down is CONTRAindicated.
deep vein thrombosis (DVT)
formation of a blood clot that becomes dislodged and is termed an embolus. can become serious since the embolus may obstruct a selected artery. sci pts have a greater risk of developing a DVT due to the absence or decrease of activity in LEs.
symptoms of DVT
swelling of LEs, pain, sensitivity over area of clot, warmth
treatment of DVT
no active or passive mvmt performed to involved LE. bed rest and anticoagulant drug therapy are usually indicated
ectopic bone
(or heterotopic ossification): spontaneous formation of bone in the soft tissue. occurs adjacent to larger joints such as knees or hips.
symptoms of ectopic bone
edema, decreased ROM, increased temp of involved joint
treatment of ectopic bone
drug intervention usually involves diphosphates that inhibit ectopic bone formation.
orthostatic hypotension
occurs due to a loss of sympathetic control of vasoconstriction in combination with absent or severely reduced muscle tone. decrease in systolic blood pressure greater than 20 mm HG after moving from a supine position to a sitting position is typically indicative of orthostatic hypotension.
symptoms of orthostatic hypotension
complaints of dizziness, light-headedness, nausea, blacking out when going from a horizontal to a vertical position
treatment of ortho hypo
monitoring of vital signs, use of elastic stockings, ace wraps to LEs, abdominal binders. gradual progression to a vertical position using a tilt table is often used. drug intervention is sometimes used to increase blood pressure.
pressure ulcers
caused by sustained pressure, friction, and or shearing to a surface. require immediate medical attention and can delay PT/rehab
symptoms of pressure ulcers:
reddened area that persists; an open area
treatment of pressure ulcers:
prevention is important. change positions frequently, maintain proper skin care, sit on appropriate cushions, consistent weight shifting, maintenance of proper nutrition and hydration.
spasticity
can sometimes be useful for a sci patient.
spasticity treatment for sci
positioning, aquatic therapy, weight bearing, estim, ROM, resting splints and inhibitive casting
aggressive spasticity treatment for sci
phenol blocks, rhizotomies, myelotomies, other surgical interventions
myelotomy
surgical procedure that severs certain tracts within the spinal cord in order to decrease spasticity and improve function
neurectomy
surgical removal of a segment of a nerve in order to decrease spasticity and improve function
neurogenic bladder
bladder empties reflexively for a pt with an injury above level of S2. sacral reflex arc remains intact.
neurologic level
lowest segment of the sc with intact strength and sensation.
nonreflexive bladder
bladder is flaccid as a result of a cauda equina or conus medullaris lesion. sacral reflex arc is damaged
rhizotomy
surgical resection of sensory component of a spinal nerve in order to decrease spasticity and improve function
sacral sparing
incomplete lesion where some of the innermost tracts remain innervated. characteristics include sensation of the saddle area, mvmt of toe flexors, and rectal sphincter contraction
spinal shock
physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. spinal shock presents with total flaccid paralysis and loss of all reflexes below the level of injury.
tenotomy
surgical release of a tendon in order to decrease spasticity and improve function
zone of preservation
poor or trace motor or sensory function for up to 3 levels below the neurologic level of injury
tbi: open injury
injury of direct penetration thru skull to brain. ex: gsw, knife or sharp object penetration, skull fragments, direct trauma
tbi: closed injury
injury to brain w/o penetration thru skull. ex: concussion, contusion (bruise), hematoma (solid swelling of clotted blood in tissues), injury to extracranial blood vessels, hypoxia, drug overdose, near drowning, acceleration/deceleration injuries
tbi: primary injury
initial injury to brain sustained by impact. ex: skull penetration, skull fractures, and contusions to gray and white matter
primary injury: coup lesion
direct lesion of brain under point of impact. local brain damage is sustained
primary injury: contrecoup lesion
injury that results on opposite side of brain. lesion is due to rebound effect of brain after impact.
secondary injury
brain damage that occurs as a response to the initial injury. ex: hematoma, hypoxia, ischemia, increased intracranial pressure, and post-traumatic epilepsy
secondary injury: epidural hematoma
hemorrhage that forms btwn skull and dura mater
secondary injury: subdural hematoma
hemorrhage that forms due to venous rupture btwn dura and arachnoid
coma
state of unconsciousness and a level of unresponsiveness to all internal and external stimuli
stupor
state of general unresponsiveness with arousal occurring from repeated stimuli
obtundity
state of consciousness that is characterized by a state of sleep, reduced alertness to arousal, and delayed responses to stimuli
delirium
state of consciousness that is characterized by disorientation, confusion, agitation, and loudness
clouding of consciousness
state of consciousness that is characterized by quiet behavior, confusion, poor attention, and delayed responses
consciousness
state of alertness, awareness, orientation and memory
acute diagnostic management
glasgow coma scale, CAT scan, x-ray, MRI, cerebral angiography, evoked potential/electroencephalogram, positron emission tomography, ventriculography, radioisotope imaging
glasgow coma scale
neuro assessment tool used initially after injury to determine arousal and cerebral cortex function. total score of 8 or less correlates to coma in 90% of patients. scores of 9-12 indicate moderate brain injuries and scores from 13-15 indicate mild brain injuries.
rancho los amigos (levels of cognitive functioning
neuro assessment tool. 1-8 levels. 1=no response. 2=generalized response. 3=localized response. 4=confused-agitated (heightened state of activity. behavior is bizarre.) 5=confused-inappropriate (pt is able to respond to simple commands fairly consistently, but more complex task responses are non-purposeful, random or fragmented.) 6=confused-appropriate (pt shows goal oriented behavior, but is dependent on external input or direction). 7=automatic-appropriate: pt appears appropriate and oriented within the hospital and home setting but frequently robot-like. 8=purposeful-appropriate (pt is able to recall and integrate past and recent events and is aware and responsive to environment.
anterograde memory impairment
inability to create new memory. usually last to recover after a comatose state.
post-traumatic memory impairment
time btwn injury and when patient is able to recall recent events. pt does not recall injury or events up until this point of recovery.
retrograde amnesia
inability to remember events prior to the injury. retrograde amnesia may progressively decrease with recovery
pharmacological interventions for tbi management
diuretic agents to decrease volume of fluid in brain and pressure (mannitol, glycerol) anticonvulsant agents to prevent early seizures in head injury (dilantin, tegretol, klonopin) calcium channel blocker agents to improve outcome for traumatic subarachnoid hemorrhage (nimotop), antidepressant agents to reduce aggressive or disruptive behavior (elavil, prozac) electrolytes because adequate stores are needed during acute phase of head injury (magnesium sulfate) selective serotonin reuptake inhibitor agents may benefit patients with head injury and emotional inhibition or impairment (zoloft, paxil)
cardiac reflexes
quick acting nervous system mechanisms that influence heart rate when triggered.
baroreceptor reflex
produced by a group of mechanoreceptors that are found w/in walls of the heart. the reflex is activated when pressure rises w/in the large arteries above 60 mm Hg. peak in activity at approx 180 mm Hg. results in vasodilation secondary to inhibition of the vasomotor centers w/in the medulla as well as a decrease in heart rate and strength of contraction secondary to vagal stimulation
bainbridge reflex
occurs when mechanoreceptors embedded within the right atrial myocardium respond to an increase in pressure and stretch (distention of the right atrium). stimulates the vasomotor centers of the medulla and results in increased sympathetic input and heart rate. reflex can also influence a decrease in heart rate when heart is beating too fast.
chemoreceptor reflex
responds to need for increased depth and rate of ventilation. chemoreceptors are located on the carotid and aortic bodies and detect lack of oxygen, responding to an increase in arterial CO2 levels.
Heart sounds: S1
lub: mitral and tricupsid valves closing at beginning of systole
Heart sounds: S2
dub: aortic and pulmonary valves closing at onset of diastole
Heart sounds: S3
ventricular gallop: abnormal in older adults: noncompliant left ventricle. may be associated with CHF
Heart sounds: S4
vibration of ventricular wall with ventricular filling and atrial contraction; may be associated with hypertension, stenosis, hypertensive heart disease or myocardial infarction
cardiac output
amount of blood pumped out of heart through the aorta each minute. males: 5.6L/min. females: 10-20% less. CO=stroke volume X heart rate
venous return
amount of blood comes from the veins to the right atrium each minute
stroke volume
amount of blood ejected from ventricles with each contraction. factors that can influence stroke volume include preload (influenced by end-diastolic volume), afterload, and contractility
cardiac index
amount of blood pumped out of heart per minute per sq meter of body mass. normal ranges btwn 2.5 to 4.2 L/min/meter2
blood volume
usually 7-8% of body weight. blood is pumped thru body at 30 cm/sec w/total circulation time of 20 seconds.
Reveresed
(synarthroses) minimal movement. ex: sutures, syndesmosis, gomphosis
fibrous joints
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(amphiarthroses) has cartilage to connect one bone to another. slightly moveable joints. ex: syndchondrosis, symphysis
cartilaginous joints
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(diarthroses) provide free mvmt btwn bones they join. have five characteristics: joint cavity, articular cartilage, synovial membrane and fluid, and fibrous capsule. ex: uniaxial joint (elbow), biaxial (condyloid: finger, saddle: thumb), multi-axial (plane: carpal jts, ball & socket: hip)
synovial joints
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sternoclavicular, acromioclavicular, glenhumeral, scapulothoracic articulation
shoulder complex articulations
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hinge joint, reinforced by ulnar collateral and radial collateral ligaments
elbow
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radiocarpal and midcarpal joints. mcp joints, prox and distal interphalangeal joints, and cmc joints
wrist and hand
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ball and socket joint. stability provided at joint by: acetabulum, iliofemoral ligament, pubofemoral ligament, and ischiofemoral ligament
hip
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hinge joint. stability by these ligaments: anterior cruciate, posterior cruciate, medial collateral, lateral collateral, ad deep medial capsular
knee
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hinge joint formed by articulation of tibia and fibula w/talus. medial ligaments: deltoid. lateral ligaments: anterior tibiofibular, anterior talofibular, calcaneofibular, lateral talocalcaneal, and posterior talofibular
ankle
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?
joint receptors
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divides body into anterior and posterior. motions are abduction and adduction, occur around an anterior-posterior axis.
frontal plane
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divides body into right and left sections. flexion and extension occur around a medial=lateral axis.
sagittal plane
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divides body into upper and lower sections. rotation occurs around vertical axis.
transverse plane
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very few class 1 levers in body. one example is triceps force on olectranon with an external counter force pushing on forearm. (seesaw). axis of rotation is btwn effort (force) and resistance (load).
class 1 lever
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resistance (load is btwn axis of rotation and effort (force). length of effort arm is always longer than resistance arm. most instances, gravity is effort and muscle activity is resistance. ex: wheelbarrow
class 2 lever
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effort (force) btwn axis of rotation and resistance (load). shoulder abduction with weight at wrist is a class 3 lever example. most common type of lever in body.
class 3 lever
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energy system producing ATP during high intensity, short duration exercise. Phosphocreatine decomposes and releases large amount of energy used to construct ATP. provides energy for muscle contraction for up to 15 seconds.
ATP-PC system
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major supplier of ATP during high intensity, short duration activities. 50% slower than ATP-PC system and can provide a person with 30-40 secs of muscle contraction
anaerobic clycolysis
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used predominantly during low intensity, long duration exercises. yields by far the most atp, but requires chemical reactions.
aerobic metabolism
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Aerobic, Red, Tonic, Slow twitch, Slow-oxidative: low fatigability, high capillary density, high myoglobin content, smaller fibers, extensive blood supply, large amt of mitochondria (ex: marathon, swimming)
Type 1 Muscle Fibers
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Anaerobic, White, Phasic, Fast twitch, Fast-glycolytic: high fatigability, low capillary density, low myoglobin content, larger fibers, less blood supply, fewer mitochondria (ex: high jump, sprinting)
Type 2 Muscle Fibers
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throughout belly of muscle. send info to nervous system about muscle LENGTH and or RATE of change of LENGTH. important in control of posture and involuntary mvmts.
muscle receptors: muscle spindle
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sensory receptors through which muscle tendons pass immediately beyond attachment to muscle fibers. very sensitive to TENSION when produced from an active muscle contraction. average of 10-15 muscle fibers are connected in series with each golgi tendon organ. stimulated through the tension produced by muscle fibers.
golgi tendon organ
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when muscle shortens while developing tension
concentric contraction
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occurs when muscle lengthens while developing tension
eccentric contraction
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occurs when tension develops but no change in length of muscle
isometric contraction
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occurs when muscle shortens or lengthens while resisting a constant load
isotonic
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occurs when tension developed by muscle is maximal over full range of motion while shortening or lengthening at a constant speed.
isokinetic contraction
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involve distal segment, usually hand or foot, moving freely in space. example: kicking a ball with LE
open-chain activity
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involve body moving over a fixed distal segment. example: squat lift
closed-chain activity
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method of calculating density of body by immersing in water and measuring amt of water that becomes displaced.
densitometry: hydrostatic weighing
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method of calculating body density utilizing amt of air displacement during testing within a closed chamber.
densitometry: plethysmography
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determines overall % of body fat thru msrmt of 9 standardized sites.
anthropometry: skinfold msrmt
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type of resistance that is felt when passively moving a joint thru end range of motion.
end feel
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(stretch) ex: ankle DF, finger extension, hip medial rotation, forearm supination
firm end feel
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(bone to bone) ex: elbow extension
hard end feel
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(soft tissue approximation) ex: elbow flexion, knee flexion
soft end feel
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cannot reach end feel due to PAIN, ex: joint inflammation, fracture or bursitis
abnormal end feel: empty
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ex: increased tone, tightening of capsule, ligament shortening
abnormal end feel: firm
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ex: fracture, OA, osteophyte formation
abnormal end feel: hard
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ex: edema, synovitis, ligament instability/tear
abnormal end feel: soft
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no muscle contraction felt
MMT 0/5
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no movement, but can feel muscle contraction
5-Jan
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does not complete ROM in gravity eliminated position
2-/5
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completes ROM with gravity eliminated
5-Feb
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able to initiate mvmt against gravity
2+/5
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does not complete ROM against gravity, but completes more than half the range
3-/5
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completes ROM against gravity w/o manual resistance
5-Mar
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completes ROM against gravity with only minimal resistance
3+/5
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completes ROM against gravity with min/mod resistance
4-/5
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completes ROM against gravity with mod resistance
5-Apr
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completes ROM against gravity with mod/max resistance
4+/5
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completes ROM against gravity with max resistance
5-May
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Heel strike: instant heel touches ground to begin stance phase
Gait: Standard - Stance Phase (60% of gait cycle)
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point in which entire foot makes contact with ground and should occur directly after heel strike
standard - foot flat
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point during stance phase when entire body weight is over the stance limb
standard - midstance
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point in which heel of the stance limb leaves ground
standard - heel off
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point in which only toe of stance limb remains on ground
standard - toe off
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acceleration: begins when toe off is complete and reference limb swings until positioned directly under body
standard - swing phase (40% of gait cycle)
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point when swing limb is directly under body
standard - midswing
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begins directly after midswing as swing limb begins to extend and ends just prior to heel strike
standard - deceleration
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initial contact, loading response, midstance, terminal stance, pre-swing; initial swing, midswing, and terminal swing
rancho los amigos terminology
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hip flexion: 0-30, hip extension: 0-15, knee flexion: 0-60, knee extension: 0, ankle DF: 0-10, ankle PF: 0-20
ROM requirements for normal gait
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activity just after heel strike. eccentric lowering of foot into PF.
Gait muscles: tibialis anterior
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activity during late stance phase. concentric raising of heel during toe off.
gait muscles: gastroc/soleus
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single support during early stance phase, and just before toe off to initiate swing phase.
gait muscles: quads
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activity during late swing phase. decelerating unsupported limb.
gait muscles: hams
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distance msrd btwn left and right foot during progression of gait. average BOS is 2-4 inches
base of support
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of steps an individual will walk over a period of time. average value for an adult is 110-120 steps per minute
cadence
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refers to the two times during a gait cycle where both feet are on the ground. does not exist when running
double support phase
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sequence of motions that occur from one initial contact of the heel to the next initial contact of the same heel.
gait cycle
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occurs when only one foot is on the ground and occurs 2ce during a single gait cycle
single support phase
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distance measured btwn right heel strike and left heel strike. average step length for adult is 13-16 inches
step length
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distance measured btwn right heel strike and the following right heel strike. average stride length for an adult is 26-32 inches.
stride
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involved step length is decreased in order to avoid weight bearing due to pain
antalgic gait
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gait characterized by staggering and unsteadiness, wide BOS and movements are exaggerated.
ataxic gait
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staggering gait
cerebellar gait
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circular motion to advance leg during swing phase
circumduction
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alternate steps are of a different length or different rate
double step
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gait pattern with high steps, excessive use of gastrocs
equine
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patient walks on toes as though pushed. starts slowly, increases and may continue until patient grabs an object in order to stop
festinating
Reveresed
abducts paralyzed limb, swings it around and brings forward so that foot comes to ground in front of them
hemiplegic
Reveresed
increased forward flexion of trunk and knees, shuffling with quick and small steps.
parkinsonian
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legs cross midline upon advancement
scissor gait pattern
Reveresed
stiff mvmt, toes catch and drag, legs held together, hip and knee joints slightly flexed
spastic
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gait pattern in which feet and toes are lifted thru hip and knee flexion to excessive heights; usually secondary to DF weakness.
steppage
Reveresed
high stepping ataxic gait pattern where feet slap ground
tabetic
Reveresed
glute medius weakness; excessive lateral trunk flexion and weight shifting over stance leg
trendelenburg
Reveresed
swing leg advances by compensating thru combination of elevation of pelvis and PF of stance leg
vaulting
Reveresed
muscle contraction that is less than optimal due to an extremely lengthened, or extremely shortened position of the muscle.
muscle insufficiency
Reveresed
when a 2 joint muscle contracts (shortens) across both joints simultaneously
active insufficiency
Reveresed
when a 2 joint muscle is lengthened over both joints simultaneously
passive insufficiency
Reveresed
measures strength through use of a load cell or spring loaded gauge. (ex: grip strength-pounds)
dynamometer
Reveresed
eval procedure where a patient is asked to apply a force against the dynamometer.
dynamometry: make test
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eval procedure where patient is asked to hold a contraction against pressure that is applied in opposite direction to contraction.
dynamometry: break test:
Reveresed
passive movement technique designed to improve joint function
joint mobilization
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restricted joint mobility, restricted accessory motion, desire neuro effects
indications for joint mobs
Reveresed
active disease, infection, advanced osteoporosis, articular hypermobility, fracture, acute inflammation, muscle guarding, muscle guarding, joint replacement
contraindications for joint mobs
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small movement performed at beginning of range
grade I
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large amplitude movement performed within the range, but not reaching limit of range and not returning to beginning of range
grade II
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large amplitude movement performed to limit of range
grade III
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small amplitude movement performed at limit of range
grade IV
Reveresed
condition found in a number of disorders characterized by inflammation, degeneration or metabolic derangement of connective tissue, soreness, joint pain and stiffness of muscles. different conditions present with rheumatism. goals are to alleviate pain, decrease inflammation, maintain strength and functional mobility
rheumatism
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chronic disease that primarily involves weight bearing joints. causes a degeneration of articular cartilage. risk factors include trauma, repetitive microtrauma, and obesity. cartilage becomes soft and damaged, bone thickens.
osteoarthritis
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systemic autoimmune disorder of unknown etiology. presents with a chronic inflammatory reaction in synovial tissues of a joint that results in erosion of cartilage and supporting structures within the capsule.
RA
Reveresed
portion of bone becomes fragmented at site of tendon attachment from a traumatic and sudden stretch of tendon
avulsion fracture
Reveresed
break in a bone where skin over site remains intact
closed fracture
Reveresed
bone that breaks into fragments at the site of injury
comminuted fracture
Reveresed
break in a bone that protrudes thru skin
compound fracture
Reveresed
break on one side of a bone that does not damage periosteum on opposite side. often seen in children.
greenstick fracture
Reveresed
break in a bone that has failed to unite and heal after 9-12 months
nonunion fracture
Reveresed
break in a bone due to repeated forces to a particular portion of the bone
stress fracture
Reveresed
break in a bone shaped as an S due to torsion and twisting
spiral fracture
Reveresed
condition caused by acute or chronic inflammation of bursae. pain and swelling limits range.
bursitis
Reveresed
sudden blow to part of body that can result in mild to severe damage to superficial and deep structures. ROM, ice, compression are treatments
contusion
Reveresed
increased volume of fluid in soft tissue outside of a joint capsule
edema
Reveresed
increased volume of fluid within a joint capsule
effusion
Reveresed
knees touch while standing with feet separated. will increase compression of lateral condyle and increase stress to medial structures. also called knock-knee.
genu valgum
Reveresed
bowing of knees. will increase compression of medial tibial condyle and increase stress to lateral structures. also called bowleg.
genu varum
Reveresed
excessive curvature of spine in posterior direction usually in thoracic spine.
kyphosis
Reveresed
excessive curvature of spine in anterior direction usually in cervical and lumbar spine.
lordosis
Reveresed
condition of heterotopic bone formation that occurs 3 to 4 wks after a contusion or trauma within the soft tissue
myositis ossificans
Reveresed
thinning of bone matrix with eventual bone loss and increased risk for fracture. usually found in postmenopausal women
osteoporosis
Reveresed
degree of angle when measureing from midpatella to ASIS and tibial tubercle. normal q angle is 13 degrees for man and 18 degrees for a woman.
q angle
Reveresed
lateral curvature of spine.
scoliosis
Reveresed
true separation of humerus from glenoid fossa
shoulder dislocation
Reveresed
disruption in stability of acromioclavicular joint
shoulder separation
Reveresed
acute injury of ligament. grade I: mild pain and swelling, little or no tear of ligament. grade II: mod pain and swelling, minimal instability of joint, min to mod tearing of ligament resulting in decreased ROM. grade III: severe pain and swelling, substantial joint instability, total tear of ligament, substantial decrease in ROM
sprain
Reveresed
acute injury of tendon, muscle. grade I: localized pain, min swelling and tenderness. grade II: localized pain, mod swelling, tenderness and impaired motor function. grade III: palpable defect of muscle, severe pain and poor motor function
strain
Reveresed
acute or chronic inflammation of a tendon.
tendonitis
Reveresed
malalignment of femoral head with acetabulum. develops during last trimester in utero. asymmetrical hip abdution with tightness and apparent femoral shortening of involved side. testing includes ortolani test, barlow maneuver, and u/s. treatment initially attempts to reposition femoral head within the acetabulum thru constant use of a harness, brace, splint or traction. PT may be indicated after cast removal for stretching, strengthening, and caregiver education.
(start of peds) congenital hip dysplasia
Reveresed
malformation that occurs in utero secondary to impaired developmental course. classified longitudinal or transverse. causative factor is an abnormality present at conception when a bone lacks potential to form. primary characteristic is a missing long bone suce as the radius. treatment may focus on symmetrical mvmts, strengthening, ROM, weight bearing and prosthetic training.
congenital limb deficiencies
Reveresed
characterized by a unilateral contracture of the SCM muscle. causative factors include malposition in utero, breech position and birth trauma. usually dx’d within first three weeks of life. lateral flexion to same side as contracture, rotation toward opposite side. treatment conservative for the first year with emphasis on stretching, active ROM, position and caregiver education. possible surgery.
congenital torticollis
Reveresed
degeneration of femoral head due to avascular necrosis. disease is self limiting and has 4 phases: condensation, fragmentation, re-ossification and remodeling. presents with pain, decreased ROM, antalgic gait, positive Trendelenburg sign. primary treatment focus is to relieve pain and maintain femoral head in proper psition.
legg-calve-perthes disease
Reveresed
also known as traction apophysis that results from repetitive traction on the tibial tuberosity apophysis. caused by repeated tension to the patella tendon over the tibial tuberosity in young athletes which results in a small avulsion of the tuberosity and swelling. self limiting condition includes point tenderness over patella tendon at insertion on tibial tubercle, antalgic gait and pain with increasing activity. treatment is conservative with focus on education, icing, and eliminating placing strain on the patella tendon.
osgood-schlatter disease
Reveresed
connective tissue disorder that affects formation of collagen during bone development. 4 classifications of osteogenesis imperfecta vary in levels of severity. caused by genetic inheritance with type I and IV considered autosomal dominant traits, and types II and III considered autosomal recessive traits. characteristics: brittle bones, weakness, impaired respiratory function. treatment begins at birth with education on proper handling and facilitation of movement.
osteogenesis imperfecta
Reveresed
lateral curvature of spine that can be classified as infantile, juvenile, adolescent or adult. structural curve cannot be corrected with active or passive mvmt and there is rotation of vertebrae towards the convexity of the curve. results in a rib hump over thoracic region. primary causative factor for a non structural curve is a leg length discrepancy. treatment is based on type and severity, generally curves that are less than 25 degrees require monitoring, btwn 25 and 40 degrees are treated with orthotic management, and beyond 40 degrees require surgery.
scoliosis
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deformity of ankle/foot known as clubfoot.
talipes equinovarus
Reveresed
most common chronic rheumatic disease in children and presents with inflammation of joints and connective tissues. systemic juvenile RA occurs in 10-20% of children with JRA and presents with acute onset and other symptoms. polyarticular JRA accounts for 30-40% of children with JRA and presents with high femal incidence, RF+ majority and arthritis in more than 5 joints. oligoarticular (pauciarticular) JRA accounts for 40-60% of children with JRA and affects less than 5 joints. treatment includes medication to relieve inflammation and pain and PT.
juvenile rhematoid arthritis
Reveresed
semirigid or rigid insert worn inside a shoe that corrects foot alignment and improves function.
Foot orthotics
Reveresed
primary purpose is to assist with dorsiflexion and prevent foot drop, can also influence knee control. commonly described for patients with peripheral neuropathy, nerve lesions or hemiplegia
AFO
Reveresed
provide support and stability to knee and ankle. allow for a lock mechanism at the knee that provides stability. ankle is also held at proper alignment.
KAFO
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designed specifically for persons with paraplegia. allows a person to stand with a posterior lean of trunk.
craig-scott KAFO
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indicated for patients with hip, foot, knee, and ankle weakness. can control rotation at hip and abduction/adduction. heavy and restricts patients to a swing to or swing thru gait pattern.
HKAFO
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incorporates a cable system to assist with advancement of lower extremities during gait. when patient shifts weight onto a selected lower extremity, the cable system advances the opposite LE.
reciprocating gait orthosis (RGO)
Reveresed
standing frame designed to allow a patient to sit when necessary. primarily used in peds.
parapodium
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constructed of fabric to provide abdominal compression and support.
corset
Reveresed
invasive cervical thoracic orthosis that provides full restriction of all cervical motion. commonly used with cervical spinal cord injuries to prevent further damage or dislocation.
halo vest orthosis
Reveresed
designed to promote realignment of spine due to scoliotic curvature.
milwaukee orthosis
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thoracolumbosacral orthosis that limits trunk flexion and extension through a 3 point control design.
taylor brace
Reveresed
utilized to prevent all trunk motions and is commonly utilized as a means of post surgical stabilization.
thoracolumbosaral orthosis (TLSO)
Reveresed
hypertension, aging, diabetes, infection, poor nutrition, cigarette smoking
factors that influence vascular disease
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vascular disease (atherosclerosis, arteriosclerosis), venous insufficiency, buerger’s disease, diabetes. malignancy/tumor (osteosarcoma), congenital deformities, infection, and trauma
risk factors for amputation
Reveresed
hemicorporectomy (surgical removal of pelvis and both LEs), hemipelvectomy (surgical removal of one half of the pelvis and LE), hip disarticulation (surgical removal of lower extremity from pelvis), transfemoral (surgical removal of LE above knee joint) knee disarticulation: thru knee joint, transtibial: below knee joint, syme’s foot at ankle joint with removal of malleoli, chopart’s: disarticulation at midtarsal joint, transmetatarsal: midsection of metatarsals
types of LE amputations
Reveresed
length of residual limb with regard to leverage and energy expenditure, no ability to weight bear thru the end of the residual limb, susceptible to hip flexion contracture, adaptation required for balance, weight of prosthesis, and energy expenditure
prosthetic training for transfemoral amputation
Reveresed
loss of ankle and foot functions, residual limb does not allow for weight bearing at its end, WB in prosthesis should be distributed over the total residual limb, patella tendon should be the area of primary weight bearing, adaptations required for balance, and susceptible to knee flexion contracture.
prosthetic training for transtibial amputation
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neuroma: bundle of nerve endings that group together an d produce pain due to scar tissue. phantom limb: refers to a painless sensation where patient feels that limb is still present. phantom pain: refers to patient’s perception of some form of painful stimuli.
possible complications with amputations
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elastic wrap should not have wrinkles, diagonal and angular patterns should be used and should not be wrapped in circular patterns, provide pressure distally to enhance shaping, anchor wrap above knee for transtibial amputations, anchor wrap around pelvis for transfemoral amputations, promote full knee extension for transtibial amputations, promote full hip extension for transfemoral amputations. secure wrap with tape, do not use clips, use 3-4 inch wrap for transtibial and 6 inch wrap for transfemoral, rewrap frequently to maintain proper pressure.
wrapping guidelines for amputees
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socket, suspension, knee, shank, foot
components of a prosthesis
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causes: prosthesis too short, improperly shaped lateral wall, high medial wall, prosthesis aligned in abduction, poor balance, abduction contracture, improper training, short residual limb, weak hip abductors on prosthetic side, hypersensitive and painful residual limb
gait deviations of amputee: lateral bending
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causes: prosthesis may be too long, high medial wall, poorly shaped lateral wall, prosthesis position in abduction, inadequate suspension, abduction contracture, improper training, adductor roll, weak HF and adductors, pain over lateral residual limb
gait deviations of amputee: abducted gait
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causes: prosthesis may be too long, too much friction in knee, socket too small, excessive PF of prosthetic foot, abduction contracture, improper training, weak HF, inability to initiate prosthetic knee flexion
gait deviations of amputee: circumducted gait
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socket set forward in relation to foot, foot set in excessive DF, stiff heel, prosthesis too long, knee flexion contracture, hip flexion contracture, poor balance, decrease in quad strength
gait deviations of amputee: excessive knee flexion during stance
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causes: prosthesis may be too long, inadequate socket suspension, excessive alignment stability, foot in excess PF, residual limb discomfort, improper training, short residual limb
gait deviations of amputee: vaulting
Reveresed
causes: excessive toe-out built in, loose fitting socket, inadequate suspension, rigid SACH heel cushion, poor muscle control, weak medial rotators, short residual limb
gait deviations of amputee: rotation of forefoot at heel strike
Reveresed
causes: socket too big, poor suspension, knee instability, hip flexion contracture, weak hip extensors
gait deviations of amputee: forward trunk flexion
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causes: excessive rotation of the knee, tight socket fit, valgus in prosthetic knee, improper alignment of toe break, improper training, weak hip rotators, knee instability
gait deviations of amputee: medial or lateral whip
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…
Start of Neuro
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Brain & Spinal Cord
CNS
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cranial nerves and their ganglia, spinal nerves and their glania and plexuses, efferent and afferent somatic nerves outside the CNS, ANS (autonomic nervous system) including sympathetic (fight or flight) and parasympathetic (activated during time of rest)
PNS (Peripheral)
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Parts include brainstem, cerebellum, diencephalon, cerebral hemispheres, fissures, sulci, meninges, ventricular system and dural spaces
Brain (encephalon)
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midbrain, pons, medulla oblongata
brainstem
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hypothalamus, infundibulum, optic chiasm
diencephalon
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cortex, white matter, basal nuclei. 2 hemispheres: deep white matter, basal ganglia, and lateral ventricles
cerebral hemispheres
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interhemispheric fissure: separates the two cerebral hemispheres. Sylvian or lateral fissure: (anterior portion) separates the temporal from frontal lobes; (posterior portion): separates temporal from parietal lobes
fissures
Reveresed
central sulcus: separates frontal and parietal lobes laterally. parietal-occipital sulcus: separates the parietal and occipital lobes medially. calcarine sulcus: separates the occipital lobe into superior and inferior halves
sulci
Reveresed
term to describe the three layers of connective tissue covering brain and spinal cord
meninges
Reveresed
outermost meninge, has 4 folds, lines periosteum of skull.
meninges: dura mater
Reveresed
middle meninge, surrounds brain in a loose manner
meninges: arachnoid
Reveresed
innermost meninge, covers contours of brain, forms choroid plexus in the ventricular system
meninges: pia mater
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designed to protect and nourish brain. comprised for 4 ventricles and multiple foramen that allow passages of CSF. CSF acts as a cushion around brain and spinal cord, and is produced by the choroid plexus of each ventricle.
ventricular system
Reveresed
space occupied between the skull and outer dura mater
dural spaces: epidural space
Reveresed
space occupied btwn the dura and arachnoid meninges
dural spaces: subdural space
Reveresed
space occupied btwn the arachnoid and pia mater that contains CSF and the circulatory system for the cortex
dural spaces: subarachnoid space
Reveresed
…
ascending and descending tracts
Reveresed
pyramidal motor tract responsible for ipsilateral voluntary mvmt
corticospinal tract (anterior)
Reveresed
pyramidal motor tract responsible or contralateral voluntary fine mvmt
corticospinal tract (lateral)
Reveresed
sensory tract for trunk and LE proprioception, 2 pt discrimination, vibration and graphesthesia
fasciculus gracilis
Reveresed
sensory tract for trunk, neck and UE proprioception, vibration, 2 pt discrimination, graphesthesia
fasciculus cuneatus
Reveresed
extrapyramidal motor tract for motor input of gross postural tone
rubrospinal tract
Reveresed
sensory tract for ipsilateral and contralateral subconscious proprioception
spinocerebellar tract (dorsal)
Reveresed
sensory tract for ipsilateral subconscious proprioception
spinocerebellar tract (ventral)
Reveresed
sensory tract for pain, light touch, and temperature
spinothalamic tract (lateral)
Reveresed
extrapyramidal motor tract for contralateral posture muscle tone associated with auditory/visual stimuli
tectospinal tract
Reveresed
extrapyramidal motor tract for ipsilateral gross postural adjustments subsequent to head movements
vestibulospinal tract
Reveresed
…
Nerve Root Dermatomes
Reveresed
vertex of skull.
C1
Reveresed
temple, forehead, occiput. myotome: longus colli, SCM, rectus capitis
C2
Reveresed
entire neck, posterior cheek, temporal area, prolongation forward under mandible. myotome: trap, splenius capitis
C3
Reveresed
shoulder area, clavicular and upper scap area. myotome: trap, levator scapulae
C4
Reveresed
deltoid area, anterior aspect of entire arm to base of thumb. myotome: supraspinatus, deltoid, biceps
C5
Reveresed
anterior arm, radial side of hand to thumb and index finger. myotome: biceps, supinator, wrist extensors.
C6
Reveresed
lateral arm and forearm to index, long and ring fingers. myotome: triceps, wrist flexors
C7
Reveresed
medial arm and forearm to long, ring and little fingers. myotome: ulnar deviators, thumb extensors, thumb adductors
C8
Reveresed
medial side of forearm to base of little finger.
T1
Reveresed
medial side of upper arm to medial elbow, pectoral and midscapular areas
T2
Reveresed
upper thorax
T3-T6
Reveresed
cotal margin
T5-T7
Reveresed
abs and lumbar region
T8-T12
Reveresed
back, over trochanter and groin
L1
Reveresed
back, front of thigh to knee. myotome: psoas, hip adductors
L2
Reveresed
back, upper buttock, anterior thigh and knee, medial lower leg. myotome: psoas ,quads, thigh atrophy
L3
Reveresed
medial buttock, lateral thigh, medial leg, dorsum of foot, big toe. myotome: tib anterior, extensor hallicus
L4
Reveresed
buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first second and third toes. myotome: extensor hallucis, peroneals, gluteus medius, dorsiflexors, hamstring and calf atrophy
L5
Reveresed
buttock, thigh and posterior leg. myotome: calf and hamstring, wasting of gluteals, peorneals, PFs
S1
Reveresed
same as S1. mytome: same as S1 except peroneals
S2
Reveresed
groin and medial thigh to knee.
S3
Reveresed
perineum, genitals, lower sacrum. myotome: bladder, rectum
S4
Reveresed
semitendinosous, soleus, popliteus, semimembranosous, plantaris, tib posterior, gastroc, biceps femoris, flexor hallucis lonus, flexor digitorum longus.
LE: Sciatic nerve innervates:
Reveresed
psoas minor, psoas major
LE: lumbar plexus innervates:
Reveresed
piriformis, superior gemelli, obturator internus, inferior gemelli, quadratus femoris
LE: sacral plexus innervates:
Reveresed
gluteus maximus
LE: inferior gluteal nerve innervates:
Reveresed
extensor digitorum longus and tib anterior
LE: deep peroneal nerve innervates:
Reveresed
gluteus medius, gluteus minimus, tensor fasciae latae
LE: superior gluteal nerve innervates:
Reveresed
peroneals (longus and brevis)
LE: superficial peroneal nerve innervates:
Reveresed
iliacus, vastus lateralis, intermedius and medialis; recturs femoris, sartorious, pectineus
LE: femoral nerve innervates:
Reveresed
abductor hallucis, lumbricale I, flexor digitorum brevis, flexor hallucis longis
LE: medial plantar nerve innervates:
Reveresed
adductor longus, gracilis, adductor brevis, obturator externus, and adductor magnus
LE: obturator nerve innervates:
Reveresed
abductor digiti minimi, dorsal interossei, quadratus plantae, adductor hallucis, lumbricale II, III, IV, plantar interossei, flexor digiti minimi brevis
LE: lateral plantar nerve innervates:
Reveresed
rhomboids, levator scapulae
UE: dorsal scapular nerve innervates:
Reveresed
serratus anterior
UE: long thoracic nerve innervates:
Reveresed
subclavius
UE: nerve to subclavius innervates
Reveresed
infraspinatus, supraspinatus
UE: suprascapular nerve innervates
Reveresed
pect major, pect minor
UE: lateral pectoral nerve innervates
Reveresed
coracobrachialis, biceps brachii, brachialis
UE: musculocutaneous nerve innervates
Reveresed
flexor muscles in forearm, 5 muscles in hand
UE: lateral root of the median nerve innervates
Reveresed
pect major and minor
UE: medial pectoral nerve innervates:
Reveresed
1 1/2 muscles of forearm and most small muscles of hand
UE: ulnar nerve innervates
Reveresed
flexor muscles in forearm, 5 muscles of hand
UE: medial root of the median nerve innervates
Reveresed
subscapularis
UE: upper subscapular nerve innervates
Reveresed
latissimus dorsi
UE: thoracodorsal nerve innervates
Reveresed
subscapularis, teres major
UE: lower subscapular nerve innervates
Reveresed
deltoid, teres minor
UE: axillary nerve innervates
Reveresed
brachioradialis, extensor muscles of forearm
UE: radial nerve innervates
Reveresed
SENSORY
AFFERENT NERVES
Reveresed
MOTOR
EFFERENT NERVES
Reveresed
olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal
Cranial Nerves
Reveresed
smell
olfactory
Reveresed
sight
optic
Reveresed
voluntary movement of eye
oculomotor
Reveresed
voluntary motor movement of eye
trochlear
Reveresed
touch, pain: skin of face, chewing
trigeminal
Reveresed
voluntary motor: muscle of eyeball, lateral
abducens
Reveresed
taste: anterior tongue, voluntary motor: facial muscles. autonomic: lacrimal, submandibular, sublingual glands
facial
Reveresed
hearing/balance: ear
vestibulocochlear (acoustic nerve)
Reveresed
touch, pain: posterior tongue, taste: tongue. swallowing
glossopharyngeal
Reveresed
touch, pain: pharynx, larynx, bronchi. taste: tongue, epiglottis.
vagus
Reveresed
voluntary motor: SCM and trapezius muscle
accessory
Reveresed
voluntary motor: muscles of tongue
hypoglossal
Reveresed
light touch, deep pain, superficial pain, vibration, proprioception, kinesthesia, temperature, stereognosis, graphesthesia, 2 point discrimination
types of sensory testing
Reveresed
light pressure with cotton ball
light touch
Reveresed
squeeze forearm or calf muscle
deep pain
Reveresed
pen cap, paper clip end, pin
superficial pain
Reveresed
tuning fork
vibration
Reveresed
identify a static position of an extremity/part
proprioception
Reveresed
identify direction and extent of mvmt of a joint or body part
kinesthesia
Reveresed
hot and cold test tubes
temperature
Reveresed
identify an object without sight
stereognosis
Reveresed
draw a number or letter on skin with finger, identify without sight
graphesthesia
Reveresed
2 point caliper on skin, identify one or two points without sight
2 pt discrimination
Reveresed
reflex is a motor response to a sensory stimulation that is used in an assessment to observe the integrity of the nervous system. DTRs elicit a muscle contraction when the muscle’s tendon is stimulated.
DTR: deep tendon reflexes
Reveresed
0=no response. 1+=diminished/depressed response. 2+=active normal response. 3+=brisk/exaggerated response. 4+=very brisk/hyperactive, abnormal response.
DTR grades
Reveresed
biceps tendon: flexion/contraction of biceps. brachioradialis tendon: elbow flexion and/or forearm pronation. triceps tendon: elbow extension or contraction of triceps muscle. patellar tendon: knee extension. tibialis posterior tendon: PF/inversion of foot. achilles tendon: PF of foot.
DTR normal responses:
Reveresed
nervous system outside of brain and spinal cord. consists of motor, sensory, and autonomic neurons. neurons are located in cranial, spinal, and peripheral nerves. PNS consists of 12 pairs of cranial nerves, 31 prs of spinal nerves, and associated ganglia and sensory receptors. most peripheral nerves contain motor (efferent) and sensory (afferent) components.
PNS: peripheral nervous system
Reveresed
large, myelinated, high conduction rate. contained in alpha and gamma motor systems. sensory components in muscle spindles, golgi tendon organs, bare nerve endings, mechanoreceptors
A fibers
Reveresed
medium, myelinated, reasonably fast conduction rate. pre ganglionic fibers of ANS.
B fibers
Reveresed
small nerve fibers, poorly myelinated or unmyelinated. slow conduction rate. post ganglionic fibers of sympathetic system. exteroceptors for pain, temp, and touch.
C fibers
Reveresed
mechanical (compression), crush and percussion (fracture, compartment syndrome), laceration, penetrating trauma (stab wound), stretch (traction injury), high velocity trauma (MVA), and cold (frostbite).
types of nerve injury
Reveresed
mildest form of injury. conduction block usually due to myelin dysfunction. axonal continuity conserved. nerve conduction is preserved proximal and distal to lesion. nerve fibers are not damaged. recovery will occur within 4/6 weeks.
neurapraxia
Reveresed
a more severe grade of injury to a peripheral nerve. is reversible injury to damaged fibers. damage occurs to the axons with preservation to endoneurium. nerve can regenerate distal to the site of lesion by one millimeter per day.
axonotmesis
Reveresed
most severe grade of injury to a peripheral nerve. all components are damaged and irreversible. all motor and sensory loss is permanently impaired.
neurotmesis
Reveresed
characterized by a lesion found in descending motor tracts within the cerebral motor cortex, internal capsule, brainstem or spinal cord. symptoms include weakness of involved muscles, hypertonicity, hyperreflexia, mild disuse atrophy, and abnormal reflexes. damaged tracts are in lateral white column of spinal cord.
upper motor neuron disease
Reveresed
characterized by a lesion that affects nerves or their axons at or below level of brainstem, usually within the “final common pathway.” ventral gray column of spinal cord may also be affected. symptoms include flaccidity or weakness of muscles, decreased tone, fasciculations, muscle atrophy, and decreased or absent reflexes.
lower motor neuron disease
Reveresed
CP, hydrocephalus, CVA, birth injuries, MS, brain tumors.
upper motor neuron lesions
Reveresed
poliomyelitis, tumors involving spinal cord, trauma, infection, muscular dystrophy.
lower motor neuron lesions
Reveresed
PCA: posterior cerebral artery, MCA: middle cerebral artery, and vertebrobasilar artery.
blood supply to brain
Reveresed
portion of midbrain, subthalamic nucleus, basal nucleus, thalamus, inferior temporal lobe, occipital and occipitoparietal cortices
PCA
Reveresed
most of outer cerebrum, basal ganglia, posterior and anterior internal capsule, putamen, pallidum, lentiform nucleus
MCA
Reveresed
medulla, cerebellum, pons, middle occipital cortex
vertebrobasila artery
Reveresed
…
CEREBRAL HEMISPHERE FUNCTION
Reveresed
responsible for: voluntary motor function, advanced motor planning, initiation of action, cranial nerves 3, 4, 6, 9, 10, 12; emotion interpretation, personality, judgment, planning, motivation, bladder & bowel inhibition, broca’s motor speech center, appreciation of intonation, understanding gestures.
frontal lobe
Reveresed
contralateral weakness, contralateral head and eye paralysis, personality changes, antisocial behavior, ataxia, primitive reflexes, broca’s aphasia, delayed or poor initiation
frontal lob impairments
Reveresed
responsible for: processing perceptual and sensory info, body schema, contralateral pain, posture, touch, proprioception (to arm, trunk and leg), perform calculations, spatial awareness, sensory: speech comprehension, visual tract, taste perception
parietal lobe
Reveresed
agraphia, finger agnosia, constructional apraxia, dressing apraxia, anosognosia, wernicke’s aphasia (receptive), homonymous visual deficits, impaired language comprehension, impairment in taste
parietal lobe impairments
Reveresed
responsible for: auditory and limbic processing, appreciation of language, music and sound, memory, learning, affective mood centers (primitive behaviors), short term memory
temporal lobe
Reveresed
auditory and hearing, impaired appreciation of music, memory deficits, learning deficits, wernicke’s aphasia, antisocial behaviors
temporal lobe impairments
Reveresed
responsible for: primary processing area of visual info, visual tract, perception of vision
occipital lobe
Reveresed
homonymous hemianopsia (only seeing half of one visual field), impaired extraocular muscle movement
occipital lobe impairments
Reveresed
responsible for: coordination of motor skills, postural tone, sensory/motor input for trunk and extremities, coordination of gait
cerebellum
Reveresed
ataxia, discoordination of trunk and extremities, intention tremor, balance deficits, ipsilateral facial sensory loss, dysdiadochokinesia (inability to perform rapidly alternating movements)
cerebellum impairments
Reveresed
left: language, sequence and perform movements, understanding language, produce written and spoken language, analytical, controlled. right: nonverbal processing, processing information in a holistic manner, artistic abilities, general concept comprehension, hand-eye coordination, spatial relationships
hemisphere specialization/dominance
Reveresed
state of physical equilibrium needing input from these three systems: somatosensory, visual and vestibular.
balance
Reveresed
receptors located in joints, muscles, ligaments, and skin to provide proprioceptive info regarding length, tension, pressure, pain, joint position.
somatosensory input
Reveresed
visual receptors allow for perceptual acuity regarding verticality, motion of objects and self, environmental orientation, postural sway, and movements of the head/neck. children rely heavily on this system for maintenance of balance.
visual input
Reveresed
provides CNS with feedback regarding position and movement of the head with relation to gravity.
vestibular input
Reveresed
allows for head/eye movement coordination. reflex supports gaze stabilization where eyes can move while head is fixed; visual tracking can also occur when both eyes and head are moving.
Balance Reflexes: Vestibuloocular reflex (VOR):
Reveresed
attempts to stabilize body and control movement. reflex assists with stability while head is moving as well as coordination of trunk during upright postures.
Balance Reflexes: Vestibulospinal reflex (VSR):
Reveresed
automatic motor responses that are used to maintain center of gravity over base of support.
automatic postural strategies
Reveresed
first strategy to be elicited by a small range and slow velocity perturbation when feet are on the ground. muscles contract in a distal to proximal fashion to control postural sway from ankle joint
ankle strategy
Reveresed
elicited by a greater force, challenge or perturbation thru pelvis and hips. hips will move in opposite direction from head in order to maintain balance. muscles contract in a proximal to distal fashion in order to counteract the loss of balance
hip strategy
Reveresed
used to lower the center of gravity during standing or ambulation in order to better control the COG. examples: knee flexion, crouching or squatting. often used when both mobility and stability are required during a task such as surfing.
suspensory strategy
Reveresed
elicited thru unexpected challenges or perturbations during static standing or when the perturbation produces such a movement that the COG is beyond the BOS. LEs step and/or UE reach to regain a new BOS
stepping strategy
Reveresed
unbalance due to ear disease
vertigo
Reveresed
abnormal eye mvmt that entails nonvolitional, rhythmic oscillation of eyes. spontaneous, peripheral, and central
nystagmus
Reveresed
intervention that can be successful for pts with vestibular or balance disorders. utilizes compensation, adaptation, and plasticity to increase brain’s sensitivity, restore symmetry
vestibular rehabilitation
Reveresed
improve balance and stability, increase strength and ROM, decrease falls, minimize dizziness
goals for vestibular rehab:
Reveresed
romberg, one legged stance test, tinetti, berg balance, get up and go test, timed get up and go test
balance tests (types)
Reveresed
antihistamine treats vertigo, anticholinergic agents decrease conduction in vestibular-cerebellar pathways. benzodiazepine (valium) treats vertigo and emesis. phenothiazine (phenergan) treats emesis. monoaminergic (ephedrine) treats vertigo
pharmacological intervention for managing vestibular disorders
Reveresed
…
COMMUNICATION DISORDERS
Reveresed
acquired neuro impairment of processing for receptive and/or expressive language. result of brain injury, head trauma, CVA, tumor or infection.
aphasia
Reveresed
lesion often in temporoparietal lobe of dominant hemisphere. word output is functional. empty speech or jargon. speech lacks any substance. uses of paraphasias (substitution of incorrect words)
fluent aphasia
Reveresed
lesion found at posterior region of superior temporal gyrus. major fluent aphasia. also known as “receptive” aphasia. comprehension is impaired, but good articulation
wernicke’s aphasia
Reveresed
major non-fluent aphasia. also known as “expressive” aphasia. most common form. lesions in frontal lobe.
broca’s aphasia
Reveresed
poor word output, increased effort for producing speech. poor articulation.
non-fluent aphasia
Reveresed
major non-fluent aphasia. lesion of frontal, temporal, and parietal lobes. comprehension (reading and auditory) is severely impaired.
global aphasia
Reveresed
motor disorder of speech that is caused by an upper motor neuron lesion that affects muscles that are used to articulate words and sounds. speech is often slurred.
dysarthria
Reveresed
cerebrovascular accident
CVA
Reveresed
cva that presents with total neuro deficits at onset.
completed stroke
Reveresed
cva usually caused by a thrombus that gradually progresses. deficits are not seen for one to two days after onset.
stroke in evolution
Reveresed
when there is a loss of perfusion to a portion of the brain within just seconds, there is a central area of irreversible infarction surrounded by an area of potential ischemia.
ischemic stroke
Reveresed
associated with cardiovascular disease, an embolus may be a solid, liquid or gas, and con originate in any part of the body. travels thru bloodstream to the cerebral arteries causing occlusion of a blood vessel and a resultant infarct. middle cerebral artery is most commonly affected by an embolus from internal carotid arteries. often presents with a headache.
embolus (20% of ischemic CVAs)
Reveresed
artherosclerotic plaque develops in an artery and eventually occludes the artery or a branching artery causing an infarct. usually occurs during sleep or upon awakening, after a MI or post surgical procedure
thrombus
Reveresed
abnormal bleeding in brain due to rupture in blood supply. due to disruption of oxygen to an area of brain and compression from accumulation of blood. hypertension is usually a precipitating factor causing rupture of an aneurysm or arteriovenous malformation. 50% of deaths from hemorrhagic stroke occur within first 48 hours.
hemorrhage (10-15% of CVAs)
Reveresed
transient ischemic attack
TIA
Reveresed
usually linked to an atherosclerotic thrombosis. temporary interruption of blood supply to an area. effects may be similar to a CVA, by symptoms resolve quickly. often occurs in the carotid and vertebrobasilar arteries, and may indicate future CVA.
TIA
Reveresed
hypertension, heart disease, DM, smoking, TIAs, obesity, high cholesterol, behaviors related to hypertension, physical inactivity, increased alcohol consumption
CVA risk factors
Reveresed
impairments include LE involvement, loss of bowel/bladder control, loss of behavioral inhibition, mental changes, may see neglect, may see aphasia, apraxia and agraphia, perseveration
If CVA is in anterior cerebral artery:
Reveresed
impairments include loss of consciousness, hemi or tetraplegia, comatose or vegetative state, inability to speak, locked in syndrome, vertigo, nystagmus, dysphagia, dysarthria, syncope, ataxia
If CVA is in vertebral-basilar artery
Reveresed
impairments include pain and temp sensory loss, contralateral hemiplegia, ataxia, athetosis or coreiform mvmt, quality of mvmt is impaired, thalamic pain syndrome, anomia, prosopagnosia with occipital infarct, hemiballismus, visual agnosia, homonymous hemianopsia, mild hemiparesis, memory impairment, dyschromatopsia, palinopsia, micropsia, macropsia, alexia, dyslexia, achromatopsia
if CVA is in posterior cerebral artery
Reveresed
impairments include wernicke’s aphasia, homonymous hemianopsia, apraxia, flat affect in rt hemisphere, impaired body schema
if CVA is in middle cerebral artery (most common area)
Reveresed
weakness, paralysis of LEFT side, decreased attention span, left hemianopsia, decreased awareness and judgment, memory deficits, left inattention, decreased abstract reasoning, emotional lability, impulsive behaviors, decreased spatial orientation
characteristics of a CVA in RIGHT hemisphere
Reveresed
weakness, paralysis of RIGHT side, increased frustration, decreased processing, possible aphasia, dysphagia, motor apraxia, decreased discrimination btwn left and right, right hemianopsia
characteristics of a CVA in LEFT hemisphere
Reveresed
unstable vital signs, decreased consciousness, ability to swallow, weakness and paralysis on both sides
characteristics of a brainstem CVA
Reveresed
decreased balance, ataxia, decreased coordination, nausea, decreased ability for postural adjustment, nystagmus
characteristics of a cerebellum CVA
Reveresed
result when higher centers of the brain lose control and the uncontrolled or partially controlled stereotyped patterns of the middle and lower centers emerge.
synergy patterns
Reveresed
seen when patient attempts to lift up their arm or reach for an object. characterized by great toe extension and flexion of the remaining toes secondary to spasticity.
flexor synergy pattern
Reveresed
neuromuscular developmental treatment: concept recognizes that interference of normal function of the brain caused by CNS dysfunction leads to a slowing down or cessation of motor development and the inhibition of righting reactions, equilibrium reactions, and automatic movements. patient should learn to control mvmt thru activities that promote normal mvmt patterns that integrate function.
NDT
Reveresed
technique utilized to elicit voluntary muscular contraction.
NDT: facilitation
Reveresed
technique utilized to decrease excessive tone or movement.
NDT: inhibition
Reveresed
specific handling of designated areas of the body (shoulder, pelvis, hand, foot) will influence and facilitate posture, alignment and control.
NDT: key points of control
Reveresed
act of moving an extremity into a position that the patient must hold against gravity.
NDT: placing
Reveresed
designated static positions that Bobath found to inhibit abnormal tonal influences and reflexes.
NDT: reflex inhibiting posture
Reveresed
stage 1: no volitional mvmt initiated. stage 2: beginning of spasticity. stage 3: voluntary synergies. spasticity increases. stage 4: spasticity begins to DEcrease. stage 5: decrease in spasticity. stage 6: jt mvmts are performed with coordination. stage 7: normal motor function is restored
Brunnstrom’s 7 stages of recovery
Reveresed
involuntary and automatic mvmt of a body part as a result of an intentional active or resistive mvmt in another body part.
associated reaction
Reveresed
flexion pattern of the involved UE facilitates flexion of the involved LE
homolateral synkinesis
Reveresed
group of muscles that produce a predictable pattern of mvmt in flexion or extension patterns
limb synergies
Reveresed
involved LE will abduct/adduct with applied resistance to the uninvolved LE in the same direction
raimiste’s phenomenon
Reveresed
raising the involved UE above 100 degrees with elbow extension with produce extension and abduction of the fingers
souque’s phenomenon
Reveresed
proprioceptive neuromuscular facilitation
PNF
Reveresed
approach is based on the premise that stronger parts of the body are utilized to stimulate and strengthen the weaker parts. development will follow normal sequence thru a component of motor learning. PNF places great emphasis on manual contacts and correct handling. movement patterns follow diagonals or spirals that each possess a flexion, extension, and rotary component and are directed toward or away from midline.
PNF
Reveresed
combination of bilateral UE asymmetrical extensor patterns performed as a closed chain activity
chopping (PNF):
Reveresed
progression of motor skill acquisition. stages of motor control include mobility, stability, controlled mobility, and skill.
developmental sequence (PNF):
Reveresed
hip, knee, and ankle move into flexion or extension simultaneously
mass mvmt patterns (PNF):
Reveresed
muscle activation of an involved extremity due to intense action of an uninvolved muscle or group of muscles
overflow (PNF):
Reveresed
mobility, stability, controlled mobility, skill
levels of motor control
Reveresed
isotonic concentric contraction performed against resistance followed by alternating concentric and eccentric contractions with resistance. (controlled mobility, skill)
agonist reversals
Reveresed
isometric contractions performed alternating from muscles on one side of joint to the other side w/o rest (stability)
alternating isometrics
Reveresed
technique used to increase ROM. as extremity reaches point of limitation the pt performs a maximal contraction of the antagonistic muscle group. therapist resists mvmt for 8-10 secs with relaxation following. technique is repeated until no further gains in ROM are noted during session (mobility)
contract-relax
Reveresed
isometric contraction used to increase ROM. contraction is facilitated for all muscle groups at the limiting point in the ROM. relaxation occurs and extremity moves thru the newly acquired range to the next point of limitation until no further increases in ROM occur. used for patients that present with pain usually. (mobility)
hold-relax
Reveresed
technique to improve initiation of mvmt to muscle groups tested at 1/5 or less. (mobility)
hold-relax active
Reveresed
proprioceptive component used to increase ROM around a joint. manual traction is provided slowly and usually in combo with mobilization techniques. (mobility)
joint distraction
Reveresed
used to improve coordination of all components of a task. performed distal to proximal sequence. (skill)
normal timing
Reveresed
used to initiate mvmt and sustain a contraction through the ROM. therapist provides a quick stretch followed by isometric or isotonic contractions (mobility)
repeated contractions
Reveresed
used to emphasize coordination of proximal components during gait. resistance is applied to an area such as the pelvis, hips, or extremity during the gait cycle in order to enhance coordination, strength or endurance (skill)
resisted progression
Reveresed
used to assist initiating movement when hypertonia exists. mvmt progresses from passive to active assist, to slightly resistive. (mobility)
rhythmic initiation
Reveresed
passive technique used to decrease hypertonia by slowing rotating an extremity around the axis. relaxation of extremity will increase ROM. (mobility)
rhythmic rotation
Reveresed
used to increase ROM and coordinate isometric contractions. requires isometric contractions of all muscles around a joint against progressive resistance. pt should relax and move into newly acquired range and repeat. (mobility, stability)
rhythmic stabilization
Reveresed
technique of slow and resisted concentric contractions of agonists and antagonists around a joint w/o rest btwn reversals. used to improve control of movement and posture. (stability, controlled mobility, skill)
slow reversal
Reveresed
using slow reversal with the addition of an isometric contraction that is performed at the end of each mvmt in order to gain stability. (stability, controlled mobility, skill)
slow reversal hold
Reveresed
ability to utilize alternate motor and sensory strategies due to an impairment that limits the normal completion of a task.
compensation
Reveresed
ability to perform a mvmt as a result of internal processes that interact with the environment and produce a consistent strategy to generate the correct mvmt
motor learning
Reveresed
ability to modify or change at the synapse level either temporarily or permanently in order to perform a particular function
plasticity
Reveresed
ability of the motor and sensory systems to stabilize position and control mvmt.
postural control
Reveresed
ability to utilize previous strategies to return to the same level of functioning
recovery
Reveresed
plan used to produce a specific result or outcome that will influence the structure or system
strategy
Reveresed
to motor control: utilizes a systems theory of motor control that views the entire body as a mechanical system with many interacting subsystems that all work cooperatively in managing internal and environmental influences. (compensation, motor learning, plasticity, postural control, recovery and strategy are all keys to this approach)
task oriented approach
Reveresed
says that all motor output was the result of both past and present sensory input. treatment is based on sensorimotor learning. takes into account the autonomic nervous system and emotional factors as well as motor ability. goal is to obtain homeostasis in motor output and to activate muscles and perform a task independently of a stimulus. examples: icing and brushing in order to elicit desired reflex motor responses.
Rood theory
Reveresed
approximation, joint compression, icing, light touch, quick stretch, resistance, tapping, traction
sensory stimulation techniques (facilitation)
Reveresed
approximation, joint compression, icing, light touch, quick stretch, resistance, tapping, traction
sensory stimulation techniques (facilitation)
Reveresed
deep pressure, prolonged stretch, warmth, prolonged cold, carotid reflex
sensory stimulation techniques (inhibition)
Reveresed
include thrombolytic agents, antiplatelet agents, cholesterol-lowering agents, antiarrhythmic agents, neuroprotective agents, antihypertensive agents
pharmacological interventions for CVA management
Reveresed
include thrombolytic agents, antiplatelet agents, cholesterol-lowering agents, antiarrhythmic agents, neuroprotective agents, antihypertensive agents
pharmacological interventions for CVA management
Reveresed
produces anticoagulation effects, destroys thrombus or emboli
thrombolytic agents (heparin, activase, coumadin
Reveresed
produces anticoagulation effects, destroys thrombus or emboli
thrombolytic agents (heparin, activase, coumadin
Reveresed
reduces atherosclerotic events and decrease the risk for CVA
antiplatelet agents (aspirin, plavix, ascriptin)
Reveresed
reduces atherosclerotic events and decrease the risk for CVA
antiplatelet agents (aspirin, plavix, ascriptin)
Reveresed
decreases the triglycerides and low-density lipoproteins in the bloodstream
cholesterol-lowering agents (lipitor, zocor, pravachol)
Reveresed
administered only within the acute stage of CVA (within 3 hrs)
neuroprotective agents (N-methyl-D-aspartate: NMDA)
Reveresed
administered only within the acute stage of CVA (within 3 hrs)
neuroprotective agents (N-methyl-D-aspartate: NMDA)
Reveresed
sodium channel blockers: norpace, Xylocaine. beta-blockers: tenormin, lopressor, inderal. Refractory period alterations: cordarone, corvert. Calcium channel blockers: norvasc, cardizem, verapamil.
antiarrhythmic agents: prevention of arrhythmias, ischemia and hypertension
Reveresed
diuretics: lasix, bumex, thiazide. beta-blockers: sectral, inderal, lopressor. calcium channel blockers: cardizem, calan. alpha-blockers: cardura, minipress
antihypertensive agents: assists to lower blood pressure; decreases tension within circulation system
Reveresed
diuretics: lasix, bumex, thiazide. beta-blockers: sectral, inderal, lopressor. calcium channel blockers: cardizem, calan. alpha-blockers: cardura, minipress
antihypertensive agents: assists to lower blood pressure; decreases tension within circulation system
Reveresed
inability to interpret information
agnosia
Reveresed
inability to interpret information
agnosia
Reveresed
inability to recognize symbols, letters or numbers traced on the skin
agraphesthesia
Reveresed
inability to recognize symbols, letters or numbers traced on the skin
agraphesthesia
Reveresed
inability to write due to a lesion within the brain
agraphia
Reveresed
inability to write due to a lesion within the brain
agraphia
Reveresed
inability to initiate mvmt; commonly seen with parkinson’s
akinesia
Reveresed
inability to initiate mvmt; commonly seen with parkinson’s
akinesia
Reveresed
inability to communicate or comprehend due to damage to specific areas of brain
aphasia
Reveresed
inability to communicate or comprehend due to damage to specific areas of brain
aphasia
Reveresed
inability to perform purposeful learned mvmts, although there is no sensory or motor impairment
apraxia
Reveresed
inability to perform purposeful learned mvmts, although there is no sensory or motor impairment
apraxia
Reveresed
inability to recognize objects by sense of touch
astereognosis
Reveresed
inability to perform coordinated movements
ataxia
Reveresed
condition that presents with involuntary mvmts combined with instability of posture. peripheral mvmts occur without central stability
athetosis
Reveresed
condition that presents with involuntary mvmts combined with instability of posture. peripheral mvmts occur without central stability
athetosis
Reveresed
mvmt that is very slow
bradykinesia
Reveresed
mvmt that is very slow
bradykinesia
Reveresed
mvmts that are sudden, random and involuntary
chorea
Reveresed
mvmts that are sudden, random and involuntary
chorea
Reveresed
characteristic of an upper motor neuron lesion; involuntary alternating spasmodic contraction of a muscle precipitated by a quick stretch reflex
clonus
Reveresed
characteristic of an upper motor neuron lesion; involuntary alternating spasmodic contraction of a muscle precipitated by a quick stretch reflex
clonus
Reveresed
inability to reproduce geometric figures
constructional apraxia
Reveresed
inability to reproduce geometric figures
constructional apraxia
Reveresed
characteristic of a corticospinal lesion at level of brainstem that results in extension of trunk and all extremities
decerebrate rigidity
Reveresed
characteristic of a corticospinal lesion at level of brainstem that results in extension of trunk and all extremities
decerebrate rigidity
Reveresed
characteristic of a corticoapinal lesion at level of diencephalon where the trunk and LEs are positioned in extension, and the UEs are positioned in flexion
decorticate rigidity
Reveresed
characteristic of a corticoapinal lesion at level of diencephalon where the trunk and LEs are positioned in extension, and the UEs are positioned in flexion
decorticate rigidity
Reveresed
double vision
diplopia
Reveresed
double vision
diplopia
Reveresed
slurred and impaired speech due to a motor deficit of the tongue or other muscles essential for speech.
dysarthria
Reveresed
slurred and impaired speech due to a motor deficit of the tongue or other muscles essential for speech.
dysarthria
Reveresed
inability to perform rapidly alternating mvmts
dysdiadochokinesia
Reveresed
inability to perform rapidly alternating mvmts
dysdiadochokinesia
Reveresed
inability to control the range of a mvmt and the force of muscular activity
dsymetria
Reveresed
inability to control the range of a mvmt and the force of muscular activity
dsymetria
Reveresed
inability to properly swallow
dysphagia
Reveresed
inability to properly swallow
dysphagia
Reveresed
closely related to athetosis; however there is larger axial muscle involvement rather than appendicular muscles
dystonia
Reveresed
closely related to athetosis; however there is larger axial muscle involvement rather than appendicular muscles
dystonia
Reveresed
characteristic of a right hemisphere infarct where there is an inability to control emotions and outbursts of laughing or crying that are inconsistent with the situation
emotional lability
Reveresed
characteristic of a right hemisphere infarct where there is an inability to control emotions and outbursts of laughing or crying that are inconsistent with the situation
emotional lability
Reveresed
involuntary and violent mvmt of a large body part
hemiballism
Reveresed
involuntary and violent mvmt of a large body part
hemiballism
Reveresed
condition of weakness on one side of body
hemiparesis
Reveresed
condition of weakness on one side of body
hemiparesis
Reveresed
condition of paralysis on one side of the body
hemiplegia
Reveresed
condition of paralysis on one side of the body
hemiplegia
Reveresed
loss of right or left half of vision in both eyes
homonymous hemianopsia
Reveresed
inability to formulate an initial motor plan and sequence tasks where the proprioceptive input necessary for mvmt is impaired
ideational apraxia
Reveresed
inability to formulate an initial motor plan and sequence tasks where the proprioceptive input necessary for mvmt is impaired
ideational apraxia
Reveresed
condition where a person plans a mvmt or task, but cannot volitionally perform it. automatic mvmt may occur, but a person cannot impose additional mvmt on command.
ideomotor apraxia
Reveresed
ability to perceive the direction and extent of mvmt of a joint or body part
kinesthesia
Reveresed
ability to perceive the direction and extent of mvmt of a joint or body part
kinesthesia
Reveresed
inability to interpret stimuli on the left side of the body due to a lesion of the rt frontal lob of brain
neglect
Reveresed
state of repeatedly performing the same segment of a task or repeatedly saying the same word/phrase without purpose
perseveration
Reveresed
state of repeatedly performing the same segment of a task or repeatedly saying the same word/phrase without purpose
perseveration
Reveresed
ability to perceive the static position of a joint or body part
proprioception
Reveresed
state of severe hypertonicity where a sustained muscle contraction does not allow for any mvmt at a specified joint
rigidity
Reveresed
result of brain damage that presents with mass mvmt patterns that are primitive in nature and coupled with spasticity
synergy
Reveresed
result of brain damage that presents with mass mvmt patterns that are primitive in nature and coupled with spasticity
synergy
Reveresed
spinal cord injury
SCI
Reveresed
spinal cord injury
SCI
Reveresed
lesion to SC where there is no preserved motor or sensory function below the level of lesion
complete lesion
Reveresed
lesion to SC where there is no preserved motor or sensory function below the level of lesion
complete lesion
Reveresed
lesion to the SC with incomplete damage to the cord. there may be scattered motor function, sensory function or both below the level of injury/lesion.
incomplete lesion
Reveresed
results from compression and damage to the anterior part of SC or anterior spinal artery. usually cervical flexion is mechanism of injury. loss of motor function and pain and temp sense below lesion due to damage of the corticospinal and spinothalamic tracts
incomplete: anterior cord syndrome
Reveresed
results from compression and damage to the anterior part of SC or anterior spinal artery. usually cervical flexion is mechanism of injury. loss of motor function and pain and temp sense below lesion due to damage of the corticospinal and spinothalamic tracts
incomplete: anterior cord syndrome
Reveresed
usually caused by a stab wound, which produces a hemisection of the sc. paralysis and loss of vibratory and position sense on same side as lesion due to damage to corticospinal tract and dorsal columns. loss of pain and temp sense on opposite side of lesion from damage to lateral spinothalamic tract. rare since most spinal cord lesions are atypical.
incomplete: brown-sequard’s syndrome
Reveresed
usually caused by a stab wound, which produces a hemisection of the sc. paralysis and loss of vibratory and position sense on same side as lesion due to damage to corticospinal tract and dorsal columns. loss of pain and temp sense on opposite side of lesion from damage to lateral spinothalamic tract. rare since most spinal cord lesions are atypical.
incomplete: brown-sequard’s syndrome
Reveresed
injury that occurs below L1 spinal level where long nerve roots transcend. mostly incomplete but rarely can be complete as well. considered a peripheral nerve injury. flaccidity, areflexia, impairment of bowel/bladder function. full recovery not typical due to distance needed for axonal regeneration.
incomplete: cauda equina injuries
Reveresed
results from compression and damage to the central portion of sc. injury is usually cervical hyperextension that damages spinothalamic tract, corticospinal tract, and dorsal columns. UEs present with greater involvement than LEs, and greater motor deficits than sensory deficits.
incomplete: central cord syndrome
Reveresed
rare syndrome that is caused by compression of posterior spinal artery and is characterized by loss of pain perception, proprioception, 2 pt discrimination, and stereognosis. motor function is preserved.
incomplete: posterior cord syndrome
Reveresed
rare syndrome that is caused by compression of posterior spinal artery and is characterized by loss of pain perception, proprioception, 2 pt discrimination, and stereognosis. motor function is preserved.
incomplete: posterior cord syndrome
Reveresed
dangerious complication of sci. can occur in pts with lesions above T6. noxious stimuls below lesion level triggers autonomic nervous system, causing a sudden elevation in blood pressure. common causes include distended or full bladder, kink or blockage in catheter, bladder infections, pressure ulcers, tight clothing.
autonomic dysreflexia
Reveresed
high bp, severe headache, blurred vision, stuffy nose, profuse sweating, goose bumps below level of lesion, and vasodilation (flushing) above level of injury.
symptoms of autonomic dysreflexia
Reveresed
high bp, severe headache, blurred vision, stuffy nose, profuse sweating, goose bumps below level of lesion, and vasodilation (flushing) above level of injury.
symptoms of autonomic dysreflexia
Reveresed
check catheter for blockage first. bowel should also be checked for impaction. pt should remain in a sitting position. lying a patient down is CONTRAindicated.
treatment of autonomic dysreflexia
Reveresed
formation of a blood clot that becomes dislodged and is termed an embolus. can become serious since the embolus may obstruct a selected artery. sci pts have a greater risk of developing a DVT due to the absence or decrease of activity in LEs.
deep vein thrombosis (DVT)
Reveresed
formation of a blood clot that becomes dislodged and is termed an embolus. can become serious since the embolus may obstruct a selected artery. sci pts have a greater risk of developing a DVT due to the absence or decrease of activity in LEs.
deep vein thrombosis (DVT)
Reveresed
swelling of LEs, pain, sensitivity over area of clot, warmth
symptoms of DVT
Reveresed
swelling of LEs, pain, sensitivity over area of clot, warmth
symptoms of DVT
Reveresed
no active or passive mvmt performed to involved LE. bed rest and anticoagulant drug therapy are usually indicated
treatment of DVT
Reveresed
no active or passive mvmt performed to involved LE. bed rest and anticoagulant drug therapy are usually indicated
treatment of DVT
Reveresed
(or heterotopic ossification): spontaneous formation of bone in the soft tissue. occurs adjacent to larger joints such as knees or hips.
ectopic bone
Reveresed
edema, decreased ROM, increased temp of involved joint
symptoms of ectopic bone
Reveresed
edema, decreased ROM, increased temp of involved joint
symptoms of ectopic bone
Reveresed
drug intervention usually involves diphosphates that inhibit ectopic bone formation.
treatment of ectopic bone
Reveresed
drug intervention usually involves diphosphates that inhibit ectopic bone formation.
treatment of ectopic bone
Reveresed
occurs due to a loss of sympathetic control of vasoconstriction in combination with absent or severely reduced muscle tone. decrease in systolic blood pressure greater than 20 mm HG after moving from a supine position to a sitting position is typically indicative of orthostatic hypotension.
orthostatic hypotension
Reveresed
occurs due to a loss of sympathetic control of vasoconstriction in combination with absent or severely reduced muscle tone. decrease in systolic blood pressure greater than 20 mm HG after moving from a supine position to a sitting position is typically indicative of orthostatic hypotension.
orthostatic hypotension
Reveresed
complaints of dizziness, light-headedness, nausea, blacking out when going from a horizontal to a vertical position
symptoms of orthostatic hypotension
Reveresed
complaints of dizziness, light-headedness, nausea, blacking out when going from a horizontal to a vertical position
symptoms of orthostatic hypotension
Reveresed
monitoring of vital signs, use of elastic stockings, ace wraps to LEs, abdominal binders. gradual progression to a vertical position using a tilt table is often used. drug intervention is sometimes used to increase blood pressure.
treatment of ortho hypo
Reveresed
monitoring of vital signs, use of elastic stockings, ace wraps to LEs, abdominal binders. gradual progression to a vertical position using a tilt table is often used. drug intervention is sometimes used to increase blood pressure.
treatment of ortho hypo
Reveresed
caused by sustained pressure, friction, and or shearing to a surface. require immediate medical attention and can delay PT/rehab
pressure ulcers
Reveresed
caused by sustained pressure, friction, and or shearing to a surface. require immediate medical attention and can delay PT/rehab
pressure ulcers
Reveresed
reddened area that persists; an open area
symptoms of pressure ulcers:
Reveresed
reddened area that persists; an open area
symptoms of pressure ulcers:
Reveresed
prevention is important. change positions frequently, maintain proper skin care, sit on appropriate cushions, consistent weight shifting, maintenance of proper nutrition and hydration.
treatment of pressure ulcers:
Reveresed
prevention is important. change positions frequently, maintain proper skin care, sit on appropriate cushions, consistent weight shifting, maintenance of proper nutrition and hydration.
treatment of pressure ulcers:
Reveresed
can sometimes be useful for a sci patient.
spasticity
Reveresed
can sometimes be useful for a sci patient.
spasticity
Reveresed
positioning, aquatic therapy, weight bearing, estim, ROM, resting splints and inhibitive casting
spasticity treatment for sci
Reveresed
positioning, aquatic therapy, weight bearing, estim, ROM, resting splints and inhibitive casting
spasticity treatment for sci
Reveresed
phenol blocks, rhizotomies, myelotomies, other surgical interventions
aggressive spasticity treatment for sci
Reveresed
surgical procedure that severs certain tracts within the spinal cord in order to decrease spasticity and improve function
myelotomy
Reveresed
surgical procedure that severs certain tracts within the spinal cord in order to decrease spasticity and improve function
myelotomy
Reveresed
surgical removal of a segment of a nerve in order to decrease spasticity and improve function
neurectomy
Reveresed
surgical removal of a segment of a nerve in order to decrease spasticity and improve function
neurectomy
Reveresed
bladder empties reflexively for a pt with an injury above level of S2. sacral reflex arc remains intact.
neurogenic bladder
Reveresed
lowest segment of the sc with intact strength and sensation.
neurologic level
Reveresed
lowest segment of the sc with intact strength and sensation.
neurologic level
Reveresed
bladder is flaccid as a result of a cauda equina or conus medullaris lesion. sacral reflex arc is damaged
nonreflexive bladder
Reveresed
surgical resection of sensory component of a spinal nerve in order to decrease spasticity and improve function
rhizotomy
Reveresed
surgical resection of sensory component of a spinal nerve in order to decrease spasticity and improve function
rhizotomy
Reveresed
incomplete lesion where some of the innermost tracts remain innervated. characteristics include sensation of the saddle area, mvmt of toe flexors, and rectal sphincter contraction
sacral sparing
Reveresed
incomplete lesion where some of the innermost tracts remain innervated. characteristics include sensation of the saddle area, mvmt of toe flexors, and rectal sphincter contraction
sacral sparing
Reveresed
physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. spinal shock presents with total flaccid paralysis and loss of all reflexes below the level of injury.
spinal shock
Reveresed
physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. spinal shock presents with total flaccid paralysis and loss of all reflexes below the level of injury.
spinal shock
Reveresed
surgical release of a tendon in order to decrease spasticity and improve function
tenotomy
Reveresed
poor or trace motor or sensory function for up to 3 levels below the neurologic level of injury
zone of preservation
Reveresed
poor or trace motor or sensory function for up to 3 levels below the neurologic level of injury
zone of preservation
Reveresed
injury of direct penetration thru skull to brain. ex: gsw, knife or sharp object penetration, skull fragments, direct trauma
tbi: open injury
Reveresed
injury of direct penetration thru skull to brain. ex: gsw, knife or sharp object penetration, skull fragments, direct trauma
tbi: open injury
Reveresed
injury to brain w/o penetration thru skull. ex: concussion, contusion (bruise), hematoma (solid swelling of clotted blood in tissues), injury to extracranial blood vessels, hypoxia, drug overdose, near drowning, acceleration/deceleration injuries
tbi: closed injury
Reveresed
initial injury to brain sustained by impact. ex: skull penetration, skull fractures, and contusions to gray and white matter
tbi: primary injury
Reveresed
initial injury to brain sustained by impact. ex: skull penetration, skull fractures, and contusions to gray and white matter
tbi: primary injury
Reveresed
direct lesion of brain under point of impact. local brain damage is sustained
primary injury: coup lesion
Reveresed
injury that results on opposite side of brain. lesion is due to rebound effect of brain after impact.
primary injury: contrecoup lesion
Reveresed
injury that results on opposite side of brain. lesion is due to rebound effect of brain after impact.
primary injury: contrecoup lesion
Reveresed
brain damage that occurs as a response to the initial injury. ex: hematoma, hypoxia, ischemia, increased intracranial pressure, and post-traumatic epilepsy
secondary injury
Reveresed
brain damage that occurs as a response to the initial injury. ex: hematoma, hypoxia, ischemia, increased intracranial pressure, and post-traumatic epilepsy
secondary injury
Reveresed
hemorrhage that forms btwn skull and dura mater
secondary injury: epidural hematoma
Reveresed
hemorrhage that forms btwn skull and dura mater
secondary injury: epidural hematoma
Reveresed
hemorrhage that forms due to venous rupture btwn dura and arachnoid
secondary injury: subdural hematoma
Reveresed
state of unconsciousness and a level of unresponsiveness to all internal and external stimuli
coma
Reveresed
state of unconsciousness and a level of unresponsiveness to all internal and external stimuli
coma
Reveresed
state of general unresponsiveness with arousal occurring from repeated stimuli
stupor
Reveresed
state of general unresponsiveness with arousal occurring from repeated stimuli
stupor
Reveresed
state of consciousness that is characterized by a state of sleep, reduced alertness to arousal, and delayed responses to stimuli
obtundity
Reveresed
state of consciousness that is characterized by a state of sleep, reduced alertness to arousal, and delayed responses to stimuli
obtundity
Reveresed
state of consciousness that is characterized by disorientation, confusion, agitation, and loudness
delirium
Reveresed
state of consciousness that is characterized by disorientation, confusion, agitation, and loudness
delirium
Reveresed
state of consciousness that is characterized by quiet behavior, confusion, poor attention, and delayed responses
clouding of consciousness
Reveresed
state of consciousness that is characterized by quiet behavior, confusion, poor attention, and delayed responses
clouding of consciousness
Reveresed
state of alertness, awareness, orientation and memory
consciousness
Reveresed
state of alertness, awareness, orientation and memory
consciousness
Reveresed
glasgow coma scale, CAT scan, x-ray, MRI, cerebral angiography, evoked potential/electroencephalogram, positron emission tomography, ventriculography, radioisotope imaging
acute diagnostic management
Reveresed
glasgow coma scale, CAT scan, x-ray, MRI, cerebral angiography, evoked potential/electroencephalogram, positron emission tomography, ventriculography, radioisotope imaging
acute diagnostic management
Reveresed
neuro assessment tool used initially after injury to determine arousal and cerebral cortex function. total score of 8 or less correlates to coma in 90% of patients. scores of 9-12 indicate moderate brain injuries and scores from 13-15 indicate mild brain injuries.
glasgow coma scale
Reveresed
neuro assessment tool used initially after injury to determine arousal and cerebral cortex function. total score of 8 or less correlates to coma in 90% of patients. scores of 9-12 indicate moderate brain injuries and scores from 13-15 indicate mild brain injuries.
glasgow coma scale
Reveresed
neuro assessment tool. 1-8 levels. 1=no response. 2=generalized response. 3=localized response. 4=confused-agitated (heightened state of activity. behavior is bizarre.) 5=confused-inappropriate (pt is able to respond to simple commands fairly consistently, but more complex task responses are non-purposeful, random or fragmented.) 6=confused-appropriate (pt shows goal oriented behavior, but is dependent on external input or direction). 7=automatic-appropriate: pt appears appropriate and oriented within the hospital and home setting but frequently robot-like. 8=purposeful-appropriate (pt is able to recall and integrate past and recent events and is aware and responsive to environment.
rancho los amigos (levels of cognitive functioning
Reveresed
neuro assessment tool. 1-8 levels. 1=no response. 2=generalized response. 3=localized response. 4=confused-agitated (heightened state of activity. behavior is bizarre.) 5=confused-inappropriate (pt is able to respond to simple commands fairly consistently, but more complex task responses are non-purposeful, random or fragmented.) 6=confused-appropriate (pt shows goal oriented behavior, but is dependent on external input or direction). 7=automatic-appropriate: pt appears appropriate and oriented within the hospital and home setting but frequently robot-like. 8=purposeful-appropriate (pt is able to recall and integrate past and recent events and is aware and responsive to environment.
rancho los amigos (levels of cognitive functioning
Reveresed
inability to create new memory. usually last to recover after a comatose state.
anterograde memory impairment
Reveresed
inability to create new memory. usually last to recover after a comatose state.
anterograde memory impairment
Reveresed
time btwn injury and when patient is able to recall recent events. pt does not recall injury or events up until this point of recovery.
post-traumatic memory impairment
Reveresed
time btwn injury and when patient is able to recall recent events. pt does not recall injury or events up until this point of recovery.
post-traumatic memory impairment
Reveresed
inability to remember events prior to the injury. retrograde amnesia may progressively decrease with recovery
retrograde amnesia
Reveresed
inability to remember events prior to the injury. retrograde amnesia may progressively decrease with recovery
retrograde amnesia
Reveresed
diuretic agents to decrease volume of fluid in brain and pressure (mannitol, glycerol) anticonvulsant agents to prevent early seizures in head injury (dilantin, tegretol, klonopin) calcium channel blocker agents to improve outcome for traumatic subarachnoid hemorrhage (nimotop), antidepressant agents to reduce aggressive or disruptive behavior (elavil, prozac) electrolytes because adequate stores are needed during acute phase of head injury (magnesium sulfate) selective serotonin reuptake inhibitor agents may benefit patients with head injury and emotional inhibition or impairment (zoloft, paxil)
pharmacological interventions for tbi management
Reveresed
quick acting nervous system mechanisms that influence heart rate when triggered.
cardiac reflexes
Reveresed
quick acting nervous system mechanisms that influence heart rate when triggered.
cardiac reflexes
Reveresed
produced by a group of mechanoreceptors that are found w/in walls of the heart. the reflex is activated when pressure rises w/in the large arteries above 60 mm Hg. peak in activity at approx 180 mm Hg. results in vasodilation secondary to inhibition of the vasomotor centers w/in the medulla as well as a decrease in heart rate and strength of contraction secondary to vagal stimulation
baroreceptor reflex
Reveresed
produced by a group of mechanoreceptors that are found w/in walls of the heart. the reflex is activated when pressure rises w/in the large arteries above 60 mm Hg. peak in activity at approx 180 mm Hg. results in vasodilation secondary to inhibition of the vasomotor centers w/in the medulla as well as a decrease in heart rate and strength of contraction secondary to vagal stimulation
baroreceptor reflex
Reveresed
occurs when mechanoreceptors embedded within the right atrial myocardium respond to an increase in pressure and stretch (distention of the right atrium). stimulates the vasomotor centers of the medulla and results in increased sympathetic input and heart rate. reflex can also influence a decrease in heart rate when heart is beating too fast.
bainbridge reflex
Reveresed
responds to need for increased depth and rate of ventilation. chemoreceptors are located on the carotid and aortic bodies and detect lack of oxygen, responding to an increase in arterial CO2 levels.
chemoreceptor reflex
Reveresed
responds to need for increased depth and rate of ventilation. chemoreceptors are located on the carotid and aortic bodies and detect lack of oxygen, responding to an increase in arterial CO2 levels.
chemoreceptor reflex
Reveresed
lub: mitral and tricupsid valves closing at beginning of systole
Heart sounds: S1
Reveresed
lub: mitral and tricupsid valves closing at beginning of systole
Heart sounds: S1
Reveresed
dub: aortic and pulmonary valves closing at onset of diastole
Heart sounds: S2
Reveresed
ventricular gallop: abnormal in older adults: noncompliant left ventricle. may be associated with CHF
Heart sounds: S3
Reveresed
ventricular gallop: abnormal in older adults: noncompliant left ventricle. may be associated with CHF
Heart sounds: S3
Reveresed
vibration of ventricular wall with ventricular filling and atrial contraction; may be associated with hypertension, stenosis, hypertensive heart disease or myocardial infarction
Heart sounds: S4
Reveresed
vibration of ventricular wall with ventricular filling and atrial contraction; may be associated with hypertension, stenosis, hypertensive heart disease or myocardial infarction
Heart sounds: S4
Reveresed
amount of blood pumped out of heart through the aorta each minute. males: 5.6L/min. females: 10-20% less. CO=stroke volume X heart rate
cardiac output
Reveresed
amount of blood pumped out of heart through the aorta each minute. males: 5.6L/min. females: 10-20% less. CO=stroke volume X heart rate
cardiac output
Reveresed
amount of blood comes from the veins to the right atrium each minute
venous return
Reveresed
amount of blood comes from the veins to the right atrium each minute
venous return
Reveresed
amount of blood ejected from ventricles with each contraction. factors that can influence stroke volume include preload (influenced by end-diastolic volume), afterload, and contractility
stroke volume
Reveresed
amount of blood pumped out of heart per minute per sq meter of body mass. normal ranges btwn 2.5 to 4.2 L/min/meter2
cardiac index
Reveresed
amount of blood pumped out of heart per minute per sq meter of body mass. normal ranges btwn 2.5 to 4.2 L/min/meter2
cardiac index
Reveresed
usually 7-8% of body weight. blood is pumped thru body at 30 cm/sec w/total circulation time of 20 seconds.
blood volume
Reveresed
usually 7-8% of body weight. blood is pumped thru body at 30 cm/sec w/total circulation time of 20 seconds.
blood volume
