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inability to perform PURPOSEFUL learned mvmts although there is no sensory or motor impairment
asymmetrical tonic neck reflex (ATNR)
with head turned to one side, arm and leg on face side are extended and arm and leg on scalp side are flexed. this reflex could interfere with an infant's ability to roll from prone to supine.
INVOLUNTARY ALTERNATING SPASMODIC CONTRACTION of a muscle precipitated by a QUICK STRETCH REFLEX. characteristic of an upper motor neuron lesion
upper lobes anterior segment
supine with pillow under knees. claps btwn clavicle and nipple on each side
upper lobes apical segment
leans back on pillow at 30 degree angle against therapist, bed flat. claps over area btwn clavicle and top of scap on each side
upper lobes posterior sgmt
pt leans over pillow at 30 degree angle. claps over upper back on each side.
left upper lobe lingular
foot of bed elevated 16 inches. lies prone on rt side and rotates 1/4 turn backward. claps over left nipple area
right middle lobe
foot of bed elevated 16 inches. prone on left side and rotates 1/4 turn backward. claps over right nipple area
lower lobe anterior basal
foot of bed elevated 20 inches. sidelying, head down, pillow under knees. claps over lower ribs.
lower lobe lateral basal
foot of bed elevated 20 inches. prone, head down, rotates 1/4 turn upward. claps over uppermost portion of lower ribs.
lower lobes posterior basal
foot of bed elevated 20 inches. prone, head down, pillow under hips. claps over lower ribs close to spine on each side
lower lobes superior segments
bed flat. patient prone with 2 pillows under hips. claps over middle of back at tip of scap on either side of spine
usually caused by arteriosclerosis. acute stage: acute arterial obstruction, distal pain, sudden onset. vascular: decreased or absent pulses, pallor of forefoot on elevation, dependent rubor. risk factors: smoking, diabetes, hypertension
severe muscle ischemia, intermittent claudication, worse with exercise, relieved by rest. rest pain means severe involvement. will present with muscle fatigue, cramping, numbness, paresthesia overtime
chronic venous insufficiency
acute stage: dvt, calf pain, aching, EDEMA, muscle tenderness. caused by vein obstruction
chronic venous insufficiency: skin
ulcers: sides of ankles, mostly MEDIAL MALLEOLUS. will be DARK, BROWN, MAY LEAD TO STASIS DERMATITIS, CELLULITIS, skin thick
vascular: venous dilation. edema: moderate to severe. risk factors: venous hypertension, varicose veins. pain: minimal to moderate steady pain. aching pain with prolonged standing or sitting
w/c for C6
manual w/c w/friction surface and hand rims independently. ability to drive a car independently. use of radial wrist extensors
w/c for C7
manual w/c w/friction surface hand rims independently. has use of triceps (elbow extension - can push up on arm rests)
TLC-total lung capacity
total amt of air lungs can hold. total amount after a max inspiration. IRV+TV+ERV+RC
max volume of air that can be forcefully expired after a max inspiration. 4000-5000 mL
when head drops into extension for a few inches the arms abduct with fingers open, crosses trunk into adduction. 28 wks of gestation to 5 months
plantar grasp reflex
pressure to base of toes will produce reflex of toe flexion. 28 weeks of gestation to 9 months
positive support reflex
weight placed on balls of feet will produce stiffening or legs and trunk into extension. 35 weeks of gestation to 2 months
cold therapy/cryotherapy contraindications
infection, ischemic tissue, peripheral vascular disease, hypertension
hot therapy/superficial heat contraindications
arterial disease, bleeding, circulation issues, malignancy, thrombophlebitis
lumbar traction guidelines
supine or prone. force of less than half of body weight for initial treatment, 25 to 50% of body weight required for actual separation. for muscle spasm, 25% of body weight should be used.
used primarily to reduce chronic or post traumatic edema. can use for venous insufficiency
standard manual w/c dimensions
average: 16x18x20 (depth, width, height), BUT to properly measure, seat width=hip width + 2 inches; seat depth=posterior buttock to popliteal space - 2 inches. if those were both 16 after measuring a patient, best fit would be seat width 18 inches, seat depth 14 inches.
involves multilevel impingement in spine ligaments. pain is worse when ambulating or extending spine.
best exercises for ankylosing spondylitis
pts tend to assume flexed postures, so back extension exercises would be most important. ankylosing spondylitis is a form of rheumatic disease w/inflammation of spine. will exhibit posture such as forward head, increased kyphosis, loss of lumbar curvature.
which nerve is compressed - carpal tunnel syndrome
median. causes atrophy and weakness of thenar muscles and lateral lumbricals. positive tinel's and phalens
regular exercise for diabetics will
lower blood glucose levels and decrease amount of insulin required
compensations of shoulder motions
flexion: extension of spine. abduction: lateral flexion. scap protraction: IR. scap elevation: shoulder hyperextension
orthostatic hypotension after bed rest
most likely result of inadequate ventricular filling during diastole - decreased venous tone
traumatic brain injury - tonic reflexes
tonic reflexes are released. TL supine reflex results in flexor stimulation when in prone, and extensor tone while in supine
inflammation of long head. impingement of proximal tendon btwn anterior acromion and bicipital groove. speed's test
2 types: structural: irreversible lateral curve with rotation. nonstructural: reversible lateral curve w/o rotation which straightens with flexion. over 45 degrees would require surgery
anterior/posterior slippage of one vertebra on another following bilateral spondylolysis. avoid extension, lateral flexion, rotation.
tibial plateau fracture
valgus and compressive forces to knee with knee in flexion. often in conjunction with MCL injury
spasm/tightness of SCM. laterally flex towards affected side, rotation away from affected side.
ulnar collateral ligament injury
due to repetitive valgus strain (overhead throw). pain at medial elbow at distal insertion, sometimes parasthesia in ulnar nerve distribution with positive tinel's sign.
firm (stretch) ex: ankle dorsiflexion. hard (bone to bone) ex: elbow extension. soft (soft tissue approximation) ex: elbow flexion, knee flexion
abnormal end feels
empty: cannot reach end feel due to pain, ex: joint inflammation, fracture. firm: increased tone, tightening of capsule. hard: fracture, osteoarthritis. soft: edema, synovitis.
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
glute medius weakness, excessive lateral trunk flexion and weight shifting over stance leg. drop in pelvis on the left during right stance phase is often indicative of right gluteus medius weakness.
degree of angulation when measuring from midpatella to ASIS, and tibial tubercle. measured in supine with knee straight: 13 degrees average for male, 18 degrees average for female. excessive Q angle can lead to pathology and abnormal tracking.
Brunnstrom's 7 stages of recovery (spasticity and tone)
1=no volitional mvmt, 2=beginning of spasticity, 3=synergies are voluntarily, spasticity increases, 4=decreasing spasticity, 5 further decrease spasticity, 6=isolated jt movements with coordination, 7=normal motor function is restored
UE: D1 Flexion
starts in shoulder flexion, adduction and ER, forearm supination, wrist flexion, and finger flexion. ends in shoulder extension, abduction, IR, forearm pronation, wrist extension and finger extension.
UE: D1 Extension
starts in shoulder extension, abduction, IR, forearm pronation, wrist extension and finger extension.
carpal bones mnemonic
Some Lovers Try Positions That They Can't Handle: Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate (proximal row, then distal row)
PNF technique "repeated contractions" should be applied when
at the point where the desired muscular response begins to diminish
To increase pt's ambulation distance (w/chronic arteriosclerotic vascular disease) with INTERMITTENT CLAUDICATION, best way is to:
short duration, frequent intervals
to stretch hip flexors (could be in Parkinson's patient)
prone lying would be best choice. increased flexibility in hip flexors will improve standing posture
when ascending a curb with axillary crutches using 3 pt gait, should lead with
the uninvolved lower extremity.
action that would place greatest stress on achilles tendon
eccentric contraction of gastroc and soleus
a quad cane should be used in the UE that is
opposite from affected LE. the longer legs should be positioned away from patient
when working with a Parkinson's patient on controlled mobility, what would be best intervention? when working with same patient on motor control, which technique should be utilized?
promote weight shifting and rotational trunk control for controlled mobility. for motor control, should use rhythmic initiation.
which component of the vertebral artery test is most likely to assess patency of intervertebral foramen?
extension to assess intervertebral foramen; lateral flexion and rotation have a greater effect on vertebral artery
movements in frontal plane occur as
side to side movements, such as ab and adduction or lateral movements. (pt rehabing from ankle surgery would have most difficulty in 6 inch "lateral" step down)
most appropriate rate to release pressure when obtaining bp measurement?
rate of 2-3 mm Hg per second.
most significant differences between heat exhaustion and heat stroke:
mental status and skin temp. heat stroke: altered mental status and elevated skin temp.
to avoid burning a pt during iontophoresis, pta should
increase size of cathode relative to anode (decreases the density)
post polio syndrome
symptoms that occur years after onset of poliomyelitis. remaining motor units become more dysfunctional. (sensation not affected.)
pronation of foot consists of:
eversion of heel, abduction of forefoot and dorsiflexion of subtalar and midtarsal joints
confused-agitated patients (rancho los amigos) would benefit from:
numerous activities since they have a short attention span.
mean angle of anteversion in an adult
8-15 degrees. patients with excessive anteversion of hip typically present with excessive medial rotation and limited lateral rotation of hip
dysmetria (inability to modulate movement-pts will overestimate or underestimate targets) is a common clinical finding with _______ dysfunction
how to calculate heart rate by QRS complexes
if there are eight QRS complexes in a six second interval, the therapist should multiply the number by ten to determine heart rate
guillain barre syndrome symptoms
rapid, progressive loss of motor function...can cause difficulty breathing, areflexia and weakness; usually sensation is normal
decorticate and decerebrate posturing
decorticate: UE flexion and LE extension. decerebrate: UE and LE extension
positive support reflex
promotes extension of LE and trunk w/weight bearing through balls of the feet. reflex normally integrates at 2 months of age
length of treatment when using u/s?
5 minutes for area that is 2-3 times the size of the transducer face
lateral trunk bending towards affected side of transfemoral amputee would indicate what problem with prosthesis?
generate info related to discriminative sensations. (2 point discrimination, kinesthesia in a sensory assessment)
acute burn produces hypermetabolism and results in:
increased oxygen consumption, increased minute ventilation, and increased core temperature.
genu recurvatum patient would benefit from increasing
plantar flexion stop of ankle foot orthosis. this would prevent PF after heel strike and inhibit full extension of knee during midstance
a lesion affecting the sensory cortex often results in impairments including loss of:
perception, sensation, proprioception, and diminished motor control
carries info from cerebral cortex to spinal nerves. the tract's projections are primarily contralateral
level or urea in the blood provides a gross estimate of what?
kidney function. increased blood urea nitrogen level can be indicative of dehydration, pre-renal failure or renal failure. normal blood urea nitrogen level for an adult is 10-20 mg/dL
progressive CNS disease marked by intermittent damage to myelin sheath. patients tend to fatigue later in day, so exercise regimen would be best in mornings.
failure to stabilize scapula while measuring glenohumeral abduction will lead to:
upward rotation and elevation of scapula
humeral head slides posteriorly on glenoid fossa during shoulder medial rotation and as a result places pressure on the:
passive insufficiency occurs when
a 2 joint muscle is stretched across two joints at the same time. when performing passive knee flexion, the 2 joint knee extensors are placed on stretch and therefore in the presence of insufficient length may contribute to a limitation in knee flexion.
infant's pulse is often assess at the ___ artery
brachial. an older child's pulse is often assessed at the radial artery.
RR _____ a intensity of exercise plateaus
decreases. patient will accommodate to level of exercise and RR will tend to decrease.
shoulder: medial rotators and adductors provide support for the
anterior joint capsule. these muscles should be strengthened after anterior shoulder dislocation
dermatome: shoulder area, clavicular area, upper scap area. myotome: trap, levator scap. parasthesias: along clavicle/upper scap
dermatome: deltoid area, anterior aspect of entire arm to base of thumb. myotome: supraspinatus, infraspinatus, deltoid, biceps. reflexes: biceps, brachioradialis
dermatome: anterior arm, radial side of hand to thumb and index finger. myotome: biceps, supinator, wrist extensor. parasthesias: thumb and index finger. reflex: biceps, brachioradialis
dermatome: lateral arm and forearm to index, long and ring fingers. myotome: triceps, wrist flexors. parasthesias: index, long and ring fingers. reflex: tricep
dermatome: medial arm and forearm to long, ring and little fingers. myotome: ulnar deviators, thumb extensors, thumb adductors. parasthesias: little finger alone or with 2 adjacent fingers. reflex: triceps
dermatome: back, over trochanter and groin. myotome: none. parasthesias: groin, after holding posture, which causes pain. reflex: none
dermatome: back, front of thigh to knee. myotome: psoas, hip adductors. parasthesias: occasionally anterior thigh. reflexes: none
dermatome: back, upper buttock, anterior thigh and knee, medial lower leg. myotome: quads, thigh. parasthesias: medial knee, anterior lower leg. reflex: knee jerk sluggish, pain on full SLR
dermatome: medial buttock, lateral thigh, medial leg, dorsum of foot, big toe. myotome: anterior tib, extensor hallicus. parasthesias: medial aspect of calf and ankle. reflex: SLR limited, neck flexion pain, weak or absent knee jerk, side flexion limited.
dermatome: buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second and third toes. myotomes: extensor hallicus, peroneals, gluteus, medius, DFs, hamstring. parasthesias: lateral aspect of leg, middle 3 toes. reflex: SLR limited one side, neck flexion painful
dermatome: buttock, thigh, posterior leg. myotome: calf and hamstrings, gluteal wasting, peroneals, PFs. parasthesias: lateral toes and foot, plantar aspect of foot. reflex: achilles reflex weak or absent
dermatome: buttock, thigh, posterior leg. myotome: calf and hamstrings, wasting of glutes, PFs. parasthesias: lateral leg, knee and heel.
dermatome: perineum, genitals, lower sacrum. myotome: bladder, rectum. parasthesias: genital area
dermatomes: medial upper arm to medial elbow, pectoral and mid scap areas, neck flexion. myotomes: scap forward and backward, neck flexion
sx: polydipsia, polyuria, rapid weight loss, polyphagia, elevation of blood glucose levels
hip joint consists of
convex femoral head within a concave acetabulum. hip flexion requires a posterior and inferior translation of the femoral head within the acetabulum
a minor lesion of a muscle or tendon will yield
mild to mod pain with resistance, without a decrease in strength
plumb line measurements
normal posture: thru lobe of ear, midway thru trunk, thru greater trochanter, slightly anterior to midline thru knee, and slightly anterior to lateral malleolus
e-stim: when measuring phase charge, unit of measure is
coulomb. phase charge is represented by the area under a single phase waveform
duchenne muscular dystrophy
proximal muscle weakness first, then progresses to distal musculature and interferes with adl's
abnormal bone growth in tissue. sx include decreased ROM, local swelling, warmth. often occurs in patients following a head injury
width of bladder should be 40% circumference of midpoint of limb. average size adult=5-6 inches
which muscles of respiration are the most active during forced expiration
internal intercostals. depress ribs during forceful expiration
emphysema will present with
hyperinflated lungs and chest wall becomes fixed in hyperinflated position. total lung capacity and dead space in lungs significantly increase
lack of full knee extension with full contraction of the quads. pts with extension lag have greater passive extension than active extension.
shortening of latissimus dorsi presents as
limitation of shoulder flexion or abduction due to muscles origin on external lip of iliac crest and its insertion on intertubercular groove of humerus
deals with errors in concepts and sequencing of tasks. most commonly due to a lesion in patient's dominant parietal lobe of cerebrum
residual limb wrapping
6 inch ace wrap most appropriate for transfemoral amputation. 4-5 inch most appropriate for transtibial amputation
involved LE will abd/adduct with applied resistance to the uninvolved LE in the same direction
raising the involved UE above 100 degrees with elbow extension will produce extension and abduction of fingers
inability to perform purposeful learned movements, although there is no sensory or motor impairment.
hemiparesis and hemiplegia
paresis: weakness on one side of body, plegia: paralysis on one side of body
ideational and ideomotor apraxia
ideational: inability to formulate an initial motor plan and sequence tasks where proprioceptive input necessary for mvmt is impaired....ideomotor: person plans a movement or task, but cannot volitionally perform it.
complete: no preserved motor or sensory function below level of lesion. incomplete: may be scattered motor function, sensory function or both below level of lesion
anterior cord syndrome
incomplete lesion from compression and damage to anterior part of cord. injury is usually cervical flexion. loss of motor function, pain, and temp sense below lesion due to damage of corticospinal and spinothalamic tracts
incomplete lesion caused by stab wound, which produces hemisection of spinal cord.
cauda equina injuries
injury below L1 spinal level where long nerve roots transcend. usually incomplete due to large number of nerve roots in area. considered a peripheral nerve injury. flaccidity, areflexia, impairment of bowel and bladder function. full recovery not typical due to distance needed for axonal regeneration
central cord syndrome
incomplete lesion from compression and damage to central portion of sc. usually cervical hyperextension that damages spinothalamic tract, corticospinal tract and dorsal columns. UE present with greater involvement than LE. greater motor deficits than sensory deficits.
posterior cord syndrome
compression of posterior spinal artery. loss of pain perception, proprioception, two point discrimination and stereognosis. motor function is preserved.
ectopic bone, or heterotopic ossification
refres to spontaneous formation of bone in soft tissue. occurs adjacent to larger joints such as knees or hips. early sx are edema, decreased ROM, increased temp of involved joint
incomplete lesion where some of innermost tracts remain innervated. sensation of saddle area, mvmt of toe flexors, and rectal sphincter contraction
surgical procedure that severs certain tracts within sc in order to decrease spasticity and improve function
bladder empties reflexively for a pt with an injury above level of S2. sacral reflex arc remains intact
bladder is flaccid as a result of cauda equina or conus medullaris lesion. sacral reflex arc is damaged
surgical resection of sensory component of a spinal nerve in order to decrease spasticity and improve function
surgical removal of a segment of a nerve in order to decrease spasticity and improve function
occurs physiologically 30 to 60 mins after trauma to sc and can last up to several weeks. presents with total flaccid paralysis and loss of all reflexes below level of injury
zone of preservation
poor or trace motor or sensory function for up to 3 levels below neurologic level of injury
glasgow coma scale
total score of 8 or less indicate coma in 90% of pts. score of 9-12 indicate moderate brain injuries, score of 13 to 15 indicate mild brain injuries
anterograde memory: inability to create new memory. post-traumatic amnesia: does not recall injury or events up until point of recovery. retrograde: inability to remember events prior to the injury.
rancho los amigos: levels of cognitive functioning
1. no response, 2. generalized response: inconsistent and nonpurposeful, 3. localized response: reacts specifically but inconsistently, 4. confused-agitated: heightened state of activity. bizarre and nonpurposeful behavior, 5. confused-inappropriate: responds to simple commands consistenly but responds randomly or inappropriate with increased complexity of commands, 6. confused-appropriate: shows goal-directed behavior, but is depended on external input, 7. automatic appropriate: appropriate and purposeful but robot-like, 8. purposeful appropriate: able to recall and integrate past and present events, and is aware and responsive to environment.
CPR Adult Flow Chart
No movement or response-phone 911, emergency response-open airway; check breathing-if no breathing, administer 2 breaths that make chest rise-if no response, check pulse. if pulse-rescue breathing only at 10-12 breaths/min-if no pulse, begin CPR with 30 compressions and 2 breaths. push hard and fast (100/min) and release completely. minimize interruptions during compressions. continue to perform CPR until medical assistance arrives, breathing, coughing or other signs of circulation return, the patient begins to move or you cannot physically continue due to exhaustion.
CHF: congestive heart failure
usually results from coronary artery disease when heart is unable to maintain adequate cardiac output. characterized by abnormal retention of fluid and results in diminished blood flow to the tissue and congestion of the pulmonary and/or systemic circulation. symptoms: pulmonary edema, dyspnea when lying down, S3 gallop, exertional hypotension, weight gain within hours, increased resting heart rate
CAD: coronary artery disease
narrowing or blockage of coronary arteries that may produce ischemia and necrosis of the myocardium. inability for vasodilation and arteries cannot meet the metabolic demands. this will produce ischemia and ultimately necrosis. significant blockage is present over 75%
typical lung volumes and capacities
tidal volume=500mL, expiratory reserve volume=1000mL, vital capacity=4000-5000mL, inspiratory capacity=3000-4000mL, 75-80% vital capacity, 55-60% of total lung capacity
metabolic alkalosis and metabolic acidosis
m. alkalosis: pH is greater than 7.45. m. acidosis: pH is less than 7.35
respiratory alkalosis and respiratory acidosis
r.alkalosis: PCO2 less than 40mmHg (hypocapnia and hyperventilation). r. acidosis: PCO2 greater than 40mmHg (hypercapnia, hypoventilation)
used to prevent accumulation of fluid by directing inspired air to predetermined areas. applying pressure downward and inward during exhalation.
medical emergency. sudden dilation of right ventricle of heart secondary to a pulmonary embolus. rt sided heart failure will occur if not treated. chronic cough, chest pain, distal swelling, dyspnea, fatigue and weakness
most occlusive to non-occlusive
hydrocolloids, hydrogels, semi-permeable foam, semi-permeable film, impregnated gauze, alginates, and traditional gauze
used for partial to full thickness wounds, can be used with granular or necrotic wounds. provides moist environment for wound healing. enables autolytic debridement. good for wounds that have moderate exudate. cannot be used on infected wounds. (hydrogels similar but used for wounds with less exudate)
foam dressings - hydrophilic polyurethane base
allow exudates to be absorbed into foam. provide protection over partial and full thickness wounds
calcium salt of alganic acid that is extracted from seaweed. highly permeable and non-occlusive. require a secondary dressing. used on partial and full thickness draining wounds such as pressure wounds or venous insufficiency ulcers. often used on infected wounds due to likelihood of excessive drainage
removes only nonviable tissues from a wound. often performed by sharp debridement, enzymatic debridement, and autolytic debridement. (nonselective debridement removes both viable and nonviable tissue. often termed mechanical and is most commonly performed by wet-to-dry dressings, wound irritation and hydrotherapy-whirlpool)
pressure ulcer staging
Stage I: intact skin, change in skin color, temp, stiffness or sensation, Stage II: partial thickness skin loss that involves epidermis and/or dermis. superficial and presents as an abrasion, blister or shallow crater. Stage III: full thickness skin loss involving damage or necrosis of subcutaneous tissue that may go down to underlying fascia. Stage IV: full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures.
zones of injury (burns)
zone of coagulation: area of burn that received most severe injury along with irreversible cell damage. zone of stasis: area of less severe injury that possesses reversible damage and surrounds the zone of coagulation. zone of hyperemia: area surrounding the zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage
superficial burn: involves outer epidermis only. red with possible slight edema. healing occurs w/o scarring. Superficial partial-thickness: involves epidermis and upper portion of dermis. extremely painful w/blisters. minimal to no scarring. Deep partial thickness burn: complete destruction of epidermis and majority of dermis. discolored with broken blisters and edema. damage to nerve endings may result only in moderate levels of pain. healing occurs with hypertrophic scars and keloids. Full thickness: complete destruction of epidermis and dermis along with partial damage of subcutaneous fat layer. presents with eschar formation and minimal pain. requires grafting and may be susceptible to infection. Subdermal burn: complete destruction of epidermis, dermis and subcutaneous layer. may involve muscle and bone.
allograft: from another human or cadaver. autograft: taken from patient's own body. heterograft (or xenograft): taken from another species. mesh: altered to create a mesh like pattern to cover larger area.
metabolic condition characterized by heightened osteoclast activity. excessive bone formation lacks true structural integrity. bone appears large but lacks strength. medication for treatment
hormones...glands of system include: hypothalamus, pituitary, thyroid, parathyroid, adrenal, pancreas, ovaries, testes
endocrine system dysfunction: signs and symptoms
neuromuscular: muscle weakness, myalgia, arthralgia, stiffness, osteoarthritis, muscle atrophy, adhesive capsulitis. systemic: polydipsia, growth dysfunction, skin pigmentation dysfunction, polyuria, increased vital signs, hair dysfunction, nervousness or anxiety
hypofunctioning of adrenal cortex. electrolyte imbalance. weakness, anorexia, weight loss, altered pigmentation. if untreated could lead to death. treatment usually corticosteroids and mineralocorticoids.
excessive amount of cortisol. persistent hyperglycemia, growth failure, truncal obesity, moon shaped face, weakness, acne, hypertension. depression, poor concentration, weight loss.
decreased levels of thyroid hormones in bloodstream. fatigue, weakness, decreased heart rate, weight gain, constipation. tx includes oral thyroid hormone replacement therapy.
excessive levels of thyroid hormones in blood. nervousness, excessive sweating, weight loss, increase in bp, bulging eyes, myopathy, enlarged gland. radioactive iodine, surgery
type 1 diabetes mellitus
pancreas fails to produce adequate insulin. rapid onset of sx, polyphagia, weight loss, polyuria, polydipsia, blurred vision, dehydration, fatigue. tx: insulin injections to maintain proper blood levels.
type 2 diabetes mellitus
when body cannot properly respond to insulin. sx: ketoacidosis does not occur since insulin is still produced.
rehab considerations for pts with diabetes
peripheral neuropathies, small vessel angiopathy, tissue ischemia and ulceration, impaired wound healing, tissue necrosis and amputation, sudden hypoglycemia, diet and physical activity, proper skin care and shoe evaluation
phases of tissue healing
inflammation: 1-6 days, presents with calor, rubor, tumor, dolur, clot formation and phagocytosis. proliferative phase: day 3-day 20, involves connective tissues and epithelial cells, collagen production, wound contracture, and neurovascularization occur. maturation phase: day 9-ongoing, longest in duration-can last over a year, collagen synthesis and lysis balance, collagen fiber orientation.
extremity tank: used for distal upper or lower extremity, lowboy: larger parts of extremities and permits long sitting-water up to midthoracic level. highboy: larger parts of extremities and trunk and permits sitting in chest high water with hips and knees flexed. hubbard: full body emersion.
qualitative vs quantitative research
qualitative: derives data from observation, interviews or verbal interactions and focuses on meaning and interpretation of participants. quantitative is based on collected objective data that can be subjected to statistical analysis
types of clinical evidence
systematic: comprehensive survey of topic which all primary studies have been identified, analyzed and summarized. meta-analysis: specific statistical strategy for deriving a single numerical estimate from results of several randomized controlled trials. randomized controlled trials (RCT): normally used to assess relative effect of a specific intervention. patients are randomized and split into 2 groups with one receiving intervention, and one as the control group. cohort study: observational study of subjects w/a specific condition and/or are receive a particular treatment. case control: involves pts who already have a particular disease being matched with controls and comparing their histories. cross-sectional study: examines frequency and characteristics of a disease or specific condition in a population at a particular point in time "snapshot." case report or case series: describes medical history of a single patient.
test designed to assess a patient's risk for falling. 14 tasks, each scored from 0-4. max score is a 56 with a score less than 45 indicating an increased risk of falling.
another tool assessing risk for falling. patients with a total score of less than 19 indicates a high risk for a fall. tool has combined max total of 28.
mini mental state exam
screening patients for cognitive impairments. one point for correct answer and 0 for incorrect answer. max score of 30, with progressive level of cognitive impairment noted with a score of 24 or less.
short portable mental status questionnaire
10 item screening tool mainly used in geriatrics. orientation and memory, practical skills and math skills are assessed. max score of 10, with a score below 8 indicating cognitive impairment. lower score below 8 the more significant the cognitive impairment.
borg rating of perceived exertion scale (endurance)
tool designated to measure perceived exertion, dyspnea, and exercise intensity. original scale measures 6-20 points and revised scale measures 0-10 points. score of 20 (original) or 10 (new) indicates high intensity exercise that cannot be completed due to exhaustion.
six minute walk test
tool used to determine a patient's functional exercise capacity. allows for observation of heart rate and oxygen consumption during activity.
functional independence measure (FIM)
used in rehab hospitals in order to determine a patient's level of disability and burden of care.
tool designed to measure the amount of assistance needed to perform 10 different activities with a total max score of 100.
special tests: shoulder
dislocation (apprehension test), biceps tendon pathology: lundington's, speed's, yergason's; rotator cuff/impingement: drop arm, hawkins-kennedy impingement, neer impingement, supraspinatus; thoracic outlet syndrome: adson, allen, costoclavicular syndrome, roos, wright (hyperabduction), miscellaneous: glenoid labrum tear
special tests: elbow
ligamentous instability (varus stress, valgus stress), epicondylitis: cozen's, lateral & medial epicondylitis tests, mill's test. neurological dysfunction: tinel's sign
special tests: wrist/hand
ligamentous instability: ulnar collateral ligament instability test. vascular insufficiency: allen test, capillary refill test. contracture/tightness: bunnel-littler test, tight retinacular ligament test. neuro dysfunction: froment's sign, phalen's test, tinel's sign. miscellaneous: finkelstein test, grind test, murphy sign
special tests: hip
contracture/tightness: ely's, ober's, piriformis, thomas, tripod sign, 90-90 slr test. pediatric: barlow's, ortolani's. miscellaneous: craig's, patrick's (faber), quadrant scouring test, trendelenburg test.
special tests: knee
ligamentous instability: anterior drawer, lachman, lateral pivot shift, posterior drawer, posterior sag, slocum test, valgus stress, varus stress. meniscal pathology: apley's compression, bounce home, McMurray. swelling: brush, patellar tap. miscellaneous: clarke's sign, hughston's plica, noble compression, patellar apprehension
special tests: ankle
ligamentous instability: anterior drawer, talar tilt. miscellaneous: homan's sign, thompson, tibial torsion, true leg length discrepancy
nerves of the brachial plexus
somatic network of nerves that originate near the neck and shoulder. These nerves begin at the spinal cord in the neck and control the hand, wrist, elbow, and shoulder
brachial plexus: dorsal scapular nerve
originates from rami of plexus. innervates rhomboids, levator scapulae
originates from lateral cord of plexus: innervates coracobrachialis, biceps brachii, brachialis
bp: lateral root of the median
originates from the lateral root of plexus: innervates flexor muscles in forearm, except flexor carpi ulnaris and five muscles in hand.
originates from medial cord of plexus: innervates 1 1/2 muscles of forearm and most small muscles of hand
bp: medial root of median
originates from medial cord of plexus: innervates flexor muscles in forearm, except flexor carpi ulnaris and five muscles of hand
bp: lower subscapular
originates from posterior cord of plexus: innervates subscapularis, teres major
originates from posterior cord of plexus: innervates brachioradialis, extensor muscles of forearm.
achilles tendon rupture
impaired blood flow along with degeneration will make tendon more susceptible to injury. occurs most frequently when pushing off a weight bearing extremity with an extended knee. patient will present with swelling over distal tendon, palpable over calcaneal tuberosity, and pain & weakness with plantar flexion. special tests: thompson's and possible O'brien needle test by physician
inflammation and fibrotic thickening of anterior joint capsule. primary is spontaneous, secondary is from an underlying condition. associated with diabetes. acute: pain radiates below elbow. arthrogram can assist with diagnosis by detecting a decreased volume of fluid within joint capsule. should avoid abduction. pain with lateral rotation. interventions may include u/s, grade 3 and 4 mobs, pnf techniques, stretching. can take up to 12-24 months to recover
ALS (amyotrophic lateral sclerosis)
degenerative disease producing upper and lower motor neuron impairments. demyelination, axon swelling and atrophy. unknown cause. tests: electromyography, muscle biopsy, spinal tap. medication: reluzole (Rilutek).
systemic condition of inflammation of spine and larger peripheral joints. leads to fibrosis and ossification. usually affects SI joint, intervertebral disks, spine, and other joints. special test: wright-schober. low impact aerobic exercise with emphasis on extension and rotation are appropriate. high impact and flexion exercises are contraindicated.
ACL Grade III sprain
injuries usually occur during hyperflexion, rapid deceleration, hyperextension or landing in an unbalanced position. grade III acl sprain is considered a complete tear of ligament with excessive laxity. laxity is often classified as anterolateral or anteromedial. MRI is preferred imaging tool. special tests: lachman, anterior drawer, pivot shift. for surgery, the patellar tendon is the most commonly utilized graft for intraarticular reconstruction. closed chain are more desirable than open chain since they minimize anterior translation of the tibia.
inflammation in long head of biceps. repeated full abduction and lateral rotation of humeral head leads to inflammation. years of shoulder wear and tear, overhead repetitive activity. deep ache in front and top of shoulder. special tests: yergason's or speed's test, biceps resistance test
carpal tunnel syndrome
median nerve passes through the carpal tunnel, along with four flexor digitorum profundus tendons, 4 flexor digitorum superficialis tendons, and flexor pollicis longus tendon. occurs as a result of compression of the median nerve. normal tissue pressure within the carpal tunnel is 7-88mmHg, but CTS can result in pressure above 30mmHg. increase in pressure produces ischemia in nerve. special tests: positive tinel's, positive phalen's, positive tethered median nerve stress test. treatment can include corticosteroid injections, splinting, and PT. PT includes carpal mobilization and gentle stretching.
broad term used to describe a group of nonprogressive movement disorders that result from brain damage. 2-4 out of 1,000 births. most common cause of permanent disability in children. spastic CP involves upper motor neuron damage. athetoid CP involves damage to cerebellum. CP is classified as monoplegia (one involved extremity), hemiplegia (unilateral involvment of upper and lower extremities), and quadriplegia (involvement of all extremities). special tests: barthel index, bayley scale of infant development, bruininks-oseretsky test of motor proficiency, alberta infant motor scale, pediatric evaluation of disability inventory.
interruption of cerebral circulation resulting in cerebral insufficiency. results from prolonged ischemia to an artery in the brain. CT can confirm, MRI, PET.
inherited disease that affects ion transport of exocrine glands resulting in impairment of hepatic, digestive, respiratory and reproductive systems. causes the exocrine glands to overproduce thick mucus. creates an elevation of sodium chloride and pancreatic enzyme insufficiency. chromosome 7. 1:2,500 births for caucasians, 1:17,000 births for african americans. most consistent symptom is finding of high sodium and chloride in sweat. symptoms are cough, salty skin, sputum production, wheezing, poor weight gain, recurrent infections. testing: neonates' meconium as screening tool for increased albumin. most common complication is exacerbation of obstructive pulmonary disease. PF testing results in decreased forced expiratory volume, forced vital capacity. functional residual capacity and residual volume become increased. hypoxemia and hypercapnia develop due to alteration in perfusion. treatment: chest PT and medications
trisomy 21. error in cell devision and cell nucleus results in 47 chromosomes. pair of 21st chromosomes is responsible for downs. 1 in every 800-1000 births. increased incidence of celiac disease
duchenne muscular dystrophy
progressive neuromuscular degenerative disorder tat manifests symptoms once fat and connective tissue begin to replace muscle that has been destroyed by disease. dystrophin gene xp21. 20-35:100,000 births. child will need to use Gower's maneuver to use hand to stabilize and walk up his legs in order to attain an upright posture, due to muscle weakness. death usually occurs in teen's or early 20's.
results from long history of chronic bronchitis. results from a non-reversible injury and destruction of elastin protein within the alveolar walls. causes permanent enlargement of air spaces distal to terminal bronchioles within the lungs. causes pockets of air to form between alveolar spaces and within the lung parenchyma. pulmonary function: impaired forced expiratory volume, vital capacity, and forced vital capacity. will caused increases in: total lung capacity, residual volume, and functional residual capacity. cor pulmonale can result with advanced emphysema. PT includes breathing exercises such as pursed lip breathing, ventilatory muscle strengthening, chest wall exercises, patient education on posture, airway secretion clearance, and energy conservation techniques.
rheumatology syndrome or a nonarticular rheumatic condition. widespread history of pain in all four quadrants of body.
acute polyneuropathy is a temporary inflammation and demyelination of the peripheral nerves' myelin sheaths, potentially resulting in axonal degeneration. results in motor weakness in a distal to proximal progression, sensory impairment, and possible respiratory paralysis. weakness will progress towards upper extremities and head. level of disability usually peaks within 2 to 4 weeks after onset. gradual recovery can take months to years. can be diagnosed through a CSF sample containing high protein levels and little to no lymphocytes.
retrovirus that invades and destroys cells within the immune system. transmitted through contact with blood, semen, vaginal secretions, and breast milk.
neuro disorder of CNS and is characterized by degeneration and atrophy of basal ganglia and cerebral cortex of brain. loss of neurons creates dysfunction in inhibition that results in the symptoms of chorea, bradykinesia, and rigidity. 4-8:100,000. can have a mild alteration in personality, unintentional facial expressions. with progression, gait will become ataxic, with speech and mental issues. medications for treatment, along with PT to maximize endurance, strength, balance, postural control, and functional mobility.
in children less than 16. inflammation and stiffness to multiple joints for a period of greater than 6 weeks. medication, PT including ROM, exercise, pain control, functional mobility, strengthening, endurance, aerobic training.
tennis elbow. inflammation or degenerative changes at common extensor tendon that attaches to the lateral epicondyle of the elbow. repeated overuse of wrist extensors, particularly the extensor carpi radialis brevis. presents with pain along lateral aspect of elbow, especially over lateral epicondyle that sometimes radiates into dorsum of hand. pain will increase with wrist flexion with elbow extension, and resisted radial deviation. will have difficulty holding or gripping objects. treatment includes: protection, rest, ice, compression, and elevation.
medical collateral ligament sprain - grade II
MCL is primary stabilizer of medial side of knee against valgus force and lateral rotation of tibia especially during knee flexion. common mechanism of injury is direct blow against the lateral surface of knee causing valgus stress and damage to medial aspect of knee. grade II injury is partial tearing of ligament's fibers resulting in joint laxity when ligament is stretched. patient will present with inability to fully extend and flex knee, will have pain along medial aspect of knee. MRI. special tests: valgus stress. may exhibit 5-15 degrees of laxity with valgus stress at 30 degrees of flexion. will often present with ACL injury. treatment: RICE, ROM and beginning light resistive exercises
produces patches of demyelination that decreases the efficiency of nerve impulse transmission. presents with visual problems, parasthesias and sensory changes, clumsiness, weakness, ataxia, balance dysfunction and fatigue. PT interventions include regulation of activity level, relaxation and energy conservation techniques, normalization of tone, balance activities, gait training, core stabilization and control, adaptive/AD training.
MI: myocardial infarction
poor coronary artery perfusion, ischemia, and subsequent necrosis of cardiac tissue. 12 lead ekg: elevated ST segment indicates acute infarction, inverted T wave indicates myocardial ischemia, depressed ST segment indicates pending subendocardial or transmural infarction. blood serum analysis can be utilized to determine the level of selected cardiac enzymes. PT intervention is a multi phase cardiac rehab program
damage to articular cartilage of patella ranging from softening to complete cartilage destruction resulting in exposure of subchondral bone. common during adolescence. management includes controlling edema, stretching, strengthening, improving ROM and activity modification
peripheral vascular disease
usually secondary to atherosclerosis (hardening of arteries). narrowing of lumen of blood vessels, causing a reduction of circulation. patient education important: protecting limbs, foot and skin care, risk factor reduction
chronic overuse secondary to repetitive stretching of plantar fascia through excessive foot pronation during loading phase of gait. interventions: ice massage, deep friction massage, heel insert, orthotics, gentle stretching of achilles tendon and plantar fascia
reflex sympathetic dystrophy
increase in sympathetic activity causing a release of norepinephrine in periphery and subsequent vasoconstriction of blood vessels resulting in pain and increase in sensitivity to peripheral stimulation. intense burning and pain in affected extremity, spreads proximally
restrictive lung disease
decrease in lung and chest wall compliance, decrease in lung volumes, increase in work of breathing.
systemic autoimmune disorder of connective tissue - chronic inflammation within synovial membranes, tendon sheaths, and articular cartilage. 3 times greater in females, dx'd more frequently between 30-50. blood work assists in diagnosis thru elevation of rheumatoid factor, wbc count, erythrocyte sedimentation rate, hemoglobin and hematocrit values
rotator cuff tendonitis
inability of a weak supraspinatus to depress head of humerus into glenoid fossa during arm elevation. caused by excessive overhead activity. weakness and painful arc of motion most occurring between 60-120 degrees of active abduction
sciatica (secondary to herniated disk)
sciatic nerve inflamed - damage secondary to compression from herniated disk. low back and gluteal pain radiating down back of thigh. pain will increase in sitting, when lifting, forward bending or twisting.
spina bifida - myelomeningocele
occulta (incomplete fusion of posterior vertebral arch with no neural tissue protruding) meningocele (incomplete fusion of posterior vertebral arch with neural tissue/meninges protruding outside neural arch) myelomeningocele (incomplete fusion of posterior vertebral arch with both meninges and sc protruding outside neural arch). approx 75% of vertebral defects are found in lumbar/sacral region most often at L5-S1. prenatal testing of AFP in blood will show elevated levels, approx week 16 of gestation
systemic lupus erythematosus
connective tissue disorder caused by autoimmune reaction in body. females greater risk, most common age group is 15-40. pt will present with red butterfly rash across cheeks and nose, red rash over light exposed areas, arthralgias, alopecia, pleurisy, kidney involvement, seizures, and depression
temporomandibular joint dysfunction
females greater risk, 20-40 yrs, limited jaw motion, headache, tinnitus. treatment: moist heat, ice, biofeedback, u/s, electrostimulation, TENS and massage
thoracic outlet syndrome
compression and damage to brachial plexus nerve trunks, subclavian vascular supply, and/or axillary artery. contributing factors in development of condition include presence of a cervical rib, abnormal first rib, postural deviations, hypertrophy or spasms of scalene muscles, and elongated cervical transverse process. females greater risk than males. 30-40
total hip arthroplasty
posterolateral approach allows abductor muscles to remain intact, but there may be higher incidence of post-op joint instability due to interruption of posterior capsule. cemented=PWB initially. noncemented=toe touch WB for up to 6 weeks
total knee arthroplasty
destruction of articular cartilage secondary to OA. post-op care includes knee immobilizer, limb elevation, CPM, knee protocol exercises. avoid squatting, quick pivoting
transfemoral abduction due to osteosarcoma
may present with fatigue, LOB, phantom pain or sensation, hypersensitivity of residual limb, psycho issues regarding loss of limb. lying in prone position is beneficial to decrease hip flexion contraction
transtibial amputation due to arteriosclerosis obliterans (closing of arteries
results in ischemia and subsequent ulceration of affected tissues. may have a decrease in cardiovascular status depending on frequency of intermittent claudication prior to amputation
TLR (tonic layrinthine reflex)
position of labyrinth in inner ear-reflected in head position. in supine, body and extremities are held in extension; i prone, body and extremities are held in flexion. birth to 6 months. often causes full body extension, which interferes with balance in sitting or standing
touch to skin along spine from shoulder to hip. response: lateral flexion of trunk to side of stimulus. 30 weeks of gestation to 2 months. can interfere with development of sitting balance. can lead to scoliosis.
positive support reflex
weight place on balls of feet when upright will produce stiffening of legs and trunk into extension. 35 weeks of gestation to 2 months. interferes with standing and walking, balance reactions, can lead to contractures of ankles into PF
arthrogryposis multiplex congenita (peds)
non-progressive neuromuscular disorder. restriction in utero allows for fibrosis of muscles and structures within the joints. cylinder-like extremities with minimal definition, contractions, joint dislocations, muscle atrophy. tx: attain max level of developmental skills through positioning, stretching, strengthening, splinting, use of adaptive equipment.
genetic condition diagnosed by physical attributes and patterns of behavior. partial deletion of chromosome 15. constant desire for food.
produced by mechanoreceptors that are found within walls of heart, vessels, large arteries. activated when pressure rises within large arteries above 60 mmHg. mechanoreceptors are sensitive to stretch and pressure peak in activity at approx 180 mmHg. activation results in vasodilation secondary to inhibition of vasomotor centers within medulla as well as a decrease in heart rate and strength of contraction secondary to vagal stimulation.
occurs when mechanoreceptors embedded within right atrial myocardium respond to increase in pressure and stretch. stimulates vasomotor centers of medulla, and results in increased sympathetic input and heart rate. can also influence a decrease in heart rate when heart is beating too fast.
responds to need for increased depth and rate of ventilation. located on carotid and aortic bodies and detect lack of oxygen, responding to an increase in arterial CO2 levels.
increased risk of thrombosis. low platelet count increases risk of bruising and bleeding.
increase will occur after hemorrhage, surgery, coronary occlusion or malignancy. decrease will indicate infection
average in adult is 7-8% of body weight. blood is pumped through body at 30 cm/sec with a total circulation time of 20 seconds.
generally increases in direct proportion to intensity of exercise since systolic pressure increases with exercise, and diastolic pressure tends to stay the same. common to see 40-50 mmHg change in systolic pressure with intense exercise.
systolic bp is legs is 10-20%
higher than pressure in arms. this is why ankle -brachial index value of greater than 1.0 is still considered be normal.
bp that fails to increase or decrease with increasing workloads may signal a
plateau or decrease in cardiac output
systolic bp normally decreases promptly with
cessation of exercise. 3 minute post exercise systolic bp should be less than the 90% of systolic bp at peak exercise.
isometric exercise and valsalva maneuver should be avoided. avoid neck and hip flexion greater than 90 degrees and lying down in prone position.
caused by insufficient circulating blood volume. primary cause is hemorrhage or severe burn. clinical presentation: hypotension due to lack of circulating volume, anxiety, altered mental state, cool and clammy skin, rapid and thready pulse, thirst and fatigue. activate emergency medical system. lie patient in supine with legs elevated approx 12" in situations where tolerated.
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