Physio Exam

  1. Which muscles perform Wrist flexion?
    • Flexor carpi radialis
    • Flexor carpi ulnaris
    • Palmaris longus
  2. Which muscles perform Wrist extension?
    • Extensor carpi radialis longus
    • Extensor carpi radialis brevis
    • Extensor carpi ulnaris
  3. Which muscles perform Wrist radial deviation?
    • Extensor carpi radialis longus
    • Extensor carpi radialis brevis
    • Flexor carpi radialis
    • Extensor pollicis longus
    • Extensor pollicis brevis
  4. Which muscles perform Wrist ulnar deviation?
    • Extensor carpi ulnaris
    • Flexor carpi ulnaris
  5. Which tendons border the anatomical snuffbox?
    • Abductor pollicis longus
    • Extensor pollicis brevis
    • Extensor pollicis longus
  6. Which muscles perform hip flexion?
    • Iliopsoas
    • Sartorius
    • Rectus femoris
    • Pectineus
  7. Which muscles perform hip extension?
    • Gluteus maximus
    • Gluteus medius
    • Semimembranosus
    • Semitendinosus
    • Biceps femoris
  8. Which muscles perform hip abduction?
    • Gluteus medius
    • Gluteus minimus
    • Piriformis
    • Obturator internus
    • Tensor fasciae latae
  9. Which muscles perform hip adduction?
    • Adductor magnus
    • Adductor longus
    • Adductor brevis
    • Gracilis
  10. Which muscles perform hip medial rotation?
    • Tensor fasciae latae
    • Gluteus medius
    • Gluteus minimus
    • Pectineus
    • Adductor longus
  11. Which muscles perform hip lateral rotation?
    • Gluteus maximus
    • Obturator externus
    • Obturator internus
    • Piriformis
    • Gemelli
    • Sartorius
  12. Which muscles perform knee flexion?
    • Biceps femoris
    • Semitendinosus
    • Sartorius
    • Semimembranosus
  13. Which muscles perform knee extension?
    • Rectus femoris
    • Vastus lateralis
    • Vastus intermedius
    • Vastus medialis
  14. Which muscles perform plantar flexion?
    • Tibialis posterior
    • Gastrocnemius
    • Soleus
    • Peroneus longus
    • Peroneus brevis
    • Plantaris
    • Flexor hallucis
  15. Which muscles perform dorsiflexion?
    • Tibialis anterior
    • Extensor hallucis longus
    • Extensor digitorum longus
    • Peroneus tertius
  16. Which muscles perform inversion?
    • Tibialis posterior
    • Tibialis anterior
    • Flexor digitorum longus
  17. Which muscles perform eversion?
    • Peroneus longus
    • Peroneus brevis
    • Peroneus tertius
  18. A sudden blow to a part of the body that can  result in mild to severe damage to superficial and deep structures.
    Contusion
  19. An injury usually caused by a blow, that does not disrupt skin integrity.
    Contusion
  20. Characterized by pain, edema, and discoloration which appears as a result of blood seepage under the surface of the skin.
    Contusion
  21. How is a contusion treated?
    AROM, ice and compression
  22. An injury involving the musculotendinous unit that involves a muscle, tendon or their attachments to bone
    Strain
  23. Localized pain, minimal swelling, and tenderness
    Strain grade I
  24. Localized pain, moderate swelling,  tenderness, and impaired motor function
    Strain grade II
  25. A palpable defect of the muscle, severe pain, and poor motor function
    Strain grade III
  26. An acute injury involving a ligament
    Sprain
  27. Mild pain and swelling, little to no tear of the ligament
    Sprain grade I
  28. Moderate pain and selling, minimal instability of the joint, minimal to moderate tearing of the ligament, decreased range of motion
    Sprain grade II
  29. Severe pain and swelling, substantial joint instability, total tear of the ligament, substantial decrease in ROM
    Sprain grade III
  30. A condition caused by acute or chronic inflammation of a tendon due to repetitive microtrauma
    Tendonitis
  31. Symptoms of tendonitis may include...
    Gradual onset, tenderness, swelling and pain.
  32. Chronic tendon dysfunction especially supraspinatous, triceps extensor, patella
    Tendinosis
  33. Patellar tendinopathy aka jumper's knee treatment
    • Slow heavy load (eccentric and concentric)
    • Scan (find muscle imbalances and biomechanical faults)
    • Knee may be in valgus position
  34. What are the risk factors of muscle strains and tears?
    Prior injury, age, no used to activity, training errors, biomechanics (poor control, inflexible)
  35. Which muscle tearing grade?
    Microscopic tearing with pain but no weakness
    Grade 1
  36. Which muscle tearing grade?
    macroscopic tearing with pain + structural change (laxity, decreased strength)
    Grade 2
  37. Which muscle tearing grade?
    complete tear, painless + weak, may see lump
    Ddx = neurological impairment (myotomal weakness)
    Grade 3
  38. How to assess muscle strain or tear?
    • Acute/Inflammation: PRICE, crutches if LEs
    • Repair: modalities (US, IFC), DTF, strength, stretching
    • Remodelling: strength (increase load, velocity) + stretching (static/dynamic)
    • Return to play if: symmetrical muscle length, strength, power, no s/s, core control. Completion of progressive fx progressions + sport specific drills + practice session
  39. Treatment for muscle laceration
    • Require surgical repair
    • RX:Careful of muscle force going through sutures
    • Small + progressive loads
    • May need other footwear
  40. Muscle injury and repair: Inflammation phase
    • Inflammation: 24 hrs to 3-4 days after
    • o Myofibers rupture and necrosis
    • o Hematomas
    • o Inflammatory cell reaction
  41. Muscle injury and repair: repair phase
    • Repair: 5 days – 2 weeks
    • o phagocytosis of necrotic fibers
    • o regeneration of myofibers
    • o formation of scar tissue
    • o capillary ingrowth
  42. Muscle injury and repair: remodeling phase
    • Remodeling: 14 days onwards to 21+: complete will take sometimes up to 2 yrs (tendon)
    • Maturation of myofibers
    • Contraction and organization of scar tissue
    • Recovery of function
  43. Treatment for muscle contusion for the first 48 hours
    • PRICE, no HARM (heat, alcohol, running, massage)
    • Put muscle on as much stretch as possible (prevent healing in shortened range)
    • Crutches if necessary
    • Gentle pain-free ROM/stretch
    • Progressive ex after acute phase
  44. Recovery time of muscle contusion depending on grade
    • Grade I – mild: 2-3 wks
    • Grade II – moderate: 4-6wks – may walk with limp, can continue sport
    • Grade III – severe: 8 wks - immediate swelling, unable to walk
  45. Name two complications that may be associated with muscle contusion
    • 1. Compartment syndrome: check capillary refill and sensation, muscle strength
    • 2. Myositis ossification: suspect if no improvement after 2-3 wk
  46. Treatment for DOMS
    • Light activity such as cycling, walking, ankle pumps
    • Massage/bath
    • Avoid anti-inflammatories, if possible
  47. The pelvic floor is innervated by...
    PUDENTAL NERVE (S4-5) off the sacral plexus
  48. Assessment of Pelvic floor dysfunction is done via...
    Digital, EMG, manometric, dynamometer, real-time US, MRI, biofeedback
  49. Chronic pelvic pain is characterized by...
    Pain for at least 3 months and located between the diaphragm and the knees
  50. What are the general causes of chronic pelvic pain?
    MSK, neuro, gynecological, urogenital
  51. Assessment of chronic pelvic pain
    Urogenital s/s, lumbar/pelvic/groin mechanical presentation, core activation difficulty
  52. Treatment for chronic pelvic pain
    • Decrease pelvic floor resting tone
    • Increase pelvic floor proprioception
    • Increase motor control
    • Decrease pain sensitization
  53. Pelvic girdle pain, what percentage of pregnancies and what is observed?
    ~50% pregnancies: weakness/laxity of PFM during pregnancy/childbirth
  54. Pelvic girdle pain risk factors
    previous hx back pain/trauma
  55. Pelvic girdle pain causes
    laxity, asymmetry, inadequate motor control
  56. Pelvic girdle pain symptoms
    • Pain at ant/lat/post pelvic, groin, ant/post thigh, abdomen, coccyx
    • - With sustained positions (prolonged sitting/standing) OR
    • - With transitional movements: rolling, sit-to stand, walking, stairs, dressing
  57. Pelvic girdle pain signs
    • Posture: locked knees, Lspine lordosis, thoracic kyphosis, FHP
    • Asymmetry: standing & supine
    • Gait: shuffling, waddling, leg drag
  58. Pelvic girdle pain assessment
    • ASLR with force and form closure
    • Hip quadrants (ER/IR)
    • Sacro-Iliac joint stability: P4, ganglens, FABERS, long dorsal lig palpation
    • TOP spinous processes
    • TOP piriformis
    • Resisted Hip ADD/ABD
  59. Pelvic girdle pain treatment
    • Education: positions to avoid, mov’t strategies
    • Posture
    •   Standing: lift chest, soften knees, equal weight distribution
    •   Sitting: lumbar support, knees at hip height or lower
    •   Sleeping: pillow to maintain neutral neck, offer support
    • Manual therapy
    • Exercise: stabilize, symmetry
    •   PFM exs (overload mm w/ longer holds, shorter rest, w/ fx mov’ts)
    •   Maintenance: 8-12 contractions, 2x/wk
    • Mov’t strategies: Use glutes (NO rotation)
  60. Pelvic girdle pain condition progression
    • Cystocele: herniation of bladder into vagina
    • Rectocele: herniation of rectum into vagina
    • Uterine prolapse: herniation of uterus into vagina
  61. When a ligament is sprained, you get pain during ...
    Activity and PROM
  62. Which ligament sprain/tear grade?
    Minor rupture with few fibers torn, but stability maintained
    Grade 1
  63. Which ligament sprain/tear grade?
    Partial rupture, increased laxity, NO gross instability
    Grade 2
  64. Which ligament sprain/tear grade?
    Complete rupture, gross instability
    Grade 3
  65. Ligament sprain/tear assessment. What are you looking for?
    • Laxity + end feel. 
    • Pain
  66. Ligament sprain/tear treatment in acute phase
    PRICE, structural support, offload area by using orthotics, braces
  67. Ligament sprain/tear treatment in repair phase
    • Stability with muscle strength (esp if chronic sprain)
    • Deep Tissue Friction Massage (DTFM), modalities
    • Progressive loading (strength/stretch), linear movements
  68. Ligament sprain/tear treatment in remodeling phase
    • Deep tissue friction massage (DTFM)
    • Progressive loads + dynamic mov’t (multidirectional)
    • Sport/function specific
  69. Syndesmotic Ankle Sprain (High Ankle Sprain) mechanism of injury
    • Planted foot + IR of LE = ER of mortise OR
    • Hyper DF, hyper PF
  70. Which ligaments are affected during a Syndesmotic Ankle Sprain (High Ankle Sprain)
    • ATFL, PTFL, interosseous
    • Possible tearing of other ligs, #, bone bruise, OA
  71. S/S in a Syndesmotic Ankle Sprain (High Ankle Sprain)
    • Not much swelling, limited DF, antalgic gait (pain w/ weightbearing)
    • TOP @ injury site: ATFL, PTFL, anterior distal tib-fib area
  72. How to diagnose a Syndesmotic Ankle Sprain (High Ankle Sprain)
    • Foot ER stress test, squeeze test (proximal tib-fib), fibular post/ant translation
    • Squat test: DF w/ pain, malleolus stabilization test decreases pain
    • Heel thump test, one-legged hop test
  73. Treatment for Syndesmotic Ankle Sprain (High Ankle Sprain) 4 phases
    • Phase 1 (2wks):PROTECTION PHASE
    • PRICE, inflammation, modalities for edema
    • Light ROM
    • NWB with crutches

    • Phase 2 (2-4wks): MANAGEMENT PHASE
    • Joint mobs
    • Regain mobility
    • strength & fx
    • PWB ambulation, bilateral stance training

    • Phase 3: MANAGEMENT
    • function
    • unilateral balance & strength

    • Phase 4: RETURN TO SPORT
    • cutting, jumping, more aggressive strengthening

    Recovery: 2x as long as regular ankle sprains
  74. Explain Tendonopathy/tendonosis
    • Chronic microtrauma causes loss of collagen organization, misalignment. Causes inflammation, pain and swelling. 
    • Treatment: proper loading and resting of tissues.
  75. Achilles Tendonopathy risk factors
    • Age, BMI/diabetes, MALE
    • Sport (running), training errors, footwear
    • Pronation,↓DF,↓LE strength, tight/weak calf mm
  76. Achilles Tendonopathy s/s
    Thickened tendon, TOP
  77. How to diagnose Achilles Tendonopathy?
    • Achilles tendon partial rupture
    • hx of trauma
    • Does not respond well to training program

    • Sever’s disease (paeds)
    •     inflamed calcaneal apophysis → pulls on tendon at insertion
    •     Effects growing, active children (9-14yrs)
    •     RX: activity modification, gentle exs
  78. Treatment for Achilles Tendonopathy
    • NSAIDS (if acute)
    • Alter contributing factors: pronation, mm imbalance, myofascia restrictions, core
    • Progressive ex program: ECCENTRIC LOADING NECESSARY
    •    Bilateral→unilateral
    •    Only drop to neutral foot
    •    Pain level <5/10
    •    Don’t want pain next day or loss of fxn
    • Footwear w/ heel lift, orthotics/brace
    • Stretching, manual therapy
  79. What is De Quervain’s Tenosynovitis?
    Tendinosis of sheath/tunnel surrounding:Extensor pollicis brevis and abductor pollicis longus
  80. S/s De Quervain’s Tenosynovitis?
    • Chronic pain
    • Tendon thickening
    • Increased w/ repetitive hand/wrist mov’t
  81. How to assess and diagnose De Quervain’s Tenosynovitis?
    Finkelstein test: Tuck thumb in fist, ulnar wrist deviation, +ve if pain along distal radius
  82. Treatment for De Quervain’s Tenosynovitis?
    • Acute: off load tissue, PRICE, risk factor education
    • Corticosteroid injection (50% effective)
  83. Lateral Elbow Pain / Tennis Elbow age group
    35-55
  84. Lateral Elbow Pain / Tennis Elbow
    Tendinosis ..% or partial tear ..%
    Tendinosis 80% or partial tear 10%
  85. Lateral Elbow Pain / Tennis Elbow
    90% of cases involves ...
    10% of cases involves ...
    • 90% of cases involves ECRB - EXT CARPI RADIALIS BREVIS
    • 10% of cases involves COMMON EXT TENDON & origin of ECRL
  86. S/s Lateral Elbow Pain / Tennis Elbow
    • Worse with:
    • Gripping (hand tools)
    • Repetitive reach/grasp
    • Repetitive overload (typing)
  87. Assessment of Lateral Elbow Pain / Tennis Elbow
    • TESTS: +VE if pain over lateral epicondyle
    •    Resist 3rd finger PIP FLEX (elbow ext, shoulder @ 90)
    •    Resist Wrist flex + ulnar dev (elbow @ 90)
    •    Passively pronate forearm, flex wrist + ext elbow
    • TOP common origin, trigger points in muscle belly
    • NO nerve S/S – check w/ radial bias ULTT
  88. Differential diagnosis Lateral Elbow Pain / Tennis Elbow
    • Cspine referred (C5-7), shoulder referred, nerve entrapment
    • Bursitis (radiohumeral bursae), LCL sprain, proximal radioulnar joint affected
  89. Lateral Elbow Pain / Tennis Elbow treatment in acute and repair phase. Outcome measure.
    • Acute
    •    PRICE - control P & inflammation
    •    Modalities (US, TENS)
    •    Maintain mm length/mobility (AROM @ elbow, wrist, hand)
    •    Offload tissue – tennis strap
    •    Education: avoid NSAIDs, posture, rest breaks
    • Repair
    •    Gentle stressing of collagenDTFM + stretching
    •    Eccentric strength training
    •    Manual therapy as indicated
    •    Needling/Mulligans
    • Outcome measure
    •    Hand grip dynamometer
  90. Rotator Cuff Tendonopathy usually involves which muscles?
    Usually long head of biceps tendon & supraspinatus (impingement)
  91. Name and explain the two types of Rotator Cuff Tendonopathy
    • 1° impingement: NARROWED SUBACROMIAL SPACE (older pt)
    •    Intrinsic factors: anatomical abnormalities, degenerative change
    •    Extrinsic factors: muscle imbalances, postural faults

    • 2° impingement: INSTABILITY (pt <35)
    •    Microtrauma→instability→subluxation of humeral head→impingement
    •       Overhead activities/sportsmicrotrauma of stabilizers
    •       Ant capsule lax, Post capsule tight  ant humeral head sublux
  92. S/s Rotator Cuff Tendonopathy
    PAIN with overhead activity, repetitive shoulder motion, longstanding
  93. Assessment for Rotator Cuff Tendonopathy
    Neers, Speeds, Empty can
  94. Treatment for Rotator Cuff Tendonopathy
    • Correct biomechanical faults, muscle imbalances
    • Modalities
    • DTFM
    • Manual therapy
    • Education (training errors, position, self-mgmt, stretches)
  95. Patellar Tendonopathy or Jumper’s Knee risk factor
    male, jumping athletes, jump height, reduced DF, age, BMI
  96. Patellar Tendonopathy or Jumper’s Knee treatment
    slow heavy load (eccentric and concentric), scan (find muscle imbalances and biomechanical faults), knee may be in valgus position,
  97. Myofascial Pain Syndrome s/s
    TOP -- trigger point (focal irritation) found within a muscle
  98. Myofascial Pain Syndrome onset
    sudden overload, over-stretching &/or repetitive strain, sustained mm activities
  99. Myofascial Pain Syndrome treatment
    • dry needling (IMS), injections
    • flexibility, ROM, mm length
    • soft tissue massage
    • modalities, cryotherapy
    • manual therapy if poor joint mechanics
  100. How to treat hypermobility?
    • mobilize stiff or hypomobile tissue/joint/segment
    •     manual, IMS, massage, stretch
    • strengthen to stabilize the hypermobile segment/tissue
    • movement retraining: maintenance
    • supportive devices (brace/tape)
  101. Myofascial Pain Syndrome s/s
    TOP -- trigger point (focal irritation) found within a muscle
  102. Spondylosis
    OA of spine: degeneration of joints which can lead to disc herniation &/or stenosis
  103. Spondylolysis
    • Pars interarticularis (fibrous tissue) defect
    • degeneration of spine joints
    • Most ASYMMPTOMATIC
  104. Which patient population is spondylolysis seen most often
    Seen in younger pt w/ hyperEXT & rotation sports
  105. What happens if spondylosysis is bilateral?
    IF BILAT may lead to spondylolisthesis
  106. Spondylolisthesis
    Slipping of one vertebrae on another
  107. Spondylolisthesis is common at which segment
    L5-S1
  108. Spondylolisthesis MOI
    hyperEXT, likely in young athelete
  109. What are the two types of Spondylolisthesis?
    • Spondyloytic spondylolisthesis
    •    Progressive period of rapid growth   
    •    Rarely progresses to adult life
    •    Younger population
    • Degenerative spondylolisthesis
    •    2° to DJD + Z-joint subluxation  OA of joints in spine, foramina narrowing. Older population
  110. How is Spondylolisthesis graded?
    I-IV: 25% of each grade of slippage
  111. Spondylolisthesis s/s
    • Central LBP +/- referred pain
    • Aggravating factor: EXT
    • Easing factor: FLEX
  112. Spondylolisthesis treatment
    • STABILITY
    • Flexion exercises
    • Inner unit exercises: deep neck flexors or TA/multifidus/PF)
    • Brace if appropriate
    • Never mobilize in direction of instability or if reactive spasm
    • Work into painful range with proper stability
    • Surgery with:
    •     slippage or instability even with brace
    •     hard neurological signs
    •     evidence of spinal cord involvement
    •     intractable pain despite tx
  113. Structural causes of hypomobility
    • Muscle: atrophy & weakness
    • Tendon: ↓ tensile strength
    • Ligament: ↓ tensile strength, stiffness/adhesions
    • Cartilage: ↓ synovial fluid, H2O content
    • Bone: ↑ resorption, ↓ bone mass/mineral content
  114. Contributing factors of hypomobility
    • prolonged immobilization
    • sedentary lifestyle, aging
    • postural dysfxn
    • paralysis or tone abnormality
    • muscle imbalance
  115. Capsular patterns spine
    • FLEX – full ROM, pain
    • Ipsi EXT + SF + ROT -- ↓ROM, pain
  116. Capsular pattern GH
    ER > ABD > IR
  117. Capsular pattern Acromioclavicular
    Pain @ extreme ROM
  118. Capsular pattern Humeroulnar
    FLEX > EXT
  119. Capsular pattern Humeroradial
    FLEX > EXT > SUP > PRON
  120. Capsular pattern Proximal radioulnar
    SUP = PRON equally limitation
  121. Capsular pattern Distal radioulnar
    Pain @ extreme ROM
  122. Capsular pattern Radiocarpal
    FLEX = EXT limitation
  123. Capsular pattern 1-5 MCP
    FLEX > EXT
  124. Capsular pattern IPs UE
    FLEX > EXT
  125. Capsular pattern hip
    FLEX > ABD > IR (order may vary)
  126. Capsular pattern knee
    FLEX > EXT
  127. Capsular pattern Talocrural
    PF > DF
  128. Capsular pattern Subtalar
    Inversion > Eversion
  129. Capsular pattern 1st MTP
    EXT > FLEX
  130. Capsular pattern MTP 2nd-5th
    Variable
  131. Capsular pattern IPs LE
    FLEX > EXT
  132. S/s of dislocation
    ↑↑ROM, soft end feel, +/-pain
  133. Instability test for scapula
    Wall push up
  134. Instability test for anterior GH
    • anterior apprehension test (ABD + ER)
    • Relocation test: push GH head posteriorly
  135. Instability test for posterior GH
    posterior apprehension test (ABD 90°, full horiz ADD, post humeral push)
  136. Instability test for inferior GH
    Sulcus sign
  137. Name two complications that can occur due to GH dislocation
    • Rotator cuff tears
    • Axillary nerve damage: teres minor/delt innervation, sensation loss
  138. Name two types of GH dislocation
    TUBS: Traumatic onset, Unidirectional anterior, Bankart lesion, Surgery

    AMBRI: Atraumatic, Multidirectional, Bilateral shoulder findings, Rehab appropriate, INF capsule shift (if surgery performed)
  139. MOI TUBS dislocation
    ABD/ER
  140. Which type of lesion?
    avulsion # of ant/inferior capsule & ligaments
    s/s – clicking, apprehension, deep vague pain
    Bankart
  141. Which type of lesion?
    Superior labrum lesion ant to post
    Elevated position w/ sudden concentric + eccentric biceps contraction
    Major cause of pain in throwers
    SLAP
  142. Which type of lesion?
    compression # post/lateral humeral head
    Hill-Sachs
  143. Which type of lesion?
    usually acromion, humeral head
    s/s:deformity, constant pain, systemic signs (nausea)
    Fracture dislocation
  144. End of long bone (where joint is)
    Epiphysis
  145. Shaft of long bones
    Diaphysis
  146. Name 3 MOI of fractures
    • Traumatic
    • Pathological
    • Stress/fatigue
  147. Give 4 exemples of pathological bone fractures
    OP, metastatic, infection, osteomalacia
  148. Name the 7 types of traumatic fractures
    • Spiral: twisting injury
    • Transverse/oblique: direct blow
    • Compression/crush: longitudinal force
    • Comminuted: fragments of bone
    • Greenstick: young kids. Malleable bones, # on only 1 side
    • Avulsion: piece of bone pulled off de-attachment of soft tissue (lig)
    • Impact: d/t compression force (usually more stable)
  149. Name 3 common fractures
    • Colles: # distal radius + sublux of distal ulna
    • Bennetts: # dislocation of CMC thumb joint
    • Scaphoid: d/t FOOSH
  150. Fracture healing time
    • Kids 4-6wks
    • Adolescents 6-8wks
    • Adults 10-18wks RX
  151. Name 8 complications of fractures
    Avascular necrosis, Muscle weakness, contractures, re-#, infection, delayed union, malunion, CRPS
  152. Which areas have the highest rate of avascular necrosis
    • Proximal femur
    • 5th MT
    • scaphoid
    • proximal humerus
    • talus neck
  153. Treatment for fractures
    • Joint mobility above/below
    • Isometric strength
    • CV fitness maintenance
  154. Name the 3 common locations for hip fractures
    femoral neck, intertrochanteric, subtrochanteric
  155. What are the characteristics of conservative hip fracture treatments
    • Less complications
    • ↑ bed rest
    • ↓ healing time
    • slower rehab
  156. Benefits of surgery for hip fractures
    • ↓ length of stay
    • improved rehad
  157. Femoral head replacement
    Hemiarthroplasty
  158. Femoral head and acetabulum replacement
    Total arthroplasty
  159. What are the 3 types of surgery (arthroplasty) for hip fractures
    • Cemented
    •    ↑ stability, better for sedentary elderly w/ poor bone quality

    • Uncemented
    •   Components coated w/ beads: where new bone can grow
    •   Better for younger pts
    •   Revision in 10 yrs

    • Hybrid
    •    femoral component: cemented
    •    acetabular component: not cemented
  160. PRECAUTIONS FOR TOTAL ARTHROPLASTY, POST-LATERAL APPROACH (75%):
    • NO hip FLEX past 90°
    • NO IR
    • NO ER
    • NO hip ADD past MIDLINE for 1st 3 mo
  161. PRECAUTIONS FOR TOTAL ARTHROPLASTY, LATERAL APPROACH (25%):
    • NO hip FLEX past 90°
    • NO IR
    • NO hip ADD past MIDLINE for 1st 3 mo
  162. PRECAUTIONS FOR TOTAL ARTHROPLASTY, ANTERIOR APPROACH (rare):
    • NO hip EXT
    • NO ER
    • NO hip ADD past MIDLINE for 1st 3 mo
  163. Osteoporosis (OP) types
    • 1° type 1: menopausal women
    • 1° type 2: 70+ yrs
    • 2° OP: d/t another med condition or tx, any age
  164. Risk factors of OP
    • FHMx, lifestyle
    • gender, age, lifetime exposure to estrogen, breast cancer
    • fragility # under 40 years
  165. Diagnostics for OP
    • Bone scan
    • # assessment tools  FRAX, CAROC 2010
  166. Fusing of 3+ segments which may increase risk of subsequent #
    Vertebroplasty
  167. OP common sites
    • Wrist
    • Humerus
    • Vertebrae
    • Hip
  168. PT treatment for OP
    • Posture
    • Aerobic: weight bearing
    • Resistance exs, core
    • Balance
    • Extension exercises
    • CAUTION w/ MANUAL THERAPY
    • NO SPINAL FLEXION or FLEXION + ROTATION!
  169. Can manifest as sports/mechanical injuries
    TUMOR/PATHOLOGICAL FRACTURES
  170. TUMOR/PATHOLOGICAL FRACTURES s/s
    • Asymptomatic, but can show cancer signs:
    •  Sudden weight loss/gain
    •  Night pain
    •  Night sweats
    •  Malaise
    •  Fatigue
  171. Types of TUMOR/PATHOLOGICAL FRACTURES
    • Osteosarcoma
    • Synovial sarcoma
    • Malignant tumors
    • Osteoid osteoma
  172. At ends of long bones
    Pain @ joint, worse with activity
    Imaging: xray – moth eaten appearance
    RX: surgery (terry fox)
    Osteosarcoma
  173. In larger joints: knee/ankle
    Pain @ night, w/ activity
    Swelling/instability
    RX: surgery, chemo/radiation
    Synovial sarcoma
  174. May metastasize to bone from breast, lung, prostate, kidney, thyroid
    RX: thorough PMHx & FMHx
    Malignant tumors
  175. Benign bone tumor
    Pain: in bone, @ night, w/ exercise (often mistaken for bone #)
    Key sign: NO PAIN W/ ASPIRIN
    Imaging: CT scan shows a central focus point
    RX: ablation, ethanol, laser
    Osteoid osteoma
  176. DEGENERATIVE JOINT DISEASE is mostly seeing in patients > ...years
    40
  177. Name 5 types of vertebral degenerative joint diseases
    • Spinal stenosis
    • Central stenosis
    • Spondylosis
    • Spondylolysis
    • Spondylolisthesis
  178. ↓ IVF space = ↑ radicular s/s (dermatome, myotome)
    Spinal (lateral) stenosis
  179. ↑ spinal canal compression = ↑ central s/s (central cord signs, b/b)
    Central stenosis
  180. Spine OA: effects z-joints, foramen
    Spondylosis
  181. Pars interarticularis defect
    May start as stress #: nut cracker effect on z-joint
    Spondylolysis
  182. Grade I-IV anterior slippage of one vertebrae on another d/t hyperEXT
     Outcome Measures:
    pain w/ lumbar EXT in SLS
    painfree lumbar EXT ROM
    facilitated segment
    lumbopelvic control
    Spondylolisthesis
  183. ↓ joint space, ↓ cartilage height, ↑ osteophytes, ↑ subchondral bone sclerosis + proliferation
    Osteoarthritis (OA)
  184. Treatment for degenerative joint diseases
    • Joint protection
    • ↑ joint mechanics
    • aquatics = ↓WB
  185. Plumb line test surface landmarks
    • Thru the ear lobe
    • Thru the the shoulder joint
    • Midway of the trunk
    • Thru the greater trochanter
    • Slightly anterior to the knee joint
    • Slightly anterior to the ankle joint
  186. Types of scoliosis
    • Idiopathic: most common (gene identified)
    • Congenital: vertebral deformities
    • Neuromuscular: 2° to other conditions : CP, spina bifida, physical injury
  187. S/s of scoliosis
    • ↓ nerve conduction: myotomes, derms, reflexes
    • ↓ nerve mobility: SLR, slump
    • Degree depends on degree of constraint
  188. Scoliosis assessment
    • Forward Bend Test: rib hump
    • Muscle imbalance
    • ↓ Proprioception
  189. Scoliosis treatment
    • Posture
    • Stretch, strengthen
    • CV training (↓pain)
    • IF severe: bracing, surgery
  190. The following s/s are associated with which condition?
    pain increases w/ sitting or prolonged postures
    poor posture/ergonomic set up
    pain not specifically caused by FLEX or EXT
    NO neurological s/s
    better in AM, worse as the day goes on
    associated w/ decreased fitness
    Low Back Pain due to postural dysfunction
  191. Treatment for Low Back Pain due to postural dysfunction
    • Correct:
    • posture and ergonomics
    • muscle imbalances
    • fitness issues
    • spinal supports (obus forme)
    • education on posture + rest/activity/breaks
  192. The following s/s are associated with which condition?
    central back pain +/- leg pain
    +/-lateral shift: name relative to shoulders
    loss of normal lordosisflat backmuscle supporting EXT
    Disc lesion
  193. Aggravating factors of disc lesions
    • FLEX (sitting, putting on socks/pants, bending forward)
    • Coughing
  194. Easing actors of disc lesions
    EXT (standing, walking, lying)
  195. Treatment for disc lesion
    • centralize pain, ⊘radiate
    • correct shift
    • support lordosis
    • posture education
    • avoid flexion postures with time
    • traction (gentle!)
    • correct: muscle balance, posture, ergonomics
  196. Stenosis population
    Older pt, hx back pain
  197. The following s/s are associated with which condition?
    Bilateral radiation: legs/feet
    Xray changes: bony hypertrophy, DDD, spurs
    Stenosis
  198. Aggravating factors of stenosis
    EXT activities =↓ IVF (lateral st),↓ spinal canal (central st)
  199. Easing factors of stenosis
    Flexion activities
  200. Treatment for stenosis
    posture avoidance, correct muscle imbalances (core, hamstrings)
  201. Grade I-IV ant slippage of one vertebrae on another
    Population: young athlete (usually gymnast, dancer) + hyperextension activities
    Spondylolisthesis
  202. S/s Spondylolisthesis
    • central low back pain +/- referred pain
    • weak abdominal muscles
    • +/- tight hamstrings
  203. Spondylolisthesis aggravating and easing factors
    • Aggravating: Extension
    • Easing: Flexion
  204. Spondylolisthesis treatment
    • address lower quadrant muscle imbalance
    • abdominal strengthening
    • biomechanical counseling
    • avoid HYPEREXT activities
  205. Inflammatory response d/t infection in bone
    Usually staph aureus infection
    Often missed: serious consequences in/around jt
    Osteomyelitis
  206. Osteomyelitis Polulation
    • Children: long bones
    • Adults: vertebrae, feet (if diabetic & have foot ulcers)
    • More common in: M, children, immune suppressed pt
  207. These s/s correspond to which condition?

    * suspect if pt has localized swollen jt w/ NO trauma hx or NO other affected jts : ER!!
    o Prominent night pain
    o Effusion in/around joint
    o Weight loss
    o Appetite loss
    o Malaise
    Osteomyelitis
  208. Treatment for osteomyelitis
    • Antibiotics
    • Surgery if in joint: remove dead bone
    • Maintain joint function
    • Cast care
  209. Tendon inflammation d/t repetitive microtrauma
    Tendonitis
  210. Chronic tendon dysfx: esp. supraspinatous, elbow extensor tendons, patella
    Tendinosis
  211. Causes of bursitis
    overuse, trauma, gout, infection
  212. S/s bursitis
    pain w/ rest, ↓ AROM/PROM
  213. Which type of amputation has these effects?
    ⇩push off power
    ⇩balance d/t ⇩proprioception, ⇩BOS
    Prosthesis
      orthoses or filler to prevent migration
      carbon fiber AFO: help with energy return at toe off
    TOE (Ray resection)
  214. Which type of amputation has these effects?
    lose forefoot lever
    ⇩ balance
    ⇧pressure on remaining WB surface = ⇧risk for tissue breakdown
    Prosthesis
      molded insole (shoe filler)
      carbon fiber AFO
      complete prosthesis
    PARTIAL FOOT
  215. Which type of amputation has these effects?
    Surgery goes through joint  distal tib-fib intact
    PROS: long lever, bulbous end, better than trans-tib, good fx outcome
    CONS: high risk of skin breakdown
    Prosthesis:
      similar to trans-tib: partial patellar WB possible
      trap door to fit over malleoli
    Ankle
  216. Which type of amputation has these effects?
    ⊘WB through end
    o some achieve normal gait pattern
    o Prosthesis:
     Sockettotal surface bearing OR patellar tendon bearing
     Pressure areas:
    o Sensitive  anterior/distal tib ends, fibular head/end, stump
    o Tolerant  post mm mass, patellar tendon, medial/lateral flares
     Suspension  supracondylar, suprapatellar cuff, sleeve (need dexterity + strength),
    locking pin, suction (1 way valve)
    o GAIT DEVIATIONS
    Stance: foot flat, foot slap, knee hyperext or buckling, early heel rise
    Swing: ⇩⇧stride length, toe drag, lat/med whip, vaulting
    Transtibial
  217. Which type of amputation has these effects?
    Potential WB through stump: thigh mm preserved
    o Prosthesis:
    trap door for condyles
    KNEE DISARTICULATION (⊘knee)
  218. Which type of amputation has these effects?
    ⊘WB on end: WB through ischial tuberosities + hydrostatic loading
    Req. 60% more energy to ambulate with prosthesis (vs. able body walking)
    Transfemoral
  219. Which type of amputation has these effects?
    Gait aid (very likely needed)
    o Gait: Asymmetrical
    o 210% energy expenditure
    HIP DISARTICULATION
  220. Which type of amputation has these effects?

    High level pelvic amputation
    o Likely d/t osteosarcoma, chondrosarcoma
    HEMIPELVECTOMY
  221. Pain mgmt. for residual limb pain, phantom pain/sensation
    exercise, relaxation/visualization, compression/massage, TENS, farabloc
  222. Typical contractures for transtibial amputation
    knee flex, hip flex
  223. Typical contractures for transfemoral amputation
    hip flex, hip abd
  224. Give examples of what may cause a firm end-feel
    • Capsular tightness
    • Muscular, ligamentous and fascial shortening
  225. Abnormality in head of femur or acetabulum shape @ birth
    Result: acetabulum & femur NOT in close contact: subluxation/dislocation
    Spontaneous recovery w/in 1st 2 wks of life is common
    DEVELOPMENTAL DYSPLASIA OF HIP (DDH)
  226. These risk factors are associated with which congenital malformation?
    F>M, famhx
    breech position, Large for gestational age
    tight swaddling
    DEVELOPMENTAL DYSPLASIA OF HIP (DDH)
  227. These s/s are associated with which congenital malformation?
    Hip subluxed or dislocated
    o Hip is dislocatable
    o Might not show signs, but contact pediatrician if any of following, b/c can lead to degenerative hip arthritis
    Leg Length Discrepancy (LLD)
    Muscle weakness
    Waddling gait
    DEVELOPMENTAL DYSPLASIA OF HIP (DDH)
  228. Assessment for DEVELOPMENTAL DYSPLASIA OF HIP (DDH)
    • Barlow maneuver: FLEX then ABD then ADD w/ post pressure
    • Ortlani maneuver: FLEX then ADD + slight traction
  229. Treatment for DEVELOPMENTAL DYSPLASIA OF HIP (DDH)
    • Keep hip in FLEX + ABD
    • Pavlik harness
    • ⊘double diapering
  230. Causes of TALIPES EQUINOVARUS (Club Foot)
    • congenital bone deformity
    • o cerebral palsy
    • o calf mm contracture
  231. What are the two types of TALIPES EQUINOVARUS (Club Foot)
    • TALIPES EQUINOVARUS
    •    Abnormal dev of talus head + neck
    •    Hereditary or Neuromuscular disorder

    • POSTURAL
    •    Feet squished in utero
  232. Which congenital malformation has this presentation?
    F (talocrural aka equinus)
    ADD forefoot
    INV/varus hindfoot
    Small calcaneous
    Smaller calf + foot on affected
    Usually part of larger problem: myelomenigocele, arthrogryposis
    TALIPES EQUINOVARUS (Club Foot)
  233. What is one risk factor for TALIPES EQUINOVARUS (Club Foot)
    intrauterine restriction (baby doesn’t grow @ normal expected rate in uterus)
  234. Treatment for TALIPES EQUINOVARUS (Club Foot)
    • Manipulation
    • Serial casting + splinting: start right after birth
    • Surgery
  235. Which congenital malformation?
    connective tissue disorder (genetic)
    issue w/ converting procollagencollagen type 1
    BONES = BRITTLE
    S/S
    o Joint laxity
    o Muscle weakness
    o Long bone bowing
    o Kyphosis
    o Diffuse OP
    o small stature
    Osteogenesis imperfecta
  236. Treatment for Osteogenesis imperfecta
    • Meds
    • Orthopedic: # prone, surgery, immobilization
    • Social integration
    • Education
    • Prognosis – dependant on severity
  237. Which congenital malformation?
    Avascular necrosis of femoral head
    Age: 3-12, M>F
    S/S
    small for age
    usually unilateral
    hip, knee, groin pain
    +ve tredenlenburg
    limp
    ⇩ROM (ABD, IR)
    LEGG CALVE-PERTHES DISEASE
  238. Which type of nerve compression?

    pain d/t nerve root compression
    S/S
    dependant on degree of compression
    Pain
    Tingling/numbness
    ⇩nerve conduction = mm weakness, ⇩sensation, ⇩reflexes
    RADICULOPATHY
  239. Which type of nerve compression?
    Hypertrophy of spinal lamina, ligamentum flavum, facets
    Vascular or neural compromise
    SPINAL STENOSIS
  240. Treatment for spinal stenosis
    • Joint mobilizations
    • FLEX bias exs, AVOID EXT
    • Traction
  241. Which type of nerve compression?
    Due to impinged:
    o nerve bundle (brachial plexus)
    o vagus nerve between bony and soft tissue
    o subclavian artery/vein
    S/s
    Pain in arms/hands, neck, axillary, pecs, upper back
    o Tingling
    o Vascular: one hand colder than other
    Thoracic outlet syndrome
  242. Common impingement sites for thoracic outlet syndrome
    • o superior thoracic outlet
    • o scalene triangle
    • o btw clavicle + 1st rib
    • o btw pec minor + thoracic wall
  243. AX - TESTS for thoracic outlet syndrome
    • o Adson
    • o Allen/wrights
    • o Military test
    • o Costoclavicular test
  244. Treatment for thoracic outlet syndrome
    • postural re-education
    • o functional training to restore normal muscle balances: endurance, strength, power, and
    • coordination
    • o biomechanical faults: joint restrictions
    • o manipulations (typically first rib) to diminish pain and soft tissue guarding: treat symptoms
  245. Location of ulnar nerve entrapment?
    cubital tunnel
  246. Causes of ulnar nerve entrapment?
    trauma, compression, thickened FCU retinaculum
  247. S/s of ulnar nerve entrapment?
    medial elbow pain
  248. Test of ulnar nerve entrapment?
    Posterior tinel sign
  249. Location of median nerve entrapment?
    in pronator teres + under Flexor digitorum superficialis
  250. Cause of median nerve entrapment?
    Repetitive gripping activities
  251. S/s of median nerve entrapment?
    Aching pain in forearm
  252. median nerve entrapment results in...
    Carpal tunnel syndrome
  253. Which test for carpal tunnel syndrome
    Phalen's test
  254. These s/s correspond to...
    Altered sensory fx in median nerve distribution
    ⇩vibration, 2-pt discrimination
    Thenar mm atrophy (thumb to 3rd finger)
    Carpal tunnel syndrome
  255. Which type of TRAUMATIC PERIPHERAL NERVE INJURY?
    Compression of the nerve
    RESULT: transient disruption
    RECOVERY: good prognosis (min  wks), as oedema resolves
    Neuropraxia
  256. Which type of TRAUMATIC PERIPHERAL NERVE INJURY?
    Disruption of axon, myelin sheath still intact, likely CRUSH INJURY
    RESULT: may cause paralysis of the motor, sensory, and autonomic
    RECOVERY: fair prognosis (months), wallerian degeneration
    Axon re-growth: 1mm/day, upper arm 4-6 mo (up to 2 yrs), lower arm 7-9mo, up to 4 yrs
    Axonotemesis
  257. Axonal regrowth rate and how long does it take for upper arm and lower arm
    Axon re-growth: 1mm/day, upper arm 4-6 mo (up to 2 yrs), lower arm 7-9mo, up to 4 yrs
  258. Which type of TRAUMATIC PERIPHERAL NERVE INJURY?
    Completely severed axon and sheath
    RECOVERY: only w/ surgery with variable success  may never recover
    Neurotemesis
  259. Which pathological pattern of neuropathy?
    Process occurs d/t cutting/crushing of nerve: axon separated from cell body
    Occurs with axonotmesis
    WALLERIAN DEGENERATION
  260. Which pathological pattern of neuropathy?
    Myelin breakdown (demyelination) for few segments, but axons are preserved
    Mostly reversible b/c Swann cells make new myelin: fx restoration
    Some axons may be permanently lost
    SEGMENTAL DEMYELINATION
  261. Give an example of SEGMENTAL DEMYELINATION
    Guillain-Barre Syndrome
  262. Immune system attacks nerves: 1st s/s - weakness + tingling  entire body paralysis
    o Hospital: most pts recover, may have slight weakness/tingling/fatigue
    Guillain-Barre Syndrome
  263. Degeneration of axon cylinder and myelin possibly d/t inability of neuronal body to keep up w/
    metabolic demands of axon
      Develops: most distal part of axon to proximal
    o IF abnormality persists: axon dies ‘backwards’
     S/S
    o Characteristic distal sensory loss + weakness
    (Distal) AXONAL DEGENERATION
  264. Autoimmune attack of ACh receptors at the NMJ
    o signal can’t travel from nerve to muscle
     Effects:
     progressive muscle weakness
    ⇩cardioresp fx
    atrophy
    fatigue
    MYASTHENIA GRAVIS
  265. Treatment for MYASTHENIA GRAVIS
    • Medication: prevent ACh breakdown @ NMJ: remaining receptors will eventually activate
    • o PT
    •  Activity within tolerance
    •  Prevent 2° conditions
  266. Extensive demyelination of motor & sensory nerves of the FOOT
      S/S
    o Symmetric mm weakness : slow progression
     Foot intrinsics atrophy
    ⇩DF, EVER mm
    ⇩⇩deep tendon reflexes
    o Pes cavus (hammer toes)
    CHARCOT MARIE TOOTH DISEASE (HEREDITARY)
  267. D/T latent herpes virus
    o Pt reports pain few days prior around mastoidvirus causes
    inflammation response over facial nerve
     S/S
    o Unilateral facial paralysis
    o ⇩Facial nerve innervation:
     facial expression mm
     stapedius mm of inner ear
     sensory + autonomic taste fibers for taste
     tears,salivation
    BELL’S PALSY
  268. Treatment for BELL’S PALSY
    corticosteroids, protect eye
  269. Entrapment syndrome d/t pressure on brachial plexus
    o Chronic compression: edema + ischemia of nerve roots: neuropraxia + wallerian deg
      Risk factors: posture, growth, trauma, body comp
      S/S
    o Paraesthesia
    o UE weakness + pain, hand fatigue
    o Neck pain: may radiate into face, scapula, ant chest
    o Raynaud’s disease (⇩UE artery size) + venous compromise: coldness
    o Edema
    Thoracic outlet syndrome
  270. Treatment for Thoracic outlet syndrome
    Correct posture; surgery (if vasculature gets compromised)
  271. Peripheral nerve disorder in diabetesoccurs w/o any other neuropathy cause
      Pathology
    o Chronic metabolic disturbanceaffects nerves + schwann cells
     RESULT: loss of both myelinated & unmyelinated axons
     S/S
    o Symmetric + distal sensory loss pattern
    o Painless paraesthesia
    o Minimal motor weakness
    DIABETIC NEUROPATHY
  272. Treatment for DIABETIC NEUROPATHY
    • Control hyperglycemia
    • o Skin care
    • o Amputation
  273. compress of N along several sites proximal and distal
    Double crush syndrome
  274. How to assess dural tension
    SLUMP, SLR, PKB, ULTT
  275. hx of⇧ speed/repetition of sport or work
    o pain distribution ⊘ match myotome/dermatome
    o stretching ⊘ feel good
    o aggravated in neural tension positions
    o ⊘ describe/point to pain area well
    o recurrent injury that ⊘ change w/ rehab
    NEURAL TISSUE DYSFX / NEURO-DYNAMIC DYSFX
  276. Thick scar that extends beyond margins of original wound
    KELOID SCAR
  277. thick scars ⊘ extend beyond boundary of original wound BUT has excess tissue amount (in comparison to what is actually needed to replace damaged dermis)
    HYPERTROPHIC SCAR
  278. S/S
    o SUDDEN numbness or weakness of face, arm, or leg (especially one sided)
    o confusion, dizziness
    o trouble speaking or understanding speech
    o trouble seeing out of one or both eyes
    o trouble walking
    o loss of balance or coordination
    o severe headache with no known cause
    Cerebral Vascular Accident/Transient Ischemic Attack ⇨ STROKE
  279. age (doubles after 55 yrs), M>F, FMHx, PREVIOUS STROKE OR TIA
    Non modifiable risk factors of Cerebral Vascular Accident/Transient Ischemic Attack ⇨ STROKE
  280. HTN, cardiac disease, diabetes, cholesterol, smoking, obesity, cocaine/meth use,
    oral contraceptives
    Modifiable risk factors of Cerebral Vascular Accident/Transient Ischemic Attack ⇨ STROKE
  281. caused by thrombosis, embolic, lacunar infarct (in deep area of the brain, related to diabetes and HTN)
    ISCHEMIC STROKE (80%)
  282. RX for ISCHEMIC STROKE (80%)
    get ppl to hospital right away, if ischemic they can get tissue plasminogen activator (TPA) which will dissolve the clots and restore blood flow (within 3 hours)* NOT APPROPRIATE FOR HEMORRAGIC STROKE!!
  283. caused by aneurysm and AV malformation, often occurs in younger people, majority occur in the cerebral cortex or basal ganglia*
    HEMORRHAGIC (20%)
  284. RX for HEMORRHAGIC (20%)
    • surgery to stop bleed
    • better long term prognosis for recovery of function (than ischemic)
  285. ABCD score (for prediction of progression and risk of stroke recurrence):
    • A=age
    • B = blood pressure
    • C= clinical features (hemiplegia, speech problems)
    • D= duration
  286. PREVENTION OF STROKE RECURRENCE:
    • anticoagulation therapy (aspirin)
    • lipid lowering agent
    • lifestyle change
    • exercise
  287. STROKE PROGNOSTIC INDICATORS
    location, extent, and duration of injury; can they voluntarily move fingers (pyramidal motor output intact, * white tracts are not plastic), cortical (most grey matter) vs subcortical (white and grey matter)⇨ grey matter is capable of functional reorganization
  288. transient blockage of circulation, mild S/S, resolves usually w/in 24 hours, huge recurrence (80% within a year), can results in lasting damage
    TRANSIENT ISCHEMIC ATTACK (TIA)
  289. change in brain fx d/t external force
      can be accompanied by:
    o dec or loss of consciousness, impaired cognition, physical function, emotion or behavior (may be temporary or permanent)
    TRAUMATIC BRAIN INJURY
  290. outside the dura, 90% assocd with skull fractures
      most often in temporal or temproparietal region
      arterial bleed
    Epidural hematomas
  291. brain collects between arachnoid mater and dura
      often requires surgical intervention (burrholes or craniotomy)
      venous bleed
    Sub-dural hematomas
  292. bleeding between pia mater an brain, from circle of willis
      fatal
    Subarachnoid hematomas
  293. most common
    blood within the brainbleed under pia mater
    Intracranial hematomas
  294. Indicates brain stem damage (lesions or compression in midbrain) and lesions in cerebellumextension of UE and LE
    Decerebrate posturing
  295. arms flexed, legs extended, damage to areas including cerebral hemisphere, thalamus, cord, corticospinal tract
    Decorticate posturing
  296. Rx for decreased mobility in TBI
    • sit up and dangle should begin as soon as medically stable , make sure tube feeds are
    • off 20 mins prior to Rx, early mobilization to prevent heterotrophic ossification
    •   other things to be aware of: hypermetabolism, DVTs, PEs
  297. Rx for contractures mobility in TBI
    place muscles in lengthened position, 20 minutes to 12 hours/day, use of resting splints; splinting and casting and passive ROM
  298. Rx when confusion and agitation in TBI
    • keep instructions short and simple, avoid over stimulation, be aware of mental and physical fatigue
    • protect joints especially if have flaccidity, transfers take more people, have environment prepared
  299. Complex pathological process affecting the brain, induced by traumatic biomechanical forces
    Mild form of brain injury (most common TBI)
    S/S
    Loss of consciousness may or may not be present
    Behavioral change (overly emotional, cannot control them)
    Cognitive impairment (problems with thinking and planning ahead)
    Sleep disturbance, dizziness, irritability, memory and visual changes
    Concussion
  300. Rare/fatal uncontrolled swelling of brain
    Minor 2nd blow before initial symptoms are resolved
    Concussion - Second impact Syndrome
  301. Persistent symptoms
    3+ concussions = 5X greater risk Alzheimers, 3x memory deficits
    Post concussion syndrome
  302. Which Post concussion syndrome grade?
    Does not lose consciousness, dazed
    Grade 1
  303. Which Post concussion syndrome grade?
    No LOC, period of confusion, does NOT recall event
    Grade 2
  304. Which Post concussion syndrome grade?
    Loss of consciousness for short time, NO memory of event, requires eval asap, classic concussion
    Grade 3
  305. Name the following concussion OUTCOME MEASURE/PROGNOSTIC INDICATOR
    3 categories: eye opening, verbal response, motor response,
    total score out of 15, done usually in acute injury
    Glasgow coma scale
  306. Name the following concussion OUTCOME MEASURE/PROGNOSTIC INDICATOR
    good predictor of functional outcomes after injury (1-10 scale)
    want a higher score
    *note: pediatric scale is opposite, want a lower score)
    Rancho Levels Of Cognition
  307. Which type of Spinal Cord Injury?
    majority result in quadriplegia
    Causes: Falls (40%), transport, sports, other
    M>F, occur between age 15-35 yr range
    17.37% are thoracic and lumbar complete
    40% are cervical incomplete
    Traumatic
  308. Which type of Spinal Cord Injury?
    majority result in paraplegia
    Causes: cancer, infection and inflammation (TB), motor neuron disorders, vascular diseases (spinal cord infarcts), congenital
    M>F, 50-60 yr +
    Non-Traumatic
  309. Early management focus in SCI
    • o spinal stability
    • o limiting neurological deficit and promote recovery
    • o minimize complications
    • o create environment for spinal column to heal
  310. SCI requires surgery if...
    • o unstable # or soft tissue injury,
    • o neuro symp getting worse
    • o *consider comprehension, cooperation, consciousness of patient
  311. Pathology of the spinal cord
    Myelopathy
  312. Surgical procedure that helps to decompress the cauda equine/roots
    Lumbar laminectomy
  313. Temporary suppression of all reflex activity below level of injury
    Can last weeks to months
    SYMPTOMS
    i. areflexia
    ii. flaccid paralysis
    Thought that return of the sacral reflexes mark beginning of spinal resolution
    Spinal shock
  314. body’s reaction to sudden loss of sympathetic control
    occurs with injuries above T6
    SYMPTOMS:
    dec vasomotor tone = hypotension and hypothermia despite normal blood volume
    bradycardia (because of unopposed vagal stim of heart)
    can lead to metabolic issues
    Neurogenic shock
  315. Which mobility order from doctor?
    Spinal Column is assumed unstable
    +/- neuro deficits
    definite risk for additional injury
    Pt must:
    1)maintain neutral spine at all times
    2) bedrest
    3) HOB at zero degrees
    4) 2-3 person turns at all times
    Spine unstable
  316. Which mobility order from doctor?
      confirmed spinal column
      +/- neuro deficits
      Pt must maintain neutral spine at all times
      Pt can turn independ with neutral alignment
      mob and rehab begins
    “Spine stable” but requires protection
  317. Which mobility order from doctor?
      injury decided stable by surgeon
      patient may do all mvmts of spine within comfort limits
      Pt may be taught to log roll with neutral spine
      watch for changes in BP when first mobilizing
      may use stockings, binders, or meds to help with postural hypotension**
    “Spine stable-no restrictions”
  318. ASIA Impairment Scale
    Motor and sensory functions are normal
    E= Normal
  319. ASIA Impairment Scale
    Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level hava a muscle grade of 3 or more.
    D = Incomplete
  320. ASIA Impairment Scale
    Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.
    C= Incomplete
  321. ASIA Impairment Scale
    Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5
    B= incomplete
  322. ASIA Impairment Scale
    No motor or sensory function is preserved in the sacral segments S4-S5
    A= Complete
  323. Which SCI clinical syndrome?
    o no sensory or motor Fx is preserved in the sacral segments S4-S5
    o may be dermatomes below the sensory level and myotomes below the motor level that remain partially innervated: The Zone of Partial Preservation
     the most caudal segment with some sensory defines extent of ZPP (within 3 segments below injury)
    Complete injury
  324. Which SCI clinical syndrome?
    o loss of motor Fx
    o P and temp below injury level
    o dorsal column is spared (i.e. kinesthesia, proprioception, vibration)
    Anterior cord syndrome
  325. Which SCI clinical syndrome?
    o most common syndrome seen
    o upper motor and sensory Fx more impaired than LE
    o often associated with spinal canal stenosis
    Central cord syndrome
  326. Which SCI clinical syndrome?
    o one side of cord more damaged than the other
    o IPSILATERAL loss of motor Fx and dorsal column Fx (reason is they cross in medulla)
    o CONTRALATERAL loss of P and temp sensation a few levels below the lesion
    Brown Sequard
  327. Which SCI clinical syndrome?
    o spinal cord terminates at L1-L2
    o more LMN lesion
    o areflexive and flaccid bladder and bowel
    Cauda equina
  328. Which SCI clinical syndrome?
    o injuries at conuscan affect both conus and root resulting in a varied neuro picture
    o i.e. mixture of UM and LMNL
    Conus Medullaris
  329. Which spinal cord tract?
    Pain + temperature
    Lateral spinothalamic tract
  330. Which spinal cord tract?
    CRUDE TOUCH + PRESSURE
    Anterior spinathalamic tract
  331. Which spinal cord tract?
    FINE TOUCH, STEREOGNOSIS, VIBRATION
    Dorsal columns
  332. Which spinal cord tract?
    the 90% that cross in the pyramid motor
    Lateral corticospinal tract
  333. Which spinal cord tract?
    the 10% cross at the level of innervations motor
    Anterior corticospinal tract
  334. SCI and cough function
    C1-C3 absent, C4-T1 non functional, T2-T4 poor, T5-T10 weak, T11 and below is normal
  335. In SCI, what is the level the patient needs to breath independently?
    C4
  336. In SCI, what is the level the patient has normal vital capacity?
    T11 and below
  337. Breathing muscles innervation
    C2-C7
    C3-C5
    T1-T11
    T6-L1
    • o C2-C7 innervate accessory mm of breathing
    • o C3-5 innervates diaphragm
    • o T1-T11 intercostals
    • o T6-L1 abdominals
  338. Which level of SCI? 
    Patterns of weaknessparalysis of trunk and UE, probably diaphragm
    o Possible mvmts: neck mvmts, slight sh retraction and addn
    C1-C4
  339. Role of PT in C1-C4 SCI
    ROM, spasticity management, neck strengthening, chest physio, prevent contractures
  340. Which level of SCI? 
    Patterns of weakness
    o sig imbalance around sh girdle
    o absence of elbow ext, wrist pronation, ext, flex or any hand/finger movement
    o Possible mvmt
    o sh abd, flex, ext, elbow flexion and supination, scapular add and abd
    C5
  341. Which level of SCI?
      FIRST LEVEL OF SCI to have potential to live in community w/o care
      Patterns of weakness : no wrist flexion, elbow ext, hand movt
      Possible mvmt
    -  radial wrist ext, some horiz adduction
    -  can extend elbow in some positions using ER of shoulder
    -  have tenodesis grip which permits a weak grasp w/o any hand mm
      Slide board transfer possible, manual W/C possible
    C6
  342. Which level of SCI?
    Patterns of weakness: limited grasp and release dexterity d/t lack of intrinsic mm of hand
      Mvmt possible
    o elbow ext (C7), wrist ext, DIP/PIP flex, MP flex (C8)
    o Triceps allow independent transfers, manual W/C, indep with most/all ADL’s
    C7-C8
  343. Which level of SCI?
      intact UE Fx, mainly use W/C * living primarily in community*
      respiratory fxn compromised above T6
      can have spasticity in trunk that is worse the higher the lesion level
      can stand in standing frame
    T1-T9
  344. Which level of SCI?
      respiratory fxn is intact, cough is normal
      community dwelling
      IND
      limited ambulation may be possible with bracing
    T10-L1
  345. Which level of SCI?
      intact trunk
      sparing of LE muscles allows for potential of functional walking
      need brace and grade 3 quads to walk w/o KAFO
      cauda equina = hidden disability , areflexive bladder and bowl and flaccid paralysis
    L2-L5
  346. Which branch of the Nervous system?
      Chain T1-L1
      EFFECTS:
    o ⇧HR and BP and blood flow to skeletal mm
    o RELAXES bronchial mm to increase oxygen intake
    Sympathetic NS
  347. Which branch of the Nervous system?
      Craniosacral
      primary interest in Vagus nerve
      EFFECTS:
    o ⇩HR and contractility
    o ⇩blood flow to smooth mm
    o contracts bronchial mm
    Parasympathetic NS
  348. WITH LEVEL OF INJURY T6 AND ABOVE, what happens to:
    Sympathetic NS
    Parasympathetic NS
    • Sympathetic effect: dependent on level of injury (b/c it goes from T1-L1)
    • Parasymp effect: remains intact and UNOPPOSED via the vagus nerve in injuries T6 and higher
  349. Which condition is caused by massive sympathetic discharge from a noxious or non-noxious stimuli below level of SCI (with
    injuries above T6)
      S/S:
    o ⇧BP of 20-30 mm Hg from normal
    o bradycardia
    o severe headache
    o blurred vision
    o feeling of anxiety or impending doom
    o dilated pupils
    o flushing, sweating skin above level of injury
    o cool, dry, pale skin (d/t vasoconstriction) below level of injury
    o penile erection
    o Common Causes:
    o urinary or colon irritation (full bladder, UTI, kink in catheter)
    o wound, painful stim
    o tight clothing
    o sex, pregnancy and labour
    o diagnostic or therapeutic interventions
    Autonomic dysreflexia
  350. Autonomic dysreflexia treatment and prevention
    • o place client in upright position!
    • o remove noxious stim/triggers, if necessary use antihypertensive drugs
    • o good bladder and bowel routines
    • o skin care, nail care
  351.   sudden drop of 20 mm Hg of sys BP or 10 mm Hg dia BP
      S/S
    o Asymptomatic
    o Dizziness, fainting
    o Light headedness
    o Headache
    o Fainting
    ORTHOSTATIC HYPOTENSION
  352. ORTHOSTATIC HYPOTENSION RX
    • o mobilize slowly w/ therapy
    • o use compression stocking or binders
  353. Name 5 health risks with SCI
    • DVT
    • PE
    • Heterotrophic ossification
    • Osteoporosis
    • Post traumatic syringomyelia
  354. Which health risk with SCI?
    o d/t venous stasis, transient hypercoagulable state
    o SIGNS:
     Sudden L/E swelling+⇧temp
    DVT & PE
  355. DVT & PE prevention
    •  Anticoagulation meds
    •  Compression stockings
    •  Sequential compression devices
    •  PROM/AROM
    •  Early mobilization
    • **note for PEtachycardia may be masked by parasympathetic dominance
  356. Which health risk with SCI?
    2 main contraindication for Rx are forced PROM and serial casting
    o S/S
      Pain (if sensory sparing)
      ⇧spasticity
      warmth, low grade fever
      erythema
      local swelling
      sudden ⇩ROM with a abnormal firm or hard end-feel
    Heterotrophic ossification
  357. Heterotrophic ossification treatment
    •   PROM within tolerable range: mobilize as able
    •   Meds
    •   Surgery if long standing
  358. Which health risk with SCI?
    d/t rapid ⇧ calcium excretion within few days of SCI
     large incidence of #, especially LE
    Osteoporosis
  359. Which health risk with SCI?
    o formation of an abnormal tubular cavity in the spinal cord
     dura tethers/scars to the arachnoid blocking CSF flow
     CSF is forced into the spinal cord progressively enlarging the cyst
     Leads to compression of cord + vascular supply
    o can occur years after the original injury
    o S/S
    looking for differences or ⇧ presentation of the injury
     pain at level and spreading upwards
     sensory changes
     motor weakness
     ⇧spasticity
     B&B dysfxn
     ⇧ autonomic dysreflexia,
     hyperhydrosis;
    Post Traumatic Syringomyelia
  360. Post Traumatic Syringomyelia treatment and prevention
    Surgery: decompression or shunt
  361. Name two tests for spasticity
    • Modified Ashworth
    • Tardieu
  362.   velocity dependent resistance to passive stretch
      Clinical characteristics:
    o ⇧mm tone/firmness
    o ⇧ stretch reflexes
    o uncontrolled movt’s
    Spasticity
  363. Spasticity treatment
    • o Meds
    •  Intrathecal baclofen: makes muscles weak as well
    •  botox: more local use
    • o therapeutic exercise
  364. injuries above the conus
      messages will continue to travel btw bladder and spinal cord since reflex arc is still intact
      may be triggered by “tapping”
      bladder can be trained to empty on its own
      bladder mngmt: either intermittent catheters or condom/foley drainage
    Spastic bladder
  365. (injury below T12)
      in conus and cauda equina injuries
      messages don’t travel btw spinal cord and bladder since the reflex centre is damaged
      bladder loses ability to empty reflexively
      bladder will continue to fill AND must be catheterized
    Flaccid bladder
  366.   peristalsis and reflex propulsion is still intact
      reflex contraction of sphincter can lead to stool retention
      need suppository or/& digital stim within anus for voiding: can be trained
    Spastic bowel
  367.   peristalsis and reflex propulsion not intact
      slow stool propulsion
      risk of incontinence
      need to balance consistency of stool (usually go more solid)
    Flaccid bowel
  368. reflex and spontaneous erection, no ejaculation, fertility reduced
    UMN lesion sexual health
  369. psychogenic erection possible, reflex erection and ejaculation not possible
    LMN lesion sexual health
  370. damage to nervous system
     stabbing, burning, electric
     normally not changed by position or activity
     RX: medications
    SCI neuropathic pain
  371. damage to viscera or MSK
      dull, crampy, achy
      altered by position and activity
      RX: physical modalities, soft tissue, therapeutic exercise, education on posture and aggravating positions
      shoulder pain = big problem*
    SCI nociceptive pain
  372. pain lasting for longer than 3 mo (expected healing time)
     2/3 SCI have this type of pain
     RX:interdisciplinary team, education, appropriate exercise
    Chronic pain
  373. SCI wound causes
    • pressure, sheering, friction, deep tissue damage from banging and bumping
    • o sitting, lying high pressure areas
  374. SCI wound description
    • o Location
    • o Size
    • o Wound base/edge
    • o Surrounding skin
    • o Stage photos
  375. SCi wound prevention
    • o regular skin checks
    • o change position regularly
    • o skin care
    • o exercise and eating well for skin health
    • o no smoking
  376. SCI and exercises
    •  ⇩symp impact
    • o HR + BP will not have normal responses (levels will be relative to before exercise)
    •   use RPE and BORG
    •   watch for orthostatic hypotension
  377. Tumor, cancer, which area?
    squamous metaplasia, squamous diplasia, carcinoma in situ, invasive carcinoma
    Lung
  378. Tumor, cancer, which area?
    2nd cause of death
    Colon
  379. Tumor, cancer, which area?
    hormonal and genetic risk factors, axillary node dissection
    Breast
  380. Tumor, cancer, which area?
      in men over 50 usually
      Tx: surgery, external beam radiation, brachytherapy, androgen deprivation therapy
    Prostate
  381. Tumor, cancer, which population?
      acute lymphocytic leukemia
      non-hodgkins, hodgkins
      brain
      small round blue cell
      sarcoma (bone based - osteosarcoma, ewing’s sarcoma)
    Kids
  382. Which skin cancer?
    o most common form of skin cancer
    o low risk of spreading, translucent and red in color
    Basal Cell Carcinoma (BCC)
  383. Which skin cancer?
    o solid skin tumor
    o often volcano shaped
    o high risk for metastasis
    Squamous Cell Carcinoma (SCC)
  384. Which skin cancer?
    most dangerous form of skin cancer
    o high potential for metastasis
    o ABCD rule for melanoma- Asymmetry, Border, Color, Diameter
    Malignant melanoma
  385. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
    X-link mutation on chromosome 21, M>F, maternal carrier
    o dystrophin protein is not produced : structural component within muscle tissue: structural
    stability: tissue now prone to damage/necrosis
    Duchenne’s Muscular Dystrophy
  386. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
     muscle cells are replaced by fat and CT
     progressive symmetrical wasting
     in w/c by 10-12 years, die by age 20
    Duchenne’s Muscular Dystrophy
  387. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
    CLASSIC SIGNS
      Gowers Sign: pushing on thighs to stand up off the floor
      Calf Pseudohypertrophy: well defined calves but by fat and CT (⊘muscle)
    Duchenne’s Muscular Dystrophy
  388. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
    S/S
      proximal muscle weakness
      waddling gait
      toe walking
      lordosis
      difficulty standing up and climbing stairs, frequent falls
      lower IQ
    Duchenne’s Muscular Dystrophy
  389. Rx Duchenne’s Muscular Dystrophy
    •   exercise by maintaining strength and balance (avoid eccentric)
    •   respiratory therapy
    •   prevention of contractures, seating, equipment
  390. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
     motor neuron disease w/ gradual deterioration of BOTH UMN and LMN
    o can have both flaccid and spastic paresis
      M>F, etiology unknown
      Disease Course: 2-5 yrs after dx (only 10% survive 10 yrs)
    AMYOTROPHIC LATERAL SCLEROSIS (Lou Gerigs)
  391. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
    S/S
    o paresis in a single muscle group
    o corresponding muscle groups are asymmetrically affected (patchy distribution)
    o fasciculations (twitching)
    o metabolic involvement of the skin (papery, fragile, cold)
    o gradual involvement of striated muscle (bulbar = major concern)
    o progress to permanent paralysis
    o flaccidity + spasticity may co-exist
    o selective sparing (no ocular or cardiac, urethral & anal sphincter)
     DX
    o physical exam, medical history, muscle biopsy (not needed to confirm Dx)
    AMYOTROPHIC LATERAL SCLEROSIS (Lou Gerigs)
  392. Rx for AMYOTROPHIC LATERAL SCLEROSIS (Lou Gerigs)
    o meds, rehab for immobility, symptom relief (spasticity, secretions, psychological)
  393. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
    usually evoked by voluntary movement
     causes: genetic,⇧ thalamus activity
    Essential tremor
  394. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
      involuntary, sustained muscle contractions, writhing
      commonly linked to a single repetitive action (ie musicians)
      causes: genetic, originates from different parts of brain
    Dystonia
  395. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
      Chronic neurodegenerative disease in basal ganglia, M=F
    ⇩ dopamine produced by substantia nigra
    o dopamine normally inhibits ACh
    o without dopamine = excessive excitatory output
     Possible causes:
    o viral (infection: swelling of brain)
    o genetic
    o toxic (drugs)
    o injury or focal ischemiacan cause PD-like symptoms
    PARKINSON’s DISEASE
  396. PARKINSON’s DISEASE treatment
    • o drugs (L-dopa + anticholinergic)pt will have mov’t tremor b/c of meds
    • o education (protective effects of exercise)
    • o functional mobility exercise  FOCUS ON BIG MOVEMENTS
    •  cueing (tactile, verbal, music)
    •  address postural changes and cardiorespiratory fitness
    •  transfers, balance and falls prevention
    • o prevention of secondary sequelae
    • o environment safety and checks
    • o care giver involvement and training
    • o equipment
  397. Outcome measures for PARKINSON’s DISEASE
    • Unified Parkinson's Disease Rating Scale (UPDRS)
    • Hoens & Yar
  398. Which DEGENERATIVE NEUROLOGICAL/NEUROMUSCULAR DISORDERS?
      hereditary disorder : atrophy of basal ganglia structures, personality disorder, dementia  * they can’t stop moving* : abnormal mov’ts
    HUNTINGTONS CHOREA
  399. HUNTINGTONS CHOREA treatment
    Symptom mgnt, antipsychotic drugs, safety, nutrition
  400. Which DEMYELINATING DISORDER?
    Inflammatory disease: fatty myelin sheaths around brain + spinal cord axons are damaged
    Leads to demyelination and scarring
    Etiology unknown
    Typical onset: 20-40y, F>M
    Multiple sclerosis
  401. Which DEMYELINATING DISORDER?
    (Early) SYMPTOMS
    o mm weakness
    o optic neuritis, diplopia
    o sensory changes (paraesthesia)
    o b/b incontinence
    o vertigo
    o fatigue
    o impaired cognition/memory
    o pain
    o depression
    Multiple sclerosis
  402. Pharmaceutical Rx for Multiple sclerosis
    • anti-inflam + immunosuppressant
    • side effects: heat intolerance, photosensitivity
  403. PT Treatment for Multiple sclerosis
    • Adresses: 
    •  vestibular dysfunction
    •  proprioception
    •  exercise (posture, core, stretches, pool therapy, interval training?)
    •  osteoporosis (?)
  404. CONTRAINDICATIONS/precautions to EXERCISE for MS
    •  Heat
    •  Fatigue
    •  Pregnancy
  405. Which INFLAMMATORY/INFECTIOUS CONDITIONS OF NERVOUS SYSTEM?
      from a bacteria, Borrelia burgdorferi, through ticks
      mimics other diseases like MS, fibromyalgia, chronic fatigue syndrome, guillan barre
      STAGES:
    o localized presentation  erythema, flu-like
    o neuro (headache and neck stiffness) MSK and cardiac (tachy, brady, arrythmia, myocarditis)
    o may have Bells palsy
    o final stage  long term neuro + arthritis(1/3) + cognitive deficits
    Lyme Disease
  406. Lyme Disease treatment
    • Meds: antibiotics
    • PT MGMT:
    • relieve pain
    • ⇧ strength in deconditioned patients for home exs
    • FITT w/out exacerbating symptoms
  407. Which INFLAMMATORY/INFECTIOUS CONDITIONS OF NERVOUS SYSTEM?
      Antibody mediated demyelination of Schwann cells in PNS from spinal nerves: terminating fibres
      May be in hospital for 6-8 mo
      Causes
    o immune disorder
    o 2/3 ppl had recent illness in last 30 days (flu vaccine)
    GUILLAIN-BARRE SYNDROME
  408. Which INFLAMMATORY/INFECTIOUS CONDITIONS OF NERVOUS SYSTEM?
     S/S
    o onset to peak 4 weeks
    o rapid ascending motor weakness and distal sensory loss
     spreads to arms, trunk, and face
     stocking and glove pattern of loss*
    o absent DTR
    o may require mechanical ventilation
    GUILLAIN-BARRE SYNDROME
  409. GUILLAIN-BARRE SYNDROME treatment
    • o MEDICAL : Plasmaphoresis, immunoglobin
    • o PT:
    •  joint protection
    •  chest rx, mobilization
    •  strength
    •  ROM (usually opposite to ALS progression)
  410. Which INFLAMMATORY/INFECTIOUS CONDITIONS OF NERVOUS SYSTEM?
      infectious disease (bacterial or viral)can be fatal
      causes inflammation of meninges (all 3: pia, arachnoid, dura)
      blood-brain barrier can break down
      can lead tothrombosis, infarction, scars, edema
      commonly seen in:
    o under development countries
    o dorms
    o infants
    o immunosuppressed
    MENINGITIS
  411. Which INFLAMMATORY/INFECTIOUS CONDITIONS OF NERVOUS SYSTEM?
    o Brudzinski sign flexing hip + knee causes neck to involuntarily flex
    o fever, headache, seizure
    o vomiting
    o focal CNS signs (nerve palsies, deafness), * pain with neck , hip, or knee flexion*
    MENINGITIS
  412. Which INFLAMMATORY/INFECTIOUS CONDITIONS OF NERVOUS SYSTEM?
      infection (1° or 2°) of the brain + spinal cord or brain parenchyma (nervous tissue in brain)
      S/S
    o headache, LOC, coma (may last for weeks)
    o nausea, vomiting
    o agitation
    o meningeal irritation
    o stiffness
     RESULT
    o can lead to necrosis, hemorrhagic necrosis, scarring
    ENCEPHALITIS
  413. MENINGITIS + ENCEPHALITIS MGMT
    •  Investigate ASAPEEG, CSF tap, MRI
    •  RX
    • o antibiotic (if bacterial)
    • o viral (control of symptoms)
  414. Which INFLAMMATORY/INFECTIOUS CONDITIONS OF NERVOUS SYSTEM?
      movement disorder/dementia  rapidly progressive + fatal
      occurs in young adults
      Pathology
    o caused by prions (misfolding proteins)bovine spongiform encephalopathy (mad cow
    disease)
    o contracted by ingestion or via the nose
    o incubates 5-8yrs
     cannot make final Dx until death*
    CREUTZFELDT JAKOB DISEASE
  415.   Attacks neurons in brainstem + anterior horn cells (spinal cord)
      INITIAL EFFECTdeath of those motor neurons controlling skeletal muscles
    o Those that survive  sprout new nerve terminals to make up for loss
    o RESULTsome mov’t recovery + enlarged motor units
     After years of usehigh metabolic stress on larger motor unitsmore than neuron can handle
    o RESULTgradual deterioration of sprouted fibers & eventually neuron
     MUSCLE WEAKNESS + PARALYSIS
    POST-POLIO SYNDROME
  416. MS
      hereditary ataxia, Friedreich’s ataxia
      neoplastic, metastatic tumors
      infection
      vascular  stroke
      developmental  ataxic cerebral palsy, arnold chiari syndrome
      trauma  TBI
      drugs  heavy metals
      chronic alcoholism; acute alcohol poisoning, effects GABA receptors
    CEREBELLAR DISORDERS
  417. S/S
    o lurching gait, falling to side of lesion, stiff legged
    o intention tremor, dysdiadochokinesia, nystagmus, dysmetria (overshooting target)
    o cerebellar ataxia, decomposition of movement, pendular knee jerk
    o othershypotonia, falling, dysphonia or dysarthria
    Cerebellum lesions
  418. x 3  horizontal, anterior, posterior
     Fxgaze/angular displacement of the head
     movement of endolymph will deflect hair cells and excite or inhibit neurons (CNVIII)
    SEMICIRCULAR CANALS
  419. x 2utricle- detects horizontal plane motion, and saccule- detects sagittal plane motion;
     together detect acceleration and deceleration, gravitational pull= POSTURAL
    OTOLITH
  420. the subjective experience of nystagmus (room spinning around you) - get it with BPPV *
    always vestib in origin
    vertigo
  421. discrepancy between R and L side, patient can’t work out where they are in space
     *non-specific, may or may not be vestib in origin
    Dizziness
  422. blurred vision * NOT THE SAME A DIPLOPIA
    oscillopsia
  423. Which antibiotic affects vestibular system?
    GENTOMYCIN
  424.   90% present with crystal in posterior SCC, 80% canalithiasis (free floating in the canal)
      S/S
    o brief (< 30 sec), delayed, transient vertigo with looking up/down, rolling to that side of bed, sit to
    supine; +/- vertigo, nystagmus, vomiting etc
    BPPV (benign paroxysmal positional vertigo)
  425. BPPV (benign paroxysmal positional vertigo) assessment
    Dix Hallpike * look for down beating nystagmus
  426. Dix Hallpike Contraindication
    cervical spine instability, VBI, Arnold- chiari malformation, acute whiplash, RA, prolapsed IV disc with radiculopathy, cervical myelopathy
  427. BPPV (benign paroxysmal positional vertigo) treatment
    Modified Epley Manoeuvre*, Semont/Liberty manoeuvre, Brandt-Daroff very good prognosis after first treatment, keep head down at end of manoeuvre because you can put the crystal in the horizontal canal
  428.   overaccumulation of endolymph
      S/S
    episodic vertigo, tinnitus, fullness of ears, hearing loss
    don’t assume that pts will benefit from VR
    Menieres Disease
  429. VOR
      reflex that moves your eyes in the opposite direction that your head is turning
      allows for visual fixation*
    Acute S/S
     spontaneous nystagmus away from the affected ear, reduced VOR, vertigo (resolves in a few
    days), dizziness, oscillopsia, imbalance, ?vomiting
      Chronic S/S
      dizziness, oscillopsia, imbalance
      symptoms worse after rapid head movementsdepends on compensation
    UVL (unilateral vestibular loss)
  430. UVL (unilateral vestibular loss) Test
    head-thrust, dynamic visual acuity test, balance and gait assessment + Dix-Hallpike
  431. UVL (unilateral vestibular loss) Treatment
    •   exercises to resolve conflict and symptoms (adaptation exercises, balance, walking programme, functional tasks)
    •   education on impact of stress on symptoms
    •   maintain general fitness
    •   address falls risk, mobility aids
    •   improve any balance deficits * 6-8 wks
  432. can be equal or unequal, NO DIZZINESS OR VERTIGO
      usually caused by ototoxic drugs (gentimicin)
      S/S
    ⇩⇩balance with eyes closed + ⇧oscillopsia
      Ototoxic Medications
    o antibiotics (gentimicin), anticancer drugs, env. chemicals, loops diuretics, aspirin
      *BALANCE AXstatic (Romberg, sharped Romberg (tandem stance)), dynamic (reach arm forward, movement with eyes opened and closed), composite tests (berg)
      *GAIT  eyes open/closed, head turns, different surfaces, negotiating objects
    BVL (bilateral vestibular loss)
  433. CAUSES  stroke, TBI, MS, tumor, neurodegeneration, epilepsy, etc  RED FLAGS  direction changing nystagmus, inconsistency in test results
      DXby a collection of oculomotor tests
      RX  based on neuroplasticity
    o exercises (habituation, substitution, balance, walking program, functional tasks), 8-12 wks
    Central Vestibular Disorders
  434. (1) sensitivity to head movement /// (2) sensitivity of moving environment
    Motion Sensitivity
  435. Motion Sensitivity treatment
    8-12 weeks of sensorimotor mismatch exercises
  436.   injury to peripheral N due to injury or illness
      mononeuropathy, mononeuritis, polyneuropathy, autonomic neuropathy, neuritis
      CAUSES
    o diabetes (most common)
    o lyme disease
    o HIV
    o Shingles
    o Guillain-Barre
    PERIPHERAL NEUROPATHY
  437. o can be focal or diffuse, involving the somatic or autonomic PNS
    o PRESENTATION
     symmetrical distal pattern (diabetic polyneuropathy)
    o CAUSES
     hyperglycemia leading to abnormal microcirculation
     change in insulin levels alter gene-regulation
     loss of myelinated + non-myelinated fibres
     vascular changes
     nerve growth reduced
    o S/S
     burning pain
     symmetrical sensory changes (paresthesia, burning)
     can be slow or rapid onset (people may not notice it)
     paraesthesiaimpaired proprioception, touch, pressure
     minimal motor weakness
    Diabetic Neuropathy
  438. Diabetic Neuropathy Rx/MGMT
    •  control hyperglycemia
    •  symptoms management
    •  skin care checks* (risk of wound and amputation)
    •  exercises:
    •   strength (ankle, hipsstrategies for prevention of falling)
    •   balance
    •   prevention of damage to skin, joint, muscle, CT
  439.   chronic pain condition
      ?result of dysfx in central or peripheral NS *sympathetic facilitation*
      PRESENTATION
    o change in color/temp of the skin over the affected limb or body part
    o intense burning pain
    o skin sensitivity
    o sweating
    o swelling
    o stiffness
    o *usually occurs after trauma or immobilization (cast)*
     STAGES
    o Stage 1 (0-3 mo) puffy swelling, redness, warmth, stiffness, allodynia, pos bone scan
    o Stage 2 (3-6 mo)P and stiffness, firm edema, cyanosis, atrophy, osteopenia on xray
    o Stage 3 (6mo+) tight, smooth, glossy, cool, pale skin
     stiffness and contractures, nail and hair changes, severe osteopenia
    COMPLEX REGIONAL PAIN SYNDROME
  440. COMPLEX REGIONAL PAIN SYNDROME Rx
    • prevention and early detection
    • o early ROM, P/edema mngmt (desensitization, contrast baths, modalities), education
  441.  Non-progressive lesion of brain, occurs before 2yrs
     COMORBITIES
    o hearing and speech problems o hydroencephalus
    o microencephaly
    o scoliosis
    o hip dislocation
    o mental retardation
     RISK FACTORS
    o prenatal (maternal infection, malnutrition, maternal seizures)
    o perinatal (prematurity, obstetric complications (breech)
    o low birth weight
    o low APGAR
    o multiple births
    o post natal: infection, environmental toxins, brain tumor, anoxia, CVA
    CEREBRAL PALSY
  442. Which type of cerebral palsy?
      monoplegia, diplegia, hemiplegia, quadriplegia
      classification by physiology type: stiffness, ⇩
     ROM, movements limited to synergies primitive movement patterns- trouble start/stop movement
    Spastic cerebral palsy
  443. Which type of cerebral palsy?
     rate, range, force, duration of movements
     difficulty with rapid movts, coordinated gait, fine motor, balance
    Ataxic cerebral palsy
  444. Which type of cerebral palsy?
     ⇧tone, can’t relax muscles easy
     long sustained involuntary movements and postures
     tend to lock joints at end range
     usually have full ROM
     mid control difficult
    Dystonic cerebral palsy
  445. cerebral palsy rx
    • o Medical
    •  bacolfen pump, dorsal rhizotomoy (cut dorsal roots of SC), botox to ADDs, serial casting,
    • tendon release, osteotomy
    • o PT Management
    •  manage atypical mmROM, orthotics
    •  habituation, not rehab
    •  positioning, sitting modificationsput pummel between legs
  446. Neural tube defectRESULT: vertebral and/or spinal cord malformation
      link between maternal decreased folic acid + infection + exposure to teratogens (alcohol)
      S/S
    o flaccid or spastic muscles
    o muscle weakness
    o contractures
    o muscle wasting
    o dec/absent DTR
    o rectal/bladder incontinence
    o hydrocephalus (chiara malformation)
    o osteoporosis, lordosis, scoliosis, kyphosis
    o foot deformitiestalipes equinovarus (club foot) esp with L4, L5 level
    SPINA BIFIDA
  447. Spina Bifida RX
    • o ROM, strengthen functional muscles
    • o teach transfers
    • o equipment (orthodics, early mob, standing and ambulation)
    • o encourage awareness of sensory deficits (protection of feet, position of legs, check for sores)
  448.  C5, C6 injury in infantsusually coming out of birth canal
     MM EFFECTs
    o rhomboids, levator scapulae, serratus anterior, delts, supraspinatus, infraspinatus
    o biceps, brachioradialis, brachialis, supinator, long extensors of wrist, fingers, thumb
    ERB’S PALSY (waiters tip)
  449. ERB’S PALSY RX
    • o immobilization initially
    • o gentle ROM
    • o play exercises
  450.  C8,T1
     MM EFFECT
    o intrinsic hand mm, flex/extensors of wrist/fingers
    KLUMKE (claw hand)
  451.  C6-8, T1 median N
     THENAR MM THUMB: ⊘Thumb ABD, oppose
    MEDIAN N PALSY
  452.   huge risk with ⇧ age, genetic link
      etiology unknown
      IMPAIRMENTS
    o memory, language, visuospatial skills
    o cognition, personality
    o slow steady decline
     PRESERVED: implicit skills (Eex piano playing
     DX: made at autopsy (neurotic plaques)
    ALZHEIMERS
  453.   multiple small lesions 2° to poor blood flow (high BP)
      leads to degeneration of medial temporal lobes“staircase pattern of functional losses”
      related to:
    o hypertension, small haemorrhages, atherosclerotic plaque,
      most patients die of pneumonia
    VASCULAR COGNITIVE DEMENTIA
  454. VASCULAR COGNITIVE DEMENTIA outcome measure
    MMSI (Mini Mental State Exam)
  455. VASCULAR COGNITIVE DEMENTIA PT concerns
    • o Falls prevention
    • o Retaining motor activities
    • o ⇩ restlessness = ⇧sleep support for caregivers
  456. How to assess Coma
    Glasgow Coma Scale
  457.   disturbances in CNS
      S/S
    o altered consciousness
    o motor activity (convulsions)
    o sensory phenomena
    o altered autonomic & cognitive fx
    EPILEPSY/ SEIZURES
  458.   tests pain, hot/cold of limbs and trunk
      receptors are free nerve endings
      sharp P is A delta fibers, slow/dull are type C fibers
      ascends in lateral white column of spinal cord, crosses w/i 1-2 segments
      finishes in parietal lobe (this lobe integrates sensory information from different modalities)
      F HALF THE CORD has lesion, at the level there ipsilateral loss, and contralateral loss below the lesion
    Lat Spinothalamic
  459.   crude touch and pressure
      receptors are Merckel discs and Ruffini corpuscles and free nerve endings
      A delta and A beta
      ascends in ant white column
      crosses w/i 1-2 segments
      finishes in parietal lobe as well
      IF HALF THE CORD has lesion, at the level there ipsilateral loss, and contralateral loss below the lesion
    Ant (ventral) Spinothalamic
  460.   2-pt discrimination
      fine touch
      sterognosis
      vibration
      receptors are pacinian corpuscles (vibration), merckels’s disc, meissners (light touch), a beta
      fibers cross in the brain stem
      lesion below medulla  ipsilateral loss
      lesion above medullacontralateral loss
      finishes in parietal lobe
    Dorsal columns (medial lemniscu)
  461.   primary motor tract
      90% cross in pyramids (part of the brain stem)
      synapses in ant horn cell in grey matter of spinal cord, goes out on an alpha motor neuron, terminates at the neuromuscular junction
      LESION above level of medulla where they crossloss of vol mvmt contralateral to the lesion
    Lateral corticospinal
  462.   primary motor
      10% that cross at level of innervation
      target lower motor neurons; start in frontal lobe
      don’t cross in the pyramids
      travel in ventral white column
      IF LESION is on one side of the cordloss of 10% voluntary mvmt contralateral to the lesion
    Anterior corticospinal
  463.   collateral supply is possible thru ant. + middle cerebral arteries
      Deficits:
    o contralat. hemiplegia and hemisensory disturbance
    o global aphasia (if dominant side)
    o mentally slow
    o contralateral homonymous hemianopia
    o partial Horner’s syndrome
    o gaze palsy (eyes to opp side)
     is the main supply for ant, post, middle cerebral arteries
    Internal carotid artery
  464. Which artery?
    Deficits:
    o weakness and sensory loss of contralat limbs
    o self care problems
    o emotional lability
    Anterior cerebral artery
  465. Which artery?
    Deficits
    o contralat hemiplegia, hemisensory loss, hemianopia
    o contralat neglect
    o aphasia (impaired language ability) if on dominant side
    o apraxia (disorder of motor planning
    o can’t carry out purposeful movements)
    o impaired hearing
    o difficulty dressing
    o may also produce motor speech dysfunction (Broca’s area)
    Middle cerebral artery
  466. Which artery?
      two join to form basilar artery
      imp branches to watch for strokesPICA (largest branch of vertebral a.), AICA, PCA
    Vertebral artery
  467. Which artery?
      supplies occipital lobes
      Deficits
      vision problems, CN III palsy, contralateral hemiplegia, chorea (abnormal invol. mvmts, looks like
    dancing)
      hemiballismas (involuntary flinging mvmts of extremities)
      hemisensory impairment
      contralat homonymous hemianopia
      difficulty with naming and colors
    Post cerebral artery (PCA)
  468. Which artery?
      supplies cerebellum
      Deficits
    o limb ataxia
    o Horner’s syndrome (droopy eyelid, red face)
    o contralateral sensory loss
    Superior cerebellar artery
  469. Which artery?
     supplies cerebellum
     Deficits
    o ipsilateral limp ataxia
    o ipsilateral horner’s
    o sensory loss
    o facial weakness
    o paralysis of lateral gaze
    o contralateral sensory loss of limbs and trunk
    Ant inf cerebellar
  470. Which artery?
      supplies cerebellum
      Deficits
    o dysarthria (poor articulation while speaking d/t motor issues)
    o ipsilateral limb ataxia
    o vertigo
    o nystagmus
    o ipsilateral horners
    o sensory loss (p and temp) of face
    o pharyngeal and laryngeal paralysis
    o contralateral sensory loss (p and temp) of trunk
    o visual sy’s (paralysis of vertical eye mvmts and decrd pupillary light reflex)
    PICA
  471. located in the left frontal lobetherefore:
    o problems with articulation of speech (dysarthria)
    o can understand speech fine
    Broca’s (expressive) aphasia
  472. located in the left temporal lobe, therefore:
    o problems with understanding speech
    o will speak normally but often doesn’t make sense  patient feels it does
    Wernicke’s (receptive) aphasia
  473. DECREASED:
     most muscles on R side of body are affected. Also aphasias, used more reasoning, numerical and scientific skills, spoken and written language, sign language.
    Left CVA
  474. DECREASED:
      musical and artistic awareness
      spatial and pattern perception
      recognition of faces
      emotional content of language (speak in montotnous voice)
      discriminating smells
      damage to right brodmann’s area have difficulty differentiating smells
      HEMINEGLECT
    Right CVA
  475. Which cranial nerve?
    damage  anosomia (inability to detect smells, seen with frontal lobe lesions)
    1. Olfactory  smell
  476. Which cranial nerve?
    damagecan cause homonymous hemianopsia (hemianopic visual field loss on the same side of both eyes)
    Hemianopias occur because the right half of the brain has visual pathways for the left hemifield of both eyes, and the left half of the brain has visual pathways for the right hemifield of both eyes
    2. Optic  vision
  477. Which cranial nerve?
    motor: medial rectus, superior and inferior rectus, and inferior oblique
    damagecan cause absence of pupillary constriction or Horner’s syndrome (combination of drooping of the eyelid (ptosis) and constriction of the pupil (miosis), sometimes accompanied by decreased sweating of the face on the same side; redness of the conjunctiva of the eye is often also present)
    3. Occulomotor  pupillary reflexes
  478. Which cranial nerve?
    turns adducted eye downwardssuperior oblique
    4. Trochlear
  479. Which cranial nerve?
    V1 sensory on face
    V2 opthalmic branch (touch with cotton)opthalamic division
    V3 motor mm of masticationmaxillary/mandibular division
    5. Trigeminal
  480. Which cranial nerve?
    turns eye outlateral rectus
    6. Abducens
  481. Which cranial nerve?
    parasympathetic control of lacrimal, submandibular, and sublingual glands, taste to anterior 2/3 of tongue, innervates ant aspect of tongue
    damage  inability to close eye, droopy corner of mouth, difficulty speaking
    LMN lesion = ipsilateral side of face
    UMN lesion = contralateral lower half of face
    7. Facial  facial expression
  482. Which cranial nerve?
    balance, gaze stability, auditory
    damage  can cause vertigo, nystagmus, deafness
    8. Vestibular
  483. Which cranial nerve?
    phonation (voice quality), swallowing, innervates the back of the tongue
    damagedysphonia (hoarse or nasal voice)
    9. Glossopharyngeal
  484. Which cranial nerve?
    elevates the soft palate
    controls position of uvula, gag reflex
    muscles in larynx and upper esophagus
    10. Vagus
  485. Which cranial nerve?
    (spinal) - innervates traps and SCM
    damage  inability to shrug ipsilateral shoulder (traps) or inability to turn head to opp side (SCM)
    11. Accessory
  486. Which cranial nerve?
    a. damagedysarthria or deviation of tongue to the weak side
    12. Hypoglossal  tongue movement
  487. Which outcome measure or test for motor control/strength:
    muscle chart (MMT) or Fugl-Meyer
  488. Which outcome measure or test for cognition and perception:
    mini-mental status exam (MMSE) or Montreal Cognitive Assessment (MOCA)
  489. Which outcome measure or test for tone and spasticity:
    modified ashworth scale (pediatric: modified tardieu)
  490. Which outcome measure or test for sensation:
    sensation body diagram, Nottingham sensory assessment
  491. Which outcome measure or test for gait:
    6MWT, TUG, 10 m walk, dynamic gait index, observational gait analysis, functional gait assessment
  492. Which outcome measure or test for balance:
    BERG, Fullerton balance assessment, community balance and mobility scale, BESTest measure, functional reach tes
  493. Which outcome measure or test for upper extremity:
    DASH, action research arm test, upper extremity performance test for elderly, wolf motorfunction test
  494. Which outcome measure or test for other:
    barthel index, chedoke mcmaster stroke assessment, clinical outcome variables scale (COVS), functional independence measure (FIM), motor assessment scale (MAS), patient specific functional scale,activities balance confidence scale (ABC), storke impact scale (SIS), falls efficacy scale
  495. Neurorehab Goals
    1. maintain : ...
    2. prevent: ...
    3. reversal of impairments: ...
    4. adaption to impairments: ...
    • 1. maintain : participation, activity, body structure and function
    • 2. prevent: complications
    • 3. reversal of impairments: as appropriate, encourage neuroplasticity
    • 4. adaption to impairments: adaptive aids, compensation
  496. use it or loose it, use it and improve it, specificity, repetition**, intensity, time matterns, salience
    matter, age matters, transference, interference * no drug alone will improve neuroplasticity, intervention needs to be paired with behavior; requires: task specific practice, dose? 6 hrs per day?
    Neuroplasticity
  497. Contraindications for STRETCHING
     bony block, recent #, acute inflamm process of the joint, sharp or acute joint pain, hematoma or tissue trauma, contracture or soft tissue is providing stability to area or function (ex: tenodesis grip)
  498. flexor synergy
    • UE = flexion of elbow, ER and ABD of shoulder, flex of wrist
    • LE = hip flex, knee flex, DF and INV of foot
  499. extensor synergy
    • UE = shoulder adducts and internally rotates, elbow extends and pronates , wrist extends 
    • LE = hip extends and internally rotates, knee extends, ankle PF and inverts
  500. velocity dependant increase in passive stretch
    spasticity
  501. o velocity independent resistance to passive stretch
    o usually seen with a head injury (decorticate or decerebrate rigidity)
    rigidity
  502. RX for spasticity and tone
    • o postural control
    • o prevent and treat biomechanical limitations (positioning, ROM, mobility, etc)
    • o promote strength, endurance, and coordination
    • o maintain extensibility/PROM
    • o address potential factors contributing to tone (agitation, motivation, pain, infection, full bladder)
    • o provide sustained pressure on tendons
    • o referral to health care team (meds, botox, etc)
  503. TREATMENT FOR CLONUS (proprioceptive reflex)
    o teach them to contract the muscle with the clonus then relax
  504. Treatment for CUTANEOUS HYPERREFLEXIA
    desensitize, promote active movements within limits of individuals capacity, strap legs whenin wheelchair to prevent falling
  505. failure of muscle coordinations; irregularity of muscle action
    CEREBELLUM LESIONS- Ataxia
  506. CEREBELLUM LESIONS- Ataxia assessment
    • coordination
    •  1) UE: finger to nose (elbow straight), dysdiadochokinesia, (elbows not supported on lap), finger opposition
    •  2) LE: toe tapping, heel on shin * do at same time , then separate; start slow then fast*
    • record how many reps and quality
    • o balance
    •  Romberg (differentiate from somatosensory deficit),
    • o functional
    •  TUG, 10 m walk
  507. CEREBELLUM LESIONS- Ataxia RX
    • o postural control
    • o prevent and treat biomechanical limitations
    • o promote muscle strength, endurance, and coordination
    • o start with specific strategies: small range near midline, work out, progress : dec guidance, cueing, number of fixed points, inc active ROM, speed, change direction
  508. localized abnormal dilation of the wall of a blood vessel 
    may rupture
    CAUSES  atherosclerosis, trauma, congenital defects
    ANEURISM
  509. MOST COMMON SITE  aneurism
    abdominal aortic aneurism
  510.  When rib cage segments breakmoves independently
    o Result of: multiple rib fractures, free floating rib section
     Accompanied w/ pulmonary contusion  lung tissue bruise
    o Usually main cause of respiratory failure
    Paradoxical breathing
    FLAIL CHEST
  511. Flail chest rx
    • o pain control
    • o intubation/ventilation if necessary
    • o O2, airway clearance
  512.   collapse of lung d/t air in pleural space
      due topuncture of chest wall or lung spontaneously bursts
      percussion  hyperresonant percussion
    PNEUMOTHORAX
  513. Rx for pneumothorax
    aspirate or chest tube
  514. inverted T waves, poor blood supply and hypoxia
    occurs w/in seconds of onset
    REVERSIBLE
    Myocardial ischemia
  515. a. Elevated ST segment
      myocardial tissue injured during MI occurs in 20-40mins
      REVERSIBLE
    b. Depressed ST segment
      injury to myocardial tissue
      can occur during angina
    Myocardial injury
  516. abnormal Q waves + QS complexes
    can also have ⇧R waves
    NOT REVERSIBLE: occurs 2hrs after onset
    Myocardial infaction
  517. Heart rate <60 bpm
    Bradycardia
  518. Heart rate >100 bpm
    Tachycardia
  519.   heart unable to pump blood at rate required by tissues of the body OR able to but at elevated filling pressures
      TYPES
    o Systolicdeterioration of contractile function
    o Diastolic  can’t accommodate ventricular blood volume
     S/S
    o breathlessness
    o abnormal retention of sodium + water
    o Resultedema w/ congestion of lungs OR peripheral circulation OR BOTH
    CONGESTIVE HEART FAILURE (CHF)
  520. Causedamming of blood in pulmonary circulation
      S/S
    o SOB when lying
    o Nocturnal gasp of breath when sleeping
    o ⇩kidney and brain perfusion
    o exertional dyspnea
    o pulmonary congestion  cough, crackles, wheezes
    LEFT SIDED HEART FAILURE (Congestive heart failure)
  521.   Causes: L sided heart failure
    long-term ⇧BP in lung arteries + R ventricle
      chronic severe pulmonary HTN  emphysema, chronic bronchitis (COPD)
      cystic fibrosis
      Resulting effects:
    o ⇩flow in periphery
    o pitting edema (⇧peripheral venous pressure)
    o congestion of the portal systemliver damage + enlarged spleen
    o kidney and brain issues
    o fatigue
    RIGHT SIDED HEART FAILURE (Cor Pulmonale)
  522.   Cause: myocardial ischemia
      S/S
    o Angina
    o MI
    o sudden cardiac death 90% due to artherosclerosis
    ISCHEMIC HEART DISEASE
  523.   paroxysmal (sudden attack, short and frequent) recurrent episodes of chest discomfort
      CAUSE:
    o Transient ischemia of heart muscle  d/t obstruction/spasm of coronary arteries
     CAN BE  stable, unstable, prinzmetal (variant angina) occurs at rest
    ANGINA PECTORIS
  524.   Blood  flowing properly to part of heart muscle  injury d/t lack of O2
      Risk factors
    o Previous cardiovascular disease
    o Old age
    o Smoking
    o High levels of certain lipids
     Cause
    o coronary artery to heart develops blockage d/t unstable atheromas (WBCs + cholesterol + triglycerides)
     S/S
    o Sudden chest pain
    o L UE/neck pain
    o May have  SOB, sweating, nausea, vomiting, abnormal heartbeats, anxiety
    o M>F in having symptoms
    MYOCARDIAL INFARCT
  525. MYOCARDIAL INFARCT assessment
    • o Blood testfor troponin + creatine kinase
    • o ECGdifferentiate btw types of MIs
    •  STEMIhigher ST segmentrequires more aggressive tx
  526. MYOCARDIAL INFARCT treatment
    • o Aspirin (immediate)prevents further blood clotting
    • o Nitroglycerintreat chest pain + O2 delivery
    • o Angioplasty (opening artery back up)
    • o Thrombolysis (blockage removed w/ meds)
    • o Bypass surgery (esp if have diabetes or multiple blockages)
  527. PT management for Lung cancer
    Manage fatigue
  528.   #2 cause of death for brain conditions (stroke #1)
      50% chance of survival, sig cause of death in kids (intra-tentorial)
      TYPES
    o Intracerebral Primary
     tumor neurons don’t proliferate (other cells around proliferate)
    o Intracerebral Metastatic
     come from lung, breast, prostate
     compensate by ⇩ brain tissue vol, CSF vol + blood flow vol
    o Other:
     Medulloblastomasfreq metastasize to other areas in brain/spine
     NeuronomasSCHWANNOMA (Cranial N 8 – Vestibular)
     S/S
    o N root pain, worse at night, pain with cough, radicular pain
    o headache and seizure, nausea, vomit, cognition and behavior
    Brain tumour
  529. Brain tumour rx
    Surgery or radiation
  530.   inflammation of parenchyma of lungs (lung tissue)
      CAUSES
    o bacterial, viral or fungal (NORMALLY – airborne pathogens)
    o inhalation of toxic chemicals (smoke, dust, gas)
    o aspiration
     impaired consciousnessalcohol abuse, after surgery, neuro disease
     TYPES
    o Typical
     Sudden symptom onsetusually bacterial cause
     Fever, sputum, physical consolidation signs
    o Atypical
     No symptoms, little sputum, min chest signs
     S/S
    o most preceded by upper respiratory infectionfollowed by sudden + sharp chest pain
    o productive  green sputum
    o Tachypnea: ⇧ rate of breathing
    o SOB
    PNEUMONIA (primary or post-operative/preventive)
  531. PNEUMONIA rx
    • o antibacterials/antibiotics
    • o airway clearance techniques
    • o antifungals (if fungal infection)
    • o oxygen support
    • o positioning
  532.   collapse of normally expanded & aerated lung tissue involving all or part of the lung
      lung distributionpatchy, segmental or lobar distribution
      CAUSES
    o blockage of bronchus/bronchiolelung is prevented from expanding due to:
     paralysis, diaphragmatic disorders, mucous or airway obstruction, hypoventilation
    o compression due to pneumothorax, pleural effusion, space-occupying lesion (tumor)
     prevents alveoli from expanding
    o postanestheticeffects of anaesthesia and prolonged recumbency
     S/S
    o CXRshifting of lung structures toward collapseif entire lobe, may show shadow
    o Quiet breath sounds
    o Dyspnea
    o Tachypnea
    o Cyanosis  low O2 saturation  skin’s blue
    ATELECTASIS (primary or post-operative/preventive)
  533. ATELECTASIS (primary or post-operative/preventive) rx
    • o identify underlying cause
    • o suctioning if d/t secretions
    • o chest tube if d/t pneumo/hemo thorax or extensive pleural effusion
  534.   acute respiratory failure w/ severe hypoxemaresult of pulmonary or systemic problem
      PATHOLOGY
    o lung injury characterized by ⇧ permeability on alveolar capillary membrane
     leakage of fluid and blood into lung interstium + alveoli
     CAUSES
    o severe trauma
    o aspiration
    o embolism
    o indirecthappen after viral infection or pneumonia
     RESULT
    o INFLAMMatory reaction
    o alveolar edema and collapse
    o CXRKEY feature = WHITE out
    ARDS – Acute Respiratory Distress Syndrome
  535. ARDS – Acute Respiratory Distress Syndrome rx
    • o PEEPkeeps airways open
    • o tackle underlying cause
    • o PRONE position
  536.   viral respiratory illnesscaused by SARS coronavirus
      S/S
    o Flu-likefever, myalgia, cough, sore throat, lethargy
     RESULT
    o Can lead to pneumonia
    SARS – Severe Acute Respiratory Syndrome
  537.   infection leading to necrosis of lung tissue and cavity formation w/ necrotic debris
      CAUSEaspirationpredisposition to it occurring if alcoholic
    LUNG ABSCESS
  538.   occurs in infants whose lungs have not fully developed
      lack surfactanthelps lungs inflate with air and keeps the sacs from collapsing
      RISK FACTORS
    o Prematurity
    o C-section
    o multiple pregnancies
    o blue baby
    o stops breathing, grunts
    IRDS – INFANT RESPIRATORY DISTRESS SYNDROME
  539. IRDS – INFANT RESPIRATORY DISTRESS SYNDROME RX
    o deliver artificial surfactant
  540.   Gas exchange failurearterial hypoxemia =⇩ blood O2, no increase in CO2
      DUE TO
    o Pneumonia
    o ARDS
    o obstructive lung disease
    o pulmonary embolism
    HYPOXEMIC RESP FAILURE
  541.   ++ CO2 in the blood: ⇩blood O2
     DUE TO
    o ⇩ ventilationd/t drugs⇩ resp control
    o acute upper/lower airway obstruction
    o weak/impaired resp mm
    o SCI
    HYPERCAPNIC RESP FAILURE
  542.   chronic inflamm of lungsvariable airflow limitation + hyper-responsiveness
      chronic inflamm disorder of airways
    o airway hyper-responsiveness  recurrent episode
    o wheezing, breathlessness, chest tightness, coughing (often reversible unlike COPD)
    o smooth mm contraction
    ASTHMA
  543. Which category of ASTHMA?
    allergic or atopic
     normally due to allergen
     mast cells release mediators which cause bronchospasm and hypersecretion
     KIDS > adults
    Extrinsic
  544. Which category of ASTHMA?
    non allergic
     hypersensitivity to bacteria, virus, drugs, cold air, ex , stress
     ADULTS > kids
    Intrinsic
  545. Asthma rx
    • o prevent triggers
    • o pharmacological - inhaled corticosteroids
    • o if exercise inducedsmooth mm constrictupright, lean forward and pursed lip breathing
  546.   chronic resp condition
      CHARACTERISTICS
    o progressive airway obstruction that is not fully reversible
    o gas exchange is normal
    o always hyperinflated
    o ⇩ elastic recoil
    o age of onsetmiddle aged to older adults
    COPD
  547. COPD rx
    • o Pharmacological FOCUS:
    •  1. smooth mm relaxation
    •  2. reduce airway inflammation
    • o O2 therapy  but ⊘ for pts with pulmonary HTN, CHF
  548.   irreversible destruction (necrosis) + dilation of airways
    with chronic bacterial infection
      caused by CF, TB, and endobronchial tumors
      CHARACTERISTICS
    o excess mucus
    o eventually alveoli replaced with scar tissue
     due to chronic inflamm
    BRONCHIECTASIS
  549. BRONCHIECTASIS rx
    Bronchodilators, antibiotics, secretion clearance
  550.  excess mucus production
    BRONCHITIS
  551.   CAUSE  smoking
      RESULTS
    o destruction of air spaces distal to the terminal bronchiole +
    destruction of alveolar septa
        causes merging of alveoli into larger air spaces
           ⇩surface area for gas exchange
    o loss of airways and capillaries as well
     IMPACT
    o EXHALATION
     Damaged alveoli = old air becomes trapped
       ⇩ space available for O2-rich new air
     Hyperventilation flattens diaphragm
        now at mechanical disadvantage
    EMPHYSEMA
  552. EMPHYSEMA rx
    Can slow down progression, but cannot reverse damage
  553.   Stiff, ⇩lung compliancy (not airway obstruction)
      S/S
    o Dyspnea
    o severe O2 desaturation
    o finger clubbing
    o scarring (CT)
    INTERSTITIAL LUNG DISEASE
  554. INTERSTITIAL LUNG DISEASE rx
    • o O2 therapy
    • o lung transplant
    • o pulmonary rehab
  555.   2⁄3 no known cause; 1⁄3 TB
      CAUSEinhaling harmful particles
    PULMONARY FIBROSIS
  556. PULMONARY FIBROSIS rx
    • o radiation therapy
    • o meds
  557.  scarring and fibrotic tissue
    IDIOPATHIC PULMONARY FIBROSIS
  558.  coal workers lung
    PNEUMOCONIOSIS
  559.   infectious, inflamm systemic disease that affects lungsairborne particles
      may disseminate to involve kidneys, growth plates, meninges, avascular necrosis of hip jt, lymph nodes + other organs
      TESTING
    o TB skin testinject in forearm
     determine of body’s immune response has been activated by TB before
     S/S
    o productive cough 3+wks
    o wt loss
    o fever
    o night sweats
    o fatigue
    o bronchial breath sounds
      RESULTgranulomas in lung tissue
    TUBERCULOSIS  (mycobacterium tuberculosis)
  560. TUBERCULOSIS  (mycobacterium tuberculosis) rx
    • o Medical MGMT10 drugs
    • o PTthorough history + self protection (masks, etc)
  561.   accumulation of fluid in the pleural space due to disease
    o ⇩lung expansion
      CAUSES
    o Transudatecommonly due to heart fail
     low protein, clear
    o Exudateformation of fluid by inflammation or disease (infection or cancer of pleura)
     opaque
     S/S
    o SOB
    o chest pain
    o percussion – dull
    o ⇩or ABSENT breath sounds
    o may hear a pleural rub
    PLEURAL EFFUSION
  562.   ⇧ fluid in extravascular spaces of the lungs
      POSSIBLE CAUSES
    o ⇧ hydrostatic pressure d/t heart or kidney failure
     pushes fluid out of vessels
    o ⇧alveolar permeability
     drug induced, ARDS, inhalation of noxious gas
      PRESENTATION
    o Stiff lungs: ⇧work of breathing
    o Dyspnea
    o Classic symptomcough that produces a frothy pink tinged sputum
     AUSCULTATION:  FINE CRACKLES
    PULMONARY EDEMA
  563.  S/S
    o bloody sputum
    o dyspnea
    o ⇧RR
    o SOB
    o cyanotic
    PULMONARY EMBOLUS
  564.   inherited autosomal disorder affecting ALL EXOCRINE GLANDS
      EFFECTS
    o defective Clexcretion and Na+ absorption = THICK MUCUS
    o recurrent chest infections
    o consolidation
    o atelectasis
    o thickened bronchial walls
     DX
    o Family history, gene testing (2 copies of abnormal gene)
    o Sweat test - chloride content of sweat
     S/S
    o respiratory symptoms most common
    o finger clubbing
    o breathlessness
    o delayed puberty
    o skeletal maturity
    o infertility in males
    o symptomatic steatorrhea
    o diabetes mellitus
    o liver disease
    o osteoperosis
    CYSTIC FIBROSIS
  565. CYSTIC FIBROSIS rx
    • o airway clearance techniques
    • o bronchodilators
    • o aggressive antibiotics
  566.   account for 95% of arterial occlusive disease
      UNDERLYING CAUSE = ARTHEROSCLEROSIS
      S/S
    o occur distal to site of narrowing or obstruction
    o intermittent claudication
    o acute ischemia (pallor, pain paralysis, pulseless)
    o ulceration and gangrene
    o skin (shiny, thin, hairless)often occurs in feet
     OUTCOME MEASURE
    o ⇩ mobility d/t pain + loss of function or limb
    PERIPHERAL ARTERIAL DISEASE
  567.   UNDERLYING CAUSE: ARTHEROSCLEROSIS
      Artherosclerotic obstruction of blood vessels supplying extremities + major abd organs
    o IF iliac, femoral, and politieal arteries in the legs
     feel pain during physical activity, most often in the calf
     S/S
    o intermittent claudication
    o ⇩ pulses
    o ulcers
    o cool skin
    o limit mobility
    o pain or loss of function of limb
    PERIPHERAL VASCULAR DISEASE(same as peripheral artery disease)
  568.   partial or complete occlusion of a vein by a thrombus with secondary inflammation
      superficial or deep
    THROMBOPHLEBITIS
  569.   can become pulm emboli
      S/S
    o tender calf (d/t thrombus in calf vein)
    o fever
     RISK
    o may become a PE
     TEST
    o Homan’s sign (passive DF)
    DVT
  570.   inadequate venous return over a prolonged period
      CAUSE
    o DVT trauma
    o obstruction by tumor
     EFFECT
    o damaged or destroyed valves lead to venous stasis
    o edema
    o thickening brown skin and ulcers
    CHRONIC VENOUS INSUFFICIENCY
  571.   faulty valves cause abnormal dilation of veins
      RESULT
    o twisting and turning of the vessel
    o at risk for thrombosis
    VARICOSE VEINS
  572. Volume inspired or expired with each normal breath
    TIDAL VOLUME (TV)500mL
  573. Max volume that can be inspired (on top of tidal volume/normal breath)
    Used during exercise/exertion
    INSPIRATORY RESERVE VOLUME (IRV)  2-3 L
  574. Maximal volume that can be expired after the expiration of a tidal volume/normal breath
    EXPIRATORY RESERVE VOLUME (ERV)  1L
  575. Volume that remains in the lungs after a maximal expiration
    CANNOT be measured by spirometry
    RESIDUAL VOLUME (RV)1L
  576. Volume of maximal inspiration
    IRV + TV
    INSPIRATORY CAPACITY (IC)2.5L-4L
  577. Volume of gas remaining in lung after normal expiration
    cannot be measured by spirometry because it includes residual volume:
    ERV + RV
    FUNCTIONAL RESIDUAL CAPACITY (FRC)  2L
  578. Volume of maximal inspiration and expiration:
    IRV + TV + ERV = IC + ERV
    VITAL CAPACITY (VC)3-4.5L
  579. Volume of the lung after maximal inspiration
    The sum of all four lung volumes
    IRV+ TV + ERV + RV = IC + FRC
    cannot be measured by spirometry because it includes residual volume
    TOTAL LUNG CAPACITY (TLC)  4-6L
  580. volume of air that can be expired in 1 second after a maximal inspiration
    normal80% (0.8) of the forced vital capacity, expressed as FEV1/FVC
    restrictive lung disease: ⇩ FEV1 & ⇩ FVC: ratio ≥ 0.8
    obstructive lung disease: ⇩⇩FEV1 & ⇩FVC: ratio < 0.8
    FORCED EXPIRATORY VOLUME in 1 SECOND (FEV1)
  581. S/S of CARDIOPULMONARY DISEASE
    •   pain in chest, neck, jaw, arms
    •   SOB at rest or mild exertion
    •   dizzy or syncope
    •   orthopnea (SOB while lying flat) or nocturnal dyspnea
    •   ankle edema
    •   palpitations or tachycardia
    •   intermittent claudication
    •   known heart murmur
    •   unusual fatigue
  582. Goals of cardiac rehab
    • restore optimal function
    • prevent progression of underlying processes
    • reduce risk of sudden death and re-infarction
  583. Exs to avoid in cardiac rehab
    •   NO VALSALVA! (or Hulk imitations)
    •   extensive upper body activity
    •   isometric/ static exercises
  584. Contraindication for simple spirometry
    MI in last month, recent stroke/abdominal/thoracic surgery, uncontrolled HTN, recent pneumothorax
  585. Muscles involved in quiet inspiration:
    Diaphragm and external intercostals
  586. Muscles involved in forced inspiration:
    SCM, scalenes, pec minor
  587. Muscles involved in quiet expiration:
    No muscles, just passive recoil of lung tissue
  588. Muscles involved in forced expiration:
    Internal intercostals, abs.
  589. ABGs normal ranges: 
    pH: ...
    PaCO2: ...
    HCO3-: ...
    PaO2: ...
    SaO2: ...
    • pH 7.35-7.45
    • PaCO2 35-45
    • HCO3- 22-28
    • PaO2 80-100 mm Hg
    • SaO2 95-100 %
  590. Indications for O2 therapy
    •   SaO2 less then 90% or PaO2 less then 80 mm Hg
    •   ⇩ work of breathing
    •   acute MI or to decrease myocardial work
    •   short term post surgery for recovery
    •   RT for O2 greater then 40%, acute respiratory distress, transport with O2, and artificial airway (trach)
  591. Low flow or high flow system?
    supplemental O2 to tidal volume
    o nasal prongs (6 L max) , simple mask, partial rebreathing, and non rebreathing mask
    Low flow system
  592. Low flow or high flow system?
    enough O2 to supply the entire tidal volume
    o venturi face mask, face tent, tracheostomy mask
    high flow system
  593. 1L/min O2 = ...%O2. Goes up by ...% every L increase
    1L/min O2 = 24%O2. Goes up by 4% every L increase
  594. INCENTIVE SPIROMETRY PURPOSE:
    inspiratory muscle retraining particularly in patients with ATELECTASIS
  595. what do you need for INCENTIVE SPIROMETRY?
    • reliable measure of max inspiratory pressure + max expiratory pressure (pulmonary tests), use a threshold trainer
    • monitor: O2 saturation, BP, HR, RR, and other SSx of respiratory distress
  596. INCENTIVE SPIROMETRY contraindications
    COPD, asthma
  597. Pros of breathing exercises
    • ⇧ventilation, to prevent atelectasis, ⇩ WOB and O2 consumption, to removal secretions,
    • ⇧ chest wall mobility and for relaxation
    • BREATHE THROUGH NOSE AND OUT THROUGH MOUTH!!
  598. Diaphragmatic Breathing INDICATIONS:
    post op patients, repiratory failure, chronic respiratory distress
  599. Diaphragmatic Breathing pros
    ⇧lung expansion and compliance, reduces VQ mismatch, ⇧respiratory muscle strength
  600. Pursed lip breathing indications
    COPD
  601. CONTRAINDICATIONS for assisted cough
    inferior vena cava filter and rupture diaphragm
  602. LUL anterior:
    sitting upright
  603. RUL anterior:
    long sitting
  604. LUL posterior –
    semiprone or sitting leaning over table
  605. RUL posterior –
    prone
  606. LUL/ RML lingual-
    side lie/semi supine table 30 degree inverted
  607. RLL/LLL superior segments-
    prone
  608. RLL/LLL anterior segments –
    supine table inverted 30 degrees
  609. RLL/LLL lateral segements-
    side lying table 30 degrees
  610. RLL/ LLL posterior segments –
    prone table inverted 30
  611. Duration for percussion
    2-5 minutes
  612. CONTRAINDICATIONS/PRECAUTIONS for percussion
    # ribs, prone to hemorrhage, metatastic bone cancer, osteoporosis, burns, subcutaneous emphysema of neck and thorax, poor/unstable CVvcondition, recent skin graft or flap, resectable tumor, pneumothorax
  613. Purpose of percussion
    to remove secretions
  614. Purpose of vibrations
    remove bronchial secretions and improve tidal volume
  615. Purpose of rib springing
    • to increase chest expansion and therefore a bigger
    • inspiration
  616. PT cancer rx
    • fatigue mngt
    • o fxn and mobility mngt
    • o physical symptom mngt
    • o psychological symptom mngt
    • o REHAB
    •  preventive, supportive, or restorative
    • o ACUTE SETTING
    •  mobility (including eqp), general strength and mobility, and bed positioning
  617.   normal Hb levelsmales (14-18 g/dl) / females (12-16 g/dl)
    effects the amount of O2 that can be carried to the cells
    EXERCISE NEEDS TO BE SCALED BACK IF BELOW 8 G/DL!
    Anemia
  618. WBC count
    >1000 MCL
  619. Lymphedema measures
    • circumferential (greater then 2 cm difference side to side)
    • o water displacement
    • o perometer and bioelectrical impedance
  620. PT ROLE lymphedema
    • o Preventionweight loss through exercise
    • o Education what to avoid, S/S to watch for
  621. PT RX AIDS
    •  Check precautions
    •  EXS:
    •   mod aerobic, strength
    •   avoid exhaustive exs
    •   ACUTEfocus on mild exs levels, activity pacing, energy conservation, stress management
  622. AUTOIMMUNE DISORDERS RX
    • o MEDICAL  Plasmaphoresis, immunoglobin
    • o PT:
    •  Positioningulcers
    •  joint protection
    •  chest rx, mobilization
    •  strength
    •  ROM (usually opposite to ALS progression)
  623.   can involve skin and other multisystemorgans (kidney, CNS, cardiac, pulmonary), arthritis
      S/S
    o skinmay find BUTTERFLY (malar) RASH
    o localized erythema
    o localized edema
    o alopecia (loss of hair)
    o photosensitivity
    o mucosal ulcers
    o Raynaud’s (fingers are cold sensitive)
    o Joint effusion
     DX
    o +VE serum “antinuclear antibodies” (ANA) symmetric arthritis
    LUPUS ERYTHEMATOSUS
  624. Systemic Sclerosis
     chronic disease primarily affecting skin, characterized by sclerosis  hardening of skin
    o provokes massive fibrotic tissue response
     CAN CAUSE:
    o joint contractures, pulmonary fibrosis, HTN
    o renal, GI dysmotility (esp esophagus), Raynaud’s
    SCLERODEMA
  625. inflam CT disorders characterized by proximal limb girdle weakness, often w/o P
    o affects both skin + mm
    o associated w/ photosensitive skin rash, purplish erythematous eruption over face, U/Es
    DERMATOMYOSITIS
  626. inflam CT disorders characterized by proximal limb girdle weakness, often w/o P
    Affects muscle only
    Polymyositis
  627.   Hereditary bleeding disorder  body unable to control blood clotting/coagulation
      CAUSES
    o vascular abnormalities
    o platelet abnormalities
    o coagulation cascade abnormalities
    PRESENTATION
    o profuse post circumcision bleeding
    o joint and soft tissue bleeding
    o excessive bleeding
    o operative & post-traumatic hemorrhage
    HAEMOPHILIA
  628. S/S
    o Bleeding in the joints is the most common problem.
    o large bruises
    o bleeding into muscles and joints (esp. knees, elbows, and ankles)
     JOINT BLEED SYMPTOMS
     JT tightness + no pain  tightness + pain, no bleeding  swollen + hot to touch, hard to moveall ROM lost + severe painbleeding slows in few days (joint full of blood)
    o prolonged bleeding after a cut, tooth removal, surgery, or an accident
    o serious trauma causes serious internal bleeding into vital organs
    HAEMOPHILIA
  629. HAEMOPHILIA rx
    • o recombinant factor VIII infusion (in the 80s, got blood products  died of AIDS, Hep C)
    • o desmopressinmild haemophilia
  630. Yes worse in AM
    Moderate to severe swelling
    Sometimes present erythema
    Warmth sometimes present
    Morning stiffness usually =/> 1 hr
    Systemic features are sometimes present
    Frequent inc ESR (erythrocyte sedimentation rate)
    Ex RA
    Inflammatory rheumatic disease
  631. Pain worse after use
    Mild swelling
    Often absent
    Absent
    Morning stiffness usually less then 30 minutes
    Very rare/absent
    Uncommon
    Ex OA
    Non-Inflammatory rheumatic disease
  632. SYNOVITISsymmetrical pattern
    RHEUMATOID ARTHRITIS
  633. S/S
    o pain, fatigue, stiffness (⇩ROM)
    o swelling, joint deformity, mm atrophy, extraarticular features
    RHEUMATOID ARTHRITIS
  634. RHEUMATOID ARTHRITIS rehab in acute phase
    energy conservation, ice, splints, gentle ROM, NO STRETCHING (may stretch the synovial membrane & cause irreversible damage)
  635. RHEUMATOID ARTHRITIS rehab in chronic phase
    •   relieve pain, i.e. modalities, heat
    •   splints, exercise (gentle ROM)
    •   relaxation/rest
    •   ⇩ stiffnessgentle ROM
    •   aquatic ex (endurance exercise)
    •   functional ex’s
    •   prevent deformity
    •   fall prevention
    •   moderate intensity physical activity
  636. COMMONLY AFFECTED JOINTS IN RA:
    •  Atlanto-Axial joint
    •    o Esp transverse lig
    •    o S/S  clunking in repositioning in Sharp Purser test, dysphagia, dizziness, blurred vision
    •   TMJend stage may result in fusion of open bite
    •   Shoulderhumeral head moves superiorly
    •   AC joint
    •   Elbow  loss of extension, i.e. flexion deformity
    •    o superior radioulnar joint commonly involved  erosion of radial head
    •   Hip  groin P, flexion deformity
    •   Kneebaker’s cyst, flexion deformity, valgus deformity, quad wasting
  637. o 1st MTP synovitis, big toe is lateral, lig laxity and erosion
    o sublux  dislocation, prox phalanx drifts lat, causes pronation of midfoot
    Hallux valgus
  638. o synovitis, displacement of the flexors, unopposed extensors pull the prox phalanx into hyperext,
    metatarsal head prolapses and get dislocation and lat drift of toes
    o Sign = callouses
    MTP subluxation
  639. o MTP synovitis, MTP ext, PIP+DIP flex, often all toes except big toe
    Claw toe
  640. o MTP and PIP synovitis, usually involves 2nd toe, flex of PIP and hyperext of DIP (similar to boutonniere)
    Hammer toe
  641. o flex of DIP, affects longest toe
    Mallet toe
  642. o flex of MCP(not always), hyperext of PIP, flex DIP
    o TEST  Bunnel Littlers
    o RX  able to actively flex & ext deformed joints, stretch interosseous muscles
    Swan neck
  643. o zig zag deformityMCP hyperext (not always), flex of PIP, hyperext of DIP
    o TEST  central slip tenodesis
    o RXable to flex and ext deformed joints
    Boutinniere
  644. o most common hand deformity
    o involves synovitits of MCP + structural differences  cause volar subluxation/laxity of MCP in radial collateral ligaments
    o TEST  radial collateral ligament test, extensor tendon subluxation test
    o RXradial finger walking, joint protection
     (prevent ulnar deviation forces in getting up from chair, turn on/off taps, holding a book
    Ulnar drift deformity
  645. o TESTgrind & crank test
    o RX  webspace massage/stretch, oppostition and abduction exercises
    Thumb deformities - BD thumb (90/90 position) or swan neck
  646. o synovitis at joint, stretches ulnar carpal ligaments, ulnar head will sublux dorsally, ECU is displaced
    and more becomes a flexor tendon
    o TEST  ballottement test
    WristDRUJ instability
  647. o tendon glides
    o active ROM for IPs with MCP in extension to protect from ulnar deviation forces
    Overall Hand Exercises
  648. o Staticto rest or ⇧ hand fxn
    o Dynamic  to provide controlled motion
    Splints
  649.   genetic disorder of purine metabolism
      ⇧serum uric acid (hyperuricemia)
      Acid ▲ to crystals and deposits into joints
      Most affected JOINTSKNEE, GREAT TOE
    GOUT
  650. Gout RX
    o Meds  NSAIDS, cox2-inhibitors, corticosteroids, ACTHo PT goals  injury prevention, education, fast intervention
  651.  release of enzymes + abnormal biomechanical forces = fibrillation + articular cartilage damage
    o RESULT:
     Cartilage Loss
     ⇧ bone turn overOsteophytes
    OSTEOARTHRITIS
  652. OA MAIN AFFECTED JOINTS
    • o Spineosteophytes in facet jts of l-spineSTENOSIS
    • o Hand
    •  PIPBouchard node
    • DIPHebernen’s node
    •  CMC joints (esp thumb)
    • o Kneemost common jt affected by OAvarus, flexion contracture, crepitus
    • o Hipwalk with trendelenburg, groin pain, osteophytes, flexion deformities
    • o Foot1st MT jointosteophytes cause hallux valgus + rigidus, bunionso
    • Uncommon sites: Shoulder/Elbow, Wrist (except if have scaphoid # or avascular necrosis), ankle
  653. OA DX
    • o X-ray findings  4 main features
    •  1)joint space narrowing
    •  2)osteophytosis
    •  3)subchondral cysts
    •  4)subchondral sclerosis
    •  (GradingKellgren – Lawrence System (0-4)
    • o 4 QUESTIONS
    •  Pain most days of the last month?
    •  Pain over the last year?
    •  Worse with activitystairs (doing down worse), overdoing it
    •  Relieved with restmay have ‘gelling’ after inactivity period
    • o TESTS INDICATIVE OF KNEE OA
    •  Flexion contracture
    •  Abnormal gait
    •  Swipe test/patellar tap test +ve
  654. OA rx
    • o Weight loss1lb weight loss = 4lb⇩ knee joint stress per step
    •  Aim =⇩10% body weight
    • o Exercise
    •  30 min mod aerobic training (most days)10 min bouts
    •  L/E resistance training
    • o Protective Aids
    •  braces, orthodics, adaptive aids (canes/walking poles)
    • o Medicationsacetaminophen (since non-inflammatory)
    • o Electromodalities  TENS
  655. Which type of FEMORAL ACETABULAR IMPINGEMENT
     ⇩/absent waist of the jx of femoral neck and head
     w/ hip flexabnormal femoral head drives into acetabulum
     young men
    CAM
  656. Which type of FEMORAL ACETABULAR IMPINGEMENT
     abnormal acetabulum provides excessive cover of femoral head
     retroverted or deep acetabulum
     impingement when femoral neck pushes against overarching acetabulum
     women 30-40 years
    Pincer
  657.   Common siteSPINE
      CHARACTERISTICS
    o Spine inflammationspondylitis and sacroilitis
    o Synovitis  unilateral peripheral joints
    o Eye inflammationiritis/uveitis & conjuctivitis
    o NO rheumatoid factor (seronegative)
    o Can be hereditary HLA-B27
    SPONDYLOARTHRITIS
  658.   M=F, can begin with kids
      CHARACTERISTICS
    o Chronic, erosive, inflammation
    o Affects digit joints + axial skeleton
     TYPES
    o Dactylitis
        sausage like fingers d/t swelling
    o Enthesitis
        usually in heels and back
    PSORIATIC ARTHRITIS - Pt w/ psoriasis
  659. PSORIATIC ARTHRITIS rx
    • o Medsacetaminophen, NSAIDs, DMARDs, corticosteroids, biological response modifiers
    • o PT Goals
    •  joint protections strategies
    •  maintain joint mechanics
    •  endurance
  660.  Related to:
    o Inflammatory conditions of the bowel (cause diarrhea):
        Ulcerative colitis (affects lower half of bowels)
        Crohn’s disease (affects whole digestive systemworse)
      ⇧ bowel disease = ⇧arthritis
      Can also affect  Spine, SI joint, limb joints
    ENTEROPATHIC SPONDYLITIS
  661.   triggered by infection (possibly STI) in bowel or GI tract
      hot swollen joints
      may go away and return
      PRESENTATION
      o L/E
      o Symmetrical
    REACTIVE ARTHRITIS
  662.   stiffness/fusing of spine d/t inflammation
      usually bilateral disease, but may start initially as unilateral then migrate
      onset BEFORE 40disease of young adults (M>F)8.9 yrs delay in diagnosis
      associated with genetic marker HLA B27, unknown cause
    ANKYLOSING SPONDYLITIS (AS)
  663. o LBP + stiffness for more than 3 months
     Improves with ex, worse with rest
    o AM stiffness
    o Altered posture/muscle imbalancesdeformities/instability
     HFP, thoracic kyphosis, flattening of anterior chest wall, protrusion of abdomen, flattening of lumbar lordosis, slight hip flex
    o ⇩strengthdeconditioning
    o ⇩L-spine ROM in sagittal + front planesflexion posture
     d/t pain, tissue contractures, mm guarding, fusing
    o Altered breathing mechanics⇩chest expansion compared to normal values
     diaphragmatic breathing pattern
     ⇩ vital capacity
    o Fatigue d/t disease process
    ANKYLOSING SPONDYLITIS (AS)
  664. ANKYLOSING SPONDYLITIS (AS) rx
    • o MEDS  DMARDs, NSAIDs, corticosteroids, biologics
    • o PHYSICAL MANAGEMENT
    •  control/decrease inflammation
    •  P management
    • stiffness/⇧ ROM (pool therapy is great)
    •  posture correction (ergonomics, frequent position changes)
    •  ⇧mm strength and endurance,⇧cardio
  665. Type of back pain
    >60 min
    12-40 yrs
    Early AM
    Chronic
    Sacroiliitis, syndesmophytes,
    spinal ankylosis
    INFLAMMATORY BACK PAIN
  666. Type of back pain
    <40 min
    20-65 yrs
    Late in day, ⇧w/ activity
    Acute/chronic
    Osteophytes, ⇩disc space,
    misalignment
    MECHANICAL BACK PAIN
  667. Pain, ROM, Joint count, Muscle strength/length, fatigue, Orthotics, gait aids
    S/S must be present for 6 weeks
    Subtype determined by presentation in 1st 6 months
    pain, ⇩ fxn, AM stiffness, fatigue, ⇩ ROM, muscle strength and length, growth abnormalities,
    asymmetrical posture + movement patterns
    eyes (uveitis)
    effects synovium, tendon sheath synovium, entheses
    JUVENILE IDIOPATHIC ARTHRITIS
  668. JUVENILE IDIOPATHIC ARTHRITIS rx
    • deacr. impact of disease
    • want child to be physically, socially, and emotionally as normal as possible
    • co-RX w/ OT
    • complete remission in 75% kids if occurs before 16
    • DISEASE STAGE
    • Acutemaintain ROM and fxn
    • Subacute increase ROM and strength
    • Chroniccomplex activities/ balance
  669. primarily affects MCP + PIP, rheumatoid cachexia (breakdown of muscle fibres), fatigue!!!
    RA
  670. affects weight bearing joints  hip, spine, DIP, PIP, first CMC, first MTP
    OA
  671. RA and OA both benefit from ...
    aerobic, resistance, and stretching/ROM  pool is great for both
  672. CONTRAINDICATIONS/RED FLAGS - RA and OA
    • o incr. pain, fatigue or AM stiffness
    • o sudden pain at joint or joint deformity
    • o joint becomes red, swollen and hot after doing exercise (within 24 hrs)
    • o decrea.  muscle strength and function (local myositis)
    • o neurological SSx (CV involvement)
    • o SOB on mild exertion
  673. PRECAUTIONS - RA and OA
    • o watch out for inappropriate exercisecan harm joints (RAdeforming forces)
    • o swollen joints at risk for capsular stretch and rupture
    • o OP bone at risk for #
    • o use machine and resistance bands rather than free weights
  674. o dizzy, nausea, weak, sweating profusely (this rules out orthostatic hypotension)
    o fatigue, irritability, confusion, fainting
    HYPOGLYCEMIA
  675. o blurred vision, fatigue, thirst, frequent urination, weakness, abnormal breathing, acetone breath
    o LONG TERM EFFECTS
      damage to small blood vessels (retinopathy and diabetic nephropathy)
      damage to large blood vessels  abnormal glucose metabolism causes incre. cholesterol levels  vessel wall damage  atherosclerosis and myocardial infarction, stroke, gangrene
      damage to peripheral nerves  diabetic neuropathy
    HYPERGLYCEMIA
  676. Diabetes rx
    • o regular exercise = very important
    • o talk to MD about insulin levels for exercise
    • o have snack before (have raisins/juice available to boost sugar levels if necessary)
    • o monitor blood sugar levels pre, during, and post exercise
    • o avoid exercise at night  person may go to sleep and slip into a hypoglemic coma and die
    • o PT always monitor pt for SSx hyper or hypoglemia
  677. pain that persists past the normal time of healing (usually 3 months)
    chronic pain
  678. Chronic pain rx
    •  have to desensitize the area
    •  educate them that it’s not in their head
    •  restore normal function to the area
    •  variety of techniques: chemical (medications), physical (electrotherapy),
    • cryotherapy, thermotherapy, exercises/stretch (reduce pain caused by muscle spasm))
  679. o by exclusion
    o persistent or relapsing fatigue for at least 6 months
    o not resolved with bed rest
    o reduces daily activity by at least 50%
    CHRONIC FATIGUE SYNDROME (possibly viral)
  680.  Etiology unknown (F>M)
      chronic pain syndrome affecting mm + soft tissue (non-articular rheumatism)
      S/S
    o headaches, sensitivity to stimuli, fatigue, myalgia (mm pain), generalized aching, sleep
    disturbances, anxiety/depression
    o 11 of 18 pointsOcciput, low cervical (C5-C7), Traps (mid-pt of upper border), Supraspinatus
    (at origin), Second rib, lateral epicondyle, gluteal, greater trochanter, knee
    FIBROMYALGIA
  681. FIBROMYALGIA rx
    • o anti-inflamm, mm relaxants, pain meds, psycholgical support, nutrition, can respond well to dry needling (this is from my own (Erika) personal experience), they like heat and not ice
    • o PT RXenergy conservation, aquatic therapy
  682. presence of whole body inflammatory state (SIRS) + presence of known or unknown infection
    SEPSIS
  683. o severe sepsis but hypoperfusion abnormalities in spite of adequate fluid resuscitation
    o immune system spirals out of control
    o normal response to infection is local but then causes widespread vasodilation and vascular permeability
    SEPTIC SHOCK
  684. o poor distribution of blood at the microcirculation level
    o ⇩ tissue perfusion = ⊘ meet cellular needs  CELL DEATH
    o TYPES
     hypovolemic (blood loss)
     cardiogenic (heart damage)
     distributive (hypotension and general tissue hypoxia)
     obstructive (great vessels of heart, usually goes with cardiogenic shock)
    SHOCK
  685.  whole body inflammatory state
     DX
    o WITH body temp, HR, RR, WBC count
    o 2 or more following signs
       (HR>90)
       temp >38 or <36
       RR>20 OR PaCo2 < 32
       WB count > 12000 or < 4000
    SIRS - SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
  686. BMI numbers
    • o overweight BMI= 25-29.9
    • o OBESITY= BMI > or = to 30
    • o morbidly obese > or = to 40
  687. Skin caliper test - Obesity =
    fat greater than 1 inch is excess
  688. Obesity rx
    • o lifestyle modifications, behavior therapy, pharmacology, surgery
    • o EXERCISE
    •   moderate intensity40-60% progress to 50-70% HRR, 5-7d/wk, 45-60mins, circuits or
    • aquatics
    •   mindful of response to heat (used therapeutically) or in response to exercise
    •  excess fat leads to heat insulationlead to overheating
  689.  lateral separation/split of rectus abdominus
    o separation from midline >2.5 cm sig, may be detected in 2nd trimester
     EFFECTS
    o weak abdominal wall
    o deacr. support for back and viscera
    o related to lumbo-pelvic pain
    DIASTASIS RECTI ABDOMINIS
  690. DIASTASIS RECTI ABDOMINIS rx
    • o education (what you can improve and what you can’t improve)
    • o posture and body mechanics
    • o movement patterns and recruitment strategies
    • o exercises (TA, multifidus, pelvic floor)
    • o abdominal binders (proprioceptive feedback)
    • o recovering usually 2-6 months, surgery in severe cases
  691.  fairly common but often not diagnosedusually seen in 2nd trimester
    o D/T incr. fluid (thefore pressure), hormone changes, poor lifting or carrying technique of toddler or newborn
    CARPAL TUNNEL SYNDROME/DE QUERVAINS
  692. CARPAL TUNNEL SYNDROME/DE QUERVAINS rx
    • o education (what to avoid, ergonomics, movements strategies)
    • o ice, electrotherapy, stretching
    • o good prognosis
  693.  S/S
    o heaviness, dull pain/ache in legs with standing and walking, may be incapacitating pain
    o apparent vein distension, reported tenderness, usually in lower legs (can be uvular)
    VARICOSE VEINS
  694. VARICOSE VEINS rx
    • o posture, positioning elevation, limit cross legged time
    • o pressure graded stockings/tights/underwear, circulatory exercises
  695.  incr. risk in vaginal delivery
      deacr. abdominal recruitment with incr. intraabdominal pressure (cough, sneeze) or strong need to urinate
    when on way toilet
      CAUSES
    o injury to connective tissue
    o damage to pelvic nerves and muscles
    o direct injury to urinary tract
    o changes in pelvic floor anatomy
    o urethral weakness
    o vaginal relaxation
    INCONTINENCE (stress, urge, mixed)
  696. INCONTINENCE (stress, urge, mixed) rx
    • o PF exercises (10 second holds, 10 contractions, 2-3x per week)w/ fx tasks
    • o co-contraction of TA and PF
    • o posture and body mechanics (poor lifting technique)
    • o urgency techniques (perch, PF contractions, walk to bathroom)
    • o diet changes (coffee intake, water, gradually inc time between urination from 2-4 hrs)
  697.  Abnormal blood sugar reading 1st seen during pregnancy
    o undetected or mismanaged can lead to very high risk to baby and to mom
    GESTATIONAL DIABETES
  698. GESTATIONAL DIABETES rx
    o team (physician, nurse, dieticianinsulin, diet, exercise)20 mins walk post-meal
  699.  D/T stretching can lead to partial or total organ prolapse
    o cystocele : herniation of bladder into vagina
    o rectocele: herniation of rectum into vagina
    o uterine prolapse: bulge of uterus into vagina
     S/S
    o Increase with activity/at end of day
    o Pelvic pain
    o urinary incontinence
    o pain with sexual intercourse
    o heaviness in saddle region,
    o incomplete B&B emptying
    PELVIC FLOOR DISORDERS
  700. PELVIC FLOOR DISORDERS rx
    • PT RXif unresolved in 6 weeks
    • o PT= pelvic floor mm ex, postural re-ed, pessary, surgery
  701.   preg induced, acute HTN after 24wks gestation
      S/S
    o HTN, edema, headache, visual disturb, hyperreflexPT to AX
    PREECLAMPSIA
  702. C-section rx
    • o TENS for incision pain
    • o breathing ex
    • o gentle ab ex
    • o pelvic floor ex
    • o postural ex, ambulation
    • o prevent incisional adhesions (scar massage)
  703. RULE OF 9sto determine body surface area involvement (include 1st degree burns)
    • o head = 9
    • o torso = 36
    • o each arm = 9
    • o each leg = 18
  704. Burns RULE OF 9s in KIDS
    • torso= 36
    • each arm= 9
    • head = 18
    • each leg = 14
  705. PHASES OF BURN WOUND HEALING
    • o inflamm (up to 2 days)
    •     vascular and cellular effects to eliminate the necrotic tissue and deliver materials for healing
    • o proliferative (days to months)
    •     rebuild the dermis and epidermis, fibroplasias and neovascularization that produce granulation tissue (early angiogenesis)
    • o remodeling (months)
    •     wound contracts and increases strength, scar
  706. Inhalation injury process: 
    w/in 24hrs:
    24-48: 
    48 hrs plus:
    • w/in 24hrs: upper airway obstruction/pulmonary edema
    • 24-48: just pulmonary edema; 
    • 48 hrs plus: bronchiolitis, alveolitis, pneumonia, ARDS
  707. Mngmt of inhalation injury:
    early mobilization, breathing ex’s, post drainage
  708. Burns PT rx
    • o keep wound moist, electrotherapy (HVPC), good health (diet, exercise (for circulation)
    • o debride wounds (whirlpool), pain mngt,
    • o first 2-3 weeks AROM and PROM to maintain range, positioning, edema management, encourage ambulation
    • o scar management BECAUSE as early as 1-4 days can get a scar tissue contracture
  709. Burns CONTRAINDICATIONS TO EXERCISE
    o exposed joint, fresh skin graft, DVT, compartment syndrome
  710. SKIN GRAFT RX:
    • o scar massage, sun protection, ROM, pressure garments
    • o strengthening can begin in 3-4 weeks
  711. Therapeutic mngmt of burn scar:
    pressure garments, massage, moisture
  712. location, size, wound base, wound edges, surrounding skin, stage, photos
    DESCRIBING WOUNDS
  713. CLIENT EDUCATION FOR WOUND PREVENTION
    • o look at skin 2X/day, check all bony prominences, use a mirror and attendants
    • o look for change in temp, colour, temperature, texture, persistent erythema, discoloration
    • o Braden scale for ax risk of wound
  714.   autoimmune disease that affects the skin
      faulty signals that speed up the growth cycle of skin cells: profound cutaneous inflammation and epidermal hyperproliferation
    SITES
    o extensor surfaces over bony prominences (elbows, knees), scalp, retroauricular, ears, palms and soles, umbilicus, penis, lumbar, shins, nails plaques, but can affect any area
    o In contrast to eczema, it is more likely to be found on the outer side of the joint
    PSORIASIS
  715. 5 CARDINAL SIGNS of psoriasis
    • o plaque (raised lesion)
    • o well circumscribed margins
    • o bright salmon red colour
    • o silvery micaceous scale
    • o symmetrical distribution
  716. Psoriasis rx
    • o Topical creams containing glucocorticoids
    • o Tars
    • o vitamin D or A
    • o phototherapy with UV light
    • o systemic therapy with immunosuppressive drugs
  717. (means “boiling over)
      form of dermatitis or inflammation of the epidermis (skin outer layer)
      itchy, red, scaly disorder
    ECZEMA
  718. Which type of eczema
    a. intensely itchy inflammatory skin disorder associated with “atopy”
    i. predisposition toward developing certain allergic hypersensitivity reactions
    1. asthma, hayfever, and allergic conjunctivitis
    PRESENTATION
    itchiness is the most outstanding feature (pruitis)
    lichenification (thickening skin lines)
    excoriations (scratching or picking at skin)
    crusting
    3 PHASES:
    Infantile (2mo-2years)-facial and extensor distribution
    Childhood-dry skin, flexural distribution (popliteal and cuboid fossa)
    Generally improves with age, less flexural distribution, primarily
    affect the hands
    ATOPIC DERMATITIS (“endogenous” eczema)
  719. ATOPIC DERMATITIS (“endogenous” eczema)- Rx
    avoid irritating factors, moisturizers, topical glucocurticoids, oral antihistamines, UV therapy for resistant or severe cases
  720. immune hypersensitivity to an allergen in contact with the skin (e.g. nickel, poison ivy)
    Allergic contact dermatitis
  721. Irritant contact dermatitis
    o contact of skin with something that primarily causes direct local irritation (harsh detergents, chemicals)
  722. Contact dermatitis rx
    usually topical steroids, clears up in 7-10 days
  723. SEBORRHEIC DERMATITIS (dandruff)
    •  occurs in areas of higher sebaceous gland activity (oily areas)
    •    o scalp, face, central chest and back
    •   probably due to an excessive immune response to a yeast
    •   ill defined areas of erythema with greasy-appearing scale
    •   Associated disorders
    •    o seen frequently in PD, neurologic disorders (stroke, TBI,
    • SCI), HIV pts that decr. mobility
  724. SEBORRHEIC DERMATITIS (dandruff) rx
    antifungals
  725. S/S
    o yellow, itching (pruitis), big belly(ascities), bleeding, and esophageal varices
    Hepatitis
  726. o virus transmitted by fecal oral route, usually self limiting bout
    o RISK FACTORS
     international travel, daycare, vaccine available
    o S/S
     jaundice, fatigue, weakness, anorexia, nausea, vomiting, abdominal pain
    o NOTEchildren are usually asymptomatic
    Hep A
  727. o infection of liver, can persist and become chronic, long standing can lead to cirrhosis and hepatocellular carcinoma
    o high (Africa) to low risk (north America) regions of countries
    o can be spreadhigh risk (mother to child) to low risk (sexual transmission and injection drug use)
    o LONG TERM COMPLICATIONS
     cirrhosis and hepatocellular carcinoma
    Hep B
  728. Hep B Rx
    antiviral agents, vaccine, NO CURE
  729. o Transmission
     percutaneously (needle stick, drug use)
     non percutaneous (sexual)
     hemodialysis
    o higher risk of it turning chronic from acute then in hep B but it can take decades for chronic
    complications to occur (20 yrs)
    Hep C
  730. Hep C Rx
    interferon and anti-viral agents
  731. F>M
      autoantibodies stimulate the thyroid (TSH receptor), T3 and T4 (these inhibit the secretion of TSH) will be high
      S/S
    o fever, wt loss, exercise intolerance, goiters, bulging eyes (exophthalmos), tachycardia, decrd fertility
    GRAVES’ DISEASE  hyperthyroidism,
  732. APGAR: neonatal ax:
    5 aspects, score 0-2, want a high score: appearance, pulse, grimace, activity, and respiration
  733. GOALS OF PEDS PHYSIO:
    participation, motor abilities, functional mobility, health & prevention
  734. asymmetrical tonic neck reflex (ATNR)
    0-4 months: head turn to one side, extension of arm at that side and flexion of the contralateral arm
  735. moro reflex:
    when feeling like they are falling the child will open their arms then bring them back to their chest
  736. grasping reflex
    0-4 months: grasp when pressure is put on palm of hand, will relax if you stroke back of hand
  737. stepping reflex:
    body weight shift and the baby will make stepping motions (first 2 months)
  738. babinski:
    normal in babies (fanning of toes)
  739. symmetrical tonic reflex
    6-9 months: stim neck flexion or extension, will flex UE and extend Le with neck flex and when neck extended UE will extend and LE are flexed
  740. plantar grasp reflex:
    present at 28 wks to 9-10 months, stim: pressure to base of toe, toe flexion
  741. rooting reflex
    (up to 3 months): stroke side of cheek they will turn their head to side of stim with mouth open
  742. Developmental milestones: able to turn head side to side, brief head righting, random kicks in supine, maintain head midline, hand fisted will reflex grasp
    Birth to 3 months
  743. Developmental milestones:
    able to prop with extended elbows, head control, rolls, supported sitting (good head control, turns head), weight bears in standing when supported , 3-5 months: grasp/hold small toys, release toys, inc frequency of reaching
    4-5 months
  744. Developmental milestones:
    head control in sitting
    5 months
  745. Developmental milestones:
    sitting independently, uses hands for play, stands with support , radial grasp, rake to grasp, reaching path is straight
    6- 8 months:
  746. Developmental milestones:
    anticipate and orient hand for reach and grasp (7.5 months), commando crawling
    7 months
  747. Developmental milestones:
    4 point kneel (start with rocking to crawl backwards to crawl forwards), moves from sit to prone, pivots in sitting, may pull to stand,
    8-9 months
  748. points and pokes with index finger, uses pincher grip
    9-11 months
  749. does like prone or supine (will get out of it), sitting bum scoot, standing (transfer from standsit without falling, picks up objects from floor w/o support, stands hands free for a few secs), mobility (crawls up stairs, cruising, walking w/ hands held, can start walking indep.)
    10-11 months
  750. walks independently, transitions to stand at mid floor, squats, picks up toys without
    support, walks up stairs with hand held or rail, initiates ball kick, throws ball, walks backwards and sideways a few steps ; opens books, puts pellets in bottle, handedness usually established
    12-18 months
  751. propels or steer push toys, walk on tiptoes, jumps, stand on on e foot, kick ball, throw and catch, ascend and descend stairs IND;
    2-2.5 yrs
  752. climb stairs independently, run faster and more controlled, walk in straight line, throw under and
    over head, somersaults, gallop and skip, dress and eat independently ; uses mature tripod grasp (4.5yrs)
    3-5 yrs:
  753. alteration on chromosome 21
    S/S  identifiable facial features, hypotonia, dec strength and lig laxity, short arms and legs, heart defects, AA
    instability, scoliosis, pronated feet, and hip dislocation
    DOWN SYNDROME:
  754. DOWN SYNDROME rx
    • try to attain developmental milestones, discourage compensatory patterns, improve muscle strength
    • (antigravity muscles), monitor ortho issues, provide oral-motor fxn, sensory and gross motor stim, monitor
    • cardiovascular and respiratory health
  755. related to disturbance in hypothalamus, genetic deletion (chrom 15 usually)
    S/S  infants (hypotonia, delayed motor and learning development, little spontaneous movement, resp difficulties, and oral motor or feeding difficulties;
    PRADER – WILLI SYNDROME:
  756. PRADER – WILLI SYNDROME rx
    gross motor development, compensatory postures, nutritionist)
  757. **older kids
    S/S  hypotonia, intellectual impairment, short stature, hyperphagia *extreme obesity, behavior problems;
    PRADER – WILLI SYNDROME:
  758. PRADER – WILLI SYNDROME rx (older kids)
    weight management, increase activity level, orthodics, improve postural control, behaviorist)
  759. < 37 weeks gestation, due to lack of surfactant
    S/S  tachypnea, in drawing, cyanosis, occurs soon after birth
    NEONATAL RESPIRATORY DISTRESS SYNDROME
  760. NEONATAL RESPIRATORY DISTRESS SYNDROME rx
    corticosteroids
  761. death of infant under 1 yr with unexplained cause, peaks at 3-4
    months and usually occurs at night, M>F, can also be caused by infection,
    RISK FACTORprone sleeping
    SIDS (SUDDEN INFANT DEATH SYNDROME)
  762. fractures that occur in children, determined by growth plate development  immobilization usually between 3-6 weeks
    SALTER HARRIS #
  763.   developmental delay in social/language/motor and/or cognitive development, more common in M>F,
    avg age of onset is 4 yrs
      S/S
    o have stereotyped and repetitive play skills, avoid eye contact, dislike change in routine, and have strong sensory preferences, dyspraxia (needs time to plan movement and execute goal related fxn), gait (waddling, abnormal weight distribution), cerebellar involvement
    AUTISM
  764. OUTCOME MEASURES Autism
    o use M-ABC, Bayley -3, PDMS-2
  765. Contraindication for resistance training
    • o acute inflammation
    • o joint effusion
    • o severe CVD
    • o#
    • o joint/muscle pain during AROM or isometric testing
  766. Precautions for resistance training
    osteoporosis/osteopenia, fatigue, medications, inappropriate temp and clothing
  767. Contraindication for stretching
    • acute inflamm or infection
    • o unhealed # that can’t be protected
    • o joint effusion
    • o recent corticosteroid injection to involved tissue
    • o specific to certain surgeries
    • o hypermobile segment
  768. Precautions for stretching
    known or suspected osteoporosis, elderly patients, newly united # must be protected, vigorous stretching of recently immobilized tissue, avoid stretching edematous tissue
  769. FITT PARAMETERS
    Strength: >...% of 1RM, <... reps, ... sets, ... min rst
    Power: 
    Hypertrophy: 
    Endurance: 
    PROM/AAROM:
    Stretching:
    • Strength: >85% of 1RM, <6 reps, 2-6 sets, 2-5 min rst
    • Power: 75-90% of 1RM, 1-5 reps, 3-5 sets, 2-5 min rest
    • Hypertrophy: 67-85% 1 RM, 6-12 reps, 3-6 sets, 30-90 second rest
    • Endurance: <67% of 1 RM, > 12 reps, 2-3 sets, < 30 second rest
    • PROM/AAROM: 10-20 reps, 1-2 sets, 1-2 times per day, everyday, into available ROM (joint stiffness should be
    • limiting factor not muscle tightness)
    • Stretching: 2-3 sets, 30 second hold, at least 1 per day if not multiple times per day
  770. CONTRAINDICATIONS to joint mobilization
    #, neoplasm, acute inflamm process, apparent hypermobility or instability in direction of technique, bone/joint infection, spinal cord signs or symptoms, spasm or bony end feel
  771. Precautions to joint mobilization
    impaired circulation or sensation, osteoporosis or compromised health, haemophiliacs, poor skin condition, open wounds, discomfort in treatment position, marked skeletal deformity
  772. Which grade?
    small amplitude movement at beginning of range:
    o with pain before resistance or at resistance(or use traction)
    1
  773. Which grade?
    large amplitude movement from beginning to middle of range (before resistance) usually into R1
    when tissues start to tighten (when pain before resistance or at resistance)
    2
  774. Which grade?
    large amplitude movement from middle to end of available range (into resistance) R2 where limitation is usually due to a tight capsule (when you get resistance before pain)
    3
  775. Which grade?
    small amplitude movement at end of available range into resistance (when you get resistance before pain or resistance and no pain)
    4
  776. Which grade?
    small amplitude high velocity movement at end of available range (when you have resistance and no pain)
    5
  777. EFFECTS of joint manipulation
    • o tearing of the scar tissue
    • o quick stretch to joint capsule
    • o stim of mechanoreceptors- neurophysiological effects
  778. reduces muscle spasm, relaxes patient, facilitates fine movement and increases ROM and exercise tolerance in some pt
    Heat
  779. post op swelling, chronic oedema and joint effusions, dec muscle spasm, dec spasticity, mild cooling enhances muscular isometric contraction and endurance, chronic inflamm; both can dec pain
    Cold
  780. Why is TENS used?
    Used for acute and chronic pain, muscle twitch, muscle strengthening and spasticity mgnt
  781. TENS rx and parameters
    • RX: conventional: 8-150 Hz, 60 microsecond, to comfortable tingle modulated or not, 30 min;
    • acupuncture like: 200 microseconds, 10 Hz, muscle twitch, on motor point/myotomal, 40 min to 1 hr
  782. TENS contraindications
    • Contraindications:
    • o electronic devices
    • o low back or ab of pregnant woman
    • o malignancy
    • o DVT or thromoboembolis
    • o infected tissue (tb)
    • o impaired sensory awareness
    • o cognitive or communication impairments
    • o cardiac disease or arrthymias
  783. Why use NMES?
    Can be used for pain, produce muscle twitch, inc muscle strength, spasticity mngt
  784. NMES parameters for pain
    • Same as tens
    • conventional: 8-150 Hz, 60 microsecond, to comfortable tingle modulated or not, 30 min;
    • acupuncture like: 200 microseconds, 10 Hz, muscle twitch, on motor point/myotomal, 40 min to 1 hr
  785. NMES parameters for edema management
    over extraarticular edema, 5-10 Hz, 200 microseconds, motor intensity to twitch
  786. NMES parameters for muscle strengthening
    >35<65 Hz, intensity to tetany, rise and fall (usually nice to have a 2 sec ramp and 1 sec off with a 6 sec contraction = 9 sec total), on/off depending on strength of muscle (I: 1:5 III: 1:3 IV: 1:1) 12-15 contractions per second
  787. NMES contraindication
    • o electrical devices
    • o pregnancy ANYWHERE
    • o active DVT or thromboembolis
    • o infected tissue
    • o chest with cardiac disease or arrthymias or heart failure
    • o neck or over eyes
    • o impaired circulation
    • o unstable (recent surgery, osteoporosis, #)
    • o intercostal muscles, lower abdomen
  788. Why use interferential current?
    pain, edema, increases blood flow, muscle stimulation (really not effective)
  789. Interferential current parameters
    • Balanced, symmetrical, biphasic, amplitude modulated, pulse duration 250 usec, phase duration 125usec
    •   Can output 50-90mA (other machines = much lower) – NO THORACIC APPLICATION OVER 50mA
    • o Motor = 1-10Hz
    • o Sensory (pain) = 80-150Hz,
    • o Motor + Sensory = 80-150 Hz for both
    •   Tx time: 20-40mins
  790. Interferential current contraindication
    • o thoracic application
    • o electronic devices
    • o malignancy
    • o low back or abdomen of pregnant women
    • o DVT of TE, active bleed or infection
    • o recently radiated tissue
    • o impaired sensory awareness
    • o seizures, gonad, eyes, neck
    • o open wounds
  791. Interferential current precautions
    o active epiphysis in children, skin disease, impaired circulation, fragile skin(elderly if suction cup)
  792. Iontophoresis used for
    hyperhidrosis, MSK inflammatory disorders, plantar fasciitis, TMJ disorders, ischemic skin ulcer, fungal infections, bursitis and tendonitis
  793. Iontophoresis contraindication
    • o over damaged skin or open lesions
    • o allergy to therapeutic ions
    • o impaired sensation
    • o over electric implants
  794. Therapeutically heat body tissues at any depth
      2 types of electromagnetic fields producing the heat (electrostatic and electromagnetic) –
    o thermal and non-thermal effects
    increased tissue healing, enhance nerve regeneration, pressure ulcers, chronic low back pain, soft tissue injuries (some evidence it can be used for pain, muscle spasm, chronic inflammation, delayed wound healing, chronic infection)
    Pulsed Short Wave Diathermy
  795. Two main indication for application of Pulsed Short Wave Diathermy
    OA and ankle sprain
  796. Pulsed Short Wave Diathermy contraindication
    metallic implants & pacemakers (implanted devices)
  797. Laser contraindication and precaution
    • CONTRAINDICATIONS:
    • o Eyes
    • o Malignancy
    • o low back or abdomen of preggo women
    • o hemorrhage or severe vascular disease
    • o tissue effect by TB or bacteria
    • o reproductive tissue
    •  Precautions: recently radiated tissue, infected regions, anterior neck, photosensitivity, cognitive
    • impairments
  798. UV use
    • TREAT: psoriasis, eczema, vitilago, pruritus (secondary to liver/kidney disease), acne, photodermatoses,
    • wound healing, atopic dermatitis
  799. UV dosage
    Dosage based on MED: then start at 70% then work up by 5-10 % as tolerated (combo of UVB and UVA)
  800. UV contraindication
    • CONTRAINDICATIONS = photosensitivity, skin cancer, and CT disorder (be aware of drugs causing photosensitivity)
    • o On eyescan cause conjunctivitis or photokeratitis (inflammation of cornea) – cataracts are caused by chronic exposure to UV
  801. US uses
    • Used for:
    • o thermal effects: decreased pain, decreased joint stiffness, improved blood flow, promote
    • healing (decreases inflammation)
    • o non-thermal effects: wound healing, inflammation and soft tissue healing, altered scar tissue
    • formation, stim of collagen synthesis, angiogenesis, repair of articular cartilage
  802. US parameters
    • Parameters:
    • o frequency 1MHz (deep) and 3MHz (superficial)
    • o intensity (0.5W/cm2 acute and 2 W/cm2 = high for chronic while 1-1.2 W/cm2 = moderate for chronic)
    • o pulsed (acute) and continuous (chronic)
    • o acute = 5-10mins, chronic = 20 minutes
    • o pulse ratio: 1:1 to 1:8
    • Apply to area not larger than 2-2.5xERA (ERA = area producing 5% or more of max. power output –higher = better) -
  803. US contraindications and precautions.
    • CONTRAINDICATIONS: implantable devices, malignancy, bleeding disorder, infection, DVT, don’t use on
    • Medtronic stimulation system, myositis ossification, #, the usual ones, impaired circulation and sensation,
    •   PRECAUTIONS: spinal cord or superficial nerves, regenerating nerves, epiphyseal plate unfused
Author
Bykan
ID
350490
Card Set
Physio Exam
Description
Questions for physio exam
Updated