14 Special Topics

Question 1

Goals of wheelchair evaluation

Answer 1

Assess pelvic alignment
Identify possible ROM limitations
Determine visual field available
Note anatomical deformities

Question 2

Seat depth of wheelchair

Answer 2

Subtract 2 inches

Question 3

Proper wheelchair fitting

Answer 3

Start at pelvis
Use 3 points of control
Increase surface area to disperse pressures
Accommodate to fixed deformities and correct flexible deformities

Question 4

Flexible posterior pelvic tilt

Answer 4

Pommel
Lumbar support
Anterior/posterior trunk supports

Question 5

Fixed posterior pelvic tilt

Answer 5

Open seat to back angle to match pelvis angle
Contoured back
Tilt in space to allow upright head

Question 6

Flexible pelvic obliquity

Answer 6

Firm foam on low side and soft foam on high side

Build up low side and grid/waffle on high side

Question 7

Fixed pelvic obliquity

Answer 7

Build up to meet high side, cut down to match low side

Question 8

Flexible windswept legs

Answer 8

Proper width seat
Contoured seat
Pommel
Lateral pelvic/thigh supports
Leg harness or troughs
Foot straps

Question 9

Fixed windswept legs

Answer 9

Foot plate that fits both feet
Ensure contact of back and seat with cushion
Measure true point of maximum for seat width

Question 10

Flexible kyphosis

Answer 10

Anterior chest/shoulder support
Mid-thoracic/lumbosacral support
Tilt in space frame

Question 11

Fixed kyphosis

Answer 11

Custom molded back
Grid seating
Open back seating
Tilt frame

Question 12

Flexible scoliosis

Answer 12

Generic contoured back
Lateral trunk supports (3-point pad system)
Anterior trunk supports

Question 13

Fixed scoliosis

Answer 13

Custom molded seating
Grid back
Lateral tilt under seat to fix head position

Question 14

Insurance coverage for manual wheelchairs

Answer 14

Must be used inside home
Sufficient UE and cognitive function
Caregiver available to provide assistance when necessary

Question 15

Insurance coverage for power wheelchairs

Answer 15

Unable to self-propel manual wheelchair

Home has adequate space

Question 16

Positioning seat cushion

Answer 16

For postural deformities
Trunk weakness
Spasticity
Orthopedic deformities

Question 17

Stage I pressure injury

Answer 17

Non-blanchable erythema
Intact skin
Usually over bony prominence

Question 18

Stage II pressure injury

Answer 18

Partial thickness
Shallow open wound with red/pink wound bed
No slough present

Question 19

Stage III pressure injury

Answer 19

Full thickness skin loss
Bone, tendon, muscle NOT visible
Subcutaneous fat may be visible
Slough may be present
May have undermining and/or tunneling

Question 20

Stage IV pressure injury

Answer 20

Full thickness skin loss
Exposed bone, tendon, or muscle
Slough or eschar present
Often includes tunneling and undermining

Question 21

Unstageable pressure injury

Answer 21

Full thickness skin loss- depth unknown
Depth obscured by slough or eschar
Dry, intact eschar should not be removed

Question 22

Suspected deep tissue injury

Answer 22

Depth unknown

Discolored, intact skin or blood-filled blister from pressure or shear

Question 23

Gait speed for ADL independence

Answer 23

>= 1.0 m/s independent
<= 0.6 m/s dependent

Question 24

Gait speed more likely to be hospitalized

Answer 24

<= 0.6 m/s more likely
>= 1.0 m/s less likely

Question 25

Gait speed necessity of fall risk intervention

Answer 25

<=1.0 m/s

Question 26

Gait speed for discharge location

Answer 26

<=0.1 m/s for SNF | >=0.1 m/s home more likely

Question 27

Gait speed ambulation status

Answer 27

<=0.4 m/s household walker 0.4-0.8 m/s limited community ambulator 0.8-1.2 m/s community ambulator >= 1.2 m/s cross street and normal walking speed

Question 28

Most common primary brain tumor in adults

Answer 28

Meningiomas (36%)

Question 29

Most common malignant brain tumors in adults

Answer 29

Gliomas (80%)

Question 30

Most common pediatric CNS tumors

Answer 30

``` Pilocytic astrocytoma Malignant glioma Medulloblastoma Neuronal and mixed neuronal-glial tumors Ependymoma ```

Question 31

Meningiomas

Answer 31

Benign from meninges | Grow slow, large size before affecting function

Question 32

Astrocytoma

Answer 32

Glioma Low grade- slow, likely in children High grade- fast, likely in adults Glioblastoma multiforme- most common and deadliest primary brain tumor

Question 33

Oligodendrocytoma

Answer 33

Glioma | Slow growing- years before symptoms

Question 34

Ependymomas

Answer 34

Glioma | Rare in adults

Question 35

Grade I tumor

Answer 35

Benign Slow-growing Usually associated with long-term survival Rare in adults

Question 36

Grade II tumor

Answer 36

Relatively slow growing May spread to nearby healthy tissue May be recurring as grade II or higher grade tumor

Question 37

Grade III tumor

Answer 37

Malignant Actively reproduces abnormal cells Spreads to nearby tissues Often returns as higher grade tumor

Question 38

Grade IV tumor

Answer 38

Most malignant Fast growing Easily spreads to normal tissue Tumor forms new blood vessels to maintain rapid growth Tumor has areas of dead cells in the center

Question 39

Signs of increased intracranial pressure

Answer 39

``` Headache Nausea/vomiting Blurred vision Balance problems Personality changes Seizures Drowsiness ```

Question 40

Spinal cord tumor presentation

Answer 40

UMN and LMN signs Nerve root pain Bowel/bladder changes

Question 41

Birth to 3 month milestones

Answer 41

Alternate kicking legs on back Hold head 45 degrees in prone by 2 months Begins to hold head midline and track objects with eyes Reflexes- step, moro, Babinski, ATNR, flexor posture, grasp, root, suck Cooing sounds and develops smile/imitates faces

Question 42

4 to 6 month milestones

Answer 42

``` Able to lift and hold head in all positions Plays with hands near face and chest Palmar grasp 4 months, raking 6 months Roll to side and tummy to back 4-5 months Roll back to tummy 6 months Bears weight on elbows/hands on tummy Sit without arms for brief periods Postural reflexes develop ```

Question 43

7 to 9 month milestones

Answer 43

``` Able to sit independently Begins to creep Pull to stand with arms, uncontrolled drop stand to sit Drop objects on purpose Inferior pincer grasp, thumb more active Cruise along furniture 9 months ```

Question 44

10 to 12 month milestones

Answer 44

``` Lower self from standing with legs Play in squat position May take first steps with wide base Kneels independently Use objects appropriately Fine pincer grasp, finger-feeds self ```

Question 45

13 to 15 month milestones

Answer 45

Begins walking Can stack 2 objects Begins using spoon Scribbles

Question 46

16 to 19 month milestones

Answer 46

``` Walks up steps with HHA and 2 feet Walks backwards Stacks 4 objects Kick stationary ball Hold toys while walking Removed clothing, drink from cup ```

Question 47

20 to 23 month milestones

Answer 47

Walk down steps with HHA and 2 feet Jump in place Imitates domestic tasks, shows independence Stacks 6 objects

Question 48

2 year milestones

Answer 48

``` Jumps on 2 feet Handedness established Uses fork Follows 2-step commands 2-word phrases ```

Question 49

3 year milestones

Answer 49

Ascends stairs alternating feet Pedals tricycle Turns pages of books Toilet trained

Question 50

4 year milestones

Answer 50

Hops on one foot Descends stairs alternating feet Able to do buttons Tells stories

Question 51

5 year milestones

Answer 51

``` Skips Balance on one foot 10 seconds Draw person Tripod pencil grasp Independent ADLs ```

Question 52

Down syndrome complications

Answer 52

``` Deafness Visual impairments Heart defects Sleep apnea Ear infections ```

Question 53

Norm-referenced outcome measure

Answer 53

Compares performance of and individual to a representative group

Question 54

Criterion-referenced outcome measure

Answer 54

Document performance in relation to domain of information or specific skill set Measures changes in performances of individual

Question 55

PDMS-2

Answer 55

Assesses fine and gross motor skills Birth to 7 years Norm and criterion referenced

Question 56

GMFM

Answer 56

``` Assess gross motor skills 5 months to 16 years Change over time in CP Also validated for Down syndrome Criterion-referenced ```

Question 57

BOT

Answer 57

Assess fine and gross motor skills 4.5-14.5 years Norm-referenced

Question 58

ICP monitor

Answer 58

Measures ICP, some allow CSF drainage Most need to stay at level of external auditory meatus If therapy performed, device needs to be recalibrated by RN after

Question 59

NG tubes, Gastrostomy, J tubes

Answer 59

HOB should not be below 30 degrees after feeding