Continuation Of Timeline Flashcards
(48 cards)
1
Q
In what year was the APTA formed?
A
In 1941
2
Q
World War II was important in the development of what?
A
Prosthetics
3
Q
When was the competency exam developed? How many members in APTA were there?
A
1951 Over 4,000 members
4
Q
When was the increased movement toward private practice and other settings?
A
In the 1960’s and 1970’s
5
Q
When were the APTA sections developed?
A
1975
6
Q
When did PT become mainstream in public schools?
A
1977
7
Q
When did joint replacements become more common, increasing the need for PT?
A
1980’s
8
Q
When was the American Disability Act?
A
1990
9
Q
“Guide to Physical Therapy Practice” developed?
A
2001
10
Q
Today’s focus in PT?
A
Evidence based and direct access
11
Q
How many practicing PT’s? How many APTA members?
A
215,000 practicing PT’s 95,000 APTA members
12
Q
How many PT programs were there in 1950’s? How many programs today?
A
-39 programs in 1950’s -Today 250
13
Q
When first baccalaureate programs?
A
1980
14
Q
Transitional DPT when and where start?
A
1992 at USC
15
Q
Entry level DPT when and where start?
A
1993 at Creighton
16
Q
4 Elements in PT Practice
A
- Evaluation/Examination
- Formulation of Clinical Judgements and Treatment Plan
- Provide interventions
- Re-evaluation and outcome measures (FIM= Functional Independent Measure)
17
Q
Evaluation/Examination
A
- -Chart review
- -PT interview
- -Recent Medical course
- -Medications
- -Cognitive status
- -Function prior to admission
- -home situation/environment
- -PT’s goals
18
Q
Evaluation/Examination cont
A
- -Vital signs
- -Pain assessment
- -Skin inspection
- -Sensation
- -Posture
- -ROM (AROM & PROM)
- -Strength/motor control
- -Tone
- -Balance
- -Functional Tests
19
Q
Evaluation of Pain (PQRSTQ)
A
- -Provoke (triggers vs. relief)
- -Quality (dull, sharp, shock-like, burning)
- -Radiates -Severity (pain scale)
- -Time (history, periods of exacerbation, constant)
- -Questionnaire (Oswestry scale etc.)
20
Q
Functional Evaluation (one of the most important part of evaluation)
A
ADLs - activities of daily living
- Bed mobility
- Transfers
- Sit to stand
- Ambulation
- WC mobility
- Standard functional tests
21
Q
Functional Tests
A
- • TUG (The Up and Go)- time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. should be less than 10 secs
- • 10 meter walk test- looks at elapsed time it takes to walk 10 meters
- • Functional ambulation profile (GAITRite®)- mat looks at step length, velocity, symmetry…
- • 6 minute walk test- walk for 6 min. look at distance & calculate velocity
- • 3 minute walk test- abbreviated one
- • Functional reach test- standing & reaching out
- • Berg balance test- test for balance to see if risk for falls
22
Q
Cinical Implications Related to Gait Velocity
A
- Correlational to general health status, functional capabilities
- Individual confidence in balance
- Need for rehabilitation / “red flag”
- Provide criteria for discharge
- Contribute to outcome measures
- Relation to quality of gait
23
Q
Fomulation of Treatment Plan
A
- -Results of evaluation (based on)
- -Problem lists (patients major problems)
- -Goals writing (short term & long term)
- -Modifications / progressions
- -Priorities
- -Referrals (if you feel patient needs a specialist)
24
Q
Provide Interventions
A
- -Functional Training
- Therapeutic Exercise
- -Stretching
- -Positioning (in bed, wheelchair)
- -Manual Therapy
- -Orthotic/prosthetic training
- -Balance activities
- -Patient education
- -Specialized interventions (kinesio tape, dry needling, manual lymph. draining)
25
Re-evaluation/ outcome measures
* **FIM scores** (Functional Independent Measure)-
* assess all functional stuff, walking with what amount of supervision
* numerical scale
* at admission & at discharge
* **Functional re-evaluation**
* Ex. needed max assistance, now need minimal, instead of numerical
* **Changes in pain**
* * **Changes in ROM**
* Passive and active
* **Changes in muscle strength / motor control**
* **Changes in balance**
* **Standardized tests**
* Ex. TUG before and after
26
Vital Signs
* Establish baseline
* Medical stability
* will determine how to monitor their treatment
* Response to treatment
* HR, BP, Pulse oximetry (SpO2 (saturation of peripheral oxygen)), RR
27
Heart Rate
* -60-100 bpm (bradycardia less, tachycardia more)
* -Rhythm
* -Amplitude (strong or weak)
* -Resting (3-5 min) after coming in
* -During or immediately after activity
* -Max HR (220-age)
* -Target HR (50 to 85% of max HR)
* Ex. patient is 80 & is ordered to not exceed 75% of max HR
* 220-80= 140
* 140 • 0.75= 105
* so wouldn't want to have Pt exceed 105 HR
28
Places to Take Heart Rate
- Radial
- Carotid
- Brachial
- Dorsalis Pedis
29
Normative Values of HR in diff. ages
* 120 - 160 bpm for neonates (1 to 28 days) \*
* 100 - 120 bpm for infants (1 to 12 months) \*
* 80 - 120 bpm for 3 to 4 yr. old
* 75 - 115 bpm for 5 to 6 yr. old
* 70 - 110 bpm for 7 to 9 yr. old
* 60 - 100 bpm for adults (\>10 yr. old)
\*\* Brachial pulses used in neonates and infants
30
Factors influencing HR
* -Medications
* -Environment
* -Activity
* Anxiety/ SNS
* -Fitness Level
* Age
31
Blood Pressure in Adults
Systole / Diastole
* Normal = 100-119/ 70-79
* Prehypertension = 120-139/ 80-89
* Stage 1 HTN = 140-159/ 90-99
* Stage 2 HTN = _\>_160/ _\>_100
32
Avg. Pediatric BP
* Neonate (1- 28 days) = 60/ 35
* Toddler = 100/ 55
* 5 yo = 105/ 70
* 10 yo = 115/ 75
33
Red Flags with Exercise
* Systolic \> 200
* Diastolic \> 100
* Drop in diastolic of \>10
34
Signs and Symptoms of hypertension
* Severe headache
* Chest pain / difficulty breathing
* Pounding chest, neck and ears
* Confusion / Fatigue
* Blood in urine
35
Signs and Symptoms of Hypotension
* Light headedness
* Blurry vision
* Fatigue / weakness
* Sleepiness
* Syncope (fainting)
36
Factors to Consider with BP
* Anxiety / pain
* Tobacco use
* Position change / activity
* Alcohol consumption
* Exposure to heat/cold
* Valsalva (holding breath)
37
Taking BP
* -Left arm desirable
* -Sphygmomanometer
* -Arm diameter = 80-100% cuff length
* -Approx 1 inch above cubital fossa
* -Palpate brachial artery and align bladder
* -Arm at heart level
* -Don't round off
* know BP before assessment ?
38
Additional Considerations for Taking BP
* -Slow deflation
* -Test stethoscope
* -Angle ear pieces forward
* -At least 1 min before retrying
* -"White coat" HTN (nervousness about Dr. office)
39
Respiration Rates
Breaths/min
* 12- 20 = adult
* 15- 30 = 1- 8 yo
* 25- 50 = 1- 12 months
* 40- 60 = 1- 28 days
* OTHER FACTORS -
* Rhythm
* Ease
* Talk (can they talk comfortably during activity)
* Accessory muscle activity
40
Pulse Oximetry
* Saturation of oxygen to hemoglobin
* NORMAL: 94-100% SpO2
* \< 92% considered hypoxemia = RED FLAG
41
Pulse Oximetry Limitations
* Weak or irregular pulse
* may not get true value
* Hypotension
* Cold fingers
* lots of vasoconstriction in vessels, may not get reliable SPO2 reading
* With inflated blood pressure cuff
* affects blow flow to finger
* Hand movement / tremors (ear lobe option)
* Excessive environmental light
* Dark nail polish
* Always Relate to patient presentation (look for other signs)
* Accessory muscle use
* Rapid shallow breaths / rapid HR
* Inability to talk
* Carbon monoxide / smoking
* PAOD (Periphery Arterial Occlusive Disease a type of PVD)
* Correlate with other indicators
42
Causes for Low SpO2
* -COPD (Chronic Obstructive Pulmonary Disease)
* -Asthma
* -Pneumonia
* -Pulmonary fibrosis or edema
* pressure impeades lungs ability to expand
* -Heart failure
* -Sleep apnea
* -Pneumothorax
* -Narcotics / anesthetics
43
Scale that Relies of Pt feedback rating level of exertion used in addition to vital signs
•Borg's Rate of Perceived Exertion (RPE) Scale
44
Body Mechanics
* -Keep neutral spine
* -Use large muscle groups
* -Keeps objects close to COG (center of gravity) and BOS (base of support)
* -Pivot on feet instead of twisting at trunk
* -Use assistive devices
45
Functional Training Terminology (Stages of Help)
* **-Independent (I)**
* Pt can do activity w/o compensation (no need walker, cane...)
* -**Mod I** - independent with adaptive device
* -**DS** - distant supervision
* Pt can do activity PT can be in same space
* -**CS** - Close supervision
* need be in ready position w/o hands on
* -**CG** - contact guard
* Hands on Pt, usually on involved side
* -**Min A** - Patient \>75%
* Pt does 75% or greater of activity
* -**Mod A** - Patient between 50-75%
* Pt does 50- 75 of work
* -**Max A** - Patient \<50%
* Pt less than 50%
* if Pt can give some sort of assistance
* -**Dependent** - 0%
* not able to do anything
46
Weight Bearing Terminology
* -**NWB** - non-weight bearing
* -**TTWB** - Toe touch weight bearing - no appreciate weight through foot, like having sponge under foot
* -**PWB** - partial weight bearing= 50%
* 50% legs, 50% arms
* should have bilateral support cause when walking transfer of weight
* -**WBAT** - weight bearing as tolerated
* -**FWB** - Full weight bearing
47
Assistive Ambulatory Devices
* -SW - Standard Walker
* -RW - Rolling Walker
* -PRW - Platform rolling walker
* For when can't weight-bear through hands
* RA, wrist fx, multiple fx
* -Axillary Crutches (AC)
* -Loftstrand Crutches - forearm cuff
* -HW - Hemiwalker - one side with major support
* used for stroke Pts
* -WBQC - Wide-based quad cane
* More acute angle faces out
* -NBQC - Narrow-based quad cane, can be used for stairs
* -SC - Straight cane
* Knee walker
* Pediatric Walker
* Rollator walker
48
Assistive Device Height
* Walker/Cane = Greater trochanter
* Walker/Axillary crutches = Styloid process (elbow flexed 20 degrees)
* Axillary crutches = 2-3 fingers below axilla
