Rehab Flashcards
(92 cards)
1
Q
Physiatrist or Rehab Physician
A
specialize in FUNCTION
practical approach to patient care
2
Q
Common Physiatric subspecialities
A
acquired brain injury spinal cord injury sport's medicine pain management pediatric physiatry palliative care
3
Q
Spinal cord injury -> paraplegia
A
not necessarily restoring function
but improve function within his or her limitations or restrictions
4
Q
Goals of Rehab
A
- Function (FIM)
- Independence (Oswestry Disability Index)
- Quality of Life (SF-36)
5
Q
Acute Rehab facility
A
must show how much progress patients made
6
Q
FIM score
A
Functional Independence Measurement
- used to measure progress of functional skills
- can be used for outcome predictor: 1. LOS 2. prognosis 3. discharge destination
- Rehab dependent of many subjective, non-measurable factors
7
Q
FIM Score interpretation
A
over 90 - patient goes home
below 40 - go to nursing home
8
Q
ADLs
A
Dressing
Eating
Ambulating - must ambulate otherwise will lead to DVTs, osteoporosis, etc.
Toileting/Transfers
Hygiene - leads to skin breakdown, cellulitis
ask at bedside !!!
9
Q
Loss of independence
A
Impairment - any loss of abnormality of physiologic, psychological, or anatomic structure or function
Disability - restriction due to impairment in the ability to perform an activity within the range of what is considered “able bodied”
Handicap-???
10
Q
radial nerve palsy
A
disease
11
Q
impairment for RNP
A
wrist drop
12
Q
disability for RNP
A
inability of the work as surgeon
13
Q
handicap for RNP
A
job loss
14
Q
60/40 rule
A
average of 60% its admitted to acute inpatient rehab needed one of the impairment categories per Medicare
15
Q
Functional deficits
A
2/2 pain, immobility, cognitive dysfunction, communication disorder, motor deficit
NOT SAFE TO RETURN TO PREVIOUS LIVING ARRANGEMENT
16
Q
Medical necessity
A
controversial
17
Q
functional improvement
A
for > 3 wks
Dx
Premorbid status
ability to tolerate/particopate 3hr/daily, 5 days/weekly
18
Q
Members of the Rehab team
A
Physiatrist PT OT Speech therapy neuropsych Rehab nursing social worker patient/social supports MOST IMPORTANT IS COMMUNICATION!!!
19
Q
Normal gait patterns
A
focus on one leg
5 parts of the stance phase
3 parts of the swing phase
20
Q
Gait cycle
A
stride
functional unit of gait
21
Q
step length
A
distance b/n both heels
22
Q
stride length
A
distance b/n heel of same foot after two steps
23
Q
gait analysis
A
faster the walk, the 80% (single limb support) goes up to 100% (person is running, jogging)
24
Q
speed for gait
A
length per time
most energy efficient and comfortable
walking speed = 3 mph
25
Stance phase
```
I Like My Tea Presweetened
Initial contact
Loading response
Midstance
terminal stance
preswing
```
26
Eccentric contraction
muscle tenses while it lengthens
27
Length-tension relationship
reason for sprains for runners
Heel strike - hamstrings max contracts while greatest length
if not trained, will get sprains
28
Swing phase
In My Teapot
Initial swing
mid swing
terminal swing
29
8 most common gait dysfunctions
```
Antalgic
Trendelenburg
Steppage
vaulting
circumduction
genu recurvatum
ataxic
festinating
```
30
Antalgic gait
stance phase abnormally shortened relative to the swing phase
shortened the amount of time on the leg that hurts
circumduction is possible
31
Bilateral tendelenburg gait (uncompensated)
myopathic gait
| =result in waddling type gait
32
compensated trendelenburg gait
patient leans the trunk on the side that hurts
so that contralateral pelvis does not drop
=pts with osteoporosis
Proximal (pelvis) problem!!!
33
Foot drop
fibular head fx can result in common fibular n. dysfunction
34
Foot slap
tibalis ant. has mild strength deficit
35
steppage gait
uses proximal m. to hip hike
| hip flexes to clear the foot with the foot drop
36
vaulting
good leg is excessively plantar flexing to allow toes of swing leg to clear the ground
37
circumduction
swing leg excessively hip abducts so that the toes of swing leg can clear the ground
WIDE ARCH is seen
can also circumduct in antalgic gait
38
genu recurvatum
weak quads or limited ankle dorsiflexion/excessive plantar flexion
BACKABENDING OF KNEE CAUSING EXCESSIVE EXTENTION AT THE TIBIOFEMORAL JOINT
dorsiflexion stretched gastrocnemius causing knee flexion movement at knee???
39
ataxic gait - DRUNKEN APPEARANCE
seems like don't know where in space
unsteady, uncoordinated walk, employing a wide base and the feet thrown out. seen with cerebellar pathology
40
Festinating gait
Parkinson's patient
Involuntary advancement of legs with short, accelerating steps often on tiptoes (shuffling)
41
Limb innervation
PROXIMAL TO DISTAL GRADIENT INN: brachial plexus - C5-6 : shoulder girdle
C8-T1 - hand
OVERLAPPING: Elbow flexion - C5-6 (even some C7)
patellar MSR - L4 (some L3)
Limb=extremity = arm/leg
42
Manual muscle testing
LMN and UMN
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LMN
anterior horn cell -> root-> plexus-> branch ->NMJ -> muscle
44
UMN
corticospinal tract -> anterior horn of spinal cord
45
Key dermatomes
UL : C5-T1
| LL: L2-S1
46
Manual muscle testing grading scale
Dont confuse this with true neurological deficits
5/5, 4/5, 3/5, 2/5, 1/5, 0/5
e.g. neck and back pain radiates to the limbs -> pain inhibition function (not a true weakness of the muscle)
47
MMT UL and LL
```
C5
C6
C7
C8
T1
L2
L3
L4
L5
S1
```
48
Muscle stretch reflexes
muscle spindle (sensory reflexes) in skeletal muscles are stimulated by stretch, causing a nonosynaptc reflex contraction of that same muscle
49
Grading reflexes
indicative of hyperreflexia when other tendons are active when only one tendon is strikened
reflex will be 3 = hyperactive without clonus
50
Clonus
rapid alternating contractions and relaxations of muscle after forced stretch
51
UL reflexes
biceps
brachioradialis tendon
triceps tendon
52
LL reflexes
```
patellar tendon
medial hamstring (unreliable)* - pt with ipsilateral below-knee amputation (no L5 dermatome test) = will work for asymmetry when one hamstring is missing?
archilles tendon
```
53
Sensation testing: light touch
wisp of cotton, gauze, fingers
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sensation testing: pain
differentiating sharp and blunt ends of safety pin
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dermatome deficit
side to side demarcation
56
sclerotome (cervical)
regional area of pain
57
cervical spine disc herniation
C6 impingement
foraminal, posterolateral, and central
58
lumber spine disc herniation
```
L5-S1 - L5 root emerges but only forminal herniation will affect it
Posteriolateral herniation (lateral recess?) and central herniation - S1 root and/or below
```
59
posterolateral disc herniation
can result in herniate into the subarticular zone or lateral recess
60
3 reasons why posterolateral herniations are common
1. lack PLL
2. posterior annulus is thinner than the anterior portion due to nucleolus pulpous being located posterior
3. flexion is the predominant motion of the lumber spine resulting in the posterior annulus receiving most repetitive tensile and shear stresses
61
disc herniation into the thecal sac
no spinal cord below L2-L3
| only spinal cords are impinged
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Pathological tests
Babinski
Oppenheim
Chaddock
Hoffman
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Brabinski
lateral plantar aspect of foot is stroked with blunt object causing dorsiflexion of great toe and fanning of other toes
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Oppenheim
downward pressure on tibia causing great toe dorsiflexion
65
Chaddock
stroking lateral foot causing great toe dorsiflexion
66
Hoffman
hand pronated with passive D3 MCP hyperextension
DIP is passively flexed and suddenly released, causing thumb flex/add. and flexion of other fingers.
Most meaningful when correlated with MMT
67
Low back pain
recurrent for life
| self-limiting
68
Proper Dx
nonspecific diagnoses -> nonspecific treatments-> nonspecific outcomes
must do Hx first
then Dx
69
Lumbago (LBP)
is a symptom not a Dx
70
Facet joints
1/3 of the pain generator
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DDx
```
Mechanical
discogenic
SIJ mediated
Facet joint
fracture
infection
cancerous
medical causes
piriformis syndrome
spinal stenosis
Somatic dysfunction (TART is the criteria) - overlap with primary pain generators
```
72
Mechanical low back pain
axial and multifactorial nature
RESULT FROM POSTURE/EXERCISE
MOST OF THE TIME IT IS THE JOINT , NOT NECESSARILY A MUSCLE
73
acute back pain
MAY NOT HAVE NO LONG TERM CONSEQUENCES
74
Discogenic
don't need to have disc herniation
```
long lasting
dull and vague pain
morning stiffness
axial unloading - lean off to the side (weight off the disc)
better with laying down
relieved with walking
```
75
straight leg raise
dural tension sign
| sciatic n.
76
SI mediated
pain over PSIS = Fortin Finger sign
| iliolumber ligament is important
77
Iliolumber ligament
MAINTAIN SI JOINT
MOST RESTRICTING MOVEMENT
attach to the transverse processes of L4-L5?
78
Fortin sign test
more reliable than faber test, yeoman's test
| no tenderness = not the source of pain
79
posterior pelvic pain provocation test
highest sensitivity
start with this in PE
assess the SI joint dysfunction or sacroiliolitis
pain over PSIS reproduced = POSITIVE TEST
80
Decision tree
copy from lecture
81
Facet joint mediated
TTP over transverse processes to rarely below the knee; never goes below the knee
sclerotomal referred pain
pain with extension and rotation
82
Medial branches of the dorsal rami
medial branches of L4 = inferior portion of the facet joint
medial branch of L5 = superior portion of the face joint
every medial branch innervate corresponding facet joint
e.g. L4-5 facet joints are inn. by L3 and L5?
83
Spinal stenosis
dont rely on imaging
go in order: Hx -> PE -> imaging
not necessarily back pain
84
spondylosis
Fx - pars articularis
translation of the bodies
step-off sign - spinal processes will dip off
low back pain is present
L4/L5 facet fx
L5 is affected
85
Tx of LBP
specific dx -> specific tx -> specific outcomes
86
Global finding
1. neck and low back - if there is one area of the spinal stenosis from disc herniation
2. dont do HVLA
87
progressive neurological deficit
get imaging
88
infection and malignancy
low back pain at night
89
pain and problem urinating
prostate cancer
90
PT
if patient will be more compliant
| OR discogenic herniation
91
multimodal
low back pain
| tx with many different modalities synergistically
92
Epidural injections
1. transforminal - through the nerve sheet - goes to the PLL and posterior annulus
2. interlaminar
3. caudal
