Review Flashcards
(146 cards)
1
Q
What are the indicators of emergence from minimally conscious state
A
functional object use
functionally accurate communication
2
Q
What is the key phase of gait
A
hip extension during mid stance to heel off
3
Q
three key inputs to CPG
A
stretch of hip flexors
unweighting triceps surae
WBing to facilitate extensor tone in stance
4
Q
what comes first for unilateral scooting: shortening or lengthening
A
shortening
5
Q
How does stroke cause increased diabetes
A
greater degree of impairment -> less slow twitch muscle fibers -> more insulin resistance
6
Q
Decreasing the duration of an illness is what kind of prevention
A
Secondary
7
Q
How much Physical activity does the WHO recommend
A
150-300 mins of moderate intensity
or 75-150 of vigorous
8
Q
Disadvantage of folding wheelchair:
A
Less durable
Heavier
9
Q
Disadvantage of soft upholstery backrest compared to solid backrest on wheelchair
A
soft upholstery will stretch overtime
10
Q
Solid wheelchair seat vs Soft upholstery seat
A
solid seat- will not stretch, also will not fold
soft seat- will fold, will stretch overtime
11
Q
Do you want a patient in a wheelchair in slight anterior pelvic tilt, or posterior pelvic tilt
A
anterior pelvic tilt
12
Q
Cambered vs vertical wheel alignment advantages/disadvantages
A
cambered wheels- quicker turning
vertical- more narrow
13
Q
High vs low mount breaks
A
Low mount- more difficult to reach for lower functioning pts
High mount- Might injure users thumb while pushing wheelchair
14
Q
MAG wheel vs spokes
A
MAG - more durable, heavier
spokes- lighter less durable
15
Q
Pneumatic vs solid wheelchair tires
A
Pneumatic = more cushion but also more maintenance
16
Q
Caster wheel larger vs smaller advantages
A
Caster wheels are the front wheels (smaller)
Smaller = easier to maneuver on level ground inside, less forward stability
Larger = easier to maneuver over uneven ground, heavier
17
Q
how to measure wheelchair seat width
A
Less than 1.25inch width wider than the greater trochanter or the widest portion of their thigh
18
Q
How to measure wheelchair seat depth
What are the 2 landmarks?
A
Less than 1-2inches than the measurement between the posterior buttocks and popliteal fossa
19
Q
Should we measure backrest height with the wheelchair cushion present or absent?
A
present!
20
Q
How to measure backrest width
A
backrest width should be 3/4 inches wider than the widest part of the torso at the top of the back rest
21
Q
When measuring foot-rest to seat distance what do we need to keep in mind? What should be absent or present
A
Cushion in wheelchair
pt wearing their normal shoes
22
Q
How much clearance should there be between the footplates and the floor
A
atleast 2 inches
23
Q
how to measure arm rest height:
A
Elbows flexed to 90 degrees
cushion in place
24
Q
Axel alignment for wheelchair:
A
As anterior as possible without compromising stability
Having a more anterior axle makes it easier to do wheelies, propel the chair, but it increases risk of tipping
25
If a patient has a curb of 8 inches to get to their front door, how long does the ramp need to be?
8 feet
26
What has the best evidence for dealing with hemiparetic shoulders
FES/NMES
But only good for handling subluxation acutely, does not improve long term benefits
27
What device for shoulders has the highest chance of overcorrections:
1. Lap Trays
2. Arm Troughs
28
According to the study shown to us by da silva what had the best results for flaccid shoulder
Sling
29
What is the disadvantaged of the laptray/arm trough
They come in standard sizes so your patient may be too small and this leads to an overcorrection or maybe theyre too big and its an undercorrection
30
What medication is used to treat HO
Biphosphonates
example: Etidronate/ Didronel
31
When does shoulder-hand syndrome first appear
1-3 months after CVA
32
What are the first signs of shoulder-hand syndrome
Swelling at the MCP and PIP
33
Shoulder hand syndrome can lead to what sympathetic NS dysfunction
What are the first signs
Complex regional pain syndrome
skin pigment changes, sweating, nail changes
34
Another disadvantage of lap board/arm trough
They cant take it with them when they start walking, its attached to the chair
35
What is the disadvantage of using a shoulder sling
Holds the pt in flexion synergy
36
Pts with shoulder hand syndrome will be unable to do what motion at the hand
flexion
37
Preventing an illness from ever taking place
Primary prevention
38
Reducing the duration of an illness or using tests to detect it early
Secondary prevention
39
Rehab, and preventing additional disability
Tertiary prevention
40
Risk factor reduction targeted towards an entire population through a focus on social and environmental conditions
Typically get promoted through laws and national policy.
Primordial
41
Brunstrom Stage 1:
Brunstrom Stage 2:
Flaccidity
minimum voluntary movement, developing spasticity
42
Brunstrom 3:
Brunstrom 4:
Max spasticity, Voluntary movement within synnergy
decreasing spasticity, 1 joint out of synnergy
43
Brunstrom 5:
Brunstrom 6:
Brunstrom 7:
2 joints out of synnergy
No more spasticity, movements are slowed
Normal
44
Sequence of inhibiting the hand:
Spread the metacarpals
Extend IP
Extend MCP
Extend Wrist
45
Sequence of mobilizing hand
Mobilizing metacarpals (one at a time) ->
Mobilizing carpals (flexion/ext of wrist) ->
Mobilizing Distal forearm (pronation/supination)
46
What area of the brain is damaged w pusher syndrome
Posterolateral thalamus
47
What syndromes are most common w/ pusher syndrome
Aphasia and neglect
48
At what age do you use the Child SCAT6 instead of the SCAT6
12 and under
49
What is the difference between the SCAT6 and the CRT6
SCAT6 - medical professionals
CRT6- meant for non-medical professionals
50
T or F: Training postural control has carry over to balance
F
51
Pt has eye closed and we put their feet on foam, what sensory system are we focusing on
Vestib
52
How to work on hip strategy for patients
Do balance activities with restricted ankle motion/ put feet in line w/ eachother
53
Pt cannot interact with world around them
example: pt cannot eat dinner with family
Participation restriction
54
Pt cannot participation in certain activities
example: cannot climb stairs
Activity restriction
55
What exercises are for temporarily decreasing dysmetria
Frenkel exercises:
-Starts with doing heel slides on mat
(Progression: Supine -> Sitting -> Standing)
56
What can help patients with dysmetria in LE (to walk)
Using therabands to apply compression/approximation from their legs to their body
NOT USING ANKLE WEIGHTS
note: Pt might not be able to wear it all day as they cant go to the bathroom
57
6 stages of the transtheoretical model
Pre-contemplation- you don't think there's a problem
contemplation- acknowledge problem
preparation- want to change within 30 days
action
maintenances- Made behavior modifications for over 6 months
relapse
58
Tardieu Scale R1 vs R2
R1: ROM Up to their first catch
R2: Full PROM
59
HO can only affect where?
BELOW level of lesion
for TBI it can be anywhere
for SCI it has to be below the level
Example T5 Spinal cord injury will not have HO in arms
60
Neurotomies vs nerve blocks
Neurotomies are permanent
Nerve blocks - temporary
Rhizotomy- only sensory fibers cut
61
Botox contraindications
Pregnancy
Children under 2
Neuromuscular transmission disease (example: Myasthenia Gravis)
Inflammation at site of injection
62
What are the most common places to get a tendon release
disadvantage?
Achilles and hamstring
Does not change the original factor that made the tendon tight
63
Split anterior tibial tendon transfer (SPLATT)
Typically done with an achilles tendon release
they split the Tibialis anterior tendon and attach it to the cuboid to correct foot varus/inversion
64
Pt needs help bringing food to mouth, what PNF pattern helps with this
D1 Flexion
65
If pt needs help reaching for a high shelf, what PNF pattern might help with that
D2 flexion
66
pt needs help reaching cross-body to put on seatbelt, what pnf pattern might help with this?
D1 Flexion
67
Balance training progression
eye head coordination
Orientation to midline
System training
Sitting balance
sit to stand/ transfer
Strategy training
Gait training
HEP
68
What is the #1 social determinant of health
economic stability
69
how much will medicare pay for DME under part B?
80%
70
What will medicare not pay for
anything in the bathroom
a automatic hi-lo bed
71
Wheelchair decision making process
Can they propel a manual wheelchair
Can they propel a light weight wheelchair
Can they use a scooter?
Can they use an automatic wheelchair
72
What device is appropriate for someone that can walk short distances but needs a motorized device for longer distances
scooter
73
Difference between scooter and automatic wheelchair
You can tell the difference by looking at how the seat is connected to the device (if its connected by 1 pole its a scooter)
Also you cannot drive an automobile w/ a scooter
74
who is more likely to have multiple concussions: athletes or military
military
75
Is the SCAT diagnositc for concussions?
no
76
SCAT6 vs SCOAT6 vs CRT6
CRT- sideline assessment by non-medical pro
SCAT- sideline assessment by medical professional
SCOAT- reassessment by medical professional at office visit typically 3+ days later
77
SCAT6/SCOAT6 vs Child SCAT6/SCOAT6
Child SCAT/SCOAT is for ages 5-12
78
Who is more vulnerable to concussions
females
children
elderly
79
Does a concussion require a loss of consciousness
no
80
Mild TBI:
Loss of consciousness:
Alteration of consciousness:
PTA:
GCS:
Mild TBI:
Loss of consciousness: 0-30 mins
Alteration of consciousness: 24 hours
PTA: 24 hours
GCS: 13-15
81
With a concussion imaging is typically ____
normal
82
What is the most common concussion symptom
headache
83
What is the slogan for managing concussions
if in doubt, sit them out
84
player has neck pain after concussion, what do you do?
Spinal precautions and arrange trip to emergency room, that is red flag
84
Player has double vision after concussion, what do you do?
Spinal precautions and arrange trip to emergency room, that is red flag
85
Concussion red flags that indicate you take spinal precautions and send them to ER
Neck pain/tenderness
Double Vision
Weakness/tingling/burning in more than one arm or in the legs
Seizure or increasing Headache
Seizure or convulsion
Loss of consciousness
Deteriorating consciousness
vomiting
increasing restlessness, agitation, aggression
GCS of less than 15
86
with all unconscious athletes it must be assumed that
they have cervical injury
87
Initial advice for concussion
not to be left home alone
no driving
monitored to sleep the first night
no medication
88
return to sport progression for concussion
symptom limited activity -> aerobic exercise -> individual sport specific practice -> noncontact training -> full contact training -> RTS
89
persistent post concussion syndrome is anything over
____ in adults
_______ in children
10-14 days
4 weeks
90
In what order do you typically treat PPCS
Visual -> Cervical -> vestib
but usually start with the main symptom generator
91
contemplation stage: no plan to change within __________
6 months
92
maintenance stage: theyve been consistent for __________
6 months
93
What is considered the primary sign of cerebellar damage
Ataxia
94
Movement decomposition definition
breaking down of a movement sequence or a multijoint movement into a series of separate movements, each simpler than the combined
note: is a compensation strategy for cerebellar problems
94
Ataxia definition
Refers generally to disordered or noncoordinated movements
95
Dysmetria definition
The inability to properly scale movements leading to hypermetria or hypometria
96
Dyssynergia definition
impairment of multijoint
movements, wherein movements of specific segments are not properly sequenced or of the proper range or direction, resulting in uncoordinated multijoint movement
97
Lack of Check definition
inability to rapidly and sufficiently
halt movement of a body part after a strong isometric force, previously resisting movement of the body part, is suddenly released.
98
Cerebellar patients usually have _______ extensor tone for holding themselves up against gravity AKA: ____________
decreased
hypotonia
99
What is the classic cerebellar tremor
Kinetic tremor w/ intention tremor
100
T or F: Cerebellar patients have increased postural sway
T, also refered to as imbalance
101
paragraph describing one of the charts da silva said we need to look at
it has been shown that clients with cerebellar damage and significant balance deficits also typically demonstrate
nearly all the classic features of gait ataxia (i.e., **reduced stride lengths, increased stride widths, reduced joint excursions, abnormal swing foot trajectories, increased variability in foot placement, and joint-joint decomposition**). In contrast, clients with cerebellar damage and significant leg coordination deficits but minimal or no balance deficits typically have very few walking abnormalities (Figure 21-7).101,102
Therefore during typical conditions of level walking, **balance deficits contribute much more strongly to cerebellar gait ataxia** than do leg coordination deficits.
102
occulomotor deficits for cerebellar patients
**Saccades** are often slowed and dysmetric
**Smooth pursuit** maybe “choppy,” referred to as saccadic pursuit, wherein the smooth tracking of a target is degraded into a series of
shorter saccadic movements following behind the target.
The ability to cancel, or suppress, the **VOR** may be impaired or absent Finally, abnormal **nystagmus** may also
be present
103
cerebellar patients have what kind of speech impairment
scanning speech
104
For all cerebellar coordination tests we need to:
repeat multiple times
compare slow vs fast
compare w/ and without vision
compare both sides
105
What is the most important activity limitation to observe for cerebellar patients
gait
106
can motor learning be measured directly?
no
107
What is best for motor learning:
Massed/blocked vs Distributed
Constant vs Variable
Contextual interference?
Physical Guidance?
Mental Practice?
Distributed
Variable
Contextual interference = good
Physical guidance = bad
Mental practice = good
108
Recovery vs Compensation
Compensation is using an alternative strategy to accomplish a task
109
What are the 2 regulatory conditions of a task in motor learning:
**Stationary** - your environment
**Motion**- Supporting surfaces, objects, or people that are in motion
So if the ground is in motion that is a motion regulatory condition
110
What are the categories by which we organize tasks in motor learning?
Body Stability vs Body Transport
Intertrial variability vs not
Motion vs Stationary
Manipulation vs No Manipulation
111
Types of feedback:
Interval:
Ratio:
Bandwidth:
Faded:
Types of feedback:
Interval: Every X mins
Ratio: every X reps
Bandwidth: only if they make a mistake
Faded: less feedback over time
112
Sedentary activity is anything below ____
1.5 METS while sitting, reclining, or lying
113
Contemplation stage means you’re thinking of changing behavior within ____
6 months
114
Precontemplation stage means you have no desire to change behavior within _____
6 months
115
Should health promotion for the disabled focus on their weaknesses or their pre existing strengths
Strength based
116
When does discharge planning start?
At the initial chart review before you even see the patient
117
When measuring the height of an entrance for a wheelchair ramp, do you include the height of the threshold?
Yes
118
Flaccidity in ______ causes downward rotation of scapula
Spasticity in _________ causes downward rotation of scapula
supraspinatus
lats/upper trap
119
What is the diff between PNF d1/d2 Contract relax and hold relax
Contract/relax involves a rotational component (they dont move their arm they just IR/ER their arm at the end range)
120
Is it easier for patients to manipulate bigger or smaller objects
bigger are easier
Exception: Those w/ contractions may need to start w/ smaller
121
Whats the minimum brunstrom for liftoffs
brunstrom 2
122
Whats the minimum brunstrom for reaching activities
4
123
What are the 3 stages of shoulder/hand syndrome
Acute- Diffuse swelling/pain
Dystrophic- no more swelling/pain, muscle atrophy
Atrophic- Deformities of hand/limited articular function
124
Can a patient skip brunnstrom stages?
No
125
You cannot superimpose efficient movement on abnormal postural alignment
You cannot superimpose efficient movement on abnormal postural alignment
You cannot superimpose efficient movement on abnormal postural alignment
**You cannot superimpose efficient movement on abnormal postural alignment**
**You cannot superimpose efficient movement on abnormal postural alignment**
**You cannot superimpose efficient movement on abnormal postural alignment**
126
Principles of neuroplasticity:
Use it or lose it
Use it and improve it
Specificity
Repetition
Intensity
Salience/meaningfulness
Time since onset
Age
Transference
Interference
127
Chronic stroke speeds:
unlimited household ambulation
limited community ambulation
unlimited community ambulation
how fast to cross a busy street?
.27
.58
.8
2.0
128
What kind of footwear should patient wear
As little as possible!
129
What are the 4 things stored in a motor schema
Initial conditions
Parameters of movement pattern
knowledge of results
Sensory consequences of movement
130
A patient has an orthotic that is rubbing their heel, is this likely because the therapist measured them at R1 or R2 by mistake?
They measured at R1 when they were suppose to measure at R2
131
Your patient has the circulation cut off to their legs, what wheelchair measurement did the PT get wrong
Wheelchair depth too long
132
Your patient is developing pressure injuries on the bottom of their legs, what wheelchair measurement did the PT get wrong?
Wheelchair depth too short
133
What percent of the US is living with a disability
25%
134
Socioecological model:
Personal:
Interpersonal:
Institutional:
Community:
Societal:
Personal: the self
Interpersonal: friends, family
Institutional: School, church, work
Community: neighborhood, community
Societal: all of these as a whole
135
What amount of people dont have health insurance in the US
1 in 10
136
Whats generally the biggest obstacle for accessibility in homes?
bathroom!
137
If a person needs a wheelchair just to get to dr appointments and go to the store and be out in their community, do they qualify for a wheelchair under medicare
No, has to be a need WITHIN the home
138
What chair is easier to push, the rigid frame chair or the folding frame chair
rigid
139
will medicare pay for quick release wheels?
No
140
what is the advantage of vinyl coating for a hand rim on a wheelchair
makes it easier to grip
141
What is a desk length arm rest
shorter arm rest so that you can pull up under a desk
142
Measurement of patient dimensions takes place in what position
seated position
143
A patient who needs to propel their wheelchair with their feet needs what wheelchair measurement adjusted
Shortened seat depth
144
If medicare covers a patients wheelchair but they also want a power assist device added on that medicare wont cover, can they get secondary insurance to pay for it?
No, secondary insurance will only pay for expenses covered under medicare
