NPTE

Vex/Cave Rule for capitate, lunate, scaphoid and triquetrum?

Vex=Opp

Loose packed position for GH Joint?

50-70 Deg Abd, 35 Deg Horz Abd

Loose packed position for Humeroulnar joint ?

70 deg flex, 10 deg Sup

Loose packed Position for Proximal Radioulnar Joint?

Full Ext 35 deg Sup

Loose packed Position for Distal Radioulnar Joint?

10 deg sup

Vex/Cave Rule for Navicular, Cuneiform?

Vex=opp

Vex/Cave Rule for Cuboid and Calcaneus?

Cave=Same

Vex/Cave Rule for Talus?

Vex=Opp

Loose packed Position for Hip ?

30 Deg Flex, 30 Deg Abd, Slight ER

Loose packed Position for Talocrural ?

10 Deg PF

Closed Packed Position for Acromioclavicular?

90 Deg Abd

Closed Packed Position for GH

Max Abd and ER

Closed Packed Position for Humeroradial

90 Flex, 5 Deg Sup

Closed Packed Position for Humeroulnar

Max Ext and Sup

Closed Packed Position for Proximal Radioulnar

MAx ext, 5 deg Sup

Closed Packed Position for Distal Radioulnar

5 Deg Sup

Closed Packed Position for Hip

Bone: 90 Flex, Slight Abd and Er
Lig: Max Ext, Abd, IR

Closed Packed Position for Knee

Max ER and Ext

Pathological End Feel: Boggy?

Swelling/Edema

Pathological End Feel: Firm decreased Elasticity?

Soft tissue Fibrosus

Pathological End Feel: Rubbery?

Muscle Spasm

Pathological End Feel: Empty?

Muscle Guarding

Muscle Substitution: Shoulder Abd weak?

Scap Stabilizers

Muscle Substitution: Hip Abductors Weak?

Lat Trunk M. TFL

Muscle Substitution: Finger Flexors Weak?

Tenodesis, Passive Finger Flex with Wrist Ext

Muscle Substitution: Pecs Weak

LOng Head Biceps, Coracobrachialis, Ant Delt

Muscle Substitution: Hip Extensors Weak?

Low Back Extensor, Adductor Magnus, QL

Muscle Substitution: Hip Flexors Weak?

Lower Obliques, Low Abs, Lat Dorsi, Hip Add

Capsular Patterns: OA Joint?

Flex>Ext

Capsular Patterns: AA Joint?

Rotation

Capsular Patterns: GH Joint?

ER>Abd>IR

Capsular Patterns: HU Joint?

Flex>Ext

Capsular Patterns: HR Joint?

Flex>Ext

Capsular Patterns: Thoracic Spine?

Rotation/Sidebending>Ext>Flex

Capsular Patterns: Lumbar Spine?

Rotation/Sidebending/Ext/Flex

Capsular Patterns: Hip?

Flex/IR>Abd

Capsular Patterns: Knee?

Flex>Ext

Capsular Patterns: talocrural?

DF>PF

Capsular Patterns: Subtalar?

INV>EVR

Capsular Patterns:Midtarsal?

Sup>Pro

Grades of Accessory Joint Motion: 0

Ankelosed

Grades of Accessory Joint Motion: 1

Hypomobile

Grades of Accessory Joint Motion: 2

Slightly Hypomobile

Grades of Accessory Joint Motion: 3

Normal

Grades of Accessory Joint Motion: 4

Slightly Hypermobile

Grades of Accessory Joint Motion: 5

Hypermobile

Grades of Accessory Joint Motion: 6

Unstable

Myotomes: C4

Upper Trap/Shld Shrug

Myotomes: C5

Shld Abd/ Delt

Myotomes: C6

ECR and Biceps/ Wrist Ext and Elbow Flexion

Myotomes: C7

Elbow Ext and Wrist Flex/ Triceps

Myotomes: C8

Thumb Ext/ EPL and EPB

Myotomes: T1

Finger Abd/ Interossei

Myotomes: C1-C2

Neck Flex

Myotomes: C3

Neck Lateral Flex

Ligament Function: Coracohumeral Lig

reinforce bicep tendon, prevent caudal dislocation, reinforces superior capsule

Ligament Function: Glenohumeral Lig

Reinforce GH Capsule

GH and Scapulothoracic Rhythm ratio at 180 deg of ABD

2:1

Deg of Movement from GH for ABD
Deg of Movement from Scapthorac for ABD

120 Deg
60 Deg

Requirements for Full Arm elevation

1. Scap Stabilization
2. Inf glide of Humerus
3. ER of humerus
4. Rotation of clavicle at SC joint
5. Scap Abd and ER of Acromion
6. Straightening of thoracic kyphosis

Ligament Function: Ulnar Collateral

reinforces Joint Medially

Ligament Function: Radial Collateral

Reinforces Joint Laterally

Ligament Function: Annular

protects radial head

Blood Supply: Elbow Joint

1. Brachial Artery
2. anterior ulnar Recurrent A
3. Post ulnar Recurrent A.
4. Radial Recurrent A.
5. Middle Collateral branch of deep brachial A.

Innervation: Hypothenar Region, 5th digit and medial half of 4th

Ulnar N.

Innervation: Palmar Lateral 1/2 of 4th and 3rd, 2nd, and 1st digit and Dorsal 2nd, 3rd and lateral 1/2 4th

Median N.

Angle of Inclination of the Hip

115-125

Coxa Valga Angle

>125

Coxa Vara Angle

<115

Normal anterior Antetorsion of the hip

10-15

Excessive Anteversion

>25-30

Excessive Retroversion

<10

Myotomes: L1-L2

Hip Flex/ Illiopsoas

Myotomes: L3

Knee Ext/Quad

Myotomes: L4

Ankle DF/Ant Tib

Myotomes: L5

Great Toe Ext/ EHL

Myotomes: S1

Ankle EVR/ CFL and CFB

Muscle Action: Iliopsoas

Hip Flexion

Muscle Action: Sartorius

Hip Flexion, ER, Hip Abd

Muscle Action: Quads

Knee Ext

Muscle Action: Pectineus

Hip ADD

Muscle Action: Adductor Longus

Hip ADD

Muscle Action: Adductor Brevis

Hip ADD

Muscle Action: Gracilis

Hip ADD

Muscle Action: Glut Med

Hip Flex, Hip IR, Hip ABD

Muscle Action: Glut Min

Hip Flex, Hip IR, Hip ABD

Muscle Action: TFL

Hip Abd, Hip Flex, Hip IR

Muscle Action: Piriformis

Hip ER

Muscle Action:Glut Max

Hip Ext, Hip ER

Muscle Action: Obturator Internus

Hip ER

Muscle Action:Gemelli

Hip ER

Muscle Action:Biceps Femoris

Knee Flex, Hip Ext, Leg ER

Muscle Action:Semitendenosus

Knee Flex, Hip Ext

Muscle Action: Semimebranosus

Leg ER

Muscle Action: Ant Tib

Ankle DF

Muscle Action: EDL

2-5 toe Extension

Muscle Action: EHL

Great Toe Ext

Muscle Action: Peroneous Longus/Brevis

Ankle EVR

Muscle Action:Popletitus

Leg IR

Muscle Action:Tib Post

Ankle INV

Muscle Action: Gastroc/Soleus

Ankle PF

Muscle Action:FDL

2-5 DIP Toe Flex

Muscle Action: FHL

Great IP Flex

Muscle Action:Dorsal Interossei

Toe ADD

Muscle Action:Plantar Interossei

Toe ABD

Muscle Action: FDB

2-5 PIP Toe Flex

Pathology: Aggravation of Ischiofemoral Bursa can cause pain in what nerve distribution?

Sciatic

Pathology: What motion can aggravate the Deep trochanteric bursa

Hip Flex and Hip IR

Blood Supply: Proximal Femur

Medial and Lateral Femoral Circumflex A.

Blood Supply: Femoral Head

Branch of Obturator A.

Blood Supply: Acetabulum

Branch of INF/SUP Gluteal A.

Gait: Normal ROM For the knee

15 Deg

Blood Supply of the Ankle

Deep Tibial and Fibular A.

Muscle Action: Diaphragm

Inspiration

Muscle Action: External Intercostals

inspiration

Muscle Action: Ant Interior Intercostals

Inspiration

Muscle Action: Internal obliques

Forced Expiration, Spine Flex, Spine Rot

Muscle Action: Transverse Abs

Forced Expiration

Muscle Action: External Obliques

Forced Expiration, Spine Flex, Spine Rot

Muscle Action: Post Int Intercostals

Forced Expiration

Muscle Action:Rectus Abdominus

Forced Expiration, Spine Flex

Muscle Action: Erector Spinae

Spine Extension

Muscle Action: Travsversospinalis

Spine Extension, Spine Rot

Muscle Action: Interspinals

Spine Extension

Muscle Action: Rotatores intertransversarii

Spine Extension, Spine Rot

Muscle Action: Psoas Minor

Spine Flex

Muscle Action: QL

Spine Lateral Flex

Muscle Action: Rotators

Spine Rot

Spinal Nerves: Innervate Structures on Post Trunk

Dorsal Rami

Spinal Nerves: Form cervical and brachial plexus

Cervical Ventral Rami

Spinal Nerves: Innervates anterior structures in thoracic region

Thoracic Ventral Rami

Spinal Nerves: vorm Lumbar and lumbosacral plexus

Lumbar Ventral Rami

Spinal Nerves: Spinal Cord Ends at what section of the Spine

L1-L2

ROM: TMJ Opening

40mm

Symptoms: 1) Px and Stiffness upon rising 2) Px eases through Morning 3) Px Increases w/ repetitive bending activities 4) constant discomfort with exacerbation 5) Sore nagging Px

DJD/OA

Symptoms: 1) Stiff upon rising 2) Px eases within an hour 3) Loss of Motion with px 4) Sharp pain with certain movements 5)movement in px free Range reduces symptoms 6) Stationary increase symptoms

Facet joint Dysfunction

Symptoms: No px in reclined or semi-reclined position 2) px increases in WB activities 3) Shooting , burning, stabbing px 4) altered strength inability to perform ADLs

Discal with Nerve Root Compromise

Symptoms: 1) Px related to position 2) Flexed position decrease px 3) ext positions increase px 4) numbness, tightness or cramping 5) walking increase px 6)px last for hours after quitting activity

Spinal Stenosis

Symptoms: Px is constant in all spinal positions 2) px increases with physical exertion 3) px relived promptly by rest 4) numbness 5) decreased or absent pulses

Vascular Claudication

Symptoms: gnawing, intense , penetrating px 2) px not resolved by changes in position, time of day or activity level 3) px will wake pt

Neoplastic Disease

ROM: Shld 1) Flex/EXT 2) ABD/ADD 3) ER/IR 4) Horz ADD

1) 160-180/50-60 2) 170-180/50-75 3) 80-90/60-100 4) 130

ROM: Elbow 1) FLEX/Ext 2) Sup/Pro

1) 140-150/0-10 2) 90/90-90

ROM: wrist 1) Flex/ext 2) Radial/Ulnar

1) 80-90/70-90 2) 15/30-45

ROM: Hip 1) Flex/EXT 2) ABD/ADD 3) ER/IR

1) 110-120/10-15 2) 30-50/30 3) 40-60/30-40

ROM: knee 1) Flex/EXT 2) ER/IR

1) 135/0-15 2) 30-40/20-30

ROM: Ankle 1) Sup/Pro 2) PF/DF

1) 45-60/15-30 2) 50/20

Diagnostic Imaging: Used for complex fractures, facet dysfunction, disc disease or spinal stenosis

CT Scan

Diagnostic Imaging: Images are multi-planar and tissues can be viewed from multiple angles

CT Scan

Diagnostic Imaging: Radiopaque Dye Injected into disc to id abnormalities

Discography

Diagnostic Imaging: demonstrates fat within the structures and assess bony anatomy

T1 MRI

Diagnostic Imaging: Suppresses fat and demonstrates tissues with high water content

T2 MRI

Diagnostic Imaging: assess soft tissue structures

T2 MRI

Diagnostic Imaging: Water soluble dye is injected into area and observed with radiograph

Arthrography

Diagnostic Imaging: Demonstrates where fluid moves within a joint

Arthrography

Diagnostic Imaging: Used to ID abnormalities within a joint such as tendon ruptures

Arthrography

Diagnostic Imaging: Injected radioactive tracer settle in areas where bone is highly metabolic

Bone Scan

Diagnostic Imaging: Used to assess pts with possible RA, stress fractures, bone CA, or bone infection

Bone Scan

Special Tests: 1) Pt sitting with shld in neutral stabilized against trunk, elbow at 90 degrees and arm supinated 2) Resistance applied to forearm supination and Shld ER

Yergason's Test

Special Tests: Positive test for Yergason's

1) biceps long head will pop out of groove or 2) px in long head of biceps

Special Tests: IDs Bicipital Tendonitis

Speed's Test

Special Tests: 1) upper limb in full extension and forearm supinated 2) resisted shld flex

Speed's Test

Special Tests: Positive Test for Speed's

reproduction of Px in long head biceps tendon

Special Tests: Impingement of long head of biceps and supraspinatus tendon

Neer's Impingement Test

Special Tests: Pt sitting and shld is passively IR then fully abducted

Neer's Impingement Test

Special Tests: Positive test for Neer's

Reproduces Px in shld region

Special Tests: ID tear and/o impingement of supraspinatus tendon and possible suprascapular N. pathology

Supraspinatus Test/Empty Ca

Special Tests: 1) Pt sitting with shld at 90 deg and no rotation 3) Resist shld abd 4) Then place shld in IR and 30 deg of horz add 5) resist shld abd

Supraspinatus Test

Special Tests: Positive sign for supraspinatus test

Reproduces px in supraspinatus tendon or weakness in empty can position

Special Tests: IDs tear and/or rupture of the RTC

Drop arm test

Special Tests: 1) Pt sitting with shld passively abd to 120 deg 2) Pt instructed to slowly lower arm

Drop arm test

Special Tests: + drop arm test

unable to lower arm

Special Tests: IDs impingement between RTC and Greater tuberosity or post glenoid and labrum

Post internal impingement test

Special Tests: 1) Pt supine 2) arm moved into 90 deg of abd, max ER and 15 deg of horz abd

Post internal impingement test

Special Tests: + post internal impingement test

reproduction of pain

Special Tests: IDs glenoid labrum tear

Clunk test

Special Tests: 1) Pt supine 2) shld max abd 3) push humeral head ant while rot humerus externally

Clunk test

Special Tests: + clunk test

clunk heard

Special Tests: IDs past ant shld dislocation

Ant apprehension sign

Special Tests: 1) Pt supine 2) Shld 90 deg abd 3) slowly ER shld

Ant Apprehension sign

Special Tests: + ant apprehension test

pt does not allow or does not like shld being moved like that

Special Tests: IDs pathology of structures that pass through thoracic inlet

Adson's test

Special Tests: 1) Pt sitting 2) find radial pulse of extremity being tested 3) rotate head toward tested side 4) extend and ER shld while extending head

Adson's Test

Special Tests:+ Adson's test

Neuro or vascular symptoms will be reproduced

Special Tests: 1) Pt sitting 2) Find radial pulse 3) move extremity down and back

Costoclavicular Syndrome Test

Special Tests: + Costoclavicular Test

Nuero or vascular symptoms will be produced

Special Tests: 1) pt sitting 2) Find radial pulse 3) move shld into max abd and er 4) pt take deep breath and rotates head to opposite side

Wright's Test

Special Tests: + wright test

Produces neuro and vascular symptoms

Special Tests: 1) Pt standing 2) shlds fully ER , 90 deg abd, and slight horz abd 3) elbows 90 deg flex 4) pt open closes hand for 3 min

Roos test

Special Tests: + Roos test

produces neuro and vascualr symptoms

Special Tests: Evaluation of median N and ant interosseous N (C5, C6, C7)

ULTT 1

Special Tests: Evaluation of Musculocutaneous N. Median N. and Axillary N.

ULTT2

Special Tests: Evaluation of Radial N.

ULTT 3

Special Tests: Evaluation of ulnar N C8, and T1

ULTT 4

Special Tests:IDs Tennis elbow (lat epicondylitis )

LAt epicondylitis Test

Special Tests: 1) pt sitting 2) elbow and 90 deg 3) resist wrist ext with RD and forearm PRO

lat epicondylitis test

Special Tests: + lat epicondylitis test

px in lateral epicondyle

Special Tests: 1) Pt sitting 2) elbow 90 deg flex 3) passive sup of forearm 4) extend elbow 5) extend wrist

Golfer's Elbow test (medial epicondyle test)

Special Tests: IDs dysfunction of ulnar n at olecranon

Tinel's Sign

Which N is trapped if performing a pronator teres test

Median Nerve

Special Tests: IDs deQuervain's Tenosynivitis

Finklestein's Test

Pathology: Paratendonitis of the abd pollicis longus and/or brevis

deQuervain's Tenosynovitis

Special Tests: 1) Pt make fist 2) Passively moves wrist into Ulnar Deviation

Finklestein's Test

Special Tests: IDs ulnar nerve dysfunction in the hand

Froment's Sign

Special Tests: 1) Pt grasps paper between 1st and 2nd digits 2) PT pulls paper out and looks for IP flexion of thumb

Froment's Sign

Special Tests: + sign for Froment's Test

IP flexion of the thump due to compensation of add pollicis weakness

Special Tests: IDs compression of the Median N. in the carpal tunnel

Tinnel's Sign or Phalen's Test

Special Tests: Pt max flexes both wrist holding them against each other for 1 min

Phalen's Test

Special Tests: Normal amount of distance that can normal be detected during two point discrimination test

<6mm

Special Tests: IDs hip dysfunction and mobility restriction

FABER Test

Special Tests: 1) Pt lies supine 2) Passively felx, abduct and ER leg so that foot is resting above knee of opp leg 3) Lower leg down to table

FABER test

Special Tests: + sign for FABERs Test

Unable to assume relaxed Position

Special Tests: IDs DJD of Hip

Grind Test

Special Tests: 1) Pts supine with hip in 90 deg flex and knee max flex 2) PT places compressive load into femur

Grind Test

Special Tests: IDs weakness of Glut Med or unstable Hip

Trendelenberg's Sign

Special Tests: Special Tests: + Trendelenberg's Sign

Ipsilateral pelvis drops

Special Tests: + 90-90 Hamstring Test

Unable to reach 10 deg from full extension

Special Tests: 1) Pt supine with foot of test leg passively placed lat to opposite knee 2) Test hip is add

Piriformis Test

Special Tests: IDs abnormal femoral ante-torsion angle

Craig's Test

Special Tests: Normal angle based on Craig's Test

8-15 deg

Special Tests: Indication of a retroverted hip

<8 deg

Special Tests: Deg of an anteverted hip

>15 deg

Special Tests: Indicates ACL integrity

Lachman's and Pivot Shift

Special Tests: 1) Pt supine with knee in extension, hip flexed and Abd to 30 deg 2) Place valgus force and flex knee

Pivot Shift

Special Tests:+ sign for pivot shift

tibia relocates during test

Special Tests: IDs meniscal tear

Mc Murray's Test

Special Tests: 1) Pt supine with knee in max flex 2) Passively IR and Extend knee

Mc Murray's Test (Lateral Menisci)

Special Tests: 1) Pt supine with knee in max flex 2) Passively ER and Extend knee

Mc Murray's test ( Medial Menisci)

Special Tests: + finding of Mc Murray's Test

Click or px in knee joint

Special Tests: Helps differentiate between Meniscus tear and ligamentous Lesions

Apply's Test

Special Tests:+ Sign of Apply's test if Meniscus Problem

Pain or decreased motion during compression

Special Tests: + Sign of Apply's if Ligament problem

Pain or decreased motion during distraction

Special Tests: IDs patellofemoral Dysfunction

Clark's Sign

Special Tests: Pt Supine with knee in extension 2) Push Post on Sup pole 3) Ask pt to perform active quad contraction

Clark's Sign

Special Tests: Indicate infrapatellar effusion

Patellar Tap Test

Special Tests:+ Patellar tap Test

perception of patella floating

Special Tests: Indicates Knee joint effusion

Fluctuation Test

Special Tests: 1) pt supine with knee in extension 2) Place one hand on suprapatellar pouch 3) Place other hand on ant aspect of joint line 4) alternate pushing down with one hand at a time

Flucuation Test

Special Tests: + Sign for fluctuation test

movement of fluid

Special Test: Anterior Drawer test IDs instability in which ligament?

ATFL

Special Tests: Talar Tilt IDs instability in which lig if moved into ADD

CFL

Special Tests: Talar Tilt IDs instability in which lig if moved into ABD

Deltoid Lig

Special Test: Procedure for Vertebral Art Test

1) Ext head 2) Extend Head With Rot to LEft then to Right 3) Head extended off table 4) Head extended off table with rot to left then right

Special Test: Differentiates between vascular vs. vestibular causes of Vertigo

Hautant's Test

Special Test: Vestibular procedure for Hautant's Test

1) 1) Pt sitting 2) shlds at 90 deg with palms up 3) have pt close eyes for 30 sec

Special Test: Vascular procedure for Hautant's Test

1) Pt sitting 2) shoulders at 90 deg with palms up 3) have pt close eyes 4) cue pt into head extension with rot to left and right

Special Test: Procedure for slump test

1) Pt slump sits at edge of table 2) Passive flex of pt head 3) Passive ext of one knee 4) Passive DF of ankle

Gait: division of Stance Phase

1) initial contact 2) Foot Flat 3) Midstance 4) Heel off 5) Preswing

Gait: heel strikes ground and limb prepares to accept GRF

Initial Contact

Gait: limb is loaded

Foot Flat

Gait: foot fully flat and trunk aligned over stance limb

midstance

Gait: wt distribution shifts from entire foot to forefoot

Heel off

gait: toe takes on final contact, force is accelerated to provide momentum for propulsion

Preswing

Gait: Divisions of Swing Phase

1) initial swing 2) mid swing 3) terminal Swing

gait: Foot loses contact with ground and accelerates fwd

Initial swing

gait: limb transitions from acceleration to deceleration

Mid swing

Gait: limb decelerates and prepares for foot strike

terminal swing

Gait: Hip ROM

0-30 of Flex 0-10 deg of ext

Gait: Phases of gait that requires 30 deg of hip flex

1) mid Swing 2) terminal swing 3) initial contact 4) foot flat

Gait: Phases of gait that requires 10 deg of hip ext

Terminal Stance

Gait: Knee ROM

0-60deg of flex

Gait: Phases of gait that require 60 deg of knee flex

1) initial swing

Gait: Ankle ROM

1) 0-10 deg of DF 2) 0-20 deg PF

Gait: Phases of gait that requires 10 deg of DF

Midstance

Gait: Phases of gait that requires 20 deg of PF

Preswing

MS Pathology:1) AM Stiffness 2) Male > women 3) Bil Si px refers to post thigh 4) Restricted AROM and PROM

Ankylosing Spondylosis

MS Pathology: 1) Chronic, erosive inflammatory disorder 2) occurs in joins of digits and axial skeleton

Psoriatic Arthritis

MS Pathology: 1) Pain referral 2) px with hyperextension and rot 3) spine stiffness 4) M. Spasm

Facet Syndrome

MS Pathology: 1) Pain Referral 2) Pain with hyperextension and Rot of the Neck 3) Parathesis 4) M. Spasms 5) (+) tension test

Cervical N Root

MS Pathology: Symmetrical pattern of dysfunction in synovial tissues and articular cartilage 2) ulnar drift 3) volar subluxation

RA

MS Pathology: 1) Decalcification of bone due to Vit D deficiency

Osteomalacia

MS Pathology: 1) Congenital deformity of skeleton and ST 2) limited joint motion 3) sausage like appearance of limbs

Arthrogryposis Multiplex Congenita

MS Pathology: 1) Abnormal collagen synthesis 2) imbalance between bone deposition and reabsorbtion 3) Bone become very weak and thin

Osteogenesis Imperfecta

MS Pathology: Separation of articular cartilage from bone 2) usually involve medial femoral condyle

osteochondritis dissecans

MS Pathology: 1) Precipitated by direct trauma resulting in hematoma and calcification of muscle belly 2) also be induced by early mobilization, stretching and aggressive PT after Muscle trauma

Myositis Ossificans

MS Pathology: 1) dysfunction of sympathetic Nervous system 2) triggered by tissue injury

CRPS type I

MS Pathology: 1) Dysfunction of Sympathetic nervous system 2) associated with Nerve injury

CRPS II

MS Pathology: 1) Metabolic bone disease with abnormal osteoclastic and osteoblastic activity 2) Results in Spinal Stenosis 3) Facet arthropathy 4) Spinal Fractures

Paget's Disease

MS Pathology: Deg of structural Scoliosis where conservative treatment can be done

<25 deg

MS Pathology: Deg of structural Scoliosis where spinal orthosis must be worn

25-45 deg

MS Pathology: Deg of structural Scoliosis where surgical treatment is performed

>45 deg

MS Pathology: Most shld dislocation occur in what direction

Ant and inf direction

MS Pathology: Cause of ANt-inf shld dislocation

abd UE is forced into ER

MS Pathology: Cause of Post Shld Dislocation

HORZ ADD shld is forced into IR

MS Pathology: Results of Shld Dislocation

1) Compression fx (hill-sachs lesion) 2) Tearing of the superior glenoid labrum from ant to post ( SLAP lesion) 3) avulsion of antinf capsule and ligs associated with glenoid rim (Bankart Lesion) 4) bruising of axillary N.

MS Pathology: 1)Tear of the glenoid labrum below the middle of the glenoid socket 2) involves the inf GH lig

Bankhart Lesion

MS Pathology: 1) Shld pain which can not be localized to specific point 2) Px made worse by overhead activities 3) Weakness 4) Instability in Shld 5) Px on resisted elbow flex 6) tenderness in front of shld

Labral Tear

MS PT Outcomes: Length of time that a pt with instability or labral tear is in a sling

3-4 weeks

MS PT Outcomes: When an instability or labrum tear pt can begin sport related activities

6 week S/p

MS PT Outcome: Time it takes a labral tear or instability pt to fully recover

3-4 months

MS Pathology: Common area of compression for TOS

1) Sup Thoracic outlet 2) Scalene triangle 3) B/T clavicle and first rib 4) B/T pec minor and thoracic wall

Special Tests: Tests for TOS

1) Adson's 2) Roo's 3) Wright's 4) Costaclavicular

Special Tests: Test for AC or SC disorders

1) Shear Test

Special Tests: Tests for RC tendonitis

1) Supraspinatus test 2) Neer's Test

Precautions: After Surgical repair for shld impingement pts should avoid _____?

Shld Elevation of greater than 90deg

MS Pathology: 1) 30-50 YO 2) Px and weaknees after eccentric load 3) Weakness in Abd/ROT 4) (+) drop arm test 5) (+) empty can test 6) Tender of RC

Rotator Cuff Lesion

MS Pathology: 1)45+YO 2) Restriction of ER, ABD, IR 3) Not pxful unless capsule is stretched

Frozen Shld

MS Pathology: 1) 10-35 YO 2) Px and instability with activity 3) Full or Excessive ROM 4) (+) load and Shift Test 5) (+) apprehension test 6) (+) relocation test 7) Ant or Post Px

Atraumatic Instability

MS Pathology: 1) 50+ YO 2) min or no cervical spine movement 3) (+) spirlings test 4) (+) Distraction Test 5) (+) ULTT 6) (+) Shld Abd test 7) Dermatomes Affected 8) Reflexes Affected 9) Teder over vertebrae

Cervical Spondylosis

MS Pathology: Inflammation of ECRB

tennis Elbow

MS Pathology: inflammation of pronator teres and FCR tendons

golfers Elbow

MS Pathology Nerves: 1) inability to Abd shld to 90 Deg 2) px in shld on abd

Spinal Accessory N

MS Pathology Nerves: 1) Px on flex fully ext arm 2) inability to flex fully ext arm 3) winging starts and 90 deg Fwd Flex

Long Thoracic N

MS Pathology Nerves: 1) increased px on FWD shld flex 2) Shld Weakness 3) Px increases with scapular abd 4) Pain increases with cervical rot to opp side

Suprascapular N.

MS Pathology Nerves: 1) inability to abd with neutral rot

Axilary N.

MS Pathology Nerves: Weak elbow flex with froearm sup

musculocutaneous n

MS Pathology: 1) Medial elbow px 2) paresthesia to 5th and medial 4th digit

ulnar N entrapment

MS Pathology: Causes of Ulnar N Entrapment

1) Direct Trauma to cubital tunnel 2) traction of ulnar N 3) Compression due to thickened retinaculum 4) hypertrophy of FCU M.

MS Pathology: 1) Repetitive gripping activities 2) aching pain and weakness in forearm M. 3) paresthesia in 1-4 palmar digits

Median N entrapment

MS Pathology: 1) lat elbow Px 2) px over supinator M. 3) parathesis in dorsal side digits 1-4

Radial N entrapment

MS Pathology: 1) most common wrist fx

Colles Fx

MS Pathology: Complication of Colles Fx

1) loss of motion 2) decreased grip strength 3) CRPS 4) CTS

MS Pathology: Femoral Anterversion causes what stance abnormalities

1) squinting Patella 2) toeing in

Special Tests: Used do determine Hip Anteversion

Craig's Test

Coxavara angle

<115 deg

Coxavalga Angle

>125

MS Pathology: Causes of Piriformis syndrome

Excessive pronation of the foot

MS Pathology: Structures involved in unhappy triad

1) MCL 2) ACL 3) Medial Meniscus

MS Pathology: Malalignment in which patella tracks superiorly in femoral intercondylar notch 2) (+) camel back sign

Patella Alta

MS Pathology: Malalignment in which patella track inferiorly 2) Restricted knee extension with abnormal cartiliginous wearing

patella Baja

MS Pathology: Excessive medial tibial torsion 2) Medial patellar Positioning 3) pigeon toe

Genu Varum

MS Pathology: Excessive lateral tibial torsion 2) Excessive lateral patellar positioning

genu valgum

MS Pathology: etiologies of Shin Splints

1) Abnormal biomechanic alignment 2) Poor Conditioning 3) improper Training Methods

MS Pathology: Entire Fracture of the epiphysis

Salter Harris FX type I

MS Pathology: Entire Fracture of the epiphysis and portion of the m
etaphysis

SALTER HARRIS TYPE II

MS Pathology: Fracture of only a portion of the epiphysis

Salter Harris Type III

MS Pathology: Fracture of a portion of the epiphysis and metaphysis

Salter Harris Type IV

MS Pathology: Compression injury of the epiphyseal plate

Salter Harris Type V

MS Pathology: 1) fracture of the pars interarticularis 2) (+) scotty dog in oblique xray view

Spondylolysis

MS Pathology: 1) ant or post slippage of the vertebra following bilateral fracture of pars interarticularis

Spondylolisthesis

MS Pathology:1) bil px and paresthesia in back 2) px decreases with spinal flexion and increases with extension 3) pain increases with walking 4) px relieved with prolonged rest

Spinal Stenosis

PT Treatment: Position to optimize gapping to improve Left posterlateral lumbar disc herniation

1) Right side lying with pillow under trunk 2) Flex both hips and knees 3) Rotate trunk to left

Special Tests: To ID SIJ Dysfunction

1) Gillet's Test 2) Ipsilateral ant rotation test 3) Gaenslen's Test 4) Long Sitting Test 5) Goldthwait's Test

MS Pathology: 1)pain in back that is unvarying and progressive 2) not relieved by rest 3) more pronounced at night

Bone Tumors

MS Pathology: 1) pain radiating to back 2) pain with swallowing 3) dysphagia 4) weight loss

esophageal CA

MS Pathology: deep gnawing pain that radiates from chest to back

pancreatic CA

PT Interventions: Acute Phase

1) immobilization for 1-2 days 2) Control inflammatory response 3) Grade I/II Joint oscillations 3) 40-60% of ORM TE 4) Assisted movement with injured tissue

PT Interventions: Subacute Phase

1) Joint Mobilization 2) TE 3) Postural Education 4) Biomechanical education

PT Interventions: Functional Restoration Phase

1) Return to optimal level of pt function 2) normalize flexibility 3) Restore loading capacity of connective tissue to normal strength 4) Functional Strengthening exercises 5) Functional Stabilization exercises for the joint

PT Interventions: Contraindications to Soft tissue techniques

1) ST breakdown 2) infection 3) Cellulitis 4) inflammation 5) neoplasm 6) Hyper mobility 7) sensitivity

PT Interventions: Used to initiate an acute inflammatory response for a tissue with tendonosis

Transverse friction massage

PT Interventions: oscillations of small amplitude at the beginning of joint play

Grade 1 Jt

PT Interventions: oscillations are large in amplitude and at the midrange of joint play

Grade II JT

PT Interventions: Oscillations are large in amplitude and at the end range of joint play

Grade III JT

PT Interventions: Oscillations are small in amplitude and at the end of joint play

Grade IV JT

PT Interventions: High velocity and low amplitude at the end of joint play

Grade V JT

PT Interventions: Used to regain normal joint mechanics as well as decrease pain and muscle guarding

Grade V

PT Interventions: Contraindication for joint manipulations/ joint mobilization/ joint oscillation

1) joint ankylosing 2) malignancy involving bone 3) disease that affect integrity of ligs 4) arterial insufficiency 5) active inflammatory of infective process 6) DJD 7) metabolic bone disease 8) hypermobility 9) Joint replacement 10) pregnancy 11) spondy

Pharmacology: Prescribed for pain relief for MusculoSkeletal dysfunction

NSAIDS

Pharmacology: 1) ibuprofen (Motrin) 2) naproxen sodium (aleve) 3) salsalate (discaled) 4) indomethacin (indocin)

NSAIDS

Pharmacology: Side effects to NSAIDS

1) GI irritation 2) fluid retention 3) renal or liver problems 4) prolonged bleeding

Pharmacology: Commonly prescribed for skeletal muscle spasm

muscle relaxants

Pharmacology: 1) cyclobenzprine HCL (Flexeril) 2) methocarbamol (Robaxin) 3) carisoprodol (soma)

muscle relaxants

Pharmacology: side affect of muscle relaxants

1) drowsiness 2) lethargy 3) ataxia 4) decreased alertness

Special Test: Test to ID maligering pts with LBP

1) hoover 2) Burn's 3) Waddell's

radiology : 1) air is black 2) Fat is absent 3) Bone is white

xray

radiology: 1) air is black 2) Fat is black 3) bone is white 4) bone marrow is gray

CT scan

Radiology: 1) Air is black 2) Fat is white 3) Bone is black 4) bone Marrow is white

T1 MRI

radiology: 1) air is black 2) fat is gray 3) bone is black 4) bone marrow is gray

T2 MRI

Brain: primary motor cortex located in the frontal lobe

Precentral Gyrus

Brain: Controls emotions and judgement located in the frontal lobe

Precentral cortex

Brain:Controls motor aspects of speech located in frontal lobe

Brocca's area

Brain: Primary sensory cortex for integration of sensation located in parietal lobe

postcentral gyrus

Brain: Receives fibers that convey touch, proprioception, pain, and temperature sensation from opposite side of body

Parietal Lobe

Brain: receives/processes auditory stimuli located in temporal lobe

primary auditory cortex

Brain: language comprehension located in temporal lobe

Wernicke's Area

Brain: receives/processes visual stimuli located in occipital lobe

primary visual cortex

Brain: basic functions include feeding, aggression, emotions, and sexual response

Limbic System

Brain: Functions with saccadic Eye Movements found within the basal ganglia

Occulomotor circuit ( caudate loop)

Brain: Functions to scale amplitude and velocity of movements, reinforces selected patterns, suppresses conflicting patterns, prepares for movement located within the basal ganglia

Skeletomotor Circuit (putamen loop)

Brain: integrate and relay sensory information from body, face retina, cochlea and tongue to cerebral cortex and found in the Dienscephalon

Sensory Nuclei of the thalamus

Brain: Relays motor information from cerebellum and globus pallidus to pre-central gyrus located in the diencephalon

Motor Nuclei of the Thalamus

Brain: Control of sensory, motor and reticular pathways located in the Diencephalon

Subthalamus

Brain: Maintains body homeostasis: regulates body temperature eating, water balance, sexual behavior ant pituitary located in the diencephalon

Hypothalamus

Brain: secretes hormones that influence the pituitary gland and circadian rhythm

pineal gland

Brain: Origin of the rubrospinal tract, important for in coordination and contains CN oculomotor and trochlear. located midbrain of the Brain stem

Red nucleus

Brain: Important for motor control and muscle tone located in the midbrain of the brainstem

Substantia nigra

Brain: contains abducens trigeminal, facial, vestibulocochlea

pons

Brain: Important for voluntary movement, contains and important centers for cardiac, respiratory and vasomotor function. located in the brainstem

Medulla Oblongata

Brain:connects with the vestibular system, helps with equilibrium and regulation of muscle tone, coordination of smooth muscle movements

cerebellum

Spinal Cord: contains efferent (motor) neurons

Anterior horn

Spinal Cord: Neurons that effect muscles

Alpha Motor neurons

Spinal Cord: Neurons that effect muscle spindles

Gamma motor Neurons

Spinal Cord: Contains afferent (sensory) neurons

Posterior Horn

Spinal Cord: convey sensations of proprioception, vibration and tactile discrimination

Dorsal Columns

Spinal Cord: Dorsal column pathway that convey sensations of proprioception, vibration and tactile discrimination for the UE

Fasciculus Cuneatus

Spinal Cord: Dorsal column pathway that convey sensations of proprioception, vibration and tactile discrimination for the LE

Fasciculus Gracilis

Spinal Cord: convey sensations of pain and temperature

Lateral Spinothalamic Tract

Spinal Cord: convey sensations of crude touch

Ant Spinothalamic tract

Spinal Cord: conveys proprioception information from M. spindles, golgi tendon organs, and touch and pressure receptors

Spinocerebellar tract

Spinal Cord: conveys deep and chronic pain

Spinoreticular Tract

Spinal Cord: voluntary motor control that arise from the primary motor cortex

corticospinal tract

Spinal Cord: important for control of muscle tone, antigravity M. and postural reflexes

Vestibulospinal Tract

Spinal Cord: Assists in motor function arising from the red nucleus

Rubrospinal Tract

Spinal Cord: Modifies transmission of sensation and influences gamma motor neurons and spinal reflexes

Reticulospinal System

Spinal Cord: Assists in head turning responses and visual stimuli

Tectospinal tract

Spinal Cord: innervations of the smooth M. heart, glands, and helps maintains homeostasis

ANS

Spinal Cord: Prepares body for flight or fight response, increases heart rate and BP, constricts peripheral blood vessels and redistributes blood

Sympathetic ANS

Spinal Cord: Conserves and restores homeostasis, slows HR and reduces BP, increases peristalisis and gladular activity

Parasympathetic ANS

Meninges: Outer, tough fibrous, attached to inner surface of cranium

Dura Matter

Meninges: Delicate, vascular membrane

Arachnoid

Meninges: formed by arachnoid and pia matter, contains CSF and cisterns

Subarachnoid Space

Meninges: thin vascular membrane that covers the brain surface

Pia Matter

Neurons: Large, myelinated fast conduction

A fibers

Neurons: Proprioceptive, somatic a fibers

Alpha Fibers

Neurons: Touch pressure A fibers

Beta Fibers

Neurons: motor to muscle spindle A fibers

Gamma Gibers

Neurons: pain, temperature, touch A fibers

Delta Fibers

Neurons: small, myelinated preganglionic fibers

B fibers

Neurons: Small unmyelinated and slow conducting

C fibers

Neurons: Pain, reflex response C fibers

Dorsal Root

Cranial Nerves: Pure Sensory CN

I, II, VIII

Cranial Nerves: Pure Motor CN

III, IV, VI, XI, XII

Cranial Nerves: CN I Function and Name

Smell and Olfactory

Cranial Nerves: CN II (Optic) Function

Vision and pupillary Reflexes

Cranial Nerves: Test for CN II

1) Snelling Eye Test 2) peripheral vision 3) Shinning a light in eye

Cranial Nerves: CN III (Oculomotor) Function

Pupillary Reflex, turns eye up, down and in and elevates eyelid

Cranial Nerves: CN III Test

Shining a light in eye, ocular movements

Cranial Nerves: CN IV (trochlear) Function

turn add eye down

Cranial Nerves: CN IV test

pursuit eye movement

Cranial Nerves: CN VI (abducens) Function

Turns Eye out

Cranial Nerves: CN VI Test

observes position of eye and pursuit movement

Cranial Nerves: CN V (Trigeminal) Function

sensory to face and cornea and motor to temporal and masseter muscles

Cranial Nerves: CN V test

feeling of pain, light touch on forehead cheeks and jaw, the corneal reflex and have pt clench teeth

Cranial Nerves: VII (Facial) Function

Facial Expression

Cranial Nerves: CN VII Test

raise eyebrows, frown, show teeth, smile

Cranial Nerves: CN VIII (Vestibulocochlear) Function

Vestibular Function, VOR, Cochlear

Cranial Nerves: CN VIII Test

Balance, gaze instability with head rotation, Auditory acuity, webers test and rinnes test

CN Test: Test for auditory lateralization. place vibrating tuning fork on top of head and check to see if sound is heard equally in both ears

Weber's Test

CN Test: Comparing air and bone conduction: place vibrating tuning fork on mastoid bone, then close ear canal.

Rinne's Test

Cranial Nerves: CN IX/X(Glossopharengeal/Vagus) Function

Phonation, Swallowing, pharynx control, Gag Reflex

Cranial Nerves: CN IX/X Test

Listen to voice quality, Examine Difficulty in swallowing, have pt say ah, and stimulate throat

Cranial Nerves: CN XI (Spinal Accessory) Function

Innervates trapezius and SCM

Cranial Nerves: CN XI test

Shrug shlds against resistance and turn head toward resistance

Cranial Nerves: CN XII (hypoglossal) function

Tongue Movement

Cranial Nerves: CN XII Test

Listen to pts articulation, examine resting position of tongue and have pt move tongue from side to side

Spinal Level Reflexes: Stimulus-muslce stretch, Reflex Arc-Afferent Ia fiber from muscle spindle back to alpha motor neuron to muscle of origin

Stretch Reflex

Spinal Level Reflexes: Function of stretch reflex

1) maintenance of muscle tone 2) support agonist muscle contraction 3) provide feedback about muscle length

Spinal Level reflex: Stimulus: muscle contraction Reflex Arc: afferent Ib fiber from GTO to muscle origin

Inverse Stretch Reflex

Spinal Level Reflex: inverse stretch reflex function

1) provide agonist inhibition 2) diminution of force of agonist contraction 3) stretch protection reflex

Spinal Level Reflex: part of the stretch reflex, allows muscle tension to come under control of descending pathways

Gamma Reflex Loop

Spinal Level Reflex: Stimulus: cutaneous sensory stimuli Reflex Arc: cutaneous receptors to flexor muscles

Flexor (withdrawal) reflex

Spinal Level Reflex: Flexor reflex function

protective withdrawal mechanism to remove body part from harmful stimuli

Spinal Level Reflex: flexors of one side are excited causing extensors to be inhibited Opposite action on opposite side of body

Crossed extension Reflex

Spinal Level Reflex: Crossed extension reflex function

Coordinates reciprocal limb activities (Gait)

LOC: pt respondes appropriately, can open eyes, look at examiner, respond fully

Alert

LOC: Pt appears drowsy: can open eyes and look at examiner, respond to questions, but falls asleep easily

Lethargy

LOC: pt can open eyes, look at examiner, but responds slowly and is confused: demonstrates decreased alertness and interest in environment

Obtundation

LOC: pt can be aroused from sleep only with painful stimuli; verbal responses are slow or absent; pt returns to unresponsiveness state when stimuli are removed; min awareness of self or environment

Stupor

LOC: pt cannot be aroused, eye closed, no response to external stimuli or environment

coma

GCS: Scores of Severe brain injury

1-8

GCS: Scores of moderate brain injury

9-12

scores of minor brain injury

13-15

MMSE: Score that indicates mild cognitive impairment

21-24

MMSE: Score that indicates moderate cognitive

16-20

MMSE: Score that indicates severe cognitive impairment

<15

Assesses cognitive recovery from a TBI

Ranchos Los Amigos Levels of Cognitive function

RLA: Pt appears to be in a deep sleep and is completely unresponsive to any stimuli

I. no response

RLA: Pt reacts inconsistently and non-purposefully to a stimuli. Responses are limited and often the same regardless of the stimulus

II. generalized response

RLA: Pt acts specifically but inconsistently to stimuli. May follow simple commands in an inconsistent and delayed manner

III. Localized response

RLA: Pt is in a heightened state of activity. Behavior is bizarre and non-purposeful. unable to cooperate directly with treatment efforts. Verbalizations are incoherent. Attention is brief. Lacks short term and long term recall

IV. Confused-Agitated

RLA: Pt able to respond to simple commands fairly consistently. Responses become non-purposeful when commands become more complex. Has gross attention to environment but is highly distractible

V. Confused-Inappropriate

RLA: Pt shows goal-directed behavior, but is dependent on external input or direction. Follows simple direction consistently and shows carryover. Responses may be incorrect but are appropriate to situation

VI. Confused Appropriate

RLA: 1) Pt appropriate and oriented 2) goes through daily routine automatically but robot like 3) min to no confusion 4) shows carry over for new learning but at decreased rate 5) judgement remains impaired

VII. automatic Appropriate

RLA: 1) able to recall and integrate past and recent events 2) Shows carryover for new learning and needs no supervision once activities are performed

VIII. Purposeful Appropriate

Communication: A central language disorder in which speech is typically awkward, restricted interrupted and produced with effort

Non-Fluent Aphasia/Brocca's Aphasia

Communication: The result of a lesion to the third frontal convolution of the left hemisphere

Brocca's Motor Aphasia

Communication: impairment of volitional articulatory control

Verbal apraxia

Communication: Verbal Apraxia is a lesion to what area of the brain

cortical, dominant hemisphere

Communication: impairment of speech production in the CNS?PNS mechanisms that control respiration, articulation, phonation and movements of jaw and tongue

Dysarthria

Receptive Function: Fluent Aphasia

Wernicke's Aphasia

Receptive Function: A central language disorder in which speech is preserved and flows smoothly but comprehension is impaired

Wernicke's Aphasia

Receptive Function: Result of a lesion to the posterior first temporal gyrus of the left hemisphere

Wernicke's Aphasia

BP: Hypertension

>140 SBP >90 DBP

Respiration: a period of apnea lasting for up to 60 sec followed by gradually increasing depth and frequency

Cheyne-Stokes respiration

Respiration: Depression of the frontal lobe and diencephalic dysfuntion

Cheyne-Stokes Respiration

CNS Examination: Tests for meningeal irritation

1) Neck mobility 2) Kernig's Sign 3) Brudzinski's Sign

ANS: 1) Dilates Pupils 2) Inc HR and Force of Contraction 3) Break down glycogen into glucose 4) Increase Blood Sugar level 5) Increases blood flow to skeletal muscles 6) decreases blood flow to skin 7) Increases BP 8

Sympathetic NS

Sensory: Superficial Sensations

1) Pain 2)temp 3) Touch

Sensory: Deep Sensations

1) Joint position 2) Kinesthesia 3) Pallesthesia (vibration)

Sensory Test: ability to perceive movement in response to your moving the pt's limb

kinesthesia

Sensory: Cortical Sensation

1) Stereognosis 2) Tactile localization 3) Two-point discrimination 4) Barognosis 5) graphesthesia 6) bil simultaneous stimulation

Sensory Test: ability to id familiar object when touched

stereognosis

SCI: Sign of Autonomic Dysreflexia

1) HTN 2) Bradycardia 3) Headache 4) diaphoresis 5) Diplopia 6) convulsions

SCI: Steps to take for Autonomic Dysreflexia

1) Elevate Head 2) check and Empty Catheter

SCI: Loss of Pain temperature and light touch below level of lesion

Contralateral Spinothalmic Tract Lesion

SCI: 1) 1) ipsilateral weakness and loss of position and vibration sense below level of lesion 2) contralateral loss of pain and temp a few segment below the lesion

Brown Sequard Syndrom

SCI: bilateral loss of pain and temperature and preservation of proprioception and discriminatory senses in UE

Central Cord LEsion

Wheelchair Prescription: C1-C4 Lesion

1) Electric Wheelchair 2) tilt-in-space 3) puff and -sip controls

Wheelchair Prescription: Cervical Lesion Shoulder Function Elbow Flexion (C5)

1) manual chair with propulsion aids 2) Ind for short distance 3) electric for distances

Wheelchair Prescription: Cervical Lesion with Radial wrist Extension (C6)

1) Manual Chair 2) Surface Friction Hand Rims 3) Ind

Wheelchair Prescription: Cervical Lesion Tricep (C7)

1) Manual Chair 2) Surface Friction Hand Rims 3) increased propulsion

Wheelchair Prescription: Hand Function (C8-T1)

1) Manual WC 2) Standard hand rims

Gait Training and Orthotic Prescription: Mid Thoracic Lesion (T6-T9)

1) Supervised amb for short distances 2) Bil KAFO and crutches 3) Swing-to gait pattern

Gait Training and Orthotic Prescription: High Lumbar Lesions (T12-L3)

1) IND in ambulation on all surfaces and stairs 2) swing through gait or 4 point 3) Bil KAFO and Crutches 4) Household Distance

Gait Training and Orthotic Prescription: Low Lumbar Lesions (L4-5)

1) IND with bil AFO and Crutches/Cane

Contraindication for Exercise for SCI pt

1) Autonomic Dysreflexia 2) UTI 3) uncontrolled Spasticity 4) Unstable Fx 5) uncontrolled hot environment 6) Insufficient ROM

Degenerative Disorder: Chronic, progressive, demyelinating disease of the CNS affecting Young Adults

MS

Degenerative Disorder: impair neural transmission cause nerves to fatigue rapidly

MS

Degenerative Disorder: Common in pyramidal tracts, dorsal columns, and periventicular areas of the cerebrum

MS

Degenerative Disorder: MS that relapses with full recovery or some remaining sign

Relapsing-Remitting MS

Degenerative Disorder: MS disease progression from onset without plateaus or remission

Primary-progressive MS

Degenerative Disorder: MS initial relapsing-remitting course followed by progression at a variable rate

Secondary-Progressive MS

Degenerative Disorder: MS progressive from onset but without clear, acute relapse

Progressive relapsing MS

Degenerative Disorder: Common sensation problems with MS

1) paresthesias 2) hyperpathia 3) dysesthesias 4) trigeminal neuralgia 5) Lhermitte's Sign

Degenerative Disorder: Common visual Problems with MS

1) diplopia 2) blurred vision

Degenerative Disorder: Common muscle tone problems with MS

1) spasticity 2) hyperreflexia

Degenerative Disorder: Coordination problems with MS

ataxia

Degenerative Disorder: Chronic, progressive disease of the CNS with degeneration of dopaminergic substantia nigra and nigrostrital pathways

PD

Degenerative Disorder: PD affects what part of the brain

1) basal ganlia 2) substantia nigra

Degenerative Disorder: rigidity, bradykinesia, resting tremors, impaired postural reflexes

PD

Degenerative Disorder: Common communication problems with PD

1) Dysarthria 2) hypophonia

Degenerative Disorder: Common oromotor problems with PD

1) dysphagia

Degenerative Disorder: Common ROM problems with PD

1) contractures in flexors and ABductors

Degenerative Disorder: neuromuscular Disorder with progressive muscular weakness and fatgiability on exertion

Myasthenia Gravis

Degenerative Disorder: Usually affects extraocualr, facial, muscles of mastication and proximal limb girdles

myasthenia gravis

Cerebellar Disorder: 1) Central Vestibular Symptoms 2) gait and trunk ataxia

Lesion of the archcerebellum

Cerebellar Disorder: 1) hypotonia 2) truncal ataxia 3) Ataxia gait

Lesion to the paleocerebellum

Cerebellar Disorder: 1) intension tremmor 2) dysdiadokinesia 3) Dysmetria 4) dysynergia

Lesion to the neocerebellum

Vestibular Dysfunction: an acute infection with prolonged attack of symptoms

Vestibual neuronitis

Vestibular Dysfunction: recurrant and usually progressive, tinnitus, deafness, sensation of pressure, edema of labryinth

Meniere Disease

Vestibular Dysfunction: Breif attacks of vertigo and nystagmus that occur with certain head positions

BPPV

Vestibular Dysfunction: bilateral vestibular disorder related to vestibular neuropathy, otosclerosis

Paget's Disease

Vestibular Dysfunction: Postive sign for BPPV

Hallpike dix

Cranial and Peripheral Nerve disorders: injury to nerve that causes transient loss of function caused by compression

Neurapraxia

Cranial and Peripheral Nerve disorders: injury to nerve that causes transient loss and wallerian degeneration caused by a crush injury and regenertion is possible

Axonotmesis

Cranial and Peripheral Nerve disorders: cutting of the nerve with severance of all structures and complete loss of function

Neurotmesis

Crania and Peripheral Nerve disorders: Bell's Palsy involves which Nerve

CN VII Facial

Crania and Peripheral Nerve disorders: Weakness of the muscle innervated by the motor nuclei of the lower brainstem

Bulbar Palsy

Crania and Peripheral Nerve disorders: Affects the muscles of the face, tongue, larynx, and pharynx

bulbar Palsy

Crania and Peripheral Nerve disorders: Polyneuritis with progressive symmetrical muscular weakness progressing from LE to UE form a distal to proximal fashion,

GBS

Crania and Peripheral Nerve disorders: a degenerative disease affecting the ant horn cell sand descending corticobulbar and corticospinal tract

ALS

Crania and Peripheral Nerve disorders: 1) muscular weakness that spreads over time 2) spasticity, hyperreflexia 3) leading to death in 2-5 years

ALS

Stages of ALS: mild focal weakness, asymmetrical distribution, symptoms of hand cramping and fasciculations

Stage 1

Stages of ALS: Moderate Weakness in groups of muscles, some wasting modified independence with AD

Stage 2

Stages of ALS: Severe weakness of specific muscles, increasing fatigue, mild to moderate functional limitation, ambulatory

Stage 3

Stages of ALS: Severe weakness of LEs mild weakness in UEs, mod assistance and assitive devices required, WC user

Stage 4

Stages of ALS: Progressive weakness with deterioration of mobility and endurance, increased fatigue, moderate to severe weakness of all limb and trunk, spasticity hyperreflexia loss of head control, max assist

Stage 5

Stages of ALS: bedridden, dependent,

Stage 6

Cranial Nerve and Peripheral Nerve Syndrome: 1) asymmetrical weakness and atrophy 2) abnormal fatigue 3) cold intolerance 4)

PPS

Pain: fast pain is transmitted over what fibers

A Delta Fibers

Pain: Pain pathway for fast pain

1) A delta Fibers 2) spinal cord dorsal horn lamina 3) excites lateral spinothalamic tract 4) brainstem reticular formation and thalamus 5) cortex

Pain: Pain pathway for slow pain

1) C fibers 2) spinal cord lamina 3) ant spinothalamic tract 4) brainstem reticular formation and thalamus

Pain: syndrome that is continuous, intense occurring on the contralateral hemiplegic side. due to a stroke in the postlat thalmus

Thalamic Pain

PNF: Response to stimulation spreads to adjacent M. working in synergistic patters

Irradiation

PNF: Stimulates afferent nerve endings and facilitates extensor muscles

Approximation

PNF: Stimulates afferent Nerve ending and facilitates flexor M

Traction

PNF techniques: voluntary relaxation followed by passive increasing ROM 2) followed by active assisted movements 3) progressing to resistive movement 4) pt arom

Rhythmic initiation

PNF techniques: Rhythmic initiation is indicated for

1) apraxia 2) uncoordinated motion 3) tonal impairments 4) motor learning deficits

PNF techniques: voluntary relaxation combined with slow passive rhythmic rotations of the body or body part

Rhythmic Rotation

PNF techniques: isometric holding is facilitated first on one side of the joint followed by alternate holding of the antagonist muscle group

Stabilizing Reversals (alternating isometrics)

PNF techniques: Stabilizing reversal is indicated for

1) decreased stability 2) poor antigravity control 3) weakness

PNF techniques: simultaneous isometric contractions of both agonist and antagonist perfromed without relaxation

Rhythmic Stabilization

PNF techniques: slow isotonic contraction of first agonist the antagonist

Dynamic Reversals (Slow reversals)

PNF techniques: Combines concentric, eccentric, and isometric contractions of one muscle gropu

Combination of isotonics ( Agonist Reversals)

PNF techniques: an isometric contraction performed in the mid to short range followed by a voluntary relaxation and passive movement into lengthened range, and resistence to an isotonic contraction into the lengthened range

Replication (Hold-Relax-Active Motion

PNF techniques: a relaxation technique usually performed at a a point of limited ROM in the agonist pattern

Contract Relax

PNF techniques: isotonic movement is performed followed by an isometric hold or the range limiting muscles in the agonist pattern against slowly increasing resistance, then relaxation and active contraction into new range

Contract-Relax

PNF techniques: an isometric contraction of the range-limiting antagonist pattern is performed against slowly increasing resistance followed by relaxation and passive movement into new range

Hold-Relax

PNF techniques: repeated stretch linked to voluntary effort to contract stretched muscles

Repeated Stretch

PNF techniques: UE D1F (Diagonal 1 Flexion)

1) Shoulder flex 2) Shoulder Add 3) Shoulder ER

PNF techniques: UE D1Ext

1) Shld Ext 2) Abd 3) IR

PNF techniques: UE D2 Flex

1) Shld Flex 2) Abd 3) ER

PNF techniques: UE D2 Ext

1) Shld Ext 2) ADD 3) IR

PNF techniques: LE D1 Flex

1) Flex 2) Add 3) ER

PNF techniques: LE D1 Ext

1) Hip Ext 2) Abd 3) IR

PNF techniques: LE D2 Flex

1) hip Flex 2) Abd 3) IR

PNF techniques: LE D2 Ext

1) Hip Ext 2) ADD 3) ER

PNF techniques: Upper Trunk Flex with rot and hands clasped, with the lead arm moving into D1Ext

Chopping

PNF techniques: Upper trunk Ext with rotation; hands clasped with lead arm moving into D2 Flex

Lifting

Neuro Techniques: Focus on enhancing motor skills, postural control, and quality of movements through movement experiences

NDT

Neuro Techniques: Facilitation of normal movement and postural patterns and inhibition of abnormal and compensatory patterns of movement

NDT

Sensory Stimulation Techniques: facilitates agonist muscle and inhibits antagonist muscles

Quick stretch

Sensory Stimulation Techniques: inhibits agonist muscle and dampens high tone

prolonged slowly applied stretch

Sensory Stimulation Techniques: recuits motor units, facilitates strengthen agonist contraction

resistance

Sensory Stimulation Techniques: enhances joint awareness, facilitates concontraction, action of postural extensors and stabilizing muscles

Joint Approximation

Sensory Stimulation Techniques: enhances joint awareness, action of flexors relieves muscle spasm

Joint Traction

Sensory Stimulation Techniques: Firm pressure on long tendons that inhibit muscles dampens tone

Inhibitory pressure

Sensory Stimulation Techniques: initiates phasic withdrawl reactions

light quick touch

Sensory Stimulation Techniques: produces calming affect generalized inhibition

Maintained touch

Sensory Stimulation Techniques: slow repetitive rocking that produces generalized ihibition of tone relaxion and calming effect

Slow, maintained vestibular stimulation

Sensory Stimulation Techniques: spinning or fast rolling that produce generalized facilitation of tone improved motor coordination and improved retinal image stability

Fast irregular vestibular stimulation

Motor Learning Strategies: a set of pre structured muscles commands that results in the production of coordinated movements

Motor program

Motor Learning Strategies: an overall strategy for movement: an action sequence requiring a coordnation of a number of motor programs

Motor plan

Motor Learning Strategies: Afferent information sent by various sensory receptors and control centers

Feedback

Motor Learning Strategies: Readies the system in advance of movement; anticipatory responses that adjust the system for incoming sensory feedback or for future movements

Feed forward

Motor Learning Strategies: determine overall quality, level of automaticity, level of effort and speed of decision making

Performance

Motor Learning Strategies:ability to demonstrate the skill after a period of time

retention

Motor Learning Strategies: the acquired capability to apply what has been learned to other similar tasks

Generalizability

Motor Learning Strategies: capability to apply what has been learned to other environmental contexts

Resistance to Contextual Change

Motor Learning Strategies: Feedback from Sensory information normally acquired during performance of a task

Intrinsic Feedback

Motor Learning Strategies: externally presented feedback tat is added to that normally acquired during task performance

Augmented feedback

Motor Learning Strategies: Augmented feedback about the outcome of a movement

knowledge of results

Motor Learning Strategies: augmented feedback about the nature of movement produced

knowledge of performance

Motor Learning Strategies: feed back given after every a set time

Feedback Schedule

Motor Learning Strategies: Practice of a single motor skill repeatedly

Blocked Practice

Motor Learning Strategies: practice of varied motor skills in which a performer is required to make rapid modifications in order to match the demand of the task

Variable practice

Motor Learning Strategies: practice of a group or class of motor skills in random order

Random practice

Motor Learning Strategies: practice of a group of motor skills in serial or predictable order

serial practice

Motor Learning Strategies: relatively continuous practice in which the amount of rest time is small

Massed practice

Motor Learning Strategies: practice in which rest time is large

distributed practice

Motor Learning Strategies: cognitive rehearsal of a skill without physical performance

Mental practice

Motor Learning: Stage in which the learner develops an understanding of the task, identifies the stimuli performs initial approximation of task, structures a motor plan and modifies initial response

Cognitive Stage

Motor Learning: Stage in which the learner practice movements, refines motor program, spatial and temporal organization, decreases errors, and extraneous movements

Associated Stage

Motor Learning: stage in which the learner practice movements, continue to refine motor responses, spatial and temporal are highly organized, movements are highly error free, and min level of cognitive monitoring

Autonomous Stage

Heart: Fibrous protective sac enclosing the heart

Pericardium

Heart: inner layer of the pericardium

epicardium

Heart: heart muscle, the major portion of the heart

myocardium

Heart: smooth lining of the inner surface and cavities of the heart

Endocardium

Heart: right heart valve

TRicuspid Valve

Heart: Left heart valve

Bicuspid (mitral valve)

Heart: prevent back flow of blood into atria during ventricular systole

Atrioventricular valves

Heart: Close when ventricular wall contract

Atrioventricular valves

Heart: Prevent back flow of blood from aorta and pulmonary arteries in the ventricles during diastole

Semilunar Valve

Heart Cycle: the period of ventricualr contraction

systole

Heart Cycle: amount of blood in the ventricle after systole usually 50 mL

End Systolic Volume

Heart Cycle: period of ventricular contraction and filling

Diastole

Heart Cycle: usually about 120 mL of blood

end diastolic volume

Heart: supplies the right atrium, most of the right ventricle, inferior wall of left ventricle, AV node and bundle of His

Right Coronary Art

Heart: supplies most of the left ventricle

left coronary Artery

supplies the left ventricle and the interventricular septum, the inferior areas of the apex, originating from the left coronary art

Left Descending Art

Heart: Supplies blood to the lateral and inferior walls of the let ventricle and orginates from the left coronary art

Circumflex art

Heart: Steps of electric current in heart

1) SA node 2) Atria 3) AV node 4) bundle of his 5) Purkinje fibers 6) ventricles

Heart: amount of blood ejected with each myocardial contraction

Stoke volume

Heart: Normal Stroke volume

55-110 ml/beat

Heart: the amount of blood left in the left ventricle at the end of diastole

preload

Heart: the ability of the ventricle to contract

contractility

Heart: the force the LV must generate during systole to overcome aortic pressure

Afterload

Heart: the amount of blood discharged form the left or right ventricle per minute

CO

Heart: Average CO for an adult at rest

4-5 L/ min

Heart: Percentage of blood emptied from the ventricle during systole

ejection fraction

Heart: SV/left ventricular diastolic Volume

Ejection Fraction

Heart: Normal EF

60-70%

Heart: Indicates and impaired LV

Low EF

ANS: parasympathetic and sympathetic control center is regulated by which area of the brain

Medulla Oblongata

CN: Controls the cardiac plexus and innervates all myocardium and releases of ACH

CN X (vegas)

PNS: the PNS causes which changes in the the heart and vascular system

1) Slows rate of the Heart and Force of the contraction 2) Coronary A vasocanstriction

SNS: Changes of the heart caused by the SNS

1) increase in rate and force of contraction 2) coronary a. vasodilation 3)

HEart: Main mechanism in controlling heart rate

Barorecpetors

Heart: Responds to change in BP

Circulatory Reflex

BP: An increase in BP will cause which changes in the ANS

1) Stimulation of PNS 2) Inhibition of SNS

BP: A decrease in BP will cause which changes in the ANS

1) SNS stimulation

Chemoreceptors: An increase in CO2 or decrease in O2 or decrease in pH levels results in what changes in heart

Increased in Heart Rate

Chemoreceptors: Increase in O2 levels will result in which changes in the heart

Decrease in HR

Increased concentration of potassium ion

Hyperkalemia

Heart: A decrease in the rate and force of contractions and widened PR and QRS interval and tall T Wave

Hyperkalemia

Heart: Flattened T wave, prolonged PR and QT intervals, arrhythmias leading to ventricle Fibrillations

Hypokalemia

Heart: increases heart actions caused by an inbalance in calcium levels

Hypercalcemia

Heart: Decreases in heart actions caused by an imbalance in calcium levels

Hypocalcemia

Heart: Risk Factors for CAD

1) Men > 45 Women > 55 2) MI or Sudden death in 1 degree male relative before 55 female 65 3) Sedentary Lifestlye 4) >30 bmi >40 in waist men >35 in female 5) SBP >140 DBP> 90 6) LDL > 130 HDL <40

Auscultation Landmarks: 2nd right intercostal space at the sternal boarder

Aortic Valve

Auscultation Landmarks: 2nd left intercostal space at the sternal boarder

Pulmonic Valve

Auscultation Landmarks: 4th left intercostal space at the sternal boarder

Tricuspid valve

Auscultation Landmarks: 5th left intercostal space at the midclavicular area

mitral valve

Heart Sounds: Lub; normal closure of the mitral and tricuspid valves: beginning of systole

S1

Heart Sounds: Decreased when there is 1st degree heart block

S1

Heart Sounds: Dub; normal closure of the aortic and pulmonary valves; end of systole

S2

Heart Sounds: Decreased in aortic stenosis

S2

Heart Sounds: abnormal tremor accompanying a vascualr or cardiac murmur

Thrill

Heart Sounds: murmur of arterial or venous origin common with atherosclerosis

Bruit

Heart Sounds: abnormal heart rhythm with three sounds in each cycle

gallop

Heart Sounds: associated with ventricular filling: heard in older individuals with congestive heart failure

S3

Heart Sounds: ventricular filling an aortic contraction: indication of CAD, MI, aortic stenosis or chronic HTN

S4

ECG: Atrial depolarization

P wave

ECG: time required for impulse to travel from atria to Purkinje fibers

P-R interval