Disclaimer: Meant as a refresher before taking an exam and not a comprehensive guide.

I
have excluded some content that I already know.

Musculoskeletal:

Class 1 Lever: Fulcrum in middle: Head and first vertebra, elbow extension

Class 2 Lever: Fulcrum at edge, load middle: Standing on tip toes, push up

Class 3 Lever: Fulcrum at edge: effort middle: elbow flexion, knee flexion

Brachial plexus: pg 250

Uniaxial: pivot and hinge
Biaxial: saddle, condyloid
Multiaxial: ball and socket, plane

Receptors:
Pacinian and Ruffini are pressure receptors: deep pressure, high velocity, high frequency
vibration

Mazzoni: knee joint compression

Golgi Tendon: stretch of tendon

Meissner: light touch - discriminatory

Merkels disc: light and crude touch - texture

Free nerve endings: pain and temperature

A alpha: motor
A beta touch/pressure/proprioception → can inhibit a delta and C
A delta: pain, cold temperature
C fibers: pain and temperature
McGill questionnaire: most common 4 parts 70 questions

Kehr’s sign: foot elevated results in left shoulder pain → rupture of spleen

Skinfold sites: abdominal, tricep, pec, medial calf, subscap, suprailiac, thigh, midaxillary: right
side, 1cm away from caliper

Body fat: 12-18 males, 18-23 females. Hydrostatic most accurate.

BIA: requires good hydration but cannot drink water, no vigorous activity, urinate 30 min before

Plum line: coronal structure, external auditory meatus, odontoid, tip of shoulder, lumbar,
posterior to hip, anterior to knee, anterior to lat mal, calcaneocuboid

Capsular pattern/joint positions: pg 78

MMT:

0 0 No visible or palpable contraction

Trace I 1 Visible or palpable contraction (No ROM)

Poor- 2-
Partial ROM, gravity eliminated

Poor II 2 Full ROM, gravity eliminated

Poor+ 2+
Gravity eliminated/slight resistance or < 1/2 range against
gravity

Fair- 3-
> 1/2 but < Full ROM, against gravity

Fair III 3 Full ROM against gravity

 Fair+ 3+
Full ROM against gravity, slight resistance

Good- 4-
Full ROM against gravity, mild resistance

Good IV 4 Full ROM against gravity, moderate resistance

Good+ 4+
Full ROM against gravity, almost full resistance

Normal V Normal, maximal resistance

Grips: cylindrical - soda, first - hammer

Spherical - baseball

Hook - handle

Digital precision: tip - needle, prehension

Lateral - key, digital prehension pencil

Hand-held dyna: 5-10 greater on dominant

Gait: stance 60, swing 40.

Initial contact, loading response, midstance, terminal stance, preswing, intial swing, mid swing
terminal swing
Heel strike, foot flat, midstance, heel off, toe off, acceleration, mid swing, deceleration

Key components: maximal knee flexion: intial swing to midswing, maximum extension big toe,
terminal stance/pre swing

ROM requirements for gait:

knee flex 6 0
hip ext, 10
hip flex 30
df 10
pf 20
ext 0

Initial contact: DF + quadriceps for full knee extension

Loading response: eccentric DF, eccentric quads to eccentric PF/tibialis posterior, concentric
quad, concentric hip extensor

Mistance: eccenric pf, concentric quad, iliopsoas eccentric

Terminal stance: concentric pf

Pre swing: PEAK ACTIVITY OF PF, concentric knee flexors, concentric hip flexor

Initial swing: hip, knee flexion + DF

Mid swing: MOMENTUM, pelvic muscles stabilize during swing

Terminal swing: hams eccentric, quad concentric, hip extensor eccentric

Degree of toe out: 7 degrees

Step length: 28 inch, stride 56
Pelvic rotation: 4 forward, 4 back

Cadence: 110-120 steps per minute, stride length doubles

Gait patterns: pg 89
Steppage: foot slap, df weakness
Vaulting: elevation of pelvis + pf

Tabetic: ataxic foot slaps (tax)

Excessive flexion on swing: flexor withdrawal, LE synergy

Goniometer: test position stabilize prox segment, move through, estimate, palpate align, record
start, stabilize prox measure record

10-0-105 means 10 degrees hyperextension

Sulcus: 1, 1-2, 3+

Ludingtons: long head biceps pathology

Adson towards. Allen away (90-90).

Roos 3 minutes.
Wright hyperabduction: costoclavicular

Murphys: 3rd in line with 2nd and 4th

Toe region, elastic region, plastic (creeping)

Delorme versus, Oxford (O down 100-50)

Total HIP Replacements

Posterolateral hip: capsule, glut max contra indications - medial rotation, extension, flexion 90
Direct lateral: minimize dislocation, glut med
Anteriolateral: TFL glut med

Glucocorticoid: immune system, buffalo hump, moon face, glaucoma, hypertension

Humira: DMARD

Opiods: respiratory depression, orthostatic hypotension

Q angle 13 males, 18 females

Volar/Dorsal forearm splint immobilizes wrist joint

Thumb Spica splint immobilizes wrist and MCP jt of thumb. Thumb splica 20 degrees extension,
mcp flexion

Radial gutter splint immobilizes metacarpals and phalanges, allows free movement of thumb

Sugar limits pro and sup

Long arm limits elbow movements in all planes

Orthosis indications: page 135!

Parapodium: sit when needed

Rocker bar: helps with terminal stance -great toe

Taylor Brace: limit flexion and extension

Need good medial lateral stability for posterior leaf

AFO floor reaction: assists with knee extension during stance

KAFO is for stability

HKAFO: restrict swing to or swing through gait pattern, for stability

Parapodium: for kids to sit and you move by rocking
RGO: for paraplegia

Rocker bar: for terminal stance

Transfemoral: quadri or ischial: Trabstubuak has the word patella in it.

Lisfranc: through metatarsal.
Chopart: cc jt, or TN jt

Medicare functional classifications:

0 not indiciated
1 even surfaces: single axis, SACH
2 uneven surfaces: polycentric, multi axial, flexible
3 variable cadence, high barers: hydrolic, microprocessor, energy storing, dynamic
4 ANY ATHLETE

Rigid dressings dont need frequent change, non ridig requires it. Cheapest is ace wrap.

Torniquette effect: areas of high low pressure: shitty bandaging technique

Dynamic response is best for accomadating to all environments, hydraulic is not

Sock: switch porsthesis after 12-15.

PRessure: shaft + ligament, ishium and sfot tissues all else is bad

Wearing: Start 1 hour a day with alf the time spent ambulating, check skin every 30 min.
Increase 15-30 min inspection.
Order of wearing: WLSN

UE: 2-4
LTranstibial 2 ….3-4
Transfem- 6

Phantom limb is painless sensation.

Ignoring page 144.

Abducted gait: think of everything long and stiff knee

Circumduction is usually due to weak knee flexion

Excessive knee flexion: hard heel, long, DF. socket forward

Vaulting , think of long and plantar flexion

Rotation: toe out, loose socket, rigid.

Forward: poor suspension, socket too big

Medial whip: excessive knee rotation

FOM: Amputee mobility predictor- correlates with K level

L-TEST: same as tug. 90 degree turn after 3 meters, total 20m (instead of 6), 4 turns involved

POM: PEQ 9 questions

Pistoning: translation of prostehetic from residual due to poor suspension

Stance control can extend even when flexed

Vaccum suspension is bettter overall for atheletic, shuttle lock requires sock changing and
sucks

----
Diseases:
Achielles tendinopathy: risk over 30, thompson test, seriel casting for 10 wks. Surgical repair
lower rate of rerupture

Afhesive capsulitis: decreased capsule size, decreased fluid. Diabetes more likely.

Acute bursitis: abd over 60, flex over 90

Ankle sprain: PTFL least likely

Biceps tendnopathy: overhead throwing like motion, transverse humeral ligament popping,

Bankart: anterior inferior labrum, hills sack

Medial epicondylitis: pronator teres and FCR

MCL more common that LCL injuries

OA: nodes more common in women, Distal Herbards Proximal Bouchards

Osteogenisis Imperfecta: mild type 1 sclera, type 2 death in utero, type 4 increased ossification
of skull, type 4 bowing of long bones, barrel shape Avoid rotation, and weight bearing at
joints

Arthrogryposis: jt contracture
Plantar fascitis: excessive foot pronation, heel wedge, high arch

Rotator cuff tendinopathy: painful arc. Stages: 25 2540 40

Juvenille idiopathic to the right. Over 40 surgery for scoliosis. 25-40 ortosis

Degenerative Spondylolithesis: african american woman L4-5

Congenital spondy common in ages 12-16 affecting L5

Osteosarcoma: most common location: knee, long bone - Codman’s triangle indicative of
neoplasm
Ewings: Bone marrow children

I90 - priformis

Osteomyelitis: staphlo: bone biopsy nerve conduction - tibial nerve

Myosisitis Ossificans: heat is contraindicated

Transtibial amputation: major cause vascular disease

Congenital limb deficiency least likely

Ambiarthrosis slighlty movable

Laminectomy is removal of everything but transverse process

Humira crohns.

What is the most common cause of transfemoral amputations in individuals under 30

years of age? Tumors
Right torticollis - left occipito

Neuromuscular:
The largest division of the brain is telenchepelon.

Brainstem: midbrain, pons, medulla oblongata

31 (33 spinal vertebrae) pairs of spinal cord - 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1
coccygeal

Anterior root: efferent

Dorsal root: afferent

ANS:

Sympathetic:
-norepinephrine: stimulating
-acetylcholine: inhibitory

SNS: Myelinated fibres, controls muscle and all senses

Limbic system: mood and emotion

Hippocampus: forming and storing new memories.
Basal Ganglia: voluntary movement, regulates autonomic movement, posture, muscle tone.
Amygdala: emotional and social processing
Thalamus: relays sensory information to other parts of the body
Hypothalamus: Regulates body temp, integrates info for autonomic nervous system
Subthalamus: Regulates movement by skeletal muscles
Epithalamus: secretes melatonin, involved in circadian rhythm, internal clock
Cerebellum: fine motor movement, rapid alternating movements
Pons: regulation of respiration rate
Medulla Oblangata: regulates respiration, HR, reflex center for vomitting, coughing, sneezing.

Left Brain: Positive emotions

Frontal Lobe: Broca’s aphasia (expressive), personality changes

Parietal: apraxia

Temporal: Wernickes (receptive aphasia)

Occipital:
 internal carotid artery is not part of the circle of willis.

Anterior cerebral artery: contralateral LE, personality changes, PARAPELEGIA

Middle cerebral artery: contralateral UE, CONTRALATERAL HEMIPLEGIA, SENSORY
IMPAIRMENT
Posterior cerebral artery: contralateral pain and temperature, ataxia, athetosis, visual,
THALAMIC PAIN, CORTICAL BLINDNESS
Vertebral basilar artery: loss of conciousness, nystagmus, dysphagia, dysarthria ,
WALLENBERG (spinothalamic contralateral pain and temp, spinal trigeminal ipsi loss of pain
and temp)

Meninges: dura, arachnoid, pia. Subdural (dura arach), subarachnoid (aracnoid pia)

Kernings sign: pain with hip flexion combined with knee extension = meninges
Brudzinski: flexion of the neck facilitates flexin of hip and knee = meninges

CSF: 500-700 ml/day

Sun setting: hydrochephalus (downward deviation of eyes)

Ascending Tracts
Fasciculus cuneatus: upper extremity
Fasciculus: gracilis: lower extremity
Spinocerebellar dorsal: ipsi proprio of lower
Spinocerebellar ventral: ipsi upper lower and posture

Spinoreticular: conciousness
Spinotectal: eye movements and head

Spinothalmic anterior: light touch

Spinothalamic lateral: pain and temp

Descending Tracts:
Corticospina anterior: ipsilateral volunatry
Corticispinal lateral: contralateral voluntary - babinski, absent superciial abdominial reflex,
cremasteric

Reticulospinal: reflex activity

Rubrospinal: flexion of upper, posture

Tectospinal: auditory visual contra

Vestibulospinal: extenso rmuscles tone

SSMMBMBSBBMM

Cranial Nerve:
Olfactory: identify familiar odors eg. smelling shit
Optic: testing visual Fields
Occulomotor: upward, downward, medial gaze, reaction to light
Trochlear: downward, inward gaze
Trigeminal: corneal reflex, face sensation, clench teeth → push down on chin to separate jaw
Abducens: lateral gaze
Facial nerve: innervates anterior ⅓ tongue, close eyes tight, smile
Vestibulocochlear: balance, cooridnation tests 512hz 18-24 inches can’t hear
Glossopharyngeal: posterior ⅔, gag reflex, ability to swallow
Vagus: gag reflex, swallowing, saying “ahh”
Accessory: resisting shrug shoulders
Hypoglossal: Tongue protrusion

Deep Tendon Reflex:

 Reflex Grading Interpretation

0 = no response Always abnormal

1+ = diminished/depressed response May or may not be normal

2+ = active normal response Normal

3+ = brisk/exaggerated response May or may not be normal

4+ = very brisk/hyperactive Always abnormal

Superficial: temp, light touch pain

Deep: proproception

Monofilaments: perpendicular has to bend 10g

Pinwheel: for pain

Vibration:128hz, over bony prominences

Anesthesia: absence of touch sensation

Casualgia: relentless pain after peripheral nerve injury
Dysesthisia: distortion
Alodynia: pain in the presence of painful stimulus
Neuralgia: shock like pain
Pallasthesia: loss of vibration sensation
Paresthesia: abnormal sensation

Wallerian degeneration: distal to nerve

Neuropraxia: mildest form of injury

Axonotmesis: reversible, rate of mm/day, traction, compression crush
Neurotmesis: irreversible regeneration is impossible sensory heals before motor

Peripheral neuropathy: Weaker distally than proximally

GBS is lower motor neuron

Athetosis: slow twisting, writhing movements

Chorea: brief irregular contractions. Ballism is higher amplitued
Dystonia: twisting abnormal posture and repetitive movements
Tics: sudden brief repetitive coordinated movements that will suually occure at irregular
intervals (Tourettte)

Postural tremors: hyperthyroidism, fatigue or anxity.

Intention tremors: indicative of cerebellum seen with MS

Asthenia: generalized weakness, typically secondary to cerebellar pathology

Lead pipe: constant rigidity

Modified ashworth:
0 no increase in tone
1 slight increase by catch and release with resistance at end
1+ catch minimal resistance throughout
2 marked resistance
3 considerable increase passive difficult
4 rigid

Suspensory strategy lower body

Tinnitus: peripheral vertigo

Peripheral: BPPC, meniers, infection, trauma, metabolic disorders, acute alcohol intoxication

Central versus peripheral page 267

Fluent: wernickes, conduction

Nonfluent: brocas, global NBG
Spinal tap L3-L4.
Antispastic meds: Diazepam, Dantrium
Alzheimer + myesthenia gravis: cholinergic agents.

Primary versus secondary: primary you cannot change

Impulsive behaviors: Right hemisphere

LEFT: motor apraxia, decreased processing frustration
RIGHT: decreased attention span, less abstract reasoning, impulsive, decreased spatial
orientation
Upper limb synergy:
Flexor: shoulder (abduction lateral rotation), elbow flexed, forearm supinatted. Scapula
retracted, elevated.
Extensor: 281

Lower limb:
Flexor: abduction lateral rotation, knee flexion, dorsiflexion supination, extension D1 flexion
Extensor:

FIM - 18 item, measures self care assessment

Adams closed loop: current movement with memory of past movement

Schdmit: adds importance of feedback on top of closed loop

3 Stages of Motor Learning: CAA: max external to max internal

● Cognitive Stage - initial stage of learning, requires high concentration
● Associative Stage - person can do more independently, can tell correct vs incorrect
performance
● Autonomous Stage - Skilled learning where person improves efficiency with out need for
cognitive control

Knowledge of results: terminal feedback comparing to outcome of the goal

Knowledge of performance: movement pattern used during

Non associative: single repeated response (habituation)

Associative: relationship between two

Practice of motor control:

Massed: more practice less rest
Distributed practice: more rest
Constant practice: under uniform
Variable: variable
Block practice: single task

Carr and Shephard Motor Relearning Approach: feedback

Bobath NDT: Interference of normal function of brain leads to dysfunction leads to slowing
down of motor development and inhibition of righting reactions, equillibrium reactions and
automatic movements.facilitation and inhibition

Brunnstrom Approach/Stages: movement therapy in hemiplegia. Encourages use of synergy

patterns during rehab
Stage 1: no volitional movement
Stage 2: spasticity appears
Stage 3: the synergies are voluntary, spasticity increases
Stage 4: spasticity begins to decrease
Stage 5 further decrease
Stage 6: isolated movements with coordination
Stage 7: normal

Raimiste phenomenon: abduct add with resistance to uninvolved in same direction

Souques phenomenon: raising the involved upper above 100 with elbow extension will produce
extension and abduction of fingers

PNF: patterns on page 290

AI progresses to RS
Conract relax: hamstring
Hold rleax is an isometric hold

HRAM indicated for ⅕

Inihibits: deep pressure, prolonged, warmth, prolonged

Decorticate: bunny flexion upper, extension lower

Decerebrate exteions of both

Agnosia: intepret information

Agraphia: inabiliy to write
Alexia: cant read
Anosognia: dont believe yur own ilness
Constructional apraxia: cant reproduce geometrica figures
Ideational: can’t form motor plan
Ideomotor: you can plan but can’t fucking move
Berg balance test
● Assess risk of falling
● 14 tasks scored 0-4
● incl. static, dynamic and transitional movements in sitting and
● standing positions
 ● max score 56, less than 45 indicated increased risk of falling

Fregley- Graybiel Ataxia test battery

● 8 test conditions
● Therapist scores each condition pass/ fail basis with normative date for comparison
● Best suited for patients with high level motor skills since each condition is challenging
● This tool used to asses and treat balance dysfunction; however, patient performance does
not assist the therapist to diagnose the cause of balance dysfunction

Fugl- Meyer sensorimotor assessment of balance performance battery

● Assess balance specifically for patients with hemiplegia
● Each of the 7 items are scored from 0-2, max score being 14
● Even though a 14 is the best score that a person can receive, the patient may still not have
normal balance

Functional reach test

● Asses standing balance and risk of falling
● Three reaches measured and averaged.
● Age related standard measurements for functional reach:
❖ » 20-40years: 14.5-17 inches
❖ » 41-69years:13.5-15inches
❖ » 70-87=10.3-13.5inches
❖ » If patient struggles to reach their appropriate, increase risk of fall is present.

Romberg test
● Assessment tool of balance and ataxia that initially positions the patient in unsupported
standing, feet together, upper extremities folded, looking at a fixed point straight ahead
with eyes open. With eyes open, three systems (visual, vestibular, somatosensory) provide
input to the cerebellum to maintain standing stability
● If there is a mild lesion in the vestibular or somatosensory system, the patient will typically
compensate through visual sense. Next the patient maintains the same standing posture,
but closes the eyes. A patient receives a grade of “normal” if they are able to maintain the
position for 30 seconds
● An abnormal response occurs with inability to maintain balance when standing erect with
the feet together and eyes closed. Patients may exhibit sway or begin to fall.
● When the visual input is removed, instability will be present if there is a larger
somatosensory or vestibular deficit producing the instability. If a patient demonstrates
ataxia and has a positive Romberg test, this indicates sensory ataxia and not cerebellar
ataxia.

Timed up and go test

● Asses mobility and balance
 ● Person initially sits on a supported chair with firm surface, transfers to a standing position,
and walks approx. 10 feet. The patient must then turn around without external help, walk
back towards the chair, and return to sitting position
● The patient is scored on amount of sway, excessive movements, reaching for support,
sidestepping, or other signs of loss of balance.
● The 5-point ordinal rating scale designates a score of 1 as normal and a score of 5 severely
abnormal.
● To increase overall reliability the use of time was implemented. Patients who are
independent can complete the multi-task process in 10 second or less. Patients that require
over 20 seconds to complete the process are at the limit for functional independence and
may be at an increased risk for falling. Patients that require 30 seconds are at high risk for a
fall.

Tinetti performance oriented mobility assessment

● Tool to asses for increased risk of falling.
● Assesses balance through sit to stand and stand to sit from an armless chair, immediate
standing balance with eyes open and closed tolerating a slight push in the standing position,
and turning 360 degrees.
● A patient is scored from 0-2 in most categories with a maximum score of 16.
● The second section assesses girth at normal speed and at a rapid, but safe speed. Items
scored in this section include initiation of gait, step length and height, step asymmetry and
continuity, path, stance during gait, and trunk motion. A patient is scored 0-2 for each with a
maximum score of 12. The tool has combined maximum total of 28 with the risk of falling
increasing as the total score decreases. A total score less than 19 indicates a high risk of fall.

Brown sequard: Loss of temperature and pain on opposite, loss of motor ipsi

Central cord: hyperextensive: UE greater, motor greater

Sensory prick testing: absent , impaired, intact

WS: 15-20 min for pressure ulcers

Autonomic dysreflexia: T6 above.

Independent C6-C7 with transfers. Sliding board. Fuck everything else.

Paradoxical breathing: tetraplagia.

OMY means removal
Head hip: move head in opposite of hips.
Rhizotomy: removal of sensory

Rancho Los Amigos Levels of Cognitive Functioning

No response- deep sleep
Generalized - inconsistent and non purposeful to stimuli
Localized - responses directly related to stimulus presented
confused agitatted - behavior is bizaare heightened
confused inappropriate - simple commands
confused appropriate -need external input, goal directed
Automatic Approprtiate - robot like
Purposeful Appropriate - normal
 Stupor: unresponsiveness to general stimuli
Obtundity: state of conciousnesss reduced alterness
Delirium: delayed response

Concussion Grades
Grade 1: resolve within 15
Grade 2: more than 15 min
Grade 3: unconcious

GLASSGOW COMA: used to determine arousal and cerebral cortex function

E4 spontaneous, M6 Obeys command, V5 Oriented. 15.
Less than 9 youre fucked.
9-12 mod
13-15- milld

APGAR: objectively reports health of newborn

● 7-10 normal.
● 3 below is considered low.
● Calculate at one minute and at 5 minute.
● Page: 305

Infant Reflexes
● ATNR, STNR, TLR 6 months
● GALANT, POsitive reflex, walking 2 months
● Moro and startle is 5 mo
● Rooting 3 mo
● Palmar grasp 4 mo
● Plantar 9 mo
● Toddler 12-36 mo

IEP once every year for goals

1mo: roll side to side, head lag with pull to sit

2-3mo: Full support to sit

4-5 mo: Feet to mouth, sits alone briefly, bears weight through legs in supported
standing
6-7 mo: sits independently, crawl backward, midline trasnfer bw hands
 8-9: crawl forward, crusing, pull to stand, sit without hand support

10-11: pick objects from floor, stand without support

12-15: walks without support, throws ball

16-24 mo: squats in play, up and downstars using both feet on one step, walk backward

2 years: ride tricycle, walk alternating stairs

Age 3-4: throw ball button smal

Age 5-8 skip gallop button big change clothe 3-6

Supine: feet positioned at 90 degrees

IDEA: is good: amendments

Menieres: fullness
Neuroma: tinnitus, hearing loss

Neuro Diseases:

Alzheimers:
● Acetylcholine involvement, amyloid plaques, neurofibrillary tangles - atrophy of
smooth muscle
● Involvement of aluminum
● Stage 1: emotional lability
● Stage 2: agitation, aphasia, apraxia
● Stage 3: long term memory
● Cognex, Aricept, Exelon
● 4th leading cause of deaths -7-11

ALS:
● Both upper and lower motor neuron
● Asymmetrical muscle weakness, fasciculations, atrophy, incoordination, Babinski -
respiratory paralysis.
● Diagnosis: electromyography
 ● Drug: Rilutek
● Progression: Distal to proximal
Carpal Tunnel:
● Abductor pollicis brevis atrophy
● Normal tissue pressure is 2-10. Above 30 is CTS
● Ape hand deformity. No opposition.
● Avoid radial deviation strengthening.
Hook of hamate and pisiform - ulnar nerve tunnel of guyon.

Central Cord Syndrome:

● Hyperextension
● Motor loss in upper extremities than lower. Sacral sparing. Bowel bladder resolve 6
mo.
● Complications autonomous dysreflexia. 30% of overall tetrapalegia.
● ACS POOR OUTCOMES. Affects motor and pain and temperature below the level of
lesion.

Cerebral Palsy
● Most common cause of permanent disability in kids
● Neuromuscular disorder of posture and controlled movement
● Monoplegia - one involved extremity
● Hemiplegia - unilateral involvement of UE and LE
● Quadriplegia - involvement of all extremities
● EEG used for lab findings
● Dorsal Rhizotomy surgical intervention

CVA
● 1st 3 mo critical for prognosis
● Modifiable: hypertension is the most common cause

Down’s:
● Trisomy 21- nondisjunction.
● Almond eyes, palmar crease, epicanthal folds, large tongue, congenital heart issues
● Hypotonia lax ligaments, poor muscle strength. Age 55.
● Prader willi: chromosome 15, obesity, excessive appetite short stature

Duchenne Muscular Dystrophy

● Fat and connective tissue replaces muscle
● Mutation in dystrophin gene xp21
● Waddling gait, proximal muscle weakness, clumsiness, toe walking
 ● Gowers maneuver - used when having difficulty getting off floor
● Lab findings - electromyography, muscle biopsy, DNA analysis (high serum creatinine
kinase levels)
● Respiratory problems & scoliosis progress once using wheelchair

Erbs Palsy:
● C5-C6 anterolateral neck. Waiters tip deformity
● Klumpke palsy: C8-T1- claw hand. Supination, extension of wrist, MCP extension,
flexion of IP.
● MOI: traction with ABD

Guiallan Barre Syndrome:

● Distal to Proximal
● Caucasion Males
● Respiratory life threatening
● Demylenation

Huntingtons Disease
● Degeneration and atrophy of basal ganglia
● Involuntary choreic movements
● Mild personality alteration
● Unintentional facial expressions (grimmace, tongue protrusion, eyebrow elevation)
● Emotional Disorder worsens over time

Multiple Sclerosis:
● More likely in woman 20-35
● Relapse remitting 85%.- progressive secondary, progressive primary, progressive
relapsing
● 50% in wheelchair in 15 years

Parkinson’s Disease
● Decrease in production of dopamine
● Basal ganglia deteriorates → less dopamine
● Hypokinesia, akinesia, COGWHEEL or LEAD PIPE rigidity or skeletal mm.

Sciatica Secondary to Herniation

Spina Bifida:
● Failure of neural tube closer by day 28
● Myelomeningocele
● Arnold chiari type 2 malformation, clubfoot, bowel and bladder dysfunction
● Alfafetoprotein 16 wks

C7 Tetraplagia:
Spinal shock: total flaccid, loss of reflexes and sensation
A halo device
45 years mortality
L3 Paraplagia:
TLSO may be indicated. KAFO.

TBI:
Most common cause is falls and MVA.

Vestibular:
Whiplash and head innjury is most common. Treated with anticholniergic, benzodiazepines

Anterior cord syndrome: best recovery is within 24h

Lymes: bulls eye pattern rash

Myasthinia gravis:
Acetylcholine receptors get destroyed, proximal to distal

Mania:
DSM-5
● Levadopa: high dose nausea. Can also cause cardiac arhymias
● Dilantin, Valium, Neurontin : Seizures
● Mass movement patterns are similar in concept to overflow, but refer specifically to the
hip, knee, and ankle moving into flexion or extension simultaneously.
● Chopping is a neuromuscular technique that uses a combination of bilateral upper
extremity asymmetrical patterns performed as a closed chain activity.
● Overflow is a proprioceptive neuromuscular facilitation concept that refers to muscle
activation of an involved extremity due to intense action of an adjacent muscle or group
of muscles.
● The muscles of the eye are typically the first muscles affected in myasthenia gravis. The
condition ultimately results in extreme muscular weakness. Often, initial symptoms
include diplopia, ptosis, and squinting of the eye.
● Suprascapular nerve does not have connections to all the trunks
● Common sites of injection are the gastrocnemius, hamstrings, hip flexors, and hip
adduct
● Anterior division obturator adductor longus

Cardiovascular
Pericardium: double walled connective tissue that surround the outside of the heart

Base: is 2nd intercostal

Apex: is the 5th intercostal space/ mid clavicular line

Left coronary artery → circumflex artery → left anterior descending artery

Right coronary artery → sinus node artery → right marginal artery → posterior descending
artery

Chronotropic effect - heart beats faster

Ionotropic Effect- greater force of contraction

Barorecepter - detects pressure changes in heart vessels

Bainbridge: increase in venous return leads increased heart - inhibit parasymphetic

Normal stroke volume : 60-80

Rbc make up 40% of the blood

Accessory muscles that help with inspiration are scalenes, pec minor, pec major, serratus
anterior

Upper respiratory tract goes from nose to larynx

Lower respiratory tract goes from larynx to alveoli

ERV = 15% TV
IRV = 50% TV
FRC = 40% TV
VC = 75% TV
RV = 25% TV
IC = 60%
TV = 10% TV
TLC = 100% TV

Ribs 1-7 are true ribs. 8-10 false ribs. Ribs 1, 10, 11 and 12 articulate with only 1 vertebrae.

During forceful: external oblique, internal oblique, external oblique and transversus abdominus

Respiratory bronchioles and alveolar sacs are respiratory zones.

10% CO2 in dissolved in blood

VSD most common congenital heart defect

S4 correleated to hypertension

S3 correlated to CHF

Blood Pressure NEW Guidelines

● Normal: Less than 120/80 mm Hg;
● Elevated: Systolic between 120-129 and diastolic less than 80;
● Stage 1: Systolic between 130-139 or diastolic between 80-89;
● Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;

●
ABG Element Normal Value Range

pH 7.4 7.35 to 7.45

Pa02 90mmHg 80 to 100 mmHg

Sa02 95-98%

PaC02 40mmHg 35 to 45 mmHg

HC03 24mEq/L 22 to 26mEq/L

HCO3: 22-26
SaO2 95-98%

Hypoxemia/: mild 80-60, moderate 40 60 severe <40

CKMB- 48-72hrs
Troponin- 5-7 days

Low hematocrit: anemia, blood loss, mineral deficiencies

Normal hematocrit: adult: 39-47

Hemoglobin: females (12-16) and male (13-16)

LDL: more than 100 is bad

HDL: 40-60
Triglyceride: 150 is desirable

Ambulatory electrocardiography: ECG recorded 24-48hrs

Angiography: plaques

Bronchoscopy: Visualization of the bronchial tree

Cardiac catherization: the test canb evaluate narrowing or occlusion of coronary artery

Cardiac ultrasound: sound waves used to examine/visualize structure of carotid arteries.

Evaluate health of artiery, and placement of stent

Chest Radiograph: visualize location, size, shape of heart, lungs, blood vessels and bones of
spine. Can also reveal fluid in lungs or pleural space

Echocardiography: size and function of ventricles, thickness of the septums, function of the
walls and valves, and chambers of the heart
Invasive hemodynamic monitoring: wan ganz catherted to obtain pulmonary artery pressure and
left atrial pressure. Central venous measures vena cava and right atrium.

Myocardial perfusion imaging- check perfusion in heart

Pharmacological stress testing: unable to exercise adenosine, dipyridamole and dobutamine

Phenocardiography: detection of s3 and s4 heart sounds

Pleroscopy: pleura, lung surface

PET is metabolic activity mostly for cancer

VQ scan: gold standard for PE

ACE: prils

Antiarthymias: Clas 1 NA, Clas 2 beta vlockers, class 3 prolong repolarization, Class 4 calcium
channel blockers

Anticoagulant: long term

Antithrombic: Inhibit platelet aggregation. Used for post MI, A-Fib and clot formation. Side
effects are hemmorhage, liver toxicity. Eg. aspirin, plavix
 Beta Blocker Agents: decrease myocardial O2 demands via decreasing HR and contractility.
Used for hypertension, angina, arrythmias, heart failure. Side effects are orthostatic
hypotension, HR and BP response will be diminished.

Calcium channel blocker: diminished contrction vasodilation decreased oxygen demand.

Verapamil, cardizem, procardia

Ca Channel Blockers: decrease entry of Ca into smooth mm → diminished myocardial

contraction, vasodilation and decreased demands for O2 demand in heart. Used for
hypertension, angina pectoris, arrythmias, CHF. Side effects, orthostatic hypotension

Diuretic Agents: increases excretion of sodium and urine, Used for hypertension. Sideeffects
are dehyrdation, hypotension, electrolyte imbalance, arrythmias

Nitrate Agents: decrease ischemia, angina pectoris. Sublingual administration most ideal for
consuming meds

Positive Ionotropic Agents: increase force and velocity of myocardial contraction, slow heart
rate, decrease conduction velocity throufh AV node.

Thrombolytic Agents, break down clots. Hemmorhage are side effects. Avoid situations that may
cause trauma d/t altered clotting activity

Atherectomy - shave off the plaques to increase blood flow

AICD: implanted to restore heart rhythm

NBG: paced, sensed, response sensed, rate of modulation, pacing multisite

CABG: treats narrowed coronary artiereis. Blood rerouted to affected artery joining saphneous
vein

Intra-aortic Balloon Counterpulsation: circulatory assistance aftercardiogenic shock

Valve Replacement: prosthetic valve implanted in heart to replace old shitty valve

Enhanced Extracorpreal Counterpulsation (EECP): compresses the veins helps with venous
returns

Symphahomemetics: albuteral, atrovent

Expectorant Agents: mucinex

Mucolytics: decrease viscocity

Endotracheal tube: into the trachea

Bullectomy: one or more of the large air spaces called bullae are removed when alveoli is
destroyed due to emphysema

Chronic hypoxemia: < 55mmHg.

Indications for Tracheostomy: airway obstruction at or above the level of larynx and respiratory
failure

ABI levels.
>1.3 Rigid Arteries, PAD
1-1.3, Normal
0.8-1, Mild Blockage, beginning of PAD
0.4-0.8 Moderate Blockage, intermittent claudication
<0.4 Severe Blockage, claudication at rest

Angina pain scale:

1-mild
2-moderate
3-moderate severe
4-most severe

Phase 1 first appearance of sounds

Phase 2 soft
Phase 3 crisp
PHase 4 muffled
Phase 5 sounds disappear

Aortic 2nd sternal border right

Pulmonic 2nd left sternal
Mitral 5th
Tricuspid 4th

Normal breath sounds: tracheal and bronchial sounds over trachea, inspiratory shortern than
expiratory. Bronchial over distal airways are abnormal!!!

Vesicular breath sounds: high pitched breezy sounds normall over the distal airways.
Inspiratory phase is longer than expiratory!!

Abnormal: adventitious. Crackle high pitched heard during inspiration indicative of COPD or
restrictive
Pleural friction. Dry craclking

Rhonci: low pitched sounds describe as having snoring or gurgling obstructed

Stridor: high pitched UPPER AIRWAY

Wheeze: small airways

Bronchial breath sounds bronchial where vesicular is

Bonchophony 99
Egophony E to A
Whuispered pectoriloquy recognition of whispered

Cant hear high pitched

BMI - if you dont know this by now leave PT (18-24)..its a joke meant for me

Claudication pain: 1-4. Discomfort, can be distracted, cant be distracted, unbearble. Wmph at
constant grade between 0-12%

Normal capillary refill is 2 seconds or less

Borg dyspnea: 3 is moderate, 7 is very severe

Normal PR: 0.2

Normal QT: 0.2- 0.4

ST: ventricular repolarizaion

Atrial flutter is more regular and a fib

1st degree: pr longer than 0.2

2nd degree type 1: long until 1 drops

2nd degree type 2: pr intervals are the same until 1 drops
3rd degree impulses are dropped

Vtach: 3 more consecutive PVCS at 150 beats per minute LIFE THREATENING

V-fib: no cardiac output patient is unconcious requires CPR and medications

Signs of MI: st segment elevation 1-2mm, st segment depression sign of subendocardial

ischemia due to digitalis toxicity or hypokalemia, q wave lagr than r wave , t wave inversion
ABSOLUTE CONTRAINDICATIONS TO EXERCISE: drop in SBP > 10mm, severe to
moderate angina, perfusion issues, 1mm ST segment elevation. v-TACH

RELATIVE INDICATIONS: 2mm ST, same drop in SBP, chest pain, hypertensive SPB > 250 or
DBP> 115

Percussion sounds:
Tympany large pneumothorax
Hyper: emphysema
Flat or dull: atelactasis or consolidation, neoplasm
Pulse grading: 0 absecense
1 small
2+ normal
3+ large rebounding

FEV1/FVC < 70 obstructive

Restrictive > 80

RPP: HR x SBP

RPE scale: 3 moderate 5 strong, 7 very strong

RPE 20: ver very light 7, somewahat hard 13, hard 15 PAGE 433

Normal inspiration ration 1:2

Breaths per minute 12-20 adults, new born 33-45

Kussmail deep and fast breathing associated with metabolic acidosis

Cheyne stokes indicative of CHF decreasing rate and depth of breathing
Biots, irregular breathing due to damage to medulla

Six minute walk test: used to measure functional status

Waist circumference 40 males, 35 females

Normal exercise crap: no change or moderate decrease in dbp, increase in SBP 8-12mm HG
per met

Chronic adaptations: no change in most of them at submaximal

ACB technique for breathing: normal breathing to deep breath to forced expiratory

Autogenic drainage: unsticking, slow breath through nose then exhale out
Collecting phase: breath at tidal volume
Evacuate is: deep to huff similar to ACB

Contrindications: 20mmH > incranial

Postural drainage: page 438

Anterior basal: head down

Superior segment of lower lobes: brone
Posterior basal head down
Lateral basal head down

Diaphramatic: semi fowlers position. Sniffing is a good start dominant hand on abdomen

PFLEX for building resistnce and strength 30-40% for 10 15 increasing to 20-30 3-5 times per
week

Breathing: basal atelatasis: sitting

Sidelying affected up

PHASE 1:
Discontinue if HR > 130
DBP 110
Decrease in sbp 10

Protocol: RPE <13

<120 bpb or <20 above resting

PHASE2:
SBP over 250
Dbp 115
St segment 1mm

Light 3, mod 3-6, vigorous >6

Light: walking 2.0

Mod: walking 3
Vigorous: walking 4.5 or jogging etc
Biking 12014 vigorous

12-16 id 60-80%
6-11 30-55%

CHF:
Orthopenea
Sudden weight gain
Framingham scale
No S3 in corda pulamane

Cystic Fibrosis:
Autosomal recessive, caucasians moe likely
High sodium and chloride in sweat, salty
Sodium greater than 60.
Mucuous in alveoili life expectancy 35 yrs

Emphysema:
Enlargement of air spaces distal to the terminal bronchioles
Loss of elastic recoil, airway collapse during exhalation
Paraseptal destroys alveoli
Decreased Pa02
TLC, FRV, RC increased rest decreased
Presents with tight pectorals, rounded shoulder, subcostal angle barrel chest
Cor pulmonale is a serious complication that can occur with advanced emphysema
Bronchiactases inflammation leading to dilation and destruction of bronchial walls

MI

Transmural full thickness, subendocardial inner third. Zones infarct, hypoxic, ischemia
Most common: left coronary artery anterior descending
Most common post complication is artyhtmias
Angina due to 90% coronary artery disease

Peripheral artery disease: elevate 4-6 inchest head

PVD 30 50

Restrictive: ERV is normal RV normal

TB causes fibrosis in lungs

Stable angina does not last mor than 15 min. Inverted t wave
HYpetension 140/90
Marfans and anurysm
Most common cause of atelactasis surgical anesthesia
Pericarditis due to viral infections, sharp pain
Venous insufficiency hyperceratoniss

ARDS and PE can cause cor ulomanle

Noncardiogenic build up of fluids due to permeability of the capillaries
REspiratory alkalosis h decreases as compensation
Sarcoidosis abnormal collection of inflammatory cells known as granulomas Lofgren

40-85% target zone

Early phase 11-13

When using an oral airway oscillation device, how many exhalation repetitions would be the
most desirable before the two large exhalations? 15
Laminar blood flow occurs when fluid flows in parallel layers without disruption between layer.
Non audible
high repetitions at 40% of one-repetition maximum
Pulse pressure over 40 is cardiovascular risk
Progressing cardio modulate duration first, 20 minutes without rest if can tolerate increase that
shit
Which of the following patients would most likely need to use a rating of perceived exertion scale when
self-monitoring exercise intensity? Neuropathy listen to omar
Fetid: smelly
Frothy: PEdema
Purulent infectious
Condition in which fluid collects in the lungs' air sacs, depriving organs of oxygen.ARDS
Maintain same heart rate - even with heat ilness, theyll ge tthere faster even with lowest intensity
Vigorous 3, 20 min
Symptoms of pacemaker malfunction include dyspnea, dizziness, bradycardia, chest
pain, and edema.
Submaximal 85%

Other systems:
Wound healing: inflammatory 1-10, proliferative ..keratinocytes, fibroblasts, endothelial 3-21,
maturation 7 days to 2 years
Red raise rigid
Pale plaible flat

Contamination no inflammation process

Colonization: does not invade or stimulate but can delay wound healing
Laceration irregular tear of tissues due to trauma
Penetrating usually is organ

75mg insesate
PAge 503
Superficial wound: non blistering epidermis intact
Partial thickness: epidermis gone blisters epithelization
Full thickness through dermis
Subcunatous through integumentary tissues
Wagner classification
NSDDGG
No open lesion
Superficial not involving sub
Deep sub
Deep osteo
Gangrene digi
Gangrene foot
0-5

Pressure Ulcer Staging

Stage 1 superficial non blanchable
Stage 2 blisters
Stage 3 full thickness subcutaneous slough
Stage 4 full thickness exposed 4mm
Un-stageable
Deep: purple or maroon localized areas of intact skin or blood filled blisters. May further evolve
and be covered in thin eschar

Don’t remove eschar on heels

Medial epicondyle supine

Serous: clear normal

Sanguineous red color new blood vessel growth
Serosanguneous: lgiht red or pink color. normal
Seropurulent cloudy or opaque. early sign of infection
Purulent yellow or green thick color. infection

Eschar dehydrated

Enzymatic can destroy vital tissue but work son infected

Autolytic pain free dont use on infected

Wound irrigation is ok with infected

High volt: angiogenesis, increase oxygen perfusion etc

Alginate”require secondary dressing used on partial and full thickness and infected wounds

Hydrogel superficial to partial thickness

Hydrocolloids: partial to full thickness anchors intact skin and absorbs exudate

Transparent permeable to oxygen superficial to partial thickness

Gauze does not enable autolytic.

Hydrocolloids attach to intact surrounding skin. Used effectively with granular or necrotic
wounds

Most occlusive: hydrocolloids, hydrogel, semi permeable foam semi film, impregnatez gauze,
alginated, traditional

Most to least retentive

Alginate foam hydrocolloids hydrogels films

Contusion surface of skin

Hematoma confined to tissue or organ
Hypergranulation exceeds the surface
Keloid goes out of boundaries

CSH . Coagulation statsis hypermia

15-35 venous mg, 22-23hr

Acetate for eschar painful metabolic acidosis, nitrofurazone painful

Iodine antifungal

Phenylketonuria: intellectual disability and cognitive

Osteomalacia is bone becoming softer

Osteoporosis is decrease of bone mass
Pagets Disease is heightened osteoclast ativity

T score lower than -1 but greater than 2.5 is osteopenia

Osteoporosis -2.5 or lower with fracture is severe

Pituitary gland: sex hormones, pain emotinal stress

Thyroid gland: control rate of metabolism

Parathyroid: antagonist to calcitonin. PArathyroid hormone increase the reabsorption of calcium

and phosphate from bones. Secretion situmation by hypocalcemia.
Adrenal gland: epinenphyrine stress hormone
Pancreas: insulin

Catecholamines: dilate airways, constrict blood vessels, block insulin, activate glycogen
breakdown

Pituitary: oxytocin, throid, adrenocorticopic, antidieretic, luteinizing, follicle stimulation, growth

Aldestrone: increase sodium

Epi: dilate
Pancrease: glucagon
Parathyroid: increase blood calcium
T4 t3 increase rate
Calcitonin: increase calcium storage in bone opposite of parathyroid

Cushing: hyperglycemia, growth, mon shape buffalo hump, hypertension, excessive

glucocorticoid

ORthostatic hypotention in hyperpituitatrism, bilateral hemianopsia

Hypothyroidism: proximal muscle weakness

Hyperparathyroid: decrease serum phosphate, gout, renal hypertension
Hypoparathyroidism: shortened 4th 5th metacarpal, cardiac arthymias common sense,
increased neuro activity

Hyper: 180 +, dry muth ketoacidosis

HYpo: 70
Short stature hypopituitarism

Fasting glucose over 125 is bad 100

Oral glucose: if over 200 is bad 140
A1c greater than 6.5% is bad

Hep BC are virus

A is feval oral route or contaminated water

Anticholinergic decrease gastric acid

Antiemetic: sedative, mine, zine, ergan

Emetic induce comitting: ipecac, morphine

PPI: can be effectibve against h plyori

Urogenital triangle: bis

Kidney failure gfr les than 15

2-3 mild 4-5 severe diastatsis recti

AVOID SUPINE AFTER FIRST TRIMESTER
CONTRADINIDACATIONS PREGNANCY: 549

Oligouria: inadequate urine les than 400

Dynamic lymp insufficiency: too much fluid usualyl causes pitting edema

mechanical “ damage

Lymphoscintigraphy preferred

Mild: mod: severe: 3-5

Staging lymphedema: 0-3 stemmers positive with stage 2, elephantitis 3

Short stretch for lhymphedema: gradient from high to low distal to proximal

Milroy bilateral edema

Papiloma: bening stage 3
Cancer caution page 556

Stage 0-4 cancer: layers of the cell, limited to tissue of origin, begins to spread lymph (2), latest
stage is to bone or other organ

Alyklating: bind to dna

Antisocial blame others

Conversion no underling cause of illness

Hyoichondriassi excessive fear of illness

Child overweight 85-94 obese 95+

Vitamin E antioxidant
B12, copper hemoglobin
Ginseng reduces effects of anticoagulants
Kava liver toxicity
Enteral: oral, sublingual rectal

Schedule 1 highest abuse no known therapetuic benefits

Schedule 5 available without pres

Drug testing: stage pre to 4

Safe dose phase 1
Low therapeutic index = less safe
Myeloma plasma

ulcerative colitis no yellow

Diseases:
Ankylosing Spondy:
HLAB27 - high risk
20-40yrs
Breathing if costovertebral jts involved. Elevated erythrocyte sedementation rate
High impact flexion contraindicated
Sjogren: women mostly post menopausal chronic arthritis

Arterial insufficiency:
Yellow nail
Nailkd bed cyanatic
Surronding skin pale

Breast cancer:
90% self examination, most comon complication pleural effusion

RDS:
Stage 1: edema thermal changes
Stage 2: trophic changes
Stage 3: atrophic changes to finger tips or toes decreased temp

Diabetes type 1: exercise 50-60

a1C levels for type 2 diabetes. DM is the leading cause of kidnet failure new blindress and non
traumatic le amputations

Fibromyalgia:
Dolorimeter, 3 months. Axial + 11/18 standaraized tender point. Woman 30s
Myofascial is trigger poitns not tender points and lacks associated symptoms

HIV:
Stage 1 is highest risk for transmitting flu like symptoms
aIDS when cd4 falls below 200

JRA:
Pauciarticular JRA involves 4 or less joints asymmetric and mild
Stills disease is systemic JRA: hepatospelemnomegaly myo and pericarditis.
Esr RHEUMATIC

SLE:
Microscopic fluorescent techniques asre indicated to detect ANA
Can lead to kidney failure

Graves:
Excessive tear drops, double vision, sensitivity to light, hyperthyroidism of thyroid gland

Dastesis Recti:
No double leg lifts, no crunches in supine, no supine to long sit. Can fuck up rectus abdominus

Addison:
Hyperpigmentation of skin and mucous membranes ACTH definitive

Appendicitis: hips flexed relieved

Chron’s Disease:
Inflammation of GI tract

IBS:
Does not result in structural changes to intestinal tissue unlike Chron’s disease

Gout:
Uric acid buildup, typically in big toe
Reynauds phenomenon:
Cold fingers

Sclerosis: excess collage, reddish white

Ulcerative collitis: most often affects signmoid colon, innermost lining

Uterine cancer: vaginal bleeding

Fibromyalgia child-bearing
Baclofen t12-l1 admoninal wall

99.5 above fever oral

Palliative have no efect on disease ie. morphine

intramuscular route anelgesic no

system resulting in increased heart rate, pale and moist skin, anxiety, and tremors.
Hypoglycemia

Rickets is the softening and weakening of bones in children, usually because of an extreme and
prolonged vitamin D deficiency
Sulfamylon metabolic acidsosis
The epidermis contains keratinocytes, Langerhans cells, melanocytes, and Merkel cells.

Rule of nine dont use with superficial

CA DM diarrhea

Acute lymphoblastic leukemia

Veneous wounds 40mmhg

Darkgreen folic acid

Endometriosis tissue inside builds otuside of uterus
Pregow

Induration fibrous
Percussion test assesses vein insufficiency saphenous

MODALITIES/ETC

Two person lift: transfering pt’s on two different levels. 1st therapist arms under axilla, second
distal thighs. Therapist at head commands lift
Dependant Squat Pivot: pts that cant stand independantly. Pt positioned at 45 degree angle.
Pt put hands on therapists shoulders, but do not choke therapists neck!
Three person lift: towards head leads
Sliding board transfer: pts that have some sitting balance, some UE strength, can follow
directions. Place lead hand 4-6 inches away from sliding board
Stand pivot transfer: pt able to stand and bear weight for one of both LE, lead with uninvolved
side
Seat width: add 2 inches 16
Seat depth: subtract 2 from from popliteal space 16
Seat height: 4 inches below axilla. At inferior angle
Arm rest: add 1 inch from elbow

Curved back seat: moderate support for back

Geri chair: can’t self propel and is not safe
Power can’t self propel and is safe

Hemi frame: can propel with lower

Back height above spine is for poor trunk control
Strap and harness for anterior listing

Liquid low shear

PArallel bars 20-25 degrees elbow flexion. Grasp bars 4-6 inches in front of body

Loftstrand: 1 inch below elbow

Guard at the affected side

Cane: grasp and hand rail with same hand, use cane on opposite side of involved extremity

Walker: used with all levels of WB’ing. Has significant BOS, offers good stability. Used in 3
point gait

Axillary Crutches: requires higher coordination for proper use. No greater than 3 finger widths
from axilla. Used with 2 pt, 3pt, 4pt, swing to and through gait patterns
Feeding Devices
NG tube - nostril
G tube - abdomen
J tube - jegenum
IV system - basilic, cephalic, antecubital (veins in arm)

Central venous: right atrium, ventricular function superior vena cava

Indwelling right atrial catheter: into cephalic vein into right atrium for substance administration

Arterial line: can be used for blood samples as well as blood pressure

Nasal Cannula - one cm in pt’s nostrils

Tent higher than normal oxygen
Oronasal mask can be used to adminster medicatoins
Tracheostomy Mask- places over stoma or trachesotomy to give supplemental O2
Balanced suspension requires imobilization
Ostomy waste from abdominal

CT high radiation
Fluoroscopy is for movement
Myleography - x-ray+fluroscopy+ contrast dye for spinal cord, n. Roots, meninges
NCV - measures speed of electrical implulse
PET - invasive, uses radiography to determine metabolic activity
Ultrasound sound wavse that can show movement and image cause its done in real time

RAdiopaque bone
Conversion ultrasound and diathermy

Pg 702
Cold pack 20 min. 30 min for spasticity.

92-96 spasticity
32-79 inflam 79-92
99-104 pain

Spray 12-18 inches at 30 degree angle

158-167 hydrocoll skin check within first 10 min

Infrared light 20 inches

Low bnr is safe

An area 2 3 times is 5 min

Chronic ulcer owund, acne, psoriasis, sinustisi, vitamin D
Highboy - up to chest
Lowboy - up to thoracic cage
Contrast bath: Hot 4 cold 1
Long stretch low working

Multi layer venous stasis

Dvt 16-18
Large current flow decreased current density. Decreased impedance, increased flow

Conventional used with activites of daily living

Pg 730

CT SCAN is best for looking for blood leakage

posterior leaf spring orthosis least restrictive

Bracing is typically used in patients with 20-40 degree scoliotic curves
What is the most common method of patient-controlled analgesia? Itnrave
Positive sharp waves are muscular dystrophy
55-64 degrees Fahrenheit
Low boy long sitting
80-90 mm Hg is an appropriate pressure for the lower extremities, while 40-60 mm Hg
would be appropriate for the upper extremities.

fibrillation potentials lower motor neuron

Compresion garments less than 20
Capillary refill is most importnat to monitor
Muscle largest heat caspacity
Static: acute conditions
30 degrees flexion
Manual most specific
25% treats disc protrusion

RESEARCH! SAFETY ETC

Gowns: for splashing of any fluids

Airborne: private room negative pressure, respiratory protection when entering room, TB,
measles, varicella

Droplet precautions: maintain at least three feet room door may remain open wear mask...flu,
pneumonia

Contact precautions: use of gloves, wear gown if you have substantial contact, do not share
equipment. Hep a, herpes simplex virus, most skin infections

Nosocomial Infections: hospital acquired infection

Heat stroke: dry skin, rapid pulse, flushed color, nausea, headache elevated temperature
dilation of pupils

Body temperature less than 95 is a medical emergency

LAceration: elevate the limb, call EMS if doesnt stop afer 10 minutes of steady pressure
Inward and upward force choking.

Compression rate - 100-120

Adult: 2 inches, 2 inches children, infants 1.5 inches

1 breath every 6-8 seconds 8-10 breaths per minute

Half knee and power require you to maintain lumbar lordosis

Wheel chair door way 32 inches, turning radius 60 inches

Nagi model: pathology, impairment, functional limitation, disability

ICF model: body function, body structure, impairments, activity, participation, activity limitation,
participation restriction, environmental factors

Non maleficience: do no harm

Paternalism: fails to recognize autonomy
Veracity: obligation to tell the truth

Medicare Part A: hospitals

Med B: outpatient

Extinction: removing variables that reinforce behavior

Transtheoretical: precontemp etc…
Health belief: susceptibility etc…

Bargaining: good behavior deal with higher being

Multidiscip: multiple inolved thorugh records only

Inter: several involved but functon independently reporting occasionally
Trans: team goals established over individual goals

Case control: retrospective particular disease matched with a comparison group of individuals
withotu disease
Cohort, case, cross.

Test-retest: consistency or equivlance of repeated measurements made on the same individual

on seperate occasions

Face validty: degree to which it measure what its supposed to

Content validty: the degree to wihch a measurement reflects meaningful elements of a construct
Construct validity: the degree to which a theoretical cosnruct is measured by a test

Criterion related validity: compare to different measurements to be a gold standard

- Cocnurrent: compare to gold standard
- Predictive”: predic future event
- Prescriptive: form of criterion related to the validity to which they should receive
treatment

Systemic sampling every n population

Stratified random sampling: stratify homogenous first then simple random sample drawn
Cluster: divide into clusters ie geographical

Purposive: selected based on predefined criteria

Quota: stratified without randomization
Snowball: asking participants if they know anyone

Cross over design: same subjects for both treatments

Repeated measures: same subjects used

Quasi: one group of subjects before and after

Single blind: subject doesn’t know

Double subject and some research don’t know
Triple double plus data analyzed dont know

Internal validity: independent cause the result

Probability of rejecting null when its true

68 95 99

One way: one independent

Two way to independent t test

Chi square for nominal

Kruskall: 3 or more from independent samples come from same population
Man whitney, wilcoxon - ordinal

Incidence new
Prevalance existing
Non Systems:

When to use Metatarsal pad

• Takes pressure off the metatarsal heads and onto the shafts
• Allows for more push off in weak or inflexible feet
• For Sesamoiditis, Metatarsalgia, Morton’s neuroma, Diabetic neuropathy

When to use UCBL

• A semi rigid plastic molded insert
• Flexible pes planus (flat foot)

When to use Scaphoid Pad

• Used to support longitudinal arch When to use Thomas Heel
• Wedge with an extended anterior medial border to support longitudinal arch
• Help correct for flexible pes valgus (pronated foot) When to use forefoot/rearfoot for
valgus/varus posts
Forefoot postings
• Use to influence how forces are transferred across foot for gait
• Forefoot medial wedge - for forefoot pronation / forefoot varus
• Forefoot lateral wedge - for forefoot valgus
Rearfoot postings
• to change the actual position of the STJ
• Rearfoot varus post (medial wedge) - controlling calcaneal eversion and tibial internal rotation
• Rearfoot valgus post (lateral wedge) - controlling calcaneal and STJ inversion and supination

AFO

Know what diagnosis would benefit

• Foot drop, SCI, Strokes, Parkinson’s Disease, Cerebral Palsy

When to use Dorsiflexion assist vs stop

• DF assist = used for neurological conditions like foot drop and helps with DF (post leaf spring)
• DF stop (anterior stop) = limits dorsiflexion and allows knee flexions to occur

When to use Plantarflexion stop

• PF stop (post stop) = used to treat knee hyperextension, tight plantarflexors, and fibular nerve
paralysis
o limits PF and helps promote knee extension

When to use Posterior Leaf Spring

 • Helps positions foot in Dorsiflexion during the swing phase • Best for weak anterior tibialis
muscles 3 / 5 strength and Foot drop • For patients to have good medial to lateral control of the
ankle

When to use a solid AFO vs the others

• Used when there is decreased stability of the ankle it allows no movement
• Cam boot for acute injuries or diabetics

Recognize pressure points

• Pressure tolerant = gastrocnemius, lateral fibular shaft, medial tibial shaft
• Pressure sensitive = anterior ankle, malleoli, fibular head due to superficial fib nerve

What are some compensations would be seen and the cause of gait deviations
• Steppage gait = weak dorsiflexors during mid-swing to clear the toe
• Knee hyperextension = PF contracture or weak quads
• Foot drop = weak dorsiflexors

KAFO

What diagnosis may be seen using this orthotic

• SCI, CVA, TBI, Parkinson’s Disease

What conditions would be appropriate

• Weak quads, tight hamstrings, femoral nerve injury, flexion/extension ROM stability

Recognize pressure points

• Pressure tolerant = lateral flare of the tibia, supracondylar areas
• Pressure sensitive = femoral condyles, patella

Compensations / Gait deviations that would occur during the gait cycle
• Leaning back = weak hip extensors (trouble going UP steps)
• Excessive knee flexion = weak quads/spastic hamstrings (trouble going DOWN steps)
• Hip hike = weak quadratus lumborum
• Knee hyperextension = weak quads, PF contracture, spastic hamstrings

Prosthetics

Recognize pressure points

Trans-tibial
• Pressure tolerant = Suprapatellar area, Patellar tendon, Medial flare of tibia, Lateral Flare of
fibula, Posterior area of the stump, Popliteal area
• Pressure sensitive = Lateral tibial Condyle, Tibial tuberosity, Tibial Crest, Anterior Distal, End
of Tibia, Fibular Head, Distal End of Fibula, Distal end of stump with surgical suture, Medial
Femoral condyle

Trans-femoral
• Pressure tolerant = Ischial tuberosity, Lateral, Medial, Anterior and Posterior Flares of the
stump, Gluteals
• Pressure sensitive = Greater Trochanter, Ramus, ASIS, Adductor Tendon, Distal End of
Femur, Inguinal Fossa, Pubic Tubercle, Surgical Suture, Perineal Area

What are some gait deviations seen

• Abduction = high medial wall; misshapen lateral wall; prosthetic set in abduction
• Circumduction = prosthetics too high
• Trendelenburg = prosthetic is too low
• Vaulting- prosthetic is too long
• Excessive knee flexion = prosthesis is too long, stiff heel
• Medial/lateral whip = excessive rotation at the knee, tight socket fit

Assistive Devices

When to use a roller vs standard (conditions - CVA, Parkinson’s, THR, CP)

• Rollator = facilitates walking as a continuous movement, allows patient to rest, has hand
brakes, allows for increasing speed (Parkinson's)
• Standard - slows down gait speed; may or may not have wheels

When to use a platform attachment

• When there is a radial nerve injury, a forearm fracture, unable to put pressure on the hand

Extra stuff:
MRI: sensitive - rules out. Identifies true positives.
Mechanical compression 3:1
Content validity measures more

Visual cerebllar, basal ganglia: post

middle
anterior

vegetaibe state: locked in, speach, vertigo, ataxia, vertebrap basilar (cerbellum)

wallen contra pain and temperature ipsi face

fugle meyer- hemiplegia

sebacious and meissners

intravmuscluar

30-150 50-100

Balance grades
Bobath
CPT is for innervation

Bobath brunstrom rood kabat

cranial als

bobath
ndt is bout posture and inhibiton

ovrflow etc pnf

Environmental factors such as clinic location, parking, time spent waiting for the therapist, and
type of equipment
hand pro ffric s 567
2-3

30 pounds
15 for bulge muscle spasm

a p per

92-96 spas
99-104 p
79-92 exer
39-79