Term
| When doing a PT Assessment in the Acute rehab setting, what percentage of patients come to you with skin integument problems? Thus you should or should not check skin? |
|
Definition
| 50% of her patient come to Madonna already with a skin related issue. Yes almost the number one thing to think about. |
|
|
Term
| what are the two main focuses for the ASIA standard neurological classification of SCI? |
|
Definition
|
|
Term
| what are the primary tone and deep tendon reflex levels to assess in the acute seeing? |
|
Definition
C6- Biceps
C7- triceps
L3/4- Quad
S1- Achilles tendon |
|
|
Term
| What is another huge assessment in the acute setting that sometimes has to pushed to the sub-acute phase due to activity precautions? |
|
Definition
| FIM- Functional Independence Measure |
|
|
Term
| Motor/ Strength assessment of key muscles with the ASIA. what are the individual classifications for grades 0-5? |
|
Definition
0= total paralysis
1= palpable or visible contraction
2= active movement in gravity eliminated position
3= active movement against gravity
4= active against some resistance
5= active against full resistance |
|
|
Term
| what do the Sensory readings for light touch and pinprick mean for (0-2, NT)? |
|
Definition
0= absent
1= impaired
2= normal
NT= not testable (TLSO, Cast blocking) |
|
|
Term
| How is the motor level classified for the ASIA? |
|
Definition
| the motor level is defined by the lowest key muscle that has a grade of at least a 3 bilaterally with all superior levels testing normal with a 5. |
|
|
Term
| Describe the different ASIA classifications (A-E)? |
|
Definition
A= complete SCI, with with no motor or sensory function preserved in the sacral S4/5 region (sphincter region).
B= incomplete, Sensory but no motor function is preserved below the neurological level.
C= incomplete, motor function is preserved below the neuolocial level, and more than half of the key muscles below the neurological level have a muscle grade less than 3.
D= incomplete, with at least half of the key muscles below the neuro level have a muscle grade greater than or equal to 3.
E= normal... motor and Sensory function is normal... |
|
|
Term
| what major muscle groups are innervated with a C6 complete (ASIA-A) SCI? |
|
Definition
| biceps, deltoids, wrist extensors, upper traps |
|
|
Term
| prone positioning in the acute rehab setting is? |
|
Definition
| as tolerated by the patient |
|
|
Term
| Contraindication for paraplegia patients with ROM and Positioning? |
|
Definition
Trunk movements- upright position, use bracing
Hips - SLR >60 degrees; Flexion (knee/hip) >90 degrees |
|
|
Term
| Contraindications for tetraplegia/ Quadriplegia patients and ROM/ Positioning? in the acute setting? |
|
Definition
Head and neck movements without bracing
shoulder stretching- dislocation risk, fracture location |
|
|
Term
Selective Stretching: functional tightness
why use tenodesis grasp? what levels does this affect? |
|
Definition
if you do not have wrist flexors or finger intrinsic, must not stretch the flexor side. this affects C6 SCI or higher
Also do not want to stretch the trunk stabolizer/ lower MM (hamstrings) |
|
|
Term
| Selective Stretching: full stretching of hamstrings in an acute setting, and after acute phase |
|
Definition
| hamstrings SLR to 90 degrees in acute phase, to 100 degrees after the acute phase. |
|
|
Term
Selective Stretching: functional tightness
Do not allow Long sitting in the acute rehab phase until the hamstrings can get to what position? for fear or doing what? |
|
Definition
do not long sit until hamstrings are at 90 degrees, to avoid over stretching lower trunk muscles used for postural support.
use the ring sitting position |
|
|
Term
| do not stretch over _______ sites, to avoid placing ______ over them? |
|
Definition
| over fracture sites, to avoid placing stress over them |
|
|
Term
| Resistive exercises are CONTRAINDICATED in what area for Tetraplegia and Praplegia patients. |
|
Definition
Tetraplegia- Scapular and shoulder muscles
Paraplegia- hip and trunk muscles |
|
|
Term
| what muscles do you strengthen in a SCI patient? but you must always thing about having ________? |
|
Definition
| strenghten all muscles that are available to the patient, but you want to have balance of anterior and posterior muscles. |
|
|
Term
| what UE muscles do you focus on for a paraplegia patient? |
|
Definition
| All UE muscles, with a FOCUS ON shoulder depressors, triceps, and latissimus dorsi |
|
|
Term
| what muscles do you focus on for a Tetraplegia pt? |
|
Definition
| Lower traps, pectorals, Anterior deltoid, shoulder extensors, biceps, triceps, radial wrist extensors |
|
|
Term
Gradual orientation to vertical position can be done after _____ is stabilized?
what are some tools used to help with this issue? |
|
Definition
only after fractures are stabilized prior to movement!!!
abdominal binders and TED hoes can be used to keep BP higher.
Elevation of the HOB slowly and in increments over time
the use of a cardiac chair or high back recline wheel chair |
|
|
Term
| what is the most IMPORTANT thing to teach the family in the Acute care? |
|
Definition
| pressure relief, the patient and the family... emphasize turning in bed every 2 hours. |
|
|
Term
| Mat activities/ progression with sitting and dynamic sitting balance? |
|
Definition
First it depends on the level of the SCI...
fist in short or long sitting, depending on hamstrings
bilateral and unilateral UE support
work on unlocking and locking out elbows (tetraplegia)
Transition from anterior/ posterior (tetraplegia)
work from supported to unsupported
reaching within/ to outside the BOS
lateral leans on elevated, then non elevated surface and back up. (bed mobility skills) |
|
|
Term
| Some activities for transfer training and Mat mobility (its allot) |
|
Definition
TRUNK and LE management stuff
rolling with bed ladder/ rails and leg loops as needed
sit to supine and vise versa using adaptive equipment as needed
supine to long sit and vise versa with/ without adaptive equipment (leg loops, bed ladder) (also work on dressing and self catherterization
wheel chair to bed/mat and back... using slideboard to start and progressing to without as able.... takes alot of strength so think about clearance first. |
|
|
Term
|
Definition
| obstacle negotiation, its for increased distances, turning it on and off, increasing and decreasing speed, accessing tilt, performing pressure reliefs, door button and elevator access, door access, home and community access |
|
|
Term
| Manual wheel chair skills |
|
Definition
| level, uneven surfaces, obstable negotiation, pressure relieft techniques, home and community access, door access, elevator access, curbs, break down and assembly of w/C for loading into and from a car. |
|
|
Term
| teaching floor transfer techniques. what are 2 techniques? |
|
Definition
| a 2 person assist and the beach transfer |
|
|
Term
| Things associated with a wheelchair evaluation? |
|
Definition
pt chooses a vendor and apointment is made.
perform a pressure mapping and trial different W/C options prior to eval.
provide pt education on options needed.
Meet with vendor to spec out W/C and write letter of medical necessity to be submitted to insurance. |
|
|
Term
| what is a good time frame for a person to have one wheel chair? |
|
Definition
| about 5 years, depending on the type and change in status |
|
|
Term
| what are the purposes of a standing frame in rehab? |
|
Definition
prevention of contractures, improve ROM
improve renal function, drain urinary tract
prevent pressure ulcers
improve circulation (orthstatic hypotension)
improve bowel function |
|
|
Term
| what are the purposes of electrical stimulation in rehab? |
|
Definition
| decrease spasticity, maintain muscle tone, circulation |
|
|
Term
| what are some standing activities for pts with LE movement? |
|
Definition
sit to stand, stand to sit: controlled to improve muscle activation and for strengthening. mini squats in standing
static standing with muscle facilitation at quads, abdominals, gluts as needed. facilitate equal BLE WB and upright position
dynamic standing: A/P and Lateral stepping with muscle facilitation as needed, reaching outside BOS, throwing/ catching ball, standing on uneven surfaces, step-ups or toe taps on 2-6 inch steps |
|
|
Term
| Gait training in rehab phase... use _____ as needed. which type is the most common? |
|
Definition
|
|
Term
| gait training in the rehab phase... bioness L300???? |
|
Definition
E-stem on DF instead of an AFO...
stimulates the nerve and has wireless communication for easier use
has switch on the bottom of the shoe to sense when the foot is off the ground and stimulates the DF |
|
|
Term
| Use of Body weight Supported treadmill training and lokomat in gait training acute setting? |
|
Definition
requires 3 skilled therapists- 2 on legs, one on hip
promotes a more symmetrical gait pattern at faster speed to activate central pattern generators and improve gait patter off of the treadmill. |
|
|
Term
| if land therapy is to hard for gait training? this type of therapy is used? and how often per week? |
|
Definition
| Aquatic therapy 2-3x per week |
|
|
Term
outpatient: Wheel chair transfers
ways to make a Floor to W/C transfer easier...
what if only one individual to help one pt back into the W/C |
|
Definition
work on transfers. floor to W/C with a step. or floor to mat to W/C....
also teach the beach transfer...
difficulty of transfer increases if TSLO is on |
|
|
Term
| outpatient: wheel chair FALLS |
|
Definition
| in the occurrence of a fall (cross arms over legs on W/C to keep from hitting in face and flex head to avoid hitting the floor) |
|
|
Term
| outpatient: functional mobility skills |
|
Definition
| slide board transfers, bed mobility to increase independence and decrease use of adaptive equipment as able. |
|
|
Term
| standing frame use in the OUTPATIENT SETTING??? |
|
Definition
30-60 min 5-7x per week
a letter of justification for fram for home use if appropriate...
need to show consistent use and good trial of equipment. |
|
|
Term
OUTPATIENT: Gait Progression
less ore more AD?
increased or decreased speed? |
|
Definition
work toward the lease restrictive assistive device that is possible
increase speed and demonstrate more symmetrical gait pattern |
|
|
Term
| OUTPATIENT SETTING: continue/ initiate these 2 therapies as appropriate |
|
Definition
| aquatic therapy and BW support treadmill training/ LOKOMAT |
|
|
Term
|
Definition
a group of congenital defects of the vertebrae and spinal cord (also skull and brain), that vary widely in functional outcomes
Neural tube defects
"myelomengiocele Syndrome" |
|
|
Term
| the lower the lesion in the lumbar spine for a myelodysplaia lesion, does what to the likely hood of walking? |
|
Definition
| it increases the likely hood the child will walk... |
|
|
Term
| at what day in gestation does the neural tube close completely? and what problem is associated with it and diet? |
|
Definition
the neural tube closes around the 28th day of gestation..
folic acid is needed to healthy neural tube development, but at 28 days alot of mother do not even know they are pregnant yet. |
|
|
Term
|
Definition
a neural tube defect that affects the brain more than the spinal cord.
the child tends to have a brainstem, but not a cortex
these children typically don't life past a month, if that. |
|
|
Term
what is the order of neural tube closure...
superior (brain)
anterior (face)
posterior (brain stem)
thoracic spine
sacrolumbar spine |
|
Definition
fist= thoracic spine
second= superior brain
third= anterior face
fourth= posterior brain stem
fifth= sacro-lumbar spine |
|
|
Term
| the prefix "myelo" means? |
|
Definition
|
|
Term
|
Definition
| a sac with the neural tissues still intact and not involved |
|
|
Term
|
Definition
| a sac that contains neural tissues, the worse kind and normally associated with paralysis... not skin covered (open or viable) |
|
|
Term
| Spina bifida aperta involves what types of neural tube defects? |
|
Definition
a visible or open neural tube defect.
this group involves myelomeningocele, meningocele, and myelodysplasia |
|
|
Term
| Spina bifida Occulta involves what types of neural tube defects? |
|
Definition
this involves hidden neural tube defects
lipomyelomeningocele, lipomeningocele, and lipoma |
|
|
Term
|
Definition
| a sac with nerve tissue involvement. a hidden form of spina bifica occulta |
|
|
Term
|
Definition
| open sac, not nerve tissue involvement, but has fat tissues... a hidden form of spina bifida occulta |
|
|
Term
| Clinical presentation of Sensory and motor impairments with neural tube defects (mylodyplasia)??? |
|
Definition
Alot similar to SCI, but also can have other issues like:
hydropcehphalus/ chiari 2 malformation (80% of those have shunts due to CSF pressure issues)
seizures (15-20%)
Tethered Cord - issues shows up at age 6-12 with growth spurts |
|
|
Term
clinical presentation of specifics myelodisplasia levels....
high lumbar (L1-2)
mid lumbar (l3)
lower lumbar (L4/5) |
|
Definition
high lumbar L1/2- issues with hip flexion and hip adduction
mid lumbar L3- issues with some knee extension
low lumbar L4/5- knee extension, some hamstrings, DF |
|
|
Term
|
Definition
| a banana shaped hind brain, with the cerebellum getting pressed into the foramen magnum... |
|
|
Term
| other orthopedic impairments associated with myelodisplasia ??? |
|
Definition
muscle weakness utero= CLUBFOOT (50%)
contractures in the hip flexors and adductors
hip subluxation- due to muscle imbalances
scoliosis (20%)- congenital or acquired
osteoporosis- due to not wt. bearing |
|
|
Term
| is bowel and bladder impaired with myelodysplasia??? |
|
Definition
| yes, think of my patient Landon |
|
|
Term
| what are the cognitive impairments associated with myelodysplasia? |
|
Definition
| can have a below average cognitive ability.... every shunt infection results in a 10 point decrease in IQ score. which is another reason MD's do not want to place shunts in if they dont have to |
|
|
Term
| % of people with hydrocephalus and myelodysplasia |
|
Definition
| 25% of the children with myelodysplasia are born with hydrocehpaus, and 60% develope it after the closure of the lesion. |
|
|
Term
| are integument and obesity issues associated with myelodysplasia? |
|
Definition
| yes, due to the decreased activity of the pt... 20% of the pts are obese |
|
|
Term
| what allergy is associated with myelodysplasia? |
|
Definition
up to 73% of the pts with it have an allergy to LATEX...
important when thinking about cathing |
|
|
Term
| is upper limb dyscoordination associated with myelodyplasia? |
|
Definition
| yes, C2M- pushing the cerebellum into the foramen magnum... and cordination issues occurs... |
|
|
Term
|
Definition
| pockets of fluid in the spine causing pressure and even tissue death |
|
|
Term
|
Definition
| spinal cord attaches to the surrounding tissues (bone, fat, skin, or other), then in a growth spur, pain and deformity occurs |
|
|
Term
| a common spinal abnormality with myelodysplasia??? and can occur 2 ways? |
|
Definition
scoliosis
congenital and acquired (weakness and positioning issues) |
|
|
Term
| Etiology of myelodysplasia? 4 main associations |
|
Definition
| genetics, medication, nutrition (folic acid), geography (England 2.5 our of every 1000 live births) |
|
|
Term
| Diagnositc methods for myelodysplasia |
|
Definition
Medical screening- looking at mother protein levels.
neuro-imaging: ultrasound for 90% accuracy to diagnose. also if a banana shaped hind brain is seen in the second trimester may be a sign for C2m.
Amniocentesis- huge needle (invasive) |
|
|
Term
| prevention of Myelodysplasia |
|
Definition
diet- foic acid 3 months prior to conception
genetic profiling... expensive |
|
|
Term
| is an osteotomy/ skull decompression surgery still used for chiari 2 malformation on a common basis? |
|
Definition
| No because we use shunts instead... |
|
|
Term
| is a Myelodysplasia a progressive or non-progressive dysfunction? |
|
Definition
| progressive... due to many factors, shunts, hydrocephalus, tethered cored and growth spurts |
|
|
Term
| surgical management for Myelodysplasia? before birth? for hydrocephalus? and for tethered cord? |
|
Definition
intrauterine repair/ closure of the lesion before birth
V-P shunt for hydrocephalus
spinal cord de-tethering |
|
|
Term
| Research for intrauterine repair vs repair after C-section birth. what were the outcomes? |
|
Definition
the intrauterine group had a decreased risk of neonatal death, hydrocephalus, chiaria 2, and of shunts by 1 year with earlier walking...
although there were no decreased risks of cognitive impairments, and an increased risk for tethered cord |
|
|
Term
why a C-section birth for Myelodysplasia
pts? |
|
Definition
| to decrease the risk of infection as the child is born... also decrease the risk of stressing the lesion though the birth canal |
|
|
Term
| what are the symptoms of tethered Spinal Cord? |
|
Definition
numbness and loss of sensation in LE
restless legs during sleep
spasticity in LE and or clonus
decreased LE strength
gait deviations
progressive scoliosis or curvature of spine
chronic low back pain
progressive loss of control over bowl and bladder (incotinence)
recurrent UTI's |
|
|
Term
| Symptoms/ Warning signs of Arnold Chiarir 2 malformation |
|
Definition
Major headaches (commonly misdiagnosed as a migraine)... pain in the back of the head, and aggrevated by valsava, yawning, sneezing, and coughing
muscle weakness - declining hand grip strength may be a good indicator
stidor
apnea
facial pain
poor feeding - reflux/ failure to thrive |
|
|
Term
| Early warning signs of shunt dysfunction..... OMG LIST FROM HELL!!! |
|
Definition
RECURRING HEADACHE
DECREASED ACTIVITY LEVEL
INCONTINENCE BEGINS OR WORSENS
START OR INCREASED SPASTICITY
PERSONALITY CHANGE
DICREASED VISUAL ACUITY OR DIPLOPIA
changes in speach, fever and malaise, decreased school performance, onset of or increased strabismus, change in appetite and weight, onset or worsening of scholiosis, decreased static grip, difficulty to arouse in morning, decreased visuomotor coordination, seizures |
|
|
Term
| Medical Management for orthopedic issues with Myelodysplasia... Hips, derotational osteotomies congenital club feet, scoliosis |
|
Definition
rarely fix the hips, ODD, let them wt bear on the dislocated hips...
try to fix the club feet with casting
scoliosis treatment depends on the COBB angle |
|
|
Term
| what type of cathing is used for Myelodysplasia pts? |
|
Definition
CIC- clean intermittent catheterization... to prevent UTI and kidney infections.....
Foley catheter for hospital settings |
|
|
Term
| at what age is CIC- clean intermittent catheterization started? and at what age is the child independent? how often should CIC be performed? |
|
Definition
begin around age 5 or even age 3, but try to be independent by age 8?
4-6x/ 24 hour period |
|
|
Term
| PT examination finding with Myelodysplasia? |
|
Definition
generally no UE involvement...
LE- check closely (hip dislocation, club foot, alignment issues)
neck and trunk (scoliosis and muscle imbalances)
look at strength and reflexes
risk for torticollis |
|
|
Term
| what standardized test are commonly used? |
|
Definition
| something with overall function (PEDI or SFA in the school) |
|
|
Term
| is the modified ashworth scale used with Myelodysplasia pts? |
|
Definition
| if the lesion is at L1 or above, there may be spasticity, thus would be appropirate |
|
|
Term
| PT goals for Myelodysplasia pt? |
|
Definition
to prevent secondary conditions
to maximize functional independence
individualized to the child
to educate the parents, child, caregiver, teacher on medical/ developmental need
Adaptive equipment/ Assistive devices
HEP- with standing program (stop contractures, pressure relief, self esteem), biophosphate medication for O/P |
|
|
Term
Ambulation factors with Myelodysplasia?
quads
illipsoas
gluteus medius strength |
|
Definition
Quad strength 3 or < 88% exclusively use W/C
grade 4 and > 82% community ambulators
illiopsoas grade 3 or < partial or compete W/C users
Grade 4 or > all community ambulators
Gluteus Medius strength (best indicator of Assistive devices, orthosis)
grade 0-1... 95% require AD, orthosis or both
Grade 2-3... 72% require AD, orthosis or both |
|
|
Term
| average walking speed for 50 feet and a kindergartener vs a 6th grader |
|
Definition
13.5 seconds for KG
10.6 seconds for 6G |
|
|
Term
OUTcomes with myelodysplasia the following lesion locations?
thoracic
high lumbar (L1-3)
low lumbar (L4-5)
Sacral S1 |
|
Definition
thoracic: difficulty with independent sitting, use W/C for mobility, cognitive deficits
high lumbar: muscle imbalances, hip flexion contractures, hip dislocation, and W/C mobility
Low lumbar: knee flex, DF, functional ambulators as kids, foot deformities
Sacral: may walk without orthotics, but may use for more active lifestyles and jogging |
|
|
Term
| 6 key factors to determine ambulation or W.C for mobility? |
|
Definition
Endurance
Efficiency
Effectiveness- with transfers
Safety
Accessibility
Prevention- obesity and osteoporosis |
|
|
Term
myelodysplasia and indicators or specific orthocics
what is needed for an SMO and what does an SMO provide the pt? |
|
Definition
lesion at S1 or below
allows DF and PF motion while giving medial/lateral support
need to have DF (foot clearence) and push-off (PF)
improves balance, ankle alignment, ankle instability |
|
|
Term
myelodysplasia and indicators or specific orthocics
what is needed for an AFO and what does an AFO provide the pt? |
|
Definition
lesion at L4 to S1
can be a standard or ground reaction (for crouched gait) AFO
knee extensors need to be a grade 4, with weak or no ankle strength?
improves crouched gait pattern, toe clearance, knee extension during stance, improved gait efficient |
|
|
Term
myelodysplasia and indicators or specific orthocics
what is needed to use an KAFO and what does an KAFO provide the pt? |
|
Definition
lesion most likely at L3-L4
need to have hip flexion of 3 or greater...
improves medial/ lateral stability of the knee and is and indicator weak quads (less than 4) |
|
|
Term
myelodysplasia and indicators or specific orthocics
what is need to use an RGo or HKAFO and what does and RGO or HKAFO provide the pt? |
|
Definition
lesion at L1 to L3...
allows for reciprocal gait (RGO)
facilitaties hip extension and swing
need some weak hip flexion to work |
|
|
Term
Evidence with orthotics and myelodysplasia
throacic and upper lumbar lesions? |
|
Definition
little benifit to walking with parapodium, RGO, HKAFO...
get medical benificts for bowl and bladder function, self motivation, osteoporosis prevention
NOT GOING TO MAKE THEM A COMMUNITY WALKER |
|
|
Term
Evidence with orthotics and myelodysplasia
Lower lumbar (L4/L5) |
|
Definition
AFO effectiveness affected the following items:
decrease DF in stance
decrease double support time
increase gait velocity (speed) |
|
|
Term
|
Definition
| velcro straps for proprioceptive sensation everywhere |
|
|
Term
| equipment used for myelodysplasia pts |
|
Definition
| carts before a W/C, W/C, standards, Environmental modification |
|
|
Term
| Evidence with the use of gaming devices for aerobic training in spinal cord dysfunction adolescents? |
|
Definition
| shows that the game cycle seems adequate to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction |
|
|
Term
| does strength training help children push there wheelchair farther? |
|
Definition
| showed to improve performance in selected disabled children... pilot study of 6 |
|
|
Term
| the evidence shows what affect on abulatory children with spina bifida and home based treadmill training? |
|
Definition
| showed an increase in 6min walk test immediately after intervention, and 3 months post intervention |
|
|
Term
| most children with spina bifida and a lesion at L4 and below are ambulatory until what age? after this depends on what major factors? |
|
Definition
| til age 12-14 normally, but then self motivation and family support will dictate if the person will stay as a community ambulatory.... |
|
|
Term
max bite force at molars?
saliva volume per day?
swallows per hour?
length of digestive system? |
|
Definition
max bite force at molars?---- 110lbs
saliva volume per day? 500-600ml
swallows per hour? 296/ hour
length of digestive system? 30 ft |
|
|
Term
| what is dysphagia? is it a medical diagnosis? |
|
Definition
difficulty with swallowing... alot of speech therapy
not a medial diagnosis |
|
|
Term
| is it possible to talk about dysphagia separate from ethology? |
|
Definition
| no because it is caused by many other conditions or surgical procedures. |
|
|
Term
| what are some common conditions associated with dysphagia? |
|
Definition
stroke, brain injury, dementia, motor neuron disease, myasthenia gravis, CP, Gillian Barre, Polio, myopathy
Parkinson's diseases, hunting-tons, progressive supranuclear pasly, age
RA, systematic sclerosis |
|
|
Term
| the results of an uncoordinated swallow? |
|
Definition
| aspiration into the lungs... |
|
|
Term
| Tanners definition of dysphasgia... |
|
Definition
| impairment of emotional, cognitive, sensory and or motor acts involved in transferring substance from mouth to stomach, resulting in failure to maintain hydration and nutrition and posing a risk of choking and aspiration. |
|
|
Term
| difference between a swallowing and a feeding disorder? |
|
Definition
swallowing= mouth to stomach
feeding involves transport outside of the alimentary system (arm weakness or coordination)
a kids with CP can have feeding and swallowing issues |
|
|
Term
| are anorexia and bulimia considered dysphagia? |
|
Definition
|
|
Term
what is the incidence of dysphagia?
acute general hospital?
acute rehab at admissions
stroke
brain injury
spinal cord |
|
Definition
ASHA: says 6-10 million Americans
acute general hospital? 13-33%
acute rehab at admissions 30%
stroke---- 50%
brain injury ---- 20%
spinal cord---- 7% |
|
|
Term
| what is the rule with the brain stem and dysphagia? |
|
Definition
| there is a high likelihood of dysphagia issues is the brain stem is damaged... |
|
|
Term
| aspiration pheumonia can have what medial consequences? |
|
Definition
| costly, increased stay in care, greater disability at 3 and 6 months post, or poor nutritional stats during hospitalization |
|
|
Term
| consequences of dehydration? medically? |
|
Definition
| increased mental confusion, generalized organ failure, lead to increased de-compensation of swallowing |
|
|
Term
| consequences of under nutrition? medically... |
|
Definition
| affects energy levels, can compromise immune system if severe |
|
|
Term
| psychosocial consequences of dysphagia? |
|
Definition
limits social interaction...
change in lifesyte
fear of chocking
social isolation
impact is pushed to the family |
|
|
Term
differences of these terms
chew
bite |
|
Definition
chew is the up and down motion
bite is to not release |
|
|
Term
| treatment goal for dysphagia? |
|
Definition
| to ensure the pt can consume enough food and liquids to remain nourished/ hydrated without treat to airway safety |
|
|
Term
| the four main interventions for dysphagia? |
|
Definition
behavioral: posture, rehab strategy, earting rate, maneuvers, strengthening
dietary: modify textures, taste and volume
Medical: medication change, nasogastric tube
surgical: mobilization of weak vocal fold, PEG |
|
|
Term
| focus of a Otolaryngolosist? |
|
Definition
evaluate of the upper digestive tract
endoscopy for visualization (nasopharynx, oropharynx, phaynx, larynx) |
|
|
Term
| focus of a gastroenterolist? |
|
Definition
esophasgeal speacilist
GERD (reflex)
manometry
endoscopy of esophageal function
non-surgical placement of per-cutaneous endoscopic gastrostomy (PEG) |
|
|
Term
| the four phases of swallowing? |
|
Definition
| oral preparatory, oral transit, phayngeal transit, esophageal |
|
|
Term
|
Definition
phase one of swallowing...
lips are closes, jaw going through a rotary grinding motion, tongue is rolling food up into a bolus |
|
|
Term
|
Definition
second phase of swallowing?
moving the food from the front of the mouth to the back of the throat, anterior posterior motion of the tongue to move the bolus back |
|
|
Term
| Pharyngeal transit phase? |
|
Definition
3rd phase...
the soft palate closure
back of the wall hits the back of the throat and larynx rises
the muscle abvoce the esophagus relaxes allowing food to pass |
|
|
Term
|
Definition
4th and last phase of swallowing...
once in the esophagus the food is squeezed into the stomach |
|
|
Term
| duration of the oral transit phase of swallowing? |
|
Definition
|
|
Term
| Examination techniques to look at swallowing.. |
|
Definition
a clinical evaluation
modified barium swallowing study
fiber-optic endoscopic evaluation of swallowing (FEES) |
|
|
Term
| What are the associated UE muscle groups to spinal levels for the ASIA? |
|
Definition
C4: Shoulder elevation
C5: Biceps
C6: Wrist extensors
C7: Triceps
C8: Finger and wrist flexors
T1: Finger abduction |
|
|
Term
| is Micheal J Foxes hyperkinetic movements normal for Parkinson's disease? |
|
Definition
| No, typically Parkinson's patients are hypokinetic |
|
|
Term
| what is the primary cause of Parkinson's disease? |
|
Definition
| a decreased or absent production of dopamine from the subtantia nigra |
|
|
Term
| where in the brain is the substantia nigra? |
|
Definition
|
|
Term
| what percentage of Parkinson's patients are idiopathic, in they don't know what caused the substantia to be affected? |
|
Definition
78% are idopathic,
the rest are secondary parkinsonism from a viral, toxic, or metabolic problem |
|
|
Term
| what is Parkinson's - plus syndrome? |
|
Definition
| have the parkinson's presentation with other medical complications such as Alzheimer's, Huntington's disease, NPH, or multi-infarct vascular disease |
|
|
Term
| with parkinson's disease, what type of tremor is present? or is there a tremor present? |
|
Definition
| yes, there are resting tremors |
|
|
Term
| what does dopamine help control? |
|
Definition
|
|
Term
| the Basal ganglia is make up of what structures? |
|
Definition
| substantia nigra, subthalamic nucleus, glubus pallidus, striatium (caudate+ putamen_ |
|
|
Term
| the Basal ganglia gets inputs from where in the brain? |
|
Definition
| cerebral cortex, thalamus, Substantia nigra, and midbrain |
|
|
Term
| the basal ganglia helps production of ___________movement? |
|
Definition
|
|
Term
| the Basal ganglia helps control of _________ adjustments? |
|
Definition
|
|
Term
| if damage occurs to the Basal ganglia one of the two will occur, what are the two things? |
|
Definition
| hypokinetic movements, or hyperkinetic movements |
|
|
Term
| what are some terms considered with hypokinetic movements |
|
Definition
|
|
Term
| what are some terms considered with hyperkinetic movements? |
|
Definition
chorea- rapid jerky movements
dyskinesia
dystonia |
|
|
Term
| what does the release phenomena have to do with Parkinson's disease? |
|
Definition
| as the production of dopamine stops, so does its inhibitory influences with in the basal ganglia, which in turn causes Tremors and eventually rigidity |
|
|
Term
| what are the 4 CARDINAL SIGNS for Parkinson's disease? |
|
Definition
akinesia and bradykinesia
rigidity
resting tremor
postural instability |
|
|
Term
| how is speech affected with Parkinson's patients? |
|
Definition
they can not get a solid closure of the vocal cords, so they are slurred and quite
this also affects dysphagia (swallowing) |
|
|
Term
| for a Diagnosis of Parkinsons what is used __________ ___________? and how many of the cardinal sings must be present? |
|
Definition
a clinical exam is performed...
and 2 of the 4 cardinal signs must be present (tremor, rigidity, akinesia/ bradykinesia, postural instability) |
|
|
Term
| lab tests and CT/MRI scans for Parkinson pts are typically _________? |
|
Definition
| typically are normal, until END STAGE |
|
|
Term
| the Hoehn-Yahr Classification of disability scale is specific for what pt population? |
|
Definition
| Parkinson's patients to see the stage and severity of the disease |
|
|
Term
| the Hoehn-Yahr classification of disability scale has how many stages? and what are they? |
|
Definition
5 stages
stage 1: minimal or no functional disability; unilateral if present
Stage 2; minimal bilateral or midline involvement; BALANCE IS NOT IMPAIRED
Stage 3: unsteadiness when turning or rising from chair; some activities are restricted; but pt can live independently and continue some form of employement
stage 4: All symptoms present and severe; standing and walking possible only with assistance
Stage 5: confined to bed or wheelchair |
|
|
Term
| Is parkinson's disease a progressive disorder? |
|
Definition
| yes, generally over the course of 20-30 years |
|
|
Term
| Monoamine Oxydase inhibitors (MAO's) are used in the treatment of parkinson's disease during what stage? what is this drug trying to do? |
|
Definition
| Monoamine oxydase inhibitors (MAO's) are used early on in diagnosis to slow the metabolism of dopamine |
|
|
Term
| Levodopa is used for Parkinson's disease once what develops? how does this drug work? |
|
Definition
Levodopa is for when symptoms develope
it is a precursor to dopamine and counteracts the symptoms |
|
|
Term
| what is Catechol-Omethyl Transferase (COMT) inhibitors used for in the treatment of Parkinson's disease? |
|
Definition
| used with Levodopa to decrease the rate that levodopa is metabolized |
|
|
Term
| do dopamine agonist drugs have more or less side effects than levodopa? |
|
Definition
|
|
Term
| anticholinergic agents are good for treating what in parkinson's pts? |
|
Definition
|
|
Term
| why is carbidopa given with L-dopa? |
|
Definition
| help L-dopa get across the blood brain barrier |
|
|
Term
| in the early stage of Parkinson's disease. what type of therapy are you doing? (prevention, restoration, or compensation) |
|
Definition
| prevention in the early stage |
|
|
Term
| in the early-middle stage of Parkinson's disease. what type of therapy are you doing? (prevention, restoration, or compensation) |
|
Definition
|
|
Term
| in the middle-late stage of Parkinson's disease. what type of therapy are you doing? (prevention, restoration, or compensation) |
|
Definition
| compensation- restoration |
|
|
Term
| in the late stage of Parkinson's disease. what type of therapy are you doing? (prevention, restoration, or compensation) |
|
Definition
|
|
Term
| what type of diets decreases the effectiveness of L-Dopa? |
|
Definition
high protein diets
try to eat proteins before going to bed when you don't need your L-Dopa |
|
|
Term
| most surgical management for parkinsons is done during what state of the disease? and why? |
|
Definition
| late stage, because better at stopping the rigidity |
|
|
Term
|
Definition
| a surgical procedure for parkinsons, where they go in and burn parts of the brain to reduce bradykinesia, improve function |
|
|
Term
| is a thalamotomy done any more for Parkinson's disease? |
|
Definition
| nope, to many side effects |
|
|
Term
| what is new procedure for parkinsons disease that is showing some results? |
|
Definition
Deep Brain stimulator, reduces tremor and rigidity....
and electrical stimulator is put in the subthalmic nuclei and the control is under the clavicle |
|
|
Term
| Parkinson's disease in Nebraska? |
|
Definition
there is a higher rate of Parkinson's disease then normal... not sure why
maybe fertillizers |
|
|
Term
| the idea behind a pt with Parkinson's Disease is to do what? |
|
Definition
slow the preogression of the disease
initially prevent
then restore
lastly compensate |
|
|
Term
the Best test has been proven to be reliable and valid in parkinson's pts for balance.
would you use a mini-BESTest or a BESTest to determine risk of falling in a Parkinson's pt? |
|
Definition
MINI-BESTest has been shown to be more accurate at showing risk for falls in Parkinson's pts
also the MINI only take about 15minutes to perform |
|
|
Term
| is balance, flexibility and functional exercises appropriate for Parkinson's patients? |
|
Definition
| yes it was proven to have the best results in a RCT study over home based programs, and supervised aerobic exercises |
|
|
Term
| what are 2 huge goals relating to the care of a Parkinson's patient? |
|
Definition
education of the family
and stop the progression of the disease and secondary conditions |
|
|
Term
| a realistic goal for impairments with Parkinson's pts? |
|
Definition
to reduce the impact of the impairment
decrease pain, increase motor function, aerobic capacity increased |
|
|
Term
| a realistic goal for ability to perform ADLs with Parkinson's pts? |
|
Definition
to increase independence, may have to adapt stuff in later stages of the disease...
MJ FOx- tooth brush on the counter still while putting tooth paste on it... |
|
|
Term
| what muscle groups do you stretch in Parkinson's patients? |
|
Definition
| hamps, hip flexors, anything in a flexed position... |
|
|
Term
| more appropriate for a parkinson's pt for balance. AFO or AD like a walker? |
|
Definition
|
|
Term
|
Definition
| have the pt exaggerate the movement you want... tend to get better rehab results |
|
|
Term
| Driving Neuroplasticity? what is this? |
|
Definition
| have to challenge the pt to get resuts... |
|
|
Term
|
Definition
meaning- for the learning, not the PT
Active- learner is driven and evaluated
task specific to the real world
challenge- hard, but not to hard
hope- within reach |
|
|
Term
|
Definition
| a type of SB occluta... that has no sac or neuro tissue involvement... adipose tissue presence |
|
|
Term
| Muscular dystrophy is an (inherited/ or not inherited disease) and is characterized by what two things... |
|
Definition
MD is inherited and is associated with progressive muscle weakness and degeneration of skeletal muscle
can also be caused by a genetic mutation |
|
|
Term
| Muscular dystrophy has a problem with the cell _______ and the production of_________ |
|
Definition
membrane and the production of dystrophin...
it is ether no produced or produced in a lessor amount |
|
|
Term
| disorders of the anterior horn cells? |
|
Definition
| spinal muscular dystrophy |
|
|
Term
| how do you prevent muscular dystrophy? |
|
Definition
you really can't
can use genetic counseling to see the percentage of possibility you child will have it... |
|
|
Term
| what comes into the cell and causes cell death in muscular dystrophy? |
|
Definition
| calcium, myofibrils are also destroied |
|
|
Term
| what disease is associated with phsudohypertrophy? and what is it? |
|
Definition
fat invades the muscle in muscular dystrophy patients...
calf normally, and it will look normal |
|
|
Term
| ways of diagnosing Muscular dystrophy? |
|
Definition
genetic mapping
muscular biopsy- increase Connective tissues and increased adipose cells
blood tests- with increase cretine kinase
EMG/ nerve velocity is normal... |
|
|
Term
| what are the 5 major kinds of muscular dystrophy? |
|
Definition
duchenne muscular dystrophy
becker
facioscapulohumeral dystrophy
limb girdle dystrophy
spinal muscular dystrophy |
|
|
Term
| of the muscular dystrophies... which is worse ducheene or becker? |
|
Definition
| Duchenne... both have a problem with dystrophin production... but the becker makes some and ducheene makes none... |
|
|
Term
| is duchenne's muscular dystrophy the most or least common? and what gender does it affect? |
|
Definition
Males only... and its the most common
X-linked recessive with defect on Xp21... inherited from asymptomatic mother |
|
|
Term
| age that DMD is normally diagnosed? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| age range to stop walking? |
|
Definition
|
|
Term
| the 3 factors relateded to DMD kids from walking? |
|
Definition
| falls, can they get up from a fall without assistance or device, LE strength loss of 50% |
|
|
Term
| DMD gross motor signs noticed first? |
|
Definition
increased falling
reluctance to run or walk...
tip-toe walking
issues getting off the floor |
|
|
Term
| they tip toe walking with DMD |
|
Definition
initially a weakness and balance issue..
then PT contracture issue |
|
|
Term
| is there congnitive issues related to DMD? |
|
Definition
| intellectual impairment due to lack of dystrophin in the brain |
|
|
Term
| does DMD have any change in the CNS, vascular system, motor neurons, sensory neurons? |
|
Definition
|
|
Term
| the lordosis of a DMD child will present clinically? |
|
Definition
|
|
Term
|
Definition
increase trunk sway and waddle with
decrease arms wing |
|
|
Term
| due to weak hip flexors kids use what muscle to compensate? and at what age does this occur? |
|
Definition
| TFL- tensor fascia lata... age 8 |
|
|
Term
| what is a Gowers sign? and what is it associated with? |
|
Definition
| walking up your own legs to get up off of the floor... DMD |
|
|
Term
| what is the leading cause of death in muscular dystrophy pts? |
|
Definition
| pulmonary infection, respiratory failures, cardiomyopthies |
|
|
Term
| long volume of muscular dystrophy pts is ______ in adult hood? |
|
Definition
| decreased due weakness and decreased chest wall expansion |
|
|
Term
| initial weakness for muscular dystrophy pts is found where? |
|
Definition
|
|
Term
| the scapula of muscular dystrophy pts tends to be? |
|
Definition
| WING A DING DINGED OUT LIKE A MOTHER FUCKN AIR PLANE!!!!! :) I HAVE LOST IT |
|
|
Term
| any tightness normally doesn't show with muscular dystrophy until age??? and found in what areas? |
|
Definition
| age 5, TFL and Gastroc-soleus |
|
|
Term
| secondary condition that need to be prevented with muscular dystrophy pts? |
|
Definition
scoliosis
pneumonia
obesity |
|
|
Term
| is there a cure for DMD and muscular dystrophy? |
|
Definition
|
|
Term
| creatine and muscular dystrophy |
|
Definition
| showed to slightly increase strength, and decreased the fat in muscle cells |
|
|
Term
| myoblast transplant is done in muscular dystrophy pts? |
|
Definition
HELL NO... still experimental... my poor family members in cages everywhere being forced to run on wheels for miles and miles!
it is thought to replace the missing dystrophin protein |
|
|
Term
| corticosteroids and muscular astrophysics pts? |
|
Definition
| shown to increase strength for 6m to 2years... but has long term side effects of wt gain, hair growth... osteoperosis |
|
|
Term
| is there a tone problem with muscular dystrophy? |
|
Definition
| no, muscular atrophy, but not a tone problem |
|
|
Term
| are dynamometers used with muscular dystrophy pts? |
|
Definition
| yes, great for objective measurements |
|
|
Term
| a standardized special test for muscular dystrophy? |
|
Definition
| VIGNOSS- looks at function |
|
|
Term
| what type of muscular dystrophy tends to have complaints about muscle cramping? |
|
Definition
| Becker's muscular dystrophy |
|
|
Term
| what is the onset age for Becker's muscular dystrophy? |
|
Definition
|
|
Term
| what is the life expectency of someone with Becker's muscular dystrophy? |
|
Definition
|
|
Term
| at what age does a Becker's muscular dystrophy pt typically ambulate til? |
|
Definition
|
|
Term
| is dystrophin produced with Becker's muscular dystrophy? |
|
Definition
| yes, just at a decreased rate/amount than normal |
|
|
Term
| FSHD- fascioscapulohumeral dystrophy affects what gender? and is on what chromosome? |
|
Definition
males and females evenly
on the 4th chromosome |
|
|
Term
| what percentage of FSHD- fascioscapulohumeral dystrophy pts ambulate their whole life? |
|
Definition
|
|
Term
| limb-Girdle MD affects what gender? and what muscles does it affect first? |
|
Definition
| male and female, hips and shoulder |
|
|
Term
| how many forms of SMA- spinal muscular atrophy are there? |
|
Definition
| 3 types... type one is the worst |
|
|
Term
| what chromosome is affected by SMA - spinal muscular atrophy? |
|
Definition
|
|
Term
| SMA - spinal muscular atrophy has what characteristics with the anterior horn of the spinal cord... |
|
Definition
| cells tend to larger, fewer of them, and degenerate over time... |
|
|
Term
| what are the types of SMA - spinal muscular atrophy? |
|
Definition
1: Werdnig Hoffman
2: Werdnig Hoffman
3: kugelberg-welander |
|
|
Term
| what are the typical lifespans for the different types of SMA - spinal muscular atrophy? |
|
Definition
1: Werdnig Hoffman----- 6 months
2: Werdnig Hoffman------ 7-10 years
3: kugelberg-welander------ can live normal lifespan |
|
|
Term
| do you want to do resistive exercises with dystrophin deficient muscles? |
|
Definition
| NOPE>.. can do more damage then good during the exercise |
|
|
Term
| what is the focus of DMD, MD, SMA.... interventions??? |
|
Definition
| maintain function level for as long as possible... these are progressive disorders.. |
|
|
Term
| when do you have to worry about skin integrity with MD pts? |
|
Definition
| when they lose the ability to ambulate by them self... increased time in the chair... |
|
|
Term
| is moderate intensity exercise safe for limb girdle MD pts? |
|
Definition
| yes, showed to increase pts ability in work capacity.... |
|
|
Term
| is aerobic exercise good for facioscapulohumeral MD pts? |
|
Definition
| yes, safe for FSHD pts... |
|
|
Term
| is there a lot of research for muscular dystrophy? what do we do about this? |
|
Definition
nope... understand the basic principles...
functional exercises... transfers and waling... not resistive stuff... more aggressive with the less involved forms of MD |
|
|
Term
| what is a HEP activity for MD pts? |
|
Definition
|
|
Term
| a disorder that is characterized by periods of progression and then recovery phases? |
|
Definition
|
|
Term
| does a Guillain-Barre patient normally recover to a prior level of function? |
|
Definition
| typically will get back to walking, but not really back to 100% |
|
|
Term
| how fast can Guillain-Barre set it? and how bad is it? |
|
Definition
can set in within a day. and goes from tingling in the feet and distal extremities to weakness to respiratory distress...
MEDICAL EMERGENCY! |
|
|
Term
|
Definition
| viral infection setting off an autoimmune reaction against the myelin of nerves |
|
|
Term
| is GB a LMN or UMN problem? |
|
Definition
|
|
Term
| how long until the initial attach of GB do you get your recovery? |
|
Definition
about a month or so....
schwann cell proliferation
inflammation resolves
remyelination begins |
|
|
Term
| how is GB diagnosed? diagnostic tests and clinical presentation? |
|
Definition
CP; flue like systems, then weakness and sensory loss starting distal, hypo reflexic, and ANS dysfuction with HR increasing and BP decreasing
nerve velocity is decreased and the CSF has increased protein levels.. |
|
|
Term
| is the weakness with BF symmetrical or asymmetrical? |
|
Definition
| symmetrical ans starts distally |
|
|
Term
| will you have a clonus sign with GB? |
|
Definition
| NO, not a UMN lesion issue |
|
|
Term
| a paresthesia (tingling and burning) is a sign of what LMN lesion issue? and what UMN lesion issue? |
|
Definition
|
|
Term
| what is the most common deficit with GB when recovering? |
|
Definition
| tib anterior weakness... gait issues with drop foot |
|
|
Term
| what percentage of GB pts die? and what percentage of GB pts walk again? |
|
Definition
5% die from secondary complication
80% are ambulatory within 6 months |
|
|
Term
| can GB pts have swalloing (dysphagia) issues? |
|
Definition
|
|
Term
| what setting do you normally see a GB pt in? |
|
Definition
| Acute, normally not on the ventilator for long... and simple tasks like rolling from supine to sideline can be extremely tiring for the pt at first |
|
|
Term
| monitory BP and HR with GB pts, but can u use it as an indicator of exercise intensity? |
|
Definition
| not with this patient, because those are commonly affected by the vagus nerve involvement... |
|
|
Term
| Is temp control, bowl and bladder affected with GB pts? |
|
Definition
| yes they are both affected... |
|
|
Term
| in what order does stuff return for a BG pt? |
|
Definition
the opposite order that they lost it... they will gain function back starting proximal and going distally...
will come off the ventilator first |
|
|
Term
| with BG pts what do you limit with exercise? |
|
Definition
| limit fatiguing exercises for up to 1 year with gradual return to regular activities.... |
|
|
Term
| what type of exercise do you start with GB pts? then what are some other intervention options? |
|
Definition
start with ADLS and basic transfers..
passive ROM while on vent
active assisted exercises as coming of the vent
aquatic therapy
PNF |
|
|
Term
| Similar to GB, MS does what? but does this where? |
|
Definition
| Ms attacks the myelination of nerve axons, but does this in the brain and the spinal cord, rather than the peripheral nerves. |
|
|
Term
| what are the 2 phases of MS? |
|
Definition
inflammation phase
demyelination phase |
|
|
Term
| what is the exact cause of MS? |
|
Definition
not really sure again!
some immune system dysfunction with a viral trigger?
possible genetic factor |
|
|
Term
|
Definition
| infection leads to an increase in WBC (lymphocytes and macrophages)... which have toxic effects destroying the oligodentrocyes and myelin sheaths in the spinal cord and brain. causing localized edema, and inflammation |
|
|
Term
| an MRI with show plaques in the brain and Spinal cord with what progressive disorder? |
|
Definition
|
|
Term
| MS plaques appear in what locations? |
|
Definition
cortiocospinal tract
optic nerve
subortical white matter
cerebellar peduncles
posterior white column of the spinal cord |
|
|
Term
|
Definition
2 or more attacks of neurological symptoms reflecting white matter lesions (more than one month apart)
or chronically progressive deficits for at least 6 months |
|
|
Term
| evoked potentials with MS will be? |
|
Definition
|
|
Term
| CSF of MS patient will be? |
|
Definition
| increase IgG- showing immune response |
|
|
Term
direct impairments from MS?
Sensory |
|
Definition
| parenthesis, pain (burning and aching), lhermitte's sign- electric shock down the leg |
|
|
Term
| direct motor impairment from MS? |
|
Definition
UMN, fatigue, ataxic, balance problems
vertigo |
|
|
Term
| what UMN issues has a problem with Diplopia? or other optic issues |
|
Definition
MS...
Double vision
24 year old mother... left eye vision lost |
|
|
Term
| can cognition be affected with MS pts? |
|
Definition
|
|
Term
| bowel and bladder is not effected from MS. |
|
Definition
|
|
Term
| what are the 4 types of MS? |
|
Definition
relapsing-remitting
primary-progressing
secondary-progressing
progressive-relapsing |
|
|
Term
| what is the worst kind of MS |
|
Definition
| primary progressive, due to not alot of recover time |
|
|
Term
| what age does MS normally set it? |
|
Definition
|
|
Term
| factors that EXACERBATE MS? |
|
Definition
infections
stress
heat, cold
hyperventilation
dehydration |
|
|
Term
|
Definition
|
|
Term
|
Definition
ACTH for immunesuppressant
Steroids- side effects
Interferon- EXPENSIVE
immunomodulators- decoy clogging T cell |
|
|
Term
|
Definition
|
|
Term
| what setting will you see MS pts most? |
|
Definition
|
|
Term
| weakness from MS is characterized as? |
|
Definition
|
|
Term
| the "Expanded Disability Status Scale (EDSS)" is for what progressive disorder? |
|
Definition
|
|
Term
|
Definition
specific for MS
can use 2 min walk, 6min walk... depends on the pt... |
|
|
Term
| rating on a Berg balance scale that indicates fall risk? |
|
Definition
|
|
Term
| DGI cut off for risk of falling? |
|
Definition
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Term
| things to teach your MS pts about with HEP? |
|
Definition
use breaks often and when needed
avoid heat! |
|
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Term
|
Definition
| leads 2 secondary conditions like pneumonia that kill you! |
|
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Term
| how long does ALS take to kill you? |
|
Definition
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Term
| ALS is what type of motor neuron lesion? |
|
Definition
| a combination of upper and lower |
|
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Term
the etiology for ALS?
the CURE FOR ALS? |
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Definition
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Term
| ALS Spares what nuclei? and what other function? |
|
Definition
it spares the oculomotor nuclei
while also not affecting bowl and bladder |
|
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Term
| what tracks does ALS affect? |
|
Definition
cortiocpinal and corticobulbar
bulbar- swallowing |
|
|
Term
| what are the two forms of ALS? |
|
Definition
Family form (FALS) has a genetic component... rare form and may have prolonged survival with childhood onset
sporadic ALS- typical form
most common |
|
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Term
| age onset for ALS? male or female? |
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Definition
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Term
|
Definition
UMN and LMN issues with 3 spinal regions, or 2 spinal regions and bulbar signs (language and swallowing)
also the progression! as ALS is progressive! |
|
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Term
| is sensory and ANS dysfunction associated with ALS? |
|
Definition
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|
Term
| are there sphincter control problems with ALS? |
|
Definition
| NO, bowel and bladder control are spared |
|
|
Term
| is the oculomotor nerve affected by ALS? |
|
Definition
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|
Term
| CPK- serum creatine phosphokinase is high in what 2 progressive disorders? |
|
Definition
|
|
Term
| what is the pts primary complaint with ALS initially? |
|
Definition
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|
Term
| ALS issues normally start ____ then ____ then_____? |
|
Definition
| LE then UE, then swallowing problems |
|
|
Term
| the weakness of ALS is more similar to MS or GB? |
|
Definition
more like MS because it is asymmetric.
GB is symmetrical |
|
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Term
| achticholinergic drugs for ALS pts helps them with? |
|
Definition
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|
Term
| ALS pts deal with spacticty with what drugs? |
|
Definition
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|
Term
| ALS leads to the total paralysis of all spinal muscles and muscles innervated by cranial nerves.... Except? |
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Definition
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|
Term
|
Definition
| mixeds, since it is a LMN and a UMN issus |
|
|
Term
focus of PT for ALS in these phases
EARLY
MIDDLE
LATE |
|
Definition
early- prevention, increase capacity
middle- compensate for what is lost and continue to prevent more loss
late- compensate main focus... |
|
|
Term
| avoid heavy eccentric exercises with this population? |
|
Definition
ALS, MS and GB, and DMD... try not to over tax them... high risk of injury
does occur |
|
|
Term
| what is demyelinated with GB, MS and ALS? |
|
Definition
GB- peripheral nerves
MS- brain and spinal cord
ALS- specifically the corticosteroid and bulbar tracts |
|
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Term
|
Definition
| This is a sign of parkinson's disease, in which the face is emotionless due to inability to voluntarily control the facial muscles and react emotionally. |
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|
Term
| How is myelomeningocele diagnosed? |
|
Definition
There are three methods:
1: Quad screen, which is a blood screen and they are looking for maternal alpha-fetoprotein levels and comparing to aged matched peers. Doesn't diagnosis but requires further testing.
2: Neuroimaging, peform an MRI and high resolution US and those are 97 percent accurate in diagnosis of myelomeningocele. (bannana and lemon sign)
3: Amniocentesis but is more risky |
|
|
Term
| What is dysautonomia? What disease is it associated with? |
|
Definition
his is a broad term for disruption of the ANS. This consists of:
Excessive fatigue
lightheadedness, vertigo, dizziness
Feeling of anxiety or panic
Rapid or slow heart rate
Syncope (fainting)
Associated with Parkinson's Disease |
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