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129 Cards in this Set
- Front
- Back
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PIPS=
HOAC= WHO= |
patient identified problems (whereas NPIPS are anticipated problems)
Hypothesis-oriented algorithm for clinicians (a guide for patient management) world house organization |
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Quickly discribe the HOAC part 1
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collect data
PIPS examination strategy conduct examination NPIPS generate hypothesis and/or identify the rationale Consult others refine problem list |
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Hemianopsia=
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only see hal fof visal feild in each eye (problem is with brain, not with the eyes)
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provacotive testing=
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reproduces the patients pain
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ICSF
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International classifcation of functioning, disability and health
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Sequence of a patients interview (just list)
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examination
evaluation diagnosis prognosis intervention outcome |
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ROS=
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review of systems ( past medical and surgical history so you know what to refer out)
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What does an examination consist of ?
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H+P
ROS tests and measurments |
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What does an evaluation consist of?
A diagnosis? |
when you take all the examination information and make a judgement.
- what is their current level of inpairment - when is their potential discharge? a label- catagories, syndromes... |
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prognosis=
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expected maximum improvements, with expected time frames. GOALS
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Describe the two different types of intervensions
Outcome means- |
direct: what your treatment will be
indirect: refer out, coordinating adjsments, documentation, home plan how they did, did you need more time? |
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HPI=
SHx= |
history of present illness
Social History |
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what would you use to examine mental status?
What kinds of things would you generally inspect during an interview |
A+0 x 3
posture gait skin color willingness to move |
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How would you test painful or painlessess upon resistance?
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Cyriax System
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Cyriax System :
SPL = SPF= WPF= WPL = |
stong, painless
strong painful weak, painful weak and painless |
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What four things canyou check in relation to neural status
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sensory
motor reflexes proprioception |
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Finklestein test=
HPI = |
for DeQuerveins
history of present illness |
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Name some Red Flags during your first interview-
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referred pain from system disease
night pain fever symptoms deep aching unrelenting pain |
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hemoptosis=
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caughing up blood
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orthopenia=
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shortness of breath when supine
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syncopy=
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room spinning
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dysmia=
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difficult breathing
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ergonomics=
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sceince of activity- the best way not to get injured
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in ICF,
the term functioning = Disability = |
refers to all body functions, activities, participations.
umbrella term for impairments, activity limitations, participation restriction |
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What does WHO use as framework for health and disability?
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ICF
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3 Major questions you need to figure out duringyour interview- these will pretty much tell you how to treat the patient
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1. pain level, type
2. how occurred 3. what reproduces it, decreases it |
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cc =
c/o = |
chief complaint
complaining of... |
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hawkins kennedy =
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impingement sign
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Basic Principals of theraputic Exercise (6)
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1. starting point individualized
2. quality of movement 3. strength, flex, ability, endurance, relaxation, tone 4. balence agonists, antagonists, suynergists 5. progression, monitor patients tolerance 6. make it interesting and appropriate |
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Namw 2 exercises that are biomechanically unsafe
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1. wrestlers bridge
2. duck walking (increases torision) |
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List 7 goals of theraputic exercise
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1 preventitive
2 maintenance (not pt candidates) 3 strength 4 endurance 5 mobility 6 stability 7 skill |
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can you alter motor unit recruitment?
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yes, by training.
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what fibers are fast twitch and which ones are slow?
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Fast = IIa, b
Slow= I |
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List 4 types of mobility exercises and then give examples for each.
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1. Joint Mobilization: traction, gliding
2. Passive Strentch: manual muscle testing, friction 3. flexibility 4. inhibition techniques: sensory or reflex organs |
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3 things to remember about Trunk Stability-
What is the ultimate point for stabilization? |
1. often closed chain
2. start in one plane 3. dont start with midline crosses PELVIS- good to work on it with a Suiss Ball |
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Why dont your muscles have to work what your slouching?
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your not creating a flexion or extension movement. This can cause nerve impingement and bone stresses
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Internal factors that effect posture
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1. CNS input
2. Visual system 3. Vestibular system 4. Musculoskelital system Vestibular and visual go to the cns- which effects neuromuscular skeletal with maintains posture |
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External factors effecting posture
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1. gravity
2. external loads 3. inertia 4. GRF |
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Why dont your muscles have to work what your slouching?
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your not creating a flexion or extension movement. This can cause nerve impingement and bone stresses
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Internal factors that effect posture
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1. CNS input
2. Visual system 3. Vestibular system 4. Musculoskelital system Vestibular and visual go to the cns- which effects neuromuscular skeletal with maintains posture |
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External factors effecting posture
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1. gravity
2. external loads 3. inertia 4. GRF |
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How should a plumb line match up laterally to the body?
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- through center of ear
- through acromian process - through greater trochantor - just ant to knee joint - just ant to lateral malleolus |
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How should a plumb line match up anteriorly to the body?
posteriorly? |
- center of nose
- xiphoid process - umbiliocus - midway between ankles - center of occiput - spinouse process of vertebrae - gluteal cleft - bewtween malleoli |
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How should a plumb line match up laterally to the body?
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- through center of ear
- through acromian process - through greater trochantor - just ant to knee joint - just ant to lateral malleolus |
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How should a plumb line match up anteriorly to the body?
posteriorly? |
- center of nose
- xiphoid process - umbiliocus - midway between ankles - center of occiput - spinouse process of vertebrae - gluteal cleft - bewtween malleoli |
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4 types of postural allignment
list come common postural disorders |
ideal
kyphosis-lordosis flat back sway back - slump sitting - hyperkyphosis/lordosis - flat back -sway back |
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Role of Neurologic examination
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1. determine level of function
2. determine type and location of lesion 3. determine cognitive and perceotual ability |
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SCI =
HNP = DM = |
spinal cord injury
herniated nucleus pulposis diabetes |
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List level of consciouness from best to worst
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normal
lethargy stupor- only respond with BAD pain coma |
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SES =
1,2,3 for memory test = |
socio ecomonic status
1 person 2 place 3 time |
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cortical sensory integration=
Cortical motor integration= |
ability to interpret sensory information and produce a proper response
ability to plan and exsecute motor acts (start to finish in a resonable time frame) |
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what lobe is involved with visual perception?
what lobe is involved with sensory reception? speaking and writing? |
occipital
parietal frontal |
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Disarthria=
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speech inpairment due to tongue, mouth muscles to articulate, a motor problem
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purpose/baseline data for sensory examination
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- functional deficits
- safety - intervention and goal setting - determine compensations |
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Sensory Age related changes
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- decreased brain weight
- decreased NCV - decreased acuity of senses - decreased kinesthesia, .. - decreased skill aquisision |
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AFO=
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ankle foot arthosis
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4 classifications of sensory receptors
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- mechanoreceptors
- thermoreceptors - nocicopters (pain) -chemoreceptors (ph, taste) |
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anterolateral spinothalamic system=
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- smaller, slower conducting afferents that carry less discriminative signals such as pain, temp, touch, and pressure
- more primitive then dorsal columns - enables someone to generally localize sensations antero- touch-, pressure latero- pain, temp |
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what collumn is medial lemniscal system associated with?
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DORSAL!
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what column is anterolateral spinothalamic system associated with?
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VENTRAL!
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Describe the medial lemniscal system-
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large rapidly conducting afferent fibers that are much mroe discriminative than anterolateral system
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what spinal column is is more discriminative for sensory?
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medial lemniscal system
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4 tests that test the medial lamniscal system-
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1. stereognosis
2. graphesthsia 3. two point discrimination 4. barognosis |
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sterognosis=
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recognize shape of an object by touch
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Graphesthesia=
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recognize shape with a skin trace
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Barognosis
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ability to recognize weight
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when testing sensory things, do you want to go distal to proximal?
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Dr. Pitts says so
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kinesthesia=
how can you test this? |
movement sense
see if they notice you moving their arm |
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tactile locaolization test
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patient either tells test where they touches or touches the area.
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Agnosia
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cant process incoming info
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Allesthesia
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sensation experienced at a site remote from stimulation
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Analgesia
Anesthesia |
complete loss of pain sensibility
loss of sensation |
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Causalgia
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painful, burning sensations, usually alongthe distrobution of a nerve
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Hypalgesia
hyperalgesia hyperesthesia Hypesthesia |
decreased sensitivy to pain
increased sensitivity to pain inc sensitivity to sensory stimuli a dec in "" |
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Paresthesia
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abnormal sensations such as numbness prickling, tingling WITHOUT APPARENT CAUSE
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Allesthesia
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sensation experienced at a site remote from stimulation
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Analgesia
Anesthesia |
complete loss of pain sensibility
loss of sensation |
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Causalgia
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painful, burning sensations, usually alongthe distrobution of a nerve
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Hypalgesia
hyperalgesia hyperesthesia Hypesthesia |
decreased sensitivy to pain
increased sensitivity to pain inc sensitivity to sensory stimuli a dec in "" |
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Paresthesia
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abnormal sensations such as numbness prickling, tingling WITHOUT APPARENT CAUSE
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Thermanalgesia=
thermaesthesia thermhyperthesia thermhypesthesia |
inability to perceieve heat
inability to perceieve sensations of heat or cold decreased sensitivity to temp opposite |
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Apraxia
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cant perform movement
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Spasticity VS rigidity
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spas- one direction resistance that increases ith speed via muscle spindle stimulation
(big time reaction) RIGID- resistance both ways |
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DTR aka
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myotatic stretch reflex
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High tone =
Low tone = |
spasticity (velocity)
Rigidity Clonus flaccidity (cyclical spasmodic hyperactivity) |
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Jendrassic Maneuver
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have patient tense part of body so reflexes can be better sceen during testing
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standard scoring key for myostatic reflexes
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0- nothing
1+ decreased response 2+ normal response 3+ exaggerated response 4+ clonus |
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on NOT palmer side of hand, what dermatome nerve gets the middle three fingers?
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C7
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Reflexes of the limbs. Name the spinal cord level tested for each tendon lsited here.
biceps brachioradialis triceps Patellar Achilles |
C5
C6 C7 L4 S1 |
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What myotome is responsible for the following joint movement?
elbow flexors Wrist extensors elbow extensors |
C5
C6 c7 |
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What myotome is responsible for the following joint movement?
finger flexors? finger abductors Hip flexors L3 |
C8
t1 L2 |
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What myotome is responsible for the following joint movement?
Knee Extensors ankle dorsiflexors Great tope extensor Ankle Plantarflexors |
L3
L4 L5 S1 |
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what dermatome is at belly button?
what dermatome is right above the genetalia |
T10
L1 |
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Agnosia
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inability to recognizze or make sense o incoming information dispite intact sensory capacities.
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two types of Apraxia
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idealational (purposeful movement isnt possible)
ideamotor ( only possible whenthey arent thinking about it) |
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whats a babinski sign?
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toes point down and leg pulls away.
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what do you do with a shaefer test?
what about oppenheim test? |
squeeze achilles tendon
stroke down the tibia |
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what is cranial nerve 1 ?
how do you test this? if they fail? what is probably injured? |
olfactory
put a smell under someones nose they have anosmia (loss of smell) temporal lobe, olfacotry bulb or tract |
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What is cranial nerve 2
____ is a loss of a single visual field what if someone had a L CVA? |
optic nerve
homonymous hemianopsia then the right sided field of vision is lostin both eyes, and temporal field cut in right eye and nasal field cut in the left eye |
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what nerve is responsibly for pupils reaction to light?
stabismus= |
CN 3 (ocular motor)- which also does vertical and medila movements of the eye.
inability to maintain eye position |
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whats a babinski sign?
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toes point down and leg pulls away.
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what do you do with a shaefer test?
what about oppenheim test? |
squeeze achilles tendon
stroke down the tibia |
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what is cranial nerve 1 ?
how do you test this? if they fail? what is probably injured? |
olfactory
put a smell under someones nose they have anosmia (loss of smell) temporal lobe, olfacotry bulb or tract |
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What is cranial nerve 2
____ is a loss of a single visual field what if someone had a L CVA? |
optic nerve
homonymous hemianopsia then the right sided field of vision is lostin both eyes, and temporal field cut in right eye and nasal field cut in the left eye |
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what nerve is responsibly for pupils reaction to light?
stabismus= |
CN 3 (ocular motor)- which also does vertical and medila movements of the eye.
inability to maintain eye position |
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what nerve is responsible for gag reflex?
what nerve is responsible for swallowing? what nerve is responsible for sticking out the tongue and moving it from side to side? |
CN 9
CN 10 CN12 |
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Define Coordination
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ability to exceute smoth acurate controlled movements.
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if someone has a visual pathology whats some good advice?
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teach them to scan
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PERLA=
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pupils equal, reactive to light, accomodation
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hypERactive tendon reflex means-
hyPOactive tendon reflex means... |
CNS associated
Peripheral NS |
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what system is much more discriminative than the anterolateral system?
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medial lemniscus.
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How do you get hyperactive DTR?
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constant inhibition from CNS. If you damage this you loose inhibition = hyperactive reflex loop.
if you damage loop in the PNS you get hypOactive reflex loop. |
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PERLA is asociated with what CN?
If the eye is deviating medially what is injuried? Bells Palsy is associated with what nerve? Nystagmus is associated with what nerve? |
CN III
Abducens Facial (LMN) CN VIII |
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Ataxia
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general term to discribe uncoordinated mvts
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4 primary functions of the basil ganglia
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1. groos intentional movt
2. automatic movt 3. postural adjustments 4. background muscle tone |
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Akinesa
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inability to initiate movt
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Athetosis
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worm writhering
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Hemiballismus
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one sided chorea/ violent
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Name 3 nonequilibrium coordination tests
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1. finger to nose
2. finger oposition 3. heel to shin 4. foot hand tapping |
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How should they do equilibrium coordination testing?
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start easy, just standing, then change BOS, tandem standing, unilateral standing, add challenges
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Rombergs sign
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close eyes and loose balence, swaying
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Discribe Frenkels exercises:
Define Balence: |
progress from prostures of greatest staility to postures of greatest challenge. then eyes closed.
Keep COG over BOS |
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Dermatomes:
1. middle 3 fingers 2. thumb and up arm 3. deltoid area 4. inner arm 5. over levator muscle |
1. C7
2. C6 3. high = c4 lower= c5 4. T1 5. C3 |
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ABS reflex=
ATNR= |
belly button moves towards stimulus
childhood reflex |
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Discribe some presentations of cerebellar ataxia-
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1. dysdisdodochokinesia worse on right side
2. intension tremor worse on right 3. hypometria bilaterally 4. decreased coordination, mild ataxia |
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How would a cerebellar stroke present?
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balence definicits.
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How would a left CVA present?
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1. weak R dorsiflexors
2. spasticity in right UE 3. decreased two point discrimination in R UE 4. Decreased sensation in UE R |
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difference between flat back and sway back?
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sway back- forward pelvis, neutral ankles
flat back- slight plantar flex in ankles, neutral pelvis |
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What muscles do you want to strengthen in someone with lordosis?
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upper traps
SCM rhomboids stretch pecs |
