Ptha 2435 - Rehab Techniques - Cameron And Monroe Book And Hays Lecture - Exam 4

Front 1

Success of walking depends upon what three critical functional tasks? ***

Back 1

- weight acceptance
- single-limb support
- swing-limb advancement

Front 2

What is “weight acceptance” with respect to the gait cycle? ***

Back 2

- the stance phase limb must rapidly accept the body’s weight

- occurs during Initial contact and loading response

Front 3

What is “single-limb support” with respect to the gait cycle? ***

Back 3

- maintaining forward momentum and stability while body’s weight is balanced on one limb

- occurs during midstance and terminal stance

Front 4

What is “swing-limb advancement” with respect to the gait cycle? ***

Back 4

- unloading and moving the reference limb forward
- preparing for the next functional phase
- clearing the foot and limb advancement

- occurs during preswing, initial swing, midswing, and terminal swing

Front 5

What is stance phase? How much of the gait cycle does it comprise? ***

Back 5

- the portion of gait during which the reference extremity is in contact with the ground

- 60% of the gait cycle

Front 6

What is swing phase? How much of the gait cycle does it comprise? ***

Back 6

- the phase of gait during which the reference limb is not in contact with the supporting surface and is moving forward

- 40% of the gait cycle

Front 7

How is the normal gait cycle divided between stance phase and swing phase? ***

Back 7

- 60% stance phase

- 40% swing phase

Front 8

What are the components of stance phase? ***

Back 8

- initial contact
- loading response
- midstance
- terminal stance
- preswing

Front 9

What is initial contact in stance phase? ***

Back 9

when the heel or another part of the foot contacts the ground

Front 10

What is loading response in stance phase? ***

Back 10

portion of the first double support phase from initial contact until the contralateral extremity leaves the ground

Front 11

What is midstance in stance phase? ***

Back 11

begins when the contralateral extremity leaves the ground and ends when the body is directly over the supporting limb. (ankles are aligned)

Front 12

What is terminal stance in stance phase? ***

Back 12

begins with heel off & continues until the contralateral extremity contacts the ground

Front 13

What is preswing in stance phase? ***

Back 13

begins the second double support period from initial contact of the contralateral extremity to lift off of the reference extremity

Front 14

What is initial swing in swing phase? ***

Back 14

reference extremity leaves the ground to maximum knee flexion of the same

Front 15

What is midswing in swing phase? ***

Back 15

from maximum knee flexion to vertical tibial position

Front 16

What is terminal swing in swing phase? ***

Back 16

(deceleration) vertical tibial position of the reference extremity to just prior to initial contact

Front 17

What is a gait cycle? ***

Back 17

- a right step and a left step

- a.k.a. as one stride

Front 18

What is a stride length? ***

Back 18

distance between the point of initial contact of one extremity and the next point of initial contact of the same extremity

Front 19

What is the adult norm for a stride length? ***

Back 19

70-82 cm

(28 – 32.8 inches)

Front 20

What is a stride width? ***

Back 20

(base of support) the distance between the two heels

Front 21

What is the adult norm for a stride width? ***

Back 21

1-3 inches

Front 22

What is cadence? ***

Back 22

number of steps per unit of time, usually steps/minute

Front 23

What is the normal cadence for a nondisabled adult? ***

Back 23

average is 100-117 steps/min for nondisabled adults

Front 24

In what direction(s) does the body’s COG move during the gait cycle? ***

Back 24

both vertically and laterally

Front 25

What is the average vertical displacement of the COG during the gait cycle? ***

Back 25

5 cm (2 inches)

Front 26

What is the normal lateral displacement of the COG during the gait cycle? ***

Back 26

2.3 cm (1 inch)

Front 27

At what point in the gait cycle is the lateral displacement of the COG the greatest? ***

Back 27

during midstance

Front 28

How does weakness and/or pain affect single-support time during the gait cycle? ***

Back 28

decreases

Front 29

What effects does increased gait velocity have on ambulation? Decreased gait velocity? ***

Back 29

- step, swing, and stride times decrease

- swing time increases (which increases single-limb support time and often contributes to LOB)

Front 30

How would post-CVA difficulty with WB on involved limb affect gait? ***

Back 30

- post-CVA , individuals often have difficulty putting weight on the involved limb
- this reduces corresponding single-support time and step length of opposite extremity
- also increases double-support time

Front 31

Which portions of the stance phase are single-limb support? ***

Back 31

- midstance
- terminal swing
- preswing

Front 32

What is the (ideal) position of the trunk throughout the gait cycle? (Table 32-2/3, page 511) ***

Back 32

0 degrees at all times

stance phase—double-limb support
- initial contact – 0 degrees flexion/extension
- loading response – 0 degrees flexion/extension

stance phase—single-limb support
- midstance – 0 degrees flexion/extension
- terminal stance – 0 degrees flexion/extension
- preswing – 0 degrees flexion/extension

swing phase
- initial swing – 0 degrees flexion/extension
- midswing – 0 degrees flexion/extension
- terminal swing – 0 degrees flexion/extension

Front 33

What is the (ideal) position of the pelvis throughout the gait cycle? (Table 32-2/3, page 511) ***

Back 33

stance phase—double-limb support
- initial contact – 5 degrees forward rotation
- loading response – 5 degrees forward rotation

stance phase—single-limb support
- midstance – 0 degrees rotation
- terminal stance – 5 degrees backward rotation
- preswing – 5 degrees backward rotation

swing phase
- initial swing – 5 degrees backward rotation
- midswing – 0 degrees rotation
- terminal swing – 5 degrees backward rotation (shouldn’t this be forward?)

Front 34

What is the (ideal) position of the hip throughout the gait cycle? (Table 32-2/3, page 511; Table 32-4/5, page 512) ***

Back 34

stance phase—double-limb support
- initial contact – 30 degrees flexion; gluteus max/med, HSs, adductors, DFs active
- loading response – 30 decreasing to 25 degrees flexion; gluteus max/med, HSs, PFs active

stance phase—single-limb support
- midstance – 25 decreasing to 0 degrees flexion; gluteus max/med, PFs active
- terminal stance – 0 increasing to 10 degrees extension; PFs active (mostly momentum, however)
- preswing – 20 decreasing to 0 degrees extension; iliopsoas, adductors, DFs active

swing phase
- initial swing – 0 increasing to 15 degrees flexion; iliopsoas, DFs active
- midswing – 15 increasing to 25 degrees flexion; HSs and DFs active
- terminal swing – 25 decreasing to 20 degrees flexion; gluteus max/med, quad femoris, HSs, DFs active

Front 35

What is the (ideal) position of the knee throughout the gait cycle? (Table 32-2/3, page 511; Table 32-4/5, page 512) ***

Back 35

stance phase—double-limb support
- initial contact – 0 degrees extension; gluteus max/med, quadriceps, HSs, adductors, DFs active
- loading response – 0 increasing to 15 degrees flexion; gluteus max/med, quadriceps, HSs, PFs active

stance phase—single-limb support
- midstance – 15 decreasing to 5 degrees flexion; gluteus max/med, quadriceps, PFs active
- terminal stance – 5 decreasing to 0 degrees flexion; PFs active (mostly momentum, however)
- preswing – 0 increasing to 30 degrees flexion; iliopsoas, adductors, DFs active, (PFs too per 32-2?)

swing phase
- initial swing – 30 increasing to 60 degrees flexion; iliopsoas, DFs, HSs, sartorius, gracilis active
- midswing – 60 decreasing to 25 degrees flexion; HSs and DFs active
- terminal swing – 20 decreasing to 5 degrees flexion; gluteus max/med, quad femoris, HSs, DFs active

Front 36

What is the (ideal) position of the ankle throughout the gait cycle? (Table 32-2/3, page 511; Table 32-4/5, page 512) ***

Back 36

stance phase—double-limb support
- initial contact – 0 degrees DF/PF; gluteus max/med, HSs, adductors, DFs active
- loading response – 0 increasing to 15 degrees PF; gluteus max/med, quadriceps, HSs, PFs active, (DFs too per 32-2?)

stance phase—single-limb support
- midstance – 15 degrees PF to 10 degrees DF; gluteus max/med, PFs active
- terminal stance – 5 decreasing to 0 degrees DF; PFs active (mostly momentum, however)
- preswing – 0 increasing to 20 degrees PF; adductors, DFs active, (PFs too per 32-2?)

swing phase
- initial swing – 20 decreasing to 5 degrees PF; DFs active
- midswing – 0 degrees PF/DF; HSs and DFs active
- terminal swing – 0 degrees PF/DF; gluteus max/med, quad femoris, HSs, DFs active

Front 37

What are the weight acceptance positions in the Stance Phase of gait? ***

Back 37

- initial contact

- loading response

Front 38

What are the single-limb support positions in the Stance Phase of gait? ***

Back 38

- midstance
- terminal stance
- preswing

Front 39

What muscles are active during the initial contact subphase of gait? ***
(The muscles given are from tables 32-4/32-5; the muscles in parentheses are those given in tables 32-2/32-3 over and above the first two tables.)

Back 39

- gluteus maximus
- gluteus medius
- adductors
(- quadriceps – knee)
- hamstrings
- dorsiflexors – tibialis anterior, extensor hallucis longus, extensor digitorum longus

Front 40

What muscles are active during the loading response subphase of gait? ***
(The muscles given are from tables 32-4/32-5; the muscles in parentheses are those given in tables 32-2/32-3 over and above the first two tables.)

Back 40

- gluteus maximus
- gluteus medius
(- quadriceps – knee)
- hamstrings
- plantar flexors – gastroc/soleus, tibialis posterior, flexor hallucis longus, extensor digitorum longus
(- dorsiflexors – ankle – tibialis anterior, extensor hallucis longus, extensor digitorum longus)

Front 41

What muscles are active during the midstance subphase of gait? ***
(The muscles given are from tables 32-4/32-5; the muscles in parentheses are those given in tables 32-2/32-3 over and above the first two tables.)

Back 41

- gluteus maximus
- gluteus medius
(- quadriceps – knee)
- plantar flexors – gastroc/soleus, tibialis posterior, flexor hallucis longus, extensor digitorum longus

Front 42

What muscles are active during the terminal stance subphase of gait? ***

Back 42

- plantar flexors – gastroc/soleus, tibialis posterior, flexor hallucis longus, extensor digitorum longus
(but mostly gravity)

Front 43

What muscles are active during the preswing subphase of gait? ***
(The muscles given are from tables 32-4/32-5; the muscles in parentheses are those given in tables 32-2/32-3 over and above the first two tables.)

Back 43

(- iliopsoas – hip)
- adductors
- dorsiflexors – tibialis anterior, extensor hallucis longus, extensor digitorum longus
(- plantar flexors – ankle – gastroc/soleus, tibialis posterior, flexor hallucis longus, extensor digitorum longus)

Front 44

What muscles are active during the initial swing subphase of gait? ***
(The muscles given are from tables 32-4/32-5; the muscles in parentheses are those given in tables 32-2/32-3 over and above the first two tables.)

Back 44

(- iliopsoas – hip)
(- hamstrings – knee)
(- sartorius – knee)
(- gracilis – knee)
- dorsiflexors – tibialis anterior, extensor hallucis longus, extensor digitorum longus

Front 45

What muscles are active during the midswing subphase of gait? ***

Back 45

- hamstrings

- dorsiflexors – tibialis anterior, extensor hallucis longus, extensor digitorum longus

Front 46

What muscles are active during the terminal swing subphase of gait? ***

Back 46

- gluteus maximus
- gluteus medius
- quadriceps femoris
- hamstrings
- dorsiflexors – tibialis anterior, extensor hallucis longus, extensor digitorum longus

Front 47

What is the ROM of the pelvis in stance phase? In swing phase? ***

Back 47

- 0-5 degrees forward and backward rotation

- 0-5 degrees forward and backward rotation

Front 48

What is the ROM of the hip in stance phase? In swing phase? ***

Back 48

- 0-30 degrees flexion

- 20-30 degrees flexion

Front 49

What is the ROM of the knee in stance phase? In swing phase? ***

Back 49

- 0-40 degrees flexion

- 0-60 degrees flexion

Front 50

What is the ROM of the ankle in stance phase? In swing phase? ***

Back 50

- 0-10 degrees dorsiflexion and 0-20 degrees plantar flexion

- 0 degrees dorsiflexion and plantar flexion

Front 51

What is the ROM of the subtalar joint in stance phase? In swing phase? ***

Back 51

- 0-5 degrees eversion

- neutral to slight inversion

Front 52

Describe an antalgic gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 52

- difficulty or decrease in weight bearing on a limb during stance phase due to the presence of pain

- stance phase

- pain caused by the compression of a joint or soft tissue structure when bearing weight

Front 53

Describe a crouch-knee gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 53

- pattern of gait characterized by excessive flexion affecting both knees

- stance

- tonal increases associated with CNS involvement; contracture involving either the joint and/or soft tissue structure crossing the joint

Front 54

Describe an early/premature heel rise. During what phase of the gait cycle does it occur? What causes it? ***

Back 54

- premature rise of the heel during the stance phase of gait

- stance

- ankle joint or soft tissue structure contracture; hyperactivity of the plantarflexors

Front 55

Describe a gluteus maximus lurch. During what phase of the gait cycle does it occur? What causes it? ***

Back 55

- posterior inclination of the trunk during the stance phase of gait as a compensation for weakness

- stance

- gluteus maximus weakness (e.g., in post-polio syndrome pt leans back and BOS shifts to point behind hips)

Front 56

Describe a quadriceps avoidance pattern. During what phase of the gait cycle does it occur? What causes it? ***

Back 56

- a decrease in the typical amount of flexion seen during stance to prevent excessive anterior tibial translation

- stance

- ACL injury

Front 57

Describe a Trendelenburg/gluteus medius gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 57

- lateral inclination of the trunk during stance phase (this is compensated; uncompensated would result in a hip drop)
--- compensated – really standing on hip (a.k.a. hip winking)
--- uncompensated – hip drops; weakness on opposite side of dropped hip (because patient is unable to perform closed-chain hip abduction)

- stance

- weakness of the hip abductors

Front 58

Describe circumduction. During what phase of the gait cycle does it occur? What causes it? ***

Back 58

- circular movement of the lower extremity into increased abduction

- swing

- leg-length discrepancy arising from a hip, knee, or ankle joint or soft tissue structure contracture; osseous shortening or lengthening

Front 59

Describe a hip-hiking gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 59

- increased vertical translation of the pelvis

- swing

- compensation for a leg-length discrepancy

Front 60

Describe a scissoring gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 60

- a gait pattern characterized by excessive hip adduction

- swing

- increased adductor tone or recruitment; synergistic pattern of recruitment (e.g., Parkinson’s or CP)

Front 61

Describe a steppage gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 61

- excessive hip and knee flexion during the swing phase to allow increased clearance

- swing

- excessive plantar flexion at the ankle because of a lack of recruitment or excessive tone

Front 62

Describe a toe drag gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 62

- contact of the foot with the supporting surface throughout swing

- swing

- impaired dorsiflexor force production; plantar flexor hypertonicity; ankle joint contracture; loss of sensation

Front 63

Describe an ataxic gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 63

- an uncoordinated pattern of gait that can be characterized by difficulty with stability of the trunk or achieving a smooth trajectory with the limb during swing

- stance and swing

- CNS dysfunction (esp. cerebellar); impaired lower extremity sensation

Front 64

Describe a stiff-knee gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 64

- decreased knee flexion

- stance and swing

- compensation for weak knee extensors; pain; increased knee extensor tone; synergistic pattern of recruitment

Front 65

Describe a vaulting gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 65

- increased vertical translation of the body’s center of gravity by plantar flexing at the ankle and increasing knee extension during stance

- stance and swing

- leg-length difference caused by osseous tissue structure changes; inadequate hip or knee flexion during swing

Front 66

Describe a hemiplegic gait. During what phase of the gait cycle does it occur? What causes it? ***

Back 66

- hip lags and never comes forward because if it did, the knee would unlock; accompanied by foot drop and circumduction

- stance (and swing)

- post CVA weakness

Front 67

What is task-specific intervention to improve gait? ***

Back 67

- emphasizes practicing the actual task of walking under variety of environmental conditions

- usually most successful and most meaningful

Front 68

What is non-task-specific intervention to improve gait? ***

Back 68

- having the patient perform activities that will strengthen or enhance recruitment of muscles contributing to gait or repetitively practicing the problematic elements of walking outside of the actual task

Front 69

Which is generally more successful, task-specific interventions or non-task-specific interventions for improving gait? ***

Back 69

task-specific

Front 70

What are some elements of task-specific training to improve gait? ***

Back 70

- practicing walking within the context that it must be performed (gait-specific therapy)

- combining activities such as walking on a variety of level surfaces, sit-to-stand transfer training, and lower extremity strengthening, for 1 hour, 3 times per week, has proven to work well

- body weight-supported training: involves partially supporting the patient’s body weight with a harness during walking; the harness can be supported by the ceiling or a mobile device with wheels

- evidence supports the task-specific approach to gait training

Front 71

How is feedback provided to patient during body weight-supported training? ***

Back 71

- feedback via tactile cues or physical assistance with LE placement provided by PT/PTA

Front 72

For what is body weight-supported training helpful? ***

Back 72

- increasing the strength of muscles used for standing and walking
- improving balance

- task specific practice to facilitate the relearning of movement patterns
- enhancing patterns of muscle activation or recruitment for standing and walking tasks

Front 73

How is body weight-supported gait training progressed to improve gait performance? ***

Back 73

gradually decrease the amount of support while controlling the speed of walking

Front 74

What approaches are taken with non-task-specific gait training? ***

Back 74

- strength training
- NDT approach

- motor relearning program
- balance training-

Front 75

How is strength training used to improve gait? ***

Back 75

LE strengthening with emphasis on hip and knee extension; hip flex/ext/abd/add, knee flex/ext, ankle PF/DF

Front 76

How is NDT used to improve gait? ***

Back 76

for pts with CNS impairments (e.g., CVA or CP); emphasizes use of verbal and tactile feedback in conjunction with functional retraining to improve motor skills

Front 77

How is motor relearning used to improve gait? ***

Back 77

involves practicing most difficult components of gait (e.g., pt has difficulty shifting weight onto paretic limb—would practice just weight shift onto that limb)

Front 78

How is balance training used to improve gait? ***

Back 78

work on balance in context of walking (not standing); walk on uneven surfaces, change directions, step up, step over/around objects, carry objects

Front 79

What form of exercise has been reported to improve gait and reduce fall risk in elderly adults? ***

Back 79

Tai Chi

Front 80

Anatomy of the airway consists of: ***

Back 80

- nose/mouth
- larynx
- trachea
- bronchi
- lungs

Front 81

Describe the anatomy of the lungs. ***

Back 81

- 5 lobes (3 right, 2 left)
- parenchyma
- primary/secondary/tertiary bronchi
- bronchioles
- alveolar sacs

Front 82

Where does gas exchange occur in the lungs? ***

Back 82

- in the alveoli

Front 83

What is the O2 pressure in the alveoli? The CO2 pressure in the veins at the alveoli? ***

Back 83

- 100 mm Hg

- 30 mm Hg

Front 84

What are the primary muscles of respiration? ***

Back 84

- diaphragm

- intercostals (external and internal)

Front 85

What portion of the respiratory cycle occurs when the diaphragm contracts? When it relaxes? ***

Back 85

- inspiration (diaphragm contracts and descends)

- expiration (diaphragm relaxes and ascends)

Front 86

What are the accessory muscles of inspiration? ***

Back 86

- scalenes
- SCM
- trapezius
- pectoralis major

Front 87

What are the accessory muscles of expiration? ***

Back 87

- rectus abdominis
- transverse abdominis
- internal obliques
- external obliques

Front 88

What factors contribute to the autonomic control of respiration? ***

Back 88

- PaCO2 – arterial carbon dioxide pressure
- PaO2 – arterial oxygen pressure

- chemoreceptors
- mechanoreceptors

Front 89

Where are the peripheral chemoreceptors for respiration located? ***

Back 89

- carotid bodies – located in right and left carotid arteries

- aortic bodies – located in aortic arch and right subclavian artery

Front 90

How do the peripheral chemoreceptors help control respiration? ***

Back 90

carotid bodies sense when PaO2 drops &/or H+ concentration increases then they signal brain to increase action of the diaphragm which increases the tidal volume (example: high altitude)

Front 91

How do the central chemoreceptors help control respiration? ***

Back 91

when medulla oblongata detects increase in PaCO2 or H+ it signals to increase respiration rate

Front 92

Name the intrapulmonary receptors for respiratory regulation. ***

Back 92

- Vagus nerve (CN X)

- stretch receptors (in airways) – prolong inspiration during periods of lung deflation & will prolong expiration during excessive lung inflation. (sigh, or yawn triggered)

- parenchymal receptors – in alveolar walls; respond to fluid changes associated with CHF.

Front 93

Name the chest wall and muscle receptors for respiratory regulation. ***

Back 93

- muscle spindles – reflex contraction of skeletal muscle when stretched

- golgi tendon organ – senses changes in force of contraction/may help coordinate muscle contractions

- proprioceptors – may affect timing of inspiration & expiration

Front 94

Name the three categories of lung dysfunction problems. ***

Back 94

- obstructive
- restrictive
- COPD

Front 95

What three pathologies comprise COPD? ***

Back 95

- chronic bronchitis
- emphysema
- chronic asthma

Front 96

Describe chronic obstructive pulmonary disease (COPD). ***

Back 96

associated changes:
- airflow obstruction, narrowing of airways, generally progressive
- airway hyperreactivity usually due to inhaled cigarette smoke, progressing to chronic inflammation, which in turn produces excessive secretions
- may be partially reversible

types of COPD:
- chronic bronchitis
- emphysema
- chronic asthma

- chronic bronchitis and emphysema can coexist and their signs & symptoms overlap
- the term “COPD” usually refers to these two disease processes although chronic asthma is also a type of COPD

Front 97

What is chronic bronchitis? ***

Back 97

chronic cough and expectoration which persists for at least a three month period for at least two consecutive years

Front 98

What is emphysema? ***

Back 98

abnormal enlargement of the distal respiratory unit accompanied by destructive changes of the alveolar walls without obvious fibrosis (which would be restrictive)

Front 99

Describe the pathophysiology of COPD. ***

Back 99

- chronic inflammation leads to increased secretions
- secretions trap air during exhalation
- trapped air leads to hyperinflation

- reduced ciliary function leads to airway obstruction

- increased sensitivity to irritants leads to bronchial hyperreactivity

- reduced elastic recoil of lungs leads to collapse of airways during exhalation
- air remains trapped in lungs

Front 100

What occurs in the advanced stages of COPD? ***

Back 100

- destruction of alveolar capillary membrane leads to:
--- hypoxemia
--- hypercapnea (elevated carbon dioxide levels in arterial blood)

Front 101

Describe Cystic Fibrosis. ***

Back 101

- excessive thick and immobile secretions leading to:
--- partial airway obstruction and air trapping (the alveoli from left to right), and
--- total airway obstruction and alveoli collapse (upper right alveoli).”

Front 102

Describe restrictive lung disease. ***

Back 102

a group of diseases with different etiologies; they have in common:
- difficulty in expanding the lungs
- reduction in lung volume

- functional changes begin with
--- chronic inflammation and
--- thickening of the alveoli and interstitium

- distal air spaces become fibrosed increasing resistance to expansion
- lung volumes are reduced
(e.g., hypoxemia and cor pulmonale—right ventricle enlargement)

Front 103

What are some causes of restrictive lung diseases? Which is the most common cause? ***

Back 103

-radiation therapy
- inorganic dust
- noxious gases
- oxygen toxicity
- asbestos exposure, and
- tuberculosis.

most common cause:
- idiopathic pulmonary fibrosis (IPF)

(some other examples: CF, kyphosis, scoliosis, SCI, mesothelioma)

Front 104

What are the signs and symptoms of restrictive lung disease? ***

Back 104

- dyspnea
- nonproductive cough
- weakness and fatigue
-rapid, shallow breathing
- limited chest expansion
- crackles
- digital clubbing (Schamroth sign)
- cyanosis

Front 105

What is the prognosis for restrictive lung disease? ***

Back 105

- chronic and progressive
- 50% die within 5 years of diagnosis

Front 106

Aerobic capacity ***

Back 106

- another term for maximum oxygen uptake (VO2 max)
- the highest amount of oxygen consumed during maximal exercise

Front 107

Alveolar ventilation ***

Back 107

the volume of gas expired from the alveoli to the outside of the body per minute

Front 108

Atelectasis ***

Back 108

alveolar collapse because of poor lung expansion or complete obstruction of an airway

Front 109

Auscultation ***

Back 109

listening with a stethoscope

Front 110

Bronchodilator ***

Back 110

medication that reduces bronchial smooth muscle spasm and thereby causes an increase in caliber of a bronchial tube

Front 111

Crackles ***

Back 111

- nonmusical sounds (previously called rales) that may be mimicked by rolling several strands of hair near your ear or by listening to a bowl of cereal that crackles when milk is added
- crackles may represent the sudden opening of previously closed airways
- expiratory crackles may indicate the presence of fluid in the large airways

Front 112

Dyspnea ***

Back 112

- shortness of breath
- a subjective difficulty or distress in breathing

Front 113

Hypercapnia ***

Back 113

increased carbon dioxide level in the arterial blood

Front 114

Hypoxemia ***

Back 114

low or insufficient oxygen in the arterial blood

Front 115

Mucolytic ***

Back 115

- a medication capable of dissolving or decreasing the viscosity of mucus

Front 116

Paradoxical breathing ***

Back 116

moving the belly in during inspiration and out during expiration

Front 117

Stertor ***

Back 117

a snoring noise created when the tongue falls back into the lower palate

Front 118

Stridor ***

Back 118

a crowing sound during inspiration

Front 119

Thoracic index ***

Back 119

ratio of the AP diameter to the transverse diameter of the thorax

Front 120

Tidal volume ***

Back 120

volume of air inspired or expired in a single breath during regular breathing

Front 121

Wheezes ***

Back 121

whistling sounds probably produced by air flowing at high velocities through narrowed airwasy

Front 122

What is a PFT? ***

Back 122

- pulmonary function test

tests:
- lung volumes and capacities
- flow rates of gases through airways
- diffusing capacity of lung

Front 123

What volumes are measured via PFT? ***

Back 123

- tidal volume (normal breath in and out)
- inspiratory reserve volume (over and above a normal/tidal inspiration)
- expiratory reserve volume (over and above normal/tidal expiration)
- residual volume (amount of air in lungs after maximal exhalation)

Front 124

What capacities are measured via PFT? ***

Back 124

- total lung capacity (volume of air in lungs at maximal inflation)
- inspiratory capacity (sum of inspiratory reserve volume and tidal volume)
- vital capacity (total lung capacity less residual volume—big breath in, big breath out)
- functional residual capacity (volume of air in lungs at end of passive expiration—to ERV)

Front 125

What is spirometry? What is its most common measure? ***

Back 125

- measurement of PFT

- forced vital capacity is most common measure (ERV + IRV)

Front 126

For what purposes is pulmonary testing used? ***

Back 126

- allows clinician to identify the presence and degree of pulmonary impairment
- understand the type of disease
- determine treatment plan

Front 127

What 5 facets comprise pulmonary rehabilitation? ***

Back 127

- exercise training regimens
- breathing exercises
- respiratory muscle training

- education
- psychosocial support

Front 128

What exercise training regimens are frequently conducted in pulmonary rehabilitation? ***

Back 128

- treadmill walking
- cycle ergometry
- arm ergometry

Front 129

A common misconception exists that respiratory diseases are primarily adult issues. What three general categories of respiratory interventions are common in children? ***

Back 129

- removal of secretions
- breathing exercises
- physical re-conditioning

Front 130

What types of breathing exercises are used in pulmonary rehabilitation? ***

Back 130

- inspiratory muscle training
- expiratory muscle training
- incentive spirometry

- pursed lip breathing
- diaphragmatic breathing
- active expiration
- relaxation breathing

Front 131

Inspiratory and expiratory muscle training are compatible with…. ***

Back 131

any type of muscle training

Front 132

Expiratory muscle training may help patients with COPD to…. ***

Back 132

reduce lung hyperinflation

Front 133

What are some specifics on the use of incentive spirometry? ***

Back 133

- sit comfortably, hold spirometer level
- breathe only through mouth (use nose clip to ensure mouth breathing)
- inhale and exhale through spirometer
- inhale as deeply and forcefully as possible, and hold for 5-10 seconds
- exhale normally
- work hard, but not to point of exhaustion
- train 10-15 minutes per day for the first week; gradually increase to 20-30 minutes per session (or 2 15-minute sessions) daily
- try to train 3-5 times per week
- when above 30 minutes (or 2 15-minute) sessions are easily tolerated, move to next highest resistance setting and start cycle again

Front 134

What is the purpose of pursed-lip breathing? ***

Back 134

- helps to stabilize bronchiolar airways which reduces dynamic hyperinflation during acute attacks or periods of exercise
- causes a change in the breathing pattern
- recruits accessory muscles, which seems to protect the diaphragm from fatigue
- increases O2 saturation levels in patients with COPD

Front 135

How is pursed-lip breathing conducted? ***

Back 135

- breathe in slowly through nose or mouth; inhalation of about 2 seconds is enough (do not need full inspiration)
- pucker/purse lips as if you were going to whistle
- exhale slowly through lips for about 4 seconds; puckered lips should provide resistance to exhalation
- repeat

- it may be helpful to count to yourself when breathing—in, one, two; out, one, two, three, four.
- it is very important that your breathing is slow and exhalation is prolonged for at least 4 seconds

Front 136

What is diaphragmatic breathing? What are its benefits? ***

Back 136

- combines pursed-lip breathing with exhalation

- improves gas distribution and lowers energy costs of ventilation
- increases interthoracic lung volume

Front 137

What are the instructions for diaphragmatic breathing/active expiration? ***

Back 137

- lie down in bed with pillow under head and pillow under knees
- place one hand on stomach and another on chest

- inhale slowly through nose; only hand on stomach should rise, hand on chest should remain still
- exhale slowly through pursed lips; to assist exhalation, actively contract abdominal muscles
- repeat for 5-10 minutes 2-3 times daily

Front 138

What are the instructions for active expiration? ***

Back 138

- sit upright without using arms for support
- breathe in slowly through nose or mouth

- breathe out slowly with active abdominal contraction (it may be helpful to place a hand on the abdomen just below the xiphoid process to assist with abdominal contraction)
- repeat step one

(sitting in front of a mirror is sometimes helpful for proper technique)

Front 139

What is relaxation breathing? What are its benefits? ***

Back 139

- relaxation techniques
- yoga maneuvers
- relaxed shoulders, slow deep breaths

shown to:
- reduce respiratory rate
- decrease dyspnea scores
- reduce anxiety

Front 140

What are some mechanisms used for airway clearance? ***

Back 140

- positive expiratory therapy
--- acapella device
--- flutter valve

- ThAIRapy bronchial drainage system
- chest PT
- forced expiratory technique

Front 141

What is positive expiratory (pressure) therapy (PEP therapy)? ***

Back 141

indicated for patients with:
- COPD
- pneumonia
- atelectasis
- unproductive cough, & for
- post-operative patients

Front 142

What are two types of PEP therapy devices? ***

Back 142

- acapella device

- flutter valve

Front 143

What is an acapella device? How does it work? ***

Back 143

- type of PEP
- hand held
- exhaled air is forced through an occasionally blocked device which produces a vibratory effect

(basically the vibrations are to allow air to get past/behind the secretions and bring them up, as well as reduce collapsibility of airways and assists in increasing airflow to small airways)

Front 144

Use of acapella device ***

Back 144

- inhale through device, breathing larger than normal tidal volume
- exhale through device, not forcefully, but over 2-3 seconds
- if patient cannot exhale for 2-3 seconds, increase resistance

- instruct patient to take 10-20 breaths through device, followed by 2-3 effective coughs
- patient should be able to expectorate secretions
- goal of treatment is duration of 10-20 minutes, 2-4 times daily
- nebulizer can be attached if bronchodilating medications are indicated

Front 145

What is a flutter valve? ***

Back 145

- another PEP therapy device
- hand held

performed in two stages:
- loosening secretions, then
- extracting secretions

Front 146

Use of flutter valve ***

Back 146

stage 1
- inhale slowly, to not quite a full breath
- hold breath for 2-3 seconds
- place flutter valve in mouth and create tight seal
- actively exhale with medium, steady-rate exhalation
- position flutter valve so vibrations can be felt on both back and chest of patient
- patient should complete 5-10 breaths and refrain from coughing

stage 2
- inhale maximally, hold for 2-3 seconds, then forcefully exhale to assist movement of secretions
- have patient cough 2-5 times
- repeat entire sequence 2-3 times if necessary
- treatment sessions should last 10-15 minutes and be repeated 2-4 times daily

Front 147

Describe the ThAIRapy bronchial drainage system. ***

Back 147

- also ABI vest (trademark American Biosystems)
- inflatable, oscillatory device used to aid secretion removal

- pt controls frequency and pressure
- provides patient self-therapy independence
- used for Cystic Fibrosis

Front 148

What is Chest PT? ***

Back 148

percussion and/or vibrations administered to patients needing
- improved ventilation
- mobilization of secretions
- re-expansion of collapsed portions of lungs
- vibration/percussion to assist postural drainage

Front 149

What are the precautions for use of percussion? ***

Back 149

circulatory
- hemoptysis – coughing up of blood/bloody sputum
- coagulation disorders (increased prothrombin time - clotting time; platelet count below 50,000)

musculoskeletal
- rib fractures
- flail chest – segment of rib cage breaks off and becomes detached from rest of chest wall
- degenerative bone disease

also, do not perform percussion
- on the spine
- below the diaphragm
- on the sternum

Front 150

What are the precautions for postural drainage? ***

Back 150

Trendelenberg position (head lower than feet in bed):
- circulatory – pulmonary edema, CHF, HTN
- abdominal – obesity, abdominal distension, hiatal hernia, nausea, recent meal
- shortness of breath made worse by the position

side-lying position:
- vascular – axillofemoral bypass graft
- musculoskeletal – arthritis, recent rib FX, shoulder bursitis, or tendonitis, any position that would make postural drainage uncomfortable.

Front 151

Name two forced expiratory techniques. ***

Back 151

- controlled cough
- huff cough

- use mid to low lung volume
- for patients with SCI, muscle dysfunction, airway instability, or pain with coughing

- huff coughing less likely to experience collapse of airway that typically occurs with full explosive cough

Front 152

What are environmental barriers? ***

Back 152

- physical impediments that keep people from functioning optimally in their surroundings

may include
- safety hazards
- difficult access and
poor home or office design

(e.g., stairs, gravel driveway, stone walkway, narrow doors/hallways, etc.)

Front 153

What is the goal of assisting the therapist & patient through analysis of the patient’s home, community and workplace? ***

Back 153

- goal of environmental analysis is to maximize functional independence by eliminating barriers & creating a plan for interventions that support preferred movement patterns & optimal function

- shortest distance, safest distance, family preference

- often you will be spending more time with the patient than the PT, so early on ask the patient & family questions about the predicted home environment – bath set-up, kitchen, access doors and walkways; then incorporate your findings into treatment

Front 154

What tests and measures do therapists use to gather information about environmental barriers? ***

Back 154

- observation – direct or by video/photo
- measurement of pt & environmental features

- patient report
- functional performance testing
- caregiver interview.

Front 155

What are the reach norms from a wheelchair? ***

Back 155

- horizontal and unobstructed forward reach – 24” is safe
- obstructed forward reach with leg space allowed – 17-19” (e.g.., reaching forward for faucet when wheeled under sink or counter; from axle of front wheel when wheelchair arms do not clear)
- obstructed forward reach when arm rests and legs are allowed to pass under objects (e.g., 30” counter/table height for wheelchair arms to clear) is 24 inches
- 9” above the floor to reach for shoes (use shoe trees or boxes)
- 54” maximum height reach

Front 156

Describe the primary reach zone (at desk.) ***

Back 156

- area closest to the body
- as if arms are windshield wipers

Front 157

Describe the secondary reach zone (at desk.) ***

Back 157

- elbows no further than anterior rib cage
- items used 4-10 times per hour

Front 158

Describe the tertiary reach zone (at desk.) ***

Back 158

- objects can be reached without exceeding full elbow extension or 90 degrees of shoulder flexion

Front 159

What is the most useful means of assessing muscle performance? ***

Back 159

- functional manual muscle testing is most useful

Front 160

Why should muscle performance testing/functional manual muscle testing be used? ***

Back 160

- to assess if there is adequate strength to handle tools, operate levers, and lift, carry, push, & pull objects as required by patient’s expected roles

- to watch for muscle substitutions that may lead to increased risk of injury!
(e.g., quads/HS weak, will bend over instead of squatting to lift)

Front 161

What types of results should the therapist be watching for in response to cardiovascular testing? ***

Back 161

- patient’s endurance and response to exertion
- time it takes & the response to climbing stairs (SOB &/or HR)
- how many rests were taken - standing or sitting.

Front 162

What types of results should the therapist be watching for in response to gait, locomotion, and balance testing? ***

Back 162

- observe patient’s movement patterns and balance throughout the environmental assessment
- even though it’s their house, stay within arm’s reach and use a gait belt! (you are still responsible if they fall!!)

- assess how patient does on uneven surfaces, getting in/out of car, bed, bath, on/off toilet

- assess balance recovery strategies – what do they grab onto? AGAIN, USE GAIT BELT!!

Front 163

How do assistive, adaptive, orthotic, protective, and prosthetic devices figure into the assessment process? ***

Back 163

- patient should use their recommended devices
(e.g., walker, AFO, slings, TED hose, bath bench, hearing aid, glasses)

- PT/PTA will assess whether any of the devices pose a safety risk

Front 164

Where should the environmental assessment begin? For what types of issues is the assessor looking? ***

Back 164

- start with exterior routes and progress to interior

exterior barriers:
- what mode of transportation will be used & can patient use it?
- what is the situation with parking? lighting?
- is there a safe path to the entrance? (gravel, cement, grass, slope & its condition)
- are there curbs, gates, electronic doors, security alarms?

Front 165

What should be noted with regards to stairs? ***

Back 165

- note height, width, and depth
- general condition, whether handrails present

- should be maximum height 7 inches
- depth of at least 11 inches
- and should not have tread lip projections

Front 166

What should be noted with regards to ramps? ***

Back 166

- if patient cannot manage stairs, measure for ramp

- if ramp is present:
--- what is the surface condition?
--- are there handrails?
--- is there edge protection?
--- can patient ascend & descend safely?

- is there a slope of 1:12?
- there should be 1 foot length for each inch of step height
(e.g., 6 inch step requires a 6 foot long ramp
- should never be more than 1:8

Front 167

What should be noted with regards to handrails? ***

Back 167

- are they present on stairs and ramps
- what is the condition? (e.g., splinters, slippery when wet, etc.)

Front 168

What should be noted with regards to elevators? ***

Back 168

- can the patient use it?
- does it come in a timely manner?
- can the patient reach the buttons?

Front 169

What is the minimum clear floor space necessary for a stationary wheelchair? ***

Back 169

- 30 inches wide by
- 48 inches long

Front 170

What is the minimum path width for a standard wheelchair or for ambulating with an assistive device? ***

Back 170

- 36 inches, to allow for passing space

Front 171

How narrow can a corridor be (briefly) to allow a wheelchair to pass? ***

Back 171

- a corridor can narrow to widths of 32 inches for distances less than 24 inches in length (e.g., to pass through doorways)

Front 172

What is the most frequent obstacle preventing full wheelchair access in a residence? ***

Back 172

- narrow width of doorways

Front 173

How wide must a doorway be for a standard wheelchair to pass for poor access? Fair access? Good access? ***

Back 173

- 32-inch doorway off a 36-inch hallway
- 32-inch doorway off a 46-inch hallway
- 36-inch doorway off a 36-inch hallway

Front 174

What are the spacing requirements when pulling a door open while seated in a wheelchair? ***

Back 174

- 60 inches perpendicular to the door
- 18 inches lateral to the latch

Front 175

What are the spacing requirements when pushing a door open while seated in a wheelchair? ***

Back 175

- 48 inches perpendicular to the door

Front 176

How much room is required for a patient to turn a wheelchair 180 degrees using both hands? Using only one hand? ***

Back 176

- 60 x 60 inches

- 60 x 72 inches

Front 177

When inspecting the environment for seating, what should the therapist be checking for? ***

Back 177

- height, width, & depth of all seats used and compare measurements to the patient

- check condition of padding, seat, & support provided (ensure neutral spine)

Front 178

What are the requirements for a task chair? ***

Back 178

- 5 point pedestal
- casters
- adequate seat cushion to avoid pressure points
- forward seat tilt to assist with neutral spine posture
- depth to support 2/3 of thigh
- adjustable backrest/armrests

Front 179

When inspecting countertops, tables, and work surfaces in the environment, what should the therapist be checking for? ***

Back 179

- measure both from floor to bottom of surface and to top, height & depth

- assess whether patient’s legs (need 24-inch depth) & armrests (need 30-inch height) will fit under counter

- average horizontal/lateral reach from WC is 24 inchesfrom the patient’s shoulder
- functional reach over counter top is 17 – 19 inches

Front 180

When inspecting sinks in the environment, what should the therapist be checking for? ***

Back 180

are faucets
- accessible (no more than 22” from edge of counter)?
- easy to use (no higher than 34” from floor)?

- does WC fit under?

Front 181

What barriers should the therapist be looking for in the kitchen? ***

Back 181

- if patient will cook, have them lift glasses, pots & pans, open and remove items from refrigerator, oven, & cabinets

- check for fire risks (grease, towels)

- can patient use fire extinguisher?
- is there a smoke detector in area? does it have batteries?

Front 182

What general barriers should the therapist be looking for in the bathroom? ***

Back 182

- door width

safety & accessibility of the
- sink
- toilet and
- bath/shower

Front 183

What specific barriers should the therapist be looking for with regards to the toilet? ***

Back 183

- seat height ideally 17” – 19”
- are there grab bars? is their location appropriate?

- can the patient use an assistive device or WC to approach toilet?
- is there space for caregiver?

Front 184

What specific barriers should the therapist be looking for with regards to the shower/bath? ***

Back 184

- check for accessibility of the faucet
- check for presence of a bath or shower seat and grab bars

- can the patient safely transfer in and out of shower/bath?
- soap dishes, towel bars & shower rods should never be used for support

Front 185

What are the required dimensions for a shower stall for a wheelchair user? ***

Back 185

- at least 36” x 60” with a 36” door opening for a WC user

Front 186

What specific barriers should the therapist be looking for with regards to the bedroom? ***

Back 186

- check width of the door opening
- check lighting, flooring, and accessibility to bed and clothing
- can patient safely maneuver in room and when reaching clothing from dresser and closet

- measure bed height, ideally when patient is seated at edge of bed, the knees are slightly below the hips & feet flat on floor

Front 187

What specific barriers should the therapist be looking for with regards to the telephone? ***

Back 187

- check type of phone
- can they hold it, dial numbers, access emergency contacts, and connect with 911?
- can the patient see & hear the phone?
- can they pick it up in a timely manner?

Front 188

What is the ADA? ***

Back 188

- Americans with Disabilities Act (ADA)
- enacted in 1990 as a national mandate for elimination of discrimination against individuals with disabilities and to provide guidance for reasonable accommodations

- prohibits discrimination against people with disabilities in
--- employment (Title I)
--- public services (Title II)
--- places of public and commercial facilities (Title III)
--- telecommunications (Title IV)

Front 189

How are the therapist’s interventions documented? ***

Back 189

- interventions for environmental barriers are generally recommendations
- given by the PT for modifying the environment

- a PTA can discuss their observations and report them to the PT

Front 190

What should the therapist’s interventions do? ***

Back 190

they should
- improve safety
- maximize functional independence
- be acceptable to the patient

Front 191

How may interventions help postural issues? ***

Back 191

posture can be optimized by selection of furniture that allows the patient to
- maintain a neutral spine and to
- optimize mechanical advantage for power & balance

(e.g., counter, chair height & lighting changes)

Front 192

How may interventions help overcome limited ROM issues? ***

Back 192

- objects may be moved closer
- extended handles utilized, and
- reachers may be helpful

Front 193

How may interventions help overcome muscle performance issues? ***

Back 193

reduce force demands from the environment
- use of lighter weight dishes
- use of lever door knobs
- use of powered tools such as can/jar openers, carving knives, and door openers
- voice recognition software when writing is challenging

- installing smooth flooring or low pile carpeting if patient uses a WC or assistive device

Front 194

How may interventions help overcome cognition issues? ***

Back 194

- if patient has cognitive impairments the environment should be simplified for safe participation in activities

- single number dialing for emergency access
- limit access to dangerous items such as power tools, guns, cooking surfaces and give simple picture instructions

Front 195

How may interventions help overcome pain issues? ***

Back 195

- if caused by pressure, add padding, change height of a surface, or change the patient’s posture

- if LE or LBP, consider a cushioned floor mat or change position

Front 196

How may interventions help overcome coordination issues? ***

Back 196

for dexterity problems
- simplify task or power the activity
- keyless controlled door entry &
- voice recognition software for writing

Front 197

How may interventions help overcome sensory integrity issues? ***

Back 197

- textured surfaces

- for patients with temperature discrimination loss hot water should not be more than 130 degrees
- purchase a temperature regulator or have family member test before showering
- turn water heater to warm, not hot, setting

Front 198

How may interventions help overcome cardiopulmonary issues? ***

Back 198

- place commonly used items close by & at waist level

- use a motorized WC or scooter

Front 199

Recommendations for overcoming environmental barriers range from _____ to _____. ***

Back 199

- simple changes of habits, routines and behaviors

- complex structural changes requiring skilled contractors

Front 200

How may environmental accesses be made safe for patient navigation? ***

Back 200

- use handicap parking closest to entrance
- access routes should be at least 36” wide, esp. for WC
- smooth, non-slip surface, maximum 8% grade

- good lighting
- clear of obstacles, cracks, and gaps
- curb cutouts/accessible curbs

Front 201

How may stairs be made safe for a patient to navigate? ***

Back 201

- repair steps as needed
- remove tread lips

- good lighting; especially if visually impaired patient
- place tape at edge of each stair – especially red, orange, or yellow (those with visual impairments can see these colors best)

- wide or abrasive tape at top & bottom step, also around railing.
- stairs for walker 30 inches wide x 22 inches deep

Front 202

How may ramps be made safe for a patient to navigate? ***

Back 202

- incline between 1:8 – 1:12
- non-skid surface

- level landing at top & bottom
- 5 feet x 3 feet or 5 feet x 5 feet if turning corner

- when ramp is straight, the landing must be at least 60 inches long and at least as wide as the ramp run
- when ramp changes direction, the landing must be at least 60 inches in length and width

Front 203

What are the requirements for edge protection and handrails? ***

Back 203

- handrail should be placed parallel to the slope of the ramp and 34-38 inches above it

- ramp edging is required to prevent 4-inch objects (walker wheel) from rolling off the edge

- edge protection at least 2” in height and placed no higher than 4” from the top of the ramp.

Front 204

How may access routes be improved in the home? ***

Back 204

- rearrange furniture, clearing a path at least 36” wide

- remove obstacles such as cords, wires, throw rugs & clutter

Front 205

What may have to be done to flooring to create a safer environment? ***

Back 205

- walking & WC easier on low pile carpet, tile, cement
- visually impaired – light floor color to contrast darker furniture
- remove any runners, mats that slide, flooring with holes

Front 206

What adjustments may have to be made to doors in the environment? ***

Back 206

for patient in WC that is 32 – 36 inches wide, door width can be increased by:
- installing offset hinges
- removing door stop
- removing door & installing curtain

if patient has limited space &/or difficulty passing through doorway:
- install double action hinge
- reverse hinge toward the larger room
- add lever style handles, pull handles to pull door shut
- remove or lower thresholds
- add kick plate 10 – 16 inches from floor
-outside shelf near door; keyless entry

Front 207

What adjustments may have to be made to lighting in the environment? ***

Back 207

- older eye needs 3 times more light than the younger eye
- avoid having patient move quickly when going from light to/from dark

- light switches and lamps placed for easy access
- emergency, and night lights

Front 208

What adjustments may have to be made to seating in the environment? ***

Back 208

- firm seating required, may need plywood added for support

- remove casters, rockers, and swivel-bases for improved stability
- add 3- 5 inch leg extenders to chairs & sofas

ensure
- knees level with (or a little lower than) hips
- 2/3rds of thigh supported
- arm rests

Front 209

What adjustments may have to be made to countertops, tables, and/or work surfaces in the environment? ***

Back 209

- raising or replacing tables that are too low
- leg extenders to raise table 3 – 5 inches

- platform to elevate pedestal-type tables
- most work surfaces are 29 inches but need to be 30-inch height so that WC armrests can fit under and allow the patient to reach forward up to 24 inches

Front 210

What adjustments may have to be made to reach zones in the environment? ***

Back 210

- move objects around to fit in reach zones
- use a lazy Susan or a rotating book caddy
- long-handled reacher to avoid strain

Front 211

What adjustments may have to be made to work area triangles in the environment? ***

Back 211

- rearrange space according to frequency of use

- create most efficient design for the patient (U-shaped, L-shaped, corridor, or wall layout)

Front 212

What adjustments may have to be made to sinks in the environment? ***

Back 212

- single-lever handles

for WC users:
- no higher than 34 inches (30-34 inches) from floor
- allow for knee clearance by removing cabinet doors, central rail, and toe board
- pad sharp edges
- insulate hot water pipes.

- space open under sink should be at least 27 inches high, 30 inches wide, & 19 inches deep

Front 213

What adjustments may have to be made in the kitchen environment? ***

Back 213

- electric stove with controls in front
- mirror tilted over the stove
- eye level oven
- side by side refrigerator with slide out drawers & water/ice dispenser

- rolling cart, stool if ambulatory
- lazy Susan-type trays on counter & inside cabinets
- heavy items moved to waist level

Front 214

What adjustments may have to be made to toilets in the environment? ***

Back 214

- ideal seat height is 17 – 19 inches for adults
- but patients with weakness or ROM restrictions may do better if higher
- commode or raised toilet seat added

- if balance problems, add grab bar 42 inches long, 33 inches from floor at the side of the toilet
- one behind the toilet can be useful also

Front 215

What are the ADA requirements for grab bars around toilets? ***

Back 215

- side wall – 33-36 inches from floor, max 12 inches from back wall, min 42 inches long

- rear wall – 33-36 inches from floor, min 12 inches on one side and 24 inches on other side of toilet, min 36 inches long

Front 216

What adjustments may have to be made to baths/showers in the environment? ***

Back 216

- hand-held shower hose
- shower chair or bath bench
- non-slip flooring in both
- remove glass doors & replace with curtain
- install grab bars

Front 217

What adjustments may have to be made to bedrooms in the environment? ***

Back 217

- raise bed to improve transfers, use bed raisers of 3 – 5 inches, boards, concrete blocks, or add box spring or mattress
- lower bed by removing casters, cutting legs off of frame
- add bed rails, bedside commode if needed

if pt in WC
- remove closet doors
- lower rod to 36 – 46 inches
- shelves no higher than 54 inches & no lower than 9 inches from floor

Front 218

What adjustments may have to be made to laundry rooms in the environment? ***

Back 218

-front-loading washer and dryer
- side hinge doors, smaller loads, wheeled cart

- shelves within patient’s reach
- ironing: wall mounted board & light weight iron

Front 219

What adjustments may have to be made to telephones in the environment? ***

Back 219

- emergency numbers programmed for neighbor, police & fire
- programmable phone, to be carried in fanny pack
- may need large buttons, lighted keypads, speaker or larger visual display

Front 220

What adjustments may have to be made to writing surfaces in the environment? ***

Back 220

- writing surface 2 inches higher than elbow
- tilt surface angle with binder/book
- large grip pens

Front 221

What adjustments may have to be made for computer use in the environment? ***

Back 221

- elbows flexed between 70 and 135 degrees
- shoulders abducted less than 20 degrees and flexed less than 25 degrees
- wrists between 30 degrees of flexion and 10 degrees of extension
- torso-thigh angle at least 90 degrees

- adjustable keyboard a few inches lower than desk and about 1 inch lower than elbow
- chair adjusted so patient is sitting with a neutral spine and feet supported
- monitor at eye level & far enough to see clearly with corrective lenses while maintaining neutral spine

Front 222

What are the controllable coronary artery disease risk factors? ***

Back 222

- tobacco
- lipids (cholesterol)
- excess body weight

- physical inactivity
- blood pressure
- diabetes
- stress

Front 223

What are the uncontrollable coronary artery disease risk factors? ***

Back 223

- age
- gender
- heredity

Front 224

Which patients live longer after heart attack? Why? ***

Back 224

- those who undergo cardiac rehabilitation (26-46% improved per her lecture)

- reduced HR and SBP with exercise
- less angina
- reduction of risk factors
--- lower serum cholesterol, triglycerides, & LDLs
--- higher HDLs

Front 225

What is cardiac rehabilitation? ***

Back 225

- coordinated, multifaceted interventions

- designed to optimize a cardiac patient’s physical, psychological, and social functioning
- stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes

Front 226

What is included in cardiac rehabilitation? ***

Back 226

- baseline patient assessment
- nutritional counseling
- exercise training

- aggressive risk factor management (e.g., lipids, HTN, weight loss, diabetes, & smoking)
- psychosocial and vocational counseling & physical activity counseling

Front 227

What is the role of the PTA in cardiac rehabilitation? ***

Back 227

- provides direct patient care:
--- acute: hospital
--- outpatient rehabilitation

Front 228

What are the four phases of the traditional model of cardiac rehabilitation? ***

Back 228

- Phase I: inpatient program, telemetry
- Phase II: 12-week clinically supervised program, ECG monitored

- Phase III: outpatient with supervision
- Phase IV: some supervision

Front 229

What is the current model of cardiac rehabilitation? ***

Back 229

- Phase I: inpatient program, telemetry
- Phase II: 12-week clinically supervised program, ECG monitored

Front 230

What occurs in Phase I of cardiac rehabilitation? ***

Back 230

- Phase I: inpatient program, telemetry

- within 48 hours of admission
- critical care unit
- close nursing and telemetric supervision

Front 231

What are the clinical indications for inpatient and outpatient cardiac rehabilitation? (Table 12-11, p. 281) ***

Back 231

INDICATIONS
- medically stable post MI
- stable angina
- CABG surgery
- percutaneous transluminal coronary angioplasty or other transcatheter procedure
- compensated CHF
- cardiomyopathy
- heart or other organ transplantation
- other cardiac surgery including valvular and pacemaker insertion (including implantable cardioverter defibrillator)
- PAD
- high-risk cardiovascular disease ineligible for surgical intervention
- sudden cardiac death syndrome
- end-stage renal disease
- at risk for CAD with diagnoses of DM, dyslipidemia, HTN, etc.
- other patients who may benefit from structured exercise and/or patient education (based on physician referral and consensus of rehab team)

Front 232

What are the clinical contraindications for inpatient and outpatient cardiac rehabilitation? (Table 12-11, p. 281) ***

Back 232

CONTRAINDICATIONS
- unstable angina
- resting SBP of > 200 mm Hg or resting diastolic BP of > 112 mm Hg should be evaluated on a case-by-case basis
- orthostatic BP drop of > 20 mm Hg with symptoms
- critical aortic stenosis (peak systolic pressure gradient of > 50 mm Hg with aortic valve orifice area of < 0.75 cm sq in average-size adult)
- acute systemic illness or fever
- uncontrolled atrial or ventricular dysrhythmias
- uncontrolled sinus tachycardia (> 120 bpm)
- uncompensated CHF
- 3-degree AV block (without pacemaker)
- active pericarditis or myocarditis
- recent embolism
- thrombophlebitis
- resting ST segment displacement (> 2 mm)
- uncontrolled diabetes (resting glucose of >200 mg/dL or > 250 mg/dL with ketones present)
- severe orthopedic conditions that would prohibit exercise
- other metabolic conditions such as acute thyroiditis, hypokalemia/hyperkalemia, hypovolemia, etc.

Front 233

What are the components of pretreatment assessment for inpatient cardiac rehabilitation? ***

Back 233

See P. 284, Table 12 – 14 “Pretreatment Assessment for Inpatient Cardiac Rehabilitation”
PT/PTA should check/recheck patient chart for:
- medical referral
- physician’s orders
- hematology values, including RBC count, hematocrit, hemoglobin, WBC count
- medications (watch for nitrates, beta blockers, calcium channel blockers)
- determining need for portable, supplemental oxygen
- determining need for pushcart/wheelchair

PTA should communicate with:
- patient’s nurse – is it safe to exercise the patient?
- telemetry technician – you will be treating patient
- PT or physician as needed
- patient/family—discuss goals and agree on plan

At the bedside, the PTA should:
- question patient’s recent activity tolerance/history
- record resting HR, BP, O2 saturation, angina, dyspnea, arrhythmia
- count resting respiratory rate
- affix telemetry transmitter (if ambulation will occur)
- affix finger-pulse oximeter/HR monitor
- select mode on wrist chronograph


During activity, the PTA should monitor vital signs:
- HR – if above threshold, decrease or stop activity
- oxygen saturation – if below threshold, stop activity
- diastolic BP > 112 mm Hg, stop activity
- systolic BP decrease > 12 mm Hg or does not increase, stop activity
- stop activity with equipment malfunction


Monitor patient for signs and symptoms of intolerance:
- dyspnea (2-3/4), stop activity
- angina (3/4), stop activity
- claudication (3/4), stop activity
- ataxia, dizziness, or near syncope, stop activity
- pallor or cyanosis, stop activity
- RPE (> or = 13), stop activity

Telemetry technician/nurse should monitor:
- significant ventricular or atrial dysrhythmias, stop activity
- second- or third-degree heart block, stop activity
- ischemic changes, stop activity
- record elapsed time, distance, and compute velocity

Following activity, the PTA should:
- return patient to bed or bedside chair
- disconnect telemetry transmitter, and any portable devices (pulse oximeter, portable BP cuff, supplemental oxygen) after taking a final vitals reading
- reconnect patient to bedside monitors
- check with nursing/telemetry for EKG responses
- record findings in chart
- personally notify nurse, PT, and/or physician of worrisome findings

Front 234

What is the recommended intensity for Phase I cardiac rehabilitation? (Table 12-16, P. 285) ***

Back 234

- RPE < 13 (on 6-20 scale)

- post-MI HR: < 120 bpm or resting HR + 20 bpm
- post-surgical HR: resting HR + 30 bpm

- to tolerance if asymptomatic

Front 235

What is the recommended duration for Phase I cardiac rehabilitation? (Table 12-16, P. 285) ***

Back 235

- begin with intermittent bouts lasting 3-5 minutes, as tolerated
- rest periods can be slower walking or complete rest at patient’s discretion; shorter than exercise bout duration
- attempt to achieve 2:1 exercise/rest ratio
- attempt to work up to 15 minutes

Front 236

What is the recommended frequency for Phase I cardiac rehabilitation? (Table 12-16, P. 285) ***

Back 236

- early mobilization: 3-4 times per day (days 1-3)

- later mobilization: 2 times per day (beginning on day 4) with increased duration of exercise bouts

Front 237

What is the recommended progression for Phase I cardiac rehabilitation? (Table 12-16, P. 285) ***

Back 237

when continuous exercise duration reaches 12-15 minutes, increase intensity as tolerated

Front 238

What is the recommended mode of exercise for Phase I cardiac rehabilitation? ***

Back 238

- UE AROM (no arms overhead while upright, at least right away—blood rush to chest)
- LE AROM

- progress to trunk twists
- walking in room

Front 239

RPE scale (P. 268) ***

Back 239

6 –
7 – very, very light
8 –
9 – very light
10 –
11 – fairly light
12 –
13 – somewhat hard ***
14 –
15 – hard
16 –
17 – very hard
18 –
19 – very, very hard
20 –

Front 240

To what activities are patients restricted during Phase I cardiac rehabilitation? ***

Back 240

- self care
- postural changes
- use of bedside commode

- arm & leg ROM
- walking in the room

- these activities are equivalent to twice the resting energy expenditure level, or 2 METs
(1 MET is sitting up in bed doing nothing)

Front 241

What are the options for discharge following Phase I cardiac rehabilitation? ***

Back 241

- skilled nursing facility (SNF)
- rehabilitation hospital
- home

- all with a walking program!!

Front 242

What are the specifications for Phase II cardiac rehabilitation? (Table 12-20, p. 289) ***

Back 242

- outpatient cardiac rehabilitation

- 12 weeks, 3X per week

entry-level exercise should be:
- resting HR + 20 (post-MI)
- resting HR + 30 (post-surgical patient—CABG/percutaneous transluminal coronary intervention)
-RPE 11-13 (on 6-20 scale)


ischemia or angina – > or = 12 bpm below symptoms
CHF – 40% to 75% of VO2 max
fixed-rate pacemaker – training SBP = (SBP max – SBP rest) (50% to 80%) + SBP rest
rate-responsive pacemaker – 50% to 85% of HR reserve + > or = 12 BPM below symptoms
antitacycardia pacemakerws and implanted cardioverter defibrillators – below threshold for defibrillation
cardiac transplant – 50% to 75% VO2 peak, RPE 11-15, ventilatory threshold, dyspnea


- discharge to home

- encourage lifelong commitment to exercise
(evidence exists to suggest that to maintain or demonstrate regression in coronary atherosclerosis lesions, one must expend 1,500 to 2,000 kcal/week)

Front 243

How should an exercise program for Phase II cardiac rehabilitation be conducted? (Table 12-18, p. 287) ***

Back 243

- safe exercise
- emphasize fun

- supervision
--- monitor HR, BP, and RPE
--- watch for signs/symptoms of exercise intolerance
- may be monitored with telemetry

- secondary prevention is taught

Front 244

What are the indications for terminating exercise for a cardiac rehabilitation patient? (Table 12-18, p. 287) ***

Back 244

ABSOLUTE INDICATIONS
- drop in SBP of > 12 mm Hg from baseline BP despite an increase in workload when accompanied by other evidence of ischemia
- moderately severe angina (defined as 3 on standard 4-point scale)
- increasing nervous system sx (e.g., ataxia, dizziness, near syncope)
- signs of poor perfusion (cyanosis or pallor)
- technical difficulties monitoring EKG or SBP
- subjects desire to stop
- sustained ventricular tachycardia
- ST elevation (+1.0 mm) in leads without diagnostic Q-waves (other than V1 or aVR)

RELATIVE INDICATIONS
- drop in SBP of > 12 mm Hg from baseline BP despite increase in workload, in the absence of other evidence of ischemia
- ST or QRS changes such as excessive ST depression (> 2 mm horizontal or downsloping ST-segment depression) or marked axis shift
- arrhythmias other than sustained ventricular tachycardia, including multifocal preventricular contractions, triplets of preventricular contractions, supraventricular tachycardia, heart block, or bradyarrhythmias
- fatigue, SOB, wheezing, leg cramps, or claudication
- development of bundle-branch block or intraventricular conduction delay that cannot be distinguished from ventricular tachycardia
- increasing chest pain
- hypertensive response (SBP > 250 mm Hg and/or DBP > 115 mm Hg)

Front 245

What types of activities should be conducted during Phase II cardiac rehabilitation? ***

Back 245

- 5- to 10-minute warm-up
- 15- to 20-minute circuit training:
--- Treadmill
--- Arm ergometry
--- Stationary bike
--- Rowing ergometer
--- Stair climber
- 5- to 10-minute cool down

Front 246

What are the advantages of a recumbent bicycle? ***

Back 246

- seat is more comfortable than traditional bicycle
- back support provides a more upright spine posture
- relatively quiet to operate
- easy to monitor/measure vital signs during use
- safer than a traditional bicycle due to a wider base of support and ease of mounting and dismounting.

Front 247

What are the disadvantages of a recumbent bicycle? ***

Back 247

- local muscle fatigue in the lower extremities may limit performance
- difficult to elevate heart rate to target range due to the more supine position compared with a traditional bicycle or other modes of upright exercise

Front 248

What is the optimum fit of a recumbent bicycle? ***

Back 248

- seat position should be adjusted to allow 15 to 20 degrees of knee flexion when LE is in the most outstretched position on the pedal
- ankle is at 90 degrees of dorsiflexion

Front 249

What are the advantages of a stationary bicycle? ***

Back 249

- allows NWB exercise
- no impact
- relatively quiet to operate
- easy to monitor/measure vital signs during use
- requires little time/effort for habituation

Front 250

What are the disadvantages of a stationary bicycle? ***

Back 250

- local muscle fatigue in the lower extremities may limit performance
- difficult to elevate heart rate to target range due to muscle fatigue limitation
- not all clients are familiar with or experienced with bicycling
- no weight bearing achieved

Front 251

What is the optimum fit of a stationary bicycle? ***

Back 251

- seat position should be adjusted to allow 15 to 20 degrees of knee flexion when foot is in lowest position on the pedal and
- ankle is in 90 degrees of dorsiflexion.

Front 252

What are the advantages of a stair climber? ***

Back 252

- motion of stepping is familiar to most clients so habituation is minimal
- provides weight bearing
- provides a low-impact form of activity
- occupies less space than most other types of equipment

Front 253

What are the disadvantages of a stair climber? ***

Back 253

- may aggravate or cause knee problem due to stress on knee joints
- posture on the equipment should be carefully scrutinized due to tendency for users to adopt poor postures and rely too much on upper extremities for support
- somewhat difficult to mount
- requires good balance

Front 254

What are the advantages of a treadmill? ***

Back 254

- walking/running are familiar activities for most clients so habituation is minimal
- provides weight bearing
- uses large lower-extremity muscles that require less energy, enabling heart rate to be elevated and kept in target range without local muscle fatigue
- easy to adjust intensity (speed and/or elevation).

Front 255

What are the disadvantages of a treadmill? ***

Back 255

- weight-bearing exercise may be difficult for obese clients or for those with orthopedic limitations
- requires a lot of space
- expensive
- difficult to monitor/measure vital signs when clients walk fast or run
- tends to make significant noise when in use (making it difficult to hear blood pressure)

- ensure you have everything set up and in place beforehand, you don’t want to distract the pt

Front 256

What are the advantages of an upper-body ergometer? ***

Back 256

- eliminates lower extremities for those with significant lower-extremity impairments, while providing a mechanism to perform aerobic exercise
- easy to mount/dismount
- relatively quiet to operate.

Front 257

What are the disadvantages of an upper-body ergometer? ***

Back 257

- local muscle fatigue limits performance
- lower heart rates are achieved due to the use of smaller muscles
- unfamiliar for most clients so requires greater habituation time
- difficult to monitor/measure vital signs during activity

Front 258

What is the optimum fit of an upper-body ergometer? ***

Back 258

- seat should be adjusted to allow slight elbow flexion during maximum upper-extremity extension while back maintains contact with seat
- seat height should be adjusted so that client shoulder height is even with axis of arm crank

Front 259

What is important to remember about the post-exercise HR response in heart transplant patients? ***

Back 259

- not as sharp a plateau
- recovery dropoff in heart rate more gradual slope

Front 260

Normal response to exercise includes increases in: ***

Back 260

- HR
- stroke volume
- systolic BP

Front 261

Training aerobically leads to what changes during exercise? ***

Back 261

- decreased HR
- increased blood flow to muscle
- increases VO2 max

Front 262

What elements comprise an exercise prescription? ***

Back 262

- mode
- intensity
- frequency
- duration

Front 263

Aerobic exercise ***

Back 263

continuous, rhythmic exercise that involves large muscles and increases the rate of aerobic metabolism

Front 264

Anaerobic threshold (AT) ***

Back 264

- an indirect measure of endurance obtained from an exercise stress test

- the point at which the blood is unable to buffer lactic acid during exercise

Front 265

Cardiac output ***

Back 265

- amount of blood ejected from the heart, expressed in liters per minute

- cardiac output is equal to the product of heart rate multiplied by stroke volume

Front 266

Cardiomyopathy ***

Back 266

a disease of the heart muscle that can result in heart failure

Front 267

Crackles ***

Back 267

adventitious or abnormal breath sounds that can reflect acute fluid accumulation in the distal airways of the lungs

Front 268

Diastole ***

Back 268

period of the heart’s pumping cycle in which the heart muscle relaxes to allow the heart to fill with blood

Front 269

Diastolic dysfunction ***

Back 269

decreased ability of the heart to accept blood

Front 270

Dilated cardiomyopathy ***

Back 270

disease of the cardiac muscle with dilation of the ventricles

Front 271

Dyspnea ***

Back 271

shortness of breath

Front 272

Echocardiography ***

Back 272

diagnostic test that uses ultrasound to assess structures and function of the heart

Front 273

Ejection fraction (EF) ***

Back 273

- the percentage of end-diastolic volume ejected from the left ventricle with each heartbeat

Front 274

End-diastolic volume ***

Back 274

- the volume of blood in the left ventricle at the end of diastole

Front 275

Heart catheterization ***

Back 275

procedure performed under fluoroscopy in which a catheter is inserted into the left side or right side of the heart to measure pressures and/or assess the coronary arteries and heart valves

Front 276

Heart failure ***

Back 276

previously called congestive heart failure; inability of the heart to pump enough blood to meet the demands of the organs

Front 277

Hypertrophic cardiomyopathy ***

Back 277

disease of the heart muscle that results in excessive thickening of the left ventricle

Front 278

Ischemic heart failure ***

Back 278

heart failure caused by an inadequate supply of blood to the heart muscle

Front 279

Jugular venous distention ***

Back 279

distention or stretching of the jugular veins because of fluid overload

Front 280

Median sternotomy ***

Back 280

surgical incision using a midline cut through the sternum

Front 281

Metabolic equivalent ***

Back 281

energy requirement while resting, which is the energy used to burn 3.5 ml of oxygen per kilogram of body weight per minute

Front 282

New York Heart Association (NYHA) Classification system ***

Back 282

system used to classify patients with heart failure according to subjective limitations in functional activities

Front 283

Orthopnea ***

Back 283

shortness of breath with lying supine

Front 284

Oxygen consumption rate (VO2) ***

Back 284

amount of oxygen consumed while performing an activity, measured by exercise testing

Front 285

Pulmonary edema ***

Back 285

excessive fluid accumulation in the lungs

Front 286

Pulmonary hypertension ***

Back 286

abnormal elevation of the pulmonary artery pressure

Front 287

Rate of Perceived Exertion (RPE) ***

Back 287

subjective rating of exercise intensity

Front 288

Rate-pressure product ***

Back 288

- heart rate multiplied by systolic blood pressure
- an index of myocardial oxygen requirement

Front 289

Restrictive cardiomyopathy ***

Back 289

disease of the heart muscle that is characterized by fibrosis of the ventricles and leads to diastolic dysfunction

Front 290

Right atrial pressure ***

Back 290

pressure of the blood in the right atrium

Front 291

Stroke volume ***

Back 291

the volume of blood ejected from the left ventricle with each heart beat

Front 292

Systolic dysfunction ***

Back 292

inability of the heart to eject blood

Front 293

Alveolar perfusion ***

Back 293

the amount of blood flow that comes in contact with the alveoli and participates in respiration

Front 294

Alveolar ventilation ***

Back 294

the amount of air flow that comes in contact with the alveoli and participates in respiration

Front 295

Alveoli ***

Back 295

the distal terminal air sacs in the lungs where gas exchange occurs

Front 296

Arterial-alveolar oxygen difference (PaO2 – PaO2) ***

Back 296

the difference between the partial pressure of O2 in the alveoli and the partial pressure of O2 in the arterial blood

Front 297

Compliance ***

Back 297

a measure of the ease of expansion of the lungs and chest wall

Front 298

Conducting airways ***

Back 298

- airways within the lungs that serve as a conduit for air to travel down to the alveoli

- because of the absence of alveoli, gas exchange does not occur in these airways

Front 299

Dead space ***

Back 299

air within the lungs that does not participate in respiration

Front 300

Elasticity ***

Back 300

the ability of an object to return to its original state after being deformed

Front 301

Hemoptysis ***

Back 301

expectoration of blood

Front 302

Hypercapnia ***

Back 302

an increased level of CO2 in the circulating blood

Front 303

Hypoxia ***

Back 303

a decreased level of O2 in the circulating blood

Front 304

Maximal voluntary ventilation (MVV) ***

Back 304

- the largest amount of air an individual can move in and out of the airways over one minute

- determined by the maximum respiratory rate and vital capacity

Front 305

Minute ventilation (MV) ***

Back 305

the amount of are moved into or out of the lungs over one minute

Front 306

Pneumothorax ***

Back 306

air in the pleural cavity

Front 307

Pulmonary shunt ***

Back 307

blood flow moving through the lungs that does not participate in respiration

Front 308

Respiration ***

Back 308

the process of gas exchange between the atmospheric air and the pulmonary capillary bed

Front 309

Respiratory airways ***

Back 309

the airways in the tracheobronchial tree in which gas exchange may occur because of the presence of alveoli

Front 310

Surfactant ***

Back 310

substance produced by the alveolar cells that reduces surface tension in the airways

Front 311

Tracheostomy ***

Back 311

surgical incision in the trachea through which an artificial airway may be placed

Front 312

Ventilation ***

Back 312

air flow through the airways

Front 313

Work of breathing (WOB) ***

Back 313

the energy cost of breathing

Front 314

Base of support ***

Back 314

distance between midpoint of the heel of one foot to the same point of the other foot

Front 315

Cadence ***

Back 315

number of steps taken in a minute

Front 316

Double stance ***

Back 316

period of time when both feet are in contact with the supporting surface

Front 317

Foot flat ***

Back 317

point in time during the stance phase when the whole plantar surface of the foot is in contact with the supporting surface

Front 318

Gait cycle ***

Back 318

- the events between initial contact of the reference limb or extremity and the successive contact of the same extremity
- a gait cycle consists of two successive steps—one right and one left

Front 319

Heel off ***

Back 319

point in time during the stance phase when the heel leaves the supporting surface in preparation for starting the swing phase of gait

Front 320

Heel strike ***

Back 320

traditional term referring to the moment of contact with the supporting surface at the beginning of the gait cycle

Front 321

Initial contact ***

Back 321

- the point in the gait cycle when the foot initially makes contact with the supporting surface
- this represents the start of the stance phase of the gait cycle

Front 322

Initial swing ***

Back 322

the period in the gait cycle that begins when the reference limb leaves the supporting surface and ends when the knee achieves maximal flexion

Front 323

Midstance ***

Back 323

- the portion of the gait cycle corresponding to the single stance phase of gait
- begins when the contralateral limb leaves the supporting surface to begin swing and neds when the stance phase limb is under the body

Front 324

Midswing ***

Back 324

the point during the swing phase of gait when the extremity passes directly beneath the body

Front 325

Preswing ***

Back 325

the period of the gait cycle involving the terminal period of double support before the foot is lifted from the supporting surface

Front 326

Single support ***

Back 326

period of time when only one foot is in contact with the supporting surface

Front 327

Stance phase ***

Back 327

- the period or phase of the gait cycle that begins when one extremity contacts the ground (heel strike/initial contact) and ends when the same limb leaves the supporting surface (toe off/heel off)

- comprises approximately 60% of the gait cycle

Front 328

Step length ***

Back 328

distance between the point of initial contact of one extremity and the point of initial contact of the opposite extremity

Front 329

Step time ***

Back 329

the amount of time needed to complete a single step

Front 330

Stride length ***

Back 330

distance between the point of initial contact of one extremity to the next point of initial contact of the same extremity

Front 331

Stride time (stride/duration) ***

Back 331

the amount of time required to complete one stride

Front 332

Swing phase ***

Back 332

- the period or phase of the gait cycle when the foot is not in contact with the supporting surface

- comprises approximately 40% of the gait cycle

Front 333

Terminal swing ***

Back 333

- period of the gait cycle that occurs just before contact of the foot with the supporting surface

- marked by movement of the reference limb from a vertical position under the body and ends before contact of the foot with the supporting surface

Front 334

Toe off ***

Back 334

final phase of stance marked by the toe being the only aspect of the foot in contact with the supporting surface

Front 335

Toe out/toe in ***

Back 335

outward or inward angulation of the foot relative to the line marking the forward progression of the body

Front 336

Walking velocity ***

Back 336

distance covered per unit of time

Front 337

Weight acceptance ***

Back 337

period of the gait cycle encompassing the initial contact and loading response phases

Front 338

What is the phase of the gait cycle encompassing initial double support and involving approximation of the foot to the supporting surface? ***

a. initial contact
b. loading response
c. midstance
d. preswing

Back 338

b. loading response

Front 339

During normal gait, the period of double support encompasses what percentage of the gait cycle? ***

a. 10%
b. 20%
c. 40%
d. 60%

Back 339

b. 20%

Front 340

True or False: An increased period of double support is a likely finding when there is unilateral lower extremity weakness? ***

a. true
b. false

Back 340

a. true

Front 341

The left knee of a patient diagnosed with postpolio syndrome, resulting in progressive unilateral quadriceps weakness affecting the left lower extremity, has a tendency to buckle during stance and the patient has altered her pattern of gait to ensure stability. When observing the patient walk, which of the following gait changes may be seen? ***

a. decreased single stance time on the involved side.
b. decreased right lower extremity step length.
c. genu recurvatum during stance on the involved side.
d. all of the above.

Back 341

d. all of the above.

Front 342

True or False: A patient recovering from a stroke has become stable and independent in the physical therapy gym when walking on level surfaces and managing curbs, ramps, and elevations. Based on this performance, you can expect the patient will likely also be safe performing these activities at home and in the community. ***

a. true
b. false

Back 342

b. false

Front 343

The hamstrings do which of the following during gait? ***

a. stabilize the trunk at the initial contact phase of gait.
b. decelerate the tibia during the terminal swing phase of gait.
c. stabilize the knee during the stance phase of gait.
d. all of the above.

Back 343

d. all of the above.

Front 344

The typical time spent in swing phase and stance phase in a gait cycle are: ***

a. swing phase 60% and stance phase 40%
b. swing phase 40% and stance phase 60%
c. swing phase 50% and stance phase 50%
d. none of the above

Back 344

b. swing phase 40% and stance phase 60%

Front 345

A patient recently had surgery on her right lower extremity. The MD orders include non-weight-bearing on the right side. The treating therapist’s plan of care includes upper extremity strengthening. What specific upper body muscle strengthening will be most functional for this patient? ***

a. triceps and biceps
b. biceps and latissimus dorsi
c. triceps and latissimus dorsi
d. deltoid and triceps

Back 345

c. triceps and latissimus dorsi

Front 346

The normal inspiratory:expiratory ratio is approximately which of the following? ***

a. 1:1
b. 1:2
c. 1:4
d. 2:1

Back 346

b. 1:2

Front 347

The inspiratory to expiratory ratio you would expect to see in the patient with COPD is which of the following? ***

a. 1:1
b. 1:2
c. 1:4
d. 2:1

Back 347

c. 1:4

Front 348

The thoracic index (AP:lateral thoracic diameter ratio) in an individual with severe pulmonary emphysema would likely be which of the following? ***

a. 1:1
b. 1:2
c. 1:3
d. 2:1

Back 348

d. 2:1

Front 349

When you palpate thoracic expansion in the patient with severe pulmonary emphysema and COPD, you would expect which of the following physical findings? ***

a. asymmetrical chest expansion
b. increased lateral expansion of the thorax—“bucket handle”
c. pain on attempts to expand
d. reduced chest expansion in all planes

Back 349

b. increased lateral expansion of the thorax—“bucket handle”

Front 350

The correct position for bronchial drainage of anterior segments of both upper lobes is: ***

a. left sidelying
b. lying prone
c. lying supine
d. right sidelying
e. sitting upright

Back 350

e. sitting upright

Front 351

What is a major benefit of diaphragmatic breathing? ***

a. enhanced expansion and ventilation of the upper lobes
b. improved airway clearance
c. improvement in postural deficits of the thorax
d. reduced dyspnea

Back 351

d. reduced dyspnea

Front 352

Pursed-lip breathing: ***

a. enhances airway clearance
b. helps expand the alveoli
c. reduces the physical work of expiration
d. should be done with a forceful expiration
e. slows respiratory rate

Back 352

e. slows respiratory rate

Front 353

Which of the following is a common cause of airway clearance dysfunction? ***

a. chronic dust/smoke inhalation
b. infectious disorders
c. cystic fibrosis
d. operative procedures
e. all of the above

Back 353

e. all of the above

Front 354

Which of the following physical therapy interventions is most likely to help a patient with dyspnea? ***

a. an aerobic exercise program
b. postural drainage
c. a strength training program
d. training with an assistive device

Back 354

a. an aerobic exercise program

Front 355

The motor innervation of the diaphragm is via which of the following? ***

a. nerve roots of C3, C4, and C5
b. the phrenic nerve
c. the vagus nerve
d. both a and b
e. all of the above

Back 355

d. both a and b

Front 356

Air within the airways that does NOT participate in gas exchange is also known as: ***

a. dead space
b. shunt
c. minute ventilation
d. tidal volume
e. reserve volume

Back 356

a. dead space

Front 357

The most common cause of respiratory failure is which of the following? ***

a. hypoventilation
b. V:Q mismatch
c. diffusion abnormalities
d. none of the above

Back 357

a. hypoventilation

Front 358

Patients receiving mechanical ventilation are more likely to wean from a mechanical ventilator if they have which of the following? ***

a. a greater maximal inspiratory pressure
b. a lower maximal inspiratory pressure
c. biofeedback concerning their breathing efforts
d. poorer exercise abilities
e. a and c

Back 358

e. a and c

Front 359

Which of the following interventions are indicated for patients receiving mechanical ventilation? ***

a. supine body positioning
b. functional and exercise training
c. deep breathing exercises or other techniques to increase ventilation
d. stress/anxiety reduction techniques
e. b, c, and d

Back 359

e. b, c, and d

Front 360

What is COPD’s rank among the leading causes of death in the United States? ***

a. second
b. fourth
c. seventh
d. twelfth

Back 360

b. fourth

Front 361

Classification of acute versus chronic respiratory failure is primarily determined by which of the following? ***

a. length of time patient has had symptoms of respiratory failure
b. underlying conditions
c. necessity for mechanical ventilation
d. chest x-ray

Back 361

a. length of time patient has had symptoms of respiratory failure

Front 362

Which one of the following is true? ***

a. type I respiratory failure is also known as hypercapnic.
b. hypercapnic respiratory failure is characterized by elevated PaCO2.
c. type I respiratory failure is characterized by abnormally high PaO2.
d. hypercapnic respiratory failure is characterized by an increase in blood pH.

Back 362

b. hypercapnic respiratory failure is characterized by elevated PaCO2.

Front 363

Which of the following are criteria for postponing functional and exercise training with a patient with respiratory failure? ***

a. hypotension associated with diaphoresis
b. severe dyspnea
c. saturation less than 90% on supplemental O2
d. chest pain
e. all of the above

Back 363

e. all of the above

Front 364

Which of the following is true about systolic heart failure? ***

a. it is most prevalent in females.
b. it is difficult to diagnose.
c. it may have ischemic or nonischemic causes.
d. it is defined by an ejection fraction (EF) greater than 35%.

Back 364

c. it may have ischemic or nonischemic causes.

Front 365

A patient with heart failure classified as New York Heart Association (NYHA) Class III would typically have which of the following? ***

a. symptoms at rest
b. symptoms with heavy exercise
c. symptoms with less than ordinary exertion
d. symptoms with stair climbing

Back 365

c. symptoms with less than ordinary exertion

Front 366

Which of the following can progress to heart failure? ***

a. heart valve disease
b. coronary artery disease
c. hypertension
d. all of the above

Back 366

d. all of the above

Front 367

What type of cardiomyopathy is characterized by stretching of the muscle fibers and enlargement of the heart? ***

a. restrictive
b. dilated
c. hypertrophic
d. none of the above

Back 367

b. dilated

Front 368

In which of the following circumstances would you terminate an exercise session with a patient with heart failure? ***

a. dyspnea index rating of 3/4
b. Borg rating of perceived exertion of 12
c. angina scale rating of 1
d. none of the above

Back 368

a. dyspnea index rating of 3/4

Front 369

Which of the following are true for a patient with NYHA Class IV heart failure? ***

a. the Borg Scale of Perceived Exertion should be used to guide exercise intensity
b. interval training may be better tolerated than continuous exercise
c. a and b
d. none of the above

Back 369

c. a and b

Front 370

In a patient with heart failure, which of the following would NOT be a reason to terminate the session? ***

a. symptomatic hypotension
b. acute onset of crackles in the lungs
c. controlled atrial fibrillation
d. symptoms of dyspnea and fatigue at rest

Back 370

c. controlled atrial fibrillation

Front 371

Which of the following should be considered during exercise by a patient after heart transplantation? ***

a. the patient should perform an adequate warm-up and cool down.
b. adhere to sternal precautions.
c. weight-bearing exercises may reduce the bone loss caused by needed medication.
d. all of the above.

Back 371

d. all of the above.

Front 372

Short bouts of moderate intensity exercise are safe and effective for improving which of the following in patients with heart failure? ***

a. strength
b. quality of life
c. range of motion
d. power

Back 372

b. quality of life

Front 373

Which type of exercise should be avoided by patients with heart failure? ***

a. isometric
b. aerobic
c. isotonic
d. range of motion

Back 373

a. isometric