Term
| Describe Maturationist theories of Development. |
|
Definition
| individual genetically & biologically determined - preformed innate aspects of human behavior |
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|
Term
| Describe Empiricist theories of development. |
|
Definition
| source of human behavior is the environment. |
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|
Term
| Describe Behavioral theories of Development. |
|
Definition
| Environmental reinforcement is the motivator & shaper of cognitive & motor behavior - used in behavior modification treatment |
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Term
| Describe Interactionist theory of Development. |
|
Definition
| child is an active social being who contributes to his/her development. |
|
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Term
| Describe the Piagetian theory of development. |
|
Definition
| interaction of environment & neural maturation results in spiraling of development with equilibrium & disequilibrium testing |
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|
Term
| Describe the neuromaturationist theory of motor control. |
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Definition
| cortex is the command center with descending control & inhibition of lower centers by higher one in CNS. |
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Term
| Describe the Systems theory of motor control |
|
Definition
command center changes from cortex to other levels depending on task
stresses interaction between brain, body, & environment
sensory systems mature, become integrated, & connected to muscle coordination patterns starting with visual system
immature postures involve co-contraction of agonists & antagonists, cocontraction decreases with maturation |
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Term
| Describe the neuronal group selection theory. |
|
Definition
genetic code of species outlines limits of neural network formation
actual network formation results from individual experience
have cell death of unexercised synaptic & strengthening of synaptic connections selectively activated |
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Term
| List 5 principles of motor development. |
|
Definition
occurs in cephalocaudal direction
unrefined to refined movement
stability to controlled mobility
occurs in spiraling manner, with periods of equilibrium & disequilibrum
sensitive periods occur when infant/child is esp. affected by environmental input |
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Term
|
Definition
| age of fetus or newborn, in weeks, from first day of mother's last normal menstrual period. |
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Term
| What is a normal gestational period. |
|
Definition
|
|
Term
| What is the first sensory system to develop? |
|
Definition
|
|
Term
| What is the most mature sensory system at birth? |
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Definition
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|
Term
| Which system is still not completely developed at the end of the first trimester? |
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Definition
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|
Term
| A fetus will turn to auditory sounds at the end of the _____ trimester. |
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Definition
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|
Term
| List the most important developmental motor abilities in the 1st month of development. |
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Definition
| lifts head, symmetrical kicking, reaching |
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Term
| List the most important developmental motor abilities in the 2nd month of development. |
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Definition
| head elevation to 45 degrees in prone, prone on elbows |
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|
Term
| List the most important developmental motor abilities in the 3rd month of development. |
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Definition
| prone on elbows with body weight support & head control, coos, chuckles |
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Term
| List the most important developmental motor abilities in the 4th month of development. |
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Definition
| rolls prone to side & supine to side, sits supported, no head lag in pull-sit, laughs out loud, ulnar & palmar grasp |
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|
Term
| List the most important developmental motor abilities in the 5th month of development. |
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Definition
| rolls from prone-supine, weight shifting from one elbow to the other in prone |
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Term
| List the most important developmental motor abilities in the 6th month of development. |
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Definition
| rolls from supine to prone, independent sitting, pulls to stand |
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Term
| List the most important developmental motor abilities in the 7th month of development. |
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Definition
| can maintain quadraped, pivots on belly, recognizes tone of voice |
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Term
| List the most important developmental motor abilities in the 8-9th month of development. |
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Definition
| belly crawls, creeps, pulls to stand through kneeling, cruises, can stand alone, has pincer grasp with thumb & forefinger, can transfer objects from one hand to the other |
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Term
| List the most important developmental motor abilities in the 10-15th month of development. |
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Definition
| begins to walk unassisted, begins to self-feed, searches for hidden toys, plays patty-cake & peekaboo, reaches with supination, neat pincer grasp with release |
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Term
| List the most important developmental motor abilities in the 20th month of development. |
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Definition
| ascends steps with step to pattern, running more coordinated, plays make believe |
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Term
| List the most important developmental motor abilities in the 2nd year of development. |
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Definition
| runs well, ascends steps with reciprocal pattern |
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Term
| List the most important developmental motor abilities in the 3rd year of development. |
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Definition
| rides tricycle, stands on one foot briefly, jumps on two feet, kicks ball, can go down steps reciprocally, understands sharing |
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Term
| List the most important developmental motor abilities in the 4th year of development. |
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Definition
| hops on one foot, throws ball overhand, relates to friends |
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Term
| List the most important developmental motor abilities in the 5th year of development. |
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Definition
| skips, kicks ball well, dresses & undresses self |
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Term
|
Definition
| assessment of premature infant behavior - assesses organization & balance of infants physiological, motor, & behavioral states |
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Term
|
Definition
| Newborn individualized developmental care & assessment of progress - systematic behavioral observation of pre-term or full-term infant in nursery or home during environmental input, caretaking, & treatments |
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Term
| What is the TIMP? What ages is it used for? |
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Definition
test of infant motor performance - evaluates spontaneous & elicited movements to evaluate postural alignment & selective control for functional movements
infants 32 weeks postconceptual age to 3 & 1/2 months post-term |
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|
Term
|
Definition
administered to newborn at 1, 5, & 10 minutes after birth.
assesses HR, respiration, reflex irritability, muscle tone, color - each scored 0, 1, or 2
>7 = good
5-6 requires some care (ventilator, stimulation, or resuscitation)
<5 = immediate action |
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Term
| Describe the neurological examination of the newborn. |
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Definition
| assigns states of consciousness & tests newborn reflexes |
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Term
| Describe talipes equinovarus. |
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Definition
| clubfoot - ankle plantarflexed & adducted |
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Term
| Describe posturing of newborn infants. |
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Definition
| physiological flexion of all four limbs d/t positioning in utero - head to one side. |
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Term
| What happens to neonatal reflexes? |
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Definition
| should be present at birth & later become integrated or inhibited - not evident later in development |
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Term
| Describe the Babinski reflex. |
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Definition
| stroke lateral aspect of plantar foot, get splaying of toes - 0-12 mo. |
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Term
| Describe the flexor withdrawal reflex. |
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Definition
| sharp, quick pressure stimulus to the sole of the foot or palm of hand causes withdrawal of simulated extremity - some say 0-2 mo., others say present throughout lifespan |
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Term
| Describe the crossed extension reflex. |
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Definition
| sharp, quick pressure stimulus to the sole of the foot or palm of the hand causes withdrawal of stimulated lower extremity & extension reflex of opp. leg - 0-2 mo. |
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Term
| Describe the galant or trunk incurvation reaction. |
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Definition
| sharp stroke along the paravertebral line from the scapula to the top of the iliac crest causes lateral trunk flexion towards the stimulated side 0-2 mo. |
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Term
| Describe the moro reflex. |
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Definition
| sudden extension of neck results in extension & ABD of UE with hand opening & crying, followed by flexion, adduction, & arms across chest - can result in crying, test last - 0-4 mo. |
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Term
| Describe the tonic labyrinthine reflex. |
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Definition
| TLR - prone positioning causes flexion tone & supine causes extensor tone (0-6 mo.) |
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Term
| Describe placing reaction reflex. |
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Definition
| drag dorsum of foot or back of hand against edge of table, get placing of foot or hand onto table top (0-6 mo.) |
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|
Term
| How long is the traction or pull-to-sit lag present? |
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Definition
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Term
| Describe the body-righting reaction acting on the head (BOH) reflex |
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Definition
| contact of the body with a solid surface results in head-righting with respect to gravity, interacts with labyrinthine-righting reaction on head to maintain orientation of head in space - begins at 4-6 mo. & maintains throughout life |
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Term
| Describe the body-righting reaction acting on the body (BOB) reflex |
|
Definition
| rotation of head or thorax results in rolling over with rotation between trunk & pelvis - begins at 6-8 months & persists throughout life |
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Term
| Describe the symmetrical tonic neck reflex |
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Definition
| flexion of the head results in flexion of the upper extremities & ext. of LE; extension of head results in ext. of UE & flex of LE (6-8 mo.) |
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Term
| Describe Landeau's reaction. |
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Definition
| if an infant is held in ventral suspension, there will be extension of the neck, trunk & hips (4-18 months) |
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Term
| Describe tilting reactions. |
|
Definition
slow shifting of the BOS or slow displacement of body in space results in lateral flexion of the spine towards the elevated side of support, ABD of extremities on the elevated side, & trunk rotation towards elevated side
prone begins at 5 mo., supine begins at 7 mo., sitting at 8 mo., quadruped at 12 mo. - persist throughout life. |
|
|
Term
| Describe the Denver Developmental Screening Test II. |
|
Definition
screens for developmental delay - tests social, fine & gross motor from birth to independent walking
from birth - 1yr |
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Term
|
Definition
| tests gross & fine motor development from birth -42 mo. - focuses on prone & supine, sitting, crawling & kneeling, standing, walking & jumping |
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Term
| Describe the SI & praxis test |
|
Definition
sensorimotor assessment for children between ages 4-9 years having mild-mod. learning impairment
includes balance, proprioception, tactile sensation, & control of specific mvts tests |
|
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Term
| Describe the Bayley scales of Infant Development. |
|
Definition
| norm-referenced motor & mental scales for children from birth -42 months of age |
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Term
|
Definition
| pediatric evaluation of disability inventory: interview or questionnaire scale of activities of daily living with or without modification completed by caregiver |
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Term
| Describe the FIM & WeeFIM. |
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Definition
| functional independence measure - for children, WeeFIM - assesses function in self-care, mobility, locomotion, & communication & social cognition. |
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|
Term
| premature babies may exhibit what posturing? |
|
Definition
hyperextended neck & trunk
shoulders may be elevated, abducted, extended, with scapular retraction
hips can be ABD & extended
pelvis anteriorly tilted
decreased midline mvt |
|
|
Term
| Define periventricular leukomalacia (PVL). |
|
Definition
| necrosis of white matter adjacent to ventricles; can cause CP - d/t systemic hypotension or ischemia |
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|
Term
| Describe periventricular intraventricular hemorrhage |
|
Definition
bleeding into immature vascular matrix
bleeds graded I-IV; grades II-IV may result in CP |
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|
Term
| Describe retinopathy of prematurity (ROP) |
|
Definition
| combo of low birth weight & high O2 levels - sequelae include detachment of retinas & blindness |
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|
Term
| Describe necrotizing enterocolitis. |
|
Definition
| ischemia results in inflammatory, infected bowel |
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|
Term
| Child is able to interact with environment at _____ weeks conceptual age. |
|
Definition
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|
Term
| which position is encouraged for sleeping to avoid SIDS? |
|
Definition
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|
Term
| Jumpers & walkers can increase ____ tone |
|
Definition
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|
Term
| Describe the causes of CP. |
|
Definition
| hemorrhage below lining of ventricles, hypoxic encephalopathy, malformations & trauma of CNS - associated with preterm birth. |
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Term
| Describe monoplegic, diplegic, hemiplegic, quadraplegic, spastic, athetotic, & ataxic CP. |
|
Definition
monoplegic - 1 limb
diplegic - both LE
upper & LE of one side of body - hemiplegic
quadriplegic - all four limbs
spastic - increased tone
athetosis - fluctuating muscle tone - BG injury
ataxia - instability of mvt - cerebellar damage |
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|
Term
| List & Describe the V levels of CP. |
|
Definition
I - walks without restrictions, limitations in more advanced gross motor skills
II - walks without assistive devices; limitations walking outdoors/community
III - walks with AD, limitations walking outdoors/community
IV - self-mobility with limitations - power mobility outdoors/community
V - self-mobility severely limited even with AD |
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|
Term
| side-lying will help reduce effect of ______. |
|
Definition
| tonic labyrinthine reflex |
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|
Term
| What does a posterior rollator walker help promote? |
|
Definition
| upright position; arm position helps decrease extensor tone |
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|
Term
| List medical/surgical management of CP. |
|
Definition
oral medications - benzodiazepines, diazepam (Valium), Baclofen (Lioresal)
Baclofen pump can hold 1-4 mo. supply
SDR - selective dorsal rhizotomy - surgical transection of EMG - selected dorsal sensory rootlets with the goals of facilitating or maintaining ambulation or improving ease of caregiving
peripheral nerve block - injection of phenol/alcohol into PNS from nerve root to motor endplate - lasts 3-6 mo.
Botox lasts 4-6 mo. |
|
|
Term
|
Definition
muscle/tendon lengthening
muscle attachments moved to change direction of force to increase function & decrease spasticity
cutting, removing or repositioning bone to facilitate normal alignment |
|
|
Term
| muscles most often lengthened in CP are: |
|
Definition
| Achilles tendon, HS, iliopsoas, & hip adductors |
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|
Term
| Muscle transfers in CP are most often done with ______. |
|
Definition
| hip adductors - transferred to hip ABD |
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|
Term
| osteotomies are most often performed at the ____. |
|
Definition
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|
Term
| What is involved in a diagnosis of spina bifida? |
|
Definition
| elevated serum or amniotic alpha-fetoprotein, amniotic acetlycholinesterase in prenatal period, & sonogram |
|
|
Term
| Define spina bifida occulta |
|
Definition
| no S.C. involvement - can be indicated by a tuft of hair, dimple, or sinus |
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|
Term
| Define spina bifida cystica. |
|
Definition
visible or open lesion
- Meningocele - cyst includes CSF, cord intact
- Myelomeningocele - cyst includes CSF, herniated cord tissue |
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|
Term
| Link between spina bifida & what factors? |
|
Definition
| decreased folic acid, infection, hot tub soaks, exposure to teratogens (alcohol, valproic acid) |
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Term
| List physical impairments associated with spina bifida. |
|
Definition
| kyphoscoliosis, shortened hip flexors & adductors, flexed knees, pronated feet, B&B dysfunction (L4-5 lesion), low tone or spasticity, osteoporosis, cognitive impairments |
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|
Term
| functional abilities in children with spina bifida should be assessed using the ___ or ___. |
|
Definition
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|
Term
| What positioning should be stressed for patients with spina bifida? |
|
Definition
| flexion, prone positioning to avoid contractures of hip flexors |
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|
Term
| What are signs of shunt malfunction? |
|
Definition
| increased irritability, increased muscle tone, seizures, vomiting, bulging fontanels, HA, & redness along shunt tract |
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|
Term
| List the invovlement in Erb's palsy, Klumpke's palsy, & Erb-Klumpke palsy. |
|
Definition
Erb's - involves C5-6, upper arm paralysis - rhomboids, levator, serratus, delts, supraspinatus, infraspinatus, biceps, barchioradialis, brachialis, supinator
Klumpke - C8-T1 - distal wrist & hand function
Erb-Klumpke - whole arm paralysis |
|
|
Term
| Describe the pathology of Trisomy 21 |
|
Definition
| chromosomal abnormality caused by breakage & translocation of piece of chromosome onto normal chromosome |
|
|
Term
| The milder form of Down Syndrome with some normal cells interspersed with abnormal cells is called the _____ type. |
|
Definition
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|
Term
| What are the changes to the structure of the brain with Down Syndrome? |
|
Definition
| less brain weight, cerebellum & brainstem lighter than normal, smaller convolutions of cortex |
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|
Term
| What motions should be avoided to limit altantoaxial ligamentous laxity in children with Down's? |
|
Definition
| forceful neck flexion & rotation activities |
|
|
Term
| How should feeding sessions be for children with Down's? |
|
Definition
| short, frequent feeding sessions for energy conservation. |
|
|
Term
| What is possible after infant TBI secondary to increased tone around joint, immobility, & coma? |
|
Definition
|
|
Term
| Describe the pathology of Duchenne's MD. |
|
Definition
X-linked recessive, inherited by boys from recessive gene of mother
Dystrophin gene missing - results increased permeability of sarcolemma & destruction of muscle cells |
|
|
Term
| List the impairments associated with Duchenne's MD. |
|
Definition
progressive weakness from prox to distal
positive Gower's sign - weak quads & gluts - patient has to walk up legs to rise from prone to stand
cardiac involvement
contractures & deformities develop d/t muscle imbalance, esp. of heel cords & TFL, as well as lumbar lordosis & kyphoscoliosis
lose ability to ambulate, progressive cardiopulmonary limitations |
|
|
Term
| List medical management of TBI. |
|
Definition
Pharmacological agents to control ICP - sedatives, paralytics, diuretics, & barbituates
ICP monitored by ICP bolt
surgical evacuation of hematoma |
|
|
Term
| In DMD, what muscles shorten first? What is the intervention? |
|
Definition
TFL & gastroc
night splints |
|
|
Term
| E-stim has been used in DMD to do what? |
|
Definition
| increase muscle contractile ability. |
|
|
Term
| What medication increases life expectancy in children with DMD? |
|
Definition
| steroids - decreases pulmonary dysfunction - antibiotics are used for pulmonary infections |
|
|
Term
| Side-lyers help decrease effects of ____. |
|
Definition
|
|
Term
| An ABD pad at hips is often used to decrease what gait deviations? |
|
Definition
| scissoring extension pattern of hip extension, ADD, with knee extension & plantar flexion of ankles |
|
|
Term
| what position of the ankle is used with AFO's to reduce genu recurvatum? |
|
Definition
|
|
Term
| KAFO's are used with kids with _____ or _____. |
|
Definition
|
|
Term
| HKAFO's are used for children with ______ or _____. |
|
Definition
| thoracic level spina bifida, SCI |
|
|
Term
| Pavlik harnesses are used for children with _____. What position is the hip held in? |
|
Definition
congenital hip dysplasia
flexion, ABD - maintains femoral head in acetabulum |
|
|
Term
| Scooters/3 wheelers require ____ sitting balance & UE control |
|
Definition
|
|
Term
| Differentiate between forward & retro walkers. |
|
Definition
forward - promote forward trunk lean & max ant. stability
retro - extension at trunk, encourages shoulder depression, elbow extension, neutral wrist - can decrease scissoring |
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|
Term
|
Definition
Early Intervention programs - infants & children 0-3 - provides comprehensive, multidisciplinary EIP.
IFSP developed (individual family service plan)
Individual Education plan - children 3-21 years - emphasizes least restrictive environment |
|
|
Term
| What is the biggest problem with metabolism with aging? |
|
Definition
| decline in homeostatic efficiency - unable to maintain temperature & metabolism |
|
|
Term
| List life expectancy for humans. |
|
Definition
| 75.8 years - women live on average 6.6 years longer than men |
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|
Term
|
Definition
| The last stages of adulthood through death. |
|
|
Term
| List the three categories of elderly. |
|
Definition
Young elderly: 65-74
Old elderly: 75-84
Old, old elderly or frail elderly: >85 |
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|
Term
| List the 5 leading causes of death in people over 65. |
|
Definition
Heart disease (CHD - coronary heart disease)
Cancer
CVA
COPD
Pneumonia |
|
|
Term
| List cellular changes associated with aging. |
|
Definition
increase in size, fragmentation of Golgi apparatus & mitochondria
decrease in cell capacity to divide & reproduce
arrest of DNA synthesis & cell division |
|
|
Term
| List tissue changes in the elderly. |
|
Definition
| accumulation of pigmented materials, lipofusins; accumulation of lipids & fats, & decreased elastic content, degradation of collagen, & presence of pseudoelastins in tissues |
|
|
Term
| Describe the genetic theory of aging & list some syndromes that go along with this theory. |
|
Definition
aging is intrinsic to the organism; genes are programmed to modulate aging changes, overall rate of progression
progeria
Hutchison-Gilford syndrome: progeria of childhoos
Werner's syndrome: progeria of young adults |
|
|
Term
| Describe the Hayflick Limit Theorem. |
|
Definition
| functional deterioration within cells i due to limited number of genetically programmed cell doublings (cell replications) |
|
|
Term
| Describe the free-radical theory. |
|
Definition
free radicals are highly reactive & toxic forms of O2 produced by cell mitochondria; the released radicals
can trigger pathologic changes: atherosclerosis in blood vessel wall; cell mutations & cancer |
|
|
Term
| Describe the cell mutation theory. |
|
Definition
| errors in the synthesis of proteins (DNA, RNA) lead to exponential cascade of abnormal proteins & aging changes |
|
|
Term
| Describe the hormonal theory of aging. |
|
Definition
| functional decrements in neurons & their associated hormones lead to aging hypothalamus, pituitary, & adrenal gland are primary timekeepers of aging - thyroxine is the master hormone of the body - controls rate of protein synthesis & metabolism secretion of regulatory pituitary hormones influence thyroid decreases in protective hormones: estrogen, growth hormone, adrenal DHEA (dehydroepiandrosterone) increases in stress hormones (cortisol): can damage brain's memory center, hippocampus, & destroy immune cells |
|
|
Term
| Describe the immunity theory of aging. |
|
Definition
thymus decreases, shrivels by puberty, becomes less functional - bone marrow cell efficiency decreases; results in steady decrease in immune responses during adulthood
immune cells, T cells become less able to fight foreign organisms; B cells become less able to make antibodies
autoimmune disease increases with age |
|
|
Term
| List environmental theories of aging. |
|
Definition
| aging is caused by an accumulation of insults from the environment - UV light, cross-linking agents (unsaturated fats), toxic chemicals, radiation & viruses |
|
|
Term
| Describe the stress theory of aging. |
|
Definition
homeostatic imbalances result in changes in structural & chemical composition
general adaptation syndrome (Selye's): initial alarm reaction, progressing to stage of resistance, progressing to state of exhaustion - closely linked to hormonal theory |
|
|
Term
| Describe Erickson's bipolar theory of lifespan development. |
|
Definition
Stages of later adulthood: Integrity: inidivudal exhibits full unification of personality; life is viewed with satsisfaction, remains optimistic, continues to grow
Despair: individual lacks ego integration; life is viewed with despair (fear of death, feelings of regret & disappointment, missed opportunities) |
|
|
Term
| Describe muscle fiber changes with aging. |
|
Definition
| selective loss of type II, fast twitch, with increase in proportion of Type I |
|
|
Term
| Describe the altered chemical composition of muscle with aging. |
|
Definition
| decreased myosin adenosine triphosphatase (ATPase activity), glycoproteins, & contractile proteins |
|
|
Term
| List collagen changes with aging. |
|
Definition
| decreased elasticity, increased water loss, denser, more irregular d/t cross-linkages - affects tendons, bone, cartilage |
|
|
Term
| Which kind of resistance exercise regimen is best for the elderly? |
|
Definition
| High-intensity better than moderate intensity - need 70-80% of 1RM |
|
|
Term
| Peak bone mass occurs at age ___; between 45 & 70 bone mass decreases. |
|
Definition
|
|
Term
| Overall loss of cerebral mass/brain weight of ______% between ages of 20 & 90; accelerates after age ____. |
|
Definition
|
|
Term
| What happens to the following aspects of the nervous system with age: gyri, ventricles, cerebral blood flow, neurotransmitters. |
|
Definition
gyri: atrophy: narrowing & flattening of gyri with widening of sulci
ventricles dilate
cerebral blood flow decreases
neurotransmitters have decreased synthesis & metabolism: ex. ACh & dopamine |
|
|
Term
| More selective cell loss with aging is found in which areas of the brain? |
|
Definition
| BG (SN & putamen), cerebellum, hippocampus, locus ceruleus |
|
|
Term
| The loss of sympathetic fibers with aging may explain _____. |
|
Definition
| diminished autonomic stability, increased incidence of postural hypotension in older adults |
|
|
Term
|
Definition
| visual loss in middle & old age characterized by inability to focus properly & blurred images d/t loss of accommodation & elasticity of the lens |
|
|
Term
| Older adults have decreased color discrimination, especially between ____ & ____. |
|
Definition
|
|
Term
| In older adults the resting pupil size _____. |
|
Definition
|
|
Term
| Describe oculomotor responses in older adults. |
|
Definition
| restricted upward gaze, reduced pursuit eye movements, ptosis |
|
|
Term
| With cataracts, loss of vision is _____ first, then _____. |
|
Definition
|
|
Term
| With glaucoma, there is an early loss in ______ vision. |
|
Definition
|
|
Term
| Define senile macular degeneration. |
|
Definition
| loss of central vision associated with age-related degeneration of the macula compromised by decreased blood supply or abnormal growth of blood vessels under the retina - initially patients retain peripheral vision but may progress to total blindness |
|
|
Term
| Diabetic retinopathy is a _____ vision impairment. |
|
Definition
|
|
Term
| T/F. Complete blindness with diabetic retinopathy is common. |
|
Definition
|
|
Term
| Which side is homonymous hemianopsia associated with? |
|
Definition
| injured side - side of sensorimotor deficit |
|
|
Term
| Define conductive hearing loss. |
|
Definition
| mechanical hearing loss from damage to external auditory canal, tympanic membrane, or middle ear ossicles - results in hearing loss, tinnitus |
|
|
Term
| Define sensorineural hearing loss. |
|
Definition
| central or neural hearing loss from multiple factors - noise damage, trauma, disease, drugs, arteriosclerosis |
|
|
Term
|
Definition
| sensorinerual hearing loss associated with middle or older ages - characterized by bilateral hearing loss, especially at high frequencies at first, then all frequencies - poor auditory discrimination & comprehension, esp. with background noise, tinnitus |
|
|
Term
|
Definition
| immobility of stapes results in profound conductive hearing loss. |
|
|
Term
| Describe vestibular/balance changes in the elderly. |
|
Definition
degenerative changes in otoconia of utricle & saccule; loss of vestibular hair-cell receptors; decreased number of vestibular neurons
VOR gain decreases |
|
|
Term
| List medical management for loss of vestibular function in the elderly. |
|
Definition
| medications: anihypertensives, anticonvulsants, tranquilizers, sleeping pills, aspirin, nonsteroidal anti-inflamatory drugs (NSAIDS) |
|
|
Term
| Describe cutaneous pain threshold changes in older adults. |
|
Definition
| threshold increased - greater changes in upper body areas (UE, face) than LE |
|
|
Term
| Age-related changes in cognition don't usually show up until age ____, with significant declines affecting everyday activities not showing up until age ____. |
|
Definition
|
|
Term
|
Definition
| describes most significant decline in measures of intelligence - usually years immediately preceding death |
|
|
Term
| What happens to neurohumeral control in older adults? |
|
Definition
| decreased responsiveness of end-organs to beta-adrenergic stimulation of baroreceptors |
|
|
Term
| What happens to blood coagulability with age? |
|
Definition
|
|
Term
| Why is OH a common problem in the elderly? |
|
Definition
| reduced baroreceptor sensitivity & vascular elasticity |
|
|
Term
| What kind of murmur is common in the elderly? |
|
Definition
|
|
Term
| What ECG changes are noted in the elderly? |
|
Definition
| loss of normal sinus rhythm; longer PR & QT intervals, wider QRS, increased arrythmias |
|
|
Term
| What happens to the following pulmonary system components with aging: alveoli size, TLC, residual volume, vital capacity, FEV. |
|
Definition
alveoli size increases & become thinner - fewer capillaries for delivery of blood
TLC decreases - increase in residual volume & decrease in vital capacity
decreased FEV1 |
|
|
Term
|
Definition
| gymnastic exercise to achieve bodily fitness & grace of mvt |
|
|
Term
| Vascular fragility in the elderly results in _____. |
|
Definition
| easy bruising - senile purpura |
|
|
Term
| Why does thinning & graying of hair occur in the elderly? |
|
Definition
| vascular insufficiency & decreased melanin production. |
|
|
Term
| Define osteoporosis & osteopenia. |
|
Definition
BMD at the hip or spine that is >2.5 standard deviations below the young normal mean.
osteopenia: between 1.0-2.5 S.D below young normal mean population |
|
|
Term
| List diseases that affect bone loss. |
|
Definition
| hyperthyroidism, DM, hyperparathyroidism, rheumatic disease (lupus), celiac disease, gastric bypass, pancreatic disease, multiple myeloma, sickle cell disease, ESRD, Paget's disease, CA, & chemotherapeutic drugs. |
|
|
Term
| List meds that affect bone loss. |
|
Definition
| Corticosteroids, thyroid hormone, anticonvulsants, catabolic drugs, estrogen antagonists, chemotherapy |
|
|
Term
| Bone loss is about ___% per year and accelerates postmenopause, at ___%/yr for approximately 5 years. |
|
Definition
|
|
Term
| Which type of bone is most affected with osteoporosis. |
|
Definition
| trabecular more involved than cortical |
|
|
Term
| List postural deformities of osteoporosis. |
|
Definition
feet: hammer toes, bunions
postural kyphosis, forward head position
hip & knee flexion contractures |
|
|
Term
| List medical treatment for osteoporosis. |
|
Definition
biphosphonates (alendronate, ibandronate, resedronate, & zoledronic acid
calcitonin
estrogens &/or hormone therapy (teriparatide)
estrogen agonist/antagonist (raloxifene) |
|
|
Term
| What should daily calcium & vitamin D intakes be? |
|
Definition
Calcium 1200 mg/day in people 50 or older
Vitamin D = 800-1000 IU/day in people 50 or older |
|
|
Term
| Describe exercise precautions for patients with osteoporosis to prevent fracture. |
|
Definition
| no forward bending & exercising with trunk in flexion, especially with twisting. |
|
|
Term
| Vertebral compression fractures usually occur in what regions? |
|
Definition
| lower thoracic & lumbar regions (T8-L3) |
|
|
Term
| Where are stress fractures most common in the elderly? |
|
Definition
| pelvis, proximal tibia, distal fibula, metatarsal shafts, & foot |
|
|
Term
|
Definition
| fluctuating attention state causing temporary confusion & loss of mental function; an acute disorder, potentially reversible |
|
|
Term
| List the causes of delirium. |
|
Definition
| drug toxicity and/or systemic illness, O2 deprivation to brain, environmental changes & sensory deprivation (ex. recent hospitilization, institutionalization) |
|
|
Term
| List the duration of multi-infarct dementia, senile dementia, & presenile dementia. |
|
Definition
multi-infarct dementia
varies from days-years
senile dementia
varies months>years; mean survival 7-11 yrs
presenile dementia
rapid - mean survival 4 years |
|
|
Term
| What do SDAT & PDAT stand for? |
|
Definition
senile dementia alzheimer's type
pre-senile dementia alzheimer's type |
|
|
Term
| Which protein is built up in dementia? |
|
Definition
|
|
Term
| Define sundowning syndrome. What is it seen in? |
|
Definition
| confusion & agitation increases in late afternoon - seen with senile dementia alzheimers type |
|
|
Term
| Describe the etiology of multi-infarct dementia. |
|
Definition
large & small vascular infarcts in both gray & white matter of brain, producing loss of brain function
sudden onset rather than insidious - stepwise progression - associated with hx of stroke cardiovascular disease, & HTN |
|
|
Term
| List other lesser known types of dementias. |
|
Definition
PD - dementia estimated in 10-35% of cases, late in the disease progression
alcohol related - prolonged nutritional (B1) deficiency - Korsakoff's psychosis |
|
|
Term
| A score of ______ on the MMSE is indicative of mental decline/dementia. |
|
Definition
|
|
Term
| A score of >___ on the Geriatric Depression Scale indicates depression. |
|
Definition
|
|
Term
| List medical management of depression in elderly adults. |
|
Definition
tricyclic antidepressants (chlorpromazine, fluioxetine, Prozac)
Psychotherapy
electroconvulsive shock wave therapy (ECT) may be used if drug treatment is unsuccessful or contraindicated |
|
|
Term
| What ECG changes show up with angina in elderly patients? |
|
Definition
|
|
Term
|
Definition
| consider the whole person; integrate all facets of an individual's life |
|
|
Term
| What is covered by Med A? |
|
Definition
inpatient hospital care, SNF care, home health care, hospice care
- no premiums, but have to pay deductibles & co-insurance |
|
|
Term
| What is covered by Med B? |
|
Definition
physician services, outpatient services, durable medical equipment
- have to pay premiums, deductibles, & coinsurance |
|
|
Term
| What is covered by Medicaid? |
|
Definition
long-term care of frail & elderly patients
- have to spend-down/exhaust income to qualify
- administered by individual states that set qualification guidelines - requirements vary by state |
|
|
Term
| T/F. Medicare is covered if prescribed by a PT. |
|
Definition
| False - must be prescribed by a physician. |
|
|
Term
| T/F. The physician has to sign the POC. |
|
Definition
|
|
Term
| The POC must be certified for the first _____ days of tx; has to be recertified every ____ days after. |
|
Definition
|
|
Term
| Where do the most falls occur in homes? |
|
Definition
|
|
Term
| WIth hip fracture, that patient will have the leg positioned in _____ & will not be able to bear weight on leg. |
|
Definition
|
|
Term
| What are signs a child may have hip dysplasia? |
|
Definition
| limited hip ABD - ADD & ext. - prone to dislocation |
|
|
Term
| What medications can cause confusion/dementia in older adults? |
|
Definition
| tranquilizers, barbiturates, digitalis, antihypertensives, anticholinergic drugs, analgesics, antiparkinsonians, diuretcs, beta-blockers |
|
|
Term
| What medications can cause sedation/immobility in older adults? |
|
Definition
| psychotropic drugs, narcotic analgesics |
|
|
Term
| What medications can cause weakness in older adults? |
|
Definition
| antihypertensives, vasodilators, digitalis, diuretics, oral hypoglycemics |
|
|
Term
| What medications can cause depression in older adults? |
|
Definition
| anihypertensives, anti-inflammatories, antimycobacterials, antiparkinsonians, diuretics, H2 receptor antagonists, sedative hypnotics, vasodilators |
|
|
Term
| Define dyskinesias & list what drugs can cause in elderly patients. |
|
Definition
| involuntary, stereotypic & repetitive movements - lip smacking, hand movements associated with long-term use of neuroleptic drugs & anticholinergic drugs, & levodopa |
|
|
Term
| Define akathisia & list what meds can cause it in older adults. |
|
Definition
| motor restlessness - associated with antipsychotic drugs |
|
|
Term
| List what drugs cause Essential tremor. |
|
Definition
| tricyclic antidepressants, andrenergic drugs |
|
|
Term
| Which drugs cause Parkinsonism in older adults? |
|
Definition
| antipsychotics, sympatholytics |
|
|
Term
| What drugs can cause incontinence in elderly patients? |
|
Definition
| barbituates, benzodiazepines, antipsychotic drugs, anticholinergic drugs |
|
|
Term
| What makes up a sacromere? |
|
Definition
| overlapping actin & myosin cross-bridges |
|
|
Term
| Describe contraction speed, force (tension) production, & fatiguability for Type I, IIa, & IIb fibers. |
|
Definition
Type I
Speed: slow
Force: low
Highly fatigue resistant
IIa
Fast
Fatigue resistant
IIb
Fast
High force
Highly fatigueable |
|
|
Term
| List the order of recruitment of fibers. |
|
Definition
|
|
Term
| Weight lifted or lowered cannot exceed that which the muscle is able to control at the _____ point in the ROM. |
|
Definition
|
|
Term
|
Definition
| when a muscle is stretched beyond the resting length, there is a mechanical disruption of cross bridges as the microfilaments slide apart & the sarcomeres lengthen. Releasing the stretch allows the sarcomeres to return to their resting length. This change in ratio of length to tension is called elasticity. - once released, a muscle stretched into the elastic range will contract & produce a force or tension as the muscle returns to its original length |
|
|
Term
| List the changes to muscle fibers with remodeling after strength training. |
|
Definition
| More actin & myosin, muscle fibers are enlarged, have more & larger myofibrils, increased # sarcomeres (sarcomeres in parallel) |
|
|
Term
| _____ of a muscle is highly correlated with strength gains. |
|
Definition
| CSA - increased muscle size = greater muscle strength |
|
|
Term
| What causes increased muscle soreness? How can it be reduced? |
|
Definition
| decreased blood flow & reduced O2 (ischemia) - creates a temporary buildup of lactic acid & potassium. A cool-down period of low-intensity exercise can facilitate the return of oxygen to the muscle & reduce soreness. |
|
|
Term
| DOMS is usually greater after ______ exercise. How can the severity of soreness be reduced? |
|
Definition
| eccentric - gradually increasing intensity & duration |
|
|
Term
| Isometric contractions should be held for at least ____ seconds to obtain adaptive changes in the muscle. |
|
Definition
|
|
Term
| Why should isometric exercises be used with caution? |
|
Definition
|
|
Term
| Define isotonic exercise. |
|
Definition
| constant load through variable speeds - can be achieved with free weights or machines |
|
|
Term
| Define isokinetic exercise. |
|
Definition
| constant speed control with variable resistance |
|
|
Term
| peak torque is inversely related to ______. |
|
Definition
|
|
Term
| eccentric contractions consume ____ oxygen & _____ energy stores than concentric contractions against similar loads |
|
Definition
|
|
Term
| mechanoreceptors are stimulated with ____ exercises, adding to joint stability, balance, coordination, and agility in functional wb-ing postures. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| A period of rest of ____ - ____ is used with circuit training. |
|
Definition
|
|
Term
| Define plyometric training. |
|
Definition
| stretch-shortening activity - an isotonic exercise that combines speed, strength, & functional activities - used in later stages of rehab to achieve high level of performance. |
|
|
Term
| A ___ second rest after isometric contractions is recommended. Why? |
|
Definition
| 20 - prevent increases in BP |
|
|
Term
| How long does it take to see strength gains with isometric training programs? |
|
Definition
|
|
Term
| Describe the FITT equation. |
|
Definition
| includes factors that affect training: frequency, intensity, time, & type. |
|
|
Term
| Intensity is inter-related with ___ & ____. |
|
Definition
|
|
Term
| If training at a low intensity, ___ should be increased. |
|
Definition
|
|
Term
| List some ways to measure HRmax or VO2max. |
|
Definition
| 3 minute step, 12 minute run, 1 mile walk |
|
|
Term
| THR can be established at ____ of maximum to increase aerobic capacity. |
|
Definition
|
|
Term
| Define the Karvonen formula. |
|
Definition
predicts HRR (heart rate reserve)
THR = (HRmax - RHR) x % of desired training intensity + RHR |
|
|
Term
| A cardiorespiratory training effect can be achieved at a rating of what on the RPE scale? |
|
Definition
| 13-16 "somewhat hard" or "hard" |
|
|
Term
| An appropriate level of training should result in a ____ test. |
|
Definition
|
|
Term
| Define minute ventilation. |
|
Definition
The volume of air breathed each minute - usually 6 liters Ve
Ve = breathing rate x TV |
|
|
Term
| O2 consumption rises rapidly during the first minutes of exercise & then levels off - why? |
|
Definition
| aerobic metabolism takes over to supply the energy required by working muscles (steady state) |
|
|
Term
| List the positive effects of aerobic training on the cardiovascular system: heart weight & volume, hemoglobin, O2 delivery capacity, resting & submax exercise HR, CO, SV, distribution of blood to working muscles, resting BP. |
|
Definition
heart weight & volume: increased
hemoglobin: increased
O2 delivery capacity: increased
resting & submax HR: decreased
CO: increased
SV: increased
distribution of blood to working muscles: increased
resting BP: decreased |
|
|
Term
| Interval training tends to improve what? |
|
Definition
| strength & power more than endurance |
|
|
Term
| At altitudes of _____ ft. or higher, there is a noticeable drop in performance of aerobic activities. |
|
Definition
|
|
Term
| At high altitudes, the partial pressure of O2 is ______, resulting in poor oxygenation of hemoglobin. |
|
Definition
|
|
Term
| What does the hypoxia at high altitudes do to breathing & HR? |
|
Definition
| causes hyperventilation, which increases HR, decreased CO2 & increases alkalinity |
|
|
Term
| It takes 2 weeks to acclimate to a height of _____meters and an additional week for every additional ____ meters in altitude |
|
Definition
|
|
Term
| VO2max is decreased 2% for every ______m above ______ m. |
|
Definition
|
|
Term
| T/F. Training at high altitudes improves sea-level performance. |
|
Definition
|
|
Term
| What does the body do when exercising in increased heat? |
|
Definition
blood is shunted to the periphery, which takes away from oxygenation to the working muscles
sweating increased - fluids must be replaced or core temperature can rise to dangerous levels |
|
|
Term
| _____ fluids are emptied from the stomach at an increased rate. |
|
Definition
|
|
Term
| Concentrated carbohydrate drinks impair ____ & ____ fluid replacement |
|
Definition
|
|
Term
| What drinks are best during exercise? |
|
Definition
| Glucose-polymer drinks - don't impair physical functioning & resupply lost electrolytes |
|
|
Term
| Repeated heat stress results in acclimatization in about ____ days of exposure. |
|
Definition
|
|
Term
| Facilitated stretching = ________. |
|
Definition
| active inhibition - patient reflexively relaxes the muscle to be elongated prior to or during the stretching technique |
|
|
Term
| Hold relax techniques utilize _____ inhibition from the ____ firing. |
|
Definition
|
|
Term
| HRAC techniques utilize _____ inhibition. |
|
Definition
|
|
Term
| a muscle that is lengthened over a prolonged period of time will have an increase in the number of sarcomeres in ________. |
|
Definition
|
|
Term
| the muscle spindle monitors ______ & ______ changes in muscle. |
|
Definition
|
|
Term
| Describe the purpose of the GTO. |
|
Definition
| inhibits contraction of the muscle - when excessive tension develops, the GTO fires, inhibiting alpha motor neuron activity & decreasing tension in the muscle (autogenic inhibition) - allows muscle to lengthen - stretch protection reflex. |
|
|
Term
|
Definition
| overstretching a muscle beyond normal ROM results in hypermobility - if the supporting structures of a joint are insufficient orweak, they cannot hold a joint in a stable, functional position during functional activities - known as stretch weakness. |
|
|
Term
| Describe controlled mobility. |
|
Definition
| postural stability of trunk while weight shifting - distal segments fixed while proximal segments are moving |
|
|
Term
| Describe static/dynamic control. |
|
Definition
| maintaining postural stability of the trunk during dynamic extremity movements |
|
|
Term
|
Definition
| prolonged holding of core muscles |
|
|
Term
| Which type of physioball gives a patient more stability - one that is under-inflated or hyper-inflated? |
|
Definition
| under - softer moves more slowly & makes patient feel more secure. |
|
|
Term
| Feedback given frequently improves ______, while feedback given less frequently improves ________. |
|
Definition
initial performance
retention of skills |
|
|
Term
| Remedial strategies focus on use of ______. |
|
Definition
| involved body parts (ex. affected extremity in a CVA patient) |
|
|
Term
| Define movement adaptation syndrome. |
|
Definition
| habituation of compensatory movement patterns that contribute to the persistence of pain |
|
|
Term
| Describe Jacobson's progressive relaxation technique. |
|
Definition
| a systematic distal to proximal progression of conscious contraction & relaxation of musculature |
|
|
Term
| Rocking & rhythmic rotation can help improve _____. |
|
Definition
| high tone, reduce spasticity |
|
|
Term
| Define Archimedes principle. |
|
Definition
| buoyancy is the upward force of the water on an immersed or partially immersed body or body part - it is equal to the weight of the water that it displaces (Archimedes principle) |
|
|
Term
| The resistance encountered while moving through water is due to ______. |
|
Definition
| cohesion - the tendency of water molecules to adhere to each other. |
|
|
Term
| Moving through turbulent water creates ______ resistance than calm water |
|
Definition
|
|
Term
| With congenital hip dysplasia, there is shortening of the affected limb. What does this look like? |
|
Definition
| asymmetrical gluteal folds; posterosuperior prominence of affected hip |
|
|
Term
| Describe the procedure for the Ortolani test. |
|
Definition
| patient in supine. one at a time, with hips & knees flexed to 90 - ABD hip & listen for audible sound or feel for clicking - supposedly reduces femoral head back into acetabulum |
|
|
Term
| Describe the procedure for the Barlow test. |
|
Definition
| Hip is flexed, thigh is adducted, while pushing posteriorly in line of shaft of femur, causing femoral head to dislocate posteriorly from acetabulum |
|
|
Term
| What is the best initial treatment of Erb-Klumpke palsy? What would be bad initial treatment ideas? |
|
Definition
partial immobilization of the limb across the abdomen followed by gentle ROM.
mobilizing in overhead motions is contraindicated
splinting in ABD causes ABD contracture & hypermobility of the shoulder. |
|
|
Term
| Define placenta previa & describe an acceptable therapeutic intervention for this pregnant patient. |
|
Definition
placenta does not elevate from its original low position & assumes a position below the fetus & lower half of the uterus - may cover the mouth of the uterus
patient should perform pelvic floor and breathing exercises - abdominal exercises can worsen & are contraindicated. |
|
|
Term
| Describe Salter Harris Injuries. What is an easy way to remember I-V? |
|
Definition
growth plate fractures
S - slipped growth plate
A - above - growth plate and metaphysis involved
L - lower - growth plate and epiphysis involved
T - through - metaphysis, growth plate, & epiphysis involved
R - rammed - crush or compression injury of growth plate |
|
|
Term
| Describe Salter Harris Classification I & II. |
|
Definition
I - disruption entirely confined to growth plate
II - fracture line runs partially through the growth plate, then extends through metaphysis - common in distal fibula - "greenstick fracture"
usually heals well, even if untreated, but tpically immobilized with short leg cast for 4-6 weeks |
|
|
Term
| Describe Salter-Harris Type III & IV fractures. |
|
Definition
III - partially through growth plate, then extends through epiphysis
IV - combined disruption of metaphysis, growth plate, & epiphysis
requires internal fixation with restoration of ankle joint congruency - at risk for incidence of growth disturbance |
|
|
Term
| Describe Salter Harris Type V & VI fractures. |
|
Definition
V - crush or compression injury of growth plate
VI - Abrasion, avulsion, or burn of the perichondrial ring of the growth plate
bone alignment and length can be affected - can permanently injury growth plate, requiring later treatment to restore alignment of limb |
|
|
