Term
|
Definition
| heat transfer from a warmer object to a colder object by means of direct molecular interaction of objects in physical contact. |
|
|
Term
|
Definition
| heat transfer by movement of air or fluid from an area of warm to cool or moving past a cooler body part. |
|
|
Term
|
Definition
| transfer of heat from a warmer object to a cooler object by means of transmission of electromagnetic energy without heating of an intervening medium. Infrared waves absorbed by cooler body, |
|
|
Term
| List the physiological effects of general heat application: CO, metabolic rate, pulse rate, RR, BP, muscle activity, blood flow, SV. |
|
Definition
CO: increased
metabolic rate: increased
pulse rate: increased
RR: increased
BP: decreased
muscle activity: decreased
blood flow: to superficial skin - reduced to organs & muscle
stroke volume: decreased |
|
|
Term
|
Definition
| for every 10 deg. increase in tissue temperature there is a two-threefold increase rate of cellular oxidation |
|
|
Term
| What is the method of application for heat? |
|
Definition
|
|
Term
| There should be ___-___ layers of toweling in between a hot pack and the patient. A terry cloth cover equals ___ - ____ layers. |
|
Definition
|
|
Term
| List the treatment time for hot packs. |
|
Definition
|
|
Term
| Paraffin melts at ___ - ___ deg. F & is self-sterilizing. The treatment temperature is ____ - ____ deg. F. |
|
Definition
|
|
Term
| What is the method of heat transmission for paraffin bath? |
|
Definition
|
|
Term
| What is the method of heat transmission for hydrotherapy? |
|
Definition
|
|
Term
|
Definition
| the heat-absorbing capacity of water - the amount of heat a gram of water absorbs or gives off to change the temperature 1 deg. Celsuis. Specific heat of water is 4x air |
|
|
Term
| Define Archimedes principle. |
|
Definition
| Buoyancy is the upward force of the water on an immersed or partially immersed body or body part which is equal to the weight of the water that it displaced |
|
|
Term
|
Definition
| the tendency of water molecules to adhere to one another. |
|
|
Term
| Define treatment temperature for whirlpool. |
|
Definition
103-110 F whirlpool
100 F Hubbard tank
95-100 F peripheral vascular disease
92-96 F open wounds |
|
|
Term
| List the treatment time for whirlpool. |
|
Definition
| 20 minutes - up to 30 minutes with other therapeutic procedures occurring simultaneously. |
|
|
Term
| What solution is used with pulsed lavage? |
|
Definition
sterile, warm saline
antimicrobials may be added |
|
|
Term
| What parameters are usually used for pulsed lavage? |
|
Definition
|
|
Term
| What is the typical treatment time for pulsed lavage? |
|
Definition
|
|
Term
| The water temperature for aquatic therapy is usually ____F |
|
Definition
|
|
Term
| List an evaporative modality. |
|
Definition
| vapocoolant sprays (Fluori-Methane) |
|
|
Term
| List the following physiological effects of general cold application: Metabolic rate, Pulse rate, RR, Venous BP, Blood Flow, CO, SV, Arterial BP |
|
Definition
Metabolic rate: decreases
Pulse rate: decreases
RR: decreases
Venous BP: decreases
Blood flow: goes to internal organs
CO: increases
SV: increases
arterial BP: increases |
|
|
Term
|
Definition
| erythema of the skin with wheal formation associated with severe itching due to histamine reaction. |
|
|
Term
| List the normal physiological stages to ice application. |
|
Definition
| cold, burning, aching, numbness |
|
|
Term
| Why is the use of vapocoolant sprays being questioned? |
|
Definition
| the chlorofluorocarbon ingredients in the spray have a possible deleterious effect on the environment |
|
|
Term
|
Definition
| the alternating immersion of a body part in warm & cold water to produce a vascular exercise through active vasodilation & vasoconstriction of the blood vessels. |
|
|
Term
| List the parameters for contrast baths. |
|
Definition
body part placed in warm water for 4 min., then transfer to cold for 1 - continue sequence of 4:1, ending with warm (end with cold if reducing edema is goal)
Hot water = 100-110 deg. F
Cold water = 55-65 deg. F
Tx time: 20 min. |
|
|
Term
|
Definition
| mechanical energy produced by sound waves at frequencies between 85 KHz & 3 MHz & delivered at intensities between 1 & 3 W/cm2 is absorbed by body tissues & changed to thermal energy. |
|
|
Term
| What is the most commonly used sound head for US? |
|
Definition
5 cm^2
range from 1-10 cm ^2
1 cm ^2 = wrist 5 cm^2 = shoulder, leg - transducer size should be selected relative to the size of the treatment area |
|
|
Term
| Continuous US is applied to achieve _____ effects. |
|
Definition
|
|
Term
| Define spatial average intensity. |
|
Definition
| The total power (watts) divided by the area (cm^2) of the transducer head - typically the measurement used to document US treatments |
|
|
Term
| Define Beam nonuniformity ratio (BNR). |
|
Definition
| ratio of the spatial peak intensity to the spatial average intensity. the lower the BNR, the more uniform the energy distribution, the less risk of tissue damage. Should be between 2:1 to 6:1 |
|
|
Term
| Pulsed US is applied when ______ effects are desired. |
|
Definition
|
|
Term
| Define temporal peak intensity. |
|
Definition
| the peak intensity of US during the on-time phase of the pulse period |
|
|
Term
|
Definition
| the reduction of acoustical energy as it passes through soft tissue - absorption, reflection & refraction effect attenuation. Absorption is highest in tissue with high collagen & protein content (muscles, tendons, ligaments, capsules) - the scattering of sound waves that result from reflection and refraction produces molecular friction that the sound wave must overcome to penetrate tissues |
|
|
Term
| At 3MHz, have greater heat production in _____ tissues, whereas at 1 MHz, have greater heat production in _____ tissues. |
|
Definition
|
|
Term
| Typically have an US duty cycle of ___ - ___ for non-thermal intervention. |
|
Definition
|
|
Term
| Differentiate between stable cavitation & unstable cavitation. |
|
Definition
stable: gas bubbles resonate but no tissue damage - may be responsible for diffusional changes in cell membranes
Unstable cavitation: severe collapse of gas bubbles during compression phase of US can result in local tissue destruction d/t high temperatures |
|
|
Term
| Define acoustic streaming. What is is useful for? |
|
Definition
| movement of fluids along the boundaries of cell membranes resulting from mechanical pressure wave - may produce alterations in cell membrane activity, increased cell wall permeability, increased intracellular calcium, increased macrophage response, & increased protein synthesis - useful in accelerating tissue healing |
|
|
Term
| With US, do not cover an area greater than _____ the size of the ERA per 5 minutes of treatment. |
|
Definition
|
|
Term
|
Definition
| effective radiating area - the area of the faceplate (crystal size) - less than soundhead |
|
|
Term
| Traction for the lumbar region should utilize a force of up to _____ body weight and for cervical, _____ body weight or _____ lbs. |
|
Definition
50%, 7%, 20-30 lbs.
Should start out at 30-40 lbs. lumbar & 8-10 lbs cervical |
|
|
Term
| List parameters for phonophoresis. |
|
Definition
| 20% pulsed, 1-3 w/cm^2, 5-10 minutes, .5-.75 W/cm^2 using a medication that is prepared in a medium that will allow transmission of the US - gel mediums or transdermal patches are good - pastes & creams - bad |
|
|
Term
| What are considered acute conditions that would indicate the use of mechanical traction? |
|
Definition
| disc, protrusion, elongation of soft tissue, muscle spasm |
|
|
Term
| Define intermittent mechanical compression. |
|
Definition
| a pneumatic device that applies external pressure to an extremity through an inflatable appliance (sleeve) |
|
|
Term
| Define treatment parameters for intermittent mechanical compression for lymphadema, traumatic edema, venous ulcers, & residual limb reduction. |
|
Definition
lymphadema: 2 hours to 2 3 hr sessions
traumatic edema: 2 hours
venous ulcers: 2.5 hours/3x/wk to 2 hours periods
residual limb reduction: 1 hour to 3 1 hour sessions |
|
|
Term
| Describe tilt-table testing. |
|
Definition
| Table raised gradually to given angle. Incremental rise to 30 deg., then 15 deg. increments to follow: 30, 45, 60, 80 - position can be maintained as long as 30-60 minutes - vital signs need to be monitored in each position to assess the patient's tolerance to the treatment |
|
|
Term
| Define tapotement & when is it used? |
|
Definition
Rhythmic percussion in swedish massage
used when stimulation is the desired treatment effect Tapotement is a more stimulating movement in which the fingers, sides or palms of the hands produce light tapping, quick pinching or gentle slapping movements. |
|
|
Term
| All stroking movements are directed ___ to ___, especially for edema. |
|
Definition
|
|
Term
| An electrical potential is generated across the cell membrane due to the higher concentration of ____ inside the cell, making the inside relatively more _____ than the outside. |
|
Definition
|
|
Term
| The RMP for a cell is _____-_____ mV for excitable cells. |
|
Definition
|
|
Term
| An AP is generated with an influx of ____ into the cell causes a reduction in the RMP, which is called _______. |
|
Definition
|
|
Term
| After the Na channels close, the K channels open, making the inside of the cell relatively more ____. This period is called _______. |
|
Definition
| negative, repolarization. |
|
|
Term
| A duration of < 1 ms is sufficient to stimulate ___, but is too short to stimulate _____. |
|
Definition
| nerve cell membranes, but not muscle cell membranes |
|
|
Term
|
Definition
| The intensity of the current having a long duration stimulus, required to produce a minimum muscle contraction. - measure of intensity |
|
|
Term
| Define chronaxie & chronaximetry. |
|
Definition
chronaxie - The duration required to produce a muscle contraction at 2x rheobase
chronaximetry - a test of electircal excitibility of peripheral nerves
|
|
|
Term
| What is a normal chronaxie value? Chronaxie of denervated muscle is > ____. |
|
Definition
<1 msec.
>1 msec, usually hundreds of milliseconds |
|
|
Term
| Very short _______ with low ______ can depolarize sensory nerves. Longer pulse durations are required to stimulate ______ nerves. What is required to elicit a response from a denervated muscle? |
|
Definition
pulse durations (<.05 msec), low intensities
motor nerves
Long pulse durations & high intensities |
|
|
Term
| Define a monophasic wave form. |
|
Definition
| direct or galvanic current - a unidirectional flow of charged particles - a current flow in one direction for a finite period of time - either has positive or negative charge |
|
|
Term
| Define Biphasic wave form. |
|
Definition
| alternating current: bidirectional flow of charged particles - one half of cycle below baseline & second phase below baseline. |
|
|
Term
| Describe where the motor point of innervated muscle is vs. denervated muscle. |
|
Definition
innervated - where the nerve enters the muscle, usually the muscle belly
denervated muscle - over the muscle distally towards the insertion |
|
|
Term
| A _____ frequency pulse produces a brief muscle twitch or muscle contraction with each stimulus. |
|
Definition
|
|
Term
| Increasing the number of stimuli (frequency) does what? |
|
Definition
| progressively fuses the individual muscle twitches to a point where the individual twitches are no longer discernible, resulting in a tetanic contraction. |
|
|
Term
| Define electrical current. |
|
Definition
| the movement of electrons through a conducting medium. |
|
|
Term
|
Definition
| the rate of flow of electrons |
|
|
Term
|
Definition
| the force that drives electrons through the conductive medium |
|
|
Term
| A substance that has a high resistance is an _____, while a substance with a low resistance is a ______. |
|
Definition
|
|
Term
|
Definition
| expresses the relationship between amperage, voltage, & resistance - current is directly proportional to voltage & inversely proportional to resistance |
|
|
Term
| The inverse of resistance is ______. |
|
Definition
|
|
Term
| Define a polyphasic wave. |
|
Definition
| more than two phases in a single pulse - may be russian or IFC. |
|
|
Term
| Describe the parameters used for muscle fatigue. |
|
Definition
| continuous contraction sustained for several minutes |
|
|
Term
| Describe the parameters for muscle pump. |
|
Definition
| interrupted or surge modulation producing rhythmic contraction & relaxation of the muscle to increase circulation. |
|
|
Term
| Describe the reason why pulsed currents would be used in wound healing. |
|
Definition
| used as a muscle pump action to improve tissue nutrition & hasten metabolic waste disposal |
|
|
Term
| List why monophasic currents are used for wound healing. |
|
Definition
(low-volt continuous or high-volt pulsed)
electrical potential theory - restoration of electrical charges in wound area
bacteriocidal effects - disruption of DNA, RNA synthesis or cell transport system of microorganisms
Biochemical effects - increased ATP concentration, amino acid uptake, & increased PRO & DNA synthesis
Galvanotaxis - attraction of tissue repair cells via electrode polarity - inflammation - macrophages (positive), mast cells (negative), neutrophils (either)
proliferation: fibroblasts (positive)
wound contraction: alternating positive/negative
epithelialization: epithelial cells (positive) |
|
|
Term
| Describe ES parameters for edema reduction. |
|
Definition
| muscle pump - increase lymph & venous flow - electrical field phenomenon for acute edema - by electrostatic repulsion, a monophasic waveform with a negative polarity is set up to surround the injured area & repel the negatively charged proteins attempting to accumulate in the interstitium |
|
|
Term
| A given current intensity passing through the smaller active electrode produces _____ current density & thus a ____ stimulus while the same current is perceived as less intense under the _____ electrode. |
|
Definition
|
|
Term
| What could large electrodes over a small treatment area do? What about small electrodes used over a large treatment area? |
|
Definition
large in small area - could overflow to surrounding muscles & produce undesired effects.
small electrodes applied to a large muscle could result in high current density under the electrodes that make ES uncomfortable to the patient. |
|
|
Term
| The space between active & dispersive electrodes should be at least _____. The greater the space between the electrodes the _____ the current density in the intervening superficial tissue. If deep penetration causes contraction of undesired muscles, what should you do? |
|
Definition
the diameter of the active electrode.
less
move the electrodes closer together. |
|
|
Term
| It has been shown that stimulation on/off ratios of >____ for muscle strengthening minimize fatigue effects of FES. |
|
Definition
|
|
Term
|
Definition
| the application of a continuous direct current to transport medicinal agents through the skin or mucous membrane for therapeutic purposes. |
|
|
Term
| Like charges repel ______ charges. Unlike charges _____. |
|
Definition
|
|
Term
| positive ions move towards the negative pole (______) & negative ions move towards the postive pole (______). |
|
Definition
|
|
Term
| When positive ions move toward the negative pole, an _______ reaction occurs. |
|
Definition
|
|
Term
| When negative ions move towards the positive pole, an ______ reaction occurs (HCl). |
|
Definition
|
|
Term
| The number of ions transferred through the skin is directly related to what three things? |
|
Definition
duration of the treatment
current density
concentration of the ions in the solution |
|
|
Term
| List the major parameters of iontophoresis. |
|
Definition
direct current
max intensity of 4-5 mA |
|
|
Term
| The active electrode for iontophoresis should have (different/the same) polarity as the medicinal ion. |
|
Definition
|
|
Term
| To reduce the alkaline effect on the skin, the _____ should be twice as large as the _____, regardless of which is the active electrode. |
|
Definition
negative electrode (cathode)
positive electrode (anode) |
|
|
Term
| Dosage is a product of ____ & _____. What is the safe limit for the active electrode? |
|
Definition
time & current intensity
safe limit for active electrode: anode, 1 mA/cm^2, cathode, .5 mA/cm^2 - Duration is 10-40 minutes |
|
|
Term
| List four common negative polarity ions. |
|
Definition
| Dexamethasone, Acetate, Salicylate, Water, (can be positive or negative) & iodine |
|
|
Term
| Describe the gate theory of pain modulation. |
|
Definition
Large-diameter A-beta fibers activate inhibitory interneurons (substantia gelatinosa) located in the dorsal horn of the spinal cord, producing inhibition of smaller A delta & C fibers
presynaptic inhibition of the T cells "closes the gate" & modulates pain - the gating mechanism also includes release of enkephalins which combine with opiate receptors to depress release of substance P from the A-delta & C fibers |
|
|
Term
| Describe pain modulation through descending pathways, generating endogenous opiates. |
|
Definition
noxious stimuli generate endorphin production from the pituitary gland & other CNS areas
endogenous opiate rich nuclei, PAG in midbrain & thalamus are also activated by strong stimuli
NT from PAG facilitate the cells of teh nucleus raphe magnus (NRM) & reticularis gigantocellularis (RGC)
efferents from these nuclei travel through the dorsal lateral funiculus to terminate on the enkephalinergic interneurons in teh pinal cord to presynaptically inhibit the release of substance P from the A-delta & C-fibers |
|
|
Term
| Describe basic characteristics of TENS. |
|
Definition
typically asymmetrical biphasic with a zero net direct current component
continuous or burst |
|
|
Term
| Which is the most common mode of TENS? |
|
Definition
| conventional (high-rate) TENS |
|
|
Term
| When is conventional high rate TENS used? |
|
Definition
| during acute or chronic phase of pain |
|
|
Term
| With high-rate conventional TENS, onset of pain relief is relatively ____ & duration of relief is relatively ______. |
|
Definition
|
|
Term
| List the parameters for high-rate TENS. |
|
Definition
amplitude: comfortable tingling sensation, paresthesia - no muscle response
pulse rate: 50-80 pps (high)
pulse duration: 50-100 microseconds (very low)
low intensity
mode: continuous
duration of treatment: 20-60 minutes duration |
|
|
Term
| Acupuncture-like (________) TENS can be applied during the _______ phase of pain. Onset of pain relief may last _______. Duration of relief may be ______. |
|
Definition
strong low rate
chronic
20-40 minutes
long lasting - 1 hr |
|
|
Term
| Conventional (high-rate) TENS utilizes which pain theory? |
|
Definition
|
|
Term
| Acupuncture like (strong low rate) TENS utilizes which pain theory? |
|
Definition
|
|
Term
| List the parameters for Strong low rate TENS. |
|
Definition
Amplitude: strong, but comfortable rhythmic muscle twitches
pulse rate: 1-5 pps (low)
pulse duration: 150-300 microseconds (high)
high intensity
mode: continuous duration of treatment: 30-40 minutes
|
|
|
Term
| List the purposes for using brief intense TENS. |
|
Definition
| provides rapid onset, short-term pain relief during painful procedures (wound debridement, deep friction massage, joint mobilization, or passive stretching |
|
|
Term
| List the parameters for brief intense TENS. |
|
Definition
Amplitude: to patient's tolerance
Pulse rate: 80-150 pps (high)
Pulse duration: 50-250 microseconds (long)
mode: continuous
Duration of treatment: 15 minutes
Duration of pain relief: temporary (30-60 minutes) |
|
|
Term
| List the purpose of Burst mode TENS. |
|
Definition
| combines characteristics of both high & low rate tens - stimulates endogenous opiates, but current is more tolerable than low-rate TENS |
|
|
Term
| List the parameters for burst mode TENS. |
|
Definition
Amplitude: comfortable, intermittent paresthesia Pulse rate: 50-100 pps delivered in packets or bursts of 1-4 pps. (high)
Pulse duration: 50-200 microseconds (high)
Mode: continuous
Duration of treatment: 20-30 minutes
Duration of pain relief: long-lasting (hours) |
|
|
Term
| List the purpose of Hyperstimulation TENS. |
|
Definition
| use a small probe to locate & noxiously stimulate acupuncture or trigger points - multiple sites may be stimulated per treatment |
|
|
Term
| List the parameters for Hyperstimulation TENS. |
|
Definition
Amplitude: strong, to patient tolerance
Pulse rate: 1-5 pps
Pulse duration: 150-300 microseconds
Duration of treatment: 15-30 second increments
Duration of pain relief: long-lasting |
|
|
Term
| Passage of HVPC ______ skin resistance caused by current flowing toward the skin capacitors (little energy loss) rather than the skin resistors) |
|
Definition
|
|
Term
| Describe the wound healing concept for e-stim. |
|
Definition
intact skin surface negative with respect to deeper epidermal layers
injury to skin develops positive potentials initially & negative potentials during the healing process
absent or insufficient positive potentials retard tissue regeneration
addition of positive potentials, initially through the anode, may promote or accelerate healing. |
|
|
Term
| List the parameters for HVPC. |
|
Definition
amplitude: comfortable tingling sensation, paresthesia, no muscle response
pulse rate: 50-200 pps
pulse duration: 20-100 microseconds
mode: continuous
duration: 20-60 minutes |
|
|
Term
| With HVPC, for a bacteriocidal effect, the active electrode should have a ______ polarity. For a culture-free wound, the active electrode should be ______. |
|
Definition
|
|
Term
| List the values for low frequency, medium frequency, & high frequency ES. |
|
Definition
low: 1-1,000 pps
medium: 1,000-10,000 pps
high: >10,000 |
|
|
Term
| Describe Russian current. |
|
Definition
| A 2500 Hz sine wave is interrupted for 10 msec at 10 msec intervals - produces 50 10 millisecond bursts per second - produces time-modulated current or burst alternating current |
|
|
Term
| Describe the general characteristics of Russian current. |
|
Definition
polyphasic sinusoidal burst
time modulated to create a pulsatile burst current |
|
|
Term
| List the parameters for Russian ES. |
|
Definition
| Amplitude: tetanic muscle contraction pulse rate: 50-70 pps pulse duration: 150-200/sec or a 50% duty cycle mode: interrupted - ramp 1-5 seconds based on pt. tolerance duty cycle 1:5 |
|
|
Term
| List three conditions where Russian current would be used. |
|
Definition
isometric exercise at several points through the ROM.
slow isokinetic exercise; ex. 5-10 deg./sec
short arc joint movement when ROM is restricted |
|
|
Term
| If muscle pumping is the goal for Russian ES, the duty cycle is ____. For ROM, duty cycle is _____. |
|
Definition
|
|
Term
| Differentiate between constructive & destructive interference. |
|
Definition
when the two waves are in phase, the sum of the superimposed wave is large
destructive: the sum of the two waves is zero when the waves are 180 degrees out of phase |
|
|
Term
|
Definition
| resultant frequency produced by the two frequencies going into & out of phase |
|
|
Term
| When does premodulated IFC occur? |
|
Definition
when two carrier frequencies are crossed in the ES unit
- use 2 electrodes because the 2 med. frequency currents are added inside the machine to produce low frequency output - more sensory stimulation - could be more unpleasant
ideal for small areas that would be amply covered with two electrodes |
|
|
Term
| Describe the parameters for IFC. |
|
Definition
polyphasic, sinusoidal
amplitude modulated continuous (pain)
amplitude modulated interrupted (muscle exercise)
pain protocol similar to high or low rate tens
muscle strengthening - similar to medium frequency ES |
|
|
Term
| FES is also known as _____. |
|
Definition
|
|
Term
| List the parameters for FES of the SHLDR after CVA. |
|
Definition
asymmetrical biphasic square
interrupted pulsed current
bipolar - electrodes on supraspinatus & post. delt.
amplitude: tetanic muscle contraction to pt. tolerance
rate: 12-25 pps
duration of tx: 15-30 minutes - 3x daily up to 6-7 hours - on/off ratio: 1:3 progressing to 12:1 (2-6 sec - 24 sec-2 sec) |
|
|
Term
| List the parameters for DF assist FES. |
|
Definition
asymmetric biphasic square
pulse duration: 20-250 microseconds
mode: interrupted by foot switch
bipolar - peroneal nerve (fibular head) or ant. tib
amplitude: tetanic muscle contraction sufficient to decrease plantar flexion
pulse rate: 30-300 pps |
|
|
Term
| Describe EMG biofeedback. |
|
Definition
| an electronic instrument used to measure motor unit action potentials (MUAP) that are generated by active muscles |
|
|
Term
|
Definition
| functional unit of the neuromuscular system that consists of the anterior horn cell, its axon, the NMJ, & all of the muscle fibers innervated by the axon. (MUP) are measured in microvolts - the signals generated by the MUP, which contain both positive & negative phases, are called compound action potentials, because the sensors pick up signals from multiple motor units |
|
|
Term
| The signal with EMG biofeedback is processed through ______, ______, & ________. |
|
Definition
| amplification, rectification (positive & negative components of the signal are made unidirectional), & integration (are under the curve is computed) |
|
|
Term
| The ______ signal provides readings in microvolt seconds & is displayed as the EMG biofeedback signal. |
|
Definition
|
|
Term
| List the purpose, advantages & disadvantages of using surface electrodes for EMG. |
|
Definition
global detection - signals from more than one muscle
detection: from mostly superficial muscles
advantages: easy to apply, acceptable to patient/client
disadvantages: detection from mostly superficial muscles and frequently from more than one muscle group |
|
|
Term
| List the purpose, advantages, & disadvantages of using needle electrodes. |
|
Definition
local detection: signals from a specific muscle or muscle group
detection of deep muscles
Used for EMG diagnosis or research - rarely used for EMG biofeedback
Advantages: detection of specific muscles
Disadvantages: requires skill to apply, less acceptable to patient/client |
|
|
Term
| The bipolar technique for EMG biofeedback minimizes _________. |
|
Definition
| extraneous electrical activity |
|
|
Term
| Generally, active electrodes for EMG are placed ____ cm apart & are _____ to muscle fibers. |
|
Definition
|
|
Term
| Active electrodes are placed close together to minimize ______. |
|
Definition
|
|
Term
| List the parameters for EMG biofeedback to increase muscle activity. |
|
Definition
for weak muscles, start with electrodes widely spaced & biofeedback instrument sensitivity high to increase detection
- for single weak muscle, begin with electrodes close together if a more precise signal is desired
-instruct patient to try to contract muscle isometrically for 6-10 seconds to produce an audiovisual signal
- as patient's motor recruitment ability improves, decrease the sensitivity, making it more difficult to produce an audiovisual signal
-use facilitation techniques (tapping, cross facilitation, vibration) to encourage motor unit recruitment) if necessary
-progress from simple to more complex/functional movements as patient gains motor control
-treatment sessions from 5-10 minutes to >30 min. depending on pt. tolerance |
|
|
Term
| List the parameters for EMG biofeedback to decrease muscle activity. |
|
Definition
begin with electrodes closely spaced & biofeedback instrument sensitivity low to minimize crosstalk
-instruct patient to relax, using deep-breathing or visual imagery, to try & lower the audiovisual signal
-progress from low to high sensitivity as patient gains ability to relax muscle & performs functional activities
-treatment sessions may be from 5-10 minutes to >30 minutes depending on patient tolerance |
|
|
Term
| What muscle activity is occurring at initial contact/heel strike? |
|
Definition
| quadriceps are contracting eccentrically to control knee flexion, ankle dorsiflexors are eccentrically contracting to decelerate the foot, hanstrings are active as hip extensors, hip extensors are active in preparation for loading response |
|
|
Term
| What muscle activity is occurring during foot flat/LR? |
|
Definition
pre-tibial muscles contract eccentrically to meet torque demands
quads contract eccentrically
glut max, adductors, & hamstrings are active to counteract flexion torque
TFL, glut med, glut min, & glut max contract to stabilize pelvis in frontal plane |
|
|
Term
| LR is the first period of ______. |
|
Definition
|
|
Term
| The contralateral limb leaves the ground when the stance leg is in _____. |
|
Definition
|
|
Term
| Describe the muscle activity during midstance. |
|
Definition
| soleus & gastroc fire to control tibial advancement eccentrically, quads are active until extension torque begins, hip abductors stabilize pelvis in SLS. |
|
|
Term
| Describe muscle activation patters for heel off/terminal stance. |
|
Definition
| concentric plantarflexion contraction |
|
|
Term
| Describe muscle activation patterns for preswing/toe off. |
|
Definition
| iliopsoas contracting concentrically - no knee flexor activity, femur falls forward by momentum, adductor longus, & rectus femoris, max plantarflexor torque |
|
|
Term
| Preswing/toe off is the second period of _______. |
|
Definition
|
|
Term
| List muscle activation patterns for acceleration/IS. |
|
Definition
| concentric iliopsoas, hamstrings, dorsiflexors opposite limb glut med. contracts to stabilize stance pelvis - iliacus, sartorius, adductor longus all active |
|
|
Term
| List muscle activation patterns for midswing. |
|
Definition
| hip flexors, knee flexors, dorsiflexors all contracting concentrically. |
|
|
Term
| List the muscle activation patterns for deceleration/terminal swing phase. |
|
Definition
| concentric glut max contraction to control hip flexion eccentric hamstrings contraction to control knee extension, quads contracting concentrically, & dorsiflexors contracting isometrically. |
|
|
Term
| Mean forward rotation with the swing limb is ____. WB extremity rotates _____ deg., totaling ____ deg. of ant.-post. pelvic rotation. |
|
Definition
|
|
Term
| The pelvis moves up & down ___ deg. on the unsupported side. The highest point is at ______ & the lowest point is during the period of _______. |
|
Definition
| 5, midstance, double support |
|
|
Term
| The pelvis moves laterally during gait approximately ____ cm, follows the stance or support limb. |
|
Definition
|
|
Term
| Mean cadence is _____ steps/min. |
|
Definition
|
|
Term
| Running occurs typically at a cadence of ____ steps/min. |
|
Definition
|
|
Term
| Normal step width ranges between ____ & ____ cm (or ___-___ in.) |
|
Definition
|
|
Term
|
Definition
| the linear distance between two consecutive contact points of the same extremity |
|
|
Term
| Average walking speed is ____ m/min. or ____ mph. |
|
Definition
|
|
Term
| The average oxygen rate for comfortable walking is ______. |
|
Definition
|
|
Term
| the metabolic cost of walking averages _____ kcal/min. on surfaces. |
|
Definition
|
|
Term
| Lateral trunk bending is the result of the _____ gluteus medius. |
|
Definition
|
|
Term
| Backward trunk lean is the result of weak _____. |
|
Definition
|
|
Term
| forward trunk lean is the result of ____ or _______. |
|
Definition
| weak quadriceps, hip & knee flexion contractures |
|
|
Term
| Excessive hip flexion occurs because of ____ or ____. |
|
Definition
| weak hip extensors or tight hip/knee flexors |
|
|
Term
| Limited hip extension occurs because of _______. |
|
Definition
| spastic/tight hip flexors |
|
|
Term
| Limited hip flexion occurs because of ______ or _____. |
|
Definition
| weak hip flexors or spastic/tight hip extensors |
|
|
Term
| List an abnormal synergistic gait pattern associated with stroke. |
|
Definition
| hip adduction combined with hip & knee extension & plantarflexion, scissoring or adducted gait |
|
|
Term
| WIth an antalgic gait, stance time is decreased on the _____ limb and step length is decreased on the ______ limb. |
|
Definition
|
|
Term
| Excessive knee flexion is the result of ______ or ______. |
|
Definition
| weak quadriceps or knee flexion contracture |
|
|
Term
| Knee hyperextension is the result of ______, _____, or _______. |
|
Definition
| weak quadriceps, plantarflexion contracture, extensor spasticity (quadriceps or plantarflexors) |
|
|
Term
| Toe first gait occurs because of ______, ______, ______, _____. |
|
Definition
| spastic plantarflexors, weak dorsiflexors, shortened leg, painful heel |
|
|
Term
| Foot slap occurs because of ______. |
|
Definition
|
|
Term
| Foot flat gait occurs because of _____ or _____. |
|
Definition
| weak dorsiflexors or limited ROM |
|
|
Term
| Excessive dorsiflexion occurs with _______. |
|
Definition
|
|
Term
| Excessive plantarflexion occurs with _____. |
|
Definition
| spasticity or contraction of the plantarflexors |
|
|
Term
| Define supination & causes. |
|
Definition
| wb-ing on the lateral foot with a varus position of the calcaneus - could be d/t spastic inverters, weak evertors, pes varus, genu varum |
|
|
Term
| Define pronation & causes. |
|
Definition
| excessive wb-ing on medial foot, calcaneal valgus - caused by weak invertors, spasticity, pes valgus, genu valgum |
|
|
Term
| Claw toes is the result of ______. |
|
Definition
|
|
Term
| Inadequate push off is due to ______, ______ or ______. |
|
Definition
| weak plantarflexors, decreased ROM, or pain in the forefoot. |
|
|
Term
| Insufficient forward rotation is due to _____, _____, or ______. |
|
Definition
| stiff pelvis, weak abdominals, or weak hip flexors |
|
|
Term
| Insufficient hip & knee flexion is the result of ______. |
|
Definition
|
|
Term
| Circumduction is the result of ______. |
|
Definition
|
|
Term
| Hip hiking is a compensatory response for ______ or _____. |
|
Definition
| weak hip & knee flexors or extensor spasticity |
|
|
Term
| Excessive hip & knee flexion is due to ________. |
|
Definition
|
|
Term
| Insufficient knee flexion during gait is a result of _______, ______, or ______. |
|
Definition
| tight quadriceps/extensor spasticity, pain/decreased ROM, or weak hamstrings |
|
|
Term
| Excessive knee flexion is due to ___________. |
|
Definition
|
|
Term
| Varus or inverted foot is the result of ________, or ______. |
|
Definition
| spastic invertors or weak evertors |
|
|
Term
| Equinovarus is a result of ______. |
|
Definition
| spasticity in the posterior tib & gastroc/soleus - developmental abnormality |
|
|
Term
| Canes can unload forces in the involved extremity by _____. |
|
Definition
|
|
Term
| Canes, Crutches and walkers should all have approximately ____-____ elbow flexion. |
|
Definition
|
|
Term
| Measure a cane from ______ to ______. |
|
Definition
| greater trochanter to the side of the toes. |
|
|
Term
| Which type of cane is not useful for stairs? |
|
Definition
|
|
Term
| How should crutches be fit? |
|
Definition
| Standing: subtract 16 in. from patient's height or measure from 2 in. below axilla to a point 6 inches in front & 2 inches lateral to foot. Supine: axilla to 6-8 in. lateral to heel Forearm crutches - crutch should cover proximal 1/3 of forearm, 1-1&1/2 in. below the elbow |
|
|
Term
| List negative features of a walker. |
|
Definition
no reciprocal arm swing
increased flexor posture |
|
|
Term
|
Definition
| one crutch & opposite extremity move together, followed by opposite crutch & extremity - requires use of 2 AD's - canes or crutches - allows for natural arm & leg motion during gait |
|
|
Term
| Describe three-point gait. |
|
Definition
| both crutches & involved leg are advance together, then ininvolved leg is advanced forward; requires two AD's. or a walker |
|
|
Term
|
Definition
| a slow gait pattern in which one crutch is advanced forward & placed on the floor, followed by advancement of the opposite leg, then the remaining crutch is advanced forward followed by the opposite remaining leg - requires 2 AD's |
|
|
Term
| With ascent of steps, should the AD go up first or last? |
|
Definition
|
|
Term
| With descent of steps, should the AD go first or last? |
|
Definition
|
|
Term
| Describe guarding for level surfaces, stairs, & sit-stand transfers. |
|
Definition
level surfaces - behind & to the side - involved side
stairs: ascent - behind & slightly to involved side
descent - in front & slightly to the involved side
sit-stand - side & behind - in front for increased assistance |
|
|
Term
| Define the three point pressure principle. |
|
Definition
| forms the mechanical basis for orthotic correction; a single force is placed at the area of deformity or angulation; two additional counterforces act in the opposing direction |
|
|
Term
| body weight support (BWS) > ____ is contraindicated as it interferes with the gait cycle. |
|
Definition
|
|
Term
|
Definition
| has vamps (the flaps contain the lace stays) - open wide apart from the anterior margin of the shoe for ease of application. |
|
|
Term
| Describe a Bal (Balmoral) opening for an orthotic. |
|
Definition
| has stitched down vamps - not suitable for orthotic wear |
|
|
Term
| Describe the purpose of a metatarsal pad. |
|
Definition
| unloads met heads & disperses pressure to shafts - allows more push off in weak or inflexible feet. |
|
|
Term
| What is the purpose of a cushion heel? |
|
Definition
| unload heel to relieve strain on plantar fascia in plantar fascitis |
|
|
Term
| Describe the purpose of longitudinal arch supports and list three kinds. |
|
Definition
prevent depression of the STJ & correct for pes planus
UCBL insert (University of California Biomechanics Laboratory) - semirigid plastic molded insert for flexible pes planus
scaphoid pad - supports longitudinal arch
Thomas heel: heel wedge with extended anterior medial border used to support longitudinal arch & correct for flexible pes valgus (pronated foot) |
|
|
Term
| Describe rearfoot & forefoot posting used for orthotics. |
|
Definition
varus post - limits or controls eversion of the calcaneus & internal rotation of the tibia after heelstrike - reduces calcaneal eversion during running
valgus post - lateral wedge - controls excessively inverted & supinated at heel strike
medial wedge prescribed for forefoot varus
lateral wedge prescribed for forefoot valgus |
|
|
Term
|
Definition
| located proximal to metatarsal heads; improves weight shift onto metatarsals |
|
|
Term
| Rocker bottom improves ______. |
|
Definition
|
|
Term
| What does a free motion AFO do? |
|
Definition
| allows free motion of DF/PF - provides m-l stability |
|
|
Term
| What does a solid ankle AFO do? |
|
Definition
| restricts motions in all planes - allows no movement |
|
|
Term
| What does a Bichannel adjustable ankle lock (BiCAAL) do? |
|
Definition
| ankle joint with the anterior & posterior channels that can be fit with pins to reduce motion or springs to assist motion |
|
|
Term
| What does a DF stop AFO do? |
|
Definition
| limits DF to 5 deg. - causes knee flexion - too much DF can lead to knee buckling - used to control for knee hyperextension |
|
|
Term
| What does a PF stop AFO do? |
|
Definition
| limits PF to control knee buckling - if allows too much PF, knee hyperextension could result |
|
|
Term
| What does a spring assist (Klenzak housing) AFO do? |
|
Definition
| single anterior channel for spring assist to aid DF |
|
|
Term
| What does a posterior leaf spring AFO do? |
|
Definition
prevents foot drop
has a flexible, narrow, posterior shell - DF assist - can be modified to have a wider posterior shell for more m-l support |
|
|
Term
| How are varus or valgus correction straps used? |
|
Definition
(T straps) - control for varus/valgus forces at the ankle.
valgus correction strap is attached to the medial portion of the shoe, exerting a lateral force to restrain pronation
varus correction strap attaches on the lateral side of the shoe and exerts a medial force to restrain supination |
|
|
Term
| If a patient's condition is changing, which AFO's are better? |
|
Definition
| conventional metal - easier to alter to accomodate changes than molded AFO's |
|
|
Term
| What is the purpose of a spiral AFO? |
|
Definition
| a molded plastic AFO that wraps around calf - provides limited control of motion in all planes |
|
|
Term
| What is a patellar-tendon-bearing brim AFO? |
|
Definition
| allows for weight distribution on the patellar shelf similar to patellar tendon bearing prosthetic sockets - reduces weight bearing forces through the foot |
|
|
Term
| WHat is a tone-reducing orthosis? |
|
Definition
| modled plastic AFO that gives constant pressure to spastic or hypertonic muscles (PF & invertors); snug fit is essential to achieve the benefits of reiprocal inhibition |
|
|
Term
|
Definition
| a distal attachment added to keep the foot off the floor - provides 100% unweighting of the limb - a lift is required on the opposite leg - used with Legg-Calve-Perthes disease. |
|
|
Term
| Describe Craig-Scott KAFO. |
|
Definition
| used for people with paraplegia (T9-12) - shoe attachments with reinforced foot plates, BiCAAL ankle joints set in slight dorsiflexion, pretibial band, pawl knee locks with bail release, & single thigh band |
|
|
Term
| Describe the Oregon orthotic system. |
|
Definition
| a combination of plastic & metal components allows for triplanar control in three planes of motion - sagittal, frontal, & transverse |
|
|
Term
| Describe a swedish knee cage. |
|
Definition
| provides mild control for excessive hyperextension of the knee |
|
|
Term
|
Definition
| control abduction, adduction, & rotation. when locked, control for hip flexion - limited to swing to or swing through gait pattern |
|
|
Term
| With Reciprocating gait orthoses (RGO's), when the patient leans on the supporting hip, it forces it into _____, while the opposite leg is pushed into _____. |
|
Definition
|
|
Term
| What is a Dennis-Browne splint? |
|
Definition
| a bar between two shoes that allows swiveling - used to correct clubfoot or pes equinovarus in children. |
|
|
Term
| What are Frejka pillows & Toronto hip abduction orthoses? |
|
Definition
keep hip abducted
Frejka pillow is used for hip dysplasia
Toronto hip ABD orthosis used for tx of Legg-Calve-Perthes disease |
|
|
Term
|
Definition
| limits flexion, but encourages hyperextension - used for compression fractures of the spine. |
|
|
Term
| Describe a four-poster orthosis. |
|
Definition
| has two plates - occipital & thoracic - with two anterior & two posterior posts to stabilize the head - used for moderate levels of control in individuals with cervical fracture/spinal cord injury. |
|
|
Term
| Describe a Milwaukee & Boston orthosis & what they are used for. |
|
Definition
| Milwaukee - CTLSO - used for scoliosis - has a molded plastic pelvic jacked & one anterior & two posterior uprights extended to a superior neck or chest ring. - used for all kyphotic & scoliotic curves <40 deg. Boston - TLSO - used for scoliosis - more cosmetic, can be worn under clothing - used for midthoracic & lower scoliosis curves of <40 deg. - also for spondylolisthesis & conditions of severe trunk weakness (ie muscular dystrophy) |
|
|
Term
| What diagnoses are cock-up splints used for? |
|
Definition
| RA, fractures of carpal bones, Colles' fracture, CTS, stroke with paralysis |
|
|
Term
| Describe an airplane splint. |
|
Definition
| position's patient arm in 90 deg. ABD & 90 deg. elbow flex - weight of outstretched arm is on padded lateral trunk bar & iliac crest band - strap holds device across trunk - immobilizes shoulder following fracture or injury when strapping to the chest is not desirable, or with burns |
|
|
Term
| What are wrist-driven prehension orthoses used for? |
|
Definition
gives wrist extension to utilize tenodesis grasp in patients with quadriplegia or weak grip
assists the patient in using wrist extensors to approximate the thumb & forefingers in the absence of finger flexion - usually C6 |
|
|
Term
What causes lateral trunk bending with orthotics?
(shoe lift height) |
|
Definition
| KAFO medial upright too high, insufficient shoe lift, hip pain, weak or tight abductors on the orthotic side, short leg, poor balance |
|
|
Term
| What causes circumducted gait with orthotics? |
|
Definition
| locked knee, excessive plantar flexion, weak hip flexors or dorsiflexors |
|
|
Term
What causes anterior trunk bending with orthotics?
(contracture, weakness, knee locked/inadequate knee lock) |
|
Definition
| weak quadriceps, inadequate knee lock, hip or knee flexion contracture |
|
|
Term
What causes posterior trunk bending with orthotics?
(hip lock - too strong/inadequate) |
|
Definition
| weak glut max, inadequate hip lock, knee anklyosis |
|
|
Term
| What causes Hyperextended knee with orthotics? |
|
Definition
| inadequate plantar flexion stop, inadequate knee lock, poor fit of calf band, weak quads, loose knee ligaments, extensor spasticity, pes equinus |
|
|
Term
| What causes knee instability with orthotics? |
|
Definition
| excessive knee flexion during stance, inadequate dorsiflexion stop, inadequate knee lock, knee & hip flexion contracture, weak quads or insufficient knee lock, knee pain |
|
|
Term
| What causes foot slap in orthotics? |
|
Definition
| inadequate dorsiflexor assist, inadequate plantarflexor stop, weak dorsiflexors |
|
|
Term
What causes toes first gait with orthotics?
(heel lift, leg length, spasticity) |
|
Definition
| inadequate dorsiflexor assist, inadequate plantarflexor stop, inadequate heel lift, heel pain, extensor spasticity, pes equinus, short leg |
|
|
Term
| What causes flat foot contact with orthotics? |
|
Definition
| inadequate longitudinal arch support, pes planus |
|
|
Term
| What causes excessive pronation with orthotics? |
|
Definition
| transverse plane malalignment, weak invertors, pes valgus, spasticity, genu valgum |
|
|
Term
What causes excessive supination with orthotics?
(weakness, plane malalignment) |
|
Definition
| weak evertors, transverse plane malalignment, pes varus, genu varum |
|
|
Term
What causes excessive stance width with orthotics?
(HKAFO medial upright & HKAFO alignment, sound limb length) |
|
Definition
| KAFO height of medial upright too high, HKAFO hip joint aligned in excessive abduction, knee is locked, ABD contracture, poor balance, sound limb is too short |
|
|
Term
|
Definition
| a skin adherent that increases adhesion of tape and aids in toughening the skin to reduce irritation |
|
|
Term
| What is a Syme's amputation? |
|
Definition
| amputation through the ankle joint - heel pad is preserved & attached to the distal end of the tibia for wb-ing |
|
|
Term
| List long, standard, & short BKA & AKA. |
|
Definition
BKA
short: <20% spared
standard = 20-50%
long: >50%
AKA
short: <35% spared
standard: 36-60%
long: >60% |
|
|
Term
|
Definition
| amputation of both lower limbs & pelvis below L4, L5 |
|
|
Term
| Socks are used in every suspension system for prosthetics except ______. |
|
Definition
|
|
Term
|
Definition
solid ankle cushion heel foot. - most commonly prescribed, contains energy absorbing cushion heel & internal wooden keel that limits sagittal plane motion , primarily PF
assists in hyperextension (knee stability) during stance |
|
|
Term
|
Definition
| solid ankle flexible foot - non-articulated foot similar to SACH, permits more non-sagittal plane motions - for more active individuals |
|
|
Term
| What kind of foot might be prescribed for B transfemoral amputees? |
|
Definition
| a single axis foot - limit dorsiflexion & plantarflexion - more stable |
|
|
Term
| Does endoskeletal or exoskeletal allow for increased ease of adjustment? |
|
Definition
|
|
Term
| Which suspension system is best for a patient with m-l instability, short residual limbs, or individuals with sensitive skin on the residual limb? |
|
Definition
m-l - supracondylar socket suspension
short residual limb - supracondylar/suprapatellar (SC/SP) - an SC with a high anterior wall thigh corset - larger surface area for wb-ing - good for sensitive skin - could cause pistoning |
|
|
Term
| Who usually benefits from constant friction knee units? |
|
Definition
| older individuals who don't vary their gait speeds greatly |
|
|
Term
| knee stabilization in extension is achieved how? |
|
Definition
| the knee center is aligned posterior to the TKA line - a knee aligned further posterior will be very stable (won't flex easily) - could be prescribed for short residual limbs - an unstable knee may occur if the knee falls anterior to the TKA line |
|
|
Term
| What does a friction brake do? |
|
Definition
| increases friction at midstance to prevent knee flexion, but permits smooth knee motion through the rest of the gait cycle |
|
|
Term
| What is an extension aid? |
|
Definition
| external elastic strap or internal coiled spring that assists in terminal knee extension during late swing |
|
|
Term
| Describe major features of a quadrilateral socket. |
|
Definition
medial wall is same height as posterior wall - anterior & lateral walls are 2.5-3 in. higher
has Scarpa's bulge - an area built up on the anterior wall to distribute forces throughout the femoral triangle
reliefs are provided for adductor longus tendon, HS tendons, sciatic nerve, glut max, & rectus femoris |
|
|
Term
| What kind of suspension can reduce Trendenlenberg gait deviations & adds m-l stability? What is a disadvantage? |
|
Definition
hinge suspension - hinged hip joint attached to a metal/leather pelvic band anchored around the pelvis
adds extra weight |
|
|
Term
| in UE prostheses, what motions are used to open the hand/hook? How do you lock the elbow? |
|
Definition
scapular ABD or ipsilateral flexion of humerus
scapular depression & humeral extension |
|
|
Term
| The _______ the amputation limb, the greater the energy demands. |
|
Definition
|
|
Term
|
Definition
| abnormal growth of nerve cells that occurs in the residual limb after amputation |
|
|
Term
| When using ace-wraps for residual limb size managment, the wrap must be in what fashion? |
|
Definition
| distal to proximal - avoid circular wrapping - produces tourniquet effect |
|
|
Term
| Which types of dressings allow for early ambulation? |
|
Definition
|
|
Term
| List positioning to avoid after a transtibial amputation. |
|
Definition
| hip ABD, flex, ER, & knee flexion |
|
|
Term
| List positioning to avoid after a transfemoral amputation. |
|
Definition
|
|
Term
| What kind of positioning is important after amputation? |
|
Definition
| prone positioning to avoid hip & knee flexion contractures. |
|
|
Term
|
Definition
| bilateral transfemoral amputatees can be fitted with a socket & foot component (no knee) - increases ease of use & function - generally poor acceptance d/t cosmesis |
|
|
Term
What causes circumduction in transfemoral prosthetics?
(socket too loose/too tight, suspension) |
|
Definition
| prosthesis too long, knee locked, small or loose socket, inadequate suspension, foot plantar flexed, ABD contracture, poor knee control |
|
|
Term
| What causes ABD gait with transfemoral amputations? |
|
Definition
| prosthesis is laterally displaced, ABD contracture, low lateral wall or crotch or medial wall discomfort |
|
|
Term
| What causes vaulting with transfemoral amputations? |
|
Definition
| prosthesis too long, inadequate suspension, socket too small, prosthetic foot PF, too little knee flexion |
|
|
Term
| What causes lateral trunk bending with transfemoral amputations? |
|
Definition
| medial wall too high, lateral wall too short (of socket), weak hip ABD, hip pain, short prosthesis, ABD contracture |
|
|
Term
| What causes forward flexion during stance with transfemoral amputations? |
|
Definition
| low AD, unstable knee unit, hip flexion contracture |
|
|
Term
What causes lumbar lordosis during stance with transfemoral amputations?
(insufficient support from which walls of socket?) |
|
Definition
| insufficient support from anterior or posterior walls, painful ischial wb-ing, hip flexion contracture, weak hip extensors or abdominals |
|
|
Term
| What causes high heel rise during early swing with transfemoral amputations? |
|
Definition
| insufficient friction, too little tension in extension aid |
|
|
Term
| What causes terminal swing impact with transfemoral amputations? |
|
Definition
| insufficient knee friction, too much tension in extension aid, forceful knee flexion secondary to worrying the knee will buckle. |
|
|
Term
What causes swing phase whips with transfemoral amputations?
(knee bolt, foot, socket) |
|
Definition
| rotated socket, malaligned foot, knee bolt is rotated |
|
|
Term
What causes foot rotation at heel strike with transfemoral amputations?
(problem with foot, heel cusion, plantar flexion bumper) |
|
Definition
| malaligned foot, stiff heel cushion or plantar flexion bumper |
|
|
Term
| What causes foot slap with transfemoral amputations? |
|
Definition
| heel cushion or plantar flexion bumper is too soft |
|
|
Term
| What causes uneven step length with transfemoral amputations? |
|
Definition
| socket discomfort, poor socket alignment, hip flexion contracture, hip instability |
|
|
Term
What causes excessive knee flexion during stance with transtibial amputations?
(heel of shoe) |
|
Definition
| socket too far forward or tiletd anteriorly, plantar flexion bumper is too hard, high heel shoe, knee flexion contracture or weak quadriceps |
|
|
Term
| What causes inadequate knee flexion during stance with transtibial amputations? |
|
Definition
| plantar flexion bumper too soft, socket aligned too posterior, low heeled shoe, anterodistal discomfort, weak quads |
|
|
Term
| What causes lateral thrust at midstance with transtibial amputations? |
|
Definition
|
|
Term
| What causes medial thrust at midstance with transtibial amputations? |
|
Definition
|
|
Term
What causes a dropoff or premature knee flexion in late stance with transtibial amputations?
(prosthetic foot keel too short/long?) |
|
Definition
| socket too far anterior, dorsiflexion bumper is too soft, prosthetic foot keel is too short, flexion contracture at knee |
|
|
Term
What causes delayed knee flexion during late stance with transtibial amputations?
(length of prosthetic foot keel) |
|
Definition
| socket too far posterior, DF bumper is too stiff, prosthetic foot keel is too long |
|
|
Term
| What does it mean to say a dorsiflexion bumper is too stiff or too soft? |
|
Definition
too stiff - doesn't allow DF - allows excessive PF
too soft - allows excess DF - can cause knee to buckle |
|
|
Term
| What does it mean to say a PF bumper is too stiff or too soft? |
|
Definition
too stiff - allows excess DF without PF
too soft - allows too much PF - can lead to foot slap, genu recurvatum |
|
|
Term
| For a patient who is w/c bound, pressure relief pushups should be performed every ______ minutes. |
|
Definition
|
|
Term
| What is a hill-holder device? |
|
Definition
| a mechanical brake that allows the chair to go forward but not backwards - gives patients breaks on hills |
|
|
Term
| Describe a hemiplegic chair. |
|
Definition
| a chair that is designed to be low to the ground, allowing propulsion with the noninvolved upper and lower extremities |
|
|
Term
| How is seat width for a w/c determined? |
|
Definition
| measure patient at widest part of hips & add 2 inches |
|
|
Term
| How is seat depth for a w/c measured? |
|
Definition
| posterior buttock to posterior aspect of lower leg in popliteal fossa - subtract 2-3 inches |
|
|
Term
| How is seat-footplate length measured for a w/c? |
|
Definition
| bottom of the shoe to just below the thigh in the popliteal fossa |
|
|
Term
| The patient with complete level _____ can be independent with slide board transfers on level surfaces. |
|
Definition
|
|
Term
| The patient with complete ____ SCI can be independent in transfers without a slide-board. |
|
Definition
|
|
Term
| A kitchen in the home should be no taller than _____ inches & at least _____ in. deep for w/c bound patients. |
|
Definition
|
|
Term
| Differentiate between work conditioning & work hardening. |
|
Definition
work conditioning - provides multihour sessions up to 4 hrs/day, 5 days/wk, for 8 weeks -addresses physical & functional needs provided by one discipline
work hardening - provided in multihour sessions up to 8 hrs/day, 5 days/wk, for 8 weeks - addresses physical, functional, behavioral, vocational needs within a multidisciplinary model |
|
|
Term
| When going from stand to sit, what happens to the lumbar spine & pelvis? |
|
Definition
| posterior rotated pelvis, flattened lumbar spine |
|
|
Term
| Pressures measured with subjects standing were 35% _____ in standing than sitting without support. How is this remedied? |
|
Definition
| lower, use a lumbar support or supported seating surface, tilt the chair backwards to offload lumbar discs, or use armrests |
|
|
Term
| The seat pan of a w/c should provide approximately ____ cm clearance from the popliteal fossa to avoid pressure on the back of the knees |
|
Definition
|
|
Term
| A backwards slope of ____ deg. in a w/c seat pan is suggested for normal upright sitting. |
|
Definition
|
|
Term
| If w/c armrests are properly placed, what should the patient's UE position be? |
|
Definition
| elbows flexed to 90 with neutral shoulder rotation |
|
|
Term
| What does WRMSD stand for? |
|
Definition
| work-related musculoskeletal disorders |
|
|
Term
| T/F. Raynaud's syndrome & CRPS/RSD are considered common upper extremity WRMSD. |
|
Definition
|
|
Term
| Vapocoolant spray is used to reduce ______. How? |
|
Definition
| muscle spasms - desensitizing trigger points. |
|
|
Term
| Lower intentsities & pulsed US are used for ______ or _____. |
|
Definition
| acute conditions or thin tissue |
|
|
Term
| Higher intensities & continuous US may be used for _______ or ______. |
|
Definition
| chronic conditions or thick tissue |
|
|
Term
| What are the physiological effects of US? |
|
Definition
| increased pain threshold, increased nerve conduction velocity, & increased tissue termperatures at tissue interfaces (bone to muscle) |
|
|
Term
| Lumbar traction requires ___-___ lbs to effect change at the spinal segments. |
|
Definition
|
|
Term
| List the proper neck positions for cervical traction treatment of patients to increase intervertebral space of upper four cervical segments, lower 3 cervical segments, & treat disc dysfunction at neck. |
|
Definition
C1-4: 0-5 degrees flexion
C5-7: 20-30 degrees flexion
disc: neutral (0 deg.) |
|
|
Term
| List treatment positions for patients recieving lumbar traction for spinal stenosis & posterior herniated disc. |
|
Definition
spinal stenosis - supine with hips/knees flexed to 90 deg.
posterior disc displacement - prone, no pillow |
|
|
Term
| Some manufacturers of intermittent compression sleeves recommend that the setting never exceed the patient's ______. Others advise the pressure can fall between the ____ & ____ pressures since the pressure is only on for a short period of time. |
|
Definition
|
|
Term
| Intermittent compression must be used at least ___ hours per day. |
|
Definition
|
|
Term
| Why can't a chronaximetry test be performed initially following a nerve injury? |
|
Definition
| takes a severed neuron 7-14 days to degenerate (Wallerian degeneration) - won't give accurate results - tests should be completed AFTER this time |
|
|
Term
| With a chronaximetry test, the lower the number of milliseconds, the _____ the nerve's excitability. |
|
Definition
|
|
Term
| High voltage pulsed monophasic stimulation has minimized chemical, polar, and thermal effects. Why? |
|
Definition
| extremely short pulse duration (width) of the stimulus |
|
|
Term
| In addition to wound healing, high volt pulsed monophasic (direct) current is useful in _______. |
|
Definition
|
|
Term
| T/F. HVPC is tolerated well by patients. |
|
Definition
| False - alternating current is much better tolerated and is used for functional ES or NMES. |
|
|
Term
| What are the indications for HVPC? |
|
Definition
| muscle stimulation/re-education, reduction of pain from TENS-like properties, reduction of edema, & facilitation of wound healing |
|
|
Term
|
Definition
| pain relief & muscle strengthening |
|
|
Term
| With FES, list proper ratios for treatment of a patient with little to no atrophy or weakness, moderate atrophy, & severe atrophy. |
|
Definition
minimal: 1:1 or 1:2
mod: 1:3 or 1:4
severe: 1:5-1:10 |
|
|
Term
| Define nerve conduction velocity. |
|
Definition
| time it takes for a muscle to respond after the peripheral nerve has been stimulated |
|
|
Term
| List upper & lower extremity nerve conduction velocity times. |
|
Definition
UE: 45-70 meters/sec. (60 m/sec avg.)
LE: 50 m/sec avg |
|
|
Term
| NCV is slower in ____ & _____. |
|
Definition
| children less than 5 y.o. & adults >70 y.o. |
|
|
Term
| With a strength-duration curve, what do a steep, continuous curve displaced to the right & a discontinuous curve mean? |
|
Definition
curve to right - denervation
discontinuous - partial denervation |
|
|
Term
| To use ambulatory aids, patients must be able to elevate the body using their upper extremities - which muscles achieve this action? |
|
Definition
shoulder depressor muscles, by pushing down on the handpiece, decrease wb-ing amount on LE's
latissimus, low trap, pec major |
|
|
Term
| Describe what a bariatric gait pattern might look like. |
|
Definition
| Hip ABD & rotation, decreased knee flexion, pronated feet, difficulty weight shifting |
|
|
Term
| Describe what patients would benefit from a high back, contoured back, and lateral trunk supports in a w/c. |
|
Definition
high back - for patients with low trunk control or extensor spasticity
contoured back - for improved trunk extension & upright alignment
lateral trunk supports - improve trunk alignment for patients with scoliosis |
|
|
Term
| Define metal posterior & metal anterior stop. |
|
Definition
metal posterior stop - PF stop
metal anterior stop - DF stop |
|
|
Term
| Describe a floor-reaction orthosis. |
|
Definition
| has an anterior band that is part of a solid ankle AFO & imposes a force near the knee, resisting knee flexion |
|
|
Term
| List the four-stage procedure to ambulate with a reciprocating gait orthosis. |
|
Definition
1. shift weight to right leg
2. tuck the pelvis by extending the upper thorax
3. press on the crutches
4. allow the left leg to swing through |
|
|
Term
| Wraparound armrests on a w/c reduce the overall width of the chair by ____ inches. |
|
Definition
|
|
Term
| Elevating leg rests are contraindicated for patients with _________. |
|
Definition
| knee flexor hypertonicity |
|
|
Term
| Rigid frame w/c's are typically _____ & _____. |
|
Definition
|
|
Term
| How is a BLE amputee w/c modified? |
|
Definition
| drive wheels are placed posterior to the back to change the COG |
|
|
Term
| List the proposed functions of the following knee braces: Lenox Hill, Can-Am, Iowa Knee Orthosis, Palumbo |
|
Definition
Lenox-Hill - M-L, mutiple ligament, rotary
Can-Am - anteroposterior, mediolateral, rotary
Iowa Knee Orthosis - M-L, collateral ligament, postoperative
Palumbo - patellar
|
|
|
Term
|
Definition
| has very sturdy hip joints that limit hip flexion & resist hip abduction & adduction as the wearer shifts weight from side-side during ambulation |
|
|
Term
| Hip orthoses are usually used for _____ disease & hold the hips in what position? |
|
Definition
Legg-Calve Perthes
ABD, IR |
|
|
Term
|
Definition
| lumbosacral flexion, extension & lateral control orthosis - Knight LSO |
|
|
Term
| Between the four cervical orthoses, which gives the most control? |
|
Definition
Halo
Minerva next - uses forehead band instead of screws
Four poster has plates with two anterior & two posterior posts to stabilize the head & Philadelphia is a hard C-collar |
|
|
Term
|
Definition
| thoracolumbar sacral flexion & extension control orthosis - components of LS FEL with axillary shoulder straps to limit upper trunk flexion (Taylor brace) |
|
|
Term
|
Definition
slightly flexible plastic keel that bends at heel contact
the keel stores energy & recoils in late stance, releasing energy for springy termination to stance |
|
|
Term
| List reliefs and build-ups on PTB sockets & AKA sockets. |
|
Definition
PTB
build ups on patellar tendon, tibial shaft, femoral shaft, distal end of tibia, medial tibial plateau
reliefs over anterior tibia, anteiror tibia crest, fibular head & neck & fibular nerve
AKA
reliefs over adductor longus tendon, sciatic nerve, glut max, & rectus femoris
supports isch tubs & gluteals - build ups |
|
|
Term
| When is a metal pelvic band added to an AKA prosthetic system? |
|
Definition
| adds control for rotation, hip ABD/ADD, reduces Trendelenburg gait deviations |
|
|
Term
| What is a standard step height in homes? |
|
Definition
|
|
Term
| what does placing electrodes farther apart allow for? |
|
Definition
| current can travel deep into muscles to stimulate a greater number of deeper muscle fibers, as with trying to stimulate large muscle groups like the quadriceps |
|
|
Term
| T/F. Low rate TENS elicits a motor contraction. |
|
Definition
|
|
Term
| What is the best placement for decreased muscle activity with biofeedback? |
|
Definition
| electrodes close together and low detection sensitivity |
|
|
Term
| Where should the alignment of an orthotic hip be? |
|
Definition
| just anterior & superior to the greater trochanter. |
|
|
Term
| What is the purpose of a CPM after a TKA? |
|
Definition
| increases AROM knee flexion ability |
|
|
Term
| What is the most appropriate device for a pediatric patient with a complete L1 SCI or meningomyelocele? |
|
Definition
| reciprocating gait orthoses - HKAFO not enough - patient needs HKAFO |
|
|
Term
| What is the benefit of sensory level e-stim over nerve roots? |
|
Definition
| can increase peripheral vasodilation - can be useful with Raynauds - sensory e-stim not usually enough to provide lasting relief from chronic pain |
|
|
