Term
| How many spinal nerves are there in each region of the spinal cord? |
|
Definition
| 8 cervical, 12 thoracic, 5 lumbar, 5 sacral |
|
|
Term
| where and why are there enlargements of the spinal cord |
|
Definition
| cervical, lumbar: more motor neurons exit these areas |
|
|
Term
|
Definition
| bundles of spinal nerves beginning at L2 |
|
|
Term
| what is the filum terminale |
|
Definition
| fibrous tissue continous with pia mater. Connects spinal cord to dura mater to provide support and stability. Attaches to coccyx |
|
|
Term
| what does the gray matter of spinal cord consist of |
|
Definition
| cell bodies and dendrites of spinal neurons |
|
|
Term
| through what spinal horn does afferent information enter |
|
Definition
|
|
Term
| what does white matter of spinal cord consist of |
|
Definition
| axons of longitudinally running fiber tracts |
|
|
Term
| what are the 3 columns of white matter, separated by gray matter? |
|
Definition
| dorsal, lateral, ventral columns |
|
|
Term
| are the dorsal column pathways ascending or descending |
|
Definition
|
|
Term
| what do the dorsal column pathways carry |
|
Definition
| vibration, light touch, proprioceptoin |
|
|
Term
| what are the 2 dorsal columns |
|
Definition
|
|
Term
| what does the fasciculus cuneate carry? |
|
Definition
|
|
Term
| is the fasciculus cuneate medial or lateral? |
|
Definition
|
|
Term
| what does the fasciculus gracilis carry? |
|
Definition
|
|
Term
| is the fasciculus gracilis medial or lateral? |
|
Definition
|
|
Term
| where do the dorsal column pathways cross? |
|
Definition
| ascend ipsilaterally and cross in medulla |
|
|
Term
| Does the spinothalamic tract ascend ipsilaterally or contralaterally? |
|
Definition
| enters dorsal DRG, goes up and down Lissauer's tract, crosses, ascends contralaterally |
|
|
Term
| what is the function of anterior and posterior spinocerebellar tracts |
|
Definition
| carries unconscious proprioception to the cerebellum |
|
|
Term
| is the anterior spinocerebellar crossed in spinal cord? |
|
Definition
| yes. Carries information contralaterally |
|
|
Term
| is the posterior spinocerebellar crossed in spinal cord? |
|
Definition
| no. conveys ipsilaterally to cerebellum |
|
|
Term
| to what part of the spinal cord does the lateral corticospinal tract synapse and where do these synapses go? |
|
Definition
| dorsal lateral horn. Goes to innervate distal flexor muscles |
|
|
Term
| to what part of the spinal cord do the vestibulospinal/reticulospinal tracts synapse and where do these synapses go? |
|
Definition
| ventral, medial cell groups. Then go to proximal, extensor muscles |
|
|
Term
| Is lateral corticospinal crossed or uncrossed? |
|
Definition
| 90% crossed, 10% uncrossed |
|
|
Term
| what info does the ventral corticospinal pathway convey and to where |
|
Definition
| Uncrossed UMNs from motor cortex to provide voluntary control of trunk muscles. A small # cross to terminate on contralateral LMNs |
|
|
Term
| Purpose/description of Rubrospinal Pathway |
|
Definition
| Descending UMNs to cervical spinal cord to influence UE muscles. Involved in distal control of limbs, fine finger movements. Contralateral/crossed. |
|
|
Term
| Does reticulospinal tract have crossed or uncrossed pathways |
|
Definition
|
|
Term
| purpose of reticulospinal tract |
|
Definition
| descending medial tract for extensors, proximal, axial muscles to keep us upright |
|
|
Term
| Does colliculospinal have crossed or uncrossed pathways |
|
Definition
|
|
Term
| purpose of colliculospinal tract |
|
Definition
| controls axial muscles in neck, responds to visual stimuli |
|
|
Term
| study the cross section of the spinal cord |
|
Definition
|
|
Term
| what is the usual cause of central cord syndrome |
|
Definition
| hyperextension injuries that cause bleeding into central gray matter of SC |
|
|
Term
| signs and symptoms of central cord syndrome |
|
Definition
| more impairment of UE than LE because of damage to the medial part of the lateral corticospinal tract |
|
|
Term
| what is the prognosis for central cord lesion |
|
Definition
| good prognosis for ambulation, poor prognosis for hand function |
|
|
Term
| what is the usual cause of anterior cord syndrome |
|
Definition
| flexion injuries in which bone or cartilage damages anterior spinal artery |
|
|
Term
| signs and symptoms of anterior cord syndrome |
|
Definition
| motor function, pain & temperature lost below level of injury. Proprioception/vibration/light touch maintained |
|
|
Term
| prognosis for anterior cord syndrome |
|
Definition
| poor for ambulation, bladder & bowel control |
|
|
Term
| What is a Brown Sequard injury |
|
Definition
|
|
Term
| what is lost with Brown Sequard |
|
Definition
| Ipsilateral motor below, ipsilateral light touch/vibration/proprioception below, contralateral pain and temp below, ipsilateral all sensory at level of injury |
|
|
Term
| Prognosis for Brown Sequard |
|
Definition
| good prognosis for recovery of function |
|
|
Term
| is posterior cord syndrome common |
|
Definition
|
|
Term
| cause of posterior cord syndrome |
|
Definition
| compromise to posterior spinal artery by compression from tumor or infarction |
|
|
Term
| signs/symptoms of posterior cord syndrome |
|
Definition
| lose proprioception, vibration, light touch |
|
|
Term
| what is Cauda Equina damage |
|
Definition
| LMN lesion: nerve roots are damaged |
|
|
Term
| signs sympoms of cauda equina injury |
|
Definition
| weakness, bowel and bladder loss, loss of spinal reflexes |
|
|
Term
| ASIA: how many dermatomes are tested on each side of the body |
|
Definition
|
|
Term
| what are the 2 types of sensory tested by ASIA |
|
Definition
|
|
Term
| For the following questions, list the sensory testing location for ASIA |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| lateral to antecubital fossa |
|
|
Term
|
Definition
| thumb: proximal phalanx, dorsal surface |
|
|
Term
|
Definition
| 3rd digit: proxmal phalanx, dorsal surface |
|
|
Term
|
Definition
| 5th digit: proximal phalanx, dorsal surface |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| inguinal ligament midpoint |
|
|
Term
|
Definition
| half the distance between T12 and L2 |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| dorsum of foot at 3rd MTPJ |
|
|
Term
|
Definition
|
|
Term
|
Definition
| popliteal fossa in midline |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is the 3 point scale system for sensory ASIA |
|
Definition
| 0 = absent. Cannot detect or cannot distinguish sharp vs. dull. 1 = impaired. Intensity of stimulus is different than on face. 2 = normal. Detects, distinguishes sharp vs dull, feels same as on face |
|
|
Term
| how many times must sensation be correct to receive a score of normal |
|
Definition
| 8/10 for both pin prick and light touch |
|
|
Term
| what tool to use for pin prick |
|
Definition
|
|
Term
| what tool to use for light touch |
|
Definition
|
|
Term
| what is the sensory level |
|
Definition
| the most causal segment of the spinal cord with normal (2) pin prick AND light touch sensation on BOTH sides of the body |
|
|
Term
|
Definition
| most caudal segment of the spinal cord with grade of 3 or better with the next most rostral segment having a normal grade |
|
|
Term
| what is a normal strength score |
|
Definition
| 5/5 or 4/5 with other circumstances such as pain |
|
|
Term
| what is the neurological level |
|
Definition
| the most caudal level with normal sensory and motor bilaterally |
|
|
Term
|
Definition
| complete. No sensory or motor function is preserved in sacral segment S4-5 |
|
|
Term
|
Definition
| incomplete. Sensory but no motor function preserved in sacral segment S4-5 |
|
|
Term
|
Definition
| incomplete. Motor function preserved below neurological level, mostly <3 |
|
|
Term
|
Definition
| incomplete. Motor function preserved below neurological level, mostly >=3 |
|
|
Term
|
Definition
| Normal. Sensation and motor function normal |
|
|
Term
| define zone of partial preservation |
|
Definition
| dermatomes and myotomes caudal to neurological level that remain partially innervated. Used ONLY with COMPLETE injuries |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| flexion of distal phalanx of middle finger |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how to determine neurologic level for T3-12 |
|
Definition
|
|
Term
|
Definition
| SCM, cervical flexors, cervical extensors, cervical rotators, levator, upper traps |
|
|
Term
|
Definition
| upper trap, diaphragm, cervical paraspinals = scapular elevation |
|
|
Term
|
Definition
| deltoid, biceps, brachialis, brachioradialis, rhomboids, serratus, early rotator cuff |
|
|
Term
| what is the action of the rhomboids at C5 |
|
Definition
|
|
Term
| what is the action of serratus |
|
Definition
| laterally rotate, protract scapula. (5, 6, 7 raise your arms up to heaven) |
|
|
Term
| Can you supinate with C5? |
|
Definition
|
|
Term
| what shoulder movements can you do with C5 |
|
Definition
| abduction, flexion, extension |
|
|
Term
|
Definition
| wrist extension, pec major clavicular portion, lats |
|
|
Term
| what are the actions of latissimus dorsi |
|
Definition
| extend, IR, adduct arm. C6, C7, C8 handcuff your date |
|
|
Term
| what is the function of pec major clavicular portion |
|
Definition
|
|
Term
|
Definition
| pec major sternal portion, triceps, pronator quadratus, extensor digitorum, flexor carpi radialis |
|
|
Term
| what movements can be done at C7 that weren't available earlier |
|
Definition
| elbow extension, wrist extension, wrist flexion |
|
|
Term
|
Definition
| More wrist flexors/extensors, hand muscles |
|
|
Term
| what actions can you do with C8 that you couldn't do earlier |
|
Definition
| sronger wrist ext/flex. May still have tenodesis depending on strength. Finger flex/ext stronger. More thumb movements. |
|
|
Term
| what are some important things to consider when working with patient with SCI |
|
Definition
| reduced activity, muscle strength and tone, ROM, respiratory status, speech, sensation, skin integrity, functional status |
|
|
Term
| what are some complications of reduced activity for people with SCI to look out for |
|
Definition
| pressure ulcers, heterotopic ossification, osteoporosis and fractures, elevated blood calcium, kidney stones, spine deformity = kyphosis |
|
|
Term
| what to look for with muscle strength following SCI |
|
Definition
| do detailed testing for specific muscles. Stabliize and watch for substitutions |
|
|
Term
| what to look for with muscle tone following SCI |
|
Definition
| when does it occur? Is it constant or fluctuating? Can inc tone be used for functional activities, such as extensor tone in extremities to get from floor to WC? |
|
|
Term
| what ROM is critical following SCI in the shoulder |
|
Definition
| flexion, abduction, ER, extension important for transfers, dressing, sitting stability, pressure relief |
|
|
Term
| what ROM is critical following SCI in the elbow |
|
Definition
| extension to lock elbows and help with transfers, pressure relief |
|
|
Term
| what ROM is critical following SCI in the wrist/hand |
|
Definition
| wrist extension without overstretching finger flexors. Some shortening of finger flexors gives tenodesis, which allows for functional flexion |
|
|
Term
| what ROM is critical following SCI in the hip |
|
Definition
| hip flexion/rotation important for dressing and transfers. Hip extension necessary for parastance. Hamstring length critical for bed mobliity, dressing, transfers |
|
|
Term
| what ROM is critical following SCI in the knee |
|
Definition
| flexion for dressing, transfers. Extension for ambulation |
|
|
Term
| what to consider when stretching hamstrings |
|
Definition
| don't overstretch hamstrings at risk of overstretching low back. Some shortening of low back can increase sitting balance to make up for weak abdominals |
|
|
Term
| what ROM is necessary in Ankle following SCI |
|
Definition
| dorsiflexion to at least neutral for ambulation |
|
|
Term
| what is the biggest cause of death following SCI |
|
Definition
| respiratory complications like pneumonia |
|
|
Term
| what to observe regarding respiratory status |
|
Definition
| overall color, presence of tracheostomy, chest shape and symmetry, bony abnormalities, chest expansion |
|
|
Term
| what is the normal amount of expansion of the ches at the xiphoid |
|
Definition
|
|
Term
| how to determine respiratory muscle strength |
|
Definition
| are abdominals present? Are accessory muscles present |
|
|
Term
| what to use of abdominals are not present |
|
Definition
|
|
Term
| list the accessory respiratory muscles |
|
Definition
| SCM, levator, pectorals, serratus, scalenes, upper trap, intercostals |
|
|
Term
|
Definition
| how many syllables you can say in one breath |
|
|
Term
| what does increased respiration rate indicate and why is this bad |
|
Definition
| shallow breathing = increased risk of infection |
|
|
Term
| what are signs of hypoventilation |
|
Definition
| drowsiness, irritability, difficulty waking |
|
|
Term
| what are signs of hyperventilation |
|
Definition
| numbness, tingling, faintness |
|
|
Term
| what to check out regarding cough |
|
Definition
| effective? Needs assistance? |
|
|
Term
|
Definition
| detailed testing using pin prick and light touch. Patient education regarding injury prevention/ulcer prevention with pressure relief, inspection, safety |
|
|
Term
| what to consider with skin integrity |
|
Definition
| inspection, pressure relief, bed mattress, WC cushion, dressing, transfers, comfy clothing: watch for seams, tight places, things in pocket |
|
|
Term
| what to consider with functional status |
|
Definition
| bed mobility, transfers, sitting/standing balance, WC mobility, ambulation, ADLs, standardized assessments |
|
|
Term
| at what SCI level does autonomic dysreflexia occur |
|
Definition
|
|
Term
|
Definition
| one month to one year post injury |
|
|
Term
|
Definition
| reflexive dysfunction of the sympathetic and parasympathetic nervous systems triggered by a noxious stimulus in the periphery |
|
|
Term
| what is the sympathetic system |
|
Definition
|
|
Term
| where is the sympathetic system |
|
Definition
|
|
Term
| what is the parasympathetic system |
|
Definition
|
|
Term
| describe pathophysiology of AD |
|
Definition
| noxious stimulus triggers reflex to create vasoconstriction, increasing BP as a sympathetic response. Receptors in brain detect hypertension and send parasympathetic signal to reduce heart rate via vagus nerve. Dilation of blood vessels is blocked at the cord. Slowing of HR alone is not enough to sufficiently lower BP. Can result in stroke |
|
|
Term
|
Definition
| pounding headache, elevated BP, sweating above injury level, goose bumps, chills, nasal obstruction |
|
|
Term
|
Definition
| distended bladder, fecal mass in rectum, infection, bladder stones, ingrown toenail, pressure sores |
|
|
Term
| what to do in the case of AD |
|
Definition
| recognize symptoms. Confirm increased BP. Sit up quickly to induce orthostatic hypotension. Look for triggers: kinked tube, tight clothes, full bag. Nursing to investigate other triggers. Medical treatment to lower BP |
|
|
Term
| what causes postural hypotension |
|
Definition
| sympathetic/parasympathetic dysufnction PLUS venous pooling |
|
|
Term
| treatments for orthostatic hypotension |
|
Definition
| reclining WC, elevating leg rests, abdominal binder, TED hose or ace wraps, slow adjustment to upright |
|
|
Term
| strategies for maximizing respiratory efficiency in patients with tetraplegia |
|
Definition
| postural drainage, percussion and vibration, assisted cough |
|
|
Term
| describe modified Heimlic cough |
|
Definition
| PT puts hand below xiphoid process and instructs patient to cough out while PT pulls in and up |
|
|
Term
| describe sitting modified Heimlich with rib compression cough |
|
Definition
| place hands laterally on ribs and provide inward pressure at same time as attempted cough from patient |
|
|
Term
| describe independent methods of asssisted coughing |
|
Definition
| use biceps to do independent Heimlich. Use pillow and lean forward. Prone: cough out while lowering yourself down from prone on elbows. |
|
|
Term
| what are some devices for airway clearance |
|
Definition
| incentive spirometry, CPAP and BiPAP, in-exsufflator device |
|
|
Term
| what is a key component of bed mobility and coming to sitting |
|
Definition
|
|
Term
| What to think of with transfers |
|
Definition
| Get WC set up, get sliding board in place |
|
|
Term
| how to preserve UE function |
|
Definition
| use power WC if needed, avoid extreme positions, provide support, educate about risk of stroke, |
|
|
Term
| how to relieve pressure for C4 |
|
Definition
| WC tilt/recline. Pressure relieving cushion |
|
|
Term
| how to relieve pressure for C5 |
|
Definition
| WC tilt/recline. Pressure relieving cushion. Use biceps to lean side to side |
|
|
Term
| how to relieve pressure for C6 |
|
Definition
| wrist extension, shoulder ER to lean forward. Lean forward using wrist |
|
|
Term
| how to relieve pressure with C7, 8 |
|
Definition
|
|
Term
| why do you rest the patient's head on your shoulder away from the direction you're going |
|
Definition
| so you can see where you're going |
|
|
Term
| what are things to think about when treating SCI |
|
Definition
| pain, secondary injuries, education, discharge planning |
|
|
Term
| what are factors that affect outcome following SCI |
|
Definition
| complete vs incomplete; body shape/size and fitness level; age; needs and motivation |
|
|
Term
| what things affect C3 and above SCI outcome |
|
Definition
| movement capabilities, ventilator dependence, total assist for most activities, require 24 hour attendant and back-up ventilator, extensive equipment needs, WC with recline/tilt, head or sip/puff, need for family asistance |
|
|
Term
| what to consider for sitting of C4 patient |
|
Definition
| can she tolerate vertical? Hands on! Totally dependent for balance |
|
|
Term
| describe bed mobility of C4 patient |
|
Definition
| independent supine to sit with electric hospital bed and modified controls. Assists with moving head. Otherwise dependent |
|
|
Term
| describe WC mobility for C4 patient |
|
Definition
| sip and puff or head control WC. Independent with power WC over level surfaces. Needs back up manual reclining WC |
|
|
Term
|
Definition
|
|
Term
|
Definition
| uses head to alter COM. May be able to remain stable for short periods of time |
|
|
Term
| decribe bed mobility for C5 |
|
Definition
| independent supine to sit with electric hospital bed. Assists with moving head, upper trunk, and shoulders |
|
|
Term
| describe WC mobility for C5 patient |
|
Definition
| independent with power WC using hand controls. Manual WC may be independent indoors. Requires assist for outdoors or carpet. |
|
|
Term
| describe transfers for C5 |
|
Definition
| mostly dependent. Some patient with very strong biceps and deltoids can do even transfers with sliding board |
|
|
Term
| can a person with C5 drive? |
|
Definition
| yes, in specialized van with lift |
|
|
Term
|
Definition
| can stabilize with head/UE movement. Can sit unsupported with elbows locked in extension via ER at shoulders |
|
|
Term
|
Definition
| independence with or without siderails, loops, etc is possible. Probably needs assistance in coming to sitting, leg management |
|
|
Term
|
Definition
| independent with power WC using joystick hand control. Some to total assist for outdoor manual WC propulsion |
|
|
Term
| describe transfers for C6 |
|
Definition
| independent to some assist for even transfers. Some to total assist for uphill transfers |
|
|
Term
| can a person with C6 drive? |
|
Definition
| yes, in specialized van with lift |
|
|
Term
|
Definition
| independent. Uses UEs to provide support. |
|
|
Term
| describe bed mobility of C7-8 patient |
|
Definition
| independent without special equipment |
|
|
Term
| describe WC mobility of C7-8 patient |
|
Definition
| independent manual with some assist for ramps, long distances, uneven terrain |
|
|
Term
| describe transfers for patient with C78 |
|
Definition
| independent even transfers. Some assist uneven transfers |
|
|
Term
| how can a person with C78 drive |
|
Definition
| transfer to captain's chair from WC or use lift in van, then transfer to captain's chair |
|
|
Term
| why his hamstring length important for a patient with paraplegic injury |
|
Definition
| getting up from the floor, wearing long leg braces, donning shoes/pants in sitting |
|
|
Term
| why is hip extension important for patient with paraplegic injury |
|
Definition
|
|
Term
| when to teach self ROM to patient with paraplegic injury |
|
Definition
|
|
Term
| describe bed mobility for patient with paraplegic injury |
|
Definition
| independent. Rolling with UEs,head, shoulders |
|
|
Term
| how to transfer supine to sit and reverse for patient with paraplegic injury |
|
Definition
| use UEs to push up straight or roll first. |
|
|
Term
| how to scoot in bed for person with paraplegic injury |
|
Definition
| small push ups using head hips relationship |
|
|
Term
| potential problem for sitting for patient with paraplegic injury |
|
Definition
|
|
Term
| how to prevent orthostatic hypotension for patient with paraplegic injury |
|
Definition
| TED hose, abdominal binder |
|
|
Term
| name an activity to improve standing balance |
|
Definition
|
|
Term
| what are the suggested times for pressure relief |
|
Definition
| 2 minutes every 20. also be sure patient has a good cushion |
|
|
Term
| how to go down a ramp in a WC |
|
Definition
|
|
Term
| how to go up a ramp in a WC |
|
Definition
|
|
Term
| which way to face when going down a ramp in a wheelie |
|
Definition
|
|
Term
| which way to face when going up a ramp in a wheelie |
|
Definition
|
|
Term
| how to transfer for patient with paraplegia |
|
Definition
| twist head and shoulders away from the surface you're transferring to |
|
|
Term
| why to limit transfers and use adaptive devices |
|
Definition
| limit stress on shoulders from repetitive use |
|
|
Term
| ways to strengthen patient with paraplegia |
|
Definition
| lat pull downs. Shoulder depression. Strengthen all innervated UE muscles. Wall pulleys, free weights, swimming |
|
|
Term
| what things to take into account for ambulation for person with paraplegia |
|
Definition
| Upper body strength, cognition, motivation, trunk strength, ROM, body proportions, BMI, muscle tone, spasticity, other health issues |
|
|
Term
| what is the cutoff point as to whether someone can walk community distances |
|
Definition
| innervation of hip flexors |
|
|
Term
| what to do for spasticity and ambulation |
|
Definition
|
|
Term
| ideas for endurance training for patient with paraplegic injury |
|
Definition
| WC propulsion, arm ergometer, swimming, ambulation, Nustep |
|
|
Term
| bathroom transfers for patient with paraplegia |
|
Definition
| independent transfers with modifications and assistive devices. Use cushioned seat |
|
|
Term
| WC-car transfers for patient with paraplegia |
|
Definition
| should be independent. Use quick-release wheels |
|
|
Term
| WC considerations for patient with paraplegia |
|
Definition
| seat inclination 10-15 degrees. Solid seat back with custom sized lumbar support. Seat to back angle 85-90 deg |
|
|
Term
| is someone with ASIA A or ASIA D more likely to be ambulatory |
|
Definition
|
|
Term
| are FIM scores higher for someone with ASIA D or ASIA A |
|
Definition
|
|
Term
| what are the major factors affecting outcome for patients with incomplete SCI |
|
Definition
| level of injury, muscle tone, age, concurrent brain injury, pressure ulcers, pain, limited ROM, obesity, body proportions, motivation, sensory sparing and return |
|
|
Term
| why does a C4 lesion have varying prognosis even for incomplete injury |
|
Definition
| depends on how much the diaphragm is affected |
|
|
Term
| what is the possible problem of TUG, Berg, FIM for patients with SCI |
|
Definition
|
|
Term
| If a patient has L2 intact, what does that mean for bracing |
|
Definition
| hip flexors available. Probably need a KAFO |
|
|
Term
| if a patient has L3 intact, what does that mean for bracing |
|
Definition
| quads now available, might be ok with just an AFO. AFO should be solid with DF and PF block since they have no control of either |
|
|
Term
| if a patient has L4 intact, what does that mean for bracing |
|
Definition
| She can now dorsiflex. AFO is probably all she needs. Might need a DF block because of limited PF to balance ability to DF can lead to crouch gait. Still needs PF block. 2 canes/crutches |
|
|
Term
| what new muscles does a patient with L4 have that can help with gait |
|
Definition
| sartorius can help with knee flexion in swing phase of gait. Starting to get some glutes for hip stability. can DF |
|
|
Term
| what new muscle is innervated with L5 |
|
Definition
|
|
Term
| what bracing/ADs needed for someone with L5 |
|
Definition
| canes, AFOs. May need DF block if they have weak plantarfleors |
|
|
Term
| what new muscles are innervated with S1 |
|
Definition
| hamstrings, glute max, partial PFs |
|
|
Term
| what braces are needed for S1 |
|
Definition
| SMO to increase stability at ankle |
|
|
Term
| can someone with S1 lesion walk without an AD |
|
Definition
|
|
Term
| is an AD needed for someone with S2 lesion |
|
Definition
|
|
Term
| what are the tenants of universal design |
|
Definition
| equitable, flexible, simple/intuitive, perceptible, tolerant of error, low physical effort, size and space for approach and use |
|
|
Term
| what is the idea ramp slope? |
|
Definition
|
|
Term
| what is the preferred ramp slope |
|
Definition
|
|
Term
| what is the acceptable/code ramp slope |
|
Definition
|
|
Term
| how often is a landing/switchback required on a ramp |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what should the surface of a ramp be like |
|
Definition
|
|
Term
| what else should be on a ramp |
|
Definition
| rails or a lip so that you don't fall off the side |
|
|
Term
| how much room should there be for a turnaround on a ramp |
|
Definition
|
|
Term
|
Definition
|
|
Term
| how high should accessible toilet be |
|
Definition
|
|
Term
| things to consider for bedroom and universal design |
|
Definition
| bed height and firmness. Special bed, rail. Can they access their clothes |
|
|
Term
| will medicare pay for home repairs |
|
Definition
|
|
Term
| will workers comp pay for home repairs |
|
Definition
|
|
Term
| who else to get help for home repairs |
|
Definition
|
|
Term
| what are the 4 major types of CNS tumors? |
|
Definition
| gliomas, meningiomas, neurilemomas, pituitary adenomas |
|
|
Term
|
Definition
| tumor involving glial cells, which are supporting cells of the nervous system |
|
|
Term
| are gliomas malignant or benign |
|
Definition
|
|
Term
| what is the most common type of glioma |
|
Definition
|
|
Term
| what is the problem with malignant astrocytomas |
|
Definition
|
|
Term
| what is the most highly malignant type of astrocytoma |
|
Definition
|
|
Term
| what part of the brain is usually affected by astrocytomas |
|
Definition
|
|
Term
| what grade malignancy is a glioblastoma multiforme |
|
Definition
|
|
Term
| what age is most likely to get a glioblastoma multiforme |
|
Definition
|
|
Term
| is glioblastoma multiforme more common in men or women |
|
Definition
|
|
Term
| what is the prognosis for glioblastoma multiforme |
|
Definition
|
|
Term
| what age is most likley to get an oligodendroma |
|
Definition
|
|
Term
| what is the prognosis for oligodendroma |
|
Definition
| good. Well defined and slow growing |
|
|
Term
| what age is most likely to get a medulloblastoma |
|
Definition
|
|
Term
| where do medulloblastomas form and what does this affect |
|
Definition
| develops near vermis of cerebellum, tends to obstruct 4th ventricle causing hydrocephalus |
|
|
Term
| what is the prognosis for medulloblastoma |
|
Definition
| highly malignant but better prognosis for older children |
|
|
Term
| at what age does ependymoma usually occur |
|
Definition
|
|
Term
| where can ependymomas form |
|
Definition
| ventricals or spinal cord |
|
|
Term
| what is the prognosis for ependymoma |
|
Definition
| fairly good. 80% survival rate of 5 years |
|
|
Term
|
Definition
|
|
Term
| are meningiomas malignant or benign |
|
Definition
| well-defined and slow-growing. Usually benign. |
|
|
Term
| in what age group are mengiomas most common |
|
Definition
|
|
Term
| in what age group are pituitary adenomas most common |
|
Definition
|
|
Term
| what is a functional pituitary adenoma |
|
Definition
| symptoms of endocrine dysfunction only |
|
|
Term
| what is a nonfunctional pituitary adenom |
|
Definition
| neurological deficits from tumo |
|
|
Term
| what is the survival of pituitary adenoma |
|
Definition
| usually longterm survival |
|
|
Term
| what are other names for neurilemomas |
|
Definition
| neurinomas, neurolemmomas, schwannomas |
|
|
Term
|
Definition
| slow-growing, benign tumors that originate from Schwann cells |
|
|
Term
| what is an acoustic neuroma |
|
Definition
| neurilemoma that involves the vestibular nerve and results in facial paralysis and hearing loss on the affected side |
|
|
Term
| what are signs and symptoms of brain tumors |
|
Definition
| increased ICP symptoms, seizures, focal disturbances |
|
|
Term
| what are the symptoms of increased ICP |
|
Definition
| headache most severe in the morning, vomiting in the morning esp in children, lethargy, drowsiness, irritability, gait disturbances |
|
|
Term
| what are focal disturbances |
|
Definition
| direct destruction of neural tissue or compression of the brain that results in headache, visual deficits, cranial nerve deficits, hemiparesis |
|
|
Term
| what are the 2 types of spinal tumors |
|
Definition
|
|
Term
| what is the first symptom of an extradural spinal tumor |
|
Definition
|
|
Term
| what do extradural spinal tumors usually come from |
|
Definition
| metastases to the vertebrae that invade epidural space |
|
|
Term
| what are the symptoms of intradural spinal tumors |
|
Definition
| either sensory and motor deficits or pain |
|
|
Term
| how are CNS tumors managed |
|
Definition
| surgery, radiation, chemotherapy, biologic therap |
|
|
Term
| describe surgical management of CNS tumors |
|
Definition
| surgical removal, stereotactic resection, stereotactic radiosurgery using a gamma knife to destroy tumor cells |
|
|
Term
| what is the purpose of radiation |
|
Definition
|
|
Term
| what is the purpose of chemotherapy |
|
Definition
| destroy cancer cells by interfering with DNA during cell division |
|
|
Term
| what do biologic therapies of CNS tumors do |
|
Definition
| angiogenesis inhibitors, gene therapy |
|
|
Term
| what are side effects of cancer treatments |
|
Definition
| nausea, fatigue, hair loss, vomiting, lethargy, skin damage from radiation, immune system depression |
|
|
Term
| what are side effects of steroids given to reduce cerebral edema |
|
Definition
| increased BP, water retention, weight gain, muscle weakness, steroid myopathy, osteoporosis |
|
|
Term
| what is diffuse cerebral radiation injury |
|
Definition
| occurs 6-18 months after radiation: patient shows cognitive changes like dementia, also gait disturbances |
|
|
Term
| what are medical complications following CNS tumors |
|
Definition
| seizures, diffuse cerebral radiation injury, focal cerebral radiation necrosis, thromboembolism |
|
|
Term
| what are the 4 Dietz classifications |
|
Definition
| preventative, restorative, supportive, palliative |
|
|
Term
| describe preventative classification |
|
Definition
| patient has no impairments that significantly impact function. |
|
|
Term
| how to treat someone with preventative classification |
|
Definition
| intervene early to minimize functional loss. Educate patient and family |
|
|
Term
| describe restorative dietz classification |
|
Definition
| patient will return to premorbid status with some residual impairments |
|
|
Term
| how to treat someone with restorative classification |
|
Definition
|
|
Term
| describe supportive dietz classification |
|
Definition
| slowly progressive disability from residual tumor |
|
|
Term
| how to treat someone with supportive classification |
|
Definition
| functional training, equipment needs, discharge early |
|
|
Term
| describe palliative dietz classification |
|
Definition
|
|
Term
| how to treat someone with palliative classification |
|
Definition
| increase comfort. Provide emotional support |
|
|
Term
| list the manifestations of myelodysplasia |
|
Definition
| myelomeningocele, meningocele, lipoma, |
|
|
Term
|
Definition
| spina bifida aperta: open spinal cord defects that protrudes dorsally and causes spinal nerve paralysis |
|
|
Term
|
Definition
| spina bifida aperta with skin covering and without paralysis |
|
|
Term
|
Definition
| fatty mass in spinal cord that can put pressure on part of the spinal cord |
|
|
Term
| do lipomyelomeningoceles cause paralysis |
|
Definition
|
|
Term
| do lipomeningoceles cause paralysis |
|
Definition
|
|
Term
| what is the impact on body structure and function from myelodysplasia |
|
Definition
| musculoskeletal deformities of spine and lower limbs, postural problems |
|
|
Term
| what causes deformities associated with myelodysplasia |
|
Definition
| coexisting congenital malformations like club foot; secondary effects of neurologic deformities like contractures, intrauterine positioning/decreased fetal movement, habitually assumed positions due to weakness, fractures |
|
|
Term
| what are some postural problems you might see in a child with myelodysplasia |
|
Definition
| forward head, rounded shoulders, kyphosis, scoliosis, lordosis, anteior pelvic tilt, rotational deformities of hip or tibia, hip and knee flexion, foot pronation |
|
|
Term
| why is the hip prone to deformity in kids with myelodysplasia |
|
Definition
| unopposed muscle action. Torsional deformities result from hip anteversion or retroversion |
|
|
Term
| what deformities can be present/caused in the knee in kids with myelodysplasia |
|
Definition
| knee flexion from prolonged WC sitting. Knee extension from immobility. Varus and valgus from positional input |
|
|
Term
| what are negative effects of musculoskeletal deformities |
|
Definition
| positioning, body image, weightbearing, ADLs, energy expenditure, mobility |
|
|
Term
| give 3 tips for examination of a child with myelodysplasia |
|
Definition
| age-specific, test all dermatomes to get a baseline, beware of shunting and cognitive deficits |
|
|
Term
| what are some intervention strategies for kids with myelodysplasia |
|
Definition
| Maintain ROM; use orthotics to improve asymmetries; casting/taping/splinting for club foot; orthotics to maintain good foot integrity and position; assitive devices; promote good posture; promote proper weightbearing; promote proper alignment |
|
|
Term
| what are causes of brain abscesses |
|
Definition
| wounds, extensions of local infections |
|
|
Term
| what visual deficit is associated with pituitary adenoma |
|
Definition
|
|
Term
| what is the term for tumors that originate from structures outside the CNS |
|
Definition
|
|
Term
| speech disturbances and right hemiparesia are an example of ICP, cerebral hemorrhage, direct destruction of neural tissue, or overproduction of CSF? |
|
Definition
| direct destruction of neural tissue |
|
|
Term
| why are patients with brain tumors often on steroids |
|
Definition
|
|
Term
| can PTs check for papilledema? |
|
Definition
| no, that's for physicians. |
|
|
Term
| in what region of the brain do most tumors occur in children |
|
Definition
|
|
Term
| in what region of the brain do must tumors occur in adults |
|
Definition
|
|
Term
| what are the 3 major types of brain infections |
|
Definition
| brain abscesses, meningitis, encephalitis |
|
|
Term
| symptoms of brain abscesses |
|
Definition
| increased ICP, altered consciousness, focal neurological deficits |
|
|
Term
| what are symptoms of increased ICP |
|
Definition
| headache, vomiting, papilledema |
|
|
Term
| what are symptoms of focal neurological deficits |
|
Definition
| hemiparesis, dysphagia, visual field deficits, ataxia |
|
|
Term
| what medical management options exist for brain abscess |
|
Definition
|
|
Term
|
Definition
| infection spread through CSF |
|
|
Term
| what parts of the CNS can be affected by meningitis |
|
Definition
| pia mater, arachnoid mater, subarachnoid space, adjacent brain and spinal cord |
|
|
Term
|
Definition
| trauma, spread of middle ear infection |
|
|
Term
| is meningitis bacterial or viral |
|
Definition
|
|
Term
| is viral or bacterial meningitis more common |
|
Definition
|
|
Term
| is viral or bacterial meningitis more severe |
|
Definition
|
|
Term
|
Definition
| increased ICP, increased BP, fever, nuchal rigidity, Kernig's sign, Brudzinski's sign |
|
|
Term
| what are symptoms of increased ICP |
|
Definition
| severe headache, nausea, vomiting |
|
|
Term
|
Definition
| resistance to passive neck flexion |
|
|
Term
|
Definition
| pain and resistance to knee extension with hips flexed to 90 deg |
|
|
Term
| what is brudzinski's sign |
|
Definition
| involuntary flexion of hips and knees with passive neck flexion |
|
|
Term
| what is medical management of meningitis |
|
Definition
| manage symptoms. Antibiotics for bacterial type |
|
|
Term
| what are longterm sequelae of meningitis |
|
Definition
| sensorineural hearing loss from involvement of CN VIII, involvement of other CN, sensorimotor dysfunction, cognitive/perceptual deficits |
|
|
Term
|
Definition
| inflammation of brain tissue and surrounding meninges |
|
|
Term
| is encephalitis more often bacterial or viral? |
|
Definition
|
|
Term
| what are symptoms of encephalitis |
|
Definition
| fever, headache, nuchal rigidity, vomiting, general malaise, CN palsy, hemiplegia, coma |
|
|
Term
| how to manage encephalitis |
|
Definition
| manage ICP. Manage symptoms |
|
|
Term
| major components of PT intervention for acute CNS infection |
|
Definition
| manage symptoms. ROM, positioning, skin care, coma stim if appropriate. Quiet environment and monitor physiological function. Progress to work on motor and functional abilities. |
|
|
Term
| major components of PT intervention for subacute/rehab CNS infection |
|
Definition
| similar to intervention for someone post TBI or CVA: improve motor and function. |
|
|
Term
| is hypertonia or hypotonia likely after CNS infection? |
|
Definition
|
|
Term
| have functional improvements been shown in research involving neuroplasticity? |
|
Definition
|
|
Term
| what types of intervention strategies have been used in research? |
|
Definition
| treadmill locomotion, uptraining/downtraining of spinal stretch reflexes, changing frequency/intensity/duration of training |
|
|
Term
| what is downtraining of a spinal stretch reflex |
|
Definition
| decreasing the spinal stretch reflex |
|
|
Term
| what are some intervention strategies for facilitating neuroplasticity and behavioral recovery |
|
Definition
| LiteGait BWST, treadmill locomotion, adding sensory feedback, using estim, aquatic treadmill, EMG + biofeedback for uptraining/downtraining |
|
|
Term
| what changes can be seen in someone with SCI following BWSTT |
|
Definition
| improvements with stepping. Least improvements with locomotor robot (more with estim, manual assistance) |
|
|
Term
| what are some options for improving functional abilities and fitness in individuals after spinal cord injury |
|
Definition
| Step Training!! Pool/aquatic treadmill. BWSTT. EMG + biofeedback to uptrain/downtrain Spinal stretch reflexes. Estim. Proprioception/sensory feedback. Neural prosthesis = brain/computer interface that takes signal from brain and implants it into muscle or other device |
|
|
Term
| what are critical components of equipment evaluation |
|
Definition
| alignment, patient ability, adjustments for growth, portable, appearance, modifiable for increase or decrease in function, replacement costs, safe, what will it be used for, who will help use it |
|
|
Term
| what are reasons for adaptive/assistive equipment |
|
Definition
| facilitate normal posture/tone/alignment. Mobility. Improve function. Improve learning experiences. |
|
|
