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Crossed Syndromes UCS Inhibited L NF Lower trap SA D Facilitated Levator L SCM Pec uppertrap LCS Inhibited L Abdominals Gluts Facilitated L Rectus Femoris Illio spoas lumbar extensors Mechanical work Concentric muscle torque...

Crossed Syndromes UCS Inhibited L NF Lower trap SA D Facilitated Levator L SCM Pec uppertrap LCS Inhibited L Abdominals Gluts Facilitated L Rectus Femoris Illio spoas lumbar extensors Mechanical work Concentric muscle torque Load torque Eccentric muscle torque Load torque BP Guidelines Normal than 120 80 Less Elevated  Systolic between 120 1297 and Diastolic less than 80 stage I between 130 139 or systolic between 80 89 Diastolic 2 Stage Systolic at least 140 90 or Diastolic at least Altitude changes Intial Acclimatization HR BP normal CO Normal SV Normal Aquatic Changes V Effects HR BP V02 CO SV Resp Effects VC Vr work of Breath MSK Effects WB Edema Heart sounds Aortic sternal border 2ⁿᵈ IC space right Pulmonic sternal border 2ⁿᵈ IC space left Tricuspid border 4ᵗʰ IC space left sternal  Mitral midclavicular line 5ᵗʰ IC space values onset of systole closure of M T values onset of diastole P Eclosure of A associated w heart failure ventricular filling S4ventricular filling atrial contraction hypertension Brain Lesions Frontal Broca's expressive aphasia nonfluent aphasia L Brokenspeech movement Plan programming personality Emotion behavioral control Olfaction Temporal comprehesion Hearing language Wernicke's fluent aphas to understand receptive aphasia Unable Parietal unilateral neglect Sensory loss Occipital Visual loss Cranial Nerves 1 Olfactory Odors 2 Optics Visual field 3 Oculomotor medialgaze Up down 4 Trochlear Down 2in 5 Trigeminal sensationof fece muscles of mastication corneal jaw reflex 6 Abducensm Lateral gaze 7 Facial muscles of facialexpression taste anterior213 close eyes tightsmile w teeth puffcheeks 8 VCS Hearing Balance 9 GPB taste post Swallow reflexafferent gag 10 B Vagus reflex efferent gag ahhh Uvula rises  SAM shoulder shrug 12 16M Tongue protrusion Deviates toward side of lesion Obstructive vs Restrictive Obstructive IC IRV ERV VC FEV FUC TV FRC RV TLC Restrictive All COPD Classification Mike Fuc 470 FEV 80 May have cough or sputum MEETFuc 470 50 FEV 80 SOB w exertion cough or sputum E EFuc 470 30 FEV 450 exercise capacity fatigue repeatedexacerbation Very Severe FEV FUC 470  FEV 430 and or chronic respiratory failure signs of heart failure Abnormal Respiratory Sounds Rhonchi Continuous low pitch Snoring Rattling COPD Bronchiectasis Pneumonia Bronchitis cystic fibrosis wheeze Highpitched Heard w expiration Asthma COPD Foreignobject Crackles Brief Popping Used to be called rales Pleural Rub Lower lateral chest Pleural inflammation Arterial Blood Gas Analysis Normal pH 7.35 7.45 Paco 35 45 HCOz 22 26 Acidosis P H 47 35 PaCo2 45 HCO 422 Alkalosis pH 77.45 PaCO2 435 HCO 26 Stages of Lymphedema Stage 0 No edema Stemmer negative Appears normal stage I soft pitting edema Reversible edema Stemmernegative stage 2 Hard swelling won pitting brawny edema Stemmerpositive Stage 3 Hard swelling won pitting brawny edema Stemmerpositive Infections Papillomas deep skinfold warts hyperkeratosis Grading Edema Imile 244 21moderate trial in 15s 31 Severe 42 1 normal in 15 30s 41 very severe 71 lasts 305 Hoehn Yahr Classification PD Stage I Minimal Unilateral Stage Minimal Bilateral Balance not impaired Stage 3  Impaired righting reflexes unsteadiness when turning Live independently work stage 4 All symptoms Standing walking w assist Stage 5 Bed wheelchair bound MS Classification Relapsing Remitting Short duration attacks Full partial recovery most common wt Primary Progressive Steady increase in disability No attacks Secondary Progressive Initially RR Symptoms increase w o remission N Progressive Relapsing Clinically Isolated Syndrom Steady increase in disability attacks we  I Skin Receptors Meissner's Corpuscles touch texture Light Merkel Discs touch texture a pressure Light Pacinian Corpuscles Deep pressure vibration Ruffini Endings warmth stetch deformation within joints Krause End Bulbs Cold temp Staging Pressure Ulcers stage Intact skin Non blanchable redness stage 2 Partial thickness Pink red wound bed Shallow crater stage 3 Full thickness wound Fat tissue visible eschar present  g Stage 4 Full thickness Exposed bone tendon or muscle Slough eschar present Tunneling undermining Unstageable To much slough eschar Deep tissue injury Intact purple maroon skin Dressings Very mild exudate Transparent films Minimal exudate Hydrogel Hydrocolloid Moderate exudate Foams Heavy exudate Calcium alginates Hydrofibler Infected Hydrofiber Hydrogel calcium alginate guaze Burn Types  p Epidermis Dry red skin notopen 5 days no scarring Superficial partial thickness Epidermis some dermis Red weeping blister Blanches quick refill painful 10 14days minimal scarring Deep Partial Thickness Epidermis dermis pinprick white areas Blanches slowcapillaryrefill Red 3weeks Full Thickness Epidermis dermis some sub Q lack pain atemp leathery pressure Dry rigid have contractures More than 3 weeks may Subdermal Epidermis dermis Sub Q Charred exposed deep tissue dry intervention required possible amputation Surgical Rule of 9 s Head 4 552 4.5 Chest 18 Back 18 Arm 4.5 4.5 952913 Leg Perineum 1 Cerebral Artery Syndromes ALAS Contra hemiparesis LE Contra hemisensory loss LE Incontinence Urinary imitation bimanual tasks apraxia Impaired motor inaction Slowness delay 2 sucking reflex Contra grasp MCAS Contra hemiparesis UE face Contra hemisensory loss UE face L lesion Global typically Broca Wernicke or R lesion Disorders ex unilateral neglect Perceptual Contra homonymous hemianopsia PCAS Contra homonymous hemianopsia  Visual agnosia w o agraphia difficulty writing Dyslexia Color discrimination Memory deficits Topographical disorientation if lesion is central Thalamic pain syndrome temisphere Strokes Right Quick impulsive safety risk Rigidity of thought emotions Difficulty w negative Left cautious Slow Distractable Difficulty w positive emotions Brunnstrom Stages Stage 1 Flaccidity No active limb movement movement 2 minimal voluntary stage In  y Increase tone 3 control of movement synergies stage Voluntary Spasticity peaks 4 movement outside of stage synergy Decreased tone movement Stage 5 Increased complex Indepence from limb synergies Stage 6 Individual jointmovement Coordinated movement Stage 7 Normal Ranchos Los Amigos for TBI I No response Coma II Generalized response Non purposeful whole body vocal inconsistent III Local response Purposeful local specific inconsistent ex close eyes squeeze hand etc IV confused Agitated Heightened activity Does notcooperate incoherent confabulations No selective attention  y I confused Inappropriate Responds consistently to simple commands Inconsistent w complex commands Can socialize for short periods Inappropriate use of objects Can t learn new tasks VI confused Appropriate Goal oriented behavior Carry over of previous skills VII Automatic Appropriate Oriented in home 2 hospital Daily routine Judgementimpaired can initiate social or recreational activity VIII Purposeful Appropriate Carry over of new skills Difficulty w emergency situations abstract Reduced tolerance to stress reasoning Metabolic Syndrome 3 need to be present waist circumference 40 in for male 35in forwomen Triglycerides 150mgdL orhigher HDL 240mg 2L in men 250mg dL in women BP diastolic 285 Systolic 130 and or Fasting Plasma Glucose 7100mg dL Hypothalamus Anterior Pituitary ACTH TSH Frogs like practically all FSH LH things green GH Prolactin Posterior Pituitary ADH Vasopressin Oxytocin Addison's Disease Causes infection neoplasm hemmorage autoimmune Adrenal insufficiency 1 cortisol aldosterone BP dehydration Hyperkalemia  glucose Bronze skin MSH weightloss anorexia GI disturbance weakness Intolerance to cold stress anxiety depression Cushing's Disease Cushing syndrome cause Adrenalgland issue tumor w M ACTH cortisol aldosterone notpituitary issue BP water retention Hypokalemia Ruddy appearancestriae on skin weight gain obesity moon face Proximal weakness atrophy infection osteoporosis buffalohump poorhealing hyperthyroidism Ts Ty lowTSH HR BMR Heat intolerance Increase glucose absorption Restless Diarrhea hair moist palm  y Weightloss appetite sweating Hyperreflexia Grave's Disease hypothyroidism Tz Ty highTSH 1 HR SBP DBP BMR Cold intolerance glucose absorption Tiredness Proximal muscle weakness Constipation Brittle nails dry skin weightgain appetite sweating delayed reflexes Hashimoto's disease swelling Myxedema typer US Hypoparathyroidism Hyper bone weakness 1 density renal  P i eys go weakness if pep yconfusion ulcers proximal muscle fatigue depression drowsiness glovestocking sensory loss Hypo low calcium Convulsions arrhythmias twitching cramps spasms sensory loss f fingertips mouth fatigue weakness Diagnosing DM Fasting blood glucose levels 126mg dL Random blood glucose level 7200mg dL HbAIC normal 4 6 10 need insulin therapy typoglycemia Glucose 270mg dL Pallor sweating Shakiness Poor coordination unsteady gait Tachycardia Dizziness fainting Hunger slurred speech  I Lose of consciousness typerglycemia Glucose300mg dL weakness mouth Dry Frequent urination Deep rapid respiration Dull senses confusion reflexes Thirst Fruity odor Coma Glucose Exercise Exercise in morning well hydrated Glucose w exercise Insulin w exercise 100 250 dL is safe mg 70 99mg dL have snack 470 or 300mg dL notsafe Pain Patterns RUQ Gallbladder Peptic ulcers  Head of pancreas RLQ Appendix Crohan's disease LLQ Diverticulitis Ulcerative colitis IBS Ifil of pancreas Spleen APGAR Score Peds Appearance o blue I blue extremities 2 No blue P v18 absent 1 005pm 2 100 1405pm Grimace 0 no response 1 grimace 2 widthdrawal Cry Activity o flaccid 1 some flexion  2 active motion Respiration o absent 1 weakcry 2 strongcry Milestones 3 months Prone on elbows Lift head in prone crawl 3 9months Belly 3 4 months Supine to sidelying 5 6 months Prone to supine Pull to sit Sitting UE support Feet to mouth 6 7 months Supine to prone Quadruped Ring sit hands Transfers objects between Trunk rotation 9 10months Quadruped creeping Cruises sideways Pulls to stand chuck 10months Improved grasping pincer jaw months  walk unassisted In out of squating 10months controls grasp release stacks cubes Neonatal Reflexes Flexor Widthdrawal Integration 1 2mo Crossed Extension Integrated 1 2mo Rooting Integrated 3 mo Traction Integrated 2 5mo ATNR Integrated 4 6 no Palmar Grasp Integrated 4 6mo Moro Integrated 5 6mo STLR Integrated 6mo Positive Supporting Integrated 6mo Plantar Grasp Integrated 9mo STNR 12mo  g Motor Classification for CP Level 1 motorskills walk w o restrictions but limitations with advanced Level 2 Limitationswalking outdoors community w o AD Level 3 walk w AD w limitations walking outdoors community Level 4 Self mobility limited powermobility outdoors a community Levels limited need caregiversupport Severely Erb is Klump keg Erb MOI stretching head downward Loss ofabd lateral rotation ofshoulder waiter's Tip Klumpke MOI stretching arm overhead Intrinsic hand paralysis Claw hand Joint motion for bait Hip stance 0 30 flex 0 10 20hyperext Swing 20 30 flex knee Stance 0 40 flex  Swing 0 60 flex Ankle Stance 0 10 df 0 20pf Swing 0 20 at Spinal Cord Syndromes PCS DCML ACS STT corticospinal Brown Sequared DCML loss ipsilateral below STT loss contralateral at below Corticospinal lossipsilateral below Conus medullaris vs cauda Equina Conus Medullaris Bilateral symetrical in perineum thighs Saddle distribution bilateral symmetrical Symmetricalmotor loss UMN LMN Cauda Equina Unilateral asymetrical in perineum thighs leg back Saddle distribution unilateral asymetrical motorloss Asymetric LMN Classification A n ASIA A Complete No motor or sensory function at 54 55 ASIA B Incomplete Sensory but no motor below level of injury ASIA C Incomplete Less than halfof keymuscle below level have 3 ASIAD Incomplete At least halfof keymuscle below level have 3 ASIA E Normal Motor is lowest level where 3 5 is presentwith 5 5 above is lowest level where 2 is present Sensory Thermal modalities Increase CO Vasodilation HR RR metabolic Rate Decrease muscle activity BP Blood to  g Blood to resting muscle SV Cryotherapy Increase Jointstiffness Painthreshold muscleactivation Decreased collagen extensability Blood flow Capillary permeability Local metabolism spasticity Nerve conduction E stim Parameters for Muscle Strengthening 35 80 pps 150 200ms for smallmuscle 200 350ms forbig 50 120soff On off ratio of 1 5 intially 6 105 on Ramptime of 2s HUPC Electrode promoteswound healing w o inflammation infected words Electrode promotes wound healing w inflammed or Ionto negative Polarity Scars Iodine  Analgesic Salicylate Calcium deposits Acetate Inflammation Dexamethasone EMG Low sensativity for muscle relaxation closely pack sensativity for muscle re ed for part High Isolation Precautions Contact MRSA VISA VRE C Diff lice scabes impetigo bacteria iarrhea HepA Hep B Dermatitis Rota Virus Droplet Rubella Strep Meningitis Pneumonia Influenza Pertussis Airborne Measles TB Varicella SARS Herpes ZosterChickpoxSmallpox Wheelchair Measurements SeatHeight Heel to popliteal fold 2 SeatDepth Posterior buttockalongthigh to popliteal fold 2 Seat width Widest aspectof buttocks of thighs 1.5 2 Back Height Chair seat to axilla 4 considerseatcushion Armrest Height  g Seat to olecranon 1 consider seat cushion 3PPU Causes Infection Trauma Vestibular weakness Age Canalithias min Cupulolithias 1min Maneuver for canalithias Epley Semont Liberatory maneuver for cupulolithias Brandt Daroff exercise fortreatment Horizontal canal use supine roll Geotropic Canal sideothers Ageotropic Cupulo sideofless intense Seripheral Vestibular Disorders Labyrinthitis Sudden onsetof vertigo nausea vomiting Positive head impulse Days to weeks HEARINGLOSS VestibularNevitis Suddenonset of vertigo nausea vomiting Positive head impulse Days to weeks Meniere's Disease Over production offluid increase pressure Vertigo  p g Hearing loss Aural Fullness minutes to hours Acoustic Neuroma Vestibula Schannoma Hearing loss Loss of balance Vertigo Facial numbness weakness r ECG p P wave AtrialDepolarization Contraction I a fit QRS atrial repolarization Ventricular depolarization Nentrical contracts atrium relaxes T wave Ventrical repolarization vertical relaxes AV Heart Blocks 1ˢᵗ degree continue exercise conduction PRinterval 1box seen in athletes Delay in 2ⁿᵈ degree or mobitz interval is block in conduction R Partial missing proceed gp Type 1 Pattern PR interval gets longer y.l.EE fibers affected 2 No pattern bundle of his purkinje moreserious Type  les 3ʳᵈ degree call911 conduction Full block in interval always changing QRSusuallywide No relationships PR ST Segment Depression Ischemia 2mm 2littlebox drop is an emergency Decreased blood supply Infarction elevation STsegment Call911 Supraventricular Arrhythmias AtrialTachycardia 100 250bpm Atrial Flutter sawtooth Stop exercise but 250 350bpm No911 for atrial conditions Fibrillation difficutto see pwaves lotsofhumps Atrial 400 600bpm Tremature Ventricular Contraction Ventricles contract before atria No P wave strange QRS 23 PUCs in row is ventriculartachycardia Levels of Evidence meta analysis 2 SR 3 RCT 4 Cohortstudy Case control series 5 cross sectional 6 series report 7 Case Cardiac Rehabilitation Phase I when patient is stable Education ECGmonitoring Phase II 24hrs after d c 6weeks 50 70 HRmax Phase III 5to 6 weeksfromdischarge 70 to 85 HRmax Can begin resistance training Phase II maintenance 6 to 12months GI Diseases GERD Heartburn 30 to 60min after eating Atnight lyingsupine LUQ Hiatal Hernia Heartburn 30 to 60min after eating  I 9 Atnight lyingsupine LUQ Peptic Ulcer Coffee groundemesis Melenatarry stools increase w food Gastric ulcer pain increases w o food Duodenalulcer pain RUQ Epigastricpain Cholecystitis Pain increases afterfatty food Positive Murphy's sign RUQ usually scapula Crohn's Disease Pain decreased w passing gas Reactive arthritis RLQ umbilicus low back Ulcerative Colitis Bloody diarrhea w mucus or pus LLQ lowback rectal pain IBS Abdominal cramping Ribbon like stools Decreasepain w bowel movement rest LLQ Appendicitis McBurney's point Fever WBC  RLQ Liver Disease light colored stool dark urine easybruising hand tremor RUQ