PT600 Final Study Guide PDF

10/19 Vitals Review - Pulse palpation and rate - Measuring peripheral pulse amplitude - Wash hands :) - Limb supported position, encourage relaxation - 2 fingers over pulse site - Apply firm/moderate pressure (period 5-10 sec) - Important to see c...

10/19 Vitals Review - Pulse palpation and rate - Measuring peripheral pulse amplitude - Wash hands :) - Limb supported position, encourage relaxation - 2 fingers over pulse site - Apply firm/moderate pressure (period 5-10 sec) - Important to see cardiac function based on initial evaluation symptoms - More difficult to feel pressure - Low BP - Dehydration - Less difficult - High BP - Pregnancy - Pulse palpation guidelines - Start distal, move proximal if pulse cannot be obtained - Palpation should be done using the fingertips and intensity of the pulse graded on a scale of 0-4 - 0= no palpable pulse - 1= indicating a faint, but detectable pulse - 2= normal - 3= increase of fill - 4= pounding pulse - Don’t use your thumb- will probs feel your own heart rate and skew results - Radial artery pulse - Brachial artery pulse - Right arm → examiner supports forearm in left hand w/ subjects arm abducted, the elbow slightly flexed, and the forearm externally rotated - Examiners right hand is then curled over the anterior aspect of the elbow to palpated along the course of the artery just medial to the biceps tendon, lateral to medial epicondyle - Carotid artery pulse - Examine with patient supine, trunk slightly elevated - Chin should be elevated, allows for easy palpation - Fingers should be between the larynx and the SCM - Apply light pressure - Dorsalis pedis artery pulse - Examined with the patient in the recumbent position and the ankle relaxed - Place the fingertips transversely across the dorsum of the forefoot near the ankle - The artery usually lies near the center of the long axis of the foot (between the 2nd and 3rd metatarsal) lateral to the extensor hallucis tendon but it may be aberrant in location and often requires some searching - This pulse is congenitally absent in approximately 10% of individuals - Posterior tibial artery pulse  - Lies just posterior to the medial malleolus - Felt most readily by curling the fingers of the examining hand anteriorly around the ankle, indenting the soft tissues in the space between the medial malleolus and the achilles tendon above the calcaneus - The thumb is applied to the opposite side of the ankle in a grasping fashion to provide SEE LECTURE - Obesity and edema make it hard to find - Popliteal artery pulse - Passes vertically through the deep portion of popliteal space - Patient should be in supine with knee bent and examiners hands should encircle and support the knee from each side - Press deeply into popliteal space w supporting fingertips, patient should be instructed to let the leg go “limp” - May be difficult to palpate in obese or very muscular individuals - Femoral artery - Common femoral artery emerges into the upper thigh from beneath inguinal ligament one-third of the distance from the pubis to the anterior superior iliac spine - Remember NAVEL - Press deep below the inguinal ligament and about midway between symphysis pubis and anterior superior iliac spine - Externally rotating the thigh helps in presenting the artery for palpation - Larger patients may require to use two hands, one on top and the other feeling for pulse - Pulse rate instructions - Can only take with reasonable reliability on carotid or radial artery pulses - To determine pulse rate, palpate the beat @ a pulse point of the radial or carotid artery - Can be done either in 15, 30, or 60 seconds, a more accurate reading would be for the full 60 seconds or at least 30 sec - 15 sec acceptable during exercise - Especially in patients w arrhythmias - Record your measurement beats per minute bpm - Always wear a watch or know where the clock is - DON’T USE CELL PHONE - Ventilation - Observation - Initial inspection- disposition: distress, short of breath, somnolence [sleepy], noisy, wheezy etc. - Body position/posture: normal, Barrel Chest, slouches, guarding, pes escavatum (indented chest) or Pectus carinatum (protruded chest) - Breathing pattern: - Rate and depth  - Amount of accessory muscle usage: these muscles are always active but in times of distress can be excessive - Asymmetrical paradoxical chest wall movements - Normally the chest wall and abdomen should move in the same direction during inspiration and expiration. Nasal flaring → opposite happens in asymmetrical paradoxical movements [chest up, belly in// chest down, belly out] (pressure gradient disrupted) - Pulse oximetry RA or with supplementation (what delivery method?) - Respiratory rate - Hands on shoulder technique - Place hand on patient shoulder - Measure the amount of times the chest rises and falls for one min - Each cycle counts as one breath - Normal 12-20 breaths per minute - Visualization - Focus on shoulder or chest wall - Measure the amount of times the chest rises and falls, for one minute - Each cycle counts as one breath 10/21/22 Pulse Oximetry - Pulse Ox (SpO2) - Pulse Oximetry indirectly measures the arterial blood oxygen saturation of hemoglobin in arterial blood - SaO2 is a direct measure of oxygen saturation taken from ABG - A healthy individual with normal lungs, breathing air at sea level, will have an arterial oxygen saturation of 95-100% - A referral for medical evaluation is advised when resting SpO2 below 90% - Consistency of the pleth waveform can inform accuracy of measurement - Pleth waveform corresponds to blood flow - Uniform wave indicates good perfusion - Factors that impair accuracy - Bright ambient light on probe - Nail thickness including nail polish - Skin pigmentation - Low peripheral perfusion states - Hypoxemia (B2 - Isoproterenol for bradycardia; B1>B2 - *Terbualine, metaproterenol albuterol; B2>B1 - Beta Blockers-Indications - Angina – chest pain - HTN - Arrhythmia prophylaxis post MI - SVT – supraventricular tachycardia Heart failure - Hypertrophic cardiomyopathy - Migraine - Glaucoma - Beta Blocker Effects - Reduced cardiac output - Reduced HR and force of contractions - Reduced automaticity of all cardiac pacemakers - Slowed AV conductions - Slowed rate of cardiac contraction - Beta blockers - Usually end in suffix “-lol” - Labetelol and carvedilol - combined beta and alpha blocking actions - Nadolol , propranolol, timolol - non selective beta receptor antagonists* may cause bronchospasm with obstructive lung disease - Acebutolol, atenolol, esmolol, metoprolol - Beta 1 cardio-seleective affinity - Beta blocker adverse effects - Bradycardia - AV block - Heart failure…? - Pt’s with obstructive lung disease may suffer bronchospasm - *Symptoms of hypoglycemia may be masked - CNS effects: fatigue, sedation, sleep, alteration  - ** Do not stop medications abruptly** - Beta blockers with trade names - Calcium channel blockers - Effective vasodilators (arterial vascular smooth muscle); CCBs do not work on venous smooth muscle - Reduce the force of contraction in the heart - Slows the conduction of electrical activity within the heat thus decreases hr - By blocking calcium signal on the adrenal cortex cells they directly reduce aldosterone production = lower blood pressure - Dihydropyridine Calcium Channel blockers - LOOK AT SLIDES - Non- Dihydropyridine calcium channel blockers - Verapamil and diltiazem (cardizem) indicated for angina, HTN, arrhythmias(A- fib, SVT), cardiomyopathy - Cardizem with less negative hemodynamic effect - Reduced myocardial oxygen demand - (-) ionotropic chronotropic effects - Reduced systemic vascular resistance - Coronary vasodilation - Diuretics - Effects on the kidney (tubular transport of the nephron) - Diuretics are divided based on their different actions on the nephron tubules - “Out the body into the potty” - Osmotic diuretics - Mannitol (Osmitrol) - filtered into the glomerulus but poorly reabsorbed by the tubule; it remains in the lumen and “hold water” - Increases volume of urine via osmotic effect - Works mostly in the proximal convoluted tubule; decreased reabsorption in the descending limb of the Loop of Henle and the collecting tubules - Adverse effects; hypo/hypernatremia, pulmonary edema, headache, nausea, vomiting - Loop Diuretics  - Furosemide (Lasix); Bumetanide; Toresmide - Inhibits the cotransport of sodium , potassium, and chloride - Relatively short acting - Diuretics occurs over 4 hour period following a dose - Effect at the Loop of Henle - Used to treat edematous states including heart failure, acute pulmonary edema - Adverse effects: potassium wasting (hypokalemia): orthostatic hypotension, reflex tachycardia - Ototoxicity (consequences for vestibular system) - Thiazide Diuretics - Hydrochlorothiazide (HCTZ or HCT) - Diuresis in 6-12 hours - Inhibits sodium chloride transport in early segment of distal convoluted tubule resulting in decreased BO - Sometimes used in conjunction with loop diuretic for synergistic effect with marked diuresis - Potassium sparing diuretics - Spironalactone; Eplerenone; Amiloride; Triamterene - Steroid derivatives that act as pharmacologic antagonist of aldosterone in the collecting tubules - Result in increased sodium clearance and a decrease in potassium and Hydrogen ion excretion - May cause hyperkalemia and metabolic acidosis - Clinical relevance for rehab - Drugs used to improve cardiac performance or decrease workload improve participation in rehabilitation - Appropriate warm up/ cool down necessary for patients - Thiazide and loop diuretics can cause hypokalemia - Bronchoconstriction is a problem with beta receptor antagonists, especially asthmatics - Beta receptor antagonists blunt the early manifestations of hypoglycemia in diabetes - Watch for depressed cardiac rate, orthostatic hypotension, reflex tachycardia - HR should not be used as a marker of exertion for patient on beta blockers - Cardiac output may be depressed during aerobic activity - Altered potassium levels can cause paresthesia, decreased skeletal muscle function, arrhythmias, and increase cramps - Aerobic activities may initiate cardiac arrhythmias - Screen lab values and med list prior to eval/treatment - Check vitals per/post aerobic activities - Monitor EKG during activity - Use of objective scales for workload: Borg RPE (6-20 → correlates to heart rate [6 - lowest, 20 - highest]) and Dyspnea scales - Use your stethoscope 11/16 transfers - Definition: moving a patient from one support surface to another - PT will evaluate the patient's ability to perform transfers and utilize transfers as part of treatment - Goals of PT - Facilitate and educate the pt to accomplish transfers in as safe and efficient manner - PT’s also responsible for educating family members and nursing/caregiver staff on proper transfer techniques - Pre-transfer - Evaluation - Review patient chart - Mental status (cognition) - Pain level - Gross ROM assessment - Gross strength assessment (shoulder depressors, hip flexors, hip ext. Knee ext.) - Bed mobility - Balance - Motivation - (All can be done quickly) - Pre-transfer set-up - Knowledge of precautions - Weight bearing, surgical motion restrictions (THA), medical status (orthostatic, contact/isolation), skin integrity, bracing (lumbar fusion) - Transfer set-up - #1: safety of pt and therapist/caregiver - Set up environment - KEY to successful and safe transfer - Before you move the pt, set up the environment - Determine and gather equipment - Clear obstacles - Manage ALL lines and tubes - Set up destination surface (wheelchair, bed, toilet, mat, etc.) - All surfaces locked and clear (leg rests/arm rests removed) - Patient privacy & modesty (gown/robe) - Proper footwear → shoes, anti-skid socks - ALWAYS USE GAIT BELT - When in doubt get assistance - Communication - Informed consent  - Pt has the right (and the need) to know what the overall goal/process is - “I’m going to help you to the chair right here… would that be okay?... first you are going to…” - May need to break down task in smaller steps - May need to demonstrate the activity - May need to simplify altogether - Egress test - Get to edge of bed - Clear bottom - Stand up - Wait 60 secs to check for orthostatic hypertension - Weight shift/sway - Couple steps forward and backwards - Assisted device close if needed - Transfer body mechanics - Practice, practice, practice - Utilize patient size and weight to your advantage - Utilize your size and weight to your advantage - PT is a full contact sport - Keep pt close, COM shifts toward added weight - Pivot toward pts stronger (uninvolved) side initially - Pivot do not twist - Position wheelchair/bedside chair/ commode closeby - Use momentum, belt, sling etc - Work with clear count or other audible initiation - PT leads initially→ patient increases - Levels of assistance - assisted - - Levels of assistance -independent - Types of transfers - Standing transfers - Knee stabilization (may be referred to as knee “blocking”) - Sit to/from stand - Seated pivot transfer - Standing pivot transfer - Dependent transfers - Mechanical lifts - 2 person lift - wheelchair to bed - Alternative method Firemen’s Carry - Floor transfers (wheelchair) - Forward - Backward - Seated transfers (wheelchair) - Sliding board - Sitting push up transfer - Sit to stand transfer set-up - Pre-transfer positioning - “Scoot forward” - To edge of surface - “Feet back” - Position feet under knees as much as possible (consider orthopedic limitations - “Push from the bed/chair” - (NOT on walker or therapist) - “Lean forward” - May need to “rock forward” for momentum - Double/Single knee stabilization - Stabilize only involved knee (both knees if bilateral involvement) - Double knee - Your feet outside patients’ - Your knees outside patient’s knees - Single knee  - Your feet on either side of one of the pt’s legs - Your knees on either side of one of pt’s knees - Usually “blocking” involved/weaker LE - Alternative method: - Your feet outside of patients - Align tibia diagonally to patient’s tibia/knees - FYI - May be referred to as blocking the knee - Use caution with limbs after orthopedic surgery - Summary: Sit to/from stand transfer - Scoot forward.. Feet back… hands here… lean forward - single/double knee stabilization as needed - Take a tandem stance as able - Squat and hip hinge as you stand, back straight - Use gait belt and assist patient from either the side or front of patient - Depending on level of assist - Standing pivot transfer - Transfer pt toward the uninvolved side initially - Position chair at an angle to and touching the plinth, lock chair - “Scoot forward… feet back… hands here…. Lean forward” - Stand and assist pivot using gait belt momentum - Cue patient to reach back to chair/bed as they slowly lower themselves - Squat-pivot transfer (low-pivot transfer) - Also referred to as seated pivot - Transfer pt toward their uninvolved side initially - Position chair, locked at angle & touching the plinth - “Scoot forward… feet back… hands here… lean forward” - Squat and hip hinge & assist patient as you stand - PT and patient remain in a squat position during pivot - Pivot the patient so their back will go toward surface - Used for patient who required mod to max assist & cannot be brought to a full stand 11/18 - Patient safety - Be prepared: monitor patient response to activity at all time - Bring necessary equipment (extra hospital gown, socks, goni, BP cuff, etc) - Always use gait belt - Consider the patient's cognition - Maintain proper body mechanics - Perform patient guarding - Utilize a second person when needed - Know precautions to mobility/WB status (spinal precautions: Bending, Lifting, Twisting) - Patient Guarding  - Consider pt’s size, weight, and level of impairment - Stand to the side (usually affected side) and behind the patient - One hand on the safety belt and the other on the patient's shoulder - NEVER grab the pt’s extremities - Use a 2nd person to assist or for w/c follow as need - Always expect the unexpected - Task Analysis - Visual analysis of task - Is the movement safe - Is the movement “normal” - Is the movement efficient? - Compensatory training approach - Achieving highest level of function using remaining abilities - Alternate ways to accomplish task - Use of intact segments to compensate - Energy conservation - Joint preservation - Adapting the environment - Assistive device - “Any device that is designed, made, or adapted to assist a person with a particular task” - Can the patient improve the impairment to return to full functional independence? - Can you provide assisted devices to reach modified independence? - Assistive devices for ADL’s - BADL: basic activities of daily living - Feeding, dressing, hygiene (showering bathing, oral hygiene), toileting, grooming - Physical mobility to complete these tasks (walking, use of w/c) - IADL: instrument activities of daily living - cooking , driving, play (for children) - Bariatric Equipment → bedside commode, crutches, wheelchair, bariatric chair bed, bariatric recovery bed - Considerations for Assistive Device Selection - WB (weight bearing) status and diagnosis - Prior history of using assistive devices - Mental and physical abilities - Environment to which patient will return - Expected or desired functional activities - Prognosis or regression of patients condition - Indications for an ambulatory assistive device - Limited weight bearing - Muscle weakness of trunk or LE - Absence of LE with or without prosthesis - Impaired balance or decreased kinesthetic awareness  - Pain - Weight bearing status - Full weight bearing (FWB): 100% of body weight - Non-weight bearing (NWB): no weight bearing through the involved limb, feet do not contact ground - Partial weight bearing (PWB): a percentage of body weight is borne through the involved limb (20-50%) - Toe-touch weight bearing (TTWB), aka touch down weight bearing (TDWB): only the toes of the affected extremity contact the floor to improve balance (should support body weight) - Weight bearing as tolerated (WBAT): limited by patient tolerance (pain) - Patient case #1 - Diagnosis: THA - Impairment: LE ROM, strength, activity restriction (postero-lateral THA precautions; dislocation precautions), limited weight bearing status (PWB) - Rationale for compensatory approach? - Interventions - Meal prep and cleanup? - Housekeeping? - Mobility? - Patient case #2 - Diagnosis: Trauma - Impairment: Limited ROM in UE, NWB status UE - Rationale for compensatory approach? - Interventions (adaptive equipment/adaptive techniques) - Meal prep and cleanup? - Dressing? - Mobility? - Mobility Assistive Devices - Parallel Bars - Walker - Cane - Hemi-walker - Crutches - Wheelchair - Proper Fit of Ambulatory AD - Increase stability - Decrease Energy Expenditure - Improve function - Maximize safety - Pre-Gait Activities - Weight shifting (lateral, anterior/posterior) - Alternate lifting UE/LE - Perform a triceps push-up  - Perform selected gait pattern - Practice moving forward, backward, sideways, and turning - Practice with device within bars - Pre-gait strengthening - Scapular stabilizers - Elbow extensors - Elbow flexors - Finger flexors - Hip extensors - Knee extensors - Dorsiflexors - Walkers - Standard (pick-up walker) - Rolling walkers (FWW) - Rollator (4WW) - Combination of maximal support/stability - Advantages - 4 point of floor contact - High level of stability - Sense of security - Lightweight and adjustable - Disadvantages - Difficult to store or transport - Difficult to use on stairs - Decrease speed of ambulation - Difficult to perform normal gait patterns - Difficult in crowded or narrow spaces - Eliminate normal arm swing - Proper fit - Line up top of walker with ulnar styloid process (crease of wrist) - 20-25 degrees elbow flexion - Greater trochanter for reference - Canes - Minimal stability and support - Primarily for assisting with balance - Does not allow for PWB - Typically used on the opposite side of involved lower extremity - Increased support with SBQC and LBQC (>BOS) - Can improve balance on unlevel surfaces, curbs, and stairs - Reduces forces acting at the hip - Proper fit for canes - With the patient standing erect, arm straight down at side, fit top of cane to the level of wrist crease, at ulnar styloid - 20-25 degrees of elbow flexion  - Lined up with greater trochanter - Hemi-Walker - Proper fit and gait patterns for hemi-walker will be the same as the cane - Increased stability - Held in the UE opposite of the involved side - May also see is called “walking cane” - Advantages: - Broad base of support - Increased stability, more than a quad cane - Can fold flat for travel/storage - Disadvantages: - Pressure may not be centered over hemi-walker - Difficult on stairs - Slower gait - Increased cost vs quad canes - Axillary crutches - Required increased coordination!!! - Advantages: - Improve balance and lateral stability - Provide functional ambulation for restricted WB - Easily adjusted - Inexpensive - Can be used on stairs - Disadvantages: - Tripod stance- awkward in tight areas - Tendency to lean on axillary bar - Proper fit of Axillary Crutches - When fitting, position with crutches 6 inches in front, 2 inches lateral - No greater than 3 fingers widths from axilla to top of crutch - Handgrip height – ulnar styloid process 20-25 degrees elbow flexion when grasping - Alternative Methods - Axillary Crutches - Multiply height of patient by 77% - Subtract 16 inches from the height - Pt in supine - use tape measure from anterior axillary fold to a point 6-8 inches lateral to heel - Pt in sitting- with BIL UE’s abducted to 90 degrees at shoulder level - One elbow extended, the other elbow bend to 90 degrees - Measure from olecranon process of flexed elbow to tip of the long finger of the opposite hand - Common errors in fitting AC - Patient does not stand erect, with slouched shoulders - Patient does not maintain wrist in neutral - Patient not wearing shoes during fit  - Crutch tips must be applied - Crutches not fit in the tripod position - Forearm crutches (Loftstand/canadian) - All levels of weight bearing - Highest level of coordination required - Advantages: - Forearm cuff allows functional use of the hands without the crutches disengaging - Adjustable - Allows stairs climbing - More cosmetic - Fits easier into car - Disadvantages: - Less lateral stability - Absence of axillary bar - Cuffs can be difficult to remove - Proper fit- forearm crutches - Fit with patient standing, crutches positioned six inches in front, 2 inches lateral - 20-25 degrees elbow flexion when holding hand grip (like up with wrist crease/ulnar styloid) - Arm piece - 1-1.5 inches below olecranon process - Arm piece should not interfere with elbow flexion What is functional training? - Training with a purpose Class 11/23 wheelchairs - Goals of seating - Provide overall postural stability and control to allow interaction with the environment - Enhance comfort and support function of body systems - Improve function at home and in the community - Minimize secondary impairments - Skin breakdown, contractures, etc - Wheelchair components - Frames types - Rigid frame - Folding frame - Frame structure - Heavy duty - Light weight - Ultra-light weight - Seat base - Sling - Firm  - Foam - Custom-molded - Cushions - Backrests - Sling - Firm - Foam - Custom-molded - Arm rests - Fixed - Removable or reversible - Full length - Desk arms - Height adjustable - Swing away - UE support surfaces - Removing armrests - Each chair may be diff - Find release button - Front and/or back - Pull armrest up with equal force anterior/posterior - May need to press release buttons again to guide back into place - Leg rests - Swing away - Detachable - Elevating - Foot rests - Foot plates - Heel loops - Removing footrests - Find swing-away handle - Easiest to remove when out to the side - Lift footrest up - Wheels - Front “casters” - Rear “drive” wheels - Hand rims - Standard - Vertical projections - Tires - Standard tires - Pneumatic tires (air filled) - Power-assist - Brakes  - Toggle lock - Z or scissor lock - Auxiliary lock for reclining back - Caster locks - Brake extenders - Anti-tip mechanism - ✨ Seatbelt (you can’t call it a seatbelt)... its a ✨ lap bel - Chest straps - Considerations - Physical need of patient - Rental vs purchase - Seating system - Functional mobility - Physical abilities - Cognition - Level of endurance - Manual vs power - Rental VS Purchase - Temporary - Permanent - used as primary mode of mobility - Assessment of Patient - Need to assess: - Functional ability/disability - Expected use of the wheelchair - Location - Purpose - Transfer needs - Wheelchair transportation - Home accessibility - Pts age, weight, height - Prognosis for change in pt.’s mobility status - Mental status - ROM, posture, balance - 5 key elements to measure for proper fit - Seat height - Seat depth - Seat width - Back height - Armrest height - Seat height/lower leg length - Measure from the patient’s heel to the posterior knee and add 2 inches to allow footrest clearance - The bottom of the footrest should be 2 inches  - You should be able to fit 2-3 fingers under the distal thigh (between the thigh and seat) - Average adult size= 19.5 to 20.5 - Seat Depth - Measure from patient's posterior buttock to posterior knee - Subtract 2 inches - Avoid pressure from front edge of seat against the popliteal space - You should be able to fit 2-3 fingers between the front edge of the seat and the patient’s popliteal fold with your palm horizontal to the seat - Average adult size = 16 inches - Seat width - Measure widest aspect of buttocks, hips, or thighs and add 2 inches - Provides space for bulky clothing (coats), orthoses, or clearance of trochanters from the armrest side panel - You should be able to place your hands between the patient’s trochanter, hip or thigh and the armrest panels with your hand positioned vertically to the seat, with slight contact to both. Both hands should be used at the same time - Average adult size = 18 inches - Back height - Measure from seat of chair to axilla with patient’s shoulder flexed to 90 degrees, then subtract 4 inches - This allows the final back height to be below the inferior angles of scapular - The inferior angles of the scapula should be approx. 1 finger-breadth above the back upholstery when the patient sits with erect posture - Average adult size = 16-16.5 inches - Armrest height - Measure from the seat of the chair to the olecranon process with the patient’s elbow flexed to 90 degrees, then add 1 inch - The patient should be able to sit erect, with level shoulders when bearing weight on the forearms as they rest on the armrest - Average adult size = 9 inches above chair seat - additional types of W/C - Heavy duty- adult - Pts weight is >300 lbs - For vigorous functional activities - Intermediate or junior - For a pt. Who is smaller than an average adult but larger than a child - Growing - Adjustable frame- used in pediatrics - Child or youth - For children under 6 years of age - Hemi-chair - For a pt with hemiparesis  - Seat is 2 in lower than standard - Allows to propel the wheelchair using one UE and one LE - One hand drive - 2 hand rims are attached to one wheel - Larger rim propels the drive wheel on the other side - 2 drive wheels are connected by a bar - When both rims are used at the same time, they propel both wheels - Amputee - Rear wheel axles are positioned 2 in posterior to that of the standard wheelchair - Widens BOS of the chair and compensates for the absent LE weight - Makes the wheelchair more stable - Power wheelchair / power scooter - Propelled by a battery system - Sports wheelchair - Lightweight, low back, angled wheels - Reclining - The back can recline to a full horizontal position - Has elevating leg rests and a headrest extension - Independent wheelchair mobility - Self-propulsion - Standard propulsion - Pt uses bilateral UE to advance wheelchair - Hemi propulsion - Pt uses one UE and one LE on the same side - One hand drive - Pt uses one UE to control both wheels - Turns - One vs two UE - With one UE, turning radius will be greater - Going through doors - Angle wheelchair - Open door - Use wheelchair to hold door open - Ramps - Up incline - Pt leans forward when facing the top of the hill - Pt leans back when using one UE and one LE while facing in downward direction - Down incline - Pt leans back, controlling descent with UE - Going up/down a curb - Use curb cutouts - Wheelie method  - Assisted wheelchair Mobility - Assisted/pushed in a wheelchair - Forward - Turns - Going through doors/entering hallways - Use mirrors - Backwards - Up and down ramp - Backwards and forward - Stairs - Generally with two people - Patient’s back to the stairs both up and down the stairs - Going up/down curb - Backwards or forward 11/30 Final exam review - True or False: you can use your thumb when palpating for the radial pulse? - False - True or False: You can only take a reliable pulse rate at the carotid and radial artery pulses? - True - You palpate your patient;s carotid pulse and it feels normal. What do you write in your documentation? - 2+ - True or False: Direct supervision applies to student physical therapists and student PTA - True - PTA stands for? - Physical therapist assistant - PTA’s are allowed to perform? - Interventions - Chest sticks out morphology = pectus carinatum - Chest sticks in morphology = Pectus excavatum - True or false: For ROM screening, perform AROM prior to the PROM - True or false: For strength screening, you should test the non-injured side first - A valgus movement at the heel would lead to which foot pathology? - Pes planus - Pronated foot - Collapsed arch - Which of the following is NOT part of pharmacokinetics? - PRODUCTION is NOT part - Absorption, distribution, and degradation ARE part - Betablocker?  - Propranolol - For a patient who requires max assist for a squat pivot transfer, which assistive device would be necessary to transfer them to a wheelchair? - Wheelchair with removable armrests - Your patient is non-weight bearing on BIL heels due to a recent fall. Patient has normal strength in BIL UE’s with normal sitting balance. Which transfer technique would be best to move this patient from the bed to the chair? - Quad pivot transfer Class lecture - Transfers/Slide Board - Zero lift policy - Occupational safety and health administration (OSHA): manual lifting of patients should be minimized in all cases and eliminated when feasible - Use mechanically assisted lifting when goal is simply to move the patient - Legal requirement in many states - Mechanical lift transfer (AKA hoyer lift) - Mechanical lift device to minimize physical labor and/or risk to caregivers - May required 2 person assist - Mechanical Lift - In bed, position sling under patient to support head through upper thigh/buttock region - Slide Hoyer into position over head of patient, opening base to widest position - Attach sling to hook on arm lever - Raise sling via mechanism to clear surface - One caregiver pivots the lift over the chair as second guards the patient’s head and legs into chair - Pivot, Sit to Stand - Two person lift - W/c should be positioned next to bed/mat with armrest removed - Cross Pt’s arms, from behind, your hands go under the axilla and hold opposite wrists - 2nd person bends pt’s knees and grabs underneath standing facing patient - Coordinate the move (talk out loud) - From w/c person behind should straddle wheel of w/c - Lift patient and move onto mat/bed - Practice chair to bed and back - Can also be used for bed/w/c to floor transfers - Two-person lift - alternative (Firemen’s Carry) - Therapists stand beside patient and grasp forearms forming a “basket” under knees and mid trunk - Coordinate the move (talk out loud) - Lift patient and carry away from w/c - Pivot patient to bed/mat  - Practice chair to bed and back - Can also be used for bed/w/c to floor transfers - Adapting Transfers - Not all transfers will work for all patients - Long leg cast - Hypertonicity - Amputees - Contractures - Orthopedic considerations - Use caution with orthopedic involved limbs when blocking or assisting in scooting - Total hip replacement- must avoid forward trunk - Total hip replacements - Neurological Considerations - Hemiplegia/Hemiparesis - Do not pull on the weak or involved extremities - Initially transfer to uninvolved side for safety, but will eventually need to practice both directions - Spinal Cord Injuries - May have internal fixation and/or external bracing, avoid distraction and rotation of trunk - No BLTs - Osteoporosis - Integumentary Considerations - Pressure Ulcers and Burns - Avoid shear forces (sliding transfers) - Patient should lift or be lifted to transfer from surface to surface - Wheelchair transfers - Transfer board - Build a bridge between sitting surfaces 12/2 - Group 1: Falls - DEB is the BEST and LINDSAY woooooo! - Great job - Falls are bad - Costs lots of money - Group 2: seizures - Categorized by three qualifiers - Beginning of seizures - Patient’s awareness during seizure - Whether movements happen during the seizure - Classification - Focal onset  - Generalized - Unknown - Types: signs and symptoms - focal - Aware - Unaware - Generalized - Impared awareness - Other types - Galstic - Febrile - Isolated seizure vs epilepsy - epilepsy= two or more unprovoked seizures that occur more than 24 hours apart - Patient with diagnosed seizure disorder - Time seizure - Clear environment - Don't stop movement - Don’t put anything in mouth - Turn on side - Support head with something soft - Note symptoms and movements - Let patient rest - Medical ID and Jewelry - Gives info such as - Medications - Allergies - Other medical info - When do you call 911? - Seizure is longer than 5 minutes - Repeated seizures - Injured during seizure - In an unsafe environment - First seizure - Complications after seizure - Individual has other medical conditions - THIS WILL BE ON EXAM - Group 3: different levels of consciousness - Alert: aware of surroundings - Confused: difficult to answer questions, perplexed, disorientated - Lethargic: drowsy and fatigued, decreased levels of responsiveness - Obtundation: similar to lethargic but more intense - Coma: unresponsive and unconscious - Grady Coma scale  - Numerical value to level of consciousness - Glasgow coma scale - Details of test to do to see how responsive someone is - Hypoglycemia - The brain does not produce glucose or store anywhere near the amount of glycogen it requires to function on a minute to minute basis - Hyperglycemia: - Primarily a concern in the presence of Diabetes Mellitus - In type 1: hyperglycemia indicates possible Diabetic Ketoacidosis - In type 2: indicates hyperosmolar hyperglycemic state, which does NOT cause ketoacidosis - Rapid correction of hyperglycemia may cause damage to brain cells as the correction of the osmolar gradient leads to water to rush back into cells after cells have already attempted to the pathological state → if hyperglycemic treatment is rushed, you could end up causing more damage. Treatment must be slow and over time - Orthostatic hypotension - Blood pooling in vessel= drop in blood pressure - Electrolyte imbalance - Brain swelling and shrinking due to imbalance - Hyponatremia: excess cellular water compared to sodium - Hypokalemia: imbalance of potassium - Most common for patients with traumatic bain injuries - Potassium is essential for maintenance of osmotic pressure, regulation of neural impulses, cell membrane potentials, pH, etc - Cerebrovascular trauma: damage to blood vessels in either the extracranial or intracranial component of the head - Probability of developing a stroke is increased after cerebrovascular trauma - Steps a physical therapist should take for this case - Return to supine position - Check vitals - Determine consciousness - If patient’s consciousness does not return to normal after going to supine, they may require immediate care from another medical professional - To prevent orthostatic hypotension, patient can do dynamic stretching, muscle pumping, and mobilization before sitting up - Assessing patients rom AND strength in areas affected by brain injury - Patients benefit from constraint-induced movement therapy → allows therapist to see which areas of the body are functioning properly - Group 4: Chest pain - Anginal pain - Angina: pain in the chest often due to accumulation of plaque and/or blockage in the coronary arteries  - Ischemia → insufficient oxygen to the heart - Types of angina - Stable - Increase in activity and generally predictable - Unstable - This can occur at any time, even at rest - Men vs Women - Similar between genders - Shortness of breath, chest pain, and pressure/tightness are overlapping symptoms - Women have more sever, sharper pain - Women have more jaw pain - Women have more variable symptoms - Women are more likely to experience myocardial infarction without chest pain - This makes it more difficult to recognize MI in women - It’s harder to pinpoint a heart attack in women due to the variability in symptoms - Non- cardiac causes of chest pain - More common is non cardiac 50-75% - Overwhelming majority of cases have to do with esophageal distress - Appropriate responses: - Hospital → take vitals - Outpatient → take vitals, take nitroglycerin or aspirin under the tongue, call 911 - Patients home → take vitals, take nitroglycerin or aspirin under the tongue, call 911 - Group 5: Respiratory Distress - Def: decrease in oxygen delivery to body - Signs and Symptoms: - Shortness of breath - Wheezing - Low blood oxygen levels - Causes - infection/illness - Pneumonia - Pulmonary edema - Sepsis - etc. - Injury - head/chest injury - Inhalation of harmful substances - Risk factors - Levels  - Minor difficulty - Normal Sp02 - Signs of difficulty breathing elevated HR - Monitor vitals - Moderate distress - SpO2 ~ 92% - Low O2 levels indicative of critical issue - Pt needs to go to hosp and contact physician - Severe distress - SpO2