628 Maturity Final Practical 628 PDF

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Maturity Final Practical Instructions: 1. Discuss case first, name 5-7 things to examine (coordination, tone, proprioception, strength, etc.) with a rationale for this patient. Proctor will choose 1-2 to perform. 2. Then we get a 2nd part of the case, which we will get evaluation findings/discuss, and we must give treatment ideas with rationale. Then we will perform a treatment (i.e. Bed mobility, transfers, gait etc.) Examination: systems review, Disorder Definition Signs and Symptoms Functional Screens Treatment Ideas musculoskeletal screen plus the following 1. Convergence / divergence – diplopia 1. Sit to stands 1. DGI Multiple Sclerosis Autoimmune disorder characterized 1. UMN signs (coticospinal tract) by inflammation, demyelination of oligodendrocytes and glial scars in the brain and SC resulting in an UMN lesion

2. Sensory (DCML) signs 3. Coordination issues 4. Intention tremors 5. Fatigue 6. Diplopia, Nystagmus 7. Lhermitte’s sign 8. Psuedobulbar affect 9. Uthoff syndrome

2. Extraocular ROM – check for nystagmus 2. Coordination – Finger to nose - tremor, finger to therapist finger, pro/sup, tapping, heel to shin 3. Sensation – light touch 4. Proprioception 5. Tone – Ashworth scale (spasticity) 6. DTR’s + check clonus or Babinski 7. Transfers 8. Static and dynamic sitting//standing balance 10. Standing balance 9. Gait – ataxia

2. TUG 3. Tinetti 4. Berg 5. 12-item MS walking scale 6. Timed 25 foot walk

Parkinson’s Disease

Progressive neurodegenerative disorder caused by a loss of dopaminergic neurons in the BG

1. Tremor – resting 2. Rigidity 3. Akinesia / Bradykinesia 4. Postural Instability

1. Proprioception 2. Coordination -Finger to nose, finger to therapist finger, pro/sup, tapping, heel to shin, Arms straight out look for tremor 3. Tone –rigidity – Trunk rotation 4. Open and close hand tests for Bradykinesia 5. Pull test – postural instability 4. Reflexes 5. Transfers 6. Static and dynamic sitting//standing balance 7. Gait

1. Mini BestTest 2. TUG 3. 6MW 4. 10MW 5. Functional reach 6. Berg 7. 5 times sit to stand

Stroke

Rapid onset of neurological deficit due to an interruption of blood flow within as a resultant of ischemia or hemorrhage of blood vessels

Cortical 1. Frontal – executive dysfunction 2. Temporal – memory and language impairments 3. Parietal – sensory impairments 4. Occipital – vision impairments

1. Tactile localization 2. Proprioception 3. Cranial Nerve (extra ocular movement) 4. Tone – Ashworth scale (spasticity vs. rigidity) 5. DTR’s – Babinski, chaddock, abdominal 6. Righting and Equilibrium reactions 7. Coordination – pro/sup, finger to nose (look for disdiadokinesia and dysmetria) 6. Motor control – synergy patterns 6. Motor coordination – heel to knee 7. Transfers 8. Static and dynamic sitting//standing balance 9. Gait

1. Berg 2. Tinetti 3. Functional Reach Test 4. TUG 5. Four Square Step Test 6. 6MWT 7. 10MW

Cerebellum 1. Balance impairments 2. Coordination impairments Brainstem 1. Breathing 2. Swallowing 3. HR + BP

2. Bridging 3. Ankle DF w Theraband 4. Aerobic conditioning – bike / treadmill 5. Static balance exercises – Romberg, SLS 6. Dynamic balance exercises – Step fwd  neutral  bkwd, heel-toewalking, side stepping, bkwards walking 7. Coordination and ataxia training – supine straighten one leg and heel slide the other and alternate, sitting DF /PF 8. Bed Mobility 9.. Transfers 10. Gait 11. Stairs 1. Walking w dual tasks – head turns 2. Big movements – side stepping, fwd, backward (compensatory strategies) 3. PNF – Rhythmic initiation 4. Static & Dynamic balance exercises 5. Coordination training – supine straighten one leg and heel slide the other and alternate, sitting DF /PF 6. Bed Mobility 7. Transfers 8. Gait 9. Stairs

1. PNF 2. NDT 4. Static & Dynamic balance exercises – using bean bags and reaching fwd, catching a ball 5. Weight shifting – LE exercises on unaffected limb i.e. tapping 6. Bed Mobility – bridging, PPT, reaching to roll, sitting at EOB, 7. B/L training – stacking blocks, throwing bean bags 8. Mental Imagery 7. Transfers – sit to stand 8. Gait – reciprocal patterns, full step length, hip extension 9. Stairs 10. Treadmill training 11. Constraint induced mvmnt therapy

Anterior THR

Hip replacement affecting TFL and Sartorius as well as medial to rectus femoris muscles

1. Decrease ROM and strength 2. Decrease Balance and proprioception 3. Gait deviations 4. Decreased Balance 5. Decreased proprioception 6. No excessive hip extension – take a shorter step on non-involved side

1. Sensation 2. Proprioception 3. Gross AROM 4. Gross Strength 5. Bed Mobility 6. Sitting and Standing Balance 6. Transfers 7. Gait 8. Stairs

1. TUG 2. Berg

1. Quad and Glute Sets 2. Ankle pumps 3. Knee Ext in to pillow 4. SAQ (Sitting) 5. Heel slides (sitting/supine) 6. Seated Marches 7. Hip abduction (sitting/supine) 7. Bed Mobility 8. Sitting and Standing Balance 9. Transfers 10. Gait 11. Stairs

Anterolateral THR

Hip replacement affecting TFL, Gluteus medius and minimus, vastus lateralis, rectus fem. (part of abductor mechanism must be detached) muscles

1. No excessive hip extension 2. No Abd 3. No ER

1. Sensation 2. Proprioception 3. Gross AROM 4. Gross Strength 5. Bed Mobility 6. Sitting and Standing Balance 7. Transfers 8. Gait 9. Stairs

1. TUG 2. Berg

1. Quad and Glute Sets 2. Ankle pumps 3. Knee Ext in to pillow 4. SAQ (Sitting) 5. Heel slides (sitting/supine) 6. Seated Marches 7. Bed Mobility 8. Sitting and Standing Balance 9. Transfers 10. Gait 11. Stairs

Posterolateral THR

Hip replacement affecting fibers along Glute max Between gluteus medius and minimus (no muscle bellies involved) w/ trochanteric osteotomy (Short ER)

1. No hip flexion > 90 2. No Add past 0 3. No IR 4. Foot drop (sciatic nerve) or Trendelenberg (s gluteal nerve)

1. Sensation 2. Proprioception 3. Gross AROM 4. Gross Strength 5. Bed Mobility 6. Sitting and Standing Balance 7. Transfers 8. Gait 9. Stairs

1. TUG 2. Berg

1. Quad and Glute Sets 2. Ankle pumps 3. Knee Ext in to pillow 4. SAQ 5. Heel slides to 45 6. Hip abduction 7. Bed Mobility 8. Sitting and Standing Balance 9. Transfers 10. Gait 11. Stairs

1. Decrease ROM and strength 2. Decrease Balance and proprioception 3. Gait deviations 4. Decreased Balance 5. Decreased proprioception

1. Sensation 2. Proprioception 3. Gross AROM 4. Gross Strength 5. Bed Mobility 6. Sitting and Standing Balance 7. Transfers 8. Gait 9. Stairs

1. TUG 2. Berg

1. Ankle Pumps 2. Quad/Glute sets 3. Assisted SLR 4. TKE/Active and AA LE exercise 5. Heel slides sitting 6. Seated Marches 7. Transfers 8. Gait training 9. Stairs

Total Knee Replacement...