Term
| what is "rehabilitation"? |
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Definition
| development of a person to the fullest psych, social, etc potential following an injury. |
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Term
| when did physical rehab become more mainstream in the US? |
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Definition
| after WWI - however physiatry become a dr-level profession after WWII to take care of the disabled. |
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Term
| what characterizes the team approach in physiatry? |
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Definition
| focus on comprehensive/interdisciplinary approach w/an informal atmosphere, full participation, well-understood objectives, comfortable disagreement, clear assignments/responsibilities, and the group should be self-conscious/examining. the physician should be a leader - but not a dictator. |
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Term
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Definition
| a pathological condition of the body with a unique set of s/s |
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Term
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Definition
| any *loss/abnormality of psychological, physical, or anatomical structure/function |
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Term
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Definition
| any *restriction resulting from an impairment of and ability to perform a normal activity. |
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Term
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Definition
| a *disadvantage resulting from an impairment or disability that limits a role that is normal for the individual |
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Term
| what does a physiatrist need to have a detailed understanding of? |
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Definition
| anatomy (functional relationships, kinesiology), electro physiology (nerve conduction, synaptic transmission, motor unit/muscle action potentials), mechanics (energy expenditure, effects of force on the musculoskeletal system), physiology (sequela of disability on biological systems), and psychosomatic considerations (effect of cognitive/behavioral systems in rehabilitation) |
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Term
| what does a physiatrist do? |
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Definition
| improve function among the disabled in 3 main fields: neurologic (stroke, TBI, SCI, MS, neuropathies), musculoskeletal (joint replacement, pain, sports injuries), and internal medicine (cardio, pulm, CA) |
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Term
| what functions does the physiatrist try to improve? |
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Definition
| mobility (bed mobility, transfers, ambulation), activities of daily living (bathing, toileting, dressing), cognition (visual-spatial perceptual, orientation, abstract thinking, memory), language (comprehension and expression), and sphincter control (bladder/bowel management) |
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Term
| what is the process from start to finish in physiatry? |
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Definition
| determine current functional level (hx, PE, functional exam), determine goals/develop tx protocol (prognostic indicators, complications, risks), treatment (therapy, medication, devices/equipment), and outcome/goals/completion. |
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Term
| why is it important to determine the current functional level? |
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Definition
| this will help determine current functional levels vs those before the incident and allows identification of potential risk factors, complications of tx, and restrictions/precautions. categories of functional levels: complete dependence (total assist is < 25%, max assist is 25%), modified dependence (moderate assist is 50%, minimal assist is 75%, and supervision is 100%), and independence (modified independence is w/a device or complete independence). |
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Term
| what characterizes the hx? |
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Definition
| chief complaint (7 dimensions of a symptom), psycho-social effects, hx (home environment, support system, substance abuse - is their coping mechanism healthy?), and classic (fam hx and ROS) |
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Term
| what characterizes the PE? |
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Definition
| this allows assessment of current levels (independence is the ultimate goal of tx) via: cognitive (folstein/clock exam, orientation, judgment, neglect, abstract thinking, *perception), language (content, fluency, articulation), cranial nerves (not just what the lesion is, but from a functional standpoint, where the patient stands), sensory (light - dermatomal, deep - joint position, stereognosis), motor control/coordination (gait, balance, romberg, tone - can inhibit functional motion), and reflex testing. |
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Term
| what is the key to muscle strength testing? |
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Definition
| isolation of the muscle (many substitution muscles can compensate for involved/weak muscles tested) |
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Term
| what is the muscle strength grading scale? |
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Definition
| 0: no movement. 1: trace movement. 2:movement only w/gravity eliminated. 3:movement possible against gravity - but not resistance. 4:full movement against gravity, some movement against resistance. 5: full movement against gravity/resistance. |
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Term
| what does the musculoskeletal portion of the PE consist of? |
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Definition
| inspection+palpation, joint stability assessment, and range of motion |
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Term
| what needs to be considered in determination of goals/tx protocol development? |
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Definition
| *information beyond acute medical findings which affects outcome: medical (does the pt have a condition which might limit overall progress ?), social economic, and pre-existing conditions - all need to be documented initially. *potential problems which can arise from condition/tx: DVTs, pressure ulceration, joint contracture, fractures/trauma, heart attack |
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Term
| what does physical therapy treatment consist of? |
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Definition
| *modalities such as heat/cold/US/EStim to improve pain/edema/ROM and *mobility retraining (transfers, walking, wheelchair use, bracing, prosthesis) to maximize functional mobility |
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Term
| what are the elements of an rx for heat/cold? |
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Definition
| indication/dx, modality, location, intensity, duration, and frequency |
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Term
| what are the factors to consider in tx modality selection? |
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Definition
| target tissue, depth and intensity of heating/cooling required, body habitus (fat?), comorbid conditions (neuropathy, vascular disease, etc), specific pt features (implants, pacemaker, cold allergy), age, and sex |
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Term
| are are the 2 mechanisms of heat transfer in modality tx? |
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Definition
| *conduction: transfer of heat when the hot pack is placed on an area of the body. *convection: water/air circulating and facilitating transfer of heat/energy. |
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Term
| what is heat specifically used to treat? |
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Definition
| musculoskeletal conditions (tendinitis, tenosynovitis, bursitis, capsulitis), pain, arthritis, contracture, muscle relaxation, and chronic inflammation |
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Term
| what are the physiologic effects of heat? |
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Definition
| hemodynamic (increased blood flow, decreased chronic inflammation, increased acute inflammation, increased edema, increased bleeding), neuromuscular (increased nerve conduction velocity), joint/connective tissue (increased tendon extensibility, increased collagenase activity, decreased joint stiffness), misc (decreases pain) |
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Term
| what are the types of heating modalities? |
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Definition
| superficial (max temp in skin/subcu fat) and deep (max temp in soft tissue: 40-45 degrees C, via US, short wave and microwave) |
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Term
| what characterizes the use of US as a deep heat modality? |
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Definition
| US produces a high frequency acoustic energy causing thermal effects in tissue. selective heat to different tissues is possible - US is commonly used for joint and tissue simultaneously. indications: particular inflammation, contractures. |
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Term
| what is an important caveat for heat as a tx modality? |
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Definition
| heat will increase the metabolic needs in that area and if the blood supply there is not sufficient, necrosis could develop |
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Term
| what are the physiologic effects of cold? |
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Definition
| hemodynamic (cutaneous vasoconstriction initially followed by reactive vasodilation = decreased inflammation), neuromuscular (slowing of conduction velocity), joint and connective tissue (temporary loss of spasticity, increased joint stiffness, decreased tendon extensibility), and misc (decreases pain, increases general relaxation). cold is more superficial in its effects. |
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Term
| what is cold specifically used to treat? |
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Definition
| musculoskeletal conditions (sprains, strains, tendinitis, teno-synovitis, bursitis, capsulitis, myofascial pain, following certain orthopedic sx, spasticity management, and emergency tx of minor burns. |
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Term
| what is an important caveat for cold as a tx modality? |
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Definition
| pts w/poor peripheral vascular function/arterial insufficiency |
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Term
| what are some common types of cold tx modalities? |
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Definition
| cold packs or ice massage |
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Term
| what is the general principle behind therapeutic exercise? |
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Definition
| greater stress than accustomed to must be applied over time in order to have adaptation in a muscular component and create change (strengthening). |
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Term
| what is isometric exercise? |
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Definition
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Term
| what is isotonic exercise? |
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Definition
| dynamic exercise w/constant load |
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Term
| what is isokinetic exercise? |
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Definition
| exercise w/constant angular velocity - where the load is variable according to joint angle. (you are most strong at a joint at midrange) |
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Term
| what is concentric contraction? |
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Definition
| contraction as the muscle is shortening |
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Term
| what is eccentric contraction? |
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Definition
| contraction as the muscle is lengthening |
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Term
| what should the exercise rx include? |
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Definition
| goals/objectives, type of exercise (ROM - passive/active/assist, strengthening - more resistance, endurance - less resistance, coordination/motor control), clinical status/precautions (specific instructions), and frequency/duration |
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Term
| what does occupational therapy provide? |
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Definition
| joint protection, self care retraining, toilet transfer, and family education for environment alteration |
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Term
| what is speech therapy indicated for? |
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Definition
| improved: swallowing functions, communication, use of non-vocal communication devices, and cognitive retraining |
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