PTH 735_Week 2 Material

What are examples of modifiable risk factors?

Caffeine intake, obesity, stress response, tobacco/alcohol use, diet, physical activity level, and medications

What are examples of non-modifiable risk factors?

Age, sex, family history, and hormonal status

What does homiothermic mean?

Warm-blooded

What is normal body temperature?

36-38 degrees C or 96.8-100.4 degrees F

What is our heart rate?

Wave of arterial blood flow due to contraction of left ventricle during cardiac cycle

Normal heart rate for adults?

70 beats per minute

What is rate?

Beats per minute

What is rhythm?

Regular or irregular

What is feel?

Smooth, flexible, and/or elastic

What is respiratory rate?

Oxygen supply for metabolic activity

What is the respiratory center?

Pons and medulla (bilateral)

How do you find blood pressure?

Cardiac output (CO) x peripheral resistance (R)

What does systolic mean?

Ventricular contraction; the highest pressure exerted against arterial walls

What does diastolic mean?

Ventricular relaxation; lowest pressure exerted against arterial walls

What is the vasomotor center?

Lower pons and upper medulla (bilateral)

What is phase I Korotkoff sound?

Tapping

What is phase II Korotkoff sound?

Soft swishing

What is phase III Korotkoff sound?

Crisp

What is phase IV Korotkoff sound?

Blowing

What is phase V Korotkoff sound?

Silence

What is normal pulse oximetry?

96-100%

When should we stop activity with heart rate?

>120 bpm at rest

When should we stop activity with blood pressure?

>180/110 mmHg at rest

When should we stop activity with SaO2?

<92% at rest

When should we stop activity with blood glucose?

<70 mg/dL or >250 mg/dL at rest

What is the role of sensation?

Creates foundation for purposeful movement and helps guide and select motor responses to create an effective interaction with the environment

When is sensation tested?

Prior to examination of motor function

What should the order of testing be for sensation?

Superficial, deep, combined cortical

What should be the direction of testing for sensation?

Distal to proximal

What is vibration tested in?

128 Hz

When would you test graphesthesia and/or recognition of textures?

If stereognosis and two-point discrimination is impaired

What is coordination?

Execution of smooth, accurate, and controlled movement

What is dexterity?

Use of digits to perform skilled fined motor tasks

What is agility?

Maintaining postural control while initiating, modifying, or stopping a skilled movement

What are some pathological motor impairments associated with the cerebellum?

Asthenia, dysarthria, dysdiadochokinesia, dysmetria, dyssynergia, asynergia, gait ataxia, hypotonia, nystagmus, rebound phenomenon, intention and/or postural tremor

What are some pathological motor impairments associated with the basal ganglia?

Akinesia, athetosis, bradykinesia, chorea, choreathetosis, dystonia, hemiballismus, hyper/hypokinesis, rigidity, tremor

What are some pathological motor impairments associated with the DCML?

Gait disturbances, dysmetria, visual compensation

What is a coordination assessment testing?

Cerebellum and motor cortex; can also test basal ganglia and dorsal columns

A physical therapist is preparing to examine a patient’s sensory function. Provide the rationale as to why the sensory examination is performed before the motor examination

Sensory integrity provides indirect information about neural processing and helps guide interpretation of subsequent motor findings

True or false: the respiratory centers responsible for neural and chemical regulation of respiration are identified as being in the pons and medulla bilaterally?

True

A patient reports difficulty identifying an object placed in the hand despite apparently intact basic sensory detection. Which combined cortical sensory test would most directly examine the ability to recognize the object by touch?

Stereognosis

True or false: stereognosis and two-point discrimination are superficial sensory tests?

False

When can irreversible cell death occur with body temperature?

>111 degrees F

What is the equation for target HR?

(Max HR - resting HR x % intensity) + resting HR

What can affect respiratory rate?

Age, body size, exercise, body position, medications

What is hypoxemia?

<93% SaO2

What is hypoxia?

<85% SaO2

What is autonomic dysreflexia?

Loss of autonomic nervous system (typically around C4)

What is alert and oriented times 4 mean?

Person is awake and can orient in at least four ways: person, place, time, and circumstance

What is awareness?

Knowledge of something, ability to perceive/aware of a fact, occurrence, or event

What facilitates memory formation?

Attention

What is memory?

Ability to initially acquire, store, and recall (remember) info from past

What is the order for screening?

Arousal/alertness, attention, cognition and executive function

What tests test for arousal?

Alert and oriented, glasgow coma scale, and rancho los amigos scale

What tests test for attention?

Test of vigilance

What tests test for cognition?

Mini-mental state examination and montreal cognitive assessment

What tests test for agitation?

Agitated behaviour scale

What is perception?

Integration or use of sensory information into meaningful information that influences decisions or movement

What are the four categories of perceptual deficits?

Body image/scheme disorders, spatial relations disorders, motor apraxia, and agnosia

What is body scheme?

Recognition of how one’s body parts are related to each other

What is aphasia?

Ability to use, create, or understand speech

What is dysphasia?

Lesion in dominant cerebral hemisphere

What is verbal apraxia?

Difficulty producing speech in absence of written language deficit

What is dysarthria?

Impairment in motor speech production

What must you test before attention?

Arousal

What is arousal?

A physiological readiness for activity and mental engagement

What does lethargic mean?

Drowsy but can be alerted with stimuli; slow and delayed but appropriate responses

What does obtunded mean?

Too drowsy; falls asleep if stimuli are not repeated frequently

What does stupor mean?

Semi-coma; needs noxious and sustained stimuli to produce any response; may open eyes or move limbs but no verbal or purposeful motor interaction

What is a coma?

Cannot be aroused with any stimuli; reflex motor responses may or may not be seen

What is attentive?

Selective awareness of environment or responsiveness to stimulus or task without being distracted by other stimuli

What is cognition?

Process of knowing; will include both awareness and judgment

What is the purpose of the mini-mental state examination?

Short, objective, practical assessment concentrating only on cognitive aspects of mental functions

What is the purpose of the glasgow coma scale?

Assess and document individual’s level of consciousness and helps define and classify severity of injury

What three areas are tested with the glasgow coma scale?

Motor response, verbal response, and eye opening

Purpose of rancho los amigos scale of cognitive functioning?

Provide a description of cognitive and behavioral recovery status as individuals emerge from a coma

What does no response mean?

Completely unresponsive to any stimuli

What is a generalized response?

Reaction to stimuli inconsistent and non-purposeful; delayed responses likely

What is a localized response?

Reaction to stimuli is specific but inconsistent; may follow simple commands such as closing eyes, or squeezing/extending extremity in an inconsistent, delayed manner

What is confused, agitated?

Patient in heightened state of activity with severely decreased ability to process information; behavior frequently bizarre and non-purposeful relative to immediate environment; may be euphoric or hostile

What is confused, inappropriate, and non-agitated?

Appears alert and responds to simple commands fairly consistently. Responses are non-purposeful as commands get more complex. May show agitated behavior; highly distractible. Lacks initiation of functional tasks and shows inappropriate use of objects without external direction

What is confused and appropriate?

Shows goal-directed behavior but dependent on external input for direction. Consistently follows simple directions and remembers relearned tasks such as self-care

What is automatic and appropriate?

Appears appropriate and oriented within hospital/home settings but robot-like. Shallow recall. Decreased judgment and problem solving abilities

What is purposeful and appropriate?

Alert, oriented and able to recall and integrate past/recent events. Shows carry-over for new learning and needs no supervision once activities are learned

Purpose of the agitated behavior scale?

Developed to assess the nature and extent of agitation during acute recovery from an acquired brain injury in an inpatient rehabilitation unit