NPTE studying

Kellgren-Lawrence Grading System

A widely used classification system that grades the severity of osteoarthritis based on radiographic findings, ranging from normal joint appearance/possible osteophytes to severe joint space narrowing and the presence of bone deformities / osteophytes. grades 1-4. Pretty similar knee and hip

Meniscus Classes

Longitudinal - perpendicular to tibial plateau, common with ACL tear (divide central and peripheral)
Horizontal - parallel to tibial plateau (divides superior and inferior)
Radial - perpendicular to both tibial plateau and long axis (extends from free edge to periphery)

Meniscus tear - displaced

mostly longitudinal tears, when displaced called bucket handle tear

Soreness Rules for progressions

during warmup + continues: 2 day break, drop down 1 level
during warmup + goes away: stay at level
during warmup + goes away + comes back: 2 days off, drop down 1 level
non-muscle soreness day after lifting: 1 day off, do not advance
no soreness: advance 1 level per week


from Adams 2012 JOSPT with running progression of walk/jog

Well’s Criteria scoring

>= 3: >= 50% prevalence
1-2: 25%
<1: <=10%

Well’s Criteria DVT

+1: active cancer, paralysis / recent immob LE, recently bedridden >3 days / major surgery within 12 weeks, localized tenderness along the deep venous system, unilateral swelling of the entire leg, calf swelling >3 cm compared to the other leg, previously documented DVT, pitting edema symptomatic LE only, collateral non varicose superficial veins
-2: alternate diagnosis => likely DVT.

Ottawa Ankle Rules

Tenderness along: posterior/tip of medial / lateral malleoli, base of 5th MT, navicular
AND
Inability to WB 4 steps immediately AND in the ED/clinic
high Sensitivity, low Specificity → screen for x-rays

Referred Pain Map Visceral

Cranial Nerve location trick

CE MI PONS MEDU
Cerebrum: 1+2
Midbrain: 3 + 4
Pons: 5-8
Medulla: 9-12

CN 1

Olfactory
Sensory
identify odors

CN 2

Optic Nerve
Sensory
Test visual fields

CN 3

Oculomotor
Motor
Upward, Donward, Medial gaze

CN 4

Trochlear
Motor
Look down and in (SO4)

CN 5

Trigeminal
Both
Sensation of face, mm of mastication, corneal reflex, jaw reflex

CN 6

Abducens
Motor
Lateral Gaze (LR6)

CN 7

Facial
Both
mm facial expression, taste anterior 2/3 tongue, close eyes tight, smile, puff cheeks

CN 8

Vestibulocochlear
Sensory
Hearing, balance and coordination: finger to nose

CN 9

Glossopharyngeal
Both
Taste and sensation posterior 1/3 tongue, swallow, gag reflex (afferent)

CN 10

Vagus
Both
Gag reflex (efferent), say “ahh”, rise of uvula (or deviate away from side of lesion)

CN 11

Spinal Accessory
Motor
Resisted shoulder shrug

CN 12

Hypoglossal
Motor
tongue protrusion (deviates toward side of lesion)

Blood Pressure Categories

Normal: 120/80
Elevated: 120-129 AND /<80
Stage 1: 130-139 OR /80-90
Stage 2: >140 OR />90
HT crisis: >180 AND/OR />120 (prompt med change or emergency if signs of organ damage)

Heart Medications

Beta-1 Blockers: “cock block” epinephrines to increase HR → blunted HR response
Diuretics: decreased blood volume → decrease heart preload
Ace-1-inhibitors: reduces angiotensin 2 (incr. vessel constriction) → decrease after load (like vasodilat. Causes dry cough

Well’s Criteria for PE

+1.5: previous PE/DVT, HR > 100 bpm, Recent surgery / immobilization
+ 3: clinical signs DVT, alternative < likely PE
+ 1: Hemoptysis, Cancer treated within last 6 months.
0-1 = low, 2-6 = intermediate, >= 6: high

Gential area nerve Sensory Map

Trunk Rotation => SS or CL facet opening?

Lumbar = SS
Cervical = CL
Thoracic = CL

Two types of hearing loss

C.A.N.S.
Conductive: bone > air, Affected louder > unaffected
Sensorimotor: air > bone (normal), Unaffected louder > affected

Infant Reflexes and order of integration

0-3 mo.: rooting (touch cheek / mouth → turn and open mouth)
0-6 mo.: ATNR, TLR. asymmetrical tonic neck reflex (head turns → E SS, F CL), Tonic labyrinthine (Head extended → body E and stiffen. Head F → body flex)
1-2 mo.: Stand + Step
3-5/6: Moro (startle → bodily E then F), Gallant (spine curve toward side stroked)
4-7: UE grasp reflex
9-12: LE grasp reflex / Babinski
6-12: STNR. Symmetric tonic neck reflex (head F → arms F, legs E)

Pattern for abnormal infant reflexes

No reflexes early on: LMN
Reflexes not integrating too late: UMN

Obstructive vs. Restrictive

Obstructive diseases: CBABE (cystic fibrosis, bronchiectasis, asthma, bronchitis, emphysema). Only one that has increases with lung volumes (TV sometimes, FRC, RV, TLC)
Restrictive: only decreased lung measurements, maybe normal FEV1

COPD - GOLD classification

pH/PaCO2/HCO3

ROMs needed for gait

stance: swing
hip = 30 F -20 E: 30 F
knee = 0-40:0-60
ankle = 20 PF - 10 DF: 20 DF

Isolation types for clinical syndromes

Wheelchair measurements

seat height: heel to political fold + 2 in
seat depth: buttock to popliteal - 2 in
seat width: hip widest point +1.5-2 in
back height: final seat to axilla - 4 in
armrest height: seat to olecranon + 1 in

axle: in line / just post to shoulder (FWD if bariatric, BCKW is BIL transfem)

Basics of 4 location of brain injuries - UMN

Structures: cortex, BS, SC
Tone: increased, spasticity = velocity dependent
Reflexes: Hyporeflexia and abnormal (clonus, babinski)
Sensation: Decreased
Involuntary Motions: mm spasms
Voluntary Movements: synergistic patterns

Basics of 4 location of brain injuries - LMN

Structures: peripheral n, n roots, cranial nerves
Tone: decreased
Reflexes: hyporeflexive / absent
Sensation: decreased
Involuntary Motions: denervation → fasiculations
Voluntary Movements: weak or absent

Basics of 4 location of brain injuries - Basal Ganglia

Structures: basal ganglia
Tone: increased, rigidity = not velocity dependent
Reflexes: decreased or normal
Sensation: normal
Involuntary Motions: resting tremors
Voluntary Movements: bradykinesia, akinesia

Basics of 4 location of brain injuries - Cerebellum

Structures: cerebellum
Tone: decreased / normal
Reflexes: decreased / normal
Sensation: normal
Involuntary Motions: none
Voluntary Movements: ataxia, intention tremor, dysdiadochokinesia (can’t rapid alternate movement), dysmetria (overshoot / undershoot), nystagmus

PD Staging

1: UL if present, minimal or absent

2: minimal BIL / midline. BALANCE NOT IMPAIRED

3: Impaired righting reflex, unsteady STS / turns. restricted, but can live independently and work (depends)

4: all symptoms present and severe. standing and walking only with assistance

5: confined to bed or wheelchair

Signs / Symptoms of MS

Lhermitte’s Sign: electric shock feeling with neck flexion (hair messy)

Uhthoff’s Phenomenon: heat intolerance (u hot)

Charcot’s Triad: cerebellar signs: scanning speech, intention tremor, nystagmus

Cranial N 2 involvement: decreased vision / pain, Marcus Gunn pupil (dilation with pupillary reflex)

ALS signs + symptoms

Motor Only, pain uncommon
UMN + LMN presentation (including bulbar): dysphagia, dysarthria, cognition changes, inappropriate affect, balance / weakness / coordination issues

Long thoracic n. impingement

C5-C7
scapular wingingggggg
pain distally when flexing extended arm

Lymphedema Grading Scale - CPG

0: subclinical, lymph impaired but no visible swelling, maybe subtle symptoms / tissue changes

1: early onset swelling visible → subsides with elevation. maybe pitting

2: consistent volume change, pitting present, elevation rarely changes, fibrosis present

3: Pitting absent, tissue is very fibrotic with skin changes (thickening, hyperpigmentation, increased folds, fat deposits, warty overgrowths)

Stroke basic: ACA

CL paresis and sensory loss LE
urinary incontinence
problems with imitation, bimanual tasks, apraxia
slowness, delay, motor inaction
CL grasp reflex, sucking reflex

ACA → ABCD → baby things

Stroke basics: L vs. R

L = language / dominant
Frontal lobe = Broca’s / expressive / non-fluent (use yes/no) ← superior branch MCA
parietal lobe = Wernicke’s / receptive / fluent (use visual) ← inferior branch MCA
global aphasia ← MCA stem

OLD: slow, cautious. distractible. always negative thoughts / difficulty pos.

R = visual / perceptive
NEGLECT, difficulty visual cues

Childish: quick, impulsive, safety risks. Rigidity of thought. Positive thoughts / difficulty negative (aka. poor deficit awareness)

both: homonymous hemianopsia

Stroke basics: MCA

CL paresis / sensory loss UE and face

L lesion: language impairments

R lesion: UL neglect (L neglect)

Contralateral homonymous hemianopsia (R MCA → L eye half vision loss)

Stroke Basics - PCA

Peripheral territory: vision related. CL homonymous hemianopsia, visual agnosia - prosopagnosia (don’t understand vision, aka can’t recognize people / things. dyslexia without agraphia. color discrimination. memory deficits. topographical disorientation (bad at directions)

Deep territory: central issues: thalamic pain syndrome

Brunnstrom Stages of Stroke Recovery

Bell curve shape between y=spasticity, x = motor control

1: flaccidity, no AROM

2: Start minimal voluntary movement - in synergy, increase tone

3: voluntary control of movement synergy - spasticity / tone is peak

4: Movement outside of synergy, tone decreasing

5: increase complex movements, greater limb synergy IND

6: Individual joint movement, coordinated movement (hand + 1 finger ~ IJC)

7: normal function

UE spasticity vs. synergy pattern

Rest (spasticity)
-scapula retract / Down Rot, shoulder ADD/IR/depressed, elbow F, forearm pronated, wrist F/ADD, hand F, thumb ADD (chicken dance)

Active (Synergy)
-F: scapula retract / elevate, shoulder ABD / ER, elbow/ wrist/ finger F, forearm supinated

-E: scapula protract, shoulder ADD/IR, elbow E, forearm pronated, wrist / finger F
strong man pose

LE spasticity vs. Synergy pattern

Passive (spasticity)
- pelvis retracted / hiked, hip ADD / IR / E, knee E, Foot PF / INV / equinovarus / claw toes / toes curl. ballerina pose

Active (synergy)
-F: hip F / ABD / ER, knee F, ankle DF / INV, toe DF (figure 4)

E: hip E / ADD / IR, knee E, ankle PF / INV, toe PF (ballerina)

Ranchos Los Amigos TBI Scale “cheat”

1-3 “Response” → 4-6 “Confused” → 7-8 “appropriate”

1: no response / coma
2: general whole body, non purposeful responses
3: purposeful, follows simple commands but still inconsistent
interventions - positioning, PROM, education, respiratory

4: + agitated, no memory, make up stories, non-cooperative
5: + inappropriate, consistent w/ simple commands / a bit complex, some socializing
6: + appropriate, more carryover, more goal oriented actions
interventions - consistency / routine, closed options (not Y/N), simple environment

7: + automatic, does routine actions but robot-like / unsure why
8: + purposeful, more carryover / getting why and abstractions. Still impaired stress / emergency responses
interventions - re-entry to outside environments and focus on life adaptations

Cryotherapy physiological effects + parameters

store @ 25 degrees, apply 10-20, every 1-2 hours

increased: joint stiffness, pain threshold, mm activation (short term)

decreased: collagen extensibility, blood flow, capillary permeability, local metabolism, spasticity (long ice times), nerve conduction velocity

Heat physiological effects + parameters

store @ 158-167 degrees F, 20-30 min, 6-8 layers, heat peaks 5 min

increased: CO, vasodilation, HR, RR, metabolic rate

decreased: mm activity, BP, blood to internal organs and resting mm, SV

E-Stem parameters mm strengthening

Pulse frequency: 35-80 pps
pusle duration: small mm = 125-200 us. large = 200-350 us
amplitude: injured = >10% MVIC. uninjured = >= 50% MVIC
On:Off: 6-10: 50-120s (1:5 initially, can reduce off with time)
ramp time: > 2 sec
treatment time: 10-20 min for 10-20 reps
times / day: every 2-3 hours while awake

E-stim for muscle re-education

Pulse frequency: 35-50 pps
pusle duration: 125-200 us. large = 200-350 us
amplitude: sufficient for functional activity
On:Off depends on activity
ramp time: > 2 sec
treatment time: depends on functional act
times / day: NA

E-stim for muscle spasm reduction

Pulse frequency: 35-50 pps
pusle duration: 125-200 us. large = 200-350 us
amplitude: to visible contraction
On:Off: 2-5:2-5 (equal on:off)
ramp time: >1 sec
treatment time: 10-30 min
times / day: 2x/day

E-stim for edema reduction with mm pump

Pulse frequency: 35-50 pps
pusle duration: 125-200 us. large = 200-350 us
amplitude: to visible contraction
On:Off: 2-5:2-5 (equal on:off)
ramp time: > 1 sec
treatment time: 30 min
times / day: 2x/day

Increase patient comfort with e-stim

ramp time: increase

pulse duration: decrease

electrode size and quality: larger, stickier

pulse frequency: increase

on:off: increase off time

High Voltage Pulsed Galvanic Current for wound healing parameters

waveform: HVPV

polarity: negative if bad/infected wound, positive if proliferating wound

pulse frequency: ~100 pps

pulse duration: ~100 us

amplitude: for comfortable tingling feeling

treatment time: 45-60 minutes, at least 3-7 days/week

placement: around wound area, if in use saline soaked gauze

Iontophoresis

TENS chart

Ultrasound parameter flow chart

transducer head should 2-3x smaller than treatment area

EMG Biofeedback Parameters

Initial
relax / inhibit mm: low sensitivity, close electrode placement (quiet cuddles)
re-educate / facilitate mm / increase tone: high sensitivity, far apart electrodes

Later: reverse parameters as they make progress

Lumbar Traction parameters

Cervical traction parameters

Joint distraction: max = 20-29 lbs / 7% BW

disc protrusion / mm spasm / elongation: 11-15 lbs

Phases of motor learning

Cognitive: initial, what to do. Heavy thinking. Bimanual transfer, outcomes / results feedback after, closed environment early

Associative: knows what to do, learning how to do it. Can do more performance based feedback

Autonomous: experienced, working on automaticity

General: Feedback = less frequent, less precise, externally focused, terminal, some delay, self-initiated = increases learning. more often / during / not above increases performance.

Distributed = better learning, but massed early performance increase and can be good cognitive impairments. Random = improved retention. Variable = increased task transfer

Smith’s Fracture

distal radial fracture with volar displacement of bone (Mrs. smith gardens in the front yard)

Colle’s Fracture

Most common distal radial fracture, bone projects dorsally. = dinner fork deformity

-acusis

hearing

hyperacusis = over sensitive hearing, can be facial n damage

presbycusis = age related hearing loss

ankle eversion glide

lateral glide “I Love emails”

Supine to Sit test

SIJ dysfunction test (boo) → apparent leg length discrepancy

ALPS: anterior longer posterior shorter: supine position

• LLE supine long → sitting short = L anterior rotated innominate

Short Form Health Survey

measures QOL

vs like DASH as symptoms / disability

Complex Regional Pain Syndrome

symptoms: swelling / stiffness, change in color / temp of skin (warm), increased sensitivity to touch including clothing, loss of fine motor control, tremor / spasm. Burning type pain

heart blocks

AV communication issues

1 degree: prolonged PR interval

2 degree: increased PR interval, occasional dropped beats

3 degree: no AV communication, no relationship P waves and QRS = emergent referral

Waves and meaning

P-wave = SA node firing / atrial depolarization

QRS complex = ventricle depolarization

PR interval = conduction from atria to ventricle

T wave = ventricle repolarization

ST segment = ventricular contraction (elevated = STEMI, depressed = NSTEMI)

S3, S4 abnormal heart sounds

S3 = CHF

S4 = MI or HTN