Just Workin' Up The Nerve
Spontaneous depolarization of a single muscle fiber recorded close to the tip of the needle electrode consisting of a biphasic wave with a sharp initial downward phase
What is a PSW. Occurs earlier than fibrillation potentials after nerve injury. Can be seen in focal neuropathy, polyneuropathy or in myopathy. Can also be seen in non pathologic foot intrinsics and paraspinal muscles of some normal individuals.
The difference between stride length and step length?
What is Step length= Distance between sequential corresponding points of contact by opposite feet
and stride length= distance between sequential corresponding points of contact by the same foot
Name and describe the phases of Cardiac rehab process.
Phase I: inpatient phase from hospital admission to discharge Ia is medical/cardiac/surgical unit and Ib inpatient rehab unit
Phase II: Outpatient training phase, includes aerobic conditioning, reacquisition of full activity, risk factor management, lifestyle change.
Phase III: Maintenance phase, patient monitored continuation of the aerobic exercise program, risk reduction, activity and work modifications
Following brain injury, there is functional depression in intact areas of the brain at a distance from, but anatomically linked to , the damaged area
What is diaschisis
Describe the Gaenslen test and what does it test for?
While supine, the symptomatic leg is draped off the table and a downward force is applied putting it into hyperextension at the hip, while a flexion based counterforce is applied to the flexed leg pushing it in the cephalad direction causing torque to the pelvis. Considered positive for a SIJ lesion, hip pathology, pubic synthesis instability, or an L4 nerve root lesion. The femoral nerve may also be stressed by this tes
Describe a motor unit
The amount of time spent in a typical walking cycle by phase at normal walking speed.
What is approximately 60% stance and 40% swing.
Possible contraindications for entry into inpatient or outpatient exercise programs (Name 3)
According to ACSM:
unstable angina, resting sbp >200, resting diastolic >100, orthostatic bp drop or during exercise of >20, moderate to severe AS, acute illness, uncontrolled sinus tachycardia >120, uncontrolled atrial or ventricular dysrhythmia, third-degree av block, active pericarditis or myocarditis, recent embolism, thrombophlebitis, resting ST displacement >3mm, uncontrolled diabetes, neurologic or orthopedic problems that prohibit exercise
The minimum motor criterion set for wrist motion before being enrolled in CIMT protocol for hemiparesis.
20 degrees voluntary extension of the wrist. Also 10 degrees abduction of the thumb and extension of at least 2 fingers repeated 3 times in 1 minute
Name the muscle affected by the nerve injury and its resulting scapula position:
Dorsal Scapular Nerve
Rhomboids. Protracted and upwardly rotated
The characteristics of a motor unit action potential (MUAP) in a myopathic process.
1. short duration. In healthy muscle normally 6-15ms but can vary by muscle type
2. small amplitude
3. increased recruitment
The subdivision of phases of the stance phase and the phases of the swing phase in order.
What is initial contact, loading response, mid stance, terminal stance for stance phase and pressing, initial swing, midswing and terminal swing for swing phase.
Define maximum aerobic capacity and how can you calculate it.
Maximal oxygen consumption (VO2max) is the greatest rate of O2 consumption a person is capable of metabolizing. Cardiac Output (CO) = Heart Rate (HR) x Stroke Volume (SV) which relates directly to the total body oxygen consumption because all O2 consumed is delivered to the body tissues via blood.
Classify this aphasia:Non fluent, poor comprehension, able to repeat
transcortical sensory (closely related to wernickes but in wernickes there is poor repetition)
Describe the Rockwood Classification and its treatments
I. AC ligament sprain- non op
II. Torn AC and sprained CC- non op
III. Torn AC and CC, CC space 25-100% widened-non op but may choose op
IV: Type III with clavicle displaced posteriorly-op
V: Type III with CC widened >100% & deltoid/trap detached from distal clavicle- op
VI: Type III with clavicle displaced inferiorly through or behind biceps tendon- op
DOUBLE JEOPARDY
How does temperature affect electrodiagnostic measurements in both NCS and EMG.
What is cooling results in decrease in nerve conduction velocity, increased amplitude, and possible false resoluition of conduction block. Cooling leads to an increase in the duration of MUAP and increase polyphgasicity. Fibrillations and PSWs decrease in frequency with cooling.
The difference between walking and running.
What is the reduction of double limb support from 20-25% of the normal walking gait cycle to no longer a period of double support.
Unique precautions necessary for an exercise regimen for cardiac transplant patients
Heart rate increases only in response to changes in circulating catecholamines due to denervation of the heart. This requires a longer warm up, slow progressive endurance exercises at 50-60% max HR, followed by longer cool-down periods.
What differentiates RANCHOS II from RANCHOS III
Both VS(II) and MCS (III) have sleep wake cycles, however, VS shows no evidence of perception while MCS often has visual tracking and reproducible although inconsistent evidence of perception, communication, or purposeful motor activity
Describe posterior interosseous n. syndrome, its clinical presentation, cause and EMG findings
Entrapment neuropathy of the PIN branch of radial nerve at the fibrous arch of the supinator or within the muscle belly. Pain on resisted pronation or supination, tinels+ over n., weakness in wrist or finger extension. No numbness. EMG involves extensor carpi ulnas, extensor digitorum communism, extensor indices, abductor pollicis longus, and extensor pollicis longus and brevis. Extensor carpi radialis longus and brevis are spared.
Explain the pathophysiology behind this disease: CMAP amplitudes are normal. With 2-5 Hz of repetitive stimulation, there is >10% decrement in CMAP amplitude, typically greatest between 1st and 2nd responses. With continued stimulation, amplitudes return to normal. A 10-sec maximum isometric contraction will result in increased response amplitude, but not >50% above baseline.
What is myasthenia graves which occurs when antibodies bind to the postsynaptic Act receptor, resulting in destruction and reduction of surface area of the postsynaptic membrane and fewer Ach receptors.
The location of the normal center of mass, how much does it move during normal ambulation, and what influences it's displacement.
What is approximately 5cm anterior to the second sacral vertebra. The average total displacement of the COM is 5cm in the vertical axis and 5cm in the horizontal axis for an average adult male step. The determinants of gait influence its displacement: heel rise, pelvic rotation, pelvic tilt, knee flexion, foot and knee motion, lateral displacement of the pelvis.
Gold Standard for evaluating cardiorespiratory fitness and how can you accomplish that.
What is the measurement of the maximal oxygen consumption (VO2max) during the maximal exercise test. Cycle ergometry provides a better estimation of VO2 max than the 6 minute walk test (influenced by other factors such as balance, strength and spasticity).
Name the syndrome and where is the lesion.
Ipsilateral 6th and 7th nerve palsy
Contralateral hemiplegia
Name at least 5 features of rheumatoid arthritis used to establish the diagnosis
1. morning stiffenss for up to 1 hour
2. arthritis involves 3+ joints with swelling observed by physician
3. arthritis of hands (MCP, PIP, wrist)
4. symmetric arthritis
5. rheumatoid nodules- sub over bony prominence
6. serum RF +
7. radiographic changes- erosions, bony decalcification localized in or most marked adjunct to the involved joints