1. How is a stroke differentiated from a TIA?
2. What are nonmodifiable risk factors for CVA?
3. Is obesity correlated to CVA?
4. What are modifiable risk factors for CVA?
Answer:
1. TIA lasts less than 24hrs, stroke lasts more than 24 hrs.
2. Age (more important risk factor), sex (M>F), race (black > white > Asian), family history.
3. No.
4. HTN, history of CVA/TIA, heart disease (CHF, CAD, a fib, valvular disease), diabetes (good BS control does not alter risk), smoking, carotid stenosis, EtOH, cocaine, high-dose estrogens, hypercoagulable states, hyperlipidemia, migraines, OSA, PFO.
Saturday, June 14, 2008
Wednesday, June 11, 2008
Middle Cerebral Artery CVA
1. What is the most common cause of occlusion of the superior division of the MCA?
2. What is the typical presentation of a superior MCA CVA? What sort of aphasia is seen if the dominant hemisphere is affected?
3. What is seen in a nondominant lesion of the superior MCA?
4. What is the typical presentation of an inferior MCA CVA?
5. What is seen with a dominant vs. nondominant hemisphere inferior MCA CVA?
Answers:
1. Embolus.
2. Sensory and motor deficits in the contralateral face and arm>leg, head and eyes deviated toward side of infarct. Initially there is decreased muscle tone that gradually increases over days or weeks. With dominant hemisphere involvement, initially global aphasia is seen, then Broca's.
3. Deficits in spacial perception, hemineglect, constructional apraxia, dressing apraxia.
4. Superior quadrantanopia or homonymous hemianopsia.
5. Dominant results in Wernicke's aphasia. Nondominant results in left visual neglect.
2. What is the typical presentation of a superior MCA CVA? What sort of aphasia is seen if the dominant hemisphere is affected?
3. What is seen in a nondominant lesion of the superior MCA?
4. What is the typical presentation of an inferior MCA CVA?
5. What is seen with a dominant vs. nondominant hemisphere inferior MCA CVA?
Answers:
1. Embolus.
2. Sensory and motor deficits in the contralateral face and arm>leg, head and eyes deviated toward side of infarct. Initially there is decreased muscle tone that gradually increases over days or weeks. With dominant hemisphere involvement, initially global aphasia is seen, then Broca's.
3. Deficits in spacial perception, hemineglect, constructional apraxia, dressing apraxia.
4. Superior quadrantanopia or homonymous hemianopsia.
5. Dominant results in Wernicke's aphasia. Nondominant results in left visual neglect.
Tuesday, June 10, 2008
Traction
1. What are the physiological effects of traction?
2. What are contraindications to traction in general? For the cervical spine?
3. What are contraindications to traction for the lumbar spine?
4. How is traction generally prescribed in terms of positioning?
5. How is traction generally prescribed in terms of amount of pull?
Answers:
1. Effects are vertebral joint distraction (elongation of C-spine), reduction of compression and nerve root/disc irritation, reduction in pain, muscle spasm, and inflammation, loosening of adhesions in dural sleeves.
2. General contraindications are spine malignancy, osteopenia, infection, congenital spinal deformity. C-spine contraindications are cervical ligamentous instability (RA, Down's, Marfan, dwarfism), infection, atlanto-axial subluxation, vertebrobasilar insufficiency.
3. L-spine contraindications are pregnancy, cauda equina compression, aortic aneurysm, restrictive lung disease, active PUD, hiatal hernia.
4. 20-30 degrees of flexion optimally opens intervertebral foramina for cervical traction. For lumbar traction, keep patient supine with 90 degrees of hip and knee flexion.
5. For C-spine, use greater than 25 pounds. For L-spine, use 50 pounds for posterior vertebral separation, 100 pounds for anterior separation. Treat for 20 minutes.
2. What are contraindications to traction in general? For the cervical spine?
3. What are contraindications to traction for the lumbar spine?
4. How is traction generally prescribed in terms of positioning?
5. How is traction generally prescribed in terms of amount of pull?
Answers:
1. Effects are vertebral joint distraction (elongation of C-spine), reduction of compression and nerve root/disc irritation, reduction in pain, muscle spasm, and inflammation, loosening of adhesions in dural sleeves.
2. General contraindications are spine malignancy, osteopenia, infection, congenital spinal deformity. C-spine contraindications are cervical ligamentous instability (RA, Down's, Marfan, dwarfism), infection, atlanto-axial subluxation, vertebrobasilar insufficiency.
3. L-spine contraindications are pregnancy, cauda equina compression, aortic aneurysm, restrictive lung disease, active PUD, hiatal hernia.
4. 20-30 degrees of flexion optimally opens intervertebral foramina for cervical traction. For lumbar traction, keep patient supine with 90 degrees of hip and knee flexion.
5. For C-spine, use greater than 25 pounds. For L-spine, use 50 pounds for posterior vertebral separation, 100 pounds for anterior separation. Treat for 20 minutes.
Monday, June 9, 2008
Massage therapy
1. What are the reflexive effects of massage therapy?
2. What are the mechanical effects of massage therapy?
3. What are contraindications to massage?
4. How do the common techniques of massage differ?
Answers:
1. Reflexive effects include reflex vasodilation with improved circulation, decreased pain through opiate release, relaxation, perspiration.
2. Mechanical effects include assisting venous blood return from periphery to CNS, increase lympathic drainage, decrease muscle tightness, prevents or breaks adhesions, softens scars, loosens secretions.
3. Contraindications include massage over malignancy, open wounds, infection, burns, nerve entrapment, acute inflammatory conditions (gout, RA, cellulits, DVT), severe varicose veins, severe clotting disorder.
4. Effleurage is a gliding movement of the skin w/o deep muscle movement, for muscle relaxation. Petrissage is kneading, which increases circulation and reduces edema. Tapotement is percussion, which helps with desensitization and improves circulation and clearing of secretions. Friction massage breaks adheasion and reduces local muscle spasm. Soft tissue mobilization is forceful massage of the fascia-muscle system for reduction in contractures. Myofascial release is prolonged light pressure in specific directions to stretch focal areas of muscle or fascial tightness. Accupressure is finger pressure applied over trigger points or acupuncture points.
2. What are the mechanical effects of massage therapy?
3. What are contraindications to massage?
4. How do the common techniques of massage differ?
Answers:
1. Reflexive effects include reflex vasodilation with improved circulation, decreased pain through opiate release, relaxation, perspiration.
2. Mechanical effects include assisting venous blood return from periphery to CNS, increase lympathic drainage, decrease muscle tightness, prevents or breaks adhesions, softens scars, loosens secretions.
3. Contraindications include massage over malignancy, open wounds, infection, burns, nerve entrapment, acute inflammatory conditions (gout, RA, cellulits, DVT), severe varicose veins, severe clotting disorder.
4. Effleurage is a gliding movement of the skin w/o deep muscle movement, for muscle relaxation. Petrissage is kneading, which increases circulation and reduces edema. Tapotement is percussion, which helps with desensitization and improves circulation and clearing of secretions. Friction massage breaks adheasion and reduces local muscle spasm. Soft tissue mobilization is forceful massage of the fascia-muscle system for reduction in contractures. Myofascial release is prolonged light pressure in specific directions to stretch focal areas of muscle or fascial tightness. Accupressure is finger pressure applied over trigger points or acupuncture points.
Neuromuscular electrical stimulation
1. What are common uses of neuromuscular e-stim?
2. How does the open-loop system work?
3. How does the closed-loop system work? What are the advantages over open-loop?
Answers:
1. Maintains muscle mass after immobilization, prevents DVT, prevents osteoporosis, strengthens muscles, increases ROM, provides feedback to enhance voluntary muscle control.
2. An open-loop system is when the user observes the results of stimulation and adjusts the stimulation based on the results.
3. A closed-loop system involves movement sensors that send signals from patient's body as results are obtained. Advantages are that it corrects unexpected problems like muscle spasms and fatigue.
2. How does the open-loop system work?
3. How does the closed-loop system work? What are the advantages over open-loop?
Answers:
1. Maintains muscle mass after immobilization, prevents DVT, prevents osteoporosis, strengthens muscles, increases ROM, provides feedback to enhance voluntary muscle control.
2. An open-loop system is when the user observes the results of stimulation and adjusts the stimulation based on the results.
3. A closed-loop system involves movement sensors that send signals from patient's body as results are obtained. Advantages are that it corrects unexpected problems like muscle spasms and fatigue.
Sunday, June 8, 2008
Types of electrical stimulation
1. What sort of frequency and intensity stimulation does a conventional stimulator deliver? How soon is it effective? What sort of pain it is used to treat?
2. What sort of stimulation is used during acupuncture?
3. How does the pulse mode work?
4. How does modulated stimulation work?
5. How does hyperstimulation work? What is the mechanism?
Answers:
1. High frequency, low intensity stimulation. Pain relief begins after 10-15 minutes of stimulation and ends when stimulation is removed; stimulation can last for hours. It is used for neuropathic pain.
2. Acupuncture usees low frequency, high intensity stimulation, lasting 30-60 mins. 3. Pulse mode involves high frequency stimulation bursts at low frequency intervals.
4. Modulated stimulation involves pulses varying in intensity and frquency.
5. Hyperstimulation involves high frequency high intensity stimulation. It is rarely tolerated more than 15-30 mins. Mechanism is possibly via stimulation of C-fibers, causing counter-irritation.
2. What sort of stimulation is used during acupuncture?
3. How does the pulse mode work?
4. How does modulated stimulation work?
5. How does hyperstimulation work? What is the mechanism?
Answers:
1. High frequency, low intensity stimulation. Pain relief begins after 10-15 minutes of stimulation and ends when stimulation is removed; stimulation can last for hours. It is used for neuropathic pain.
2. Acupuncture usees low frequency, high intensity stimulation, lasting 30-60 mins. 3. Pulse mode involves high frequency stimulation bursts at low frequency intervals.
4. Modulated stimulation involves pulses varying in intensity and frquency.
5. Hyperstimulation involves high frequency high intensity stimulation. It is rarely tolerated more than 15-30 mins. Mechanism is possibly via stimulation of C-fibers, causing counter-irritation.
Saturday, June 7, 2008
Electrotherapy
1. What are the physiologic effects of electrotherapy?
2. What are indications to electrotherapy?
3. What are contraindications to electrotherapy?
4. What is transcutaneous nerve stimulation (TENS)? Where are electrodes usually placed?
5. What are the proposed mechanisms of pain control via electrotherapy?
6. What is the gate-control theory?
Answers:
1. Increase in joint ROM, muscle group contraction, retards muscle atrophy, increases muscle strength, increases circulation, decreases muscles spasm, releases polypeptides and neurotransmitters, decreases spasticity, promotes wound healing, induces osteogenesis, inhibits pain fibers, drives medicated ions across skin.
2. Indications are pain management (msk pain, neurogenic pain, systemic pain), joint effusion, interstitial edema, muscle disuse atrophy, dermal ulcers and wounds, circulatory disorders, postherpetic neuralgia, arthritis, ROM.
3. Contraindications are circulatory impairment, stimulation over carotid sinus or heart, pregnancy, seizure disorder, fresh fracture, active hemorrhage, malignancy, decreased sensation, atrophic skin, inability to report pain, allergy to gel or pads.
4. TENS stimulates nerve fibers through a programmable device to apply an electrical signal through lead wires and electrodes on the skin. Electrodes are usually place over peripheral nerve distribution.
5. Placebo, gate-control theory, release of endogenous opioids.
6. The gate-control theory involves blocking pain signals at the spinal cord before they are transmitted to the thalamus. For example, a TENS stimulates large Ia afferent nerve fibers that stimulate the substantia gelatinosa in the dorsal horn of the spinal cord, that closes the gate on pain transmission to the thalamus.
2. What are indications to electrotherapy?
3. What are contraindications to electrotherapy?
4. What is transcutaneous nerve stimulation (TENS)? Where are electrodes usually placed?
5. What are the proposed mechanisms of pain control via electrotherapy?
6. What is the gate-control theory?
Answers:
1. Increase in joint ROM, muscle group contraction, retards muscle atrophy, increases muscle strength, increases circulation, decreases muscles spasm, releases polypeptides and neurotransmitters, decreases spasticity, promotes wound healing, induces osteogenesis, inhibits pain fibers, drives medicated ions across skin.
2. Indications are pain management (msk pain, neurogenic pain, systemic pain), joint effusion, interstitial edema, muscle disuse atrophy, dermal ulcers and wounds, circulatory disorders, postherpetic neuralgia, arthritis, ROM.
3. Contraindications are circulatory impairment, stimulation over carotid sinus or heart, pregnancy, seizure disorder, fresh fracture, active hemorrhage, malignancy, decreased sensation, atrophic skin, inability to report pain, allergy to gel or pads.
4. TENS stimulates nerve fibers through a programmable device to apply an electrical signal through lead wires and electrodes on the skin. Electrodes are usually place over peripheral nerve distribution.
5. Placebo, gate-control theory, release of endogenous opioids.
6. The gate-control theory involves blocking pain signals at the spinal cord before they are transmitted to the thalamus. For example, a TENS stimulates large Ia afferent nerve fibers that stimulate the substantia gelatinosa in the dorsal horn of the spinal cord, that closes the gate on pain transmission to the thalamus.
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