NR548 Final Exam Latest Update with Verified Answers, Study Guides, Projects, Research of Nursing

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NR548 Final Exam Latest Update with Verified Answers Describe the compensated Trendelenburg gait that occurs with hip pain - ANS ✔-Compensated Trendelenburg gait shifts GRFV *through* the painful hip joint to *stabilize* the joint and *decrease* torque -Without compensation, abductor muscles have to contract against abduction moment, which causes *compression* at hip joint % of people with Parkinson's disease have difficulty walking within 3 years of diagnosis - ANS ✔*85%* of people with Parkinson's disease have difficulty walking within 3 years of diagnosis % of people with MS experience mobility problems - ANS ✔*75%* of people with MS experience mobility problems % of people who have strokes regain community mobility - ANS ✔*50%* of people who have strokes regain community mobility Define *gait* versus *walking* versus *mobility* - ANS ✔-*Gait*: pattern of movement of the limbs during locomotion -*Walking*: one form of locomotion -*Mobility*: ability to safely and independently move from one point to another List 3 dimensions of the neural control of walking - ANS ✔1. *Sensory*: afferent input 2. *Spinal cord*: central pattern generators 3. *Supraspinal*: cortical systems for complex navigation (obsticles, etc.) to adapt gait pattern Define and describe the function of *central pattern generators (CPG)* - ANS ✔-*CPG* = network of neurons and inter-neurons in spinal cord -Generate coordinated movements autonomously -Modified by ascending and descending signals from cortex and the periphery Name two *ascending sensory inputs* that influence the stance-to-swing transition - ANS ✔-Hip extension -Unloading of ankle PFs The same ascending sensory input can modify gait responses to stimuli in (the same/different) ways - ANS ✔The same ascending sensory input can modify gait responses to stimuli in *different* ways Describe the *reactive control* to an obstacle encountered EARLY during swing phase - ANS ✔-"Elevating strategy" -Flexion of swing limb to clear obstacle -Extension of stance leg to prolong stance Describe the *reactive control* to an obstacle encountered LATE during swing phase - ANS ✔-"Extension strategy" -Extension of swing limb to lower leg -Flexion during opposite leg's swing phase to clear obstacle What are the two greatest requirements during gait in terms of body function? - ANS ✔- PROGRESSION: Moving forward -STABILITY: Staying upright Describe the two major domains of the proactive control during walking - ANS ✔*Sensory* -Vision: avoidance & accommodation *Cognitive* -Piloting/navigating -Anticipation -Attention In which phases of gait is adductor spasticity most provoked? What effects does this have? - ANS ✔*Swing* -Increased hip adduction during swing leads to foot placement that crosses midline *Stance* -Contralateral hip drop (e.g. L hip drops during R stance due to R hip adduction) Generally: "scissoring" gait pattern seen in SCI, MS, & CP -Narrow BOS = instability -Moving into swing phase, can catch foot on opposite leg = risk for tripping/falling Define *rigidity*. Which populations experience rigidity? When is rigidity apparent in gait pattern? - ANS ✔-Increased resistance to passive stretch that is independent of velocity -Common in: PD and Parkinson-plus syndromes -Tends to affect the entire limb versus certain muscle groups; effect on gait depends upon degree of rigidity Define *paresis*. Which populations experience paresis? - ANS ✔-Inability to contract a muscle due to insufficient supraspinal recruitment of motor neurons -Common in: CVA, TBI, SCI, MS In which phases of gait is PF paresis most evident? What effects does this have? - ANS ✔Reduced PF force from *mid stance --> terminal stance* reduces advancement of limb during *swing phase*; can result in compensatory strategies at hip & trunk to advance limb: -Posterior trunk lean -LE external rotation to use hip adductors -Circumduction In which phases of gait is DF paresis most evident? What effects does this have? - ANS ✔*Pre Swing--> Initial Contact* -Reduced DF leads to reduced foot clearance during swing phase; can result in compensatory strategies at knee, hip, or trunk -Hip circumduction -Elevation of ipsilateral hip to clear foot In which phases of gait is hip flexor paresis most evident? What effects does this have? - ANS ✔*Pre Swing --> Terminal Swing* -Reduced hip flexor activation limits limb advancement during swing; can result in compensatory strategies to advance limb -LE external rotation to use hip adductors -Posterior trunk lean Define *ataxia*. Which populations experience ataxia? How does ataxia affect gait? - ANS ✔- Abnormal patterns of muscle activation that affect the timing or scaling of muscle activity -Common in: cerebellar dysfunction (CVA, MS, TBI, degenerative disease), proprioceptive loss -Highly variable effect on gait (generally may see a "high steppage gait"; more hip & knee flexion) Loss of sensory inputs can be or - ANS ✔Loss of sensory inputs can be *central* or *peripheral* -Central = visual, vestibular, perceptual (e.g. hemispatial inattention) -Peripheral = peripheral neuropathy How might *cognitive/behavioral* impairments affect gait? - ANS ✔-Impulsivity -Impaired judgment -Attention & memory deficits impacting route finding/navigation -After ~ years, half of the population has a gait impairment -20-30% of individuals above years fall every year (and 10-30% of falls result in injury) - ANS ✔-After ~*85* years, half of the population has a gait impairment -20-30% of individuals above *65* years fall every year (and 10-30% of falls result in injury) According to the Functional Independence Measure (FIM) you must be able to walk m/ ft to be designated an "independent ambulator" - ANS ✔According to the Functional Independence Measure (FIM) you must be able to walk *46*m/*150*ft to be designated an "independent ambulator" Community ambulation requires: -Crosswalks: m -Curb height: cm -Post office: m -Club warehouse (e.g. Costco): m - ANS ✔Community ambulation requires: -Crosswalks: *10-20*m -Curb height: *17-18.5*cm -Post office: *64*m -Club warehouse (e.g. Costco): *677*m What is the "normal" speed of walking? - ANS ✔1.33m/s Which populations typically display a *hemiparetic gait*? How does a hemiparetic gait affect gait? - ANS ✔-Common in: CVA, TBI -Stance phase shortened on hemiparetic side due to lack of stability and swing phase lengthened Name 4 variable contributing impairments that can occur with *hemiparetic gait* - ANS ✔- *Musculoskeletal*: ROM, weakness -*Neuromuscular*: spasticity, paresis, coordination -*Sensory/perceptual*: hemianopsia, somatosensory deficits, hemispatial inattention -*Cognitive/behavioral*: confusion/impulsiveness What are some common spatiotemporal characteristics of *hemiparetic gait*? Think in general terms as well as in the involved and uninvolved LE. - ANS ✔General: What are some common kinematic characteristics of *parkinsonian gait* during the STANCE phase at the ankle, knee, hip, and trunk? - ANS ✔-*Ankle*: decreased heel strike and PF at IC -*Knee & Hip*: decreased excursion, especially extension -*Trunk*: forward trunk lean, decreased trunk rotation and arm swing What are some common kinematic characteristics of *parkinsonian gait* during the SWING phase? - ANS ✔-Decreased toe clearance ("shuffling" steps) Why are many sockets for residual limbs clear? - ANS ✔To see how residual limb fits in socket (then covered in fiber glass taping What material is commonly used in the socket interface to protect the residual limb from sheer forces? - ANS ✔Silicon liner Which is more important on a prosthesis: the foot or the socket? - ANS ✔While advertisers focus on prosthetic feet, socket fit is the most important What are the goals of trans-tibial socket? - ANS ✔-Eliminate "pseudoarthrosis" (false joint between limb and socket) -Connect residual limb to foot -Transfer loads without skin breakdown What are the biggest challenges when designing a trans-tibial socket? - ANS ✔-End of residual limb intolerance to weight bearing -Tibial crest vulnerable to skin breakdown -Fibular head vulnerable to skin breakdown and common fibular nerve exposed to undue pressure -Tibial tubercle vulnerable to skin breakdown What is a PTB socket design? - ANS ✔-PTB = Patella Tendon Bearing -Revolutionary socket design from the '50s -Incorporates specific regions of weight bearing and relief What are the PTB weight bearing areas? - ANS ✔-Patella tendon -Pretibial musculature -Medial tibial flare -Popliteal area -Fibular shaft -Gastroc-soleus muscle belly What are some missing elements to keep in mind about wearing a prosthetic during gait? - ANS ✔-No variable ankle & foot stiffness/ROM -No active power generation (DF and PF) -No sensation -No proprioception -No skin surface area to dissipate heat --> excessive sweating -Body image Which populations typically have a LE amputation? - ANS ✔-PVD = 70-80% -Trauma = 20-25% -Tumor -Congenital -Infection How does prosthetic *alignment* affect gait? (generally) - ANS ✔-Balance -Stability -Force distribution in socket -"Smooth" ambulation Describe an *induced moment* versus a *reaction moment* - ANS ✔*Induced moment*: EXTERNAL force that causes rotation about a joint (forces causing knee flexion or extension) *Reaction moment*: INTERNAL force of the musculature to resist induced moment (how we physically react to the induced moment) The placement of a transtibial prosthetic foot POSTERIOR to the knee joint will (increase/decrease) the knee flexion moment during loading response - ANS ✔The placement of a transtibial prosthetic foot POSTERIOR to the knee joint will *increase* knee flexion moment during loading response The placement of a transtibial prosthetic foot ANTERIOR to the knee joint will (increase/decrease) the knee flexion moment during loading response - ANS ✔The placement of a transtibial prosthetic foot ANTERIOR to the knee joint will *decrease* the knee flexion moment during loading response What is a major detriment of placing a transtibial prosthetic too far posterior to the knee joint? - ANS ✔It places pressure on the neurovascular bundle behind the knee Increased PLANTARFLEXION of a transtibial prosthetic foot during loading response will (increase/decrease) the knee flexion moment - ANS ✔Increased PLANTARFLEXION of a transtibial prosthetic foot during loading response will *decrease* the knee flexion moment The placement of a transtibial prosthetic foot POSTERIOR to the knee joint will (increase/decrease) the knee extension moment during terminal stance - ANS ✔The placement of a transtibial prosthetic foot POSTERIOR to the knee joint will *decrease* the knee extension moment during terminal stance The placement of a transtibial prosthetic foot ANTERIOR to the knee joint will (increase/decrease) the knee extension moment during terminal stance - ANS ✔The placement of a transtibial prosthetic foot ANTERIOR to the knee joint will *increase* the knee extension moment during terminal stance Increased DORSIFLEXION of a transtibial prosthetic foot during terminal stance will (increase/decrease) the knee flexion moment - ANS ✔Increased DORSIFLEXION of a transtibial requires *more* energy to initiate knee flexion and *less* energy to stabilize the knee. A poly-centric prosthetic knee creates a virtual axis (proximal/distal) and (anterior/posterior) to the GRFV. How are these features advantageous? - ANS ✔A poly-centric prosthetic knee creates a virtual axis *proximal* and *posterior* to the GRFV. -Proximal = easier to leverage motion -Posterior = more stable A weight activated stance control knee (swings/breaks) if you LOAD the knee in front and (swings/breaks) if you UNLOAD the knee in front. What is the biggest problem with this type of prosthesis? - ANS ✔A weight activated stance control knee *breaks* if you LOAD the knee in front and *swings* if you UNLOAD the knee in front. -Less stable the more bent the knee is; have to take smaller steps when going down stairs or hills to control stability -During terminal stance, weight on toe prevents knee from bending What is the biggest coronal plane instability you see in someone with a trans-femoral amputation? What is one mechanism to decrease this instability? - ANS ✔-Trendelenburg (weak gluteus medius) -Bone lock on ischial tuberosity provides more coronal plane stability Describe an effective way for someone with a transfemoral amputation to rise from sit to stand - ANS ✔-UE for balance and lift -COM anterior to knees -Pivot on one leg What are three major weight bearing areas in a trans-femoral socket? - ANS ✔-*Ishial tuberosity* -Gluteal musculature -Soft tissue compression of thigh What is the function of w/c breaks? - ANS ✔W/C breaks *do not* slow down or stop the w/c, only your hands can slow down or stop the w/c. W/C breaks are used for stationary transfers, etc. Describe the frame and function of a standard folding wheelchair ("depot chair") - ANS ✔Frame -Folding with cross bars -Chrome plated, cold-rolled steel -40-50lbs *Function* -Increased resistance with self-propulsion -Increased turning radius What is an advantage and disadvantage of w/c cross bars - ANS ✔-Advantage: good for storing w/c -Disadvantage: adds extra joints to the w/c that can wear down The COM is (anterior/posterior) to the wheel axle for (stability/mobility) in a standard folding w/c - ANS ✔The COM is *anterior* to the wheel axle for *stability* in a standard folding w/c How does a light weight standard w/c differ in material from a standard weight w/c? What advantage does this provide in terms of function? - ANS ✔-Made with carbon steel instead of chrome plated, cold-rolled steel -Weight = 30-40lbs instead of 40-50lbs -Decreases resistance for self-propulsion and easier for caregiver to push/lift Which populations would benefit from a reclining seat w/c system? How does a reclining seat affect self-propulsion and turning radius? - ANS ✔-Individuals who are unable to sit upright (e.g. hip flexion restrictions, orthostatic hypotension, etc) -Inefficient for self propulsion -Large turning radius Is a w/c user able to self-propel a tilt-in-space seating system? What advantages does this type of w/c provide to the user? - ANS ✔*No*; provides support for poor trunk and head control and pressure relief In a hemi-height w/c, there are two hand rims on the wheel. What do these outer and inner rims control? - ANS ✔-Inside rim: controls both wheels at the same time for going forward and backward -Outside rim: for turning (but coordination difficult for these patient populations) How do one arm drive w/c's allow the user to control the w/c from one side? - ANS ✔The axles are linked so that both wheels are operated from one side In an ultralight w/c, the axle is moved (forward/back) OR the seat is moved (forward/back) so that the user is seated right above the axle. What advantage does this achieve? - ANS ✔-In an ultralight w/c, the axle is moved *forward* OR the seat is moved *back* so that the user is seated right above the axle. -W/C is more maneuverable but more tippy What is the approximate weight of an ultralight w/c? - ANS ✔+/- 20lbs What are some materials used in ultralight w/c's? - ANS ✔-Chrome-moly steel -Aluminum-carbon composite -Titanium (lightest) Which has more efficient propulsion, a folding frame ultralight w/c or a rigid frame ultralight w/c? - ANS ✔*Rigid frame ultralight w/c* -No flex in frame = less energy loss during propulsion Do sport wheelchairs have a folding or rigid frame? How much do they weight? - ANS ✔-Rigid frame ANS ✔The highest joint moments and power values in the UE occur at the *shoulder* Peak hub torque occurs from ° of shoulder extension --> ° of shoulder flexion during the push phase - ANS ✔Peak hub torque occurs from 15° of shoulder extension --> 15° of shoulder flexion during the push phase Peak hub torque occurs from ° of elbow flexion --> ° of elbow flexion during the push phase - ANS ✔Peak hub torque occurs from *100°* of elbow flexion --> *80°* of elbow flexion during the push phase The highest joint reaction forces occur at the (shoulder, elbow, wrists) during propulsion - ANS ✔Wrist; joint reaction forces increase with fatigue Trunk (flexion/extension) often increases with fatigue - ANS ✔Trunk *flexion* often increases with fatigue Describe the weight distribution of a standard w/c configuration versus when the COG is posterior (seat move back or axle moved forward). Which configuration reduces rolling resistance? - ANS ✔Standard -60% rear wheel -40% front casters COG posterior -75% rear wheel -25% front casters If all other factors remain constant, RR is reduced by 6% with COG posterior Higher tire pressure pneumatics (100-160 psi) are (more/less) efficient than convention pneumatics (65 psi). Describe this in terms of RR. - ANS ✔High pressure pneumatics (100-160 psi) are *more efficient* than convention pneumatics (65 psi). -20-35% less RR than convention (but INCREASED RR on soft surfaces) Foam inserts that replace air in w/c tires have - % higher RR than conventional pneumatics - ANS ✔Foam inserts that replace air in w/c tires have *25-30%* higher RR than conventional pneumatics All terrain tires have increased RR on (hard/soft) surfaces and decreased RR on (hard/soft) surfaces - ANS ✔All terrain tires have increased RR on *hard* surfaces and decreased RR on *soft* surfaces Larger wheels have (higher/lower) RR over surface irregularities - ANS ✔Larger wheels have *lower* RR over surface irregularities What are the advantages and disadvantages of camber? - ANS ✔Advantages: -Lower COG -Decreased downward turning tendency -Increased lateral stability -Increased propulsion efficiency -Protects hands in tight spaces Disadvantages: -Lowers seat to floor height --> transfers more difficult -Too wide for some doors -Narrow seat width What happens if a caster stem is not vertical? - ANS ✔Increased flutter --> Increased RR The optimal seat height for effective propulsion has the elbow flexed at ° when the hand hits highest point of rim. Conventional seat height, however, has the elbow flexed at - ° when the hand hits the highest point of rim - ANS ✔The optimal seat height for effective propulsion has the elbow flexed at *120°* when the hand hits highest point of rim. Conventional seat height, however, has the elbow flexed at *60-80°* when the hand hits the highest point of rim What is the optimal position of the shoulder axis relative to the rear axle for propulsion? - ANS ✔The shoulder axis should be less than or equal to 2" posterior to the rear axle Describe the optimal positioning for a w/c athlete - ANS ✔-Shoulder position 3" posterior to rear axle -Rear axle in line with greater trochanter -Push rim is 2" below the elbow (arm at sides) -Elbows are flexed 100-120° with hands on rims A forward axle relative to the COG creates a (larger/smaller) turning radius and (longer/shorter) wheel base - ANS ✔A forward axle relative to the COG creates a *smaller* turning radius and *shorter* wheel base Orthoses provide support for which two main body impairments? - ANS ✔-Loss of muscle function (weakness) -Excessive spasticity Skeletal as well as muscle stability is of utmost important when fitting an orthotic device - ANS ✔Skeletal *alignment* as well as muscle stability is of utmost important when fitting an orthotic device Ankle joint orthotics usually provide support in the plane - ANS ✔Ankle joint orthotics usually provide support in the *sagittal* plane With proper orthotic stabilization of the subtalar joint, plane control of forefoot ABduction and ADduction is achieved. - ANS ✔With proper orthotic stabilization of the subtalar joint, *transverse* plane control of forefoot ABduction and ADduction is achieved How can an orthosis control transverse rotation? - ANS ✔Internal rotation of the femur and tibia via careful material selection and design principles