Remarkable

Massage
Achilles Tendinitis
Soleus
Origin: Tibula/fibula
Insertion: Calcaneous

Gastrocnemius
Origin: Superior to articular surfaces of lateral condyle of femur and medial condyle of femur
Insertion: Calcaneous

Trochanteric bursitis
Outside (lateral) point of the hip known as the greater trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. This is a common cause of hip pain. Illiotibial band.

Medial epicondylitis pain in thenar eminence

Rhomboid strain

Bicipital tendinitis
Muscle attachments are Pectoralis Muscle.

1) C4 tetra with catheter foley
C4 tetra has limited shoulder movement. Requires total assistance because of complete paralysis of body and legs. No finger, wrist or elbow flexion or extension. Needs a two man lift.

2) Left cemented THR 3 days post op.
Do not flex hip over 90 degrees. Hold leg up while instructing patient to move around using the strength of their upper body. Use one standing pivot.

3) T12 paraplegic
Use sliding board to transfer to the wheelchair since patient has full head and neck movement with normal muscle strength. Normal shoulder movement. Full use of arms, wrists and fingers. Partial paralysis of lower body and legs. Upper body strength and balance will vary depending on level of injury, but the lower the level, the stronger the upper body strength and balance.

4) Patient with MS with generalized good strength. IV in dorsal right hand.
Be mindful of the IV as I transfer the patient.

5) Right cemented THR 3 days post op.
Same thing. One leg-stand pivot.

6) Patient has both short legged casts, non-weight-bearing.
Since patient is nonweight bearing, but good muscle strength, patient cannot stand on the floor. Therefore, using a sliding board to make use the patient's strength.

7) Parkinson's disease, generalized fair strength, foley catheter, tendency to loose balance backwards

Which muscles they innervated?
Secondly, what those muscles do?
sources
Hands

Ulnar nerve
Flexor carpi ulnaris - Wrist flexion
Extensor carpi ulnaris - Ulnar deviation (adduction), wrist extension

Claw hand
Someone with clawed hand will have weak wrist flexion, weak flexion of the 5th finger flexion, weak finger add/abd, and has a benediction sign.

Therefore, thumb cannot be adducted or abduction, but can oppose.

Radial nerve
Innervates extensors. If this nerve is paralyzed, person has dropped wrists.

No extension or abduction of thumb. Can oppose and adduct.

Medial
Affected the flexors carpis. Weak wrist flexion. Cannot Abduct or oppose thumb.

Ape hand - No thumb opposition, extension, and flexion. Severence of this nerve paralyzes the thenar muscles, and the thumb loses much of its usefulness.

Carpal tunnal syndrome - compression of the median nerve

Dupuytren's contracture - Too much thickening of the fascia.

Monday: 11:15?
Tuesday, 3:30
Wednedsay: 4:30

Things to do list
Revised wheelchair paper

Revised peer review paper

Read chapters on ultrasound, diathermy, fluidotherapy, and biofeedback for quiz on Nov.18, Wed

Call and reserved a seat for CPR class for Nov.21 Sat.

Get together signing contracts and medical packets

Doctors appointment on Nov.20, Friday

Mobility exam on Nov.23, Monday

Buy insurance liability

Esims appointment: 11/24/2009, 8:30am

( What it's like to be a wheelchair person? )

Mobility

Quadriplegic line
C1-C4
Able to move neck
May need ventilator to help with breathing

C5-C7
Able to use hands and arms, but weak

Paraplegic line
T1-T7
Able to use chest muscles

T7-T12
Able to use abdominal muscles

L1-L5
Able to use leg muscles

S1-3
Bowel and bladder functions

S3-S5
Sexual functions

1) Pt is a 75 yo with terminal stage ALS. Poor strength throughout BUEs and BLEs. Has an IV in right dorsal hand.

Poor strength in both upper extremities and both lower extremities.

Amyotrophic lateral sclerosis, or ALS. Symptoms or degeneration of motor neaurons that controls voluntary muscles movement. Usually do not develop until after age 50 years. Loss of muscle strength and coordination that eventually gets worse. Makes one unable to do routine tasks such sitting down or climbing up the stairs. This patient has life expectancy of six months or less. Has shortness of breath due to muscle weakness. Pt maybe on ventilator due to weakness of the respiratory muscles and provide comfort.


2) Patient wearing two short casts (BK) and is non weight bearing. Good upper body strength.
Below-knee cast for management of severe ankle sprains. Pt has short period of immobilisation. Maintains 10 degrees of ROM and control against inversion of the feet. This person can move his knees? Also, for myself, here something to look at. Tibial fractions. Assist for both legs.

3) Pt s/p right CVA with normal strength on non involved side
Patient left side is weak. Right side is normal. When put into sidelying position, lay the patient on the right side.

4) Pt s/p non cemented R THR. Good upper body strength
Be aware that this patient, when sit up, cannot overflexion of 90 degrees. This patient takes longer to recover and regain mobility therefore limits activities. Make Pt use upper body strength as much as possible.

5) Pt is s/p auto accident with TBI. Confusion but generally good strength.
Proper communication and time management. Be aware that this patient has confusion and is prone to headaces, amensia, nauseua, wonky sleept patterns, due to the accident to the head. Assist patient by using their own strength and do not touch the head, which is most vulnerable. Instead tell patient to make use of their neck muscles.

6) Pt with advanced parkinsonism and generalized upper extremity weakness. Has tendency to lose his balance backwards. Moderate tremor present.
Muscle stiffness contributes with the upper extremities and in tremor. Assist this patient whenever possible.

October 14th - Weds
October 15th - Thursday - Event at 6pm - bring membership I.D
October 22nd - Thursday
November 9th - Monday

Projects
Hamstring curl - First week of November due
Mobility - Go to library around the fourth week after Kins exam

1. A Description of the Agonists, Assistors and Stabilizers.
- hamstrings(agonists) contract, your quadriceps (antagonists)
- Antagonist to the quadriceps femoris: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius
- Origin: Tuberosity of the ischium, linea aspera,
- Insertion: Tibia, fibula
- Artery: Inferior gluteal artery, profunda femoris artery
- Nerve: Sciatic nerve, tibial nerve
- Actions: Flexion of knee
- Antagonist: Rectus femoris muscle
- Assistors to the glutes in hip extension

2. The type of muscle contractions those are required for the activity
A concentric contraction is a type of muscle contraction where the length of the muscles shortens while undergoing tension.

Another example would be if you were to perform a couple of leg curls on a hamstring machine. As your knee is flexing, your foot is approaching your buttocks, and your hamstring muscles shorten in the process.

Any muscle activity where the strength of the muscle can overcome the resistance of an object forcing the muscle’s length to shorten is considered a concentric contraction.

TEXTBOOK

Hamstrings
biceps femoris
semitendinosus
semimebranosus

Biceps femoris
Description: Most lateral muscle of the group, arises from two heads
O – Ischial tuberosity (long head); linea aspera and distal femur (short head)
I - Common tendom passes downward and laterally (forming lateral border of politeal fossa) to insert into head of fibula and lateral condyle of tibia
Action: Extends thigh and flexes knee; laterally rotates leg, especially when knee is flexed
Nerve: Sciatic nerve – tibial nerve to long head, common fibular nerve to short head (L5-S2)

Semitendinosus
Description: Lies medial to biceps femoris; although its name suggest that this muscle is largely tendinous, it is quite fleshy; its long slender tendon begins about two-thirds of the way down thigh
O - Ischial tuberosity in common with long head of biceps femois
I – medial aspect of upper tibial shaft
Action: Extends thigh at hip; flexes knee; with semimembranosus, medially rotates leg
Nerve: Sciatic nerve – Tibial nerve portion (L5-S2)

Semimembranosus: Deep to semitendinosus
O – Ischial tuberosity
I – Medial condyle of tibia; via oblique popliteal ligament to lateral condyle of femur
Actions: Extends thigh and flexes knee; medially rotates leg
Nerve: Sciatic nerve – tibial nerve portion (L5-S2)

Modalities: Paper
Kins: Group project and present
Mobility: Building assesment and graphic paper

Fall session I 2009

9/24 - No class
9/28 - No class

OCTOBER
Clinical Kinesiology - 9/29 or 10/1 - First quiz - Tuesday or Thursday

FIRST WEEK OF OCTOBER
FREE

SECOND WEEK OF OCTOBER
10/12 - No Class - Monday

THIRD WEEK OF OCTOBER
Therapeutic Procedures I - 10/14- *Quiz I * Lab Competency - Wednesday

Event - Panel - 10/15 - Goes after class - Thursday

CPE workshop - Oct.17-18 - 10am-4pm

Therapeutic Procedures I - 10/19 - 10/21 - Midterm Practical Exam - Mon/Weds

FOURTH WEEK OF OCTOBER
CPE workshop 10/24 - 10/25 - 10am-4pm

Mobility skills - Exams #1 - 10/26 - Monday

NOVEMBER
Mobility Skills - 11/2 - Midterm practicals

TBI is caused by a blow or jolt to the head, producing trauma or brain damage.

People affected
Young adults up to 24: More common in motor vehicle accidents
Elderly persons: Unintentional falls
Infants: Shaking syndrome
Soldiers: Explosive blasts

Each year about 1.4 million people suffer from TBI and 5.3 million live with TBI disabilities.

Types of injury
Open, close, penetrating wounds.
Traumaic injury to extra cranial blood vessels
Primary injuries immediately after accidents.
Secondary injuries as a result of primary injuries.

Signs and symptoms
Mild TBI symptoms may or not include loss of consciousness (LOS), amnesia, headache, dizziness, blurred vision, confusion, bad taste in the mouth, ringing ears, change in sleep patterns, and fatigue. It can affect concentration, attention, and thinking. Severe brain trauma can have nausea, migranes, personality changes, motor abnormalities and loss of coordination.

Treatment
Depends on severity. The first 3-5 days are the most crucial. Surgery maybe need to remove bullets from the brain and work on preventing infection and blood clots and decrease intracranial presure from the swelling.

Therapy
In rehabilitation focuses on recovering most cognitive and physical abilities which requires evaluation, measurement, and assessment of motor function, motivation, emotional stability, memory, and learning to identify weakness and strengths. If the patient works with the professionals, chances of recovery will increase, this also includes patient goals to determine their motivation.

Results of physical therapy is slow since it depends on the patient's medical history and performance during therapy since TBI involve physical and cognitive aspects.

Face
Orbicularis Oculi
Zygomaticus Major + Minor
Buccinator
Temporalis
Orbicularis Oris
Mentalis
Masseter

Neck
Trapezius (upper region)
Semispinalis
Sternohyoid
Scaleni muscles
Splenius cervicis
Sternocleidomastoid
Splenius capitis
Mylohyoid
Thyrohyoid

Back and shoulder girdle
Deltoid (alternative view)
Levator scapulae
Rhomboideus minor
Trapezius
Teres minor
Supraspinatus
Latissimus Dorsi
Rhomboideus major
Serratus anterior
Infraspinatus
Subscapularis

Thorax
Pectoralis major
Pectoralis minor
External intercostals
Internal intercostals
Serratus anterior (alternative view)
Diaphragm

Abdominal wall
External oblique
Internal oblique
Rectus abdominis
Transversus abdominis

Arms and shoulder girdle
Biceps brachii
Brachioradialis
Brachialis
Triceps brachii
Deltoid
Flexor carpi radialis
Flexor carpi ulnaris
Extensor carpi ulnaris
Pronator teres
Supinator
Teres major
Teres minor
Supraspinatus
Infraspinatus
Extensor carpi radialis
Extensor digitorum
Palmaris longus

Legs
Illiopsas = Psoas major / Illiacus
Gluteus maximus
Gluteus mediu
Gluteus minimus
Tensor fascia latae
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
Sartorius
Gracilis
Adductor longus
Adductor magnus
Pectineus
Biceps femoris
Semitendinosus
Semimembranosus
Peroneus longus or Fibularis longus
Peroneus brevis or Fibularis brevis
Tibialis anterior
Gastrocnemius
Soleus
Calcaneal tendon
Extensor digitorium longus
Flexor digitorium

The skull
Frontal
Parietal
Occipital
Temporal
Sphenoid
Zygomatic
Ethmoid
Lacrimal
Nasal
Maxilla
Palatine
Vomer
Mandible
Ramus

Supraorbital Fissure
Infraorbital Fissure
Supraorbital Foramen
Infraorbital Foramen
Jugular Foramen
Mental Foramen
Optic Foramen
Foramen Magnum
Foramen Ovale
Olfactory Foramina
Carotid canal
External Auditory Meatus
Sinuses
Alveoli (sockets)

Mastoid Process
Styloid Process
Coronoid Process
Condylar Process
Occipital Condyle
Coronal Suture
Squamosal Suture
Lambdoidal Suture
Sagittal Suture
Cribriform Plate
Sella Turcica
Crista galli
Nasal conchae
Fetal fontanels

Pelvis Girdle
Illium
Pubis
Symphysis Pubis
Obturator Foramen
Acetabulum
Ischium

Femur
Head
Greater Trochanter
Lesser Trochanter
Lateral Epicondyle
Medial Epicondyle
Lateral Condyle
Medial condyle

Tibia
Lateral Condyle
Medial Condyle
Medial Malleolus
Tibial Tuberosity
Anterior crest

Fibula
Head
Lateral Mallolus

Foot
Tarsals:
- Calcaneous
- Talus
- Cuboid
- Navicular
- Cueniform

Metatarsals
Phalanges

Scapula
Acromion
Coracoid Process
Glenoid Cavity (fossa)
Spine of scapula

Humerus
Greater Tubercle
Lesser Tubercle
Capitulum
Lateral Epicondyle
Medial Epicondyle
Trochlea
Olecranon Fossa
Coronoid Fossa

Radius
Head
Radial Tuberosity
Styloid
Process

Ulna
Coronoid process
Olecranon process
Styloid process
Radial notch
Trochlear notch

Hand
Carpals
- Scaphoid
- Lunate
- Triangular or triquetral
- Hamate
- Capitate
- Trapezoid
- Trapezium
Metacarpals
Phalanages

Sternum
Manubrium
Body
Xiphoid process

Ribs
True ribs
False ribs
Floating ribs

Vertebra
Cervical
- Atlas
- Axis (Dens) or Odontoid process

Thoracic
Lumbar
Transverse foramen
Vertebral foramen
Spinous process
Transverse process
Body (centrum)
Lamina
Pedicle

Burns
Carpal Tunnel Syndrome
Cerebral Palsy
Cerebrovasular Accident
Diabetes Mellitus
Fibromyalgia
Muscular Dystrophy
Osteoporosis
Parkinson Disease
Plantar Fasciitis
Rheumatoid Arthritis
Rotator Cuff Injury
Scoliosis
Spinal Cord Injury
Traumatic Brain Injury [TBI]
Total Hip Replacement
Total Knee Replacement

( Prehab and rehab with Total Knee Replacement )

Forgot talking about care equipment. I probably will talk about in the power point version.

( Total Knee Surgery Presentation )

( TKR glossary )

( Legal cases )

( Advocacy letter for Student Loan Repayment and Loan Forgiveness HR2891 )