PNF Review

I found this site this week that had a great review of PNF definitions

http://physical-therapy.advanceweb.com/Article/The-Truth-About-PNF-Techniques-1.aspx

Pica Disorder

Pica disorder is a disorder when a person eats things that are not food items, like clay, dirt, laundry starch.  This week I learned about Pica because I heard of a patient eating laundry starch, this is called Amylophagia.  This has been a long term habit and this patient craves the starch and feels like she needs it to feel better, in reality laundry starch is harmful to the kidneys and bladder.  The reasons for this behavior is still under discussion, the lack of iron, social behavior, frontal lobe problems, what ever the issue this patient was eating herself into a bad situation.

Links for more info:
http://medical-dictionary.thefreedictionary.com/amylophagia

http://www.ncbi.nlm.nih.gov/pubmed?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=20595493

http://www.webmd.com/mental-health/mental-health-pica

Death and Dying

I know work at my first job at a SNF.  I am coming up on my one year anniversary and one thing I have learned a lot about in Death and Dying.

 Today I got to work and one of the cleaning personnel.  Reported we had lost a patient during the night.  I was shocked, I was not ready for this patient to be gone.  I was just working with this patient. yesterday and now this life is gone.  This wonderful patient was a handful at times but I still grew to love and cherish this patient.  Dying is something we are all doing everyday we live, but when death  of a patient comes unexpectedly my day gets turned upside down, but yet you need to continue on treating all the patients on Your list, because they are just as important.  Finding a way to grieve for all those who have left us is not always easy to do.

This is one lesson I am still learning
Lord help me to remember each one and rejoice in the lives lived and memories we shared and all the wonderful lessons they each have taught me along the way.

ORIF

Learning that it is ok to add resistance to add/abd with an ORIF at 3 and 4 weeks . 

Exercises that are good. 

Sit to stand maintaining weight bearing status.  Have them stand for 10 sec repeat 10 times.  

Clam shells  in side lining with T-band, pillow between knees. 

In supine knees flexed with ball between knees, and t band  let them do adduction for 5 sec and than switch to abd for 5 sec. 

Downward parachute

Stimulus: Downward momentum toward a solid surface
Response: in the upper extremities: Extension of shoulders and elbows to support self
Response in the lower extremities:  Extension of hips and knees to support self.
Normal age of response: 4 months through adulthood

Source:  Dreeben p. 424

Protective in Standing

Staggering response at 15 to 18 months

Stimulus:  Loss of equilibrium
Response: Placement of lower extremities to reestablish equilibrium

Stepping strategy

Source: Dreeben p. 424

Protective Reactions in Sitting

Forward at 6 months
Lateral at 7 moths
backwards 9 months

Stimulus: Loss of equilibrium
Response: Extension of the arm to support the body and keep from falling

Source: Dreeben p. 424

Tilting Reactions

Onset
In prone 5 to 7 months
In supine 7 to 9 months
sitting  8-11 months
quadruped 9-12 month
standing 12 to 18 months

Stimulus:  instability at the base of support
Response:  Abductions of arm, leg and concavity of the spine toward the upward side

normal are of response: 5 months through adulthood

Source:  Dreeben p. 424

Labyrinthine Righting

Normal age of response 1 month through adulthood
Stimulus: Body tilted with respect to upright with eyes blindfolded
Response:  Head orients to upright position


Source: Dreeben p. 424

Optical righting

Normal age of Response:  1 month through Adulthood
Stimulus:  Body tilted with respect to upright position
Response:  Head orients to upright position

Source: Dreeben p. 424

Body Righting on Body

Onset:  4th month
Stimulus: Body in contact with solid horizontal surface
Response: The body orients itself to gravity.
Integration: 5 years


Source: Dreeben p. 424

Body Righting on Head BOH

Onset:  4th month
Stimulus: Body contract with solid horizontal surface
Response: Head orients to upright position
Integration: 5 years

Source: Dreeben p. 424

Neck on Body

Onset:  Birth
Stimulus:  Head turned to the side
Response: Body tuns to the side following the head
Integration:  6 months

Source:  Dreeben p.  424

Landau Reflex

Onset: 3rd Month
Stimulus: In a prone Position when passively flexing the head
Response: the body flexes
Stimulus: In supine when the passively extending the head
Response:  The body extends; the arms are extended
Integration:  18 months

If the reflex persist
child may have difficulty developing various body movements
The Landau reflex is absent in children with cerebral palsy and gross motor retardation


Source:  Dreeben p. 423

Traction Response

Onset: 1 Month
Stimulus:  Traction on the upper extremities as in pull to sit
Respond: Body tightens
Integration:  5 months
If the reflex persists
 May have difficulty grading the upper-extremity response to traction


Source: Dreeben p. 423

Sucking Reflex

Onset: 28 weeks of gestation
Stimulus: Object in mouth
Response: begins to suck
Integration: 2 months
Negative Effects if Persistent
may have difficulty developing more mature oral motor patterns
similar to the rooting reflex

Source:  Dreeben p. 423

Flexor Withdrawal Reflex

Onset:  Birth
Stimulus:  Noxious stimulus (pressure or pain) to the sole of the foot or the palm of the hands
Response:  The foot or hand withdrawals away from the stimulus
Integration: 2 months
Negative Effects if Persistent
may have hypersensitivity to sensory stimuli


Source: Dreeben p. 423

Babinski Reflex

Onset:  Birth
Stimulus:  Stroking the lateral aspect of the plantar surface of the foot
Response:  Extension and fanning of the toes
Integration: 12 months
Negative Effects if Persistent
difficulty with balance in standing
Weight bearing on his or her feet

Source Dreeben p. 423

Walking Reflex

Onset: 38 weeks of gestation
Stimulus: Supported upright position with soles of feet on a firm surface
Response:  Reciprocal flexion/extension of the legs.
Integration: 2 months
Negative Effects if Persistent
Standing and walking
Balance reactions and weight shift in standing
Development of smooth, coordinated reciprocal movements of lower extremities

Source: Dreeben p.422

Positive Support Reflex

Onset:  35 weeks gestation
Stimulus:  Weight placed on balls of feet when upright
Response:  Stiffening of legs and trunk into extension
Integration:  2 months
Negative Effects if Persistent
Standing and walking
Balance reactions and weight shift in standing
Can also lead to contractures of ankles into plantarflexion

Source:  Dreeben p. 422