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CP/Physio Glossary The words in this glossary were
obtained from the following sources Abducted: away from center of body Abductor muscle: Any muscle used to pull a body part way from the midline of the body. For example, the abductor leg muscles serve to spread the legs away from the midline and way from one another. Acetabular Index: The angle formed by drawing a horizontal line at the bottom of the pelvis and an angled line from the bottom of the pelvis to the outer edge of the socket. See a picture. By 4 months of age, a normal child will have an index of 30 degrees or less with the index decreasing until it reaches 20 degrees or less. An index above 30 degrees should prompt the doctor to begin treatment, with the treatment being more aggressive the higher the index. See a graph of the index versus age. The source for this graph is not currently known. Acetabulum: The area on the pelvis that is capable of becoming a hip socket. In newborns this area is cartilage, as the child matures this area will ossify or harden into bone. Sometimes also called the area of triradiate cartilage because three bones come together to form the acetabulum. Adaptation - means finding another way to do things. It's partly being creative about solving problems and partly being insistent about getting back to the things that are important to you. "Adaptive thinking" involve making changes in your everyday environment. Some examples are: changing how you do certain tasks or activities, changing the "tools" you use to do them or changing the features of places by doing things like adding ramps, widening doorways or getting rid of throw rugs. When you can learn to think "adaptively" you are using the best parts of human nature--resilience and creativity! ADA - Americans with Disabilities Act. The civil rights law for people with disabilities passed in 1990, which contain protections for employment, transportation, access to telecommunications, and access to public places Adducted: towards center of body Adductors: tendons on inside of legs, they pull the legs together. Common surgery: adductor tenotomy cuts adductors to prevent legs scissoring. Adductor tenotomy: The adductor muscle is used to bring the legs together. It is located across the groin. An adductor tenotomy is the term used to describe the snipping of the tendon that attaches to the muscle. This will allow the legs to fall further apart giving better movement of the child's leg so that the doctor can properly position the femur into the acetabulum. ADL: (activity of daily living): usually used in the plural form to refer to self care activities such as washing, bathing, dressing, using the toilet. AFO (ankle-foot orthosis): a brace used to stretch the Achilles tendon. Commonly made of a thin, light plastic material that is individually molded for a child. As a child grows, a new AFO may be needed. Ambulatory: able to walk. Associated reactions: These are also referred to as “associated movements”. If a child uses undue effort to move a limb there is often an increase in spasticity in the rest of the body. For example, if a Hemiplegic child squeezed an object with his sound hand, spasticity will increase in the affected arm and hand causing the hand to clench and the elbow to bend, often making the affected leg and foot stiff. Asymmetrical: One side of the body is different in attitude and action from the other. For instance, the head is always or frequently turned to one side, one arm remains flexed and fisted and the child does not use it. He may also kick with one leg. Ataxic: Wobbly and having no balance. Athetosis: involuntary (uncontrollable) writhing movements of face, arms and hands. Athetosis is present in some individuals with cerebral palsy. And: There are many varieties of this condition and one refers to them all under the term of the “the athetoid group”. All types in this group have in common an unstable type of muscle tension, which makes it impossible for the child to keep still. When he is at rest and comfortable the tension is often too low and the child will then have great difficulty in starting to move. If, on the other hand, he becomes excited or tries to do something that is difficult for him he may become very stiff. This instability of muscle tensions therefore interferes with any attempted movement. ATNR: Asymmetric Tonic Neck Reflex: flexion in prone of side closest to the floor, extension of side away from floor. Generally it means that one side of the body is flexed and the other side is extended, therefore limiting the child’s activities. Atrophy Usually attributed to muscle, it is a shrinking in size, usually following a period of disuse or immobility Avascular Necrosis: "A" means without and vascular pertains to blood flow. Necrosis is a type tissue death. Therefore, this means that no blood is getting to the tissue and the tissue dies. In most cases, the tissue here refers to the top of the femur. Babinski reflex: An important neurologic test based, believe it or not, upon what the big toe does when the sole of the foot is stimulated. If the big toe goes up, that may mean trouble. The Babinski reflex is obtained by stimulating the external portion (the outside) of the sole. The examiner begins the stimulation back at the heel and goes forward to the base of the toes. There are diverse ways to elicit the Babinski response. A useful way that requires no special equipment is with firm pressure from the examiner's thumb. Just stroke the sole firmly with the thumb from back to front along the outside edge. Care must be taken not to overdo it. Too vigorous stimulation may cause withdrawal of the foot or toe, which can be mistaken as a Babinski response. The Babinski reflex is characterized by extension of the great toe and also by fanning of the other toes. Most newborn babies are not neurologically mature and therefore show a Babinski response. Upon stimulation of the sole, they extend the great toe . Many young infants do this, too, and it is perfectly normal. However, in time during infancy the Babinski response vanishes and, under normal circumstances, should never return. A Babinski response in an older child or adult is abnormal. It is a sign of a problem in the central nervous system (CNS), most likely in a part of the CNS called the pyramidal tract. Asymmetry of the Babinski response -- when it is present on one side but not the other -- is abnormal. It is a sign not merely of trouble but helps to lateralize that trouble (tell which side of the CNS is involved). The Babinski reflex is known by a number of other names: the plantar response (because the sole is the plantar surface of the foot), the toe or big toe sign or phenomenon, the Babinski phenomenon or sign. (It is wrong to say that the Babinski sign is positive or negative; it is present or absent). Babinski, despite the Slavic sound of the name, was French: Joseph Francois Felix Babinski (1857-1932). He will never be forgotten in medicine, thanks to the reflex he found. Baclofen: muscle relaxant used to treat spasticity. Can be administered as an oral dose or intrathecally, via pump. (Lioresal®) Body mechanics - refers to the best or safest body position to use in order to accomplish a heavy task. Botulinum toxin: a drug, administered via intramuscular injection, to treat spasticity. (Botox®) Camber - the off-vertical tilt of the large wheels of a wheelchair, which increases the chair's stability and brings the tops of the wheels closer to the user. It also makes the wheelchair wider. Casters - the two small wheels at the front (or the rear) of the wheelchair which swivel in all directions. They contribute to the maneuverability of the wheelchair and come in either solid or pneumatic styles. Central Nervous System (CNS): the brain and the spinal cord. The CNS receives sensory impulses from the rest of the nervous system and then controls the body's response to those impulses. Cerebral Palsy: The generic title of a condition due to damage to the brain occurring in earliest childhood. This disturbs the normal coordination of the muscles of the body and makes it difficult or impossible to maintain normal postures and perform normal movements and skills. Those suffering from Cerebral Palsy are divided into the following main groups: Spastic, Athetoid, Ataxic, Hyperkinetic. Chiari Osteotomy: Surgery that cuts through the pelvis is of several kinds. One kind strives to make a deeper socket. Chiari, many years ago, developed a way to cut the pelvis just above the socket and push the socket inward so that the overhang of bone above would enhance the "coverage" of the ball. Steel pins to hold the slide position are often used. Pelvis bone heals fast. Things are usually solid within four weeks. The Chiari approach just covers the mature hip ball with raw bone, which lacks the slippery hip cartilage of a good socket. However, this was the first really effective hip augmentation. Hip socket augmentation is done for a variety of reasons. The most common, in handicapped persons, is to deal with a dislocating hip. In that setting the hip dislocates because the hip socket is too shallow and too vertical. Chorea: uncontrollable, small, jerky types of movements of toes and fingers. Chorea is present in some individuals with cerebral palsy. Closed Reduction: During a closed reduction, the surgeon typically injects dye into the hip to verify whether something is holding the hip out of the correct position. A closed reduction does not require a surgeon to cut into the hip socket. The surgeon then manipulates the hip externally to bring the head of the femur into the correct position in the hip socket (acetabulum). The surgeon stabilizes the hip by applying a spica cast. Cognitive functions: the skills of the brain. For example, memory, attention and concentration are cognitive functions. Contractures: permanent muscle and tendon shortening, a result of spastic tightening of muscles for long periods of time. Coordination: The patterning of the action of the muscles of the body, ie’ their “working together” is controlled by the brain and is necessary for the maintenance of posture, for balance and the performance of movements. Crossbrace - the center frame of the wheelchair, which is just below the seat. On folding wheelchair, crossbraces join the two sides of the wheelchair frame together, as well as providing support for seating. Custom - as in a frame or a wheelchair, when either are built to an individual's specifications. D A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head. Diffuse spasticity: term used when spasticity is in several different muscles in the arms and the legs. Diplegia: Another type of cerebral palsy where the whole body is affected. The lower parts, that is, the legs and lower trunk, are more severely involved than the head and arms.. The children usually use their arms and hands quite well and have good control of the head and fair or normal speech. Dorsiflexion: lifting toes up Durable Medical Equipment (DME) - The general category of equipment which includes wheelchairs, bath benches, hospital beds, bedside commodes and walker etc. Also see Rehabilitation Technology Supplier. Dystonia: involuntary slow, sustained muscle contractions, which result in abnormal postures and twisting motions of arm(s), leg(s), trunk. Evaluation - the service offered by rehabilitation professionals, such as occupational or physical therapists, who work with their client to assemble equipment specifications and then justify the need for those specifications to third-party payers. Extension: Stretching of any part of the body. Facilitation: A technical term used in many treatment techniques. Normal automatic patterns of muscle action, such as the lifting of the head, rolling over from back to tummy, sitting up and balance reactions, are obtained by special techniques of handling the child. Femoral osteotomy: Cutting and repositioning the femur in order to hold the femur in the acetabulum. A femoral osteotomy is performed when there is adequate coverage of the femur but still the femur can move with the possibility of dislocation. The surgeon begins by opening the hip capsule. The femur is cut all the way across just slightly below the ball area. The surgeon then rotates the top of the femur slightly around towards the acetabulum. The femur is then put back together with a plate and screws. Lastly a hip spica cast is placed on the child, which remains on up to 8 weeks. The plate and screws are removed in a separate operation at a later date. The femoral osteotomy rotates the top of the femur around to fit better into the acetabulum (socket) while the bottom of the leg remains unchanged. Flexion: Bending of any part of the body. Flexor: front of hand or foot Footrests - the place where the wheelchair user can rest his/her feet and it is also called a foot plate. Fork - the part that attaches the front wheel or caster to the frame of the wheelchair. Function: a clinical term that usually refers to an ability (or abilities) or skill needed to carry out an activity of daily living(ADL) such as sitting, walking, eating, dressing, writing, washing or using the toilet. H Hemiplegia: A type of cerebral palsy in which one half of the body is involved only. It is usually this type, which shows asymmetry most clearly. Hip dislocation: the hip is a joint where the upper end of the thigh bone (femur) meets the pelvic bone. In children with spasticity, the end of the femur can gradually be pulled out of its socket where it connects with the hip. This condition is treated surgically Hydrotherapy: Rehabilitation exercises performed in a appropriately designed pool. Hyperextension Active or passive force which takes the joint into extension, but beyond its normal physiological range. Hypotonia: (Floppiness): In some children brain damage leads to a state of tension of their muscles which is too low. They cannot therefore maintain any postures against gravity, and they cannot start a movement, maintain any postures against gravity, and they cannot start a movement. Inhibition: A technical term of treatment. Special techniques of handling are aimed at stopping the spastic or athetoid patterns which prevent or interfere with normal activity. Kyphosis: Exaggerated curvature of the spine, in the flexion/extension axis. In the thoracic spine, in adolescents, the most common cause of kyphosis is Sheuermann's disease. In the elderly, the most common cause of kyphosis is disc degeneration. Localized kyphosis may be caused by collapse of one or more thoracic vertebrae which, in the elderly, may be associated with osteoporosis Lateral: Out to side Lateral Hamstring: runs along outside of leg Lordosis: Curve of the spine, whereby there is hollowing. Normal lordosis is seen in the lumbar spine, although variances do exist. Medial: Turns inward Medial Hamstring: runs along inside of leg. Muscle tone: The level of tension in the muscle. O Orthotics: the filed of knowledge relations to orthopedic apparatus (orthoses) used to support, align, prevent or correct deformities or to improve function of movable parts of the body. Osteotomy: Osteo means bone, and otomy means the cutting of, therefore an osteotomy is the cutting of bone. There are two main classifications of osteotomies (pelvic and femoral), which are determined by the part of the body that is cut. Patterns of Movement: In every movement and change of posture produced by it, the brain throws muscles into action always in well-coordinated groups, that is, patterns. Pelvic Obliquity: angulation of the pelvis from the horizontal in the frontal plane, possibly secondary to a contraction below the pelvis, e.g. of the hip joint. If this angulation is due to a leg length inequality, then the leg lengths should be equalized to create a level pelvis for measurement purposes Pelvic osteotomy: Cutting and reshaping the pelvis in order to hold the femur in the acetabulum. A pelvic osteotomy is used when the acetabular index is not improving and there is not adequate coverage of the femur. The surgeon begins by opening the hip capsule up, hence many times the surgery is osteotomy with an open reduction. After the hip capsule is opened, the surgeon will take a wedge shaped piece of bone from the bony protuberance further up on the pelvis. This is the graft bone. Next the surgeon will cut across the pelvis slightly above the acetabulum. The bone graft will be inserted into this cut and held in place with 2 four-inch long pins. Lastly the surgeon will place a spica cast on the child, which remains on up 8 weeks. The pins are taken out later, sometimes when the cast comes off and sometimes in a separate operation. The pelvic osteotomy brings the whole acetabulum (socket) down and around without changing the shape of the socket. There are different pelvic osteotomies depending on where the surgeon opens the hip socket (anterior, medial or posterior), where exactly on the pelvis the cut is made and whether more than one cut is made. But the resulting operation is still the same. Pemberton Osteotomy: Pemberton found that he could not get that cut to swing far enough to the side in the older more neglected cases (Indian reservation) that he was dealing with. His cut takes a steep arcing curve, parallel to the socket, to allow a steeper over the top swing of the socket from a lower pivot axis. That arc required that the growth zone in the hip be mature as it crossed where Salter avoided, a growing zone. Pappas devised a hybrid of the two for the in between cases. Sutherland found that the pubic hinge, on which these operations rely, is stiff in certain patients, so he added another bone division near the pubis so as to not depend on the suppleness of that structure. These surgeries are very similar, save for subtle geometry shifts. They avoid crossing vascular supply. Then the more aggressive surgeries were developed which, in various ways, essentially carve the hip socket right out of the pelvis altogether and put it anywhere the surgeon pleases. The down side is that it may not be where the blood supply pleases, nor where stability of the result is as secure. The general name for the three bones that make up the pelvic bone is innominate bone. Altogether, these surgeries are grouped as innominate osteotomies (oste = bone, tome = cut). Pneumatic - involving "air" as in air-filled or pneumatic tires. Posture - the alignment of the body. Posture can affect how you feel and how you function in your wheelchair, especially over the long run. Pressure - or more accurately, interface pressure, which is the measure of the force exerted over an area of the body due to contact with a seating support surface. If sensation is impaired, the person does not realize that they need to change position and relieve the pressure. Prone: Lying face downward. Propel - making a wheelchair move. It can be by "hand," as in manual propulsion, or by motor. Push handle - the handles on the back of some wheelchairs that make it easier for an attendant to push the chair from behind. Push rims - the ring on the sides of the rear wheels of a wheelchair where the hands are placed for propelling the wheelchair. They can be plain aluminum, coated with plastic or even fitted with projections that make it possible to push forward with the heel of the palm. Quadriplegia: Spastic Quadriplegia refers to the fact that all 4 limbs are affected by spasticity. Most children with Hydranencephaly have spastic quadriplegia. Quick-release axle - a push-button, removable axle that allows quick removal of rear wheel from a wheelchair for transporting it. Range of motion (ROM) refers to the flexibility of joins such as elbows, wrists, ankles, knees, hips. Spastic muscles make joints stiff; this decreases the range of motion (span of movement possible) of the joint. Range of movement: The full amount of movement possible in a body joint (such as the knee or elbow). Reduction: Reduction is the term used to describe putting a bone back into its proper position. A closed reduction is accomplished without making an incision in the skin. An open reduction is when an incision is made and the socket is cleaned and any debris is removed. Rehabilitation Technology Suppliers (RTS) - these are the professionals who sell you your wheelchair. This means that they specify the order to the manufacturer, deliver the chair to you and adjust it to your needs and later service or repair your wheelchair. They are also sometimes called Durable Medical Equipment salespersons Salter Osteotomy: To try to get the shallow socket more over the top of the ball (more like a cap and less like an ear muff) another sort of pelvis cut is performed. Depending on from where to where that cut is made, each version has a slightly different way it swings the socket. A very well liked straight cut version, the Salter Osteotomy, for certain kinds of pathology attempts to swing the socket more forward as well as a bit over the top. The bone pivots on the pubic symphysis.. Scoliosis: Sideways (lateral)
curvature of the spine (the backbone). The degree of scoliosis can range from
mild to severe. Scoliosis is most commonly an incidental and harmless finding.
Patients with milder curves may only need to visit their doctor for periodic
observation. Persons with more severe scoliosis may require treatment. Severe
scoliosis can often be improved by bracing, casting and/or surgical correction.
Seat height - the distance from floor to either the front or the rear of the wheelchair seat. Serial casting: using a cast to stretch tightened muscle(s) and then reacting as the muscle stretches. The goal is to increase the range of motion Spasticity: The increased stiffness or ‘muscle tone’ felt in children with cerebral palsy. Muscle spasm can often be felt when such a child’s limbs are moved. The limbs are hard to bend or straighten because of the spasticity of the muscles. The doctor usually finds increased tendon jerks in a child with spasticity. Subluxation: Partial dislocation of a joint. A complete dislocation is a luxation. Supine: Lying on the back. Symmetrical: The postural patterns of both sides of the body are alike and therefore movements can also be performed in the same way> If, for example, the head is in the middle, the hands can be brought to the mouth, both arms can reach out, and the legs also have the same attitude. Tendon: a fibrous band of tissue that connects muscle to bone. Third-party payer - the party (other than the user) that actually pays for a wheelchair, such as an insurance company, Medicare, the Veterans Administration or an organization such as the Multiple Sclerosis Society. Tires - the solid rubber or air-filled rubber/synthetic part of the wheel that makes contact with the floor. Tolerance: in reference to Medication, refers to the body becoming less responsive to a particular dosage of medication. Accordingly, to maintain the effect of medication, dosage needs to be increased. Tone: As applied to the body's muscles, tone refers to natural tension; i.e., the muscle's ability to resist passive elongation or stretch. Tone is the normal state of balanced tension and responsiveness of the body. Valgus deformity: weight bearing on inside of foot Varus deformity: weight bearing on outside of foot. Wheelbase - the distance between center of front caster on the wheelchair and the center of the rear wheel. Wheelchair accessible - the characteristic of a building or a public place that lets a person using a wheelchair to move around without interference and with access to all the features of that place. Wheelchair Standards - the terms, definitions, design requirements, performance requirements, test methods and disclosure requirements of wheelchairs that are agreed upon and formalized by a national or international standards organization. Wheelie - balancing on the two rear wheels of a manual wheelchair. This skill is useful for dealing with obstacles such as curbs or uneven surfaces like ramps or hills.Other pages in this section: |
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