Therapeutic Exercise:

Benefits of ex INCREASE
● Boost mood
● Combat chronic diseases
● Manage weight
● Boost energy level
● Promotes better sleep
● Self-confidence
● Strength and stamina

Effects of bed rest DECREASE

● Muscle mass
● Strength
● Heart volume
● Orthostatic tolerance
● Exercise tolerance
● Bone mineral density

The effect of aging

● Decrease in muscle mass
● Decrease bone density
● Decreased flexibility and balance
● Reduced coordination and reaction time
● Increase in joint stiffness

Effects of ex
● Increase HR
● Increase BP
● Increase breathing
● Increase body temp
● Increase metabolism

Define and give examples:

● Isometric: muscle contracts without a length change (plank)
● Isokinetic: contraction at constant speed (UBE)
● Isotonic: muscle changes length (bicep curl)
● Concentric: muscle SHORTENS while contracting
● Eccentric: muscle LENGTHENS while contracting
● Open chain: distal end moves freely
● Close chain: distal end is fixed

Mistakes of ex
● Valsalva:
 ○ Increase intrathoracic pressure
○ Slows HR
○ Increase venous pressure
● Cool-down:
○ Cessation (venous pooling)
○ Decrease the return of blood to the heart
● Warm-up:
○ Strain or injury

Stretches BENEFITS
● Flexibility and ROM
● Posture and stabilization
● Relaxation and circulation

Aerobic ex
● Use oxygen for energy
● Builds cardiovascular endurance

Fibers
● Slow-Twitch (type I) ENDURANCE → Aerobic
○ Slow contraction speed
○ Low force production, resistant to fatigue
● Fast Twitch (type IIa) POWER + ENDURANCE → Anaerobic Glycolysis
○ Fast contraction speed, low force production
○ Fatigue resistant
● Fast Twitch (type IIb) POWER → ATP-PC
○ Fast contraction speed, high force production
○ Susceptible to quick fatigue

Types of energy systems

● ATP-PC: POWERFUL + QUICK
○ Uses stored ATP and creatine phosphate in the muscle to make quick energy
bursts (<30 sec)
● Anaerobic Glycolytic: BURN
○ Breaks down glucose without oxygen to make energy (30-90 sec)
● Aerobic: BREATHE
○ Uses oxygen to break down carbs and fats for slow, steady energy (>2 mins)

Different stages of healing

1. Acute (MAX protection): full ROM, decreased pain
2. Subacute (MOD protection): strengthening, stability
3. Chronic (MIN → NO protection): body mechanics
Kinesiology:
Kinesiology: study of human movement (art + science)
Biomechanics: applies mechanics to the body
Clinical kinesiology: uses this knowledge in healthcare to…
● Prevent injury
● Restore function
● Improve performance

Kinematics: describes motion WITHOUT considering forces (arm flexing)

Kinetics: describes the forces/torques causing motion (muscle pulling to lift an arm)

Motion Types:
● Translations: whole body moves in a line
○ Rectilinear (straight): sled sliding
○ Curvilinear (curved): ball tossed in the air
● Rotation: body spins around the axis (elbow flexion)
● Active: done by muscles
● Passive: done by outside force (therapist, gravity)

Directional Terms: SHOULD KNOW

Planes of Motion and Axes: SHOULD KNOW

Open Chain vs. Closed Chain: SHOULD KNOW

Degrees of Freedom:
● Uniaxial: 1 movement
○ Hinge or pivot (humeroulnar, radioulnar)
● Biaxial: 2 movements
○ Condyloid/ellipsoid, and saddle (radiocarpal, carpometacarpal)
● Triaxial: 3 movements
○ Ball-and-socket (femoral-acetabular, glenoid-humeral)

Arthrokinematics:
● Roll: multiple points on another articular surface (tire rolling on ground)
● Slide: single point on one articular surface contacts multiple points on another articular
surface (box sliding on ground)
● Spin: single point on one articular surface rotates on a single point on another articular
surface (top spinning on one spot on the floor)

Types of Joints:
● Synarthrosis—no movement (skulls) STABILITY
● Syndesmosis—little movement (tibia/fibula)
● Gomphosis—peg in socket (teeth)
● Amphiarthrosis—slight movement (pubic symphysis) MOBILITY AND STABILITY
○ SHOCK ABSORPTION
● Diarthrosis—most common (freely movable) MOBILITY
Joint Positions:
Close-packed: joint surfaces fit tightly, least movement (STABILITY)
Open packed: joint surfaces move freely, unstable but flexible (MOVEMENT)

Kinetics: Forces and Torque

● Force: a push or pull
○ Internal: muscles
○ External: gravity, weights

Torque: a force that causes rotation about an axis

Force x Distance (moment arm)

The farther the muscle attaches from the joint = the more torque (strength)

Levers:
1. 1st class: fulcrum in the middle (neck) BALANCE + POSTURE
2. 2nd class: resistance in the middle (calf) POWER
3. 3rd class: axis in the middle (elbow flexion) ROM + SPEED

Mechanical advantage: MA = A/R

● >1 = easier (2nd class)
● <1 = harder but faster (3rd class)

Vectors: show magnitude (length of arrow) and direction (arrowhead)

● When 2 forces combine → resultant vector shows the overall direction and
strength

Force Directions:
● Compression: push together
● Tension: pull apart
● Shear: parallel to surface (sliding)
● Bending: compression to one side, tension to the other
● Torsion: twisting

Newton's Laws:
● Inertia: an object stays still or in motion unless acted on
● Acceleration: heavier things need more force to move (F=MxA)
● Action: every action has an equal and opposite reaction

Types of Equilibrium:
● Stable: body returns to its former position after a light perturbation
● Unstable: body seeks a new position after a light perturbation
● Neutral: COG displaced but remains at the same level (rolling ball)
Movement System:
● Purposeful movement = muscle + nerves working together
● Brain → Nerves → Muscles
○ Afferent: sensory input ASCENDING
○ Efferent: sensory output DESCENDING
● Action potential: an electrical impulse that makes a muscle contract
● Depolarization: the cell becomes positive, triggering movement

Nervous System:
● Somatic: voluntary muscle and skin (moving arm)
● Visceral (autonomic): involuntary organs (heart rate)
● CNS: brain and SC (control center)
● PNS: nerves from CNS to body (communication lines)

Nerve Fibers:
● Type A: the fastest and thickest (MYELINATED)
○ Alpha:
■ Control skeletal muscle contraction (motor neurons)
■ Carry signals from muscle spindles for muscle position sense
(proprioception)
○ Beta:
■ Touch and pressure
○ Gamma:
■ Send signals to muscle spindles to help control muscle tone
○ Delta:
■ Pain and temperature (faster pain)
● Type B: medium size and speed (MYELINATED)
○ Carry AUTONOMIC signals: heart rate, smooth muscle, and glands
● Type C: smallest and slowest (UNMYELINATED)
○ Slow, dull, or aching pain
○ Autonomic nervous system

Motor Neurons:
● Alpha: activate EXTRAFUSAL fibers (main movers)
● Gamma: activate INTRAFUSAL fibers (muscle spindle sensors)

Skeletal muscle mechanics: study of how muscles’ internal + external forces affect strength
and movement
● Internal:
○ Muscle proteins (actin/myosin)
○ Length-tension
○ Motor unit recruitment
○ Fiber type and shape
 ● External:
○ Gravity
○ External load
○ Pulleys, position
○ Body orientation

Muscle Composition:
● Sarcomere: basic contractile tissue
● Contractile proteins:
○ Actin (thin) and Myosin (thick) = generate ACTIVE force
● Non-contractile proteins:
○ Support and create PASSIVE tension when stretched

Muscle Shapes:
● Fusiform: parallel → fast, LESS force (biceps)
● Pennate: angled → slower, MORE force (gastroc)
○ Pennate angle: angle between muscle fibers and tendons
■ Larger angle = more fibers fit = greater force

Physiologic Cross-Sectional Area (PCSA)

● PCSA: total fiber area → determines strength
○ Thicker muscle = more fibers = more force

Muscle Fiber Types:

● Slow-Twitch (type I) ENDURANCE → Aerobic
○ Slow contraction speed
○ Low force production, resistant to fatigue
● Fast Twitch (type IIa) POWER + ENDURANCE → Anaerobic Glycolysis
○ Fast contraction speed, low force production
○ Fatigue resistant
● Fast Twitch (type IIb) POWER → ATP-PC
○ Fast contraction speed, high force production
○ Susceptible to quick fatigue
Elastic Components:
● Series Elastic (SEC): in series with contractile (tendon) → transmits force
● Parallel Elastic (PEC): alongside contractile (connective tissue) → adds passive
tension

Passive Length-Tension Curve:

● Stretching muscle = tension increases (spring-like)
● Passive tension protects muscles and stabilizes joints
● Critical length: the point where resistance starts
TOO MUCH STRETCH → TISSUE FAILURE
Active Length-Tension Curve:
● Sliding filament theory: actin and myosin crossbridges slide → muscle shortens
→ force generated
● Optimal overlap = MAX crossbridges = max force
● Too short or too long → fewer crossbridges → weak forces
RESTING LENGTH = STRONGEST POINT

Total Length-Tension Curve:

● Total force = Active + Passive
● At resting length → mostly active
● As stretched → passive helps increase total tension

Pre-stretch concept:
● Pre-stretching before contraction = greater force output (squatting before jumping)

Muscular Insufficiency:
● Active: muscle SHORTENED too much → can't contract further (WEAK)
● Passive: muscle LENGTHENED too much → can’t lengthen further (TIGHT)

Bone Structure:
● Compact: hard outer layer STRENGTH AND STRUCTURE
● Cancellous (spongy): inner layer ABSORBS SHOCK
● Periosteum: tough outer covering that nourishes bone and serves as a muscle
attachment site FEEDS AND PROTECTS
● Marrow: makes blood cells
Neurology:
Brain Lobes and Key Structures:
Frontal Lobe: thinking, planning, movement, speech, personality
Parietal Lobe: sensation, touch, body awareness, spatial sense
Temporal Lobe: hearing, memory, understanding language
Occipital Lobe: vision and visual processing

Basal Ganglia: controls smooth, coordinated movement and posture

Hypothalamus: regulates body temp, hunger, thirst, hormones, and the autonomic nervous
system
Limbic: emotions, memory, motivation
Cerebellum: balance, coordination, fine movement, motor learning

Left hemisphere: logic, math, sequential thinking; LANGUAGE

● Anxiety
● Motor tasks
Right hemisphere: creativity, spatial awareness, art, emotion, intuition; RECKLESS
● Nonverbal communication
● Regulate emotion
● Irritable

Major Neural Tracts:

Descending: motor
Ascending: sensory

Corticospinal: voluntary muscle movement (FINE MOTOR)

Lateral Spinothalamic: pain and temperature
Anterior spinocerebellar: sends proprioception (body position) to the cerebellum

Cranial Nerves: LMN

1. Olfactory → smell
2. Optic → vision
3. Oculomotor → eye movement
4. Trochlear → medial and downward eye movement
5. Trigeminal → facial sensation, chewing
6. Abducens → lateral eye movement
7. Facial → facial expression, anterior 3rd of tongue
8. Vestibulocochlear → hearing and balance
9. Glossopharyngeal → taste, ⅔ posterior tongue, swallow, gag reflex
10. Vagus → heart, lungs, digestion, speech
11. Accessory → shoulder shrug
12. Hypoglossal → tongue movement
Cerebral Circulation:
ACA (FRONTAL + PARIETAL)
● Aphasia (Broca’s)
● Incontinence
● Contralateral sensory/motor loss (LE)
● Memory loss
● Personality changes
MCA (FRONTAL + PARIETAL + TEMPORAL)
● Contralateral sensory/motor loss UE (face + UE)
● Hemianopsia (visual field loss)
PCA (TEMPORAL + OCCIPITAL + THALAMUS)
● Visual agnosia (can see but not recognize)
● Aphasia (Wernicke’s)
● Diplopia (double vision)
● Hemianopsia
● Thalamic pain
Vertebrobasilar (BRAINSTEM + CEREBELLUM)
● Postural control
● Ataxia

Non-Modifiable Stroke Risk Factors:

- Age, sex, race, prior stroke, family history
Modifiable Stroke Risk Factors:
- Hypertension, Heart disease, smoking, diabetes, obesity, TIA

Types of CVA?
- Ischemic: occlusive, depriving tissue of O₂ due to blockage (thrombosis, embolism)
- Hemorrhagic: bleeding in or around the brain due to a burst blood vessel
- Transient Ischemic Attack (TIA): “warning stroke,” temporary disruption of the blood
supply

Brunnstrom Stages:
Brunnstrom: uses reflexes and spasticity to regain movement
1. Flaccidity (approximation) → positioning, prevent contractures, PROM
2. Spasticity appears (approximation) → begin using reflexes and synergy patterns
3. Spasticity peaks (synergy patterns) → use synergies for function (facilitate
movement)
4. Movement begins out of synergy → work on isolated control
5. More complex movement → refine coordination
6. Near-normal control → functional retraining, speed, and accuracy
Flexor Synergy: UPPER extremity
● Scapula: elevation and retraction
● Shoulder: ABDuction and ER
● Elbow: flexion
● Forearm: supination
● Wrist: flexion
● Fingers: flexion with ADDuction
● Thumb: flexion with ADDuction

Flexor Synergy: LOWER extremity

● Hip: flexion, ABDuction, and ER
● Knee: flexion
● Ankle: DF with INversion
● Toes: extension

Extensor Synergy: UPPER extremity

● Scapula: depression and protraction
● Shoulder: ADDuction and IR
● Elbow: extension
● Forearm: pronation
● Wrist: extension
● Fingers: flexion with ADDuction
● Thumb: flexion with ADDuction

Extensor Synergy: LOWER extremity

● Hip: extension, ADDuction, and IR
● Knee: extension
● Ankle: PF with INversion
● Toes: flexion and ADDuction

Positioning:
Supine (early phase) → keeps alignment; prevents pressure; good for relaxation and
tone reduction; REST AND RELAXATION
Sidelying on AFFECTED side → promotes weight bearing through the affected
arm/leg; normalizes tone; REGAIN SENSORY INPUT AND AWARENESS.
Sidelying on UNAFFECTED side → keeps affected arm protracted to avoid flexor tone;
supports leg in slight flexion; PREVENT NEGLECT, PROTECT SHOULDER
Sitting → encourages postural control, awareness of midline, and visual scanning;
BALANCE AND TRUNK RE-ED
Standing → improves WB, proprioception, and gait re-ed PRE-GAIT AND ENDURANCE
TRAINING
Clinical Concepts:
Pusher Syndrome: pushes toward the affected side due to midline misperception (R CVA
leans on the left side while seated) → visual cues (mirror), tactile input, vertical alignment
training.
Ramiste’s Phenomenon: resisted ABD/ADD on sound limb; same movement on
affected limb → initiates movement
Souques Phenomenon: raise arms above head, fingers automatically extend →
reduce hand flexor spasticity

Milestones/Impllications: Head → Roll → Sit → Crawl → Stand → Walk → Run

0-6 months: rolls front ↔ back, sits with support → independent
● Weak core = poor early movement
● Delayed independent play
6-12 months: crawls/creeps, pulls to stand, cruises furniture, moves between positions
● Sensory delay
● Poor muscle and play development
18 months: walks/climbs, pushes ball
● Delayed play and environment interaction
● Poor muscle development
2 years: walks smoothly, turns corners, climbs furniture, picks up toys, up/down steps with
support
● Poor leg strength → delayed running/jumping
3 years: stands on one foot, pedals tricycle, alternating stairs, catches ball with body, jumps in
place
● Low confidence and coordination
● Trouble on the playground/social play
4 years: one-foot balance (5 secs), catches, bounces, kicks, and throws a ball, jumps over
objects
● Poor coordination → avoids active play
● Less peer interaction
5 years: walks stairs carrying objects, skips, catches a ball with hands, walks backward toe-
heel
● Poor self-esteem is behind peers
● Difficulty with sports/toys (bikes and scooters)
6 years: runs on toes, balance beam, skips rope, mature throw, catch, and jump
● Sports and confidence issues if delayed
0-1: movement foundations
1-3: mobility + exploration
4-6: coordination + play skills

0-6 months: head, rolling, sitting → core control, sensory play

6-12 months: crawling, pulling to stand → WB, motor exploration
18 months: walk/climb → balance, EARLY coordination
2-3 years: stairs, throw/catch → leg strength, coordination
4-6 years: jump, skip, balance beam → play skills, social confidence
Reflexes:
● Rooting → helps find the nipple for breastfeeding
● Palmar grasp → early hand awareness
● Plantar grasp → prepares for standing balance
● ATNR → eye-hand coordination, rolling prep
● STNR → prepares for crawling
● TLR → head and neck control

PNF Progression:
1. Rhythmic Initiation → teach the pattern
2. Hold Relax Active Movement → wake up weak muscles
3. Repeated Contractions → build strength and activation
4. Hold Relax/Contract Relax → increase ROM
5. Alternating Isometrics → improve stability and endurance
6. Rhythmic Stabilization → strong postural stability and coordination
7. Agonist Reversal → improves control (STS)
8. Resisted Progression → builds coordination, timing, and endurance for
function (gait)

Kinesiology 2:
UE:
1. Nerves
2. Muscles, OINA
3. Mobs (arthrokinematics): shoulder, elbow, wrist
4. Axiohumeral, Scapulohumeral, Axioscapular
5. Force coupling
6. Planes and axes
7. End feels
8. Types of joints
9. Degrees of freedom
10. Grips
11. Functional position of the hand

Planes & Axes:

Plane Axis Movements

Sagittal Frontal/Coronal Flexion & Extension

Frontal Sagittal Abduction & Adduction

Transverse Vertical Rotation, Pronation/Supination

End Feels:
● Normal:
○ Soft: elbow flexion (soft tissue)
○ Firm: most joints (capsule, muscle stretch)
○ Hard: elbow extension (bone on bone)
● Abnormal: empty (pain), spasm, boggy, springy

Types of Joints & DOF

Joint Type Example DOF Movements

Hinge Elbow 1 Flex/Ext

Pivot Radioulnar 1 Rotation

Ellipsoidal Wrist 2 Flex/Ext, Radial/Ulnar Dev

(Condyloid)

Ball & Socket Shoulder 3 Flex/Ext, ABD/ADD,

Rotations

Plane (Gliding) AC joint Variable Glide, slide

Saddle Thumb CMC 2 Flex/Ext, ABD/ADD,

opposition

Arthrokinematics & Joint Mobs

Shoulder (Glenohumeral)
● Convex: Humeral head
● Concave: Glenoid fossa
● Rule: Convex on concave → roll & glide OPPOSITE
○ Flexion/ABD → inferior glide
○ ER → anterior glide
○ IR → posterior glide
Elbow
● Humeroulnar: Concave ulna on convex humerus → roll & glide SAME
○ Flex → anterior glide
○ Ext → posterior glide
● Humeroradial: Same rule (concave radius on convex humerus).
Wrist
● Radiocarpal joint: Convex carpals on concave radius → roll & glide OPPOSITE
○ Flex → dorsal glide
○ Ext → volar (palmar) glide
 ○ Radial dev → ulnar glide
○ Ulnar dev → radial glide

Muscle Groups
Axiohumeral (attach trunk → humerus)
● Latissimus Dorsi:
○ O: Lumbodorsal fascia, lower 3-4 ribs, iliac crest, SP T6-12
○ I: Bicipital groove of humerus
○ N: Thoracodorsal
○ A: ARM → Ext, ADD, IR; BACK/SPINE → thoracic flexion, lumbar
extension; SCAP → depression
● Pectoralis Major:
○ O: Sternal ½ of clavicle, ribs 1-6, rib cartilage, aponeurosis of external
oblique
○ I: Bicipital groove of humerus
○ N: Medial/Lateral Pec
○ A: ALL FIBERS → ADD, IR, elevate thoracic; UPPER → Flexion,
horizontal ADD; LOWER → Extension

Scapulohumeral (scapula → humerus)

● Deltoid:
○ O: Lateral 3rd of clavicle, arcomion, spine of scap
○ I: Deltoid tuberosity
○ N: Axillary
○ A: ANT → Flexion, IR; MID → ABD; POST → Extension, ER
● Teres Major:
○ O: Inferior angle of scapula
○ I: Bicipital groove of humerus
○ N: LOWER subscapular
○ A: ADD, IR
● Supraspinatus:
○ O: Supraspinous fossa
○ I: Greater tubercle of humerus
○ N: Suprascapular
○ A: INTIATES ABD
● Infraspinatus:
○ O: Infraspinous fossa
○ I: Greater tubercle of humerus
○ N: Suprascapular
○ A: ER
● Teres Minor:
○ O: Axillary (lateral) border of scapula
○ I: Greater tubercle of humerus
○ N: Axillary
 ○ A: ADD, ER

● Subscapularis:
○ O: Subscapular fossa
○ I: Lesser tubercle of the humerus
○ N: Subscapular
○ A: IR

Axioscapular (trunk → scapula)

● Trapezius:
○ O: EOP, superior nuchal line, nuchal ligament, SP C7-T12
○ I: Lateral 3rd of clavicle, acromion, spine of scapula
○ N: Cranial #11 (Spinal Accessory) C3-4
○ A: Scap elevation, retraction, depression
● Serratus Anterior:
○ O: Outer surfaces of ribs 1-8
○ I: Vertebral (medial) border of scap
○ N: LTN
○ A: Protraction, upward rotation of the scapula
● Rhomboid Minor:
○ O: SP C7-T1
○ I: Spine of scap
○ N: Dorsal scapular
○ A: Scap elevation, retraction, downward rotation
● Rhomboid Major:
○ O: SP T2-5
○ I: Medial border of scap between spine & inferior angle
○ N: Dorsal scapular
○ A: Retraction, downward rotation
● Levator Scapulae:
○ O: SP C1-C4
○ I: Vertebral (medial) border of scap between root of spine & superior angle
○ N: Dorsal scapular, C2-3
○ A: Scap elevation, downward rotation
● Pec Minor:
○ O: Outer surfaces of ribs 3-5
○ I: Coracoid process of scapula
○ N: Medial pec
○ A: Pulls scap forward, anteriorly tips, scap elevation

Force Couples:
Movement Muscles Working Together
Upward rotation of scap Upper trap + Lower trap + Serratus Anterior

Downward rotation of scap Rhomboids + Levator Scapulae + Pec Minor

GH Abduction Deltoid + Supraspinatus

Major Muscles (OINA): SIMPLIFIED

Muscle Origin Insertion Nerve Action

Deltoid Lateral 3rd of the Deltoid Axillary Flex, IR, ABD, Ext,
clavicle, acromion. tuberosity ER
Spine of scapula

Lat Dorsi SP T6-12, Bicipital groove Thoracodorsal EXT, ADD, IR

lumbodorsal fascia,
lower 3-4 ribs, iliac
crest

Pec Major Sternal ½ of clavicle, Bicipital groove Medial/Lateral Pec ADD, Flexion,
ribs 1-6, rib cartilage, Horizontal ADD,
aponeurosis of IR, Extension
external oblique

Supraspinatus Supraspinous Fossa Greater Suprascapular Initiates ABD

tubercle

Infraspinatus Infraspinous Fossa Greater Suprascapular ER

tubercle

Teres Minor Lateral border of the Greater Axillary ADD, ER

scapula tubercle

Subscapularis Subscapular fossa Lesser tubercle Subscapular IR

Biceps Brachii Coracoid process, Radial Musculocutaneous Elbow flexion,

supraglenoid tuberosity Supination
tubercle

Brachialis Lower ⅔ of the Coronoid Musculocutaneous Elbow flexion

anterior surface of process, ulnar PRIME
the humerus tuberosity

Triceps Post and lateral Post Olecranon Radial Elbow extension

humerus,
infraglenoid tubercle
Brachioradialis Supracondylar ridge Styloid process Radial Elbow flexion,
supination, and
pronation

Supinator Lateral epicondyle, Upper 3rd and Radial Supination

annular ligament of surface of
radius, supinator radius
crest of ulna

Pronator Teres CFT, coronoid Lateral radius Medial Pronation assists

process with flexion

Flexor Carpi CFT Bases of 2nd & Medial Wrist flexion, radial
Radialis 3rd MC dev

Flexor Carpi CFT, olecranon Pisiform, Ulnar Wrist flexion, ulnar

Ulnaris hamate, 5th dev
MC

Extensor Carpi Supracondylar ridge Base of 2nd Radial Wrist ext, radial
Radialis MC dev
Longus

Extensor Carpi CET, RCL Base of 3rd MC Radial Wrist ext, radial
Radialis Brevis dev

Extensor Carpi CET, post ulna Base of 5th MC Radial Wrist ext, ulnar
Ulnaris deviation

Grips & Functional Hand Positions:

Grip Type Description Example/Use

Power Grip Fingers flex around the object Holding hammer

with the thumb reinforcing

Precision Grip The thumb & one or more Writing, picking up a coin
fingers manipulate the object

Hook Grip Fingers flexed, thumb not Carrying suitcase

involved

Cylindrical Grip Full hand around the object Holding bottle

Spherical Grip Hand around a round object Holding ball

Lateral (Key) Grip The thumb pad presses the Holding key
lateral side of the index finger

Tip-to-Tip Pinch Thumb tip → fingertip Picking up a bead

 Three-Jaw Chuck Thumb + 2 fingers Writing, a gripping pencil

Functional Positions of the Hand

● Wrist: about 20° ext, slight ulnar dev
● MCP flexion 45°, PIP/DIP flexed slightly

Therex: 45 MC, 3 Short Answers

Shoulder: Impingement, AC joint, dislocation, Hill-Sachs, SLAP, Bankart, Subluxation,
Adhesive Capsulitis, Apprehension,
Causes/Test
Treatment
Ex program
Stages
Clinical Approach
Phases of Rehab
Open Chain
Closed Chain
Concentric
Eccentric
Thoracic outlet (structures involved test)
- Test: Roo’s
- Structures: Subclavian artery and
UE MMT
UE goniometry (fulcrum, moveable arm, stationary arm)
MOI: AC dislocation, Tennis + Golfer’s Elbow
Snuffbox: Tendons that make it up
- ABD Pollicis Longus
- Extensor Pollicis Longus
- Extensor Pollicis Brevis

Shoulder Conditions
Impingement Syndrome:
Causes: Compression of the supraspinatus tendon, the subacromial bursa, and the long head
of the biceps under the acromion
● MOI:
○ Repetitive overhead activities
○ Poor posture → forward shoulder → decreased subacromial space
● Special Test:
○ Neer’s (IR + Flexion)
○ Hawkins-Kennedy (90° flex + IR)
○ Painful Arc (60-120°)
● Treatment:
 ○ Scapular strengthening: middle + lower traps, serratus anterior
○ RTC strengthening
○ Posterior capsule stretch
○ Postural training
○ Avoid impingement positions early (IR + ABD)
● Exercise Program:
○ Acute: Scapular squeezes, isometrics
○ Subacute: ER strengthening (bands), rows
○ Chronic: Overhead strengthening, functional training
AC Joint Dislocation:
● MOI:
○ FOOSH, direct blow
○ Clavicle pops up (step deformity)
● Special Test:
○ Crossarm
● Treatment:
○ Sling early
○ Gradual ROM
○ Avoid horizontal ADD early
○ Strengthen deltoid + scapular stabilizers
Shoulder Dislocation:
● MOI:
○ Forced ABD + ER = Anterior Dislocation
● Special Test:
○ Apprehension test
○ Relocation test (reduces symptoms)
● Associated lesions:
○ Hill-Sachs: compression fracture of the posterior humeral head
○ Bankart: anterior-inferior labrum tear
○ SLAP: superior labrum tear involving the biceps anchor
● Treatment:
○ Immobilization briefly
○ Strengthen RTC (ER) + scapular stabilizers
○ Avoid ABD + ER early
○ Closed-chain for joint protection
Subluxation:
● Common post-stroke
● The humeral head slides inferiorly
● Weak supraspinatus, deltoid
● Treatment:
○ Proper positioning
○ Strengthen the cuff & deltoid
○ No overhead pulling early
Adhesive Capsulitis:
 ● MOI:
○ Unknown; associated with diabetes
○ Capsular pattern loss: ER > ABD > IR
● Stages:
○ 1. Freezing (Painful) → pain dominates, ROM ↓
○ 2. Frozen → pain ↓, stiffness max
○ 3. Thawing → slow improvement in ROM
● Treatment:
○ AROM, PROM
○ Joint mobs:
■ ER → posterior glide
■ ABD → inferior glide
○ Heat + stretching
○ Scapular strengthening
● Exercise Program:
○ Pendulums
○ Wand ER
○ Table slides
○ Posterior capsule stretch
Thoracic Outlet Syndrome:
Structures compressed: Subclavian artery + vein, brachial plexus
Possible compression sites:
1. Between anterior + middle scalene
2. Between clavicle + 1st rib
3. Under pectoralis minor
● Symptoms:
○ Arm numbness, heaviness, fatigue
○ Color changes
○ Weak grip
● Test:
○ Roo’s
○ Adson’s
● Treatment:
○ Stretch scalenes, pec minor
○ Strengthen lower traps, serratus anterior
○ Postural training
○ First rib mobility

Therex Fundamentals:
Open Chain:
● Distal segment free
○ Bicep curl
● Better for isolating muscles
Closed Chain:
 ● Distal segment fixed
○ Push-up, wall slide
● Better for joint stability
Concentric:
● Muscle shortens
○ RAISING DB in bicep curl
Eccentric:
● Muscle lengthens
○ LOWERING DB in bicep curl
● Produces more force
● More DOMS

Phases of Shoulder Rehab

1. Acute: 6 WEEKS
a. Pain control
b. PROM, AAROM
c. Isometrics
d. Scapular setting
2. Subacute: 7-12 WEEKS
a. AROM
b. Begin light strengthening
c. Postural correction
d. Closed-chain (wall slides)
3. Chronic: 13-21 WEEKS
a. RTC strengthening
b. Scapular stabilizers
c. Rhythmic stabilization
d. Theraband ER, IR
4. Return to Activity: 21+ WEEKS
a. Plyometrics
b. Sport-specific
c. Functional strengthening

MOI for Common Injuries

AC Joint Separation:
● FOOSH
● Direct fall onto the shoulder
● Tackle impact
Tennis Elbow:
● Overuse of wrist extensors
● Pain with wrist extension
Golfer's Elbow:
● Overuse of wrist flexors
● Pain with wrist flexion
Snuffbox
● Radial side:
○ Abductor Pollicis Longus
○ Extensor Pollicis Brevis
● Ulnar side:
○ Extensor Pollicis Longus
● Clinical Relevance:
○ Tenderness → scaphoid fracture
● Test:
○ Finkelstein

SCI: Injuries
What you can do functionally for each level
Complications at each level
Autonomic dysreflexia
HO

TBI: Sequelae complications

RANCHOS LOS AMIGOS SCALE
- Coup: Brain hits front part of skull
- Countercoup
- Coup-countercoup: combination of both

PD: Chronic, progressive neurological condition affecting the motor system due to
inability of dopamine receptors to work properly (basal ganglia)
- Symptoms:
- Bradykinesia (slow movement)
- Rigidity (know two types)
- Lead pipe: constant resistance / increased tone throughout entire
passive movement in any direction, regardless of speed
- Cog-wheel: Jerky, ratchet like response of tensing and letting go
- Tremors
- Akinesia (inability to initiate movement)
 - Postural Instability: Leads to greater fear of falling due to loss of postural
extension
- Presentation

MS: Degeneration / damage of axons due to demyelination of the CNS

- Symptoms / Presentation:
- Fatigue: Most common and disabling sx
- Motor Weakness: due to diminishment of sensory and spinal tracts that
helps w/ proprioception, causing LOB, clumsiness,
- Sensory (1st signs of MS): paresthesia, dysesthesia (abnormal burn/ache)
- Visual: Decreased visual acuity, diplopia, neuritis (grey vision)
- Autonomic Dysfunction: Bowel / bladder
- Cognitive impairment
- Treatment: Maintain optimal level of functional independence

Here’s a clean, concise study sheet based on what you listed—organized by diagnosis
+ key points you’ll need for PTA exams/clinicals.

SPINAL CORD INJURY (SCI)

Functional Ability by Level (General)

C1–C3

● Ventilator dependent

● Total assist for all ADLs

● Power WC with sip/puff

C4

● Diaphragm partially intact—may be off ventilator

● Shoulder elevation (traps)

● Power WC

C5

● Elbow flexion (biceps)

 ● Assist for transfers, manual WC possible short distances

● ADLs w/ adaptive equipment

C6

● Wrist extension → tenodesis grip

● Independent sliding board transfers

● Manual WC, driving adaptive possible

C7

● Elbow extension (triceps)

● Independent transfers, ADLs, WC mobility

C8–T1

● Finger flexors & hand intrinsic function

● Full hand function, independent living

T2–T6

● Trunk control improved, standing frame possible

● Wheelchair independent

T7–T12

● Full abdominals, improved gait potential w/ orthotics

L1–L3

● Hip flexion, knee extension → community ambulation w/ braces

L4–S3

● Increasing return to functional ambulation, AFO possibly

SCI Complications
 ● Autonomic Dysreflexia (T6 and above): BP↑, headache, flushing,
bradycardia → sit them up, find noxious stimulus

● Orthostatic Hypotension

● Pressure injuries

● Respiratory issues (higher levels)

● Spasticity

● Neurogenic bowel/bladder

Autonomic Dysreflexia

● Sympathetic overreaction from noxious stimulus below injury

● Signs: severe HA, HTN, sweating, goosebumps, bradycardia

● Intervention: sit upright, loosen clothing, check catheter, check bowel, call
medical team

Heterotopic Ossification (HO)

● Abnormal bone growth in soft tissue around joints (hips common)

● Signs: ↓ ROM, pain, warmth, swelling

● Tx: gentle ROM (avoid aggressive stretching), meds, surgery if severe

TRAUMATIC BRAIN INJURY (TBI)

Sequelae / Complications

● Cognitive deficits (memory, attention)

● Behavioral changes (impulsivity, agitation)

● Speech issues (aphasia, dysarthria)

● Motor impairment (spasticity, ataxia)

 ● Seizures

● Swallowing issues (dysphagia)

Rancho Los Amigos Cognitive Scale

● I – No Response

● II–III – General/Localized Response

● IV – Confused / Agitated

● V – Confused / Inappropriate

● VI – Confused / Appropriate

● VII – Automatic / Appropriate

● VIII – Purposeful / Appropriate

(9 & 10 exist depending on extended scale)

Mechanisms of Injury

● Coup: Brain hits front where impact occurs

● Contrecoup: Brain hits opposite side due to rebound

● Coup–Contrecoup: Both sides damaged

PARKINSON’S DISEASE (PD)

Chronic, progressive neurological disorder of basal ganglia → ↓
dopamine

Key Symptoms

● Bradykinesia

● Rigidity
 ○ Lead Pipe: constant tone

○ Cogwheel: jerky, ratchet-like

● Resting Tremor

● Akinesia (difficulty initiating movement)

● Postural Instability

Presentation

● Shuffling gait, festination, forward posture

● Masked face

● Hypophonia (soft voice)

● Difficulty turning / freezing episodes

MULTIPLE SCLEROSIS (MS)

Autoimmune demyelination of CNS → plaques → slowed conduction

Symptoms / Presentation

● Fatigue (most common + debilitating)

● Motor Weakness → coordination issues, LOB

● Sensory changes: paresthesia, dysesthesia

● Vision issues: neuritis, diplopia

● Autonomic dysfunction: bowel/bladder

● Cognitive impairment

Treatment Goals

● Maintain independence
 ● Energy conservation

● Avoid over-heating (Uhthoff’s phenomenon)

● Task-specific training

● Flexibility + spasticity management

Neuro 2:

Wheelchair Types by SCI Level:

SCI Level Wheelchair Type Why

C4 Sip-and-Puff WC, Tilt-in- No UE control. Need

space pressure relief automatically.

C5 Power WC with joystick Deltoid + biceps intact →

can use joystick

C6 Manual WC with rim Wrist extensors →

projections tendesis grip → can push
using projections

C7 Manual WC with friction rims Triceps = full push propulsion

C8 & below Standard Manual WC Full UE function (hand

intrinsics return)

Memory Trick: “4 puff, 5 power, 6 projections, 7 friction, 8 normal.”

Spinal Cord Injury:

Complications:

● Autonomic Dysreflexia (T6 & above)

○ Sx: pounding headache, flushed face, sweating above lesion, bradycardia, high
BP
○ Cause: bowel/bladder issue, tight clothing
○ Action: Sit patient UP, loosen clothes, check catheter
● Orthostatic Hypotension:
○ Common in early rehab
○ Tilt table, abdominal binder, elastic stockings
● Heterotopic Ossification (HO):
○ Sx: ↓ ROM, warm, swollen joint
○ Common: hips, knees
○ Stop aggressive stretching, notify PT
● Pressure Injuries:
○ Needs pressure relief:
■ C4 = tilt-in-space
■ C5-8 = pressure relief every 15 minutes
● Spasticity:
○ Stretching, weight-bearing, meds (baclofen), slow rotation
● DVT risk:
○ Lack of LE movement

Functional Expectations by Level:

● C4:
○ Diaphragm (partially), traps
○ Dependent for all mobility
● C5:
○ Elbow flexion (biceps)
○ Can feed self with adaptive equipment
○ Power WC
● C6:
○ Wrist extension (tenodesis)
○ Independent slide-board transfers possible
○ Manual WC with projections
○ Can drive with hand controls
● C7:
○ Triceps
○ Independent transfers
○ Manual WC
○ Pressure relief independently
● C8:
○ Hand intrinsics
○ Full independence with ADLs + WC mobility
Driving, Walking, Transfers:

● Highest level for driving = C6 (hand controls)

● Therapeutic ambulation = T6-9
● Household ambulation = T12-L2
● Community ambulation = L3-5
● Independent WC → bed transfers = C7

Key muscles for transfers: Triceps = C7

Traumatic Brain Injury:

● Coup-Contrecoup:
○ Coup: brain hits skull at site of impact
○ Contrecoup: brain rebounds → opposite side of impact
■ Predicts opposite lobe damage
● Lobes Function:
○ Frontal: judgement, motor planning, behavior
○ Parietal: sensation
○ Temporal: memory, hearing
○ Occipital: vision
○ Cerebellum: coordination
○ Brainstem: breathing, HR → MOST dangerous
● Signs of ICP:
○ Headache
○ Vomiting
○ Vision changes
○ Papilledema
○ LOC changes
○ Cushing’s Triad:
■ ↑ BP
■ ↓ HR
■ Irregular respirations

STOP therapy & notify immediately

● Glasgow Coma Scale:

○ Eye opening (1-4)
○ Verbal (1-5)
○ Motor (1-6)

Total: 3-15

○ Scores:
■ 3-8 = severe
■ 9-12 = moderate
■ 13-15 = mild
● Rancho Levels:
○ 1-3 = Total A (severe)
 ○ 4-6 = MAX-MOD A (moderate)
○ 7-10 = MIN-I (mild)
● Parkinson’s Disease:
○ Symptoms:
■ Bradykinesia (MOST disabling)
■ Resting tremor
■ Rigidity:
● Cogwheel (jerky)
● Lead-pipe (constant)
■ Festination (short, shuffling steps)
■ Decreased arm swing
■ Stooped posture
■ Freezing episodes
○ Treatment:
■ BIG MOVEMENTS (LSVT BIG)
■ Rhythmic cueing (metronome)
■ Ambulation with trekking poles for arm swing
■ Trunk rotation exercises
■ Avoid dual-task early
■ Stretch flexors (chest, hip flexors)
● Multiple Sclerosis:
○ Symptoms:
■ Vision changes
■ Spasticity
■ Weakness
■ Fatigue
■ Heat intolerance
■ Sensory changes
■ Balance deficits
■ Intention tremor
○ Treatment Principles:
■ Cool environment
■ Energy conservation
■ Avoid overheating (Uhthoff’s phenomenon)
■ Submaximal strengthening
■ Frequent rest breaks
■ Functional training
■ Aerobic activity: morning is best