NPTE Studycast | Physical Therapy: Recent Episodes
Jimmy McKay, PT, DPT
An NPTE podcast for Physical Therapy students looking to get some extra time with test prep on the go. From the brewers of the PT Pintcast.
In this episode, we dive into the highly anticipated 2025 revision of the Clinical Practice Guidelines for Hip Pain and Mobility Deficits—Hip Osteoarthritis, published by the APTA Academy of Orthopaedic Physical Therapy. Join us as we explore the latest evidence on how to best classify, examine, and treat patients living with mild-to-moderate hip OA. We break down the updated recommendations for manual therapy, specific exercise dosing, patient education, and a brand-new "Level A" recommendation for dry needling. Whether you are looking to optimize your conservative management strategies or understand when to use (and when to avoid) modalities like ultrasound and bracing, this episode covers the essential updates every physical therapist needs to know.
Key Show Notes & Takeaways:
- Manual Therapy Matters: Clinicians should utilize soft tissue and joint mobilization, including both high- and low-force long-axis distraction and mobilization with movement. These techniques are strongly recommended to increase range of motion, decrease pain, and improve overall function. Therapists are encouraged to modify their force amplitude based on the patient's specific bony hip morphology and tissue irritability.
- Exercise Prescription & Dosing: Individualized exercise programs (including aquatic therapy) are vital. The updated guidelines recommend a specific dosage: 1 to 5 times per week, lasting 30 to 120 minutes per session, over a duration of 5 to 16 weeks.
- New Evidence for Dry Needling: The 2025 CPG introduces a strong recommendation for dry needling. Targeting myofascial trigger points in the iliopsoas, rectus femoris, tensor fasciae latae, and gluteus medius/minimus provides short-term (3-week) improvements in pain, muscle extensibility, and force production for patients with Grades II and III hip OA.
- Patient Education & Weight Management: Education should go beyond just giving advice. Clinicians should integrate internet-based pain coping skills training alongside manual therapy and exercise. Additionally, for overweight or obese patients, physical therapists should actively collaborate with physicians and dietitians to support a targeted weight loss of 5%–7.5%.
- Modalities and Bracing – What to Avoid:
- Bracing should not be used as a first-line treatment, though it can be considered if exercise and manual therapy fail to improve activities requiring pivoting.
- Therapeutic Ultrasound has conflicting evidence regarding its efficacy. It may be used in shared decision-making, but patients must be informed about its questionable benefits and potential costs.
References & Resources:
- Koc, T. A., et al. (2025). Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2025. Journal of Orthopaedic & Sports Physical Therapy, 55(11), CPG1-CPG31.
ACL Tear — NPTE Cheat Sheet* What it is: * ACL failure from excessive anterior tibial translation — basically the tibia tries to run off and the ACL can’t hold the line. * Classic signs: * Pop * Immediate swelling (1–2 hours) * Pivot / cutting mechanism * Instability * Difficulty weight-bearing * Rule-in test: * Lachman test — NPTE’s #1. * Rule-out clues: * Slow swelling → Meniscus * Posterior sag → PCL * Medial pain → MCL * NPTE trap: * Delayed swelling means NOT ACL. * Best treatment: * Early ROM, quads, swelling control, gait normalized. * Mock question included: Yes — test yourself before you move on.
Lock down ACLs in under 3 minutes. Hit follow for more NPTE wins.
PCL Injury — NPTE Cheat Sheet* What it is: * Injury to the posterior cruciate ligament from excessive posterior translation of the tibia — often from dashboard impact or falling on a flexed knee. * Classic signs: * Posterior sag sign * Posterior knee pain * Difficulty descending stairs * Instability (less dramatic than ACL) * Dashboard injury mechanism * Rule-in test: * Posterior Drawer Test (NPTE’s favorite) * Rule-out clues: * Immediate swelling → ACL * Locking/catching → Meniscus * Medial tenderness → MCL * NPTE trap: * “Dashboard injury” = PCL. Never ignore it. * Best treatment: * ROM, quad strength, avoid early hamstring loading. * Mock question included: Yes.
Lock down PCL injuries in under 3 minutes. Hit follow for more NPTE wins.
BPPV — NPTE Cheat Sheet* What it is: Otoconia displaced into a semicircular canal (ear crystals where they shouldn’t be). * Classic signs: Brief vertigo (<60 sec), triggered by position changes, upbeating torsional nystagmus, no hearing loss. * Rule-in test: Dix-Hallpike. * Rule-out clues: Long-lasting vertigo, neuro deficits, hearing symptoms → think neuritis/Ménière’s. * NPTE trap: Nystagmus >60 seconds = NOT typical BPPV (think cupulolithiasis). * Best treatment: Epley every. single. time. * Mock question included: Yes — test yourself before you move on.
Listen in and pass this question forever in under 3 minutes.
More NPTE wins every week — hit follow.
Meniscus Tear — NPTE Cheat Sheet* What it is: * Injury to the medial or lateral meniscus — the knee’s shock-absorbing cartilage — often caused by twisting or deep flexion. * Classic signs: * Joint line pain * Locking or catching * Clicking * Delayed swelling (24–48 hours) * Pain with squatting/twisting * Rule-in test: * McMurray test (NPTE’s go-to) * Rule-out clues: * Immediate swelling → ACL * Posterior sag → PCL * Medial tenderness → MCL * NPTE trap: * Locking/catching = meniscus, even if the question tries to distract you. * Best treatment: * ROM, swelling reduction, quads/hip strength, progressive loading. * Mock question included: Yes.
Lock down meniscus tears in under 3 minutes. Hit follow for more NPTE wins.
SHOW NOTES — Red Flags for Cancer (Cheat Sheet)* What it is: * Non-mechanical symptoms raising suspicion for malignancy. * Classic signs: * Night pain * Unexplained weight loss * Constant, deep ache * No mechanical pattern * History of cancer * Rule-in test: * None — this is a screening cluster. * Rule-out clues: * Pain that changes with movement or position. * NPTE trap: * Night pain + weight loss = refer immediately. * Best treatment: * Medical referral, not PT.
MCL Injury — NPTE Cheat Sheet* What it is: * Sprain/tear of the MCL from valgus force or lateral blow. * Classic signs: * Medial knee pain * Pain with valgus stress * Local tenderness * Mild swelling * Lateral blow mechanism * Rule-in test: * Valgus Stress Test at 30° * Rule-out clues: * Pop + immediate swelling → ACL * Locking → Meniscus * Posterior sag → PCL * NPTE trap: * Valgus force + medial pain = MCL. Full stop. * Best treatment: * ROM, quad/hip strength, bracing, progressive load.
Mock question included. Listen in and lock it down.
Jimmy McKay hosts a webinar hosted by the Academy of Orthopedic Physical Therapy to answer frequently asked questions about becoming an orthopedic clinical specialist (OCS)
Key Topics Covered:
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Prerequisites and eligibility requirements for taking the OCS exam
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Realistic timeframes for preparing for the OCS exam
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Recommended study materials and resources for OCS exam preparation
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Key content areas tested on the OCS exam
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Study strategies and tips for retaining information
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Role of residency and fellowship programs in enhancing OCS exam preparation
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Common challenges OCS candidates face and how to overcome them
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What to expect on OCS exam day
Resources Mentioned:
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Academy of Orthopedic Physical Therapy (AOPT) website, YouTube channel, podcast
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AOPT Independent Study Courses and Current Concepts monographs
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Medbridge OCS prep course
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OCS Field Guide podcast
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OCS Prep podcast
The webinar focuses on providing an overview of the OCS exam, eligibility requirements, realistic preparation timelines, recommended study strategies and resources, challenges candidates may face, and insight into what to expect on exam day. Several free and paid resources to aid in exam preparation are highlighted.
You studied and passed the NPTE!
CONGRATS!
Um... now what?
Our 3 hosts give you advice on what to do NOW that you did the thing you set out to do in the first place!
Finding a job
Networking
Self Assessment
Welcome back to NPTE Studycast, your indispensable guide for mastering the NPTE! In this episode, we're diving deep into Parkinson's Disease—a subject crucial not just for the NPTE but also for your real-world clinical practice. Listen in to expand your understanding and enhance your skills in addressing this complex condition.
Rachele Burriesci of All Things Cardio Pulm dives into the essential topic of sublingual nitroglycerin, specifically tailored for physical therapy students gearing up for the NPTE (National Physical Therapy Examination) exam. Join us as we explore the ins and outs of this medication, its clinical applications, and its implications in the context of physical therapy practice.
Episode Highlights:
- Overview of sublingual nitroglycerin: We provide a comprehensive introduction to sublingual nitroglycerin, discussing its pharmacological properties, mechanism of action, and common indications.
- Understanding angina and cardiovascular conditions: Learn about the pathophysiology of angina, different types of angina, and how sublingual nitroglycerin is utilized as a primary treatment for angina and other cardiovascular conditions.
- Clinical considerations for physical therapists: Discover the role of physical therapists in managing patients who use sublingual nitroglycerin, including safety precautions, monitoring, and potential contraindications.
- Interprofessional collaboration: Explore the importance of interdisciplinary collaboration when working with patients on sublingual nitroglycerin, highlighting the significance of effective communication and shared decision-making.
- NPTE exam preparation tips: We provide valuable insights and strategies to help physical therapy students effectively study and master the topic of sublingual nitroglycerin for the NPTE exam.
In this episode, Dr. Burriesci breaks down sublingual nitroglycerin. She gives the need-to-know facts, safety considerations and important education tips for your patients.
In This Episode
- MOA of Sublingual Nitro
- Indications of Nitro
- Side effects of Nitro
- How to take Nitro
- 3 Rules of Nitro
- Safety Considerations
Find Dr. Burriesci on:
IG: @all_things_cardiopulm
Website: https://www.allthingscardiopulm.com
Podcast: Talking All Things Cardiopulm
Twitter: @allcardiopulm
Angina - It’s Not just chest pain
Dive into understanding Angina with Dr. Rachele Burriesci, as she breaks down the pathophysiologic cause of angina, describes the 3 most common types and what you as a physical therapist should be aware of in its description in order to differentiate from other types of chest pain.
In this episode:
- Atherosclerosis
- Define Angina
- Describe Angina
- 3 Types of Angina
- How to differentiate Angina
Find Dr. Burriesci on:
IG: @all_things_cardiopulm
Website: https://www.allthingscardiopulm.com
In today's episode, we're going to talk about the key factors that every physical therapist should consider when looking for a new job.
Keri Ammons, Director of Talent Acquisition at ATI explains that finding a place where you can grow with the company is essential. Look for a company that offers various paths within the organization to satisfy different interests. Whether it's IT, project management, research, or HR, there should be enough room for career growth.
She also notes that the highest offer isn't always the best offer. While money is a significant factor, don't overlook other important things like a 401k, medical benefits, and time away. It's important to consider the entire package before accepting an offer.
Mentorship is also critical in a new job. Keri encourages candidates to ask companies to define their mentorship program and if there's a structured approach. Knowing what mentorship means to you and what you're looking for is important in finding a company that aligns with your values.
Finally, Keri talks about work-life balance. Patients need us to be flexible, and clinicians need to find a schedule that works for them. Whether it's getting out at 5 every day to make it to your rec softball league on Tuesday or working on Saturdays because that's when you have childcare, finding a work schedule that aligns with your needs is crucial.
Keri ends the episode by highlighting that ATI PT is one of the leaders in clinical research within the PT profession. With all 900+ ATI clinics placing in the 100th percentile in CMS's Merit-Based Incentive Program for the second consecutive year, it's clear that ATI PT is a great place to work.
If you're looking to jumpstart your career and join a team that values career growth, mentorship, work-life balance, and clinical research, head to ATIpt.com to learn more about job opportunities at ATI.
Dr. Burriesci gives you the quick and dirty techniques to calculate rate on ECG and tips on how to determine a 6 second strip. She describes 4 different methods to determine rate and helps determine which technique to choose and why. Dive into this episode to get better at calculating rate and/or refresh your skills. Happy Practicing!
In this episode:
- ECG paper importance
- How to determine a 6-sec strip
- Discuss 4 methods to determine rate on ECG
- Learn the mantra
- Best methods for calculating regular vs irregular rates
Find Dr. Burriesci on:
IG: @all_things_cardiopulm
Website: https://www.allthingscardiopulm.com
In this comprehensive episode, we dive deep into the world of hip pathologies, providing you with an essential guide to prepare for the NPTE Exam. We'll cover the most common hip conditions, their causes, symptoms, and treatment options, as well as key clinical concepts and examination techniques that you need to know. Professor Matthew Condo provides insight and practical tips that will help you gain a solid understanding of hip pathologies and boost your confidence as you approach the NPTE Exam. Don't miss this opportunity to enhance your knowledge and improve your test-taking skills. Subscribe to our channel for more valuable content on physical therapy and exam preparation!
In 2002, Dr. Matthew Condo earned a Bachelor of Science degree from The Ohio State University. He then pursued further studies and obtained a Doctorate of Physical Therapy from the University of St. Augustine in 2015, followed by a Doctorate of Education from the same institution in 2019. For his doctoral dissertation, Dr. Condo delved into the qualitative aspects of clinical reasoning in physical therapy. He has contributed to the field of medical science education by publishing his research in Medical Science Educator and presenting multiple peer-reviewed posters and presentations at the state, regional, and national levels. Dr. Condo's research interests revolve around identifying best practices in healthcare education delivery.
Are you struggling to understand electrical conduction for the NPTE exam? Look no further! In this video, we'll guide you through the ins and outs of electrical conduction, from the basics to the more complex concepts. We'll show you how to identify different types of conductors and insulators, and explain how conductivity is affected by factors such as temperature and material properties. We'll also cover Ohm's Law and Kirchhoff's Laws, and demonstrate how to apply them to solve problems. With our clear explanations and practical examples, you'll gain the knowledge and confidence you need to excel on the NPTE exam. So, whether you're a visual learner or prefer a more hands-on approach, join us for this comprehensive guide to mastering electrical conduction for NPTE study prep!
Powered by All Things Cardio Pulm
Bringing Excellence to Heart & Lung Health & Wellness and Cardiopulm Education & Mentoring
Matthew Condo, PT, DPT, EdD covers hand deformities that frequently show up on the NPTE
Find out more about Matt here
Learn the Mechanics of Breathing from Rachele Burriesci, PT, DPT, CCS, GCS
www.allthingscardiopulm.com/
Anatomy Trivia to help you prepare for the NPTE with Matthew Condo of Methodist University
The second of four rounds of anatomy trivia as part of our Clash of the Craniums Broadcast.
Thanks to Matt Condo, professor from Methodist University for helping us put on this inaugural trivia night of CLASH OF THE CRANIUMS!
Thanks to Matt Condo, professor from Methodist University for helping us put on this inaugural trivia night of CLASH OF THE CRANIUMS!
What Makes A Great PT School Applicant?
Skye Donovan, Lori Bordenave and Chris Petrosino are physical therapists and have extensive experience in the PT admissions process as program chairs of three different PT programs across the country - Marymount University, A.T. Still University and Sacred Heart University.
The panel agrees a great PT applicant is someone who is strong academically, has grit, can persevere, is passionate, caring, compassionate and ready to change gears.
Applicants are highly encouraged to do their research when selecting a school. Each school has their own pre-requisites, separate applications aside from PTCAS, and interviews for admissions.
When it comes to the interview process whether it is an individual, group or video interview, the guests discuss that they look for strong communication skills and professionalism in the potential PT student. Listen to the stories these three share about their worst PT interview experiences (start 25:20).
The behavior guide of PTs and PTAs are the APTA Core Values. To understand how to behave and treat in this profession, these core values can guide how to come off on an application or personal statement.
QUOTES
15:11 One of the ways that you know you have everything on that application that is pertinent is to find somebody who knows you, loves you, and wants you to go to PT school.” - LORI
PARTING SHOT
1:04:32 “Everybody has a story. Know your story. Tell your story. I think that will make you genuine and really get you further by telling that story.” - LORI
1:05:02 “Optimize your talents. You have a lot of talents to bring to the table.” - CHRIS
1:05:51 “Don’t let fear paralyze you. Don’t be afraid of showing your true self. Try not to let fear overcome your ability to shine.” - SKYE
hool Applicant?
Sample QnA episode with Will Crane from PTFinalExam.com
Get your NPTE Strategy Cheat Sheet here: https://ptfinalexam.com/studycast/
Plus 10% off for NPTE Studycast Listeners
Download free study guides from Aureus Medical Staffing: https://www.aureusmedical.com/nptestudycast.aspx
Will Humphreys is a physical therapist, entrepreneur, author, and speaker. Will coaches business owners and physical therapists across the country to his knowledge and belief of profitability. If you thought that was all, Will created a medical billing and consulting company called In the Black this past April.
Will tells us about the events he endured to ultimately choose his path in physical therapy and becoming a physical therapist.
Will goes further in how his past has shaped who he is today and describes the entrepreneur’s mindset: learn, endure, and lead. He discusses the difficulty starting his company Rise Rehab back in 2003 but mentions that even though that was the most difficult situation he had to endure, it is possible with work. In 2018, Rise merged with now Empower Physical Therapy.
He gives us a clear understanding on what “profitability unlocks possibility” means and how this benefits the entrepreneur and current physical therapists.
One topic Will coaches about is the 5 Pillars of Profitability:
1. Reliability and transparency
2. Consistency
3. Efficiency
4. Stability
5. Predictability
Will has created a YouTube channel to assist business owners, PTs, new graduates, and students on success in our industry. Take a listen here: https://www.youtube.com/channel/UCd9MwDrfXzXbDjnEqRCW8wA
Will describes to us the Core Four (heart, mind, body, spirit) and how he believes working on yourself everyday leads to success.
Download free study guides from Aureus Medical Staffing: https://www.aureusmedical.com/nptestudycast.aspx
Sample QnA episode with Will Crane from PTFinalExam.com
Get your NPTE Strategy Cheat Sheet here: https://ptfinalexam.com/studycast/
Plus 10% off for NPTE Studycast Listeners
Download free study guides from Aureus Medical Staffing: https://www.aureusmedical.com/nptestudycast.aspx
Joe Reinke of www.FITBUx.com talks loans, making/saving money and having a plan that works for you.
Download free study guides from Aureus Medical Staffing: https://www.aureusmedical.com/nptestudycast.aspx
Sample QnA episode with Will Crane from PTFinalExam.com
Get your NPTE Strategy Cheat Sheet here: https://ptfinalexam.com/studycast/
Plus 10% off for NPTE Studycast Listeners
Download free study guides from Aureus Medical Staffing: https://www.aureusmedical.com/nptestudycast.aspx
Sample QnA episode with Will Crane from PTFinalExam.com
Get your NPTE Strategy Cheat Sheet here: https://ptfinalexam.com/studycast/
Plus 10% off for NPTE Studycast Listeners
Download free study guides from Aureus Medical Staffing: https://www.aureusmedical.com/nptestudycast.aspx
Congenital Muscular Torticollis (CMT) is a postural abnormality affecting 4-16% of infants. Shortening of the sternocleidomastoid muscle (SCM) on one side of the neck causes the infant to tilt their head toward and rotate their head away from the tight side.
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Osgood Schlatter's Disease is an overuse type injury of the knee that is most common in adolescents and is usually characterized by a gradual onset of anterior knee pain. This disease is caused by repetitive strain on the tibial tuberosity via the patellar tendon. It is most common in adolescent athletes with higher demand on the quadriceps with sports that involve running and jumping.
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Looking at Osteomyelitis Osteomyelitis which is a serious infection of the bone that is most commonly caused by a bacterial infection in the blood stream or exposure of the bone to contaminants (open fracture, surgical procedures).
In 25% of cases, this condition is predisposed by trauma. In children, this condition is most common in long bones due to the increased blood supply to the metaphysis to assist the growth plates.
In adults, this condition is most common in the spine due to increased vascular supply to the spine with aging or to other bone areas via an open wound and is also common in patients with diabetes mellitus due to increase risk of diabetic ulcers and delayed healing time.
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
NPTE Upper Extremity Special Tests with a look at Sensitivity, Specificity and Likelihood Ratios.
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
A complete look at Shoulder Impingement Syndrome for the NPTE
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
A complete look at plantar fasciitis for the NPTE
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Will Crane from PTFinalExam.com comes on to walk you through the first part of your NPTE Journey, signing up for the exam!
Helpful Links:
FSBPTState Licensing ContactsExam RegistrationDates & DeadlinesLocate a testing center near you
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
Vestibular Disorders Host: Jimmy McKay, PT, DPT Featured Guest; Alicia Flach, PT, DPT, NCS Notes by Alexis Lancaster Vestibular Disorders What is it?
Disruption that can occur from vestibular apparatus (inner ear) through the cranial nerve to the CNS where the information is processed Any disruption along this path will cause a vestibular disorder
Anatomy
Peripheral vestibular system
BPPV: problems within the vestibular apparatus, specifically semicircular canal
Creates sensation of moving, pt feels dizzy
Problem with cranial nerve 8 (before synapse in brain stem) Problem here= peripheral problem
Central vestibular system
After cranial nerve 8 synapses in brainstem Travels different pathways to locations within the brain Problem here= central problem
Differential diagnosis
Dizziness can be due to different things
Vertigo: room spinning, could be peripheral or central vestibular problem Feeling of imbalance or disequilibrium, pt doesnt feel steady on their feet. Could be peripheral or central vestibular problem
Unrelated to vestibular system
Polypharmacy Orthostatic hypotension (pt complains of feeling light-headed, passing out, fainting) Low blood sugar (hypoglycemia) Migraines
Get to the root of how the patient describes their dizziness
Special Tests
Subjective interview: try to understand when it happens, how long it has been going on, how long it lasts when it happens, does it come and go or is it constant, is it related to positional changes? Rule out/in peripheral condition, BPPV: Dix Hallpike, head thrust test, dynamic visual acuity test Look for central signs throughout exam
Hypermetria with saccades Abnormal changes in the ability to perform
Vestibulo-occular reflex cancellation: being able to follow a moving object with your eyes and head moving in the same direction Rule in the vestibular system overall, rule in/out peripheral vs. central
Treatment
Common encounter: BPPV
Managed through canalith repositioning maneuvers (otoconia getting stuck in canal): Epley and BBQ Roll
Dysfunction of peripheral nerve/hypofunction
Gaze stabilization Tx
Movement sensitivity/central component
Habituation Exercise Graded exposure
Sample Question A physical therapist evaluates a patient who reports dizziness when getting out of bed. The physical therapist suspects the pt is experiencing symptoms related to BPPV. Which of the following would be the most appropriate assessment to confirm the presence of BPPV
Head thrust test Dynamic visual acuity testing Dix Hallpike maneuver Clock drawing test
Answer: C. Dix Hallpike: it is an assessment in which an individual is moved into a position and is intended to elicit a response from the presence of otoconia in the semicircular canal. Position the patient and look for the presence of nystagmus to rule in BPPV.
Why the others are wrong: A: Head thrust test looks at the ability of a patient to perform VOR (vestibulo-ocular reflex)--> specifically looks for hypofunction
B: Dynamic visual acuity testing tests for peripheral hypofunction. Perform eye chart and look at visual acuity in static position and then pt will move head side to side to see visual acuity dynamically.
Episode 20: Cauda Equina Syndrome Host Jimmy McKay
Featured guest Bridget Ripa
Notes Alexis Lancaster Cauda equina: “horse’s tail” What is it?
Injury to lumbar and sacral spinal nerve roots within the canal
Presentation
Variable lower extremity paralysis Sensory loss Bowel and bladder dysfunction
Causes
Trauma, pelvic crush (MVA), child birth could precede it
Differential diagnosis
Other spinal cord syndromes Transverse myelitis MS Spinal infarct Spinal tumor
Special tests
CT, MRI Clinical presentation & mechanism of injury
Treatment
Make sure they are managed medically first Bowel/bladder program Motor learning Task-specific training ICF model Weight-bearing Neuromuscular re-education Tone management FES Aerobic training Positioning Bracing/splinting Locomotion if applicable Keeping an eye on shoulder pain Allow compensation in this population when they need to
How will it look on the test?
Mechanism of injury and clinical presentation Bowel and bladder dysfunction will be present with cauda equina!
Episode 19: Central Cord Syndrome Host Jimmy McKay
Featured guest Bridget Ripa
Notes Alexis Lancaster What is it?
Damage to the central portion of the spinal cord
How does it happen?
Hyperextension of the cervical spine is the typical cause Inflammation or pressure on the cord centrally
Anatomy/Presentation
Tricky Damages spinothalamic, corticospinal, and dorsal columns Upper extremities weaker than lower extremities Greater motor deficits than sensory deficits The sensation of the sacral region is present
Differential diagnosis
The other spinal cord syndromes
Rely on clinical presentation
Imaging (CT/MRI)
Special tests
CT/MRI Clinical presentations (UE deficits>LE)
Treatment
Medically stable first Bowel/bladder program Motor learning Task-specific training Weight-bearing Neuromuscular re-education Strengthening Tone management FES Aerobic training Positioning Bracing/splinting Locomotion if applicable
LE stronger than UE! So you will probably be walking
Keeping an eye on shoulder pain Allow compensation in this population
How it will look on the NPTE
Upper involved more than lower (hallmark sign) Mechanism of injury→ hyperextension injury
Episode 18: Brown Sequard Syndrome Notes by Alexis Lancaster, SPT What is it?
Damage to one side of the spinal cord
Mechanism of injury:
MVA, gunshot wound, stab wound
Impairments/presentation:
Ipsilateral losses: proprioception, vibration, deep touch, discriminative touch, and voluntary motor control Contralateral losses: pain, temperature, crude touch
Differential diagnosis:
Other spinal cord injuries (see above impairments list and differentiate this way) MS Spinal infarct Spinal tumor Transverse myelitis
Special tests:
CT, MRI Clinical presentation
Treatment:
Medically stable/managed Bowel/bladder program Task-specific training Motor learning Neuromuscular re-education Weight-bearing Tone management FES Aerobic training Positioning, splinting, bracing Keep an eye on shoulder pain
- Allow for compensation!! (This is different, usually with the neurological population you want to use less compensation and aim for recovery of function, but these patients will need to compensate some)
How it will appear on the test:
Know how it presents clinically Know the type of injury that may result in Brown-Sequard
Episode17: Posterior Cord Syndrome Notes by Alexis Lancaster, SPT What is it?
Damage to the posterior cord itself Occlusion of posterior spinal artery Very rare
Differential diagnosis
Any of the other spinal cord syndromes (anterior/brown sequard/central cord)
Clinical presentation
Isolated loss of proprioception, vibration, & discriminative touch
Special tests
Clinical presentation stated above CT/MRI for confirmation
Treatment
ICF model Medical management Bowel/bladder program Motor learning Task-specific training Weight-bearing Neuromuscular re-education Tone management FES Aerobic training Positioning Bracing/splinting Locomotion Keeping an eye on shoulder pain Allow compensation in this population
Sample question
Identification of the mechanism of injury related to this condition Identification of clinical presentation
Episode 15- Autonomic Dysreflexia What is it?
Excessive autonomic nervous system activity triggered by afferent stimuli below the level of the spinal cord injury (usually level T6 and above)
The stimulus can be noxious or non-noxious Usually it is a noxious stimulus Example: kinked catheter, tight clothing, overheating, UTI, bowel impaction, skin irritation
Need to realize that the patient does not have sensation at this level, so their body is telling them that something is wrong via AD/excessive ANS activity and you as the PT need to figure out what is causing this response
Anatomy
Know what level it can occur at (T6 level of injury and above) Noxious/non-noxious stimuli
Differential Diagnosis
Orthostatic hypotension: presents similarly, check BP! OH: BP drops, AD: BP stays the same or is rising Migraine: a lot of reports from patients involve a pounding headache Essential hypertension: a person is becoming hypertensive with a certain activity Anxiety Withdrawal from pharmacologic drugs
Special tests
BP Clinical diagnosis: look at the signs & symptoms
Signs: very rapid increase in BP (doesn’t always increase, but if it does, it will be rapid), decreased heart rate, goosebumps, diaphoresis, flushed skin above the level of the injury Symptoms: pounding headache, chills, anxiety, nausea
How it will look on the test:
Incorporating a patient with a SCI and identifying AD and knowing how to manage it, what level injuries it may occur with How to manage: sit the patient up! (the direct opposite of orthostatic hypotension), quickly identify what the irritant is
Fun way to remember how to treat immediately:
AD: BP up, sit the patient up OH: BP down, lay patient down
Episode 14: Huntington’s Disease Host Jimmy McKay
Featured guest Bridget Ripa
Notes by Alexis Lancaster What is it?
Inherited, an autosomal dominant trait Causes degeneration to specific brain regions Huntington’s disease gene is on chromosome 4 and it produces the Huntington protein that’s found throughout the body
Signs/Symptoms
Symptoms can present at any age Symptoms can include physical, cognitive, and psychiatric signs & symptoms The disease is divided into 5 stages
Preclinical, early, middle, late, end of life
Anatomy/Presentation
Mechanism unclear Hallmark sign: atrophy of striatum that later involves cerebral cortex and subcortical structures
Leads to severe loss of neurons in caudate and putamen Also affects basal ganglia pathways, the indirect pathway is affected before direct pathway (important)
Differential diagnosis
Lupus, chorea, ataxia, generalized neurodegenerative disorder R/O with genetic testing
Treatment
PT will see patients in middle/later stages (95% of pts)
Check medications→ should have meds for abnormal movements and psychiatric disorders Specific to individual
Family training Management of falls and decreased mobility
On the NPTE
Medications will be important (drastically changes function)
Know meds they may be on
Antipsychotics Antidepressants disorder. Side effects may include nausea, diarrhea, drowsiness and low blood pressure. Mood stabilizing drugs
Know the PT management of disease progression (family education, etc.)
Episode 12: Orthostatic Hypotension NPTE Studycast Featured Expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS Notes by Alexis Lancaster, SPT What is it
- A decrease in blood pressure by ≥20mmHg systolic and ≥10mmHg diastolic when moving from a supine to upright position
Causes
- Cardiovascular system, BP, blood supply to the brain
Signs & Symptoms:
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Physical signs: pallor, diaphoresis, loss of consciousness (potentially)
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Symptoms pt will report: dizziness, light-headedness, faintness, nausea
Differential Diagnosis:
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Autonomic dysreflexia
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Look at the blood pressure: AD will have ↑ in BP, OH will have ↓ in BP
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Vertigo, BPPV: b/c of dizziness and light-headedness symptoms
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Generalized nausea from infection, etc.
Special tests
- Orthostatic testing: monitor BP with position changes
Treatment examples:
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Immediately: lay the person down, elevate legs to prevent loss of consciousness
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After: talk to the team about BP treatment medications
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Encourage fluids with pt
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Progress upright tolerance with a hospital bed, tilt table to decrease the number of OH episodes/frequency & duration of OH episodes
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Abdominal binders, ace wraps on legs to keep BP up
How can it look on the test?
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The important part: recognizing OH and manage it
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Emergent scenario: decide that it’s OH and what you would do about it
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May need to differentiate between OH and more emergent conditions, such as AD
TIA – Transient Ischemic Attack Notes by Nick O'Hanlon, SPT What is it? The same underlying mechanism as an ischemic stroke; with the main difference being the duration of symptoms is significantly less
In other words, a brief episode of neurological dysfunction caused by ischemia (lack of blood supply) to the brain
No tissue death occurs Signs and Symptoms Clinically presents like a stroke, but can also look like: a seizure disorder, tumor, migraines, or hypoglycemia
Stroke symptoms – slurred speech, paralysis, overactive reflexes, balance and coordination issues, reduced sensation
A complete resolution of symptoms occurs within 24 hours
Anatomy Dependent on an area of the brain the ischemic attack occurs, but any part of the brain
Crescendo TIAs – having more than one TIA within a specified time period
2 within 24 hours
3 within 3 days
4 within 2 weeks
Special Tests Imaging – CT/MRI Clinical Exam – ABCDD2 prediction rule, which can predict risk of stroke after a TIA Age, >60 years BP, >140/90 Clinical presentation: unilateral weakness with or without speech impairment Duration of symptoms Diabetes
Above a certain point threshold for the rule, patient is at increased risk for a stroke Differential Diagnosis Can present similarly to stroke, but the duration of symptoms for a stroke is much longer Causes Risk factors for TIA include: smoking, high blood pressure, high cholesterol, diabetes, and family history Treatment examples Treating the person as they present with their impairments
There is a good possibility the duration of symptoms is too short for us to see them during the dysfunctional window before resolution of symptoms
Education about risk factors and crescendo TIAs
How does it look on the test?
ABCDD prediction rule is important to know
Be able to differentiate between TIA and stroke