ABPMR PM&R cheat sheet

ASIA Impairment Scale: A = no sacral sparing (complete); B = sensory incomplete with sacral sparing; C = motor incomplete with more than half of key muscles below the level graded less than 3/5; D = at least half graded 3/5 or better; E = normal motor and sensory function.

Key myotomes for level testing: C5 biceps, C6 extensor carpi radialis longus, C7 triceps, C8 flexor digitorum profundus, T1 abductor digiti minimi, L2 iliopsoas, L3 quadriceps, L4 tibialis anterior, L5 extensor hallucis longus, S1 gastrocnemius.

Acute ischemic stroke: intravenous thrombolysis is approved within 4.5 hours of last known well; mechanical thrombectomy is beneficial up to 24 hours in selected anterior circulation large-vessel occlusions.

Guillain-Barre syndrome: ascending areflexic weakness reaching nadir in 2-4 weeks, albuminocytologic dissociation in CSF, treated with IVIG or plasma exchange rather than steroids.

Multiple sclerosis: McDonald criteria require dissemination in space and time; the EDSS is a 0-10 scale weighted toward ambulation beyond 4.0.

Parkinson disease: Hoehn and Yahr stages 1-5; carbidopa-levodopa is most effective for bradykinesia; deep brain stimulation of the subthalamic nucleus or globus pallidus interna helps motor fluctuations and dyskinesia.

Rancho Los Amigos levels: I no response, II generalized response, III localized response, IV confused-agitated, V confused-inappropriate, VI confused-appropriate, VII automatic-appropriate, VIII purposeful-appropriate.

Myasthenia gravis: fatigable weakness, anti-acetylcholine receptor antibodies in most generalized cases, greater than 10% decrement on 2-3 Hz repetitive stimulation, treated with pyridostigmine and immunotherapy.

Upper motor neuron neurogenic bladder after suprasacral injury shows detrusor overactivity with detrusor-sphincter dyssynergia, risking high storage pressures and upper tract damage.

Anterior cruciate ligament: the Lachman test is the most sensitive maneuver and the pivot shift the most specific; MRI confirms the diagnosis.

Ottawa ankle rules: radiographs are indicated with malleolar pain plus bone tenderness at the posterior edge or tip of either malleolus, tenderness at the navicular or base of the fifth metatarsal, or inability to bear weight four steps.

Ottawa knee rules: radiographs are indicated with age 55 or older, isolated patellar tenderness, fibular head tenderness, inability to flex to 90 degrees, or inability to bear weight four steps.

De Quervain tenosynovitis: Finkelstein test is positive; the involved structures are the abductor pollicis longus and extensor pollicis brevis in the first dorsal compartment.

Rotator cuff examination: Jobe empty-can for supraspinatus, external rotation lag sign for infraspinatus, lift-off or belly-press for subscapularis, and drop-arm sign suggesting a massive tear.

Acute compartment syndrome: pain out of proportion and pain with passive stretch are earliest; a diastolic-to-compartment pressure difference under 30 mmHg supports fasciotomy.

Femoral neck stress fracture: deep groin pain with impact activity; MRI is most sensitive, and management is strictly non-weight bearing because of displacement risk.

Femoroacetabular impingement: positive FADIR (flexion, adduction, internal rotation) reproducing groin pain; cam morphology is a femoral head-neck offset loss, pincer is acetabular overcoverage.

Lateral ankle sprain most commonly injures the anterior talofibular ligament, followed by the calcaneofibular ligament; the deltoid ligament injury implies a higher-energy mechanism.

Nerve conduction studies are performed at 32 degrees Celsius for the upper limb and 30-32 degrees Celsius for the lower limb; cooling slows conduction and prolongs latencies.

Median nerve normal values: motor distal latency under 4.4 ms and sensory peak latency under 3.5 ms; a median-ulnar palmar mixed nerve latency difference above 0.3 ms is abnormal.

Ulnar neuropathy at the elbow is localized by focal slowing across the elbow segment exceeding 10 m/s compared with the forearm segment, or by conduction block or differential amplitude drop.

Fibrillation potentials and positive sharp waves appear 2-3 weeks after nerve injury and signify active denervation; they are absent in normal muscle.

Chronic reinnervation produces motor unit action potentials of increased amplitude and duration that are often polyphasic, reflecting collateral sprouting.

H reflex assesses the S1 root and tibial nerve proximally; F waves assess proximal motor conduction of any nerve but are nonspecific.

Repetitive nerve stimulation at 2-3 Hz showing greater than 10% decrement indicates a postsynaptic disorder such as myasthenia gravis; presynaptic disorders show low baseline amplitude with post-exercise facilitation.

ALS electrodiagnostic criteria require active and chronic denervation in at least three of four body regions (bulbar, cervical, thoracic, lumbosacral).

In radiculopathy, paraspinal muscle fibrillations are the most useful needle finding because limb muscles may show changes from plexopathy or neuropathy.

Autonomic dysreflexia occurs with spinal cord injury at T6 or above; paroxysmal hypertension with headache, flushing, and sweating is managed by sitting the patient upright, removing the noxious stimulus (usually bladder or bowel), and using nifedipine if it persists.

Heterotopic ossification: alkaline phosphatase rises early, a triple-phase bone scan is positive before radiographs, and the hip is the most common site after spinal cord injury or traumatic brain injury.

Pressure injury staging: stage 1 non-blanchable erythema, stage 2 partial-thickness loss, stage 3 full-thickness loss without exposed deep structures, stage 4 exposed fascia, muscle, tendon, or bone; plus unstageable and deep tissue injury categories.

Venous thromboembolism prophylaxis after stroke or spinal cord injury uses low-molecular-weight heparin or unfractionated heparin plus intermittent pneumatic compression; duplex ultrasound is the test for suspected deep vein thrombosis.

Neurogenic bowel: suprasacral lesions produce a reflex (upper motor neuron) bowel responsive to suppositories or digital stimulation, while sacral lesions produce an areflexic bowel requiring manual evacuation.

Osteoporosis is defined by a DXA T-score of -2.5 or lower; FRAX estimates 10-year fracture probability and guides treatment thresholds.

Cardiac rehabilitation typically provides 36 supervised sessions; exercise prescription uses metabolic equivalents, a symptom-limited stress test, and a target heart rate of 60-80% of measured maximum.

Dysphagia after stroke is evaluated with a videofluoroscopic swallow study or fiberoptic endoscopic evaluation; compensatory strategies include chin tuck, head rotation, and thickened liquids.

Urinary tract infection is the most common nosocomial infection in rehabilitation units, and indwelling catheter duration is the strongest modifiable risk factor.

Gross Motor Function Classification System for cerebral palsy: level I walks without limitations, level II walks with limitations, level III walks with hand-held mobility devices, level IV self-mobility with powered mobility, level V transported in a manual wheelchair.

Spastic diplegia is the cerebral palsy subtype most associated with prematurity and periventricular leukomalacia; spastic quadriplegia carries the highest risk of seizures and intellectual disability.

Brachial plexus birth palsy: Erb (C5-C6) produces the waiter's tip posture with the arm adducted and internally rotated; Klumpke (C8-T1) produces a claw hand and possible Horner syndrome.

Duchenne muscular dystrophy is X-linked dystrophin deficiency with Gowers sign, calf pseudohypertrophy, markedly elevated creatine kinase, and cardiomyopathy; corticosteroids slow loss of ambulation.

Myelomeningocele is associated with Chiari II malformation, hydrocephalus requiring shunt, neurogenic bladder and bowel, tethered cord, and latex allergy from early repeated exposures.

Developmental dysplasia of the hip: Ortolani maneuver reduces a dislocated hip and Barlow maneuver dislocates a reducible hip; a Pavlik harness is used in infants under about 6 months.

Primitive reflexes and typical disappearance: Moro by 4-6 months, asymmetric tonic neck reflex by 6 months, and palmar grasp by 4-6 months; persistence suggests central nervous system abnormality.

Congenital muscular torticollis involves the sternocleidomastoid with head tilt toward and rotation away from the affected side; first-line treatment is positioning and stretching therapy.

Apgar score components are appearance, pulse, grimace, activity, and respiration, scored 0-2 each at 1 and 5 minutes; it describes newborn status and does not by itself diagnose cerebral palsy.

Modified Ashworth Scale grades resistance to passive stretch as 0 (no increase), 1 (catch and release), 1+ (catch followed by minimal resistance through less than half the range), 2 (marked increase through most of the range), 3 (considerable, passive movement difficult), and 4 (rigid).

Botulinum toxin cleaves presynaptic SNARE proteins to block acetylcholine release; onset is 3-7 days, peak effect 2-6 weeks, and duration about 3 months, with total dose limited by body weight and toxin type.

Intrathecal baclofen delivers drug directly to spinal GABA-B receptors; abrupt pump failure or withdrawal causes rebound spasticity, hyperthermia, rigidity, and autonomic instability that can be fatal.

Phenol and alcohol neurolysis destroy nerve fibers nonselectively for months and are used for large proximal motor nerves; dysesthesia from sensory contamination is a recognized risk.

Complex regional pain syndrome is diagnosed by the Budapest criteria: continuing pain disproportionate to the inciting event plus at least one symptom in three of four categories and at least one sign in two categories.

First-line pharmacotherapy for neuropathic pain includes gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors such as duloxetine.

Tilt-in-space wheelchairs rotate the seat and backrest together about a fixed pivot, redistributing pressure and improving upright tolerance without changing hip or knee joint angles.

Spinal cord stimulation is best supported for failed back surgery syndrome and complex regional pain syndrome, with a trial of temporary leads preceding permanent implantation.

Ankle-foot orthoses control ankle dorsiflexion for foot drop and can be tuned (ground reaction AFO) to limit crouch gait by controlling the knee through the shank.