Medical, Surgical, and Pharmacologic Considerations
Core concepts
Know medical and surgical conditions that affect rehabilitation: stroke (ischemic vs hemorrhagic, thrombolysis windows, precautions), traumatic brain injury, spinal cord injury (surgical stabilization, halo precautions), brain and spine tumors, hydrocephalus and shunts, epilepsy and seizure precautions, and deep brain stimulation in Parkinson disease. Understand pharmacologic effects relevant to PT: anticoagulants (bleeding risk, mobilization timing), corticosteroids, antispasticity agents, dopaminergic medications (on-off phenomena, timing of sessions), and medications that cause orthostasis or sedation. Recognize postsurgical precautions and wound healing.
Traps
Questions test whether you know when to hold or modify therapy (e.g., mobilization after thrombolysis, precautions after spinal surgery, seizure precautions). Watch for drug side effects masquerading as neurologic decline. Do not overlook anticoagulation status before manual techniques or falls risk.
Rule of thumb
Before intervening, ask: what medical or surgical precautions apply, what medications affect today's session, and what would make me stop? Coordinate with the medical team when uncertain.
Worked example
A patient with Parkinson disease reports freezing and stiffness before a session; recognizing medication timing (levodopa on-off) guides scheduling and cueing strategies rather than assuming disease progression.