AOBPMR PM&R cheat sheet

ASIA Impairment Scale: A = no sacral sparing (no S4-5 sensation, no deep anal pressure); B = sacral sensory sparing only; C = motor sparing with >50% of key muscles below level <3/5; D = ≥50% of key muscles below level ≥3/5; E = normal.

Upper motor neuron lesion signs: hyperreflexia, spasticity, Babinski sign, clonus; lower motor neuron signs: flaccidity, atrophy, fasciculations, areflexia.

Spinal shock duration is typically days to weeks; bulbocavernosus and anal wink reflexes return as shock resolves, marking transition to UMN physiology.

Burn Rule of Nines: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%; Lund-Browder chart adjusts for age in children.

Parkinson disease: resting tremor, rigidity, bradykinesia, postural instability; treat with levodopa-carbidopa; dopamine agonists and MAO-B inhibitors are alternatives.

Stroke thrombolysis window: IV alteplase within 3–4.5 hours of symptom onset in eligible patients; mechanical thrombectomy up to 24 hours in selected large-vessel occlusion.

Glasgow Coma Scale: eye 1–4, verbal 1–5, motor 1–6; total 3–15; score ≤8 indicates need for airway protection.

Nerve conduction: demyelinating = slowed conduction velocity, prolonged distal latency, conduction block; axonal = reduced amplitude with relatively preserved velocity.

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

Oral case presentation structure: chief complaint → history → exam findings → functional assessment → problem list → differential → plan → prognosis → disposition.

Functional outcome tools: Functional Independence Measure (FIM) for inpatient rehab, Barthel Index for ADLs, Berg Balance Scale for balance, 6-minute walk test for endurance.

Spasticity management ladder: physical modalities → oral agents (baclofen, tizanidine, dantrolene) → focal chemodenervation (botulinum toxin) → intrathecal baclofen → orthopedic/surgical procedures.

Pressure injury staging: Stage 1 = intact skin with non-blanchable erythema; Stage 2 = partial-thickness loss; Stage 3 = full-thickness loss; Stage 4 = exposed bone, tendon, or muscle; unstageable = eschar/slough.

DVT prophylaxis in rehab: mechanical (IPC) plus pharmacologic (LMWH, UFH) based on risk; hold pharmacologic if active bleeding or recent neuraxial procedure.

Neurogenic bladder management: intermittent catheterization preferred; anticholinergics (oxybutynin, tolterodine) for detrusor overactivity; alpha-blockers for sphincter dyssynergia.

Amputee prosthetic prescription: energy-storing foot for active community ambulators; microprocessor knee for transfemoral amputees with variable cadence; body-powered upper limb for durability.

Cardiac rehab phases: Phase I (inpatient), Phase II (outpatient monitored), Phase III (supervised), Phase IV (maintenance); MET levels guide activity progression.

Home safety and DME: assess bathroom (grab bars, shower chair), bedroom (bed height), and mobility (walker vs cane vs wheelchair) based on weight-bearing status and endurance.