07-11 Final Review Flashcards
1
Q
Different Types of Fibers and How We Strengthen Them
A
- Type 1 (Tonic) (Slow Twitch): Postural Muscles - Enduranxe
- Type 2 (Phasic) (Fast Twitch): Burst of Energy - Fatigues easily - Power
2
Q
ICD-9 and CPT codes, How they are used in Therapy
A
- ICD-9: International Classification Codes [for Diagnosis]
- Ex: 724.9 = Lumbago
- CPT: Billing Codes [Ex: 97001 = PT Evaluation]
- CPT is used for outpatient settings
- Different reimbursement scales, depending on reason for visit
3
Q
Key insurance terms
A
- Co-Pay: Pre-determined set payment for service
- Deductible: Amount paid out of pocket prior to insurance making payment for services
- Coinsurance: Percentage payment for service
- HMO: Health Maintenance Organization
- PPO: Preferred Provider Organization
- Case Rate [Global Fee]: Total reimbursement for the treatment of an injury; Used for Workers’ Comp
- Functional G Codes: Required documentation on Medicare B patients
4
Q
Types of Medicare
A
- Medicare A [Hospital/Inpatient]
- Medicare B [Outpatient]
- Medicare C [Medicare Advantage Plans - Provided by private insurance companies approved by Medicare]
- Medicare D [Outpatient Prescription Drug Coverage]
5
Q
Appropriate times of rest when pt complains of fatigue
A
- Acute Fatigue: 3-4 minutes
6
Q
Functional G Codes
A
- Required documentation on Medicare B patients
- Outpatient
- If not included in billing, payment will be denied [July 1, 2013]
- Reports functional limitations, goals and outcomes
7
Q
When are Functional G Codes documented
A
- Outset of therapy
- Every 10th visit
- Formal evaluation
- Upon pt discharge
8
Q
Functional Limitation Categores [G Codes]
A
- Mobility
- Changing/maintaining body postion [transfers, bed mobility]
- Carrying/moving/handling objects [more OT, but can incorporate into PT]
- Self-care [ADLs - bathroom, dress themselves]
- Therapy services not intended to treat functional limitations [includes wound care]
9
Q
How would you increase muscle girth when strengthening?
A
- Hypertrophy: Increase in size of myofibrils
- 4-8 weeks of high intensity training
- High-volume moderate resistance eccentric training
10
Q
Billing Times
A
- 0 units: 0-7 minutes
- 1 unit: 8-22 minutes
- 2 units: 23-37 minutes
- 3 units: 38-52 minutes
- 4 units: 53-67 minutes
11
Q
Strength vs. Endurance [Muscle exercise]
A
- Endurance: Higher reps, lower loads
- Strength: Higher loads, lower reps
12
Q
How long it takes for muscle strength to increase
A
- True muscle gain takes 6-12 weeks
13
Q
Indications for strengthening
A
- Muscle weakness
- Prevent atrophy
14
Q
Contraindications for strengthening
A
- Pain
- Inflammation [Acute inflammation NM disease like acute Guillain-Barre Disease or inflammatory disease like acute polio; Dynamic exercise contraindicated with acute joint inflammation]
- Severe cardiopulmonary disease [5 wks or less after MI, CABG; need MD clearance]
15
Q
Precautions for strengthening
A
- Valsalva
- Substitute motions
- Overtraining: Decreased strength due to inadequate rest/recovery
- Overwork: weakness; requires longer recovery time
- Exercise-induced muscle soreness: DOMS
- Pathologic fracture
16
Q
Government-funded payer sources [insurance]
A
- Medicare
- Medicaid
- Tricare
17
Q
Resistive exercises [variable resistance]
A
- Elastic resistance bands and tubing
- Manual resistance
- Some designed machines
- Isokinetic machines
18
Q
Resistive exercises [fixed resistance]
A
- Free weights
- Nautilus machines
- Pulley systems
19
Q
Open-kinetic chain
A
- Distal segment moves in space
- Independent jt movement
- Movement distal to the moving jt
- Muscle activation occurs primarily in prime mover; isolated to muscles of the moving jt
- Performed in no weight bearing positions
- Resistance applied to moving distal segment
- External rotary loading
- External stabilization
20
Q
Closed-kinetic chain
A
- Distal contact remains in contact with or stationary on support surface
- Interdependent jt movement; predictable movement in adjacent jts
- Movement of body segments occur distal and/or proximal to the moving jt
- Muscle activation occurs in multiple muscle groups, both distal/proximal to the moving jt
- Typically performed in WB positions
- Resistance applied simultaneously to multiple moving segments
- Axial loading
- Internal stabilization by means of
Muscle action, jt compression and congruency, and postural control
21
Q
Case rates [global fees]
A
- Total reimbursement for the treatment of an injury
- Used by managed care workers’ compensation
- Can pay per modality, visit or injury
- Requires authorization for initiation of care or any special services
- Case rate is set regardless of number of visits
22
Q
PNF Patterns
A
- D1 Flexion
- D1 Extension
- D2 Flexion
- D2 Extension
23
Q
Soft tissue injuries
A
- Strain: Overstretching or overuse of muscle/tendon
- Sprain: Ligament [3 grades]
- Dislocation: Loss of anatomical relationship [separated joint]
- Subluxation: Partial dislocation [common in stroke pts; measured by fingers]
- Muscle tendon rupture/tear: Complete or incomplete
- Tendinous Lesion: Tendinopathy, tenosynovitis, tendonitis, tenovaginitis; tendonosis
- Synovitis: Inflammation of synovial membrane
- Hemarthrosis: Bleeding in joint due to trauma
- Ganglia: Ballooning of capsule wall [joint of tendon or sheath - trauma or RA]
- Bursitis: Inflammation of bursa sac
- Contusion: Bruising from direct blow with capillary rupture, bleeding, edema and inflammatory response
- Overuse syndrome, cumulative trauma disorder, repetitive strain injury, submaximal overload, fractured wear and tear to muscle/tendon
24
Q
Tendinous lesions
A
- Tendinopathy: Refers to chronic tendon pathology
- Tenosynovitis: Inflammation of the synovial membrane covering a tendon
- Tendonitis: Inflammation of a tendon [may have resulting scarring or calcium deposits]
- Tenovaginitis: Inflammation with thickening of tendon sheath
- Tendonosis: Condition of degeneration of the tendon due to repetitive microtrauma
25
Q
Dysfunction
A
- Loss of normal functioning
- Joint dysfunction: Mechanical loss of joint play
- Contracture: Adaptive shortening [skin, muscle, fascia]
- Adhesions: Scarring [collagen - immobilized]
26
Q
Ligament sprain grades [Tissue Injury]
A
- Grade 1 [first degree]: Mild pain; 0-24 hrs; mild swelling, local tenderness, pain when stressed
- Grade 2 [second degree]: Mod pain - must stop the activity; Stress and palpation increases pain; lig injury - some fibers are torn, so some increased joint mobility
- Grade 3 [third degree]: Near complete or complete tear or avulsion of tendon/ligament with severe pain; stress to tissue painless and palpation reveals defect; Torn ligament = jt. instability
27
Q
Causes of Muscle Spasm
A
- Local circulatory and metabolic changes while muscle is in a continued state of contraction
- Viral infection
- Cold
- Prolonged immobilization
- Emotional tension
- Direct trauma to muscle
28
Q
Stages of Tissue Repair; How to Manage
A
- Acute: Pt education; RICE; Passive ROM; Low-dosage joint mobilization; Muscle setting, Massage
- Sub-Acute: Pt education; Manage pain/inflammation; Correct contributing factors; Initiation of active exercises [submaximal isometric, AROM, muscular endurance, protected WB exercises]; Initiation and progression of stretching
- Chronic: Pt education; Progression of exercise [adequate jt play, then progress related to functional needs - more independence]; Progression of stretching; Progression of muscle performance exercise; Return to high-demand activities
- Chronic Recurring: Modalities and rest; PT Education; Initiation of exercise at non-stressful activities; Stabilization exercises; Muscle endurance activities
29
Q
Timeframes of Tissue Repair
A
- Acute: 4-6 days, scarring by 10 days
- Sub-Acute: 10 days to 3 weeks
- Chronic: 3 weeks to whatever…
- Chronic pain syndrome: Greater than 6 months
30
Q
Signs of Osteoarthritis [OA]
A
- Usually > 40 years old
- Usually over years/stress
- Degeneration
- Asymmetrical/local
- Stiffness, pain with WB, crepitus, loss of ROM
- No systemic symptoms
31
Q
Signs of Rheumatoid Arthritis [RA]
A
- Anytime between 15-50 years old
- Suddenly or over weeks/months
- Inflammation, synovitis, destruction
- Symmetrical, systemic
- Redness, warmth, swelling, pain with activity, prolonged stiffness
- General feeling of sick/fatigue
32
Q
Signs of Fibromyalgia
A
- Tendonitis
33
Q
Osteoporosis - most susceptible to fractures?
A
- Spine
- Wrist
- Hips
34
Q
Types of fractures
A
- Malunion: Heals in unsatisfactory condition
- Delayed healing: Takes longer than expected
- Nonunion: Fails to unite, fibrous union
- Bone healing [Children]: 4-6 weeks
- Bone healing [Adolescents]: 6-8 weeks
- Bone healing [Adult]: 10-18 weeks
35
Q
Signs and Symptoms of Fatigue with Resistive Exercises
A
- Pain and cramping
- Tremors
- Jerky motions
- Incomplete ROM
- Substitutions
- Unable to finish exercise
How to adjust:
- Decrease load
- Stop exercise
- Do not ignore
36
Q
DeLorme vs. Oxford method of PRE
A
DeLorme:
- 10 reps @ 50% of 10 RM
- 10 reps @ 75% of 10 RM
- 10 reps @ 100% of 10 RM
Oxford:
- 10 reps @ 100% of 10 RM
- 10 reps @ 75% of 10 RM
- 10 reps @ 50% of 10 RM
37
Q
What type of resistive exercises cause the most soreness?
A
- Dynamic Exercises - Dynamic Eccentric
38
Q
PNF Techniques
A
- Rhythmic Initiation: Pt into PROM, let them know what they’re working on
- Repetitive Contraction: Quick stretch, pt moves through motion
- Reversal of antagonist: contract agonist before antagonist
- Slow Reversal: Repeated antagonistic movements prior to end range
- Slow Reversal Hold: Isometric holds at end range prior to antagonistic movement
- Rhythmic Stabilization: Simultaneous or alternating contractions (trunk)
- D1/D2 patterns
39
Q
Decision Making - Pain BEFORE onset of restriction
A
- Acute condition
- Inflammatory response
- Gentle pain-inhibiting techniques
40
Q
Decision Making - Pain AT onset of restriction
A
- Subacute condition
- Fibroblastic repair
- Tissue is healing, so caution with gentle stretching
41
Q
Decision Making - Pain AFTER onset of restriction
A
- Chronic
- Maturation Remodeling
- Stretching of tight capsule or periarticular tissue
- Stretch more aggressively
