Acute Final Flashcards
Functional Excursion
The full range of extensibility and contractility of a muscle
How can PROM be produced?
gravity
machine
another individual
another part of individual’s body
Benefits of CPM?
prevents adhesion, contractures, joint stiffness
healing incisions
quicker ROM
Active insufficiency:
when a muscle can shorten no more
Passive insufficieny:
when a muscle can no longer be elongated
When would you use PROM?
- areas of acute, inflammed tissue
- following a surgical repair of muscular or tissue
- comatose, paralyzed
- therapist is examining, teaching or demonstrating
When would you use AAROM?
- pt has weak musculature and is unable to move joint thru desired ROM
- used in areas above and beloew an immboilzed joint to maintain ROM
When would you use AROM>
Any time the patient is able to contract muscles to actively move a segment through the desired ROM
PROM does not:
Prevent muscle atrophy
Increase strength or endurance
Assist circulation to the same degree active, voluntary muscle contractions do
AROM does not
Maintain or increase strength in strong muscles
Develop skill or coordination except in the movement patterns used
Contraindications to ROM
-When motion is disruptive to the healing process
Immediately after acute tears, fractures, and surgery
When patient response or condition is life-threatening
Functional ROM
ability of structures to move or be moved to allow the presence of ROM for functional activities
Functional Mobility
ability of an individual to initiate, control, or sustain active movements of the body to perform simple to complex motor skills
Flexibility or extensibility:
ability of a muscle and other soft tissue to yield a stretch force
Contracture:
Adaptive shortening of the muscle-tendon unit and other soft tissues that cross or surround a joint that results in significant resistance to stretch, limits ROM, and may compromise functional abilities
Muscle spindle
- stretch receptor
- transmits info about velocity and duration and changes in muscle via type Ia and type II
- stimulate via stretch and via gamma efferent neural pathways
Golgi Tendon Organ
- transmit afferent stimuli via II B fibers
- sensitive to tension in muscle from passive stretch or and active muscle contraction
When is stretching indicated?
- result of contracture, adhesion or scar tissue
- vigorous exercise to minimize post exercise soreness/fitness program
- muscle weakness results from opposing muscle tightness
Contraindications for streching
- bony block limits joint motion
- after a recent fracture
- acute inflammatory process
- sharp, acute pain
- hematoma
- hypermobility
- contractures provide stability
- contractures are basis for functional ability
Precautions for Stretching
- beyond normal ROM
- recent fractures
- osteoporosis
- joint pain lasting more than 24 hours=too much force
- edematous tissue
- overstretching weak muscles
- overstretching tissues that have been immobilized for a long period of time
Therapeutic Exercise:
Systematic, planned performance of bodily movements, postures, or physical activities
Intent of therapeutic exercise:
prevent or improve impairements
enhance physical function
prevent or reduce health related risk factors
improve overall health
Balance
the ability to maintain or move the body against gravity within the available BOS without falling
Cardiopulmonary fitness
the ability to perform moderate-intensity, repetitive, total body movements over an extended period of time
Coordination
performing effective, guided, graded movements using the proper timing and sequencing of muscle firing and contraction intensity
Flexibilty
the ability to move freely without restrictions
Mobility
the ability of the body (or body parts) to move to allow ROM for functional activities
Muscle performance
the capacity of muscles to produce tension to do physical work
Neuromuscular control
the interaction of the sensory and motor systems to control the body in response to proprioceptive or kinesthetic information
Neuromuscular control utilizes:
- synergists
- agonists
- stabilizers
- antagonists
- neutralizers
Discrete
Has a recognizable beginning and end
quad set, push up, locking a wheelchair, kicking a ball
Serial
Made up of a series of discrete movements combined in a particular sequence
eating with a fork, wheelchair transfer, getting dressed
Continous
Repetitive, uninterrupted movements that have no distinct beginning or ending
walking, ascending or descending stairs, cycling
Stage of motor learning
cognitive
associative
autonomous
Cognitive stage
learning how to do motor task safety and correctly
frequent feedback
Associative Stage
-patient is fine tuning motor task
infrequent feedback
-focused on consistency and errors
Autonomous Stage
movements are automatic
easily adapts to variations in task demands
little or no instruction needed
Variables affecting motor learning
-pt understanding of the purpose of exervise
-pt interest in exercise
-pt attention
-pt observation
feedback
Ligament or tendon stage inflammation:
48-72 hours
Ligament or tendon stage proliferation:
48 hours - 6 weeks
Ligament or tendon stage remodeling:
6 weeks to 6 months
Tissue injury grade 1:
mild pain at time of injury, mild swelling
Tissue injury grade 2:
Moderate pain that requires stopping the activity. If ligamentous injury, some of the fibers are torn, thus increasing joint mobility.
Tissue injury grade 3:
Near complete or complete tear or avulsion of the tissue (tendon or ligament) with severe pain. Stress to the tissue is usually painless; joint instability is usually present.
Acute stage inflammation duration:
4-6 days
Subacute stage: repair and healing
decreased signs of inflammation
pain w/tissue stress
weakened tissue
14-21 days; can last up to 6 weeks
Bone inflammatory:
1-7 days
Bone soft callus formation:
2-3 weeks
Bone hard callus:
3-4 months
Bone remodeling
up to one year s/p injury or surgery
What are Neuromuscular facilitation and inhibition procedures?
relax tension in shortened muscles reflexively prior to or during muscle elongation.
Agonist Contraction
agonist muscle opposite the range-limiting muscle
reciprocal inhibition of the antagonist
Contract-Relax with Agonist Contraction
Combines autogenic inhibition and reciprocal inhibition
agonist
refers to the muscle opposite the range-limiting target muscle
antagonist
refers to the range-limiting muscle
Precautions for Resistance Exercise:
Valsalva maneuver Fatigue Recovery from exercise Overwork/overtraining Substitute motions Osteoporosis Exercise induced muscle soreness
Contraindications for Resistance exercise:
pain, inflammation, cardiopulmonary disease
Progressive Overload
For muscle performance to improve the muscle must be challenged to perform at a higher level than it was accustomed.
Programs to increase muscular strength and hypertrophy:
Both multiple and single joint exercises Slow to moderate lifting velocity 1 to 3 sets per exercise 60-80% of 1 RM for 8-12 repetitions 1-2 minutes of rest between sets
Programs to increase muscular power:
Both multiple and single joint exercises High Repetition Velocity 1 to 3 sets per exercise Light to moderate loading (40-60% of 1 RM) for 6-10 repetitions 1-2 minutes of rest between sets
Programs to increase muscular endurance:
Low to moderate loads
Moderate to high repetitions (10-15 or more)
Short rest intervals
Fitness
The ability to perform physical work
VO2MAX
Measure of the body’s capacity to use O2.
mL of O2/kg per minute
Endurance
Ability to work for prolonged periods of time
3 Major Energy Systems
ATP-PC
Anaerobic Glycolytic
Aerobic System
ATP-PC
PC short, quick bursts anaerobic first 30 seconds replenished within cell
Anaerobic Glycolytic
glycogen moderate intensity anaerobic 30-90 seconds latcic acid produced
Aerobic System
glycogen, protein,fat long duration aerobic after 2nd minute ATP resynthesized in mitochondria
Slow twitch
used in low-intensity exercise
low anaerobic capacity
Type I
endurance
Fast twitch
Type IIB
Recruited for activities requiring power
Fast Twitch
type IIA
METs
Approx. 3.5 mL of O2/kg per minute
4 P’s needed for an exercise program:
principle
purpose
preparation
precautions
Karvonen’s Formula
HR = Hrrest + 60-70% (HRmax-HRrest)
Inpatient Phase I
Self care, education, orthostatic challenge (transfers, ambulation)
Outpatient: (Phase II)
Starts upon d/c from hospital OR 6-8 weeks post cardiac event
Undergo symptom limited exercise stress test
Circuit-Interval Training is common; monitored with telemetry
Outpatient: (Phase III)
Continue to improve or maintain fitness levels
Is myocardial oxygen consumption is higher with what exercises?
arms exercises than with leg exercises
Creatinine Phospho - Kinase
CPK
30-170 U/L
O2 sat
> 94%
PaO2
> 80 mm Hg
Adult male Red blood cells,
(RBCs
25-35 mL/kg
Adult male hematocrit (Hct):
41-51%
Adult male hemoglobin(Hgb
14-17Gm/dL
Critical Illness Polyneuropathy
Distal extremity weakness, muscle wasting, sensory loss, decreased or absent DTRs
Critical Illness Myopathy
Steroid induced
Muscle weakness affects large, proximal muscles
Treatment goals in acute care?
Prevent/minimize adverse effects of immobility/inactivity
Prevent contractures
Improve general conditioning, bed mobility, respiration, prevent pressure ulcers
Guidelines for acute care :
shorter treatment sessions, fewer repetitions, less demand for active participation
Adult male hemoglobin (Hgb)
14-17Gm/dL
Adult female RBCs
20-30 mL/kg
Adult female Hct:
36-47%
Adult female Hgb:
12-16 Gm/dL
Hct less than 25%
essential
activities of daily living,
assistance as needed for safety
Hct 25-35%
essential activities of daily living;
assistance as needed for
safety; light aerobics, light
weights (1-2 lbs)
Hct greater than 35%
Ambulation and
self care as tolerated;
resistance and aerobic
exercises
Hgb less than 8gm/dl
essential daily activities
Hgb between 8-10gm/dL
Essential activities
of daily living, assistance
as needed for safety; light
aerobics, lightweights (1-2lbs)
Hgb greater than or equal to 10 gm/dL
Ambulation and self care as tolerated; resistance exercises
PLT less than 10,000 and/or temperature greater than 100.5 degrees:
No therapeutic exercise/Hold
therapy
PLT: 10,000-20,000
Therapeutic exercise/bike
without resistance
PLT greater than 20,000
Therapeutic exercise/bike with or without resistance
