Background/Physical Modalities/Aging Flashcards
Impairment
loss of structure or function (ex: foot droop)
Disability
Inability to preform ADL (ex: inability to ambulate)
Handicap
Difficulty with participation in society (ex: cannot climb stairs to get to office)
Therapy Rx components
Dx, exercise type, frequency, sets, reps, precautions
Type I muscle fibers
slow twitch, aerobic, “red” muscle, “One slow, red ox”
Type II muscle fibers
fast twitch, “white”, anaerobic
Sarcomere
Sarcomere = Z to Z line
A-band: Myosin
I-band: Actin not overlapped with Myosin
H zone: Myosin not overlapped with Actin
Most useful exercise type for muscle building and tendon health
Eccentric
Type of exercise that puts the most stress on tendon
fast eccentric
What are 5 contraindications to use of heat?
- Ischemia (heat increases metabolic demands)
- Scar tissue (inadequate vascular supply)
- Bleeding disorders (heat increases blood flow)
- Malignancy (heat may increase tumor growth)
- Impaired Sensation
Cane height
level of greater trochanter or level of hand with elbow flexed to 25 degrees
Two modalities used to increase tendon extensibility
heat and stretching
Type of contraction with higher metabolic cost
concentric
Transfer of heat through circulation
Convection
transfer of heat through direct contact
conduction
What are 3 therapeutic modalities that transfer heat through conversion?
heat lamp, US, diathermy
deep of tissue heating with superficial heat
1-2cm
what is erythema ab igne?
superfical heat causing skin mottling characterized by reticular pigmentation and telangiectasia
Where anatomically is US heat absorption the greatest?
bone-muscle soft tissue interface
Type of water used when using US to treat small joints?
degassed
What are 4 conditions treated with therapeutic US?
- Contracture
- Arthritis
- Bursitis
- Tendinitis
What are 5 areas to avoid with therapeutic US?
- CNS (brain and cord), heart and reproductive organs
- Pacemakers
- Tumors
- Skeletal immaturity (deep heat can damage growth plates)
- Arthroplasties (TKA, THA)
Frequency used with therapeutic US
About 1 MHz = megaHz = 1 million Hz
Average intensity of therapeutic US used for tendinitis and bursitis?
1.5 W/cm2
What depth (in cm) can be reached with deep heating via therapeutic US?
8 cm
what two types medications can be used to treat tendinits via phonophoresis?
steroids (10% hydrocortisone) and anesthetics (1% lidocaine)
what type of energy does shortwave diathermy convert into heat?
electromagnetic radio waves
frequency used for shortwave diathermy?
27 MHz (Mega Hz)
What depth (in cm) does short wave diathermy reach?
4 - 5cm
What are three indications for use of short-wave diathermy?
- Pelvic inflammatory disease (PID)
- Prostatitis
- Muscle spasms
In addition to general heat precautions, what are three contraindications to the use of shortwave diathermy?
- metal items (intrauterine device, surgical implant)
- pregnancy
- skeletal immaturity
Microwave diathermy frequency, depth and indications?
- 1000 MHz
- 1-3 cm
- superfical structures, hematomas
therapeutic modality used to reduce inflammation?
cold
How does cold reduce spasticity?
It reduces muscle spindle (Ia, II) and Golgi tendor organ (Ib) activity
What is spray and stretch?
Using vapocoolant sprays to treat myofascial and MSK pain applied parallel to muscle fibers while muscle is stretched
What type of therapy can increase vascularization of wound margins?
Light therapy
What is Goeckerman’s technique?
Using coal-tar ointment followed by UV light to treat psoriasis
Starting dosage for light therapy?
- 1-2 MED (minimal erythema dosage - time to cause erythem on the forearm)
- Usually kept below 5 MED
What are two proposed mechanisms of pain control with TENS unit?
- Placebo (30%)
- Gate Control (stimulation of large IA fibers closes gate in spinal cord blocking C fibers from sending pain signal to the thalamus)
Most effective type of TENS?
High-frequency, low-intensity
Benefits of neuromuscular electrical stimulation (NMES)?
- increase muscle mass
- increase stroke volume and cardiac output
- improve cardiorespiratory fitness
What are two reflexive effects of massage?
- vasodilation improving circulation
- decrease pain via gate control or endogenous opiate release
What are two mechanical effects of massage?
- assist in venous blood return from periphery
- increase lymphatic drainage
How much force is used with cervical traction?
25 - 50lb of force
What are four contraindications to cervical spine traction?
- A-A instability (RA, Downs, Marfans, Ehlers-Danlos)
- Cervical stenosis
- Vertebrobasilar insuffiency
- Infection of the spine
How much force is used in lumbar traction?
- Posterior distraction: > 50 lb of force
- Anterior distraction: > 100 lb of force
What is optimal positioning to relieve foraminal nerve root compression with cervical traction?
20-30 degrees of flexion
What is the I band?
Actin not overlaped with Myosin
What is the H zone?
Myosin not overlaped with Actin
What is a closed kinetic chain exercise?
Distal segment of a joint is fixed to an object or the ground
What is the downside of open kinetic chain exercises?
they increase shear forces at the joint
What are Delorme’s exercises?
- Progressive resistive exercises
- Best method for building strength
- 3 sets of 50%, 75%, and 100% of 10 repetition maximum
List greatest force to least force when it come to fast/slow, eccentric/concentric/isometric
fast eccentric > slow eccentric > isometric > slow concentric > fast concentric
With plyometric exercises, what allows for more powerful concentric contractions?
elastic energy stored in the eccentric phase
What amount of exercise does the American College of Sports Medicine recommend?
- At least 30 minutes, 5 days a week
- At least 500 METS per week
- Flexability for each major group at least 2 days a week
What are two things a patient needs to have to participate in biofeedback?
voluntary muscle control and ability to follow commands
What type of stretching has a high risk of injury?
Ballistic stretching (repetitive bouncing) can cause bone avulsion or muscle-tendon tears
Why causes the gradual increase in systolic and diastolic blood pressure with aging?
decreased arterial elasticity
What is the cause of increased orthostatic hypotension and cough/micturition syncope syndromes with aging?
decreased baroreceptor sensitivity
What is the cause of increased residual volume with aging?
loss of elastic recoil of lung tissue
Most common lab finding associated with NSAID induced kidney injury?
prerenal azotemia
Why is digitalis toxicity common in elderly?
impaired renal function
What is presbyacusis?
loss of ability to perceive or discriminate sounds with aging
What is the most common cause of fecal incontinence in the elderly?
fecal impaction
Which TCA has the best side-effect profile (fewer anticholinergic effects, less sedation, and less orthostatic hypotension due to alpha-blockade)?
nortriptyline
Why do benzodiazepines tend to accumulate more in the elderly?
fat-soluble drugs accumulate more in the elderly due to changes in metabolism and body composition
