Bae's Last Lecture 8/9 (10-1/6) Flashcards
What does a grade 1 mean for non thrust
barely touching the skin and small amplitude
What does a grade 1 non thrust do
stimulates mechanoreceptors and inhibit nocioceptors
What does a grade 2 mean for non thrust
Starting to feel something is happening and large amplitude
What does a grade 2 non thrust do
Takes patient to point of first resistance
What does a grade 3 mean for non thrust
Some tissue resistance and large amplitude
What does a grade 3 non thrust do
Takes patient past point of first resistance making some sort of impact on mobility
What does a grade 4 mean for non thrust
End range pushing into barrier and small amplitude
What does a grad 4 non thrust do
Brings patient to second resistance (end range)
How long do you do grade 1 and 2 non thrusts for
60 seconds
How long do you do grade 3 and 4 non thrusts for
3-5 minutes
What are something you can do with a patient in the inflammatory stage (3)
- Gentle sub maximal isometrics
- Retrograde massage
- Maintain function where/if appropriate
What is the purpose of gentle sub maximal isometrics (2)
- Increase blood flow
2. Maintenance of strength
True or False:
Gentle sub maximal isometrics are usually not pain free or comfortable
True
What is the purpose of retrograde massage
Trying to work fluid back towards the heart
What are the goals of the proliferation phase (4)
- Promote tissue growth
- Continue protection as needed
- Encourage safe controlled mobility
- Progress to more active rehab
What is the general intervention principle of the proliferation phase
Do interventions that are safe and progress tissue loading
What should you educate the patient about during the proliferation phase (3)
- Signs of inflammation
- Tell them exactly what they can’t do
- Sometimes you have to inform other people of what to do
What does often mean during the proliferation phase
Too much too soon
What does maybe mean during the proliferation phase
Not enough too late
What are things that should be done during the proliferation phase (4)
- AROM
- Multiangle sub maximal isometrics
- Muscle endurance
- Initiation and progression of stretching
Where should AROM be done during the proliferation phase
Within available pain free ROM
What do multiangle sub maximal isometrics do
Initiate muscular control and strengthening
What muscle fibers are first to atrophy
Slow twitch
What are 2 ways to initiate and progress stretching
- PNF inhibition techniques
2. Joint mobilization
What does PNF stand for
Proprioceptive neuromuscular facilitation
How do you improve endurance during the proliferation phase
Low load and cyclic loading for extended periods of time
What are the goals of the maturation phase (2)
- Progress functional activities
2. Continue tissue reorganization
How long does it take collagen to rearrange completely
12-18 months
What are the general intervention principles of the maturation phase (3)
- Prepare to return to full ADLs
- Secondary prevention
- Complete D/C plan
What are 2 types of secondary prevention
- Maintenance exercise plan
2. Lifestyle alteration
Activities/therapeutic exercise should not have persistent discomfort beyond how long
4-24 hours
What is a key thing to look for during the maturation phase
Signs of inflammation returning
What is chronic inflammation
A chemical process
What causes repetitive microtrauma and/or strain overload
Not giving the tissue a break
What are 3 types of inflammation that can perpetuate
- Chronic inflammation
- Repeated microtrauma
- Repeated strain overload
What should you do with the 3 perpetuated types of inflammation
Treat them as if they were in the inflammatory stage of healing
Why would the inflammatory process perpetuate (10)
- Muscle length and strength imbalances
- Rapid or excessive repeated eccentric demand
- Muscle weakness
- Bone misalignment or weak structural support
- Change in usual intensities or demands
- Return to activity too soon
- Sustained poor posture or motion
- Environmental factors
- Age related
- Training errors
What are 4 typical musculoskeletal impairments of body structure
- Impaired joint mobility
- Impaired muscle performance
- Tissue reactivity
- Impaired motor performance
What are 3 causes of impaired joint mobility
- Inextensible capsule/ligament
- Inflexible muscle
- Excessive laxity of capsule or ligament
What are 3 types of impaired muscle performance
- Strength (decreased force magnitude
- Endurace (decreased force duration)
- Hypertonicity (elevated resting tone)
What are 2 types of tissue reactivity
- Compression load intolerance
2. Tension load intolerance
What are the 2 types of direct interventions PT can do with patients with musculoskeletal dysfunction
- Add cyclic biomechanical load
2. Remove biomechanical laod
What are the 2 reactive tissue load intolerance questions
- Was the premorbid tissue “normal”
2. Were the premorbid biomechanical loads “normal”
What do you look at to determine if the premorbid tissue was “normal” (3)
- Length abnormality
- Contractile abnormality
- Infrastructure abnormality
What are examples of length abnormalities (2)
- Inelastic
2. Inflexible
What are examples of contractile abnormalities (2)
- Strength
2. Endurance
What are examples of infrastructure abnormalities (3)
- Degeneration
- Osteoporosis
- Post immobilization
What do you look at to determine if the premorbid loads were “normal” (3)
- Excessive intensity
- Excessive frequency
- Excessive duration
What type of tissue load intolerance is more severe in nature
Premorbid tissue: abnormal
Premorbid biomechanical loads: abnormal
What type of tissue load intolerance is some degenerative changes, older patient, integrity of tissue is abnormal making normal load more difficult
Premorbid tissue: abnormal
Premorbid biomechanical loads: normal
What type of tissue load intolerance is some one who helped you move in or weekend warriors
Premorbid tissue: normal
Premorbid biomechanical loads: abnormal
What type of tissue load intolerance is healthy people, not patient, potential clients
Premorbid tissue: normal
Premorbid biomechanical loads: normal
True or False:
there is a window of appropriate cyclic loading
True
What is the stress shield
“elastic” activity tissue
What happens when you exceed the physiologic limit
Tissue disruption
True or False:
It is ok to exceed the physiolgic limit as long as it doesn’t can any damage
False
What are the parameters for working on strength
6-12 reps
3-5 sets
What are the parameters for working on endurance
20-30 reps
3-5 sets
What are the parameters for working on tendons
30-40 reps
3-5 sets
What are the parameters for working on ligaments
1000s of reps
What are the parameters for working on cartilage
Hours of reps
What is the window of where you are confident you won’t make the patient worse
Clinical confidence interval
What does the top of the box represent
The threshold of making the patient worse
What does the bottom of the box represent
Not make them worse or better
What happens if you don’t get into the box
The patient gets better but not as quickly
What happens if you do not impart enough stress
No change in patients functional levels
What happens if you push the patient too hard
They may get better for a bit but after a while they will get worse
True or False:
You should treat the impairments and treat the activities they are having trouble with
True
What do you do if gravity is too much for the patient to do the motion (4)
- Manual assist
- Change patient position
- Water buoyancy
- Counterweight and pulley
