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BOC domain 4 > basis of rehab > Flashcards

basis of rehab Flashcards

1
Q

Rehabilitate the injury consists

A

Knowledge of injury
Evaluation
Examination
Healing process

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2
Q

List 5 signs of inflammation

A 
Edema
Pain
Function
Redness
Heat
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3
Q

Phase of healing

Hemostasis
Inflammation
Proliferation
Remodeling

A

Hemostasis
Inflammation
Proliferation
Remodeling

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4
Q

Hemostasis phase alongside treatment modalities

A

RICE

POLICE

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5
Q

Inflammation phase alongside treatment modalities

A

….

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6
Q

Proliferation phase alongside treatment modalities

A

….

isometric exercises

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7
Q

Remodeling phase alongside treatment modalities

A

….

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8
Q

Providing a comprehensive rehabilitation program for an injured patient starts with

A

Patient assessment
Treatment selection
Implementation
Functional exercises and return to play

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9
Q

When rehabilitating an injured patient, AT, coach, and physician must take the time to

A

explain and inform the patient’s parents about the course of injury rehab process.

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10
Q

Exercise intensity in rehab

A

It will gradually adapt over time. During rehab, the stresses of reconditioning exercises must not be so great as to exacerbate the injury before the injured structure has had a chance to adapt specifically to the increased demands.

Engaging in exercise that is too intense or too prolonged can be detrimental

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11
Q

If baseball player recently underwent surgery for a few tears in shoulder region and wanted to know why he cannot start throwing right away. What’s your reason for why he must progress slowly?

A

Swelling and limited ROM. All starts with early exercise in short bouts that are repeated several times daily. It begins with local modalities to re-educate muscle and extensibility of collagen fibers. Understanding the healing process is the key. Primary goal is to minimize edema and improve ROM.

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12
Q

Massage: safety concerns

A

Bruising

Soreness

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13
Q

Traction is designated for what use

A

Decreased back and neck pain

Stretch connective tissue

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14
Q

establishing short goals in a rehab program in the following steps

A
  1. Providing correct immediate first aid and management following injury to limit or control swelling
  2. Reducing or minimizing pain
  3. Establishing core stability
  4. Reestablishing neuromuscular control
  5. Improving postural stability and balance
  6. Restoring full ROM
  7. Restoring or increasing muscular strength, endurance, and power
  8. Maintaining cardiorespiratory fitness
  9. Incorporating appropriate functional progression
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15
Q

Establishing long term goals in rehab program

A

Return athlete to practice or competition as quickly and safely as possible

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16
Q

Importance of controlling swelling beings with

A

POLICE

Compression: wrap directly over the injury from distal to proximal.

17
Q

basis of re-establishing neuromuscular control

A

Relies on central nervous system to interpret and integrate proprioceptive and kinesthetic information and then control individual muscles and joints to produce coordinated movements.

Example: following injury, subsequent rest and immobilization, CNS “forgets” how to put together

Requires many repetitions of same movement, progressing step by step from simple to more complex movements.

18
Q

basis of restoring range of motion

A

musculotendinous unit: muscle, tendon, fascia to stretch

contracture of connective tissues: ligaments, joint capsule, or both

19
Q

basis of restoring muscular strength, endurance, and power

A

Isometric, progressive resistive (isotonic), Isokinetic, and plyometric exercises

main goal in performing strengthening exercises is to work through a full, pain free ROM

Isometric: increasing static strength and decrease amount of atrophy. Lessen the swelling by causing a muscle pump to remove fluid and edema.

PRE: free weights, exercise machines, or rubber tubing. It uses isotonic contraction (concentric and eccentric).

Isokinetic: used later in phase of rehab program. Commonly used as a criteria for RTF activity following injury

Plyos: reactive neuromuscular training which is often incorporated into later stage of rehab program. It is a quick eccentric stretch to facilitate a subsequent concentric contraction. It is useful in restoring or developing the patient’s ability to produce dynamic movements associated with muscular power. The ability to generate force rapidly is a key to successful performance in many sports activities.

20
Q

ligament sprains

physiological characteristics

A

Grade 1: some stretching or tearing of ligamentous fibers, with little or no joint instability. Mild pain, little swelling, and joint stiffness.

Grade 2: some tearing and separation of ligamentous fibers and moderate instability of joint. Moderate to severe pain, swelling, and joint stiffness.

Grade 3: total rupture aka gross laxity. Severe pain might be present initially followed by little or no pain because of total disruption of nerve fibers.

21
Q

Phase 1 the acute injury phase - incorporating therapeutic exercises

A

Injury occurs and can last as long as 4 days following injury.

Control swelling and modulate pain by using POLICE. Immobility during the first 24-48 hours following injury is necessary to control inflammation.

Acutely, that loss can be attributed primarily to pain; thus, modalities (ice and electrical stimulation) that modulate pain should be routinely incorporated into each treatment session.

At this point, patient should begin active mobility exercises working through a pain free ROM. Importantly, regaining ROM.

NSAIDs to help control swelling and inflammation.

22
Q

Phase 2: repair phase (fibroblastic)

incorporating therapeutic exercises

A

As soon as inflammation is controlled, incorporating activities into rehab program that can maintain levels of cardiorespiratory fitness, restore full ROM, restore or increase strength and reestablish neuromuscular control.

As neuromuscular control improves, strength will also improve.

Cryotherapy and Electrical stimulation can help with controlling pain and improving strength and ROM.

23
Q

Phase 3: remodeling phase incorporating therapeutic exercises

A

Maturation stage of healing process is return to activity. The injury is no longer painful to the touch. The collagen fibers must be re-aligned according to tensile stresses and strains placed upon them during functional exercises.

Focus: regaining functional skills. It involves repeated performance of movement or skill for the purpose of perfecting that skill.

Plyo strengthening exercises can be used to improve muscle power and explosiveness. Functional testing should be done to determine specific skill weaknesses that need to be addressed prior to normal activity return.

Deep heating modalities - ultrasound or diathermy should be used to increase circulation to deeper tissues.

Massage used to reduce guarding, increase circulation, and reduce pain. Increased blood flow delivers the essential nutrients to the injured area to promote healing.

24
Q

medications to affect the healing process

A

aspirin (salicylate)
common for analgesic, anti-inflammatory, and antipyretic capabilities.

Tylenol (acetaminophen)
naproxen sodium
ketoprofen
ibuprofen

25
Q

differentiate inflammation, cyanosis, and contusion

A

inflammation - redness and swelling rapidly

cyanosis - blue and vascular compromise

contusion - black-blue

26
Q

purpose of point tenderness while palpating

A

it is indicative of pain over the area being palpated. ask patient to rate this pain from 0 - 10.

27
Q

signs of trigger point and crepitus

A

located in the muscle and feel like a small nodule or muscle spasm.

crunching or crackling sensation along the tendon, bone, and joint. if it is located on bone, indicating fracture.

28
Q

basic rules about performing ROM tests

A

should first be performed on patient’s uninjured limb through each of the joint’s cardinal planes of motion and quantity of motion available should be recorded. then ROM testing is repeated on the injured limb.

important part in progress during rehab. to assess ROM is to measure the integrity of inert and contractile tissue components of the joint complex.

29
Q

contractile tissue pathology

A

muscle
tendon
nerve structures

30
Q

rules about determining if inert tissue pathology is present

A

it is indicated when patient reports pain occurring during both active and passive ROM in the same direction of movement. typically pain due to inert tissue pathology will occur near the end of the ROM.

EX: patient reports pain in the anterior shoulder region when actively and passively moving the humerus into the end range of shoulder flexion. because pain was present in the same direction of motion (direction of shoulder flexion = anterior shoulder) during active and passive movements.

31
Q

rules about determining if contractile tissue pathology is present

A

it is indicated when patient reports pain in the same direction of motion during active ROM, then reports pain in the opposite direction of motion during passive ROM.

pain in shoulder flexion - active ROM and pain in shoulder extension that is being stretched by the athletic trainer - passive ROM. it is not possible to determine the specific location of either inert or contractile tissue pathology through ROM assessment. Move forward to incorporate manual muscle and special tests to locate the exact location of pathology.

32
Q

abnormal end-feels

empty
spasm
loose

A

empty: movement beyond the anatomical limit or pain prevents the body part from moving through available ROM - ligament ruptures
spasm: involuntary muscle contraction that prevents normal ROM due to pain (guarding, muscle spasm)
loose: extreme hypermobility (chronic anke sprain, chronic shoulder subluxation/dislocation)

33
Q

assess patient’s arthrokinematic motion and find that it is hypomobile - incorporate what exercises into a rehab plan?

A

joint mobilization in addition to traditional stretching exercises to regain normal ROM.

34
Q

explanations for arthrokinematic motion assessment

page 72

A

…

35
Q

potential referral resources based on rehab setting

high school
college
semi-professional and professional sports
clinic
hospital
A

HS: school nurse, school counselor, psychologist

college: licensed counselor, social worker, licensed clinical psychologist
professional: licensed clinical psychologist, psychiatrist
clinic: medical doctor
hospital: licensed counselor, social worker

36
Q

manual therapy techniques for increasing mobility

myofascial release stretching
active release technique
graston
massage

A

….

page 223

BOC domain 4 (3 decks)

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