Chapter 16 - Using Therapeutic Exercise in Rehabilitation Flashcards
RAMP
rehab goals
management of Acute responses
restoration of mobility
successful completion of performance goals
effects of immobilization on muscle
atrophy and fiber type conversion (mostly type 1 - slow twitch)
prevent with e-stim and iso contraction
decreases neuromuscular efficiency (returns within 1 week)
effects of immobilization on joints
loss of normal compression
decrease in lubrication
degneration
prevent: passive motion, e-stim, hinged casts
effects of immobilization on ligaments and bone
weakening
preventing: high freq, short duration endurance exercise
may take 12 months of rehab
effects of immobilization on cardiorespiratory system
resting heart rate increases .5 bpm for each day
stroke volume, max oxygen uptake, vital capacity decrease w/ increase in heart rate
major components of rehabilitation program
minimizing initial swelling
controlling pain
restoring range of motion
restoring muscular strength, endurance, power
regaining postural stability and balance
maintaining cardiorespiratory fitness
incorporation function progressions
minimizing swelling
RICE
reduce secondary cell death
controlling pain
RICE, medications
restoring range of motion
attributed to contracture of CT or resistance to stretch .
restore physiological and accessory movements
restoring muscular strength, endurance, and power
isometric
PRE
Isokinetic exercise
testing strength, endurance, and power
isometric
early rehab phase
increase static strength
decrease atrophy
PRE
Progressive Resistance Exercise
free weights, machines, tubing , etc
isotonic contractions
concentric and eccentric contractions
isokinetic exercise
later stages of rehab, fixed speed with accommodating resistance to provide maximal resistance throughout ROM
calculate torque, average power, total work, ratios of torque to body weight
testing strength, endurance, and power
evaluations though manual muscle tests, resistance exercise, isokinetic dynamometers
re-establishing neuromuscular control, propioception, kinesthesia, joint position sense
mind’s attempt to teach the body conscious control of a specific movement
- several reps, same movement, progression from simple to complex
- functional strengthening, re-learning sensory pattern, dynamic stability, preparatory and reactive muscle characteristics,
propioception
ability to determine the position of a joint in space
mediated by mechanoreceptors (muscles and joints) and by cutaneous, visual, and vestibular input
kinesthesia
ability to detect movement
joint mechanoreceptors
in ligaments, capsules, menisci, labrum, and fat pads.
muscle mechanoreceptors
muscle spindle (changes in length) and Golgi tendon organ (changes in tension)
regaining postural stability and balance
integrating muscle, neuro, and biomechanical info
positioning the body’s center of gravity within the base of support
Phases of injuries
acute inflammatory response stage (1-4 days)
fibroblastic repair phase
Maturation-remodelign phase
rehab during acute phase
control swelling and
modulate pain
RICE
rest for only the injured body part
day 3-4: active mobility exercise, pain free ROM, progressively bear more weight
NSAIDS
rehab during fibroblastic repair phase
maintain cardio, restore full ROM, increase strength, re-establish neuromuscular control
modalities to control pain and swelling (cryotherapy, e-stim)
rehab during maturation phase
goal: RTP
fibers realign according to tensile stress placed upon them
aggressive AROM and strengthening
sport specific activities
dynamic functionality
plyometric strengthening
thermal modalities
CKC
closed kinetic chain
forces begin at ground
forces absorbed by various structures
offer more functionality
contract-relax
move part passively until resistance is felt;
athlete contracts antagonistic muscle
isotonically
(movement resisted by AT for 10 seconds or until fatigue);
athlete relaxes for 10
seconds;
limb is passively moved to a new stretch position (repeat process 3 times)
hold-relax
move part passively until resistance is felt;
athlete contracts antagonistic muscle
isometrically (movement resisted by AT for 10 seconds or until fatigue);
athlete relaxes for 10 seconds;
limb is either actively or passively moved to a new stretch position (repeat process 3 times)
slow-reversal-hold-relax
athlete actively moves body part to point of resistance and holds position;
muscles are isometrically resisted by AT for 10 seconds.
Athlete relaxes for 10 seconds, thus relaxing the antagonist while the agonist is contracted, moving the part to a new limited range
repeated contraction
used for general weakness or weakness at one specific point. Athlete moves limb isotonically against manual resistance until fatigue (at time of fatigue, stretch is applied at that ROM to facilitate greater force production)
slow-reversal
athlete moves thru complete ROM against maximal resistance (examiner reverses resistance as movement pattern reverses) = promotes normal reciprocal coordination of agonist/antagonist muscle groups
rhythmic initiation
progressive series of passive movement active assistive movement active movement through an agonist pattern (helps athletes with limited ROM regain strength)
rhythmic stabilization
uses an isometric contraction of the agonist, followed by an isometric contraction of the antagonist muscles
PNF flexibility techniques
contract-relax
hold-relax
slow-reversal-hold-relax
PNF strength techniques
repeated contraction
slow reversal
rhythmic initiation
rhythmic stabilization
repeated contraction
used for general weakness at one specific point
move limb against resistance isotonically against manual resistance until fatigue then apply stretch at time of fatigue
slow-reversal
athlete moves thru complete ROM against max resistance (reverse resistance as movement at pattern reverses)
promotes normal reciprocal condition of agonist/antagonist
rhythmic initiation
progressive series of passive movement –> active assistive movement–> active movement through an agonist pattern
helps with limited ROM and to regain strength
Rhythmic stabilization
uses an isometric contraction of the agonists, followed by an isometric contraction of the antagonist muscles
