Chapter 3 and 4 Flashcards
Structures affected through the ROM:
muscles, joint surfaces, capsules, ligaments, fasciae, vessels, and nerves
Functional excursion
distance a muscle is capable of shortening after it has been elongated to its maximum
Example of active insufficiency.
bend the knee to shorten the gastroc. in order to focus on the soleus, flex the elbow and supinate and flex shoulder to shorten the bicep
Example of passive insufficiency.
extending the knee and flexing the hip to lengthen the hamstrings
Passive ROM (PROM)
movement of a segment within the unrestricted ROM that is produced entirely by an external force with little to no muscle contraction, external force may be from gravity, machine, another person, or another part of the individual’s own body
Active ROM (AROM)
movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint
Active-Assisted ROM (AAROM)
assistance is provided manually or mechanically by an outside force because the prime mover muscles need assistance to complete the motion
Indications for PROM
- passive motion is beneficial but active motion would be detrimental to the healing process
- patient is not able to or not supposed to actively move a segment as when comatose, paralyzed, or complete bed rest
When a patient is able to contract the muscles actively and move a segment with or without assistance _____ is used.
AROM
This type of ROM increases circulation and prevents thrombus formation.
AROM
Passive motion does NOT:
- prevent muscle atrophy
- increase strength or endurance
- assist circulation to the extent that active, voluntary muscle contraction does
Patient preparation:
- communicate with patient
- prepare the region and drape patient
- position the patient in comfortable position with proper body alignment and stabilization
- position yourself so proper body mechanics can be used
Perform ROM smoothly and rhythmically, with ___ repetitions.
5-10
Determines flexibility:
- muscle length
- joint integrity
- extensibility of periarticular soft tissues
Dynamic flexibility
active mobility or active ROM
Passive flexibility
passive mobility or passive ROM
Contractures
adaptive shortening of the muscle-tendon unit and other soft tissues that cross the joint that results in a significant resistance to passive or active stretch and limitation of ROM
Myostatic contracture
musculotendinous unit has adaptively shortened and there is a significant loss of ROM, but there is not specific muscle pathology, no decrease in individual sarcomere length
Pseudomyostatic contracture
impaired mobility and limited ROM may be the result of hypertonicity (spasticity or rigidity) associated with a CNS lesion such as a CVA, SCI, or traumatic brain injury
Arthrogenic and Periarticular contractures
adhesions, synovial proliferation, irregularities in articular cartilage, or osteophyte formation
Fibrotic contracture
fibrous changes in the connective tissue of muscle or periarticular structures causing adherence of these tissues (generally irreversible)
Contraindications for stretching
- bony block that limits joint motion
- recent fracture and bony union is incomplete
- acute inflammatory or infectious processes
- sharp, acute pain
- hematoma
- hypermobility
- shortened structures are assisting the patient with stability (paralysis, for example)
Interventions to increase mobility of soft tissues.
- manual or mechanical/passive or assisted stretching
- self-stretching
- neuromuscular facilitation and inhibition techniques
- muscle energy techniques
- joint mobilization/manipulation
- soft tissue mobilization and manipulation
- neural tissue mobilization
Tenodesis
slight hypomobility in the long flexors of the fingers while maintaining flexibility of the wrist enables the patient with SCI who lacks innervation of the intrinsic finger muscles to develop a grasp ability
Elasticity
ability of soft tissue to return to its pre-stretch resting length directly after a short-duration stretch force has been removed
Viscoelasticity
time-dependent property of soft tissue that initially resists deformation, but if stretch force is maintained, change in length can be achieved but it will return to original length when force is removed (only non-contractile tissues)
Plasticity
tendency of a soft tissue to assume a new or greater length after the stretch has been removed
Contractile tissues have which properties?
elasticity and plasticity
Primary source of muscle’s resistance to passive elongation?
connective tissue framework (epimysium, perimysium, endomysium)
Muscle spindle
sensitive to quick and sustained (tonic) stretch, receive and convey information about the changes in length of a muscle and the velocity of length changes (intrafusal muscle fibers)
Gamma motor neurons
innervate the contractile polar regions of intrafusal fibers and adjust the sensitivity of the muscle spindle
Alpha motor neurons
innervate extrafusal muscle fibers (motor unit)
Intrafusal muscle fibers
nuclear bag fibers (primary type Ia afferents) - quick and tonic stretch
nuclear chain fibers (secondary type II afferents) - tonic stretch only
Golgi tendon organ (GTO)
sensory organ located near the musculotendinous junctions of extrafusal muscle fibers, low threshold for firing so it monitors and adjusts movement or the tension in muscle during passive stretch
Autogenic inhibition
GTO has an inhibitory impact on the level of muscle tension in the muscle-tendon unit in which it lies, particularly if the stretch force is prolonged
Responsible for the strength and stiffness of tissue and resist tensile deformation.
collagen fibers
Fibers of tendons and ligaments are composed mostly of?
type I collagen
Building blocks of collagen microfibrils.
tropocollagen crystals
_________ fibers provide tissue with bulk.
Reticulin
Ground substance is made up of ___________ and ____________.
proteoglycans (PGs) and glycoproteins
Proteoglycans (PGs)
- hydrate the matrix
- stabilize the collagen networks
- resist compressive forces
Glycoproteins
linkage between the matrix components and between the cells and matrix opponents
GTO transmit sensory information via ___ fibers.
Ib
The structural element that absorbs most of the tensile stress.
collagen
Grade I ligament strain
microfailure: rupture of a few fibers in the lower part of the plastic range
Grade II ligament strain
macrofailure: rupture of a great number of fibers resulting in partial tear further into the plastic range
Grade III ligament strain
complete rupture or tissue failure
Tissue response to prolonged stretch forces as a result of viscoelastic properties.
creep and stress relaxation
Cyclic stretching vs. ballistic stretching
cyclic is slow-velocity and ballistic is high-velocity
PNF stretching is designed to affect the non-contractile/contractile elements.
contractile (more appropriate for use with muscle spasm vs. fibrotic contractures)
PNF stretching procedures:
- hold-relax or contract-relax
- agonist contraction
- hold-relax with agonist contraction
