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ES stuff Flashcards

1
Q

What is the starting position for D1 UE flexion?

A

Fingers and wrist and elbow extended; wrist ulnarly deviated;elbow pronated; shoulder extended, internally rotated and abducted

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2
Q

What is the ending position for D1 UE flexion? what is this the starting position for?

A

Fingers, wrist and elbow flexed; wrist radially deviated; elbow supinated; shoulder flexed, adducted and externally rotated
-D1 extension

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3
Q

What is the starting position for D2 UE flexion?

A

Fingers, wrist, flexed; wrist ulnar deviated; elbow pronated; shoulder adducted and internally rotated and extended (not hyperextended)

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4
Q

What is the starting position for D2 UE extension?

A

Fingers, wrist extended, wrist radially deviated; shoulder abducted and flexed and externally rotated ( arm, 8-10” from ear, thumb pointing to floor)

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5
Q

What is the starting position for D1 LE flexion?

A

Hip extended, abducted, and internally rotated; knee extended; ankle plantar flexed and eversion

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6
Q

What is the ending position for D1 LE flexion?

A

Hip flexed, adducted, and externally rotated; knee flexed; ankle dorsiflexed and inversion

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7
Q

What is the starting position for D2 LE flexion?

A

Hip extended, adducted, externally rotated, Knee extended; ankle plantar flexed and inverted

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8
Q

What is the ending position for D2 LE flexion?

A

Hip flexed, abducted, and internally rotated, Knee flexed, ankle dorsiflexed and everted

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9
Q

Concentric contractions in both directions of PNF pattern

A

Slow reversal of antagonist

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10
Q

Add an isometric component to the reversal in the weakned range of PNF pattern

A

Slow reversal hold of antagonists

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11
Q

At the end of the concentric agonist range of movement, reverse direction of movement, while facilitating an eccentric contraction of the agonist

A

Agonist reversal

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12
Q

For improvement of isometric strength and stability, primarily of the postural muscles of trunk or limbs; Patient holds position as resistance is alternated from one direction to the opposite direction; No joint movement should occur

A

Alternating isometrics

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13
Q

refers to the muscle opposite the range-limiting target muscle

A

agonist

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14
Q

refers to the range-limiting muscle

A

antagonist

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15
Q

To perform this procedure, the patient concentrically contracts the muscle opposite the range-limiting muscle (agonist) and then holds the end range position for at least several seconds

A

Agonist contraction stretching technique

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16
Q

What is the physiologic basis of agonist contract procedure?

A

When the agonist is activated and contracts concentrically, the antagonist is reciprocally inhibited

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17
Q

To perform this procedure, move limb to the point that tissue resistance is felt in the range-limiting target m. Then have the pt perform a resisted, pre stretch isometric contraction of the range limiting muscle followed by voluntary relaxation of that m. and an immediate concentric contraction of the agonist m.

A

hold relax agonist contraction stretching technique

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18
Q

The range limiting target m is first lengthened to the point of tissue resistance. The pt then performs a pre-stretch, end-range, isometric contraction (~5 s) followed by voluntary relaxation of the range limiting target m. The limb is then passively moved into the new range

A

Hold relax stretching technique
- note: rotators of the limb (i.e., shoulder m’s) can contract concentrically while all other muscle groups should contract isometrically

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19
Q

What is the physiologic evidence that supports HR stretching technique?

A

decrease in EMG activity (due to autogenic inhibition) following the sustained pre stretch isometric contraction of the muscle to be lengthened

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20
Q

When is passive range of motion indicated?

A
  1. In regions where there is acute, inflamed tissue
  2. when a patient is not able or supposed to actively move a segment of the body (comatose, paralyzed or complete bed rest)
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21
Q

When is AROM indicated?

A
  1. when a patient is able to contract the m actively and move a body segment
  2. Assist AROM is used when pt is weak - allows m to be used at full firing to build strength
  3. used on regions above and below immobilized segment to maintain the areas in as normal a condition as possible
  4. can be used for aerobic conditioning program
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22
Q

What are precautions and contraindications to range of motion exercises?

A
  1. when motion is disruptive to the healing process

2. when pt response or the condition is life-threatening

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23
Q

What treatment should be used in acute stage of healing?

A

PROM

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24
Q

What treatment should be used in early subacute stage of healing?

A

AAROM, Isometrics

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25
Q

What treatment should be used in late subacute and chronic stage of healing?

A

Stretching

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26
Q

What are the clinical signs of the inflammatory stage and what are the PT goals and intervention?

A

Signs: inflammation and pain before tissue resistance
PT goals and intervention:
-Protection phase
1. control effects of inflammation (RICE)
2. prevent deleterious effects of rest (nondestructive movement: PROM, massage, m. setting with caution)

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27
Q

What are the clinical signs of the proliferation, repair, and healing stage and what are the PT goals and intervention?

A

Signs: decreasing inflammation, pain synchronous with tissue resistance
PT goals and intervention:
- controlled motion phase
1. develop mobile scar (selective stretching, mobilization/ manipulation of restrictions)
2. Promote healing (nondestructive active resistive, OC and CC stabilization, m. endurance, and cardiopulm endurance exercises, carefully progressed)

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28
Q

What are the clinical signs of the maturation and remodeling stage and what are the PT goals and intervention?

A

Signs: absence of inflammation, pain after tissue resistance
PT goals and intervention:
- Return to function phase
1. increase tensile quality of scar (progressive strengthening and endurance exercises)
2. Develop fxn’l independence (fxn’l exercises and specificity drills)

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29
Q

What is the intervention used for chronic inflammation/ cumulative trauma syndromes?

A

non stressful PROM

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30
Q

What are the signs of excessive stress with exercise or activities?

A
  1. soreness that does not decrease after 4 hours and not resolved after 24 hours
  2. pain that comes on early or is increased over the previous session
  3. progressively increased feelings of stiffness and decreased ROM
  4. Swelling, redness and warmth
  5. progressive weakness over several exercise sessions
  6. decreased fxn’l usage of involved part
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31
Q

What is a Grade I distraction? Grade II? Grade III?

A

Grade I = initial joint separation, small amplitude with no stress on capsule
Grade II = to point of resistance, tightening capsule tissue
Grade III = applied beyond tissue resistance, stretching capsule

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32
Q

What is a Grade I articulation technique? Grade II? Grade III? Grade IV?

A

Grade I = beginning of the range
Grade II = within range not reaching the limit
Grade III = up to the limit of the available motion and are stressed into the tissue resistance
Grade IV = at the limit of the available motion and stress into tissue resistance

33
Q

What oscillation speed would you use for grades I, II, III, and IV articulation techniques?

A

I and IV = small-amplitude; vibrations

II and III = large amplitude; 2-3 per second for 1-2 minutes

34
Q

What sustained distraction technique should be applied to painful joints?

A

Grade I and II intermittent distractions for 7-10 seconds with 2-3 s rest between application

35
Q

What sustained distraction technique should be applied to restricted joints?

A

Grade III stretch force lasting min of 6 s, followed by a partial release of the distraction force to grade I or II for 3-4 seconds (repeated)

36
Q

How long should you hold an isometric contraction? how many times should it be repeated?

A

6-10s holds

repeated 5-10 times

37
Q

How do you stretch parasminal m’s for pts with thoracic scoliosis in prone?

A
  1. Same side arm raised of concavity (tight side)

2. Opposite SB w/ rotate away concave side

38
Q

How do you stretch parasminal m’s for pts with scoliosis in side-lying?

A
  • Lay on convex side
    1. Bolster between table & patient, same side arm above head
    2. Edge of table, top arm reaching toward floor
39
Q

How is scoliosis named?

A

The convex side of the curve

40
Q

Which side of the curve (convex or concave) with the rib be humped on when a pt bends forward?

A

Convex side

- TVP will be raised on convex side of the curve

41
Q

What grade distraction is contraindicated during joint effusion and inflammation?

A

Grade III distraction

42
Q

To decrease the limitation of supination at the proximal radioulnar joint – the most effective (first) direction to mobilize is:

A

Anterior (volar) glide

- Stabilize ulna, move the radius

43
Q

To improve thumb flexion at the carpometacarpal joint (CMC) (movement plane is parallel to the palm) the correct first direction is:

A

Ulnar glide

- Stabilize trapezium, move 1st metacarpal

44
Q

For patient with limited CMC abduction (movement plane perpendicular to the palm) To improve thumb abduction at the CMC the correct (first) direction to mobilize is:

A

Dorsal Glide

- Stabilize trapezium, move 1st metacarpal

45
Q

For a patient with limited ankle dorsiflexion, to improve dorsiflexion at the talocrural joint, the correct first direction to mobilize is:

A

Posterior glide

- Stabilize distal tibia, move the talus

46
Q

For limited ankle plantar flexion the correct first direction to mobilize is:

A

Anterior glide

47
Q

For limited knee flexion, to improve knee flexion ROM the correct first direction to mobilize is:

A

Posterior glide

  • Stabilize femur, move the proximal tibia
  • can also do caudal glide of patella
48
Q

To improve shoulder flexion at the glenohumeral joint, the correct direction to mobilize is:

A

Posterior glide

  • Stabilize the scapula, move the proximal humerus
  • humerus is spinning (half is sliding posterior, half is sliding anterior, thought to have more posterior slide though)
49
Q

For limited external rotation and/or extension at the shoulder the first direction to mobilize is:

A

Anterior glide

- Stabilize the scapula, move the proximal humerus

50
Q

For limited supination at the distal radioulnar joint the first or correct direction to mobilize is:

A

Dorsal glide

- Stabilize ulna, move the distal radius

51
Q

To improve wrist extension at the radiocarpal (wrist joint), the first correct direction to mobilize is:

A

Volar glide

- Stabilize distal radius, move the proximal row of carpal bones (scaphoid, lunate, triquetrum)

52
Q

What are the cardinal signs of the inflammatory phase?

A
  1. Swelling
  2. Redness
  3. Warmth
  4. Pain
  5. Decreased function
53
Q

What are the standard airborne precautions?

A
  1. Pt is in private room with special air handling and ventilation systems (pts can be cohort if private room isn’t available)
  2. Healthcare workers must wear personal fit-tested respirators (N95 most common)
  3. If pt must be transported, pt must wear surgical mask
54
Q

What are the standard droplet precautions?

A
  1. Pt is isolated or with cohort
  2. Must wear gloves and mask (gown and eye protection may be needed)
  3. Hands should be decontaminated after removing gloves
  4. If pt is transported, pt must wear surgical mask
55
Q

What are the standard contact precautions?

A
  1. Pt in private or cohort rooms
  2. Must wear gown and gloves
  3. Limit transport
  4. Patient-care equipment must be disinfected
56
Q

What are the standard airborne precautions?

A
  1. Pt is in private room with special air handling and ventilation systems (pts can be cohort if private room isn’t available)
  2. Healthcare workers must wear personal fit-tested respirators (N95 most common)
  3. If pt must be transported, pt must wear surgical mask
57
Q

What are CDC guidelines on hand hygiene?

A
  1. Use of soap and water for washing visibly soiled hands
  2. Use of alcohol-based hand rubs for routine decontamination of hands between patient contacts
    - Improves the condition of your skin
    - Use when there’s no visible contamination
    - Do not use for patients with C. difficile
    - Alcohol products are flammable - use caution
58
Q

What are the 5 rules when lifting and object?

A
  1. Wide base of support
  2. Keep load close
  3. Lift with leg
  4. Do not twist
  5. Keep back straight during lifting and lowering phase
59
Q

What should you do before you begin a transfer?

A
  1. Gather items needed
  2. Organize the equipment
  3. Set-up as close as possible
  4. Prepare the surfaces
  5. Communicate to the patient
60
Q

What should you keep in mind during a transfer?

A
  1. Maintain patient modesty
  2. Proper body mechanics
  3. Communicate to pt and those helping
61
Q

Where should your hands be placed during a transfer?

A
  • Under the ischial tuberosities to lift

- behind the hips for moving

62
Q

During a sit to stand transfer, what side should the pt who has hemiparesis from stroke go towards?

A

Go to strong side

63
Q

Weight-bearing status where pt can bear (usually) 20-50% of their body weight

A

PWB

64
Q

Weight-bearing status where pt can bear (usually) 50-100% of their body weight

A

WBAT

65
Q

Most sturdy supportive AD; helpful when pt is fearful or you need both hands on pt

A

parallel bars

66
Q

AD used for generalized weakness; reduce wight bearing on one or both LE’s; poor balance/coordination; fear of falling; aging population

A

Walker

67
Q

AD generally seen with kids; facilitates upright posture for kids; allows access to play more easily for children

A

Posture (posterior) walker

68
Q

What side would you put a cane or hemiwalker on?

A

Strong side

69
Q

What side should go towards a railing when going up or down stairs?

A

Weak side

70
Q

What ADs should be used with PWB pts?

A

Hemiwalker, bilat. crutches, or walker

71
Q

What ADs should be used with TTWB or NWB?

A

Bilat. crutches or walker

72
Q

What ADs should not be used for limited weight bearing?

A

Canes

73
Q

List the ADs from most stable to least stable (10 of them)

A
  1. Parallel bars
  2. High platform walker
  3. Standard walker
  4. Front wheeled walker
  5. 4 wheeled walker
  6. Bilateral axillary crutches
  7. Bilateral forearm crutches
  8. Hemiwalker
  9. Quad cane
  10. Single point cane
74
Q

Explain the diff between 2-pt, 3-pt, and 4-pt gait

A

2-point gait—AD and opposite LE advance together
3-point gait—two Ads are advance followed by one LE (often used with unilateral NWB)
4-point gait—deliberate two-point gait; AD 1, opposite LE, AD 2, opposite LE

75
Q

Explain the diff between swing to and swing through gait

A

Swing-to—Crutches advanced simultaneously followed by LEs to level of AD
Swing-through—crutches advanced simultaneously follwed by LE’s beyond level of Ads

76
Q

How do you fit a walker?

A
  • Pt stands upright with shoulders/arms relaxed
  • Top of handgrips at level of pt’s ulnar styloid processes or greater trochanter
  • Elbows flexed 20-30 degrees
77
Q

How do you fit axillary crutches?

A
  • 6 in. anterior and lateral to small toe, crutch tips at 45 degrees, shoulders relaxed
  • 2-3 finger width between crutch and axilla
  • handgrip height at level of ulnar styloid process (elbow bent 20-30 degrees)
  • same with forearm crutches except forearm cuff height will be high as possible without interfering with elbow flexion (1-2 in. from olecranon)
78
Q

How do you fit a cane?

A
  • Standing with shoulders relaxed, can tip alongside small toe
  • Top of cane at ulnar styloid process
  • 20-30 degrees of elbow flexion

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