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SA Phys Rehab > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the differences between NMES and TENS

A

NMES is for Muscle Weakness targeting MOSTLY Type I (slow twitch cardio) muscles fibers after initial Type II (fast twitch strength) fibers to create tetanic contractions of selected muscle groups WITHOUT PAIN

TENS is for Pain relief and uses hyper stimulation of nociception (pain gate theory) to release enkephalins (sensory level) and/or endorphins (motor level)

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2
Q

How can Non-noxious stimulation reduce pain?

A

Activates “closed” gate control mechanisms to reduce pain

Ex: soothing, rubbing, ice/heat, TENS

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3
Q

What are the indications for RICE?

A

Acute inflammatory response day 1 to 5

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4
Q

What are the indications for TENS?

A

Pain relief; acute/chronic pain

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5
Q

What are the indications for NMES?

A

Treat muscular weakness, disuse atrophy, early post-op edema

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6
Q

What are indications for ESWT?

A

Great for horses; OA, tendon/ligament injuries, nonunion or delayed healing fractures

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7
Q

What are indications for Therapeutic US?

A

Breakdown of scar tissue, increase elasticity of muscles, aid in healing, increase circulation, reduction of pain/spasms

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8
Q

What are indications for PEMF?

A

Wound healing, pain management, inflammation, post surgical healing, OA

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9
Q

What are the SENSORY settings for TENS?

A

Pulse duration: 2-50 pulses/usec
Frequency: 50-150 Hz (pulse/sec)
Duration: 20-30 min, no cycle time
Amplitude: comfortable tingling for the patient
GOAL: Produce enkephalin release

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10
Q

What are the MOTOR settings for TENS?

A

Pulse Duration: >150 pulses/usec
Frequency: 2-4 Hz (pulses/sec)
Duration: 30-45 minutes, no cycle time
Amplitude: visible muscle contraction
Goal: Endorphin release (long half life)

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11
Q

What are the settings for NMES?

A

Waveform: symmetrical or biphasic
Pulse duration: 100-300 usec
Frequency: 30-50 Hz (pulse/sec)
On/off time; strengthening: 1:3-1:5, Endurance: 1:1-1:2
Electrode size: larger more comfortable but appropriate for muscle groups you are trying to isolate
Treatment time: 15-20 min
Goal: tetanic contractions of selected muscle group WITHOUT PAIN

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12
Q

What are the settings for Therapeutic U/S?

A

Frequency:
1 MHz: longer wavelength penetrate 2-5 cm requires higher intensities
3.3 MHz wavelength penetrates 0.5-2cm requires lower intensities
Pulsed vs. continuous waves

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13
Q

What are contraindications for ESWT?

A

Infectious arthritis
Immune mediated joint disease
Immature bone
Cancer
Unstable fractures
Neurological deficits
Neural tissue
Lung tissue

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14
Q

What are contraindications for Therapeutic U/S?

A

Neoplasia
Areas of hemorrhage
Immediate injury
Eyes
Gonads
Gravid uterus
Ischemic tissue/devitalized tissue
Spinal cord post laminectomy
Phase two incision sites (wait at least 14 days)

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15
Q

What are contraindications for PEMF?

A

Tumors
Pregnant uterus
Open growth plates
Over the heart
Electro medical devices
Acute/active inflammation
Eyes

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16
Q

What are the healing qualities of PEMF?

A

Electrical currents—>increase Ca2+ concentrations—>creates short burst of NO prodxn—>vasodilation, osteoblasts proliferation, immune response, down regulation of Cox2, cellular proliferation, chondrocyte proliferation, reduction of cytokines

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17
Q

What are the healing qualites of therapeutic U/S?

A

Increase metabolic rate
Increase enzyme activity
Increase circulation
Increase extensibility in tissues
Decrease pain

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18
Q

What are the healing qualities of ESWT?

A

Reducing inflammation
Short-term analgesia
Increase neovascularization
Increase osteoblast activity
Realign fibers for more parallel healing

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19
Q

What are the healing qualities of NMES?

A

Selective contraction of a muscle group
Less strong than voluntary contraction
Recruitment of type II muscle fibers (strength fast twitch)
MOSTLY affects Type I muscle fibers (slow twitch cardio)

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20
Q

What are the healing qualities of TENS?

A

Stimulation of the A-Beta fibers via the TENS blocks smaller fiber activity.
Hyper stimulation of nociceptors (pain gate theory)

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21
Q

What are the settings for PEMF?

A

Acute/post op: every 2 hours self cycle option
Chronic: 2-3x/ week

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22
Q

Which manual therapies require specialized training?

A

Chiropractic work (joint mobilization)

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23
Q

What is massage?

A

The rubbing and kneading of muscles and joints of the body with the hands, especially to relive tension or pain; Tui Na in Vet med

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24
Q

What is effleurage?

A

Rhythmic stroking-mild/moderate pressure parallel with muscle fibers. Increase pressure with the larger areas, decrease with the smaller areas.

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25
Q

What is petrissage/kneading?

A

Skin rolling, wringing or squeezing with moderate pressure.
Benefits: breaks up adhesions/knots, relives muscle spasms, contractions, improved blood flow

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26
Q

What is tapotement?

A

Rhythmic percussion
Benefits: stimulates skin and provides warmth, parasympathetic NS stimulation for longer periods of time

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27
Q

What is massage friction?

A

Soft tissue manipulation with thumbs and fingers perpendicular to fibers.
Benefits: Great for joints and tendons, trigger points and to break up scar tissue

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28
Q

What is massage vibration?

A

Trembling movement with hands, fingers or massage gun
Benefits relax before deeper massage, stimulates soft tissue, relives tensions, decrease stress

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29
Q

What is “normal end feel”?

A

When the joint has FULL ROM and the range is stopped by the anatomy of the joint

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30
Q

What is soft end feel?

A

Involving ST such as knee flexion (contact between ST of posterior leg and posterior thigh)

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31
Q

What is “Abnormal end feel”?

A

When the range of the joint is less or greater than normal. It is PAINFUL or when a structure other than the normal anatomy of the joint stops the motion

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32
Q

What are the grades of joint mobilization?

A

Grade I: small amplitude at the beginning of the ROM
Grade II: Large amplitude not reaching the end of the ROM
Grade III: Large amplitude reaching the limited ROM
Grade IV: Small amplitude at the end of the limited ROM
Grade V: Small amplitude and high velocity at the end of limited ROM (manipulation or thrust)

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33
Q

What is physiologic mobilization?

A

Motion that mimics voluntary movements

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34
Q

What is accessory mobilization?

A

Motion that could NOT be accomplished by voluntary movement

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35
Q

What are firm normal end feels?

A

Muscular stretch: ex hip flexion with the knee straight
Capsular stretch: Ex: extension of the metacarpophalangeal joints of the fingers
Ligamentous stretch: Ex: forearm supination

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36
Q

What are hard normal end feels?

A

Bone contacting bones: Ex: elbow extension

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37
Q

What are indications for joint mobilization?

A

Reduced joint range of motion

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38
Q

What are contraindications for joint mobilization?

A

Neoplasia
Infection
Malignancy
Recent surgery
Open wound
Severe muscle contracture
Instability

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39
Q

What are contraindications for massage therapy?

A

Cutaneous disease
Shock
Fever
Acute incision
Aggressive demeanor

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40
Q

What are indications for massage therapy?

A

Swelling and edema
Prolonged recumbency
OA
Chronic pain
Cancer pain
Palliative/hospice
Contractures
Trigger points (MTPs)
Athletic warm up and recovery

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41
Q

What are indications for PROM therapy?

A

Post surgical
No active/voluntary limb use (plegic)
OA

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42
Q

What are indications for stretching?

A

Athletes to prevent injury, conditioning
Tightness: know the end feels, more difficult in chronic disease

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43
Q

Where do most acupuncture points lie over?

A

Type III: overlie superficial nerves or plexuses (70%), most points emerge from anatomical bony foramina

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44
Q

Which meridian is modulating the somatovisceral systems

A

Bladder meridian

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45
Q

What gauge needles is generally used in acupuncture?

A

28-34 gauge needles, there are coated and non-coated forms

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46
Q

What are adverse affects of acupuncture?

A

Bent or stick needles, broken needles, puncture of organs, puncture of joint capsules, infections, hematomas, EXACERBATION OF INITIAL CLINICAL SIGNS (things get worse before they get better. )

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47
Q

What acupuncture clinical application does not require any training?

A

Needling of trigger point complexes (Ashi/contraction knots)

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48
Q

What are the acupuncture points of the hip triangle?

A

BL54 (master point)
GB29
GB30

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49
Q

What acupuncture point is the master point of the caudal back and hips?

A

BL40 (popliteal fossa in front of the popliteal LN)

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50
Q

What is the master acupuncture point of the stomach and GI?

A

ST36 (at the stifle)
Stifle pain, GI motility issues or disease, pelvic limb dysfunction

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51
Q

What is the master acupuncture point for the chest and cranial abdomen?

A

PC6 (at the carpus)

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52
Q

What is PC6 used for?

A

Nausea, vomiting, cranial GI tract dysfunction, cardiac arrhythmias

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53
Q

What is ST36 used for

A

Stifle pain, GI motility issues or disease, pelvic limb dysfunction

54
Q

What is BL40 used for?

A

Pelvic limb pain, weakness, urinary retention, stifle pain

55
Q

What is the hip triangle used for?

A

OA and hipdysplasia

56
Q

What is the master point of the face and mouth?

A

LI4 (ventromedial to the carpalmetacarpal joint)

57
Q

What is LI4 used for?

A

Dental pain, facial pain, headache, sympathetic regulation, stomatitis

58
Q

What is the Shen point/100 convergences?

A

GV20 (between the eyebrows at center of forehead), great for anxiety but doesn’t too much once the animal is at the veterinarian

59
Q

What is GV20 used for?

A

Agitation, headaches, dizziness, CVA (stroke)

60
Q

What is the resuscitation point?

A

GV26 (at the nasal filtrum)

61
Q

What is GV26 used for?

A

Activation of sympathetic nervous system, aggressive use in resuscitation/CV arrest, apnea

62
Q

What are the downstream effects of photobiomodulation?

A

Increase Angioneogenesis
Increase neovascularization
Increase collagen production
Increase muscle regeneration
Decrease muscle atrophy
Decrease inflammation and edema
Increase nerve regeneration
Increase cartilage production
Increase bone formation

63
Q

What are the secondary mitochondrial downstream effects of photobiomodulation?

A

When the light is absorbed by Cytochrome C Oxidase biomodulation occurs with

Increase ATP by 150%
Modulation of ROS
Increase release of NO
Increase cytosolic Ca2+

64
Q

What are the main applications of LLLT?

A

Reduce inflammation
Promote tissue repair
Induce analgesia

65
Q

What are some indications for LLLT?

A

Inflammation
Arthritis
Trauma
Ulcers/granulomas
ST injuries
Neuropathies
Pain

66
Q

What are the parameters of the type of light used in LLLT?

A

Monochromatic (one wavelength)
Coherent (photons travel in same phase and direction)
Collimated (minimal divergence over distance)

67
Q

Is class III or Class IV laser for shallow treatments?

A

Class III (1-500 mW/ <0.5 W) is for shallow and probe must contact the skin directly
Class IV (>500 mW >0.5W) is for deeper treatments and can be contact free as it has LONGER wavelengths

68
Q

What are the tertiary effects of PBM?

A

Increase gene transcription
Increase cell proliferation
Cell migration
Decrease Necrosis
Decrease inflammation

69
Q

What are quaternary effects of PBM?

A

Response to tertiary effect secretions
Cells in blood and lymph will migrate to the Tx area to induce autocrine, paracrine and endocrine (bystanders) effects

70
Q

How does LLLT produce analgesia?

A

Laser (>300 me/cm^2) absorbed by nociceptors which inhibit specific pain fibers, slow conduction velocity, reduce AP amplitude and suppress neurogenic inflammation

71
Q

Why does PBM work on MTPs?

A

There is high electrical activity at these locations, LLLT reduces the amplitude of the APs to reduce pain

72
Q

What is a concern of treating with Class IV lasers?

A

Increase risk of thermal injury when it comes to treating deeper structures (they have higher wattage)

73
Q

What are contraindications for LLLT?

A

Over pregnant uterus
Over open fontanel (space between bones for the skull of infant fetus where ossification has not completed)
Over a tumor (retrograde signaling can make it more invasive)
Over open growth plates of young animals
Over thyroid gland
NO PROBE CONTACT when treating open wounds

74
Q

What power are fibroblasts stimulated with LLLT?

A

1-5 J/cm^2 which can increase collagen production, greater than 5 will inhibit and delay healing

75
Q

Why is there a lot of research that says LLLT doesnt do what it advertises?

A

They don’t know how to design the study for long enough (or all the correct parameters) and they don’t know what the heck they are talking about

76
Q

What is the weight distribution at a stance?

A

Normal; 60% FL and 40% HL

77
Q

What is the weight distribution at a trot?

A

Normal: 120% FL and 75% HL (there is increased force)

78
Q

What joint uses the most ROM at a walk?

A

Carpus; uses 50% of range, all other joints use very little. More speed will demand more ROM of all joints

79
Q

Type I muscle fibers are (fast/slow) twitch for (anaerobic/aerobic) exercise and are used for (endurance/strength training). They also fatigue (slowly/fast)

A

Slow twitch
Aerobic exercise
Endurance
Fatigue slowly

80
Q

Type 2 muscle fibers are (fast/slow) twitch for (anaerobic/aerobic) exercise and are used for (endurance/strength training). They also fatigue (slowly/fast)

A

Fast twitch
Anaerobic
Strength training
Fatigue fast

81
Q

Which muscle fibers are recruited first when muscles are being used?

A

Type 2 fibers are recruited first then Type 1

82
Q

What is the difference between isometric and isotonic muscle activity?

A

Isometric is where the muscles stay the same length
Isotonic muscles change in length with concentric (shorten) or eccentric (lengthen) movements

83
Q

Where is the majority of the movement in the spine?

A

Lumbar (7 vertebrae) within the T-L junction

84
Q

What are the phases of healing in terms of length of time?

A

Phase 1: 1-5 days, acute inflammatory
Phase 2: 5-21 days, subacute proliferative
Phase 3: 21-60 days, consolidation phase
Phase 4: 61+ days, Organizational phase

85
Q

What are some of the excercise indications for musculoskeletal disorders?

A

OA (chronic disease assigned in Phase 3)
Conservative therapy

86
Q

What are contraindications to exercise?

A

Deterioration occurs with exercise
Febrile
Acute musculoskeletal injuries (fractures, torn ligaments, etc)
Acute neurological compression
Serious internal disease process
Serious cardiac diseases
Acute thrombosis, venous thrombosis

87
Q

What are some examples of P1 ground exercises?

A

Standing ( P1)
Weight shifting (P1-P4)
Rhythmic stabilization
Slow walking (P1 and P2 level surfaces)
Cavaletti and weave poles
Balance discs (P1-P4)

88
Q

What are some examples of P3-P4 ground exercises?

A

Handshaking (P3-P4)
Slow walking on uneven surfaces for dynamic weight stabilization (P3-P4)
Creative use of balls
Backwards walking
Incline walking
Decline walking
Ascending/descending stairs
Sit to stands
Dancing
Wheelbarrow
Army crawls

89
Q

What property of water allows for a decrease in overall weight on an animal?

A

Buoyancy

90
Q

At what level does the water in UWTM need to be to get the weight of the animal to shift to the front?

A

The hip

91
Q

What property of water allows for the reduction of edema in a patient?

A

Hydrostatic pressure (caution with respiratory patients)

92
Q

What are contraindications of aquatic therapy?

A

Severe cardiac or respiratory disease
Infections
Biosecurity orange
Severe Diarrhea
Laryngeal paralysis
Fecal incontinence
Patients with UTI (be on ABx for 72 hours prior)

93
Q

What water level does most flexion of the joint occur?

A

At or above the joint

Hip has more fexlion at ANY water level
Stifle has more flexion at DEEPER water

94
Q

What are contraindications for swimming therapy?

A

Cervical instability
Post op patients before P3 or P4

95
Q

What is one thing canine athlete owners love to give?

A

Supplements! Make sure you get a full list/history on these

96
Q

How is gonadectomy status important for history?

A

Fixing prior to puberty can predispose to orthopedic injury

97
Q

What are two low impact canine sports that are uncommon to have injuries?

A

Rally
Conformation

98
Q

What is a common injury for obedience?

A

Left shoulder injuries because they are staring at their owners the whole time

99
Q

What is are common injuries of flyball?

A

Chronic repeated stress injuries or the shoulder, carpus, iliopsoas, medial shoulder syndrome and hip arthritis

100
Q

What are common injuries of dock diving?

A

Back pain
Hips

101
Q

What are common injuries of field trials/hunt trials?

A

Feet
Carpus
Shoulders
Arthritis
Carpal hyper extension

102
Q

What are some considerations for FHO rehab?

A

Maintain ROM IMMEDIATLEY to prevent too much fibrosis
Longer term NSAIDs and possible Gabapentin

103
Q

What are complications of THR?

A

Luxation
Infection
Fracture
Implant failure/loosening

104
Q

What are important rehab considerations for THR?

A

3 months of EXTREME CARE to prevent hip dislocation
No abduction/adduction
Leg moves in saggital plane only
OWNER EDUCATION: some surgeons don’t instruct owners to perform PROM at home

105
Q

What is the timeline for THR limb function rehab?

A

Regain limb function: 2-10 weeks with limb placement (slow walks/gentle weight shifting)
Limb strengthening: 10-12 weeks (check radiographs first)

106
Q

The (medial/lateral) meniscus injury is more common

A

Medial meniscus (tibia and median collateral ligament)

107
Q

What is the goal of the lateral fabellar suture procedure?

A

Prevent cranial displacement of the tibia, scar tissue forms over joint to stabilize long term

108
Q

What modalities can be used with LFS in rehab?

A

TENS and massage to reduce edema
PROM Day 1 and therapeutic U/S to improve ROM

109
Q

What is the rehab schedule for LFS?

A

Day 1: PROM
Week 2: avoid extreme flexion and extension; can do gentle passive stretching and start UWTM
Week 4-5: no stair climbing until week 5 to 6; can do cavaletti poles to add more AROM

110
Q

When can you add UWTM to TPLO and TTA post op?

A

As early as 2 weeks

111
Q

What are complications of TPLO and TTA?

A

Meniscus tear
CCL rupture on other limb
Fracture, infection, implant loosening
Patellar desmitis

112
Q

What are rehab considerations for TPLO and TTA?

A

Avoid TENS and Laser over the plate
Avoid extreme flexion/extension until week 6
Avoid increased loading exercises until week 8-10
Don’t walk more than 20 min 2x/day until recheck of radiographs

113
Q

What procedure fixes a patellar luxation?

A

TTT and trochlear wedge recession

114
Q

What are TTT rehab considerations?

A

Improve ROM on SAGGITAL plane only
Gradual increase of limb use but still avoid extreme flexion and extension

115
Q

What is the difference between physcial therapy and physical rehab?

A

State practice acts limit the term, physical therapy is for human medicine. Physical rehab is what we use for animals term wise

116
Q

What are post surgical neurologic indications for Physcial rehab?

A

Ventral slots
Hemilamenectomies
Stabilizations

117
Q

Are there reasons to do physical rehab over surgery?

A

Yes
Financial constraints
Comorbidities
PREHAB

118
Q

Why should you meet a potential physical rehab patient outside?

A

Neutral environment and fear free. You can see how the patient interacts with the owner as well

119
Q

What phase does suture removal occur in?

A

Phase 2 ( Day 5 to 21) subacute/proliferative

120
Q

Which phase is the “stupid phase”?

A

Phase 2 (day 5-21) subacute/proliferative phase. Collagen is very fragile at this point (pre 14 days) risk of reinjury is high here. Owners get a little less strict because things look to be doing better…but things are still fragile

121
Q

What phases are great for rechecks?

A

Phase 2 for suture removal (Day 5 to 21) subacute/proliferative
Phase 4 (day 61+) organizational phase

122
Q

Why is nutrition important in physical rehab?

A

Fatter patients have more difficulty because of excess weight

123
Q

Why is the dog’s job important in the patient history?

A

Is it a couch potato or agility star. Helps to get realistic expectations of the rehab as well as the owner’s commitment to the tasks

124
Q

What are three areas that are important to check on PE of Physical Rehab evaluation

A

Iliopsoas (compensatory problems)
Thoracolumbar+sacroiliac
Caudal to scapula (weight bearing)

125
Q

How do you approach pain with a physical rehab treatment plan?

A

Presence of pain
Acute Pain: modalities and manual therapies
Chronic Pain: modalities, manual therapies and exercise

Absence of pain: just exercise

126
Q

What is the normal ROM for the STIFLE joint?

A

Normal FLEXION of stifle: 40-43 degrees
Normal EXTENSION of stifle: 160-164 degrees

127
Q

What is the normal ROM for the coxofemoral joint?

A

Normal FLEXION of coxofemoral joint: 48-52 degrees
Normal EXTENSION of coxofemoral joint: 160-164 degrees

128
Q

What is gradual increase of amplitude over time and how does it relate other the patient?

A

Ramp: relates to patient comfort

129
Q

What tissue temperature should TUS be maintained at and for how long?

A

104-112 F for no longer than 5 minutes

130
Q

Which modality house you let patents react to?

A

Therapeutic US; dont sedate too much, dont ice

SA Phys Rehab (1 decks)

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