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Ex Phys II > Exam 1 > Flashcards

Exam 1 Flashcards

0
Q

Active vs. Passive Warm Up (which is better?)

A

Active- muscles are active
Passive- muscles are not active
Active is better for performance = increase to same level of temperature for activity

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1
Q

Physiologic Reasons for Warm Ups

A 
Increase Body Temp: 
-O2 dissociates from hemoglobin
-vasodilation
-Q10 enzymatic reaction effect
-increase muscle contraction speed
-decrease muscle relaxation time
-extensibility of connective tissue
-nerve conduction velocity
-muscle thixotropy (time dependent viscosity)
-actin myosin bonds
-
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2
Q

Warm Up Recommendations (Parts of Warm Up)

A

Aerobic/Callisthenic –> Stretching –> Activity Specific

  1. gradual
  2. not too intense
  3. general –> specific
  4. sweat
  5. increase HR
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3
Q

Consequences of Immobility

A
  • Joint contractures
  • Muscle atrophy
  • Thrombus formation
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4
Q

Passive ROM (Define, Indications, Goal, Limitations)

A

Define: segment moved by device or therapist, no active contraction, through pain free ROM without tissue resistance
Indications: acute inflammation, inability or contraindication to move
Goal: decrease complications of immobilization
Limitations: no change in muscle size/strength/endurance, limited improvement in circulation

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5
Q

Active ROM (Define, Indications, Goals)

A

Define: patient performs motion, provide assistance if needed to control movement/weakness/beginning & end range, move within pain free ROM, helping assist initiation or change of direction & keepings smooth motion
Indications: able to move, early strengthening, movement above and below immobilization
Goals: decrease consequences of immobility, maintain elasticity of structures, sensory feedback, maintain bone/joint integrity, prevent thrombus, coordination, motor skills

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6
Q

Active Assisted ROM (Define, Indications)

A

Define: patient performs movement but assistance is provided throughout by pulley/T bar/therapist, move through pain free ROM
Indications: able to move but not attaining full range, same as AROM

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7
Q

PROM, AROM, and AAROM Limitation

A

does not improve strength!!!

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8
Q

ROM Application & Preparation

A
  • Free up work area, Drape & position patient, Position yourself, Remember gravity
  • Control mov’t (support jt and areas of poor structural integrity), MOVE THROUGH PAIN FREE RANGE TO POINT OF RESISTANCE, smooth and slow, patterns best meet patient goals, 5-10 reps based on goals
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9
Q

Define: functional ROM, functional mobility, hypomobility, flexibility, goal of strethcing

A
  • functional ROM: comfortable ROM needed to perform an ADL
  • functional mobility: incorporates NS and motor control needed to perform ADL
  • hypomobility: restricted ROM due to immobilization, sedentary, postural alignment, muscle weakness, inflammation, deformity
  • flexibility: ability to move a single joint or series of joints smoothly & easily through an unrestricted, pain free ROM
  • goal of stretching: improve extensibility of contractile & noncontractile components of muscle-tendon units and periarticular structures
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10
Q

Types of Contractures

A
  1. myostatic- shortened/tight musculature, no specific pathology
  2. pseudomyostatic- hypertonicity, muscle spasm, NM inhibition
  3. arthrogenic (in jt) and periarticular (around jt)- cartilage damage, osteophyte formation
  4. fibrotic- scar tissue, adhesive capsulitis, heterotopic ossification
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11
Q

Hypomobility

A
  • decreased extensibility of CT (not contractile elements)
  • stretch induced gains in ROM: neural changes first and biomechanical changes, increased extensibility & length, decreased stiffness, not changing length of sarcomeres
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12
Q

Guidelines for Stretching

A
  • at least 3x/week for ROM increases
  • at least 1-2x/week to maintain
  • slow elongation and hold at low force TO THE POINT OF MILD DISCOMFORT
  • 15-30 second hold (better than shorter holds/as good as longer holds)
  • 3 to 5 different stretches for each different muscle group
  • no consensus on repetitions or speed for dynamic stretching
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13
Q

Stretching in Chronic Contractures

A
  • may need longer duration stretch
  • prolonged static stretch with splints or casting
  • LLPS: low load, prolonged duration stretch
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14
Q

Proprioceptive Neuromuscular Facilitation Stretching

A
  • takes advantage of stretch reflexes to increase range: GTOs and muscle spindles
  • reciprocal inhibition***- when agonist contracts then antagonist relaxes
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15
Q

Stretch Rflexes

A
  • muscle spindles: embedded in muscle, cause muscle to contract when stretched too quickly, antagonist relaxes
  • GTOs: causes relaxation before tension gets too high
  • reciprocal inhibition
  • spinal level reflexes- only goes to spinal cord
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16
Q

Review the Literature for PNF

A
  • hold contraction for 3 seconds
  • may not be result of muscle spindle/GTO
  • alters stretch perception with neural distraction
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17
Q

Stretching and Athletic Performance

A
  • acute stretch does not improve performance and may be detrimental
  • regular/chronic stretching improves force, jump height, running speed
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18
Q

Stretching and Injury Risk

A
  • no link shown to prevent injury
  • analgesic (desensitizing) effect in muscle that could predispose you to injury
  • beneficial to maintain normal ROM
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19
Q

Contraindications to Stretching

A
  • PAIN WITH MOVEMENT!!! (4 or less)
  • bony block
  • recent fracture
  • acute inflammation or infection
  • fragile tissue, tissue trauma
  • hypermobility
  • contracture is helpful to patient
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20
Q

Spine Stabilization- What is it? Basic Motor Learning?

A
  • proximal stability for distal mobility
  • deep segmental muscle activation
  • basic motor learning: awareness, control with simple movements, control with complex movements, automatic maintenance of stability
  • tension on thoracolumbar fascia is increase with muscle contraction (internal weight lifting belt)
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21
Q

Tripodism- loads change between flexion and extension

A

tripodism- defined as the load relationship between the vertebral bone-disc interface and facet joints (and lamina)

  • with flexion: compressive load to facets decrease, load to discs increase
  • with extension: compressive load to facets increase, load to discs decrease
  • force from abdominal muscles counteract shear forces
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22
Q

Guidelines for Training

A
  • awareness (neutral positions)
  • activation in neutral
  • add extremity motions
  • reps to improve endurance
  • alternate isometric contractions
  • move from one place to another
  • challenge with unstable surface
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23
Q

Deep Segmental Muscles

A
  • neck: longus colli

- lumbar spine: transverse abdominus (does not hypertrophy but will improve activiation), multifidus

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24
Q

Deep Neck Extensor Activation

A
  • craniocervical flexion: nod
  • axial extension: double chin
  • supine with pressure feedback
  • prone lift head while looking down
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25
Q

Deep Lumbar Musculature Activation

A
  • fine neutral spine
  • belly button to spine (draw in): no pelvic movement, normal breathing, different than bearing down
  • pressure feedback: abdominal draw in
  • quadratus lumborus: side plank
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26
Q

Pressure Feedback

A
  • use standard blood pressure cuff
  • cervical: under neck –> increase pressure with contraction
  • lumbar: under belly prone –> decrease pressure with contraction
  • lumbar: under low back supine –> increase pressure with contraction
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27
Q

Physical Activity Guidelines

A
  • Department of Health and Human Services

- First published in 2008

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28
Q

Committee Report: Health Outcomes

A 
All cause mortality
cardiorespiratory health
metabolic health
energy balance
musculoskeletal health
functional health
cancer
mental health***
youth
adverse effects
other populations***(people with disabilities, pregnancy, racial/ethnic groups)
29
Q

Why We Need PA Guidelines

A
  • Americans are largely inactive & engineered out of our environment
  • Physical activity is repeatedly shown to improve health, lifestyle change accessible to nearly everyone
  • prevention oriented
  • previous “guidelines” said some is good, more is better
  • guidelines address specific groups
30
Q

Major Research Findings

A
  • regular activity reduces risk of many adverse health outcomes
  • some activity is better than none
  • added health benefits generally occur as amount of activity increases
  • most health benefits require at least 2 hours and 30 minutes a week of mod intensity PA
  • benefits from aerobic and muscle strengthening
  • beneficial for all people: age, disability, gender
  • benefits far outweigh risks
31
Q

How Much Activity?*******

A
  • 150 minutes per week of mod intensity to substantially reduce risk of chronic disease
  • additional benefits seen at 5 hours per week
32
Q

Children and Adolescents (age 6-17)

A
  • 1 hour per day of mod intensity
  • vigorous intensity at least 3 days per week
  • obesity prevention
  • bone strengthening
  • motor development
33
Q

Adults (age 18-64)

A
  • 150 min per week of mod aerobic activity
  • OR 75 min of vigorous aerobic activity
  • muscle strengthening activities 2 or more days/week of all major muscle groups
  • 10 min or greater bouts
34
Q

Older Adults (> 65 yrs)

A
  • follow adult guidelines
  • as active as possible (if less than adult guidelines)
  • include balance activities
  • if no symptoms: don’t need to consult a health care provider
35
Q

Getting Started

A
  • look for ways to do more
  • pick something enjoyable and feasible
  • establish support
  • build up over time
  • Be Active Your Way Guidebook
36
Q

Gauging Exercise Intensity

A
  • rating of Perceived Exertion: scale of 6 to 20
  • heart rate
  • metabolic equivalents: 1 MET is rest
  • talk test
37
Q

Moderate and Vigorous Physical Activity

A 
Moderate:
-RPE 11 to 14 (on a scale of 6 to 20)
-50 to 69% of Max HR
-3 to 5 METs
-can talk, but not sing
Vigorous:
-RPE of 17-19
- > 70% of Max HR
-6 METs or higher
-cannot talk without taking extra breaths
38
Q

The best type of exercise, is…

A

the type of exercise you’re actually going to do.

39
Q

Stretch Shortening Cycle

A
  • muscle contraction isn’t just a muscle contraction
  • muscle spindles stretch–>tell brain to contract
  • elastic potential especially in tendons
  • 4 Steps: Preparation, Eccentric, Transition, Concentric
  • Always remember: position, biarticular muscles, one muscle can do more than one thing, gravity
40
Q

Principles of Manual Muscle Testing (Resistance, Break Test, Active Resistance Test)

A

Resistance: concentric force in line with line of pull of muscle and in opposition to contracting muscle (remember anatomy)
Break Test: end of available ROM and patient holds while therapist tries to “break”, most common MMT procedure
Active Resistance Test: apply progressive resistance until motion stops, not recommended because scores equal to break test

41
Q

Principles of Manual Muscle Testing (application of resistance, one joint muscles, biarticular muscles)

A

Application of Resistance: length tension relationship, joint mechanics
One Joint Muscles: apply resistance at end range
Biarticular Muscles: apply resistance at mid range with most favorable length-tension postion

42
Q

Where do you apply resistance? What do you do if there is any variation in procedure?

A
  • apply resistance at distal end of segment the muscle attaches to (EXCEPT weak knee joint during hip testing = 4 or lower, scapular muscle assessment)
  • apply gradually over 2 to 3 seconds
  • if variation is noted, DOCUMENT, JUSTIFY, and REPEAT IN SAME WAY
43
Q

MMT Grading Scale

A

1 = no activity
2 = trace activity
3 = poor
4 = good
5 = normal
testing (get baseline and compare) vs. screening (find weakness)
represents performance of all muscles in that motion

44
Q

Grade Zero Muscles

A

muscle is completely inert on palpation and visual inspection

45
Q

Grade 1 Muscles

A
  • visible or palpable contractile activity (1 or more muscles in mov’t group, tendon tension)
  • move limb into testing position –> ask patient to hold and then relax –> compare
46
Q

Grade 2 Muscle

A
  • completes full ROM in gravity minimized position

- reduce friction

47
Q

Grade 3 Muscle

A
  • can complete full ROM against gravity & any additional resistance leads to break
  • **functional threshold for upper extremity because need to be able to move limb against gravity
  • check that joint is not locked during testing
48
Q

Grade 4 Muscle

A
  • complete full ROM against gravity & “yields” or “gives” with maximum resistance at end range
  • must document if break is due to pain or weakness
  • says it is “Good”, but it is NOT “Normal”= not endpoint for rehab
  • clinical observation very important (ex: getting up from chair)
49
Q

Grade 5 Muscle

A
  • able to complete full ROM & therapist cannot break at end range
  • compare bilaterally
  • consider how much force the muscle functionally producess
50
Q

Using + and -

A

-discouraged from general use because too subjective
Exception!!!!- plantar flexors
-pt who is walking, do not assess PF strength in supine
-2+ if partial weight bearing heel raise or max resistance in supine
-2 if full ROM with no resistance
-2- if partial range in supine

51
Q

Practical Considerations for Grading

A
  • ordinal scale
  • jump between 1 and 2 then jump between 4 and 5 (fuzzy)
  • smaller increments between 0-1, 2-3, 3-4
52
Q

Practical Considerations for Testing

A
  • optimize patient comfort
  • quiet, non distracting test area
  • testing surface is adequate size, firm but not too firm
  • organize testing order to minimize position changes
  • knowledge and skill will determine the usefulness of results
53
Q

Required Practitioner Knowledge for MMT

A
  • location and anatomical features of involved muscles (O, I, LOP)
  • consistent test application: method and positioning
  • identify patterns of substitution
  • detections of minimally contracting muscle
  • able to identify bilateral differences & deviation from normal
54
Q

Continued Required Practitioner Knowledge for MMT

A
  • do not grasp muscle belly
  • innervations: weakness in one group requires testing of all
  • definitive vs. confirmatory (diagnosis specific)
  • modify without impacting test results
  • consideration of fatigue
  • effect of sensory loss on movement
55
Q

Things to Look Out For:

A
  • open wounds
  • tubes, monitors, wire, ostomes, traction, ventilators
  • patient cannot assume test position
  • don’t take shortcuts: **don’t assign lower grade without testing that grade first
  • listen to your patient
56
Q

Influence of the Patient on MMT

A
  • effort
  • willingness to endure pain
  • ability to comprehend instructions
  • motor skills
  • cultural implications
57
Q

Usefulness in Various Settings: Acute Care, Acute Rehab, Long Term, Home Health

A

Acute Care: post surgical assessment, transfer safety, discharge plans
Acute Rehab: baseline, plan, changes (not always due to increase muscle strength, could be neural)
Long Term: progression, assessments, plan of care
Home Health: community mobility requirements, CMS requires home bound to be considerable and taxing effort in leaving the home

58
Q

Usefulness of MMT in Outpatient Setting

A
  • origin of pain
  • quality of contraction
  • symmetry
  • weakness in kinetic chain
  • assessment**- due to ceiling effect
59
Q

Limitations of MMT

A
  • population variation
  • objectivity and some subjectivity
  • validity and reliability
  • sensitivity and diagnostic validity
  • Ceiling Effect: not recommended to use as progress measure over grade 3, bilateral comparison as instrumented assessment
  • tester’s strength
60
Q

Method of MMT

A
  • position patient
  • assume they are weaker than you think
  • determine LOP
  • use good body mechanics
  • stabilize surrounding joints
  • patient moves limb into position
61
Q

Alternatives to MMT

A
  • repetition max tests
  • isokinetic dynamometer
  • hand held dynamometer
  • biodex
  • throwing tests
  • jumping tests
  • body weight testing
62
Q

Medical Evaluation

A
  • useful and important prior to starting exercise program (baseline)
  • can identify high risk individuals that should only exercise under medical supervision
  • can be used to help motivate a person to adhere to program (BP, body fat, blood lipid)
  • periodic med evals can identify dangerous conditions earlier
  • not everyone needs an eval
  • med eval target moderate to high risk individuals
63
Q

Pre participation Health Screening

A
  1. Physical Activity Readiness Questionnaire
  2. Signs and Symptoms
  3. CVD Risk Factors
  4. Med Eval including physical and stress test
64
Q

Purposes of Preparticipation Screening and Risk Stratification

A
  • ID individuals w/ med contraindications that require exclusion from exercise program until conditions abated or controlled
  • recognize individuals w/ clinically significant diseases or conditions who should participate in a medically supervises exercise program
  • detect individuals who should undergo a med eval and/or ex testing as part of screening process before initiating exercise program or increasing frequency/intensity of current program
65
Q

Risk Stratification Steps

A
  1. Assess presence of previously diagnosed disease (cardiovascular, pulmonary, metabolic) –> HIGH RISK
  2. Assess presence of signs and symptoms of disease (1 or more –> HIGH RISK)
  3. No disease or S&S, determine total number of CAD risk factors present (2 or more –> MODERATE, 0 or 1 –> LOW)
66
Q

Signs or Symptoms of Disease (9)

A
  1. pain/discomfort in chest, neck, jaw, arms, or others that may result from ischemia
  2. shortness of breath at rest or w/ mild exertion
  3. dizziness or syncope (fainting)
  4. orthopnea (SOB lying down relieved by being upright) or paroxysmal nocturnal dyspnea (same but occurs 2-5 hrs after going to bed)
  5. ankle edema
  6. palpitations or tachycardia
  7. intermittent claudication (pain in muscle with inadequate blood supply, walking upstairs/hill causes cramp & gone in 1-2 min)
  8. known heart murmur
  9. unusual fatigue or SOB with usual activities
67
Q

CVD Risk Factors (8)

A
  1. Age: men great or equal to 45, women 55
  2. Family History: MI, coronary revasc, death before 55 of male 1st degree or 65 female 1st degree
  3. Smoking: current, exposed to environmental, quit within previous 6 months
  4. Hypertension: SBP greater or equal to 140, DBP greater or equal to 90, or on meds
  5. Dyslipidemia: LDL greater or equal to 130, HDL less or equal to 40, total greater or equal to 200, or on med (subtract 1 if HDL greater or equal to 60)
  6. Prediabetes Fasting Glucose: fasting blood glucose greater or equal to 100 but less than 126, or determined by oral glucose 140-199
  7. Obesity: BMI greater or equal to 30, waist greater that 40 in for men or 35 in for women
  8. Sedentary: not in 30 min mod intensity (40-60% VO2R or 3-6 METs) on at least 3 days per week for at least 3 months
68
Q

If presence or absence of CVD risk factor is not disclosed or is not available…& prediabetes.

A
  • …that CVD risk factor should be counted as a risk factor EXCEPT prediabetes:
  • age greater or equal to 45 and BMI greater or equal to 25kg/m2
  • age less or equal to 45 with BMI greater or equal to 25 and additional CVD risk factor for diabetes (family history of DM)
69
Q

Low Risk Individuals

A
  • low risk of acute CV event

- exercise may pursued safely without the necessity for med exam or clearance

70
Q

Moderate Risk Individuals

A
  • risk of acute CV event is increased
  • in most cases, individuals may safely engage in low to moderate intensity PA without needing med exam for clearance
  • advised to have med exam and exercise test before vigorous intensity exercise
71
Q

High Risk Individual

A
  • extreme risk of acute CV event

- thorough med exam should take place & clearance given before initiating exercise or PA of any intensity

Ex Phys II (5 decks)

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