Exam 1 Ch.1,2,4,6 Flashcards
Acute or chronic pathology, disease, injury, or disorder
Health condition
Of musculoskeletal neuromuscular cardiovascular/pulmonary or integumentary systems
Impairment
ADLs and functional limitations
Activity limitations
Impairments and activity limitations that is unacceptable to the individual, their family or society
Disability
Does not focus on disability or on disease, but is intended to classify and code different health and health-related states experience by everyone
International Classification of Functioning, Disability and Health (ICF)
Health conditions
Fracture, SCI, CVA, rheumatoid arthritis, ACL repair, down syndrome, DM
Impairments
Musculoskeletal (pain, mm weakness, decreased ROM)
Neuromuscular (balance, delayed motor development, abnormal tone)
Cardio pulmonary (decreased aerobic capacity, impaired circulation)
Integumentary (hypo mobility of skin, post op incisions, scar tissue)
Influences on prognosis
Patients general health, comorbidities and risk factors
Patients previous loss of function (PLOF) and living environment, Patient goals, patient support system, safety concerns
Individualized, systematic, planned performance of movements, postures or physical activities designed by a PT or PTA for a patient or client with the goal to:
- Remediate or prevent impairments
- Improve, restore or enhance physical function
- Optimize overall health status, fitness or sense of well-being
Therapeutic exercise
What are the three stages of Motor Learning?
Cognitive stage,
Associative stage,
Autonomous stage
Stage of motor learning when patient thinks about every movement, frequent errors in performance, frequent feedback
“What to do and how to do it”
Cognitive stage
Stage of motor learning with consistency, efficiency, timing, self correction, less feedback from clinician
Associative stage
Stage of motor learning where movements are automatic, dual tasking is possible, adapts to varied task demands in environmental conditions
Autonomous stage
What variables might adversely influence motor learning?
Intrinsic factors- Pain, level of cognition, hunger
Extrinsic factors- External stimuli (lights, noise, movement)
Ex. CVA pt. getting distracted
How could you modify these variables to improve learning?
Pain meds, quiet room, snacks?
What is the single most important variable in learning a motor skill?
Practice!
- Does the client understand the purpose of the task/exercise?
- Is the task meaningful to the patient/client? Is it aligned with the patient’s personal goals?
The strategies you choose will determine how well the patient learns a task.
Strategies include:
Setting, demonstration, type of practice, and feedback
What are the different types of practice?
- Part vs. Whole
- Blocked, Random, Random/Blocked practice order
- Physical vs. mental imaging
Part vs. Whole Practice
Part-Breaking a complex activity down into parts is effective in cognitive phase of learning for acquisition of complex skill that has simple and difficult components
Whole-Whole practice is more effective for a continuous activity, such as walking
Block order practice
Improves performance at a faster rate
Random order practice
Introduces variability and leads to better skill retention
Random/Block practice
Results in faster skill acquisition and better retention. Gives patient the opportunity to identify and correct errors before proceeding to the next variation of the task.
Physical vs. mental imaging type of practice
Mental practice combined with physical practice enhances motor skill acquisition at a faster rate than physical practice alone
What is the second most important variable in motor learning?
Feedback
What are the different types of feedback?
Intrinsic (sensory)
Extrinsic (Pt, pta)
Concurrent (during time of task)
Post-response (after completion of task)
Frequency (continuous or intermittent)
Home exercise program should include:
- Clear, concise verbal and written instructions
- Illustrations to complement written instructions
- Demonstrate exercise for patient or caregiver
- Have patient or caregiver demonstrate for you and then provide them with feedback
- Include your name and contact info and date on HEP
- Place copy of HEP in medical record
- May need more than one session to educate patient or caregiver
- Strategies that improve compliance ( explain importance, help pt. identify personal benefits to HEP, etc)
Causes of Hypomobility:
- Prolonged immobilization of body part
- Sedentary lifestyle
- Postural malalignment/muscle imbalances
- Muscle weakness
- Trauma to tissue with resulting pain and/or inflammation
- Congenital or acquired deformities
Myostatic contracture
Significant loss of ROM, but there is no specific muscle pathology present.
-Responds to manual stretch and MFR
Contracture where the muscles appear to be in a constant state of contraction, giving rise to excessive resistance to passive stretch.
Tx: Inhibitory techniques, orthosis
Pseudomyostatic contracture
Type of contracture that responds to manual stretching joint mobilizations
Arthrogenic and Periarticular contractures
Fibrous changes in the connective tissue of muscle and periarticular structures can cause adherence of these tissues resulting in a _____ contracture.
Treatment is surgery, orthosis, cross friction massage, MFR
Fibrotic contracture/irreversible
When is limited range of motion beneficial to a patient?
Tenodesis effect
When is overstretching OK?
Certain healthy individuals with normal strength and stability who participate in sports that require extensive flexibility
Contraindications for stretching
- Bony block
- Recent fracture
- Acute inflammation or infection
- Sharp, acute pain w/ joint movement
- New hematoma
- Pre-existing hypermobility
- When limited ROM is desired
Precautions for stretching
- Osteoporosis
- Newly healed fracture
- Prolonged immobilization
- Edematous tissue
Benefits of stretching
- Restore/increase extensibility of muscles
- Improve general fitness
- Reduced post-exercise muscle soreness
How does soft tissue respond to stretching?
Elasticity- Ability of soft tissue to return to its resting length after a short duration stretch
Visoelasticity- Sustained stretch produces a change in the links of connective tissue but once force is removed the tissue gradually returns to pre-stretch state
Plasticity- Soft tissue assumes and maintains a new, greater length even after the stretch force is removed
*Viso- & Plasticity changes Requires stretch over an extended period of time
What are the 7 determinants of stretching?
- Alignment-Patient comfort and added stability
- Stabilization- Of proximal and/or distal joints
- Intensity- low intensity
- Duration- (5 seconds- 2 minutes)
* * We will use a minute of 30 sec hold - Speed- Apply and release gradually
- Frequency- Min 2x / week healthy person. Frequency will be based on etiology, acute vs. chronic, age, meds, etc.
- Mode- Selection based on stage of healing, underlying disease process, pain, inflammation, etc.
Modes of stretching:
- Manual
- Self
- Mechanical
- Hold Relax (Contract Relax)
- Agonist Contraction
- Hold Relax with Agonist Contraction
Pre-stretching interventions
Heat
Active, low intensity exercises
Post-stretching interventions
- Cold pack (When soft tissues are cooled in a lengthened position, increases in range of motion or more readily maintained)
- Have the patient perform active range of motion and strengthening exercises through the gained range immediately after stretching
The greatest force that can be exerted by a muscle to overcome resistance during a single maximum effort
STRENGTH
A product of strength and speed.
*Single burst of high intensity activity (anaerobic power) OR repeated bursts of less intense muscle activity (aerobic power)
POWER
Low intensity contractions for multiple contractions over a PROLONGED PERIOD OF TIME
ENDURANCE
Benefits of Resistive Exercise
Increase in:
- Muscle performance
- strength of connective tissue
- Bone mineral density
- Lean muscle mass
- Improved balance
Decrease in:
- Body fat
- Less stress on joints
- Tissue remodeling
- Enhanced sense of well being
- Improved perception of a disability and quality of life
What is the Overload Principle?
Progressive loading of muscle by manipulating:
- weight/resistance
- Repetitions
- Sets
- Frequency of exercise
- Length of time an activity is performed
Cross-training/Transfer of training benefits:
- VO2 max (how efficiently can your body use O2)
- Increase strength in contralateral extremity
- We can increase strength in one extremity by exercising the contralateral extremity
Strength training leads to improved _____.
Endurance
Endurance has little to no cross training effect on ____.
Strength
What principle is associated with “Use it or lose it” ?
Reversibility principle
(Skeletal muscle properties that impact tension generated)
Larger muscle diameter=
Greater tension producing capacity
(Skeletal muscle properties that impact tension generated)
Short pennate/Bipennate/Multipennate design muscles = ____force production
HIGH
(Skeletal muscle properties that impact tension generated)
Type 1 fibers resist ____
Fatigue
(Skeletal muscle properties that impact tension generated)
Muscles produce greatest tension at physiological ____ ____.
Resting length
(Skeletal muscle properties that impact tension generated)
Type of muscle contraction depends on force output.
____ cont. > ____> ____ cont.
Eccentric > Isometric > Concentric
Name some Bipennate muscles with high force production:
Quads, Biceps brachii, Gastrocs
What factors contribute to how susceptible a muscle is to fatigue?
The speed, magnitude, and duration of a muscle contraction
S&S of muscle fatigue
- Pain and cramping
- Trembling of muscle
- Slowing of movement
- Jerky movements
- Unable to complete ROM
- Substitutions
Factors that influence fatigue:
Health Diet, lifestyle Hydration Altitude Ambient temp
Physiological Adaptations to Resistive Exercise:
*Skeletal muscle
Strength training vs. Endurance training
Which causes muscle fiber hypertrophy and no change in capillary bed density?
Strength training
Physiological Adaptations to Resistive Exercise:
*Body composition
Strength training vs. Endurance training
Which increases lean body mass, but decreases % body fat ?
Strength training
Endurance training = no change in lean body mass and lower % body fat
Physiological Adaptations to Resistive Exercise:
*Connective tissue
BOTH Strength and Endurance training increase _____ _____ of tendons, lig, & connective tissue of mm and increase bone ____.
Tensile strength
Bone density
Determinants of Resistive Exercise :
- Alignment & Stabilization
- Intensity
- Volume
- Exercise order
- Frequency
- Duration
- Rest interval
- Mode of Exercise
- Velocity
- Integration of function
- Periodization
Types of resistive exercise:
- Manual
- Mechanical resistive
- Isometric
- Isotonic
- Isokinetic
- Concentric/Eccentric
- Open chain/closed chain
General Principles of Resistance Training:
-Examination and Evaluation
-Preparation for Exercise
-Exercise
Which includes..
- warm up
- resistance (placement and direction)
- Stabilization
- Intensity of ex/ amount of resistance
- Volume/ # of sets, reps, rest intervals
- Verbal or written instructions
- Monitoring pt
- Cool down
Precautions for Resistive Exercise:
- Valsalva maneuver
- Substitute motions
- overtraining/overwork
- Exercise induced muscle soreness
- Pathological fracture (bone cancer, causes weakened bones)
(3) CONTRAINDICATIONS to Resistive Exercise:
- Severe joint or muscle pain
- Inflammation
- Severe cardiopulmonary disease
5 General Sources of Pain:
- Cutaneous
- Somatic
- Visceral
- Neuropathic
- Referred
Type of stretch Where devices apply a very low intensity stretch force over a prolonged period of time to create relatively permanent lengthening of soft tissues
Mechanical stretching (You could use cuff weights, weight pulley system, or automated stretching machines
Type of stretch where the clinician or caregiver applies an external force that lengthens the targeted tissue beyond the point of tissue resistance. The therapist manually controls the site of stabilization and the direction, rate of application, intensity, and duration of stretch.
Static stretch (Manual stretch)
*usually hold for about 30 sec
Stretching should or should NOT be the first activity in an exercise routine?
Should NOT
*cold tissue may be easier to injure
When stretching muscles of the shoulder girdle you stabilize the..
Scapula
(PNF Stretches)
Describe Hold Relax :
or Contract relax
All PROM, therapist places limb in comfortable position to stretch muscle, patient them isometrically contracts for 5 seconds against therapists resistance, pt. relaxes and therapist passively lengthens muscles to new gained range (repeat)
Ex. pectoralis major pg.104
(PNF Stretches)
AROM; Pt. concentrically contracts the agonist (prime mover) and holds for 5-10 sec, brief rest, repeat
Agonist Contraction
(PNF Stretches)
AROM; Place patient in comfortable end-range position, apply resistance while pt. performs isometric contraction of shortened muscle; patient relaxes, then actively contracts prime mover (agonist)
Hold Relax with Agonist Contraction
- Muscle needing to be stretched= Isometric cont. against res.
Followed by pt. actively contracting prime mover (action you want to improve)
Stretching techniques used to Inhibit or facilitate muscle activation and to increase the likelihood that the muscle to be lengthened remain as relaxed as possible as it is stretched
Proprioceptive Neuromuscular Facilitation Stretching (PNF)
