final

Question 1

Characteristics of the various learner strategies

Answer 1

cognitive: learn what to do and how to do it. “feel” of the exercise. errors are common.
associative: infrequent error and concentrates in task, problem solving, infrequent feedback and adjustments and makes corrections before error occur.
autonomous: “movements are autonomic”, pt does not have to pay attention to movements, they happen simultaneously.

Question 2

Identify an impairment vs participation restriction
vs
activity limitation vs contextual factors from a
scenario

Answer 2

-impairment: impairment directly from the health condition (pain, limited ROM, etc).
-participation restriction: problems a person may experience in life because of a health condition (self-care, mobility in the community, socializing)

-activity limitation: the exact task or action (reaching, lifting, pushing)
-contextual factors-
*environmental: social(friends), outside influencing stuff
*personal: race, gender, education, psychological status

Question 3

types of prevention

Answer 3

-primary prevention: health promotion to identify risks and PREVENT conditions.
-secondary prevention: early diagnosis and reduction of existing disease.
-tertiary prevention: use of rehabilitation to decrease or limit the progression of a chronic condition.

Question 4

goals of PROM

Answer 4

-maintain joint and connective tissue mobility and mechanical elasticity of muscle
-minimize the effects of formation of contractures circulation and vascular dynamics
-enhance synovial movement for cartilage nutrition and diffusion.

Question 5

goals of AROM

Answer 5

-maintain physiological elasticity and contractility of muscles
-sensory feedback from muscles
-stimulus for bones and joint tissue integrity
-increase circulation and prevent thrombus formation
-develop coordination and motor skills for functional activities.

Question 6

Interventions to improve impairments in contractures

Answer 6

contracture: shortening of soft tissue (muscle), resulting in resistance to passive or active mobility and limited ROM
(EXAMPLE: elbow FLEXION contracture: motion limited is EXTENSION.

INTERVENTIONS: any type of stretching, muscle energy techniques (lengthen muscle), joint and soft tissue mobilization.

Question 7

indications/contraindications for stretching

Answer 7

INDICATIONS: -When ROM is limited bc soft tissue lost their extensibility (adhesions, contractures).
-When there is restricted motion and can lead to structural deformities.
-Muscle weakness and shortening of opposing tissue.
-Prevent risk of musculoskeletal injuries and warm up/cool downs before/after exercise.

CONTRAINDICATIONS:
-When a bony block limits joint motion
-Recent fracture/ bony union is incomplete
-Infection
-Sharp, acute pain with joint movement or muscle enlongation.
-shortened soft tissue enable pt with paralysis or severe muscle weakness to perform specific functional skills.

Question 8

characteristics of DOMS (delayed onset muscle soreness)

Answer 8

-develop approx. 12 to 24 hrs after exercise. peaking at 48-72hrs and subsiding 2-3 days later.
-high intensity eccentric muscle contractions causes the most severe DOMS symptoms.
-s/s: tenderness w palpation in muscle, increase soreness w lengthening/stretch or active contractions, edema and warmth, decreased ROM.

*can be prevented by warming up/ cooling down and gentle stretching.

Question 9

Overload vs SAID/Specificity vs reversibility principles

Answer 9

-Overload: the use of resistance exercise in improving muscle performance. (muscle needs to be challenged)
-SAID: improve a specific muscle. specific training to meet pt specific training needs and goals

-Specificity: “mimic the anticipated function”-rule out pathology.
-Reversibility principle: reduction in muscle performance, training effects are lost.

Question 10

advantages/disadvantages of the various types muscle contractions

Answer 10

-eccentric (lowering, lengthening), Cause muscle damage and delayed pain.

-concentric (shortening, upward movement), Concentric movements depend on joint movement for proper function, but repeated exercises and contractions can lead to strain and soreness.

-isometric (hold, no length movement) , Affects coordination, and
decreases soft tissue elasticity.

-Concentric muscle contractions used to generate motion.
-Eccentric muscle contractions used for resisting or slowing motion
-Isometric contractions are used for producing shock absorption and maintaining stability, and protects structures in healing process.

Question 11

Distinguish between CKC and OKC exercises

Answer 11

closed: when segment is fixed and meets external resistance (squat), WB
open: when the segment is free to move unrestricted. (kick backs), NWB

Question 12

How to train for strength vs endurance (aerobic)

Answer 12

To improve muscle strength: 40-60% is necessary, however 60-80% that causes fatigue after 8-12 reps, 2-3 sets. when thats not fatigued anymore, increase weight.

To improve endurance: as many as 3-5 sets of many reps (40-50) against low amount of external resistance. Can also do isometrics for longer periods.

Question 13

Indications/contraindications to resistance
training/exercise

Answer 13

contraindications: inflammation, pain and severe cardiopulmonary disease.

Question 14

Muscle activation sequence for each motor strategy

Answer 14

-ANKLE STABILITY: gastrocnemius, then hamstrings, paraspinals after.
-(backward instability)—ant tib, then quadriceps and abdominal mscl.

• WEIGHT SHIFT: hip abductors and adductor, w/ some ankle invertors and evertors.

-SUSPENSION: ankle and weight shift combined.

-HIP STRATEGY: abdominals, then quadriceps.
-(when its forward and there is extension at the hips)— paraspinals, then hamstrings.

-STEPPING STRATEGY: ankle muscles.

Question 15

Fall prevention strategies

Answer 15

-exercises that target balance, function, and strength.
-the home setting is the best option for exercise for prevention; environmental factors also play a huge factor (rugs, not enough lighting, pets, etc).

Question 16

Proper lifting technique (elderly)

Answer 16

leg lifting style: with the knees bent and trunk erect when lifting loads.

-safe lifting: reducing forward inclination of trunk when lifting heavy loads and slow movements. Optimizing horizontal and vertical position of the load, avoiding asymmetrical lifts.

elderly: if balance is a problem, lifting styles in which the knees are more extended are safer.

Question 17

Dysfunctions/impairments from ligament injuries

Answer 17

ligament: stability of the joint where the ligament is attached to.

Question 18

Role of ligaments in joint motion

Answer 18

knee:
ACL- controls rotation and forward movement
PCL- controls backward movement
MCL- gives stability to the medial side of knee.
LCL- gives stability to the lateral side of knee.

ankle:
ATFL- lateral side
deltoid- medial side
calcaneofibular- lateral side

spine:
anterior longitudinal ligament- limits back extension
posterior- limits flexion

hip:
iliofemoral, (anterior portion of capsule) limits external rotation.
pubofemoral, (inferior/anterior) limits abduction
ishciofemoral, (posterior) limits internal rotations and adduction when the hip is flexed.

Question 19

Most commonly injured ligaments

Answer 19

knee: ACL (preventing excessive forward movements or limiting rotation), (rotational mechanism when the tibia externally rotates on the planted foot and forceful hyperextension)

ankle: ATFL (prevents excessive inversion)(inversion)

Question 20

Grades of ligament tears

Answer 20

-grade 1: mild pain at the time of injury pr within 24 hrs. Mild swelling, local tenderness and pain when tissue is distress.

-grade 2: moderate pain (stop activity). stress and palpation of tissue that increases pain. *if ligaments (injured), fibers are torn, resulting in increased joint mobility.

-grade 3: near/complete tear of tissue w/ severe pain. A torn ligament results in instability of joint.

Question 21

Interventons appropriate at each phase of
healing/stage of rehab (conservative management vs
post-op management) – be able to apply to various
injuries/surgeries

Answer 21

10.1
max protection (1): control inflammation, RICE, PROM-progress to AROM, grade l or ll joint mobs, muscle settings. protection and AD.

mod protection (2): develop mobile scar: selective stretching, progressive mobilization, manipulation. Promote healing: open/closed stabilization, muscular endurance, balance, cardio, progressed intensity.

min protection: (3)increase strength and endurance. develop functional independent progress, balance, functional exercises and specificity. (4) progress specific training for high demand activities (sports).

Question 22

Appropriate exercises after a fracture

Answer 22

11.8-9

Question 23

Management of RA – appropriate interventions,
energy conservation strategies, pt education

Answer 23

-educate pt importance of rest, joint protection, energy conservation and ROM.
-relieve pain - modalities, relaxation techniques, gentle massage
-minimize joint stiffness and maintain ROM
-prevent deformity. do not over stress.

Question 24

Benefits and complications of surgical intervention

Answer 24

complications: infection, hemorrhage, incision, longer recovery
benefits: pain is gone quicker, no incision, etc

Question 25

types of grafts

Answer 25

-autograft: pts OWN tissue harvested from another part of their OWN body.
-allograft: tissue that comes from a cadaver donor or someone else.
-synthetic graft: synthetic materials.

Question 26

indications/contraindications for total joint arthroplasty

Answer 26

contraindications: active infection in joint, chronic osteomyelitis, systemic infection, loss of bone or malignant tumor, paralysis, neuropathic joint.

Question 27

common nerve injuries and S/sx

Answer 27

seddon: neuropraxia, axonotmesis, neurotmesis.
s/s: sensory changes and loss and motor weakness of nerve fibers, ischemic pain and autonomic responses.

Question 28

TOS (thoracic outlet syndrome) impairments

Answer 28

-intermittent brachial plexus and vascular symptoms of pain (paresthesia, numbness, weakness, swelling)
-muscle length- strength imbalance
-faulty postural awareness in upper quarter
-poor endurance
-poor scapular control
-poor clavicular and first rib mobility
-neurological symptoms

Question 29

TMJ dysfunction- appropiate exercises

Answer 29

s/s: (TMJ region pain, joint noise, limitations with jaw movements)

-aggressive and irreversible treatment should be avoided.
-fascial muscle relaxation and tongue proprioception
-control of jaw muscles and joint proprioception
-stretching techniques (unilateral-bilateral distractions)
-reduction of upper quarter muscle imbalances.

Question 30

exercises to relieve disc impairments

Question 31

exercises to address faulty postures

Answer 31

-cervical, thoracic, scapular and pelvic tilt alignment and control, procedures to control posture when sitting, standing, walking and performing targeted activities.
-ROM, joint mobility, flexibility

Question 32

adhesive capsulitis - stages and interventions for each stage

Answer 32

“idiopathic frozen shoulder”
-stage 1: gradual onset of pain that increases with movement and its present at night. loss of ER w intact rotator cuff strength. less than 3 months.

-stage 2: “freezing stage”
persistent and more intense pain even at rest. motion limited all directions. 3-9 months after onset.

-stage 3: “frozen stage”
pain only with movement, significant adhesions and limited GH motions. atrophy of deltoid. RC, biceps and triceps. 9-15 months after onset.

-stage 4: “thawing stage:
minimal pain and no synovitis but significant capsular restrictions from adhesions. motion improves. 15-24 months after onset, although some pt do not regain normal ROM.

Question 33

How to strengthen each of the SITS & shoulder girdle
muscles

Answer 33

Rotator cuff muscles:
-Abducts (elevates) the shoulder joint out to the side (by supraspinatus)
-Externally rotates the shoulder joint. (infraspinatus and teres minor)
-medially rotates humerus (subscapularis)

-flx/ext, abd/add, ir/er.

Question 34

Common overuse injuries of the shoulder &
appropriate interventions

Answer 34

tendinitis, shoulder instability, labrum injuries (SLAP tears), shoulder impingement syndrome, etc.

Question 35

joint motions that cause hip dislocation

Answer 35

avoid bending at the hip past 90°,twisting legs in or out, and crossing the legs.

Question 36

Conservative management for knee ligament injury

Answer 36

-rest, joint protection and exercise.
After the acute stage of healing, exercises should focus on ROM, balance, normalizing gait pattern and developing strength and endurance of muscles.

Question 37

Common ankle & foot conditions & S/sx

Answer 37

-tendinosis, tendonitis, tenosynovitis: (pain when acton or when involved tendon is stretched or palpated. (Achilles tendinopathy pain is proximal to the calcaneal insertion).

-shin splints: pain along posterior medial or anterior lateral aspect of tibia. (muscle fatigue w vigorous WB exercise, tight musculature)

s/s common impairments of structure: pain w repetitive activity, muscle length imbalances, decrease duration of standing tolerance, abnormal foot posture, etc.

Question 38

specific stretching techniques for two-joint muscles

Answer 38

elongating both ends (joints)
EX: wrist-elbow, hip-knee

Question 39

proper stabilization during stretching

Answer 39

fixation of one segment (stable segment) while the other segment moves, (the one being stretched).

Question 40

gait: causes of deviation (specific joint motions, muscle tightness, during each phase of cycle)

Answer 40

-dorsiflexors: initial foot contact and loading responses (heel strike to foot flat) to counter the plantar flexion torque and to control the lowering of the foot to the ground. also function during the swing phase to keep the foot from plantar flexing and dragging on the ground. ***with loss of dorsiflexors, foot slap occurs at initial contact, and the hip and knee flex excessively during swing to prevent the toes from catching on the ground.

-plantar flexors: early in stance, plantar flexors function eccentrically to control the rate of forward movement of the tibia. then, mid stance there is burst of concentric to initiate plantar flexion for push off. ***loss of function results in a lag of lower extremity during terminal stance with no push off.

-evertors: peroneus longus
-inverters: tibialis anterior
-intrinsic muscles: support the transverse and longitudinal arches during gait.

Question 41

special tests: knee

Answer 41

-integrity of ACL-anterior drawer test & lachman test

-rotary instability in the knee- dial test (tibial rotation)

-meniscal injury- joint line tenderness, meniscal lesion- mcmurray & thessaly test

-iliotibial band friction- noble compression

-integrity of MCL and ACL (rotary instability)- pivot shift

-integrity PCL- posterior drawer test/ posterior sag sign & quad active test

-integrity MCL- valgus

-integrity LCL- varus

Question 42

special tests: spine

Answer 42

-integrity of the alar ligaments and thus upper cervical stability- Alar ligament

-contribution of cervical radiculopathy to the patients symptoms. cervical distraction

-contributions of vertebral artery occlusion to the patient’s symptoms-vertebral artery

-proximal lower extremity muscle weakness-gower’s sign

-to assess whether a herniated disc, neural tension, or altered neurodynamics are contributing to the pts symptoms-slump

-scoliosis- adams

-presence of disc herniation- SLR

Question 43

special tests: shoulder

Answer 43

-assess anterior instability of glenohumeral jc.- anterior apprehension

-presence of a full thickness rotator c. tear- drop arm

• subacromial impingement- hawkins K Is & neer test & painful arc sign

-integrity of biceps tendon or labrum - speeds test

-shoulder instability- sulcus

-thoracic outlet syndrome, compression btwn anterior and mid scalene muscle- adsons

-neural or vascular compromise in thoracic outlet- roos test

-long head of bicep tendon pathology and SLAP lesion- yergasons

Question 44

special test: wrist

Answer 44

-arterial blood flow to the hand- allens

-asses for carpal tunnel, carpal compression & phalens

-presence of DeQuevain’s disease- Finkelstein Test

-lateral epicondylalgia- cozens & mills

-medial epicondylagia- medial epicondylagia

Question 45

How to document goni

Answer 45

8-0-40= hyper
0-40/ 4-40=normal
0-22= hypo

Question 46

intro to assessments: specificity, reliability, validity

Answer 46

Sensitivity: used to rule out pathology (SnOut)
Specificity: used to rule pathology more likely (SpIn).

-Some tests have been studied extensively and others not as much. Those that have been research have a greater ability to rule out pathology or identify aka rule in pathology.
We can used tests that have not be extensively studied with the hope that someday research will be able to look at the use of the tests over time to help determine their reliability and/or diagnostic accuracy.

-The use of EBP helps us determine what is valid, reliable, and accurate when it comes to special tests to make objective decisions regarding the patients.

Question 47

REVIEW MMT-GONI SHEET