Final Flashcards
What does zero mean in MMT?
No activity
What does T mean in MMT?
Trace
What does P mean for MMT?
Poor
What does F mean for MMT?
Fair
What does G mean for MMT?
Good
What does N mean for MMT?
Normal
How long should you apply resistance over in MMT?
Gradually for 2-3 sec
Why do you gradually add resistance in MMT?
Allows for pt motor units to recruit and stabilize
Will someone who has a contracture be able to have a 3 score in MMT?
No - more so 0-2, but could have a 3 or higher WAR
What does WAR mean?
Within available range
What does 2- mean?
Able to move through partial range in minimized gravity position
What does 2+ mean?
Partial range against gravity OR full AROM in gravity minimized position and holds against pressure
What does 2+ mean for PF?
WB complete with partial heel raise OR performed supine and pt can take max resistance (full AROM)
What is the definition of strength?
Greatest measurable F that can be exerted by a muscle or group to overcome R during 1 max effort
Low reps in short time period
What does power mean?
F x distance/time; rate of performing work
Power training
What is the definition of endurance?
Ability of muscle to contract repeatedly against a load (R)
Light load for many reps or sustained muscle contraction over an extended period of time
What is the Overload Principle?
Load that exceeds metabolic capacity of the muscle must be applied
ST (strength training): R is increased, add time component, and manipulate R
ET (endurance training): time of muscle contraction must be applied, high reps, hold position by increased time but not necessarily R or load
What is the SAID Principle?
Specificity of training
- Endurance vs strength; mode, velocity, joint angle
- Transfer of training: significantly less than effects of specificity: FUNCTIONAL
- Body systems adapt to stress
- Breaking down task
- Trial and error
What is the Reversibility Principle?
- Begins in 1-2 weeks
- Incorporate gains into ADLs early in rehab program
- Muscles can atrophy within 48 hours at the cellular level
- Use it or lose it
What factors influence tension generation in skeletal muscle?
Energy stores and blood supply - contract, generate tension, and resist fatigue
How do muscles recover from exercise?
- Microtrauma tears - need rest to rebuild
- Between 24-48 hours
What should the rest period be for power exercise?
More rest because body needs to perform at a higher level
What should rest periods be for endurance exercises?
Shorter rest periods for more activity
When do neural adaptations occur?
-Increased EMG activity within the first 4-8 weeks
What are skeletal muscle adaptations?
- Hypertrophy
- Hyperplasia
- Muscle fiber adaptation
When does hypertrophy occur?
-Occurs after 4-8 weeks or 2-3 weeks with high intensity
What is hyperplasia?
Increase in the number of muscle cells
What are type I muscle fibers?
Slow twitch
IE Endurance
What are type II muscle fibers?
Fast twich
IE. Sports
Can type I turn to type II?
Yes, but not vice versa
What are adaptations of CT?
Tendons and ligaments increase tensile strength
CT in muscle thickens
Bone density increases
What are determinants of resistance exercise?
Alignment Stabilization Intensity Volume Exercise order Frequency Rest interval Duration Mode Velocity Periodization Integration into functional activities
What is intensity for resistance exercise?
- Submax vs max ex load
- Initial ex load (amount of resistance) and documentation
- Rep max - use rep max
- Alternate methods of determining baseline strength or initial exercise load - IE. dynamometer and percentage of body weight
- Training zone
What is a beginners training zone?
30-40%
What is a highly trained individuals training zone?
80%
What is a healthy, untrained individuals training zone?
40-70%
What is volume in resistance exercise?
Total reps during session x intensity
What is the average volume of an untrained adult?
Load of 75%
1 RM
Able to complete 10 reps before rest
What is the common set recommendation?
2-4 sets
What are benefits to sets of an exercise?
Improve strength and endurance
What if fatigue is not experienced after reps are completed?
Intensity is not appropriate
How do you improve muscle endurance?
Increase reps first and then load in small increments or time
What is the proper exercise order?
- Large Mm before small Mm
- Multijoint before single
- High intensity before lower
How do you determine frequency?
It depends
How do you determine duration?
Time to achieve goal vs maintaining optimal function
What is the recommended rest interval?
- Dynamic rest - alternate muscle groups
- Integrate rest into exercise
What determines the mode of exercise?
- Type of muscle contraction
- Positioning - WB vs NWB
- Forms of resistance - manual, constant or variable, BW or partial BW
- Energy systems
- Range of movement
- Mode of exercise and application to function
What is periodization training?
Peak performance - intensity, volume, frequency, and rest vary
How do you integrate training to functional activities?
- Balance of stability and mobility
- Strength, power, and endurance
- Task specific movement patterns with resistance
What is DOMS?
Delayed onset muscle soreness
What is happening during DOMS?
- Microtrauma is healing
- Empty stores - emptying energy
- Lactic acid partially
- Tell pt “your muscles have not worked like this in awhile. We expect some soreness to happen, but we do not want an increase in your pain. Pain such as burning, tingling, or intense pain”
What is an isokinetic exercise?
- Constant velocity, but resistance and force vary
- Can accommodate to fatigue - still perform despite F
- Accommodate painful arc of motion
How do you implement resistance exercise?
-Warm up
-Placement of resistance
-Direction of resistance
-Stabilization
-Intensity of exercise/amount of R
Verbal/written instructions
-Monitor pt - before, during, and after
-Cool down (~2-3 min)
What are the precautions to resistance exercise?
- Intensity - IE. Osteoporosis
- Reps/sets - progression
- Type - high impact, velocity, spine and hip positions
- Balance
- Group exercise
What are contraindications to resistance exercise?
- Pain - severe during AROM, MMT, or does not decrease with reduced R
- Inflammation - acute for dynamic, static is okay, inflammatory disease
- Severe cardiopulmonary disease - IE. post MI or CABG (no R for at least 5 weeks post)
What are mechanical R exercises?
-External R applied by equipment
What are special considerations to R exercise to children?
- Can use R to gain strength, but still questionable studies on benefit to sports related injuries
- Use BW as a source of R
- Use specific equipment designed for youth
What are special considerations to R exercise with older adults?
- Less rigorous initially
- Be aware of poor vision, impaired balance, and age-related postural changes
What is the cut off for R training for children?
Should not be younger than 7
At risk for growth plate injuries
Where should you start with R training for older adults?
Start at 30-40% of 1 RM with impaired balance or age-related postural problems
What is the definition of overload?
Threshold to obtain hypertrophy
What is progressive resistance exercise (PRE)?
Constant external load (free weight or machine) that incrementally increases
What do studies state is the best PRE to improve strength?
2-3 sets of 6-12 reps
Increase R 5-10% when reps are complete without significant fatigue
What is circuit weight training?
- 8-12 muscle groups for total body conditioning
- Usually higher reps, but lower intensity
- Order is important
What is RPE?
Rate of perceived exertion
What are cam machines?
Claims load will be heaviest at mid-range
What does hydraulic mean?
The faster the piston = the more R being applied
What is limb loading?
- Once core is stabilized then we add limb movement
- Goal to maintain contraction while breathing
- Load the spine with UE first then LE
How is the strength of the pelvic floor measured?
0-6 scale
Perineometer - 3 contractions with 10 sec hold
-Record avg or highest of 3
-Length of contraction can also be measured
What are clinical conditions that can result from trauma or pathology?
- Dysfunction
- Jt dysfunction
- Contracture
- Adhesions
- Muscle guarding
- Muscle weakness
- Myofascial compartment syndrome
What is a Grade 1 tissue injury?
- First degree
- Mild pain and swelling
What is a Grade 2 tissue injury?
- Second degree
- Moderate pain
- Significant increased pain - stress and palpation
- Ligaments may be torn
What is a Grade 3 tissue injury?
- Third degree
- Severe pain
- Near complete or complete ligament tear
- Tendon avulsion
- Jt instability
What is the anterior pillar of the spine?
- Made from bodies and discs
- WB and shock absorbing portion
What is the posterior pillar of the spine?
- Consists of articular processes, facet joints, TPs, and SPs
- Responsible for gliding motion
Why do we lose height as we age?
- Lose hydration in the disc
- Leads to pain
What do we do if someone has a “stuck facet”?
Joint glides/joint mobs
If someone has a disc herniation and they flex the spine what will happen?
Make posterior herniation worse
What is spondylolithesis?
Vertebrae above slides on the one below
Shear force
Why does lateral shearing occur?
Poor posture and body mechanics
Vertebrae above slides laterally to the one below
What is the best way to keep the spine stable?
Recruit muscles of the spine
What type of muscle fibers do our bodies use during our ADLs?
Type I - endurance
How much muscle contraction is needed during our usual activities?
~10%
What is feedforward control?
Anticipate load from limb movement to maintain spinal stability
What effects do limb movements have on spinal stability?
- Without stabilization there would be excessive stress
- Localized muscle fatigue
- Muscle imbalance
What happens if there is too little pressure on the spine?
Too much room for movement
What if there is too much pressure on the spine?
Compressive force
What is the cause of pain?
Effects of mechanical stress
Effects of impaired posture
Pain syndromes
What is postural fault pain syndrome?
No structural impairment
What is postural pain syndrome?
Postural fault over time; no functional strength or flexibility impairments yet
What is postural dysfunction?
Shortening and weakness
What are postural habits?
Need good ones to avoid pain and dysfunction
What is kinesthetic training of the spine?
Total body training
- Head nodding and pelvic tilts
- Neutral spine
What is stabilization training of the spine?
Deep segmental muscle activation
Superficial global muscle control
What is functional training of basic body mechanics of the spine?
Bed mobility
Transfers
Walking
What are the elements of kinesthetic training of the spine?
Position of symptom relief
Effects of movement on the spine
What is directional preference or bias?
- Expecting 1D movement to relieve symptoms
- Not everyone is the same
What are the goals of muscle performance of the spine?
- Activate and develop neuromuscular control of deep segmental and global spinal muscles to support the spine against external load
- Develop endurance and strength in muscles of axial skeleton for function
- Develop control of balance in stable and unstable situations
What are global muscle stabilization exercises?
Progressions
-Mm activation, increase time or #, add UE/LE movement (partial then full range), resistance (progress through), unstable surfaces, endurance and strength principles repeated for fxn
What is the goal of cardiopulmonary endurance?
Develop cardiopulm fitness for overall endurance and well-being
What is the goal of functional activity?
To progress to independence safely
How to figure out an individuals max HR?
220-age
What is the definition of physical fitness?
Based on energy expenditure during physical work
How is physical fitness measured?
VO2 max
What is VO2 max?
Max O2 consumed per min when max effort has been reached
What influences VO2 max?
Age, gender, heredity, inactivity, and disease
How is VO2 max measured?
Usually during walking, running, or swimming
What are energy systems?
Intensity and duration of activity determined when and to what extent each system contributes
What are the 3 major energy systems?
Phosphagen ATP-PC
Anaerobic glycolytic
Aerobic system
What is the phosphagen ATP-PC system?
- No oxygen required
- When muscle rested - ATP replenished
- Max capacity is small, max power is great
- Short, quick bursts of energy
- Major energy source for the 1st 30 sec of intense exercise
What is the anaerobic glycolytic system?
-Glucose is fuel
-No oxygen required
-Lactic acid produced
Max capacity and power are intermediate
-Provides energy for moderate activity for short duration
-Major energy released during 30-90 sec of exercise
What is the aerobic system?
- Oxygen is required
- Max capacity is great, power is small
- Predominates other systems after 2 min of exercise
- What marathoners use
What is energy expenditure?
- Expressed as kcal
- Light, mod, or heavy based on energy cost
- Affected by mechanical efficiency and body mass
What are METs?
Energy expenditure
What is light energy expenditure?
2.0-2.9 METs
Walking less than 2.5 mph
What is moderate energy expenditure?
3.0-5.9 METs
Mowing lawn, walking with power mower
What is high energy expenditure?
6.0-8.8 METS
Running 5.0 mph
What is the physiological response to aerobic exercise?
- CV response - SNS (fight or flight) and total peripheral resistance (blood shunted from non-working mm)
- Increased oxygen extraction - more oxygen extracted from each L of blood
What is the formula for cardiac output?
HR x SV
How to test healthy individuals for exercise programs?
- Timed 1.5 mil or distance in 12 min
- 1-mile walk test, 6 MWT, and step test
- TM or cycle for VO2max
How to test for exercise programs using stress test?
- Changing workloads by increasing TM speed and/or grad or bike R
- Low workload for ~1 min and terminating test if symptoms of ECG present abnormally
- Purpose - dx heart disease, cardio functional capacity
What systems contribute to balance control?
Visual system Somatosensory system Vestibular system Sensory organization Types of balance control
How does the visual system contribute to balance?
Head position relative to environment
Direction and speed of head movement
How does somatosensory system contribute to balance?
Position and motion of body/body parts relative to each other and support surface
How does the vestibular system contribute to balance?
Position and movement of head with respect to gravity and inertial forces
Where is sensory info organized?
Cerebellum
Basal ganglia
Motor cortex
T/F the somatosensory has the the fastest processing time for rapid responses?
True
2 for visual and 3 for vestibular
What happens if the sensory system is impaired?
CNS suppresses inaccurate input and selects from the other two systems
What is the cerebellum responsible for?
Coordination tasks and motor response to judge that coordination
What is the motor cortex responsible for?
Houses motor response after receiving sensory input
What are the three postural reactions?
- Feedforward
- Anticipatory control
- Closed loop control
What is feedforward control?
Automatic, fast movements and processing time, and cannot anticipate
What is anticipatory control?
Activating postural muscles before performing movement
What is closed loop control?
Precision movements that require sensory feedback
IE. Balance beam or standing on BOSU
What are the most common risk factor for falls among the elderly?
- Muscle weakness
- Hx of falls
- Gait, visual, and balance deficit
- Use of AD
- Arthritis
- Impaired ADLs
- Depression
- Cognitive impairment
- Greater than 80 years old
How to respond to an RA exacerbation
- Use cold packs during flare ups
- If strengthening during flare up reduce weight or resistance
- Do not stretch during flare up
- Hydrotherapy can reduce the stress
What is stress incontinence?
Involuntary urination caused by physical movement or activity
What are some exercise implications with GERD?
Moderate activity may help with acid reflux, while higher level activity can aggravate it
Exercise implications for those with SLE?
Exercise may help stiffened joints, but too much may cause more pain and damage
What are the exercise implications for patient’s undergoing chemo for bone cancer?
Patients experience fatigue and nausea when on chemo. Too much exercise may cause greater fatigue and increase nausea/other symptoms
