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TherEx > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Physiological Effects of Message

A

-increase circulation
-reactive hyperemia
-increase lymphatic flow
-disperse waste, 02, increase lactic acid

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2
Q

Reflexive Massage

A

-stimulates receptors in skin and fascia
-decreases pain
-ANS response (increase parasympathetic tone)
-GTO activation
-Gate control theory
-release of opiates

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3
Q

Mechanical Massage

A

-performed after reflexive to decrease pain and guarding
-deeper tissues
-loosens adhesions, scar tissue, trigger points
-realigns cartilage
-increase ROM

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4
Q

Indications for Massage

A

-decrease SNS, muscle tone, prottective spasms
-evaluate restrictions
-realign cartilage
-reduce edema
-circulation
-increase ROM

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5
Q

Containdications for Massage

A

-skin infections/open
-thrombosis/embolism or phlebitis, severe varicose veins
-new tendon transplant
-fracture/non union
-acute inflammation
-cellulitis
-synovitis
-absesses
-cancer
-fever

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6
Q

Skin Rolling

A

-evalutes skinn conectivity and underlying restrictions
-no lotion
-lifting skin

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7
Q

Light Effleurage

A

-warm up and cool down
-light, continuous pressure
-get used to contact

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8
Q

Deep Effleurage

A

-medium, continuous pressure distal (light) to heart (deeper)
-promotes relaxation
-decreases pain
-searching for spasms

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9
Q

Petrissage

A

-kneading, deeper
-grasp and lift muscle and skin toward heart
-push waste to increase lymphatic and venous return
-loosen tissue and increase elasticity

Effect:
-spreads fibers
-tension of connective tissue
-proprioceptive input
-reduce collagen cross-linking

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10
Q

Friction

A

-deep, circular or transverse mmts
-no skin mmt, move underlying tissues
-where a trigger point, adhesion or scar is felt
-realign collagen fibers

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11
Q

Transverse Friction

A

-intense perpendicular to tendon
-should be painful, explain
-used for chronic tendon inflammation

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12
Q

Percussion or Tapotement

A

-brisk, rapid blows with relaxed hands
-increase circulation

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13
Q

Myofascial Trigger Points

A

-hyperirritable locus: taught band of tissue
-reffered pain, lump, decreased ROM, jump sign

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14
Q

Trigger Point Massage

A

-related to acupressure
-find point until pain or jump sign
-press on point and maintain pressure (will increase pain then lessen)

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15
Q

Myofascial Release

A

-mid pressure and stretch
-move in direction of restriction
-superficial to deep
-relieves soft tissue from abnormal grip of tight fascia

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16
Q

Active Release Technique

A

-deep tissue to break down fibrotic adhesions that restrict movement and scar tissue
-apply pressure in direction of fibers while pt actively elongates muscle

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17
Q

Sprains

A

Grade 1: ligament stetched
Grade 2: incomplete or partial tear, most pain, most common, reduced strength
Grade 3: complete tear, no pain, loss of function

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18
Q

Strains

A

Grade 1: Microtearing of muscle, mild pain and swelling

Grade 2: partially torn muscle, moderate pain, affecting activity

Grade 3: complete or avulsion, severe pain initially, defect, loss of function

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19
Q

Acute Stage of Healing

A

-inflammatory
-pain early in ROM
-0-10 days
-chemicals irritate nerve endings

PT:
-prevent negative effects of rest
-reduce inflammation, edema, pain
-protect area

Teqniques:
-soft tissue
-estim: tens, IFC
-cryo
-joint mobilizations (I-II)
-ultrasound

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20
Q

Subacute Stage of Healing

A

-proliferation and repair
-pain at endfeel
-2-22 days
-growth of capillaries, collagen formation, wound is covered, granulation tissue

PT:
-mobilize scar
-promote healing and function (PROM>AAROM>AROM)
-develop neurmuscular control
-pt education about 6w healing

Teqniques:
-soft tissue: Cross friction, TP, MFR, AR
-estim: tens, IFC
-heat: increase circulation
-joint mobilizations (III-IV)
-stretching
-Isometrics, AROM, endurance, WE exercises

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21
Q

Chronic Stage of Healing

A

-maturation and remodeling
-pain at overpressure
-12 days -1+ yr
-new collagen (type 2) to align with stress
-scar formation

PT:
-return to function
-increase tensile quality of scar
- develop functional independence
-mobilize scar
-improve neurmuscular control

Teqniques:
-soft tissue: Cross friction, TP, MFR, AR
-estim: russian, NMES
-deep heat: increase circulation
-joint mobilizations (III-IV)
-stretching
-increase strength

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22
Q

Ligament Injuries

A

-trauma, mechanical stress, gender differences
-3-6weeks
-85% type I collagen, turn into type III
-30-50% weaker

Laxity:
-3 weeks= mild tension
-6 weeks= resume normal activities
-12 weeks= almost max tensile strength

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23
Q

Tendon Injuries

A

-singular incident or cumulative
-patial tear or rupture @ junction
-surgical repair essential for full return if >50% diameter

Healing:
-limited blood supply, 7.5x lower than muscle
-type III collagen aligned randomly (proliferative)
-increase in type 1 lonngitudianlly (remodeling)

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24
Q

Tendon Healing Precautions

A

-AROM 3 weeks across repair site results in poor outcomes
-should be exposed to limitted motion-PROM
-slow progression from PROM->AAROM->AROM->Resisted

Rehab lasts: 6m-2 years

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25
Q

Causes of Muscle Injury

A

Mechanical Forces:
stretch, contraction, contusion

Thermal Stresses:
heat or cold

Nerve Injury

Myotoxic Agent:
lidocaine, corticosteroids, venom

Prolonged Ischemia:
compartment syn, tourniquet

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26
Q

Management of Muscle Injury

A

Short term mobilization (2-5 days)
-manage inflammation and hemorrhage

Cautious mobilization
-2-3 weeks= tissue extensibility & protection
-4-6 weeks= gentle AROM < full range

After 6 week:
-warm up period and endurance activities to reduce reinjury
-avoid eccentric

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27
Q

Fracture Healing

A
  1. Hematoma (6-12h): Blood clot forms and inflammation
  2. Proliferation (1-2d): granulation tissue and fibrocartilage
  3. Callous Formation (1-3w):
    Soft callous
  4. Ossification (6w): Soft callous replaced by bony callous
  5. Remodeling (4m-1y): restoration of medullary canal
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28
Q

Factors to Hinder Fracture Healing

A

-inadequate blood supply
-poor nutritional status
-poor apposition
-infection
-diseases
-corticosteroid
-soft tissue damage

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29
Q

Bone Healing Prognosis

A

Children: 4-6w
Adolescents: 6-8w
Adults: 10-18w

-distal faster than proximal

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30
Q

Joint Mobilization

A

Direction: traction or gliding
Technique: oscillation or sustained

Grade I: early joint play
Grade II: further joint play close to tissue resistence
Grade III: joint play past resistence
Grade IV: passed resistance toward anaotmical limit

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31
Q

Signs of Excessive Exercise

A

-soreness not relieved in 24h
-pain increased or comes on early
-increased stiffness
-inflammation
-weakness
-decreased function

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32
Q

Fuctional Excursion

A

-entire length of a muscle
-max elongation

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33
Q

Range of Motion

A

-used for examination of movement

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34
Q

PROM

A

-motion produced by external force (PT)
-no active contraction
-motion only through pain free range

Indication:
-Don’t disrupt repair
-pain
-neurological inability to activate muscles

Goals:
-avoid stiffness
-mainstain mobility
-mitigate pain
-avoid contracture

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35
Q

AROM and A-AROM

A

-motion produced by active contraction or a combination
-demonstrate using PROM
-movement in pain free range

Indication:
-move against gravity

Goals:
-restore AROM

Limitations:
-not enough to sustain strength

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36
Q

ROM Contraindications

A

-disruptive to healing process (precautions)
-response or condition is life threatening

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37
Q

Continuous PROM

A

-CPM
-mechanical device that moves joint slowly and continuously through controlled ROM
-for pt unable to move themselves

Benefits:
-prevents contractures
-stimulates healing structures
-increases synovial fluid lube
-prevents degrading from immobilization
-quicker return of ROM
-decreases postop pain

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38
Q

Functional Patterns

A

-asssits teaching ADLs and IADLs
-help realize value and purpose
-motor patterns
-meaningful exercises

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39
Q

Acute ROM

A

PROM
-3-5 reps w/in pain tolerance
-several times a day

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40
Q

Subacute ROM

A

-PROM to AAROM to AROM
-gravity eliminated to antigravity
10-15 reps with brief hold w/in pain free range
-2-3x per day

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41
Q

Chronic/Functional ROM

A

-AROM
->30 reps for maintenance of ROM
-stretching to gain ROM

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42
Q

Dynamic Flexibility

A

-flexibility of muscle due to active mmt
-how high you can kick your leg

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43
Q

Passive Flexibility

A

-flexibility of muscle due to a passsive force
-PROM usually greater
-how far someone can bend your leg

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44
Q

Hypomobility

A

-limited arthrokinematic mmt of a joint
-motion you can feel

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45
Q

Arthrokinematics

A

-movement at the joint
-can be improved to improve osteokinematics
-can treat glides not rolls

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46
Q

Active Insufficiency

A

-muscle comprimises movement from being too contracted to produce movement

Ex: triceps in full ext and shoulder hyperext

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47
Q

Passive Insufficiency

A

-muscle comprimsies movement from being too lengetthend to produce movement

ex: finger extensors in full wrist flexion

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48
Q

Myostatic Contracture

A

-MT unitt is adaptively shortended

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49
Q

Pseudomyostatic Contracture

A

-hypertonicity due to CNS lesion

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50
Q

Arthrogenic and Periarticular Contractures

A

-adhesions, synovial proliferation, joint effusion, osteophytes

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51
Q

Fibrotic and Irreversible Contractures

A

-fibrous changes in connective tissue leads to adhesions
-difficult to re-establish normal tissue length

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52
Q

Selective Stretching

A

-purposeful stretch certain muscles and joints while letting others become hypomobile to improve function

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53
Q

Overstretching/Hypermobility

A

-purposefully overstretch certain muscles or joint to increase function

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54
Q

Interventions to Increase Mobility

A

Manual Stretching
-external force to perform a passive stretch

Passive Stretching
-no active contraction of contractile unit

Assisted Stretching
-patient assistance by themselves, machine or another person
-self stretching

Neuromuscular Fasciltation and Inhibition
-PNF
-increase or decrease msucle tone

Muscle Energy Techniques
-hold-relax-repositon techniques

Joint Mobilization/Manipulation
-passive techniques to restore arthrokinematics

Soft Tissue Mobiliation

Neural Tissue Mobilization

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55
Q

Indications for Stretching

A

-adhesions, scars, scar tissue limit ROM
-potential deformity due to ROM limitations
-muscle weakness, shortening
-part of training
-pre/post exercise

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56
Q

Contraindications for Stretching

A

-bony block
-non-union fracture
-acute inflammation
-infection
-sharp pain
-hematoma or tissue trauma
-hypermobility
-hypomobility provides stability or control

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57
Q

Mechanical behaviors: toe region

A

-Laxity in tissue/collagen begins to straighten

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58
Q

Mechanical behaviors: elastic region

A

Can return to original shape and size after being deformed

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59
Q

Mechanical behaviors: elastic limit/yield point

A

Following elastic region, the yield point signals, the point of no return for the tissue

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60
Q

Mechanical behaviors: plastic range

A

Residual deformations of the tissues will be permanent

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61
Q

Mechanical behaviors: failure point

A

Tear or break of tissues

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62
Q

Mechanical behaviors: Necking

A

-ultimate strength
-warning for failure

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63
Q

Creep

A

-load applied for extended time to elongate
-PROM

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64
Q

Hypertrophic Scar

A

-rasied scar within bounds of injured region

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65
Q

Keloid Scar

A

-extends beyond boundary of the injured site

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66
Q

Scars

A

-inelastic
-dependent on 02
-prolonged pressure can limit scar by limiting 02

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67
Q

Chronic Inflammation

A

-repeated stress/trauma
-immune responce
-low grade inflammatory responses
-increased fibroblast, immature collagen, decredattion of mature collagen= weak tissues

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68
Q

Ampere

A

-rate of current flow

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69
Q

Current

A

-net mmt of electrons
-high to low
-can be increased by increasing pulse duration and frequency

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70
Q

Voltage

A

-force of current flow

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71
Q

Good Conductors

A

-nerve
-muscle
-blood**

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72
Q

Resistance/Impedance

A

-opposition to electron flow
-skin and fat are highest

-increases as electrode disease increases
-decreases as frequency increases

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73
Q

Ohm’s Law

A

I= V/R

-more resistance=less current

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74
Q

Good Insulators

A

-skin
-fat
-bone
-nerve sheath
-tendon

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75
Q

Current Flow: Skin

A

-insulator
-need more voltage to penetrate skin and layers

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76
Q

Current Flow: Fat

A

-insulator
-most resistance

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77
Q

Current Flow: Nerve

A

-conductor
-6x better than muscle, but surrunded by fat and sheath (insulator)

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78
Q

Current Flow: Blood

A

-best electrical conductor

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79
Q

Current Flow: Tendon

A

-poor conductor
-most resistance

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80
Q

Current Flow: Muscle

A

-good conductor

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81
Q

Current Flow: Bone

A

-Poorest conductor
-most resistance

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82
Q

Frequency vs Impedence

A

-increased frequencies decreases impedence

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83
Q

Biphasic/Alternating

A

-goes positive and negative
-pain relieving
-continous flow, changing directions
-no chemical reactions

ex: TENS, IFC

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84
Q

Monophasic/Direct Current

A

-uninterupted flow of electrons toward positive pole
-can be reversed
-chemical changes: electrolysis
-muscle contraction when meeting threshold

Ex: ionto

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85
Q

Pulsatile

A

-2+ pulses grouped together
-discontinuous
-most nerve/muscle stimulation

ex: Russian and High Volt

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86
Q

Accommodation Phenomenon

A

-a fiber subjected to constant depolarization will become unexcitable at the same intensity

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87
Q

Frequency

A

-cycles per second Hz
-can determine the type of muscle contraction elicited
-Tetany: 50Hz

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88
Q

Intensity

A

-amplitude/volatge/intensity
-increasing the stimulation or amplitude to reach deeper tissues, more nerves, stronger contraction
-knob on top

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89
Q

Pulse Duration

A

-pulse width
-targets specific structures

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90
Q

Capacitance

A

-ability of a tissue to store electricity
-higher capacitance= more time before a response
-capacitance can be reduced by increasing frequency
-larger diameter= smaller capacitance

Muscle: most
Nerve: least

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91
Q

Pulses

A

-individual waveforms
-monophasic current

Symmetric, asymmetric, balanced, unbalanced

Cycle: biphasic

92
Q

Cathode

A

-negative
-site of depolarization
-most electrons
-usually black
-where muscle contraction happens

IONTO
-alkaline effects
-repels neg/attrac pos

93
Q

Anode

A

-positive
-least electrons
-usually red

IONTO:
-repel pos/ attract neg
-acidic effects

94
Q

Alpha Beta Nerve

A

-sensory nerves
-100usec chronaxie
-tingling sensation
-TENS, IFC
-largest diameter

95
Q

Motor Nerve

A

-contraction and tingling
-200-250usec chronaxie
-TENS, Russian, NMES

96
Q

Alpha Delta Nerve

A

-sharp pain
-300-700usec chronaxie
-noxious paresthesias, strong muscle contraction
-TENS

97
Q

C FIbers

A

-dull pain
-noxious paresthesias, strong muscle contraction
-1.0msec

98
Q

Denervated Muscle

A

-thinnest
-minimizes atrophy and edema
-10msec

99
Q

Neuro Muscular Electrical Stimulation (functional electric stimulator)

A

-NMES/FES

100
Q

Russian Currents

A

-muscle strengthening*
-muscle re-education*
-increasing ROM
-Slow atrophy
-Edema control (via muscle)

-2,000-10,00z frequency
-burst mode
-fast oscillating AC current, burst

101
Q

Interferential Currents

A

-IFC
-pain control*
-muscle stimulation
-2 bipolar configurations (relief where they cross)
-4000-4100Hz frequencies
-120usec pulse width

Sweep Mode: frequencies modulated to avoid accommodation

Scan Mode: amplitude can be modulated
-for poorly localized pain

Target Mode: move with finger

102
Q

High-Volt Pulsed Current

A

-HVPC
-reducing edema
-muscle pump 1:1
-wound healing

-twin peaked monophasic
-unequal electrodes, small over treatment

103
Q

Transcutaneous Electrical Nerve Stimulation: Conventional

A

-TENS
-acute pain relief; surgical, labor*
-gate control theory; A-Beta*
-asymmetric biphasic
-tingle with no contraction*

Settings:
-75-150msec Duration/Width
-80-125pps Frequency
-continuous*
- Starting: 100p/100f*
-30mins, til pain is gone*

104
Q

Iontophoresis

A

-low volt, continuous direct current
-drive ions into body
-medicine
-less than 30min on big machines
-longer with home devices

Doses:
-40mA-min= 4.0 current x 10min
-40mA-min= 2.0 current x 20min

Meds:
-Acetate, -, calcium depositis
-Dexamethasone, -, tendonitis/bursitis
-Lidocaine, +, trigeminal neuralgia

105
Q

Wound Care

A

HVPC:
-promotes faster healing
-Negative Polarity: inflammatory phase of healing
-Positive Polarity:
proliferattion phase of healing (bacterial)

106
Q

Transcutaneous Electrical Nerve Stimulation: Low-Frequency/Acupuncture/Motor-Level

A

-TENS
-chronic pain relief*
-Descending Pain control theory: modulation; enkephalin*
-asymmetric biphasic
-tingle AND contraction*

Settings:
-100-600msec Duration/Width
-<20pps Frequency
-Duty cycle: 30-60s*
- Starting: 180p/18f*
-15-60min*
-over motor point

107
Q

Gate Control Theory

A

-increase A-Beta afferents triggers release of enkephalin to inhibit 2nd order neuron to block pain

108
Q

Descending Pain Control: Modulation

A

-activate opiate receptors in PNS of nociceptive afferent fibers

109
Q

Transcutaneous Electrical Nerve Stimulation: Noxious- Level

A

-TENS
-hyperstimulation analgesia
-chronic pain relief*
-Endogenous opiate pain control theory*
-asymmetric biphasic
-high intensity to noxious level; muscle contraction acceptable*

Settings:
-100-1000msec Duration/Width
-1-5pps Frequency
-Duty cycle: 30-45s
- Starting: 250p/2f*
-15-60min*
-over trigger point, until pain is no longer percieved

110
Q

Endogenous Opiate Pain Control Theory

A

-peripheral blockage and extrasegmental analgesia
-stimulation of small afferents to release endorphins

111
Q

Transcutaneous Electrical Nerve Stimulation: Brief Intense

A

-TENS
-fast pain relief during procedure*
-Descending: peripheral and central anagelsia theory*
-asymmetric biphasic
-muscle fasciculation to sustain contraction*

Settings:
-100-600msec Duration/Width
-100 pps Frequency
-Duty cycle: 30-45s
- Starting: 250p/100f*
-15min*
-around wound

112
Q

Descending Pain Control: Peripheral and Central Analgesia

A

-serotonergic efferents from thalamus to activate enkephalin interneurons

113
Q

Premodulated (Bipolar)

A

-2 currents switch within the device
-only 2 electrodes
-pain control
-muscle stimulation/reeducation
-slow atrophy

-2 bipolar configurations (relief where they cross)
-duty 10:10, ramp 1-2s, 10-20min
-200-400usec pulse width

114
Q

E-stim Indications

A

-pain
-contraction
-muscle reeducation
-slow atrophy
-strengthening
-increasing ROM
-decrease edema
-decrease spasms
-healing
-regenerate tissues
-stimulate PNS
-protein synthesis

115
Q

E-Stim Contraindications

A

-pacemaker/defib
-internal stimulators
-chest or heart area
-carotid
-thrombosis/vascular or arterial disease
-confusion
-seizure
-infection
-open wounds (unless treatin)
-cancer
-pregnancy
-high level SCI

116
Q

Muscle Re-education

A

-Russian, NMES
-following surgery
-CNS inhibition of muscle
-improve motor control
-200-600 usec/ 35-55 pulse
-15min
-Duty 1:1

117
Q

Muscle Pump Contractions

A

-HVPC, Russian, NMES
-increase circulation
-mimic normal contractions
-200-600usec/ 35-55 pulse
-comfortable muscle contraction
-20-30min
-duty 1:1
-elevatte the body part (can use AROM)

118
Q

Edema Control

A

-HVPC
-elevate extremity*
-space electrodes far apart*
-negative polarity distal to swelling*
-driving forve to move plasma away
-30min
-best results immediately after injury
-80-120Hz/ low frequency*
-intensity as needed >60*

119
Q

Muscle Strengthening

A

-Russian, NMES
-200-600usec/ 50-85pps
-gradual ramp
-duty 1:5
-to muscle fatigue 60% MVIC
-pt working with estim

120
Q

Increasing ROM

A

-Russian, NMES
-200-600usec/ 35-55pps
-strong contraction
-interrupted current with gradual ramp
-antagonist muscles to joint contracture
-90min
-duty 1:1
-pt passive

121
Q

Denervated Muscle

A

-lost peripheral nerve supply
-if reinnervation doesnt occur in 2 years connective tive replaces contractile elements so recovery not possible
-1st week <1ms duration
-2 weeks >10ms duration

-NMES

122
Q

Slow Muscle Atrophy

A

-Russian, MNES, HVPC
-200-600usec/ 50-86pps
-15-20mins
-duty 1:5
-to muscle fatigue
-pt working with estim

123
Q

IONTO Indications

A

-analgesia
-bone spurs
-ulcers
-edema reduction
-fungal infections
-sweating
-muscle spasms
-tendonitis

124
Q

IONTO Contraindications

A

-estim rules
-impaired skin sensation
-allergy
-recent scar
-broken skin
-metal

125
Q

Ultrasound Indications

A

-acute conditions
-calcium deosits
-chronic inflammation
-delayed healing
-ulcers
-contractures/spasms
-trigger points
-pain
-scar
-warts

126
Q

Ultrasound Contraindications

A

-active bleeding
-decreased sensation to temp
-decrease circulation
-DVT
-infecion
-malignancy
-breast implants
-carotid
-epiphyseal plates in young
-heart, eyes, genitalia
-cement or plastic
-pelvic and thrunk of pregnant
-pacemaker
-vascular insufficiency

127
Q

Ultrasound Function

A

-deep heating 5cm
-piezoelectric crystals vibrate to produce sound waves into tissues through transucer
-most waves reflect, need gel or water

128
Q

Attenuation

A

-decrease in energy intensity due to absorption in tissues and dispersing of waves

129
Q

Ultrasound Absorption

A

-penetration and absorption inversely related
-absorption increases with frequency
-high protein=high absorption

Bone: highest
Blood: least

130
Q

ERA

A

-effective radiating area
-energy output is greatest at center, small than transducer
Treatment area= 2-3x ERA

131
Q

Collimation

A

-focus of the beam
-larger tranducer and higher frequency=more collimation

132
Q

Bean Nonuniformity Ratio

A

-BNR
-peak intensity:average intensity
-lower is better
-better BNR=less risk foor hot spots

133
Q

Non-Thermal Ultrasound

A

Acute Injury, Edema, Healing Ultrasound
-superficial and deep (3-1MHz)
-non-thermal and pulsed
-20% Duty Cycle
-1 Intensity/ 8-10mins

134
Q

Mid Thermal Ultrasound

A

Subacute Injury or Hematoma Ultrasound
-increase 1deg C
-continuous

Superficial (3MHz)
-0.5 in/ 3 mins

Deep (1MHz)
-1 in/ 5min

135
Q

Moderate Thermal Ultrasound

A

-chronic injury, inflammation, pain, trigger points
-increase 2 degree C
-continuous

Superficial (3MHz)
-0.5 in/ 6min

Deep (1MHz)
-1 in/ 10min
-1.5 in/ 6min
-2 in/ 5min

136
Q

Vigorous Thermal Ultrasound

A

-stretching collagen, joint contractures
-increase 4 deg C
-continuous

Superficial (3MHz)
-1 in/ 6min

Deep (1MHz)
-2 in/ 10 min

137
Q

Ultrasound Cautions

A

-tissue damage at 45 deg
-continue only improvement
-placebo

138
Q

BFR

A

-Blood flow restriction
-4 sets of 30/15/15/15 (75reps) with 30s breaks
-10-30% 1RM

Arms: 200mmHG, red cuff or 50%
Legs: 300mmhg, yellow cuff or 80%

Contraindications:
-severe HTN
-Compromised circulation
-Varicose veins
-IV drug use
-swelling
-trauma
-open fractures
-skin gradt
-direct nerve injury
-uncontrolled DM
-sickle cell

139
Q

Heat Types

A

Conduction:
-contact with source
-hot/ice pack, cold spray
-1cm penetration (cold>hot)

Convection:
-air of liquid transfer
-whirlpool or cryotherapy

Radiation:
-no physical contact needed
-laser, UV

Conversion:
-energy changes when contact is made
-US

140
Q

Cold

A

Uses:
-decrease inflammation/swelling/pain (gate control)
-decrease muscle activity
-decrease BF, temp, metabolic rate, nerve confuction

Contraindications:
-impaired circulation
-hypersensitivity
-skinn anesthesia
-open wounds/infections
-joint pain
-dont lay on top

141
Q

Biofeedback

A

-used to measure motor unit action and pressure
-can be used to assess or to self educate pt
-Myotrac and Pressure cuff (neck=20, back=70)

Uses:
-relaxation
-neuromuscular re-ed
-coordination

Sensitivity:
-start low then progress for NMR
-start high for relaxattion

142
Q

Physiological Responses to heat

A

Increased:
-CO, metabolism, pulse, breathing, vasodilation, BF, permeability, edema

Decreased:
-BP, muscle activity, SV, BF to resting structures, joint stiffness, spasms, pain

143
Q

Heat Preparation/Contraindications

A

-40-45 celcius
-subacute to chronic
-less than 2cm of depth
-lot for long term outcomes

Contraindications:
-acute/subacute inflammation
-decresed circulation/sensation
-DVT
-cognitive
-cancer
-eldery/very young

144
Q

Heat Modalities

A

Hot pack:
-160-170deg
-6-8 layers protection
-check skin @5

Parafin:
-dipping odd shaped parts
-126deg
-6 layers
-15-20min

Fluidotherapy:
-tank of warm air and corn husks

Whirlpool

145
Q

Hyrdrotherapy

A

-immersion baths mixed with air
-Whirlpool and Aquatic Therapy

Effects:
-decreased tone
-increased BF, temp
-pain relief/relaxation
-vasodilation
-debridement

Contraindications:
-advanced Cardiopulm disease
-bleeding
-less sensation or circulation
-gangrene/infection
-maceration
-Peripheral vascular disease

146
Q

Physiologic Response to Cold

A

-Cold
-Burning
-Aching
-Numbness

-redness, vasocontriction

147
Q

Cold Modalities

A

Ice Pack:
-acute to subacute
-muscle spasms and inflammation

Cold Spray:
-acute or subacute
-pain, spasms

Cryo Cuff:
-provides cold and compression
-moves water/ needs 1 layers

Contrast Bath:
-subacute
-alternating hot and cold
-edema, DOMS, desensittation

148
Q

Postural control

A

Controlling body position for stability and orientation

149
Q

Postural orientation

A

Maintain relationship between segment and body and
Environment

150
Q

Posture stability (balance)

A

Control COM in relationship to BOS with balanced forces

151
Q

Center of mass

A

Center of the body mass, average of body segments

152
Q

Center of mass on Adults

A

S2

153
Q

Center of gravity

A

Vertical projection of COM, changes with environment

154
Q

Center of pressure

A

Center distribution of total force, sum of all forces on the floor

155
Q

Base of support

A

Body part in contact with support surface, usually feet

156
Q

Vertical line of body alignment: Standing

A

Mastoid process, anterior to shoulders, hip joints, anterior to knee joints, anterior to ankle joints

157
Q

Ankle strategy

A

Small perturbation, reactive balance training
-rotation around ankle joint

Post Displacement:
-dorsiflexors, quads, abs

Ant Displacement:
-plantarflexors, gastroc, hamstring, errectors

158
Q

Hip Strategy

A

Larger, faster perturbation, ankle motion limited

Post Displacement:
-quads, abs

Ant Displacement:
-hamstring, errectors

159
Q

Stepping Strategy

A

Largest, fastest

160
Q

Reach strategy

A

Arms engage, similar to stepping strategy

161
Q

Normal Postural Sway

A

Ant/Pst: 12deg
Lateral: 16deg

162
Q

MSK Components of Balance

A

-joint ROM, spine flexibility, muscle tone, segmental mmt

163
Q

Neuro Components of Balance

A

-sensory processes
-hihger level integration
-Neuromuscular

164
Q

Vertical line of body alignment: Sitting

A

-head balanced on level shoulders
-upper body erect
-shoulders over hips
-deett and knees apart

165
Q

Semicircular Canals

A

-angular acceleration
-sensitive to fast movements
-slips, falls, trips, gait

166
Q

Otolith Organs

A

-linear position and acceleration
-head in space
-respond to slow head movements

167
Q

Causes of Balance Impairments

A

-injury to inner ear, SC, peripheral receptors, cerebellum, basal ganglia, proprioceptors, MSK
-lesions to neuro

168
Q

Spatiotemporal Compensations

A

Change BOS:
-widen, shuffling feet, shifting onto stronger leg

Restriction of mmt:
-stiffening, moving slowly
-Standing Reaching forward: flx hips instead of DF ankles
-Standing Reaching sideways:
flex trunk instead of lat moving hips
-Sitting Reaching Sideways: flexing forward and not to side
-In standing: not ttaking step when needed

Using hands for support
-holding onto things

169
Q

Balance Guidelines

A

-cannot be trained in isolation
-stand/sitt, static/dynamic
-double/single limb
-postural adjustments are action specific
-should progress
-include external cues that require stepping

Safety:
-gait belt
-stand behind and to the side
-near railing, no sharp edges
-check equipment
-clean floor

170
Q

Balance Training: Mode

A

-weight shift w/ increasing sway
-speed
-surface challenges
-weight distribution on chairs (balls and leaning)

171
Q

Balance Training: Postural Training

A

-awareness of posture

-modified position
-increase varietty of BOS and arm positions
-unstable sessions
-visual cues and mirros
-static and dynamic posture
-Change environment

172
Q

Balance Training: Movements

A

-movment patterns (PNF)
-trunk rotations
-head movements
-stepping

173
Q

Balance Training: Progression

A

-BOS: wide to narrow
-Posture: stable to unstable
-Visual: closing
-COG: distrupitions
-Unable surfaces
-environments
-REPETITION

174
Q

Balance PNF Techniques

A

Stability:
-rhythmic stabilization
-alternating isometrics

Enhance Dynamic Balance:
-Isotonic contractions
-Slow and quick reversals

175
Q

What is PNF?

A

-proprioceptive neuromusclular fascilitation
-functional diagonal and neuro facilitation to improve control and function

Improve: stabilization, strength, endurance, control, agonist/antagonish, trains nerves

176
Q

D1 UE

A

-putting a seatbelt on

Flexion: reaching for seatbelt
-Shoulder: add, ER
-Scap: UR, abd
-Forearm: sup
-Wrist: flex, rad dev
-Fingers: flx, add

Extension: buckling it
-Shoulder: abd, IR
-Scap: DR, add
-Forearm: pronation
-Wrist: ext, ulnar dev
-Fingers: ext, abd

177
Q

D2 UE

A

-Sword and waiter

Flexion: waiter holding a tray
-Shoulder: flx, abd, ER
-Scap: elevat, UR, abd
-Forearm: sup
-Wrist: ext, rad dev
-Fingers: ext, abd

Extension: reaching for sword
-Shoulder: ext, add, IR
-Scap: depress, DR, add
-Forearm: pronation
-Wrist: flex, ular dev
-Fingers: flx, add

178
Q

D1 LE

A

-hacky sack and ballet

Flexion: hackey sack
-Hip: flx, ER, add
-Knee: flx
-Ankle: DF, inv
-Toes: extension

Extension: Ballet
-Hip: ext, ITR, abd
-Knee: ext
-Ankle: PF, ev
-Toes: flx

179
Q

D2 LE

A

-dog peeing and curtsey

Flexion: dog peeing
-Hip: flx, IR, abd
-Knee: flx
-Ankle: DF, ev
-Toes: extension

Extension: curtsey
-Hip: ext, ER, add
-Knee: ext
-Ankle: PF, inv
-Toes: flx

180
Q

Rhythmic Initiation

A

-PT guiding through ROM
-for pts with difficulting initiating
-improves controlled mmts
-AROM, PROM, AAROM

181
Q

Repeated Contractions

A

-jerking motions
-PT stretches in jerks pt while going through the RROM
-strengthens weak agonists
-need AROM and RROM

182
Q

Slow Reversal

A

-kind of reversal of antagonist
-function changes in agonist to antagonist mmt
-contant resistance applied through ROM
-strong concentric of agonist followed by less strong eccentric of antagonist

183
Q

Slow Reversal Hold

A

-kind of reversal of antagonist
-function changes in agonist to antagonist mmt
-contant resistance applied through ROM with isometric hold at end of range
-better detection of joint/space tension

184
Q

Alternating Isometrics

A

-most common
-isometric hold of agonist then antagonist
-alternatting resistance to opposite muscles
-no ROM, inproves stabilization

185
Q

Rhythmic Stabilization

A

-isometric hold of agonist AND antagonist (co-contraation)
-simultaneous multidirectional resistance to opposite muscles
-no ROM, inproves rotary stabilization

186
Q

Stretching Time

A

10-30s hold

187
Q

Stretch: Upper Traps

A

Postition: Supine

Stabilize: Shoulder

Movement: LSB, flexion away

Home:
-flex head and rotate away with one hand

188
Q

Stretch: Levator

A

Postition: Supine

Stabilize: Shoulder

Movement: Flex, LSB, Rotate away

Home:
-flexion and rotation away with one hand
-ipsi scap upward rotation and depression with other hannd

189
Q

Stretch: SCM

A

Postition: Sitting up

Stabilize: Clavicular head

Movement:
-Stand behind pt
-Pt actively Ext, LSB away and Rotate toward

190
Q

Hold-Relax

A

-stretch msucle and maintain stretch
-isometrically contract against stetch

  1. Stretch muscle
  2. Isometrically Contract same muscle (being stretched)
  3. Hold and go into further stretch
191
Q

Contract-Relax

A

-stretch muscle and maintain stretch
-isotonically contract against stetch, moving

  1. Stretch muscle
  2. Isotonically Contract same muscle (being stretched)
  3. Hold and go into further stretch
192
Q

Hold-Relax w/ Agonist Contraction

A
  1. Stretch muscle
  2. Isometrically Contract same muscle (being stretched)
  3. Hold and go into further stretch
  4. Concentrically contract antagonist (move in opposite direction)
193
Q

Stretch: Quadratus Lumborum

A

Postition: Side lying

Stabilize: Ribs and iliac crest with forearms

Movement:
-Stand in front of pt
-break the bread

Home:
-cat stretch with LSB away, ipsi shoulder abducted

194
Q

Stretch: ITB

A

Postition: Sidelying

Stabilize: Ribs

Movement:
-Stand behind pt
-extend and adduct leg off of table

Home:
-extend and adduct leg off of table
-use roller
also for QL

195
Q

Home Stretch: Scalene

A

-Cervical extension, rotation towards, and 1st rib depression

196
Q

Home Stretch: Adductors

A

-ipsi side proped up while standing on contra leg
-drop ipsi pelvic for more stretch

or
-crossing legs and stretch

197
Q

Stretching Contraindications

A

-hypermobile
-hypomobility provides stability
-bony block
-non union fracture
-inflammation
-pain
-tissue trauma
-

198
Q

Daily Adjustable Progressice Resistive Exercise

A

-DAPRE
-pt perform max reps during 3rd and 4th sets
-uses last reps tto guide future reps
-each side worked independently for fucntional goals
-Increase weight and decrease reps

Set 3= Set 4
0-2=dec 5-10
3-4= dec 0-5
5-7=same
8-12= inc 5-10
13+= inc 10-15

199
Q

DeLorme- Walking Training Progression

A

-determine 10RM
-do 3 sets
-increase percentage of 10RM each set (50%, 75%, 100%)

200
Q

SAID Principle

A

Specificity of training: training specific groups, patterns and energy systems

Trransder of Training: improve applicability of program for caryover value

201
Q

FITT Principle

A

-Frequency
-Intensity
-Time
-Type

202
Q

Adaptations to Resistance

A

Neural:
-1st adaptations (2 weeks)
-motor learning
-not true muscle adaptations

Skeletal Muscle Adaptations:
-2nd adaptations (1 month)
-hypertrophy/hyperplasia

203
Q

Determinant of Resistance

A

Alignnment & Muscle action: done within lines of muscle force

Alignment & Gravity: limb in antigravity for max

Stabilization:
-muscle groups are synergistic stabilizers

204
Q

Reversibility Principle

A

-detraining after 1-2 weeks
-must maintain

205
Q

Acute/Post Surgical Exercise

A

Isometrics:
-multiple angles, stability, msucle recruitment
-no weightbearing
-alter time, angle, reps
-3-5s hold, 10s for endurance

Isotonics:
-slow eccentrics (more force)
-Concentric (less force needed)
-gravity only
-use available ROM
-3-5 reps

206
Q

Subacute Phase Exercise

A

Isometrics:
-multiple angles, weight bearing
-increase time, angle, reps
-3-5s hold, 10s for endurance

Isotonics:
-slow eccentrics (more force)
-Concentric (less force needed)
-resistance
-reps determined by goals

207
Q

Concentric

A

-less force
-acceleration

208
Q

Isometric

A

-no change in length
-balance of eccentric and concentric
-stabilization
-power

209
Q

Eccentric

A

-more force
-deceleration, shock absorbtion, changing directions
-tissue healing

210
Q

Strength Prescription

A

8-12 reps

211
Q

Power Prescription

A

2-6 reps

212
Q

Endurance Prescription

A

12-20 reps

213
Q

BFR Mechanism of Action

A

Hypertrophy Theory: blocks venous outflow

Lactate Theory: limited o2 forces use of fast twitch

Muscle Recruitment Theory: lactate forced larger muscle recruitment

Growth Hormone Theory: lactate and lactic acid increases growth hormone release

214
Q

Chronic Phase Exercise

A

-specifc muscle group
-total body conditioning
-integrate power, strength, function, speed, endurance

Order:
-multi joint/complex
-single joint, less complex

215
Q

Dynamic Exercise-Constant External Resistance

A

-DCER
-same external load applied to mmt
-external load doesn’t move during mmt
-aka isotonic

216
Q

Variable-Resistance Exercise

A

-same external load applied to mmt
-extternal load accomidates to the changes in muscle
-strengthen all parts of ROM

217
Q

Elastic Resistance Training

A

-therabands
-(stretch length - rest length)/ (rest length x 10)

218
Q

Precautions of Resistance Exercise

A

-valsalva
-substitutions
-overtraining: decreased performance
-overworking: decreased strength
-Acute Muscle soreness: decreased bf and increased metabolites irritating nerves
-DOMS: unacustomed vigorous exercise; microtrauma

219
Q

Contraindications of Resistance Exercise

A

-pain
-inflammation
-severe CP disease

220
Q

PEACE & LOVE

A

Protection
Elevation
Avoid anti inflammatories
Compression
Elevation

Load
Optimism
Vacularization
Exercise

221
Q

Stress Shielding

A

-absolute stability
-held together by plates/compression
-NWB

222
Q

Stress Sharing

A

-allows callous formation
-partial load transmission
-screws, pins, wires
-WBAT

223
Q

Indication for Spinal Surgery

A

-cauda equina or failure of 3 months treatment

224
Q

Posterior Hip Precautions

A

-add, flx, IR

225
Q

Anterior Hip Precautions

A

-abd, ext, ER

226
Q

MC Shoulder Replacement

A

-reverse
-most severe
-more stable for those who glenoid and cuff are torn

TherEx (20 decks)

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