Final Review Flashcards
Name the three main sensory systems that pertain to balance and posture.
- Vestibular
- Vision
- Somatosensory
What is stability?
The ability to maintain your CoM within your BoS
What is considered normal for neutral pelvis AP rotation?
~15 degrees of anterior tilt is considered normal.
Name the muscles that are tight and weak in a person with a Flat back posture.
Tight hamstrings
weak rectus femoris and iliopsoas
Name the muscles that are tight and weak in a person with a sway back posture.
Tight hamstrings
Weak rectus femoris, external obliques, and hip flexors.
Tend to be kyphotic in the Thoracic spine and increased lordosis in the c-spine
Name the muscles that are tight and weak in a person with a kyphosis - lordosis posture.
Weak hamstrings, Abs, and back extensors
Tight Quads, neck extensors, hip flexors
Name the spine levels that lines up with the spine of the scapula, the iliac crests, and the PSIS.
Spine of the scapula = T3
Iliac crests = L4 or L5
PSIS = S2
What is considered okay for leg length discrepancy?
1 to 1.5 cm
What is scoliosis in the spine?
It is a lateral shift of the spine in the frontal plane
Which direction from the midline do Varus and Valgus alignment go?
Varus = away from the midline Valgus = toward the midline
What is a windswept deformity?
Genu varum in one knee and Genu valgum in the other
If the angle of the head of the femur and the shaft of the femur is too small, what kind of alignment will we see in the knee?
Knee valgus
If the angle of the head of the femur and the shaft of the femur is too big, what kind of alignment will we see in the knee?
Knee varus
A person that has anteverted hips will have what alignment in the feet?
Pigeon toed (internal rotation)
A person that has retroverted hips will have what alignment in the feet?
Duck footed (outward rotation)
What movement does thoracic kyphosis primarily limit? why?
It limits flexion and possibly abduction at the shoulder due the scapula being anteriorly tilted.
Why is it so hard for people to not hyperextend their knees in standing?
Line of gravity is anterior tot the axis of rotation
Postural adjustments above and below the knee can cause hyperextension. (e.g. tight PFs, anterior pelvic tilt)
What movements happen in the sagittal plane?
Flexion and extension
What movements happen in the frontal plane?
Abduction and adduction
What movements happen in the transverse plane?
Rotation
What are the two components of Kinematics?
Rotation and translation
What are arthrokinematics?
Describes motion that occurs between the articular surfaces of the joint
What three movements are associated with arthrokinematics?
Roll
Slide/glide
Spin
Name the three laws developed by Newton.
Law of inertia
Law of acceleration
Law of Action-reaction
Describe the law of inertia
A body at rest or at a constant linear/angular velocity except when compelled by a force to change its state
Describe the law of acceleration
Linear acceleration of a body is directly proportional to the force causing it.
Law of Action-Reaction
For every action there is a opposite and equal reaction
Name the 5 types of forces
Shear Compression Tension Torsion Combined loading
How does the tension change in a ligament that is continued to be lengthened following recruitment of all of its fibers?
Tension drastically increases
How does creep affect ligaments?
It will cause the to lengthen over a period of time making them less effective.
Give an example of hysteresis of a ligament.
Marathon runner’s ACL length at the beginning of a run vs. length at the end of the marathon. It will have gotten longer due to sustained load and the ligament loses its tension.
What is it called when the physical properties of the stress strain curve change as a function of time?
Visco-elastic properties
What are the three subsystems of Panjabi’s Model
Neural subsystem
Passive Osteoligamentous subsytem
Active Muscular subsystem
What is the role of the passive osteoligamentous subsystem?
Contributes the most to stability
Act as dynamic, active mechanoreceptors
What is the role of the active muscular subsystem?
Force generation
Mechanoreceptors
What is the role of the neural control subsystem?
Receives information
Determines specific requirements for joint function
Causes the active muscular subsystem to achieve the desired outcome
What are the contraindications of AROM or PROM?
If motion might disrupt healing
If a fracture or dislocation is suspected
If ossification in the muscle is suspected
A lesion of which nerve could cause winging of the scapula?
Long Thoracic Nerve
How does the rotator cuff muscles help prevent impingement?
by pulling the humeral and down and in during abduction
Define a discrete motor skill.
A movement with an identifiable beginning and end e.g. a pitch
Define a serial motor skill.
Several discrete movements together in a series e.g. playing piano
Define a continuous motor skill
Walking, running, or swimming
What is the goal of balance?
Maintain appropriate orientation of the body relative to the environment
Which joint to people tend to move at during strong perturbations?
The hip
Give examples of internal perturbations.
Taking a step
Lifting objects
Bending
Define CoP
the centre of the distribution of the total force applied to the support surface
How would you progress UE movements?
Casual movements –> rapid movements –> loaded movements
How would you isolate the visual system for balance?
Compliant surface
Head tilt
How would you isolate the somatosensory system for balance?
Firm surface
Eyes closed
Head tilt
How would you isolate the vestibular system for balance?
Compliant surface
Eyes closed
Define the ages of newborns, infants, children, and adolescents.
New borns = 1 to 28 days
Infants = up to 12 months
Children = 1 to 10 yrs
Adolescents = 10 to 19 yrs
Describe clubfoot and its treatment.
A condition in which one or both feet are twisted into an abnormal position at birth
Treatment: casting
What causes longitudinal growth of muscle?
Tension
What causes increase in muscle thickness?
active stress of exercise
Which type of muscle atrophies more with denervation?
Type II
What other conditions demonstrate similar signs to ITW?
CP and autism
What is the physio intervention for ITW?
Casts
Work on PROM and then recast as appropriate
Fit for night splints
What is a brachial plexus lesion characterized by in a infant?
Arm is medially rotated, elbow is extended and forearm is pronated
What muscle is shortened in Congenital Torticollis?
SCM
What is the usual cause of plagiocephaly/brachycephaly?
Usually due to babies not being put on their tummies enough
What are the three factors influecing typical skeletal modelling?
Genetic coding
Nutrition
Combination of various mechanical forces imposed over time
What is osteogenesis imperfecta better known as?
Brittle bone disease
What is the cause of Rickets disease?
Due to a deficiency in vitamin D and C as a child
What are the WHO classifications of aging?
Elderly = 60-75
Old = 76-90
Very old = 90 +
What is Senescence?
It is a term to describe the group deleterious effects that lead to a decrease in the efficient functioning with increasing age, and to an increased probability of death
What is the progression of the CTSIB?
- Firm surface, eyes open
- firm surface, eyes closed
- Firm surface, inaccurate visual info
- compliant surface
- Compliant surface, eyes closed
- compliant surface, inaccurate visual info.
What are two adaptations to the periarticular tissue that occur with aging?
increased stiffness of the ligaments and tendons
Decrease in the length at which rupture occurs
What are three adaptations to the articular cartilage that are seen with aging?
potential increase in susceptibility to mechanical failure
Reduced water content
Disruption of collagen
What are 3 adaptations to bone that are seen with aging?
Progressive loss of bone density
More vulnerable to fracture
May affect posture as well
What happens to the spinal curvature with age?
lordosis decreases and kyphosis increases
What is the closed-packed position of the GH joint?
external rotation and abduction
What is the closed-packed position of the AC joint
Arm abducted to 90 degrees
What is the closed-packed position of the ulno-hemoral joint?
extension
What is the closed-packed position of the hip?
Medial rotation, extension, and abduction
What is the closed-packed position of the knee
full extension
What is the closed-packed position of the ankle?
Dorsiflexion and eversion
What are 4 common considerations to make during a movement analysis?
Effect of environment
Coordinated behaviour
Nature of the movement
Movement phases
What are the three requirements for independent locomotion?
Progression
Stability
Adaptation
Classify the young walkers.
8 to 11 months = pre-walkers
12 to 18 months = new walkers
18 to 24 months = experienced walkers
Name the 5 attributes of gait.
Stability in stance Foot clearance in swing Pre-position of the foot in terminal stance Adequate step length Energy conservation
What are the two stages of gait development?
- balance control (3-6 months)
2. Refinement of locomotion pattern (5-7 yrs)
Name 4 main characteristics of pre-walker gait.
- Forward lean
- Large BOS
- Uneven step lengths
- Short swing phase
Name 4 main characteristics of New walkers.
- Increased cadence
- Relative foot drop
- High stepping gait
- Lordosis
Name 4 main characteristics of experienced walkers
- Decrease in BOS
- Foot drop disappears
- Decrease in lordosis
- Heel strike at initial contact
What are 4 characteristics of mature gait?
Duration of SLS Walking velocity Cadence Step length Ratio of pelvic span to ankle spread
Name 3 functional gait assessments.
- TUG
- 6MWT
- Functional Gait Assessment
Why do we walk with an inverted pendulum motion?
To reduce the change in the vertical displacement of our CoM
When is our CoM highest during walking?
Midstance
Where would the most amount of energy be required?
When CoM is lowest
@ 5% (loading phase)
@ 55% (Terminal Stance phase)
In which direction does the GRF act during initial contact?
posteriorly
What is considered a comfortable cadence?
80 - 110 steps per minute
What are three temporal characteristics of gait?
Cadence
Stance time
Swing time
Stride time
What are 4 spatial parameters of gait?
Stride length
Step length
Step width
Foot progression angle
What will cause greater disruption to gait patterns: hip flexion decreased ROM or Hip extension decreased ROM?
Hip extension because it gets closer to max
What is the typical range that the hip goes through during walking?
30 degrees of flexion to 10 degrees of extension
People with swelling in their knees tend to walk with more flexion or extension?
Flexion
What ankle movement would cause more disruption to walking: DF or PF?
DF
What is the typical range that the ankle goes through during walking?
10 degrees of DF to 20 degrees of PF
Describe what is meant by Support Moment?
If one joint has a decreased moment, the other joints must compensate in order to maintain functional gait
Name three important factors from the hip, knee and ankle joints for Sit-to-stand
- hip ROM
- Knee extensor strength
- Dorsiflexion ROM
Name the three movement strategies for going from Sit-to-stand.
Momentum Transfer Strategy
Exaggerated Trunk Flexion
Dominant Vertical Strategy
Describe the momentum transfer strategy.
Horizontal momentum into vertical momentum effectively. No exaggeration of hip flexion
No use of arms
Describe Exaggerated Trunk Flexion strategy
placing CoM over their feet before take off
May result from Quad weakness
w/o assistance from momentum transfer
Describe Dominant vertical strategy.
Less forward trunk flexion
Can reduce hip joint moment by 50% due to use of arms
Typically adopted if arms are used to stand up
What are the 4 main factors that influence sit to stand ability?
Chair height Chair type Arm rests Foot position Personal determinants
What are the personal determinants of sit to stand?
LE muscle strength ROM Disease balance pain Need roughly 90 to 110 degrees of knee flexion
What are the 4 phases of sit to stand
Flexion momentum
Momentum transfer
Extension
Stabilitzation
Is knee extensor strength important to perform a sit to stand independently? Why?
Yes! because if your knee extensor strength is below 28 % BW than you will have difficulty standing independently even with other strategies.
Is knee extensor the only thing that needs to trained during rehab to gain the ability to perform a sit to stand?
No, there is coordination and balance involved as well.
Can STS be used as a measure of strength/strengthening exercise?
No, unless you lower the seat and also not in healthy people
More of an endurance test
What are the pre-reqs for successful sit to stand?
Coordination Stability ROM Strength Appropriate environment.
