First Quiz Flashcards
1
Q
TherEx Predisposing Factors
A
Age, Sex, Occupation, Past Med Hx, At ris behaviors, activities:risk, exercise and if done correctly
2
Q
TherEx Definition
A
scientific application of bodily movements designed to specifically correct an impairment in strength, mobility, and/or control, or to maintain normal musculoskeletal function… used to improve volounatry control
3
Q
What is TherEx
A
segmental movements to increase strength, endurance, isometrics to produce muscle activation, functional movements
4
Q
indications for TherEx
A
- develop motor awareness and voluntary control
- develop functional strength and endurance
- improve ROM and general mobility
- improve any deficit necessary for the client’s goal
5
Q
treatment techniques
A
- tactile/cutaneous stim
- visual:complement/replace kinesthetic awareness
- proprioreceptive- feeling change in joint angle
- conscious awareness of activity
- PNF
- NMES
- EMG biofeedback
6
Q
Treatment progression
A
- simple, 1’ of freedom movement>complex
- therapist may assist in movement
- open chain before closed chain
- low resistance> high resistance
- progress to dynamic, weight-bearing exerc.
- provide ongoing feedback on qual of movement
- avoid fatigue when working on coordination
- go to fatigue when strengthening
7
Q
objectives of TherEx
A
increse/devel strength, power, endurance, coordination, improve proproireceptive awareness, enhance muscle retraining, improve speed, promote relaxation, improve ROM or flexibility, improve motor control
8
Q
Frenkel
A
19th century, described ataxic gait secondary to nerve cell destruction could be improved by prepetition exercises and amulation with supervision
9
Q
Wright
A
early TherEx w/polio, developed ambulating w/crutches, developed MMT
10
Q
Olive Gurthrie-Smithth
A
developed our-of water method of exercise w/suspension system, (dry hydrotherapy)
11
Q
Codman
A
surgeon, found function of supraspinatus and developed Codman (pendulum) exercises for shoulder
12
Q
Goldwaithe
A
taught that backpain was often due to bad posture/habits, developed exercises
13
Q
Williams
A
further analyzed spinal flexors/extensors to strengthen them and decrease LBP
14
Q
Brueger
A
first to develop exercises for PVD (elevate leg @45’ hip flexion for 2 minutes, lower for 3 min and pump calf)
15
Q
DeLorme
A
developed progressive Resistive Exercise protocol based on 10 rep max (10 @50% RM, 10 @75%, 10 @ 100%)
16
Q
Leithauser
A
got people out of bed post-op, learned form his patients,
17
Q
Sherrington
A
experimental neurophysiologist, reflexes, reciprocal innervation, PNF based on his work
18
Q
Knott and Voss
A
developed PNF
19
Q
Brunnstrom
A
stroke
20
Q
Dorman-Delcato
A
sensory info on kids, no evidence, patterning
21
Q
Cyriax
A
father of orthopedic medicine, first to deal with soft tissue injury
22
Q
East/West/ Holistic views of stress
A
East: absence of inner peace
West: loss of control
Holistic: inability to cope with percieved, real, or imagined threat to ones mental, physical, emotional, and spiritual well-being
23
Q
Types of Stress
A
- Life-cycle stress (retirement, adolescence)
- social (economic, relationships)
- physical (illness, substance abuse)
- personal (self-esteem, expectations)
- job (dissatisfaction, overwork)
24
Q
Positive vs Negative Stress
A
Pos: motivates, excites, energizes (new job, travel)
Neg: crushes, oppresses, unusual events carried beyond acceptable limits (death, debt)
25
Symptoms of fight or flight
inc hear rate, inc blood pressure, inc ventilation, vasodilatation of art to extremeties, inc serum glucose levels... all returns to normal when threat is gone`
26
Stress Symptoms- Physical
- headaches, neck & shoulder stiffness
- rash, acne, hives
- elevated BP, HR, & RR
- fatigue
- nervousness
- cold, clammy palms
- bruxism
- stomach aches&/ diarrhea
- decreased abdominal blood flow
27
Stress Symptoms- Emotional
worrying, depression, impatience, frustration, inflexibility, loss of sex drive, loneliness
28
Stress SYmptoms- Behavioral
crying, forgetfulness, yelling, blaming others, bossiness, compulsive gum chewing, eating, smoking, stuttering, finger/foot tapping
29
Burnout, causes & signs of it
Burnout: indicates a state of emo & phys. exhaustion that results from intense and long-standing professional stress, caused by work overload (understaffing, lack of professional challenge/patient diversity, too many patients/day), vague job description, inability to use prof skills & creativity, low self-esteem, difficulty separating personal/prof needs, unrealistic goals
signs: demands>normal, fatigue and discouragement occur, feeling of failure or lack of control
30
Dealing with Burnout
- reduce patient loads-prioritize patients
- rotate staff to change patient experiences
- select non-patient care activities that are needed (record keeping, plan research, participate in QA, don't work during lunch)
- take vacation
- "psych rounds"
- accept limitations, everything can't be cured
31
Steps to Stress Management
1. Awareness (Holmes-Rahe scale of life changes)
2. Positive attitude and lifestyle
3. Relaxation techniques & fitness
4. Time management
32
Relaxation Techniques
deep breathing, self suggestion (talking to self), meditation, yoga, biofeedback (mood ring), Jacobson's progressive relaxation, exercise don't feel guilty when dealing with stress!, mental imagery
33
Physiological Effects of Meditation
decreased oxygen consumption, decreased muscle tension, decreased blood lactate levels, decreased heart rte, decreased blood pressure
34
Physiological Effects of Physical Exercise
decreased resting HR, decreased resting BP, decreased muscle tension, better sleep, increased resistance to colds and illness, increased tolerance to heat and cold
35
Psychological Effects of Exercise
improved self-esteem, improved sense of self-reliance, improved mental alertness, perception, and information processing, increased perceptions of acceptance by others, decreased depression and anxiety, decreased overall sense of stress and tension
36
Steps to initiate Time Management techniques
Prioritization: ABC rank order method, Pareto pronciple: small proportion of issues produce a large portion of problems, important vs urgent method
- Scheduling: boxing out long specific sched activities, time mapping (short blocks), clustering (group responsibilities by type)
- Execution: assign specific deadlines, break large projects into small tasks, work on one section/time
37
Additional Time Management Ideas
- delegate responsibilities, schedule personal time, schedule interruptions, carry and use idea book, edit your life, refine organizational skills, refine networking skills, bring balance into life
38
Normal limitations to joint mobility
- soft tissue approximation (muscle bulk, obesity)
- soft tissue restraints (muscle, tendons, and ligaments have limited elasticity)
- Joint capsule restraings
39
Abnormal Limitations to Mobility
- Pain (produces splinting: guarding of limb)
- Muscular: spasticity, hypertrophy, spasm
- Swelling: edema
- Effusion: excess synovial fluid protection w/in joint space, greatly reduces mobility
- soft tissue adhesions: fibrous tissue can ahdere to surrounding tissue/skin
40
Capsular Patterns
```
GH: los of ABd> ext rot> int rotation
Elbow: Loss of flexion
Wrist: loss of Flex/Ext equally
Hip: loss of flexion & int rotation equally> ABd
Knee: Loss of flexion> extension
```
41
SOC
Synovial Osteochondromatosis: benign proliferation of synovium, progressive enlargement and ossification occur with time, if they remain free they continue to grow larger and become more calcified
42
Evaluation to Determine if Pathology is w/in Joint or Muscle
- test joint ROM
- physiological movement (normal joint movement)
- accessory movement (those that cannot be performed independently but occur w/in full ROM)
- test muscle flexibility (2 joint must be across both)
- x-ray for bony changes: decreased joint space
43
objectives for mobilizing a patient
- maintain ROM
- increase join ROM if limited: the sooner it begins, the quicker the recovery
- prevent deformities
- decreased pain due to immobility
44
Methods for preventing Joint Limitations
- maintain elasticity of skin, fascia, scar via gentle movements, massage PROM, positioning
- reduce swelling (compression, elevation, ice (acute), heat (subacute), active exercise, NMES, intermittent compression)
- Flaccid paralysis: PROM, positioning splints
- muscle weakness: AAROM, CPM, self-ROM
- spasticity: cold pack, self-ROM, rotation, facilitation of antagonist, biofeedback, slow movements
45
End Ranges & Joint Status
End Feel: movement to the point of limitation & then applying a little over-pressure
- Soft: related to compression/stretch of soft tissue
- Firm: related to stretching joint capsule/ligament
- Hard: Bony block
- Empty: pt prevents movement (anticipating pain)
- Springy: intra-articular block; articular cartilage or torn meniscus, springs back, often associated w/pain
46
State of Joint Pathology
Acute: pain &/or guarding before end feel
Subacute: pain/& guarding with end feel
Chronic: pain &/or guarding after application of overpressure
Joint Stability 1-7 (1-3: hypomobility, 1=fused, 4: normal, 5: slightly increased mobility, 6: increased mobility, almost subluxed (unstable), 7: almost dislocated, very mobile & unstable
47
Indications & Procedures for PROM
- Maintain joint/soft tissue mobility, prevent deformity/loss of ROM, when pt is unable to move through ROM, when active movement contraindicated
- Therapist or CPM moves pt throughout ROM w/o assistance from pt
48
Indications and Procedures for AAROM
- same as PROM (Maintain mobility, prevent loss of ROM, etc) plus engage muscle activity
- Body part is taken through as much ROM as possible with the patient assisting the therapist in the motion
49
Indications and Procedures for AROM
Indications: maintain ROM while maintaining or increasing muscle strength, prevent atrophy
- Body part is taken through as much ROM as possible by pt only
50
General Procedures for ROM
pt should be positioned comfortable by allowing therapist to move limbs through available ROM, free limb form restrictive clothing (drape if necessary), support limb, evaluate pt first, position yourself w/proper body mechanics, determine if painful arc exists, move slowly & steadily, communicate & watch pt's response
51
Effects of being bedridden
lose 3% of function/day, altered sensation, decreased motor activity, ANS less responsive, emotional disturbances,
52
Muscular and Skeletal Response to Immobilization
Decreased strength and endurance (20% in one week), atrophy, poor coordination, osteoperosis, fibrosis and ankylosis of joints
53
Cardiovascular and Respiratory Responses to Immobilzation
Increased HR, decreased cardiac reserve, orthostatic hypotension, increased risk of phlebitis and thrombosis, decreased vital capacity (25%) and max ventilatory response (25%), under-ventilation of areas with over-perfusion of others, impaired cough
54
Digestion and Skin Responses to Immobilization
anorexia, constipation (secondary to decreased peristalsis), skin atrophy (dec thickness & strength, dec subcut fat), bedsores (secondary to tissue ischemia
55
Prevention & Treatment of the Effects of Immobilization
Sensory stimulation (keep CNS working), active exercise, positioning & ROM, cardiovascular reconditioning (Target HR=120), respiratory exercises and coughing (blow bubbles, incentive spirometer), proper nutrition and fluid balance, bowel regime, skin hygene
56
Abnormal Soft End Feel
occurs sooner or later in the ROM than usual in a joint that normally has a firm or hard end feel, could be soft tissue edema, synovitis, or ligamentous stretch/tear
57
Abnormal Firm End Feel...
occurs sooner or later in the ROM than usual in a joint that usually has a soft or hard end feel, could be caused by increased muscular tonus, or capsular, muscular, ligamentous shortening
58
Abnormal Hard End Feel...
occurs sooner or later in the ROM than is usual or in a joint that normally has a soft or firm end feel; a bony grating or block is felt; could be chondromalacia, osteoarthritis, loose bodies in joint, myositis ossificans, or fracture
59
Abnormal Empty End Feel...
has no end feel because the enf of ROM b/c of pain; no resistance is felt except the pt's protective muscle splinting/spasm; caused by acute joint inflammation, bursitis, fracture, or psychogenic in nature
60
Elements of Fibrous Connective Tissue
Cells, Fiber (collagen provides strength, elastin provides elasticity, and retuculum provides bulk), Ground Substance (1% of dry weight but 90% of water volume, provides strength, reduces friction, and enhances nutrition transport), Glycosaminoglycans (GAGs, very important for strength)
61
Physiology of Dense COnnective Tissue
DCT is constantly remodeling (slows w/aging), normally becoming stronger. Strength is a factor of alignment of collagen fibers aong stress lines, increased size of fibers, and increased strength of bonds
62
Connective Tissue response to immobilization w/o trauma
loss of water, loss of GAG concentration, increased collagen cross linkages, and disorganization of collagen fibers
63
Muscle Tissue Response to Immobilization
Immobilization in lengthened: adults: # of sarcomeres increase to maintain optimal length/tension relationship, muscle weakness and atrophy
Immobilization in shortened:adults: # of sarcomeres decrease; change in peak muscle tension, muscle weakness and atrophy occur faster than in lengthened position
64
Connective Tissue Response Timeline
immediately- inflammation
2-4 days- no collagen fibers present, stretch would elongate & rupture, no active movements (passive below threshold for pain)
day 5- significant amt of collagen& ground substance (until 4th week). If scar is slack, collagen will be random, if scar has tension, fibers will organize along lines of stress
65
Factors that promote adhesion formation
- immobilization (must be eliminated ASAP)
- edema (shows healing)
- trauma: inflammatory response slows healing
- poor circulation(prolongs healing time)
66
Scar Tissue Composition after Trauma (collagen)
2-4 days: no collagen
5-21 days: scar tissue rapidly increases in bulk
21-60 days: scar stops to increase; vascularity decreases as strength
60 days-1 year: collagen turnover remains hight until approx 120 days
67
Clinical Implications of Immobilizing PostTrauma
control inflammation, improve GAG concentratiion, influence remodelling of DCT, controlled immobilization vs total immobilization
68
Clinical Management of Changes in DCT
contractures form in muscle first, after post traumatic immobilization, expect shortening and decreased mobility, chronic contractures will include all connective tissue
69
Stres vs Strain
Stress: amt of tension or load per unit of cross sectional area
Strain: proportional elongation that occurs due to stress
70
Stress-strain curve
Toe Range: taking up slack, crimps straighten
Elastic Range: as tissue is taken to end of full normal ROM, collagen fibers line up, some water lost (most end feels)
Elastic Limit: point where tissue won't return to original shape/size
Plastic Range: sequential failure of the bonds btw collagen fibers, heat released, permanent deformation
Major Failure Region: max load, strain increased w/o stress, tissue fails
71
Effect Rate of Stretch
SLower= greater strain/elongation, Faster- less strain and greater chance of rupture
72
Creep phenomenon
cycle loading, 10s hold, 8s ret, for 15 min
73
Treatment Stages and Stretch
Acute- 4-6 days, pain b4 end ROM, control infl, immob, CPM, Cautious PROM
SubAccute- 7-21 days, decreased inflam, pain @ end ROM, gentle AAROM or AROM, prevent contracture
Chronic- +21 days, no inflam, pain @ overpressure, pregressive stretching, strength, functional ex
