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TherEx > First Quiz > Flashcards

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

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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

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3
Q

What is TherEx

A

segmental movements to increase strength, endurance, isometrics to produce muscle activation, functional movements

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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
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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
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6
Q

Treatment progression

A
  1. simple, 1’ of freedom movement>complex
  2. therapist may assist in movement
  3. open chain before closed chain
  4. low resistance> high resistance
  5. progress to dynamic, weight-bearing exerc.
  6. provide ongoing feedback on qual of movement
  7. avoid fatigue when working on coordination
  8. go to fatigue when strengthening
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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

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8
Q

Frenkel

A

19th century, described ataxic gait secondary to nerve cell destruction could be improved by prepetition exercises and amulation with supervision

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9
Q

Wright

A

early TherEx w/polio, developed ambulating w/crutches, developed MMT

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10
Q

Olive Gurthrie-Smithth

A

developed our-of water method of exercise w/suspension system, (dry hydrotherapy)

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11
Q

Codman

A

surgeon, found function of supraspinatus and developed Codman (pendulum) exercises for shoulder

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12
Q

Goldwaithe

A

taught that backpain was often due to bad posture/habits, developed exercises

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13
Q

Williams

A

further analyzed spinal flexors/extensors to strengthen them and decrease LBP

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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)

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15
Q

DeLorme

A

developed progressive Resistive Exercise protocol based on 10 rep max (10 @50% RM, 10 @75%, 10 @ 100%)

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16
Q

Leithauser

A

got people out of bed post-op, learned form his patients,

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17
Q

Sherrington

A

experimental neurophysiologist, reflexes, reciprocal innervation, PNF based on his work

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18
Q

Knott and Voss

A

developed PNF

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19
Q

Brunnstrom

A

stroke

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20
Q

Dorman-Delcato

A

sensory info on kids, no evidence, patterning

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21
Q

Cyriax

A

father of orthopedic medicine, first to deal with soft tissue injury

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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

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23
Q

Types of Stress

A
  1. Life-cycle stress (retirement, adolescence)
  2. social (economic, relationships)
  3. physical (illness, substance abuse)
  4. personal (self-esteem, expectations)
  5. job (dissatisfaction, overwork)
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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)

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25
Q

Symptoms of fight or flight

A

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`

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26
Q

Stress Symptoms- Physical

A
  • headaches, neck & shoulder stiffness
  • rash, acne, hives
  • elevated BP, HR, & RR
  • fatigue
  • nervousness
  • cold, clammy palms
  • bruxism
  • stomach aches&/ diarrhea
  • decreased abdominal blood flow
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27
Q

Stress Symptoms- Emotional

A

worrying, depression, impatience, frustration, inflexibility, loss of sex drive, loneliness

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28
Q

Stress SYmptoms- Behavioral

A

crying, forgetfulness, yelling, blaming others, bossiness, compulsive gum chewing, eating, smoking, stuttering, finger/foot tapping

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29
Q

Burnout, causes & signs of it

A

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

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30
Q

Dealing with Burnout

A
  • 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
Q

Steps to Stress Management

A
  1. Awareness (Holmes-Rahe scale of life changes)
  2. Positive attitude and lifestyle
  3. Relaxation techniques & fitness
  4. Time management
32
Q

Relaxation Techniques

A

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
Q

Physiological Effects of Meditation

A

decreased oxygen consumption, decreased muscle tension, decreased blood lactate levels, decreased heart rte, decreased blood pressure

34
Q

Physiological Effects of Physical Exercise

A

decreased resting HR, decreased resting BP, decreased muscle tension, better sleep, increased resistance to colds and illness, increased tolerance to heat and cold

35
Q

Psychological Effects of Exercise

A

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
Q

Steps to initiate Time Management techniques

A

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
Q

Additional Time Management Ideas

A
  • 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
Q

Normal limitations to joint mobility

A
  • soft tissue approximation (muscle bulk, obesity)
  • soft tissue restraints (muscle, tendons, and ligaments have limited elasticity)
  • Joint capsule restraings
39
Q

Abnormal Limitations to Mobility

A
  • 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
Q

Capsular Patterns

A 
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
Q

SOC

A

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
Q

Evaluation to Determine if Pathology is w/in Joint or Muscle

A
  • 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
Q

objectives for mobilizing a patient

A
  • maintain ROM
  • increase join ROM if limited: the sooner it begins, the quicker the recovery
  • prevent deformities
  • decreased pain due to immobility
44
Q

Methods for preventing Joint Limitations

A
  • 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
Q

End Ranges & Joint Status

A

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
Q

State of Joint Pathology

A

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
Q

Indications & Procedures for PROM

A
  • 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
Q

Indications and Procedures for AAROM

A
  • 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
Q

Indications and Procedures for AROM

A

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
Q

General Procedures for ROM

A

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
Q

Effects of being bedridden

A

lose 3% of function/day, altered sensation, decreased motor activity, ANS less responsive, emotional disturbances,

52
Q

Muscular and Skeletal Response to Immobilization

A

Decreased strength and endurance (20% in one week), atrophy, poor coordination, osteoperosis, fibrosis and ankylosis of joints

53
Q

Cardiovascular and Respiratory Responses to Immobilzation

A

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
Q

Digestion and Skin Responses to Immobilization

A

anorexia, constipation (secondary to decreased peristalsis), skin atrophy (dec thickness & strength, dec subcut fat), bedsores (secondary to tissue ischemia

55
Q

Prevention & Treatment of the Effects of Immobilization

A

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
Q

Abnormal Soft End Feel

A

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
Q

Abnormal Firm End Feel…

A

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
Q

Abnormal Hard End Feel…

A

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
Q

Abnormal Empty End Feel…

A

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
Q

Elements of Fibrous Connective Tissue

A

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
Q

Physiology of Dense COnnective Tissue

A

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
Q

Connective Tissue response to immobilization w/o trauma

A

loss of water, loss of GAG concentration, increased collagen cross linkages, and disorganization of collagen fibers

63
Q

Muscle Tissue Response to Immobilization

A

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
Q

Connective Tissue Response Timeline

A

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
Q

Factors that promote adhesion formation

A
  • immobilization (must be eliminated ASAP)
  • edema (shows healing)
  • trauma: inflammatory response slows healing
  • poor circulation(prolongs healing time)
66
Q

Scar Tissue Composition after Trauma (collagen)

A

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
Q

Clinical Implications of Immobilizing PostTrauma

A

control inflammation, improve GAG concentratiion, influence remodelling of DCT, controlled immobilization vs total immobilization

68
Q

Clinical Management of Changes in DCT

A

contractures form in muscle first, after post traumatic immobilization, expect shortening and decreased mobility, chronic contractures will include all connective tissue

69
Q

Stres vs Strain

A

Stress: amt of tension or load per unit of cross sectional area
Strain: proportional elongation that occurs due to stress

70
Q

Stress-strain curve

A

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
Q

Effect Rate of Stretch

A

SLower= greater strain/elongation, Faster- less strain and greater chance of rupture

72
Q

Creep phenomenon

A

cycle loading, 10s hold, 8s ret, for 15 min

73
Q

Treatment Stages and Stretch

A

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

TherEx (1 decks)

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