Intro Material Flashcards
Pathology
disease, disorder, or condition at cellular level
impairment
abnormality in anatomical, psychological structure and/or function
activity limitation
restriction to perform at level of whole person
participation restriction
inability to perform actions, tasks, and activities related to self-care, home management, work, or leisure
patient management model
exam
eval
diagnosis
prognosis
intervention
outcome
purpose of exam (4)
1 - gather info (sub/obj)
2 - determine functional and social status (ADLs/work)
3 - identify pt goals
4 - assess performance of structure
examination includes (3)
history
systems review
tests/measures
history from exam includes…
demographics
occupation
general health
past medical history
systems review from exam includes
cardiopulmonary
musculoskeletal
neuromuscular
integumentary
communication
tests/measures from exam include
- identify specific impairments
- confirm your hypothesis
- symptoms vs signs (sub vs obj)
- provocation testing
- positive/negative signs
evaluation is…
your clinical judgements based on the exam
medical diagnosis is the ________ code
ICD-10
* do not give pts a medical diagnosis
prognosis
process of determining the optimal level of improvement
plan of care
specific interventions that will be used including duration and frequency
how are short term goals different from long term goals?
- 1-2 weeks
- not really functional
- focuses on simple impairments like increasing ROM and strength
how are long term goals different from short term?
- > 4 weeks
- more functional
goals show progress to who?
patients, us, and insurance
intervention
purposeful and skilled interaction of the PT with the patient using various techniques consistent with eval, diagnosis, and prognosis
effects of AROM (3)
1 - nutrition (self-lubrication of joints)
2- motor re-education
3 - range of motion
effects of PROM (3)
1 - nutrition
2- decreased swelling
3 - range of motion increase
effects of RROM
1 - vascularization
2 - hypertrophy/strength
3 - neurologic changes
T or F: you get stronger by just doing AROM
F - you have to stress the system
range of motion progression
Passive > active-assisted > active
what to consider when working on ROM?
- mobility and stability of joint
- structure of the joint
- soft tissue across the joint
what are some reasons you could lose ROM?
trauma
surgery
disease
inactivity
hypertrophy
indications for PROM
- examination
- not able or allowed to move (pathology/post surgery)
- prepare for stretching
- education
Does PROM increase muscle strength, size, or endurance
NO
what does PROM do?
gains joint ROM
stretches muscles
controls pain
indications for AAROM and AROM
- Pt can partially/completely move a joint
- beginning of strengthening or cardiovascular training
what are some limitation of AAROM and AROM
- only allows for active ROM strength
- doesn’t facilitate skill development outside the motionc
contraindications for AAROM and AROM
- immediately after certain surgeries
- immediately after fracture/tear
- DVT
- excessive pain
- cardiovascular compromise
T or F: you have to have full pain free range of motion to add resistance
F: you can add resistance but only go to pain-free range
immobilization leads to…
- decrease soft tissue mobility
- decreased motion
- atrophy
- functional loss (neurological inactivity)
Do 2 or 1 joint muscles atrophy quicker if only 1 joint is immobilized?
1 joint, b/c 2nd joint still allows for some movement
T or F: slow twitch and fast twitch fibers atrophy at about the same rate
T
If you are immobilized in a shortened position there is a __________ in the number of sarcomeres and muscle is ____________.
decrease
stiffer
*opposite if muscle is immobilized in lengthened position
what stays the same regardless if the muscle is immobilized in a shortened or lengthened position
loss of mass, CSA, strength
T or F: early protected mobilization of muscle will increase results
T
effects of tendon immobilization
- decrease in size and number of collagen fiber bundles
- disorganization of fiber orientation
- decreased strength, elastic stiffness, and total weight
gentle passive mobilization of tendons does what?
- increase tensile strength
- decrease adhesions
- promotes normal soft tissue relationship
- decreases scar tissue
effects of ligament immobilization
- decrease collagen mass
- decrease in strength and stiffness
- increase joint stiffness
- will shorten if not exposed to stress
T or F: for ligaments, remobilization period is usually much longer than immobilization
T b/c low metabolic activity it takes longer for them to get stretched back out once shortened
ligaments can remodel for up to ________
1 year
effects of cartilage immobilization
- degeneration
- softening and fragmentation
- becomes vulnerable to injury
- chondrocyte deterioration leads to sclerosis
- osteophyte formation
after ____ weeks of immobilization, there is usually irreparable damage to cartilage
4
to avoid arthritic changes in cartilage it is important to obtain full ______-
AROM
effects of bone immobilization
- resorption
- decrease in bone mass
- possible osteoporosis
when does most resorption of bone typically occur during immobilization
first 6 weeks
with immobilization there is up to ____% increase in bone resorption and _____% decrease in formation
30, 70
T or F: bone responds quickest to remobilization
T: b/c increased metabolic activity
what does stretching do?
increase extensibility of muscle tendon unit
flexibility depends of what 2 things
joint ROM
soft tissue extensibility
3 types of stretching
static, ballistic, PNF
physiologically, what does static stretching do?
decrease in reflex activity of the spindle
how long to hold static stretch
30-60 seconds
ballistic stretching
repetitive bouncing motions
* may cause injury
process of PNF stretching
take to end range
active isometric contraction
relax
take up slack to end range
repeat
two types of PNF stretching
autogenic inhibition ad reciprocal inhibition
autogenic inhibition
contract the muscle you are trying to stretch
ex. for hamstring stretch, contract ham by having pt push down into your shoulder, then stretch
reciprocal inhibition
contract the antagonist of the muscle you are trying to stretch
ex: for hamstring stretch, contract quad by having pt push up into your hands
acute effects of stretching (3)
- elongation of musculotendinous junction
- decreased resistance to stretch
- increased tolerance to stretch
chronic effects of stretching
addition of sarcomeres
hypermobility
excessive laxity or length of tissue which can lead to instability
agility
ability to perform an accurate motion quickly
coordination
ability to produce smooth controlled motion
power
combo of strength, speed, and skill
strength
max force a muscle can develop in one contraction
two ways you gain strength
1 - neural changes
2 - hypertrophy
what kind of muscles respond well to high volume reps
posture muscles b/c they need good endurance
endurance exercise advantages
comfort, early rehab, less joint stress, ensures proper form before adding weight
why should you avoid valsalva
- decreases blood flow to heart and cardiac output
- raises HR and BP
how to prevent patients from holding their breath
talk to them, if they are talking then they’re breathing
what kind of exercise should you usually start with
isometric
immediate muscle soreness is due to
- increased lactic acid
- decreased O2
- increase in K
- decrease in blood flow
DOMS
delayed-onset muscle soreness microtrauma to muscles, tendons, and connective tissue
symptoms of DOMS
diffuse pain, stiffness, tender to palpate
DOMS starts how many hours after exercise and resolves in how long?
24-48 hours
1 week
T or F: you should exercise when sick
F
you should perform strength training at least _____ times a week for maintenance
2
how many weeks does it take to see significant strength gains
6
why do you warm-up
- increase blood flow, oxygen delivery, and metabolic activity
- mental transition
how to warm up for strength training
12-15 reps without weight before set
do you need to warm up for abdominal training and isometrics
no
what can happen if you don’t cool down
blood can pool in muscles
1 advantage and 1 disadvantage of manual resistance
- allows for control of ROM and resistance
- not measured quantitatively
3 advantages and 1 disadvantage of mechanical resistance
it is specific, quantifiable, and can be done w/o assistance but it can be dangerous
machine weights are more stable than free weights but may limit what?
plane of joint/muscle action
isometric
same length
can be performed daily but only develops strength at position held
isotonic
same tension (ex. dumbbell)
isokinetics
same speed
used mostly for objective data, often not functional
central activation ratio
tells us how much strength we have and if that strength loss is physiologic
T or F: you should review HEP at every visit
T
closed chain
fixed distal segment
open chain
distal segment not fixed
T or F: gait is both open and closed chain
T
open chain is more functional in the ________ extremity while closed chain is more functional in the ________ extremity
upper, lower
volume of resistance exercise =
sum of reps and sets
you want limb symmetry to be within ______%
10
ACSM guidelines for strength training
- minimum 2x per week
- 8-10 exercises targeting major muscle groups
- one set of 8-12 for healthy adults of 10-15 for older/frail
ACSM guidelines for cardiovascular training
30 minutes of moderate intensity physical activity 5x week or 20 mins vigorous activity 3x week
T or F: older adults may need to stretch longer
T: b/c the tissues are often stiffer
T or F: the ACSM guidelines recognize elite athletes
F
There is a ______% decrease in mortality rate between those with mod fitness level and those with low cardiorespiratory fitness level
60
How many steps are recommended per day?
10000
