Introduction Flashcards
Impairment vs disability vs participiation/handicap?
Impairment = loss of a structure of function (foot drop) Disability = essentially the inability to perform ADLs (inability to ambulate) Participation/Handicap = participation in society (cannot climb stairs to reach the office at work)
Isometric vs Isotonic vs Isokinetic?
Isometric = no movement occurs Isotonic = tone pulling on the muscle is the same Isokinetic = movement and rhythm of the exercise is constant
Examples of isometric exercises
Planks, wall sits, pushing against a wall, flexing your muscle in the mirror
Examples of isotonic exercises
Bicep curls
Examples of isokinetic exercises
Cardio machines: elliptical, bike, rowing
Type I vs Type II muscle fibers (speed, twitch, color, oxygenation)
Type I = slow twitch, “red” muscle, + oxidative phosphorylation (aerobic)
Type II = fast twitch, “white” muscle, anaerobic
EMG typically picks up what type of muscle fibers?
Type I (slow twitch, red, oxidative)
What are the subtypes of Type II muscle fibers?
Type IIa = mixed glycolytic and aerobic
Type IIb = pure glycolytic (anaerobic)
What type of aerobics are particularly useful for patients with OA-related pain?
Non-weight bearing –> water aerobics
Not great for patients with osteoporosis
Concentric contraction vs eccentric contraction?
Concentric = muscle shortens as it contracts against a load (curling a dumbbell up in a biceps curl)
Eccentric = muscle lengthens as it fights to contract against this (slowly lowering the dumbbell back down to your waist)
What type of contraction tends to be the most useful in therapy programs for muscle building and tendon health?
Eccentric
What type of contraction places patient at highest risk of stress on a tendon/rupture?
Fast eccentric
What are progressive resistance exercises?
Invoke the idea that in order for a motor unit and muscle to adapt and grow stronger with better control and more precise firing patterns, the athlete/patient needs to progressively add weight to the exercise to make it harder
Muscle must “grow or die”
Muscle must be challenged to adapt
Another name = DeLorme’s exercises
What is Biofeedback in exercise?
Which patients benefit most from this?
Biofeedback is the principle of utilizing some type of sensory input to augment exercise.
Useful in patients with motor and sensory impairments (stroke, TBI, SCi)
Feedback can be touch, visual, audio, EMG biofeedback, breathing related.
What are the types of heat therapy, give an example of each.
How does heat help patients in therapy?
Contraindications to heat therapy?
Heat therapy can be transmitted via direct skin contact (conduction), via a flowing fluid (convection) or via radiation (conversion)
Conduction = heat pads Convection = whirlpool Conversion = heat lamp
Heat is useful to loosen structures up for improved ROM and for comfort
Contraindications = electrical implants (pacemaker), cancer, infection, or over insensate areas, skin damage, DVT
What are the types of cold therapy, give an example of each.
How does cold help patients in therapy?
Contraindications to cold therapy?
Cold works by conduction and convection. (not conversion as heat does).
Conduction = cold packs Convection = cold whirlpool
Cold is useful for pain (Decreases metabolism and blood flow on that area)
Do not use cold over areas of skin breakdown, insensate skin, PVD
Ultrasound and Diathermy
Which is best for deep tissues (tendonitis), ligaments, up to 8 cm deep?
Ultrasound
Contraindication = electrical implants or cancer
Ultrasound and Diathermy
Which is best for superficial structures up to 5cm deep
Short wave diathermy (radio waves bombard the tissues to heat them up)
(Contraindications = metal, over pregnancy)
Ultrasound and Diathermy
Which is best for superficial structures 1-3 cm deep (hematomas)?
Microwave diathermy
Contraindications = metal, over pregnancy, cancer
What is the principle behind phonophoresis?
Using sound waves to blast medication through the skin and deeper tissues in order to reach some target structure
(usually inject lidocaine and corticosteroids into superficial structures such as Achilles tendon)
What is muscle energy techniques?
Isometric contractions followed by stretching
What is myofascial release techniques?
Stretch the heck out of a muscle so that the muscle and fascia are no longer tight
What are traction techniques?
When are they contraindicated?
Traction can be useful to pull the vertebrae apart to relive pressure on the nerve roots
Do not perform if patient has spinal infection or cancer, ligamentous instability, VBI
What is the principle behind iontophoresis?
Use electricity to drive medicated ions through the skin and towards a target structure
What is the principle behind TENS?
(Transcutaneous nerve stimulation)
Electrodes are placed onto the patient’s skin, usually over areas of pain. The electrodes supply electricity directly into the skin.
Gate Control Theory kicks in and decreases the patient’s pain.
What is the Gate Control Theory of Pain?
Light touch and pressure neurons (large Ia/A beta sensory neurons) synapse onto the same layer in the substantia gelatinosa as pain fibers do (C fibers).
If a ton of light touch/pressure sensations are occurring on the skin, this can actually inhibit any pain signals coming in at that level from the pain fibers (C fibers).
What is the principle behind NMES?
(Neuromuscular electrical stimulation)
Stimulate motor nerves to contract muscles.
This helps with biofeedback in patients learning to use these muscles again and restore proper motor patterns.
Either a therapist can trigger the contraction or a more complicated system can be installed to do this.
Good for muscle-building, motor training, circulation, fitness
What is the principle behind light therapy?
UV radiation can be used mostly for skin conditions.
Psorasis uses UV light to treat plaques.
Can help wound healing and kill bacteria.
What are spoke wheels best for on a wheelchair?
Lighter but require more maintenance
What are mag wheels best for on a wheelchair?
Heavier, but more durable (more popular)
What are pneumatic tires best for on a wheelchair?
(Pneumatic tire = rubber with an inner air-filled tube) Smooth, cushioned ride better for carpets Can be popped and go flat Need to be refilled with air
What are solid rubber tires best for on a wheelchair?
Less smooth ride compared to pneumatic tires because you feel every bump.
These tires will not go flay
Little if any maintenance
What are caster wheels on a wheelchair?
Tiny wheels at the front of the wheelchair that allow for steering.
What are the pros and cons to smaller caster wheels on a wheelchair?
Easier to maneuver and turn WC
Get caught on every pebble
What are the pros and cons to placing the rear wheels more anteriorly on a wheelchair?
Easier to manuever the chair, smaller turning radius, easier to do wheelies and go up curbs
Less stable (which is the reason you can do wheelies in the first place)
What are the pros and cons to placing the rear wheels more posteriorly on a wheelchair?
Harder to maneuver, accelerate, and ascend inclines
More stable
What is the camber angle on a wheelchair?
The amount of inward lean that the wheels have
What are pros and cons to having a higher camber angle?
(Top of wheels point inward toward your body)
Allows for really tight turns (playing competitive sports)
Chair is a lot wider (bottoms of the wheel sticks out wider)
What are the pros to tubular and removable wheelchair arm rests?
Tubular = better for transfers than standard arm rests
Removable = better for transfers and storage
Desk-length allows you to get closer to the sink
What is the pro to a solid wheelchair seat vs a vinyl sling?
Solid = firm, good for putting a cushion on the top
Vinyl sling = cheap, good for transport of the WC and folding/storage
Why are seat cushions important in wheelchairs?
What is the most popular type?
Seat cushions are important to provide comfort and prevent skin breakdown
Air villous cushions are most popular, but require a lot of maintenance, but are light and provide excellent pressure relief
Wheelchair measurements:
What is seat height?
Distance from heel to posterior thigh when knee is bent 90 degrees
+ a few inches to clear the floor
- any extra padding (seat)
Wheelchair measurements:
What is seat width?
Distance between the hips
+1 inch if using a power wheel chair
Wheelchair measurements:
What is seat depth?
Distance from popliteal fossa straight backward to the buttocks
-1/2 inch so that popliteal fossa actually clears the seat and doesn’t get compressed
Wheelchair measurements:
What is backrest height?
Just below the bottom corner of the scapula to the top
bottom corner of scapula to spine of scapula if power wheel chair
What is a recline wheelchair?
Pros and cons?
Recline = backrest reclines backward and allows you to lie flat
Pros: Good for opening up space to allow access for clean intermittent cath
Cons: Bad because it can increase shear forces on the posterior
What is a Tilt-in-space wheelchair?
Pros and cons?
Tilt in space = Entire chair keeps you in whatever seated position you are in while the whole thing tilts backward as one unit.
Pros: Good for pressure relief and redistribution to prevent pressure injuries. Does not increase shear forces (like reclining WC).
Cons: More expensive
What is a power assist for manual wheelchairs?
A power-generating device can be attached to the back of the chair and connect to the wheels.
With each manual stroke of the wheelchair during propulsion, the device sends power into the wheels that assists in rolling the wheels and accelerating the chair.
Key: Enables you go either go fast or go up a hill with ease.
What is the primary purpose of canes, walkers, and crutches?
Widen a patient’s base of support so they don’t fall
Besides preventing falls, what else are canes useful for?
Offloading painful limbs (painful, arthritic hip or knee)
What types of canes exist?
Straight cane = metal stick
Pronged cane = 3 points of contact with ground (or 4 = quad cane)
Quad canes are less maneuverable and fashionable and take up more space, but provide great support.
What is the ideal level for cane height?
At the level of the greater trochanter, or the level of the hand when the elbow is flexed to 20-30 degrees
Walkers provide more support than canes. What are they particularly good for?
Leg weakness, pain, and instability (ALS, PD, stroke, cerebellar disease)
How should standard axillary crutches be used?
Grip for hands is midway down the crutch shaft
Do NOT apply pressure in your axillae; you’re supposed to tense your triceps and keep your arms straight as you bear weight through your triceps, not armpits
How should Lofstrand crutches (forearm crutches) be used?
Allow forearms to bear the weight while it frees up your hands for ADLs, turning door handles, ect.
less fashionable/socially acceptable.
