Midterm Flashcards
1
Q
what is ankylosis? Is passive movement possible?
A
fusion of the joint
no
2
Q
What are the absolute contraindications for joint mobilizations? (8)
A
- malignancy in area
- active inflammation and/or infectious joint
- ankylosis of joint
- fracture at the joint
- practitioner lack of ability
- neurological deterioration
- diseases with affect integrity of ligaments
- arterial insufficiency
3
Q
What are relative contraindications for joint mobilizations? (6)
A
- excessive pain or swelling
- arthroplasty (joint replacement)
- hypermobility
- metabolic bone disease
- pregnancy
- spondylolisthesis
4
Q
What direction are you assessing with Grade 3 distraction?
A
general mobility
5
Q
What is the dosage for joint mobilization oscillations?
A
- 1-3 seconds each
- 1-5 sets for 15-30 seconds each
6
Q
What is the dosage for joint mobilization sustained holds
A
1-5 sets for 15-30 seconds each
7
Q
What direction will you do grade 1 and 2 joint mobilizations?
A
the direction doesn’t matter; must be done in open packed positions
8
Q
How many times should joint mobilizations with movements be done before reassessing joint motion?
A
10 times
9
Q
What is the ability of contractile tissue to produce tension and a resultant force based on demand placed on the muscle
A
muscle strength
10
Q
What is the ability of the neuromuscular system to produce, reduce, or control forces during functional activities in a smooth coordinated manner
A
muscle functional strength
11
Q
What is the ability of related to the strength and speed of a movement; the amount of work produced by a muscle in a given amount of time
A
muscle power
12
Q
What is the ability to perform low-intensity, repetitive, or sustained activities over a prolonged period of time
A
muscle endurance
13
Q
Which muscle fibers atrophy fastest?
A
type 1 fibers - endurance fibers
14
Q
Which type of muscle fibers shows the greatest hypertrophy?
A
type 2 fibers - strength/power fibers
15
Q
What occurs at the capillary beds during hypertrophy?
A
there is no change because there is no extra demand for O2 for strength and power - they are anaerobic
16
Q
What are resistance training guidelines for children under 7
A
- no “formal” training
- encourage daily physical activity and bodyweight exercises
- emphasize multi-joint, functional movements
- increase weight by no more than 5% at a time
17
Q
What muscle performance training would have some sort of time/speed component to it combined with strength?
A
TUG test
18
Q
What does FITT stand for?
A
Frequency
Intensity
Time
Type
19
Q
Training zone of 1 RM for sedentary/untrained patients
A
30 -40% of 1 RM
20
Q
Training zone of 1 RM for highly trained patients
A
over 80% of 1 RM
21
Q
Training zone of 1 RM for normal patients
A
60 - 80% of 1 RM
22
Q
________ recovery leads to more rapid recovery than _______
A
active is more rapid than passive
23
Q
What type of exercise has an analgesic effect based on research?
A
isometric exercise
24
Q
At a minimum, how long should a static isometric muscle contraction hold last
A
6-10 seconds
25
When can patients progress to the mobility phase of their exercise prescription?
when signs of inflammation have disappeared
| - some patients can skip tissue healing phase and go right to mobility phase
26
What kind of exercises would you do during the tissue healing phase?
ROM and isometrics
27
What kind of exercises would you do during the mobility phase?
ROM and stretching exercises
28
What is required for the patient to progress from the mobility phase to the performance initiation/stabilization and motor control phase?
pain free ROM
| - they do not have to have full mobility, just has to be pain free
29
What type of exercises can be used in the performance initiation/stabilization and motor control phase
concentric, eccentric, and isometric
| - apply the SAID principle
30
What is required for the performance improvement phase?
pain free ROM
| - does not have to have full mobility, just has to have pain free ROM
31
What is the goal of BFR?
mimic the effects of high intensity exercise by recreating a hypoxic environment using a cuff while performing low intensity exercises
32
Does PROM increase strength and endurance?
No
33
reciprocal inhibition
When the stretch reflex is activated in a muscle being lengthened (antagonist), inhibition in the muscle on the opposite side of the joint may occur
- relaxation of muscles on 1 side of a joint to accommodate contraction on the other side of the joint
- activating the agonist to get the antagonist to relax
34
What part of the muscle control reciprocal inhibition?
muscle spindles
35
What part of the muscle controls autogenic inhibition?
golgi tendon organs
36
autogenic inhibition
When tension develops, the GTO fires and decreases tension in the muscle-tendon unit being stretched, enabling a muscle to be elongated against less muscle tension
- ability for a muscle to relax when it experiences increased tension
- activating the antagonist to get the antagonist the relax
37
When is PNF stretching more appropriate?
when muscle spasm limits motion
38
When is PNF stretching less appropriate?
for stretching long-standing, fibrotic contractures
39
antagonist contraction
- hold-relax
- using autogenic inhibition
- stretch range limiting (antagonist) muscle to end range, then have patient contract muscle, then stretch farther
40
agonist contraction
- contract relax
- using reciprocal inhibition
- stretch range limiting (antagonist) muscle to end range, then have patient contract agonist (opposite) muscle, then stretch antagonist
41
When is agonist contraction useful?
- when muscle guarding restricts muscle lengthening and joint movement
- when the patient can't generate a strong, pain-free contraction of antagonist
42
What does SBAR stand for?
Situation
Background
Assessment
Recommendation
43
nociceptive vs neuropathic pain
nociceptive - increased sensitivity to a peripheral nerve, usually from an injury
neuropathic - injury to a nerve
44
What are the 5 moments for hand hygiene?
1) BEFORE touching the patient
2) BEFORE clean/aseptic procedures
3) AFTER a body fluid exposure risk
4) AFTER touching the patient
5) AFTER touching a patient's surroundings
45
What PPE should be worn with contact precautions?
gloves and gown
46
What PPE should be worn with droplet precautions?
gloves and mask
47
What PPE should be worn with airborne precautions?
masks and respirators
48
PNF overflow (irradation)
Spread of a muscle response from stronger to weaker muscles – the more resistance you apply, the more muscles recruited
49
What does PNF manual contact do?
stimulates the muscle to reinforce the movement AND guide the direction of the movement
50
Where is the therapist position during PNF stretching?
directly in line with the desired motion and should be facing the direction of the desired movement
51
What is applied manually during PNF patterns to facilitate muscle contraction?
traction
52
D1 Flexion UE pattern
- the most important motion is eating
- shoulder flexion, adduction, ER
- forearm supination
- wrist radial deviation
- fingers flexed
53
D1 Extension UE pattern
- throw away the trash
- shoulder extension, abduction, IR
- forearm pronation
- wrist ulnar deviation
- fingers extended
54
D2 Flexion UE pattern
- drawing the sword and throwing it behind you
- shoulder flexion, abduction, ER
- forearm supination
- wrist radial deviation
- fingers extended
55
D2 Extension UE pattern
- putting the sword back
- shoulder extension, adduction, IR
- forearm pronation
- wrist ulnar deviation
- fingers flexed
56
What pattern is the involved and non-involved side doing during lift and reverse lift?
- involved side doing D2 pattern
| - non-involved side doing D1 pattern
57
What pattern is the involved and non-involved side doing during chop and reverse chop?
- involved side doing D1 pattern
| - non-involved side doing D2 pattern
58
rhythmic initiation steps
1) therapists performs PROM
2) therapist has patient perform AAROM
3) patient performs AROM
4) patient performs AROM against resistance
59
alternating isometrics
Patient performs isometric contraction while resistance is applied to agonist and antagonist – very little joint movement occurs
- best for core strength
60
dynamic reversals
Apply resistance through the pattern on both sides
| - ex: resist D2 flexion then resist D2 extension
61
fast/quick stretch
- Provide a quick stretch of the agonist when changing directions
- Produces a relatively short-lived contraction of the agonist's muscle and short-lived inhibition of the antagonist muscle which facilitates a muscle contraction (muscle spindle)
62
Repeated contraction/stretch
- Move through a pattern pausing and applying a quick stretch, press through more motion, pause, quick stretch, push
- Emphasizes strengthening in specific ranges throughout the motion
63
dynamic reversal hold
Same as dynamic reversals but with an isometric hold at end of the motion prior to changing directions
64
agonist reversal
Reversing the type of contraction you are eliciting from your patient, working concentrically, isometrically, then eccentrically
65
Antalgic Gait
Short, choppy steps because they don’t want to bear weight on the involved side
66
What hip deviation will cause forward trunk lean?
- weak quads
- hip flexure contracture
- weak lumbar or hip extensors
- hypomobile anterior hip capsule - they can't get into extension
67
What hip deviation will cause decreased hip extension? What will this do to their steps?
- Tight hip flexors
- Decreased anterior joint mobility
- Weak glutes
- shorten their steps
68
If glute max is weak how will my body compensate?
Rock themselves back and use their trunk to create hip extension
69
What might you see with weak gluteus medius?
Hip drop on contralateral side
70
What can cause knee hyperextension during gait?
- Quadriceps weakness – doesn’t control the knee eccentrically so the sling it back to lock out the knee
- Hamstring weakness
- Increased tone of quadriceps
- Compensation for plantarflexion contracture or spasticity
- hypermobile posterior capsule
71
What can cause decreased knee extension during gait?
- Quadriceps weakness (unable to straighten knee) – tight anterior joint capsule
- Knee joint hypomobility
- Hamstring contracture or stiffness
- Strategy to avoid heel rocker
72
What is equinus gait? What may cause this?
excessive plantarflexion during gait
- Tib ant weakness
- Plantarflexion contracture
- Hypomobility of talocrural joint – posterior capsule hypomobile
- Compensation for short leg/short stride length
- Painful heel/avoiding heel rocker
73
What is calcaneal gait? What may cause this?
- increased dorsiflexion
- tib anterior contracture
- weak gastroc
- hypomobility talocruel joint
74
What is Equinovarus gait?
- club foot
| - Ankle plantar flexion and subtalar inversion
75
What often causes foot drop? What muscles would you MMT? What muscles would be tight?
- Often due to dorsiflexor weakness caused by paralysis of common peroneal nerve
- tib anterior MMT
- tight gastroc soleus (PF)
76
What might cause foot flat?
- Weak dorsiflexors
- limited ROM
- hypomobility
- normal immature gait pattern (neonatal)
77
What position is the foot in during excessive supination?
varus
78
What position is the foot in during excessive pronation?
valgus
79
What might cause inadequate push off?
- Result of weak plantar flexors
- Tight/spastic dorsiflexors
- Hypomobile talocrural joint – anterior (convex on concave)
- Pain in forefoot
80
What causes excessive anterior pelvic tilt?
- Weak hip extensors
- Hip flexion contracture
- Abdominal muscle weakness
- Limited hip extension ROM
81
What causes excessive posterior pelvic tilt?
- tight hamstrings
- hip flexor weakness
- low back pain
- limited lumbar extension ROM
82
anatomical vs functional leg length discrepancies
- anatomical - one bone is longer than the other
| - functional - bones are the same length but something is causing one leg to be longer or shorter than the other
83
What are causes for waddling gait?
- Tight IT band
- Contralateral hip abductor weakness
- Limited hip or knee flexion- leans to contralateral side to compensate to clear foot
- Commonly seen with pain in hip related to arthritis
84
What is Sensory Ataxic Gait?
- abnormal and uncoordinated movements
| - often seen with cerebellar disorders
85
What is Festinating Gait?
- flexed forward gait often seen with Parkinson's
| - short, choppy steps
86
A 2 handed device is required for which weight bearing statuses?
NWB
TTWB
PWB
87
A 1 handed device can be used with what weight bearing statuses?
WBAT
| FWB
88
4 point gait weight bearing status
no weight bearing restrictions
89
modified 4 point gait weight bearing restrictions
no weight bearing restrictions
90
3 point gait weight bearing status
NWB
91
modified 3 point gait weight bearing status
TTWB, PWB, or WBAT
92
2 point gait weight bearing status
no weight bearing restrictions
93
modified 2 point gait weight bearing status
no weight bearing restrictions or WBAT
94
consequences of shallow seat depth on wheelchair
thighs are not properly supported, affecting weight distribution and comfort, pelvic position
95
consequences of deep seat depth on wheelchair
sacral sitting
| - Individual slouches, sliding buttocks forward and posteriorly tilting pelvis
96
consequences of side width too wide on wheelchair
- difficult to reach the drive wheels
| - Individual may lean to one side to rest on the armrests
97
consequences of side width too narrow on wheelchair
excessive pressure on lateral aspects of pelvis and thighs
98
consequences of back height too high in wheelchair
restricts movement, skin irritation over inferior angles of scapulae
99
consequences of back height too low in wheelchair
decreased trunk stability, postural deviations
100
What is ideal seat to footplate length?
set so that the thigh rests parallel to the cushion surface with the foot comfortably placed on the footrest
101
consequences of too high seat to footplate length
individual may sacral sit in order to rest feet on footplates
102
consequences of too low seat to footplate length
pressure distribution along thigh is uneven
103
What are the areas at risk for pressure while in a wheelchair?
- inferior angle of scapula
- sacrum/coccyx
- Ischial tuberosity
- greater trochanter
- popliteal fossa
104
What impairments are you targeting with oscillation mobilizations?
- muscle guarding
- pain
- joint hypomobility
105
What impairments are you targeting with sustained hold mobilizations?
- joint mobility - end range
| - pain - beginning range to mid range
106
D1 Flexion LE pattern
- Hip flex, add, ER
- Dorsiflexion
- Inversion
- Toes extended
107
D1 Extension LE pattern
- Hip ext, abd, IR
- Plantar flexion
- Eversion
- Toes flexed
108
D2 Flexion LE pattern
- Hip flex, abd, IR
- Dorsiflexion
- Eversion
- Toes extended
109
D2 Extension LE pattern
- Hip ext, add, ER
- Plantar flexion
- Inversion
- Toes flexed
