Midterm Flashcards
When do you perform PROM?
Before MMT
What do you do if there is a limitation in the AROM?
Immediately test PROM
What do end feels tell you?
Where the individual is limited
What factors affect ROM?
Age and gender
Why do females tend to be more mobile?
Primarily due to hormones
What is passive insufficiency?
Inability to lengthen and allow full ROM across all joints it crosses
Which muscle group do you need enough lengthening in in order to see proper ROM?
Antagonist
What is therapeutic exercise used for?
Aerobic conditioning and reconditioning
Muscle performance - IE. strength, power, and endurance
Stretching
Neuromuscular control - IE. inhibition/facilitation techniques (hyper and hypotonicity)
Postural control, body mechanics, and stabilization
Balance exercises and agility
Relaxation, breathing, ventilatory muscle training
Task specific, functional training
What is the role of TherEx?
Reduce risk factors
Manage/treat pathophysiologic or pathologic condition
Manage/treat impairment
Reduce/eliminate functional limitations
Use task specific training
What should you not assume when intervening at the impairment level?
That reducing impairment generally means improvement of functional limitations and restores functional ADLs
What are the categories of disability prevention?
1st degree - health promotion, at risk population
2nd degree - early dx and reduction of severity and duration
3rd degree - use of rehab to reduce or limit progress
What are buffers of disability prevention?
Interventions aimed to reduce progression of pathology, impairment, limitation, or disability
IE. A regular exercise program/removing barriers
What are three important aspects of functional outcomes?
Must be:
- Meaningful
- Practical
- Sustainable
What are key effective exercise instruction strategies?
Acquisition and retention
Measured by observation and analysis
Adherence to exercise
What are the three types of motor tasks?
- Discrete
- Serial
- Continuous
What is a discrete task?
Movement that has a recognizable beginning and end
IE. Grasping an object
What is a serial task?
Task complete in a series of discrete movements
IE. Eat with a fork, WC transfers
What is a continuous task?
Repetitive uninterrupted movements and have no distinct beginning and end
What are the three stages of motor learning?
- Cognitive
- Associative
- Autonomous
What is the cognitive stage?
Novice learner
Learning the what and how
Errors are common
Feeling the exercise and understanding intensity/alignment/speed
What is the associative stage?
Making few errors and concentrate on fine tuning
Understand the when/where
What is the autonomous stage?
Understand and adapt different variables
Pt is usually discharged before this stage of learning
What are the categories of practice order?
- Blocked
- Random
- Block/random
What is blocked practice order?
Same conditions
Cognitive stage
More successful at ACQUIRING
What is random practice order?
Changing the environment
Less predictable
Hand in hand with cognitive stage
Better for RETENTION
What is blocked/random practice order?
Also helps with RETENTION and to transfer skill
At least two repetitions before changing the skill
IE. Sit to stand x5 at one height, sit to stand x5 a little higher, next 5x but put an unstable surface under the feet, etc
What is intrinsic feedback?
Comes from the learner (patient), NOT PTA
What is extrinsic or augmented feedback?
PTA controls type, timing and frequency of feedback
Given during or after regarding knowledge of performance and/or results
Start with extrinsic before intrinsic can be achieved
Examples - hands on, demo, verbalize
What are the various types of schedule-timing feedback?
Concurrent - “real time”
Immediate, postresponse - during initial learning
Delayed - after each rep
Summary - after several trials
What does KP stand for?
Knowledge of performance
What does KR stand for?
Knowledge of results
- After they performed a task give feedback
- Better for retention
What is schedule-frequency feedback?
“Less is more/better”
Variable over continuous to help with RETENTION
Decrease it - promote problem solving, self-monitoring and correction
What factors can influence adherence to an exercise program?
- Pt related factors - motivation, understanding, changes, time, stress, culture, age, sex, etc
- Factors related to health condition or impairment
- Program-related variables - program atmosphere, social support, individualized attention
What does SDOH stand for?
Social determinants of health
Where is the greatest loss in capsular pattern of the GH jt?
ER followed by ABD
Where is the greatest loss in capsular patter of the elbow?
Loss of flexion is greater than loss of extension
Where is the greatest loss in capsular patter of the wrist?
Equal loss of flexion and extension
Where is the greatest loss in capsular patter of the fingers?
Equal loss of flexion and extension
What is the difference between ROM and stretching?
Stretching is when the limiting factor of jt mobility and the goal is to lengthen that muscle. ROM is focused on moving the jt through osteokinematic motion
When stretching a patient in pain where should your body position be?
Close to the patient and jt
When performing scap mobs what position should the patient be in?
S/L
When stretching forearm pronation and supination what other position should the elbow be in?
Perform with elbow flexion and extension
What components does stretching do when trying to improve mobility?
- Flexibility
- Hypermobility
- Contracture
What is flexibility for?
Improve ROM - need to be flexible enough to perform a motion
Can be either static or dynamic
Why do we stretch with contractures?
We stretch when we do not get any more movement from the jt because it is at a fixed angle
Common in FLEXED positions
Seen in pt with SCI, SVA, nerve injury, etc
What are stretching indications?
- Soft tissue has lost extensibility - IE. adhesions, contractures, scar tissue
- Restricted motion may lead to deformity
- Mm weakness and shortening can lead to limited ROM
- Prevent or reduce risk of injury and potentially Mm soreness
- Prior to and after exercise
What are stretching contraindications?
- Bony block
- Recent fracture
- Acute inflammatory process
- Sharp, acute pain with movement or elongation
- Hematoma or other trauma
- Hypermobility
- Shortened tissues that provide stability or function - IE. tendodesis
What is the definition of stress?
Force or load per unit area.
What is mechanical stress?
Internal reaction or resistance to an externally applied load
What is strain?
Amount of deformation or lengthening that occurs when an external load is applied to a structure
What are the three types of stress?
- Tension
- Compression
- Shear
What happens in the toe region of the stress-strain curve?
The wavy collagen fibers straighten
When does deformation of the collagen fibers occur in the stress-strain curve?
Elastic limit
What occurs in the plastic range of the stress-strain curve?
After elastic limit is reached, sequential failure of the collagen fibers and tissue occurs, which results in heat and new muscle length after stress is released
What does X to X1 represent on the stress-strain curve?
New length of muscle
What does Y to Y1 represent on the stress-strain curve?
Additional length added in the plastic region with more heat release
What is the neck region of the stress-strain curve?
Considerable weakening of tissue
Less force needed for deformation
When does total failure occur?
Quickly follows necking even with small loads
Rupture
What is CR PNF stretch?
Contract relax
- Passively lengthen muscle to first point of resistance
- Isometrically contract muscle submaxially for 5-10 sec
- Passively lengthen for another 10 seconds
What is AC PNF stretch?
Agonist contraction - agonist is this sense means opposite of range limiting muscle group (antagonist)
- Concentric contraction of the opposite muscle to the range limiting muscle
- Hold for few seconds
- Rest then repeat
What is HR-AC PNF stretch?
AKA slow reversal hold-relax technique
- Passively move limb
- Have pt perform isometric contraction for about 5 seconds followed by voluntary relaxation and concentric contraction of opposite muscle of range limiting muscle for about 5 seconds
What are precautions of PNF stretching?
- DO NOT force jt beyond normal ROM
- Osteoporosis, prolonged bed rest, age, or prolonged steroid use
- Newly united fracture
- Overstretch weak muscle
What is the Thomas test?
Test of hip flexors
What muscles could be limitations in the Thomas test?
Iliopsoas, rectus femoris, sartorius, adductor longus and brevis, pectineus, and TFL
What is a normal Thomas test?
Flat thigh and knee at about 80 degrees
Where should the goniometer be during a Thomas test?
Fulcrum - greater trochanter
Proximal arm - lateral midline of pelvis
Distal arm - lateral midline of femur in line with lateral epicondyle
What happens if the rectus femoris is the limiting factor?
More motion with the knee in extension
What does it mean if the leg goes into ER and ABD?
Sartorius is the limiting muscle
What does it mean if the leg goes into ABD and IR?
The TFL is the limiting muscle
What does it mean if the leg is pulled into ADD?
The pectineus and ADD are the limiting muscles
What are you doing in the Thomas test?
- Have pt bring knees to chest
- Lower suspected limiting side down towards the ground in a flexed position
- Look for any compensations
What is the Hamstring SLR test?
- Have both knees extended
- Lift one in a SLR
What compensations might you see?
- Knee flexion
- Posterior pelvic tilt
- Lumbar flexion
What is the normal measurement in a hamstring SLR test?
70-80 degrees
Where does the goniometer go during a hamstring SLR test?
Fulcrum - greater trochanter
Proximal arm - lateral midline of pelvis
Distal arm - lateral midline of femur with reference to lateral epicondyle
What is the Ober test?
Tests flexibility of TFL and IT band
What position is the pt in during Ober test?
- Bottom hip and knees are flexed to help stabilize
- PTA have firm pressure on iliac crest
- Slowly lower top leg into ADD position
What is normal during an Ober test?
Thigh can lower slightly below horizontal
When is the Ober test abnormal?
If pt cannot lower the leg into ADD. Gets “stuck” somewhere along the way
Where is the goniometer placement during an Ober test?
Fulcrum - over ASIS
Proximal arm - horizontal line to the other ASIS
Distal arm - anterior midline of femur using midline of patella as reference
What is the Modified Ober test?
- Knee extended instead of flexed
- DON’T allow hip IR
When do you used Modified Ober test?
When a tight rectus femoris is involved
What is constant load with variable displacement?
- Same tension
- Allows for some movement
What is constant displacement with a variable load?
- Tension can vary
- No movement is allowed
How long should you stay in a stretching range?
30-90 seconds
What are common compensations during cervical lateral flexion?
- Rotating head to the same side
- Shoulder hike
What are common compensations during cervical flexion?
- Lateral flexion
- Shoulder hike
- Movement of trunk
What is creep?
Change in muscle tissue length dependent on load and time.
Microtrauma/change in muscle length the muscle endures over time with a certain load
What is stress-relaxation?
Internal tension is decreased when there is a low load applied over a period of time and remains constant
Keeping a low constant load over a longer duration leads to “relaxation” of muscle fibers and ultimately increase in muscle length
