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Advanced Rehab > Midterm Lecture > Flashcards

Midterm Lecture Flashcards

1
Q

What are goals of rehabilitation?

A

Restoring mobility and functions needed to do ADLs

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2
Q

Short term goal includes “increase function by …” or “decrease pain by” ___ %

“Increase aROM by” ___ %

“Increase flexibility by” ___ %

A

50% over next 2 weeks

AROM 30%

Flexibility 40%

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3
Q

Long term goals regarding strength and flexibility?

*Exam Q

A

90% strength, 100% flexibility within 6 weeks

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4
Q

Do you perform movement screening on acute patients/

A

No

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5
Q

What is FMS?

A

Functional movement screen by Gray Cook, PT

7 movements, each exercise is a test. Some of them have clearing exams.

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6
Q

What is Mag 7?

A

Magnificent Seven by Craig Liebenson, DC

Tweaked from FMS, no dowels or special equipment necessary.

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7
Q

What are the 7 exercise in FMS? And which ones have clearing tests?

A
  1. Deep squat
  2. Hurdle step
  3. Inline lunge
  4. Shoulder mobility*
  5. ASLR
  6. Trunk stability pushup*
  7. Rotary stability*
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8
Q

What are the 7 exercise in Mag 7?

A
  1. aROM of area of c/c
  2. Wall angel/T4 mobility
  3. Overhead squat
  4. Single leg stance
  5. Single leg squat
  6. Lunge to kneeling
  7. Respiration
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9
Q

How do you score FMS and Mag7?

A

0-3

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10
Q

When scoringFMS and Mag7, what does 0 mean?

A

Pain

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11
Q

When scoringFMS and Mag7, what does 1 mean?

A

Can’t perform movement/>50% loss of ROM

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12
Q

When scoringFMS and Mag7, what does 2 mean?

A

Performs movement with compensation (imperfect)/looks ok, but dysfunction is present

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13
Q

When scoringFMS and Mag7, what does 3 mean?

A

Performs movement without compensation

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14
Q

What is the goal score with FMS and Mag7?

A

To correct key fault that is causing trouble

At least 14 points (all 7 tests get at least a 2)

If there are a lot of 0s or 1s but the score is above 15, that’s not great.

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15
Q

What is Lx instability?

A

Painful disorder hypothesized to result from loss of spine’s ability to maintain appropriate mechanical stiffness in neutral, midrange, or end-range movements

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16
Q

Vertebrae, intervertebral discs, ligaments, joint capsules, and zygapophyseal joints are what stabilization system?

A

Passive stabilization

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17
Q

Stabilizing muscles such as multifidi, trans versus abdominis, diaphragm, etc. make up what stabilization system?

A

Active stabilization

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18
Q

Motor control, coordination, and proprioception make up what stabilizing system?

A

Neuromuscular control

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19
Q

Structural instability is also called

A

Radiographic instability

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20
Q

Radiographs are NOT indicated within the first 6 weeks of LBP if the following criteria are met

A 
– No neurologic symptoms 
– No constitutional symptoms 
– No history of trauma 
– No symptoms of malignancy 
– Patient is 18 to 50 years old
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21
Q

Do you do ancillary studies for structural instability? If so, what kind?

A

X-ray plain film is first choice

But its NOT indicated within the first 6 weeks of LBP if
– No neurologic symptoms 
– No constitutional symptoms 
– No history of trauma 
– No symptoms of malignancy 
– Patient is 18 to 50 years old
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22
Q

What are the types of spondylolisthesis?

Which one is the MC?

A 
Type I dysplastic
Type II isthmic **MC
Type III degenerative
Type IV traumatic
Type V pathological
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23
Q

Spondylolisthesis Type I

A

Dysplastic (congenital)

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24
Q

Spondylolisthesis Type II

A

Isthmic (stress Fox in the pars-interarticularis)

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25
Q

Spondylolisthesis Type III

A

Degenerative (degeneration of the IVDs)

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26
Q

Spondylolisthesis Type IV

A

Traumatic (Acute Fx)

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27
Q

Spondylolisthesis Type V

A

Pathological (bone disease/infections/tumors)

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28
Q

Functional instability is also called

A

Clinical instability

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29
Q

What are key points from the HISTORY for a patient with functional instability?

A

– Complaints of “giving way” or “going out”
– Recurrent episodes
– Pain during sudden or trivial activities
– Pain during transitional activities
– Pain with sustained postures
– Difficulty with unsupported sitting
– Short term relief from manual therapy

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30
Q

What clues from PE would you see in a patient with functional instability?

A 
– Aberrant movement pattern during active
trunk flexion 
– Painful arc on return 
– Minor’s Sign (“thigh climbing”) 
– Catching or locking 
– Reversal of lumbopelvic rhythm 
– (+) Prone Instability Test
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31
Q

Describe prone instability test and (+) finding

A
  1. Patient lays on their tummy, feet on the floor.
  2. Doc applies P-A stress to SPs.
  3. Patient then lifts their legs away from the floor.

(+) finding is if there is decrease pain

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32
Q

Describe passive leg extension test AND (+) finding. What does this suggest?

A

Both legs are lifted about 30 cm and gently tractioned to allow the lumbar spine to settle into extension

(+) test is pain or feeling of heaviness in the low back which disappears when the leg is lowered

Suggests: unstable spondylolisthesis

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33
Q

Which kind of instability do you get poor motor control? And which one do you see radiographic evidence?

A

Frankly, maybe both. But FUNCTIONAL speaks to the functional instability. Structural instability will have radiographic evidence.

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34
Q

In addition to having aberrant Lx flexion, what are the 3 other components that predicts patients with functional instability will have a positive response to stabilization exercises?

A

Those with:

  1. (+) prone instability test
  2. <40 yo
  3. Bilateral SLR flexilbity >91˚
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35
Q

How do you manage functional instability?

A
  • diaphragmatic breathing
  • abdominal bracing/neutral pelvis
  • hip hinging
  • lumbar stabilization exercises
  • CMT to adjacent areas
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36
Q

What are some lumbar stabilization exercises?

A

Quadruped track
Bridge track
Side bridge track

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37
Q

Case Presentation

Hx

  • 37y.o. male office manager presents with intermittent Lx pain
  • Most recent episode was initiated by bending over to pick up a pen he dropped and felt “my back go out.”
  • Reports having these episodic sx’s about 2-3x/year, but are becoming more frequent

PE
• Lx aROM:
– Painful arc when returning from flexion
• Neuro Exam:
– Unremarkable L.E.: DTR’s/Lt. Touch/Mscl Testing
• Ortho. Exam:
– Decreased resistance with prone Jt. Play
– Poor Motor Control with movement
– (+) Prone Instability Test

A

Lumbar instability

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38
Q

Case Presentation

Hx
• 45y.o. Female presents with Cx pain of 2 weeks duration
• Sx’s began after a MVA 2 weeks ago
• Stated that she was rear-ended while at a stop light
• Since injury, has been having daily HA’s and right arm sx’s (down into her hand)
• Has been taking Ibuprofen and resting hoping that it would go away, but hasn’t.

PE
• Limited Cx aROM (very splinted)
• Ortho: (+) Cx compression/Max Compression/Shldr depression/Cx Kemps
• Feels better with Cx distraction (arm sx’s decrease)
• Neuro: (-) sharp/dull/vibration, but Lt. Touch is decreased on R side (C6).
• (-) Rapid wrist clonus
• DTR’s: +2/4 Biceps/Triceps/Brachioradialis
• Palp: Cx Jt. Dysfunctions/Hypertonic suboccipitals and Cx paraspinals.

What is on the DDX list?

A

Cx sprain
Cx strain
Cx disc herniation
Cx disc derangement

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39
Q

Goals in the acute phase of Cx patient (2)

A

Slow atrophy

Maintain muscle memory/neuro programming

40
Q

Cx Rehab - Acute Care interventions (4)

A

1 — aROM (painfree)
2 — pROM
3 — Isometric exercises w/ 20% mm contraction (painfree)
4 — directional preference (McKenzie) including end-range loading static hold vs repetitive end-range loading

41
Q

What is the rehabilitation strategy for Cx patient?

A
  • address postural / mm imbalances (strengthen/stretch upper cross syndrome)
  • evaluate and train Cx joint dysfunction, scapular stabilizers, breathing
  • retrain proprioception
  • work on mm endurance
42
Q

How do you assess posture with Cx patient? (5)

A

Thx extension with motion palpation (T4 mobility)

Pec evaluation with length test (esp sternal portion)

Controlled head nodding (NOT retraction) look for shaking/ratcheting = deep Cx flexor weakness

Shoulder abduction movement pattern*** gown patient so you can see hiking/imbalances side to side

Breathing/respiration - because involved mm are also postural mm

43
Q

Faulty shoulder ABD: elevation of shoulder during 1st 60˚ of ABD.

What mm are inhibited/weak?

A

Middle and lower traps

44
Q

Faulty shoulder ABD: elevation of shoulder during 1st 60˚ of ABD.

What mm are overtight/active?

A

Upper trap and levator scap

45
Q

Faulty shoulder ABD: scapular winging.

What mm are inhibited/weak?

A

Serratus anterior

46
Q

Faulty shoulder ABD: scapular winging.

What mm are overactive/tight?

A

Pecs and rhomboids

47
Q

Faulty shoulder ABD: contra trunk flexion.

What mm are inhibited/weak?

A

Shoulder abductors

48
Q

Faulty shoulder ABD: contra trunk flexion.

What mm are overactive/tight?

A

Opposite side QL

49
Q

What could you do in office to manage/exercise thx extension? (7)

A
  • Manipulation
  • Bruggers relief position
  • Foam rolling
  • Table walks w/ foam roller
  • Lat. Pull-downs
  • Banded pull-a-parts
  • Serratus punch w/ band
50
Q

What could you do in office to tight postural muscles?

A

PIR to the suboccipitals, upper traps, levator scap

Doorway/wall corner pec stretch

51
Q

What could you do in office to weak postural muscles? (6)

A

Controlled nodding

Craniocervical flexion exercise with biofeedback (BP cuff)

Chin retraction

Wall angle

Serratus punch (w/ band)

Push-up plus

52
Q

Goal for craniocervical flexion exercise with biofeedback (BP Cuff) is ____ mm increments

A

2 mm

53
Q

Mouth breathing at rest could indicate ___.

Hx of:

A

Not enough 02

Hx: emphysema, chronic bronchitis, asthma

54
Q

Recurrent mid-thoracic pain could be d/t?

A

Faulty breathing patterns d/t lack of mobilizing effect of normal rib motion

55
Q

What is one breathing exercise to Inhibit chest-lifting during inspiration?

A

Sit on chair with armrests.

Press elbows into arm rest during deep inhalation.

56
Q

Good ab strength w/o _________________ has been shown to lead to spine instab during challenging aerobic activities

A

Proper coordination b/w abs and diaphragm

57
Q

When should you take a Brugger’s micro break?

And how long do you hold Brugger’s?

A

Break: 20-30 minutes

Hold: 1/2-1 minute

59
Q

Cx Rehab strategy 1: eval and train deep neck stabilizers

How do you assess?

A

Hx
Observation
Julll’s test
Craniocervical test

60
Q

Cx Rehab strategy 1: eval and train deep neck stabilizers

How do you treat?

A
  • Cervical mobilization/manipulation
  • Isometric progressions (chin tuck, ball squeeze)
  • Chin retractions (seated/supine)
  • Craniocervical flexion (nodding, ball roll)
  • Neck extensors: Cx Quadruped track
61
Q

Cx Rehab strategy 2: assess and treat posture and respiration

How do you treat?

A

Anterior head carriage

Thoracic kyphosis exercises

Respiration assessment in standing, supine, prone

Teach basic ab breathing

Ab breathing with bracing exercises

62
Q

Cx Rehab strategy 3: address muscle imbalance of large torque producers

How do you assess/treat?

A

Assess: upper cross syndrome

  • general long and short extensor muscles and general home stretches
  • re-train scapular stabilizers (w/ wall angles, Serratus punch, push-up plus)
  • pec major stretches
  • strengthen large torque muscles of the neck (resistance training - Cx banded exercises)
63
Q

Cx Rehab strategy 4: retrain sensory motor response loop

How do you Assess/treat?

A

Assess: Revel’s and oculomotor testing

  • cervical Proprioceptive Neuromuscular Facilitation (PNF) cross patterns
  • rhythmic stabilization
  • head repositioning
  • oculomotor training
  • balance training
79
Q

Cx Rehab - Sub-Acute Care interventions (4 step rehab strategy)

“What are the 4 main components of a cervical stabilization program?” (Dr. LeF)

A
  1. Eval and train deep neck stabilizers
  2. Assess and Tx posture and respiration
  3. Address mm imbalance of large torque producers
  4. Retrain sensory motor response loop
80
Q

For the nervous system to move normally, it must execute 3 primary mechanical functions:

A

Withstand tension
Slide in its container
Be compressible

81
Q

What does tension to do intraneural blood flow?

A

Reduces it

82
Q

How much tension reduces intraneural blood flow?

A

8% elongation reduces venous

15% elongation reduces ALL blood flow

83
Q

A __% strain held for 1 hour reduced nerve conduction by ___%

A

6% strain
70%

The longer the stretch, the increased likelihood of producing adverse effects

84
Q

_____mmHg compression causes hypoxia, impairs conduction and axonal transport?

A

30-50 mmHg (~1 pound/square inch)

85
Q

What is structural differentiation?

A

Any maneuver that affects nerve tension w/o moving the MSK tissue in the same area

E.g. ankle dorsi flexion slides lumbar nerve roots inferiorly

86
Q

A procedure that produces increase pressure on a nerve by reducing the space around it

A

Closing mechanisms or a Closer

E.g. maximal IVF closing

87
Q

A procedure that reduces pressure on a nerve by increasing the space around it

A

Opening mechanisms or an Opener

E.g. Maximal IVF opening

88
Q

A procedure that creates longitudinal elongation of a nerve

A

Tensioner

E.g. SLR

89
Q

Peripheral nerves system is exposed to noxious stimulation (at NR, peripheral nerve, or neural nociceptor) it can cause inflammatory response.

Inflammatory response can be not ONLY the nerve, but at the MSK tissue that is innervated by the nerve.

This sequence of events may be one mechanism for what phenomenon?

A

Trigger points

90
Q

What does the IVF do in spinal extension vs flexion?

A

Extension: IVF compression = Closer

Flexion: IVF opening = Opener

91
Q

The spinal canal can elongate by up to

A

9 cm

92
Q

Increased Sx with spinal flexion may be d/t

A

Increased neural tension

E.g. tension of affected NR

93
Q

Decreased Sx with spinal flexion may be d/t

A

Decreased compression

E.g. relief of central canal stenosis Sx

94
Q

What motions gap the Right cervical facet?

A

Flexion
Contralateral lateral flexion
Ipsi rotation

95
Q

During gapping, what occurs at the cervical IVF?

A

…it opens….

96
Q

What are the 3 basic tissue classifications of neuro-patho-dynamics?

A

1 — Mechanical interface: tissues around the nervous system causing neural problems

2 — Neural: neural tissues causing neural problems

3 — Innervated tissue: tissue innervated by nerves causing neural problems

97
Q

Know PNF patterns

A

:)

98
Q

What do you do in acute care of shoulder rehab? (3)

A
  1. passive ROM activities e.g. Codman’s pendulum, wand exercises
  2. Isometric exercises
  3. Postural awareness
99
Q

How do you do cod man pendulum exercises?

A
  • Hang 2-4 kg (4-6 pounds) from wrist to traction

- Do 10-15 small, passive circles in each direction

100
Q

When do you begin active ROM for shoulder rehab?

A

Immediately in internal and external rotation (10-15 reps 2-3x/day)

101
Q

What instructions do you give shoulder rehab patient on isometric shoulder exercises? What is the force of contraction?

A

Use pillow to isometrically contract in ext/flex/internal rotation/external rotation/abd/add

10-15 reps
2-3 x/day or every hour
Hold 5-10 secs

Force of contraction: below pain threshold but at least 10-20% of MCV

102
Q

What can you give a shoulder rehab patient if shoulder isometrics are too painful?

A

Ball squeeze or exercise the opposite shoulder

103
Q

What are the 5 S’s of shoulder rehab principles?

A 
Strength &amp; endurance
Scapular stability
Stretch
Synchronize
Stimulate
104
Q

In shoulder rehab, what needs to be stretched?

A

Subscap and ext rotators/posterior capsulE

Tight pecs

105
Q

In shoulder rehab, what needs to be strengthened?

A

All rotator cuff mm starting with exercises with the arm at the side

Strengthen external rotators: infraspinatus, trees minor

106
Q

When are tubing or weights introduced in shoulder rehab patient?

A

When they have >20-30 degrees of painfree AROM in flexion, ABD, scaption

107
Q

What is the sequence of exercises for shoulder rehab?

A 
FIRST
- int/ext rotation
- shoulder flex/extend
- biceps
THEN
- ABD, scaption
FINALLY
- diagonals
108
Q

What are the 5 phases of tubing rehab?

A

Phase 1: Slow, mid range for 60 seconds or until fatigue (optional)

Phase 2: Fast, mid range for 60 seconds or until fatigue (goal: facilitation)

Phase 3: Slow full range, hold at end range up to 30 seconds, release through eccentric range in slow, controlled manner (goal: strength)

Phase 4: Fast, full range for 60 seconds or until fatigue (goal: endurance)

Phase 5. Use movements that mimic the sport or job the patient is returning to. (goal: functional training)

109
Q

What is the goal of phase 2-5 tubing rehabilitation?

A

2: Facilitation
3: Strength
4: Endurance
5: Functional training

110
Q

2 approaches to giving a patient instructions on how to to repetitions

A

Target number e.g. 10 and build up to 30 (for strength)

Exercise to fatigue (goal: endurance)

111
Q

What is the most effective exercise fro infraspinatus activity with minimal strain on capsule?

A

External rotators: side lying ER at 0 ABD

112
Q

When shoulder reaches about ____% strength and endurance as compared to the opposite shoulder, overhead medicine ball toss can be introduced

A

90%

Advanced Rehab (2 decks)

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