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Ortho > Physical Rehabilitation > Flashcards

Physical Rehabilitation Flashcards

1
Q

What is physical rehabiliation?

A
  • Treatment of injury or illness to decrease pain and restore function
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2
Q

Who gets physical rehabilitation?

A
  • Post-op orthopedic and neurologic patients
  • Orthopedic injuries or conditions - both surgical and non-surgical
  • Including soft tissue injuries such as tendinopathies
  • Neurologic conditions (IVDD, neuropathies, degenerative myelopathy, FCE)
  • Osteoarthritis/geriatrics
  • Sports medicine/fitness
  • Obesity
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3
Q

What are the benefits of physical rehabilitation?

A
  • Improve function and quality of movement
  • Reduce pain
  • Increase the speed and success of post-op recovery
  • Improve range of motion (ROM), increase strength and endurance
  • Conditioning and weight loss
  • Additional treatment option for the non-surgical patient
  • Improve and prolong quality of life
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4
Q

Goals of post-operative physical rehabilitation

A
  • Decrease pain and inflammation
  • Promote healing
  • Improve and maintain normal range of motion and strengthening
  • Identify and manage compensatory problems
  • Return to normal pain-free function sooner
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5
Q

Post-op pain meds

A
  • Fentanyl/Hydro
  • NSAIDs
  • Tramadol
  • Gabapentin
  • Muscle relaxants (methocarbamol, diazepam)
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6
Q

What is part of pain management for physical rehabilitation?

A
  • Post-op pain meds
  • Anti-anxiety meds if needed (trazadone, alprazolam, diazepam, acepromazine)
  • Acupuncture
  • Laser therapy
  • Cryotherapy
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7
Q

Thermotherapy

A
  • Use of superficial heat and cold as a therapeutic modality for the treatment of disease or trauma
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8
Q

How far does thermotherapy penetrate?

A
  • Estimated depth is approximately 1-2 cm (possibly up to 4cm for cryotherapy)
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9
Q

Cryotherapy

A
  • Temperatures decrease 2.2°C, 4.1°C, and 6.5°C after 5, 15, and 30 minutes of ice pack application, respectively during studies
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10
Q

When to use cryotherapy?

A
  • Primarily used during acute phase of tissue injury and healing - first 72 hours
  • May be used after exercise to minimize adverse secondary inflammatory responses or chronic conditions such as arthritis
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11
Q

Physiological effects of cryotherapy

A
  • Vasoconstriction, decrease blood flow, analgesia, reduce edema, reduce inflammation, and reduce muscle spasms
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12
Q

Benefits of cryotherapy

A
  • Assist in facilitating pain free exercise

- May permit decrease in pain medications

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13
Q

Application methods of cryotherapy

A
  • Reusable commercial ice packs
  • Home made ice packs
  • Crushed or cubed ice
  • Water/alcohol (3:1) slush packs)
  • Ice cups (for ice massage)
  • Cold compression units
  • Vapocoolant sprays
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14
Q

What type of barrier should be between ice pack and skin?

A
  • Thin towel to no barrier

- Too much of a barrier decreases efficacy

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15
Q

How long for cryotherapy?

A
  • 10-20 minutes

- q2-4 hours during the first 24-48 hours

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16
Q

Precautions and contraindications for cryotherapy

A
  • Check skin every 5-10 minutes for redness or blanching
  • Areas of previous frostbite
  • Areas of nerve impairment
  • Over areas of open wounds or superficial nerves
  • Areas of decreased to absent sensation
  • Patients with hypertension (may increase BP)
  • Very young or very old patients
  • Not very effective over bandages
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17
Q

How to decrease risks of cryotherapy?

A
  • Alternate times

- 10 min on/10 min off

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18
Q

Superficial heat

A
  • Skin temperature may increase 10°C or more, tissues at 1 cm in depth <3°C, and tissues at 2cm <1°C
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19
Q

When do use heat?

A
  • After acute inflammatory period (>72 hours) or LONGER
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20
Q

Effects of superficial heat therapy

A
  • Opposite cryotherapy (vasodilation, increase blood flow) except also helps with analgesia and reducing muscle spasms
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21
Q

Most important effects of superficial heat therapy

A
  • Vasodilation
  • Increase soft tissue extensibility
  • Pain relief
  • Relaxation of muscle spasm
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22
Q

What is best timing for superficial heat therapy?

A
  • Before stretching and exercises to improve range of motion
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23
Q

How long to do superficial heat therapy?

A
  • 10-20 minutes 3-4 times a day
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24
Q

Methods of application for superficial heat therapy

A
  • Hot packs
  • Heat wrap
  • Whirlpools
  • Circulating warm water blankets
  • Heating pads (BE CAREFUL)
  • Heated dog beds - arthritic dogs
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25
Q

What is the temperature to avoid for superficial heat therapy?

A
  • 113°F
  • Greater than 45°C
  • Painful and can cause IRREVERSIBLE DAMAGE
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26
Q

Precautions for superficial heat therapy

A
  • Risks for thermal injury (greatest with heat lamps and electric heat pads)
  • NEVER PLACE UNDER an anesthetized or heavily sedated animal or one with decreased skin sensation
  • Use towels in between hot pack and patient if concerned
  • If using over abscess/infection, decrease temp and use warm pack to make more comfortable
  • Precautions with: pregnancy, obesity, impaired circulation, poor thermal regulation, cardiac insufficiency, young and old patients
  • Contraindications are active bleeding, acute inflammation, malignancy, thrombophlebitis, fever
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27
Q

Passive range of motion

A
  • Motion of a joint that is performed without muscle contraction within the available ROM, using an external force (therapist/owner) to move the joint
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28
Q

Active range of motion

A
  • The motion of a joint that may be achieved by active muscle contraction
  • The pet is doing this
  • This is your ultimate goal
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29
Q

Stretching

A
  • Additional force applied at the end of the available ROM is defined as stretching
  • Used in conjunction with PROM
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30
Q

Benefits of Passive range of motion

A
  • Measure progress
  • Decrease pain
  • Improve range of motion of a joint
  • Improves rate of recovery
  • Prevents joint and soft tissue contracture or shortening
  • Maintains mobility between soft tissue layers
  • Enhances blood and lymphatic flow
  • improves synovial fluid production and diffusion
  • Can slow but not prevent muscle atrophy
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31
Q

Proper technique for PROM

A
  • Relaxed, comfortable patient in lateral recumbency
  • Quiet area, away from people and animals
  • Gentle massage for 2-3 minutes before it can help
  • Try to be gentle and not create pain (though may need a muzzle initially)
  • Support bones proximal and distal to joint and avoid varus and valgus stresses
  • Try and isolate each joint but be aware that some joints affect ROM in other joints (hock and stifle)
  • Smooth, slow and steady, monitor for response
  • 15-20 repetitions 2-4 times a day for routine problems but may need more
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32
Q

Precuations or contraindications for PROM

A
  • If the motion will further injury or instability

- Unstable fracture near a joint or unstable ligament or tendon injury

33
Q

In hospital PROM

A
  • Board and PROM post-op if needed

- Staff training

34
Q

Stretching

A
  • Indicates maneuvers (passive exercise) to elongate tissues shortened as a result of a pathologic condition and to increase flexibility and joint motion in normal and abnormal tissues
  • Opposite the action of the target muscle
  • Two joint muscles require two actions to stretch
  • Performed at the end of PROM by holding the end movement for 15-30 seconds then repeat
  • Beneficial to apply heat prior to stretching
35
Q

Mechanical benefits of massage

A
  • Relieve tense muscles through relaxation, decreased pain, and increased mobility
  • Improve circulation and lymphatic flow
  • Specialized massage can help with scar tissue mobilization, trigger points, and myofascial tissue release
36
Q

Other patient benefits of massage

A
  • Reduce tension
  • Relaxes patient
  • Reduces stress hormones
  • helps release endorphins
  • Improves human-animal bond
37
Q

Contraindications of massage

A
  • Shock (lowers blood pressure)
  • Fever
  • Acute inflammation (can massage elsewhere)
  • Skin problems
  • Infectious diseases
38
Q

What determines post-op exercise?

A
  • Intensity and return to activity will depend on type of surgery, surgeon’s preference, patient healing, etc.
  • No off leash activity until stable or healed
39
Q

Goals for exercise

A
  • Controlled weight bearing to facilitate healing
  • Decrease compensatory issues
  • Reduce/slow muscle atrophy
  • Active range of motion
  • Faster return to function
  • Exercise the mind
40
Q

Weight shifting or proprioceptive exercises

A
  • Some can start immediately
  • Swaying, rocking, foam pads
  • Side bends
  • Happy Butt Rub Dance
  • Walking in a circle or weave cones
41
Q

Further along post-op exercises

A
  • Three or two legged stands
  • Front foot on a step
  • Obstacle course and/or Cavalettis
  • Placing an annoyance on good foot
  • Pick 2-3 exercises to do 2-3 times a day
42
Q

Non-ambulatory cases post-op exercise

A
  • Assistive standing exercises
  • Slings
  • Carts
  • Physiorolls/Physioballs
43
Q

Independent ambulation

A
  • Leash walks (inclines/declines)
  • Leg weights
  • Stair climbing
  • Treadmill
  • Cavalettis
44
Q

What do physioballs work on?

A
  • Balance and core strengthening
45
Q

Front-limb strengthening exercises

A
  • Downhill walking
  • Wheelbarrowing
  • Digging
  • High fives/shake
  • Sit to down
  • push-ups
46
Q

Hind limb strengthening exercise

A
  • Up-hill walking
  • Stairs
  • Backward walking
  • Sit to stand
  • Dancing
  • Weight pulls
47
Q

What determines when to start exercises?

A
  • Surgery type and patient
48
Q

Indications for underwater treadmill therapy

A
  • Post-op recovery (TPLO, fracture, FHO) - after incision is healed
  • Neurologic rehabilitation (surgical and non-surgical)
  • Osteoarthritis
  • Non-surgical candidates
  • Conditioning
  • Weight loss
49
Q

Indications for swimming

A
  • Forelimb rehabilitation
  • Osteoarthritis
  • Conditioning/weight loss
50
Q

Benefits of hydrotherapy

A
  • Improves strength
  • Improves muscular and cardiorespiratory endurance
  • Range of motion
  • Minimizes/decreases pain
  • Proprioception
  • Reduces edema
  • mental well-being
51
Q

Ideal water temp

A

-78-90°F; 86-92°F

52
Q

Buoyancy

A
  • Upward thrust of water on a body that creates an apparent decrease in the weight of the body while immersed
53
Q

How does hydrotherapy work?

A
  • Buoyancy and hydrostatic pressure
  • Reduces weight on distal joints
  • Aids in rehabilitation of weak and painful joints
  • Allows patient to exercise in an upright position with decreased pain by minimizing amount of weight bearing on joints
54
Q

Hydrostatic pressure

Pascal’s law

A
  • Fluid pressure is exerted equally on all surfaces of an immersed body at rest at a given depth
  • The deeper a body is immersed in water, the greater the pressure exerted
55
Q

Benefits of hydrostatic pressure

A
  • Constant pressure helps working with swollen joints or edematous tissues
  • May also decrease pain during exercise –> stimultes sensory receptors that cause a decrease in nociceptor hypersensitivity
56
Q

Viscosity and resistance

A
  • Measure of frictional resistance caused by cohesive or attractive forces between the molecules of a liquid
  • Significantly greater in water than air –> more difficult to move through water than air
57
Q

Benefits of viscosity and resistance in hydrotherapy

A
  • Provides more resistance to strengthen muscles and improve cardiovascular fitness
  • Increases sensory awareness and assists in stabilizing unstable joints
  • Helps prevent from falling (gives more time to react) –> increased confidence in the patient to ambulate
58
Q

Surface tension

A
  • Water molecules tend to adhere to each other = cohesion
  • Water molecules have a greater tendency to adhere together on the surface –> resistance to movement is slightly greater at the surface of the water due to more cohesion at the surface
  • Not a factor if body is submerged in water
  • Significant factor when a limb breaks the surface of the water
  • Weak patients perform better with movements just below the surface
59
Q

Contraindications or precautions with hydrotherapy

A
  • cardiac dysfunction
  • Respiratory dysfunction
  • Skin infections
  • Post-op incisions
  • Diarrhea
  • patient tolerance or disposition
60
Q

Class IIIB laser

A
  • “cold laser”
  • under 500 nM
  • Doesn’t produce heat
61
Q

Class IV laser

A
  • Anything over 500 nM

- therapeutic to surgical

62
Q

Optic window

A

600 nM and 1000 nM

63
Q

What type of wavelength for superficial vs deeper tissues?

A
  • Superficial tissues: lower wavelengths (670nm)

- Deeper tissues: higher wavelengths (808 nM)

64
Q

How deep do lasers penetrate?

A
  • up to 5cm
65
Q

How do therapeutic lasers work?

A
  • Stressed/damaged cells absorb photons –> absorbed by chromophores on mitochondria
  • Improve cell respiration, improve/normalize cellular function, and improve ATP production (release of nitrous oxide to decrease edema)
66
Q

What do therapeutic lasers do therapeutically?

A
  • Decrease inflammation and edema, improve blood flow, decrease pain, improve healing
67
Q

Contraindications or precautions for lasers

A
  • Neoplasia
  • Active bleeding
  • Epiphyseal plates (Risk vs benefit)
  • Eyes (Class IV can burn out retina)
  • Photoesensitization medicatiosn
  • Reproductive organs or pregnancy
68
Q

Therapeutic ultrasound indication

A
  • Modality of choice for deep tissue heating
69
Q

Actions of therapeutic ultrasound

A
  • Improves blood flow, warms tissues, increases tissue flexibility, decreases pain, improves healing
  • Good for contractures, tendinopathies, muscle spasms
70
Q

Contraindications or precautions with therapeutic ultrasound

A
  • Directly over the heart in animals with pacemakers
  • Over areas that have risk of emboli
  • Over epiphyseal area of bones
  • Over spinal cord in post-laminectomy patients
  • Pregnancy (over the abdomen)
  • Plastic and metal implants
  • Infected areas and neoplasia
71
Q

NMES (neuromuscular electrical stimulation) benefits

A
  • Help prevent muscle atrophy

- Helps facilitate muscle contraction to retrain muscles

72
Q

TENS (transcutaneous electrical nerve stimulation)

A
  • Help with pain - gate theory
  • Used to stimulate acupuncture points
  • Reduce edema
73
Q

Contraindications/precautions of NMES and TENS

A
  • Over the heart in patients with a pacemaker
  • Patients with seizure disorders
  • Over areas of reduced sensation/infection/neoplasia
  • Over the trunk of patients that are pregnant
74
Q

Platelet rich plasma

A
  • Can augment or stimulate healing by turning on the same biological healing process that normally occurs
  • Can enhance the proliferation of stem cells and fibroblasts
  • Act as “scaffolding” for stem cells when used together
  • Often used for tendinopathies
75
Q

STEM cell therapy

A
  • Ability to differentiate and transdifferentiate into tissue-specific cells, to fuse with the resident cells, to secrete a wide array of paracrine factors to stimulate the survival and functional recovery of the resident cells, or to regulate the local microenvironment or niche and immune response
76
Q

Shock wave - what is it used for?

A
  • Tendinopathies, arthritis, non-healing fractures
  • Often used in equine
  • Often have to be sedated
77
Q

Shock wave - what is it?

A
  • High frequency sound wave
78
Q

Shock wave - how is it proposed to work?

A
  • Decrease inflammation by down-regulating TNF-alpha, IL-10
  • Increase bone and tissue healing by increasing BMP2, TGFB, VEGF, eNOS, PCNA
  • Decrease pain: increased serotonin in dorsal horn, descending inhibition
79
Q

Pulsed electronic magnetic field therapy

A
  • Signal is specifically targeted to enhance the binding of calcium
  • This, in turn, accelerates the nitric oxide (NO) cascade, which regulates inflammation and healing

Ortho (10 decks)

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