Physical Rehabilitation Flashcards
1
Q
What is physical rehabiliation?
A
- Treatment of injury or illness to decrease pain and restore function
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
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
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
5
Q
Post-op pain meds
A
- Fentanyl/Hydro
- NSAIDs
- Tramadol
- Gabapentin
- Muscle relaxants (methocarbamol, diazepam)
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
7
Q
Thermotherapy
A
- Use of superficial heat and cold as a therapeutic modality for the treatment of disease or trauma
8
Q
How far does thermotherapy penetrate?
A
- Estimated depth is approximately 1-2 cm (possibly up to 4cm for cryotherapy)
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
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
11
Q
Physiological effects of cryotherapy
A
- Vasoconstriction, decrease blood flow, analgesia, reduce edema, reduce inflammation, and reduce muscle spasms
12
Q
Benefits of cryotherapy
A
- Assist in facilitating pain free exercise
- May permit decrease in pain medications
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
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
15
Q
How long for cryotherapy?
A
- 10-20 minutes
- q2-4 hours during the first 24-48 hours
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
17
Q
How to decrease risks of cryotherapy?
A
- Alternate times
- 10 min on/10 min off
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
19
Q
When do use heat?
A
- After acute inflammatory period (>72 hours) or LONGER
20
Q
Effects of superficial heat therapy
A
- Opposite cryotherapy (vasodilation, increase blood flow) except also helps with analgesia and reducing muscle spasms
21
Q
Most important effects of superficial heat therapy
A
- Vasodilation
- Increase soft tissue extensibility
- Pain relief
- Relaxation of muscle spasm
22
Q
What is best timing for superficial heat therapy?
A
- Before stretching and exercises to improve range of motion
23
Q
How long to do superficial heat therapy?
A
- 10-20 minutes 3-4 times a day
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
25
What is the temperature to avoid for superficial heat therapy?
- 113°F
- Greater than 45°C
- Painful and can cause IRREVERSIBLE DAMAGE
26
Precautions for superficial heat therapy
- 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
27
Passive range of motion
- Motion of a joint that is performed without muscle contraction within the available ROM, using an external force (therapist/owner) to move the joint
28
Active range of motion
- The motion of a joint that may be achieved by active muscle contraction
- The pet is doing this
- This is your ultimate goal
29
Stretching
- Additional force applied at the end of the available ROM is defined as stretching
- Used in conjunction with PROM
30
Benefits of Passive range of motion
- 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
31
Proper technique for PROM
- 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
32
Precuations or contraindications for PROM
- If the motion will further injury or instability
| - Unstable fracture near a joint or unstable ligament or tendon injury
33
In hospital PROM
- Board and PROM post-op if needed
| - Staff training
34
Stretching
- 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
Mechanical benefits of massage
- 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
Other patient benefits of massage
- Reduce tension
- Relaxes patient
- Reduces stress hormones
- helps release endorphins
- Improves human-animal bond
37
Contraindications of massage
- Shock (lowers blood pressure)
- Fever
- Acute inflammation (can massage elsewhere)
- Skin problems
- Infectious diseases
38
What determines post-op exercise?
- 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
Goals for exercise
- 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
Weight shifting or proprioceptive exercises
- Some can start immediately
- Swaying, rocking, foam pads
- Side bends
- Happy Butt Rub Dance
- Walking in a circle or weave cones
41
Further along post-op exercises
- 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
Non-ambulatory cases post-op exercise
- Assistive standing exercises
- Slings
- Carts
- Physiorolls/Physioballs
43
Independent ambulation
- Leash walks (inclines/declines)
- Leg weights
- Stair climbing
- Treadmill
- Cavalettis
44
What do physioballs work on?
- Balance and core strengthening
45
Front-limb strengthening exercises
- Downhill walking
- Wheelbarrowing
- Digging
- High fives/shake
- Sit to down
- push-ups
46
Hind limb strengthening exercise
- Up-hill walking
- Stairs
- Backward walking
- Sit to stand
- Dancing
- Weight pulls
47
What determines when to start exercises?
- Surgery type and patient
48
Indications for underwater treadmill therapy
- Post-op recovery (TPLO, fracture, FHO) - after incision is healed
- Neurologic rehabilitation (surgical and non-surgical)
- Osteoarthritis
- Non-surgical candidates
- Conditioning
- Weight loss
49
Indications for swimming
- Forelimb rehabilitation
- Osteoarthritis
- Conditioning/weight loss
50
Benefits of hydrotherapy
- Improves strength
- Improves muscular and cardiorespiratory endurance
- Range of motion
- Minimizes/decreases pain
- Proprioception
- Reduces edema
- mental well-being
51
Ideal water temp
-78-90°F; 86-92°F
52
Buoyancy
- Upward thrust of water on a body that creates an apparent decrease in the weight of the body while immersed
53
How does hydrotherapy work?
- 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
Hydrostatic pressure
| Pascal's law
- 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
Benefits of hydrostatic pressure
- 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
Viscosity and resistance
- 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
Benefits of viscosity and resistance in hydrotherapy
- 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
Surface tension
- 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
Contraindications or precautions with hydrotherapy
- cardiac dysfunction
- Respiratory dysfunction
- Skin infections
- Post-op incisions
- Diarrhea
- patient tolerance or disposition
60
Class IIIB laser
- "cold laser"
- under 500 nM
- Doesn't produce heat
61
Class IV laser
- Anything over 500 nM
| - therapeutic to surgical
62
Optic window
600 nM and 1000 nM
63
What type of wavelength for superficial vs deeper tissues?
- Superficial tissues: lower wavelengths (670nm)
| - Deeper tissues: higher wavelengths (808 nM)
64
How deep do lasers penetrate?
- up to 5cm
65
How do therapeutic lasers work?
- 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
What do therapeutic lasers do therapeutically?
- Decrease inflammation and edema, improve blood flow, decrease pain, improve healing
67
Contraindications or precautions for lasers
- Neoplasia
- Active bleeding
- Epiphyseal plates (Risk vs benefit)
- Eyes (Class IV can burn out retina)
- Photoesensitization medicatiosn
- Reproductive organs or pregnancy
68
Therapeutic ultrasound indication
- Modality of choice for deep tissue heating
69
Actions of therapeutic ultrasound
- Improves blood flow, warms tissues, increases tissue flexibility, decreases pain, improves healing
- Good for contractures, tendinopathies, muscle spasms
70
Contraindications or precautions with therapeutic ultrasound
- 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
NMES (neuromuscular electrical stimulation) benefits
- Help prevent muscle atrophy
| - Helps facilitate muscle contraction to retrain muscles
72
TENS (transcutaneous electrical nerve stimulation)
- Help with pain - gate theory
- Used to stimulate acupuncture points
- Reduce edema
73
Contraindications/precautions of NMES and TENS
- 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
Platelet rich plasma
- 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
STEM cell therapy
- 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
Shock wave - what is it used for?
- Tendinopathies, arthritis, non-healing fractures
- Often used in equine
- Often have to be sedated
77
Shock wave - what is it?
- High frequency sound wave
78
Shock wave - how is it proposed to work?
- 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
Pulsed electronic magnetic field therapy
- Signal is specifically targeted to enhance the binding of calcium
- This, in turn, accelerates the nitric oxide (NO) cascade, which regulates inflammation and healing
