Precautions and Contraindications Flashcards
Assisted Cough (BIG FAT PIGRR)
Bowel obstruction
increased ICP
gastric reflux/hiatus hernia
fragile thoracic cage (osteoporosis, rib metastases, AS)
abdominal aortic aneurysm
trauma to thorax (fractured rib, flail segments, pulmonary contusion, cardiac contusion, acute dysrhythmia, pericardial effusion)
pregnancy
inferior vena cava filters
gastrostomy/jejunostomy tubes
recent abdominal surgery
ruptured diaphragm [not an exhaustive list, includes contraindication (ruptured diaphragm)]
Manual Hyperinflation (HUURP)
CI: High frequency oscillation ventilation, unstable head injury, undrained pneumothorax, injury, recent pneumonectomy/lung resection, proximal tumor
PC: hemoptysis, bullae, high RR or PEEP, severe bronchospasm, CVS instability
Percussions / Vibrations / Rib Springing
Burns
unstable CV condition,
recent skin graft/flaps,
respectable tumour,
pneumothorax,
fractured ribs,
osteoporosis,
hemorrhage,
metastatic bone cancer,
emphysema of neck/thorax,
Postural Drainage
Hemoptysis
aneurism
PE,
patient upset/agitated,
increased ICP,
esophageal anastomosis,
CHF,
recent laminectomy,
unstable CV status,
untreated pnemothorax
Proning
Facial trauma, unstable spinal injury uncontrolled cerebral hypertension, burns, open chest or abdomen,
PC: hemodynamic instability, active intra-abdominal processes
Suctioning (Nasopharyngeal)
Nasal bleeding,
bleeding disorder,
epiglottitis or coup,
acute head or facial injury,
CSF leakage,
nasal stenosis,
nasal pathology (epistaxis, polyps, septal deviation, infection),
basal skull fracture
Cardiac Rehab
No Valsalva,
extensive upper body activity,
isometric or static exercises
Beta Blockers
Blunted heart rate and blood pressure response therefore use RPE not age predicted heart rate range
Simple Spirometry
MI in the last month
recent stroke/abdominal/thoracic surgery
uncontrolled HTN
recent pneumothorax
Inspiratory Muscle Training
Acute respiratory failure, cognitive impairments
Incentive Spirometry
Cognitive impairment,
patient unable to deep breathe effectively due to pain,
diaphragmatic dysfunction or opiate analgesia.
Pt unable to generate adequate inspiration with a vital capacity <10 mL/kg or an inspiratory capacity <33% of predicted normal
Lumbar Scan
Mandatory Questions: Bowel or bladder changes
saddle paresthesia,
anesthesia,
effect of cough/sneeze/Valsalva (increased abdominal pressure),
neurological symptoms,
bilateral lower extremity symptoms
Lumbar Detailed Articular Ax
CI: Spondylolisthesis, fracture, infection, local neoplasm
PC: Osteopenia/porosis, inflammation, active cancer, acute trauma
Lumbar Traction
Acute, patient unable to tolerate position, patient has bad response to traction, recent surgery, underlying hypermobility or instability, vascular compromise
Cervical Scan
Mandatory questions: Bowel or bladder changes, Bilateral or quadrilateral paresthesia or anaesthesia, 5 D’s (dysarthria, dysphagia, dizziness, diplopia, drop attacks), nystagmus, perioral numbness, headaches coupled with neck pain, recent upper respiratory tract infection
Cervical Detailed Articular Ax
CI: Local fracture or inflammation, active neoplasm or infection, acute trauma, local instability, vascular pathology of carotid or vertebral arteries
PC: Osteoporosis, anti-coagulant medications
Cervical Traction
S/S of vertebral artery compromise, cervical myelopathy, rheumatoid arthritis, TMJ dysfunction, glaucoma, cervical instability
Pelvic Assessment
Mandatory questions: Bowel or bladder changes, saddle paresthesia, anesthesia, perianal numbness, clicking or feeling of giving way (pubic symphysis)
Dix Hallpike (BPPV)
Cervical spine instability, VBI, Arnold-Chiari malformation, acute whiplash, RA, prolapsed IV disc with radiculopathy, cervical myelopathy
Resistance Exercise
CI: acute inflammation, joint effusion, severe CVD, #, joint muscle pain during AROM or isometric testing
PC: osteoporosis/osteopenia, fatigue, medications, inappropriate temp and clothing
Avoid: Valsalva, ballistic uncontrolled movements, pain, dizziness, usual SOB
Massage
Autoimmune disease during flare ups, fever, haemorrhage, embolism, DVT, flu, migraine, serious psych diagnosis, recent surgery, acute RA, sickle cell disease, pneumonia
DTFM
CI: Infection/skin breakdown, inflammatory joint disease, recent local injection, ossification/calcification, bursitis, neural irritation, anticoagulant or anti-inflammatory drug use
PC: elderly, children, diabetics (due to decreased sensation)
Stretching
Bony block, recent #, acute inflammatory process of the joint, sharp or acute joint pain, hematoma or tissue trauma, contracture or soft tissue is providing stability to area or function (ex. tendodesis grip), hypermobile segment, recent corticosteroid injection to involved tissue
PNF (Neuro)
Precautions: avoid quick stretch on hypertonic muscles, gentle stretch and care on hypotonic muscles, care to not promote invariant movement patterns, watch for substitutions
Sliders and Tensioners
CI: Undiagnosed condition, conditioning worsening, severe irritability, presence of hard neurosigns
Traction
CI: acute, patient can’t tolerate traction position, bad response to manual traction, recent surgery, underlying hypermobility or instability, malignancy, SSx of spinal cord or cauda equina compression, ankylosing spondylitis
PC: pregnancy, respiratory problems, osteoporosis, spondylolisthesis, hypermobility/instability, claustrophobia, extremely restricted ROM, little improvement with rest
*always check: BCI, neuro test, neuromobility, neurocondution, stability
Cervical CI: VBI, TMJ dysfunction, RA, down syndrome, cervical myelopathy, glaucoma
Joint Mobilizations
CI: #, neoplasm, acute inflammatory condition, apparent hypermobility or instability n direction of techniques, bone/joint infection, spinal cord sign or symptoms, spasm or boney end feel
PC: impaired circulation or sensation, osteoporosis or compromised health, haemophiliacs, poor skin conditions, open wounds, discomfort in treatment positions, marked skeletal deformity
Joint Manipulations
, joint instability in the direction of manipulation, inflammatory joint disease, malignancy, bone disease, osteoporosis, open wound or skin lesion in area, poor circulation or sensory deficit in the area, spasm or increased pain with test pull, unsure of health or diagnosis, patient doesn’t want to be manipulated, patient is on anticoagulants, haemophiliacs, inability of patient to relax
Precautions for Novice Manipulators: pain or instability proximally in the lower kinetic chain, uncertainty about indications of technique, children, diabetics, elderly, positive straight leg raise (for talocrural manipulation)
Infection/skin breakdown, inflammatory joint disease, recent local injection, ossification/calcification, bursitis
THR – Posterio-lateral Approach
No hip flexion past 90 deg, No IR or ER, No hip adduction past midline for first 3 months
THR - Lateral Approach
No hip flexion past 90 deg, no IR, no hip adduction past midline for first 3 months
THR – Anterior Approach
No hip extension, no ER, no hip adduction past midline for first 3 months
Total Shoulder Arthroplasty
Immobilization 24hours for 1 week, nightly for 1 month, sling for 4 weeks
Reverse Total Shoulder Arthroplasty
Avoid IR for 6 weeks
Laminectomy
Neutral spine, Log roll for rolling side to side
Spine Unstable
Maintain neutral spine at all times, bed rest, HOB at 0deg, 2-3 person turns at all times
Spine Stable but requires protection
Neutral spine at all times
Sternotomy
No pushing for STS, no lifting 10lbs above waist, no push/pull over 5 lbs
Osteoporosis
No spinal flexion + rotation, Precaution for manual therapy (extension is good!)
Heterotrophic Ossification
Forced PROM, serial casting
Muscular dystrophies
Avoid eccentric exercises
Multiple Sclerosis
Fatigue easily* Contraindications to exercise: heat, and pregnancy, Recommend: interval training
Cerebral Palsy
Monitor hip subluxation – be suspicious if pt cannot ABD leg more than 45 deg
Flaccid Shoulder Post Stroke
No pulleys for ROM exercises above 90 degrees flexion and abduction
COPD
No breath stacking – and only exhale through purse lips
Thrombocytopenia (150,000 – 400,000)
<50,000: avoid activities with contact or risk of falling
40,000-60,000: low weights (1-2lbs), stationary bike low resistance, walking or ADLs
20,000-40,000: low intensity, low weights (0-1 lbs), stationary bike no resistance or minimal, walking and ADLs
<20,000: risk of spontaneous bleed unrelated to trauma
10,000-20,000: doctor approval, active ROM exercises, walking, ADLs
<10,000: no exercise, only essential ADLs, prevent falls and injury
Rheumatoid Arthritis
Acute phase: no stretching (may stretch the synovial membrane and cause irreversible damage)
Exercise and RA and OA
PC: swollen joints at risk for capsular stretch and rupture, OP bone at risk for #, use machines and resistance bands rather than free weights
CI: Increase pain, fatigue or AM stiffness, sudden pain at joint or joint deformity, joint becomes red, swollen and hot after doing exercise (within 24 hours), decreased muscle strength and function (local myositis), neurological SSx (CV involvement), SOB on mild exertion
Pregnancy
Exercise: Antepartum bleed, preterm labor, ruptured membrane, incompetent cervix/changes, Valsalva, exercise techniques that stress the PF and abdominals, rapid uncontrolled movements
Avoid: deep heat modalities or electrical stimulation, manual therapy
Positioning: supine is not contraindicated for short periods of time, prone is not well tolerated, inversion positioning
Exercise and Burns
CI: exposed joint, fresh skin graft, DVT, compartment syndrome
ART
Infusion bag must be kept above insertion line, notify RN if transducer disconnected, ROM restrictions (no hip flexion past 90 deg with femoral ART line)
PICC
Do not mobilize until proper insertion confirmed with x-ray
Patient Controlled Analgesic
Do not push the button for the patient
Epidural
Check sensation and movements prior to mobilizing, if dislodged get help immediately
NG tube
Keep HOB at 30 deg when feeds are on, Do not suction from the same nare that NG is placed
Chest tube
Keep below site of insertion to prevent backflow
Urinary catheter
Keep below site of insertion to prevent backflow
General Subjective Hx - Cancer
Unexplained weight loss, night pain, night sweats
General Subjective Hx -Visceral Dysfx
Non-mechanical behaviour pain, abdominal pain/cramping, pain on urination, pain post-eating/indigestion/reflux
Central Vestibular Disorder
Direction changing nystagmus, inconsistency in test result
