Principles Of Exercise Testing Flashcards
What are some tasks that need to be completed before you start a patient on an exercise test?
Collected full medical history?
Has a phycisian performed a prescreeening for exercise capacity or an exercise stress test?
Risk factor analysis done?
Is the patient using any meds that might affect health, performance or result interpretation?
Have they completed a pre-exercise questionnaire [PAR-Q]?
What other difficulties [learning, memory, commutation, balance, thermoreg,etc] might the patient have?
Is the patient ready to exercise?
Are they appropriately attired?
Are they stress? Ill informed?
Some guidelines for Aerobic testing?
Follow standard guidelines for AE testing [ACSM guidelines], including use of slow, progressive warmup, familiarisation, good instruction, etc.
May need prior stretch session to increase ROM in spastic patients
May be a need for extra stabilisation, ‘spotting’ and padding to prevent injury
Thermoreg might be impaired, must then perform in temp and humidity controlled room
In some patients with brain injury, CP, etc, it might not be possible to collect expired air; facial muscles may distort mouth/nose area.
Aerobic Testing - Choosing a walk/run treadmill test
No pacing strategy required
May need to increase treadmill incline rather than speed; unhealthy or people with spasticity may be speed limited
May need to relate performance to RPE if meds or injury affects HR responses - important if muscle weaknesses since ‘working’ muscles does more work and fatigues faster
Likely need to use harness for stability and provide extra supervision/protection.
Aerobic Testing - What are the starting loads for incremental tests?
In most cases, there will be a need for alternative tests - spasticity might cause foot drop and increase fall risk, patients lacking limb functions need specific testing etc. can use wheelchair, arm cranking, stationary bike
Can use incremental tests- starting load and increments just need adjusting - most patients lack cooordination, strength or limb movement and fitness:
Arm crank: start 0-15W @ 30-50rpm and increase 5-10W every 2 min
Cycle ergometer: start 25-50W @ 50-60rpm and increase 15-30W every 2 min
Benefits of Wheelchair Aerobic testing?
Provides postural stabilisation for those lacking muscle function
Can use own chair for familiarity
Well practised movement pattern and confident with it
Other issues to consider for reliability?
Workloads differ in al circumstances depending on capacity of patient, friction of tyres on runway [check tyre pressure- keep it consistent between tests]
Patients health on the day of testing, familiarisation with treadmill, etc.
Muscle Strength Testing Guidelines ?
Follow normal strength testing practices, including prescreenng, warm up, instruction, familiarisation, etc
Must choose strength ex that:
- provide both overall strength qualification as well as info about strength in tests similar to the tasks of daily living [e.g. Specificity]
- provide no danger to the patient [e.g. May use isometric tests instead of dynamic]
- have a high reliability for that patient
Muscle Strength Testing - Considerations?
Extra instruction and learning if learning difficulties [e.g. Stroke/brain injury patients]
Stabilisation if trunk muscle paralysis [trunk muscles often lose tone and peripheral muscles gain it (spasticity) with brain and spinal cord injury]
Fix/strap hands or feet to equipment to allow lift - ensure they have sufficient ROM for machine
Spasticity of antagonists might impact on load lifted - muscle may be strong but lift is weak
Reduce movement speed [especially eccentric phas - 4s to minimise muscle tone increases in spastic muscles]
Consider other special cases e.g. Spina bifida patients often allergic to latex/rubber weights
Flexibility Testing Guidelines?
Important component of fitness
Spasticity may limit ROM, need continual feedback on effect of interventions
Can measure flexibility and balance simultaneously, e.g. Touch toes and measure distance from floor
Be as accurate and reproducible as possible - use manual or electronic goniometer, ‘sit & reach’ box, etc.
How can you ensure the reliability of flexibility tests?
Same postures used every time
Same instructions given
Same time of the day
Same warm up and number of practices stretches
In many spastic patients, continued stretching allows increased ROM, so need to keep test attempts constant
Balance testing - Why do we need to test balance?
Brain/SC injuries/disorders often cause balance problems
Poor postural control in spastic patients, lesions in motor planning areas or cerebellum have significant effects
Need to test balance:
- to determine capacity of daily living
- to assess progress of injury recovery [balance improves as injury repairs - need specific tests]
- to determine capability of performing other training and testing tasks
Balance Testing -
What is the Romberg’s test?
How do you perform the Romberg’s Test?
The Romberg’s test is a neurological test to asses dorsal columns of SC; position and vibration sense.
Maintaining balance requires 3 main inputs: 1. Visual, 2. Vestibular and 3. Joint position sense.
Step 1: stand still with feet together and eyes open - if unable to do so, then probable cerebellar dysfunction, poor sensorimotor integration of corticospinal and medial lemniscus [dorsal column] tract.
Step 2: close eyes- significant swaying or falling indicative of ‘Romberg’s positive, proprioceptive and vestibular pathways affected.
Positive Romberg’s test suggests ‘sensory ataxia’ i.e. Lack of movement coordination
There’s a learning effect, which plateaus after about 3-4 attempts, need to watch for injury of falling patients
Balance Testing - Berg Balance Scale
Score 14 elements out of 4 marks based on com-entrench Add all scores: 0-20 = wheelchair bound 21-40 = walking with assistance 41-56 = independent
Can track progress over time after strength, fitness, flexibility and balance training
