PRINCIPLES OF REHAB

Question 1

What is a physiological movement?

Answer 1

A movement that can be achieved and performed actively by an individual

Question 2

What is a passive physiological movement?

Answer 2

A physiological movement where the therapist does the movement for the patient

Question 3

What is an accessory movement?

Answer 3

Cannot be performed by the individual
They include the roll/spin/glide that occurs in joints during physilogical movements.

Question 4

What are the basic principles of joint mobilisations?

Answer 4

Assess pre and post intervention
Fix procimally - move distally
Stop if painful
Pain dominant
Stiffness dominant
Tissue response
End feel

Question 5

What is pacing?

Answer 5

Building a movement up in small steps based on the patients goals eg starting by walking, then jogging then running

Question 6

Name some different types of exercise

Answer 6

Muscular strength training
Muscular ensurance training
Flexibility
Stability exercises
Balance
CV fitness
Plyometrics

Question 7

How is exercuse prescription goal orientated?

Answer 7

Should be based around the patient’s needs and expectations
Should fit around their lifestyle
Should consider the current state of their tissues
Should be shared goals
The patient should understand the commitment involved

Question 8

What is the FITT acronym?

Answer 8

Frequency
Intensity
Time
Type

Question 9

What is the Borg scale?

Answer 9

1-10: rating of percieved exertion scale
0 - rest
2 - easy
3 - moderate
5 - hard
10 - maximal

Question 10

What is the principle of progressive overload?

Answer 10

Thi is what we require for muscle hypertrophy.
We need to know the baseline
After intial recovery need to time next session to optimise training
Over time will habituate so need to progress load/frequency

Question 11

Apply to FITT principle to strength training

Answer 11

F: 2-3 days per week
I: to muscular fatigue
T - 8-12 reps, 3 second concentric, 3 second eccentric
T - resistance greater than what the body part would normally move

Question 12

Apply the FITT principle to endurance training?

Answer 12

F: 3-5 times per week
I - to muscle fatigure
T - Greater than 15 reps with 1 set
T - lower load
Current ACSM guidelines include strength and endurance training together

Question 13

What are some example of flexibility training?

Answer 13

Static stretching
PNF (hold relax/contract relax)
Ballistic
Dynamic

Question 14

Apply the FITT principle to static stretching

Answer 14

F - daily or on days of strength training
I - to end of available range or onset of symptoms, stretch not pain
T - 15-30 second holds, repeated 2-4 times in one session
T -take muscle to the end of range and hold

Question 15

Apply the FITTprinciple to Balance?

Answer 15

F - no recomendation but not harmful to do daily
I - activity to challenge current level of balance undertaken to loss of balance
T - gradual increase of time able to stay in balance position
T - balance on one leg, stride stance, gym ball, wobble board, trampett, wobble cushion, eyes open, shut and/or distract attention.

Always test the baseline.

Question 16

Apply the FITT principle to CV training?

Answer 16

F - minimum 5 times per week depending on intensity
I - moderate to vigorous (12-16 RPE)
T - 20-60 minutes depending on intensity
T - run, swim, walk, row, cross trainer
= to 150 minutes per week
+ strength work 2 days per week.

Question 17

How can you increase compliance with exercise prescription?

Answer 17

Draw a picture or write it down
Don’t give too many exercises
Fit it into their daily life style
Clear dosage
Clear prognosis
Match what they want to be able to do even if it isn’t what you would like to be able to do.
Get the patient goal orientated (short term, measureable and attainable goals) as this will improve internal motivation, and achieving short term goals can further improve self efficacy.

Question 18

What are some steps on the exercise prescription checklist?

Answer 18

Did you explain the importance of the exercise for the problem
Did you go through the program with them
Did you provide a resource to refer back to
Did you give regression/progression options
Make it fun

Question 19

Explain the motor learning stages within the nervous system?

Answer 19

Cognitive stage: may need more external feedback eg visual, verbal or knowledge of performance
Associative stage: starts to become more coordinated
Autonomous stage: can reply more on internal feedback from the body through kinesthetic awareness from proprioceptors.

Question 20

What are some red flags to look out for in patients presenting back pain?

Answer 20

Onset less than 20 years or greater than 55 years
Non mechanical pain
Thoracic pain
History of cancer, steroid use or HIV
Systemically unwell
Weight loss
Widespread neurological symptoms
Significant trauma.
However, CSP reported there are 163 individual items that could be considered red flags

Therefore, we should consider CES, major intra-abdo pathology, focal infections and fractures and, if suspected, take action.

Question 21

What are some of the symptoms of cauda equina?

Answer 21

Saddle anaesthesia
Bladder/bowel dysfunction
Faecal incontinence
Urine incontinence/urinary retention/loss of urinary sensation
Leg weakness/giving way
Sexual dysfunction

Question 22

What type of infections can be linked with low back pain?

Answer 22

Osteomyelitis - bone/bone marrow or discitis - discs

Question 23

What are some other potential causes of back pain?

Answer 23

Osteoporotic fracture - more likely in the elderly population, can occur even in the absence of obvious trauma risk factors: women in perimenopuase, long term steroid use, family history of osteoporosis, low BMI, heavy drinking and smoking

Neoplasm - a new abnormal growth of tissue

Metastatic cord compression - MSCC is spinal crd compression by direct pressure and/or intervertebral collapse caused by metastatic spread - consider if nocturnal pain, and pain progression, gait disturbance, sensory loss

Spondyloarthropathy - a group of inflammatory conditions

Disc herniation - displacement of disc material beyond the intervertebral disc space, most common lower lumbar

Spinal stenosis - degenerative condition where there is reduced space for neural and vascular structures due to degenerative changes in the spinal canal - radiating pain and paraestheisa into the legs.

Spondylolithesis - when one vertebra (most commonly L4/L5) moves out of position

Scoliosis - sideways curve of the spine with the additon of rotation sometimes

Spondylolysis - defect or stress fracture in the pars interarticularis.

Question 24

What are the three groups of MSK conditions?

Answer 24

Inflammatory conditions eg rheumatoid arthiritis
Conditions of MSK pain eg osteoarthiritis, back pain
Osteoporosis and fragility fractures

Question 25

What is graded exposure?

Answer 25

When we have a problem with pain, our body becomes fearful of the movement which causes the pain
Graded exposure is doing incremental tasks surrounding this movement, to train the brain to feel safe
Working on the edge of the pain, slowly increasing

Question 26

What is population attritable risk?

Answer 26

Considers the number of people with that risk factor

Question 27

What are some conditions that physical activity can help to prevent or manage?

Answer 27

CV: stroke, MI, PVD, CHD, heart failure
Respitory: asthma, COPD, cystic fibrosis
MSK: rheumatoid arthitis, osteoporis, hip fractures, low back pain, fibromyalgia
Endocrine: diabetes
Phsycho + neuro: depression, dementia, schizophrenia, parkinsons disease
Cancer: breat, colon
Beneficial effects on other risk factors: obesity, blood pressure, cholestorol

Question 28

What are the minimum physical activity guidelines for different age groups?

Answer 28

19-64 year olds : 30 minutes of moderate-intensity exercise 5 days per week or 75 minutes of vigorous intesnity spread across the week
Over 64: Muscle strengthening 2 days per week, balance and coordination

Question 29

Managing osteoarthiritis (OA) of the knees?

Answer 29

Exercise
Hydrotherapy
ROM exercise eg stretching
Strengthening exercises (at least 2 days per week)
Aerobic exercise (endorphins are pain relieving hormones)
Weight management
Reducing strain eg pacing activities, good shoes, walking sticks, changes to home
Managing low mood and sleep problems
Painkillers
Surgery

Question 30

What are some initial exercises to perform for the ankle for ankle fracture?

Answer 30

Sitting or lying, pointing toes to the ceiling then away from body.
Moving your feet in circles, 5 times in each direction.
Write the alphabet with your foot.

Question 31

What are some isometric ankle exercises that can be performed after week 6 for ankle fracture?

Answer 31

Without muscle changing length
Isometric dorsiflexion (using opposite foot for resistance)
Isometric plantarflexion (with feet against the wall
Isometric inversion (using opposite foot for resistance)
Isometric eversion (using foot for resistance, scrossed legs)
Static bike

Question 32

What are some additional exercises that can be performed 8 weeks post fracture injury?

Answer 32

Increasing walking distance
Balance
Walking on uneven surfaces
Pick things up with foot
Heel raises
Running

Question 33

What is a closed vs open fracture?

Answer 33

Closed is when the bone does not pierce the skin
Open the bone pierces the skin

Question 34

What is a complete vs incomplete fracture?

Answer 34

Complete extends the whole way across the bone
Incomplete does not cross the bone completely

Question 35

Explain the different types of fracture?

Answer 35

Transverse - stright line across or perpendicular to the bone
Oblique -
Spiral
Stress - small crack or severe bruising in the bone
Comminuted - fracture is in 3 or more pieces with fragments present
Compression - bone is crushed caused fracture bone to be wide and flatter
Segmental - same bone is fractured in 2 places so there is a floating bone
Bowing - incomplete fracture of long bone
Bukle fracture - due to direct axial load the cortex is buckled often distal radius
Greenstick fracture - fracture of a young soft bone in which bone bends and the cortex is broken on one side.

Question 36

What are the Maitland mobilisation grades?

Answer 36

Grade 1 - small amplitude at the beginning of the available range of movement
Grade 2 - large amplitude movement within available range of movement
Grade 3 - large amplitude movement that moves into stiffness or muscle spasm
Grade 4 - small amplitude movement stretching into stiffness or muscle spasm.

Grades 1 and 2 are used to reduce pain and irritability
Grades 3 and 4 are used to stretch the joint capsule and passive tissues which support and stabilise the joint so increase range of movement.