Relaxation Flashcards
What Is Stress?
Stimulus-An outside force that puts demands on you.
Response-A physical response going on within you.
Transaction-An exchange between a stimulus, our perception of it, and the response it causes.
Holistic Phenomenon-Describes stress as part of a larger whole taking into account lifestyles and other circumstances.
Stressor- Stimuli which causes a stress response.
Stress Response- A set of physiological adaptations of the body to regain homeostasis in the face of threat, harm, or loss.
Homeostasis
Is a state of “normalcy or balance.”
BP, heart rate, hormone levels and other vital functions are maintained within a narrow range.
General Adaptation Syndrome
Alarm Phase- (Fight-or-Flight reaction) the body mobilizes energy to meet the demands of stressors.
Resistance Phase- The body attempts to maintain homeostasis.
Exhaustion Phase- A body part or system breaks down as a result of the energy demands of chronic stress.
Alarm Phase:Fight-or-Flight Response
Endocrine system releases hormones (cortisol, epinephrine, norepinephrine)
Hearing & vision becomes acute.
Heart rate accelerates to pump more oxygen.
Liver releases extra sugar to provide energy boost to muscles.
Perspiration increases to cool the skin.
Endorphins are released to relieve pain in case of injury.
Increased metabolic rate.
Decreased digestive activity.
Cortisol Response
Decreased immune function
changes in glucose metabolism
changes in neurochemistry
changes in cardiovascular status
Physical Therapist Role
Most common symptom: tension related pain
Disorders related to increase tension/stress:
Heart attacks
Cerebrovascular injuries
Chronic musculoskeletal problems
Peripheral and neurovascular syndromes
Recognize Signs of Tension
Within scope of practice, treat signs of tension
Relaxation is a key to reducing muscle tension, anxiety, nervousness and stress
Relaxation is not a Magic Button and does NOT cure joint dysfunction or other musculoskeletal trauma
Contributors to Increase Muscle Tension
Emotional tension Physical trauma Infection Immobilization Other stressors
Cycle of pain, muscle guarding,Retained metabolites, and restricted motion
Managing Stress
Social Support Exercise Proper Nutrition Time Management Cognitive Techniques Clear Communication Relaxation Techniques
Relaxation
Definition:
transitive verb
1: to make less tense or rigid : slacken
2: to make less severe or stringent : modify
3: to deprive of energy, zeal, or strength of purpose
4: to relieve from nervous tension
intransitive verb
1: to become lax, weak, or loose : rest
2: to become less intense or severe
3: of a muscle or muscle fiber : to become inactive and lengthen
4: to cast off social restraint, nervous tension, or anxiety
5: to seek rest or recreation
6: to relieve constipation
7: to attain equilibrium following the abrupt removal of some influence (as light, high temperature, or stress)
Physical Signs of Tension
HR BP Increased muscle tone Altered breathing pattern “agitated” or “fidgety”
Examination for Tension
PMH: Cardiovascular and respiratory symptoms Eye, ear, nose and throat symptoms, Headaches or head pain TMJ dysfunctions Digestive disorders Endocrine imbalances Muscle tension pain
Symptoms patient may relate:
Increased eating, smoking, drinking
Difficulty falling asleep, waking up feeling exhausted, keyed up and jittery during the day
Observation: Signs of agitation, signs of anxiety or restlessness
Chewing of lips Grinding or clenching teeth Biting fingernails Pacing Clenching, unclenching of hands
Assessment of Stress
One tool: symptoms of stress checklist 0-7 = low 8-14 = moderate 15-21 = high 22+ = very high
How do we treat tension?
Massage Modalities: Moist Heat Ultrasound Electrical Stimulation TENS Muscle Re-education Progressive Relaxation Biofeedback Autogenic training
Approaches to Treatment
Cognitive or mental
Somatic or physical
Cognitive or mental approach
Meditation
Sensory awareness techniques
Autogenic training
Somatic or physical approach
Passive distraction (Jacobson’s techniques) Active or dynamic distraction (Feldenkreis Techniques, Tai chi)
Passive Relaxation Strategies
Deep Breathing
Meditation
Visual Imagery
Autogenic Training
Sit in the meditative posture and scan the body
“my right arm is heavy”
“my arms and legs are heavy and warm” (repeat 3 or more times)
“my heartbeat is calm and regular” (repeat 3 times)
“my solar plexus is warm” (repeat 3 times)
“my forehead is cool”
“my neck and shoulders are heavy” (repeat 3 times)
“I am at peace” (repeat 3 times)
Active Relaxation Strategies
Systematic Muscle Relaxation Yoga Static Stretching T’ai Chi Massage Hobbies & recreational activities
Patient/Client-Related Instruction
Process of educating, informing, or training
Patients, clients, family members, significant others, or care givers
Promote and optimize physical therapy services
Types of Instruction
Current condition Enhancement of performance Health wellness and fitness programs Plan of care Risk factors for pathology Transitions across settings Transitions to new roles
Patient Learning
Cognitive: information and facts
Affective: attitude and motivation
Psychomotor: motor programs and exercise programs
Perceptions
Physical Therapists believe they educate 80-100% of their patients in some manner
Most education is in one of the following:
Current condition
Diagnosis
Plan of care
Less likely to educate on…
Relationships between symptoms and patients daily routines
Expected response to exercise
Stress management
Health and wellness
Literature Results
Studies have shown that patients adherence to physical therapy exercise programs depends on the time spent educating the patient on prognosis and expectations from rehab.
With education, there can be as much as an 80% change in attitudes and behaviors
Why there’s need for patient education
Patients are discharged quicker
Patients are sicker when discharged
Patients require more education for home than they use to.
Pro: limits the development of an external focus = patient dependence on the therapist for management of condition
Skill Set for Effective Communication
Active listening skills
Reflection on patient replies
Providing appropriate feedback
Active Listening
Close observation of words
Intonation
Body language
Eye contact with affirmation
Reflection of Patient Report
Seeks to clarify what the PT heard
Allows patients to change or modify comments
Validates patient report – I heard what you are saying
Helps to build rapport with patient
Clarify how progress is defined (pain, time, movement)
Providing appropriate feedback
Sluijs et al: lack of positive feedback is one of the primary factors related to adherence to a rehab exercise program
Need to learn how much feedback to give, when to give it and what type to give.
Response of patient: listen to it and adjust feedback accordingly
Adherence and Motivation
Best designed program will do nothing for the patient if the patient isn’t compelled to participate
Sluijs et al:
% patients who fully comply: 37%
% patients who partially comply: 76%
Lack of Compliance or Adherence
Affective Domain Barriers to Adherence Lack of positive feedback Feeling of helplessness Less educated: more likely to have adherence to a program No gender differences with compliance
Theories on Patient Behavior
Health Belief: stresses elimination of behaviors
Health Locus of Control
Self Efficacy
Trans theoretical: stages of change Pre-contemplation Contemplation Preparation Action Maintenance
Pre-contemplation Contemplation Preparation Action Maintenance
Pre-Contemplation
No intention of changing
See no need for change
Contemplation
Considering change, haven’t initiated it yet
Plan to make a change within 6 months
Patients are usually here
Preparation
Planning to change within the month
No action yet
Patients are usually here
Action
Have reached a certain criterion level which demands change for the individual
We want our patients here!
Maintenance
Reached criterion level
Maintained at least months
Habit breaking
Application to Patient Education
What stage is the patient in?
Listen for cues
Help patient identify barriers to participation
Input from the patient – what would it take to remove the barriers?
Pro’s of participation need to outweigh the cons of participation
If pre-contemplation
Help patient identify goals that could be achieved
If contemplation
Encouragement
Provide information
Help patient to perceive a relationship among an injury or pathology, exercise and expected outcome
If Action
Engage in a plan of care
Identify barriers
Positive reinforcement
Motivation is the Key
What motivates the patient?
Identify the motivators and tutor the program to the motivators
Non specific programs, not geared for a patient’s goal, will result in adherence issues for the patient.
Exercise program should reflect patient goals
Developing a Home Program
Design a program that requires the fewest lifestyle changes – increases adherence
Choose exercises that can be incorporated into a patient’s daily activates when possible
Sluijh identified three things that contribute to adherence/compliance
Self motivation
Scheduling concerns
Biggest concern
Pain tolerance
HEP Issues
Type of learner: visual, auditory, kinesthetic Cultural barriers: language, background Clarity of instruction Education around exercise program Pictures or drawings, arrows “Canned” program vs Individualized Communication: written and verbal Organize, cluster exercises together to minimize position changes
Psychomotor Learning Skill Phases
Cognitive Phase
Associative Phase
Autonomous Phase
Cognitive Phase
attention to task is necessary
Gross motor skills are developed
Overcorrection
Exaggerated movements
Associative Phase
Refinement of gross motor skills
Efficient
Less overcorrection
Less exaggeration
Autonomous Phase
Motor program is activated
Little cognitive input is needed
