review worksheet Flashcards
Therapeutic exercise “is the systematic, planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with the means to what?
Remediate or prevent impairments
Improve, restore, or enhance physical function
Prevent or reduce health-related risk factors
Optimize overall health status, fitness, or sense of well-being
It is important that a PTA be able to understand and articulate (verbally and in written form) the relationship between impairments and the impact on functional limitations, participation restrictions and disability. Utilizing the Nagi Model, provide an example of a pathology, impairments and functional limitations that resulted from the pathology that you observed clinically.
Pathology: TKA
Impairments: significant loss of ROM
Functional Limitations: cannot transfer from bed<>w/c
Disability? Unable to get around at home and take care of self
Aspects of Physical Function
Impairment of any one or more of the body systems and subsequent impairment of any of the following aspects of physical function can result in functional limitations and disability.
what are the aspects?
- Balance
- Cardiopulmonary Fitness
- Coordination
- Flexibility
- Mobility
- Muscle Performance
- Neuromuscular Control
- Postural Control
- Stability
Consider 3 activities of daily living or recreational activities that you currently perform or would like to perform effectively and efficiently.
- get my kids up and ready for school
- Yoga
- Go to school
What aspects of physical function are needed to complete each of these tasks?
All of them
Therapeutic Exercise Interventions**(Know These!)
SNAP B BRTS
- Stretching techniques including muscle lengthening and joint mobilization techniques\
- Neuromuscular control, inhibition and facilitation techniques and posture awareness training
- Aerobic conditioning and reconditioning
- Postural control, body mechanics, and stabilization exercises
- Balance exercises and agility training
- Muscle performance exercises: strength, power and endurance training
- Breathing exercises and ventilatory muscle training
- Relaxation exercises
- Task-specific functional training
Provide 1-2 examples of the types of therapeutic exercises that were utilized in your clinic and how you feel it impacted (or could impact) patient deficits in the aspects of physical function.
- Bean bag pickup- This was demonstrated by a pt with sternal precautions that was going home the next day. He also just received a Drako boot the day before and was learning how to maneuver it.. We put bean bags on the floor to make sure he could pick them up with and without a device. This was to practice dynamic movement to helpf facilitate safe and effective balance.
- The Nu-step- This was a recumbant LE and UE bike to help stengthen the pts cardiovascular system needed to assist with safe and effective amb.
When a muscle cannot stretch anymore
Passive Insufficiency:
shortening or hypomoblilty of the skin, fascia, muscle, or joint capsule that prevents normal mobiltiy or flexibility of that structure
Contracture
when there is slight tension in the muscles and tissue.
Tightness
when a contracture cannot be stretched out.
Irreversible contracture:
stretching beyond the normal ROM of a joint and the surrounding soft tissue
Overstretching
technique where the pt is taught to stretch a joint or soft tissue passively by using another body part for applying the force
Selective stretching
The pt is not providing any assistance with a stretch.
Passive stretching
a type of stretching exercise in which there is reflex inhibition and subsequent elongation of the contractile elemnts of muscles.
Active inhibition
The muscle must be challenged to perform at a level greater than that to which it is accustomed.
Overload principle
Specificity is a necessary foundation on which exercise programs should be built.
The SAID (Specific Adaptation to Imposed Demands) principle
Adaptive effects of training are highly specific to the training method employed. Therefore, whenever possible, exercises incorporated into a program should mimic the anticipated function.
Specificity of training or specificity of exercise
Carryover of training effects from one variation of exercise or task to another.
Example:
Transfer of training, overflow or cross training
Example: A program designed to improve muscular strength may also have an impact (at least moderately) in muscular endurance
Adaptive changes are transient unless training induced improvements are regularly used or unless an individual participates in a maintenance program of resistance exercises.
Reversibility Principle
Reduction in muscle performance that begins within a week or two after the cessation of resistance exercises and continues until training effects are lost.
Detraining
Provide a clinical example of how the overload principle was applied to a patient’s exercise program.
One of my pts was able to use heavier ankle weights doing LAQs after a few days time.
Provide a clinical example of how specificity of training was applied to a patient’s exercise program.
Some of the pt doing standing dynamic balance activities day to day got better at the task as their bodies rememberted what it did from the day before.
Provide an example of how the reversibility principle may impact a patient’s recovery.
There was one Stroke pt that refused a tx one day. We tried to get him to do his exercises in bed with no luck. We explained to him he could loose strength that he gained (which was not much as it was) . The pts are usually in pain when they work do their exercises to gain some strength. We have to remind them it will be harder the next time if the take a break.
Factors that Influence Exercise Safety
- Health history
- Being unaccustomed to physical exertion
- Undiagnosed health conditions
- Medications
- Environments
- Use of exercise equipment
- Improper technique
- Fatigue
Signs and Symptoms of Muscular Fatigue
- An uncontrollable sensation in the muscle, even pain and cramping
- Tremulousness in the contracting muscle
- Active movements jerky, not smooth
- Inability to complete the movement pattern through the full available range
- Use of substitute motions to complete the movement pattern
- Inability to continue low-intensity physical activity
- Decline in peak torque during isokinetic testing
Provide signs/symptoms that you observed clinically that demonstrated patient fatigue
most of them let me know when they needed a break. One pts quad shook a little when he was getting fatigued
Identify if the patient was provided with an active or passive rest period
The pts in the rehab were pretty much provided with a passive rest period d/t doing exercises in a w/c.
Before beginning an exercise program, it is important to determine if resistance training is appropriate for your patient.
Review Box 6.10 , K & C - Is Resistance Training Appropriate? Questions to Consider
- identify muscle performance deficit (do they limit function)
- Could these deficits cause future impairment/func
- what is irritability and current stage of healing
- is there inflammation
- is there pain(rest or move, what portion of ROM, where in tissue)
- other deficits(mobility, balance,sensation, coordination, or cognition)
- pts goals for outcome (realistic)
- if resistance is ok…. how much?
- should one are be emphasized over another.
- will pt required supervision or assistance
- expected frequency and duration /maintenance
- any precautions specific to the pts physical status, general health or age
Contraindications to Resistance Exercises
- Pain
- Inflammation
- Severe Cardiopulmonary Disease
Important Clinical Note: What is important to remember about MI or CABG and resistance training?
“Resistance training should be postponed for up to 12 weeks after a MI or CABG (coronary artery bypass graft) surgery or until the patient has clearance from a physician.
Self Assisted Range of Motion (REVIEW)
Instruction of patient to perform range of motion exercises to the involved part in cases of unilateral weakness or paralysis or during early stages of recovery after trauma or surgery.
what are some forms?
Manual
Equipment
- Wand, Cane or T bar
- Finger ladder, wall climbing, ball rolling
- Pulleys
- Skateboard/powder board
- Reciprocal exercise devices
Basis often of home exercise program
when is Wand (Cane Exercises) used
Used when patient needs guidance or assistance to complete range in the involved extremity BUT has some voluntary muscle control
Used in shoulder or elbow ranges
Perform in supine if max protection is needed
- Can progress to sitting or standing for more advanced
Guide the patient for the first few repetitions, than relinquish control to patient
- Shoulder flex and return
- Shoulder horizontal abd and add
- Shoulder IR and ER
- Elbow flex and ext
- Shoulder hypertext
Finger Ladder/Wall Climbing
- Device that provides patient with objective reinforcement for performing shoulder ROM via a ladder or wall markings
- Shoulder flex and ABD
Overhead pulleys
- Single pulley attached to strap that is held in place by closing strap in door, position so that pulley is directly over the joint and line of pull is moving the extremity and not just compressing the joint
- Shoulder flex, ABD, scaption
Skateboard and power board
- Use of friction free surface to encourage movement without the resistance of gravity or friction
- ABD/ADD of hip, Horizontal ABD/ADD of shoulder
Reciprocal Exercise Units
- Bicycle, UBE, lower body ergometer
- Reciprocal exercise unit in which flex and ext of involved extremity is provided by strength of uninvolved extremity
ROM through functional activities
Combining movements in activities of daily living
- Combing Hair (Shoulder ER and ABD, elbow flex, cerv rotation)
- Pulling on socks and shoes (Hip ER and ABD, Knee flex, Ankle PF/DF and trunk flex)
Look at various activities of daily living or activities that the patient would like to return to so that you can determine the motions needed to complete the task. Focus on those motions during rehab to demonstrate your impact on function.
Review Box 3.3 K & C
Plyometrics
- Stretch shortening drills – employs high velocity eccentric to concentric muscle loading, reflexive reactions and functional movement patterns – reactive neuromuscular training
- Characterized by a rapid eccentric contraction during which the muscle elongates followed immediately by a rapid reversal of movement with a resisted shortening contraction of the same muscle
- Only appropriate in the later stages of rehabilitation of active individuals who must achieve a high level of physical performance in specific, high demand activities
- Criteria to begin usually an 80-85% level of strength and 90-95% of ROM
- Progress by increasing the resistance applied, but not enough to slow down activity or by increasing the number of repetitions of an activity as long as proper form is maintained or to increase the number of plyometric sessions
- Recommend a 48-72 hour recovery period
Plyometrics: Precautions
- Do not use if patient cannot tolerate high stress, shock absorbing activities
- With children and elderly, only beginning level stretch shortening drills
- Patient must have good flexibility and strength
- Wear good shoes for LE plyometrics
- Always warm up
- Emphasize good form and proper technique
- Progress repetitions before increasing the level of intensity
- Stop if patient cannot perform because of fatigue
Motor Learning and Performance
- Integration of motor learning principles into exercise instruction can increase learning of an exercise or functional motor task.
What is the difference between motor learning and motor performance?
motor learning: aquisition and retention of a skilled movement or task through practice.
motor performance: performance involves aquistion of the ability to carry out a skill, whereas learing invovles both acquisiton and retention
Three Types of Motor Tasks*
Discrete
Serial
Motor
In this stage of motor learning, movements are automatic and the patient/client may be able to do other tasks simultaneously. ________
autonomous
In this stage of motor learning, the patient must learn how to perform the motor task safely and correctly. The patient will have to think about how to sequence the movement. ________
Cognitive
In this stage of motor learning, the patient requires infrequent feedback from the therapist and uses problem solving to self-correct errors when they occur. __________
Associative
For various reasons, it is important to recognize that most patients will not dutifully adhere to any rehabilitation program especially if regular exercise was not a part of their life prior to receiving physical therapy. Review Strategies to Foster Adherence to Exercise Program Box 1.22 K & C. Discuss a clinical example of a patient that demonstrated noncompliance with an exercise program or decreased motivation and explain a strategy(ies) that you could have implemented to foster compliance.
