Test3 Flashcards
1
Q
FCE: functional capacity evaluation
Primary purpose
A
To evaluate a person’s ability to participate in work, although other ADLs that support work performance may also be evaluated
2
Q
Endurance: tuck jump assessment
A
10 seconds
10 errors yes/no
Maximum effort
3
Q
Marfan’s syndrome- ocular
A
Myopia (nearsided) Chromic myopia Ectopic lentis (upward) Retinal detachment Hypoplasia of dilator muscle Flat cornea
4
Q
Selective functional movement assessment (SFMA)
Movements
A
- Active cervical flexion
- Active cervical extension
- Cervical rotation
- UE pattern 1 (MRE)
- UE pattern 2 (LRF)
- Multi-segmental flexion
- Multi-segmental extension
- Multi-segmental rotation
- Single-leg stance
- Overhead deep squat
5
Q
Hop and stop test
A
Hoping on/off affected/unaffected sides
6
Q
Stop exercise- pregnancy
A
Dizziness or fainting Bleeding Calf pain Chest pain Painful contractions ( > 6-8 per hour) Any fluid “gush” from vagina Decreased fetal movement
7
Q
LESS: landing error scoring system
A
Jump off box
Horizontal distance = 50% body height
Focus on initial landing and amortization
8
Q
Need to assess ___ for May return to sport
A
- Strength, ROM, balance
- Motor engrams
- Power
- Endurance
- Agility and reactivity
- Psychological readiness
9
Q
Physical stigmata- Marfan’s
A
- Tall, thin build
- Long arms, legs, fingers
- Flexible joints (Brighton signs)
- Scoliosis
- Pectus excavatum or carinatum
- High palate, small jaw
- Crowded teeth
- Flat feet
- Stretch marks
- Ocular lens dislocation
- Nearsightedness, blurred vision
- Corneal flatness, strabismus, exo- or endotropia
10
Q
Female athlete triad
A
PPS May be best opportunity to identify “at risk”
Disordered eating
Amenorrhea
Osteoporosis
11
Q
Exercise precautions in pregnancy
A
No ... Contact sports Activities with increased risk of falling Hot/humid conditions Hot yoga/hot Pilates Exercise at high altitudes Avoid exercises in supine
12
Q
Conditions that may be life threatening or disabling
A
Cardiac anomalies
Significant cervical ROM deficits
Concussion history
Sickle cell disease
13
Q
Relative contraindications for exercise during pregnancy
A
Severe anemia Unevaluated maternal cardiac dysrhythmia Chronic bronchitis Poorly controlled DM type 1 Extremely overweight History of extremely sedentary lifestyle Intrauterine growth restrictions Poorly controlled HTN Orthopedic limitations Poorly controlled seizure disorder Poorly controlled hyperthyroidism Heavy smoker
14
Q
Max aerobic tests- sports performance testing
A
Bruce treadmill
Balk treadmill
PACER test
1.5 mile run
15
Q
Pregnant exercise recommendations
A
Walking Stationary bike Swimming Yoga Modified pilates Impact exercise if consistently doing prior pregnancy (jogging, racquet sports) consult with physician
16
Q
8 conditions that may limit participation
A
- Hernia
- Diabetes
- Asthma
- HTN
- Single organ
- Sickle cell trait
- Seizures
- Eating disorders
17
Q
Return to sport continuum
A
Return to participation->
Return to sport->
Return to performance
18
Q
Y-balance test - LE and UE: research
A
LE:
A difference > 3-4 cm side to side places an individual at increased risk for injury
UE…less research…potential problem, CKC test for predominantly open chain activities
19
Q
Older adults- aerobic activity
A
3-5x week
Moderate intensity (RPE 5-6/10 or 12-13/20)
20-30 min per day
Walking, jogging, elliptical, biking, swimming, etc
Enjoyable aerobic activities
20
Q
Return to sport testing is designed to …
A
Stimulate- in a controlled manner- the stresses produced and imposed during athletic performance.
NOT to return them to their pre-injury state
Because most are non-contact injuries and need to correct so not setup for future injuries
21
Q
Strength, ROM and balance
Return to sport tests
A
MMT
Goniometry (OKC and CKC)
Y balance test
Balance error scoring system
22
Q
Purpose of PPEs (pre-participation exam)
A
Primary:
Detection of conditions that may limit participation or predispose to injury
Detect conditions that may be life threatening or disabling
Secondary: Meet legal requirements Determine general health Entry point to healthcare system Opportunity to initiate dialogue
23
Q
4 conditions that may predispose athlete to injuries
A
- History of orthopedic problems
- Level of preparedness
- Biomechanical issues of the foot and ankle
- Neurological deficits
24
Q
Agility tests
Return to sport
A
Be sport specific
50% -> 75% -> 100%
Linear to multiplanar
Predictable to unpredictable
Consider playing surface
T-test, pro agility, LE functional test
25
Selective functional movement assessment (SFMA) - Breakouts
Each breakout is built in a specific pattern:
Bilateral vs unilateral
Loaded vs unloaded
Active vs passive
Determine the parts that are affecting the pattern
26
Exercise benefits during pregnancy
```
Decrease health risks:
Gestational DM
Preeclampsia
Reduced LBP
Low birth-weight baby
```
Shorter duration of active labor
Reduced recovery time following delivery
27
Functional movement screen - score/research
Heavily debated whether total score or individual score on each movement matters most
Big picture...be familiar with research on the specific population you are utilizing screen on
28
Absolute contraindications for exercise during pregnancy
Hemodynamically significant heart disease
Restrictive lung disease
Incompetent cervix/cerclage
Multiple gestation at risk for premature labor
Persistent second or third trimester bleeding
Placenta previa after 26 weeks
Premature labor
Ruptured membranes
Preeclampsia/pregnancy induced HTN
29
Return to sport testing is not 1 day. ____ must be laid out from beginning. Should be ...
Goals and plan must be laid out from the beginning
Should be progressive and logical (minimize fear), sport specific, measure all dimensions of sport demands
30
Patient eligibility for work rehab
1. Must be medically stable (participation on functionally based program would not be prohibited)
2. Must have stated/demonstrated a willingness to participate
3. Must be physical and functional deficits that interfere with work
4. Must have a treatment goal that includes returning to an occupational situation
5. Should not begin until functional evaluation performed to identify the specific physical limitations preventing current return to full-duty work
31
Cardiac anomalies- 5
1. Hypertrophic cardiomyopathy
2. Marfan’s syndrome
3. Myocarditis (exercise with flu/cold?)
4. Commotio cordis (direct blow)
5. Congenital coronary artery anomalies
32
Post-partum exercise benefits
Reduces fatigue
Improves fitness, mood and mental acuity
Promotes return to pre-pregnancy weight
Decreases risk of developing chronic health conditions
Provides important mom time and social interactions
Reduces risk of DVT
33
Cardiovascular response in children
Lower SV, CO, BP
| Higher HR and HRmax
34
Recommended exam structure- selective functional movement assessment (SFMA)
```
History
Postural and neuro exam
Respiration
SFMA
Local biomechanical exam
```
35
An intensive, work related, goal-oriented conditioning program designed specifically to restore systemic neuromusculoskeletal functions, motor function, ROM, and cardiovascular/pulmonary functions.
Work conditioning
36
Coronary artery anomalies
Abnormal artery is compressed as the ascending aorta dilates with exercise
Blood flow to heart limited
Hypoperfusion of myocardium occurs and is primary cause of death
Early symptoms include fatigue, exercise-induced syncope, chest pain
37
Functional movement screen
10 movement screen:
7 scored on 4 point scale,
3 clearing movements for individuals with pain
Designed with fitness professionals in mind including personal trainers and strength coaches
Population: healthy and non-painful individuals
38
Muscular endurance
| Return to sport testing
Retest when fatigued
| Shuttle hop test
39
What is usual cause of sudden cardiac death in sports?
Electrical disturbances- arrhythmia
| External trauma
40
Periodization cycles
Macrocycles: largest division which typically includes 1 training year
Mesocycle: comprises to first subgroup, typically multiple months
Microcycles: smallest subgroup typically lasting 1-3 weeks
Cycles to better organize individual goals and needs
41
4 common sudden cardiac arrest conditions
1. HCM: hypertrophic cardiomyopathy
2. Coronary artery anomalies
3. Commotio cordis
4. Myocarditis
42
Older adults- strength training
2-3x week
60-80% 1 RM
Initial program: 10-15 reps
Strength and power: 8-12 reps
Muscle endurance: 15-20 reps
Sets: 2-3 per exercise
Target: primary muscle groups with emphasis on regions with low bone density
43
Exercise guidelines for children
60 min or more daily
aerobic:
Most of daily activity, should be either moderate or vigorous
Vigorous at least 3 days week
strength: at least 3 days week
60-80% est 1RM, 8-15 reps, 1-3 sets
bone-strengthening: at least 3 days week
Weight-bearing...jump rope, push-ups, sports, running...
44
Health risk factors (children) that track into adulthood
HTN
Obesity
Impaired glucose tolerance
Sedentary behavior
45
Functional movement screen scoring
Total score: x/21
```
3 = movement performed correctly without compensation
2 = movement completed but compensatory strategy or assistance provided
1 = unable to complete the movement
0 = pain anywhere in the body on a movement
```
Left vs right side:
The lower side is counted towards total score
46
CPR
1. Chest compression at rate 100-120/min
2. Compress to depth of at least 2”
3. Allow full chest recoil with compressions
4. Minimize pauses in compressions
5. Ventilate adequately (2 breaths/30 compressions) with each breath lasting 1 second
47
Kinesiophobia scales/measures
ACL-RSI
ACL return to sport after injury
K-SES
Knee self-efficacy scale
Injury psychological readiness return to sport scale
TSK-11
Tampa scale of kinesiophobia
48
Sudden cardiac death
Electrical disturbances in heart causes arrest or arrhythmia
With or without external trauma
Typically without warning
Can have prodromal signs
Death < 1 hour
49
Older adult exercise program design
Promote compliance
Include modes of activity the patient prefers: traditional exercise; functional or lifestyle specific
Exercise does not need to be structured (METs) .. 30 min gardening, 45 min grocery shopping
50
Children- thermoregulation
Higher threshold for sweating
Maintain proper hydration
Avoid exercise in climates greater than body temperature
Plan to exercise in areas with climate control
51
Power sport performance testing
1RM
Broad jump
Vertical jump
Medicine ball throw
52
Power : LE
| Return to sport tests
Single hop for distance
6-m timed hop
Triple hop for distance
Crossover hop for distance
Test fresh and fatigued
53
MSK considerations for exercise in children
NM adaptations
Pre-pubescent hormones
Epiphyseal plate
Circulation
54
Marfan’s syndrome- skeletal
```
Tall,
thin,
arm span exceeds height,
pectus excavatum,
joint hypermobility,
scoliosis
```
55
The objective of the work conditioning program is to ...
Restore physical capacity and function to enable the patient/client to return to work
56
Medical contraindications for resistance training
Unstable angina, untreated severe CAD
Angina, HTN, or arrhythmias provoked by activity strenuous to the patient
Severe valvular heart disease
Significant exacerbation of MSK pain with resistance training
End-stage CHF
Failure to thrive, terminal illness
57
Program design post-partum
Begin 4-6 after vaginal delivery; 8-10 weeks after C-section
150 min moderate intensity
Aerobic: recommended to begin with 20-30 min walking. Gradually progress intensity and running as tolerated
Strengthening: emphasis on abdominals and paraspinals (diastasis recti)
Major muscle groups
During lactation, decrease in bone density in lumbar spine- exercise will reduce amount of loss
Pelvic floor program -especially if there is incontinence
58
Timing and frequency - PPE
> 6 weeks pre-season
Secondary education: at entry- every 2 years
Collegiate: initial, brief annual
59
Components of PPE/PPS
```
Check in station
Vitals
Medical history
MSK screening
General medical evaluation
Athlete fitness testing?
Special populations?
Check out station
```
60
Probability of returning to work ...
Probability of returning to work decreases with every quarter... 55.4% at 2 quarters...
8 quarters 4.9% chance of returning
61
Periodization phases
Developed as part of preparatory period but can be applied throughout program
Hypertrophy/endurance- very low intensity, very high volume with goal to develop a base level of fitness
Basic strength- increase muscular strength through sport specific exercises
Strength/Power- speed drills, plyometric and resistance training at high loads and volumes
62
Selective functional movement assessment (SFMA)
Designed as a movement assessment for rehab professionals as part of an exam
Parts vs patterns
Results in either a stability, motor control, joint and/or soft tissue dysfunction
63
Selective functional movement assessment (SFMA) - Scoring
Functional: non-painful
Functional: painful
Dysfunctional: painful
Dysfunctional: non-painful
Movements scored as dysfunctional: non-painful are broken down into components/impairments
64
Motor engrams
| Return to sport tests
Functional movement screen
LESS: landing error scoring system
65
Commotio cordis
```
Anatomically normal heart
Males > Females
Mean age 13.6 years
80% blow from projectile
20% hit from another player
Timing, not force
(Ventricular)
```
66
Exercise induced asthma
```
Severe wheezing
Coughing that won’t stop
Rapid breathing
Chest tightness or pressure
Difficulty talking
Feelings of anxiety or panic
Pale, sweaty face
```
Administer short-acting bronchodilator
Keep clam
Diaphragmatic breathing
67
PT exam, diag and treatment
| Workers comp
```
Pre-existing conditions
Aggravating factors
Functional loss
Psychosocial barriers
Co-morbidities
```
Seek to understand work demands
68
Key players involved in occupational medicine (return to work/workers comp)
```
Employee
Employers
Caregivers
Insurance companies
Regulators
Attorneys
```
69
MSK screen (PPE/PPS)
NATA 90-second MSK screen
70
Seizures
```
Temporary confusion
A staring spell
Uncontrollable jerking of arms and legs
Loss of consciousness or awareness
Psychic symptoms
```
Let seizure run its course
Do not restrain patient
Protect modesty
71
Children- flexibility training
```
Regular sessions of flexibility and ROM exercises
3 days/week - preferably daily
Intensity (mild discomfort)
Duration 10-30 sec
Static and targeting large muscle groups
```
72
Cardiac events- aspirin?
Aspirin should be used with suspected MI- standard 325 mg dose, chewed better than swallowed whole
If unclear event is MI, do NOT give aspirin
73
Y-balance test scoring
Side to side score:
Left vs right- main concern is looking for asymmetry
Composite score:
Anterior + posteromedial + posterolateral
Divided by
3x Limb length
X 100
74
Injury prevention- functional movement tests
```
Y balance test
Functional movement screen
CKC DF test
Tuck jump test
Landing error scoring system
Move2Perform
```
75
Special populations -PPE/PPS
```
Disabled athlete
Female athlete
Sickle cell trait
Solitary organs
Diabetic athlete
Olympic athlete
```
76
Hypoglycemia signs
1. Anxiety
2. Weakness, fatigue
3. Dizziness
4. Fast heartbeat
5. Headache
6. Blurry vision
7. Shakiness
8. Irritability
9. Hunger
77
Hop testing: ankle
| Tests
Figure 8 hop test
Side hop test
6-meter crossover hop test
Square hop test
78
Concussion assessments
Balance assessment
Cognitive assessment
Graded symptoms checklist
Baseline/preseason testing
Impact testing
79
Anaphylaxis
Fainting, lightheadedness, low BP, dizziness or flushing
Difficulty breathing, rapid breathing, shortness of breath, or wheezing
Hives, swelling under the skin, blue skin from poor circulation, or rashes
Tachycardia, feeling of impending doom, itching, tongue swelling, difficulty swallowing, facial swelling
Epinephrine pen - and then get them to ED
80
EAP: Emergency action plan
Formal written response plan
Required by OSHA
Emergency medical service activation procedure
Names and contact info for primary, 2ndary, and tertiary individuals to contact
Clinic address
Location of phones, exits, emergency supplies, 1st aid kit
Designated personnel qualified to care for injuries
Ambulance access
Plan for fire, tornado, terrorism, etc
81
Benefits of exercise for children
Physiological:
Reduces CVD factors, maintain healthy weight, enhance motor coordination
Psychosocial:
Improves academic performance, self-esteem, confidence and social interaction
82
Child exercise motivation
```
Goal is to promote lifelong activity and fitness
Make fun
Parental involvement
Perceived confidence
Education
```
83
Sport performance testing
Agility
Power
Max aerobic test
Submaximal aerobic test
84
Myocarditis
```
Inflammatory process of the myocardium
Echovirus, adenovirus, influenza
Dyspnea, orthopnea
Exercise intolerance
Tachycardia
Diarrhea, malaise, fatigue
```
85
PPE vs PPS
Pre-participation exam vs screen
```
Evaluation:
Done by medical professional
Performed in an office
Cost involved
1-1 rapport
```
```
Screen:
Mass participation
Free or reduced price
Low anxiety
Potential for performance testing
```
86
Exercise guidelines for older adults
When cannot do 150 moderate intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow.
Older adults should determine their level of effort of physical activity relative to their level of fitness
Should do exercises that maintain or improve balance if they are at risk of falling
87
Yearly periodization periods
Preparatory:
Typically off-season, progressing from low-intensity to higher load and volume
1st transition: lower intensity and volume period to allow recovery before competitive season
Competition: increasing sport specific tasks, increase training intensity decrease in volume
2nd transition (active rest): low intensity and volume recovery activities typically lasting 2-4 weeks
88
Pregnant women- exercise guidelines
Weren’t active pre-pregnancy: at least 150 min moderate intensity aerobic activity during pregnancy and post-partum
Women who habitually engaged in vigorous aerobic activity or highly active prior to pregnancy - can continue provided they remain healthy and discuss with health-care provider on how/when to adjust
89
Cardiovascular response to exercise during pregnancy
```
Peripheral resistance decreases
Resting HR increases 15 bpm
HRmax decreases
HRR reduces
Increased blood volume, CO and SV
```
90
4 principle roles in clinic EAP
Immediate care (head of team)
Equipment retrieval
Activation and direction of EMS
Secondary care support
91
A highly structured, goal-oriented, individualized intervention program designed to return patient/client to work.
Work hardening
92
Marfan’s syndrome
Fibrillin gene defect
Alters connective tissue throughout body
Leads to ruptured aortic aneurysm
Skeletal, ocular, cardiovascular changes
Higher rate of sudden cardiac death
93
HCM
Hypertrophic cardiomyopathy
1 in 500
Most common cause of sudden cardiac death (especially <40)
Typically inherited as autosomal dominant
Over 100 genetic defects can result in the condition
60% have affected first degree relative
94
Childhood obesity
Has tripled since 1970s
| Physical activity decreases as children age
95
Pregnant exercise program design
3-4x times/week
Intensity should not exceed pre-pregnancy intensity
Moderate intensity recommended
RPE 12-14/20 or 6-7/10
Resistance training with submaximal intensity 12-15 reps
= or > 15 min and progress to max of 30 min
10-15 warm up and cool down with light intensity
96
Agility sports performance testing
T test
Pro agility test
LEFT
97
9 vital questions
Have you ever...
1. Passed out or nearly passed out during exercise?
2. Passed out or nearly passed out after exercise?
3. Had discomfort, pain, or pressure in your chest during exercise?
4. Does your heart ever race or skip a beat?
5. Has a doctor ever told you that you have s heart murmur?
6. Has s doctor ever ordered a test for your heart?
7. Has anyone in your family died for no apparent reason?
8. Does anyone in your family have a heart problem?
9. Has. My family member or relative died of heart problems or sudden death before age 50?
98
Physiologic changes during pregnancy
Carb and lipid metabolism changes over course
Glucose production increases 30% in 3rd trimester
Insulin secretion increases in 3rd trimester
Circulating glucose decreases 10-20%
Reduced liver storage of glucose
Muscle glucose uptake decreases 40%
Type IIb fibers elevated in obese women
End result is fatigue
99
Return to work continuum
Return to participation->
Return to job ->
Return to performance
100
Submaximal aerobic tests- sports performance testing
Harvard step test
12- minute run
Modified Bruce treadmill
101
Work hardening programs are _____, and use ____
| They address the issues of...
Multidisciplinary in nature
Use real/simulated work activities designed to restore physical, behavioral and vocational functions
Addresses issues of productivity, safety, physical tolerances, and worker behaviors
102
Older adults exert ___ than younger populations
A higher percentage of maximal capacity and effort that younger populations (ex METs)
103
Medical emergencies- sideline sports
1. Cardiac: sudden cardiac arrest
2. Spinal: primarily cervical
3. Concussions
4. Environmental: heat, lighting
5. Abdomen: spleen
6. Pulmonary: pneumothorax
7. Genital: testicular trauma
8. Thread injuries
9. Ocular injuries
10. MSK injuries
104
Functional movement screen
| Movements
1. Deep squat
2. Hurdle step
3. Inline lunge
4. Shoulder mobility
5. Impingement clearing test
6. Active straight-leg raise
7. Trunk stability push-up
8. Press-up clearing test
9. Rotary stability
10. Posterior rocking clearing test
105
Pregnant and lactating water intake
3 L per day during pregnancy
3.8 L per day during lactation
106
What is functional movement systems?
Functional movement screen
Y-balance test
Selective functional movement assessment
