Test3 Flashcards
FCE: functional capacity evaluation
Primary purpose
To evaluate a person’s ability to participate in work, although other ADLs that support work performance may also be evaluated
Endurance: tuck jump assessment
10 seconds
10 errors yes/no
Maximum effort
Marfan’s syndrome- ocular
Myopia (nearsided) Chromic myopia Ectopic lentis (upward) Retinal detachment Hypoplasia of dilator muscle Flat cornea
Selective functional movement assessment (SFMA)
Movements
- 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
Hop and stop test
Hoping on/off affected/unaffected sides
Stop exercise- pregnancy
Dizziness or fainting Bleeding Calf pain Chest pain Painful contractions ( > 6-8 per hour) Any fluid “gush” from vagina Decreased fetal movement
LESS: landing error scoring system
Jump off box
Horizontal distance = 50% body height
Focus on initial landing and amortization
Need to assess ___ for May return to sport
- Strength, ROM, balance
- Motor engrams
- Power
- Endurance
- Agility and reactivity
- Psychological readiness
Physical stigmata- Marfan’s
- 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
Female athlete triad
PPS May be best opportunity to identify “at risk”
Disordered eating
Amenorrhea
Osteoporosis
Exercise precautions in pregnancy
No ... Contact sports Activities with increased risk of falling Hot/humid conditions Hot yoga/hot Pilates Exercise at high altitudes Avoid exercises in supine
Conditions that may be life threatening or disabling
Cardiac anomalies
Significant cervical ROM deficits
Concussion history
Sickle cell disease
Relative contraindications for exercise during pregnancy
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
Max aerobic tests- sports performance testing
Bruce treadmill
Balk treadmill
PACER test
1.5 mile run
Pregnant exercise recommendations
Walking Stationary bike Swimming Yoga Modified pilates Impact exercise if consistently doing prior pregnancy (jogging, racquet sports) consult with physician
8 conditions that may limit participation
- Hernia
- Diabetes
- Asthma
- HTN
- Single organ
- Sickle cell trait
- Seizures
- Eating disorders
Return to sport continuum
Return to participation->
Return to sport->
Return to performance
Y-balance test - LE and UE: research
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
Older adults- aerobic activity
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
Return to sport testing is designed to …
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
Strength, ROM and balance
Return to sport tests
MMT
Goniometry (OKC and CKC)
Y balance test
Balance error scoring system
Purpose of PPEs (pre-participation exam)
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
4 conditions that may predispose athlete to injuries
- History of orthopedic problems
- Level of preparedness
- Biomechanical issues of the foot and ankle
- Neurological deficits
Agility tests
Return to sport
Be sport specific
50% -> 75% -> 100%
Linear to multiplanar
Predictable to unpredictable
Consider playing surface
T-test, pro agility, LE functional test
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
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
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
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
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
Patient eligibility for work rehab
- Must be medically stable (participation on functionally based program would not be prohibited)
- Must have stated/demonstrated a willingness to participate
- Must be physical and functional deficits that interfere with work
- Must have a treatment goal that includes returning to an occupational situation
- Should not begin until functional evaluation performed to identify the specific physical limitations preventing current return to full-duty work
Cardiac anomalies- 5
- Hypertrophic cardiomyopathy
- Marfan’s syndrome
- Myocarditis (exercise with flu/cold?)
- Commotio cordis (direct blow)
- Congenital coronary artery anomalies
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
Cardiovascular response in children
Lower SV, CO, BP
Higher HR and HRmax
Recommended exam structure- selective functional movement assessment (SFMA)
History Postural and neuro exam Respiration SFMA Local biomechanical exam
An intensive, work related, goal-oriented conditioning program designed specifically to restore systemic neuromusculoskeletal functions, motor function, ROM, and cardiovascular/pulmonary functions.
Work conditioning
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
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
Muscular endurance
Return to sport testing
Retest when fatigued
Shuttle hop test
What is usual cause of sudden cardiac death in sports?
Electrical disturbances- arrhythmia
External trauma
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
4 common sudden cardiac arrest conditions
- HCM: hypertrophic cardiomyopathy
- Coronary artery anomalies
- Commotio cordis
- Myocarditis
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
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…
Health risk factors (children) that track into adulthood
HTN
Obesity
Impaired glucose tolerance
Sedentary behavior
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
CPR
- Chest compression at rate 100-120/min
- Compress to depth of at least 2”
- Allow full chest recoil with compressions
- Minimize pauses in compressions
- Ventilate adequately (2 breaths/30 compressions) with each breath lasting 1 second
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
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
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
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
Power sport performance testing
1RM
Broad jump
Vertical jump
Medicine ball throw
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
MSK considerations for exercise in children
NM adaptations
Pre-pubescent hormones
Epiphyseal plate
Circulation
Marfan’s syndrome- skeletal
Tall, thin, arm span exceeds height, pectus excavatum, joint hypermobility, scoliosis
The objective of the work conditioning program is to …
Restore physical capacity and function to enable the patient/client to return to work
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
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
Timing and frequency - PPE
> 6 weeks pre-season
Secondary education: at entry- every 2 years
Collegiate: initial, brief annual
Components of PPE/PPS
Check in station Vitals Medical history MSK screening General medical evaluation Athlete fitness testing? Special populations? Check out station
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
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
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
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
Motor engrams
Return to sport tests
Functional movement screen
LESS: landing error scoring system
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)
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
PT exam, diag and treatment
Workers comp
Pre-existing conditions Aggravating factors Functional loss Psychosocial barriers Co-morbidities
Seek to understand work demands
Key players involved in occupational medicine (return to work/workers comp)
Employee Employers Caregivers Insurance companies Regulators Attorneys
MSK screen (PPE/PPS)
NATA 90-second MSK screen
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
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
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
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
Injury prevention- functional movement tests
Y balance test Functional movement screen CKC DF test Tuck jump test Landing error scoring system Move2Perform
Special populations -PPE/PPS
Disabled athlete Female athlete Sickle cell trait Solitary organs Diabetic athlete Olympic athlete
Hypoglycemia signs
- Anxiety
- Weakness, fatigue
- Dizziness
- Fast heartbeat
- Headache
- Blurry vision
- Shakiness
- Irritability
- Hunger
Hop testing: ankle
Tests
Figure 8 hop test
Side hop test
6-meter crossover hop test
Square hop test
Concussion assessments
Balance assessment
Cognitive assessment
Graded symptoms checklist
Baseline/preseason testing
Impact testing
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
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
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
Child exercise motivation
Goal is to promote lifelong activity and fitness Make fun Parental involvement Perceived confidence Education
Sport performance testing
Agility
Power
Max aerobic test
Submaximal aerobic test
Myocarditis
Inflammatory process of the myocardium Echovirus, adenovirus, influenza Dyspnea, orthopnea Exercise intolerance Tachycardia Diarrhea, malaise, fatigue
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
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
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
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
Cardiovascular response to exercise during pregnancy
Peripheral resistance decreases Resting HR increases 15 bpm HRmax decreases HRR reduces Increased blood volume, CO and SV
4 principle roles in clinic EAP
Immediate care (head of team)
Equipment retrieval
Activation and direction of EMS
Secondary care support
A highly structured, goal-oriented, individualized intervention program designed to return patient/client to work.
Work hardening
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
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
Childhood obesity
Has tripled since 1970s
Physical activity decreases as children age
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
Agility sports performance testing
T test
Pro agility test
LEFT
9 vital questions
Have you ever…
- Passed out or nearly passed out during exercise?
- Passed out or nearly passed out after exercise?
- Had discomfort, pain, or pressure in your chest during exercise?
- Does your heart ever race or skip a beat?
- Has a doctor ever told you that you have s heart murmur?
- Has s doctor ever ordered a test for your heart?
- Has anyone in your family died for no apparent reason?
- Does anyone in your family have a heart problem?
- Has. My family member or relative died of heart problems or sudden death before age 50?
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
Return to work continuum
Return to participation->
Return to job ->
Return to performance
Submaximal aerobic tests- sports performance testing
Harvard step test
12- minute run
Modified Bruce treadmill
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
Older adults exert ___ than younger populations
A higher percentage of maximal capacity and effort that younger populations (ex METs)
Medical emergencies- sideline sports
- Cardiac: sudden cardiac arrest
- Spinal: primarily cervical
- Concussions
- Environmental: heat, lighting
- Abdomen: spleen
- Pulmonary: pneumothorax
- Genital: testicular trauma
- Thread injuries
- Ocular injuries
- MSK injuries
Functional movement screen
Movements
- Deep squat
- Hurdle step
- Inline lunge
- Shoulder mobility
- Impingement clearing test
- Active straight-leg raise
- Trunk stability push-up
- Press-up clearing test
- Rotary stability
- Posterior rocking clearing test
Pregnant and lactating water intake
3 L per day during pregnancy
3.8 L per day during lactation
What is functional movement systems?
Functional movement screen
Y-balance test
Selective functional movement assessment
