Therapeutic interventions Flashcards
What is the appropriate intensity for novice to intermediate exercisers to improve strength as described by FITT-VP?
60-70%
What is the appropriate intensity for Experienced exercisers to improve strength as described by FITT-VP?
Gradually increases to > 80%
1 RM
What is the appropriate intensity for older individuals beginning exercise to improve strength as described by FITT-VP?
40-50%
1 RM
What is the appropriate intensity for sedentary individuals beginning a resistance exercise program as described by FITT-VP?
40-50%
1 RM
According to FITT-VP, what intensity is best for improving endurance?
< 50%
1 RM
According to FITT-VP, what intensity is best for older adults who want to improve power?
20-50%
1 RM
How many reps are recommended for improving strength in those who are middle-aged and older starting a resistance program?
10-15
What are the effects of Valsalva maneuver on intrathoracic pressure, HR, return of blood to the heart, venous pressure, and cardiac workload?
- Increases intrathoracic pressure
- Slows HR
- Decreases return of blood to the heart
- increases venous pressure
- increases cardiac workload
When does the most rapid recovery occur after exercise?
Within the first minute
When can DOMS begin?
12-24 hours after vigorous exercise
Peaks at 24-48 hrs after exercise
How long can muscle tenderness and stiffness caused by DOMS last?
5-7 days
Does OKC or CKC exercises prepare a patient for functional WB activities?
CKC
What is ventilation?
Volume of air breathed each minute.
How do you calculate minute ventilation?
RR x Tidal volume
(true/false) Exercise can reverse any damage to pulmonary tissue
False
At altitudes of >6,000 ft, there can be a (increase/decrease) in performance with aerobic activities.
decrease
Why at altitudes of >6,000 ft (1,829 m) is there a decrease in aerobic activity performance?
PPO2 is reduced resulting in poor oxygenation of hemoglobin
Hypoxia at altitude can result in immediate compensatory hyperventilation and increased HR
–> Hyperventilation = decreased CO2 = increase in alkaline body fluids
How long does it take to acclimate to altitude starting at 7,545 ft (2,300 m)?
–> How much additional time is added when altitude increases by 1,968 ft (600m)?
a. 2 weeks
b. 1 week for every additional 600 m
What happens to plasma volume and total red blood cell count with increasing altitude?
Plasma Volume: Decreased
Total RBC count: Increased –> increased hemoglobin = improved oxygenation
VO2 max (increases/decreases) starting at 1,500 m.
decreases - continues to decrease by 2% for every 300 m increase.
Bottom line: decreased endurance performance
(true/False) training at altitude provides improvement in performance at sea level.
FALSE
(true/false) Dehydration is common when training in altitude.
True - air is dry and cool
Heat (increases/decreases) GTO sensitivity.
increases
When improving stability, those with hyperkinetic movement disorders should start with (small/large) range movements.
Large range
progress to small range and then holding steady
Are CKC or OKC exercises better for enhancing postural stabilization?
CKC
Aquatic therapy (decreases/increases) peripheral blood flow.
increases - counteracts effusion and edema
At what water temperature do most patients have difficulty maintaining core temperature?
77 degrees
What structure(s) of the body exhibit the greatest temperature change?
skin
rises rapidly
subcutaneous tissue rises less rapidly and does not show a large change
What structure(s) of the body exhibit the least change in temperature?
muscles and joints
Regarding thermotherapy, what do structures > 3cm under the surface require?
shortwave diathermy or ultrasound
What are contraindications for use of superficial thermotherapy?
- acute/subacute traumatic and inflammatory conditions
- decreased circulation and sensation
- DVT
- impaired cognitive function
- risk of hemorrhage or edema
- malignant tumors
- irradiation to eyes or reproductive organs
- pregnancy (full-body heat)
- thrombophlebitis
What changes occur to the following when using general heat application?
Cardiac output
metabolic rate
muscle activity
blood flow to internal organs and resting muscles
HR
RR
BP
Stroke volume
- Cardiac output: increased
- metabolic rate: increased
- muscle activity: decreased
- blood flow to internal organs and resting muscles: decreased
- HR: increased
- RR: increased
- BP: decreased
- Stroke volume: decreased
Capillary permeability and pressure (decrease/increase) with localized heat application
increase
What precautions must you consider before using thermotherapy?
- acute injury
- edema
- metal implants
- open wounds
- topical agents
- cognitive status
- pregnancy
- cardiac insufficiency/impaired circulation
- impaired thermoregulation
What temperature should water be when storing hot packs?
165-170 degrees
At what temperature does paraffin wax self-sterilize?
175-180 degrees
What method of heat transmission is used with hydrotherapy (whirlpool)?
convection
What temperature is most appropriate for exercising in water?
79-92 degrees
What temperature is most appropriate if a person has an open wound?
92-96 degrees
What precautions must be considered before utilizing local immersion?
- decreased temperature sensation
- decreased cognition
- recent skin graft
What precautions must be considered before utilizing full body immersion for hydrotherapy (whirlpool)?
- poor thermoregulation
- impaired temperature sensation
- cardiac medications
- urinary incontinence
- respiratory issues
- fear of water
What are contraindications for local immersion with hydrotherapy?
- maceration
- bleeding
What are contraindications for full body immersion with hydrotherapy (whirlpool)?
- unstable CVD
- bowel incontinence
- severe epilepsy
- potential for cross contamination
- pregnancy
- suicidal ideations
What is the appropriate treatment pressure when using nonimmersion irrigating devices?
4-15 psi
What must you avoid if using non-immersion irrigation devices?
- granulating tissues
- body cavities
definition
erythema of the skin with wealing formations- associated with severe itching due to histamine reaction
cold uticaria
What precautions should be considered before utilizing cryotherapy?
- HTN
- poor thermal regulation
- open wounds
- over superficial nerves
- cognition status
What changes occur to the following when using general cold application?
Cardiac output
metabolic rate
blood flow to internal organs and resting muscles
HR
RR
arterial BP
venous BP
Stroke volume
- Cardiac output: increased
- metabolic rate: decreased
- blood flow to internal organs and resting muscles: increased
- HR: decreased
- RR: decreased
- arterial BP: increased
- venous BP: decreased
- Stroke volume: increased
What are contraindications for cryotherapy?
- cold sensitivity/intolerance
- PVD
- raynaud’s
- paroxysmal cold hemoglobinuria
- compromised circulation
- regenerating nerves
What is continuous ultrasound used to achieve?
thermal effects
(true/false) With US, the intensity is not uniformly distributed over the surface of the transducer
true
Why?
The energy is mechanically blocked by the adhesive bonding of the crystals within the transducer head and the pressure waves interfere with eachother as they radiate to different areas of the crystal
definition
The total power (Watts) divided by the area of the transducer head
spatial avg. intensity
definition
The ratio of spatial peak intensity to spatial avg. intensity.
beam nonuniformity ratio (BNR)
The higher the BNR, the (less/more) uniform the energy distribution is and the (less/more) risk of tissue damage occurring.
Higher BNR =
more uniformed energy
less risk of tissue damage
What is the ideal ratio of BNR?
between 2:1 and 6:1
When is pulsed US applied?
When non-thermal effects are desired
ex: treatment of acute soft tissue injuries
definition
The fraction of time the US energy is on over one pulse period (time on + time off)
duty cycle
What duty cycle is considered as pulsed US?
20-50%
definition
reduction of acoustal energy as it passes through soft tissue.
- affected by refraction, absorption, and reflection
attenuation
What US frequency causes greater heat production in superficial layers (1-2.5 cm deep)?
3 MHz
Why?
Greater attenuation (scattering) of sound waves within the superficial tissue
What US frequency causes greater heat production in deeper layers (3-6 cm deep)?
1 MHz
Why?
Less attenuation (scattering) of the sound waves within the tissues causing more energy to penetrate deeper into the tissues
What is the intensity of the following US frequency?
1 MHz
1.5 - 2.0 W/cm2
What is the intensity of the following US frequency?
3 MHz
0.5 - 1.0 W/cm2
definition
movement of fluids along the boundaries of cell membranes resulting from mechanical pressure waves
acoustic streaming
What precautions should be considered before using US?
- breast implants
- acute inflammation
- open epiphyses
- healing fractures
- over joint cement or plastic components
What are the contraindications for ultrasound?
- cardiac pacemakers
- impaired circulation and sensation
- malignant tumors, thrombophlebitis, or myositis ossificans
- over reproductive organs and heart
- over the abdomen, low back and uterus during pregnancy
- recently irradiated tissue
(Low/high) intensities of US should be considered with acute conditions
low intensities
(Low/high) intensities of US should be considered with chronic conditions
high intensity
What is the regular treatment time for US?
3-10 minutes
definition
The use of US to drive medications through the skin into deeper tissues
phonophoresis
For joint distraction in the lumbar region, a force of ___% of the patient’s body weight is required to cause separation
50%
Do not exceed
NOTE:
for initial treatment, lower traction force is recommended to decrease reactive muscle spasm and determine patient tolerance
For joint distraction in the cervical region, a force of ___% of the patient’s body weight is required to cause separation
7%
do not exceed
NOTE:
for initial treatment, lower traction force is recommended to decrease reactive muscle spasm and determine patient tolerance
What traction force is sufficient to receive the effects of soft-tissue stretching in the lumbar region?
25% of body weight
What traction force is sufficient to receive the effects of soft-tissue stretching in the cervical region?
12-15 pounds
(true/false) traction can be isolated to a particular joint segment
false
What are the contraindications to using intermittent mechanical compression?
- acute inflammation
- trauma
- Fx
- acute DVT
- thrombophlebbitis
- obstructed lymph or venous return
- arterial insufficiency and/or revascularization
- acute pulmonary edema
- cancer
- impaired sensation
- infection
- ABI < 0.6
What is the optimal inflation-deflation ratio for intermittent mechanical compression?
3:1
What is the optimal inflation-deflation ratio for shaping a residual limb when using intermittent mechanical compression?
4:1
What on/off cycle of intermittent mechanical compression should be used for edema?
On: 45-90 seconds
Off: 15-30 seconds
3:1
What determines the setting of intermittent mechanical compression?
Patient’s BP
- some say do not exceed DBP
- some say to fall between the systolic and diastolic values
(true/false) both continuous and pulsed waveforms can be used for healing
true
What E-stim parameters has the greatest amount of evidence for facilitating tissue healing?
High voltage pulsed monophasic current
What precautions should be considered with use of E-stim?
- CVD
- impaired sensation
- malignancies
- iontophoresis
- hypotension / hypertension
- bleeding disorders
- menstrating uterus
- pregnancy (during labor and delivery)
- skin irritation
- open wounds
What are the contraindications for E-stim?
- electronic devices (pacemakers, insulin pumps, etc)
- unstable arrythmias
- epilepsy/Sz disorders
- over carotid sinus, eyes, phrenic nerve, urinary bladder stimulator, pharyngeal/laryngeal muscles
- over abdomen or low back during pregnancy
- infection
- uncontrolled bleeding
- superficial metal implants
- thrombosis
(true/false) electrodes that are too small can cause skin irritation and/or burns
true
Same with those that have uneven contact and/or have self-adhesive that no longer sticks
(smaller/larger) electrodes produce a high current density and therefore a strong stimulus
smaller
Note:
With larger electrodes, the same intensity is perceived as less intense due to a decreased current density
What modality is designed specifically to provide afferent stimulation for pain management?
TENS
(true/false) high rate TENS can be applied during the chronic phase of pain but not the acute phase
FALSE
Can be applied during both acute and chronic phases of pain
Strong low rate TENS can be applied during what phases of pain?
Acupuncture-like TENS
chronic
What TENS setting is used to provide rapid-onset, short-term pain relief during painful procedures?
ex: debridement, deep friction massage, etc)
Brief intense TENS
description
electronic instrument used to measure motor unit action potentials generated my active muscles
- signals are detected, amplified, and converted into audiovisual signals that are used to reinforce voluntary control
EMG biofeedback
When using iontophoresis, what ion(s) are commonly used for pain reduction? Are each of them of positive or negative polarity?
- lidocaine (positive)
- xylocaine (positive)
- salicylate (Negative)
When using iontophoresis, what ion(s) are commonly used for calcium deposits and myositis ossificans? Are each of them of positive or negative polarity?
acetate / acetic acid (negative)
When using iontophoresis, what ion(s) are commonly used for wound healing and dermal ulcers? Are each of them of positive or negative polarity?
Zinc / zinc oxide (positive)
When using iontophoresis, what ion(s) are commonly used for edema reduction? Are each of them of positive or negative polarity?
hyaluronidase / wydase (positive)
When using iontophoresis, what ion(s) are commonly used for fungal infections? Are each of them of positive or negative polarity?
copper / copper sulfate (positive)
When using iontophoresis, what ion(s) are commonly used for hyperhidrosis? Are each of them of positive or negative polarity?
Water (postive and negative)
When using iontophoresis, what ion(s) are commonly used for muscle spasms? Are each of them of positive or negative polarity?
- calcium / calcium chloride (positive)
- magnesium / magnesium sulfate (positive)
When using iontophoresis, what ion(s) are commonly used for MSK inflammatory conditions? Are each of them of positive or negative polarity?
- dexamethasone (negative)
- hydrocortisone (positive)
When using iontophoresis, what ion(s) are commonly used for scars and adhesive capsulitis? Are each of them of positive or negative polarity?
iodine (negative)
When performing isometric exercise, what must you consider in those with vascular and/or cardiac disease?
Avoidance of valsalva maneuver due to risk of causing sharp rise in BP
Describe isometric exercise.
static contraction at a point within the ROM
Describe isotonic exercise.
contraction throughout with ROM with the same resistance
*variable speed of movement
Describe isokinetic exercise.
Contraction varies throughout the ROM at a constant speed
*resistance varies
Aerobic exercise is performed at a target HR for at least ___ mintutes.
20 minutes
What changes occur to the following as a result of aerobic exercise training?
a. resting and submaximal HR
b. systolic and diastolic BP at rest
c. cardiac output during exercise
d. stroke volume during exercise
a. decreased
b. decreased
c. increased
d. increased
What changes occur to the following as a result of aerobic exercise training?
a. Tidal volume
b. Ventilation rate during submaximal exercise
c. oxygen extraction from the blood
a. increased
b. decreased
c. increased
What is Karvonen’s formula used for?
calculation of target HR
(HR max - RHR) x percent of desired training intensity + RHR
What occurs to the following during aquatic therapy/exercise?
a. stroke volume
b. cardiac output
c. HR
d. inspiratory reserve volume
e. FVC
a. increased
b. increased
c. decreased or same
d. decreased
e. decreased
Why should a target HR be established while in the pool?
due to lower HR during deep-water exercise compared to exercises on land
Aging sedentary individuals have ___x the rate of decline in VO2 max
2x
Age predicted HR max (increases/decreases) with age.
decreases
Cardiac output may decline with aging due to what?
increase in SV
When performing isotonic exercise, what should be considered for selected resistance?
Selected resistance should not be greater than that of the weakest joint position
What vascular change occurs with the use of a cold pack for greater than 20 minutes?
Vasodilation
Initially vasoconstriction until time exceeds 20 minutes
If the fixed joint surface is concave and the mobilized surface is convex, what direction will mobilization be in compared to direction of limitation?
opposite
ex: GH joint abduction requires inferior glide
If the fixed joint surface is convex and the mobilized surface is concave, what direction will mobilization be in compared to direction of limitation?
Same direction
Increase knee EXT with an anterior glide
If the spine segments are in full FLX/EXT with the facets locked, ROT and SB will occur in the (same/opposite) direction
same direction
If lumbar or thoracic segments are in neutral and not locked, ROT and SB are (opposite/same)
opposite
(true/false) if motion in any plane is introduced within a spinal segment, motion in the other planes will increase.
false - they will be reduced
When a person has a flaccid bladder, what maneuver can be utilized to assist with emptying the bladder?
valsalva maneuver
What head position is recommended for those with altered airway protection and are at a higher risk of aspiration?
Chin tuck
For initial treatment of ankylosing spondylitis, what should you promote in the early stages of the diagnosis?
Posture and EXT
as the disease progresses, excessive postural FLX will develop
(true/false) Strengthening exercises for those with duchenne’s will further deterioration
true
What are common signs of respiratory distress?
- dyspnea
- SOB
- cramping of calf muscles
What occurs to the following ABG values when COPD is present?
PaO2
PaCO2
pH
PaO2: decreased
PaCO2: increased
pH: decreased
What CN is responsible for pupillary response?
CN III
What positioning of the hand will make the trapezium more prominent to palpate?
Opposition and UD
During gait, when do the DF muscles terminate their action?
End of loading response
What muscle is commonly used for Median nerve conduction velocity testing?
ABD pollicis brevis
(true/false) Cardiac denervation syndrome is a long term complication of T1DM.
True
Cardiac denervation syndrome is a long term complication of T1DM… how will this effect HR during rest and activity?
Fixed HR that is unresponsive to exercise and rest.
When performing bicycle crunches, what muscles are contracting in the abdomen?
Ipsilateral internal oblique
Contralateral external oblique
What is polycythemia?
increase in RBC and Hgb production
Results in increased blood viscosity and blood volume = increased SBP
When testing CN X, what response of the uvula will you see if a lesion is present?
Deviation to the OPPOSITE side of the lesion
What CN maintains the gag reflex?
CN X
What does S3 sound indicate?
CHF
What does S4 sound indicate?
MI, ventricular hypertrophy, or HTN
What is otitis media?
Infection of the middle ear resulting in fever and pain
Why do those with congestive HF have difficulty when in supine?
fluid will move into the atrium and lungs from the extremities
If the subscapularis is torn, what would happen to overhead activity?
Overhead activity will become difficult due to a weakened hold over the LHOB
In which direction will the vertebrae rotate to when scoliosis is present?
Towards the convex
In which direction will the spinous processes deviate to when scoliosis is present?
concave side
Anorexia and diarrhea are (earlier/later) manifestations of cystic fibrosis
later
Meconium ileus and acute bronchitis are (early/late) manifestations of cystic fibrosis
early
Where wound paresthesia be when anterior compartment syndrome of the LE is present?
1st and 2nd toes due to compression of the deep peroneal nerve
will result in weak DF
What heart condition can occur in later stages of COPD?
Cor pulmonale
What will occur to the thorax when COPD is present? Why?
kyphosis and barrel chest (increased AP diameter) due to hyperinflation and loss of elastic recoil
Perceptual deficits/neglect are attributed to what kind of brain lesion?
Parietal lobe lesion in the non-dominant hemisphere
commonly R hemisphere
What will an increase in fatigue result in on an EMG?
increase in EMG signal due to more neural activity being required to maintain the same level of force production
What direction will the clavicle at the SC joint slide during elevation?
Inferiorly
Superior dislocation will cause the inability to elevate the scapula
Where is pain from IBS found?
LLQ
Where will pain from diverticulitis be experienced?
LLQ
Where will pain from crohn’s disease be experienced?
RLQ
(true/false) Cold therapy can be used to reduce tone/spasticity
true
slows nerve conduction velocity and decreases muscle spindle activity for temporary results
What muscles are tightened causing posterior innominate ROT?
hip extensors
Isometric contraction of the iliopsoas and stretching of the hip extensors are used for treatment
What infarction of the MCA results in homonymous hemianopsia and fluent aphasia?
Inferior division of MCA
What infarction of the MCA results in broca’s aphasia?
superior division of MCA
What does left MCA stem occlusion result in?
- homonymous hemianopsia
- hemiparesis
- global aphasia
GBS is a (LMN/UMN) disorder
LMN
MS is a (LMN/UMN) disorder
UMN
What direction does the trachea shift to as the result of asymmetrical intrathoracic pressure or lung volumes?
Shifts away
Same result will occur with the mediastinum when a hemothorax is present
If a hematocrit value is <25%, what activity is allowed to be performed?
ADLs only
(true/false) Bursitis only causes pain during activity
false
causes pain at rest
What position of the LE precipitates ITB syndrome pain?
30 degrees knee FLX
will be over the lateral condyle
What is the normal range of INR?
0.9 - 1.1
What criteria are required for metabolic syndrome dx?
3+ of the following:
Waist:
> 40 inches (M)
>35 inches (F)
Triglycerides > 150
Elevated BP (> 130/85)
Fasting blood glucose > 100
HDL:
< 40 (M)
< 50 (F)
What are the ACSM guidelines for obese patients?
Moderate intensity (40-60%)
> 5 days/wk
30-60 mins/day
What position should be avoided during third trimester of pregnancy?
supine
What movements increase pain caused by spondylisthesis?
- EXT
- ipsilateral SB
- contralateral ROT
What movements increase pain caused by facet arthropathy?
- EXT
- ipsilateral ROT
no sensory/motor changes occur
To prevent pressure ulcers, how would you position the pt when side-lying?
30-45 degrees
do not raise HOB above 30 degrees when supine
What are the time limits for position change to prevent pressure wounds?
In bed: 2 hours
Seated: 1 hour
IF the person can move themselves: 15 mins
What is Bakody’s test?
Pt actively elevates the arm through ABD and rests the hand or forearm on the top of the head.
Used to test for radicular symptoms (primarily c4/c5) - relief would indicate possible cervical extradural compression, epidural vein compression, or nerve root compression
–> ABD decreases the length of the neurological pathway and decreases the pressure on the lower nerve roots
–> TOS commonly has a negative result
Where is pain precipitated if the pt has an iliac artery occlusion?
- buttock
- hip
- thigh
will have absent or decreased femoral and/or distal pulses
s/s
- malaise
- fatigue
- lethargy
- prolonged/recurrent fever
- irritability
- growth restriction or failure to thrive
- SOB and/or reduced activity tolerance
- dizziness
- palpitations
- bleeded diathesis
- epistaxis
- bleeding gums
- easy bruising
- bone or joint pain
- constipation
- prolonged cough
- HA
- N/V
Pediatric leukemia
What muscle must a person with a T6 SCI use to clear the buttocks from the surface they’re leaving when performing a transfer?
Lats
QL, erector spinae, and internal oblique are not innervated
Why are metal implants not an absolute contraindication for use of US?
- metal is not rapidly heated by US
- hardware is not affected
What is Kehr’s sign?
Pain in the L shoulder when pressure is placed in the upper abdomen
caused by free air or blood in the abdominal cavity
To ambulate for functional mobility, a spinal lesion must be at the ___ segment or lower
L3 or lower
What causes a greater Q-angle?
- anteversion
- wide pelvis
- coxa vara
- genu valgum
- laterally displaced tibial tuberosity
What muscles stabilize the longitudinal arch of the foot?
Tibialis posterior and fibularis longus
What activity will be most difficult for a person with adhesive capsulitis?
Combing hair
(true/false) TMJ hypomobility causes pain
false
(true/false) TMJ synovitis has decreased mouth opening with mandibular deviation
false
(true/false) TMJ capsulitis has decreased mouth opening with mandibular deviation
True
Diagnosis
Chronic facial skin disorder that causes episodic redness of the cheeks, nose, chin, and forehead
Rosacea
Migraines accompany this dx.
SLE does NOT have migraine involvement
What strengthening is emphasized for knee control after PCL reconstruction? Why?
Quadriceps strengthening due to the action of dynamic restraint to posterior tibial translation
strengthening of HS will increase posterior tibial translation - avoid
What CN can cause hyperacusis if damaged?
Sound disorder that makes sounds unbearably loud
CN VII
What CN controls submandibular and sublingual glands?
CN VII
will result in dry mouth/eyes if damaged
What LE compensations are used for retroversion?
tibial IR
subtalar PRON
(true/false) Greater trochanteric syndrome has neural involvement
False
Pain from buttock down to knee
Diagnosis
Tissue attachments that limit the movement of the spinal cord and result in an abnormal stretching of the spinal cord
tethered cord
s/s
- back pain worsened by activity
- LE pain and weakness
- LE N/T
- deterioration of gait
- spine tenderness
- scoliosis
- B/B dysfunction
tethered cord
What duration of capillary refill is indicative of arterial disease?
> 15 seconds
What duration of capillary refill is indicative of venous disease?
< 15 seconds
(true/false) Those with a C7 spinal lesion will benefit from glossopharyngeal breathing
FALSE
diaphragm is fully innervated
Nocturnal pain and positive Tinel’s sign at the wrist is indicative of what diagnosis?
CTS
What is Wartenberg’s syndrome?
entrapment of superficial branch of the radial nerve
only sensory deficits
What is warranted if a pt has an active occlusion of an artery?
Bed rest
What is thrombophlebitis?
clot formation and inflammation within a vein
What is the optimal positioning of a CVA patient while in bed?
- protracted pelvis
- slight hip ABD and FLX
- slight knee FLX
- neutral ankle
What movement/exercise is not advised post ACL repair?
OKC terminal knee EXT
will cause increased tibial translation and stress on the graft
What deformity is caused by contracture of the soleus?
knee hyperEXT
compensates for lack of FWD tibial displacement during gait/stance phase