Therapeutic Practice

Question 1

active rom

Answer 1

patient does it them selves

can use goniometry

Question 2

passive rom

Answer 2

patient moves with assistance

see if movement is possible but muscles can’t produce it

Question 3

goniometry

Answer 3

measuring joint angles

use anatomical landmarks

Question 4

limiting factors

Answer 4

pain
soft tissue apposition
apprehension
bone on bone

Question 5

measuring crutches

Answer 5

put at an angle
hand piece at level of greater trochanter or middle wrist crease
elbows slightly bent

Question 6

crutches positioning

Answer 6

sit to stand - crutches on same side in a H

stairs - opposite hand to bannister in a letter T

Question 7

crutches and stairs

Answer 7

nwb
up - hop up, crutches, good leg
down - crutches, hop, good leg

pwb
up - good leg, bad leg, crutch
down - crutch, bad leg, good leg

Question 8

frames

Answer 8

dont use frame to get up and out of chairs with push up from seat
more stability

Question 9

stick measurement

Answer 9

take ferrule off
turn upside down and hold a few inches away from body
mark level of greater trochanter - a few for ferrule
saw off and replace ferrule

Question 10

sticks

Answer 10

hold on opposite side to bad leg

Question 11

wheelchair - kurbs

Answer 11

up - move till wheels touch kerb, push down on tipping lever, move forwards and then lift back end up
down - move backwards until wheels at edge, lower wheels, keep tilted until front wheels clear

Question 12

wheelchair - taking it apart

Answer 12

brakes on, foot rests off, arm rests off, collapse it in the middle, fold down the back, remove wheels

putting it back together - make sure everything clicks in place

Question 13

wheel chair transfers

Answer 13

no assistance - pop over, move to edge of chair, take arm off, push arm with arms onto transfer surface
one person - positioned at the front, puts hands under pelvis and hips to help lift patient over
two people - one leans patient forward, other hands under hips to help guide pelvis over

Question 14

massage pain gate theory

Answer 14

gate in dorsal horn of the spine called pain gate receives sensory info and passes it onto the brain
during massage - non painful fibres are stimulated and blocks the transmission of painful fibres being sent to the brain
the non painful fibres send info about touch and these excite the interneurone which inhibits the pain signal and closes the pain gate

Question 15

soft tissue healing

Answer 15

1. bleeding - couple hours
2. inflammatory - few hours to couple days, bring blood and chemicals to the area
3. proliferation - generation of repair materials, 24-48 hours to a couple weeks, scar formation
4. remodelling - functional scar similar to parent tissue, couple weeks after trauma

Question 16

lymphatic systems

Answer 16

get rid of waste and toxins
transports lymph
helping lymph flow = important

Question 17

energy crisis

Answer 17

increased muscle fibre tension = sustained contraction = increased pressure = tissue hypoxia = can’t break down atp = switch to anaerobic system = lactic acid = sarcomeres can’t unhook

Question 18

motor end plate

Answer 18

increased acetylcholine = trigger point location

could lead to energy crisis and increased tension

Question 19

central sensitivity

Answer 19

referred pain = intensity and size correlates with cns excitability
chronic pain = more sensitised nervous system = more pain travels to brain

Question 20

descending inhibition

Answer 20

inhibitory affect from the brain down to the spinal cord to inhibit pain pathways
excite inhibitory inter neurones which inhibit pain

Question 21

DTFM

Answer 21

continuous for 10 mins
pain relief - may bruise
mechanically break down scar tissue
exact localisation at 90 angle

Question 22

trigger points & technique

Answer 22

deep taut bands localised areas
increase blood flow
5 holds of 60-90 seconds
gradually apply pressure pain should reduce

Question 23

efflurage

Answer 23

stroke pressure towards heart and lymph distal to proximal

remove chemical irritants

Question 24

stroking

Answer 24

pt gets used to touch
increase flow to superficial muscles
proximal to distal

Question 25

petrissage

Answer 25

increase mobility between surface interfaces | compress soft tissue

Question 26

kneading

Answer 26

proximal to distal circular motions hands in opposite directions pressure up middle of spine

Question 27

wringing

Answer 27

grab tissue tissue compressed to get a roll of tissue push one hand away and one hand towards

Question 28

rolling

Answer 28

create diamond shape with hands proximal to distal along fibres grab tissue and pull back towards self

Question 29

picking up

Answer 29

compress and scoop tissue to end feel | continue along tissue length

Question 30

pnf

Answer 30

proprioreceptive neuromuscular facilitation max contraction = max relaxation form of stretching

Question 31

pnf method

Answer 31

``` stretch - hold 10 secs isometric or concentric contract - resistance for 10 secs relax passive stretch 30 secs repeat 2-5 times ```

Question 32

pnf hold / relax - autogenic

Answer 32

stretching same muscle as tight muscle | isometric contraction at end of range

Question 33

pnf hold / contract - autogenic

Answer 33

stretching same muscle as tight muscle | concentric contraction of agonist through range from end of range

Question 34

pnf hold / relax - reciprocal inhibition

Answer 34

stretch antagonist of tight muscle | ismometric contraction at end of range

Question 35

MET

Answer 35

muscle energy technique muscle held at resistance barrier relax and lengthen muscle

Question 36

MET technique

Answer 36

``` 20% strength 5-10 secs hold use agonist or antagonist use resistance from physio or object stretch within 15 sec latency period - 30 secs 2-5 reps ```

Question 37

Massage questioning points

Answer 37

J - increase blood flow, pain gate theory, break down scar tissue, accelerate healing B - increase mobility, reduced pain and tension S - patient positioning, consent, finger nails short, only expose areas needed C - open wounds, allergies, inflammation, bone growth, infection P - fragile skin, pain, oil staining clothes PT - continue until improved function O - medical history

Question 38

Active / passive ROM questioning points

Answer 38

J - see if joint capable of movement, identify weak muscles B - improve flexibilty S - over stretching, patient positioning P - pain, different end feels C - injury, early healing stages PT - test at beginning and end of treatment

Question 39

PNF questioning points

Answer 39

J - tight restrictive muscles B - improve rom, flexibility, mobility, reduce pain S - over stretching, previous injury C - bony block, inflammation, sharp pain, early healing P - over stretch, muscle weakness, elderly, immobilisation

Question 40

walking aids questioning points

Answer 40

J - unbalanced, pwb, nwb, poor posture B - increase stability, help posture, reduce falls, weight relief S - stairs, chairs, p/nwb, ferrule isn't worn, correct height P - working brakes, tipping up frames, correct use PT - injury, increase weight bearing capacity, and less reliant C - body strength, hand dexterity, type of walking aid, access to home

Question 41

wheelchair questioning points

Answer 41

J - safety, injury, balance disturbances, lower limb problems, CR issues B - mobility S - getting in and out, kerbs, secure arm and foot rests, brakes work, free spinning wheels C - stairs, home layout, space in house P - correct use, manipulation of doorways, previous experience O - upper body strength, family members / carers, preference of wheelchair, leg length, height, weight