Therapeutic Practice Flashcards
active rom
patient does it them selves
can use goniometry
passive rom
patient moves with assistance
see if movement is possible but muscles can’t produce it
goniometry
measuring joint angles
use anatomical landmarks
limiting factors
pain
soft tissue apposition
apprehension
bone on bone
measuring crutches
put at an angle
hand piece at level of greater trochanter or middle wrist crease
elbows slightly bent
crutches positioning
sit to stand - crutches on same side in a H
stairs - opposite hand to bannister in a letter T
crutches and stairs
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
frames
dont use frame to get up and out of chairs with push up from seat
more stability
stick measurement
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
sticks
hold on opposite side to bad leg
wheelchair - kurbs
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
wheelchair - taking it apart
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
wheel chair transfers
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
massage pain gate theory
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
soft tissue healing
- bleeding - couple hours
- inflammatory - few hours to couple days, bring blood and chemicals to the area
- proliferation - generation of repair materials, 24-48 hours to a couple weeks, scar formation
- remodelling - functional scar similar to parent tissue, couple weeks after trauma
lymphatic systems
get rid of waste and toxins
transports lymph
helping lymph flow = important
energy crisis
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
motor end plate
increased acetylcholine = trigger point location
could lead to energy crisis and increased tension
central sensitivity
referred pain = intensity and size correlates with cns excitability
chronic pain = more sensitised nervous system = more pain travels to brain
descending inhibition
inhibitory affect from the brain down to the spinal cord to inhibit pain pathways
excite inhibitory inter neurones which inhibit pain
DTFM
continuous for 10 mins
pain relief - may bruise
mechanically break down scar tissue
exact localisation at 90 angle
trigger points & technique
deep taut bands localised areas
increase blood flow
5 holds of 60-90 seconds
gradually apply pressure pain should reduce
efflurage
stroke pressure towards heart and lymph distal to proximal
remove chemical irritants
stroking
pt gets used to touch
increase flow to superficial muscles
proximal to distal
petrissage
increase mobility between surface interfaces
compress soft tissue
kneading
proximal to distal
circular motions
hands in opposite directions
pressure up middle of spine
wringing
grab tissue
tissue compressed to get a roll of tissue
push one hand away and one hand towards
rolling
create diamond shape with hands
proximal to distal along fibres
grab tissue and pull back towards self
picking up
compress and scoop tissue to end feel
continue along tissue length
pnf
proprioreceptive neuromuscular facilitation
max contraction = max relaxation
form of stretching
pnf method
stretch - hold 10 secs isometric or concentric contract - resistance for 10 secs relax passive stretch 30 secs repeat 2-5 times
pnf hold / relax - autogenic
stretching same muscle as tight muscle
isometric contraction at end of range
pnf hold / contract - autogenic
stretching same muscle as tight muscle
concentric contraction of agonist through range from end of range
pnf hold / relax - reciprocal inhibition
stretch antagonist of tight muscle
ismometric contraction at end of range
MET
muscle energy technique
muscle held at resistance barrier
relax and lengthen muscle
MET technique
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
Massage questioning points
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
Active / passive ROM questioning points
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
PNF questioning points
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
walking aids questioning points
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
wheelchair questioning points
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
