Therex 2 (Davies part 1) Flashcards
How old is evidence based practice?
about 10 years
what is a major trend types of rehab exercises right now?
Functional exercises
what is Ockham’s razor?
It is a problem-solving principle devised by William of Ockham (c. 1287–1347), who was an English Franciscan friar and scholastic philosopher and theologian. The principle states that among competing hypotheses that predict equally well, the one with the fewest assumptions should be selected. Other, more complicated solutions may ultimately prove to provide better predictions, but—in the absence of differences in predictive ability—the fewer assumptions that are made, the better.
explain the house-building analogy
building an exercise program is like building a house. You want to start with a solid foundation (which is making sure each link in the kinematic chain is strong) before you billd the walls (which is more functional and plyometric exercises that could be a goal but must come after each link is strong).
In order to build a strong foundation by making sure all the links in the kenematic chain are strong, do you have to test each link before proceeding?
no
you don’t even have to test each link. Just strengthen all of them first
What is the order that we should use to build an exercise program?
(important slide)
- Muscle activation/motor control/learning
- Muscle strength, power, enduranace
- Neuro-muscular dynamic stability (proprioception)
- Functional specificity
Draw the Rehabilitation Phases chart
Rehabilitation phases: Acute phase
Task Charecteristics
dscrete
Rehabilitation phases: Subacute phase
Task Charecteristics
discrete/Serial
Rehabilitation phases: Chronic phase
Task Charecteristics
Discrete/Serial/Continuous
Rehabilitation phases: Acute phase
Practice Schedule
blocked
Rehabilitation phases: Subacute phase
Practice Schedule
Blocked
Rehabilitation phases: Chronic phase
Practice Schedule
Random or Random/Blocked
Rehabilitation phases: Acute phase
Skill
Part/Progressive-Part
Rehabilitation phases: Subacute phase
Skill
Part/Progressive-Part
Rehabilitation phases: Chronic phase
Skill
Part to whole
Rehabilitation phases: Acute phase
Feedback
KP and KR
Rehabilitation phases: Subacute phase
Feedback
KP and KR
Rehabilitation phases: Chronic phase
Feedback
Intrinsic Feedback
do we always have to train skill re-aquisition?
yes!
things are always different for a pt after an injury or surgery
If a muscle cannot function in an isolated muscle pattern, then . . . (finish the sentence)
. . . there is no way it can function normally in functional patter!!!
What is the idea behind integrated functional rehab?
It is important to develop isolated muscle function before progression to more complex multi-planar functional exercises. It provides the patient with a firm base to build on.
what are three problems that can occur if functional exercises are focused on without strengthening each link in the kinematic chain?
- When perforiming functional “composite exercises”, muscles proximal & distal to the specific muscles oftentimes compensate
- When performing functional “composite exercises” when there is a weak link in the kinematic chain, creates abnormal motor synergy patters.
- Because of the synergistic co-contraction of other muscles, functional training prevents the optimum activation of teh specific muscle to create a training effect
- (remember the muscle must be contracted at at least 60% of MVC to get a training effect)
What is almost the same as MVC?
1RM
MVC = maximal volitional contraction
1RM = 1 rep max
who is the scapular guru guy?
Kibler, WB
What is a positive use of multi-joint exercises early in rehab?
They are useful if you want to “stress-sheild” a muscle early in rehab
because surrounding muscles compensate for the injured muscle so the foce demand on the injured muscle is relatively less.
What are the tree justifications fo rnot doing functional exercises early in rehab?
(know this!)
- Ablnormal pteerns of movment/muscle activity happen
- Muscle compensation
- Low MVCs of muscle
In the recent ACL study by Freddie Fu, what was found about ACL strength in an ACL reconstruction at 6 months vs 1 year?
An MRI showed that
- at 6 months the quality of the graft went down
- at 1 year the quality of the graft was good again.
This shows that the extra-articular tissue of the graft needs time to adapt to being inside of the joint in synovial fluid. There is a rejection phase first, then the graft must progress through the phases of healing with an extra phase (the ligamentization phase) following the proliferation phase.
Also, blood flow is lost at first so it takes time for revascularization of the graft before it can properly heal.
Eventually the tendon will take on the characteristics of a ligament (ligamentumization).
This may not be apparent from PT testing. The person may look ready to return to play, but the graft tissue is still compromised.
what is ligamentumization?
Eventually a ligament graft derived from a tendon will take on the characteristics of a ligament.
The ligamentization phase follows directly after the proliferation phase and involves the ongoing process of continuous remodeling of the ACL graft toward the morphology and mechanical strength of the intact ACL. A clear endpoint of this phase cannot be defined because certain changes still occur even years after ACL reconstruction. It is still a matter of debate whether a full restoration of the biological and mechanical properties of the intact ACL is possible or whether it is more of a transformation of graft tissue that resembles but not does not fully replicate the properties of the intact ACL.
Ligamentization Phase of Graft Healing
The ligamentization phase follows directly after the proliferation phase and involves the ongoing process of continuous remodeling of the ACL graft toward the morphology and mechanical strength of the intact ACL. A clear endpoint of this phase cannot be defined because certain changes still occur even years after ACL reconstruction. It is still a matter of debate whether a full restoration of the biological and mechanical properties of the intact ACL is possible or whether it is more of a transformation of graft tissue that resembles but not does not fully replicate the properties of the intact ACL.
http://www.expertconsultbook.com/expertconsult/op/book.do?method=display&type=bookPage&decorator=none&eid=4-u1.0-B978-1-4160-5332-3..10055-6–s0030&isbn=978-1-4160-5332-3
List Davies’ Exercise Progression Continuum (14)
(know this inside and out)
this is the long version from fall semester
- Multiple angle isometrics, sub-maximal intensity, pain-free
- Multiple angle isometrics, maximal intensity, pain-free
- “Dynamic” isometrics
- Short Arc (limited ROM) eccentric dynamic exercises, sub-maximal intensity, pain-free
- Short Arc (limited ROM) concentric dynamic exercises, sub-maximal intensity, pain-free
- Short Arc (limited ROM) eccentric dynamic exercises, maximal intensity, pain-free
- Short Arc (limited ROM) concentric dynamic exercises, maximal intensity, pain-free
- Long arc (full ROM) eccentric dynamic exercises, sub-maximal intensity, pain-free
- Long arc (full ROM) concentric dynamic exercises, sub-maximal intensity, pain-free
- Long arc (full ROM) concentric dynamic exercises, maximal intensity, pain-free
- Long arc (full ROM) eccentric dynamic exercises, maximal intensity, pain-free
- Neuromuscular dynamic stability exercises
- Plyometrics
- Functional Exercises
5 questions we need to ask about patient progression:
- How?
- What?
- When?
- Where?
- Why?
what is patient progression dependant on?
signs & symptoms
Three criteria categories commonly used to decide whether to progress a patient in a rehab program
- Subjective Criteria (Symptoms)
- Objective Criteria (Signs)
- Functional Performence Testing
Three Subjective criteria commonly used to decide whether to progress a patient in a rehab program
- Pain
- Stiffness
- Changes in function
Eight Objective criteria commonly used to decide whether to progress a patient in a rehab program:
- Anthropometric Measurements
- Goniomentric Measurememtns
- Palpable Cutaneous Temperature Changes
- Redness
- MMT
- Isokinetic Testing
- Kinesthetic Testing
- KT 1000 Testing
How could you assess pain to determine if you should progress a patient?
VAS
(visual analog scale)
What does Dr. Davies like to use best and second best as an objective measurement to determine whether to progress a pt or not?
When to use them?
He likes to use anthropometrics
If that doesn’t work, then use goinio
(Anthropometrics for small joints, Gonio for larger joints)
Would you progress pt if they are objectively better but subjectively worse?
Can progress
It is okay to let them go up one pain number
Would you progress pt if they are objectively worse but subjectively worse?
Do not progress
possibly regress back to last level
Would you progress pt if they are objectively better and subjectively better?
Yes!
How long should Isometrics be performed?
6 seconds
This is very clear since 1953
any longer or shorter wastes our and patient’s time
However, 10 seconds gives us 2 seconds for ramp-up and 2 seconds for ramp-down, so 6 seconds is how long the full force should be applied but it should take 10 seconds per rep to perfomr