Treatment interventions Flashcards
1
Q
4 training principles for all exercise?
A
- specificity
- overload
- reversibility
- individuality
2
Q
5 CI’s to resisted training?
A
- acute inflammation
- joint effusion
- severe CVD
- #
- joint / muscle pain during AROM OR isometric testing**
3
Q
4 precautions to resisted training?
A
- OP/ osteopenia
- fatigue
- medications
- inappropriate temp and clothing
4
Q
Increase resisted training by __ - __ %
A
2-10
5
Q
For ____ ______ resisted training = focus on body weight exercises, ADLs, walking program, endurance, major muscle groups
A
older adult
6
Q
For ____ resisted training = focus on bone loading, endurance not hypertrophy, body weight
A
kids
7
Q
External stabilization is typically required for OKC exercise (T/F)
A
TRUE
8
Q
Better ______ in OKC exercise
A
isolation
9
Q
May be more joint _____ in OKC exercise
A
shear
10
Q
OKC = usually ____ bearing
A
non - weight
11
Q
CKC exercise = typically ____ bearing
A
weight
12
Q
CKC = activation of multiple muscles (T/F)
A
TRUE
13
Q
CKC = _____ stabilization
A
internal
14
Q
Easier to cheat w/ compensatory movements in OKC or CKC exercise ?
A
CKC
15
Q
Increase joint _______ in CKC exercise, greater co-contraction, proprioception and kinaesthetic feedback is debatable
A
approximation (decrease joint shear)
16
Q
6 CI’s to stretching?
A
- acute inflammation or infection
- unhealed # that can’t be protected
- joint effusion
- recent corticosteroid injection to involved tissue
- specific to certain Sx
- hypermobile segment
17
Q
5 precautions for stretching?
A
- known or suspected OP
- elders patients
- newly united # *must be protected
- vigorous stretching of recently immobilized tissue
- edematous tissue
18
Q
Prescription for stretching ?
A
- slowly applied, low intensity stretch (comfortable)
- 30-60s static duration
- 2-4 reps
- at least 1x per day
19
Q
_____ = requires normal innervations and voluntary control of either shortened muscle of its opposing muscle
A
PNF (proprioceptive neuromuscular facilitation)
20
Q
3 types of PNF stretches?
A
- hold-relax
- agonist-contract
- hold-contract agonist contract
21
Q
FIIT parameters for STRENGTH?
A
F = < 6 reps , 2-6 sets I = > 85% of 1RM T = 2-5 min rest
22
Q
FIIT parameters for POWER?
A
F = 1-5 reps, 3-5 sets I = 75-90% 1RM T = 2-5 min rest
23
Q
FITT parameters for HYPERTROPHY?
A
F = 6-12 reps, 3-5 sets I = 67-85% 1RM T = 30-90s rest
24
Q
FITT parameters for ENDURANCE?
A
F = > 12 reps, 2-3 sets I = < 67% of 1RM T = < 30s rest
25
PROM/AROM FITT parameters>
```
F = 10-20 reps, 1-2 sets, 1-2x per day
I = into available ROM (joint stiffness should be limiting factor, not mm tightness)
T = every day
```
26
Stretching FITT parameters?
```
F = 2-3 sets
I = comfortable stretch
T = 30 s hold; at least 1x per day if not multiple times
```
27
Accessory joint motions occur naturally during active movement (T/F)
TRUE
28
Accessory joint motions are required for proper ________ and _______ (distraction, compression, roll, spin, glide)
osteokinematics; arthrokinematics
29
3 indications for joint mobilization?
1. decreased passive movement of joint
2. early capsular EF
3. mechanical pain
30
CI's for joint mobilizations? (7) ***
1. #
2. neoplasm
3. acute inflammatory process
4. apparent hyper mobility of instability in direction of technique
5. bone / joint infection
6. SC S/S
7. spasm or bony end feel
31
Precautions to joint mobilizations?
1. impaired circulation or sensation
2. OP or compromised health
3. haemophiliacs
4. poor skin conditions
5. open wounds
6. discomfort in Rx position
7. marked skeletal deformity
32
Joint mobilizations: if concave surface is moving it will move in the ____ direction as the long bone; if the convex surface is moving it will move in the ____ direction of the long bone
same; opposite
33
NEVER mobilize through a _____ EF
SPASM!
34
Grade __ Maitland : small amplitude movement at beginning of range
I
35
Grade __ Maitland: large amplitude movement from beginning to middle range (before resistance) usually into R1 when issues start to tighten
II
36
Grade __ Maitland = large amplitude movement from middle to end of available range (into resistance) R2 where limitation is usually due to a tight capsule
III
37
Grade __ Maitland = small amplitude movement at end of available range into resistance
IV
38
Grade __ Maitland = small amplitude high velocity movement at end of available range
V
39
Appropriate joint mob for when you have resistance and no pain?
Gr IV or V
40
Appropriate joint mob for when you have resistance before pain?
Gr IV or III
41
Appropriate joint mob for when you have pain before resistance or AT resistance?
Gr I or II
42
Kaltenborn Gr __ = small amplitude distraction
I
43
Kaltenborn Gr __ = distraction or glide to take up slack
II
44
Kaltenborn Gr __ = distraction of glide to stretch the tissues
III
45
Kaltenborn sustained joint mobs: cycle of __ - __ s hold
6-10
46
Joint mobs Rx: __ x __ s boughts, checking in with patient; re-Ax ____ and ____ movement (PIVM or PAVM); repeat __ more times, always re Az
3x10; active; passive; 2
47
What to warn pt to expect post joint mobs?
1. treatment soreness
| 2. temporary after effects
48
4 effects of grade I and II joint mobilizations?
1. neurophysiological
2. mechanoreceptor stimuatlion
3. mechanical effect
4. vascular affect
49
Neurophysiolocal effects of Gr I and II joint mobs = ___ muscle tone, _____ and ______ release
decreased; endorphin; enkephalin
50
Vascular effects of Gr I and II joint mobs = joint _____
nutrition
51
Mechanoreceptor effect of Gr I and II joint mobs = _____ gaiting
pain
52
Mechanical effects of Gr I and II joint mobs = mobilize _____ and ______tissue; joint lubricaiton
collagen; neuromeningeal
53
Grade III and IV joint mobs: same as grade I and II, plus greater _____ effects and enhanced joint ______, elongated shortened capsuloligamentous tissue
mechanical; lubrication
54
Grade V joint mob = same as previous grades but with greater _________ and more _______ effects, joint cavitation
neurophysiological; mechanical
55
2 indications to perform TC joint manipulation ?
1. to restore rull ROM at end range of DF and PF when the progressive mobilizations are no longer effective (last 5 deg()
2. to gain last few degrees of DF and PF when a NON CAPSULAR limitation of motion is present
56
After a TC joint manipulation, ALWAYS suspect an underlying ______ and reAx ______
hypermobility; stability
57
3 effects of TC joint manipulation?
1. tearing of scar tissue
2. quick stretch to joint capsule
3. stim of mechanoreceptors -neurophysiological effects
58
CI's to joint manipulation (15)? ***
1. #
2. joint instability in direction of manipulation
3. inflammatory joint disease
4. malignancy
5. bone disease
6. OP
7. open wound of skin lesion in area
8. poor circulation or sensory deficit in area
9. spasm of increased pain w/ test hold
10. unsure of health or Dx
11. pt doesn't want to be manipulated
12. pt is on anticoagulants
13. haemophiliacs
14. inability of pt to relax
15. PT factors
59
Cautions / CI's for novice manipulators
1. pain or instability PROXIMALLY in lower kinetic chain ( for TC joint manipulation)
2. uncertainty about indications of technique
3. children
4. diabetics
5. elderly
6. + SLR on effected side (for TC manip)
60
Follow up Rx for TC joint manip?
1. ROM exercises (assuming joint is stable)
2. post Rx soreness can occur, suggest use of ice
3. balance
4. proprioception
5. strength
6. protected function
7. taping / bracing if joint is unstable
61
4 purposes of DTFM?
1. to maintain / regain mobility
2. prevent scar tissue adhesions
3. create hyperemia
4. create analgesia
62
3 affects of DTFM?
1. hyperaemia
2. mechanical stress to break adhesions / align collagen
3. mechanoreceptor stim and dec pain
63
Rx for DTFM?
1. 2-3 cycles / second
| 2. at least 3-5 minutes
64
DTFM: find lesion, friction ________ to tissue
perpendicular
65
When to perform DTFM for muscle injuries? For ligament and tendon?
1. muscle = only done when subacute ** (5-10 days+) or chronic
2. tendon and ligament can be done in acute to chronic
66
DTFM for muscle: have muscle belly ____, follow w/ _____ contractions in inner range
relaxed; active
67
DTFM for ligament / tendon: have on pain free ____, follow up w/ exercise
STRETCH
68
CI's to DTFM? (8)
1. infection
2. skin breakdown
3. ossification / clacification
4. CT or inflammatory joint disease
5. neural irritation
6. bursitis
7. recent local injection
8. long term steroid, anticoagulant or anti inflammatory use
69
3 precautions to DTRM?
1. elderly
2. children
3. diabetic
70
Metabolic syndrome: need > __ diagnostic criteria
3
71
What are the diagnostic criteria you need > 3 for Dx of metabolic syndrome ?
1. inc blood pressure
2. fasting blood glucose
3. waist girth
4. triglycerides
5. decreased HDL
72
Things to consider when functional activity training w/ athletes? (8)
1. stage of healing (NOT during acute)
2. ROM
3. strength / power / endurance
4. neuromuscular control
5. proprioception
6. core control
7. prophylactic taping / bracing / padding
8. responsibilities of the athlete
73
CI's to functional activity training ? (5)
1. persistent joint effusion
2. joint instability
3. poor motor control
4. lack of ROM
5. muscle length and appropriate muscle strength and power (at least 90% of contralateral side)
74
Criteria for RTP when working w/ athletes? (7)
1. no acute S/S
2. full AROM and PROM of joints involved
3. adequate muscle strength, power, endurance (90%)
4. correct movement mechanics
5. adequate CR fitness
6. successful competition of Fx tests
7. psychologically ready
75
Concepts of functional activity training? (7)
1. load
2. stability
3. velocity
4. direction changes
5. test environment
6. correct movement mechanics throughout
7. energy systems
76
Most stable gait aid device?
walker
77
No ____ swing when using walkers
arm
78
Measurement of walkers: stand inside, handles to ____ ____ or __ - __ degree elbow flexion holding handles
wrist crease; 20-30
79
Cane = ____ base of support, help balance, ____ stable type of aid
widen; least
80
Measurement of cane: cane parallel to leg w/ tip in line with _____, hand position as per ______
ankle; walker
81
Crutches: help with _____ stability and improve balance (increases BOS); helps ______ WB
lateral; decrease
82
Measurement of crutches: has distal end __ inches lateral and __ inches in front and anterior to for, hands placed as per walkers
2; 6
83
Need more arm strength to use forearm crutches (T/F)
TRUE
84
Measurement of forearm crutches: cuff on proximal ___ of forearm, __ - __ inches below elbow
1/3; 1 - 1.5
85
Normal gait = __ % stance, __ % swing
60;40
86
Step TO or step THROUGH gait can be done with what 2 gait aids?
1. crutches
| 2. walker
87
4 point gait = ______, __ aid advanced, then opposite LE advanced
asynchronous; 1
88
4 pt gait = __ - __ points of support on ground at all times
3-4
89
4 pt gait can be done w/ bilateral ____, ____ or ____ if FeWB
crutches. canes, walkers
90
4pt gait provides slow, stable gait (T/F)
TRUE
91
2 point gait = _____, similar to 4 pt gait but only __ point of contact maintained at all times
Synchronous, 2
92
2 pt gait: __ leg and _____ aid advanced at the same time
1; contralateral
93
2 gait aids 2 point gait can be done w/?
1. bilateral crutches
| 2. canes
94
2 point gait = _____ when only 1 crutch or cane is used
MODIFIED
95
__ point gait = for NWB, FeWB, or PWB
3
96
If pt is PWB < __ % can't use cane for 3 point gait
80!
97
3pt gait can be done with what 2 gait aids?
1. crutches
| 2. standard walker
98
3 pt gait: step__ pattern progressed to step ___
to; through
99
Neurodynamic techniques: do NOT treat or asses if ____ ____ signs are present!!!
hard neuro
100
Neuruodynamics: do assess if _____ _____ signs are present but be careful!
peripheral conduction
101
CI's to neurodynamic techniques?
1. undiagnosed condition
2. worsening condition
3. severe irritability
4. presence of hard neuro signs
102
PKB tests L __ - L __
2-4
103
SLR rests L__/__ - S__
4/5 - 2
104
Neurodynamic Rx: start movement at ____ area and perform indirect Rx (treat ____)
remote; interface
105
Name two population mirror therapy can be very beneficial for
1. amputees
| 2. CRPS
106
________ = sensory and motor integration
stereognosis
107
8 benefits of traction?
1. separation of vertebral bodies
2. increased IVF diameter
3. mobilization of the Z joints
4. flattening of spinal curves
5. mechanoreceptor stimulation / pain inhibition
6. decreased muscle spasm
7. mobilization of muscle and CT
8. improved circulation (blood and lymph)
108
Indications for traction?
1. joint dysfunction (hypo mobility)
2. degeneration (associated hypo mobility)
3. nerve root compression or disc pathology
4. pain
109
CI's to traction? (L spine; 8)
1. acute
2. pt can't tolerate traction position
3. bad response to manual traction
4. recent Sx
5. underling hypermobility or instability
6. malignancy
7. S/S of SC or CE compression
8. vascular compromise
110
CI's to C spine traction?
same as L spine, also:
1. S/S VBI
2. TMJ dysfunction
3. RA
4. down syndrome
5. cervical myelopathy
6. glaucoma
111
Precautions for traction? (8)
1. pregnancy
2. resp Problems
3. OP
4. spondylolisthesis
5. hypermobility / instability
6. claustrophobia
7. extremely restricted ROM
8. little improvement w/ rest
112
4 things to ALWAYS check prior to traction?
1. VBI
2. neuro test
3. neuromobility and conduction
4. stability
113
Traction: forces that are required are usually __ - __ % of body weight, do manual first then if good response for __ - __ sessions can put on mechanical
10-20; 2-3
114
CI's to DTFM? (5)
1. skin breakdown / infection
2. inflammatory joint disease
3. recent local injection
4. ossification / calcification
5. bursitis
115
CI's to massage? (12)
1. autoimmune diseases during flare ups
2. fever
3. haemorrhage
4. embolism
5. DVT
6. flu
7. migraine headache
8. serious psych diagnosis
9. recent surgery
10. acute RA
11. sickle cell disease
12. pneumonia
