Week 8 Flashcards
___ establishes direction and meaning for the activities integrated into the rehab process
Patient’s life outside of the clinic establishes direction and meaning for the activities integrated into the rehab process
__ are often very dissimilar to the functional movement demands of a patient’s life
Impairment based interventions are often very dissimilar to the functional movement demands of a patient’s life
Impairment based interventions can aide in the ___
Impairment based interventions can aide in the development of tissues specific physical capacities
What is the limitation of a strictly impairments based intervention?
Improvements in specific physical capacities as developed in impairment based interventions do not always translate into meaningful changes in performance
What do activity based interventions center upon?
The considerations of a patient’s activity limitations and to movement prescription and progression
Activity based interventions are more similar to __
Activity based interventions are more similar to skilled activities and foundational activities
Understanding a patient’s ___ is what can most directly inform a clinician’s consideration of the specific skilled activities a patient needs to be able to perform in order to maximize function
Understanding a patient’s participation restrictions is what can most directly inform a clinician’s consideration of the specific skilled activities a patient needs to be able to perform in order to maximize function
What are the characteristics of skilled activities?
- Complexity
- Variability
- Automaticity
What is functional progression?
An ordered sequence of activities enabling the acquisition or reacquisition of skills required for the safe effective performance of athletic endeavors.
What are the components that make up the desired adaptation for designing a functional progression?
- Demands of target activity
- Performance capabilities of patient
Activity demands can be progressed using ___
Activity demands can be progressed using the FITT principle
What does FITT stand for?
- Frequency
- Intensity
- Type
- Time
__ can be included in the implementation of the functional progression in patients with low functioning and highly irritable patients
Active rest can be included in the implementation of the functional progression in patients with low functioning and highly irritable patients
Functional progressions of exercise should be done in response to ___
Functional progressions of exercise should be done in response to patient response
Return to function testing may serve as ___
Return to function testing may serve as a pre-test and post test
Return to function testing can involve __
Return to function testing can involve having a patient attempt the targeted skill activity in a direct or simulated fashion
The ___ properties of non formal return to function testing are rarely known
The psychometric properties of non formal return to function testing are rarely known
The ___ properties of standardized performance based test may be known
The psychometric properties of standardized performance based test may be known
What are functional capacity evaluation?
Performance based assessments that involve a series of test items in an attempt to capture information regarding physical performance with respect to common occupational task
The functional movement screen may be used to assess ___
The functional movement screen may be used to assess general readiness and therefore injury risk for returning to sport activities
True or False
The fact that a test says that you are ready to return to work/sport safely always mean that you are
False
It does not always mean that
What are the extrinsic injury risk factors?
- Playing surface
- Foot wear
- Level of participation
What are the intrinsic injury risk factors?
- Gender
- Age
- Health status (etc)
What is one of the most consistent predictors of recurrent injury regarding the same site or subsequent injury involving different sites in the LE?
Previous history of LE injury
Return to function after ___ peak in training
workload is better for reducing an injury risk
Return to function after SUSTAINING peak in training
workload is better for reducing an injury risk
Movement as a result of interaction of: ____
Movement as a result of interaction of: Individual,
Task, Environment
What is motor skill acquisition?
Process in which performer learns to control and
integrate posture, locomotion, sensory information and muscle activations that allow individual to engage in variety of motor behaviors that are constrained by a range of
task, individual and/or environmental requirements
What does skilled actions equate to?
Consistency, flexibility, and efficiency
What does consistency mean?
A skill is repeatable
What does flexibility mean?
The ability to adapt and modify a task performance based on changing conditions
What does efficiency refer to?
A ability to be able to complete the task
Movement pattern emerges as a result of the interaction between ___
Movement pattern emerges as a result of the interaction between Individual,
Task, Environment
___ is the most important factor in retraining motor skills
Practice is the most important factor in retraining motor skills is amount of practice
What is performance improvement is dependent upon?
The amount of practice, but there are other factors in addition to the amount
of practice
What is task specific training?
The systematic and repetitive practice of functional tasks
What is the transfer of practice?
A task learned in one condition transfers to another
What does the transfer of task depend on?
Similarity between tasks or environments
What is the key to the transfer of practice?
Intensity of practice
Why do we need a large of amount of practice?
More opportunities to establish relationships among various types of info associated with each movement
What does a large number of trials do for a patient?
Enhance stability of recall and recognition schemas
A large number of trials gives a patient ___
A large number of trials gives a patient more instances of retrieval of motor programs
The amount of times a patient practices, it may help __
The amount of times a patient practices, it may help automatize activation of generalized motor patterns
for future use
What does the variability of practice rely on?
Variable practice relies on higher order motor areas
Wha does constant practice depend on?
Depends more heavily on primary motor cortex for motor-memory consolidation
When does variability work best?
When variability is within same generalized motor pattern
True or false
Variability of practice is applicable for everyone
False
May not be applicable for everyone
What are some practice conditions to partake in?
- Massed v Distributed Practice
- Constant v Variable Practice
- Random v Blocked Practice
- Whole v Part training
- Transfer
- Mental Practice
- Guidance v Discovery Learning
What does the massed in Massed v Distributed Practice mean?
Amount of practice time in trial ˃ amount of rest between trials
What does the distributed in Massed v Distributed Practice mean?
Amount of rest between trials ≥ amount of time for trial
What does the choice whether to pick Massed v Distributed Practice depend on?
Depends on goal of practice session and learner’s capacity
What does the variable in Constant v Variable Practice mean?
Variable practice increases ability to adapt and generalize
What does the constant in Constant v Variable Practice mean?
Only one task, practiced the same way over and over again
Which form of practice out of the Constant v Variable Practice is better?
Most useful when learning tasks performed in variable
conditions (variable is better)
What happens in blocked practice in Random v Blocked Practice?
When all practice is completed under one condition before moving to the next
What happens in random practice in Random v Blocked Practice?
Maximize variability of practice by practicing in a random order
From Random v Blocked Practice, which is better for performance?
Blocked
From Random v Blocked Practice, which is better for retention and transfer?
Random
Random practice when introduced causes ___
Random practice when introduced causes contextual interference
What does contextual interference mean?
Increased difficulty initially of task makes learning more effective
When may random practice be inappropriate?
Random may be inappropriate until earner understands dynamics of task
What does practicing in parts before combining it into whole do?
Takes things out of context
Quick, discrete skills and continuous skills should be practiced ___
Quick, discrete skills and continuous skills should be practiced as whole
What kind of skills are on to do part- whole?
Serial skills are ok to do part-whole
What is mental practice?
A cognitive rehearsal
What does mental practice do?
Enhance learning when physical practice not possible
Mental practice has been shown to significantly increase ___
Mental practice has been shown to significantly increase efficacy of repetitive task-specific practice
Unguided conditions less effective during ____, but
more effective for ___
Unguided conditions less effective during acquisition, but more effective for retention and transfer
What does replacing guidance learning with discovery do for a patient?
Patient allowed to explore “perceptual motor workspace
___ of best strategies and perceptual cues
Trial and error discovery of best strategies and perceptual
cues
What is the guidance hypothesis?
Information provided via feedback guides learner to
correct movement, improving performance during
practice; frequent feedback has negative effect
Properties of augmented
feedback are beneficial for motor learning when used to
____, but detrimental when relied upon
Properties of augmented
feedback are beneficial for motor learning when used to
reduce error, but detrimental when relied upon
What are the categories of feedback?
- Intrinsic
- Extrinsic
Where does intrinsic feedback come from?
- Comes via sensory systems
* Vision, somatosensation
What does intrinsic feedback give a learner?
Is movement accurate/meeting goal?
What is extrinsic feedback??
What we provide as a PT that supplements intrinsic feedback in effort to increase learning
Extrinsic feedback is also know as ___
Extrinsic feedback is also know as augmented feedback
What are some types of extrinsic feedback that we can provide?
• Concurrent • Immediate • Verbal • Distinct • Knowledge of performance (KP) • Terminal • Delayed • Nonverbal • Accumulated • Knowledge of results (KR)
What is concurrent extrinsic feedback?
Giving feedback while the patient is doing the skill
What is concurrent extrinsic feedback good for?
The acquisition/performance of the movement.
What is the downside of concurrent extrinsic feedback?
The patient may become reliant upon it, and will be bad for retention
What is terminal extrinsic feedback?
Providing patient with feedback after they’re done with the skill
What may terminal extrinsic feedback be more beneficial for?
May be more beneficial for helping the patient retain the skill
What is immediate extrinsic feedback?
Giving feedback as soon as patient is done with skill
What is delayed extrinsic feedback?
Waiting a while to give ac feedback
What is distinct extrinsic feedback?
Giving feedback on specific aspect of the skill, can result in overload
What is Knowledge of
performance (KP) extrinsic feedback?
Feedback related to the movement pattern used to achieve the goal (feedback about how they are moving)
What is Knowledge of
results (KR) extrinsic feedback?
Giving terminal feedback about the outcome of the movement in terms of the movement goal
What are the types of cuing that can be provided to a patient?
- Explicit
- Implicit
What is an explicit cue?
Providing learner with instructions according
to precise kinematic strategy
What is an implicit cue?
Providing learner with goal oriented cues
Explicit cues focuses on ____, because ____
Explicit cues focuses on internal focus of attention because they focus on a specific body movement/ how to move
Implicit cues establish ____, because they emphasize ____
Implicit cues establish external focus of attention because they emphasize object movement/ the goal
Implicit cues are based on ___
Implicit cues are based on outcome
When is a high frequency of feed back ok?
At the beginning of learning
When should patients be given KR?
Depends on complexity of task; 5-15 trial in literature
What are the effects of erroneous feedback?
- Learning incorrectly
* Unlearning what has already been learned!
Too much feedback suppresses error detection; ___ does not do that
Too much feedback suppresses error detection; modeling does not do that
Manual guidance is a type of ___ feedback
Manual guidance is a type of concurrent feedback
Can we measure motor learning?
No, it is inferred by changes in behavior
What is acquisition?
Initial practice or performance of a new skill
What is retention?
Ability to demonstrate attainment of goal after time delay without practice
What is the transfer of skills?
Performance of a task with similar movement yet different from original task practiced
What is proprioceptive neuromuscular facilitation?
Exercise based on the principles of functional human anatomy and neurophysiology
What is PNF used for?
- To increase strength, flexibility, coordination and functional mobility
- To facilitate the patient achieving a particular movement or posture
- To improve functional mobility and athletic performance
What are the PNF principles?
- Patient position
- Therapist position
- Manual contact
- Verbal Cues/Commands
What should a patient position be?
- Neutral position for optimal alignment
- Proper body support
Where should a therapist be positioned?
- Placing yourself in relation to technique
- Directly in line with movement performed
Where should resistance from a therapist come from?
Resistance should come from a patient’s body, the hands and arms should stay relatively relaxed
What should the hand placement for manual placement be?
- Purposeful
- Directional
- Comfortable
What are the types of verbal cues/ commands that we use?
- Prepatory verbal cues
- Action verbal cues
- Corrective verbal cues
What are prepatory verbal cues?
Cues telling the patient what you are about to do. Ensures the patient knows what to expect. Demonstration, guided movement, PROM
What are action verbal cues used for?
Used for when you start the patient through the movement, includes the timing of the movement, changes during the movement, increased or decreased force production
What are corrective verbal cues?
What we tend to give in modifying the activity. Can be done during or after the movement
The volume with which the command is given affects the ____
The volume with which the command is given affects the strength of resulting muscle contraction
When should louder commands be used?
Louder command when strong muscle contraction is required
When should softer and calmer commands be used?
Softer and calmer tone when the goal is relaxation and pain relief
Why are PNF patterns developed?
Because all normal coordinated human movement occurs in a spiral or diagonal movement and is rarely in cardinal planes
When are muscular contractions strongest and most coordinated?
During diagonal patterns of movement
What do diagonal patterns involve?
Rotation of the extremities and tend to require more core stability
What does normal timing look at?
Proper sequence of muscle contraction
For most functional activities, do we need stability or mobility first?
We tend to need more proximal stability first, before we can utilize our distal mobility
What is approximation?
To bring 2 joint surfaces together
What are the benefits of approximation?
- Promotes stabilization
- Facilitates WB and contraction of postural muscles
- Facilitates upright reactions
What is traction?
To separate two joint surfaces
What are the effects of traction?
- Relax patient
- Reduce tone
- Pain relief
What is irradiation?
The spread of response to stimulation, from stronger to weaker motor units
What is reinforcement?
To strengthen by fresh addition, make stronger
What are the PNF strengthening techniques?
- Rhythmic initiation
- Repeated contraction
- Slow reversal
- Slow reversal hold
- Rhythmic stabilization
What are the PNF stretching techniques?
- Contract- relax
- Hold relax
What is the goal of rhythmic initiation?
To promote learning of a new movement, to improve intra
and inter-muscular coordination, and to promote relaxation and independent movement
What is the goal of rhythmic rotation?
To promote relaxation and increased range in muscles
restricted by excess tone
What is the goal of dynamic reversals (slow reversals)?
To improve intra-and inter muscular coordination, strength, and AROM
What is the goal of rhythmic stabilization- stabilizing reversals (Alternating Isometrics)
Improve stability, strength, endurance, ROM and intra-and
intermuscular coordination; promote relaxation and decrease pain
What is the goal of combination of isotonics (Agonist Reversals)?
Improve motor learning and improve intra-and inter muscular coordination, increase strength and ROM, promote stability, eccentric controls and endurance; improve function
What is the goal of Hold-Relax, Contract-Relax?
Improve ROM through facilitating, inhibiting,
strengthening and relaxing muscle groups
What is the goal of replication (Hold-Relax-Active Motion)
Contract-Relax Active Contraction (CRAC)?
Improve intra-and inter muscular coordination and agonist muscle control in the shorted range and to promote motor learning
What is the goal of Repeated Stretch (repeated contraction)?
To enhance initiation of motion and motor learning, increase
agonist strength and endurance, improve intra- and intermuscular coordination and ROM, and to reduce fatigue
How is irradiation done?
Applying graded resistance to larger muscle groups to enhance muscle contraction in the weaker groups
We start rhythmic initiation with what kind of movement?
PROM, in order for the patient to understand the pattern of movement and once they do, they can be progressed to AAROM, then to AROM
In what patients are rhythmic rotation seen in more?
Patients with neurologic conditions
What happen in rhythmic stabilization?
The patient is trying to hold themselves steady, and the PT makes predictable or unpredictable movements to the body part while the patient tries to hold it steady and aligned
What is the difference between hold relax and contract relax?
In hold relax the patient is holding against the PT’s resistance, while in contract relax, the patient is attempting to push the limb down and the PT is holding it, hence holding agains the patient’s resistance
What are the goals of aquatic therapy?
- Facilitate ROM
- Initiate resistance training
- Facilitate/inhibit WB activities
- Enhance delivery of manual techniques
- Facilitate cardiovascular exercise
- Initiate functional activity replication
- Enhance patient relaxation
What are the precautions to take for aquatic therapy?
- Fear of water
- Neurologic disorders
- ataxia
- heat intolerance (MS)
- controlled epilepsy
- Respiratory disorders
- Cardiac disorders
What are the contraindications of aquatic therapy?
- Unstable angina
- Severe PVD
- Danger of bleeding
- Severe kidney disease
- Uncontrolled DM
- Wound wounds without occlusive dressing
- Uncontrolled bowel or bladder
- Menstruation without internal protection
- Water and airborne infections
What are the principles of aquatic therapy?
- Buoyancy
- Moment of force
- Density
- Hydrostatic pressure
- Cohesion & viscosity
- Drag force
What is buoyancy?
Upward push equal to the weight of the flute the object displaced in water
What are the benefits of buoyancy?
- Can help to assist, or resist, patient
* Helps to promote decreased WB
___ influences the ability of the buoyancy to assist pushing the limb to the surface
Position of the limb influences the ability of the buoyancy to assist pushing the limb to the surface
The more ___ you are, the more buoyancy you have
The more horizontal you are, the more buoyancy you have
What can assist with buoyancy?
Adding floatation devices to a limb will assist with buoyancy
What is the moment of force?
Position representing the turning effect of buoyancy
The longer the lever arm, the
___ the torque produced
The longer the lever arm, the
greater the torque produced
What is density?
Mass per unit volume
___ of a substance affects its ability to float
Relative density of a substance affects its ability to float
What is the specific gravity of H2O?
1.0
What will sink and what will float?
Anything less than 1.0 will float and anything greater than 1.0 will float
What is hydrostatic pressure?
Fluid pressure exerted equally
on all surface areas of an
immersed body at a given
depth (Pascal’s Law)
Hydrostatic pressure is proportional to the ___
Hydrostatic pressure is proportional to the *depth of
submersion*
What is viscosity?
Amount of friction acting on a moving part in water
What is cohesion?
Tendency of water molecules to stick together
What is slow movement?
Less friction, less resistance from cohesion
What is fast movement?
More friction, more resistance from cohesion
What are the effects of hydrostatic pressure?
- Leads to decreased blood pooling
- Provides static support for unstable joints
- Resist rib expansion
What is drag force?
The force that is created from dragging an object
Drag force is modified by ____
Drag force is modified by shape and speed of object
What does increased streamline of an object equal?
Decreased drag
What does increased speed of an object equal?
Increased drag
What does increased drag equal?
Increased torque on limb
What do you use cooler temperatures for in aquatic therapy?
High-intensity exercise
What do you use warmer temperatures for in aquatic therapy?
- Mobility and flexibility
* Relaxation exercise
What temperature should the air around the pool be?
> 3 deg C high than water
___ conducts temperature 25x faster than ___
Water conducts temperature 25x faster than air
What are the characteristics of temperature in aquatic therapy?
- Patients can perceive small changes in temperature
- Temperature will penetrate to deeper tissues
- Can not maintain core warmth with temp <25oC
- Exercise at temps >37oC may be harmful if prolonged
